Recently paraquat poisoning cases are increasing, and vicious crimes such as suicides and accidental troubles are now serious social problems.
We experienced 59 paraquat poisoning cases for the last four years and the number of deaths were 39. We changed the treatrents of paraquat poisoning from September 1982. In consequence the lifesaving rate was improved from 7.1 percent to 42.2 percent. But the mortality of the paraquat poisoning cases is still much higher than that of poisoning due to other agricultural chemicals.
We made questionnaire inquiries about paraquat poisoning in the rural population in Kumamoto in June and July 1984. As a result of this investigation we found that they can buy the paraquat liquid easily but receive no explanation about the toxic effects. Moreover they neglect severe custody. These factors are promoting the increase of paraquat poisoning.
It seems to be dangerous to use the paraquat liquid without strong prescriptions. We hope administrative measures to be done without delay

The paraquat liquid is a kind of herbicides which have extremely high mortality rate. A few years ago, such crimes as the paraquat liquid is poured into soft drinks occurred frequently and paraquat poisoning became a serious social problem. And now the lower concentrated paraquat liquid is on sale.
We experienced 190 paraquat poisoning cases for the past twelve years in Kumamoto Red Cross Hospital. Although the treatments of paraquat poisoning were improved at 1982, the mortality rate is extremely high (63.7%) as ever. Moreover paraquat poisoning cases have not been decreased for the last few years.
Judging from the latest trend of paraquat poisoning cases, miss-drinking cases and accidental cases during agricultural works are decreasing. This fact shows improvement of the knowledge about paraquat poisoning in the population. However suicide cases are increasing. On the other hand, paraguat poisoning occurred in the same frequency between farmers and non-farmers. Moreover accidents by former products, which are discontinued selling, are frequent as before. From these facts, we feel sales control and supervision of the paraquat liquid is unsatisfactory. But the fact that former products were not collected and the use of them was not forbidden is one of more important problems. The lower concentrated paraquat liquid still have high mortarity rate (70.0%) in addition.
There is no certain treatment for paraquat poisoning. And paraquat poisoning include many problems which cannot be solved only by the consciousness of the users and the administrative advices. From now on, it is natural to make efforts to solve various problems we are faced. Moreover it seems to be necessary to reconsider the worth of the paraquat liquid for preventing social crimes, too.

Kikusui, situated in the northwestern part of Kumamoto Prefecture, is famous for its remains of ancient Japan and at the same time known as a town blessed with the natural environment. As is the case with many other rural areas in this country, graying in population has been progressing at a fast clip here in recent years. To cope with the situation, Kikusui Town has taken uponitself to implement a comprehensive geriatric health care scheme since 1973 that covers not the physical aspect alone but also the mental aspect of the lives of the senior members of the population. During the period, the social welfare council and the societies of old people linked up with public health nurses. Later, the town hospital and its health control center joined with them to establish a home visit system to take care of the aged at home with the support of the government. Further, a nursing home for old people was built on the premises of the town hospital and started the day care services to back up the home care system. Various programs for home care were carried out in the main by visiting nurses. From the standpoint of the medical institution, cooperation with welfare workers was vital. Moreover, it was important for the residents of Kikusui Town to participate in this project. In the present paper, we will report on how the home care system for old people came into being.

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.

The remarkable progress and spread of ultrasonic diagnostic equipment has maid it possible to diagnose various diseases more easily and quickly.
From August, 1983, we began to examine abdominal organs such as the liver, gallbladder, pancreas, kidney, spleen, and bile duct using ultrasonic diagnostic equipment in the Health Care Center. On the other hand, we began ultrasonographic (US) mass screening for the people in the rural areas and occupational areas from March, 1984.
We examined 9803 subjects in the Health Care Center and 11558 subjects in 23 rural areas and 15 occupational areas of Kumamoto Prefecture through June, 1986. Among these 21361 subjects, 6882 (32.2 percent) cases showed abnormal findings. Main diseases detected by US screening were gallstone, gallbladder polyp, liver cyst, liver tumor, renal cyst, renal tumor, renal stone, and so on.
In the Health Care Center we could find 23 cancer cases such as two gallbladder cancer cases, seven hepatoma cases, twelve renal cell carcinoma cases, one bile duct carcinoma case, and one gastric cancer case. The prevalence rate was 0.23 percent. On the other hand, 14 cancer cases such as two gallbladder cancer cases, three hepatoma cases, two metastatic liver cancer cases, four renal cell carcinoma cases, one transitional cell carcinoma case of the kidney, and one pancreas cancer case were found in the US mass screening. The prevalence rate was 0.12 percent.
By using ultrasonic diagnostic equipment, we can find many latent diseases which show no abdominal findings by the traditional screening systems. Especially the fact that we discovered many cancer cases and the majority of them were operated on in their early stage was highly important. If we had no chance to examine these patients by US examination, these cancer cases could probably not have been discovered.
To conqure various problems such as the training of examiners, the systematization of these thorough examinations as well as post examination therapy, and the education of examinees will difinitely contribute significantly to the effectiveness of the US mass screening method.

Nowadays the agricultural production system in the farm area has remarkably been changed and this has influenced the farmers in many aspects of life.
We tried by epidemiologic cross-sectional survey to ascertain the health level of 6, 597 farmers, who are self-supporting and middle class in the sixty-seven different districts of Kumamoto Prefecture. It is noticeable that judging from the difference of districts, the health level of the farmers who have a big gricultural production is low, and judging from the difference of the class, that of the farmers who have other jobs besides agriculture is low, too In general, the health level of males is relatively higher than that of females, but the health level of males is higher than that of females, depending on the class difference.
Generally speaking, we noticed that the health level of female is very low, and at the same time the variation of the health level of females is more remarkable than that of males, depending on the quality of the district in which they live.
These resutls of these investigations should be utilized as the basic materials source for a prospective survey of changing farm village from now.

We have performed mass surveys for colorectal cancer by using an immunological fecal occult blood test (OC Hemodia) since April, 1987. In this report, we evaluated the mass survey protocol, and investigated the upcoming problems and measures.
The total number of examinees for six years until March, 1993 was 172, 474. The persons needed detailed examination amounted to 6, 952 (4.0%) and the persons received the detailed examination, 4, 706 (67.7%). A total of 144 colorectal cancer cases (detection rate: 0.08%, 153 lesions) were discovered, 93 cases (64.6%) were in their early stage. 101 cases (66.0%) of 153 lesions were early cancer, and 71 cases (70.3%) were cured by endoscopic polypectomy.
The detection rate of colorectal cancer was higher in males than females. In particular, the finding rate for males 50 years old and above was extremely high. We strongly recommend that the elderly people should receive a mass survey. Moreover, it is important to offer the opportunity for detailed examination to the persons who don't receive them. That might raise the detection rate.
It was found that detailed examination has left much room for improvement in terms of methodology. Some medical institutions performed only fecal occult blood testing. They are require d to raise the understanding of mass surveys for colorectal cancer. Collaboration with the medical institutions that are capable of detailed examination and care is indispensable to raise the accuracy of examination.
On the basis of the results in 1992, we calculated the diagnostic accuracy of immunological fecal occult blood test. The sensitivity of the one-day-method was 70.8%, the specificity, 97.0%, and the positive predictive value 2.1. The sensitivity of the two-days-method was 86.7%, the specificity, 95. 3%, and the positive predictive value, 2.7, and was better than the one-day-method.
These findings suggest that the carcinomas, negative to the occult blood test, still exist in a high frequency rate. Therefore, we should perform mass surveys by the two-days-method every year, in order to improve the evaluation of the mass survey method for colorectal cancer.