Prévention des alcoolisations aiguës a l'adolescence: quel rôle pour le médecin de famille [Prevention of binge drinking in adolescents: do family doctors have a role to play?].

Binge drinking has nearly become the norm for young people and is thus worrying. Although alcohol use in males attracts more media attention, females are also frequently affected. A variety of preventive measures can be proposed: at the individual level by parents, peers and family doctors; at the school and community level, particularly to postpone age of first use and first episode of drunkenness; at the structural level through a policy restricting access to alcohol for young people and increasing its price. Family doctors can play an important role in identifying at risk users and individualising preventive messages to which these young people are exposed in other contexts

Risk of COVID-19 and Psychological Impact of the Pandemic in Swiss Primary Care Physicians.

There is limited data on primary care physicians (PCPs) who suffered from COVID-19. We aimed to assess the proportion of PCPs with COVID-19, the proportion hospitalized with COVID-19, and the number of days off work. We also explored their psychological suffering due to the pandemic. We selected a random sample of 1,000 PCPs practicing in the seven cantons of Western Switzerland (November/December 2020). PCPs were invited by mail to complete a questionnaire. The participation rate was 51% (N=506). The burden of disease was high among PCPs: 13% suffered from COVID-19, 0.4% needed hospitalization, and 10 days off work were required on average. In addition, many PCPs reported experiencing heightened psychological symptoms, mainly fatigue (53%) and stress/anxiety (48%). These findings highlight the urgent need to implement preventive measures to reduce the risk of COVID-19 and psychological illness in PCPs

Binding and activation properties of angiotensin II in dispersed rat anterior pituitary cells

The properties of angiotensin II receptors were studied in isolated rat anterior pituitary cells prepared by trypsin digestion. Angiotensin II bound in a time- and temperature-dependent manner to pituitary cells, with Kd of 4.1 x 10(-9) M. The heptapeptide, des-Asp1-angiotensin II, had only one-tenth of the affinity of the octapeptide (Ki = 5.5 x 10(-8) M). These two peptides displayed a similar potency ratio in their ability to stimulate ACTH release from pituitary cells. These results indicate that angiotensin II may play a regulatory role in controlling ACTH secretion from the pituitary gland

Corticotropin-releasing activity of the renin-angiotensin system peptides in rat and in man

In this study we investigated in the rat the binding and corticotropin-releasing factor (CRF) activity of various constituents of the renin-angiotensin system and the possible angiotensin II receptor changes following procedures known to alter plasma renin activity. We investigated also the CRF activity of angiotensin II in vitro and in vivo in humans. The CRF activity of peptides was studied by their ability to stimulate ACTH release from pituitary cells. Deleting amino acids from the N-terminus of angiotensin II resulted in decreased CRF activity; while the ED50 for angiotensin II was 2 nM, it increased to about 10 nM for the (2-8)-heptapeptide. Angiotensin I had a weak CRF activity, whereas the substrate angiotensinogen had no stimulatory effect even at a concentration of 100 nM. There was a strong correlation between the activation and binding properties of all peptides tested. Dietary salt load or depletion as well as dexamethasone treatment did not affect the number nor the affinity of pituitary angiotensin II receptors. Angiotensin II had a CRF activity on human pituitary cells in vitro. However, peripherally injected agiotensin II at a pressive dose of 7 ng/kg/min did not produce any ACTH release in normal male volunteers. These data suggest that angiotensin II may play a modulatory role in the physiological regulation of ACTH secretion, but this role might be attributed to the endogenous brain angiotensin II as it is not closely dependent on the angiotensin II plasma levels

A cross-sectional study of the health status of Swiss primary care physicians.

There is limited data on the general health of primary care physicians (PCPs). We aimed to assess the physical and psychological health of Swiss PCPs. We selected a random sample of 1000 PCPs in Western Switzerland. They were asked about their self-rated health status, all medical conditions experienced in the past five years, and the number of days they were hospitalized and off work in 2019. They were also asked whether they had their own general practitioner (GP) and seen a psychiatrist/psychologist in the past 12 months. A total of 503 PCPs were included in the study (women = 51%, GPs = 67%, pediatricians = 19%, gynecologists = 14%). Ninety-four percent considered themselves in good or very good health. In the past five years, PCPs suffered mostly from depression/anxiety (21%), burnout (21%), dyslipidemia (19%) and hypertension (17%). Male and older PCPs had more often cardiovascular disorders, younger PCPs and GPs had more often psychiatric disorders. They were 9% to have been hospitalized (15% for PCPs over 60) and 20% to have been off work (32% for PCPs under 45). Only 47% had their own GP (37% for GPs). They were 16% (mostly female and younger PCPs) to have consulted a psychiatrist/psychologist. In conclusion, although PCPs considered themselves to be in good health, a substantial proportion suffered from a medical condition, mainly psychiatric (depression or burnout) and/or cardiovascular disorders, or were recently hospitalized or off work. Only half had a GP for themselves. These results may be useful for implementing specific health strategies targeting PCPs

The prevalence of five lifestyle risk factors in primary care physicians: A cross-sectional study in Switzerland.

Having a healthy lifestyle is important not only for the health of physicians, but also for the realisation and effectiveness of counselling on patients. Information on lifestyle habits and the presence of health-related behaviours in primary care physicians (PCPs) is lacking. Using a cross-sectional study design, an anonymous questionnaire was sent to a random sample of 1'000 PCPs practicing in the seven Western cantons of Switzerland. In our sample, we assessed the presence of five lifestyle risk factors, namely current smoking, at risk alcohol consumption, insufficient physical activity, being overweight and insufficient hours of sleep. 510 physicians participated in our study (51% participation rate). Respondents were 51% women, with a majority of general practitioners (67%), followed by paediatricians (19%) and gynaecologists (14%). 57% of PCPs had no or one lifestyle risk factor, 40% had two or three and 3% had four or all five. The average number of lifestyle risk factors was 1.39. Insufficient physical activity was the most prevalent lifestyle risk factor (40%), followed by excess weight and insufficient hours of sleep (32%), at risk drinking (25%) and current smoking (9%). Having ≥2 lifestyle risk factors was associated to being a man, working in a solo practice and for ≥7 half-days per week. Overall, a majority of Swiss PCPs have no or one lifestyle risk factor, but certain unfavourable health-related behaviours are present, notably insufficient physical activity. Developing strategies and courses to improve physicians' lifestyles should be proposed early on in the medical curriculum

Primary Care Physicians' Personal and Professional Attributes Associated With Forgoing Own Care and Presenteeism: A Cross Sectional Study.

Objective: The aim of this study was to describe the prevalence of forgoing care and forgoing sick leave among primary care physicians (PCPs) in Switzerland and to investigate associated factors. Methods: A random sample of 1,000 PCPs in French-speaking regions of Switzerland (participation rate: 50%) was asked whether they had forgone care and sick leave during the last year. Sociodemographic, personal and occupational characteristics were recorded. Logistic regressions were performed to study these behaviours. Results: 37% of respondents reported at least one episode of forgoing care and 29% reported an episode of forgoing sick leave. No associations were found between individual characteristics and forgoing care. A heavy workload was the most common reason evoked for forgoing care. Coming to work when sick (presenteeism) was associated with female sex, younger age, having a chronic illness, working in a suburban area and working full-time. Conclusion: A high proportion of PCPs in Switzerland is forgoing own care and continues to work despite sickness. New generations of PCPs should require careful monitoring, and specific solutions should be sought to reduce these harmful behaviours

Anatomical localization of corticotropin-releasing activity in the human brain

Corticotropin-releasing activity (CRa) and arginine-vasopressin (AVP) content were measured in seven human hypothalami. The hypothalami were obtained from routine autopsy of patients suffering from no obvious neuroendocrinological abnormality. Twelve distinct hypothalamic areas were dissected in the frozen state and extracted in aqueous solution. CRa was measured by a bioassay measuring the aCTH released by rat pituitary cells in vitro, and vasopressin by direct radioimmunoassay. CRa was detectable in almost every area with the highest values in the supraoptic, paraventricular and infundibular (arcuate) areas. Vasopressin concentrations were maximum in the supraoptic nucleus, followed by the paraventricular and infundibular nuclei. We conclude that: hypothalami obtained from routine autopsy at a general hospital can be used for consistent CRa and vasopressin assay. Vasopressin and CRa are similarly distributed in man and in the rat. In both species, high CRa, which is not explained by AVP, is found in the paraventricular nucleus. The infundibular (arcuate) nucleus seems to display non AVP-dependent CRa much greater in the human than in the rat