A 19-year-old girl was admitted to our hospital with nausea, vomiting, hiccups, constipation and syncope. After hiccups or vomiting sinus arrest developed and lasted more than 5-8 seconds. She lost consciousness every one hour. Based on an electrocardiographic diagnosis of sick sinus syndrome (SSS), a temporary pacemaker was implanted. The next day, although her syncope and bradycardia disappeared, she had orthostatic tachycardia of over 120 beats/minute and swelling of the legs, which led to a diagnosis of postural orthostatic tachycardia syndrome (POTS). Neurologically, she showed the right-sided tongue deviation and parasympathetic system disorders revealed by coefficient of variation of R-R interval (CV_R-R), the Achner eye-ball pressure test, the valsalva ratio, and the head-up-tilt test. Brain MRI disclosed a small hyperintense lesion on a T2-weighted image with gadolinium enhancement in the right dorsal medulla including the hypoglottis nucleus and the posterior nucleus of vagus. After steroid pulse therapy (methyl prednisolone 1 g/day×3 days, 5 times) was administered, this lesion became smaller and finally disappeared. Before the lesion disappeared, she was able to begin rehabilitation by wearing elastic stockings and treatment with midodrine hydrochloride. The following year, she developed other MRI-proven brain lesions, suggestive of demyelination. Such a spinal and temporal distribution of lesions led to a diagnosis of multiple sclerosis (MS). A case of POTS caused by MS has not been reported previously, however, MS often affects the medullary paraventricular regions associated with autonomic failures. Autonomic failures often prevent patients from experiencing early rehabilitations. We should promptly give symptomatic treatment against autonomic failures, which leads to good patient recovery not only in patient vitality but also functionality.

OBJECTIVETo examine the effectiveness of a drug abuse prevention program focusing on social influences for drug education classes in high school.

METHODSThe social influence program in the experimental group used role-playing led by a pharmacist, a police officer and a teacher. The intervention evaluation used a quasi-experimental design. The subjects were first-year students from 10 high schools assigned to the experimental group (6 schools, 828 students) and the control group (4 schools, 408 students). In the control group, a pharmacist used a conventional information program in a lecture format.

RESULTSRegarding knowledge about drug abuse, in both the experimental and control groups, and for both males and females, a long-term effect was observed immediately after the program and lasted up to 15 months. For three other measures, attitudes toward drug abuse problem, self-efficacy regarding drug abuse prevention, and perception of social support for preventing drug abuse, a short-term effect was generally observed in the experimental group beginning immediately after the program and lasting for 3 months. A long-term effect was evident in high-risk students with positive opinions regarding drugs. In the control group and for both males and females, although an effect was generally evident immediately after the program, neither a short-nor a long-term effect was observed in males, suggesting the difficulty in achieving lasting effects.

CONCLUSIONSThe social influence program in the experimental group showed remarkable effectiveness. Thus, the program may be useful for preventing drug abuse among high school students in Japan.