[Ketamin: a harmful recreational drug]. / Kétamine : une substance récréative qui fait mal.

Adolescence is a developmental phase that exposes young people to exploratory behaviors, including substance abuse. In Switzerland, recreational ketamine use among young people is on the rise and is likely to lead to irreversible somatic complications. Primary care physicians play an essential role in identifying ketamine users, and should offer brief interventions, risk-reduction advice and a psychosocial assessment of the situation, involving close relatives. In the event of secondary damage, particularly urological damage, coordinated management by specialists is essential to achieve symptom regression. Primary and secondary prevention measures are also essential in the fight against addiction among young people.

L'adolescence est une phase développementale exposant les jeunes à des comportements exploratoires, dont la prise de substances. En Suisse, la consommation récréative de kétamine chez les jeunes est en augmentation et est susceptible d'entraîner des complications somatiques irréversibles. Le médecin de premier recours joue un rôle essentiel dans l'identification des usager-e-s de kétamine et doit proposer des interventions brèves, des conseils de réduction des risques et une évaluation globale de la situation (anamnèse psychosociale), en impliquant les proches. En cas d'atteinte secondaire, en particulier urologique, une prise en charge coordonnée entre spécialistes est primordiale pour viser une régression des symptômes. Des mesures de prévention primaires et secondaires sont également essentielles dans la lutte contre les addictions chez les jeunes.

[Interdisciplinary care for gender diverse adolescents. The example of the Centre hospitalier universitaire vaudois (CHUV)]. / Prise en charge interdisciplinaire des adolescent-e-s transgenres et non binaires. L'exemple du Centre hospitalier universitaire vaudois (CHUV).

This article outlines the management of transgender and non-binary adolescents at CHUV. The current rise in visibility of this topic is associated with an increased demand for intervention and at the same time with an increased generation of continuously expanding medical evidence to guide interventions. The close collaboration among various specialized adolescent health services enables an interdisciplinary evaluation of diagnostic elements and indications for potential psychological, social or medical interventions. This article underscores the significance of an interdisciplinary and individualized approach to transgender and non-binary adolescents, respecting the diversity of the human being.

Cet article présente la prise en charge des adolescent-e-s transgenres et non binaires (TNB) au Centre hospitalier universitaire vaudois (CHUV). L'actuel gain en visibilité de la thématique conduit à une augmentation des demandes de prise en charge et, parallèlement, à une augmentation de la production d'évidence médicale pour orienter les prises en charge. La collaboration étroite entre les différents services spécialisés en santé des adolescents permet une évaluation interdisciplinaire des éléments diagnostiques et des indications aux éventuelles interventions psychologiques, sociales ou médicales. Cet article souligne l'importance d'une approche interdisciplinaire, basée sur l'évidence médicale et individualisée des adolescent-e-s TNB, dans le respect de la diversité de l'être humain.

[Childhood, adolescence and the risk of addiction: a developmental perspective]. / Enfance, adolescence et risque d'addiction : une perspective développementale.

The period between the ages of 0 and 25 is a crucial phase in human development, during which many aspects of physical, psychological, personality, behavioral and health development take place. Important neurobiological changes during adolescence play a key role in their natural propensity to seek reward, putting them at greater risk of different kind of addictive behaviours. In addition, childhood adversity can foster the emergence of vulnerabilities which, for some, increases the risk of addiction by the time they reach adolescence. This article describes the normal development of the brain from childhood to adulthood, and its influence on addictive behaviours.

La période entre 0 et 25 ans est une phase cruciale du développement humain, au cours de laquelle de nombreux aspects physiques, psychologiques, de la personnalité, du comportement et de la santé se forment. D'importants changements neurobiologiques durant l'adolescence jouent un rôle essentiel dans la propension naturelle des jeunes à rechercher la récompense, ce qui les rend plus à risque de différents types de comportements addictifs. De plus, l'adversité rencontrée pendant l'enfance peut favoriser l'émergence d'une vulnérabilité augmentant, pour certains, le risque d'addictions lorsqu'ils atteignent l'adolescence. Cet article décrit le développement normal du cerveau de l'enfance à l'âge adulte ainsi que l'influence de ce dernier sur les comportements en lien avec les addictions.

[Adolescent medicine. Explaining chronic functional pain to teenagers]. / Médecine de l'adolescence. Expliquer la douleur chronique fonctionnelle aux adolescents.

There is a growing body of scientific understanding surrounding the topic of functional chronic pain. Numerous studies have highlighted a persistent low-grade inflammation within the fascial and central nervous systems, coupled with detrimental neuroplasticity involving substantial remodeling of pain pathways in the spinal cord and brain. These findings provide a more concrete basis for explaining functional chronic pain to adolescents, simplifying the establishment of trust and the justification of proposed treatments in the process.

Il y a de plus en plus de compréhension scientifique autour du thème de la douleur chronique fonctionnelle. Plusieurs études mettent en évidence une inflammation de bas grade, persistante, au niveau des systèmes fascial et nerveux central, ainsi qu'une neuroplasticité délétère avec un remodelage majeur des voies douloureuses de la moëlle épinière et du cerveau. Tous ces éléments permettent une meilleure compréhension des mécanismes qui sous-tendent la douleur chronique fonctionnelle et donnent ainsi la possibilité de l'expliquer plus concrètement aux adolescents comme partie intégrante de la prise en charge. Créer le lien de confiance devient plus simple, de même que la justification des traitements proposés.

How to approach and take care of minor adolescents whose situations raise ethical dilemmas? a position paper of the European academy of pediatrics.

In the care of adolescents, health care providers often face situations raising ethical concerns or dilemmas, such as refusal of a treatment or hospitalization, or request of confidentiality while engaging in risky behaviors or facing unplanned pregnancy. This position paper provides concrete avenues as how to assess the adolescent's capacity for autonomous decision making, e.g. the patient's competence in a specific situation, and how to elicit informed choice or consent. To do so, professionals need to be sensitized and trained as how to assess the cognitive and socio-psychological development of the young patient. Another challenge for the health professionals is to balance the needs to support patient's autonomy while offering secure guidance and protection if needed. To optimize such a process, they establish a climate of trust and empathy that will allow the patient to participate freely in the decision. In addition, especially when the decisions have potentially important consequences on the health and life, the professionals include, with the adolescent's permission, parents, caregivers or other significant adults, as well as they may request the opinion of other members of the health care team or expert colleagues such as ethicists.

[Actively supporting youth participation and autonomous decision-making in health matters]. / Soutenir activement la participation et les prises de décisions des adolescent-e-s dans le domaine de la santé.

The adolescent's process of brain maturation has important consequences for their ability to reason in decision-making processes. The notion of evolving capacity, for which age is not a sufficient indicator, implies a progressive vision of the nature and degree of participation according to the level of maturity. Health professionals are at the forefront of actively promoting young people's participation, supporting their decision-making about their own health, and seeing them as true partners and agents of change. The active participation of young people in all decisions that concern them is essential to make real progress in the field of adolescent health. This step implies a paradigm shift from "thinking for them" to "thinking with them".

Le processus de maturation cérébrale des adolescents a des conséquences importantes sur leur capacité de raisonnement dans les processus de décision. La notion de capacité évolutive, dont l'âge n'est pas un indicateur suffisant, implique une vision progressive de la nature et du degré de participation en fonction du niveau de maturité. Les professionnel-le-s de la santé sont aux premières loges pour favoriser activement la participation des jeunes, en soutenant leurs prises de décision concernant leur propre santé et en les considérant comme de véritables partenaires et acteurs de changement. La participation active des jeunes dans toutes les décisions qui les concernent est indispensable pour réellement progresser dans le domaine de la santé des adolescents. Cette étape implique un changement de paradigme de penser « avec eux ¼ plutôt que « pour eux ¼.

The Impact of COVID on Adolescent Mental Health, Self-Harm and Suicide: How Can Primary Care Provider Respond? A Position Paper of the European Academy of Pediatrics.

Adolescents aged 10 to 19 live a period of their life marked by opportunities and vulnerabilities during which the issue of mental health is of prime importance. Since several decades, and especially since the start of the COVID pandemic, mental health problems and disorders among adolescents have increased around the world. Depression, self-harm and suicidal behavior are common during this period of life, and pediatricians can play a pivotal role in identifying affected or vulnerable youngsters. This article describes risk factors for self-harm and suicidal behavior and reviews how primary care pediatricians and health professionals can respond to such situations. This scoping review is based on existing evidences as well as the authors clinical experience. It suggests concrete actions that can be taken to secure the life of at risk teenagers, and discusses how to organize the transfer to mental health professionals when needed.

'Demystifying' the encounter with adolescent patients: a qualitative study on medical students' experiences and perspectives during training with adolescent simulated patients.

Training with adolescent simulated patients (ASP) is increasingly recognized as an effective form of teaching interviewing skills with adolescent patients. Beyond the acknowledged effectiveness and satisfaction of training with ASP, little is known on medical students' actual experience and specific learning needs related to simulated encounters with ASP, as well as factors influencing their learning experience.The aim of this study was an in-depth exploration of medical students' perspectives about training with ASP.Using a qualitative design with grounded theory methods, we conducted in-field observation of training sessions with ASP and individual interviews with eighteen fourth-year medical students participating in training.When provided with an actual experience in a simulated setting, students go through a process of anticipating then modulating the challenge of the encounter with an adolescent patient. This challenge is influenced and modulated within 3 main dimensions: preconceptions about adolescents, level of experience with adolescent patients and professional distance. This process is also influenced by how students perceive and cope with the educational setting.Training with ASP, as a first concrete experience of an adolescent consultation, is an opportunity to address important aspects of students' attitudes towards adolescent patients such as students' preconceptions, personal experiences and feelings that could influence the doctor-patient relationship later on. Training should focus on ways to reflect upon and handle such attitudes and the emotional resonance experienced by medical students.

[Impact of the COVID-19 pandemic on adolescent health and development: a role to play for physicians]. / Impact de la pandémie de Covid-19 sur la santé et le développement des jeunes en Suisse - Quel rôle pour les médecins ?

This article summarizes the conclusion of a two-days interprofessional online workshop held under the auspices of the Brocher Foundation. The objectives were to review the impact of COVID on adolescent health and development and to generate some key responses to the situation. The pandemic has severely affected the mental health of a large proportion of adolescents and has significantly reduced access to health care. It has as well disturbed the school education of vulnerable youngsters and decreased social contacts with adults and peers. In the future, authorities should better consider the rights of young people and request their opinion and participation in decision making. Physicians should systematically explore their young patients' opinions and queries regarding the COVID and address problematic situations such as family conflicts, misuse of internet or risky behaviour.

Cet article résume le contenu d'un colloque participatif interprofessionnel en ligne de 2 jours visant à faire un état des lieux et à élaborer des réponses à la situation des adolescent·e·s à l'ère du Covid. La pandémie affecte leur santé en réduisant l'accès aux soins (confinement) et en induisant des problèmes psychologiques chez certains d'entre eux. Elle affecte la formation et la scolarité des plus démunis, réduit les contacts sociaux avec les adultes et les pairs. À l'avenir, les autorités devraient mieux respecter les droits des jeunes en sollicitant leur avis et leur participation et en adaptant leurs messages. Les médecins doivent, lors des consultations avec eux, offrir systématiquement un dialogue et des informations, et repérer des problématiques telles que conflits familiaux, abus d'internet ou prise de risque sanitaire.

Previsit Multidomain Psychosocial Screening Tools for Adolescents and Young Adults: A Systematic Review.

Adolescence and young adulthood constitute a period when exploratory behaviors can evolve into risky behaviors. Most causes of adolescent ill health are preventable; therefore, it is a priority to detect them early before they turn into health problems. Previsit multidomain psychosocial screening tools are used by professionals to detect and prioritize potentially problematic issues. In conjunction with appropriate clinician training, these tools have improved clinician screening rates in several areas of adolescent health. This article reviews existing multidomain previsit psychosocial screening tools developed in the 21st century and describes their characteristics using a systematic methodology. We reviewed 10,623 records to identify 15 different tools in use since 2000 and described their characteristics. Results show that all tools were developed in high-income countries. The tools provide sufficient coverage of many psychosocial domains relevant to young people's health. However, some psychosocial domains such as screen use and strengths are seldomly addressed. Furthermore, the tools rarely focus on young adults as a target population. Future research should assess the effectiveness, acceptability, and psychometric properties of validated psychosocial screening tools and examine how to expand their use in low- and middle-income countries.

Medical students' knowledge of and attitudes towards LGBT people and their health care needs: Impact of a lecture on LGBT health.

OBJECTIVES: Lesbian, gay, bisexual, and transgender (LGBT) adolescents have specific health care needs and are susceptible to health care disparities. Lack of skills and knowledge on the part of health care providers have a negative effect on their access to care and health outcomes. This study 1) explores the knowledge and attitudes of medical students regarding LGBT people, and 2) assesses the impact of a one-hour lecture targeting adolescent LGBT health needs. METHODS: Fourth-year medical students attended a compulsory one-hour lecture on sexual orientation and gender identity development in adolescence, highlighting health issues. We created a questionnaire with items to elicit students' knowledge and attitudes about LGBT health issues. Students were invited to complete this questionnaire online anonymously one week before the lecture and one month after the lecture. RESULTS: Out of a total of 157 students, 107 (68.2%) responded to the pre-intervention questionnaire and 96 (61.1%) to the post-intervention questionnaire. A significant proportion-13.7% of all respondents-identified as LGBT or questioning. Our results show that most medical students already show favorable attitudes towards LGBT people and a certain degree of knowledge of LGBT health needs. They demonstrated a large and significant increase in knowledge of LGBT health issues one month after the lecture. DISCUSSION: A single one-hour lecture on sexual orientation and LGBT health issues may increase knowledge among medical students. Medical students and professionals should receive such training to increase their knowledge about LGBT patients as it, together with favorable attitudes, has the potential to improve health outcomes among this vulnerable population.

Correction to: How can primary care practitioners address substance use by adolescents? A position paper of the EUROPEAN academy of PAEDIATRICS.

The authors of the published version of this article inadvertently omitted the table note of the Table 2 under the Appendix section. The complete Table 2 is shown in this article].

Correction to: how can primary care practitioners address substance use by adolescents? A position paper of the EUROPEAN academy of PEDIATRICS.

The authors of the published version of this article inadvertently omitted the table note of the Table 2 under the Appendix section. The complete Table 2 is shown in this article].

[Practical approach of media use in consultation with adolescents]. / Approche pratique des écrans en consultation avec les adolescents.

Digital media are central in our modern society and, as such, have an impact not only on teenagers but on most of us. Adolescents are among the most observed and stigmatized in terms of screens use. The encounter between the crucial developmental phase they cross and the neurobiological changes in their brains can be relatively «â€…noisy ¼. Because of the pervasive nature of screens in our daily lives and the potential effect on adolescent health, it is essential for health professionals to offer a systematic assessment of media use when consulting with an adolescent. This article provides practical tools for screening the use of media in consultation with the -adolescent and illustrates with a clinical story what lies behind the screens.

Les écrans occupent une place centrale dans la société et ont un impact non seulement sur les adolescents mais sur la plupart d'entre nous. Les adolescents figurent toutefois parmi les plus observés et montrés du doigt en termes d'utilisation d'écrans. La résonnance entre les modifications neurobiologiques de leur cerveau durant cette période de vie et l'utilisation d'écrans peut se manifester de façon relativement «â€…bruyante ¼. Étant donné le caractère ­omniprésent de ces derniers dans notre vie quotidienne et du potentiel effet sur la santé des jeunes, il est indispensable pour les professionnels de la santé d'intégrer l'évaluation ­systématique de l'utilisation des écrans en consultation avec un adolescent. Cet article propose des outils pratiques pour en ­investiguer l'usage et illustre au moyen d'une histoire clinique ce qui se cache derrière les écrans.

[Transgender and non-binary teenagers : management in primary care]. / Adolescents transgenres et non ­binaires : approche et prise en charge par les médecins de premier recours.

Transgender, non-binary and questioning teenagers are increasingly visible. However, they face barriers in accessing appropriate care that meet their needs, both specific and regarding their general health. Primary care physicians increasingly see them in consultations but often lack elements of communication and recent knowledge that is needed to accompany them and their close ones in their -individual trajectories. This article aims to answer this need and provides a synthesis about recent evidence and suggested communication approaches for primary care physicians, who play a central role for the health of all patients.

Les adolescents transgenres, non binaires ou en questionnement sont de plus en plus visibles et font face à de nombreux obstacles pour accéder à des soins appropriés, tant pour leurs besoins de santé spécifiques que généraux. Les médecins de premier recours les rencontrent au cabinet et peuvent manquer d'éléments de communication et de connaissances spécifiques récentes pour mener la consultation et accompagner ces personnes et leurs proches dans leurs trajectoires individuelles. Cet article propose une synthèse des éléments et des ressources utiles pour le médecin de premier recours, dont le rôle est ­central pour la santé de tous les patients.