Health status and healthcare services utilisation among unaccompanied asylum-seeking minors settled in Switzerland: a protocol for a retrospective cohort study from a hospital-based youth outpatient clinic.

INTRODUCTION: Unaccompanied asylum-seeking minors (UASMs) represent a population group with complex healthcare needs. Initial and ongoing healthcare is challenging for host countries but considered essential. This publication describes the protocol concerning a large cohort of UASMs settled in Switzerland in 2015-2016. Our aim is to assess their health status and examine their trajectories of healthcare services utilisation during the 3-year period after their initial health control. METHODS AND ANALYSIS: We will retrospectively analyse data of all newly arrived UASMs aged 12-18 years who benefited from a first health assessment at the Youth Clinic of Geneva University Hospitals between 1 January 2015 and 31 December 2016. Source of data will be electronic medical records. Main outcomes include the determination of their health status (acute and chronic conditions) and the utilisation of different care sectors (ambulatory primary care and subspecialty clinics, emergency room and inpatient wards). A secondary outcome will be the identification of patients at risk for high use of services as well as those with limited access to care. We will extract the following data: demographic characteristics (age, gender and country of origin), social determinants (place of residence, the presence of family in Geneva, school performance and asylum status), clinical information (reason for attending service, anthropometric measurements and medical diagnosis at discharge) and laboratory parameters (complete blood count, ferritin level, 25-hydroxyvitamin D level, hepatitis B antigen and antibodies, tetanus antibodies, QuantiFERON and stool and serology tests for intestinal parasites). We will collect data from first health assessment and during a follow-up period of 3 years for each patient. ETHICS AND DISSEMINATION: In accordance with the Swiss clinical research law, this protocol has been approved by the local ethics committee (project ID: 2021-01260). Our findings will provide important information for the development of quality healthcare services focusing to UASMs. We intend to disseminate our results through publication in peer-reviewed journals.

Three monthly doses of 150,000 IU of oral cholecalciferol correct vitamin D deficiency in adolescents: A pragmatic study.

OBJECTIVES: To assess the efficacy of an oral high-dose cholecalciferol regimen in correcting vitamin D deficiency (VDD) in adolescents and to explore potential predictive factors on the response to treatment. METHODS: This is a retrospective chart review conducted in the Adolescent Outpatient Clinic, Geneva University Hospitals, Switzerland. One hundred-three otherwise healthy vitamin D deficient [serum 25-hydroxyvitamin D, 25(OH)D, level <50 nmol/L] adolescents (mean age 16.6) attending the clinic between 1 January 2016 and 31 December 2018 received 150,000 IU of oral cholecalciferol every month for 3 months (cumulative dose of 450,000 IU). We measured the change in serum 25(OH)D levels pre- and post-treatment and the achievement of serum 25(OH)D level post-treatment ≥75 nmol/L. RESULTS: The mean serum 25(OH)D level increased by 320%, from 26 nmol/L at baseline to 83 nmol/L at the end of the study (P < .001). The rise was significantly higher for patients initially tested in the winter/spring (mean 65 nmol/L) compared with those initially tested in the summer/autumn (mean 48 nmol/L) (P < .003). No clear relationship was found between the response to treatment and the vitamin D status at baseline. The effect of age, gender, origin and body mass index was not statistically significant. CONCLUSIONS: The present intermittent high-dose regimen is effective in treating VDD in healthy adolescents without significant variations in response between different subgroups.

[Innovating to understand the unknown : COVID-19 pandemic research in family medicine]. / Innover pour comprendre l'inconnu : recherche sur la pandémie de Covid-19 en médecine de famille.

The COVID-19 pandemic has brought challenges that sparked a multitude of research questions at the Institutes of Family Medicine in Geneva and Lausanne. This article presents a synthesis of these questions, and the research projects that have resulted from them.

Les défis posés par la pandémie de Covid-19 ont éveillé une multitude de questions de recherche au sein des instituts de médecine de famille de Genève et Lausanne. Cet article présente une synthèse de ces questions et des projets de recherche qui en découlent.

Clinical preventive guidelines for school-aged children and adolescents in primary care: a protocol for a systematic review.

INTRODUCTION: Guidelines for clinical preventive services targeting school-aged children and adolescents in primary care are limited, often inconsistent and difficult to apply in clinical contexts. This publication describes the protocol concerning a comprehensive systematic review that primarily aims to collect and synthesise available guidelines for prevention in primary care focused on school-aged children living in high-income regions. A second objective is to assess the quality of identified documents. METHODS AND ANALYSIS: We will search for reports providing clinical practice guidelines or consensus or expert opinion on preventive actions in paediatric primary care. We will use the WHO definition of prevention. We will focus on children aged 6-18 years living in the European region, the USA, Canada and Australia. We will search PubMed, Embase, Web of Science and Cochrane Library and guidelines-specific databases from 1 January 2010. We will also explore the grey literature using web search engines (Google and Google Scholar). We will finally obtain unpublished information through personal contact with national paediatric societies. We will summarise all identified documents as well as their potential methodological bias. We will further use the Appraisal of Guidelines Research and Evaluation Instrument, version II tool to critically appraise their quality. ETHICS AND DISSEMINATION: Our findings will contribute to the identification of clinical preventive guidelines for which implementation in routine paediatric primary care should be considered. We intend to disseminate our results through publication in peer-reviewed journals and conference proceedings.PROSPERO registration numberCRD42020163184.

[Vitamin D in adolescents: summarizing guidelines for general practice]. / Vitamine D chez les adolescents: résumé des recommandations pour la pratique Clinique.

Vitamin D plays a critical role in bone health in adolescence. Is screening and treatment of vitamin D deficiency therefore necessary at this age? Inspired by a clinical case, we try to answer this question by presenting a summary of worldwide recommendations for vitamin D in adolescents.

La vitamine D joue un rôle indispensable pour la santé osseuse des adolescents. Faut-il de ce fait dépister et traiter d'éventuelles carences en vitamine D à cet âge ? À partir d'un cas clinique, nous tentons de répondre à cette question en présentant une synthèse des recommandations disponibles dans la littérature mondiale à propos de la vitamine D chez les adolescents.

Vitamin D in Adolescents: A Systematic Review and Narrative Synthesis of Available Recommendations.

PURPOSE: Practical guidelines help clinicians make their preventive and therapeutic choices and improve care management. Our purpose was to collect and synthesize available recommendations concerning vitamin D in adolescents (aged 10-19 years). METHODS: We searched PubMed, EMBASE, and Cochrane databases from inception to February 5, 2019, for guidance published by different professional associations and governments. We also searched the reference lists of identified recommendations and explored the gray literature using Web search engines. We organized documents by theme: dietary requirements, thresholds, prophylactic supplementation, and treatment of deficiency. RESULTS: A total of 32 documents were identified. Most of them targeted the general population and not specifically the age group of adolescents. There is a general agreement that adolescents should not have serum 25-hydroxyvitamin D concentrations below 25-30 nmol/L to avoid poor bone health. However, there is lack of consensus on the optimal concentration to aim for, levels varying between 25 nmol/L and 150 nmol/L. Adequate nutritional requirements of vitamin D are also subject to debate with values ranging between 200 IU/d and 1,000 IU/d. The upper tolerable intake is estimated at 4,000 IU/d by all study groups. Certain associations recommend routine vitamin D supplementation in adolescents. The recommended daily preventive doses vary between 400 IU and 4,000 IU, depending on season, skin pigmentation, sun exposure, consumption of vitamin D-fortified foods, body mass index, and coexistence of certain medical conditions. In case of deficiency, different therapeutic regimens of oral vitamin D are proposed depending on the presence of illness and/or the baseline serum 25-hydroxyvitamin D concentrations. Duration of the treatment varies between 4 weeks and 3 months. A maintenance dose is generally recommended after treatment. CONCLUSIONS: At present, there is no consensus among the different societies about vitamin D needs during adolescence. Stronger, evidence-based guidance is needed to inform clinical practice.

Usage of the levonorgestrel-releasing intrauterine system (LNG-IUS) in adolescence: what is the evidence so far?

PURPOSE: The levonorgestrel-releasing intrauterine system (LNG-IUS) is an effective method of contraception, while also providing various non-contraceptive benefits. Although targeted primarily to adults, there is increasing experience in its use in adolescence. The aim of this review is to assess the available information on LNG-IUS usage in adolescence. METHODS: We conducted an online search on MEDLINE and SCOPUS from inception to May 24, 2015. All studies that examined LNG-IUS use in teen populations were eligible for inclusion. Primary outcome measures included description of indications for LNG-IUS usage and relevant efficacy. Secondary outcomes included complications, such as device-related problems (perforation and expulsion) and other adverse events (pelvic inflammatory disease, PID). Acceptability of the LNG-IUS was also estimated through evaluation of continuation rate and reasons for removal were assessed. RESULTS: Twenty-one studies met our inclusion criteria. We identified only one randomized controlled trial (RCT). All other twenty studies were observational. Pregnancy rates ranged from 0 to 2.7%. Management of heavy or/and painful periods was successful in 92-100%. Menstrual manipulation in patients with developmental delay was achieved in over 93% of cases. Expulsion rates ranged from 0 to 13% and pelvic infection/cervicitis between 0 and 2.7%. There were no reported uterine perforations. CONCLUSION: Usage of the LNG-IUS in teen populations appears to be safe and efficacious both in terms of contraception and menstrual management. However, more robust evidence is needed so as to provide firm confirmation on benefits and potential side effects.

Factors associated with the onset of sexual activity among Greek high school students.

OBJECTIVE: To record variables of the sexual behaviour of high school students in Northern Greece and to investigate factors associated with the onset of sexual activity. METHODS: A questionnaire (Centers of Disease Control /Prevention) adapted to national characteristics, was distributed to students from a representative sample of 11 high schools (7 public, 2 private, 2 vocational). A total of 523 students (1st, 2nd, 3rd grade) completed the questionnaire. Frequencies of certain sexual behaviours were estimated and multivariable logistic regression models were used to evaluate correlates of the onset of sexual activity. RESULTS: Onset of sexual activity was reported by 48% of adolescents, half of whom stated this had occurred by the age of 15. At last sexual intercourse 76% had used a condom and 21% no contraception at all. Initiation of sexual activity was influenced by gender, age, type of school and smoking. Boys, students attending vocational high schools and smokers were significantly more likely to have been sexually active. CONCLUSIONS: Sexually-related behaviours among Greek high school students are quite frequent; they should be regularly registered. Sexual education programmes specifically designed for youths must be implemented.