Occupational Health Services Improve Effective Coverage for Hypertension and Diabetes Mellitus at Japanese Companies

Healthcare administrators and hypertension at small-to-medium worksites in Okinawa, Japan

This longitudinal study investigated whether the presence of a person in charge of healthcare at a worksite, termed a healthcare administrator (HA), and not limited to licensed staff, facilitated visits to medical facilities for treatment of newly-identified hypertension after a health checkup. The study included employees at small-to-medium companies in Okinawa, Japan who had systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg, no history of hypertension in the last year, and not taking antihypertensive medication. Pre-existing data on worksite characteristics, employees' health checkups, and health insurance claims were collected. The odds ratio (OR) and 95% confidence interval (CI) were calculated for visits in the HA group using a multi-level logistic regression model, with the non-HA group serving as the reference. The cumulative incidence of visits during the 1st month after the health checkup in 2906 participants with newly-identified hypertension employed at 1366 worksites was 2.00% for the non-HA group and 2.97% for the HA group. The OR for visits in the HA group was 1.74 (95% CI, 0.94-3.22) after adjusting for potential confounding factors. When the hypertensive population was stratified using the cut-off values of 150 mmHg for systolic and 95 mmHg for diastolic blood pressure, more hypertensive stratum showed a cumulative incidence of 2.29% in the non-HA group and 4.97% in the HA group, with an adjusted OR of 3.05 (1.12-8.29). The presence of a HA at a worksite was associated with increased early visits to medical facilities by employees for treatment of hypertension.

Relationship between diabetes treatment status and occupational accidents

AIMS

To evaluate the relationship between diabetes treatment status and occupational accidents.

METHODS

A cross-sectional study was conducted using an online questionnaire survey completed in March 2022 among workers aged 20 years or older. The questionnaire included questions about diabetes treatment status and occupational accidents. The association between the treatment status of diabetes and occupational accidents was examined using a logistic regression analysis.

RESULTS

The study included 25,756 participants with no diabetes, 1,364 participants receiving diabetes treatment, 177 participants who had interrupted diabetes treatment, and 396 participants who needed diabetes treatment but had not seen a doctor. Compared with those with diabetes treatment, the odds ratio of occupational accidents among participants without diabetes was 0.40 (95% CI: 0.32-0.49), the odds ratio among participants with interrupted diabetes treatment was 4.15 (95% CI: 2.86-6.01), and the odds ratio among participants who needed diabetes treatment but had not seen a doctor was 1.25 (95% CI: 0.89-1.77).

CONCLUSIONS

This study showed that diabetes treatment status was related to occupational accidents, and it may be important for workers with diabetes to be supported to balance their diabetes management and their work commitments.

Inequality in workplace support for various types of precarious workers compared with permanent workers in Japan: A cross-sectional study

OBJECTIVES

The purpose of this study was to examine, by sex, whether precarious workers in Japan receive less support in the workplace than permanent workers.

METHODS

We conducted a cross-sectional study using an online questionnaire in 2022. We stratified participants by sex and performed modified Poisson regression analysis. The outcomes were support from supervisors, co-workers, occupational health professionals, and no one. Adjusted prevalence ratios (aPR) were calculated for contract workers, part-time workers, and dispatched workers, using permanent workers as reference.

RESULTS

This study had 21 047 participants. For men, 87.9% were permanent workers; for women, 50.7% were permanent workers and 37.3% were part-time workers. For workplace support, 47.5% of men and 45.2% of women selected superiors; 41.8% of men and 50.5% of women selected colleagues; 16.8% of men and 6.2% of women selected occupational health professionals. Female contract workers were less likely to receive support from their supervisors (aPR 0.88) or co-workers (aPR 0.89). Male part-time workers were less likely to be supported by their co-workers (aPR 0.86). Dispatched workers were less likely to be supported by their supervisors (men aPR 0.71, women aPR 0.84) and co-workers (men aPR 0.73, women aPR 0.77). Part-time and dispatched workers were less likely to receive support from occupational health professionals.

CONCLUSIONS

Precarious workers could get less workplace support than permanent workers. This may contribute to occupational health problems with precarious workers.

Evidence for an expanded hypertension care cascade in low- and middle-income countries: a scoping review

BACKGROUND

With nearly 90% of annual hypertension-related deaths occurring in low- and middle-income countries (LMICs), there is an urgent need to measure the coverage of health services that effectively manage hypertension. However, there is little agreement on how to define effective coverage and the existing hypertension care cascade (hypertension prevalence, percent aware, percent treated, and percent controlled) does not account for the quality of care received by patients. This study reviews definitions of effective coverage and service quality for hypertension management services and proposes an expanded hypertension care cascade to improve measurement of health systems performance.

METHODS

A systematic scoping review of literature published in six electronic databases between January 2000 and October 2020 identified studies that defined effective coverage of hypertension management services or integrated dimensions of service quality into population-based estimates of hypertension management in LMICs. Findings informed an expanded hypertension care cascade from which quality-adjusted service coverage can be calculated to approximate effective coverage.

RESULTS

The review identified 18 relevant studies, including 6 that defined effective coverage for hypertension management services and 12 that reported a measure of service quality in a population-based study. Based on commonly reported barriers to hypertension management, new steps on the proposed expanded care cascade include (i) population screened, (ii) population linked to quality care, and (iii) population adhering to prescribed treatment.

CONCLUSION

There is little consensus on the definition of effective coverage of hypertension management services, and most studies do not describe the quality of hypertension management services provided to populations. Incorporating aspects of service quality to the hypertension care cascade allows for the calculation of quality-adjusted coverage of relevant services, enabling an appropriate measurement of health systems performance through effective coverage.

Association of Organizational Factors With the Proportion of Healthy Behaviours and Control of Blood Pressure at a Company Level

OBJECTIVES

The study examined a relationship between organizational factors and the health outcomes (health behaviors and blood pressure control) at a company level.

METHODS

This cross-sectional study using data from listed corporations on a stock exchange with 1000 to 30,000 employees that completed the health and productivity management survey of Japan in 2019.

RESULTS

We analyzed 886 companies. The presence of occupational health staff was associated with good health behaviors (no smoking and healthy body mass index) and good control of blood pressure. Implementation of education for manager was associated with low smoking rates.

CONCLUSION

The implementation of organizational factors by corporations may improve the lifestyle behaviors and disease management of their employees.

Assessing the effect of mandatory progress reporting on treatment requirements identified during health examinations at the Fukushima Daiichi Nuclear Power Plant: A time series analysis

OBJECTIVES

At the Fukushima Daiichi Nuclear Power Plant, run by the Tokyo Electric Power Company, new procedures were introduced as part of the fitness for duty program in July 2016. These were designed to ensure that treatment and further investigations identified as necessary during health examinations were carried out. This study aimed to assess the effectiveness of the initiative by testing whether workers who needed further health examinations obtained them promptly, and whether the number with unmet health needs decreased and the number of workers being treated increased.

METHODS

The primary contractors reported aggregated quarterly results of health examinations of both their own and their subcontractors' employees, and follow-up visits to medical institutions were also reported over the next two quarters. The study used data for the period from July 2016 to December 2018. Incident rate ratios were estimated using a multilevel Poisson regression model, including the logarithm of the number of workers who took health examination for each primary contractor company as offset. The linear trend was assessed by treating the number of periods as a continuous variable.

RESULTS

The incident rate ratio for workers who needed treatment having a follow-up examination promptly showed a significant decrease over time. The incident rate ratio for those with unmet needs decreased, and those being treated increased over time.

CONCLUSIONS

The findings showed that the initiative was effective, with the number of early visits for further health examinations increasing and a decrease in the number of people with unmet health needs.