Showing papers in "Adolescent medicine (Philadelphia) in 1998"

Injuries to the hand and wrist.

Abstract: Because sports-related injuries to the hand and wrist are relatively frequent and lead to significant disability if misdiagnosed or improperly treated, it is important to identify the specific nature of such an injury to reach an accurate diagnosis and administer appropriate treatment. The author advocates an initial three-step process that may help the clinician to effectively diagnose and treat injuries: listen to the description of injury mechanisms; observe the site of injury; palpate the area for tenderness or instability.

Adolescent cigarette smoking: prevalence, causes, and intervention approaches.

Abstract: Cigarette smoking continues to be a major public health problem that specifically affects the adolescent population. This chapter discusses current prevalence rates, recent trends, and the etiology of adolescent smoking, as well as strategies for preventing or reducing it. The authors highlight the prevention approaches demonstrated to effectively influence smoking behavior, such as those that teach adolescents social resistance skills and antismoking norms alone or in combination with teaching overall personal and social skills.

Depression in the adolescent patient.

Abstract: Depression in adolescence is a major public health problem that is associated with significant morbidity and mortality. A large number of clinically depressed adolescents still are unrecognized and untreated. This chapter provides pediatricians with useful guidelines for recognizing and managing adolescent depression in a primary care setting.

Adolescent growth, development, and psychosocial aspects of sports participation: an overview.

Abstract: This chapter examines sports participation in the context of adolescent growth and development. Because the nature of sports participation is highly organized and competitive, it is imperative that parents, coaches, physicians, and other clinicians remember that they may be placing increased pressures on the adolescent to perform and practice. The authors review the impact of physical growth and psychosocial development and also describe how substance abuse, depression, and aggressive behavior may or may not be influenced by sports participation.

Nutritional supplements: fact vs. fiction.

Abstract: An athlete may think that if a small amount of a chemical helps his or her performance, more will work better. The most appealing supplements are those that claim to help build muscle, improve endurance, and reduce body fat. Widespread acceptance of herbal of "natural" alternatives to mainstream medicine (especially nutritional supplements) is increasing, and the market is largely unregulated. The authors summarize the facts and fiction surrounding the use of popular products that may be found at the pharmacy and health food store that are being used in the locker rooms of high schools, colleges, and gyms in the U.S. They urge clinicians to stress the value of a well balanced diet to their active adolescent patients and not to encourage supplement use.

Pediatricians' pet peeves about mental health referrals.

Abstract: This chapter has described a number of problems encountered by pediatricians when referring their patients for mental health services; these are related to access to care, quality of providers and service, attitudes of patients and providers, and lack of adequate communication. We have discussed some of the reasons for these difficulties, provided information that may assist pediatricians in making referrals to appropriate mental health providers, and offered suggestions to facilitate the referral process. We have highlighted the utility of developing and maintaining a relationship with mental health referral sources, and noted a number of advantages of including mental health providers in pediatric practices.

Tobacco, youth, and sports.

Abstract: Cigarette smoking constitutes the single largest threat to the health and longevity of American youth. Each year, almost 400,000 people die prematurely from tobacco-related diseases. Moreover, 90% of adult smokers began using tobacco before their eighteenth birthday, and each day 3,000 children and adolescents begin smoking. Smokeless tobacco use is less prevalent than cigarette smoking but has similar deleterious health effects and is often also glamorized by sports figures. This article examines the relationship between tobacco and sports and offers specific steps that physicians (specifically orthopedic surgeons and sports medicine physicians, who interact with athletes at sporting events and in schools as well as at the clinic) can take to help prevent or minimize tobacco use. Although sports have been used by the tobacco industry to promote tobacco products to young people, the authors suggest new ways to prevent its success.

The breast and sports: issues for the clinician.

Abstract: Although a number of recent reviews have focused on the effects of exercise and sports on menstrual function, minimal emphasis has been placed on how the breast is affected. Increasing numbers of female athletes are participating in previously male-dominated contact sports; the effect on overall breast health from medium-to-high impact activities remains to be seen. This article reviews the basic anatomy and embryology of breast tissue, outlines various problems of the breast that the adolescent athlete may encounter, and offers management strategies for such problems. Language: en

The adolescent with conduct disorder.

Abstract: Conduct disturbances are some of the most prevalent, enduring, impairing, and costly problems of childhood and adolescence. Despite many advances in our understanding of these disorders, they still remain a problem for the individuals, families, and society alike. Large-scale, multifaceted efforts are needed within our schools and communities if we are to have an impact on the prevalence and progression of these very problematic disturbances.

Conditions of the spine.

Abstract: Sequelae of congenital, developmental, infectious, degenerative, and neoplastic processes present themselves throughout adolescence, a time of rapid growth and spinal development. The author outlines the elements of an accurate diagnostic physical examination, the signs and symptoms of various spinal deformities, and their diagnosis and treatment. The potential causes of back pain in children and adolescents are explored. The author cautions against dismissing complaints of back pain in the skeletally immature population as mere "growing pains."

Exercise and sports in the adolescent with chronic pulmonary disease.

Abstract: Every young person with a respiratory disability should be given the opportunity to maximize his or her exercise potential. Conditions such as asthma, affecting some 14 to 15 million people and cystic fibrosis (CF), affecting about 30,000 people in the U.S., may exclude young people from sports participation. And yet regular aerobic exercise and weight training have been shown to provide significant psychological and physical benefits to people with lung disease and diseases of the respiratory muscles and chest wall. The authors document the effects of asthma, CF, and neuromuscular diseases on aerobic exercise to prevent unnecessary limitations on participation due to inaccurate preconceived notions of sports of exercise capacity in chronically ill adolescents.

Early identification of emotional and behavioral problems in a primary care setting.

Abstract: Adolescence is a time when many psychiatric disorders first manifest themselves. The challenge to pediatricians is to recognize early signs of behavioral problems in their adolescent patients. This review suggests several practical approaches to the detection, assessment, and treatment of emotional problems in adolescents within the time limits of a typical pediatric exam. The approaches presented range from general health supervision of all adolescents to more intensive evaluation of at-risk adolescents.

Shoulder and elbow injuries and painful syndromes.

Abstract: Childhood participation in organized sports has led to increased incidence of orthopedic complaints in the pediatric and adolescent populations, and year-round participation in a single sport allows no rest period from muscle use, bone development, and maturation. What effect do these factors have on the musculoskeletal system of the young athlete? They may lead to injuries such as dislocations, fractures, and problems of bone growth. This comprehensive review of shoulder and elbow anatomy and mechanisms of injury includes specific recommendations for rehabilitation.

Cardiovascular evaluation of the young athlete.

Abstract: Young athletes with possible cardiac problems may require medical advice, sports medicine information, and treatment before a clinician can sanction sports participation. In addition, the potential medical liability of cardiac abnormalities makes the preparticipation cardiac evaluation a top priority. The author emphasizes the importance of obtaining a thorough cardiac history and performing a cardiac-specific physical examination, which may include diagnostic tests such as the treadmill and color flow Doppler echocardiography. Common cardiac referral complaints such as chest pain, murmurs, and syncope are also reviewed.

Caring for the adolescent with systemic lupus erythematosus.

Abstract: Nearly 15% of patients with systemic lupus erythematosus (SLE) present during adolescence; it is therefore highly likely that a pediatrician will care for a young adult with SLE in his or her practice. The author stresses the importance of an individualized medical treatment plan that suits the patient and disease stage, as well as the clinician's obligation to provide clear and accurate information to adolescents and their parents. Guidelines to facilitate patient compliance and understanding are also offered.

A private practitioner's approach to adolescent problems.

Abstract: This chapter presents an approach to caring for adolescent problems in a practice situation and addresses many important adolescent issues. It highlights the importance of establishing a trusting and confidential relationship with adolescents, offers guidelines for conducting routine adolescent visits and formal psychosocial evaluations, and emphasizes the importance of collaboration with other practitioners and mental health professionals.

Etiology and pathogenesis of rheumatic diseases of adolescence.

Abstract: The pathogenesis of SLE is multifactorial. Immune complexes, autoantibodies, and abnormal T-lymphocyte responses all play a part. Genetic predispositions are present, but not as strongly expressed as in the spondylarthropathies. Environmental agents and the effects of sex hormones also contribute.

The physically challenged athlete.

Abstract: Several studies note that the relative risk of injury for physically challenged athletes is approximately the same as that of nondisabled athletes. Since the 1940s physically challenged athletes have increasingly competed on national and international levels. This chapter describes sport-specific adaptations (such as a prosthesis or wheelchair), classifies the suitability of sports activities according to disability, and outlines measures to prevent injury in disabled athletes. The author also includes a resource list of publications, organizations, and web sites for disabled athletes.

Diet and adolescent behavior: is there a relationship?

Abstract: Behavioral problems such as hyperactivity, learning disabilities, mental illness, aggressive and antisocial behavior, and juvenile delinquency have been purportedly linked to the potential influence of foods or nutrients. This article examines the scientific evidence of the relationship between food and behavior in children and adolescents. It highlights the implications for practitioners important to consider in the assessment of the relationship between diet and behavior. Language: en

Cultural and medical issues of Latino adolescents.

Abstract: While the cultural and medical issues of providing care to immigrants have been primarily addressed in the adult literature, this article discusses how these issues concern Latino adolescents. Recognizing the multitude and complexity of immigrant experiences and responses to the acculturation process, the authors address myths and stereotypes associated with Latino culture that interfere with health care delivery.

Psychological problems manifested by somatic symptoms.

Abstract: Physicians often encounter patients with somatic symptoms that reflect a wide range of life difficulties and psychological problems. This review covers common somatic symptomatology in adolescents, diagnosis and management of somatoform disorders, somatic presentations of other major psychiatric disorders, and discusses ways of approaching and screening for difficulties in adolescent populations.

Practical and emotional consequences of parental divorce.

Abstract: This review explores divorce as a risk factor for psychological problems among children and adolescents and the difficult emotional and practical transitions it creates for them. The authors provide helpful suggestions for primary care pediatricians on how best to assist their adolescent patients and their families in dealing with the transition.

Foot and ankle injuries and disorders.

Abstract: This chapter analyses the mechanics of walking and running gait and delineates the terminology used to describe foot and ankle injuries. A helpful anatomic review precedes explanations of the mechanisms of sports injuries in this area. The author documents the correct diagnoses and treatments for foot and ankle sprains, fractures, and stress injuries.

Hip, pelvic, and thigh injuries and disorders in the adolescent athlete.

Abstract: The common injuries and disorders that affect the hip joint, pelvis, and thigh and its surrounding tissues are discussed in this chapter. The clinician's challenge is to determine the severity of the injury and select the correct treatment and rehabilitation. Careful observation, diagnostic tests, and a thorough medical history aids this selection. The characteristics of several sports injuries are highlighted with the essential components of effective treatment and physical rehabilitation.

Other rheumatic diseases in adolescence. Dermatomyositis, scleroderma, overlap syndromes, systemic vasculitis, and panniculitis.

Abstract: In addition to juvenile rheumatoid arthritis (JRA) and systemic lupus erythematosus (SLE), dermatomyosytis, scleroderma, overlap syndromes, systemic vasculitis, and panniculitis also present in adolescence. The authors discuss the complex epidemiology, diagnosis, clinical features, diagnostic testing, treatment, and prognosis of these diseases.

Diabetes mellitus and sports.

Abstract: The adolescent with insulin-dependent diabetes mellitus (IDDM) can safely participate in sports activities without interference from the disease. To ensure safe and successful participation, clinicians must appreciate how diabetes may alter the physiologic adaptation to strenuous exercise and how an individualized self-care plan can empower the adolescent with IDDM to effectively manage meal planning, blood glucose testing, and insulin injections. Various types of insulin, insulin schedules, and insulin delivery devices that may suit a wide variety of training and activity regimens are described.

An update on adolescent psychopharmacology.

Abstract: Adolescent pediatricians are being asked to assume a larger role in the management of psychiatric disorders. Therefore, dissemination of the knowledge base regarding the use of psychotropic medications to treat these disorders in children and adolescents is critical. This chapter is an update to the previous "Primer on Adolescent Psychopharmacology" by Bailey and Hendren. Many of the disorders that occur in adolescence are associated with significant morbidity and functional impairment. While the evaluation of adolescents involves a careful assessment of the psychosocial milieu and the implementation of an intervention that involves the use of multiple modalities, pharmacotherapy can diminish symptom severity and thereby assist in the process of recovery. Successful pharmacotherapy begins with the development of an active and reciprocal alliance with the patient and family that allows for sharing of critical information and provision of support. The initiation of treatment should include a clear definition of target symptoms, the potential risks and benefits of the proposed intervention, and a discussion that includes a review of the current treatment experiences in both adult and child psychiatry. The establishment of a method that allows for adequate monitoring of both response and side effects is critical. Clearly, this is a field in its infancy. Thus, practitioners must be acutely aware of both the extent and limitations of the existing knowledge base as well as critical need for more controlled studies of these interventions in adolescence.

Infectious causes of arthritis in adolescents.

Abstract: Although most joint pain in adolescents is secondary to injury, inflammatory arthritis, mechanical problems, and other causes, infectious causes of arthritis should always be considered. Infections may cause arthritis by direct infection, reactive disease, or immune-mediated mechanisms. This chapter reviews common infectious causes of arthritis and also recognizes the difficulties in distinguishing categories.

Displaced children: meeting the health, mental health, and educational needs of immigrant, migrant, and homeless youth.

Abstract: A growing number of children of all ages are experiencing homelessness and displacement. This chapter explores the needs of displaced children in the U.S., focusing on children of immigrants, children from families of migrant farmworkers, and homeless youth. The author discusses many of the common challenges and needs of displaced youth, but also points out the differences between younger children and adolescents, followed by a set of recommendations for health care and service providers.

Juvenile rheumatoid arthritis and the spondyloarthropathies.

Abstract: Juvenile rheumatoid arthritis (JRA) and the spondyloarthropathies affect approximately one in a thousand children under the age of 17 years and are more common than diabetes, cystic fibrosis, and many other chronic conditions. The author explores differential diagnoses for musculoskeletal pain, classifies types of JRA and the spondyloarthropathies, and describes how such conditions may be effectively managed with drug and physical rehabilitation therapy. The article also discusses behavioral, school, and vocational issues.