The global environment in which we live has changed dramatically in the past 50 years. High-speed transport implies that an infectious disease that breaks out in one region may quickly spread to encompass the entire world. Cases of dermatitis caused by chemical fibers are on the rise as chemical fibers replace natural fibers in the clothing we wear. Unbeknown to us, residual pesticides and postharvest chemicals undermine our health.
The life span of people living in this new environment has also changed dramatically. Health targets designed for an aging society are how to raise quality of life and how to reduce the time spent bedridden before death. One example of medical technology for terminal care in an aging society is the medical examination.
One typical medical technology of Multiphasic Health Testing and Services is the establishment of standard values: A factor that affects standard diagnostic values is normal reference values of test reagents. One method of measurement has 100 test reagents, and the normal values for each are different. The sensitivity of dipsticks, for example, differs depending upon the manufacturer. This situation makes it difficult to follow health trends continuously. Reagents are now an integral part of pharmaceutical manufacturers' global strategy. It will not be easy to achieve standardization if manufactures think only of themselves.
An international conference such as this is the perfect place for us to speak out as one in favor of standardization.
I would also like to touch upon how reagents currently stand internationally.

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To study sex differences in preprandial data and their postprandial fluctuations, 65 men and 59 women consumed a meal consisting of 30.9 g of fat, 21.3 g of proteins, and 95.9 g of carbohydrates with total calories of 764.9 KC. Blood specimens were collected before and 2, 3, and 4 hours after the meal.
For the statistical analysis, Dunnett's multiple comparison was used.
Men exhibited higher values for TG, AST, ALT, γGTP, BUN, CRE, and UA, while HDL-C was higher in women. No sex-related difference was noted in the T-Cho, PL, and TBA levels.
Compared with the preprandial values, TG increased with significant differences in both men and women, 2, 3, and 4 hours after the meal. The maximum value was recorded 3 hours after the meal, with an increase of 46.9% for men and 43.0% for women.
Sensitivity and specificity were 92.0% and 92.9%, respectively, when the value 2, 3, and 4 hours after the meal was over 200 mg/dl and the preprandial value was estimated to be over 150 mg/dl.
Compared with the preprandial values, TBA increased in both men and women 2, 3, and 4 hours after the meal. Significant differences were noted for men 2 and 3 hours after the meal. The maximum value was obtained 3 hours after the meal for both genders (increases of 40.6% for men and 39.3% for women) .
The fluctuation curves for TG and TBA of some individuals suggested an effect from meals taken on the previous day. It was con-cluded that the subjects should avoid attending sumptuous affairs-such as parties-on the previous day and blood specimens should be collected before a meal.
Only slight fluctuations were found in the postprandial values for T-Cho, HDL-C, PL, AST, ALT, γGTP, BUN, CRE, and UA. The maximum change from the preprandial value was less than 8.0%.

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This study measured the QOL in 140 healthy elderly who consulted the Japanese Red Cross Kumamoto Health Care Center for a medical check-up in March 1994 using QUIK. QUIK is the generic screening test for the QOL, which covered four domains including physical functioning (20 questions), emotional adjustment (10 questions), social relationships (10 questions), and attitudes toward life (10 questions), totaling 50 questions.
The mean and standard deviation of the total score was 5.1 ± 5.4, and those of each domain were 2.7 ± 2.7 for physical functioning, 1.0 ± 1.5 for emotional adjustment, 0.7 ± 1.1 for social relationships, and 0.6 ± 1.2 for attitudes toward life, respectively.
According to the six-tiered rating scale, the QUIK total scores were as follows; excellent 15%, good 35%, fair 36%, poor 11%, very poor 2% and grossly impaired 0%. The results of the mean and standard deviation and the distribution by a six-tiered rating scale of the total score were significantly better than those in patient controls.
The internal consistency in terms of the QUIK total score was α =0.86 (0.71 for physical functioning, 0.61 for emotional adjustment, 0.61 for social relationships and 0.61 for attitudes toward life) . If the cut-off points of total score were set between 9 and 10, the sensitivity was 0.65, the specificity was 0.65 for age, the sensitivity was 1.00, the specificity was 0.29 for satisfaction, and sensitivity was 0.85, the specificity was 0.48 for a refreshed feeling. And there was a very tight reciprocal correlation among the four domains, except for the relation between physical functioning and social relationships.
From this study, it should be concluded that QUIK is reliable, valid and useful for health evaluation as a generic screening test for the QOL in the elderly despite some clinical limitations in its use.

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BackgroundThe correct incidence of brain tumors remains unknown in Japanese population, based on large number of individuals with brain check-up.
PurposeTo examine thh incidence of brain tumors in the retrospective study of brain check-up in PL Tokyo Health Care Center, Japan. We also evaluated whether multiphasic health tests, including physical and brain check-up, have benefits for the early diagnosis of brain tumors.
MethodWe analyzed 2, 312 participants who received brain and physical health check-up simultaneously between April 1, 2001 and January 31, 2002. Male was 1, 592 subjects and female was 720 subjects. Mean age was 53.5 (SD 11.0) years in all, 53.7 (SD 11.0) years in men, and 53.1 (SD 11.1) years in women. Among them, the first brain check-up was performed in total of 1, 343 (58.1%) subjects, 868 (54.4%) in men, and 475 (66.0%) in women. Brain check-up was produced by 1.5-tesla superconducting system (Stratis II, Hitachi Medical Co., Japan) . Conventional magnetic resonance imaging (MRI) and magnetic resonance angiography were studied in all sub-jects.
ResultsBrain tumors were seen in total of 16 subjects (10 men and 6 women) . The overall incidence was 0.69%, 0.63% in men and 0.83% in women. The mean age of subjects with tumors was 55.1 (SD 10.5) years in all, 55.1 (SD 13.0) years in men, and 55.0 (SD 5.5) years in women. The first study of brain check-up revealed brain tumors in 14 of 16 subjects (9 men and 5 women) . The overall inci-dence of tumors on the first brain check-up was 1.04%, 1.04% in men and 1.05% in women. The mean age was 54.7 (SD 10.9) years in total, 54.0 (SD 13.2) years in men, and 56.0 (SD 5.5) years in women. The results of self-questionnaire indicated that 14 of 16 subjects had no significant symptoms. The retrospective study supported that physical check-up showed no malignant tumors in other organs in all subjects with brain tumors. Primary brain tumors were diagnosed in all cases. Neuropathological diagnoses were confirmed in 10 subjects. The histological results indicated meningioma (1 man), pituitary adenoma (1 man and 2 women), glioma (1 man and 1 woman), neurinoma (1 man and 1 woman) and malignant lymphoma (1 man) . In two follow up subjects, meningioma was diagnosed by typical patterns of MRI. Benign lipoma (4 men) was diagnosed with fat-suppression MRI.
ConclusionOur studies indicate that the incidence of primary brain tumors is 690 per 100, 000 population on all check-up and 1, 040 per 100, 000 population on the first check-up. The brain check-up-based evidence elucidates that the incidence of brain tumors is approximately 50 to 100 fold higher, in comparison with previous reports of Japanese prevalence. Multiphasic health tests are valuable for a differential diagnosis between primary and metastatic tumors. Brain check-up frequently discovers asymptomatic tumors. Thus, we should pay more attention to asymptomatic brain tumors in subjects with brain check-up.

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We report a 75-year-old man with primary central nervous system (CNS) lymphoma which was detected on the first physical and brain check-up. He developed headache, depression and the loss of body weight for recent two months, and received multiphasic health check-up in our institute. On brain check-up (Stratis II, Hitachi Medical Co., Japan), T2-weiiiihed imaginnnng revealed multiple hyperintense signal areas in the periventricular white matter and basal ganglia. The differential diagnosis between brain tumors and multiple lacunar infarctions was needed because he had hypertension and severe degree of diabetes mellitus. Fluid-attenuated inversion recovery imaging disclosed markedly multiple hyperintense mass lesions. Gadolinium-enhanced T1-weighted imaging showed strong and homogenous enhancement. Brain tumor was confirmed by these features of MRI. Physical check-up showed no advanced malignant tumors in other organs. At first, brain metastatic tumor of unknown origin was suspected on physical and brain check-up. The definite diagnosis of primary CNS lymphoma was made by stereotactic brain biopsy in a University hospital. He was recovered after administration of steroid and radiotherapy. Primary CNS lymphoma was detected in one of 2, 312 adult subjects who received brain check-up between April 1, 2001 and January 31, 2002 in our institute. This unique case points out that multiphasic health tests, including simultaneous brain check-up, contribute to the early discover of fetal brain tumors. The combined data of physical and brain check-up could have benefits for the selection of further laboratory studies and therapeutic strategy in patients with brain tumors.

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Background 30+ % of whole population are screened for but death rate yet keeps increasing of colorectal cancer (CRC) in Japan. Low specificity of fecal occult blood test (FOBT) is considered to be the reason. Detection rate of a CRC screening plan markedly improved following the switching of FOBT data interpretation.
Objective To prove a hypothesis that protrusion of colon mucosa is a major causative factor of colonic bleeding.
Setting Membership-based multiphasic health testing plan participants. Test protocol includes quantitative EIA FOBT, rectosig-moidoscopy and optional barium enema.
Participants 8, 966 health test plan participants who had 23, 188 health tests including 69, 558 FOBT during 2 years. 152 cases of CRC and /or colon adenoma detected were studied.
Methods FOBT data were compared concerning density, resemblance of 3 figures, chronological change between CRC and non-CRC cases, as well as before and after removal of protrusion.
Results FOBT densities, both of colon cancer and adenoma cases, were unexceptionally high and resembled in each case that markedly decreased to near zero after removal of protrusion. FOBT data of rectal cancer and adenoma cases were not necessarily high and dispersed widely.
Conclusion Unexceptionally noted marked decrease of FOBT after removal of masses in colon adenoma cases in exactly same manner as in colon cancer cases suggested that origins of bleeding was collisions between masses and colon contents rather than fragility of tissues.
When interpreted properly paying attention to the continuity of being positive and resemblance of FOBT, 30ng/ml should be optimal cut-off value for cancer detection.

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Simultaneous multisitic cancer screening is a key task in multipha-sic health testing and services in Japan. Among the cancers of various sites detected by current standard test methods, colorectal cancer detected by the 2-day immunological fecal occult blood test has one of the highest detection rates among cancers of all sites and is one of the easiest cancers from whichhhcer detected by the 2-day immunological fecal occult blood test has one of the highest detection rates among cancers of all sites and is one of the easiest cancers from which to save the patient as judged by 5-year cumulative survival rates after detection. Thus, given such low-cost, low-risk, and precise immunological test methods, we conclude that colorectal cancer is one of the cancers that is most suited to secondary prevention. Qualitative assays have been the main type of fecal occult blood test, but in recent years quantitative assays have also come to be used. It is possible to predict the degree of progression of the detected cancer from the positive pattern in the 2-day qualitative test, and from the hemoglobin concentration in addition to the positive pattern in the quantitative test. These methods are promising as a means to move away from the vagueness of group tests toward predictions for individual cancer cases in cancer screening.

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The aim of this study was to clarify the validity and efficacy of cancer screening in the Multiphasic Health Testing and Services (MHTS) . A total of 19, 922 people visited our Health Evaluation Center for MHTS between 1995 and 1996. There were 14, 422 males who all received chest X-rays, barium meal, abdominal ultrasonography, and single-day immunological fecal occult blood test, and 5, 500 females who additionally received palpation of mamma, and uterine cervical cytology. By collating the Osaka cancer registry with the examinee's list, the cancer cases with unknown results of further examination, the false negative cancers, the progressive stage, the treatment and so forth were clarified. Esophageal cancer, gastric cancer, hepatic cancer, biliary tract cancer, pancreatic cancer, renal cancer, colon cancer, breast cancer, and uterine cervical cancer were defined as cancers detected by the MHTS. A detected cancer was defined as a cancer registered within one year after a positive result of the screening. A false negative cancer was defined as a cancer registered within one year after a negative result of the screening. As a result, the prevalence of the cancer was 0.225%. The sensitivity was 73.3% and the specificity was 81.3%. With regard to the progressive stage of the detected cancer, localized cancer (no metastasis) or carcinoma in situ accounted for 78.8%. The existence of cancer with neighboring organ invasion or distant metastasis was not described. With regard to the treatment of the detected cancer, a curative resection was done in 84.8%. It is expected that the stage of the detected cancer in the MHTS is comparatively early and the possibility of the curative resection is high.

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Purpose To assess whether multiphasic health testing and services (MHTS) using low-dose spiral CT can contribute to detecting small and early lung cancer, and subsequently decrease mortality. This report deals with clinical application of low-dose spiral CT to MHTS, as well as related issues.
Methods and Materials Starting April 1998, 8, 978 individuals (7, 243 men, 1735 women; range 50-69 years; average age, 57 years) underwent first baseline low-dose spiral CT. Low-dose spiral CT parameters were 120 kV, 50 mA, 10-mm collimation, and 2: 1 pitch. Each CT was read independently by two radiologisits and a physician. When the two readers could not reach consensus, the final decesion was made at a weekly conference. High resolution CT examination was performed our institute for cases with suspicion of lung cancer.
Results For 3 years from April 1998 through March 2001, the total number of the examinations amounted to 17, 785 (males 14, 050, females 3, 735) . Fifty three lung cancers were detected at the occasion of CT screening. Detection rate of lung cancer accounted for 0.457% in the baseline screening while the counterpart was 0.136% in the annual repeat screening.
Conclusion We have routinely performed low-dose spiral CT for all the participants at ages of more than 50 years upon the MHTS. Low-dose spiral CT is a potentially useful screening method in the detection of early lung cancer.

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A mental consulting system to prevent lifestyle-related diseases was developed as an application of health risk appraisal (HRA) . The self-administered questionnaire, known as the revised Mental General Questionnaire, Version 2 (MGQ2) was developed based on the results of statistical studies of the association between the incidences of lifestyle-related diseases and the results of a previously developed personality questionnaire. The MGQ2 was constructed using six personality scales related to cancer, diabetes mellitus, hypertension, cerebral apoplexy, heart diseases, and tooth lap diseases. The personality scales, of the above six diseases, consist of thirteen sub-scales. From the MGQ2 answers, scores and profiles of thirteen personality sub-scales were calculated and the appropriate mental advice was selected automatically for the test taker. High scores in the personality sub-scale questions indicate high-risk men-tal habits which can result in lifestyle-related diseases. The mental advice provided enables the test taker to take care of mental conditions in addition to the advice generally used to support physical conditions such as exercise and nutrition under development.

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Clinical breast examination (CBE), ultrasonography (US) and mammography (MMG) have been used as a standard breast cancer screening methods in the practice of Automatic Multiphasic Health Testing and Service (AMHTS) . Of 12, 950 subjects screened, 855 cases (6.6%) were recalled for a close examination and the examination were performed in 681 cases (80.0%) . As a results, 58 cases (0.45%) were diagnosed as having breast cancer, and 38 of them were in the early stage of the cancer (66.7%) . In the 58 cases detected, the detection rates with CBE, US and MMG were 29.3%, 86.3% and 75.9%, respectively. In the 38 subjects of early cancer, the detection rate for CBE, US and MMG were 17.9%, 84.6% and 71.8%, respectively. The sensitivity was the highest in US. The detection rate with CBE was remarkably lower than US. All subjects detected with CBE were detectable with US.

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The present study assessed the peripheral circulatory function of women by measuring accelerated plethysmogram (APG) and then investigated its relationship to target maximum oxygen intake levels (established by the ministry of Health and Welfare of Japan) . Based on the medical records of 511 women in whom APG was measured during a physical examination at some time between 1993 and 2001, height, body weight, body mass index (BMI), percent body fat (% body fat), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were extracted. Maximum oxygen intake (VO₂max) was estimated by the indirect method. Peripheral circulatory function was measured at the tip of the right index finger using a precaregraph (Misawa Homes Inc., APG-200) or a blood circulation checker (Future Wave Inc., BC-001) . The results showed a significant positive correlation between APG index and the following parameters: height, % body fat and VO₂max; and a significant negative correlation with the following parameters: age, weight, BMI, SBP and DBP. Although subsequent partial correlation analysis corrected for the effects of age, SBP and DBP, a significant positive correlation between APG index, which is used to assess peripheral hemodynamics, and VO₂max was evident.

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PurposeThe endoscopic examination has been increasingly performed in the initial stage of the screening in medical checkups in Japan, but there were few studies with regard to same-day screening for gastric and colon cancers using endoscopy. The aim of the present study was to assess the usefulness and shortcomings of same-day examinations by endoscopy of the stomach and colon.
Materials and MethodsThe examination for gastric cancer was performed using a panendoscope in about 10 examinees in the morning. A new small caliber electronic panendoscope with outer diameter of 6 mm was used as a transnasal gastric endoscope because of the increased safety and decreased invasiveness. Immedi-ately after gastric endoscopy, sigmoidoscopy carried out using a small-caliber videocolonoscope for detection of colon cancer. An immunological fecal occult blood test (FOBT) was also performed by a 2-day method for colon cancer screening. The subjects consisted of 3, 218 examinees, 1, 461 men and 1, 757 women with a mean age of 46.8 years old. The questionnaire for evaluation of the same-day endoscopy was collected from consecutive 1, 459 examinees.
ResultsGastric endoscopy found early gastric cancer in 4 cases (0.12%) and esophageal cancer in 1. Colon cancer screening revealed colon cancer in 7 cases (0.22%) ; of these, intramucosal carcinoma was found in 6 cases and invasive cancer in 1. In addition, adenomatous polyp was detected in 209 cases (6.5%) ; of those 209 cases, FOBT was positive in only 10.5%. The results of the questionnaire indicated that the examination was generally acceptable as a mass screening.
ConclusionThe same-day gastric and colon endoscopy system has an acceptable degree of accuracy and can be recommended as effective for routine screening of digestive tract cancer in relatively limited subjects coming to multiphasic health testing and services.

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For finding the optimum combination of multiple tests in the multiphasic health-checkup system, it was considered how the healthcheckup accuracy changes with the number of tests (n) and five kinds of combination methods: A) Sequential tests, B) Sequential tests after changing the order in A, C) Simultaneous tests using the Believe-the-Negative Rule, D) Simultaneous tests using the Believe-the-Positive Rule, and E) Simultaneous tests using the Believe-all-Positive-all-Negative Rule. The health-checkup accuracy is defined by sensitivity (α) and specificity (β) . An over-all two-by-two table for multiple tests was inducted from the two-by-two tables for each test. An over-all health-checkup accuracy was calculated from the over-all two-by-two table, and was expressed by a generalized formula. As it was proved that combination methods A, B and C are“equivalent”for the accuracy, the five methods could be summarized into three kinds of methods. As results, for A, B and C: R increased but a decreased with increasing n. For D: a increased but R decreased with n. For E: Both a and R increased with n, although problem exists concerning how to judge the remaining subjects who are between positive in all tests and negative in all tests. In order solve this problem, “the case grading and categorization method”are proposed. Six kinds of unified index of diagnostic accuracy are comparatively discussed.

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We conducted a survey of 11, 734 health-checkups participants (7, 774 male and 3, 960 female) regarding actual condition of‘stiff neck’ that was one of the major complaints reported in The Basic Research of National Living in the 1998 fiscal year, by The Japanese Ministry of Health and Welfare. The number of people who suffered from stiff neck was as follows: 2, 218 male (28.5% of all male participants) ; 1, 979 female (50.0% of all female participants) . Prevalence of stiff neck was significantly higher in female than that in males, as the same as in the other previous reports (p<0.05, chi-square) . Stiff neck also significantly related with lumbago. Furthermore, those who suffered from stiff neck had the tendency of the following life styles: inactive in daily life, less exercise, feel more stress, not drink, and not smoke. We would like to make use of the results of this research for the consultation to improve life styles.

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This research aims to provide the protocol to achieve efficient information exchange by means of electronic data communication between health-checkup facilities. Joint Working Group of JMHTS (The Japan Society of Multiphasic Health Testing and Service) and JAHIS (The Japanese Association of HHHealthcaae Information Systems Industry) developed a health/medical data interchange model that stood on the markup information structure. Our data encoding language, HDML (Health-checkups Data Markup Language), was based on SGML that has context-free grammar. HDML had the standard DTD which defined anamnesis, physical examination, laboratory examination, summary findings, and judgment of total health status, etc. The laboratory examination contains following items: item's name, method, unit, device, company name, product name, principle, and standard reference value. We take into account the interchangeability of data with HL7 and other international standard protocols. As a preliminary study, we carried out an experimental trial in October 1999, which transferred laboratory data by translating into HDML, from 2 health-checkup facilities to other 2 health-checkup facilities. We have succeeded in transferring almost all laboratory data appropriately by using the HDML protocol between the health-checkup facilities. Moreover, we could convert and standardize the laboratory data properly from the information written in the DTD. We propose the HDML protocol to standardize health/medical data that will make it available for multihealth facilities on the basis of the standardization of data exchange regarding health-checkups. We found this HDML protocol worked effectively in using the actual health/medical data.

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