Looking back on the history of the Japanese Association of Rural Medicine on the occasion of its 44th general meeting, I am overwhelmed with deep emotion. Things have changed dramatically during the period, and our health activities by reaching out into the communities in the middle of nowhere are quite different from what they used to be.
The activities our association has evolved is multifarious. But, in this paper, I dwell on the results of the health screening project, one of our association's major themes, with reference to the health reports presented at the past meetings by its members.
In the early period, the outreach program emphasized the improvement of the living environment and the backward character of morbidity derived from poverty and difficulty of access, while physicals and health education were carried out. In later years, with the nation's rapid economic growth, the network of roads was remarkably expanded. However, material affluence has given rise to new types of health hazard and the incidence of adult diseases in a developed society is threatening the lives of rural inhabitante. In the meantime, the state of things surrounding medical care services has also been improved. Nonetheless, there are a mountain of issues with the advent of an aging society. They include an increase in the number of households with aged people alone in parallel with an increase in the number of nuclear families and the aging of those engaged in farming. The welfare of the aged has now become one of the primary issues we have to grapple with.
This paper reviews the changes in the results of health checkups with the changing times and themes taken up in the scientific sessions of the annual meetings.

OBJECTIVES: A questionnaire survey commissioned by the National Mutual Insurance Federation of Agricultural Cooperatives (Zenkyoren) was conducted to evaluate the study of the health status, urination and urinary incontinence in the elderly populace of 65 years and over in the rural districts in Japan.
METHODS: 8, 023 elderly persons (3, 360 male, 4, 369 female, 294 unknown sex) were entered into this study.
RESULTS: The most troublesome voiding symptoms in elderly persons were weak stream and nocturia for men, and frequency in daytime and at night for women. The QOL questionnaire for urination was of little difference between men and women. It was found that 12.8% of the elderly persons have the incontinence problem. The survey showed that types of urinary incontinence in the elderly populace were mainly mixed, or stress, urgent incontinence. Many people in the populace had functional incontinence due to handicap status. Many people in the populace had not consulted a medical practitioner for their incontinence. The survey revealed that the burdens of caregivers were heavy and the quality of the caregivers' life was of low.
CONCLUSIONS: These findings suggest that the medical and welfare staffs should face up to the actual status of affairs connected with incontinent people in the elderly populace and care for those people and hasten to frame measures to cope with the situation.

In Niigata Prefecute, which is known as Japan's major agricultural district, the number of farm households is on the downward tendency. The ratio of full-time farmers is decreasing, the scale of farming per household is becoming larger, and the number of farmhouses with supplementary incomes from non-agricultural businesses are growing fastly.
Amid increasing trend of farm management toward complexity, women play a large role, accounting nearly 60 percent of the total number of those engaged in agriculture in Niigata Prefecture. Production structure, life style, working conditions and everything have changed drastically.
Such being the situation, it is worth while to try an investigation into the actual conditions of health and labor of women farmers, and to shed light on health-injurious factors and work loads.
We have selected communities so as to obtain a cross section of the farming areas of Niigata, which consists of a large plain called Japan's rice producing center, mountainous districts covered with snow for one-trird of a year, and suburban areas.

In step with the drift of the condition of public life, farmers' working conditions and lifestyle have undergone a phenomenal transformation. In Niigata Prefecture, too, drastic changes have taken place, particularly in the living of farmers who are engaged in mixed farming in the flat land areas.
Inhabitants in remote, mountainous districts, where snow falls heavily, lead frugal lives. In these districts, housewives play leading roles in farming work.
In previous surveys, it was found that the health status of these women was comparable favorably with that of women living the flat land areas.
Recently, we have conducted surveys of health and living conditions of adult female members of the community in an area of heavy snowfall. The surveys were carried out during the snowy season and the warm season. The results were examined carefully, taking acount of seasonal factors.
The health survey conducted during the snowy season revealed that obesity and hypertension rates are high and lumbago and anemia are not remarkable.
The surveys of living conditions did not reveal any significant seasonal difference.
Of special note is the finding that the women frequently eat sweet stuff between meals. The consumption of cow milk is low. They have not taken physical examinations of their own volition, and work hard even if they do not feel well.
With these findings in mind, we have held lecture meetings on health and cooking classes many times during the past three years. As a result, 90.4% of the attendants have become conscious of their mode of living, and 56.2% have come to take care not to overwork themselves.
The incidences of hypertension and farmer's syndrome have declined sharply. However, the obesity rate has not fallen.
In the districts, snowbound for as many as 150 days a year, the housewives have to remove snow from the roof of their houses 154 times on the annual average. However, they take it in their stride. Excepting snow raking, there is no physical labor during the winter months, so that they can rest well.

Between 1968 and 1992, a total of 174, 632 people were discharged from our hospital, of which 6, 265, or 3.6%, were dead. During the 25-year period, the number of discharges increased by 1.5 times, while the number of deaths by 2.6 times. We looked into, physicians' reports to find out the age, sex and the cause of death of the patients. Age-wise death rates have been on the decline among the younger patients and on the increase among the eledery patients of 60 years and above, during the period under review. Malignant neoplasms accounted for 62.2% of the causes of death. Especially worthy of note was the fact that deaths from lung cancer have increased at an alarmingly fast rate.

Loss of bladder control has a significant psychological and social impact on the well-being of affected individuals. In the present study, a questionnaire survey regarding the incidence of urination trouble was conducted on individuals aged 40-86 years from a selected community.
A total of 281 individuals (137 males and 144 females) responded to our survey. In this study, urination trouble was categorized into: painful urination, retension and a decreased daily activity due to loss of bladder control. Of the 281 respondents, 122 (43.4%) said they had one or more symptoms of dysuria, 89 (31.7%) had irritative symtoms, 67 (23.8%) had obstructive symtoms, and 53 (18.9%) experienced a decrease in daily activities due to loss of bladder control.
The cases of abnormal urination showed no relationship to age, disease, or exercise. However, urinary abnormalities appeared to be related to frequent nocturnal and diurncl urination.
Loss of bladder control showed a positive correlation with the individual's perception concerning the quality of life. Thus, it was made clear that urinary trouble should be grappled with in earnest in the field of community health care.