In a district of southern Ibaraki Prefecture, we have establsihed a regional medical care conference to approach a task that serves elderly people who need home care, in a comprehensive sort of way mustering expertise in health, medicine and welfare. We have also held joint study meetings of visiting nurses and health workers and courses to train leaders among old people. Thanks to these efforts, it has been made possible to put home health care into practice more effectively.
Home patients cannot be cared for fully by their family alone; home health care is something that must be tackled by the whole community. Our hospital, as the nucleus of regional medical institutions, must take it upon itself to play a central role in promoting education regarding home care.
Home nursing costs now almost equal revenues because of a revision of the rate of fees for medical services.

A survey was conducted on the health of young people engaged in farming in a suburban district in the southwestern part of Ibaraki Prefecture. The purpose was to seek a more effective way of implementing a health-control program. The results of the survey revealed several points that have arrested our attention.
First, many of the young people surveyed seemed to be indifferent to their health. It is necessary, therefore, to help them understand the importance of health examination and to encourage them to participate in mass screening projects.
Second, not a few young people were found to suffer more or less from stress diseases. A majority of those who were found to need medical attention are considered to be at risk to adult diseases.
Third, in view of the fact that bed habits have caused many physical disorders in the subjects, primary preventive care is called for before everything else in rural medicine. Periodic checkups are just a secondary level of preventive medicine to detect adult diseases for earlytreatment.
The incidence of adult diseases is linked with such factors as the mode of living, social environment, and many others. Although some of the risk factors are beyond the control of each individual, cigarette smoking, drinking, overnutrition, lack of exercise and other lifestyle-induced health problems are controllable.
We should urge young people to train and build up their bodies, and to shake off unhealthy eating habits. Improvenment of domestic conditions is also an important point in reducing health risks.

828 female agricultural workers were studied. Their age, blood pressure, Broca index, hemoglobin content, serum total cholesterol, activity of serum cholinesterase and transaminase (GOT and GPT) was measured. The distribution of each factor was examined in the sample of agricultural workers. The data for mean blood pressure, total cholesterol, activity of cholinesterase, GOT and GPT showed a log normal distribution.
For the screening of the data, Mahalanobis's distance was calculated and the abnormal data (P<0.01) was compared with the worker's medical record. The data of non healthy women was excluded from the following calculation.
The correlation coefficients between the activity of cholinesterase and other factors (age, Broca index, mean blood pressure, hemoglobin content, GOT and GPT) were statistically significant. This result indicates that the activity of cholinesterase somewhat depends on these factors.
It is important to investigate the relationships between the activity of cholinesterase and some biochemical factors, and to establish the standard value of its activity in order to estimate the effect of pesticides.

Respiratory and dermal exposures of the sprayman to pesticide sprayed by a dilute spray machine (speed sprayer) were studied in fruits orchards. Aerial concentration change of pesticide in the air were also investigated. The degrees of respiratory and dermal exposures were nearly independent on the size of machine, while they were higher in spring than in summer. The degree of respiratory exposure of pesticide was proportional to that of dermal exposure. The dermal exposure of sprayman was greatly reduced by the use of the machine equipped with a hood, which was not so effective against his respiratory exposure.
Serum choline esterase activity of the sprayman was almost unchanged after pesticide spraying. The pesticide in orchard air was detected more than 3 hours after spraying. When pesticide was sprayed by the speed sprayer, the pesticide mist drifted into the house near the orchard.

For the purpose of clarifying the different roles of two tertiary care hospitals, namely the Tsukuba University Hospital and Tsuchiura Kyodo Hospital, we researched for the consulting behaviours of out patients in these two hospitals.
As Results:
1) About the classification of the diseases and the morbidity rate, there was slight degree of differences between the out patients in these two hospitals.
2) The motivations of consulting both of these two hospitals were seen in a large number the items of “confidence to the scientific medical arts” and “excellent medical instruments”.
3) The majority of out patients of both hospitals take about within one hour coming to hospital, in spite of various transport methods.
4) Specific functions and different roles were seen only a little between these two tertiary care hospitals in the same region.
We hope to make more propaganda and education, not only to patients but also to medical staffs, concerning with the regional activities of comprehensive health and medical planning and resources.

The regression analysis between the activity of serum cholinesterase and some biochemical factors of female agricultural workers was examined.
To normalize the value of the factors, logarithmic value was calculated. Multiple regression analysis between the activity of cholinesterase and the factors related to liver function, such as the activity of GOT, GPT and total cholesterol content were calculated. The most significant factor related to cholinesterase was total cholesterol content, and the activity of GPT was the second. The Multiple regression coefficients of the equation between the cholinesterase and total cholesterol and GPT were from 9.7 to 18.3.
Using all biochemical factors as independent variables, the most suitable equation was determined from calculating the predictive sum of square (PSS). The activity of cholinesterase (ln (ChE)) depends upon the following factors, age, ln (GPT), ln (TCh) and Broca index. Hemoglobin content could also be added as a variable. The equation is;
ln (ChE) =0.002126 (age) +0.04028 ln (GPT) +0.2112 ln (TCh) +0.002188 (Broca index)-1.5687+α Where α is the parameter of each population.
From this equation, the standard value of the activity of cholinesterase of each woman was calculated. The estimate of cholinesterase activity may be useful to examine the inhibitory effect of pesticides on cholinesterase.

During winter months, lotus growers have to harvest edible roots, waist-deep in the muddy fields. In addition to such an external factor as the cold, physical labor involved is so hard that a level of stress is considered high, especially on the cardiovascular system. In this study, we examined how hard the labor is on the cardiovascular system, based on the measurements of hemodynamic parameters taken in the fields while farmers were working. The subjects were comprised of a total of 18 lotus growers-11 men and 7 women-aged between 41 and 66 years (mean: 56.7 years old). During a week before the measurement was performed, a physical examination and an anaerobic threshold (AT) test were given. In the field, each examinee carried an ambulatory electrocardiograph with him or her and levels of blood Pressure (BP), heart rate (HR), and blood saturation-O₂ (SO₂) were measured. During work, the heart rate was elevated significantly, but did not exceed the evaluated maximum heart rate in every case. Immediately after the work, the HR returned to the level measured before the work began. No significant fluctuation was noted in BP, pressure-rate-products (PRP) and SO₂ even during the work. Any sign associated with ischemia was not observed on ECG, either. Soon after the work began, the blood pressure level tended to lower in women compared with that in men and the PRP did not rise in women so much as it did in the opposite sex. However, in two elderly subjects of over 60 years, arrhythmia was noted along with the elevation of blood pressure soon after the stop of the work. These results showed that harvesting lotus roots did not bring about marked changes in the hemodynamic parameters and that the caraiovascular load was slight. However, an adequate health control system should be worked out for the lotus growers of advanced age over 60.

In a series of studies of the workload of lotus growers and their health condition, we checked up on the results of group health screening of lotus growers in comparison with those of other farmers among Tsuchiura agricultural cooperative members in 1992. During that year, we also carried out a time study of lotus cultiration from planting through harvesting. In 1993, we investigated the lifestyle and behavioral pattern of lotus growers. In 1994, an index of cummulative fatigue symptoms was made for lotus growers and loads exerted on their circulatory system were examined.
These studies brought to light hard facts about lotus growing. The farmers have to work in muddy fields laboriously, and for many hours at that, planting in the hottest season and harvesting in the coldest season for many hours. Even when they feel ill, they cannot afford to leave toiling off for their health. We found many signs and symptoms of physical disorder resulting from overwork and peculiar to lotus growing. To improve the working conditions of lotus growing, we recommended the use of the lotus center as a labor saving mode of work so as to facilitate the introduction of power harvesters or the use of greenhouses.
Although there are many socioeconomic issues such as aging of the farming populace, lack of successors and decline in agricultural economy, we will continue to make efforts at health control to protect the health and welfare of farmers by accumulating our knowlege through studies of the state of lotus farming and the health condition of the lotus farmers in other areas as well.

We have carried out a health developing project for three years at two flat rural areas in Ibaraki prefecture, O in Ushiku town and N in Iwai city, taking female farmers as the subjects.
As a result, people in these areas obtained by developing reciprocal assistance a belief in selfsupport and knowledge of diseases, which lead to remarkable progress of their health such as improvement of nutrition and cosolidation of agricultural and life environment. Some observations in the study are discussed below.
1) In the two areas, the number of people with no abnormality increased while those requiring care decreased, The number of people to be treated or under treatment was nearly unchanged, probably because of chronic deseases. No death and complication occured during the three years.
2) Owing to the difference between O and N areas in the age structure of examinees, areal characteristics and types of agricultural products, the results of health examinations in these two areas were somewhat different.
3) The health developing project will become more effective if male farmers participate together with the female farmers.
4) Continuation of the health care activity in these areas will establish voluntary organizations of residents.

A survey was made of the state of home care for healthy old folks and those elderly patients who have been disabled by illness or injury, and the care provided by institutions in six areas throughout the nation.
The number of healthy old people was larger in women than in men. However, men had the edgeon women in Activity Daily Living (ADL). Compared to the healthy aged people, many ill or disabled elderly patients receiving home care were found to be suffering from anemia, low cholesterol level, hypoproteinemia, and poor glucose-tolerance. The major cause of disability was cerebral apoplexy. Recently, the cases of cerebral hemorrhage have decreased in number, and the rate of death in acute stage has notability declined ; however, the incidence of cerebral infarction is on the increase among the aged.
There are limits to care for disabled elderly patients at home by the family because of the aging of their spouses and the increasing trend toward the nuclear family. Many of those who look after the sick persons are crying for expert help and services capable of coping with a sudden change in the patient's condition. Hence the need to establish a 24-hour home care providing system. It is desirable to establish old people's homes, as residential care institusion, in alignment with hospitals. This system would facilitate hospitalization in case of emergency. To execute care programs more effectively, close collaboration will be necessary among hospital, home care services, clinics, local governments, agricultural cooperatives, and neighborhood associations.