Looking back on the history of the Japanese Association of Rural Medicine on the occasion of its 44th general meeting, I am overwhelmed with deep emotion. Things have changed dramatically during the period, and our health activities by reaching out into the communities in the middle of nowhere are quite different from what they used to be.
The activities our association has evolved is multifarious. But, in this paper, I dwell on the results of the health screening project, one of our association's major themes, with reference to the health reports presented at the past meetings by its members.
In the early period, the outreach program emphasized the improvement of the living environment and the backward character of morbidity derived from poverty and difficulty of access, while physicals and health education were carried out. In later years, with the nation's rapid economic growth, the network of roads was remarkably expanded. However, material affluence has given rise to new types of health hazard and the incidence of adult diseases in a developed society is threatening the lives of rural inhabitante. In the meantime, the state of things surrounding medical care services has also been improved. Nonetheless, there are a mountain of issues with the advent of an aging society. They include an increase in the number of households with aged people alone in parallel with an increase in the number of nuclear families and the aging of those engaged in farming. The welfare of the aged has now become one of the primary issues we have to grapple with.
This paper reviews the changes in the results of health checkups with the changing times and themes taken up in the scientific sessions of the annual meetings.

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Truth telling to the cancer patients (TTCP) is a part of informed consent (IC). The name of IC was firstly used in a judgement of the Court of Appeal of California in 1957 and then in Helsinki Declare of the 18th Congress of World Medical Association. The core of IC is “self-determination” in every medical treatment including diagnosis and therapy. Self-determination should be respected to the utmost in TTCP.
The rate of TTCP is more than 90% in USA and northern countries of Europe, but slightly higher than 20% in Japan. However, Dr. M. Sasago who is a surgeon of National Cancer Center Hospital in Tokyo has reported the high rater of TTCP (97.1%).
In attitude of doctors, devices of manner in TTCP such as a stepwise truth telling are necessary in order to prevent or reduce shock of cancer patients following TTCP. In attitude of cancér patients, they are recommended to have usually their own views of life and thanatopsis or religions to be able to receive TTCP without perturbation.
Patient's prepardness confronting to cancer and considerable support of doctor, nurse and family are necessary following TTCP.
In conclusion, it is stressed that doctors have to endeavor to tell the truth to the cancer patients considering thinkings of patients and families as possible they can.

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Chemical fertilizers, pesticides and large-size machinery characterize present-day intensive agricultural operations. Technological advances in the application of those chemicals and machinery have made a large contribution toward solving the food problem, to be sure, but with detriment to the earth's environment and endangering man's health. Such untoward consequences were also observable not in agriculture and the manufacturing industry alone but in medicine and many other branches of science as well. In 1972, I was diagnosed with pesticide poisoning. With this as a turning point, I washed my hands of modern agriculture, which had been in my line for many years, and decided to do research in microbiology in earnest with my sights set on establishing farming of the sort that is friendly to the natural environment and compatible with the laws of nature. So far, I have harvested well over 2, 000 varieties of microbes. At least two years would be required for the study of one variety thoroughly if conventional methods were employed. So, I gave up all the old ways and resorted to my own method of eliminating harmful bugs and unpleasant odors using pH values and activated water. As a result, a symbiotic group of colonies made up of more than 80 kinds of “effective microorganisms”(EMs) has been formed.
Without reliance on chemical fertilizers and pesticides, it has become possible to produce more than twice as much crops of high quality only by dint of EMs. Not only that, those microscopic organisms have proved to be surprisingly helpful in the improvement as well as conservation of the environment. Agricultural, livestock and fishery products produced through the use of EMs are rated high as healthy foods today. Now that it has been made clear that the favorable effects of EMs are due to the antioxidizing substances synthesized by EMs, the scope of their application is being expanded from the above-mentioned sectors to medicine, manufacturing industry, environmental protection, energy resource development and so on. Thus, the EM technology is hailed as something that will bring about a new industrial revolution.
The principle of the technology is very simple: Oxidation breaks down everything on earth, but is prevented by the work of antioxidizing substances formed in EMs. The application of this principle could not have been thought of no matter how much the knowledge of modern science as based on the law of entropy was extended. A good idea occurs when you get your thinking on a different track, see the natural phenomena as they are and study them multidimensionally.

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Due to increase of population of elderly patients, dramatic increase of patients with dementia is becoming a serious social problem in Japan. At the moment it is being estimated that more than one million patients suffer from dementia in Japan. Among the patients with dementia, Alzheimer's disease and cerebrovascular dementia are the leading cause for dementia. In clinical practice, it is important to make a correct diagnosis for dementia. Special attention should be made not to misdiagnose “treatable dementia”.
On the basis of a genetic view point, Alzheimer's disease can be classified into familial Alzheimer's disease as a single gene disease, and sporadic Alzheimer's disease as a polygenic disease. The causative genes for familial Alzheimer's disease have been found to be amyloidprecursor protein gene on chromosome 21, presenilin I on chromosome 14 and presenilin II on chromosome 1. As a genetic risk factor for sporadic Alzheimer's disease as well as late-onset Alzheimer's disease, an isoform of apolipoprotein E (ApoE4) has been found to play an important role for the pathogenesis of Alzheimer's disease. Given the genes which are involved in the pathogenesis of Alzheimer's disease, the elucidation of the mechanisms of Alzheimer's disease and the development of strategies for the treatment of Alzheimer's disease should become a reality in the near future.

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Geographical distribution of standardized mortality ratio (SMR) for biliary tract cancer (BTC) showed a characteristic clustering pattern; high in the northeastern regions and low in the southwestern regions of Japan. Among the 47 prefectures (corresponding to counties in the U. S.) with high SMRs, Niigata Prefecture has been the highest in both sexes for the last two decades. It was found that the cities, towns and villages in Niigata where the mortalities from BTC were high were correspondent with rice producing areas.
In addition, it was revealed that the sources of tap water in the cities with high SMRs in Niigata were commonly big rivers, whereas in those with low SMRs they were either reservoirs located in the mountains, underground water or small river originating from the mountains. Based on these findings, the contamination of tap water by agricultural chemicals form paddy fields was suspected as a cause of the high mortality from BTC. Among several chemicals examined, diphenylether herbicide, chlornitrofen (CNP) and its derivative (CNP-amino) were detected high in tap water in the cities with higher SMRs and they seem to be related to the occurrence of BTC, particularly of female gallbladder cancer.

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[in Japanese]

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In second thoughts over the conventional method of farming with chemicals, premised on the massive use of pesticides and chemical fertilizer, organic farming, the necessity of which was advocated several years ago, is now in wide use across Japan. There are calls for checks into the effects of organic farming on man's health in a medical perspective.
Given those calls, I and colleagues of mine made studies, such as a fact-finding survey on the health status of people engaged in organic farming, a check into the effects of agricultural chemicals on human bodies and a series of animal tests which would be essential to the check.
On the basis of the findings, we assessed the way organic farming is today and discussed the necessity of pursuing organic farming. This issue may well be characterized as a pursuit of the way agriculture ought to be not only in Japan but elsewhere in the world in the future as well. It is not just a social issue for farm producers and consumers. It also constitutes a global environmental issue on soil and nature.
Though we have just taken the first step in striving to solve this question, we have taken to heart the importance evolving organic farming as a national movement along with the people.

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Research work of the Special Research Group for Survey of Pesticide Poisoning (Chief: T. Matsushita) was presented and discussed.
The main items are as follows:
1) Long term years of nation-wide survey for clinical cases of pesticide poisoning (disorders) in Japan from 1967 to 1989, which was carried out by the Research Group of the Pesticide Poisoning under the Japanese Association of Rural Medicine, was reconsidered. And, revised systems of this survey including new survey forms were proposed.
2) Results of methodological research work of our group for epidemiological study to clarify health disturbance from pesticides were indicated and a personal protocol was also presented.

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The Shikoku Association of Agricultural Medicine-Rural Health, which was organized in 1975 as a local chapter of the Japanese Association of Rural Medicine, last year celebrated the 20th anniversary of its existence. At the beginning of a new year, the author would like to look back on the past years and dwell on what it should be in the future.
Agricultural medicine-rural health, which has a character of agricultural medicine and rural health combined in practice, is such a branch of social medicine that its mission is to provide comprehensive medical and health care for the rural populace.
Foreseeing its future requires us to envison what the Japanese rural community and agriculture would be like in the future. There is every indication that agriculture will become more and more specialized and larger in scale from now on. In parallel with this trend, rural medicine will be required more than ever to make an approach to the specialized farmers group and agricultural management group from the viewpoint of agricultural medicine. In the meantime, the rural community will get more mixed in terms of sociology, with an increasing number of inhabitants finding their occupation in other than agriculture, and our preventive health services will become more important. Moreover, care for aging rural inhabitants will become a problem we have to address ourselves to more resolutely.
And lastly, the author would feel like to propose that a rural medical laboratory be establish within hospitals affiliated with the Welfare Federation of Agricultural Cooperatives.

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About 20 years have passed since the first intraocular lens (IOL) was implanted in our country. IOL has been less commonly used in extreme myopic eyes because of a higher incidence of retinal detachment and other complications postoperatively. We analyzed the data on cataract extraction with IOL implantation in 57 severe _ myopic eyes (axial length (AL)≥26 mm). All the patients had IOL implanted in the posterior chamber of the eye. Period of they have been followed up for an average period of 12.8 months after surgery. In predicting the power of IOL, we used the SRK formula. Axial lengths were measured on the TOMEY AL-010 and keratometry values were obtained with the TOPCON KR-7100. The errors of refraction (predicted postoperative refraction minus actual postoperative refraction) were 1.52D (AL<;29 mm) and 1.66D (AL≥29 mm). Sixty-seven percent of the SRK predictions were within±2.0D of the actual values. The SRK formula predicted a stronger IOL power than actually required, resulting in a slightly more myopic postoperative correction. Postoperative complications included retinal detachment (1 eye) and after cataracts (5 eyes). The visual acuity was improved in 54 of 57 eyes (94.7%). IOL implantation in severe myopic patients was an effective method of visual rehabilitation following cataract extraction.

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This study was carried out to clarify the relationship between aggression and feelings of well-being in 37 patients with diabetes mellitus. They were 15 irritable and 22 non-irritable subjects. There were no differences between the two groups in glucose control and therapy. But the morale scale in irritable subjects was significantly lower than in non-irritable subjects (p≤0.0005).
We conclude that there may be a close relationship between anger and feeling of well-being in patient with diabetes mellitus.

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The mental health of nurses was surveyed using the Japanese version of the 60-item General Health Questionnaire (GHQ). A total of 48 nurses responded to the survey.
There was no significant correlation between GHQ score and age in all the respondents. There were no significant differences in GHQ score among the outpatient nurses, those who worked in the surgical ward and those who worked in the internal medicine department and those in the care of geriatrics inpatient. Scores over 17 were marked by 45.5 % of the outpatient nurses, 58.8 % of those who worked in the surgical ward, 35 % of those in the internal medicine departmentand 35 % of those in the geriatrics ward. However, the percentage of those who had subjective symptoms was higher among the nurses in the surgical ward than the nurses in any other wards (p≤0.05).
Our results suggest that more thought should be given to the mental health of nurses and methods be developed to improve it.

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