[Cervical smears among women after 65 years. One-year retrospective descriptive study]. / Frottis du col de l'utérus chez les femmes de plus de 65 ans. Etude descriptive rétrospective réalisée sur une année.

BACKGROUND: 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. AIM: How many pathological smears are after 65 years? METHOD: 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. RESULTS: 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. CONCLUSION: This work encourages us to continue smear's practice among women of more than 65 years.

[Quality of life assessment of type 2 diabetic patients in general medicine]. / Evaluation de la qualité de vie des patients diabétiques de type 2 en médecine générale.

OBJECTIVE: The QUODIEM study assessed the quality of life of type II diabetic patients and the factors that influenced it, according to recent medical recommendations. Method The quality of life (QOL) of 437 type II diabetic patients in the Rhone-Alps area, monitored in general medicine, was assessed using two QOL questionaires, the SF 36, a generic, and the DQOL, a specific questionnaire that we adapted to type II diabetics. A third questionnaire assessed the wishes of the patients concerning the management of their disease. RESULTS: The QOL of type II diabetics is negatively influenced by age (>75 Years), female gender, loneliness, and the absence of professional or physical activity. A poorly balanced diabetes, its management by a specialist, the presence of two complications or more related to the disease, and treatment with insulin were all factors reducing QOL. Self-management of glycaema was associated with improved QOL. Few patients wished enhanced management of their diabetes. CONCLUSION: The QUODIEM study underlined the fact that the QOL of type II diabetics must be taken into account and tools for its assessment are available in France.

Vitamin D supplementation for diffuse musculoskeletal pain: results of a before-and-after study.

BACKGROUND: Several studies have shown that vitamin D supplementation could be useful for treating diffuse musculoskeletal (DMS) pain in adults. OBJECTIVES: 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. METHODS: 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. RESULTS: 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 (P < 0.001), the mean quality of life score increased to 2.8 nmol/l (P < 0.001) and the mean pain evaluation score decreased to 2.8 (P < 0.001). CONCLUSION: 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.

[Musculoskeletal chronic pains and Vitamin D deficiency. Study before after in general practice]. / Douleurs musculo-squelettiques non systématisées diffuses et déficit sévère en vitamine D. Étude avant-après en médecine générale.

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<0.001), 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 (P<0.001) and dressing (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.

Risk factors for vitamin D deficiency in women aged 20-50 years consulting in general practice: a cross-sectional study.

OBJECTIVE: Vitamin D deficiency is often unidentified, although treatment is simple and inexpensive. Our objective was to estimate the influence of concealing clothes and other risk factors for vitamin D deficiency in women aged 20 to 50 years consulting general practitioners. METHODS: 13 GPs in the Rhone Alps area planned to recruit 300 women (100 veiled and 200 non-veiled) from January to March 2008. Serum 25(OH)D and PTH were measured in one single laboratory (Biomnis(®)) by a radio-immunoassay method. A survey was administered about dietary habits, sun exposure, and quality of life. RESULTS: Among 247 women enrolled, 196 were analysed: 61 wearing concealing clothes (31.2%) and 135 without (68.8%). As expected, 25(OH)D serum level was significantly lower in covered women (20.1 versus 38.9 nmol/l P < 0.001). Of women who did not wear concealing clothing, 39.3% had severe hypovitaminosis D (25(OH)D concentration < 30 nmol/l). Women wearing concealing clothes had more often other known risk factors such as dark skin (P < 0.001), less sunlight exposure, or a higher Body Mass Index (P = 0.009). Besides concealing clothing (OR 6.37, 95% CI: 1.35-30.09), multivariate analyses revealed two independent risk factors for vitamin D deficiency: no full-body sun exposure (OR: 3.06, 95% CI: 1.18-7.94) and no outdoor sports (OR: 2.81, 95% CI: 1.11-7.12) for threshold 52 nmol/l. CONCLUSION: Young women consulting their GP had hypovitaminosis D more often than expected. Besides concealing clothing, absence of full body sun exposure during summer and of outdoor sports practice could suggest a possible vitamin D deficiency.

[Impact of adverse events on the practices of 15 general practitioners]. / Impact des événements indésirables sur la pratique de 15 médecins généralistes maîtres de stage.

INTRODUCTION: General practitioners are sometimes faced with adverse events, which we define here as "all untoward or unfortunate events occurring unintentionally during the provision of health care services, but also all such events related to any kind of intervention during care." While their social, economic, and health repercussions are often studied, little is known about their effects on general practitioners, except perhaps for their legal consequences. Our principal objectives here were to study the impact of adverse events (including medical errors) on the practices of general practitioners and to study their representations of the concepts of adverse events and medical errors. METHOD: This qualitative work is based on interviews with 15 general practitioners in the Rhone-Alpes region. RESULTS: This study collected 66 real situations experienced and identified as adverse events by the subjects. Analysis shows that these events had a major impact on these practitioners: they caused changes in their procedures for diagnosis and treatment, had sometimes important psychological consequences, induced them to participate in targeted continuing education, and increased their awareness of the legal aspects of some practices, including, for example, record-keeping. Most expressed a need to discuss these situations, especially in peer groups. CONCLUSION: It appears essential to study adverse events and professional practices in primary care and to facilitate their ongoing study, especially in the area of family care.

[Hypovitaminosis D among 18-to-49-years-old women wearing concealing clothes, an ignored reality in general practice]. / La carence en vitamine D chez la femme de 18 à 49 ans portant des vêtements couvrants, une réalité méconnue en médecine générale.

BACKGROUND: Although the morbidity and mortality of vitamin D deficiency are well known in the elderly and among children, doctors are unlikely to consider it as a diagnosis in young adults, even when it is symptomatic. Numerous additional examinations are thus unnecessarily prescribed, while diagnosis is delayed. After observing several cases of severe vitamin D deficiency among women aged 18 to 49 years who wore concealing clothing, we conducted an investigation of the prevalence of this vitamin deficiency in this community. We asked ourselves 2 questions: What proportion of women in this population has a vitamin D deficiency and how severe is it? Are general practitioners (GPs) aware of this problem? METHODS: A cross-sectional study was conducted in Lyon, located at a latitude 45 N. We included women aged 18 to 49 years, who wore concealing clothes, and consulted their GP from November 2005 through March 2006 and had no disease likely to cause hypovitaminosis D. Physicians completed a questionnaire and collected serum for a vitamin 25 (OH)D assay. We looked for correlations between vitamin D deficiency and several factor: ages, parity, associated diseases, and clinical signs. RESULTS: The study included 96 women. Defining hypovitaminosis D at a threshold of 53 nmol/L or 75 nmol/L, we found a prevalence of 99%, and 72.6% of the women had symptoms. Using a stricter threshold of 30 nmol/L, below which secondary hyperparathyroidism can appear and reduce bone mass, we found a prevalence of 82.5%, 71% of whom were symptomatic. The failure to prescribe vitamin D supplementation during the previous 3 months for 99% of these women indicates that GPs are not aware of this issue. CONCLUSION: These results highlight the endemic character of vitamin D deficiency in a population of young women of childbearing age, usually in good health. GPs must be involved in targeted activities to screen for and prevent vitamin D deficiency among this population, because food sources provide minimal quantities of vitamin D.