Clinical and dermoscopic characteristics of Merkel cell carcinoma.

BACKGROUND: Merkel cell carcinoma (MCC) is an aggressive cutaneous malignancy with a high mortality rate. Diagnosis is often delayed. OBJECTIVES: To characterize the dermoscopic features of MCC. METHODS: Clinical and dermoscopic images of 12 biopsy-proven MCCs were analysed in a retrospective manner, with existing dermoscopic criteria being scored independently by three dermatologists. RESULTS: The four most frequent clinical features were cherry red colour, shiny surface, sharp circumscription and nodular morphology. Significant dermoscopic features included linear irregular and polymorphous vessels, poorly focused vessels, milky pink areas, white areas, structureless areas and architectural disorder. Pigmented structures were absent from all lesions. CONCLUSIONS: The dermoscopic features described herein help the clinician to distinguish MCC from other benign and malignant red nodules. Increasing recognition of the presenting features will facilitate earlier diagnosis of MCC and reduced mortality.

Interobserver variability of teledermoscopy: an international study.

BACKGROUND: Teledermoscopy is a rapidly developing field of dermatology with studies demonstrating excellent agreement with face-to-face diagnosis. However, we are unaware of studies evaluating interobserver variability in diagnosis between dermatologists from different continents. This evaluation is important to determine the robustness of teledermoscopy and allow comparisons to be made between different studies. OBJECTIVES: To assess the interobserver diagnostic variability between five independent experienced dermatologists (A-E) in New Zealand, Australia and the U.S.A. METHODS: Images from 979 lesions from 206 patients were distributed to five dermatologists. The lesions were viewed and diagnoses recorded using MoleMap Diagnose (MoleMap, Auckland, New Zealand) software. The diagnoses were analysed for interobserver variability. RESULTS: There was excellent agreement between four of five dermatologists (A-D) for lesions that were agreed upon as melanoma (κ = 0·81-0·97) and benign naevus (κ = 0·77-0·82).The fifth dermatologist (E) made a more frequent diagnosis of atypical naevus and melanoma than the others. For nonmelanocytic lesions, there was moderate to very good agreement for seborrhoeic keratosis (κ = 0·64-0·80) and basal cell carcinoma (κ = 0·55-0·67), but poor agreement for invasive squamous cell carcinoma (SCC) (κ = 0·05-0·15). Agreement for actinic keratosis (κ = 0·32-0·67) and SCC in situ (κ = 0·15-0·32) was only moderate. When atypical and benign naevi were grouped together and actinic keratosis and SCC in situ grouped together, there was better agreement among all dermatologists. There was good ability to distinguish malignant from benign lesions (κ = 0·57-0·93). CONCLUSIONS: There was good agreement among dermatologists A-D but dermatologist E varied from the group with more frequent diagnosis of melanoma and atypical naevus. This difference could be due to different definition of terms with lack of consensus guidelines in definition of atypical naevus, lack of familiarity with the specific patient population and/or diagnostic drift.

Paths to child social adjustment: parenting quality and children's processing of social information.

BACKGROUND: The purpose of this research was to examine the manner in which multiple influences on child social adjustment operated together to predict differential outcomes for young children. Specifically, this study was designed to (i) examine the role of social cognitive and emotional factors in parents' observed and self-reported behaviour towards their children, and (ii) investigate the impact of parenting and children's social information processing (SIP) patterns on children's subsequent social adjustment in the school setting. METHODS: A model of children's peer social adjustment was evaluated using a group of 166 children, over-sampled for history of physical child abuse. Assessment of constructs was multi-method, including parent and child self-reports as well as teacher reports of child adjustment and observations of parent-child and child-peer interactions. RESULTS: Using structural equation modelling, support was found for our theoretical model. Specifically, parents' negative child-related beliefs and clinical elevations in emotional distress were predictors of harsh, insensitive parenting, which in turn predicted children's SIP operations and social maladjustment 6 months later. However, children's SIP did not significantly predict their social adjustment above and beyond the impact of parenting. CONCLUSIONS: Results indicated that the quality of parenting that children received was more central to subsequent adjustment in peer interactions than were children's SIP operations. Furthermore, the quality of parenting children experienced was closely linked to parents' beliefs about their children and parents' mental health status. Directions for future research and potential implications for clinical practice are discussed.

Absence of males in maltreatment research: a survey of recent literature.

This paper provides a review of research in the area of physical maltreatment with respect to the degree to which males are represented in research samples. The systematic, comprehensive review includes 126 articles published between the years 1989 and 1994 in nine primary journals. Results show that adult males are dramatically underrepresented in this research. Specifically, males were included in fewer than one-half (47.7%) of the 77 articles reviewed and the total number and percentage of males in research samples was significantly less than the number and percentage of females. Only three studies included males exclusively, yet 40 studies involved solely female participants. Of the studies that did include men, only 37.5% provided an evaluation of gender differences. Research involving abused children showed a much greater representation of male subjects than research with adult participants. Only four of 49 studies of abused children were based exclusively on girls; a full 62.8% included an equal representation of boys and girls.

Child abuse potential inventory and parenting behavior: relationships with high-risk correlates.

The primary purpose of this research was to examine the construct validity of the Child Abuse Potential Inventory by comparing maltreating and high-risk parents' CAP Inventory abuse scores to their behavior during interactions with their children. A second purpose was to determine the degree to which CAP Inventory scores and parenting behavior were related to several known correlates of abuse, as measured by parent and teacher reports. Participants (n = 41) included abusive and high-risk parents and their children referred to a treatment group. Correlational analyses revealed that CAP Inventory scores and observed parenting style yielded highly related findings, supporting construct validity of the CAP Inventory. However, the CAP Inventory and observed behavior index showed a different pattern of relationships to the risk correlates. Implications for assessment of risk status are discussed and recommendations are provided for continued research.

Individual differences in risk of child abuse by adolescent mothers: assessment in the perinatal period.

Abuse risk potential and parenting attitudes of 66 adolescent mothers were examined during the perinatal period using self-report instruments. Approximately one-half of the sample was considered to be at significant risk. Specific risk factors included distress, rigidity in parenting attitudes, and inappropriate expectations of children. Younger adolescents were at greater risk of abuse, advocated the use of physical punishment more strongly, and reported greater unhappiness than older adolescents. Teens reporting limited social support were also at greater risk for abuse. Low acceptance of the pregnancy was related to abuse potential for parenting, but not pregnant, adolescents. A history of maltreatment was related to self-reported problems with family members but not to overall risk. Implications for the prevention of abuse among adolescent mothers are discussed.

Social interactions and peer perceptions of young physically abused children.

14 3-6-year-old children with a history of physical abuse and a closely matched comparison group of 14 nonabused children, all of whom had been in day-care for more than a year, participated in this investigation. Behavior observations, teacher reports, and peer sociometric ratings were used to evaluate children's peer interactions. It was found that abused children initiated fewer positive interactions with peers and exhibited a higher proportion of negative behavior than nonabused comparison children. Peers viewed abused children as less well liked. Further, peers were less likely to reciprocate the initiations of abused children, although they approached abused children as often as they approached comparison children. Teachers viewed abused children as more behaviorally disturbed. Overall, results indicated that abused children experience disturbed social interactions outside the home environment, despite involvement in a day-care setting that provides alternative peer and adult role models.

Factors associated with successful entry into therapy in child sexual abuse cases.

Given the well-documented, long-term, negative mental health consequences of child sexual abuse, it is important that children receive counseling following abuse. Often, the social worker's responsibility is to insure that abused children are appropriately referred for counseling following disclosure of sexual abuse. There are multiple factors that could facilitate or hinder this process, and identification of these factors is important in assisting families in becoming engaged in therapy. The purpose of this study was to (1) determine the extent of the problem of sexual abuse victims failing to keep their first scheduled therapy appointment, and (2) identify factors associated with failure to attend. Subjects were 129 consecutive child sexual abuse clients referred to long-term therapy by counselors at a crisis intervention center. Those who attended their first therapy session (n = 84) were found to differ from those who did not (n = 45) on the basis of their race, the center to which they were referred (private or public), whether the family had a telephone in the home, and whether the child's mother agreed that the family needed counseling. Implications of this study for increasing attendance at therapy are presented and recommendations are made for further research.

Social problem-solving skills of young physically abused children.

The ability of physically abused children to resolve hypothetical social problems was compared to the social problem-solving skills of a comparison group of nonabused children. Analyses indicated that the abused children generated a more narrow range of solutions and were more likely to perserverate on negative solutions. Implications for intervention and future research are made.

Assessment and skill remediation of hyperlexic children.

Assessment and remedial approaches derived from the field of learning disabilities were applied in two studies of hyperlexic children. Information-processing strengths and weaknesses of hyperlexic children were assessed in the first study, and the hypothesis that hyperlexic children have superior abilities to retain sound/symbol associations was investigated. Results supported this hypothesis, and indicated that the exceptional reading skills of hyperlexic children are not simply a result of repeated exposure to words. In the second study, a hyperlexic child's ability to decode words was used to increase her functional speech. Written prompts resulted in rapid increases in appropriate verbal responses in naturalistic settings. Furthermore, our results demonstrated maintenance and generalization of the positive effects of written prompts.

Comparison of the Standard Pseudoisochromatic Plates to the Ishihara color vision test.

The Standard Pseudoisochromatic Plates (SPP) color vision test was compared to the Ishihara color vision test with respect to screening validity, digit confusion errors, and individual plate efficiency. Results from 315 1st and 3rd grade males confirmed previous reports that the SPP is an effective screening test. Moreover, the SPP test was superior to the Ishihara test with respect to digit confusion errors. Color normal children made about 5 to 7 times as many errors on the Ishihara test as on the SPP. Screening inefficiency values of individual plates of both tests were calculated. A high inefficiency value of a SPP plate was usually caused by its inability to detect color defective subjects.

Development of learning-disabled and normally achieving children's causal attributions.

The causal attributions of learning-disabled (LD) and normally achieving (NA) children in grades 3 through 8 were compared. Attributions were measured by two scales that asked children to attribute hypothetical academic failure situations to factors that were either within (e.g., insufficient effort) or beyond (e.g., insufficient ability, blaming others) their control. Consistent with a learned helplessness hypothesis. LD girls, regardless of age, were more likely than NA children to attribute their failures to factors beyond their control. In contrast, LD boys' explanations for their failures paralleled those of NA children. That is, with increasing age the LD boys were more likely to attribute their failures to insufficient effort. Explanations and implications of sex differences in developmental patterns of LD children's causal attributions are discussed.

Acquired zinc deficiency in a breast-fed premature infant.

Zinc deficiency that was diagnosed at 14 weeks of age developed in a breast-fed premature infant. There was a rapid response to zinc supplements (20 mg/day) and therapy was stopped after three weeks without recurrent disease. The maternal breast milk had a low level of zinc and this could not be corrected by oral zinc supplements.