The specific health guidance (SHG) has been carried out since fiscal 2008 and has shown efficient effect. However, it is not obvious whether the guidance conducted by each public health nurse (PHN) has the same effect or not. The purpose of this study is to verify the difference of the SHG effect among PHNs.
Subjects were 233 male staffs of the A company who received the proactive support of the SHG in the fiscal 2012-2015 for the first time and who consulted a health checkup in the next fiscal year of the guidance. 5 PHNs who had experience of 6-15 years were in charge of them.
We analyzed the abdominal circumference, the weight and the BMI of the whole subjects and the subjects grouped by each PHN and we compared these data and the next fiscal data. (the Wilcoxon rank sum test) Then, we compared the amount of change of these checkup items among 5 groups. (the Kruskal-Wallis test)
There was no difference of the background factors among the subjects grouped by each PHN. The health checkup results of whole subjects in the next fiscal decreased significantly. Also the checkup results of each of the groups decreased significantly.
The amount of change of the abdominal circumference (p = 0.622), the weight (p = 0.511) and the BMI (p = 0.378) didn't show the difference among PHNs.
Following factors would be imagined such as standardizing the guidance contents by producing manuals of the SHG, unifying the guidance documents and OJT. Also these results could be obtained because of these PHN's career. We need to verify in the future whether a similar result could be found even if the less experience PHNs or other types of jobs were in charge of.
These results suggest that the SHG effects are similar among 5 PHNs.
Reflux esophagitis might be a risk factor for Barrett's esophagus which indicates high risk of esophageal adenocarcinoma in Europe and North America, and it is becoming more prevalent in recent years. While reflux esophagitis is more prevalent in males than in females, gender risk factors for the disease are unclear.
We studied eight backgrounds of 1,062 examinees of esophagogastroduodenoscopy in general medical checkup to analyze risk factors for reflux esophagitis in men and women. We also examined the degree of atrophic gastritis by gender.
Multivariate logistic regression analyses revealed that hiatus hernia, gastric mucosa without atrophy and obesity were significant positive risk factors in males while hiatus hernia and obesity were significant risk factors in females. From the results of the examination about gastric mucosal atrophy by gender, the possible reason for gastric mucosa without atrophy being a risk factor only in males is the low rate of severe mucosal atrophy above O-1 with clearly decreased gastric acid secretion in females.
Based on the Cancer Control Act, Toyokawa-city, Aichi Prefecture is scheduled to apply endoscopy for the preventive mass screening examination for gastric cancer in the year of 2019. To prepare this schedule, we examined endoscopic gastric screening examinations performed as component of multiphasic health examination between October 2012 and December 2017. The total number of examinees was 3,482 (men 2,348, women 1,134). The age distribution of examinees was: 40-49 years (n=1,207), 50-59 years (n=1,085), 60-69 years (n=591), and 30-39 years (n=430). Examinees screened for gastric cancer are increasing annually. The overall rate of endoscopic examination was 16.3% during this period. The rate of transnasal endoscopy was 61.3%. The rapid urease test for the detection of Helicobacter pylori was performed in 20.0% of the examinees, among which 32.5% showed positive test. Six patients with gastric cancer were detected among the examinees. All patients showed early gastric cancer. Among these, 4 patients were treated endoscopically using ESD and 2 were surgically. H. pylori was positive in 2 patients. Nasal bleeding requiring treatment by an otolaryngologist occurred in 2 patients who underwent transnasal endoscopy. No severe complications occurred among the examinees.
A hospitalized health screening program (Ningen-Dock) initiated in 1954, aimed at conducting detailed general health examinations. Since a health insurance society referral system of designated hospitals was introduced in 1959, hospitalized health screenings have become widely available to the public. Around the same time (1960s), automated multiphasic health testing system (AMHTS) was developed in the US to allow health examinations of many people within a short period of time. The AMHTS was introduced in Japan in 1970, leading to a rapid increase in the number of examinees because of the program's convenience. Detailed examinations comparable to hospitalized screenings are available in half a day. Moreover, a referral system designating suitable facilities was also initiated. Accuracy of the examination results was a major factor in popularizing the AMHTS. Therefore, the accuracy management project has been positioned as a primary activity since the establishment of the Japan Society of Health Evaluation and Promotion. Currently, comprehensive health checkups have been implemented in various facilities as "one-day hospitalized" or "out-patient" health screenings. Looking back on the history of AMHTS raises awareness of the major underlying principles and marked the importance of quality control.
The Nippon COPD Epidemiology (NICE) study estimated that 5.3 million Japanese people over the age of 40 are afflicted with COPD. Although COPD is one of the known life-style diseases, there is currently limited awareness that it is one of the three most common life-style diseases in Japan.
It is important to identify patients with COPD in the early stage to prevent exacerbation. However, it is difficult to identify patients with early-stage COPD, as a diagnosis of COPD can only be made if spirometric analysis reveals an FEV1.0% of less than 70% and spirometory is not currently included as an item in regular health examinations in Japan.
Recently, It has been reported that a COPD questionnaire is effective for identifying patients with air-flow limitation in general health examinations. Screening for COPD useing questionnaire administered during a health examination is easier than performing spirometory and could identify a lot of COPD patients, especially patients with asymptomatic early-stage COPD. Therefore, we recommend that a COPD questionnaire be used in more health examinations to increase the detection of early-stage COPD. Furthermore, aggressive educational activities should be implemented to increase awareness of COPD.
In the Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases published by the Japan Atherosclerosis Society, the risks were evaluated based upon the 10-year prevalence of coronary artery disease (CAD) by the Suita Score which determined both LDL-cholesterol (LDL-C) and HDL-cholesterol (HDL-C) levels. Hyperuricemia and sleep apnea syndrome were included as a high-risk state. Abdominal aortic aneurysm and renal artery stenosis were designated as a high-risk state. For the diagnosis of dyslipidemia, hyper-non-HDL-cholesterolemia and borderline hyper-non-HDL-cholesterolemia have been added to the previous classification, including hyper-LDL-cholesterolemia, borderline hyper-LDL-cholesterolemia, hypo-HDL-cholesterolemia, and hypertriglyceridemia. For estimation of LDL-C, direct LDL-C methods can be used as well as Friedewald's equation. In cases with TG≥400 mg/dL or in a nonfasting condition, direct LDL-C methods or non-HDL-C should be used. For primary prevention, patients with diabetes, chronic kidney disease (CKD), noncardiogenic cerebral infarction or peripheral artery disease (PAD) are classified as high-risk group. Patients without any of these diseases, 10-year prevalence of coronary artery disease is calculated using Suita score and patients are classified into low-risk, medium-risk or high-risk group. Thus, the target lipid levels are determined. For secondary prevention, LDL-C should be less than 100 mg/dL, however in cases of familial hypercholesterolemia (FH), acute coronary syndrome (ACS) or diabetes with a high-risk state, LDL-C less than 70 mg/dL should be considered. The diagnosis and treatment of patients with FH have been described in detail because new drugs such as PCSK9 inhibitors (evolocumab and alirocumab) and an MTP inhibitor (lomitapide) have been launched. For pediatric FH patients, statins are now the first line drug. Patients with FH should be diagnosed and treated as early as possible, thus annual health check is very important. A selective PPARα modulator (pemafibrate) has been on market for the treatment of hypertriglyceridemia. In the current review, the guidelines for prevention of atherosclerotic cardiovascular diseases with special focus on treatment of dyslipidemia are described.