Medical crisis intervention with children and adolescents with chronic pain.

A specific application of medical crisis counseling (Pollin 1994, 1995)—a time-limited, clinical intervention for individuals with a chronic illness—is presented for work with children and adolescents who are experiencing chronic pain. Particular emphasis is placed on the meaning patients make of their illness experience and the role of explanatory models of chronic pain in shaping the psychosocial experience of patients. An integrated biological and psychosocial approach to understanding and treating pain is emphasized. A conceptual framework and set of strategies for treating chronic pain and addressing the common fears and concerns that arise for patients are described. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nutritional intervention and growth in children with chronic renal failure

During fifties there were at most few tens of persons in this country who believed in the future of computers and cybernetics. One group of such enthusiasts, headed by Antonín Svoboda, was working at a construction of the first Czech computer SAPO. The other group tried to analyse, anticipate, and prepare in advance various applications for the new systemic conceptions and for the information processing machines. Members of both groups met for discussions which opened prospects to the future and influenced many of other activities for a long time. At the early sixties, the Czechoslovak Cybernetic Society was established at the Czechoslovak Academy of Sciences and in 1962 the Main Problem Committee for the Medical Cybernetics was founded at the Department of Health. It coordinated majority of the research programmes in the medical cybernetics and informatics. In 1967-1969 the Committee prepared an extensive project of a medical information system (ZIS), but its accomplishment was finally blocked by the then authorities. However, interests for that topics kept growing and the new working places equipped with available computer technology were formed at the health and clinical centres. The first tentative lectures in medical cybernetics and biocybernetics at our faculty were introduced into the students curricula in the late sixties. Thematically, medical cybernetics subsequently differentiated into the medical informatics, simulations of biological and medical systems, and the biosignal analysis. The growing interest enabled to hold conferences since the middle of seventies, some of which were held periodically, sometimes with international participation. It is not possible in brevity to include the whole spectrum to those goal-directed activities nor to appraise adequately their future significance.     

Familial combined hyperlipidemia: detection and characterisation of the hyperlipidemic profile among children and adolescents

BACKGROUND: Familial combined hyperlipidemia is the commonest genetic form of hyperlipidemia among survivors of myocardial infarction and, therefore, its early detection is crucial for the prevention of coronary artery disease. The aim of the study was to establish the prevalence of hyperlipidemia in the offspring of affected families and to characterize their lipid, lipoprotein and apolipoprotein profile. PATIENT AND METHODS: Forty five subjects below the age of 19 were studied from which 30 were from affected families and 15 from healthy control families. Cholesterol and triglycerides in plasma, VLDL, IDL, LDL and HDL as well as apolipoproteins AI, B, C-II and C-III were measured. RESULTS: Hyperlipidemia was detected in 13 children (43%) from affected families. They also presented significantly elevated concentrations of cholesterol in plasma (p < 0.0001), LDL (p < 0.0001) and HDL (p < 0.05); triglycerides in plasma (p < 0.007), VLDL (p < 0.05) and LDL (p < 0.008), together with significantly increased concentrations of apolipoproteins AI (p < 0.02), B (p < 0.0004), C-II (p < 0.0005) and C-III (p < 0.03). No changes were observed in the IDL fraction. CONCLUSIONS: There is an elevated prevalence of hyperlipidemia among the offspring of patients with familial combined hyperlipidemia. On the contrary to that observed in adults, no alterations of the IDL fraction are present among affected children.     

Family problem solving versus home notes as early intervention with high-risk children.

Assigned 69 2nd–6th graders, identified as inconsistent because of extreme variability over baseline in math class work, to a home-note, family problem-solving, or control condition. Teachers scored Ss' math daily and sent home a Good-News Note with Ss in both intervention conditions when their daily means equaled or exceeded their baseline means. Ss in the family problem-solving condition wrote contingency contracts with their families, guided by a problem-solving board game, specifying consequences for receipt of Good-News Notes. Families in the home-note condition were instructed by letter to deliver favorable consequences on receipt of Good-News Notes. Compared to no treatment both forms of intervention significantly reduced class work scatter. Whereas Ss in the control and home-note conditions became less accurate during intervention, Ss in the family problem-solving condition maintained their accuracy. Only Ss in the family problem-solving condition demonstrated generalization to nonreinforced intervention probes. Involvement of the family meant that children produced high quality work even when their classmates' work dropped in quality and that they worked hard even when they expected no reward. (9 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of stature growth curves in children and adolescents

During the period 1988-1966, 737 pregnancies, in which the infant birth weight was > or = 4000 grams were studied. During the same period there were 11,631 newborns, and 6.3% of them were infants with a birth weight > or = 4000 grams. Normal vaginal delivery occurred in 583 cases (79.1%), vacuum extraction in 24 cases (3.3%) and caesarean section in 130 cases (17.6%). Regarding the caesarean section, 38 (29.2%) of them were elective and 92 (70.8%) were done in different periods of the labour. In these macrosomic babies perinatal death never occurred, but different pathological neonatal outcomes were observed and the majority of these were clavicle abruptions (39 cases: 5.3%). Maternal morbidity observed in the 607 (82.4%) cases with vaginal delivery is characterized by: 60 cases (9.8%) of vaginal and perineal tears, 4 cases (0.6%) of cervical tears, and 2 cases (0.3%) of pubic symphysis traumatic diastasis. Shoulder dystocia is the most likely outcome in fetal macrosomic delivery; for this reason we considered the diagnostic and therapeutic management of this obstetrical complication. Because the normal outcome of neonatal births actually encourages the preference for normal vaginal delivery, we concluded that mothers with macrosomic fetuses can safely be managed expectantly unless there is a high maternal and fetal risk.     

Behavioral and cognitive effects of a moral reasoning development intervention for high-risk behavior-disordered adolescents.

Because delinquents have consistently been shown to function at lower stages of moral reasoning than nondelinquents, it was hypothesized that adolescents at risk for juvenile delinquency would benefit both cognitively and behaviorally from an intervention designed to accelerate moral reasoning development. Subsequent to participation in a cognitively based moral reasoning development program (16–20 weekly 45-min sessions), 24 White 13–17 yr olds identified by teachers as aggressive and/or disruptive (compared with 24 matched and randomly assigned nonparticipating White controls) demonstrated (a) advance in moral reasoning stage and (b) improvement on several behavioral indices, including behavior referrals, tardiness, academic performance, and police/court contacts. (Results approached significance for teacher ratings). For a subgroup, 1-yr follow-up data show significant effects for moral reasoning, behavior referrals, and academic performance, as well as teacher ratings and absenteeism. Moral reasoning change scores were associated with all outcome change scores for pre- to posttest and with grades for posttest to follow-up. (32 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological intervention and medical utilization in children and adolescents of low-income families.

Studied the effect on medical utilization when psychological care was provided to 63 children and adolescents whose low-income families were members of a completely subsidized health program. Comparisons of medical visits were made over a 2-yr period for 3 groups: a treatment group of registrants receiving psychological services; a control group matched with the treatment group according to age, sex, ethnicity, medical utilization, and psychological distress; and a group matched only by age, sex, and ethnicity. Results indicate that registrants who received psychological treatment had significant decreases in overall medical utilization, whereas there were no decreases in the other 2 groups. Findings are consistent with earlier research but extend the pattern of results into younger populations as well as low-income families. (8 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Fatigue in children and adolescents with cancer

Mitochondrial DNA (mtDNA) forms a semi-autonomous asexually reproducing genome in eukaryotic organisms. It plays an essential role in the life cycle through the control of energy production, by the inherently dangerous process of oxidative phosphorylation. The asymmetric nature of its inheritance--almost exclusively through the female--imposes different evolutionary constraints on males and females, and may lie at the heart of anisogamy. This review examines the implications of recent findings on the biology of mtDNA for reproduction and inheritance in mammals.     

Self-generated drug outcomes in high-risk adolescents.

The perceived outcomes of drug use were studied in a sample of high-risk adolescents. Participants' self-generated responses provided the actual words they used to describe drug outcomes as well as associative frequency norms valuable for future research. The authors also compared outcomes in terms of class of outcome (positive vs. negative) and class of drug (alcohol, marijuana, cigarettes, cocaine, speed, and LSD). Although the studied drugs have divergent pharmacological effects. participants self-generated some of the same outcomes (e.g., relaxation) across some of the drugs. In addition, outcomes self-generated as positive outcomes were very rarely also self-generated as negative outcomes. Finally, regressions revealed that self-generated responses were not predicted by ethnicity, gender, or previous drug use. Many drug use outcomes thus appeared to be available in memory regardless of previous drug use or other characteristics. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Normal growth hormone secretion in growth hormone insufficient children retested after completion of linear growth

Tuberculosis of the cervical spine is rare, comprising 3-5% of cases of tuberculosis of the spine. Eight patients with tuberculosis of the cervical spine seen during 1989-1992 were reviewed. They all presented with neck pain. The 4 children presented with a kyphotic deformity. In all the children the disease was extensive, with a large prevertebral abscess formation, while in the adults it was localised to one or two motion segments. Cord compression was present in 4 of the 8 patients. All the patients were treated with antituberculosis drugs and 6 underwent surgery. There was full neurological recovery in all patients. The kyphosis was improved though not fully corrected. There was a problem in stabilisation of severe involvement of the body and dens of C2. Surgery seems to play a major role in the treatment of tuberculosis of the cervical spine.     

Stress and dietary practices in adolescents.

Baseline data from the Health and Behavior in Teenagers Study (HABITS) were used to investigate associations between stress and dietary practices in a socioeconomically and ethnically diverse sample of 4,320 schoolchildren (mean age=11.83 years). Male (n=2,578) and female (n=1,742) pupils completed questionnaire measures of stress and 4 aspects of dietary practice (fatty food intake, fruit and vegetable intake, snacking, and breakfast consumption) and also provided demographic and anthropometric data. Multivariate analyses revealed that greater stress was associated with more fatty food intake, less fruit and vegetable intake, more snacking, and a reduced likelihood of daily breakfast consumption. These effects were independent of individual (gender, weight) and social (socioeconomic status, ethnicity) factors. Stress may contribute to long-term disease risk by steering the diet in a more unhealthy direction. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dietary treatment and growth of hyperchylomicronemic children severely restricted in dietary fat

BACKGROUND AND OBJECTIVES: A 9-year-old boy with a history of poorly controlled insulin-dependent diabetes mellitus was found at home unresponsive. QT prolongation was diagnosed on inspection of Holter monitoring performed immediately before episodes of ventricular fibrillation. METHODS: In spite of medical management with propranolol, esmolol, phenytoin, and diazepam, the patient continued to have episodes of QT prolongation followed by ventricular dysrhythmias that reverted to sinus rhythm only after cardiopulmonary resuscitation and cardioversion. RESULTS: A series of left stellate ganglion blocks with bupivacaine eradicated the dysrhythmias. The child was then referred to another institution for insertion of an automatic internal cardioverter defibrillator. CONCLUSIONS: This case report emphasizes the effectiveness of left stellate ganglion block with bupivacaine in a child with a variant of long QT syndrome.     

Psychopathology in children and adolescents with developmental disorders

Children and adolescents with developmental disorders suffer from a wide range of psychopathology. However, there are no published studies examining this subject exclusively in this population using recent diagnostic criteria. The primary purpose of this paper is to report on the diagnosis encountered in a clinical setting using DSM-III-R. The medical records of all individuals assessed in a specialized program during a 1-year period were reviewed looking at their demographic features, diagnoses, and target behaviors. Our sample consisted of 233 subjects and contained significantly more boys than girls. The most common psychiatric diagnoses were oppositional defiant disorder and attention deficit hyperactivity disorder. Pica, organic mental disorder NOS, and Autistic Disorder were more often encountered in individuals with low intellectual functioning. Depressive disorders, posttraumatic stress disorder, and developmental speech/language disorders were diagnosed more in high functioning subjects. The most common symptom was impulsivity. This retrospective study highlights the need for more rigorous examination of current diagnostic concepts and criteria in children and adolescents with developmental disorders. Prospective studies should be conducted with standardized instruments in clinics and community samples to provide more information on psychiatric disorders in this population.     

Quality-of-life assessment in children and adolescents with asthma

Health-related quality of life has become an essential part of health outcome measurement in chronic disorders. However, it is only recently that health professionals have focused on quality-of-life assessment in children and adolescents. Several generic, as well as the asthma-specific quality-of-life instruments specifically designed for use in children and adolescents are reviewed in this article with particular regard to the conceptual and methodological features of the measures and their applicability in clinical studies. The recently published Child Health Questionnaire is a useful generic instrument to comprehensively assess quality of life, in particular when comparing young people with different chronic disorders. The Pediatric Asthma Quality-of-life Questionnaire has shown responsiveness to change over time, but it lacks age-specificity with regard to psychosocial issues and comprehensiveness of quality-of-life assessment. In contrast, the Childhood Asthma Questionnaire provides three different versions for different target ages. However, its generic part is not reflective of the respondent's health status. The other asthma-specific instruments have major conceptual deficiencies when used as a single measure for quality-of-life assessment. In the absence of a single ideal instrument, the use of batteries of quality-of-life instruments is therefore recommended and further research is required to identify the impact that age and developmental status have on quality-of-life assessment.     

Longitudinal outcomes of young high-risk adolescents with imaginary companions.

The creation and cultivation of an imaginary companion is considered to be a healthy form of pretend play in early childhood, but there tends to be a less positive view of older children who have them. To test the extent that having an imaginary companion in middle school is associated with positive or negative outcomes, an ethnically diverse sample of 152 middle school children at high risk for developing problem behaviors were interviewed about imaginary companions, coping styles, and problem behaviors. Although having a current imaginary companion (n = 13) was associated with using more positive coping strategies, peer nomination data indicated that these children had low social preference with peers. In addition, our data indicated that these children were perceived by their parents as having more problem behaviors compared with young adolescents who never had imaginary companions (n = 108) or children who had imaginary companions in the past (n = 31). However, a longitudinal follow-up at the end of high school indicated that the children who had imaginary companions in middle school showed greater positive adjustment on a multiple-indicator adjustment construct. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preventing HIV infection and AIDS in children and adolescents: Behavioral research and intervention strategies.

This article focuses on pediatric and adolescent AIDS. Literature is reviewed on the incidence of AIDS in various age groups, highlighting differences in demographic patterns among pediatric, adolescent, and adult AIDS cases. Behaviors that increase the likelihood that a child or adolescent will contract AIDS, as well as prevention strategies that target the prevention of human immunodeficiency virus (HIV) infection, are discussed. Finally, recommendations are made for social science research directed toward altering behavior associated with HIV. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trichobezoars in children and adolescents

BACKGROUND: Trichobezoars are composed of hair or fibres. The typical patient presenting with a trichobezoar is an adolescent girl experiencing mental disturbance or retardation. CASE REPORT: Three girls with trichobezoars were seen. Two of them, 4 and 15 years old, had serious digestive antecedents (corrosive oesophagogastritis and oesophageal atresia, respectively) and had undergone previous surgery. The third was a 13-year-old mentally retarded girl. In two cases, an enzymatic dissolution trial was unsuccessful, requiring secondary surgical removal after, in one case, ineffective gastroscopic removal complicated by an oesophageal perforation. The third child had an initial operative removal. DISCUSSION: Serious digestive antecedents may favour bezoars, a diagnosis that must be evoked in such patients presenting with chronic digestive symptoms. Enzymatic dissolution is ineffective for large bezoars, and gastroscopic removal carries some risks such as perforation or intestinal obstruction. Operative removal is usually indicated. Psychiatric follow-up is needed to prevent this complication in children with serious digestive antecedents and to reduce the risk of recurrences.     

Syncope in children and adolescents

OBJECTIVES: The objectives of this study were to 1) define the incidence of syncope coming to medical attention among children and adolescents, 2) determine the outcome of syncope in these patients, and 3) determine changes over time in the evaluation and charges for evaluating this problem. BACKGROUND: Syncope occurs commonly in children and adolescents. However, the mid- and long-term outcome of children and adolescents who experience syncope is unknown. METHODS: Utilizing the Rochester Epidemiology Project, we determined the incidence, outcome and charges for medical evaluation for patients seeking medical attention for syncope during an early 5-year period (1950 to 1954) and a more recent 5-year period (1987 to 1991). RESULTS: The incidence of syncope coming to medical attention was 71.9 and 125.8/100,000 population for the early and more recent cohort, respectively. The incidence was higher for female than for male patients. The incidence peaked in 15- to 19-year old patients. Acute illness and noxious stimuli were associated with 24% and 23% of the episodes, respectively. Although long-term survival was not different from that of the general population, one child died suddenly, and another had hereditary prolonged QT interval syndrome. These were two of only six patients who had exertional syncope. Total charges for evaluation of syncope were similar in the two time periods. However, charges for testing procedures were greater for the more recent cohort. CONCLUSIONS: In general, syncope in children and adolescents is a benign event. Syncope occurring during exercise may identify patients with a potentially fatal condition. Detailed evaluation should be considered for patients who have syncope during exercise or who have a family history of syncope, sudden death, myocardial disease or arrhythmias. It may be prudent to obtain an electrocardiogram for all patients who seek medical attention for syncope.