In ophthalmology, rapid advances in diagnostic capabilities and detailed pathological elucidation accompanied by rapid advances in examination equipment over the past 20 years have led to the expansion and increase of diseases indicated for treatment, and rapid developments in surgical treatment and other areas. As a result, the need for a dedicated ophthalmology facility and a dedicated team for ophthalmology care, which requires a special treatment system and nursing system, has increased. Kurashiki Medical Center opened an eye center with the construction of a new wing in February 2021. The main treatment in hospital ophthalmology is surgical treatment, and at our hospital, vitreoretinal surgery, glaucoma surgery, and lens-related surgery are common. Because of the ocular nature, most of the surgeries are performed under local anesthesia, even for serious diseases. The stress of having the inside of the eye manipulated is greater for patients than one might imagine. Therefore, it is not uncommon for blood pressure to rise or for patients to be in a state of restlessness during surgery. In establishing the Eye Center, we focused on what we could do to provide not only advanced medical care as a final hospital, but also to alleviate the mental stress and physical strain of patients who are anxious and nervous during treatment. The key, we thought, was staff. All the staff involved are dedicated to ophthalmology, and if everyone shares and expresses the mindset of trying to cure the disease together with the patient, the patient will feel reassured in various phases of the treatment. We then created an environment with a strong awareness of the medical, human, and physical environment that surrounds the patient as a therapeutic environment. I would like to introduce our attempts and their effects.

 After the completion of the Human Genome Project, the enormous budget was allocated to the development of the analysis technology to speed up and improve the efficiency. As a result, next-generation sequencers (NGS) have been developed, and the analysis speed has changed dramatically to 1 million times in just a few years. Until now, it has not been extremely easy to investigate individual genes, but with NGS, comprehensive analysis has become possible. Exhaustive analyses often yield findings that differ from their original purpose due to their nature. In Japan, the policy of promoting cancer genomic medicine as a national policy has become an important issue in how to share the results of NGS analysis with patients, and in FY2017-19, the AMED research group "Research on the Establishment of a System for Appropriate Disclosure of Genomic Information in the Medical Field" compiled "Recommendations on the Information Transmission Process in Genomic Medicine". This includes not only cancer genomic medicine, but also comprehensive testing of germline. In the 2020-22 Health, Labour and Welfare Science Research, we took over the AMED research and organized a research group on "Identifying Ethical and Social Issues and Improving the Social Environment for the Realization of a Society in which the public can receive genomic medicine with peace of mind." The research group examined the issue by members of the group, including patients, the general public, researchers in the field of ethics and social sciences, and lawyers, and changed the title of the AMED recommendation to "communication process" → "communication process" to emphasize more interactivity. Since it is not enough to develop guidelines, we have held seven "Genome Exchange Meetings" so far as a new attempt to promote two-way communication between patients, the general public, and medical professionals from a completely flat standpoint. In addition, in terms of social infrastructure development, studies were conducted to break away from the gene exceptionalism and to develop legislation such as the prohibition of genetic discrimination.

 Background: In medical checkups, imaging tests and blood data sometimes reveal diseases that are not the original purpose of the examination. This report describes diseases incidentally discovered from medical checkup data at our medical checkup facility.

 Subjects: I. 2,426 patients who underwent pulmonary helical CT at our facility during a 6-month period. II. 13,550 patients who visited our facility during one year.

 Subjects and Methods: I. For patients with coronary artery calcification on CT, a thorough examination was recommended. Coronary risk factors and the presence of significant stenosis were examined. II. Hypophosphatasemia (HPP) is an inborn error of metabolism caused by genetic mutation, and a low serum ALP level is one of the diagnostic criteria. Patients with low serum ALP levels (33 U/L or less in men and 29 U/L or less in women) were recommended a thorough examination to verify the prevalence of HPP.

 Results: I. We validated 2,426 patients who underwent CT and found coronary artery calcification in 296 (12%). Compared to the negative subjects, those who were positive for calcification had a significantly higher prevalence of coronary risk factors except eGFR. Of the 296 patients with calcification, we were able to confirm medical consultation and test results in 80 patients; 16 of the 80 patients underwent PCI (percutaneous coronary angioplasty) and had a significantly higher prevalence of diabetes mellitus. II. Out of 13,055 patients (8,607 males and 4,943 females), 79 patients were found to have low ALP and were advised to visit the Outpatient Genetics. 12 patients visited the Outpatient Genetics and 10 patients (5 males and 5 females) were found to have positive gene tests.

 Discussion: Although these diseases found in medical checkups are unrelated to the original purpose of medical checkups, they are thought to lead to the prevention of serious complications and the diagnosis of undiagnosed diseases. Because health checkups handle a large amount of data, it is necessary to give consideration to undetected diseases. On the other hand, there are issues to be addressed in the prognostic tracking of health checkup results and the difficulty of raising awareness of diseases.

 Given that the key role of health checkups is the early detection of disease, it is particularly important for examinees to receive medical consultation immediately after a checkup. Encouraging medical consultations due to hyperglycemia is one of the most important responsibilities of the Japan Society of Health Evaluation and Promotion, whose mission is to prevent diseases, maintain, and promote the health of the nation. The number of people with diabetes in Japan is steadily increasing each year, and is predicted to reach approximately 20 million people. The 2019 National Health and Nutrition Survey found that 19.7% of men and 10.8% of women are strongly suspected of having diabetes. The percentage of these patients who are currently not under treatment is 25.5% (male, 21.4%; female, 29.6%). Therefore, it is necessary to encourage these individuals to start diabetes treatment. In particular, the lower rate of treatment among people in the working generation is a great problem. The Japan Society of Health Evaluation and Promotion must collaborate with multiple health check institutions to accurately understand the number of untreated diabetic patients and improve the rate of medical consultation among individuals with hyperglycemia. In addition, prejudice against diabetes will be eliminated through stigma reduction and advocacy activities, so that diabetic patients can more easily receive treatment and care. This paper reviews the current situation, challenges, and recent advocacy activities related to diabetes, in order to encourage the members of the Japan Society of Health Evaluation to improve the medical consultation rate among individuals with hyperglycemia.