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效度，我们进行了以下调查。肝功能检测效度：三千名40岁男性工作人员。对年龄较大的人进行调查，以评估强制性年度肝功能检查的有效性。分别用HBs抗原、丙型肝炎病毒抗体、腹部超声和饮酒详细访谈结果诊断乙肝、丙型肝炎、脂肪肝和酗酒。结果：AST、ALT、GTP异常值提示靶条件具有较高的特异性，但无一项检测达到50%的敏感性水平。这些测试发现只有不到一半的工人患有这些异常情况。尿糖检测时机：我们对工业医生进行了尿糖检测作为糖尿病筛查时机的问卷调查。在107名接受调查的工业医生中，58%的人在考生禁食时采集尿样，只有3%的人在饭后采集尿样。在另一项对455名男性葡萄糖耐量测试者进行的研究中，禁食时采集的尿样显示，检测糖尿病的敏感性仅为10%。这一结果表明，在10例糖尿病患者中，仅有1例在禁食时采集尿液标本进行检测。AAI：动脉粥样硬化是日本劳动人口中最常见的疾病。为了开发更有效的动脉粥样硬化筛查试验，我们检查了446名男性工人的踝臂指数，以确定其有效性和最合适的临界值。结果发现，眼底镜诊断动脉粥样硬化的最佳临界值为1.0，在此水平下，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，我们提出了改进现行定期健康体检的几点建议。

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.