[Majority in asylum seekers and unaccompanied minors: Practical aspects for an effective inter-professional approach]. / Passage à la majoritéchez les adolescents requérants d'asile et mineurs non accompagnés: Aspects pratiques pour une approche interprofessionnelle efficace.

An unaccompanied minor is a young person under 18 years of age separated from both parents and who is not cared for by an adult invested of this responsability by law or the custom. Their number has increased in Switzerland in 2015, prompting medical and social professionals to adapt their care to respond more appropriately to their needs. Specific elements of an initial health check for these young people, transcultural skills and a good knowledge of the network are necessary to provide optimal management. As these young people grow up and reach legal majority in Switzerland, it is important to anticipate a transition towards actors in the adult medical world. We propose an integrative and transversal understanding of this transition by exploring relationships with the community, associative, social, educational and mental health.

Un mineur non accompagné est un jeune de moins de 18 ans séparé de ses deux parents qui n'est pas pris en charge par un adulte investi par la loi ou la coutume de cette responsabilité. Devant l'importante augmentation des mineurs non accompagnés arrivés en Suisse en 2015, les professionnels de santé ont adapté leur prise en charge pour mieux répondre à leurs besoins. Un bilan de santé initial adapté pour ces jeunes, l'acquisition de compétences transculturelles et une bonne connaissance du réseau sont nécessaires pour une prise en charge optimale. Ces jeunes atteignant leur majorité en Suisse, il est important d'étendre la réflexion à une transition des soins. Nous proposons une compréhension intégrative et transversale de cette transition en explorant les relations avec le milieu communautaire et la santé mentale.

[Adolescence and sexuality: a risky business How best to inform parents ?] / Sexualité et adolescence :liaisons dangereuses ?: Guide des meilleures pratiques pour informer les parents.

Parents are often reluctant to discuss sexuality and romantic relationships with their teenagers. However, these discussions can have a strong impact on their children's health. Care providers can act as a reliable source of information to support parents in this task. Through repeated short interactions with their child over their adolescence, parents can cover most topics related to sexuality, based on teenagers' questions and the situations that they face (e.g. LGBT bullying at school). This article summarizes current best practice on how to facilitate parental dialogue with adolescents about sexuality and offer care providers guidance in transmitting this information to parents.

Les parents sont souvent réticents à parler de sexualité et de relations amoureuses avec leurs adolescents. Cependant, ces discussions ont un rôle majeur pour la santé de leurs enfants. Les professionnels de santé sont une source d'informations fiable et de soutien pour les parents dans cette démarche. De nombreuses interactions courtes durant les années de l'adolescence, entre parents et adolescents, basées sur des questions et des situations rencontrées permettent de couvrir les nombreuses thématiques liées à la sexualité. Cet article propose une aide pour les professionnels de santé afin d'informer les parents et les encourager à ouvrir le dialogue avec leurs enfants. Il résume les meilleures pratiques pour favoriser la communication avec des adolescents concernant la sexualité.

Parents' integration in the treatment of adolescents with obesity: A qualitative study.

INTRODUCTION: Obesity during adolescence is particularly challenging. Our aims were to identify parents' and adolescents' perceptions regarding obesity, as well as family dynamics before and after family-based behavioral therapy (FBBT) to improve obesity. METHOD: Using a qualitative approach, 23 parents and 21 adolescents aged 12 to 18 years participated in 6 focus groups, before and after FBBT. Focus groups were audio-taped, transcribed verbatim, and analyzed using content analysis. RESULTS: Transcript analyses suggested 3 major themes from both adolescents and parents: obesity as a source of strong negative emotions, adolescents and weight-control responsibility, and disruption in family dynamics. FBBT improved self-confidence and family functioning, allowing for behavioral changes. Both adolescents and their parents felt empowered. DISCUSSION: Family dynamics are an important issue in weight-loss treatment during adolescence. Including both parents and adolescents in therapy is crucial for tackling obesity and addressing health needs related to this age group. (PsycINFO Database Record

[Assess spirituality with adolescent outpatients: taboo or necessity?]. / Aborder la spiritualité avec les adolescents en consultation ambulatoire: tabou ou nécessité?

Spirituality affects adolescents' as well as adults' daily life. It is usually considered to be a protective factor in physical and psychological health outcomes, but might also be a cause of suffering. In the perspective of an holistic approach, health professional should assess this subject with tact and sensitivity. Until there is a suitable instrument adapted to this age group and European culture, the exploration of spirituality and religious practices can be evaluated while taking the clinical history. Nevertheless, resistance which is common in health professionals, could be overcome by appropriate training.

[Not without my family! The importance of the entourage in primary care medicine with youth]. / Pas sans ma famille! L'importance de l'entourage en médecine de premier recours avec des jeunes.

At the doctor's office primary care, symptomatology of young is often vague or nonspecific. Faced with such symptoms, via the analysis of a clinical case, significant in many clinical situations, we show the importance of considering the significant members of the entourage and invite them to the surgery. A therapeutic alliance better weaves between the youth and his doctor if the environment is taken into account and will lead to better therapeutic response.

Immunization Status of Young People Attending a Youth Clinic in Geneva, Switzerland.

Adolescent vaccination coverage is very variable in European countries and data are scarce. The aim of this study was to assess immunization status and analyze potential variations according to sociodemographic variables in a youth clinic in Geneva, Switzerland. Immunization status was assessed retrospectively: Tetanus (number of doses or in absence of data tetanus antibodies) and measles as indicators of childhood coverage as well as hepatitis B and human papillomavirus. All new patients (N = 390) of Geneva University Hospital's youth clinic were included between January 2010 and June 2011. Vaccine coverage was low for all vaccines regardless of sex or origin. 89% of young people tested (mostly recent immigrants with no available data) had tetanus antibodies indicating adequate childhood immunization but hepatitis B and HPV coverage was low especially in recent immigrants. Systematic assessment allows better adolescent vaccine coverage and can improve safety by avoiding unnecessary dosis.

Reasons for encounter in young people consulting a family doctor in the French speaking part of Switzerland: a cross sectional study.

BACKGROUND: Knowledge of patient's reasons for encounter is useful to inform health service planning and health professional education. Our aim was to describe reasons for encounter as stated by an unselected group of young people attending primary care practices in the French-speaking part of Switzerland. METHODS: Consecutive patients aged between 15 and 24 years were recruited as part of the PRISM-Ado trial (n = 594). They completed an anonymous questionnaire in the waiting room, including their main reason for encounter (free text). Reasons for encounter were coded using ICPC-2 classification and analyzed according to sex, age and living in a rural or urban area. RESULTS: 95 % of questionnaires contained valid data about reasons for encounter (n = 567). General and unspecific (A) reasons were the most common in boys (44 %) and girls (42 %), followed by respiratory, musculoskeletal, dermatological and psychological reasons. Psychological reasons were more frequent in girls attending urban practices; musculoskeletal and dermatological reasons were more frequent in rural areas. Sexually transmitted infections or substance use were very rarely stated as a reason for encounter. CONCLUSIONS: This is the first study describing reasons for encounter as stated by young people themselves in primary care in Switzerland. These findings provide useful guidance for family doctors training and health service planning in Europe. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, ACTRN12608000432314 .

Excessive substance use among young people consulting family doctors: a cross-sectional study.

BACKGROUND: Family doctors can only play a role in the prevention of excessive substance use in young people if those affected are seen in the practice. OBJECTIVE: To describe the prevalence of excessive substance use among young people consulting family doctors in a European context. METHODS: As part of a trial of an intervention addressing substance use we collected data from young people consulting 32 family doctors in the French-speaking part of Switzerland. Before the consultation, consecutive patients aged 15-24 years completed a self-administered questionnaire on their general health and substance use. Outcomes were excessive alcohol (defined as ≥1 episode of binge drinking), excessive cannabis (use ≥1/week), regular tobacco (≥1 cigarettes a day) and/or any other substance use in the past 30 days. Prevalence data were computed with 95% confidence intervals (CIs) adjusted for clustering within practices, stratified by age and gender. RESULTS: Between February 2009 and November 2010, 636 patients were eligible. Participation rate was 93.4% (n=594, 53% female). The prevalence of excessive use in the past 30 days was alcohol 44.9% (95% CI: 37.8-52.1), cannabis 11.1% (95% CI: 8.0-14.1), tobacco 23.4% (95% CI: 19.0-28.1) and any other drug 2.6 (95% CI: 1.4-4.2). Excessive use was higher in males than in females. Except for tobacco prevalence of excessive use was only slightly higher in young adults compared to adolescents. CONCLUSION: Excessive substance use is frequent among young people consulting family doctors in a European context. Future research should provide guidance about how to best seize this window of opportunity for prevention and early intervention.

[A new perspective in adolescent contraception--why prescribe an IUD first?]. / Un nouveau regard sur la contraception des adolescentes: pourquoi prescrire un dispositif intra-utérin en première intention?

Adolescent girls are very fertile and therefore need a reliable contraceptive strategy in order to prevent unwanted pregnancies. Although highly recommended by international gynecological and adolescent societies and in spite of its high efficiency, good tolerance and ease of use, only minority of adolescents use IUD as a contraceptive method. This article will focus on available IUDs suitable for adolescents and will address misconceptions and barriers to use of IUDs in this age group. We believe this information will encourage physicians in recommending IUD use to adolescents during their most vulnerable years.

Development of youth friendly family medicine services in Bosnia and Herzegovina: protocol for a cluster randomized controlled trial.

BACKGROUND: Young people face many barriers in accessing health services that are responsive to their needs. The World Health Organization has led a call to develop services that address these barriers, i.e. youth-friendly health services. Addressing the needs of young people is one of the priorities of Foundation fami, an organisation working in collaboration with the Swiss Federal Department of Development and Cooperation and Geneva University Hospitals to develop quality family medicine services in Bosnia and Herzegovina. This paper describes the design of a trial to assess the effectiveness of a multifaceted intervention involving family medicine teams (primary care doctors and nurses) to improve the youth-friendliness of family medicine services in Bosnia and Herzegovina. METHODS/DESIGN: This is a stratified cluster randomised trial with a repeated cross-sectional design involving 59 health services in 10 municipalities of the canton of Zenica in Bosnia and Herzegovina. Municipalities were the unit of randomisation: five municipalities were randomised to the intervention arm and five to a wait-list control arm. Family medicine teams in the intervention arm were invited to participate in an interactive training program about youth-friendly service principles and change processes within their service. The primary outcome was the youth-friendliness of the primary care service measured using the YFHS-WHO + questionnaire, a validated tool which young people aged 15 to 24 years complete following a family medicine consultation. A total of 600 young people aged 15 to 24 years were invited to participate and complete the YFHS-WHO + questionnaire: 300 (30 per municipality) at baseline, and 300 at follow-up, three to five months after the training program. DISCUSSION: The results of this trial should provide much awaited evidence about the development of youth-friendly primary care services and inform their further development both in Bosnia and Herzegovina and worldwide. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry_ ACTRN12610000142033.

[Specialized adolescent health clinic: who should be referred to it?]. / Consultations spécialisées en médecine de l'adolescent: à qui s'adressent-elles?

Adolescent health clinics were created in response to the specific health needs of this age-group. Adolescents may present complex health problems which require a multidisciplinary and global assessment. The aim of this article is to provide an overview of the type of health problems for which adolescents are referred to our clinics and the care they receive in response to them.

[Adolescents with chronic pain: practical assessment and management]. / "Perdre du temps ... pour en gagner". Mieux soigner l'adolescent souffrant de douleurs chroniques.

More than 20% of adolescents in the general population suffer of chronic pain mainly headaches, abdominal or musculoskeletal pain. Often, these complaints are self limited without impact on adolescent development but the cause of emergency consultations, unnecessary costs or inappropriate prescriptions. For a small number of adolescents, chronic pain can express psychological suffering or impact on growth and physical, cognitive or social development. Continuity of care and collaboration among professionals is central. Primary care phyisicians play a crucial role (private practice, adolescent clinic...). Efforts should be made to increase access to modern approaches of chronic pain taking into account family, development as well as aspects related to pain in itself.

[Which follow-up of the second generation antipsychotic in adolescents?]. / Quelle surveillance médicale des adolescents sous antipsychotiques de deuxième génération?

Since the introduction of so called second generation antipsychotic (SGA), the prescription of these drugs has been relatively frequent in adolescence. This article gives a synopsis of the potential side effects and contra-indications, and proposes a practical guideline for the follow-up of these SGAs in adolescent and young adults. The main secondary side effects are in metabolic, endocrine, neurologic, cardiovascular systems and also on the hematological and liver functions. Thus, a strict follow-up should start before the introduction of a SGA treatment and should be continued during the time of administration. Since there is no common consent for a follow-up in SGA use in adolescents for Europe, this article may give a practical guideline for general practitioners and pediatricians, including a clinical exam and biological parameters to be controlled.

Effectiveness of training family physicians to deliver a brief intervention to address excessive substance use among young patients: a cluster randomized controlled trial.

BACKGROUND: Brief interventions delivered by family physicians to address excessive alcohol use among adult patients are effective. We conducted a study to determine whether such an intervention would be similarly effective in reducing binge drinking and excessive cannabis use among young people. METHODS: We conducted a cluster randomized controlled trial involving 33 family physicians in Switzerland. Physicians in the intervention group received training in delivering a brief intervention to young people during the consultation in addition to usual care. Physicians in the control group delivered usual care only. Consecutive patients aged 15-24 years were recruited from each practice and, before the consultation, completed a confidential questionnaire about their general health and substance use. Patients were followed up at 3, 6 and 12 months after the consultation. The primary outcome measure was self-reported excessive substance use (≥ 1 episode of binge drinking, or ≥ 1 joint of cannabis per week, or both) in the past 30 days. RESULTS: Of the 33 participating physicians, 17 were randomly allocated to the intervention group and 16 to the control group. Of the 594 participating patients, 279 (47.0%) identified themselves as binge drinkers or excessive cannabis users, or both, at baseline. Excessive substance use did not differ significantly between patients whose physicians were in the intervention group and those whose physicians were in the control group at any of the follow-up points (odds ratio [OR] and 95% confidence interval [CI] at 3 months: 0.9 [0.6-1.4]; at 6 mo: 1.0 [0.6-1.6]; and at 12 mo: 1.1 [0.7-1.8]). The differences between groups were also nonsignificant after we restricted the analysis to patients who reported excessive substance use at baseline (OR 1.6, 95% CI 0.9-2.8, at 3 mo; OR 1.7, 95% CI 0.9-3.2, at 6 mo; and OR 1.9, 95% CI 0.9-4.0, at 12 mo). INTERPRETATION: Training family physicians to use a brief intervention to address excessive substance use among young people was not effective in reducing binge drinking and excessive cannabis use in this patient population. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, no. ACTRN12608000432314.

Text-messaging to reduce missed appointment in a youth clinic: a randomised controlled trial.

BACKGROUND: To assess the effectiveness of text-messages in reducing the proportion of non-attendance in a youth clinic of a University Hospital. METHODS: Patients who registered for an appointment and provided a mobile phone number were randomly selected to receive or not a text-message reminder before the planned appointment. A 10% reduction in the proportion of missed appointments was considered clinically and economically useful and the study was powered accordingly. RESULTS: The proportion of missed appointments was 16.4% (95% CI 13.1% to 19.8%) in the text-message group (N 462) and 20.0% (95% CI 16.6% to 23.4%) in the control group (N 529), showing no significant effect of the intervention (p=0.346). CONCLUSIONS: In our primary care youth clinic, text-message reminders are not effective in reducing the proportion of missed appointments. This may in part be due to the fact that most patients are referred by a professional or by their parents and do not initiate appointments themselves.

Text-messaging versus telephone reminders to reduce missed appointments in an academic primary care clinic: a randomized controlled trial.

BACKGROUND: Telephone or text-message reminders have been shown to significantly reduce the rate of missed appointments in different medical settings. Since text-messaging is less resource-demanding, we tested the hypothesis that text-message reminders would be as effective as telephone reminders in an academic primary care clinic. METHODS: A randomized controlled non-inferiority trial was conducted in the academic primary care division of the Geneva University Hospitals between November 2010 and April 2011. Patients registered for an appointment at the clinic, and for whom a cell phone number was available, were randomly selected to receive a text-message or a telephone call reminder 24 hours before the planned appointment. Patients were included each time they had an appointment. The main outcome was the rate of unexplained missed appointments. Appointments were not missed if they were cancelled or re-scheduled before or independently from the intervention. We defined non-inferiority as a difference below 2% in the rate of missed appointments and powered the study accordingly. A satisfaction survey was conducted among a random sample of 900 patients (response rate 41%). RESULTS: 6450 patients were included, 3285 in the text-message group and 3165 in the telephone group. The rate of missed appointments was similar in the text-message group (11.7%, 95% CI: 10.6-12.8) and in the telephone group (10.2%, 95% CI: 9.2-11.3 p = 0.07). However, only text message reminders were cost-effective. No patient reported any disturbance by any type of reminder in the satisfaction survey. Three quarters of surveyed patients recommended its regular implementation in the clinic. CONCLUSIONS: Text-message reminders are equivalent to telephone reminders in reducing the proportion of missed appointments in an academic primary care clinic and are more cost-effective. Both types of reminders are well accepted by patients.