Evaluation of effectiveness of health checkups

在日本，作为二级预防的一部分，健康检查在预防方案中得到特别强调。然而，其有效性很少得到评价。本项目的目的是通过文献调查和流行病学研究，评估目前在日本工作场所和社区进行的健康检查的有效性。以往的随机对照试验研究表明，与对照组相比，更多地进行健康检查对患者没有实际益处。为了找出目前体检效果不佳的原因，改进体检工作，我们从目标疾病、筛查、诊断、治疗和干预四个层面提出了八项要求。根据建议的要求，我们评估了目前在工作场所进行的健康检查中的所有筛查项目。此外，我们对一些筛选测试项目进行了观察性研究。后者发现目前肝功能检查的敏感性较差，建议采用更好的方法。在糖尿病尿分析的情况下，样本采集通常在空腹时进行，检测糖尿病和肾炎后的干预仍然非常无效或未被普遍接受。此外，其他项目没有充分的证据支持强制纳入定期健康检查。这与加拿大和美国预防服务工作队的报告一致。总括而言，在目前的健康检查项目中，只有血压和身高体重的测量是可以接受的，因为有效的证据。此外，还应考虑健康检查和受检者隐私的不利影响。我们公布了我们的研究结果，并提出了改进现行制度的建议。我们还出版了一本医学统计学教科书，其中包括新开发的统计分析软件包，以进行循证医学。

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.