We held the 49th meeting of The Japanese Association of Rural Medicine in Mie Prefecture in November, 2000. The main theme of this meeting was “Future Aspect of Health, Medicine and Welfare in the next Century, with special reference to the medical service in local community”.
Firstly, I introduced the history of our hospital, that wasestablished in 1938, named Chusei Hospital with 30 beds. In 1993, our hospital was transferred in present place, and renamed Suzuka General Hospital, with 500 beds. Since, our hospital has been recognized as the Suzuka city hospital.
Secondly, I mentioned my career as a cardiologist. My lifelong teacher, Professor Hideo TAKEZAWA, led me a clinician and researcher by bedside teaching, with intense passion and research mind.
Finally, I described a clinical results in the diagnosis and treatment for coronary artery disease in our cardiology division with my colleagues. Especially, focusing in recent one year, we performed percutaneous coronary intervention (PCI) to both native and in-stent restenosis lesions using cutting balloon ^TM. Initial success rate, rate of restenosis and complication rate were favorable results.

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Health condition of the middle- and old-age women living in various agricultural and mountain villeges of Japan was examined and measures for promoting their health were discussed.
The study performed for two years from 1997. The cooperative team was composed of community health specialists who had dedicated their efforts of health promotion for a long time in rural area in Japan.
1. A sheet concerning community profile was made to reveal the present situation of rural communities. The community characteristics was useful to analyse various health problems occuring in rapidly changing rural areas.
2. A health check list of middle- and old-age women in rural communities was made from the aspects of woman health and rights. Also the sheets of community health management were prepared on the basis of each character of community and of age group, which were useful for promotion plan making of woman health.
3. Health examination of middle- and old-age women in rual communities was carried out. Special attention was paid to menopausal disorders. By analysing its relation with life-style, 5% of the disorders were found to be of “the vascular neuromotor type” and each of 1% was “the sleep-disturbance type”, “the neurotic type” and “the sensory-disturbance type”. These results revealed the higher possibility of the influence of sociopsychological factors in women's living conditions rather than that of endocrine environment such as estrogen deficiency.

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Japan's food self-sufficiency rate has fallen off to around 40%. A questionnaire survey of residents of Toride-city reveals that 60% of the citizens are concerned about this low self-support rate. Even junior and senior high school students are anxious about this situation.
It is feared that world food production will not increase in proportion the rise in demand from now on by the influence of global warming. There is a possibility that foods supply could be temporarily cut off by the interruption of shipping lanes considering the unstable political conditions around Japan.
Although the decline in the self-sufficiency rate should be discussed as a fundamental subject of the country, the mass media of Japan do not take it up seriously. The mass media would not show how to deal with the food crisis, but only blame it as a result of the unreasonable agricultural policy.
Since 1993, Japan has approved minimum access of rice import, because the GATT and WTO put pressure on the Japanese government to approve the liberalization of the rice market. In 1999, rice tariffication was put into effect. The mass media and the government are afraid of the import restriction by foreign nation of industrial products from Japan as a result of the opposition to rice import in the name of food security.
The opening of the rice market will increase the imports of rice and the rice growers of Japan will sustain serious damage. Countries other than the U. S. and the Cairns Group will understand the Japanese assertion of food self-sufficiency as Japan is an island country. After reaching an agreement with the developing countries and NGO on this matter, Japan should revise the WTO agreement.
Although a farm village should retain some original scenery of Japan, housing styles and colors of a farm village in Japan are in total disarray. We want to propose to build 10-20 “model farm villages” in the country. If the model farm village retains Japanese original scenery, many city residents visit it and the image of an old farm village will give them a good impression, opening up the possibility of green tourism. If the model farm village gets a good reputation, the number of farm villages which hope to retain Japanese original scenery will increase and regain the rural beauty.
It is also important for a farm village to return to its original recycling life style. In Europe, it is a prevailing practice to recycle the garbage discharged from a farm village, including excretions of livestock, straw and so forth. And the technology, that changes biomass into methane or ethanol has been developed and become commercialized in Europe. It is important for a farm village to introduce such a technology and aim at a circulation style society more promptly than a city.
The Japanese Association of Rural Medicine should conduct a long-term prospective epidemiological survey to clarify whether the decrease in carbohydrate intake including rice and the increase in the ingestion of animal food have some relations with the recent rapid increase of diabetes. It will not be impossible to do so if collaboraion from medical examination centers across the country is obtained. If it becomes clear that the present eating habits are not good for our health, the rice-based diet revives and the demand for rice grows. And Japan's food self-sufficiency rate will go up in the long run.

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The most common mandibular fractures involve the condyloid process. It is necessary to diagnose and treat the cases of mandibular condylar fracture carefully, because the temporomandibular joint is complicated anatomically and functionally.
A clinical study was made in 72 patients with mandibular condylar fracture referred to the Department of Oral and Maxillofacial Surgery, Gunma University Hospital from April 1991 to March 1995.
The results were as follows:
1. Mandibular condylar fracture occurred in 42.6% of the mandibular fractures. The male-to-female ratio was 2 to 1. The largest age group of patients was from 10 to 19 years (31.9%).
2. The most frequent cause of the injury was falls (50.0%). Of all the patients 84.7% visited our department within 2 weeks after injury.
3. Fifty-nine cases (81.9%) were unilateral fractures and 13 (18.1%) were bilateral. Of the total, thirty-six cases (50.0%) were combined with other fractures of the mandible and/or maxillofacial fractures.
4. As for the fracture level and position of fragment, fractures with deviation were most frequently observed in the subcondylar region (20.5%).
5. Of the 67 cases treated at our department, 62 (92.5%) were treated with a conservative therapy for mandibular condylar fracture, primarily by maxillomandibular fixation followed by functional rehabilitation. The remaining 5 (7.5%) cases were treated surgically.
6. Fifty-nine patients were recalled after more than 6 months. As for the treatment outcome in 54 nonsurgical cases, 46 cases (85.2%) showed excellent prognosis, 6 (11.1%) had disorder I and 2 (3.7%) had disorder II. In 5 surgical cases, 3 cases showed excellent prognosis and 2 had disorder II. Most of the patients treated nonsurgically had relatively good results.

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