The purpose of this paper is to investigate the situation of maternal and child health for thirty years from 1952 to 1981. I have reported the changes of natural features, communities, living conditions, labor technology, and structure of population in farming villages, and the twelve subjects such as 1) superstition, 2) artificial abortion, 3) birth control, 4) labor in menstrual period, 5) signs of physical fatigue of pregnant women, 6) birth and child nursing, 7) pesticide poisoning, 8) abortion due to use of small type cultivators, 9) unbalanced diets, 10) lumbosacral pain, 11) influence of rural environments and 12) decrease of farm population. Mechanization in agriculture, urbanization of rural life, and stagflation have been proceeding, therefore farmers' wives have to work with might and main to earn agricultural and non-agricultural income. By my opinion the socioeconomic policies are essential in the rural areas to ensure an early and strong recovery, to increase of farmhouseholds income, and to secure an ample national budget for the development of health services.
Nagato-machi and Wada-mura Nagano prefecture, are mountainous farm villages, with a population of about 8, 000. Over the past years, depopulation has progressed at a steady pace. The trend is still continuing and the average age of the populace is following an upward curve. Since 1971, mass screening for early detection of stomach cancer has been conducted on a regular basis in Nagato-machi and Wada-mura. While looking back upon the past 10 years, we made an attempt to analyze the cases of gastrectomy performed since 1978. Some of the cancer cases had been detected by the mass screening and the rest had been detected among the outpatients. (1) The ratio of those who receive the mass screening tests to the total number of eligible inhabitants stood somewhere around 6% during the initial years, rose to the 10% level in 1976, and went up further to the 20% level in 1978, when stomach exams were started as part of the adult disease prevention scheme by the local health center of both town and village. However, the ratio of the elderly persons (65 and above) who come in for the checkup has been, and still is, notably low. This is one of the serious problems yet to be solved. It is serious in light of the fact that the average age of those outpatients who have been found contracting gastric cancer is 66. (2) Since 1978, fiberscopy has been incorporated into the intensive examination course following the primary screening. During the past three years, seven cases of stomach cancer have been detected. The detection ratio was 0.23%. Six out of the seven cases were diagnosed as early stomach cancer. (3) Between September 1978 and March 1981, 53 stomach cancer patients were treated in our hospital. Of the number, 10 had been screened by the mass survey and 43 had been diagnosed at the outpatient clinics. Except for three outpatients, 50 cases were operated. We have reviewed the outcome of operations and prognoses of the operated cases and the following observations have been obtained The average age of the patients who had been screened by the mass medical checkup is 62.0, and that of the outpatients is 64.9. Eighty percent of the screened patients had no complaints. Out of the outpatients, 75% had not undergone screening at any time previously. Six patients out of the 50 had received screening five times or more. Five out of the six cases had early stomach cancer. Curative operation could be performed on all of the patients who had been found in mass screening, but was possible in only 65% of the cases detected in the outpatient clinics. Histologically, it was found, cancer had invaded no further than the submucosal layer in 80% of the screened patients as against 20% of the outpatients. Metastasis to the lymph node had not taken place in 60% of the screened patients as against 40% of the outpatients. As for the progress of cancer, 90% of the cases screened by mass survey had been at stage II or below as against 40% of the outpatients. As of October 1981, 11 cases of the outpatients had died from cancer.
It can be surmised that housewives' awareness of the need of health care and personal behavior patterns differ according to different factors of the environment in which they live. A questionnaire on health and living conditions sent by us to housewives in three different villages has produced the following information. 1. In a doctorless village, the number of days spent in a sick-bed a year is on the increase. 2. Irrespective of differences in environmental factors, most housewives are mindful of their health. 3. They are careful about what they eat and trying to have a good sleep for the sake of health. 4. They often eat vegetables frizzled in oil, and less consume milk and protein-rich food in their diets. 5. Most houses lack adequate sewage facilities. The diffusion ratio of flush toilets is extremely low. These findings seem to indicate that in the community which lacks access to medical service and groceries, such environmental factors adversely affect the delivery of medical care to the aged and the supply of varieties of meat and fresh vegetables. The low diffusion ratio of flush toilets is due conceivably to the fact that priority is placed on domestic economy at the sacrifice of community hygiene and sanitation. The survey results also demonstrate clearly that house-wives' awareness of health preservation does not agree with their behavior. This discrepancy is attributable to the socio-economic conditions of the community to which they belong. From the above, it is deemed necessary to take measures to remedy the doctorless situation and poor sanitary conditions. At the same time, proper health guidance should be given to villagers to improve the dietary life, while encouraging them to practice physical exercises before and after farmwork.
Blood enzymes and lipids that might cause fluctuations with organophosphate pesticides were measured before and after spraying mecarbam with the conventional way using the nozzle on 76 farmers (37 males and 39 females) in citrat fluit area of Ehime Prefeture. 1. Serum pseudocholinesterase activity measured by the method of Voss et al. was found to be reduced significantly in the female group after spraying over 2 l mecarbam (P>0.05) and remained to be the control level in other groups after spraying. 2. The values of serum pseudocholinesterase activity measured by the method of Bellino et al. was correlated (γ=0.78) with the values by the method of Voss et al., but erythrocyte acetylcholinesterase activity measured by the method of Bellino et al. did not show any fluctuation after spraying in all the groups. 3. There was no increase in both β-glucronidase and alkaline phosphatase activity in sera. 4. Total cholesterol and HDL-cholesterol levels in sera decreased significantly in males (P<0.05), but did not decrease in females after spraying. Based on these results, we suggested that spraying of mecarbam for 4 hours with wearing protectors might not induced any danger in farmers.
A filter pad-one respirator-per man measuring system (Filter pad system) has been devised as a method to evaluate the respiratory exposure to pesticide spray. This method was compared with a conventional method and results are as follows ; 1. Experiments to test the filter's efficiency in collecting both dust and mist pesticides demonstrated a high collecting efficiency level within the range of a simulated air flow, inhalation time, air concentration similar to actual working conditions. These materials thus appear to be sufficiently useful in evaluating the respiratory exposure to pesticide spray. 2. The experiments using the filter pad evaluation method (Filter pad method) of collecting sprayed pesticides and the experiments measuring the respiratory exposure to pesticides by employing the impinger tube evaluation method (Impinger method), resulted in the obtainment of a correlation between the two. The results from evaluating the respiratory exposure to pesticides by workers during spray work employing both methods, the Filter pad system and Impinger system (impinger-one respirator-per man measuring system) also gave values of similar levels. 3. When compared, Filter pad system has several advantages over the Impinger system. It is a more desirable Filter pad system in evaluating the respiratory exposure to pesticides by spraying wokers.
Kochi Prefecture is noted for its high mortality rate attributable to degenerative diseases. Among them, cardiovascular disease takes the heaviest toll of lives. In quest of risk factors associated with the scourge, we probed into its possible relations with lipid in the blood, specifically with total serum cholesterol levels. At the same time, we took note of nutritional aspects. Our study found that the cardiovascular death rate has a negative correlation to total serum cholesterol levels and that the subjects who scored low total cholesterol values were exceedingly ill-fed as compared with ordinary people. This finding suggests that, in Kochi Prefecture, the lowering of total serum cholesterol levels triggered off by unbalanced nutritional conditions may increase the chance of succumbing to car-diovascular disease.
Ophthalmofundoscopic examinations were conducted on 262 young hypertensive people living in a rural district of Akita Prefecture. The district is noted for its high incidence of cerebral apoplexy among the populace. Young hypertensives are defined as those who are 39 years old and younger, and whose blood pressure levels exceed 160 mgHg/95 mgHg. The narrowing of retinal arterioles was observed in the highest 31.7% of the examinees. It was followed by calibreirregularity, arteriolar-venular crossing defects and increases in the arteriolar light reflex. The occurrence ratio of over Scheie H2 and/or S2 was 42.4%. The occurrence ratio of over Scheie H2 was significantly higher than that of over Scheie S2. In a nutshell, hypertensive changes such as retinal arteriolar narrowing were high in occurrence, but sclerotic changes took place less frequently, and retinopathy scarecely occured in the eyeground among young hypertensives.