Internet medical usage in Japan: current situation and issues.

Internet use by physicians and patients has become very popular in Japan. Fifty percent of physicians use the Internet to search for medical and other information. Over the past year, 22% of patients used the Internet to obtain medical information. Because there are no restrictions within Japan on using Web sites to advertise medical treatment, information can be freely sent out, and over the past two or three years this practice has increased dramatically. Internet medical information provides information about illnesses and medications, and it helps improve the quality of life of patients and families. Yet, depending on the content of the information provided and the way this information is used, there is a potential negative side as well. On principle, users are responsible for the way information is used, but there is a need for information providers to consider users safety and to make the information effective for use. Because there is no absolute standard for evaluating the value of medical information, it is necessary to establish a system that opens a dialogue with society and that continuously accumulates high-quality information through the collection of various evaluations, rather than rely on an established authority. For industries and organizations related to commercial pursuits, in particular, it is most effective to establish their own codes for ethical conduct, rather than rely on governmental regulations. At the same time, it is important to have a confirmation function to evaluate how goals set by the outside are being implemented. Aiming at establishing a framework for the Internet medical usage, the Japan Internet Medical Association (JIMA) was founded in 1998 by medical professionals, lawyers, researchers, consumer representatives, patients and their families. We propose a system that would combine feedback from users, who would take on the role of evaluators of the implementation of an ethical code, with a displayed mark that verifies the identity of the Web site. Objective evaluation of information is needed to ensure that users have the power to make choices. Medical experts or patient and family groups would assist in this task. The development of medical care will be promoted through patients and physicians working together in the accumulation of shared resources for good medical care information.

Application of telepsychiatry: a preliminary study.

Telemedicine is the provision of professional medical services from sites removed from the patient. This study was conducted in order to assess the reliability of psychiatric evaluations via video-consultation. The inter-rater reliability was determined for each interviewing condition by employing the reliability-testing paradigm in which the brief psychiatric rating scale (BPRS) and the interclass correlation coefficient (ICC) are used. The inter-rater reliability scores between face-to-face interviews and interviews conducted by video at two different levels of image qualities were compared by the authors. Reliability was found to be in perfect agreement in each of the interviewing conditions. This study verifies that telepsychiatry is a reliable method of assessing patient conditions. It may be used to provide much needed mental health-care services to patients whose access to them is restricted.

Is interest in art effective in health-related quality of life? Results of a cross-sectional survey on lifestyle and health promotion.

The objective of this survey was to examine whether lifestyle and health practices can change the health-related quality of life (HRQOL), and how much weight should be placed on each item. A cross-sectional survey by self-administered questionnaires using the SF-36 and questions of our own on lifestyle was conducted in Japan on November 5 to 7, 1999. Volunteers consisted of 147 men and 152 women over 20 years of age. Gender, age, living alone, and lifestyle items such as eating breakfast, regular sleep, and drinking alcohol were significantly associated with the SF-36 profiles. The trends corresponded to those obtained with the previous studies conducted in other countries. Interest in art and regular sleep showed the highest significance (P<0.001) in MANCOVA of eight domains. From the results of multiple regression analysis, drinking alcohol and regular sleep was closely related to physical health status. In the mental component summary and related domains, the important factors were regularity of sleep, not living alone, eating breakfast, interest in art, and drinking alcohol. We concluded that the SF-36 is an appropriate measure to determine effects of lifestyle improvement and assess health promotion programs.

Disaster drills and continuous medical education using satellite-based Internet.

We designed and evaluated a satellite-based Internet system for use in medical applications. Many experimental telemedicine projects use satellites, but we combined digital satellite communication with an ordinary telephone network to realize an economical countrywide network for emergency medicine and continuous medical education. The system appears to be a useful and practical technology for daily clinical activities.

Status and perspective of hospital information systems in Japan.

Questionnaire surveys were sent to hospital managers, designed to shape the policy for future hospital information systems in Japan. The answers show that many hospitals use dedicated management systems, especially for patient registration and accounting, and personnel, food control, pharmacy and financial departments. In many hospitals, order-entry systems for laboratory tests and prescriptions are well developed. Half of the hospitals have patient databases used for inquiries of basic patient information, history of outpatient care and hospital care. The most obvious benefit is the reduction of office work, due to effective hospital information system. Many hospital managers want to use the following sub systems in the future for automatic payment, waiting time display, patient records search, automatic prescription verification, drug side-effect monitoring, and graphical display of patient record data.

Treatments of generalized pustular psoriasis: a multicenter study in Japan.

This study analyzed data from treatments of 385 cases of generalized pustular psoriasis (GPP) from 325 hospitals in Japan. Retinoid treatment was effective in 84.1% of patients, methotrexate in 76.2%, cyclosporine in 71.2%, oral PUVA therapy in 45.7%, and tonsillectomy in 16.7%. Short-term therapy with systemic corticosteroid for GPP during only the phase with severe systemic clinical findings may be also effective (75.4%). However, these treatments for GPP each differed in clinical effects, prognosis, and side effects. These findings may be useful in creating guidelines for treatment of generalized pustular psoriasis. Further studies based on these specific clinical effects are necessary.

Follow-up of clinical efficacy of iontophoresis therapy for postherpetic neuralgia (PHN).

A great variety of therapies have been attempted for PHN, including pharmacotherapy and physical therapy. However, there has been no decisive treatment, and reports of the clinical efficacy of all available therapies have been rather controversial. Almost all studies conducted so far have looked only at short-term therapeutic efficacy, and only a few investigators have conducted long-term observations or studies on long-term outcome. We followed up the clinical efficacy of iontophoresis therapy using lidocaine and methylprednisolone in 197 PHN patients. Monitoring conducted for an average of 4 years after completion of the treatment showed that pain remained unchanged or improved compared to pain observed upon completion of the treatment in 90.4% of patients. Although 42.6% of patients were still continuing some treatment, 90.9% were found to be able to take care of themselves. Findings obtained were reviewed and discussed from various viewpoints. Our findings showed that iontophoresis therapy is not only effective at the end of the treatment, but its efficacy is maintained over a long period of time, indicating that it is clinically very useful for the treatment of PHN.

A review of Japanese telemedicine research and global co-operation.

We can trace 229 telemedicine trials in Japan. Of these, 150 were active in 1998, including 73 in radiology, 24 in home care, 22 in medical imaging, 20 in pathology, 5 in ophthalmology, and 3 in dentistry. Some of them have been reformed into practical daily activities. However, activities using the same method work in some local areas but not in others. Typical successful cases will be presented and discussed. We are constructing Japan-Canada cooperation in numerous areas using several communicative methods: ordinary telephone, ordinary Internet, ISDN (2B/6B), and an offline network using optical memory cards (which patients carry). We have introduced successful domestic cases into global cooperation. Some of them will be useful for exchanging medical information among developing countries.

Development and evaluation of regional health database systems.

We have developed information systems for regional public health in some areas. These systems have the following functions: (1) to register results of examinations, life style, follow-up data, diseases, (2) to output some reports and statistics for daily jobs, (3) to make a personal health database, (4) to display stored data by character, trend graph, radar chart or bar chart, (5) to analyze regional health problems, (6) to extract dada about persons with some conditions, (7) to compare data among some examinations, (8) to analyze risk factors. Each database can be transferred to mini-notebook type personal computers. So, they can be used anywhere and any time. Some access controls are performed for security. The systems are used in routine works, health consultation for persons and health education for groups. We have evaluated the systems and got some useful results. Using the systems, daily jobs can be performed with good accuracy and less labor, each subject can understand one's health status easily and clearly, grasps of health problems can be made quantitatively and health projects can be planned by scientific methods.

Lifestyle and colorectal cancer: A case-control study.

A case-control study has been conducted to investigate the relationship between lifestyle and risk of colorectal cancer. Cases are one hundred patients diagnosed with colon and rectal cancer in Tokai University Hospital between 1986 and 1994. Three controls per case were individually matched by age, sex, local areas and date of health checkups at the Automated Multi-phasic Health Testing and Services (AMHTS ) Center of the hospital. The results were analyzed by multi-factorial logistic regression models. Positive history of maternal cancer, large consumption of alcohol, frequent consumption of potato products and white-collar job were predominant risk factors while frequent intake of seaweed was a protective factor. Frequent intakes of dairy foods and lack of exercise showed no significant tendency to increase risk of colorectal cancer. Smoking habits, intakes of meat and egg were shown not to be related to this disease. These findings suggest that family history of cancer and dietary factors play a key role in causation and prevention of colorectal cancer.

Health and welfare data on optical memory cards in Isehara city.

An off-line network system of health and welfare for elderly people using optical memory cards has been established in Isehara city (Japan) since 1991. 2775 citizens have the cards and 24 offices have the terminals. It covers almost one third of people aged over 65 in Isehara city and almost all of the offices concerned with their health and welfare. About a half of holders use optical memory cards every time they visit these offices. The optical memory card holds data including basic data for health and welfare, health check data over 5 years, medical images with scripts and history of welfare services. All the data are used for medical care, health consultation and management of health and welfare services. A card can hold health and welfare data for a lifetime, and it is easy to expand the system. It has been a good experience for us, because the optical memory card system needs co-operation among citizens, medical association and local government, and the experience will help us to expand the system in the future.

[Effects of inclination of trunk and head on emotional awareness].

Posture is a nonverbal behavior and a universal means of animal and human communication. It is observed not only in interpersonal communication but in clinical situation. Our recent research shows that posture affects the mood and emotional awareness of the subjects. This study compared the subjects' awareness between two groups, the operational group (actual posture) and the image group, which only imagined a postural change. Six kinds of posture were adopted. These postures included two dimensions; inclination of trunk (straight or bent), and head (up, front or down). In these conditions the subjects estimated their mood and emotional awareness with 17 pairs of adjectives on a 3 point scale. The results of ANOVA showed statistically significant differences in conditions of both inclination of trunk and head. Especially, when the subject bent his back while hanging his head, this made most feeble, lifeless, and shadowy mood than any other postures. The authors confirmed that posture exerted a strong influence on one's emotional awareness.

[Learning and resistance to extinction in external-self dual reinforcement as compared with those in external reinforcement].

Learning and resistance to extinction in external-self dual reinforcement (ESR) were compared with those in external reinforcement (ER). delta ESR (delta: extinction process) was also compared with the corresponding process of other two conditions; 1) discontinuation of self reinforcement after external-self dual reinforcement (delta SR), 2) discontinuation of external reinforcement following the dual reinforcement (delta ER). Undergraduates (n = 58 in Experiment I, n = 74 in Experiment II) were randomly assigned to one of the four conditions. Subjects were given association learning in Exp. I and memory task in Exp. II, respectively. Those who responded successfully were then shifted to extinction session for testing. Effects of ESR on learning were same as those of ER in the two experiments. Resistance to extinction in Exp. I was significantly higher for delta SR and delta ESR as compared with delta ER and *ER (extinction switched from external reinforcement). Resistance for delta SR in Exp. II was significantly higher than for the remaining conditions. Based on these findings, high level of the resistance for delta ESR was discussed by attributing it to the internalization of ESR.

Immunohistochemical evidence of progestin target cells in the pituitary gland of ovariectomized rat.

Progestin (P) target cells were identified in the pituitary gland of gonadectomized female rats which had been primed with estrogen (E). P staining was localized using the immunohistochemical avidin-biotin-peroxidase (ABP) complex method. Dark brown precipitates were primarily found over the cytoplasm of cells in the pars distalis, but not in the pars intermedia nor in the pars nervosa. The majority of P-sensitive cells in the pars distalis were identical with luteotrophs, a few being lactotrophs. These observations suggest a role of P in the regulation of production and secretion of gonadotrophins in the pituitary glands of female rats.

Progestin receptors in adult rat ovary during estrous cycle.

Using a synthetic progestin (P)(i.e. R5020), characteristics of P receptors were determined in the ovarian tissue cytosols from adult estradiol benzoate-treated or 4-day cycling rats. In the estradiol benzoate-treated rats a specific 3H-R5020 binding in the cytosol was found with a number of binding sites, V max = 110 fmol/mg protein and the equilibrium dissociation constant, Kd = 14 nM. In the 4-day cycling rats, specific binding was found in the 6-7 S region with the Vmax which fluctuated during the estrous cycle: the sequence of Vmax (fmol/mg protein) was 395 (proestrus) greater than 122 (diestrus) greater than 96 (late estrus) greater than 62 (metestrus) greater than 40 (early estrus). The Kd value varied during the cycle, the highest (22 nM) in proestrus and the lowest (5 nM) in early estrus. In addition, 3H-R5020 binders were thermolabile and of protein in nature. These results suggest that the rat ovary contains P receptors in its cytoplasm with high affinity and low capacity of P binding, the level of which fluctuates during the estrous cycle.

Progestin receptors in ovaries of 4-day cycling rats. An autoradiographic study.

Using an autoradiographic technique we investigated in vitro the localization of cell constituents with concentrations of a radioactive synthetic progestin (P), 3H-R5020 (17 alpha, 21-dimethyl-19-nor-pregna-4, 9-diene-3, 20-dione) and its metabolites in the ovaries of 4-day cycling adult rats. After incubation of the ovarian tissue sections with radioactive R5020 in the presence or absence of various non-radioactive steroids, specific labeling was found in the tissue sections in each phase of the estrous cycle. The intensity of labeling in the ovary during the estrous cycle was highest in proestrus, followed by that in diestrus, metestrus and estrus. The intensity of labeling in cell constituents was as follows: granulosa cells greater than luteal cells greater than thecal cells greater than stromal cells. These results indicate that the rat ovaries contain cell constituents that specifically bind P and that the intensity of binding fluctuates during the estrous cycle.

Effect of ovarian steroids on uptake of radioactive amino acids by brain tissues.

Effects of two major ovarian hormones, estrogen (E) and progesterone (P), on the uptake of amino acids by the brain nuclei of ovariectomized mice were examined. They were divided into four groups: (1) oil controls, (2) P-treated, (3) estradiol benzoate (E2B)-treated, and (4) E2B-primed P-treated mice. Two hr after the last hormonal treatment they were given a single s.c. injection of a mixture of 3H-leucine and 3H-methionine, and then sacrificed 2 hr later. Intensity of the uptake of radioactivity was measured on autoradiograms of the stained tissue sections. Group 1 showed a relatively high uptake of radioactivity by the SO, PV and SPH, compared with that by the remaining brain cells. Group 2 had a slight enhancement of the uptake by the VM, SPH and CC, compared with that in group 1. Group 3 showed a significant enhancement of the uptake by most of the preoptico-hypothalamic nuclei except for the VM, DM and PM, compared with that in group 1. Group 4 had slightly enhanced uptake by the POM, POL, SCH, SO, PV, VM, ARC, SPH and CC, compared with that in group 1. E-priming affected the uptake; it enhanced the uptake by the VM and SPH, and inhibited it by the PVA, AH, LH and CC. Uptake by the PM and EC remained unchanged in all groups. The present results suggest that two major steroids, E and P, influence protein synthesis in most of the brain regions including the preoptic and hypothalamic areas.(ABSTRACT TRUNCATED AT 250 WORDS)

Estrogen receptor in the "non-lymphocytes" in the thymus of the ovariectomized rat.

Estrogen binding components have been characterized in cytosols from lymphocyte fractions and non-lymphocyte fractions of the thymus and mesenteric lymph node of ovariectomized rats. The cytosol from the non-lymphocyte fraction of the thymus contained high affinity-specific binding estrogen receptor (equilibrium dissociation constant .=. 3 X 10(-10) M, number of binding sites .=. 10 fmol/mg protein) with a sedimentation coefficient of 8 S. The receptor showed specific binding for estradiol-17 beta, estrone and estriol, but not for corticosterone, progesterone or testosterone. Only lower estrogen binding was observed in the cytosols from the lymphocyte fraction of both tissues and the non-lymphocyte fraction of the lymph node. Morphological changes of the thymus in ovariectomized rats after administration of estradiol benzoate were also observed. Clustered vacuoles with incomplete microvilli in the epithelial cells increased in number and in size after estrogen treatment. These findings suggest that the effect of estrogen on the thymus is mediated via the cytoplasmic estrogen receptor in the non-lymphocytes, probably thymic epithelial cells.

Effect of progesterone and FSH on testes of immature chickens.

The effect of progesterone (P), estradiol benzoate (EB) plus P, and FSH on the testicular weight, macromolecular content, and incorporation of 3H-leucine, 3H-uridine and 3H-thymidine into macromolecules was examined in the testes of immature chickens. Not P alone but EB plus P lowered the testicular weight, and content of protein and RNA in the tissues, whereas FSH brought about an increase in the weight, and content of the two macromolecular elements. The DNA content was not affected by any hormones used. P, EB plus P and FSH brought about a decrease in the incorporation of radioactive leucine, uridine and thymidine into the macromolecules in the testes, with the exception of no change in the incorporation of 3H-uridine after EB plus P treatment and 3H-thymidine after FSH treatment. These results suggest that P, alone or in combination with estrogen, and FSH cause several changes in metabolic activity in the testes of immature chickens.

Progestin receptors in testes from various animal species.

Using a synthetic progestin, R5020 (17 alpha, 21-dimethyl-19-nor-4, 9-pregnadiene-3, 20-dione), we investigated the presence of progestin receptor(s) in testicular cytosol from various animal species including humans. After incubation of cytosol from adult chickens with [3H]R5020 in the presence or absence of various unlabeled steroids, specific progestin binding was found in the 8 S region with an equilibrium dissociation constant of 2 nM and a binding capacity of 75 fmoles/mg protein. Specific progestin binding was also found in cytosol from immature chickens sedimenting in the 4 S region with a dissociation constant of 61 nM and a binding capacity of 1 pmole/mg protein. Although 5 S binding was found in the cytosols from humans, a monkey and rats, the binding specificity was low. These results clearly indicate that the testicular cytosols from chickens contain progestin receptor(s), whereas those from the other species do not.