[Urinary incontinence: neither men nor women should be forgotten]. / Incontinence urinaire: n'oublions ni les hommes ni les femmes.

The prevalence of urinary incontinence is higher in women, but up to 40% of elderly men suffer from it. It is very important for care givers to search actively for this problem, because only half of the patients, mostly men, will seek help specifically for this symptom. The patients, who do not ask for help, mostly women, think that urinary incontinence is a normal problem while getting old and think that there is no specific treatment for it. Urinary incontinence has an important impact on physical and mental health and has a high economic cost. Men with urinary incontinence are less well taken in charge than women up to the use of absorbent pads, which they partly fix up themselves.

[Are there differences between men and women with pain?]. / Hommes et femmes: sommes-nous tous égaux face à la douleur?

An increasing number of articles are published on the differences about pain in men and women. These differences seem to be due to the sex, the biological dimension of the person, and to the gender, which is the role given to that person in a given social and culture environment. The pain prevalence is higher in women, its threshold and tolerance are lower. The pain interpretation, its perception and the coping is also different in men and women. Finally doctors translate and treat pain differently. This article proposes some explanations on these differences which should help us to treat this frequent and noxious symptom for the quality of life in a better way.

[Hypertension: is the actual definition adapted to women?]. / Hypertension: la définition actuelle est-elle adaptée la femme?

The control of blood pressure in men and women differs due to different physiological pathways. Moreover, conditions increasing the risk of hypertension, such as pre-eclampsia, exposure to oral contraceptives are specific to women. Men have a higher blood pressure than women from pubertal growth to advanced age. However, the definition of hypertension (blood pressure--140/90 mmHg) is the same for adult men and women. The management of hypertension should be based not only on the level of blood pressure, but also on the global cardiovascular risk. Sex is included in the global evaluation of the cardiovascular risk.

[The place of the clinic in primary case--the TOPIC study]. / Place de la clinique en médecine ambulatoire--les enseignements de l'etude TOPIC.

We know very little about the importance of history and physical examination compared to the importance of paraclinical tests in the diagnostic process in primary care. To answer this question, we examined prospectively 672 consecutive patients with chest pain in primary care. We recorded the timing and the clinical characteristics of the most frequent diagnosis. The resort to laboratory or other clinical tests and reference to specialist were influenced by: emergency consultation, potentially life-threatening aetiology, personal characteristics of the general practitioners' (GP) and patients' anxiety. GPs attributed the diagnosis to history and physical examination alone in 66% and to the association of history, physical examination and tests in 31% cases. This, clinical strategy remains the most important factor in the diagnostic process; even when they are insufficient, they allowed to generate hypotheses and guide investigations.

[Innovations in ambulatory care]. / Nouveautés en médecine ambulatoire.

During 2008, we selected 8 studies of interest. It seems important to continue to treat high tension for old patients. To give a good medication against pain, to maintain activity and to reassure patient is the treatment for acute back pain; surgery for spinal stenosis has better results than other treatments at two years of evolution. Pregabalin seems to provide clinically benefit to patients with fibromyalgia. Helicobacter pylori test and treat has the same results than proton pomp inhibitor in initial management of dyspepsia; extending triple therapy beyond 7 days is unlikely to be a clinical useful strategy. Syphilis testing algorithms using treponemal tests for initial screening could be inversed. Finally, selective reporting of clinical trials results for antidepressant are relatively frequent.

[Innovations in ambulatory care: screening, treatment and iatrogenicity]. / Nouveautés en médecine ambutatoire: dépistage, traitement et iatrogénicité.

This year we have selected six studies useful for the day to day practice. A mammography in women 40 to 49 years of age should be evaluated taking into account the patient's profile and the possible risks and benefits of this exam. In patients over 65 years of age, a systematic atrial fibrillation screening, with pulse rate measuring then ECG (if irregular beat) should be realised on a regular basis. The risks for complications following colonoscopies do exist, especially after biopsies/polypectomies and this risk should be discussed. Long term proton pump inhibitor treatment is a risk factor for hip fracture. It is important to treat high blood pressure problems in the elderly, but the orthostatic risks should be adressed. A corticoid treatment started quickly for Bell's palsy is efficient.

[News in internal ambulatory medicine]. / Médecine interne générale ambulatoire.

Since 2005, the chief residents of the University Outpatient Clinic of Lausanne have established a database of articles chosen from miscellaneous reviews and electronic journals and selected for their scientific value and practical usefulness. This first review is based on articles published in 2006 and covering five topics useful for the primary care physician: chronic daily headaches are frequent in women, isolated vertigo is only exceptionally a sign of stroke and a bipolar disorder must be investigated in case of depression. HIV testing in a medical setting is at present more satisfactory than rapid HIV testing at home and finally watchful waiting of inguinal hernia is possible in asymptomatic or pauci-symptomatic men.

[Is there a future for women and part-time doctors in primary care?]. / Y a-t-il un avenir pour les femmes et le temps partiel en médecine de premier recours?

We tried to understand the extent and the consequences of the feminization of medicine and of the upcoming of part-time jobs in primary care. In 2003, 52% of medical graduates are women, with an increase of 80% of women studying medicine and a decrease of 30% of men, since 1980. The women practice rather in group practices, in the cities and part-time. Working part-time increases satisfaction of the patients, the doctors with a part-time job and their colleagues. We urge the politicians and the medical societies to create a flexible training and adjusted possibilities to practice, so that we won't loose many motivated and proficient doctors especially as the attraction of primary care decreases.