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Background: Since the Fukushima Daiichi nuclear power plant (FDNPP) accident in 2011, measures have been taken to address occupational health risks, such as heat illness and infectious diseases, and ensure fitness for duty with the Tokyo Electric Power Company and its contractors. However, with the decommissioning operations set to span several decades and an aging workforce, there arose a need for proactive occupational health strategies that not only addressed these risks but also promoted employee health and created a comfortable work environment. With the Japanese government's promotion of health and productivity management (HPM) for corporations, an HPM-based initiative was launched at the FDNPP in 2019., Case: We designed an HPM questionnaire tailored to the unique conditions at the FDNPP for contractors in 2019. Subsequently, we adjusted the questionnaire annually in light of evolving societal contexts and insights derived from contractors' feedback. This initiative also involved the annual recognition of outstanding contractors. These efforts have led to a steady increase in the number of contractors participating in the HPM survey, with respondents' scores continually improving. We also emphasized dissemination of HPM practices from contractors to their subcontractors due to the complex subcontracting structure at FDNPP, and our results showed that more contractors have been extending these efforts to their subcontractors., Conclusions: Our findings suggest that individual contractors are steadily enhancing their HPM efforts. We are committed to continually offering support to advance HPM throughout the FDNPP., (© The Author(s) [2024]. Published by Oxford University Press on behalf of Journal of Occupational Health.)

Background: The coronavirus disease 2019 (COVID-19) pandemic has had various impacts on businesses and workers worldwide. The spread of infection has been reported through cluster outbreaks in the workplace, and World Health Organization has emphasized workplace infection control measures. Occupational physicians (OPs) are expected to actively support employers' efforts to minimize the damage of the pandemic. However, there is little research on the role of these specialists during a pandemic. Clarification of the contributions of OPs to health and safety at the workplace in the COVID-19 pandemic would be beneficial to ensure that OPs can be effectively deployed in the next pandemic., Methods: We employed semi-structured interviews and qualitative content analysis of the interview transcripts. Twenty OPs were selected as priority candidates from among 600 OPs certificated of the JSOH, and thirteen who met the eligibility criteria agreed to participate. The online interviews were conducted in November and December 2020 with thirteen OPs. We extracted meaning units (MUs) from interview transcripts according to the research question: "What was the role of OP in the COVID-19 pandemic?" and condensed and abstracted them into codes and categorized them. Validity was confirmed by additional 5 OPs interviews., Results: A total of 503 MUs were extracted from the transcripts. These were abstracted into 10 sub-categories and two categories. Categories 1 and 2 dealt with "Role in confronting the direct effects of the pandemic" and "Role in confronting the indirect effects of the pandemic" and accounted for 434 (86.3%) and 69 (13.7%) MUs, respectively. These results were validated by another 5 interviews., Conclusion: This study identified the role of OPs in Japan in the COVID-19 pandemic. The results showed that they made a wide range of contributions to the direct and indirect effects of the pandemic. We hope our findings will help OPs during future pandemics or other long-term emergency situations., (© 2022. The Author(s).)

Objectives: This study aimed to clarify the competencies required for occupational health professionals in disaster management based on their personal experiences of workplaces damaged by the Kumamoto earthquakes., Methods: This study adopted a qualitative descriptive design using semi-structured interviews. The study participants included eight occupational health professionals who had been engaged in occupational health practice at workplaces affected by the Kumamoto earthquakes and subsequently employed at the same workplace. Data analyses were performed using a qualitative data analysis method. The researcher read transcripts of the interviews verbatim and extracted subcategories and categories, seeking points of commonality among homogeneous and heterogeneous elements while identifying content related to the competencies of the professionals during a disaster., Results: Nine categories and 29 subcategories were extracted. The following competencies were identified as skills required for occupational health professionals when a disaster occurred: "perceiving the essentials of the situation through a comprehensive understanding of the health impacts caused by disasters," "prioritizing tasks while appropriately understanding a situation that is changing over time," "starting from what one can do while ensuring one's own health and safety," "continuing occupational health practice by devising efficient approaches while flexibly responding to the situation," "creating an environment that enables each occupational health team member to fulfill their role," and "adjusting the positions of occupational health departments within organizations to utilize networks." The following competencies were identified as skills required for occupational health professionals' disaster response and preparedness: "having the essential personal qualities of occupational health professionals," "establishing relationships of trust with employees and companies," and "linking one's experience of a disaster to future occupational health practice.", Conclusions: The competencies required for occupational health professionals in disaster management are disaster response and preparedness. Moreover, these aspects in disaster response and preparedness suggest that occupational health professionals are required to have strategic and creative thinking skills including organizational approaches such as boosting networking in the workplace and establishing employer-employee relationships based on multifaceted assessment and situational flexibility.

Objectives: In Japan, the population is aging and there is a declining birth rate. It is an important occupational health issue to support the balance between illness treatment (including nursing care, childcare, etc.) and work. Many patients require mental and financial support to help them with their work-treatment balance. In 2016, the Ministry of Health, Labor and Welfare provided guidelines for supporting employee's work-treatment balance, and in 2018, "Consulting Fee" was approved as an insured medical treatment when clinic doctors supported their patients for continuing to work. The request for the consulting fee requires that the clinician and the occupational physician exchange information on the support necessary for the patient to continue working. Generally, occupational physicians obtain medical information from clinicians to give advice on a worker's employment considerations. However, we do not know what kind of workplace information clinicians hope to know when treating their patients. Therefore, we conducted this survey to clarify how occupational physicians could provide useful information to clinicians., Methods: We asked approximately 1,500 occupational physicians from the Occupational Health Subcommittee of the Japan Society for Occupational Health to provide us with a letter sent to their clinician to assist workers. From the collected letters, the structural parts of the letters (titles, greetings, acknowledgments, etc.) were removed. We defined a section as a contextual unit that does not impair the meaning. The prepared sections underwent qualitative inductive analysis using the content analysis method of "Berelson, B.", Results: A total of 103 cases and 178 documents from 42 people were included in the analysis. Extracting descriptions that could be interpreted as providing information, including descriptions related to treatment, employment, and living environment, and opinions and suggestions from occupational physicians resulted in 596 sections. As a result of the qualitative and inductive classification, the information was classified into three large categories that consisted of information provision, opinions of occupational physicians, and information handling, five middle and eighteen small classifications. In addition, some good practices that were considered significant to clinicians were illustrated., Conclusions: We analyzed and categorized the information present in the letters sent by occupational physicians to clinicians. The letter does not need to contain all the information in the category table. However, it is important that it should have the necessary and sufficient information considering the case in question. We believe that this category table will aid occupational physicians in writing letters to clinicians.

The ever-changing social implications of the COVID-19 pandemic have resulted in an urgent need to understand the working environments and health status of workers. We conducted a nationwide Internet-based health survey of Japanese workers in December 2020, in the midst the country's "third wave" of COVID-19 infection. Of 33,087 surveys collected, 6,051 were determined to have invalid responses. The 27,036 surveys included in the study were balanced in terms of geographical area, sex of participants, and type of work, according to the sampling plan. Men were more likely than women to have telecommuted, while women were more likely to have resigned since April 2020. Forty percent and 9.1% of respondents had a K6 score of 5 or higher and 13 or higher, respectively, and they did not exhibit extremely poor health. The present study describes the protocol used to conduct an Internet-based health survey of workers and a summary of its results during a period when COVID-19 was spreading rapidly in Japan. In the future, we plan to use this survey to examine the impact of COVID-19 on workers' work styles and health.

Objectives: The COVID-19 pandemic has caused interruptions to chronic disease and non-emergency treatment. The purpose of this study is to examine which socioeconomic status groups are most at risk of treatment interruption among Japanese workers., Methods: This cross-sectional internet monitor study was conducted among Japanese workers on December 22-26, 2020. Out of a total of 33 302 participants in the survey, 9510 (5392 males and 4118 females) who responded that they required regular treatment or hospital visits were included in the analysis. A multilevel logistic model nested in the prefecture of residence was used to estimate the odds ratio (OR) for treatment disruption. We examined separate multivariate models for socioeconomic factors, health factors, and lifestyle factors., Results: During a period of rapid COVID-19 infection, about 11% of Japanese workers who required regular treatment experienced interruptions to their treatment. The OR of treatment interruption associated with not being married compared with being married was 1.44 (95%CI: 1.17-1.76); manual labor work compared with desk work was 1.30 (95%CI: 1.11-1.52); loss of employment when the COVID-19 pandemic started and continued unemployment compared with being employed over the entire pandemic period was 1.62 (95%CI: 1.13-2.31) and 2.57 (95%CI: 1.63-4.07), respectively; and feeling financially unstable was 2.92 (95%CI: 2.25-3.80)., Conclusion: Treatment interruption is a new health inequality brought about by COVID-19 with possible medium- and long-term effects, including excess mortality, morbidity, and productivity loss due to increased presenteeism. Efforts are needed to reduce treatment interruptions among workers who require regular treatment., (© 2021 The Authors. Journal of Occupational Health published by John Wiley & Sons Australia, Ltd on behalf of The Japan Society for Occupational Health.)

Objective: Many companies in Japan have been increasingly interested in "health and productivity management (H&PM)." In terms of H&PM, we hypothesized that companies can enhance their employees' perceived workplace health support (PWHS) by supporting workers' lively working and healthy living. This could then improve their health-related quality of life (HRQOL) by increasing PWHS. Consequently, this study explored the relationship between PWHS and HRQOL., Methods: In December 2020, during the COVID-19 pandemic, we conducted an Internet-based nationwide health survey of Japanese workers (CORoNaWork study). A database of 27 036 participants was created. The intensity of PWHS was measured using a four-point Likert scale. We used multilevel ordered logistic regression to analyze the relationship between PWHS intensity and the four domains of the Centers for Disease Control's HRQOL-4 (self-rated health, number of poor physical health days, number of poor mental health days, and activity limitation days during the past 30 days)., Results: In the sex- and age-adjusted and multivariate models, the intensity of PWHS significantly affected self-rated health and the three domains of unhealthy days (physical, mental, and activity limitation). There was also a trend toward worse HRQOL scores as the PWHS decreased., Conclusions: We found that the higher the PWHS of Japanese workers, the higher their self-rated health and the fewer their unhealthy days. Companies need to assess workers' PWHS and HRQOL and promote H&PM. H&PM is also necessary to maintain and promote the health of workers during the COVID-19 pandemic., (© 2021 The Authors. Journal of Occupational Health published by John Wiley & Sons Australia, Ltd on behalf of The Japan Society for Occupational Health.)

Objectives: To follow up arising occupational health (OH) issues, measures taken, and their performances in the Fukushima Daiichi Nuclear Power Plant since 2014, and thus share experiences and extend the contribution of OH to long-term decommissioning work and preparation for future disasters., Methods: Necessary information from official reports and through the OH-related activities involved was collected and analyzed., Results: The issues were categorized into establishment of the OH management system, three individual issues, and others. During the 6 years until end 2019, the OH management system has been strengthened and OH measures have been enriched gradually by visualizing the broader picture, even though some resistance and problems have been encountered., Conclusions: Improvement in the autonomy of contractors and their ability to respond to environmental changes is necessary.

The results of a survey of radiation workers suggest that they are worried about the effects of radiation exposure on health, and approximately 30% of Fukushima Daiichi Nuclear Power Plant (FDNPP) workers have anxiety. This questionnaire survey reveals that the higher the frequency of radiation education, the higher the knowledge of radiation the workers will have, and that the higher the level of knowledge, the lower the anxiety. To reduce anxiety, it is important to increase knowledge about radiation through radiation education. However, even those workers who had radiation education several times still had anxiety. According to the Ordinance on the Prevention of Ionizing Radiation Hazards, the time spent on education about the effects of radiation on the human body is only about 30 minutes. This education is not enough to reduce anxiety. FDNPP workers needed more effective education to increase their knowledge and to reduce their anxiety.

Objectives: At the Fukushima Daiichi Nuclear Power Plant, run by the Tokyo Electric Power Company, new procedures were introduced as part of the fitness for duty program in July 2016. These were designed to ensure that treatment and further investigations identified as necessary during health examinations were carried out. This study aimed to assess the effectiveness of the initiative by testing whether workers who needed further health examinations obtained them promptly, and whether the number with unmet health needs decreased and the number of workers being treated increased., Methods: The primary contractors reported aggregated quarterly results of health examinations of both their own and their subcontractors' employees, and follow-up visits to medical institutions were also reported over the next two quarters. The study used data for the period from July 2016 to December 2018. Incident rate ratios were estimated using a multilevel Poisson regression model, including the logarithm of the number of workers who took health examination for each primary contractor company as offset. The linear trend was assessed by treating the number of periods as a continuous variable., Results: The incident rate ratio for workers who needed treatment having a follow-up examination promptly showed a significant decrease over time. The incident rate ratio for those with unmet needs decreased, and those being treated increased over time., Conclusions: The findings showed that the initiative was effective, with the number of early visits for further health examinations increasing and a decrease in the number of people with unmet health needs., (© 2020 The Authors. Journal of Occupational Health published by John Wiley & Sons Australia, Ltd on behalf of The Japan Society for Occupational Health.)

Background: Numerous workers have participated in recovery efforts following the accident that occurred at the Tokyo Electric Power Company (TEPCO) Fukushima Daiichi Nuclear Power Plant after the Great East Japan Earthquake. These workers, belonging to various companies, have been engaged in various tasks since the accident. Given the hazards and stress involved in these tasks and the relatively long time required to transport sick or injured workers to medical institutions, it became necessary to quickly implement a more stringent management program for fitness for duty than in ordinary work environments., Case: It took considerable time to introduce and improve a fitness-for-duty program because of several concerns. Various efforts were conducted, sometimes triggered by guidance from the Ministry of Health, Labour and Welfare (MHLW), but the implementation of the program was insufficient. In April 2016, a new program was initiated in which all primary contractors confirmed that their subcontractors had achieved five conditions for workers' fitness for duty on the basis of guidance from the MHLW and occupational health experts. TEPCO confirmed that all primary contractors had implemented the program successfully as of the end of November 2016., Conclusion: Following a disaster, even though the parties concerned understand the necessity of fitness-for-duty programs and that companies in high positions have responsibilities beyond their legal requirements, it is highly possible that they may hesitate to introduce such programs without guidance from the government. It is necessary to prepare a governmental framework and professional resources that introduce these stringent management programs quickly.

Objectives: We sought to share our experiences with occupational health efforts at a manufacturing site after a large earthquake event, and to evaluate the effectiveness of our "List of Occupational Health Needs Following Disasters" (Needs List)., Methods: We implemented occupational health efforts following the 2016 Kumamoto earthquakes in Japan, with reference to the Needs List and a related manual, and analyzed the needs that arose., Results: The instruments used enabled occupational health personnel to predict what needs would arise and facilitate their countermeasures. Among such needs that arose, 87.7% were in the Needs List, but seven undocumented needs were also observed., Conclusion: We confirmed that the Needs List could predict as many occupational health needs as we had expected at the disaster, though it is necessary to improve them by reflecting on our experiences.

Objective: 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., Methods: 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., Results: 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.", Conclusions: 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.

Objectives: In Japan, employee fitness for work is determined by annual medical examinations. It may be possible to reduce the variability in the results of work fitness determination, particularly for situation, if there is consensus among experts regarding consideration of limitation of work by means of a single parameter., Methods: Consensus building was attempted among 104 occupational physicians by employing a 3-round Delphi method. Among the medical examination parameters for which at least 50% of participants agreed in the 3rd round of the survey that the parameter would independently merit consideration for limitation of work, the values of the parameters proposed as criterion values that trigger consideration of limitation of work were sought. Parameters, along with their most frequently proposed criterion values, were defined in the study group meeting as parameters for which consensus was reached., Results: Consensus was obtained for 8 parameters: systolic blood pressure 180 mmHg (86.6%), diastolic blood pressure 110 mmHg (85.9%), postprandial plasma glucose 300 mg/dl (76.9%), fasting plasma glucose 200 mg/dl (69.1%), Cre 2.0mg/dl (67.2%), HbA1c (JDS) 10% (62.3%), ALT 200 U/l (61.6%), and Hb 8 g/l (58.5%)., Conclusions: To support physicians who give advice to employers about work-related measures based on the results of general medical examinations of employees, expert consensus information was obtained that can serve as background material for making judgements. It is expected that the use of this information will facilitate the ability to take appropriate measures after medical examination of employees.

Objective: To clarify the occupational health (OH) issues that arose, what actions were taken, and the OH performances during the disaster involving the Fukushima Daiichi Nuclear Power Plant and thus improve the OH management system with respect to long-term decommissioning work and preparation for future disasters., Methods: We used information in advisory reports to the Tokyo Electric Power Company by an OH expert group, observation through support activities, and data officially released by the Tokyo Electric Power Company., Results: Occupational health issues transitioned as work progressed and seasons changed. They were categorized into OH management system establishment, radiation exposure control, heat illness prevention, infectious disease prevention and control, and fitness for workers' duties., Conclusions: Occupational health management systems involving OH experts should be implemented to manage multiple health risks with several conflicts and trade-offs after a disaster.

Background: A nuclear accident occurred at the Fukushima Daiichi Nuclear Power Plant of Tokyo Electric Power Company (TEPCO) as a result of a mega-earthquake and tsunami in March, 2011. A large number of workers were engaged in response and recovery operations under a complex structure of involved companies. They were exposed not only to radiation but also to other health hazards. TEPCO implemented programs to prevent radiation exposure, but had no effective systems for managing the other health risks and few occupational health (OH) professionals contributed to the health risk management., Activities: The University of Occupational and Environmental Health (UOEH), Japan, dispatched physicians to a quake-proof building at the plant to provide first-aid services from mid-May, 2011, and took a strategic approach to protecting workers from existing health risks. UOEH presented recommendations on OH systems and preventive measures against heat stress to the Government and TEPCO. The Ministry of Health, Labour, and Welfare issued guidelines to TEPCO and contractors. TEPCO implemented a comprehensive program against heat stress according to the guidelines and in cooperation with UOEH. As a result, we successfully prevented severe heat illness during summer 2011., Discussion: From our experiences, we believe that the following recommendations should be considered: (1) the role of OH and the participation of experts should be defined in emergency response plans; (2) regulations should allow the national government and main companies involved to lead safety and health initiatives for all workers at disaster sites; and (3) OH professionals, response manuals and drills should be organized at a national level.

Objective: In this research, we reviewed studies about assessment of fitness for work and adjustments for health and safety at worksites overseas., Methods: We systematically searched PubMed (1980-2010) using keywords related to fitness for work. The collected studies are discussed with respect to the country, timing of medical examinations, health problems of workers, occupations, categories of health level in workers, criteria for assessment of fitness for work, and the decision-making process related to accommodations at work., Results: Seventy articles were identified that met the inclusion criteria. They focused on two key points related to assessing fitness for work: 1) safety and risk to workers themselves, to other workers and the public, and 2) ability to perform in potentially dangerous situations, such as those encountered by the military and firemen. Employers were required to provide reasonable accommodations for disabled or sick workers. The following steps were taken to make accommodation decisions: 1) analysis of job requirements; 2) worker analysis, including evaluation of work limitations or risks related to disabilities or illness; 3) choice of necessary adjustments at work, based on reasonable accommodations decided during talks between the disabled or sick workers and employers, including feasibility, effectiveness, and costs of such adjustments; 4) judgment of fitness for work based on steps 1 to 3, and opinions of specialists in various fields., Conclusion: In this investigation, we could not find any clear criteria for judgments about fitness for work or numerical criteria for adjustments at worksites after medical examinations of employees. However, we confirmed the following. Assessing fitness for work should be based on a comparison of workers' health with the risks and demands of the job. In addition, doctors should have the ability to offer opinions on adjustments at worksites. The employer's obligation to provide reasonable accommodations is attracting more attention in Japan. To make adjustments for health and safety at worksites for all workers, the procedures and important issues must be determined as well as criteria of judgments or numerical criteria. Moreover, doctors should provide opinions about adjustments at worksites. Therefore, they need more training in assessing fitness for work.

Objectives: No consistent procedure has been established for advice given by occupational physicians concerning scope of disease, criteria of diagnosis and laboratory data, and basis of judgment. The aim of this study was to identify practice-based contexts of occupational physician's advice., Methods: We interviewed 6 occupational physicians, and held focus group discussions (FGD) involving 19 occupational physicians, academic researchers, and clinical doctors. Scripts of the interview and FGD were coded to identify the contexts of occupational physician's advice. Additionally, to assure the generalizability of the proposed contexts of occupational physician's advice, we also conducted a survey to collect cases of advice, for which the fitness of the proposed contexts was confirmed., Results: Four contexts of occupational physician's advice were identified from interviews and FGD, and an additional context was detected through the occupational physician's survey, namely Type 1, work potentially affects a worker's health; Type 2, risk management and prevention of accidents relating to disease; Type 3, recommendation to visit a doctor (referral); Type 4, communication to the head of the department/supervisor; and Type 5, fit for work with appropriate adjustment of work environment and/or conditions. All 48 cases collected could be classified into one or more of these five contexts., Discussion: This study clarified that several contexts exist for occupational physician's advice in practice. The five proposed contexts reveal different responsibilities and judgments between occupational physician, worker, and employer. Understanding the contexts of occupational physician's advice is important for enhancing consensus-building between stakeholders.