Objectives: People who get periodical medical check-ups are categorized with the results of their follow-up medical examinations from the previous year. Physicians in health care centers usually ask their patients whether or not they had visited a hospital or clinic for a required follow-up medical examination in the previous year. Sometimes, the people's statements are not in agreement with their actual examination results. Therefore, we asked people who had annual medical check-ups whether or not they had a follow-up examination in the previous year and, if so, what the diagnosis was. We compared the diagnosis they stated with the actual findings from their clinical records. Subjects and Methods: The subjects were 505 people who were categorized as being required to have a follow-up examination following medical check-ups. They answered questionnaires that asked whether or not they had a follow-up examination and, if they did, what their diagnosis was. The association between having a follow-up examination and gender, age, getting a health guidance from a doctor, and a letter of introduction from a physician were evaluated. We selected 36 people who had received a letter of introduction for a follow-up examination, and compared the people's statements regarding their diagnoses with the actual results from their clinical records. Results: There were 460 people (80.4%) who visited hospitals or clinics for their follow-up examinations. Among the factors, only the letter of introduction was associated with those visits for the follow-up examinations. Of 36, 5 people thought their status less serious than the actual results. Conclusion: The rate of people's receiving follow-up examinations would likely increase by a letter of introduction from a physician. Doctors should carefully ask individuals about a follow-up examination, because sometimes the statements from those individuals are not in agreement with their actual examination results.
Purpose: The purpose of this clinical study was to examine the anthropometric indices that are most useful in the determination of obesity. In this study, based on these results, the association between visceral fat and gender difference was studied. Subjects and methods: Subjects were 128 employees who gave consent at our hospital's periodic staff health checkup. This study examined correlations between past disease history, current medical history, medication history, anthropometric indices (abdominal circumference, BMI, waist-hip ratio, abdominal circumference to height ratio), blood pressure (systolic: SBP, diastolic: DBP), blood examination (Tcho, TG, HDL, LDL, non-HDL, TG/HDL ratio, LDL/HDL ratio, fasting plasma glucose: FPG, fasting insulin level: insulin), HOMA-β, HOMA-IR, and visceral fat area: VFA. We investigated the associations indicated by factors derived from correlations. For statistical analysis, factor analysis and receivers operating characteristic analysis were used. Results: VFA and abdominal circumference to height ratio in males, and VFA and BMI in females are useful anthropometric indices compared with the association between abdominal circumference measurement and VFA. In this study, items which showed positive correlation with visceral fat obesity included: aging, abdominal circumference, BMI, BMI 25 or greater, waist-hip ratio, abdominal circumference to height ratio, SBP, TG, TG/HDL ratio, insulin, HOMA-β, HOMA-IR both in males and females. As for correlation between gender difference and VFA, significant positive correlation was observed in TG150 mg/dL or greater; and significant negative correlation was observed in HDL in males. Significant positive correlation was observed in DBP, Tcho, LDL, non-HDL, LDL/HDL ratio, FPG, SBP130mmHg or greater, LDL 140 mg/dL or greater, FPG 110 mg/dL or greater in females. Discussion: The results thus far have revealed that in addition to abdominal circumference, VFA was significantly associated with abdominal circumference to height ratio (cut-off point 0.48) in males and BMI (cut-off point 25.10) in females. LDL was closely associated with VFA in females.
Objectives: At Health Examination Center Urasoe General Hospital, customer satisfaction is surveyed twice a year to improve customer service and its operation. In 2013, a new method was introduced using correlation coefficient to efficiently extract the areas that needed improvement. Subjects: Clients who underwent health examinations at the health center from July 30 through August 5, 2013. Health examinations included physical examination by a physician and health guidance offered by medical staff members. Methods: Five grade values were used. Higher than “matched expectations” were considered satisfied. The degree of satisfaction in each area was described as ratios of satisfied/valid respondents. For importance, the Spearman's rank correlation coefficient (hereinafter referred to as “correlation coefficient”) was used to describe each item and the overall evaluation. The correlation coefficient was calculated by the score given by the choices. When the correlations were statistically significant, those items were considered important to increasing client overall satisfaction. Results: Items that had low satisfaction were the following: (numers shown are t-scores) doctors bedside manner (38.9), clear explanation and guidance by doctors (35.7), waiting time (28.9), fees (41.2). Caluculated importance were as follows: (numbers shown are correlation coefficient) doctors bedside manner (0.624), clear explanation and guidance by doctors (0.664), waiting time (0.685), fees (0.539). All correlations were statistically significant (p<0.01). Discussion: We interpreted those four items that had low satisfaction scores as important to increasing overall customer satisfaction. To improve business operations we decided to work on the three items in the order of lowest satisfaction. The first to be improved is “waiting time”. The second is “clear explanation and guidance by doctors” followed by “doctors bedside manner.” We will refer the fee feedback to management for further consideration.
Gastroesophageal reflux disease (GERD) including reflux esophagitis is recently increasing in Japan, and the guideline for GERD in Japan was reported in 2009. One cause of GERD is increased gastric acid secretion due to increased protein intake, decreased intake of fishes and salt, decreasing rate of Helicobacter pylori infection, or an increased use of low-dose aspirin and NSAIDs. Another cause is increased reflux of gastric juice, which may be caused by the lower esophageal sphincter dysfunction due to increased rates of hiatus hernia, bending of the back, increased fat intake, increased doses of calcium blockers and nitrates or obesity. GERD sometimes disturbs food intake, sleep, work, and QOL and is associated with functional dyspepsia or irritable bowel syndrome. GERD is also related Barrett's esophagus and Barrett's adenocarcinoma. Most cases of GERD can be diagnosed by symptoms, and proton pump inhibitors (PPIs) are efficacious for diagnostic therapy for GERD. They are the first choice of treatment for GERD. If one of the PPIs is ineffective, another may be effective. The change of administration time, dose division, and dose level might also be considered. Additional Rikkunshito, mucoprotecting drugs, or psychotropic drugs is sometimes useful. Esophageal pH-impedance monitoring and high- resolution manometry in addition to upper gastrointestinal endoscopy can be useful for differentiating cases refractory to PPI. Reducing body weight and lifting of the head in bed is useful for preventing GERD. Laparoscopic antireflux surgery is considered in cases refractory to medication and when patients hope to avoid medication for a long time. Not only treatment but also prophylaxis of GERD are important, and they are expected to be established.