[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.

[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.

[Not without my family! The importance of the entourage in primary care medicine with youth]. / Pas sans ma famille! L'importance de l'entourage en médecine de premier recours avec des jeunes.

At the doctor's office primary care, symptomatology of young is often vague or nonspecific. Faced with such symptoms, via the analysis of a clinical case, significant in many clinical situations, we show the importance of considering the significant members of the entourage and invite them to the surgery. A therapeutic alliance better weaves between the youth and his doctor if the environment is taken into account and will lead to better therapeutic response.

[Assess spirituality with adolescent outpatients: taboo or necessity?]. / Aborder la spiritualité avec les adolescents en consultation ambulatoire: tabou ou nécessité?

Spirituality affects adolescents' as well as adults' daily life. It is usually considered to be a protective factor in physical and psychological health outcomes, but might also be a cause of suffering. In the perspective of an holistic approach, health professional should assess this subject with tact and sensitivity. Until there is a suitable instrument adapted to this age group and European culture, the exploration of spirituality and religious practices can be evaluated while taking the clinical history. Nevertheless, resistance which is common in health professionals, could be overcome by appropriate training.

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.

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 .

[A new perspective in adolescent contraception--why prescribe an IUD first?]. / Un nouveau regard sur la contraception des adolescentes: pourquoi prescrire un dispositif intra-utérin en première intention?

Adolescent girls are very fertile and therefore need a reliable contraceptive strategy in order to prevent unwanted pregnancies. Although highly recommended by international gynecological and adolescent societies and in spite of its high efficiency, good tolerance and ease of use, only minority of adolescents use IUD as a contraceptive method. This article will focus on available IUDs suitable for adolescents and will address misconceptions and barriers to use of IUDs in this age group. We believe this information will encourage physicians in recommending IUD use to adolescents during their most vulnerable years.

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.

[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.

[Which follow-up of the second generation antipsychotic in adolescents?]. / Quelle surveillance médicale des adolescents sous antipsychotiques de deuxième génération?

Since the introduction of so called second generation antipsychotic (SGA), the prescription of these drugs has been relatively frequent in adolescence. This article gives a synopsis of the potential side effects and contra-indications, and proposes a practical guideline for the follow-up of these SGAs in adolescent and young adults. The main secondary side effects are in metabolic, endocrine, neurologic, cardiovascular systems and also on the hematological and liver functions. Thus, a strict follow-up should start before the introduction of a SGA treatment and should be continued during the time of administration. Since there is no common consent for a follow-up in SGA use in adolescents for Europe, this article may give a practical guideline for general practitioners and pediatricians, including a clinical exam and biological parameters to be controlled.

[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.

Text-messaging versus telephone reminders to reduce missed appointments in an academic primary care clinic: a randomized controlled trial.

BACKGROUND: Telephone or text-message reminders have been shown to significantly reduce the rate of missed appointments in different medical settings. Since text-messaging is less resource-demanding, we tested the hypothesis that text-message reminders would be as effective as telephone reminders in an academic primary care clinic. METHODS: A randomized controlled non-inferiority trial was conducted in the academic primary care division of the Geneva University Hospitals between November 2010 and April 2011. Patients registered for an appointment at the clinic, and for whom a cell phone number was available, were randomly selected to receive a text-message or a telephone call reminder 24 hours before the planned appointment. Patients were included each time they had an appointment. The main outcome was the rate of unexplained missed appointments. Appointments were not missed if they were cancelled or re-scheduled before or independently from the intervention. We defined non-inferiority as a difference below 2% in the rate of missed appointments and powered the study accordingly. A satisfaction survey was conducted among a random sample of 900 patients (response rate 41%). RESULTS: 6450 patients were included, 3285 in the text-message group and 3165 in the telephone group. The rate of missed appointments was similar in the text-message group (11.7%, 95% CI: 10.6-12.8) and in the telephone group (10.2%, 95% CI: 9.2-11.3 p = 0.07). However, only text message reminders were cost-effective. No patient reported any disturbance by any type of reminder in the satisfaction survey. Three quarters of surveyed patients recommended its regular implementation in the clinic. CONCLUSIONS: Text-message reminders are equivalent to telephone reminders in reducing the proportion of missed appointments in an academic primary care clinic and are more cost-effective. Both types of reminders are well accepted by patients.

[Do the adolescents have medical decision-making capacity? A sensitive issue for the doctor]. / Les adolescents sont-ils capables de discernement? Une question délicate pour le médecin.

The physician who cares for adolescents should routinely assess the medical decision-making capacity of the minor. The physician must always ask whether the young person has the capacity of discernment, after having given the patient the necessary information, and before obtaining his consent. This analysis is helpful for the physician to determine who can make the decision, and to consider the limits of confidentiality. This paper reviews the Swiss law situation in terms of age limits, and provides information to guide the physician in the evaluation process with the use of practical questions and help of other professionals when in doubt.

[Obesity, migration and adolescence]. / Obésité, migration et adolescence.

Weight management interventions during adolescence are challenging. Migration adds complexity to this problem, making migrant families more vulnerable. Teenagers confront families to new values transmitted by the host society: opulence, junk food, video games. Obesity should not be seen as a single issue of calories-excess, but must be considered as being part of a larger problem, which takes into account the context of the familial and societal life of the migrants. The caregivers must have an overall view of the situation to provide appropriate approaches to weight management.

[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'.

[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.

[Adolescent medicine. Is the weight of the obese adolescent difficult for their family?]. / Médecine de l'adolescence. Le poids des adolescents: un poids pour la famille?

The increasing prevalence of obesity creates a need to develop healthcare services that address both obesity and the health problems common to all young people. It is particularly important to involve parents and significant adults to promote easy access and continuity. Improved quality of life is as important as weight loss and prevention of complications. The family has an important role to play in helping adolescents develop their autonomy and enter adulthood. When family structures are affected by a child's chronic condition, it is necessary to provide support to parents during these changes. Feelings of isolation and discouragement are best tackled by involving parents and helping them to find ways to motivate and assist their children on their developmental path.

Is there a role for primary care physicians' screening of excessive weight and eating concerns in adolescence?

OBJECTIVES: To determine the extent to which adolescents with excessive weight concerns and eating concerns are in contact with primary care physicians and could thus be identified in primary care. STUDY DESIGN: A representative sample of 7548 (16 to 20 years old) students completed a self-administered questionnaire on health-related topics (2002 Swiss Multicenter Adolescent Health Survey). Adolescents with excessive weight and eating concerns were compared with control subjects for frequency of somatic complaints and primary care visits in the past year. Analyses were stratified by sex. Logistic regression was used to adjust for confounders. RESULTS: Excessive weight and eating concerns were frequent in adolescents, particularly in girls (girls, 13.9%; boys, 1.6%). Adolescents with these concerns reported more frequent somatic complaints compared with their peers. Nearly 80% of them were in contact with a primary care physician at least once a year. CONCLUSION: Primary care physicians are in contact with adolescents who have excessive weight and eating concerns. Identification of these concerns should be encouraged for appropriate management.