Objective: Foreign workers in Japan are expected to play a greater role as the severity of the labor shortage worsens due to the decreasing birthrate and aging population. The number of foreign residents is rising nationwide, and Ehime Prefecture is no exception. As the number of foreigners examined at our center has also been increasing, we sought to consider future challenges by gaining a thorough understanding of the status of such examinations.

Method: We collected data including nationality, sex, age, and examination results for foreigners who received a medical examination at our center between 2015 and 2017. We further administered a questionnaire or made a survey visit to the workplaces of foreigners examined at our center in 2018 and Ehime Prefecture’s Technical Intern Training Supervisory Group concerning problem areas regarding medical examinations and hospital consultations.

Results: The number of medical examinations for foreigners increased each year with 1,781 examinees in 2017, which accounted for 1.3% of all medical examinees. Foreign examinees were primarily from East or Southeast Asia (93.8%); 56.8% were employed in manufacturing. The survey of workplaces found that 63.5% planned to increase the number of foreign employees in the future and requested multilingual resources for medical history forms, test instructions, and examination results in various languages. Many examinees had Limited Japanese Proficiency and were unable to speak English at their examination upon being hired. Examinations were successfully completed using a multilingual translation device or simple Japanese, but interpreting was necessary if there were any important findings.

Conclusion: Immediate strategies necessary to provide services on par with those provided to Japanese individuals for medical interviews, examinations, examination results, and health-related instruction as well as how to coordinate between medical facilities will be essential in handling the continuously increasing number of foreigners in Japan.

Objective: We focused on people who did not implement the Specific Health Guidance in order to improve the consultation rate, and it turned out that about 30% of the candidates refused to answer for reasons of “self-management” and “busyness”. We tried to work on the first interview and clarify the effects.

Methods: During the period of July 2016 to March 2017, 479 candidates for specific health guidance were placed in a control group (2016 group), and 460 persons in an intervention group (2017 group). Unification of explanation methods among staff at the first interview was performed and additional explanations along with a flowchart were given to subjects who refused to adhere to specific health guidance since June 2017. We examined the number of implementers, consultation rate, and the reasons for refusing to adhere to Specific Health Guidance.

Results: The consultation rate of Specific Health Guidance was 17.9% (86 persons) in the control group and increased by 25.5% (117 persons) in the intervention group. There were two examinees who accepted the consultation after an explanation using the subsequent flowchart was provided.

Conclusions: This intervention activated the awareness of staff to introduce Specific Health Guidance, and motivated examinees. These interventions may have contributed to an increase in the rate of initiation of Specific Health Guidance.

Objective: To clarify the characteristics of hybrid IR-based streak artifact (SA)-reduction effects by conducting quantitative evaluations using the Gumbel method on lung field SAs in low-dose chest CT images.

Methods: The superior lobes of anthropomorphic phantoms in the chest were imaged (tube current: 10–50mA) using a 16DAS CT Alexion device (Canon Medical Systems). Each evaluated image was obtained using the following six reconstruction methods: original image, ORG; conventional SA-reduction method, Boost3D; hybrid IR: AIDR 3D (preset strengths: four types). ROIs were set within the lung field (SAs included) of each image, and the correlation coefficients from the obtained Gumbel plots were used to determine the suitability of the Gumbel method for quantitative analysis of the lung field SAs. Hybrid IR-based SA reduction effects were also analyzed from the positional parameters in each image.

Results: The correlation coefficients r of the Gumbel plots for all the evaluated images were in the range 0.963 ≦ r ≦ 0.997, and the Gumbel properties were confirmed due to r ≒ 1. The positional parameters for hybrid IR were lower than those with the conventional method, and furthermore, those values were also independent of the tube current and were constant for each preset strength.

Conclusion: The Gumbel method can be applied for the quantitative evaluations of lung field SAs in low-dose chest CT images. Hybrid IR was also able to further reduce the SAs, as compared to the conventional method, and was shown to be more effective with lower doses.

Objective: Atrial fibrillation (AF) is a causative disease of thrombotic cerebral embolism, and anti-coagulant therapy is used for its prevention. Since the prevalence rate is expected to increase with age, we examined the prevalence rate of AF and current state of treatment in medical check-ups and examined the changes over time.

Methods: Based on the findings of 12-lead electrocardiograms (ECG) of 175,462 patients (86,923 males, 88,539 females) in 2017, the treatment rates were calculated from the prevalence of sex and age and by using a questionnaire. We also examined the change in AF prevalence for 5 years from 2013 to 2017.

Results: The prevalence of AF was 1.13% (1.81 in males, 0.47 in women) and increased with age. Furthermore, a higher percentage was observed in males at each age. The treatment rates were 55.7% for those below 60 years of age, 68.8% for those in their 60s, 66.6% for those in their 70s, and 63.9% for those aged 80 years and above. In patients aged 75 years or older with a CHADS₂ score of 1 or more, the treatment ratio was 65.0%. The trend of the AF prevalence over time was 1.03% in 2013, 1.04% in 2014, 1.10% in 2015, 1.12% in 2016, and 1.13% in 2017. There was no difference observed in morbidity, probably due to the aging of the examinees.

Conclusions: The prevalence of AF was 1.13%, and was found to be higher in males and in older age groups. There are many untreated patients below 60 years of age, and approximately 35% cases above the age of 75 years remain untreated. Therefore, it is necessary to educate patients regarding the need for medical treatment.

Objective: In this study, PSA and MRI screening for prostate cancer were performed simultaneously for the check-up of male participants. The usefulness of MRI screening for prostate cancer was evaluated.

Methods: Twenty-two men seen between June 1, 2018 and February 28, 2019 were included. Data about age, PSA value, and MRI diagnosis were collected. In the cases where detailed examination was required, the additional information was also collected. Plain 1.5 Tesla MRI with T1-weighted, T2-weighted, diffusion-weighted (b value 1,000 and 2,000) scans and ADC map images were acquired and interpreted by radiologists. A digital rectal examination was not performed.

Results: Twenty-two of the 206 participants (10.7%) chose optional MRI screening for prostate cancer. The average age and PSA value of these participants were 67.0 ± 11.8 years old, and 1.14 ± 1.02 ng/mL, respectively. Twelve participants were diagnosed with benign prostatic hyperplasia using MRI, with an average PSA value of 1.10 ± 0.90 ng/mL. All the participants’ PSA values were under the cut-off value of 4.0 ng/mL. However, one participant in his 70s, with a PSA of 3.54 ng/mL, showed abnormal diffusion of high intensity on the right side of the prostate on MRI. A detailed examination revealed that he had intermediate risk prostate cancer.

Conclusion: PSA combined with MRI screening for prostate cancer is effective in detecting clinically significant prostate cancer under the PSA cut-off value.

Objective: Health screening participants who test positive for fecal occult blood are typically referred for further medical follow-up. Many of these individuals are reluctant to undergo a thorough examination and state that hemorrhoids are the reason for their hesitancy. Therefore, we examined the results of extensive testing of patients with a previous or current history of hemorrhoids, or who were having subjective symptoms of hemorrhoids at the time of the study. We considered aggressive promotion of extensive testing for such patients.

Methods: The study was conducted among 110,813 individuals who were examined using a fecal occult blood test (two-day method) at our medical center between April 2016 and December 2018. The participants were allocated into two groups: Group A (individuals with a previous or current history of hemorrhoids, who mentioned having subjective symptoms of hemorrhoids when they were referred for further examination), and Group B (individuals without any previous or current history of hemorrhoids, who mentioned having subjective symptoms of hemorrhoids when they were referred for an in-depth examination). The two groups were compared on the basis of the rate of consultation for extensive testing, the rate of positive findings, and the results of abnormal findings.

Results: The rate of consultation for extensive testing was 39.2% (237/604) in Group A and 46.5% (2,361/5,082) in Group B, which indicates that the rate was significantly lower in Group A than in Group B (p<0.001). However, the results of extensive testing showed that in both groups, approximately 40% of the participants had colon polyps and approximately 2% had colorectal cancers. There were no significant differences between the groups.

Conclusion: For the prevention, early detection, and early treatment of colorectal cancers, it is crucial that health screening participants with subjective symptoms of hemorrhoids be aggressively encouraged to undergo extensive testing.

Objective: Our facility delivers recommendation guidance twice to patients needing detailed examinations or treatment decisions. Future issues were clarified through questionnaire results obtained from non-consultation/non-response patients with the aim of increasing the recommendation response rate.

Methods: A questionnaire survey (accepting multiple answers) regarding pre-examination inquiries and post-examination reasons for non-consultation or non-response was conducted on 288 patients who had undergone a complete medical check-up in January 2019, and from whom we had not received a recommendation response during the previous fiscal year. Analyses were conducted based on survey responses according to the stage model of behavioral change.

Results: Of the patients from whom we did not receive recommendation responses, 105 were actually consulted. Survey responses for reasons for non-consultation included “I had forgotten,” “not enough time,” “I was told every year,” and “I didn’t know how to explain to the consulting physician.” Survey responses for reasons for non-response included “I was not aware that a reply was needed,” “too much hassle,” “I had forgotten,” and “I can explain it during the next health check-up.”

Conclusions: The reasons for non-consultation and non-response during each stage were analyzed based on the stage model of behavioral change, and the survey responses were classified into three stages: indifference, awareness, and intent (preparation). We found that it is important to nudge non-consultation patients toward consultation using appropriate content for each stage of behavioral change. Furthermore, since many non-response patients were at the indifference stage, we believe that making patients understand the significance of recommendations and widely disseminating this information will lead to improved implementation ascertainment rates. In the future, we hope to devise simpler response methods, such as by incorporating IT, in order to improve this implementation ascertainment rate.