Journal de médecine générale

The herbst mandibular advancement orthosis on thermoformed gutters is a recognized device for its effectiveness in reducing the apnea-hypopnea index. But its effect may be undermined by poor attendance on the part of the patient. This article poses this problem between the expected effects and those obtained by the healthcare team. It describes some practical solutions to solve them.

Background: Balanced and healthy nutrition is needed in order to avert adverse effects of poor eating practices. Children and adults often miss breakfast due to many reasons including lack of time. Evidence indicates that breakfast consumption is more beneficial than skipping breakfast following a long overnight fast. Its effect on cognitive function is still under debate. Our aim was to conduct a preliminary study to investigate breakfast habits and its effect of certain aspects of cognition in medical students in a university in Colombo, Sri Lanka. Methods: This study was a descriptive cross-sectional study. We assessed breakfast eating practices of final year medical students. Self-administered and questionnaire and trail making test for visual attention, task switching, speed of processing, and executive functioning were used as study instruments. Results and Conclusions: We recruited 121 clinical students. Majority (55.4%) skipped breakfast at least one or more days per week. Most consumed rice or wheat flour based meals and snacks and only a minority consumed cereals. We did not find any significant difference in trail making test between the two groups of students who skipped and consumed breakfast. A more comprehensive study exploring this topic is recommended.

Clostridium difficile infection (CDI) is reported to be frequently associated with inflammatory bowel disease (IBD). Because of the common characteristics of the clinical appearance of CDI and IBD the diagnosis and treatment of the same becomes complicated. We analyzed the prevalence of CDI in patients with IBD along with their demographic and clinical profile from our meticulously maintained laboratory records. During analysis, the IBD patients (n=721; M:F=1.10:1) comprised of test group and an equal number of gender-matched patients with no indication of IBD was included as non-IBD controls. The demographic and clinical data as well as fecal C. difficile toxin status of all the patients were retrieved from laboratory records. The number of C. difficile positivity was more in the non-IBD group (20%) compared to IBD patients (16%) with non-significant difference (p<0.064). The patients in non-IBD group were relatively older (p<0.001) compared to those in IBD group. The duration of diarrhea in the IBD group was significantly longer (p<0.001) compared to the non-IBD group, but no significant difference (p>0.063) in the frequency of diarrhea between the two groups was observed. Blood in stool and abdominal pain symptoms were found to be significantly higher (p<0.001) among the IBD group whereas watery diarrhea and fever were significantly linked (p<0.001) with non-IBD group. Significant improvement was seen in most of the parameters during the time of follow-up. Though the prevalence of CDI in both IBD and non-IBD groups were almost comparable, clinical symptom and age of presentation varied in them.

Family medicine is a major source of information about health problems and their variation. For most illnesses the general practitioner is the first point of contact in the health care system and he looks after a population whose age and sex composition is known. He is therefore in an ideal position to conduct inquiries about seasonal variations of diseases. There are diseases where possible patterns of seasonal variation have been established: psychiatric disorders, allergies, heart disease, etc. It has long been accepted that morbidity patterns in general practice vary seasonally, which mainly depends on the acute pathology of infectious origin. In addition, it can be affirmed that respiratory infections represent the most important percentage of infections. So, seasonal variability of diseases in family medicine can be attributed to the variability of respiratory infections. Infectious disease dynamics offer a wide variety of intriguing and unexplained phenomena. There is a gap in how diverse studies encompassing immunology, mathematics, epidemiology, and virology combine to form a complete picture of seasonality. This may be due to the daunting complexity of seasonality itself, which is likely to reflect the actions of a vast multitude of variables. An understanding of what drives seasonal trends may allow: 1) better understanding of transmission dynamics, leading to better methods of prevention, health education, triage, diagnosis and management; 2) generate causal and risk factor hypotheses; 3) awareness of risks and surveillance systems; 4) monitoring the effects of intervention studies such as immunization programs; 5) identifying the specific environmental and socioeconomic factors underlying seasonal transmission; 6) better Interpretation of prevalence or incidence studies; And 7) redistribution of resources for the care of the demand in family medicine and health care system.

Background and study aims: Primary care physicians play a principal role in colorectal cancer (CRC) screening in many countries that are using a two-step program; faecal occult blood test (FOBT)+colonoscopy. In order to improve the screening uptake in the Czech Republic ambulatory gynaecologists in addition to GPs were involved in FOB testing in 2009. Our objective was to describe the contribution of gynaecologists to the provision of CRC screening.

Methods: Data reported to health insurance companies and aggregated by the Czech National Reference Centre were used to monitor the screening process. We focused on the coverage by FOBT examination and positive FOBT rate. We describe time trends in the number and proportion of people tested, describe regional variations and show differences according to sex and age.

Results: The target population for CRC screening above age 50 in the Czech Republic was 3,955,968 (37.7% of total population) in 2014. The number of all FOBT performed in primary care (by GPs and gynaecologists) increased from 357,893 in 2008 (417,364 - 2009) to 744,015 in 2014. In 2012, the total coverage of the target population was 25.5%; 23% of men and 27.5% of all women and in 2014 30.8%, 28.5% of men and 32.8% of women. In the years 2009, 2012, 2014 the total contribution of gynaecologists was 3.6%, 8% and 6.4% respectively, of all FOBT performed. Overall in the female target population it was 6.2% in 2009 (out of 236987) 13.6% in 2012 (out of 325,631 FOBT) and 11.2% in 2014 (out of 423660), while in the 50-54 age group 24.4% women were screened by gynaecologists in 2012 and 18.9% in 2014. The data showed significant variations between the 14 regions of the country. The overall positivity rate of FOBT has increased from 4.6% in 2009 to 7.2% in the year 2014.

Conclusions: The participation of gynaecologists has contributed significantly to the higher participation of women in the real life Czech CRC screening program, particularly in the 50-54 years old age group, nevertheless the key responsibility stays with GPs. This measure is likely to be applicable in health care systems with a network of ambulatory gynaecologists, as is the case in the Czech Republic and in most Central and Eastern European countries.