Objective: We introduced the plan-do-check-act (PDCA) cycle as a centerpiece of the occupational safety and health management system to health guidance and discussed its methods. Methods: A project for the promotion of exercise for the prevention of lower back pain was performed in staff members of a small-scale local government. Considering that not only the evaluation of the contents of exercise but also the development of teaching materials and improvement in the instruction method are important, we instructed staff members in simple exercise techniques, developed an original brochure and video, visited each workplace, and directly distributed them, introducing the exercise. Results: Though effects of our exercise method were expected, it was not performed in any workplace. To improve this situation, the results of a questionnaire suggested the importance of the enhancement of staff members eagerness for health management. Conclusion: For the further promotion of an exercise habit, an environment increasing the eagerness to perform exercise throughout the entire workplace may be necessary. In the present attempt, the introduction of the PDCA cycle allowed the identification of problems and measures for improvement. Also, since we evaluated the measures for the spread of exercise guidance for the prevention of lower back pain in the workplace, this method can be also applied to health guidance for lifestyle-related diseases.

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Objective: The purpose of this study was to evaluate the association between body composition and the prevalence of metabolic syndrome (MetS). Methods: The subjects were middle-aged males and females who underwent a ningen dock or health checkup examination. BMI (B), body fat ratio (F), and estimated visceral fat area (V: cm2) were measured using a body composition analyzer by the upper/lower limb impedance method. The males and females were separately classified according to whether the value in each item (B, F, V) is in the standard range (o) or not (x) into 8 groups with different body composition types. The prevalence of MetS diagnosed on the same day was evaluated for each body composition type. Results: The body composition types frequently observed were BoFoVo(30.8%), BxFxVx(26.5%), and BoFxVx(20.5%)in the males and BoFoVo(62.2%)and BoFoVo(23.1%) in the females. The prevalence of MetS was 19.7%in the males and 2.4% in the females. In the males, MetS was most frequently observed in the group with BxFxVx (44.4%), followed by the group with BoFxVx (34.7%), and the group with BoFoVx (22.2%). In the females, MetS was observed in43.3%in the group with BxFxVx but was not observed in any other body composition group. Conclusion: Body composition classification allows concrete health guidance appropriate to individual body composition in males and females separately. Since MetS prevalence differed among the body composition types, a high risk group for MetS can be extracted by body composition classification.

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Objective: By Ministry of Health Labour and Welfare, it has been shown that one of two in Japanese male, while one of five in Japanese female, is either MS or reserve subject (MS candidate). However, there is a little study about pathogenesis of reserve subjects, then we aimed to investigate about their insulin resistance. Methods: The 386 outpatients (262 men and 124 women) who received medical screening for health (Ningen Dock) at Megumino Hospital from October 2005 to May 2006 were used to this present study. These outpatients were devided into three groups: MS, reserve and noncorrespond group. Added to routine examinations, Homeostasis model assessment of insulin resistance (HOMA-R) was determined. Results: Of male patients, MS group was 17%, reserve group25% and noncorrespond group 58%. Average value of HOMA-R in three groups 3.00,2.12 and 1.32, and the appearance rate of abnormally increased HOMA-R 48%,25% and 12%, in order. Of female, MS was 3%, reserve 13% and noncorrespod 84%. Average value of HOMA-R 3.88,2.36 and 1.07, and the appearance rate of abnormally increased resistance 75%,31% and 10% in order. The data indicates that an increase of insulin resitance occurs already at the stage of reserve group, and is enhanced following progress into MS. (Conclusion): In order to promote preventation of MS, it could be important to pick up not only MS group but also reserve group, and to try reduction of insulin resistannce.

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Objective and Methods: The basic approach for health promotion is simply to improve lifestyle habits, and it is important to see this as being based on the intent of individuals and voluntary. Further epidemiological studies showed that it must be noted that coordination training needed to be focused on, and knowing about these, or mental coordination training was also found to exist and was added as a result. Results: Current middle-aged people (people that are currently working) still tend to be passive with regard to exercise habits and nutrition habits, and it was realized that it is desirable to first provide guidance to ensure this behavior becomes active, centric and voluntary. Conclusions: In providing the guidance, the most important thing is to create programs suiting individual needs, and mental training must not be forgotten. In particular, many (more than80%) of the people that are currently working who wish to continue working when they are older (after mandatory retirement age) understand this and continue exercising, showing that there is a clear effect on improvement of lifestyle habits.

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Objective: Specific health examination and health guidance system will become compulsory from 2008. The Ministry of Health, Labour and Welfare has announced standard guidelines. In the future, it may be important to select high-risk subjects and improve the efficiency of guidance contents based on the guidelines. Methods: In this study, based on the waist circumference (male: 85cm, female: 90cm) and body mass index(BMI)(25kg/m2), we classified subjects who underwent a health examination into 4 types: low risk type(LRT), in which the two parameters are low, subcutaneous fat type(SET), in which only the BMI is high, visceral fat type(VET), in which only the waist circumference is high, and pathogenic obesity type (POT), in which the two parameters are high. We investigated the incidence of metabolic abnormality with respect to age, and analyzed lifestyle with respect to the physical status. Results: In the POT group, a higher proportion of subjects aged 30years or above showed the concurrent development of several metabolic disorders in comparison with the LRT group. In addition, the incidence increased with age. In the VET and POT groups, the odds ratios for smoking and alcohol ingestion were high, suggesting their marked influence on visceral fat accumulation. Conclusion: These results suggest that health guidance starting early after detection is important in the POT group, and that guidance on abstinence from smoking and drinking is effective in such a group.

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Objective: The author has reported that total cholesterol levels decrease significantly of those with hypercholesterolemia when they stop to take eggs and milk. In the study changes of serum lipids; total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C) were compared between the results of the current year and the previous year of ningen dock. Materials and Methods: 418 workers (258 males and 160 females) at five companies where the author was an occupational health doctor responded to the questionnaire about the condition of ingestion of eggs and milk from 2001 to 2004.418 subjects were divided three groups; Group A (282 subjects) who took eggs and milk usually, Group B (56 subjects) who stopped to take them and Group C (80 subjects) who did not take them as usual. Also all subjects were divided four subgroups; a subgroup was 280mg/dl and more, b subgroup 280mg/dl-250mg /dl, c subgroup 250mg/dl-220mg/dl, and d subgroup less than 220mg/dl according to the TC levels of the previous year. Results: About the relations of serum lipids there were a linear relationship between TC (x) and LDL-C (y), y=0.76x-32(r=0.72) and an exponential relationship between TG (x) and HDL-C (y), y=160x^-0.2(r=0.20). In Group A, TC levels (mean) changed 292mg/dl to 287mg/dl,261mg/dl to 258mg/dl,233mg/dl to 241mg/dl, and 190mg /dl to 204mg/dl in a, b, c and d subgroups respectively. Also HDL-C levels of c subgroup and LDL-C levels of c and d subgroups increased significantly. In Group B, TC levels decreased 316m/dl to 255mg/dl,265mg/dl to 233mg/dl,237mg/dl to 215mg/dl and 179mg/dl to 160mg/dl in a, b, c and d subgroups respectively. LDL-C levels also decreased significantly. In Group C, serum lipids did not changed significantly in all subgroups. Conclusions: TC and LDL-C levels decreased significantly after stopping to ingest eggs and milk especially in hypercholesterolemia. The higher TC levels were, the more TC and LDL-C levels decreased. It could be necessary to reduce TG levels in order to increase HDL-C levels because of an exponential relationship between them.

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Objective: We performed ningen dock using gastroscopy, sigmoid colonoscopy(SCS), and ultrasonography (US) to detect malignant tumors in the early stage, and investigated its usefulness and limitations. Methods: The subjects were 25,980 persons who underwent our ningen dock between 1989 and 2006. Results: Malignant tumors were detected in 122patients(detection rate: 0.47%). The stage was evaluated as I or lower in 80.3% of the lesions. The 5-year survival rate was 93.1%. The malignant tumors consisted of malignant gastric tumors in 55 patients, colorectal cancer in 32, thyroid cancer in 11, lung cancer in 8, breast cancer in 7, liver cancer in 2, leukemia in 2, renal cell carcinoma in 1, ovarian cancer in 1, prostate cancer in 1, bladder cancer in 1, and malignant lymphoma in 1. Concerning the malignant gastric tumors, the detection and early cancer rates were 0.21% and 83.6%, respectively, suggesting the usefulness of gastroscopy. The annual detection rate on ningen dock was 33%. Concerning colorectal cancer, the detection and early cancer rates were 0.12% and 75%, respectively. This was because subjects requiring detailed examination were not followed-up. SCS was useful for detecting colorectal cancer. US revealed breast cancer in 5 patients. However, the detection rate was low, which was possibly associated with a low initial consultation rate. Furthermore, US of the thyroid revealed thyroid cancer in 11 patients. Conclusion: Our ningen dock using gastroscopy, SCS, and US was useful for detecting malignant tumors in the early stage. To improve the detection rate, the number of subjects who initially undergo this ningen dock should be increased, and it must be recommended to undergo annual ningen dock. In addition, a follow-up system for subjects requiring detailed examination must be established.

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Objective: The delay of serum separation from blood specimens is reported to induce changes in the level of serum potassium and the changes are affected by the time of the delay and the temperature surrounding blood specimens. We examined changes in the ratio of hypokalemia(≤3.4mEq/L) and hyperkalemia(≥5.1mEq/L) due to a delay in serum separation observed at an institution for health checkup in Tokyo. Methods: We analyzed the data of 2645 subjects who underwent a health checkup during the seven months from April to October in 2003. Sera were separated from blood specimens 7-10 hours after taking blood in April to July and 0.5-1 hours after taking blood in July to October. Results: The ratio of hypokalemia was12.7% in April,14.1% in May,21.5% in June,24.5% in July,1.6%in August,0.8% in September and 0.6% in October. The ratio of hyperkalemia was 0.28% in April to July and 0.58% in August to October. Conclusions: The ratio of pseudhypokalemia was increased markedly by leaving blood specimens at room temperature without serum separation for 7-10 hours between April and July in Tokyo. Sera should be separated soon after taking blood.

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