[Detecting psycho-active substance abuse: why, how and what for?]. / Dépister l'usage de substances psycho-actives: pourquoi, comment, et ensuite?

Misuse of psycho-active substances is frequent in primary care and concerns patients of all ages and conditions. Physicians should screen for use of such substances, especially in the case of tobacco dependence and/or clinical symptoms. Independently from the substance used (or from the behaviour), screening can be performed through clinical interviewing, focusing on the frequency and the quantity of the substance used, loss of control and its consequences, or through screening tools. Questionnaires (ASSIST; AUDIT; FACE) allow both screening and evaluation of the severity of misuse, guiding appropriate advice, treatment or referral to specialist. Motivational interviewing is the best option to discuss and induce behavioural changes.

[Brief motivational interventions in primary care]. / L'intervention brève motivationnelle au cabinet du médecin de premier recours.

Primary care physicians see a majority of the population at least once a year and are in an ideal position to promote health and to discuss health behaviour change. Two proven methods to help people change are: brief intervention and motivational interviewing. We propose a combination of these two methods. The interview is structured following the 5 A's with an added first step: 1) agenda; 2) assess ambivalence; 3) advise; 4) agree; 5) assist and 6) arrange and is motivational in that it uses collaboration, non-judgement, and respect of the patient's autonomy. The aim is to help the patient explore and resolve his ambivalence and progress towards change.

[Motivational interviewing: some theoretical aspects and some practical exercises]. / L'entretien motivationnel: quelques repères thèoriques et quelques exercices pratiques.

Heath behavior change is an important task for caregivers. Motivational Interviewing (MI) is an effective evidence-based approach to overcoming the ambivalence that keeps many people from desired changes in their lives. In a warm and empathic atmosphere and in a basic trust in the patient self efficacy for achieving the change, MI is a patient-centered approach to enhance patient motivation to commit them in the change decision. Among critical conditions of change, MI practicing emphasizes on expressing empathy, supporting self-efficacy, rolling with resistance and developing discrepancy. Regular practicing with helping and non judgmental teachers is a necessary condition of a fruitful learning.

[Practitioners confronted with the four main health behavioral risk factors]. / Le généraliste face aux quatre principaux facteurs de risque comportementaux.

Four behavioural risk factors are common in primary care and are often clustered in individuals. Smoking is present from I cigarette per day, excessive alcohol use is defined either by drinking regularly more than 2-3 standard glasses per day or by occasional heavy drinking of more than 4-5 glasses at a time. Patients who don't have regular moderate physical activity of at least 30 minutes during 5 days of a week or intensive physical activity of at least 20 minutes 3 times a week are sedentary. A Body Mass Index of over 30 defines obesity. We propose a "generic" counselling tool in 5 steps, the 5 As, that can be used for any of the four behavioural risk factors during routine consultations. With this counselling guide, practitioners can help patients change behaviour in a motivational style that allows shared decision-making.

[High blood pressure and alcohol consumption]. / Hypertension artérielle et consommation d'alcool.

The possible effects of individual alcoholic beverages on blood pressure continue to arouse interest. There is a positive relationship between alcohol intake and blood pressure. The nature of this relationship still remains unresolved. Authors led studies where different patterns of drinking were assessed. First, different mechanisms are involved for generating hypertension when alcohol drinking. Vasoconstriction effects and modification of smooth muscles are well established factors of alcohol-induced hypertension. Calcium movements are also involved. Men and women are affected by hypertensive effects of excessive alcohol consumption. Drinking alcohol during meals is a probable protective factor of developing hypertension. Reducing alcohol consumption provokes a significant diminution of hypertension.

[The use of psychotropic drugs in alcoholism]. / Du bon usage des psychotropes en alcoologie.

Comorbid psychiatric disorders occur frequently in patients with alcohol dependence. Psychotropic medications as antidepressants, benzodiazepines, antipsychotic or hypnotic medications are sometimes useful with alcoholic patients. Their prescription has to be cautious, well-assessed and time-framed. Globally, antidepressants have very little effect on alcohol outcomes meanwhile benzodiazepines are the drug of choice for alcohol withdrawal. But their use has to be very careful because of their addictive potential. Antipsychotic medications have no real indications. Considering the risk of relapse related to insomnia, sedative medications might be useful after detoxification to prevent relapse.

[Assessment and diagnosis of alcohol problems in general practice]. / Erfassung und Diagnose der Alkoholproblematik in der Praxis.

Problem drinkers and alcoholics are not easily identified in primary health care settings or among hospitalised patients. An early detection can be the basis of a better therapeutic approach for these patients. Clinical interviewing is an important phase during the detection process. Every patient should be asked about alcohol consumption. Standardised questionnaires, clinical examination and laboratory tests are also useful for screening and contribute to diagnosis. The screening must be organised in a progressive and opportunistic way.

[Detection and diagnosis of alcoholism]. / Repérage et diagnostic des malades de l'alcool.

Problem drinkers and alcoholics are not easily identified in primary health care settings or among hospitalized patients. An early detection can be the basis of a better therapeutic approach for these patients. Clinical interviewing is an important phase during the detection process. Every patient should be asked about alcohol consumption. Standardized questionnaires, clinical examination and laboratory tests are also useful for screening and contributing to diagnosis. The screening must be organized in a progressive and opportunistic way.

[Pregnancy and delivery after the age of 40]. / Grossesse et accouchement après 40 ans.

When pregnancy occurs in a woman who is more than 40 years of age there are certain risks, ranging from the risks of chromosome abnormalities to those associated with grand multiparity and the syndrome of "the precious baby", when it is a first pregnancy. We have looked at the case notes of 52 patients who delivered after the age of 40. This was a total of 59 pregnancies which occurred in our service between the 1st January 1981 and the 31st December 1986. Of these patients 6 were primiparous, which was 1.17% of all those women delivered in the service. 83% delivered vaginally, with or without the help of forceps. In this group hypertension as well as vein troubles and fatness are more common. Prematurity was of a low order (3.4%), as was perinatal mortality as compared with other series in the literature. We only had one case of trisomy and this was very upsetting for us because we could not get across to our patients the importance of antenatal screening in more than one third of all cases.