Advantage of Introducing Quantitative Light-Induced Fluorescence in School Dental Checkups

Background: Caries detection in school oral examinations insufficient accuracy. Objective: To evaluate advantages of introducing quantitative light-induced fluorescence-digital (QLF-D) in school oral examinations. Methods: Experiment No. 1. Early demineralized lesions in the upper and lower incisors and canines were visually inspected by three dentists and by QLF-D. The numbers of tooth planes with early demineralized lesions were compared between the methods. Experiment No. 2. Approximal demineralized lesions in molars were assessed by visual inspection, x-ray imaging, and QLF-D. The numbers of tooth planes with demineralized lesions were compared among the methods. Experiment No. 3. Plaque distribution was evaluated by QLF-D and a traditional staining method. The ratio of the diameter of plaque to tooth crown in the tooth axis direction in each method was calculated. The results were evaluated by Pearson’s correlation coefficient analysis and Bland-Altman plot. Results: Experiment No. 1. The three dentists found 0.67 tooth planes on average. QLF-D found 22 tooth planes with early demineralized lesions in the same samples. Experiment No. 2. Fourteen approximal tooth planes of molars were found to have demineralized lesions by x-ray imaging. QLF-D detected 71.4% of the tooth planes out of the 14, whereas visual inspection found 7.1%. Experiment No. 3. The Pearson’s correlation coefficient for the evaluations of plaque distribution between the QLF-D and traditional staining methods was 0.77 (P Conclusion: The results support introduction of QLF-D for use in school dental examinations.

Evaluation of the Distribution and Factors Affecting Blood Pressure Using Medical Checkup Data in Japan

In this paper, we first evaluated the distribution of blood pressure (BP) using a dataset containing 113,979 measurements in 48,022 individuals with the cooperation of one health insurance society in Japan from April, 2013 to March, 2016. The means of the systolic BP (SBP) and diastolic BP (DBP) were 125.4 and 77.6 mmHg with standard deviations of 16.5 and 11.7 mmHg, respectively. Under the 140/90 criterion, 21.6% of the measurements showed hypertension. According to the World Health Organization/International Society of Hypertension criterion, 16.4%, 4.2% and 0.96% were classified as grades 1, 2 and 3, respectively. The factors affecting BP were evaluated by a regression analysis and were found to include age, gender, some eating habits, daily activities, smoking, drinking alcohol, sleeping and wages. Age was a very important factor, and the age cohorts from the previous study might be revised based on these findings. Among factors that individuals can control, the influence of drinking alcohol is very large. Comparing to an individual who does not drink, SBP and DBP of a heavy drinker are more than 5.0 mmHg higher on the average.

Self-care practices and health-seeking behavior among older persons in a developing country:Theories-based research

Purpose:The aim of this study was to examine the self-care practices and health-seeking behaviours of older adults in urban Indonesia.Methods:The cross-sectional study was performed from January to March 2014 in the Tammua sub-district of Indonesia.At the time of the study,273 older adults resided in Tammua,and half of them(51.2%)participated in this study.Data collection was carried out including self-care practices,health literacy,self-efficacy and basic conditioning factors.Results:It was found that most respondents(124;88.6%)always ate various protein sources daily.However,many participants never limited consumption of sugar(55;39.3%)or salt(40;28.6%),and more than half of respondents(96;68.6%)did not regularly visit MHCs.Health status(p<0.05),health maintenance(p<0.01)and salt limitation(p<0.05)were all significantly associated with salt limitation.It was found that respondents with higher selfefficacy,those who did not want to get information,and those of younger ages are less likely to visit MHCs regularly.Conclusion:An understanding of self-care practices and self-efficacy is needed to improve health care in developing countries.High self-efficacy should be promoted along with adequate health literacy.Older persons should learn the importance of regular health examinations to promote health,prevent diseases,and slow the progress of chronic diseases.The number of respondents who never limit their sugar and salt intake was especially surprising.An intervention program should be developed to limit salt and sugar intake of Indonesian elderly and to motivate older persons to use primary health services.

An Analysis of Blood Pressure Situations in Japan Using the Large-Scale Medical Checkup Dataset

Background: The high blood pressure (BP) or hypertension is a widely prevalent disease and its costs are very high, and many studies about the relationships between BP and health conditions have been done. We need to know the precise distributions of BP and factors affecting BP. Data and Methods: The distributions of BP are analyzed using 12,877,653 observations obtained from the JMDC Claims Database. The factors that may affect the BP are analyzed by the regression models using 4,615,346 observations. Results: The averages of systolic BP (SBP) and diastolic BP (DBP) are 120.4 and 74.2 mmHg with standard deviations of 15.9 and 11.3 mmHg, respectively. Among the nonmodifiable factors, age and gender are important factors. Among the modifiable factors, variables related to obesity are important risk factors. Taking antihypertensive drugs makes SBP and DBP 13.4 mmHg and 7.8 mmHg lower. Conclusion: The criteria of BP should be carefully determined considering age and gender. The effects of age may be a little different for SBP and DBP. It is necessary to use the proper model to evaluate the effect of antihypertensive drugs correctly. Limitations: The dataset is observatory. Although there are various types of treatment methods and antihypertension drugs, their effects are not evaluated.

Evaluation of Blood Pressure Control Medicines Using Health and Medical Checkup Data in Japan: Alternative Methods for Randomized Controlled Trials

Background: Many people take medicines to control high blood pressure (BP), or hypertension. Randomized clinical trials (RCT) are usually used for the evaluation of effects of medicines. However, RCT have some serious problems. Data and Methods: We evaluated the effects of BP medicines in Japan using a dataset containing 113,979 cases. We employed four statistical methods in the analysis. First, we simply compared the systolic blood pressure (SBP) of individuals with and without BP medicines. We then used a regression model with a dummy variable, representing taking medicines or not. We replaced the dummy variable by its expected value, and estimated the regression model again. Finally, we selected individuals who had both taken and not taken medicines at different times. The effect of sample selection was also considered in the estimation. Results: For the simple comparison, SBP with BP medicines was 11 mmHg higher than without medicines. In the next regression analysis, SBP with BP medicines was still 5 mmHg higher. When the dummy variable was replaced by its expected value, SBP with medicines decreased by 7 mmHg. For individuals taking medicines at some times and not at others, SBP decreased by 9 and 8 mmHg in models with and without a sample bias correction, respectively. Conclusion: The methods eliminated some problems of RCT and might be attractive. However, we obtained contradictory conclusions depending on the statistical methods employed, despite using the identical dataset. Statistical methods must be selected carefully to obtain a reliable evaluation. Limitations: The dataset was observatory, and the sample period was only 3 years.

Reliability of Blood Pressure Measurements: An Analysis of the White Coat Effect and Its Fluctuations

In this paper, we evaluate the difference between the first and second measurements of blood pressure (BP) when BP is measured twice using the results of 17,775 medical checkups. The two measurements for both systolic BP (SBP) and the diastolic BP (DBP) fluctuated a large amount even though they were measured at a short interval. The first measurements were 6.7 and 2.4 mmHg higher than the second ones for SBP and DBP, suggesting a white coat effect. Then, the factors that might affect the differences between the two measurements were analyzed by the regression models. For both SBP and DBP, the difference increased as the first measurement increased. Age, gender, BMI and alcohol consumption were other important factors affecting the difference. In the case of a typical male individual, the typical criteria for hypertension of 140/90, 160/100 and 180/110 mmHg criteria in the first measurement would correspond to 135/86, 150/94 and 165/102 mmHg in the second measurement. The necessity of developing accurate and cost-efficient BP measurement methods is strongly suggested.

An Analysis of the Medical Costs of and Factors Affecting Diabetes Using the Medical Checkup and Payment Dataset in Japan: Can We Reduce the Prevalence of Diabetes?

Background: The cost and economic burden of diabetes are a serious worldwide issue. In this study, we evaluated medical payments for persons diagnosed with diabetes and the factors that led to a person having diabetes to reduce its prevalence. Methods: A dataset containing 113,979 medical checkups and 3,671,783 monthly medical, dental, care-giving and pharmacy payment records of one health insurance society was used. The dataset contains information of normal and healthy persons. The sample period ran from April, 2013 to March, 2016. The medical payments for persons diagnosed with diabetes were calculated. The regression analysis was used to remove the effects of age and gender. The probit analysis was used to analyze the factors that led to a person having diabetes. Results: In 2.9% of cases, the person undergoing the checkup was diagnosed with diabetes, and the medical payments for these patients were 2.7 times as much as the average medical payment per person. This result did not change significantly even if age and gender were considered. The results of the probit analysis suggested that body mass index, high systolic blood pressure, low diastolic blood pressure, eating habits, physical activities, smoking, drinking alcohol and sleeping were important factors for diabetes. Conclusion: The diabetes might be a costlier disease than previously thought in Japan. By the estimation, 8% of all medical payments were made for these persons with diabetes, which is much higher than the result shown by national survey data. However, overall prevalence could be recused by efforts such as prevention of overweight and obesity.

Does High Systolic Blood Pressure Truly Increase Medical Expenditure?—An Empirical Analysis of the New 2017 ACC/AHA Hypertension Guideline

Background: High blood pressure (BP) or hypertension is considered one of the top global disease burden risk factors. In November 2017, the ACC/AHA and other organizations announced a new hypertension guideline of 130/80 mmHg. Data and Methods: We evaluate the effects of BP on increases in medical expenditures using transformation tobit models and a dataset containing 175,123 medical checkups and 6,312,125 receipts from 88,211 individuals in three health insurance societies. The sample period was April 2013 to March 2016. We first created a database of combined checkup results and medical expenditures. The power transformation tobit model was then used to remove the effects of other variables, and we investigated the relation between medical expenditures and BP, especially systolic BP (SBP). Results: We observed negative effects of SBP on medical expenditures. The results raise uncertainty about the reliability of the new guideline, at least for SBP. Although the simple correlation coefficient of medical expenditures and SBP was positive, the sign of the SBP estimate became negative when a variable representing obesity was included. In terms of other medical checkup items, while LDL is considered the “bad” cholesterol, it reduced medical expenditures. Conclusion: Our results did not support the new 2017 ACC/AHA guideline for SBP. A wide and careful range of reviews not only for heart diseases but also for other disease types will be absolutely necessary. New studies to verify the guideline should also be conducted. Limitations: The dataset was observatory, the sample period only 3 years, and we could not complete a time-series analysis of individuals.

Prevalence and risk factors of asymptomatic peptic ulcer disease in Taiwan

AIM:To investigate the prevalence and risk factors of asymptomatic peptic ulcer disease(PUD)in a general Taiwan Residents population. METHODS:From January to August 2008,consecutive asymptomatic subjects undergoing a routine health check-up were evaluated by upper gastrointestinal endoscopy.Gastroduodenal mucosal breaks were carefully assessed,and a complete medical history and demographic data were obtained from each patient.Logistic regression analysis was conducted to identify indepen-dent risk factors for asymptomatic PUD. RESULTS:Of the 572 asymptomatic subjects,54(9.4%) were diagnosed as having PUD.The prevalence of gastric ulcer,duodenal ulcer and both gastric and duodenal ulcers were 4.7%,3.9%,and 0.9%,respectively. Multivariate analysis revealed that prior history of PUD [odds ratio(OR),2.0,95%CI:1.3-2.9],high body mass index[body mass index(BMI)25-30:OR,1.5,95%CI: 1.0-2.2;BMI>30 kg/m 2 :OR,3.6,95%CI:1.5-8.7] and current smoker(OR,2.6,95%CI:1.6-4.4)were independent predictors of asymptomatic PUD.In contrast, high education level was a negative predictor of PUD (years of education 10-12:OR,0.5,95%CI:0.3-0.8; years of education>12:OR,0.6,95%CI:0.3-0.9). CONCLUSION:The prevalence of PUD in asymptomatic subjects is 9.4%in Taiwan.Prior history of PUD, low education level,a high BMI and current smoker are independent risk factors for developing asymptomatic PUD.

Effect of HbA_(1c) combined FPG on screening diabetes in health checkup

Objective:To appraise the effectiveness of HbA_(1c) and fasting plasma glucose(FPG) on screening diabetes in health check-up.Methods:A total of 1 337 individuals(male 850,female 487),aged 27 to 91 years with HbA_(1c) test were included.Participates with HbA_(1c)≥6.0%or FPG≥6.1 mmol/ L underwent oral glucose tolerance test(OGTT).Diabetes mellitus was diagnosed according to the criteria of WHO in 1999,FPG≥7.0 mmol/L and/or OGTT 2 h-postload plasm glucose(2 h-PG)≥11.1 mmol/L.The sensitivity and specificity of HbA_(1c) thresholds and FPG or combination test on screening of diabetes were analyzed.Results:A total of 842 subjects had HbA_(1c)<6.0%,in which 32 had isolated FPG≥6.1 mmol/L,of 495 had HbA_(1c)≥6.0%.Subjects with HbA_(1c)≥6.0% had significant increased disorder indexes than those with HbA_(1c)<6.0%.527 subjects who had HbA_(1c)≥6.0%or FPG≥6.1 mmol/L underwent OGTT.A total of 234 subjects were newly diagnosed diabetes,including 123(123/234,52.56%) with FPG≥7.0 mmol/L,and 111 subjects(111/234, 47.43%) with isolated 2 h-PG≥11.1 mmol/L.Among 234 new diabetes,91.88%(215 subjects) had HbA_(1c)≥6.3%,and 77.40%(181 subjects) had HbA_(1c)≥6.5%.HbA_(1c)≥6.3%combined FPG≥7.0 mmol/L increased the positive rate of newly diagnosed diabetes from 91.88%to 96.58%. Conclusions:HbA_(1c) is a practical and convenient tool for screening undiagnosed diabetes in routine health check-up of a large population.Combined use of HbA_(1c)≥6.3%and/or FPG≥7.0 mmol/L is efficient for early detection of diabetes.

Factors associated with diabetic retinopathy screening and regular eye checkup practice among diabetic patients attending Felege Hiwot Specialized Hospital

AIM: To identify associated factors of diabetic retinopathy(DR) screening and ey e check-up practice among diabetes mellitus(DM) patients attending Felege Hiwot Specialized Hospital.METHODS: An institution-based cross-sectional study was applied from October 4, 2019 to January 12, 2020 at Felege Hiwot Specialized Hospital. A systematic random sampling technique was used to recruit participants and an interviewer-administered questionnaire was employed to collect the data. The collected data were entered into Epi Info version 7 and transposed to SPSS version 24 for statistical analysis. Descriptive statistics were executed and associated factors were identified using binary logistic regression. The strength of association between the independent and the outcome variable was determined using an adjusted odds ratio(AOR) with 95% confidence interval(CI). RESULTS: Four hundred and six participants partake with a response rate of 95.7% and a mean age of 47±11.5y. The magnitude of DR screening was 308(75.9%, 95%CI: 71.5%, 79.8%). Higher educational level(AOR=3.25;95%CI: 1.40, 8.78), good knowledge of DR(AOR=2.50;95%CI: 1.55, 4.46), and family history of DM(AOR=2.15;95%CI: 1.41,3.85) were significantly associated with DR screening. On the other side, rural residence [AOR=3.11(1.89, 5.02)] and undesirable attitudes toward DR [AOR=5.65(3.14, 8.76)] were significantly associated with poor regular eye checkup practice.CONCLUSION: Most of the participants are screened for DR. Higher education, family history, and good knowledge are associated with DR screening. In addition, rural residence and undesirable attitudes toward DR are associated with regular eye checkup practice.

Design of the Saitama Cardiometabolic Disease and Organ Impairment Study (SCDOIS): A Multidisciplinary Observational Epidemiological Study

Background: In the past few decades, the incidence of cardiometabolic diseases and disorders of the liver, kidney, pancreas, heart, and lung, have been increasing in Western and Asian countries, including Japan. Numerous factors, including abnormal body weight (obesity, overweight, or underweight), infrequent exercise, and other unfavorable lifestyle factors (e.g., smoking and heavy alcohol drinking) have been proposed as risk factors for the development and the progression of diseases, such as type 2 diabetes, hypertension, and dyslipidemia, which ultimately lead to impaired organ function and possibly death. However, the mechanisms that link these risk factors with diseases are still poorly understood, and the potential treatments, including pharmacotherapy and diet, have not been fully evaluated. Methods: In 2011, we established a new collaborative research program, the Saitama Cardiometabolic Disease and Organ Impairment Study (SCDOIS). This multidisciplinary observational epidemiological research study was designed to cover several high-profile diseases and some traditional fields of internal medicine, as well as apparently unrelated fields and particular lifestyle factors, such as unhealthy eating behaviors. In a series of studies, apparently healthy subjects who underwent a regular medical checkup were retrospectively identified based on the results of their medical checkups. In this way, the incidence, prevalence, causality, and clinical relevance of specific conditions and diseases have been investigated in cross-sectional analyses of 100,000 - 200,000 adults, and in longitudinal studies of several thousand subjects who underwent medical checkups multiple times. Discussion: This article describes the background, rationale, purpose, and methods of the SCDOIS. Using data obtained from annual medical checkups, our goals are to 1) establish criteria or identify clinical features that would enable clinicians to detect the presence of abnormal conditions associated with cardiometabolic diseases and/or organ impairment much earlier in the disease course;and 2) determine the potential mechanisms and therapies for these conditions.

Identifying Characteristics of Adults Absent from a Metabolic Syndrome Checkup in Japan Using CHAID Dendrograms and Insurance Claim Data

To prevent the development of metabolic syndrome among adult members of the community, improving the participation rate in the specific medical checkup (a medical examination focused on factors associated with metabolic syndrome prior to the onset of lifestyle-related disease) is an important public health issue. This study used claim data and health checkup data and aimed to detect those community-dwelling adults who were least likely to participate in the specific medical checkup. Analysis included the medical and health checkup chart data of 61,753 adults aged 60 - 69 years (as of April 2011) who lived in Fukui prefecture, Japan. The chi-squared interaction was used to analyze data. If a person did not participate in the specific medical checkup, individual was categorized as “absent.” Between April 2012 and March 2013, 66.3% of subjects were absent from the specific medical checkup. Those most likely to be absent included those who were also absent at the previous year’s checkup, those who were men, and those who did not have an examination for hypertension;87.9% of patients who met all of these criteria were absent. Among women who were absent at the previous year’s checkup, the absentee rate differed by about 10.0% between those whose municipalities did (74.8%) or did not (84.2%) have a free checkup program. Our findings may help public health professionals detect those who require intervention and to effectively and efficiently improve participation in the specific medical checkup.

Early diagnosis of health damage in arc welders based on their serum ferritin level

To develop a method for the early diagnosis of health damage due to arc welding, we measured serum ferritin in 96 general employees and 320 arc welders in Company A. A positive correlation was observed between age and the serum ferritin level in the young group (age, 20 - 44 years) among the general employees. The mean serum ferritin level in the general employees was 119 ± 56 ng/ml. When the mean ± 2.5 SD was used as the standard value, ferritin levels > 260 ng / ml could be regarded as high. Based on this standard value, high ferritin levels were observed in 7 (6.6%) of 106 young arc welders in Company A but none of the general employees. Chest X-ray films showed minimal abnormality in one of 7 young arc welders who showed high ferritin levels. These results suggest that the determination of the serum ferritin level is useful for the early diagnosis of health damage due to arc welding.

Annual Checkup

Zhu Xinlian,a village doctor in Ningxia Hui Autonomous Region,has received a significant salary raise：earning 70,000 yuan（$10,606）in 2015 after earning less than 5,000yuan（$758）a year in the late 2000’s.Graduating from Ningxia Medical School in 1996,Zhu has witnessed the dramatic change of the village clinic in the past years.