Generalized

Sixty years have elapsed since the Saku Central Hospital was established in 1944, or the year preceding the end of World War II.That year, the 20-bed hospital began to deliver medical care with only two physicians. It has now developed to a point where it has a staff of 1,682 employees, including 193 doctors, with 1,193 beds. In the immediate years that followed poverty-stricken rural communities were left far behind the times, and not blessed with benefits from the government's policy of economic rehabilitation and development which led to the emergence of modern industrial society. In attempts to save rural people and their environment and health from a wide variety of postwar social distortions attendant upon the production-first policy, the hospital staff dedicated itself to the delivery of comprehensive health care under the leadership of Dr. Toshikazu Wakatsuki, the then hospital director, with the cooperation of many like-minded health professionals and local residents.The fact historically stands forth that the Saku Central Hospital, keeping in close touch with the community and making sure of their needs, was always quick to come out with health care of the kind they really wished to have. The impelling force is organizational management in tune with the spirit of cooperatives' movement with the involvement of its workers' union in the hospital's management and a great variety of cultural activities in the rural communities.The health care-related industry is now a key industry in many regions. This fact is tied in with the creation of job opportunities for youngsters in those districts that are distressed by depopulation, turning out to be an indispensable factor for the building and management of a healthy community.Given the recent exposures of corporate irregularities and medical errors, we are determined to become a hospital trusted and chosen by locals by reviewing hospital care from a standpoint of obligations to society and incorporating quality-first principles, assurance of safety, transparency and accountability, and users' satisfaction in the management system.
Hospitals ; Central brand of multivitamin with minerals ; seconds ; Health Care ; Medical History

Objective: Paraquat poisoning occurs worldwide, and both the fatality rate and the number of deaths are out of the ordinary. Japan is one of the few countries in the world that have replaced 24% products with 5% products. This report is an attempt to introduce information about paraquat poisoning in Japan.
Methods: The Japanese Association of Rural Medicine has carried out extensive surveys on clinical cases of pesticide poisoning at its 122 member installations since 2007. Of all the findings, we have picked out and evaluated those concerned with paraquat poisoning.
Findings: Twenty-two out of 28 persons who attempted to commit suicide with paraquat died in 2007-2011. The rate of deaths from suicide attempts with paraquat stands at somewhere near 80% or so even with 5% products, so it appears that the attempts to reduce the death rate did not have the intended effect even with products having a lower concentration.
Conclusion: The “outcome prediction line” propounded in 1979 still stands today, while a wide variety of therapies have been studied. It seems that paraquat should at least be classified into Class Ib (highly hazardous) given that the mortality remains high and efficacious therapies remain elusive.

　　Clinical cases of pesticide poisoning from 2010 through 2012 were analyzed based on data collected from the hospitals affiliated with the Japanese Association of Rural Medicine.　　One hundred and thirty-seven cases of pesticide poisoning were reported from 37 hospitals. By gender, males and females made up almost the same number. By age group, those in the 70-79 age band accounted for 22% of the total number of the cases, followed by those in their 60s (18%) and those in their 80s (18%). By month, the incidence peaked in May, accounting for 16%. When it comes to occupational poisoning, the majority of the cases occurred in spring and summer, when pesticides were used frequently.　　By type of pesticide exposure, suicide accounted for 71%, followed by accidental ingestion (13%) and occupational exposure (12%).　　By type of clinical manifestation, acute poisoning was most frequent (83%), followed by dermatitis (6%) and ocular disorders (5%). When it comes to occupational exposure, the rate of acute poisoning decreased to 42%, and dermatitis and ocular disorders increased to 47% and 11%, respectively.　　Amino acid herbicides topped the list of agricultural chemical compounds causing poisoning (29%), followed by and organo-phosphate insecticides (29%) and bipyridilium herbicide (8%).　　As regards main ingredients, glyphosate was the most frequent inducer (38 cases), followed by fenitrothion (18 cases) and paraquat (12 cases).　　Twenty-two death cases were reported, of which eight cases were by paraquat and three cases by fenitrothion. The death rate from paraquat poisoning was far higher than those from any other pesticides. The death number has been decreased gradually, which was correlated with the downward trend of paraquat sales.

  Clinical cases of pesticide poisoning from 2007 through 2009 were analyzed based on data collected from the hospitals affiliated with the Japanese Association of Rural Medicine.
  Two hundred and twelve cases of pesticide poisoning were reported from 48 hospitals. By gender, males accounted for 54%. By age group, those in the 60-69 age band accounted for 23%, followed by those 70-79 years old (22%) and those 50-59 years old (19%). By month, the incidence peaked in May or August accounted for 12% respectively. When it comes to occupational poisoning, the majority of the cases occurred in spring and summer, when pesticides were used frequently.
  By type of pesticide exposure, suicide accounted for 77%, followed by occupation exposure (16%) and accidental ingestion (4%).
  By type of clinical manifestation, acute poisoning was most frequent (90%), followed by dermatitis (3%) and ocular disorders (2%). When it comes to occupational exposure, the rate of acute poisoning decreased to 70%, and dermatitis and ocular disorders increased to 11% respectively.
  Organo-phosphate insecticides topped the list of agricultural chemical compounds causing poisoning (32%), followed by amino acid herbicides (22%) and bipyridilium herbicide (10%). When it comes to main ingredients, glyphosate was the most frequent inducer (32 cases), followed by fenitrothion (25 cases) and paraquat (21 cases).
  Thirty-six death cases were reported, of which 16 cases were by paraquat and 9 cases by organo-phosphate insecticides. The death rate and number from paraquat poisoning were by far larger than those from any other pesticides. A ban on the use of paraquat must be considered.

  Mass poisoning with an organo-phosphate insecticide occurred at a junior high school in Japan. We collected clinical data from four hospitals, which treated the patients, and investigated this poisoning.
  In late July, the janitor of the school dropped an undiluted solution of 40% methidathion insecticide into the nest of ant near the classroom between 10:00 and 11:00 a.m The volatilized gas spread into the classroom, and many students presented some symptoms of poisonig, 16 students were taken to neighborhood hospitals around noon.
  Of the 16 patients, 13 complained of headache, 11 of nausea, and 4 of dizziness. One patient vomited twice. The serum cholinesterase activities, the pupil diameters and the light reflexes of the patients were normal. Three patients were hospitalized one night for observation. All patients did not get sever poisoning, and recovered and had no sequela.
   It has to be admonished against spraying an undiluted solution of high toxic insecticide near the classroom, and it is necessary to take stern measures to prevent another such accident.

　　Sales of cut flowers depend much on outside appearance. They are not supposed to be, so pesticide is used more liberally for cut flower growing than for other agricultural products. When the annual group health checkups for cut-flower farmers were held in late-August in 2009, 2010, 2011, we sampled spot urines and measured four dialkylphosphates, the metabolites of the organo-phosphorous pesticide.　　At one time, concentrations of dimethylphosphate in 2 males were around 1,000-fold as much as the median of this group. Their serum cholinesterase activity levels at that time declined to 64% and 72% of their average measurements in the other years. These figures were comparable to the level that the pesticide spraying procedure should be revised, as suggested by the agricultural worker health system in California, United States which monitored cholinesterase activity levels in farmers.　　We had interviews with the two Japanese cut flower growers. One of them complained of unbearable cough with pyrethroid insecticide spraying. We advised him some measures in consideration of his history of respiratory disease. He decided not to use pyrethroid insecticides. Another man refused to talk about the pesticide exposure risk at first. But later on, we heard that he had decided to wear dust protective mask.　　The risk communication using the measurement of the index of pesticide exposure seemed to be a effective way to decrease pesticide exposure and its adverse effect. Although this procedure needs some trained interviewers and is sometimes refused by farmer, we are going to continue this type of dialogue from now on.

A total of 194 cases of liver cirrhosis, which had been treated in our hospital during the past 5 years, were calssified by the causes into the following four groups:(I) hepatitis B virus, (II) alcoholic, (III) special origins, and (IV) reasons unknown. They each accounted for 23.2%, 35.6%, 1.5% and 39.7%, of the total.
Their clinical features and prognosis were examined. To be noted is the finding that many patients in group IV had had blood transfusions. This suggests that non A non B hepatitis viruses might be involved in the occurrence of the liver disease. On the whole, the five-year survival rate was 45.6%. There was not any significant difference among the four groups. However, prognoses were poor in groups II, I and IV, in that order.
As regards the cause of death, rupture of esophageal varice and hepatic failure showed a gradual decline, but complications of hepatocellular carcinomas sharply increased. Especially, in group I, this mortality was as high as 31.1%.

Koumimachi Clinic attached to Saku Central Hospital is located in an underpopulated rural area. We have annually performed a close medical examination by upper gastrointestinal endoscopy since 1982. Since 1986, it has been done early in the morning. In 1995, a total of 1, 513 radiographic examinations were performed and 555 cases were examined by upper gastrointestinal endoscopy. Two cases of gastric cancer-one being early stage and the other, advanced stage-were detected. Despite the busy season all the farmers who had been advised to have the endoscopic examination attended because it was performed early in the morning. The early morning examination was performed in cooperation with Saku Central Hospital, Naganoken Kouseiren Health Screening Center, and public health nurses of local governments. Without such cooporation, any health care project could not be carried out a rural area.

　　Soil fumigants are used to control pests, fungi, and weeds before planting crops. As they are highly volatile and acutely toxic, farmers are often exposed to serious risks of poisoning by inhalation and contact. We investigated the use of soil fumigants and subjective symptoms of cut flower farmers by interviewing them.　　The subjects of this study consisted of 69 male farmers who came to health check, and we asked them about the names of soil fumigants they used in recent years, whether or not they wore the gas mask and the goggle, and whether they had had any subjective symptoms, and many other questions.　　Of the subjects, 68% said they used Chloropicrin and 64% gave D-D. Chloropicrin tablet and carbam were used by 15% of them, respectively.　　It was found that 38% of the chloropicrin users put on the gas mask, and that 32% put on the goggle. The occurrences of subjective symptoms differed with whether the farmer put on gas mask or goggle. The farmers without gas mask or goggle complained about watery eye (72%), couch (31%), runny nose (31%), breathing difficulties (21%), and eye irritation (19%).　　The farmers put into practice some measures to prevent chloropicrin exposure, as follows: Using the machine with injector crawls under the ground, working when gentle wind is blowing, working when the temperature of soil is low, and using the refrigerated chloropicrin.　　Some farmers and their wives informed that they had runny eye, sneeze when covering fumigated hillings with plastic films. The workers are recommended to put on the gas mask on working this process.　　The use of low-permeable film, developed in recent years, could economize on soil fumigants for cultivating some corps. It is hoped that the use of this new material will spread in cut flower farming and reduce risks of fumigant exposure.