General Health Check-up Research Articles

Prevalence of metabolic syndrome in pre as well as postmenopausal women in a tertiary care center

Background: Metabolic syndrome is a constellation of metabolic abnormalities and a complex pre-disease state that predicts future development of type 2 diabetes mellitus and cardiovascular diseases. Epidemiologically it is observed that incidence of metabolic syndrome increases with age and more so in women once they attain menopause. Objectives: To study the prevalence of metabolic syndrome in pre as well as post-menopausal women and to study the various components of metabolic syndrome. Materials and Methods: We performed an observational study in a tertiary care teaching institute. Women attending general health checkup were selected for the study A total of 484 women were selected. 267 were in the postmenopausal group and 217 in premenopausal group. After a detailed collection of demographic data, medical, surgical, obstetrical and gynecological history, general physical and systemic examination was done. Height, weight, waist circumference were measured. BMI was calculated. Venous blood sample sent for fasting blood glucose, HDL, Triglycerides. Metabolic syndrome was diagnosed when three out of five parameters were found abnormal. Results: Metabolic syndrome was seen in 158 women (32.6%). Among these women, 118 (44.19%) were postmenopausal women and 40 (18.4%) were premenopausal. Postmenopausal women are at twice the risk of developing metabolic syndrome.

Vascular endothelial growth factor (VEGF) polymorphism rs3025039 and atherosclerosis among older with hypertension

Angiogenesis inhibition therapy causes hypertension by increasing peripheral vascular resistance. Vasa vasorum angiogenesis plays a crucial role in the development of atherosclerosis. Since vascular endothelial growth factor (VEGF), which contributes to the progress of angiogenesis, is reported to be inversely associated with the minor allele of polymorphism rs3025039, the minor allele of rs3025039 could be inversely associated with atherosclerosis among individuals with hypertension. A cross-sectional study of 1793 older Japanese adults aged 60–89 years with hypertension who participated in general health check-ups was conducted. Atherosclerosis was defined as carotid intima-media thickness (CIMT) ≥ 1.1 mm. The minor allele of polymorphism rs3025020 was positively associated with VEGF. Therefore, in addition to known cardiovascular risk factors, rs3025020 genotype acted as a confounding factor in the present study. Independent of known confounding factors, the minor allele of rs3025039 was inversely associated with atherosclerosis among older Japanese adults with hypertension. The fully adjusted odds ratio (OR) and 95% confidence interval (CI) for atherosclerosis with the minor allele of rs3025039 was 0.78 (0.64, 0.96). The angiogenesis-related polymorphism rs3025039 was associated with the development of atherosclerosis among older Japanese individuals. This study indicates that the development of atherosclerosis among older individuals might partly indicate a capacity for angiogenesis.

Biological variation and reference change values of serum Mac-2-binding protein glycosylation isomer (M2BPGi).

BackgroundLimited data are available with regard to biological variations of the Mac‐2–binding protein glycosylation isomer (M2BPGi), a liver fibrosis biomarker.MethodsLong‐term biological variation of M2BPGi was investigated using longitudinally measured M2BPGi test results from healthy Korean adult subjects. One‐way analysis of variance (ANOVA) tests were used to calculate the reference change value (RCV) of M2BPGi based on biological variation estimates. Furthermore, asymmetric RCV was calculated according to a recent publication of the European Federation of Clinical Chemistry and Laboratory Medicine Working Group on Biological Variation and Task Group for the Biological Variation Database (EFLM TG‐BVD).ResultsA total of 363 test results from 174 Korean subjects undergoing general health checkups were requested from 13 local clinics and hospitals during a 38‐month period. The within‐subjects biological variation (CVI), between‐subject biological variation (CVG), analytical variation (CVA), RCV, and individuality index (II) values for serum M2BPGi were 23.3%, 30.0%, 4.3%, 65.6%, and 0.78, respectively. Asymmetric RCV calculated using formulae by a recent EFLM TG‐BVD publication ranged from −41.9 to 72.0%. Desirable analytical performance specifications for M2BPGi derived from biological variation were as follows: imprecision 11.6%, bias 9.6%, and total allowable error 28.7%.ConclusionsRCV based on biological estimates may be helpful for evaluating and interpreting serial M2BPGi measurements by physicians and in clinical laboratories.

U-Shaped Associations Between Body Weight Changes and Major Cardiovascular Events in Type 2 Diabetes Mellitus: A Longitudinal Follow-up Study of a Nationwide Cohort of Over 1.5 Million.

Despite the benefits of weight loss on metabolic profiles in patients with type 2 diabetes mellitus (T2DM), its association with myocardial infarction (MI), ischemic stroke (IS), atrial fibrillation (AF), heart failure (HF), and all-cause death remains elusive. Using the National Health Insurance Service Database, we screened subjects who underwent general health checkups twice in a 2-year interval between 2009 and 2012. After identifying 1,522,241 patients with T2DM without a previous history of MI, IS, AF, and HF, we followed them until December 2018. Patients were stratified according to the magnitude of weight changes between two general health checkups: ≤ -10%, -10 to ≤ -5%, -5 to ≤5%, 5 to ≤10%, and >10%. During the follow-up (median 7.0 years), 32,106 cases of MI, 44,406 cases of IS, 34,953 cases of AF, 68,745 cases of HF, and 84,635 all-cause deaths occurred. Patients with weight changes of -5 to ≤5% showed the lowest risk of each cardiovascular event. Both directions of weight change were associated with an increased cardiovascular risk. Stepwise increases in the risks of MI, IS, AF, HF, and all-cause death were noted with progressive weight gain (all P < 0.0001). Similarly, the more weight loss occurred, the higher the cardiovascular risks observed (all P < 0.0001). The U-shaped associations were consistently observed in both univariate and multivariate analyses. Explorative subgroup analyses also consistently showed a U-shaped association. Both weight loss and gain >5% within a 2-year interval were associated with an increased risk of major cardiovascular events in patients with T2DM.

Postal reminder with reduced burden of clinic information seeking for equitable participation in general health check-ups: A randomized controlled trial

High participation rate and low inequality in participation are key to the program success of general health check-ups in Japan. This study examined the effectiveness of a postal reminder including nearest clinic information, compared to the standard postal reminder including details of all local clinics, on participation rate and income-based participation rate in general health checks.This was a single-blind, two-arm, prospective, randomized controlled study conducted at the Fukuoka Branch of Japan Health Insurance Association. Dependents (family members) of insured persons aged 40–69 years were randomly assigned (1:1) to the intervention group that received a tailored postal reminder intervention (showing information on the nearest clinic from each participant's address) or to the control group that received an original template postal reminder (containing just the URL of the website listing all available clinics). Allocation was concealed from participants and service providers of general health check-up. The primary outcome was participation in general health check-ups within 1 month of intervention.Between February 1 and February 10, 2017, 21,017 were randomly assigned to the intervention (n = 10,474) or control (n = 10,543) group. The participation rate in the intervention group was higher than control group (3.2% vs. 2.1%; OR: 1.55, 95% CI: 1.31–1.85, P < 0.001). The intervention effect was estimated to decrease as the income category increased (P for interaction = 0.037).Tailored postal reminders with information on the nearest clinic were able to improve the overall participation rate and reduce income-based inequality in participation for general health check-ups in Japan.Trial registration: UMIN-CTR, UMIN000042509, Registered 26 November 2020 – Retrospectively registered.

Hip Fracture Risk According to Diabetic Kidney Disease Phenotype in a Korean Population.

BackgroundDiabetic kidney disease (DKD) is associated with an elevated risk of fractures. However, little is known about the association between proteinuric or non-proteinuric DKD and the risk of hip fracture. Thus, we investigated the incidence of hip fractures among Korean adults with type 2 diabetes mellitus (T2DM) stratified by DKD phenotype.MethodsIn this retrospective cohort study using the Korean National Health Insurance Service database, patients with T2DM who received at least one general health checkup between 2009 and 2012 were followed until the date of hip fracture, death, or December 31, 2018. We classified the DKD phenotype by proteinuria and estimated glomerular filtration rate (eGFR), as follows: no DKD (PU−GFR−), proteinuric DKD with normal eGFR (PU+GFR−), non-proteinuric DKD with reduced eGFR (PU−GFR+), and proteinuric DKD with reduced eGFR (PU+GFR+)ResultsThe cumulative incidence of hip fractures was highest in the PU+GFR+ group, followed by the PU−GFR+ group and the PU+GFR− group. After adjustment for confounding factors, the hazard ratio (HR) for hip fracture was still highest in the PU+GFR+ group. However, the PU+GFR− group had a higher HR for hip fracture than the PU−GFR+ group (PU+GFR+: HR, 1.69; 95% confidence interval [CI], 1.57 to 1.81; PU+GFR−: HR, 1.37; 95% CI, 1.30 to 1.46; PU−GFR+: HR, 1.20; 95% CI, 1.16 to 1.24 using the PU−GFR− group as the reference category).ConclusionThe present study demonstrated that DKD was significantly associated with a higher risk of hip fracture, with proteinuria as a major determinant.

Explainable Machine Learning for Atrial Fibrillation in the General Population Using a Generalized Additive Model - A Cross-Sectional Study.

Background: Atrial fibrillation (AF) is the most common arrhythmia and is associated with increased thromboembolic stroke risk and heart failure. Although various prediction models for AF risk have been developed using machine learning, their output cannot be accurately explained to doctors and patients. Therefore, we developed an explainable model with high interpretability and accuracy accounting for the non-linear effects of clinical characteristics on AF incidence. Methods and Results: Of the 489,073 residents who underwent specific health checkups between 2009 and 2018 and were registered in the Kanazawa Medical Association database, data were used for 5,378 subjects with AF and 167,950 subjects with normal electrocardiogram readings. Forty-seven clinical parameters were combined using a generalized additive model algorithm. We validated the model and found that the area under the curve, sensitivity, and specificity were 0.964, 0.879, and 0.920, respectively. The 9 most important variables were the physical examination of arrhythmia, a medical history of coronary artery disease, age, hematocrit, γ-glutamyl transpeptidase, creatinine, hemoglobin, systolic blood pressure, and HbA1c. Further, non-linear relationships of clinical variables to the probability of AF diagnosis were visualized. Conclusions: We established a novel AF risk explanation model with high interpretability and accuracy accounting for non-linear information obtained at general health checkups. This model contributes not only to more accurate AF risk prediction, but also to a greater understanding of the effects of each characteristic.

Intraindividual Changes in Mac-2 Binding Protein Glycosylation Isomer (M2BPGi) Performed in Korean Subjects.

Limited data are available regarding intraindividual changes in the Mac-2 binding protein glycosylation isomer (M2BPGi), a liver fibrosis biomarker, performed for health checkups in Korean subjects. Through a laboratory information system, we retrospectively investigated longitudinally measured M2BPGi to assess intraindividual changes in M2BPGi test results. During a 38-month study period, 526 test results from 246 Korean subjects undergoing general health checkups were requested from 13 local clinics and hospitals. Among all 246 subjects, 190 (77.2%) exhibited negative M2BPGi (< 1.0 C.O.I.) during the initial measurement. Among all 246 subjects, 210 (85.4%) did not experience any changes in qualitative results during a follow-up. Among 42 subjects with initially 1+ positive results for M2BPGi, 17 (40.5%) changed to a negative M2BPGi result at least once during follow-up. No subjects with initially negative results or 1+ positive (1.0 ≤ C.O.I. < 3.0) results changed to 2+ positive (≥ 3.0 C.O.I.) results during the 38-month follow-up period. Some subjects exhibited qualitative changes in M2BPGi during follow-up health examinations. Future studies are needed to clarify the clinical implication of such changes.

Overall and cardiovascular mortality according to 10-year cardiovascular risk of the general health checkup: the Kangbuk Samsung Cohort Study.

According to the occupational accident status analysis in 2020, of 1,180 occupational deaths, 463 were caused by cardiovascular disease (CVD). Workers should be assessed for CVD risk at regular intervals to prevent work-related CVD in accordance with the rules on occupational safety and health standards. However, no previous study has addressed risk and mortality. Therefore, this longitudinal study was conducted to evaluate the relationship between 10-year cardiovascular risk of the general health checkup and mortality. The study included 545,859 participants who visited Kangbuk Samsung Total Healthcare Centers from January 1, 2002, to December 31, 2017. We performed 10-year cardiovascular risk assessment for the participants and the risk was divided into 4 groups (low, moderate, high, and very high). The study used death data from the Korea National Statistical Office for survival status as an outcome variable by December 31, 2019, and the cause of death based on the International Classification of Diseases, 10th Revision (ICD-10) was identified. Statistical analysis was performed using Cox proportional hazards regression analysis, and the sum of the periods from the first visit to the date of death or December 31, 2019, was used as a time scale. We also performed a stratified analysis for age at baseline and sex. During 5,253,627.9 person-years, 4,738 overall deaths and 654 cardiovascular deaths occurred. When the low-risk group was set as a reference, in the multivariable-adjusted model, the hazard ratios (HRs) (95% confidence interval [CI]) for overall mortality were 3.36 (2.87-3.95) in the moderate-risk group, 11.08 (9.27-13.25) in the high-risk group, and 21.20 (17.42-25.79) in the very-high-risk group, all of which were statistically significant. In cardiovascular deaths, the difference according to the risk classification was more pronounced. The HRs (95% CI) were 8.57 (4.95-14.83), 38.95 (21.77-69.69), and 78.81 (42.62-145.71) in each group. As a result of a subgroup analysis by age and sex, the HRs of all-cause mortality and cardiovascular mortality tended to be higher in the high-risk group. This large-scale longitudinal study confirmed that the risk of death increases with the 10-year cardiovascular risk of general health checkup.

Nationwide trends in prevalence of underweight, overweight, and obesity among people with disabilities in South Korea from 2008 to 2017

ObjectivesThis study investigated the 10-year trends of weight and prevalence of underweight, overweight and obesity according to disability grade and types compared with those without disabilities.MethodsThis serial cross-sectional analysis was conducted using national disability registration data with national general health checkup data from 2008 to 2017. Age-standardized prevalence of underweight and obesity were analyzed for each year, according to the presence, type, and severity of disabilities. Odds of underweight, overweight, obesity, and severe obesity were examined by multinomial logistic regression after adjusting for socio-demographic and clinical variables using data in 2017.ResultsOver 10 million subjects in each year were included in the analysis. In 2017, 14,246,785 people with age between 19 and 110 years were included and 53.1% was men. For 10 years, age-standardized prevalence of obesity and severe obesity showed significant increases regardless of sex and presence of disability. However, age-standardized underweight prevalence in people without disability tended to decrease whereas it was an increase in 2012 and the prevalence has remained steady since in people with disability. People with disabilities had higher odds of underweight compared to those without disability (OR 1.41, 95% CI 1.38–1.44 in male and OR 1.31, 95% CI 1.28–1.34 in female), especially in those with severe disabilities (OR 2.00, 95% CI 1.94–2.06 in male and OR 1.83, 95% CI 1.77–1.89 in female). Women with disabilities are more likely to be obese than those without disabilities regardless of disability severity (OR 1.40, 95% CI 1.38–1.41). Participants with mental disorder showed the highest prevalence of obesity, followed by epilepsy and developmental disability.ConclusionsHaving a disability was associated with higher odds/probability of both obesity and underweight. The intersection of female, severe disability, and mental/developmental disabilities was associated with probability of severe obesity. Simultaneous efforts are needed to develop health policy to reduce both the prevalence of obesity and underweight.

Malnutrition measured by unintended weight loss among patients in general practice

Objective: Disease-related malnutrition should be managed before negative consequences occur. The aim of this study was to investigate the prevalence of unintended weight loss and reduced food intake among patients ≥18 y of age attending a general practice.Methods: All patients visiting five general practices in Denmark, for 4 d in each place, were invited to participate in this questionnaire-based cross-sectional study. The questionnaire consisted of eight questions including unintended weight loss within the previous 2 mo, reduced food intake within the previous week, and symptoms that affected nutrition. Descriptive statistics, χ2 tests, and simple and multivariable logistic regression analysis were performed. The study included 1087 patients with an 88.7% response rate.Results: Unintended weight loss was found in 14.2% and 12.9% had reduced food intake. Of the patients with unintended weight loss, 62.3% also had reduced food intake. Patients 18 to 39 and >80 y of age; underweight patients; and patients visiting general practice for chronic pain, mental discomfort, and suspicion of serious illness had significantly higher odds for unintended weight loss and reduced food intake. Patients with reduced food intake had higher odds for unintended weight loss, and those visiting the general practice due to fatigue had higher odds for reduced food intake. Patients in obesity class 1 to 3 and patients who had come for a general health checkup had lower odds. Patients visiting for follow-up on chronic physical illness had higher odds of having unintended weight loss and reduced food intake combined.Conclusion: Overall, 14.2% of the patients had unintended weight loss, 12.9% had reduced food intake, and 62.3% had both, indicating a high prevalence of unintended weight loss among patients in general practice. Unintended weight loss seems relevant and feasible to use as an initial indicator for the need for further nutritional screening in general practice. Studies are needed to investigate the effect of interventions and outcomes.

AAUS guidelines 2021 revision sexually transmitted infection (STIs) diagnostic strategy for STI

AAUS guidelines 2021 revision sexually transmitted infection (STIs) diagnostic strategy for STI

Mapping the Korean National Health Checkup Questionnaire to Standard Terminologies.

ObjectivesAn increasing emphasis has been placed on the integration of clinical data and patient-generated health data (PGHD), which are generated outside of hospitals. This study explored the possibility of using standard terminologies to represent PGHD for data integration.MethodsWe chose the 2020 general health checkup questionnaire of the Korean Health Screening Program as a resource. We divided every component of the questionnaire into entities and values, which were mapped to standard terminologies—Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) version 2020-07-31 and Logical Observation Identifiers Names and Codes (LOINC) version 2.68.ResultsEighty-nine items were derived from the 17 questions of the 2020 health examination questionnaire, of which 76 (85.4%) were mapped to standard terms. Fifty-two items were mapped to SNOMED CT and 24 items were mapped to LOINC. Among the items mapped to SNOMED CT, 35 were mapped to pre-coordinated expressions and 17 to post-coordinated expressions. Forty items had one-to-one relationships, and 17 items had one-to-many relationships.ConclusionsWe achieved a high mapping rate (85.4%) by using both SNOMED CT and LOINC. However, we noticed some issues while mapping the Korean general health checkup questionnaire (i.e., lack of explanations, vague questions, and overly narrow concepts). In particular, items combining two or more concepts into a single item were not appropriate for mapping using standard terminologies. Although it is not the case that all items need to be expressed in standard terminology, essential items should be presented in a way suitable for mapping to standard terminology by revising the questionnaire in the future.

Efficacy of Silymarin and SAM in the Management of Hepatic Disorders in Dogs

Background: Treatment of canine liver diseases is often supportive and enables combinations of drug therapy and dietary support. Many nutraceutical compounds that have anti-oxidant properties have been suggested as supplements in animals suffering with hepatic diseases especially silymarin and S-adenosyl methionine The current study was aimed to evaluate therapeutic efficacy of certain nutraceuticals in the management of hepatic disorders in dogs. Methods: Dogs presented to Veterinary Hospital, Bhoiguda, Hyderabad with the clinical signs suggestive of hepatobiliary disorders were selected. Detailed history of the affected dogs was collected. Later, these cases were subjected for detailed clinical examination. While, apparently healthy dogs presented for general health checkup and vaccination with no clinical condition in the age group of 2-5 years were selected randomly as healthy control group for this study. Result: The present investigation was under taken to study the therapeutic efficacy of certain nutraceuticals in the management of hepatic disorders in dogs. Based on history, clinical signs, haemato biochemistry and ultrasonography, 32 dogs were histologically confirmed as hepatic disorders which formed the largest group. These dogs were selected for therapeutic trial. Apart from the specific drugs, addition of nutraceuticals like Silymarin and S-adenosyl methionine therapy was effective in the treatment of hepatic disorders.

The Effects of Glucose Lowering Agents on the Secondary Prevention of Coronary Artery Disease in Patients with Type 2 Diabetes.

BackgroundPatients with diabetes have a higher risk of requiring repeated percutaneous coronary intervention (PCI) than non-diabetic patients. We aimed to evaluate and compare the effects of anti-diabetic drugs on the secondary prevention of myocardial infarction among type 2 diabetes mellitus patients.MethodsWe analyzed the general health check-up dataset and claims data of the Korean National Health Insurance Service of 199,714 participants (age ≥30 years) who underwent PCIs between 2010 and 2013. Those who underwent additional PCI within 1 year of their first PCI (n=3,325) and those who died within 1 year (n=1,312) were excluded. Patients were classified according to their prescription records for glucose-lowering agents. The primary endpoint was the incidence rate of coronary revascularization.ResultsA total of 35,348 patients were included in the study. Metformin significantly decreased the risk of requiring repeat PCI in all patients (adjusted hazard ratio [aHR], 0.77). In obese patients with body mass index (BMI) ≥25 kg/m2, patients treated with thiazolidinedione (TZD) exhibited a decreased risk of requiring repeat revascularization than those who were not treated with TZD (aHR, 0.77; 95% confidence interval, 0.63 to 0.95). Patients treated with metformin showed a decreased risk of requiring revascularization regardless of their BMI. Insulin, meglitinide, and alpha-glucosidase inhibitor were associated with increased risk of repeated PCI.ConclusionThe risk of requiring repeat revascularization was lower in diabetic patients treated with metformin and in obese patients treated with TZD. These results suggest that physicians should choose appropriate glucose-lowering agents for the secondary prevention of coronary artery disease.

Using data mining technology to explore homocysteine at low levels.

A high homocysteine level is known to be an independent risk factor for cardiovascular diseases; however, whether or not low homocysteine level contributes to any damage to the body has not been extensively studied. Furthermore, acquiring healthy subject databases from domestic studies on homocysteine is not trivial. Therefore, we aimed to investigate the causality between serum homocysteine levels and health status and lifestyle factors, particularly with a focus on low serum homocysteine levels. Additionally, we discussed a systematic methodical platform for data collection and statistical analysis, using the descriptive analysis of the chi-square test, t test, multivariate analysis of variance, and logistic regression.This study was a cross-sectional analysis of 5864 subjects (i.e., clients of a health examination clinic) in Taipei, Taiwan during a general health check-up in 2017. The patients’ personal information and associated links were excluded. A sample group was selected as per the health criteria defined for this research whose data were processed using SPSS for descriptive statistical analysis using chi-square test, t test, multivariate analysis of variance, and logistic regression analysis.Those working for >12 hours/day had a higher homocysteine level than those working for <12 hours/day (P < .001). The average serum homocysteine level was 7.9 and 8.6 mol/L for people with poor sleep quality and good sleep quality, respectively (P = .003). The homocysteine value of people known to have cancer was analyzed using the logistic regression analysis, revealing a Δodds value of 0.898. The percentage of subjects with a homocysteine value of ≤6.3 μmol/L, who perceived their health status as “not very good” or “very bad,” was higher than those with a higher homocysteine level. The number of subjects who perceived their health as poor was higher than expected.The results suggest that the homocysteine level could be an effective health management indicator. We conclude that normal homocysteine level should not be ≤6.3 μmol/L. Moreover, homocysteine should not be considered as harmful and its fluctuations from the normal range could be utilized to infer a person's physical status for health management.

Long-term cumulative incidence of metachronous advanced colorectal neoplasia after colonoscopy and a novel risk factor: a cohort study.

Long-term cumulative incidence of and risk factors for metachronous advanced colorectal neoplasia, including both advanced colorectal adenoma (≥10 mm, or with villous or high-grade dysplasia) and colorectal cancer, are critical for surveillance strategies. The aim of this study was to determine the cumulative incidence of metachronous advanced colorectal neoplasia and its risk factors. A retrospective cohort study was conducted on 6720 consecutive individuals who underwent general health check-ups and colonoscopy. Colorectal adenomas at initial colonoscopy were categorized as low-risk (1-2 small [<10 mm] tubular adenomas) or high-risk adenoma (≥3 tubular adenomas of any size; at least one adenoma ≥10 mm; or villous adenoma or adenoma with high-grade dysplasia). Kaplan-Meier estimates and hazard ratio by Cox-proportional hazard regression were calculated. The cumulative incidence (95% confidence interval [CI]) of metachronous advanced colorectal neoplasia at 5 and 10 years was 5.7% [4.6-7.1], and 11% [8.9-14] in the low-risk adenoma group, and 10% [8.6-13], and 17% [14-21] in high-risk adenoma group, respectively. Adjusted hazard ratio [95% CI] of low-risk adenoma (vs. no colorectal adenoma), high-risk adenoma (vs. no colorectal adenoma), current smoking and positive fecal immunochemical test were 1.34 [1.04-1.74], 1.94 [1.48-2.55], 1.55 [1.2-2.02] and 1.69 [1.35-2.1], respectively. Adjusted hazard ratio [95% CI] of positive fecal immunochemical test was 1.88 [1.29-2.74] in those with normal colonoscopy. Both low-risk and high-risk adenomas confer substantial risk for metachronous advanced colorectal neoplasia at 10 years. Positive fecal immunochemical test was a significant risk factor for metachronous advanced colorectal neoplasia despite normal colonoscopy.

Income-based inequality in nationwide general health checkup participation in Japan

ObjectiveIn Japan, it is mandatory for employers to provide general health checkup opportunities to employees. Although many companies have subsidized checkups for employees' dependent family members, their participation is low. We assessed income-based inequality in the participation of employees’ dependents in the general health checkup. Study designThis is a cross-sectional descriptive study. Annual participation rate in general health checkup and various factors including income, age, and sex were collected and analyzed to examine the income-based inequality of participation rate in general health checkup. MethodsThe data for the present study were sourced from the Fukuoka Branch of the Japan Health Insurance Association, a large medical insurer in Japan. We extracted data of 196,057 dependents aged 40–74 years. We conducted a multiple logistic regression analysis using participation from April 2015 to March 2016 as dependent variable and income category ranging from 1 (lowest) to 4 (highest) between April and June 2015 as independent variable (adjusted for sex and age). We computed slope index of inequality (SII) and relative index of inequality (RII) based on income category. ResultsHigher the income, the more likely were dependents to participate in the general health checkup. SII for the participation rate of general health checkup ranged between −0.02 (95% confidence interval [CI]: −0.07 to 0.03) and 0.06 (0.03–0.09) for men; 0.03 (0.01–0.06) and 0.10 (0.09–0.11) for women. RII for the participation rate of general health checkup ranged between −0.19 (95% CI: −0.66 to 0.29) and 0.88 (0.15–1.61) for men; 0.22 (0.05–0.39) and 0.68 (0.60–0.76) for women. The highest inequality existed for men in their 50s and 60s and women in their 50s; the lowest inequality was among men and women aged 70–74 years. ConclusionThere was income-based inequality in participation in the general health checkup among dependents (family members) of the insured persons. The degree of inequality differed with age group. It cannot be explained solely by financial barrier among low-income group, rather it may reflect Japanese unique context in medical insurance system.

Prevalence of Non-Alcoholic Fatty Liver Disease (NAFLD) in Obese Type Two Diabetes Patients in an Endocrine Clinic

Introduction: Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver diseases that is expected to become the main cause for liver transplantation by 2030.1 Its prevalence is increasing globally and regionally, and it is set to become the leading cause of chronic liver disease in many parts of the world. However, the epidemiology and demographic characteristics of NAFLD vary worldwide.2About 20% to 30% of the patients progress to develop nonalcoholic steatohepatitis (NASH), a subtype of NAFLD, with features of hepatocyte injury such as hepatocyte ballooning. NASH can develop to fibrosis, cirrhosis, and even hepatocellular carcinoma.3 NAFLD is correlated with obesity and insulin resistance in most cases in the Western world.2In Kuwait, obesity prevalence is estimated to be 39% for adult males and 52% for adult females.4 There is no pharmacotherapy approved for NAFLD treatment, and the main treatment is lifestyle modifications focusing on body fat loss.5 Methods: In 18 months duration, a total number of 306 patients who attended an endocrine clinic in Kuwait for general health checkups with an average BMI of 33.6 (Kg/m2) were requested to do an abdominal ultrasound for fatty liver screening. And out of 306 patients, 218 patients (71% of the patients) were diagnosed with NAFLD, the rest 29% of the patients either didn’t come back for a follow up or were not diagnosed with NAFLD. Results: 218 patients have NAFLD, 153 of them are females and 65 are males with an average age and weight of 56.4 years and 87.9kg respectively. 78% of the patients were diabetic with an average HbA1c of 7.6%. The abdominal ultrasound showed the following result:83 patients had NAFLD grade 184 patients had NAFLD grade 2 21 patients had NAFLD grade 3While 30 patients had no grading, the results showed that they have a fatty liver with no grades mentioned. Also, reports showed that 27 patients had liver cirrhosis.The 218 patients were requested to do blood test and average results of the following parameter were as shown at baseline:Ferritin 98.3 ng/mLHemoglobin 13.5 g/dLPlatelets 274.5 x1000/cmmAST 23.8 U/LALT 27.9 U/LDirect Bilirubin 3.5 umol/LTotal Bilirubin 8.9 umol/LThe average calculated NAFLD, BARD and Fib-4 scores were -1.1, 3 and 1.1 respectively. All patients were unaware of NAFLD. Conclusion: 78% of the study population had NAFLD and were unaware of that. More researches on NAFLD awareness and occurrence in the region are required.

Prevalence of Metabolic Syndrome among Subjects attending General Health Checkup of a Tertiary Center of Kathmandu, Nepal

Introduction Metabolic syndrome is one of the major concerns of modern health causing morbidity and mortality. The metabolic syndrome is the constellation of metabolic disorders - insulin resistance; obesity, dyslipidemia and hypertension that are interrelated which lead to higher risk of cardiovascular disease, diabetes, stroke, atherosclerosis and serious health condition. The study focused on the prevalence of all the metabolic syndrome cases that came to general health checkup (GHC) of Tribhuvan University Teaching Hospital.&#x0D; MethodsThe study was a cross-sectional retrospective study of all cases that came to GHC from July 2019 to October 2019. GHC records files of all patients that came for their general health check-up were used to obtain data that included demographic details and the criteria for metabolic syndrome. Waist circumference, weight, height and blood investigations were sent as a routine examination of the general health checkup. Data analysis was done in Microsoft Excel 2019 and SPSS 20.&#x0D; ResultsAmong 311 cases enrolled in our study, 99 (31.8%) met the revised National Cholesterol Education Program, Adult Treatment Panel III (NCEP ATP III) criteria for metabolic syndrome. Among those with metabolic syndrome, males were 52 (52.53%) and females were 47 (47.47%). Also, 81 (81.81%) out of 99 cases had decreased HDL (&lt;1.03 mmol/L for males and &lt;1.30 mmol/L for females), which was the most common component of metabolic syndrome in the study.&#x0D; ConclusionMetabolic syndrome is present in almost one third of the studied apparently healthy patients coming for general health checkup and it emphasizes on awareness regarding screening for metabolic syndrome.