Adolescent medicine (Philadelphia, Pa.)最新文献

Asthma is the most common chronic disease in adolescents. Despite advances in the understanding of this disease and the availability of more specific treatment, the prevalence of asthma and its morbidity and mortality are increasing. This trend is especially prominent and worrisome in the age group that includes adolescents and young adults. Possible factors contributing to this significant problem in adolescents include a lack of knowledge about the disease, delays in seeking medical attention due to denial of symptoms or overuse of acute relief medication that mask the progression of the inflammation, and various psychological problems such as low self-esteem or depression. These factors, in addition to the typical developmental behaviors recognized in adolescence, contribute to the complexity of asthma management in this age group. This article comprehensively reviews the pathophysiology and precipitating factors of asthma as well as all aspects of medical care of affected individuals, including monitoring and self-care.

This article reviews pulmonary function tests (quantitative measurements of physiologic functioning of lungs, chest wall, and respiratory muscles) as valuable tools for the diagnosis and management of chronic respiratory disease in adolescents. Advances in technology have made pulmonary function testing more available and, for some tests, easier to perform. Pulmonary function evaluation is used for diagnosis of pulmonary disease. Testing will identify abnormal physiologic processes that result in obstructive or restrictive pulmonary disease and, together with a complete history, physical examination, and other tests, help to determine the specific etiology. Pulmonary function measurement may be used to manage a patientís disease over time. Quantitative evaluation of the response to many specific therapies, such as asthma medications and environmental control, can only be achieved by measuring pulmonary function. Monitoring pulmonary toxicity of medications, such as chemotherapeutic agents, is also done by measuring pulmonary function. In many patients with chronic pulmonary disease, such as cystic fibrosis, the pulmonary function laboratory can be used to assess the patient's physiologic limitation.

Gastroesophageal reflux (GER) is relatively common in adolescence. The severity of gastrointestinal symptoms associated with gastroesophageal reflux varies from an occasional burp to persistent emesis. Evaluation of most of these patients reveals no definable anatomic, metabolic, infectious, or neurologic etiology. The clinical determination of a cause-and-effect relationship between GER and other disorders, including associated respiratory disease, is often difficult and must be approached with considerable caution. Tests that merely document the presence of GER add little to the diagnosis. The adolescent with GER often has persistent symptoms of esophagitis that lead to appropriate intervention. Understanding the capabilities and limitations of the various diagnostic maneuvers available to assess GER is important to avoid subjecting these patients to invasive, costly, and inappropriate testing. This article includes a general discussion of physiology, diagnostic evaluation, and therapy of GER, followed by a review of respiratory and other complications.

Advances in knowledge and medical science have resulted in an increased life span and quality of life of patients with cystic fibrosis (CF). The median age of survival for CF patients is 32.3 years of age and patients 18 years of age or older now constitute one third of the total patients with CF. Because of these advances, a new patient population has emerged: the adolescents and young adults with CF. Adolescence is normally a time of great cognitive, social and developmental changes. Adolescents with CF not only have to deal with the normal changes expected, but also have to deal with the transition of assuming responsibility for their care from the parents and transitioning their care from a pediatric to an adult care team. Moreover, many of these young adults have to deal with the impact of the progressive deterioration of their CF disease. This review discusses issues of significance to this emerging patient population, including medical care, issues of disability, and psychosocial and other medical conditions associated with an increased life expectancy.

Complementary and alternative therapies are a growing part of our nation's health care and culture. The numbers of people using such forms of treatment are increasing, especially for patients with chronic diseases. There are an estimated 15 million prescription drug users nationwide who also use herbal medication. At the same time, asthma has increased in prevalence and severity, despite the increase in therapeutic options. Asthma patients and their parents may be interested in complementary medicine because of the long-term nature of their illness and perceived toxicities of therapies such as inhaled corticosteroids. Many alternative nutritional therapies are available in stores without a prescription, and this may also appeal to an adolescent's desire for independence. This article examines the phenomenon of alternative medicine, the possible reasons for its rising prevalence, and who may be using it. The emergence of increasing numbers of patients with asthma and the pathophysiology of this disease is discussed briefly. Finally, individual therapies with their proposed mechanism of action and known studies related to their use in asthma are examined.

Adolescence is often a time of emotional upheaval and it is no wonder that many respiratory diseases with a psychosomatic component find their origins or time of exacerbation during this time of life. Adolescents who present with unexplained respiratory diseases may also suffer from some form of psychosomatic illness. Recognition of the psychological contributions to symptoms related to the respiratory tract is essential for practitioners who care for adolescents. This article includes some of the more common respiratory or related conditions that have psychological etiologies or components and are encountered in the adolescent patient. These include psychogenic cough, sighing dyspnea, hyperventilation, vocal cord dysfunction, and emotional state as a trigger for asthma. This review provides a general discussion of these conditions and an overview of issues related to psychological/psychiatric evaluation and the reluctance of patients and their parents to access mental health treatment.

Pulmonary compromise can result from primarily peripheral or central neuropathic disease (including neurodegenerative diseases) or diseases of the muscle or neuromuscular junction. Some diseases present with a combination of nervous system and muscle tissue involvement (due to secondary changes like atrophy or primary pathology, as in mitochondrial diseases). While clinically different in pathophysiology, these diseases may progress to produce and ìshareî common pulmonary pathology by the time the patient reaches the adolescent years. This article presents a review of the categories of neurologic disease that may lead to respiratory compromise, followed by thorough description of the pulmonary complications that can result from these types of diseases. Finally, a review of currently accepted treatment options that may aid in improving the quality of life of these patients is offered.

Pulmonary infections in the immunocompromised adolescent are important causes of significant morbidity and mortality. Advances in the fields of chemotherapy, organ transplantation, and use of corticosteroid and immunosuppressive therapies have led to significant improvement in the outcome of patients with malignancy and a variety of other disorders. HIV infection has become a major additional cause of immune suppression. In turn, physicians are encountering growing numbers of patients with an impaired immune system presenting with respiratory and other infections. This article presents a brief review of defense mechanisms in the respiratory tract, selected conditions leading to impaired immune responses in the adolescent, specific pulmonary pathogens and their evaluation in the immunocompromised adolescent, and general considerations of the management of pulmonary infections in the immunocompromised adolescent. Infections of the upper respiratory tract and pulmonary infections seen in adolescents with cystic fibrosis are not discussed.

The 20th century brought incredible changes throughout the world and one of the most far-reaching results has been in the arena of public health, which, according to the CDC, means that people now live an average of 30 years longer. Despite these achievements, there are other diseases and health problems to handle. The expansion of world travel has led to increased chances for acquiring rare or exotic diseases. The shrinking world also means that people from other countries arriving in the U.S. bring the risk of new and re-emerging strains of old pathogens and other health problems. The ease of accessibility of antibacterial products means that their overuse and misuse continues to add to the ever-growing problem of drug-resistant bacteria. Gaps in adolescent immunization schedules and adolescent risk-taking behaviors are still at alarming levels. Large percentages of adolescents are either underinsured or uninsured, leading to delays in receiving effective and complete health care. Physicians have the chance to influence adolescent behaviors, and play and important role in helping to reduce these risks through informed decision making for these adolescents.

Adolescent medicine physicians are frequently the initial contact for adolescents newly arriving in the U.S. and it is important that they recognize the needs of their patients. The adolescent immigrant may be encountered in a school-based health setting, private practice, community health center, or other health care settings. This article begins with a review of the categories of immigrants comprising the adolescent population. It gives an extensive review of tuberculosis among Mexican-American adolescents, detailing history, epidemiology, diagnosis, social factors, and treatment modalities. It further delineates the impact of Mexican tuberculosis control strategies on the practice of medicine in the U.S., and outlines preventive, diagnostic, and therapeutic strategies that should be followed in the adolescent immigrant. This article also reviews viral hepatitis in its multiple forms and its impact on the adolescent immigrant. It concludes by delineating prevention practices required for the adolescent immigrant and summarizes the interventions an initial contact physician should undertake upon encountering such adolescents.