Revue medicale de Liege最新文献

Smoking rates in Europe are falling steadily among teenagers. The main reasons why young people start smoking are highlighted. Preventing young people from starting to smoke is based on a combination of three approaches: firstly, interventions in schools, incorporating educational programs from an early age; secondly, comprehensive tobacco control measures, such as bans on sales to minors and higher taxes on tobacco products; -thirdly, targeted communication campaigns. Finally, parents and families play an important role in providing a smoke-free environment and setting an example by giving up smoking. Many prevention programmes have been validated, but are still too infrequently deployed. We also need to prevent new modes of consumption that bring nicotine. In this way, we can work by accelerating progress to curb the tobacco epidemics and moving towards the ultimate goal of a smoke-free generation.

Type 2 diabetes (T2D) represents a major medical and public health problem. The ability to prevent or delay T2D by modifying some of its risk factors has been hypothesized for several decades. Indeed, the slow and gradual deterioration of glycaemia prior to the diabetes diagnosis constitutes a period during which interventions could be effective in preventing T2D. Lifestyle modifications demonstrated that modest weight loss (at least 7% of initial weight) and moderate to intense physical activity of at least 150 minutes per week, markedly and significantly delayed the onset of T2D in subjects at high risk of developing the disease. Pharmacological interventions indicated that metformin should be considered, particularly in young patients (< 60 years) with a body mass index ≥ 35 kg/m², and in women with a history of gestational diabetes. Bariatric surgery, which allows significant weight loss in subjects with severe or morbid obesity, has also demonstrated important preventive effectiveness and metabolic surgery in now considered in at-risk patients with less severe obesity. In conclusion, in overweight or obese adults at high risk of developing T2D, treatment aimed at losing weight (including bariatric surgery) and increasing physical activity should be implemented, and a pharmacotherapy might be considered case by case.

Preventing falls in older adults requires a comprehensive approach that distinguishes between accidental falls and falls related to underlying medical problems, such as syncope. For unintentional falls, prevention follows a three-stage model. The primary level focuses on encouraging regular physical activity, assessing, and reducing footwear and environmental risks, managing comorbidities, and promoting healthy lifestyles. The secondary level aims to identify and manage all risk factors, including in-depth medical assessment and education of older people and their careers. Finally, the tertiary level aims to minimise the consequences of falls through post-fall care, regular medical monitoring and the introduction of mobility aids or monitoring technologies. Educating older people about the risks, adopting safe behaviours, promoting physical activity, and creating safe environments go beyond these levels. This holistic approach anticipates, identifies, and mitigates risks, promotes safe and active ageing, and aims to achieve overall well-being, reduce adverse outcomes, and promote optimal quality of life throughout the ageing process.

The importance of physical activity in preventing diseases and maintaining physical and mental health in humans is undeniable. An active lifestyle plays a significant role in the primary, secondary, and tertiary prevention of chronic diseases. Despite abundant evidence in the literature and recommendations from the World Health Organization (WHO) on physical activity, the global population remains insufficiently active. It is therefore essential to promote physical activity and educate individuals in order to create an environment conducive to the sustainable adoption of an active lifestyle and the maintenance of health. In Belgium, initiatives such as «Sport-Health» programmes are emerging to overcome barriers to autonomous physical activity by offering tailored programmes for individuals with chronic diseases or those wishing to age healthily. With this perspective, the «Citizen, in motion for my health» project offers physical activity sessions while improving the physical literacy of participants to promote their autonomy.

This article focuses on the secondary prevention of cardiovascular (CV) diseases, namely the prevention of recurrence in subjects with a personal history of CV event, and the prevention of a first event in patients identified as at very high risk. For all these patients at very high risk, treatment is primarily based on the application of hygienic and dietary measures, including increasing the volume of physical activity, modifying the diet, and obtaining, if necessary, weight loss, as well as stopping smoking. This strategy has proven its benefits in terms of reducing morbidity and mortality. In addition, these patients must receive pharmacological treatment, whose the additional benefits are proven. The article details the pharmacological classes that are currently recommended, as well as the optimal management of CV risk factors and the therapeutic targets to be achieved.

Preeclampsia is a pregnancy-specific condition characterized by gestational hypertension associated with proteinuria or organ dysfunction after 20 weeks of gestation. It complicates 2 to 8 % of pregnancies worldwide and represents the leading cause of maternal and fetal mortality in developed countries. The only definitive treatment remains termination of pregnancy and delivery of the placenta. Prompt assessment of maternal and fetal status should be held in search of severity criteria and adequate management of this condition according to gestational age. Foremost concerns for pregnant patients are impending eclampsia or placental abruption, while fetal complications arise from placental insufficiency and risks associated with premature pregnancy termination. The sole efficient prophylaxis of preeclampsia in current state of evidence is aspirin at a dosage of 160 mg per day in high risk patients. Preeclampsia is now recognized as a high-risk factor for cardiovascular, renal, and neurological diseases and should therefore be considered as an opportunity for screening and prevention.

Adverse events related to drug therapy are a major cause of iatrogenicity. They are responsible of increased morbidity, leading to hospitalization, sometimes in emergency, and mortality, not only in ambulatory care but also during hospitalization itself. Causes are multiple : among them, confusion leading to an erroneous drug administration, mistakes regarding dosage, risks associated to self-medication, drug-drug interactions or even food-drug interactions. Elderly population is exposed to an increased incidence of drug iatrogenicity because older patients cumulate numerous risk factors, especially polypharmacy and cognitive disorders. Prevention of drug iatrogenicity is a key objective from a public health point of view. Preventive measures should target the prescriber (physician), the dispenser (pharmacist), the user (patient) and the supplier (pharmaceutical industry).

Smoking cessation appears to be the response that provides the best cost/benefit ratio among cardiovascular prevention actions. However, hospitalization precisely offers a strategic opportunity to initiate smoking cessation. This work evaluates the assistance in smoking cessation of patients treated by coronary angioplasty at the University Hospital of Liege over the last 6 years. It aims to provide food for thought regarding optimal management of smoking. Analysis of data showed a withdrawal rate of 55 % at year one. Strengthening motivation (with motivational interviewing and conversational hypnosis), the use of nicotine replacement and participation in cardiac rehabilitation have been identified as factors in consolidating abstinence. This work attests to the relevance and necessity of the intervention of a tobacco specialist in hospitalization and outpatient settings to ensure follow-up and improve the success rate of smoking cessation.

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The latest guidelines for the management of arterial hypertension, the silent killer, were published in summer 2023. They particularly emphasize again the quality of blood pressure measurement which ideally should always be automated using oscillometric device and an arm cuff already in the consulting room. They remind you how to manage the blood pressure of a patient whose hypertension has been confirmed, to stimulate drug compliance and to avoid therapeutic inertia. A holistic view of the patient with all his or her risk factors is always required. The general practitioner is the key player in the diagnosis, treatment and monitoring of the hypertensive patient whose therapeutic education has been as complete as possible with practice of self-measurement of blood pressure at home if possible. The goal is to normalize blood pressure within the first three months of treatment initiation and to reduce as much as possible the cardiovascular risk of the treated patient in the frame of preventive medicine.