The results of workplace breast cancer screenings conducted by the Chugoku Occupational Health Association from April 2006 to March 2013 were gathered, and factors influencing the screening rate were examined. In total, 27,750 people underwent screening, of which 72.4% underwent clinical breast examination (“CBE”) and mammography (“MMG”), 20.4% only MMG, and 7.2% only CBE. Over this period, there were 41 cases of breast cancer, all MMG examinees. In total, 25,755 people underwent MMG, with 46.9% doing so for the first time. Among those who underwent CBE and MMG, 7.4% required a close examination, of which 74.7% returned for one; the discovery rate was 0.179%. Among those who underwent only MMG, 6.7% required a close examination, of which 72.4% returned for one; the discovery rate was 0.088%. Among those who underwent only CBE, 2.0% required a close examination, of which 35.0% returned for one; the discovery rate was 0.000%. A major factor affecting CBE is hesitation by the examinees, and there are also problems on the examination side, such as the difficulty of securing physicians and managing accuracy, and the limited number of physicians implementing CBE. A reduction in the death rate of persons who underwent only MMG was recognized. As MMG-only screenings have come to be promoted even at workplaces, examinees can be screened more easily, resulting in increased detection of the cancer. These improvements are thought to be effective also for subsidizing costs and increasing the screening rate. Although workplace breast cancer screening is convenient for working women and facilitates continued screenings, coordination with workplaces is important to make the screenings effective. A mechanism for linking workplaces with screening agencies while protecting personal information needs to be built.
Low HDL cholesterol (HDL-C) is a risk factor for atherosclerotic diseases, and appropriate HDL-C control has been a requirement of health guidance, especially for males. HDL-C has a negative correlation with smoking and BMI and a positive correlation with drinking and exercise habits. HDL-C varies depending on these health behaviors, but the mutual relationships between HDL-C and various health behaviors remain unclear. The objective of this study was to investigate the effects of alcohol quantity, number of cigarettes and exercise habits on HDL-C cholesterol in male drinkers. The subjects were 4,668 male drinkers who had undergone health checkups and who drank every day. The subjects were divided into a smoking group (2,648 men) and a non-smoking group (2,020 men). The non-smoking group had higher HDL-C and BMI as well as more frequent exercise habits and a lower alcohol quantity than the smoking group. Multiple linear regression analysis was performed for both groups separately. The dependent variable was HDL and independent variables were age, BMI, alcohol quantity, exercise habits and number of cigarettes (only in the smoking group). In the smoking group, HDL-C had a positive correlation with alcohol quantity (β = 0.175, p < 0.001) and exercise (β = 0.041, p = 0.023) and a negative correlation with BMI (β = -0.348, p < 0.001) and number of cigarettes (β = -0.079, p < 0.001). In the non-smoking group, HDL-C had a positive correlation with alcohol quantity (β = 0.212, p < 0.001) and exercise (β = 0.073, p = 0.023) and a negative correlation with BMI (β = -0.375, p < 0.001). In both groups, HDL-C had no correlation with age (p = 0.560). In conclusion, the negative effect of BMI on HDL-C was strongest, although drinking and exercise had a positive effect on HDL-C in both the smoking group and non-smoking group. Smokers are considered to be strongly affected by an increase in HDL-C due to drinking and exercise on quitting smoking. In the smoking group, the number of cigarettes had a negative correlation with HDL-C.
I investigated the features of the “medical checkup service” as a service business, from the viewpoint of the person undergoing the checkup. This service is featured by ① being intangible, ② including both elements of production and consumption simultaneously, ③ showing diversity, ④ covering results and a course of events, and ⑤ joint production. Joint production with the client in particular was shown to involve the functions of decision-making and quality control of the content of the service, education, as well as marketing. To understand the way clients (persons undergoing the medical checkup) experience the service, I performed an interview survey of persons who had undergone a medical checkup. Based on the narratives provided by four interviewees, we concluded that ① people undergo the medical checkups with various feelings (and for various reasons); ② those who have undergone the medical checkups are basically only interested in the results of the various examinations; ③ they prefer to keep a “businesslike distance” with the provider of the medical checkup service; however, ④ if they are greeted in a friendly way indicating that they have been remembered, e.g. with the word, “I’m glad to see you this year too,” it increases the value they attach to the health guidance provided based on the results of the checkup.
Nowadays, the goal of health evaluation in the elderly has been focused on frailty under the screening name of FRAIL that looked specifically for Fatigue, Resistance (inability to walk up a flight of stairs), Ambulation (inability to walk a short distance), Illness (>five comorbid conditions), and Loss of body mass (>5% of total body weight). In this introductive remark of frailty and sarcopenia, we will first demonstrate the current concept of frailty with special regards to its clinical phenotype introduced by Freid and others in 2001 that included 5 items including loss of body weight, sarcopenia, reduced hand grip, fatigability and slow walking. Then conceptually, a transitional state in a dynamic process of frailty proposed by Lang and others (2013) with special regards to impairment of homeostasis was introduced to understand its lability and stabilization. Since clinical frailty scale proposed by Rockwood and others (2005) is a quite usable idea for evaluation of the severity of frailty, this is a recommendable tool for the cohort study and general clinical practices. Concerning sarcopenia, its fundamental concepts, details of definitions and evaluation in research and clinical practices have already been described by European Working Group on Sarcopenia in Older People (EWGSOP). Sarcopenia itself is one of the most important items in frailty definition and its evaluation has to be done both in its mass and force. In clinical basis, manual evaluations must be the most practical and desirable method as semi-quantitative evaluation. Lastly, sarcopenic obesity is an another important health problem, of which prevalence has been increasing. This is thought to be an infiltration of fat cells into the muscle mass, of which quality might be greatly changed and deteriorated. Fat tissue itself is an active endocrine organ which releases inflammatory cytokines and hormones. Treatment strategies consist of dietary regimens and exercise program associated with vaccinations for herpes zoster, influenza and pneumococcal pneumonia. Other co-morbidities associated with frailty should be treated appropriately.
The Stress Check Program was first considered as a screening tool for depression from the standpoint of suicide prevention. Through the review process, however, concerns were raised about potentially disadvantageous treatment of workers based on their screening results (e.g., layoffs), which shifted the purpose of the program to the provision of opportunities for companies to be aware of psychological stress among employees. Under the Stress Check Program, strict and unique information control is enforced; for example, individual workers’ stress test results cannot be accessed by employers without their consent, and employers are prohibited from treating workers unfavorably based on their stress test results. Moreover, employers are required to make adequate improvements in workplace environments based on the results of group analysis by departmental units. This also set the Stress Check Program apart from conventional health management, which targets individuals. Since questionnaire items and assessment criteria for stress check are left to each employer’s judgment, ensuring the accuracy of test results is expected to be a major challenge in the implementation of the program. As the stress test is conducted with self-administered questionnaires, workers who are concerned about the possibility of unfair treatment may manipulate their responses so as not to reveal their actual stress levels. Therefore, further examination is needed to verify the effectiveness of the Stress Check Program as a screening tool. With regard to the stress check as a “general health checkup,” future challenges include the quantification of stress using objective indicators and verification of the relationships between stress and other diseases. Group analysis is expected to contribute to the establishment of Data Health Plans and even healthy companies through examination of correlations between stress and mental health indicators (such as the number of working days lost due to poor mental health) and other associated factors.
In Western countries, considerable effort has focused on evaluating the ability of CT colonography (CTC) for colorectal cancer screening from the early 2000s. In United States, National CT Colonography Trial (ACRIN6664) suggest CTC is comparable to colonoscopy for the detection of colorectal neoplasia in asymptomatic average-risk adults. Large clinical trials from Germany, Italy, and France also suggest that CTC has high sensitivities and specificities for neoplasia ≥10mm. The American Cancer Society, the US Multi Society Task Force on Colorectal Cancer, and the American College of Radiology have developed consensus guidelines for the detection of colorectal neoplasia in asymptomatic average-risk adults. In this consensus guidelines, CTC is one of testing options that detect adenomatous polyps and cancer every 5 years. The European Society of Gastrointestinal Endoscopy (ESGE) and the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) produced the common guideline regarding indications for CTC in clinical practice. When endoscopy is contraindicated or not possible, ESGE/ESGAR recommend CTC as an acceptable and equally sensitive alternative for patients with symptoms suggestive of colorectal cancer (strong recommendation, high quality evidence). In Japan, two large clinical trials (UMIN 2097 and 6665) show that CTC has high accuracy in detecting clinically significant neoplasia. Although there are no guidelines or consensus of clinical indications for CTC, it has good indications for health check-up and diagnosis of colorectal neoplasia if colonoscopy is incomplete or contraindicated or not possible. For CTC quality control, evidence-based training and reading and standardization for preparation and examination techniques mandatory.