A regional care system for ill or disabled elderly people, with a non-governmental general hospital playing a central role in providing health and medical services, was investigated in a rural area. In the southern part of Oita City, the Hetsugi Hospital is such a central medical institution. Attached to the hospital, there are the geriatric intermediate care facilities and the home-care service unit for the elederly with two full-time nurses. Organizationally independent, the hospital, the health facilities and the home-care service unit are united in their efforts to deliver comprehensive services ranging from emergency service to home health care. As a result of improvements in residential and home care activities, the average number of days the elderly patients spent in the hospital has decreased by some 10 days in the past 7 years. Our survey also found that most of the old people andtheir families are satisfied with day health-care services provided to them. In a rural setting where health, medical and welfare resources are wanting, we considered, the system in this region could serve as a model for the practical and effective care system for the disabled elederly.

Background: Recently a new direct assay for measurement oflow-density lipoprotein cholesterol has been developed. The purpose of this study was to evaluate the new method and elucidate the association of lifestyle factors with the serum levels of lowdensity lipoprotein cholesterol determined by the direct assay (LDLC/d) among healthy adults in a rural district. At the same time the levels of low-density lipoprotein cholesterol were worked out using the Friedewald formula (LDLC/f) and a comparison was made between LDLC/d and LDLC/f.
Method: Data obtained during the medical checkups in 1998 were used. LDLC/d was estimated by use of the direct assay, Cholestest (Daiichi Pure Chemicals, Japan). The subjects consisted of 678 middle-aged men and women ranging from 40-65 years of age. Co-variance analysis was performed to examine the association of lifestyle factors with lipid and lipoprotein levels.
Results: An inverse relationship was observed between LDLC/d and alcohol drinking among both male and female subjects. The body mass index (BMI) was positively related with LDLC/d among female subjects. Eating between meals was positively related with LDLC/d among males. The association of LDLC/d with these lifestyle factors was stronger than that of LDLC/f. The levels of LDLC/d weresignificantly higher than LDLC/f, suggesting that a different classification of hypercholesterolemia could be formulated by those two levels.
Conclusion: These results indicated that LDLC/d has an advantage over LDLC/f. Further research should focus on the standardization of themethod using LDLC/d to categorize the type of hypercholesterolemia.

Background: Behavior modification approaches involve various strategies of cognitive therapy. There is increasing interest in adopting such approaches in order to achieve more modest and sustainable weight control and also prevent the prevalence of hypercholesterolemia.
Objective: To better understand the risk factors associated with the development of hypercholesterolemia, we examined the relationship between changes in eating behavior based on cognitive therapy and serum low density lipoprotein cholesterol (LDLC) levels. In addition, the outlook for such individuals, lifestyle improvement was also examined based on a behavior modification approach.
Research methods: Data were obtained during regular medical checkups in 1999 from subjects. They consistied of 611 males and females ranging from 40 to 65 years of age in Kyushu, Japan. A co-variance analysis was performed to examine the independent relationship between eating behavior and the LDL-C levels.
Results: “Overeating” when not related to cognitive restraint showed a considerably strong correlation with the LDL-C levels among male subjects. In contrast, both “unplanned eating” and “pessimistic thoughts concerning dieting” were strongly associated with the LDL-C levels among female subjects. Regarding lifestyle improvement, the need to lose weight and exercise was accepted by 40-50% of the subjects.
Discussion: Male subjects need to better recognize their overeating behavior: for example, they need to understand the influence of advertising for many high-calorie fast foods. In addition, they should limit their intake of high-calorie foods and try to only eat at regular meal times. Female subjects should prepare only as much food as will be eaten at one meal. Moreover, female subjects also need to modify their pessimistic thoughts concerning dieting: for example, if they become fat, they often do not try to improve their eating habits because they assume that getting fat is unavoidable because of their innate constitution. These features of cognitive eating behavior provide both barriers and opportunities for changing LDL-C levels. Accordingly, future research needs to focus on the relationship between such cognitive behavior and the LDL-C levels.

OBJECTIVES: The purpose of this study was to evaluate the relationship between circulating serum leptin concentrations and regulation of body weight longitudinally among Japanese men and women. DESIGN: Ten-year retrospective study. SUBJECTS: A total of 328 Japanese men and women, who at baseline (2000) were 40-65 years of age, were free of hypertension, cardiovascular diseases, diabetes mellitus and hypercholesterolemia. They completed detailed lifestyle questionnaires. MEASUREMENTS: Baseline serum leptin concentrations and 10-year weight changes. RESULTS: The average levels of serum leptin were 2.93±1.47ng/ml in men and 5.67±3.00ng/ml in women. Subsequently weight gain was observed among 52% of men and 46% of women. The average gain in weight per year was 1.0±0.8kg in men and 1.3±0.9 kg in women. The observed association between weight gain and leptin concentration was limited to men with body mass index (BMI) of 18.5-25.0kg/m² in 1990, among whom a significant correlation was observed between log-transformed leptin levels and weight gain (r=0.281, p=0.002). CONCLUSION: These results suggest that elevated serum leptin concentrations among normal weight men may be used as an indicator of both leptin resistance and subsequent weight gain.

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.

OBJECTIVES: With the spread of new cultivation methods of strawberries, working conditions have been changed in recent years. Strawberry growers have also been advanced in age. And now, the need to take new measures against physiological fatigue in strawberry growers has become pressing. We investigated the relationship between physiological fatigue and risk factors among middle-aged strawberry growers due to a paucity of such epidemiological studies. DESIGN: Cross-sectional study. Questionnaires were mailed to strawberry growers. SETTING: A rural district in southern part of Japan. SUBJECTS: A total of 1,113 healthy strawberry growers (681 men and 432 women) who were 40—69 years of age. RESULTS: Prevalence of low back pain was the highest (74.0% of males and 73.8% of females), followed by shoulder stiffness and/or pain (49.6% of males and 60.4% of females), and eyestrain (45.2% of males and 50.9% of females). After adjustment of age, working hours, and sleeping hours using a logistic regression analysis, low back pain had the strongest association with agricultural-chemicals spraying among males (odds ratio 2.0; 95% confidence interval 1.4 to 2.8), but there was no significantly association among females. Shoulder stiffness and/or pain had the strongest association with removing old leaves among males (odds ratio 1.5; 95% confidence interval 1.1 to 2.2), and with agricultural-chemicals spraying among females (odds ratio 1.6; 95% confidence interval 1.1 to 2.4). Eyestrain had the strongest association with strawberry sorting among males (odds ratio 2.7; 95% confidence interval 1.9 to 3.8) and with strawberry harvesting among females (odds ratio 3.2; 95% confidence interval 2.0 to 5.1). CONCLUSON: Although the main physiological fatigue among males and females were similar in prevalence, related risk factors differed, and thus the results suggest that it is necessary to take measures against physiological fatigue in consideration of sex difference in the case of middled-aged strawberry growers.
Fatigue <1> ; Relationship by association ; Risk Factors ; Strawberry ; Statistical Prevalence

Objective: Job satisfaction and mental distress may contribute to mental illness, particularly in regard to depression and even suicide. The aim of this study was to investigate the level of job satisfaction and its relationship to the level of mental distress among farmers in comparison to non-farming rural residents. Materials and Methods: A cross-sectional questionnaire survey of 7,000 rural residents was performed to assess the level of job satisfaction and mental distress. Mental distress was measured using the 12-item General Health Questionnaire (GHQ-12). The adjusted odds ratios and their 95% confidence intervals were calculated by means of multivariate logistic regression models. Results: A total of 5,364 rural residents (1,888 farmers and 3,476 non-farmers) responded, therefore yielding a response rate of 76.6%. Twenty-five percent of the farmers and 24 percent of non-farmers were either very dissatisfied or somewhat dissatisfied with their jobs. Twenty-five percent of the farmers and 29 percent of non-farmers had mental distress (GHQ score of 4 or above). The crude odds ratio of mental distress among dissatisfied farmers in comparison to satisfied farmers was 4.38 (95% CI = 3.49-5.51). Similarly, the crude odds ratio of mental distress among dissatisfied non-farmers in comparison to satisfied non-farmers was 5.01 (95% CI = 4.19-5.98). These statistically significant odds ratios remained even after controlling for age, gender and family structure. The most important cause of mental distress among farmers was related to family finances. Among non-farmers, however, the most important cause of mental distress tended to be human relations in the workplace. Conclusion: Although farmers experienced similar levels of job satisfaction and mental distress in comparison to non-farmers, the most important cause of mental distress differed between farmers and non-farmers. As the underlying risks for this level of job satisfaction, family finances are therefore considered to be a potentially hazardous factor in regard to mental distress for farmers.
Psyche, NOS ; Job Satisfaction ; percent ; Cancer patients and suicide and depression ; Cephalic index

Objective: Due to the spread of new cultivation methods for strawberries, working conditions have changed in recent years. In addition, the average age of strawberry growers has been increasing. As a result, the need to take new measures to prevent physical fatigue in middle-aged strawberry growers has been increasing. Due to a general paucity of epidemiological studies, we investigated the relationship between physical fatigue and farmwork among middle-aged strawberry growers during the harvest season.Materials and Methods: A mail survey was carried out among 621 healthy Japanese strawberry growers (368 men and 253 women) in January 2003.Results: Lower back pain was the most frequent complaint (71% of males and 67% of females), followed by shoulder pain (45% of males and 59% of females), and eye pain (46% of males and 57% of females). After adjusting for such factors as age, working hours, and sleeping hours using a multiple logistic regression analysis, lower back pain demonstrated the strongest association with the application of gibberellins at bloom among males (odds ratio 2.0) and with the harvesting of strawberries among females (odds ratio 1.8). Shoulder pain had the strongest association with the removal of older leaves among males (odds ratio 1.9) and with the harvesting of strawberries among females (odds ratio 2.2). Eye pain had the strongest association with the clipping of needless runners among males (odds ratio 1.6) and with the application of gibberellins at bloom among females (odds ratio 2.4).Conclusion: Although the three main types of physical fatigue -- lower back pain, shoulder pain, and eye pain -- tended to have a similar prevalence, the related farmwork differed between males and females. Our results therefore suggest that it is necessary to take appropriate measures based on gender differences in order to prevent physical fatigue in middle-aged strawberry growers. Consequently, there is now an urgent need to evaluate ergonomic intervention in a controlled trial.
Fatigue <1> ; Relationship by association ; Shoulder Pain ; Seasons ; Pain

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.