In health checkups, particularly the mandatory ones, the Minnesota Code of electrocardiographic findings is used to evaluate electrocardiographic (ECG) findings. This coding system has strict criteria based on waveforms and leads. However, there are cases where the findings of normal variants overlap with these criteria. Additionally, several textbooks describe normal variants was compiled and compared with the corresponding Minnesota Codes. By identifying normal variants, the burden of health checkup professionals and referral medical facilities can be reduced.

 In order to improve the implementation rate of specific health guidance (hereinafter, referred to as "SHG"), we have incorporated remote interviews for the first interview regarding specific health on the day of mobile medical examinations from FY2020. We herein report on the status of this initiative along with the difference in the effectiveness thereof compared to face-to-face interviews. From FY2020-2023, we looked into the differences in the number of medical examination venues conducting the first interview regarding SHG on the day of mobile medical examinations, the percentage of venues conducting remote interviews, the number of instructors for each implementation method, and the differences in the effectiveness of decreasing weight/abdominal circumference. Additionally, questionnaires were conducted among remote interviewers as well as public health nurses and nutritionists. The number of people who received SHG increased from 892 in FY2020 (of which, 0.3% were remote interviews) to 1,505 in FY2023 (of which, 11.9% were 179 remote interviews). Among the 992 people who received SHG in FY2023, 499 of 863 (57.8%) people who had face-to-face interviews saw a decrease in weight and abdominal circumference, while 79 of 129 (61.2%) people who had remote interviews saw a decrease in weight and abdominal circumference, with no significant difference observed (p = 0.46). In a questionnaire among remote interviewers, 90% answered that it was good, with many public health nurses and nutritionists expressing that they had positive impressions, mainly in terms of time benefits. With the introduction of remote interviews, the number of SHG on the day of mobile medical examinations increased, allowing public health nurses and nutritionists to make more effective use of their time. Given that no differences between remote interviews and face-to-face interviews were observed, going forward, we would like to further promote remote interviews by sharing data through systematization.

 Well-being encompasses not just physical and mental health, but also social and economic fulfillment. The awareness of well-being has been rapidly increasing in the field of diabetes.

 The term "diabetes mellitus" conveys a highly negative image in Japan. According to a survey conducted by the Japan Association for Diabetes Education and Care, 72.5% of people with diabetes feel stigmatized, and 78.9% would prefer the disease's name to be changed. The stigma surrounding diabetes stems from the historical perception that many people with diabetes died from vascular diseases half a century ago, along with the notion that "diabetes is the result of a lazy lifestyle."

 Previously, it was believed that people with diabetes had a life expectancy 10 years shorter than that of non-diabetic individuals. However, the life prognosis for Japanese people with diabetes has improved, and this gap has narrowed each year. Vascular diseases have significantly decreased, and cancer is now the leading cause of death. It is crucial to understand that people with diabetes are at a heightened risk for certain cancers, including pancreatic and liver cancer.

 The goals of diabetes management are to improve metabolic abnormalities resulting from hyperglycemia, prevent complications and comorbidities, and achieve a quality of life (QOL) and life expectancy comparable to those of non-diabetic individuals. Diabetes stigma can impact self-care and self-esteem, and it may hinder people with diabetes from receiving appropriate treatment. It is essential to diminish negative attitudes and discrimination toward diabetes through advocacy efforts.

 This article is based on a presentation delivered at the 53rd Annual Meeting of the Japan Society of Health Evaluation and Promotion, and aims to provide updated information on diabetes treatment, as well as a deeper understanding of diabetes and well-being.

 In the promotion of health and productivity management, occupational physicians play a critical role not only in fulfilling their legal obligations under the Industrial Safety and Health Act, but also in facilitating corporate investment in human capital. This report reviews the essential duties and responsibilities of occupational physicians, such as conducting health checkups and supporting mental health, and highlights their contributions from a well-being perspective—encompassing physical, mental, and social dimensions. Specific initiatives implemented at Mitsui & Co., Ltd. are presented as a practical example. Occupational physicians are positioned as strategic partners who support employee productivity and contribute to the sustainable growth of enterprises.

 Background and Aim: The upright compression technique in gastric radiography is an important method that complements double-contrast imaging. However, standardized image quality targets and procedural criteria have not been clearly defined. This study aimed to investigate the success rate and effectiveness of upright compression, and to clarify its utility and limitations as a screening modality.

 Methods: We evaluated 682 individuals who underwent gastric X-ray examinations at our institution in June 2024. The performance and success rates of the upright compression technique were assessed. Additionally, among 101 patients referred for further evaluation between April and December 2024, we examined the diagnostic contribution of compression imaging. Image adequacy was determined based on the degree of compression at the target site, image density, and barium coating. Statistical analyses included the chi-square test, Mann–Whitney U test, and logistic regression.

 Results: The implementation rate of upright compression was 81.8% (558/682), with a completion rate of 68.6% (468/682). Adequate compression images across all four target regions were obtained in 47.5% (324/682). Multivariate analysis identified independent predictors of successful compression: female sex (OR 3.80, 95% CI 2.41–6.07), lower BMI (per 5 kg/m² decrease: OR 1.92, 95% CI 1.29–2.91), non-transverse stomach (OR 2.06, 95% CI 1.14–3.76), and operator experience (per 5-year increase: OR 1.32, 95% CI 1.18–1.48). Among 45 evaluable cases in the follow-up cohort, compression was performed in 22, of which 10 (45.5%) demonstrated additional diagnostic value. Higher operator experience was significantly associated with improved effectiveness (median 30.0 vs. 7.0 years, p<0.01).

 Conclusion: The success of upright compression is influenced by patient sex, BMI, gastric morphology, and operator experience. Establishing standardized procedural criteria and strengthening training systems may enhance diagnostic accuracy in gastric screening.

 [Background and Objective] In gastric X-ray screening using upright compression, some cases show inadequate compression. This study aimed to identify factors affecting the effectiveness of compression imaging.

 [Subjects and Methods] A total of 800 individuals (400 men and 400 women) who underwent gastric X-ray screening were examined. Cases showing clear radiolucency in all four gastric regions (body, angle, antrum, and prepyloric area) were classified as the effective group, and those without full radiolucency were the ineffective group. Gender, BMI, and gastric morphology were compared between groups. In the effective group, images showing mucosal folds and areae gastricae were defined as high-quality, and the regions most likely to yield such quality were evaluated.

 [Results] The effective group included 344 cases (43%). Women were significantly more frequent in the effective group (68.6%) compared to the ineffective group (36.0%) (p < 0.01). Fewer individuals in the effective group had a BMI ≥ 25 (10.8% vs. 31.4%, p < 0.01). Hook-shaped stomachs were more prevalent in the effective group (93.0% vs. 66.9%, p < 0.01). High-quality images in the effective group were obtained most frequently in the prepyloric area (96.5%), followed by the body (70.1%), angle (45.3%), and antrum (39.5%).

 [Conclusion] Gender, BMI, and gastric shape influence the effectiveness of compression imaging. The prepyloric region, likely due to its anatomical characteristics, yields consistently high image quality. These findings suggest the need to consider individual patient factors and potentially redefine imaging protocols with emphasis on the prepyloric area as a primary target.

 Objective: To clarify the usefulness of the compression method in X-ray screening for stomach cancer.

 Subjects: 71 cases of gastric cancer and gastric adenoma discovered during gastric cancer X-ray screening conducted at our affiliated facilities.

 Methods: The degree of clarity of the lesion morphology shown on double-contrast images and compression images obtained using the standard radiography was defined as the degree of lesion visualization. The degree of lesion visualization was assessed based on retrospectively obtained endoscopic or resected specimens and macroscopic findings, and was divided into two categories: good and poor. Study 1. Lesion visualization on double-contrast and compression images, Study 2. Lesion visualization on compression images by lesion factor (① area, ② wall side, ③ macroscopic type, ④ size).

 Results: Study 1. The degree of lesion visualization in double-contrast images was good in 85.9% (61/71) and poor in 14.1% (10/71), while the degree of lesion visualization in compression images was good in 76.1% (54/71) and poor in 23.9% (17/71), with no significant difference observed between the degree of lesion visualization in double-contrast and compression images. In particular, eight out of 10 cases with poor double contrast images had good compression images. Study 2. By lesion factor, ③ macroscopic type 1 to 5 was significantly better than type 0, but no differences in lesion visualization were observed by ① area, ② wall, or ④ size.

 Conclusion: In gastric cancer X-ray screening, the compression method is useful for visualizing lesions and is considered to be a method that can complement the double contrast method.

 Steatotic liver disease (SLD) encompasses metabolic dysfunction-associated steatotic liver disease (MASLD), alcohol-associated liver disease (ALD), drug-induced liver injury, and metabolic dysfunction-associated alcohol-related liver disease (MetALD), which represents an intermediate condition between MASLD and ALD. Significant progress has been made in the development of non-invasive diagnostic methods. In 2024, serum CK-18F was approved for insurance coverage in Japan as an adjunctive diagnostic tool for metabolic dysfunction-associated steatohepatitis (MASH). The CLIONE study demonstrated that the degree of liver fibrosis is a critical factor in predicting the occurrence of liver disease-related events. For non-invasive assessment of liver fibrosis, the FIB-4 index is recommended as a first-step screening tool. For second-step evaluations, imaging techniques such as ultrasound elastography or magnetic resonance elastography, as well as fibrosis biomarkers, are considered useful. Among fibrosis biomarkers, type IV collagen 7S and Mac-2 binding protein glycosylation isomer have proven utility. Additionally, the globally standardized ELF (enhanced liver fibrosis) test received insurance coverage in 2024. The Nara Declaration 2023 was issued with the aim of early detection of chronic liver diseases, but it has not been approved by all stakeholder. Regarding pharmacological therapy, the U.S. Food and Drug Administration (FDA) approved the thyroid hormone receptor-beta agonist resmetirom; however, it has not yet been approved in Japan. The GLP-1 receptor agonist semaglutide demonstrated significant improvements in MASH or liver fibrosis compared to placebo in the Phase 3 ESSENCE trial, raising expectations for its approval in Japan. Other promising antidiabetic agents include SGLT2 inhibitors and the dual GLP-1/GIP receptor agonist tirzepatide. In cases of hypertriglyceridemia with MASLD, pemafibrate is recommended based on findings from the PORTRAIT trial, which showed its superiority over DHA/EPA in patients with elevated triglycerides.

 Background: The study aimed to assess the prevalence of fatty liver screening and identify predictive factors for the efficacy of SGLT2 inhibitor treatment in diabetic patients.

 Methods: A total of 916 SLD patients who received SGLT2 inhibitors for more than 6 months since 2014 were included. The rate of liver imaging tests before and after treatment was evaluated. Additionally, 263 diabetic patients with SLD who received SGLT2 inhibitors for over 1 year were analyzed for changes in platelet count, liver enzymes, liver function, and fibrosis markers before and after treatment.

 Results: The rate of liver imaging tests was 69.4%, and the prevalence of MASLD was 57.7%. Significant reductions in ALT, ALP, γGT, and ALBI score were observed after SGLT2 inhibitor treatment, while the FIB-4 index did not show improvement. Stratified analysis revealed that ALT, ALP, γGT, ALBI score, and FIB-4 index improved in the MASLD group, whereas γGT and FIB-4 index worsened in the MetALD group. Factors associated with a high FIB-4 index after 1 year, indicating non-improvement of liver fibrosis, included high pre-treatment FIB-4 index and high alcohol consumption.

 Conclusion: The importance of liver disease screening in diabetic patients is reaffirmed, with a need for appropriate treatment and evaluation of prognostic factors for MASLD patients. Further research is expected to clarify the effects and contribute to clinical application.

 The standard 12-lead electrocardiogram (ECG) test is one of the key examinations in comprehensive health checkups. In interpreting its results, automated ECG diagnosis serves as an important reference indicator. Through years of research by predecessors and advances in computer technology, automated diagnosis has achieved high accuracy and reliability. However, since some diseases do not present ECG abnormalities, it may not be diagnosed with all conditions. The Minnesota Code is an excellent classification system that is useful for ECG diagnosis and interpretation of findings. However, the question remains as to how to interpret findings with a wide range of possible meanings. Strict interpretation reduces overdiagnosis but increases the number of missed diagnoses. Broad interpretation reduces missed diagnoses but may lead to accusations of overdiagnosis. Furthermore, even with current diagnostic program technology, there are pitfalls that cannot be completely resolved when performing automatic diagnosis. Even when pacing spikes are clearly distinguishable by visual inspection, automatic diagnosis may fail to recognize them. Furthermore, while "judgment" requires comprehensive assessment based on automatic diagnosis results, the criteria for judgment are not standardized, and it is necessary to consider information other than ECG findings. It is important to recognize these limitations of automatic ECG diagnosis and to utilize it in comprehensive health checkups with this awareness.

 Recent advances in longevity research have underscored the growing importance of anti-aging medical checkups as a preventive strategy against age-related diseases. Conditions such as cardiovascular disease, cancer, and immune dysfunction are increasingly understood to stem from biological aging processes, including vascular and immunological aging. Anti-aging checkups aim to detect these changes at an early stage and mitigate future disease risk through targeted interventions.

 Unlike standard health screenings, anti-aging checkups involve specialized assessments tailored to aging-related biomarkers, with test selection varying by facility. AAD LifeWorks is one such initiative currently in beta development. Its diagnostic framework categorizes results into two domains: current aging status and aging risk factors. Each domain is evaluated using five indicators and visualized via radar charts, enabling identification of individual vulnerabilities. Since aging progresses heterogeneously across systems, the approach emphasizes strengthening weaker domains to promote overall physiological resilience.

 To support broader adoption, a web-based platform for AAD LifeWorks was developed beginning in 2022. The system enables secure data upload, automated analysis, and personalized lifestyle guidance. The output includes a 20-page report with pre-filled medical advice, which can be customized by physicians familiar with the patient's context. While the platform enhances usability and clinical integration, future challenges include raising public awareness, embedding the system into routine practice, and ensuring equitable cost distribution for testing.