In search of effective programs to address students' emotional distress and behavioral problems part III: student assessment of school-based support groups

Emotional distress and behavioral problems are common in high schools. This report describes the efficacy of an in-school program based on participation in volunteer-facilitated peer support groups in addressing these problems. Two hundred and fifty students who experienced such problems participated in weekly 50-minute peer support groups led by adult nonmental health professional volunteers. The students anonymously evaluated their progress and program acceptability using an instrument developed specifically to evaluate the group experience. Analysis of the evaluation of the 131 respondents documented the reliability of a proposed Self-Assessment Questionnaire which showed that participation led to improvement in school, interpersonal, and internal domains. The program was highly accepted and showed other signs of success: half of the alcohol and substance users reduced their intake, and 60% of those who considered dropping out of school continued their education. The results provide preliminary evidence that peer support groups show promise as an economical and well-accepted method for early recognition and management of emotional and behavioral problems in high schools. For some adolescents, these groups may be the only acceptable or available therapeutic modality.

Quantification of Spatial Correlation in Porous Media and Its Effect on Mercury Porosimetry

In many porous media the grains are packed in a disordered manner, rather than in regular lattices. Theoretical treatments of the properties of these media often assume that because there is no regular lattice, the pore space between grains is completely spatially disordered. Here we present an analysis of a real granular medium (a close packing of equal spheres) which shows that, contrary to the popular assumption, the pore space is spatially correlated. The origin of this pore space correlation is the strong spatial correlation of grain locations, which is a feature of all dense granular media. Our analysis relies on physically representative network models of the pore space constructed from knowledge of the grain locations. Simulated drainage experiments on these networks agree with mercury porosimetry experiments in simple sandstones, whereas simulations in uncorrelated but otherwise identical networks do not. Thus the spatial correlation inherent in the pore space of simple porous media significantly affects mercury porosimetry. Deriving pore size distributions from mercury porosimetry without considering spatial correlation can give misleading results. The likelihood of error is compounded if such pore size distributions are used to estimate transport coefficients such as permeability, diffusivity, and electrical conductivity.

Plantar wart presenting as a cutaneous horn

An elderly man presented with a longstanding, tender lesion on the sole of the foot. Clinically this was a cutaneous horn but biopsy revealed the features of a viral wart. The cytopathic effects of cutaneous human papillomaviruses are discussed.

Clinical significance of fetal choroid plexus cysts

Choroid plexus (CP) cysts are commonly detected on routine mid-trimester ultrasound scan. When associated anomalies are detected, the risk is sufficient to justify an invasive diagnostic test such as amniocentesis. However, the risk when no associated anomalies are detected is much less well defined. This information is required to determine the appropriate management in cases of apparently isolated CP cysts. We thought the only way to resolve the difficulties in counselling prospective parents was to conduct a prospective study in a large unselected population. A registry of fetal CP cysts detected over 3 years in the Yorkshire Region was compiled and we identified 524 CP cysts. These cases were then amalgamated and analysed with 1361 cases from prospective studies reported in the world English literature and a further 71 unpublished cases identified from a 2 year prospective series from Ninewells Hospital, Dundee. The risk of chromosomal abnormalities was 1 in 150 (95% CI 1 in 85, 1 in 261) when no fetal anatomic abnormalities, apart from the CP cysts themselves, were detected antenatally. The risk increased to approximately 1 in 3 if any other associated ultrasound abnormalities were detected antenatally. The risk did not appear to be related to whether or not cyst size diminished as gestation progresses, whether they were unilateral or bilateral, and whether they were small or large in size (60-80% < 10 mm). 76% of aneuploidic cases were trisomy 18 and 17% were trisomy 21. The risk of Down's syndrome in fetuses with CP cysts but no other anomalies detected antenatally is 1 in 880. The probability of a chromosomal abnormality is high when CP cysts are associated with any other antenatally detected anomaly, indicating a clear need to offering amniocentesis. The predictive value is much lower when no other anomalies are detected. In such cases, it is probably advisable to regard CP cysts as an indication for detailed ultrasound assessment, rather than invasive testing.

Proton nuclear magnetic resonance spectroscopic imaging of human temporal lobe epilepsy at 4.1 T

We performed proton magnetic resonance spectroscopic imaging (MRSI) at high magnetic field (4.1 T) to study N-acetylaspartate, creatine, and choline levels in the brains of normal control subjects and patients with intractable temporal lobe epilepsy. We compared the results of MRSI to those of other presurgical techniques to determine the sensitivity of this method in the lateralization of the epileptic focus. The normal hippocampal creatine-N-acetylaspartate ratio was 0.71 +/- 0.14 with no differences between left and right. Using the mean control hippocampal creatine-N-acetylaspartate ratio plus 2 standard deviations to identify statistically significant changes, we found lateralizing metabolic abnormalities corresponding to the operated temporal lobe in all patients. Four patients (40%) had contralateral abnormalities, and 2 of them had bilateral independent seizure onset confirmed by intracranial electroencephalographic studies. Statistically significant increases in the choline-N-acetylaspartate ratio in comparison to healthy volunteers were observed in 8 of the 10 patients. With the creatine-N-acetylaspartate ratio, MRSI demonstrated a 100% sensitivity compared to magnetic resonance imaging, which identified pathology in 70% of the patients. These findings suggest that proton MRSI yields a distinctive metabolic profile in patients with temporal lobe epilepsy and is sensitive in detecting bilateral metabolic abnormalities in some patients. These preliminary findings suggest that MRSI is more sensitive than magnetic resonance imaging in the lateralization of epileptic foci in temporal lobe epilepsy.

Polydactylous Bowen's disease of the nail bed

A case is presented with tender swelling and nail bed hyperplasia in 2 fingers. Histopathology revealed Bowen's disease in both fingers and after amputation, invasive squamous cell carcinoma in one finger.

Keratotic basal cell carcinoma of the upper eyelid

A 62 year old woman presented with two large slowly growing pedunculated tumours. These were excised from the lateral aspect of the upper eyelid and were found to be keratotic basal cell carcinomas.

Fungal eosinophilic pustular folliculitis

A young woman presented with a persistent unilateral erosive and pustular plaque of the forearm. Repeated biopsy was required to make the diagnosis of a fungal cause for her eosinophilic pustular folliculitis.

In search of effective programs to address students' emotional distress and behavioral problems. Part II: Critique of school- and community-based programs

Part I of this article discussed the dimensions of students' emotional distress and behavioral problems and proposed school programs to address it. This section evaluates the school- and community-based programs advocated in educational, psychological, and psychiatric journals over the past five years. Twenty-nine articles were selected, and the programs classified by location, focus, and format. Their merits and limitations based on their results are discussed. This review found that (1) some programs poorly defined the study populations; (2) emotional distress was not included as a criterion; (3) a strictly behavioral approach or narrow focus on specific populations or issues prevailed. Only four programs used emotional expression and social support; (4) outcome measures focused on specific behaviors with only one study evaluating the emotional outcome; (5) none addressed the student's acceptance of the program; (6) only five measured the outcome beyond the immediate termination of the intervention, and only to a limited degree. While the programs reviewed support the likelihood that such interventions may be helpful, definitive conclusions which can be generalized to average high school students are still lacking. Recommendations for future school-based programs are proposed.

In search of effective programs to address students' emotional distress and behavioral problems. Part I: Defining the problem

This article discusses the prevalence and seriousness of emotional difficulties and behavioral problems in students, with a special focus on high school students and the obstacles they encounter when addressing these problems. The educational, psychological, and medical literature which addressed the problem over the past five years was evaluated, and 22 references were selected. It was determined that the lack of consensus on the terms used to describe the problem prevented accurate assessment of its prevalence. However, one fifth to one third of the students were found to be affected, leading to serious educational, psychosocial, and economic difficulties--and more are likely to be affected in the 1990s. Since the school and mental health systems have not been entirely successful in addressing the problem, adolescents' patterns of seeking help indicate that peer support groups can be part of the solution. It was concluded that the enormity of the problem requires a low-cost gate-keeping mechanism to facilitate early identification and intervention. Thus, school peer-support programs, if proven effective, may complement traditional mental health services in addressing adolescents' emotional distress and behavioral problems.

Plasma cell balanitis and vulvitis (of Zoon). A study of 10 cases

We report six cases of plasma cell balanitis and four of plasma cell vulvitis. The patients' ages ranged from 26-88 years in males and 30-60 in females. All the men were uncircumcised and presented with a discharge and erythematous lesions on the glans penis and prepuce. In females the main presenting complaints were vulvar soreness, pruritus, smarting/burning, discharge and bleeding. Two were on hormone replacement therapy, two had undergone a mastectomy for carcinoma of the breast, and one was an insulin-dependent diabetic. Another patient subsequently developed diabetes mellitus. Topical and intralesional corticosteroid preparations resulted in satisfactory improvements in all cases, male and female. Two males subsequently underwent circumcision, which was curative.

Examining the role of the practitioner-teacher in nursing

This article examines the difficulties faced by specialist nurses when they attempt to combine practice and teaching roles. It gives a detailed analysis of the emergence of full-time practitioner-teachers in nursing, including the role of joint appointees. It is recommended that the practitioner-teacher role should be promoted, and this will necessitate research into the feasibility of such roles.

Taking account of vaginal bleeding in screening for Down's syndrome

OBJECTIVE

To derive a method for revising the risk of Down's syndrome in maternal serum marker screening when there is vaginal bleeding. The effect on screening performance of routinely allowing for the presence or absence of bleeding in all women is also assessed.

DESIGN

Overview of published studies on the rate of reported vaginal bleeding in pregnancies with Down's syndrome, on the rate according to maternal age and on the association of bleeding with alpha-fetoprotein (AFP) level. The publications are supplemented with data on unconjugated oestriol (uE3), human chorionic gonadotrophin (hCG) and AFP levels in a consecutive series of screened women.

SETTING

Routine Down's syndrome screening tests carried out on women having antenatal care at the St James's University Hospital, Leeds.

SUBJECTS

Eight hundred and nine screened women.

RESULTS

In five studies the rate of vaginal bleeding in Down's syndrome pregnancies was 1.7 times that in unaffected pregnancies on average. In three studies, the vaginal bleeding rate increased proportionally by 2.2% on average for each year of maternal age. Three studies and our own data were consistent with a 10% increase in the mean AFP level associated with vaginal bleeding, but it did not appear to materially alter uE3 and hCG levels or the standard deviations and correlation coefficients for any of the three analytes. An individual woman's risk was calculated by multiplying her age-specific odds of Down's syndrome by two likelihood ratios, one relating to the vaginal bleeding itself and one from the marker levels. Routine allowance for the presence or absence of vaginal bleeding was estimated to increase the detection rate by less than 1%.

CONCLUSION

Our method is of clinical value in revising the risk when there is concern that vaginal bleeding might be responsible for a negative maternal serum Down's syndrome screening result. A policy of routinely incorporating information on vaginal bleeding in risk estimation for all women would have too small an effect on overall screening performance to recommend it.

An unusual tricentric X chromosome detected prenatally

We describe a female fetus with a de novo X chromosome rearrangement detected prenatally in both chorion villi and a pleural effusion. Chromosome painting showed the chromosome to be composed entirely of X chromosome material, while G-banding indicated a duplication of X short arms, four copies of the proximal long arm, and deletion of the distal long arm of the X. C-banding showed the presence of one active and two inactive centromeres and X-inactivation studies demonstrated the tricentric chromosome to be late replicating in all cells examined. The origin of this complex de novo rearrangement appears to have involved two separate breakage events, the first leading to the production of a dicentric X chromosome and the second generating the tricentric X.

Central serotonergic changes following antidepressant treatment: a neuroendocrine assessment

We employed a neuroendocrine challenge paradigm to study the effects of antidepressant treatment on serotonergic systems in depressed patients. We compared the maximum prolactin response to intravenous clomipramine (CMI) in depressed patients who responded to antidepressant treatment to that of nonresponders. Pretreatment baseline prolactin concentrations and pretreatment prolactin responses to clomipramine challenge were not different in responders compared to non-responders. However, following antidepressant treatment, the 6 responders demonstrated a significant change in their clomipramine challenge test results, as indicated by an increase in prolactin responses. In contrast, the 7 nonresponders did not demonstrate a change in their prolactin response to clomipramine challenge following treatment. These data support the hypothesis that serotonergic system dysfunction, as manifested by blunted prolactin response to clomipramine challenge, tends to normalize after successful treatment for depression, and that abnormal serotonergic function may be a state-dependent characteristic.