Paraquat Poisoning in Japan: A Hospital-based Survey / Journal of Rural Medicine

Background: Paraquat has been a matter of grave concern around the world, including Japan, in light of high mortality rates and numerous fatalities.;Method: We undertook a cross-sectional survey of pesticide poisoning by collecting data for 6 years, from 1998 to 2003, from 102 hospitals affiliated with the Japanese Association of Rural Medicine. From these cases, we analyzed those with exposure to paraquat.;Results: There were 79 paraquat poisoning cases, including 71 cases of suicide. Of the suicide cases with 5% paraquat and 7% diquat products, more than 80% resulted in suicide deaths. All people who used 24% paraquat products completed suicide. The outcomes of these cases were related to age and volume of ingestion. The prognosis line proposed by Proudfoot in 1979 continues to explain the final outcome of almost all cases even though more than 25 years have passed since it was first proposed. More than 80% of fatalities died within the first three days of ingestion.;Conclusion: Numerous lifesaving methods have been proposed by physicians around the world. However, almost all of these methods treat pulmonary disorders in the sub-acute and subsequent periods and seem unable to effectively decrease mortality rates. It is necessary to take administrative measures to reduce paraquat concentrations in products and, furthermore, to impose strict restrictions on its distribution.

Studies on the Cost-Effectiveness Analysis of Activities for Health Promotion in Rural Communities / 日本農村医学会雑誌

We have carried out mass health screenig projects and health-related educational programs including those for health promotion and lifestyle improvements. The purpose of this study was to clarify how instrumental those activities are in preventing disease and cutting down outlays for medical care. The findings are as follows:<BR>1. In an analysis of the costs shared by all municipalities in Kumamoto Prefecture under the National Health Insurance Scheme (NHIS), the larger the number of public health nurses and the higher the response rate of the basic health screening, the lower the various outlays for health care of seniors and others.<BR>2. In the municipalities where activities for health care are briskly evolved, the percapita outlay for medical care under the NHIS is low-significantly low for the medical care of seniors, in particular-and the drop in the outlay for medical care is large as against the cost involved in health screening. Conversely, in the municipalities where the per-capital expenditure for medical care under the NHIS was low, the activities for health screening and health-related education were brisk.<BR>3. In an analysis of <I>Rezept</I>, or bills for medical care, the higher the willingness to undergo a health screening, the lower the expenditure for medical care under the NHIS. This holds true particularly of the NHIS expenditure for the medical care of inpatients.<BR>4. Gastric mass screenig is instrumental in reducing the mortality rate of stomach cancer. Its cost-effectiveness could be ascertained when the lost profit was included.<BR>5. Mass health screening was not directly tied in with a drop in the morbidity prevalence rate, but it was found instrumental in improving everyday life practices.

A Clinical, Epidemiological Study on Chronic Neurological and Psychiatric Disorders Caused by Pesticides / 日本農村医学会雑誌

Pesticide poisoning is one of the most inportant health issues associated with rural medicine, and chronic nervous and mental disorders are its importnat sequelae. We investigated suquela cases nationwide, and reviewed chronic nervous and mental disorders from a clinical and epidemiological point of view.<BR>Our nationwide survey found one reported case of delayed neuropathy. The patient ingested organophosphorus insecticides, and showed delayed neuropathy dozens days after.<BR>Cases of delayed neuropathy attributable to Mipafox was reported in1951.This disease is mainly caused by organophosphorus insecticides. Carbamate insecticides are also known as the agents to induce delayed neuropathy. Herbicide Glufosinate (Basta<SUP>TM</SUP>) was put on the market in 1984. The case reports published during the 1990's pointed out that some Glufosinate poisonings cause amnesia and disorientation. Thesecases were reviewed according to the types of pesticides or their groups.<BR>An epidemiological investigation of neurological and psychiatric desorders among such workers exposed to several types of pesticides as plantation workers and sheep dippers was made. These exposed workers were at high risk of mild cognitive dysfunction, tremor, weakness, and so on to a significant extent. Those children who were exposed to organochlorine insecticide and pollutant via placenta or milk were also surveyed whether they had impairments of nervous and mental development. Highly exposed children were significantly slow in development relative to their peers. The results of these investigations were also reviewed.

Chronic Disorders Brought by Pesticides to Human Bodies / 日本農村医学会雑誌

As regards the chronic disorders brought about by pesticides to human bodies, attempts have been made to review theses that have been published both at home and abroad in the last several years on the basis of epidemiological studies. The chronic disorders that are found to have something to do with pesticides are neurological disorders (Parkinson's disease, peripheral nervous symptoms, poor coordinations and abnormal deep tendon reflexes), mental disorders (mild cognitive dysfunction and neurosis), pulmonary and bronchial disorders, hematopietic disorders (aplastic anemia), thyroid disorders, ocular disorders, immune disorders, natal disorders and birth defects (teratism, spontaneous abortion, complete transposition of the great arteries and cryptorchism), disorders in childhood growth (disorders in social development and attention deficit disorders, among others), genital disorders (reduction in fertility, erectile dysfunction (ED) and oligozoospermia), oncogenesis and carcinogenesis (childhood cancer, leukemia, non-Hodgkin lymphoma, multiple myeloma, others and pulmonary, mammary, cystic, pancreatic, and prostatic cancers).The findings of epidemiological studies do not necessarily produce casual relationships but, as identical findings have come out in many epidemiological studies, it may be argued that they produce findings the casual relationship of which is considerably suspicious. The working of pesticides as chemicals to stir incretion (the working similar to that of estrogen), the working of dioxin contained as a byproduct and the impairment of DNA have something to do with causes to chronic disorders.With not only acute poisoning by pesticides but also chronic disorders, the greatest adverse impacts fall on farmers who are directly engaged in the spraying of pesticides. When it comes to genital disorders, birth defects and tumorigenesis, among others, the spraying of insecticides and the extermination of white ants in and out of the houses ought to be taken into full account.

A study on Cost-Effectiveness of Health Promotion Activities in Rural Communities / 日本農村医学会雑誌

We have studied the degree to which health screenings and health education activities, including health promotion and improvements in the lifestyle, are contributory to the reduction of outlays for disease prevention and medical care.<BR>An analysis of all municipalities in one prefecture reveals that the larger the number of public health nurses and the rate of undergoing a health checkup, the smaller the expenses required for inpatient and outpatient services. In a comparison between the municipalities where adequate health screenings and health education are provided and those in which no such activities are evolved yet in another prefecture, the outlays necessary for the medical care of seniors are significantly lower in the former.<BR>An analysis of Rezept, or the monthly bills for medical treatment forwarded by hospitals to the associations that take charge of the National Health Insurance Scheme, shows that the coverage of per-capita costs under the scheme for the treatment of people who undergo a health screening on a regular basis is lower than that of those who do not do so, despite the fact that the latter more often undergo treatment at medical institutions after they suffer from some kind of disease or the other. In a comparison of municipalities that differ in terms of the per-capita share in the coverage of the scheme, the lower the medical outlay, the higher the rate of undergoing a health screening, that of receiving treatment at local hospitals and that of deaths at home.<BR>An analysis of persons who have regularly undergone a health checkup over a period of five years indicates that the improvements made in the everyday lifestyle, and in dietary practices, exercises and calisthenics are more significant than is the case with people who have not undergone it. In stomach cancer screenings (mass X-ray stomach screenings or endoscopy), the rate of deaths from cancer and the outlay for inpatient services are lower than those of people who have not undergone a health-checkup. When outlays for health screenings, those for inpatient services and a deathderived losses in the benefit are all taken into account, it follows that the benefit is higher for people who have undergone a health screening on a regular basis.

Review of Epidemiological Research of Cancer Related to Pesticide Exposure / 日本農村医学会雑誌

The authors reviewed the English language papers concerning chronic health effects of agricultural chemicals, focusing on the incidence of cancer in pesticide users. These papers were collected using MEDLINE between 1988 and 1998 as a referencetool. According to the standard study design, the epidemiological literature is classified into cohort studies and case-control studies. These studies suggested the association between pesticides and various types of cancer such as soft tissue sarcoma, non-Hodgkin's lymphoma, lung cancer, and breast cancer. Categories of pesticides included in these studies, varied greatly, including herbicides and insecticides.<BR>In this paper, we discussed about such problems as the selection of control groups and the assessment of pesticide exposure levels, which may pose some problems in conducting epidemiological research on the relationship between pesticides and cancer.<BR>A model for a method of epidemiological study of health hazards due to pesticide exposure was also presented.

A Study on Glucomannan's Function to Reduce Cholesterol / 日本農村医学会雑誌

We have checked into the function of <I>konjak</I>, or the devil's-tongue (<I>Hydrosme vivieri</I>) to reduce cholesterol in order to cast light on its significance as a health food. We processed chipped glucomannan into crackers (hereinafter referred to as “mannan crackers”) and examined its impacts on lipid metabolism. Enrolled for this study were hospital staff members whose total cholesterol exceeded 200mg/dl and students boarding in the hospital's nursing college.<BR>The findings attested to the fact that the intake of mannan crackers may serve to reduce the values of total cholesterol. The higher the value of total cholesterol before this study, the greater the drop. Since we could not detect any effect on either HDLcholesterol or triglyceride, the mannan crackers were considered capable of specifically reducing LDL-cholesterol. We observed no numerical changes in the complete blood cell count (CBCC) and blood chemistry, either. Some of the subjects had abdominal swelling, diarrhea and other digestive problems but theirs were not serious cases. Yet in another aspect, there was no difference in body weight between before and after this study, but the intake of energy and lipid dropped during the period, suggesting that the intake of mannan crackers would produce an effect on the dietary pattern. Having said that, <I>konjak</I> (mannan crackers) may be considered capable of directly or indirectly reducing cholesterol, particularly LDL-cholesterol, suggesting that mannan crackers are of significance as a health food.<BR>The significance of this study for agriculture and rural community must not go unmarked. This study will contribute to the development of agriculture as an industry, while the farm product by the name of <I>konjak</I> has something to do for health, and will be instrumental in protecting the rural environment, not to mention the lives of farm workers engaged in its production. It is a task for us to grapple with by associating itself with farm work and rural villages with the close collaboration of those farm producers.

Research on Fluoride Pollution and Fluorosis in Rural Areas of China / 日本農村医学会雑誌

A China-Japan joint project was carried out to study the incidence of fluorosis caused by coal burning in China from 1995 to 1997.<BR>The health survey covered a control area and two flourosis areas. In those research areas, drinking water was not polluted with fluorides. The survey was designed to analyze the health status of people exposed to fluorides and evaluate the relationships between the dose and incidence of fluorosis. The concentration of airborne pollutants in both indoor and outdoor air was measured. The concentration of fluoride in the urine was analyzed and definite diagnoses for dental fluorosis and skeletal fluorosis were determined.<BR>As a result, the incidence of coal burning fluorosis was confirmed in studied areas. Moreover, the fluorosis was caused not only by the direct inhalation of the airbone fluorides in indoor air but also by the intake of cereals polluted with fluorides. Fluoride was contained in both coal and soil. Therefore the mixture of coal and soil used for the adjustment of fire energy contributed to the air pollution to a great extent. The typical polluted crops were red pepper, corn and potato. An extremely high concentration of fluoride in the urine of residents in the polluted areas was detected.

Skin Cancer Screening Project in Saku District, Nagano Prefecture. Effects of Ultraviolet Radiation on Health / 日本農村医学会雑誌

In recent years, an increasing number of researchers have warned that depltion of the Earth's ozone layer by chlorofluorocarbons allows extra ultraviolet radiation from space to strike our planet, causing a rise in the incidence of skin cancers and precancerous dermatoses worldwide. This motivated us to perform a series of screening for skin cancers on the inhabitants at age 40 and above of the Saku District, Nagano Prefecture, where the intensity of the sun's harmful ultraviolet radiation is thought to be relatively high.<BR>The first screening was carried out from 1993 through 1995. The number of subjects totaled 7, 528-2, 658 men and 4, 870 women-which represents 7.4% of the populace. Of the total, 67 people had a histopathological examination. The result revealed that there were four cases of malignancy and 45 cases of precancerous dermatosis. The malignant cases were made up of one case of malignant melanoma and three cases of basal-cell carcinoma, while the precancerous cases were one case of Bowen's disease and 44 cases of solar keratosis.<BR>The follow-up examination was conducted in 1996 on 93 subjects (40.6%) of the 229 examiness who had been found to need to be watched in the first screening. Biopsy was indicated in five subjects. Treatment was suggested to 11 subjects. A visit to the department of dermatology at Sake Central Hospital was recommended to 10 people. Further observation was needed in 24 cases.<BR>The screening project for skin cancers under a long-range plan would raise awareness of the diseases among the people and contribute to the early detection, treatment and prevention of various forms of skin cancer. It could also serve the purpose of protecting the environment from deterioration on n global srnle.

Group Medical Examination Upper Gastrointestinal Endoscopy Performed Early in the Morning at a Rural Clinic / 日本農村医学会雑誌

Koumimachi Clinic attached to Saku Central Hospital is located in an underpopulated rural area. We have annually performed a close medical examination by upper gastrointestinal endoscopy since 1982. Since 1986, it has been done early in the morning. In 1995, a total of 1, 513 radiographic examinations were performed and 555 cases were examined by upper gastrointestinal endoscopy. Two cases of gastric cancer-one being early stage and the other, advanced stage-were detected. Despite the busy season all the farmers who had been advised to have the endoscopic examination attended because it was performed early in the morning. The early morning examination was performed in cooperation with Saku Central Hospital, Naganoken Kouseiren Health Screening Center, and public health nurses of local governments. Without such cooporation, any health care project could not be carried out a rural area.

A Clinical and Epidemiological Review on Chronic Pesticide Poisoning (Disorders). 2. Disorders in Organs / 日本農村医学会雑誌

Of all chronic pesticide poisoning (disorders), this is an attempt to review pulmo-bronchial disorders, hepatic disorders, stomach disorders, blood and hematopoietic disorders, hypertension and vascular disorders, dysbolism and immunological disorders in a clinical and epidemiological perspective.<BR>The pulmo-bronchial disorders consist mostly of those with pneumonic episodes and chronic progressive lung fibrosis. Then there were asthma, chronic bronchitis and degenerated hepatic functions, among others. The prevalence of hepatic disorders was high among persons exposed to pesticides, and they were caused by organochlorine and TCDD. Then there were cases with hepatic cirrhosis because of a continued intake of arsenic, a residue in the wine. When it comes to stomach disorders, some were caused by a sustained exposure to organophosphate and sustained intakes from vegetables. In regard to blood and hematopoietic disorders, many cases with apalastic anemia caused by PCP and other blood diseases were observed. As for vascular disorders, cases with arteriosclerotic episodes by paraquat, whereas cases with porphyria by HCB and hyperlipemia by organochlorine. Then there were cases with immunological abnormalities by organochlorine, organophosphate and carbamate.<BR>As many pesticides are mucocutaneously stimulative and allergic in addition to their own toxicity, there is a need to give thought to their compound effects when it comes to disorders to human bodies.

A Clinical and Epidemiological Review on Chronic Pesticide Poisoning(Disorders). Part I. Nervous and Mental Disorders / 日本農村医学会雑誌

Of all chronic pesticide poisoning (disorders), I reviewed nervous and mental disorders from a clinical and epidemiological point of view.<BR>Exhibiting signs of a chronic course, nervous and mental disorders are classified into three types: delayed polyneuropathy, chronic sequelae following acute poisoning and poisoning (disorders) from a chronic exposure. Delayed polyneuropathy consists of extremital sensory disorders and motor paralysis which occur 2-4 weeks after the acute phase, and organophosphorous agents are responsible for them in many cases. The chronic sequelae following acute poisoning are something the symptoms of which persist for months or even for years after an acute exposure. Some of them primarily feature headaches and vision disorders, and central nervous system disorders, mental symptoms, psychic sequelae, and drops in the neuropsychiatric function, among others, are observed. Poisoning (disorders) from a chronic exposure results from an uninterrupted long-period exposure, and neurobehavioral effects, central and peripheral nervous disorders, Parkinson's disease, parkinsonism, dementia and mental disorders, among others, are observed.<BR>I analyzed the clinical features of nervous and mental disorders and at the same time studied methods for clinical diagnosis.

Studies for Development of Regional Care System for Bedridden Elderly People in Rural Community / 日本農村医学会雑誌

With aging in progress, the increase of the elderly with disorders and their care has become a serious regional problem. To step up regional care in an efficient manner, there is the need for well-organized activities with the involvement of all sorts of local people, such as medical workers (physicians, nurses, etc.), health workers (public health nurses, home helpers, medical social workers (MSW), etc.), volunteers and other people in the neighborhood in a system of coordination with various local institutions (hospitals, general practitioners' clinics, municipalities, welfare offices, social security councils, etc.) and facilities (homes for the elderly and health service facilities for the aged). Given this necessity, I have studied the efficient way in which a regional care system ought to be and the way we should wrestle with this issue in order to upgrade the delivery of regional careto old people with disorders.<BR>In a system for the delivery of regional care, the first necessary step is to prepare a place for information and liaison among various regional institutions. In this study, it has become evident that local liaison meetings, round-table discussions and research meetings are enthusiastically held to produce significant effects. For studies on actual cases of regional care, welfare service teams for the elderly are organized, but it is necessary for them to involve field personnel, such as municipal officials, medical institution officials, murses on call, home helpers, volunteers, social security council officials, agricultural cooperative officials and workers at health service facilities fore the aged.<BR>In the process of helping at-home care, the coordination of local medical institution workers, public health nurses and officials of welfare offices is particularly required. More than anything else, it is necessary for medical institutions to have an in-house division in charge of at-home care for the offer of over-the-counter services. Presumably, there are a wide variety of forms and methods for the creation of a local network. As each district has its own conditions and circumstances, the most efficient method should be worked out for each district.<BR>With the aging of subject patients, there are sure signs of an increase in the delivery of care by nurses on call, and the responses have become all the more compolicated. The necessity of care by hospital nurses on call is greater than ever. On the other hand, there are many calls for a doctor's visit. Particularly in rural communities where enough physicians are not available, it is an urgent task to establish a system of home calls while coordinating with local general practitioners and sharing roles with them.<BR>Health service facilities for the aged play a role in supplementing care at home, but those facilities which are not established side by side with hospitals have to render on-call services, whereas when it comes to hospitals without health service facilities for the aged, it is desirable for them to establish day care facilities. Attempts are already under way at various places to integrate health, medical and welfare facilities in one area so that high hopes may be pinned on significant effects both in terms of hardware and software. In this situation, it is necessary for medical institutions to play a significant role. It is necessary to step up support to the reversion to society of people given care at home and the training of volunteers as one of those medical institutions' principal roles.

Efficacy of Urinalysis Conducted as Part of Mass Screening / 日本農村医学会雑誌

We reexamined the cases of renal disease found in urinalyses which had been performed as part of the mass screening, to ascertain its efficacy. During 1990, a total of 94, 913 people underwent physical checkups made by the Naganoken Kouseiren Health Screening Center. The mean positive rates of proteinuria, occult blood in urine and both were 2.4%, 6.2% and 0.5%. Of the total number of examinees, 59, 803 had undergone the previous year's checkup. The mean positive rates of proteinuria, occult blood in urine and both for two consecutive years were 0.8%, 3.4% and 0.1%. The mean positive rates of proteinuria and occult blood increased with age. The mean positive rate of proteinuria was 1.7 times higher in males than in females. On the other hand, the mean positive rate of occult blood was 2.7 times higher in females than in males. However, there was no difference what so ever between men and women in the mean positive rate of both proteinuria and occult blood.<BR>In the mean time, we reviewed the 85 cases in which renal biopsy was performed at the Saku Central Hospital from 1985 through 1990. Among them, 35 (41.2%) were the cases which had been suspected to have kidney disorder in the urinalysis conducted as part of a mass screening, and IgA nephropathy accounted for about 60% of them. The reports from medical institutions which made follow up examinations using the results of the health screening showed that the rate of renal disease was highest in the proteinuria positive cases; that of urological diseases, in the occult blood positive cases; that of chronic glomerulonephritis and urological diseases, in the proteinureal occult blood positive cases. We concluded that urinalysis included in a battery of tests at the time of the mass health screening is an effective procedure for detecting chronic glomerulonephritis and urological diseases.

Urinary Incontinence Among the Middle-Aged and Senior Members of a Rural Community / 日本農村医学会雑誌

We investigated the prevalence of, and factors in, urinary incontinence among the people of middle to advanced age, using a yes/no questionnaire. The total number of respondents was 4, 020 (1, 520 males and 2, 500 females). Seventy-five percent of them were over 65 years old (median age: 67 years). The prevalence of urinary incontinence was 14% for the males and 30% for the females. The data were analyzed by standard statistical tests, such as χ<SUP>2</SUP> tests. The factors closely associated with urinary incontinence were aging, the high urinary frequency in a day, a history of cerebrovascular accidents, difficulty of urination in the males and UTI in the females. Urinary incontinence of the urge type account for 64% of the males and that of the stress type 81% of the females. Fifteen percent of the males and 6% of the females had consulted with physicians or urologists about urinary incontinence. These percentages were lower than those in European countries. However, we suspect that there may be much more latent patients who suffer from urinary incontinence in their daily community life.

Lipid peroxidative damage and inhalation toxicity by suspended particulate pesticide / 日本農村医学会雑誌

High concentration of airborne particles was detected in greenhouse air after suspended particulate pesticide spraying. The reduction of aerial concentration of resprirable particulate pesticide was relatively slow.<BR>To study the potential health effects of inhaled pesticide, the animals were exposed to the pesticide, methidathion particles in the inhalation exposure chamber. The exposed pesticide particles were approximately 2.16 μm mass median diameter.<BR>The animals exposed to suspended particulate pesticide had a considerable amount of particles within alveolar macropharges and alveolar epithelia. The serious lesion of alveolar epithelia and capillary endothelia of the animals occured after inhalation of methidathion particles.<BR>The vacuolar degeneration of hepatic cell was also cytosol decreased significantly after inhalation of methidathione particles.<BR>The exposure to suspended particulate methidathion induced production of thiobarbituric acid reacting substances (TBARS) in hepatic cells of the exposed animals. The induction of TBARS formation in hepatic cells was remarkable at early period of exposure.<BR>The change of serum transaminase (GOT) activities after exposure to methidathion particle was remarkable. GOT activities also markedly increased at early period of exposure.

Inhalation toxicity of suspended particulate pesticide-supracide FD / 日本農村医学会雑誌

To study the potential health effects of suspended particulate pesticide-Supracide FD, the animals were exposed to the pesticide particle in the inhalation exposure chamber. The suspended particulate pesticide was approximately 2.16μm mass median diameter.<BR>The animals exposed to suspended particulate pesticide had a considerable amount of particles throughout the alveolar region.The particles deposited mainly within alveolar macropharge and alveolar epithelium. The epithelial lesion of the pulmonary tissue and the vacuolar degeneration of hepatic cell of the animals occured after inhalation of pesticide particle.<BR>The exposure to Supracide FD induced production of more thiobarbituric acid reacting substances (TBARS) in comparison to the controls. The change of serum GOT and LDH activities after exposure to pesticide particle was also remarkable. The exposure to the pesticide particle caused no significant effect on the serum cholinesterase activity.

Primary health care in rural communities. A collective approach to health control / 日本農村医学会雑誌

A survey was conducted on 117 agricultural cooperatives and 121 city, town and village offices in Nagano Prefecture to find out how they provide health care to the population. The following is a summary of the findigs of the questionnaire survey based on interviews.<BR>1. Collaboration between agricultural co-ops and local public offices in health control activities has become closer. Nearly half of the agricultural co-ops plan and implement health screening programs jointly with city, town and village authorities. One of the favorable effects of the joint undertaking manifests itself in the form of improvement in the ratio of participants to the total populace. The average percentage of participation in the joint programs comes at 48.8% as against the prefectural average of some 22%. Moreover, the joint efforts bring about the desired effect on the implementation of after-screening guidance and other health promotion programs.<BR>2. Of local health leaders, 87.2% said that they keep in contact with each other. Those who meet once in every one to three months account for 24.8% of the total. In the areas where health leaders have liaison meetings regularly, it is noted that there is close cooperation between medical insitutions and various health-related organizations, resulting in a marked improvement in the percentage of participation in health screenings. It is also noted that there is overall improvement in the attitude toward health control.<BR>3. As regards the participation of inhabitants in health control activities, the women's, the young men's and the producers' associations have representatives to the health control promotion council of the agricultural cooperative in each region. Of the three associations, the women's association is the most enthusiastic with the participation ratio of 55.4%. Meanwhile, 67.8% of the agricultural co-ops send their representatives to the health promotion council of each municipal body. More representatives of agricultural co-ops and inhabitants should take part in the council in the interest of people's well-being.

Fundamental and clinical studies of tumor markers for effective use in cancer screening / 日本農村医学会雑誌

Part of the blood samples collected during group medical examinations might possibly be used as tumor markers a in preliminary screening for cancer. However, at the present, it would be too hasty a conclusion that the tumor markers in the blood samples are definitely effective in terms of practicality. There is much more probing yet to be done.<BR>To begin with, the authors think it necessary to examine the normal values and basal ranges of tumor markers currently available and compare them with clinical values according to the types of cancer.<BR>In this report, the five tumor markers (CEA, AFP, Ferritin, SCC and CA19-9) are dealt with. All these markers are undergoing clinical testing on patients in our hospital. The results so far obtained showed that each marker has its own characteristics. CEA has proved to be helpful in making the diagnosis of advanced colo-rectal carcinoma; AEP is useful for liver cancer; Ferritin, liver and lung cancers; SCC, squamous cell, carcinoma; CA19-9, cancer of the pancreas. However, to be noted is the fact that the cancer specificity of these markers are not alway high. Therefore, due caution should be exercised in the use of any one of the markers for cancer screening.<BR>In the light of the fact that a combination assay of AFP and Ferritin is effective in diagnosis of primary hepatocellular carcinoma, combinations of dif-ferent markers are worth studying. Furthermore, the finding of blood tests and urianalyses should be checked against the measurements of markers. These efforts will certainly open up a new vista for more effective imple mentation of group cancer screening programs

Working and health conditions of female vegetable growers in highlands / 日本農村医学会雑誌

An extesive survey of labor, health and living conditions was conducted on female members of farm households who are primarily growing vegetables such as lettuce and cabbage in the highlands of Nagano Prefecture. The survey included a follow-up on the attitude of those examined physically toward health.<BR>The busiest season for the vegetable growers extends from July to September. About one-third of the respondents in our survey said that they work more than 12 hours a day during the most part of the period.<BR>From the viewpoint of health, the major problem was connected with pesticides, which are sprayed in relatively large quantities over the vegetable fields. Our findings showed that 65% of the female farmers are engaged in the spraying of pesticides, of whom 13% said that they had suffered from intoxication and other types of physical disturbances.<BR>Many complained about trouble in locomotive organs. To be noted is the finding that a half of the examinees had lower back pain, which presumably has something to do with the half-rising posture which the farmers take for a long time while working in the fields.<BR>Our examination also revealed that about 25% of the women are prone to pyelitis and cystitis.<BR>During the busiest season, these working housewives have to bear particular burdens and pressures that have a profund impact on their ability to carry through house work. A half of the housewives said that they do not have time to do family duties such as cooking, washing and cleaning.<BR>Since physical examinations were carried out during the slack season, the attendance at the briefing on the results of examination was pretty good. Most of the examinees who had been told they need a thorough medical checkup or treatment followed the doctors' advice.<BR>The survey found that a majority of the housewives are doing what they can in order to improve their eating habits. As for the improvement of working conditions, however, they find it difficult to lighten their burdens due to the nature of farm work.