Objective: In relation to the opening of a new facility of our association, a previous health guidance system was reviewed, and a new operation system was introduced. The purpose was to achieve a 100% initial consultation rate for delivering specific health guidance on the same day of the specific health check-ups.
Methods: A new operation system was established where doctors issued health guidance directives during patient consultation. The operating system enabled doctors to classify examinees with specific health guidance while explaining the results of the medical check-ups. Patients who were not covered by a specific health guidance were offered lifestyle improvement guidance aimed at improving lifestyle parameters, such as eating habits, physical activity, smoking cessation, and alcohol reduction. A questionnaire survey was utilized to investigate the satisfaction level of the examinees.
Results: From July 2018 to March 2019, 1,064 people underwent specific health check-ups, and 214 (91.1%) of the 235 examinees received specific health guidance during the initial consultation on the same day. A total of 1,095 people underwent medical check-ups, and 1,003 people were given health guidance (80 specific health guidance and 923 lifestyle improvement guidance). A completion rate of 72.1% for specific health guidance, 56.3% for active support, and 95.8% for motivational support was observed. From the questionnaire survey, we noticed that examinee satisfaction and motivation to improve lifestyle was high, except for those who were recommended lifestyle improvement guidance as they were not expecting any health guidance in the pre-examination questionnaire.
Conclusion: The new operation system improved the rate of delivering specific health guidance during initial consultation.
Objective: To examine temporal changes in spirometry and chronic obstructive pulmonary disease (COPD)-related subjective symptoms among males with respect to a smoking index with a 6-year follow-up historical cohort study.
Methods: Overall, 2,454 men who underwent annual human dock were recruited in 2010. Of those participants, men with missing values related to smoking, respiratory, and heart diseases or arrhythmia; ex-smokers; and men repeatedly considered as smokers or non-smokers were excluded. Finally, 1,066 participants who were classified based on pack-years (Py) <20, ≥20 and <40, ≥40, and non-smokers (Py=0) completed the spirometry test and self-reported symptoms for 6 years follow-up. Changes in spirometry were analyzed using a repeated analysis with analysis of variance. The symptoms (cough or sputum, breathlessness) were analyzed using the Cochran Q test and multiple logistic regression model.
Results: Compared with baseline, FEV1% of Py≥40 (2.6%), Py20-40 (2.3%), Py<20 (2.3%), and Py=0 (1.4%) significantly decreased after 6 years of follow-up (p <0.001). %FEV1 of Py20-40 and ≥40 significantly decreased and were lower than Py=0 and Py<20 at each year. There was no significant change in symptoms over the years; however, the rate of cough or sputum symptoms in the Py≥40 group had the highest odds ratio among the four groups.
Conclusion: The higher Py, FEV1％, and %FEV1 declined early and largely. However, subjective symptoms in smokers, excluding Py≥40, appear few. These findings suggest that early detection of COPD without spirometry is more likely to be difficult. To prevent COPD and its progression, respiratory function tests are necessary for all smokers.
Objective: A number of physiological indicators specific to glaucoma included enlarged optic disc depression and peri-optic disc hemorrhage have been introduced in the examination of fundus test results from comprehensive medical check-ups. Here, we aimed to study the outcomes of diagnosing novel cases of glaucoma and the viability of the indicators after their introduction.
Methods: We compared the outcomes of glaucoma diagnosis before the introduction of the indicators in 2013 with those after their introduction between 2014 and 2017. We retrospectively studied the data from the ledger of medical follow-up administration of those who underwent fundus examinations during comprehensive medical check-ups from 2013 to 2017. Logistic regression analysis adjusted for age and sex was used to assess the association between the introduction of two indicators (enlarged optic disc depression and peri-optic disc hemorrhage) and correct diagnosis of novel cases.
Results: We observed an increase in the number of novel cases of glaucoma after the introduction of the diagnostic indicators. The effectiveness of the glaucoma-specific indicators was 46.5% (enlarged optic disc depression, 29.7%; peri-optic disc hemorrhage, 70.3%), but only 8.5% of the other indicators could successfully diagnose glaucoma. Additionally, there were no significant differences in the rate of correct diagnoses between the indicators (enlarged optic disc depression, 55.3%; peri-optic disc hemorrhage, 57.8%). Significant associations were found between the introduction of two indicators (enlarged optic disc depression and peri-optic disc hemorrhage) and correct diagnosis of novel cases.
Conclusions: The introduction of enlarged optic disc depression and peri-optic disc hemorrhage as specific physiological indicators of glaucoma has contributed to an increase in the number of correct diagnosis of novel cases.
Objective: To report an adult case of transient hyperphosphatasemia, which has been reported to be rarely asymptomatic.
Methods: A healthy male in his early thirties underwent a one-day health check-up. Although he had a previous medical history of diarrhea, abdominal pain, rash, and fever of unknown etiology, he was asymptomatic at the health check-up.
Results: The health check-up revealed an abnormally high ALP level of 1,297U/L, but the other test results were normal. During follow-up as an outpatient, the ALP level decreased to 591U/L after six days and to 327U/L after 14 days. Several examinations were unable to identify background disorders of hyperphosphatasemia. The ALP isozyme test revealed a fast α2 band specific to transient hyperphosphatasemia in the serum at the health check-up. The band remained slightly after 14 days.
Conclusion: Transient hyperphosphatasemia can occur in asymptomatic adults. Additionally, the ALP isozyme test may be useful for the diagnosis of transient hyperphosphatasemia even if the ALP level decreases.
Objective: This study aims to clarify the main reasons why patients do not receive specific health guidance (SHG) on the same day of their check-ups from the Japan Health Insurance Association (JHIA), especially regarding background characteristics.
Methods: Subjects were patients who did not receive SHG on the same day of check-ups by the JHIA in our hospital. We investigated the reasons by analyzing a questionnaire as well as opinions freely given by these patients.
Results: The questionnaire was distributed to 57 subjects. We received and examined 53 (94.6%) valid responses from 44 (83%) men and 9 (17%) women.
A total of 25 patients (47.2%) were in their 40s, 17 (32.1%) were working in service industries, and 21 (39.6%) were either taking care of their children and seniors, or participating in social activities besides their jobs.
Among the main reasons for not receiving SHG the same day of check-ups were the following: “I must go back to work as soon as possible” (29, 54.7%), “I have no time today for activities not related to work” (13, 24.5%), and “I’ll improve my lifestyle habits by myself if necessary” (10, 18.9%).
Regarding the statistical analyses, there was a significant positive association between subjects who beforehand knew they were able to receive SHG on the same day and the response “I’ll improve my lifestyle habits by myself.” On the other hand, there was a positive association between subjects who worked on the night shift and the response “I’ve already tried to improve my lifestyle habits.”
Conclusion: This study suggests that the main reasons for insured patients not receiving SHG the same day of check-ups were responses related to lack of time and concern that it would interfere in matters that were more important than their health problems.
To increase the rate of receiving SHG the same day, it is important for us to provide proper information about this procedure to insured patients. Furthermore, we need to recommend employers in cooperation with the JHIA to provide better work conditions for their employees.
Purpose: In recent years, more than half of working professionals have been experiencing considerable stress from their jobs and working life. In response, attempts have been made to improve the capacity of occupational health physicians and the relevant treatments. In this study, the relationship between stress and lifestyle habits was examined, with the aim of providing comprehensive physical and mental health support during health instruction.
Method: The subjects were 19,181 individuals (47.3±11.9 years old; 10,074 males, and 9,107 females), who underwent health examinations and stress checks at our center in FY2017. The relationship between people under high stress and lifestyle habit items listed on a standard questionnaire were analyzed.
Results: People under high stress accounted for 13.0% of the subjects, a high number of which were males (male: 14.2%, female: 11.8%) (p<0.001). Males in their 30s (17.6%) and females aged 29 and below (18.9%) made up the highest percentage of those highly stressed. The percentage decreased as the age increased. In the relationship with lifestyle habit items, the response rates in “can take sufficient rest by sleep” were extremely low among people under high stress, and significant differences were observed across all age groups in both men and women (p<0.001). Additionally, in age groups with a high percentage of people under high stress, there were significant differences in several question items concerning diet and weight changes in both men and women. In particular, the smoking rate of women under high stress was significantly high (29 years old and below: p<0.01, 30s and 40s: p<0.001, and 50s: p<0.05).
Conclusion: Most people under high levels of stress had unorganized lifestyles, suggesting that stress and lifestyle influence each other. It is, thus, concluded that the content of health instruction can be improved by giving guidance on lifestyle habits, taking into account the individual’s stress background, which could also contribute to mental health support.
Objective: The evaluation of visceral obesity is important in relation to metabolic syndromes. While measurement of waist circumference (WC) is useful, visceral obesity and lifestyle-related diseases are detected even with normal WC. In this study, we measured visceral fat area (VFA) and examined its benefit in health check-ups.
Methods: We studied 12,679 patients (54.2 ± 10.0 years old, 1,424 men, and 11,255 women) who underwent a health check-up between October 2014 and March 2018. VFA was measured by the abdominal bioimpedance method, and atherosclerotic and lifestyle risk factors were evaluated.
Results: Significant positive correlations were observed between WC and VFA (r=0.876). We determined that 13.8% men and 3.2% women from the patient group had normal WC and high VFA. These patients had significantly higher number of risk factors that exceeded 1.0 (men, 1.18 ± 0.87 vs. 0.93 ± 0.82, p<0.01; women, 1.14 ± 0.91 vs. 0.60 ± 0.76, p<0.001) when compared to patients with normal VFA. In addition, there were significant differences in weight change which was defined as weight gain of 10kg past 20 years of age and eating habits such as fast eating speed and duration of less than 2 hours between dinner and bedtime.
Conclusion: Patients with high VFA will likely develop risk factors for atherosclerosis in spite of normal WC. In these patients, especially those with difficulties in weight change and eating habits, it is important to measure VFA in addition to WC.
Objective: The aim of this study was to analyze the effects of weight changes over 5 years on the risk of developing hypertension, diabetes mellitus, and high non-HDL cholesterol levels.
Methods: The study subjects were men with BMI ≥ 25kg/m2 or waist circumference ≥ 85cm. They were divided into 7 groups based on the change in their weight over a period of 5 years: >5% gain, 3%–5% gain, 1%–3% gain, stable weight, >5% loss, 3%–5% loss, 1%–3% loss. We analyzed the subjects’ risks of developing hypertension, diabetes mellitus, and high non-HDL cholesterol using logistic regression analysis.
Results: A significant risk reduction was observed in the >5% weight loss group [odds ratio (OR)=0.60] for hypertension; for three weight loss groups of 1%–3% (OR=0.42), 3%–5% (OR=0.26), and >5% (OR=0.12) for diabetes mellitus; and for two weight loss groups of 3%–5% (OR=0.42) and >5% (OR=0.33) for high non-HDL cholesterol compared to the stable weight group.
Conclusion: Our results suggest that, compared to those with stable weight, men who lost more than 5% of their body weight have significantly reduced risk for all three diseases.
We report a case of late-onset Fabry disease diagnosed by the detection of urinary mulberry cells during a medical check-up. A Japanese male patient in his mid-50s had been treated for hypertension since his late 40s. His electrocardiogram in a medical check-up showed a typical pattern of left ventricular hypertrophy. Based on the echocardiogram findings in our hospital, he was considered to have asymptomatic hypertrophic cardiomyopathy. In the next year’s check-up, mulberry cells were observed in his urine sediment. Since he was suspected to have Fabry disease, he underwent detailed examinations by a cardiologist. He had low alpha- galactosidase activity in the leucocytes. The gene mutation analysis identified the p.N215S missense mutation, which is a well-known lesion of “cardiac variants”; therefore, he was diagnosed with late-onset Fabry disease.
Late-onset Fabry disease is a disease with progressive left ventricular hypertrophy, and its prognosis depends on heart failure and fatal arrhythmia. Enzyme replacement therapy has been recognized as an effective treatment for Fabry disease in recent years; however, an early definitive diagnosis is crucial. In cases where a medical check-up presents with left ventricular hypertrophy, such patients may potentially have late-onset Fabry disease. We suggest that urinary mulberry bodies and cells should be helpful in confirming the diagnosis of this disease.
Purpose: The goal of this study was to contribute to improved safety and peace of mind for examinations, as well as examinee satisfaction, by strengthening cooperation with the medical safety management system and establishing “Your Consultation Room” to improve examinee services.
Methods: By carrying out universal management of examinee feedback through “Your Consultation Room,” including collection, analysis, and improvement proposals, this study attempted to strengthen risk management. In addition to striving for smooth problem-solving related to adverse medical events through coordination with the medical safety management system, the study also strived to strengthen post-event follow-up by incorporating medical coordination functions into “Your Consultation Room.”
Results: For nine cases of medical adverse events, the medical mediator assigned to “Your Consultation Room” served as a bridge to the examinee, solving problems while simultaneously carrying out activities to prevent recurrences. In addition, measures such as the creation of examination compliance standards were taken based on examinee feedback, which led to improved safety and peace of mind. Although around 100 complaints had been collected from the suggestion box each year up until now, starting from the year after “Your Consultation Room” was established, the number of requests decreased and the number of expressions of gratitude increased.
Conclusion: By carrying out universal management of examinee feedback and making efforts for risk management while simultaneously organizing the medical safety management system, this study not only provided safer examinations and greater examinee satisfaction but also improved risk management awareness among staff members.