Objectives: In Japan, so-called “medical examinations for those engaged in specified work” involve the same tests as those in general medical examinations, regardless of the type of work engaged in. The role of these medical examinations and “medical examinations with specified items for those engaged in harmful work operations” is also unclear. Therefore, questions have been raised about the appropriateness of the work covered by this medical examination. However, its legal system is complex and difficult to interpret. This study clarifies the changes in the type of work and their criteria covered by this medical examination. Methods: We investigated laws and regulations, notifications, papers, and publications related to the history of medical examinations for those engaged in specified work. Results: In 1947, Article 48 of the former ordinance on industrial safety and health stipulated that those engaged in work involving the handling of harmful substances that require special safety and health management shall undergo so-called “medical examinations for those engaged in specified work.” Quantitative criteria for this work were indicated in a notification in 1948 in the form of tentative reference values, and they have not changed significantly since then. As a result, many of the standards used to determine who is subject to medical examinations for those engaged in specified work have exceeded allowable concentrations. Conclusion: The work covered by medical examinations for those engaged in specified work and its criteria have hardly been modified in approximately 70 years. In view of the changes in social environment and improvement in management methods for harmful work, it is necessary to rearrange the purposes and roles of the medical examinations with specified items for those engaged in harmful work operations and medical examinations for those engaged in specified work and to reconsider the method of the medical examinations for those engaged in specified work.
Aim: Labor and social security attorneys (LSSAs) are involved in the field of occupational mental health. However, little attention has been paid to the involvement of LSSAs in this field. This study investigated the occupational mental health competencies that are expected of LSSAs. Subjects and methods: Our investigation utilized the Delphi method. In Step 1, we conducted semi-structured interviews with LSSAs and then created an initial list of competencies based on the interviews and a previous investigation. In Step 2, we recruited LSSAs with 10 or more cases related to occupational mental health. They completed a questionnaire assessing the importance of their work (how important they felt it was to conduct work related to mental health) and level of achievement (how much they felt they had achieved). The respondents were also asked to provide additional competencies (not listed on the questionnaire) if they regarded them as necessary for their work, and these were later added to the list of proposed competencies. In Step 3, we presented the results of Step 2 to the same respondents and asked them to rate their agreement with the proposed competencies. Items with agreement of 80% or higher were set as competencies. We also asked LSSAs about the level of importance of their work and their perceived level of achievement with regard to the additional items created in Step 2. Items for which the level of achievement fell below the median were extracted even if the level of importance of the work fell at or above the median. Results: We recruited 8 LSSAs in Step 1 and created a list of 68 preliminary competencies in 20 fields. We recruited 57 LSSAs in Step 2, and 45 LSSAs completed the survey (response rate: 78.9%). Seven competencies were added to the list as a result. We recruited 34 LSSAs in Step 3 (response rate: 75.6%) . Two items with an agreement rate of less than 80% were removed, resulting in 73 competencies in 20 fields. One of the items with an agreement rate of 100% was “The plan is based on the merits and disadvantages (risks) for both labor and management.” Conclusions: This study identified the competencies required of LSSAs in the field of occupational mental health. Our findings suggest that specifying these competencies will enable efficient training of LSSAs.