Pediatrician最新文献

In countries where it has been studied, between 10 and 15% of adolescents appear to have an emotional disorder, and an additional 5-10% have significant emotional symptomatology. Despite this prevalence, pediatricians appear poorly trained to identify children with emotional and behavioral problems. This paper focuses on schizophrenia, affective and chronic stress disorders. Schizophrenia in adolescence has a reported prevalence ranging from 0.9/10,000 hospital admissions for adolescents in Great Britain to 0.4% of cases in a university setting in the United States. For affective disorders, studies have placed the prevalence rates at nearly 3% for boys and almost double that for girls. A much larger percent of adolescents have significant depressive symptomatology. Many youths grow up in chronically stressful environments. This paper reviews the prevalence as well as the major diagnostic and prognostic issues, for the leading chronic mental health disorders of youth.

Superficial fungal infections are problems frequently encountered by the pediatrician. Presentation can be quite varied as causative organisms, environment, patient characteristics and secondary infections can significantly alter the clinical picture. A brief review of these common infections with an approach to examination and diagnosis is presented, as well as updated treatment recommendations.

When broader aspects of health are considered especially when assessing the life of the disabled it becomes necessary to reach beyond physical measurements to more dynamic aspects including the individual's other resources and demands. In such a context issues of quality of life are important. Quality of life is here defined as a term describing the total existence of an individual or a group and is operationalized in three life spheres: external conditions, interpersonal conditions and personal psychological conditions. National samples of youths aged 12-18 years with cystic fibrosis and myelomeningocele are compared to a reference group of normal youths in the five Nordic countries. The study was based on a mailed questionnaire. The results show that the disabled groups had equal external conditions as their peers while they rated lower on the interpersonal and personal levels. This indicates that the Nordic countries have succeeded in providing a good material support for families with handicapped youths. The fact that these families are also more satisfied with the different life spheres means that both objective and subjective needs are met. The social networks and personal psychological conditions, though, proved to be less sufficient and there is still a lot to be done to give handicapped youngsters a full life.

Linear growth and final adult stature in survivors of childhood cancer may be affected adversely by the disease itself as well as by the treatments utilized. The endocrine causes of impaired growth, which include growth hormone deficiency, primary thyroid dysfunction, and premature sexual maturation, are generally the consequence of radiation therapy. Growth failure is most prominent following craniospinal irradiation for brain tumors and total body irradiation for bone marrow transplantation. Pubertal development in both males and females is generally unaffected by chemotherapy. Leydig cell failure is seen most often after direct testicular irradiation with doses greater than 20 Gy. Ovarian failure is seen commonly following abdominal, craniospinal and total body irradiation.

As the treatment of childhood cancer continues to improve, the number of survivors at risk for late effects rises. One such late effect is the risk of second malignant neoplasms. Large multicenter registries have been established to accumulate data on the incidence of second cancers. Relative risks and cumulative risks can now be calculated for retinoblastoma, Wilm's tumor and Hodgkin's disease. Early data are now available for leukemia, sarcomas and central nervous system tumors. Genetic cancer syndromes, radiation therapy and treatment with chemotherapeutic agents are known risk factors for second malignant neoplasms in survivors of childhood cancer.

There is a paucity of information on the process of transition from pediatric to adult services for young people with chronic disease/disability. Adolescents and young adults have differing needs from children and older adults, and ideally transition services should take these needs into account. Diabetes provides a useful model to examine the process of transition and to seek views of young people. A study of 70 young adults with diabetes is reported. It is suggested that the ideal time for a transfer from a pediatric to an adult service is between 17 and 20 years, but this will vary considerably depending on developmental needs. Specialist physicians remain the most important professionals in the view of the young diabetics, who valued the physician as one to whom they can relate and get to know well by seeing regularly. The role of educational programs and help with psychosocial problems at this age are discussed in the light of conflicting evidence in the literature.

Late sequelae of bone marrow transplantation (BMT) include growth impairment, gonadal failure, cataract formation, neurological and pulmonary complications, nephropathy, hepatic dysfunction, development of secondary malignancies, chronic graft-vs.-host disease, and psychosocial stress. Lifelong follow-up after BMT is required to detect late sequelae.

Five community-based services in Israel for disabled adolescents are described. Three of them are day centers and two are afternoon clubs. They provide rehabilitation resources for teenagers with various kinds of disabilities including cerebral palsy, mental retardation, blindness, deafness and emotional handicaps. These services are analyzed and discussed with regard to addressing the major needs of adolescents with disabilities, with the aim of achieving an optimal degree of independence and preparation for normalized life. The programs include resources such as vocational rehabilitation, independent living education, recreational activities, social skills training, sexuality education in addition to creating opportunities to mix and socialize with nondisabled youth. The function of pediatric and adolescent medicine physicians in such services is emphasized as imperative in providing a comprehensive rehabilitation program for youth with disabilities.

A wide variety of clinical expressions of the acquired immunodeficiency syndrome (AIDS) has been apparent from the earliest case reports in adult patients and pediatric patients. Both human immunodeficiency virus (HIV) infection and AIDS in children are associated with an increased prevalence of several dermatologic manifestations. In this article we present a review of the recent literature describing the cutaneous manifestations of pediatric AIDS. The cutaneous manifestations of AIDS in children can be divided into three categories: (1) neoplastic manifestations; (2) viral, bacterial and fungal manifestations, and (3) vascular lesions and other manifestations. Pediatricians as well as dermatologists may be the first physicians to recognize and to treat the clinical manifestations of AIDS.

Tissue complications of radiation therapy depend on the interplay of therapy, patient and tumor factors. Acute local effects result from parenchymal cell hypoplasia. Chronic damage is caused by both injury to parenchymal cells and to the underlying vasculature. No body tissue or system is immune to damage from radiation therapy, but many effects are dose-dependent. Many of the toxicities can currently be avoided by the optimal use of this important cancer therapy.