Vegetarianism and eating disorders: The subjective experience of healthcare professionals.

Vegetarianism is growing dramatically among adolescents and young adults. Professionals specialized in eating disorders (ED) may routinely face patients adhering to these popular vegetarian practices. This qualitative study aimed to investigate healthcare professionals' subjective experience of vegetarianism in ED patients. Interviews of practitioners specialized in ED, recruited from the French federation of anorexia and bulimia (FFAB), were conducted using a semi-structured guide. We reached data saturation. Thematic analysis was used to identify and analyze patterns of meaning in the dataset. Eighteen professionals (dieticians, physician-nutritionists, and a psychiatrist) with private or institutional practices were interviewed. Three meta-themes emerged from our thematic analysis: (1) heterogeneous perceptions of vegetarianism among healthcare professionals, (2) diverse nutritional care practices, (3) factors influencing professionals' nutritional strategies and approaches. This original qualitative and exploratory study reported vegetarianism is a fast-growing phenomenon observed in a majority of adolescent patients with anorexia nervosa, with various underlying motivations reported. In all cases, the nature of the timing and relation between the vegetarian practices and the ED should be carefully assessed, using specific tools. Because of the ethical dimension of this issue and the risk of professional bias, institutional policy based on specific practice guidelines, to be developed, are strongly encouraged.

["The interpreter, a third party who remains present"]. / « L'interprète, un tiers qui demeure bien présent ¼.

Stéphanie Larchanché is a medical anthropologist and therapist who specializes in the study of cultural representations of illness and care strategies in a migratory context, particularly in mental health. Currently a consultant, independent trainer and head of research at Sigmund-Freud University-Paris, she has, for twelve years, directed training, teaching and research activities at the Françoise-Minkowska medical-psychological center in Paris. She is also an administrator of the ISM-Interpretariat association, and has a pertinent view of the role played by the interpreter with the health professional and his patient. The following interview took place before she left the Minkowska Center.

["Roma adolescents: a more varied reality than we think"]. / « Les adolescents roms : une réalité plus variée qu'on ne croit ¼.

The Roma are a population that has been recorded in Europe since the Middle Ages. Today, there are more than ten million of them on the European continent, especially in Eastern Europe. They form several groups of great linguistic, cultural and social diversity, who are generally stigmatized by the majority populations despite multiple forms of integration. Some of them live in very precarious conditions, sometimes in ghettoized neighborhoods, like the people cared for by the association Médecins du Monde in Bulgaria. Livia Otal, an anthropologist by training and coordinator of the Bulgaria mission of Médecins du Monde, presents the actions carried out with these populations, particularly adolescents.

When refeeding is not enough: severe and prolonged pancytopenia in an adolescent with anorexia nervosa.

A 15-year-old female patient with anorexia nervosa presented an unusually prolonged and severe episode of pancytopenia with severe thrombopenia and severe leucopenia. Despite effective refeeding, active specialized interventions were necessary. Upon admission, the patient presented with severe and symptomatic thrombopenia, severe neutropenia and gelatinous marrow transformation. In addition to refeeding, active interventions such as platelet transfusion and granulocyte-colony stimulating factor were successful to manage the patient's complications. The etiological search for pancytopenia was negative. The patient's prolonged starvation was probably a key factor. Medical history, clinical presentation, evolution, and biological data including bone marrow aspiration results are presented. Management of cytopenia and of their complications in a context of severe starvation is discussed in regard of existing literature. A simple monitoring attitude may prove insufficient in cases of severe pancytopenia in anorexia nervosa.Level of evidence V, descriptive study.

[Professional representation of chronic idiopathic musculoskeletal pain in adolescents]. / Représentation des professionnels face aux douleurs musculo-squelettiques chroniques idiopathiques de l'adolescent.

Chronic idiopathic musculoskeletal pain is common in adolescence, and its impact is sometimes severe. The diagnostic process, which consists of eliminating other etiologies, can be long, complex, and at risk of medical nomadism. Specialists rely on many clinical elements to orient themselves. The care pathway and the subjective feeling of the professional are valuable diagnostic elements.

Chronic idiopathic musculoskeletal pain in youth: a qualitative study.

BACKGROUND: Chronic musculoskeletal pain (MSP) is frequent in adolescents and has major medical and social consequences. In many cases, when no cause has been clearly established, this pain may be considered to be chronic idiopathic MSP. Our study seeks to identify general criteria for this type of pain through the experience of professionals from tertiary care centers with expertise in pediatric and adolescent chronic MSP. METHODS: Cross-sectional multicenter qualitative study. Semi-structured interviews of 25 professionals at a rheumatology reference center and in its network for pain management, including diverse specialists and professions. Interpretative Phenomenological Analysis is used to explore the data. RESULTS: This approach led us to identify 10 themes organized around three superordinate themes covering different stages of the diagnostic process: 1) the medical pain history up to the consultation at the reference center; 2) the professional's subjective feelings about the clinical presentation; 3) from the clinical examination to diagnosis and treatment of chronic idiopathic MSP. The main elements guiding this diagnosis do not come from the physical examination but from the medical history and the professionals' subjective feelings, that is, their clinical judgment. The professionals' impression of uneasiness and frustration, induced by patients and their parents, is of major importance. CONCLUSION: The principal elements guiding the diagnosis of chronic idiopathic MSP do not come primarily from the physical examination but rather from the pain history and the health professional's subjective feelings. Our results suggest that the concept of Juvenile Fibromyalgia (JFM) does not appear to cover all situations of chronic idiopathic MSP in adolescence. A constellation of non-organic criteria enables diagnosis of the latter; these criteria should be validated to avoid medical nomadism and multiple investigations and to shorten the interval until patients receive optimal pain management. CLINICAL TRIAL REGISTRATION: clinicaltrials.gov, NCT03171792, https://clinicaltrials.gov/ct2/show/NCT03171792?term=LACHAL&cntry=FR&city=paris&rank=1.