La médecine ambulatoire youth-friendly. [Youth-friendly outpatient care].

Ambulatory pediatric and family medicine takes care of adolescent patients, most of whom regularly consult a physician. Consultations with young people involve issues specifically related to their age. Regarding health care systems and physicians, adolescents' expectations vary from those of adults, not so much in terms of the issues discussed but in terms of the priorities that they give to them. Confidential interviews are not always proposed but are highly appreciated, as are certain personal qualities on the part of the caregivers such as honesty, respect, and friendliness. Finally, easy access to care together with the continuity of care are essential. Prevention of risk behaviors by screening and health education is clearly insufficient. This issue could be approached during the consultation through a psychosocial history. This is a good opportunity to discuss sensitive issues that adolescents seldom bring up themselves. More systematic prevention would probably decrease youth morbidity and mortality, which are both closely related to risk behaviors. To meet these expectations and special health care needs, the World Health Organization has developed the concept of youth-friendly health services. This concept can be applied in both a specialized adolescence center and a pediatric or family practice. Youth-friendly services are still rarely evaluated but seem to bring a clear benefit in terms of patient satisfaction and access to care.

Alcohol-attributable mortality in Switzerland in 2011--age-specific causes of death and impact of heavy versus non-heavy drinking.

BACKGROUND: Alcohol use causes high burden of disease and injury globally. Switzerland has a high consumption of alcohol, almost twice the global average. Alcohol-attributable deaths and years of life lost in Switzerland were estimated by age and sex for the year 2011. Additionally, the impact of heavy drinking (40+grams/day for women and 60+g/day for men) was estimated. METHODS: Alcohol consumption estimates were based on the Addiction Monitoring in Switzerland study and were adjusted to per capita consumption based on sales data. Mortality data were taken from the Swiss mortality register. Methodology of the Comparative Risk Assessment for alcohol was used to estimate alcohol-attributable fractions. RESULTS: Alcohol use caused 1,600 (95% CI: 1,472 - 1,728) net deaths (1,768 deaths caused, 168 deaths prevented) among 15 to 74 year olds, corresponding to 8.7% of all deaths (men: 1,181 deaths; women: 419 deaths). Overall, 42,627 years of life (9.7%, 95% CI: 40,245 - 45,008) were lost due to alcohol. Main causes of alcohol-attributable mortality were injuries at younger ages (15-34 years), with increasing age digestive diseases (mainly liver cirrhosis) and cancers (particularly breast cancers among women). The majority (62%) of all alcohol-attributable deaths was caused by chronic heavy drinking (men: 67%; women: 48 %). CONCLUSION: Alcohol is a major cause of premature mortality in Switzerland. Its impact, among young people mainly via injuries, among men mainly through heavy drinking, calls for a mix of preventive actions targeting chronic heavy drinking, binge drinking and mean consumption.

Prévention du métanome en Suisse: où en sommes-nous [Melanoma prevention in Switzerland: where do we stand?]

Over the last 50 years, skin cancer rates (particularly melanoma) have markedly increased in Caucasian populations. Switzerland, with some 1,600 cases of, and 220 deaths from, malignant melanoma per year has among the highest rates in Europe. This public health issue, affecting relatively young people, has led to primary and secondary nationwide prevention campaigns being carried out for nearly 20 years. Observed changes in sun protection knowledge and attitudes have yet to impact on incidence trend. Early detection has resulted in a large increase in rates of thin melanoma with little change in rates of thick melanoma. Mortality has levelled off and a recent decrease, especially in women, cannot be ruled out. The efficiency of prevention campaigns should soon become more blatant if current efforts persist.

Cannabis Dependence in Swiss Adolescents Exploration of the Role of Anxiety, Coping Styles, and Psychosocial Difficulties

This naturalistic cross-sectional study explores how and to what extent cannabis dependence was associated with intrapersonal aspects (anxiety, coping styles) and interpersonal aspects of adolescent functioning (school status, family relationships, peer relationships, social life). A convenience sample of 110 adolescents (aged 12 to 19) was recruited and subdivided into two groups (38 with a cannabis dependence and 72 nondependent) according to DSM-IV-TR criteria for cannabis dependence. Participants completed the State-Trait Anxiety Inventory (STAI-Y), the Coping Across Situations Questionnaire (CASQ), and the Adolescent Drug Abuse Diagnosis (ADAD) interview investigating psychosocial and interpersonal problems in an adolescent's life. Factors associated with cannabis dependence were explored with logistic regression analyses. The results indicated that severity of problems in social life and peer relationships (OR = 1.68, 95% CI = 1.21 - 2.33) and avoidant coping (OR = 4.22, 95% CI = 1.01 - 17.73) were the only discriminatory factors for cannabis dependence. This model correctly classified 84.5% of the adolescents. These findings are partially consistent with the "self-medication hypothesis" and underlined the importance of peer relationships and dysfunctional coping strategies in cannabis dependence in adolescence. Limitations of the study and implications for clinical work with adolescents are discussed.

Médecine de l'adolescence : troubles des conduites alimentaires atypiques [Adolescent medicine : eating disorders not otherwise specified (EDNOS)]

Young people (mostly females) suffering from eating disorders not otherwise specified (EDNOS) are more and more numerous and their difficulties pose serious problems to health care providers as well as the society. These situations correspond to eating disorders which do not totally meet the DSM-IV criteria for either anorexia or bulimia nervosa. The duration of the symptoms, the extent of suffering as well as the impact on daily life should be taken into account to set-up the treatment. The therapeutic approach to these disorders should ideally include both cognitive/dietary and psychodynamic approaches. The Multidisciplinary Unit for Adolescent Health in Lausanne has set-up a group treatment for these patients.

Cap a una escola secundària inclusiva: sabers i experiències de joves en situació d'exclusió

[cat] Aquest projecte revisa la narrativa al voltant del fracàs escolar a partir del desenvolupament de deu històries de joves - set nois i tres noies- de Catalunya en situació d'exclusió escolar. Dins d'aquest marc la recerca s'ha articulat a partir de tres eixos: (1) La realització d'un mapa dels estudis realitzats a Catalunya entorn l'anomenat fracàs escolar, amb la finalitat de situar i contextualitzar les seves narratives dominants. (2) La recerca entorn a les històries biogràfiques d'un grup de joves per explorar alternatives a l'actual crisi internacional de l'escola secundària que es reflecteix, entre d'altres fenòmens, en els elevats índexs d'abandonament d'aquesta etapa educativa per part dels estudiants. (3) La recerca conclou amb una sèrie de consideracions que pretenen contribuir a una narrativa a favor d¿una escola inclusiva per a l'educació secundària que tingui en compte les experiències i sabers d'aquests joves que, per diferents raons, no finalitzen la seva educació bàsica.

¿Qué nos cuentan los jóvenes? Narraciones biográficas sobre las relaciones de los jóvenes con el saber en la escuela secundaria

[spa] El contenido de esta publicación se deriva de la investigación "Repensar el éxito y el fracaso escolar de la Educación Secundaria desde la relación de los jóvenes con el saber". Ministerio de Ciencia e Innovación. EDU2008-03287. 2008-2011. Las narraciones biográficas rescatan las experiencias escolares de estudiantes que durante su recorrido en la escuela secundaria se encontraron en una posición de éxito o fracaso escolar. La publicación da cuenta de relatos de situaciones, historias, conductas y discursos en torno a las experiencias de relación de un grupo de jóvenes con los saberes de la escuela secundaria y fuera de ella.

Cap a una escola secundària inclusiva: sabers i experiències de joves en situació d'exclusió

[cat] Aquest projecte revisa la narrativa al voltant del fracàs escolar a partir del desenvolupament de deu històries de joves - set nois i tres noies- de Catalunya en situació d'exclusió escolar. Dins d'aquest marc la recerca s'ha articulat a partir de tres eixos: (1) La realització d'un mapa dels estudis realitzats a Catalunya entorn l'anomenat fracàs escolar, amb la finalitat de situar i contextualitzar les seves narratives dominants. (2) La recerca entorn a les històries biogràfiques d'un grup de joves per explorar alternatives a l'actual crisi internacional de l'escola secundària que es reflecteix, entre d'altres fenòmens, en els elevats índexs d'abandonament d'aquesta etapa educativa per part dels estudiants. (3) La recerca conclou amb una sèrie de consideracions que pretenen contribuir a una narrativa a favor d¿una escola inclusiva per a l'educació secundària que tingui en compte les experiències i sabers d'aquests joves que, per diferents raons, no finalitzen la seva educació bàsica.

¿Qué nos cuentan los jóvenes? Narraciones biográficas sobre las relaciones de los jóvenes con el saber en la escuela secundaria

[spa] El contenido de esta publicación se deriva de la investigación "Repensar el éxito y el fracaso escolar de la Educación Secundaria desde la relación de los jóvenes con el saber". Ministerio de Ciencia e Innovación. EDU2008-03287. 2008-2011. Las narraciones biográficas rescatan las experiencias escolares de estudiantes que durante su recorrido en la escuela secundaria se encontraron en una posición de éxito o fracaso escolar. La publicación da cuenta de relatos de situaciones, historias, conductas y discursos en torno a las experiencias de relación de un grupo de jóvenes con los saberes de la escuela secundaria y fuera de ella.

Diagnòstic en profunditat sobre la integració dels i les joves de 14 a 18 anys migrats a Catalunya

[cat] La finalitat d’aquest projecte és aprofundir en el procés d’integració socioeducativa de la joventut migrada a Catalunya, específicament, dels i les joves entre 14 i 18 anys. Entre els resultats destaquem que els joves tenen un concepte força tancat i excloent del concepte de ciutadania com a estatus, i un baix grau de coneixement de la diversitat cultural, especialment els joves autòctons; tot i que tenen una actitud de reconeixement i acceptació, favorable a la convivència intercultural, tant al centre educatiu com al seu barri. No obstant, tenen una visió de la diversitat cultural i del fet migratori en clau de coexistència, sense el reconeixement que suposaria un pas més per a la convivència. La immigració és vista com un col·lectiu vulnerable, amb un baix nivell econòmic i cultural i que també és percebut com un problema i, fins i tot, com a causant de les dificultats que actualment pateix i travessa el conjunt de la societat. Els joves tendeixen a relacionar-se amb el seu grup cultural, i responen de forma passiva en la comprensió i actuació davant dels problemes i assumptes públics. Entre els elements que valoren per sentir-se ciutadà té una especial importància la llengua. Els joves que fa més de 10 anys que viuen a Catalunya són els que tendeixen a tenir un sentiment de pertinença cívica amb el lloc de residència. De fet, com més temps porten els joves estrangers vivint al lloc d’acollida, perden importància elements d’identificació cultural del país d’origen, però la religió, les celebracions populars, l’art i la tendència a formar parella són elements identitaris del lloc d’origen, més estables. Es demana una intervenció urgent en diversos nivells i destinades a diferents agents. Destaquem: -La importància d’una acollida afectiva i efectiva, -Potenciar espais de trobada, -Treballar els prejudicis, -Transversalitzar l’educació intercultural, - Potenciació de l’aprenentatge de la llengua catalana, -Formació del professorat en competències interculturals.

Assessing the epidemiology and pattern of care of colorectal cancer in Valais, Switzerland

Background: The Valais's cancer registry (RVsT) of the Observatoire valaisan de le santé (OVS) and the department of oncology of Valais's Hospital conducted a study on the epidemiology and pattern of care of colorectal cancer in Valais. Colorectal cancer is the third cause of death by cancer in Switzerland with about 1600 deaths per year. It is the third most frequent cancer for males and the second most frequent for females in Valais. The number of new colorectal cancer cases (average per year) increased between 1989 and 2009 for males as well as for females in Valais. The number of colorectal cancer death cases (average per year) slightly increased between 1989 and 2009 for males as well as for females in Valais. Age-standardized rates of incidence were stable for males and females in Valais and in Switzerland between 1989 and 2009, while age-standardized rates of mortality decreased for males and females in Valais and Switzerland. Results: 774 cases were recorded (59% males). Median age at diagnosis was 70 years old. Most of cancers were invasive (79%) and the main localization was the colon (71%). The most frequent mode of detection was a consultation for non emergency symptoms (75%), but almost 10% of patients consulted in emergency. 82% of patients were treated within 30 days from diagnosis. 90% of the patients were treated by surgery alone or with combined treatment. The first treatment was surgery, including endoscopic resection in 86% of the cases. The treatment was different according to the localization and the stage of the cancer. Survival rate was 95% at 30 days and 79% at one year. The survival was dependent on the stage and the age at diagnosis. Cox model shows an association between mortality and age (better survival for young people) and between mortality and stage (better survival for the lower stages). Methods: RVsT collects information on all cancer cases since 1989 for people registered in the communes of Valais. RVsT has an authorization to collect non anonymized data. All new incident cancers are coded according to the International Classification of Diseases for Oncology (ICD-O-3) and the stages are coded according to the TNM classification. We studied all cases of in situ and invasive colorectal cancers diagnosed between 2006 and 2009 and registered routinely at the RVsT. We checked for data completeness and if necessary sent questionnaires to avoid missing data. A distance of 15 cm has been chosen to delimitate the colon (sigmoid) and the rectal cancers. We made an active follow-up for vital status to have a valid survival analysis. We analyzed the characteristics of the tumors according to age, sex, localization and stage with stata 9 software. Kaplan-Meier curves were generated and Cox model were fitted to analyze survival. Conclusion: The characteristics of patients and tumors and the one year survival were similar to those observed in Switzerland and some European countries. Patterns of care were close to those recommended in guidelines. Routine data recorded in a cancer registry can be used, not only to provide general statistics, but also to help clinicians assess local practices.

Neutralizing antibodies in Multiple Sclerosis a model-based analysis of Interferon beta signaling pathway in macrophages

Multiple Sclerosis is the most common non-traumatic cause of neurologicaldisability in young people. There is no cure yet, and until recently, few long-termtherapies existed. Interferon beta (IFNβ) was the first treatment, and remains the mostcommonly prescribed. One of the most significant problems of IFNβ therapy is theproduction of drug specific antibodies. Up to 45% of patients develop neutralizingantibodies (NAbs) to IFNβ products. The neutralizing antibody binds to the biologicalagent preventing its interaction with its receptor, inhibiting the biological action of theprotein, which abrogates the clinical efficacy of IFNβ treatment. Interferon-betamediates its response by binding to its high affinity cell surface receptor and initiatingthe JAK/STAT signalling cascade. In this project we have analyzed the IFNβ signalingpathway in macrophages when neutralizing antibodies are present. The response tothis pathway after IFNβ stimulation shows a transient oscillatory rhythm of STAT1phosphorylation, which varies as NAbs concentration increases. To improve ourunderstanding of that behavior, we extended an existing mathematical model based onnonlinear ordinary differential equations of JAK/STAT pathway by including IFN-NAbassociation and IFN-activation receptor. Combining our theoretical model withexperimental data we could study the role of neutralizing antibodies on the molecularresponse and determine its lifetime after cytokine stimulation.

Londres, terra promesa: l'emigració de joves universitaris titulats catalans a Londres

L’alta taxa d’atur juvenil a Catalunya i la precarització persistent del mercat laboral per als joves, han provocat que molts d’ells es plantegin marxar a l’estranger per a provar sort. Segons l’INE, al 2012 van emigrar 10791 catalans i el 35,7% són joves d’entre 16 i 34 anys. El Regne Unit va ser la tercera destinació preferida, amb 958 catalans emigrants reconeguts. La globalització ha difuminat les fronteres i ha obert els horitzons a empreses i treballadors. Les experiències internacionals són cada cop més necessàries si volem formar part d’aquest món, però tenen les seves contrapartides. La present investigació estudia el cas de 10 joves catalans amb titulacions universitàries que han marxat a Londres a la recerca d’aquesta experiència internacional, tot desitjant assentar les bases d’una carrera professional exitosa. El focus d’estudi és conèixer les motivacions de l’emigració que han trobat a la ciutat anglesa i quines són les expectatives de futur

Mentoría para fomentar el éxito socioeducativo de jóvenes peruanos residentes en Barcelona

El programa de mentoría propuesto, toma como punto de partida la actual situación académica y social de jóvenes peruanos residentes en Barcelona y cercanías. Diversos estudios señalan la existencia de un alto índice de abandono escolar en Catalunya, así como un bajo rendimiento escolar que afecta principalmente a estudiantes extranjeros. El objetivo general es fomentar y optimizar la adecuada escolarización de jóvenes peruanos de entre 12 y 20 años. A través de procesos de mentoría y voluntariado se pretenden mejorar sus competencias escolares y sociales favoreciendo la creación de modelos de referencia positivos para los jóvenes en riesgo, así como espacios de aprendizaje, intercambio y acercamiento que fomenten la integración y la cohesión social entre las comunidades extranjera y autóctona. Para la realización del programa se prevé optimizar los recursos ya existentes, como los puntos de información juvenil y los centros de Asesoramiento Académica para jóvenes (CAAJ) y por otro lado se cuenta con la colaboración del Consulado General del Perú en Barcelona y de la escuela Virolai de Barcelona

Project DAPHNE II: summary of results

This paper sets out the main findings of a comparative research project carried out by research groups in five European countries (Belgium, France, Portugal, Italy and Spain), with the support of the European Union as part of the Daphne II programme. The goal of the project was to analyse violent situations in night-time leisure activities, especially those occurring between young people, together with the efficacy of social and institutional responses to these situations.