Utility of the Brief Symptom Inventory in the Assessment of Psychological Distress

Introduction People with intellectual disabilities are now acknowledged to be susceptible to the full range of mental health disorders. This acknowledgement has resulted in the need to develop and evaluate instruments for the assessment and detection of mental health problems. This research evaluates the use of the Brief Symptom Inventory (BSI) with 200 people with mild intellectual disabilities representing community, clinical and forensic populations. Results and conclusions Results illustrate the reliability of the BSI for each of the groups and demonstrates how the Positive Symptom Total (PST) index effectively discriminates between study groups. Case rates for each group are provided. The study illustrates that the BSI could be employed as a brief multitrait assessment instrument and as a treatment outcome measure with people with an intellectual disability.     

Anorectal function in the solitary rectal ulcer syndrome

The anorectal function of nine patients with solitary rectal ulcer syndrome (SRUS) (5 F: 4 M, median age, 27 (range, 19–41 years) and nine control subjects (5 F: 4 M, median age, 47 (35–66)P<0.01) has been investigated by a new technique that radiologically visualizes the anorectum during voiding of a semisolid contrast medium, while simultaneously measuring intrarectal pressure and anal sphincter EMG activity. A degree of rectal prolapse was demonstrated in eight of the SRUS patients; six of these lesions were clinically occult. Abnormal failure of the anal sphincter to relax on voiding was present in seven of the SRUS patients. These abnormalities resulted in the SRUS patients requiring a greater increase in intrarectal pressure (median, 100 cm water) to void than the control subjects (median, 65 cm water,P<0.01). This combination of high intrarectal pressure and rectal prolapse during straining seems to be the cause of SRUS This work was supported by a grant from the Medical Research Council.     

Binocular contrast detection with unequal monocular illuminance

Binocular summation was measured in eight normal subjects by means of psychometric functions for contrast detection. An average 47% increase in binocular over monocular performance was obtained. Our data agreed with the simple summation model of Signal Detection Theory (Legge, 1984). Binocular psychometric functions were also measured when the sensitivity of one eye was decreased by means of a 1.0 neutral density (ND) filter. We found that binocular detectability in this case was reduced to below that of the better eye. This binocular inhibition was seen in all subjects. The slope of a contrast detection function gives a measure of the rate of change in detectability with contrast. If the slopes of two functions are equal, then the difference in detectability between these functions remains constant for all the contrast values used. When the slopes of the measured functions were analysed, no significant differences were found under any of the testing conditions. This indicates that the magnitude of summation (with equal monocular sensitivities), and of inhibition (with unequal monocular sensitivities), remains constant across the range of stimulus contrasts. The clinical implications of binocular inhibition are discussed.     

Impact of asthma and air pollution on school attendance of primary school children: are they at increased risk of school absenteeism?

AIM: The aim of this study was to determine the impact of asthma and air pollution on school attendance of primary school children 6 to 12 years of age in Qatar. STUDY DESIGN: This was a cross-sectional population-based study. SUBJECTS: The total 31,400 Qatari school children at the primary school (16,130 boys and 15,270 girls) 6 to 12 of age were studied to investigate school absenteeism caused by asthma and wheezing during the academic year October 2003 to July 2004. METHODS: We have used the School Health Registry for obtaining the student information and school absenteeism due to asthma and wheezing. Again we had double confirmation on the data obtained on asthmatic children by using the modified version of the International Study of Asthma and Allergies in Childhood [ISAAC] questionnaire. RESULTS: A total of 3,270 (10.4%) pupils were diagnosed as having asthma and wheezing. Overall 2,516 (8.02%) pupils were absent from the school for at least one day during the year. There was a statistically significant difference between asthmatic and wheezing students in number of days absent from the school (p < 0.0001). Most absenteeism occurred during spring for both boys (45%) and girls (47%), followed by autumn for boys (33%) and girls (36%). The measured pollutants reached a peak during the spring season and then in autumn of the studied academic year. CONCLUSION: Children with known asthma miss more days of school than those who do not have asthma. This study finding shows that air pollution has an impact on asthma, which results in significant school absenteeism.     

Respiratory syncytial virus

RSV is now understood to be the most significant viral respiratory pathogen of infants and is capable of causing both bronchiolitis and pneumonia. It is a particular risk to hospitalized infants as the virus is easily spread through close contact. The most vulnerable infants are those who suffer with either congenital heart disease or bronchopulmonary dysplasia who easily fall prey to pulmonary complications of infection. Strict environmental control and the use of protective clothing and eyewear should be implemented to decrease the nosocomial spread of RSV. Available diagnostic studies include viral isolation, fluorescent antibody stains, and enzyme immunoassays. Treatment of the disease is usually supportive but hospitalized patients frequently benefit from aerosolized ribavirin therapy. Hopefully, current vaccine trials will be successful and this pathogen will not only be treatable but will also be preventable.     

Instrumentation and patient characteristics that influence postoperative haemorrhage rates following tonsil and adenoid surgery

Objectives: To investigate the effect of the type instrumentation used and the age and gender characteristics of patients on postoperative haemorrhage rates following tonsil and adenoid surgery. Design: A retrospective analysis of 13 593 procedures was performed from The Patient Episode Database for Wales between 1 January 1999 and 31 March 2004. Setting: National health policy changes created four periods of different instrument usage (reusable, single‐use with diathermy, single‐use alone, specified single‐use with diathermy). These and the age and gender distribution of the patients were examined against four categories of postoperative haemorrhage. Main outcome measures: Postoperative haemorrhage rates were expressed as the number of complications per operations performed. Primary postoperative haemorrhage that occurred during the initial admission either required a return to theatre [R1] or was managed conservatively [N1]; secondary postoperative haemorrhage that required a return to hospital either returned to theatre [R2] or was managed conservatively [N2], were compared. Results: Primary haemorrhage with return to theatre doubled, from the baseline rate with reusable instruments, from 0.6% (CI 0.5–0.8) to 1.2% (CI 0.7–1.9) when single‐use instruments were introduced and remained high at 1.4% (CI 0.9–2.1) after the withdrawal of single‐use diathermy. This haemorrhage rate returned to the baseline rate (0.6% CI 0.3–1.0) when specified single‐use instruments were introduced. None of the other haemorrhage rates changed significantly throughout the four observation periods. Adenotonsillectomy and tonsillectomy patients have different age and gender patterns. In a univariate analysis, males over the age of 12 years were twice as likely to have haemorrhage with return to theatre than girls of the same age, 3.8% (CI 3.0–4.7) versus 1.7% (CI 1.4–2.1). Conclusions: A significant rise in serious postoperative primary haemorrhage but not secondary haemorrhage was seen following the initial introduction of single‐use instruments that reverted to baseline with the introduction of specified single‐use instruments. Diathermy does not appear to have affected the haemorrhage rates. There is a distinct age and gender pattern for tonsil and adenoid surgery and risk of postoperative haemorrhage. The use of arbitrary divisions of age may be misleading in studies that examine post‐tonsillectomy haemorrhage.