[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.

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.

[Qualitative evaluation of employer requirements associated with occupational health and safety as good practice in small-scale enterprises].

The purpose of this study was to identify what motivates employers to promote good occupational health and safety practices in small-scale enterprises. Previous studies have shown that small-scale enterprises generally pay insufficient attention to issues of occupational health and safety. These findings were mainly derived from questionnaire based surveys. Nevertheless, some small-scale enterprises in which employers exercise good leadership do take a progressive approach to occupational health and safety. Although good practices can be identified in small-scale enterprises, it remains unclear what motivates employers in small-scale enterprises to actively implement occupational health and safety practices. We speculated that identifying employer motivations in promoting occupational health would help to spread good practices among small-scale enterprises. Using a qualitative approach based on the KJ methods, we interviewed ten employers who actively promote occupational health and safety in the workplace. The employers were asked to discuss their views of occupational health and safety in their own words. A semi-structured interview format was used, and transcripts were made of the interviews. Each transcript was independently coded by two or more researchers. These transcripts and codes were integrated and then the research group members discussed the heading titles and structural relationships between them according to the KJ method. Qualitative analysis revealed that all the employers expressed a strong interest in a "good company" and "good management". They emphasized four elements of "good management", namely "securing human resources", "trust of business partners", "social responsibility" and "employer's health condition itself", and considered that addressing occupational health and safety was essential to the achievement of these four elements. Consistent with previous findings, the results showed that implementation of occupational health and safety activities depended on "cost", "human resources", "time to perform", and "advisory organization". These results suggest that employer awareness of the relationship between good management and occupational health is essential to the implementation of occupational health and safety practices in small-scale enterprises.

Biological marker of furfural, chemicals without administrative control level.

Furfural, a colorless liquid used in solvent-extraction processes, petroleum refining and as a rubber additive, has been assigned an occupational exposure limit of 2.5 ppm by the Japan Society for Occupational Health, but an administrative control level for furfural has not been established. In order to conduct effective occupational health management in workplaces where furfural is used, we measured furfural concentrations in working environments and collected urine samples to measure furoic acid levels (one of the principal metabolites), which act as a biomarker of exposure to furfural. The measurements of airborne concentrations in a working environment where furfural or a solution containing furfural was handled were made in 2004. Workers answered a questionnaire on working conditions, urine samples were collected at the end of the workshift, and furoic acid in the urine was measured by gas chromatography/flame ionization detector (GC/FID). The ambient concentrations of furfural during the period were 2.1 ppm in a mixer room and 1.6 ppm in a filling room. The mean concentrations of furoic acid in the workers' urine were 7.7 +/- 7.8 mg/g-creatinine in summer and winter, respectively (normal range: 3 - 60 mg/g-creatinine). The average exposure to furfural per month calculated by multiplying the concentration in the working environment by working hours for a month was 86.4 +/- 108.6 ppm hours/months (mean +/- standard deviation) (range; 0 - 336 ppm hours/month). The relationship between average exposure to furfural and furoic acid in the urine was analyzed by simple linear regression analysis and a positive correlation was found. These findings suggest that furoic acid in urine is useful for biological monitoring of exposure to furfural, and that the measurement of both furfural in the environment and furoic acid in the urine are beneficial in occupational health management of furfural.

Inequality in the health status of workers in small-scale enterprises.

BACKGROUND: Small-scale enterprises (SSEs) usually share poorer resources for promoting occupational health. AIM: To investigate inequality of health status among SSEs in Japan. METHOD: A cross-sectional, multiple-centred study was carried out using the periodical health check-up data for the fiscal year 2000 to compare the age-adjusted proportions of workers with hypertension (HT), hyperlipidaemia, impaired glucose tolerance (IGT) and obesity and of current smokers by size of enterprise, i.e. or=1000 employees in Japan. RESULTS: From five leading occupational health organizations, data were collected for 9833 enterprises with a total of 436 729 subjects, 302 383 males and 134 346 females. The proportions of workers in SSEs with or=50 male employees. The prevalence of smokers in SSEs with or=50 male employees. These proportions showed a significantly increasing tendency with decreasing size of male workforce. CONCLUSION: Despite the cross-sectional design and only adjusting age as a potential confounder, higher proportions of HT, IGT, obesity and smoking in male workers were found in SSEs compared to larger organizations.

The challenges of occupational health service centers in Japan.

The improvement of occupational health conditions in Small- and medium-scale enterprises (SMEs) is the most crucial issue in occupational health in Japan today. Improvement will depend on how occupational health services are provided to SMEs. Recently, Occupational Health Service Centers (OHSCs) providing occupational health services for SMEs have become more firmly established and expectations for further improvement in quality and quantity are high. In this way it is hoped that the challenges of providing "occupational health for all" can be met.

[Effect of the Training Program at Occupational Health Training Center (OHTC) on the attitude of occupational health residents].

University of Occupational and Environmental Health (UOEH) conducts three courses in postgraduate education of occupational health (OH). Graduates of UOEH who have already received a basic education in OH can participate in any course and are trained to play an appropriate role as an occupational physician (OP). We operate the training program to provide practical knowledge and skills as well as to encourage interest in occupational health and to promote a further understanding of the role of the OP. In this study we evaluated changes in attitude of participants and the effectiveness of our program by an anonymous questionnaire. The subjects were all 19 participants of the 3-month program conducted between September 2003 and February 2004 as a part of the postgraduate education following several years of clinical experience. They were expected to be occupational physicians with a clinical specialty. The data were collected from questionnaires handed out at the beginning and the end of the program. The questionnaire included 8 items on the attitude toward occupational health. The subjects answered the questions according to a scale of 1 to 7. Data analysis was performed using the unpaired t-test by SPSS. The results suggested that our training program had a positive effect on trainees. Interest in occupational practice (P < 0.05) and willingness to act as a full-time occupational physician in a large company (P < 0.05) increased significantly. When considering the positive correlation between willingness to act as an OP and interest in a field that has some overlap between the speciality and occupational health, it was thought that developing a vision as an OP with respect to their career was important for training. However, in some clinical fields it may be difficult to define a relationship between the clinical speciality and occupational health. Understanding the role of an OP (P < 0.05) and self-confidence in playing an appropriate role as an OP (P < 0.05) also showed significant improvement. On the other hand, fourteen of the trainees (74%) did not have enough confidence to play a role as an OP even after completion of the program. In this study, the questionnaire we used was anonymous and did not include items concerning various attributes of the subjects. Therefore it was not possible to analyze changes of attitude at the individual level. We recognize the need to improve the program and are preparing a new version of the educational program with emphasis on understanding company organization activities and practical skills for problem solving. Opportunities to consider association between clinical speciality and occupational health are also included in this new version. We hope that the new program will further encourage trainees.

[Actual situation of medical checkups carried out by Industrial Health Organizations in Japan--manpower and service].

Japanese Industrial Health Organizations (IHOs) have been taking part in medical checkups for employees in accordance with the law of industrial safety and health in Japan. We carried out a questionnaire survey for each IHO in order to learn the actual number of full-time doctors and their proportion of work time. We sent a questionnaire to 112 IHOs (members of International Federation of Industrial Health Organizations) by mail, of which 77 replied (68.8%). In addition, we carried out an interview survey in 3 IHOs. The actual number of full-time doctors was 0 to 51, about half of IHOs have less than 5 doctors/each. Regarding the proportion of work time, among full-time doctors, half of them take part in general health checkups. About 70% of nurses' work time is taken up doing health checkups. The results revealed that the number and the proportion of work time of full-time doctors depends on the characteristics of the area and the background of the organization, for instance, what kind of hygiene services they provide. Depending on the doctors' work style (e.g. full-time or part-time) and their specialities and experience, their work may be shared. Japanese employers are required to report the number of workers with abnormal findings found by medical checkups to the Labor Standards Office. Many IHOs provide service to employers in filling out their reports. Thus, we also asked each IHO about this service. Forty out of the 77 IHOs (51.9%) answered that they are providing statistical analysis and the filling-out service. They count the number of workers with abnormal findings in each company and helped the employer to fill out the report form. Twenty-nine of those 40 IHOs responded that they decided which findings were "abnormal" by using only items that are set by law. However, 7 IHOs reported the fact that they also add some optional items when making the decision. The prevalence of workers with abnormal findings in annual medical checkups, which is one of the msot important indices of the state of occupational health, should be measured by using an objective definition and by being compatible with future systems of medical checkups for all Japanese workers. Although IHOs are endeavoring to improve their level, it will be difficult, and because of diversities in the way of periodical medical checkups among IHOs, there are still many problems to be solved.