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.

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

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.

　　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.

　　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.

Data concerning clinical cases of pesticide poisoning/disorders were collected from members of the Japanese Association of Rural Medicine during 2001-2003, and were analyzed statistically.A total of 194 cases of poisoning/disorders by pesticide exposure were reported from 36 hospitals and other medical institutions. Suicide cases accounted for 74% of the total number of cases, which was followed by the cases caused by exposure during spraying (17%) and drinking/eating by mistake (7%).In 144 suicide cases, those of males accounted for 52%, the middle-aged and older people constituted the majority. By types of clinical manifestations, almost all of the cases were acute or subacute pesticide poisoning (98%). Organophosphate insecticides were the most frequent inducers of the cases (39%), which was followed by bipyridylium herbicides (23%). When it comes to the outcome, more than 80% of suicide cases with paraquat products resulted in death.There were 39 cases of pesticide poisoning/disorders resulting from exposure during spraying, preparation or settling, and working in sprayed area. In these cases, males accounted for 70% the middle-aged and older people made up the majority. By types of clinical manifestations, the cases of acute or subacute pesticide poisoning accounted for 39%, which was followed by acute dermatitis (33%), chemical burn (14%), and ocular disorders (11%). The pesticides that induced clinical cases varied greatly. Main factors contributing to the onset of pesticide poisoning/disorders were insufficient protective clothing (44%), self conceit (19%), insufficient information (14%), and carelessness (12%).
Pesticides ; Clinical ; Poisoning aspects ; Acute ; Cases