School, behavior and health-related difficulties in early adolescents with contraceptive consultation: a population-based study in eastern France.

BACKGROUND: Early adolescence (10-16 years) is a crucial period for physical, mental and cognitive development where a wide range of school, behavior and health-related difficulties may occur. These issues may be aggravated in adolescents with early affective/sexual live and contraceptive consultation. This study assessed the risk of school, behavior and health-related problems among younger boys and girls having a contraceptive consultation. Such knowledge would inform care providers about their main role in monitoring and caring adolescent problems. METHODS: This cross-sectional study included 1559 middle-school adolescents from north-eastern France (mean age 13.5±1.3). They completed a questionnaire gathering socioeconomic features, obesity, school difficulties, substances use, physical health, psychological health, social relationship, violence, sexual abuse, and suicide behaviors. Data were analyzed for each gender separately using logistic regression models. RESULTS: The contraceptive consultation concerned 6.7% of girls and 3.2% of boys (P=0.002). Based on Odds Ratio (adjusted for age, school-class level and socioeconomic factors), both boys and girls with contraceptive consultation had 2-to-7-time higher risk of consumption of alcohol, tobacco, cannabis and other drogues, poor physical health, relational problems, and perpetrated violence. Additionally, the girls had a 4-time higher risk of low academic-performance and obesity while the boys had 6-to-37-time higher risk of sexual abuse, school dropout ideation, suicide ideation and suicide attempts. CONCLUSIONS: Although based on self-reported data, we found that primary care providers play a prominent role in detecting and monitoring school, behavior and health-related problems during adolescent contraceptive consultations.

Recurrent oral granuloma gravidarum during two pregnancies of a patient with orthodontic treatment: A case report.

The aim of this article was to present the medical management and follow-up of a recurrent oral granuloma gravidarum (OGG). OGG is a common benign tumour that can occur during pregnancy in response to poor oral hygiene and hormonal factors. Its identification and management by primary health care professionals is necessary, including an orientation to a dentist, if needed. Indeed, this lesion may induce troubles such as gingival bleeding, oral hygiene difficulties, and sometimes pain or eating difficulties, but also presents a high risk of relapse. An early twenties woman consulted several times during two pregnancies for an OGG presented in the same proximal maxillary gingival area. The patient reported dental hygiene difficulties because of orthodontic treatment and developed this recurrent tumour four times in two years, despite surgical excisions. Oral hygiene, and information continuously provided by healthcare professionals are required to prevent gingival inflammation and recurrence of OGG. This tumour usually regresses spontaneously post-partum, except in the presence of aggravating factors such as orthodontics treatment and mouth breathing. Surgery of OGG is required when it interferes with normal oral functions.

Perceptions, professional responsibility and management experiences of patients with alcohol, tobacco and opioid use disorder by residents in general practice and teaching general practitioners.

BACKGROUND: Substance use disorders (SUDs) are based on pathophysiological mechanisms common to all psychoactive substances. However, general practitioners (GPs) hold different views depending on the substance in question. OBJECTIVES: To determine whether the perceptions that teaching GPs and final-year residents in general practice have of patients with a SUD vary according to the substance involved and explore their professional responsibility and management experiences. METHODS: A cross-sectional observational study was carried out by asking residents and teaching GPs from eight faculties of medicine about their perceptions, professional responsibility and management experience of patients with tobacco, alcohol and opioid use disorders, using an online questionnaire between June and September 2017. RESULTS: The responses of 238 teaching GPs (mean age 50 years SD 3.5; 58% men) and 327 residents (mean age 28 years SD 9.9; 67% women) were analysed (response rates: 9 and 15% respectively). Tobacco smokers were considered to be more responsible for their acts than the other users. Teaching GPs and residents considered that it was their responsibility to discuss substance use. They did not feel able to manage alcohol and opioid use disorders. Tobacco cessation was mainly managed alone (78%). The results were quite similar among teaching GPs and residents. CONCLUSION: The majority of practitioners had no difficulty managing smoking cessation. During the management of alcohol and particularly opioid use disorders, practitioners did not feel competent. The gap between their perceived responsibility and competencies should be addressed by training and promoting collaborative care.

[Co-occurrent cannabis and tobacco uses: Clinical knowledge and therapeutic prospects]. / Consommations conjointes de cannabis et de tabac : connaissances cliniques et perspectives thérapeutiques.

Cannabis and tobacco are two of the most prevalent addictive drugs used worldwide. Concurrent use of cannabis and tobacco is common, whether simultaneous in joints or not. In France, cannabis is mainly used in joints also containing tobacco. According to the current literature, combined use of cannabis and tobacco exacerbates on additive or multiplicative mode the somatic, psychological and social consequences of each drug. In addition, concurrent use of cannabis and tobacco potentiates tobacco and cannabis dependence, which maintains the use of both drugs, increases the risk of relapse and reduces motivation to care. Combined use thus leads to a reduced likelihood of therapeutic success. We discuss the usefulness of simultaneous cessation treatment together with the use of currently available pharmacological and psychological help as valuable therapeutic tools.

[Assessment of liberal physician's occupational risks management on the exposure to biological fluids]. / Évaluation des pratiques des médecins libéraux sur la gestion des risques professionnels liés à l'exposition aux liquides biologiques.

INTRODUCTION: During their practice, liberal physicians might have a risk of viral exposure to biological fluids. That risk is well-known in hospitals. The purpose of this study was to measure those occupational risks into their own private practice. METHODS: This observational descriptive transversal multicentral, epidemiological study is based on the information collected from 400 physicians (general practitioners, ENT specialists, dermatologists, pediatricians, rheumatologists and gynecologists), working in own private practice in Lorraine. They received by post a confidential survey consisting of multiple-choice and open questions, asking for their activity, their risks of being exposed to biological fluids, their vaccine coverage and their potentially infectious medical waste (PIMW) management. RESULTS: Among 175 physicians who replied to the survey, 153 did invasive procedures and 58 encountered an accidental blood exposure (ABE). The execution of invasive procedures was the main factor in having an ABE (P=0.0023). Around 89.5 % of the complications were due to percutaneous injuries. Still 30.9 % of the physicians always recapped needles and 40 % hadn't a complementary health cover. More than 82 % were up-to-date on mandatory vaccinations (hepatitis B and diphtheria-tetanus-poliomyelitis). In private practice, 97.6 % of physicians sort out blunt objects (prickly or sharp), which is quite satisfactory in comparison with only 60.5 % of them who sort out soft wastes and 44.6 % of blunt objects at patient's home. CONCLUSION: Even if physician's blunt objects disposal in private practice and their mandatory vaccination are satisfactory, "standard" precautions, safety equipment use and soft wastes disposal can be improved.