Search

Study Objectives International guidelines recommend using benzodiazepine receptor agonists (BZRA) for maximally four weeks. Nevertheless, long-term use for chronic insomnia disorder remains a common practice. This study aimed to test the effectiveness of blended care for discontinuing long-term BZRA use in general practice. Methods A pragmatic cluster randomized controlled superiority trial compared blended care to usual care through urine toxicology screening. In the intervention, care by the general practitioner (GP) was complemented by an interactive e-learning program, based on cognitive behavioral therapy for insomnia. Adults using BZRA daily for minimally 6 months were eligible. Participants were clustered at the level of the GP surgery for allocation (1:1). Effectiveness was measured as the proportion of patients who had discontinued at one-year follow-up. Data analysis followed intention-to-treat principles. Results In total, 916 patients in 86 clusters, represented by 99 GPs, were randomized. Primary outcome data was obtained from 727 patients (79%). At one-year follow-up, 82 patients (18%) in blended care, compared to 91 patients (20%) in usual care, had discontinued. There was no statistically significant effect for the intervention (OR: 0.924; 95% CI: 0.60; 1.43). No adverse events were reported to the research team. Conclusions The findings did not support the superiority of blended care over usual care. Both strategies showed clinical effectiveness, with an average of 19% of patients having discontinued at one-year follow-up. Further research is important to study the effect of structurally implementing digital interventions in general practice. Clinical trial Big Bird trial; KCE-17016. This trial is registered at clinicaltrials.gov (NCT03937180).

"Teen dating violence" is a poorly studied issue in the literature. Several sociodemographic and psychiatric risk factors have been identified in the literature, and the consequences are numerous. The aim of this mixed study is to establish an initial inventory of the problem in French-speaking Belgium, to establish links with the socio-demographic and overall health characteristics of the population, and to issue recommendations for the future.A study by questionnaire was conducted among 103 young people aged between 14 and 18 living in French-speaking Belgium and speaking French in particular. Qualitative and quantitative (descriptive and inferential statistics) analyses were performed.29.1% of respondents experienced violence. Significant links exist between the fact of having experienced violence and consumption as well as the presence of STDs. The combination of potential risk factors predicts a considerable part of the violence in the sample. A significant link exists between the fact of being subjected to violence and a high score on the scale of depression and violence suffered and committed.The prevalence of teen dating violence is relatively high in Belgium. A link between these and a large part of the potential consequences studied could be highlighted through the study.

International guidelines recommend using benzodiazepine receptor agonists (BZRA) for maximally four weeks. Nevertheless, long-term use for chronic insomnia disorder remains a common practice. This study aimed to test the effectiveness of blended care for discontinuing long-term BZRA use in general practice.A pragmatic cluster randomized controlled superiority trial compared blended care to usual care through urine toxicology screening. In the intervention, care by the general practitioner (GP) was complemented by an interactive e-learning program, based on cognitive behavioral therapy for insomnia. Adults using BZRA daily for minimally six months were eligible. Participants were clustered at the level of the GP surgery for allocation (1:1). Effectiveness was measured as the proportion of patients who had discontinued at one-year follow-up. Data analysis followed intention-to-treat principles.In total, 916 patients in 86 clusters, represented by 99 GPs, were randomized. Primary outcome data was obtained from 727 patients (79%). At one-year follow-up, 82 patients (18%) in blended care, compared to 91 patients (20%) in usual care, had discontinued. There was no statistically significant effect for the intervention (OR: 0·924; 95% CI: 0·60, 1·43). No adverse events were reported to the research team.The findings did not support the superiority of blended care over usual care. Both strategies showed clinical effectiveness, with an average of 19% of patients having discontinued at one-year follow-up. Further research is important to study the effect of structurally implementing digital interventions in general practice.

To evaluate the impact of a new Substance Use Disorder (SUD) education program on medical students’ attitudes, we selected the Substance Abuse Attitude Survey (SAAS) questionnaire, which we adapted to our curriculum and cultural context. To validate this adapted version, we conducted an exploratory factor analysis following the administration of our 29-item bSAAS questionnaire to 657 medical students in Belgium (response rate: 71.1%). Twenty-three items correlated to three factors; namely, “Stereotypes and moralism”, “Treatment optimism” and “Specialized treatment” were retained (70% of total variance explained, Cronbach’s alpha = 0.80) and constituted the new questionnaire called beSAAS. The factor “Specialized treatment” stood out from previous studies, which could be explained by our target population and the impact of the formal, informal and hidden curricula in medical education. This study was able to highlight certain factors influencing stereotypical representations such as age, gender, origin, personal or professional experience with substance use. Our study allowed us to retain the beSAAS as a good questionnaire to evaluate SUD stigma and highlighted interesting findings to improve SUD training in medicine. Further studies are needed to complete its validity and reliability.

Background: Diet is an essential determinant of health. Among the health determinants, we find access problemsthat are summarized as food insecurity. While such food insecurity has been studied in other countries andcorrelated to several health problems, it has been scarcely assessed in Belgium. The purpose of this work was todetermine the factors of food insecurity existing within the Belgian population.Method: From November 2016 to February 2017, a qualitative study using semi-structured interviews with 19adults present attending the waiting rooms of six Public Social Action Centers in French-speaking Belgium,analyzed by grounded theory.Results: In Belgium, for given food preferences and needs, food insecurity could be summarized as inadequacybetween necessary and available resources within two dimensions: at the access level, for financial, temporal,informational, and freedom of action, and at the food use level, for temporal factors, material, knowledge, and skills.In these situations of inadequacy, participants reported finding either strategies to restore balance, or being forcedto alter the quality or quantity of their diet.Conclusion: While several factors of food insecurity may exist in Belgium, it appears essential that the first line ofcare these factors into consideration, since they could interfere with care and health, and because the first line ofcare is ideally placed to inform and refer the patients in question. Several courses of action are proposed in thiswork, which must still be confirmed by other studies., info:eu-repo/semantics/published

Background People with substance use disorder, and pregnant women especially, are subject to a lot of stigmas, which can prevent optimal accessibility and quality of care. In this survey, we investigated attitudes of final year medical students regarding substance use during pregnancy and identified the factors that influence these attitudes. Method This cross-sectional study was conducted in 2019 and 2020 in Belgium using the short version of the “Substance Abuse Attitude Survey” questionnaire. We focused on two items regarding punishment of substance use during pregnancy. We analysed the concordance between these two, their correlation with other items (e.g. stereotyping, morality, forced withdrawal, low treatment optimism) and the association between respondents’ opinion on punishment and their sociodemographic data. Results The response rate was 65.2% (370/567 online and face-to face questionnaires). 19.2% of respondents were in favour of punishment for alcohol use (n = 353) and 15.1% for drug use (n = 356) during pregnancy. The agreement analysis between the two items showed that 14.3% of students were in favour of punishing both pregnant women who use drugs and those using alcohol. Respondents tended to be more in favour of punishment if they were male students, older, their mothers’ had a lower education level or had no personal or family history of substance use. Attitudes appeared to be more punitive among students with limited contact with people with substance use disorder (i.e. none or limited to hospital). Students intending to specialise in internal medicine were more in favour of punishment of women whereas none of those intending to specialise in psychiatry were in favour. Conclusion Our study shows that about 20% of surveyed medical students favoured punishing substance-using pregnant women. Awareness and training work seems to be necessary to ensure adequate care and support for this already vulnerable population.

info:eu-repo/semantics/published

Introduction Problematic benzodiazepine use is a global health issue. Although the adverse side effects of long-term use of benzodiazepines are well known, it remains difficult to implement interventions for discontinuation in primary care. Considering the success of blended care for the treatment of sleeping disorders and the support of substance use disorders, evidence suggests that a blended care approach, combining face-to-face consultations with the general practitioner with web-based self-learning by the patient, is beneficial for the discontinuation of chronic benzodiazepine use for primary insomnia in general practice. Therefore, the aim of this study is to evaluate the effectiveness of such an approach for the discontinuation of benzodiazepine and zolpidem, zopiclone and zaleplon drugs ((z-)BZD) use in the long term and evaluate the implementation process. Methods and analysis This study is a multicentre, pragmatic, cluster randomised controlled trial with 1200 patients, included by 120 general practitioners. Allocation to usual or blended care happens at the level of the general practice in a 1:1 ratio using a block randomisation system stratified per language. The study population consists of adult primary care patients who have been using (z-)BZD for primary insomnia on a daily basis for at least 6 months. Primary outcome measure is the proportion of patients that discontinued (z-)BZD at 12 months assessed by toxicological screening for (z-)BZD in urine. Secondary outcomes include discontinuation of (z-)BZD at 6 months, quality of life and the number of defined daily doses of (z-)BZD prescribed. Data will be collected using a study-specific online platform and analysed using the intention-to-treat approach. The process of implementing blended care will be evaluated in a nested study. Ethics and dissemination This trial was approved by the Ethics Committee for Research of UZ/KU Leuven (ref. S61194). Study results will be disseminated via open-access, peer-reviewed publications and conference presentations. Trial registration number NCT03937180., SCOPUS: ar.j, info:eu-repo/semantics/published

Background: In Western countries, many children are affected by the separation of their parents. The study's main objective was to analyse the parental behaviours potentially influential for preschool children's health by family structure (parents together or separated). Methods: We conducted a cross-sectional study based on data collected from examinations as part of free preventive medical consultations in the French Community of Belgium. During the assessment of 30,769 infants aged 28 to 32 months, information was collected on the parents' use of tobacco, brushing of the infant's teeth, being monitored by a dentist, and receiving vision screening. The chi2 test was applied and the odds ratios were derived to compare the two groups of children (exposed/not exposed to parental separation). Multivariate logistic regression analyses were used to adjust the effect of exposure. Results: Nearly one in ten (9.8%) did not live with both parents under the same roof. Taking into account the social and cultural environment and other potential confounders at our disposal, we found that in the event of parental separation, behaviours differ in comparison with situations where parents live together; the adjusted odds ratios (ORs) (95% confidence interval) for the infant's exposure to tobacco, absence of teeth brushing, lack of monitoring by a dentist and absence of visual screening, were respectively 1.7 (1.2-2.0), 1.1 (0.9-1.2), 1.3 (1.1-1.6), 1.2 (1.1-1.2), and 1.2 (1.1-1.4). Conclusions: This study confirms the suspicion that parental separation is an independent risk factor for parental behaviours that negatively influence the infant's health. If these results are confirmed, this it could affect the work of the family doctors and paediatricians, especially in terms of family support and information to parents., SCOPUS: ar.j, info:eu-repo/semantics/published

Context :In Belgium 70 % of the children aged 0 - 14 years have at least one annual contact with their family doctor, while for the same period, only 6 - 12 % of them will see a neuropaediatrician and/or a child psychiatrist, despite the fact that a diagnostic of Externalizing behavior before the age of 6 to 7 years, such as various ways of aggressiveness, of anger or of stealing will very often alert the family, the staff of creches or nursery as well as the teachers. Other children are showing signs of Internalizing behavior, very often together with depression or other forms of anxiety. Objective :Considering the role and the skills of the family doctor, the target is to propose a clinical approach adapted to the first line practitioner having to face the majority of complaints about the behaviour of a child younger than 10 years. Methodology: Bibliographic research. The research equations were used on the data base TRIP DATA BASE, Cochrane Library, PUBMED and Google Scholar (EN/FR), searching, bare exception, the literature of the last five years. Moreover, the sites of the Haute Autorité Française (HAS), Société Scientifique de Médecine Générale (SSMG), Centre d'Expertise en Soins de Santé (KCE), Institut Scientifique en Santé Publique (ISSP) and of the DSM V (Diagnostic and Statistical Manual of Mental Disorders) were consulted too. Results :The age of the child, his social and family environment will guide the family doctor and in the majority of cases, he will be able to reassure the family. Moreover, when in front of any problem within the family life it should be advisable to inquire about the health of the children in question, especially from a behavioural point of view. To the opposite, when a child is showing TEC or TIC, it is important to inquire about circumstances in his environment that might potentially be at the origin of (or contributing to) the troubles. Conclusions :The challenge the family doctor is facing is to be able in a consultation of 15- 30 minutes to make the difference between serious and less serious behaviour troubles of the child. We are suggesting a first approach to a tool that would allow the front-line doctors to make an evaluation. More developed evaluation scales to be used by the family doctor will be the subject matter of future research work., SCOPUS: ar.j, info:eu-repo/semantics/published

Background: In Western countries, many children are affected by the separation of their parents. Our mainobjective was to assess the possible impact of parental separation family structure on certain aspects of somatichealth in low-age children.Methods: We conducted a cross-sectional study based on data collected in the framework of free preventivemedicine consultations in the French Community of Belgium. The data was derived from assessments conducted,between 2006 and 2012, on children 7 to 11 months after birth during which information of 79701 infants wascollected regarding the risk of sudden infant death, psychomotor development, and development in terms ofheight and weight. The main outcome measures were: episode of risk of sudden infant death, polysomnography,home monitoring, psychomotor development, and body mass index.Results: The parents of 6.6% of the infants were separated. We established multivariable models, based on thepresence or absence of confounders. The adjusted ORs (95% CI) of symptoms perceived as frightening, notably atnight, of a prescription for a polysomnography, of an abnormal polysomnography result, and of follow-up by homemonitoring were thus respectively 1.3 (1.1–1.6), 1.1 (0.9–1.3), 1.8 (1.3–2.4), and 1.3 (1.1–1.6). The adjusted ORs (95% CI)for psychomotor delay and for a body mass index above the 97th percentile were respectively 1.3 (1.0–1.6) and 1.2(1.1–1.3) in the event of separation.Conclusions: This study confirms the possibility that not living with both parents is an independent risk factor for thesomatic health and psychomotor development of infants. This observation should be verified because it would have amajor impact on the actions of family doctors and other first-line healthcare providers, in particular with regard toinformation and targeted prevention., SCOPUS: ar.j, info:eu-repo/semantics/published

Objective Analyse the parental behaviours that are recognised as influencing the health of very young children based on family structure (parents separated or not).Design Cross-sectional study.Setting Free preventive medicine consultations in the French Community of Belgium.Participants Examination of 79 701 infants aged 7–11 months as part of a free preventive medicine consultation. The data came from an assessment conducted 7–11 months after birth during which information was collected, namely about the parents’ use of tobacco, the infant’s type of nutrition and adherence to vaccination schedules.Main outcome measures Parental behaviours: smoking, nutrition and compliance with vaccination schedule.Results The percentage of infants whose parents were separated was 6.6%. After adjusting for the cultural and socioeconomic environment as well as for other potential confounders, in the event of separation as compared with non-separated parents, the adjusted ORs (95% CI) were as follows: 1.5 (1.3 to 1.7) for the infant’s exposure to tobacco; 1.3 (1.2 to 1.4) for total lack of exclusive breast feeding; 1.3 (1.1 to 1.4) and 1.2 (1.1 to 1.2) for breast feeding for a duration of less than 3 and 6 months, respectively; 1.2 (1.1 to 1.4) for non-compliance with the vaccination schedule against rotavirus. The duration of exclusive breast feeding was shorter when parents were separated (p, SCOPUS: ar.j, info:eu-repo/semantics/published

Background: Many children are experiencing their parents’ separation and General practitioners (GPs) oftenhave the responsibility to medically follow these young patients.Objectives: The goals were to identify the main difficulties GPs are confronted with when following childrenof separated (or divorced) parents and to find ways to improve the quality of these children’s continuous medicalmonitoring.Methods: Eight focus groups of GPs were organized in 2004 in the French-speaking Community of Belgium.Each meeting focused on couples separated for less than three years, with children aged 0 to 15. The debates wereanalysed with the QSR N5 software. Data saturation was obtained after four focus groups.Results: The viewpoint of GPs is: 1. Divorce affects the working conditions of GPs. 2. Conflicts between theparents cause difficulties for the GP, particularly the fact of being « exploited » by the parents. 3. All GPs do nothave the same attitude towards conflicts between the parents; only some of them will try to « manage » the conflictsto improve the child’s situation. 4. Especially in the case of conflicts, parental separation brings a risk for the child:psychological disorders, physical health problems. 5. The professional attitudes of GPs can have a positive influenceon the child’s development, including direct child-centred communication with the child. 6. Some actions, such asproducing sickness certificates or official reports of neglect, can aggravate these children’s situation, especially inthe case of conflicts between the parents.Discussion: Parental separation could be an independent risk factor for the child’s health by inducing somedifficulties of tracking in primary care medicine. If this is confirmed, in case of a family breakdown, the GP shouldadapt the practice of prevention and care, recognizing young patients as most at risk. In order to confirm the possibleimpact of family status, cohort studies must be conducted either transverse observational targeting unselectedpaediatric populations of different ages, or even better in prospective research. Given the high prevalence of parentalseparation in Belgium, the influence of these situations should be measured in terms of public health., info:eu-repo/semantics/published

Analyse deWhite P, Lewith G, Prescott P, Conway J. Acupuncture versus placebo for the treatment of chronic mechanical neck pain: a randomized, controlled trial. Ann Intern Med 2004;141:911-9.Question cliniqueCette étude en simple aveugle montre qu'un traitement par acupuncture, comparé à un traitement par simulation électrique, n'est pas plus efficace dans le soulagement des cervicalgies chroniques d’origine mécanique. Ces résultats confirment les conclusions d'autres études et de méta-analyses précédentes.Conclusion Minerva:Cette étude en simple aveugle montre qu'un traitement par acupuncture, comparé à un traitement par simulation électrique, n'est pas plus efficace dans le soulagement des cervicalgies chroniques d’origine mécanique. Ces résultats confirment les conclusions d'autres études et de méta-analyses précédentes., info:eu-repo/semantics/published

Contexte: En Belgique, on évalue à 600.000 le nombre de mineurs vivant à un moment donné la séparation de leurs parents, ce qui est déjà le cas pour 10% des enfants en âge préscolaire pour monter à 25, voire 30% pour les adolescents. Une étude qualitative finalisée en 2006, avait permis d’établir un premier état des lieux, en analysant 240 cas de séparation concernant des enfants de 0 à 15 ans. Les éléments reconnus importants étaient les suivants: - Dans les suites d’une séparation, les enfants de parents séparés risqueraient plus souvent que les autres, des troubles psychologiques, somatoformes ou comportementaux, des difficultés scolaires et des problèmes liés à la gestion de leur santé physique.- Les conflits entre les parents après la séparation sont un facteur de risque majeur de troubles pour l’enfant et de difficultés de suivi pour le généraliste.- L’environnement de l’enfant après la séparation et notamment le type de garde influence également l’évolution du jeune patient, même si aucun type d’hébergement (alterné ou pas) ne parait adapté à toutes les situations.- Les principales difficultés professionnelles pour les généralistes sont le fait d’être «instrumentalisés» par les familles avec ses corollaires et par exemple l’aggravation de la situation de l’enfant, de même que le morcellement du suivi médical.Objectif: Dans les suites de cette recherche, et en tenant compte de la littérature disponible, nous avons voulu étudier l’hypothèse selon laquelle le fait pour un enfant de ne pas vivre avec ses deux parents, serait un facteur de risque indépendant pour sa santé.Si cette hypothèse devait se confirmer il était prévisible que le généraliste en soit le témoin privilégié.Méthodologie: A cette fin, nous avons procédé à des études transversales à partir de données de la Banque de données médico-sociales de l’Office de la Naissance et de l’Enfance (ONE) pour les enfants de 7 à 32 mois. Ensuite, nous avons confronté ces résultats avec ceux rapportés par la littérature et ceux de notre étude qualitative.Résultats:Ce que les résultats confirment:Pour les enfants de 7 à 32 mois, nos travaux corroborent l’utilité d’un travail de prévention tant primaire que secondaire, à l’intention de toutes les familles d’enfants de moins de trois ans, entre autre pour l’éviction du tabac dans les habitations, le respect du calendrier vaccinal et pour une alimentation optimale. De même, les parents doivent être encouragés à suivre, les recommandations concernant l’hygiène buccodentaire et la détection précoce de l’amblyopie. Nous confirmons aussi la nécessité de la promotion auprès de toutes les familles, des conseils de sécurité autour du sommeil du nourrisson, de même que la surveillance de l’évolution du développement psychomoteur et du BMI des enfants en âge préscolaire. Nos résultats comme ceux rapportés par la littérature, rappellent que les jeunes issus des familles les plus démunies et au sein desquelles les parents sont les moins instruits, non seulement bénéficient plus rarement d’un environnement optimal pour leur évolution, mais aussi que dès les premiers mois après leur naissance, plus souvent, ils présenteront des problèmes de santé. Ce que les résultats révèlent:Par comparaison avec les parents vivant ensemble, lorsque les parents d’enfants de 7 à 32 mois vivent séparément, leurs comportements sont significativement moins souvent adéquats quelque soit le niveau social, et ce en matière de tabagisme dans l’habitation, d’alimentation, de vaccination, de suivi des recommandations d’hygiène buccodentaire et de dépistage de l’amblyopie. Par ailleurs, lorsque les parents ne vivent pas ensemble et en tenant compte des confondants potentiels, les enfants risquent plus fréquemment de présenter certains troubles du sommeil (Apparent Life-Threatening Event - ALTE), ont plus fréquemment un résultat anormal à la polysomnographie et nécessitent plus souvent un monitoring à domicile. Toujours en considérant comme référence la famille avec les deux parents sous le même toit, on observe chez ces enfants de moins de trois ans, un ralentissement relatif de leur développement psychomoteur surtout au niveau des compétences graphiques et langagières et ce de manière indépendante vis-à-vis des facteurs causaux connus. Il est également possible, que la configuration familiale ait une influence sur l’évolution du Body Mass Index (BMI), comme objectivé chez les nourrissons de 7 à 11 mois :en cas de séparation, le risque de surpoids est significativement augmenté. Discussions et conclusions: La particularité de ce travail, est le fait que pour la première fois en Fédération Wallonie-Bruxelles, nous avons pu quantifier des associations entre la séparation parentale et plusieurs indicateurs concernant la santé des enfants de moins de trois ans. Ainsi, nos résultats confrontés à ce que nous rapporte la littérature, nous font prendre de la distance avec l’idée habituellement véhiculée, que l’évolution plus fréquemment moins optimale des enfants de parents séparés, serait uniquement la conséquence d’un environnement économiquement plus précaire. Ce que les résultats impliquent en termes de pratique clinique:En tenant compte à la fois de la littérature, des résultats de notre étude qualitative et de nos études transversales, nous proposons un ensemble d’attitudes susceptibles d’améliorer nos pratiques ambulatoires de première ligne. En effet, à ce niveau la proactivité du généraliste reste essentielle, car presque toutes les familles du pays ont un médecin de famille attitré, que consultent au moins une fois par an (en moyenne 4 fois) 90% des adultes et 70% des enfants. On sait aussi que plus les familles vivent des difficultés socioéconomiques et plus elles consulteront leur généraliste.- Un travail de prévention auprès de toutes les familles d’enfants de 7 mois à 32 mois, en matière d’éviction du tabac dans les habitations, de respect du calendrier vaccinal, d’une alimentation optimale (allaitement les 6 premiers mois et/ou lait adapté pour l’âge), mais aussi de santé buccodentaire et de suivi des recommandations en matière de dépistage de l’amblyopie.- Un travail ciblé de promotion de la santé et de prévention en étant particulièrement attentif non seulement aux parents et enfants démunis pour des raisons matérielles et/ou culturelles, ou lorsque les mères sont âgées de moins de 18 ans, autant de situations déjà connues dans lesquelles les adultes sont moins informés concernant leur propre santé et celle de leurs enfants, mais aussi lorsque les parents ne vivent pas sous le même toit.- Une détection optimalisée des problèmes de santé de l’enfant de moins de trois ans, surtout s’il avait un petit poids à la naissance, lorsque sa mère est très jeune, si sa famille est démunie pour des raisons matérielles et/ou culturelles, mais également lorsque ses parents ne vivent pas ensemble.- Un travail d’accompagnement et d’information des couples de parents d’enfants en bas âge en s’informant sur la qualité relationnelle entre les parents et ce en vue de détecter les conflits, voire la violence entre les conjoints. A chaque contact avec une famille dans les premières années après une naissance, nous proposons de s’enquérir des difficultés rencontrées, informer le ou les parent(s) de ce qui est «banal» ou pas, d’évaluer l’état de santé des parents et de proposer les solutions les plus adéquates aux différents problèmes.- Un accompagnement des (futurs) parents vivant ensemble ou non et notamment en les informant également sur les différences observées en matière de santé de l’enfant en fonction de la situation familiale (parents sous le même toit ou non).- Un accompagnement des familles dont les parents entrevoient leur séparation ou qui ne vivent pas/plus sous le même toit pour le suivi de l’enfant. Les grands axes sont les suivants:  S’informer systématiquement sur la situation familiale de l’enfant. Informer/sensibiliser les parents en voie de séparation/séparés (ou non) sur les risques pour les enfants dans les suites d’une séparation parentale. Informer les parents sur les facteurs aggravants et protecteurs pour l’enfant. Améliorer le suivi médical de l’enfant en proposant le choix d’un seul généraliste pour le suivi de l’enfant. Mais aussi, en cas de morcellement du suivi, communiquer entre confrères (avec si possible partage des dossiers). Ecouter la plainte de l’enfant en s’adressant à lui directement, soutenir l’enfant psychologiquement et le référer vers d’autres lignes de soins si jugé utile. Tenir compte du conflit entre parents :Diagnostiquer le conflit en collectant activement les informations nécessaires, éviter d’être instrumentalisé par les parents pour ne pas aggraver le conflit et le mal-être de l’enfant et si possible rétablir une communication entre les ex-conjoints (en respectant l’impartialité, en parlant aux deux parents, en soumettant des suggestions aux deux parents), même lorsque l’on ne suit plus qu’un seul parent. Soutenir les parents en écoutant leur plainte.Ce que nos résultats impliquent d’un point de vue santé publique en Belgique:Des répercussions collectives de la séparation parentale sont probables et ce par différentes voies.- Via les conséquences directes et à court termes de la population d’enfants de moins de trois ans :en partant des résultats de nos études transversales, nous avons estimé les fractions étiologiques du risque chez les exposés ou dans la population. Nous constatons que de manière notable les problèmes listés chez les enfants de 7 à 32 mois lors des bilans ONE entre 2006 et 2012, sont attribuables soit dans la population, soit parmi les enfants exposés, au fait que les parents ne vivent pas ensemble, et ce de manière indépendante par rapport aux confondants potentiels dont entre autre, le niveau social. Ces items répertoriés, sont par définition prépondérants en matière de prévention collective, puisqu’ils sont évalués par un organisme dont le rôle est justement de favoriser le bien-être au niveau pédiatrique, dans le cadre d’une vision globale de santé publique. - Via les conséquences à long termes pour l’adolescent ou l’adulte, ayant vécu la séparation de ses parents au cours de l’enfance :notre étude qualitative en focus group, de même que la littérature confirme l’hypothèse selon laquelle l’adolescent ou le jeune adulte ayant vécu une séparation parentale pendant son enfance, présenterait plus de troubles tant somatique que psychosociaux, notamment liés aux style de vie plus à risque comme la consommation de tabac ou d’alcool. - Via la précarité engendrée par la séparation :l’impact de la séparation des parents sur la santé de l’enfant est probablement à la fois direct (effet de la séparation par elle-même) et indirect via la précarité induite par la dissolution familiale.- Du point de vue de l’enfant, la séparation équivaudrait à une adversité environnementale indépendante qui agit potentiellement comme un filtre de sélection, en termes de réussite scolaire et les implications que cela suppose (intégration professionnelle, niveau d’instruction et de vie, santé globale), mais aussi en termes d’influence directe et indirecte (comportements de l’entourage) sur la santé somatique et psychologique des jeunes et ce par comparaison avec les situations familiales où les deux parents vivent ensemble.Perspectives:Ces résultats appellent d’autres questions de recherches.- L’association entre la séparation parentale et la santé de l’enfant, se vérifie-t-elle en Belgique lorsque celui-ci est plus âgé? En ce moment Maud Dujeu et Isabelle Godin (ESP-SIPES-ULB) procèdent au travail d’analyse ciblant les 10 à 19 ans en partant de l’enquête de santé des jeunes en âge scolaire 2010.Par ailleurs nous prévoyons d’initialiser une étude transversale observationnelle centrée sur les enfants de 5 à 6 ans à partir des dossiers de médecine scolaire.- Que dit la littérature concernant la santé somatique de l’enfant dont les parents ne vivent pas ensemble? Nous prévoyons une synthèse méthodique des études ciblant la santé somatique des enfants à différents âges. - Quels sont les éléments associés à l’évolution favorable des jeunes en cas de séparation parentale? Nous devrions déterminer quels sont les facteurs de protection et de vulnérabilité ayant un impact sur l’évolution d’un enfant du point de vue de sa santé psycho-sociale, scolaire et somatique, et ce quel que soit l’environnement familial. Une étude prospective d’observation suivant des enfants dès leur naissance (ou leur conception) pourrait lever les doutes en matière de causalité entre la structure familiale et la santé de l’enfant, et faire apparaître les facteurs de risque et de protection vis-à-vis des problèmes potentiels. Cela nécessiterait une collaboration interdisciplinaire de large envergure.Par ailleurs, des études à design qualitatif individuel ou en groupe de parents, enfants et adolescents pourraient aussi apporter des informations à ce niveau.- Inciter au niveau fédéral ou régional, un recensement récurrent des différentes structures familiales du point de vue de l’enfant, élément important d’un point de vue santé publique., Doctorat en Sciences médicales (Médecine), info:eu-repo/semantics/nonPublished

Tobacco is a major health problem leading to 20.000 deaths between the ages of 35 and 69 each year in Belgium. This is the reason why all general practitioners should be concerned about this problem and mainly because there is existing evidence that some of their simple professional attitudes accompanying smoking cessation could be effective. This article proposes all valid attitudes adapted for the management of smoking cessation in primary care, not only for adults but also for adolescents., English Abstract, Journal Article, info:eu-repo/semantics/published

BackgroundIn Western countries, about a quarter of children are affected by parental separation and a number of authors have previously investigated how familial structure impacts children’s health. The purpose of the work: to analyze the psychomotor development of children aged 28 to 32 months based on family structure (parents together or separated), independently of the influence of socio-economic environment that is well documented.To analyse the psychomotor development of children younger than 3 years based on family structure (parents together or separated) independently of the influence of socio-economic environment that is well documented.MethodsCross-sectional study by examination of 28 871 children as part of a free preventive medicine consultation. The data came from an assessment conducted 28 to 32 months after birth during which information was collected about the psychomotor development: to perform a standing jump, dress themselves, draw a vertical line and circle, use the “I” pronoun, build a three-word sentence, and say their first nameResultsTen percent of the children had separated parents. Compared to parents who were together, when adjusting for the socioeconomic environment, as well as all potential confounders, the adjusted odds ratios (ORs) (95 % confidence interval [CI]) for children with separated parents, in terms of their ability to perform a standing jump, dress themselves, and draw a vertical line and circle were respectively 0.9 (0.7-1.1), 1.1 (0.9-1.2), 1.3 (1.1-1.4) and 1.2 (1.1-1.4). The adjusted ORs (95 % CI) for children’s inability to say the “I” pronoun, build a three-word sentence, and say their first name were respectively 1.2 (1.1-1.3), 1.3 (1.2-1.5), and 1.2 (0.9-1.5).ConclusionsAfter adjusting for sociocultural factors and other potential confounders, we observed that the children exhibited slower progression in psychomotor development, especially in language and graphic abilities when their parents were separated. While the implications of our study are somewhat limited, they do provide us with the necessary arguments enabling us to set up a prospective cohort study. Such a study should be able to better assess the impact of parental separation on the child's development, confirming our preliminary results., SCOPUS: ar.j, info:eu-repo/semantics/published

Weight excess is an increasingly frequent disorder of nutritional origin in industrialized areas. In Belgium, 40% of the population suffers from weight overload (BMI between 25 and 29.9 kg/m2) and 10 to 15% are obese (BMI > or = 30 kg/m2). The overweight is responsible for increased morbidity, in particular cardiovascular, and surmortality mainly among patients less than 60 years. The causes of the overweight are related to many interdependent determinants: food, sedentarity, socio-economical environment, genetic, psychological and behavioral characteristics. This complexity explains partly the difficulties of the medical follow-up of these patients. The role of the general practitioner (GP) in this Community health problem is essential at two levels: 1) Treatment of weight excess: a moderate and sustained loss, such as of 5 to 10% of the initial body weight, already significantly decreases the risks of morbi-mortality. The first role of GP will be to target the patients at particular risk and to treat them while adapting to their motivation. 2) Systematic prevention: all patients, all families, must have access through their GP to information of quality concerning the nutrition and the management of weight. This information should be adapted to each patient, according to the various stages of life. Nutritional imbalances and sedentarity should be detected systematically., English Abstract, Journal Article, Review, info:eu-repo/semantics/published