World wide web-based cytological analysis of atypical squamous cells cannot exclude high-grade intraepithelial lesions.

OBJECTIVE: It has been reported that the low level of consistency of diagnosis of atypical squamous cells cannot exclude high-grade squamous intraepithelial lesions (ASC-H) in uterine cervical cancer screening using the Bethesda System, indicating the necessity of a large-scale survey. We presented cases cytologically judged as ASC-H on our website and invited our members to give their opinions regarding the diagnosis by voting online. The Web voting results were analyzed and ASC-H was cytologically investigated. STUDY DESIGN: Virtual slides of atypical cells in cytology preparations of 53 cases were prepared and presented on a website. ASC-H cases were divided into 42 cases sampled by brush scraping and 11 cases sampled by cotton swab scraping. Fifty-three cases cytologically judged as ASC-H were classified into benign and CIN2/3, and their patterns of arrangement of atypical cells and 8 cytological parameters were morphologically investigated. RESULTS: The frequency of ASC-H diagnosis in the Web votes was low: 29.2% for brush-scraped and 26.2% for cotton swab-scraped cases. Three-dimensionality, coarse chromatin and irregular nuclei were significantly different between high-grade squamous intraepithelial lesions and benign cases. CONCLUSION: Web-based surveys showed the difference of cytological findings between high-grade squamous intraepithelial lesions and benign cases. To increase interobserver consistency, it may be useful to share information online, which avoids geographical and temporal limitations.

Development of a new instrument for evaluating leg motions using acceleration sensors (II).

OBJECTIVE: The purpose of this study was to investigate the characteristics of the average acceleration of elderly people during walking. METHOD: The subject cohort comprised nine men and 21 women aged ≥63 years. Subjects walked a 10-m straight course (walk test) which required stepping over six obstacles (hurdle walk test). The average acceleration was calculated from the accelerograms. Functional reach test scores and the Tokyo Metropolitan Institute of Gerontology (TMIG) index of competence, fall risk assessment, fall experience within the last year, and carelessness were used as standard indices to estimate the dynamic postural movement and fall risk. RESULTS: The average acceleration during the walk test was not significantly correlated with the standard indices. The average accelerations at the lumbar and knee positions clustered with fall experience and carelessness, while those at the ankle and toe positions clustered with the hurdle walk test, TMIG index of competence, and fall risk assessment. Between the high- and low-risk groups classified by the conventional indices, there was a significant difference in the average acceleration at some measurement positions. The receiver operating characteristic analysis showed the possibility to discriminate the high-risk group according to the standard indices with average acceleration. CONCLUSIONS: The average acceleration during walking may be a composite index that encompasses standard indices and discriminate the high-risk group. As such, it may be a useful tool to estimate the dynamic postural movement and fall risk at all measurement positions.

[Relationships of self-reported physical health, sociability, and spiritual life with mental health: an investigation according to gender and life stage].

OBJECTIVE: To investigate the relationships of self-reported physical health, social and spiritual satisfactions with subjective mental health according to gender and life stage. METHODS: Self-reported questionnaires with questions regarding subjective health status and lifestyles were sent to 1905 community residents aged 20 years or older selected by random sampling in Wakayama Prefecture, Japan. Subjective mental health, physical health, social and spiritual satisfactions as measures of subjective health status were assessed using a visual analogue scale. Multiple logistic regression analysis was used to evaluate the relationships between the subjective mental health and the other three components of the subjective health status with adjustment for life style factors related to the subjective mental health in the subjects without missing values of relevant factors (n=1,752). The subjects were divided into three life stages depending on their ages: young (20-39), middle (40-59), and old (60 or more). RESULTS: Overall, the poor statuses of the three components, namely, physical health, social and spiritual satisfactions, were significantly associated with poor mental health in both genders at any life stage. However, detailed analysis revealed some interesting characteristics. In young men, social dissatisfaction was strongly associated with poor mental health whereas spiritual dissatisfaction in addition to social dissatisfaction was strongly associated with poor mental health in young women. In the middle aged group, both social and spiritual dissatisfactions were strongly associated with poor mental health in both genders. On the other hand, poor physical health status was strongly associated with poor mental health in the old aged group. CONCLUSIONS: These results suggest the importance of the mental health interventions under consideration for each life stage and gender.

[Drinking behavior of female nursing students and stress factors related problem drinking].

The survey was done to clarify how the behavior of drinking alcoholic beverages of female nursing students relates to the stress they feel in their school life. The questionnaires were sent to 337 female students of two nursing schools located in metropolitan area. Students were asked to reply the questions of Adolescent Alcohol Involvement Scale (AAIS), and other questions related to their smoking habits and stress felt in their school life. Alcohol misusers who scored 42 points or more on AAIS were 13.7% of the valid respondents and non-drinkers and those who scored 19 and under on the scale were 4.1%. Those who drink more than over per week accounted for 12.0%, and those who have more than 3 drinks at one time accounted for 61.5%. Those who experienced alcohol drinking during childhood replied that this was encouraged by their parents. Those parents were found to be very generous about children's drinking at home later. The analysis of stress factors in students' life in relation to drinking behavior revealed that the students with scores on AAIS above 42 tended to show less eagerness in studying, and that clinical practice and report writing did not give than much stress.

[Actual conditions of heavy drinkers in a community and measures against alcoholic problems].

We surveyed the health conditions of people in an area, as a baseline survey for a local plan of Healthy Japan 21. Among the 2,469 subjects, we selected 40 ones, as a drinker group, who drank alcohol more than 3 days a week (more than 60 g a day), and 80 ones, as a control group, whose gender, age and resident area were matched to the drinker group. More subjects took no breakfast in the drinker group than in the control group. More smoked and felt stress in the drinker group. Subjective health conditions were worse in the drinker group. Half in the drinker group took no annual health examination. Half in the drinker group wanted to reduce or quit alcohol, but felt that they could not do so and that the dissolution of stress was necessary to do so. The both groups had low understanding on alcoholism and little information on supporting organizations for alcoholic problems. These results suggest that measures against alcoholic problems in the area are encouraging people to take an annual health examination, giving them substantial guidance after a health examination for drinkers and intervention to raise the understanding on alcoholism.

Development of new instrument for evaluating leg motions using acceleration sensors.

The purpose of this study is to develop a new system for measuring leg motions using a portable three-dimensional accelerometer. The measuring system is composed of acceleration sensors (Micro Stone, MA3-10Ac), a data logger, a data reader, and a personal computer. The personal computer draws a graph of the acceleration of movements (i.e., accelerogram) from the output signals of the acceleration sensors. We then calculated the average acceleration to evaluate leg motions. We drew the accelerograms from 19 young subjects and 36 elderly subjects during the performance of physical fitness activities and walking. Different accelerograms were obtained from two subjects for different walking styles. The average accelerations at the lumbar, ankle and toe points were higher at all axes during movements from the physical fitness activities in the elderly subjects. The accelerations of leg motion at the knee point were, however, lower in the up and down axis in the elderly subjects than in the young subjects, although they were higher in the back and forth and the right and left axes. The new instrument has enabled us to evaluate leg motions by measuring three-dimensional acceleration during the performance of physical fitness activities and walking. The average accelerations of leg motions showed age-related changes. Thus, the average acceleration of leg motions may be used as a new index for evaluating leg motions at the dynamic state.

Thymidine phosphorylase gene mutation is not a primary cause of mitochondrial neurogastrointestinal encephalomyopathy (MNGIE).

OBJECTIVE: The authors identified a patient with mitochondrial neurogastrointestinal encephalomyopathy (MNGIE), who completely fulfilled the clinical criteria with low thymidine phosphorylase (TP) activity. However, the same homozygotic S471L TP gene mutation was also found in her unaffected mother, but with normal TP activity. To elucidate the pathogenesis of MNGIE, we performed the analysis below. METHODS: We analyzed the TP gene mutation in the proband and 145 unrelated individuals by direct sequence and restriction fragment length polymorphism (RFLP). TP activity was determined by the spectrophotometric method for each TP S471L genotype. RESULTS: Among 145 normal persons, the S471L homozygote mutants were identified in 2.76% and their enzyme activity was normal. CONCLUSION: TP gene mutation is not a primary cause of MNGIE, but with a mitochondrial deletion mutation, a single nucleotide polymorphism (SNP) of the TP gene may be crucial in the pathogenesis of MNGIE.