Adolescent medicine (Philadelphia, Pa.)最新文献

Central nervous system infections in adolescents range from the diffuse cerebritis of encephalitis to the regional inflammation of meningitis, and very focal disease of brain abscess. Clinical presentations reflect this wide spectrum, with encephalitis primarily characterized by altered mental status, meningitis by fever, headache, and neck stiffness, and brain abscess manifesting localizing findings. Encephalitis and viral meningitis are frequently caused by the seasonal enteroviruses and arboviruses, while most adolescent bacterial meningitis is due to Neisseria meningitidis and Streptococcus pneumoniae. The microbiology of brain abscess reflects underlying host risk factors. Gram-positive cocci are seen in patients with congenital heart disease, while respiratory flora including anaerobes are associated with sinus or otic disease. Lumbar puncture to characterize and culture the CSF remains the optimal test for the diagnosis and management of encephalitis and meningitis, while CT-guided needle biopsy may be both diagnostic and therapeutic for brain abscesses. New diagnostic tests include the use of PCR. A variety of safe and effective treatment regimens exists for most bacterial infections as well as for some herpesvirus infections. New vaccines are under study to further control bacterial meningitis.

The dramatic improvements achieved in the control of vaccine-preventable diseases in children have only been shared partially by adolescents and young adults, as today several million adolescents are not receiving the full complement of vaccines recommended by the Advisory Committee on Immunization Practices (ACIP). This article discusses the reasons for this problem and the tools to bridge this gap. In particular, medical societies and the Centers for Disease Control and Prevention (CDC) recommend a close assessment of the adolescentís immunization status between 11 and 12 years of age, inclusion of school immunization, and providing missing immunizations at any opportunity. The article also addresses other vaccines recommended for groups of adolescents with special needs, reporting information, and provides an update on the vaccines of the future.

Nearly three-fourths of deaths among American adolescents and young adults result from only four causes: motor vehicle accidents, other unintentional injuries, homicide, and suicide. Thirty percent of those deaths result from motor vehicle accidents, the number one cause of death among adolescents. A number of factors that influence the morbidity and mortality are associated with driving. Compared to other countries, it is easier for American adolescent to obtain a relatively inexpensive license and gain access to a car. For the young driver, adolescent development and increased risk taking, inexperience, dangerous driving behavior, and alcohol-related factors are of special significance. In this article, we review recent crash statistics as well as effectiveness of various preventive measures, including driver education, graduated licensing, alcohol-related measures, and vehicle-related factors. Graduated licensing and alcohol-related measures have been the most effective measures so far.

The last decade has been characterized by an increasing focus on the question: "What works to promote and protect the health and well-being of adolescents?" This question is raised in multiple arenas, from pregnancy prevention to substance use and violence prevention, as well as for broad populations of young people. An accumulating body of evidence underscores the effectiveness of a dual strategy of enhancing protective factors and promoting healthy youth development while seeking to reduce risk factors in the lives of youth. Building upon research frameworks of the 1970s and 1980s that emphasized the concepts of resiliency, risk, vulnerability, and protective factors, this research provides insights into best practices when the weight of evidence is sufficiently developed, as well as ideas about "best bets" when strategies show particular promise. Critical to the ongoing advancement of adolescent health is a powerful, evidence-based response to the argument that "nothing can be done" for high-risk youth. This perspective must be superseded by practitioners, researchers, and advocates who demonstrate, at multiple points of intervention, that the dual approach of risk reduction and enhancement of protective factors constitutes an effective strategy for adolescent health promotion.

Substance abuse continues to be a major adolescent health risk. Despite encouraging trends toward decreased drug use in the late 1980s, an increase in use occurred in the early 1990s and only now is beginning to level off. A brief update on the status of the most commonly abused substances is provided. A discussion of current research is given in support of viewing drug addiction as a medical condition, i.e., a "brain disease." Reasons are suggested to explain why adolescents use and abuse drugs and why trends occur in their use. Two aspects of diagnosis are reviewed: psychiatric and medical comorbidity and drug screening and laboratory assessment of the adolescent. Prevention and early intervention are presented with an emphasis on drug education, behavioral wellness, family communication, doctor-patient discussion and assessment, and referral. Commentary is made on the ethics of care; issues of confidentiality and the right to privacy with regard to drug testing and sharing of information are explored. A review of various policy statements of the American Academy of Pediatrics and other medical organizations is presented.

Violence is a form of aggressive behavior that has a debilitating effect on the optimal growth and development of our youth. Violence pervades the lives of a significant proportion of all adolescents in the U.S., but has a particularly devastating impact on males and minority youth. Adolescent males are more likely to be victimizers and victims of violence and aggression, except in cases of sexual victimization and suicide attempts. For all adolescents, exposure to violence at home, school, or in the community is associated with aggression later in life, the development of supportive attitudes toward aggression and violence, psychological distress, school absenteeism, academic dysfunction, and subsequent injury. Violence has historical, cultural, and societal roots in our world. Until and unless we begin to understand where violence fits on the continuum of aggressive behavior and until we address the politics of violence, we will remain conflicted and paralyzed by the dangers our youth face. By understanding the social, political, and developmental aspects of violence and understanding the nature and characteristics of resilient children, we can better prepare our youth for life. We may not be able to protect our adolescents from exposure to violence, but we most certainly can help them develop the necessary skills to survive such exposure and work to enhance and strengthen their access to protective factors so that they can experience a healthy transition from adolescence to adulthood in this new millennium.

American children and adolescents spend an average of 3-5 hours per day with a variety of media, including television, radio, videos, videogames, and the Internet. Considerable research exists to document concerns about media violence, the impact of media on teen sexual attitudes and behavior, the relationship between alcohol and cigarette advertising and adolescent drug use, and the impact of R-rated films on attitudes about sexual violence. Very little research exists concerning adolescents' use of the Internet and the potential behavioral impact, but many parents and professionals are concerned. Solutions include: better programming, stricter regulation by parents, media education at home and in schools, and greater advocacy on the part of health professionals.

Financing health care for adolescents involves a combination of public and private sources of payment and, in the public sector, a combination of insurance coverage and categorical programs. In recent years, the importance of health insurance coverage has increased along with the potential for insuring more adolescents. Medicaid and the new State Children's Health Insurance Program (CHIP) offer numerous options for reducing the proportion of uninsured adolescents and for increasing adolescents' access to necessary health care. This article explores the potential of Medicaid and CHIP for meeting adolescents' needs, the extent to which they have done so already, and the gaps or missing links that remain. It also reviews issues that cut across funding sources related to managed care, consent, and confidentiality.

Parents have known since time immemorial, and social scientists have agreed since the turn of the last century, that adolescents are "a people unto themselves"-a distinct developmental category. Yet it was not until the 1950s that a medical subspecialty focusing specifically on teenagers came into being. This article examines the interplay between the emergence of adolescent medicine and changes in American family relationships, youth culture, popular perceptions about young people, and the social experience of adolescence. The author traces the development of adolescent medicine from its origins in the works of J. Roswell Gallagher at Boston Children's Hospital in the 1950s to its uncertain prospects today, when, despite heightened recognition of their specific medical needs, most adolescents still receive inadequate health care.

Human sexuality can be defined as including the physical characteristics of and capacities for specific sex behaviors, together with psychosocial values, norms, attitudes, and learning processes that influence these behaviors. It also includes a sense of gender identity and related concepts, behaviors, and attitudes about the self and others as women or men in the context of one's society. At the dawn of the new century, adolescent sexuality remains a topic of concern to adults throughout the world. This concern is not unique to this new age. In each era of recorded history, adults have been concerned about adolescent sexual behavior, particularly sexual intercourse and its consequences. Things have not changed all that much in the realm of adolescent sexual behavior. What has changed is our ability to prevent the serious consequences of this behavior and, hopefully, to help adolescents avoid behaviors that put them at risk for the negative consequences of expressing their burgeoning sexuality. This article reviews the major influences on adolescents developing' sexuality, the data on adolescent sexual activity, some tips on caring for adolescents comprehensively, and ends with some predictions of how this issue will be addressed in the new century.