Ophthalmofundoscopic examinations were conducted on 262 young hypertensive people living in a rural district of Akita Prefecture. The district is noted for its high incidence of cerebral apoplexy among the populace.
Young hypertensives are defined as those who are 39 years old and younger, and whose blood pressure levels exceed 160 mgHg/95 mgHg.
The narrowing of retinal arterioles was observed in the highest 31.7% of the examinees. It was followed by calibreirregularity, arteriolar-venular crossing defects and increases in the arteriolar light reflex.
The occurrence ratio of over Scheie H₂ and/or S₂ was 42.4%. The occurrence ratio of over Scheie H₂ was significantly higher than that of over Scheie S₂.
In a nutshell, hypertensive changes such as retinal arteriolar narrowing were high in occurrence, but sclerotic changes took place less frequently, and retinopathy scarecely occured in the eyeground among young hypertensives.

The examination of the optic fundus constitutes an essential part of the mass health screening course. However, the significance and the use of its findings are yet to be clarified fully. So, we have recently conducted two research studies.
One is concerned with quantitation of information made available about the changes in the blood vessels in the retina of the eye. Following a basic investigation in which the diameter of retinal vessles was measured, we examined changes in the diameter of retinal arteries after administration of vasodilators in search of the relationship between vasodilation and arteriosclerosis.
The other is concerned with a comparative study of abnormal retinal findings and the occurrence of cerebral apoplexy. We closely examined the appearance ratios of retinal abnormalities and compared them with the data obtained in our previous study of the incidence of cerebral apoplexy over the period of five years.
The subjects are rural inhabitants of the Yuri district, Akita Prefecture, which is noted for its high incidence of cerebral apoplexy in this country. Particularly in the Yuri district, not only the aged but people under 60 years of age are frequently attacked with cerebral apoplexy.
Our current survey findings showed that the average diameter of retinal vessels-both arterial and venous-was slightly small compared with those reported by other researchers. The dilation of retinal arteries after intravenous injection of 20mg of nicotinic acid was large in the moderate arteriosclerosis group and small in the advanced arteriosclerosis group.
The appearance of retinal abnormalities increased as the age of the subjects advanced.
Hypertensive retinopathy was predominant among those aged between 30 and 49, while among those aged 50 or above arteriosclerotic changes were observed as frequently as any abnormality. Irrespective of age, the subjects who showed retinal abnormalities developed symptoms of cerebral apoplexy at a significantly higher rate than those who did not show any abnormality in the eyeground. Particularly, the narrowing of the retinal arterioles was observed at a notably high rate.
Thus, it has been proved that the eyeground examination is effective in predicting cerebral apoplexy and useful in mass health screening.

The actual state of high density lipoprotein-cholesterol levels (in part, total cholesterol ratio) among rural inhabitants in Akita Prefecture is discussed in this report based on the findings of our extensive research work from basic statistics to experiments to improve the HDL-cholesterol level.
In the basic study, we checked up on errors in measuring HDL-C levels or instrumental errors. Variations during a day (before, after eating), daily variations (five consecutive days) and seasonal variations (spring, summer, winter) were also examined. In actual fact, errors of measurement were not found, but significant errors caused by measuring instruments (precipitation method) were observed. There is no variation during a day. Daily and seasonal variations were significant.
The mean value of HDL-C levels among 386 males examined was 57.5 mg/dl±14.7, while the mean value among 359 females was 55.2 mg/dl±14.0. A normal distribution with 50-59 mg/dl as the most commonly occurring values was shown in the frequency table for both sexes. By body build, obese persons, both male and female, showed significantly lower levels than the standard value.
Geographical variations did not make any significant difference in the HDL-C level. However, the levels for those who engage in hard labor were high.
By type of disease, the group of healthy, normal persons showed higher HDL-C levels than the groups of hypertension, cerebral apoplexy, hypercholesterolemia, hypertriglyceridemia, ischemic heart disease, liver ailment and anemia. There was no significant differential between the healthy normal group and the diabetes group.
Retinal and electrocardiographical findings revealed that the normal group has higher levels than the abnormal group. It was also found that the HDL-C level has positive correlation with GOT and negative correlation with the triglyceride value.
The HDL-C level was the highest among those who drink sake and do not smoke cigarettes, and the lowest among those who smoke but do not drink sake. The difference was significant. Linkings for coffee, juice and sweets did not affect the HDL-C level.
A study was made of the changes in HDL-C levels in relation to drug administration and exercise.
For eight weeks before administration, examinations were made to find changes in the HDL-C levels of healthy normal persons. However, their mean value did not fluctuate. Eight weeks after administration, it was found that the HDL-C levels of healthy, arteriosclerotic disease and hyperliPoproteinemia groups of persons rose significantly. Diabetics and cigarette smokers showed some improvement, thought not significantly.
Exercise was rope skipping. The subjects were asked to do the light physical activity for four minutes a day over a period of four weeks. The experiment brought about significant improvements in the HDL-C levels.

We investigated the occurrence of paragonimiasis in the area along the Shimanto River and its branches flowing through Nishitosa Village, Kouchi Prefecture, by studying parasitism of metacercariae in Eriocheir japonicus and Geothelphusa dehaani and infection in humans.
A. Investigation of crabs
Fifty nine Eriocheir japonicus were caught at two points of a branches of the Shimanto River, and two (3.4%) were found with metacercariae.
One hundred and seventy eight Geothelphusa dehaani were captured at six points of the branches of the Shimanto River, and 105 (59.0%) were found with metacercariae.
B. Investigation of infection in humans
The first to fifth screenings were conducted on 2, 274 inhabitants of Nishitosa Village ; the first screeing was performed by questionnairing on paragonimiasis, the second intracutaneous reaction, the third chest X-ray, the fourth sputum test, and the fifth serum test. The screenings revealed one subject infected with Westermann paragonimiasis, the source of infection being raw wildboar meat.
The study has confirmed the existence of paragonimiasis in the area along the Shimanto River, and showed to the villagers that eating Eriocheir japonicus and Geothelphusa dehaami raw is dangerous to their health.

In promoting studies on health, it is essential to organize various forms of learning into a comprehensive system. First of all, leaders are to be trained and study groups in the form of executive committees are organized under their leadership. People who have completed the study course hold voluntary study groups in their own communities. If the activities to promote studies on health are carried out in this direction, a majority of people in these communities will be able to participate in the study and achieve their goals in health studies.
Concrete examples at Nishitosa Village, Kouchi Prefecture are discussed based on the author's experience in health studies for the past 20 years.

Home-Care services for aged people are being provided in Nishi-Tosa Village, Kochi Prefecture, to prevent the elderly from being bedridden. The village is one of the so-called “old communities.” About 25% of the village's 4, 250 inhabitants are over the age of 64.
This paper deals with the preventive steps taken by the community health center and the results that have been obtained thus far. The number of bedfast elderly people (ranked as B and C according to the Health and Welfare Ministry criteria of judgment for the lives of ailing old people) has been tending to decrease yearly: from 31 persons in 1985 down to 18 and 19 in 1990 and 1991. The percentage of bedridden old people to the total number of the elderly also decreased from 3.8% in 1985 to 1.9% in 1991.
In working out the preventive measures for the elderly, special emphasis has been laid on the following four points:
1. Opening of health study course more than 200 times a year;
2. Encouragement of dietary cure for the hypertensive and medication;
3. Recommending hospital care after a stroke occurs and early rehabilitation practice;
4. Continued rehabilitation after discharge of hospital and regular visits by nurses and health aides to patients in their homes.
We are convinced that these activities must have contributed to the decline in the number of bedridden old people.

What is called “health promotion” should be considered in the framework of its rationale rather than its contents.
If emphasis is placed on the contents, the means of health promotion such as increasing the number of persons receiving health checkups or of persons attending health seminars may become the ends in themselves.
By understanding its rationale, we could appreciate the essence of “living more humanely” and reach the counclusion that the end of health promotion is to establish a healthy and affluent society. Health-promoting activities in a community are revitalized through participation of people of the community, and empowerment of inhabitants is achieved through putting into practice what has been gained in health learning. These two factors combine to make for the promotion of health. It is strongly recommended that those involved in public health and medical welfare stand on the same footing as the people of a community in supporting their activities and achieve by learning from them.

To detect essential hypertension and eventually to prevent cerebral apoplexy, we have measured blood pressureof the inhabitants in the Kamigo Section of Kisakata Town, Akita Prefecture (no. of households- 515 ; pop.- 2, 489) by making house-to-house calls once every three years since 1971.
The ratio of those having their blood pressure taken to the total population was 49% in 1971, 79% in 1974 and54% in 1977.
The average systolic pressure reading was 138.7mm/Hg for man and 136.5mm/Hg for woman, while the averagediastolic pressure was 84.9mm/Hg for man and 82.0mm/Hg for woman.
Twenty-six percent of the hypertensives were taking anti-hypertensive drugs regularly in 1971. The percentagewent up to 51% in 1974 and 56% in 1977.
Over the past six years, the patients with cerebrovascular attacks (CVA) dropped from 60 to 53 persons (changesin population adjusted). The deaths from cerebral apoplexy also decreased from 84 to 64.
The peak age of the persons who were seized with and died of cerebral apoplexy advanced from 65 to 75. Only4% of the CVA patients aged below 70 took anti-hypertensive drugs regularly. Seventy-nine percent did not takethe medicine at all.
All this suggests that taking anti-hypertensive drugs is effective to the prevention of cerebral apoplexy.

This study was conducted to clarify the actual status of deaths at home in rural communities and factors that enable patients to die at home. From all over Japan, 123 towns and villages were selected and a questionnaire survey was conducted by mail. The response ratio was 31.7% and the number of respondents 767. The ratio of deaths at home during the three-year period from 1994 through 1996 was 29.0% on an average, ranging from 6.8% to 63.0%. In most of the areas with higher ratios of deaths at home, there were doctors willing to provide care to patients in their homes and well-organized nurse stations for home visits.
Heart diseases and cerebrovascular diseases each accounted for more than 20% of all deaths at home, and cancer 14.0% for men and 9.0% for women. As for the length of stay at home from the onset until death, 19.3% was within 24 hours (sudden death), 27.5% more than one year, 18.4% more three years, and 7.3% more than 5 years. The length of care at home rarely extended over a very long period.
Those who had access to more than three types of home medical care and welfare services (home visits by nurses, homemaking services by home health aides, etc.) accounted for a mere 32.0%, indicating that home care still means hardly anything more than care by family members.
Medical treatment had been received by 73.1% of the patients before death, and it was assumed that the minimum medical care to remove pains and sufferings such as oxygen inhalation (15.5%) and use of narcotics (7.2%) was being dispensed.
Care or dying at home is based on five basic elements of primary care Accessibility, Comprehensiveness, Coordination, Continuity and Accountability, and implementing those five elements will realize a desirable form of home care.

  This study was designed to explore what would make it possible for old people with moderately severe dementia to receive health care in their homes. For this purpose, a questionnaire survey was conducted on the cases of patients who had been given home care services for more than six months. A total of 97 cases (31 males and 66 female) were enrolled in this multilateral study. Of the total, 60 cases were admitted to facilities six months after the start of home care. As it turned out, the degree of cognitive decline was severer in those who had continued receiving home care than in those institutionalized. Ardent physicians and zealous care managers played a crucial role in sustaining home care services. Also indispensable were able, hardworking caregivers with profound knowledge of nursing care. The availability of nursing care insurance services, especially day services, short stay and regular visits by a physician and a nurse to patients in their homes might be necessary. Given all these things combined, it would be possible for people with moderately severe dementia to receive long-term home care services.