A study on the validity of the workplace health examinations and proposals for the reform

为了评估工作场所健康检查的有效性，我们进行了以下调查。肝功能检查的有效性：我们调查了3000名40岁以上的男性工人，以评估强制性年度肝功能检查的有效性。采用HBs抗原检测结果、HCV抗体检测结果、腹部超声检查结果和详细的酒精摄入量访谈，分别对HBV和HCV感染、脂肪肝和过量饮酒进行诊断试验。结果表明，AST、ALT和γ - gtp的异常值提示靶状态，特异性高，但均未达到50%的敏感性水平。人们发现，这些测试只能检测出不到一半的工人有这些异常状况。尿糖试验的时机：我们对工业医生进行问卷调查，了解尿糖试验作为糖尿病筛查的时机。在107名受访的行业医生中，58%的人在考生空腹时采集尿样，只有3%的人在餐后采集尿样。在另一项对455名男性葡萄糖耐量试验受试者的研究中，空腹时收集的尿样对糖尿病的敏感度仅为10%。这一结果表明，在10例糖尿病患者中，只有1例在空腹时尿液中检测到糖尿病。AAI：动脉粥样硬化是日本工作人群中最普遍的疾病。为了建立更有效的动脉粥样硬化筛查方法，我们对446名男性工人进行了踝臂指数的有效性和最合适的截止水平的检查。结果发现，最佳临界值为1.0，在此临界值下，眼底镜诊断动脉粥样硬化的敏感性和特异性均在80%左右。结论：根据以上研究结果，我们提出了几点改进现行定期体检的建议。

In order to evaluate the validity of the workplace health examinations, we performed the following investigations.1. Validity of liver function tests : Three thousand male workers aged 40 y.o. or older were investigated to evaluate the validity of mandatory annual liver function tests. Results of HBs antigen, HCV antibody, abdominal ultrasound, and a detailed interview on alcohol intake were used for the diagnostic tests for HBV and HCV infection, fatty liver and excessive drinking, respectively. As a result, abnormal value of AST, ALT and gamma-GTP indicated target conditions with high specificities but non of the tests reached the sensitivity level of 50%. These tests were found to detect only less than half of the workers with these abnormal conditions.2. Timing of urine glucose test : We surveyed industrial physicians by a questionnaire for the timing of urine glucose test as a screening for diabetes. Of the 107 responded industrial physicians, 58% collected urine sample when the examinee were fasting and only 3% collected after meal. In a separate study in 455 male glucose tolerance test examinee, urine sample collected at fasting showed sensitivity of only 10% to detect diabetes. This results indicate that only one out of 10 patients with diabetes were detected by urine sample collected at fasting.3. AAI : Atherosclerosis is the most prevalent ailment among the working population in Japan. To develop more valid screening test for atherosclerosis, we examined 446 male workers for the ankle-arm index for its validity and most appropriate cutoff level. As a result, the best cutoff level was found to be 1.0 and with that level both sensitivity and specificity were about 80% to detect atherosclerosis diagnosed by fundoscopy.4. Conclusion : Suggested by the results of above studies, we made several proposals to improve current regular health examinations.