Checklist for follow-up of adolescents with chronic illness. A monitoring tool to help prepare the transition from pediatric to adult care.

Adolescence can be a particularly challenging period for individuals with a chronic illness. To help the specialized healthcare teams, an expert panel drafted a checklist of topics to be addressed throughout adolescence that are often not covered in subspecialty clinic visits such as peers, coping, adherence, understanding of illness, sexuality, etc., since these topics apply to youth with special healthcare needs. Each member of the specialized team can discuss one of the themes according to their role with the adolescent as a doctor, educator, nurse, dietician, etc. The coherence of the team enables a comprehensive approach and will facilitate the transition to adult medical care.

[Perception of adolescent medicine among French pediatric residents]. / Représentations de la médecine de l'adolescent chez les futurs pédiatres.

PURPOSE: The perception of adolescent medicine (AM) among future pediatricians in France has scarcely been explored although adolescent health care is an integral part of the pediatrician's job. Moreover, pediatric residents seem to have a lack of enthusiasm for this field. The aim of this study was to assess the beliefs and perceptions of fourth-year French pediatric residents regarding adolescents and AM. METHODOLOGY: We conducted a national electronic survey among French pediatric residents in their last year of residency. An original 51-item, open-ended declarative questionnaire was sent out including questions on demographics, career expectations, AM block rotation experiences, and perceptions and beliefs regarding adolescents and AM. Difficulties and barriers experienced in this field were investigated. Queries about residents' specific AM courses and about their educational needs were also explored. RESULTS: The survey was conducted online between January and March 2015. There were 121 respondents, achieving a 43% response rate. The majority of respondents perceived teens as interesting (75%), vulnerable (83%), and time-consuming (84%). Up to four fifths of respondents (81%) considered AM to be a skill that all pediatricians should acquire. A subgroup analysis showed that the residents who had not experienced an AM block rotation did not seem to be convinced of the need for training in this field (P=0.09). The following issues were reported as major difficulties by residents: providing care for teens reluctant to seek health care (65%), managing violent behavior among adolescents in the emergency ward (98%), and managing adolescents who attempt suicide (80%). Less than half (45%) of the residents reported their residency program had a specific AM course. Among them, 73% attended the lectures and 57% found them useful. One third (32%) of the respondents had experienced a 2-month block rotation in the field of AM during their residency. DISCUSSION: This is the first nationwide study in France in this field. Although the response rate is below 50%, it exceeded our expectations. Our results are in line with previous studies showing that pediatric residents report a high interest in working with adolescents and yet their educational needs in AM are unmet. The limitations of this study include the self-selection bias and implicit limitations carried by the phrasing of the survey questions. CONCLUSIONS: There is a need to devise a better educational approach combining a broader proposal of AM block rotations together with a specific competency framework in adolescent health, since we know it improves the quality of health care delivered to adolescents. Moreover, training pediatricians in AM is a public health priority so as to comply with medical schools' principles of social accountability and address the priority health needs for an efficient, equitable, and sustainable health system. At a time when postgraduate reform is being made, the inclusion of an AM curriculum in the general pediatrician course is necessary.

[Bulimia during adolescence]. / Les crises de boulimie à l'adolescence.

Binge eating, bulimia nervosa, binge eating disorder, anorexia-bulimia are terms often used without really knowing what precisely one is referring to. Otherwise, there are many articles concerning anorexia nervosa in medical literature, a disease, which can be seen and fascinates. These eating disorders are frequent in today's society; medical, psychological and social consequences are important.

[Teenagers' suicides and suicide attempts: finding one's way in epidemiologic data]. / Suicides et tentatives de suicide à l'adolescence. "Données épidémiologiques: comment s'y retrouver?"

This paper engages into a global assessment of statistics and their potential uses, ranging from 19th century accounts of "suicidal acts" by the central services of criminal justice in France, to European comparative data on suicide in the years 2000. The most recent facts and figures about teenagers' suicides in France are taken into account, thanks to the Inserm records on deaths by suicide and to public polls on suicidal attempts.

[The first consultation with an adolescent]. / La première consultation avec un adolescent.

It is crucial not to miss the first consultation with an adolescent. This article reviews some of the essential step necessary to help make the first consultation a success: the time to devote to the patient, the preparation of the consultation, mandatory issues to address, clinical/physical examination, conclusion of the consultation, the prescriptions and the follow-up.

[Anorexia nervosa: impact on growth and bone mineral density]. / Anorexie mentale: conséquences sur la croissance et la minéralisation osseuse.

Anorexia nervosa (AN) concerns 1% of adolescent girls and happens at a time of intense bone growth. Adolescents who develop AN before or during puberty have growth retardation and may not achieve their genetic height potential. Osteopenia, as evidenced by dual-energy X-ray absorptiometry, is also frequent. The degree of osteopenia depends on the age of onset and the duration of AN. The role of estrogen deficiency is no more considered paramount with regards to other factors like the fall of growth factor IGF1. The prevention of osteopenia in AN relies mostly on early nutritional intervention. Hormone replacement therapy or calcium/vit D supplements are not sufficient to improve bone density in undernourished patients. New therapeutic strategies combining anabolic and antiresorptive agents are being developed.

[Chronic illness in adolescence: ten pertinent questions]. / Maladie chronique à l'adolescence: dix questions pertinentes.

Among adolescents with chronic illness or disability, some are survivors of a severe disease in childhood, some have a long-standing yet less severe condition and some have been ill since adolescence only. Owing to the considerable progress of pediatrics, the number of these adolescents and young adults has been regularly increasing. For all, the major question is that of their future and for many, that of the transition from pediatric to adult medical care. This work of follow-up and guidance requires, beyond a strong medical knowledge of each condition, a good understanding of the specific global needs at that age as well as of the multiple and reciprocal impacts between chronic illness and the progression of adolescence. In order to increase pediatricians' awareness and skills in that field, the authors propose a clinical guide composed of ten relevant questions to be addressed when dealing with any chronically ill or disabled adolescent.

[Anorexia nervosa and severe malnutrition: nutritional practice guidelines in pediatrics]. / Anorexie mentale et dénutrition grave: comment assurer la prise en charge nutritionnelle en milieu pédiatrique.

The nutritional care of a severely emaciated anorexic adolescent can be performed in any pediatric ward. This article is a practical guide which reminds the indications, mostly clinical, for hospitalization and the way to achieve a progressive but efficient renutrition. We wish to share our own practical experience while focusing on acute nutritional care, according to the aim of this section of the journal.

[Munchausen syndrome by proxy]. / Le syndrome de Munchausen par procuration.

Munchausen syndrome by proxy is a form of child abuse presenting as a disease produced or simulated by a parent, the mother in most cases. Its diagnosis is uneasy because of its miscellaneous and unusual clinical presentation and of the misleading apparently normal attitude of the parents. Physicians may participate in the abuse by insistently looking for diagnostic and therapeutic measures, therefore contributing to the significant mortality of the syndrome. It is therefore important that physicians consider Munchausen syndrome in any ambiguous situation in order to protect the child by an early diagnosis.

[Septic sacroiliac arthritis in an adolescent]. / Arthrite septique sacro-iliaque chez une adolescente.

BACKGROUND: Septic sacroiliitis is often difficult to diagnose because the clinical findings can be misleading and the radiological signs delayed. CASE REPORT: A 16-year-old adolescent was hospitalized with a history of fever and painful hip. The initial hypothesis of hip osteoarthritis was not confirmed by ultrasonography or CT-scan. The bone scan was also normal. The definitive diagnosis of sacroiliitis was made 1 week later based on the clinical evolution and a positive blood culture. It was confirmed by a second bone scan and MR imaging. CONCLUSION: Examination of the sacroiliac joint needs several different tests. Although the initial bone scan may be normal, an osteoarticular infection cannot be definitively ruled out and iterative radiological investigation is warranted. MR imaging may be an additional diagnostic tool for detecting sacroiliitis.

[Specific iatrogenic risks to patients with HIV infection]. / Risques iatrogènes particuliers aux patients infectés par le VIH.

Human immunodeficiency virus-infected patients are exposed to more or less specific iatrogenic diseases. The main characteristics of the risks encountered in this field are described: drug intolerance, mostly to sulfamethoxazole-trimethoprim, is extremely frequent; nucleoside analogue antiviral toxicity is reminiscent of that of chemotherapy; nosocomial infections, in general, are more prominent than in HIV-non infected patients. Intravenous line infections are particularly frequent, but these devices are necessary for prolonged intravenous therapies such as anti-CMV treatment of parenteral nutrition. An improved understanding of different etiopathogenic mechanisms and a better approach of the toxicity/efficacy ratio for each treatment would allow to reduce the excessive morbidity due to iatrogenicity.