[Deterioration of Healthcare Service Quality Provided by Occupational Physicians Due to Dumping by Health Checkup and Switching Health Checkup Organizations].

INTRODUCTION: From 2007, competitive bidding for procurement became widely employed by the Japanese Government, and health check providers for government workers are selected every year by this method. Deterioration of health check quality due to excessive price competition is a serious concern. The National Federation of Industrial Health Organization (Zeneiren) conducted an investigative research on the contracting of health check providers and occupational physicians in workplaces in 2015-2016 in an effort to prevent low-cost but low-quality health checks. The report of the research is available on the homepage of Zeneiren. In this paper, we provide a brief overview of the report, and deterioration of health check quality due to dumping by and switching of health check providers is discussed from economic and legal viewpoints. METHOD: Information was obtained from articles in print and on the Internet. RESULTS: A questionnaire survey of health check providers revealed that excessive discounts due to both competitive bidding and demand from companies commissioning health checks occurred on a routine basis, and some providers were concerned about worsening business conditions in the future. In a separate questionnaire survey of occupational physicians, it was discovered that they were able to evaluate the quality of health checks, whereas administrative officials responsible for selecting the providers were seldom able to adequately evaluate the health check quality, resulting in contracting providers of questionable quality, which in turn caused considerable dissatisfaction on the part of occupational physicians. Moreover, when health check providers were switched, the reporting format of health check results changed. The physicians did not favor such a change because of the considerably increased workload involved in coordinating past and current data and the risk of decreased occupational health service quality. DISCUSSION: Dumping makes the management of health check providers very difficult and is a cause of loss of social capital. If health check providers of good quality withdraw from the market, the supply of high-quality health checks decreases. This corresponds to external diseconomy caused by dumping on the part of the health check providers and loss of social surplus (economic surplus). CONCLUSIONS: To avoid deterioration of occupational health service due to low-quality health checks and changes in the reporting format, occupational physicians must actively engage in the selection of health check providers of good quality.

Association Between Serum Uric Acid Levels/Hyperuricemia and Hypertension Among 85,286 Japanese Workers.

This cross-sectional study from January 2012 to December 2012 aimed to examine the sex-specific association between serum uric acid (SUA) levels/hyperuricemia and hypertension among Japanese patients. SUA level, medical histories, and lifestyle-related items were collected from 85,286 of 136,770 participants. Among those with hyperuricemia, the median age was 46 years and 97% were men, which was significantly different than those without hyperurecemia (44 years and 56%, respectively; P<.01). Hyperuricemia was 1.79 times more likely in hypertensive men than normotensive men and almost six times more likely in hypertensive women (odds ratio=5.92 and adjusted odds ratio=1.33 for men and adjusted odds ratio=1.81 for women) after multivariate analysis. SUA quartiles positively correlated with systolic and diastolic blood pressures in both sexes. Hyperuricemia and SUA levels were significantly associated with hypertension in both sexes. These findings underscore the importance of maintaining normal SUA levels to manage and prevent hypertension. Better management of SUA as well as blood pressure may have potential in preventing future cardiovascular disorders.

Achievement of Target Blood Pressure Levels among Japanese Workers with Hypertension and Healthy Lifestyle Characteristics Associated with Therapeutic Failure.

BACKGROUND: Few studies have examined Japanese with regard to the achievement rates for target blood pressure levels, or the relationship between these rates and healthy lifestyle characteristics in patients with hypertension as defined by the newly established hypertension management guidelines (JSH2014). The aim of this study was to elucidate achievement rates and examine healthy lifestyle characteristics associated with achievement status among Japanese. METHODS: This cross-sectional study, conducted in January-December 2012, examined blood pressure control and healthy lifestyle characteristics in 8,001 Japanese workers with hypertension (mean age, 57.0 years; 78.8% were men) who participated in a workplace health checkup. Data were collected from workplace medical checkup records and participants' self-administered questionnaires. We divided into 5 groups [G1; young, middle-aged, and early-phase elderly patients (65-74 years old) without diabetes mellitus or chronic kidney disease (CKD) (<140/90 mmHg), G2; late-phase elderly patients (≥75 years old) without diabetes mellitus or CKD (<150/90 mmHg), G3; diabetic patients (<130/80 mmHg), G4; patients with CKD (<130/80 mmHg), and G5; patients with cerebrovascular and/or coronary artery diseases (<140/90 mmHg)] according to JSH2014. And then, achievement rates were calculated in each group. Multivariate analysis identified healthy lifestyle characteristics associated with "therapeutic failure" of target blood pressure. RESULTS: Target blood pressures were achieved by 60.2% of young, middle-aged, and early-phase elderly patients (G1), 71.4% of late-phase elderly patients (G2), 30.5% of diabetic patients (G3), 33.4% of those with chronic kidney disease (G4), and 66.0% of those with cerebrovascular and/or coronary artery diseases (G5). A body mass index of 18.5-24.9 and non-daily alcohol consumption were protective factors, and adequate sleep was found to contribute to therapeutic success. DISCUSSION: We found low achievement rates for treatment goals among patients with chronic kidney disease and diabetes mellitus. Maintaining an ideal body weight and adequate alcohol consumption may help with blood pressure control. Lifestyle modification may be necessary for better management of hypertension.

[Changes in the prevalence of cardiovascular risk factors in Japanese workers during decade 2001-2011].

OBJECTIVE: To describe the 10-year changes in the prevalence of cardiovascular risk factors in Japanese workers. METHODS: Annual health examination data between 2001 and 2011 were collected from the Tokyo Health Service Association. The data covers an average 119,956 (73,842 male and 46,114 female) workers at 1,159 worksites each year. The prevalences of obesity, hypertension, hypercholesterolemia, diabetes, and smoking were calculated in 5-year age groups for each year. Overall prevalence estimates were adjusted for age using the indirect method. RESULTS: For male workers, the crude prevalences of obesity, hypertension, hypercholesterolemia, diabetes, and smoking were 26.9%, 19.0%, 22.7%, 6.9%, and 49.4%, respectively, in 2001, and 28.5%, 19.9%, 26.6%, 5.9%, and 34.4%, respectively, in 2011. The age-adjusted prevalence of hypercholesterolemia has increased over the 10-year period. Especially among those aged 50 years or over, significant increasing trends were found for obesity, hypertension, hypercholesterolemia, and diabetes. For female workers, the crude prevalences of obesity, hypertension, hypercholesterolemia, diabetes, and smoking were 10.4%, 7.1%, 19.1%, 1.7%, and 16.6%, respectively, in 2001 and 11.6%, 7.4%, 16.7%, 1.7%, and 10.3%, respectively, in 2011. The age-adjusted prevalence of hypercholesterolemia has decreased over the 10-year period. Especially among those aged 40-59 years, a significant decreasing trend was found for hypercholesterolemia. Smoking prevalence showed a steady decrease among both male and female workers. CONCLUSIONS: Overall cardiovascular risk prevalence of Japanese workers has remained almost unchanged over the 10-year period, but there is a significant increasing trend in the prevalence of hypercholesterolemia among male workers. Male workers aged 50 years or over are identified as a subgroup requiring special attention, whose cardiovascular risk prevalence is increasing.

Impact of weight gain on cardiovascular risk factors in Japanese male workers.

OBJECTIVE: To evaluate the impact of weight gain on cardiovascular risk factors among younger (25 to 44 years) and older (45 to 64 years) Japanese male workers in terms of population attributable risk percentage (PAR%). METHODS: Using the 2008 and 2009 health examination data, 49,587 eligible male workers aged 25 to 64 years were examined for their 1-year changes in body weight and cardiovascular risk factors. RESULTS: Mean weight change was significantly greater than zero in the younger group (+0.27 kg) but not in the older group (-0.08 kg). The PAR% due to weight gain for the development and maintenance of cardiovascular risk factors was estimated at 21.8% and 5.4%, respectively, in the younger and older groups. CONCLUSIONS: The age-stratified PAR% estimates suggest that weight gain prevention programs will make greater contributions to cardiovascular health in younger than in older male workers.

BMI, waist circumference, and clustering of cardiovascular risk factors in Japanese adults.

OBJECTIVE: To examine whether the association between waist circumference (WC) and clustering of cardiovascular risk factors varies with obesity (BMI) status. METHODS: Using the 2008 health examination data of a Japanese health service association, eligible 57,141 adults aged 20-65 years without coronary heart disease or stroke, whose blood sample had been taken in the fasting state, were enrolled in the study. The participants were classified as being underweight (BMI <18.5), normal weight (BMI 18.5-24.9), and overweight (BMI ≥25.0). Multiple logistic regression analysis was performed to calculate adjusted odds ratios (OR) for clustering of cardiovascular risk factors. Receiver operating characteristic analysis was performed to assess the ability of WC to discriminate subjects with and without a clustering of cardiovascular risk factors. RESULTS: Clustering of cardiovascular risk factors was found in 16.0% of men and 3.4% of women. The adjusted OR [95% confidence intervals (CI)] per 5-cm increase in WC of the underweight, normal weight, and overweight groups was 1.57 (1.12-2.20), 1.55 (1.49-1.62), and 1.34 (1.30-1.38), respectively, for men and 1.50 (0.84-2.69), 1.53 (1.40-1.68), and 1.32 (1.23-1.41), respectively, for women. The area under curve (95% CI) of the underweight, normal weight, and overweight groups was 0.68 (0.59-0.77), 0.70 (0.69-0.71), and 0.62 (0.61-0.63), respectively, for men and 0.70 (0.53-0.86), 0.75 (0.73-0.78), and 0.64 (0.61-0.68), respectively, for women. CONCLUSION: High WC was associated with increased risk of clustering of cardiovascular risk factors independent of BMI. As well as the magnitude of the association, the ability of WC to discriminate subjects with and without a clustering of cardiovascular risk factors varied with obesity (BMI) status.

Predictors of Japanese workers' satisfaction with their annual health checkups.

To seek the factors associated with the degree of Japanese workers' satisfaction with their annual health checkups, a survey with an anonymous self-administered questionnaire was conducted. A total of 1,389 questionnaires were analyzed. The average age of the analyzed subjects was 37.4 yr (range, 18-66 yr). Multiple linear regression analysis showed that the degree of such satisfaction was significantly associated with the effectiveness of annual health checkups, the hassle of receiving them, the receptionist's good manners, cleanliness of the examination site, the long waiting time, privacy invasion issues, anxiety concerning the skills of the persons conducting the examinations, and helpful advice from a physician. Various activities including promoting primary preventions, e.g., medical education must be conducted to convey the effectiveness of annual health checkups to examinees and to reduce the hassle of receiving those checkups. Health checkup staffs must keep their health checkup sites clean and try to find ways to reduce the waiting time. Moreover, they must pay particular attention to examinees' privacy. It is imperative that examinees are not anxious concerning the skills of the persons conducting the examinations. Many examinees want helpful advice from a physician regarding their health management.

Survey of the degree of examinees' satisfaction with instructions on how to read results of general health checkups at a workplace.

To clarify measures for making clearer instructions on how to read the results of general health checkups in a workplace by surveying the views of workers on these instructions, an anonymous self-administered questionnaire survey was conducted at a Japanese manufacturing plant. The responses of 984 male workers were analyzed. The average age of the subjects was 32.1 yr (range, 19-60 yr). Regarding the instructions, 4.1% of the subjects answered "definitely sufficient," 58.9% "somewhat sufficient," 28.0% "neither sufficient nor insufficient," 8.1% "somewhat insufficient" and 0.8% "definitely insufficient." Multiple regression analysis showed that the degree of examinees' satisfaction significantly correlated with the health condition (standard partial regression coefficient =0.189, p<0.001), knowledge of health management (standard partial regression coefficient =0.095, p=0.014), and fear of lifestyle-related diseases (standard partial regression coefficient =0.095, p=0.009). The adjusted R square value of the multiple regression analysis was 0.064. It is necessary to provide more detailed information to those with poor health. Because the instructions contain many difficult medical terms, health professionals must give instructions that are easy to understand. Those feeling fear of lifestyle-related diseases may already know how to read checkup results. It is necessary to promote awareness of lifestyle-related diseases targeting people unfamiliar with such diseases.