Objective: Based on a review of follow-up activities after health check-ups, we investigated future issues in health support activities.

Methods: The subjects were 15,219 individuals who had undergone an opportunistic health check-up during the period from July 2014 to June 2016. We examined the breakdown of assessment categories for individual examinations, rates of requiring secondary examination or treatment by age and sex and rates of undergoing examinations following recommendation for lifestyle-related diseases and non-lifestyle-related diseases.

Results: Of the 15,219 subjects who had received a health check-up, 5,388 (35.4%) required secondary examinations or treatment. Among them, 3,371 (62.6%) underwent examination of their own volition after receiving the health check-ups report. Considering the remaining 2,017 (37.4%) to be unexamined, we focused recommendation on them. Recommendation letters were mailed to 624 subjects with lifestyle-related diseases and 20 underwent examination (examination rate 3.2%). On the other hand, 168 (12.1%) of 1,393 subjects with non-lifestyle related diseases that we sent letters to underwent examination. Statistically, the examination rate for lifestyle-related diseases was significantly lower than that for non-lifestyle-related diseases (p<0.01).

Conclusion: It was difficult to have many of those given post-examination follow-up undergo secondary examination, even with active interventions by telephone or letter. Also, on the day of the health check–up when people’s interest in their health is greatest, there should be a system for providing all examinees with explanation of results, health consultation and health guidance. This would help to raise secondary examination rates at hospitals for those who do not undergo examination of their own volition and reduce rates of secondary examination and treatment through mitigation of lifestyle-related diseases.

Objective: The purpose of this study was to investigate the cause of overdiagnosis in gastric cancer screening, especially with respect to methods used in the double contrast study with barium meal.

Methods: From among 25,538 examinees who underwent upper GI series at Kansai Occupational Health Association, we selected 477 cases where precise examination by endoscopy was considered necessary. Of them, 26 cases were false positives, with no cancer endoscopically, despite malignancy being suspected radiographically. We applied a double contrast method using compression of the gastric antrum in addition to the standard gastric X-ray examination method recommended by the Japanese Society of Gastrointestinal Cancer Screening.

Results: False-positive results were most frequently produced by the initial X-ray examination. Deformation of the gastric angle due to scarring or submucosal tumor-like elevation may have provided the reason to suspect cancer. Inadequate X-ray photography often produces misleading results. Among reasons for inadequacy of radiography were problem lesion not being noticed during fluoroscopy, failure of barium adhesion to mucosal surface, defective image due to residual barium, apparent abnormality of normal mucosal folds due to method of compression, and inadequate skill in front wall photography.

Conclusions: To prevent false-positive results, in the X-ray study, we should use such measures as increasing the number of posture transformations, having examinees drink additional barium, appropriate removal of barium from the target site, improving front wall photography technique, adjusting amount of air in the stomach, and increasing reading ability so that lesions are noticed during fluoroscopic observation.

Background: AminoIndex^TM Cancer Screening (AICS) is based on “AminoIndex^TM Technology”, which involves multivariate analysis of plasma amino acid concentrations between cancer patients and healthy subjects. It has been developed as a novel cancer screening test, which evaluates the probabilities of seven-types of cancer, to determine subjects for secondary examination. In this study, we report the relationship between the distribution of AICS ranks and age.

Methods: The distribution of AICS ranks by age was investigated in 4,368 examinees. The age-stratified distributions of various diseases in rank C subjects were also investigated when a significant increasing trend in rank C percentage with age was observed.

Results: A significant increase in the rank C percentage was observed with increase in age for AICS (gastric), AICS (prostate) and AICS (breast). The percentages of atrophic gastritis and intestinal metaplasia in AICS (gastric) rank C subjects and the percentage of high PSA level subjects for AICS (prostate) rank C significantly increased with age. The percentage of category 3 in AICS (breast) rank C subjects did not significantly change with age.

Conclusion: These results suggested that the increases in rank C percentage with age for AICS (gastric) and AICS (prostate) might reflect increases in cancer incidence and high cancer risk persons with age.

Objective: AminoIndex^TM Cancer Screening (AICS^TM) is an examination involving statistical analysis of the plasma amino acid concentration balance between cancer patients and healthy persons, in order to evaluate the probabilities of various cancers. AICS is now used in practice as an examination for seven types of cancer. In this study, we conducted a questionnaire survey with the aim of clarifying the influence of undergoing AICS on health consciousness, after determining examinees’ degree of recognition of AICS and level of satisfaction with it.

Methods: From February 2015 to September 2017, a questionnaire survey of 349 examinees who underwent AICS at our clinic was conducted by mail. With 159 responses, the effective response rate was 46%.

Results: In 58% of examinees, including exercise and diet, the number of lifestyle aspects examinees paid attention to after AICS increased showing that their health consciousness had also increased. The increase in the number of aspects from before to after the examination was significantly higher in the “Rank C” group than in the “No Rank C” group. In addition, 77% of persons in the rank C group underwent secondary examination, confirming that AICS was effective in this respect. The satisfaction level of the examinees was 92%, and did not differ whether rank C was present or not.

Conclusions: Based on the results of the questionnaire survey, AICS not only increased cancer recognition but also health awareness. It is thus thought to be a useful tool in cancer risk management and for improving health awareness.

Objective: To evaluate the characteristics of women with low blood hemoglobin (Hb) levels (≤ 11.0 g/dL) and apply the findings in detecting anemia in health check-ups and providing guidance for mitigating it.

Methods: We used the data of 3,385 women who had received health check-ups at our Ningen Dock clinic from April 2016 to March 2017. Age, examination results, clinical history, subjective symptoms and lifestyle habits of low Hb women were compared with non-low Hb women. The consultation rates of women determined to need secondary examination were compared among those for some health check-up items.

Results: The percentage of low Hb women was higher in the 40s age group: 16.6% compared to 9.7% for subjects overall. Low Hb women had higher percentages for medical history of anemia, currently treated uterine leiomyoma, and the subjective symptom of lightheadedness than non-low Hb women; however, there were no major differences. The percentage of low Hb women told they had an anemic appearance in a physical examination was18.2%. For 11 check-up items, the rate for low Hb women receiving secondary examination was lower.

Conclusion: It was difficult to efficiently detect low Hb women through physical examination, clinical history, subjective symptoms and/or lifestyle habits. We consider it necessary to reinforce detection of low Hb women through blood examination in all health check-up programs and recommend consultation or health guidance for those who need secondary examination after check-ups.

Objective: Renal hypouricemia (RHUC) is caused by impaired renal reabsorption and is relatively common in the Japanese population. RHUC is reported to be a risk factor for reduced renal function, urolithiasis and exercise-induced acute kidney injury (EIAKI). However, little is known about the prevalence of these complications. This study was conducted to clarify the prevalence of RHUC and its complications using large-scale population data from the Seaman’s Insurance Health Care and Research Center, Japan.

Methods: We analyzed the health check-up records of 317,952 Japanese subjects (203,166 men and 114,786 women) in 2016. Previous records were also checked when individuals with hypouricemia had repeatedly received health check-ups in the past 10 years. Hypouricemia was defined as a serum uric acid level of ≤ 2.0mg/dL.

Results: 230 men and 301 women were identified as having hypouricemia, and the prevalence was 0.11% in men and 0.26% in women. The renal function in individuals with hypouricemia was better than that of the control group. Incidence of urolithiasis was less frequent in individuals with hypouricemia, compared with the control group. There was no history of renal failure in individuals with hypouricemia in their records.

Conclusion: Through analysis of the previous health check-up records of a Japanese population, we found that individuals with hypouricemia had good renal function, and incidence of urolithiasis was lower than in the control group. Further studies are necessary to determine the prevalence of EIAKI among individuals with hypouricemia.

Objective: Low rates for undergoing secondary testing after occupational cancer screening have been viewed as a problem for some time．Since 2014, as a health check-up follow-up activity, we have been encouraging people to undergo secondary testing with the cooperation of workplaces in our group. In this study, we assessed the means of encouragement and its results．

Methods: Our health check-up center sends a letter encouraging people to undergo the recommended secondary testing together with check-up results and again 3 months later. In 2014, we started conducting questionnaire surveys of group employees 6 months later and carried out individual interviews for those who had not yet undergone testing to encourage them to do so. Since 2016, we have been checking whether people have undergone testing in the previous year in medical interviews during health check-ups, and encouraging them to do so if they have not.

Results: In 2013, rates for group employees undergoing secondary testing were 76.9% for lung cancer, 50.0% for gastric cancer and 38.5% for colon cancer, whereas after starting the interviews to encourage testing, rates had significantly increased in 2016, to 96.0% for lung cancer, 93.3% for gastric cancer and 76.1% for colon cancer (gastric cancer, colon cancer p<0.001)．

Conclusion: As in the case of community health screening, our efforts enhanced the health literacy of workers and this raised the secondary testing rate. This was achieved by the screening organization gaining an accurate appraisal of the secondary testing situation, sharing information with workplace staff and industrial physician to encourage testing, continuously encouraging untested persons from the time of the health check-up until they underwent testing in the following year, and through personalized health support. Issues for the future will be determining how to expand this initiative outside our group and working out an approach to workplaces, which emphasizes the handling of health information.

Objective: To clarify the process for those completing their first 6 months of active support under Specific Health Guidance.

Methods: For people who completed active support at 2 health check-up facilities in the Kanto area, within half a year, attribute and other information was collected and a semi-structured interview was conducted once. Transcripts were made and qualitative inductive analysis was conducted on statements that described the process from deciding to use specific health guidance to completing it.

Results: To describe the process in completing Specific Health Guidance, the following were extracted: “I feel no obstacles in my present life”; “Aware of the change in my physical condition”; “Resolved to receive specific health guidance in order to change my physical condition”; “Speaking with medical staff showed the way to achieving goals”; “Specific Health Guidance was an opportunity to change my attitude”; “Discovered a way suited to me through repeated trial and error”; “While feeling a sense of relief because it was over, a new way of approaching my life and health had started to take root”. As a phrase underlying all of them “Continue developing the ability to control my health so that it permeates my life” was extracted.

Conclusion: While those who participated in this research did not feel any obstacles in their present lives, they resolved to complete the Specific Health Guidance because they had become aware of changes in their physical condition. Also, when feeling that they were wavering in their resolve, interaction with medical staff had allowed them to discover that they had a natural ability to control their health and afterwards a new attitude to life and health had started to take root.

  Crystals of 2,8-dihydroxyadenine (DHA) are precipitated in the urine of people with adenine phosphoribosyltransferase (APRT) deficiency, an autosomal recessive purine metabolic disorder. 2,8-DHA crystals are extremely insoluble and the resulting urinary calculi and tubular deposition cause renal damage. As APRT deficiency can be treated with diet and drugs, early detection and diagnosis are important. We experienced a case of suspected APRT deficiency based on the presence of 2,8-DHA crystals in a urine sediment in a health checkup. This was a 54-year-old man who visited our center in December 2017. A large number of round brown crystals having a central axle-like shape were observed in the urine sediment. They were determined to be 2,8-DHA crystals from their form and properties. Abdominal ultrasonography revealed an 11 mm renal stone in the left kidney. The examinee had a history of recurrent urolithiasis beginning in his twenties. His sister also had a history of recurrent urolithiasis and urinary tract infections from a young age. This case was diagnosed as APRT deficiency by metabolomic analysis of urinary purine nucleotide metabolites. APRT activity was not detected in a T cell test, and in genetic analysis, the genotype was determined to be APRT*J allele homozygote. Based on the above, a definite diagnosis of APRT deficiency was made. Identification of 2,8-DHA crystals in urine sediments through careful observation is important for early diagnosis of APRT deficiency.