Transition from paediatric to adult care: what makes it easier for parents?

OBJECTIVE: To assess differences between parents of adolescents with chronic illness (CI) going through a self-reported easy or difficult transfer. METHODS: Seventy-two parents of CI youths who had already transferred to adult care were divided according to whether they considered that the transfer had been easy (n = 45) or difficult (n = 27). We performed a bivariate analysis comparing both groups and variables with a significance level < .1 were included in a logistic regression. Results are presented as adjusted odds ratio (aOR). RESULTS: Over one third of parents (27/72) reported a difficult transfer. At the multivariate level, higher socioeconomic status (aOR: 7.74), parents feeling ready for transfer (aOR: 6.54) and a good coordination between teams (aOR: 7.66) were associated with an easy transfer. CONCLUSIONS: An easy transfer for parents is associated with feeling ready and considering that the coordination between teams is good. Health providers should consider these requisites for a successful transfer.

Factors Associated with Unwanted Pregnancy among Adolescents in Russia.

STUDY OBJECTIVE: To identify social and behavioral factors associated with unintended pregnancy among adolescents in Russia. DESIGN: Cross-sectional. SETTING AND PARTICIPANTS: The investigation group consisted of 145 adolescents aged 15-19 years admitted to a youth-friendly clinic for induced abortion. The control group consisted of 77 sexually active never pregnant adolescent girls of similar age admitted for other reasons. INTERVENTIONS: Both groups completed a self-administered questionnaire about their occupation, educational level of their mother, family structure and socioeconomic status, relationship with their mother, sexual behavior, and substance use. MAIN OUTCOME MEASURES: Factors associated with unintended pregnancy. RESULTS: In the bivariate analysis pregnant adolescents tended to have a lower educational level, to live in a nonintact family, to prefer stronger alcohol drinks, and to have a younger age at sexual debut and more frequent sexual intercourse. In the log-linear model six factors appeared to be directly linked to pregnancy: mother's lower education, alcohol consumption, nonintact family structure, low academic grades, higher frequency of sexual intercourse, and lower age at sexual debut. CONCLUSION: Although the issue of unwanted pregnancy and possible ways to prevent it should be kept in mind in the psychosocial assessment of any adolescent, the results of our study suggest that some adolescents are at increased risk of unwanted pregnancy. This group includes adolescent girls with low educational attainment, living in a disrupted family, and reporting other risk behaviors. These adolescents might specially benefit from specific preventive programs to reduce the number of adverse outcomes.

The relation between internet use and overweight among adolescents: a longitudinal study in Switzerland.

OBJECTIVE: This longitudinal study aimed to investigate the characteristics and predictive risk factors of overweight among adolescents. The hypothesis was that baseline overweight predicted most overweight over time compared to other factors, especially excessive internet use. SUBJECTS: A sample of 621 youths were followed from age 14 (T0 Spring 2012) to age 16 (T1 Spring 2014) in Switzerland. Participants were divided into two groups according to their weight at the final assessment: overweight and non-overweight. At T0, participants reported demographic, health, substance use and internet use data. A logistic regression was performed to assess the explanatory variables of overweight at T1. Data are presented as adjusted odds ratios (aORs) with 95% confidence interval. RESULTS: The 2-year evolution showed a net BMI increase of 4.8%. Overweight adolescents were significantly more likely to be male, to live in an urban area, to be on a diet and to report using the internet more than 2 h per day on weekends at T0. However, with the addition of baseline overweight, only the excessive use of internet on weekends remained as an explanatory variable. An adolescent who was already overweight at T0 had a more than 20-fold risk (aOR 21.04) of being overweight 2 years later. Moreover, among adolescents becoming overweight between T0 and T1, internet use did not show any significant effect. CONCLUSION: The risk of being overweight is mostly influenced by weight status at baseline compared to excessive internet use. Thus, our results do not confirm the negative effect of internet on healthier activities. Internet use could at most reinforce an already existing risk of being overweight.

Parent-adolescent relationship in youths with a chronic condition.

BACKGROUND: Suffering from a chronic disease or disability (CDD) during adolescence can be a burden for both the adolescents and their parents. The aim of the present study is to assess how living with a CDD during adolescence, the quality of parent-adolescent relationship (PAR) and the adolescent's psychosocial development interact with each other. METHODS: Using the Swiss Multicenter Adolescent Survey on Health 2002 (SMASH02) database, we compared adolescents aged 16-20 years with a CDD (n = 760) with their healthy peers (n = 6493) on sociodemographics, adolescents' general and psychosocial health, interparental relationship and PAR. RESULTS: Bivariate analyses showed that adolescents with a CDD had a poorer psychosocial health and a more difficult relationship with their parents. The log-linear model indirectly linked CDD and poor PAR through four variables: two of the adolescents' psychosocial health variables (suicide attempt and sensation seeking), the need for help regarding difficulties with parents and a highly educated mother that acted as a protective factor, allowing for a better parent-adolescent with a CDD relationship. CONCLUSION: It is essential for health professionals taking care of adolescents with a CDD to distinguish between issues in relation with the CDD from other psychosocial difficulties, in order to help these adolescents and their parents deal with them appropriately and thus maintain a healthy PAR.

Qualities of a French version of the Wolf Motor Function Test: a multicenter study.

INTRODUCTION: There are currently a small number of standardized tools in French that measure and compare the effect of constraint-induced movement therapy, or other recent therapies promoting motor recovery OBJECTIVE: To create a French version of the Wolf Motor Function Test (WMFT) and assess its reliability, minimal detectable change, and criterion validity. METHOD: Prospective multicenter repeated-measure design with 44 patients with post stroke hemiparesis. A French Version of the WMFT was created; it was then assessed against the Fugl Meyer Assessment-Upper Extremity (French version) to establish its reliability, the minimal detectable change and its validity. RESULTS: Inter-rater reliability was very good. Reproducibility of the scores was good. Cronbach α coefficients showed adequate internal consistency. The minimal detectable change (MDC95%) for functional ability scores was below 10% of the highest possible score; the MDC95% for performance time was very high at more than 90 seconds. Criterion validity was good. CONCLUSION: The French version of the WMFT is reliable and valid. The test shows promise for use as an objective outcome measure for people post stroke in French speaking countries.

[Development and validation of a nutritional knowledge questionnaire among 9- to 15-year-olds]. / Développement et validation d'un questionnaire permettant d'évaluer les connaissances alimentaires (QuesCA) auprès de jeunes de 9 à 15ans.

Improving nutritional knowledge is a frequent goal in nutritional education programs. However, there is a lack of valid instruments to assess nutritional knowledge in children. Questionnaires on nutritional knowledge are usually related to a specific curriculum or program, and their development or validation process is rarely available. Our goal was to develop a valid, self-administered questionnaire to assess nutritional knowledge among French-speaking children and adolescents aged 9-15 years. The conceptual framework and concepts were based on a literature review. For each concept, an expert panel selected a number of items, and successive versions of the questionnaire were pretested. The edited version of a 30-item questionnaire (QuesCA) was administered to 475 children aged 9-15, in two French-speaking cantons in Switzerland. We calculated internal consistency (Cronbach alpha), the rate of correct answers for each question, and the mean scores for each concept. The mean scores were 16.32 (95% CI: [15.69; 16.94]) in the 9- to11-year-olds and 18.62 [18.19; 19.06] in the 12- to 15-year-olds (maximum possible, 30). Beverages, breakfast, fruit, and vegetables were the concepts that gathered the most correct answers. The overall Cronbach alpha score was good (0.66), but as the internal consistency for each concept was low (0.06-0.45), we developed an optimal scale for each age group. The result is a two-part questionnaire: QuesCA 9-11 and QuesCA 12-15, with 9 items each, that enables a rapid and reliable assessment of nutritional knowledge in children and adolescents.

Are adolescents with chronic conditions particularly at risk for bullying?

OBJECTIVE: To compare the prevalence and intensity of victimisation from bullying and the characteristics of the victim of bullying, comparing adolescents with and adolescents without chronic conditions (CC). DESIGN: School survey. SETTING: Postmandatory schools. PARTICIPANTS: A total of 7005 students (48% females) aged 16-20 years, distributed into adolescents with CC (728, 50% females) and controls (6277, 48% females). Chronic condition was defined as having a chronic disease and/or a physical disability. OUTCOME MEASURES: Prevalence of bullying-intensity of bullying-and sociodemographic, biopsychosocial, familial, school and violence context characteristics of the victims of bullying. RESULTS: The prevalence of bullying in our sample was 13.85%. Adolescents with CC were more likely to be victims of bullying (adjusted OR 1.53), and to be victims of two or three forms of bullying (adjusted OR 1.92). Victims of bullying with CC were more likely than non-victims to be depressed (RR 1.57), to have more physical symptoms (RR 1.61), to have a poorer relationship with their parents (RR 1.33), to have a poorer school climate (RR 1.60) and to have been victims of sexual abuse (RR 1.79) or other forms of violence (RR 1.80). Although these characteristics apply to victims in general, in most cases, they are less pronounced among victims without CC. CONCLUSIONS: CC seems to be a risk factor for victimisation from bullying. Therefore, as adolescents with CC are increasingly mainstreamed, schools should be encouraged to undertake preventive measures to avoid victimisation of such adolescents.

Secular trends in legal and illegal substance use among 16 to 20 year old adolescents in Switzerland.

BACKGROUND: Data targeting trends in legal and illegal substance use by adolescents are scarce. Using the data from two similar large national surveys run in 1993 and 2002, this paper assesses secular trends in rates of substance use among 16-20-year-old Swiss adolescents. METHODS: Self-reported regular use of tobacco, alcohol misuse, regular cannabis use (01 occasion over last 30 days) and lifetime use of psychoactive medication, LSD, ecstasy, cocaine and heroine were assessed through identical questions using an anonymous self-administered questionnaire. 9268 (1993) and 7428 (2002) high school students and apprentices were included in the analyses. RESULTS: There is a higher proportion of regular smokers among apprentices than among students (p <0.001). Between 1993 and 2002 the increase in regular tobacco consumption was significant among both female and male apprentices (p <0.001) but not among students. Between 1993 and 2002 alcohol misuse significantly increased in all four groups (p <0.001). It is more prevalent among males than among females (p <0.001) and higher among apprentices than among students (p <0.001). Regular use of cannabis has increased in the four groups (p <0.0001). It is higher among males than among females (p <0.001), while it is largely the same among students and apprentices. While the increase in ecstasy use is highly significant in all four groups (p <0.001), the increase in LSD and cocaine use is significant among apprentices only (p <0.001). Use of LSD, ecstasy and cocaine is more prevalent among males than among females (<0.001) and higher among apprentices than among students (p <0.001). CONCLUSION: The secular increase in psychoactive substance use among older Swiss adolescents calls for the implementation of effective strategies both from individual and public health viewpoints.