Search

Background: Through carrier screening, prospective parents can acquire information about whether they have an increased risk of conceiving a child affected with an autosomal recessive or X-linked condition. Within the last decade, advances in genomic technologies have facilitated a shift from condition-directed carrier screening to expanded carrier screening (ECS). Following the introduction of ECS, several studies have been performed to gauge the interest in this new technology among individuals and couples in the general population.Objective and Rationale: The aim of this systematic review was to synthesize evidence from empirical studies that assess the interest in ECS among individuals and couples in the general population. As the availability and accessibility of ECS grow, more couples who are a priori not at risk based on their personal or family history will be presented with the choice to accept or decline such an offer. Their attitudes and beliefs, as well as the perceived usefulness of this screening modality, will likely determine whether ECS is to become a widespread reproductive genetic test.Search Methods: Four databases (Pubmed, Web of Science, CINAHL, Cochrane Library) were systematically searched to identify English language studies performed between January 2009 and January 2019 using the following search terms: carrier screening, carrier testing, attitudes, intention, interest, views, opinions, perspectives and uptake. Studies were eligible for inclusion if they reported on intentions to undergo a (hypothetical) ECS test, uptake of an actual ECS offer or both. Two researchers performed a multistep selection process independently for validation purposes.Outcomes: Twelve empirical studies performed between 2015 and 2019 were included for analysis. The studies originated from the USA (n = 6), the Netherlands (n = 3), Belgium (n = 1), Sweden (n = 1) and Australia (n = 1). The sample size of the studies varied from 80 to 1669. In the included studies, 32%-76% of respondents were interested in a (hypothetical) ECS test, while uptake rates for actual ECS offers ranged from 8% to 50%. The highest overall uptake was observed when ECS was offered to pregnant women (50%). By contrast, studies focusing on the preconception population reported lower overall uptake rates (8-34%) with the exception of one study where women were counseled preconception in preparation for IVF (68.7%).Wider Implications: Our findings suggest that there may be discrepancies between prospective parents' reported intentions to undergo ECS and their actual uptake, particularly during the preconception period. As ECS is a new and relatively unknown test for most future parents, the awareness and comprehension within the general population could be rather limited. Adequate pre- and post-test counseling services should be made available to couples offered ECS to ensure informed reproductive decision-making, together with guidelines for primary health care professionals. Due to restricted nature of the samples and methods of the underlying primary studies, some of the reported results might not be transferable to a broader population. More research is needed to see if the observed trends also apply to a broader and more diverse population. [ABSTRACT FROM AUTHOR]

In this contribution, we focus on the question of how social workers actually deal with the complexity of sharing private information in three local networks of social provision that aim to combat child poverty. Building on the existing body of social work research, we discuss how practices for exchanging private information are enmeshed in a field of tension between both regulation and discretion. This complexity reveals a major challenge for social workers to justify their interventions. Based on a combination of qualitative semi-structured interviews with social workers in the network and participant observation during the network meetings, we examine the strategies of discretion, considerations and potential justifications of social workers in dealing with private information. Our analysis reveals three major themes: (i) legitimacy to act, (ii) deserving versus undeserving families and (iii) powerlessness to collectively act. We conclude that a rights-based approach can be crucial as a normative value orientation and as a point of reference to enable social workers in justifying how and why they exchange private information about families in poverty situations. [ABSTRACT FROM AUTHOR]

Background Tobacco-control policies have been suggested to reduce smoking among adolescents. However, there is limited evidence on the real-world costs of implementation in different settings. In this study, we aimed at estimating the costs of school smoking bans, school prevention programmes and non-school bans (smoking bans in non-educational public settings, bans on sales to minors and bans on point-of-sale advertising), implemented in Finland, Ireland, the Netherlands, Belgium, Germany, Italy and Portugal, for 2016. Methods We retrospectively collected costs related to the inspection, monitoring and sanctioning activities related to bans and educational activities related to smoking prevention programmes. We used an 'ingredients-based' approach, identifying each resource used, quantity and unit value for one full year, under the state perspective. Costs were measured at national, regional, local and school-level and were informed by data on how these activities were performed in reality. Results Purchasing power parities adjusted-costs varied between €0.02 and €0.74 (average €0.24) per person (pp) for bans implemented outside schools. Mean costs of school smoking bans ranged from €3.31 to €34.76 (average €20.60), and mean costs of school educational programmes from €0.75 to €4.65 (average €2.92). Conclusions It is feasible to estimate costs of health policies as implemented in different settings. Costs of the tobacco control policies evaluated here depend mainly on the number of person-hours allocated to their implementation, and on the scale of intervention. Non-school bans presented the lowest costs, and the implementation of all policies cost up to €36 pp for 1 year. [ABSTRACT FROM AUTHOR]

Study Question: Are progesterone vaginal pessaries 400 mg twice a day (bid) non-inferior to progesterone vaginal gel (90 mg) once a day (od) in the primary endpoint of clinical pregnancy rate after 38 days of luteal phase support in women undergoing in vitro fertilisation (IVF)?Summary Answer: Non-inferiority of progesterone vaginal pessaries 400 mg bid to progesterone 8% vaginal gel (90 mg od) was shown for clinical pregnancy rate after 38 days of luteal phase support.What Is Known Already: To maximise successful embryo transfer after IVF, additionally administered progesterone is used for proper endometrium transformation in the luteal phase. Vaginally administered progesterone results in adequate secretory transformation of the endometrium.Study Design, Size, Duration: This multicentre, multinational, open, randomised, two-parallel group, non-inferiority Phase 3 clinical trial was carried out at 17 study sites in five European countries (Belgium, Bulgaria, Czech Republic, Hungary and Serbia) between October 2013 and August 2014. An interactive web response system (IWRS) was implemented for treatment allocation at the sites. Power analysis, based on the assumptions of a non-inferiority margin of -9%, a significance level of α 2.5% (one-sided), power 90%, at a reference pregnancy rate for the progesterone vaginal gel group of 30%, as well as applying a dropout rate of 10%, yielded a total number of 766 patients to be randomised.Participants/materials, Setting, Methods: Women aged between 18 and 40 years with a clinical indication for IVF/intracytoplasmic sperm injection (ICSI) and embryo transfer were eligible to participate. The clinical pregnancy rate was assessed by fetal heart movement measured by transvaginal ultrasound at day 38 (D38) (primary endpoint) and D70. Also assessed were biochemical pregnancy rate (assessed by serum β-hCG ≥25 IU/L), clinical implantation rates at D38, patient evaluation of vaginal bleeding and discharge (assessed by diary) and adverse event (AE) incidence, severity and relationship to study medication.Main Results and the Role Of Chance: A total of 769 female patients were randomised to progesterone 400 mg vaginal pessaries bid (n = 385, 50.1%) or progesterone 90 mg vaginal gel od (n = 384, 49.9%). Patients receiving progesterone vaginal pessaries and progesterone vaginal gel were comparable in demographics, baseline characteristics and number of retrieved oocytes. In the full analysis set (FAS; n = 369 progesterone vaginal pessaries and n = 368 progesterone vaginal gel), clinical pregnancy rates on D38 were 38.3% for progesterone vaginal pessaries and 39.9% for progesterone vaginal gel. In the per protocol analysis set (PP; n = 357 progesterone vaginal pessaries and n = 356 progesterone vaginal gel), clinical pregnancy rates on D38 were 38.1% for progesterone vaginal pessaries and 40.4% for progesterone vaginal gel. For the differences in pregnancy rates between the progesterone vaginal pessaries group and the progesterone vaginal gel, the lower limit of the 97.5% CI was -8.6 and -9.5% for the FAS and PP datasets, respectively. The original prespecified non-inferiority margin of -9% was thus met in the FAS dataset but was marginally below this in the PP dataset. However, the pregnancy rate of the comparator was higher than the anticipated rate of 30%, and a predetermined logistic regression model including treatment group, country and age group effects without interaction terms showed non-inferiority of progesterone vaginal pessaries to progesterone vaginal gel for both the FAS and PP populations, in that the lower limits of the 95% CIs were above 0.7 for both analyses. As a result of this, the relevant authorities accepted to widen the acceptable non-inferiority margin to -10%, and as such both the FAS and PP populations succeeded in showing non-inferiority. Biochemical pregnancy and clinical implantation rates were comparable for both treatments. Both treatment groups showed similar high compliance throughout the study, and the safety profiles were also comparable between the groups. Drug-related AEs occurred with frequencies of 15.1% with progesterone vaginal pessaries and 14.4% with progesterone vaginal gel.Limitations, Reasons For Caution: Clinical pregnancy rate is a surrogate for the outcome of live birth rate.Wider Implications Of the Findings: Progesterone 400 mg pessaries bid for luteal phase support is an effective, safe and tolerable treatment option for women undergoing IVF during ART.Study Funding/competing Interest(s): This work was funded by Actavis Group PTC ehf., Iceland, part of Teva Pharmaceuticals, and by L.D. Collins & Co. Ltd. Gedeon Richter plc has recently entered into a license and distribution agreement to commercialise the vaginal pessaries in the European Union (except Ireland/UK). The progesterone vaginal pessaries studied are now marketed as Cyclogest®, Amelgen®, Cyclovita®, Luteum and Cygest® throughout the EU, Asia and Middle East & North Africa. The competing interests are as follows. H.S.: employee of Gedeon Richter plc/PregLem S.A. C.K.: consultant to L.D. Collins & Co. Ltd and received consulting fees for work performed. T.D.H.: at the initiation and completion of this study, full professor at KU Leuven and Head of Leuven University Fertility Center at the University Hospital Gasthuisberg, Leuven, Belgium. In October 2015, T.D.H. became vice president of Global Medical Affairs Fertility at the pharmaceutical company Merck-marketing authorisation holder of the Progesterone vaginal gel (Crinone®)-and has remained a part-time professor at KU Leuven (Belgium) and adjunct professor at Yale University (New Haven, CT, USA). T.B.M.: at the initiation and completion of this study, employee of Actavis Group PTC ehf. I.K.: consultant to Actavis, later TEVA and received consulting fees for work performed. S.H.: at the initiation and completion of this study, employee of Actavis Group PTC ehf.Trial Registration Number: EudraCT number 2013-001105-81.Trial Registration Date: 2 July 2013.Date Of First Patient’s Enrolment: 9 October 2013. [ABSTRACT FROM AUTHOR]

We present a recruitment model for pure and mixed beech and oak stands in Belgium, the first empirical model for this forest type in this geographical area. Data from the Wallonia National Forest Inventory were used to fit the model. We adopted a zero-inflated formulation where model parameters governing species' behaviour were simultaneously fitted. Plot random effects specific to each species were included, the simultaneous fit allowing them to correlate. Model predictions proved accurate and corresponded to current ecological knowledge about the regeneration dynamics of this kind of mixture. While our model could potentially be used to complement the existing beech and oak growth models for this region of Europe, our results also show that beech recruits tend to dominate regardless of the oak share in the overstorey composition and the stand stocking. This confirms that the beech–oak mixture may not be stable under the conditions of the study area and current management aimed at promoting continuous forest cover. [ABSTRACT FROM AUTHOR]

Assessing the impacts of bank mergers on small firms requires separating borrowers with single versus multiple banking relationships and distinguishing the three alternatives of “staying,” “dropping,” and “switching” of relationships. Single-relationship borrowers who “switch” to another bank following a merger will be less harmed than those whose relationship is “dropped” and not replaced. Using Belgian data, we find that single-relationship borrowers of target banks are more likely than other borrowers to be dropped. We track postmerger performance and show that many dropped target-bank borrowers are harmed by the merger. Multiple-relationship borrowers are less harmed, as they can better hedge against relationship discontinuations. [ABSTRACT FROM PUBLISHER]

Antimicrobial resistance is an important issue in Belgium. For more than a decade, national projects aiming to promote the prudent use of antimicrobials and to decrease antimicrobial resistance in ambulatory, nursing-home and hospital settings have been launched by the Belgian Antibiotic Policy Coordination Committee (BAPCOC), coordinated by the Federal Public Service of Public Health, Food Chain Safety and Environment. In this paper, we describe the implementation of the e-Bug Project in Belgium by the University of Antwerp in collaboration with BAPCOC and supported by the Ministries of Education, and how e-Bug complemented a new national campaign focusing on antibiotic use in children first started on the European Antibiotic Awareness Day in 2008. We also describe the impact of the organization of education in Belgium on the implementation process, as well as plans for the future of e-Bug in our country. [ABSTRACT FROM PUBLISHER]

The article discusses the highlights of the ninth European Conference on Computational Biology 2010 (ECCB10) which was held on September 26 to 29, 2010 at the International Conference Center in Ghent, Belgium. Some of the topics discussed include all areas of methodological developments for computational biology as well as applications of computational methods to molecular biology. A workshop on computational methods to leverage perturbation techniques was also conducted.

Burn disaster is defined as a massive influx of patients that exceeds a burn center's capacity and capability. This study investigates the capacity and capability of burn centers to respond to burn disasters in the Belgian ground. Quantitative survey and qualitative semistructured interview questionnaires were administered directly to key informants of burn centers. The data collected from both methods were compared to get a more in-depth overview of the issue. Quantitative data were converted into a narrative to enrich the qualitative data and included in the thematic analysis. Finally, data from both methods were analyzed and organized into five themes. The Belgian Association of Burn Injury (BABI) has a specific prehospital plan for burn disaster management. Once the BABI Plan is activated, all burn centers respond as one entity. Burn Team (B-Team) is a professional team that is formed in case of urgent need and it is deployed to a scene or to nonburn specialized hospitals to help in disaster relief. The challenges for burn disasters response occur particularly in the area of triage, transfer, communication, funding, and training. We conclude that there is a variation in the capacity and capability of burn centers. Overall, the system of burn disaster management is advanced and it is comparable to other high-income countries. Nevertheless, further improvement in the areas of preparation, triage, communication, and finally training would make disaster response more resilient in the future. Therefore, there is still space for further improvement of the management of burn disasters in Belgium. [ABSTRACT FROM AUTHOR]

Study Question: Can we use a mitochondrial-targeted antioxidant (Mitoquinone) during in vitro embryo culture to rescue developmental competence of oocytes matured under lipotoxic conditions, exhibiting mitochondrial dysfunction and oxidative stress?Summary Answer: Supplementation of embryo culture media with Mitoquinone reduced oxidative stress and prevented mitochondrial uncoupling in embryos derived from metabolically compromised oocytes in vitro, leading to higher blastocyst rates and lower blastomeric apoptosis.What Is Known Already: Maternal metabolic disorders, such as obesity and type-II diabetes are associated with hyperlipidemia and elevated free fatty acid (FFA) concentrations in the ovarian follicular fluid (FF). Oocyte maturation under these lipotoxic conditions results in increased oxidative stress levels, mitochondrial dysfunction, reduced developmental competence and disappointing IVF results.Study Design, Size, Duration: A well-described bovine oocyte IVM model was used, where a pathophysiologically relevant elevated FF concentrations of palmitic acid (PA; 150 μM or 300 μM) were added to induce oxidative stress. After fertilization (Day 0, D0), zygotes were in vitro cultured (IVC, from D1 to D8) in standard fatty acid-free media in the presence or absence of Mitoquinone or its carrier triphenyl-phosphonium.Participants/materials, Setting, Methods: Embryo cleavage and fragmentation (D2) and blastocyst rates (D8) were recorded. Mitochondrial activity and oxidative stress in cleaved embryos at D2 were determined using specific fluorogenic probes and confocal microscopy. D8 blastocysts were used to (i) examine the expression of marker genes related to mitochondrial unfolded protein responses (UPRmt; HSPD1 and HSPE1), mitochondrial biogenesis (TFAM), endoplasmic reticulum (ER) UPR (ATF4, ATF6 and BiP) and oxidative stress (CAT, GPX1 and SOD2) using real time RT-PCR; (ii) determine cell differentiation and apoptosis using CDX-2 and cleaved caspase-3 immunostaining; and (iii) measure mtDNA copy numbers. This was tested in a series of experiments with at least three independent replicates for each, using a total of 2525 oocytes. Differences were considered significant if a P value was <0.05 after Bonferroni correction.Main Results and the Role Of Chance: Exposure to PA during IVM followed by culture under control conditions resulted in a significant increase in oxidative stress in embryos at D2. This was associated with a significant reduction in mitochondrial inner membrane potential (uncoupling) compared with solvent control (P < 0.05). The magnitude of these effects was PA-concentration dependent. Consequently, development to the blastocysts stage was significantly hampered. Surviving blastocysts exhibited high apoptotic cell indices and upregulated mRNA expression indicating persistent oxidative stress, mitochondrial and ER UPRs. In contrast, supplementation of PA-derived zygotes with Mitoquinone during IVC (i) prevented mitochondrial uncoupling and alleviated oxidative stress at D2; and (ii) rescued blastocyst quality; normalized oxidative stress and UPR related genes and apoptotic cell indices (P > 0.01 compared with solvent control). Mitoquinone also improved blastocyst rate in PA-exposed groups, an effect that was dependent on PA concentration.Large Scale Data: N/A.Limitations, Reasons For Caution: This is a fundamental study performed using a bovine in vitro model using PA-induced lipotoxicity during oocyte maturation. PA is the most predominant FFA in the FF that is known to induce lipotoxicity; however, in vivo maturation in patients suffering from maternal metabolic disorders involve more factors that cannot be represented in one model. Nevertheless, focusing on the carryover oxidative stress as a known key factor affecting developmental competence, and considering the novel beneficial rescuing effects of Mitoquinone shown here, we believe this model is of high biological relevance.Wider Implications Of the Findings: Human oocytes collected for IVF treatments from patients with maternal metabolic disorders are vulnerable to lipotoxicity and oxidative stress during in vivo maturation. The results shown here suggest that mitochondrial targeted therapy, such as using Mitoquinone, during IVC may rescue the developmental competence and quality of these compromised oocytes. After further clinical trials, this may be a valuable approach to increase IVF success rates for infertile patients experiencing metabolic disorders.Study Funding/competing Interest(s): This study was financially supported by a BOF/KP grant number 34399, from the University of Antwerp, Belgium. W.F.A.M. was supported by a postdoctoral fellowship from the Research Foundation-Flanders (FWO), grant number 12I1417N, Antwerp, Belgium. The Leica SP 8 confocal microscope used in this study was funded by the Hercules Foundation of the Flemish Government (Hercules grant AUHA.15.12). All authors have no financial or non-financial competing interests to declare. [ABSTRACT FROM AUTHOR]

Study Question: Does IVM of immature oocytes retrieved from small antral follicles in women with polycystic ovary syndrome (PCOS) have an impact on obstetric and neonatal outcomes compared to controlled ovarian stimulation (COS)?Summary Answer: Obstetric and neonatal outcomes after IVM appear to be similar to those after COS.What Is Know Already: Women with PCOS have an increased risk of adverse pregnancy outcomes and congenital malformations in their offspring. For patients with PCOS who require IVF, IVM of germinal vesicle (GV)-stage oocytes retrieved from antral follicles has been adopted as a mild approach ART, with improved pregnancy rates over the last two decades. Although reports of obstetrical and neonatal outcomes after IVM have been reassuring, the limited sample sizes in previous studies preclude firm conclusions, and further study is warranted.Study Design, Size, Duration: This is a retrospective observational study analysing obstetric and neonatal data from 1036 clinical pregnancies in unique patients with PCOS who conceived following a cycle of IVM or COS between January 2010 and December 2016 in a tertiary reproductive centre. In total, 393 singleton pregnancies with a gestational age beyond 20 weeks were included. A phenotypic approach was used for the diagnosis of PCOS. Pregnancies following oocyte donation, standard IVF (as opposed to ICSI) or preimplantation genetic testing and pregnancies requiring testicular biopsy in the male partners were excluded.Participants/materials,setting, Methods: Pregnancy outcomes were analysed in women with PCOS phenotype A, C or D, as defined by different combinations of the Rotterdam criteria. Data from 164 pregnancies beyond 20 weeks after IVM were compared with those from 229 pregnancies after COS. Pregnancies in the IVM group were obtained after minimal ovarian stimulation and IVF with ICSI of transvaginally collected GV oocytes that had reached the metaphase II stage in vitro after 28 to 40 h of culture. No hCG trigger was administered before oocyte retrieval. Outcome measures were analysed or reported in singleton pregnancies only and included adverse obstetric events and neonatal health parameters, in particular birthweight, prematurity, small-for-gestational age, large-for-gestational age, perinatal death and major/minor malformation rates. The incidence of hypertensive disorders of pregnancy (HDP) and birthweight was analysed by multiple linear and logistic regression, adjusted for relevant treatment variables and maternal characteristics.Main Results and the Role Of Chance: The IVM and the COS groups differed significantly (P < 0.001) for maternal circulating AMH levels and PCOS phenotype distribution, with more of the PCOS phenotype A in the IVM group. Pregnant women in the IVM group were younger than pregnant women in the COS group (P = 0.05). With regard to obstetric complications in singleton pregnancies, in the unadjusted analysis, mothers of infants in the IVM group more often had HDP (29/164 (17.9%) vs 22/229 (9.6%), P = 0.02) compared with mothers in the COS group. Singletons born after IVM and COS had a similar birthweight standard deviation score (SDS) (0.51 ± 0.94 after IVM vs 0.33 ± 1.05 after COS, P = 0.19). Preterm birth rate (32-36.9 weeks) and early preterm birth rate (<32 weeks) were also similar in both groups. The total malformation rate was 4.1% in singletons after IVM and 2.4% in singletons after COS. Multivariate linear regression analysis accounting for relevant confounders demonstrated that parity was the only independent predictive factor (P = 0.04) for birthweight SDS. Multivariate logistic regression analysis showed that BMI, parity and type of ART (IVM as opposed to COS) were significantly correlated with the incidence of HDP. Only patients with the PCOS phenotype A showed a tendency towards a higher risk of HDP in those who underwent IVM compared to those who had COS.Limitations, Reasons For Caution: The study is limited by its retrospective nature and loss to follow-up of a subset of children with no information regarding congenital malformations. Furthermore, the paediatricians who assessed the children after birth were not blinded for the type of ART procedure.Wider Implications Of the Findings: This study provides further evidence that, compared to COS, IVM of oocytes derived from small antral follicles does not adversely affect the neonatal health of the offspring of patients with PCOS. The observed increased risk of HDP in patients with PCOS phenotype A following IVM treatment warrants further scrutiny.Study Funding/competing Interest(s): Translational IVM research at Universitair Ziekenhuis Brussel (UZ Brussel) and Vrije Universiteit Brussel (VUB) has been supported by grants from the Institute for the Promotion of Innovation by Science and Technology in Flanders (Agentschap voor Innovatie door Wetenschap en Technologie-IWT, project 110680), the Fund for Research Flanders (Fonds Wetenschappelijk Onderzoek-Vlaanderen-FWO, project G.0343.13) and the Belgian Foundation Against Cancer (HOPE project, Dossier C69). Clinical IVM research was supported by research grants from Cook Medical and Besins Healthcare. M.D.V. reports honoraria for lectures from Cook Medical and Besins Healthcare outside the submitted work. S.S.R. reports honoraria for lectures by MSD and Besins and research grants by MSD, Ferring and Merck Serono outside of the submitted work. C.B. reports personal fees from Merck-Serono, Ferring, IBSA, Finox, MSD and Abbott outside the submitted work. H.T. reports grants from Merck, MSD, Goodlife, Cook, Roche, Besins, Ferring, Mithra (now Allergan) and the Research Fund of Flanders (FWO) and consultancy fees from Finox, Abbott, Obseva and Ovascience outside the submitted work. The other authors have nothing to disclose. [ABSTRACT FROM AUTHOR]

Background Complementary and alternative medicine (CAM) is oftenused to alleviate the discomfort, disability and pain involved in many chronic diseases. Besides this, females, middle-aged and higher educated people are also known to use CAM the most. This study explores whether the sociodemographic characteristics associated with CAM use differ by type of disease. Methods The following data were taken from the Belgian Health Interview Survey 2013 for the individuals aged 15+ years (n = 8942): sociodemographic characteristics, past 12-month diseases (using a list) and contact with a homeopath, chiropractor, acupuncturist and/or osteopath (CAM-therapists) in the past year. The association between CAM use and disease, controlled for gender, age, education and conventional medicine use, was assessed through logistic regressions. When interactions with the sociodemographic characteristics were found, stratified regressions were conducted. Results People with musculoskeletal diseases [odds ratio (OR) = 2.6], allergy (OR = 1.4) and severe headache (OR = 1.5) had higher odds of using CAM in the past year with statistical significance. For musculoskeletal diseases, the odds of using CAM was higher, with statistical significance, for every sociodemographic subclass. For allergy, CAM use was higher among men, people aged 45+ years and lower educated people, while for severe headache CAM use was higher among women, people aged 45+ years and higher educated people, all with statistical significance. Conclusions Sociodemographic characteristics associated with CAM use differ by diseases. The role of CAM in disease management cannot be ignored. Making physicians aware for which disease CAM is used and by whom, may facilitate disease management. [ABSTRACT FROM AUTHOR]

In this article, we focus on how social workers use their agency when implementing top-down policy measures as street-level bureaucrats. We report on findings of a case study that was conducted in Flanders, the Dutch-speaking region of Belgium, about the top-down introduction of an electronic information system (IS) in the field of Child Welfare and Protection (CWP). Starting from insights derived from neo-institutional theory, we explore how social workers perform a role as so-called 'institutional entrepreneurs' by initiating critical reflections about policy rationales. In our contribution, we show that, despite social workers' awareness of being embedded in their own field or service area, they use their field-level expertise and day-to-day experiences to disengage from this context as well. Besides unravelling the lack of coherence informing the IS's initial ambitions of transparency and efficiency, they constantly (re)frame their views and explain their alternative ideas with the aim of convincing other social workers and managers. In this vein, we conclude by highlighting the importance of 'distributed' forms of agency that involve a gradual process, which is co-produced by social workers as street-level bureaucrats in close collaboration with service users, other professionals, other organisations and policy makers. [ABSTRACT FROM AUTHOR]

Background Decreasing gender differences in mental health are found largely in countries in which the roles of men and women have improved in terms of opportunities for employment, education, child care and other indicators of increasing gender equality. In this study, we examine how European welfare regimes influence this association between mental health and the social roles that men and women occupy. Methods The EU-World Mental Health data are used, which covers the general population in 10 European countries (n = 37 289); Countries were grouped into four welfare regions: Liberal regime (Northern Ireland), Bismarckian regime (Belgium, Germany, the Netherlands and France), Southern regime (Spain, Italy, Portugal) and Central-Eastern regime (Romania and Bulgaria). The lifetime prevalence of mood, anxiety and alcohol disorders was determined by using the Composite International Diagnostic Interview 3.0. Overall prevalence rates along with odds ratios by means of bivariate logistic regression models are calculated to compare the presence of common mental disorders in women versus men per welfare regime. Results Overall prevalence of common mental disorders is highest in the Liberal regime and lowest in the Central/Eastern regime. The gender gap in mental disorders is largest in the Southern regime and smallest in the Liberal regime. Marital status and certain employment positions help to explain variation in mental disorders across and within welfare regimes. Conclusion Most prominent pathways linking gender to mental ill-health being are related to marital status and certain employment positions. However, these pathways also show substantial variation across welfare regimes. [ABSTRACT FROM AUTHOR]

Background Health literacy (HL) is an important determinant of health and health behaviours, and there is a need to monitor HL levels among all population groups. It is therefore essential to develop instruments to assess HL during childhood and adolescence. The aim of this study was to examine the cross-national measurement invariance of the instrument Health Literacy for School-aged Children (HLSAC) in four European countries. Methods The data were collected via standardized self-administered anonymous questionnaires within classrooms in Finland, Poland, Slovakia, and Belgium. There were in total 1468 respondents (aged 13, N = 690; aged 15, N = 778). The HLSAC instrument was used to measure the subjective HL of adolescents in each country. A multigroup confirmatory factor analysis was applied to test measurement invariance. Results Configural and metric invariance was established, but scalar invariance did not hold. However, the instrument exhibited high internal consistency (α = 0.85) and showed adequate fit with the data. Moreover, the partial invariance allowed comparison of mean values across the countries in question. There were significant mean value differences between countries and age-groups. Conclusions HL mean values (as assessed via the HLSAC instrument) can be compared across countries. The instrument has utility for large-scale international HL studies on adolescents. [ABSTRACT FROM AUTHOR]

Background Opioids, antipsychotics and hypnotics are recommended for comfort care in dying. We studied their prescription during the last 3 days in residents deceased in the long-term care facility (LTCF). Methods In a retrospective, cross-sectional survey in Belgium, England, Finland, Italy, the Netherlands and Poland, LTCFs, selected by proportional stratified random sampling, reported all deaths over the previous 3 months. The nurse most involved in the residents' care reviewed the chart for opioid, antipsychotic and hypnotic prescription, cause of death and comorbidities. Multivariable logistic regression was performed to adjust for resident characteristics. Results Response rate was 81.6%. We included 1079 deceased residents in 322 LCTFs. Opioid prescription ranged from 18.5% (95% CI: 13.0–25.8) of residents in Poland to 77.9% (95% CI: 69.5–84.5) in the Netherlands, antipsychotic prescription from 4.8% (95% CI: 2.4–9.1) in Finland to 22.4% (95% CI: 14.7–32.4) in Italy, hypnotic prescription from 7.8% (95% CI: 4.6–12.8) in Finland to 47.9% (95% CI: 38.5–57.3) in the Netherlands. Differences in opioid, antipsychotic and hypnotic prescription between countries remained significant (P < 0.001) when controlling for age, gender, length of stay, cognitive status, cause of death in multilevel, multivariable analyses. Dying from cancer showed higher odds for receiving opioids (OR 3.51; P < 0.001) and hypnotics (OR 2.10; P = 0.010). Conclusions Opioid, antipsychotic and hypnotic prescription in the dying phase differed significantly between six European countries. Further research should determine the appropriateness of their prescription and refine guidelines especially for LTCF residents dying of non-cancer diseases. [ABSTRACT FROM AUTHOR]

Influence exerted by husbands and wives at different stages in the decision process was examined for 25 economic decisions in a convenience sample of Belgian households in which both spouses were questioned. The analysis considers changes in marital roles throughout decision-making and extent of role consensus within families. Implications are discussed in relation to communication strategies as well as for research on household economic behavior. [ABSTRACT FROM AUTHOR]

Background measuring the quality of primary palliative care for older people with dementia in different countries is important to identify areas where improvements can be made. Objective using quality indicators (QIs), we systematically investigated the overall quality of primary palliative care for older people with dementia in three different countries. Design/setting a mortality follow-back survey through nation- and region-wide representative Sentinel Networks of General Practitioners (GPs) in Belgium, Italy and Spain. GPs registered all patient deaths in their practice. We applied a set of nine QIs developed through literature review and expert consensus. Subjects patients aged 65 or older, who died non-suddenly with mild or severe dementia as judged by GPs (n = 874). Results findings showed significantly different QI scores between Belgium and Italy for regular pain measurement (mild dementia: BE = 44%, IT = 12%, SP = 50% | severe dementia: BE = 41%, IT = 9%, SP = 47%), acceptance of approaching death (mild: BE = 59%, IT = 48%, SP = 33% | severe: BE = 41%, IT = 21%, SP = 20%), patient–GP communication about illness (mild: BE = 42%, IT = 6%, SP = 20%) and involvement of specialised palliative services (mild: BE = 60%, IT = 20%, SP = 77%). The scores in Belgium differed from Italy and Spain for patient–GP communication about medical treatments (mild: BE = 34%, IT = 12%, SP = 4%) and repeated multidisciplinary consultations (mild: BE = 39%, IT = 5%, SP = 8% | severe: BE = 36%, IT = 10%, SP = 8%). The scores for relative-GP communication, patient death outside hospitals and bereavement counselling did not differ between countries. Conclusion while the countries studied differed considerably in the overall quality of primary palliative care, they have similarities in room for improvement, in particular, pain measurement and prevention of avoidable hospitalisations. [ABSTRACT FROM AUTHOR]

This article investigates the determinants of split-ticket voting at the 2014 simultaneous federal, regional, and European elections in Belgium. We seek to explain why over a third of the voters made distinct party choices at different levels of government. Using data from the 2014 PartiRep Survey, we test a model of ballot-splitting, incorporating various types of explanations. Of specific interest to students of federalism, results show that some voters engage in vertical party-balancing. At the same time, perceiving a differential in importance between the levels does not appear as a driver of split-ticket voting, which runs contrary to the main assumption of the “second-order” elections model. [ABSTRACT FROM AUTHOR]

Background: Use of the Xpert MTB/RIF assay has increased the number of people diagnosed with rifampicin-resistant tuberculosis (RR-TB), especially in South Africa where Xpert is now the initial diagnostic for individuals with TB symptoms. We hypothesized that a proportion of RR-TB patients determined by Xpert can be treated with a rifabutin-containing regimen.Methods: Rifabutin susceptibility by rpoB mutation was assessed in 349 individuals from South Africa and 172 from Belgium. rpoB polymorphisms were identified by Sanger sequencing. Rifampicin and rifabutin susceptibility was assessed phenotypically. A systematic review was performed to comprehensively collate information on rifabutin susceptibility by rpoB polymorphism. Rifabutin susceptibility was assigned to rpoB polymorphisms based on their positive likelihood ratios and ORs.Results: One hundred and twelve rpoB polymorphisms (67.9% from literature) were identified from all 2045 RR-TB patients, of which 17 polymorphisms could be classified as susceptible/resistant to rifabutin. Eleven polymorphisms were associated with rifabutin susceptibility. The 516GTC mutation was the most common, representing 70% (South Africa) and 76% (Belgium) of all rifabutin-susceptible isolates. At a population level, the 11 polymorphisms associated with rifabutin susceptibility occurred in 33.2% and 16.6% of all South African and Belgian patients diagnosed with RR-TB, respectively.Conclusions: Identification of the exact rpoB polymorphism leading to the diagnosis of RR-TB has the potential to allow inclusion of rifabutin in the treatment regimen of a substantial proportion of RR-TB patients. A randomized controlled trial evaluating the efficacy of a rifabutin-containing TB treatment regimen in these selected patients is needed to provide the evidence required for a change in policy. [ABSTRACT FROM AUTHOR]

Background: Research about advance care planning (ACP) has often targeted those with serious illness and limited prognosis, thereby not addressing the preferences of healthy adults or adults with a stable condition.Aims: (i) To describe to what extent patients aged 50 and older who are relatively stable or in good health are thinking about the end of life (EOL) and willing to discuss this with their family physician (FP) and (ii) to explore whether patients and FPs indicate the same topics as triggers for ACP discussions in family practice.Methods: A cross-sectional study was conducted in a diverse sample of 289 patients aged ≥50 years in family practice in Flanders, Belgium. Subsequently, semi-structured interviews were conducted with patients (n = 5) and FPs (n = 5) to explore their preferences and views on ACP in family practice.Results: The majority (69.8%) of patients had thought about the EOL and would appreciate it if their FP would initiate a conversation about this (75.9%). The qualitative interviews revealed that when thinking about the EOL, a number of themes captured the thoughts of people according to both patients and FPs: (i) becoming care dependent, (ii) physical and mental deterioration, (iii) dying alone and (iv) having paperwork in order. However, on the basis of patients' ideas and FPs' experiences in practice, a difference was noticed between them when it comes to identifying the themes as triggers for initiating ACP discussions.Conclusion: Although patients are willing to discuss the EOL with their FPs, patients and FPs identified different themes as triggers to initiate discussions about the EOL. The variation in triggers could lead to missed opportunities to engage in ACP in a timely manner. [ABSTRACT FROM AUTHOR]

Studies of family reunification suggest that migrants' decisions whether to pursue family reunion vary across migration patterns. To explain why, this article draws from the literature on social reproduction in the context of migration and examines two cases of mother-child reunification (or lack thereof) in the Filipino labour and Thai marriage migrations respectively to France and to Belgium. Interview data analysis brings to the fore the forces that influence the decisions of Filipino and Thai migrant women regarding family reunion: the inequalities of access to rights and resources stemming from their positions in the global reproductive systems, which are stratified and structured by gendered norms and state policies. Their positions within the reproductive systems in their countries of origin and of immigration entail obligations to fulfil, expectations to meet, and (dis)advantages to live with. As a result, not all Filipino and Thai migrants pursue family reunion, even in the presence of favourable factors such as a regular migration status and stable economic resources. [ABSTRACT FROM AUTHOR]

In the nineteenth century, the distribution of corpses to anatomists was based on a reciprocal logic. In exchange for state-funded care, the poor subordinated their bodies to the advancement of science. Recent research has shown that this practice was increasingly contested in continental Europe from the late nineteenth century onwards. In this article, the Belgian debate on dissection without consent is scrutinised from multiple perspectives. I argue that political and legal debates on the treatment of the poor and the ownership of the dead led to changes in the distribution of corpses for dissection. As indigent patients obtained ownership of their bodies, anatomists increasingly had to comply with the standard of consent. By contextualising the emergence of anatomical donation, this article sheds light on a neglected topic in the social history of anatomy and on the changing significance of death customs, which began to express the will of the deceased. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the quality of care for all patients diagnosed with lung cancer in Belgium based on a set of evidence-based quality indicators and to study the variability of care between hospitals.Design, Setting, Participants: A retrospective study based on linked data from the cancer registry, insurance claims and vital status for all patients diagnosed with lung cancer between 2010 and 2011. Evidence-based quality indicators were identified from a systematic literature search. A specific algorithm to attribute patients to a centre was developed, and funnel plots were used to assess variability of care between centres.Intervention: None.Main Outcome Measure: The proportion of patients who received appropriate care as defined by the indicator. Secondary outcome included the variability of care between centres.Results: Twenty indicators were measured for a total of 12 839 patients. Good results were achieved for 60-day post-surgical mortality (3.9%), histopathological confirmation of diagnosis (93%) and for the use of PET-CT before treatment with curative intent (94%). Areas to be improved include the reporting of staging information to the Belgian Cancer Registry (80%), the use of brain imaging for clinical stage III patients eligible for curative treatment (79%), and the time between diagnosis and start of first active treatment (median 20 days). High variability between centres was observed for several indicators. Twenty-three indicators were found relevant but could not be measured.Conclusion: This study highlights the feasibility to develop a multidisciplinary set of quality indicators using population-based data. The main advantage of this approach is that not additional registration is required, but the non-measurability of many relevant indicators is a hamper. It allows however to easily point to areas of large variability in care. [ABSTRACT FROM AUTHOR]

Background: adults aged 80 and over, a fast growing age-group, with increased co-morbidity and frailty have not been the focus of previous research on dyspnoea. We investigate the correlates of dyspnoea and its association with adverse outcomes in a cohort of adults aged 80 and over. Methods: about 565 community-dwelling adults aged 80 and over of the BELFRAIL prospective cohort had assessment of Medical Research Council dyspnoea scale (MRC), forced expiratory volume in 1 s (FEVi), N-terminal pro-brain natriuretic peptide (NT-proBNP), physical performance tests, grip strength, 15 items geriatric depression scale, activities of daily living (ADL), body mass index (BMI) and demographics data. Kaplan--Meier survival curves, Cox and logistic multivariable regression, classification and regression tree (CART) analysis assessed association of dyspnoea (MRC 3-5) with time-to-cardiovascular and all- cause death (5 years), time to first hospitalisation (3 years), new/worsened ADL disability (2 years), and its correlates. Results: participants with dyspnoea MRC 3-5 (29.9%) had increased hazard ratios for cardiovascular mortality 2.85 (95% confidence interval 1.93-4.20), all-cause mortality 2.04 (1.58-2.64), first hospitalisation 1.72 (1.35-2.19); and increased odds ratio for new/worsened disability 2.49 (1.54-4.04), independent of age, sex and smoking status. Only FEV1, physical performance, BMI and NT-proBNP (in order of importance) were selected in the tree-based classification model for dyspnoea. Conclusions: in a cohort of adults aged 80 and over, dyspnoea was common and an independent predictor of adverse outcomes, with cardio-respiratory and physical performance impairments as key independent correlates. Its routine and comprehensive evaluation in primary care could be very valuable in caring for this age-group. [ABSTRACT FROM AUTHOR]

Background: National Health Interview Surveys are used to produce country-wide results for a substantial number of health indicators. However, if some educational groups are underrepresented in the sample, estimates may be biased. This study investigated the impact of the use of post-stratification weights that adjust for the population distribution by education on estimates from the Belgian Health Interview Survey 2013. Methods: For 25 health- related indicators that match the European Core Health Indicator shortlist, estimates were computed using two different sets of post-stratification weights: one based on age group, gender and province only and the other one including also education. The Census 2011 was used as auxiliary data source. Statistical differences between the two estimates were assessed with the Delta method. Results: If education is not included as post-stratification weighting factor, low educational groups (ISCED 0-2) represent 31.1% of the total study population aged 25 years and older. If education is taken into account this proportion rises to 40.3%. The use of post-stratification weights adjusting for the population distribution by education has an impact on several survey estimates. The most pronounced effect is an increase in the estimated proportion of people with diabetes (+0.73%; 95% CI 0.191.27; relative increase+11.6%), asthma (+0.52%; 95% CI, 0.06-0.98; relative increase+12.4%) and difficulties to cover their health expenses (+2.31%; 95% CI, 1.52-3.10; relative increase+9.4%). Conclusions: Including education in the calculation of post-stratification weights reduces bias due to educational differences in survey participation. Auxiliary information used to calculate post-stratification weights for national health surveys should include education. [ABSTRACT FROM AUTHOR]

Background In this study, we aimed to (i) determine the prevalence of potentially inappropriate prescribing (PIP) in community-dwelling older polypharmacy patients using the Ghent Older People's Prescriptions community-Pharmacy Screening (GheOP³S) tool, (ii) identify the items that account for the highest proportion of PIP and (iii) identify the patient variables that may influence the occurrence of PIP. Additionally, pharmacist--physician contacts emerging from PIP screening with the GheOP³S tool and feasibility of the GheOP³S tool in daily practice were evaluated. Methods A prospective observational study was carried out between December 2013 and July 2014 in 204 community pharmacies in Belgium. Patients were eligible if they were (i) ≥70 years, (ii) community-dwelling, (iii) using ≥5 chronic drugs, (iv) a regular visitor of the pharmacy and (v) understanding Dutch or French. Community pharmacists used a structured interview to obtain demographic data and medication use and subsequently screened for PIP using the GheOP³S tool. A Poisson regression was used to investigate the association between different covariates and the number of PIP. Results In 987 (97%) of 1016 included patients, 3721 PIP items were detected (median of 3 per patient; inter quartile range: 2-5). Most frequently involved with PIP are drugs for the central nervous system such as hypnosedatives, antipsychotics and antidepressants. Risk factors for a higher PIP prevalence appeared to be a higher number of drugs (30% extra PIPs per 5 extra drugs), female gender (20% extra PIPs), higher body mass index (BMI, 20% extra PIPs per 10-unit increase in BMI) and poorer functional status (30% extra PIPs with 6-point increase). The feasibility of the GheOP³S tool was acceptable although digitalization of the tool would improve implementation. Despite detecting at least one PIP in 987 patients, only 39 physicians were contacted by the community pharmacists to discuss the items. Conclusion A high prevalence of PIP in community-dwelling older polypharmacy patients in Belgium was detected which urges for interventions to reduce PIP. [ABSTRACT FROM AUTHOR]

This article discusses scientific researches involving epidemiology, and they include one which investigated which factors increased the risk of falls and fractures after stroke, another which examined the outcome of older surgical patients with poor cognition who are admitted to the acute surgical setting, and one which explored differences in physical performance (PP) in relation to health and lifestyle factors among ethnically diverse community-dwelling older adults from one geographic area.

Child welfare and protection (CWP) has engaged in the introduction of Electronic Information Systems (EIS), such as electronic recording, assessment and decisionmaking tools. It has been argued that EIS have adverse consequences in which governments are conceived as homogeneous entities that install EIS for self-interested purposes. Consequently, research focuses on how social workers evade/reshape the sometimes pernicious effects of EIS. Insufficient attention has been given to the governmental perspective and to why governments install EIS. In this article, we contribute to this debate by performing semi-structured interviews with policy actors (directors, policy advisers and staff members) in the field of CWP in Flanders. Asked about their rationales for installing EIS, they spoke of administrative, policy, care and economic reasons. However, while advocating these EIS, they also expressed a critical attitude concerning the usefulness of EIS, hoping that practitioners would move back and forth between governmental demands and day-to-day realities, to establish a more responsive social work. This ambiguous situation in which policy makers seem to be both strong supporters and critics of EIS at the same time is captivating, since it seems no longer necessary to perceive governments as a homogeneous bogeyman and social work as a victim. [ABSTRACT FROM AUTHOR]

Background: European societies are rapidly ageing and becoming multicultural. We studied differences in overall and cause-specific mortality between migrants and non-migrants in Belgium specifically focusing on the older population. Methods: We performed a mortality follow-up until 2009 of the population aged 50 and over living in Flanders and the Brussels-Capital Region by linking the 2001 census data with the population and mortality registers. Overall mortality differences were analysed via directly age-standardized mortality rates. Cause-specific mortality differences between non-migrants and various western and non-western migrant groups were analysed using Poisson regression models, controlling for age (model 1) and additionally controlling for socio-economic status and urban typology (model 2). Results: At older ages, most migrants had an overall mortality advantage relative to non-migrants, regardless of a lower socio-economic status. Specific migrant groups (e.g. Turkish migrants, French and eastern European male migrants and German female migrants) had an overall mortality disadvantage, which was, at least partially, attributable to a lower socio-economic status. Despite the general overall mortality advantage, migrants experienced higher mortality from infectious diseases, diabetes-related causes, respiratory diseases (western migrants), cardiovascular diseases (non-western female migrants) and lung cancer (western female migrants). Conclusion: Mortality differences between older migrants and non-migrants depend on cause of death, age, sex, migrant origin and socio-economic status. These differences can be related to lifestyle, social networks and health care use. Policies aimed at reducing mortality inequalities between older migrants and non-migrants should address the specific health needs of the various migrant groups, as well as socio-economic disparities. [ABSTRACT FROM AUTHOR]

The article offers information on obesity research in Europe. One study evaluated the compliance to food-based dietary guidelines in Belgium using data from the Belgian Food Consumption Survey. Another paper presented a comparison of physical activity in preschool children and adolescents in the Czech Republic in relation to health recommendations.

The article highlights the conference entitled "Canons and Canonic Techniques, 14th-16th century, Katholieke Universiteit te Leuven" which was held on October 4-6, 2005 in Louvain, Belgium. It includes topics discussed and presented during the conference including compositional process and decoding canons, as well as sightseeing suggestions.

Background. Chiropractors throughout the world by and large focus on patients with musculoskelctal complaints who are generally in good health. Currently, it is widely accepted that neck pain and low back pain are best understood as biopsychosocial phenomena. Objective. The purpose of this study was to determine whether certain psychosocial factors provide added value for predicting recovery. Design. This was a prospective, multicenter, chiropractic, practice-based cohort study in Belgium and the Netherlands. Methods. A total of 917 participants, 326 with neck pain and 591 with low back pain, completed self-administered questionnaires at baseline and at 3, 6, and 12 months. They provided information on several demographic, biomedical, and psychosocial variables. Lasting perceived recovery was used as the outcome measure, that is, recovery at all follow-up assessments from 3 months on. Twenty-seven potential predictors of outcome were used to build the predictive model. Stepwise, backward generalized estimating equation regression models were used to take into account the clustering of participants within practices. For assessment of the added value of psychosocial variables, 2 model fit indexes were compared. Results. After the addition of psychosocial variables, predictors in the final model for neck pain included occupational status, body mass index, duration of complaints, previous treatment, and participant expectations (the model fit was marginally improved from 0.684 to 0.695 for the area under the curve and from 65.0% to 66.1% for the percentage correctly predicted). In the final model for low back pain, the selected predictors included country of treatment, age, duration of complaints, previous imaging, and somatization (the area under the curve changed from 0.669 to 0.715, and the percentage correctly predicted changed from 68.6% to 69.5%). Only a minority of participants had high scores on psychological variables. Limitations. The reliability and validity of lasting recovery as an outcome measure have not been tested. The cohort needs to be seen as a convenience sample. Selection bias, therefore, not be ruled out. There are no indications, however, that patients with complex psychosocial profiles were excluded from this study. Conclusions. Psychosocial variables provided little added value for predicting outcome in people who had neck pain or low back pain and sought chiropractic care. Therefore, chiropractors should not screen extensively for them at baseline. With regard to the identification of the small subgroup of people with high scores on psychosocial variables and a high risk for chronic pain, further investigation is needed. [ABSTRACT FROM AUTHOR]

Background: The European population is aging. The main drivers of public spending on health care for people of 65 years and older are hospital admission and admission to long-term care facilities. High quality community care can be a cost-effective and quality solution to respond to the impact of ageing populations on health-care systems. It is unclear how well countries are equipped to provide affordable and quality community care. The aim of this article is to describe and compare community care delivery with care-dependent older people in Europe. Methods: This study is conducted within the European Union-financed IBenC project [Identifying best practices for care-dependent elderly by Benchmarking Costs and outcomes of community care (FP7)] in which six European countries are involved. To compare the community care delivery with care-dependent older people in these countries, we performed a systematic comparison of macro indicators using metadata complemented with data from multinational surveys. Results: Data on the following dimensions are described and compared: population of the country, governmental expenditures on health, sources of community health services funding, governmental vision and regulation on community care, community care organisations and care professionals, eligibility criteria for and equity in receiving care and the involvement of informal care. Conclusion: Because of the variations in the European community care contexts, the growing demand for community care as a cost-effective and quality solution to the care burden of aging populations will have country-specific impacts. When learning from other countries' best practices, in addition to researchers, policy makers should take full account of local and national care contexts. [ABSTRACT FROM AUTHOR]

The article explores on the threat of terrorism following the shooting at the Jewish Museum of Belgium in Brussels, Belgium on May 24, 2014. It highlights the increase number of recruits to produce international terrorism with the foreign fighters of Islamic State. It outlines the conflict of the international terrorists in Syria and Iraq. It also cites the importance of security cooperation between the U.S. and Europe to prevent terrorism and improve the national security of both countries as well as to maintain public safety.

We identified in a cohort of patients with frontotemporal dementia (n = 481) or amyotrophic lateral sclerosis (n = 147), 10 index patients carrying a TBK1 loss of function mutation reducing TBK1 expression by 50%. Here, we describe the clinical and pathological characteristics of the 10 index patients and six of their affected relatives carrying a TBK1 mutation. Six TBK1 carriers were diagnosed with frontotemporal dementia, seven with amyotrophic lateral sclerosis, one with both clinical phenotypes and two with dementia unspecified. The mean age at onset of all 16 TBK1 carriers was 62.1 ± 8.9 years (range 41-73) with a mean disease duration of 4.7 ± 4.5 years (range 1-13). TBK1 carriers with amyotrophic lateral sclerosis had shorter disease duration than carriers with frontotemporal dementia. Six of seven TBK1 carriers were diagnosed with the behavioural variant of frontotemporal dementia, presenting predominantly as disinhibition. Memory loss was an important associated symptom in the initial phase of the disease in all but one of the carriers with frontotemporal dementia. Three of the patients with amyotrophic lateral sclerosis exhibited pronounced upper motor neuron symptoms. Overall, neuroimaging displayed widespread atrophy, both symmetric and asymmetric. Brain perfusion single-photon emission computed tomography or fluorodeoxyglucose-positron emission tomography showed asymmetric and predominantly frontotemporal involvement. Neuropathology in two patients demonstrated TDP-43 type B pathology. Further, we compared genotype-phenotype data of TBK1 carriers with frontotemporal dementia (n = 7), with those of frontotemporal dementia patients with a C9orf72 repeat expansion (n = 65) or a GRN mutation (n = 52) and with frontotemporal dementia patients (n = 259) negative for mutations in currently known causal genes. TBK1 carriers with frontotemporal dementia had a later age at onset (63.3 years) than C9orf72 carriers (54.3 years) (P = 0.019). In clear contrast with TBK1 carriers, GRN carriers were more often diagnosed with the language variant than the behavioural variant, and presented in case of the diagnosis of behavioural variant, more often than TBK1 carriers with apathy as the predominant characteristic (P = 0.004). Also, TBK1 carriers exhibited more often extrapyramidal symptoms than C9orf72 carriers (P = 0.038). In conclusion, our study identified clinical differences between the TBK1, C9orf72 and GRN carriers, which allows us to formulate guidelines for genetic diagnosis. After a negative result for C9orf72, patients with both frontotemporal dementia and amyotrophic lateral sclerosis should be tested first for mutations in TBK1. Specifically in frontotemporal dementia patients with early memory difficulties, a relatively late age at onset or extrapyramidal symptoms, screening for TBK1 mutations should be considered. [ABSTRACT FROM AUTHOR]

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For several months in 2013 and 2014, a group of failed Afghan asylum seekers in Brussels became a constant focus of Belgian media and public attention. Through a combination of factors, they succeeded in highlighting the precarious situation of their group in a manner that garnered unprecedented levels of public support, although they ultimately failed to deliver their primary political goal--a moratorium on deportations to Afghanistan. This article analyses the specific combination of factors underlying the short-lived success of this social protest movement and the group dynamics that propelled it to national prominence. [ABSTRACT FROM AUTHOR]

Background: Changes in work and working conditions continuously give rise to new work-related health risks. Without sufficient knowledge of these, opportunities for prevention and intervention may be missed. Aims: To develop, implement and evaluate an online tool called SIGNAAL for reporting and assessment of new work-related health risks by occupational health physicians and experts in the Netherlands and Belgium. Methods: Development and implementation of SIGNAAL to allow both easy and sufficient detailed reporting by occupational health physicians and structured and transparent assessment by occupational health experts. A new work-related health risk is defined as a work-related disease due to specific exposure in a specific work setting not described in the literature before. Results: The online reporting and assessment tool proved to be a feasible means of reporting possible new combinations of health problems and exposures in the work situation. Eleven of the 15 cases reported until October 2014 were fully assessed: one was an entirely new work-related disease, four were known but uncommon work-related diseases, five were known but new in the reported work situation and one was a well-known work-related disease. Conclusions: An online reporting system used in an occupational health setting can provide insight into new workrelated health risks by creating a structured way to gather, report and assess new combinations of health problems and exposure in the workplace. [ABSTRACT FROM AUTHOR]

Background: Both media use and cancer knowledge have been identified as important predictors of a healthy lifestyle. However, little is known about the interplay between these two variables, and about differences between cancer diagnosed and non-diagnosed consumers of media and knowledge. This study investigated the relationship between media use (television and internet exposure) and lifestyle choices of cancer diagnosed and non-diagnosed individuals, and looked at the influence of cancer knowledge on this relationship. Methods: A cross-sectional, quantitative survey (the Leuven Cancer Information Survey) was administered to 621 cancer diagnosed and 1387 non-diagnosed individuals, aged 16-88 years old in Flanders (Belgium). Bivariate analyses, hierarchical linear regression analyses and advanced moderation and mediation analyses were conducted. Results: Internet exposure was not a predictor of lifestyle choices. Television exposure, however, was a negative predictor of healthy lifestyle choices. Moreover, television exposure was a direct negative predictor of cancer knowledge, which in turn positively predicted lifestyle choices. However, no differences were found in the investigated relationships between the two subsamples. Conclusion: These results indicate that higher levels of television exposure coincide with less cancer knowledge and with less healthy lifestyle choices. It offers a pathway for intervention by suggesting that improving cancer knowledge through television might positively affect lifestyle choices. [ABSTRACT FROM AUTHOR]

Many university students engage in risky alcohol consumption behaviour during their stay at university. So far, however, most studies have relied on cross-sectional surveys and paid little attention to the role of social ties. University students, however, are socially connected, so it is likely that their alcohol consumption behaviour is also connected. We hypothesized that university students' social positions within their networks are related to their drinking behaviour. We carried out a social network analysis within a whole network approach with undergraduates in two faculties (n = 487), those of Engineering and Psychology, in a Belgian university. All students filled out a questionnaire recording their drinking behaviour and their social ties (friendship, working with, partying with and room-mate). For each individual, indicators of centrality, social capital, and cross-gender relationships were computed. We found that being socially close to binge drinkers was associated with a higher frequency of binge drinking. The risk of binge drinking increased with centrality but decreased with social capital. Having cross-gender relationships decreased the risk of binge drinking. We found indications that the effect of centrality and gender on binge drinking depends on the composition of the network. We conclude that social position has important effects on risky drinking behaviour and that the composition of the network may affect these factors. Those developing health promotion strategies could investigate the benefits of targeting central individuals in order to prevent binge drinking among university students. [ABSTRACT FROM AUTHOR]

With more social support and environment-centered interventions being recommended in web-based interventions, this study examined the efficacy of three intervention conditions aimed at promoting physical activity (PA) in older adults. The efficacy analyses included the self-reported PA level, stage of change for PA and awareness about PA among participants. Eligible participants (N=149; M=65 years old, SD=6), recruited in a unique Belgian French-speaking municipality, were randomized in four research arms for a 3-month intervention: (i) web-based; (ii) center-based; (iii) mixed (combination of web- and center-based); and (iv) control (no intervention). Web-based condition included a PA website and monthly tailored emails whereas center-based condition comprised 12 sessions (1 per week) of group exercising. With a significant increase in PA, the PA stage of change and the PA awareness at 12 months, the mixed intervention condition seemed to include the key social and motivating elements for sustainable behavior change. Center-based intervention was more likely to produce significant improvements of the PA level and the stage of change for PA change whereas web-based intervention was more likely to extend the awareness about PA. [ABSTRACT FROM AUTHOR]

The article presents abstracts of studies on rheumatology which include the preliminary validation of an illness perception questionnaire for healthcare professionals, the personality traits of rheumatoid arthritis (RA) patients and the management of patients with hip osteoarthritis.

Objective: previous studies have demonstrated an association between cytomegalovirus (CMV) infection and mortality in adults. In this prospective study, it was investigated whether these findings could be confirmed in the oldest old.Methodology: data obtained from a prospective observational cohort study (2008–2012) of 549 community-dwelling persons in Belgium aged 80 and older.Results: seventy-six percent were anti-CMV seropositive of whom 37.5% had an anti-CMV IgG titre in the highest tertile (>250 IU/ml). After a median time of follow-up of 1,049 days, 127 deaths occurred. Cox proportional hazard models failed to show an association between CMV serostatus and all-cause mortality. Among persons seropositive for CMV, after adjusting for multiple confounders an anti-CMV in the highest tertile was statistically significantly associated with all-cause mortality (hazard ratio: 1.64, 95% confidence interval: 1.08, 2.48).Conclusion: in contrast to previous findings, a positive CMV serostatus was not associated with an increased risk for all-cause mortality in this cohort of very old people. This is probably the result of a survival effect. CMV seropositive subjects with high anti-CMV titres were at higher risk for all-cause mortality compared with other individuals. This may reflect CMV infection reactivation to be more common in the end stages of life. [ABSTRACT FROM PUBLISHER]

Lifelong learning has become a necessity for individuals' employability and a source of sustainable competitive advantage for organisations. Learning does not only occur through education and training, informal learning—learning from engagement in daily work-related activities—is considered an important source for establishing a sustainable change aimed at achieving individual and organisational goals. The purpose of this study is to develop and validate a measurement instrument of informal workplace learning outcomes focusing on socio-educational care workers. Due to their constantly changing profession, continuous learning has become a necessity. After the construction of the questionnaire on socio-educational care workers' informal workplace learning outcomes, data were collected by means of an online questionnaire (N = 1,186). These data were randomly divided into two data sets. An exploratory factor analysis was conducted on the first data set (n = 593) to provide insight into the latent factors underpinning the questionnaire. Three factors were derived: generic, job-specific and organisational-level learning outcomes. Following, a confirmatory factor analysis was conducted on the second dataset (n = 593) to validate the retrieved structure. The results reflect a good fit between the proposed three-factor model and the observed data. Future research perspectives within the field of social work are discussed. [ABSTRACT FROM AUTHOR]

Unaccompanied refugee mothers—young mothers living in another country and separated from their parents—are, in research and migration policies, often defined in terms of four social categories: refugee, unaccompanied, adolescent and mother. In-depth interviews were conducted with twenty unaccompanied refugee mothers from different countries of origin and now living in Belgium to listen, first, to their feelings and experiences. These narratives revealed four central themes in the mothers' experiences (constrained and constraining daily living conditions, emotional challenges, connectedness and motherhood as a turning point), which appeared to be, in a second analysis, related to intersections between the four social categories. However, the intersectional analysis revealed large gaps between the mothers' and migration policies' interpretations of these categories: the mothers not only define the categories differently, but also set other priorities as they identify themselves first as mothers, while the policies prioritise their status as refugees. These findings, together with reflections on the value of adopting an intersectional perspective, lead to several recommendations for research, social work practices and migration policies. [ABSTRACT FROM PUBLISHER]

Aging is associated with a chronic low-grade inflammatory status that contributes to chronic diseases such as age-related muscle wasting, kidney disease, and diabetes mellitus. Since advanced glycation end products ( AGEs) are known to be proinflammatory, this systematic review examined the relation between the dietary intake of AGEs and inflammatory processes. The PubMed and Web of Science databases were screened systematically. Seventeen relevant studies in humans or animals were included. The intervention studies in humans showed mainly a decrease in inflammation in subjects on a low- AGE diet, while an increase in inflammation in subjects on a high- AGE diet was less apparent. About half of the observational studies found a relationship between inflammatory processes and AGEs in food. When the results are considered together, the dietary intake of AGEs appears to be related to inflammatory status and the level of circulating AGEs. Moreover, limiting AGE intake may lead to a decrease in inflammation and chronic diseases related to inflammatory status. Most of the trials were conducted in patients with chronic kidney disease or diabetes, and thus additional studies in healthy individuals are needed. Further investigation is needed to elucidate the effects of lifetime exposure of dietary AGEs on aging and health. [ABSTRACT FROM AUTHOR]

Implementation is an emerging research topic in the field of health promotion. Most of the implementation research adheres to one of two paradigms: implementing interventions with maximum fidelity or designing interventions that are responsive to the needs of a local community. While fidelity and adaptation are often considered as contradictory, they are both essential elements of preventive interventions. An innovative program design strategy is therefore to develop hybrid programs that ‘build in’ adaptation to enhance program fit, while also maximizing the implementation fidelity. The present article presents guidelines for this hybrid approach to program implementation and illustrates them with a concrete psycho-educational group intervention. The approach, which is referred to as ‘empowerment implementation’ on the analogy of empowerment evaluation, builds on theory of implementation fidelity and community-based participatory research. To demonstrate the use of these guidelines, a psycho-educational course aimed at stress reduction and the prevention of depression and anxiety was implemented according to these guidelines. The main focus lies on how an intervention can benefit from adaptations guided by local expertise, while maintaining the core program components and still respecting the implementation fidelity. [ABSTRACT FROM AUTHOR]

Background: The aim was to study the impact of psychosocial risk factors on long-term sickness absence due to mental health problems (LSA-MH) or musculoskeletal disorders (LSA-MSD) in 2983 Belgian middle-aged workers. Methods: Data were collected from 1372 male and 1611 female workers in the Belstress III study. Considered psychosocial risk factors were job demands, job control, social support, job strain, efforts, rewards, effort–reward imbalance and bullying. Prospective registered sickness absence data were collected during 12 months follow-up; the causes for long-term sickness absence episodes of at least 15 consecutive days were obtained by contacting the general practitioner of the worker. Multiple logistic regression models were used to investigate the relationship between the psychosocial risk factors and LSA-MH and LSA-MSD. Results: Higher levels of rewards at baseline were independently and significantly associated with a lower risk for LSA-MH. Higher levels of control were associated with a lower risk for LSA-MSD during follow-up. Higher job demands and efforts were significantly related to a lower risk for LSA-MSD. Finally, bullying was significantly and independently related to both LSA-MH and LSA-MSD during the follow-up period. Conclusions: These results suggest that psychosocial risk factors are related to LSA-MH and LSA-MSD, of which especially bullying seems to be a potent stressor. [ABSTRACT FROM AUTHOR]

Is Belgium threatened by secession? In this article we highlight why Belgium is unlikely to experience the secession of Flanders and investigate Belgium’s journey to federalism. We first call upon tools provided by economic theory. Then we turn to facts, first having a look at Belgium’s history and second presenting the six reforms of the state which occurred between 1970 and 2013, progressively increasing the autonomy of Belgian regions and communities and making Belgian federalism an evolutionary, maybe endless, repeated game whose players have different strategies: an offensive one for the north and a conservative one for the south. Then we examine the contemporary dangers and discuss the outcome of Belgian game from the point of view of fiscal federalism and subsidiarity. [ABSTRACT FROM AUTHOR]