[The PLANOPH study: Ophthalmologic symptoms collected by the general practitioner]. / Étude PLANOPH : plaintes ophtalmologiques recueillies par le médecin généraliste.

Little data concerning the management of eye disease in general medical practice is reported in the literature. The main objective of the study was the description and management of ophthalmologic symptoms encountered by the general practitioner. The study was a quantitative, longitudinal, prospective, multi-center trial conducted in 3 departments in France, with data gathered from medical residents' consultation results. The inclusion criteria were: any new ophthalmologic problem with or without complaint, regardless of the patient's age. The resident filled in an observatory questionnaire collecting data on: the complaint within its context ; specific and non-specific reasons for the complaint ; identification of the medical problem and the management offered. The consultation data were classified according to the CISP-2. From May 1, 2015 to April 30, 2016, 674 of the 53,463 consultations held by resident investigators were for an ophthalmologic problem, corresponding to a 1.3% incidence. In over 70% of the cases, the ocular complaint was the main reason for the consultation. The majority of the conditions were benign and managed without specialty consultation. Eighty-six percent of the consultations lead to medication prescription, including 47% topical antibiotics. Eleven percent of the consultations led to referral to a hospital emergency or eye department. Additional multidisciplinary studies could compliment this study and enable a global vision of patients' clinical care pathways.

Pre-employment examination for low back risk in workers exposed to manual handling of loads: French guidelines.

BACKGROUND: Low back pain (LBP) is a major cause of sickness absence and disability in the working population, and the pre-employment examination should insure that worker's state of health is compatible with the requirements of proposed job. This paper summarizes the main recommendations of the good practice guidelines of the French Society of Occupational Medicine for pre-employment examination in workers exposed to manual handling of loads apart from pre-employment test. METHODS: The recommendations were developed according to the Clinical Practice Guidelines proposed by the French National Health Authority and based on a systematic search of the literature 1990-2012 in several databases. The guidelines were written and reviewed by two multidisciplinary committees. On the basis of the level of evidence in the literature, the proposed guidelines are classified as grade A, B, C or expert consensus. RESULTS: The main recommendations of these guidelines are as follows: (1) medical contraindications alone should not exclude employment in a job associated with a low back risk on the basis of a history of "simple" nonspecific LBP; (2) the relevance of examining a previous history of LBP, which is the best predictor of future LBP due to the recurrent nature of LBP. CONCLUSIONS: These guidelines correspond to a constant concern with prevention of occupational risk. Primarily intended for occupational physicians, they are also intended for general practitioners who carry out pre-employment examinations in many countries and are likely to be increasingly faced with this type of situation because of the combination of increasing work constraints with ageing of the workforce.

Evolution of psychosocial factors at work in a French region.

BACKGROUND: Psychosocial factors at work (PFW) can be defined as all non-physicochemical occupational risks. Several epidemiological models have been proposed to measure PFW, but one of the most widely used is Karasek's model. AIMS: To determine whether psychosocial factors, evaluated by Karasek's questionnaire, had increased in a cohort of workers. METHODS: A random sample of workers in the Pays de la Loire region of France, who could be considered representative of the region's population of salaried workers, filled in a self-administered questionnaire, including Karasek's self-administered questionnaire, in 2002-05 and 2007-09. Karasek's questionnaire can be used to study three psychosocial dimensions (psychological demand, decision latitude and social support in the workplace) in workers in order to define two high-risk situations for their health: 'Job Strain' and 'Iso Strain'. Changes in job strain and iso strain among workers were studied according to the workers' sociodemographic characteristics and their working conditions. RESULTS: In this sample of 2049 workers, the proportion with iso strain increased between the two periods from 12 to 16%, P < 0.001, mainly among manual workers. Deterioration of Karasek indicators was mainly explained by an increase of the 'low social support' dimension (38 versus 49%, P < 0.001). Working conditions such as temporary employment of colleagues and high perceived physical exertion were associated with higher PFW. CONCLUSIONS: This study, based on a quantitative and collective model, showed deterioration of working team environments and increased risk for individual mental health in this cohort of French workers in recent years.

[Diagnostic and therapeutic management of the benign prostatic hyperplasia by the general practitioners in the Maine-et-Loire]. / Evaluation des pratiques des médecins généralistes du Maine et Loire concernant l'hypertrophie bénigne de la prostate.

AIM: To assess the diagnosis and therapeutic management of the benign prostatic hyperplasia (BPH) by the general practitioners (GPs) in the Maine-et-Loire. PATIENT AND METHODS: A questionnaire evaluating the management of BPH was sent to the 686 GPs of the Maine-et-Loire between March and June 2008. RESULTS: One hundred and seventy-one GPs answered. Among them 24% were women, 35.1% worked in urban areas, 34.5% worked in semi-urban areas and 30.4% worked in rural areas. 17.5 % had been working less than 10 years, 29.2% had been working between 10 and 20 years and 53.2% had been working more than 20 years. The medical interview, the digital rectal examination (DRE) and the assay of the prostatic serum antigen (PSA) were performed by more than 90% of the GPs whereas the ultrasound scan and the international prostatic score symptom (IPSS) were respectively used by only 15,2 and 69,6% of them. Phytotherapy, alphablockers and inhibitors of 5 alpha reductase were respectively prescribed by 85.4, 95.3 and 53.8% of the GPs. 96.5% of the GPs addressed the patient to a urologist after the failure of the first line treatment. There were no differences according to the working environment. Women performed less DRE (p<0.0001) and sent more patients to urologist than men (p=0.0197). Finally, 88.9% of the GPs were interested in having an update on the last recommendations. CONCLUSION: The GPs diagnosed BPH and initiated the first line treatment. In case of failure, they sent the patients to a urologist. Their primary treatment management was not really in adequation with the recommendations. The recent therapeutic innovations may explain this discordance between the clinical practice and the recommendations. It is noteworthy that most of the GPs who answered this survey were keen in having an update on the recent advances in the BPH management.

Management of low back pain in primary care prior to multidisciplinary functional restoration: a retrospective study of 72 patients.

OBJECTIVE: Chronic low back pain is a major socioeconomic health issue, due to the high direct (healthcare) and indirect (sick leave) costs. The aim of the present study was to describe the primary care management of low back pain patients prior to their inclusion in a multidisciplinary functional restoration network. METHODS: A descriptive, retrospective, questionnaire-based survey of the general practitioners dealing with 72 low back pain patients. RESULTS: Patients had been monitored by their general practitioner for an average of four years, with a mean frequency of eight appointments per year per patient. Ninety-three percent and 60% of the patients had been referred to a rheumatologist and a surgeon, respectively. Ninety-eight percent had had lumbar radiographies, 80% had undergone a computed tomography scan and 64% had undergone magnetic resonance imaging. The most commonly prescribed medications were anti-inflammatories and first- or second-line analgesics. Thirty percent had already received morphine analgesics and 50% had taken antidepressants. Thirty-two percent had undergone lumbar surgery. Physiotherapy was frequently reported and, indeed, 6% of patients had participated in over 100 sessions. Total sick leave averaged 8.25 months over the study's follow-up period. CONCLUSION: The time interval before referral to a multidisciplinary care team is long and so GPs should be encouraged and helped to organize this process earlier. It is also essential to determine factors which predict progression to chronic LBP.