Descriptive and Psychometric Properties of the Inventory of Motivations for Suicide Attempts (IMSA) in an Inpatient Adolescent Sample

Little is known about why adolescents attempt suicide. The current study examined the endorsement, structure, and clinical correlates of adolescents’ suicide attempt motivations as measured by the Inventory of Motivations for Suicide Attempts (IMSA). Suicidal adolescents (n = 52) in a psychiatric unit were administered the IMSA and interviewed about their suicide attempts. Psychache, Hopelessness, and Escape were the most strongly endorsed motivations, and Interpersonal Influence the least endorsed. IMSA scales exhibited a 2-factor solution: 1) Internal and 2) Communication. Suicide intent was strongly correlated with Internal motivations and moderately inversely correlated with Communication motivations. Factor structure and mean endorsements were similar to adult samples. The IMSA is a useful measure to assess attempt motivations in adolescents.     

Semitendinosus tenodesis for recurrent subluxation or dislocation of the patella

In 26 knees treated by semitendinosus tenodesis, there was no recurrence of dislocation, but fair and poor results totaled 38% due to persistent pain because of chondromalacia of the patella. Poor results are also more common in the patients with generalized ligamentous laxity. Postoperative complications in wound healing suggest that the medial parapatellar skin incision is less than adequate. Semitendinosus tenodesis with or without modifications is a useful procedure to prevent recurrent dislocations and subluxation during the growth period.     

Effectiveness and safety of digoxin to induce fetal demise prior to second-trimester abortion

BACKGROUND: The study was conducted to assess the effectiveness in inducing fetal demise through digoxin injection given 1 day prior to second-trimester pregnancy termination and to evaluate related maternal safety. STUDY DESIGN: A retrospective cohort analysis of 1795 pregnant women between 17 and 24 weeks' gestation who received varying doses of digoxin by transabdominal intrafetal or intra-amniotic injection at the time of laminaria placement was conducted. Fetal heart activity documented by M-mode Doppler sonography on the subsequent day was considered failure. Digoxin dosages started at 1.0 mg for intrafetal and 0.5 mg for intra-amniotic injections and were progressively decreased based on best clinical judgment. RESULTS: The overall rate of failure to achieve fetal demise was 6.6% (95% CI, 5.5-7.9). Failure rates varied according to route of administration and dosage. There were no failures using a 1.0-mg intrafetal dose, but failures occurred with lower doses. Failure rates were higher with 0.5 mg for intra-amniotic (8.3%) than intrafetal administration (3.6%). There were no adverse maternal events at any of the doses in this study. CONCLUSION: Intrafetal digoxin injection at a dose of 1.0 mg is safe and effective for fetal demise prior to pregnancy termination in the second trimester. Significantly lower doses are effective in most cases. Additional doses merit further testing.     

Medical coverage of high school athletics in North Carolina

BACKGROUND: A significant percentage of high school students participate in athletics, and of those participating, at least one third will experience a sport-related injury. Despite the high risk of injury, there are few guidelines on what type of medical coverage should be provided for high school athletics. Although vague recommendations are present, it is not known to what extent high schools comply with these guidelines. The primary objective of this cross-sectional study was to assess the quality and extent of medical coverage at high school athletic events in North Carolina. METHODS: A questionnaire, mailed to all athletic directors at public and private North Carolina high school members of the North Carolina High School Athletic Association, was used to assess medical coverage. RESULTS: Only 56% of the schools had coverage by either nationally or state certified athletic trainers. Although 71% of schools had physician coverage at some athletic events, less than 10% of physician coverage included monitoring of athletic practices. Only 27% of the schools surveyed felt that their existing medical coverage of athletic events could be considered adequate. CONCLUSIONS: These preliminary findings suggest that medical coverage of high school athletics in North Carolina, as in other states, is lacking and inconsistent.     

The surgical treatment of osteochondritis of the capitellum

This paper reviews 14 patients who underwent elbow arthrotomy for osteochondritis of the capitellum. The etiology in 7 of the 14 cases appears to be the result of repeated trauma from throwing sports. Five of the 14 described a singular significant traumatic episode, and in 2 of the 14, a clear etiology is uncertain. The diagnostic features including signs, symptoms, and elbow range of motion are examined. The operative findings are correlated with plain x-ray films of the elbow in all cases and with an elbow arthrogram in 11 out of 14 cases. The average length of followup was 24 months. The postoperative range of motion was increased an average of 18 degrees. Eighty-six percent (12 out of 14) patients returned to organized, competitive athletic activity without restrictions. The Little League background of those patients with apparent repetitive microtrauma to the elbow is examined in terms of length of pitching experience and types of pitches thrown. In addition, the throwing mechanism of these patients is evaluated with respect to the type of delivery at possible risk for the development of osteochondritis. We conclude that after a failure of conservative therapy, surgical treatment, including removal of the intraarticular loose bodies, excision of capitellar lesions, and curettage to bleeding bone can be expected to produce pain relief and improvement in joint motion. A return to organized competitive sport activities can be expected.     

Meeting the social and behavioral health needs of students: rethinking the relationship between teachers and school social workers

BACKGROUND: While school‐based mental health professionals obviously must provide mental health services to students directly, the literature is increasingly identifying an empowerment role for these professionals, whereby they support teachers as primary service providers. The purpose of this study was to identify subtypes of school social workers within the context of collaborative practice, and to identify individual and contextual factors associated with these classifications as well as overall levels of collaboration. METHODS: Latent class analysis, conducted using data collected as part of the National School Social Work Survey 2008 (N = 1639), was employed to examine underlying subtypes of school social work practitioners in relation to collaborative practices and to examine predictors of collaborative practice. RESULTS: Four broad categories of school social workers were identified, including (1) noncollaborators, (2) system‐level specialists, (3) consultants, and (4) well‐balanced collaborators. These classes were associated with the number of schools served, grade level, education, and clinical licensure status; level of administrative responsibility was not associated with class membership. CONCLUSION: While school social workers varied in collaborative practices, opportunities exist to enhance their role in educating and supporting teachers to serve as primary providers to students with social, mental health, and behavioral needs. The implications for school‐based mental health providers, teachers, administrators, policymakers, and researchers are discussed.     

Platelet aggregation by fibrinogen polymers crosslinked across the E domain

There is evidence that platelet interactions with artificial surfaces are mediated by plasma proteins, especially fibrinogen, adsorbed on the surfaces. Multiple site interactions between fibrinogen molecules adsorbed in high concentration and receptors in the unactivated platelet may be sufficient for platelet adhesion and subsequent activation. To examine this hypothesis, we prepared soluble polymers of fibrinogen. Polymers produced by interaction of fibrinogen with Fab'2 fragments of antibodies against fibrinogen's E (central) domain (Fg- Fab'2(E] induced, in gel-filtered platelets, aggregation and serotonin release, which were blocked by monoclonal antibodies against the GPIIb/IIIa complex, by Fab fragments against the D domain, and by metabolic inhibitors; aggregation was attenuated but not abolished by enzymatic removal of ADP (with CP/CPK) or by blockage of ADP binding sites (with FSBA), and when secretion was inhibited by aspirin. Fg- Fab'2(E) also induced a dose-dependent elevation in cytoplasmic Ca2+ (measured by Aequorin luminescence) which was attenuated by CP/CPK and by FSBA, and was eliminated by metabolic inhibitors and by anti- IIb/IIIa antibody. Fibrinogen complexes crosslinked with dimethylsuberimidate or Factor XIII neither aggregated gel-filtered platelets nor inhibited platelet aggregation by ADP and fibrinogen, probably because of inaccessibility of lysine residues in the D (terminal) domain of fibrinogen, which are thought to be required for platelet binding. Thus, soluble complexes of fibrinogen having multiple available platelet receptor recognition sites activate gel-filtered platelets and may provide a useful model for platelet-surface interactions mediated by adsorbed fibrinogen.     

Parental Monitoring Affects the Relationship Between Depressed Mood and Alcohol-Related Problems in Adolescents

Background: Parental monitoring has been identified as a protective factor for adolescent drinking, whereas depressed mood, peer substance use, and peer tolerance of substance use have been identified as risk factors. The purpose of this study was to test the association between depressed mood and alcohol-related problems in adolescents, and to test whether parental monitoring and peer substance use/tolerance of use moderate the strength of this relationship. Methods: Participants included 227 adolescents (M_age = 15.36; 51.5% female) recruited from a hospital emergency department and surrounding community who completed self-report assessments. Results: Hierarchical linear regression analysis demonstrated that depressed mood was associated with more alcohol-related problems. A significant interaction between depressed mood and parental monitoring indicated a moderating effect, with high levels of depressed mood being associated with alcohol-related problems when parental monitoring was low; at low levels of depressed mood, parental monitoring was not related to alcohol-related problems. Conclusions: This study highlights the protective role that parental monitoring may play in the association between depressed mood and alcohol-related problems and suggests that parenting practices, in addition to individual counseling, should be addressed in treatment of depressed adolescents who drink.     

Does the conformation of adsorbed fibrinogen dictate platelet interactions with artificial surfaces?

Platelet activation by polymer surfaces is thought to require preliminary adsorption of fibrinogen and perhaps changes in fibrinogen conformation. We measured fibrinogen adsorption by a series of polymers by two methods, using either 125I-labeled fibrinogen or 125I-labeled antifibrinogen antibodies, and correlated the results with platelet reactivity (retention and secretion) in columns of beads coated with the polymers. For polyalkyl methacrylates with 1 to 4 carbon side chains, platelet reactivity varied directly with increasing length of the alkyl side chain and with the quantity of bound fibrinogen recognizable by antifibrinogen antibody but not with the total quantity of fibrinogen adsorbed. The same pattern of results was seen with five antibody preparations, including affinity-purified Fab fragments against the D or E domain of fibrinogen. Tests of platelet retention and fibrinogen binding to four polyalkyl acrylates and to three unrelated polymers (polystyrene, polymethyl methacrylate, and a polyether polyurethane) indicated that platelet retention correlated positively with both total fibrinogen binding and with the amount of antibody-recognizable fibrinogen bound. Drugs that block platelet aggregation, but not adhesion, did not alter the hierarchy of platelet retention to the polyalkyl methacrylates. These data suggest that, contrary to previous views, platelet adhesion to artificial surfaces increases with increasing surface coverage of adsorbed fibrinogen if the bound fibrinogen maintains a conformation such that its functional domains remain recognizable by antibody probes.