Donald E. Greydanus

Marijuana: Current Concepts†

Marijuana (cannabis) remains a controversial drug in the twenty-first century. This paper considers current research on use of Cannabis sativa and its constituents such as the cannabinoids. Topics reviewed include prevalence of cannabis (pot) use, other drugs consumed with pot, the endocannabinoid system, use of medicinal marijuana, medical adverse effects of cannabis, and psychiatric adverse effects of cannabis use. Treatment of cannabis withdrawal and dependence is difficult and remains mainly based on psychological therapy; current research on pharmacologic management of problems related to cannabis consumption is also considered. The potential role of specific cannabinoids for medical benefit will be revealed as the twenty-first century matures. However, potential dangerous adverse effects from smoking marijuana are well known and should be clearly taught to a public that is often confused by a media-driven, though false message and promise of benign pot consumption.

Cyberbullying victimization prevalence and associations with internalizing and externalizing problems among adolescents in six European countries

More than one in five of European adolescents reported cyberbullying victimization.The prevalence rate of cyber victimization was higher among girls than boys.The prevalence rate was highest in Romania while the lowest was in Spain.Externalizing, internalizing and academic problems were associated with cyber victimization. Cyberbullying victimization is an important adolescent health issue. The cross-national study aimed to investigate the prevalence of cyber victimization and associated internalizing, externalizing and academic problems among adolescents in six European countries. A cross-sectional school-based study of 14-17year-old adolescents (N=10,930; F/M: 5719/5211; mean age 15.8?0.7years) was conducted in Spain, Poland, the Netherlands, Romania, Iceland and Greece. In total, 21.4% of adolescents reported cyber victimization in the past 12months. Reports were more frequent among girls than boys (23.9% vs. 18.5%), and among the older adolescents compared to the younger ones (24.2% vs. 19.7%). The prevalence was highest in Romania and Greece (37.3% and 26.8%) and lowest in Spain and Iceland (13.3% and 13.5%). Multiple logistic regression analysis indicated that cyber victimization was more frequent among adolescents using the internet and social networking sites for two or more hours daily. Multiple linear regression analysis showed that externalizing, internalizing and academic problems were associated with cyber victimization. Overall, cyber victimization was found to be a problem of substantial extent, concerning more than one in five of the studied European adolescents. Action against cyber victimization is crucial while policy planning should be aimed at the prevention of the phenomenon.

Complex febrile seizures—A systematic review

In early medical writings only the following three types of neurological disorders were recognized: seizures, paralysis, and hydrocephalus. From the time of the early Greeks, seizures were solely recognized as complications of a febrile illness. Soon after, the beginnings of the current day complicated categorization of seizures types began to occur with the distinction of a form of seizure called a febrile seizure. From the Hippocratic era of medicine, the two accepted characteristics of febrile seizures were that they occurred in childhood, with high susceptibility of a child to have febrile seizures during the first 2–3 years of life, and that the child convulses with the accompaniment of a fever. During the 1950s, there was an attempt to associate the occurrence of febrile seizures as related to specific infections. At that time, the only illness that found to be connected to febrile seizures was shigellosis, an intestinal disease caused by a family of bacteria known as shigella. While study results varied, likely due to severity selection bias, in all four studies, seizures were probable if shigellosis was contracted in children younger than 5 years of age. Now it is known that febrile seizures can occur with most any infectious etiology; with viral infections, such as HHV6 and influenza, being the most common, and bacterial infections, such as pneumococcal bacteremia, also associated with febrile seizures. Additionally, since the mid-nineteenth century the importance of age and a positive familial history (genetics)

Maintenance of Certification: The Elephant in the Room

Although the American Board of Pediatrics (ABP) is doing yeoman’s work in trying to spare hospitals and pediatricians the time and expense of re-credentialing, spending

Historical Perspectives on the Antaean Animadversion of Vaccine Science in the 21st Century

1300 on recerti-fication and preparing for a new 4-part Maintenance of Certification (MOC) process is not ideal in our view.To be sure, there are extremely powerful political forces at work here. The American Board of Medical Spe-cialties has mandated that every specialty board develop a recertification process. State legislatures, insurance companies, Medicare, hospital credentialing committees, national medical examiners, and the US Congress are all apparently trying hard to target physicians who don’t “keep up” and are threatening to increase the already loathsome credentialing paperwork burden on pediatri-cians. The ABP’s efforts to take control of the situation and head them off at the pass are laudable. If the ABP doesn’t act quickly and authoritatively, outside forces will begin making decisions for pediatricians that would probably be far more troublesome. We also appreciate the fact that the ABP is a certifying organization, not an educational one. But the answer may not be a cumbersome, 4-step process that will add to pediatricians’ burdens. And it raises the question, what—exactly—does Board certifi-cation mean? Interestingly, in the collective 60 years that we have practiced medicine, we have never been asked by parents or patients if we were board certified or have recertified.Has the ABP lost sight of its own primary (and worthy) goal, which is to ensure that pediatricians remain up-to-date and knowledgeable? Given the 21st-century technology that now exists, couldn’t this goal be better accomplished by creating an interactive computer module that every pediatrician would take annually? This module would test current knowledge, provide immediate feed-back on correct responses, and give a detailed synopsis of the deficient or problem areas so that learning might occur. It could be part of a reformed continuing medical education (CME) initiative.

Pediatric obesity: Current concepts

Anti-vaccine sentiment has been present since the concept of immunization was first introduced by Edward Jenner in the fin de siecle decade of the 18th century in England. This paper considers historical perspectives surrounding contravening and injurious views toward vaccinations. Clinicians and scientists are often perplexed by how seemingly intelligent and caring parents can conclude that scientifically-validated vaccines are dangerous to their children, prompting such parents to refuse to provide some or even all of the vaccines recommended by major organizations in medicine around the world. The pungent philippic of the anti-vaccine community can seem disingenuous and desipient to the science community; unfortunately, this antipodal diatribe is often positively perceived by some members of the public and has been for countless eons. Anti-vaccine animus is not a fugacious movement of lilliputian dimensions but an antaean, amaranthine straw man fallacy with deep roots buried in the zeitgeist of Homo sapiens that has and will cause tragic harm to helpless children from what are vaccine preventable diseases. Appreciation of such concepts can be useful in constructing strategies to improve this 21st century vaccine animadversion. One can accurately adumbrate that failing to effectively address such issues will only lead to more vaccine refusals despite the persistent and impressive progress that is being made in vaccinology. Modern science does not have a nepenthe for the parents who have needlessly lost children because these precious little ones were not vaccinated for a vaccine preventable disease. The silence of the anti-vaccine mantics and maudits in such cases is deafening and pantagruelian.

Introduction to Intellectual and Developmental Disabilities

This discussion reflects on concepts of obesity in children and adolescents in the early 21st century. It includes reflections on its history, definition, epidemiology, diagnostic perspectives, psychosocial considerations, musculoskeletal complications, endocrine complications and principles of management. In addition to emphasis on diet and exercise, research and clinical applications in the second decade of the 21st century emphasize the increasing use of pharmacotherapy and bariatric surgery for adolescent and adult populations with critical problems of overweight and obesity. We conclude with a discussion of future directions in pediatric obesity management.

Pharmacology of Autism Spectrum Disorder

Intellectual disability (ID) is the term used to describe a condition defined by limits in cognitive and adaptive abilities that affect function and initially manifest before 18 years of age. This term supplanted the earlier term ‘mental retardation’ within the past two decades. The term developmental disability (DD) was coined de novo in the 1970s when the Developmental Disabilities Act of the US Congress was passed. While an ID is determined by formal psychometric testing to assess the intelligence quotient and adaptive functioning, the term DD is more generic and may include elements of physical limitations in addition to the ID. Both terms are often used interchangeably and have been blended into the term intellectual and developmental disabilities (IDD) to be inclusive for or all individuals who have limitations in cognitive as well as physical functions that are: based on central nervous system dysfunction, manifest in the childhood years, and have lifelong implications. Our goal as members of society is to support and enhance the function of children and adults with IDD and their families and to assure optimal physical, emotional and social well-being in order for them to lead fulfilling lives.

Cross-national aspects of cyberbullying victimization among 14–17-year-old adolescents across seven European countries

ASD is a complex and common neurobehavioral disorder with no identified single specific biologic etiology. Instead there appear to be diverse abnormalities of brain networks with cellular, biochemical, and genetic factors. Though behavioral therapy is a major component to management of individuals with ASD, psychopharmacology has emerged as an important therapeutic tool. Pharmacology is targeted at associated disorders such as sleep disorders, aggression, anxiety, depression, repetitive behaviors, and hyperactivity. This chapter reviews current agents noted by research trials to be of benefit. Additional medications under current research are also briefly noted.

Smith-Magenis Syndrome

BackgroundThe increasing use of the Internet and social network sites (SNS) has created a new domain of socio-emotional development for adolescents. The aim of this cross-sectional study was to explore cybervictimization across seven European countries, in relation to socio-demographic, Internet use and psychosocial variables.MethodsA cross-sectional school-based study was conducted in the participating countries: Germany, Greece, Iceland the Netherlands, Poland, Romania and Spain. Anonymous self-completed questionnaires included sociodemographic data, internet usage characteristics, school achievement, parental control, the Internet Addiction Test and Achenbach’s Youth Self-Report.ResultsThe highest rate of cyber victimization was found in Romania (37.3%) and the lowest in Spain (13.3%). Multiple logistic regression analyses gave differing results between countries. In Romania, Poland and Germany cyberbullying victimization was associated with SNS use, whereas Internet use was associated with increased odds of cybervictimization only in Romania. Cybervictimization was associated with greater internalizing behavior problems in all countries analysed, and with externalizing problems in all except Romania.ConclusionsCyberbullying victimization is an on-going problem, which is subject to country-specific socio-demographic factors and diverse patterns of current Internet use and its development. Preventive measures should emphasize the integration of Internet communication technology education in educational contexts, and focus on the consistent association between cybervictimization and internalizing and externalizing difficulties.