The experience of healthcare professionals treating adolescents with eating disorders in psychiatric and pediatric inpatient units for adolescents: A qualitative study.

OBJECTIVES: The recommended treatment for Eating Disorders (EDs) is multidisciplinary and multimodal. Nonetheless, the complex linkage of the different disciplines involved is not necessarily simple. We analyzed the experience of healthcare professionals faced with psychiatric and psychological symptoms in adolescents with EDs in two "multidisciplinary" inpatient units embedded predominantly in different paradigms - one pediatric and one psychiatric. METHODS: Qualitative analysis of 20 healthcare staff members' interviews from different professional backgrounds working in inpatient units for EDs in Montreal (Canada) and Paris (France). RESULTS: The "Complex patients" theme discusses the need for a global approach to the multiplicity of symptoms presented by these patients. "Management and its limits" describes the daily management of psychiatric symptoms in both units. "Psychiatry and Adolescent medicine: from opposition to collaboration" describes the different levels at which these disciplines work together and how this cooperation may be evolving. CONCLUSIONS: The complex entanglement intrinsic in EDs of the patients' somatic, psychosocial, psychiatric, and adolescent problems requires collaboration between disciplines, but the modalities of this collaboration are multiple and evolve non-linearly in specialized treatment units. A multilevel approach must be offered, with the degree of collaboration (multidisciplinary, interdisciplinary and transdisciplinary) appropriate to the complexity of each adolescent's issues.

Prevalence of HIV infection and risk behaviours among Montreal street youth.

We aim to estimate HIV prevalence and associated risk factors among street youth in Montreal, Canada. We conducted a one-year cross-sectional anonymous study in 1995. We recruited youth aged 13-25 years meeting specific criteria for itinerancy through the 20 major Montreal street youth agencies. Participation included a structured interview and provision of an oral specimen for HIV testing. Among the 909 subjects studied, 99.3% had been sexually active, 25.9% had exchanged sex for money, gifts, drugs, a place to sleep, or other things; 31.8% reported anal sex; and 36.4% reported having ever injected drugs. Overall, HIV prevalence was 1.9% (1.1% in girls and 2.2% in boys). Multivariate logistic regression showed that being over 20 years of age (adjusted odds ratio (AOR) 7.09), having injected drugs (AOR 4.48), having engaged in prostitution (AOR 3.32), and being born outside Canada (AOR 4.41) were all independently associated with HIV infection.

Prevalence of chlamydial infection and frequency of risk behaviours for STDs and HIV infection among adolescents in public juvenile facilities in the province of Quebec.

This study aimed to determine the prevalence of chlamydial infection in adolescents entering public juvenile facilities in the province of Quebec and the frequency of their risk behaviours for STDs and HIV infection. Adolescents were asked to complete an anonymous self-administered questionnaire and to be screened for Chlamydia trachomatis. Of 731 sexually active adolescents, 62% agreed to be tested. The overall prevalence rate was 7.7% (95% confidence interval: 5.1%-10.3%). The prevalence was significantly higher in female than in male teenagers: 12% vs 3% (p < 0.001, Fisher's exact test). These results suggest that screening for chlamydial infection should be offered to all sexually active female teenagers admitted into juvenile facilities. For males, selective screening taking into account sexual history would be a more realistic approach. The frequency of high risk activities for STDs and HIV infection points to the importance of specific prevention programs for this population.

[Let us start medical school again! Value of problem-based learning]. / Et si vous recommenciez vos études médicales! Intérêt de la méthode pédagogique basée sur l'apprentissage par problème.

In 1993, the University of Montreal Medical School changed from an old teaching curriculum to a new one with Problem-Based-Learning as its major component. The first group of problems covers growth and development at all ages. The authors present this new learning method and discuss their experience and that of students with problems involving physiologic, psychologic and environmental learning objectives.

[Therapeutic compliance in adolescents with chronic disease]. / Compliance thérapeutique chez l'adolescent malade chronique.

In clinical practice, non-compliance is an often unrecognised or frustrating reality, which physicians find difficult to accept or deal with. Possible determinants of adolescents' level of compliance may be divided into demographic factors, patient and family characteristics, aspects of the illness and treatment regimen, and quality of the patient-doctor relationship. Compliance should be viewed as a reflexion of the experience of chronic illness as well as the expression of specific adolescent developmental issues. Practical guidelines are proposed.

[Compliance in adolescents with chronic disease]. / La compliance d'adolescents souffrant d'une maladie chronique.

This study was undertaken with the aim of improving the understanding of the phenomenon of compliance in adolescents presenting with chronic diseases. In 192 subjects aged 12 to 20 years presenting with diabetes, asthma, cystic fibrosis, systemic lupus erythematosus or juvenile rheumatoid arthritis, appointment keeping, compliance with prescribed medical regimens or general instructions and the filling up of a calendar describing the daily levels of fatigue were studied. Correlations (Pearson) between these various types of measurements were weak: from 0.04 to 0.26. Appointment keeping was about 90%. Overall compliance either with treatments or with general instructions was 50% only (without clearcut changes according to diseases); however only 11% of subjects presented with a good compliance with all the treatment components. Various factors (familial environment, perception of the disease and of the patient-physician relationships) were significantly associated with compliance (p less than 0.005). These results emphasize the necessity of taking care of all aspects of compliance, which is difficult to predict at this age, due to the multiple factors involved.

The epidemiology of road accidents in childhood.

We report the incidence of traffic injuries to children in Montreal: 33.4 per 10,000, 57 per cent pedestrians, 24.5 per cent passengers, and 18.4 per cent bicyclists. Nearly 20 per cent were hospitalized and 1.2 per cent died. One-third had MAIS scores of 2 or more with the highest rate of severe injuries found among pedestrians. Pedestrian and bicycle (but not passenger) injuries in low income areas were four to nine times greater than those in more affluent areas.

Adolescents with chronic disease. Are they receiving comprehensive health care?

A survey of adolescents with a chronic disease attending six specialty clinics was conducted to determine the sources of their primary health care and to estimate the extent of unmet health needs. Sixty-one patients completed a self-administered questionnaire. Forty percent had no source of primary care other than the subspecialty clinic treating their chronic condition. Seventy-eight percent regarded the subspecialist as their "personal" physician, although only 27% actually spoke to this physician about their general health needs. For 44% general health needs were not being met. These findings suggest that these adolescents expect the subspecialty clinic to provide primary care; yet they receive, at best, fragmented health care. This situation could be improved by a decision on the part of the subspecialty to restrict its role to providing only specific specialty care or to coordinate overall care.

[Contraception in adolescence]. / La contraception à l'adolescence.

PIP: Contraception for the adolescent girl presents a few problems which are mainly related to age. Before prescribing a contraceptive method a doctor should find out whether the girl is regularly or sporadically sexually active, whether she has previously used a method and why it was terminated; life style and habits also should be investigated. Contraindications to the use of the pill are the same as for older women, with the added disadvantage that a teenager will be more likely to forget to take her pills. The IUD may, however rarely, cause salpingitis and possible later infertility. Mechanical methods of contraception would be perfect for the motivated young woman with only sporadic relations. Whatever the choice the opinion of the patient is very important, and any choice must be made on an individual basis from one case to the other.^ieng

Health problems and health care for adolescents in residential facilities in Quebec.

The health problems of 160 adolescents in four residential facilities of the Quebec social welfare court were studied. At the time of admission 44% had at least one problem requiring consultation with a specialist and 80% had an average of two problems requiring primary care. The medical records of 106 youngsters in two re-education centres were also reviewed and similar results were noted. The health services available, particularly physical examination and laboratory testing at the time of admission and arrangements for referral and follow-up were judged to be insufficient in most centres. Although society has taken custody of these adolescents, no one is responsible for their health care. Since February 1976 the social welfare court residential facilities and the network involved in the care of socially disturbed youngsters have been undergoing reorganization. Health programs and services ought to be part of this reorganization, and private physicians, hospitals and government each should have a role in the establishment and functioning of these programs.