Autoinflammatory Diseases/Periodic Fevers.

Children with intermittent fevers present to pediatricians and other primary care child health providers for evaluation. Most patients will have self-limited, benign infectious illnesses. However, the possibility of a periodic fever syndrome should be considered if febrile episodes become recurrent over an extended period and are associated with particular signs and symptoms during each attack.

Off-on-off-on use of imatinib in three children with fibrodysplasia ossificans progressiva.

The compassionate use of available medications with unproven efficacy is often in conflict with their clinical evaluation in placebo-controlled clinical trials. For ultra-rare diseases where no approved treatments exist, such as fibrodysplasia ossificans progressiva (FOP), routine clinical trial enrollment for available medications may be difficult to achieve. Therefore adaptive methods of evaluation are often desirable.

Social anxiety and interpersonal stress generation: the moderating role of interpersonal distress.

Background And Objectives: Existing models of social anxiety scarcely account for interpersonal stress generation. These models also seldom include interpersonal factors that compound the effects of social anxiety. Given recent findings that two forms of interpersonal distress, perceived burdensomeness and thwarted belongingness, intensify social anxiety and cause interpersonal stress generation, these two constructs may be especially relevant to examining social anxiety and interpersonal stress generation together.

Recording routine forensic mental health evaluations should be a standard of practice in the 21st century.

The standard of practice for forensic interviews in criminal and delinquency cases, other than those conducted as part of brief preliminary screening evaluations or in emergency situations, should include a digital recording requirement. This standard should be adopted because of the greater availability of, and familiarity with, recording technology on the part of mental health professionals, the greater use and proven effectiveness of recording in other contexts of the criminal justice system, and the improvement in court presentation and accuracy of judicial determinations involving forensic assessments that recording will provide. The experience of practitioners with recording since professional associations last studied the issue should be taken into account, as informal data suggest it has been positive.

Early clinical observations on the use of imatinib mesylate in FOP: A report of seven cases.

Background: Fibrodysplasia ossificans progressiva (FOP) is an ultrarare genetic disorder of progressive, disabling heterotopic ossification (HO) for which there is presently no definitive treatment. Research studies have identified multiple potential targets for therapy in FOP, and novel drug candidates are being developed for testing in clinical trials. A complementary approach seeks to identify approved drugs that could be re-purposed for off-label use against defined targets in FOP.

The supreme court and the sentencing of juveniles in the United States: reaffirming the distinctiveness of youth.

The US Supreme Court has set 2 key constitutionally based limits to punishment of juveniles; a bar on the imposition of the death penalty for crimes committed by juveniles and of life imprisonment without possibility of parole for juveniles who commit nonhomicide offenses. Both decisions held that these penalties were disproportionate given juveniles' distinctive characteristics. The Court's adoption of a developmental model of culpability may produce future challenges to lengthy juvenile sentences, broad provisions allowing transfer of juveniles for trial as adults, and even possibly to younger juveniles'competence to stand trial.

Educating residents in behavioral health care and collaboration: integrated clinical training of pediatric residents and psychology fellows.

Pediatric residency practices face the challenge of providing both behavioral health (BH) training for pediatricians and psychosocial care for children. The University of Rochester School of Medicine and Dentistry and Rochester General Hospital developed a joint training program and continuity clinic infrastructure in which pediatric residents and postdoctoral psychology fellows train and practice together. The integrated program provides children access to BH care in a primary care setting and gives trainees the opportunity to integrate collaborative BH care into their regular practice routines.

Educating residents in behavioral health care and collaboration: comparison of conventional and integrated training models.

Purpose: To determine whether former pediatric residents trained using a model of integrated behavioral health (BH) care in their primary care continuity clinics felt more comfortable managing BH care and better prepared to collaborate with BH professionals than did peers from the same residency who trained in clinics with a conventional model of BH care.

Method: University of Rochester School of Medicine and Dentistry pediatric residents were assigned to one of two continuity clinic sites. At one site, psychology fellows and faculty were integrated into the clinic teams in the mid-1990s.

A blood lead benchmark for assessing risks from childhood lead exposure.

Lead exposure is an insidious problem, causing subtle effects in children at low exposure levels where clinical signs are not apparent. Although a target blood lead concentration (Pb(B)) of ten micrograms per deciliter (10 microg/dL) has been used as the basis for environmental decision-making in California for nearly two decades, recent epidemiologic evidence suggests a relationship between cognitive deficits and Pb(B) at concentrations < 10 microg/dL. Based on a published meta-analysis of children's IQ scores and their blood lead concentrations, we developed a new blood lead benchmark: an incremental increase in blood lead concentration (DeltaPb(B)) of 1 microg/dL, an increase that we estimate could decrease the IQ score in an average school child in California by up to one point.

Munchausen Syndrome by Proxy: a pediatrician's observations.

Munchausen Syndrome by Proxy (MSP) is a disturbing diagnosis that should be considered when persistent signs and symptoms defy adequate explanation despite extensive testing. Insistence by a parent (often mother) that more, and particularly invasive investigations be pursued, should serve as a warning sign that MSP might be present. The primary care provider who has an existing, over-time, relationship with the child and family is in an important position to raise the question of MSP because this professional may be able to recognize larger dynamics at play between child and family that are less apparent to subspecialists who are focused on a narrow aspect of the evaluation.

Chronic arthritis in adolescence.

Musculoskeletal complaints, and joint pain in particular, are common symptoms among adolescents presenting to primary care providers. In this article, the distinction between arthralgia and arthritis is described, and important inflammatory arthropathies seen in teenagers are addressed. The current nomenclature of juvenile idiopathic arthritis is used to address each of the major clinical entities that account for chronic arthritis in teens, including oligoarthritis, polyarthritis, systemic arthritis, psoriatic arthritis, and spondyloarthropathy.

The growing admissibility of expert testimony by clinical social workers on competence to stand trial.

Expert testimony by clinical social workers concerning a criminal defendant's competence to stand trial has increasingly been admitted in certain state courts over the past two decades, yet most state laws still require that court-appointed competence evaluators be psychiatrists or psychologists. Pressure to admit social workers' testimony will come from social workers' increasing role in diagnosis and treatment of mental disorders. The evolution of forensic assessment instruments that permits greater transparency in competence evaluation and facilitates training, and the standardization of forensic evaluation in general, support greater use of clinical social workers as competence evaluators.

The diagnostic significance of soluble CD163 and soluble interleukin-2 receptor alpha-chain in macrophage activation syndrome and untreated new-onset systemic juvenile idiopathic arthritis.

Objective: Macrophage activation syndrome is characterized by an overwhelming inflammatory reaction driven by excessive expansion of T cells and hemophagocytic macrophages. Levels of soluble interleukin-2 receptor alpha (sIL-2Ralpha) and soluble CD163 (sCD163) may reflect the degree of activation and expansion of T cells and macrophages, respectively. This study was undertaken to assess the value of serum sIL-2Ralpha and sCD163 in diagnosing acute macrophage activation syndrome complicating systemic juvenile idiopathic arthritis (JIA).

Keeping middle school students abstinent: outcomes of a primary prevention intervention.

Purpose: (a) To test the longer-term (6-12 month) effect of a school-based intervention designed to delay the onset of sexual intercourse on continuation of abstinence, (b) to compare the effect of the intervention when delivered by different providers, and (c) to describe the factors that influence students' transition from abstinence to sexual activity.

Methods: This study was a nonrandomized control trial with one control and three intervention groups. The setting was health education classes in urban, predominantly ethnic minority schools.