Substance abuse is a major health problem in the United States. Drug abuse has increased significantly in the adolescent age group since 1990, particularly among those in grades 8 to 12. About 20% of youth admit to drinking alcohol before age 13. Approximately one third of teenagers admit to binge drinking. Drinking and driving is one of the reasons why motor vehicle accidents are the major cause of death in this age group in the United States.
Marijuana is the Most Commonly Abused Drug
While marijuana is the most commonly used illicit drug in the adolescent age group, other abused substances include ecstasy, hallucinogens such as LSD, opioids, cocaine, and stimulants. Even over-the-counter medications like the cough suppressant dextromethorphan can be abused. Drugs intended to treat Attention Deficit / Hyperactivity Disorder (ADHD) are used by a significant number of teens to boost their school performance, although there is no evidence that they make any difference.
Risk Factors for Drug Abuse
There are a number of factors that may contribute to determining whether a child will abuse drugs or not. The presence of a mood disorder, criminal activity or a family history of drug abuse are all risk factors for drug abuse in children. On the other hand, children who have close parental supervision, a good relationship with their parents, good self-esteem, and involvement in social and religious activities are less likely to abuse drugs.
Getting Help
It is important to recognize drug abuse in adolescents and to get help for these individuals, starting with a visit to your primary care physician. You should suspect drug abuse when there is a change in mood or behavior (including changes in sleeping and eating habits), academic difficulties, increased family conflict or the presence of risky behaviors. A urine drug screen can be useful in confirming drug use. More information on treatment referral is available at: http://www.Drug-Rehab.org.
Mosquitoes are much more than just annoying insects that cause itchy bumps which last a few days and then clear up. In reality, the number of individuals suffering illness and death as a result of diseases transmitted by mosquitoes is staggering. More than one million people throughout the world die from mosquito borne illnesses each year. Mosquitoes transmit diseases from one human or animal to another human by ingesting a virus or small parasite along with a blood meal. The virus or parasite then replicates within the mosquito without harming it and is passed onto another individual when the mosquito bites it. With the increase in international travel, all of us are susceptible to mosquito borne illnesses.
Diseases Caused by Mosquitoes
West Nile Virus is one of several viral diseases transmitted by mosquitoes. These arboviruses can cause brain inflammation or encephalitis. West Nile virus first appeared in the United States in 1999 and spread rapidly over the next several years. Patients may only have flu-like symptoms such as fever, headache, fatigue and muscle aches lasting several days to weeks, but many patients have symptoms lasting more than 30 days. In its most severe life-threatening form, the virus invades the brain and the membranes around it.
Malaria is an infectious disease caused by several species of Plasmodium, which is a one-celled parasitic protozoan. When an infected mosquito bites a human the parasite is introduced into the blood stream where it travels to the liver and reproduces. Symptoms of malaria include fever and headache and the infection can progress to coma and death. Malaria occurs mostly around the tropical equatorial regions of the world, especially in Africa, but also in Asia and South America. Malaria is treated with medications and it is recommended that travelers to endemic areas take antimalarial prophylaxis medication.
Dengue Fever is caused by a virus that is related to the ones that cause yellow fever and West Nile virus. While most people infected with the dengue virus are asymptomatic or have only minor symptoms, such as fever, a small percent of infected individuals will have more severe illness, characterized by sudden onset of headache, a measles-like rash and pain in the muscles and joints, giving it the name ‘breakbone fever’. In about 5 percent of infected individuals, the disease will progress to a serious phase characterized by fluid accumulation in the tissues, bleeding, especially in the GI tract, shock and sometimes death. Treatment is supportive. The incidence of dengue fever has increased dramatically during the last fifty years and the distribution again follows the tropical regions around the equator, affecting Africa, Asia and the Americas.
Yellow Fever is an acute hemorrhagic disease transmitted by the bite of a mosquito. It occurs mainly in the tropical regions of Africa and South America. Symptoms include fever, chills, loss of appetite, nausea, headache and muscle pain, most noticeable in the back. In more severe cases, the liver is affected causing jaundice and giving the disease the name ‘yellow fever’. In some cases the liver damage and increased tendency to bleed can lead to death. While there is no specific therapy for yellow fever, a safe and effective vaccine is available.
Elephantiasis, commonly mispronounced ‘elephantitis’, is caused by microscopic worms that are transmitted by mosquito bites. It generally occurs in Africa and other tropical regions. The filarial worms live in the lymphatic system where they block drainage and can cause dramatic thickening and swelling of the skin, particularly in the legs and genitals.
Our Individual Responsibility to Help Control Mosquitoes
There are a number of measures that can be taken to avoid mosquito bites. These simple steps can be particularly useful in the early evening and nighttime when mosquitoes are most active. Wearing long sleeve shirts, using repellant and netting and maintaining secure screens on your house are especially important considerations. Beyond that, we all have a responsibility to eliminate the favorite breeding ground of mosquitoes…stagnant or still water. Careful attention to making sure that pots, fountains, rain gutters, buckets, cans, bird baths, swimming pool covers and unused tires are drained is one of the most important aspects of mosquito control.
Stagnant Water…the Favorite Breeding Ground of the Mosquito
Anyone who lived through the U.S. polio epidemic of the early 1950s has an understanding of this dreaded viral disease which can cause paralysis and death. They will also have a tremendous appreciation for the vaccines that finally brought it under control. Almost everyone at that time knew someone who had been touched by this infection, which can have sequelae ranging from a residual limp to confinement for years in an iron lung or even death. While there are still a few polio victims of the 1950s using iron lungs, this device has largely been replaced by positive pressure airway ventilators which allow for greater mobility. Because children were particularly targeted, this disease was also known as infantile paralysis. Back in the 1950s children were often warned to stay out of pools in the summertime or even to stay indoors away from other people altogether. Parents worried about every little complaint their children had that might possibly be an indication of polio, such as fever, sore throat or headache. There had been many polio epidemics throughout history, but the one that got everyone’s attention reached its peak in 1952 when there were 59,000 cases of paralytic polio reported in the United States, with outbreaks reported in every state. By the late 1950s, with help from money raised by the March of Dimes, vaccines were developed first by Jonas Salk (injectable) and then by Albert Sabin (oral) which virtually eradicated polio as a public health threat in the developed world.
The Polio Virus
Polio or poliomyelitis is caused by an enterovirus of serotypes 1, 2 or 3 which invades the brain and spinal cord. It occurs only in humans and is transmitted by the fecal-oral or respiratory routes. It can be transmitted through contaminated water or food or through direct contact with an infected individual. It is so contagious that if you lived in the same household with someone with polio it was very likely that you would become infected. An infected individual can shed the virus in their feces for weeks. Most poliovirus infections (95%) are asymptomatic, but 4 to 8% of patients will exhibit minor symptoms such as low grade fever, sore throat, fatigue, nausea, headache, stiff neck or pain in the limbs. Most of the time these symptoms resolve completely. Less than 1% of patients with polio will experience permanent paralysis, usually of the lower limbs and, of these, about 5 to 10% will die as a result of involvement of the respiratory muscles.
Efforts to Eradicate Polio Worldwide
There is no cure for polio, so immunization is the only way to protect yourself from this potentially serious infection. It was entirely because of the polio vaccination that the most feared disease of the 20th Century was eradicated from the United States by 1979. Unfortunately, polio still exists today in other parts of the world such as Africa and the Middle East. While much progress has been made in ridding the rest of the world of polio there are still a handful of countries that are considered to be endemic for this infection, but this is still a significant reduction from the 125 countries which reported cases in 1988. Several international health agencies are working together to completely eradicate polio from the world by 2018. While only the injectable inactivated poliovirus (IPV) vaccine is used in the United States now, the live oral poliovirus vaccine (OPV) will continue to be used in other parts of the world in the near future due to its ease of administration and low cost.
http://youtu.be/eqGvDwzerNs
A Stunning Success Story
The benefits provided by vaccinations are one of the most important achievements in public health during our lifetime. The eradication of polio from the United States is just one example of how vaccinations have benefited everyone in our country and we can all be proud of our wonderful health care system which has fostered innovations such as this. To keep this legacy of success going, infants and children should receive a dose of the inactivated poliovirus (IPV) vaccine at 2 months, four months, 6 to 18 months and at 4 to 6 years of age, for a total of four doses. For more information on the polio vaccine and other vaccinations, check out the Vaccine Education Center website sponsored by the Children’s Hospital of Philadelphia.
Summertime means fun time for kids of all ages, you know, like ‘from one to ninety-two’. The warm weather has a way of drawing us outdoors to enjoy the sunshine, participate in sports and other activities and then cool off in the water. Here are some simple reminders that will help keep you and your family safe as you enjoy this wonderful time of the year.
Sun and Heat Protection
While the sun may be the main draw during the summer, it can also be the source of several significant health problems. Sunburn can cause red, painful skin that appears several hours after exposure. It can be particularly dangerous in younger children and older adults, because the skin is more sensitive, as well as for those with fair skin. Sunburn increases your chance of developing dry, wrinkled skin and certain types of skin cancer, such as melanoma. Sunburn can occur even on cloudy days, or on the ski slopes and while you are in or on the water. You can protect yourself from sunburn by covering up with clothing and a hat while outside and by applying sunscreen with an SPF of 15 to 30 or greater on all exposed areas of your body. It is also important to wear sunglasses to protect your eyes from the harmful effects of ultraviolet light, which include cataracts and retinal degeneration. Heat exhaustion is another serious condition, usually caused by the combination of strenuous physical activity and heat exposure. It is characterized by sweating and rapid pulse and without treatment can lead to a life threatening condition known as heat stroke. Heat related injuries can be prevented by avoiding strenuous activity in the heat, staying hydrated, wearing loose fitting clothing and taking time to rest and cool down at intervals.
Injury Prevention
Who would have guessed that a couple of simple round objects like a wheel or a ball could provide so much fun and entertainment for so many people down through the ages! One way or another, almost all of us will include one or both of these objects in our activities this summer…think bicycling, skateboarding, baseball and tennis! Whether it’s a neighborhood game of basketball or early high school football practice, it is important to wear protective gear and be alert to signs of concussion. Be sure to check out our full article addressing the increasingly recognized problem of sports related Concussion. Many of us will head out on a road trip for the family vacation this year and that means we need to pay particular attention to driving safety and the proper use of seat belts and car seats. Biking, skateboarding and off road activities all require the use of helmets and other protective gear. Common sense, proper supervision and engaging in age-appropriate activities all play a role in injury prevention.
Water Safety
Pools, lakes, rivers and oceans attract all manner of water sportsmen during the summertime, enjoying activities such as swimming, boating and water skiing. It is a sad fact that there are more than 3,000 unintentional drowning deaths in the U.S. each year. Children four years of age and younger and adolescent boys are at the greatest risk of drowning. Children should be watched at all times while swimming or near the water. Backyard pools should be equipped with appropriate alarm systems and surrounded by secure fences. Swimming lessons, especially for children under four years of age, will significantly decrease their chance of drowning. Life jackets should be worn at all times while boating. It is important to remember that operating a boat while under the influence of alcohol is illegal and for a good reason. For more suggestions on staying safe while having fun in the water see our article on Water Safety. Here’s hoping you and your family have a fun, memorable and safe summer.
Attention to Water Safety is Essential During the Summer.
By now we are all aware that there is an epidemic of obesity in the United States. This modern day scourge affects all age groups, from children through seniors. The Centers for Disease Control and Prevention (CDC) estimates that obesity affects more than one third of adults. The American Heart Association states that the proportion of children who are obese has increased five times from 1974 to 2009. The attendant health consequences have been well described in both the medical literature and the popular press and include heart disease, stroke, type 2 diabetes, certain types of cancer and lower extremity osteoarthritis. The two main contributors to obesity are overeating and lack of exercise, which means that this is a preventable health condition. For many people it seems that they awaken one morning and find without warning that they are suddenly overweight. But how did they get that way without knowing it? Whether they truly did not see it coming or subconsciously ignored the obvious signs along the way, the end result is the same…they now have a major health problem.
Weigh Yourself Daily
There is an easy way to help yourself confront reality. Simply get into the habit of weighing yourself daily. If you do this there will be no surprises and you will be able to catch the problem while it is still manageable. By weighing yourself each day you will learn how to interpret the normal daily fluctuations in your weight based on factors such as hydration and exercise and you will be able to recognize a true increase in your weight. At this stage you can more easily regulate your intake until you return to your ideal weight. In essence, you will be titrating your weight by controlling intake and exercise. For the most accurate readings, weigh yourself at the same time every day, preferably just before or after your daily shower without your clothes.
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An Excellent Scale
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At the same time as adolescence seems to be lasting longer, puberty is beginning earlier in both boys and girls. Adolescence was defined in the 1975 edition of Nelson’s Textbook of Pediatrics as a ‘physiological and psychosocial process… lasting in Western society from the age of 12 or 13 years into the late teens or even the early 20’s’. The endpoint was based on both psychological maturity and ‘economic and social emancipation from the parental family’. Fast forward to the 21st Century and both of these benchmarks indicating the end of adolescence have been pushed ahead for many young people. Evidence includes the fact that children are staying at home with their parents longer or moving back in after an initial foray out into the real world, students are taking longer to finish college, physically mature young adults are now able to depend on their parents’ health insurance until the age of 26 and, finally, taking on the responsibilities of marriage and childrearing have been pushed farther ahead. In its extreme form this phenomenon has recently been described as Failure to Launch Syndrome where young adults, males in particular, seem almost incapable of taking the plunge to independence.
Puberty Beginning Earlier
It has long been recognized that girls have been reaching puberty at earlier and earlier ages, depending on race. It is estimated that childhood for girls has decreased by a year and a half over the last 30 years. According to a 2011 article appearing in the journal Pediatrics 15% of American girls now begin puberty by age 7 and that number rises to 23% for black girls. One in ten white girls begins developing breasts by age 7, double the number in a comparable study done in 1997. It has only recently been recognized that boys are beginning puberty at an earlier age, as well. A study published in Pediatrics in 2012 indicates that boys are showing the first physical signs of puberty six months to two years earlier than in previous studies. The average age when genital development began in the recent study was 10.14 years for white boys and 9.14 years for black boys, about a year and a half earlier than in previously published studies.
Lost Childhood
Adolescence, then, begins with the physical changes of puberty and ends with the psychosocial achievement of autonomy and independence. As we have seen, this period of life is literally being stretched at both ends of the timeline. At one end, physiological changes are beginning sooner and on the other end, psychological changes are occurring later. There are a number of social and physiological factors that have lead to this conundrum, and it may take a while to sort out all the ramifications. Regardless, there are bound to be significant societal accommodations that will have to be made. Medical researchers are not sure why puberty is beginning earlier in children, but have speculated that the increasing incidence of obesity may be playing a role in girls and environmental and nutritional factors may play a role in both boys and girls. While the physical signs of puberty may be appearing earlier, children’s brains may not be ready for the change. For this reason, it is important to be on the alert for increased anxiety, depression and behavior disorders in these individuals resulting from this seeming imbalance. Ironically, while children of the 21st Century may look forward to more years of old age, they seem to be having fewer years of childhood. This is unfortunate, in my opinion, because childhood, after all, can be one of the most wonderful periods of our lifetime.
