Showing papers in "Adolescent medicine (Philadelphia) in 2000"

Protective factors, resiliency and healthy youth development.

Abstract: 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 This perspective must be superseded by practitioners, researchers, and advocates who demonstrate, at multiple points of intervention, that the dual approach of risk reduction and enhancement of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.

Children, adolescents, and the media in the 21st century.

Abstract: 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.

Sport participation, risk taking, and health risk behaviors.

Abstract: 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.

Respiratory problems in the adolescent with developmental delay.

Abstract: Patients with developmental disorders, including adolescents, comprise a large and heterogeneous group of individuals who vary in underlying diagnosis and degree of disability The largest numbers of patients are those with cerebral palsy and with traumatic brain injury While these conditions themselves do not directly cause airway or parenchymal lung dysfunction, consequences of neuromuscular dysfunction, especially aspiration and ineffective cough, may lead to lung damage Poor nutritional status, impairment of airway clearance by muscular weakness or incoordination and poor pulmonary reserve (due to chest wall or spine deformity) increase the risk of significant morbidity and mortality from respiratory infections Individuals who were premature infants or who had prolonged neonatal courses may also have residual chronic lung disease (bronchopulmonary dysplasia) contributing to their pulmonary problems This review discusses conditions that have adverse effects on the airway and lung (drooling, feeding problems, gastroesophageal reflux, aspiration, spasticity, scoliosis) and some of the consequences of these insults (disordered airway clearance, pneumonia, sleep apnea) Also discussed are issues important to the prevention or amelioration of respiratory difficulties, including preventive care, the effects of exercise, dental hygiene, and surgical intervention

Substance abuse: an overview.

Abstract: 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.

Cystic fibrosis in adolescents and young adults.

Abstract: 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.

Adolescent violence: concepts for a new millennium.

Abstract: 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.

Adolescent sexuality at the dawn of the 21st century.

Abstract: 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.

Current challenges in antibiotic resistance.

Abstract: The striking, widespread increase in bacterial resistance to antibiotics is an issue of great concern. Worldwide emergence of antibiotic resistances in our common gram-positive coccal pathogens is probably the most serious problem we have in the realm of bacterial infections. The most important of these organisms are penicillin-resistant Streptococcus pneumoniae, vancomycin-resistant Enterococcus, and methicillin- (and now vancomycin-) resistant Staphylococcus aureus. Although known by the above names, all of these organisms are multidrug-resistant. Beta-lactam and vancomycin resistances in gram-positive cocci are caused by altered cell wallnbinding sites with decreased affinity for the drug. Another serious problem is that of resistance in certain gram-negative bacilli due to extended-spectrum beta-lactamase production. These antibiotic resistances in common pathogens have made antimicrobial therapy of many infections extremely difficult or virtually impossible in some instances. The extensive, and often inappropriate, use of antibiotics in the U.S. and worldwide is the major factor in the emergence and spread of antimicrobial resistance. Microbial mechanisms, epidemiology, clinical importance, treatment, and prevention of these antibiotic resistance problems are discussed.

Respiratory diseases with a psychosomatic component in adolescents.

Abstract: 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.

Upper respiratory tract infections in adolescents.

Abstract: While upper respiratory tract infections (URTIs) cause much infectious morbidity in infants and young children, adolescents are not immune to infections. Adolescents experience two to four episodes of viral nasopharyngitis annually. In addition to group A streptococcus (GAS), pharyngitis may occur with other streptococci, Arcanobacterium haemolyticum, Epstein-Barr virus, Neisseria gonorrhoeae, and other pathogens. Uvulits, typically in association with GAS, occurs occasionally. Peritonsillar abscess is the most common deep neck space infection seen in adolescents, but retropharyngeal and parapharyngeal abscesses also occur, causing major morbidity. Adolescents experience fewer cases of otitis media than younger children. Rhinosinusitis occurs commonly in adolescents, occasionally leading to chronic sinusitis and serious sequelae such as osteomyelitis. This article reviews the major URTIs likely to be encountered by physicians caring for adolescents. For each entity there is a brief description of the epidemiology, morbidity, microbiology, clinical and laboratory features, treatment, and prevention.

Adolescent urinary tract infections.

Abstract: Urinary symptoms in adolescents are common, particularly in females. Urinary tract infections (UTIs) cause many of these symptoms. For uncomplicated UTIs, both lower and upper tract, therapy is straightforward. Commonly used antibiotics are trimethoprim/sulfamethoxazole (TMP/SMX), cefixime, and ciprofloxacin (off-label use) for 3 days for lower tract infections and 10n14 days for upper tract infections. Adolescent UTIs are markers for sexual activity, just as UTIs in younger children are often markers for anatomic defects, e.g., congenital abnormalities. Adolescents with upper and lower UTIs often have concurrent sexual activity or a complication of that activity. Issues among adolescents with UTIs are more similar to those of young adults than to those of younger children. It is as important to counsel adolescents about sexual activity and its consequences as it is to treat the UTIs. All adolescents with UTIs should be queried for sexual activity; evidence of sexually transmitted diseases (STDs) should be sought; and counseling for STDs and responsible sexual activity is recommended. Complicated UTIs include those in patients who have grown into adolescence after a childhood of infections or who have anatomic abnormalities, recurrent infections, reflux and reflux nephropathy, spina bifida and neurogenic bladder, transplanted kidneys, diabetes, and urolithiasis. These patients require individualized medical programs, unique for their condition, history, and microbiology.

Serious infections of the central nervous system: encephalitis, meningitis, and brain abscess.

Abstract: 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

Use of complementary and alternative medicine in the treatment of asthma.

Abstract: 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.

Computers and information technology: implications for the 21st century.

Abstract: 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.

Pulmonary effects of smoking.

Abstract: The problems of tobacco addiction have evolved over centuries. The possible relationship between smoking and oral cancer was recognized as early as the 19th century. The use of tobacco results in an estimated 4 million deaths each year worldwide. Approximately 3,000 adolescents start smoking every day; 4.5 million children and adolescents smoke cigarettes; 1 million use smokeless tobacco. This article reviews the effects of environmental tobacco smoke and primary smoking on lung health and maturation and the pathophysiology of smoking-related pulmonary disease. Smoking prevention and timely smoking cessation will significantly reduce the risk of not only lung diseases (chronic obstructive pulmonary disease, cancer, chronic bronchitis, asthma, etc.) but also suboptimal lung growth during preadolescent and adolescent years.

History of adolescent medicine in the 20th century: from Hall to Elkind.

Abstract: 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.

Medical care of the adolescent with asthma.

Abstract: 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.

Prevention and management of sexually transmitted diseases in adolescents.

Abstract: This review focuses on the diagnosis and treatment of common sexually transmitted diseases (STDs) encountered among adolescents in the U.S. and other developed countries. Included are new recommendations for the treatment of primary and recurrent genital herpes, management of pelvic inflammatory disease, and a revised approach to the care of adolescent victims of sexual assault. Diagnosis begins with a classification based on major clinical findings: genital ulcers with lymphadenitis, urethritis, vaginal discharge, pelvic inflammatory disease, and male STD syndromes. Appropriate laboratory evaluation for each of these clinical presentations is detailed and treatment options are summarized. Preventive interventions along with suggestions for an approach to the preadolescent well care visit, generally scheduled at age 11n12 years, are offered. Routine preventive therapy after a sexual assault takes into account difficulty in follow-up and the need to reassure adolescents and their families that all prophylaxis for possible infection has been provided.

Romance with the automobile in the 20th century: implications for adolescents in a new millennium.

Abstract: 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. Language: en

Evaluation and treatment of sleep disorders in adolescents.

Abstract: Sleep disorders are quite common in adolescents and sleep disturbances occur most often during the mid-adolescent years. These disorders result in considerable negative consequences in terms of increased accidents, decreased academic performance, and increased behavioral difficulties. Over the past 25 years, the evaluation, diagnosis, and treatment of sleep-related breathing disorders has undergone dramatic changes. The diagnosis and treatment of pediatric sleep disorders are now the focus of more complex and collaborative research efforts. This article discusses the differences between childhood and adolescent sleep cycles, delayed sleep phase syndrome, sleep-related breathing disorders, narcolepsy, parasomnias, and behavior-related sleep problems.

Community-acquired pneumonia in adolescents.

Abstract: Community acquired pneumonia (CAP) is defined as pneumonia acquired outside of the hospital setting. Extensive studies of CAP in adolescents that characterize the true incidence of various etiologic pathogens are not available. However, Streptococcus pneumoniae, Mycoplasma pneumoniae, and Chlamydia pneumoniae appear to be the most frequently encountered pathogens. These organisms often cause CAP in adults as well; other infections are noted as well, including Legionella. "Atypical pneumonia" refers to pneumonia not presenting with the usual clinical picture of pneumococcal infection (which includes high fever, productive cough, chills, and other "classic" features). The term is frequently used in adolescents with CAP. However, this classification may not help in individual patients, who often show a high degree of variability in the clinical presentation of pneumonia; also it does not always predict microbial cause. There is currently a trend away from the concept of atypical pneumonia syndrome and more discussion of atypical pathogens as commonly causes of CAP. This article reviews recent literature on CAP with special emphasis on its diagnosis and management in adolescent patients.

Human immunodeficiency virus infections in adolescents.

Abstract: Human immunodeficiency virus (HIV) infection, once largely confined to adolescents with hemophilia, has come to involve the general adolescent population. Individuals younger than 22 years comprise up to 25% of the people newly infected with HIV. Unsafe sexual practices, intravenous drug abuse, homelessness, psychiatric disorders, and inadequate psychosocial support are only some of the factors that have contributed to the epidemic. Present data indicate that interventions have had a positive impact on adolescent behavior in preventing the continuing spread of the disease, but more needs to be accomplished before we consider the problem controlled. Although proper medical treatment and providing adequate psychological and social support to adolescents who are already infected constitute an important aspect of care, the true solution of the problem lies in altering the behavior and practices that lead to the acquisition of this infection.

Infectious exanthems and unusual infections.

Abstract: Invasive disease due to group A beta-hemolytic streptococci (GABHS) can be divided into 3 categories of disease: streptococcal toxic shock syndrome (strepTSS), necrotizing fasciitis, and other invasive GABHS disease. Patients with strepTSS may have multiorgan failure within hours of presentation. Clindamycin and penicillin G should be used in combination for treatment of invasive GABHS disease. The mortality rate for menstrual staphylococcal toxic shock syndrome has decreased with early recognition and treatment, and removal of hyperabsorbent tampons from the market. Kawasaki syndrome (KS) is the most common cause of acquired heart disease in children in the U. S., and atypical forms have a higher mortality rate than typical KS. Hantavirus pulmonary syndrome is a zoonosis with an 80% mortality rate if the diagnosis is not made on first presentation and patients return to the hospital in shock. Children and adolescents with Lyme disease have an excellent prognosis and respond well to antimicrobial therapy. Cat scratch disease (CSD) is caused by Bartonella henselae and is transmitted by flea-infested kittens. CSD lymphadenopathy typically resolves spontaneously in 2n3 months; however, there is a 50% likelihood of resolution in 1 month if patients receive a 5-day treatment course with azithromycin.

Office interventions for adolescent smokers.

Abstract: Smoking-prevention efforts can be undertaken at a national level, with enactment and enforcement of laws on the use of tobacco products by youth; at the state and local level, with involvement of community organizations; and through school systems, with education regarding the harmful effects of tobacco use. This review, however, focuses on the role of individual practitioners who also can make significant contributions by working at an individual level to incorporate prevention and treatment strategies in their daily medical practice. This article reviews two types of smoking cessation interventions-behavioral and pharmacologic. Currently available data on the prevention and treatment of nicotine addiction in adolescents, particularly pharmacotherapy, are quite limited. The individual clinician can contribute to prevention and treatment of tobacco use among children and adolescents by using many of the known behavioral and pharmacologic strategies.

Acute and chronic viral hepatitis.

Abstract: Viral hepatitis is the most common cause of acute and chronic hepatitis. The term viral hepatitis generally refers to infections resulting from one of the hepatotrophic viruses: hepatitis A, B, C, D, and E. The last 10 years have brought many important advances in understanding the epidemiology, pathogenesis, molecular biology, and immunoprophylaxis of infections caused by hepatotrophic viruses. Development of sensitive and specific immunoassays has enabled detection of specific agents. This has allowed for identification of infected patients and monitoring response to therapy. Additionally, serologic markers have allowed for isolation of contaminated blood products and a reduction in the spread of disease. The remaining challenge is the application of this knowledge to the treatment and prevention of viral hepatitis. This article explores the risk factors, epidemiology, microbiology, clinical and laboratory diagnosis, treatment, and prevention of the hepatotrophic viral infections.

Adolescent medicine: a model for the millennium.

Abstract: 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.

Infectious diseases of gastrointestinal tract in adolescents.

Abstract: This article reviews the following gastrointestinal infections: esophagitis, gastritis, duodenitis including duodenal ulcers, and enteritis (gastroenteritis) The epidemiology, risk factors, microbiology and pathogenesis, diagnosis, treatment, morbidity/mortality, and prevention are discussed in relation to the most important pathogens The symptoms and pathogenesis of esophagitis caused by Candida albicans and herpes simplex are contrasted with the symptoms of esophagitis caused by Helicobacter pylori and gastroesophageal reflux disease (GERD) The incidence of gastritis and gastric and duodenal ulcers caused by H pylori is discussed The treatment regimens of H pylori infection recommended by the CDC are presented Endoscopic findings in esophagitis, gastritis, and duodenal ulcers are presented and discussed The difference in symptoms caused by viral agents (Norwalk virus), bacterial agents (enterotoxigenic E coli), and parasites (Giardia lamblia and Cryptosporidium parvum) are compared and contrasted The symptoms of infections of the terminal small bowel caused by Salmonella and Campylobacter jejuni and the symptoms of pure colonic infection, dysentery, caused by Shigella and enteroinvasive E coli and Entamoeba histolytica are discussed The treatment regimens for enteritis are presented

The family and parenting in the 21st century.

Abstract: 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.

Turning the tide: tobacco and the 21st century.

Abstract: 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.