During about thirty years, from April 1969 to December 1999, we experienced 2, 987 cases of gastric cancer, hospitalized in the surgical department of Tsuchiura Kyodo General Hospital.
Clinical and pathological observations revealed that the most important factor to improve the post-operative survival is to diagnose and treat as soon as possible, regardless of patients' subjective symptoms.
We divided our gastric cancer cases into three categories. Category one: those who visited our hospital with some abdominal symptoms. Category two: those who were checked by indirect radiography in gastric mass screening. Category three: those who were examined by direct gastric radiography or gastric fiberscopy, as a part of total health check-up, or during following-up of other diseases than stomach trouble.
The results were as follows. In category one, total operated patients were 1, 994, those who died were 1, 218, and those who died of gastric cancer were 985 (49.4% of operated cases). In category two, total operated patients were 517, those who died were 118, and those who died of gastric cancer were 86 people (16.6%). In category three, total operated patients were 449, those who died were 117, and only 53 patients (11.8%) died of gastric cancer.
It became clear that to get gastric examination radiologically or endoscopically before any abdominal symptoms appear, is critically beneficial to avoid deaths by gastric cancer.

View full abstract

Ibaraki prefecture is located in the northeast of the nation's capital, Tokyo, and the distance of the prefecture to Tokyo ranges from 30 km to 160 km. The population of the prefecture is approximately 3 million, ranked as the 11th out of 47 prefectures in Japan. Ibaraki is rich in nature. The agricultural product output is ranked as the 3rd, and the industrial product shipment value is the 9th. Ibaraki prefecture also has Tsukuba Science City, which is famous as a center for science and technology all over the world.
Nowadays, preparation for an aging society is our first priority. In fact, the number of children is decreasing rapidly every year. This is a result of a drop in the total fertility rate (1.35, as of 2000), a rise in the rate of unmarried young women ranging from 25 to 29 (20.9% in 1975, 54.0% in 2000), as well as the fact that people come to marry later than before. We are concerned about the serious influence on the Japanese pension system and medical insurance system. Here is an example to show how serious the situation is; an examination of teenagers' attitudes toward marriage was made in the different 4 countries. The questionnarie asked, “Do you feel that you have to marry in the future?”. The rate of teenagers, who said yes, was as follows:
The United States: 79%, Korea: 51%, France: 30%, Japan: 20%
In one sense, these results show that Japanese teenagers don't care much about marriage, continuing of family lines, and the subsistence of human beings. Taking into consideration the freedom of individuals, we must seriously consider the way that young people can meet their partner naturally and initiate a policy to encourage them to marry.
Although the Japanese National Government initiated nursing care insurance last year to cope with aging society, Ibaraki prefectural government has provided the original welfare service called the Regional Care System for elderly people who live alone, the challenged, and patients with obstinate diseases who are not covered by nursing care insurance. The Regional Care System aims at giving each person good care services in combination with doctors, nurses, and volunteers.
Rehabilitation is the key to dealing with an aging society. The prefectural government established the Ibaraki Prefectural University of Health Sciences with departments of physical therapy, occupational therapy, nursing, and so on. Moreover, we arestrongly promoting the rehabilitation support system especially in the Ibaraki Prefectural University of Health Sciences Hospital, which specializes in rehabilitation, to prevent people from being bedridden due to strokes or fractures
In addition, the Prefectural University of Health Sciences Hospital and city health centers have already been connected by TV conference system, so even people who live far from hospitals can be rehabilitated and consult therapists. We also promote to make regional central hospitals for the people who live in the areas where there are few emergency hospitals with skill doctors and high-tech medical equipments. To reduce deaths caused by cancer, which is the worst cause of deaths in Japan, we are constructing 4 regional cancer centers in the prefecture so that peoeple can receive good medical services.
We believe that health is the most important thing. Therefore, we are tackling the health promotion activity to live long healthfully and peacefully in cooperation with all citizens by setting clear goals. We will continue striving to improve health, welfare, and medical services in Ibaraki prefecture.

View full abstract

1. Postmortem examinations are conducted to judge the cause and circumstances of death. The investigation is not only for the confirmation of death but also to establish the date, manner, and cause of death and identification of the person.
Causes of death that require a medical examination are:
1) Natural deaths which fall within these parameters;
a. death without consultation of physician
b. death with unknown cause despite physician's consultation
c. death under medical condition different from that during treatment
d. unusual circumstance at onset of the disease and death e.g. acute sudden death
sudden death of an apparently healthy person death suspicious of accident or overworking unusual circumstances
2) All cases suspected of external causes such as drowning, hanging, traffic accident, suffocation, burn and cold
3) Unclear deaths, either natural or unnatural
4) Cases found dead
2. Causes of death: statistical trends Since 1967 the number of natural deaths has taken the lead and now accounts for 65% of all examinations.(natural deaths over 65 years old have amounted to over 40%). Current statistics reflect a rapid progress of the aging society.
In 1999, the frequency of the natural death was 64.3% of all medical examiner cases in Tokyo. Most frequent causes of deaths were the diseases of circulatory system (66.9%), that was ischemic heart failure (62.8%) such as myocardial infarction, cerebrovascular diseases (19.8%), such as cerebral haemorrhage, subarachnoid haemorrhage.The next were those of gastro-intestinal tract (11.5%), especially alcoholic liver disease, liver cirrhosis and those of respiratory system (8.2%) such as pneumonia, bronchial asthma.
3. Child abuse, usually committed by parents, causes abrasions, burns, fractures, hypodermal bleedings, internal injuries, and in the worst cases, death of children. It is also referred to as “Battered Child Syndrome”.
Since there are abuses conducted not only by parents but also by other guardians or teachers who are responsible for child health and safety, it has been also comprehensively called maltreatment syndrome.
Maltreatment syndrome includes child abuse and child neglect. Child abuse includesphysical abuse, sexual abuse, and mental abuse, whereas child neglect includes not feeding, not giving appropriate medical treatment, and neglecting safety.
1) Japanese Society of Legal Medicine's survey shows that cases involving a biological mother often tends to be triggered by her mental problem, a child's intellectual handicap, or her lack of affection toward her own child. On the other hand, many cases involving a father occurred during times he was stressed by his family troubles or achild's continuous crying. Recently financial worries, bad residential environments, and children's defiant attitudes have been added to the contributing factors of abuse.
2) Main means of child abuse include punching and kicking, throwing a child, burning by cigarettes or incense sticks, not feeding, choking, and so on. It is important for doctors to see any suspicious cases very carefully and to diagnose them as soon as possible, which will lead to prevent further cases.
4. When a pedestrian was hit by a bonnet-type vehicle, we frequently found that the head injuries, by collision with a bonnet of the car, and the lower thigh injuries, by the bumper, are easy to occur. Primary impact injuries were more serious than that acquired after falling down to the ground. In particular, a pedestrian sometime suffered serious injury in collision with hard parts of the vehicle, such as an A-pillar, and indirect collision with some parts of strong components under the bonnet such as shock - tower and battery, etc. If the car hit the pedestrian with a speed of more than 40 km/h, the frequency of the fatal injury sustained to a victim is increased.

View full abstract

Urbanization is progressing gradually in rural areas, but there still are large differences between rural areas near major cities and those far from them. In order to determine differences between these two types of rural areas, we compared the results of group medical examinations conducted in 1997 and 1999 in villages near Hiroshima City (rural area A), Hiraka-gun in Akita Prefecture and Minamisaku-gun in Nagano Prefecture, rural areas far from major cities (rural area B), and villages near Izumo City, Shimane Prefecture, rural areas in-between rural areas A and B (rural area C). The results of group medical examinations conducted in 1995 and 2000 were compared in each area to determined changes in the five years. A questionnaire survey on eating habits and life style was conducted during the group medical examinations in the 4 areas in order to evaluate the effects of life style on health-related parameters. In addition, mean health-related parameters were compared before and after exercise (at least 8, 000 steps per day) in the 4 areas in order to evaluate the effects of exercise on health. HDL cholesterol levels increased significantly in each area and overall in only 3 months. Findings obtained in areas where data from a non-exercise control group were obtained indicated that exercise inhibited increases in the percent of body fat.
A study on the effects of exercise on life style-related diseases and QOL of patients was conducted in Ibaraki Prefecture. No apparent correlation was seen between exercise and QOL in patients with myocardial infarction, but exercise showed a tendency to increase the QOL score in patients with good cardiac function. In diabetic patients, exercise seemed to improve not only glucose tolerance but patients' QOL as well. In hypertensive patients, exercise reduced blood pressure and improved patients' QOL. In addition, co-investigators in each area conducted the following area-specific studies: Akita Prefecture, 1) study on the relationship between the survival rate and the results of group medical examinations by age and the life style and 2) study on the effects of eating habits on health-related parameters; Nagano, study on the effects of primary prevention in the life style; Shimane, 1) cross sectional survey on the life style and health and 2) clinical epidemiological study on multiple risk factor syndrome in rural areas; and Hiroshima, study on the effects of education and guidance in high-risk patients receiving regular medical examinations.

View full abstract