The following four possible pathways for itching sensation have been suggested by recent reports. 1) Histaminergic TRPV1-positive pathway: Although histamine-positive nerve fibers cannot strictly be classified as “itch specific” due to their excitation also by pure algogens (making them itch-selective), the existence of a subpopulation of nociceptors responsible for itching is strongly suggested. Moreover, the TRPV1-expressing neurons have been suggested to be the main sensors and mediators of itching. 2) Histaminergic TRPV1-negative pathway: The scratching behavior caused by itching was not different between capsaicin-pre-treated and vehicle-treated (control) mast cell-rich NC mice. This result suggests the existence of a capsaicin-insensitive (TRPV1-negative) histaminergic pathway. 3) Non-histaminergic PAR-2 pathway: Protease-activated receptor 2 (PAR-2) has been shown to play a role in the itching of atopic dermatitis (AD). The itch evoked by cowhage (a non-histaminergic pruritogen that activates PAR-2) is very similar in characteristics to the itch evoked by conditions such as AD. 4) Non-histaminergic serotonin (5-HT) pathway: 5-HT alone applied to the human skin evokes an itching sensation and has been suggested to be involved in the itching associated with pruritic diseases, such as polycythemia vera and cholestasis.
Pruritus ; Histamine

For the purpose to clarify the industrial fatigue and causative factors, the health examinations and the investigations of daily life were made to 138 workingwomen in a cotton-yarn factory in the rural district.
1) Comparing with other occupations, the fatigue in workingwomen was generally severe, especially in the middle-aged women who engaged in an agricultural labor besides the labor in the factory. As for the characteristics of their fatigue, the mental fatigue was more predominant than the physical fatigue. The results of Flicker test, autonomic nerve function test and urine creatinin test revealed the alternate shift working system in the factory was one of the causative factors which was responsible for the fatigue of the workingwomen.
2) The health examination revealed the high prevalence of anemia. The occurrence of the mild hypertension, the localized muscle fatigue and low back pain were also noteworthy. The investigations on the workingwomen's daily lives revealed that they engaged in an agricultural labor and households early in the morning or in the holidays, and worked for 8.6 hours in the average, and 16 hours in the maximum.
In addition to the industrial fatigue, the burdens of the agricultural labor and the households got worse the health conditions of the workingwomen. In the rural district it becomes very important to promote the comprehensive health care activities from the both sides of community health care system and occupational health care system.

A questionnaire was sent to school health nurses in rural districts of Shimane Prefecture asking them about health conditions and emergency accidents of children, problems of the health care, and safety administration in schools.
The health conditions of children in rural districts were almost common with those of children in cities of Japan. It was suggested that the increase of psychosomatic complaints and disorders of children was directly or indirectly affected by the changes of life conditions in households of side-work farmers, the inhumane competition in education and the drastic urbanization of life style.
The cooperative approach to comprehensive health care of children by the participants of school health and community health is urgently needed to promote the health level.

The state and problems of health care to farmers in the rural district, San-in, the west northern part of Japan were studied in cooperation with Agricultural Cooperative Associations, Municipalities, Health Centers, Agricultural Mutual Benefit Association and Agriculture Guide Center since 1977.
Various features of interrelationship among the demographic, living, and physical conditions were analysed from the standpoint of promoting community health level.
In our investigation almost of the farmers complained commonly of some diseases such as hypertension, anemia and lesion concerned with bone-muscle-connective tissue system. The health problems on connection with the community characteristics in each district were as follow;
1) In the truck gardening district, the fatigue, overwork, lumbago and greenhouse workers' syndrom were found in a high rate.
2) In mountainous rice crop district, anemia and fatigue in women were prevalent.
3) In the urbanized area around the city, hypertension was prevalent. High frequency of the discontinued treatment type in hypertensive patients and low consiousness for self health care were noted.
4) In the tea and grape plantation district, lumbago, cervical syndrom, osteo-arthritis of knee joint and numbness of fingers which is similar to “vibration syndrom” were noted.
It is, therefore, clear that the adequate, comprehensive medical care program in a community on the basis of socioeconomical characteristics of each district is needed to promote the cooperative activity of health service of administration, agricultural policy and inhabitant participation.

Today's one of the most important problems both in the industrial hygiene and the community health care is the health protection of farmers who are working in factories. There are many such farmers in the San'in rural districts. We surveyed the working conditions of 370 factories in Shimane Prefecture and found that they had many problems to be solved. The problems in the factories, mostly small-scale factories, are summarized as aging of workers, long working hours, insufficient rest, harmful work and night work.
Even in Sada-cho, where the local government is promoting the comprehensive community health care and encouraging the health care activity of inhabitants, the health care for factory workers is performed insufficiently. Some factories do not carry out even a periodical health examination of the workers.
We established the Sada-cho Occupational Health Association in cooperation with the local government, Izumo Health Center, Shimane Labor Standard Inspection Office and the factories in Sada-cho for the purpose of promoting the unified activity of the industrial hygiene and the community health care.

For the purpose of studying the systematization of community health care in the rural district, we made health examinations and investigations into labor conditions and daily life of women working in grape farms.
The health conditions of the women working in grape farms were considerably unfavorable. They were compelled extremely busy lives including agricultural labor, households, childcare and nursing of the elderly who were lying ill in bed.
The health examinations revealed the high prevalence of cervicobrachial disorder, lumbago, fatigue of the sensory-nervous system and some health hazards by agricultural chemicals, in addition to anemia and hypertention which show generally higher prevalence among farmers in Japan. Taking into account that the new technical know-how and agricultural chemicals will be more and more introduced to the intensive agricultural system, it will become important to raise the health level both through approaches of the community health and through industrial hygiene.
The cooperative activities which we carried out with the Agricultural Cooperative Association, Municipality, Health Center, the Agricultural Mutual Benefit Association and the Agricultural Guide Center, improved the health condition, health care delivery system and participation of workers in the activities. These effects also proved the necessity of improving living conditions in parallel with the promotion of the comprehensive health care system.

A health examination and an occupational health investigation were executed to find health problems of workingwomen in a rural factory which produces the disposable medical tools on the line. The results were as follows
1) Most of workingwomen complain of fatigue of muscle and neuro-sensory systems which is due to simple work of assembly-line operation. Mild hypertension, anemia, backpain and eyestrain are also prevalent.
2) The exposure to organic solvents was scarcely defined by our occupational environmental investigation, but an attention should be paid to the chronic intoxication by long-term, trace exposure to organic solvents. Recently organic solvents are so often used in factories in rural districts that it is very important to arrange the health check system for the intoxication by organic solvents, and to call special attentions of workingwomen to the occupational disease through the health education.
3) As many workingwomen must work hard not only at the factory but also at their homes after their duties, carrying on agricultural cultivation, household and nursing of infants, they are usually fatigued and are chronically in anemic condition. To promote the health level of workingwomen in rural district, it is very important to realize the comprehensive health care. from the standpoint of promoting community health and occupational health care.

Actual conditions of the health care of school personnel in rural districts of Shimane Prefecture were investigated, concentrating our attention on the structure of diseases, the contents of health examination, factors impeding health, and so forth.
As a result of our investigation we found that the incidence of adult diseases among school personnel is considerably high. Health examinations with complete contents should be practised in the near future.
Further, the establishment of health care system in the work place, the improvement of working conditions considering sufficiently the peculiarity of mental work and of femininity, the independence of school nurses as specialist should be realized on the basis of the understanding of actual problems, which are obtained by examinations of health care conditions at each work place including epidemiological examination.

The recent urbanization of rural communities and the associated changes of the living environments influenced the health conditions of children in rural districts of Shimane Prefecture, Japan. It obliged therefore to review the usual school health approach and to evaluate the care system to new trends of critical health problems of children.
A questionnaire was sent to school nurses asking their worries and problems about each step of the scientific school health procedure to recognize the health needs, to analyse the health problems, to plan the appropriate counterplans, to practice and to evaluate.
As a result of our investigations, the following remedies were necessary for the development of rural school health activities.
Firstly, the specialization of school nurses should be established without delay, and their working conditions should be more improved.
Secondary, school nurses should strengthen the contacts with teachers, parents and other school staffs to organize the developed school health system.
Finally, school nurses should make their efforts to delop the community-based school health care which connected the comprehensive community health care.

The rise of the average age of the population in Shimane Prefecture has become more and more conspicuous in these years. According to the estimation of the future population the aging phenome-non in Shimane Prefecture is going about fifteen years ahead of the average of Japan. Therefore it is significant to perform a community experiment of the comprehensive health care for the elderly in this prefecture, in the sense that its results will offer many useful experiences to other districts of Japan, where the aging of the population is proceeding a little more slowly.
We carried out an experiment called “the Service Package System for the Bedridden Elderly”, in Sada-cho, Shimane Prefecture in cooperation with Sada-cho, Izumo Health Center and Izumo Medical Association. It is an improvement on the health care system for the bedridden elderly and their family, which has been performed in Scandinavian countries.
The results of our experiment obviously showed the existence of many problems stemming from the lack of integration among different fields such as health care, medical care, social welfare, working and cultural life. To establish the comprehensivehealth service system for the elderly and their family the integration of these fields is most urgently demanded.