As the president of this congress of the Japanese Association of Rural Medicine, I would like to address you on some aspects of my contribution to the community from the viewpoint of agricultural medicine and rural health in the Tokachi district. The aspects of my contribution could be divided into three parts; one is relating to Farmer's lung, the next is to fatty liver, one of the important problems found by our physical check-up center, and the third is relating to reforms of the hospital management so as to meet the needs of the community with regard to medical care.
Farmer's lung is in my line since I have made a specialty of respiratory medicine. When I came to Obihiro 18 years ago, farmer's lung was prevailing. Farmers were in fear of the lung disease. I took it upon myself to cope with the epidemic. Group examinations for farmer's lung were initiated. We learned what state farmers were in and what should be done by way of prevention. Nowadays, farmer's lung is rare in this district.
As regards fatty liver, we have analyzed this pathophysiological aspect of steatosis of the liver with relation to obesity and hyperinsulinemia. In persons with fatty liver, significantly high blood levels of insulin after the glucose tolerance test was recognized. Hyperinsulinemia is well known as a risk factor for morbidity leading death. Fatty liver should be considered to be among high-risk factors for deadly diseases.
Thirdly about our hospital. Obihiro Kousei Hospital has been contributing so much to the Tokachi district. As the director of the hospital responsible for regional health care, I have encouraged our staff members to take good care of patients who visited our hospital. I have also endeavored to ameliorate our system to provide quick emergency care. The number of patients rushed to our emergency ward has been increasing as a result.
Finally, we would like to thank all the participants in the 51st Congress of the Japanese Association of Rural Medicine in Obihiro city.

View full abstract

1) Japan made a remarkable recovery from ashes in the aftermath of World War II due to the people's effort to rebuild their lives and policy markers strong leadership. Moreover, great progress in medicine improved the quality of life.
2) A sweeping change in the living environment brought about a salient change in “disease structure.” There is no major difference between diseases endemic in the rural area and those in urban area.
3) Services provided by hospitals affiliated Koseiren (the Agricultural Cooperation for Health and Welfare) include internal medicine, pediatrics, surgery, orthopedics and obstetrics and gynecology. Medical services are provided by expert doctors in each department, and their mission is to improve the quality of rural medicine.
4) Apart from department-wise treatment, there is an interdisciplinary system making it easier for clinicians in different departments to cooperate. More attention should therefore be given to medical practices by these clinicians. Clinical medicine needs not be considered a particular type of practice in a rural setting. Rural medicine should be included in the category of general medicine.
5) Unlike teaching hospitals affiliated with a university, Koseiren hospitals have an extensive range of services including treatment of common diseases (eg, common cold or diarrhea, etc.), primary care, prevention of the three most common causes of death, treatment of lifestyle-related diseases, emergency treatment, a routine health checkup, home-visit nursing care services and home care. Given the present status surrounding a rural hospital which offers extensive services, young clinicians should no longer be equally encouraged to embrace the traditional idea of rural medicine. They should rather make better use of their expertise in the management of community-based medical services.
6) Studies on clinical medicine have gradually outnumberd those on rural medicine in the collection of lectures given at the general meeting of the Japanese Association of Rural Medicine (JARM) since its establishment indicating a change in the trend of rural medicine.
7) A course in rural medicine is not offered by the faculty of medicine in Japanese universities, which indicates that Japanese Ministry of Education, Culture, Sports, Science and Technology underestimates the importance of rural medicine.
8) Rural medicine dedicated to maintaining and improving the health of the rural populace is not related to the declining tendency of agriculture and rural population as a result of irresponsible Japanese agricultural administration. Rural clinicians are not responsible for that.
9) There is no point in discussing a definition of rural medicine usually influeneced by the thought, career and religious idea of those who govern. From my standpoint as a director of a community general hospital, I think clinical medicine should cover a broad range of areas.
10) Last but not least, my strongest hope is that an increasing number of young researchers will be interested in rural medicine besides pursuing their interests im their own area of expertise, and will be enrolled a members of the JARM. With a reduced number of members, the society's idea will die. I will follow the way that the JARM changes over time hoping for its further develpoment.

View full abstract

We have carried out mass health screenig projects and health-related educational programs including those for health promotion and lifestyle improvements. The purpose of this study was to clarify how instrumental those activities are in preventing disease and cutting down outlays for medical care. The findings are as follows:
1. In an analysis of the costs shared by all municipalities in Kumamoto Prefecture under the National Health Insurance Scheme (NHIS), the larger the number of public health nurses and the higher the response rate of the basic health screening, the lower the various outlays for health care of seniors and others.
2. In the municipalities where activities for health care are briskly evolved, the percapita outlay for medical care under the NHIS is low-significantly low for the medical care of seniors, in particular-and the drop in the outlay for medical care is large as against the cost involved in health screening. Conversely, in the municipalities where the per-capital expenditure for medical care under the NHIS was low, the activities for health screening and health-related education were brisk.
3. In an analysis of Rezept, or bills for medical care, the higher the willingness to undergo a health screening, the lower the expenditure for medical care under the NHIS. This holds true particularly of the NHIS expenditure for the medical care of inpatients.
4. Gastric mass screenig is instrumental in reducing the mortality rate of stomach cancer. Its cost-effectiveness could be ascertained when the lost profit was included.
5. Mass health screening was not directly tied in with a drop in the morbidity prevalence rate, but it was found instrumental in improving everyday life practices.

View full abstract

It took more than one century after modernization started in Japan for rural residents, in contrast with urban residents, to come to enjoy modern medicine. The delay was caused by the geographic distance from medical institutions and the extreme shortage of medical doctors in countryside even after the national health insurance system for all the people started in 1961. Through the difficult period the residents have maintained a reciprocal aid system in each community and their traditional medicine, and local governments have developed their own systems of medical aid.
The recent financial difficulties both at national and local levels would inevitably arouse dissatisfaction with the current public health care system. The medical aid systems which have been developed among residents and local governments in countryside could be a new model of medical care if the dissatisfaction caused by the financial difficulties increases in the future.
From the viewpoint of medical anthropology, the traditional health care system was the complex and compound system which consisted of not only medical professionals, medical institutions and medical facilities but also a vast network of ordinary people. The financial difficulties in medical administration could provide a good opportunity to change the current health care system which will cost a greater deal and ultimately collapse.

View full abstract

Bioethics has raised many questions in the field of contemporary medicine, and successfully contributed to the reconstruction of medical ethics. Bioethics is in its character controversial and accusatory on the basis of its own principles. It is now seen to stand in confrontation with environmental ethics, which has a radically different perspective from the former. The practice of medicine in rural communities offers an opportunity to weigh and evaluate both branches of ethics for gainig a new perspective for a better and higer life.

View full abstract

There is such an opinion that low protein diet (LPD) is unnecessary for preventing progression of renal insufficiency in chronic kidney disease (CKD). However, three randomized control trials of nondiabetic nephropathy (NDN) with CKD, using a metaanalysis method, revealed the usefulness of LPD in preventing progression of renal insufficiency. It is thought that the usefulness of LPD may increase further, if we evaluate randomized control trials one by one and select only what has high quality.
WHO/FAO recommended 0.8 g/kg/day of daily protein intake (DPI) to healthy people from a viewpoint of illness prevention 30 years ago. As, in advanced nations, DPI is 1.1 to 1.3 kg/day/kg in every country, DPI of CKD will become the same level of healthy people if not regulated. It cannot be considered at all that protein restriction is not required for CKD who is more susceptive to cardiovascular diseases than healthy poeple.
In conclusion, we should monitor DPI of patients with CKD, and control DPI between 0.6 and 0.8 g/kg/day. Under the restriction of DPI, we should manage NDN with CKD to prevent progression of renal insufficiency by controlling blood pressure, suppressing rennin-angiotensin system, compensating acidosis and correcting renal anemia.

View full abstract

At present, among the types of viral hepatitis, hepatitis C virus (HCV) appears to be the major cause of hepatitis in hemodialysis units. Previously, we took blood samples from the blood tubing at the inlet and the outlet of different dialyzers and measured serum HCV-RNA levels in hemodialysis patients with HCV. We found a significant reduction in serum HCV-RNA levels through the use of a polymethylmethacrylate (PMMA) membrane in dialysis. In the present paper, we report on a case in which HCV was extinct during hemodialysis treatment. The patient was a 72- year-old woman. The duration of hemodialysis was 259 months. The biochemical findings revealed high levels of serum alkaline phosphatase and TTT. The data of other liver enzymes were within normal range. The serum HCV-RNA level, which had been tending downward, was 32 KIU/ml, when the dialyzing membrane was changed to a PMMA membrane. Thereafter, the serum HCV-RNA level further reduced and reached below 0.5 KIU/ml in 12 months. This result suggests that HCV reduction efficiency should be considered when dialyzing membranes are selected from among many.

View full abstract

This paper describes a clinical review of cases of gastric cancer treated surgically at the Department of Surgery of the Shirakawa Kosei General Hospital, the core medical institution in the southern part of Fukushima Prefecture.
During the period of 20 years from January 1981 through December 2000, a total of 1, 132 cases were operated on for gastric carcinoma. Surgical resection cases totaled 1, 023 (resection ratio: 90.4%); curative resection cases, 894 (curative resection ratio: 79.0%); 5-year survival rate for resection cases, 68.3%; and 5-year survival rate for curative resection cases, 75.6%. When the cases were divided into those treated during the first half of the 20 years nad those treated during the latter half of the 20 years, the number or resection cases was smaller during the latter than during the first half but the resection ratio was larger. The early stomach cancer cases in terms of the degree of progress, histological classification, depth and metastasis to lymph nodes have been increasing and the 5-year survival rate has been on the rise.

View full abstract