We investigated long-term changes in physical examination outcomes and abnormal blood test values (including for the present illness) in workers aged 30-50 years who were engaged in construction work or in construction-related business. These workers underwent medical checkups in 1993 and 2008 with the aim to prevent lifestyle-related diseases; they were categorized by gender and age, and their medical checkup outcomes were compared. In males, the values of body mass index (BMI), blood pressure, serum total cholesterol (TC), and serum uric acid for all age groups and the fasting blood glucose values in their 50s were significantly higher in 2008 than in 1993, while the triglyceride (TG) values for all age groups were significantly lower. There were significant increases in the rates of obesity for workers in their 40s and 50s, of hypertension and hyperuricemia for all age groups, of hypercholesteremia in their 30s and 40s, and of hyperglycemia in their 50s. In addition, the incidence of hypertriglyceridemia decreased for all age groups. In females, the BMI value in 2008 was significantly lower and the percentage of lean workers increased for all age groups as compared with those in 1993. There was no significant change in the incidence of hypertension. The TC values were significantly higher in females in their 40s and 50s, while the TG values were significantly lower for all age groups. The rate of hypercholesterolemia significantly increased for all age groups, but hypertriglyceridemia significantly decreased in females in their 40s and 50s. There was no change in the values of fasting blood glucose and in the rate of hyperglycemia, hyperuricemia, and fatty liver disease. These results showed that during past 15 years, the blood test values became significantly higher and the rate of workers with lifestyle-related diseases increased significantly in males, whereas little changes were observed in females.
The purpose of this study was to investigate the effects of cigarette smoking on brachial ankle pulse wave velocity (baPWV) in young male and female subjects. Hypertensive and obese subjects were excluded. Twenty one male subjects were divided into 9 smokers and 12 nonsmokers. Twenty two female subjects were divided into 10 smokers and 13 nonsmokers. The mean cumulative nicotine consumption of male and female smokers were 8.1±3.4 pack/years and 4.1±2.4pack/years, respectively. Nutrient intake between smokers and nonsmokers in male and female subjects were not significantly different. In male subjects, mean baPWV was significantly higher in smokers than in nonsmokers. In female subjects, such difference was not observed. The results of this study suggest that cigarette smoking can accelerate arterial stiffness degree in young male smokers.
In the first half of my speech, I placed the governmental policies on health care system among the following four strata: (1) the relationship between each served user (e.g. patient) and health care professionals, (2) the system of providing and utilizing public health, medical care, and long-term nursing care services, (3) the governmental policies on health care, on social security system, and on the reimbursement fee schedules from the public insurance schemes to service providers, and (4) politics over the former three aspects of health care. Then the notion of vision, mission, value, core concept, and core technology was presented as the important elements of a policy strategy. In the latter half of my speech, I applied these five elements to the actual health care policies. They were: (1) the Japanese public long-term nursing insurance scheme enforced in 2000, (2) the comprehensive regional care system being constructed in Japan aiming for the year 2025, (3) the disease management programs expanded in the U.S.A. in 1990's, and (4) the specific medical examination and guidance adapted by the Japanese Government in 2008.
It is well known for superoxide anion, hydroxyl peroxide, nitric oxide and peroxynitrite to be the free radicals. To protect the living body from the oxidative stress with the free radicals production, we have the various reduction functions. It is called the Redox control. The NO was discovered as a gaseous mediator for the dilation of vascular smooth muscle produced by vascular endothelial cells. As the nitric oxide was discovered from vascular endothelial cells at first, it was thought that the mediator was only concerned to regulate the circulation. However, the NO does not only function as neurotransmitter either, and it is known that NO produced with inflammatory reaction is associated with biophylaxis. On the other hand, the produced NO is converted into extremely potent reactive ONOO- in presence of O2- produced at the same time in site of inflammation non-enzymatically and these induce nitration with the oxidation of the surrounding tissue and cause tissue injury. The large amounts of inflammatory mediators are released from the surrounding region of thermal injury by thermal stimulation, and then the various kinds of reactive molecular species are also produced in the same region. These inflammatory factors and free radicals cause a systemic inflammatory response syndrome (SIRS) by affecting to normal tissues and organs. The author reported that the inhibition of NO production at acute inflammatory phase (0.5~3.0 hours after thermal injury) caused by invasive stimulation of heat induced the potent anti-inflammatory effect. Especially, NO did not affect the inflammatory reaction, but ONOO- which reacted non-enzymatically under the presence of O2- induced tissue damage by nitrating a surrounding tissue. In other words, it means that the nonenzymatic responses between active molecular species are fraught with the risk of the tissue damage as far as we breathe. The redox control failure may affect acceleration of aging and the induction of the disease.
Anti-aging medicine is a field of preventive medicine focusing on health promotion and the achievement of long and healthy life. The main objectives of anti-aging medical treatments are to prevent aging and promote rejuvenation in terms of functional age including the muscle age, blood vessel age, neurological age, hormone age, and bone age, which can be evaluated by anti-aging medical checkup. Functional change is influenced by physical, mental, oxidative, and glycation stresses associated with lifestyles. Glycation stress is as a factor linked with age related diseases and functional and structural alterations of the body. Glycation stress is a representative risk factor of aging as well as oxidative stress. Glycation occurs when reducing sugars, such as glucose and fructose, combine with lysine or arginine residues of protein in a non-enzymatic reaction forming a glycated protein. Further reactions form advanced glycation end products (AGEs), which may accumulate in tissue, and bind to specific receptors, called RAGE (receptor for AGEs), thus inducing inflammatory changes in various parts of the body. In adipocytes, another pathway for post-translational modification is generated by reaction of fumaric acid, a Krebs cycle intermediate, with cysteine residues of various proteins. For example, collagen modified by AGEs, forming cross-linkage between fibers, is less elastic leading to skin sclerosis. Low-density lipoprotein cholesterol modified by AGEs, engulfed by macrophages, causes atherome formation in the blood vessels. To maintain youth and health, it is important to manage these risk factors. Glycation stress may be reduced (1) by appropriate management of plasma glucose and insulin secretion, (2) by avoiding high fructose ingredients, (3) by maintaining muscle mass and endocrinological function which may reduce with aging and (4) by intake of anti-glycation materials such as AGEs generation inhibitors. We hope this scientific field will develop further treatments in anti-aging medicine.
Atherosclerosis and osteoporosis are important factors for quality of life in the elderly people. Homocysteine is reported to accelerate atherosclerotic change in vessel and to have adverse affects on extracellular bone matrix by disturbing collagen cross-linking, leading to osteoporosis. High level of serum homocysteine was found in male cases who did not meet the Japanese criteria for metabolic syndrome, but have hypertension. In addition, level of serum homocysteine was higher in female cases in reduced bone mineral density with disturbed metabolism of serum LDL-cholesterol and/ or plasma glucose. These results suggested that measurement of serum homocysteine is necessary to predict health promotion, as homocysteine plays a significant role in the association between atherosclerosis and osteoporosis.
Novel imaging techniques to detect the arteriosclerosis have been reviewed. Some of those imaging techniques were used for medical health examinations. In this article, we will review the ultrasound carotid artery method as well as recently highlighted CT and MR plaque imaging. Carotid ultrasound screening is a non-invasive imaging method used to measure the thickness of the wall of carotid arteries and the presence or absence of atherosclerotic plaque. To assess the screening performance of carotid artery intima-media thickness and carotid plaque in the identification of individuals who have been vising our health care section. We analyzed the relationship between IMT and risk factors of arteriosclerosis. We found a good correlation of age and sex to IMT using logistic regression analysis. In meta-analysis, neither carotid plaque nor IMT has a CHD screening performance that is sufficiently discriminatory between affected and unaffected individuals. MR imaging has excellent soft tissue contrast and can allow for a more accurate and objective estimation of carotid wall morphology and plaque composition. Recent work has shown a correlation between clinical symptoms and features of vulnerable plaque, raising the possibility that MRI of the carotid arteries may have a potential clinical role in the management of symptomatic carotid artery disease. Calcium is the plaque characteristic most readily identified by CT. Even if recent technical advances to reduce the effective radiation dose, the optimal investigative use of serial CT plaque imaging in the clinical arena remains to be clarified. FDG-PET demonstrates impressive repeatability for quantification of plaque uptake in the carotid and aorta. Many of the features associated with a high-risk plaque can now be probed by novel imaging techniques. Each technique has its own strengths and drawbacks. We need to clarify the various imaging modalities used for the evaluation and quantification of atherosclerosis in medical health examinations.
Japan's universal health insurance coverage is now threatened by rising medical cost. In 2008, so-called specific health examination was induced with the hope of preventing ischemic heart diseases, strokes, and diabetes, along with the new public medical insurance system for the elderly people aged 75 and over. Health examination policy in Japan originated from the tuberculosis control program and nowadays some health insurance societies voluntarily offer comprehensive medical examination for their members. Besides, nationwide health promotion movement was first launched in 1978 and currently promoted as Health Japan 21 programs. Occupational health service in Japan was also initiated aiming to combat tuberculosis and, in 1938, factory owners were legally obligated to implement screening of their work forces. Industrial Safety and Health Law promulgated in 1972 started to require employers to perform both periodic measurement of working environment and general health examination of all workers. The law has been repeatedly amended to strengthen the health surveillance function on work-related disease. So-called total health promotion plan (THP) for workers has also been promoted since 1989. In 2008, the list of clinical test items for specific health examination and those for general health examination were unified and employers are asked to report the results of health examination to health insurance societies. This employers' obligation on handing health information of their workers is peculiar to Japan. To enhance affiliation between employers and health insurance societies, Japanese government should financially aid small enterprise, pursue unification of the resource and the information on health examination, evaluate and disclose the effectiveness of the specific health examination to prevent lifestyle-related diseases, activate alliance councils of local community and workplace, and plan to reduce the dual burdens of health professionals on-site. This new policy is expected to enable occupational health professionals to focus on their essential function at workplace.
Fundamental concept of quality assurance in specific health checkup and specific health guidance is that same examination results should be obtained regardless of time or laboratories. For this purpose, standardization of examination items and quality assurance in measurement are indispensable. As for standardization, standard materials of all parameters in specific health checkup had been developed before specific health checkup has started, traceability has been taken using these material. Moreover, sharing of test results between laboratories in some area or related hospitals is also being attained. About quality control, many institutions participate in external quality control surveys held by Japan Medical Association etc. and the records of them are quite good. However, it is said that cribbing serves as a background with such excellent results of these surveys, some improvements in operation methods of them are expected in future. The most important thing, however, is reconfirmation of original meaning of an external quality control survey, we must enlighten it. Furthermore, in order to obtain exact test results in specific health checkup, not only quality management of measurement itself, but quality management from before collecting samples to after measurement is required, therefore procedures before taking medical checkup or pre-analytical procedures after sample collection are directed in specific medical checkup. In plasma glucose measurement, sodium fluoride (NaF) has been used as an glycolytic inhibitor, however, the inhibition effect of NaF alone is not sufficiently immediate, the blood sample for glucose measurement is to be refrigerated in specific medical checkup. In these days, the blood container including citric acid with NaF, which quickly suppress glycolysis, has been spreading, and other inhibitors of glycolysis are being investigated also, these blood collection tubes (glycolytic inhibitor) will be considered to be used more widely from now on. The reconsideration of items included in specific health checkup, urine glucose is raised as reevaluation of its necessity. If we don't take expense into consideration, I think urine microalbumin and serum cystatin C are candidates as new items from the cardio-renal correlation.
Health guidance is to correspond to health problems of the insured individuals. However, eligibles for Healthcare Advice with Particular Focus on the Metabolic Syndrome are limited to those with metabolic problems. Its advice items are defined with a central focus on exercise and dietary instructions, and sleep is rather viewed as less important. In many cases, the healthcare advices often entirely focus on metabolism even to the mentally disordered, without precious opportunities of the health guidance being well-utilized. Those cases are assumed as the adverse effects for public institutions to avoid from adding more assistance grant funding to Medical Care System for People Aged 75 and over. At the same time, in order to evaluate the healthcare advice program, we need to evaluate satisfaction and attainment levels of those who had the healthcare advices. And, we do also need to evaluate the annual transitions of the morbidity and the rate of abnormal values of lifestyle related diseases, not only by confining the target to the metabolic-syndrome related or the potentials, but by setting it to the entire group members. For the next approach, we need to implement and deploy Health Checkups and Healthcare Advice with a Particular Focus on the Metabolic Syndrome into the traditional health management operation. The effective and efficient approach for this purpose would be highly expected.
Objectives To analyze the current state of time load of customers who consult medical institutes and to clarify problem that should be improved as one of approaches that improve customer’s satisfaction. Materials and Methods A total of 14,588 people, consulting our institute for health screening between May 2011 and September 2011, were enrolled in this study. We analyzed total examination time, total waiting time, and sojourn time from check-in to the end of all examinations. In 2009, we did not manage time as a whole, and we guided customers according to their transit order on health checkup system. In 2010, each examination section thoroughly managed each individual time, and we looked at the next examination guide on the health checkup system that displayed the number of waiting customers, and then we had the customer sent to the examination section with little number of waiting customers by priority. Furthermore, in 2011, we developed the tool and visualized the time burden. Results When 2010 is compared with 2009, the average sojourn time was shortened by 14 minutes and 40 seconds. When 2011 is compared with 2010, 477 customers increased in number, but there was no change with big the average sojourn time. Furthermore, when 2011 were compared with 2009, 1,263 customers increased in number, but the average sojourn time was shortened by 14 minutes and 17 seconds. We developed the tool, in order to visualize time, and we were successful about mitigation of the time burden. Discussions We consider that the sojourn time was shortened by every operator’s consciousness to time load for customers and then the waiting time was decreased. However, it is a problem that their lines of flow become longer and their loads rather increase by sending customers to the vacant examination booth. In addition, if we considered only even an individual level of management of the examination time, our hospitality might decrease and it will be easy for the mistake to happen. In conclusion, we consider that it is a pressing need for us to maintain the environment of our hospitality and lines of flow for customers.
In Japan, the number of suicides has exceeded 30,000 per year for the past 14 years. Among the victims, two-thirds of them were of working-age, 50% suffered from health problems, and 90% of those suffered from depression. Therefore, it seems that one measure of suicide is the mental health metric of depression among the working-aged. From this background in December 2011, The Ministry of Health, Labor, and Welfare decided to introduce stress checks into mental health examinations. The proposed stress checks include nine items, divided into three categories: anxiety, fatigue, and depression. Given the sensitivity of the data, results are only provided to the employee. For companies that are without in-house medical professionals, if an employee receives the result of a high stress level, s/he may request a physician's diagnosis. Then, if the physician diagnoses the workplace as a contributing factor, the employer will be advised. For companies that employ a public health nurse or a physician, stress checks will be performed by that professional, and based on the individual's results, they will prescribe a course of action, such as a health interview or clinical introduction. They will also be charged with notifying and advising their employer company of problems. The proposal reflects two fundamental policy positions: 1. the systematic, proactive improvement in workplace quality of health. 2. the increased reliance on and cooperation public health nurses and physicians.
Japan is now among the countries with the longest life expectancy in the world. Among the factors that have helped Japanese people to live longer is a healthcare system covering the medical needs of all people. This system is also highly regarded abroad1). However, there are a number of health problems in Japan today. Briefly, lifestyle-related diseases are increasing as the society ages rapidly, the associated nursing care poses problems, social security is threatened by worsening economics, and, as people worry about their health, mental diseases are increasing. At workplaces, older and female workers are increasing. In 2010, while women accounted for 42.0% of all employees2), a large percentage of female workers were non-regular employees, who suffered many disadvantages in the status and conditions of employment. All employers are obligated to provide health check-ups once yearly to all of their employees under the Industrial Safety and Health Act, but diseases specific to women are not among the objects of health check-ups. In fact, men and women differ greatly in the structure of diseases. While gynecologic and breast diseases are major problems for working women, the consultation rate for women is low in Japan, which greatly interferes with the early detection and prevention of these female diseases. Health check-ups for women usually mean examinations for gynecologic and breast diseases, but broadly they include examinations for urologic diseases, climacteric disturbance, osteoporosis, and mental health measures. For women, these diseases are a source of great anxiety, and should be examined under a special health check-up system tailored to women. There is a recent trend for more and more business enterprises and municipalities to establish a women's health check-up system, which is extremely popular among working women. This women's health check-up system is characterized by a large proportion of women with positive findings. In the present center, the percentage of examinees in their latter 40's with clinically significant findings was 50.9% for the gynecologic examination, and 24.5% for the breast examination (2010-2011 statistics)3). Though the majority required only observation of the course, it is important to present health check-up results with good instructions and counseling. As more and more women take up jobs outside the home, we would like to build an effective and efficient health check-up system encompassing successive life stages. For this purpose, it is essential that medical institutions be organized to cope with female medical check-ups along with general health check-ups. Health check-ups in future will be required not only to assess health at the time of the examination itself, but also as a total support for life and work including mental health.