Use of a multidimensional assessment tool in a psychiatric adolescent care unit.

AIMS: Adolescent mental health problems require treatment and care that are adapted to their needs. To evaluate this issue, it was decided to implement a multidimensional instrument focused on a global approach to adolescent social and behavioural functioning, combined with the ICD-10 classification. METHODS: The combination of an assessment interview and a classification tool enabled the method to integrate the measurement of several domains of patient-based outcome rather than focus on the measurement of symptoms. A group of 68 adolescents from an inpatient unit were compared with 67 adolescents from the general population. RESULTS: Results suggest that adolescents from the care unit adopt significantly riskier behaviour compared with adolescents from the control group. As expected, the main problems identified refer to the psychological and familial areas. A cluster analysis was performed and provided three different profiles: a group with externalizing disorders and two groups with internalizing disorders. On the basis of a structured interview it was possible to obtain information in a systematic way about the adolescents' trajectory (delinquency, physical and sexual abuse, psychoactive substance use). CONCLUSION: It was shown that treatment and care should not focus exclusively on mental health symptoms, but also upon physical, psychological and social aspects of the adolescent. A global approach helps in the consideration of the multitude of factors which must be taken into account when working with people with serious mental health problems and may help to turn the care unit's activity more specifically towards the needs of these adolescents.

Psychiatrie de l'enfant et de l'adolescent : une approche basée sur les preuves

L'approche basée sur les preuves, dérivée de I'evidence based medicine anglo-saxonne, offre une vision élargie de la pédopsychiatrie en permettant aux thérapeutes de s'extraire de la stricte soumission aux conclusions de la recherche pour donner à la pratique, dans une certaine mesure, la possibilité de valider des choix de prise en charge pluridisciplinaires. Alors que l'evidence based médecine s'est imposée dans la plupart des spécialités médicales, elle tarde à s'implanter en psychiatrie de l'enfant et de l'adolescent. Cet ouvrage fait donc le point sur les connaissances actuelles et propose une approche plus globale fondée sur les preuves. Les 13 chapitres qui le composent couvrent une grande partie des troubles pédopsychiatriques en y intégrant des sujets d'ouverture comme l'alliance thérapeutique, les soins sous contrainte ou les équipes mobiles. Un chapitre consacré aux médicaments psychotropes utilisés chez l'enfant et l'adolescent permet d'offrir un aperçu complet des moyens thérapeutiques à disposition pour chacun de ces troubles.

Santé et styles de vie des adolescents âgés de 16 à 20 ans en Suisse (2002). SMASH 2002 : Swiss multicenter adolescent survey on health 2002

Le présent rapport décrit les grandes tendances qui se dégagent des résultats de l'Enquête SMASH 2002 et propose quelques hypothèses pour éclairer la compréhension et les enjeux de la situation actuelle ainsi que des pistes de réflexion pour l'avenir. Cette étude repose sur deux approches complémentaires de la santé: l'une donne la primauté aux aspects sociologiques des conduites de santé ("lifestyle"); l'autre, de nature épidémiologique, met l'accent sur la prévalence des comportements et procède à des analyses dans divers sous-groupes ou dans le temps. L'étude SMASH 2002 fournit une photographie de la situation des adolescents et de leur état de santé : besoins et comportements de santé, facteurs associés et évaluation des grands changements intervenus depuis une dizaine d'années. Ces données doivent permettre de réfléchir à une planification optimale des services de soins et des programmes de prévention et de promotion de la santé en faveur des adolescents. [extraits du résumé des auteurs]

L'adolescent consommateur de substances face au réseau de soins [Substance abuse adolescents and the health care network]

Substance user adolescents were asked to report on each contact they had had with any type of care providers since they had begun to use alcohol or illegal drugs regularly. Primary care doctors and social workers represent the main access to the care network. In one out of two contacts substance use was not discussed.

Jeune dans sa tête. Une histoire critique du cerveau adolescent

Les recherches visant à élucider les bases neurales de l'adolescence ont émergé au cours des années 1990 pour s'imposer cette dernière décennie. Il est aujourd'hui accepté dans le champ des neurosciences cognitives et du développement que le cerveau continue à se développer après la 10eme année de vie et qu'il atteint un stade de maturation similaire à l'adulte seulement vers 25 ans. La configuration structurelle et fonctionnelle du cerveau spécifique à la période de l'adolescence impliquerait un manque de contrôle émotionnel, favorisant des comportements dits de prise de risques qui à la fois permettent l'acquisition de l'indépendance et provoquent des situations de mise en danger du jeune individu et de son entourage. Ses mêmes comportements, dans leur acception négative - consommation d'alcool et de stupéfiants, conduite en état d'ivresse, rapports sexuels non-protégés, port d'arme, etc. - mobilisent les politiques de prévention et de santé publique relatives à l'adolescence et à la jeunesse. Cette thèse qui retrace l'histoire du cerveau adolescent de la fin des années 1950 à nos jours se situe à l'intersection de ces deux thèmes d'intérêt scientifique et public. A partir d'une perspective d'histoire culturelle et sociale des sciences, elle approche les éléments expérimentaux, institutionnels et contextuels qui ont contribué à la construction d'une adolescence définie par son immaturité cérébrale, associée à des comportements dits à risque. Plus précisément, elle met en évidence, sous l'angle privilégié du genre, selon quelles modalités et quelles temporalités l'histoire des recherches scientifiques sur le développement cérébral humain à l'adolescence et celle du façonnage d'un type d'adolescent-e impulsif/ve et preneur/euse de risques - c'est-à-dire potentiellement délinquant, dépendant, invalide ou malade chronique, constitué en problème de politique et de santé publique - sont amenées à converger. L'argument développé est que le genre et le sexe sont des catégories actives dans la construction d'un cerveau adolescent idéalement unisexe. En d'autres termes, bien que le cerveau adolescent qualifie des individus en regard de leur âge, sans distinction apparente de sexe et de genre, les conditions de sa production et les critères de sa définition sont constitutivement genrés, notamment par des comportements à risque qui concernent une majorité de garçons. Il s'agit d'analyser comment du sexe et du genre peuvent produire de l'âge, a priori unisexe, et d'interroger les enjeux scientifiques, sociaux et politiques qui participent de cette invisibilisation des catégories de sexe et de genre. Le but est de considérer la manière dont l'adolescence cérébrale reconfigure la gestion des questions liées à l'adolescence et à la jeunesse, en termes de problèmes sanitaires et de délinquance, mais aussi en termes de reproduction des normes sociales, de ce qu'implique devenir un homme ou une femme.

Skin cancer in survivors of childhood and adolescent cancer.

The incidence of basal cell carcinoma (BCC) has been related to ionizing radiation, particularly for exposure occurring at young age. In this study, we considered the incidence of second skin neoplasms in long-term survivors from childhood cancer. We considered second primary cancers occurring among 776 subjects (436 males, 340 females) with first primary cancer diagnosed before age 20 years, between 1974 and 2001, in the Swiss Cantons of Vaud and Neuchâtel (786,000 inhabitants). Five BCC were observed versus 0.43 expected (standardized incidence ratio: 11.6, 95% confidence interval: 3.7-27.1). No case of cutaneous squamous cell carcinoma, nor of malignant melanoma was observed. The estimated radiation doses at 1mm through the skin ranged between 7 and 27 Sv. These data confirm that BCC are strongly related to ionizing radiation exposure in childhood. All the BCC were located within the radiation field, thus indicating that ionizing radiation is the key aetiological factor, even in the absence of any meaningful interaction with UV.

Capacité de discernement des adolescents mineurs: étude qualitative sur les représentations en Suisse romande. [Minor adolescent's competence: a qualitative study about representations in Switzerland's French-speaking part]

This exploratory qualitative study run using focus groups investigates the representations in the field of adolescent confidentiality and competence. Four groups of 3 to 8 participants (two of respectively younger and older adolescents, one of parents, one of pediatricians) have participated in a hone hour and a half discussion, than transcribed verbatim and analyzed by main themes. The concept of confidentiality is well known and understood, but the legal framework which underpins it is less well identified, both among young people and adults. Also, while the participants of all four groups agree with the idea that 14 year old youngsters are usually competent, they all admit that there are circumstances in which this statement should be revisited. Physicians report that they do not feel skilled in how to evaluate competence in such specific situations.

Factor analysis of the North American Spine Society outcome assessment instrument: a study based on a spine registry of patients treated with lumbar and cervical disc arthroplasty.

BACKGROUND CONTEXT: Studies involving factor analysis (FA) of the items in the North American Spine Society (NASS) outcome assessment instrument have revealed inconsistent factor structures for the individual items. PURPOSE: This study examined whether the factor structure of the NASS varied in relation to the severity of the back/neck problem and differed from that originally recommended by the developers of the questionnaire, by analyzing data before and after surgery in a large series of patients undergoing lumbar or cervical disc arthroplasty. STUDY DESIGN/SETTING: Prospective multicenter observational case series. PATIENT SAMPLE: Three hundred ninety-one patients with low back pain and 553 patients with neck pain completed questionnaires preoperatively and again at 3 to 6 and 12 months follow-ups (FUs), in connection with the SWISSspine disc arthroplasty registry. OUTCOME MEASURES: North American Spine Society outcome assessment instrument. METHODS: First, an exploratory FA without a priori assumptions and subsequently a confirmatory FA were performed on the 17 items of the NASS-lumbar and 19 items of the NASS-cervical collected at each assessment time point. The item-loading invariance was tested in the German version of the questionnaire for baseline and FU. RESULTS: Both NASS-lumbar and NASS-cervical factor structures differed between baseline and postoperative data sets. The confirmatory analysis and item-loading invariance showed better fit for a three-factor (3F) structure for NASS-lumbar, containing items on "disability," "back pain," and "radiating pain, numbness, and weakness (leg/foot)" and for a 5F structure for NASS-cervical including disability, "neck pain," "radiating pain and numbness (arm/hand)," "weakness (arm/hand)," and "motor deficit (legs)." CONCLUSIONS: The best-fitting factor structure at both baseline and FU was selected for both the lumbar- and cervical-NASS questionnaires. It differed from that proposed by the originators of the NASS instruments. Although the NASS questionnaire represents a valid outcome measure for degenerative spine diseases, it is able to distinguish among all major symptom domains (factors) in patients undergoing lumbar and cervical disc arthroplasty; overall, the item structure could be improved. Any potential revision of the NASS should consider its factorial structure; factorial invariance over time should be aimed for, to allow for more precise interpretations of treatment success.

A U-shaped association between intensity of Internet use and adolescent health.

OBJECTIVE: To examine the relationship between different Internet-use intensities and adolescent mental and somatic health. METHODS: Data were drawn from the 2002 Swiss Multicenter Adolescent Survey on Health, a nationally representative survey of adolescents aged 16 to 20 years in post-mandatory school. From a self-administered anonymous questionnaire, 3906 adolescent boys and 3305 girls were categorized into 4 groups according to their intensity of Internet use: heavy Internet users (HIUs; >2 hours/day), regular Internet users (RIUs; several days per week and <= 2 hours/day), occasional users (<= 1 hour/week), and non-Internet users (NIUs; no use in the previous month). Health factors examined were perceived health, depression, overweight, headaches and back pain, and insufficient sleep. RESULTS: In controlled multivariate analysis, using RIUs as a reference, HIUs of both genders were more likely to report higher depressive scores, whereas only male users were found at increased risk of overweight and female users at increased risk of insufficient sleep. Male NIUs and female NIUs and occasional users also were found at increased risk of higher depressive scores. Back-pain complaints were found predominantly among male NIUs. CONCLUSIONS: Our study provides evidence of a U-shaped relationship between intensity of Internet use and poorer mental health of adolescents. In addition, HIUs were confirmed at increased risk for somatic health problems. Thus, health professionals should be on the alert when caring for adolescents who report either heavy Internet use or very little/none. Also, they should consider regular Internet use as a normative behavior without major health consequence. Pediatrics 2011;127:e330-e335

My older sibling was drunk - younger siblings' drunkenness in relation to parental monitoring and the parent-adolescent relationship.

This study explored the links between having older siblings who get drunk, satisfaction with the parent-adolescent relationship, parental monitoring, and adolescents' risky drinking. Regression models were conducted based on a national representative sample of 3725 8th to 10th graders in Switzerland (mean age 15.0, SD = .93) who indicated having older siblings. Results showed that both parental factors and older siblings' drinking behaviour shape younger siblings' frequency of risky drinking. Parental monitoring showed a linear dose-response relationship, and siblings' influence had an additive effect. There was a non-linear interaction effect between parent-adolescent relationship and older sibling's drunkenness. The findings suggest that, apart from avoiding an increasingly unsatisfactory relationship with their children, parental monitoring appears to be important in preventing risky drinking by their younger children, even if the older sibling drinks in such a way. However, a satisfying relationship with parents does not seem to be sufficient to counterbalance older siblings' influence.

To use it or not to use it: differences between adolescent males carrying a weapon and those using it in a fight

Purpose Data indicate that 19% of male adolescents living in Switzerland carried a weapon in the last 12 months. The main objective of this research is to compare the characteristics of male adolescents carrying a weapon and having used it in a fight from those who have carried but not used it in the previous 12 months. Methods Data were drawn from the 2002 Swiss Multicenter Adolescent Survey on Health (SMASH02) data base, a survey including 7,548[3,710 males] in-school adolescents aged 16-20 years in Switzerland. Only males declaring having carried a weapon (N = 711; 19.2% of the sample) were included in the analysis. Three groups were created: those not having used a weapon (WO; N = 538 subjects), those having used a weapon in a fight once or twice (W12; N = 127), and those having used a weapon in a fight 3 or more times (W3+; N = 46). Multinomial logistic regression was performed to compare the 3 groups on individual, family, school, and social factors using WO as the reference category. Analyses were performed with STATA9. Results are presented as relative risk ratios (RRR). Results W12 males were significantly more likely to perceive their puberty as advanced compared to their peers (RRR: 2.1), to be foreign born (RRR: 2.6), to live in an urban environment (RRR: 1.9), to be in vocational school (RRR: 4.7), to have a poor school connectedness (RRR: 1.8), to skip classes (RRR: 2.1) and to quarrel while intoxicated (RRR: 5.3). W3+ males were significantly more likely to be foreign born (RRR: 3.6) and to live in an urban environment (RRR: 2.4), to be current users of illegal drugs other than cannabis (RRR: 3.8) and to quarrel while intoxicated (RRR: 4.1). No differences were found between groups for tobacco, alcohol, or cannabis use. Conclusions Within a national sample of Swiss youth aged 16-20 years, almost one fifth of male adolescents have carried a weapon in the previous 12 months. Nevertheless, most of them (75.7%) have never used a weapon in a fight. Whether they carry a weapon for defense purposes or as a manly behavior remains to be elucidated. However, urban foreign-born adolescents who quarrel while intoxicated are the most at risk of using a weapon in a fight, and therefore culturally-sensitive prevention approaches need to be developed to decrease violence in this specific population of youth. Having school problems or using illegal drugs other than cannabis seem to differentiate between those who use it in a fight occasionally (once or twice) and those who do it more often.

Demographic and behavioral factors associated with adolescent pregnancy in Switzerland.

Switzerland has the lowest adolescent fertility rate in Western Europe. According to data collected in 1993 as part of the Swiss Multicentre Adolescent Survey on Health, 5% of 1,726 sexually active adolescents in a group of 3,993 15-20-year-old women enrolled in academic or vocational classes had ever been pregnant; most of these women (80%) had terminated their pregnancy. Adolescents who had ever been pregnant did not differ significantly from those who had not by demographic characteristics. Multiple logistic regression analysis identified seven factors associated with pregnancy: having had four or more sexual partners; not having used contraceptives at first intercourse; ever use of less-effective contraceptive methods; having used illicit drugs during the last 30 days; living apart from one's parents; recently experiencing stress; and perceiving a lack of future prospects.