Search

Background & Aims: Nutrition education is necessary in the training of healthcare professionals, including medical students. However, recent surveys showed that there is a high variability within Medical Schools in different countries. The aim of this ESPEN position paper is to identify a minimum curriculum knowledge in nutrition that serves to improve the training of the future doctors and how to solve the main barriers of its implementation in university centres., Methods: In 2017, the ESPEN Executive Committee launched the Nutrition Education in Medical Schools (NEMS) Project and formed a core working group including members of the ESPEN Nutrition Education Study Group (NESG) and representatives of several European Medical Schools. This group met in Brussels, on 19th July 2018 and decided to prepare a position paper on this topic., Results: Five main learning objectives and twenty-one topics on human nutrition, within its three domains (basic, applied and clinical nutrition) were identified to be fulfilled at the end of training in all Medical Schools. The experts showed the following key factors for its implementation: establish a nutrition curriculum committee, use different models of integration of the contents in the curriculum (vertical and horizontal), have a multidisciplinary and experienced faculty, incorporate a variety of teaching models, and evaluate the programme periodically., Conclusions: Nutrition Education is necessary and should be mandatory in all Medical Schools. This position paper aims at improving this gap knowledge and gives some clues for a successful implementation of the changes in the medical curriculum at university centres., (Copyright © 2019 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

The general practitioner is regularly confronted with aggressive patients. He will have to spot the very first signs in order to manage as quickly as possible such a situation. The ideal is to remain calm, to listen actively and to try to understand the cause of the aggressiveness, knowing that it is not always directed against the doctor. Putting limits is also important to avoid situations that could degenerate. The generalist must also be able to share his difficult experiences with his colleagues, among others in the framework of a Balint group.

Medical studies have recently undergone three reforms in Belgium : passing from 7 to 6 years, the " Paysage " decree and the organization of a competition at the end of the first year. The article analyzes these reforms and organizational and educational consequences.

Background: In Western countries, many children are affected by the separation of their parents. Our main objective was to assess the possible impact of parental separation family structure on certain aspects of somatic health in low-age children., Methods: We conducted a cross-sectional study based on data collected in the framework of free preventive medicine 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 was collected regarding the risk of sudden infant death, psychomotor development, and development in terms of height 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 the presence or absence of confounders. The adjusted ORs (95% CI) of symptoms perceived as frightening, notably at night, of a prescription for a polysomnography, of an abnormal polysomnography result, and of follow-up by home monitoring 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 97(th) 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 the somatic health and psychomotor development of infants. This observation should be verified because it would have a major impact on the actions of family doctors and other first-line healthcare providers, in particular with regard to information and targeted prevention.

In 2007, due to the number of invasive pneumococcal infections and resistance to antibiotics, Belgium introduced juvenile anti-pneumococcal vaccination, recommending the 7-valent conjugate vaccine which provides better immune protection and memory than the 23-valent one for adults. In 2011, due to the increase in non-vaccine serotypes, the decision was taken to replace the 7-valent vaccine with a conjugate 13-valent one. Henceforth, essentially high-risk adults are given a 13-valent vaccine followed 8 weeks later by a 23-valent one, with a 23-valent booster every 5 years.

The "global medical record +" can be offered to all 45 to 75 year-old patients in the form of a prevention module within the global medical record and which the general practitioner and the patient will regularly update. It will include in particular an assessment of cardiovascular risk, cervical, breast and colon cancer screening, a check of main adult vaccinations, as well as a primary prevention section focused on smoking, alcohol consumption and various hygiene and dietary measures. The inclusion of this module in a computerized medical record will make it more efficient and will lighten the practitioner's workload.

A care procedure for type 2 diabetics was set up in Belgium in 2009. A three-way contract can be concluded between some patients, their general practitioner and their diabetologist to improve support, to promote communication among the care givers and to stimulate the patients' active participation and self-evaluation. The care teams are backed up by instructors, dieticians and podologists. Financial incentives have been set up for the patients as well as for the doctors. A global evaluation will take place in 2012.

General practitioners, central to Belgian healthcare, can have an impact on its cost, e.g. by rationalising the prescription of antibiotics. Among the tools enabling them to reach this objective, and thus also influencing the decrease in resistance, one finds good practice recommendations. However, the reality of work on the field leads general practitioners to take their global knowledge of their patients into account. Moreover, the diagnostic and therapeutic approach which is specific to primary care does not always allow for a strict application of these recommendations. Patient and society pressure is another factor general practitioners are confronted with. An intensification of continuous training, a greater front line collaboration in establishing guidelines, an improvement in quick diagnosis tests and the maintenance of a privileged dialogue with patients are the way forward to improve the present situation, Belgium being for the moment one of the European leaders in antibiotics prescribing.

In Belgium, on 10 millions of inhabitants, there are more than 31.000 divorces per year and we estimate that 600.000 children are experiencing separation of their parents. The general practitioner (GP) have inevitably the responsability of the medical follow-up of some of these children. The possible professional implications related to these young patients, concerning the GP have never been the subject of a study so far. Consequently the aim of this research was to reveal what is happening in the daily practice of the family practitioner related with the children of separete parents. There were some hypothesis notably about particular working conditions for the GP in connection with possible consequences for these children and possible necessity of special professional attitudes. A qualitative research in focus group was organized with GPs in order to get an interaction between the participants and to go past the concepts supposed before the study. Therefore between September and December 04, 8 focus groups of 10-18 generalist practitioners were set up in Brussels and Mons. Each meeting was axed around couples separated for less than 3 years and children between 0 and 15 years. Finally, 120 GPs discussed about 242 cases of divorces from their practice. The debates totally typed word by word were analysed with assistance of the software QSR N5. The point of view of the GPs is: 1) A divorce affects the working conditions of the general practitioner, for example the parcelling out of the medical follow-up of the child and the fact " of being used" by the family. 2) The conflict between the parents after the separation increases the difficulties for the GP in his daily practice. 3) The parental's separation influences the choice of professional attitudes of the GP, notably vis-a-vis the conflict (for instance to try or not to try the conflict's management). 4) Mainly in conflict situation, parental divorce is a risk for the child; psychological or behavioural disorders, physical health problems, school difficulties, ... 5) Certain professional attitudes of the general practitioner can influence positively the evolution of these children, for example to speak to the two parents. 6) Some professional actions aggravate the situation of the these children, for instance to product certain official written documents (attestations, reports, certificats, ...) in a conflicts context. In conclusion, this study desmonstrates that parental separation affects the medical follow-up of the children by the GPs and that professional attitudes influences positively or negatively the child's evolution. For the first time, some negative consequences of the divorce on children are described in the first line. All this results must be confirmed by quantitative research work.

The law relating to patients' rights, published in 2002 in Belgium, could change communication and even relations between general practitioners and their patients. This law stipulates, among other things, the information to be communicated to the patient, the rules for file sharing and litigation procedure. In the field, this law should be applied more by the spirit rather than the letter so as to preserve trust, the source of a real partnership. Moreover, one could be surprised by the fact that a law on patients' rights is not followed by rules also defining their duties.

Adults have insufficient vaccination coverage in Belgium today. It is up to the general practitioner, who is a key player in the Belgian health system, to ensure that this coverage is improved. The most efficient measures are: systematic patient notification, population and practitioner instruction, reduced cost for the patient, improved access to vaccination services and vaccination reminders to practitioners. These measures will be made easier by the development of the Global Medical Record and the Computerised Medical Record.

The new law relative to euthanasia does not explicitly foresee the implication of the general practitioner when an euthanasia procedure is carried out an hospital. At home, the law confers a central role on the general practitioner as far as information and coordination are concerned. There is a risk that the foreseen procedure will, in some cases, come up against the profoundly dual and intimate aspect of the patient-doctor relationship. The general practitioner is also given an administrative role. The doctor will, after having helped the patient die with dignity, have to fill in a registration document.