Suicidal ideation in people with tinnitus: a systematic review and meta-analysis

OBJECTIVE

Tinnitus is associated with a variety of cognitive, psychosocial and psychiatric disorders, and may contribute to suicidality. However, the prevalence of suicidal ideation (SI) in tinnitus populations has not previously been systematically reviewed.

METHOD

Medline, Embase and PsychInfo were searched in August 2020 to identify studies that assessed suicidal ideation in people aged 16 years and above with subjective tinnitus.

RESULTS

Six cross-sectional studies were included, representing 7192 tinnitus sufferers across 4 countries. The pooled prevalence of suicidal ideation in tinnitus populations was 20.6 per cent (95 per cent confidence interval, 10.8-30.3 per cent; I2 = 88 per cent). Two studies included a control population, in which the prevalence of suicidal ideation was significantly lower. The quality of included studies was variable.

CONCLUSION

It is not possible to arrive at any reasonable conclusion given the lack of quality studies, meaning the pooled prevalence should be interpreted very cautiously. Suicidal ideation may be more prevalent in tinnitus populations. Further large-scale epidemiological research investigating this relationship is needed, which may help psychiatric risk stratification.

Hippocampal subfield pathologic burden in Lewy body diseases vs. Alzheimer's disease

AIMS

Lewy body diseases (LBD) are characterized by alpha-synuclein (SYN) pathology, but comorbid Alzheimer's disease (AD) pathology is common and the relationship between these pathologies in microanatomic hippocampal subfields is understudied. Here we use digital histological methods to test the association between hippocampal SYN pathology and the distribution of tau and amyloid-beta (Aβ) pathology in LBD and contrast with AD subjects. We also correlate pathologic burden with antemortem episodic memory testing.

METHODS

Hippocampal sections from 49 autopsy-confirmed LBD cases, 30 with no/low AD copathology (LBD - AD) and 19 with moderate/severe AD copathology (LBD + AD), and 30 AD patients were stained for SYN, tau, and Aβ. Sections underwent digital histological analysis of subfield pathological burden which was correlated with antemortem memory testing.

RESULTS

LBD - AD and LBD + AD had similar severity and distribution of SYN pathology (P > 0.05), CA2/3 being the most affected subfield (P < 0.02). In LBD, SYN correlated with tau across subfields (R = 0.49, P < 0.001). Tau burden was higher in AD than LBD + AD (P < 0.001), CA1/subiculum and entorhinal cortex (ERC) being most affected regions (P = 0.04 to <0.01). However, tau pathology in LBD - AD was greatest in CA2/3, which was equivalent to LBD + AD. Aβ severity and distribution was similar between LBD + AD and AD. Total hippocampal tau and CA2/3 tau was inversely correlated with memory performance in LBD (R = -0.52, -0.69, P = 0.04, 0.009).

CONCLUSIONS

Our findings suggest that tau burden in hippocampal subfields may map closely with the distribution of SYN pathology in subfield CA2/3 in LBD diverging from traditional AD and contribute to episodic memory dysfunction in LBD.

Should adults with isolated serous otitis media be undergoing routine biopsies of the post-nasal space?

BACKGROUND

Serous otitis media is a recognised presentation of Eustachian tube dysfunction secondary to post-nasal space pathology. Post-nasal space biopsies are commonly taken in patients with isolated serous otitis media, despite normal nasendoscopy findings, without robust evidence for doing so. This study examined cases of unilateral serous otitis media with effusion in adults. It is the largest known retrospective study to investigate whether post-nasal space biopsies are indicated in non-endemic regions.

METHODS

A retrospective analysis was performed of 119 patients who underwent post-nasal space biopsy because of isolated serous otitis media, in a tertiary referral centre, from 2007 to 2017. Endoscopic examination and final histological report findings were reviewed.

RESULTS

Of the 119 patients identified, 6 (5.0 per cent) were found to have abnormal histology. In all six cases, suspicious clinical findings had been noted on nasendoscopic examination prior to biopsy.

CONCLUSION

Suspicious findings pre-operatively predict sinister pathology. Biopsies are not recommended in cases of adult serous otitis media with normal nasendoscopy findings if no other risk factors exist. A UK-wide retrospective study or prospective study over the next 10 years will help provide the evidence necessary to support this guidance.

COMQ-12 scores in adult patients without chronic middle ear disease

OBJECTIVE

To determine the COMQ-12 score in an adult population without active COM.

DESIGN

Analysis of COMQ-12 scores in participants without active COM.

SETTING

East Anglia, United Kingdom.

PARTICIPANTS

70 healthy volunteers recruited from two local hospitals.

MAIN OUTCOME MEASURES

COMQ-12.

RESULTS

The median COMQ-12 score overall was two and the modal score was 0 with 27 (39%) participants achieving this score.

CONCLUSION

We recommend that the 'normal' values defined in this study be seriously considered before contemplating intervention, especially when patients with low scores are considered for surgery.

A break-even analysis of major ear surgery

OBJECTIVES

To determine variables which affect cost and profit for major ear surgery and perform a break-even analysis.

DESIGN

Retrospective financial analysis.

SETTING

UK teaching hospital.

PARTICIPANTS

Patients who underwent major ear surgery under general anaesthesia performed by the senior author in main theatre over a 2-year period between dates of 07 September 2010 and 07 September 2012.

MAIN OUTCOME MEASURES

Income, cost and profit for each major ear patient spell. Variables that affect major ear surgery profitability.

RESULTS

Seventy-six patients met inclusion criteria. Wide variation in earnings, with a median net loss of £-1345.50 was observed. Income was relatively uniform across all patient spells; however, theatre time of major ear surgery at a cost of £953.24 per hour varied between patients and was the main determinant of cost and profit for the patient spell. Bivariate linear regression of earnings on theatre time identified 94% of variation in earnings was due to variation in theatre time (r = -0.969; P < 0.0001) and derived a break-even time for major ear surgery of 110.6 min. Theatre time was dependent on complexity of procedure and number of OPCS4 procedures performed, with a significant increase in theatre time when three or more procedures were performed during major ear surgery (P = 0.015).

CONCLUSION

For major ear surgery to either break-even or return a profit, total theatre time should not exceed 110 min and 36 s.

Current trends in tonsillitis and tonsillectomy

INTRODUCTION

The aim of this study was to assess tonsillitis and tonsillectomy trends, both from a local and national perspective.

METHODS

Retrospective analysis was carried out of tonsillitis admissions and tonsillectomy rates over a ten-year period in a university teaching hospital from 2003 to 2012.

RESULTS

Since 2003 tonsillitis admissions have increased locally by 118% in adults and 179% in children despite negligible changes in tonsillectomy rates. Similar trends have been observed nationally.

CONCLUSIONS

The findings of this study may be considered to be the result of current National Health Service policy. A reconsideration of agreed indications for tonsillectomy could potentially reduce hospital admissions of patients with tonsillitis in the long term.

Factors associated with injuries among first-division Rwandan female soccer players

BACKGROUND

Female soccer has grown tremendously in the last decade. Studies have suggested that female soccer players are more susceptible to injuries than their male counterparts, and their vulnerability is due mainly to intrinsic factors such as their anatomical and physiological structure.

OBJECTIVES

To establish factors associated with soccer injuries among first-division Rwandan female soccer players.

METHODS

In a descriptive cross-sectional study, self-administered questionnaires were used to investigate factors associated with injuries among soccer players.

RESULTS

Almost half of the 300 participants (45%) indicated having been injured in the three seasons prior to the study. More than half (52.6%) were recurrent injuries. The ankle was the most common body part injured. Intrinsic factors associated with injuries were age, excessive ankle range of motion, pre-menstrual symptoms, and previous injury (p-value < 0.05). Extrinsic factors associated with injuries were use of oral contraceptive pills, (OCP), competition level, use of protective equipment, and player's position.

CONCLUSIONS

The large number of recurring injuries was notable, emphasizing the importance of prevention strategies and access to adequately trained medical personnel as research has shown a significant reduction in the prevalence of recurring injuries after the introduction of effective prevention programmes.

The role of caffeine in otorhinolaryngology: guilty as charged?

Caffeine is implicated as causing or aggravating numerous otorhinolaryngological conditions, including tinnitus, Ménière's disease, laryngopharyngeal reflux, globus pharyngeus and dysphonia. We address caffeine's effects in such conditions and to determine whether such implications are founded. The defined search limits of data sources included human trials and either randomised control trials, meta-analyses, editorials, letters, clinical trials, case reports, comments or journal articles over the last 40 years. MEDLINE, EMBASE and CINAHL databases were searched using 'otorhinolaryngological diseases' and 'caffeine' as a duplicate filter. PubMed databases were searched using 'caffeine' in combination with 'tinnitus', 'Ménière's', 'vertigo', 'motion sickness', 'imbalance', 'vestibular migraine', 'voice', 'vocal hygiene', 'reflux', 'ear', 'nose', 'throat' and 'head neck cancer', respectively. Searches were not limited to the English language. MEDLINE, EMBASE and CINAHL database searches identified 417 papers. Of these, 200 abstracts were chosen for further scrutiny, following which 30 full manuscripts were chosen for full review. The PubMed database search identified 275 abstracts of which 33 were reviewed. Of the total 692 studies searched, 63 studies were reviewed and 36 were finally used. At present, there is little evidence in the literature to support the notion that caffeine causes or aggravates otorhinolaryngological conditions. In tinnitus, its withdrawal may actually worsen symptoms whereas in motion sickness, there is some clinical evidence for its benefit. More research is needed into the role caffeine plays in otorhinolaryngological conditions to allow clinicians to give informed advice to their patients.

Written consent - a prospective audit of practices for ENT patients

INTRODUCTION

It is very important that patients are given sufficient time to consider the implications of surgical treatment.

PATIENTS AND METHODS

The authors audited the consenting practices for patients undergoing surgery in a busy ENT unit.

RESULTS

The first cycle demonstrated that 15% of patients were providing written consent for surgery on the same day as their operation. Subsequent to a simple change in departmental policy, this was reduced to 2%. The medicolegal implications of this audit are discussed with reference to current recommendations.

CONCLUSIONS

This simple policy change not only protects the hospital trust from potential litigation but also provides a smooth journey for the patients from diagnosis to making the decision to operate and finally to undergoing surgery.

Evidence review and ENT-UK consensus report for the use of aminoglycoside-containing ear drops in the presence of an open middle ear

BACKGROUND AND OBJECTIVES OF REVIEW: The use of aminoglycoside drops in the presence of a perforation/grommet is still a common practice amongst the UK ENT community, in spite of theoretical risk of ototoxicity. Mindful of the need to produce clinical guidelines based on the best available evidence, it was the intention of the Clinical Audit and Practice Advisory Group of the British Association of Otolaryngologists - Head and Neck Surgeons (ENT-UK) to produce evidence-based guidelines. In the absence of good evidence, intentions were shifted towards producing consensus guidelines using validated methodology.

TYPE OF REVIEW

Literature review, review of international guidelines and consensus guidelines.

SEARCH STRATEGY

A MEDLINE literature search (1966 to August 2006) was conducted, using the following strategies: 'ototoxicity and drops', 'ototoxic and drops', 'vestibulotoxicity and drops', 'vestibulotoxic and drops', 'cochleotoxicity and drops', 'cochleotoxic and drops'. Foreign language articles were not excluded. RESULTS OF THE LITERATURE REVIEW: The inclusion of foreign language articles and manually searching the reference sections of identified articles revealed further evidence not considered in previous reviews on this subject. However, the available 'evidence' that does exist remains to be of poor quality, consisting of data from a number of case reports and small case series. Prospective studies into the ototoxic effects of aminoglycoside ear drops either support their use but lack power to statistically confirm this, or are performed in conditions that are not representative of normal clinical conditions.

EVALUATION METHOD

In the light of issues raised from the literature review, a questionnaire was produced. The questionnaire was initially completed by council members of the British Society of Otology, then revised and presented at a meeting of the British Society of Otology, where a consensus panel was formed.

CONCLUSIONS

ENT-UK recommends that when treating a patient with a discharging ear, in whom there is a perforation or patent grommet: if a topical aminoglycoside is used, this should only be in the presence of obvious infection. Topical aminoglycosides should be used for no longer than 2 weeks. The justification for using topical aminoglycosides should be explained to the patient. Baseline audiometry should be performed, if possible or practical, before treatment with topical aminoglycosides.

Endoscopic sinus surgery for 'sinus headache'

The relationship between sinus disease and headache is complicated. We undertook a prospective study to examine the success of endoscopic sinus surgery for the alleviation of headache in a defined group of individuals. In particular we wished to discover whether the presence of asthma, nasal polyposis and purulent rhinosinusitis indicated that surgical intervention achieved any greater relief of symptoms compared to those without these conditions. Overall we found a significant improvement in headache symptoms after endoscopic sinus surgery, but subgroup analysis of patients with or without asthma, nasal polyposis and purulent rhinosinusitis showed no differences between the groups.

Basal cell adenocarcinoma of the ethmoid sinuses

Basal cell adenocarcinoma is a rare and relatively recently characterised malignant salivary gland tumour. It accounts for 5 per cent of parotid gland tumours and 1 per cent of salivary gland malignancies. It is very rarely documented in anatomical sites other than the major salivary glands. Basal cell adenocarcinoma has only been described once before in the ethmoid sinus. We report a case of basal cell adenocarcinoma in the ethmoid sinus, extending into the right orbit and anterior cranial fossa. We describe the clinical aspects of the patient's management and detail the histopathological features of this very rare diagnosis.

Rapid thyrotoxicosis in anaplastic thyroid carcinoma

We present the case of a 71-year-old man with anaplastic thyroid cancer. On presentation, his thyroid function was normal, but he subsequently developed sudden, rapid thyrotoxicosis. Thyrotoxicosis in anaplastic thyroid carcinoma is very rare, but in all previously reported cases the patient was thyrotoxic at presentation. Our case is unusual as our patient presented euthyroid, and thyrotoxicosis developed subsequently. We challenge current ideas regarding the biochemical pathophysiology of rapid thyrotoxicosis in anaplastic thyroid carcinoma and provide an alternative explanation.

Tinnitus

Chronic idiopathic subjective tinnitus is a common condition affecting around one in ten of the population at any given time. For the majority of people it is an annoyance rather than a major health issue but for approximately 0.5 per cent of the population tinnitus interferes with their ability to pursue a normal life. Modern theories of the pathogenesis of the condition concentrate on the central auditory system although the peripheral auditory system can be a trigger or ignition site for tinnitus. Although a cure remains elusive there are several good treatment strategies based on psychological and neurophysiological models of tinnitus that promote habituation to the symptom.

Colonic carcinoma metastasis to the thyroid: a case of skip metastasis

Colonic carcinoma metastasis to the thyroid is rare. Here the authors present the case of an 81-year-old lady who presented with metastatic colonic adenocarcinoma in her thyroid gland. This case is unique as it is the first to demonstrate metastasis from the colon to the thyroid with no other site involvement. The use of cytokeratin immunohistochemical staining is reviewed along with the current perspectives on the concept of skip metastasis.

Hyperbaric oxygen as an adjuvant treatment for malignant otitis externa

BACKGROUND

Malignant, or necrotising, otitis externa is a potentially fatal infection of the external ear canal and surrounding soft tissue and bone. It may be complicated by involvement of cranial nerves, principally the facial nerves and the contents of the jugular foramen. It is an uncommon condition mainly found in the elderly or in diabetics.

OBJECTIVES

To assess the effectiveness of adjunctive hyperbaric oxygen treatment for malignant otitis externa.

SEARCH STRATEGY

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 4, 2003), MEDLINE (January 1966 to April 2004) and EMBASE (January 1985 to April 2004) with pre-specified terms. The date of the last search was 5th April 2004.

SELECTION CRITERIA

Randomised controlled trials, involving adults, undergoing hyperbaric oxygen therapy in malignant otitis externa.

DATA COLLECTION AND ANALYSIS

No identified articles described randomised controlled trials of hyperbaric oxygen therapy in the treatment of malignant otitis externa.

MAIN RESULTS

Due to the lack of data no results could be presented.

AUTHORS' CONCLUSIONS

No clear evidence exists to demonstrate the efficacy of hyperbaric oxygen therapy when compared to treatment with antibiotics and/or surgery. No data were found to compare rates of complication between the different treatment modalities. Further research is required.

Sudden unilateral deafness after bilateral knee replacement

This case report presents profound unremitting hearing loss in a 76-year-old man after having a bilateral knee replacement. There have been no other cases of permanent post-operative deafness after joint replacement in the world literature. Sudden post-operative deafness is rare. We conclude that this man's deafness is due to a fat embolism in his auditory circulation.

Injury surveillance in taekwondo and judo during physiotherapy coverage of the seventh all Africa Games

Objective: To obtain data relating to the incidence of injuries sustained during taekwondo and judo competitions at the 7th All Africa Games.Methods: Prospective recording of injuries sustained by athletes who sought physiotherapy services at the games. Details of type of injury, injury sites and injury severity were obtained.Results: Seventy athletes out of 390 participants reported injuries. The overall injury risk ratio was 0.18. Injuries reported were strains/sprains (65,6%), bruises/contusions (16.1%) and dislocations or fractures (12,9%). The upper limbs were more commonly injured. Of the injuries sustained, approximately 18%, 69% and 13% were respectively classified as mild, moderate and severe injuries.Conclusions: The high incidence of moderate to severe injuries highlights the need for injury prevention programs and the presence of medical staff at major tournaments in order to make early diagnosis and appropriate intervention.

Employee retaliation: the neglected consequence of poor leader-member exchange relations

Although the beneficial effects of high-quality leader-member exchange (LMX) relationships have been well-documented in the leadership literature, much less is known about the potentially damaging effects of poor exchange relationships. Using 150 intact leader-member dyads, the authors investigated the relationship between LMX and supervisors' reports of employee retaliation behavior, performance, and citizenship. Results indicated that performance and citizenship were positively related to LMX. More important, LMX was negatively correlated with retaliation behavior. Supervisors reported that subordinates in poor exchange relationships were more likely to engage in retaliation against the organization than subordinates in high-quality relationships. The lack of a high-quality exchange relationship was, therefore, not just associated with the absence of positive consequences but also led to reports of potentially disruptive behaviors.

Job context, selection decision outcome, and the perceived fairness of selection tests: biodata as an illustrative case

S. W. Gilliland (1993) has proposed a model of perceived selection system fairness to help understand applicants' prehire and posthire behavior. The present study aimed to verify and extend his framework by investigating the role of job context in the formation of fairness perceptions of biodata. A sample of 255 students (108 men, 147 women) completed an operational biodata instrument, believing that it would be used to hire persons for either international, local, or unspecified entry-level managerial positions. Participants were then presented with outcome information (selected or rejected for further consideration). Consistent support was found for the research hypotheses derived from the Gilliland model. Participants' perceptions of the fairness and job relatedness of biodata were affected by the selection context and decision outcome. The importance of considering selection context in assessments of perceived test fairness is discussed.

Utilization management affects health care practices at Walter Reed Army Medical Center: analytical methods applied to decrease length of stay and assign appropriate level of care

The Department of Defense has embraced utilization management (UM) as an important tool to control and possibly decrease medical costs. Budgetary withholds have been taken by the Office of the Assistant Secretary of Defense (Health Affairs) to encourage the military services to implement UM programs. In response, Walter Reed Army Medical Center implemented a UM program along with other initiatives to effect changes in the delivery of inpatient care. This paper describes this UM program and other organizational initiatives, such as the introduction of new levels of care in an attempt to effect reductions in length of stay and unnecessary admissions. We demonstrate the use of a diversity of databases and analytical methods to quantify improved utilization and management of resources. The initiatives described significantly reduced hospital length of stay and inappropriate inpatient days. Without solid command and clinical leadership support and empowerment of the professional staffs, these significant changes and improvements could not have occurred.

Telomerase activation in human fibroblasts during escape from crisis

The immortalization of human diploid fibroblasts requires the circumvention of both the senescence (M1) and crisis (M2) mechanisms of growth control. Cells expressing the SV40 T antigen virtually always bypass senescence, but only rarely escape crisis. The low frequency of this latter event indicates that cellular mutations are necessary to escape crisis. Thirteen subpopulations of T antigen-expressing human fibroblasts were cultured into crisis. Colonies that appeared to resume growth were assayed for telomerase activity, telomere maintenance, and the immortal phenotype. Our results show that 33 of 35 colonies were telomerase negative and were not immortal. Two colonies were telomerase positive when assayed in the first approximately 15 population doublings after crisis. The first was strongly positive, maintained telomeres at a stable short length, and was later determined to be immortal. The second initially had a weak telomerase signal, grew extremely slowly, and when examined had greatly elongated telomeres consistent with the ALT (alternative lengthening of telomeres) mechanism of telomere maintenance. These cells eventually grew faster and were later determined to be immortal. Additionally, two subpopulations had initially weak and later strong telomerase activity and the cells never entered a defined crisis period. We observed a perfect correlation between telomere maintenance and escape from crisis, supporting the hypothesis that the lack of stable telomeres causes crisis and that the ability to maintain telomeres abrogates crisis.

Evaluating sex discrimination claims: the mediating role of attributions

The role of attributions in judgments of sex discrimination was examined in 2 laboratory experiments. In Study 1, participants read 1 of 12 brief scenarios in which limited information about the strength of evidence against a fictitious corporation and occupational gender stereotype were manipulated. Results suggested that attributions mediated the relationships between participants' gender, strength of evidence, and discrimination judgments. In Study 2, participants were provided with 1 of 3 detailed, typewritten summaries of evidence presented in a sex discrimination trial. Results indicated that jurors' gender was again significantly related to attributions and to sex discrimination judgments even in the face of substantial objective information related to the case. The variance in observers' judgments associated with gender, however, appeared to be greatest when information about the organization's guilt or innocence was equivocal.

Reproductive bionomics of the soft tick, Ornithodoros turicata (Acari: Argasidae)

The effects of different temperatures and relative humidities (RHs) were tested on various reproductive parameters of Ornithodoros turicata, an argasid tick that inhabits gopher tortoise burrows in Florida, USA. The pre-oviposition, oviposition and incubation periods of the ticks decreased as temperature increased. These periods were also affected by the RH. The number of eggs oviposited was affected significantly by the combined effect of temperature and RH. Fewer eggs were laid by ticks in the 24 degrees C regimes and the 27 degrees C/95% RH regime compared to those in the other temperature/RH groups. There was an inverse relationship between the number of eggs oviposited and the percentage of hatched larvae that was correlated with the temperature and RH. Ticks reared at 27 degrees C/90% RH and 30 degrees C/90% RH laid more eggs than those reared in the other combinations of temperature and humidity but fewer larvae hatched from these eggs. The reproductive fitness index (RFI) values were highest in females held in the 24 degrees C groups and the 30 degrees C/95% RH group, although significantly more larvae hatched at the lower temperatures. The optimum reproductive conditions for O. turicata under laboratory conditions appear to be 24 degrees C and 90-95% RH. While mating occurred at all temperatures, none of the females laid eggs at 22 degrees C. The ticks may move preferentially to low temperatures when not feeding to remain above the critical equilibrium humidity and/or below the critical metabolic level necessary for prolonged survival. However, most female ticks oviposited after 45 days when moved to 27 degrees C/95% RH. Ornithodoros turicata females may have a limited capability to delay oviposition until an optimal microenvironment for egg deposition can be located in the burrow.

Photoperiodic response in the soft tick, Ornithodoros turicata

The effects of photoperiod on the feeding, development and quiescent behavior of the burrow-dwelling soft tick, Ornithodoros turicata (Dugès) were investigated. Ticks were assigned randomly to either continuous darkness (DD), a short-day photoperiod (L:D 10:14), a long-day photoperiod (L:D 14:10) or constant light (LL). Ticks reared under constant light succumbed to much higher mortality than those reared under the other conditions. However, photoperiod did not induce quiescent behavior in O. turicata; the ticks were active and fed regularly throughout the study. Also, ticks reared in continuous darkness developed more slowly than those reared under short-day or long-day conditions. In contrast, pre-oviposition period was significantly longer for ticks reared in long-day conditions. Egg-hatch success was significantly higher for ticks reared in continuous darkness than for those reared under the photoperiods. The stage-specific effects of photoperiod on O. turicata are adaptive; these ticks very likely utilize photoperiod information to predict seasonal conditions.

Behavioral and emotional problems among Chinese and American children: parent and teacher reports for ages 6 to 13

This study compared behavioral and emotional problems reported by parents and teachers in Chinese urban and rural samples and demographically similar American samples. Parents of 469 6-to-13-year-old children of each nationality completed the Child Behavior Checklist (CBCL). Teachers completed the Teacher's Report Form (TRF). Cross-cultural differences were generally modest in magnitude. Chinese children scored higher on TRF Delinquent Behavior and Anxious/Depressed syndromes, and on Internalizing. American children scored higher on CBCL Aggressive Behavior and TRF Attention Problems syndromes. Boys exhibited more externalizing behaviors across both cultures. The mean correlation between parent and teacher ratings was .36 in the Chinese sample and .29 in the American sample, a nonsignificant difference. Findings indicate considerable similarity between problems reported for children in very different societies.

Respiratory metabolism of the soft tick, Ornithodoros turicata (Dugès)

The rate of oxygen consumption was investigated in fed larval, nymphal and adult Ornithodoros turicata ticks and in starved nymphal and adult ticks. Oxygen consumption rate of fed adult ticks increased with increasing temperature. The metabolic rate of adult ticks was affected by starvation whereby starved adult ticks showed a significantly lower oxygen consumption than their fed counterparts. The oxygen consumption rate of fed female ticks was significantly higher than that of fed males but, there was no significant difference between the oxygen consumption rates of starved female versus starved male ticks. Oxygen consumption of fed larvae was significantly greater than those of fed first through third instar nymphs. Fed and starved nymphal ticks as well as fed adult ticks ventilated continuously. In contrast, starved adults ventilated discontinuously. The ability to reduce metabolic rate, plus the capability to ventilate discontinuously allow O. turicata adults to cope with prolonged starvation.

Child therapy training: closing gaps with research and practice

Previous surveys have revealed troubling gaps between training and research and practice in psychotherapy. In this study, a selective review of research on child therapy and therapy training was conducted in order to address questions concerning who, what, how, and when to train child therapists. This review revealed substantial gaps in our current empirical knowledge about child therapy training, but some promising leads as well. A science-based approach to child therapy training is advocated.

Child therapy training: Closing gaps with research and practice

Previous surveys have revealed troubling gaps between training and research and practice in psychotherapy. In this study, a selective review of research on child therapy and therapy training was conducted in order to address questions concerning who, what, how, and when to train child therapists. This review revealed substantial gaps in our current empirical knowledge about child therapy training, but some promising leads as well. A science-based approach to child therapy training is advocated.

Worksite stress management interventions

Despite the general agreement that stress plays a role in everyday life, there continues to be substantial controversy about how stress can be managed at the worksite. During the last decade, our knowledge of stress management interventions has increased substantially. Despite this improvement, deficiencies in the literature exist. In this article, we offer a framework that may be used for viewing organizational stress interventions, briefly review some of the stress management intervention literature in the context of this framework, and identify future needs that may be particularly appropriate for organizational psychologists to address.

Worksite stress management interventions

Despite the general agreement that stress plays a role in everyday life, there continues to be substantial controversy about how stress can be managed at the worksite. During the last decade, our knowledge of stress management interventions has increased substantially. Despite this improvement, deficiencies in the literature exist. In this article, we offer a framework that may be used for viewing organizational stress interventions, briefly review some of the stress management intervention literature in the context of this framework, and identify future needs that may be particularly appropriate for organizational psychologists to address.

Goal utility, task satisfaction, and the self-appraisal hypothesis of type A behavior

Strube's (1987) self-appraisal model of Type A behavior suggests that externally mediated performance goals that are useful for assessing task-related competencies will possess greater utility and be more satisfying to Type A persons than to Type B persons. In contrast, because Type Bs may have an aversion to competency verifications, they should be more satisfied than Type As when goals are uninformative about task-related competencies. The 102 undergraduate Ss performed either a word puzzle or proofreading task under 1 of 4 goal conditions that varied in terms of the goal's instrumentality for assessing competencies and for obtaining a financial incentive. Results are generally consistent with this prediction, thereby providing verification for one of the more basic propositions derived from the self-appraisal model.

Goal utility, task satisfaction, and the self-appraisal hypothesis of Type A behavior

Strube's (1987) self-appraisal model of Type A behavior suggests that externally mediated performance goals that are useful for assessing task-related competencies will possess greater utility and be more satisfying to Type A persons than to Type B persons. In contrast, because Type Bs may have an aversion to competency verifications, they should be more satisfied than Type As when goals are uninformative about task-related competencies. The 102 undergraduate Ss performed either a word puzzle or proofreading task under 1 of 4 goal conditions that varied in terms of the goal's instrumentality for assessing competencies and for obtaining a financial incentive. Results are generally consistent with this prediction, thereby providing verification for one of the more basic propositions derived from the self-appraisal model.

The use of tools by children with haemophilia

Eight mothers with their 3.1- to 5.7-year-old children with haemophilia and eight control mothers with their children were videotaped while playing three games using a knife, a pair of scissors and a wooden hammer, and two games without tools. Although the children with haemophilia were less proficient, took less care, and were more excited when handling sharp tools than the control children, their mothers did not correct their children when they used a knife incompetently and carelessly. It is recommended that counselling should emphasize the deliberate preparation and training of the haemophilic child in the use of tools which are potentially dangerous.