[Ability of French General Practitioners to detect common mental disorders identified using the Patient Health Questionnaire: Has this changed with the introduction of gatekeeping and registration with a chosen doctor?] / Détection par le médecin généraliste des troubles psychiatriques courants selon l'auto-questionnaire diagnostique le Patient Health Questionnaire : dix ans après, le dispositif du médecin traitant a-t-il modifié la donne ?

OBJECTIVES: The general practitioner (GP) is the most frequently consulted health professional by patients with common mental disorders (CMD). Yet approximately half of cases are not detected by the GP. Many factors linked to the patient, the doctor and the health care system influence detection. For example, detection rates are higher when patients are better known to their GP. On the other hand, patients visiting a different GP for reasons of dissatisfaction with previous care are more likely to be detected on the survey-day. In France, a form of gatekeeping was introduced in 2005 to encourage patients to register with a doctor (most often a GP) of their choice (known as the Preferred Doctor), responsible for care coordination and referral if necessary to secondary care. Visiting a different GP, other than for non-avoidable reasons (for e.g. GP unreachable, patient on holiday), is still possible but financially sanctioned with lower reimbursement rates. We aimed to compare GP detection rates before and after the introduction of this gatekeeping scheme. Patient service use behaviour such as doctor-shopping and GP referral to secondary care were also compared. METHODS: Two cross-sectional surveys using the same study methods were carried out 10 years apart. In 2003, 46 GPs and 1151 patients participated (approximately 25 patients per GP), with a 32.7% GP participation rate. In 2013, 38 GPs participated (of which 29 had participated in the previous study, with a 85.3% "recapture" rate) and 1133 patients (approximately 30 patients per GP). Patient participation rates were 89.8% and 67%, respectively. Patients completed self-report questionnaires in the waiting room of which the DSM-IV diagnostic criteria Patient Health Questionnaire (PHQ) and an adapted version of the Client Service Receipt Inventory (CSRI) on contacts with health care services in the previous six months. For each patient, the GP completed a questionnaire giving his rating of psychiatric illness on a five-point scale with his/her diagnosis for cases, and action undertaken. RESULTS: Of the patients, 27% and 25.4% had a CMD according to the PHQ (defined as a diagnosis of minor or major depression, panic attack, anxiety or somatoform disorder) in 2003 and 2013 respectively. Corresponding detection rates were 51% and 52.6%. Rates were highest for threshold disorders: panic disorder (69.4% and 79.9% in 2003 and 2013, respectively), major depression (75% and 63.3% in 2003 and 2013, respectively) and other anxiety disorders (69.1% and 78.8% in 2003 and 2013, respectively). In 2003, the GPs declared seeing 15.5% for the first time on the survey-day, compared to 9.6% in 2013 (P=0.006). Doctor-shopping declined between the two studies, from 18.4% to 12.1% for practical and mostly unavoidable reasons, and from 9.8% to 4.2% for dissatisfaction reasons (P<0.0001). Referral to specialist doctors increased from 9.7% in 2003 to 14.7% in 2013 (P=0.014). In 2013, on the survey-day, 94.8% of patients had registered with a Preferred Doctor and 81.2% were seeing this Preferred Doctor. In 2003, 93.5% of patients declared having a usual GP and 79.9% were visiting this GP on the survey-day. CONCLUSIONS: This is one of the first studies to report data from two repeated surveys carried out before and after a change in the health service organisation, with data collected from both the patient and the GP. We report relatively high GP detection rates for the two periods, with about 50% of CMDs, including subsyndromic conditions, detected by the GP. Rates are considerably higher for the threshold disorders. The overall detection rate did not increase as expected between the two studies. Detection is a complex topic, involving issues such as the suitability of applying categorical DSM-IV criteria diagnoses to primary care, the relevance of detecting subthreshold conditions and the ability of cross-sectional studies to correctly assess the ability of GPs to recognise cases. The introduction of gatekeeping with the choice of a Preferred Doctor has led to a decline in the frequency of doctor-shopping, whatever its reason, with patients no doubt being better known to the GP. Yet it appears most patients had already chosen a GP they were loyal to before the scheme, with a similar proportion of patients consulting their chosen GP or Preferred Doctor on both survey-days in 2003 and 2013, suggesting the scheme may to some extent only have officialised what already existed with respect to having a usual GP. The French reform still allows for doctor-shopping which can be considered as a positive aspect of the scheme: patients either dissatisfied with previous care or needing to change GP are thus able to "test" and choose the doctor that best suits their needs.

Relation between overweight, diabetes, stress and hypertension: a case-control study in Yarumal--Antioquia, Colombia.

AIMS: The aim of this study was to assess the association between overweight, diabetes, stress and other postulated risk factors for a high blood pressure, on the risk of hypertension. METHODS AND RESULTS: This matched case-control study included 228 cases randomly selected in a rural adult population in Yarumal--Antioquia, Colombia. For every case, one control, individually matched by age (+/- 5 years), sex and residence, was selected from the general population. Conditional logistic regression was used to estimate odds ratios (OR). Obese people (body mass index (BMI) > or = 30 kg/m2) showed an increased OR of hypertension compared to those with a BMI < 25 kg/m2, OR: 3.83 [95% confidence interval (CI): 1.83-8.00]. A high level of psychological stress was associated with hypertension (measured on a tension-anxiety scale), OR: 5.02 (95% CI: 2.25-11.19). A positive association was also observed for diabetes although it was of borderline significance, OR: 2.58 (95% CI: 0.88-7.55). Having a family member with hypertension or myocardial infarction was related to a higher risk of hypertension (p < 0.05). CONCLUSIONS: This study provides evidence that BMI, stress (feelings of anxiety or tension), and diabetes are independently associated with an increased risk of hypertension in a rural area of Colombia.

[The transition of migratory patterns in medium-sized cities]. / La transicion de los patrones migratorios y las ciudades medias.

"The authors attempt to present some empirical findings regarding a phenomenon which they chose to call the 'transition in migratory patterns'.... The general hypothesis states that: changes in migratory patterns are due to an interaction between those economic, political and social processes which affect the distribution of the population; and that this interaction is also highly influenced by macroeconomic politics--an arena where technology plays a dominant role." Data are for Guadalajara and the state of Jalisco in Mexico. (SUMMARY IN ENG)

Role of Lagomorpha in the wild cycle of Rickettsia conorii in Salamanca (Spain).

In an endemic zone for Mediterranean spotted fever levels of antibodies to R. conorii were evaluated in serum samples from wild rabbits (Orytolagus cuniculus) and hares (Lepus granatensis) using an indirect microimmunofluorescence antibody test. The results of the study show that the wild rabbit may carry out in this area an important function in the maintenance of R. conorii in nature.

Nickel nitrate: a new junction permeability tracer for the study of the blood-testis barrier.

With the purpose of evaluating a new intercellular tracer, nickel-K ferrocyanide, we compared results yielded by lanthanum with information provided by nickel. This was done in the seminiferous epithelium of Holtzman rats of several postnatal ages and in a wild local seasonal breeder Galea musteloides. Tissues were studied with transmission electron microscopy and freeze-fracture replications. Nickel tracing proved to delineate cell contours more intensely and less interruptedly than lanthanum. With regard to seasonal variations in adult galea, the limits of the barrier were similar to those described in other mammals: spermatogonia, preleptotene, and leptotene spermatocytes were surrounded by the tracer in the basal compartment. The zygotenepachytenes were contained in the lumenal compartment and tracers were stopped at the inter-Sertoli cell tight junctions. During the inactive spermatogenic phase in winter, the seminiferous epithelium contained Sertoli cells and occasional germ cells, never beyond the spermatocyte stage. The tracer filled intercellular spaces, indicating that the barrier was incompetent. Some resting germ cells showed nuclear hyperchromasia, karyolysis, organelle loss, cell shrinkage, and cell fusion leading to a multinucleated cells. The inter-Sertoli tight junctions were scanty and had randomly oriented and discontinuous junctional strands. Moreover, inter-Sertoli cell gap junctions proliferated. During the active spermatogenic phase in summer, junctions were numerous. Their junctional strands were parallel to each other, and continuous.