The Hokkaido Welfare Federation of Agricultural Cooperatives runs a total of 15 hospitals including six general hospitals. Each hospital constitutes a nucleus of medical care facilities for people in each region of Hokkaido, Japan's largest prefecture. In addition to daily medical consultation, examination and treatment, they are carrying out extensive programs associated with health control for inhabitants in agricultural districts and care for the aged, whose number is increasing at a fast clip. In this paper, the author will review their activities in the past and present, and dwell on the future.

Located in the northernmost part of Hokkaido, Tenpoku is one of the representative dairy farming districts in the prefecture. Official data for fiscal 1983 show that the size of grassland per dairy farm household is 35 ha and that the number of milch cows averages 48 head.
Between 1981 and 1984, investigation was made on the health of women on dairy farms by means of a questionnaire, consultation and multi-programmed health examination. The survey project was actually under-taken during the spring and summer months. The effective number of subjects were 350.
The results of the investigation was compared with those of another health survey which was conducted in the same period on a total of 960 women engaged in paddy rice farming.
The comparison revealed that there are marked differences in health conditions between the two groups.
(1) The frequency of complaints such as associated with the “farmers' syndrome” is higher among the dairy farmers than the rice growers.
(2) The incidence of anemia is also higher in the former group than the latter.
Dairy farming in the district mostly is a family business.The larger the ranch becomes, the harder women, particularly housewives, have to work.
In order to improve health standards, changes in eating habits and implementation of preventive measures against stiffness in the shoulders, low back pain and other lifestyle-related maladies.
To lessen the work load, cooperation among neighbors in a larger part of work should be encouraged.

Takasu-machi is a small rural community (population: about 7, 500) adjacent to Asahikawa, one of the largest cities in Hokkaido, Japan's nothernmost major island. Its economy is largely based on agriculture dominated by paddy rice growing. The only medical institution available here is a bedless clinic. To meet total health needs of the inhabitants, we have implemented a total health control program since 1975, with multiphasic screening as its main component. The objectives of of the program are prevention of disease by means of education, early detection and early treatment of disease, and establishment of a primary health care system.
Recently we have conducted a survey of the outcome of the program. The survey found that significant results have been obtained during the past decade.
(1) The number of untreated cases has fallen.
(2) The costs of medical care have been beld down.
(3) The relations between the hospital and practicing physicians have become closer.
(4) People have become health-conscious and aware of the significance of symptoms.
These findings suggest that the establishment of a primary health care system emphasising health screening will be conductive to the health of the medically underserved rural populace.

　To improve hospital quality, the development of authorized clinical instructors is urgently needed. Therefore, we held a workshop to develop clinical instructors. At a monthly meeting of the clinical training committee in June 2014, an agenda for holding a workshop was proposed. At the meeting in July 2014, most committee members said they were reluctant to hold a workshop because of heavy clinical duties. However, the hospital president strongly suggested that a workshop might be a foundation for reforming the stagnated hospital and persuaded committee members to hold a workshop to improve the instructors’ skill in teaching residents. At the September meeting, the workshop schedule was discussed. All members of the taskforce, except the chief coordinator and a lecturer, were selected from hospital physicians, and 3 preparatory meetings and 1 rehearsal were held. With the help of administrative staff, our first workshop for clinical instructors was held at Daido Hospital in February 2014. Our workshop helped create new hopes for improving educational tasks at our teaching hospital and improved the educational skills of participants. We also achieved mutual understanding as a team to accomplish a single goal.

Studies were performed on 44 cases of hepatocirrhosis found by laparoscopy and 75 cases resulting in death from hepatocirrhosis in order to shed light on the etiology of this disease.
Thanks to progress in radiographic diagnosis, it has become possible to detect minute tumors in the liver. In our hospital, six patients have been diagnosed as having less than 5 cm tumors in the liver. The diagnositic procedures that had led to the detection of the lesions were reviewed.
Furthermore, the treatment methods of liver cancer were analyzed using the ten cases.

OBJECTIVEBecause the analysis of polychlorinated biphenyls (PCBs) in 1970's was performed using a packed column gas chromatograph, with an electron capture detector to determine total-PCB concentration, analytical data obtained by this analysis do not meet the requirement for the risk assessment of PCB congeners. In this context, the present study was carried out to reevaluate the congeneric analysis data by analyzing breast milk fat specimens that have been kept frozen.

METHODSPCB congeners in human breast milk were analyzed by high-resolution gas chromatography/high-resolution mass spectrometry (HRGC/HRMS) using a capillary column for the selected ion monitoring (SIM) of PCBs.

RESULTSTwelve major PCB congeners were detected in breast milk. The concentrations of all congeners of PCBs in breast milk were found to decrease annually, and their changes over time differed greatly for each congener. Between 1973 and 2000, almost no changes in the proportions of the 12 congeners of heptachlorinated biphenyls (HpCBs) and hexachlorinated biphenyls (HxCBs) were found whereas a marked and a slight decrease in the proportion of pentachlorinated biphenyls (PeCBs) and tetrachlorinated biphenyls (TeCBs), respectively, were observed.

CONCLUSIONSThe PCB contamination of the Japanese population is estimated to be largely caused by seafood intake, but the proportions of PCB congeners in fish commodities were different from those in breast milk. The absorption, metabolism and therefore the accumulation of PCBs in the human body differ greatly depending on the congener.

It is to be noted that in rural districts where they live and work in fresh and clean air the incidence of chronic obstructive pulmonary diseases is as high as in the districts of air-pollution. Besides, there are a variety of respiratory diseases particularly incidental to life-environment and farm work. To be more informed of their actual conditions, the Japanese Association of Rural Medicine organized a special study group and has carried out various studies for four consecutive years with grants from the Ministry of Health and Welfare. The major results obtained are as follows:
(1) There were a variety of farm operations which produced or increased respiratory symptoms, including thrashing and scatteringof agricultural chemicals;
(2) It became clear that there existed in an advanced age group certain cases of “agricultural pneumoconiosis” which could be regarded as the terminal of the so-called “thrash-bronchitis”
(3) Among the cultivators of rush, raw material for Tatami, there existed cases of pneumoconiosis;
(4) There were a variety of agents to produce bronchial asthma, such as rice straw, chaff, tea-leaves and chrysanthemum-leaves;
(5) In Japan only two cases of farmer's lung were reported prior to this study. One more case was added to the list by this study group. Besides, cases positive to fungous agents were found among farmers in considerably high percentage.

It is to be noted that in rural districts where they live and work in fresh and clean air the incidence of chronic obstructive pulmonary diseases is as high as in the districts of air-pollution. Besides, there are a variety of respiratory diseases particularly incidental to life-environment and farm work. To be more informed of their actual conditions, the Japanese Association of Rural Medicine organized a special study group and has carried out various studies for four consecutive years with grants from the Ministry of Health and Welfare. The major results obtained are as follows
(1) There were a variety of farm operations which produced or increased respiratory symptoms, including thrashing and scattering of agricultural chemicals;
(2) It became clear that there existed in an advanced age group certain cases of “agricultural pneumoconiosis” which could be regarded as the terminal of the so-called “thrash-bronchitis”
(3) Among the cultivators of rush, raw material for Tatami, There existed cases of pneumoconiosis;
(4) There were a variety of agents to produce bronchial asthma, such as rice straw, chaff, tea-leaves and chrysanthemum-leaves;
(5) In Japan only two cases of farmer's lung were reported prior to this study. One more case was added to the list by this study group. Besides, cases positive to fungous agents were found among farmers in considerably high percentage.

One is inclined to imagine that the incidence of respiratory diseases will be negligible among rural people who live and work in fresh and clean air. On the contrary, however, we have reports on the high incidence of chronic obstructive pulmonary diseases and on the existence of a variety of specific respiratory diseases which are incidental to farm work. To clarify this situation, the Japanese Association of Rural Medicine organized a special study group and carried out various studies with grants from the Ministry of Health and Welfare. This is the study group's summary report of the four year research project prepared in conclusion of the project.
The actual state of respiratory diseases among rural people, as investigated by the present study group, can be summarized as follows:
1) In rural districts, in spite of its freedom air-pollution, there exist in high percentages people suffering from respiratory symptoms and patients of obstructive pulmonary diseases. As the important cause of this phenomenon, farm operations, especially thrashing, rice-hulling, compost preparation, scattering of agricultural chemicals can bementioned, which invite the development of symptoms and their aggravation.
2) Pathologically, farmer's pneumoconiosis attributable to farm operation dust was evidenced, crying for the necessity of dust prevention measure during farm operations.
3) In connection with atopic asthma the study group proved the antigenicity of rice-straw, wheat-straw, celiae of tea-sprout, young leaves, and chrysanthemum leaves. There are also anumber of already known antigens. It is necessary to establish measures for its prevention and treatment.
4) In rural districts of Japan, esp. in stock-raising farm houses, there are in comparatively high percentages those who react positive to fungous antigens which are the causes of farmer's lung. However, there have hitherto been reported only two cases, and the study group added one more. In the future, more extensive practice of immunological tests and clinical follow-ups of the positive cases will be necessary.
5) In view of the results reported above, it is considered that there are numerous questions concerning respiratory troubles and diseases in rural districts which are awaiting further study.

BACKGROUND: Previous studies have suggested that exposures to heavy metals (arsenic, cadmium, lead, and selenium) may be associated with differences in blood pressure. However, the findings of these studies have been inconsistent. This study was performed to examine the associations between urinary heavy metal concentrations and blood pressure among residents of four Asian countries (Bangladesh, Indonesia, Nepal, and Vietnam). METHODS: This cross-sectional study examined 1899 adults in four Asian countries. Urinary concentrations of heavy metals were measured by inductively coupled plasma mass spectrometry. A questionnaire survey was administered regarding individual characteristics. Anthropometric measurements (height and weight) were performed. Systolic and diastolic blood pressures were measured after a short rest. Multiple linear regression models were applied to investigate associations between urinary heavy metal concentrations and blood pressure after adjustments for age, sex, and body mass index. RESULTS: The geometric means of the urinary concentrations of arsenic, cadmium, lead, and selenium were 84.6, 0.885, 2.09, and 16.5 μg/g creatinine, respectively. The urinary arsenic concentrations were slightly higher than those typically reported in non-polluted populations, while urinary cadmium, lead, and selenium concentrations were equivalent or slightly lower. The urinary lead concentrations were positively associated with both systolic and diastolic blood pressure, but urinary selenium concentrations were negatively associated with them. CONCLUSIONS Variations in the urinary concentrations of lead and selenium were associated with blood pressure at low levels of exposure/intake.
Adult ; Arsenic/urine* ; Bangladesh ; Blood Pressure ; Cadmium/urine* ; Cross-Sectional Studies ; Environmental Exposure ; Female ; Humans ; Indonesia ; Lead/urine* ; Linear Models ; Male ; Metals, Heavy/urine* ; Middle Aged ; Nepal ; Selenium/urine* ; Vietnam