In recent years, the issue of carcinogenic risk due to exposure to radiation during medical procedures has been receiving a lot of attention. In medical institutions, radiological examinations are carried out with great care and only on body parts where health problems are suspected. However, in health check-up facilities, not only radiological examinations for the basic items in the health check-up procedure list but also those chosen by patients themselves are conducted. Among patients, there are many who want to undergo such examinations just to be sure there is nothing abnormal, even though there is no diagnostic need. I would like to share my thoughts on the current and future situations of radiation exposure in health check-ups.

Objective: The purpose of this study was to evaluate our new method for detection of Helicobacter pylori infection using gastric X-ray findings.

Methods: The subjects were all people who underwent blood tests using the ABC classification and gastric X-ray examinations in 2013 and 2014, which are both optional examinations. We examined stomach X-ray images as follows. Initially, we examined the images using previously reported methods such as mucosal fold distribution range and mucosal fold flexion. Next, we examined them using our original method based on presence or absence of gastric area patterns in the stomach body and degree of barium coating.

Results: By previously reported methods, it was difficult to clearly distinguish between group A and groups B, C, and D. However, our original method was effective and accurate in detecting H. pylori infection and easy to use.

Conclusion: Our method appeared to increase the accuracy of detecting Helicobacter pylori infection, and complement the blood ABC classification.

Objective: We conducted a detailed analysis of liver dysfunction in order to perform meaningful health guidance.

Methods: From among 21,730 individuals (13,162 men, 8,568 women), we extracted those who had liver dysfunction and classified them into three groups, (1) ALT ≧ 31 IU/L and ALT>AST, (2) AST ≧ 31 IU/L and AST>ALT, (3) γ-GTP ≧ 101 IU/L and both ALT and AST in normal range.

Results: Proportions of subjects in Groups (1) – (3) were 30.8, 3.8, and 2.5% for men and 7.5, 1.8, and 0.5% for women, respectively. In group (1), drinking habit was significantly less prevalent and fatty liver more prevalent than in group (2) and (3), suggesting that NAFLD is a major cause of liver dysfunction. In group (2) and (3), drinking habit was significantly more prevalent and fatty liver less prevalent than in group (1), with prevalence of fatty liver similar to that in individuals with measurements in the reference ranges. Therefore, factors that seemed to play a major role in liver dysfunction were alcoholic liver injury in group (2) and enzyme induction due to alcohol intake in group (3). Things that should also be considered are smoking or underlying heart disease in men in group (2) and (3), and other causative factors in women in group (3). In addition, it was felt that individuals of unknown etiology in group (3) should have further evaluation to elucidate their clinical etiology including examination for autoimmune liver disease.

Conclusion: A good understanding of the clinical situation of liver dysfunction is required to promote regular annual examination.

Objective: To evaluate the results of repetitive efforts to raise rates of having follow-up examinations after health check-ups, and clarify the issues to work on.

Methods: The subjects were examinees who underwent health check-ups at our hospital from January 2008 to November 2016 (average 2,265 per year). During the period, we improved methods of encouraging people to undergo follow-up examinations. We evaluated the change in consultation rates between 2008 and 2016.

Results: We started our investigation on follow-up examinations at our hospital in 2008, and at another hospital in 2009. The investigation was conducted by sending a questionnaire to examinees. In 2013, we changed the system for receiving follow-up examination results; obtaining them from the hospital of consultation, not from the examinee as before. In 2014, we changed to an automated health check-up system that enabled us to make a time-series database of the results of follow-up examinations, which streamlined the process of the investigation. Consultation rates for life style-related disease follow-up examinations rose significantly between 2008 and 2016 due to these efforts. An increasing trend for cancer-related examination consultation rates was observed, except for upper endoscopy.

Conclusion: In order to further raise consultation rates for follow-up examinations in the future, it will be necessary to continue finding ways of motivating examinees to take them.

Objective: Japanese have the 2^nd shortest sleep time in the world, around 30% sleep for less than 6 hours and sleep time is particularly short for women. Female health check-up examinees in their 40s and 50s have been found to sleep for the shortest time. In this group, we identified factors affecting sleep time for use in health guidance.

Methods: During medical interviews, we asked examinees questions using a questionnaire sheet we created ourselves. We also collected information from medical interview forms.

Results: All of the 27 subjects were in employment; consisting of 20 teaching staff, 5 people working for local governments, 1 telephone company employee, and 1 illustrator. The mean working time was 11 hours 7 minutes and the mean sleep time 6 hours 15 minutes. Regarding sleep satisfaction, 55.6% were not satisfied, 14.8% couldn’t say and 29.6% were satisfied. Subjects waking up during the night accounted for 51.9%, those feeling insufficiently rested by sleep 59.3% and those feeling their sleep was insufficient for 66.7%. The time for going home from work was 6 pm or later for all subjects. Regarding activities from the time of arriving home to going to bed, 96.3% spent 84 minutes on housework, 51.9% spent 38 minutes on work and 55.6% spent 49 minutes on leisure activities. Among reasons for not making efforts to get enough sleep were “I’m used to sleeping not very much” and “I don’t place importance on sleep”.

Conclusion: In order to provide specific, individual guidance on sleep in the same was as for diet and exercise, an overall assessment of lifestyles is required. Also, we should inform people about the importance of sleep and have them understand the mental and physical effects of lack of sleep. In the future, we will make leaflets and other materials that enable us to provide specific health guidance on sleep.

Objective: The aim of this study was to analyze locomotive syndrome and health check-up data including that on emotional well-being in young and middle-aged workers and determine factors for preventing locomotive syndrome.

Methods: Ninety-three young and middle-aged workers who underwent a health check-up participated in this study. The subjects performed locomotive syndrome assessment and grip strength tests. We conducted multivariate analysis on medical interview, anthropometric, blood test and locomotive syndrome assessment results.

Results: Twenty-seven subjects (27.6%) were diagnosed as locomotive syndrome. Nineteen subjects (4 men and 15 women) had mild locomotive syndrome and 8 subjects (3 men and 5 women) had severe locomotive syndrome. Twenty of the 27 subjects were diagnosed as locomotive syndrome on the basis of the Locomo 25 questionnaire. A WHO-5 score was significantly associated with locomotive syndrome. In addition, “sleeping enough” and “habitual physical exercise” were significantly associated with a WHO-5 score (R²=0.313, p<0.001).

Conclusions: In the present study on young and middle-aged workers, 27.6% of the subjects were diagnosed as locomotive syndrome, and mental health status was significantly associated with locomotive syndrome.

  An 82-year-old woman had regularly seen a doctor for treatment of diabetes mellitus, bronchial asthma, hypertension and angina pectoris. Acarbose had been prescribed for her diabetes mellitus. Since February 2016, loose stools had continued and she underwent a fecal occult blood test, which was positive. Total colonoscopy was performed, and multiple smooth submucosal tumors were detected in the sigmoid colon, which were partially reddish, and had attached clots. These lesions appeared as multiple emphysematous cysts along the colon wall on CT colonography and pneumatosis cystoides intestinalis was diagnosed. As symptoms were mild and blood glucose control was good, administration of acarbose was continued carefully. As the loose stools continued, they were probably due to acarbose, which was stopped. One month later, colonoscopy revealed improvement in the cystoid lesions of the sigmoid colon and therefore the pneumatosis cystoides intestinalis in this case was thought to be an adverse effect of acarbose.

  Pneumatosis cystoides intestinalis appears as submucosal or subserosal emphysematous cysts, which sometimes result in a positive fecal occult blood test. As cases of pneumatosis cystoides intestinalis occurring as a complication of colon cancer have been reported, care is needed. Rupture of subserosal cysts results in intraperitoneal free air, but rarely requires surgery. When intraperitoneal free air is detected in an imaging study, a calm response in view of organic solvent usage history, present illness, medication taken, symptoms and abdominal examination findings should be made. Medical staff engaged in general checkups need to keep pneumatosis cystoides intestinalis in mind.