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The vaccination coverage in Flanders is high, but some regions show lower vaccination willingness as compared to the overall vaccination coverage. Beginning November of 2021, the vaccination rate in Flanders was above 93% in age groups above 45 years, and around 85% in the age groups 12 to 44 years. Apart from Flanders as a whole, focus here is on the health sector Maasland, which has a slightly lower vaccination rate, especially in the age groups 12 to 44 years. In the Maasland region, located on the eastern border of Flanders, there are between 1% and 10% less vaccinated individuals than expected according to the vaccination rate in the whole of Flanders, with lowest vaccination rates in the south of the Maasland region. We study the impact of ethnic diversity in the population, population composition with respect to the ethnicity of individuals (in the sense of how the local population composition differs from the Flemish average), and socio-economic status on the vaccination rate at the level of the statistical sector, apart from the effect of age. We explain the statistical methods to investigate geographical differences and illustrate how one can deal with incomplete information in vaccination registries. Ethnic diversity in a region is associated with lower vaccination rates, as is a lower regional socio-economic status. The composition of the population in Maasland is associated with a 35% reduction in the odds to get vaccinated as compared to the overall Flemish population.

The basic reproduction number R0 and the effective reproduction number R are pivotal parameters in infectious disease epidemiology, quantifying the transmission potential of an infection in a population. We estimate both parameters from 13 pre-vaccination serological data sets on varicella zoster virus (VZV) in 12 European countries and from population-based social contact surveys under the commonly made assumptions of endemic and demographic equilibrium. The fit to the serology is evaluated using the inferred effective reproduction number R as a model eligibility criterion combined with AIC as a model selection criterion. For only 2 out of 12 countries, the common choice of a constant proportionality factor is sufficient to provide a good fit to the seroprevalence data. For the other countries, an age-specific proportionality factor provides a better fit, assuming physical contacts lasting longer than 15 min are a good proxy for potential varicella transmission events. In all countries, primary infection with VZV most often occurs in early childhood, but there is substantial variation in transmission potential with R0 ranging from 2.8 in England and Wales to 7.6 in The Netherlands. Two non-parametric methods, the maximal information coefficient (MIC) and a random forest approach, are used to explain these differences in R0 in terms of relevant country-specific characteristics. Our results suggest an association with three general factors: inequality in wealth, infant vaccination coverage and child care attendance. This illustrates the need to consider fundamental differences between European countries when formulating and parameterizing infectious disease models.

À l'occasion des 30 ans de la loi Montagne de 1985, une session nationale de l'Atelier des territoires a été organisée en 2016-2017 par le ministère en charge de la cohésion des territoires, sur la thématique "Vivre et travailler en montagne à l'heure du changement climatique". L'Atelier des territoires est une démarche qui conduit à la « mise en mouvement » des acteurs d'un territoire pour co-construire un projet stratégique territorial. L'observation de la démarche sur six sites en montagne (trois dans le massif du Jura, un dans le massif des Vosges, un dans les Alpes et un dans les Pyrénées) permet de tirer quelques enseignements sur les conditions favorisant l'adaptation des territoires de montagne au changement climatique : développer la confiance entre acteurs locaux en créant des espaces de dialogue hors-cadre institutionnel ou procédural avec l'appui de l'Etat local, s'extraire des périmètres administratifs pour travailler à l'échelle territoriale adaptée au sujet traité, développer la coopération entre territoires d'un même massif, partir des besoins du territoire pour co-construire des solutions sur-mesure... Les résultats tangibles en matière d'adaptation ne seront visibles qu'à plus long terme, lorsque des actions opérationnelles auront été mises en œuvre.

Background: The clinical frailty scale (CFS) was used as a triage tool for medical decision making during the COVID-19 pandemic. The CFS has been posed as a suitable risk marker for in-hospital mortality in COVID-19 patients. We evaluated whether the CFS is associated with mortality 24 months after hospitalisation for COVID-19. Methods: The COvid MEdicaTion (COMET) study is an international, multicentre, observational cohort study, including adult patients hospitalised for COVID-19 between March 2020–July 2020. Patients’ characteristics, prescribed medication, clinical characteristics, and CFS were collected at admission, survival data were collected 24 months after hospitalisation. Multivariable cox proportional hazard models stratified by age (

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Summary: Background: During the COVID-19 pandemic, the scarcity of resources has necessitated triage of critical care for patients with the disease. In patients aged 65 years and older, triage decisions are regularly based on degree of frailty measured by the Clinical Frailty Scale (CFS). However, the CFS could also be useful in patients younger than 65 years. We aimed to examine the association between CFS score and hospital mortality and between CFS score and admission to intensive care in adult patients of all ages with COVID-19 across Europe. Methods: This analysis was part of the COVID Medication (COMET) study, an international, multicentre, retrospective observational cohort study in 63 hospitals in 11 countries in Europe. Eligible patients were aged 18 years and older, had been admitted to hospital, and either tested positive by PCR for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or were judged to have a high clinical likelihood of having SARS-CoV-2 infection by the local COVID-19 expert team. CFS was used to assess level of frailty: fit (CFS1–3), mildly frail (CFS4–5), or frail (CFS6–9). The primary outcome was hospital mortality. The secondary outcome was admission to intensive care. Data were analysed using a multivariable binary logistic regression model adjusted for covariates (age, sex, number of drugs prescribed, and type of drug class as a proxy for comorbidities). Findings: Between March 30 and July 15, 2020, 2434 patients (median age 68 years [IQR 55–77]; 1480 [61%] men, 954 [30%] women) had CFS scores available and were included in the analyses. In the total sample and in patients aged 65 years and older, frail patients and mildly frail patients had a significantly higher risk of hospital mortality than fit patients (total sample: CFS6–9 vs CFS1–3 odds ratio [OR] 2·71 [95% CI 2·04–3·60], p

Introduction: Coronary arterial stenosis may impair myocardial perfusion with myocardial ischemia and associated morbidity and mortality as result. The myocardial fractional flow reserve (FFR) is clinically used as a stenosis-specific index.Aim: This study aims to identify the relation between the FFR and the degree of coronary arterial stenosis using a simple mathematical model of the coronary circulation.Methods: A mathematical model of the coronary circulation, including an arterial stenosis of variable degree, was developed. The relation between the FFR and the degree of stenosis (defined as the fractional cross sectional area narrowing) was investigated, including the influence of the aortic and venous pressures and the capillary resistance. An additional study concerning 22 patients with coronary artery disease permits comparison of clinical data and in silico findings.Results: The FFR shows an S-shaped relationship with the stenosis index. We found a marked influence of venous and aortic pressure and capillary resistance. The FFR is accompanied by a clinically relevant co-metric (FFRC), defined by the Pythagorean sum of the two pressures in the definition formula for FFR. In the patient group the FFRC is strongly related to the post-stenotic pressure (R = 0.91). The FFRC requires establishment of a validated cut-off point using future trials.Conclusion: The S-shaped dependence of FFR on the severity of the stenosis makes the FFR a measure of the ordinal scale. The marked influences of the aortic and venous pressures and the capillary resistance on the FFR will be interpreted as significant variations in intra- and inter-individual clinical findings. These fluctuations are partly connected to the neglect of considering the FFRC. At otherwise identical conditions the FFR as measured at baseline differs from the value obtained during hyperemic conditions. This expected observation requires further investigation, as the current hyperemia based evaluation fails to take advantage of available baseline data.

Desde 1974, temos empregado anuloplastia sem suporte para tratamento da insuficiência mitral de etiologia reumática em uma população predominantemente jovem. A avaliação dos resultados tardios forma a base deste relato. São 154 pacientes com insuficiência mitral isolada (sem estenose ou dupla lesão), sendo 55 (36%) do sexo masculino e 99 (64%) do feminino, idade média = 36 ± 16 (5 a 73) anos; as lesões associadas foram: 47 lesões aórticas, 21 tricuspídeas e 2 comunicações interatriais; a classe funcional pré-operatória foi I-II em 19% e III-IV em 81 % e o índice cardiotorácico 0,61 ± 0,10. Todos os pacientes foram submetidos a uma anuloplastia similar à descrita por WOOLER et alii 21 que consiste na redução da porção mural do anel mitral obtida pela aplicação de dois pontos ancorados em feltros nas comissuras, sem comprometer a extensão de cúspide septal. Quando necessário, procedimentos adicionais sobre as cordas tendíneas foram realizados. Nenhum paciente recebeu suporte anular por anel ou barra posterior. A mortalidade precoce foi de 3 (1,9%) pacientes: falência miocárdica (1) e embolia pulmonar (2). A mortalidade tardia foi de 9 (5,8%), falência miocárdica (3), septicemia (1), embolia pulmonar (1) e morte súbita (1) e causa desconhecida (3). Reoperações foram realizadas em 28 (18,2%) casos, dos quais 2 (1,3%) por disfunção de prótese aórtica. Sopro sistólico residual esteve presente em 48% dos casos. Complicações tardias: embolias sistêmicas 5,8% (1/3 como prótese aórtica), endocardite infecciosa 1,3% e embolia pulmonar 0,7%. Classe funcional pós-operatória (p. a.) foi I - II em 84% e III - IV em 16%; índice cardiotorácico p. o. 0,58 ± 0,10. Probalidade atuarial de sobrevida tardia é estimada em 79,5 ± 5,3% aos 10 anos e 71,0 ± 7,4% aos 14 anos. Sobrevida sem eventos: 67,9 ± 8,9% aos 10 anos e 56,1 ± 11,7% aos 14 anos. A insuficiência mitral reumática pode ser tratada efetivamente por anuloplastia sem suporte anular profético, com resultados tardios comparáveis àqueles obtidos por técnicas mais complexas. Isto tem importância no tratamento de crianças e adultos jovens, especialmente no sexo feminino, quando se deseja evitar implante de próteses mecânicas.Since 1974 a non-supported mitral annuloplasty technique has been employed for treatment of pure mitral regurgitation (PMR), in a population that was predominantly young and of rheumatic ethnology. An evaluation of late results forms the basis of this report. There were 154 patients operated on for PMR, 55 (36%) male and 99 (64%) female. Mean age was 36 ± 16 (5 to 73) years. Associated lesions were: 47 aortic, 21 tricuspid and 2 ASDs (atrial aptal defects). Cases with concomitant mitral stenosis were not included. Properative functional class was I-II in 19% and III-IV in 81%. The cardiothoracic ratio was 0.61 ± 0.10. All patients were submitted to an unsupported mitral annuloplastic procedure, similar to that described by WOOLER, that consisted in reduction of the mural portion of the annulus obtained with the application of two buttressed mattress sutures at the comissures without compromisse to the width of the septal leaflet. When necessary, additional chordal procedures were performed. No patients received ring or posterior annular support. Residual late systolic murmur was present in 48%. Late complications were: systemic thromboembolism 5.8% (1/3 with aortic prosthesis), infective endocardites 1.3% and pulmonary thromboembolism 0.7%. Postoperative functional class was I-II in 84% and III-IV in 16%. Cardiothoracic ratio was 0.58 ± 0.10. Actuarial probability of late survival was 79.5 ± 5.3% at 10 years and 71.0 ± 7.4% at 14 years. Event free survival was 67.9 ± 8.9% at 10 years and 56.1 ± 11.7% at 14 years. Rheumatic mitral regurgitation can be effectively treated by annuloplasty without prosthetic annular support with late results comparable to those obtained with more complicated procedures. This is particularly important for treatment of children and young patients, specially females at child-bearing age which, in some areas, form a substantial cohort in mitral disease.