Does an evidence-based healthy relationships program for 9th graders show similar effects for 7th and 8th graders? Results from 57 schools randomized to intervention.

Integrating social and emotional learning (SEL) programming throughout curricula to support the development of healthy behaviors and prevent violence is critical for a comprehensive approach to school health. This study used a post-test comparison design to evaluate a healthy relationships program for eighth grade students that applies a SEL approach. The program was adapted from the Fourth R, an evidence-based program for ninth graders, but matches the curriculum and developmental context for eighth graders. Surveys were collected post-intervention from 1012 students within 57 schools randomized to intervention or control conditions. Multivariate multilevel analysis accounted for the nested nature of students within schools. There were significant group differences on three of four outcomes following intervention, including improved knowledge about violence, critical thinking around the impact of violence, and identification of more successful coping strategies. There was no group difference on general acceptance of violence. Overall, students learned relevant information and strategies and were able to apply that knowledge to demonstrate critical thinking, suggesting that adapting an evidence-based approach for use with younger students provided similar benefits. These findings build a case for 2 years of consecutive evidence-based healthy relationships programming in grades 8 and 9, consistent with best practice guidelines.

The fate of amoco cadiz oil.

The Amoco Cadiz oil spill (223,000 metric tons) of March 1978 is the largest and best studied tanker spill in history. Of the total oil lost, 30,000 tons (13.5 percent) rapidly became incorporated into the water column, 18,000 tons (8 percent) were deposited in subtidal sediments, 62,000 tons (28 percent) washed into the intertidal zone, and 67,000 tons (30 percent) evaporated. While still at sea, approximately 10,000 tons of oil were degraded microbiologically. After 3 years, the most obvious effects of the spill have passed, although hydrocarbon concentrations remain elevated in those estuaries and marshes that were initially most heavily oiled.

Witnessing domestic violence during childhood and adolescence: implication for pediatric practice.

The traditional role of the pediatrician, which consisted primarily of making diagnoses and prescribing treatments for specific disease entities in children, has expanded dramatically to include psychosocial aspects of health care as well as problems that are primarily psychological, emotional, or social in nature and that extend in various ways to the family and to the child's environment. One of these problems has been identified as the manner in which witnessing domestic violence, a significant and relatively commonplace event for many children today, affects child development and behavior. This paper reviews our existing knowledge of such events and explores how exposure to conflict and violence plays a major role in how children learn to relate to others, how they develop their self-concept and self-control, and how they interact with dating and marital partners in the future. We conclude with a discussion of the role of the pediatrician in interviewing children and other family members and in identifying appropriate avenues for prevention and treatment. Major recommendations derived from this paper include: decreasing the attitudinal barriers to exploring this issue; increasing sensitivity to clinical features and behavioral symptoms of children who witness domestic violence; and increasing knowledge of available resources for treatment and prevention.

Child maltreatment: risk of adjustment problems and dating violence in adolescence.

OBJECTIVE: To examine the relationship between child maltreatment, clinically relevant adjustment problems, and dating violence in a community sample of adolescents. METHOD: Adolescents from 10 high schools (N= 1,419; response rate = 62%) in southwestern Ontario completed questionnaires that assessed past maltreatment, current adjustment, and dating violence. Logistic regression was used to compare maltreated and nonmaltreated youths across outcome domains. RESULTS: One third (n = 462) of the school sample reported levels of maltreatment above the cutoff score on the Childhood Trauma Questionnaire. Girls with a history of maltreatment had a higher risk of emotional distress compared with girls without such histories (e.g., odds ratios [OR] for anger, depression, anxiety, and posttraumatic stress-related problems were 7.1, 7.2, 9.3, and 9.8, respectively). They were also at greater risk of violent and nonviolent delinquency (OR = 2.7) and carrying concealed weapons (OR = 7.1). Boys with histories of maltreatment were 2.5 to 3.5 times as likely to report clinical levels of depression, posttraumatic stress, and overt dissociation as were boys without a maltreatment history. They also had a significantly greater risk of using threatening behaviors (OR = 2.8) or physical abuse (OR = 3.4) against their dating partners. CONCLUSIONS: Maltreatment is a significant risk factor for adolescent maladjustment and shows a differential pattern for male and female adolescents.

Dating violence in mid-adolescence: theory, significance, and emerging prevention initiatives.

Adolescent dating violence is an important juncture in the developmental pathway to adult partnership violence. As a window of opportunity for positive change, the present review considers the theoretical and empirical work on adolescent dating and dating violence. A consideration of the scope of the problem, developmental processes, and theoretical formulations precede a review of six relationship violence prevention programs designed for and delivered to youth. Five programs are school-based and one operates in the community. Prevention is targeted toward both universal (e.g., all high school students) and selected adolescent populations (e.g., youths with histories of maltreatment, or problems with peer aggression). Programs addressed specific skills and knowledge that oppose the use of violent and abusive behavior toward intimate partners; one program addressed interpersonal violence more generally, and was also included in this review because of its implications for dating violence initiatives. Positive changes were found across studies in violence-related attitudes and knowledge, also, positive gains were noted in self-reported perpetration of dating violence, with less consistent evidence in self-reported victimization. However, these findings should be considered preliminary due to limited follow-up and generalizability. Conceptual and methodological issues are discussed with a view toward improving assessment methods and research design.

Tilt table testing in the evaluation and management of athletes with recurrent exercise-induced syncope.

Recurrent idiopathic exercise-related syncope in the young athlete is often a challenging and frustrating condition. Vasovagally mediated hypotension and bradycardia is believed to be a common, but difficult to prove, cause of this form of syncope. This study evaluated the usefulness of head-upright tilt table testing in the evaluation and management of young athletes with recurrent idiopathic exercise-related syncope. Twenty-four trained young athletes (12 male, 12 female mean age 18 +/- 3.4 yr) with recurrent unexplained exercise-related syncope were evaluated by use of an upright tilt table test for 30 min, with or without an infusion of isoproterenol (1-3 micrograms.min-1 given intravenously) in an effort to provoke bradycardia, hypotension, or both. Ten control patients with no history of syncope were also studied. Syncope occurred in 10 patients (41%) during the baseline tilt and in nine patients (37%) during the isoproterenol infusion (total positives 79%). Seventeen patients who had positive test results eventually became tilt table negative with pharmacotherapy, and over a mean follow-up period of 23 +/- 7 months, no further syncopal episodes have occurred. Two patients refused pharmacotherapy and have continued to experience syncope. We conclude that head-upright tilt table testing combined with isoproterenol infusion is useful in the diagnosis of vasovagal syncope in young athletes with recurrent exercise related syncope, and in the evaluation of prophylactic pharmacotherapy.

Syncope and seizures of psychogenic origin: identification with head-upright tilt table testing.

Psychogenic seizures and psychogenic syncope are common disorders but are difficult to identify. Head-upright tilt table testing has emerged as a promising means of evaluating vasovagally mediated syncope and convulsive syncope. Of a total of 42 patients evaluated by head-up tilt for recurrent syncope and 10 evaluated for recurrent idiopathic seizures, a total of 5 patients experienced syncope and 3 had tonic-clonic seizure activity unaccompanied by any significant changes in blood pressure, heart rate, transcranial Doppler cerebral blood flow velocity, and electroencephalographic monitoring. Psychiatric evaluation revealed that seven patients suffered from conversion reactions and one from probable malingering. We conclude that patients who pass out or convulse during head-upright tilt without any change in physiologic parameters can be presumed psychogenic in origin and may be referred for psychiatric evaluation without further expensive diagnostic studies.

Child witnesses to violence between parents: critical issues in behavioral and social adjustment.

This study examined the impact of exposure to family violence on children's adjustment. Two groups of residents of shelters for battered women (current and former residents) were compared to a nonviolent control group. All three groups of mothers completed interviews and self-report questionnaires related to both their own and their children's adjustment. Children recently witnessing violence tended to have the lowest levels of social competence ratings, and their mothers reported the most health and emotional difficulties. Former residents of shelters experienced the highest level of family/social disadvantage. The results are discussed in the context of previous research findings, and implications for intervention programs are outlined.

Development and validation of the Conflict in Adolescent Dating Relationships Inventory.

Four studies examined the Conflict in Adolescent Dating Relationships Inventory (CADRI), a measure of abusive behavior among adolescent dating partners. Exploratory factor analysis was used to refine items based on high school participants with dating experience (N = 393; 49% female). Confirmatory factor analysis was used to derive and cross-validate the factor structure with participants from 10 high schools (N = 1,019, 55% female; ages 14-16). The model structure fit for all grades and both sexes, with physical abuse, verbal abuse, and threatening behavior most representative of the underlying "abuse" factor. In Studies 3 and 4, the second-order abuse factor showed acceptable test-retest reliability, partner agreement, and correlation (significant for males only) between observer ratings of dating partners' interactions and youths' CADRI scores. Results support the CADRI as a measure of abusive behavior in adolescent dating relationships.

Factors associated with the development of posttraumatic stress disorder among child victims of sexual abuse.

This study examined the relationship between the development of PTSD and selected victim and event characteristics. The sample consisted of 69 girls and 21 boys (mean age = 12.4 years) who had been referred to a child witness preparation program following documentation of sexual abuse. Comparisons of PTSD positive (N = 44) and PTSD negative (N = 46) subgroups found significant differences on variables of age, sex, duration of the abuse, and the use of violence or coercion by the offender. Comparisons on psychological test data indicated that the PTSD subgroup significantly differed from the non-PTSD subgroup on the basis of children's abuse-related fears, anxiety, depression, and feelings of guilt related to the abuse. Hierarchical multiple regression analysis indicated that factors related to the nature and severity of the abuse and the child's self-report of guilt feelings each contributed significantly to explaining 37% of the variance in PTSD symptoms, even after the variables of receptive language ability, age, and sex were controlled. Discriminant function analysis correctly classified 78.4% of the respondents. The importance of considering PTSD in relation to child sexual abuse is discussed, along with limitations of the current study.

Evaluation of a brief intervention for educating school children in awareness of physical and sexual abuse.

The development and evaluation of procedures for imparting information to children regarding inappropriate treatment by adults is a challenging task that warrants increased methodological sophistication. The present study was conducted to evaluate proximal changes in fourth and fifth graders' knowledge and attitudes of physical and sexual abuse following brief skits and focal discussion in the classroom. The study used a control group of children that did not receive the intervention, which permitted a more accurate understanding of the program's effectiveness. Relative to controls, children who received the program showed an overall increase in knowledge of correct actions to take in the event of potential or actual abuse. Limitations of the study, as well as suggestions for broadening the scope and impact of child abuse prevention programs for children are discussed in relation to these findings.

The measurement of maltreatment: a comparison of approaches.

This study examined the comparability and predictive validity of three approaches to the measurement of child maltreatment. Adolescents (N = 160, aged 11-17) were randomly selected from the open caseload of a child protection agency. Global ratings of maltreatment severity were made by three reporting sources: researchers on the basis of protection agency case files, protection agency social workers, and the adolescents themselves. Ratings were made of five types of maltreatment: physical, sexual, emotional, neglect, and exposure to family violence. Self-reported (YSR) and caretaker-reported (CBCL) adjustment measures were also obtained for each subject. Results indicated that over 90% of the sample had experienced more than one type of maltreatment. Comparison of ratings across sources indicated considerable disagreement with respect to judgments of maltreatment occurrence and severity. Relative to professional ratings, adolescent ratings were better predictors of externalizing and internalizing symptomatology in both univariate and multivariate analyses.

Ibutilide: a class III rapidly acting antidysrhythmic for atrial fibrillation or atrial flutter.

Ibutilide is an intravenous Class III antidysrhythmic approved for the treatment of recent onset atrial fibrillation or atrial flutter. Pharmacological effect occurs within 30 min, and the efficacy approaches 40%. In contrast to DC electrical cardioversion, which requires anesthesia, pharmacologic cardioversion offers an alternative in which sedation can be avoided. Patients receiving ibutilide should be monitored for at least 4 h after completed drug administration because of a small chance of ventricular dysrhythmia, mainly torsades de pointes. Careful patient selection is the key to avoiding dysrhythmic complications. The purpose of this article is to review the mechanisms, clinical applications, potential complications, and appropriate use of ibutilide.

Urethral prosthesis for treatment of prostatic abscess in a dog.

A dog with a prostatic abscess was treated successfully with surgical implantation of a urethral prosthesis after 6 recurring episodes of abscess formation failed to respond to antibiotic therapy, surgical drainage, and bilateral marsupialization.

Recurrent intestinal intussusceptions in the dog.

Intestinal intussusceptions in 2 young dogs recurred within 3 days of initial surgical reduction. Subsequent recurrence was prevented by intestinal resection and creation of multiple intestinal adhesions in 1 dog and by creation of adhesions alone in the other.

Update on implantable cardioverter-defibrillators. New, safer devices have led to changes in indications.

The safety and efficacy of ICDs have improved significantly in the past few years. Recent evidence supports the value of these devices not only for secondary prevention of sudden cardiac death, but also for primary prevention in post-myocardial infarction patients with poor left ventricular function, unsustained ventricular tachycardia, and inducible ventricular tachycardia on electrophysiologic study. Transvenous defibrillation using the defibrillator case as the high-voltage electrode and a biphasic shock is currently the procedure of choice. Implantation is simple, and the defibrillation thresholds are acceptably low. However, the possibility of interactions must be considered in patients with cardiac pacemakers.

Catheter ablation for atrial flutter and fibrillation. An effective alternative to medical therapy.

Atrial flutter and atrial fibrillation are common arrhythmias that can be difficult to manage clinically. In many patients, these conditions are refractory to pharmacologic therapy because of drug failure or intolerance. Radiofrequency catheter ablation may be a reasonable alternative in patients with typical atrial flutter. The procedure has a high initial success rate and a low complication rate. However, recurrence after ablation is common, and a second treatment session may be needed. In selected patients with atrial fibrillation, radiofrequency ablation can be useful for rate control. However, its use in curing chronic fibrillation is still experimental. The procedure involves insertion of a pacemaker, anticoagulation therapy is still needed in most patients, and the need for antiarrhythmic medication may not be obviated.

PMMA bead versus parenteral treatment of Staphylococcus aureus osteomyelitis.

A. rabbit model of Staphylococcus aureus osteomyelitis was used to compare 3 weeks of clindamycin-impregnated polymethylmethacralate (PMMA) bead treatment with 3 weeks of gentamicin-impregnated polymethylmethacralate bead treatment, 4 weeks of parenteral clindamycin treatment, and surgical debridement without any antibiotic treatment. The animals were weighed throughout the course of the experiment and cortical bone and marrow flush specimens were obtained for bacterial culture at the end of therapy. The cortical specimens were bacteria free in 100% (6/6) of the animals receiving parenteral clindamycin, 83% (5/6) of the animals in the clindamycin PMMA group and, none of the animals in the gentamicin PMMA group. The marrow flush specimens were bacteria free in 83% (5/6) of the animals in the parenteral clindamycin group, 67% (4/6) of the animals in the clindamycin PMMA group, and 40% (2/5) of the animals in the gentamicin PMMA group. While these findings are preliminary and further studies with larger numbers of animals are needed, the authors suggest that when PMMA bead therapy is being contemplated, serious consideration should be given to replacing gentamicin with clindamycin in treatment of gram-positive osteomyelitis. Furthermore, incorporation of clindamycin with gentamicin (or tobramycin) should be considered when treating mixed gram-positive and gram-negative osteomyelitis.

A parent-administered program to reduce children's television viewing.

A parent-administered program to reduce television viewing of primary school-aged children was tested on two boys and three girls from three different families who were heavy viewers of television. Children were given 20 unearned tokens each week by their parents, which they could exchange for up to 10 hours of viewing time. The child earned a gold token for viewing in accordance with the rules for 4 consecutive weeks, which was exchanged for a reward. Parents were given instructions to follow the program independently. Data on hours of television viewing, homework, and reading were recorded each day by one or both parents. A multiple-baseline analysis of the effects of the TV reduction program indicated that children reduced their baseline television viewing by more than half once the program was implemented, and continued to maintain these changes 6 months and 1 year after the program was discontinued. Reading time increased for all children whereas effects on homework varied across children. The results support the effectiveness of a parent-administered program for nonbehavior problem children who watch excessive amounts of television.