Osteoporosis case finding in the general practice: phalangeal radiographic absorptiometry with and without risk factors for osteoporosis to select postmenopausal women eligible for lumbar spine and hip densitometry

Mass screening for osteoporosis using DXA measurements at the spine and hip is presently not recommended by health authorities. Instead, risk factor questionnaires and peripheral bone measurements may facilitate the selection of women eligible for axial bone densitometry. The aim of this study was to validate a case finding strategy for postmenopausal women who would benefit most from subsequent DXA measurement by using phalangeal radiographic absorptiometry (RA) alone or in combination with risk factors in a general practice setting. The sensitivity and specificity of this strategy in detecting osteoporosis (T-score ≤2.5SD at the spine and/or the hip) were compared with those of the current reimbursement criteria for DXA measurements in Switzerland. Four hundred and twenty-three postmenopausal women with one or more risk factors for osteoporosis were recruited by 90 primary care physicians who also performed the phalangeal RA measurements. All women underwent subsequent DXA measurement of the spine and the hip at the Osteoporosis Policlinic of the University Hospital of Berne. They were allocated to one of two groups depending on whether they matched with the Swiss reimbursement conditions for DXA measurement or not. Logistic regression models were used to predict the likelihood of osteoporosis versus "no osteoporosis” and to derive ROC curves for the various strategies. Differences in the areas under the ROC curves (AUC) were tested for significance. In women lacking reimbursement criteria, RA achieved a significantly larger AUC (0.81; 95% CI 0.72-0.89) than the risk factors associated with patients' age, height and weight (0.71; 95% C.I. 0.62-0.80). Furthermore, in this study, RA provided a better sensitivity and specificity in identifying women with underlying osteoporosis than the currently accepted criteria for reimbursement of DXA measurement. In the Swiss environment, RA is a valid case finding tool for patients with risk factors for osteoporosis, especially for those who do not qualify for DXA reimbursemen

Quand le médecin rencontre l’oiseau : quelques similitudes entre la pratique clinique et l’ornithologie

L’observation des oiseaux peut constituer une activité idéale pour le médecin. Par leur formation, les disciples d’Hippocrate sont peut-être plus enclins que d’autres professionnels à prendre le temps de les observer. Les études médicales apportent des connaissances de base, en biologie et physique notamment. La formation clinique nous apprend ensuite à regarder, à écouter. Cet article propose un regard sur les similitudes entre la médecine et l’ornithologie : importance du sens de l’observation, démarche « diagnostique » identique, recours à une méthodologie scientifique identique (science participative), impact de la migration. Il rappelle également l’équilibre qu’apporte la pratique de l’observation aux médecins

Importance of lifestyle counselling by primary care physicians for diabetic patients

To identify diabetic patients' characteristics and medical care factors associated with recommended glycaemic control (HbA(1c) < or =7%). As part of a cross-sectional assessment of diabetes care involving 204 Swiss primary care physicians, we identified 366 diabetic patients with a recent HbA(1c) value. Cross-tabulations and X(2) tests were used to explore the association of patients' sociodemographic and disease characteristics and medical care characteristics with HbA(1c) < or =7%. Significant factors were included in a regression logistic model to identify multivariate predictors of HbA(1c) < or =7%

Adherence to recommended standards of diabetes care by Swiss primary care physicians

To assess adherence to recommended standards of diabetes care by Swiss primary care physicians