Clinical evaluation of atypical glandular cells of undetermined significance on cervical cytology.

OBJECTIVE: To determine the incidence of and identify risk factors for clinically significant diagnoses associated with the diagnosis on Papanicolaou test of atypical glandular cells of undetermined significance. METHODS: A computer search was initiated of diagnoses of atypical glandular cells of undetermined significance at the Massachusetts General Hospital from January 1993 through December 1996. Seventy-three patients with 81 smears were identified that were seen in the Colposcopy Clinic. All cytology was reviewed. A clinically significant lesion was defined as high-grade squamous intraepithelial lesion (SIL) or worse, endocervical glandular atypia or worse, or carcinoma. RESULTS: The rate of diagnoses of atypical glandular cells of undetermined significance was 0.167%. All patients underwent colposcopy, and 88% underwent endocervical curettage. A clinically significant diagnosis was made in 34.2% of patients, including cancer in 8.2%. A concurrent squamous diagnosis carried a risk of clinically significant lesion of 50%, compared with a risk of 25.5% for atypical glandular cells of undetermined significance alone (P = .043). Premenopausal and postmenopausal patients were both at risk for clinically important lesions, but premenopausal patients were more likely to have a high-grade SIL (30.4% versus 7.4%, P = .04). The subtype "suggestive of reactive" was a significant negative predictor of significant lesion (odds ratio = 0.09, 95% confidence interval 0.018, 0.482) in a logistic regression model controlling for age, menopausal status, and concurrent squamous diagnosis. CONCLUSION: Atypical glandular cells of undetermined significance is an important Papanicolaou test diagnosis that needs appropriate and careful evaluation. Further studies are required to clarify areas of risk and to make triage algorithms.

Occupational outcome in military aviators after psychiatric hospitalization.

OBJECTIVE: To determine if psychiatric hospitalization precluded a return to occupational status in United States Air Force aviators. DESIGN: A 7-yr retrospective review that joined hospitalization and occupational databases using individual identifiers. SUBJECTS: From a population of over 35,000 USAF rated aviation officers present between January 1986 and December 1990, 214 were both psychiatrically hospitalized and on flying status the quarter prior. PRIMARY OUTCOME MEASURE: Return to flying duties during a minimum follow-up period of 2 yr. RESULTS: Within 2 yr from psychiatric admission, 138 (64.5%) aviators returned to flying status; 141 (65.9%) returned over 7 yr. In this patient population, an affective disorder diagnosis predicted poor outcome (chi 2 = 12.86; df = 1; p = 0.0003), independent of length of hospitalization. CONCLUSION: Psychiatric hospitalization did not prevent a return to flying status for a majority of these high functioning aviators. Although an affective disorder diagnosis negatively affected occupational outcome, it is unclear whether institutional policy or poor prognosis was etiologic.

Defining and measuring the "right stuff": neuropsychiatrically enhanced flight screening (N-EFS).

BACKGROUND: United States Air Force (USAF) commanders wish to make better pilot-selection and cockpit-assignment decisions. Also, some pilots will sustain head injuries that will affect their flying careers. The complex and unforgiving nature of aviation demands a conservative approach to occupational return after neurological insult. Therefore, a neuropsychological assessment is required to return to flying. The lack of pre-injury neuropsychological data, however, hinders accurate assessment of post-injury functioning. HYPOTHESES: a) Psychological data may improve the pilot selection and assignment processes as military resources dwindle; and b) baseline intellectual/cognitive data may support the scientific basis of aeromedical decision-making. METHODS: Neuropsychiatrically Enhanced Flight Screening (N-EFS) attempts to validate the Multidimensional Aptitude Battery (MAB), CogScreen, Revised NEO-PI (NEO-PI-R), and Personal Characteristics Inventory (PCI) for pilot selection and cockpit assignment. N-EFS also measures baseline intelligence (using the MAB) and cognitive functioning (using the CogScreen) for comparison purposes if a future medical flying waiver is needed after neurological insult. These assessments will compare the aviator's postinjury functioning to a personal intellectual functioning baseline captured at entry into aviation training. RESULTS: N-EFS students are scoring from below average to very superior in intellectual assessment. Very preliminary personality testing results suggest few significant differences between male and female student pilots, with high extraversion being the most striking personality characteristic. DISCUSSION: The wide range of intellectual functioning in pilot candidates argues for baseline data collection to improve future aeromedical decisions.

Top performer survey: computerized psychological assessment in aircrew.

There were 29 (80%) subjects from a squadron of 36 F-16 pilots who voluntarily participated in a newly developed anonymous, self-administered, computerized testing protocol. The test battery consisted of two 2.5-h blocks that gathered demographic information and measured personality (MMPI-2), cognitive capacity (MAB), crew coordination skills (PCI), and history of psychiatric diagnoses (C-DIS). The test battery also included a peer rating survey that collected information about the squadron's top performers and their personal qualities. Results indicated that aviators can agree who are top performers and what personal qualities are important in top performers. This pilot project demonstrated the success of the battery to gather aircrew information in a field location. Test data are presented.

Alcoholism and treatment in airline aviators: one company's results.

Airline transport pilots are at risk for alcoholism, although prevalence statistics are not known. (Alcoholism is used to mean alcohol dependence as defined in DSM-III-R.) Whether their prevalence of alcoholism is consistent with that of the general population's, less, or possibly enhanced by psychological vulnerabilities, is considered. However, the development and implementation of this job-based, peer-oriented alcohol treatment can be an asset to pilot career progression and airline pilot retention. According to a retrospective analysis of identified aviators, 87% of alcoholic pilots of this major airline returned to flight duties after substance abuse treatment. Relapse occurred in 13% of those accepting treatment. Early identification and treatment of the substance-abusing aviator can be enhanced by encouraging teamwork between pilots, union, airline management, flight surgeons, and employee assistance program professionals.

Effects of acute increases in altitude on mental status: prevention and treatment.

Healthy individuals may develop mental status changes and somatic symptoms, known as acute altitude (or mountain) sickness, when rapidly ascending to higher altitudes. Patients with cardiopulmonary and neurologic problems and elderly individuals are at an increased risk for developing these symptoms. This article describes the symptomatology and risk factors for the condition and presents four case examples. Preventive and treatment measures are recommended.