Substance abuse remains a critical problem for children and adolescents. This mini course will focus on current epidemiologic, neuropharmacologic and management data of these drugs: cocaine, heroin, "club" drugs (i.e., MDMA {Ecstasy}, GHB), other designer drugs and sport doping drugs. The issue of the influence of the media on drug abuse in adolescents will also be presented. Questions from the audience will be encouraged.

Introduction
Donald E. Greydanus, Michigan State University College of Human Medicine, Kalamazoo, MI

Science of Cocaine and Heroin Abuse in Adolescents
Manuel Schydlower, Texas Tech University School of Medicine Health Sciences Center at El Paso, El Paso, TX

Science of Designer Drugs and Date Rape Drugs
Pierre Paul Tellier, McGill University, Montreal, Canada

Science of Sports Doping Drugs
Dilip R. Patel, Michigan State University College of Human Medicine, Kalamazoo Center for Medical Studies, Kalamazoo, MI

The Media and Drug Abuse in American Adolescents
Victor C. Strasburger, University of New Mexico School of Medicine, Albuquerque, NM

Toxic exposures to nuclear, biological and chemical (NBC) agents can be difficult to diagnose and treat. The workshop goals are to:

1. Improve clinical skills associated with diagnosing pediatric exposures to NBC toxins,

2. Teach an evidence-based approach to treatment based on pediatric pharmacology and toxicology principles, and

3. Review state of the art resources available to the pediatrician.

Emphasis is placed on current treatment modalities as well as their potential toxicities. Secondarily, the FDA's role in approving these pharmaceuticals for children is discussed. Additional NBC information from the AAP's policy statements is reviewed, with particular attention to chemical-biological terrorism and radiation disasters. Attendees will be given an information packet so they can promote educational development on the topic of NBC terrorism in children within their own communities.
 

There are approximately 200,000 school-aged children with diabetes in the United States. Pediatricians must be aware of the increasing complexities of the diabetes regimen and strategies that can be implemented in schools to improve management and prevention. This workshop will address how to set up a diabetes health care plan, empower families, improve the nutrition environment and promote physical activity. Numerous tools will be presented, including a guide for school personnel, materials to energize the student body to form nutrition clubs and support materials for families.
 

This mini course will set the stage for several discussions of particular issues of major importance and interest. What is "preparedness" and what are the real risks of continuing terrorism in the United States? What is the current status of preparedness in the U.S. hospital and public health systems? How do children differ from adults in terms of response to weapons of mass destruction (chemical, biological and radiological)? How do these differences matter in disaster planning? Are the needs of children being incorporated in local, state and federal disaster plans? Smallpox, anthrax and other biological threats: Where do we stand? What do we do? Nuclear power plants, nuclear weapons, dirty bombs and potassium iodide: What do we know? The mental health consequences of terrorism: What have we learned since 9/11, how do we prepare children for an increasingly vulnerable world, building resiliency and sustaining a positive vision. The new pediatric agenda: What do we have to teach students, residents and pediatricians about the pediatric aspects of terrorism planning. Children and exposure to weapons of mass destruction: science and the essential research agenda.

Introduction
Paul H. Saenger, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY

Welcome and Context
Irwin Redlener, National Center for Disaster Preparedness, Columbia University Mailman School of Public Health, New York, NY

Pediatric Preparedness for Terrorism and Disasters
David S. Markenson, Columbia University Mailman School of Public Health, New York, NY

Biological Weapons of Terror: What Pediatricians Need To Know
Theodore J. Cieslak, U.S. Army Research Institute of Infectious Diseases, Ft. Detrick, MD

Helping Children and Families Cope with Terrorism
David J. Schonfeld, Yale University School of Medicine, New Haven, CT

Radiologic Terrorism, Children and the Question of Potassium Iodide
Thomas P. Foley, University of Pittsburgh, Children's Hospital of Pittsburgh, Pittsburgh, PA

Anorexia nervosa is an eating disorder characterized by a relentless and obsessive pursuit of thinness that most commonly develops in adolescent females. The severe restriction of calories and compulsive exercising that can occur in this chronic condition may result in life-threatening weight loss. In addition to the serious medical complications associated with semi-starvation and severe energy deficits, there are often significant psychological and social problems that may precede or follow, as well as complicate the treatment during, the active phase of the illness. Practitioners and researchers in pediatrics and adolescent medicine in the field of eating disorders have generally focused on the acute and the chronic medical complications associated with anorexia nervosa.

Although no organ is spared the effects of chronic malnutrition that occur with this condition, two that have the potential of long-term biological morbidity are the reproductive and skeletal systems, respectively. The long-term clinical outcomes of continued morbidity in these organs are amenorrhea with reproductive failure, and osteoporosis respectively. The latest research findings and their clinical implications relative to these organ systems will be discussed, and future research directions will be explored. In addition to the biological effects of anorexia nervosa, we shall address the biological vulnerability to developing anorexia nervosa, based on genetic predisposition. Emerging data from research studies and their clinical implications will be presented.

Overview
Richard E. Kreipe, University of Rochester School of Medicine, Golisano Children's Hospital at Strong, Rochester, NY

Morbidity of the Reproductive System in Anorexia Nervosa
S. Jean Emans, Harvard Medical School, Children's Hospital Boston, Boston, MA

Morbidity of the Skeletal System in Anorexia Nervosa
Neville H. Golden, Schneider Children's Hospital, New Hyde Park, NY

Genetic Susceptibility to Anorexia Nervosa
Wade Berrettini, University of Pennsylvania, Institute of Neurological Sciences, Center for Neurobiology and Behavior, Philadelphia, PA

Discussion
 

There are now unheralded opportunities in Adolescent Medicine to understand the relationship of biologic and behavioral processes during adolescence. For example, new functional magnetic resonance imaging provides data about the continued development of the adolescent brain that might provide insights into some aspects of adolescent behavior. The greatest intellectual gains in our understanding of adolescents will be made as a result of studies that include interdisciplinary teams of investigators from diverse biologic and behavioral backgrounds. Future academicians in Adolescent Medicine will be well-served by training with colleagues expert in the related sciences (neural sciences, endocrinology, immunology, behavioral sciences as examples). Discussion will focus on the challenges balancing never-ending clinical demands and on the pursuit of substantive science.

Adolescent Medicine—Unheralded Opportunities
Elizabeth R. McAnarney
 

Children who are victims of violent behavior or merely observers of violence may learn destructive or self-destructive patterns of behavior. Violence is a major public health problem. This symposium will focus on breaking the cycle of violence and will showcase speakers who are working on violence prevention in the pediatric emergency department, school and community. The speakers will demonstrate what can be done by physicians who see the importance of this issue and the ways in which we can make a difference.

Violence Prevention in Primary Care: Moving from Public Health to Private Practice
Robert D. Sege, Tufts-New England Medical Center, Boston, MA

Beyond Treat and Street: Violence Prevention in the Emergency Department
Joel Fein, The Children’s Hospital of Philadelphia, PA

Efforts in the Community
Sheryl A. Ryan, University of Rochester School of Medicine, Rochester, NY

Discussion

The neuroendocrine and genetic control of puberty remains one of the fundamental mysteries in human biology. Recent advances derived from sequencing the human genome have enabled the identification of novel genes affecting human puberty via clinical investigations of single patients or families with human disorders that were simply not possible even three years ago. Using these techniques, clinical investigators have been able to identify and chart several genetic defects affecting reproductive development and translate these insights into an improved understanding of how the brain controls puberty in the human. The lecture will focus upon several of these major advances and describe a new gene recently discovered that controls puberty.

William F. Crowley, Harvard Medical School, Massachusetts General Hospital, Boston, MA

The use of psychopharmacologic agents in children and adolescents has increased significantly over the past decade. Clinicians and researchers are becoming more involved in using these various medications, and this trend will continue in the future. What is the evidence-based medicine (EBM) for these medications as they apply to children and adolescents? This mini course will review the current research as applied to antidepressants, stimulants, mood stabilizers and antipsychotics. Applications to mental disorders in children and adolescents will be discussed. Questions from the audience will be encouraged. This is a continuation to the popular session held in May 2003 in Seattle.

Introduction
Donald E. Greydanus, Michigan State University College of Human Medicine, Kalamazoo, MI

Antidepressants
Susan Smiga, Langley Porter Child and Adolescent Psychiatric Center, University of California, San Francisco, CA

Stimulants
Glen R. Elliott, Langley Porter Child and Adolescent Psychiatric Center, University of California, San Francisco, CA

Mood Stabilizers
Glen R. Elliott, Langley Porter Child and Adolescent Psychiatric Center, University of California, San Francisco, CA

Antipsychotics
Chris K. Varley, University of Washington Medical Center, Children's Hospital and Regional Medical Center, Seattle, WA

With the increasing number of homeless adolescents in the United States, health care providers can expect to address numerous medical issues within this population. As a group, homeless adolescents have unique health care needs, yet they are unlikely to receive the quality of health care that appropriately meets these needs. This workshop is designed to:

1. Inform participants of the wide range of medical/psychosocial problems which face homeless teenagers today;
2. discuss the numerous barriers to receiving primary care;
3. present strategies for overcoming existing barriers;
4. provide participants with tools to advocate for homeless adolescents in their communities.
    

This workshop will focus on enhancing faculty comfort with sports medicine using a hands-on review of functional anatomy related to the lower extremity. This will be followed by small group creative problem solving around three common sport injury cases. Participants will be gently reminded of anatomic considerations with visual aids and guided examination of a live model. Case discussions will emphasize development of creative teaching strategies and discussion of potential trainee evaluation techniques. Participants are encouraged to bring along any sports medicine curricular modules they are willing to share.

Participants completing this workshop should be able to:

1. Identify functional anatomic landmarks,
2. List the most common pediatric sports injuries,
3. Describe teaching strategies to improve trainee access to sports medicine curricula and
4. Develop trainee evaluation strategies.
    

Obesity is currently one of the greatest health threats facing the health of our children and youth. Reasons for this epidemic are rooted in the changing lifestyle of Americans: one that embraces little physical activity and the consumption of large amounts of processed, high caloric foods. While problems in our societal fabric may take decades to address, pediatricians need effective ways to treat children who are already obese or are at imminent risk. Despite the significance and magnitude of this problem, most attempts at therapy have not been effective. We will discuss current dietary, pharmacologic and surgical approaches to therapy that are gaining in popularity in pediatric populations and will address what is known about the effectiveness of these approaches and the controversies associated with them. The rationale for different diets, including "popular" ones, their efficacy and safety will be discussed. Data concerning safety and efficacy of approved and experimental drug therapies in children will be presented. Finally, we will discuss when to consider bariatric surgery in children.

Novel Dietary Treatments for Obesity and Related Complications
David S. Ludwig, Children's Hospital, Boston, MA

Pharmacotherapy of Childhood Obesity
Robert H. Lustig, University of California, San Francisco, CA

Surgical Weight Loss in Pediatrics
Victor F. Garcia, Cincinnati Children's Hospital Medical Center, Cincinnati, OH

Discussion

Every day, nearly 5,000 children in the United States smoke their first cigarette. Approximately 60% of smokers start by the age of 13 and fully 90% before the age of 20. Publicly the tobacco companies have always maintained that they do not target youth, but internal documents reveal that they set out to aggressively advertise to kids.

This session will describe litigation as a public health strategy for fighting Big Tobacco in the United States and provide examples of the techniques used to attract children to smoking. Global trends and counter-advertising measures will be discussed.

Overview
Ruth A. Etzel, George Washington University School of Public Health and Health Services, Washington, DC

Fighting Big Tobacco in the United States: Litigation as a Public Health Strategy
Madelyn J. Chaber, Law Offices of Madelyn J. Chaber, Alameda, CA

Goliath Fleeing from David: The Global March of the Marlboro Man
Ronald M. Davis, Henry Ford Health System, Detroit, MI

Discussion