[Hypnosis: a complementary tool for managing adolescents affected by anorexia nervosa]. / Hypnose : outil complémentaire chez les adolescent-e-s souffrant d'anorexie mentale.

Anorexia Nervosa (AN) mainly affects adolescent girls and requires specialized, multidisciplinary care. In Geneva, the HUG's AliNEA unit and the pediatric hypnosis consultation have been collaborating since 2021 to integrate hypnosis into the management of AN. Hypnosis is seen as a complementary tool to the Maudsley therapeutic model, but not a miracle solution. It needs to be adapted to each patient's individual needs and to the different phases of treatment : re-association with the body, reinforcement of motivation, exploration of interpersonal relationships and consolidation of progress. Although scientific evidence is limited, patient testimonials underline its beneficial potential as a non-medicinal, individualized form of support.

L'anorexie mentale (AM) affecte principalement les adolescentes et requiert une prise en charge spécialisée et multidisciplinaire. Aux Hôpitaux universitaires de Genève (HUG), l'unité AliNEA et la consultation d'hypnose pédiatrique collaborent depuis 2021 pour intégrer l'hypnose dans la prise en charge de l'AM. L'hypnose est considérée comme un outil complémentaire au modèle thérapeutique Maudsley, mais non une solution miracle. Elle nécessite une adaptation aux besoins individuels de chaque patiente et aux différentes phases de la prise en charge : réassociation avec le corps, renforcement de la motivation, exploration des relations interpersonnelles et consolidation des progrès. Bien que les preuves scientifiques soient limitées, les témoignages des patientes soulignent son potentiel bénéfice comme soutien non médicamenteux et individualisé.

[Eating disorders in the light of addiction]. / Troubles du comportement alimentaire à l'aune de l'addiction.

Eating disorders (ED) are complex and damaging to health. They cause suffering similar to that of addictions. Although they share some similarities, eating disorders remain distinct from addictions. Fundamental differences emerge in binge eating and restrictive behaviors. Eating disorder treatment in adolescents relies mainly on family therapy and can incorporate a reflection on these similarities and differences. For instance, understanding the addictive nature of the illness helps parents and patients to avoid sterile negotiations around food. An individualized approach is crucial to the effective management of ED by a specialized multidisciplinary team. Clarity in explaining physiological mechanisms strengthens the therapeutic alliance.

Les troubles du comportement alimentaire (TCA) sont complexes et portent atteinte à la santé. Ils peuvent engendrer des souffrances similaires à celles des addictions. Bien qu'ils partagent des similitudes, les TCA demeurent distincts des addictions. Des différences fondamentales émergent dans les comportements d'hyperphagie et de restriction. La prise en charge des TCA, axée sur la thérapie familiale, peut intégrer une réflexion sur ces similitudes et ces différences. Par exemple, la compréhension de la nature addictive de la maladie aide parents et patients à éviter des négociations stériles autour de l'alimentation. Une approche individualisée est cruciale pour une prise en charge efficace des TCA par une équipe multidisciplinaire spécialisée. La clarté dans l'explication des mécanismes physiologiques renforce l'alliance thérapeutique.

[Postural tachycardia syndrome among adolescents]. / Syndrome de tachycardie posturale chez les adolescent-e-s.

Postural tachycardia syndrome (PoTS) is a frequent polymorphic clinical syndrome, poorly known and, as a result, underdiagnosed especially in adolescents. It is a form of dysautonomia, but its exact physiopathology remains elusive. It is characterized by heterogeneous symptoms that accompany a disproportionate tachycardia upon the upright position. It can significantly impact adolescents' quality of life. Only a Schellong test is useful to make the diagnosis; however additional testing is frequently performed in order to exclude conditions that may mimic, exacerbate or impact management. Treatment in PoTS is primarily symptomatic. The main goal is to restore the patient's condition as quickly as possible. Its management is multidisciplinary and must involve the parents. The course of the syndrome is sometimes marked by relapses, but the prognosis is mostly favorable.

Le syndrome de tachycardie posturale (STPo) est un syndrome clinique polymorphe sous-diagnostiqué. Il est fréquent et son impact est majeur sur la qualité de vie des adolescent-e-s. Il résulte d'une dysautonomie. Il est caractérisé par une tachycardie disproportionnée lors du passage en position debout, avec des symptômes hétérogènes. Seul un test de Schellong permet de poser le diagnostic ; des analyses complémentaires sont néanmoins fréquemment réalisées pour rechercher des affections qui peuvent mimer ou aggraver un STPo ou avoir un impact sur sa prise en charge. Son traitement est symptomatique avant tout. L'objectif est de reconditionner le patient, le plus rapidement possible. Sa prise en charge est multidisciplinaire et doit impliquer les parents. L'évolution vers la guérison est émaillée de rechutes, mais le pronostic est bon le plus souvent.

Prevalence and forms of gender discrimination and sexual harassment among medical students and physicians in French-speaking Switzerland: a survey.

OBJECTIVES: The aim of this study was to determine the prevalence and forms of gender discrimination and sexual harassment experienced by medical students and physicians in French-speaking part of Switzerland. DESIGN AND SETTING: We conducted an online survey using a questionnaire of 9 multiple-choice and 2 open questions between 24 January 2019 and 24 February 2019. Our target population was medical students and physicians working at hospitals and general practitioners from the French-speaking part of Switzerland. The online survey was sent via social media platforms and direct emails. We compared answers between male-determined and female-determined respondents using either χ2 or Fisher's exact tests. RESULTS: Among 1071 responders, a total of 893 were included (625 females, 264 males, 4 non-binary and 1 non-binary and male). 178 were excluded because they did not mention their working place or were working only outside Switzerland. Because of the small number of non-binary participants, they were not contemplated in further statistical analysis. Of 889 participants left, 199 (31.8%) women and 18 (6.8%) men reported having personally experienced gender discrimination, in terms of sexism, difficulties in career development and psychological pressure. Among women, senior attendings were the most affected (55.2%), followed by residents (44.1%) and junior attendings (41.1%). Sexual harassment was equally observed among women (19.0%) and men (16.7%). Compared with men (47.0%), women (61.4%) expressed the need to promote equality and inclusivity in medicine more frequently (p<0.001), as well as the need for support in their professional development (38.7% women and 23.9% men; p<0.001). CONCLUSIONS: Gender discrimination in medicine in French-speaking Switzerland affects one-third of women, in particular, those working in hospital settings and senior positions.

Does age influence self-perception of the soft-tissue profile in children?

INTRODUCTION: Appreciation of the soft-tissue profile is important in orthodontic diagnosis and treatment. However, are the patients themselves aware of their profile appearance? We aimed to evaluate if age influences self-perception of the soft-tissue profile in children. METHODS: The study population for this prospective cross-sectional investigation consisted of 3 groups of 60 patients, classified according to age (<12 years; 12-15 years; >15 years). Each subject's right-sided facial profile was photographed to obtain a silhouette. Facial profile silhouette templates were created to represent the local population. Each subject's photograph was inserted into the corresponding template, and the subjects were asked to identify themselves. Facial profile self-recognition was recorded as a binary variable (yes or no). Other recorded variables included age, sex, and sexual maturity rating (using Tanner staging). Chi-square tests were used to analyze facial profile self-recognition between different subgroups, and stepwise multiple regression was used to predict the probabilities of facial profile self-recognition, with age, sexual maturity rating, and other recorded variables as independent variables. RESULTS: Eighty percent of subjects aged >15 years recognized their own profile, compared with only 55% and 50% of subjects aged 12-15 years and <12 years, respectively. Subjects aged >15 years were significantly more likely to recognize their profile than younger subjects (P = 0.001). Similarly, subjects with the most advanced sexual maturity rating (stage V) were significantly more likely to recognize their profile (85% self-recognition) than those in groups I-IV (P <0.001). Girls were more likely to recognize their profiles than boys (P = 0.028). When using multiple regression analysis, sexual maturity rating appears to be the only significant predictor for facial profile self-recognition (R2 = 0.25; P <0.001). CONCLUSIONS: Facial profile self-recognition seems to improve with age and sexual maturity (sexual maturity rating stage V). Because orthodontic treatment planning takes possible soft-tissue changes into account, it is important to evaluate the degree of self-perception of the patients to adapt our goals and treatment discussions.

Acute monophasic erythromelalgia pain in five children diagnosed as small-fiber neuropathy.

The small-fiber polyneuropathies (SFN) are a class of diseases in which the small thin myelinated (Aδ) and/or unmyelinated (C) fibers within peripheral nerves malfunction and can degenerate. SFN usually begins in the farthest, most-vulnerable axons, so distal neuropathic pain and symptoms from microvascular dysregulation are common. It is well known in adults, e.g. from diabetes, human immunodeficiency virus, or neurotoxins, but considered extremely rare in children, linked mostly with pathogenic genetic variants in voltage-gated sodium channels. However, increasing evidence suggests that pediatric SFN is not rare, and that dysimmunity is the most common cause. Because most pediatric neurologists are unfamiliar with SFN, we report the diagnosis and management of 5 Swiss children, aged 6-11y, who presented with severe paroxysmal burning pain in the hands and feet temporarily relieved by cooling-the erythromelalgia presentation. Medical evaluations revealed autoimmune diseases in 3 families and 3/5 had preceding or concomitant infections. The standard diagnostic test (PGP9.5-immunolabeled lower-leg skin biopsy) confirmed SFN diagnoses in 3/4, and autonomic function testing (AFT) was abnormal in 2/3. Blood testing for etiology was unrevealing, including genetic testing in 3. Paracetamol and ibuprofen were ineffective. Two children responded to gabapentin plus mexiletine, one to carbamazepine, two to mexiletine plus immunotherapy (methylprednisolone/IVIg). All recovered within 6 months, remaining well for years. These monophasic tempos and therapeutic responses are most consistent with acute post-infectious immune-mediated causality akin to Guillain-Barré large-fiber polyneuropathy. Skin biopsy and AFT for SFN, neuropathic-pain medications and immunotherapy should be considered for acute sporadic pediatric erythromelalgia.

[Transgender and non-binary teenagers : management in primary care]. / Adolescents transgenres et non ­binaires : approche et prise en charge par les médecins de premier recours.

Transgender, non-binary and questioning teenagers are increasingly visible. However, they face barriers in accessing appropriate care that meet their needs, both specific and regarding their general health. Primary care physicians increasingly see them in consultations but often lack elements of communication and recent knowledge that is needed to accompany them and their close ones in their -individual trajectories. This article aims to answer this need and provides a synthesis about recent evidence and suggested communication approaches for primary care physicians, who play a central role for the health of all patients.

Les adolescents transgenres, non binaires ou en questionnement sont de plus en plus visibles et font face à de nombreux obstacles pour accéder à des soins appropriés, tant pour leurs besoins de santé spécifiques que généraux. Les médecins de premier recours les rencontrent au cabinet et peuvent manquer d'éléments de communication et de connaissances spécifiques récentes pour mener la consultation et accompagner ces personnes et leurs proches dans leurs trajectoires individuelles. Cet article propose une synthèse des éléments et des ressources utiles pour le médecin de premier recours, dont le rôle est ­central pour la santé de tous les patients.

[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.

Combined VIth and VIIth nerve palsy: Consider idiopathic intracranial hypertension!

BACKGROUND: Idiopathic intracranial hypertension (IIH) is a rare condition in children. VIth nerve palsy is the most common cranial nerve deficit related to that condition. Other cranial nerve dysfunctions have also been described but remain rare in paediatric daily practice. CASE PRESENTATION: We here report the case of a 13-year-old girl who presented with VIth and contralateral VIIth nerve palsy due to IIH. CONCLUSION: Although rarely encountered, paediatricians should be familiar with the possible association of VIth and contralateral VIIth nerve palsy in children suffering from IIH. Moreover, other cranial nerve deficits may also be affected.