Arterial Ketone Body Ratio(AKBR) on Alcoholic Liver Disease / 日本農村医学会雑誌

The liver mitochondrial redox state (the liver mitochondrial free NAD+/NADH ratio), which indicates hepatic energy charge, is known to parallel the ketone body ratio (acetoacetate/3-hydroxybutyrate) in liver tissue. Since the ketone body ratio in arterial blood was reported to correlate with that in liver tissue; the arterial ketone body ratio (AKBR) has been widely accepted as a useful measure of the liver function reserve. The liver mitochondrial redox state is known to decrease with the oxidation of ethanol in alcohol abusers. To evaluate whether AKBR reflected the effect of alcohol intake on the liver, AKBR was measured in normal controls (n=8), and patients with alcoholic liver injuries (n=14) and chronic active hepatitis (n=15). The mean AKBRs in the normal control subjects, in patients with chronic active viral hepatitis, and in those with alcoholic liver disease were 1.68±0.77, 2.22±1.02, and 1.55±0.79, respectively. Though the AKBR in patients with alcoholic liver disease tended to be lower than the other groups, there was no significant difference in AKBR among those three groups. In conclusion, this study demonstrated that AKBR was doubtful as an accurate parameter to estimate the changes in the liver mitochondrial redox state by alcoholic intake.

Studies of Facility Care and Home Care for the Aged in a Rural Community / 日本農村医学会雑誌

A survey was made of the state of home care for healthy old folks and those elderly patients who have been disabled by illness or injury, and the care provided by institutions in six areas throughout the nation.<BR>The number of healthy old people was larger in women than in men. However, men had the edgeon women in Activity Daily Living (ADL). Compared to the healthy aged people, many ill or disabled elderly patients receiving home care were found to be suffering from anemia, low cholesterol level, hypoproteinemia, and poor glucose-tolerance. The major cause of disability was cerebral apoplexy. Recently, the cases of cerebral hemorrhage have decreased in number, and the rate of death in acute stage has notability declined ; however, the incidence of cerebral infarction is on the increase among the aged.<BR>There are limits to care for disabled elderly patients at home by the family because of the aging of their spouses and the increasing trend toward the nuclear family. Many of those who look after the sick persons are crying for expert help and services capable of coping with a sudden change in the patient's condition. Hence the need to establish a 24-hour home care providing system. It is desirable to establish old people's homes, as residential care institusion, in alignment with hospitals. This system would facilitate hospitalization in case of emergency. To execute care programs more effectively, close collaboration will be necessary among hospital, home care services, clinics, local governments, agricultural cooperatives, and neighborhood associations.

Research and study on health of young generation in rural communities in Nagano prefecture / 日本農村医学会雑誌

A check of the health of residents in their twenties and thirties in Nagano Prefecture's rural communities indicates that the rate of hypertensives and the incidence of cholesterolemia were low in those age groups. There were signs that the prevalence of obesity is somewhat high among males but low among females. Virtually no incidence of anemia was observed among men but the incidence was fairly high among women. The number of persons with hepatic dysfunction was relatively large among men. In terms of the intake of nutrients, there were not a few men for whom the meals were imbalanced, and the intake of alcoholic beverages was high.<BR>It is necessary that women should refrain from taking in confectionary and taken in fishmeat, meat, milk, egg, soybeans and other proteins. In Nagano Prefecture's rural communities, there remain signs that the intake of salt is high even in young generation, so that it is important to take measures for the prevention of hypertension.

Prediction of cerebral apoplexy - Survey results / 日本農村医学会雑誌

Cerebrovascular disease is still considered a serious health problem in Japanese rural areas. The rate of death from the disease is very high. Many clinical and epidemiological studies have been conducted so far. However, they have failed to come up with answers effective for prediction and prevention of the scourge.<BR>As part of the agricultural coop commissioned research project entitled “Study of Cerebral Apoplexy: Its Prediction and Prevention, ” we took a questionnaire survey in 1985-86, to obtain data as regards patients' subjective symptoms, electrocardiographic observations, hematological findings and many others before the onset of cerebral apoplexy. Five medical research institutes affiliated with the national welfare federation of agricultural cooperatives responded to our questionnaire.<BR>As a result, the subjective symptoms that showed stochastically significant increases from one year to three months before the onset of the disease as a whole were fatigue, forgetfulness and insomnia. When it comes to cerebrovascular infarction, shortness of breath, angina, forgetfulness, and nocturia were particularly notable.<BR>All these symptoms are not peculiar to cerebral apoplexy, but it should be noted that these are the warning signals of the killer disease.

Risk factors of strokes in a rural area of nagano prefecture and control for prevention / 日本農村医学会雑誌

Conducted in the Saku district (pop: 105, 000) of Nagano Prefecture, a WHO collaborative study and a district survey on the onset of stroke (994 respondents), it is evident that the past history of hypertension was extremely significant both for patients with cerebral hemorrhage and cerebral thrombosis. Among patients with cerebral hemorrhage and those, 69 years old and under, with cerebral thrombosis, the group which undid or suspended hypertension treatment was evidently larger than that who continued to undergo treatment. But among those, 70 years old and over, with cerebral thrombosis, no significant statistical difference was noted between the two groups.<BR>In Yachiho, a mountain village in the Saku district, hypertension control has been carried out since 1959. As a result of the adequate control of blood pressure, strokes as a whole have dropped by about 30% and cerebral hemorrhage has halved. But there are signs of an increase in the prevalence of cerebral infarction, and multiple cerebral infarction in particular, among the elderly.<BR>In recent years, the Westernization of the dietary pattern has been in progress in rural communities, thereby raising the serum total cholesterol level among their residents. An epidemiological study of strokes in 1964-71 demonstrated minus correlations between serum total cholesterol and the incidence of cerebral thrombosis, but no such correlations are observed at present. Nor is any correlation observed between serum total cholesterol and cerebral infarction.

Prediction of impending attacks of cerebral stroke in rural areas and their prevention / 日本農村医学会雑誌

Cerebral stroke in rural areas is a very important disease both from medical and social aspects. Among strokes, infarction which occurs most frequently in elderly persons is liable to result from atherosclerosis. And for the development of atherosclerosis, essential hypertension is the most important predisposing factor. Other than hypertension, aging, diabetes mellitus, hyperlipemia, esp. low HDL/Tch ratio, increased hematocrit values, coronary insufficiency, cardiac failure, arythmia, esp. atrial fibrillation, are also accepted important risk factors. Affirmative of such findings, the authors are convinced of the fact that atrial fibrillation which is increasing recently is closely related to both cerebral thrombosis and embolism.<BR>But, in regard to cerebral infarction no signifying or trigger factor, similar to very high blood pressure, that trigger cerebral hemorrhage, is clarified as yet. It is made clear in this connection that cardiac failure predisposed by hypertensive heart disease in old age, assisted by pathophysiological and other environmental conditions, is the important factor. The authors also studied the clinical predisposing parameters and preventive measures about strokes.

Clinical studies of liver cirrhosis with special reference to its etiology and prognosis / 日本農村医学会雑誌

A total of 194 cases of liver cirrhosis, which had been treated in our hospital during the past 5 years, were calssified by the causes into the following four groups:(I) hepatitis B virus, (II) alcoholic, (III) special origins, and (IV) reasons unknown. They each accounted for 23.2%, 35.6%, 1.5% and 39.7%, of the total.<BR>Their clinical features and prognosis were examined. To be noted is the finding that many patients in group IV had had blood transfusions. This suggests that non A non B hepatitis viruses might be involved in the occurrence of the liver disease. On the whole, the five-year survival rate was 45.6%. There was not any significant difference among the four groups. However, prognoses were poor in groups II, I and IV, in that order.<BR>As regards the cause of death, rupture of esophageal varice and hepatic failure showed a gradual decline, but complications of hepatocellular carcinomas sharply increased. Especially, in group I, this mortality was as high as 31.1%.

Changes in living pattern and health of middle- and high-aged people in Yachiho Village, Nagano Prefecture with special reference to relations between blood patterns and circulatory organs / 日本農村医学会雑誌

In the last 20 years since 1960, the population of Yachiho Village in Nagano Prefecture had decreased by 1, 089 (17.5%). In the same period, the share of people, 70 years old and over, had increased from 4.5% to 10.4 percent, suggesting that depopulation and aging are in progress. By type of farm management, farming families with sideline jobs share 87.4% of the population and there is a conspicuous increase in the number of farming families for which the non-agricultural income is greater than the agricultural income. Agricultural mechanization began to make rapid progress in or 1970: power cultivators are owned by all farming families and power sprayers and harvesters by about half of them.<BR>Due to the increase in income from non-agricultural work and the development of merchandise distribution systems, the intake of animal food, which used to be significantly small in the rural communities, has increased. In the last 20 years, the intake has increased by 6.3 times for meat, 1.4 times for fish and 4.7 times for eggs.<BR>A health care program for all residents of Yachiho Village has been instituted since 1954. The disease the prevalence of which was found to be highest in the past annual mass health screenings is hypertension. A check of the prevalence of stroke and myocardial infarction, which is an important parameter to assess effects from hypertension control, indicates that the prevalence of strokes was down 30.7% in 1971-82, the latter half of the control perind, from 1959-70, the former half. Howevre, there was a slight rise is the prevalence of myocardial infarction. The prevalence of strokes to myocardial infarction was 16: 1 in the former half and 9: 1 in the latter half, suggesting that prevalence of strokes was overwhelmingly high.<BR>There has been an increase in the number of healthy old people under the village's comprehensive health care program. They work till they reach a considerably high age and their health condition is good.<BR>Due to changes in the dietary pattern and a drop in the burdening of farm work, however, the obesity rate has increased among residents of Yachiho Village, and the cholesterol level, which used to be low, has risen. Particularly conspicuous are the rises in the numbers of obese persons and patients with cholesteremia among females in their 50s and 60s and among males in their 40s.<BR>In order to further decrease the prevalence of strokes and prevent an increase in that of myocardial infarction, there is a need for an elaborate guidance and control program by vocation, sex and age.

Survey on Cerebral Stroke of Young People in Nagano Prefecture's Rural Area / 日本農村医学会雑誌

Of the patients with cerebral stroke admitted to the Saku Central Hospital from April 1972 to October 1977, we surveyed 60 people, aged 49 and under.<BR>1) By type of disease, cerebral hemorrhage accounted for 40%, cerebral infarction 30%, and subarachnoid hemorrhage 30%. The prevalence of cerebral hemorrhage and subarachnoideal hemorrhage in this age group was higher than those in all ages.<BR>2) Even in this age bracket, there were many with histories of hypertension and long periods of affection. The onset was observed among many of those who had not undergone or had discontinued treatment.<BR>3) Abnormal ECG findings were observed in 35%.<BR>4) Patients with a cardio-thoracic ratio of 51% and over in chest X-ray findings accounted for 64% of all patients.<BR>5) Abnomally high hematocrit, serum and total cholesterol values were noted for few cases.<BR>6) In respect to the prognosis of life and sequela, patients with cerebral infarction in this age bracket were better than those of all ages, but no statistically significant difference was observed between patients with ceberal hemorrhage in this age bracket and those in all ages.

Respitatory Disorders Caused by Farm Work-Thresher's Pneumoconiosis / 日本農村医学会雑誌

Of all types of farm work in Japan, the threshing of rice, in which dust is generated in large quantities, produces the worst influence on the respiratory organ, and the author termed this symptom “thresher's bronchitis.” The repetition of thresher's bronchitis gives rise to chronic bronchitis. There have been the autposy cases of elderly farmers who suffered from pneumoconiosis, as he had been exposed to dustin over 30 years of threshing work. The symptom might well be called “thresher's pneumoconiosis.”

Respiratory Troubles and Diseases caused by Farm Work / 日本農村医学会雑誌

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.<BR>The actual state of respiratory diseases among rural people, as investigated by the present study group, can be summarized as follows:<BR>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.<BR>2) Pathologically, farmer's pneumoconiosis attributable to farm operation dust was evidenced, crying for the necessity of dust prevention measure during farm operations.<BR>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.<BR>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.<BR>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.

Respiratory Troubles and Diseases caused by Farm Work (Farmer's Lung, etc.) / 日本農村医学会雑誌

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:<BR>(1) There were a variety of farm operations which produced or increased respiratory symptoms, including thrashing and scatteringof agricultural chemicals;<BR>(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”<BR>(3) Among the cultivators of rush, raw material for Tatami, there existed cases of pneumoconiosis;<BR>(4) There were a variety of agents to produce bronchial asthma, such as rice straw, chaff, tea-leaves and chrysanthemum-leaves;<BR>(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.

Respiratory Troubles and Diseases caused by Farm Work / 日本農村医学会雑誌

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<BR>(1) There were a variety of farm operations which produced or increased respiratory symptoms, including thrashing and scattering of agricultural chemicals;<BR>(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”<BR>(3) Among the cultivators of rush, raw material for Tatami, There existed cases of pneumoconiosis;<BR>(4) There were a variety of agents to produce bronchial asthma, such as rice straw, chaff, tea-leaves and chrysanthemum-leaves;<BR>(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.

Study on Respiratory Disturbances Caused in Farm Work / 日本農村医学会雑誌

A total village health control program has been instituted in Yachiho Village (pop. 5, 211, 1975National Census) since1959.<BR>When the deaths caused by respiratory diseases in this village are compared between the first eight years under the health control program (1960-67) and the second eight years (1968-75), the deaths caused by lung tuberculosis decreased by67% and those by pneumonia and bronchitis dropped by52%. On the other hand, there have been no drops in the deaths caused by pulmonary emphysema and bronchial asthma, and their ratios are higher than the national averages.<BR>The prevalence of bronchial asthma among inhabitants of Yachiho Village stands at0.9% among males and1.2% among females, and these percentages are practically the same as the national averages. On the other hand, the prevalence of chronic bronchitis is9.8% among males and5.7% among females, and these ratios are lower than in air-polluted urban areas but higher than in nonpolluted cities.<BR>A wide variety of farm work-particularly, rice threshing and hulling-greatly infuences the incidence and course of chronic bronchitis. It is therefore important to implement measures for the prevention of chronic bronchitis and pulmonary emphysema.

A Survey on Incidence of Cerebral Apoplexy in Saku District, Nagano Prefecture, and Follow-up Study (Report I) / 日本農村医学会雑誌

A survey has been under way on the incidence of cerebral apoplexy among the inhabitants (pop. 105, 185, National Census, 1970) of the Saku district of Nagano Prefecture since April 1972.<BR>This survey, which constitutes a WHO cooperative study, has been under way with cooperation rendered by the local Medical Association, Association of Public Health Nurses in Saku District and Saku Public Health Center with the Saku Central Hospital acting as the survey center.<BR>In the period of two years till March 1974, 585 persons were registered as having been seized with cerebral apoplexy. The annual incidence rate stood at 265 per 100, 000 population. Classified by types of cerebral apoplexy, cerebral hemorrhage accounted for 26%, cerebral thrombosis for 57%, cerebral embolism for 3%, subarachnoid hemorrhage for 9%, and other types for 5%.<BR>By sexes, the incidence rate among males was 1.3 times higher than among females. By ages, the incidence was highest in the seventies.<BR>When the prognosis of cerebral apoplexy is viewed in terms of deaths in the early period of less than three weeks after the onset, the mortality rate stood at 45%.<BR>The hospitalization rate of patients seized with cerebral apoplexy was 55%. There was a significant difference in the mortality rate between inpatients (with 28%) and outpatients (65%).<BR>The ratio of concurrence of autopsy and clinical diagnosis stood at 83% with Okinaka's criteria and 79% with Ikeda's CVD index.<BR>The incidence of hypertension before the onset of cerebral apoplexy was extremely high among the patients seized with cerebral hemorrhage and cerebral infarction.With respect to the treatment of hypertension, the discontinuance of treatment and the failure to undergo it are high in percentage among the patients seized with cerebral hemorrhage. With reference to cerebral infarction patients of 70 years and older in age, there is little defference between the group who discontinued or failed to undergo treatment and the group who underwent it.<BR>The recurrence of cerebral apoplexy stood at 11% for cerebral hemorrhage, 19% for cerebral infarction, and 11% for subarachnoid hemorrhage.

A Study on Chronic Obstructive Diseases of the Lung in Rural Village / 日本農村医学会雑誌

In this article, an attempt was made to epidemiologically study chronic obstructive diseases of the lung, particularly chronic bronchitis, in Yachiho, a rural village in Nagano Prefecture.<BR>The findings reveal that the incidence of chronic bronchitis among inhabitants from 40 to 69 years of age stands at 9.8% for males and 5.7% for females.This incidence is lower than in air-polluted areas but higher than in the non-polluted areas in Japan.<BR>The cause to this phenomenon is presumably attributable to the influences of threshing work in paddy fields.<BR>The repeated recurrence of Dakkoku Kikanshien (bronchitis for which threshing is responsible) once in a year is associated to a great extent with incidence of chronic bronchitis or its deterioration. Another conceivable factor is the inadequacy of household facillities against the cold weather in this village.