Evaluation de l'efficacité clinique de la prise en charge pédopsychiatrique par l'Antenne d'Intervention dans le Milieu pour Adolescents (AIMA)

Contexte : Depuis les années 60, en lien avec la vague de désinstitutionalisation, un peu partout dans le monde, des équipes mobiles ont vu le jour. L'Antenne d'Intervention dans le Milieu pour Adolescents (AIMA) a été fondée en 2005, elle est destinée aux adolescents à haut risque psychopathologique qui échappent au système classique des soins pédopsychiatriques. Etant donné que ce dispositif est amené à se développer, il est souhaitable d'évaluer les résultats obtenus. Méthode : Etude ouverte prospective sur un échantillon comprenant 20 adolescents de 13 à 18 ans suivis par l'AIMA. Des données cliniques et sociodémographiques ont été collectées, différentes échelles ont été utilisées, dont l' « Health of Nation Outcome Scale for Children and Adolescents » (HoNOSCA) et la « Crisis Triage Rating Scale » en évaluation pré-­‐ et post-­‐suivi dans le milieu. L'effet de l'intervention est évalué à travers les données de l'HoNOSCA et de la « Crisis Triage Rating Scale » et nous avons également étudié l'effet dose-­‐réponse. Nous nous sommes intéressés à l'effet des événements de vie indésirables dans l'enfance sur les changements des scores de l'HoNOSCA. Résultats : On retrouve une nette amélioration clinique évaluée par l'HoNOSCA et de certains de ses sous-­‐scores (symptômes et contexte social). Par contre nous n'avons pas observé d'effet dose-­‐ réponse de l'intervention AIMA. L'amélioration de l'HoNOSCA est corrélée avec la diminution de la dangerosité et l'amélioration du réseau de soutien, mais pas avec la capacité à coopérer de l'adolescent. Les adolescents ayant subi plusieurs événements de vie indésirables pendant l'enfance bénéficient de manière significative de l'intervention de l'AIMA. Conclusion : Cette étude est en faveur de l'efficacité clinique de la prise en charge pédopsychiatrique par l'AIMA. Elle suggère que les adolescents ayant été confrontés à des événements de vie indésirables bénéficient grandement de ce type d'intervention. Ces conclusions mériteraient d'être confirmées par d'autres études (plus puissantes) et avec plus de sujets.

Education and male-female differences in later-life cognition: international evidence from latin america and the Caribbean.

This study explores the role of early-life education for differences in cognitive functioning between men and women aged 60 and older from seven major urban areas in Latin America and the Caribbean. After documenting statistically significant differences in cognitive functioning between men and women for six of the seven study sites, I assess the extent to which these differences can be explained by prevailing male-female differences in education. I decompose predicted male-female differences in cognitive functioning based on various statistical models for later-life cognition and find robust evidence that male-female differences in education are a major driving force behind cognitive functioning differences between older men and women. This study therefore suggests that early-life differences in educational attainment between boys and girls during childhood have a lasting impact on gender inequity in cognitive functioning at older ages. Increases in educational attainment and the closing of the gender gap in education in many countries in Latin America and the Caribbean may thus result in both higher levels and a more gender-equitable distribution of later-life cognition among the future elderly in those countries.

Metacognitive training for adolescents with psychosis: A multiple case study

Cognitive biases may be one of the explaining factor underlying psychotic symptoms like delusions and hallucinations. Metacognitive training (MCT) was demonstrated, in adults with schizophrenia, to reduce these cognitive biases. However, to the best of our knowledge, there has been no research on adolescents with psychosis. The current study aimed at assessing the feasibility, treatment adherence and its benefi cial effects on psychotic symptoms, depression, social functioning and self-esteem of a MCT. Participants were fi ve psychotic adolescents with psychosis, aged 16-18, who attended the Day Care Unit for Adolescents (DCUA). The MCT, delivered in group, corresponds to 2x8 modules, lasting between 45 and 60 minutes once a week. To measure MCT's effi ciency, the Positive And Negative Syndrome Scale (PANSS), the Social and Occupational Functioning Assessment Scale (SOFAS), the Health of Nation Outcome Scale for Children and Adolescent (HoNOSCA), the depression scale of Calgary and the self-esteem scale of Rosenberg have been used. The results of the 5 patients indicate that MCT is feasible and the treatment adherence is moderate. The schedule of the MCT needs to be adapted to the availability of the participants. At a descriptive level, the MCT allows to reduce psychotic and depressive symptoms (PANSS & Calgary) as well as to improve the social functioning (SOFAS & HoNOSCA) and self-esteem (Rosenberg). To sum up, MCT seem to be an interesting alternative and/or a good additional treatment to reduce cognitive bias, psychotic symptoms as well as improving social functioning

Intervenció per millorar la comunicació dels nens i adolescents amb DAR i els seus pares : Aplicació pel programa d'intervenció online DARWeb

Chronic pain is a relevant problem in our society. Concerning the young population, recurring abdominal pain (RAP in English, DAR in Spanish and Catalan) is very common among children and adolescents. DARWeb is an online treatment program addressed to children and teenagers with DAR and their parents. This work is aimed to develop an intervention to improve the communication skills of the children/adolescents with DAR and their parents. It is also proposed how this could be implemented to DARWeb.

Versión reducida del cuestionario CaMir (CaMir-R) para la evaluación del apego [Short version of CaMir questionnaire (CaMir-R) to assess attachment].

The CaMir is a questionnaire aimed at measuring attachment cognitions. It is based on subjects' evaluations of past and present attachment experiences and family functioning. It is a widely used tool both in research and in clinical settings. The aim of this study was to develop a short version of CaMir in Spanish (CaMir-R) and to obtain evidence about its validity and reliability in a sample of 676 adolescents (364 female and 312 male) belonging to different groups (clinical, maltreated, and community samples) with an age range between 13 and 19 years (M = 15.62, SD = 1.49). We examined its internal structure, convergent, and decision validity, the relationship between its dimensions and psychopathological symptoms, as well as its internal consistency and temporal stability. The CaMir-R included 7 factors whose internal consistency indexes ranged between 0.60 and 0.85. With the exception of the «Parental Permissiveness» dimension, which did not show good reliability, the results suggest that the CaMir-R provides a valid and reliable assessment of attachment representations and of the conception of family functioning.

Triade de la femme sportive [Female athlete triad]

The practitioner, as well as specialist such as gynecologist and endocrinologist, may face in their office women with eating disorders, abnormalities of menstrual cycles and low bone mass, which may be the first hints of the female athlete triad. In these situations, the practitioner may search other findings of these triad by looking at some particular physical findings and by using appropriate questionnaire. In some advanced forms of this triad specific abnormalities of eating disorders (anorexia and boulimia) may be present as well as amenorrhea and osteoporosis, which may disturb the well-being and cause health damages of women practising sport either as amateur or in a elite setting. An appropriate handling of such disorders has to be proposed to these women.

Médecine de l'adolescence. La Guglera: une réponse nouvelle et originale aux adolescents gravement obèses et sans travail [Adolescent medicine in Guglera: a novel approach for unemployed, severely obese adolescents]

The Center "la Guglera", located in the canton of Fribourg (Switzerland) provides a novel approach to the care of severely obese adolescents who are currently unemployed. These young people, whose BMI is usually higher than 35 to 40 kg/m2 spend a 6 to 12 months long stay in an in-patient institution which also takes care of other unemployed non obese adolescents on an outpatient basis. Besides a nutritional education which is part of the everyday life of the institution, the program includes a generous amount of hours of physical activities and sports. The adolescents also participate in a rehabilitation training program which fosters the future integration in a professional milieu, such as an apprenticeship. The short term results of la Guglera seem very promising. The program is financially co-supported by the Swiss and cantonal administrations, the insurance companies and the parents.

Female Juvenile Justice Report, June 1997

Female Juvenile Justice Report from the Iowa Commission on the Status of Women

Providing Gender-Specific Services for Adolescent Female Offenders: Guidelines & Resources, January 1999

Information of Gender-Specific Services for Adolescent Female Offenders produced by the Iowa Commission on the Status of Women.

From controlling to letting go : what are the psychosocial needs of parents of adolescents with a chronic illness?

While one of the main objectives of adolescence is to achieve autonomy, for the specific population of adolescents with a chronic illness (CI), the struggle for autonomy is accentuated by the limits implied by their illness. However, little is known concerning the way their parents manage and cope with their children's autonomy acquisition. Our aim was to identify the needs and preoccupations of parents of adolescents with CI in coping with their children's autonomy acquisition and to determine whether mothers and fathers coped differently. Using a qualitative approach, 30 parents of adolescents with CI participated in five focus groups. Recruitment took place in five specialized pediatric clinics from our university hospital. Thematic analysis was conducted. Transcript analyses suggested four major categories of preoccupations, those regarding autonomy acquisition, giving or taking on autonomy, shared management of treatment and child's future. Some aspects implied differences between mothers' and fathers' viewpoints and ways of experiencing this period of life. Letting go can be hard for the father, mother, adolescent or all three. Helping one or the other can in turn improve family functioning as a whole. Reported findings may help health professionals better assist parents in managing their child's acquisition of autonomy.

Substrate metabolism, nutrient balance and obesity development in children and adolescents: a target for intervention?

Obesity results from the organism's inability to maintain energy balance over a long term. Childhood obesity and its related factors and pathological consequences tend to persist into adulthood. A cluster of factors, including high energy density in the diet (high fat intake), low energy expenditure, and disturbed substrate oxidation, favour the increase in fat mass. Oxidation of three major macronutrients and their roles in the regulation of energy balance, particularly in children and adolescents, are discussed. Total glucose oxidation is not different between obese and lean children; exogenous glucose utilization is higher whereas endogenous glucose utilization is lower in obese compared with lean children. Carbohydrate composition of the diet determines carbohydrate oxidation regardless of fat content of the diet. Both exogenous and endogenous fat oxidation are higher in obese than in lean subjects. The influence of high fat intake on accumulation of fat mass is operative rather over a long term. Several future directions are addressed, such that a combination of increased physical activity and modification in diet composition, in terms of energy density and glycemic index, is recommended for children and adolescents.

Abortion trends 1990-1999 in a Swiss region and determinants of abortion recurrence.

OBJECTIVE: To assess age- and nationality-specific trends in abortion rates over the last decade, and to describe women's characteristics, identifying risk factors for repeated abortion. METHODS: From 1990-1999, the Health Department of Canton Vaud (Switzerland) received 13'857 abortion requests from residents aged 14-49. Population data were obtained to compute rates. RESULTS: Both the number of abortions (1400 annually) as well as their rate (8.9 per thousand women [95% confidence interval (CI) 7.3-10.5]) were stable over the decade in question. The rate of abortion for foreign women, especially from ex-Yugoslavia and Africa, was twice that for Swiss women. Half of the requests came from single women, 43% had a low education level, and half were childless. The main reason for requesting termination of pregnancy was psychosocial (93%). The mean gestational age was 7.7 weeks (SD +/- 2.3), but 96% of requests were submitted before 12 weeks. Sixty-three percent of women reported that they had used no contraception, 36% the condom and 17% the pill. Among requests, the adjusted risk of repeated abortion (22% of abortion candidates) was greater among divorced/separated/widowed women (odds ratio [OR] 1.9 [95% CI 1.5-2.4]), unemployed women (OR 1.8 [95% CI 1.5-2.1]), and those who had not attended university (OR 1.6 [95% CI 1.1-2.2]). CONCLUSIONS: Although Swiss law only permitted abortion under strict conditions, this procedure was widely available in Vaud, which nevertheless has one of the lowest rates worldwide. Efforts must be intensified to ensure universal access to family planning services, especially for foreign women and adolescents. Professionals should also target "repeaters" to provide personalised counselling.