Showing papers in "Adolescent medicine (Philadelphia) in 2001"

The impact of skin disease on the quality of life of adolescents.

Abstract: Though relatively well-investigated in adults, the impact of skin disease on the health-related quality of life (HRQL) of adolescents has only recently begun to be systematically evaluated. The primary goal of this article is to critically review previous research that has examined the relationship between HRQL and three types of skin disease commonly experienced by adolescents, namely acne vulgaris, alopecia areata, and atopic dermatitis. A secondary goal is to provide strategies to adolescent medicine physicians that will enable them to more effectively manage the psychological components of their patients dermatological conditions.

The health of youth in the juvenile justice systems.

Abstract: A substantial number of adolescents are imprisoned each year in the United States. Many of them come to detention with significant medical and mental health problems which, in many cases, have been neglected. The time of detention provides an opportunity to address these problems, thereby benefiting both the juvenile and society. The medical department has a vital role in giving individual care and ensuring that the detention facility provides a safe, positive environment in which delinquents can be rehabilitated. There are substantial barriers impeding the care of detainees that can be overcome using a variety of collaborations in the local and national communities. Involving teaching institutions brings outside oversight as well as new ideas into these closed institutions. Research in areas that will benefit inmates can improve our ability to provide appropriate care. Adolescent medicine and pediatric training programs have a duty to expose physician trainees to detention medicine so that an adequate number of appropriately trained physicians are available to work in juvenile correctional facilities. Juvenile detention medicine should be fully integrated into mainstream medical care and seen as a valuable career.

Syncope and sudden death in the adolescent

Abstract: Syncope is the sudden loss of consciousness and postural tone resulting from an abrupt, transient cerebral malfunction, followed by spontaneous recovery. It is common among adolescents and is usually due to a benign neurocardiogenic (vasovagal) etiology. Rarely, syncope is premonitory of sudden death. The physician must be knowledgeable about the characteristics of neurocardiogenic syncope and what distinguishes it from life-threatening causes. Evaluation of syncope should be based on a complete personal and family history, a thorough physical examination, and an electrocardiogram. Risk factors include syncope that is recurrent, exercise-induced, or not neurocardiogenic in nature; accompanying anginal chest pain, palpitations, and/or dyspnea; cardiac disease; seizure activity; athletic competition; and positive family history for conditions associated with sudden death (e.g., hypertrophic cardiomyopathy, long QT syndrome). Adolescents with these risk factors should be referred to a pediatric cardiologist for specialized testing and management.

Volunteering and community service in adolescence.

Abstract: Since the 1980s, volunteering has been studied as an avenue for positive development in adolescents. Reviews in the early 1990s were mixed regarding the benefits of volunteering, questioning the ability to transfer volunteer skills to other aspects of life as well as the true reduction in risky behaviors the adolescent will go on to undertake. This article addresses the gaps in the prior reviews and looks more closely at the benefits of volunteering. The author suggests that adolescent volunteers develop fewer problem behaviors in their later teens, enjoy a sense of connection to their community, maintain a better work ethic, and show a greater concern for the welfare of others. There are innumerable options for integrating volunteering into the life of an adolescent. This article offers many options, reviews some of the most popular, and suggests conditions that may increase the success of a volunteering program.

Body and spirit: Religion, spirituality, and health among adolescents.

Abstract: Religion and spirituality are important in the lives of many adolescents. This article traces patterns of adolescent religious/spiritual belief and practice and summarizes theories about religious development as they pertain to this age group. Data are provided that explore possible relationships between religion and health-related behavior among adolescents. Much of this data shows that greater religiosity/spirituality may be associated with less involvement in high-risk behaviors and more involvement in health-promoting behaviors. Implications of these data are discussed as well as possible negative roles that religion may play in youths' lives. The doctor's role in approaching religion and spirituality with patients is controversial. Health care professionals should be prepared to discuss these issues with adolescents for whom they are important, especially with patients who are hospitalized. Yet, doctors should be sensitive to those adolescents who may not want to delve into spiritual/religious issues in a health care setting.

Consumerism: its impact on the health of adolescents.

Abstract: Marketplace practices are integral to the larger economic and social context of adolescent health risk behaviors. To corporations and marketers, adolescents represent a gold mine of current and future profits. Adolescent incomes increased by almost a third in the 1990s. The annual spending of the U.S. adolescent population is estimated now to have reached 155 billion US dollars. The sheer size of the adolescent population and its spending power are of keen interest to corporations and marketers. This chapter presents a brief history of youth-targeted marketing and examines the major avenues in the media and inside schools that marketers and corporations use today to reach adolescents with their messages and products. It outlines the impact of consumerism and marketing on adolescent health using five case examples: tobacco, alcohol, cosmetic surgery, laxatives, and diet pills. It then concludes with a discussion of resistance efforts, led by health advocates, policy makers, parents, and youth themselves to restrict sales of harmful products to youth and curtail advertisers' access to adolescents in schools. A critical role for adolescent health researchers and advocates is to contribute a public health perspective into ongoing debates over regulating business practices that negatively affect the health of young people.

Cardiovascular risk factors in adolescents: relevance, detection, and intervention.

Abstract: Recent epidemiologic studies have documented worrisome trends towards increasing obesity and increased cigarette smoking in adolescents. Since cardiovascular risk factors have been shown to persist into adulthood, this may translate into an epidemic of cardiovascular disease in the future. Health care providers should assume some responsibility for the prevention, detection, and intervention relevant to cardiovascular risk factors in adolescents, which include hyperlipidemia, hypertension, obesity, and tobacco use. Promotion of a healthy lifestyle, including a low-fat prudent diet, regular physical activity, and avoidance of risky behaviors should be incorporated into health maintenance encounters. Interventions directed at the adolescent must take into account their social milieu, particularly the family, school, and community. Adolescents should be empowered through education and skill development to assume increasing responsibility for their own health behaviors.

Cardiac involvement in inflammatory disease: systemic lupus erythematosus, rheumatic fever, and Kawasaki disease.

Abstract: This review focuses on treatment and preventive issues relevant to cardiac problems associated with systemic lupus erythematosus, acute rheumatic fever, and Kawasaki disease in adolescence. Cardiac abnormalities occur as a result of the immune dysfunction and as side effects of therapy. With increased survival, more cardiac complications are being detected. Screening for cardiac risk factors, such as cigarette smoking, hypertension, obesity, and hypercholesterolemia, should begin in adolescence.

Myocarditis and pericarditis in adolescents.

Abstract: Two of the most common inflammatory disorders affecting the heart, myocarditis and pericarditis, are significant causes of morbidity and mortality in adolescents. In this review, the clinical presentation, underlying etiologies, and treatment options for these disorders are discussed. As viral causes of both disorders are commonplace, issues regarding the identification of the causative virus and potential future approaches to the care of these individuals are also discussed.

Adolescent health in a globalised world: a picture of health inequalities.

Abstract: More than half of the world's population of 6 billion people is under age 25 years. Of the estimated 1.2 billion adolescents worldwide (1 in every 5 people is an adolescent), about 85% live in developing countries and the remainder in the industrialised world. Changing social, political, and economic realities are having a major and dramatic impact on young people and their families. In this context, however, the health of young people in developing countries has been largely ignored. Of particular concern are the implications of poverty, health inequality, gender discrimination, economic instability, and political unrest. These troubling dimensions create scenarios that challenge paediatricians and other health workers to become more active and courageous as advocates for the health rights and health care of young people. In this chapter, we outline and describe some of the key issues involved, recognise a number of initiatives being undertaken, and propose additional measures for consideration.

Chest pain in the adolescent.

Abstract: Chest pain invokes serious concern in adolescents, their families, and their primary care physicians. These concerns are fueled by media reports of sudden death in high-profile athletes and the high incidence of ischemic heart disease in our society. However, chest pain in this age group is usually benign and a careful clinical evaluation including a detailed history and physical examination may guide the clinician in reaching a diagnosis, obtaining the appropriate diagnostic studies, and making the proper referrals to specialists.

The adolescent with simple or corrected congenital heart disease.

Abstract: An ever-increasing number of congenital heart disease patients are surviving into and beyond adolescence. Despite the encouraging cardiac results, with the vast majority asymptomatic and requiring no medication and having few, if any, limitations, there are many challenges for this patient population. They are likely to find obstacles to attaining education, social development, health and life insurance, and employment. Most of these obstacles are attributable to the stresses upon children with congenital heart disease and their families, and the prejudices of a society that knows little about congenital heart disease. Practitioners caring for these young people must be familiar with these issues and knowledgeable about the facts of individual cases, so that they may anticipate needs and offer support to their patients in their progress toward adulthood.

Management of warts and molluscum in adolescents.

Abstract: Warts continue to be a therapeutic challenge, especially when they are numerous or widespread; in contrast, treatment of molluscum is comparatively more successful. A single, most effective treatment for either infection has not been defined. Conventional methods attempt to non-specifically destroy infected tissue. Most of these procedures are painful and require multiple treatments or compliance with daily application of a medication. The efficacy of destructive techniques has not been verified in placebo-controlled clinical trials and success rates reported in uncontrolled studies are difficult to interpret and often no better than that those achieved with a placebo. Alternative pharmacological approaches are aimed at stimulating immunologic or antiviral responses. Further study is needed to establish efficacy of these treatments.

Palliated congenital heart disease.

Abstract: The group of patients with palliated complex forms of congenital heart disease presents a challenging and difficult management problem during the adolescent years In patients not considered to be candidates for more fully palliated procedures that separate the circulations, a bidirectional caval pulmonary shunt, often associated with a systemic to pulmonary shunt, may provide significant palliation for several more decades However, there remain a significant number of patients who, after some years, may develop increasing problems associated with myocardial failure and the development of serious atrial arrhythmias Interventional cardiac catheterization combined with newer surgical techniques may return many of these patients to more satisfactory hemodynamic states However, some patients during their adolescent years may eventually require cardiac transplantation for the long-term management of their complex congenital cardiac defects

Adolescent children of drug-abusing parents.

Abstract: The effects of a substance-abusing parent on a child are wide-spread, and unfortunately they follow that child well into adolescence and adulthood. Cognitive difficulty, poor judgment, and conduct problems are but a few of the sequelae, and similar results are seen whether the drug is alcohol or cocaine or another illicit substance. In addition to affecting the biology of the adolescent from the perinatal period, parental substance abuse often causes a disrupted, chaotic home, financial insecurity, and exposure of the teen to illegal substances and violence. The emotional toll on the adolescent is steep, and the overall cost to the health care system is enormous. Ultimately, many of these adolescents progress to substance abuse themselves. Health care providers need to be sensitive to the possibility of substance abuse in the home, and should aggressively pursue early treatment/therapy options for those teens at risk.

Managing adolescent acne.

Abstract: Acne vulgaris, more commonly termed acne, is the most common skin disease treated by physicians. It affects an estimated 17 million people in the United States, including 85% or more of adolescents and young adults. Acne is a chronic condition that may last for years and cause emotional distress and permanent scarring. Although there is no cure, medications can control the disease and limit or prevent scar formation.

Photoprotection in adolescents.

Abstract: Over the recent decades, there has been mounting medical evidence about the risks of ultraviolet light exposure and its potential for cutaneous malignancy. In the year 2000, an estimated one million Americans were diagnosed with skin cancer, which accounted for half of all new cancers. Worldwide, the incidence of cutaneous melanoma is increasing more rapidly than any other malignant neoplasm. Despite intensive educational efforts by the medical community, the public has not embraced adequate sun protection measures. This is especially true in adolescence, where peer acceptance and conflicting advertisements directly compete with the notion that pale is beautiful. There is strong evidence that preventive measures instituted early and encouraged throughout childhood and adolescence, can positively modify behavior. Towards this end, this article reviews the photobiology of ultraviolet light and its effects on the skin, as well as highlight practical information on sunscreens, adjunctive sun protection methods, sunless tanners, and tanning salons, which will help pediatricians educate adolescents and their families on proper photoprotective techniques.

Cardiomyopathies in adolescents: dilated, hypertrophic, and restrictive.

Abstract: Three major types of cardiomyopathies affect adolescents: dilated, hypertrophic, and restrictive. At the present time the etiologies of the majority of these cardiomyopathies in children remain elusive. Treatment of these diseases is generally directed toward improving symptoms, survival, myocardial performance, and hemodynamics. Most treatment strategies are extrapolated from studies in adults with these types of cardiomyopathies, although prospective, randomized therapeutic trials are currently underway in children. All three types of cardiomyopathy can be associated with a wide range of symptoms (from none to severe) and also are associated with sudden death. For those in whom medical management fails, heart transplantation is a therapeutic option with an excellent intermediate-term success rate.

Gynecologic and obstetric issues in the adolescent with heart disease.

Abstract: It is necessary to adopt a proactive, prevention-based strategy for addressing gynecologic and obstetric issues in the adolescent with heart disease. Pregnancy carries known cardiovascular alterations, manifestations and risks. The nature of the underlying cardiac disease needs to be considered in preconception counseling and in the prevention of pregnancy. Specific risks of oral contraceptive methods must be considered as well. Estrogen-based oral contraceptives may confer risks of thromboembolic phenomenon, whereas progesterone-based agents may be associated with increased risk of bleeding. Medical termination of pregnancy may pose risks to the young woman with cyanotic heart disease or pulmonary hypertension. Full prepregnancy evaluation helps to ensure a good outcome for both mother and baby. There are risks of continuing specific cardiovascular medications during pregnancy; however, certain medications are continued to safeguard maternal health. This is particularly problematic in the patient who must remain on anticoagulation.

Pigmented lesions in adolescents.

Abstract: Accurate diagnosis of congenital and acquired pigmented lesions accompanied by an understanding of their natural history and disease associations is critical for the appropriate management and counseling of adolescents, as well as timely referral to specialists when indicated The recognition of atypical nevi and other melanoma risk factors in adolescents should lead to institution of preventive measures, such as routine skin examinations and counseling regarding sun protection Because the incidence of melanoma is increasing in adolescents as well as adults, prompt identification of suspicious melanocytic lesions may lead to early diagnosis and effective treatment of melanoma Numerous pigmented lesions can also herald the presence of a multisystem disorder; the recognition of syndromes associated with these lesions should result in appropriate evaluation and genetic counseling of affected individuals This review distinguishes pigmented lesions that histologically represent a proliferation of melanocytes and that may therefore confer an increased risk for melanoma, from pigmented lesions due to increased melanization alone (ie, increased melanin content) that are not associated with malignancy

Superficial fungal infections in adolescence.

Abstract: Cutaneous fungal infections occur frequently in the adolescent population, and are second only to acne in generating skin-related adolescent anguish. Though superficial fungal infections of the skin are rarely life-threatening, they can cause significant worrisome cutaneous findings (e.g., white spots from pityriasis versicolor, distorted nails from onychomycosis). Such changes are particularly threatening to an adolescent who wants to be just like everybody else. This article focuses on several of the more common cutaneous fungal infections in adolescence, including pityrosporum (tinea) versicolor and dermatophyte infections of the feet, groin, skin, and nails. The prevalence of each disease is discussed, along with its clinical presentation, differential diagnosis, and methods of treatment.

Growing up in an affluent family: unique psychosocial issues for the adolescent.

Abstract: Most people would agree that it is preferable to grow up in a wealthy family than in one that is impoverished. However, adolescents who live in affluent families are in danger of developing a sense of entitlement that may impede future vocational and social success. Parental presence may be minimal, with discipline and child-rearing delegated to paid caretakers. The pressure to achieve in school may overwhelm the less than gifted adolescent. Excessive parental participation in school affairs may deter the adolescent from developing a sense of independence and competency. Eating disorders are more likely to develop in affluent youth. Participation in delinquent behaviors may be due to boredom with the affluent lifestyle, and such behavior may not be punished since youth from affluent families are often shielded from proper discipline by law enforcement authorities. Because of their social standing in the community and as a consequence of their wealth, affluent youth are in unique positions to become leaders and to participate in altruistic endeavors. Health care providers taking care of adolescents in wealthy families should be aware of these issues and should discuss them with adolescents and their families.

High schools and development of healthy young people.

Abstract: While high schools were designed to teach and guide adolescents, institutions today often fail and even harm their students. Low-income and minority youth are the most affected by this trend because poor quality schools are most often found in urban settings, and poorer students are the least able to call upon other resources to make up for the inadequacies in the school. Furthermore, today's high school paradigm is the least helpful to the student who will enter the job market immediately after high school, carrying few marketable skills and little understanding of his or her place in the community. Several effective school models do exist, and these often meet the needs of the minority students as traditional high schools do not. Physicians in the adolescent health field can and must help in this arena. Getting a teen out of a poor school and offering alternative schools where appropriate will contribute to the health of each individual, and hopefully will encourage change in schools generally.

The impact of parental divorce for adolescents: a consideration of intervention beyond the crisis.

Abstract: The effects of divorce on children and adolescents remain a major public health issue. Over the last three decades, there has been ongoing debate among researchers and mental health and legal professionals who counsel divorcing families as to whether the effects are acute but time-limited or more enduring. This chapter looks at the tasks of normal adolescent psychosocial development and how divorce complicates those tasks. It suggests ways that pediatricians and other health professionals can intervene effectively with divorcing families within the context of their role. Divorce-specific resources and services are explained.

Adolescents and the workplace.

Abstract: Adolescents have always played a major role in the workplace, whether using employment to add to the family's income needs or to provide the adolescent with "extra" spending money. Although employment affords many positive aspects to today's youths (including improved self-esteem and practical, real-world skills), there are many potential risks faced by the working adolescent. Workplaces create physical risks for disability, and adolescents who work long hours do so to the detriment of their social and educational obligations. Physicians should be aware that teens are working in record numbers, they should take careful occupational histories, and they should be aware of the pitfalls common to employment in their area (farm hazards in rural communities versus homicide and personal injury risks in an urban area, for example). Physicians should join with other authority figures in communities to push for the safest working environments possible for their adolescent patients.

Bacterial skin infections in adolescents.

Abstract: Bacterial skin infections are the single most common skin disorder for which pediatric patients seek care. This manuscript reviews the principles of skin infections and the most common and important bacterial skin infections in adolescents.

Diagnosis and treatment of pulmonary hypertension in the adolescent.

Abstract: This article discusses diagnostic and therapeutic options of adolescents with primary and secondary pulmonary hypertension. Pulmonary hypertension is an important determinant of morbidity and mortality in many diseases, including congenital heart disease and respiratory disease. Previously, the diagnosis of pulmonary hypertension in children carried a poor prognosis. However, advances in the diagnosis and treatment of pulmonary hypertension over the last decade have markedly improved survival of many patients. A targeted approach includes treatment of the underlying disease, and therefore requires an extensive evaluation. Many of the treatment modalities are based on advanced understanding of basic pulmonary vascular biology.

Adolescence and poverty.

Abstract: Adolescents living in America suffer the triple burden of a disproportionate representation among the poor, a major conflict of developmental challenges and poverty-related challenges, and, frequently, additional challenges accompanying a minority heritage. At the same time, these individuals and the communities in which they live enjoy many strengths. This chapter reviews these and related issues.

Atopic, contact, and seborrheic dermatitis in adolescents.

Abstract: Atopic dermatitis, contact dermatitis, and seborrheic dermatitis are chronic or recurrent inflammatory dermatoses that commonly affect adolescents. They may present a diagnostic and therapeutic challenge for physicians, and can be frustrating for patients. This article reviews the pathogenesis, diagnosis, and management of these diseases.

Skin signs of sexually transmitted diseases in adolescents.

Abstract: Sexually transmitted diseases (STDs) continue to be a significant and prevalent problem among adolescents. One in four sexually active teenagers are infected with one or more STDs. Certain STDs, including gonorrhea, chlamydia, and possibly human papillomavirus infections have the highest prevalence in this age group. The determinants of risk for STDs in adolescence encompass a range of behavioral, biological, and social factors. This review focuses on the skin signs of STDs in adolescents. Recognition of these findings is important since they may represent the most prominent, earliest, or only evidence of an STD. The recognition of the non-AIDs STDs has the added importance of identifying a population at high risk for HIV infection. Although recent data suggest encouraging trends in sexual risk behaviors among high school students in the United States, great challenges remain in the efforts to expand primary and secondary prevention strategies for STDs in adolescents. Expertise in the recognition and treatment of STDs in adolescents remains important for clinicians who care for adolescents.