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.

OBJECTIVESThere is a growing need to evaluate the performance status of the activities of daily living (ADL) of the elderly in the rapidly aging Japanese society. The purpose of this study was to verify the usefulness of our new scoring sheet for assessing present ADL status and to clarify whether or not the assessed ADL status can predict the future risk of adverse conditions related to falls.

METHODSThe validation study was performed using 116 non-handicapped community-dwelling Japanese elderly at least 60 years of age. Of those subjects, 44 were also analyzed for the relationship between baseline ADL status and subsequent risk of adverse conditions related to falls.

RESULTSThe daily living performance score sheet had good internal consistency, with a Cronbach's alpha of 0.82 and a sequential hierarchical structure that reflected the difficulty of the activities. The total score was significantly and positively associated with six of eight subscale scores on the Short-Form 36-Item Health Survey (P < 0.01). In the follow-up study, every one-point decrease in total score was significantly associated with a 39% elevated risk of a stumble or fall (P = 0.022) and also borderline significantly associated with higher risks of a fall, anxiety while walking indoors, and anxiety while walking outdoors (P < 0.10).

CONCLUSIONOur new scoring sheet can reliably and comprehensively assess present ADL status. The assessed ADL could predict the future risk of adverse conditions related to falls.

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.