As regards hypertension in rural areas, many studies have so far been conducted in Japan by members of the Japanese Association of Rural Medicine and other medical societies. The findings have greatly contributed to the lowering of the incidence of cerebrovascular diseases. However, due to their still high incidence and problematic complications, they as yet remain to be one of the most serious health problems of rural people. On November 24, 1983, the author in had an opportunity to attend the 8th Congress of the Korean Association of Rural Medicine Seoul and had the honor of delivering lectures on the hypertension in Japanese rural areas. This paper was prepared in regard to the following four major aspects primarily on the basis of the relevent recent reports filed with the Japanese Association of Rural Medicine. 1 Epidemiology of Cerebrovascular Diseases and Hypertension. In terms of the mortality rate from cerebrovascular diseases, Niigata Prefecture ranks among the 10 top regions in Japan. This fact had led many medical scientists to believe that the incidence rate of the hypertensives in rural areas in the northern prefecture must be high. Actually, however, it was found to be low when compared with the national average registered in a nationwide survey of nutrition. The fact that replacing cerebral hemorrhage cerebral infarction has emerged as a primary cause of the deaths from cerebrovascular diseases in Japanese rural areas, suggests that it is necessary to probe into the factors that may lie in the process of transition from hypertension to cerebral Infarction, with emphasis on their possible link with the lifestyles and other environmental factors in rural settings. 2. Association between Hypertension and Lifestyles in Rural Areas. Aside from genetic predisposition, high salt intake is the most important factor contributing to the incidence of hypertension. Salt consumption should be reduced along with improvement of dietary habits. Especially important is proper intake of protein. 3. Hypertension Control and Clinical Tests. Before everything else, regular checkups on blood pressure are necessary for bringing hypertension under control. Among evaluating test results, electrocardiographic findings should be given a preferential status. Apperance ofe high R with strain pattern and atrial fibrillation should be taken special note of as a problem indicative of the onset of cerebral infarction. These findings suggest the occurence of heart failure in the development of cerebral infarction. 4, Ischemic Heart Disease among Rural Inhabitants. More Japanese-Americans who have emigrated from Hiroshima Prefecture than their relatives living in the rural areas of the prefecture were found to be suffering from hypertension, obesity, hyperlimpemia and abnormal glucose tolerance. And ischemic changes on ECG were more evident among these Americans of Japanese descent than the people in Hiroshima. Such findings suggest that the traditional daily fare of the rural communities in Hiroshima contains something that can prevent ischemic heart disease. In conclusion, to bring hypertension under control in the agrarian society in Japan, strong willpower to that end is required at both individual and community levels. Encouragement should also be given to farmers so as to have their blood pressure measured and receive ECG tests on a regular basis. On the otherhand, Japan's traditional dietary patterns are considered worth reviewing with a view to further reducing cerebrovascular disease incidence rate and preventing ischemic heart disease whose incidence is anticipated to go up in the future
In the central part of Shizuoka Prefecture, tea growing is carried out on hillsides. From the posture taken by farmers while they are picking tea-leaves, it is assumed that a heavy load is laid on the cervical region and that they must have complaints in that region frequently. On this assumption, we have conducted a survey covering a total of 228 persons working in tea plantations, with 42 persons living in plains as a control group. Of the total, 172 persons filled out a questionnaire and the remaining 56 underwent a physical checkup. Of those surveyed, 92.8% said that they feel fatigued from work. Complaints in the cervical region were filed by 69.5% of the males and 89.0% of the females. X-ray pictures revealed abnormal signs in 69.5% of the males and 89.0% of the females. Radiographic observation suggested that 77.0% of the abnormalities have some bearing on their complaints. It was also found that the stiffness in the shoulders accounted for most of the complaints. From these findings, we have keenly felt it is necessary for us to continue to engourage them into practicing calisthenics designed to prevent the stiffness in the shoulders.
Percutaneous toxicity of Paraquat has been widely believed to be of little clinical significance in our country. But we experienced a patient seemed to die from the effect of percutaneous absorption of paraquat, This is probably the first report about the fatal case of agricaltual worker using paraquat in usual way in our country. Although we found 4 similar case reports in foreign countries. We thought this fatal case of paraquat poisoning in agricultual use was a part of iceburg above the water. So we practiced the mass survey of the health effect by paraquat on agricultual workers (24 male and 51 female). Pulmonary functions were investigated by spirogram, flowvolume curve and atrial blood gas analysis. In this report, we analysed the data about 39 farmers using paraquat during more than 3 years and 36 control farmers in age from 41 to 59. There were no significant differences in the parametersthat seemed to detect the impairment of large air way. But we found a tendency of decreasing in value of the parameters of small air way in paraquat group than control. Values of the maximum respiratory flow rate at 25% of vital capacity per height (V25/h) decreased significantry (P<0.05) in non-smoking farmers using paraquat than control. The result showed that chronic agricaltual use of paraquat gave some adverse effect on small airways of farmers.
Elderly patients with delirious state which is a common psychiatric complication occuring with various underlying diseases were investigated from the viewpoint of liaison-psychiatric consultationwork. On 30 cases of the inpatients with delirious state above 65 years of age in our Hospital during the time spanned from 6. 1982 to 2. 1984 were statistically analysed with their prevalence, nature of underlying diseases and provocating factors of these state. Differential diagnosis of delirium, particularly from dementias, the treatment and the management of it were discussed. Delirium in the aged occurs not only due to intra- and extracerebrally existing disorders but also to some therapeutic drugs or even to common life events so that the psychosomatically carefull management should be required face with delirious patients to lead to a successfull outcome.
An epidemiological examination was carried out on 330 farmers engaged in pear and apple cultivation. First, all examinees answered questions about the presence of allergic symptoms. To those who have had any allergic symptoms, the intradermal skin reaction tests with pollen extracts (Japanese pear, apple, cedar and orchard grass) and house dust were performed. The results were as follows: 1. 35.8% of all examinees manifested some allergic symptoms during the bloom of pear and apple (from April to May). 2. Nasal or ocular symptoms were observed in 28.5% and 27.3% respectively. About three-fourth (20.3%) of them manifested both symptoms. 3. The rate of farmers with allergic symptoms was higher in younger generations and many of these symptoms occurred within these five years. 4. The rate of positive skin reactions of each allergen extracts were 40.5% for Japanese pear pollens, 63.8% for apple pollens, 30.5% for cedar pollens, 6.7% for orchard grass pollens and 10.5% for house dust. From a pollen calender of Nagano Prefecture, high rate of allergic symptons during the bloom of pear and apple and the results of the intradermal skin reaction tests, it may, be suggested that a considerable number of farmers possibly suffer from pear and apple pollinosis. The rates showed above are much higher than reported so far.
The incidences of obesity in school children of urban area were compared with those of rural area, using Rohrer index as a parameter of obesity. Body weight and height were measured in primary schools of both areas on May, 1982. The subjects studied were 2054 boys and 1887 girls in the ages from 6 to 12 years. Incidences of obesity in urban and rural areas were 7.5% and 8.6% respectively (p<0.05). For boys, average incidences of obesity in urban and rural school were 8.1%, and 7.5%, respectively. For girls, they were 7.2%, and 7.6%, respectively. These results showed that there were no significant differences in incidences of obesity between the two districts and both sexes of school children. We also found the eight cases of fatty liver in obese children.They were six boys and two girls, aged from 8 to 15. In 7 of eight cases, obesity started from early childhood. During the first six months of life, they were fully fed cows milk formula. Of the cases, one developed hypertension, and two had hyperlipidemia. With accurate exercise and optimal nutritional treatment, obesity, hepatic involvement and hypertension promptly improved. However, three cases had frequent recurrences. Abdominal CTwas examined in six cases of the eight obese children with hepatic involvement. They showed that there were low CT numbers of liver in obese children with hepatic involvement. The usefulness of abdominal CT in terms of evaluation of fatty liver in obese children was discussed.
The purpose of this study is to make clear a comprehensive relationship between two groups of blood properties and nutrient intakes. The first group of measurement include hemoglobin contents, hematocrits and blood specific gravity and the second group of measurements includ energy, protein, fat, carbohydorate, vitamin A, B1, B2, C, animal protein, animal fat, iron, animal iron and age. These figures are taken from the epidemiological survey of Tokushima prefecture, including 301 males and 379 females, investigated from 1975 to 1980. Appling the canonical correlation analysis, we found the following results. 1) In male, only canonical correlations were statistically significant. The hematocrit related strongly to carbohydorate, animal protein, fat intakes and age. 2) In female, only canonical correlations were statisticall significant. Both hemoglobin contents and blood specific gravity effected carbohydorate and energy intakes.