Health care issues as the child with chronic illness transitions to adulthood. (Editorial).In this continuing medical education continuing medical education See CME. section, I have invited experts in pediatric pediatric /pe·di·at·ric/ (pe?de-at´rik) pertaining to the health of children.
Of or relating to pediatrics. newborn medicine, hematology/oncology, behavioral developmental pediatrics, and pediatric endocrinology to contribute articles centered on the transition of the youngster with a chronic health care need from pediatric-centered to adult-centered care. Our therapeutic successes in newborn medicine and hematology/oncology have resulted in an increased proportion of young adults with the medical consequences of either prematurity or a childhood malignancy. By contrast, in behavioral developmental pediatrics and endocrinology, changes in lifestyle have resulted in an epidemic of youngsters and adolescents with attention-deficit/hyperactivity disorder (ADHD Attention-Deficit/Hyperactivity Disorder (ADHD) Definition
Attention-deficit/hyperactivity disorder (ADHD) is a developmental disorder characterized by distractibility, hyperactivity, impulsive behaviors, and the inability to remain focused on tasks or ) and a rise in the incidence of childhood obesity childhood obesity Public health Overweight in a child, an average BMI of ≥ 85% for age and sex; ≥ 95% for age and sex is very obese. See Body-mass index, Obesity. Cf Adult obesity. and subsequent type 2 diabetes mellitus Type 2 diabetes mellitus
One of the two major types of diabetes mellitus, characterized by late age of onset (30 years or older), insulin resistance, high levels of blood sugar, and little or no need for supple-mental insulin. . The articles in this section provide guidelines for the practitioner who cares for these youngsters as they progress from pediatric care to adult care.
In the past 30 years, dramatic improvements have been made in the cure rate for childhood cancers, with 75% to 80% of youngsters with acute lymphocytic leukemia acute lymphocytic leukemia
See acute lymphoblastic leukemia.
acute lymphocytic leukemia Acute lymphoblastic leukemia, ALL A malignant lymphoproliferative process that commonly affects children and young adults now cured. (1) Since the estimated cure rate for all childhood cancer exceeds 60%, 1 of 1,000 young adults in the age range of 20 to 29 years is now a survivor of a childhood malignancy. (2,3) In the article by Castellino and Hudson (elsewhere in this issue), a review of late effects of specific treatment modalities serves as an instruction module for long-term follow-up by the internist and family physician of young adults who have survived intensive chemotherapy, radiation, and/or surgery for a childhood malignancy. Anticipatory guidance for reducing risk behavior, including efforts at smoking cessation smoking cessation Public health Temporary or permanent halting of habitual cigarette smoking; withdrawal therapies–eg, hypnosis, psychotherapy, group counseling, exposing smokers to Pts with terminal lung CA and nicotine chewing gum are often ineffective. , increased physical activity, and improvements in nutrition, seems especially important in this group.
Recommendations for specific emphasis on endocrine, cardiac, and pulmonary late effects are predicated by the type of previous treatment. Accelerated atherosclerotic cardiovascular disease Cardiovascular disease
Disease that affects the heart and blood vessels.
Mentioned in: Lipoproteins Test
cardiovascular disease and the increased incidence of breast cancer now seen after thoracic radiation therapy should alter routine surveillance for young adults who survive chest wall malignancies or Hodgkin's disease Hodgkin's disease, a type of cancer of the lymphatic system. First identified in 1832 in England by Thomas Hodgkin, it is a type of malignant lymphoma. Incidence peaks in young adults and the elderly. . The authors' overall emphasis on ideal habits of nutrition, exercise, weight control, and smoking cessation are integral to the long-term obviation of late effects in these young adults.
In newborn medicine, the limits of viability of the premature infant have been significantly lowered over the past 3 decades with improved perinatal care, advances in neonatal intensive care management, and the development of surfactant replacement therapies. (4,5) Elsewhere in this issue, York et al review the neurocognitive, cardiopulmonary, gastrointestinal, ophthalmologic, and audiologic late effects on survivors of prematurity, and highlight areas of increased emphasis for surveillance by the primary care physician.
Attention-deficit/hyperactivity disorder is among the most commonly recognized behavioral disorders of childhood and results in immediate health care costs that mirror the costs of treating a child with asthma. (6) The prevalence of ADHD in adolescents has been underestimated, and this is a difficult primary diagnosis in the adolescent or young adult with comorbidities that frequently mask this diagnosis. (7) It has now been documented that a higher proportion of youngsters with ADHD grow into adulthood with persistent ADHD symptoms, often associated with suboptimal Suboptimal
A solution is called suboptimal if a part of the solution has been optimized without regards to the overall objective. social function, poor occupational achievement, and increased potential for abusing drugs. (7,8) Stern et al, in this special section, review the difficulties inherent in making the diagnosis of ADHD, not only in the child or adolescent, but also in the young adult. Although there are consensus guidelines for both the diagnosis and treatment of the school-aged child with ADHD, (9,10) the long-term role of drug, behavioral, or combination intervent ions for the adolescent or young adult has not been firmly established. (7,8,11) For the primary care parctitioner challenged by the young adult with a previous ADHD diagnosis, we probably have more questions than we have answers.
Finally, Beck et al (elsewhere in this issue) have addressed the management of another emerging social morbidity, childhood obesity with type 2 diabetes type 2 diabetes
See diabetes mellitus. . As a consequence of the rise of the fast-food industry and of changes in family dynamics dictating that both parents work, childhood obesity has risen to epidemic proportions, with a concomitant increase in the incidence of childhood type 2 diabetes. (12,13) As pediatricians and as primary care providers, we must find effective means for better nutrition and weight control, not only for the overweight child, but also for the entire family. Beck et al (elsewhere in this issue) review the specific therapeutic options for the adolescent/young adult with type 2 diabetes. Whether our medical interventions will impact on the renal, ophthalmologic, and cardiovascular complications of long-term type 2 diabetes will require extended, prospective follow-up studies. To prevent this disease, we need to engage our entire community to emphasize increased physical activity and healthy nutrition for all children. (13)
David K. Kalwinsky, MD FAAP FAAP Fundação Armando Álvares Penteado (University from São Paulo - Brazil)
FAAP Fellow of the American Academy of Pediatrics
FAAP Framework for African Agricultural Productivity
FAAP Food Allergy Action Plan
FAAP Federal-Aid Airport Program
Department of Pediatrics
East Tennessee State University East Tennessee State University (ETSU) is an accredited American university, founded October 21911 and located in Johnson City, Tennessee. It is part of the Tennessee Board of Regents system of colleges and universities. College of Medicine
PO Box 70578
Johnson City, TN 37614-1708
(1.) Pui C-H, Evans WE: Acute lymphoblastic leukemia acute lymphoblastic leukemia
n. Abbr. ALL
Lymphoblastic leukemia occurring mainly in older adults, characterized by rapid onset and progression of symptoms. Also called acute lymphocytic leukemia. . N Engl Med 1998; 339:605-615
(2.) Marina N: Long-term survivors of childhood cancer. Pediatr Clin North Am 1997; 44:1021-1042
(3.) Meadows AJ, Hobbie WL: The medical consequences of cure. Cancer 1986; 58:524-528
(4.) Richardson DK, Gray JE, Gortmaker SL, et al: Declining severity adjusted mortality: evidence of improving neonatal intensive care. Pediatrics 1998; 102:893-899
(5.) Lee K-S K-S Kolmogorov-Smirnov (statistical test) . Khoshnood BK, Wall SN, et al: Trend in mortality from respiratory distress syndrome respiratory distress syndrome
or hyaline membrane disease
Common complication in newborns, especially after premature birth. Symptoms include very laboured breathing, bluish skin tinge, and low blood oxygen levels. in the United States. J Pediatr 1999; 134:434-440
(6.) Chan E, Zhan C, Homer CJ: Health care use and costs for children with attention-deficit/hyperactivity disorder. Arch Pediatr Adolesc Med 2002; 156:504-511
(7.) Baren M: ADI-ID in adolescents: will you know it when you see it? Contem Pediatr 2002; 19:124-143
(8.) Elia J, Ambrosini PJ, Rapoport JL: Treatment of attention-deficit/hyperactivity disorder. N Engl J Med 1999; 340:780-788
(9.) Homer CJ, Boltz RD, Hickson GB, et al: Clinical practice guidelines clinical practice guidelines Clinical policies, practice guidelines, practice parameters, practice policies Medtalk Systematically developed statements to assist practitioner and Pt decisions about appropriate health care for specific clinical circumstances. See Psychology. diagnosis and evaluation of the child with attention-deficit/hyperactivity disorder: Pediatrics 2000; 105:1158-1170
(10.) American Academy of Pediatrics The American Academy of Pediatrics ("AAP") is an organization of pediatricians, physicians trained to deal with the medical care of infants, children, and adolescents. Its motto is: "Dedicated to the Health of All Children. : Clinical practice guideline: treatment of the school-aged child with attention-deficit! hyperactivity disorder. Pediatrics 2001; 108:1033-1044
(11.) Zametkin AJ, Ernst M: Problems in the management of attention-deficit/hyperactivity disorder. N Engi] Med 1999; 340:4046
(12.) Schlossea E: Fast Food Nation. Boston, Houghton Mifflin Co, 2001, pp 239-243
(13.) Rocchini AP: Childhood obesity and a diabetes epidemic. N Engl J Med 2002; 346:854-855
(14.) Rosenbloom A, Arslanian S, Brink S: Type 2 diabetes in children and adolescents. Pediatrics 2000; 105:671-680