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Copyright of Environnement, Risques & Santé is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Context: In 2021, 122 women were killed due to domestic violence. When any kind of domestic violence occurs, the general practitioners are meant to be women's first confidants. This study's objective was to collect the testimonials of women in the Ile-de-France region who had been victims of intimate partner violence, to assess the place of general practitioners in their lives. Methods: A qualitative study using semi-directed interviews was conducted with women in the Ile-de-France region who had been victims of intimate partner violence. Results: 13 interviews were conducted from November 2021 to May 2022. A timeline was created for each woman. It presents interactions with identified resource people. The women themselves were the first to relate the intimate partner violence incidents. In order to talk about what they endured the general practitioner should not be the violent partner's doctor. The women had to be alone, and the general practitioner had to listen to them and be available. The general practitioner was described as confidant, prescribing, coordinating, informative, directive, passive, faulty or absent depending on the care offered. The participating women suggested improvements based on their life experiences. Conclusion: They advised us with some recommendations about how to help them and future victims: our interview should leave some realm to open questions and complete closed questions, while being able to listen and understand their stories without any kind of judgment. [ABSTRACT FROM AUTHOR]

Physiotherapists working in collaboration with family physicians in French multidisciplinary primary healthcare clinics are now able to manage patients with acute low back pain or ankle sprain as first-contact practitioners in advanced practice roles. This includes medical act delegation such as making a medical diagnosis and prescribing medication. The aim of this study is to explore physiotherapists and family physicians' experience and perceptions regarding this new model of care. [ABSTRACT FROM AUTHOR]

Copyright of Gériatrie et Psychologie Neuropsychiatrie du Vieillissement is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Interprofessional collaboration is one of the keys to optimal patient care. Neuropsychologists and general practitioners are still not used to working together. The recent introduction of coordination and referral platforms has facilitated links between these two professions in the care of children with neurodevelopmental disorders. This article describes a profession that is often overlooked by general practitioners. [ABSTRACT FROM AUTHOR]

Among the expected skills of a General Practitioner, the ability to formulate a situational diagnosis is crucial. He must assess the bio-psycho-social and cultural context for an overall patient care, known as Holistic Approach, Patient-Centered Approach or Global Medicine. In this context, alongside the patient's medical history and conditions, their life events (LE) are incontestably precious. Following an experiment conducted in a general practice, consisting of systematically asking the following question to the patient: "Can you tell me three significant events from your biography?", a study was carried out by three general practitioners from an urban provincial practice, to assess the interest, the feasibility and the acceptability of this approach. Method: The study was organized around a retrospective collection of 254 files containing the three biographical events entrusted by each patient and a prospective collection involving 100 new patients of the medical practice. Results: Among the 254 files examined, 699 LE lines were identified including 67% from the negative register. The most common LE were related to marital and family life (2/3), followed by bereavement (101 LE). Psychological, physical, and sexual violence were found in 24.8 % of the cases (63/254). Sexual violence was observed in 8.3% of all patients. In the prospective study, doctors did not ask the question 1 time out of 10, due to a lack of time or because they did not dare or because of hesitancy, but they never felt uncomfortable with the inquiry. Only one patient refused to take part in the exercise, and 5 were unable to, including 4 men. In 85 % of cases, patients were able to share three significant LE. Conclusion: This study suggests that it is possible to collect Life Events (LE) through systematic open-ended questioning. This does not seem to pose a problem for patients, who readily disclose significant, sometimes very painful, events of their lives. The EVs are genuine antecedents, having knowledge of them would prove useful for the patient-centered approach. A larger-scale, multicenter study should be conducted by disseminating the method to volunteer practitioners. [ABSTRACT FROM AUTHOR]

The occurrence of an accident or a disease can disrupt the social and occupational integration of the patient. The general practitioner must be able to identify this situation at risk of work disability. The clinical situations concerned are those of patients who can no longer, a priori, continue working under the same conditions. The analysis of the professional literature has made it possible to identify the chronological course of care, from the acute phase to the resumption of work or cessation of activity, respecting the rights. It identifies the contacts and the tools to be used in each step. The main challenges are related to legislative and regulatory developments. [ABSTRACT FROM AUTHOR]

The occurrence of an accident or a disease can disrupt the social and occupational integration of the patient. The general practitioner must be able to identify this situation at risk of work disability. The clinical situations concerned are those of patients who can no longer, a priori, continue working under the same conditions. The analysis of the professional literature has made it possible to identify the chronological course of care, from the acute phase to the resumption of work or cessation of activity, respecting the rights. It identifies the contacts and the tools to be used in each step. The main challenges are related to legislative and regulatory developments. [ABSTRACT FROM AUTHOR]

Copyright of Gériatrie et Psychologie Neuropsychiatrie du Vieillissement is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The use of the Asthma Control Test (ACT) is one of the best practice recommendations to help caregivers assess asthma control. According to the literature, its interest seems demonstrated from a biomedical point of view. This study, resulting from a thesis work and conducted with general practitioners (GPs) using an open interview guide, aims to present the latter's point of view concerning the relevance and challenges in using this tool in their practice. The results show that GPs have a positive view of the tool, in its form and content, and that the educational issues depending on the way in which the caregiver interacts with the patient can be multiple. [ABSTRACT FROM AUTHOR]

Taking the caregivers' health into account is a key point of the periodic certification. Besides the benefit for themselves, general practitioners' well-being is crucial to the healthcare system quality and sustainability. This study focuses on specific components of this population's quality of life, namely their practice condition and health management. Methods: Transversal, quantitative study, through a self-administered survey of 39 questions, mailed to the French general practitioners registered in the Collège de la Médecine Générale database, during 2022's first trimester. Descriptive and subgroups analysis were conducted. Results: 508 questionnaires were analysed, which is a participation rate of 13,9%. The respondents were mainly women (60%) and young physicians (46% are less than 40 years old), working in group (81%), with exclusive private practice (77%). Two-thirds of them were involved in the training of medical students. The average amount of caregiving time was 39,2h per week, and was lower for young and salaried physicians. 36% of the respondents declared another treating doctor. It was more frequent for women (p = 0.046), young doctors (p < 0.001), and those with a shorter caregiving time (p = 0.028). They hardly consulted them; when needed, they relied on social support, but also on medicines (for 16 % of them). Self-assessed professional well-being (6,6/10) and global health (7,4/10) were closely connected with each other (p < 0.001). Decrease of the caregiving time was linked to their enhancement (p < 0.001). Working in group was linked to a better health (p = 0.02). 79% of the general practitioners have identified at least one peer in need. Conclusion: Worktime, while lower than those reported in the literature, was still the main variable linked to the general practitioners' professional well-being and health. The declaration of an independent treating doctor, although less and less rare, wasn't linked with the perceived health status, maybe because of the scarcity of medical consultations. Keeping that in mind will allow the elaboration of appropriate measures to enhance the care given to general practitioners? [ABSTRACT FROM AUTHOR]

The medical certificate from the Maison Départementale des Personnes Handicapées (MDPH) provides the essential information for the MDPH multidisciplinary team to assess the child's compensation needs. This assessment, combined with consideration of the child's life project and environmental factors, will be decisive in the choice of compensation measures to be put in place. It is therefore important that GPs are able to complete the certificate in a relevant manner. The compensation needs of children with TSLA are often covered by a common law response. However, the severity of the disorders, their impact on the social and daily life of children and the presence of comorbidity may lead to requesting a specific legal response and therefore obtaining an MDPH certificate. [ABSTRACT FROM AUTHOR]

The growing interest in biomedicine, particularly in the form of monoclonal antibodies, in cancerology, but also in inflammatory, infectious and autoimmune diseases, means that GPs today need to be in a position to support these patients. What questions should they be able to answer, and how should they monitor? The first part deals with general information, vaccination and travel, while this second part looks at monitoring and the main adverse effects. [ABSTRACT FROM AUTHOR]

In 2016 in France, 4.6% of women between the ages of 15 and 49 used natural family planning (NFP). A majority of them are dissatisfied with the listening and training of general practitioners on this subject. They feel judged, ill-informed and poorly supported by them. The effectiveness of NFP depends on the motivation of the couple as well as the support of a health professional. Objective: To assess the knowledge of general practitioners concerning NFPs, as well as their perception of their effectiveness, and their desire to improve and modify practices. Method: Cross-sectional observational study of general practitioners in the former Midi-Pyrénées region by questionnaire distributed online between 18 February 2022 and 1 April 2022. Results: 189 responses were received. The best-known NFPs were the Ogino, Billings, temperature and withdrawal methods. 46.5% of participants considered none of the NFPs to be effective. The more recent and more reliable methods such as the Sympto-Thermal Method (STM) or the Lactation-Amenorrhea Method (LAM) were less known and less considered effective. One in five doctors knew a network to which they could refer patients to and more than one in two were interested in learning about such network. 44 % of the doctors questioned were interested in taking training in NFP. The perception of a lack of effectiveness of these methods was one of the main reasons given by those not wishing to take training. Conclusion: NFPs are little known to general practitioners and perceived as ineffective. There are gaps in medical training regarding NFPs, and networks or tools around NFPs are little known and uncertain. Thus, an improvement in medical training, through the performance of rigorous studies on NFP, would allow a better knowledge of general practitioners and thus better quality support and care for users. [ABSTRACT FROM AUTHOR]

The medical certificate from the Maison Départementale des Personnes Handicapées (MDPH) provides the essential information for the MDPH multidisciplinary team to assess the child's compensation needs. This assessment, combined with consideration of the child's life project and environmental factors, will be decisive in the choice of compensation measures to be put in place. It is therefore important that GPs are able to complete the certificate in a relevant manner. Intellectual disability often gives entitlement to specific compensatory measures. Indeed, it affects general intellectual functioning, leading to a reduction in the child's adaptive capacities, and to significant difficulties in carrying out the activities of daily life. [ABSTRACT FROM AUTHOR]

Copyright of Gériatrie et Psychologie Neuropsychiatrie du Vieillissement is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Since 2018, a team from a French primary health care center, composed of general practitioners, physiotherapists, Asalée nurses, and a psychologist, has implemented a program for the management of low back pain with high risk of chronicity. However, many patients who were enrolled in the program abandoned it during the course. This qualitative study aims to explore the patients' feelings regarding this program. It reveals that patients found positive elements at each stage of the care process: awareness, a key message, specific learning, or psychological support, enabling some to significantly improve their low back pain or empower themselves even before completing the program. For others, schedules that were incompatible with work or family obligations acted as significant barriers to continuing the program. Improved selection and follow-up of patients, as well as other measures to enhance the experience of particularly working patients could perhaps limit absenteeism. [ABSTRACT FROM AUTHOR]

The medical certificate issued by the Maison Départementale des Personnes Handicapées (MDPH) makes it possible to collect essential information for MDPH's multidisciplinary team in order to assess the child's compensation needs. This assessment, combined with the consideration of the child's life plan and environmental factors, will be decisive in the choice of compensatory measures that will be put in place. It is therefore important that general practitioners are able to complete the certificate in a relevant way. [ABSTRACT FROM AUTHOR]

Chronic calcifying pancreatitis is a chronic inflammatory disease of the pancreas which leads to the development of parenchymal and ductal fibrosis. The main cause is chronic alcoholism. From its lesions arise symptoms, acute and chronic complications which will tag the evolution of this disease which takes place over 15 to 20 years. In addition to the clinical and paraclinical check-ups necessary for acute complications, the GI specialist must ensure the long-term follow-up. It will rely on several practitioners from different specialties reflecting the multidisciplinary nature of this disease. At the clinical level, a six-monthly consultation will address the problem of chronic pain (type, evolution, treatment, opiate medications, dependence), nutritional status, alcohol and tobacco consumption, signs of pancreatic exocrine insufficiency (weight, diarrhea) and diabetes, as well as complications related to chronic alcohol and tobacco consumptions. Biologically, exocrine insufficiency is detected by measuring fecal elastase (annually), and diabetes by measuring glycated hemoglobin every six months. It is also necessary to monitor the serum albumin level, the hydroelectrolytic, renal and hepatic parameters and the vitamin D level. Imaging (cholangiopancreatography MRI and/or CT scan) is necessary in case of complications or new symptoms and systematically over the long term to detect the occurrence of pancreatic adenocarcinoma, particularly in cases of hereditary chronic pancreatitis (imaging every year or two depending on the cause of the pancreatitis). If there is any doubt, an endoscopic ultrasound with biopsy will complete this assessment. It will therefore be necessary to adapt the treatment with analgesics, pancreatic extracts, oral antidiabetics or insulin, or even to discuss in certain cases a therapeutic endoscopy in an expert center. The multidisciplinary approach will involve the general practitioner, diabetologist, psychiatrist, addictologist, algologist, biliary and pancreatic endoscopist and sometimes even the pancreas surgeon. [ABSTRACT FROM AUTHOR]

Introduction: Building a lasting out-patient therapeutic patient education (TPE) program can only be achieved if new patients are regularly recruited. This proves to be the main challenge in maintaining out-patient TPE programs. Objective: The objective of this study was to increase the number of new patients reported and included in the POLIPATO TPE program in 2020 compared to the previous couple of years, by developing a new recruitment method. Method: After developing new communication materials, the program was actively promoted among health professionals (general practitioners (GPs), pharmacists, nurses) in primary care facilities of 4 rural or semi-rural towns. Four days were dedicated to recruitment over two consecutive months: professionals were invited to briefly present the program to any patient meeting the inclusion criteria. If interested, the patient was called back for further information and potential inclusion in the program. Results: Over the four days, 100 patients were reported (89 by GPs, 8 by nurses, 3 by pharmacists), among which 29 were included. In 2020, the number of patients reported was multiplied by 3, and the number of patients included increased by 50% compared to 2018 and 44.4% compared to 2019. Conclusion: This recruitment method has proven to be effective for reporting patients. However, the majority of patients were recruited by general practitioners. An alternative recruitment method should be sought for pharmacists and nurses. [ABSTRACT FROM AUTHOR]

The article offers information on the current crisis in the French healthcare system, which is not limited to the general practitioners (GPs), but is also affecting the whole healthcare system, both in the hospital and the outpatient sectors. Topics include the failure of the French National Strategy for Quality of Life at Work; the need for a new curriculum in general medicine; and the importance of addressing the problems of medical students.

Pharmacological changes related to aging or polymedication expose elderly to drug-related iatrogenia. The fight against potentially inappropriate medications prescription in these patients is therefore necessary. We assessed the impact of the collaboration between physicians and pharmacists within the acute geriatric care unit of the University Hospital of Montpellier on the treatment of elderly patients. Moreover, we assessed the follow-up of hospital therapeutic changes by general practitioners one month after the discharge of the patients from hospital. Méthodes: After inclusion of the patients between January 2nd and March 16th, 2020, we called their dispensary pharmacist and general practitioner from February 1st to April 30th, 2020 to obtain their treatment one month after their discharge from the hospital and the opinion of these healthcare professionals on ways to improve the management of medication for elderly patients. Résultats: The collaboration between physicians and pharmacists in the hospital has significantly reduced the number of potentially inappropriate drugs per prescription: their prevalence has decreased from 57.6 % to 23.7 % between admission and discharge from the 59 study patients. Although increased one month after the release of the patients (27.1 %), the prevalence has remained significantly lower than what we found before the hospital therapeutic optimization suggesting the general practitioners' agreement with therapeutic changes done in the hospital. Conclusion: The improvement of collaboration between hospitals and local healthcare services in the one hand and between dispensary pharmacists and general practitioners in the other hand are many perspectives to optimize drug management of elderly. [ABSTRACT FROM AUTHOR]

Copyright of Environnement, Risques & Santé is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article reports that the first prescription of feminizing HRT is possible by a general practitioner (GP). Topics include considered that the first prescription of masculinizing HRT is restricted to a specialist such as endocrinologist, urologist or gynecologist. Renewal is possible by the general practitioner.

Résumé: La prophylaxie pré-exposition au VIH (PrEP) consiste en l'utilisation de l'association de Ténofovir disoproxil fumarate et d'Emtricitabine, molécules utilisées comme traitement anti-rétroviral, afin de prévenir une contamination par le virus de l'immunodéficience humaine (VIH) chez des patients à risque. Les généralistes qui pouvaient jusqu'à présent assurer le renouvellement trimestriel, peuvent initier et assurer seul le suivi depuis le 1er juin 2021. Cette étude qualitative vise à explorer la place que les patients sous PrEP accordent à leur médecin généraliste dans la gestion de cette prophylaxie. Il ressort que les patients sont très satisfaits de la PrEP et du suivi spécialisé actuel. Ils accueillent favorablement l'investissement des généralistes pour permettre sa diffusion et faciliter le suivi. Cependant, ils attendent d'eux un discours ouvert sur la sexualité, une bonne maitrise de la PrEP et de la prise en charge diagnostique et thérapeutique des infections sexuellement transmissibles. HIV pre-exposure prophylaxis (PrEP) consists of the use of the combination of Tenofovir disoproxil fumarate and Emtricitabine, molecules used as anti-retroviral treatment, to prevent immunodeficiency virus (HIV) contamination in patients at risk. General practitioners who had until then been able to ensure quarterly renewal, can initiate and ensure follow-up on their own since June 1, 2021. This qualitative study aims to explore the place that patients on PrEP assign to their general practitioner in the management of this prophylaxis. It appears that patients are very satisfied with PrEP and the current specialized follow-up. They welcome the investment of GPs, to allow the dissemination of PrEP and facilitate follow-up. However, they expect from them an open discourse on sexuality and a good mastery of PrEP and the diagnostic and therapeutic management of sexually transmitted infections. [ABSTRACT FROM AUTHOR]

Résumé: Le sevrage est une des étapes inévitables de l'allaitement maternel. Les questions des patientes concernant sa gestion peuvent être rencontrées en consultation de médecine générale. Souvent les réponses pertinentes et fondées sur des données probantes peuvent manquer. Ce travail propose d'explorer les retours d'expériences des mères vis-à-vis du sevrage de l'allaitement maternel, mis en perspective des conseils apportés par les professionnels de santé en consultation. Weaning is one of the inevitable stages of breastfeeding. Patient questions regarding its management may be encountered in the general practice setting. Often relevant and evidence-based answers may be lacking. This work proposes to explore mothers' experiences of weaning from breastfeeding, put in perspective with the advice given by health professionals in consultation. [ABSTRACT FROM AUTHOR]

Résumé: Introdutrion: La haute autorité de santé (HAS) encourage la pratique d'une activité physique (AP) pendant la grossesse et en post-partum. Il est avancé que 150 minutes d'activité par semaine réparties en trois séances ont des effets bénéfiques sur la santé maternelle, fœtale et néonatale. L'objectif était d'établir une revue systématique de la littérature sur les effets d'une activité physique pendant la grossesse. Matériels et méthodes: Il s'agit d'une revue systématique descriptive de la littérature effectuée à partir de neuf bases de données, étudiant six années de publications (2014-2019), réalisée entre septembre et novembre 2019, par trois investigateurs. Les mots-clés de recherche MESH étaient « physical activity », « exercise », « pregnancy OR pregnant women », « general practice OR primary care ». Résultats: Trente-cinq articles ont été inclus. La synthèse des résultats a permis de séparer les effets en huit catégories : les troubles anxio-dépressifs et la qualité de vie, le poids, le diabète gestationnel, la santé cardiométabolique, la pré-éclampsie, le travail et l'accouchement, les douleurs lombaires et pelviennes et les effets sur le nouveau-né. Les associations détectées entre ces effets et l'activité physique étaient globalement bénéfiques chez les femmes enceintes. Ces bénéfices peuvent dépendre du type d'activité physique réalisée et de son intensité. Conclusion: La pratique de l'activité physique de la femme enceinte s'inscrira dans son quotidien et tiendra compte de son espace écologique. The French National Authority for Health (HAS) encourages physical activity (PA) during pregnancy and postpartum. It is argued that 150 minutes of activity per week divided into 3 sessions has beneficial effects on maternal, fetal, and neonatal health. The purpose of this systematic literature review was to determine the effects of physical activity during pregnancy. Materials and methods: This was a descriptive systematic literature review including nine databases, focusing on six years of publication (2014-2019), conducted between September and November 2019, by three investigators. MESH search terms were 'physical activity', 'exercise', 'pregnancy OR pregnant women', 'general practice OR primary care'. Results: Thirty-five articles were included. Themes included anxiety disorders and quality of life, weight, gestational diabetes, cardiometabolic health, pre-eclampsia, labor and delivery, low back and pelvic pain and effects on the newborn. It was found that physical activity was overall beneficial for pregnant women. These benefits may depend on the type of physical activity undertaken and its intensity. Conclusion: Pregnant women benefit from physical activity. To optimize this benefit, they must develop a strategy to incorporate physical activity into her daily life and consider her ecological space. [ABSTRACT FROM AUTHOR]

Résumé: La sédentarité, première cause de mortalité évitable dans le monde, est un enjeu de santé publique majeur qui a conduit les autorités de santé à voter un amendement autorisant la prescription d'activité physique adaptée (APA) par le médecin généraliste. Cependant, cette pratique reste encore méconnue par la plupart des professionnels de santé. Les principaux obstacles à la prescription d'APA sont le manque de connaissances, une formation universitaire insuffisante avec des référentiels peu adaptés et un manque de temps dans la consultation. Quelques outils simples, proposés dans cet article, peuvent faciliter cette prescription d'APA. Sedentary lifestyle is the first death cause worldwide which can be avoided. This major issue has brought the health authorities to vote in favour of an amendment allowing the general practitioners to prescribe adapted physical activity. However, many health professionals remain unaware of this type of prescription. The main obstacles are the lack of knowledge, insufficient university training with unadapted reference documents and a lack of time spent with the patient during the appointment. In this article, simple tools are suggested to help the general practitioners in their prescription of adapted physical activity. [ABSTRACT FROM AUTHOR]

Résumé: La vitesse de sédimentation (VS) constituait un examen de base pour les médecins généralistes à la fin du XXe siècle comme marqueur de l'inflammation. Aujourd'hui encore, la VS est largement utilisée comme en témoignent les 14 millions de dosages en médecine ambulatoire en 2018. Pourtant, la VS est un marqueur peu spécifique maintenant concurrencé par d'autres dosages plus performants. Une revue systématique de la littérature a été réalisée entre le 30 mars 2020 et le 30 janvier 2022 ainsi qu'une analyse des recommandations des sociétés savantes. L' Evidence Based Medicine ne permet pas de justifier le dosage de la vitesse de sédimentation en pratique courante de médecine générale, même si elle reste possible dans quelques rares situations : Horton, Hodgkin, Polyarthrite rhumatoïde. La faible littérature scientifique sur l'utilisation de la VS en médecine générale et sa disparition progressive des référentiels des sociétés savantes justifient l'arrêt de l'utilisation de ce dosage en pratique courante. The blood sedimentation (BS) was a basic test for general practitioners at the end of the 20th century as a marker of inflammation. Today, the BS is still widely used, as evidenced by the 14 million determinations in ambulatory medicine in 2018. However, the BS is a non-specific marker that is now competing with other more efficient assays. A systematic review of the literature was carried out between 30 March 2020 and 30 January 2022 as well as an analysis of the recommendations of learned societies. Evidence Based Medicine does not justify the use of the blood sedimentation rate in general practice (even if it remains possible in a few rare situations: Horton, Hodgkin, rheumatoid arthritis). The limited scientific literature on the use of the BS in general practice and its gradual disappearance from the guidelines of learned societies justifies the cessation of the use of this assay in general practice. [ABSTRACT FROM AUTHOR]

In view of the increasing number of patients with somato-psychic comorbidities, a tool for identifying complex patients such as the INTERMED self-assessment (IMSA) would prove useful in family medicine. An observational study was conducted in a practice with seven general practitioners to evaluate the acceptability of patients to fill in this questionnaire in the waiting room. The IMSA was quickly completed and well accepted by patients, who found the questions easy to understand and relevant to their health. The waiting room environment didn't seem to hinder the process. The majority of participants deemed useful that their doctor received the data from the questionnaire. The IMSA could be implemented in the practice to detect certain psycho-social fragilities at an early stage. [ABSTRACT FROM AUTHOR]

Résumé: Introduction: La prévalence des patients recevant un traitement anticoagulant en France est de 1 Français sur 20 et ne fera qu'augmenter avec le temps, parallèlement au vieillissement de la population. Les anticoagulants sont les principaux médicaments associés à des effets indésirables. Leur utilisation s'impose à tous les médecins généralistes. Avec une patientèle diversifiée, souvent polypathologique et des situations parfois complexes, le médecin généraliste peut, dans certaines situations, se retrouver dans l'incertitude. Objectif: Identifier les outils d'aide à la prescription des anticoagulants disponibles, les attentes des médecins généralistes envers ces outils et identifier les situations cliniques les plus fréquentes posant des difficultés lors de la prescription des anticoagulants. Matériel et méthodes: Étude épidémiologique descriptive transversale réalisée auprès des médecins généralistes installés dans la région Île-de-France par un sondage en ligne du 8 octobre 2020 et 22 juin 2021 recensant les données démographiques, les pratiques des prescripteurs et la description démographique et clinique de leur patientèle. Résultats: 105 médecins généralistes ont répondu au questionnaire. Les attentes envers les outils d'aide à la prescription sont : accès facile, rapide, fiable, utilisation facile, mise à jour régulière, format d'une application numérique et/ou d'un référentiel de consensus et des avis d'expert. Les difficultés et le besoin d'un avis lors de la prescription des anticoagulants existent chez 80 % et 78 % des médecins respectivement, et sont présents notamment dans les départements de Seine-et-Marne et du Val d'Oise. Conclusion: Cette étude souligne avec l'usage des anticoagulants, les difficultés au quotidien de la pratique de la médecine générale à l'interconnexion des autres spécialités. Il existe un besoin franc de recours concernant le traitement anticoagulant, pour lequel les résultats de cette étude peuvent être le socle du développement d'une application et/ou d'un référentiel. The prevalence of patients receiving anticoagulant therapy in France is 1 French in 20 and will increase over time as the population ages. Anticoagulants are the most common cause of adverse drug reactions. Use of oral anticoagulants is compulsory for all general practitioners. Facing a diversified patient base, various pathologies and complex situations, general practitioner may therefore find himself faced with the uncertainty of his practice. Objective: To identify the available prescribing aids, their quality, the expectations towards prescribing aids for anticoagulants, and to identify the most frequent clinical situations posing difficulties when prescribing anticoagulants. Material and methods: Cross-sectional descriptive epidemiological study carried out among general practitioners established in the Île-de-France region through an online survey from October 8, 2020 to June 22, 2021, including demographic data, prescribing practices, and demographic and clinical data of their patients. Results: 105 general practitioners responded to the questionnaire. Expectations for anticoagulant prescribing aids were ease of use, easy access, fast, reliable, regularly updated, and in the format of a digital application and/or a consensus reference and expert opinion. Difficulties and the need for advice when prescribing anticoagulants exist in 80 % and 78 % of physicians respectively and are present in particular in the departments of Seine-et-Marne and Val d'Oise. Conclusion: There is a clear need for the development of an application and/or a reference manual that could be done based on the results of this study as specifications. Beyond the tool, this study highlights, with the use of anticoagulants, the difficulties in the daily practice of general medicine interconnected with other specialties. [ABSTRACT FROM AUTHOR]

Résumé: Introduction: La consultation de médecine générale est une rencontre entre un médecin et un patient demandeur de soin, qu'il recherche en exprimant un motif de consultation. La demande exprimée d'emblée n'est pas forcément sa principale préoccupation. Objectif: Déterminer quelles sont les différentes techniques de communication utilisées dans les entretiens qui favoriseraient l'expression des motifs secondairement révélés par le patient et établir leur moment d'apparition dans la consultation. Méthodes: Une étude qualitative descriptive a été réalisée à partir d'une base de données d'enregistrements audio de 72 consultations chez trois médecins généralistes exerçant dans trois cabinets libéraux de Gironde. Les verbatims obtenus par retranscription manuelle ont été analysés par la méthode de double codage avec triangulation des données. Nous avons établi un score de communication selon le guide de Calgary-Cambridge. Résultats: Les motifs secondairement révélés sont principalement énoncés au cours de l'interrogatoire. Nous retrouvons majoritairement des techniques de communication comme la facilitation, les questions ouvertes et fermées, la reformulation, la clarification, le résumé, l'empathie, l'implication active, la légitimation, l'humour et les menus-propos. Conclusion: Pour créer un climat de confiance au sein d'une consultation de médecine générale, l'apprentissage de la communication, en tant qu'habileté complexe, doit être intégrée dans la formation du médecin. Celui-ci pourra s'aider de la grille de Calgary-Cambridge pour mener au mieux son entrevue et ainsi obtenir une relation optimale avec ses patients. Introduction: Medical consultation is a meeting between a doctor and a patient seeking care, which he seeks by expressing a reason for consultation. The patient's initial request is not necessarily his main concern. Aim: Determine the different communication techniques used in the consultation that would promote the expression of secondarily revealed reasons and establish when in the session these reasons are revealed. Methods: A descriptive qualitative study was carried out using a database of audio recordings of 72 consultations by three general practitioners in three private practices in Gironde. The verbatims obtained by manual transcription were analyzed using the double coding method with data triangulation. We have established a communication score according to the Calgary-Cambridge guide. Results: Secondarily revealed reasons are mainly stated during the questioning. There are mostly communication techniques such as facilitation, open and closed questions, reformulation, clarification, summary, empathy, active involvement, legitimation, humor and small talk. Conclusion: To create a climate of trust within a consultation, the learning of communication, as a complex skill, must therefore be integrated into the training of becoming a doctor. He will be able to use the Calgary-Cambridge grid to conduct his interview and obtain an optimal relationship with his patients. [ABSTRACT FROM AUTHOR]

Résumé: Dans un précédent article, nous avons présenté une organisation innovante développée à l'Hôpital Suburbain du Bouscat à Bordeaux pour l'accompagnement à l'arrêt du tabac sous la forme d'un parcours coordonné entre l'addictologue et les médecins traitants des patients reçus en consultation spécialisée soutenu par un référentiel synthétique et un dossier conjoint. Dans cette deuxième partie nous présentons les résultats de cette expérimentation sur trois années consécutives. In a previous article we presented an innovative organization developed at the Bouscat Suburban Hospital in Bordeaux for support in quitting smoking in the form of a coordinated course between the addictologist and the doctors treating patients seen in specialized consultation supported by a synthetic repository and a joint file. In this second part we present the results of this experiment over three consecutive years. [ABSTRACT FROM AUTHOR]

Background: Clinical reasoning is a complex process that is central to medical practice. GPs who follow patients with multimorbidities have to combine several roles in their care. Metaphors are a language tool that potentially provides access to the clinical reasoning behind this management. Aim: To analyse the metaphors expressed by GPs to better understand their clinical reasoning. Methods: Nine general practitioners (5 women and 4 men) aged between 29 and 57 years participated in the study. Non-directive interviews were conducted, transcribed and analysed using Schmitt's systematic metaphor analysis framework. Results: Seven metaphorical themes. Within these metaphorical themes, GPs described their clinical reasoning processes in the face of multimorbidity as (1) a building process, (2) a sudoku or puzzle, (3) an Odyssey, (4) a story with someone, (5) a race, (6) looking at a painting, and (7) playing a tune. Conclusion: The metaphors may highlight the complexity of the clinical reasoning process of general practitioners in the long-term management of patients suffering from multimorbidity and support a deeper understanding and awareness. [ABSTRACT FROM AUTHOR]

Acousticians, ethnomusicologists and organologists, these general practitioners and specialists in Southeast or East Asia have come together to create a new general description of the mouth organ and of the free reed pipe. As an introduction to this issue of Circuit, connecting musicians and composers with musicologists and specialists in acoustics and sound recording, this essay takes an approach that passes through history, morphology, materials, details of workmanship and acoustics, pausing to make clarifications or corrections to a literature that is vast but scattered. Regarding the modernization of the instruments and the contexts where it occurs, the authors take the musicians’ point of view into account. [ABSTRACT FROM AUTHOR]

Résumé: En 2017, une organisation innovante a été initiée et développée à l'Hôpital Suburbain du Bouscat à Bordeaux pour l'accompagnement à l'arrêt du tabac. Un parcours coordonné entre l'addictologue et les médecins traitants des patients reçus en consultation spécialisée est soutenu par un référentiel synthétique et un dossier conjoint. Cette prise en charge partagée permet aux médecins généralistes d'expérimenter l'aide au sevrage tabagique de façon concrète et intégrée à leur pratique. Des résultats prometteurs sur trois années consécutives seront présentés ultérieurement dans une deuxième partie. In 2017, an innovative organization was initiated and developed at the Bouscat Suburban Hospital in Bordeaux to support smoking cessation. A coordinated course between the addictologist and the physicians treating patients received in specialized consultation is supported by a synthetic reference system and a joint file. This shared care allows general practitioners to experience smoking cessation assistance in a concrete way that is integrated into their practice. Promising results over three consecutive years will be presented later in a second part. [ABSTRACT FROM AUTHOR]

Résumé: La clinique transculturelle est pratiquée et enseignée à partir de dispositifs innovants, mais extrêmement complexes et coûteux en personnel. Cet article, centré autour de la narration minutieuse et intimiste d'une prise en charge en soins primaires, montre comment nouer une alliance propice à la clinique transculturelle quand les esprits s'invitent à la consultation. The transcultural clinic is practised and taught using innovative, but extremely complex and staff-intensive systems. This article, centred around the careful and intimate narration of a primary care case, shows how to build an alliance suitable for a transcultural clinic, when the spirits come to the consultation. [ABSTRACT FROM AUTHOR]

Résumé: Le généraliste est régulièrement consulté pour accompagner des élèves de tout âge en difficultés éducatives, scolaires, psychologiques, comportementales. La notion de « haut potentiel intellectuel » est souvent convoquée par les familles pour expliquer l'un de ces troubles. Des filières scolaires font la promotion de classes adaptées, spécialisées. Comment le généraliste doit-il intervenir dans l'accompagnement de ces situations ? The general practitioner is regularly consulted to assist pupils of all ages with educational, academic, psychological and behavioral difficulties. The notion of gifted children is often invoked by families to explain one of these disorders. Some schools promote adapted, specialized classes. How should the general practitioner intervene in the support of these situations? [ABSTRACT FROM AUTHOR]

Résumé: Contexte : L'antibiorésistance représente un enjeu majeur de santé publique. La majorité des antibiotiques sont prescrits par des médecins de ville dans des pathologies qui ne nécessitent que très rarement une antibiothérapie. La prescription différée d'antibiotique (PDA) se présente comme une option dans cet objectif de diminution de consommation d'antibiotique. Méthodes : Étude prospective, interventionnelle, quantitative de deux groupes parallèles auprès de médecins généralistes habitués à la pratique de PDA en France. Le critère de jugement principal était le taux de consommation d'antibiotique par le patient selon son groupe (PDA protocolisées ou PDA habituelles). Le groupe de PDA protocolisées devait coller une étiquette sur l'ordonnance. L'étiquette mentionnait des informations pour le patient sur les conditions de prise et de délai avant la prise d'antibiotique. Résultats : 205 PDA ont pu être analysées. La consommation d'antibiotiques dans le groupe avec étiquette (40,7 %) était inférieure à celle du groupe sans étiquette (51,9 %) (p = 0,11). Afin d'être le plus fidèle à la pratique, nous avons réalisé une deuxième comparaison en séparant les PDA avec modalités orales seules (sur lesquelles il n'y avait pas d'indications écrites sur la PDA) et les PDA avec modalités écrites. La consommation d'antibiotiques avec modalités écrites (43,7 %) était inférieure à celle avec modalité orale seule (52,4 %) (p = 0,25). Dans notre étude 42 sur 137 (30,7 %) patients sont allés chercher les antibiotiques à la pharmacie mais ne l'ont pas consommé. Conclusion : Nos résultats montrent une tendance vers la diminution de consommation des antibiotiques après une consigne écrite chez des médecins habitués à la réalisation de la PDA. Quelles que soient les modalités de prescription par des médecins généralistes habitués à cette pratique, la consommation d'antibiotique diminue tant que les informations transmises sont claires et appropriées Background: Antibiotic resistance is a major public health issue. Most antibiotics are prescribed by general practitioners for pathologies that rarely require antibiotic therapy. Delayed antibiotic prescription (DAP) is an alternative way to reduce antibiotic consumption. Methods: Prospective, interventional, quantitative study of two parallel groups of general practitioners accustomed to the practice of DAP in France. The primary outcome was the rate of antibiotic consumption by the patient according to group (protocolized DAP or usual DAP). The protocolized DAP group had to stick a label on the prescription. The label included information for the patient on the conditions for taking the antibiotic and the delay before taking it. Results : 205 DAPs were analyzed. Antibiotic consumption in the labelled group (40.7%) was lower than in the unlabeled group (51.9%) (P = 0.11). We performed a second comparison by separating DAPs with oral modalities only (on which there were no written indications on the DAP) and DAPs with written modalities. Antibiotic consumption with written modalities (43.7%) was lower than that with oral modality alone (52.4%) (P = 0.25). In our study 42 out of 137 (30.7%) patients went to the pharmacy to get the antibiotics but did not consume it Conclusion: Our results show a tendency towards a decrease in antibiotic consumption after written instructions in physicians accustomed to performing DAP. Regardless of the prescribing methods used by general practitioners accustomed to this practice, antibiotic consumption decreased if the information transmitted is clear and appropriate. [ABSTRACT FROM AUTHOR]

The number of elderly people is constantly increasing in Switzerland. This population is often at higher risk of infections and concomitant decompensation of underlying comorbidities, in particular cardiac or respiratory diseases. Vaccines are some of the most effective preventive measures for limiting morbidity and mortality related to some of those infections, such as influenza or shingles. In order to improve vaccination coverage, it is essential to inform the patients of the benefits of vaccination, and to plan a catch-up vaccination consultation. The goal of this article is to offer a practical guide for the general practitioner detailing vaccines for the elderly recommended in Switzerland., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

While most episodes of community-acquired pneumonia are caused by Streptococcus pneumoniae and respiratory viruses, other atypical pathogens can also be responsible for lung infections. The Infectious Diseases Service of the Lausanne University Hospital (CHUV) organizes an annual meeting aimed at general practitioners, during which interesting clinical cases are presented. In this article, we summarize five cases of community-aquired respiratory infection due to atypical pathogens that were presented during the 2023 meeting, each with a particular teaching point. Although these infections are rare, expanding the differential diagnosis in cases of suboptimal response to therapy or particular exposures is warranted., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Introduction: The 2019 coronavirus (COVID-19) pandemic has caused a public health crisis worldwide. Concerns have been expressed about the rapid deterioration of mental health among primary care physicians among whom burnout already had a high prevalence prior to the pandemic. However, there is little data on private doctors during the pandemic. France experienced a second wave with a second lockdown. We aimed to assess and compare physicians' burnout, anxiety and depression symptoms and insomnia between general practitioners (GP) and all other private specialists during the second Covid-19 wave., Methods: We conducted an online survey of private practitioners registered on Doctolib® (n=32,655), the interface software most used by private practitioners for booking medical appointments in France. Doctors were invited by email to complete an online survey in November 2020. Inclusions were closed on 1st December. The 2nd lockdown lasted from 30th October to 15th December 2020. We used the Copenhagen Burnout Inventory (CBI) to assess burnout syndrome. A mean score of>50 in at least one subscale defined burnout. The Hospital Anxiety and Depression Scale assessed anxiety and depression symptoms. We used two cut-offs, 8 (>7) and 11 (>10), as both are validated in the ability to find cases. The Insomnia Severity Index (ISI) measures sleep-related complaints among physicians (cut-off >7). To link variations in the psychological scales to the COVID-19 pandemic, one of the items asked explicitly whether participants considered that "the COVID-19 epidemic we are currently experiencing is a source of excess stress, psychological suffering or burnout". Approval for this study was obtained from the local institutional review board of the University of Paris-Saclay, France. The questionnaires were collected anonymously. Statistical significance was tested using the chi-square test and student's t-test to compare the prevalence between GPs and other specialities. Subsequently, logistic regression models were run for statistically significant associations., Results: 1992 physicians replied, a response rate of 12.8% of those who received the invitation email. Among them, 79.4% suffered from psychological distress (symptoms of anxiety or depression or burnout), of which 71.3% suffered from burnout, 26.7% from depressive symptoms, 58.9% from anxiety symptoms and 45.8% from insomnia. There was no difference in gender between GPs and specialists, but there was an age difference (P<0.001). GPs had a higher prevalence of burnout (OR=1.33 CI95 [1.09;1.63]) and took more psychotropic drugs (1.38 CI95 [1.05;1.81]). They were also more likely to perceive their stress as work-related (OR=1.50 CI95 [1.23;1.81]) or COVID-19-related (OR=1.43 CI95 [1.16;1.77])., Conclusion: Our study is the first to assess the mental health of private practitioners in the second wave in association with COVID-19 stress. Firstly, GPs who provide primary care have a significantly higher burnout rate than other doctors. Secondly, COVID-19 stress is associated with more significant psychological distress. Thirdly, almost 80% of the private doctors surveyed suffer from psychological pain, and 71% suffer from burnout. This study has strengths and limitations. Firstly, this study assesses mental health and stress related to its COVID-19 association. Second, this is the largest population of private physicians during the COVID-19 pandemic. The low response rate is the main limit of this study. The alarming rates of psychological distress among private doctors and, in particular, GPs should lead to intervention to help doctors reduce stress, burnout and other mental disorders. This study gives a picture of the situation during the second wave and the lock-in, and we need to be cautious with the next waves., (Copyright © 2023 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Initial medical certificate is a descriptive medical and legal document whose purpose is to prove the existence of a damage and to enable the victim to access his or her right. The purpose of our study was to study the content and to evaluate the writing quality of initial medical certificates. We conducted a retrospective and descriptive study over an 18-month period, from January 2017 to June 2018. We collected data from 450 initial medical certificates at the Forensic Medicine Department of the Charles Nicolle University Hospital in Tunis. The quality of the initial medical certificates was assessed using a template that allowed to assign them a score out of 30. A mean score was mainly assigned to initial medical certificates Template scores ranged between 9.5 and 27.5/30 with an mean of 18.59/30. General practitioners and specialist physicians, such as ophthalmologists, neurosurgeons and doctors using the support provided by the Ministry of Health wrote better certificates. Similarly, we noted better quality of writing when certificates dealt with intentional assaults and injuries. Our study shows that the majority of initial medical certificates does not conform to editorial guidelines. These shortcomings are probably related to the fact that doctors have never received adequate medical-legal training. [ABSTRACT FROM AUTHOR]

Pseudarthrosis is a dreadful condition because it is very difficult to treat even for the orthopedic surgeons. The best thing to do is always to prevent it. The purpose of our study was to determine the prevalence and risk factors for traumatic long-bone pseudarthrosis in the city of Butembo. We conducted a retrospective study of 36 patients with traumatic pseudarthrosis. Data were collected from the hospital records of 968 patients with long-bone fractures at the Matanda Hospital, in the town of Butembo, eastern Democratic Republic of the Congo from 01/06/2016 to 31/05/2019. We calculated the rate of pseudarthrosis and used a single- and multiple logistic regression model to investigate factors associated with pseudarthrosis. The rate of pseudarthrosis was 3.72%. The most common type of pseudarthrosis included floating injuries (69.44%). Risk factors were: working as a rickshaw driver (aOR: 4.60; aCI 95% 1.04-15.21; p = 0.023) and a cultivator (aOR: 2.31; aCI 95% 1.17-4.68; p = 0.008), malnutrition (aOR: 5.83; aCI 95% 1.87-15.62; p = 0.004), tobacco poisoning (aOR: 6.70; aCI 95% 1.84-20.11; p = 0.003) and tobacco+ alcohol consumption (aOR: 4.74; aCI 95% 2.17-9.89; p < 0.001); gunshot injuries (aOR: 6.70; aCI 95% 1.84-20.11; p = 0.003), open fractures (aOR: 4.35; aCI 95% 2.17-9.12; p < 0.001), fracture site infections (aOR: 3.10; aCI 95% 1.03-7.95; p = 0.023); traditional healer (aOR: 12.18; aCI 95%: 5.74-25.37; p < 0.001), general practitioner (aOR: 8.33; aCI 95% 1.77-30.31; p = 0.006) initial absence X-ray assessment (aOR: 12.21; aCI 95% 5.92-24.96; p < 0.001). Long bone pseudarthroses are common in Butembo. The most effective way to prevent them is to know and avoid risk factors. [ABSTRACT FROM AUTHOR]

Résumé: Des audits environnementaux sont réalisés gratuitement depuis 20 ans par le Service parisien de santé environnementale (SPSE) de la Ville de Paris, sur prescription médicale, au domicile de Parisiens dont la pathologie est suspectée être liée à leur environnement intérieur. Ces audits, complétés par la mesure si nécessaire de polluants chimiques et microbiologiques, permettent de proposer des conseils aux patients pour qu'ils réduisent leur exposition aux polluants incriminés. Le SPSE a diversifié ses activités en mettant en place des consultations (sans déplacement à domicile) depuis 2017 : consultations avec un conseiller médical en environnement intérieur (CMEI) permettant aux bénéficiaires de disposer d'une évaluation des facteurs de risque dans leur logement et de conseils pour leur permettre de réduire les expositions identifiées ; consultations bilan-environnement pour l'évaluation des expositions domestiques et professionnelles afin de déterminer si un audit est nécessaire. Cet article décrit l'évolution des 765 interventions (391 audits, 374 consultations) menées entre 2015 et 2019 et caractérise principalement les médecins prescripteurs. Un total de 391 audits a concerné 426 Parisiens, dont 39 % d'enfants, prescrits en grande partie par des pneumologues et des pédiatres pratiquant principalement à Paris, en secteurs hospitalier et libéral. Pour les médecins prescripteurs, ces audits permettent de connaître l'exposition de leurs patients à domicile et de leur apporter des conseils adaptés à leur situation. Depuis 2017, 58 consultations CMEI ont été délivrées au SPSE à 64 Parisiens, dont 30 % d'enfants, prescrites en majorité par des médecins généralistes libéraux et de centres de santé situés à Paris également. Depuis 2018, 202 consultations CMEI et 114 consultations bilan-environnement ont été délivrées à 248 patients adultes, parisiens ou franciliens, du service de pneumologie de l'hôpital Tenon (Paris, 20e). Les actions de prévention constituées par ces interventions, ciblées sur la réduction des expositions domestiques, pourraient être plus nombreuses si elles étaient mieux connues et si les moyens permettant leur mise en œuvre étaient augmentés. For the past 20 years, the Paris municipal environmental health department (Service parisien de santé environnementale, SPSE) has been providing onsite free-of-charge, environmental interventions (audits) to Parisians whose physicians prescribe them for patients with a disease associated with their home environment. When necessary, these audits include measurements of chemical and microbiological pollutants so that patients can receive advice about reducing their exposure to the pollutants identified. Since 2017, the SPSE has added consultations at sites other than the patient's home to the range of its services of medical indoor environment counseling (MIEC): MIEC consultations provide the clientele with both an assessment of the risk factors that may be present in their homes and advice aimed at reducing the identified exposures, while environmental appraisals assess both home and occupational exposures to determine if a home-based audit is necessary. This article describes the changes over time of the 765 interventions (391 audits and 374 consultations) that took place from 2015 through 2019 and characterizes the prescribing physicians. In all, 391 audits have been performed for 426 Parisians, 39% of them children; they were prescribed mainly by pulmonologists and pediatricians, working both in hospitals and private practice, mainly in Paris. These doctors report that these audits enable them to know their patients' domestic exposure and thus provide them with appropriate advice. Since 2017, 64 Parisians, 30% of them children, have received 58 MIEC consultations, most often prescribed by general practitioners from private practice and community health centers in Paris. Since 2018, a partnership with Tenon Hospital (Paris, 20th district) has made it possible to provide 202 MIEC consultations and 114 environmental appraisals to 248 adult patients of the hospital's pulmonary department, living in Paris or its region. These interventions are preventive actions aiming to reduce exposure to indoor air pollution in homes. Public health would benefit from an increase in physicians' awareness of these services and their greater availability. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Despite the high prevalence and significant burden of mental disorders, they remain grossly under-diagnosed and undertreated. In low-income countries, such as Mali, integrating mental health services into primary care is the most viable way of closing the treatment gap. This program aimed to provide a mental health training intervention to rural general practitioners (GPs), to organize community awareness activities, and to evaluate the impact on mental health knowledge and through the number of new patients diagnosed with mental disorders and managed by these general practitioners. METHODS: a pre-test/post-test design and the monthly monitoring of the number of new patients diagnosed with mental disorders by the trained GPs were used to evaluate the effect of the training interventions (2 face-to-face group training workshops followed by individual follow-up supervisions) and of the community awareness activities. RESULTS: the mean knowledge score of the 19 GPs who completed the initial 12-day group training raised from 24.6/100 at baseline, to 61.5/100 after training (p=0.001), a 150% increase. Among them, sixteen completed the second 6-day group training with a mean score increasing from 50.2/100 to 70.1/100 (p=0.001), a 39.6% improvement. Between July 2018 and June 2020, 2,396 new patients were diagnosed with a mental disorder by the 19 GPs who took part in the program. CONCLUSION: despite limited data regarding the effect of the community awareness component at this stage, the findings from this study suggest that the training intervention improved GPs’ knowledge and skills, resulting in a significant number of new patients being identified and managed.

Résumé: Depuis le 2 février 2016, la loi Claeys-Leonetti définit la sédation profonde et continue maintenue jusqu'au décès (SPCMD) et ouvre le droit au patient d'en bénéficier sous certaines conditions, lorsque son pronostic vital est engagé à court terme. En février 2020, la ministre de la Santé a annoncé que le midazolam, la molécule recommandée pour induire la sédation, serait prochainement disponible dans les pharmacies de ville, à disposition des médecins généralistes (MG). La SPCMD est une procédure qui doit pouvoir être proposée aux patients à domicile qui le souhaitent et la nécessitent dans de bonnes conditions. Since February 2, 2016, the Claeys-Leonetti law defines deep and continuous sedation maintained until death (SPCMD) and gives the patient the right to benefit from it under certain conditions, when their vital prognosis is engaged in the short term. In February 2020, the Minister of Health announced that midazolam, the molecule recommended to induce sedation, would soon be available in city pharmacies, available to general practitioners. SPCMD is a procedure that must be able to be offered to patients at home who want and need it under good conditions. [ABSTRACT FROM AUTHOR]