Objectives To predict the prognosis by lung collapse rate of spontaneous pneumothorax detected during health checkups. Design A cross-sectional study. Setting and Participants Subjects consisted of 30 pneumothorax cases among a total of 837,979 people consulting our institute for health screening over a five-year period. Measurement and Results Lung collapse rates were 1.9% to 19.2% for 30 pneumothorax cases. There was no significant difference between the mild group and moderate group in the men/women ratio, laterality, Brinkman index, respiratory symptom. However, the BMI of the moderate group was significantly lower than that of the mild group (p=0.004). The rate of “treatment required” in the moderate group was significantly higher than that in the mild group (p=0.001). There were no “treatment required” cases in the mild group. Minimum degree of lung collapse requiring treatment was 13.4%. Conclusions It was found in this study that none of the cases need treatment of pneumothorax with a lung collapse rate less than 10%. However, considering the characteristics of pneumothorax as a disease, it seems difficult to reduce the judgment from “treatment required” to “observation” even when the lung collapse rate is less than 10%. Instead, we consider that the judgment “reexamination required” should be given to “mild pneumothorax”.
Purpose Since most of chronic liver diseases progress with no symptoms, health check-up plays an important role as triggers for further examinations and treatments. Here, we studied the proportion of liver dysfunction among patients receiving health check-up, and investigated the causes. Method The study targeted 42,003 subjects who underwent health check-up at the PL Tokyo Health Care Center between April 2007 and March 2008. We selected subjects showing liver dysfunctions with readings of GPT40-79 IU/ml and 80IU/l or more, divided by gender and age specific group in every 10-year intervals. We then took those with positive serum HBs antigen and HCV antibody as HBV (+) and HCV (+), those who drank more than 40 g of ethanol per day at least six days a week as alcohol consumption (+), and those who satisfied diagnostic criteria for fatty liver under the abdominal ultrasound examination as fatty liver (+), and analyzed the proportions of each. Results GPT40-79 IU/l liver dysfunction were found in 13.1% of males and 2.5% of females, and GPT80 IU/l or more in 2.3% of males and 0.4% of females, both showing higher levels in males. In the analysis by age, males with liver dysfunction ended to be most numerous in their 30s with 22.5% but gradually decreased with age, while females tended to gradually increase with age, peaking at 7.8% in their 70s. The most common cause of liver dysfunction was fatty liver in both men and women, this accounting for liver dysfunction in 13.0% of male cases and 17.6% of females. The next most common for males was alcohol consumption with 10.4%, while for women it was HCV (+) with 6.0%. NAFLD was 1.7% in males and 2.3% in females. Cases thought to be non-alcoholic steatohepatitis (NASH) combined with liver dysfunction were found in 0.4% of males and 0.5% females. Conclusions Liver dysfunction were found in about 15% of males and 3% of females undergoing health checkups, the most common cause being fatty liver. NAFLD, a subject of some attention in recent years, was seen in about 2% of the whole group. A quarter of those were thought to be NASH accompanied by liver dysfunction.
Recently, deaths due to Chronic Obstructive Pulmonary Disease (COPD) have been increasing slightly in Japan. Pulmonary function test is indispensable for establishing a diagnosis of COPD. At present, however, pulmonary function test has been added to only several percent of health checkups. Since most of those demonstrating COPD are smokers, countermeasures against smoking are important. We investigated the effectiveness of interventions to promote smoking cessation within the short time available. Subjects were 382 smokers (199 intervention group and 183 control group) who worked for three different manufacturing companies in Okayama prefecture. On the day of health checkup, physicians provided simple guidance on smoking cessation for approximately 1-2 minutes based on the degree of readiness for smoking cessation for each individual in the intervention group. The adjusted odds ratios of point prevalence abstinence rate by multiple logistic regression analysis were 1.56, 1.51 at the six months and one year follow-up, and 3.41, 3.17 among smokers who were planning to quit smoking within the next six months. There were no significant differences due to small sample size, but these results would suggest the effects of brief intervention by physician at health checkup. To increase the effect of brief intervention for smoking cessation at health checkup, it is necessary to increase accessibility smoking cessation treatment by increasing the number of registered medical facilities that provide reimbursed treatment by public health insurance. We also consider that it is necessary to enlighten smokers on the necessity of smoking cessation treatment including the usefulness of medication. It is also necessary to perform pulmonary function tests routinely as one of health checkup items for the diagnosis of COPD. In addition, it is important to provide smoking cessation intervention even for a short time at health checkup for prevention of COPD.
In Japan, the breast cancer screening for women aged 30 and older was started in 1987. However, in spite of an introduction of mammography in 2000, the participants have been still a few. The screening system for workers has not been established, that is, the subject and the modality have been variable yet. In our institute, there were also same problems. Therefore, in order to provide better screening for many more women, we started up the project for promoting breast cancer screening, Happy Mamma, in April 2008. Then, we found out the problems of breast cancer screening, and we discussed for improving them. In a charity event, which was a part of the promotion activity, we got a lot of opinions from the participants, and we obtained new problems. We must do more efforts to solve the problems.