Objective. We investigated visit trends of participants with suspected Chronic Kidney Disease (CKD) who received secondary consultation after health checkups to identify effective countermeasures.
 Design. We administered a questionnaire survey to Tokyo residents at medical institutions, in cooperation with the Tokyo Medical Association.
 Participants and Setting. Participants were selected from a population of 586,766 individuals (mean age, 50.6 years; 63.6% male) attending a preventive health checkups for lifestyle-related diseases conducted by the Japan Health Insurance Association, Tokyo Branch in both 2012 and 2013.
 Methods. CKD severity classification comprised urine protein results examined using a test paper method and eGFR level. We selected participants with red or orange CKD heat maps both years, and those with yellow heat maps if the eGFR level was reduced by 1.0 mL/min/1.73m² or more from the previous year. Additionally, the data on hypertension, diabetes mellitus, dislipidemia and obesity were extracted for untreated participants from their receipt information. To investigate the visit trends among Tokyo residents, we administered a questionnaire survey at the medical institutions, in cooperation with the Tokyo Medical Association. We created the eGFR graphs indicating their renal function.
 Results. Of the 5,210 untreated people (0.83%), 2,468 Tokyo residents received the survey; 345 (14.0%) returned the questionnaire. Analysis revealed 62.0% (214) “first visits”; 31.9% (110) visited a nephrologist. Of the 68.1% (235) who visited a primary care physician, 66.0% (155/235) “continued treatment or follow-up in the same hospital” and 8.9% (21) were “introduced to a nephrologist”. The questionnaire return rate of the group with the eGFR graph was significantly higher.
 Conclusion. Primary care physicians play a major role in CKD countermeasures after a health check-up and they should be active in CKD treatment in cooperation with nephrologists.

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 The number of internet users has continued to increase through the rapid spread of smart phones. Internet dependence is a crucial issue. The purpose of this research is to find the relationship between overall health performance (physical and mental health, social health, and lifestyle health), in university students with an addictive internet dependence tendency. We investigated this tendency in university students using a J-scale to measure such internet dependence tendency as described by Zheng Yanhua. We divided the university students into two groups (an internet dependence tendency group and a non-internet dependence group). In this research, university students were asked about awareness of their own internet dependence tendencies, and the impact of this tendency on their overall health performance including their mood states.
 As a result, 58% of the 156 university students were found to be internet dependentee, and 42% were found to be non-internet dependentee. We found that the subjects with an internet dependence tendency may also have problems sleeping, which is affected both by physical and mental health problems. The dependent were also unstable, had depression, and were generally more impatientee than the non-dependent group.
 Although the university students with the internet dependence tendency were more aware of their dependence tendency, they still depended on the internet. University students without awareness of their internet dependence tendency were less so, but it is possible that their internet dependence could become worse due to their lack of awareness.
 Based on this study and others, university students need preventive education to teach them how to use the internet appropriately to ameliorate the ill effects of internet dependence on their overall health and lifestyles.

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 BACKGROUND: In the revised Japanese guidelines for gastric cancer screening published in 2014, population-based and opportunistic endoscopic and radiographic screening were both recommended. Advances in esophagogastroduodenoscopy have enabled detection of minimal changes in the gastric mucosa due to early stage cancer, but opaque gastric mucus covering the surface of gastric lesions hampers detailed observation of microlesions. We reported a novel, simple pretreatment with pronase to remove this opaque mucus and improve endoscopic observation of the gastric mucosa. In this study, we explored the usefulness of this pretreatment in clinical cases of gastritis.
 METHODS: We randomly assigned 609 subjects to receive pronase pretreatment (404 subjects) or no pretreatment (205 subjects). The subjects were not taking proton pump inhibitors or H2-receptor antagonists and had no history of gastrectomy. The degree of opacity of mucus was compared between the two groups.
 RESULTS: The opacity of mucus, which was copious in chronic gastritis compared to that in normal or superficial gastritis, was decreased by pretreatment with pronase. The opacity of mucus was higher in Helicobacter pylori-positive subjects. The difference between groups was significant with pronase pretreatment.
 CONCLUSIONS: The degree of opacity of mucus was high in patients with chronic gastritis and H. pylori-positive gastritis and hampered detailed observation of microlesions. A novel, simple pretreatment with pronase to remove this opaque mucus was considered effective for enabling detailed observation of lesions, including early gastric cancer.

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 The practice of health examinations originated from 19th-century screening for communicable diseases, and grew popular among health-conscious people. In Japan, health examinations are stipulated by legislation and are now also used for health counselling regarding cancer and cardiovascular diseases. Scientific studies have repeatedly noted the lack of evidence that multiphasic health examinations reduce mortality. However, despite the dubious overall benefits, medical providers, public servants, and everyday citizens worldwide typically expect such examinations will promote health. Examinations intrinsically imply an assessment of one’s healthiness; however, proposed methods of evaluation have not been widely unified. Health examinations performed as a part of occupational health should function as either surveillance of human exposure and/or effects of the working environment or screenings for occupational diseases. Surveillance analyzing biological specimens can be referred to as biological monitoring. This should follow the guidelines issued by the International Labour Organization and by academic organizations, which recommend less-invasive methods and comprehensive evaluations with reference to the results of assessment of the working environment. If suspect symptoms or other signs are noted among workers, the workers’ relationship with their workplace and/or work itself must be carefully investigated so as to never overlook occupational diseases. Pre-employment health examinations should not be used in the recruitment process. All relevant personnel should work with due consideration of the bioethical principles of safeguarding autonomy, promoting and protecting welfare, and maintaining fairness for examinees throughout the processes of planning, execution, reporting results, and personal information control. It is particularly necessary to establish a system for obtaining consent when requiring tests that are not legally required. Medical personnel specializing in health examinations should participate from the planning stage in pursuit of continuous improvement; giving advice for applying the latest scientific knowledge, assuring the quality of testing, and facilitating appropriate use of the results acquired.

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