An extesive survey of labor, health and living conditions was conducted on female members of farm households who are primarily growing vegetables such as lettuce and cabbage in the highlands of Nagano Prefecture. The survey included a follow-up on the attitude of those examined physically toward health.
The busiest season for the vegetable growers extends from July to September. About one-third of the respondents in our survey said that they work more than 12 hours a day during the most part of the period.
From the viewpoint of health, the major problem was connected with pesticides, which are sprayed in relatively large quantities over the vegetable fields. Our findings showed that 65% of the female farmers are engaged in the spraying of pesticides, of whom 13% said that they had suffered from intoxication and other types of physical disturbances.
Many complained about trouble in locomotive organs. To be noted is the finding that a half of the examinees had lower back pain, which presumably has something to do with the half-rising posture which the farmers take for a long time while working in the fields.
Our examination also revealed that about 25% of the women are prone to pyelitis and cystitis.
During the busiest season, these working housewives have to bear particular burdens and pressures that have a profund impact on their ability to carry through house work. A half of the housewives said that they do not have time to do family duties such as cooking, washing and cleaning.
Since physical examinations were carried out during the slack season, the attendance at the briefing on the results of examination was pretty good. Most of the examinees who had been told they need a thorough medical checkup or treatment followed the doctors' advice.
The survey found that a majority of the housewives are doing what they can in order to improve their eating habits. As for the improvement of working conditions, however, they find it difficult to lighten their burdens due to the nature of farm work.

An epidemiological examination was carried out on 330 farmers engaged in pear and apple cultivation. First, all examinees answered questions about the presence of allergic symptoms. To those who have had any allergic symptoms, the intradermal skin reaction tests with pollen extracts (Japanese pear, apple, cedar and orchard grass) and house dust were performed.
The results were as follows:
1. 35.8% of all examinees manifested some allergic symptoms during the bloom of pear and apple (from April to May).
2. Nasal or ocular symptoms were observed in 28.5% and 27.3% respectively. About three-fourth (20.3%) of them manifested both symptoms.
3. The rate of farmers with allergic symptoms was higher in younger generations and many of these symptoms occurred within these five years.
4. The rate of positive skin reactions of each allergen extracts were 40.5% for Japanese pear pollens, 63.8% for apple pollens, 30.5% for cedar pollens, 6.7% for orchard grass pollens and 10.5% for house dust.
From a pollen calender of Nagano Prefecture, high rate of allergic symptons during the bloom of pear and apple and the results of the intradermal skin reaction tests, it may, be suggested that a considerable number of farmers possibly suffer from pear and apple pollinosis. The rates showed above are much higher than reported so far.

A survey has been under way on the incidence of cerebral apoplexy among the inhabitants (pop. 105, 185, National Census, 1970) of the Saku district of Nagano Prefecture since April 1972.
This survey, which constitutes a WHO cooperative study, has been under way with cooperation rendered by the local Medical Association, Association of Public Health Nurses in Saku District and Saku Public Health Center with the Saku Central Hospital acting as the survey center.
In the period of two years till March 1974, 585 persons were registered as having been seized with cerebral apoplexy. The annual incidence rate stood at 265 per 100, 000 population. Classified by types of cerebral apoplexy, cerebral hemorrhage accounted for 26%, cerebral thrombosis for 57%, cerebral embolism for 3%, subarachnoid hemorrhage for 9%, and other types for 5%.
By sexes, the incidence rate among males was 1.3 times higher than among females. By ages, the incidence was highest in the seventies.
When the prognosis of cerebral apoplexy is viewed in terms of deaths in the early period of less than three weeks after the onset, the mortality rate stood at 45%.
The hospitalization rate of patients seized with cerebral apoplexy was 55%. There was a significant difference in the mortality rate between inpatients (with 28%) and outpatients (65%).
The ratio of concurrence of autopsy and clinical diagnosis stood at 83% with Okinaka's criteria and 79% with Ikeda's CVD index.
The incidence of hypertension before the onset of cerebral apoplexy was extremely high among the patients seized with cerebral hemorrhage and cerebral infarction.With respect to the treatment of hypertension, the discontinuance of treatment and the failure to undergo it are high in percentage among the patients seized with cerebral hemorrhage. With reference to cerebral infarction patients of 70 years and older in age, there is little defference between the group who discontinued or failed to undergo treatment and the group who underwent it.
The recurrence of cerebral apoplexy stood at 11% for cerebral hemorrhage, 19% for cerebral infarction, and 11% for subarachnoid hemorrhage.

A survey was conducted on 117 agricultural cooperatives and 121 city, town and village offices in Nagano Prefecture to find out how they provide health care to the population. The following is a summary of the findigs of the questionnaire survey based on interviews.
1. Collaboration between agricultural co-ops and local public offices in health control activities has become closer. Nearly half of the agricultural co-ops plan and implement health screening programs jointly with city, town and village authorities. One of the favorable effects of the joint undertaking manifests itself in the form of improvement in the ratio of participants to the total populace. The average percentage of participation in the joint programs comes at 48.8% as against the prefectural average of some 22%. Moreover, the joint efforts bring about the desired effect on the implementation of after-screening guidance and other health promotion programs.
2. Of local health leaders, 87.2% said that they keep in contact with each other. Those who meet once in every one to three months account for 24.8% of the total. In the areas where health leaders have liaison meetings regularly, it is noted that there is close cooperation between medical insitutions and various health-related organizations, resulting in a marked improvement in the percentage of participation in health screenings. It is also noted that there is overall improvement in the attitude toward health control.
3. As regards the participation of inhabitants in health control activities, the women's, the young men's and the producers' associations have representatives to the health control promotion council of the agricultural cooperative in each region. Of the three associations, the women's association is the most enthusiastic with the participation ratio of 55.4%. Meanwhile, 67.8% of the agricultural co-ops send their representatives to the health promotion council of each municipal body. More representatives of agricultural co-ops and inhabitants should take part in the council in the interest of people's well-being.

In view of the present situation of agriculture in which housewives have to handlethe bulk of farm work, a study was made on the health conditions of women engaged in farming in comparison with those of non-farmers.
The study covered a total of 28, 600 females, aged from 40 to 59, who received masshealth screenings conducted between 1978 and 1980 on rural inhabitants in Nagano Prefecture as part of the outreach program by the health service corps of our hospital.
All the examinees live in areas whose principal crops are rice, vegetables and/or fruits.
The data were arranged according to seasons based on the dates of health examination in order to clarify the seasonal variations of morbidity rates and other indices of health.
Another investigation was made into seasonal changes in the length of time used byhousewives in farming, domestic chores, rest and so on with a view to studying correlation between the mode of living and health conditions.
To sum up, our findings are as fllows:
(1) Seasonal variations in the results of various laboratory tests and morbidity rates were notable, depending on the amount of farm work, dietary habits, coldness and the height above sea level.
(2) During summer months, the incidence of anemia was exceedingly high, obesity rates plummeted, and serum cholinesterase values dropped sharply among housewives who are engaged in farm work, compared with those who are not.
(3) In summer, farm housewives worked long hours in the fields, slept less and rested less. They had not enough time to attend to household duties.

Recently, there have been signs of a rise in the number of farm workers with lumbago. The authors have surveyed and researched farm workers' complaints about lumbago and the relations among lumbago, farm work and daily life. The findings revealed that:
1) Complaints about lumbago are evidenthly greater among farm workers than other people.
2) People with complaints about lumbago increase with age. Men and women in their 40s reach a peak.
3) In terms of farm work, the rate of complaints about lumbago is great for forward-bending and half-sitting postures and for the carrying of heavy objects and the bending and stretching of the waist. In terms of the work environment, cold weather produces a great impact on the incidence and degeneration of lumbago.
4) In checkups of people with lumbago, there are many cases with muscular and myofasiogenic lumbago.
5) Complaints have something to do with an elapse of time. Daily calithenics is believed to the alleviation of complaints about lumbago.

We studied cardiac function and outcome long after aortic valve replacement using a 19mm bileaflet valve. The subjects consisted of 10 of 12 patients living 10 or more years after the operation and 7 of 8 living 5-9 years after the operation. We measured the left ventricular ejection fraction (LVEF), %fraction shortening (%FS), left ventricular diastolic dimension (LVDd), systolic dimension (LVDs), PWT, IVST, and LV-aortic pressure gradient (PG) of in 6 patients each in 10 more years after the operation (Group I) and 5-9 years after the operation (Group II) who underwent ultrasonography, and calculated the left ventricular mass index (LVMI). No statistically significant differences were seen in either parameter in either group. Prognosis was 1 cardiac 2 cancer deaths each in 10 or more years after the operation group. The cumulative survival rate was in 85.7% post operative 5-9 years and 72.7% in 10 years. Although cardiac function was maintained in both groups, more observation is needed from now on because the pressure difference or LVMI may increase.

Median sternotomy is commonly used for suture fixation of a myocardial lead. Instead of this conventional technique, we used the technique of resecting the 5th costal cartilage through a small horizontal skin incision at the left 5th sternocostal junction in 33 patients, between 1980 and 2001. Here we describe this procedure, as well as the outcome of patients who underwent this myocardial lead fixation procedure. A skin incision of about 6 to 8cm was made in the left 5th intercostal space. Approximately 5cm of the 5th costal cartilage was resected through the skin incision. Then, a myocardial lead was sutured on to the anterior wall of the right ventricle. The generator was generally placed in the upper subcutaneous space of abdomen. Additional costal cartilages were removed in 7 patients in whom a larger operating field could not be obtained initially. The electrode was sutured to the right ventricular wall in 28 patients, right atrial wall in 6 patients, and the left ventricular wall in 5 patients. The mean operation time was 150min and mean bleeding during operation was 82ml. Long-term results (258 months at the longest, at the time of writing) showed that all the patients did well, except for one adult who suffered cerebral infarction, and one child with pacing failure. Based on these findings, we believe that this procedure is minimally invasive method, and is good for fixation of a myocardial lead.

BACKGROUND/AIMS: Recent genome-wide analyses have provided strong evidence concerning adverse events caused by thiopurine drugs such as azathioprine (AZA) and 6-mercaptopurine. The strong associations identified between NUDT15 p.Arg139Cys and thiopurine-induced leukopenia and severe hair loss have been studied and confirmed over the last 2 years. However, other coding variants, including NUDT15 p.Val18_Val19insGlyVal, NUDT15 p.Val18Ile, and FTO p.Ala134Thr, and a noncoding variation in RUNX1 (rs2834826) remain to be examined in detail in this respect. Therefore, we investigated the correlation between these adverse events and the 5 recently identified variants mentioned above among Japanese patients with inflammatory bowel diseases (IBD). METHODS: One hundred sixty thiopurine-treated patients with IBD were enrolled. Genotyping was performed using TaqMan SNP Genotyping Assays or Sanger sequencing. RESULTS: None of the 5 variants were associated with gastrointestinal intolerance to AZA. However, NUDT15 p.Arg139Cys was significantly associated with the interval between initiation and discontinuation of AZA among patients with gastrointestinal intolerance. This variant was strongly associated with early (<8 weeks) and late (≥8 weeks) leukopenia and severe hair loss. Moreover, it correlated with the interval between initiation of thiopurine therapy and leukopenia occurrence, and average thiopurine dose. NUDT15 p.Val18_Val19insGlyVal, NUDT15 p.Val18Ile, FTO p.Ala134Thr, and RUNX1 rs2834826 exhibited no significant relationship with the adverse events examined. CONCLUSIONS: Of the 5 variants investigated, NUDT15 p.Arg139Cys had the strongest impact on thiopurine-induced leukopenia and severe hair loss; therefore, its genotyping should be prioritized over that of other variants in efforts to predict these adverse events in Japanese patients with IBD.
6-Mercaptopurine ; Asian Continental Ancestry Group* ; Azathioprine ; Clinical Coding ; Hair ; Humans ; Inflammatory Bowel Diseases* ; Leukopenia

Purpose: To examine the feasibility of the Integrated Palliative care Outcome Scale (IPOS), a comprehensive palliative care scale, for non-cancer patients. Methods: Twenty non-cancer patients and 20 healthcare providers who provide care to the participating patients were asked to complete the IPOS questionnaire, and cognitive interviews were conducted with them. The interviews were analysed using content analysis, a qualitative analysis method. Results: About half to 90% of both patients and healthcare providers answered that they did not find it difficult to answer or understand all items of the IPOS. Therefore, we confirmed its surface validity, and the content validity of the IPOS was confirmed. Conclusion: The surface validity and content validity of the IPOS for non-cancer patients were confirmed, and it became clear that the IPOS can be used as a comprehensive assessment tool for the palliative care of non-cancer patients.