Définie comme la non-concordance entre la prescription médicale et sa mise en application, l’observance est un enjeu majeur de santé pour le pédiatre et l’équipe soignante prenant en charge l’enfant ...et l’adolescent porteurs d’une maladie chronique. Au temps de l’enfance, l’alliance avec les parents repose sur un accompagnement attentif et vigilant. L’adolescence est une période sensible, souvent problématique où le pédiatre et l’équipe soignante doivent mobiliser leur capacité d’écoute, d’empathie, pour appréhender toutes les dimensions de la non-observance : révolte, appropriation de la maladie, dépression… non seulement en direction de l’adolescent, mais vers les parents. L’éducation thérapeutique de l’enfant et de l’adolescent est ainsi essentielle pour mener l’adolescent à l’autonomie et préparer la transition vers la médecine adulte.
The extend to which a patient's behaviour, in terms of taking medication, coincide with medical prescription define the adherence. Adherence is a major challenge for the paediatrician and medical staff taking care of chronic conditions patients. During childhood greater attention should be given to alliance with parents. During adolescence, various reasons for poor adherence should be analysed to be understood: rebellion, consciousness of disease, depression… Parents must be included in the analysis because they are very concerned by the illness experience of their child from the announcement until the autonomy. Patient education program should be based on an appraisal of each adolescent's need and must lead to autonomy and prepare to adult transition.
Over a 3-month period, ten children (aged 1-13 years) from a 15-km radius in southern Picardy developed typical D+ hemolytic uremic syndrome (HUS). Polymerase chain reaction, using two pairs of ...verocytotoxin 1-(VT1) and VT2-specific oligonucleotide primers and an internal control was used to detect VT genes directly from stools samples. VT2 gene was detected in seven of nine patients' stools and in 5 of 14 contacts' stool samples. A VT2-producing Escherichia coli (VTEC) O111 was isolated from five of nine children's stools and in 3 adults' stools of the 14 tested. A retrospective case-control study was performed which showed a higher rate of absence in school A, where the first four cases were detected, compared with a control school. The odds ratio for the whole school was 2.77 (confidence interval 1.46-5.26), and 15 (confidence interval 2.54-115.6) if only the nursery classes were considered. A culture of all food samples from households was always negative for VTEC. A retrospective cohort study performed in 89% of children attending school A showed no linkage between food or drink and gastroenteritis. These findings emphasize the potential for person-to-person transmission of VT2-producing E. coli O111, since the only salient risk factor was close contact.
Peu d’études explorent comment les futurs pédiatres se représentent la médecine de l’adolescent (MA) alors qu’ils y seront confrontés. Ce travail avait pour objectif principal de recueillir les ...représentations de la MA auprès de futurs pédiatres et pour objectif secondaire de préciser leurs besoins en termes de formation. Un questionnaire déclaratif électronique a été diffusé via l’Association des juniors de pédiatrie (AJP) aux internes de pédiatrie ayant validé 6 semestres. Ce questionnaire, composé de 51 questions, explorait leur caractéristiques démographiques et leur formation pratique en MA ; leur représentations de la MA ; et les besoins ressentis en termes de formation. Cent vingt et un internes ont répondu à l’enquête (taux de réponse 43 %). Les adolescents étaient perçus comme intéressants (75 %) et chronophages (84 %). Quatre cinquième des répondants considéraient qu’une formation spécifique à la MA était nécessaire. Les internes jugeant cette formation inutile étaient ceux qui n’avaient pas pratiqué de stage hospitalier en MA. Un enseignement dédié à la MA avait été proposé à moins de la moitié des internes (45 %). Un tiers des répondants avait effectué un stage d’au moins 2 mois dans une unité de MA. Former les futurs pédiatres à la MA est une priorité en matière de santé publique. Le référentiel de compétences dans ce champ de la pédiatrie doit être articulé avec l’identification de terrains de stages hospitaliers et extra-hospitaliers. À l’heure de la réforme du troisième cycle une mobilisation de la pédiatrie s’impose.
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.
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.
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.
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.
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.
La pseudo-obstruction intestinale chronique (POIC) est une maladie rare et sévère qui débute dans l’enfance et peut toucher toutes les structures du tube digestif. Son diagnostic est d’élimination ...mais certains patients présentent des anomalies histologiques. Cet article rapporte le cas d’une jeune fille atteinte d’une POIC et d’un trouble des conduites alimentaires (TCA) apparu au décours d’une intervention chirurgicale. Il semble difficile de dissocier les troubles digestifs et alimentaires. Quels effets psychologiques peut avoir cette maladie ? Les troubles alimentaires sont-ils secondaires ?
Chronic idiopathic intestinal pseudo-obstruction is a rare and serious chronic disease starting in childhood, which can affect the entire digestive tract. It is caused by a peristalsis intestinal disorder that leads to occlusions without any obvious obstruction. Few studies have been carried out regarding the prognosis of this illness. This disease is often diagnosed by a process of elimination, but some histological anomalies have been present in the digestive wall of certain patients. This clinical case concerns a 17-year-old girl affected by CIPO and eating disorders. It seems difficult to discriminate between digestive disorders and eating disorders. What psychological effects can this severe pathology have? Are eating disorders induced by CIPO? These questions are raised in this article through the example of this patient's somatopsychic complexity and the ensuing difficulties in her overall care.
La dysplasie micronodulaire pigmentée des surrénales (PPNAD) doit être connue des pédiatres: une observation au diagnostic trop tardif.
Chez l’enfant, le syndrome de Cushing, responsable d’une prise ...de poids sans accélération staturale, est une pathologie rare dans sa forme ACTH-indépendante.
Nous rapportons le cas d’une fillette de 11 ans porteuse d’un syndrome de Cushing secondaire d’une dysplasie micronodulaire pigmentée des surrénales.
Un syndrome de Cushing ACTH-indépendant est biologiquement confirmé. Le frein fort met en évidence une élévation paradoxale du CLU. Les imageries surrénaliennes sont subnormales. Le génotypage retrouve une mutation dans le gène de la sous unité régulatrice 1A de la protéine kinase A prédisposant à une atteinte surrénalienne isolée.
Une surrénalectomie bilatérale est réalisée, l’étude anatomopathologique confirme le diagnostic.
La PPNAD est une maladie rare responsable de syndrome de Cushing ACTH indépendant. Elle peut être isolée ou s’intégrer dans un complexe de Carney. La particularité biologique de la PPNAD est la réponse paradoxale au test de freinage fort à la déxaméthasone avec augmentation du CLU. Le traitement consiste en une surrénalectomie bilatérale puis en une surveillance attentive.
