Publications by authors named "Michel Roland"

10 Publications

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SARS-CoV-2 screening among people living in homeless shelters in Brussels, Belgium.

PLoS One 2021 15;16(6):e0252886. Epub 2021 Jun 15.

Research Center in Epidemiology, Biostatistics and Clinical Research, School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium.

Background: Subgroups of precarious populations such as homeless people are more exposed to infection and at higher risk of developing severe forms of COVID-19 compared to the general population. Many of the recommended prevention measures, such as social distancing and self-isolation, are not feasible for a population living in shelters characterised by physical proximity and a high population density. The objective of the study was to describe SARS-CoV-2 infection prevalence in homeless shelters in Brussels (Belgium), and to identify risk factors and infection control practices associated with SARS-CoV-2 positivity rates.

Methods: A total of 1994 adults were tested by quantitative PCR tests in 52 shelters in Brussels (Belgium) between April and June, 2020, in collaboration with Doctors of the World. SARS-CoV-2 prevalence is here described site by site, and we identify risk factors associated with SARS-CoV-2 positivity rates. We also investigate associations between seropositivity and reported symptoms.

Results: We found an overall prevalence of 4.6% for the period, and a cluster of high rates of SARS-CoV-2 positivity (20-30% in two shelters). Among homeless people, being under 40 years of age (OR (CI95%) 2.3 (1.2-4.4), p = 0.02), having access to urgent medical care (AMU) (OR(CI95%): 2.4 (1.4-4.4)], p = 0.02), and sharing a room with someone who tested positive (OR(CI95%): 5.3 (2.9-9.9), p<0.0001) were factors associated with SARS-CoV-2 positivity rates. 93% of those who tested positive were asymptomatic.

Conclusion: This study shows high rates of SARS-COV-2 infection positive tests in some shelters, with a high proportion of asymptomatic cases. The survey reveals how important testing and isolation measures are, together with actions taken by medical and social workers during the outbreak.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0252886PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8205130PMC
June 2021

[Study on the integration of mental health support into primary health care in Guinea].

Pan Afr Med J 2020 1;37:107. Epub 2020 Oct 1.

Ecole de Santé Publique, Université Libre de Bruxelles, Bruxelles, Belgique.

Introduction: the low coverage of specialized mental health services and the shortage of human resources for mental health are enormous challenges for the health care system in Africa. The integration of mental health support into primary health care is a substantial and feasible complementary intervention to specialized services. We collected and analyzed data from 5 Health Care Centers (HCC) that had integrated this care package in Guinea.

Methods: we conducted a descriptive study of new cases of mental health issues between 2012 and 2017. The reasons for consultations and diagnoses were identified and analyzed on the basis of consultation registries and individual medical records.

Results: a total of 4.995 patients with mental health problems received consultations (2.8% of general consultations; 0.5 -7.7% according to the centers). The average age of patients was 27,9 years (± 16.1). The most common reasons for consultations were: insomnia 44.4% (n = 2081), seizures 39% (n = 1827), behavioral disorders 31.9% (n = 1263) and hallucinations 26.1% (n = 1224). The most common diagnoses were: epilepsy 36.8% (n = 1773) and psychotic disorders 33.5% (n = 1613). Eighty eight point four per cent (n = 4418) of patients received medical treatment, most often combined with psychological support.

Conclusion: this study highlights that in the Guinean context, where access to specialized mental health care is very limited, patients with mental ill, even with severe medical conditions, can be followed up in the health centers by non-specialized but trained mental health professionals.
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http://dx.doi.org/10.11604/pamj.2020.37.107.20351DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7757329PMC
January 2021

In defence of a single body of clinical and public health, medical ethics.

BMC Health Serv Res 2020 Dec 9;20(Suppl 2):1070. Epub 2020 Dec 9.

Département de Médecine Générale, Université Libre de Bruxelles, Route de Lennik, 808, BP 612/1, B-1070, Brussels, Belgium.

Background: Since some form of dual clinical/public health practice is desirable, this paper explains why their ethics should be combined to influence medical practice and explores a way to achieve that.

Main Text: In our attempt to merge clinical and public health ethics, we empirically compared the individual and collective health consequences of two illustrative lists of medical and public health ethical tenets and discussed their reciprocal relevance to praxis. The studied codes share four principles, namely, 1. respect for individual/collective rights and the patient's autonomy; 2. cultural respect and treatment that upholds the patient's dignity; 3. honestly informed consent; and 4. confidentiality of information. However, they also shed light on the strengths and deficiencies of each other's tenets. Designing a combined clinical and public health code requires fleshing out three similar principles, namely, beneficence, medical and public health engagement in favour of health equality, and community and individual participation; and adopting three stand-alone principles, namely, professional excellence, non-maleficence, and scientific excellence. Finally, we suggest that eco-biopsychosocial and patient-centred care delivery and dual clinical/public health practice should become a doctor's moral obligation. We propose to call ethics based on non-maleficence, beneficence, autonomy, and justice - the values upon which, according to Pellegrino and Thomasma, the others are grounded and that physicians and ethicists use to resolve ethical dilemmas - "neo-Hippocratic". The neo- prefix is justified by the adjunct of a distributive dimension (justice) to traditional Hippocratic ethics.

Conclusion: Ethical codes ought to be constantly updated. The above values do not escape the rule. We have formulated them to feed discussions in health services and medical associations. Not only are these values fragmentary and in progress, but they have no universal ambition: they are applicable to the dilemmas of modern Western medicine only, not Ayurvedic or Shamanic medicine, because each professional culture has its own philosophical rationale. Efforts to combine clinical and public health ethics whilst resolving medical dilemmas can reasonably be expected to call upon the physician's professional identity because they are intellectual challenges to be associated with case management.
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http://dx.doi.org/10.1186/s12913-020-05887-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7723753PMC
December 2020

A plea to merge clinical and public health practices: reasons and consequences.

BMC Health Serv Res 2020 Dec 9;20(Suppl 2):1068. Epub 2020 Dec 9.

Département de Médecine Générale, Université Libre de Bruxelles, Route de Lennik, 808, BP 612/1, B-1070, Brussels, Belgium.

Background: Revisiting professionalism, both as a medical ideal and educational topic, this paper asks whether, in the rise of artificial intelligence, healthcare commoditisation and environmental challenges, a rationale exists for merging clinical and public health practices. To optimize doctors' impact on community health, clinicians should introduce public health thinking and action into clinical practice, above and beyond controlling nosocomial infections and iatrogenesis. However, in the interest of effectiveness they should do everything possible to personalise care delivery. To solve this paradox, we explore why it is necessary for the boundaries between medicine and public health to be blurred.

Main Body: Proceeding sequentially, we derive standards for medical professionalism from care quality criteria, neo-Hippocratic ethics, public health concepts, and policy outcomes. Thereby, we formulate benchmarks for health care management and apply them to policy evaluation. During this process we justify the social, professional - and by implication, non-commercial, non-industrial - mission of healthcare financing and policies. The complexity of ethical, person-centred, biopsychosocial practice requires a human interface between suffering, health risks and their therapeutic solution - and thus legitimises the medical profession's existence. Consequently, the universal human right to healthcare is a right to access professionally delivered care. Its enforcement requires significant updating of the existing medical culture, and not just in respect of the man/machine interface. This will allow physicians to focus on what artificial intelligence cannot do, or not do well. These duties should become the touchstone of their practice, knowledge and ethics. Artificial intelligence must support medical professionalism, not determine it. Because physicians need sufficient autonomy to exercise professional judgement, medical ethics will conflict with attempts to introduce clinical standardisation as a managerial paradigm, which is what happens when industrial-style management is applied to healthcare.

Conclusion: Public healthcare financing and policy ought to support medical professionalism, alongside integrated clinical and public health practice, and its management. Publicly-financed health management should actively promote ethics in publicly- oriented services. Commercialised healthcare is antithetical to ethical medical, and to clinical / public health practice integration. To lobby governments effectively, physicians need to appreciate the political economy of care.
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http://dx.doi.org/10.1186/s12913-020-05885-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7725113PMC
December 2020

Integrating clinical and public health knowledge in support of joint medical practice.

BMC Health Serv Res 2020 Dec 9;20(Suppl 2):1073. Epub 2020 Dec 9.

Département de Médecine Générale, Université Libre de Bruxelles, Route de Lennik, 808, BP 612/1, B-1070, Brussels, Belgium.

Background: Strong relations between medicine and public health have long been advocated. Today, professional medical practice assumes joint clinical/public health objectives: GPs are expected to practice community medicine; Hospital specialists can be involved in disease control and health service organisation; Doctors can teach, coach, evaluate, and coordinate care; Clinicians should interpret protocols with reference to clinical epidemiology. Public health physicians should tailor preventive medicine to individual health risks. This paper is targeted at those practitioners and academics responsible for their teams' professionalism and the accessibility of care, where the authors argue in favour of the epistemological integration of clinical medicine and public health.

Main Text: Based on empirical evidence the authors revisit the epistemological border of clinical and public health knowledge to support joint practice. From action-research and cognitive psychology, we derive clinical/public health knowledge categories that require different transmission and discovery techniques. The knowledge needed to support the universal human right to access professional care bridges both clinical and public health concepts, and summons professional ethics to validate medical decisions. To provide a rational framework for teaching and research, we propose the following categories: 'Know-how/practice techniques', corresponding a.o. to behavioural, communication, and manual skills; 'Procedural knowledge' to choose and apply procedures that meet explicit quality criteria; 'Practical knowledge' to design new procedures and inform the design of established procedures in new contexts; and Theoretical knowledge teaches the reasoning and theory of knowledge and the laws of existence and functioning of reality to validate clinical and public health procedures. Even though medical interventions benefit from science, they are, in essence, professional: science cannot standardise eco-biopsychosocial decisions; doctor-patient negotiations; emotional intelligence; manual and behavioural skills; and resolution of ethical conflicts.

Conclusion: Because the quality of care utilises the professionals' skill-base but is also affected by their intangible motivations, health systems should individually tailor continuing medical education and treat collective knowledge management as a priority. Teamwork and coaching by those with more experience provide such opportunities. In the future, physicians and health professionals could jointly develop clinical/public health integrated knowledge. To this end, governments should make provision to finance non-clinical activities.
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http://dx.doi.org/10.1186/s12913-020-05886-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7724788PMC
December 2020

Neo-Hippocratic healthcare policies: professional or industrial healthcare delivery? A choice for doctors, patients, and their organisations.

BMC Health Serv Res 2020 Dec 9;20(Suppl 2):1067. Epub 2020 Dec 9.

Département de Médecine Générale, Université Libre de Bruxelles, Route de Lennik, 808, BP 612/1, B-1070, Brussels, Belgium.

Background: Ethical medical practice requires managing health services to promote professionalism and secure accessibility to care. Commercially financed and industrially managed services strain the physicians' clinical autonomy and ethics because the industry's profitability depends on commercial, clinical standardisation. Private insurance companies also reduce access to care whilst fragmenting and segmenting health systems. Against this background, given the powerful, symbolic significance of their common voice, physicians' and patients' organisations could effectively leverage together political parties and employers' organisations to promote policies favouring access to professional care.

Main Text: To provide a foundation for negotiations between physicians' and patients' organisations, we propose policy principles derived from an analysis of rights-holders and duty-bearers' stakes, i.e., patients, physicians and health professionals, and taxpayers. Their concerns are scrutinised from the standpoints of public health and right to health. Illustrated with post-WWII European policies, these principles are formulated as inputs for tentative action-research. The paper also identifies potential stumbling blocks for collective doctor/patient negotiations based on the authors' personal experience. The patients' concerns are care accessibility, quality, and price. Those of physicians and other professionals are problem-solving capacity, autonomy, intellectual progress, ethics, work environment, and revenue. The majority of taxpayers have an interest in taxes being progressive and public spending on health regressive. Mutual aid associations tend to under-estimate the physician's role in delivering care. Physicians' organisations often disregard the mission of financing care and its impact on healthcare quality.

Conclusion: The proposed physicians-patients' alliance could promote policies in tune with professional ethics, prevent European policies' putting industrial concerns above suffering and death, bar care financing from the ambit of international trade treaties, and foster international cooperation policies consistent with the principles that inspire the design of healthcare policies at home and so reduce international migration. To be credible partners in this alliance, physicians' associations should promote a public health culture amongst their members and a team culture in healthcare services. To promote a universal health system, patients' organisations should strive to represent universal health interests rather than those of patients with specific diseases, ethnic groups, or social classes.
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http://dx.doi.org/10.1186/s12913-020-05890-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7724692PMC
December 2020

The physician and professionalism today: challenges to and strategies for ethical professional medical practice.

BMC Health Serv Res 2020 12 9;20(Suppl 2):1069. Epub 2020 Dec 9.

Département de Médecine Générale, Université Libre de Bruxelles, Route de Lennik, 808, BP 612/1, B-1070, Brussels, Belgium.

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http://dx.doi.org/10.1186/s12913-020-05884-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7723462PMC
December 2020

Not living with both parents is associated with more health- and developmental problems in infants aged 7 to 11 months: a cross sectional study.

BMC Public Health 2015 Feb 19;15:159. Epub 2015 Feb 19.

Département de Médecine Générale, Université Libre de Bruxelles, Campus Facultaire Erasme, Route de Lennik 808/612, 1070, Bruxelles, Belgium.

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.
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http://dx.doi.org/10.1186/s12889-015-1505-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4340291PMC
February 2015

Health networks: actors, professional relationships, and controversies.

Stud Health Technol Inform 2008 ;141:23-31

Health Systems Research - Université Catholique de Louvain, Belgium.

In recent years international policies have aimed to stimulate the use of information and communication technologies (ICT) in the field of health care. Belgium has also been affected by these developments and, for example, health electronic regional networks ("HNs") are established. Thanks to a qualitative case study we have explored the implementation of such innovations (HN) to better understand how health professionals collaborate through the HN and how the HN affect their relationships. Within the HNs studied a common good unites the actors: the continuity of care for a better quality of care. However behind this objective of continuity of care other individual motivations emerge. Some controversies need also to be resolved in order to achieve cooperative relationships. HNs have notably to take national developments into account. These developments raise the question of the control of medical knowledge and medical practice. Professional issues, and not only practical changes, are involved in these innovations.
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December 2008

GPs working in solo practice: obstacles and motivations for working in a group? A qualitative study.

Fam Pract 2003 Apr;20(2):167-72

Centre Universitaire de Medecine Generale, Université Catholique de Louvain, Avenue Mounier 5360, 1200 Bruxelles, Belgium.

Objective: Our aim was to analyse the obstacles and eventual motivations of solo GPs for working in group practice.

Methods: A qualitative study using 12 focus groups was carried out in primary care in French-speaking Belgium. The subjects comprised four samples of GPs: 20 GP trainers, 18 GP trainees, 25 women GPs and 25 other GPs. The focus groups were taped and transcribed. Two independent researchers carried out the analysis using the QSR NUD.IST software.

Results: The participants (88 GPs) did not share a common definition of group practice-in particular multidisciplinary working-the need for a common pool of patients and shared premises. Their main sources of motivation for eventually setting up a group practice were better quality of life, continuity of care and sharing professional knowledge. The main obstacles were a required agreement between colleagues, the loss of a personal patient-GP relationship, budgetary constraints, and divergent views on group practice and GPs' profession (especially true for the association of GPs from different age groups).

Conclusion: The current study shows that GPs working solo have divergent views of group practice. However, they clearly perceive advantages to this type of association (e.g. better quality of life and continuity of care). This study also confirms the high level of stress and tiredness felt by GPs and especially senior practitioners.
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http://dx.doi.org/10.1093/fampra/20.2.167DOI Listing
April 2003
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