Medicine and Health Sciences Commons^™

Intellectual And Developmental Disability: Healthcare Financing, David A. Ervin, Joav Merrick

Pediatrics Faculty Publications

The World Health Organization (WHO) estimates global spending on healthcare at $6.5 trillion, approximately 10.5% of the world’s gross domestic product. The United States’ (US) share of that spending is $2.6 trillion, essentially quadrupling since 1980. The 2010 United States Patient Protection and Affordable Care Act (PPACA), also known as Obamacare, has stimulated extensive debate over the way in which healthcare is financed, and whether or not the costs of healthcare are sustainable. Among publicly funded healthcare in the US, Medicaid and Medicare are primary sources of funding. In federal fiscal year 2012, Medicaid spending on acute health exceeded $275.4 …

Pheochromocytoma In A Twelve-Year-Old Girl With Sdhb-Related Hereditary Paraganglioma-Pheochromocytoma Syndrome, Daryl Graham, Megan Gooch, Zhan Ye, Edward Richer, Aftab S. Chishti, Elizabeth Reilly, John D’Orazio

Pediatrics Faculty Publications

A twelve-year-old girl presented with a history of several weeks of worsening headaches accompanied by flushing and diaphoresis. The discovery of markedly elevated blood pressure and tachycardia led the child's pediatrician to consider the diagnosis of a catecholamine-secreting tumor, and an abdominal CT scan confirmed the presence of a pheochromocytoma. The patient was found to have a mutation in the succinyl dehydrogenase B (SDHB) gene, which is causative for SDHB-related hereditary paraganglioma-pheochromocytoma syndrome. Herein, we describe her presentation and medical management and discuss the clinical implications of SDHB deficiency.

Newborn Care: What We Can Learn From The Kangaroo Mother, Donald E. Greydanus, Joav Merrick

Pediatrics Faculty Publications

No abstract provided.

Healthcare For Persons With Intellectual And Developmental Disability In The Community, David A. Ervin, Brian Hennen, Joav Merrick, Mohammed Morad

Pediatrics Faculty Publications

INTRODUCTION: While there has been impressive progress in creating and improving community healthcare delivery systems that support people with intellectual and developmental disabilities (IDD), there is much more that can and should be done.

METHODS: This paper offers a review of healthcare delivery concepts on which new models are being developed, while also establishing an historical context. We review the need for creating fully integrated models of healthcare, and at the same time offer practical considerations that range from specific healthcare delivery system components to the need to expand our approach to training healthcare providers. The models and delivery systems, …

Primary Care: Mental And Behavioral Health And Persons With Intellectual And Developmental Disabilities, David A. Ervin, Ashley Williams, Joav Merrick

Pediatrics Faculty Publications

INTRODUCTION: There are multiple ways to address the mental and behavioral health needs of people with intellectual and developmental disabilities (IDD).

METHOD: In this paper, we do not argue for a particular approach or set of approaches, but instead review the benefits of integrating mental and behavioral health supports with primary healthcare based primarily on our experience in and understanding of healthcare systems in the United States. It is estimated that between 35 and 40% of people with IDD also live with psychiatric disorders. NADD, an association for persons with developmental disabilities and mental health needs in the US holds …

Firesetting And Maltreatment: A Review, Amy L. Burnett, Hatim A. Omar

Pediatrics Faculty Publications

The objective of this review is to determine if a link exists between firesetting offenders and a past history of maltreatment. A literature review was performed using research from various studies and populations. Firesetting is a significant problem that affects the world’s youth today. Even though there is substantial loss of property and life from juvenile firesetters, there is not a great deal of research to provide insight into early identification of those at risk. In the literature review performed, 6 of 7 studies found a link with maltreatment and firesetting behaviors. There does seem to be a correlation between …

Firesetting Behavior And Associated Comorbid Psychiatric Disorders, Stephanie Stockburger, Hatim A. Omar

Pediatrics Faculty Publications

Firesetting behavior results in serious damage to lives and property every year. Firesetting has been linked to a number of comorbid psychiatric disorders including depression, substance abuse, conduct disorder, antisocial personality disorder, obsessive compulsive disorder, psychotic disorder, schizoid personality disorder, and schizophrenia. Psychiatric disorders differ by gender. In addition, juvenile firesetters have history of a separate set of psychiatric comorbidities. The strong correlation between psychiatric comorbidities and firesetting behavior illustrates the need for fire service and mental health collaboration.

Long-Term Consequences Of Childhood Sexual Abuse, Lesley Davidson, Hatim A. Omar

Pediatrics Faculty Publications

The aim of this paper is to summarize the limited studies on post-pubertal consequences of female childhood sexual abuse that includes both psychological distress and physiological stress. The characteristics of sexual abuse are discussed and determined to play a major role in the degree of trauma experienced and in the later effects. The concept of hormones and how disruptions in various endocrine systems can affect the development of these females are examined, especially during the pubertal period. Outcomes of interest included competence, in terms of cognitive, social, self-esteem, and locus of control, and psychopathology including depression, anxiety, dissociation, and hypersexuality. …

Do Not Play With Fire, Joav Merrick, Hatim A. Omar

Pediatrics Faculty Publications

Fire is the rapid oxidation of a material in the exothermic chemical process of combustion, releasing heat, light and various reaction products. Fire is intriguing and therefore something that will attract a curious child from an early age. In 2010, the United States fire department responded to 44,900 fires started by someone, usually a child, playing with fire. These fires caused 90 civilian deaths, 890 civilian injuries and $210 million in direct property damage. Preschoolers and kindergartners are most likely to start these fires, while playing with matches or lighters and most likely to die in these fires. Most fire-play …

Hospitalization Of Children With Down Syndrome, Ariel Tenenbaum, Rana N. Hanna, Diana Averbuch, Isaiah D. Wexler, Maor Chavkin, Joav Merrick

Pediatrics Faculty Publications

INTRODUCTION: Children with Down syndrome present with multiple medical problems in a higher prevalence compared with the general population, which may lead to hospitalizations.

METHODS: Analysis of 560 hospitalizations of 162 children aged 0-16 years with Down syndrome at Hadassah Medical Center during the years 1988-2007 compared with data on children in the general population, hospitalized at the same period. Data was collected from patient files and statistical data from the Ministry of Health.

RESULTS: Respiratory infections were the leading cause for hospitalization of children with Down syndrome. The number of hospitalizations of children with Down syndrome compared to the …

Selectivity And Potency Of Microcystin Congeners Against Oatp1b1 And Oatp1b3 Expressing Cancer Cells, Timo H.J. Niedermeyer, Abigail Daily, Monika Swiatecka-Hagenbruch, Jeffrey A. Moscow

Pediatrics Faculty Publications

Microcystins are potent phosphatase inhibitors and cellular toxins. They require active transport by OATP1B1 and OATP1B3 transporters for uptake into human cells, and the high expression of these transporters in the liver accounts for their selective hepatic toxicity. Several human tumors have been shown to have high levels of expression of OATP1B3 but not OATP1B1, the main transporter in liver cells. We hypothesized that microcystin variants could be isolated that are transported preferentially by OATP1B3 relative to OATP1B1 to advance as anticancer agents with clinically tolerable hepatic toxicity. Microcystin variants have been isolated and tested for cytotoxicity in cancer cells …

Syphilis: A Forgotten Sexually Transmitted Disease?, Amy Burnett, Hatim A. Omar

Pediatrics Faculty Publications

Syphilis has declined significantly over the last 30 years. Due to that success, many physicians no longer have the skills to recognize its symptoms. We present a case of syphilis as a demonstration of this fact and hope that health professionals in the field of adolescent medicine will think about this diagnosis in their clinical work.

Consanguineous Marriage And Intellectual And Developmental Disabilities Among Arab Bedouins Children Of The Negev Region In Southern Israel: A Pilot Study, Hassan Abu Saad, Salman Elbedour, Eyad Hallaq, Joav Merrick, Ariel Tenenbaum

Pediatrics Faculty Publications

No abstract provided.

Metabolic Effects Of Acute Thiamine Depletion Are Reversed By Rapamycin In Breast And Leukemia Cells, Shuqian Liu, Sumitra Miriyala, Mignon A Keaton, Craig T. Jordan, Christina Wiedl, Daret K. St Clair, Jeffrey A. Moscow

Pediatrics Faculty Publications

Thiamine-dependent enzymes (TDEs) control metabolic pathways that are frequently altered in cancer and therefore present cancer-relevant targets. We have previously shown that the recombinant enzyme thiaminase cleaves and depletes intracellular thiamine, has growth inhibitory activity against leukemia and breast cancer cell lines, and that its growth inhibitory effects were reversed in leukemia cell lines by rapamycin. Now, we first show further evidence of thiaminase therapeutic potential by demonstrating its activity against breast and leukemia xenografts, and against a primary leukemia xenograft. We therefore further explored the metabolic effects of thiaminase in combination with rapamycin in leukemia and breast cell lines. …

What We Are Not Talking About, Hatim A. Omar

Pediatrics Faculty Publications

Adolescents undergo significant physical and cognitive changes during their pubertal development. These changes contribute to and impact their future development. Educating adolescents at an early age about their expected development decreases the possible anxiety associated with this period of life and also helps adolescents make better choices in regards to their sexuality. In order to assess the degree of education regarding pubertal development and sexuality, we conducted a survey of late adolescents (median age 19 years) and parents of adolescents. A total of 409 adolescents (237 females, 172 males) and 124 parents completed the survey. 14.4% of teens (36.6% of …

Children, Adolescents And Firesetting, Joav Merrick, Carrie Howell Bowling, Hatim A. Omar

Pediatrics Faculty Publications

The research of firesetting has been conducted in different ways and lacks a coherent, consistent and comprehensive set of empirical findings. A recent review concluded that despite a number of risk factors being repeatedly identified, an understanding of the etiology behind firesetting behavior and potential developmental trajectories remains theoretically rather than empirically based. Existing theories do not take sufficient account of the complexities of firesetting behavior and there is not yet a typology and accompanying assessment that has undergone thorough empirical testing and is of significant clinical utility. Due to the relationship between firesetting and antisocial behavior there is a …

Firesetting And Maltreatment, Amy L. Burnett, Hatim A. Omar

Pediatrics Faculty Publications

In this chapter we try to determine if a link exists between firesetting offenders and a past history of maltreatment. A literature review was performed using research from various studies and populations. Firesetting is a significant problem that affects the world's youth today. Even though there is substantial loss of property and life from juvenile firesetters, there is not a great deal of research to provide insight into early identification of those at risk. In the literature review performed, 6 of 7 studies found a link with maltreatment and firesetting behaviors. There does seem to be a correlation between the …

Firesetting Behavior And Psychiatric Disorders, Stephanie Stockburger, Hatim A. Omar

Pediatrics Faculty Publications

Firesetting behavior results in serious damage to lives and property every year. Firesetting has been linked to a number of comorbid psychiatric disorders including depression, substance abuse, conduct disorder, antisocial personality disorder, obsessive compulsive disorder, psychotic disorder, schizoid personality disorder, and schizophrenia. Psychiatric disorders differ by gender. In addition, juvenile firesetters have history of a separate set of psychiatric comorbidities. The strong correlation between psychiatric comorbidities and firesetting behavior illustrates the need for fire service and mental health collaboration.

Firesetting, Sexual Abuse And Long-Term Consequences, Lesley Davidson, Hatim A. Omar

Pediatrics Faculty Publications

In this chapter we summarize the limited studies on post-pubertal consequences of female childhood sexual abuse that includes both psychological distress and physiological stress. The characteristics of sexual abuse are discussed and determined to play a major role in the degree of trauma experienced and in the later effects. The concept of hormones and how disruptions in various endocrine systems can affect the development of these females are examined, especially during the pubertal period. Outcomes of interest included competence, in terms of cognitive, social, self-esteem, and locus of control, and psychopathology including depression, anxiety, dissociation, and hypersexuality. Direct physical results …

Self-Reported Juvenile Firesetting, Carrie Howell Bowling, Hatim A. Omar

Pediatrics Faculty Publications

In this chapter we address gaps in existing research by examining the relationship between academic performance and attention problems with juvenile firesetting. Two datasets from the Achenbach System for Empirically Based Assessment (ASEBA) were used. The Factor Analysis Dataset (N = 975) was utilized and results indicated that adolescents who report lower academic performance are more likely to set fires. Additionally, adolescents who report a poor attitude toward school are even more likely to set fires. Logistic regressions were run to determine if attention problems predicted firesetting and the findings indicated that attention problems are predictive of self-reported firesetting. The …

Adolescent Bereavement, Leslie Robin, Hatim A. Omar

Pediatrics Faculty Publications

Depending on cognitive and emotional development, an adolescent may grieve very differently than a child or an adult. While mature enough to understand death's irreversibility, adolescents may not fully comprehend the enduring consequences of a loved one's death. As the desire to separate from their families and forge new intimate relationships with peers assumes increasing priority, adolescents can seem egocentric in their reaction to death, a response which often frustrates and perplexes adults. Because volatile behavior is characteristic of adolescence, health providers struggle to differentiate between normal and complicated bereavement. Here we review the commonly-accepted characteristics of normal and complicated …

Adolescent Health Issues, Joav Merrick, Ariel Tenenbaum, Hatim A. Omar

Pediatrics Faculty Publications

No abstract provided.

Adolescence And Human Sexuality, Donald E. Greydanus, Hatim A. Omar

Pediatrics Faculty Publications

Human sexuality is a complex phenomenon involving the interaction of biology, sex, core gender identity, and gender role behavior. Successful completion of normal stages of sexuality development is important for children and adolescents to allow for optimal life as an adult. Controversies arise for clinicians as they work with their pediatric patients regarding health care sexuality issues. It is important that clinicians help these patients in an unbiased and neutral manner. As adults, these children and adolescents will function in a number of sexuality roles, whether heterosexual, homosexual, or bisexual. This chapter reviews many of these complex and critical issues …

United States: Sexual Behavior In Association With Human Papilloma Virus Vaccination In Young Girls, Wafa R.R. Al Romaih, Said Shahtahmasebi, Hatim A. Omar

Pediatrics Faculty Publications

The first human Papilloma virus (HPV) vaccine was approved in the United States in 2006 with the potential to reduce cervical cancer and genital warts. Since then, its efficacy in preventing HPV-related cancers in both males and females has been promising. Despite CDC recommendations, opponents of the vaccine assert that vaccinating preadolescents and adolescents will increase their sexual activity, as well as overtly condone risky sexual behavior. We analyzed clinic data of 499 adolescents with a mean age of 16 years to explore whether vaccination led to change in sexual behavior after one year. Our results showed no statistically significant …

Children, Violence And Bullying, Joav Merrick, Isack Kandel, Hatim A. Omar

Pediatrics Faculty Publications

Adolescent violence is a very visible phenomenon in our modern society, where you just have to open the newspaper or the television and you find yourself right in the middle of it. In order to understand the scope of the problem, we need to look at the epidemiology of global violence. Each year, more than 1.6 million people worldwide lose their lives to violence and for every person who dies as a result of violence, many more are injured and suffer from a range of physical, sexual, reproductive and mental health problems. Violence places a massive burden on national economies …

Dating Violence In Adolescence, Anuja Bandyopadhyay, Amit M. Deokar, Hatim A. Omar

Pediatrics Faculty Publications

Adolescent dating violence is a health and social problem, worldwide. The objective of this chapter was to identify the risk factors and consequences of dating violence, assess the prevention measures taken to increase awareness regarding it and provide an overview of the screening and interventional tools used to support the teens involved in dating violence. Methods: A review of the literature, published in the last 29 years, was conducted and the content was clinically analyzed. Conclusions: There is an increasing trend of dating violence in a younger population. Consistent definitions, comprehensive assessment tools and focused screening are required to assess …

Prevention: Sexual Violence Against Adolescent And Young Adult Women, Kimberly K. Mcclanahan, Marlene B. Huff, Hatim A. Omar, Joav Merrick

Pediatrics Faculty Publications

No abstract provided.

Menarche, Stephanie Stockburger, Hatim A. Omar

Pediatrics Faculty Publications

Menarche is a female’s first menstrual period and a landmark event for females during puberty. Historically, menarche has been thought of as a time when women were “unclean.” However, cultural acceptance and scientific knowledge of menarche has greatly increased. Menarche occurs as part of the typical progression of puberty caused by rises in luteinizing hormone (LH), follicle stimulating hormone (FSH), and estrogen. The achievement of menstruation is associated with reproductive capability. Menarche that occurs earlier or later than expected should be evaluated by an experienced clinician and may signal a serious underlying problem. Currently, researchers are evaluating whether menarche is …

A Grassroots Program For Youth Suicide Prevention: An Overview Of Participant Comments Following Stop Youth Suicide Conference, Stephanie Stockburger, Hatim A. Omar

Pediatrics Faculty Publications

No abstract provided.

A Grassroots Program For Youth Suicide Prevention, Stephanie Stockburger, Hatim A. Omar

Pediatrics Faculty Publications

Suicide is a major public health problem. It affects people of all ages. Youth, in particular, have a disturbingly high suicide rate. Suicide is the third leading cause of death for young people between the ages of 10 and 24 (1). Approximately 4600 young people die each year from a suicide attempt (1). The most common methods used in suicides are firearms (45%), suffocation (which may be in the form of hanging) (40%), and poisoning (8%) (1). However, more young people survive suicide attempts than actually die from the attempt. A national survey of youth in both private and public …