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：3000名40岁的男性工人。或更老的人进行了调查，以评估强制性年度肝功能检查的有效性。乙肝表面抗原，丙肝抗体，腹部超声，和详细的采访酒精摄入量的结果被用于诊断测试的HBV和HCV感染，脂肪肝和过量饮酒，分别。结果，AST、ALT和γ-GTP的异常值指示具有高特异性的目标条件，但没有测试达到50%的灵敏度水平。这些测试发现只有不到一半的工人发现这些异常情况。尿糖检查的时间：我们通过问卷调查了工业医生，了解尿糖检查作为糖尿病筛查的时间。在107位工业医师中，58%的人在空腹时采集尿液样本，只有3%的人在餐后采集。在一项对455名男性葡萄糖耐量试验受试者的单独研究中，空腹时采集的尿液样本显示检测糖尿病的灵敏度仅为10%。这一结果表明，只有1/10的糖尿病患者空腹时采集的尿液样本被检出. AAI：动脉粥样硬化是日本劳动人口中最普遍的疾病。为开发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检查，以确定其有效性和最佳临界值。结果发现，最佳临界值为1.0，在此水平下，眼底镜检查诊断动脉粥样硬化的敏感性和特异性均为80%左右.结论：根据上述研究结果，我们提出了一些建议，以改善目前的定期健康检查。

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.