Objective: We report on 4 thyrotoxic patients occasionally diagnosed from very slight biochemical changes due to thyroid hormone increases in a regular health check-up.
Methods and Results: They themselves were not aware of being in the thyrotoxic state and neither were physicians who had examined them because there were no symptoms. The thyrotoxic state had been discovered in more detailed examinations conducted after the regular check-up. The reasons for doing this were palpable goiter in 2 patients, increased serum alkaline phosphatase with slight tachycardia in 1 patient and low serum cholesterol in 1 patient. Three patients were diagnosed with painless thyroiditis from very low uptake of radioactive iodine by the thyroid gland, and they recovered without any treatment. There were increases and decreases in their serum thyroid hormone levels during the following period, which finally returned to normal without any treatment. The remaining patient was diagnosed with Plummer disease. Her thyroid nodule was not palpable and only detectable in an ultra-sonogram and a scintigram, which revealed that the nodule was functioning.
Conclusion: The incidence of painless thyroiditis in thyrotoxic patients occasionally diagnosed in a regular health check-up was high. They did not have prominent clinical thyrotoxic signs or symptoms. It was diagnosed from small changes in their laboratory data due to increases in thyroid hormone levels.

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Objective: The Japanese Red Cross Society Kumamoto Health Center has made efforts to provide better service based on customers' comments collected through the use of opinion boxes since March 2003. The number of comments praising our medical services was decreasing, while the number of complaints and suggestions remained about the same. We adopted an organized approach to analyzing the data we obtained and report on our approach to satisfying our customers needs and the success achieved. Study material: 1,537 opinions received from customers who visited our center for a general check-up from April 2009 to September 2010 were used as the material for our study.
Method: We obtained customers' comments through the use of written questionnaires, by verbal communication, e-mail, telephone and letters and then categorized them in a database, following the Method of Ishikawa. et al. We shared the resulting data with staff in each section using Groupware so that they could respond to customers' needs promptly.
Results: 58.9% of the comments concerned medical services and 41.1% other issues; 20.4% were complaints, 25.3% suggestions, and 54.3% were positive feedback. Using the database and Groupware, the results could be easily shared with all workers and improvements swiftly discussed, enabling us to respond appropriately to customers' comments.
Conclusions: The direct involvement of management staff in the program allowed standards to be set for specific responses in each case. Our efforts made feedback to customers smoother and raised staff awareness of customer needs at the same time.

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Objective: The purpose of this retrospective cohort study was to evaluate the relationship between oral-glucose tolerance tests (OGTT) and fasting plasma glucose (FPG) + hemoglobin A1c (HbA1c, JDS-value).
Methods: A total of 1,036 health check-up examinees were enrolled in the present study. They were examined for FPG, HbA1c, and OGTT at the same time.
Results: 1. Of 782 subjects with a FPG of ≤ 99 mg/dL, 9 (1.2 %) had an HbA1c level of 5.9 % ≤. 2. Four (0.9%) of 470 subjects with a FPG of ≤ 99 mg/dL and HbA1c of ≤ 5.1 % had “ OGTT 2hr-value ≥ 200mg/dL ” and 55 (11.7%) had “ 140 ≤ OGTT 2hr-value < 200mg/dL: impaired glucose tolerance (IGT) ” 3. Eleven (3.3%) of 326 subjects with FPG of 100 mg/dL ≤ or HbA1c of 5.2 % ≤ had “ OGTT 2hr-value ≥ 200mg/dL ” and 75 had IGT(23 %). 4. Eighty-three (35.0%)of 240 subjects with an FPG of 100 mg/dL ≤ and HbA1c of 5.2 % ≤ had “ OGTT 2hr-value ≥ 200mg/dL ” and 87 (36 %) had IGT.
Conclusion: The present study indicates that examining both FPG and HbA1c is important, and that people with an FPG of 100 mg/dL ≤ or HbA1c of 5.2 % ≤ should be given OGTT.

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Purpose: In June 2009, our institution introduced a new criterion for detecting chronic obstructive pulmonary disease (COPD) based on spirometric findings during the general health check-up. In this study, we investigated the validity and usefulness of this criterion.
Subjects and Methods: Our subjects were 16,744 health check-up examinees (10,108 men, 6,636 females) who underwent spirometry between June 2009 and May 2010, and those with airflow limitation (percent forced expiratory volume in one second (FEV1%) less than 70%) and reduced FEV1% (less than 80%) were recommended for further examination for diagnosis of COPD. Beginning in September 2009, smoking history and clinical history were also considered when determining the need for further examination.
Results: Of the 16,744 subjects, 475 (2.8%) met the criteria for airflow limitation and had a significantly lower FEV1%. Of them, 235 were referred to the hospital for further evaluation. This was 20 times higher than the number of referrals in the previous year. We investigated the results of detailed examinations for 200 subjects, and 144 of them (72%) were ultimately diagnosed as having COPD. Among these subjects with COPD, 25% were classified as stage I, 67% as stage II, and 8% as stage III. In 21 patients, medical treatment was initiated.
Conclusion: We considered our new criterion to be useful for the preliminary screening and detection of COPD

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Objective: Ultra-thin endoscopes used for transnasal endoscopy (TNE) have some problems regarding diagnosis, among them the lower resolution of their small charged coupled device(CCD), reduction in lens washing performance and difficulty in performing biopsy in the upward direction. We report the present situation of TNE in our hospital and discuss various ideas for improving the diagnostic capability of the ultrathin endoscope, for instance using 150 ml of dimethicon water in preparation, and a new biopsy operation.
Methods: We evaluated the trend in stomach cancer screening after introducing TNE in October 2004. We also evaluated some of our ideas from the standpoint of the stomach cancer detection rates and false negative detection rates in 9, 874 subjects from 2006 to 2009.
Results: The number of UGI series gradually decreased once TNE had become well-known and 49% of examinees preferred it. In the above period, we detected 21 cases of stomach cancer, a detection rate of 0.21%, and the false negative rate was 28.6%. These results were much the same as in previous studies.
Conclusions: We thought that the diagnostic capability of TNE was as good as that of conventional endoscopy and consider it to be a significant procedure for gastric cancer screening.

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Objective: We screened examinees with hypercalcemia in Ningen Dock for primary hyperparathyroidism.
Methods: Examinees were screened from July 1995 to December 2010. Serum calcium (Ca), phosphate and albumin (Alb) were measured using an auto-analyzer. Examinees with hypercalcemia were selected for primary hyperparathyroidism screening and their serum Ca levels were adjusted using serum Alb levels to provide corrected serum calcium(cCa) levels. For those with high serum Ca and cCa levels, serum parathyroid hormone(PTH)levels were measured for diagnosis of primary hyperparathyroidism. We also investigated examinees from July 2001 to December 2010 regarding a relationship between primary hyperparathyroidism and hypercalcemia.
Results: The total number of examinees was 1,936 (1,324 males, 612 females). The first case of serum high Ca and cCa levels was the 817th examinee since our Ningen Dock started, and the second was the 1,737th (920th case after first detected case). These 2 examinees were diagnosed with primary hyperparathyroidism due to high serum PTH levels. When we investigated 1,615 examinees during the period July 2001 to December 2010, high serum Ca levels were detected in 24 cases(1.5%). High serum cCa levels were detected in 3 cases, consisting of 2 cases of primary hyperparathyroidism and one of multiple myeloma.
Conclusions: On screening for primary hyperparathyroidism in Ningen Dock examinees, we detected 2 cases of primary hyperparathyroidism. The first case was the 817th examinee and the second case the 1,737th examinee. The detection rate for hyperparathyroidism in Ningen Dock seems to be about 1/1,000.

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Objective: We conducted a survey of the medical treatment patients with diabetes undergoing Ningen Dock health check-ups (hereafter Ningen Dock") were receiving and then considered the guidance they should be given concerning medication following Ningen Dock.
Methods: Examinees under drug therapy for diabetes were selected from among 2,613 persons undergoing Ningen Dock from January 4 to March 31 2010 and the status of their drug therapy was investigated using interview sheets.
Results: Among the 2,613 persons undergoing Ningen Dock, 64 were under medical treatment for diabetes. Ten of them were being treated by subcutaneous insulin injection (7 were also taking oral anti-diabetic agents), 53 were taking oral medication and the type of medication used by 1 patient was unknown. Though 1 patient had injected insulin before coming for examination and 1 had taken medication beforehand, there were no hypoglycemic symptoms in either.
Conclusion: Many persons coming to our institute for Ningen Dock are being treated and given guidance by various types of medical institution. It is difficult to obtain information on the guidance they have been given beforehand making it necessary to check this through interviews on the day they come for Ningen Dock. After Ningen Dock requiring fasting, instruction regarding oral medication and injections is particularly important and the nurses involved in this should ensure that their knowledge in this respect is always up-to-date so that they can provide evidence-based individual guidance and support. Doing this should lead to improved adherence among examinees with diabetes.

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Objective: We investigated the effect of Specific Health Guidance on the health behavior of the families of persons receiving it.
Subjects: Our subjects were the families of 33 persons receiving Specific Health Guidance from December 2009 to April 2010 (17 receiving active support, 16 receiving motivational support) whose results had been evaluated by our health management center.
Methods: After evaluating the results of Specific Health Guidance for the persons undergoing it, we conducted a questionnaire survey of their families to compare extents of cooperation from them and changes in their health behavior.
Results: Responses were received from 22 families (recovery rate 67%). Eleven families had been asked cooperation by recipients of Specific Health Guidance. Among these families, changes in health behavior were noted for 9 families and no changes for 2 families. As for the families who had not been asked for cooperation, changes in health behavior were observed for 3 families and no changes for 8 families. In addition, positive changes in health behavior were noted in families who had cooperated with recipients, such as regarding diet (eating more vegetables, etc.) for 7 families and doing exercise, such as walking together with the recipient, for 7 families (multiple responses).
Conclusion: Specific Health Guidance was having a beneficial effect not just on the persons receiving it but also on their families.

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Objective: We report on the problems found in the one-day Ningen Dock including endoscopy of the upper and lower gastrointestinal tract (digestive system course) conducted at our institution.
Methods: A questionnaire survey of examinees of our institute was conducted over a 2-week period (actually 11 working days) concerning the hardship, they suffered in endoscopic examinations or Ningen Dock examinations overall. Also, during the period of the survey, our staff recorded the times that examinees entered the room for each examination and the times that they came out, and calculated the approximate waiting time before undergoing each examination.
Results: Compared to examinees undergoing the general course (one-day Ningen Dock consisting only of endoscopy of the upper gastrointestinal tract), examinees taking the digestive system course spent over 2 hours more in our institute on average. It seemed that the degree of hardship for examinees taking the digestive system course was similar to that for those taking the general course. Regarding the endoscopy courses overall, the degree of hardship concerning preparatory procedures and waiting time seemed to be greater than that concerning the endoscopy itself.
Conclusion: Considering the ever-increasing incidence of colon cancer in Japan and the very busy lives of Japanese workers, we can expect the digestive system course to be continually useful in the future. In view of this, we aim to improve procedures in consideration of the findings regarding the hardship of examinees we became aware of in the current study.

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Objective: We investigated the risk factors of reflux esophagitis in healthy individuals focusing on lifestyle diseases, including metabolic syndrome, and reflux symptoms.
Methods: Our subjects were taken from 1,531 persons (884 males, 647 females) who underwent endoscopy of the upper gastrointestinal tract during Ningen Dock from January 2003 to November 2008. Those who had undergone surgery of the upper gastrointestinal tract, those taking medication for diseases of the upper gastrointestinal tract, hypertension, dyslipidemia, diabetes and hyperuricemia, and those with viral liver diseases and chronic liver diseases were excluded.
Results: Reflux esophagitis was observed in many men, with central obesity, metabolic syndrome and smoking as risk factors. In an analysis of a relationship between reflux symptoms and reflux esophagitis, there was a significant incidence of reflux esophagitis in persons with heartburn and the incidence of reflux esophagitis in subjects with many upper gastrointestinal tract symptoms was also significantly higher.
Conclusion: When heartburn or other reflux symptoms are present, endoscopy of the upper gastrointestinal tract should be conducted to check whether there is reflux esophagitis or not. Also in the case that a diagnosis of reflux esophagitis is accompanied by central obesity and metabolic syndrome, guidance on diet and exercise is important. Guidance regarding smoking cessation would also be important.

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Objective: With the switch to the Bethesda classification from the so-called Nichibo classification that has been in use up till now for reporting pap smear results, a revision of the Japan Society of Ningen Dock's guidelines concerning judgment of results and aftercare has become necessary. For cervical cancer screening conducted by the gynecology departments of health check-up facilities in the Takeda Hospital Group, we have prepared judgment standards for the newly introduced Bethesda classification and aim to use them as a basis for aftercare in the future.
Methods: We applied the Bethesda classification and the Nichibo class classification to 4,948 persons undergoing cervical cancer screening from the beginning of February to the end of June 2010 at 4 health check-up facilities using the same screening center among the 5 such facilities in the Takeda Hospital Group, and also classified them by age. Based on the Bethesda classification, we assigned judgments and diagnoses for the individual health check-up facilities and made new aftercare charts based on them.
Results: On applying the Bethesda 2001 system to the total of 4,948 persons undergoing cervical cancer screening at the 4 health check-up facilities in the Takeda Hospital Group in the 5-month period, 4,853 people were judged as NILM, which indicates no abnormalities. According to the conventional Nichibo Class classification, 4,914 people came under Class I or II which indicate no abnormalities. Simple calculations show that the number of people with no abnormalities under the Bethesda classification was 61 less than that under the former Nichibo class classification and there was a decrease of 1.23% in such people with respect to the total number of examinees. The major reason for this was thought to be insufficient cell numbers due to the cell collection procedure. Under the Bethesda classification, a reported pap smear result of NILM was considered to be fine, while examinees receiving other diagnoses required aftercare including referral for more detailed screening. We also felt that it was important to provide a simple explanation of the results of screening according to the Bethesda system to examinees.
Conclusion: All judgments other than NILM were D, for which aftercare was necessary. In the future, the Society should establish new guidelines concerning judgment grades under the Bethesda classification corresponding to the grades of A, B, C, D and E for pap smear results under the existing system of classification.

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Objective: We examined the validity of waist circumference measurement and subsequent diagnostic criteria for metabolic syndrome (MS) by comparing them with the visceral fat area measured by an abdominal CT scan.
Subjects and Methods: Our subjects were 194 males. We recorded their age, height (cm), weight (kg), body mass index, waist circumference (cm), maximum blood pressure (mmHg), minimum blood pressure (mmHg), HDL cholesterol (mg/dl), triglycerides (mg/dl), fasting glucose (mg/dl), visceral fat area (cm2), and subcutaneous fat area (cm2). Through comparison with the visceral fat area, referred to as the optimal criterion, we examined the validity of waist circumference measurement by calculating its sensitivity, specificity, and positive likelihood ratio. We selected subjects with an abnormal waist circumference and 2 or more abnormal values from among diagnostic criteria for MS, and examined the validity of their waist circumference measurement by calculating the sensitivity, specificity, and positive likelihood ratio, using the visceral fat area as the optimal criterion.
Results: The miss rate for waist circumference measurement was low and its sensitivity high. We did not observe any relationships between the subsequent diagnostic criteria for MS and visceral fat area.
Conclusion: We believe that there is valid relationship between visceral fat area and waist circumference measurement, in view of the low miss rate and high sensitivity observed for this diagnostic criterion for MS. Our results suggested that the validity of subsequent diagnostic criteria referred to after waist circumference measurement requires further examination.

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