[in Japanese]

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Objective: We started to use an urgent reporting system for abnormal electrocardiograms seen in health check-ups, and investigated its operation.
Methods: When they observe abnormalities during the recording of electrocardiograms, medical technologists fill out an urgent report sheet giving details of the electrocardiographic diagnosis, the symptoms, history of treatment and prescriptions, and any changes from previous electrocardiograms. They then report promptly to the duty doctor for the day. We then ask whether we should continue the other examinations or not. In this study, we investigated further developments in the situations of people subject to urgent reports.
Results: A total of 132,577 subjects, including previous examinees, came to our health screening center to undergo electrocardiography as part of a health check-up from July 2012 to February 2015. Twenty-five of them came under the urgent report category. Fifteen were examined by the doctor, the upper gastrointestinal contrast study was cancelled for 6, and 8 were referred to cardiovascular specialists at this hospital on the day or the next day. Of these 25 urgent report examinees, 10 could be followed-up. One was diagnosed with 90% coronary artery stenosis and underwent PCI. Another needed to have a pacemaker implanted. Five underwent radiofrequency catheter ablation, and 3 started taking medication or became follow-up patients.
Conclusion: These results suggest that our urgent report system contributes to securing the safety of people who come for check-ups and allows entry into early phase treatment when necessary.

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Objective: To determine the effect of introducing transvaginal ultrasonography into Ningen Dock gynecologic examinations
Methods: We compared the diagnostic outcomes of transvaginal ultrasonography with those from abdominal ultrasonography for malignant disease.
Results: Transvaginal ultrasonography produced different results from abdominal ultrasonography in the gynecologic examination. The percentage of patients who needed follow-up increased from 7.9% to 72.4%, whereas that of patients who required further examinations decreased from 77.9% to 16.4%. Furthermore, transvaginal ultrasonography was more effective in detecting uterine cancer than pelvic examination or abdominal ultrasonography.
Conclusions: A considerable amount of information was obtained through the introduction of transvaginal ultrasonography, and it led to early detection of malignant disease. We were therefore able to make more accurate diagnoses during gynecologic examinations. These results suggested that transvaginal ultrasonography was highly useful in Ningen Dock gynecologic examinations.

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Objective: The ABC classification designed for early gastric cancer screening seems to be a useful means of detecting high-risk subjects, some of whom may be candidates for Helicobacter pylori (Hp) eradication. However, one well-known major problem of using this classification is to eliminate ‘not truly low-risk cases with previous/present Hp infection’ as “group pseudo-A”. Another controversial issue concerns “group D”, that has been shown to be a mixture of diverse statuses of Hp infection and non-Hp-related causes. The aim of our study was to clarify the characteristics of “group pseudo-A” and “group D” among our subjects.
Methods: A total of 6,236 examinees of our health check-up program were enrolled for ABC classification from April 2014 to March 2015. Subjects in group B, C and D were referred for further examinations and/or Hp eradication. Those with possible present Hp infection in group A were also referred for additional assessment. Their clinical information, which had been collected until the end of 2015, and laboratory data were analyzed.
Results: The proportions of the enrolled subjects classified into group A, B, C and D were 73.6%, 15.7%, 9.2% and 1.5%, respectively. Among the 4,591 subjects in group A, 342 (7.4%) had high negative titers for serum anti-Hp antibody in the range 3.0 - 9.9 U/mL. In detailed examinations that they were referred for, 38.5% were Hp positive and differences in pepsinogen (PG) values between them and negative examinees were statistically significant. In group D, the rate of present Hp infection was 38.0%. Other notable observations were that 28.2% of group D seemed to be non-infected, and 21.1% were previously infected or had non-Hp-related atrophic gastritis.
Conclusion: As the proportion of younger examinees undergoing our health check-up program is high, it is important to evaluate them according to the three different Hp infection statuses, which are non-infected, presently infected and previously infected. The interpretation of the results of the ABC classification should be done in conjunction with a consideration of clinical history, actual Hp titer and PG values, together with X-ray/endoscopy findings. This will help ensure that candidates for Hp eradication are identified and that latent high-risk cases are discovered.

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Objective: In order to raise the accuracy of the combined use of mammography (MMG) and breast ultrasonographic examinations (US), the standardization of the procedure through a change from single criterion to combined criteria evaluation is underway. We studied the current situation of combined criteria evaluation in our facility regarding focal asymmetric density (FAD) in MMG and tumor solid mass findings in in order to clarify the usefulness of combined criteria.
Methods: In a total of 5,519 subjects who underwent combined MMG and US examinations from January 2013 to June 2014, we conducted a comparison of single criterion MMG and combined criteria evaluation using FAD findings and tumor mass findings.
Results: FAD findings: The number of subjects requiring further detailed examination for MMG single criterion evaluation was 81 (1.5%). On the other hand, regarding those requiring further detailed examinations on the basis of combined criteria evaluation, 35 subjects who were judged as not requiring further examination by US (findings in the same location, category 2 benign lesions visualized in 12 subjects, normal mammary gland in 23 subjects) were eliminated, reducing the number requiring further detailed examination to 46 (0.8%). In a comparison by direction of imaging, there was no significant difference in reduction rate (p=0.6485). Tumor mass findings: The rate for requiring further detailed examination for MMG single criterion evaluation was 73 subjects (1.3%). For combined criteria, the elimination of 29 subjects with benign lesions visualized in US reduced the number requiring further examination to 44 (0.8%). In the comparison by direction of imaging, there was a much greater reduction in those requiring further examination for 2-direction imaging than 1-direction imaging (p=0.029).
Conclusion: Combined criteria evaluation enabled determination of whether a finding was mammary gland overlap or a tumor mass and was useful in preventing the selection of those with benign lesions for further examinations, thereby leading to a reduction in the further detailed examination rate.

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Objective: We objectively evaluated the skill of health guidance staff in giving health guidance on metabolic syndrome using videos. We also examined correlation coefficients between subjective and objective evaluations.
Methods: The subjects were 37 health guidance staff from 3 institutions (Hamamatsu, Shizuoka, and Niigata, Japan). They simulated giving specific health guidance to a mock patient and we made a video of them doing it. Three evaluators scored their skill in health guidance using a questionnaire for this purpose having questions on 29 items. The subjects also evaluated themselves using the questionnaire. We analyzed the scores for these objective and subjective evaluations of skill and calculated their correlation coefficients.
Results: The highest mean score (SD) of the objective evaluation was 3.48 (0.26), for the item of “assessment of patients” and this was followed by 3.46 (0.34) for the item of “can think of improvements that can be made together with patients”. The highest mean score for self-evaluation was for the item of “purpose and schedule of the specific health guidance” and this was followed by the item of “goal of dietary habits and effect of weight reduction”. The correlation coefficients were significantly high for “exercise”-related items.
Conclusion: The health guidance staff had mastered assessment, counseling and coaching skills relatively well.

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Objective: Early detection of insulin resistance is important in preventing the onset of diabetes mellitus. However, few corporations measure insulin levels, a basic parameter for calculation of insulin resistance, as a basic item of health check-ups. Instead, TG and HDL-C are measured by most corporations. Therefore, first, we examined whether the TG/HDL-C ratio is useful as a surrogate marker of insulin resistance. Second, we investigated retrospectively whether the TG/HDL-C ratio is a risk marker for the onset of diabetes mellitus in the same individuals during ten years follow-up.
Methods: Men and women were divided into quartiles on the basis of their TG/HDL-C ratio. The 25% of the population with highest TG/HDL-C ratio was defined as abnormal, and values for homeostasis model assessment-insulin resistance (HOMA-IR) were compared between this quartile and the remaining three quartiles. The onset of diabetes mellitus during 10 years was also compared between them.
Results: The more insulin resistance increased, the higher the level of the TG/HDL-C ratio. The onset of diabetes mellitus was 2 times higher in the highest TG/HDL-C ratio group than the remaining groups. The Cox proportional hazard model showed that TG/HDL-C ratio was an independent risk marker for the onset of diabetes mellitus.
Conclusions: The TG/HDL-C ratio may serve as a simple and clinically useful approach in identifying insulin resistance and increased diabetes mellitus risk.

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Objective: In April 2013, we started an evening health check-up service in order to provide preventive medical care to women with difficulty in coming to our center in the daytime. With the focus on diseases particular to women, gynecology, breast, thyroid and bone density exams are carried out. We call it Evening Ladies Dock (EL) in our center and all staff are female. We report on our evaluation of EL over 2 years.
Methods: We conducted a comparative analysis of 3,013 women who underwent the daytime ladies health check-up (general health check-up + EL items) and 1,179 women who underwent EL in the period from April 2013 - March 2015 regarding examinee characteristics and test results. The data were analyzed statistically by the chi square. We also administered a questionnaire to the EL examinees to determine their level of satisfaction with the health check-up content and analyzed the findings.
Results: At 34.9%, the proportion of EL examinees under the age of 40 was higher than that of non-EL examinees at 15.8%. The rates for first-time examinees were 13.5% and 47.8% for Non-EL and EL, respectively, so that for EL was considerably higher. While the rates for examinees undergoing further detailed examinations and those for cancer detection were similar in the EL and non-EL groups, rates for requiring further detailed examinations were higher in the EL group. Rates for undergoing detailed examinations in EL subjects were 84.8%, 95.2% and 89.8% for gynecology exams, breast exams and thyroid exams, respectively. Cancer discovery rates were 0.26% for gynecology exams, 0.59% for breast exams and 0.93% for thyroid exams. According to the questionnaire, 94% of respondents wished to recommend EL to family members or friends.
Conclusion: Based on our analysis of examinee characteristics and exam results, many EL examinees were first-time examinees, they were younger and many of them had applied for EL themselves so EL had been effective in developing a new segment of Ningen Dock examinees. Also, high rates for undergoing further detailed exams and cancer detection showed that EL was a useful health check-up service. Based on the examinee questionnaire, satisfaction with EL was high due to consideration given to privacy and time of examinations.

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Objective: In our health check-up center it is standard practice to conduct stomach exams by endoscopy and it is possible to accept 60 persons per day for such exams. However, regarding appointment performance, vacant slots often occurred due to cancelations and reducing them had been an issue at our center. In this study, we established a new method to solve this problem.
Methods: In order to maximize the use of appointment slots on a daily basis, we created our own appointment slot management tool. It displays the current appointment situation and maximum number of appointments possible in calendar format, and enables the provision of commonly required appointment information to all persons in charge of appointments. Through checking the changing appointments situation from day to day, the system can be precisely updated in anticipation of cancelations. We also created a appointment performance management tool for use in combination with this tool and set up the system so that the appointment situation can be viewed from all terminals in our center by all staff concerned. Furthermore, as the system updates appointment performance data every day, achievement rates for annual targets can be checked on a daily basis.
Results: The use of the appointment slot management tool has made the acceptance of persons desiring stomach exams during the year more efficient and made it possible to reduce the number of wasted appointment slots to the maximum extent. As a result, annual examinee number achievement rates for each exam program were 96% or over. We were also able to achieve annual earnings targets.
Conclusion: We believe that our appointment slot management tool has been highly effective in reducing wasted appointment slots and in allowing the maximum number of appointments to be inserted. The combined use of this tool and our appointment performance management tool has made it possible to constantly monitor achievement rates for annual targets.

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Objective: Anisakiasis may be coincidentally discovered in upper gastrointestinal endoscopy carried out in health check-ups so we studied its features.
Subjects: Subjects were 14 examinees in whom gastric anisakiasis was observed in upper gastrointestinal endoscopy carried out in the Ningen Dock of our institution from April 2013 to March 2016.
Methods: A retrospective comparative study of such factors as age, gender, subjective symptoms and endoscopic findings was carried out.
Results: The male-female ratio was 3:4 and the median age was 44 years. Discovery was concentrated in the November to February period, when there were 8 subjects with the parasite, so there was a tendency toward frequent occurrence in winter. Six subjects had subjective symptoms and all of them had eaten mackerel, squid or other seafood within 2-3 days prior to examination. In blood tests, an increase in the eosinophil fraction was observed in 4 subjects. As for endoscopic findings, while locations infected by anisakis varied a lot, more were in the greater curvature than in the lesser curvature, and 2 subjects had the parasite in the cardiac region. Regarding the condition of mucosa around locations with anisakis, in 3 subjects only edema was observed, with 4 lesions, 7 subjects had redness in addition to edema and in 1 subject erosion was observed in addition to edema and redness. Furthermore, 3 subjects also had a submucosal tumor-like protrusion. Two subjects were infected with Helicobacter pylori.
Conclusion: For anisakiasis, it is necessary to recognize that some patients are asymptomatic and deal with this in examinee interviews and endoscopic examinations during health check-ups.

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We encountered a case of rectal perforation without organic disease after upper gastrointestinal radiography. The patient was a 66-year-old woman who experienced abdominal pain 2 days after upper gastrointestinal radiography. Based on baroliths and mucosal laceration observed in the rectum in colonoscopy and free air noted in abdominal CT, a diagnosis of rectal perforation was made and emergent surgery was carried out. Perforation was observed in the rectosigmoid colon and baroliths were incarcerated. Resection of the colon including the perforated portion and end-to-end anastomosis were carried out. Owing to a satisfactory post-operative course, the patient was discharged 17 days after surgery. Our report on the defecation status and baroliths after gastrointestinal radiography includes a discussion of the literature.

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