Association between workaholism and headaches causing presenteeism: A cross-sectional study in Japan

OBJECTIVES

This study investigates the association between workaholism and headaches causing presenteeism among Japanese employees.

METHODS

Used data from self-reporting questionnaire and annual health checkups. Workaholism was assessed using the Dutch Workaholic Scale and headaches causing presenteeism were identified as the symptom hindering work. We performed a logistic regression analysis adjusted for covariates.

RESULTS

Among 5,802 respondents, 3.7% cited headaches as the symptom hindering work. We found an association between workaholism and such headaches (Odds ratios [OR]: 1.05, 95% confidence intervals [CI]: 1.03-1.08). Both working excessively (OR: 1.08, 95% CI: 1.04-1.12) and working compulsively (OR: 1.10, 95% CI: 1.05-1.15) subscales were also related.

CONCLUSIONS

Workaholism may lead to productivity loss due to headaches, and addressing workaholism can prevent this loss. Combining health examination data with work hours data may enable the early detection of workaholism.

Association between lifestyle habits and presenteeism

BACKGROUND

Presenteeism is affected by work-related and individual factors. Among individual factors, the effect of combining various lifestyle habits on presenteeism is unknown.

AIMS

This study aimed to determine the relationship between changes in multiple good lifestyle habits with a change in presenteeism and to examine the effect of psychological factors on this relationship.

METHODS

We performed a 1-year retrospective cohort study on employees of large Japanese companies. Data were collected from health check-ups and a self-administered questionnaire. Changes in presenteeism were measured using the Quality and Quantity method. Changes in lifestyle habits were measured using a modified form of Breslow's seven health practices. Psychological factors were measured using the Kessler 6-Item Psychological Distress Scale. Linear regression was used for statistical analysis.

RESULTS

The number of practised lifestyle habit changes was negatively correlated with a change in presenteeism. This result was consistent when adjusted for age, sex and company (B, -0.010; P < 0.05), but became non-significant when additionally adjusted for psychological distress (B, -0.006). When analysed separately, only an improvement in the body mass index (B, -0.054; P < 0.05) and a worsened sleep habit (B, 0.040; P < 0.01) influenced a change in presenteeism.

CONCLUSIONS

This study suggests that improving various practised lifestyle habits in combination, rather than improving a single lifestyle habit, is beneficial in reducing presenteeism. Our finding that psychological distress altered the relationship of practised lifestyle habit changes with presenteeism indicates the importance of organizational-level intervention in presenteeism.

Seeking Treatment Profile of Male Shift Workers With Hypertension and Diabetes

OBJECTIVE

This study was identified seeking treatment for hypertension and diabetes among male shift workers.

METHOD

This retrospective cohort study included nine large companies in Japan. Data were collected from health checkup, health insurance records, and self-administered questionnaires in 2017 and 2020. Data were analyzed using Kaplan-Meier curves and Cox regression.

RESULT

Person-days shift workers and day workers seeking treatment for hypertension were 41,604 and 327,301, respectively and, for diabetes, were 7326 and 60,735, respectively. The log ranks were statistically significant. Shift workers were 46% and 56% less likely to seek treatment for hypertension and diabetes, respectively, than day workers were after adjustment for age, marital status, education level, and intention to modify lifestyle (model 2) ( P < 0.01).

CONCLUSIONS

Male shift workers are less likely to seek treatment for hypertension and diabetes compared with day workers.

The Effect of Pre-Operative Verbal Confirmation for Interventional Radiology Physicians on Their Use of Personal Dosimeters and Personal Protective Equipment

Interventional radiology (IR) physicians must be equipped with personal passive dosimeters and personal protective equipment (PPE); however, they are inconsistently used. Therefore, we aimed to explore practical measures to increase PPE usage and ascertain whether these measures could lead to an actual decrease in exposure doses to IR physicians. Dosimeters and PPE were visually inspected. Then, a pre-operative briefing was conducted as a direct intervention, and the use of dosimeters and PPE was verbally confirmed. Finally, the intervention effect was verified by measuring the use rates and individual exposure doses. Because of the intervention, the use rate markedly improved and was almost 100%. However, both the effective dose rate (effective dose/fluoroscopy time) and the lens equivalent dose rate (lens equivalent dose/fluoroscopy time) showed that the intervention led to a statistically significant increase in exposure (effective dose rate: p = 0.033; lens equivalent dose rate: p = 0.003). In conclusion, the proper use of dosimeters and PPE raised the radiation exposure values for IR physicians immediately after the intervention, which was hypothesized to be due to the inclusion of exposure overlooked to date and the changes in the dosimeter management method from a single- to a double-dosimeter approach.

Relationship between occupational injury and gig work experience in Japanese workers during the COVID-19 pandemic: a cross-sectional internet survey

This study evaluated the relationship between occupational injury risk and gig work, which included the exchange of labor for money between individuals or companies via digital platforms. As Japan has experienced a severe economic decline during the coronavirus disease 2019 (COVID-19) pandemic, an increasing number of individuals have engaged in gig work. While few studies have evaluated occupational risks in gig work, several traffic accidents associated with food delivery gig work have been reported in the mass media. In this study, 18,317 individuals completed an internet survey that collected information pertaining to their involvement in gig work and experience of related occupational injuries; data regarding several confounding factors were also recorded. Multiple logistic regression analysis showed that workers involved in gig work had a greater risk of any minor occupational injuries (odds ratio, 3.68; 95% confidence interval, 3.02-4.49) and activity-limiting injuries (odds ratio, 9.11; 95% confidence interval, 7.03-11.8) than those not involved in gig work, after adjusting for age, sex, household income, lifestyle factors, and work-related factors. The results of this study indicate that gig workers are exposed to greater occupational hazards during the COVID-19 pandemic. Additional studies are warranted to clarify the causal mechanism for this relationship.

The differences of the economic losses due to presenteeism and treatment costs between high-stress workers and non-high-stress workers using the stress check survey in Japan

OBJECTIVES

This study sought to examine differences in the economic losses due to presenteeism and costs of medical and dental treatment between high-stress workers and non-high-stress workers using the stress check survey.

METHODS

We conducted a cross-sectional study from April 1, 2018 to March 31, 2019 in a pharmaceutical company. High-stress workers were classified with the Brief Job Stress Questionnaire using two methods: the sum method and the score converted method. The incidence of presenteeism and its costs were determined using a questionnaire. The costs of medical and dental treatment were calculated according to claims. We compared the costs between high-stress and non-high-stress workers using Wilcoxon's rank-sum test.

RESULTS

Of 3910 workers, 6.3% were classified as high-stress using the sum method and 6.6% were classified as high-stress using the score converted method. The costs associated with presenteeism and medical treatment among high-stress workers were higher than the costs among non-high-stress workers, whereas the costs associated with dental treatment were not.

CONCLUSIONS

To motivate employers to improve stressful work environments, it is recommended that presenteeism measurement items be added to the stress check survey, and that the methods used in this study be used to calculate the loss associated with high-stress workers in Japanese companies. However, we must be careful in interpreting absolute presenteeism loss amounts because they are poorly reliable and valid.

Effects of an Artificial Intelligence-Assisted Health Program on Workers With Neck/Shoulder Pain/Stiffness and Low Back Pain: Randomized Controlled Trial

Background

Musculoskeletal symptoms such as neck and shoulder pain/stiffness and low back pain are common health problems in the working population. They are the leading causes of presenteeism (employees being physically present at work but unable to be fully engaged). Recently, digital interventions have begun to be used to manage health but their effectiveness has not yet been fully verified, and adherence to such programs is always a problem.

Objective

This study aimed to evaluate the improvements in musculoskeletal symptoms in workers with neck/shoulder stiffness/pain and low back pain after the use of an exercise-based artificial intelligence (AI)–assisted interactive health promotion system that operates through a mobile messaging app (the AI-assisted health program). We expected that this program would support participants’ adherence to exercises.

Methods

We conducted a two-armed, randomized, controlled, and unblinded trial in workers with either neck/shoulder stiffness/pain or low back pain or both. We recruited participants with these symptoms through email notifications. The intervention group received the AI-assisted health program, in which the chatbot sent messages to users with the exercise instructions at a fixed time every day through the smartphone’s chatting app (LINE) for 12 weeks. The program was fully automated. The control group continued with their usual care routines. We assessed the subjective severity of the neck and shoulder pain/stiffness and low back pain of the participants by using a scoring scale of 1 to 5 for both the intervention group and the control group at baseline and after 12 weeks of intervention by using a web-based form. We used a logistic regression model to calculate the odds ratios (ORs) of the intervention group to achieve to reduce pain scores with those of the control group, and the ORs of the subjective assessment of the improvement of the symptoms compared to the intervention and control groups, which were performed using Stata software (version 16, StataCorp LLC).

Results

We analyzed 48 participants in the intervention group and 46 participants in the control group. The adherence rate was 92% (44/48) during the intervention. The participants in the intervention group showed significant improvements in the severity of the neck/shoulder pain/stiffness and low back pain compared to those in the control group (OR 6.36, 95% CI 2.57-15.73; P<.001). Based on the subjective assessment of the improvement of the pain/stiffness at 12 weeks, 36 (75%) out of 48 participants in the intervention group and 3 (7%) out of 46 participants in the control group showed improvements (improved, slightly improved) (OR 43.00, 95% CI 11.25-164.28; P<.001).

Conclusions

This study shows that the short exercises provided by the AI-assisted health program improved both neck/shoulder pain/stiffness and low back pain in 12 weeks. Further studies are needed to identify the elements contributing to the successful outcome of the AI-assisted health program.

Trial Registration

University hospital Medical Information Network-Clinical Trials Registry (UMIN-CTR) 000033894; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000038307.

Anticipated health effects and proposed countermeasures following the immediate introduction of telework in response to the spread of COVID-19: The findings of a rapid health impact assessment in Japan

OBJECTIVES

The health effects of telework, which was introduced extensively in the immediate context of the COVID-19 pandemic crisis in Japan, on teleworkers, their families, and non-teleworkers, are unknown. Accordingly, we developed a rapid health impact assessment (HIA) to evaluate positive and negative health effects of telework on these groups and recommended easily implementable countermeasures.

METHODS

Immediately after an emergency was declared in Japan, we implemented a rapid, five-step HIA. We screened and categorized health effects of telework for the three above-mentioned groups, extracting their content, directionality, and likelihood. Following a scoping exercise to determine the HIA's overall implementation, five experienced occupational health physicians appraised and prioritized the screened items and added new items. We outlined specific countermeasures and disseminated the results on our website. A short-term evaluation was conducted by three external occupational health physicians and three nurses.

RESULTS

Following screening and appraisal, 59, 29, and 27 items were listed for teleworkers, non-teleworkers, and family members of teleworkers, respectively, covering work, lifestyle, disease and medical care, and home and community. Targeted countermeasures focused on the work environment, business management, communications, and lifestyles for teleworkers; safety and medical guidelines, work prioritization, and regular communication for non-teleworkers; and shared responsibilities within families and communication outside families for family members of teleworkers.

CONCLUSION

The HIA's validity and the countermeasures' practical applicability were confirmed by the external evaluators. They can be easily applied and adapted across diverse industries to mitigate the wider negative effects of telework and enhance its positive effects.

Relationship between impaired work function and coping behaviors in workers with low back pain

OBJECTIVES

The aim of the present study was to clarify the relationship between work functional impairment levels and three coping behaviors of workers with low back pain, which were about seeking medical attention, taking over-the-counter drugs, and taking self-care.

METHODS

We conducted a cross-sectional study on 14 Japanese companies in 2016. Work function impairment was measured using the Work Functioning Impairment Scale. Logistic regression analyses were conducted for the three coping behaviors and odds ratios (ORs) calculated for work functional impairment levels.

RESULTS

We analyzed 2232 subjects; 226 were women and 790 worked on production lines. 688 workers had sought medical attention, 436 had taken over-the-counter medication, and 1225 had engaged in self-care. Those seeking medical attention were associated with severe work function impairment compared with no work function impairment (adjusted OR = 2.84, 95% confidence interval: 1.82-4.45, p < .001). We observed a trend for the association between over-the-counter drug use with high levels of work function impairment (adjusted OR: 1.19 for low, 1.35 for moderate, 1.65 for severe). There was no apparent relationship between self-care and the degree of work functional impairment.

CONCLUSION

In workers with low back pain, severe work functional impairment may promote medical attention and over-the-counter medication use, but it would not encourage self-care, such as stretching or exercise. Therefore, workplaces need to provide special support to help them take care of themselves. Therefore, it is desirable to provide good support for self-care in the workplace.

Work functioning impairment in the course of pharmacotherapy treatment for depression

This study investigated the association between the duration of pharmacotherapy treatment for depression, or discontinuation from treatment, and work functioning impairment. This was a retrospective cohort study examining 30,409 workers. Work functioning impairment was assessed using a questionnaire, and treatment status was assessed using medical claims data. Odds ratios (ORs) of workers with severe work functioning impairment compared with healthy workers (control group) were calculated using logistic regression analysis. Continuous medical treatment was associated with severely impaired work functioning regardless of treatment period [continuous medical treatment; 4 months <: OR = 3.2, 4 months ≥, 10 months <: OR = 2.6, 10 months ≥, 14 months <: OR = 2.3, 14 months ≥, 16 months <: OR = 2.3, which are all statistically significant (p < 0.05)]. Workers who initially received pharmacotherapy treatment but discontinued in < 11 months had a significantly higher OR (treatment discontinuation period; 3 months <: OR = 2.3, 3 months ≥, 8 months <; OR = 2.0, 8 months ≥, 11 months <; OR = 3.0), while those who discontinued at ≥ 11 months did not (OR = 1.4, 95% CI 0.6-3.5). The sensitivity analysis excluding participants with at least one psychiatric comorbidity other than depression did not change the final result. It is important for the occupational health practitioners and attending psychiatrists to follow up in cooperation with each other, paying attention to the decrease in work functioning in addition to the symptoms.

Cardiovascular and cerebrovascular diseases risk associated with the incidence of presenteeism and the costs of presenteeism

Objectives

The objective of this study was to estimate a risk of cardiovascular and cerebrovascular diseases for each worker and to determine whether this risk is associated with the incidence and costs of presenteeism, absenteeism, and medical/drug treatments.

Methods

Established risk equations were used to estimate the 10‐year probability of developing coronary artery disease and ischemic stroke in male workers aged 40‐65 years who were recruited from four pharmaceutical companies in Japan. The incidence of presenteeism was defined as existence of presenteeism for the past a month, and the incidence of absenteeism was defined as existence of sick‐leave for the past three months by a self‐administered questionnaire. Each cost was calculated based on the human capital method. Data on medical/drug treatments were collected from health insurance claims.

Results

The risks were calculated for 6047 workers. Individuals at moderate and high risk of coronary artery disease had a significantly higher rate of presenteeism and absenteeism than workers at low risk. Workers at moderate and high risk of ischemic stroke also had a significantly higher rate of presenteeism and absenteeism than workers at low risk. Mean costs for absenteeism and medical/drug treatments increased with the risk of developing coronary artery disease or ischemic stroke, while costs for presenteeism did not.

Conclusions

To prevent the costs of presenteeism, workers not only at high risk but also at low and moderate risk of developing cardiovascular and cerebrovascular diseases should receive health care services.

[Systems and human resource development for occupational health in India: Effective occupational health management for Japanese enterprises with overseas branches]

OBJECTIVES

This study aimed to collect and assess information about occupational health in India, for Japanese enterprises.

METHODS

We conducted a preliminary survey through literature reviews and internet search engines. We then conducted interview-based surveys at a central government agency, an international organization, the Japanese embassy, educational and research institutions, and Japanese enterprises in India. This information was categorized into: (1) organizations, legal and inspection systems in occupational health, (2) occupational health management and specialists in workplaces, (3) occupational health-related activities in workplaces resulting from legal obligations, and (4) healthcare and workers' compensation systems.

RESULTS

The Indian Ministry of Labour and Employment is primarily responsible for occupational safety and health. There are four main acts of legislation covering occupational safety and health in the factories, ports, mines, and construction sites. The Factories Act, 1948, mandates the establishment of an occupational health center and a safety committee in the factories; the appointment of factory medical officers and safety officers. These medical officers must possess an Indian medical degree, and undertake a three months' course to obtain an Associate Fellow of Industrial Health certificate. The rules and regulations under this act differ in each Indian state. Low-wage workers are registered with a medical insurance scheme. Most workers are covered by workers' compensation schemes, although the number of reported occupational injuries are low.

CONCLUSIONS

Japanese enterprises should consider the local conditions of occupational health in India because of the different legalities and occupational health status in each state. Regardless of the Factories Act, 1948, stipulating a variety of occupational health-related activities, inadequate legal compliance is suspected to be common because of the ineffective labor inspection requirements and a shortage of specialists on human resources. The study also revealed a deficient social security system. Therefore, the internal educational support for specialists, external support from the company headquarters in Japan, and the local institutions in India; and the systemic support for effective occupational health-related activities are required for improving the status of occupational health in the factories in India.

[Systems and actual practices of occupational safety and health risk management in the People's Republic of China]

OBJECTIVES

To investigate the systems and actual practices of occupational safety and health risk management in China.

METHODS

First, we gathered basic information through a literature review using an academic search engine (Japan Medical Abstracts society, Pubmed, and Google Scholar), as well as a general search on the Internet. Next, we conducted field surveys at a graduate school for public health, providers of occupational health services (e.g. medical examinations, working environment measurements), and local workplaces of a Japanese construction machinery company in China. This information was analyzed in terms of legal framework, professional staff, working environment measurements, medical examinations, occupational diseases, and occupational health service providers.

RESULTS

Health and safety-related matters have become codified in Chinese workplaces as a result of safety laws and measures to prevent occupational diseases. While the country does have safety and hygiene officers, they lack official frameworks for occupational physicians and nursing professionals. The employers are not obligated to appoint medical professionals. While general medical examinations are not provided for under Chinese law, businesses are obligated to bring in external providers of occupational safety to perform special medical exams and working environment measurements. Occupational diseases are on the rise; pneumoconiosis comprises roughly 80% of cases. In addition, occupational health technical service providers have specialized staff and are not permitted to perform medical examinations or other services without government accreditation.

DISCUSSION/CONCLUSION

There are great disparities in specialist knowledge about health and hygiene between company staff and external organizations, thus running the risk of corporate health and safety policies existing only on paper. This issue demands greater utilization of public health physicians in Chinese workplaces and support from Japanese professionals who understand how occupational safety and health risk management operate in China.

Developing a global occupational health and safety management system model for Japanese companies

Objectives

To develop and validate a global occupational health and safety management system (OHSMS) model for Japanese companies.

Methods

In cooperation with a Japanese company, we established a research team and gathered information on occupational health and safety (OHS) practices in nine countries where the target company operated manufacturing sites. We then developed a model hypothesis via research team meeting. The model hypothesis was introduced to local factories in Indonesia and Thailand as trial sites. We evaluated the roles of the company headquarters, the implementation process, and any improvements in OHS practices at the sites. Based on the results, a global OHSMS model was formalized for global introduction.

Results

The model consisted of both headquarters and site roles. These roles were well‐functioning, and OHS at the sites improved. Two issues concerning the functioning of the headquarters were identified: the need to establish a reporting system to the headquarters and the need to support the improvement of specialized human resources. By improving the model hypothesis to address these issues, the model was formalized for global introduction.

Conclusions

The global OHSMS model was based on the use of methods and specialized human resources relevant to each region and their common objectives, as well as evaluation indicators based on the minimum requirements of the company headquarters. To verify the effectiveness of this model, the experiment should be extended to other countries.

Characteristics of self-reported daily life note (LN) users in return-to-work judgment for workers on sick leave due to mental health conditions, and usefulness of the tool

A self-reported daily life note (LN) is an effective tool used by occupational physicians to assess the capacity of workers on sick leave due to mental illness to return to work (RTW). We aimed to clarify whether there were differences in the criteria used to define recovery for RTW between LN users and non-users, whether LN users were satisfied with LN, and whether non-users wanted to use LN. In total, 363 occupational physicians (238 LN users, 125 non-users) completed self-reported questionnaires covering demographic and occupational variables, and RTW assessment criteria. We investigated which of the 10 assessment criteria were considered most important for RTW. The proportion of LN users was higher among women, younger physicians, and occupational physicians with more working days per month. LN users emphasized four criteria in assessing RTW: 1) constant wake-up time, 2) constant bedtime, 3) no midnight waking, and 4) no feeling of drowsiness during the day. LN users regard regular sleep rhythm and the absence of drowsiness during the day as important criteria for RTW. Ninety-seven percent of users regarded LN as useful. Seventy-four percent of non-users had interest in using LN.

[Examination of factors for promoting cooperation using documents between occupational health physicians and psychiatrists]

OBJECTIVES

There is little specific information concerning the method and the efficacy of sharing information between occupational health physicians and psychiatrists regarding the employment status and medical history of their patients with mental illnesses. To promote cooperation between occupational health physicians and psychiatrists, we examined the points necessary to be included on medical information request forms exchanged between them.

METHODS

We conducted focused group discussion (FGD) to identify the points that need to be described on the request form and the concerns in cooperation between occupational health physicians and psychiatrists. We conducted FGDs twice, with two different groups of nine psychiatrists participating in each round. We extracted and organized FGD results and determined the necessary request form points. Next, we assumed two different cases of workers with mental illnesses and created three request form templates with differing item descriptions and lengths. We also conducted a questionnaire survey among clinical psychiatrists to determine their impression of the templates. We performed logistic regression analysis on the obtained results.

RESULTS

On the basis of the FGD results we extracted the situation in the workplace, clarification of points to be confirmed, representation of the occupational health physician's position, and handling of information provided by the doctor as points required for the request form. On the basis of these results and the opinions of occupational health specialists, we created a new request form using these points. Additionally, the results from the questionnaire survey about the prescribed items revealed the proportion of favorable answers regarding sufficient information written on the request form and a feeling of security for information provision increased (p < 0.01). Conversely, the proportion of favorable responses for readability decreased.

CONCLUSIONS

Psychiatrists are concerned about the possibility that their patient may be at a disadvantageous situation by providing their personal medical information and believe the clinical information required by the occupational health physicians is unclear. This suggests that there are factors impeding the cooperation between the occupational health physicians and psychiatrists. When an occupational health physician writes a request form, cooperation with psychiatrists may be promoted by enriching the request form contents and by including the representation of the occupational health physician's position and the intended purpose of the provided information by paying attention to the volume of sentences.

[The System and Human Resources for Occupational Health in Republic Of Indonesia for Japanese Enterprises to Manage Proper Occupational Health Activities at Overseas Workplaces]

OBJECTIVES

To consider the appropriate occupational health system for Japanese enterprises in Indonesia with information on the regulations and development of the specialists.

METHODS

In this study, we used the information-gathering checklist developed by Kajiki et al. Along with literature and internet surveys, we surveyed local corporations owned and operated by Indonesians, central government agencies in charge of medical and health issues, a Japanese independent administrative agency supporting subsidiaries of overseas Japanese enterprises, and an educational institution formulating specialized occupational physician training curricula.

RESULTS

In Indonesia, the Ministry of Manpower and the Ministry of Health administer occupational health matters. The act No. 1 on safety serves as the fundamental regulation. We confirmed at least 40 respective regulations in pertinent areas, such as the placement of medical and health professionals, health examinations, occupational disease, and occupational health service agencies. There are some regulations that indicate only an outline of activities but not details. Occupational physicians and safety officers are the two professional roles responsible for occupational health activities. A new medical insurance system was started in 2014, and a workers' compensation system was also established in 2017 in Indonesia according to the National Social Security System Act.

DISCUSSION

Although safety and health laws and regulations exist in Indonesia, their details are unclear and the quality of expert human resources needed varies. To conduct high-quality occupational health activities from the standpoint of Japanese companies' headquarters, the active promotion of employing highly specialized professionals and cooperation with educational institutions is recommended.

Developing a checklist for collecting information from overseas hospitals

OBJECTIVE

Expatriate workers and their families may encounter difficulties and uncertainties when visiting local hospitals. These problems include differences in the medical system, higher healthcare costs, and language problems. Occupational health staff in companies need to know about the healthcare system, including emergency transportation arrangements, to reduce anxiety in workers and families attending hospitals. This study was designed to create a checklist to allow occupational health staff to collect information from overseas hospitals efficiently and effectively.

METHODS

We used documentary searches and the knowledge and experience of researchers to identify the support requirements of expatriate workers and drafted a checklist for information collection from overseas hospitals. The validity of the checklist was assessed in two stages. First, we interviewed health specialists caring for expatriate workers and their families and then tested the draft in international hospitals. We revised the draft based on our findings and again tested the new version in different overseas hospitals, enabling us to create a final version of the checklist.

RESULTS

Our checklist contains 12 major categories: reception, administration, inpatient wards, available tests, outpatient clinics, emergency services, pediatrics, gynecology, dentistry, general health check-ups, vaccination services, and precautions against infection. These categories cover a total of 51 subcategories, each of which is further divided into a total of 131 smaller categories.

DISCUSSIONS

Occupational health staff can use this checklist to gather information in order to provide comprehensive and effective support for expatriate workers attending hospitals. We recommend that the staff gather all possible information from hospital websites before visiting and use the visiting time to gather information available only on site. In order to gather as much information as accurately as possible, the staff are recommended to visit the facilities related to the checklist categories, that is, Japanese language reception, outpatient services, inpatient wards, emergency services, pediatrics, gynecology, general health check-up centers, and cardiac catheterization labs, and obtain information directly from doctors, nurses, and specialists working at the hospitals.

A randomized controlled trial of the effect of participatory ergonomic low back pain training on workplace improvement

Objectives:

This study aimed to determine the effects of participatory workplace improvement (PWI) -based provision of ergonomic training and ergonomic action checklists (ACLs) to on-site managers on workplace improvement activities for low back pain (LBP).

Methods:

A randomized controlled trial (RCT) was conducted at a manufacturing company in Japan. Teams entered in the study were randomly assigned to a control and an intervention group. A total of three interventional training sessions on methods of ergonomics were provided to on-site managers in the intervention group, with 1-month intervals between sessions. Ergonomic ACLs were provided at the same time. After completion of the training sessions, each team then provided a report of improvements each month for the next 10 months. Two people in charge of safety and health chose two major objectives of the implemented activities from the five categories. The reported number of improvements was analyzed using a Poisson regression model.

Results:

In the intervention group, although the incident rate ratio (IRR) of PWIs in countermeasures for the LBP category was significantly elevated after the training sessions, the IRR of improvements decreased over time during the 10-month follow-up period. No significant difference was observed in the IRR of total PWIs in either the control or intervention group.

Conclusions:

PWI-based provision of ergonomic training sessions and ergonomics ACLs to on-site managers was shown to be effective for workplace improvement activities targeted at LBP. However, because the effects decrease over time, efforts should be made to maintain the effects through regular interventions.

Development of a check sheet for collecting information necessary for occupational safety and health activities and building relevant systems in overseas business places

OBJECTIVES

This study aimed to develop an information gathering check sheet to efficiently collect information necessary for Japanese companies to build global occupational safety and health management systems in overseas business places.

METHODS

The study group consisted of 2 researchers with occupational physician careers in a foreign-affiliated company in Japan and 3 supervising occupational physicians who were engaged in occupational safety and health activities in overseas business places. After investigating information and sources of information necessary for implementing occupational safety and health activities and building relevant systems, we conducted information acquisition using an information gathering check sheet in the field, by visiting 10 regions in 5 countries (first phase). The accuracy of the information acquired and the appropriateness of the information sources were then verified in study group meetings to improve the information gathering check sheet. Next, the improved information gathering check sheet was used in another setting (3 regions in 1 country) to confirm its efficacy (second phase), and the information gathering check sheet was thereby completed.

RESULTS

The information gathering check sheet was composed of 9 major items (basic information on the local business place, safety and health overview, safety and health systems, safety and health staff, planning/implementation/evaluation/improvement, safety and health activities, laws and administrative organs, local medical care systems and public health, and medical support for resident personnel) and 61 medium items. We relied on the following eight information sources: the internet, company (local business place and head office in Japan), embassy/consulate, ISO certification body, university or other educational institutions, and medical institutions (aimed at Japanese people or at local workers).

CONCLUSIONS

Through multiple study group meetings and a two-phased field survey (13 regions in 6 countries), an information gathering check sheet was completed. We confirmed the possibility that this check sheet would enable the user to obtain necessary information when expanding safety and health activities in a country or region that is new to the user. It is necessary in the future to evaluate safety and health systems and activities using this information gathering check sheet in a local business place in any country in which a Japanese business will be established, and to verify the efficacy of the check sheet by conducting model programs to test specific approaches.

Surveys on the competencies of specialist occupational physicians and effective methods for acquisition of competencies in Japan

OBJECTIVES

The aim of this study was to study the necessary competencies for specialist occupational physicians in Japan and the effective training methods for acquiring them.

METHODS

A competency list (61 items) was developed for the questionnaires in the study by making use of existing competency lists from the Japan Society for Occupational Health (JSOH) as well as lists from the US and Europe. Certified senior occupational physicians (CSOPs) in the certification program of the JSOH completed a questionnaire on the necessary competencies. Examiners of the examination for certified occupational physicians (COPs) completed another questionnaire on effective training methods.

RESULTS

All 61 competencies in the questionnaires were evaluated as "necessary". Some of the competencies in the list from the JSOH were evaluated lower than the items added from the American and European lists. When the respondents were categorized into a "practical group", the members of which mainly provided occupational health services, an "academic group", the members of which belonged to research or education institutes such as medical schools, and all others, the practical group evaluated some competencies significantly higher than the academic group, particularly those related to work accommodation. Among three options for training methods, the most effective methods were lectures and textbooks for 5 competency items, on-the-job training (OJT) for 30 items, and case-based learning (CBL) for 29 items.

CONCLUSIONS

Some competencies should be added to the JSOH list. CBL should be introduced in training programs for specialist occupational physicians.

Functions and Positions of Corporate Occupational Health Managers in Company-Wide Occupational Health Management

Objectives: It has become necessary for Japanese corporations to manage occupational health (OH) programs consistently throughout their organizations. Corporations need to clarify their health policies, develop standardized programs, assign OH staff, and ensure that they communicate with each other. To realize such conditions, many occupational physicians (OPs), who have the skills to lead corporation-wide OH activities, are now being assigned to head offices of corporations and referred to as corporate OH managers. However, there has been no research to date in Japan on their actual situation and function. We conducted an interview study of corporate OH managers to clarify their functions and positions in corporations. Subjects and Methods: We conducted semi-structural interviews with 14 corporate OH managers in large corporations employing more than 5,000 workers and multiple OPs. Interview scripts were coded to identify their functions as corporate OH managers and the context of their positions within corporate-wide OH management systems. Results: Five contexts were suggested. 1) Corporate OH managers played central roles in developing corporate health policies, standards and plans. 2) Head office department managers who supervised the sites distributed the policies and standards, and corporate OH managers instructed site OPs and OH staff. 3) In some corporations, corporate OH managers participated in the evaluation process of OH programs as part of occupational safety and health management systems or business audits. 4) Corporate OH managers led communications among OPs and OH staff by facilitating corporate OH meetings, and provided technical training. 5) Corporate OH managers in positions that enabled them to report directly or indirectly to decision makers (i.e., directors in charge) on human resource issues. Discussion: The results of this study suggest that companies that promote consistent company-wide OH programs also utilized the professional knowledge of OH managers as well as their decision-making skills and direction processes. They also suggest that these companies play significant roles in securing qualified OH professionals and reaching a common understanding of corporate OH systems. It is necessary to study cases of corporate OH managers to clarify their essential competences and to develop appropriate training programs.

[Health impact assessment of occupational health policy reform at a multinational chemical company in Japan]

A health impact assessment (HIA) was conducted to identify potential health impacts arising from policy reform of occupational health and safety at S-chemical company, a multinational global company that employs about 13,000 workers. A multidisciplinary team of health professionals including occupational physicians, an epidemiologist, and public health researchers oversaw the HIA. A project manager from S-company was also involved in the whole HIA process. A literature review, profiling using annual health examination data and interviews with stakeholders and key informants were undertaken in order to identify possible impacts. A range of positive and negative health impacts were identified and develop recommendations for implementation of the new occupational health policy were proposed. The HIA added value to the planning process for the occupational health policy reform.

Evaluation of the control banding method--comparison with measurement-based comprehensive risk assessment

The control banding method, or "control banding", is a simplified risk assessment system for chemical handling tasks. This system is supposed to provide assessment results of reasonable quality without expert involvement. The objective of this study was to evaluate the appropriateness of control banding judgment on the basis of workplace safety. A common approach for assessing workplace risk, which is called "comprehensive risk assessment" in this study, is to measure workers' exposure and compare it with relevant occupational exposure limits. Risk assessment was performed with control banding (COSHH Essentials, UK) at 12 workplaces of a petroleum company in Japan, where health risks had already been assessed separately through comprehensive risk assessment by experts and control technologies implemented accordingly. The obtained control banding judgments were then examined with regard to their adequacy by comparing them with existing control technologies. There was majority of cases (seven) where judgments by control banding were identified as "over-controlled"; there was no judgments identified as "under-controlled". Control banding also requested the seeking of expert advice in the majority of cases (eight). Thus, it was demonstrated that control banding tends to provide safe-sided judgment. A possible interpretation of this is that control banding is inherently designed to secure workplace safety by compensating for its insufficient exposure information with safe-sided judgment criteria and by requiring experts' intervention in high-risk cases. Control banding could be widely and effectively utilized in Japan, especially by employers in small enterprises, provided that the above characteristics are pre-acknowledged and health experts are made available. To this aim, it is essential to develop new local health experts and establish institutional mechanisms for facilitating employers' access to expert advice. It should however be noted that the number of workplaces evaluated in this study was small.