Public health and prevention research within the Medical Research Future Fund.

OBJECTIVE: To explore the amount and type of research funded under relevant Medical Research Future Fund (MRFF) Initiatives that addressed public health and prevention from 2018 to July 2023. METHODS: Projects funded by six MRFF Initiatives, with objectives relevant to public health and public health nominated as "field of research" by >25% of applicants, were evaluated against a set of public health research criteria and were categorised based on levels of prevention. RESULTS: Fifty-seven per cent of 249 funded projects were categorised as public health research. Projects with curative features, focusing on tertiary (32%) and quaternary (4%) prevention, were as common as projects with earlier preventive features, focussed on primordial (7%) and primary (28%) prevention. The Preventive and Public Health Research Initiative had the lowest proportion of public health research (48%) of the six evaluated Initiatives and a dominance of curative (39%) and non-preventive (26%) research over preventive research (30%). CONCLUSION: This study highlighted variable levels of public health research across public-health-relevant MRFF Initiatives and generally low proportions of primary and primordial prevention. A greater emphasis on primordial and primary prevention research in public-health-relevant Initiatives could advance prevention in Australia. IMPLICATIONS FOR PUBLIC HEALTH: There appears to be scope for improvement in the prioritisation of upstream prevention research in public-health-relevant MRFF Initiatives and projects. Addressing this may enhance the benefit of MRFF to Australian public health.

[Construction of terminology system in public health and preventive medicine].

Public Health and Preventive Medicine, as a first-level discipline within the field of medical sciences, plays a crucial role in standardizing terminology for the purposes of discipline construction, technological advancement, and societal progress. Given the current macro-environment of social development, establishing and perfecting a standardized terminology system for Public Health and Preventive Medicine is not only a necessity for the discipline itself but also a pressing need for the nation and the world. This paper focuses on the development environment and current status of the Public Health and Preventive Medicine discipline system. It explores the current state, challenges, and future prospects of building a terminology system for Public Health and Preventive Medicine from the perspectives of terminology evaluation, standardized application, and discipline construction.

The Role of Quercetin as a Plant-Derived Bioactive Agent in Preventive Medicine and Treatment in Skin Disorders.

Quercetin, a bioactive plant flavonoid, is an antioxidant, and as such it exhibits numerous beneficial properties including anti-inflammatory, antiallergic, antibacterial and antiviral activity. It occurs naturally in fruit and vegetables such as apples, blueberries, cranberries, lettuce, and is present in plant waste such as onion peel or grape pomace which constitute good sources of quercetin for technological or pharmaceutical purposes. The presented study focuses on the role of quercetin in prevention and treatment of dermatological diseases analyzing its effect at a molecular level, its signal transduction and metabolism. Presented aspects of quercetin potential for skin treatment include protection against aging and UV radiation, stimulation of wound healing, reduction in melanogenesis, and prevention of skin oxidation. The article discusses quercetin sources (plant waste products included), methods of its medical administration, and perspectives for its further use in dermatology and diet therapy.

[Physical activity, a key-role in preventive medicine]. / L'activité physique, un rôle essentiel dans le cadre d'une médecine préventive.

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-Health¼ 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 health¼ project offers physical activity sessions while improving the physical literacy of participants to promote their autonomy.

L'importance de l'activité physique dans la prévention des maladies et le maintien de la santé physique et mentale de l'être humain n'est plus à démontrer. Un mode de vie actif joue un rôle considérable dans la prévention primaire, secondaire et tertiaire des maladies chroniques. Malgré les preuves abondantes dans la littérature ainsi que les recommandations de l'Organisation Mondiale de la Santé (OMS) en matière d'activité physique, la population mondiale demeure insuffisamment active. Il est donc essentiel de promouvoir l'activité physique et l'éducation des individus pour créer un environnement favorable à l'adoption durable d'un mode de vie actif en vue de la préservation de la santé. En Belgique, des initiatives telles que les programmes «Sport-Santé¼ émergent pour surmonter les obstacles à la pratique autonome de l'activité physique en proposant des programmes adaptés aux besoins des personnes atteintes de maladies chroniques ou souhaitant vieillir en bonne santé. C'est dans cette optique que le projet «Citoyen, en mouvement pour ma santé¼ offre des séances d'activité physique, tout en développant la littératie physique des participants pour favoriser leur autonomie.

[Interest in the use of polygenic risk scores in breast cancer screening and preventive medicine]. / Intérêt de l'utilisation des scores de risques polygéniques dans le dépistage du cancer du sein et la médecine de prévention.

Despite screening programmes, numerous clinical studies and new breast imaging techniques, breast cancer incidence for women continues to rise. The arrival of predictive and personalized medicine could clearly redefine our screening recommendations. One promising approach to improving screening would be to use tools to predict the risk of developing breast cancer, including polygenic risk scores (PRS). This approach will enable us to offer women risk-based screening by adapting the frequency, type and age of screening. This article reviews some definitions of the PRS and breast cancer screening. We also explain the risk assessment models that have been developed and the various studies underway on personalized screening.

Malgré les programmes de dépistage, les nombreuses études cliniques et les nouvelles techniques d'imagerie mammaire, l'incidence du cancer du sein chez la femme continue à augmenter. L'arrivée de la médecine prédictive et personnalisée pourrait clairement redéfinir nos recommandations de dépistage. Une des approches prometteuses pour améliorer le dépistage serait d'utiliser les outils de prédiction du risque de développer un cancer du sein en incluant les scores de risques polygéniques (PRS). Cette approche permettra de proposer aux femmes un dépistage basé sur le risque en adaptant la fréquence des examens ainsi que le type et l'âge du début du dépistage. Cet article reprend quelques définitions concernant le PRS et le dépistage du cancer sein. Nous allons passer en revue les modèles de prédiction de risque qui ont été développés et les différentes études en cours sur le dépistage personnalisé.

[Clinical metabolomics : an innovative approach towards preventive and personalized medicine]. / La métabolomique clinique : une approche novatrice vers une médecine préventive et personnalisée.

In order to improve our healthcare system, it is undeniable that the future of modern medicine must focus on a more preventive and personalized approach, notably based on the individual characteristics specific to each patient. In this perspective, clinical metabolomics, which focuses on metabolites, emerges as a particularly interesting and promising approach. Indeed, this science reflects the internal and external stimuli received by an individual, thus capturing their physiological and/or pathological state. Close to the phenotype, it represents the interface between the patient, their genes, and their environment in the broadest sense. Its translational nature requires the conjunction of several expertise areas, both in analytical, biostatistical, and clinical levels. Combined with other data, it allows the generation of predictive or diagnostic models useful for early detection and monitoring of pathologies, taking into account notably the individual characteristics of patients. There are, of course, many obstacles and challenges to overcome for metabolomics to transition into clinical practice, but it is evident that this innovative approach will, in the years to come, find its place among the tools available to clinicians in a more personalized vision of patient care.

Dans le but d'améliorer notre système de santé, il est indéniable que l'avenir de la médecine moderne doit se porter sur une approche plus préventive et personnalisée, basée, notamment, sur les caractéristiques individuelles propres au patient. Dans cette optique, la métabolomique clinique, qui s'intéresse aux métabolites, apparaît comme une approche particulièrement intéressante et prometteuse. En effet, cette science est le reflet des stimuli internes et externes que reçoit un individu et permet donc de capturer son état physiologique et/ou pathologique. Proche du phénotype, elle représente l'interface entre le patient, ses gènes et son environnement au sens large. Sa nature translationnelle nécessite la conjonction de plusieurs expertises, tant au niveau analytique que bio-statistique et clinique. Combinée à d'autres données, elle permet de générer des modèles prédictifs ou diagnostiques utiles pour détecter précocement et suivre des pathologies, en tenant compte, notamment, des caractéristiques individuelles des patients. Il reste, bien entendu, de nombreux obstacles et défis à relever pour que la métabolomique passe dans la pratique clinique. Cependant, il apparaît évident que cette approche novatrice trouvera, dans les années à venir, sa place parmi les outils à disposition des cliniciens dans une vision préventive et plus personnalisée de la prise en charge du patient.

[Towards a disruptive preventive approach for sustainable healthcare systems]. / Vers une approche préventive disruptive pour «soigner¼ durablement nos systèmes de santé.

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.

Devant les multiples défis auxquels est confronté le système de santé belge - notamment le vieillissement de la population, la progression des maladies chroniques, l'accroissement des inégalités sociales de santé - le développement d'une approche préventive disruptive, qui trouve ses fondements dans la promotion de la santé, est essentiel pour aborder, de façon transversale et intersectorielle, les problèmes de santé de la population. Toutefois, la faible place accordée à la prévention et à la promotion dans le paysage politique belge (seulement 3 % des dépenses de santé), accentuée par un éclatement de son déploiement entre les différentes entités politico-institutionnelles (Autorité fédérale, Communautés et Régions), représente des limites non négligeables. De nouvelles opportunités, notamment soutenues par une «médecine des 4P¼, ouvrent la voie à une modernisation des approches préventives. Toutefois, cette nouvelle façon de concevoir la prévention ne sera profitable à la collectivité, prise dans sa diversité et sa complexité, qu'à la condition de se réancrer dans les fondamentaux inhérents à la promotion de la santé.

Towards fair and clinically relevant polygenic predictions.

Lennon et al. recently proposed a clinical polygenic score (PGS) pipeline as part of the Electronic Medical Records and Genomics (eMERGE) network initiative. In this spotlight article we discuss the broader context for the use of PGS in preventive medicine and highlight key limitations and challenges facing their inclusion in prediction models.

Accuracy of Online Artificial Intelligence Models in Primary Care Settings.

INTRODUCTION: The importance of preventive medicine and primary care in the sphere of public health is expanding, yet a gap exists in the utilization of recommended medical services. As patients increasingly turn to online resources for supplementary advice, the role of artificial intelligence (AI) in providing accurate and reliable information has emerged. The present study aimed to assess ChatGPT-4's and Google Bard's capacity to deliver accurate recommendations in preventive medicine and primary care. METHODS: Fifty-six questions were formulated and presented to ChatGPT-4 in June 2023 and Google Bard in October 2023, and the responses were independently reviewed by two physicians, with each answer being classified as "accurate," "inaccurate," or "accurate with missing information." Disagreements were resolved by a third physician. RESULTS: Initial inter-reviewer agreement on grading was substantial (Cohen's Kappa was 0.76, 95%CI [0.61-0.90] for ChatGPT-4 and 0.89, 95%CI [0.79-0.99] for Bard). After reaching a consensus, 28.6% of ChatGPT-4-generated answers were deemed accurate, 28.6% inaccurate, and 42.8% accurate with missing information. In comparison, 53.6% of Bard-generated answers were deemed accurate, 17.8% inaccurate, and 28.6% accurate with missing information. Responses to CDC and immunization-related questions showed notable inaccuracies (80%) in both models. CONCLUSIONS: ChatGPT-4 and Bard demonstrated potential in offering accurate information in preventive care. It also brought to light the critical need for regular updates, particularly in the rapidly evolving areas of medicine. A significant proportion of the AI models' responses were deemed "accurate with missing information," emphasizing the importance of viewing AI tools as complementary resources when seeking medical information.

Atitudes e crenças de médicos ginecologistas- -obstetras e de pacientes do Hospital Universitário de Brasília sobre o rastreamento cervical e o exame pélvico / Attitudes and beliefs of obstetrician-gynecologists and patients at the University Hospital of Brasília about cervical screening and pelvic examination

Objetivo: Avaliar as atitudes e crenças de pacientes e médicos ginecologistas-obstetras sobre o rastreamento cervical e o exame pélvico no Hospital Universitário de Brasília (HUB). Métodos: Foram realizadas entrevistas com pacientes que aguardavam por uma consulta previamente agendada no ambulatório de ginecologia e com médicos ginecologistas-obstetras que atuavam no HUB. Cada grupo respondeu a um questionário que enfocava a realização do rastreamento cervical e do exame pélvico (EP). Resultados: No total, 387 pacientes responderam ao questionário. Dessas, apenas 4,13% sabiam que, de acordo com as diretrizes brasileiras, o rastreamento cervical deveria ser iniciado aos 25 anos de idade, 5,17% sabiam que ele deveria ser encerrado aos 64 anos e 97,93% esperavam um intervalo menor do que o trienal recomendado. Após serem informadas sobre as diretrizes, 66,93% acreditavam que o início aos 25 anos é tardio, 61,5%, que o encerramento aos 64 anos é precoce, 88,37%, que o intervalo trienal é muito longo e 94,06% ficaram com receio de que problemas de saúde pudessem aparecer nesse intervalo. Dos 44 médicos que responderam ao questionário, embora a maioria concordasse com as diretrizes, somente 31,82%, 38,64% e 34,1% as seguia com relação à frequência, à idade de início e à idade de encerramento, respectivamente. Quanto ao EP, aproximadamente metade dos participantes de cada grupo considerava que o exame deveria ser realizado nas consultas regulares com o ginecologista. Conclusão: Foi observada uma discrepância entre as expectativas das pacientes e as diretrizes para o rastreamento de câncer cervical. A maior parte das pacientes não as conhecia e, quando informadas, não concordava com elas. Quanto aos médicos ginecologistas- obstetras, a maioria não as seguia, apesar de conhecê-las. Quanto ao EP, grande parte dos médicos e pacientes considerava-o importante e acreditava que ele deveria ser realizado de forma rotineira nas consultas ginecológicas.

Objective: Evaluate the attitudes and beliefs of patients and obstetrician-gynecologists about cervical screening and pelvic examination in the University Hospital of Brasília (HUB). Methods: Face-to-face interviews with patients waiting for a previously scheduled consultation at the gynecology outpatient clinics and attending obstetrician-gynecologists at the HUB. Each group answered a questionnaire addressing cervical screening and pelvic examination (PE). Results: 387 patients answered the questionnaire. Of these, only 4.13% were aware that, according to Brazilian guidelines, cervical screening should begin at age 25, 5.17% that it should stop at age 64 and 97.93% expected a shorter interval than the recommended triennial. After being informed of the guidelines, 66.93% believed that starting at age 25 is late, 61.5% that stopping at 64 is early, 88.37% that the triennial interval is too long, and 94.06% would be afraid that health problems could appear during the interval. Of the 44 participating physicians, although most agreed with the guidelines, only 31.82%, 38.64% and 34.1% followed them regarding frequency, starting and stopping age, respectively. As for EP, approximately half of the participants in each group believed that it should be performed in regular consultations with the gynecologist. Conclusion: There was a discrepancy between patients' expectations and cervical screening guidelines. Most patients didn't know and, when informed, didn't agree with them. As for Ob-Gyn physicians, most did not follow these guidelines, despite knowing them. As for pelvic exam, most physicians and patients considered it important and believed it should be routinely performed during gynecological consultations.