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.

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.

Rheumatoid arthritis and interstitial pneumonitis were diagnosed in a 72-year-old man and thoracic computed tomography revealed an aortic arch aneurysm 50mm in diameter. Steroid therapy gave symptomatic relief and improved laboratory findings, but hyperglycemia and hypertension developed. Two months later the thoracic aneurysm ruptured, and computed tomography revealed expansion of the aneurysm to 60mm in diameter and surrounding hematoma. Emergency total arch replacement was performed successfully with deep hypothermic cardiopulmonary bypass and selective cerebral perfusion. The steroid therapy was considered to be responsible for the rapid expansion and rupture of the thoracic aneurysm. When prescribing steroids for a patient who has a concomitant atherosclerotic cardiovascular disease, we should not only control the steroidal side effects strictly, but also carefully watch the course of the atherosclerotic lesion.

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.

In order to develop the health care system for the elderly we need to analyse fundamentally the phenomenon that the average age of population in each community is rapidly becoming older, as well as we have to grasp life conditions and health needs of old people. We investigated the rate of increase or decrease of population, rate of the elderly living by themselves and the index of the aging of population of each community, classified these communities into several types, and presented the points necessary to develop a community-based comprehensive health care for the elderly as to each type by considering the meanings the indices of health care, medical care and social welfare of the communities disclose.

Recently, while the medical technology developed remarkably on the one hand, the soscial need for preventive medicine largely increased on the other. In Japan, it is an urgent problem of the medical education how to create effective methodology and technology of the preventive medicine that can attract students who generally prefer to become professionals in clinical medicine.
Since 1978 we have practiced an educational programme in which each student looks after one family picked up from the agricultural district for one year, caring for the health of the family members and helping them out of health problems, if there are any. In this way students can learn primary health care and community health of their own will.
Compared with the traditional method, this method is effective in making the students understand with real interest the meanings of comprehensive primary health care through concerning themselves in the health care of a family as “a socio-economical-psycho-complex”.

In a farm village of Shimane Prefecture we conducted an investigation on the difference of nutrition between young, middle-aged and old generations. The result showed that nutrition was below the necessary level in the old generation, with many foods being scantily taken. Irrespective of generation the diet was of Japanese style. It will be necessary to guide people to the improvement of dietary life according to generations.
The dietary life of bedridden people and of those who attend to them was the worst of all. Some social measures to improve the situation, as well as the repletion of primary health care for old people are urgently required.
Women in rural communities generally have concrete demands for improvement of the dietary life. It is important to carry out the improvement in harmony with the actual condition of life in the community and the demand of inhabitants.

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.