[Management of allergic rhinitis in general practitioner's office]. / Prise en charge de la rhinite allergique au cabinet du généraliste.

In Switzerland, almost 20 % of the population suffers from allergic rhinitis, which has a major impact on patients' quality of life. Allergen avoidance remains the most effective measure but is not always possible. Intranasal corticosteroids, oral antihistamines, or combination of intranasal corticosteroids and antihistamines remain first-line pharmacological treatments. In case of refractory symptoms, despite well-managed symptomatic treatment, when the patient wishes a more long-term effect or for prevention of asthma, the patient can be referred to the allergologist for specific immunotherapy. The specific immunotherapy is the only treatment option that targets the underlying pathophysiology of allergy and therefore shows disease-modifying effects.

En Suisse, près de 20 % de la population sont atteints de rhinite allergique et cette dernière impacte de manière importante la qualité de vie des patients. L'éviction des allergènes reste la mesure la plus efficace mais n'est pas toujours possible. Les corticostéroïdes intranasaux, les antihistaminiques per os, ainsi que les combinaisons de corticostéroïdes et d'antihistaminiques intranasaux demeurent les traitements pharmacologiques de première ligne. En cas de symptômes réfractaires, lorsque le patient souhaite un effet à long terme ou dans un contexte de prévention de l'asthme, il peut être référé chez l'allergologue pour une immunothérapie spécifique. C'est la seule option thérapeutique ciblant la physiopathologie sous-jacente de l'allergie et avec un effet modificateur sur la maladie.

[Pilot project for a Medical Home in Geneva]. / Projet pilote de maison de santé à Genève.

The aging of the population and the increase in chronic diseases are overloading our healthcare system, with complex patients requiring more care. To meet their needs and keep them at home, interprofessional team management is necessary. The Directorate of Health of the Canton of Geneva issued a call for tenders to set up Medical Homes. We responded, were selected and have been building its various components over the past two years: identification of complex patients, setting up coordinated teams, the shared care plan, coordination with the medical assistant and the financing system. The preliminary results show its success, yet specific project management skills and financial resources are needed.

Le vieillissement de la population et l'augmentation des maladies chroniques surchargent notre système de santé, les patients complexes demandant plus de soins. Pour répondre à leurs besoins et les maintenir à domicile, une prise en charge en équipe interprofessionnelle est nécessaire. La Direction générale de la santé du canton de Genève a fait un appel d'offres pour mettre en place des maisons de santé (MdS). Nous y avons répondu et construisons depuis deux ans ses différents composants : l'identification des patients complexes, la mise en place d'équipes coordonnées, le plan de soins partagé, la coordination avec l'assistante médicale et le système de financement. Si les résultats démontrent l'intérêt de la MdS, des compétences spécifiques en gestion de projet et des ressources financières restent nécessaires.

Excessive substance use screening to encourage behaviour change among young people in primary care: Pilot study in preparation for a randomized trial.

INTRODUCTION: Alcohol, cannabis and other substance use affects young people's health. Primary care physicians are encouraged to screen and provide brief interventions for substance use in this population, but implementation is often limited. Pre-consultation self-administered screening may decrease at-risk substance use and could have population-level benefits. A randomized controlled trial is planned to test this hypothesis. The present pilot study's objective was to assess the feasibility of methods for the future trial. METHODS: The parallel-group randomized controlled pilot trial was undertaken in 6 primary care practices in Geneva, Switzerland, over 2 months. 29 patients aged 15-24 years consulting for any reason were randomly assigned to intervention (substance use screening, n = 14) or control (physical activity questionnaire, n = 15) using computer-generated random number tables. Outcomes were assessed one month later by telephone questionnaire. Physicians, practice staff and outcome assessors were blinded to allocation. The primary outcomes were feasibility of procedures and acceptability to participants, primary care physicians and practice staff. RESULTS: Of 16 participants reached at follow-up, 3 reported excessive substance use. Methods were acceptable to all participants, especially regarding confidentiality. Three participants were lost due to technical difficulties with the consent form. No major problems with study methods were reported in the practices. 4 practices did not meet recruitment targets. CONCLUSION: The study procedures proved to be feasible in primary care practices and acceptable to young people who were readily available to participate. The main challenge for the future full-sized trial will be to ensure that recruitment targets can be met.

[Continuity of care from pediatrician to general practitioner in Switzerland : a practical approach]. / Du pédiatre au généraliste: apporter une continuité aux soins de premier recours de l'enfance à l'âge adulte.

The transition from a pediatrician to a general practitioner builds on a strong relationship with the pediatrician. Informed consent and decision making in children and adolescents are greatly improved by a trustful relationship with healthcare providers. In Switzerland, minors can access their medical file without parental consent if considered competent. Electronic files can be helpful but may lead to breeches in confidentiality : transmission of data concerning the family or parent's health status not relevant for the adolescent's medical follow-up, parental access to the medical files. A simple transmission file can be given to the adolescent at the end of pediatric follow up. Visits to mark the end of the pediatric follow-up and the beginning of the GP follow-up should be systematically offered to young people with special needs.

La relation de confiance avec le pédiatre favorise la capacité des enfants et adolescents à prendre des décisions éclairées pour leur santé et représente un fondement essentiel pour la relation avec les soignants à l'âge adulte. Le cadre médico-légal suisse autorise un mineur capable de discernement à disposer seul de son dossier médical. Le dossier électronique facilite la transmission des données mais peut conduire à des ruptures de confidentialité : informations sur l'état de santé des parents ou sur la famille non pertinentes pour le suivi du jeune, accès des parents au dossier. Une simple fiche de transfert peut être remise au jeune à la fin du suivi pédiatrique. Pour les jeunes avec des besoins spéciaux, une visite de fin de suivi pédiatrique et une autre de début de suivi chez le généraliste devraient être systématiquement proposées.

[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.

Building a transitional care checklist in rheumatology: A Delphi-like survey.

OBJECTIVES: To design a transitional care checklist to be used by and facilitate the work of health professionals in providing transitional care for children with a chronic rheumatologic disease and their families. METHODS: A Delphi-like study among an international expert panel was carried out in four steps: (1) a working group of 6 specialists established a draft; (2) a web-survey among a panel of international experts evaluated it; (3) a 2-day consensus conference with an expert panel discussed items not reaching agreement; (4) a web-survey among the panel of international experts with the list of reformulated items. RESULTS: The first draft of the checklist included 38 items in 3 phases of transition and 5 age groups. Thirty-three international experts evaluated the checklist reaching≥80% agreement for 26 items and ≤80% for 12. The consensus conference of 12 experts discussed and redefined the 12 items. Twenty-five international experts filled out the web-survey and all items reached a minimum of 80% agreement except one. The final checklist was reached. CONCLUSIONS: This Delphi-like study defined what themes should be included and at what age they need to be addressed with patients with a chronic rheumatology disease and their families during transition. This checklist reached a strong international and interdisciplinary consensus while examining transition in a broad way. It should now be spread widely to health professionals to be used by all those who care for adolescents aged≥12 years at times of transition. It could be transposed to most chronic conditions. Recommendations for further research are given.

Using the HEADSSS guide to teach students diagnostic skills in adolescent health Views from students participating in interprofessional courses. / Apport du guide d'entretien HEADSSS dans l'apprentissage de la démarche diagnostique avec un adolescent Perspectives d'étudiants lors de coursà option interprofessionnels.

Over the past few years, an interprofessional team of lecturers in Geneva has developed courses entitled « adolescent health and development ¼. These courses are open to students in medicine, nursing and nutrition, as well as to other interested health professionals. Using vignettes, students who participated in the courses present their thoughts on the use of the HEADSSS interview guide in the diagnostic approach with adolescents. These optional courses provide an opportunity to explore infrequently taught domains of the curriculum in a creative way. They give students the chance to develop common practice skills providing the basis for improved inter-professional collaborations in the future.

Depuis quelques années des cours à option « Santé et développement à l'adolescence ¼ ont été développés par une équipe d'enseignants interprofessionnels à Genève. Ces cours s'adressent aux étudiants en médecine, soins infirmiers, nutrition et diététique, mais sont également ouverts à d'autres professionnels. A l'aide de vignettes, des étudiants ayant participé à ces cours nous présentent leurs réflexions sur l'usage de l'outil d'entretien HEADSSS (habitat, éducation, activités, alimentation, drogues, sexualité, suicide, santé mentale, sécurité, médias sociaux) dans la démarche diagnostique auprès d'adolescents. Ce type d'enseignement optionnel permet d'explorer de façon créative des domaines moins enseignés dans le curriculum. Il permet aussi aux étudiants de développer des outils de pratique, communs entre diverses professions, permettant de poser des bases pour une meilleure collaboration interprofessionnelle dans le futur.

[Tuberculosis screening in school health services in Geneva, Switzerland]. / Le dépistage de la tuberculose en milieu scolaire.

Recent immigrantyouth have multiple health needs that need to be adapted to the context of migration. School health services provide a systematic health check to allyoung immigrants starting school in Geneva, including a tuberculin skin test if coming from a middle or high incidence country. Positive tests are confirmed with Interferon Gamma Release Assay (IGRA) and if indicated, offered treatment of latent tuberculosis even in the absence of clear guidelines. Collective and individual benefits outweigh the difficult logistics: reducing risk of reactivation of latent tuberculosis for populations living in promiscuity, effective collaboration between primary care and school health services to answer the needs of these underserved youth.

The health of Swiss adolescents and its implications for training of health professionals in Switzerland.

Swiss adolescents generally enjoy satisfying life conditions. Nonetheless, violence, suicide and mental health are the main concerns together with injuries, chronic conditions and eating disorders. Adolescents still face barriers to access the care they need. Adequate training can improve practitioners' skills when dealing with adolescents. The last two decades have seen the development of innovative adolescent health units and networks in various regions of Switzerland as well as research and public health programmes. Training programmes in adolescent health (continuous medical education, post-graduate or pre-graduate) for physicians and nurses are developing but still patchy in Switzerland. Adolescent health is not a sub-specialty as such. Efforts have to be made in order to link with professional associations and institutions to implement adolescent health curricula more efficiently.

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.

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.

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.

YFHS-WHO+ Questionnaire: validation of a measure of youth-friendly primary care services.

PURPOSE: To develop and validate a research tool to measure the youth friendliness of primary care services from a client's perspective. METHODS: The questionnaire was initially developed in English, but as it was to be used in Bosnia and Herzegovina (BiH), it was validated in the language of this country. Items were adapted from two sources: a reproductive health services quality improvement questionnaire from the World Health Organization, and an Australian survey used to assess youth-friendly primary care services. An English-speaking international panel reviewed the list of items for face validity. After translation-back translation, the questionnaire was pretested with adolescent patients from a family practice in BiH. The stability and construct validation were then conducted with 60 young people from six different health services in BiH. Items for the final questionnaire were selected using item response theory. RESULTS: The validation and item response analysis led to a 49-item tool. Test-retest stability at 1 week was excellent (mean κ: .93). Construct validation was supported by the fact that services with the highest and the lowest scores on the questionnaire were also those that had many and few, respectively, youth-friendly characteristics, as assessed by experts, on a predefined evaluation grid. Services seeing a higher proportion of adolescents also had higher scores on the questionnaire. CONCLUSIONS: This study supports the validity of the YFHS-WHO+ questionnaire for assessing the level of youth friendliness of family medicine services for research purposes. Further validations in English and French will allow wider use of this tool in the future.

[Immunization and preventive care for young people in Switzerland]. / Rattrapage vaccinal a l'adolescence: une occasion a ne pas manquer.

Children of foreign origin have better immunization coverage than children of swiss origin. This difference fades as children reach the teenage years and disappears in adulthood. On the other hand migrants have less access to preventive services. In teenagers, school immunization programs are the strongest determinant of good coverage. Immunization is only one aspect of adolescent preventive care but it provides the opportunity for a wider range of preventive activities. Multi-sectoral approaches including national and cantonal policies, school health services, primary care are needed to improve vaccine coverage and preventive opportunities at the same time. This article highlights the benefits of preventive services for young people whatever their origin and offers practical recommendations for immunization catch up in 11-25 year olds'.

[Being a migrant and an adolescent: which strategies for health promotion?]. / Etre migrant et adolescent: quelles actions préventives proposer?

Young recently arrived migrants represent a vulnerable population. The influence of socioeconomic and environmental factors on health is now well known. The accumulation of protective factors can counterbalance the negative effect of risk factors, based on the concept of health assets. The migration process may threaten this balance. Some studies have observed better health in migrants than in the host population, but this is not a permanent effect as health deteriorates with time. Pre-migration experiences as well as post-migration conditions in the host country largely influence migrants' health outcomes. Family and social support and integration into the host society are primordial factors that need to be strengthened.

[Young and migrants: a multidisicplinary approach in a youth clinic in Geneva]. / Jeunes avant tout: travail en réseau avec les jeunes migrants récemment arrivés.

Recent young migrants are a very heterogeneous population with mixed health needs. The global world mortality and morbidity of 12-25 year olds' is mostly related to accidents and other preventable causes or mental disorders. Most severe psychiatric disorders begin in this age group. Adolescence and the migrant status of young people and their families impact on their expression of needs. The adolescent and young adult program of Geneva University Hospitals is a specialized, multidisciplinary integrated team contributing to improve delivery of care through an easy access to care and preventative activities. In collaboration with Geneva's health network it offers a valuable continuity of care in this population.