Details of a Researcher - Shimazu, Akihito

Papers - Shimazu, Akihito

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病棟看護師における感情労働とワーク・エンゲイジメントおよびストレス反応との関連

加賀田聡子, 井上彰臣, 窪田和巳, 島津明人

行動医学研究 (日本行動医学会) 21 ( 2 ) 83 - 90 2015.10

Research paper (scientific journal), Accepted, ISSN 1341-6790

看護師を対象に、感情労働による心理学的影響を調べた近年の先行研究では、感情労働がバーンアウト/抑うつの悪化や職務満足感の向上に影響を与えることが着目されている。しかし、日本の看護師を対象に感情労働の心理学的側面に着目した先行研究は少なく、感情労働を要素別に分類し、ワーク・エンゲイジメントやストレス反応との関連を検証した研究は、我々の知る限り見当たらない。そこで本研究では、日本の看護師を対象に「看護師の感情労働測定尺度:ELIN」を用いて感情労働の要素を詳細に測定し、これらの各要素とワーク・エンゲイジメント、心理的ストレス反応および身体的ストレス反応との関連を検討することを目的とした。関東圏内の1つの総合病院に勤務する女性病棟看護師306名を対象に、感情労働(ELIN:「探索的理解」、「ケアの表現」、「深層適応」、「表層適応」、「表出抑制」の5下位尺度からなる)、ワーク・エンゲイジメント(The Japanese Short Version of the Utrecht Work Engagement Scale:UWES-J短縮版による)、心理的ストレス反応および身体的ストレス反応(職業性ストレス簡易調査票:BJSQによる)、個人属性(年齢、診療科、同居者の有無)に関する質問項目を含めた自記式質問紙を用いて調査を実施した(調査期間:2011年8〜9月)。分析は、感情労働とワーク・エンゲイジメント、心理的ストレス反応および身体的ストレス反応との関連を検討するため、感情労働の各下位尺度を独立変数、ワーク・エンゲイジメント、心理的ストレス反応および身体的ストレス反応を従属変数、個人属性を調整因子とした重回帰分析を実施した。重回帰分析の結果、感情労働の構成要素の一つである「探索的理解」とワーク・エンゲイジメントとの間に正の関連が、「表出抑制」とワーク・エンゲイジメントとの間に負の関連が認められた。また、感情労働の構成要素の一つである「深層適応」と心理的ストレス反応および身体的ストレス反応との間に正の関連が認められた。これらの結果から、「探索的理解」を高め、「表出抑制」や「深層適応」を低減させるようなアプローチによって、看護師が自身の感情をコントロールしながらも、心身の健康を保持・増進するために有効な可能性が示唆された。(著者抄録)

労働者の収入とメンタルヘルス　職の不安定性による媒介効果に注目して

堤明純, 井上彰臣, 島津明人, 高橋正也, 川上憲人, 栗岡住子, 江口尚, 宮木幸一, 遠田和彦, 小杉由起, 戸津崎貴文

厚生の指標 ((一財)厚生労働統計協会) 62 ( 11 ) 1 - 8 2015.09

Research paper (scientific journal), Accepted, ISSN 0452-6104

目的収入の低い集団は高収入の集団に比してメンタルヘルス不調のリスクが高いとされるが,労働者における収入とメンタルヘルス不調の関係,およびその媒介要因を検証した研究はわが国では少ない。労働者の健康格差の実態とそのメカニズムを解明することを目的として行われているパネル研究のベースラインデータを用いて,労働者の収入とメンタルヘルスの関連,その媒介要因としての職の不安定性の影響を検討することを目的とした。方法労働者の健康格差のメカニズム解明を目的とした多目的パネルのベースライン調査参加者の男性7,645人,女性2,241人を対象とした。税込みの世帯収入を世帯員数で調整した世帯収入の下位3分位を低収入とした。将来の職の安定性,季節雇用,過去および将来の失業の可能性を尋ねる4項目の得点和の上位5分位以上を職の不安定とした。K6得点の13点以上をメンタルヘルス不調とした。男女別に,低収入群がメンタルヘルス不調に陥るリスクを,年齢,教育歴,職業,労働時間を調整したロジスティック回帰分析を用いて算出した調整後オッズ比,および95%信頼区間で推定した。低収入群とメンタルヘルス不調の関連を,職の不安定性がどの程度説明するかを,それぞれの変数を投入したオッズ比を求めて検討した。結果男女とも,低収入はメンタルヘルス不調と関連していた。低収入の男性労働者がメンタルヘルス不調に陥るリスク(属性・就業状況を調整したオッズ比)は1.26で,女性では1.62であった。職の不安定性を調整すると,メンタルヘルス不調に対する低収入のリスクは男女ともに約9%減弱し,男性において低収入とメンタルヘルス不調の関連は統計的有意ではなくなった。職の不安定性とメンタルヘルス不調の関連性の変化は,低収入を調整してもわずかであった。結論日本人労働者において,低収入は労働者のメンタルヘルス不調と関連することが観察された。低収入の労働者におけるメンタルヘルス不調のリスク増加の一部は職の不安定性によって説明され,職の安定の確保は,労働者のメンタルヘルスの所得格差を軽減する方策となる可能性が示された。(著者抄録)

Does Internet-based cognitive behavioral therapy (iCBT) prevent major depressive episode for workers? A 12-month follow-up of a randomized controlled trial

Imamura K., Kawakami N., Furukawa T., Matsuyama Y., Shimazu A., Umanodan R., Kawakami S., Kasai K.

Psychological Medicine (Psychological Medicine) 45 ( 9 ) 1907 - 1917 2015.07

Research paper (scientific journal), Accepted, ISSN 00332917

Copyright © Cambridge University Press 2015. Background In this study we investigated whether an Internet-based computerized cognitive behavioral therapy (iCBT) program can decrease the risk of DSM-IV-TR major depressive episodes (MDE) during a 12-month follow-up of a randomized controlled trial of Japanese workers. Method Participants were recruited from one company and three departments of another company. Those participants who did not experience MDE in the past month were randomly allocated to intervention or control groups (n = 381 for each). A 6-week, six-lesson iCBT program was provided to the intervention group. While the control group only received the usual preventive mental health service for the first 6 months, the control group was given a chance to undertake the iCBT program after a 6-month follow-up. The primary outcome was a new onset of DSM-IV-TR MDE during the 12-month follow-up, as assessed by means of the web version of the WHO Composite International Diagnostic Interview (CIDI), version 3.0 depression section. Results The intervention group had a significantly lower incidence of MDE at the 12-month follow-up than the control group (Log-rank χ2 = 7.04, p < 0.01). The hazard ratio for the intervention group was 0.22 (95% confidence interval 0.06-0.75), when estimated by the Cox proportional hazard model. Conclusions The present study demonstrates that an iCBT program is effective in preventing MDE in the working population. However, it should be noted that MDE was measured by self-report, while the CIDI can measure the episodes more strictly following DSM-IV criteria.

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Towards Healthy Workers and Workplaces : From a Perspective of Work Engagement

島津明人

日本職業・災害医学会会誌 = Japanese journal of occupational medicine and traumatology (日本職業・災害医学会) 63 ( 4 ) 205 - 209 2015.07

Research paper (scientific journal), Accepted, ISSN 1345-2592

ワーク・ライフ・バランス (特集シリーズ・今これからの心理職(3)これだけは知っておきたい産業・組織領域で働く心理職のスタンダード) -- (産業・組織領域において知っておくべき基本的知識と技能)

島津明人

臨床心理学 (金剛出版) 15 ( 3 ) 308 - 312 2015.05

Research paper (scientific journal), Accepted, ISSN 1345-9171

特別座談会組織開発とポジティブメンタルヘルスの出会いみんながやる気で、成果も上がる組織づくりに人事ができること (特集経営者視点から従業員視点へ働く人たちが元気になる組織活性化の秘訣)

西出恵美, 島津明人, 香取一昭

人材教育 : 人材開発の実践情報誌 (日本能率協会マネジメントセンター) 27 ( 5 ) 28 - 33 2015.05

Research paper (scientific journal), Accepted

Towards Collaboration between Occupational Health and Management : From a Perspective of Work Engagement

島津明人

産業・組織心理学研究 (産業・組織心理学会) 28 ( 2 ) 103 - 110 2015.03

Research paper (scientific journal), Accepted, ISSN 0917-0391

ワーク・エンゲイジメントのすすめ産業保健とマネジメント層が協調しモチベーションの高い組織づくりを (特集職員のモチベーションアップを図るには)

島津明人

地方公務員安全と健康フォーラム (地方公務員安全衛生推進協会) 25 ( 1 ) 6 - 10 2015.01

Research paper (scientific journal), Accepted, ISSN 0917-6993

Effects of an Internet-Based Cognitive Behavioral Therapy Intervention on Improving Work Engagement and Other Work-Related Outcomes: An Analysis of Secondary Outcomes of a Randomized Controlled Trial.

Imamura K, Kawakami N, Furukawa T, Matsuyama Y, Shimazu A, Umanodan R, et al.

Journal of Occupational and Environmental Medicine (Journal of Occupational and Environmental Medicine) 57 ( 5 ) 578 - 584 2015

Research paper (scientific journal), Joint Work, Accepted, ISSN 10762752

Copyright © 2015 by American College of Occupational and Environmental Medicine. Objective: This study reported a randomized controlled trial of the effectiveness of an Internet-based cognitive behavioral therapy (iCBT) program on work engagement and secondary work-related outcomes. Methods: Participants who fulfilled the inclusion criteria were randomly allocated to an intervention or a control group (N = 381 for each). A 6-week, 6-lesson iCBT program using a Manga (Japanese comic) story was provided only to the intervention group.Work engagement was assessed at baseline and at 3- and 6-month follow-ups for both groups. Results: The iCBT program showed a significant intervention effect on work engagement (P = 0.04) with small effect sizes (Cohen's d = 0.16 at 6-month follow-up). Conclusions: The study showed computerized cognitive behavior therapy delivered via the Internet to be effective (with a small effect size) in increasing work engagement in the general working population. Trial Registration: UMIN Clinical Trials Registry (UMIN-CTR) UMIN000006210.

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Effects of an internet-based cognitive behavioural therapy intervention on preventing major depressive episodes among workers: a protocol for a randomised controlled trial.

Imamura K, Kawakami N, Furukawa TA, Matsuyama Y, Shimazu A, Kasai K.

BMJ Open (BMJ Open) 5 ( 5 ) e007590 2015

Research paper (scientific journal), Joint Work, Accepted, ISSN 2044-6055

© 2015, BMJ Publishing Group. All rights reserved. Introduction: The aim of this study is to examine the effects of an internet-based cognitive behavioural therapy (iCBT) program on decreasing the risk of major depressive episodes (MDEs) among workers employed in a private corporate group in Japan, using a randomised controlled trial design. Methods and analysis: All of the workers in a corporate group (n=20 000) will be recruited through an invitation email. Participants who fulfil the inclusion criteria will be randomly allocated to intervention or control groups ( planned N=4050 for each group). They will be allowed to complete the six lessons of the iCBT program within 10 weeks after the baseline survey. Those in the control group will receive the same iCBT after 12 months. The program includes several CBT skills: self-monitoring, cognitive restructuring, assertiveness, problem-solving and relaxation. The primary outcome measure is no new onset of MDE (using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR)/DSM-5 criteria) during the 12-month follow-up. Assessment will use the web version of the WHO Composite International Diagnostic Interview V.3.0 depression section. Ethics and dissemination: The Research Ethics Review Board of Graduate School of Medicine, the University of Tokyo (No. 3083-(2)), approved the study procedures. Trial registration number: The study protocol is registered at the UMIN Clinical Trials Registry (UMIN-CTR; ID=UMIN000014146).

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Disabling low back pain associated with night shift duration: Sleep problems as a potentiator

Takahashi, M., Matsudaira, K., & Shimazu, A.

American Journal of Industrial Medicine (American Journal of Industrial Medicine) 58 ( 12 ) 1300 - 1310 2015

Research paper (scientific journal), Joint Work, Accepted, ISSN 02713586

© 2015 Wiley Periodicals, Inc. Background: We investigated how night shift duration and sleep problems were jointly associated with disabling low back pain (LBP) among workers in different occupations. Methods: An online-survey was conducted regarding work schedules, disabling LBP, sleep problems, and other relevant factors in 5,008 workers who were randomly selected from a market research panel. Multiple logistic regression analyses determined the joint associations of night shift duration (0 [permanent day shift], <8, 8-9.9, 10-15.9, ≥16hr) and sleep problems (no, yes) with disabling LBP adjusted for potential confounders. Results: A night shift ≥16hr was associated with a significant increase in the likelihood of disabling LBP. The magnitude of this association was elevated when participants perceived sleep problems including both sleep duration and quality. Conclusion: Associations between extended night shifts and disabling LBP became stronger in the presence of short or poor quality sleep.

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Epigenetic changes caused by occupational stress in humans revealed through noninvasive assessment of DNA methylation of the Tyrosine Hydroxylase Gene

Miyaki, K., Suzuki, T., Song, Y., Suzuki, T., Tsutsumi, A., Kawakami, N., Takahashi, M., Shimazu, A., Inoue, A., Kurioka, K., Kan, C., Sasaki, Y., Shimbo, T.

Journal of Neurology and Neurological Disorders 2 ( 2 ) 201 2015

Research paper (scientific journal), Joint Work, Accepted

Relationship between sickness presenteeism (WHO-HPQ) with depression and sickness absence due to mental disease in a cohort of Japanese workers

Suzuki, T., Miyaki, K., Song, Y., Tsutsumi, A., Kawakami, N., Shimazu, A., Takahashi, M., Inoue, A., & Kurioka, S.

Journal of Affective Disorders. (Journal of Affective Disorders) 180 14 - 20 2015

Research paper (scientific journal), Joint Work, Accepted, ISSN 01650327

© 2015 Published by Elsevier B.V. Background Absence due to mental disease in the workplace has become a global public health problem. We aimed to evaluate the influence of presenteeism on depression and absence due to mental disease. Methods A prospective study of 1831 Japanese employees from all areas of Japan was conducted. Presenteeism and depression were measured by the validated Japanese version of the World Health Organization Health and Work Performance Questionnaire (WHO-HPQ) and the K6 scale, respectively. Absence due to mental disease across a 2-year follow up was surveyed through medical certificates obtained for work absence. Results After adjusting for age and gender, participants with higher rates of sickness absolute and relative presenteeism (the lowest tertile of the scores) were significantly more likely to be absent due to mental disease (OR=4.40, 95% CI: 1.65-11.73, and OR=3.31, 95% CI: 1.50-7.27). Subsequently, higher rates of sickness absolute or relative presenteeism were significantly associated with higher rates of depression (K6=13) one year later (OR=3.79, 95% CI: 2.48-5.81, and OR=2.89, 95% CI: 1.98-4.22). Limitations The number of females in the sample was relatively small. However, the rates of absence for females with and without mental illness did not significantly differ from those of men. Conclusions More sickness presenteeism scores were found to be related to higher rates of depression and absence due to mental disease in this large-scale cohort of Japanese workers. Measurement of presenteeism could be used to evaluate the risk for depression and absenteeism. Furthermore, our findings suggest that intervention to improve presenteeism would be effective in preventing depression and absence due to mental illness.

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Workaholism vs. work engagement: The two different predictors of future well-being and performance.

Shimazu, A., Schaufeli, W. B., Kamiyama, K., & Kawakami, N.

International Journal of Behavioral Medicine. (International Journal of Behavioral Medicine) 22 ( 1 ) 18 - 23 2015

Research paper (scientific journal), Joint Work, Accepted, ISSN 10705503

© 2014, International Society of Behavioral Medicine. Purpose: This study investigated the distinctiveness of two types of heavy work investment (i.e., workaholism and work engagement) by examining their 2-year longitudinal relationships with employee well-being and job performance. Based on a previous cross-sectional study by Shimazu and Schaufeli (Ind Health 47:495–502, 2009) and a shorter term longitudinal study by Shimazu et al. (Ind Health 50:316–21, 2012; measurement interval = 7 months), we predicted that workaholism predicts long-term future unwell-being (i.e., high ill-health and low life satisfaction) and poor job performance, whereas work engagement predicts future well-being (i.e., low ill-health and high life satisfaction) and superior job performance. Method: A two-wave survey was conducted among employees from one Japanese company, and valid data from 1,196 employees was analyzed using structural equation modeling. T1–T2 changes in ill-health, life satisfaction, and job performance were measured as residual scores, which were included in the structural equation model. Results: Workaholism and work engagement were weakly and positively related to each other. In addition, and as expected, workaholism was related to an increase in ill-health and to a decrease in life satisfaction. In contrast, and also as expected, work engagement was related to increases in both life satisfaction and job performance and to a decrease in ill-health. Conclusion: Although workaholism and work engagement are weakly positively related, they constitute two different concepts. More specifically, workaholism has negative consequences across an extended period of 2 years, whereas work engagement has positive consequences in terms of well-being and performance. Hence, workaholism should be prevented and work engagement should be stimulated.

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Work engagement and high-sensitivity C-reactive protein levels among Japanese workers: A 1-year prospective cohort study.

Eguchi, H., Kawakami, N., Inoue, A., Shimazu, A., & Tsutsumi, A.

International Archives of Occupational and Environmental Health. (International Archives of Occupational and Environmental Health) 88 ( 6 ) 651 - 658 2015

Research paper (scientific journal), Joint Work, Accepted, ISSN 03400131

© 2014, Springer-Verlag Berlin Heidelberg. Purpose: Evidence on the association between psychological well-being and high-sensitivity C-reactive protein (hs-CRP) levels is limited. We carried out a prospective study to investigate the association between work engagement and hs-CRP levels in a group of Japanese workers. Methods: Our cohort included 1,857 men and 657 women aged 65 and under, and free from major illness, working at two manufacturing worksites in Japan. Baseline examinations were conducted from April to June 2011 to determine the demographic and lifestyle characteristics and levels of work engagement. Blood samples were obtained from participants at baseline and after 1 year. Participants were classified into tertiles of low, moderate, and high work engagement at baseline. Hs-CRP levels were split into low (≤3.0 mg/L) and high (>3.0 mg/L). We used multiple logistic regression analyses to evaluate the association between work engagement at baseline and hs-CRP levels at follow-up, adjusting for hs-CRP at baseline and potential confounding factors. Results: Participants reporting moderate and high levels of work engagement at baseline had significantly lower odds ratios (ORs) of having high hs-CRP levels at follow-up than those with low levels of work engagement at baseline [OR of moderate level 0.44, 95 % confidence interval (CI) 0.24–0.81; OR of high level 0.57, 95 % CI 0.33–0.99; p for trend <0.05]. Conclusion: Findings suggest that work engagement has beneficial effects on workers’ cardiovascular health.

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Using social epidemiology and neuroscience to explore the relationship between job stress and frontotemporal cortex activity among workers.

Kawasaki S, Nishimura Y, Takizawa R, Koike S, Kinoshita A, Satomura Y, Sakakibara E, Sakurada H, Yamagishi M, Nishimura F, Yoshikawa A, Inai A, Nishioka M, Eriguchi Y, Kakiuchi C, Araki T, Kan C, Umeda M, Shimazu A, Hashimoto H, Kawakami N, Kasai K

Social neuroscience (Social Neuroscience) 10 ( 3 ) 230 - 242 2015

Research paper (scientific journal), Joint Work, Accepted, ISSN 1747-0919

© 2015, © 2015 Taylor & Francis. Mental health problems, such as depression, are increasingly common among workers. Job-related stresses, including psychological demands and a lack of discretion in controlling one’s own work environment, are important causal factors. However, the mechanisms through which job-related stress may affect brain function remain unknown. We sought to identify the relationship between job-related stress and frontotemporal cortex activation using near-infrared spectroscopy. Seventy-nine (45 females, 34 males) Japanese employees, aged 26–51 years, were recruited from respondents to the Japanese Study of Stratification, Health, Income, and Neighborhood survey. Job-related stress was measured using the Japanese version of Job Content Questionnaire, which can index “job demand” and “job control”. We found a significant correlation between higher “job demand” and smaller oxygenated hemoglobin [oxy-Hb] changes in the left dorsolateral prefrontal cortex in female (r = −.54 to −.44). Significant correlations between higher “job control” and greater [oxy-Hb] changes in the right temporal cortex were observed among male, and in the combined sample (r = .46–.64). This initial cross-sectional observation suggests that elevated job-related stress is related to decrease frontotemporal cortex activation among workers. Integrating social epidemiology and neuroscience may be a powerful strategy for understanding how individuals’ brain functions may mediate between the job-related stress or psychosocial work characteristics and public mental health.

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Socioeconomic determinants of bullying in the workplace: A national representative sample in Japan.

Tsuno K, Kawakami N, Tsutsumi A, Shimazu A, Inoue A, Odagiri Y, Yoshikawa T, Haratani T, Shimomitsu T, Kawachi I.

PLosOne (PLoS ONE) 10(3) ( 3 ) e0119435 - 8 2015

Research paper (scientific journal), Joint Work, Accepted, ISSN 1932-6203

© 2015 Tsuno et al. Bullying in the workplace is an increasingly recognized threat to employee health.We sought to test three hypotheses related to the determinants of workplace bullying: power distance at work; safety climate; and frustration related to perceived social inequality. A questionnaire survey was administered to a nationally representative community-based sample of 5,000 residents in Japan aged 20-60 years. The questionnaire included questions about employment, occupation, company size, education, household income, and subjective social status (SSS). We inquired about both the witnessing and personal experience of workplace bullying during the past 30 days. Among 2,384 respondents, data were analyzed from 1,546 workers. Multiple logistic regression analyses were used to examine the social determinants of workplace bullying. Six percent and 15 percent of the total sample reported experiencing or witnessing workplace bullying, respectively. After adjusting for gender and age, temporary employees (Odds Ratio [OR]: 2.45 [95%Confidence Interval (CI) = 1.03-5.85]), junior high school graduates (OR: 2.62 [95%CI: 1.01-6.79]), workers with lowest household income (OR: 4.13 [95%CI:1.58-10.8]), and workers in the lowest SSS stratum (OR: 4.21 [95% CI:1.66-10.7]) were at increased risk of experiencing workplace bullying. When all variables were entered simultaneously in the model, a significant inverse association was observed between higher SSS and experiencing bullying (p = 0.002). Similarly in terms of witnessing bullying; SSS was significantly inversely associated (p = 0.017) while temporary employees reported a significantly higher risk of witnessing bullying compared to permanent workers (OR: 2.25 [95%CI:1.04 to 4.87]). The significant association between SSS and experiencing/witnessing workplace bullying supports the frustration hypothesis. The power distance hypothesis was also partly supported by the finding that temporary employees experienced a higher prevalence of workplace bullying.

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労働者の収入とメンタルヘルス　－職の不安定性による媒介効果に注目して－

堤明純・井上彰臣・島津明人・高橋正也・川上憲人・栗岡住子・江口尚・宮木幸一・遠田和彦・小杉由起・戸津崎貴文

校正の指標 62 ( 11 ) 1 - 8 2015

Research paper (scientific journal), Single Work, Accepted

Association of Emotional Labor with Work Engagement andStress Responses among Hospital Ward Nurses

KAGATA Satoko, INOUE Akiomi, KUBOTA Kazumi, SHIMAZU Akihito

Japanese Journal of Behavioral Medicine (The Japanese Society of Behavioral Medicine) 21 ( 2 ) 83 - 90 2015

Research paper (scientific journal), Joint Work, Accepted, ISSN 1341-6790

<b>Summary:</b> Recent studies on the psychological effects of emotional labor among hospital nurses have focused not only on aversive effects such as progression of burnout or depression but also on favorable effects, such as enhanced job satisfaction. However, few studies investigated these effects among Japanese hospital nurses. This study measured elements of emotional labor in detail and investigated the association of each element of emotional labor with work engagement and stress responses among 306 Japanese female hospital ward nurses in the Kanto region. In August–September 2011, they were surveyed using a self-administered questionnaire, measuring on emotional labor, work engagement, psychological and physical stress responses, and demographics. Multiple regression analyses were conducted to examine the association of each element of emotional labor ("Exploring and understanding", "Expression of caring", "Deep adjustment", "Suppressed expression", and "Surface adjustment") with work engagement, and psychological and physical stress responses. The results showed that "Exploring and understanding" was positively associated with work engagement, whereas "Suppressed expression" was negatively associated with work engagement. "Deep adjustment" was positively associated with psychological and physical stress responses. These findings suggest that enhancing "Exploring and understanding" and reducing "Suppressed expression" and "Deep adjustment" have an effect on improving mental health among nurses.

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Work-life Balance and Mental Health among Dual-earner Couples

島津明人

日本労働研究雑誌 (労働政策研究・研修機構) 56 ( 12 ) 75 - 84 2014.12

Research paper (scientific journal), Accepted, ISSN 0916-3808

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