Objective: To analyze the lifestyle habits of persons getting a specific health checkup using a “standard questionnaire” and characterize the lifestyle habits of those receiving specific health guidance. In addition, the effects of providing health guidance by presenting such characteristics are examined.

Methods: The results of a standard questionnaire conducted during specific health checkups between 2008 and 2016 at company A in Kumamoto Prefecture were tabulated to clarify the lifestyle habits characteristic of those receiving specific health guidance at company A. Those receiving specific health guidance in 2016 were randomly divided into two groups: the “presentation group” that was introduced to the characteristic lifestyle habits at the time of the health guidance and the “non-presentation group” that was not introduced to such habits. The “non-presentation group” was given conventional specific health guidance. The “presentation group” was introduced to the characteristic lifestyle habits through materials in addition to the conventional method, and they were instructed to promote lifestyle changes. The effects of specific health guidance based on the results of the standard questionnaire were evaluated by comparing the results of health checkups in 2017 with those in 2016.

Results: The characteristic lifestyle habits of those receiving specific health guidance at company A were “little physical activity,” “a habit of skipping breakfast,” and “fast eating.” When the specific health guidance was carried out by presenting materials on “skipping breakfast” and “fast eating,” the systolic blood pressure increased in the non-presentation group, while it decreased in the presentation group in 2017. The change was significantly different.

Conclusion: It is suggested that the effectiveness of guidance may be improved by analyzing a standard questionnaire conducted during specific health checkups to clarify the characteristics of the target population and implement specific health guidance based on the results.

Objective: To report the attempts undertaken to reduce radiation exposure in colorectal computed tomography examinations (CTCs), starting from October 2017.

Methods: Our study included 99 patients who underwent CTC as part of a medical examination between October 2017 and March 2020. The study period was divided into three timeframes, according to the timing of the change in the filming conditions: 11 months from October 2017 to August 2018 (Period A); 9 months from September 2018 to May 2019 (Period B); and 11 months from May 2019 to March 2020 (Period C). The period A cohort included 20 patients (mean age, 50.1 years; mean body mass index [BMI], 23.4) and a tube voltage of 120 kV with a standard deviation (SD) of 20 was applied; the period B cohort contained 20 patients (mean age, 45.3 years; BMI, 23.9) and the applied tube voltage and SD differed according to BMI (120 kV, SD of 30 at BMI≧25, 120 kV, SD of 40 at 20≦BMI＜25, and 100 kV, SD of 45 at BMI＜20); and the period C cohort contained 59 patients (mean age, 47.8 years; BMI, 23.0) and a tube voltage of 120 kV, SD of 30 was applied. The dose-length product (DLP) at prone position (mGy・cm) and effective dose (mSv) were calculated for the different time periods.

Results: In period A, the DLP was 101.5 mGy･cm and effective dose was 5.0 mSv; in period B, the DLP was 45.1 mGy･cm and effective dose was 5.1 mSv; and in period C, the DLP was 47.1 mGy･cm and effective dose was 4.5 mSv.

Conclusion: In this study, we carried out CTC examinations by changing the filming conditions for three periods. By setting the tube voltage to 120 kV, SD of 30, the effective dose was reduced to 4.5 mSv, and we were able to set a value of image noise that did not cause diagnostic or interpretation failure.

  During routine health consults, four cases of resectable uncinate process cancer of the pancreas were detected by contrast-enhanced CT, which was performed because of the elevated level of serum carbohydrate antigen 19-9 (CA19-9). The male-to-female ratio was 3:1, and the age range was 53-64 years. The serum CA19-9 values of the patients were 165, 66, 111, and 43 U/mL and the tumor diameters were 15, 25, 30, and 20 mm, respectively. All tumors were in contact with the superior mesenteric vein (SMV). The tumor-SMV circumferential interface of cases 2 and 3 were within 180°. Both cases were sent to the low-volume center, where cancers were not resected due to SMV invasion. Conversely, cases 1 and 4 were sent to the high-volume center and underwent preoperative adjuvant chemotherapy, in which both attained Stage IIA. In case 2, magnetic resonance cholangiopancreatography (MRCP) revealed a branch-duct type intraductal papillary mucinous neoplasm (IPMN) at the tail of the pancreas. In case 3, the patient came to our hospital, five months after the last medical consult, for jaundice and CA19-9 level five times the normal level. Despite being aware of his abnormal CA19-9 level, the patient in case 4 only visited our hospital after one year. At consultation, the CA19-9 level had already increased 30 times. His MRCP revealed multiple branch-duct type IPMNs from the head to the body of the pancreas. The aforementioned pancreatic cancers would not have been detected if not for the measurement of their serum CA19-9 levels. Therefore, CA19-9 aids in the early detection of pancreatic cancer during opportunistic screening.

  We report a case of polycystic kidney disease, diagnosed only after multiple health checkup examinations. We suspected multiple hepatic and renal cysts using ultrasonography, aortic valve regurgitation using cardiac auscultation, and renal dysfunction using laboratory tests in 2018. Although according to the Manual for Abdominal Ultrasonography, 2014 edition, a health checkup once per year is recommended for polycystic kidney disease cases, the revised version of the Manual, 2021 edition recommends further examination for the disease. Thus, diagnosed cases of polycystic kidney disease would be expected to increase with additional health checkups. Additionally, health checkup information in the Manual for Abdominal Ultrasonography, 2021 edition should be shared with sonographers and physicians of the Ningen-Dock program.

  We report a case of achalasia, which was identified and diagnosed during a health check-up. A 53-year-old man was screened by a periodic employee involved with the health check-up. Chest radiography was performed and showed abnormal findings such as the disappearance of gastric air bubbles, abnormal shadowing of the esophagus, and a dilated esophagus. In addition, the enlarged esophagus was confirmed by chest computed tomography.

  The diagnosis was subsequently confirmed by barium swallow imaging. Pneumatic dilation using Rigiflex^TM 3.0 cm in the outer diameter was performed and all complaints have disappeared. In most cases of achalasia, abnormal esophageal dilation is shown before the appearance of symptoms, and the characteristic shadow and disappearance of gastric air bubbles in chest radiography can be an important diagnostic strategy. However, little knowledge and a high level of attention may be enough to detect achalasia during a health check-up.

Objective: The results of diagnostic testing following a comprehensive screening conducted outside of Japan are difficult to obtain and may influence diagnostic test participation rates. This study aimed to clarify the impact of this phenomenon.

Methods: We surveyed 8,504 participants who underwent comprehensive screening in 2018, including 210 (2.5%) participants living abroad. We examined the international participants included in the total number of screening tests and those who required a diagnostic test. Further, we investigated the diagnostic test participation rate among international participants.

Results: The percentages of international participants receiving screening tests and requiring diagnostic tests were 6.3% (106/1,686) and 7.1% (12/170, including those requiring lesion resection), respectively, for screening colonoscopy; 2.8% (68/2,414) and 6.5% (3/46), respectively, for breast cancer screening; and 6.1% (114/1,881) and 4.7% (5/107), respectively, for the prostate-specific antigen test. The diagnostic test participation rates for those identified as “Japanese participants” and “international participants” and for the overall sample were 91.8% (145/158), 16.7% (2/12), and 86.5% (147/170), respectively, for screening colonoscopy; 93.0% (40/43), 0.0% (0/3), and 87.0% (40/46), respectively, for breast cancer screening; and 78.4% (80/102), 0.0% (0/5), 74.8% (80/107), respectively, for the prostate-specific antigen test. There was a significant difference in the diagnostic test participation rate between Japanese and international participants in all three tests (p<0.001, p=0.01, p<0.001). The percentage of international participants who could not be counted as participating in a diagnostic test was 43.5% (10/23) for screening colonoscopy, 50.0% (3/6) for breast cancer screening, and 18.5% (5/27) for the prostate-specific antigen test.

Conclusion: The failure to track diagnostic test participation of international participants contributes to the decline in overall diagnostic test participation in Japan. Measures are required to determine the status of the diagnostic test participation among international participants.

Objective: In this study, a questionnaire survey was conducted among hearing-impaired people at the time of medical examination and among assisting staff in order to understand their desired language media and support methods.

Methods: Twenty-five people with hearing impairment who visited our center between April 1, 2020, and March 31, 2021, were surveyed about the inconveniences they experienced during examination. Furthermore, a questionnaire survey was also conducted among assisting staff members to identify the problems and innovations in the various departments (administrative department, radiology department, nursing department, and laboratory department). The questionnaires from both surveys were tabulated, examined, and compared.

Results: The tests perceived as inconvenient by people with hearing impairement were gastric X-ray test (32.0%) and abdominal ultrasonography (24.0%). The preferred language media were written (29.6%), gesture (22.2%) and oral (22.2%), and a small percentage (3.7%) preferred sign language. As for their ideal support method, many people requested the use of explanation panels and materials detailing the test procedures. The responses in the staff questionnaire differed in all departments.

Conclusion: Most hearing-impaired people who are examined at our center prefer written conversation as a language medium and need easy-to-understand visual explanations. In the future, we believe that it would be beneficial to use tablet devices for visual explanations and voice-to-text conversation function. Moving forward, we plan to share information among staff members and aim to become a barrier-free medical test center that caters to all examinees and not only those with hearing impairment.