Official Journal of Japan Society of Ningen Dock
Online ISSN : 2186-5027
Print ISSN : 1880-1021
ISSN-L : 1880-1021
Volume 35, Issue 4
Displaying 1-13 of 13 articles from this issue
Foreword
Review
Original Articles
  • Naomi Tsujimoto, Takuya Tamura, Asami Oshima, Yukari Miyata, Yukari Ma ...
    2020 Volume 35 Issue 4 Pages 552-561
    Published: 2020
    Released on J-STAGE: March 31, 2021
    JOURNAL FREE ACCESS

    Objective: We investigated initiatives to improve the implementation rate of specific health guidance and their consequences.

    Methods: We described the number of initial interview guidelines and the Health Guidance program’s continuous support from April 2011 to March 2018, and the annual implementation rate. We summarized the transition of numbers of the medical staff and the process improvement and organization development initiatives in chronological order for the same period.

    Results: First, interviews were continued to increase from 357 in 2011 (54.0%) to 2,309 in 2018 (99.1%). The completion rate for continuation support increased from 20.1% in 2011 to 80.9% in 2018. We have systematically built the competence of the public health nurse over the years since joining the team. All the public health nurses experienced wide-ranging efforts in the health check-up center in the first year. A clerk in charge of specific health guidance was assigned in 2014. Since 2017, occupational safety, health activities, and health guidance have been conducted in the workplace.

    Conclusions: The implementation rate improved steadily due to ingenuity. Our competence formations made it possible to cooperate with other staff members smoothly. Through OSH activities, we introduced the health guidance programs in workplaces. It was suggested that the public health nurse-centered organization fostered a culture of solving their problems with others and achieved high goals efficiently.

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  • Izumi Kure, Yuko Imada, Etsuko Sugawara, Hiroki Morimoto, Kaori Kotani ...
    2020 Volume 35 Issue 4 Pages 562-569
    Published: 2020
    Released on J-STAGE: March 31, 2021
    JOURNAL FREE ACCESS

    Objective: The purpose of this study was to measure the frequency of non-ampullary duodenal epithelial tumors (NADET) and describe their clinical characteristics in healthy subjects in whom tumors were identified.

    Methods: We performed esophagogastroduodenoscopy (EGD) in 32,542 subjects during health check-ups from 2016 to 2018. We selected subjects diagnosed with NADET by pathological examination and investigated the clinical characteristics.

    Results: Twenty subjects were diagnosed with NADET, corresponding to an endoscopic detection frequency of 0.061%. The male-to-female ratio among the 20 cases was 13:7, and the mean age was 56.2 ± 11.4 years (range: 35–79 years). In 15 subjects, (75.0%) lesions were 10mm or less in diameter. The most common macroscopic type was Ⅱ a (11 lesions, 55.0%). Fifteen lesions (75.0%) were either entirely white or had white margins. Thirteen patients underwent endoscopic resection, and one had surgery. Two cases (10.0%) were diagnosed with intramucosal cancer by analysis of the resected specimen.

    Conclusions: The frequency of NADET found on EGD during health check-ups was 0.061%, and 2 out of 20 cases (10.0%) were intramucosal cancers. Endoscopists who perform screening using EGD should examine the descending part of the duodenum as far as possible, and check for tumors of small sizes.

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  • Yoshie Yotsukura, Azusa Sato, Mariko Inoue, Yoshiko Inoue, Makiko Yama ...
    2020 Volume 35 Issue 4 Pages 570-577
    Published: 2020
    Released on J-STAGE: March 31, 2021
    JOURNAL FREE ACCESS

    Objective: The combination of mammography and ultrasonography for breast cancer screening has recently become more common. We aimed to evaluate the value of the combined assessment by analyzing breast cancer cases that were positive only on either mammography or ultrasonography.

    Methods: Of the 27,449 patients who underwent combined screening for breast cancer using mammography and ultrasonography at our institution, 117 were diagnosed as having breast cancer. We analyzed the characteristics of 28 patients with ultrasonography-positive and mammography-negative cancer and 19 patients with mammography-positive and ultrasonography-negative cancer.

    Results: The detection of breast cancer by mammography and ultrasonography in combination was 1.3 times higher than that by single-modality screening. High breast density accounted for 78.6% of the cancers cases that were positive only on ultrasonography during screening. The diameters of the cancers that were positive only on ultrasonography were 4–20mm and 4.5–8mm in high- and non-high-density breasts, respectively. Ultrasonography screening permitted the detection of early-stage invasive ductal carcinoma and changes in lesions of even 1–2mm. The most common finding and site of the cancer that showed positive results on only mammography were calcification (63.2%) and periphery of the breast and below the nipple (52.6%), respectively.

    Conclusions: Owing to the specific characteristics of each modality, the use of mammography and ultrasonography in combination is valuable for breast cancer screening.

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  • Toshiki Fukui, Kazuhiro Yamauchi, Syuji Matsumura, Mie Maruyama, Norik ...
    2020 Volume 35 Issue 4 Pages 578-585
    Published: 2020
    Released on J-STAGE: March 31, 2021
    JOURNAL FREE ACCESS

    Objective: Here, we continue to report the relationship between various factors associated with lifestyle-related disease and brachial-ankle pulse wave velocity (baPWV), which is a stiffness index of large arteries. Although smoking is a risk factor for arteriosclerosis, there are few longitudinal analysis reports related to the effects of smoking on baPWV.

    Methods: Overall, 419 men and 38 women who smoked continuously for 10 years (smoking group) and those who did not smoke continuously (nonsmoking group) were selected from among 7,251 men and 2,707 women who underwent health checkups and for whom baPWV was measured at our facility.

    As very few female smokers could be included and to exclude those who quit and re-started smoking in the course of 10 years and also exclude the effect of blood pressure that greatly affected baPWV, 274 men, i.e., 181 nonsmokers and 93 smokers, who had never been on antihypertensive drugs were included in this analysis.

    Results: Among age, BMI, blood pressure, and various lifestyle-related disease factors, HDL cholesterol and triglyceride levels were significantly different between the first year and tenth year in both groups. The increase in baPWV during the 10-year period was significantly greater in the smoking group (200 cm/sec) than in the nonsmoking group (128 cm/sec). In addition, among the analyzed subjects who had all measurement results, in the first year, after 3 years, after 5 years, after 7 years, and after 10 years, the change in baPWV was significantly greater in the smoking group from after 3 years and above.

    Conclusion: Our findings suggest for the first time that the effects of smoking on the progression of the stiffness of large arteries can be detected by changes over years in baPWV.

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  • Mika Sato, Tsuyoshi Kato, Yukiko Dazai, Kiyo Takeda, Yukie Sasaki, Mih ...
    2020 Volume 35 Issue 4 Pages 586-594
    Published: 2020
    Released on J-STAGE: March 31, 2021
    JOURNAL FREE ACCESS

    Objective: In Japan, the prevalence of COPD increases with smoking history and age. During a population-based lung cancer screening, we conducted COPD screening of these highly prevalent aged smoking group using a questionnaire. We investigated whether COPD patients could be identified and whether they could be effectively treated. Furthermore, the feasibility and usefulness of COPD screening were assessed.

    Methods: A questionnaire, including items from the mMRC questionnaire and other items related to subjective symptoms, such as shortness of breath, cough, and sputum, was distributed among 730 patients who underwent sputum cytology examination during lung cancer screening performed annually in Miyagi Prefecture. Based on the results of the questionnaire, we evaluated the possibility of COPD in all the study participants. Thereafter, we identified patients who required further examination and recommended that they should be examined at our institution or by their family doctors.

    After further examination, including lung function tests, treatment with inhalants and smoking cessation guidance were provided as necessary. Two weeks later, a reexamination of the lung function was conducted to confirm improvement of COPD, and the affected patients were referred to a primary care doctor.

    Results: Of 730 patients, 306 completed the questionnaire. After evaluating patients for COPD using the questionnaire, 64 patients were selected to undergo a detailed examination.

    A pulmonary function test confirmed the diagnosis of COPD in 13 patients and identified four additional borderline COPD cases.

    Of 11 patients treated at our facility, six experienced a reduction in the symptoms by ≥ 3 points in the CAT questionnaire after treatment.

    Eight people who smoked at the time of pulmonary function test examination were instructed to discontinue smoking, and three people subsequently quitted smoking and three reduced smoking.

    Conclusion: Patients with confirmed or borderline COPD were diagnosed using a questionnaire distributed during lung cancer mass screening. Using treatment and intervention, we improved the quality of life of patients and successfully introduced smoking cessation in many cases. Thus, this COPD screening could be considered useful and feasible.

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  • Tomio Kametani
    2020 Volume 35 Issue 4 Pages 595-602
    Published: 2020
    Released on J-STAGE: March 31, 2021
    JOURNAL FREE ACCESS

    Objective: Hyperuricemia is a risk factor for chronic kidney disease (CKD). I examined gender-specific differences in the association between mean uric acid (MUA) and progression to CKD.

    Methods: Between 2008 and 2011, 3,166 participants from the Takaoka Health Care Center who did not have diabetes or hypertension, or an eGFR<60mL/min/1.73m2, were followed up for an average of 6.7 years. Study participants were divided into four groups according to results of baseline uric acid or follow-up MUA. CKD was defined as an eGFR<60mL/min/1.73m2.

    Results: In men, patients with MUA < 6mg/mL were used as the baseline group and multivariate adjusted hazard ratios for incident CKD were: 1.34 (95% CI: 0.97–1.84, p=0.07) in patients with MUA ranging from 6 to < 7mg/dL, 1.64 (95% CI: 1.04–2.57, p<0.04) in patients with MUA ranging from 7 to < 8mg/dL, and 2.32 (95% CI: 1.07–5.04, p<0.04) in patients with MUA > 8mg/dL. In women, patients with MUA < 4.5mg/dL were the baseline group and hazard ratios for incident CKD were: 1.22 (95% CI: 0.90–1.65, p=0.19) when MUA ranged from 4.5 to < 5.5mg/dL, 2.18 (95% CI: 1.41–3.38, p<0.001) when MUA ranged from 5.5 to < 6.5mg/dL, and 11.20 (95% CI: 3.81–32.91, p<0.001) when MUA was > 6.5mg/dL.

    Conclusions: MUA is a better predictor of CKD compared to baseline uric acid. The risk of CKD was higher when MUA was > 7mg/dL in men and > 5.5mg/dL in women. Hyperuricemia was associated with a higher risk of CKD in women compared to men.

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  • Yasuko Hasebe, Hidehiko Onoue, Naoko Matsugi, Sanae Watanabe, Kan Yagi
    2020 Volume 35 Issue 4 Pages 603-611
    Published: 2020
    Released on J-STAGE: March 31, 2021
    JOURNAL FREE ACCESS

    Objectives: In recent years, the incidence of cerebral cardiovascular disease (CVD) has increased due to the rapid aging of the population in Japan and westernization of lifestyles. Therefore, the initiatives to combat CVD have become an urgent issue. Abdominal vascular findings obtained through abdominal ultrasonography were investigated, and issues requiring future medical examinations were considered.

    Method: Overall, 10,594 individuals who underwent abdominal ultrasonography from 2015 to 2017 were enrolled in this study; their abdominal artery findings and background factors were investigated.

    Results: Abdominal ultrasonography revealed abdominal aortic aneurysms in 8 patients (0.08%), common iliac artery aneurysms in 4 patients (0.04%), and visceral artery aneurysms in 6 patients (0.06%) (splenic artery in 2, renal artery in 3, and right gastroepiploic artery in 1 patient). In addition, penetrating atherosclerotic ulcers (PAUs) of the abdominal aorta were found in 10 patients (0.09%). Atherosclerosis was severe in the abdominal aorta and iliac artery lesions but hardly noticeable in the visceral artery aneurysms.

    Conclusion: The indication of arterial disease with abdominal ultrasonography in medical examinations has significance in terms of reducing mortality from CVD and extending healthy life expectancy. For the indication of visceral artery aneurysms, it is important to perform Color Doppler and Fast Fourier Transform analysis for anechoic masses that cannot be confidently identified as cysts. When scanning the abdominal aorta, it is necessary, as much as possible, to scan the periphery of the iliac artery for the evaluation of PAU precursor lesions and PAU/aneurysms, while checking for the existence of subintimal hypoechoic images, in cases diagnosed with stenosis in the: celiac artery, superior mesenteric artery, origin of the renal artery or iliac artery, and arteries with noticeable atherosclerosis.

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  • Kaori Murayama, Akane Chiba, Chiduru Sato, Kaori Mikami, Yoshie Kureha ...
    2020 Volume 35 Issue 4 Pages 612-619
    Published: 2020
    Released on J-STAGE: March 31, 2021
    JOURNAL FREE ACCESS

    Objective: The present study aimed to evaluate the usefulness and challenges of propofol (pf) sedation for esophagogastroduodenoscopy (EGD) in a comprehensive health check-up system (CHCS).

    Materials and Methods: The subjects were 8,889 patients who received CHCS in our hospital between 2014 and 2019. The subjects chose between EGD or barium meal radiography for examination of the upper gastrointestinal tract. Furthermore, they decided to undergo EGD with or without pf sedation. A bolus dose (0.8–1.2mg/kg) of pf was injected intravenously just prior to EGD. SpO2 and pulse were monitored in patients who underwent EGD with pf sedation. Medical records detailed the adverse effects. The sentiments of the subjects who underwent EGD with pf sedation were studied in 600 patients with a satisfactory investigation. An interview was conducted to collect their opinions on the topic.

    Results: The number of patients who received CHCS had increased annually, and in 2018, it increased to approximately 1.4 times that in 2014. The patients who underwent EGD with or without pf sedation also increased. Adverse effects, such as respiratory suppression (3.25%), unconscious body movement (0.81%), and emergence delay (0.56%), were seen among patients who underwent EGD with pf sedation. However, no severe complications developed except bronchial convulsion in one case. Patients who underwent EGD with pf sedation stated their positive opinions in the interview. Most negative opinions could be attributed to their increased workload.

    Conclusions: Introduction of EGD with pf sedation may increase the number of patients who receive CHCS. However, awareness of the harmful effects and increase in medical staff may be necessary to improve safety of the n the future.

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  • Naoko Yamahashi, Misato Miyata, Miyuki Hirayama, Ryuji Togawa, Sachiko ...
    2020 Volume 35 Issue 4 Pages 620-630
    Published: 2020
    Released on J-STAGE: March 31, 2021
    JOURNAL FREE ACCESS

    Objective: The aim of this study was to obtain information regarding the status of working environment improvement, as required by the legislated Stress Check (SC) from December 2015, and suggestions for its further expansion and promotion.

    Method: Our foundation conducted an awareness survey in November 2017 of 283 business sites which have been implementing SC since the enactment of the law.

    Results: Responses were received from 20 businesses (42.4% response rate), with about 65% of them being small- to medium-sized. Regarding the post-SC initiatives, group analysis was conducted at approximately 70% of the business sites, with the majority of businesses indicating that the implementation was signified by “understanding the stress situation in the workplace.” Respondents who indicated that they did not feel the significance of the program offered opinions such as, “Methods to use the system and implement measures are unclear,” and “We have been unable to take action based on the results.” Moreover, although only about 30% of businesses were working on improving the workplace environment, large numbers, almost 50%, of businesses indicated a willingness to do so in the future, reflecting a high level of interest. Reasons behind the lack of implementation included “not knowing how to proceed”, “the large managerial burden”, and a “lack of specialist staff.”

    Conclusion: The survey results suggest that the use of group analysis does not lead to sufficient use, and that the lack of know-how and response staff are hindering efforts, in spite of high interest in improving the working environment. In particular, these factors were observed to be a major hindrance to the efforts of small- to medium-sized businesses.

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  • Eri Noda, Kunihito Nishikawa, Akemi Oku, Eri Sueoka, Kayo Ito, Masayuk ...
    2020 Volume 35 Issue 4 Pages 631-640
    Published: 2020
    Released on J-STAGE: March 31, 2021
    JOURNAL FREE ACCESS

    Objective: We aimed to clarify the factors influencing the degree of discomfort in examinees undergoing upper gastrointestinal endoscopy (GIE).

    Methods: We included 5,249 individuals who underwent a health check-up including the upper GIE between November 2018 and April 2019 at our clinic. After the health check-up, a self-administered questionnaire survey was conducted to assess the examinees’ discomfort during GIE and their satisfaction with the health check-up. We obtained data on subjects’ background factors and GIE examination findings regarding the following aspects: transnasal or transoral, sedated or unsedated, use of thin (diameter 5.9mm) or conventional (diameter 9.3mm) endoscope, the degree of vomiting reflexes, and body movement during GIE.

    Results: After multivariate adjustment, younger age, female sex, higher pre-GIE anxiety, less number of previous GIEs, long time for GIE, and high number of vomiting reflexes and body movement during GIE were observed to be associated with discomfort during GIE. Transnasal GIE significantly reduced the number of vomiting reflexes, while using sedatives reduced discomfort. In transoral GIE, using a thin endoscope reduced discomfort better than a conventional endoscope, especially without sedatives. The examinees who felt stronger discomfort during GIE tended to be more dissatisfied with the health check-up.

    Conclusion: Depending on age, sex, pre-GIE anxiety, the number of past GIEs, and discomfort level during past GIEs, using sedatives and/or a thin scope may be useful for reducing the discomfort level during GIE, possibly leading to improved examinee satisfaction with the health check-up.

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