[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.

[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 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.

Aligning Prevention Evidence Gaps With Prevention Research.

This Viewpoint describes the development of tools to communicate actionable steps to address research needs and gaps for USPSTF recommendations that have insufficient evidence to make definitive guidance.

Training and career opportunities for residencies in Hygiene and Preventive Medicine: results of a survey on 39 Italian schools.

INTRODUCTION: The Italian National Health Service (SSN) is currently grappling. with a complex situation, characterized by a persistent shortage of medical personnel and the divergent aspirations of young medical graduates. Additionally, recent regulatory developments concerning specialist training further contribute to the intricacies of the landscape, calling for a comprehensive analysis of the challenges and opportunities within the sector. This study aims to provide an updated overview of the current placement of medical graduates, residents and specialists in the specific hygiene and preventive medicine (Public Health) field. METHODS: Data on admissions, withdrawals and resignations were obtained from the Ministries of Universities and Health and from the archives of the "Associazione Liberi Specializzandi" (ALS). Information regarding the professional prospects for specialists and residents in the field of Public Health was gathered through a tailored survey conducted by the "Consulta dei Medici in Formazione Specialistica" (Council of Medical Residents) of the Italian Society of Hygiene (SItI). RESULTS: In 2022, a total of 483 specialization contracts were granted, indicating a decrease of 37% compared to the previous year. Notably, 85 positions (17.6%) remained unallocated or resulted in dropouts. Six months after completing their residency, 1.5% of hygiene residents were still actively seeking employment. On a positive note, 75.4% of fourth-year residents secured contracts under the "Decreto Calabria". Career opportunities within the Italian SSN have witnessed growth, with a significant proportion of placements in territorial services and hospital medical directorates. DISCUSSION AND CONCLUSIONS: The updating of training programs provided by residency schools and the exploration of innovative approaches are of paramount importance to address the urgent need for high-quality training and to cater to the requirements of the national health system.