Revue medicale de Liege最新文献

Follow-up consultations in gynaecology and general practice offer valuable opportunities to discuss fertility and the importance of a pre-conceptional assessment before attempting pregnancy. During these consultations, it is vital for healthcare professionals to provide patients with essential information about considerations before conceiving a child. Additionally, it is important to educate patients about basic hygiene practices that can impact both male and female fertility. The prevention of fertility disorders requires a holistic approach identifying and targeting numerous risk factors.

Osteoporosis is a skeletal disease characterized by low bone density and altered microarchitecture, exposing to bone fragility and an increased risk of fracture. Several therapeutic modalities can effectively reduce the risk of fractures both vertebral and non-vertebral. While a significant part of bone strength and structure is genetically determined, it should be recalled that the environment also plays a significant role in these parameters and the risk of fracture, thus offering preventive opportunities thanks to lifestyle. In this article, we review the common misconceptions and myths about the influence of diet and physical activity on bone mineral density and fracture risk.

In this article, we will define «quaternary prevention», which consists in minimizing the iatrogenic effects of medical interventions, and more specifically the notion of «overdiagnosis». We will then discuss how a poor appreciation of the risks, on the part of both patients and clinicians, seems to fuel the phenomenon. We will discuss the interest of placing quaternary prevention within the broader framework of Shared Decision Making. We will focus on one of the stages of Shared Decision Making process, that of risk communication. Finally, we'll conclude that, fundamentally, clinicians should not only share information with patients, but also the power to decide.

Urine cytology is a long-used technique for the detection of high grade neoplastic urothelial lesions. Since 2016, «The Paris System» classification has revolutionized this field by introducing a standardized terminology widely adopted by cytopathologists and urologists. In this article, we explain this classification and discuss its impact on the clinical management of patients with urothelial lesions, as well as its role in the secondary prevention of these lesions.

Preventing chronic kidney disease (CKD) is a major public health objective. CKD leads to significant cardiovascular morbidity and mortality, with a negative impact on quality of life and significant societal repercussions. Several drugs are effective in preventing and curbing CKD, including blockers of the renin/angiotensin/aldosterone system and inhibitors of the SGLT2 co-transporter. New molecules are currently in clinical trials focusing on the nephro-protection, such as non-steroidal mineralocorticoid receptor antagonists and GPL-1 receptor agonists. In addition to this drug arsenal, CKD prevention also relies on non-pharmacological optimization of hygienic-dietary measures, including smoking avoidance, physical activity and dietetics. The aim of this article is to detail this non-medicinal approach to the prevention and slow down of CKD.

Prematurity remains a leading cause of mortality and morbidity in neonates and children. Prevention of preterm birth and of its complications is a major public health issue. From before conception to long term follow up, many health actors are engaged in this preventive strategy with the same goal : to give the best quality of life for these vulnerable young patients. We will review different preventive aspects during antenatal and perinatal period, during NICU (Neonatal Intensive Care Unit) stay and after discharge. Prevention of prematurity's complications requires a global approach including respiratory, nutritional and infectious aspects among others. Neuroprotective strategies are a key point of this global approach.

The brain is a vital organ that partly regulates our homeostasis and governs our interactions with the world (i.e. the physical, biological, and social environments). A healthy environment and a peaceful and equitable society ensure a normal brain development and promote individual (physical, mental, social, and spiritual) well-being. However, brain health is never certain and can be deteriorated, from conception until death, by exposure to multiple physical, chemical, biological, psychological, and social agents - the so-called exposome. From an integrated perspective, this article highlights the need to value, promote and protect brain health. The current challenge is to strengthen public awareness, education and research on brain health, in order to prevent neurological and psychiatric diseases.

Occupational medicine is an essential branch of preventive medicine that aims to protect the health of workers in the workplace. Any work situation exposes the worker to occupational hazards. The three levels of prevention applied in occupational medicine make it possible, together, to control risks. Primary prevention aims to prevent the occurrence of damage related to occupational risks, secondary prevention aims to early detect work-related health problems and in tertiary prevention, the objective is to limit the consequences of occupational risks or diseases already developed. It is not always possible to completely eliminate an occupational hazard. Regular medical examinations, at a frequency appropriate to the risks identified, meet this objective and therefore make it possible to detect work-related health problems or problems that could influence work. A proactive approach focused on prevention helps to reduce occupational risks, prevent work-related diseases, and to promote a healthy and safe work environment for all.

Faced with the multiple challenges impacting the Belgian healthcare system - notably the aging of the population, the increase in chronic diseases and growing social inequalities in health - the development of a disruptive preventive approach rooted in health promotion is essential to address the population's health problems in a cross-sectional and intersectoral way. However, the scant attention paid to prevention and promotion in the Belgian political landscape (only 3 % of healthcare expenditure), accentuated by the fragmentation of its deployment between the various political-institutional entities (Federal Authority, Communities and Regions), represents a significant limitation. New opportunities, supported in particular by "4P medicine", are paving the way for a modernization of preventive approaches. However, this new way of conceiving prevention will only be beneficial to the community, in all its diversity and complexity, if it re-engages with the fundamentals of health promotion.

Belgian community pharmacists play a pivotal role in both primary and tertiary preventive health activities. Their involvement extends beyond the pharmaceutical care associated with dispensing to include innovative services such as medication review. Additionally, they offer therapeutic education sessions to patients as part of the «Good Use of Medicines» programme. The recent pandemic has precipitated significant changes in pharmacists' responsibilities: they have been temporarily granted authority to prescribe and administer vaccines for COVID-19 and influenza, as well as to perform nasopharyngeal screenings for SARS-CoV-2. As frontline healthcare providers, pharmacists have the potential to expand their role in secondary prevention, particularly in screening and providing diagnostic guidance using in vitro diagnostic medical assays. The skills developed in the vaccination domain could be leveraged to enhance vaccination coverage for other diseases, emulating models used in other countries. Furthermore, the challenges posed by climate change present opportunities for pharmacists to contribute meaningfully to public health.