Occupational Health Staff Research Articles

Return-to-work support programs for workers on sick leave: a systematic review and meta-analysis

We are responsible for answering the research question, "Does a return-to-work program improve the returning outcome?" This is one of the six research questions in the evidence-based "Return-to-work Guidance in Occupational Health 2017" developed by the Kanto branch of the Japanese Society of Occupational Health. This study aimed to integrate the effectiveness of the return-to-work program to improve the state of sick-listed employees suffering from cardiovascular disease, cancer, and musculoskeletal and mental health problems. Three different databases, PubMed, Cochrane Library, and Ichushi-Web were searched. Based on the results of a systematic review, the guidance developing group created the draft of the recommendations with evidence to decision framework and used a poll to determine the recommendations. We integrated the evidence from a systematic review and meta-analysis at the disease level. This study protocol was registered with PROSPERO (the registration number is: CRD42016048937). A total of five articles on musculoskeletal diseases and six on mental health problems were retrieved. No articles in the cardiovascular and cancer areas matched the eligibility criteria. When workers suffered from musculoskeletal disorders, the rehabilitation group statistically returned to work earlier than the usual care group did [HR 1.58 (95% CI 1.26-1.97), -40.71days (95% CI -60.69--20.72) ]. In the mental health problems group, the psychological intervention program group had statistically less days of sick leaves as compared to that in the usual care group [-18.64 days (95% CI -27.98--9.30) ]. It might be suggested that work environment management, work management, tackling psychological problems, cognitive behavioral approach, and several meetings with supervisors and occupational health staff, in addition to a direct focus on backache contributed to the early return-to-work of workers suffering from musculoskeletal disease. Regarding mental health problems, interviews with a psychological approach and consultations with psychologists and psychiatrists might be effective in reducing the days of sick leaves. However, because these methods were investigated in Europe, we need to be careful when introducing these practises in Japan due to the differences in the occupational health support systems. Further, high quality evidence level studies are needed in Japan.

Extending working life and the management of change. Is the workplace ready for the ageing worker?

AbstractIncreasing longevity and the strain on state and occupational pensions have brought into question long-held assumptions about the age of retirement, and raised the prospect of a workplace populated by ageing workers. In the United Kingdom the default retirement age has gone, incremental increases in state pension age are being implemented and ageism has been added to workplace anti-discrimination laws. These changes are yet to bring about the anticipated transformation in workplace demographics, but it is coming, making it timely to ask if the workplace is ready for the ageing worker and how the extension of working life will be managed. We report findings from qualitative case studies of five large organisations located in the United Kingdom. Interviews and focus groups were conducted with employees, line managers, occupational health staff and human resources managers. Our findings reveal a high degree of uncertainty and ambivalence among workers and managers regarding the desirability and feasibility of extending working life; wide variations in how older workers are managed within workplaces; a gap between policies and practices; and evidence that while casualisation might be experienced negatively by younger workers, it may be viewed positively by financially secure older workers seeking flexibility. We conclude with a discussion of the challenges facing employers and policy makers in making the modern workplace fit for the ageing worker.

Structure of Relationships Formed by Occupational Health Nurses for Co-operating with Managers to Support Workers with Mental Health Concerns

Occupational health staff and managers play important roles in supporting workers with mental health concerns and mutual co-operation among them is a necessary element. However, when co-operating with other professionals, several problems arise that often make such co-operation a challenge. Effective mutual actions are needed to promote such co-operation, and relationships must be formed for this purpose. Therefore, in this study, we aimed to clarify how occupational health nurses form relationships for facilitating co-operation with managers to provide support to workers with mental health concerns. Data were collected using semi-structured interviews with 11 occupational health nurses who provide individualized mental health support and who have at least 5 years of experience as occupational health nurses. Analysis of the recorded interviews was performed using a qualitative statistical method (KJ method). Six elements that constitute the formation of relationships were identified. When occupational health nurses form relationships for facilitating co-operation with a manager to provide support to workers, they "form relationships through strategic communication" with them and when co-operation is required, they form a relationship by "acting in a manner that suits the manager," such as his/her character and the situation. To support this relationship, occupational health nurses "provide mental support to the manager" by listening to his/her anxiety or real intention about supporting the subordinate with mental health concerns and provide relief while understanding their burdens during the co-operation. Occupational health nurses even "provide support to the manager in their activities," which assessed the situation at the workplace as the specialist and advised the manager to understand how to concern to the subordinate specifically. In addition, they "indirectly support the manager" which included coordinating with the concerned persons so as to not excessively burden the manager. Such support promoted the "creation of systems for clear roles" of managers in supporting the subordinate with mental health concerns. Relationships that occupational health nurses form with their managers were the structure which formed emotional human relationships from the front or back necessity of co-operation causes and developing confidence in relationships with the foundation of emotional human relationships.

Integral Diagnosis of Occupational Health and Safety Management in Colombian Construction Companies

Given the particular characteristics of the construction sector, its rate of accidents and contracted illnesses is high. Therefore, construction companies seek to protect the health of their workers through the design and implementation of occupational health and safety management systems (OHSMS). This paper presents the results of a study that aimed to perform a comprehensive diagnosis of the implementation of the requirements of the Colombian Technical Standard (Norma Tecnica Colombiana, NTC-OHSAS 18001) in Colombian construction companies through a SWOT analysis. A survey of 25 questions to industry professionals in 5 capital cities was used for data collection. The survey was conducted in two ways: virtually with the help of the Google Docs platform and directly through written forms. A total of 209 questionnaires with valid answers were received. The findings show that a lack of commitment and a lack of knowledge about safety are the main weaknesses. On the other hand, the existence of occupational health and safety (OHS) staff and the promotion of OHS by Occupational Risk Administrators (ORA) are the main strengths. From this data, alternatives for improving OHS are proposed, such as greater investment in builders, increasing organizational culture, and adequate monitoring by the State

Solutions against Declining Birthrates Confronting Japan's Aging Society by Supporting Female Workers in Harmonizing Work with Their Health and Social Issues: Fertility, Chronic Illness, and Raising Children

Japan is currently facing serious social problems related to low birth rates and aging. We propose two possible solutions from the perspective of occupational health. First, companies should establish support systems to help working women with pregnancy and childbirth. Such systems would require the cooperation and understanding of coworkers, including men, and the introduction of flexible work schedules that are also designed to allow workers to care for family members with disabilities. Additionally, with regard to the protection and promotion of the fertility of working women, occupational health staff members should provide education to working women regarding appropriate lifestyle choices in areas such as diet, prevention of work-related health problems, and mental health before and after childbirth. Moreover, workers undergoing assisted reproductive technology procedures should be supported as they experience physical, mental, and economic burdens associated with this process. Second, companies should guarantee the right of workers to take a sick leave and then return to work so they can balance work and the need to treat chronic conditions. Occupational staff members should follow up employees who return to work, by offering, for example, mental health care to cancer survivors. They should also play important roles in preventing the exacerbation of disease and empowering workers to continue their visits to medical institutions. Collaborative study bridges between companies and medical institutions are necessary for the promotion of these harmonization schemes.

Current Status and Issues for the Role of Occupational Health Physicians in Japan.

This paper reviews the circumstances, current situation, and issues for Japanese occupational health physicians and discusses future developments. The Industrial Safety and Health Act requires workplaces that regularly employ 50 or more workers to appoint one occupational health physician. Their duties have been expanded by amendments to the Act, and they now have increased authority. Under these conditions, the occupational health physicians not only comply with laws and regulations but also follow a professional code of ethics. After the Act was amended in 1996, occupational health physicians had to complete additional training requirements. Basic training courses are provided by the Japan Medical Association (JMA) and the University of Occupational and Environmental Health, Japan. Most of the occupational health physicians certified by the JMA do not spend enough time on occupational health. Many Japanese occupational health work issues can be separated into issues of exposure, labor, and the occupational health system. Occupational health is characterized by changing needs because of new industrial structures and technological innovations. Given occupational health physicians’ expanding duties and professional development, they need to collaborate with one other and other occupational health staff to meet society’s expectations.

An overview of the implementation of the Stress Check Program from the view point of Occupational Health staff

An overview of the implementation of the Stress Check Program from the view point of Occupational Health staff

Use of the Psychomotor Vigilance Test in Fitness for Work Assessments.

The objective of the pilot program was to evaluate the utility of the psychomotor vigilance test (PVT) in aiding clinicians in making fitness for work determinations. A 10-minute PVT was incorporated into fitness for work examinations by occupational health staff at two integrated refining/petrochemical plants. Based on all evidence from the clinical examination, including PVT results, clinicians made their fitness for work determination. Employees who were determined to be fit for work had significantly fewer PVT errors than did employees determined to be unfit for work or fit for work with limitations, with t(98) = -14.71, P < 0.001. The pilot assessed a new application of the PVT as an adjunct to occupational health evaluations focused on determining fitness for work. Results demonstrated that the PVT can be a valuable tool for this purpose.

Effects of Occupational Health Nurses and Staff on the Performance of Occupational Health Physicians in the Workplace

Effects of Occupational Health Nurses and Staff on the Performance of Occupational Health Physicians in the Workplace

A consensus for occupational health management of healthcare workers infected with human immunodeficiency virus, hepatitis B virus, and / or hepatitis C virus.

Occupational health management plays an important role in the prevention of provider-to-patient transmission in healthcare workers infected with human immunodeficiency virus (HIV), hepatitis B virus (HBV), and/or hepatitis C virus (HCV). Therefore, the Japan Society for Occupational Health's Research Group on Occupational Health for Health Care Workers has proposed a consensus for the management of healthcare workers infected with HIV, HBV, and/or HCV based on recent evidence for each concerned group. The consensus recommends that: (1) employers in medical institutions should establish a policy of respecting the human rights of healthcare workers, management strategies for occupational blood exposure, and occupational health consultation; (2) occupational health staff should appropriately assess the risk of provider-to-patient transmission of HIV, HBV, and/or HCV infection and rearrange their tasks if necessary. When conducting risk assessment, occupational health staff should obtain informed consent and then cooperate with the physician in charge as well as infection control experts in the workplace; (3) healthcare workers infected with HIV, HBV, and/or HCV should disclose their employment to their treating physician and consult with their doctor regarding the need for special considerations at work; and (4) supervisors and colleagues in medical institutions should correctly understand the risks of HIV, HBV, and HCV infection and should not engage in any behavior that leads to discrimination against colleagues infected with HIV, HBV, and/or HCV.

Developing a checklist for collecting information from overseas hospitals.

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. 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. 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. 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.

Establishment of reference costs for occupational health services and implementation of cost management in Japanese manufacturing companies.

We developed a standardized cost estimation method for occupational health (OH) services. The purpose of this study was to set reference OH services costs and to conduct OH services cost management assessments in two workplaces by comparing actual OH services costs with the reference costs. Data were obtained from retrospective analyses of OH services costs regarding 15 OH activities over a 1-year period in three manufacturing workplaces. We set the reference OH services costs in one of the three locations and compared OH services costs of each of the two other workplaces with the reference costs. The total reference OH services cost was 176,654 Japanese yen (JPY) per employee. The personnel cost for OH staff to conduct OH services was JPY 47,993, and the personnel cost for non-OH staff was JPY 38,699. The personnel cost for receipt of OH services-opportunity cost-was JPY 19,747, expense was JPY 25,512, depreciation expense was 34,849, and outsourcing cost was JPY 9,854. We compared actual OH services costs from two workplaces (the total OH services costs were JPY 182,151 and JPY 238,023) with the reference costs according to OH activity. The actual costs were different from the reference costs, especially in the case of personnel cost for non-OH staff, expense, and depreciation expense. Using our cost estimation tool, it is helpful to compare actual OH services cost data with reference cost data. The outcomes help employers make informed decisions regarding investment in OH services.

The effectiveness of smoking cessation program in a workplace with high risk

Initiatives for smoking cessation (SC) at workplace have become more prominent due to both health and safety risks associated with smoking. We aimed to determine 6-month successful SC rates of a group of employees who participated in a SC program as they worked in a workplace that exhibited high risk of fire and explosion. Having delivered a compulsory smoking training to the paint manufacturing department with 276 employees, we invited 147 smoker employees to participate in a SC initiative (SCI) program. The SCI program was implemented by the occupational health and safety (OHS) staff. Employees were administered a self-reported questionnaire including the age at starting smoking, number of cigarettes smoked (pack years), family members' attitudes towards smoking, reasons for smoking and harms of smoking. Nicotine addiction levels were assessed with Fagerström Nicotine Dependence Test (FNDT). 276 employees (270 male and 6 female) had an average age of 36.8 ± 8.4 years. 144 active smokers presented an average age of 38.4 ± 6.9 and smoked on average 18.5 ± 12.8 pack/year. Active smokers started smoking at the age of 19.8 ± 4.9 on average. Their average score in FNDT was 6.6 ± 1.9 points. Fifty-one (35.4%) employees participated in the SCIs. The participants in the SCP training exhibited statistically significant differences with respect to the following parameters: chronic disease (p= 0.03), pack/year (p< 0.001), age at starting smoking (p= 0.001), attempted methods to SC (p= 0.002), average score in self-reported harms of smoking (p< 0.001), average FNDT score (p< 0.001), average score of self-reported smoking addiction (p= 0.001), and whether the smoker considers smoking a means of socialization (p≤ 0.001). After six months, we observed that 12 (23%) of the participants, and 4 (4%) of the non-participants employees quitted smoking (p< 0.001). In our study, participants in the SCI exhibited higher SC rates compared to the non-participants. Further studies are required to standardize such initiatives, which improve occupational health.

Implementation of stress assessments by occupational health nurses working in occupational health agencies and their confidence in conducting such assessments.

Stress assessments are due to be conducted in December 2015. It is expected that there will be an increase in the number of private health agencies that provide stress assessment services and mental health care. This study aimed to clarify the current situation of and the factors related to stress assessments conducted by nurses in occupational health agencies. Nurses working full time were randomly selected from 60 organizations that were members of the National Federation of Industrial Health Organization. Self-administered questionnaires were sent out between November 2013 and January 2014. The questionnaire included the personal attributes of the participants, training programs, job contents, and how practical mental health care, including stress assessment, is. The study was approved by the ethics committees in the respective organizations. Out of the 162 questionnaires that were distributed, 89 (54.9%) were returned and 85 (53.1%) were valid for analysis. Stress assessments were conducted by 38.8% of the participants. With reference to their confidence in conducting stress assessments, "confidence and" 70.6%, respectively. The groups that conducted and did not conduct the stress assessments did not show any differences in the findings or other attributes. Further, the implementation of stress assessment was not associated with occupational health nurse (OHN) training, education, position, age, years of experience, attendance of lectures on mental health, etc. However, the confidence in conducting the assessment was related to age when dealing with cases on confidence stress assessment consultation in follow-up to the implementation of screening, such as stress, persons at high risk, and so on. Approximately 40% of the nurses were already conducting stress assessments, but most of them conducted such assessments about once a year and were not deeply involved in them. Approximately 70% of the nurses were confident in implementing stress assessments. Further, they reported that they were confident to do so even if OHNs were not involved. We found that to encourage OHNs in occupational health agencies to provide mental health care and stress assessments, practical training programs are required. Such programs should include a series of stress assessments and help foster cooperation with superiors, colleagues, and occupational health staff such that the OHNs obtain experience and confidence.

Survey of Information Sharing Related to the Occupational Considerations of Working Cancer Patients Between Occupational Physicians and Treating Physicians.

Although a vital element in providing career support to workers with medical ailments is coordination between the worker, the treating physician, and the company (the occupational health staff), little is known about factors that promote or impede coordination between these parties. This study aims to demonstrate what kinds of actions by treating physicians promote or impede the occupational considerations made by occupational physicians. A total of 43 occupational physicians who had completed the postgraduate training course (4 years) at the University of Occupational and Environmental Health Japan and were current or former instructors at the Occupational Health Training Center were surveyed using a self-reported questionnaire form. The questionnaire asked about individual attributes (age, years of experience as an occupational physician, etc.) and actions taken by treating physicians that were useful in making occupational considerations in the workplace (good practice cases) or that impeded such considerations (trouble cases). Responses about cases were obtained as freely written descriptions. Case content was analyzed qualitatively according to the KJ method. During the survey period from December 17, 2013 to January 18, 2014, responses were received from 33 occupational physicians (valid response rate, 76.7%; mean age, 37.4±6.1 years). Of these, 60.6% exclusively specialized in occupational medicine. Respondents provided 32 good practice cases and 16 trouble cases. The timing of coordination was the period of rehabilitation in 35 of the 48 cases (72.9%). Actions by the treating physicians that influenced occupational considerations were divided into seven major categories: "providing treatment information," "providing physical information," "appropriateness of rehabilitation or occupational considerations," "consistency of information provided," "issuing documentation," "communication that was cognizant of the occupational physician's presence," and "providing information unknown to the worker." This study clarified the kind of actions by the treating physicians that were relevant to occupational support provided by occupational physicians. Additionally, this study clarified the need for information sharing with occupational physician and treating physician. The good practice cases and trouble cases presented by the respondents were inextricably linked, and actions by the treating physicians that are based on good practices are highly likely to lead to smooth information sharing and occupational considerations.

An Evaluation of Visual Function in Working Age Patients with Glaucoma

Visual function affects working ability in occupational health. We investigated the frequencies and grades of low vision in working age people who have glaucoma, and studied patients who were receiving low vision care, for example eye movement training. Among 3,905 patients aged 15 to 64 years old who visited Murakami eye clinic from October 2013 to September 2014, there were 363 patients suspected of having glaucoma and 138 patients diagnosed with glaucoma and receiving treatment. We measured their visual acuity and visual field to calculate their functional vision score (FVS). We studied the amount of reduction in visual ability and the number of patients undergoing low vision care by age groups. The vision test and visual field test showed that 18 patients had reduced visual ability, according to the FVS. Their FVS classification was from class 1 (mild vision loss) to class 3a (severe vision loss). The FVS matches the statistics of the WHO and can predict the reading and walking ability in each class. Reduced visual ability was recognized in about 14% of the glaucoma patients older than 45 years of age. 78% of the patients were classified in class 1. In FVS, class 2 (moderate vision loss) or greater is defined as low vision, and class 1 is a condition with no visual reserve. Although such patients have no problems in daily life and office work, they are challenged by on-site work and the on-site environment, and occupational health staff intervention becomes necessary.

Implementing NICE obesity guidance for staff: an NHS trust audit.

The UK National Institute of Health and Clinical Excellence (NICE) has produced guidelines (CG43) on preventing and managing overweight and obesity, which apply to the National Health Service (NHS) as an employer. To record in an NHS trust baseline assessment and management of obesity by its occupational health (OH) service staff, with reference to the standards in CG43, enabling deficiencies to be identified and improvements to be recommended as a benchmark for future measurement. Criteria relevant to OH in CG43 were identified and data were collected from trust policies, interviews with managers, questionnaires to OH staff, examination of OH resources and case notes of staff attending OH. Results were checked for compliance with CG43 standards. Although the trust met NICE standards as an employer, significant lack of compliance was found in its OH service. Only 53% of staff attending medical examinations had weight recorded, OH resources were inadequate and 75% of its staff had received no training. Problems identified included lack of written guidance, time and care pathways. The resulting action plan included a consultant-led working party liaising with the trust's health and well-being committee, training, enhanced OH resources, an obesity protocol, a database and weight management clinics. We found not only a lack of OH policy guidance but apparent inertia in dealing with obesity. The action plan demonstrated how OH clinical practice can draw upon CG43 to combat obesity in an NHS workforce.

Impact of visceral fat measurements and a weight loss support web system on visceral fat loss in a workplace setting: insights from a JVALUE2 (Japanese study of visceral adiposity and lifestyle information; utilization and evaluation)

Providing different programs of occupational health services in the same company is difficult. We report the results of a parallel randomized trial for the employees of our company for visceral fat measurements and the effect of a weight loss support web system. 181 healthy employees with BMI over 23 who volunteered to participate in this study. In a parallel randomized study, we divided them into 3 groups (A, health guidance by occupational health staff with visceral fat measurements and a weight loss support web system; B, health guidance by occupational health staff with a weight loss support web system; C, without health guidance (control)) by date of birth. To assess the effects of guidance and support, we compared each group's waist circumference (WC), weight, and BMI, before and after the guidance. We also conducted questionnaire surveys of eating behavior and life activities before and after the guidance to estimate the relationship between the intervention method used for each group and their behavioral modification. 150 employees (83%) finished this program. Within 3 months, reduction in the outcome measures was largest in group A, and showed significant differences from the other two groups. For many employees in group A, eating behavior factors improved markedly; however, in the control group, there were no changes in eating behavior or daily living activities. A parallel randomized trial involving the employees of our company was performed and we scientifically verified the effects of an occupational health programs. Objective study of occupational health activities and measures were enabled by devising methods and procedures, e.g., applying the waiting-list method for the control group. This approach will lead to appropriate selection and precise implementation of evidence-based measures in occupational health in the future.

Development of a short version of the new brief job stress questionnaire.

This study was aimed to investigate the test-retest reliability and validity of a short version of the New Brief Job Stress Questionnaire (New BJSQ) whose scales have one item selected from a standard version. Based on the results from an anonymous web-based questionnaire of occupational health staffs and personnel/labor staffs, we selected higher-priority scales from the standard version. After selecting one item with highest item-total correlation coefficient from each scale, a 23-item questionnaire was developed. A nationally representative survey was administered to Japanese employees (n=1,633) to examine test-retest reliability and validity. Most scales (or items) showed modest but adequate levels of test-retest reliability (r>0.50). Furthermore, job demands and job resources scales (or items) were associated with mental and physical stress reactions while job resources scales (or items) were also associated with positive outcomes. These findings provided a piece of evidence that the short version of the New BJSQ is reliable and valid.

Smoking cessation in the workplace

The workplace is an important setting for reaching potentially large numbers of smokers. To review the evidence about smoking cessation in the workplace. Literature review including a synthesis of findings from recent systematic reviews and meta-analyses of workplace smoking cessation programmes, a separate review of the qualitative evidence, case studies and an expert panel assessment. We found advantages, identified or confirmed from the mixed methods used in this work to holding smoking cessation programmes in the workplace. These included: (i) easy access to large numbers of worker populations for large workplaces, (ii) the potential improved recruitment to such programmes given this, (iii) the opportunity to access young men, traditionally difficult to achieve, (iv) access to occupational health and other staff who can assist with support and delivery and (v) ability for workers to attend relatively easily. Evidence on the importance of developing peer support at work was mixed. The simple provision or availability of programmes and interventions was unlikely to provide any beneficial behaviour change. Interventions should target workers that actively want to stop smoking, use elements that workers have identified as useful or focus on altering beliefs about smoking and the need to stop. Smoking cessation programmes at work can provide useful support for workers wishing to stop smoking. They are only likely to be effective if participants have moved beyond the contemplation stage regarding smoking cessation, so that stopping smoking is a personal priority.