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Among adolescents with chronic illness or disability, some are survivors of a severe disease in childhood, some have a long-standing yet less severe condition and some have been ill since adolescence only. Owing to the considerable progress of pediatrics, the number of these adolescents and young adults has been regularly increasing. For all, the major question is that of their future and for many, that of the transition from pediatric to adult medical care. This work of follow-up and guidance requires, beyond a strong medical knowledge of each condition, a good understanding of the specific global needs at that age as well as of the multiple and reciprocal impacts between chronic illness and the progression of adolescence. In order to increase pediatricians’ awareness and skills in that field, the authors propose a clinical guide composed of ten relevant questions to be addressed when dealing with any chronically ill or disabled adolescent. [Copyright &y& Elsevier]

A` partir des donne´es d’une enqueˆte effectue´e aupre`s de 6 hoˆpitaux de l’Assistance Publique – Hoˆpitaux de Paris (AP–HP) en 1999, est re´sume´ l’usage des services d’urgences tel qu’en font les « usagers adolescents ». La distinction entre me´decine d’urgence et me´decine de crise semble particulie`rement approprie´e a` cet aˆge, ou` les urgences somatiques, de loin les plus fre´quentes, les urgences psychiatriques et les urgences mixtes re´clament des re´ponses diffe´rentes. Le phe´nome`ne des multiconsultations est pre´occupant. Les auteurs proposent quelques pistes de re´flexion pour une meilleure organisation de l’accueil des adolescents en situation d’urgence. [Copyright &y& Elsevier]

Background and Context: Problematic use of physical activity is frequent in subjects with anorexia nervosa (AN). Although it increases resistance to therapeutic treatment, paradoxically, physical activity in AN can also improve mental and physical health. Based on the literature review we hypothesized that adding an adapted physical activity (APA) program to treatment programs could be more beneficial than a total suppression of physical activities. We designed this open study to evaluate the outcome of AN inpatients after an APA program implementation as well as the perceived effect of APA., Method: Forty-one women with AN (17.2 (±2.5) years old, BMI of 16.86 (±2.0)) were included. An eight-session (1 h30/session/week) standardized APA program was delivered and evaluated by structured questionnaires assessing exercise dependence, perceived physical activity, eating disorder (ED) symptoms, body mass index (BMI), along with an interview before and after the APA program., Results: Twenty-nine women complete the PA program and evaluation. BMI and perceived PA score significantly increased, ED and exercise dependence scores significantly decreased (p < .01). Participants appreciated the program., Discussion/conclusion: The inpatient program which included APA program helped AN inpatients in decreasing their ED symptoms and their dependence to PA, without any deleterious effect on BMI. Furthermore, APA was appreciated by participants., (© 2020 Eating Disorders Association and John Wiley & Sons Ltd.)

Purpose: The perception of adolescent medicine (AM) among future pediatricians in France has scarcely been explored although adolescent health care is an integral part of the pediatrician's job. Moreover, pediatric residents seem to have a lack of enthusiasm for this field. The aim of this study was to assess the beliefs and perceptions of fourth-year French pediatric residents regarding adolescents and AM., Methodology: We conducted a national electronic survey among French pediatric residents in their last year of residency. An original 51-item, open-ended declarative questionnaire was sent out including questions on demographics, career expectations, AM block rotation experiences, and perceptions and beliefs regarding adolescents and AM. Difficulties and barriers experienced in this field were investigated. Queries about residents' specific AM courses and about their educational needs were also explored., Results: The survey was conducted online between January and March 2015. There were 121 respondents, achieving a 43% response rate. The majority of respondents perceived teens as interesting (75%), vulnerable (83%), and time-consuming (84%). Up to four fifths of respondents (81%) considered AM to be a skill that all pediatricians should acquire. A subgroup analysis showed that the residents who had not experienced an AM block rotation did not seem to be convinced of the need for training in this field (P=0.09). The following issues were reported as major difficulties by residents: providing care for teens reluctant to seek health care (65%), managing violent behavior among adolescents in the emergency ward (98%), and managing adolescents who attempt suicide (80%). Less than half (45%) of the residents reported their residency program had a specific AM course. Among them, 73% attended the lectures and 57% found them useful. One third (32%) of the respondents had experienced a 2-month block rotation in the field of AM during their residency., Discussion: This is the first nationwide study in France in this field. Although the response rate is below 50%, it exceeded our expectations. Our results are in line with previous studies showing that pediatric residents report a high interest in working with adolescents and yet their educational needs in AM are unmet. The limitations of this study include the self-selection bias and implicit limitations carried by the phrasing of the survey questions., Conclusions: There is a need to devise a better educational approach combining a broader proposal of AM block rotations together with a specific competency framework in adolescent health, since we know it improves the quality of health care delivered to adolescents. Moreover, training pediatricians in AM is a public health priority so as to comply with medical schools' principles of social accountability and address the priority health needs for an efficient, equitable, and sustainable health system. At a time when postgraduate reform is being made, the inclusion of an AM curriculum in the general pediatrician course is necessary., (Copyright © 2016. Published by Elsevier SAS.)

Binge eating, bulimia nervosa, binge eating disorder, anorexia-bulimia are terms often used without really knowing what precisely one is referring to. Otherwise, there are many articles concerning anorexia nervosa in medical literature, a disease, which can be seen and fascinates. These eating disorders are frequent in today's society; medical, psychological and social consequences are important., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Centropontine myelinolysis (CPM) is a rare neurologic disorder defined by symmetric demyelination in the central pons, mostly due to alcoholism, malnutrition, or water-electrolyte abnormalities. We report an unusual case of CPM likely due to hypophosphatemia, related to a refeeding syndrome in the context of mental anorexia. A 15-year-old girl with mental anorexia presented with hypophosphatemia in the following days of enteral refeeding, and then suffered from confusion, neurological signs, and typical MRI lesions of CPM. Hypophosphoremia may be considered as a causative agent in CPM related to refeeding syndrome. This clinical observation also highlights the importance of recognizing patients at high risk of refeeding syndrome to initiate a balanced nutrition with careful monitoring., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

This paper engages into a global assessment of statistics and their potential uses, ranging from 19th century accounts of "suicidal acts" by the central services of criminal justice in France, to European comparative data on suicide in the years 2000. The most recent facts and figures about teenagers' suicides in France are taken into account, thanks to the Inserm records on deaths by suicide and to public polls on suicidal attempts., (Copyright (c) 2010 Elsevier Masson SAS. All rights reserved.)

It is crucial not to miss the first consultation with an adolescent. This article reviews some of the essential step necessary to help make the first consultation a success: the time to devote to the patient, the preparation of the consultation, mandatory issues to address, clinical/physical examination, conclusion of the consultation, the prescriptions and the follow-up.

The nutritional care of a severely emaciated anorexic adolescent can be performed in any pediatric ward. This article is a practical guide which reminds the indications, mostly clinical, for hospitalization and the way to achieve a progressive but efficient renutrition. We wish to share our own practical experience while focusing on acute nutritional care, according to the aim of this section of the journal.

Munchausen syndrome by proxy is a form of child abuse presenting as a disease produced or simulated by a parent, the mother in most cases. Its diagnosis is uneasy because of its miscellaneous and unusual clinical presentation and of the misleading apparently normal attitude of the parents. Physicians may participate in the abuse by insistently looking for diagnostic and therapeutic measures, therefore contributing to the significant mortality of the syndrome. It is therefore important that physicians consider Munchausen syndrome in any ambiguous situation in order to protect the child by an early diagnosis.

Background: Septic sacroiliitis is often difficult to diagnose because the clinical findings can be misleading and the radiological signs delayed., Case Report: A 16-year-old adolescent was hospitalized with a history of fever and painful hip. The initial hypothesis of hip osteoarthritis was not confirmed by ultrasonography or CT-scan. The bone scan was also normal. The definitive diagnosis of sacroiliitis was made 1 week later based on the clinical evolution and a positive blood culture. It was confirmed by a second bone scan and MR imaging., Conclusion: Examination of the sacroiliac joint needs several different tests. Although the initial bone scan may be normal, an osteoarticular infection cannot be definitively ruled out and iterative radiological investigation is warranted. MR imaging may be an additional diagnostic tool for detecting sacroiliitis.

Human immunodeficiency virus-infected patients are exposed to more or less specific iatrogenic diseases. The main characteristics of the risks encountered in this field are described: drug intolerance, mostly to sulfamethoxazole-trimethoprim, is extremely frequent; nucleoside analogue antiviral toxicity is reminiscent of that of chemotherapy; nosocomial infections, in general, are more prominent than in HIV-non infected patients. Intravenous line infections are particularly frequent, but these devices are necessary for prolonged intravenous therapies such as anti-CMV treatment of parenteral nutrition. An improved understanding of different etiopathogenic mechanisms and a better approach of the toxicity/efficacy ratio for each treatment would allow to reduce the excessive morbidity due to iatrogenicity.