We held the 48th meeting of the Japanese Association of Agricultural Medicine and Rural Health in Matsue, Shimane Prefecture in November, 1999. The main theme of this meeting was “Strategies of Agricultural Medicine and Rural Health with a Perspective toward the 21st Century”.
The attendants of the meeting held discussion about four subthemes with the relation to the development of rural communities: environmental crisis and the human existence, medical high technology and humanism, human dignity and the quality of medicine and welfare, and the co-existence of rural and urban communities.
The presidential lecture, which is reported here, treated the international trend of rural medicine and health care, our practice of rural medicine in San' in District, Japan, and some measures against aging society practiced by us in San' in District. The lecture also discussed about problems presented to the rural medicine in the 21st Century, and proposed several objectives to be carried out: integration of health care, medical care, welfare and education in rural districts, promotion of healthy lifestyle in rural districts, corporatism between administrators and researchers in medical care and welfare, policy-making for healthy rural communities and the protection of enviroment and eco-system.

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The large-scale mercury contamination has occurred in the Amazon river basin in Brazil. Also, I have visited Tanzania, the Philippines and other countries a number of times, and I convinced that similar problems are spreading worldwide. A numbers of gold-miners already suffer from inorganic mercury poisoning. None of the fishermen living downstream of the gold mine showed symptoms of Minamata disease. However, the mercury content of their hair indicates that the situation is becoming dangerous. Serious arsenic poisoning is occurring on a large scale in various areas of Asia. This is attributable to the use of great quantities of underground water in the large-scale agriculture, particularly in West Bengal (India). In developingcountries, various industrial sectors are developing simultaneously, such as refining, chemical, pulp, petrochemical and high-tech industries, causing complex environmental contamination such as at the Weonsan Industrial Park in Korea. The residents of Weonsan district tended to suffer from combined poisoning that it should be called Weonsan disease instead. The hazardous technologies and industrial plants being transferred from developed countries to developing countries are major cause of industrial poisoning and environmental contamination. Examples of such cases are the Onjin case of Cabon disulfide poisoning in Korea, the gas leak at the agricultural chemical plant in Bhopal, India and radioactive contamination in Ipho city, Malasya.
Health damage due to industrial and environmental contaminations is often masked by the effects of unsanitary living condition and health effects of novel chemicals and complex contamination are also frequently invisible.

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OBJECTIVES: A questionnaire survey commissioned by the National Mutual Insurance Federation of Agricultural Cooperatives (Zenkyoren) was conducted to evaluate the study of the health status, urination and urinary incontinence in the elderly populace of 65 years and over in the rural districts in Japan.
METHODS: 8, 023 elderly persons (3, 360 male, 4, 369 female, 294 unknown sex) were entered into this study.
RESULTS: The most troublesome voiding symptoms in elderly persons were weak stream and nocturia for men, and frequency in daytime and at night for women. The QOL questionnaire for urination was of little difference between men and women. It was found that 12.8% of the elderly persons have the incontinence problem. The survey showed that types of urinary incontinence in the elderly populace were mainly mixed, or stress, urgent incontinence. Many people in the populace had functional incontinence due to handicap status. Many people in the populace had not consulted a medical practitioner for their incontinence. The survey revealed that the burdens of caregivers were heavy and the quality of the caregivers' life was of low.
CONCLUSIONS: These findings suggest that the medical and welfare staffs should face up to the actual status of affairs connected with incontinent people in the elderly populace and care for those people and hasten to frame measures to cope with the situation.

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We developed a questionnaire for analysing actual state of stress and determining affective stressors in agricultural workers based on their works and lives. Using that we conducted the collaborative surveys to agricultural workers in 5 different districts in Japan. The results were as follows;
Among agricultural workers (662 males, 1, 084 females) 48% of males and 59% of females were being felt stress with higher prevalance rates in younger age group (under 59yr.) than in elders (over 60yr.). Affective stressors were found in various situations of agricultural works and lives, such as, factors related to work demand category by Karasek's psychological work model, and to agricultural work elements, i. e., dangerous equipments, dust generating condition, works under the sun, long work hours, irregular meal, etc, and to life-events, i. e., a debt, decrease of products, difficulty of relation to neighbors, care of the aged, personal and family member's disease and injury, etc. It was noticeable that the intensity to develop stress by those stressors was manifested stronger in female workers than in male workers. The results of the multiple regression analysis with the scores of those items indicated that the most affective factor for disturbance of quality of life (QOL) was to be the stress and for improvement of QOL was to be the social support. Those results indicated that to keep advantageous factors in the agricultural works categorised by Karasek's psycological work model, i. e., high control and low demans work, and to improve stressful work elements leading to high demand and low control work might be the most effective measure to improve the QOL of agricultural workers. To construct an appropriate network system for the social support in the rural communities using JA and other organizations might be also essential.
The present study also revealed that the process of the present investigation, i. e., to develop the questionnaire and to analyse an actual state of stress and factors of stress coping in agricultural workers using that questionnaire was to be useful to propose appropriate measures for improving QOL of agricultural workers based on actual state of their work and living conditions.

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OBJECTIVE: The Short Inversion Time Inversion Recovery (STIR) is a magnetic resonance imaging (MRI) technique that minimizes fat signals and produces images different from those obtained by T1-and T2-weighted spin echo (SE). In imaging of gynecologic tumors, T1-and T2-weighted SE sequences have been routinely used. However, the usefulness of STIR in routine MRI examinations for detecting gynecologic tumors has not been reported. So we studied the STIR images in comparison with T1- and T2-weighted SE images.
METHODS: One hundred twenty-one patients with uterine tumors, normal uterus and ovarian tumors who were examined with T1-and T2-weighted SE and STIR between December 1997 and October 1998 were enrolled as subjects. Results of MRI using both techniques were evaluated and images were graded CLEAR, SLIGHTLY CLEAR and UNCLEAR.
RESULTS: As for boundaries between the uterus with uterine tumors, normal uterus, and the pelvic organs, CLEAR accounted for 68.7% of the images on T1- weighted SE, 42.2% on T2-weighted SE and 74.7% on STIR. There were significant differences between T2-weighted SE, and T1-weighted SE (P<.0001) and STIR (P<.0001). In identification of the inner structure of the uterine tumors, CLEAR was 6.3% on T1-weighted SE, 82.5% on T2-weighted SE and 82.5% on STIR. There was no significant difference between T2-weighted SE and STIR. In identification of the inner structure of the tumors, the cases, one is CLEAR and the other is UNCLEAR, are 7 (T2- weighted SE, CLEAR) and 6 (STIR, CLEAR) (total 13) in uterine tumors and 3 (T2- weighted SE, CLEAR) in ovarian tumors.
CONCLUSION: STIR imaging should be used more in a routine MRI examination for gynecologic tumors in addition to ordinary spin echo sequences for T1-and T2- weighted images.

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The DCCT syudy report (in 1993) showed that long-term maintenance of near normoglycemia markedly delays the onset and/or progression of microangiopathic complications of type 1 diabetes. Now, intensive insulin therapy has been considered to be a standard treatment of type 1 diabetes. However, it brings about serious hypoglycemia three times as frequently as conventional therapy with split-dose insulin mixtures. If IDDM patients could predict their blood glucose levels, it would be beneficial to prevention of hypoglycemia and to strict glycemic control. We intended to research whether insulin-treated diabetic children in a diabetic summer camp could predict their blood glucose levels. The number of subjects was 28. They were elementary and junior high school children 9 to 16 years of age. They predicted their blood glucose levels before every meal and bedtime, and then monitored their blood glucose levels. Their HbA₁c was 7.6±0.3%, total daily insulin dosage 36.0±3.2U/day, and infection times 3.3±0.2/ day.
Measured blood glucose levels and predicted blood glucose levels were not distributed normally, but their natural logarithms (Ln (mBG), Ln (pBG)) were. Ln (pBG) (5.01±0.02) was significantly higher than Ln (mBG) (4.92±0.03) (p<0.01)
A positive correlation was found between Ln (mBG) (x) and Ln (pBG) (y) (y=0.359 x+3.239, r=0.495). Events of which Ln (pBG) was within±20% and±30% of Ln (mBG) were 124 (31.5%) and 175 (44.5%), respectively, of the total 393 events. As for the relationship between Ln (mBG) and Ln (pBG) at each time, a change of Ln (mBG) was significantly larger than that of Ln (pBG).
These results showed that prediction of blood glucose levels was difficult for type 1 iabetic children, especially when blood glucose levels were extremely high or low and when they fluctuated sharply.

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