Non-suicidal self-injury within the school context: Multilevel analysis of teachers' support and peer climate.

BACKGROUND: Recent studies regarding non-suicidal self-injury (NSSI) among adolescents have focused primarily on individual characteristics (e.g., depressive symptoms) and background factors (e.g., parental relationship), whereas less emphasis has been given to the role of school-related factors in NSSI. Therefore, the purpose of the current study was to explore the relationships between teachers' support, peer climate, and NSSI within the school context. METHODS: The sample consisted of 594 high school students nested within 27 regular classes (54.4% boys; mean age 14.96, SD=1.33 years). The students were evaluated for NSSI behaviors, perception of teacher support, peer climate, relationships with mothers, and depressive symptoms using validated scales. RESULTS: The primary analysis used hierarchical linear modeling (HLM), controlling for gender and age. The main findings indicated that teacher support was positively associated with NSSI at the classroom-level (OR=6.15, 95% CI=2.05-18.5) but negatively associated at the student-level (OR=0.66, 95% CI=0.49-0.89). There was a trend toward an association between positive peer climate and NSSI at the classroom-level (OR=0.43, 95% CI=0.18-1.05), while negative peer climate was associated with NSSI at the student-level (OR=1.37, 95% CI=1.00-1.87). CONCLUSIONS: School-related factors are associated with NSSI behaviors among students. Teachers and educators should focus on both individual-level and classroom-level perceptions of school context. Students who feel supported by their teachers and who are exposed to a positive peer climate are less likely to engage in NSSI.

Assessment of stereopsis in college baseball pitchers and batters.

BACKGROUND/PURPOSE: In baseball pitching is a much less visually demanding task than hitting is. We sought to find a stronger relationship between visual function (as measured by stereopsis) and hitting a baseball than between stereopsis and pitching skill. METHODS: Multiple parameters including near and distance stereopsis (as a measure of visual function) were measured in 23 returning college baseball players (with a prior year's record). Their level of stereopsis (measured at distance with use of the B-VAT II BVS Binocular Vision Testing System) was compared with their batting statistics (in the case of the 14 position players) or their pitching statistics (for the 9 pitchers). Batting average and slugging percentage were used as measures of hitting skill, and earned run average, "out percentage" (1.000--Opposing players' batting average) and "strike-out percentage" (frequency of batters struck out) were used as pitching parameters. RESULTS: As a group, visual parameters were excellent in these college athletes. Although the newer test of distance stereopsis correlated with the standard near stereo test (Spearman coefficients), there was no correlation between distance stereopsis and any of the pitching or hitting performance parameters. CONCLUSIONS: The nature of the visual demands required of successful baseball hitters may have yet to be determined or are difficult to identify among a population homogeneous for excellent visual function, true for most groups of competitive athletes. In addition, simpler parameters such as plain visual acuity may be the most important factor(s).

Anterior polar cataract in two sisters with an unbalanced 3;18 chromosomal translocation.

Congenital anterior polar cataracts can be associated with chromosomal abnormalities. We treated two sisters with this condition who had the same unbalanced translocation between the long arm of chromosome 3 and the short arm of chromosome 18. Their mother had a balanced translocation between those chromosomes but had no cataract. Both sisters had dysmorphic features. Their genetic status resulted in partial trisomy of the long arm of chromosome 3 and partial monosomy of the short arm of chromosome 18. To aid in the identification of specific cataract genes, patients with chromosomal abnormalities should have careful ophthalmic examinations, and their lenticular findings should be reported.

Amblyopia. Diagnosis and management.

Amblyopia is a difficult challenge for physicians caring for these children. If detected early with screening programs, the prognosis for successful treatment is greatly increased. If missed, the child may suffer from a lifetime of poor vision in one eye. Children who fail a visual screening test should be promptly referred to an ophthalmologist. Prompt detection and treatment of amblyopia secure a child the best chance for a good visual outcome.

Thyroid ophthalmopathy presenting as superior oblique paresis.

Six patients with thyroid ophthalmopathy presented with what appeared to be a unilateral superior oblique paresis by the three-step test, which was eventually followed by more typical findings of thyroid disease. This early motility defect in thyroid ophthalmopathy may be caused by a restrictive process due to involvement of the inferior rectus muscle. Clues to the proper diagnosis included an increase in vertical deviation in upgaze, elevation of intraocular tension in upgaze, and the lack of excyclodeviation. These features should be assessed in patients with isolated superior oblique paresis.

Job roles of assistive technology service providers in the United States.

The purpose of this study was to identify empirically the roles of assistive technology service providers in the United States. Via factor analysis, the following six job roles were identified: (a) Device Selection and Maintenance Activities, (b) Environmental Modification Activities, (c) Dissemination of Information on Assistive Technology Activities, (d) Evaluation of Suitability of Assistive Device Activities, (e) Administration Activities, and (f) Product Development Activities. The identified roles can provide a potential guide for the development of education or training curricula for assistive technology service providers. Those job role categories can be considered to be required areas of knowledge in a curriculum for assistive technology specialists. The identified roles can also be utilized to help define the profession of assistive technology. That definition could help guide the development of eligibility criterion and examination content for a credentialing programme for qualified assistive technology service providers in the future. A clear description of the job of assistive technology service providers can help administrators create needed positions within service delivery organizations such as state department of rehabilitation services and a rehabilitation hospital. The results could be valuable to the administrators responsible for setting job role criteria for assistive technology service providers. Such criteria are necessary for making effective hiring and employee evaluation decisions. In addition, the results can provide other professionals who utilize assistive technology services with an accurate picture of the services available from assistive technology service providers. When professionals on a rehabilitation team know what to expect of each other, clients are better served. Thus a better understanding of the roles of assistive technology service providers can contribute to better utilization of their services by a multidisciplinary team. This would in turn increase the chances of assistive technology services being offered to clients. Replication of the present study is encouraged to verify the obtained results. A future study should also focus on examining the roles of assistive technology service providers by directly observing their daily work activities. The task inventory used in the present study (ATTI) might be utilized to help guide such observations.

Head nodding associated with intermittent esotropia.

Head nodding (to-and-fro turning about the vertical cervical axis) associated with abnormal eye movements may be seen in spasmus nutans and congenital nystagmus. In the absence of abnormal eye movements, it may be indicative of neurological disease (eg, cerebellar disease, basal ganglia dysfunction). We report a neurologically normal infant without nystagmus but with intermittent head nodding and intermittent esotropia, whose head movements manifested only when his eyes were straight. The head movements ceased with the occlusion of either eye or spontaneous onset of esotropia. When his head was forcibly stabilized, he immediately developed esotropia. The head movement presumably facilitated fusion, although the mechanism of action is unknown.

Acute acquired comitant esotropia.

Acute acquired comitant esotropia has been used to describe a dramatic onset of a relatively large angle of esotropia with diplopia and minimal refractive error. We describe six children aged 5 to 11 years who developed an acute non-accommodative esotropia with diplopia. Neurological examination, including CT scan, in each of these children gave negative results. We suggest that this is an unusual presentation of esotropia of undetermined aetiology. The diagnosis, clinical characteristics, and management are discussed.

Eyelid swelling and erythema as the only signs of subperiosteal abscess.

On clinical grounds it is usually easy to distinguish between preseptal cellulitis, a cutaneous infection not threatening to vision, and orbital cellulitis, a potentially vision threatening infection of the orbital tissues generally arising from paranasal sinusitis. We recently cared for two patients with a clinical diagnosis of preseptal cellulitis who had CT scan evidence of subperiosteal abscess. Antibiotic therapy alone resulted in clinical resolution in each case.

Medical management of orbital subperiosteal abscess in children.

The traditional treatment of subperiosteal orbital abscess consists of surgical drainage and antibiotic therapy. We successfully treated with antibiotics alone nine children (age range 26 months to 12 years) with clinical signs and symptoms of orbital cellulitis and computerized tomographic (CT) evidence of subperiosteal abscess and contiguous ethmoid sinusitis. Two additional patients successfully treated with nonsurgical therapy were identified retrospectively. All patients were admitted to the pediatric service with normal vision. Their visual function was assessed twice daily during the early stages of their illness. All patients improved with intravenous antibiotic therapy. One additional patient required surgical drainage for persistent pain after 1 week of slow but steady clinical improvement. All other patients were clinically cured with medical therapy alone. Five of the medical "cures" had posttreatment CT, which documented the resolution. No patient had a recurrence. We conclude that orbital subperiosteal abscess, like some other abscesses located elsewhere, may be amenable to non-surgical treatment, or that these patients may have had a phlegmon rather than an abscess and the currently accepted CT criteria for diagnosis of a subperiosteal abscess may require modification. We recommend that children with a subperiosteal abscess from contiguous ethmoidal sinusitis who have no evidence of compromised optic nerve function be given a trial of intravenous antibiotic therapy prior to consideration of surgical drainage.

Infantile exotropia in healthy children.

Constant exotropia is uncommon during the first year of life. We retrospectively identified 13 patients with large, constant exotropia during the first year of life which required surgery. Bilateral lateral rectus muscle recessions were done in all 13 cases. Only two patients have required reoperation. The clinical characteristics and management of this unusual condition are similar to those of infantile esotropia.

Asymptomatic physiologic hyperdeviation in peripheral gaze.

Asymptomatic hyperdeviation (HD) in peripheral gaze may be caused by muscle paresis, restrictive orbital diseases, cranial neuropathy, or skew deviation. The authors suspected that this finding was often physiologic and therefore examined 61 normal subjects with the Maddox rod. Forty-seven of 61 patients (77%) showed an HD of 2 prism diopters (PD) or greater in any field of gaze; 22 of these 47 patients (47%) showed an isolated left HD in right upgaze and right HD in left upgaze; an additional 15 of the 47 patients (32%) had either a right HD in left upgaze or a left HD in right upgaze. In only one patient was a vertical phoria evident in primary gaze. Ninety-four percent noted vertical diplopia where the deviation was found. In 40 of 47 patients (85%), a "V" pattern of less than 15 PD was detected. No HD in primary gaze on head tilt was elicited in those tested. Awareness of this highly prevalent physiologic HD, which follows the pattern of primary overaction of the inferior oblique muscle, may ward off erroneous neurologic diagnoses.

Multicenter trial of sucralfate suspension for the treatment of reflux esophagitis.

The efficacy of sucralfate suspension in the treatment of reflux esophagitis was assessed in a multicenter, randomized, double-blind, placebo-controlled trial. Sixty-eight patients with symptomatic and endoscopic esophagitis received either sucralfate suspension (n = 31) or liquid placebo (n = 37) for eight weeks. The two groups were comparable at entry with the exception that despite randomization, a disproportionately high number of patients with esophageal ulcers were assigned to receive sucralfate. After four and eight weeks of treatment, both groups had reduced heartburn frequency and severity, but there was no difference in improvement between sucralfate and placebo (p greater than 0.05). Endoscopic results after eight weeks of sucralfate treatment revealed complete healing in 36 percent (placebo, 35 percent) and improvement in an additional 45 percent (placebo, 24 percent). Although neither of these differences was significant, the percent of patients in whom healing or improvement occurred with sucralfate (81 percent) was greater than with placebo (59 percent) (p = 0.07). These data fail to establish that eight weeks of treatment with sucralfate suspension improves symptoms or heals lesions in reflux esophagitis at a rate significantly greater than placebo. However, the unequal distribution of patients with ulcers and the trend toward endoscopic improvement indicate that a potential beneficial effect of sucralfate suspension for the treatment of reflux esophagitis cannot be excluded.

Ocular torticollis.

Torticollis can arise from nonocular (usually musculoskeletal) and ocular conditions. Abnormal head position for ocular reasons is usually assumed in order to maintain binocularity and/or to optimize visual acuity. A variety of conditions may be responsible. The sensory organ of position sense, the labyrinth, lies within the inner ear and it relates to eye movement in both a dynamic and static fashion. The Bielschowsky head tilt test is based on the functioning of the otolithic apparatus and is the primary test in evaluating abnormal head position. Treatment is usually surgical, with extent and location dependent upon on the underlying cause. While corrective surgery has usually been done on an elective basis for cosmetic purposes, there is evidence that uncorrected torticollis can cause musculoskeletal problems. This review describes the physiological bases for ocular torticollis and the diagnosis and treatment of its various underlying causes.