ISSN:1040-8703    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Noise, pollution, and crowding have long been part of the urban environment. Substance abuse and poverty have come to assert tremendous influences on our inner cities. The health effects of these social factors on urban children include epidemics of human immunodeficiency virus, syphilis, and measles infection; foster care and homelessness; and child abuse and neglect. Asthma, lead exposure, and certain types of injuries also are seen more commonly in poor urban children. The complexity and interactive nature of these problems require comprehensive solutions. Pediatricians must serve as both primary care providers and case managers for these children.

ISSN:1040-8703    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

This review examines recent research on the influence of the family system on children's developmental, behavioral, and emotional difficulties. Family variables represent important contributors to positive development, on the one hand, or significant risks to adjustment on the other. Socioeconomic disadvantage emerges as a strong predictor of an increased vulnerability to a variety of childhood disorders. The effects of low socioeconomic status may be mediated by a variety of mechanisms, including overcrowding, poor parenting, parental depression, family dysfunction, and abuse. General family functioning, marital conflict, divorce, and postdivorce disputes are associated with adjustment difficulties in both boys and girls. Parental psychopathology may increase marital conflict and family dysfunction, and may adversely affect parenting and parent-child relationships. Family dysfunction, marital conflict, and poor parenting may contribute to problems in peer relationships that exert an important influence on children's development. Extrafamily supports, friendships, and peer relationships provide important protective influences that may buffer the effects of adverse family environments.

ISSN:1040-8703    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Recent advances in the study of neurobehavioral outcome following pediatric traumatic brain injury include objective means of assessing the duration of posttraumatic amnesia. Investigations of the impact of injury severity on outcome revealed that mild head injury is not related to global cognitive, academic, or behavioral difficulties. Although declines in adaptive behaviors were present following severe brain injury, a significant increase in behavioral disturbance was not identified on behavior checklists. Moreover, specific posttraumatic behavioral syndromes characterized by overactive and aggressive behaviors were not apparent. Age at injury was not strongly related to outcome; cognitive and motor difficulties were comparable in children and adolescents.

ISSN:1040-8703    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Several factors have contributed to a recent increased emphasis on children's school readiness. Research has more clearly delineated certain adverse influences on school performance; low-birth-weight infants appear to be at increased risk for later learning problems despite apparently normal neurodevelopmental status during the preschool years. Low-level lead exposure is associated with learning disabilities. Meningitis due toHaemophilus influenzaetype b has a more favorable prognosis for school performance than previously believed. Poverty exerts a particularly devastating impact on children's school readiness. Legislative factors, most notably Pub L No. 99–457, have extended early identification and educational intervention services to disabled children from birth onward. The benefits of early educational intervention for disabled children and for those living in environmental risk continue to be documented. The pediatrician can participate meaningfully and effectively in early identification through the process of developmental surveillance. With developmental surveillance, the importance of eliciting parents' opinions and concerns, obtaining a relevant developmental history, and performing skilled, longitudinal observations of children is emphasized.

ISSN:1040-8703    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The management of recurrent pain in children has changed as the methods of the measurement, diagnosis, and treatment of pain have become more sophisticated. Over the past two decades, clinicians have become more aware of the extent of recurrent pain and the amount of disability it causes children, adolescents, and their families. While recurrent pain encompasses pain in the abdomen, limbs, back, and chest, as well as headaches, this review is limited to headache and abdominal pain. Much research remains to be done to elucidate the mechanism of recurrent pain. Nonpharmacologic management is being used more frequently with good results. As measures of pain become better standardized, it will be possible to monitor accurately various forms of management and make better decisions regarding the efficacy and cost-effectiveness of various modalities.

ISSN:1040-8703    

出版商:OVID    

年代:1991

数据来源: OVID

ISSN:1040-8703    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The advent of the 1990s brought to a close a decade of remarkable accomplishments in the medical and surgical treatment of children born with congenital heart disease. One of the most significant advances has been the addition of hypoplastic left-heart syndrome to the list of congenital heart malformations amenable to definitive surgical therapy.

ISSN:1040-8703    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The Fontan operation and its modifications are the appropriate surgical treatment for many forms of complex congenital heart disease. Current literature reviewed for this article advocates use of the Fontan operation in younger patients. There is concern about defining and evaluating the selection process of patients for the Fontan operation in attempting to determine which patients are most likely to survive. Articles on this subject are also part of this review. For certain high-risk patients, a bidirectional caval-pulmonary anastomosis has been advocated, and those reports are reviewed. The perioperative and postoperative assessment of patients after the Fontan operation—including arrhythmias and electrophysiologic findings—have continued to be of interest, and this literature has been reviewed. Other postoperative studies reviewed include magnetic resonance imaging results, exercise response, and effect of menstrual patterns in women. Although the Fontan operation is now widely used, the selection process and postoperative management is still evolving. The articles in this review are not the last needed to fully understand all the ramifications of this innovative operation.

ISSN:1040-8703    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The clinical experience with intravascular stenting of arterial stenosis found to be resistant to balloon angioplasty is small, although preliminary results are encouraging. Most experience is with the Palmaz-Schatz (Johnson & Johnson Interventional Systems, Warren, NJ) stainless steel stent, a device characterized by high expansion ratio, low thrombogenicity, and high patency rates. Anticoagulation is essential to ensure an ideal flow surface so as to optimize patency. Clinical results so far have suggested that stents will play an important role in the management of arterial stenosis, with perhaps a greater applicability in the setting of pulmonary artery than pulmonary vein or conduit obstruction.

ISSN:1040-8703    

出版商:OVID    

年代:1991

数据来源: OVID