Objectives: 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. Methods: 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). Results: 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) ]. Conclusions: 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.

Objectives: Although both occupational health centers and occupational health service centers (OHSCs) support small-scale enterprises in Japan, the activities of OHSCs are not well detailed. This survey aimed to clarify the activities and subjective evaluation by directors and coordinators of OHSCs, with a focus on improving occupational health services in small-scale enterprises. Methods: The survey was conducted by mailing questionnaires to 377 directors and 507 coordinators at 344 OHSCs in Japan from September 2016 to January 2017. The survey items comprised questions about director and coordinator characteristics, OHSCs' systems and activities, and subjective evaluations of OHSCs' activities. Results: Responses were obtained from 290 directors (76.9%) and 413 coordinators (81.5%) of OHSCs. Of the directors, 66.2% were occupational health directors of medical associations. The average number of years' experience for coordinators was 5.7 years, and 44.6% were specially qualified, most as health officers. The percentage of OHSC staff who were not coordinators was 22%, and 29.8% of OHSCs had a public health nurse. The Office of Labor Standard's guidance was most often cited as the reason why small-scale enterprises decided to use OHSCs. At least 90% of OHSC directors and coordinators evaluated OHSCs' activities as "good". Directors not consulted by a coordinator evaluated OHSCs' activities as "very good" significantly more often than directors who were consulted by a coordinator (p<.001). Similarly, directors not consulted by occupational health centers' members evaluated OHSCs' activities as "very good" significantly more often than directors who were consulted by occupational health centers' members (p<.006). Coordinators who were in charge of two or more regions medical associations evaluated OHSCs' activities as "very good" significantly more often than those who were in charge of only one regions medical association (p=.014).Coordinators who had qualification of occupational health evaluated OHSCs' activities as "very good" significantly more often than coordinators who had not (p=.007). Coordinators who conducted public relations activities evaluated OHSCs' activities as "very good" significantly more often than those who did not (p=.011). Similarly, coordinators who conducted public relations activities via email and homepage promotions evaluated OHSCs' activities as "very good" significantly more often than those who did not (p<.001). In addition, coordinators who used the consultation record evaluated OHSCs' activities as "very good" significantly more often than those who did not (p<.001), whereas coordinators who consulted with a director evaluated OHSCs' activities as "very good" significantly more often than those who did not (p=.028). Coordinators who thought doctors were fit for the OHSCs' activities had significantly higher percentages of qualifications than those who did not think this way (p=.032). Likewise, coordinators who conducted public relations activities had significantly higher percentages of qualifications than those who did not (p<.001), whereas coordinators who used the consultation record had significantly higher percentages of qualifications than those who did not (p=.006). Conclusions: This survey clarified OHSCs' activities and suggested that systems and activities are not the same across OHSCs. We found that coordinators need to master knowledge of occupational health and work support. In addition, improving the relationship between directors and coordinators, enhancing public relations activities, and utilizing tools such as a chart improved OHSCs' activities.