Parental separation and behaviours that influence the health of infants aged 28 to 32 months: a cross-sectional study.

BACKGROUND: In Western countries, many children are affected by the separation of their parents. The study's main objective was to analyse the parental behaviours potentially influential for preschool children's health by family structure (parents together or separated). METHODS: We conducted a cross-sectional study based on data collected from examinations as part of free preventive medical consultations in the French Community of Belgium. During the assessment of 30,769 infants aged 28 to 32 months, information was collected on the parents' use of tobacco, brushing of the infant's teeth, being monitored by a dentist, and receiving vision screening. The chi2 test was applied and the odds ratios were derived to compare the two groups of children (exposed/not exposed to parental separation). Multivariate logistic regression analyses were used to adjust the effect of exposure. RESULTS: Nearly one in ten (9.8%) did not live with both parents under the same roof. Taking into account the social and cultural environment and other potential confounders at our disposal, we found that in the event of parental separation, behaviours differ in comparison with situations where parents live together; the adjusted odds ratios (ORs) (95% confidence interval) for the infant's exposure to tobacco, absence of teeth brushing, lack of monitoring by a dentist and absence of visual screening, were respectively 1.7 (1.2-2.0), 1.1 (0.9-1.2), 1.3 (1.1-1.6), 1.2 (1.1-1.2), and 1.2 (1.1-1.4). CONCLUSIONS: This study confirms the suspicion that parental separation is an independent risk factor for parental behaviours that negatively influence the infant's health. If these results are confirmed, this it could affect the work of the family doctors and paediatricians, especially in terms of family support and information to parents.

[The general practitioner confronted with aggressive patients]. / Le médecin généraliste face à un patient agressif.

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.

Le médecin généraliste est régulièrement confronté à des patients agressifs. Il devra repérer les tous premiers signes afin de gérer au plus vite une telle situation. L'idéal est de rester calme, d'assurer une écoute active et de tenter de comprendre la cause de l'agressivité, sachant qu'elle n'est pas toujours dirigée contre le médecin. Mettre des limites est aussi important pour éviter des situations qui pourraient dégénérer. Le généraliste doit par ailleurs pouvoir partager ses expériences difficiles avec ses collègues, entre autres dans le cadre d'un groupe Balint.

Parental separation: a risk for the psychomotor development of children aged 28 to 32 months? A cross-sectional study.

BACKGROUND: In Western countries, about a quarter of children are affected by parental separation and a number of authors have previously investigated how familial structure impacts children's health. The purpose of the work: to analyze the psychomotor development of children aged 28 to 32 months based on family structure (parents together or separated), independently of the influence of socio-economic environment that is well documented. To analyse the psychomotor development of children younger than 3 years based on family structure (parents together or separated) independently of the influence of socio-economic environment that is well documented. METHODS: Cross-sectional study by examination of 28 871 children as part of a free preventive medicine consultation. The data came from an assessment conducted 28 to 32 months after birth during which information was collected about the psychomotor development: to perform a standing jump, dress themselves, draw a vertical line and circle, use the "I" pronoun, build a three-word sentence, and say their first name RESULTS: Ten percent of the children had separated parents. Compared to parents who were together, when adjusting for the socioeconomic environment, as well as all potential confounders, the adjusted odds ratios (ORs) (95 % confidence interval [CI]) for children with separated parents, in terms of their ability to perform a standing jump, dress themselves, and draw a vertical line and circle were respectively 0.9 (0.7-1.1), 1.1 (0.9-1.2), 1.3 (1.1-1.4) and 1.2 (1.1-1.4). The adjusted ORs (95 % CI) for children's inability to say the "I" pronoun, build a three-word sentence, and say their first name were respectively 1.2 (1.1-1.3), 1.3 (1.2-1.5), and 1.2 (0.9-1.5). CONCLUSIONS: After adjusting for sociocultural factors and other potential confounders, we observed that the children exhibited slower progression in psychomotor development, especially in language and graphic abilities when their parents were separated. While the implications of our study are somewhat limited, they do provide us with the necessary arguments enabling us to set up a prospective cohort study. Such a study should be able to better assess the impact of parental separation on the child's development, confirming our preliminary results.

Deux réformes des études de médecine en 2 ans : Un nouveau paradigme pédagogique.

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.

Les études de médecine ont subi trois réformes récemment en Belgique : passage de 7 à 6 ans, le décret Paysage et l'organisation d'un concours en fin de 1re année. L'article analyse ces dif férentes réformes et les conséquences organisationnelles et pédagogiques.

Parental separation and behaviours that influence the health of infants aged 7-11†months: a cross-sectional study.

OBJECTIVE: Analyse the parental behaviours that are recognised as influencing the health of very young children based on family structure (parents separated or not). DESIGN: Cross-sectional study. SETTING: Free preventive medicine consultations in the French Community of Belgium. PARTICIPANTS: Examination of 79 701 infants aged 7-11 months as part of a free preventive medicine consultation. The data came from an assessment conducted 7-11 months after birth during which information was collected, namely about the parents' use of tobacco, the infant's type of nutrition and adherence to vaccination schedules. MAIN OUTCOME MEASURES: Parental behaviours: smoking, nutrition and compliance with vaccination schedule. RESULTS: The percentage of infants whose parents were separated was 6.6%. After adjusting for the cultural and socioeconomic environment as well as for other potential confounders, in the event of separation as compared with non-separated parents, the adjusted ORs (95% CI) were as follows: 1.5 (1.3 to 1.7) for the infant's exposure to tobacco; 1.3 (1.2 to 1.4) for total lack of exclusive breast feeding; 1.3 (1.1 to 1.4) and 1.2 (1.1 to 1.2) for breast feeding for a duration of less than 3 and 6 months, respectively; 1.2 (1.1 to 1.4) for non-compliance with the vaccination schedule against rotavirus. The duration of exclusive breast feeding was shorter when parents were separated (p<0.001; median 10 vs 13 weeks). CONCLUSIONS: This study reinforces the possibility that parental separation is independently associated with certain parental at-risk behaviours regarding the children's health. This observation should be verified because this could result in major consequences for the work of family doctors, in particular in terms of parent information and targeted prevention.

[Anti-pneumococcal vaccination in 2014]. / La vaccination antipneumococcique en 2014.

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 + (DMG+), tool for prevention in first line care]. / Le dossier médical global + (DMG+), outil de prévention de la première ligne de soins.

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.

[General practitioner and care procedure for diabetes]. / Le médecin généraliste en première ligne: le trajet de soins diabète.

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 medicine in the 21st century]. / La Médecine générale du XXIe Siècle.

General medicine is the main pivot of our healthcare system. General practitioners' tasks are numerous: front line responsibility, networking coordination, long-term patient care, community medicine and also primary care research. In the framework of general medicine that has been undergoing profound change for many years, we have chosen to develop three of these facets: general practitioners' knowledge of family, psychological, social or environmental factors and their capacity to coordinate with other health workers will help them in their primary and secondary prevention and also quaternary work by sparing patients unnecessary treatment and examinations. General medicine will increasingly become a discipline, one of which specific expertise will be to manage bio-psycho-societal complexity. Multidisciplinary action will be the rule: general practitioners will no longer be able to claim they can deal with all the curative, preventive and health education tasks. And the research in general medicine is essential because general practitioners can deal with over 80% of the health problems identified by patients and because the symptoms leading to the treatment cannot only be studied by laboratory or hospital research.

[Rational use of antibiotics. Reality on the ground of the general medicine]. / Utilisation rationnelle des antibiotiques. La réalité sur le terrain de la médecine générale.

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.

[Study of the follow-up by the general practitioner of the children of separated parents]. / Etude du suivi par le généraliste des enfants de parents séparés.

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.

[Communication general practitioner/patient in the light of the patient' rights law]. / La communication médecin généraliste/patient a la lumière de la loi sur les droits du patient.

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.

Recommendations for the use of the 23-valent polysaccharide pneumococcal vaccine in adults: a Belgian consensus report.

A multidisciplinary expert panel, appointed by the High Council for Public Health, evaluated the scientific evidence on which the recommendations for the appropriate use of the pneumococcal vaccine was based and reviewed the studies that became available since previous reports. The conclusions of the working group, presented in this manuscript, resulted in an update of the Belgian recommendations for pneumococcal vaccination.

[General practitioners and vaccination coverage of the population]. / Les médecins généralistes et la couverture vaccinale de la population.

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.