Adapting culturally appropriate mental health screening tools for use among conflict-affected and other vulnerable adolescents in Nigeria.

BACKGROUND: The Boko Haram insurgency has brought turmoil and instability to Nigeria, generating a large number of internally displaced people and adding to the country's 17.5 million orphans and vulnerable children. Recently, steps have been taken to improve the mental healthcare infrastructure in Nigeria, including revamping national policies and initiating training of primary care providers in mental healthcare. In order for these efforts to succeed, they require means for community-based detection and linkage to care. A major gap preventing such efforts is the shortage of culturally appropriate, valid screening tools for identifying emotional and behavioral disorders among adolescents. In particular, studies have not conducted simultaneous validation of screening tools in multiple languages, to support screening and detection efforts in linguistically diverse populations. We aim to culturally adapt screening tools for emotional and behavioral disorders for use among adolescents in Nigeria, in order to facilitate future validation studies. METHODS: We used a rigorous mixed-method process to culturally adapt the Depression Self Rating Scale, Child PTSD Symptom Scale, and Disruptive Behavior Disorders Rating Scale. We employed expert translations, focus group discussions (N = 24), and piloting with cognitive interviewing (N = 24) to achieve semantic, content, technical, and criterion equivalence of screening tool items. RESULTS: We identified and adapted items that were conceptually difficult for adolescents to understand, conceptually non-equivalent across languages, considered unacceptable to discuss, or stigmatizing. Findings regarding problematic items largely align with existing literature regarding cross-cultural adaptation. CONCLUSIONS: Culturally adapting screening tools represents a vital first step toward improving community case detection.

Immunopathologic study of herpes gestationis in mother and infant.

In vivo bound C3 was demonstrated by immunofluorescence in lesions of both maternal and infant skin in an immunopathologic study of herpes gestationis. Immunoglobulins and other complement components of both classical and alternative pathways were not found. The serum was also negative for circulating antibody to basement membrane of skin. Maternal serum had a factor present that was able to deposit C3 from fresh normal serum onto the basement membrane zone of skin. Hemolytic complement titrations showed a decrease of CH50 levels in serum of both classical and alternative pathways in the mother and the classical pathway in the infant, with a decrease of C2 and C4 in both. To our knowledge, this is the first reportof a decrease in serum complements in herpes gestationis and indicates that complement may not be activated locally.

Using ECT to study hemispheric specialization for sequential processes.

Two studies are reported, citing the effects of unilateral versus bilateral electroconvulsive shock therapy on the performance of short cognitive tests. In Study 1, seven tets were administered before and after three treatment sessions. The most interesting finding was that performance improved significantly on the Knox Cube Imitation test following right unilateral shock. Study 2 replicated this unexpected finding. These results were interpreted as demonstrating that the left cerebral hemisphere is specialized for the processing of sequential time-dependent information.