Adolescent medicine (Philadelphia, Pa.)最新文献

This article summarizes the past decade of technological development and the past century of adolescent development in order to predict the future of adolescent medicine. The technology of communication will revolutionize behavior change approaches in the 21st century. Health will be seen as an interactive loop of connections between patients, physicians, families, institutions, peers, and support networks that may be voluntarily navigated and searched. The low-tech of counseling will be replaced with the high-tech of the interactive sensor that will be developed from our knowledge of human development. The inter-relationships between social and personal ecology-a basic premise of adolescent health care-will take on new importance in the first decade of the 21st century. The old will guide the application; the new will define the science. The major morbidities of adolescence of the 20th century will now be correctable and preventable. Models of care for all age groups will draw heavily on the experience of ephebiatrics. With application of the new science, biobehavioral issues will surface as the new technology and the practitioners of adolescent health care have the potential to lead the way.

Adolescents participate in sports for a variety of reasons. Some seem to enjoy participating in what some might consider very-high-risk or "extreme" sports activities. For some adolescents risk taking becomes pervasive and can be detrimental to normal health and development. The majority of adolescents will do well in the context of athletics, and the many positive benefits of regular physical activity and sports participation should be appropriately emphasized. However, a subset of adolescents may be at greater risk for adverse consequences. This article reviews the reasons for participation and attrition from sports, the phenomenon of thrill seeking in sports, certain risk-taking behaviors of athletes, and studies comparing health risk behaviors in athletes and non-athletes.

The rapidly changing world of computer and information technology will have dramatic changes for adolescent medicine clinicians in the 21st century. This article reviews some of this evolving technology, including the electronic medical record, the Internet, and telemedicine as well as various advances in health screening, assessment, and education. The importance of integrating this technology into a total information system is stressed. The article concludes with a day in the life of an adolescent medicine clinician in the new century.

As we enter a new millennium, many are questioning the nature of the family and its future in a rapidly changing society. To put these issues in proper perspective, this article reviews the changes the family has undergone in the past and explores what this suggests about the future. First, a brief historical sketch of the American family over the past two centuries is presented. Next, the modern concept of the family as a functioning system is explored. Family systems not only evolve in structure through history, but each family also develops individually through its own family life cycle. These ideas are presented from a family therapy perspective in order to give the physician a more practical framework within which to view families seen in practice. Finally, some implications for the future of families in the next decade are discussed.

Despite efforts by groups as diverse as the federal and state governments, public health agencies, and various advocacy groups, tobacco use continued to increase among youth during the latter part of the 1990s. This article reviews the history of tobacco control in the latter part of the 20th century with special emphasis on policy development aimed at controlling use by children and adolescents. New trends in prevention and cessation are reviewed along with a discussion of tobacco control policies that will extend into this new century.

While many pediatric malignancies are seen predominantly in pre-school children, many cases of childhood non-Hodgkin's lymphoma and most cases of Hodgkin's disease and bone tumors are seen in the older child and adolescent. This review focuses on current knowledge concerning the epidemiology, histopathology, molecular biology, clinical presentation, diagnosis, staging, treatment, and prognosis for older children and adolescents diagnosed with lymphoma or either of the two commonly seen childhood bone tumors, namely osteosarcoma and Ewing's sarcoma. Survival figures for all of these childhood malignancies have increased markedly in the past two decades. We now have the relatively new experience of having an increasingly large population of childhood cancer survivors to study and, unfortunately, are beginning to see the long-term consequences of these more successful treatments. This review concludes with an overview of the potential late effects of cancer therapy, effects that may first be detected by the primary care physician caring for the adolescent who is a cancer survivor.

This paper reviews bone marrow transplantation in adolescents. The primary indications for bone marrow transplantation are malignancies, usually relapsed lymphomas or acute/chronic leukemias. Autologous bone marrow transplantation is used as a high-dose consolidation therapy in some solid tumor patients with varied success. Peripheral blood stem cells are a feasible source of autologous stem cells in adolescents. The process of stem cell transplantation and the complications are the same in adolescents as in younger children and adults. Adolescents face the same biologic barriers to allogeneic transplant (minimal residual disease, availability of donor), but may also face more problems with their insurance status. The psychological and social aspects of bone marrow transplantation during adolescence are unique to their developmental stage. With appropriate medical, nursing, and psychosocial support, bone marrow transplantation offers cure for the adolescent with high-risk disease.

The cognitive, biological, and psychological characteristics of adolescents affect their adaptation to a chronic medical condition. This article reviews the literature on how sickle cell disease alters the normal developmental challenges facing adolescents. Examples of these challenges include delayed maturation, neurologic complications, sequelae of pain episodes, and prolonged financial and family dependence. These challenges are also discussed within the context of family and peer relationships, as well as cultural norms. Using the principles of anticipatory guidance, interventions into the psychological development may help to preserve normal functioning. These interventions need to be provided in a manner acceptable to the adolescent within the community context. The education, counseling, and medical services provided by the multidisciplinary team in the Comprehensive Sickle Cell Program at Children's Hospital in Columbus, Ohio are used to highlight these intervention strategies.

The transition from childhood to adulthood represents a time of great physiologic and psychologic change. The adolescence period can be divided into early, middle, and late adolescence. The diagnosis of cancer and impending death during adolescence can add more stress and demands during this difficult period. The normal tasks of adolescence include separation from parents, development of abstract thinking, sexual awareness, and future orientation with goals for career and marriage. These tasks must be accomplished even in the face of severe illness. The physical changes brought about by cancer and its treatment may be the major concern for the adolescent patient. The prospect of death is met with denial and anger. Independence and therefore refusal of help is maintained until the younger adolescent can no longer care for himself. The older adolescent is more confident and may allow family closeness as death approaches. The uniqueness of the adolescent requires the knowledge and patience of health care providers. Hospice professionals who are trained to understand adolescents may be able to allow them to die with independence and dignity.

The transition of childhood to adulthood includes many changes to nearly all parts of the body and that is certainly true of blood and the coagulation system. Some disorders, like iron deficiency anemia, develop as the result of rapid growth. Approximately 10% of American adolescents are anemic and the prevalence is far greater in high-risk populations, such as urban, indigent African-American adolescents, in which 40-50% of young women are anemic. Adolescents at greater-than-average risk for developing iron deficiency anemia, such as athletes involved in lengthy, intense physical activities and pregnant adolescents, should be screened for anemia. Other blood problems are inherited but the first manifestations may not emerge until adolescence, as in the case of an adolescent girl discovered to have von Willebrand's disease during the evaluation of excessive menstrual bleeding. Besides iron deficiency anemia and von Willebrand's disease, this review focuses on management of other common hematologic disorders seen in adolescent patients, including immune thrombocytopenic purpura, hemophilia, thrombocytosis, and hypercoagulable disorders.