CKD is a syndrome of renal dysfunction, which defined with abnormality of renal function and decrease in eGFR calculated by serum creatinine, gender, and age. In Japan, there are more than 13,300,000 CKD patients and ESRD patients increased up to 300,00. Therefore we are prompt to act for CKD prevention. Clinical Practice Guidebook for Diagnosis and Treatment of CKD 2012 is published this June in Japan from Japanese Society of Nephrology and is expected for the treatment of CKD. The major points of changes between this new guidebook and former guidebook are Classification of the CKD stage, formula of eGFR, Treatment strategy for hypertension with CKD. This Guidebook is hoped to change the better CKD prognosis.

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 While the relationship between food, health and disease are discussed in a wide variety of ways throughout the world, only nutrition can survive as a field of life sciences. Because food components were analyzed from the source of life to discover that the nutrients, is related to the generation of nutrients. The nutrition has contributed to the prevention and treatment of many diseases caused by malnutrition and unbalanced diet. In our country, malnutrition in the world war II was solved in a short period of time by the appropriate distribution of food through the school lunch and nutritional guidance. However, since about 1980 obesity and lifestyle-related diseases by over nutrition, on the other hand underweight and new malnutrition in young women by the diet and patients and elderly victims have become the problems. This trend is seen in the world, Double Burden Malnutrition is called. While being affected by a large amount of information, the westernization of diet and eating habits traditional has been handed down on a regular basis in the regional home, nutrition problem are more complex and individualized. In order to solve such a problem, intervention study largescale use for the purpose of improvement of diet and nutrition, and how the nutritional management based of human nutrition has been held, its limit and effectiveness have been discussed. In recent years, it has also started study the effects of time and speed of eating, the physical properties of the food, such as eating more order types of food, combination, cooking method, to eat on the biological while being quantity of same nutrition. It is necessary to consider not only “what eat and how much” but also “how to eat”.

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 Screening for lung cancer with chest X'ray is not currently recommended to asymptomatic persons except in Japan. There are several retrospective case-control studies showed decrease of mortality rate with lung cancer in the screened cohort. The recently reported NLST showed a 20% decrease in deaths from lung cancer in smokers with LDCT screening. The important issues to resolve will be identification of appropriate cohort for LDCT screening, development of guidelines for better performance of nation-wide screening using LDCT, well-designed management of screened nodules and integration of smoking cessation practices into future screening programmes.

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 Since Japan Society for Lipid Nutrition (JSLN) published their cholesterol guideline in 2010, controversy and confusion occurred between patients and general physicians.
 In this guideline, JSLN criticized several clinical studies which were reffered in guideline of Japan Atherosclerosis Society and JSLN denied the conclusion of guideline of Japan Atherosclerosis Society. Although JSLN claimed that they made their guideline emphasizing all-cause mortality, their guideline did not refer any prospective randomized intervention trial. They made their conclusion without exclusion of confounders. Furthermore, their process was informal consensus development which is called black-box method.
 In general, human can understand the fact, but not the truth. When investigators accumulate the mountains of the facts, they can look into one aspect of the truth.
 JSLN must not consider they have got the truth. They just built their hypothesis. They must prove their hypothesis performing randomized interventional trial and basic research. Until these data would be published, general physicians do not have to read or obey JSLN guideline.

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 Late-onset hypogonadism (LOH) as “a clinical and biochemical syndrome associated with advancing age and characterized by typical symptoms and a deficiency in serum testosterone levels. It may result in significant detriment in the quality of life and adversely affect the function of multiple organ systems” was defined. Therefore, the basis of diagnosis of LOH is the measurement of androgen levels. In Japan, as specified in the “Clinical Practice Manual for LOH Syndrome” it has been decided to recommend the measurement of free testosterone (free T) levels as a diagnostic test for LOH. The standard value for diagnosis of LOH is set at a mean–2SD value of 8.5 pg/mL, by calculating the mean value in young adults in their 20s (young adult mean: YAM). The symptom most closely associated with hypogonadism is said to be low libido. Other symptoms associated with hypogonadism include erectile dysfunction, decreased muscle mass and strength, increased body fat, decreased bone mineral density and osteoporosis, decreased vitality, and impaired mood. In Japan, the use of the YAM of free T in the standard diagnostic criteria for LOH has been proposed. However, it should be verified that free T is clinically applicable as a criterion for determining the LOH cases to be indicated for ART. In addition, it is required to clarify whether normalization of androgen levels by ART can lead to improvement of symptoms.

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 Since the 2008 introduction of the specific health examination and health guidance system for metabolic syndrome, the issues facing specific health examination have been: converting data to XML; the low participation rate of dependents; the system not being widely known; and the validity of abdominal circumference. Similarly, the issues facing specific health guidance have been: the lack of manpower and skill; the low continuation rate of active support; difficult cases such as the seriously ill and mentally impaired; the lack of a population approach. In summary, the health guidance has a certain effect, but is not often implemented.
 Health guidance staff have also reported encountering various metabolic syndromes. Amongst the subjects of health guidance, the existence of cases with various backgrounds such as a combination of serious illness, mental impairment or cancer, and visual, auditory and intellectual disabilities have come to light. In addition, to maintain the quality of health guidance, a lot of effort and costs are required for staff development and devising teaching mediums. However, the effect of this system is becoming apparent due to a focus on preventive medicine, the improvement of health guidance skills, and the accumulation of data on lifestyle-related diseases.
 This system started with measures for lifestyle-related diseases as the first step in the road. If specific health guidance for those over 40 is the first step, then from the perspective of optimized medical costs of future health insurance societies, the second step (measures for those requiring treatment who have not yet had examinations) and the third step (healthcare guidance and generic introductions for during treatment) are important. From the perspective of CSR, businesses aim to achieve a healthy company and an improvement in the health literacy of employees, and it is becoming important to carry out comprehensive workplace health promotions for those under 40 years of age who have not reached the first step. For Japan, a nation approaching a super-aging society at the fastest rate in the world, it is necessary to find out how this kind of collaborative effort connects the second step of post-retirement (over 60 years of age) to the third step of old age (over 75 years of age), and how healthy aging is achieved. When considering the first step in the road while looking at measures for lifestyle related diseases, it appears that the way health insurance associations, companies and health guidance organizations should cooperate and divide their responsibilities has come in sight.

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 Recent increase in the number of epidemiological reports from Japan means the progress in the epidemiological research among Japanese. Now, both large number of participants and quality of data are expected in conducting a new epidemiological study. It is becoming more valuable selection for Japanese researchers to develop a collaborative framework with corporations for health check-ups.
 In the fields of health evaluation and promotion, various kinds of data, such as cancer screening, lung function as well as traditional cardiovascular risk factors have been accumulated. We propose 3 major frames to make epidemiological evidence utilizing these backgrounds.
 The first is to report basic characteristics of participants in periodical health check-ups through collecting data from all over Japan by utilizing quality control programs of the society. The second is to make a new project consisting with newly designed questionnaires and measuring new items in addition to health check-ups under quality control. The third is to design a prospective study to find risk factor for lifestyle related diseases only detectable by periodical health check-ups (hypertension, diabetes, gouts and so on). When we treat a data-set of health check-up of a year as a baseline survey, subsequent yearly health check-ups would be used as follow up study to detect incidence of hypertension.
 We have been conducting annual health check-up in all over Japan, and provide chances to improve lifestyles of participants. Unfortunately, we have not been fully utilizing these frames to establish epidemiological evidences. It is important for corporations for health check-ups to make a new evidence for health promotion under the quality control programs of the society.

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 Orion Health Rhapsody provides a key link in public health reporting in the United States. Used in almost all States, and all tiers of public health reporting. Rhapsody offers a flexible solution that accelerate reporting and provides departments of health with fast, efficient access to public health information. Hospitals, commercial laboratories, public health departments and federal (national) systems such as those provided by the US Centers for Disease Control & Prevention (CDC) all rely on Rhapsody for their public health data.
 Orion Health Rhapsody is used by CDC as part of their National Electronic Disease Surveillance System (NEDSS) to facilitate direct electronic data exchange. Rhapsody adheres to Public Health information Network (PHIN) functions and specifications, is Meaningful Use certified and has become the de-facto standard for many CDC projects.

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 The Japan Society of Health Evaluation and Promotion (JHEP) is convinced that showing the data objectively collected from a survey could be used as evidence in quality management. The JHEP designates basic policy with regard to quality management, which is that the quality assurance in an individual facility is thought to be well controlled if the data from a survey comes within a certain range for current standards. The JHEP awards an “A” rank when the results measured in individual facility are within mean±2SD in a sample survey. The JHEP also gives A rank when the diagnostic assessments from several questions both in an electrocardiogram and in a chest X-ray are judged to be appropriate by more than one expert. At present more than 99.5% of facilities out of approximately four hundred are classified as “A” class. This amounts to proof of excellence in quality assurance at a facility. These surveys are carried out four times a year and the results are of major importance for highly-ranked facilities. These results were thought to be entirely due to routine efforts of both the manufacturers and staff of individual facilities. The quality assurance survey is considered to be of great importance in its support of root-level health evaluation and promotion. In order to continue to improve social reliance, the committee will continue to send this evidencebased message to an each of the survey participants.

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 Multiphasic health checkups aim to contribute to health promotion (primary prevention) and disease prevention (secondary prevention). All providers of multiphasic health checkups should make efforts to offer evidence-based user-oriented services and accomplish lifelong healthcare. This article lists unsolved problems in multiphasic health checkups and describes some ideas on how to approach these problems. The cooperation between scientific societies and service providers is essential for sustainable improvement in health promotion services and establishment of a lifelong healthcare system.

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 Japan is one of the countries where health check is fully arranged. One purpose of health check is to change health behavior into healthier one and to improve health condition. Public nurses or medical doctors often help this change by proper guidance.
 But we have not so much evidence that change of health behavior cause to improve health condition in quality or in quantity.
 Now Japanese Government is practicing a five-year project from 2008 to 2012. This project aims for decrease in the risk of occurrence of cardiovascular disease or diabetes for metabolic syndrome patients or the candidates. I hope that much evidence will be made by this national project.
 The purpose of medical examination for cancer detection is to cause decrease in mortality rate by cancer, improve of quality of life and decrease in medical cost. It is a pity that we have not so much reliable evidence which secure the effect of the examination. All prefectures have cancer registry in Japan. It is necessary that we utilize this registry to make reliable evidence.
 The Japanese Society of Health Evaluation and Promotion must fulfill the role to make evidence for effects of change of health behavior and for effects of medical examination for cancer detection. I propose the society have a committee to play the role and many organizations for health check in whole countries cooperate with the committee to make evidence.

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 Any employer must be compliant with not only regional legislations and customs but also international conventions as well. Marubeni, one of the leading companies in Japan, has kept these rules while successfully expanding its business all over the world. Under the WHO Framework Convention of Tobacco Control, smoking in the public area has been prohibited worldwide for the purpose of passive smoking prevention. In Japan, actions for passive smoking prevention have been recommended to be introduced in public areas under the Health Promotion Act 2003. Marubeni started its tobacco control in the workplace in 1994. Smoking in the office areas has been prohibited since then. Nevertheless, smoking was permitted in the enclosed meeting rooms. After the implementation of Health Promotion Act 2003, additional actions for passive smoking prevention and tobacco control have been taken in Marubeni. Actions include a completely smoke free office, removal of tobacco automatic vending machines, and the installation of several separated smoking rooms equipped with forced air exhaust systems. The aim of actions was to ensure the coexistence of smokers and non-smokers' rights at the workplace. These actions were well accepted by most of employees. However, there still remain problems concerning passive smoking prevention and health consequences of smokers. Further actions should be followed to seek a more comfortable workplace.

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 Lifestyle diseases (diseases of longevity or diseases of civilization) are diseases that appear to increase in frequency as countries become more industrialized and people live longer. Tobacco smoking as well as a lack of exercise may increase the risk of developing certain diseases, especially later in life. When considering lifestyle diseases in respiratory diseases, they can include chronic obstructive pulmonary disease (COPD) or lung cancer as one of the comorbidities regarding COPD. Cigarette smoking is the leading cause of COPD. Most people who have COPD smoke or used to smoke. Long-term exposure to other lung irritants, such as air pollution, chemical fumes or dust, also may contribute to COPD. COPD is a major cause of disability, and it's the nineth leading cause of death in Japan. More than 5 million people may have the disease and 90% of them do not even know it. COPD develops slowly. Symptoms often worsen over time and can limit the ability to do routine activities. Severe COPD may prevent people from doing even basic activities like walking, cooking, or taking care of themselves. Most of the time, COPD is diagnosed in middle-aged or older people. COPD has no cure yet, and doctors don't know how to reverse the damage to the airways and lungs. However, treatments and lifestyle changes can help COPD patients feel better, stay more active, and slow the progress of the disease. Certain diseases, such as asthma appear at greater rates in young populations living in the western way. Their increased incidence is not related to age, so the terms of lifestyle diseases cannot accurately be used interchangeably for asthma. However, smoking certainly makes worsen the pathophysiology of asthma. A part of pathogenesis is linked to smoking in interstitial lung diseases. Respiratory diseases should be evaluated as lifestyle-related diseases.

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 We must take the tobacco measures based on the WHO Framework Convention on Tobacco Control (WHO FCTC). However, there is the law called as “Tobacco Business Act” in Japan, and then the country still recommends people smoking. So, the essential problem about smoking are not well-known even for the medics includes doctors. We, the members of the Japan Society of Health Evaluation and Promotion, are not exceptions, either. Of course, the information that don't obtain even for us are never been understood in the smokers. Therefore, we have to collect right knowledge first, and do the education based on these then.
 And regrettably, almost all smokers fall into the nicotine dependence already, and their acknowledgments have been distorted because of social background of Japan. Therefore, the smokers seem not to want to quit smoking. On the other hand, the psychotherapies are effective. Especially, some studies show that the cognitive behavioral therapy (CBT) or motivational interviewing (MI) is more helpful.
 Moreover, it seems the social psychology methods are effective as for the population approach. Then, I propose the use of the marketing process which is called R-STP-4Ps. R-STP means the steps where the object persons are selected, but all the human beings, which ever they smoke or not, will be objects when it follows FCTC. 4Ps show the process tried to spread, and are initials of Product, Price, Place, and Promotion.
 It is rare that people change their life-styles only by knowledge. But minds are changed when they made surprised by the new knowledge, and change of the minds change their actions. The effectiveness of these approaches is not limited to quit smoking, but also may to most lifestyle improvements.

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 The HOYA Group carries out its managerial policy that discrepancy in medical services or care should not present among the workers including Japanese employees stationed abroad (ESA) over the local employees. However, it is true that Japan has its own history and scheme of healthcare for its people and occupational healthcare services, such as periodical general health examination for its workers. Medical care in Japan is famed as the best in the world, and therefore it would be preposterous if the healthcare and medical service for the ESA were to be reduced. In under developing area including some Asian regions, the hygienic condition and the level of medical care are far behind to those in Japan. And it goes without saying that a certain level of healthcare support is necessary to the Japanese people living and working in such areas today. In this sense, the author believes that this symposium presents an excellent opportunity to discuss on health management service practice in the global community with a focus on the healthcare for the Japanese nationals engaged in overseas duties.
 In providing healthcare for people stationed abroad, it is desirable that any major health problems can be avoided during the period of their assignment, and a consistent and continuous healthcare is offered them from before the departure to the location of assignment till after the return to their home country from the viewpoint of life-long healthcare. To achieve such healthcare, it is meaningful to provide overseas medical examination and take adequate follow-up healthcare measures. Also, in providing emergency medical care or ambulance service, efficient medical support systems should be structured through the cooperation among medical support agents, affiliated companies in overseas locations, head office staffs in charge of personnel affairs, and occupational physicians.
 In this paper, the author attempts to outline the overseas medical examination and other healthcare activities for the Japanese workers engaged in overseas duties from the viewpoint of an occupational physician. Beside that, as a health service recipient, the author would like to encourage the members of this society who may represent health management or occupational health establishments, in order to provide higher value added services to exercising overseas medical examination and followup healthcare measures for support of globally active Japanese enterprises.

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 Thanks to the convenience of the internet and expanded global travel options, medical tourism – the practice of travelling to another country to receive medical care – has become so popular that some fifty countries now receive patients from outside their borders. Where the flow of patients had once been overwhelmingly from developing countries to the industrialized world, a significant stream of patients now travel in the opposite direction. In an expanding market, Asia is fast becoming a hub for medical tourism. As most Asian hospitals serving this market operate on a for-profit basis, and thus have a powerful incentive to pursue medical tourism as a new source of revenue, they can be regarded as instrumental to the growth of medical tourism in Asia. Japan has been in step with the trend: international medical exchange (the acceptance of foreign patients) was incorporated in the “New Growth Strategy” announced by the Cabinet in 2010. Medical tourism can be challenging for participating medical institutions in that it involves dealing with different cultures and different languages. While working to resolve these issues, Japan will need to proactively market Japanese medical treatment through appropriate publicity while promoting two-way medical exchange through enhanced interaction with foreign counterparts.

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 Globalization has led to the need for implementation of new infection control measures among corporate employees.
 First among them are measures dealing with the recent rapid increase in employees working overseas. This employee group has a high risk of bringing food- and mosquito-borne infectious diseases with them upon their return, necessitating the implementation of measures including predeparture vaccinations and education regarding disease prophylaxis, as well as early diagnosis and treatment of infectious diseases once the employees have returned home.
 Second among them are measures involving foreign employees who are employed domestically in Japan. There have been many recent reports of cases where an onset of infection has occurred after their arrival in Japan. Along with screening for infection during health checks performed at the time of hiring, it is crucial that symptoms that emerge once employment has commenced are rapidly examined and disease diagnoses be made.
 Finally, measures that must be taken against avian influenza because there is a fear of a global epidemic. The likelihood of the underlying H5N1 virus infection spreading as a highly pathogenic pandemic influenza is high. Therefore, companies must create workplace measures to deal with such an epidemic. Analysis of experiences during the novel influenza epidemic of 2009 should be useful for this purpose.

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 Linguistic gaps can occur to religious, cultural and other words with wide meanings when the speakers and listeners infer different meanings if only a little. For medical and pharmaceutical words including stomach, intestines, heart, cardia and pylorus, however, both sides hardly have different images.
 Unlike general terms, technical terms are specialized and limited so that anyone can identify the meanings without misunderstanding. If they are taken wrongly, it means the speakers or listeners are not professionally educated. There could be some risk of misunderstanding or misinterpretation among nonprofessional interpreters, volunteers and patient families.
 In fact, looking at medical malpractice cases caused by linguistic gaps in the U.S., they were all without professional or specialized interpreters. The communications were directly made between foreign language speaking patients and the medical staff who were not able to understand the language very much in examination rooms or pharmacies.

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