How to approach and take care of minor adolescents whose situations raise ethical dilemmas? a position paper of the European academy of pediatrics.

In the care of adolescents, health care providers often face situations raising ethical concerns or dilemmas, such as refusal of a treatment or hospitalization, or request of confidentiality while engaging in risky behaviors or facing unplanned pregnancy. This position paper provides concrete avenues as how to assess the adolescent's capacity for autonomous decision making, e.g. the patient's competence in a specific situation, and how to elicit informed choice or consent. To do so, professionals need to be sensitized and trained as how to assess the cognitive and socio-psychological development of the young patient. Another challenge for the health professionals is to balance the needs to support patient's autonomy while offering secure guidance and protection if needed. To optimize such a process, they establish a climate of trust and empathy that will allow the patient to participate freely in the decision. In addition, especially when the decisions have potentially important consequences on the health and life, the professionals include, with the adolescent's permission, parents, caregivers or other significant adults, as well as they may request the opinion of other members of the health care team or expert colleagues such as ethicists.

[Actively supporting youth participation and autonomous decision-making in health matters]. / Soutenir activement la participation et les prises de décisions des adolescent-e-s dans le domaine de la santé.

The adolescent's process of brain maturation has important consequences for their ability to reason in decision-making processes. The notion of evolving capacity, for which age is not a sufficient indicator, implies a progressive vision of the nature and degree of participation according to the level of maturity. Health professionals are at the forefront of actively promoting young people's participation, supporting their decision-making about their own health, and seeing them as true partners and agents of change. The active participation of young people in all decisions that concern them is essential to make real progress in the field of adolescent health. This step implies a paradigm shift from "thinking for them" to "thinking with them".

Le processus de maturation cérébrale des adolescents a des conséquences importantes sur leur capacité de raisonnement dans les processus de décision. La notion de capacité évolutive, dont l'âge n'est pas un indicateur suffisant, implique une vision progressive de la nature et du degré de participation en fonction du niveau de maturité. Les professionnel-le-s de la santé sont aux premières loges pour favoriser activement la participation des jeunes, en soutenant leurs prises de décision concernant leur propre santé et en les considérant comme de véritables partenaires et acteurs de changement. La participation active des jeunes dans toutes les décisions qui les concernent est indispensable pour réellement progresser dans le domaine de la santé des adolescents. Cette étape implique un changement de paradigme de penser « avec eux ¼ plutôt que « pour eux ¼.

'Demystifying' the encounter with adolescent patients: a qualitative study on medical students' experiences and perspectives during training with adolescent simulated patients.

Training with adolescent simulated patients (ASP) is increasingly recognized as an effective form of teaching interviewing skills with adolescent patients. Beyond the acknowledged effectiveness and satisfaction of training with ASP, little is known on medical students' actual experience and specific learning needs related to simulated encounters with ASP, as well as factors influencing their learning experience.The aim of this study was an in-depth exploration of medical students' perspectives about training with ASP.Using a qualitative design with grounded theory methods, we conducted in-field observation of training sessions with ASP and individual interviews with eighteen fourth-year medical students participating in training.When provided with an actual experience in a simulated setting, students go through a process of anticipating then modulating the challenge of the encounter with an adolescent patient. This challenge is influenced and modulated within 3 main dimensions: preconceptions about adolescents, level of experience with adolescent patients and professional distance. This process is also influenced by how students perceive and cope with the educational setting.Training with ASP, as a first concrete experience of an adolescent consultation, is an opportunity to address important aspects of students' attitudes towards adolescent patients such as students' preconceptions, personal experiences and feelings that could influence the doctor-patient relationship later on. Training should focus on ways to reflect upon and handle such attitudes and the emotional resonance experienced by medical students.

[«â€ Let's talk about sex†¼â€ : adolescent boys' sexual health in the primary care setting]. / «â€ Parlons de sexe avec eux aussi†¼â€ : ­la santé sexuelle des adolescents garçons en médecine de premier recours.

Despite obvious needs, adolescent boys do not access information and care in the field of sexual and reproductive health as easily as adolescent girls. The primary care setting gives the opportunity to tackle sexuality topics with boys. It allows to defuse frequent causes of concern in this crucial developmental phase, in a proactive and open-minded way, while focusing on strengths rather than on risks. It also allows to discuss masculine norms and their impact on health, and to come up with essential prevention elements. It is -necessary to focus on boys' health to have them involved in a -changing process on behalf of their own health but also on behalf of girls' and young women's health.

Malgré des besoins évidents en matière de santé sexuelle, les adolescents garçons accèdent moins à l'information et aux soins dans ce domaine que les filles. Toute consultation en médecine de premier recours avec un garçon fournit dès lors l'occasion d'élargir l'entretien aux questions de sexualité. Grâce à une ­approche proactive, ouverte, centrée sur les ressources plutôt que sur les risques, l'entretien permet d'aborder des inquiétudes courantes en cette période développementale cruciale, de discuter les modèles masculins et leur impact sur la santé ou encore d'évoquer des éléments incontournables de prévention. Porter notre attention sur la santé des garçons est essentiel afin de les engager en tant qu'acteurs de changement pour leur propre ­santé, mais aussi pour celle des filles et jeunes femmes.

[PROFILES: typical portrait of the future Swiss doctors]. / PROFILES: portrait-type de nos futurs médecins !

In each professional practice, a greater or lesser part of the activity is devoted to teaching. Indeed, the transmission of the medical knowledge is an essential objective for the training of students and residents, but also an opportunity to adapt one's own practices to the current context, since fast changes are not necessarily easy to follow and assimilate. If the relationship with Medical school is rather straightforward in the university hospitals, it is not always the same for those who are more distant, but whose participation in teaching is desired, and clearly growing. In this way, it is therefore crucial that everyone is informed about recent changes to the undergraduated learning objectives (PROFILES) and the resulting needs for educational reforms for all Medical schools in Switzerland.

Dans chaque pratique professionnelle, une part plus ou moins grande de l'activité est dévolue à l'enseignement. En effet, la transmission de l'art médical représente un objectif essentiel pour la formation des étudiant·e·s et des jeunes collègues, mais aussi une opportunité pour adapter ses pratiques au contexte actuel, car les changements, rapides, ne sont pas forcément faciles à assimiler. Si, dans les hôpitaux universitaires, le contact avec les Facultés de médecine est plutôt aisé, il n'en va pas toujours de même pour ceux qui en sont plus distants, mais dont la participation à l'enseignement est souhaitée et croissante. En ce sens, il apparaît crucial que tou·te·s soient informé·e·s sur les modifications récentes des objectifs d'apprentissage prégradué (PROFILES) et sur les réformes qui en découlent pour les Facultés de médecine en Suisse.

[Fatigue in the adolescent athlète]. / La fatigue chez l'athlète adolescent.

Adolescent athletes frequently complain of fatigue. Acute fatigue after intense training is physiological and necessary in order to develop capacity and increase performance. However, healthcare practitioners must question persistant fatigue, which causes are multiple, sometimes clear, though mostly multifactorial. A comprehensive and holistic approach is especially required in adolescents, with a complete somatic, psychosocial and athletic history. The role of healthcare professionals is to quickly identify specific signs and complex diagnoses, which can lead to physical and psychological consequences in the long term (overtraining, burnout, abuse, eating disorders). Finally, in a time where overweight and inactivity is rampant in the youth, we must imperatively avoid adolescents dropping out of sports and activity.

La fatigue est un motif de consultation fréquent chez l'athlète adolescent. Une fatigue aiguë après un effort intensif est physiologique, voire même recherchée dans le but d'améliorer les performances. Une fatigue qui s'installe doit interpeller. Les causes sont multiples, parfois bien précises, mais souvent multifactorielles. Une approche holistique est indispensable, surtout chez l'adolescent, avec une anamnèse somatique, psychosociale et sportive détaillée. Le rôle du professionnel de la santé est de détecter au plus vite les premiers signes, certains diagnostics difficiles à poser pouvant avoir de lourdes conséquences physiques et psychiques à long terme (surentraînement, burnout, abus, trouble du comportement alimentaire). En cette ère d'épidémie de surpoids chez les jeunes, l'abandon du sport est à éviter absolument.

[Lost in transition: crossed looks on the 18-25 years old]. / Lost in transition :regards croisés sur les 18-25 ans.

Social determinants have an impact on patients' access to care and on their health at any age. Young adults are a population at risk of being affected in their health because of a lack of social protection or unavailability of healthcare system adapted to their specific needs. Primary healthcare providers need to identify that window of social vulnerability in order to avoid a discontinuation in healthcare and to prevent biopsychosocial co-morbidity leading to ongoing consequences on their health.

L'impact des déterminants sociaux sur l'accès aux soins des patients et sur leur santé concerne toutes les catégories d'âge. Les jeunes adultes sont une population particulièrement à risque d'être pénalisés dans leur santé par un défaut de protection sociale ou de réseau de soins adapté à leurs besoins spécifiques. Le médecin de premier recours, pédiatre ou généraliste, doit identifier cette fenêtre de vulnérabilité sociale afin d'éviter une rupture de soins et prévenir les comorbidités biopsychosociales ayant des conséquences durables sur la santé.

[Atopic dermatitis in children: general principles of management]. / Dermatite atopique de l'enfant: principes généraux de la prise en charge.

Atopic dermatitis is the most frequent dermatosis in childhood. Numerous studies underscored the central role of skin barrier alterations in the pathogenesis of the inflammatory skin lesions. The management of atopic dermatitis has to be multidimensional. It combines among others some daily local care and a sporadic topical anti-inflammatory treatment during the acute flare-ups. The objective of this article is to summarize, in light of the recent European guidelines, the general principles of management of atopic dermatitis, for the general practitioner.