[in Japanese]

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[in Japanese]

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[in Japanese]

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 “Health and Productivity Management” is a topic that on have recently been often organized in magazines like a boom and it is the trigger when the Second Abe Cabinet took up “nation’s extension of the healthy life expectancy” as one of the main themes in Japan Revitalization Strategy. The government, mainly Ministry of Economy, Trade and Industries and Ministry of Health, Labour and Welfare, are promoting several related programs, such as the selecting one leading company in each industry in stock exchanges, certifying excellent companies and so on. The value of companies engaging in health management of employees is to improve productivity through their health. The necessary elements for the effective practices are i) Management Policy, ii) Organizational Structure, iii) Health Care Programs, iv) Evaluation and Improvement. In addition, v) Compliance and Risk Management is essential as the foundation. There are two types of programs, risk management and support/promotion in “Health Care Programs” among the elements. In order to achieve results in health and productivity management, it is necessary to evaluate the return of the employee’s investment and to improve the programs continuously. There are a number of issues to establish the concept as the culture in Japanese society and achieve results. They are classified into three aspects, that from program delivery, that from practice and evaluation, that from system. It can be said that health and productivity management is an initiative that leads to sustainability of the company through sustainability of each employee and further leads to sustainability of Japanese society.

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 Maintaining a balance between work and disease treatment or prevention has become a major social issue in Japan because of the aging labor force and low birth rate. The harmonization outlined here aims at meeting two important challenges with regard to preventive medicine: protection against workers’ illness exacerbation (PWE) and supporting fitness for returning-to-work (RTW) patients. There is much room for improving PWE, especially for lifestyle-related diseases, such as diabetes mellitus, hypertension, and some cancers. More than 80% of the high-risk examinees of non-communicable diseases do not visit medical institutions during the 1-year period after a health check-up, although approximately half of individuals with an extremely high risk of diabetes visit physicians at least once. Several problems are related to RTW, such as repeated sick leave by employees for mental disorders and the short sick leaves available for cancer-diagnosed patients.
 In 2016, the Japanese Government and the Ministry of Health, Labour, and Welfare of Japan published guidelines for balancing work and disease treatment in the workplace. According to these guidelines, collaboration between medical institutions and workplaces through employee-approved medical information exchange is important. This collaboration means cooperative support for the empowerment of workers with diseases controlled by general clinical medicine and occupational medicine. An effective social system that acts as a sturdy bridge between clinics and companies (C&C) should be developed to promote harmonization of work with illness treatment or prevention in the context of PWE and RTW.

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 In recent years, we are facing a situation where more than 50 percent of workers experience strong anxieties, worries, and stresses in their workplaces. As increasing number of workers are developing stress-related mental disorders and getting qualified for workers compensation, prevention of mental health ailments are becoming an ever more important challenge.
 Given that backdrop, a system of providing company employees “stress checks” and face-to-face consultations based on the results of them has been implemented since December 2015.
 The Japan Medical Association conducted a survey during March, 2017, to study the impact of the introduction of stress check on occupational physicians’ contracts and activities. They surveyed 5,000 randomly selected JMA-certified occupational physicians (out of the total of 63,879 as of January 24, 2017, a sampling rate of 7.8%) and received responses from more than 40% physicians. Based on the findings of this survey, we will look at the circumstances the occupational physicians face following the introduction of Stress Check and examine the system itself.
 Although the stress check system has already been enforced by law, the survey responses included opinions of many certified occupational physicians who still question its effectiveness. It seems that we need to examine the effectiveness by conducting scientific studies and make the necessary improvements, in order to better utilize the stress check system in future to prevent stressed workers from damaging their health and being unable to work due to such conditions as depression. It is desirable to make improvements so that many directly-involved occupational physicians getting active in undertaking of stress check is not merely something that increases their responsibilities and time constraints; but rather it is something that results in appropriate rewards-both financial and emotional.
 JMA Occupational Health Committee is currently conducting a review of this issue, and will deliver its recommendations to the Ministry of Health, Labour and Welfare sometime in the future.

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 Medical interview is the most important method to identify sleep disorders at usual medical examinations. Sleep disorders can be classified to insomnia, hypersomnia and rhythm disorders. Insomnia is the most common disorders and the cause of insomnia is various and the treatment is different. The case of senior insomnia, nocturnal frequent urination, decreased melatonin insomnia, REM sleep behavior disorder, hypothyroidism, and sleep apnea syndrome, which are the common insomnia, are reported and explained in this chapter.

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[in Japanese]

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 From the results of lifestyle disease prevention medical examinations requiring colorectal cancer examinations (IFOBT 2-day method) by the Japan Health Insurance Association, the workplace colorectal cancer screening rate and close examination screening rate were compared and reviewed. The scope was examinees who underwent such examinations by the Association from April 2011 to March 2016, with a total of 218,764 examinees (158,432 men and 60,332 women). Colorectal cancer was discovered in 85 men and 16 women. The screening rate was 89.1%, and 5.1% required a close examination, of which 36.1% returned for one; the discovery rate was 0.052%. Among males, 91.3% underwent screening, 5.5% required a close examination, of which 33.4% returned for one; the discovery rate was 0.059%. Among females, 83.3% underwent screening, 3.8% required a close examination, of which 47.1% returned for one; the discovery rate was 0.032%.
 The screening rate of women in their 30s and 40s was low compared to men of the same age, but the rates converged among examinees in their 50s. The screening rate of people who submitted one specimen was highest among examinees in their 30s, and decreased with age. Among people who submitted two specimens, the screening rate of women in their 30s and 40s was considerably lower than for males, due to the effect of menstruation. The percentage of males that required a close examination was high, and the percentage of females who returned for one was high. Examinees in their 40s had the lowest rate of return. Among both men and women who submitted two specimens, the screening rate, percentage requiring a close examination, and percentage who returned were higher than those who submitted one specimen. Recommending people who have submitted one specimen to submit another is effective in improving the rate of returning for a close examination.

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 This study was performed with subjects who received active support including specific health guidance, with the aim of clarifying the effects of changes in lifestyle on weight loss. The results are based on the answers that they provided in standard questionnaires before and after the support intervention. The subjects included 4,318 males and 810 females at 155 facilities who were categorized as requiring active support based on the results of special health check-up from April 2011 to March 2013, and completed the health guidance. In the study, a weight loss of 3% or more was considered as a positive outcome.
 The percentage of subjects with a weight loss of 3% or higher was 32.3% and 39.6% in the male and female subjects, respectively. The male and female subjects with a weight loss of 3% or higher accounted for 20% or higher of the subjects who maintained or increased their bad lifestyle habits, and those who maintained or reduced their good lifestyle habits. A reduction in the bad lifestyle habits with the intervention was significantly correlated with a weight loss of 3% or higher. For male subjects, these parameters included “having a snack or midnight meal after dinner” (odds ratio: 2.01, 95% confidence interval: 1.42-2.84), “exercise with light sweating for 30 minutes or longer per day” (1.70, 1.41-2.07), “pace of eating when compared to others” (1.55, 1.23-1.97), “high-risk alcohol drinking” (1.52, 1.06-2.19), and “walking or physical activity for 1 hour or longer per day” (1.32, 1.10-1.58). For female subjects, the parameters were “not having breakfast” (2.56, 1.14-5.73) and “exercise with light sweating for 30 minutes or longer per day” (1.72, 1.15-2.56). In addition, even after adjustment for the factors of age, BMI, smoking, and high-risk alcohol drinking, similar results were obtained.
 Based on these findings, it was suggested that a certain level of weight loss could be confirmed in the subjects who received active support, and the effects tended to be increased when concrete improvements were made in their lifestyle.

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 Our hospital opened in Hamamatsu in 1986 as a specialized hospital focusing on gastroenterology and proctology. In 1988, we began occult blood testing for colorectal cancer for companies located in the western region of Shizuoka Prefecture. For corporate examinations, the examinations are first systematized and organized, and the annual examination counts are decided through negotiations with health insurance organizations. Stool collection containers are sent to each examinee, and after stool is collected, it is sent directly back to our hospital. Preliminary results are sent individually and our hospital asks examinees with positive results to come in for a full colonoscopy. Based on the second examination, progress and treatment are discussed, and reports are made individually. An annual examination report meeting is held once a year, at which the details of the examinations are reported to the health insurance organizations, etc. We have now spent 30 years on promoting colorectal examinations. After organizing all the data we have collected in our corporate examinations on diagnosis, detection, and early-stage and advanced cancers, it was evident that there is an increase in cancer incidence in young examinees aged 40 and younger. Additionally, by looking at time and costs of common surgeries, it is clear that colorectal examinations are meaningful with respect to treatment costs.

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[in Japanese]

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