A study was made to elucidate growing health problems confronting women in rural communities today amidst drastic changes in agriculture. From the standpoint of production structure, the area covered by our survey was divided into single-crop (paddy-rice), paddy-rice and fruits (apple), paddy-rice and water melon, and fishing village districts. In each of these districts, we conducted a survey by the use of a questionnaire and a health examination. 1, About 45 to 70 % of women engaged in farming complained that they could not take enough time to sleep. Especially in the paddy-rice and water melon producing district, the percentage was high. 2. Female farmers who complained of pains in the legs and the lower part of the back accounted for 40-60 % of the total. The rates were high in the rice producing district, and the paddy-rice and water melon producing district. This is probably due to the nature of farm work. However, the cause of the complaints was not always clear in the paddy-rice district. 3. Depending on the working postures (work on the stepladden in the orchard, work on hillsides, work in the supine position, etc.), the ailing region they complained about differed. 4. Those women who take care of supplementary work when machines are employed said that they feel they are subordinate to mechnization. 5. When pesticides are used, 10-20 % of the subjects showed toxic symptoms. In the paddy-rice and apple growing district, high ratios were recorded. 6. Of the total, 52.7 % were found negative in the mass health screening. The rate was the highest in the paddy-rice and water melon producing district. 7. The obesity rate rose in proportion to the rise in age. 8. The incidence of hypertension (WHO criteria) was the lowest in the fishing community, followed by the paddy-rice and apple district, and the rice producing district in that order. 9. As regards the hemoglobin level, those who showed less than 12.0 g/dl accounted for 11 to 32%. The level was lowest in the paddy-rice and apple producing district, followed by the paddy-rice district and the fishing village. There were few who need medical treatment immediately. 10. Abnormality of liver function was found among some 5 % of the examined. Serum cholesterol levels were lower in the paddy-rice district than in the other districts.
In Niigata Prefecute, which is known as Japan's major agricultural district, the number of farm households is on the downward tendency. The ratio of full-time farmers is decreasing, the scale of farming per household is becoming larger, and the number of farmhouses with supplementary incomes from non-agricultural businesses are growing fastly. Amid increasing trend of farm management toward complexity, women play a large role, accounting nearly 60 percent of the total number of those engaged in agriculture in Niigata Prefecture. Production structure, life style, working conditions and everything have changed drastically. Such being the situation, it is worth while to try an investigation into the actual conditions of health and labor of women farmers, and to shed light on health-injurious factors and work loads. We have selected communities so as to obtain a cross section of the farming areas of Niigata, which consists of a large plain called Japan's rice producing center, mountainous districts covered with snow for one-trird of a year, and suburban areas.
In view of the present situation of agriculture in which housewives have to handlethe bulk of farm work, a study was made on the health conditions of women engaged in farming in comparison with those of non-farmers. The study covered a total of 28, 600 females, aged from 40 to 59, who received masshealth screenings conducted between 1978 and 1980 on rural inhabitants in Nagano Prefecture as part of the outreach program by the health service corps of our hospital. All the examinees live in areas whose principal crops are rice, vegetables and/or fruits. The data were arranged according to seasons based on the dates of health examination in order to clarify the seasonal variations of morbidity rates and other indices of health. Another investigation was made into seasonal changes in the length of time used byhousewives in farming, domestic chores, rest and so on with a view to studying correlation between the mode of living and health conditions. To sum up, our findings are as fllows: (1) Seasonal variations in the results of various laboratory tests and morbidity rates were notable, depending on the amount of farm work, dietary habits, coldness and the height above sea level. (2) During summer months, the incidence of anemia was exceedingly high, obesity rates plummeted, and serum cholinesterase values dropped sharply among housewives who are engaged in farm work, compared with those who are not. (3) In summer, farm housewives worked long hours in the fields, slept less and rested less. They had not enough time to attend to household duties.
Health problems of the farmers were surveyed in two districts where progressed mechanization, green hause culture or other improved management systems were introduced. The following results were obtained: 1. Long daily working hours remain as before, therefore, sleeping hours and hausehold hours in female are shortened in busy seasons. 2. By introduction of joint management or cooperative manegement working hours of female farmers were shortened in some cases, but not enough. 3. New health hazards as noise, vibration, toxic chemicals, continuing of forced posture, forced repetitive motion of hands and arms are being marked. 4. High incidence of subjective symptoms relating to their acute or chronic fatigue were obserbed in most type of agriculture, which were considered to indicate that modernization of agricultural production had been promoted in lacking of consideration for farmer's health.
In the farm household of “vegetable planting by plastic green house”, “mandarin orange”, “rush (igusa)”, “dairy-farming” and “silk worm”, measurement of energy expenditure in agricultural work and analysis of daily working hours were conducted at the busy season of each crops. The results are as follows: The energy consumption per day are estimated respectively to be 3300 Cal for male and 2900 Cal for female in the household of the “plastic green house”; 3500 and 2500 Cal in the “mandarin orange”, 3800 and 3600 Cal in the “rush”, 3300 and 2700 Cal in the “dairy-farming”, 3400 and 2700 Cal in the “silk worm”. The agricultural machines and tools are mainly operated by male and so attached muscular works not yet machanized are carried by female. And management of animals or crops specially required prudent care have a tendency to be also carried by female. Then the average relative metabolic rate (RMR) a working day is relatively higher in female than male, except “mandarin orange”. In the “rush harvesting” and “dairy-farming”, having the most development of the agricultural mechanization it seems obviousely to be rising the labor efficiency, but because of expansion of management scale and decreasing number of employee the reduction of work load for a worker is not necessory obvious.
The purpose of this study was the evaluation of the relationship between the degree of obesity (relative body weight ratio) and values of various components in blood. The degree of lean and obesity was defined as the ratio of actual body weight to standard body weight calculated by the method of katsura. Mean ± standard error and percent frequency of abnormal values of blood components were studied in 880 women with degree of lean and obesity from 80 to 170 % among the women in agricultural villages. The class mean in subjects with relative body weight ratio between 100 and 109 % was used as the standard class value for comparison with these values. The following results were obtained. 1, Red blood count, hemoglobin and hematocrit values were significantly increased as the degree of obesity reached 130-140 %, compared to the standard class value, along with a significant fall of % frequency. 2. Behavior of serum components with reference to the degree of obesity showed a marked component to component variation. The mean level of SGOT, SGPT, γ-GTP, TRIG, CHOL and UA rose along with the increase of the degree of obesity from the lean range via the standard body weight range to the obesity range. ALP, however, was high in the obese and lean ranges, and low in the standard body weight range. BUN showed a tendency in reverse. Electrolyte and creatinine values were not remarkably different between lean and obese persons. 3. Marked changes of the mean levels were seen along with obesity in SGOT, SGPT, γ-GTP, cholesterol and triglyceride. Many of these showed significant increase of the mean in subjects with degree of obesity between 120 and 129 % compared to the standard class value. In subjects with degree of obesity of 140-149 %, frequency of abnormal values were significantly elevated. These results would suggest on an epidemiological basis that detailed examinations of the functional abnormalities of organs and environment in vivo thorugh blood testing is necessary for health control in subjects with degree of obesity of more than 140 % by Katsura method.
The rate of obesity both in man and woman in this district reached the highest (male 18.1%, female 27.8% Minowa Method) in 1978, but has been decreasing since then. It came down to 16.5% in case of male adults and 23.0% in case of female adults. These figures clearly show that the obese rate of female is higher than that of male. Skin-fold thickness meassurement corresponded to direct meassurement performed at the time of gastrectomy (=0.956). Compared with rate of obesity (Minowa Method) skin-fold thickness measurement proved particularly corresponding in navel area of male and in back of female. Regarding relationship between obesity and morbidity, a greater number of thin people suffered from atony or ptosis of the stomach or anemia. On the contrary the following diseases were more common with people as they grew fatter; hyperlipidemia, hypertension, ischemic heart diseases and diabetes mellitus. Patients with diabetes mellitus or hypertension who succeeded in losing weight improved their conditions or completely recovered. Our survey conducted in 1978 proved that residents over the age of forty in our district were not well aware of their obesity. Few of them were concious that their obesity were due to over-feeding. Regarding the effect of weight control conducted at three groups, instituts for the handicapped showed the most effective and successful result, 68.0% succeeded in losing more than 4 kg in a year at the instituts. The rate is incredibly high compared with 33.0% at our obesity clinic or 4.3% at field.
We have taken measurements of skinfold thickness in the 10 regions of the body of the adult farmers. The regions were cheek, submandibular region, upper arm, scapular region, abdomen, side, femoral region, waist and calf. Included in this study were 148 men and 150 women. A summary of the results is as follows: 1. The average skinfold thickness in each of the 10 regions was larger in women than in men. Subcutaneous fat was the thickest in the abdomen, followed by the scapular region and the cheek, irrespective of sex. 2. The average reading by age and sex in each of the regions also indicated that there is little variation in the case of men. Only in the abdomen and the waist, measurements slightly decreased with aging. However, in the case of women aged 70, the thickness readings went up with aging. Women in their 70s showed a decreasing tendency. 3. When those examined are broken down into the persons of the pyknic type and the persons of the leptosome type, the average thickness value in each of the 10 regions reveals that the leptosome-type persons, regardless of sex, have subcutaneous fat deposited evenly throughout the body. By contrast, men of the pyknic type have subcutaneous fat accumulated mainly in the abdominal region and women of the pyknic type in the scapular region, abdomen and upper arms. 4, Correlation between total skin thickness and region-wise skinfold thickness was higher in the sum of values for two regions than in values for any single region. In men, the scapular region+ abdominal region values have higher correlation than the upper arm+the scapular region values. 5. From the above, it can be said, the scapular region + the abdominal region, rather than the upper arm + the scapular region, should be selected for the diagnosis of obesity.
Qualitative changes in the health hazards are at issue as the rural communities have been transformed in recent years. One such sign is the obesity of women in the rural communities. There is a need to make an epidemiological study on what effects obesity has brought about on their health. We have conducted a fact-finding survey on the distribution of obesity among rural women, changes in the rate of obesity by age, relations among obesity, abnormal findings in various examinations and morbidity, relations between annual changes in body weight and changes in the test values as well as relations between obesity and factors associated with the living environment for an analysis. The survey covered persons who underwent a mass health screening we carried out in Nagano Prefecture. In checking relations between changes in the rate of obesity and factors associated with the living environment, inhabitants of the village of Yachiho in South Saku County of Nagano Prefecture were covered, Findings: The rate of obesity has become higher among rural women in their middle and high age brackets. Particularly, there were marked signs of obesity between 1950 and 1970. By occupation, the rate was high among women who were not engaged in farm work, but by area, the rate was high among women living in the mountain areas. By crop, there were signs of a rise in the rate in areas where vegetables constituted the main produce. There were also signs of a rise among women whose gross income and non-agricultural income were high. In relation to health hazards, the morbidityassociated with the circulatory, endocrine, muscular and skeletal systems was high. In terms of test values, the higher the obesity, the higher the maximum and minimum blood pressure values, ischemic changes ECG, arteriosclerotic changes in the fundus, GOT, GPT, blood glucose, uric acid and total cholesterol. In the dietary pattern, there were signs that the intakes of calory, protein, fat and sugar were higher among women with obesity, whereas the intake of calcium, iron and vitamin C was rather low. By type of food, the intake of sugar, oil and drinks was high among women with obesity, but that of beans, fishes and shellfishes, milk and greens was low. Though the calory was high, signs of an unbalanced nutrition intake, which could be described as low in nutrition, could be observed.
Mass health survey was conducted to discuss the relationship between obesity and some factors of agricultural managements and living and working conditions among 349 pairs of housewives and their husbands selected from the rural communities in Kumamoto prefecture. The prevalence rates of obesity (20% over of the Minowa's standard weights) were 13.1% for housewives of farmers, 13.7% for their husbands and 15.6 % for housewives of non-farmers, 9.2% for their husbands. The significant correlationship was found in the degree of obesity by Minowa's standard between housewives and their husbands (r= 0.1566, P<0.05). Being compared the prevalence of obesity according with the kinds of each household's producting crops, peoples of the household of “shiitake: cortinellus shiitake”, “vegetables by plastic greenhouse”, “tabacco” and “animal husbandary ” were more likely to be obese and, inversely, those of “barley”, “vegetables in upland” and “sericulture” were less, than those of “rice”, “mandarin orange” and “forestry”. In the household of “vegetables by plastic greenhouse”, “rice”, “barley”, “mandarin orange” and “vegetables in upland” husbands were more obese than housewives and, inversely, in the household of “shiitake” and “forestry” housewives were more obese than husbands. Peoples of fishing households were less likely to be obese than those of the farm households and/or other profession. Among the households of non-farmers it was noteworthy that higher prevalence rates of obesity were found in housewives than husbands, being inverse finding in the farmers case. The results suggested that the agricultural management and it's labor conditions, as well as the level of agricultural economics, might strongly affect the occurrence of obesity in the Japanese rural community.
A field study on the hourly working pattern, energy expenditure, air conditions and the testing for fatigue of the process of the raising silk worms for 4 days in August, the period of early autumn raising. Three couples of the typical raising silk worms households in Kikuchi district in Kumamoto Pref. were selected for the study. The results were as follows. 1. In Kikuchi district, there were 5-10 raising periods in a year from april to november for each households and the yearly working days for the process were to be 160-260 days. In the period of early autumn raising, the average working times and energy expenditure a day were calculated to be 374±136 min. and 2891±277 kcal for males and 383±119 min. and 2494±91 kcal for females in the third state of period (after 5 days of accepting the larva); and in the fifth state of the process (after 10 days of the former state) 644±112 min. and 3087±136 kcal for males, 618±65 min. 2851±48 kcal for females; in the state of the spinning cocoons, 944±238 min. and 3735±459 kcal for males, 846±271 min. and 3209±754 kcal for females; in the state of the controlling cocoons, 560±115 min. and 2944±233 kcal for males, 478±68 min. and 2537±101 kcal for females. In the spinning state it was the highest work loads to be taken for both males and females through one raising period. 2. The RMR (relative metabolic rates) values of each elemental work were measured to be 0.6-3.7 (0.0322-0.0995 kcal/kg/min). The average RMR in a working time was 2.2±0.3 (1.7-2.9) for males and 2.1±0.3 (1.4-2.5) for females, and in the spinning state higher average value was observed for females than for males. 3. There was some difference between males and females in the distribution of working posture. For males 30.8%(9.5-46.2%) of all working times was the standing position, but in the contrally, for females, 66.0%(64.0-69.8%) was the half sitting position and only 11.0% was the standing position. 4. The considerable reduction of flicker frequency was observed at the end of working a day in each state of the period especially in the spinning state, and the increasing of complaints of fatigue symptoms was also observed.
We have established NICU (Neonatal Intensive Care Unit) in our hospital and concentrated our efforts on improving the contents of medical treatment since 1976 in order to accomplish a regionalization of neonatal medical treatment in our district. Thereafter, the mortality rate of low birth weight infants at different weight have decreased markedly. During this period, we have gathered information by means of questinnaire concerning the prognosis of low birth weight (below 2, 000 g) infants whowere admitted in our hospital in the preimprovement period of five years (1971 through 1975, Group 1; N =110) and in the post-improvement period of five years (1976 through 1980, Group 2; N = 96). The results were as follows: 1, In terms of height and weight, both groups revealed to be no less than those of normal infants. 2. The occurrence of cerebral palsy in Group 2 (2.2%) decreased to below one third of Group 1 (7.5%). 3. There were two infants with blindness resulting from retrolental fibloplasia in Group 1 and one in Group 2. 4. As regards the occurrence rate of epilepsy, there were two children with it in Group 1 (1.98%) and one in Group 2 (1.1%), whereas four children in Group 1 had episodes of afebrile convulsion. 5. Five (5.4%) of 92 grade-school pupils in Group 1 were attending a clss for handicapped. From these results, it may be concluded that the improvement of neonatal medical treatment brought about a decrease of death rate of low birth weight infants and the improvement of theirprognosis as well.