Helicobacter pylori has been receiving much attention in recent years, because H. pylori was reported to be significantly related to gastric cancer development. However, many of the H. pylori examinations are rarely included in the general checkup items as a default. Here we examined how recommendation of H. pylori test as an option changed the recognition and understanding of the test. The subjects of our investigation consisted of group A) 395 people who were inspected the serum H. pylori antibody (H. pylori antibody) from July 2014 to June 2015, group B1) 323 who were examined H. pylori antibody as an already included item and group B2) 381 people who chose H. pylori antibody test as an option from July 2015 to June 2016. All people in group B1 and B2 were explained that they would need secondary screening test and H. pylori eradication treatment if their results were positive and that they could obtain the introduction letter to the specialist. People in group A were not thus explained. The age at which people had the highest test rate was 40, counting 40% in both groups. Forty-and fifty-year-old people accounted for 70% of the total. Participation rate of secondary screening in the first H. pylori test positive people were as follows- group A: 45.1%, group B1: 42.1%, group B2: 42.3%. -in men, group A: 42.6%, group B1: 34.1%, group B2: 38.8%- in women, group A: 52.9%, group B1: 69.2%, group B2: 50%.
 The number of people who got first H. pylori antibody examination increased by about twice as much if they were informed of an optional H. pylori test, suggesting the interest in H. pylori was very high. However, the secondary screening participation rate was not so high. Therefore, these data suggested that people tended to underestimate secondary screening test though they knew the importance of H. pylori infection. In order to promote the secondary screening test from July 2016, our health evaluation center decided to send the brochure explaining the importance of secondary screening with the positive result of the first H. pylori checkup. In addition to brochures, we started to encourage H. pylori test positive people to get secondary screening test by phone. In the future, we will make these efforts to improve the rate of secondary screening examination.

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 Objective: Atrial fibrillation (AF) is the most common cardiac arrhythmia, and affected individuals experience reductions in quality of life and functional status. Patients with AF show a higher risk of stroke than patients without AF. Enhanced recognition of AF is needed in occupational health to decrease the number of patients with cerebral infarction caused by AF. We therefore performed a questionnaire survey of AF awareness and correlations between AF and cerebral infarction in a sample of our workers.
 Material and Methods: A questionnaire about AF was administered to employees >50 years old working at the Hirai offices of Lion Corporation.
 Results: The majority of employees knew about AF (72.5%), but fewer were aware of asymptomatic AF (46.3%) and the tendency for AF to result in thrombosis formation (43.8%). The proportion of employees who knew that AF is a risk factor for cerebral infarction was 54%, whereas only 33.8% knew that medical treatment can prevent cerebral infarction in individuals with AF.
 Conclusion: The present survey showed a low level of awareness of asymptomatic AF and anticoagulant pharmacotherapy to prevent stroke. Detecting asymptomatic AF and paroxysmal AF in annual health examinations is difficult. Preventing the occurrence of ischemic stroke requires dissemination of knowledge about AF and that measuring one’s own pulse rate is useful for early detection of AF. Lectures in occupational health provide a good opportunity to enhance information about AF and stroke, and might contribute to preventing severe cerebral infarction due to AF.

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 Thirteen union members of the Marui Health Insurance Society were made to participate in a diabetes mellitus aggravation prevention program underwent at the Institute of Health Promotion. They were selected because their HbA1c was higher than 8.4% as per a medical examination performed in the fiscal year 2013. The program comprised a medical interview, a physical examination, and trials for collaboration with medical institutions using an information exchange notebook. Data pertaining to HbA1c showed a significant decrease 6 months after the program (from 10.1±1.3% to 8.1±1.4%), whereas that pertaining to body weight showed no significant changes (from 78.5±13.8 kg to 80.0±14.0 kg). Of note, the clients who gained over 2kg of body weight during these 6 months received an additional dose of insulin injection or increased dose of sulfonylurea. In these clients, HbA1c did not decrease owing to the beneficial changes in their lifestyles but owing to the increased use of medication. However, HbA1c of the 12 clients under medical treatment in the fiscal year 2016 was 7.8±1.9%, demonstrating continual effects of the aggravation prevention program. We are developing a new program for the union members to help promote beneficial lifestyle changes for preventing diabetes aggravation by collaborating with medical institutions as well as with the head office of the Marui group.

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 We retrospectively studied 454 patients with Hashimoto’s disease (69 males and 385 females) at the Health Service Association (Kenko Life Plaza) between 2003 and 2016.
 Fluctuating thyroid function, ultrasonographic findings of the thyroid and antithyroid antibodies in Hashimoto’s disease were examined.
 Of the 454 patients, 252 (Group A) had had a thyroid function test only once in our facility, of whom148 were referred to a thyroid specialist for detailed examination and treatment and their patient referral document replies were investigated. The remaining 202 patients (Group B) were followed up periodically with thyroid function tests during studies.
 The Follow-up studies of thyroid function of 350 patients with Hashimoto’s disease demonstrated that 73% of them were euthyroid and 27% had thyroid dysfunction, consisting of 6.6% with hypothyroidism at the initial testing. The final thyroid state was as follows: euthyroid 76% and thyroid dysfunction 24%, with 10.6% developing hypothyroidism.
 An Ultrasonographic study (US) was performed in 427 patients with Hashimoto’s disease. A heterogeneous distribution was found in 312 patients (73.1%) and homogeneous distribution in 115 patients (26.9%). Of the 286 patients with Hashimoto’s disease, 198 (69.2%) had an enlarged thyroid gland (≥20g).
 The detection rate of TgAb was 93.1%, which was higher than the 71.2% for TPOAb in 333 patients who had both TgAb and TPOAb examinations.
 The detection rate of TgAb was 95.7% in 258 patients with heterogeneous echogenicity while 84% of 75 patients with a homogeneous distribution of thyroid were positive.
 Of 164 nodules, 13 (3.0%) had papillary carcinoma and 151 (35.4%) had benign thyroid nodules. On the other hand, Hashimoto’s disease was concomitantly seen in 16 (24.6%) of 65 patients with papillary carcinoma and in 98 (19.6%) of 501 patients with benign nodules.
 We conclude that most patients with Hashimoto’s disease asymptomatically progress slowly over years in the euthyroid state. However, thyroid dysfunction occasionally appears and returns to euthyroid or develops to overt hypothyroidism.
 We devised a flowchart for the management of patients with Hashimoto’s disease.
 Ultrasound images of the thyroid and nodules of the patients and chest X-rays of myxedema heart are presented.

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 Background and Aims: For the past decades, the incidence and mortality rate of colorectal cancer (CRC) has been increased in Japan. The association of metabolic syndrome (MetS) and CRC has been reported in several studies, however, individual factors contributing to development of CRC have been obscure, especially in Japan. In the present study, we investigated the risk factors, especially focusing on MetS for development of colorectal adenomatous polyps (CP) as precancerous lesions by using comprehensive health checkup data.
 Methods: Among 7,213 subjects who took comprehensive health checkup at our hospital between in August 2012 and July 2015, 1,772 subjects who also underwent screening colonoscopy were analyzed. Demographic characteristics, anthropometric measurements, visceral fat area (VFA), blood pressure and hematological metabolic parameters were assessed. Association between variables and CP was evaluated by univariate analysis, and then by multivariate analysis using multiple logistic regression model. A p value < 0.05 was considered statistically significant.
 Results: Of 1,772 subjects analyzed, 506 subjects had CP (28.6%) and 5 had invasive colorectal cancer (0.28%). Four hundred and forty-six subjects were diagnosed as MetS (25.2%) and presence of MetS was significantly associated with CP (p < 0.01). Univariate analysis identified significant association of sex, age, body mass index (BMI), and VFA with prevalence of CP. Logistic regression analysis revealed that sex, age, VFA and abnormal blood glucose, which is one of factors consisting of MetS, were independent factors associated with CP.
 Conclusion: The present study demonstrated that male, aging, obesity and MetS might be risk factors for colorectal neoplasia in Japan.

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 BACKGROUND AND AIMS: The prevalence of reflux esophagitis which might be a risk factor for Barrett’s esophagus has been increasing in Japan. Therefore it is essential to identify the risk factors for reflux esophagitis. We examined the backgrounds of general medical checkup examinees to analyze the risk factors for reflux esophagitis.
 METHODS: We studied the result of esophagogastroduodenoscopy on 1,062 subjects (680 males and 382 females; mean age 55.3) in general medical checkup examinees from April 2015 to March 2016. Two hundred and twenty subjects (20.7%) had reflux esophagitis classified as Los Angeles grade A-D. The χ2 test was calculated for the frequency difference of nine background factors for the patients and those without the disease. Logistic regression analysis was performed to evaluate the risk factors for reflux esophagitis.
 RESULTS: Reflux esophagitis was more frequent in males than females (27.6 vs. 8.4%). Although in males, the incidence of reflux esophagitis in the group under 60 years old was higher than in the group over 60 years old, there were no statistically significant differences between the two age groups in females. The prevalence of six background factors: Male gender, 0besity, Drinking, Smoking, Gastric mucosal atrophy (Kimura · Takemoto C-0 and C-1), and Hiatus hernia, were significantly higher in patients of esophagitis than those without the disease. Multivariate logistic regression analyses revealed that hiatus hernia (OR 3.4), male gender (OR 3.3), obesity (OR 1.8), age under 60 years old (OR 1.7) were significant positive risk factors while gastric mucosal atrophy of C-0 and C-1 was not.
 CONCLUSIONS: The result of no statistically significant differences between age groups in females differed from previous studies. To analyze significant risk of gastric mucosa without atrophy for reflux esophagitis, moderate-severe mucosal atrophy above C-3 with decreased gastric acid secretion, should have been used as control group. Endoscopically checking for hiatus hernia is essential to prevent onset of reflux esophagitis. Also consideration of gender difference, age and prevention of obesity are important.

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 [Objective] Differences in the results of serum HP antibody tests according to test method (CLEIA method or LA method) were investigated. In addition, the relation between the ABC classification (the risk of developing gastric cancer) and the results of serum HP antibody tests was investigated.
 [Subjects] The subjects were 199 volunteers who underwent an HP antibody/pepsinogen (PG) test as part of a comprehensive medical examination and a health checkup at our institution since August 2016.
 [Methods] The CLEIA method was performed with “SphereLight Wako” and its dedicated reagents “SphereLight H. pylori antibody J” and “SphereLight pepsinogen I/II”. Test by the LA method was outsourced and was performed by using the “LZ Test Eiken H. pylori antibody.” The HP antibody-positive rate was compared between the CLEIA method and the LA method. Also, the ABC classification was compared between subjects who were HP antibody-positive with the CLEIA method and subjects who were positive with the LA method. The HP antibody cut-off value was 4 U/mL for the CLEIA method and 10 U/mL for the LA method.
 [Results] Serum HP antibody tests were positive in 27 (13.6%) of the 199 subjects by the CLEIA method and in 15 subjects (7.5%) by the LA method. Tests were positive in 13 subjects (6.5%) by both the CLEIA method and the LA method. The HP antibody test results differed in 16 subjects, only being positive by the CLEIA method in 14 of the 16 subjects and only being positive by the LA method in two subjects. The concordance rate of antibody tests with the ABC classification was 92.0%.
 [Discussion] The percentage of subjects who were HP antibody-positive was higher when the CLEIA method was used compared to the LA method. This is considered to be attributable to differences of the cut-off value, detectability, or HP strains. For more accurate determination of the ABC classification, it is important to reduce the number of persons with a false-negative test for HP antibodies. Because HP antibody detectability was greater when the CLEIA method was used, this suggests that the CLEIA method is superior to the LA method.

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[in Japanese]

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 Familial hypercholesterolemia (FH) is mainly an autosomal dominant disorder caused by mutations in the LDL receptor and related molecules causing increased serum LDL-cholesterol (LDL-C). It is characterized by Achilles tendon and tuberous xanthomas and premature coronary artery disease (CAD) as well as hyper-LDL-cholesterolemia in the family members. Dominant-active mutations in the PCSK9 gene is also involved in the pathogenesis of FH. Japan Atherosclerosis Society (JAS) has published the 2017 Edition of Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases, in which the diagnosis and treatment strategies for FH are described. Prevalence of heterozygous FH is estimated to be one in 200-500 and FH is the most frequent genetic disorder, however less than 1% of FH patients are diagnosed properly. Therefore, the awareness of FH and its early diagnosis is crucial from the point of health check-up.
 Recent advances in the drug development of FH such as inhibitors of PCSK9 and MTP have enabled us to lower LDL-C less than 100 mg/dL, thus CAD can be reduced even in FH patients by early diagnosis and treatment. To treat FH patients, statins and/or intestinal cholesterol transporter inhibitor are used. In case LDL-C reduction is not adequate, the addition of PCSK9 inhibitor and/or resins and/or probucol is considered. In case LDL-C reduction is still not enough, LDL apheresis is applied. The indications of LDL apheresis are homozygous and severe heterozygous FH patients. JAS has recently published guidelines for adult and pediatric FH patients. For the primary prevention of CAD, the treatment goal of LDL-C is less than 100 mg/dL or less than 50% of the pretreatment LDL-C level is also possible when patients are resistant to drug therapy. For the secondary prevention of CAD, the treatment goal of LDL-C is less than 70 mg/dL. For pediatric FH patients, in collaboration with Japan Pediatric Society, JAS has published a Guide for the Treatment of Pediatric FH. Although resins were the first-choice drug in Japan, statins are now first-choice for pediatric FH patients over 10 years old.
 JAS has been involved in the promotion of FH awareness in Japan by holding lectures open to the public, seminars for medical professionals and press conferences for journalists. In conjunction with the FH Day, JAS has planned and supported these meetings. The early diagnosis and treatment are essential for FH, therefore JAS will continue to promote these educational activities.

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Familial hypercholesterolemia (FH) is an autosomal dominant severe hyper-low-density lipoprotein (LDL)-cholesterolemia, the frequency of which is estimated as 1 in 200 to 300 general population. Thus, FH could be found in ordinal medical checkups. Despite the clinical diagnostic criteria of FH has been established, the definitive diagnosis of FH is rarely made. Almost all the homozygous FH and more than 60% of heterozygous FH without effective cholesterol lowering therapy are to be die from cardiovascular events. On the other hand, FH is the most beneficial condition to avoid cardiovascular events by cholesterol lowering therapy. Thus, from the view point of preventive medicine, it is important to make a diagnosis of FH.
 FH is caused by absent or defective gene mutations in LDL receptor, which is associated with intracellular uptake of LDL. Recently, gain-of-function mutations in proprotein convertase subtilisin/kexin type 9 (PCSK9), which is leading intracellular degeneration of LDL receptor, was found as a cause of autosomal dominant hypercholesterolemia.
 Because the conventional cholesterol lowering therapy could result in 66% reduction in LDL-cholesterol (LDL-C), multiple cholesterol lowering medicine in addition to maximum doses of statin should be considered for the treatment of FH. However, FH is still highly resistant to conventional lipid lowering medicines. Although LDL apheresis used to be the strongest LDL-C lowering therapy, it is an invasive, time-consuming, expensive therapy and can only reduce LDL-C levels transiently.
 PCSK9 inhibitors are novel cholesterol lowering medicine, which were developed based on the discovery of PCSK9. Monoclonal anti-PCSK9 antibodies reduce LDL-C by more than 60% in addition to conventional cholesterol lowering therapy and significantly reduce cardiovascular events as well as coronary plaque volume. PCSK9 inhibitors are more effective to reduce LDL-C than LDL apheresis.
 Although it is not easy to make a definitive diagnosis of FH in an ordinal annual health checkup, the patients suspected to have FH should be referred to specialists and treated intensively to avoid future cardiovascular events.

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 In order to prevent lifestyle-related diseases, we investigated the lifestyles of patients with lifestyle-related disease and examined countermeasures. Subjects were 10,417 patients (4,054 males, 6,363 females) who underwent specific medical examination at our hospital from April 2008 to the end of March 2016. Examination on the relation between 20 items of the specific medical examination questionnaire and lifestyle-related diseases (hypertension (HT), diabetes (DM), dyslipidemia (DL), HT + DM, HT + DL, DM + DL, HT + DM + DL) was conducted for the groups without oral administration, and groups with oral administration using Pearson correlation coefficient and multivariate analysis. As a result, the lifestyle of patients with lifestyle disease was different in each disease. However, commonalities were male gender, weight gain of greater than 10 kg from the age of 20, and high awareness of the need to improve lifestyle habits. Since patients with lifestyle disease are able to continue daily life, action leads to disease improvement. As for the weight gain from the age of 20, it is considered that early intervention for the maintenance and promotion of health from a young age is necessary.

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 In metabolic syndrome screening program, we conduct motivational interviewing with individual patients with metabolic syndrome as a risk factor to reduce cerebrovascular disease mortality, ischemic cardiac disease mortality, and the number of newly initiated dialysis patients with diabetic nephropathy. However, there are many determinants of health that patients could not change themselves, we need a population approach in addition to an individual approach. Chronic care model is one of the useful tools for a population approach to metabolic syndrome. We need to conduct a systematic research if this population approach based on chronic care model is really effective to prevent important outcomes. Finally, all of us who are engaged in metabolic syndrome screening program need to fulfill our responsibilities to the society by putting the concept of the concept of transdisciplinary professionalism into practice.

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