The maintenance of life-supporting systems, such as respirators, has been the responsibillity of the central management unit since December 1991. The in-house unit was set up to ensure a high-quality level of maintenance and safety of medical equipment.
We analyzed the incidence of trouble with respirators between 1995 and 1999, based on the logs of the machines and check lists. Fifty-one percent of the incidence was found by medical engineers while they were making their rounds of inspection in the wards, thirty-four percent during periodical checkups at the central safety management unit, and fifteen percent upon request for examination. The faults in warmers and humidifiers attached to the respirators were found only at the wards or upon request for examination. The causes of trouble in the respirators were mechanical failures rather than human error. The mechanical factors was responsible for the incidence 2.9 times as much as human factors. The incidence of trouble associated with the warmers and humidifiers notably dropped after the types of instruments were unified in 1997. To ensure safety, we came to the conviction that the dual check system-the regular inspection at the central safety management unit and the engineers' rounds of inspection-is very effective. The selection of appropriate instruments was also important.

Cerebral stroke in rural areas is a very important disease both from medical and social aspects. Among strokes, infarction which occurs most frequently in elderly persons is liable to result from atherosclerosis. And for the development of atherosclerosis, essential hypertension is the most important predisposing factor. Other than hypertension, aging, diabetes mellitus, hyperlipemia, esp. low HDL/Tch ratio, increased hematocrit values, coronary insufficiency, cardiac failure, arythmia, esp. atrial fibrillation, are also accepted important risk factors. Affirmative of such findings, the authors are convinced of the fact that atrial fibrillation which is increasing recently is closely related to both cerebral thrombosis and embolism.
But, in regard to cerebral infarction no signifying or trigger factor, similar to very high blood pressure, that trigger cerebral hemorrhage, is clarified as yet. It is made clear in this connection that cardiac failure predisposed by hypertensive heart disease in old age, assisted by pathophysiological and other environmental conditions, is the important factor. The authors also studied the clinical predisposing parameters and preventive measures about strokes.

Cerebrovascular disease is still considered a serious health problem in Japanese rural areas. The rate of death from the disease is very high. Many clinical and epidemiological studies have been conducted so far. However, they have failed to come up with answers effective for prediction and prevention of the scourge.
As part of the agricultural coop commissioned research project entitled “Study of Cerebral Apoplexy: Its Prediction and Prevention, ” we took a questionnaire survey in 1985-86, to obtain data as regards patients' subjective symptoms, electrocardiographic observations, hematological findings and many others before the onset of cerebral apoplexy. Five medical research institutes affiliated with the national welfare federation of agricultural cooperatives responded to our questionnaire.
As a result, the subjective symptoms that showed stochastically significant increases from one year to three months before the onset of the disease as a whole were fatigue, forgetfulness and insomnia. When it comes to cerebrovascular infarction, shortness of breath, angina, forgetfulness, and nocturia were particularly notable.
All these symptoms are not peculiar to cerebral apoplexy, but it should be noted that these are the warning signals of the killer disease.