title: An initial analysis: working hours and delay in seeking care during acute coronary events.
abstract: BACKGROUND
  The purpose of the study was to examine the association between working hours, job strain, and duration of prehospital delay in seeking care by employed patients with acute coronary syndrome (ACS) in the United States and Japan.
  
  
  METHODS
  In this cross-sectional study, a total of 234 consecutive patients (Americans, n = 148; mean age, 50.7 [SD +/- 7.1] years and 73.6% male, and Japanese, n = 86; mean age, 56.3 [SD +/- 11.0] years and 93.0% male) admitted with ACS who worked more than 20 h/wk were recruited. A structured interview was conducted while patients were hospitalized to assess prehospital delay time, ambulance use, number of working hours per week, and job strain.
  
  
  RESULTS
  In the US sample, the median delay time was 4.4 hours, whereas in the Japanese sample, the median delay time was 8.3 hours. Average working hours per week in the US and Japanese samples were 49.7 (SD +/- 13.2) hours and 55.1 (SD +/- 19.5) hours, respectively. In multivariate analysis, the interaction between working hours and nationality on log-transformed delay time was significant (P = .001) after controlling for potential confounding factors. Among the Japanese sample, for every 1-hour increase in working hours per week, prehospital delay increased by approximately 4% (95% confidence interval [CI]; 1.0%-7% [P = .003]). However, among the US sample, no association was found (-2.0%; 95% CI, -4.0% to 0%; P = .08).
  
  
  CONCLUSIONS
  These findings support the need for worksite educational programs, particularly in Japan, that encourage a rapid response to acute cardiac symptoms.
authors.affiliation: University of California San Francisco, California 94143, USA. youshimi.fukuoka@ucsf.edu
authors.forename: Yoshimi
authors.initials: Y
authors.lastname: Fukuoka
authors.forename: Masako
authors.initials: M
authors.lastname: Takeshima
authors.forename: Noriko
authors.initials: N
authors.lastname: Ishii
authors.forename: Miura
authors.initials: M
authors.lastname: Chikako
authors.forename: Miyuki
authors.initials: M
authors.lastname: Makaya
authors.forename: Linda
authors.initials: L
authors.lastname: Groah
authors.forename: Erick
authors.initials: E
authors.lastname: Kyriakidis
authors.forename: Kathleen
authors.initials: K
authors.lastname: Dracup
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D004651:Employment; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D012307:Risk Factors; D013315:Stress, Psychological / Q000150:complications*; D013997:Time Factors; D014481:United States; D016526:Workload