Objective: At our facility, we are making efforts to raise the percentage of examinees undergoing further examinations, focusing on cancer screening. Since 2010, we have been studying effective methods of encouraging people to undergo further examinations and have improved working procedures. We studied the effectiveness of these methods.
Methods: We made it a necessary requirement to issue referral letters to examinees deemed to need further examination in health check-up cancer screening. In addition to encouraging examinees to undergo further examinations in interviews with public health nurses, in order to provide appropriate information on medical institutions, various tools for were made available, such as a list of referral medical institutions and tablet computers. Furthermore, when the further examination status (i.e. undergone or not) or their results were not known, we conducted a follow-up investigation 6 months after the health check-up.
Results: We compared the further examination rates for each year, beginning in 2010. In 2010 and 2011, the rates increased for all examinations. Comparing 2011 with 2009, the increase in the stomach X ray examination rate in 2012 was 30.9%, the biggest increase. Next came, fecal occult blood, chest X ray, cervical cytology, breast cancer and gastroscopy examinations, in that order, with increases of 27.6%, 24.2%, 16.0%, 14.7% and 10.8%, respectively.
Conclusion: Our findings suggested that encouragement from doctors and public health nurses and the provision of information on medical institutions on the day of the health check-up could motivate examinees to undergo further examinations. Also, issuing referral letters and conducting follow-up investigations were effective in increasing the rate of knowing the further examination status as well as the percentage of examinees undergoing further examinations. Future issues to be addressed are raising the effectiveness of interviews with public health nurses and improving response rates for questionnaires used in follow-up investigations.

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Objective: At our center, in order to ensure safety in examinations, the treatment status of examinees is checked by collecting information beforehand as well as in medical interviews on the day of examinations, for those deemed to be at high risk, a nursing record is generated and risk management conducted. We carried out a study to enhance the accuracy of medical interviews by assessing the current situations of examinees.
Methods: From among 25,352 persons who underwent a one-day Ningen Dock between April 1 2012 and March 31 2013, we extracted those at high risk and conducted an investigation to determine the numbers of those for whom a nursing record was generated and those in whom an exam had been cancelled, as well as the numbers of incidents that occurred, We also investigated the times taken for information collection and medical interviews.
Results: Among the 25,352 persons who underwent the 1-day Ningen Dock, 4,772 had a history of high-risk conditions. There were 4,697 with hypertension (nothing was done about 136), 129 with unruptured aneurysms (86 not operated on) and 64 with thoraco-abdominal aneurysms (48 not operated on). The number of nursing records generated was 258 for hypertension (Ningen Dock cancelled for 13, certain exams cancelled for 79, exams performed at a later date for 15, exams continued with completion of consent form for 151), 38 for abdominal aortic aneurysms (certain exams cancelled for 18) 17 for thoracic aortic aneurysms (certain exams cancelled for 10) and 72 for unruptured cerebral aneurysms (certain exams cancelled for 12). There was one case of exacerbation of symptoms, involving hyperkalemia in a person undergoing dialysis. The collection of information on the previous day had taken 121 min on average and the medical interview on the day of Ningen Dock 7 min per person on average.
Conclusion: As a result of risk management conducted in medical interviews, there was only one case of exacerbation of symptoms. However, as the collection of information took a lot of time, collection methods should be studied in the future. It will also be necessary to raise the skill of center staff in conducting medical interviews.

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Objective: Helicobacter pylori (H. pylori) are gram negative, microaerophilic, spiral-shaped bacteria found in the gastric mucosa. Infection with this organism is connected with peptic and duodenal ulcers, gastric carcinoma and non-Hodgkin’s lymphomas of gastric mucosa-associated lymphoid tissue (MALT). On average, 50% of people in the world are infected by this microorganism. The route by which H. pylori infection is transmitted is not yet clear and there are many unanswered questions, among them whether the oral cavity could be considered as a reservoir of these bacteria. We investigated a relationship between H. pylori infection and dental caries/periodontitis.
Methods: The population of the study was 68 subjects (34-82 years old, mean age 59) who had undergone esophagogastroduodenoscopy and blood tests. Student’s t test and the chi-square test were applied.
Results: In line with previous studies, pepsinogen I/II and anti-helicobacter pylori antigens (IgG) were low (gastric disease (+) 4.2, disease (-) 5.8, p=0.023) and high (gastric disease (+) 42.2U/mL, disease (-) 8.7U/mL, p=0.015), respectively, in subjects with gastric disease. However, subjects with dental caries/periodontitis had a low prevalence of gastric disease. Moreover, the pepsinogen I/II ratio was high (p=0.012) and anti-helicobacter pylori antigen levels were low (p=0.020) in subjects with periodontitis. Similar results were seen in those with dental caries, although they were not statistically significant.
Conclusions: There was not enough evidence for an association between H. pylori infection and dental disease. Further studies are needed to clarify whether there is a causative link between H. pylori infection and dental disease in the Japanese population.

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Objective: The aim of this study was to clarify the pathological significance of a trace protein reading in urinalysis by dipsticks.
Methods: The rate of abnormal findings in renal and cardiovascular functions was cross-sectionally compared at each year and longitudinally compared at 6-year intervals between groups divided by the degree of urinary protein reading in 222,255 specimens examined for 7 years from 2005 to 2011 at The Niigata Health Care Association. Serum creatinine level, estimated glomerular filtration rate, systolic and diastolic blood pressure, electrocardiographic findings, and serum uric acid level were examined.
Results: The cross-sectional and longitudinal examinations revealed that the rate of abnormal findings for the examined items was higher in the trace proteinuria positive (±) group than in the negative (-) group.
Conclusion: The rates of abnormal findings for renal and cardiovascular functions and also uric acid levels were higher in the trace proteinuria positive group than in the negative group. Therefore, a trace protein reading in urinalysis by dipsticks was concluded to have pathological significance.

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Objective: At our center, among subjects deemed to require further examinations and medical treatment (further examination candidates) on the basis of health check-up results, those suspected of having malignant diseases and those with abnormal test results (follow-up subjects) are actively encouraged to undergo prompt examination at medical institutions. In the present study, we analyzed factors determining whether persons undergo further examinations or not in order to raise further examination rates.
Methods: Our subjects were 347 follow-up subjects (308 who underwent further examinations, 39 who did not) among 8,572 further examination candidates in the period April 1 2011 - March 31 2012. Backgrounds of follow-up subjects undergoing further examinations were analyzed based on medical interview findings. For follow-up subjects undergoing further examinations, motivational factors were evaluated by means of a questionnaire survey, with responses according to 5 grades. Follow-up subjects undergoing further examinations were divided into a cancer examinations-related group (A group) and an others/lifestyle-related disease examinations-related group (B group), and analyzed according to the Ajzen theory of planned behavior.
Results: In the analysis of background factors of follow-up subjects having and not having further examinations, there were significant differences in examination behavior (undergo or not undergo further examinations) regarding age and married/unmarried status (p<0.05). In the analysis of the results of the questionnaire survey according to planned behavior theory, factors encouraging positive examination behavior identified for the A group were “Results report”, “Examinee awareness”, “Recommendation by other person” and “System of institution performing further examinations”.
Conclusion: Based on the above findings, we considered that important actions required to further increase further examination rates were: more thorough explanation of results by doctors, more detailed selection of institutions for further examinations in consideration of examinee convenience, provision of appointment systems and investigation of examinee workplace situations.

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Objective: To investigate the clinicopathological features of 6 patients who were diagnosed as eosinophilic esophagitis (EoE) in our clinic
Methods: From October 2012 to February 2014, 6 patients who were definitively diagnosed as EoE with endoscopic biopsies of the esophagus (more than 20 eosinocytes/HPF) in our clinic were analyzed retrospectively.
Results: All the patients were men, with a median age of 38.5 (range 25-47) years old. Two patients visited our clinic complaining of dysphagia. Four patients underwent endoscopy and were coincidentally diagnosed as EoE during a health check-up. Three of the 4 patients were asymptomatic while one had slight dysphagia. Endoscopic examination revealed furrows and fixed rings in all patients, while exudates were observed in 2 patients. Three patients who had allergic disease (allergy to buckwheat, prawns, and crustaceans) were treated with dietary elimination. One patient was treated with topical steroid therapy (fluticasone). In one patient who had dietary elimination therapy, endoscopic and histopathologic findings disappeared after two months.
Conclusion: When the patients without any symptoms during a health check-up have endoscopic features, such as furrows, rings, or exudates, multiple esophageal mucosal biopsies should be obtained for diagnosis of EoE.

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