[Editorial: 2005, the RMLG enters its seventh decade!].
Explore the source record for details and available documents.
Belgium↗
Biomedical subjects
D Giet
Publications and source records attributed to D Giet.
[Elderly abuse].
Elderly abuse is still far too much ignored. A better understanding of this problem allows us to a better answer proposing an appropriate coping as well as a preventing action. This article describe this society phenomenon with is worth looking at by every health professional. Identifying such situation as elderly abuse is a very tricky process, anyway, some risk factors bound to the victims, the authors or environment can lead us to watch situations that can need to be surrounded. Elderly abuse includes physical, psychological, financial, civilian, medical abuse and neglecting. One of the reasons of the taboo around the problem is the victim's silence connected to their fears and feelings and also the circle's attitude. An acute perception of this phenomenon can lead to adequate prevention and coping. In these conditions, the " Centre d'Aide aux Personnes Agées Maltraitées" (CAPAM) can develop its listening attitude as well as pluridisciplinar team actions.
Aged↗
[Evaluation of tetanus vaccine coverage in rural society].
The Liège University Department of General Practice and the Association of the General Practitioners of Sprimont (Belgian municipality) have jointly drawn up a study protocol named "Evaluation of anti-tetanus cover in rural society". The aim of this epidemiological search program was to answer the 2 following questions: What is the status of anti-tetanus cover among the rural population, according to age, sex and social classes? Is vaccine protection influenced by leisure activities (sport practice, gardening and animal farming at a small scale)? We received 790 answers out of 960 forms sent in a at random selected population (82.3%). A sampling classification has been done by the general practitioners, who have determined 3 categories of patients: unprotected patients (no vaccination for the last 10 years), patients in the process of vaccination, protected patients. Protected patients represent 51.8% of the population. Surprisingly enough, more than 45% of that rural population are not protected. This study clearly shows that two factors highly influence the vaccination cover against tetanus: age (elderly are less protected) and sex (women are always less protected than men). It also emerges from our analysis that the nature of the population's professional activities does not influence the protection rate. In contrast, leisure activities seem to have a favourable impact on the vaccination rate, sport leading to a better protection for both sexes. It is also true in the case of gardening practice, frequent in rural environment. We must then be careful to reach optimal vaccination among a population with an increasing life expectancy, therefore with more and more elderly people, and we must be careful with vaccination among females, presently less protected. The role of the family doctor is paramount to carry out that mission.
Activities of Daily Living↗
[General medicine: is it concerned with EBM?].
Whereas Evidence-Based Medicine (EBM) is recommended by all experts, it should be recognized that it remains far from the preoccupations of most General Practitioners (GPs). The present paper analyzes the multiple reasons explaining such a discordance. They can be found in the fundaments of EBM itself, in the characteristics of medical learning and practice and, finally, in the particularities of the individual patient-physician relationship. GPs should become active partners in the EBM process in order to influence it positively and not to bear it passively, for greater patient's benefits.
Evidence-Based Medicine↗
[Melanogenesis, an expression of the differentiation of cancer cells in culture].
In B 16 mouse melanoma in culture, differentiated cells actively synthesize melanin. They are analysed by cytological and cytochemical methods. When cultured for long periods (several months), melanogenesis is expressed according to a cyclic way, even when maintained in a culture medium of constant composition and without adding any chemical agent eventually able to influence this phenomenon. This spontaneous cyclic activity is analysed and an explanation is given as an hypothesis.
Animals↗
[Prevention of type 2 diabetes: a new public health challenge].
Owing to the epidemics of type 2 diabetes, it is important to develop strategies of prevention of the disease. The first step should detect patients at risk, in function of simple anamnesis, clinical and biological criteria. Afterwards, those individuals should be encouraged to follow a prevention programme, which essentially comprises better lifestyle habits (diet and physical exercise), especially to prevent or correct weight excess. In at very high risk subjects, for instance because of moderately increased fasting or post-glucose load glucose levels, eventually in a context of family history of type 2 diabetes, a pharmacological approach could be considered. Various drugs (metformin, acarbose, glitazones, orlistat, inhibitors of the renin-angiotensin system) have proven their efficacy in reducing the incidence of type 2 diabetes, in particular in individuals with impaired glucose tolerance, with obesity and/or with arterial hypertension.
Diabetes Mellitus, Type 2↗
[Multidisciplinary educational health programme for type 2 diabetic patients in primary care].
Type 2 diabetic patients followed in primary care rarely benefit from a structured educational approach in spite of the fact that the intervention of a multidisciplinary team has proven its efficacy for improving metabolic control. We describe a pilot project, which aimed at implementing an ambulatory multidisciplinary programme and at evaluating the feasibility of an educational module in type 2 diabetic patients followed in primary care. Four general practitioners (GP) selected 25 type 2 diabetic patients, not well controlled or with poor knowledge of their disease. Fourteen health care providers developed an intervention module comprising, over 4 months, an initial interview with the GP, three interviews with a dietician, two with a nurse and three with a psychologist. Besides studying the feasibility of the project, the primary objective was to analyze the subjective feeling of both patients and heath care providers participating to the project. A secondary objective was to compare some parameters of control (HbA1c, body weight) before and after the intervention in these 25 patients, and in 10 control patients followed as usual in general practice. The multidisciplinary educational intervention was well appreciated by diabetic patients whose adhesion was excellent. Health care provider's mobilization was enthusiastic, and all emphasized the human positive aspects of such a multidisciplinary approach. Preliminary analysis demonstrates beneficial effects of the educational programme.
Aged↗
[Does pertussis in adolescents and adults concern general practitioners?].
A significant resurgence of whooping-cough has been observed in countries with high vaccine coverage. More than half of the cases reported in Belgium occur in children aged less than 6 months. However, many authors report that Bordetella infection is diagnosed in 30 to 40% of adults and teenagers who suffer from a cough lasting more than 7 days. This article addresses the practical consequences of this epidemiological evolution for general practitioners. The clinical presentation is not very specific and differential diagnosis includes infectious as well as non-infectious affections. Diagnostic methods--bacterial culture techniques, PCR and serological tests--are not always easily available to general practitioners. Confirmed diagnosis of a case of whooping-cough presents an interest both at the individual, as well as collective level: evidence of a cycle of transmission between adults and very young infants has been shown, and prophylactic measures are therefore requested. The widespread use of an acellular vaccine among teenager and adult populations should provide an answer to this public health concern. General practitioners should be made aware of the epidemiological evolution of whooping-cough and should be alert to clinical symptoms possibly related to Bordetella infection of adults.
Anti-Bacterial Agents↗
[Ecology of medical care, the square of White, primary care and general practice].
The White-Williams-Greenberg diagram, also called the square of White, illustrates the repartition of health care as it was assessed in the sixties based on US and UK observations. The concept of the ecology of medical care led to passionate debates. The present article aims at reviewing the history of the square of White and of its successive adaptations. It will focus on its influence in various fields, such as research in primary care, general practice and teaching of medicine.
Family Practice↗
[Family practitioner and carbon monoxide poisoning].
Carbon monoxide poisoning is not easily identifiable. It is the first cause of death by accidental poisoning in Europe. The family practitioner, who has not been made aware of this problem, incurs the risk of diagnostic indecision or of involuntary personal poisoning. Since symptomatology is non specific, the general practitioner answering housecalls is sometimes confronted with an urgent medical problem linked to the complications of this intoxication (coronary, neurological problems...), without having ways of documenting its origin of the poisoning or any means to protect himself. Through direct contact with his patients' environment, the family practitioner, being made sensitive to this problem, can certainly contribute to care and aftercare of the patient suffering from carbon monoxide poisoning, but also to the prevention of this public health problem often called "the silent killer".
Carbon Monoxide Poisoning↗
[Management of hyperferritinemia].
Hemochromatosis is the most common genetic disorder in persons of northern European descent, and the majority of cases are caused by a mutation in the gene HFE. Genetic testing for hemochromatosis is therefore indicated in all patients with increases in transferrine saturation and ferritin levels. When this genetic testing does not demonstrate a hemochromatosis, other diseases responsible for elevated ferritin levels have to be ruled out, mainly hemolytic anemia, chronic inflammatory disorders, liver diseases such as hepatitis B or C, alcohol abuse, and non alcoholic fatty liver disease. In demonstrated iron overload with absence of classic causes, second-line genetic testing should be considered.
Algorithms↗
[Should general practitioners be interested in homocysteine measurements?].
The role of hyperhomocysteinemia as a cardiovascular risk factor has been a matter of debate of several decades. The present paper briefly describes the metabolism of homocysteine, the main genetic and acquired causes of hyperhomocysteinemia and the mechanisms presumably involved in the pathogenesis of cardiovascular and thromboembolic diseases. Current evidence-based data from epidemiological and interventional studies assessing the potential role of hyperhomocysteinemia in the occurrence of vascular complications are presented. Guidelines on screening and treatment of hyperhomocysteinemia are analysed in the context of daily practice of general practitioners.
Cardiovascular Diseases↗
[Advices for a better drug prescription].
The prescription of a pharmacological agent concludes most medical visits. The rational basis of drug prescription by the physician relies on numerous pharmacodynamic, pharmacokinetic, pragmatic and economic considerations. However, it is a pity to notice that one patient out of two does not strictly follow the pharmacological treatment as it was prescribed. This article analyses some problems of the patient-doctor relationship, which may reduce medication compliance, and provides practical advice for improving such a situation in order to enhance both efficacy and safety of drug prescribing.
Drug Prescriptions↗
[Medico legal issues related to driving: the role of the general practitionner].
The Belgian law requires that the physician informs his/her patient when he diagnoses a medical reason that makes him/her unfit to drive a vehicle. This paper lists, as they appear in the official texts, the physical conditions and diseases which may be responsible for the inaptitude to drive. Thus are detailed the rules applied in the presence of neurological diseases, psychic disorders, epilepsia, pathological sleepiness, locomotive disorders, cardiovascular disease, rhythm or conduction disturbances, blood pressure abnormalities, coronary or myocardial disease, and hearing loss or vestibular problems. The reader will also find a summary of the rules related to visual ability, alcohol use, driving under the influence of psychotropic drugs, or medicines in general, renal or hepatic diseases, and to the patient who received an organ transplant or an artificial implant. The responsibility of the physician, primarily the general practionner, may be involved in these matters; this issue is discussed.
Automobile Driving↗
[Some Websites frequently used in general practice].
Internet use is booming worldwide. The general practitioner can find on the Web a significant help for his research of information, as well as for his medical practice and the administrative management of his office. The proportion of general practitioners who make use of Internet in their professional life is constantly increasing, but their major difficulty remains to know where to quickly find the reliable information. The purpose of this paper is to describe ten Websites of particular interest in general practice.
Dermatology↗