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To present reference values, clinically significant changes (CSC), and prediction equations of lower-limb muscle strength (LMS) and physical performance (PP) in community-dwelling older adults in a rural area. Quadriceps muscle and toe grip strength were measured as LMS. Maximal gait speed, Timed-Up and Go test, one-legged stand test, and four-square step test were measured as PP. Overall and age-specific reference values for both sexes were presented. CSC was calculated using a distribution-based approach. We conducted multivariate regression analyses to make prediction equations for each variable. The prediction error was checked using 10-fold cross-validation. Three-hundred ninety-two participants (male, n = 116; female, n = 276) were included. LMS was maintained with age, while PS declined linearly. The prediction equations were significant, but the prediction error was high. Reference values and CSC help evaluate the deterioration of LMS and PP and the effectiveness of an intervention on these outcomes. [ABSTRACT FROM AUTHOR]

Background: Health checkups are important in patients with chronic kidney disease (CKD), which is not easily accompanied by subjective symptoms. CKD can be caused or aggravated by factors that have not yet been identified., Methods: This retrospective cohort study included 7 483 patients who underwent specific annual health checkups at a medical institution in Tama City, did not have CKD in 2012, and continued to undergo checkups (aged 40-74 years). We examined the risk factors for new-onset CKD and 1.5-fold increase in serum creatinine levels among laboratory values from 2012 to 2020., Results: Age, body mass index (BMI), triglyceride levels, atrial fibrillation, and medication for hypertension (HT) and diabetes mellitus were independent risk factors for proteinuria, whereas current smoking, BMI, systolic blood pressure (SBP), and medication for HT were independent risk factors for estimated glomerular filtration rate < 60 mL/min/1.73 m 2 . SBP, triglyceride levels and medication for HT were risk factors for a 1.5-fold increase in serum creatinine levels during course of the study. The cut-off values of BMI for eGFR < 60 mL/min/1.73 m 2 were 22.2 (men 24.7, women 22.1) kg/m 2 and fasting triglyceride levels for a 1.5-fold increase in serum creatinine level were 171 (men 247, women 170) mg/dL, respectively., Conclusions: Health checkups provide information to prevent new-onset CKD and worsening of renal function. It is necessary to increase the rate of health checkups and visits to medical institutions after health checkups as well as to use these results for health guidance., (© 2024. The Author(s).)

Background: Respiration with mandibular movement (RMM) is one of the important clinical signs of impending death. However, there is very limited data on its natural course. Objective and Methods: This study was conducted in 23 inpatient palliative care units in Japan. It aimed to explore the natural course of RMM. Results: Among a total of 1526 cancer patients included, 1065 patients (69.8%) had RMM. A total of 14.8% patients experienced respiratory arrest within 30 minutes from RMM onset, 14.3% within 30–60 minutes, 34.4% within 1–4 hours, 17.5% within 4–12 hours, 8.9% within 12–24 hours, and 10.4%> 24 hours. Mean oxygen saturation and percentage of patients with SpO2 ≥90% at RMM onset were found to be significantly higher in patients with longer durations from RMM onset to death (p < 0.001). Conclusion: RMM occurred in a majority (80%) of dying patients within 12 hours. A minority of the patients survived >24 hours. [ABSTRACT FROM AUTHOR]

Background: There is no consensus regarding the best time to teach two fundamental pillars of clinical medicine: medical interview and physical examination. We investigated the impacts of teaching the course "Medical Interview and Physical Examination" in Japan from the very beginning of medical school. In addition, we also evaluated the educational value of using "Escape Rooms", a series of timed, game-based scenarios using simulators, as a part of the final assessment of the course. Methods: At the end of the course, the interview capabilities of 140 first year medical students at International University of Health and Welfare (Japan) were assessed by physicians who acted as simulated patients. Physical examination skills were assessed using the "Escape Room" team task method. Students also self-assessed their confidence in their physical examination skills pre and post "Escape Rooms." A day prior to the final assessment, students completed an anonymous course evaluation. Results: The average global rating of the students' medical interview skills using a rating scale from 1 to 6 (1-fail 6-outstanding, no different from practicing junior physician's level) was 4.6. Twenty-two students scored the highest mark of 6. An average of 89% of "Escape Room" teams finished all the physical examination tasks correctly within the allotted time. All teams that could not finish in time completed all tasks correctly when given an additional 3 to 5 min. Students' self-assessed confidence in their physical examination skills increased from 49 to 73 (out of 100) pre and post "Escape Rooms." In the course evaluation questionnaire, 99% of students answered "this course enhanced their motivation" (response rate 89%) and 99% also answered "this course was interesting and useful" (response rate 86%). Conclusions: This descriptive study analyzing both quantitative and qualitative data showed that the course not only achieved the intended objectives of successfully conducting comprehensive medical interview and basic physical examination skills, but also enhanced student motivation. "Escape Rooms", used for the course assessment, in itself enhanced students' self-perceived physical examination skills and had an added educational value. [ABSTRACT FROM AUTHOR]

Background: Most Japanese medical schools likely continue to rely on peer physical examination (PPE) as a tool to for teaching physical examination skills to students. However, the attitudes of medical students in Japan toward PPEs have not be identified. Therefore, we evaluated students' attitudes toward PPE in a Japanese medical school as a preparation for developing a PPE policy tailored to the context of Japanese culture., Methods: We conducted a mixed-methods study with an explanatory sequential approach, in which qualitative data were used to interpret the quantitative findings. Surveys and interviews were conducted with medical students and junior residents at a Japanese university. A total of 63 medical students and 50 junior residents responded to the questionnaire. We interviewed 16 participants to reach theoretical saturation and investigated the attitudes of medical students toward PPE and the themes emerging from the interview data, providing detailed descriptions of the quantitative findings., Results: Female participants were significantly more likely than male participants to report varying degrees of resistance to being a model patient during PPE (male: 59.7%, female: 87%, p < 0.001). Most of the participants who took on the role of patients that involved undressing were males. The participants expected improvements in issues related to the guarantee of freedom to refuse to be a model patient and measures to protect confidentiality. Approximately 22% of the participants reported that they witnessed incidental findings (including variations within the normal range) in front of other students during PPE., Conclusions: The findings imply that medical students expect high levels of autonomy and confidentiality when volunteering as model patients during PPE. Thus, developing a PPE policy suitable for Japanese culture may be effective in establishing a student-centered PPE environment., (© 2024. The Author(s).)

Background: Training for the fundus examination using traditional teaching is challenging, resulting in low generalist physicians' confidence in performing the funduscopic examination. There is growing evidence suggesting a flexible e-learning video approach's value in teaching physical examination procedures. However, whether the flexible e-learning video approach is superior to the traditional, face-to-face (F2F) lecture-based teaching for the funduscopic exam and the cognitive processes supporting its effectiveness has not yet been determined. Methods: We conducted a sequential explanatory mixed-method study to compare the flexible e-learning video approach's effectiveness versus the F2F lecture-based approach for teaching the funduscopic exam to medical students at Chiba University in Japan. Medical students were randomly assigned to either a flexible e-learning video approach group or a F2F lecture approach group. We then quantitatively measured the diagnostic accuracy of funduscopic findings before and after attending the specific classrooms. Next, we conducted student focus groups to explore the students' thinking processes in the flexible e-learning video approach vs. the F2F lecture-based teaching of fundus examination. The qualitative data were analyzed using the qualitative content analysis method. Results: The mean diagnostic accuracy scores in the post-test significantly increased from pre-test in the intervention group (36.6 to 63.4%, p < 0.001). Post-post comparisons across the two groups revealed a significant difference (intervention group 63.4% vs. control group 34.6%, p < 0.001). Six semi-structured focused group interviews were conducted (n = 36). In the flexible e-learning video approach group, we identified ten categories corresponding to four levels of the revised Bloom's taxonomy: remember, understand, apply, analyze. Five categories were identified in the traditional F2F lecture approach group corresponding to three revised Bloom's taxonomy levels: understand, apply, analyze. Interrater reliability was substantial (Cohen's kappa = 0.81). Conclusions: Teaching medical students funduscopic examination using the flexible e-learning video approach leads to improved diagnostic accuracy of funduscopic examinations. The flexible e-learning video teaching method enabled higher cognitive activity levels than the traditional, lecture-based classroom, as assessed using the revised Bloom's taxonomy. Trial registration: This study was registered with the University Hospital Medical Information Network Clinical Trials Registry on 08/02/2020 (Unique trial number: UMIN 000039434). [ABSTRACT FROM AUTHOR]

The association between blood glucose and fractures is not consistent across populations. Blood glucose was associated with fractures five years later in middle-aged and elderly men who underwent health examinations in Japan, respectively. Blood glucose-targeted fracture alerts are crucial for middle-aged and elderly individuals., Objectives: The evidence on blood glucose as a fracture risk marker has not been adequately examined in various populations, and there are no studies in middle-aged Japanese. We aimed to determine the association between blood glucose status and self-report fractures among middle-aged and elderly Japanese men., Methods: The data from the Japan Multi-Institutional Collaborative Cohort (J-MICC) Okazaki Study were used. Hemoglobin A1c (HbA1c) and fasting plasma glucose (FPG) measured at baseline physical examinations were examined for association with fractures questioned five years later. Analyses were performed for the middle-aged and elderly respondents., Results: The HbA1c was dichotomized into 290 (11.8%) with HbA1c ≥ 6.5% and 2165 (88.2%) with HbA1c < 6.5%. Compared to the group with an HbA1c < 6.5, the odds ratio for the risks of fracture among the group with an HbA1c ≥ 6.5% were 3.46 (95% confidence interval (CI), 1.75-6.84) in Model 1 (adjusted for age) and 3.60 (95% CI, 1.77-7.34) in Model 2 (adjusted for various confounding factors). These associations were also observed in both middle-aged and elderly generations, whereas no association was observed for FPG., Conclusions: Among Japanese men who have undergone physical examinations, those with an HbA1c of 6.5% or higher are at higher risk for fractures, and HbA1c-targeted fracture alerts are crucial for middle-aged and elderly individuals., (© 2024. International Osteoporosis Foundation and Bone Health and Osteoporosis Foundation.)

No studies have yet reported the influence of swelling in individual joints on serum C-reactive protein and erythrocyte sedimentation rate. To examine this association, we used data from the NinJa registry, the largest registry of rheumatoid arthritis patients in Japan. Sixty-six palpable joints were categorized by size into three groups (small, medium-sized, and knees) with surface area cutoffs of 10 and 100 cm. Of 10,720 cases registered in NinJa in 2012, 8444 cases with either no swollen joints or swelling limited to one joint-size category were analyzed. Groups with larger numbers of swollen joints showed higher levels of both markers in each joint-size category. Groups with larger swollen joints had higher levels of both markers compared with groups with the same number of (smaller) swollen joints. Linear regression revealed that the increments of C-reactive protein (mg/dL/joint) and erythrocyte sedimentation rate (mm/1 h/joint) were 0.056 and 0.89, 0.24 and 5.0, and 0.46 and 8.9 for small and medium-sized joints and knee joints, respectively. The levels of systemic inflammation markers increased with the involvement of larger and/or more joints. These results were successfully illustrated by the use of large-scale data, which eliminated wide intragroup scattering of the marker values. [ABSTRACT FROM AUTHOR]

Background and Objectives: Survey items of the Japan National Nutrition Survey (J-NNS) have changed over time. Several papers on dietary surveys have been published; however, to date, there are no in-depth papers regarding physical examinations. Therefore, we investigated changes in the survey items in the physical examinations performed in the J-NNS and the National Health and Nutrition Survey (NHNS), with the aim of incorporating useful data for future policy decisions.Methods and Study Design: We summarized the description of physical examinations and marshalled the changes of survey items from the J-NNS and NHNS from 1946 to 2012. The physical examination is roughly classified into the following six components: some are relevant to anthropometric measurements, clinical measurements, physical symptoms, blood tests, lifestyle and medication by interview, and others.Results: Items related to nutritional deficiency, such as anaemia and tendon reflex disappearance, and body weight measurements were collected during the early period, according to the instructions of the General Headquarters. From 1989, blood tests and measurement of physical activity were added, and serum total protein, total cholesterol, triglycerides, HDL-cholesterol, blood glucose, red blood corpuscles and haemoglobin measurements have been performed continuously for more than 20 years.Conclusions: This is the first report on the items of physical examination in the J-NNS and NHNS. Our research results provide basic information for the utilization of the J-NNS and NHNS, to researchers, clinicians or policy makers. Monitoring the current state correctly is essential for national health promotion, and also for improvement of the investigation methods to apply country-by-country comparisons. [ABSTRACT FROM AUTHOR]

Background: Muscle mass evaluation methods are often expensive and therefore limited in their daily use in clinical practice. In this study, we investigated the relationship between hand grip strength (HGS) and other parameters of body measurements with urine creatinine, especially to investigate whether HGS measurement is an indicator of muscle metabolism., Methods: In total, 310 relatively healthy people (mean age 47.8 + 9.6; 161 people or 51.9% of the total population were men) who were undergoing preventive examinations were included in this study and given a container to collect 24-h urine, and the amount of creatinine in the urine was determined by a kinetic test without deproteinization according to the Jaffe method. A digital dynamometer (Takei Hand Grip Dynamometer, Japan) was used in the measurement of HGS., Results: There was a significant difference in 24-h urine creatinine (24 hCER) between the sexes, with a mean of 1382.9 mg/24 h in men and 960.3 mg/24 h in women. According to the correlation analysis, the amount of urine creatinine was related to age (r = -0.307, p < 0.001 in men, r = -0.309, p < 0.001 in women), and HGS (r = 0.207, p = 0.011 in men, r = 0.273, p = 0.002 in women) was significant for either sex. However, other parameters of body measurements, such as girth, forearm circumference, and muscle mass measured by bioelectrical impedance, were not related to urine 24 hCER. A correlation between HGS and 24 hCER was observed in age groups., Conclusions: We found that HGS is a potential marker in muscle metabolism assessment that is proven through 24 hCER. In addition, therefore, we suggest using the HGS measure in clinical practice to evaluate muscle function and well-being.

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Objectives: This study aims to determine whether there is a difference in the academic performance of medical students based on admission type and examine the extent to which entrance examinations predict their performance., Methods: This observational study utilized existing data from Asahikawa Medical University. Participants were 1057 medical students who had enrolled between 2010 and 2019. Analysis of variance and Tukey's test were utilized to identify differences between admission types. The multiple linear regression explored predictors of cumulative grade point average for each type., Results: Analysis of variance showed significant differences in the National Center Test (F (3, 1053) =70.78, p <0.001) and cumulative grade point average (F (3, 1053) =3.93, p <0.01). Tukey's post hoc test revealed that two types of general admission students (M=83.52, SD=3.22; M=85.57, SD=3.01) were significantly higher on the National Center Test than two types of regional quota students (M=81.61, SD=3.93; M=80.65, SD=3.61). The cumulative grade point average of a regional quota group (M=2.23, SD=0.34) was significantly higher than two types of general admissions (M=2.11, SD=0.36; M=2.12, SD=0.34). High school grade point averages and females were significant in predicting cumulative grade point averages for each admission (16.0-28.3% variance)., Conclusions: Regional quota students earned a higher cumulative grade point average than those from general admissions, despite their significantly lower scores on the National Center Test. Enhanced utilization of regional quota admissions could become an effective strategy to increase the rural physician workforce.

Aim: To investigate the association of the Japan Science and Technology Agency Index of Competence with physical and cognitive functions in community-dwelling older adults., Methods: This study used the data of 565 community-dwelling adults aged ≥65 years (mean age: 74.3 ± 5.2 years) from the Kasama Health Checkup for Longevity survey in Japan. The Japan Science and Technology Agency Index of Competence was used to comprehensively evaluate the higher-level functional capacity and subscale functional capacity: technology usage, information practice, life management and social engagement. Physical functions were assessed using grip strength, the five-repetition sit-to-stand test, 5-m habitual walking test, one-leg standing test and hand working test with a pegboard. Cognitive functions were evaluated using the Five-Cog test consisting of attention, memory ability, visuospatial function, language ability and reasoning ability. Multiple regression analysis was conducted to examine the associations between total Japan Science and Technology Agency Index of Competence score and physical and cognitive functions., Results: After adjusting for potential confounders, the total Japan Science and Technology Agency Index of Competence score was favorably associated with static balance ability (β = 0.09; B = 0.01; 95% confidence interval: 0.00-0.02), lower limb strength (β = -0.19; B = -0.29; 95% confidence interval: -0.41 to -0.16), walking ability (β = -0.15; B = -0.67; 95% confidence interval: -1.05 to -0.30), hand dexterity (β = -0.13; B = -0.08; 95% confidence interval: -0.14 to -0.03) and overall cognitive function (β = 0.28; B = 0.04; 95% confidence interval: 0.03-0.05)., Conclusions: Physical and cognitive functions are important for maintaining higher-level functional capacity. Geriatr Gerontol Int 2022; 22: 753-758., (© 2022 Japan Geriatrics Society.)

We assessed the relationship between health literacy and participation in health checkups among middle-aged Japanese community residents. Additionally, we explored the health information sources related to participation in health checkups among those with low, medium, and high health literacy. This mail survey using a self-administered questionnaire was conducted in 2020 and included 33,902 community residents with National Health Insurance (NHI), aged 40-64 years from five cities in Osaka Prefecture, Japan. Of these, 12,446 (36.7%) agreed to participate in the survey. After exclusion of those with regular visits to medical institutions and those with missing data, the analysis included 3582 participants. Health literacy was measured by the Communicative and Critical Health Literacy (CCHL) scale, and participants were classified into three groups (low, medium, and high health literacy groups) by the tertiles of CCHL scale score. After adjusting for confounding factors, the multivariable-adjusted odds ratios for non-participation in health checkups were 1.20 (95% CI 1.01-1.43, p = 0.039) in the medium health literacy group and 1.47 (95% CI 1.20-1.80, p < 0.001) in the low health literacy group compared with the high health literacy group. Additionally, some health information sources were associated with participation in health checkups in the medium and high health literacy groups, whereas none of the health information sources were associated with participation in health checkups in the low health literacy group. We believe that it is important to develop materials and interventions aimed at low health literacy populations to promote participation in health checkups., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Purpose: To investigate the association between smoking and health-related quality of life (HRQOL) in a rural Japanese population.Methods: A cross-sectional study of data from 823 subjects in Iwaki area of Hirosaki City, Japan. SF-36 scores between non-smokers and smokers were compared. To test the sensitivity of SF-36 scores in detecting health deterioration, effects of having diseases and having deviations from normal thresholds in health check-up were analyzed by adding them into covariates in ANCOVA.Results: There was no significant difference in SF-36 scores between non-smokers and smokers. Presence of diseases significantly decreased the physical components of SF-36 scores while the results of health check-up had no significant influence on SF-36 scores.Conclusions: The results suggested the possibility that in Japan, where smoking prevalence is still relatively high, smokers may be less sensitive to sub-clinical deterioration in their own health status than smokers in Western countries that already have experienced the major decline in their smoking rate. The importance of having the smoker become more sensitive to the sub-clinical adverse effects of cigarette smoking should be stressed for the success of smoking control programs. [ABSTRACT FROM AUTHOR]

Background: Most studies on the relationship between serum C-reactive protein (CRP) and periodontal disease have been cross-sectional. In this study, we investigated the temporal association between CRP and periodontal disease by following a large number of subjects for 1 year. Methods: We studied 11,162 men in Nagoya, Japan, who had an initial dental examination as part of a complete physical examination and then underwent the same examination 1 year later. For the 4,997 men without periodontal disease at baseline, logistic regression analysis was performed to examine the relationship between baseline CRP and periodontal disease 1 year later, adjusting for age, body mass index, glycosylated hemoglobin A1c level, and smoking status. Similarly, logistic regression analysis was performed to examine the relationship between periodontal disease at baseline and CRP 1 year later for the 10,376 men with normal baseline CRP, adjusting for the same confounding factors. Results: Among men without high CRP at baseline, periodontal disease at baseline correlated to CRP 1 year later. The odds ratio was 1.336 (95% confidence interval [CI]: 1.115 to 1.674). However, in the men without periodontal disease, no significant correlations were seen with baseline CRP or periodontal disease 1 year later. The odds ratio was 1.163 (95% CI: 0.694 to 1.513). Conclusion: Periodontal disease increased the risk for high serum CRP levels in men after 1 year of follow-up. [ABSTRACT FROM AUTHOR]

The article reports on the findings of the study that examined the characteristics of age-related pulmonary crackles or rales in patients with stage A cardiovascular disease in Japan. The study found significant difference in the prevalence of crackles among patients in the low, medium and high age-groups. In addition, the risk for audible crackles increased roughly thrice every 10 years after 45 years of age, which might interfere with the physician's management of cardiopulmonary patients.

Introduction: Dental problems may have a great impact on military mission effectiveness, as such, evidence-based dental classification guidelines are required for minimizing the occurrence of dental problems. The aim of this study is to elucidate the independent contribution of each oral disease to the perception of dental problems among Japan Maritime Self-Defense Force (JMSDF) personnel in order to make the dental classification guidelines more precise for the prediction of future dental problems., Materials and Methods: Japan Maritime Self-Defense Force personnel who were examined during the annual dental checkup in 2013 answered questions about the experience of dental problems within the last 12 months in 2014. The associations between the items of a dental checkup and the perception of dental problems were examined using multiple logistic regression analysis with a stepwise procedure to calculate odds ratios (ORs) and 95% CIs., Results: The data of a total of 22,441 subjects were included in the analysis. Those who declared to have perceived dental problems within the last 12 months were 5,088 (22.7%). The multiple logistic regression analysis showed that personnel who had decayed teeth had a higher chance of experiencing dental problems than those who had no dental caries. Personnel whose periodontal disease was judged to be more severe in a dental examination had a greater OR for the perception of dental problems., Conclusion: These results may become recommendations for operations in the JMSDF dental classification system., (© The Association of Military Surgeons of the United States 2021. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

The Japan "Ordinance on Safety and Health of Work under High Pressure", which is the law regulating health conditions for workers under high pressure environments, was amended in 2014. The revised regulations have highlighted other difficulties and new problems, but they have not yet written an appropriate amendment based on the aspect of occupational and environmental health. Health management for occupational divers and caisson workers in accordance with the new regulations has not determined the best approach to reducing related disorders and will cause other legal problems. This paper presents some issues in the new regulations for hyperbaric workers, which directly or indirectly involve occupational health physicians. Health checkups and work limitations should be done in consideration of the occupational characteristics of the undersea and hyperbaric environment. Regular examinations using specific studies are useful to diagnose the early stages of chronic conditions for workers, and are also useful for determining the hiring suitability for hyperbaric workers. Work limitations should be decided by the conditions that induce serious accidents or disorders that result from exposure to hyperbaric environments, and depend on the obstacles for work due to sequelae of decompression sickness. The new regulations need to be properly revised, based on scientific evidence, to include health management for workers in undersea and hyperbaric environments.

Objectives: To develop a prediction tool based on physical findings and environmental conditions without utilizing color Doppler ultrasonography to guide non-urologists and patients' families in determining the testicular torsion possibility among patients with acute scrotal pain., Methods: Overall, 110 consecutive patients aged ≤30 years with acute scrotal pain at Saitama Medical Center between 2012 and 2014 were retrospectively evaluated. Physical examination results, including scrotal inspection, palpation and gait observation, and environmental conditions at pain onset (time range and ambient temperature) were collected. Multivariate analysis identified significant and independent risk factors for testicular torsion, and a nomogram predicting testicular torsion was constructed. The model underwent prospective validation in an independent set of 123 consecutive patients admitted with acute scrotal pain to our institution between 2015 and 2017., Results: Testicular torsion diagnosis rates were 27% (30/110) and 26% (32/123) in the training and validation cohorts, respectively. Logistic regression analysis showed four risk factors for developing testicular torsion: abnormal testicular position, walking difficulty, midnight to early morning onset and ambient temperature <15°C at pain onset. The constructed nomogram showed that the areas under the receiver operating characteristic curves were 0.92 and 0.84 for the training and validation cohorts, respectively. The calibration plot showed an acceptable fitness between the predicted probability and the observed rate of testicular torsion., Conclusions: A novel nomogram was developed solely based on physical findings and environmental conditions to predict testicular torsion in Japanese patients with acute scrotal pain., (© 2021 The Japanese Urological Association.)

Background: The establishment of health screening systems for children is important, however, such systems are not always well-established in developing countries. This study aimed to improve child health screening systems in developing countries by analyzing the factors that contribute to enabling continuous and proper screenings at various governmental levels in Japan., Methods: We reviewed the history of child health and development screening systems in Japan and examined factors that enabled their regular and nationwide implementation., Results: We identified the six enabling factors: (i) the existence of relevant laws and regulations in health and education systems for health checkups, (ii) mandated and detailed conditions for health checkups within both school and community health, (iii) the provision of guidelines and manuals for health checkups, (iv) a sufficient number of professionals to carry out the health checkups, (v) clear criteria for evaluating and interpreting the checkup results, and (vi) understanding among teachers, children, and guardians of the importance of health checkups., Conclusion: We proposed the following six requirements to the governments in developing countries for establishing their own health screening programs: (i) a clear description of the need for regular and continuous health checkups in the relevant laws, regulations, and policies, (ii) mandate as essential activity and detailed requirements of the screening activities, (iii) provision of relevant manuals for health workers and teachers, (iv) provision of enough well-trained professionals and a training system, (v) studying growth and development curves for children, and (vi) promoting understanding among stakeholders about the importance of health checkups., (© 2021 Japan Pediatric Society.)

Objectives: The present study aimed to conduct an epidemiological survey of Central Sensitization Inventory (CSI) scores in an older adult population and to investigate the association between the CSI scores, age, sex, pain intensity, site of pain, and health-related quality of life (QOL)., Methods: Participants were 373 Japanese adults aged ≥ 50 years who underwent a health checkup in 2018. We collected demographic data and clinical characteristics along with the CSI scores, QOL questionnaire, site of pain (neck, lower back, upper limb, and lower limb) and pain severity. We performed an epidemiological survey of the CSI scores and investigated the gender difference in CSI scores and the relationship between the CSI scores, site of pain, and QOL., Results: The prevalence of low back pain was the highest (67.6%). The average CSI score was 14.2 points; 8% of volunteers had a high (> 30) CSI score. The CSI scores among women were significantly higher than those among men ( p  = .016). The CSI scores had a significantly moderate correlation with the numerical rating scale and QOL scores (all p  < .001). Volunteers with neck pain showed the highest CSI scores (average 22.4 points)., Conclusions: The CSI total score showed sex differences and had a significant correlation with pain severity and QOL., Study Design: Cross-sectional study.

Background: The traditional curriculum for medical students in Japan does not include sufficient opportunities for students to develop their skills for musculoskeletal (MSK) examination and clinical reasoning and diagnosis. Therefore, an effective programme is required to help medical students and residents improve their clinical skills in MSK. This paper aims to assess the clinical skills of medical students who have participated in a peer role-playing simulation programme using a mini clinical evaluation exercise (mini-CEX)., Methods: Participants were 90 female medical students who were completing their first orthopaedic clinical clerkship. They were divided into two groups. The simulation group participated in a role-play focussed on MSK cases as low-fidelity simulation, a structured debriefing with the course supervisor, and a self-reflection on Day 1 (n = 64). The control group did not participate in the role-play due to randomised clerkship schedules (n = 26). On Day 2 of the intervention, we observed and assessed all participants' performances during MSK outpatient encounters using the mini-CEX. We compared the mini-CEX score between the simulation group and the control group; the Wilcoxon rank-sum test was used for statistical analysis., Results: The mini-CEX scores for physical examination, clinical reasoning and diagnosis, and overall clinical competency were significantly higher in the simulation group than in the control group (p < .05, physical examination: p = .014, clinical reasoning: p = .042, overall: p = .016). These findings suggest that medical students who partake in a peer role-playing simulation programme could experience improved clinical skills for physical examination, clinical reasoning and diagnosis, and overall clinical competency in real-life MSK outpatient encounters., Conclusions: Through a mini-CEX assessment, our findings indicate that medical students who participated in our peer role-playing simulation programme have improved clinical skills. Peer role-playing as a low-fidelity simulation and practical educational opportunity will enable educators to polish the competency of medical students in musculoskeletal physical examinations and clinical reasoning and diagnosis in a clinical setting.

Background: We aimed to determine whether combined assessments of single movement tasks could predict falls in community dwelling people with stroke and it was more precision than the berg balance Scale consists of 14 movements., Methods: This prospective cohort study performed at five rehabilitation hospitals in Japan. Participants comprised 78 patients with ambulatory stroke. The single movement task assessments performed at discharge and included the weight bearing ratio, the 30-second chair standing test, the one-leg standing time, the four square step test and the timed up and go test. The results were used to derive a logistic regression equation to predict falls within 6 months from discharge. Area under the curve was used to compare prediction accuracy between the logistic regression equation and the berg balance Scale., Results: Overall, fifteen participants experienced a fall. The weight bearing ratio of the unaffected side and four square step test were observed to be significant assessments identified from the logistic regression analysis. The Area under the curve of the combined tests of weight bearing ratio of the unaffected side and four square step test was 0.78, which was higher than the than that of the berg balance Scale (0.70)., Conclusions: This study found that a combined assessment using single movement tasks including the weight bearing ratio of the unaffected side and four square step test predicted falls in people with stroke post-discharge more precisely than the berg balance Scale., Competing Interests: Declaration of Competing Interest No potential conflict of interest was reported by the authors., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objectives　In Japan, medical questionnaires on diet and lifestyle are administered during health checkups for children. Since the rate of health checkup participation is high, the information obtained from these questionnaires can be used for regional diagnoses. In this study, we evaluated the relationship between sweet snack eating habits (SSEHs) and lifestyle habits in toddlers using data from the questionnaires.Methods　This study was conducted across 35 municipalities in Aichi Prefecture, Japan, where individual toddlers can be tracked at medical examinations at the age of 1 year 6 months (18 m) and 3 years (36 m). The subjects were 18,251 toddlers (9,393 boys [51.5%]) who participated in the health checkup in the same municipalities at 18 m in 2013 and 36 m in 2014-2015. Subjects were divided into four categories based on their SSEHs at 18 m and 36 m: N-N (no SSEH at either 18 m or 36 m); Y-N (no SSEH at 36 m only); N-Y (no SSEH at 18 m only); Y-Y (SSEH at both 18 m and 36 m). Other lifestyle habits were divided into two levels: good habits and bad habits. A multinomial logistic regression analysis was performed using the SSEH category as the dependent variable and lifestyle as the independent variable. The control groups were the Y-Y category and bad habit for the dependent and independent variables, respectively.Results　The proportions of N-N, Y-N, N-Y, and Y-Y subjects were 27.7%, 8.6%, 24.1%, and 39.6%, respectively. At 18 m, 48.2% toddlers had an SSEH, which increased to 63.7% at 36 m. Most toddlers (82.2%) had a habit of sweet snacking at 18 m and habitually consumed sweet snacks at 36 m. The absence of nursing at bedtime at 18 m was positively associated with the N-N group (odds ratio [99% confidence interval]=1.25 [1.11-1.41]) and the Y-N group (1.28 [1.07-1.52]); however, no association was found with the N-Y group (0.99 [0.88-1.11]). Parental finish polishing at 18 m tended to show a positive association only with the N-N group (1.10 [0.99-1.23]).Conclusion　Nearly half of toddlers had SSEHs by 18 m, and most of them continued to have the habit at 36 m. Oral hygiene behavior at 18 m was associated with SSEHs of toddlers up to 36 m. A regional diagnosis using the results of the health checkup for children is useful for identifying factors related to health problems.

Background: Locomotive syndrome (LoS) is defined as the loss of mobility due to age-related impairment of motor organs. The purpose of this study was to evaluate the prevalence and severity of LoS, muscular strength and balancing ability, and prevalence of sarcopenia in relation to the presence of LoS according to sex and age groups ranging between 50 and 89 years., Methods: Male and female participants between the ages of 50-89 were randomly selected in the resident registry of a cooperating town. Calls for participation continued until approximately 50 consenting participants were successfully recruited for each age group and sex. A total of 413 participants (203 male and 210 female) were enrolled for undergoing a LoS risk test and measuring their physical function. Physical function was compared to participants with or without LoS., Results: A total of 312 patients (75.5%) were diagnosed as LoS, of which 144 (46.2%) were male and 168 (53.8%) were female. The severity of LoS for the 312 patients were 210 (67.3%) for stage 1 and 102 (32.7%) for stage 2. The prevalence of LoS in males were 37, 59, 91, and 100% in the 50s, 60s, 70s, and 80s age strata, respectively. The prevalence of LoS in females were 71, 62, 89, and 98% in the 50s, 60s, 70s, and 80s age strata, respectively. The prevalence of sarcopenia was significantly higher as the age strata in males grew higher. Knee extension strength was significantly lower for participants in their 50s and females in addition to females in their 60s with LoS. The 31 patients diagnosed as sarcopenia included 29 (93.5%) with LoS, 11 (35.4%) classified as LoS stage 1, and 18 (58.1%) classified as stage 2., Conclusions: The prevalence of LoS was high in participants over 70 years of age. In males, the prevalence of sarcopenia was higher as the age strata grew higher. Patients with LoS exhibited lower knee extension strength. We believe that some measures to prevent or improve LoS may require exercise to increase the muscle strength of the lower limbs.

Evidence shows that atypical antipsychotics (AAPs), a treatment of psychosis in Parkinson's disease (PD), are associated with factors reflecting the severity of the disease. Therefore, we evaluated the applicability of these factors in risk stratification for physical morbidity in PD patients requiring AAPs. We implemented a nested case-control analysis using administrative claims data derived from PD inpatients in 143 National Hospitals in Japan between April 2012 and March 2017. The analysis compared PD patients exposed to AAPs with unexposed matched controls using conditional logistic regression. The cases were then stratified by the weighted score using the partial regression coefficients of extracted factors or the number of factors that they had. Physical morbidity was evaluated using length of stay (LOS) and readmission. After comparing the cases (n = 829) with the matched controls (n = 3316), 10 factors were extracted. The cases were stratified into four level groups using the weighted score, or five level groups using the number of factors. LOS was prolonged with increasing score (49.7; 58.5; 72.7; and 83.3 days) and number of factors (52.1; 52.9; 63.9; 80.7; and 79.1 days). Readmission within 30 days increased along with increasing score (5.7; 10.2; 10.2 and 12.9%) and number of factors (5.9; 9.3; 8.9; 11.3; and 14.3%). We confirmed two stratification manners for physical morbidity in PD patients requiring AAPs. These manners would be useful for considering management plan for these patients., Competing Interests: Declarations of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Objective　This study aims to identify changes in homebound status and related factors in community-dwelling older adults participating in physical checkups over two years in order to help with prevention and recovery from being homebound.Methods　A survey on needs in the sphere of daily life was conducted in July 2011 among 6,696 independent older adults in 10 regions of Kameoka City (baseline survey). Of the 6,696 adults, 1,379 responded to the survey and participated in a physical checkup held between March and April 2012. These individuals were then invited to a similar checkup again in September 2013. Of these, 638 consenting individuals were administered a questionnaire survey (follow-up survey). In all, 522 subjects responded to both surveys (baseline and follow-up) regarding being homebound. The responses involved basic attributes, state of daily living, state of health, items of the Kihon Checklist, items concerning daily living activities in the baseline survey, and items concerning being homebound in the follow-up survey. The responses were analyzed, and an evaluation of homebound status was conducted based on whether or not one (or both) of the two items of the Kihon Checklist were applicable. The subjects were classified according to the following: 1) whether non-homebound individuals remained non-homebound (non-homebound group) or whether they became homebound (homebound transition group) and 2) whether individuals who became homebound recovered (recovery group) or remained the same (persisting group). After comparing the characteristics of each group, a logistic regression analysis was employed to analyze the factors related to changes in homebound status after two years.Results　Of the 375 non-homebound individuals in the baseline survey, 326 (86.9%) and 49 (13.1%) were classified into non-homebound and homebound transition groups, respectively. Of the 147 subjects who became homebound, 85 (57.8%) and 62 (42.2%) were classified into the recovery and persisting groups, respectively.　Among the factors related to change in homebound status after two years, a low score of social role (OR=0.675, CI=0.458-0.997) was an independent factor for being at risk of becoming homebound (P<0.05). Having no diseases under treatment (OR=14.340, CI=1.345-152.944) and a high intellectual activity score (OR=2.643, CI=1.378-5.069) were independent factors of recovery from being homebound (P<0.05).Conclusion　The results of the two year longitudinal study suggest the need for support for non-homebound older individuals devoid of social roles to prevent homebound status. Additionally, there is a need for support surrounding the reduction in obtaining a disease and maintaining intellectual activity in order to recover from being homebound.

Background: Elbow injuries are common in young baseball players and evaluating the characteristics of young baseball players in a large-scale population is necessary. However, few studies have compared playing position, length of baseball experience, physical findings, and elbow pain in young baseball players. This retrospective multi-regional cohort study sought to document the physical findings at the elbow in Japanese elementary school baseball players and to examine the relationship between playing position, length of baseball experience, physical findings at the elbow, and elbow pain., Methods: In 2014, 720 fifth-grade baseball players from four regions in Japan were invited to participate in a questionnaire survey and undergo physical examination to obtain data on position played, length of baseball experience, presence of elbow pain, and physical findings at the elbow, including range of motion, tenderness, and valgus stress test results. Potential risk factors associated with elbow pain and correlations between physical findings and playing position, length of baseball experience, and elbow pain were investigated., Results: The 720 subjects had a mean age of 10.4 years and 29.4% reported having experienced elbow pain for ≥1 week. Risk factors for elbow pain included playing pitcher and catcher, playing pitcher and fielder, and length of baseball experience. The most frequent finding was limitation of flexion (21.1%) followed by tenderness of the medial epicondyle (18.3%) and a positive valgus stress test (14.3%). These three findings were also significantly associated with elbow pain. Elbow extension was limited in 14.9% of subjects but there was no correlation with length of baseball experience or elbow pain., Conclusions: Our data show that elementary school baseball players who experienced elbow pain are likely to have valgus stress overload. Elbow pain might be prevented by not playing pitcher and catcher., (Copyright © 2019. Published by Elsevier B.V.)

Objective Acute abdominal pain (AAP) of diverse etiology is a common chief complaint of patients who present to the emergency department (ED). AAP may pose a diagnostic challenge to physicians in training. We aimed to evaluate whether or not resident trainee doctors examine patients presenting with AAP in a Japanese acute-care hospital following Kendall's diagnostic algorithm. Methods We conducted a retrospective medical chart review from January 2015 to December 2016. Patients Patients ≥50 years old who presented to the ED within 7 days of the onset of AAP who were evaluated by residents at the ED of an acute care hospital were enrolled in this study. Patients transported by ambulance and referred from other hospitals and classified as level 1 or 2 according to the Japanese version of the Canadian Triage and Acuity Scale were excluded. Data, including the clinical history, location and character of pain, and age and gender of patients as well as the level of experience of residents, were abstracted from charts. We evaluated the concordance rate between the actual diagnostic process followed by residents and Kendall's diagnostic algorithm for AAP. Results We analyzed 466 patients (mean age 67.6 years) in the study who were evaluated and diagnosed by 123 residents. The concordance rate between the diagnostic procedures performed by residents and those suggested by Kendall's diagnostic algorithm was 61.2%. A low concordance rate was observed among patients with peritoneal signs, shock or toxic appearance (25.0%), suggested acute coronary syndromes (ACS) (55.1%), epigastric or right upper-quadrant pain (52.8%), and left upper-quadrant pain (55.6%). Abdominal ultrasonography is one of the recommended examinations for patients with signs of peritoneal irritation, shock or toxic appearance, right lower-quadrant pain, and left upper- or lower-quadrant pain, but the rates were relatively low at 25.0%, 34.4%, 31.8%, and 26.7%, respectively. Conclusion Abdominal ultrasonography required by Kendall's diagnostic algorithm was not performed appropriately in patients with symptoms and signs of peritonitis, shock or toxic appearance, right lower-quadrant pain, and left upper- or lower-quadrant pain or in female patients by resident trainees. Our findings underscore the importance of providing resident doctors with focused training concerning ultrasonography by attending physicians.

Backgrounds Pembrolizumab is recently approved in Japan for the microsatellite instability-high (MSI-H) solid tumor patients (pts) diagnosed with Promega panel (FALCOTM). Pembrolizumab is the first anti-tumor agent based on the biomarker, regardless of tumor types. MSI test has been performed as the screening test for the diagnosis of Lynch syndrome. However, it is not so familiar for the clinicians treating non-colorectal cancer. It is necessary to establish the in-hospital workflow and share the information and problems beyond the clinical departments as soon as possible. Methods We discussed the issue on the MSI test at the existing multidisciplinary conference which was organized to standardize the management of the immune-related adverse events (irAEs). In addition, we collaborated with the departments of pathology, clinical examination, and clinical genetic oncology. We used the MSI test itself to an inspection company outside of the hospital. Results The first case started from January 4th and a total of 142 pts received MSI test until March 7th. The origin of tumors were as follow; colorectal (n = 59), pancreas (n = 27), stomach (n = 12), cervix, uterine body and hepatobiliary tract (n = 8),prostate (n = 6) and, ovary and esophageal (n = 3), breast (n = 2) and others (n = 6). Surgical specimens were available in 94 cases (66.2%) and biopsy in 48 cases (33.8%). The results were obtained for 107 pts at the cut-off date. Among them, additional blood testswere required in 4 pts (3.7%). Due to the severe DNA degradation, one case (0.9%) could not be analyzed. Median turnaround time for the test was 15 days. Five pts (colon, n = 3/endometrial, n = 2) were found to have MSI-H and 3 were administered pembrolizumab with appropriate genetic counseling support. Conclusions We succeeded to introduce MSI test smoothly using the framework of multidisciplinary team approach. These efforts would be considered to be the basis for handling of comprehensive cancer panel in clinical practice. [ABSTRACT FROM AUTHOR]

Background: Hepatic portal venous gas (HPVG) is rare with high mortality. There are few reports on HPVG's association with appendicitis. Here we report a case of HPVG associated with appendicitis. Case presentation: A 79-year-old man presented with acute abdominal pain. Physical examination suggested peritoneal irritation. Blood tests indicated acute inflammation, metabolic acidosis, renal dysfunction and disseminated intravascular coagulation. Contrast-enhanced abdominal computed tomography revealed HPVG, a contrast defect in the small intestine, and minor ascites around the intestine. Urgent laparotomy was performed as intestinal ischemia was suspected. There were no findings of intestinal ischemia, but the appendix was discolored with wall thickening. We confirmed a clinical diagnosis of peritonitis caused by gangrenous appendicitis. We performed appendectomy and abdominal drainage. After surgery, the patient needed intensive care for septic shock. He left the ICU 7 days after the surgery and was discharged 10 days later. Conclusion: Thus, appendicitis may cause HPVG. [ABSTRACT FROM AUTHOR]

Taking action in response to health examination results is important to stay healthy. We aimed to investigate the associations between occupation, employment type and company size, and having a health examination and taking action in response to the results among Japanese employees. We focused on three particular actions by employees in response to health examination results: paying attention to one's health, receiving health guidance, and visiting a medical institution. We used anonymous data from the 2010 Comprehensive Survey of Living Conditions of Japan, a self-administered nationwide questionnaire survey. The data of 23,963 employees (12,938 male and 11,025 female) aged 20-64 yr were analyzed using logistic regression models adjusted by covariates. There were significant changes in odds ratios for receiving a health examination by occupation, employment type and company size. We found significant odds ratios for receiving health guidance by occupation and company size, but there was almost no significant association with paying attention to one's health and visiting a medical institution. These results confirmed that receiving a health examination was associated with occupational factors, and suggested that receiving health guidance after health examination results was associated with occupation and company size.

Regional epidemiological studies for respiratory diseases have been rarely performed in Japan, because spirometry is not regularly conducted in the standard annual health checks. The Yamagata-Takahata Study is an epidemiological study utilizing regional characteristics based on the 21st Century Centers of Excellence (COE) Program and the Global COE Program. Spirometric examination and other specific measurements via blood sampling were performed for the study participants in annual health check-ups held in Takahata, a town in Yamagata Prefecture. The Yamagata-Takahata Study revealed the impact of cigarette smoking habit on pulmonary function, the impact of reduced pulmonary function on mortality, and the situation regarding COPD comorbidities in Japan. Additionally, the study identified biomarkers of decline in pulmonary function among active smokers, and the risk factors for respiratory mortality in Japan. In this review, we summarize the findings of the Yamagata-Takahata study regarding the association between lower pulmonary function and the clinical characteristics of a Japanese general population., (Copyright © 2019 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.)

Background: Although fat accumulation in human organs is associated with a variety of diseases, there is little evidence about the effect of a fatty pancreas on the development of subclinical chronic pancreatitis over the clinical course., Methods: We conducted a prospective cohort study from 2008 to 2014 of patients who underwent a medical checkup consultation for fat accumulated in the pancreas. Patients included in the analysis were divided into a non-fatty pancreas group (n = 9710) and fatty pancreas group (n = 223). The primary end point was the odds ratio (OR) for chronic pancreatitis associated with fatty pancreas, which was diagnosed using ultrasonography. We used a multiple logistic regression model to estimate the OR and the corresponding 95% confidence interval (CI)., Results: Ninety-two people were diagnosed with chronic pancreatitis, including both presumptive and definitive diagnoses. Twelve people were diagnosed with chronic pancreatitis by ultrasonography among the 223 patients with fatty pancreas, and 80 patients among 9710 were diagnosed with non-fatty pancreas. The crude OR was 6.85 (95% CI 3.68, 12.75), and the multiple adjusted OR was 3.96 (95% CI 2.04, 7.66)., Conclusions: Fat accumulation in the pancreas could be a risk factor for developing subclinical chronic pancreatitis.

This study aimed to evaluate whether normal serum matrix metalloproteinase-3 (MMP-3) levels can be used to predict clinical remission and normal physical function at a single time point when treating patients with rheumatoid arthritis (RA) in daily practice settings. Subjects were all 1321 RA patients who were treated at our hospital. The accuracy of serum MMP-3 levels was larger than those of C-reactive protein (CRP) levels for predicting clinical remission [Simplified Disease Activity Index (SDAI) ≤ 3.3], normal function [Disability Index of the Health Assessment Questionnaire (HAQ-DI) ≤ 0.5], and both in clinical remission and with normal function (clinical remission + normal function) using receiver operating characteristic curve analysis. Serum MMP-3 levels were significantly correlated with CRP levels [r 0.229 (men), r 0.476 (women)] using Pearson's correlation coefficients. Among patients with normal CRP levels (n = 807), the percentage of patients in clinical remission, with normal function, and with clinical remission + normal function having normal serum MMP-3 levels was significantly higher than those with abnormal serum MMP-3 levels. In addition, among patients with the 28-point count Disease Activity Score-CRP (DAS28-CRP) remission (DAS28-CRP < 2.3), the percentage of patients in clinical remission, with normal function, and with clinical remission + normal function having normal serum MMP-3 levels was significantly higher than those with abnormal serum MMP-3 levels. Our findings suggest that normal serum MMP-3 levels, in combination with CRP levels or disease activity, are useful for predicting clinical remission and normal physical function in patients with RA.

Introduction: There have been no reports about predicting survival of patients with advanced cancer constructed entirely with objective variables. We aimed to develop a prognostic model based on laboratory findings and vital signs using a fractional polynomial (FP) model., Methods: A multicentre prospective cohort study was conducted at 58 specialist palliative care services in Japan from September 2012 to April 2014. Eligible patients were older than 20 years and had advanced cancer. We developed models for predicting 7-day, 14-day, 30-day, 56-day and 90-day survival by using the FP modelling method., Results: Data from 1039 patients were analysed to develop each prognostic model (Objective Prognostic Index for advanced cancer [OPI-AC]). All models included the heart rate, urea and albumin, while some models included the respiratory rate, creatinine, C-reactive protein, lymphocyte count, neutrophil count, total bilirubin, lactate dehydrogenase and platelet/lymphocyte ratio. The area under the curve was 0.77, 0.81, 0.90, 0.90 and 0.92 for the 7-day, 14-day, 30-day, 56-day and 90-day model, respectively. The accuracy of the OPI-AC predicting 30-day, 56-day and 90-day survival was significantly higher than that of the Palliative Prognostic Score or the Prognosis in Palliative Care Study model, which are based on a combination of symptoms and physician estimation., Conclusion: We developed highly accurate prognostic indexes for predicting the survival of patients with advanced cancer from objective variables alone, which may be useful for end-of-life management. The FP modelling method could be promising for developing other prognostic models in future research., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Objectives: To clarify the priority given to periodical medical examination items among occupational physicians in Japan., Methods: Sixty-two occupational physicians who participated in this study selected statutory and non-statutory items within two types of budget plans: one lower (8,500 yen) than the total fee of statutory medical examinations (9,250 and 11,290 yen), and the other higher (12,000 yen) than the total fee. Medical fee points were used to set the cost of each medical examination item. A three round Delphi method was used from May to July 2016 to clarify the consensus opinion of occupational physicians., Results: The statutory items (selection rate: between 66 and 100%), except for waist circumference (15%) and sputum examination (0%), and serum creatinine (58%, non-statutory item) were included in the smaller budget plan (8,500 yen). In the larger budget plan (12,000 yen), the statutory items (selection rate: between 92 and 100%), except for waist circumference (39%) and sputum examination (0%), and some non-statutory items, namely serum creatinine (95%), leukocytes (92%), uric acid (89%), and fecal occult blood reaction (81%), had a selection rate over 80%. In addition, statutory items with higher accuracy were preferred, which included the following: air conduction pure-tone audiometry (92%), imaging diagnosis of thoracic X-ray examinations by a specialist (97%), glycated hemoglobin levels (98%), and electrocardiogram assessment by a specialist (100%)., Conclusion: The statutory items, except for waist circumference and sputum examination, and some of the non-statutory items (e.g., serum creatinine) were given higher priority among occupational physicians in Japan.

Purpose: The purpose of this study was to compare centenarians in the United States and Japan on sensory, cognitive, and physical functioning and to evaluate a model that tests the interrelationship between physical function, cognition, and sensory impairment in these two unique samples of the oldest old., Methods: The sample of U. S. centenarians included 245 centenarians, the sample of Japanese centenarians included 304 centenarians. Sensory impairment was assessed by general assessments of vision and hearing, and physical function was assessed with six physical activities of daily living (i.e., eating, grooming, dressing, transporting, bathing, and walking)., Results: The results suggest that centenarians from the Georgia study showed higher levels of functioning in all domains when compared to the Tokyo sample. A structural equation model yielded stronger associations between cognitive and sensory function with physical function for the Tokyo sample., Conclusions: Functional differences may be due, in part, to different care patterns for the oldest old in the United States when compared to Japan.

Background: Health personnel must provide continuous support in response to problematic results from health checks of infants and toddlers (hereinafter "infant[s]"). Among this support, it is important for health personnel to provide nutritional guidance to families as a collaborative effort between the staff from multiple disciplines and community organizations. This study aimed to clarify the factors affecting collaboration with community organizations in providing nutritional guidance to families following health checks for infants in Japan., Methods: The design of this study consisted of a cross-sectional, multilevel survey. A self-administered questionnaire was mailed to all municipalities (1741 towns and cities) in Japan to be completed by the person responsible for nutrition advice. The research was performed in August 2015. We obtained 988 valid responses (response rate of 56.7%). To identify the factors that affect the collaboration with community organizations in providing nutritional guidance, we determined how municipalities responded to infants needing support (five items), how municipalities evaluated health guidance (five items), the number of distributed maternal and child health handbooks, and the number of infants who received follow-up evaluations., Results: The results of multivariate analyses showed that the factors related to successful community collaboration in providing nutritional guidance included holding a multi-professional staff meeting after health checks (post-conference; odds ratio [OR], 2.34; P = 0.001); following up children suspected of having developmental and mental disabilities or delays before entering elementary school (OR, 1.77; P = 0.0004); and considering dental caries data from dental checkups in providing health guidance (OR, 1.56; P = 0.003)., Conclusions: Holding a multi-professional meeting after infant health checks (post-conference) was strongly associated with community collaboration in providing nutritional guidance for infants.

Objectives: The aim of this study was to determine whether haemoglobin A1c (HbA1c) level is associated with the incidence of hearing impairment accounting for smoking status and diabetic condition at baseline., Methods: Participants were 131 689 men and 71 286 women aged 30-65 years and free of hearing impairment at baseline (2008) who attended Japanese occupational annual health check-ups from 2008 to 2015. We defined low-frequency hearing impairment at a hearing threshold >30 dB at 1 kHz and high frequency at >40 dB at 4 kHz in the better ear in pure-tone audiometric tests. HbA1c was categorised into seven categories. The association between HbA1c and hearing impairment was assessed using the Cox proportional hazards model., Results: On 5 years mean follow-up, high HbA1c was associated with high-frequency hearing impairment. In non-smokers, HbA1c≥8.0% was associated with high-frequency hearing impairment, with a multivariable HR (95% CI) compared with HbA1c 5.0%-5.4% of 1.46 (1.10 to 1.94) in men and 2.15 (1.13 to 4.10) in women. There was no significant association between HbA1c and hearing impairment in smokers. A J-shaped association between HbA1c and high-frequency hearing impairment was observed for participants with diabetes at baseline. HbA1c was not associated with low-frequency hearing impairment among any participants., Conclusions: HbA1c ≥8.0% of non-smokers and ≥7.3% of participants with diabetes was associated with high-frequency hearing impairment. These findings indicate that appropriate glycaemic control may prevent diabetic-related hearing impairment., Competing Interests: Competing interests: SN is occupational physicians in All Japan Labor Welfare Foundation., (© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Aim: Despite Japan being a developed nation, half of its older population does not attend regular health checkups. The aim of the present study was to examine the individual health beliefs and personal recommendations that strongly influence health checkup attendance among community-dwelling older adults., Methods: In 2013, questionnaires were sent to 5401 community-dwelling older adults who were not receiving long-term institutionalized care. The response rate was 94.3%. We analyzed response data from 4984 older adults using multiple imputation to manage missing data. Participation in health checkups was defined as having undergone at least one checkup in the past 3 years, and non-participation as having attended no checkups in this period., Results: The participants' mean age was 75.8 years, and 57.9% were women. The adjusted odds ratio of health checkup participation ranged from 1.35 (95% confidence interval [CI] 1.13-1.61) to 1.62 (95% CI 1.34-1.95) for positive individual health beliefs about health checkups, and was 2.21 (95% CI: 1.51-3.24) and 1.28 (95% CI: 1.17-2.08) for recommendations to participate from family and neighbors, respectively. All odds ratios were adjusted for age, sex, driving by oneself to daily shopping or clinic, paid work, method of response, internal medical therapy, polypharmacy, serious disease, periodic blood test, frailty and neighborly relationships., Conclusions: The present findings suggest that both individual and community approaches might be effective in promoting participation in health checkups among community-dwelling older adults. Geriatr Gerontol Int 2018; 18: 338-351., (© 2017 Japan Geriatrics Society.)

Aim: The public mandatory long-term care insurance system in Japan has supposedly mitigated the care burden for family caregivers of older adults, whereas family caregivers still play a considerable role in providing care. The effect of informal caregiving on the caregiver's health has been of great interest. We investigated the relationship between the amplitude of informal caregiving and caregiver participation in health check-ups in Japan., Methods: The present study was a cross-sectional analysis of nationally representative data in Japan (2010 Comprehensive Survey of Living Conditions). We investigated the relationship between care recipients' care-need level and in-home caregiver participation in health check-ups during the last year of the survey for caregivers., Results: A total of 3354 caregiver/recipient pairs were included in the study. Crude proportions of caregivers completing a health check-up by care-need level were 68.4% (support required 1 and 2), 63.5% (care required 1-3) and 60.3% (care required 4 and 5). Higher care-need level was negatively associated with caregiver participation in health check-ups (support required 1 and 2as reference, care required 1-3: odds ratio 0.82, 95% confidence interval 0.75-0.90), care required 4 and 5: odds ratio 0.76, 95% confidence interval 0.74-0.79) after adjustment for possible confounders. Inclusion of the caregiver time devoted to care per day and caregiver self-rating of health as independent variables did not change the result., Conclusions: These results suggest that facilitating health check-up participation for family caregivers of care recipients with higher care-need levels might be an effective intervention for decreasing the gap in health behavior possibly caused by informal caregiving. Geriatr Gerontol Int 2018; 18: 26-32., (© 2017 Japan Geriatrics Society.)

Background and Objectives: To investigate the prolonged effects of a 12-month exercise-plus-diet intervention in Japanese adults at risk of impaired glucose or lipid metabolism., Methods and Study Design: A total of 180 participants were randomly divided into an intervention group (n=94), and a control group (n=86). An exercise-plus- diet intervention was conducted on the intervention group for 12 months. The effects were evaluated by questionnaire, physical examinations, and blood tests at baseline, 3 months, 12 months (the end of intervention), and 24 months (one year after the end of intervention). The control group took only the same examinations as the intervention group., Results: At the end of the 12-month intervention, body weight, waist circumference, fasting glucose, HbA1c, triglycerides, and LDL-cholesterol were improved in the intervention group compared to the control group (all p<0.05). One year after the end of the intervention, body weight, waist circumference, fasting glucose, triglycerides, and LDL-cholesterol were still decreased in the intervention group compared to the control group (all p<0.05), especially among non-overweight participants. Among overweight persons, only body weight in the intervention group was lower than the control group. The personal behaviours of physical activity and diet in the intervention group were also improved., Conclusions: The 12-month exercise-plus-diet programs were found to be effective in improving glucose and lipid metabolism, as well as personal behaviour one year after completion of the intervention.

Background: Prediabetes, defined as impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), likely develops to type 2 diabetes mellitus (DM) and independently increases cardiovascular risk. We employed disposition index (DI), a new metabolic parameter indicating the pancreatic beta cell function adjusted for insulin resistance, and investigated whether it could be altered in Japanese population with prediabetes and associated with early glucose intolerance., Methods: A total of 102 adults who underwent an oral glucose tolerance test at the medical screening were designated to normal glucose tolerance (NGT), IFG, IGT, and DM. We calculated insulinogenic index (IGI) and homeostasis model assessment (HOMA) of β cell function (HOMA-β) as insulin secretory function, HOMA-insulin resistance (HOMA-IR), and quantitative insulin sensitivity check index (QUICKI) as insulin resistance and DI, and assessed correlations between these indices and glycemic parameters., Results: We observed graded increase of glycemic parameters in the order of NGT, IFG, IGT, and DM. HOMA-IR was significantly higher only in DM compared with NGT, although HOMA-β, IGI, and QUICKI showed no significant differences among the groups. In contrast, DI was significantly lower in IFG, IGT, and DM compared with NGT. In correlation analysis, glycemic parameters related positively to HOMA-IR, but inversely to DI. Only two parameters, IGI and particularly DI, were significantly decreased in the subjects with 1-hr postload glucose >8.6 mmol/L previously proposed as a predictor of type 2 diabetes., Conclusions: Our results suggest that reduction of DI promptly reflects the alteration of early glucose intolerance in Japanese population presenting with prediabetes.

Background: The forced oscillation technique (FOT) can measure respiratory system resistance and reactance under tidal volume respiration. MostGraph is a device that incorporates the FOT and enables the immediate, three-dimensional visualization of resistance and reactance parameters. The aim of this study was to establish MostGraph reference values for middle-aged and elderly Japanese individuals., Methods: From 2004 to 2006, 3253 subjects living in Takahata, Yamagata underwent spirometry. Of these, 872 again underwent spirometry in 2011, and 784 (368 men, ages 46-89 years; 416 women, ages 47-90 years) underwent FOT examinations using MostGraph-01., Results: In this study population, 19.0% of the men and 91.5% of the women were life-long never smokers. Abnormal spirometric findings were observed in 30.2% of the men and 14.6% of the women. Although the respiratory system resistance and reactance parameters obtained using MostGraph were not distributed normally, normal distribution was achieved via natural logarithm (R5, R20, Fres, and ALX), square root (R5-R20), or exponential (X5) transformation. Furthermore, the transformed values were converted back to the actual values after determining the values representing one and two standard deviations from the mean., Conclusion: Respiratory system resistance and reactance reference values were determined using MostGraph in middle-aged and elderly Japanese individuals who participated in annual health checkups., (Copyright © 2016 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.)

Excess salt intake is a risk factor for increased blood pressure (BP) and hypertension. To prevent hypertension, the reduction of salt intake is promoted in many countries. For people with hypertension or cardiovascular disease (CVD), a more severe restriction of salt intake is indispensable. Japanese individuals consume high quantities of salt, and it is thus important to determine the degree to which the salt intake of these individuals has been restricted. Here, we investigated the current level of salt consumption of Japanese individuals using data obtained during annual health check-ups. A total of 10 762 individuals were assessed who underwent annual health check-ups at our institution in 2011. The estimated daily salt intake (EDSI) was calculated using spot urine samples. The average EDSI was 7.83±2.02 g per day. BP increased in proportion to the EDSI, and multivariate logistic regression analysis showed that the EDSI was a significant and independent risk factor for hypertension. The average EDSI of the subjects with hypertension or a history of CVD was higher than that of the subjects without these diseases. The subjects who drank more heavily showed higher EDSIs. This study demonstrated that the average EDSI of the subjects needing to restrict their salt intake because of past or present illnesses was high. To achieve adherence to the recommended reduction of salt intake, more efforts are required.