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ObjectivesOur main objective was to describe transgender people’s reasons for consulting a general practitioner (GP) outside of transition-related issues; the secondary objective was to study the qualitative aspects of the primary care visits for this population.DesignDescriptive, cross-sectional study in France.SettingThe study questionnaire was distributed online and to healthcare centres in France.ParticipantsSelf-identified transgender people aged 18 and older.Primary and secondary outcomesReasons for consulting were collected retrospectively and classified according to the International Classification of Primary Care, second edition (ICPC-2). The answers to the open-ended questions were analysed qualitatively by theme and occurrences.ResultsOut of 320 respondents, 50% visited their GP for a problem unrelated to their transition, with a total of 155 reported reasons. Procedures such as prescription renewal and administrative paperwork represented 33% of the reasons to visit, followed by general symptoms (15%). Benevolence from the physician was the most important criteria for a successful consultation.ConclusionTransgender people visit their GP for reasons either related (50%) or unrelated (50%) to transition. When unrelated, reasons appear to be similar to the reasons found in the general population. Further research and training should be developed on comprehensive primary healthcare for transgender people to provide quality patient-centred care for transgender patients.

We conducted a qualitative study with French men and women in order to provide insight into individuals’ experiences, behaviors, and perceptions about osteoporosis (OP) and OP care. The data showed that both sexes, but especially men, were unfamiliar with OP, did not always feel concerned, and mistrusted pharmacological treatments. To engage actively in osteoporosis (OP) prevention, people need to have basic knowledge about the disease. The aim of this qualitative study was to explore knowledge and representations of OP care and prevention among both men and women. Focus groups were conducted in the Rhone-Alpes Region, France, with women aged 50–85 years and men aged 60–85 years, with or without a history of fragility fracture and/or an OP diagnosis (respectively referred to as “aware” or “unaware”). A total of 45 women (23 “aware” and 22 “unaware” in 5 and 4 focus groups, respectively) and 53 men (19 “aware” and 34 “unaware” in 3 and 4 focus groups, respectively) were included. A thematic analysis of transcripts was performed to explore knowledge and representations about OP, risk factors, prevention, and treatment. The data showed that both sexes, but especially men, had limited knowledge of OP and considered it as a natural aging process not related to fragility fractures. They generally did not feel concerned by OP and no important difference was observed between “aware” and “unaware” patients. Women expressed their fear of the disease, associated with aging and the end of life, while men considered it to be a women’s disease only. Both sexes were aware of OP risk factors, but were suspicious towards treatments because of the associated side effects. Understanding people’s representation of OP might help to provide patients with relevant information in order to optimize their preventive behavior and decrease the burden of the disease.

BackgroundOsteoporosis prevention, diagnosis and treatment remain suboptimal.ObjectivesWe conducted a qualitative study to understand barriers towards care initiation and levers to improve awareness and management of osteoporosis among general practitioners (GPs).MethodsSemi-structured face-to face interviews were conducted with 16 GPs in the Rhône area of France to explore their knowledge and representations regarding osteoporosis. A thematic analysis of transcripts was performed to identify GPs' perceptions on osteoporosis diagnosis, prevention, treatment and patients' expectations.ResultsInterviewed GPs considered osteoporosis far less important than other chronic diseases. They questioned whether osteoporosis was a disease or normal aspect of ageing. They associated osteoporosis with fragility fractures, female sex, menopause, and old age but rarely with male sex. They regarded bone mineral density as the reference diagnostic test, but certain GPs indicated that they had difficulties to interpret the results and to know when to prescribe. Biphosphonates were mentioned as the reference treatment but some GPs expressed distrust about osteoporosis medications. Most of them did not think to screen for osteoporosis risk factors in their patients in a preventive medical approach. They mentioned the lack of time to implement prevention and were expecting clear and pragmatic guidelines, as well as information campaigns in general population to increase awareness on osteoporosis.ConclusionGPs tended to underestimate the salience of osteoporosis. Clear recommendations, better awareness of GPs and the general population could improve osteoporosis prevention and treatment.

Contexte : La loi HPST (2009) introduit le suivi gynecologique de prevention et la prescription de contraception en dehors de la grossesse dans les competences des sages-femmes. Medecins generalistes et sages-femmes ont des competences communes decrites pour chaque profession dans un referentiel metier et competences. Il convient de connaitre et d’articuler ces competences des la formation initiale pour exercer ensuite en cooperation. But : Recueillir les propositions des enseignants et enseignes de maieutique et de medecine generale de l’universite de Lyon a propos d’un futur enseignement commun entre etudiants des deux filieres. Methodes : Une etude qualitative exploratrice dans le champ de la planification pedagogique a ete conduite a l’aide de groupes de discussion focalisee et d’entretiens individuels semi-structures. Les participants etaient respectivement des enseignants et des enseignes des deux filieres de l’universite. Les themes explores etaient les etudiants concernes, le moment pour le realiser, le contenu, la forme pedagogique, l’encadrement, la frequence et l’objectif attendu. Resultats : Cet enseignement interprofessionnel se baserait sur des cas cliniques inspires de familles de situations cliniques issus des referentiels metiers et competences. Il concernerait les etudiants en fin de cursus. Le travail s’effectuerait en petits groupes encadres par un binome medecin generaliste et sage-femme, formes a la pedagogie et ayant une activite clinique. L’enseignement comprendrait : la presentation des deux professions, une analyse de pratiques a partir de cas cliniques rapportes et une synthese. L’interet serait de mieux connaitre le champ de competences des deux professions. Conclusion : Cette etude definit les caracteristiques d’un enseignement interprofessionnel de maieutique et medecine generale, qui puisse repondre aux attentes de chacune des filieres qui se connaissent peu.

Summary Objectives The objective of this study was to evaluate the effect of the correction of vitamin D deficiency (defined by a rate ≤ 50 nmol/l) on the pain, fatigue and quality of life. Methods A pragmatic prospective study was conducted in Rhone-Alpes area, in general practices between February 1 and April 30, 2009. All patients aged 18 to 50 years consulting for diffuse musculoskeletal pain and/or chronic unexplained fatigue, with the only abnormality deficient serum vitamin D were enrolled in this study. They might agree to complete questionnaires on quality of life, pain assessment and control their vitamin D levels after treatment. Results Forty-nine complete records were analyzed. The deficiency was severe (mean 26 nmol/l). High doses of vitamin were necessary to correct deficiency, between 400,000 to 600,000 units. The correction of vitamin D deficiency resulted in a significant decrease in the level of pain intensity according to verbal rating scale ( P = 0.034) and the Digital Scale ( P P = 0.002) and discomfort in carrying out activities of daily living following: the shopping, cleaning, walking for more than a kilometer ( P P = 0.012). Conclusion The correction has had a positive impact both physical, mental and social activities. Non-specific musculoskeletal pain or unexplained asthenia are common in primary care. Make a dosage of vitamin D and correct deficits is a necessity before performing complex and expensive examinations.

Objectif : Le taux de couverture par frottis est estime a 57 %, loin de l’objectif de sante publique de 80 %. Il serait meme inferieur a 50 % chez les plus de 55 ans. Cette etude avait pour objectif de determiner les obstacles au depistage du cancer du col chez les femmes de 50-65 ans en medecine generale, etape indispensable avant l’elaboration de mesures correctrices.Methodes : Des groupes de pairs de medecins generalistes exercant en region Rhone-Alpes ont ete interroges grâce a la methode des focus groups jusqu’a la saturation des donnees. Les medecins ont ete selectionnes de facon a former un echantillon heterogene en termes de caracteristiques demographiques et de pratique gynecologique.Resultats : Quatre focus groups ont permis d’interroger cinq femmes et dix-sept hommes âges de 36 a 63 ans. De nombreux obstacles au depistage ont ete souleves : ils etaient lies a la patiente (meconnaissance du depistage, peur, freins economiques ou sociaux), au medecin lui-meme (doute sur le benefice, meconnaissance de l’âge d’arret, difficultes techniques, faible motivation pour les frottis, oubli) ou a la relation medecin-patiente (pudeur, manque de disponibilite, alliance therapeutique fragile). L’organisation du systeme de sante, et notamment le mode de remuneration, pouvaient egalement intervenir.Conclusion : Au-dela des freins au depistage, cette etude qualitative permet de degager des pistes interessantes pour ameliorer le taux de couverture par frottis : organisation du depistage, meilleure information des patientes et des medecins, revalorisation des actions de prevention et implication d’autres professionnels de sante.Prat Organ Soins. 2012;43(4):261-268

Resume Contexte Un tiers des cancers du col uterin est decouvert apres 65 ans. Or, les recommandations francaises, concernant le depistage du cancer du col, sont d’exclure du depistage les femmes apres 65 ans ayant eu au moins deux frottis normaux consecutifs. Objectif Etudier la frequence des lesions cytologiques chez les femmes âgees de plus de 65 ans dont le rythme de suivi cytologique anterieur avait ete normal et suffisant, afin de determiner s’il existe un interet de poursuivre les frottis de depistage apres 65 ans. Patientes et methodes Etude retrospective multicentrique a partir des donnees de trois laboratoires de cytopathologie de la region Rhone-Alpes. Etude d’une population de 53 644 femmes de plus de 65 ans chez qui un frottis a ete realise entre 2004 et 2008. Resultats Des lesions precancereuses et cancereuses du col sont decouvertes apres 65 ans malgre un suivi anterieur suffisant. Le taux de frottis pathologique pour ce groupe de femmes est de 14,2 ‰ et il est de 1,4 ‰ pour les frottis evocateurs de cancer. Conclusion Il existe un interet a poursuivre les frottis de depistage apres 65 ans. Cette approche semble raisonnable tant du point de vue medical qu’economique.

Several studies have shown that vitamin D supplementation could be useful for treating diffuse musculoskeletal (DMS) pain in adults.The aim of this study was to evaluate the effects of correcting a vitamin D deficiency (≤ 50 nmol/l) on DMS pain and quality of life in adults.A pragmatic prospective study was conducted in a general practice setting in the Rhone-Alps area between 1 February and 30 April 2009. Patients between the ages of 18 and 50 years old who consulted their general practitioner (GP) for DMS pain or chronic unexplained asthenia and had a deficient serum 25 (OH) D level with no signs of any other disease were enrolled in this study. The patients received high doses of vitamin D supplements (400 000 to 600 000 units). Mean pain evaluation scores were evaluated before and after vitamin D supplementation using mixed models and accounting for repeated measures.Before vitamin D supplementation, the adult study cohort (n = 49) had an adjusted mean serum 25 (OH) D level of 23.7 nmol/l, a mean pain evaluation score of 5.07 and a mean quality of life score of 3.55. After vitamin D supplementation, the adjusted mean serum 25 (OH) D level increased to 118.8 nmol/l (P0.001), the mean quality of life score increased to 2.8 nmol/l (P0.001) and the mean pain evaluation score decreased to 2.8 (P0.001).In this small before-and-after study, vitamin D supplementation decreased pain scores in adult patients with diffuse musculoskeletal pain and vitamin D deficiency. These results must be confirmed by further studies.

The objective of this study was to evaluate the effect of the correction of vitamin D deficiency (defined by a rate≤50 nmol/l) on the pain, fatigue and quality of life.A pragmatic prospective study was conducted in Rhone-Alpes area, in general practices between February 1 and April 30, 2009. All patients aged 18 to 50 years consulting for diffuse musculoskeletal pain and/or chronic unexplained fatigue, with the only abnormality deficient serum vitamin D were enrolled in this study. They might agree to complete questionnaires on quality of life, pain assessment and control their vitamin D levels after treatment.Forty-nine complete records were analyzed. The deficiency was severe (mean 26 nmol/l). High doses of vitamin were necessary to correct deficiency, between 400,000 to 600,000 units. The correction of vitamin D deficiency resulted in a significant decrease in the level of pain intensity according to verbal rating scale (P=0.034) and the Digital Scale (P0.001), consumption of analgesics (P=0.002) and discomfort in carrying out activities of daily living following: the shopping, cleaning, walking for more than a kilometer (P0.001) and dressing (P=0.012).The correction has had a positive impact both physical, mental and social activities. Non-specific musculoskeletal pain or unexplained asthenia are common in primary care. Make a dosage of vitamin D and correct deficits is a necessity before performing complex and expensive examinations.

One third of cervical cancers are discovered after age 65. French guidelines allow women to cease having cervical pap smears at age 65, providing they have had a minimum of two consecutive negative smears.To study the frequency of pathological smears in the group of women aged over 65 with a normal and sufficient cytological follow-up, according to the guidelines. To analyze the smear results and the former follow-up of this population to determine whether there is an interest to continue the smear screening after age 65.This is a retrospective multicenter study based on collecting data from three pathology laboratories of the region Rhone-Alpes. We study a population of women 65 and older with smears that have been made between 2004 and 2008.Precancerous lesions and cervical cancer can be discovered after age 65 despite an adequate former follow-up. The rate of these women for having a pathological smear is 14,2‰, including 1,2‰ with cytological abnormalities in favour of cancer.These results show that there is interest to continue the smear tests after age 65 at least, while considering medical and financial issues of a reasonable screening strategy.

Objective To identify markers (phenotypic, genetic, or environmental) of blood pressure (BP) response profiles to angiotensin converting enzyme inhibitors (ACEIs) and diuretics. Methods IDEAL was a crossover (two active and two wash out phases), double-blind, placebo-controlled trial. Eligible patients were untreated hypertensive, aged 25 to 70. After two visits, patients were randomized to one of four sequences. The main outcome was BP differences between the active treatment and placebo. Results One hundred and twenty-four patients were randomised: mean age 53, men 65%, family history of hypertension 60%. Average BP fall at each visit before randomisation was about 2% of the initial level reflecting both a regression to the mean and a placebo effect. Conclusion The results are expected to improve knowledge in drug’s mechanisms of action and pathophysiology of hypertension, and to help in personalizing treatment. The estimation of BP responses to each drug in standardized conditions provided a benefit to each participant.

The recommendations of the French consensus (Lille 1990) advise the stop of the tracking by cervical smears of cancer at 65-years-old, if the former follow-up were regular and if the last two smears were normal. 33% cervical cancers are after 65-years-old.How many pathological smears are after 65 years?Descriptive, retrospective study analyzing the results of 12339 smears of women of more than 65 years, carried out during one year in the same laboratory of anatomo-pathology. They were analysed with Bethesda's system.2.67% of smears are of insufficient quality (CI 95%: 2, 46%; 3%); 2.43% of smears are pathological (CI 95%: 2, 2%; 2, 7%). That pathological smear's rate is comparable to the one found among women of less than 65-years-old (2 to 3%). The squamous cell carcinoma's rate is more important in this group.This work encourages us to continue smear's practice among women of more than 65 years.

To determine the prevalence of problems with treatment adherence among type-2 diabetic patients with regards to medication, dietary advice, and physical activity; to identify the associated clinical and psychosocial factors; and to investigate the degree of agreement between patient-perceived and GP-perceived adherence.Consecutive patients were solicited during visits to 39 GPs. In total, 521 patients self-reported on treatment adherence, anxiety and depression, and disease perception. The GPs reported clinical and laboratory data and patients' adherence. A multivariate analysis identified the factors associated with adherence problems.Problems of adherence to medication, dietary advice, and physical activity recommendations were reported by 17%, 62%, and 47% of the patients, respectively. Six independent factors were found associated with adherence problems: young age, body-mass index (BMI)30 kg/m(2), glycosylated haemoglobin (HbA(1c))8%, single life, depression, and perception of medication as a constraint. Agreement between patients' and GPs' assessments of treatment problems reached 70%.In type 2 diabetes, problems with dietary advice or physical activity are far more frequent than problems with medication, and not all physicians are fully aware of patients' problems. More active listening and shared decision-making should enhance adherence and improve outcomes.