risk of dia betes, methods used to detect diabetes, and key criteria of study quality. Relative risks (RRs) were pooled using a random-effects mode!. Associations were tested in sub groups representing different patient characteristics and study quality criteria. Results The search yielded 25 prospective cohort studies (N = 1.2 million partici pants) that reported 45 844 incident cases of diabetes during a study follow-up pe riod ranging from 5 to 30 years. Of the 25 studies, 24 reported adjusted RRs greater than 1 (range for ail studies, 0.82-3.74). The pooled adjusted RR was 1.44 (95% con fidence interval [Cl], 1.31-1.58). Results were consistent and statistically significant in ail subgroups. The risk of diabetes was greater for heavy smokers (220 cigarettes/ day; RR, 1.61; 95% Cl, 1.43-1.80) than for lighter smokers (RR, 1.29; 95% Cl, 1.13- 1.48) and lower for former smokers (RR, 1.23; 95% Cl, 1.14-1.33) compared with active smokers, consistent with a dose-response phenomenon. Conclusion Future research should attempt to establish whether this association is causal and to clarify its mechanisms.

3,537 men enrolling in 2007 for mandatory army recruitment procedures were assessed for the co-occurrence of risky licit substance use among risky cannabis users. Risky cannabis use was defined as at least twice weekly; risky alcohol use as 6+ drinks more than once/monthly, or more than 20 drinks per week; and risky tobacco use as daily smoking. Ninety-five percent of all risky cannabis users reported other risky use. They began using cannabis earlier than did non-risky users, but age of onset was unrelated to other risky substance use. A pressing public health issue among cannabis users stems from risky licit substance use warranting preventive efforts within this age group.

OBJECTIVES:Exercise combined with nicotine therapy may help smoking cessation and minimise weight gain after quitting. Low participation in vigorous-intensity physical activity programmes precludes their population-wide applicability. In a randomised controlled trial, we tested whether a population-based moderate-intensity physical activity programme increases quit rates among sedentary smokers receiving nicotine therapy.METHODS:Participants (n=481; 57% male; mean age, 42.2 years (SD 10.1); mean cigarette consumption, 27 (SD 10.2) per day) were offered a nine-week smoking cessation programme consisting of a weekly 15-minute counselling session and the prescription of nicotine replacement therapy. In addition, participants in the physical activity group (n=229) also took part in a programme of moderate-intensity physical activity implemented at the national level, and offering nine weekly 60-minute sessions of physical activity. To ensure equal contact conditions, participants in the control group (n=252) attended weekly 60-minute health behaviour education sessions unrelated to physical activity. The primary outcome was continuous CO-verified smoking abstinence rates at 1-year follow-up.RESULTS:Continuous smoking abstinence rates were high and similar in the physical activity group and the control group at the end of the intervention (47% versus 46%, p=0.81) and at 1-year follow-up (27% versus 29%, p=0.71). The mean weight gain after one year was 4.4 kg and 6.2 kg among sustained quitters of the physical activity and control groups, respectively (p=0.06).CONCLUSION:Participation in a population-based moderate-intensity physical activity programme for 9 weeks in addition to a comprehensive smoking cessation programme did not significantly increase smoking cessation rates. A non-significant reduction in weight gain was observed among participants who quit smoking in the physical activity group.TRIAL REGISTRATION:ClinicalTrials.gov; US National Institutes for Health (available online at http://clinicaltrials.gov/;CLINICAL TRIAL REGISTRATION NUMBER:NCT00521391).

Acute non-traumatic headache is a frequent complaint in emergency primary care. In the majority of cases, the cause is a primary headache, which can be invalidating, but should not lead to additional investigations. Secondary headaches are rare but their diagnosis is essential to avoid potentially lethal consequences. In practice, a primary headache may be difficult to differentiate from a secondary headache, especially if the initial management does not follow a systematic approach. We have adapted evidence-based guidelines to improve the diagnostic management of patients presenting acute headache. We propose an algorithm that facilitates the systematic screening of alert signs with a focused patient history and clinical exam. In the presence of red flags, appropriate complementary exams are needed to rule out a secondary headache.

Cette annee, six etudes utiles pour la pratique ont ete retenues. L'indication a la mammographie entre 40 et 49 ans devrait etre evaluee individuellement et en tenant compte des risques/benefices de cet examen. Au-dela de 65 ans, un depistage systematique de la fibrillation auriculaire avec prise de pouls puis ECG (si pouls irregulier) pourrait etre realise de maniere systematique. Les risques de complications postcolonoscopie existent, particulierement suite a des biopsies/polypectomies, et ce risque devrait etre discute. Les inhibiteurs de la pompe a protons au long court sont un facteur de risque de fracture de hanche. S'il est important de prendre en charge des pressions arterielles elevees au-dela de 80 ans, il faut etre prudent (orthostatisme). Une corticotherapie precoce suite a une paralysie faciale peripherique est efficace.

Observational studies have suggested an association between active smoking and the incidence of type 2 diabetes.To conduct a systematic review with meta-analysis of studies assessing the association between active smoking and incidence of type 2 diabetes.A search of MEDLINE (1966 to May 2007) and EMBASE (1980 to May 2007) databases was supplemented by manual searches of bibliographies of key retrieved articles, reviews of abstracts from scientific meetings, and contact with experts.Studies were included if they reported risk of impaired fasting glucose, impaired glucose tolerance, or type 2 diabetes in relationship to smoking status at baseline; had a cohort design; and excluded persons with diabetes at baseline.Two authors independently extracted the data, including the presence or absence of active smoking at baseline, the risk of diabetes, methods used to detect diabetes, and key criteria of study quality. Relative risks (RRs) were pooled using a random-effects model. Associations were tested in subgroups representing different patient characteristics and study quality criteria.The search yielded 25 prospective cohort studies (N = 1.2 million participants) that reported 45 844 incident cases of diabetes during a study follow-up period ranging from 5 to 30 years. Of the 25 studies, 24 reported adjusted RRs greater than 1 (range for all studies, 0.82-3.74). The pooled adjusted RR was 1.44 (95% confidence interval [CI], 1.31-1.58). Results were consistent and statistically significant in all subgroups. The risk of diabetes was greater for heavy smokers (> or =20 cigarettes/day; RR, 1.61; 95% CI, 1.43-1.80) than for lighter smokers (RR,1.29; 95% CI, 1.13-1.48) and lower for former smokers (RR, 1.23; 95% CI, 1.14-1.33) compared with active smokers, consistent with a dose-response phenomenon.Active smoking is associated with an increased risk of type 2 diabetes. Future research should attempt to establish whether this association is causal and to clarify its mechanisms.

Cette revue synthetise cinq articles de therapeutique en medecine interne generale parus en 2006 : lors d'une rhino-sinusite aigue non compliquee, l'usage de corticoides topiques en monotherapie est indique ; les reactions allergiques croisees penicillines/cephalosporines semblent moins frequentes que ce qui a ete etabli jusqu'alors. Dans notre pratique, nous devrions etre plus «pro-actifs» dans la prescription de probiotiques, efficaces dans la prevention de diarrhees secondaires aux antibiotiques; un traitement antibiotique de trois jours est efficace lors de cystite non compliquee chez la femme âgee de moins de 65 ans. Enfin, toute personne sous bisphosphonates doit etre regulierement suivie au niveau dentaire.