At the process of rush harvesting farmers are exposed to high concentratedusts of “sendo” for short times a day during 3 weeks in summer, and in continuously for all seasons low density of chronic long-term exposure of dusts are observed in the process of weaving.
We examined 320 rush farmers in Yatsushiro district in 1970 and found pneumoconiosis as1p in their direct chest x ray films, 32 men (18%) and 12 women (9%).
In 1975, 36 men and 34 women amang them were reexamined, contrasting their respiratory findings with that of the former examination. The chest x ray film of each subject was classified according to the ILO U/C International Classification of Pneumoconiosis 1971 (ILO).
In this definition, 15men (42%) and6women (18%) of the subjects were classified as pneumoconiosis (1/0, 1/1, 1/2) of the p type of rounded small opacities except one case of irregular type (s): on the contorary, 9men (25%) and 2 women (6%) in the formers. Thirteen cases of men (36%) and11cases of women (32%) showed increasing numbers of opacities and/or extention of disorder zones. It sugests that the intensity of lung disorders in rush farmers have been becomming slowly into more serioustages. Small opacities were seen in the middle and lower, especially lower (47%), zones of the lung. Adding, 3 men and 2 women were tuberculosis (activity uncertain) cases.
Twenty men (58%) and 15 women (42%) have complaints of respiratory symptoms, such as cough (17%), phlegm (34%), short breath (17%), wheezing (16%), and nasal catarrh (22%). Four men (14%) and5women (15%) showed slightly impairment of lung functions.
These findings shown in chest x ray films or respiratory symptoms were related significantly to the amount of cigarett smoking.
Increasing intensity of their respiratory disorders, we may consider, due to increasing dust exposure of “sendo” according to expantion of rush management. Then we must accomplish an improvement of working environment and hygienic control for dusts. In addition, we must exploit a new “sendo” containing less amount of free silica and technical improvements of working process.

Two hundreds and seventy one cases of sera of farmers (48.8±10.8 yr.) in mountain district of Kumamoto prefecture were examined by gel diffusion test for precipitins to M. faeni, T. vulgaris and other 12 antigens of fungus and pigeon proteins.
Ten positive sera (3.7%) from 271 sera tested were detected to M. faeni and 13 were to T. vulgaris. The confidence intervals (95%) of the positive ratiowas calculated 1.8%-6.6%and 2.3%-7.4%, respectively. To other 10 antigens 1-22 sera were positive, such as C. corticale (0.1%-2.7%, as confidence intervals), S.granarius (4.9%-11.4%), P. pullulans (0.4%-3.7%), Aspergillus mix (0.6%-4.2%), Pigeon serum & droppings (0.2%-3.1%), C. acremonium (0.8%-4.7%), T. viride (0.0%-2.0%), Candida (1.6%-6.2%) and P.casei (0.2%-3.1%). NO cases were positive toCladsporium and Alternaria. And 61 cases (17.5%-27.5%) were positive to at least one antigen of all 14 tested.
There was no significance of the proportions of positive reactions between male and female, or age groups. But higher percentagewas found in farmers longer experience of works with hay, straw and compost. Thepresence of a positive precipitin test has been considered as unsatisfactory criterion for the diagnosis of the farmer's lung. However, the findings of our survey suggest that farmers in West Japan has been exposed relatively high amount and/or various kinds of fungus antigens throughout the farm works with hay, straw and compost.

In the previous study, relatively high prevalence of asthma-like attacks associated with handling rushes was observed. In this connection, mass survey of the intradermal skin test (×10000, 0.02ml) by the extracts of rush (Juncus effusus L. var decipiens Buch. forma utilis Makino) and the dusts in the weaving room containing rushes, dyeing materials (sendo) and other house dusts was conducted for the rush farmers (65 males, 143 females), other farmers (21 males, 91 females) and women without farming (28 females). The results were summerized as follows.
1) The positive rates in skin test were estimated to be 7.7% for males and 2.1% for females of the rush farmers by the extracts of rush, and 23.1% for males, 10.5% for females by the extracts of dusts in the weaving room. On the centrally, 4.8% for males, 1.1% for females of the controlled farmers by the former extracts, and 19.0% for males, 8.8% for females by the latter extracts. And among females without farmiing, 0% and 3.6%, were positive respectively.
2) The positive rates were not associated with age, respiratory symptoms and past history of asthmalike anfall. The rush farmers were observed relatively higher percentages of positive reaction than the controlled groups, but not signifficantlly.
3) The results do not clarify the causative agent of antigen-antibody reaction to the asthmatic anfall among the rush farmers, but suggest that peoples, whether farmer or not farmer, may be sensitized by the rush antigen through the farm works and or using tatami mat and other rush products in daily life.

One hundred and thirty one city inhabitants, have been lived in Kumamoto city over 20 years, were examined by gel diffusion test for precipitins to 12 antigens of fungi and 2 pigeon proteins. And the prevalence of positive reactions to these antigens was compared with the former research for the farmers in mountain district in last year. The results were summerized as follows.
Fifteen positive sera of 131 tested (11.5%) were detected to c. acremonium. And, 6.7% to candida, 6.1% to s. granarius, 5.9% to p. pullulans, 3.8% to t. vulgaris, 1.5% to m. faeni and positive to other 7 antigens tested. Thirty seven cases (28.2%) were positive to at least one antigen of all 14 tested. The proportion of positive selological tests in city inhabitants was rather higher than that of the farmers. The results suggest that the city inhabitants in Kumamoto prefecture have been exposed relatively high amount and/ or various kinds of fungi antigens as well as farmer's case.

Appropriate observational studies with sufficient external validity are apparently warranted to assess comparative effectiveness and safety of treatment with approved drugs in real world clinical practice. This kind of study must register patients consecutively without any arbitrariness, assess outcome carefully, (e.g. cardiovascular events) and automatically extract clinical data including results from laboratory tests and prescribed drugs. Clinical trials for the assessment of efficacy of newly developing drugs may also need such patients' registry. Data storage system by SS-MIX may be appropriate for this purpose. (Jpn J Pharmacoepidemiol 2013；18(1)：31-34)

We are conducting research funded by a grant from the Ministry of Health, Labor and Welfare of Japan to create standardized, high-quality medical education content that incorporates video, images, and sound files, to develop a system that can be widely used by everyone from medical students to clinicians, and to create CBT-enabled examination questions for the future CBT National Medical Licensing Examination. The research aims to conduct trial examinations, study issues and measures to deal with them, and make proposals for their implementation.　With regard to the CBT system for the National Medical Licensing Examination, questions incorporating video, images and sound files were prepared based on the scope of the current national examination, and a trial examination was conducted with the cooperation of 10 universities nationwide using the CBT examination system via the internet. The trial was generally conducted smoothly, with smooth playback of videos, etc., and no system problems.　In conducting this research, we believe that it should not be considered as an extension of the previous national examination initiatives for doctors, nor should it be regarded merely as a technological initiative. In addition, as advances in AI-based diagnostic technology and patients’ medical literacy are foreseen to change significantly in 2040, the competence of doctors to cope with these changes will be questioned.　For this reason, it is fundamental to consider medical education content and examination questions for the CBT National Medical Licensing Examination with a view to the ideal image of doctors of the future.

In order to observe the actual work types and the work load of female farmers in various kinds of agriculture that have gradually become a large part of agriculture in Japan as a result of changes in the structure of agricultural production, the authors performed a questionnaire and interview with a large number of female farmers (2, 113) and women in non-agricultural households.
Greenhouse farming was the most common work type for female farmers, followed by tobacco cultivation. The jobs conventionally undertaken by men, that have required a large dynamic work load, have been progressively mechanized, while auxiliary work before and after machinary work remain as manual labor by women. Some clear differences in the work type between full-time farming and part-time farming of female farmers were observed. On the other hand, it does not seem to be easy to estimate the work strain due to the work loads as mentioned above.

In the farm household of “vegetable planting by plastic green house”, “mandarin orange”, “rush (igusa)”, “dairy-farming” and “silk worm”, measurement of energy expenditure in agricultural work and analysis of daily working hours were conducted at the busy season of each crops. The results are as follows:
The energy consumption per day are estimated respectively to be 3300 Cal for male and 2900 Cal for female in the household of the “plastic green house”; 3500 and 2500 Cal in the “mandarin orange”, 3800 and 3600 Cal in the “rush”, 3300 and 2700 Cal in the “dairy-farming”, 3400 and 2700 Cal in the “silk worm”.
The agricultural machines and tools are mainly operated by male and so attached muscular works not yet machanized are carried by female. And management of animals or crops specially required prudent care have a tendency to be also carried by female. Then the average relative metabolic rate (RMR) a working day is relatively higher in female than male, except “mandarin orange”.
In the “rush harvesting” and “dairy-farming”, having the most development of the agricultural mechanization it seems obviousely to be rising the labor efficiency, but because of expansion of management scale and decreasing number of employee the reduction of work load for a worker is not necessory obvious.

An epidemiological survey on allergic conditions of 58 male (aged 38.6±11.8yrs) and 47 female (aged 42.2 ± 9.6yrs) farmers engaged in growing chrysanthemums.
Among the subjects, 47% of males and 62% of females had complaints of at least one of inquired allergic symptoms associated with the work. The immediate type of allergic reaction on nasal and/ or upper respiratory system raised in the process of sorting flowers in the working room and delayed ype of contact dermatitis in pinching the lateral bud of chrysanthemums or spraying agricultural chemicals in the field were the main complaints of those farmers.
Incidence of positive reaction for patch testing to six kinds of chrysanthemums was 5% for males and 17% for females and that of eight kinds at agricultural chemicals was 34% and 45% for each sex. And relatively high incidence was also observed in those subjects from other immunological tests such as determination of serum immunoglobulin, prick testing and calculation of eosinophil in blood and rhinorrhoea.
There were 39 (67%) males and 36 (77%) females who had at least one of the abnormal finding of those test items above mentioned. However, not the particular kind of Chrysanthemum cultivated in that area was found to be strong causative allergen for the observed allergic conditions.
From these results, it is indicated that relatively high incidence of allergic disorders may be found in the chrysanthemum growers due to inhalation and/or contact of some kinds of allergens introduced from the process of growing to forwarding, such allergen as Chrysanthemum itself, agricultural chemicals and other elements.

A field study on the hourly working pattern, energy expenditure, air conditions and the testing for fatigue of the process of the raising silk worms for 4 days in August, the period of early autumn raising. Three couples of the typical raising silk worms households in Kikuchi district in Kumamoto Pref. were selected for the study. The results were as follows.
1. In Kikuchi district, there were 5-10 raising periods in a year from april to november for each households and the yearly working days for the process were to be 160-260 days.
In the period of early autumn raising, the average working times and energy expenditure a day were calculated to be 374±136 min. and 2891±277 kcal for males and 383±119 min. and 2494±91 kcal for females in the third state of period (after 5 days of accepting the larva); and in the fifth state of the process (after 10 days of the former state) 644±112 min. and 3087±136 kcal for males, 618±65 min. 2851±48 kcal for females; in the state of the spinning cocoons, 944±238 min. and 3735±459 kcal for males, 846±271 min. and 3209±754 kcal for females; in the state of the controlling cocoons, 560±115 min. and 2944±233 kcal for males, 478±68 min. and 2537±101 kcal for females. In the spinning state it was the highest work loads to be taken for both males and females through one raising period.
2. The RMR (relative metabolic rates) values of each elemental work were measured to be 0.6-3.7 (0.0322-0.0995 kcal/kg/min). The average RMR in a working time was 2.2±0.3 (1.7-2.9) for males and 2.1±0.3 (1.4-2.5) for females, and in the spinning state higher average value was observed for females than for males.
3. There was some difference between males and females in the distribution of working posture. For males 30.8%(9.5-46.2%) of all working times was the standing position, but in the contrally, for females, 66.0%(64.0-69.8%) was the half sitting position and only 11.0% was the standing position.
4. The considerable reduction of flicker frequency was observed at the end of working a day in each state of the period especially in the spinning state, and the increasing of complaints of fatigue symptoms was also observed.