Different reporting patterns for occupational diseases among physicians: a study of French general practitioners, pulmonologists and rheumatologists.

PURPOSE: Physicians can play an important role in the reporting of occupational diseases (ODs), which are still under-reported in many countries. We aimed to identify physicians' difficulties in recognizing and reporting ODs and to study the characteristics of the physicians that do report ODs. METHODS: We conducted a telephone study in 2006-2007 among general practitioners (GPs), pulmonologists and rheumatologists in south-eastern France, concerning their knowledge, attitudes and practice in occupational health. Simple and multiple logistic regressions were performed to study factors associated with the issue of medical certificates for the claim process. RESULTS: Three hundred and ninety-one GPs, 95 pulmonologists and 96 rheumatologists participated. GPs reported significantly less often than specialists that they questioned their patients on past occupational exposure. They more frequently reported difficulties in identifying the occupational origin of diseases, and lack of knowledge on the OD reporting system. Issue of medical certificates for OD reporting was significantly more frequent among specialists than among GPs, among physicians considering that ODs are a public health problem, among those acquainted with the forms required to establish certificates, using internet to obtain information, having trade union activities, or having contact with occupational physicians (OPs). CONCLUSION: Initial and continuing training should be developed to encourage physicians, in particular GPs, to question patients on their working conditions and to become better acquainted with claim procedures. Physicians should also be provided with tools for identification of ODs that are suited to their practices, and collaboration with OPs should be fostered.

General practitioners and patients with psychological stress at work.

INTRODUCTION: Identifying patients with psychological stress at work (PSW) and managing them are complex tasks. We studied the frequency of PSW as perceived by general practitioners (GPs), their practices in such situations, and the factors associated with these perceptions and practices, especially drug prescription. METHODS: Cross-sectional telephone study of GPs in southeastern France with a questionnaire about knowledge, attitudes, behavior, and practices in occupational health. We explored the management of PSW with a case-vignette of a 45-year-old supermarket cashier consulting for psychological stress that he or she attributes to the job. RESULTS: In all, 391 GPs participated; 87.2% reported that they encountered PSW often in their practice. GPs reported that they would treat the case-vignette patient by prescribing anxiolytics (66.5%) or sick leaves (65.7%) or referral to an occupational physician (80.3%) or a mental health specialist (44.8%). A multiple logistic regression showed that GPs reported prescribing an anxiolytic most frequently for the vignette-patient when they saw a high number of patients daily, asked patients about working conditions, suggested a sick leave or a referral to a specialist to the case-vignette patient and perceived more obstacles to reporting an occupational disease. CONCLUSION: Our study suggests that PSW is perceived by GPs as one of the principal work-related health problems and that in such situations, most GPs say they would prescribe drugs and sick leave and refer the patient to an occupational physician. Initial and continuing education programs and good practice guidelines would be useful to help them deal with these problems.

Intended and actual use of self-medication and alternative products during pregnancy by French women.

OBJECTIVES: (i) To identify the proportion of non-pregnant women intending to use self-medication and self-administered alternative products (dietary supplements, essential oils and herbal teas) in the event of pregnancy, and the proportion of pregnant women using these products. (ii) To describe women's risk perception related to these products and the advice given by health professionals. METHODS: A cross-sectional study was conducted. One hundred and twenty-eight women (60 non-pregnant and 68 pregnant women) responded to a self-administered questionnaire. RESULTS: The proportion of pregnant women using self-medication was higher than the proportion of non-pregnant women intending to use self-medication (72% vs 48%, P=0.01) and lower for the use of herbal teas (29% vs 63%, P<0.01). There were no differences between the two groups for dietary supplements (25%) and essential oils (18%). Non-prescribed medications were perceived as a risk by 90% of all the women. Dietary supplements were considered as a medication by 68% of pregnant women and 48% of non-pregnant women (P=0.04). Health professionals provided advice for alternative products to 23% of the pregnant women, and 83% of the non-pregnant women expressed the wish to receive advice if they became pregnant. CONCLUSION: Health professionals should inform women, even before pregnancy, about the safe use of medications and alternative products during pregnancy.

[Skin manifestations revealing monocytic leukemia. A case report]. / Manifestations cutanées révélatrices d'une leucémie monocytaire. Une observation.

A three-month-old developed a deep nodule over the elbow, then two weeks later additional nodules over the trunk with enlargement of the liver and spleen. Examination of the bone marrow established the diagnosis of monocytic leukemia. Acute monocytic leukemia is the most common leukemia in infants. Skin lesions, visible as red, brown or purple nodules ("blueberry muffin lesions") and confluent areas of purpura are common and may occur as the first manifestations of the disease. These skin lesions are not specific of leukemia and other diagnoses should be considered including histiocytosis, neuroblastoma, and skin erythropoiesis (in Torch syndrome, hemolytic disease of the newborn, hereditary spherocytosis, and twin-to-twin transfusion syndrome).