Improvement measures in relation to the functional assessment of superior facilities are being implemented in Japan's general health checkup system for the further promotion of the safety and comfort levels among community residents. These measures include promoting the innovation of effective diagnostic techniques for early detection and treatment of lifestyle-related diseases and enhancing primary prevention for health promotion and healthcare support. Efforts are being made toward achievement of these objectives. In the present study, by conducting a cluster analysis, we aimed to elucidate mutual relationships between functional assessment items related to the diagnostic ratio of “no abnormalities” among individuals undergoing general health checkups. We also aimed to obtain an overview of similarities among health checkup facilities by dividing Japan into seven regions. In order to achieve these objectives, we analyzed and published in our society's journal the nationwide results collected for facilities in fiscal year 2010. The data were composed of complex confounding factors; therefore, it was analyzed using self-organizing maps (SOM). No sex differences were observed in the ratios of facilities where a judgment of “no abnormalities” was made, but the following differences were found among the seven regions: similar relationships in functional assessment items related to regional characteristics were observed between “Kanto” and “Tokyo”, “Tokai/Koshinetsu” and “Chugoku/Shikoku”, and “Hokkaido/Tohoku” and “Kyushu/Okinawa”. According to component map analysis of SOM, the ratio of individuals judged as having “no abnormalities” on health checkups was the highest in the “Kinki” region, somewhat high in “Tokai/Koshinetsu”, and the lowest in “Hokkaido/Tohoku”. Functional assessment items that were closely related to the ratio of “no abnormalities” included the following: facilities having test equipment for helical computed tomography (CT), magnetic resonance imaging (MRI), and mammography; facilities with a large number of specialists; facilities with an independent floor for health checkups; facilities implementing smoking cessation measures; facilities at which physicians explain the results of health checkups; facilities conducting a small number of health checkups; facilities that provide lifestyle guidance and support or follow-up; facilities that do not have a large number of office personnel; facilities providing special health checkups and health guidance; facilities that do not conduct examinations more advanced than regular health checkups, such as Tokutei-Kenshin (Specific Health Examinations); and facilities at which the rate of instructions to undergo detailed examination in the general judgment was <30%. The above findings suggest that conducting a large number of health checkups and having a large number of staff do not necessarily indicate a high level of quality, and reaffirm that assessment of the level of the contents of health checkup services at each facility is a more important issue. In other words, these findings indicate that health checkup facilities have internal issues they must actively address in order to improve each item in functional assessment.
Chronic kidney disease (CKD) has attracted attention as a condition that can progress to end-stage kidney disease, one that can serve as a risk factor for the development of cardiovascular diseases or even death. We conducted a cross-sectional study among recipients of multiphasic health testing and services to determine the levels of awareness about CKD, the self-reported salt intake levels, the urinary salt excretion levels, and a suitable method to evaluate the estimated glomerular filtration rate (eGFR) as a reliable screening method for CKD. One-hundred seven men and women (age: 49.6±11.4) who received multiphasic health testing and services between October 2010 and August 2011 who were free from diseases requiring treatment or chronic diseases under follow-up observation at the time of enrollment were enrolled as the subjects. In addition to the ordinary health testing items, a self-reporting questionnaire for CKD was prepared for this study, and the questionnaires were recovered on the day of the health testing and service. Serum cystatin C, spot urinary sodium concentration, spot urinary albumin concentration and spot urinary creatinine concentration were measured in addition to the routine testing, and the spot urine sodium chloride (NaCl) excretion and eGFR were calculated by estimation equations Of the surveyed subjects, 56.1% were not aware about CKD. The urinary NaCl excretion (7.8±2.0g/day) was in the range of 3.3 to 12.0g/day. There was no correlation between the urinary NaCl excretion and the self-reported levels of salt intake; the salt intake was high in those who reported that their dietary intake was high (p=0.02). A positive correlation was observed (r=0.576, p<0.0001) between the eGFR (eGFRcreat) values calculated using creatinine and those calculated using cystatin C (eGFRcys). The eGFR was less than 60mL/min/1.73m2 in 5 cases and 1 case, respectively, when the eGFRcreat and eGFRcys were used for the estimation. There was no relation between the urinary albumin excretion and the eGFR. As the level of awareness about CKD among recipients of multiphasic health testing and services was low, an improvement of the awareness through health testing and services is required. The discrepancy between the self-reported level of salt intake and the urinary NaCl excretion suggested that the validity of evaluation of the salt intake by diagnostic interview examination was low. Use of eGFRcreat for CKD screening may be associated with a reduced risk of overlooking CKD.
Recently, an increase in the incidence of uterine cervical cancer, especially in women in their 20-30's, has become a major social problem. It is expected that uterine cervical cancer can be prevented and eradicated. The authors gave a lecture about uterine cancer to female junior college students, and explained the need for procedures such as Pap smears, vaccines, and inoculations to prevent such cancer. The authors also used psychological tests to investigate the students' conscious changes for prevention before and after the lecture. As a result, although the student's initial knowledge about uterine cancer was low, the number of students wanting to receive cancer screening tests was high. However, it was found that those who do not know much about the contents of the uterine cancer screening tests including Pap smears are liable to have some reservations about uterine cancer screening tests. It was also found that awareness of a vaccine for the prevention of uterine cervical cancer was low among the students. If a cancer screening test rate can be improved by education, it will lead to the early detection of uterine cervical cancer and to inoculation with the vaccine for the prevention of cervical cancer.
Headache is one of the most common symptoms encountered in routine medical practice and brain checkups. In Japan, more than 30 million people are suffering from chronic headache, which may affect quality of life and can also have social negative influences due to decreasing productivity. Although simplistic treatment that involved taking painkillers for headache was customary in the past, many advances have been made including the development of drugs effective against migraine, the establishment of prophylactic therapies. Conducting this type of tailor-made treatment in accordance with each patient is expected to improve chronic headache. However, treatment up until now placed too much focus on distinguishing primary headache from secondary headache, which are directly related to vital prognosis and aftereffects. Primary headache, which require time and effort for correct diagnosis as they mainly, involve medical interviews, tended to be disregarded. Thus, despite experiencing headache that caused a high degree of impairment to their daily lives, many chronic headache sufferers were not receiving adequate care at medical facilities. However, with the aim of improving the level of treatment, the Japanese Headache Society established a specialist system since 2005 and, in the medical care guidelines for chronic headache published in 2006. While our hospital has a role as a major center for neuronal disease in the Tohoku region, 30-40% of patients visit to our hospital complaining of headaches. Until 2009, headache patients were seen by non-specialists, but since 2010 it conducted by a specialist had been established. Setting up this system has caused great change to be observed in headache treatment and particularly in the treatment of migraine, which are considered severe. This report outlines changes in headache treatment brought about by intervention with specialists and investigates what constitutes better treatment.
Improving the teaching skills of instructors and improving participation rates in health screening are key for the success of health promotion. The common issue of these two is raising the value of being healthy and maintaining the motivation for self care. To achieve it, it is necessary, in particular, to provide information that relates to the mental and economic merits of participating in health screening so that individuals can understand the significance and necessity of health screening. Meanwhile, it is urgent to have employers recognize the managerial merits of improved health of their employees and construct a system to maintain their health. With regard to improving the teaching skills of instructors on health guidance, maintaining the motivation of self care by individuals is indispensable. It was found that 68% of those who underwent health guidance failed to live a healthy lifestyle and the proportion of those who lost body weight six months after the health guidance was markedly low. Therefore, it is necessary to evaluate whether or not individuals have the intention to improve their lifestyle and keep them motivated accordingly. Meanwhile, nutritional assessment is also necessary for health guidance. This is a teaching method that is indispensable for prevention of complications and subsequently prolongation of healthy life expectancy.
Diseases due to obesity and lifestyle, including diabetes mellitus type 2, liver function abnormalities caused by fatty liver and hypercholesteronemia, are increasing in Japanese children. In addition, under-weight children are also increased. These are considered to be caused by unhealthy dietary habits, such as skip of breakfast, picky eating, overeating and excessive diet. These habits are formed in childhood and are continuing to adulthood. In order to prevent these lifestyle-related diseases, dietary education is necessary since childhood. The basic law on Nutritional Education in 2005 defines “dietary education” as “helping people acquire the knowledge on the food and the capacity to select appropriate foods so that they are implementing healthy dietary habits”. At the medical check-up of children, obesity and underweight children should be checked up, and then dietary education should be approved to these children, In addition, physicians and school teachers are requested to provide children' parents and guardians with medical knowledge concerning “health/disease and nutrition”.