A systematic review of longitudinal population-based studies on the predictors of smoking cessation in adolescent and young adult smokers

Le tabagisme est responsable de plus de 5 million de décès par an à travers le monde. En Suisse (2010), la prévalence de fumeurs chez les 14-19 ans était de 22% et la prévalence d'ex-fumeurs de 3%, taux qui reste relativement stable au fil des dernières années. La plupart des jeunes fumeurs désirant arrêter de fumer rencontrent des difficultés pour y parvenir. Les revues empiriques ont conclu que les programmes ayant pour but l'arrêt du tabagisme chez les jeunes ont une efficacité limitée. Afin de fournir une base solide de connaissances pour les programmes d'interventions contre le tabagisme, les déterminants de l'auto-cessation ont besoin d'être compris. Nous avons systématiquement recherché dans PUBMED et EMBASE des études longitudinales, basées sur la population, portant sur les déterminants de l'auto-cessation chez des adolescents et des jeunes adultes fumeurs. Nous avons passé en revue 4'502 titres et 871 abstracts, tous examinés indépendamment par deux et trois examinateurs, respectivement. Les critères d'inclusion étant : articles publiés entre janvier 1984 et août 2010, concernant les jeunes entre 10 et 29 ans et avoir une définition de cessation de fumer d'au moins 6 mois. Neuf articles ont été retenus pour une analyse détaillée. Les données suivantes ont été extraites de chaque article : le lieu de l'étude, la période étudiée, la durée du suivi, le nombre de collecte de données, la taille de l'échantillon, l'âge ou l'année scolaire des participants, le nombre de participants qui arrêtent de fumer, le status tabagique lors de la première collecte, la définition de cessation, les co-variantes et la méthode analytique. Le nombre d'études qui montrent une association significativement significative entre un déterminant et l'arrêt du tabagisme a été tabulé à partir de toutes les études qui ont évalués ce déterminant. Trois des neufs articles retenus ont défini l'arrêt du tabagisme comme une abstinence de plus de 6 mois et les six autres comme 12 mois d'abstinence. Malgré l'hétérogénéité des méthodes utilisées, cinq facteurs principaux ressortent comme prédicteur de l'arrêt du tabagisme : 1) ne pas avoir d'amis qui fument, 2) ne pas avoir l'intention de continuer de fumer dans le futur, 3) résister à la pression sociale, 4) être âgé de plus de 18 ans lors de la première cigarette, et 5) avoir un avis négatif au sujet du tabagisme. D'autres facteurs sont significatifs mais ne sont évalués que dans peu d'articles. La littérature au sujet des prédicteurs de cessation chez les adolescents et les jeunes adultes est peu développée. Cependant, nous remarquons que les facteurs que nous avons mis en évidence ne dépendent pas que de l'individu, mais aussi de l'environnement. La prévention du tabagisme peut se centrer sur les bienfaits de l'arrêt (p.ex., par rapport à l'asthme ou les performances sportives) et ainsi motiver les jeunes gens à songer d'arrêter de fumer. Une taxation plus lourde sur le prix des cigarettes peut être envisagée afin de retarder l'âge de la première cigarette. Les publicités anti-tabagiques (non sponsorisées par les entreprises de tabac) peuvent influencer la perception des jeunes par rapport au tabagisme, renforçant ou créant une attitude anti-tabagique. Les prochaines campagnes anti- tabac devraient donc tenir compte de ces différents aspects.

Body dissatisfaction on top of depressive mood among adolescent with severe dysmenorrhea

Purpose: Dysmenorrhea is the leading cause of recurrent short-term school absenteeism among adolescent girls. Yet, studies of menstrual symptoms in the light of adolescent psychological background seldom appear in the recent literature. This study aims to determine whether adolescent girls with severe dysmenorrhea (SD) have different body perception on top of poorer psychological health. Methods: We analyzed data from the Swiss Multicentre Adolescent Survey on Health (SMASH 2002) among a nationally representative sample of adolescents (n = 7548; 3340 females) aged 16 to 20 years attending post-mandatory education. Dysmenorrhea was defined as presence of abdominal or back pain during menstruation on the last 12 months. The severity of dysmenorrhea was defined according to the impact on daily activity and was assessed by 3 questions on the way menstruations interfere with daily life: 1) "You feel well and have normal activities", 2)"you must stay at home" and 3) "you feel restricted in your school or professional activities". Studied variables were: depressive symptoms, suicidal attempt, sexual abuse, health perception in general, body satisfaction, desire to modify body shape, and disordered eating behavior (DEB) with restrictive or bulimic tendency. Controlling variables included socio-economic status (SES) as measured by both parent's level of education, gynecological age (age-age at menarche), academic track (student/apprentice) and age. Results: 12.4% (95% CI: 11.0-14) declared severe dysmenorrhea, 74.2% (95% CI: 71.8-76.5) mild to moderate dysmenorrhea and 13,4% (95% CI: 11.5-15.5) had no dysmenorrhea. Compared to their peers, controlling for confounding variables, subjects with SD were more numerous to report depressive symptoms (AOR: 1.73; 95% CI: 1.39-2.15), to feel in poor health (AOR: 1.44; 95% CI: 1.14-1.81). Moreover, the proportion of those reporting dissatisfaction with their body appearance was higher (AOR: 1.48; 95% CI: 1.00-2.18). Conclusion: Patients with SD not only show a different profile than their peers in terms of their mental health and health perception, but also a distinct relation to their body. Therefore clinicians should pay particular attention to patients with SD and offer them a global evaluation keeping in mind what can be associated with SD.

Robotic, fluoroscopic or EMG assisted pedicle screw insertion. A CT based comparative study

Introduction: In order to improve safety of pedicle screw placement several techniques have been developed. More recently robotically assisted pedicle insertion has been introduced aiming at increasing accuracy. The aim of this study was to compare this new technique with the two main pedicle insertion techniques in our unit namely fluoroscopically assisted vs EMG aided insertion. Material and methods: A total of 382 screws (78 thoracic,304 lumbar) were introduced in 64 patients (m/f = 1.37, equally distributed between insertion technique groups) by a single experienced spinal surgeon. From those, 64 (10 thoracic, 54 lumbar) were introduced in 11 patients using a miniature robotic device based on pre operative CT images under fluoroscopic control. 142 (4 thoracic, 138 lumbar) screws were introduced using lateral fluoroscopy in 27 patients while 176 (64 thoracic, 112 lumbar) screws in 26 patients were inserted using both fluoroscopy and EMG monitoring. There was no difference in the distribution of scoliotic spines between the 3 groups (n = 13). Screw position was assessed by an independent observer on CTs in axial, sagittal and coronal planes using the Rampersaud A to D classification. Data of lumbar and thoracic screws were processed separately as well as data obtained from axial, sagittal and coronal CT planes. Results: Intra- and interobserver reliability of the Rampersaud classification was moderate, (0.35 and 0.45 respectively) being the least good on axial plane. The total number of misplaced screws (C&D grades) was generally low (12 thoracic and 12 lumbar screws). Misplacement rates were same in straight and scoliotic spines. The only difference in misplacement rates was observed on axial and coronal images in the EMG assisted thoracic screw group with a higher proportion of C or D grades (p <0.05) in that group. Recorded compound muscle action potentials (CMAP) values of the inserted screws were 30.4 mA for the robot and 24.9mA for the freehand technique with a CI of 3.8 of the mean difference of 5.5 mA. Discussion: Robotic placement did improve the placement of thoracic screws but not that of lumbar screws possibly because our misplacement rates in general near that of published navigation series. Robotically assisted spine surgery might therefore enhance the safety of screw placement in particular in training settings were different users at various stages of their learning curve are involved in pedicle instrumentation.

Varicocèle de l'enfant et de l'adolescent [Children and adolescent varicocele]

About 15% of adolescent males present with a varicocele. It rarely causes symptoms and is often diagnosed on the routine physical examination. There are evidences of an association between duration of a varicocele and testicular impairment. Surgical treatment is indicated in case of testicular growth arrest, testicular asymmetry, grade II or more, symptoms i.e. pain or swelling, parental or patient's anxiety. Several treatment options include open surgery (with or without micro-anastomosis), laparoscopy, embolization by interventional radiology, antegrade scrotal sclerotherapy. Informations should include a recurrence rate as hight as 15% whatever the technique may be, postoperative hydroceles and some testicular atrophies. Those complications can be delayed.

Psychoses a l'adolescence, les neurosciences ameliorent-elles la prediction? [Adolescent psychosis, can neuroscience improve prediction?]

Developments in the field of neuroscience have created a high level of interest in the subject of adolescent psychosis, particularly in relation to prediction and prevention. As the medical practice of adolescent psychosis and its treatment is characterised by a heterogeneity which is both symptomatic and evolutive, the somewhat poor prognosis of chronic development justifies the research performed: apparent indicators of schizophrenic disorders on the one hand and specific endophenotypes on the other are becoming increasingly important. The significant progresses made on the human genome show that the genetic predetermination in current psychiatric pathologies is complex and subject to moderating effects and there is therefore significant potential for nature-nurture interactions (between the environment and the genes). The road to be followed in researching the phenotypic expression of a psychosis gene is long and winding and is susceptible to many external influences at various levels with different effects. Neurobiological, neurophysiological, neuropsychological and neuroanatomical studies help to identify endophenotypes, which allow researchers to create identifying "markers" along this winding road. The endophenotypes could make it possible to redefine the nosological categories and enhance understanding of the physiopathology of schizophrenia. In a predictive approach, large-scale retrospective and prospective studies make it possible to identify risk factors, which are compatible with the neurodevelopmental hypothesis of schizophrenia. However, the predictive value of such markers or risk indicators is not yet sufficiently developed to offer a reliable early-detection method or possible schizophrenia prevention measures. Nonetheless, new developments show promise against the background of a possible future nosographic revolution, based on a paradigm shift. It is perhaps on the basis of homogeneous endophenotypes in particular that we will be able to understand what protects against, or indeed can trigger, psychosis irrespective of the clinical expression or attempts to isolate the common genetic and biological bases according to homogeneous clinical characteristics, which have to date, proved unsuccessful

Three-dimensional cholangio-spiral CT demonstration of a post-traumatic bile leak in a child.

Bilioma is a rare complication of traumatic liver injury, and the precise site of bile leak is often difficult to demonstrate with a non-invasive technique. We report a case of post-traumatic bile leak in a 15-year-old girl in whom spiral CT after intravenous cholangiography allowed excellent preoperative demonstration of the extent of the liver rupture and an exact location of the bile leak. We think that spiral-CT cholangiography could be an accurate, non-invasive technique to investigate the biliary system in cases of paediatric liver trauma.

Reliable acetabular cup orientation with a new gravity-assisted guidance system.

Acetabular cup orientation is a key factor determining hip stability, and standard mechanical guides have shown little help in improving alignment. An in vitro study was carried out to compare the accuracy and precision of a new gravity-assisted guidance system with a standard mechanical guide. Three hundred ten cups were impacted by 5 surgeons, and the final cup orientation was measured. With the new guide, the average error in anteversion was 0.4 degrees , compared with 10.4 degrees with the standard guide and 0.3 degrees and -4.7 degrees , respectively, for abduction angles. The average time required for orienting the cups was similar for both guides. The accuracy and reproducibility obtained with the new guide were better (P < .0001). These good results would require a clinical validation.

An epidemiological and clinical approach to adolescent suicide. A comparison between suicidal and non-suicidal clinical groups in a health foundation center for French students.

Suicidal behaviour among young people represents a major public health problem. This study seeks to compare the major sociological, clinical, schooling and family features of suicidal and non-suicidal subgroups of adolescents hospitalised in the Health Foundation Center for French Students of neufmoutiers en Brie (France). All these adolescents suffered from the severe mental disorders. The adolescents from the suicidal subgroup presented significantly fewer psychoses and more mood disorders than those of the non-suicidal subgroup. Half of the patients from the suicidal subgroup presented some features of personality disorders, mostly borderline personality disorders. Nevertheless, their global functioning was more frequently improved between admission and discharge than was the case for the non-suicidal group.

Adolescent's suicide attempts: populations at risk, vulnerability, and substance use.

Adolescence corresponds to a transition period that requires adaptation and change capacities and skills. Most young people succeed with this challenge, whereas a minority fail. In order to identify with the teenage culture, become autonomous, and differentiate from their parents, some adolescents choose to use drugs, beginning with the use of cigarettes, alcohol, cannabis, followed by other illicit drugs such as opiates and stimulants. A high proportion of these adolescents attempt suicide, which is the primary cause of death during adolescence in many European countries. Who are the "vulnerable" adolescents? What are the mechanisms that can explain the varieties of drug-use initiation or suicide attempts? Can "protective factors" be identified? What kind of strategies might be developed at a social and political level in order to prevent or to minimize drug abuse and suicide attempts, among other harmful behaviors? These issues will be discussed on the basis of the recent literature and in the light of a recent study carried out in the French-speaking part of Switzerland on large cohorts of adolescent drug users. Unresolved critical issues are noted and future needed research is suggested.

Lessons of peace in Aceh: administrative decentralization and political freedom as a strategy of pacification in Aceh

This working paper shows the evolution of the Aceh conflict until its peaceful resolution in 2005. The key factors in the success of this peace process have been the confluence of several factors related to the internal and external dynamics of the country, including the new political leadership, the decreasing role of the military power, the international support and the meeting of the objectives of both groups, and so on. The end of the conflict in Aceh shows that the administrative decentralization and the promotion of the political participation of the main actors involved have made possible the development of a solid alternative to the arms strategy of conflict resolution used for years in Indonesia.