Evaluation of effectiveness of health checkups

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In Japan, health checkups, a part of the secondary prevention, has been particularly emphasized in the prevention programs. However, its effectiveness has been rarely evaluated. The aim of the present project is to evaluate the effectiveness of health checkups currently performed in the workplace and community in Japan by literature survey and epidemiological study. The preceding studies by randomized control trial demonstrated no practical benefit to those taking health checkups more often than the control. In order to find the cause of ineffectiveness of current checkups and to improve the health checkups we proposed eight requirements at four levels of health checkups and afterwards (target diseases, screening tests, diagnostic tests, treatments a innterventions). Based on the proposed requirements we evaluated all the screening items currently performed in the health checkups at the workplace. Also, we performed observational studies on some of the screening tests items. The latter found that the sensitivity of current liver function tests is poor and better methods are recomnended. In case of urinalysis for diabetes, the sample collection was generally performed at the least effective timing of fasting and the intervention after detecting diabetes and nephritis is still very ineffective or not universally accepted. Also, other items have poor evidence to support mandatory inclusion in the regular health checkups. These are in agreement with the reports by Canadian and US Preventive Services Task Forces. In conclusion, among the current health checkup items, only blood pressure and height and weight measurements are acceptable as effective with evidence. In addition, adverse effects of health checkups and privacy of the examinee should be considered. We published our results with proposals to improve the current system. We also published a textbook of medical statistics with newly developed package for statistical analysis to perform evidence based medicine.