Efficacy of endoscopy under general anesthesia for the detection of synchronous lesions in oro-hypopharyngeal cancer

Background/Aims@#Image-enhanced endoscopy can detect superficial oro-hypopharyngeal squamous cell carcinoma; however, reliable endoscopy of the pharyngeal region is challenging. Endoscopy under general anesthesia during transoral surgery occasionally reveals multiple synchronous lesions that remained undetected on preoperative endoscopy. Therefore, we aimed to determine the lesion detection capability of endoscopy under general anesthesia for superficial oro-hypopharyngeal squamous cell carcinoma. @*Methods@#This retrospective study included 63 patients who underwent transoral surgery for superficial oropharyngeal squamous cell carcinoma between April 2005 and December 2020. The primary endpoint was to compare the lesion detection capabilities of preoperative endoscopy and endoscopy under general anesthesia. Other endpoints included the comparison of clinicopathological findings between lesions detected using preoperative endoscopy and those newly detected using endoscopy under general anesthesia. @*Results@#Fifty-eight patients (85 lesions) were analyzed. The mean number of lesions per patient detected was 1.17 for preoperative endoscopy and 1.47 for endoscopy under general anesthesia. Endoscopy under general anesthesia helped detect more lesions than preoperative endoscopy did (p<0.001). The lesions that were newly detected on endoscopy under general anesthesia were small and characterized by few changes in color and surface ruggedness. @*Conclusions@#Endoscopy under general anesthesia for superficial squamous cell carcinoma is helpful for detecting multiple synchronous lesions.

Relationships between physical activity, ADL capability and fall risk in community-dwelling Japanese elderly population

<p><b>OBJECTIVE</b>The purpose of this study was to clarify the relationships among fall risk, physical activity habits, and ADL capability in a community-dwelling Japanese elderly population.</p><p><b>METHODS</b>The subjects were 1,407 Japanese aged 65 or older (604 males, 803 females). Fall risk was evaluated using the Falling Assessment Chart of Suzuki et al. (2003). Physical activity habits such as the frequency of leaving the house, the use of transportation, the frequency of physical exercise, and interests were evaluated. ADL capability was evaluated using the Tokyo Metropolitan Institute of Gerontology Index of Competence.</p><p><b>RESULTS</b>Approximately 25% of the subjects had a high fall risk (score of 5 or more). Fall risk increased with age and ADL capability decreased with age. The group with a low fall risk (score<5) had a significantly higher ADL capability than the group with a high fall risk (score≥5). From results of two-way ANCOVA (gender×physical activity habits) with age as the covariate, the fall risk of people who regularly go on leaving the house, exercise, and have interests tended to be low. Further more, the relationships between the scores and physical activity habits were examined by two-way ANCOVA with age and ADL capability as the covariates. There were significant differences in the frequency of leaving the house, and elderly persons who leaved regularly the house, had a low fall risk.</p><p><b>CONCLUSIONS</b>This study showed that fall risk is closely related to ADL capability, and that the frequency of leaving the house is very important for reducing fall risk.</p>

Relationships between Physical Activity, ADL Capability and Fall Risk in Community-Dwelling Japanese Elderly Population

Objective: The purpose of this study was to clarify the relationships among fall risk, physical activity habits, and ADL capability in a community-dwelling Japanese elderly population. Methods: The subjects were 1,407 Japanese aged 65 or older (604 males, 803 females). Fall risk was evaluated using the Falling Assessment Chart of Suzuki et al. (2003). Physical activity habits such as the frequency of leaving the house, the use of transportation, the frequency of physical exercise, and interests were evaluated. ADL capability was evaluated using the Tokyo Metropolitan Institute of Gerontology Index of Competence. Results: Approximately 25% of the subjects had a high fall risk (score of 5 or more). Fall risk increased with age and ADL capability decreased with age. The group with a low fall risk (score <5) had a significantly higher ADL capability than the group with a high fall risk (score ³5). From results of two-way ANCOVA (gender×physical activity habits) with age as the covariate, the fall risk of people who regularly go on leaving the house, exercise, and have interests tended to be low. Further more, the relationships between the scores and physical activity habits were examined by two-way ANCOVA with age and ADL capability as the covariates. There were significant differences in the frequency of leaving the house, and elderly persons who leaved regularly the house, had a low fall risk. Conclusions: This study showed that fall risk is closely related to ADL capability, and that the frequency of leaving the house is very important for reducing fall risk.

Agreement in depression determination among four self-rating depression scales applied to Japanese community-dwelling elderly

<p><b>OBJECTIVE</b>In this study, we examined the characteristics of depression determination using four representative self-rating depression scales (Geriatric Depression Scale, GDS; Self-rating Depression Scale, SDS; Center for Epidermiologic Studies Depression Scale, CES-D; and Carroll Rating Scale, CRS) applied to Japanese community-dwelling elderly.</p><p><b>METHODS</b>Subjects were 563 community-dwelling independent elderly living in twelve prefectures (330 males, 68,9±6.3 yr; 233 females, 68.1±5.8 yr).</p><p><b>RESULTS</b>Depression rates determined using SDS (45.8%) and CES-D (68.6%) were higher than those determined using GDS (5.7%) and CRS (14.7%). Although correlations of depression scale scores among the four scales were significant and comparable (r: 0.61 (GDS vs. SDS, p<0.01) to 0.78 (SDS vs. CES-D, p<0.01)), the agreement in depression determination varied among scales (kappa coefficients: 0.05 (GDS vs. CES-D, p>0.05) to 0.46 (SDS vs. CES-D, p<0.01)).</p><p><b>CONCLUSIONS</b>Similarities in depression determination were found between GDS and CRS, and between CES-D and SDS. Depression rates determined on the basis of cut-off point for each scale were higher for CES-D and SDS than for GDS and CRS. Depression determination using a four-point rating scale may overestimate a slightly depressive symptom, compared with that using a two-point scale.</p>

Agreement in Depression Determination among Four Self-Rating Depression Scales Applied to Japanese Community-Dwelling Elderly

Objective: In this study, we examined the characteristics of depression determination using four representative self-rating depression scales (Geriatric Depression Scale, GDS; Self-rating Depression Scale, SDS; Center for Epidemiologic Studies Depression Scale, CES-D; and Carroll Rating Scale, CRS) applied to Japanese community-dwelling elderly. Methods: Subjects were 563 community-dwelling independent elderly living in twelve prefectures (330 males, 68.9±6.3 yr; 233 females, 68.1±5.8 yr). Results: Depression rates determined using SDS (45.8%) and CES-D (68.6%) were higher than those determined using GDS (5.7%) and CRS (14.7%). Although correlations of depression scale scores among the four scales were significant and comparable (r: 0.61 (GDS vs. SDS, p<0.01) to 0.78 (SDS vs. CES-D, p<0.01)), the agreement in depression determination varied among scales (kappa coefficients: 0.05 (GDS vs. CES-D, p>0.05) to 0.46 (SDS vs. CES-D, p<0.01)). Conclusions: Similarities in depression determination were found between GDS and CRS, and between CES-D and SDS. Depression rates determined on the basis of cut-off point for each scale were higher for CES-D and SDS than for GDS and CRS. Depression determination using a four-point rating scale may overestimate a slightly depressive symptom, compared with that using a two-point scale.

Urban-rural differences in subjective symptoms of fatigue and their relations with lifestyle factors in young male Japanese students

<p><b>OBJECT</b>The purposes of this study were to investigate the actual status in subjective symptoms of fatigue (SSF) and lifestyles of young male students living in two different life spheres of the Tokyo metropolitan area and a rural area, and to find, regional differences in these characteristics and relations between SSF and lifestyles in school life.</p><p><b>METHODS</b>A questionnaire regarding SSF and lifestyle was administered to 412 healthy male students (16-18 yr) attending the two National Colleges of Technology located in the Tokyo metropolitan area (MA) and a local city (LC). Statistical techniques such as a chi-square test and Hayashi's Quantification Theory I analysis were used to examine relations between SSF and lifestyles.</p><p><b>RESULTS AND CONCLUSION</b>A significant difference was found only in "feeling of physical disintegration,", and the MA group was higher than the LC group. The MA students showed shorter sleeping hours and earlier awaken time compared with LC students. In the relations between SSF and lifestyles, sleeping habit was an important factor significantly relating to SSF in both groups. Paying attention to good sleeping habits is an important countermeasure for preventing SSF in the male students.</p>

Activity groupings reflecting functional characteristics required in daily life in institutionalized dependent females in the old old elderly group

<p><b>OBJECTIVES</b>This study aimed to determine the activity groupings reflecting functional characteristics required in daily life for the institutionalized dependent females in the old-old elderly group, by examining the interrelationships of activities based on actual achievement characteristics.</p><p><b>METHODS</b>The participants were 697 dependent elderly living at welfare institutions in Japan and 344 old-old females were used for analysis. Factor analysis, based on Promax with the Kaiser Normalization method, was conducted using 74 activities of daily living (ADL) items to determine activity groups. Furthermore, whether each activity group could be classified into sub-groups was confirmed by applying factor analysis to the activities consisting of each activity group.</p><p><b>RESULTS</b>Four activity groups of lower extremity activities, manual activities, changing and holding posture activities, and upper extremity and dexterous manual activities were interpreted. Except for the manual activity group, these activity groups were classified into two sub-groups.</p><p><b>CONCLUSIONS</b>These activity groupings were characterized by similarities of the body parts used in achievement and the difficulty of activity. The activity groupings obtained in this study are considered to be useful in ADL assessment focusing on evaluating functional characteristics of the dependent elderly.</p>

Problems with the Japanese version of the Center for Epidemiologic Studies Depression (CES-D) scale when applied to Japanese independent community-dwelling elderly: an examination of the factor structure

<p><b>PURPOSE</b>The present study aimed to determine the problems of the Japanese version of the Center for Epidemiologic Studies Depression (CES-D) scale when applied to Japanese independent community-dwelling elderly focusing on its factor structure.</p><p><b>METHODS</b>The subjects were 1791 community-dwelling independent elderly aged 60 and over (848 males and 943 females). This study used the Japanese version of the CES-D scale to assess depression in the elderly.</p><p><b>RESULTS</b>From the results of an exploratory factor analysis, the four factors of somatic symptoms, depression affect, positive affect and relation with others were interpreted.These factors were the same as those in the previous study, but the items making up each subscale differed. Therefore, the construct validity of each subscale was not necessarily assured. In the confirmatory factor analysis, goodness-offit was high for both the first and second-order factor models. In examining the validity by Akaike's information criterion (AIC), the second-order factor model assuming depression as a higher-order factor among the four factors was a better fit than the first-order factor model. Although the reliability of each subscale was not sufficient, adequate reliability was assured in the total scale.</p><p><b>CONCLUSION</b>An assessment of depression using the Japanese version of the CES-D scale should be conducted using the total score, while a re-examination of items making up each subscale is needed.</p>

Problems with the Japanese Version of the Center for Epidemiologic Studies Depression (CES-D) Scale when Applied to Japanese Independent Community-Dwelling Elderly: an Examination of the Factor Structure

Purpose: The present study aimed to determine the problems of the Japanese version of the Center for Epidemiologic Studies Depression (CES-D) scale when applied to Japanese independent community-dwelling elderly focusing on its factor structure. Methods: The subjects were 1791 community-dwelling independent elderly aged 60 and over (848 males and 943 females). This study used the Japanese version of the CES-D scale to assess depression in the elderly. Results: From the results of an exploratory factor analysis, the four factors of somatic symptoms, depression affect, positive affect and relation with others were interpreted. These factors were the same as those in the previous study, but the items making up each subscale differed. Therefore, the construct validity of each subscale was not necessarily assured. In the confirmatory factor analysis, goodness-of-fit was high for both the first and second-order factor models. In examining the validity by Akaike's information criterion (AIC), the second-order factor model assuming depression as a higher-order factor among the four factors was a better fit than the first-order factor model. Although the reliability of each subscale was not sufficient, adequate reliability was assured in the total scale. Conclusion: An assessment of depression using the Japanese version of the CES-D scale should be conducted using the total score, while a re-examination of items making up each subscale is needed.

Activity Groupings Reflecting Functional Characteristics Required in Daily Life in Institutionalized Dependent Females in the Old Old Elderly Group

Objectives: This study aimed to determine the activity groupings reflecting functional characteristics required in daily life for the institutionalized dependent females in the old-old elderly group, by examining the interrelationships of activities based on actual achievement characteristics. Methods: The participants were 697 dependent elderly living at welfare institutions in Japan and 344 old-old females were used for analysis. Factor analysis, based on Promax with the Kaiser Normalization method, was conducted using 74 activities of daily living (ADL) items to determine activity groups. Furthermore, whether each activity group could be classified into sub-groups was confirmed by applying factor analysis to the activities consisting of each activity group. Results: Four activity groups of lower extremity activities, manual activities, changing and holding posture activities, and upper extremity and dexterous manual activities were interpreted. Except for the manual activity group, these activity groups were classified into two sub-groups. Conclusions: These activity groupings were characterized by similarities of the body parts used in achievement and the difficulty of activity. The activity groupings obtained in this study are considered to be useful in ADL assessment focusing on evaluating functional characteristics of the dependent elderly.

Urban-Rural Differences in Subjective Symptoms of Fatigue and Their Relations with Lifestyle Factors in Young Male Japanese Students

Object: The purposes of this study were to investigate the actual status in subjective symptoms of fatigue (SSF) and lifestyles of young male students living in two different life spheres of the Tokyo metropolitan area and a rural area, and to find regional differences in these characteristics and relations between SSF and lifestyles in school life. Methods: A questionnaire regarding SSF and lifestyle was administered to 412 healthy male students (16-18 yr) attending the two National Colleges of Technology located in the Tokyo metropolitan area (MA) and a local city (LC). Statistical techniques such as a chi-square test and Hayashi’s Quantification Theory I analysis were used to examine relations between SSF and lifestyles. Results and conclusion: A significant difference was found only in “feeling of physical disintegration,” and the MA group was higher than the LC group. The MA students showed shorter sleeping hours and earlier awaken time compared with LC students. In the relations between SSF and lifestyles, sleeping habit was an important factor significantly relating to SSF in both groups. Paying attention to good sleeping habits is an important countermeasure for preventing SSF in the male students.

ADL Ability Characteristics of Partially Dependent Older People: Gender and Age Differences in ADL Ability

Age and gender differences in ADL ability were investigated using 568 Japanese partially dependent older people (PD, Mean age=82.2 ±7.76 years) living in welfare institutions. The subjects were asked about 17 ADL items representing 7 ADL domains by the professional staff working at subjects’ institutions. Each item was assessed by a dichotomous scale of “possible” or “impossible”. Item proportions of “possible” response were calculated for gender and age groups (60s, 70s, 80s and 90s). Two-way analysis of variance (ANOVA) using the arcsine transformation method indicated no gender differences. Significant decreases in ADL ability with aging were found in 13 of the 17 items. The dependency of ADL in the PD significantly increases with aging, and there is no significant difference in this trend between men and women. The dependency of more difficult activities using lower limb increase from the 70s, and independency of low-difficult activities such as manual activities, feeding and changing posture while lying is maintained until the 80s and over.

Utility of an ADL Index for Institutionalized Elderly People: Examining Possible Applications for Independent Elderly People

The purpose of this study was to clarify the application range and utility of an ADL index for disabled elderly people (Demura et al., 2000), by examining the ADL characteristics of an elderly population when this index was applied to disabled and independent elderly people. Subjects of this study were 697 Japanese institutionalized disabled elderly people and 482 independent elderly people (ID) living at home. Disabled elderly people were classified into four groups based on conditions of use of assisting devices for movement; D1 did not use assisting devices; D2 used a stick or a walker; D3 used a wheelchair; D4 was immobile. From the findings of comparing achievement proportions, ADL score and the distribution of total score among elderly groups, it was suggested that this ADL index can assess gradually from disabled elderly people who cannot move to independent elderly people. Since this index classifies independent elderly people and disabled elderly people with high probability, it can evaluate if elderly people can maintain a functional level needed for independent living, and can recognize the symptoms of disability. Furthermore, this study proposed useful activities to discriminate the functional level for each elderly group. Although it is important to comprehensively assess ADL ability, further use of this ADL index to discriminate the functional level of an elderly population, by making use of these useful activities, is expected.

Development of ADL index for older community people / 体力科学

The purposes of this study were to examine reliability and validity of ADL index for older people at home, and relationships between ADL score and various factors (ex. self-assessment of health status and physical fitness level, and exercise frequency/week), and to examine the screening basis for execution of physical fitness test based on distribution of ADL score. A questionnaire consisting of 12 ADL items and a physical fitness test of Ministry of Education, Science and Clture were administered to 5, 715 subjects 65 years or more age (male: 2, 745; female: 2, 970) . As a result of examining test-retest reliability of the ADL index, significant high correlations were shown among 12 ADL items (0.674≤r≤0.886), and in overall score (r=0.943) . The ADL score was significantly related to age and physical fitness test scores, and tended to be higher in subjects with a higher self-assessment of health status and physical fitness level, and with more frequency. It was suggested that these results prove the utility of the present ADL index. Further, as the result of examining relationships between distribution of overall ADL score and physical fitness test scores, the following screening bases were considered to be valid for judgement whether the physical fitness tests could be executed. The three screening bases using overall ADL score were: 1) 12 or under; 2) over 13 to under 24; 3) 24 and over. The four bases using item score were: 1) a category 1 response for items 1, 5 and 6; 2) a category 2 or 3 response for items 1, 5 and 6, and a category 1 response for items 3 and 4; 3) a category 3 response for items 2 and 14; 4) a category 1 response for items 10 and 12.

Examination of useful ADL items and scales to assess ADL ability in older community people. Regarding aging, physical fitness level, and interrelationships among ADL items / 体力科学

The purpose of this study was to propose useful ADLs (activities of daily living) and scales to estimate ADL ability on community older people from the viewpoints of aging, physical fitness level, and interrelationship among ADL. The survey constructing of 15 ADL items and physical fitness test of Ministry of Education, Science and Culture were carried out on 458 older people. Each ADL item was constructed with 3 level scales.<BR>As the results of this study, the following 12 ADLs were proposed as useful ADL items; in the locomotion domain, jumping across a ditch, walking, running, up and down stairs, and transfer; in the manipulation domain, taking bedding in and out, buttoning a shirt; in stability domain, standing in the bus or train, dressing while standing (trousers), standing on one foot with eyes open; in the posture-change domain, sitting up, standing up from the floor. These items were significantly related to age and physical fitness elements contributed largely to achievement of each ADL. Since significant high correlation was found between the index using 12 ADL items and that using 15 items, it is considered that the 12 items scale can account for the variance corresponded enough to that of 15 items scale, and that the new index is practical and simple.<BR>In further research, it will be required to examine validity of each ADL item and index by using more large sample, and to clarify the relation to various factors influenced to ADL ability level.

Sex differences in subjective symptoms of fatigue and associated factors in adolescence / 体力科学

The purpose of this study was to examine sex differences in subjective symptoms of fatigue (SSF) in high school and college students by considering the relationship between subjective feeling of fatigue and life habits.<BR>A questionnaire on SSF (54 items), dealing with subjective feeling of fatigue and life habits (frequency of exercise, going to sleep, waking in the morning and physical condition) was administered to 5622 healthy students aged 15-20 yr, and data of 5335 properly completed questionnaires was analyzed.<BR>The following was determined :<BR>1) Sex differences were confirmed in most SSF items. SSF complaints for females was generally higher than that of males.<BR>2) The relationship between SSF and the age was low in both sexes.<BR>3) Subjective feeling of fatigue is somewhat related to SSF.<BR>4) The going to sleep last night influence on SSF was different in both sexes and related largely to the next day SSF in males.<BR>5) Waking this morning and today's physical condition are related to SSF in both sexes.<BR>6) In males, the influence of exercise habits on SSF regarding drowsiness is relatively large.

The changind of physique and physical fitness with age and its sex-difference in elderly people / 体力科学

A study was performed to examine sex and age differences in physique and physical fitness and the sex differences in the change of these parameters with age, and to clarify the relationship between the amount of exercise and fundamental physical fitness in 326 healthy elderly individuals over 60 years of age.<BR>A total of 22 variables consisting of 9 items concerning body linearity, quantitative growth, circumference growth and posture, and 13 items representing 4 domains (muscular, joint, neural, and cardiorespiratory functions) were selected. The exercise performance index (EPI) was calculated as the product of frequency and duration (yr) of exercise. The sex and age differences in physique and physical fitness were examined using two-way ANOVA (sex × age group) . Post hoc tests using Ryan's procedure were carried out when the main effect of these factors proved significant. To examine the characteristics of changes in physique and physical fitness with age, Pearson's correlation coefficient was calculated, and linear regression analysis [test item was the dependent variable (X) and age was the independent variable (Y) ] was applied. Then significant differences in the regression coefficient and intercept between males and females were examined. Furthermore, curved-line regression analysis was executed for the above variables. Applying principal component analysis for 13 physical fitness items, the first principal component was interpreted as fundamental physical fitness for performance, and the above analysis was applied to the fundamental physical fitness score (FPS) . To examine the relationship between EPI and FPS, the difference in FPS among the three EPI groups was examined using analysis of co-variance (ANCOVA) with age as the co-variable.<BR>The main findings of this study can be summarized as follows.<BR>1. With regard to physique, males showed greater body linearity, and females had more skinfold. Sex differences in circumference growth were not as significant as those in body linearity and quantitative growth. Changes in physique with age were greater in females than in males, the change becoming obvious in individuals over 80 years of age.<BR>2. With regard to physical fitness, males had superior muscular function and vital capacity, while females outperformed males in standing-reach. However, there was little sex difference in neural function. The trend for deterioration in physical fitness with age differed between the sexes among 4 domains of physical fitness. For example, in males muscular, neural, and joint functions deterioration significantly with age, while in females, all physical fitness variable did so. In addition, the age-related trends of deterioration in muscular function (grip strength and vertical jump), cardiorespiratory function (duration of breath-holding and vital capacity), and neural function (stepping) were differed between the sexes.<BR>3. The FPS was higher in males than in females. However, FPS decreased significantly with age in both sexes.<BR>4. It was inferred that among active and healthy elderly males and females who exercised regularly, FPS was not influenced by EPI.

Sex differences of fatigue in young men and women. From the viewpoint of experience of awareness and cognitive appraisal / 体力科学

A study was conducted to examine sex differences in subjective symptoms of fatigue in men and women with reference to the experience of awareness and cognitive appraisal based on symptom of fatigue content. A total of 54 questionnaire items were administered to 730 people (290 men and 440 women) . The subjects indicated whether or not they were aware of the content, and to what degree the content of the question for each item was important. Sex differences in the response to the ratio of awareness and the degree of importance were then. The mean importance scores for subjective symptoms of fatigue in men and women were 3.9-5.4 and 4.5-5.6, respectively. It was found that a majority of the men and women showed awareness of each item. A significant difference was recognized in the factor of awareness in all items as a result of two-way ANOVA of the degree of importance by which the presence of awareness and its sex difference were assumed to be factors, and those who were aware deemed the degree of importance high. On the other hand, the 28 items for which a significant sex difference was recognized showed a high value, and there was a marked content of Languor, Loss of Vigor, and A Feeling of Impatience and Physical Disintegration in women. In the same items, it was inferred that persons who were more aware than the persons who were not aware regarded subjective symptoms of fatigue as important. Most items in which a main effect of sex was recognized were content of Loss of Vigor and a Feeling of Impatience and Physical Disintegration. It was thought that women considered these symptoms more important than men. The sex difference in symptoms of fatigue was inferred to be due to the difference in the level of acknowledgment based on experienced knowledge.