High school consultation.

High schools painstakingly plan their academic standards, curricula, instructional approaches, technology, and facilities. Also essential to the vision is a systematic plan for developmental guidance, prevention, at-risk services, intervention, crisis responding, and postvention. The consultant, working in partnership with a caring school staff, can promote safety and well-being and reduce risk-taking behaviors so that adolescents can get the most benefit from school experiences. Several protocols have been described that may guide a consultant in helping school personnel.

Project 2000 student nurses' creative approach to peer education.

This research paper gives an account of an unique initiative using interactive drama with Project 2000 student nurses, to facilitate health promotion with pupils at secondary school level. Through an open-ended play lasting 12 minutes (entitled Debbie) and workshops, student nurses communicated sexual health promotion and how to make choices to a group of 14-18 year olds in a large comprehensive school. The initiative, which uses participant action research (Altricher 1993), was designed to assess whether student nurses could effectively communicate health promotion to pupils with whom they were comparable in age, and the educative effects on the students as a result of engaging in the initiative. It was clear from the findings that several student nurses were unprepared for the impact that the initiative would have on them. The play had immense power and they had empathy with the pupils. Perceived personal and professional benefits gained by the students (as reported by them) included a sense of belonging, more independence, more openness, less inhibition, increased knowledge, improved communication skills, confidence, assertiveness, self-esteem, and the ability to educate people. The author argues that a creative approach to teaching the theoretical underpinning of health promotion alongside practical dramatic skills of communication to empower, as well as promote change, can enable effective facilitation amongst young people.

Serum copper and zinc in random samples of the population of Northern Ireland.

Serum copper and zinc concentrations (mumol/L) were measured in nonfasting subjects aged 25-64 y participating in two independent population surveys in Northern Ireland. In 1983-84, copper in 1144 males was 17.2 +/- 3.1 (mean +/- SD) and zinc was 12.1 +/- 1.7 (SD). Copper in 1055 females, neither pregnant nor taking estrogens or progestogens, was 19.0 +/- 3.9 and zinc was 11.6 +/- 1.4. In 1986-87 copper in 1142 males was 17.9 +/- 3.3 and zinc was 13.2 +/- 2.1. Copper in 1034 females was 20.1 +/- 3.9 and zinc was 12.7 +/- 2.0. Zinc but not copper concentrations decreased from early morning to late afternoon; both were unaffected by reported postprandial time. There was a positive relationship between copper and age for both sexes but zinc showed only a slight upward trend with age. A positive relationship between copper and the aggregation of classical risk factors for coronary heart disease was demonstrated.

An outbreak of suicide and suicidal behavior in a high school.

In a high school of 1,496 students, two students committed suicide within 4 days. During an 18-day period that included the two suicides, seven students attempted suicide and an additional 23 manifested suicidal ideation. Compared to expected rates, the rates of both completed and attempted suicide were markedly elevated. Seventy-five percent of the members of the cluster had at least one major psychiatric disorder antedating their exposure. One hundred ten students thought to be at high risk were psychiatrically screened on site. Within this group, students who became suicidal after exposure were more likely than their nonsuicidal counterparts to be currently depressed and to have had past episodes of depression and suicidality. Close friends of the victims manifested suicidality at a lower psychopathological threshold than those who were less close to the victims. Students who are friends of a victim or who have a history of affective disorder and/or previous suicidality should be screened for suicidality after exposure.

Coronary risk factor prevalence in a high incidence area: results from the Belfast MONICA Project.

Northern Ireland remains at the top of the world mortality league for ischaemic heart disease. The Province is providing a centre for the World Health Organisation's MONICA Project. Registration of coronary heart disease events began in 1983 and the first of three population surveys took place in 1983-4. A total of 2,361 men and women aged 25-64 years was screened. Subjects were shorter and heavier than their fellow citizens in Great Britain. The estimated mean cholesterol levels in the 25-64-year-old population (5.80 mmol/l in males and 5.85 mmol/l in females) were similar to those reported from Great Britain. Although mean systolic blood pressures were lower, mild diastolic hypertension was considerably more common; cigarette smoking levels were similar. The results were consistent with those expected for an area with a high coronary heart disease mortality, with more than 80% of subjects being at increased risk in terms of the three major factors (cigarette smoking, hypertension and raised cholesterol). Public concern about coronary heart disease has grown and recently the Department of Health and Social Services (NI) has launched a 10-year prevention programme which will primarily employ a population approach.

Myocardial infarction: hospital and home management in Northern Ireland.

Some 262 general practitioners in the Belfast area were asked to complete a questionnaire about their attitudes and practice regarding the management of myocardial infarction at home. Of the 211 responders, only nine per cent would sometimes consider home care for patients under 65 years of age, although 55 per cent would sometimes consider home care for those over 65 years and three per cent preferred home management for this age group. In the year preceding this study, seven per cent of these general practitioners treated only 22 myocardial infarction patients under 65 years of age at home (two per cent of all cases in the area). Home care for myocardial infarction patients appears to be less popular in Belfast than in other parts of the United Kingdom. The views of the general practitioners concerning home care are discussed.

Diagnosis of myocardial infarction from serum creatine kinase MB isoenzyme (CKMB) measurement.

The cardiospecific isoenzyme MB of creatine kinase (CKMB) has previously been shown to be of value in the diagnosis of myocardial infarction (MI). We studied 418 admissions to a coronary care unit (CCU) with suspected MI and calculated the sensitivity, specificity and positive and negative predictive values for several CKMB test functions. Several functions performed better than any combination of the other enzymes in common use. 97% of patients achieving a CKMB activity of at least 15 U/l did so between 6 and 30 h following the onset of symptoms. The present study confirms that the use of the CKMB isoenzyme leads to an earlier and more accurate diagnosis or exclusion of MI compared to the "cardiac enzyme series". The timing of blood sampling for CKMB estimation is also discussed.

Naturalistic assessment of children's compliance to teachers' requests and consequences for compliance.

Naturally occurring levels of teacher commands, child compliance to those commands, and positive and negative teacher feedback were studied in 19 teachers and 130 children in kindergarten through third grade. Seventy-five of the children had been identified as "making a good social adjustment" to school (high-rated) and 55 children were identified as "not making a good social adjustment" to school (low-rated). Results of intensive observation over a 4-wk period showed that: (a) individual teachers differed significantly in their overall use of commands; however, they did not differentially respond to high- versus low-rated children; (b) high-rated children were more likely to comply with commands than were low-rated children; (c) although the overall level of positive social consequences was extremely low, there was some indication that high-rated children were more likely to receive positive feedback for compliance than were low-rated children; (d) low-rated children received significantly more positive feedback than high-rated children for noncompliance; (e) teachers gave negative feedback for noncompliance at an equal level to both groups of children; and (f) although repeated teacher commands following noncompliance were equal across groups, low-rated children were exposed to significantly higher levels of repeated commands following compliance than were high-rated youngsters.

A pharmacological study of cefaclor in the newborn infant.

The absorption and excretion of cefaclor were studied in 10 newborn infants. A mean peak serum concentration of 7.7 microgram/ml was achieved at 1 hour after an oral dose of 7.5 mg/kg. It is concluded that cefaclor is a well absorbed and tolerated cephalosporin for use in newborn infants.

Effects of peer-mediated social initiations and prompting/reinforcement procedures on the social behavior of autistic children.

Peer-mediated social initiations and prompting/reinforcement procedures were evaluated (in training and generalization sessions) as interventions for increasing the positive social behavior of four autistic children. During baseline, the peer trainer made few social initiations and did not prompt or socially reinforce subjects. For two subjects, baseline was followed by social initiation intervention, and for the other two, baseline was followed by prompting and social reinforcement. Both interventions produced dramatic and comparable increases in positive social behavior in training sessions. Post-treatment responding was not observed for either intervention. When interventions terminated in a second baseline period, the subjects' behavior returned to the level observed during the initial baseline. The subjects were then exposed to the intervention procedure they had not yet experienced. Again, there were positive and comparable behavior changes in the treatment setting, but no increase in positive social behavior was observed during generalization assessment.

Lack of transmission of hepatitis B after surgical exposure.

An orthopedic surgeon in whom hepatitis B subsequently developed participated in operations on 49 patients in the two months preceding his illness. Thirty of these patients were available for subsequent clinical and serologic follow-up: five had positive reactions for antibody to hepatitis B surface antigen (anti-HBs) and one had a positive reaction for hepatitis B surface antigen (HBsAg) at the initial examination an average of 77 days after surgery. No new patients had either clinical or serologic evidence of hepatitis B during four months of subsequent follow-up (mean of 6.7 months after surgery). A control group of 56 orthopedic patients had a 25% prevalence of positive reactions for anti-HBs and negative reactions for HBsAg- this was not significantly different from the exposed group. The risk to patients of acquiring hepatitis B after surgical exposure in this setting from a surgeon is low.

Amoxycillin and co-trimoxazole in presumed viral respiratory infections of childhood: placebo-controlled trial.

A double-blind randomized controlled trial of amoxycillin, co-trimoxazole, and placebo was conducted on 197 children presenting with presumed viral respiratory infections. Routine throat swabs were taken to exclude streptococcal diseases. The three disease categories studied--nasopharyngitis, pharyngotonsillitis, and bronchitis (including laryngotracheobronchitis)--showed a generally similar pattern of resolution irrespective of treatment. Nevertheless, seven out of 66 children receiving placebo were withdrawn from the trial with unremitting symptoms or complications thought to require antimicrobial treatment. Only two of 56 children receiving amoxycillin and none of 75 receiving co-trimoxazole were withdrawn. Three other children receiving amoxycillin and three receiving placebo were seen during the trial but further treatment was not thought to be necessary. Thus the return consultation rate in children receiving placebo therapy was 15% compared with 4% for those receiving antimicrobial treatment. Antimicrobial treatment was associated with less nasal discharge on the eighth day of treatment. Placebo treatment allowed an earlier return to normal activity. There was a high incidence of possible side effects on all regimens including placebo. It is concluded that the benefits of antimicrobial treatment in presumed viral respiratory infections are marginal, and they should not be routinely prescribed for these conditions.

The place of continuous external negative pressure (CNP) in the management of respiratory distress syndrome of the new born.

This work has been carried out on 28 cases of respiratory distress syndrome (R.D.S.), 17 cases of mild and moderate severity were treated by oxygen therapy, excess humidity, and correction of acid-base balance with 100% recovery within an average time of 72 hrs., while 11 cases of severe R.D.S. needed continuous negative external pressure (C.N.P.) in addition to routine management. The use of C.N.P. in spontaneously breathing infants reduced the need for high ambient oxygen, raised PaO2", shortened the duration of therapy; average time of recovery was 48 hrs. In addition, C.N.P. reduced the need for excessive alkali therapy and assisted ventilation. So, in addition to routine therapy, C.N.P. is recommended as an additional line of management of severe cases of R.D.S., i.e. cases that cannot maintain an arterial oxygen of 60 mmHg. at 60% ambient oxygen or above; or cases with frequent apnoeic attacks.

The natural history of bacterial colonization of the newborn in a maternity hospital (Part II).

The object of this study was to determine the sources from which the newborn infant derives his bacterial flora during the first 5 days after birth. Detailed bacteriological data was obtained from 193 mothers antenatally and during labour, and from their infants on the day of birth and on Day 5. Organisms were typed by appropriate methods and the 193 mother-baby pairs declared to be a 'match' or a 'non-match' according as to whether or not identical bacteria were isolated from both members of the pair. Weekly swabs from hands and noses of staff were taken throughout the 12 months of the study. Swabs were also taken from the environment and air samples from different areas in the hospital. In approximately one third of infants the colonizing bacteria are derived from their mothers, in over 70 per cent of instances from the mother's rectum. The mother's birth canal is not a common source of bacteria and there is no direct relationship with the noses or hands of staff. Artificial feeds are not a source of the colonizing bacteria. The overall distribution of the bacterial species in the infants differed from that found in the hospital environment but this does, none the less, constitute a reservoir of bacteria which is being continually replenished from human sources. Pathogens such as Staph, aureus and Strep. pyogenes are no longer commonly found in newborn infants in the modern maternity hospital, but the need for continual vigilance and an efficient bacteriological service in all maternity units has been in no way diminished.

Calcium, phosphorus, and magnesium concentrations in plasma during first week of life and their relation to type of milk feed.

Serial changes in plasma levels of calcium, phosphorus, magnesium, alkaline phosphatase, and total proteins have been investigated in 138 healthy, term Caucasian infants. Blood samples were obtained for each infant from cord blood and on day 1 and day 6. The infants were studied in three groups according to whether they were breast fed, received 'Ostermilk No. 1' or 'Cow and Gate V' formulas. Levels of calcium, phosphorus, magnesium, alkaline phosphatase, and total proteins did not differ between the groups at birth or on day 1. By day 6 calcium levels were higher and phosphorus levels lower in the breast-fed infants compared with either of the artificially-fed groups. Phosphorus levels were lower in the V Formula group compared with the Ostermilk group but the mean calcium levels of these two groups did not differ significantly. However, only 2-8% of the V Formula group developed hypocalcaemia compared with 18-2% of the Ostermilk group. The only infant developing clinical tetany belonged to the group fed Ostermilk. Evidence is also given which suggests that those infants with low calcium levels on day 1 who were fed the high-solute milk tended to show a fall in calcium by day 6. This did not apply to the two other groups. It is concluded that the use of adapted cows' milk preparations for infant feeding should lead to a reduction in the incidence of neonatal tetany.