Du pédiatre au généraliste : apporter une continuité aux soins de premier recours de l'enfance à l'âge adulte

The transition from a pediatrician to a general practitioner builds on a strong relationship with the pediatrician. Informed consent and decision making in children and adolescents are greatly improved by a trustful relationship with healthcare providers. In Switzerland, minors can access their medical file without parental consent if considered competent. Electronic files can be helpful but may lead to breeches in confidentiality : transmission of data concerning the family or parent's health status not relevant for the adolescent's medical follow-up, parental access to the medical files. A simple transmission file can be given to the adolescent at the end of pediatric follow up. Visits to mark the end of the pediatric follow-up and the beginning of the GP follow-up should be systematically offered to young people with special needs

Angiotensin II promotes selective uptake of high density lipoprotein cholesterol esters in bovine adrenal glomerulosa and human adrenocortical carcinoma cells through induction of scavenger receptor class B type I.

Angiotensin II is one of the main physiological regulators of aldosterone biosynthesis in the zona glomerulosa of the adrenal cortex. The hormone stimulates intracellular cholesterol mobilization to the mitochondrion for steroid biosynthesis. Here we have examined whether angiotensin II also modulates exogenous lipoprotein cholesterol ester supply to the steroidogenic machinery and whether this control is exerted on the selective transport of high density lipoprotein-derived cholesterol ester to intracellular lipid droplets through the scavenger receptor class B type I. In bovine adrenal glomerulosa and human NCI H295R adrenocortical carcinoma cells, high density lipoprotein stimulated steroid production. Angiotensin II pretreatment for 24 h potentiated this response. Fluorescence microscopy of cellular uptake of reconstituted high density lipoprotein containing a fluorescent cholesterol ester revealed an initial, time-dependent narrow labeling of the cell membrane followed by an intense accumulation of the fluorescent cholesterol ester within lipid droplets. At all time points, labeling was more pronounced in cells that had been treated for 24 h with angiotensin II. Fluorescence incorporation into cells was prevented by a monoclonal antibody directed against apolipoprotein A-I. Upon quantitative fluorometric determination, cholesterol ester uptake in angiotensin II-treated bovine cells was increased to 175 +/- 15% of controls after 2 h and to 260 +/- 10% after 4 h of exposure to fluorescent high density lipoprotein. The amount of scavenger receptor class B type I protein detected in cells treated with angiotensin II for 24 h reached 203 +/- 12% of that measured in control cells (n = 3, P < 0.01). In contrast, low density lipoprotein receptors were only minimally affected by angiotensin II treatment. This increase in scavenger receptor class B type I protein was associated with a 3-fold induction of scavenger receptor class B type I mRNA, which could be prevented by actinomycin D but not by cycloheximide. Similar results were obtained in the human adenocarcinoma cell line H295R. These observations show that angiotensin II regulates the scavenger receptor class B type I-mediated selective transport of lipoprotein cholesterol ester across the cell membrane as a major source of precursor for mineralocorticoid biosynthesis in both human and bovine adrenal cells

Insulin-secreting beta-cell dysfunction induced by human lipoproteins

Diabetes is associated with significant changes in plasma concentrations of lipoproteins. We tested the hypothesis that lipoproteins modulate the function and survival of insulin-secreting cells. We first detected the presence of several receptors that participate in the binding and processing of plasma lipoproteins and confirmed the internalization of fluorescent low density lipoprotein (LDL) and high density lipoprotein (HDL) particles in insulin-secreting beta-cells. Purified human very low density lipoprotein (VLDL) and LDL particles reduced insulin mRNA levels and beta-cell proliferation and induced a dose-dependent increase in the rate of apoptosis. In mice lacking the LDL receptor, islets showed a dramatic decrease in LDL uptake and were partially resistant to apoptosis caused by LDL. VLDL-induced apoptosis of beta-cells involved caspase-3 cleavage and reduction in the levels of the c-Jun N-terminal kinase-interacting protein-1. In contrast, the proapoptotic signaling of lipoproteins was antagonized by HDL particles or by a small peptide inhibitor of c-Jun N-terminal kinase. The protective effects of HDL were mediated, in part, by inhibition of caspase-3 cleavage and activation of Akt/protein kinase B. In conclusion, human lipoproteins are critical regulators of beta-cell survival and may therefore contribute to the beta-cell dysfunction observed during the development of type 2 diabetes

Cercles de qualité pédagogique (CQP) : une recherche-action visant à optimiser la formation des cliniciens enseignants en cabinet

Contexte et problématique : Les stages en cabinet privé de médecine de famille offrent l’opportunité aux étudiants de développer les compétences nécessaires à la prise en charge ambulatoire. Les cliniciens enseignants qui accueillent les étudiants au sein de leur cabinet (CEC) doivent développer des outils pédagogiques spécifiques pour faire face aux difficultés rencontrées lors des supervisions. Ils peuvent ainsi participer à la formation de la relève médicale dans le domaine de la médecine de famille tout en développant une posture pédagogique qui les aidera dans la gestion de leur double rôle de clinicien et enseignant. Les programmes de formation pédagogique des cliniciens doivent s’adapter aux réalités de leur pratique. En effet, l’activité clinique en cabinet implique des contraintes de temps et de structure entraînant des conséquences sur la forme et le contenu de l’enseignement qui y est délivré. Objectif : Rapporter le processus et les résultats d’une démarche de recherche-action visant à élaborer un programme de formation visant à mieux répondre aux besoins pédagogiques des cliniciens-enseignants en cabinet accueillant dans leur cabinet des étudiants en troisième année de master pendant leur mois de stage. Méthodes : Deux équipes (recherche en éducation médicale et formation pédagogique) de l’Institut de médecine de famille et de l’enfance de la Faculté de médecine, à Genève, Suisse, ont développé un modèle de formation destiné aux cliniciens enseignants accueillant dans leur cabinet les étudiants de dernière année d’études de médecine, en tenant compte des spécificités de ce contexte d’enseignement et en mettant en commun leurs savoirs et expériences selon une méthodologie inspirée des principes de la recherche action collaborative. Résultats : La mise à l’essai de ce nouveau modèle de formation s’est heurtée à la réalité pandémique, obligeant les différents acteurs – cliniciens, formateurs et chercheurs – à s’adapter aux nouvelles contraintes et limites. Depuis 2023, ce modèle de formation est toujours d’actualité ; il s’enrichit au fur et à mesure de sa pratique, il est apprécié des participants et constitue désormais la pierre angulaire du programme de formation continue pédagogique des cliniciens enseignants en cabinet. Conclusion : Les cercles de qualité pédagogique apportent aux CEC des outils pédagogiques centrés sur leurs besoins directement applicables sur leur terrain d’enseignement et ce, malgré les distances sociales.Background and issues: Internships in private family medicine practices offer students the opportunity to develop the skills necessary for the outpatient care. Clinical teachers who welcome students in their ambulatory clinical practice setting, must develop specific educational tools to deal with the difficulties encountered during supervision. They can thus participate in the training of medical succession in the field of family medicine while developing an educational posture that will help them in the management of their dual role of clinician and teacher. Educational training programs for clinicians must adapt to the realities of their practice. Indeed, clinical activity in the office involves time and structure constraints that have consequences on the form and content of the teaching delivered. Objective: To report on two teams (research in medical education and pedagogical training) from the Institut universitaire de médecine de famille et de l’enfance (IuMFE) at the Faculty of Medicine in Geneva, Switzerland, that have developed a training model for teaching clinicians welcoming final year students in their outpatient practice setting, considering the specificities of this teaching context, and pooling their knowledge and experiences according to a methodology inspired by the principles of collaborative action research. Methods: The implementation of this new training model has come up against the pandemic reality, forcing the various actors - clinicians, trainers, and researchers - to adapt to the new constraints and limits. Results: Since 2023, this training model is still relevant; it is enriched as it is being practiced, it is appreciated by the participants and it is now the cornerstone of the training programme for clinical teachers in private practice. Conclusion: Pedagogical quality circles provide teaching clinicians with pedagogical tools that focus on their needs and are directly applicable in their teaching field, despite social distances.</p