Objective: We administer sedatives intravenously to examinees from whom informed consent was obtained after an inquiry prior to upper gastrointestinal endoscopy (GFS). In this study, we investigated the effects of sedatives on pain by a questionnaire survey. Methods: We conducted a questionnaire survey at the end of all examinations (survey period: May 2006 to March 2007, subjects: 2,432 patients undergoing GFS). The questionnaire consisted of items concerning discomfort during GFS and health check-up parameters, including the waiting time, health professionals' attitudes, and satisfaction with health check-up items. Results: There was a significant difference (p<0.05) between the examinees (842) who responded that sedatives reduced discomfort during GFS and those (181) who responded that it was comfortable without sedatives. However, it was painful despite the use of sedatives in 784 patients. In addition, the side effects of sedatives were observed in approximately 20% of the examinees. Therefore, the questionnaire was additionally analyzed, and reviewed. The waiting time before GFS was associated with the degree of pain during GFS. Examinees who reported less painful GFS felt that the waiting time was short, whereas those who reported painful GFS felt that the waiting time was long. Conclusions: Sedatives were useful for reducing pain. However, GFS was painful despite the use of sedatives in approximately 48% of the examinees, and we reviewed strategies to reduce pain. The waiting time before examination was associated with the degree of discomfort on GFS.

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Objective: To investigate the influence of stress on health, we analyzed lifestyle-related factors, the results of ningen dock, and their changes over 3 years in persons who underwent ningen dock, who considered their life to be stressful. Methods: The subjects were 3,244 persons who underwent a one day ningen dock between January 2004 and December 2006(2,242 males,1,002 females). They were divided into 3 groups based on responses to a question( “Do you sometimes feel stress?” ): Group A, No; Group B, Sometimes; and Group C, Relatively/always. Results: Approximately 15% of the subjects comprised Group C. The mean age was lower than those in Groups A and Bathe proportion of young company employees and housewives was high. Concerning lifestyle-related factors, their hobbies, enjoyment, and exercise were restricted. In addition, they complained of sleep disorder and various physical symptoms. Although the proportion of examinees without abnormalities was high, abnormal findings were newly detected in approximately 70% of these during the 3-year follow-up. In particular, lipid disorder was the most frequent, appearing in the early stage. In Group C, in which chronic stress and sleep disorder were noted,14.6% of the subjects had been treated due to psychiatric disorders including insomnia. Conclusions: In most young persons, the results of ningen dock did not suggest any abnormalities. However, in those complaining of stress and sleep disorder, abnormal findings may appear during the course, leading to physical and mental disorders. Physicians must understand the importance of sleep disorder. Ningen dock may contribute to early consultations, guidance, and treatment in Departments of Psychological Internal Medicine and Psychiatrics.

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Objective: We analyzed the significance of serum uric acid (UA) levels in the onset of chronic kidney disease (CKD). Methods: We investigated the correlation of the estimated glomerular filtration rate (eGFR), by the formala which was established by the Modification of Diet in Renal Disease (MDRD) study group, with age, BMI, blood pressure, and other laboratory data via correlation analysis based on the data on initial consultation from 71,632 persons (50,363 males,21,269 females) who underwent an annual ningen dock in the Toranomon Hospital over the past 21 years. Among males who had regularly undergone ningen dock for more than 3 years after 1995,7,026 without CKD on initial consultation were stratified into 4 groups based on the initial UA levels, and the incidence of newly developing CKD was analyzed using Cox's proportional hazard model. Results: UA was correlated with eGFR, the correlation coefficient was similar to that of urea nitrogen in females, and followed that in males. In patients with a UA level of 5.1 mg /dl or more on initial consultation, including hyperuricemia (7.1 mg/dl or more) patients, the incidence of newly deveioping CKD was significantly higher than that in those with a UA level of less than 5.1 mg/dl. Conclusion: The UA level may be not only an independent risk factor for the onset of CKD but also a prognostic indicator.

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Objective: Our health care center was established as a hospital annex in June 2007. Herein, we report on the medical examination system that is linked to an electronic medical record system using medical equipment at our hospital. Methods: Examinees use medical equipment installed in the hospital and the center. The systems operating in the center are classified into the following three general categories: an electronic medical record system, a medical examination system, and a uniquely developed system. Results: Examinee IDs and outpatient IDs were made common to allow examinees to use equipment in the hospital. Conclusion: The medical examination system developed herein was put into service as one of the hospital information systems under common operation where medical equipment is shared and linked to an electronic medical record system.

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Objective: We have examined the relevance of responses to a questionnaire relating to a person's work environment, administered during an interview undertaken as a part of the check-up procedure of the ningen dock, in relationship to their lifestyle. We have studied a total of 4,540 people (2,869 men and 1,671 women) who consulted a physician at a health clinic between January and December,2005. Methods: We investigated the relationship between work and lifestyle by using eight questionnaire items concerning work (six items relating to attitudes to work and two work situation items) in addition to the normal interview. Results: We examined the relationship between exercise, smoking and drinking habits and the question “Do you feel your work is worthwhile ? ” The result indicated that a person's work situation and attitudes towards work are important environmental factors to be considered when the person's lifestyle is reviewed. Conclusion: According to our results, a questionnaire relating to a person's work environment is a useful part of any ningen dock consultation.

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Objective: Transnasal endoscopy causes nasal pain at the time of insertion in many patients. In this study, we evaluated the usefulness of pretreatment by the intranasal insertion of Nelaton's catheter (16Fr) as a strategy to control transnasal endoscopy-related nasal pain. Subjects and Methods: We performed transnasal endoscopy (GIF-N260) in 80patients in whom the vomiting reflex was particularly marked between January and March 2006. The subjects were randomly divided into 2 groups: Group A in which Nelaton's catheter was not employed for pretreatment (n=40) and Group B in which it was employed (n=40). We conducted a questionnaire survey regarding the grade of pain and stress. For basic nasal mucosal anesthesia, a mixture of 4% lidocaine hydrochloride solution at 9 ml and 0.1% epinephrine solution at 1 ml was sprayed. Results: Our questionnaire survey showed that the scores of nasal pain at the time of insertion(0-10)were 4.1-12.4 and 3.8±1.9 in Groups A and B in males, respectively. In females, the scores were 4.5 ± 2.3 and 3.2 ±2.1, respectively, with a significant difference (p<0.05). The global stress scores were 2.7±1.1 and 2.8± 1.4 in Groups A and B in males, respectively. In females, the scores were 3.9-12.2 and 2.2± 1.1, respectively, with a significant difference (p<0.05). In Group B consisting of females, the proportion of patients who wished to undergo transnasal endoscopy on subsequent examination was significantly higher than that in Group A (p<0.05). Conclusion: For transnasal endoscopy in females, pretreatment by Nelaton's catheter insertion following basic anesthesia reduced nasal pain and the grade of examination-related stress.

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Objective: Metabolic syndrome (MS) causes arteriosclerotic disorders via visceral fat accumulation. In Japan, a diagnostic criteria for MS include waist circumference of 85cm or more in males and 90cm or more in females. This is because a visceral fat area of 100cm² or more is considered to correspond to the above waist circumference. In this study, we investigated the association between waist circumference and visceral fat area based on health check-up results of persons who consulted our clinic. Methods: The subjects were 176males who underwent abdominal CT in our clinic between October and December 2006. We examined the correlation between visceral fat area obtained from CT image and waist circumference. Results: In the males, there was a positive correlation between waist circumference and visceral fat area, suggesting the usefulness of the former. In 20% of these, visceral fat area was 100cm² or more despite waist circumference of less than 85cm. Furthermore,23% showed waist circumference exceeding 85cm despite visceral fat area of less than 100cm². Conclusions: Waist circumference, of 85cm or more, as a diagnostic criterion for MS in males, was statistically equivalent to visceral fat area of 100cm² or more. However, it should be considered that 20% of patients are overlooked.

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Objective: For safe and efficient endoscopy, we introduced an information management system with importance being placed on patients' individuality. The method of its use and results are reported. Methods: A medical interview was performed with informed consent, and high-risk patients in examinations and the use of drugs were identified. After production of physician's direction and confirmation forms, medical examination and history taking were performed by physicians. All information was inputted into the information management system and utilized at the time of pretreatment and examination assistance. After examination, useful information for examination is inputted again into the information management system and fed back in the next examination. Complications that developed in endoscopic examination of 87,201 cases during a 6-year period after the introduction of this system were evaluated. Results: Interview work could be standardized, and its efficiency was increased using a detailed consent form. High-risk patients were identified by this interview, and physicians' direction and confirmation forms were issued to transmit information to physicians. This check system was useful for preventing complications. The information management system also promoted information sharing between nurses in charge of interviews and those in charge of endoscopy, and endoscopy-related nursing according to patients' individuality became possible. Re-input and feedback of useful information on patients could promote a data source that provides information on examinations with importance being placed on patients' individuality, on risk avoidance, and on degree of patient satisfaction. Since the introduction of the information management system, no serious complications have developed. Conclusion: Our information management system increased the efficiency of interview and endoscopy-related nursing activities, allowed safe examination, and facilitated coping with claims and the risk management of complications.

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Objective Early stage postprandial hyperglycemia (PPHG) screening is extremely important in order to prevent diabetes and macroangiopathy. We devised an efficient screen method for PPHG without oral glucose tolerance test (OGTT) and compared with conventional methods. Using this method (the KKC method), we estimated the number of subjects with PPHG in ningen dock. Method Consented 230 subjects received fasting plasma glucose (FPG) test, HbA1c test,1,5-anhydroglucitol (1,5-AG) test and OGTT. Gender-segregated cutoff values for 1,5-AG were set and the 1,5-AG level was combined with the FPG level in cases that fell close to the 1,5-AG threshold. We compared this method with conventional methods using FPG and HbA1c. Then we divided 2,708,538subjects of ningen dock into 4 groups by age; under 40,40-49,50-59,60 and over. We estimated the number of subjects with PPHG in 4 groups respectively; 520,242,832,152,902,344 and 453,800 subjects using the KKC method. Results We obtained a sensitivity 85.9% and a specificity 79.7% using the KKC method. We obtained a sensitivity of 91.3%(under 40),86.6% (40-49),84.8% (50-59),83.3% (60 and over) by this method. We could estimate 48,278,97,927,113,680 and 63,012 new subjects with PPHG in 4 groups additionally. Conclusion We could discover new younger subjects with PPHG more efficiently than older subjects in ningen dock.

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Objective: Clinical significance of anti-cyclic citrullinated peptide (CCP) antibody was investigated in patients with positive results of IgM rheumatoid factor (RF) received medical screening for health (Ningen Dock). Methods: The subjects consisted of 6 patients. They were examined in outpatient clinic for physical states, hand X-ray films and serological data. Results: One patient was diagnosed as having early onset of rheumatoid arthritis (RA), and another one patient was diagnosed as having Sjogren' s syndrome. RAPA and anti-agalactosyl IgG antibody were found in sera from these two patients, although IgG rheumatid factor was negative in all 6 sera. Therefore, these RAPA, anti-agalactosyl IgG antibody and IgG rheumatoid factor were considered not to be specific for patients with RA. The level of MMP-3 was high in serum from a patient with RA. However, it has been reported that MMP-3 is not a marker for RA, and that the level of MMP-3 is also high in patients with other collagen diseases and polymyalgia rheumatica. Anti-CCP antibody was solely positive in serum from a patient with RA, and the level of anti-CCP antibody was extremely high in this patient. Conclusion: Anti-CCP antibody is useful for early diagnosis of rheumatoid arthritis in patients with positive results of IgM rheumatoid factor in Ningen Dock.

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