We looked at health problems in rural areas with high rate of the elderly from the standpoint of the prevention of adult diseases and health care.
Our studies have showed that to prevent circulatory diseases, weight control and cessation of smoking are effective, and that moderate drinking could work as a protective factor.
As for the age-related decrease in the body's ability to process carbohydrates and complications of diabetes among the elderly, their relations with glucose tolerance, and lipidometabolism were investigated in the middle-aged and older groups.
Of the patients undergoing the treatment of chronic renal failure by the “Toride Method, ” 60% showed their renal function remained unchanged. To grasp the actual state of patients receiving dialysis, the physically handicapped persons' certificates they possess should be utilized.
It was found that a combination system of ultrasonography and dual energy x-ray absorptiometry is useful in mass screenings for osteoporosis. A major protective factor for osteoporosis is regular exercise.
In light of the opinions sought from many people regarding the practice for a member of the family to attend on the inpatient at the bedside, terminal care, euthanasia and hospice, we dwelt on the realities of medical care.
We also analyzed the present state of institutional services based on a questionnaire survey of hospitals affiliated with the prefectural welfare federation of agricultural cooperatives and the welfare programs for the elderly made by local governments in order to make clear the area where hospitals and other medical institutions should partake.

Serum levels of total high-density lipoprotein cholesterol (HDL-C) and its subfractions (HDL₂-Cand HD_L3-C) were measured in 227 healthy Japanese adults. These values were related to a number of lifestyle factors.
On co-variance analysis, alcohol drinking had an independent contribution to HDL-C and HDL₃-C (p<0.05) in males. Cigarette smoking showed no association with subfractions of HDL-C in males. Three physical activities-sport, work and leisure time activity-had no significant association with subfractions of HDL-C. The degree of obesity as expressed by body mass index (BMI) was significantly negatively related (p<0.05) to HDL-C and HDL₂-C levels among females. Among males, although a trend test showed no statistically significant relation to BMI, HDL-C and HDL₂-C levels were significantly higher (p<0.05) in the normal group (20≤BMI<25) than in the obese group (BMI≥25).

Using the 1983-87 data on deaths from pesticide poisoning (in 1986, the fatalities hit an all-time high in Japan), we analysed the geographical differences in the rate of incidence in Fukuoka Prefecture by the standardized mortality ratios (SMRs). The SMRs were compared with the controls of local health centers separately.
The number of deaths from pesticide poisoning were 10, 753 (male: female ratio 3: 2) according to the vital statistics in Japan during the 5 years, and 81% of them was attiributed to suicide and 15% was to accidental exposure.
Fukuoka Prefecture had 351 deaths (223 males and 128 females) from pesticide poisoning, most of them being at age 40 to 50.
Seventy-one percent of the deaths from pesticide were suicide, and the percentage of suicide was higher in females (77%, 99/128) than in males (68%, 151/223).
A study of the SMRs of pesticide poisoning showed that the rates are higher in rural areas (including the Chikugo district) than urban areas (including the Fukuoka City and Kitakyushu City) both in males and females. A similar pattern was observed in the distribution of SMRs of suicide by pesticide.
It was made clear that the higher the mortality from pesticide poisoning, the higher the rate of suicide by pesticide. The easy access to pesticides in rural areas may have contributed to the high incidence of suicide by pesticide. Therefore, it is absolutely necessary for all users to exercise strict rigilance against the misuse of pesticides.

We have been delivering health care to the residents and investigating about their health administration in Yasu-machi of Fukuoka prefecture, since 1982. This study has suggested that the results of three examinations are useful to establish in primary health care of the rural area.
First, examination was carried out to evaluate their health consciousness and their attitude about treatment in 1982. Then we conducted their health needs from the data, which were gathered from questionaires of 1259 adults who were between 20 and 74 years of age.
Second, health statuses of 498 adults in objective group were certificated by medical examination including the data used for electrocardiograph and ophthalmofundoscope.
Third, we investigated both the case history and the medical cost utilizing the details of the medical expenses of national health insurance in the all area (26, 103 cases in 1982 and 27, 437 cases in 1983). For these data, we examined the difference in medical costs before the Health Service Law for the Aged was enforced and the medical costs after that. Further correlations between medical expenses and social factors such as family pattern and spouse presence were devised.
We conclude that the results of these three examinations provide basal materials which are useful to proceed further with the policy of primary health care in this area.

To examine relationship between the family composition and medical expenses for circuration diseases in the elderly people who were 65 or more, we analysed the 1982 and 1983 data of medical expenses of national health insurance in the rural area of Fukuoka Prefecture.
The elderly people were classified into five groups according to whether they were living with their children and whether their spouse was alive.
The results were as follows:
1) In the elderly people who were living with their children, the medical expenses were low among those living with their spouses and high among those living without.
2) In the elderly people who were not living with their children, the medicalexpenses were low among the elderly men with their spouses and high among the eldrly women without.
3) In the elderly people who were living alone, the elderly men and women had low medical expenses in hospital services and ambulatory services.
4) The medical expenses for circulation diseases were more influenced by the presence of spouses than living with their children.

About 7, 000 workers migrated from Kochi Prefecture in 1965. Recently the number of patients with pneumoconiosis and vibration syndrome has increased among these persons who worked on constructing tunnels. To investigate the health status of these workers, we interviewed 73 of these workers with regard to history of migration, work situations, health condition and so on in Niyodo Village in Kochi Prefecture. Thirty workers were examined for pneumoconiosis and vibration syndrome. Geographical distribution of the areas from which these workers had migrated were also analysed by using the statistical data of Kochi Prefecture in 1965.
The results were as follows:
1) Numerous migrant workers come from the mountain villages along the Shikoku Mountains. In the middle-northern areas, included Niyodo Village, the number of migrant workers was large.
2) Their working conditions in the tunnel were poor and measures for prevention of pneumoconiosis, such as wearing of a dust respirator and drilling the rock with water, were poorly carried out. Vibrating tools were also used for long periods of time.
3) Of 73 workers, 40 have been given the compensation follwing a diagnosis of pneumoconiosis or vibration syndrome.
4) In 23 examinees, silicosis was detected in the chest X-ray examination. Classifications included 13 of type 1, 7 of type 2, and 3 of type 4. Also examinees had subjective symptoms and/or objective findings of vibration syndrome. Eighty seven percent were classified as Grade III according to the criteria of Andreeva-Galanina. Thus, most of migrant workers involved in tunnel construction work had complications of pneumoconsosis and vibration syndrome.