Abdominal radiography typically offers limited diagnostic value with relatively low sensitivity and specificity. According to the National Radiation Protection Board, one abdominal x-ray (AXR) is equivalent to thirty chest x-rays. To guide its appropriate use, the iRefer guidelines developed by the Royal College of Radiologists (RCR) provide recommendations on when AXRs may provide useful diagnostic information.To determine whether AXR indications in general practice align with the RCR iRefer guidelines.All patients who had an AXR performed in health centres in XXX between January and June 2025 were included. Data collected included patient demographics, request details for AXRs and x-ray reports.A total of 148 AXRs were taken, approximately 25 x-rays monthly. 57% of patients were male and 43% female. Ages ranged from 2 to 89 years, with the commonest age group being 60 years and over. All AXRs had an indication present, with 52.7% regarded as appropriately indicated as per iRefer guidelines, while 47.3% were not indicated. The commonest indication was suspected bowel obstruction (34.5%), followed by abdominal pain (17.6%) and constipation (13.5%). Faecal loading was the commonest reported finding (52.7%). Only 7.8% of AXRs ordered in view of suspected bowel obstruction showed actual evidence of obstruction, whilst in those taken in view of foreign body ingestion, 36.8% showed evidence of a radio-opaque substance.Compliance with RCR guidelines when ordering AXRs in general practice was not optimal. Although there is limited literature available on the subject, our findings showed that there might be AXR overuse in general practice. This might be stemming from the notion of ordering AXRs as a “screening tool” to rule out serious pathology and the lack of familiarity with the RCR guidelines. A limitation of our audit was that our results were influenced by the quality of the documented x-ray indication by the requesting physician, which might have led to misclassification of guideline adherence.Our study highlighted that almost half of AXRs performed in general practice in XXX were not indicated as per iRefer guidelines. Increasing awareness of the indications for abdominal radiography can limit unnecessary radiation exposure and improve quality of patient care.

Algorithm-based validation of medical prescriptions is increasingly used to standardise care. Since June 2024 in France, prescriptions for continuous positive airway pressure (CPAP) therapy for sleep apnea must be validated through a national algorithm based on French National Authority for Health (HAS) criteria. While this system aims to improve efficiency and equity, its impact on complex, real-life primary care situations—where clinical judgement is essential—remains poorly documented.We conducted a practice-based retrospective review of electronically submitted CPAP prescriptions between June 2024 and September 2025. Data from 127 submissions were analysed to document algorithm-based decisions, administrative outcomes at the Commission de Recours Amiable (CRA), and the role of the general practitioner (GP) in the appeal process.This contribution provides a rare real-world primary care perspective on the practical limits of algorithm-based medical validation. It explores how digital decision-support systems may outweigh general practitioners’ clinical assessment of treatment benefit. Rather than a theoretical evaluation of artificial intelligence, this reflection highlights how administrative frameworks can shape the balance between algorithms and professional judgement in everyday practice.The analysis showed that 30% of prescriptions were rejected by the validation system. Rejections mainly concerned patients whose clinical profiles were consistent with international recommendations but did not meet national threshold-based criteria. Several patients had an apnea–hypopnea index below 15/h but significant respiratory events during REM sleep or in the supine position. The appeal process relied exclusively on the initial algorithm-based opinion, without medical reassessment, and did not integrate the GP’s documentation of clinical improvement. Older patients with multimorbidity or cognitive impairment were particularly affected.This reflection highlights tensions between algorithm-driven decision-making and the realities of primary care. Reliance on global numerical thresholds may overlook clinically meaningful situations, while the absence of a medical reassessment pathway during appeals undermines continuity of care and professional responsibility.Algorithm-based validation should support, not replace, clinical judgement. Digital decision-support systems need to evolve to integrate contextual clinical information and observed treatment benefit, ensuring that standardisation does not limit patient-centred care.

The goal of environmental health is to identify environmental exposure threatening human health, in order to control, reduce and prevent its impacts. Recent massive environmental change is of interest in studies due to its link to health in general. Health systems undergoing a “green” transition allow an opening for healthcare workers  to participate in the inclusion of environmental factors in care.Our main goal in this thesis was to study the way primary healthcare workers in the XXX region practice with environmental health in mind. The different level of interest between professions was also a point of interest.Ours is an observational, transversal, descriptive study. The medium used is an online questionnaire shared via email to various healthcare workers, including general practitioners, nurses, midwives, physiotherapists and pharmacists shared between April and July 2024.We included 128 healthcare workers in our study. A majority of them were general practitioners, working in a semi rural area, more often young women settled in their practice for more than ten years, and having some previous knowledge of environmental health. Our study shows a positive correlation between personal life and professional life interest in environmental health. Midwives give significantly more preventive environmental health advice. Healthcare workers report needing better training and more time to include environmental health in care.Our participation rate was very low, estimated at 1,5%. Our sample is therefore not representative of the primary healthcare workers of the region XXX. Our study seems to show increasing interest in healthcare workers for environmental health compared to previous studies. However, interest seems lower when compared to other countries experiencing climate change more acutely. Within our sample, there is differential interest within the professions when it comes to environmental health.Primary healthcare workers in our study seem to be aware of the importance of environmental health. However, there is insufficient training and an important time constraint preventing them from including it in care.  Complementary studies on patient expectations from healthcare workers could be of interest in the future.

Targeted antimicrobial susceptibility testing (AST) enhances urinary track infections antibiotic stewardship by supporting recommended empiric treatments and reducing the use of critically important antibiotics. As recommended by HAS 2023, partial AST reporting applies only to positive enterobacteria urine cultures in women and girls aged ≥12 years. Despite their potential benefits, the extent of their implementation in routine laboratory practice remains unclear.To assess the implementation of targeted AST in French medical laboratories, identify barriers to adoption, and explore factors facilitating their use.A 23-section questionnaire was developed by 12 biologists and physicians from 7 regions. It covered laboratory characteristics, implementation modalities, frequency of use, communication strategies, professional perceptions, and identified barriers and facilitators. The survey was distributed between March and June 2025 through the Regional Antibiotic Therapy Centers Network, Mobile Antibiotic Therapy Teams, the Ministry's Infection Prevention and Antimicrobial Resistance Mission, social media, and direct contacts with independent laboratories, with multiple reminders. Descriptive analysis was performed using frequencies and percentages.A total of 148 biologists responded, representing 91 departments (90%) and about 52% of French laboratories. Of these, 65 (44%) reported using targeted AST. Among the 83 non-users, the main barriers were insufficient human or material resources (n=54; 63%) and lack of time (n=34; 41%). Among the 65 users, 50 (78%) complied with national health authority recommendations, while 27 (41%) extended targeted AST to male and/or pediatric urinary tract infections. Prescriber adherence was considered good by 60 respondents (92%). The main limitations reported by users were poor quality of clinical information provided on prescriptions (n=49; 75%) and difficulties in obtaining additional patient data when needed (n=38; 58%).Only 44% of respondents use targeted AST, primarily hindered by organizational constraints rather than scientific disagreement. However, strong prescriber adherence and extension to men and children demonstrate growing acceptance.Targeted AST faces significant implementation barriers but shows promising results. To facilitate adoption, the Regional Antibiotic Therapy Centers Network provides a standardized prescription form and informational letter. Addressing resource limitations and improving clinical information quality remain key priorities. Extension to other clinical contexts represents a valuable lever for enhancing antimicrobial stewardship in primary care.

Poisonings are a common reason for consultation, yet long-run large-scale XXX epidemiology is scarce. The XXX Poison Control Centre’s historic XXX database, curated from 1988 to 2020, offers a 33-year window on exposures across ages and contexts.To improve primary-care prevention by characterizing trends, risk groups and substances in cases reported to the Centre, using indicators aligned with international studies.Retrospective descriptive analysis (1988-2020) of the XXX (XXX XXX XXX XXX XXX) database (SQL extraction). Age, circumstances and substances were mapped to identify trends and emerging risks.Among 662,179 cases, calls increased until 2013. Children aged 1–5 years were most affected (46.6%). Circumstances were dominated by domestic accidents (67.9%), followed by suicidal ingestions (12.7%), and therapeutic errors (12.1%). Suicidal poisonings mainly involved adolescents (56% in 13–20y). Domestic accidents remained stable, mostly in children. Frequent substances were household detergents (9.1%), benzodiazepines (7.3%), and paracetamol (5.7%). Detergent exposures were almost exclusively accidental (65.8% for <5-year-old; 91.8% accidental). Benzodiazepines and paracetamol were often linked to suicidal intent. Over time, domestic accidents remained stable, while adolescent suicidal poisonings persisted and therapeutic errors rose steadily. Opioid exposures increased nearly fourfold (notably tramadol +311%, codeine +229%, opium +730%), mostly with suicidal intent (48.6%). Most cases were asymptomatic or mild; severe/fatal cases were <1% (574 deaths).Long-term trends show stable paediatric domestic poisonings but persistent adolescent suicidal exposures, especially involving benzodiazepines, paracetamol and opioids. Rising therapeutic errors and the marked increase in opioid cases mirror national patterns and highlight preventable iatrogenic risks. Most exposures were asymptomatic, yet severe presentations clustered in adolescent self-harm. These findings are consistent with international toxicovigilance data and underscore the need for targeted prevention, improved prescribing practices ("less is more" approach), and early GP-led intervention. Integrating similar analyses into a nationwide database would strengthen surveillance capacity and support future public-health action.This is the largest longitudinal poisoning study in XXX. It reveals enduring paediatric domestic risk, sustained adolescent self-harm, and a rising opioid signal. Insights can guide GPs’ anticipatory guidance, safe-use counselling and early intervention.

Primary healthcare (PHC) provides patient-centred care supported by community resources that enhance health and quality of life. This project aimed to improve access to resources by adapting the ecomap concept into a wall-mounted map within a PHC unit. The initiative strengthened support networks, promoted health equity for vulnerable populations, and facilitated connections between healthcare teams and the community. It was guided by the ecomap framework and the Ottawa Charter (WHO, 1986).The project was conducted from July 2024 to July 2025 at a PHC unit and teaching site of IDOMED University of Medicine in Rio de Janeiro, Brazil. The initiative adapted the ecomap concept into a resource map supported by cards summarising contacts. Systematic visits and semi-structured interviews identified and documented twenty free-of-charge social initiatives, an assistance centre for unemployed individuals with disabilities, organisations offering food, clothing, an Alcoholics Anonymous centre, a community empowerment hub for Black women, and a wellness therapy for patients experiencing chronic pain. Activities were coordinated by medical students under supervision. Qualitative feedback showed increased engagement resources. Strengths included cost participatory design; limitations involved restriction absence of quantitative outcomes.Few initiatives in the literature have adapted the ecomap concept into a physical, interactive wall display within PHC settings. This project introduced a low-cost, participatory, engaging tool that transformed abstract social resource mapping into a tangible and accessible instrument for use.The experience reinforced the value of community integration in patient-centred care and highlighted the importance of visual communication tools in promoting health equity. Future steps may include digital versions of the map and evaluation of outcomes such as referrals and satisfaction. The project underscored the role of students in developing innovative public health strategies and can be integrated into primary care training.The wall-mounted map and resource cards proved practical, interactive and accessible for patients and health professionals, fostering collaboration and engagement within the PHC unit.Mapping community assets can support autonomy, promote equity, and foster solidarity through collective action. Although implemented locally, the approach is adaptable to other PHC contexts and may inform policies and training programmes aimed at integrating community resources into primary healthcare.