[in Japanese]

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Objective: We have already reported that the advice sheet (AD) prepared for use in active support during fiscal year 2013 was an effective tool for health guidance. With a view to clarifying whether its effectiveness was sustained thereafter, we conducted this study at the end of the year after the support was given to explore associations of changes in bodyweight, results of an attitude survey and stratified assessment data over time with utilization or non-utilization of the AD.
Methods: Of the 71 male subjects (AD utilization group, 55; AD non-utilization group, 16) receiving active support in fiscal year 2013, 52 (AD utilization group, 42; AD non-utilization group, 10) who were examined in Ningen Dock between April 2014 and the end of December 2014 were included in this study. Using the information obtained in the Ningen Dock conducted 1 year after the support, associations of changes in bodyweight, attitude survey results and stratified assessment data over time with utilization or non-utilization of the AD were analyzed using the χ² test.
Results: There were significant differences between the AD utilization group and AD non-utilization group with respect to reduction in weight, attitude survey results and stratified assessment data.
Conclusion: This study suggests that the supportive effect of the AD was sustained even after the completion of active support.

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Objective: We reported that the measurement of serum carbohydrate antigen (CA) 19-9 levels in routine health check-ups enabled us to detect resectable pancreatic cancers three years ago. Here, we report on our experience over the following six years.
Methods: A total of 99,807 persons receiving health check-ups in the period from April 2010 to July 2015 were enrolled in the present study. Approximately 80% of the subjects were repeat examinees. All subjects underwent CA19-9 measurement and abdominal ultrasonography. Those with elevated CA19-9 levels underwent further imaging examinations and were followed up every three months.
Results: The detection rate for pancreatic cancers in the first year was 0.025% but the average detection rate for the six years decreased to 0.010%. Out of 10 pancreatic cancers, nine were ductal cancers and one was a cystadenocarcinoma: two at stage I, one at stage II, four at stage IVa, and three at stage IVb. Therefore, the curative surgery rate was 70%. As for the sites of the pancreatic cancers, one was in the head, three were in the body, and six in the tail. Five subjects with tail cancer were diagnosed only on the basis of elevated CA19-9 levels, and four of them underwent curative surgery.
Conclusion: Using CA19-9 levels, four curable pancreatic tail cancers were detected, the first time for such a result to be reported in a mass screening study. Although measurement of CA19-9 levels may not be cost effective, it is useful in the early detection of pancreatic cancer in opportunistic screening.

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Objective: We investigated the change in examination rate for secondary testing due to improved guidance methods and examined future issues.
Methods: The subjects of this study were health check-up examinees who were deemed to require additional testing based on the results of a physical examination and medical interview performed by a doctor, during the period from April 1, 2012 to December 31, 2015. We made a list of these subjects and investigated whether they underwent secondary testing from electronic medical records held by our medical care department or response documents from other medical institutions. We compared the findings with those from a period in which we used an improved guidance method. For the years 2014 and 2015, we compared examination rates by examination type and age group.
Results: The examination rate in 2012 was 62.6%, but it gradually increased and was 84.5% in 2015. The rate for examinees who went to other medical institutions despite the doctor referring them to our department was 1.2% in 2012 but had increased to 8.5% in 2015.
Conclusions: Reasons for the increase in the examination rate were thought to be improvement in the guidance methods based on an evaluation of changes made the previous year, such as provision of better support by nurses and a special referral prepared by a doctor for an examinee who changed their mind and wanted to go to another medical institution, and addition of a reply space to the special referral form so that other institutions could inform us by FAX (or mail) when the examinee underwent the secondary testing.

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Objective: A comparative study was performed to investigate the characteristics of cancers discovered in hospital patients and those in health check-up examinees regarding stage, organ and prognosis.
Methods: 568 cancer patients reported to the population-based cancer registry of Aichi Prefecture in Japan were enrolled in this study. In 86 of them, the cancer had been detected in a health check-up. We compared organ, stage and prognosis between the health check-up examinees and hospital patients.
Results: Stomach, colonic and urogenital cancers were prevalent in the health check-up examinees and hospital patients. The rate of stage I stomach cancer in health check-up examinees was 100%. The rate of stage I stomach cancer in hospital patients was 32.3% and the total for stage Ⅲ and Ⅳ exceeded 50%. As for colonic cancer, the percentage of early stage cancer was greatest in both health check-up examinees and hospital patients. However, the percentage of stage Ⅲ and Ⅳ in hospital patients was two or three times greater than in health check-up examinees. Regarding urogenital cancers, 60% were in the early stage in the health check-up examinees, while the proportion in the early stage for the hospital patients was 30%. The prognosis of the cancer detected in health check-ups was better as compared with the hospital patients.
Conclusion: The data reported to the cancer registry showed that cancers were detected at an earlier stage in health check-up examinees as compared with hospital patients. Thus, preventive cancer screening should be promoted.

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Objective: To compare the performance of transvaginal and transabdominal ultrasonography for diagnosis of uterine myoma using the results of transvaginal ultrasonography as the reference.
Methods: Our study subjects were 266 consecutive examinees who received both transvaginal and transabdominal ultrasonography at Aizawa Health Center during the period April 1 2014 to March 31 2015. The results of the two exams were compared, using the transvaginal method as the reference. The performance of the transabdominal approach in the diagnosis of uterine myoma was evaluated with particular regard to sensitivity, cause of non-diagnosis, localization and size of non-diagnosed lesions.
Results: Eight subjects with positive transabdominal but negative transvaginal ultrasonography findings were excluded, leaving 258 for the analysis. In 133 of the 258 subjects (52%), uterine myoma was detected by the transvaginal approach. The lesion was detected in 112 of them by the transabdominal method too. In other words, uterine myoma could be diagnosed by transvaginal ultrasonography alone in 21 subjects. The commonest cause of non-diagnosis by the transabdominal method was poor demarcation of the myoma (11/21, 52%). Intestinal gas accumulation was the next most common cause of non-diagnosis (9/21, 43%). Non-diagnosed lesions were frequently in the fundus. At 29.4 mm, the mean diameter of myomas detected by both the transvaginal and transabdominal approaches was significantly larger than that of myomas detected only by transvaginal method of 15.3 mm.
Conclusion: The sensitivity of transabdominal ultrasonography for diagnosis of uterine myoma was marginally lower than that of the transavaginal method. However, we consider that the transabdominal method can be used for first-line screening provided that its limitations are recognized.

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Objective: We studied the features of gastric cancer discovered at our center and made a comparison of that discovered in screening undergone annually and non-annually.
Methods: Gastric cancer was discovered in 29 of 15,961 persons who underwent gastroscopy at our center in 2014. They were investigated regarding age, sex, lesion location, mural thickening, diameter, morphological type, invasion depth, degree of differentiation and treatment. They were also classified into an annual screening group and a non-annual screening group for comparison.
Results: Regarding background factors for the discovered gastric cancers, they occurred in 24 men and 5 women whose mean age was 62.4±11.2 years (36 - 79 years) and the mean lesion diameter was 22.7±17.2mm (5 - 80 mm). Treatment in 10 of them was endoscopic submucosal dissection (ESD) and the other 19 had surgery. In 21 of them, the cancer was discovered in annual screening and in 8 it was discovered in non-annual screening. The early cancer rate was 95.2% and the mean tumor diameter was 18.2±10.3mm for gastric cancer discovered in annual screening; whereas the early cancer rate and mean tumor diameter were 75.0% and 34.4±24.6mm, respectively, for discovery in non-annual screening. Also, the ESD treatment rates were 38.1% and 25.0%, for discovery in annual and non-annual screening, respectively. Regarding the 21 subjects with gastric cancer in the annual screening group, a comparison with the previous year’s images revealed that there were 8 subjects who had lesions requiring action in the previous year, there were 10 subjects with lesions that did not, and there were 3 subjects with lesions that were not evident in the previous year’s images.
Conclusion: Undergoing endoscopic screening annually would be useful for the early discovery of gastric cancer. Based on annual screening, however, while there were lesions in the previous year’s images that required action, keeping in mind the fact that there are also false negatives, there is a need for highly accurate examination of findings.

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We report the case of a large left atrial myxoma with no serious complications detected coincidentally during upper gastrointestinal tract radiography, which was conducted in a routine health check-up.
The patient was a 50-year-old woman who had been suffering from fatigability, sense of malaise, and precordial discomfort over the previous 4 years. During the preceding two years, she had a persistent sensation of food being lodged in her throat, which she ignored since the symptom did not hinder her everyday life. Upper gastrointestinal tract radiography performed as an option in a regular health check-up revealed a mass that was greatly displacing the lower esophagus. Further evaluation indicated the presence of a large, neoplastic lesion with severe calcification in the left atrium. She subsequently underwent surgery. The tumor was a wide-base sessile myxoma in the atrial septum that measured 9 cm in diameter.
There is a distinct possibility of rare diseases being detected during a routine health check-up. Therefore, it is important to be careful and observant while conducting the medical examinations.

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Objective: To clarify the situation of Ningen Dock and Specific Health Guidance at member institutions of Japan Society of Ningen Dock.
Methods: Japan Society of Ningen Dock investigated the situation of Ningen Dock and Specific Health Guidance at member institutions through an on-line survey. Seven hundred institutions (43.3% of total) responded.
Results: The total number of Ningen Dock examinees was 2,090,000 and 77% of them underwent Specific Health Check-ups in addition to Ningen Dock. The proportions of institutions conducting Specific Health Check-ups and Specific Health Guidance were 99% and 78%, respectively. The total number of instances of Specific Health Guidance was 70,917 (active support: 33,633; motivational support 36,984). For almost half of them, the guidance was carried out on the same day as Ningen Dock. The average number of instances of Specific Health Guidance per year per institution was 140. However, there were 310 institutions (44%) that had not conducted specific health guidance or had less than 10 instances per year. The completion rate for Specific Health Guidance on the same day as Ningen Dock was slightly lower than for that conducted at a later date. Public health nurses and registered dietitians had carried out Specific Health Guidance more than doctors, other nurses and exercise coaches. Institutions had clearly started to cooperate in data health plans operated by insurers, though their number was still small.
Conclusion: In order to further improve skill in health guidance and raise rates of conducting Specific Health Guidance, an increase in the number of instances of Specific Health Guidance is needed. The completion rate for Specific Health Guidance should also be increased.

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