Objective and Methods: “Speediness” and “Courtesy” are two essential factors for gaining the satisfaction of medical examinees, though these factors could be incompatible with each other. We have focused on these factors since our medical check-up division was established in 2006. Two years after establishing it, we conducted a customer satisfaction survey using a 23-item questionnaire with a choice of 5 graded responses for each question. The responses of 167 people were analyzed.
Results: Ninety percent of the respondents were satisfied with our service. About 70% of them said they would visit our division again due to the “courtesy” of doctors and “cleanness” of waiting rooms. About 55% would recommend others to select our division due to the “courtesy” of doctors and “speediness” of our system.
Conclusion: “Courtesy” of doctors, “cleanness” of waiting rooms and “speediness” are important factors for examinees in selecting medical check-up facilities.

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Background: As it is difficult for people who have normal results in brain check-up to appreciate the future risk of cerebrovascular disease (CVD), we developed computer software to explain the results of brain check-up to examinees as well as the potential risk of CVD.
Methods: Brain magnetic resonance imaging (MRI), blood test, urinalysis and blood pressure data obtained from a series of 2,023 brain check-up examinees were analyzed and based on this data, we used our newly developed software to produce graphs showing the examinees’ current results and CVD prevalence rates.
Results: Regarding the 2 graphs produced by the data analysis, 1 was based on 7 parameters - age, creatinine, uric acid, red blood cell count, systolic pressure, C-reactive protein, and urine glucose and the other on 2 parameters - age and systolic pressure. Subject data was classified according to 6 categories. Examinees in the poor category were considered to have an increased risk of CVD.
Conclusion: The graphs produced by the new software we developed have been successful in educating examinees about the risk of CVD and even those with normal results can understand the potential risk. This software could contribute to raising awareness of the future risk of CVD.

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Objective: Among people (n=652) who underwent health check-ups at our hospital, we compared the results of the pulse wave velocity test (PWV) for those who had been diagnosed with metabolic syndrome and those who had not.
Methods: First, the examinees were divided into 3 groups: metabolic syndrome group (MetS), non-metabolic syndrome group (non-MetS) and normal group, and then further divided into an A group (PWV ≥ 1,600cm/sec) and a B group (PWV <1,600cm/sec).
The groups were then compared using multiple medical check-up factors.
Results: The proportion of all examinees diagnosed with MetS was 43.7%. There were significant differences between the MetS and non-MetS groups as regards PWV , gender, GPT, γ-GTP,uric acid, serum creatinine, and BMI. For the MetS group, there were significant differences regarding age and maximum blood pressure between the A and B subgroups while for the non-MetS group, there were significant differences regarding gender, age, maximum blood pressure, minimum blood pressure, GOT, and fasting plasma glucose between the A and B subgroups. For the normal group, there were significant differences in age, maximum blood pressure and minimum blood pressure between the A and B groups.
Conclusion: As high PWV values were also observed in the non-MetS groups, such people should also have proper health counseling concerning arteriosclerosis.

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Objective: Our objective was to determine the kind of continuous support provided in specific health guidance that would lead to behavioral changes and to clarify the conditions necessary for people to continue such modified behavior by themselves.
Methods: We selected 10 people from among those insured with health insurance associations with which our hospital has agreements to provide specific health guidance and underwent one-day ningen dock checkups during the period July to October 2008. Our subjects had either received “active support” or “motivational support” and we interviewed them concerning the type of continuous support that would be feasible, behavioral improvements and other aspects. The interview results were categorized in accordance with the open coding of the grounded theory approach and then subjected to qualitative analysis.
Results: The analysis revealed “clear motivation” and objective setting in consideration of “actions feasible for the individual” as important factors in promoting behavioral changes and “lack of medical knowledge” and “stress” as inhibitory factors.
Conclusion: In order to enhance continuity in support of behavioral modification, it would be necessary to provide abundant information concerning the importance of prevention and support systems as well as that in consideration of individual characteristics.

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Objective: Pepsinogen I and II (PG I and PG II) levels in the blood are good indicators of gastric activity, and can be used independently or in combination to monitor for peptic ulcer and atrophic gastritis in the screening of patients at high risk of stomach cancer. In particular, PG I/II ratio is being increasingly used in routine health screening and other medical check-ups. In the present study, CIAS LATEX™ PG I and PG II latex immunoassays were evaluated with regard to fundamental performance and screening in medical check-ups.
Materials and Methods: Assays were performed using a TBA™-c8000 automated analyzer. A total of 678 samples obtained during medical checkups were analyzed.
Results: The fundamental performance of the assay was good. In a clinical assessment, positive rates for the latex immunoassay and chemiluminescent assay were 8.0% and 12.6%, respectively. The coincidence rates were 95.1%, and 96.9% of disagreements were positive for the chemiluminescent assay but negative for the latex immunoassay. In addition, upper esophagogastroduodenoscopy and endoscopic diagnosis findings for 51 subjects in whom there was disagreement for both assays produced concordance rates of 68.6% for the latex immunoassay and 56.9% for the chemiluminescent assay. The positive rate increased with age. It was <3% in the <49 years group and >11% in the >50 years group.
Conclusions: The results reported here indicate that the accuracy and precision of the latex immunoassay were very high. Also, as this assay can be adapted for use with a universal automated analyzer, it would be useful in pepsinogen level testing in health screening and other medical check-ups.

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Objective: To assess the possibility of using regulated meal load for myoinositol measurement instead of glucose loading.
Methods: Subjects were 47 volunteers who underwent 75-g oral glucose tolerance testing (OGTT) and were classified according to 1998 WHO criteria. For subjects with normal glucose tolerance, those with 1 h plasma glucose ≥180 mg/dl were defined as pre-borderline. On a separate day, the subjects also underwent a regulated meal load test (MT). We measured urinary myoinositol before and 2 h after both OGTT and MT and then change in urinary myoinositol (ΔUMI: myoinositol/creatinine ratio 2 h after loading-myoinositol/creatinine ratio before loading) was compared between the 2 tests. In addition, we investigated the relationship between glucose intolerance and ΔUMI.
Results: A good correlation was seen between ΔUMI for OGTT and that for MT (r=0.853). Lower glucose tolerance was associated with a greater ΔUMI. Setting 6 mg/gCr as a tentative cut-off value for MT to detect glucose intolerance, ΔUMI was positive in 93.3% of patients (14/15) with diabetes mellitus (DM) and 100% (6/6) with impaired glucose tolerance (IGT). Conversely, for OGTT, ΔUMI was positive in 100% of subjects with DM (15/15) and 66.7% of those with IGT (4/6). Thus the positive rate for ΔUMI of MT was quite similar to that of OGTT.
Conclusion: These results show that ΔUMI from the MT can be used as a non-invasive and sensitive marker of glucose intolerance since it is comparable to that from the OGTT.

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Objective: Despite the relatively high prevalence of thyroid disease, there are a few medical examination centers that test thyroid function. Recently, the Japan Thyroid Association has started treating subclinical hypothyroidism as a major clinical issue. In the present study, we investigated the prevalence and characteristics of thyroid dysfunction by means of serum TSH measurements.
Methods: The subjects were 10,330 men and 6,334 women who underwent health check-ups in 2005. The mean ages were 52.2 for males and 51.5 for females. Serum TSH concentrations were measured using a chemiluminescent immunoassay.
Results: The ranges of TSH concentrations in males, females and overall were, respectively, 0.35~3.31, 0.41~4.16 and 0.36~3.67μU/ml. The prevalence of low TSH(<0.1μU/ml) was 0.5% for males and 1.0% for females, and decreased with age. The prevalences of high TSH(≧5.0μU/ml) were, respectively, 1.3% and 1.7%, and increased with age. Based on the results for subjects who underwent detailed examinations, we estimated the prevalence of thyroid diseases. The prevalences for both Graves’disease and silent thyroiditis were 0.19% for males and 0.45% for females. That of overt hypothyroidism was 0.56% for males and 0.55% for females and the respective prevalences of subclinical hypothyroidism were 0.41% and 0.69%. In subjects with high TSH levels, the prevalences for Hashimoto’s thyroiditis were 38.5% and 61.1%, respectively. In a quarter of the subjects with high TSH levels, they had become normal at re-examination.
Conclusion: The prevalences of thyroid dysfunction requiring detailed examination as defined by low(<0.1) and high(≧5.0) TSH levels were 1.8% for males and 2.7% for females. This suggests that the measurement of serum TSH concentrations would be useful in ningen dock.

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Objective: Through appropriate support for lifestyle behavior changes under specific health guidance, a reduction in waist cirumference (WC) is considered attainable. For persons receiving specific health guidance in our hospital, we studied the connection between lifestyle habits and WC both in those in whom there was a sustained decrease and those for whom there was a rebound in WC after an initial decrease.
Subjects and Methods: Our subjects were 303 persons who completed 6 months of specific health guidance (active support 170 persons, motivational support 133 persons) in fiscal 2009. In them, we investigated WC, body weight and behavior modification scores (for diet, exercise, drinking and smoking) before receiving specific health guidance and at 3 (active support subjects only) and 6 months after beginning it.
Results: Six months of specific health guidance achieved a significant decrease in WC overall but the decrease of 3.8±3.8% for persons receiving active support was more significant than that for persons receiving motivational support of 2.4±4.1%. A significant negative correlation between behavior modification score and percentage decrease in WC was observed. However, this correlation was influenced by changes in eating and exercise habits but not by changes in drinking and smoking habits. For the 100 persons (59%) receiving active guidance, there was a decrease in WC of at least 2% after 3 months. In the remaining 3 months, 27% of these subjects achieved a further decrease of at least 2% but in 16% there was an increase of 2% or more in WC. For all of the 100 subjects who had achieved a decrease in WC in the first 3 months, in the second 3 months, there was a significant correlation between eating habits and WC reduction but there was no correlation between exercise habits and WC reduction.
Conclusion: The degree of reduction in WC during the 6 months of guidance was correlated with improvement in eating and exercise habits. The rebound in WC after an initial decrease was thought to be due to deterioration in eating habits.

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Objective: The effectiveness of endoscopic screening for gastric cancer was evaluated through comparison with X-ray screening which has been proved to be effective in reducing gastric cancer deaths.
Methods: We compared results for 8,807 participants examined by endoscopy in medical check-up from 1993 to 1999 and 36,876 participants examined using indirect X-rays in 1995.
Results: Gastric cancer and early cancer detection rates, and five year survival rates were 0.14%, 68.6% and 78.4%, respectively for X-ray screening and 0.34%, 93.9% and 97.0% for endoscopic screening, respectively, so the rates for the latter were higher. Subjects who were not diagnosed as having gastric cancer in the 2 screenings were referred to the Fukui Cancer Registry which is considered to be the most accurate population based cancer registry in Japan. There were 2 deaths due to gastric cancer in patients who underwent endoscopic screening and 41 for X-ray screening. The relative risk of gastric cancer death in the endoscopic screening group was 0.2042 as compared to the X-ray screening group.
Conclusions: We found a statistical difference in gastric cancer deaths between persons undergoing endoscopic screening and those having X-ray screening and our findings suggest that endoscopic screening would decrease gastric cancer deaths when used in health check-up.

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