We examined values of fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA_1c) in 8, 870 subjects who underwent the mass screening conducted by Naganoken Koseiren Kenkokanri Center. The mean values of FPG and HbA_1c were 95.3±15.0mg/dl, and 5.12±0.50%. Both values increased significantly withage. FPG was correlated significantly with HbA_1c. Neither age nor body mass index wasrelated with HbA_1c statistically. 60.8% of the cases of the HbA_1c value of 5.8 werediagnosed as impaired fasting glucose (IFG) or diabetes mellitus (DM). 68.7% of the cases of at the HbA_1c value of 5.9 were in normal FPG range. In a mass screening, diagnosis of IFG or DM by FPG value is easy and lessens a burden of those who take on a group checkup. But diagnosis by FPG level may bring about excess diabetic patients who arehealthy. So diagnosis of IFG or DM in a mass screening should be made by both FPG and HbA_1c values instead of FPG alone.

The numbers of cases of high level of serum lactate dehydrogenase (LDH) found in the mass screening program by Naganoken Koseiren Kenkokanri Center was 1, 358 (1.5% of total 89, 837 examinees) in 1995. In 235 of these cases, 141 cases (60.0%) were diagnosed as normal; 56 cases (23.8%), hyper lactate dehydrogenasenemia; 27 (11.5%), diseases of the liver or gallbladder. Close medical examinations including abdominal ultrasonography and check on viral hepatitis may be necessary for cases of increased LDH levels detected by mass screening.

  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.

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.

Background: Paraquat has been a matter of grave concern around the world, including Japan, in light of high mortality rates and numerous fatalities.;Method: We undertook a cross-sectional survey of pesticide poisoning by collecting data for 6 years, from 1998 to 2003, from 102 hospitals affiliated with the Japanese Association of Rural Medicine. From these cases, we analyzed those with exposure to paraquat.;Results: There were 79 paraquat poisoning cases, including 71 cases of suicide. Of the suicide cases with 5% paraquat and 7% diquat products, more than 80% resulted in suicide deaths. All people who used 24% paraquat products completed suicide. The outcomes of these cases were related to age and volume of ingestion. The prognosis line proposed by Proudfoot in 1979 continues to explain the final outcome of almost all cases even though more than 25 years have passed since it was first proposed. More than 80% of fatalities died within the first three days of ingestion.;Conclusion: Numerous lifesaving methods have been proposed by physicians around the world. However, almost all of these methods treat pulmonary disorders in the sub-acute and subsequent periods and seem unable to effectively decrease mortality rates. It is necessary to take administrative measures to reduce paraquat concentrations in products and, furthermore, to impose strict restrictions on its distribution.
Paraquat ; Cancer patients and suicide and depression ; Surveys ; Japan ; seconds

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.

Data concerning clinical cases of pesticide-induced disorders were collected from members of the Japanese Association of Rural Medicine during 1998-2000 FY throughout the nation, and were analyzed statistically.
1) A total of 209 cases of poisoning by agricultural chemicals were reported from 49 hospitals and other medical institutions.
2) By types of clinical manifestations, the majority of the cases were acute or subacute pesticide poisoning (91%), which was followed by acute dermatitis (5%) and chemical burn (3%).
3) Suicide accounted for 67% of the pesticide poisoning cases, which was followed by accidental exposure on the job during spraying (17%), and so forth.
4) Organophosphate insecticides were the most frequent inducers of the clinical cases (34%), which was followed by bipyridylium herbicides (21%) and a carbamate insecticides (9%), and so forth.
5) There were 43 cases of intoxication during spraying, during preparation or settling, and working in sprayed areas By types of clinical manifestations, the majority of the cases were acute or subacute pesticide poisoning (56%), which was followed by acute dermatitis (23%) and chemical burn (16%).
6) Agricultural chemical compounds responsible for the clinical cases varied greatly. They induced organophosphate insecticides (19%), and bipyridylium herbicides (12%).
7) Main factors contributing to the onset of pesticide-related disorders were insufficient protective clothing (32%), carelessness (22%), and inevitable consequences of pesticide use (10%).

Pesticide poisoning is one of the most inportant health issues associated with rural medicine, and chronic nervous and mental disorders are its importnat sequelae. We investigated suquela cases nationwide, and reviewed chronic nervous and mental disorders from a clinical and epidemiological point of view.
Our nationwide survey found one reported case of delayed neuropathy. The patient ingested organophosphorus insecticides, and showed delayed neuropathy dozens days after.
Cases of delayed neuropathy attributable to Mipafox was reported in1951.This disease is mainly caused by organophosphorus insecticides. Carbamate insecticides are also known as the agents to induce delayed neuropathy. Herbicide Glufosinate (Basta^TM) was put on the market in 1984. The case reports published during the 1990's pointed out that some Glufosinate poisonings cause amnesia and disorientation. Thesecases were reviewed according to the types of pesticides or their groups.
An epidemiological investigation of neurological and psychiatric desorders among such workers exposed to several types of pesticides as plantation workers and sheep dippers was made. These exposed workers were at high risk of mild cognitive dysfunction, tremor, weakness, and so on to a significant extent. Those children who were exposed to organochlorine insecticide and pollutant via placenta or milk were also surveyed whether they had impairments of nervous and mental development. Highly exposed children were significantly slow in development relative to their peers. The results of these investigations were also reviewed.