Current problems in pediatric and adolescent health care
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Curr Probl Pediatr Adolesc Health Care · Sep 2012
ReviewNail disorders as signs of pediatric systemic disease.
Herein, we describe some of the more common changes in the nail unit that can be seen in systemic diseases in children. Changes that can be seen are not limited to those discussed in the following pages. ⋯ When evaluating a pediatric patient with a nail disorder, it is important to perform a complete physical examination of the skin and oral mucosa, as other clues to the diagnosis of the nail problem may be found. A comprehensive family history is also important to uncover possible syndromic associations with nail disease or diseases that can manifest with nail changes.
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Curr Probl Pediatr Adolesc Health Care · May 2012
Review Historical ArticlePediatric hospital medicine: historical perspectives, inspired future.
Pediatric hospital medicine (PHM) is in an accelerated growth phase. Multiple elements have combined to affect the current state of the field. PHM is similar to other geographic specialties such as pediatric emergency medicine and pediatric critical care that deliver general, comprehensive care to patients based on hospital site. ⋯ Further decisions regarding scope and demonstration of competencies are important to make with clarity of purpose. Pediatric hospitalists are advancing child health in the inpatient setting through evidence-based care, research, education, clinical excellence, advocacy, and health care business acumen. With a strong community sense and leadership evident, PHM has a bright future.
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Curr Probl Pediatr Adolesc Health Care · Jan 2012
ReviewThe role of polysomnography in diagnosing and treating obstructive sleep apnea in pediatric patients.
Obstructive sleep apnea in children is associated with serious neurocognitive and cardiovascular morbidity, systemic inflammation, and increased health care use, yet remains underdiagnosed. Although the prevalence of obstructive sleep apnea is 1-3% in the pediatric population, the prevalence of primary snoring (PS) is estimated to be 3-12%. ⋯ The validity of polysomnography as the gold standard for diagnosing obstructive sleep apnea has been challenged, primarily related to concerns that abnormalities on polysomnography do not correlate well with adverse outcomes, that those abnormalities have statistical more than clinical significance, and that performing polysomnograms on all children who snore is a practical impossibility. The aim of this article is to review the clinical utility of diagnostic tests other than polysomnography to diagnose obstructive sleep apnea, to highlight the limitations and strengths of polysomnography, to underscore the threshold levels of abnormalities detected on polysomnography that correlate with morbidity, and to discuss what the practical implications are for treatment.
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Curr Probl Pediatr Adolesc Health Care · Sep 2011
ReviewGlobal teens and tobacco: a review of the globalization of the tobacco epidemic.
Worldwide, the burden of suffering to children caused by tobacco does not just originate from exposure to tobacco smoke or smoking, but includes exposure to tobacco-friendly media, poverty associated with money spent on tobacco, increased incidence of tobacco-related fires, and the harms related to child labor in tobacco cultivation. Despite global efforts through human rights acts, the Framework Convention on Tobacco Control, and the MPOWER report, tobacco use continues to accelerate in most countries. While the efforts that have been taken, such as smoking bans in public, are worthy actions, not enough is being done to protect children and teens. More can be done at the policy level, by individuals, and by health care providers.
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Curr Probl Pediatr Adolesc Health Care · Aug 2011
The Patient Protection and Affordable Care Act: an opportunity to address barriers that impact pediatric practice.
Pediatricians are uniquely positioned to partner with parents as they rear and nurture their young children. This article addresses the barriers that influence the pediatrician's ability to engage in developmental guidance during regular well-child visits. ⋯ Recent changes in the public policy arena provide an opportunity to overcome barriers. Specific provisions are described within the Patient Protection and Affordable Care Act that have the potential to enhance opportunities to address social and emotional development through the provision of developmental guidance to parents with very young children.