[Diagnosis and management of endometriosis by general practitioners in the south of France]. / Diagnostic et prise en charge de l'endométriose par les médecins généralistes de la région PACA.

OBJECTIVE: Assessment of the practices and knowledge of general practitioners in the south of France regarding the diagnosis and management of endometriosis. METHOD: A descriptive cross-sectional study was conducted among general practitioners in the south of France from November 14, 2021 to February 14, 2022. A questionnaire was developed in consultation with and validated by two university endometriosis reference services of the AP-HM and was sent to general practitioners practicing in the south of France. It was distributed via professional emails, care networks and the south of France's medical order. The questionnaire was divided into three parts: the first simply collected demographic and epidemiological data, the second assessed knowledge of the disease, and the last assessed individual practices. The primary endpoint was the percentage of practitioners with>75% correct responses. RESULTS: 133 general practitioners responded to the questionnaire (133/407, 32.1%). 60.2% performed more than one gynecological consultation per week. 61.7% obtained a rate of correct answers>75%. The general practitioners with the best response rates were more aware of the latest HAS guidelines (P=0.027) and performed gynecological consultations more regularly in the office (P=0.025). Intense dysmenorrhea, chronic pelvic pain and deep dyspareunia were considered as evocative by 98.1%, 95.5% and 95.5% of respondents respectively. On the other hand, uro-digestive disorders were not often mentioned. In case of suspicion of endometriosis on questioning, 54.9% of general practitioners performed a clinical gynaecological examination. 76.7% prescribed an imaging test and 32.3% introduced hormonal treatment during the consultation. Referral of patients to specialists was made by the general practitioner as soon as clinical suspicion arose for 36.8%. CONCLUSION: The results of our study suggest that the knowledge and practices of general practitioners, performing gynecology consultations in the south of France, is perfectible. In the context of the announcement of a regional reorganization of endometriosis-related care, other similar studies should be conducted regularly in order to assess the evolution of general practitioner's practices.

Endometriosis and environmental factors: A critical review.

This review provides an overview of current knowledge on the relationship between various environmental factors and endometriosis. We successively searched for a given exposure factor combined with the word "endometriosis." The literature was comprehensively analyzed and summarized by quoting only the most important and recent studies on each exposition factor. The data focused primarily on endocrine disruptors, such as dioxins and polychlorinated biphenyls, that appear to have the strongest effect. Intriguing data suggest a link with night work, sun exposure and red meat consumption. For the other risk factors studied, particularly those related to lifestyle (tobacco consumption, alcohol, coffee, soy, physical exercise), the data are not sufficient to draw conclusions. In summary, the epidemiological evidence does not support a strong, scientific link between exposure to environmental factors and endometriosis. The complexity of this disease requires advanced study designs and standardized methodology. Future studies should be carefully designed to address these issues to advance our understanding of the impact of the environment and its consequences on endometriosis.

Assessment of a Screening Questionnaire to Identify Exposure to Lead in Pregnant Women.

Lead readily crosses the placenta and displays adverse effects on birth outcomes and neurodevelopment. Systematic identification of the risk of exposure during pregnancy is essential but rarely performed, probably due to hospital staff's workload and their lack of awareness. We aimed to evaluate the relevance of a questionnaire to screen pregnant women for lead exposure. A cross-sectional, multicentre study was carried out on a population of 792 pregnant women from February 2018 to May 2020. A total of 596 women had a blood lead test: 68.5% had blood lead levels below 10 µg/L. The estimated prevalence above 25 µg/L was 4% (95% confidence interval (CI) [2.6-5.9]) and 1.3% had levels above 50 µg/L (95% CI [0.6-2.6]). Multivariate analysis showed that three risk factors significantly increased the probability of blood lead levels above 25 µg/L: the use of traditional cosmetics (adjusted odds ratio [aOR]: 3.90; 95% CI [1.65-9.21]; p = 0.002), degraded old housing (aOR: 2.67; 95% CI [1.19-6.038]; p = 0.018), and (marginally) eating bread more than twice a day (aOR: 2.40; 95% CI [0.96-6.11]; p = 0.060). Our study reveals that a three-question tool can be used to quickly screen for the risk of lead exposure in our population and to trigger lead blood tests and special vigilance during pregnancy follow-up.