RESUMO
Turner syndrome is recognized now as a syndrome familiar not only to pediatricians and pediatric specialists, medical geneticists, adult endocrinologists, and cardiologists, but also increasingly to primary care providers, internal medicine specialists, obstetricians, and reproductive medicine specialists. In addition, the care of women with Turner syndrome may involve social services, and various educational and neuropsychologic therapies. This article focuses on the recognition and management of Turner syndrome from adolescents in transition, through adulthood, and into another transition as older women. It can be viewed as an interpretation of recent international guidelines, complementary to those recommendations, and in some instances, an update. An attempt was made to provide an international perspective. Finally, the women and families who live with Turner syndrome and who inspired several sections, are themselves part of the broad readership that may benefit from this review.
Assuntos
Síndrome de Turner/diagnóstico , Síndrome de Turner/terapia , Adolescente , Adulto , Idoso , Criança , Cromossomos Humanos Y/genética , Humanos , Cariótipo , Saúde Mental , Pessoa de Meia-Idade , Fenótipo , Síndrome de Turner/epidemiologia , Síndrome de Turner/genética , Adulto JovemAssuntos
Transtorno Bipolar/etiologia , Encéfalo/diagnóstico por imagem , Função Executiva , Lobo Frontal , Comportamento Impulsivo , Acidente Vascular Cerebral/diagnóstico por imagem , Antidepressivos/efeitos adversos , Transtorno Bipolar/induzido quimicamente , Transtorno Bipolar/diagnóstico , Encéfalo/patologia , Diagnóstico Diferencial , Lobo Frontal/patologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Transtornos da Personalidade/etiologia , Transtornos do Sono-Vigília/etiologia , Acidente Vascular Cerebral/complicaçõesRESUMO
Suicide is 1 of the top 3 leading causes of death in the pediatric population and a serious public health concern. There are evidence-based screening tools for suicide in the pediatric population; however, predicting suicide risks can be a difficult task. The emergency department is an essential source of mental health care for youths and can serve as an important opportunity for suicide screening and subsequent targeted interventions and resource management. More research is needed in emergency department-based screening algorithms and evidence-driven interventions in the pediatric population.
Assuntos
Serviço Hospitalar de Emergência , Medição de Risco/métodos , Prevenção do Suicídio , Adolescente , Criança , HumanosRESUMO
Pediatric psychiatric emergency care is delivered in different settings with vastly different resources around the country. Training programs lack guidance on developing optimal curricula for this highly variable but crucial setting. A model curriculum for child and adolescent psychiatry trainees may be helpful to provide such guidance; its components include recommendations for assessing baseline knowledge, identifying and teaching core subject content, encouraging development of essential skills, and building in supervision for learners. Future directions include further study in current pediatric emergency psychiatry education and expanding the scope of curricula to include different learners and delivery models.
Assuntos
Psiquiatria do Adolescente/educação , Psiquiatria Infantil/educação , Competência Clínica , Currículo , Transtornos Mentais/terapia , Medicina de Emergência Pediátrica , Adolescente , Criança , HumanosAssuntos
Alta do Paciente , Ideação Suicida , Adolescente , Humanos , Fatores de Risco , Estresse PsicológicoAssuntos
Transtorno Depressivo/epidemiologia , Transtorno Depressivo/terapia , Suicídio/estatística & dados numéricos , Adolescente , Terapia Comportamental/métodos , Criança , Terapia Combinada , Transtorno Depressivo/diagnóstico , Diagnóstico Precoce , Feminino , Humanos , Incidência , Masculino , Prognóstico , Psicoterapia/métodos , Medição de Risco , Grupos de Autoajuda , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Índice de Gravidade de Doença , Análise de Sobrevida , Estados Unidos/epidemiologia , Prevenção do SuicídioRESUMO
BACKGROUND: Living donor lobar lung transplantation is a viable therapy for carefully selected patients with end-stage pulmonary disease. Its success is largely dependent upon donor outcome, including both physical and emotional factors. To date, there has been little focus on psychosocial outcomes of lobar lung donors. METHODS: Retrospective evaluation of 15 of 20 living lobar lung transplant donors was performed. Donors underwent evaluation of pulmonary function after recovery from donor lobectomy. Participants completed two self-report questionnaires, the SF-36 Health Survey (SF-36) and the Beck Depression Inventory (BDI), as well as an open-ended psychiatric interview. RESULTS: After lobar donation, mean forced expiratory volume in 1 second (FEV(1)) decreased by 21 +/- 2%, forced vital capacity (FVC) decreased by 16 +/- 3%, total lung capacity (TLC) decreased by 15 +/- 3%, and single-breath diffusing capacity (DLCO) decreased by 14 +/- 4%. All subjects scored higher than the national average on both the physical and mental health components of the SF-36. The BDI scores showed no evidence of clinical depression. However, the subjective interviews elicited two common complaints: (1) a decline in exercise performance, not accounted for by resting lung function measurements; and (2) a dissatisfaction with the degree of acknowledgment of their donation. CONCLUSIONS: Living lobar lung transplant donors enjoy generally satisfactory physical and emotional health. Donors report positive feelings about donation, but wish to be recognized and valued by the transplant team and by the recipient. Despite preservation of lung function within the normal range, some donors also experience a subjective decline in exercise tolerance. Long-term medical and psychologic follow-up appears warranted to monitor symptoms of exercise impairment and to enhance the donor experience.