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The number of PhD candidates who experience psychological problems has risen significantly over the past few years. Poor mental health can have numerous negative consequences for PhD candidates and their supervisors, as it may adversely affect their quality of life, attrition, and academic productivity. Despite these well-documented challenges, few studies have looked at how the supervisor-supervisee relationship can influence the emotional well-being of male and female doctoral candidates. The current work examined the role of the supervisor's support in emotions and intended doctoral persistence among men (n = 411) and women (n = 514), in all disciplines at two large universities in Belgium. Results indicate that emotional well-being was low for all doctoral candidates but women experienced even more negative emotions (anxiety, stress, discouragement, demoralization, sadness and depression) and fewer positive emotions (confidence, optimism, happiness, fulfillment, satisfaction and content) than men. Interestingly, we also found that perceived structure and autonomy, two dimensions of supervisor support, have a positive effect on emotional well-being and intention of pursuing a PhD trajectory for both men and women. This paper makes a contribution to the higher education and research supervision literature by offering new directions for research and by providing guidelines for the training of research supervisors.

The issue of considerable dropout rate in doctoral programs is well documented across a large number of countries. However, few studies address the factors associated with doctoral completion among Non-U.S. countries, multiple universities and fields of research. Nor do they investigate the interactions between these factors. The present paper aimed to overcome these limitations and analyzed the population of doctoral students in all disciplines of the two largest universities of the French-speaking Community of Belgium (N = 1509). Specifically, we focused on several factors: gender, nationality, marital status, master grade, whether students continued at the same university when transitioning to the doctoral degree, whether they continued in the same field, age at registration, research field and funding (i.e., type of funding and associated job requirements). Findings indicate that four factors (marital status, master grade, research field and funding) are directly associated with dropout rate when all factors are considered jointly in the same model. Furthermore, results indicate that some of these factors, such as the marital status and gender, interact. In addition, we found that an accumulation of risk factors leads to a massive increase in dropout rates. Finally, a time course analysis revealed that the highest dropout rate occurs during the first two years and is related to the absence of funding or scholarship. The results, limits and futures perspectives are discussed.

Introduction: Older adults face a higher risk of vancomycin-related toxicity given their (patho)-physiological changes, making early management of supratherapeutic exposure crucial. Yet, data on vancomycin exposure in older adults is scarce. This study aims to compare vancomycin concentrations between older and younger patients, emphasizing supratherapeutic concentrations and the effect of patient characteristics. Methods: This observational retrospective study was conducted in the University Hospital of Leuven (EC Research S65213). We analyzed early (first) vancomycin concentrations between older (≥ 75 years) and younger patients. Multivariable analyses were conducted to evaluate the association between baseline patient characteristics with supratherapeutic exposure (logistic regression), and dose-normalized concentrations (linear regression). Results: We included 449 patients aged ≥ 75 years (median 80) and 1609 aged < 75 years (median 61). In univariable analysis, the first-measured vancomycin concentrations were significantly higher in older adults (p < 0.001), who more frequently reached supratherapeutic concentrations (30.7% versus 21%; p < 0.001). In multivariable analysis, factors associated with supratherapeutic concentrations were decreased the estimated glomerular filtration rate calculated by using the Chronic Kidney Disease Epidemiology Collaboration equation (eGFRCKD-EPI) [odds ratio (OR) of 0.98, confidence interval (CI) 0.97–0.98]. Supratherapeutic concentrations had inverse association with giving lower loading dose (OR of 0.59, CI 0.39–0.90), and lower maintenance dose (OR of 0.45, CI 0.26–0.77). Factors that predicted increased dose-normalized concentrations included decreased eGFRCKD-EPI (coefficient of −0.05, CI −0.06 to −0.04), lower body weight (coefficient of −0.04, CI −0.05 to −0.03), increased blood urea nitrogen (coefficient of 0.02, CI 0.01–0.03), and delayed time to therapeutic drug monitoring (TDM) sampling (coefficient of 0.08, CI 0.06–0.09). Conclusions: The absence of age as a significant factor in the multivariable analysis suggests that eGFRCKD-EPI mediated the relationship between age and vancomycin exposure. Older adults may benefit more from vancomycin TDM. [ABSTRACT FROM AUTHOR]

Background: Polypharmacy is a growing concern, impacting patient safety and healthcare costs. Monitoring its prevalence and temporal trends is essential for effective healthcare management. Aim: This study aimed to determine prevalence and trends of polypharmacy and excessive polypharmacy in Belgium. Method: Utilizing a federal claims database, medication data were analyzed from 2012 to 2021. Polypharmacy (≥ 5 medications) and excessive polypharmacy (≥ 10 medications) were evaluated, with prevalence calculated per 1000 inhabitants, and reported per year, age group and region. Linear regression estimated the impact of age and year on polypharmacy prevalence. Results: In 2021, polypharmacy and excessive polypharmacy were reported in 135/1000 and 31/1000 Belgians respectively. Prevalence of both increased steadily from 2012 to 2021, with excessive polypharmacy rising more prominently. Among adults aged ≥ 65 years, prevalence rates were higher, with polypharmacy at 434/1000 and excessive polypharmacy at 106/1000. Regional variations were observed, with prevalence highest in the Walloons region. Patient age and year (2012–2021) were associated with both polypharmacy and excessive polypharmacy (p < 0.001). Conclusion: We observed increases in polypharmacy and excessive polypharmacy over a decade in Belgium, particularly among older adults. Efforts to monitor, manage, and optimize medication use are imperative to ensure safe and effective healthcare delivery. [ABSTRACT FROM AUTHOR]

The present study explored the relation between language control and nonverbal cognitive control in different bilingual populations. We compared monolinguals, Dutch-French unbalanced bilinguals, balanced bilinguals, and interpreters on the Simon task (Simon & Rudell, 1967) and the Attention Network Test (ANT; Fan, McCandliss, Sommer, Raz, & Posner, 2002). All bilingual groups showed a smaller congruency effect in the Simon task than the monolingual group. They were also faster overall in the ANT. Furthermore, interpreters outperformed unbalanced, but not balanced, bilinguals in terms of overall accuracy on both tasks. In the ANT, the error congruency effect was significantly smaller for interpreters and balanced bilinguals. Using a measure of switching fluency in language production, this study also found direct evidence for a relation between language control and executive control. This relation was only observed in balanced bilinguals, where fluent switching was correlated with the Simon effect. These findings support the existence of a bilingual advantage and also indicate that different patterns of bilingual language use modulate the nature and extent of a cognitive control advantage in multilingual populations.

Language outcome in children experiencing fluctuant hearing loss due to otitis media (OME) remains highly equivocal. In the current study, we assessed performance on highly sensitive verbal short-term memory (STM), new word learning and phonological processing tasks in 8-year-old children who had suffered from recurrent OME before the age of 3. Relative to a control group with no history of OME, we observed strictly normal performance for different STM and new word learning tasks. Performance on these tasks was also normally influenced by phonotactic, lexical and semantic variables. However, at the level of phonological processing, a small but significant decrease of performance was found in a speeded nonword identification task and a rhyme judgment task. The results of this study suggest that outcome of OME is characterized by subtle impairments at the level of perceptual-phonological analysis, but there is no significant impact on verbal STM and new word learning abilities. Learning outcomes: As a result of this activity, the participant will be able to (1) explain the outcome of recurrent OME before age 3 on later language and verbal STM development, (2) be aware of the complex relationships that link language development and verbal STM, (3) explain how fluctuant hearing loss during infancy and early childhood could affect verbal STM development and learning capacity for new phonological information, (4) describe different verbal STM measures that distinguish retention capacities for phonological and lexico-semantic information, and (5) explain the influence of phonotactic frequency on nonword processing in language and verbal STM tasks.

Schools have been a point of attention during the pandemic, and their closure one of the mitigating measures taken. A better understanding of the dynamics of the transmission of SARS-CoV-2 in elementary education is essential to advise decisionmakers. We conducted an uncontrolled non-interventional prospective study in Belgian French-speaking schools to describe the role of attending asymptomatic children and school staff in the spread of COVID-19 and to estimate the transmission to others. Each participant from selected schools was tested for SARS-CoV-2 using a polymerase chain reaction (PCR) analysis on saliva sample, on a weekly basis, during six consecutive visits. In accordance with recommendations in force at the time, symptomatic individuals were excluded from school, but per the study protocol, being that participants were blinded to PCR results, asymptomatic participants were maintained at school. Among 11 selected schools, 932 pupils and 242 school staff were included between January and May 2021. Overall, 6449 saliva samples were collected, of which 44 came back positive. Most positive samples came from isolated cases. We observed that asymptomatic positive children remaining at school did not lead to increasing numbers of cases or clusters. However, we conducted our study during a period of low prevalence in Belgium. It would be interesting to conduct the same analysis during a high prevalence period. [ABSTRACT FROM AUTHOR]

A large sample study (n = 513) was conducted to investigate executive control performance in pupils following an immersion education program. We recruited 10-year-old children (n = 128) and 16-year-old adolescents (n = 127) who were enrolled in English or Dutch immersion education in French-speaking Belgium for at least 4 school years. They were compared to non-immersed children (n = 102) and adolescents (n = 156) on a number of executive control tasks assessing inhibitory control, monitoring, switching and attentional abilities. Several control variables such as receptive vocabulary, nonverbal intelligence, socioeconomic status and other potentially relevant background variables were also considered. Our results show significant gains in foreign-language proficiency for the immersed compared to the non-immersed participants. These gains were however not associated with any measurable benefits on executive control. Our findings make a unique contribution to understanding how language and cognition develop through formal education methods that promote bilingualism. [ABSTRACT FROM AUTHOR]

Background Clinical pharmacist interventions have been shown to improve drug use in older adults. Study findings are seldom externally validated however. Objective First, to validate a minimized iteration of a previously tested intervention of clinical pharmacists in a non-academic setting with limited staffing resources. Second, to compare the potentially inappropriate medication (PIM) reduction to two previous controlled interventional studies. Methods A controlled study was performed at geriatric wards. The control group received usual care. The intervention group was exposed to a clinical pharmacist led medication review, based on the use of the RASP list, (the Rationalization of Home Medication by an Adjusted STOPP list in Older Patients). Drug use on admission and at discharge were evaluated, including the number of RASP-identified potentially inappropriate medications (PIMs). The PIM reduction was compared to two previous controlled study findings using a linear mixed model. Results Drug use declined during hospital stay, without differences between control (n = 29) and intervention group (n = 32). Antidepressants and hypnotic drugs were discontinued more frequently in IG patients. More PIMs were reduced in the intervention patients (control vs. intervention: 1.0 vs. 3.0, p < 0.001). Across three controlled studies, a robust reduction of 1.56 PIMs (95% confidence interval 1.10-2.02, p < 0.001) was observed in favor of the CP interventions. Conclusion The minimal CP intervention resulted in fewer RASP PIMs. No net reduction of drug use was observed, yet fewer antidepressants and hypnotic drugs were used. The RASP PIM reduction was comparable to previous investigations. [ABSTRACT FROM AUTHOR]

Abstract: Background: Until today, there is no satisfying explanation for why one language may recover worse than another in differential bilingual aphasia. One potential explanation that has been largely unexplored is that differential aphasia is the consequence of a loss of language control rather than a loss of linguistic representations. Language control is part of a general control mechanism that also manages non‐linguistic cognitive control. If this system is impaired, patients with differential aphasia could still show bilingual language activation, but they may be unable to manage activation in non‐target languages, so that performance in another language is hindered. Aims: To investigate whether a loss of cognitive control, rather than the loss of word representations in a particular language, might underlie differential aphasia symptoms. Methods & Procedures: We compared the performance of seven bilinguals with differential and eight bilinguals with parallel aphasia with 19 control bilinguals in a lexical decision and a flanker task to assess bilingual language co‐activation and non‐linguistic control respectively. Outcomes & Results: We found similar cognate effects in the three groups, indicating similar lexical processing across groups. Additionally, we found a larger non‐linguistic control congruency effect only for the patients with differential aphasia. Conclusions & Implications: The present data indicate preserved language co‐activation for patients with parallel as well as differential aphasia. Furthermore, the results suggest a general cognitive control dysfunction, specifically for differential aphasia. Taken together, the results of the current study provide further support for the hypothesis of impaired cognitive control abilities in patients with differential aphasia, which has both theoretical and practical implications. [ABSTRACT FROM AUTHOR]

Background: Cardiac surgery in Jehovah's Witnesses may be challenging during the operation and postoperative period given their refusal of blood products. The aim of this study was to document our center's experience with Jehovah's Witnesses undergoing major cardiac surgery and to compare surgical outcomes with a matched control group.Methods: We retrospectively reviewed the demographic, perioperative, and in-hospital postoperative data for 31 Jehovah's Witness patients undergoing surgery from 1991 to 2012 and compared findings with a control group of 62 patients of the same sex and age, who underwent the same type of operations in the same period. Early mortality, major in-hospital morbidity, laboratory findings, and hospital stays were compared between groups.Results: Demographic data were similar between groups, except that more patients in the Jehovah's Witness group had extracardiac arteriopathy compared with controls (p = 0.04). There was no difference in predicted mortality, calculated by the Euroscore II, between groups (2.8 ± 3.3 in study group versus 2.4 ± 2.2 in control group, p = 0.469). For postoperative outcomes, there were no differences between Jehovah's Witnesses versus controls in hospital mortality (3 % versus 2 %, p = 0.548), total drain loss (847 ± 583 mL versus 812 ± 365 mL, p = 0.721), mechanical ventilation time (1.26 ± 2.24 versus 0.89 ± 0.55 days, p = 0.218), intensive care unit stay (4.3 ± 3.9 versus 3 ± 1.4 days, p = 0.080), and hospital stay (12.9 ± 7.6 versus 10.9 ± 6.6 days, p = 0.223).Conclusions: Outcomes after cardiac surgery are similar between Jehovah's Witnesses and general population, in centers applying rigorous blood patient management protocols. [ABSTRACT FROM AUTHOR]

Background: Hospital admissions due to fall-related fractures are a major problem in the aging population. Several risk factors have been identified, including drug use. Most studies often retrieved prescription-only drugs from national databases. These are associated with some limitations as they do not always reliably reproduce the complete patient's active drug list.Objective: To evaluate the association between the number of FRIDs intake identified by a standardised medication reconciliation process and a fall-related fracture leading to a hospital admission in older adults.Setting: The first cohort has been recruited from one traumatology ward of a tertiary teaching hospital in Belgium and the second cohort has been recruited from 11 community pharmacies in Belgium.Method: A prospective study with two individually matched cohorts was performed. Adult patients (≥75 years) admitted with an injury due to a fall were included in the first cohort (faller group). The second cohort consisted of patients who did not suffer from a fall within the last 6 months (non-faller group). Matching was performed for age, gender, place of residence and use of a walking aid. In both groups, clinical pharmacists and undergraduate pharmacy students obtained the medication history, using a standardised approach. A list of drugs considered to increase the risk of falling was created. It included cardiovascular drugs and drugs acting on the nervous system. A linear mixed model was used to compare the number of fall risk-increasing drugs between fallers and non-fallers.Main Outcome Measure: The number of fall risk-increasing drugs in a faller versus a non-faller group.Results: Sixty-one patients were matched with 121 non-fallers. Patients received on average 3.1 ± 2.1 and 3.2 ± 1.8 fall risk-increasing drugs in the faller and in the non-faller group, respectively. The mean number of fall risk-increasing drugs was comparable in both groups (p = 0.844), even after adjusting for alcohol consumption, fear of falling, vision and foot problems (p = 0.721).Conclusion: In a sample of hospitalised patients admitted for a fall-related injury, no significant difference in the number of fall risk-increasing drugs versus that of an outpatient group of non-fallers was found. [ABSTRACT FROM AUTHOR]

Perception results from a combination of actual data and interpretive schemata based on preexisting knowledge. Thus, ensuing subjective experience depends on the dynamic interplay between data-driven and conceptually driven processing. A chronic imbalance between these two sources of stimulus encoding is likely to be maladaptive and could underlie cognitive and behavioral disturbances similar to those observed in schizotypy, especially if the balance is tipped too far toward conceptually driven processing (i.e., Internal encoding style). This study aimed to examine the relationships between encoding style and various dimensions of schizotypy by using a questionnaire that evaluates the extent to which preexisting schemata (versus cues from the outside world) affect encoding processes. Consistent with previous findings, the authors' results revealed that both Cognitive-Perceptual and Disorganization dimensions were related to an internal mode of encoding, suggesting that individuals with these features may be characterized by a disposition to biases at early stages of encoding. [ABSTRACT FROM AUTHOR]

Background: Internationally, urine on-site testing has been used for detecting drivers under the influence of drugs (DUID) but more and more countries, such as Belgium, are switching to oral fluid screening. Objective: To compare the previous (published in 1999) and current (published 2009) enforcement procedures of DUID in Belgium. The two evaluated procedures differ in the way the drivers are screened by the police (signs of impairment versus signs of recent drug use), the matrix for screening (urine versus oral fluid) and the analytical cut-off concentrations in plasma. Methods: Data on positive screening and confirmation results were gathered from 1st April 2008 to 30th September 2010, when urine screening (Dipro Druglab panels test) was performed; and from 1st October 2010 to 31st March 2013, when an on-site oral fluid test (Securetec Drugwipe 5+) was used. Results: Approximately 4100 data sets related to urine screening and 3900 data sets related to oral fluid screening were studied. Eighty-eight percent of positive urine on-site tests yielded positive results in plasma for cannabis, 21% for cocaine, 20% for amphetamines and 7% for opiates. Sixty-six percent of the positive oral fluid on-site tests yielded positive results in plasma for cannabis, 30% for cocaine, 28% for amphetamines and 8% for opiates. For cannabis, opiates and amphetamines more negative results in plasma were observed in the period of urine screening. Conclusions: The percentage of plasma samples of tested drivers, in which none of the positive screened target drugs were present in a concentration above the legal cut-off value, has decreased from 17% to 8% since the introduction of the current legislation involving oral fluid screening. [ABSTRACT FROM AUTHOR]

Traffic signs and pavement markings are a crucial aspect of road design since they are essential sources of information for road users to calibrate their driving behavior, evaluate route possibilities and cope with unexpected events. A proactive evaluation of (the quality of) these road design elements will help to improve the safety performance of the roadway. This paper presents the Traffic Sign Simulator, an innovative research tool to study the influence of these elements on road users' routing decisions, lane choice and visual behavior, to investigate road users' comprehension of these signs, and to collect suggestions for improvements. Using a driving simulator mock-up, participants navigate through a full HD video from route(s) in which the planned traffic signs have been digitally implemented using specialized software for camera-tracking and 3D video-integration. Participants' route and lane choice and their visual behavior (using eye tracking) are monitored while driving through the scenario(s). Laptop preand post-tests are applied to collect additional in-depth information concerning the participants'processing, comprehension and general evaluation of the traffic signs and suggestions for improvement. The paper illustrates the possibilities of the Traffic Sign Simulator with a case study that examined the effectiveness of temporary work zone signalization (i.e., traffic signs, digital information panels and pavement markings) as it was used during the reconstruction works on the Vilvoorde fly-over near Brussels, one of the busiest interchanges in the Belgian motorway network. [ABSTRACT FROM AUTHOR]

The enamel of 20 Email Champlevé objects dating between the 12th and 19th centuries was investigated by means of microscopic and portable X-ray fluorescence analysis (μ-XRF and PXRF). Seven of these objects were microsampled and the fragments were analyzed with electron probe microanalysis (EPMA) and vacuum μ-XRF to obtain quantitative data about the composition of the glass used to produce these enameled objects. As a result of the evolution of the raw materials employed to produce the base glass, three different compositional groups could be discriminated. The first group consisted of soda-lime-silica glass with a sodium source of mineral origin (with low K content) that was opacified by addition of calcium antimonate crystals. This type of glass was only used in objects made in the 12th century. Email Champlevé objects from the beginning of the 13th century onward were enameled with soda-lime-silica glass with a sodium source of vegetal origin. This type of glass, which has a higher potassium content, was opacified with SnO2 crystals. The glass used for 19th century Email Champlevé artifacts was produced with synthetic and purified components resulting in a different chemical composition compared to the other groups. Although the four analytical techniques employed in this study have their own specific characteristics, they were all found to be suitable for classifying the objects into the different chronological categories. [ABSTRACT FROM AUTHOR]

. Belgium's systems of unemployment insurance and employment protection legislation were set up in the context of typically enduring and stable relationships between workers and firms. Economic globalization and rapid technological and organizational change, however, are now demanding more flexibility of both workers and firms. As a result, current labour market institutions are in urgent need of reform to reconcile such increased flexibility with adequate security for workers. Though the call for a 'flexicurity' approach is not new, there is no single view of what institutional model the latter implies. This paper proposes a reform explicitly guided by economic principles. [ABSTRACT FROM AUTHOR]

Domestic gardens provide residents with immediate access to landscape amenities and numerous ecological provisions. These ecological provisions have been proven to be largely determined by greenspace composition and landscape, but the fragmentation and heterogeneity of garden environments present challenges to greenspace mapping. Here, we first developed a recognition method to create a garden parcel data set in the medieval Leuven city of Belgium, based on the land use layers and agricultural land parcels. Then, we applied multi-sourced satellite imagery to evaluate the added value of spatial resolution, plant phenology and 3D structure in identifying four vegetation types. Finally, we characterized the greenspace landscapes in garden parcels. Compared with single ALOS-2 imagery, SPOT-7 imagery and Pleiades-1A imagery increased the overall accuracy by 4% and 8%, respectively. The accuracy improvement (21%) produced from multi-temporal stereo Pleiades-1A imagery strongly verified the significance of plant phenology and 3D structure in garden mapping. The average greenspace cover in garden parcels was 71% but varied from 56% in urban gardens to 82% in rural gardens. The garden greenspace landscape is fragmented by the artificial structures in urban areas but has a more aggregated size and less complex shapes in rural areas. This study calls for greater attention to be paid to gardens, and for multi-disciplinary studies conducted in collaboration with urban ecologists and landscape designers to maximize the benefits to residents of both immediate landscape amenities and ecological provisions, in the face of global environmental changes and public health risks. [ABSTRACT FROM AUTHOR]

Objectives: To compare the hospitalization day price, and the hospitalization costs 100 years ago with the present situation.Methods: Municipal and hospital archives of two cities, Maastricht in The Netherlands and Tongeren in Belgium, were studied systematically for reports of costs. These were compared with the present accounts.Results: Starting from the second part of the nineteenth century, an official day price was calculated each year by averaging the total hospital expenditures by the total number of hospitalization days. Of all expenditures, nutrition accounted for nearly 50% of expenses. Differences with the current situation are striking. Nowadays, the day price is a negotiated tariff. Management and salaries make up more than 70% of the present expenditures.Conclusions: Hospitalization day prices have been used for approximately 150 years to determine hospitalization costs. Since then, the total hospital expenditures and the relative cost components have changed considerably. Compared with the spending power of people, the cost of one day in the hospital increased substantially. [ABSTRACT FROM AUTHOR]

The day care centre appears to be a structure especially well suited for the management of mild to moderate Alzheimer patients. It constitutes a place in which performance in everyday life activities can be explored, and optimisation strategies can be installed before they are used at home. Another objective of the day care centre might also be to provide caregivers with support and ease the burden that the daily care of a demented patient represents. Finally, it may also help to alleviate the patient's loneliness. In this perspective, we describe the general organisation of the recently-created day care centre at the University Hospital of Liège. We also present the assessment and intervention programme which was conducted in this day care centre in order to reduce the generalised apathy and depressed mood observed in a 70-year-old Alzheimer patient (AM). This programme aimed at restoring a leisure activity (knitting) at home by proposing several adaptations designed to minimise the impact of AM's cognitive deficits on knitting activity. While an aggravation of her memory deficits was observed, the intervention significantly decreased AM's apathy and depressed mood as well as her husband's burden. [ABSTRACT FROM AUTHOR]

Background Vertically HIV-1-infected infants are at high risk of severe manifestations of the disease in the first year of life. For this reason, we have elected, since 1996, to treat all infants born to HIV-1-infected mothers with a combination of 3 reverse transcriptase inhibitors as soon as the diagnosis of vertical transmission is established. Material and methods This is a cohort study of the effectiveness and tolerance of therapy in the 17 HIV-1-infected infants followed from birth in 3 belgian paediatric reference centres since 1996. All of them had been treated according to these guidelines. Results Treatment was initiated in all patients before 66 days of life. All but one were asymptomatic at initiation of therapy. Median follow-up was 56 months (range: 26-103). Twelve out of the 17 patients (70.6%), including 11/13 (85%) infants treated with the combination of zidovudine, lamivudine and nevirapine, experienced a complete viral suppression (<50 copies/mL) with their first drug regimen. Lack of compliance was acknowledged by the parents of 3 of the 5 infants whose initial regimen failed. At last follow-up, 12 patients were asymptomatic, two were CDC stage A and three were stage B; 15 had HIV-1 RNA levels of < 50 copies/mL and 14 had ≥25% CD4 lymphocytes. Among them 11 were still treated with their first line regimen (Figure 1). One child experienced a transient severe side effect, another child had clinical lipodystrophy and 4 developed hypercholesterolemia. Conclusions Early initiation of treatment with 3 reverse transcriptase inhibitors appeared to be highly effective in this cohort of vertically HIV-1 infected infants. Parental adherence is crucial to the effectiveness of therapy. [ABSTRACT FROM AUTHOR]

Chronic antipsychotic use among nursing home (NH) residents carries risks with uncertain benefits. Despite guidelines recommending restricted use, these agents remain widely prescribed. This study investigates chronic antipsychotic use in Belgian NHs. We examined the evolution of chronic antipsychotic use, associated NH resident profiles, impact of NH admissions, and variation among Belgian NHs in a retrospective dynamic cohort study between 2017 and 2022. Antipsychotic dispensation rates were extracted for members of the Independent Health Insurance Funds in NHs. Prescription trends and resident profiles were evaluated for around 15,000 residents yearly (n = 14,733-15,451) from 2017 to 2022 and variation was assessed among 59 NHs. The impact of NH admission was analyzed for 9647 admissions between 2020 and 2022, and variation was evaluated among 22 NHs. For 22 antipsychotics identified at the ATC3 level, chronic use was defined as ≥80 defined daily doses (DDD) and/or ≥16 weekly dispensations per year. We analyzed changes in the 4 most frequently used antipsychotics (haloperidol, olanzapine, quetiapine, risperidone) on NH admission, with chronic use defined as ≥80 minimal prescribed doses (MPD) annually. The prevalence of chronic antipsychotic use among NH residents decreased from 24% in 2017 to 22.5% in 2022 (P =.002). Factors associated with higher antipsychotic use included younger age, greater dependency, and lower socioeconomic status. Upon NH admission, 30% (n = 818 of 2723) of residents discontinued treatment, while in 33% (n = 949 of 2854) treatment was initiated, predominantly with quetiapine or risperidone. This led to a small but significant increase of 1.4% after admission (P <.001). Defining chronic use as ≥80 MPD annually appeared to be more sensitive in measuring chronic antipsychotic use. Chronic antipsychotic use remains widespread in Belgian NHs, with care transition as an important decision point. Further research should explore effects of safer (de)prescribing strategies on patient well-being. [ABSTRACT FROM AUTHOR]

Abstract: Waste consumer batteries are recycled using different routes based on hydrometallurgical and pyrometallurgical processes. Two hydrometallurgical and two pyrometallurgical treatment scenarios are compared starting from an average composition of Belgian waste batteries. The environmental performance is compared using life cycle analysis (LCA). The recycling rate is studied through mass balance calculation. Each treatment scenario results in a specific recycling rate. The environmental impact and benefits also vary between the treatment options. There is no such thing as a typical hydrometallurgical or pyrometallurgical treatment. When applying a hydrometallurgical treatment scenario, the focus lies on zinc and iron recycling. When allowing manganese recycling, the energy demand of the hydrometallurgical process increases considerably. Both pyrometallurgical options recycle zinc, iron and manganese. According to the LCA, none of the treatment scenarios performs generally better or worse than the others. Each option has specific advantages and disadvantages. The Batteries Directive 2006/66/EC sets out a recycling rate of 50% for consumer waste batteries. Based on metal recycling alone, the mass balances show that the target is difficult to obtain. [Copyright &y& Elsevier]

Background: Many patients do not receive a comprehensive medication reconciliation, mostly owing to limited resources. We hence need an approach to identify those patients at the emergency department (ED) who are at increased risk for clinically relevant discrepancies., Objective: The aim of our study was to develop and externally validate a prediction model to identify patients at risk for at least 1 clinically relevant medication discrepancy upon ED presentation., Methods: A prospective, multicenter, observational study was conducted at the University Hospitals Leuven and General Hospital Sint-Jan Brugge-Oostende AV, Belgium. Medication histories were obtained from patients admitted to the ED between November 2017 and May 2022, and clinically relevant medication discrepancies were identified. Three distinct datasets were created for model development, temporal external validation, and geographic external validation. Multivariable logistic regression with backward stepwise selection was used to select the final model. The presence of at least 1 clinically relevant discrepancy was the dependent variable. The model was evaluated by measuring calibration, discrimination, classification, and net benefit., Results: We included 824, 350, and 119 patients in the development, temporal validation, and geographic validation dataset, respectively. The final model contained 8 predictors, for example, age, residence before admission, number of drugs, and number of drugs of certain drug classes based on Anatomical Therapeutic Chemical coding. Temporal validation showed excellent calibration with a slope of 1.09 and an intercept of 0.18. Discrimination was moderate with a c-index (concordance index) of 0.67 (95% CI 0.61-0.73). In the geographic validation dataset, the calibration slope and intercept were 1.35 and 0.83, respectively, and the c-index was 0.68 (95% CI 0.58-0.78). The model showed net benefit over a range of clinically reasonable threshold probabilities and outperformed other selection criteria., Conclusions: Our software-implemented prediction model shows moderate performance, outperforming random or typical selection criteria for medication reconciliation. Depending on available resources, the probability threshold can be customized to increase either the specificity or the sensitivity of the model., (©Greet Van De Sijpe, Matthias Gijsen, Lorenz Van der Linden, Stephanie Strouven, Eline Simons, Emily Martens, Nele Persan, Veerle Grootaert, Veerle Foulon, Minne Casteels, Sandra Verelst, Peter Vanbrabant, Sabrina De Winter, Isabel Spriet. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 27.11.2024.)

Fixed and broad screening intervals for drug-drug interaction (DDI) alerts lead to false positive alerts, thereby contributing to alert fatigue among healthcare professionals. Hence, we aimed to investigate the impact of customized screening intervals on the daily incidence of DDI alerts. An interrupted time series analysis was performed at the University Hospitals Leuven to evaluate the impact of a pragmatic intervention on the daily incidence of DDI alerts per 100 prescriptions. The study period encompassed 100 randomly selected days between April 2021 and December 2022. Preceding the intervention, a fixed and broad screening interval of 7 days before and after prescribing an interacting drug was applied. The intervention involved implementing customized screening intervals for a subset of highly prevalent or clinically relevant DDIs into the hospital information system. Additionally, the sensitivity of the tailored approach was evaluated. During the study period, a mean of 5731 (± 2909) new prescriptions per day was generated. The daily incidence of DDI alerts significantly decreased from 9.8% (95% confidence interval (CI) 8.4;11.1) before the intervention, to 6.3% (95% CI 5.4;7.2) afterwards, p < 0.0001. This corresponded to avoiding 201 (0.035*5731) false positive DDI alerts per day. Sensitivity was not compromised by our intervention. Defining and implementing customized screening intervals was feasible and effective in reducing the DDI alert burden without compromising sensitivity., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Our study aimed to assess the severity of severe acute respiratory syndrome coronavirus 2 infection in hospitalized infants under 40 days old, across 21 Belgian hospitals between 2020 and 2022. Of the 365 infants studied, 14.2% needed respiratory support. The median hospital stay was 3 days (interquartile range, 2-4), and there were no deaths. Infection severity was similar during the Omicron and Alpha/Delta periods., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Safinamide is a recent multimodal antiparkinsonian drug that inhibits monoamine oxidase B and modulates the glutamatergic system with positive effects on motor and nonmotor symptoms of Parkinson's disease (PD). This post-hoc analysis of the European SYNAPSES study provides first-time data on the use of safinamide in routine clinical practice in Belgium., Objective: To describe the efficacy and safety of safinamide in Belgian PD patients in real-life conditions., Methods: Post-hoc analysis of the Belgian cohort from the European SYNAPSES trial, which was an observational, multicenter, retrospective-prospective cohort study. Patients were followed up to 12 months. Analyses were performed in the overall population and according to different criteria such as the age limit (> 75 years), presence or absence of relevant comorbidities, presence or absence of psychiatric conditions such as depression and anxiety, patients on levodopa monotherapy or levodopa in combination with other treatments, patients on rasagiline before inclusion or not., Results: Of the 172 patients included, 29.2% were > 75 years, 58.9% had relevant comorbidities and 32.7% had psychiatric conditions. Almost all the patients reported motor (98.8%) or non-motor (86.3%) symptoms. During the study, 36.3% of patients reported drug-related reactions. The adverse drug reactions were those already described in the patients' information leaflet. The majority were mild or moderate and completely resolved and no differences were detected between the subgroups of patients. Almost 35% of the patients demonstrated a clinically significant improvement in the UPDRS and 50% of the patients with wearing-off at baseline, did not report wearing-off anymore after one year of treatment. Patients under levodopa monotherapy compared to patients receiving levodopa combined with other antiparkinsonian treatments benefit more from safinamide treatment. Patients switched from rasagiline to safinamide seemed also to benefit more from safinamide treatment., Conclusion: The study confirms the excellent safety and efficacy profile of safinamide, particularly in more vulnerable groups of patients such as the elderly and patients with significant comorbidities or psychiatric conditions such as depression or anxiety., (© 2022. The Author(s).)

Objective: Inappropriate prescribing remains highly prevalent on geriatric units. The aim of this investigation, initiated by the Belgian College for Geriatrics, was to evaluate the implementation of strategies to optimize pharmacotherapy on geriatric units in Belgium., Methods: A literature search was performed to identify strategies to support the appropriate use of medications in very old inpatients. These strategies were subsequently validated based on Delphi consensus rounds and a national survey was developed. Experts were selected by the research team in collaboration with the Belgian College for Geriatrics. The survey was sent to the heads of the geriatric departments of all Belgian hospitals (n = 100)., Results: After 3 months a response rate of 55% was achieved. Strategies that were implemented more frequently were the use of electronic prescribing (85%), performing a structured medication review (69%) and providing patient education (76%). In a minority (24%) of hospitals, a clinical pharmacist was directly involved in the multidisciplinary geriatric team. Implementation of clinical decisions support systems (CDSS) was reported by 36% of the hospitals. Educational strategies for healthcare professionals and strategies to optimize transitional care were variable., Conclusion: Taking into account the current body of evidence, strategies that include transitional care components, CDSS or ward-based clinical pharmacy services should be further promoted on Belgian geriatric units.

Although most invasive meningococcal disease (IMD) cases are sporadic without identified transmission links, outbreaks can occur. We report three cases caused by meningococcus B (MenB) at a Belgian nursery school over 9 months. The first two cases of IMD occurred in spring and summer 2018 in healthy children (aged 3-5 years) attending the same classroom. Chemoprophylaxis was given to close contacts of both cases following regional guidelines. The third case, a healthy child of similar age in the same class as a sibling of one case, developed disease in late 2018. Microbiological analyses revealed MenB with identical finetype clonal complex 269 for Case 1 and 3 (unavailable for Case 2). Antimicrobial susceptibility testing revealed no antibiotic resistance. Following Case 3, after multidisciplinary discussion, chemoprophylaxis and 4CMenB (Bexsero) vaccination were offered to close contacts. In the 12-month follow-up of Case 3, no additional cases were reported by the school. IMD outbreaks are difficult to manage and generate public anxiety, particularly in the case of an ongoing cluster, despite contact tracing and management. This outbreak resulted in the addition of MenB vaccination to close contacts in Wallonian regional guidelines, highlighting the potential need and added value of vaccination in outbreak management.

Advances in noninvasive hemodynamic monitoring systems allow delivery of goal-directed fluid therapy and could therefore be used in less-invasive surgical procedures. In this randomized controlled trial, we compared closed-loop-assisted goal-directed fluid therapy using a noninvasive cardiac output (Clearsight system) monitor (personalized approach) to a protocolized fluid therapy approach in 40 patients undergoing moderate-risk laparoscopic abdominal surgery. Cardiac output and stroke volume variations were not significantly different in both groups and remained within predefined target values >90% of the study time. Personalized fluid therapy does not seem to offer any hemodynamic advantage over a protocolized approach in this population.

Background: Emotion reactivity is defined as the extent to which an individual experiences emotions in response to a wide array of stimuli, intensely, and for a prolonged period. This construct is a key psychological factor in the development and maintenance of psychopathological disorders. The aim of the current study was to develop and validate a French version of the Emotion Reactivity Scale (ERS), which gauges three aspects of emotion reactivity: (1) emotional sensitivity, (2) emotional intensity, and (3) emotional persistence., Method: The French ERS and both concurrent and divergent validated scales were administered to 258 participants from the community., Results: Confirmatory factor analyses revealed good fit indices for: (1) a single-factor model, (2) a three-factor model, and (3) a hierarchical three-factor solution with a single-factor solution as a second-order latent variable for a generic construct of emotion reactivity. The French version of the Emotion Reactivity Scale also exhibits acceptable internal scale score reliability (total scale and subscales). Eventually, meaningful relationships were found between factors of emotion reactivity and depression, distinct aspects of impulsive behaviors, and maladaptive emotion regulation strategies., Conclusion: Findings of the confirmatory factor analyses are consistent with previous studies suggesting that the ERS is mainly captured by a single major construct of emotion reactivity., (Copyright © 2014 Elsevier Inc. All rights reserved.)

It is accepted that irrigation water is a potential carrier of enteric pathogens, such as Salmonella and E. coli O157:H7 and, therefore, a source for contamination of fresh produce. We tested this by comparing irrigation water samples taken from five different greenhouses in Belgium. The water samples were inoculated with four zoonotic strains, two Salmonella and two E. coli O157:H7 strains, and pathogen survival and growth in the water were monitored up till 14 days. The influence of water temperature and chemical water quality was evaluated, and the survival tests were also performed in water samples from which the resident aquatic microbiota had previously been eliminated by filter sterilization. The pathogen's survival differed greatly in the different irrigation waters. Three water samples contained nutrients to support important growth of the pathogens, and another enabled weaker growth. However, for all, growth was only observed in the samples that did not contain the resident aquatic microbiota. In the original waters with their specific water biota, pathogen levels declined. The same survival tendencies existed in water of 4 °C and 20 °C, although always more expressed at 20 °C. Low water temperatures resulted in longer pathogen survival. Remarkably, the survival capacity of two E. coli 0157:H7 strains differed, while Salmonella Thompson and Salmonella Typhimurium behaved similarly. The pathogens were also transferred to detached lettuce leaves, while suspended in two of the water samples or in a buffer. The effect of the water sample on the pathogen's fitness was also reproduced on the leaves when stored at 100% relative humidity. Inoculation of the suspension in buffer or in one of the water samples enabled epiphytic growth and survival, while the pathogen level in the other water sample decreased once loaded on the leaves. Our results show that irrigation waters from different origin may have a different capacity to transmit enteric pathogens and an important impact on the fitness of the pathogens to sustain and even grow on the leaf surface.

Data concerning efficacy, safety, and patient satisfaction of levodopa/carbidopa intestinal gel (LCIG, Duodopa, AbbVie, Wavre, Belgium) infusion in routine clinical practice were needed to maintain reimbursement of the drug in Belgium. Patients with advanced Parkinson's disease in 27 neurology centers across Belgium were included. Of 100 patients who underwent naso-intestinal (NI) evaluation with LCIG, 67 received permanent treatment with LCIG via percutaneous endoscopic gastrostomy and jejunal tube (PEG/J). Efficacy was evaluated at baseline (on levodopa) and during a follow-up (FU) visit (on LCIG) using the Unified Parkinson's Disease Rating Scale (UPDRS) IV. Patient appraisal of the Duodopa system was evaluated using a visual analog scale for therapy compliance, user-friendliness, and global appreciation. Safety was assessed by reporting suspected adverse drug reactions (ADRs) and medical device-related complaints. FU evaluations were conducted in 37 patients. Significant improvement at FU was observed for motor complications (UPDRS IV) as the mean change from baseline to FU was -6.3 (95 % CI -8.1 to -4.5). Patient appraisal showed high scores for hospital delivery, user-friendliness, and patient global appreciation, as well as family appreciation of the system on daily life. Few ADRs and system malfunctions were reported, with no unexpected ADRs. In conclusion, the symptoms and impact of Parkinsonism improved markedly when LCIG PEG/J was initiated.

The objective of this paper is to compare concentrations of alcohol, illicit, and medicinal drugs in seriously injured drivers and drivers selected randomly at the roadside. Blood samples were analyzed for alcohol, 17 medicinal drugs and 8 illicit psychoactive substances and/or their metabolites by ultra performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) and gas chromatography mass spectrometry (GC-MS) in injured drivers admitted to the emergency departments of five hospitals in Belgium between January 2008 and May 2010 and in drivers randomly selected between January 2008 and September 2009. Three hundred and seventy-seven seriously injured drivers and 2750 roadside respondents were selected. In the roadside survey, out of the 203 concentrations above DRUID (Driving Under the Influence of Drugs, Alcohol and Medicines) cut-offs for medicinal drugs, 51% were in the therapeutic range, 46% infratherapeutic, and 2.5% supratherapeutic. In the seriously injured drivers, out of the 78 concentrations above DRUID cut-offs for medicinal drugs, these percentages were respectively 63%, 33%, and 4%. Significant differences were found in the distribution of concentrations for opioids, benzodiazepines, and Z-drugs. For the latter, while in the seriously injured drivers study most concentrations were therapeutic, in the roadside survey most were infratherapeutic. The opposite was observed for the opioids. Eight and 41% of the roadside respondents and injured drivers, respectively, had an alcohol concentration above 0.1 g/L, with higher concentrations found in the injured drivers. For illicit drugs, significant differences were found for amphetamine and cocaine, for which respectively lower and higher concentrations were observed in the blood samples taken in the roadside survey., (Copyright © 2012 John Wiley & Sons, Ltd.)

The survival of Salmonella enterica serovar Thompson and Escherichia coli O157 was investigated on growing butterhead lettuce plants in the plant-growth chamber and greenhouse. All inoculation tests were made under conditions that approximate the greenhouse conditions for butterhead lettuce cultivation in Flanders (Belgium). The survival and proliferation of the pathogens on the leaves was determined at days 0, 4, and 8 after inoculation using standard plating techniques on selective medium. In the growth chamber, the extent to which both pathogens were able to multiply on the lettuce leaves was influenced by crop stage and leaf age. On young plants, the older leaves supported pathogen survival better. On nearly mature plants, pathogen population sizes were significantly higher on the old and young leaves compared with middle-aged leaves (p<0.001). In the greenhouse, the environmental regimen with high fluctuations in temperature and relative humidity was less conducive to the survival of E. coli O157, though its survival on nearly mature lettuce was enhanced by overhead irrigation. The moist conditions between the folded inner leaves are likely contributing to the survival of enteric pathogens in the lettuce head. Butterhead lettuce grown in greenhouses with a sprinkle irrigation system may present a potential health hazard when contaminated near harvest. Experimental design (growth chamber versus greenhouse) largely influences enteric pathogen behavior on growing lettuce plants.

Background: Impulsivity is a multifaceted construct that has a prominent role in psychiatry. Lynam et al (2006) have developed the UPPS-P, a 59-item scale measuring 5 impulsivity components: negative urgency, positive urgency, lack of premeditation, lack of perseverance, and sensation seeking. The aim of the present study was to validate a short, 20-item French version of the UPPS-P., Methods: Six hundred fifty participants filled out the short French UPPS-P. A subgroup of participants (n = 145) took part in a follow-up study and completed the scale twice to determine test-retest stability; another subgroup (n = 105) was screened with other questionnaires also to establish external validity., Results: Confirmatory factor analyses supported a hierarchical model comprising 2 higher order factors of urgency (resulting from negative urgency and positive urgency) and lack of conscientiousness (resulting from lack of premeditation and lack of perseverance) as well as a separate factor of sensation seeking. The results indicated good internal consistency and test-retest stability. External validity was supported by relationships with psychopathological symptoms., Conclusion: The short French version of the UPPS-P therefore presents good psychometric properties and may be considered a promising instrument for both research and clinical practice., (Copyright © 2012 Elsevier Inc. All rights reserved.)

The objective of this study was to compare the number of drivers with drug concentrations above the legal cutoffs for driving under the influence of illicit substances in paired samples of blood and oral fluid. Between January 2008 and September 2009, 2,949 randomly selected drivers participated in a roadside survey. Each was asked to provide blood and oral fluid. Samples were analyzed for 11 illicit substances or metabolites by ultra-performance liquid chromatography-tandem mass spectrometry and gas chromatography-tandem mass spectrometry. Out of the 2,750 drivers who gave both blood and oral fluid, 28 (1.0%) had drug concentrations above the legal cutoff in blood and 71 (2.6%) were above the legal cutoff in oral fluid. Fifteen (7.5%) of the 199 drivers who gave an oral fluid sample but refused to provide blood tested positive, significantly more than drivers who provided both samples. Based on oral fluid analysis, 2.6 times more subjects tested positive for drugs compared to blood analysis. Those that refused to give a blood sample were 3 times more likely to test positive for drugs. Even in a survey that guaranteed total anonymity, people fearing a positive test result might have been more likely to refuse to give a blood sample.

The following recommendations, which aim at improving the clinical diagnosis ofTRALI and the laboratory investigations that can support it, were drawn up by a working group of the Superior Health Council. TRALI is a complication of blood transfusion that is both serious and underreported. Systematic reporting may help to develop preventive actions. Therefore, the Superior Health Council recommends that there should be a more stringent surveillance of patients who receive a blood component transfusion. The clinician should pay very close attention to any change in the patient's respiratory status (cf. dyspnoea and arterial desaturation), which should be notified systematically to the haemovigilance contact person in the hospital.

This study shows that the androgen receptor agonistic potency is clearly concealed by the effects of androgen receptor antagonists in a total sediment extract, demonstrating that toxicity screening of total extracts is not enough to evaluate the full in vitro endocrine disrupting potential of a complex chemical mixture, as encountered in the environment. The anti-androgenic compounds were masking the activity of androgenic compounds in the extract with relatively high anti-androgenic potency, equivalent to 200 nmol flutamide equivalents/g dry weight. A two-step serial liquid chromatography fractionation of the extract successfully separated anti-androgenic compounds from androgenic compounds, resulting in a total androgenic potency of 3,820 pmol dihydrotestosterone equivalents/g dry weight. The fractionation simplified the chemical identification analysis of the original complex sample matrix. Seventeen chemical structures were tentatively identified. Polyaromatic hydrocarbons, a technical mixture of nonylphenol and dibutyl phthalate were identified to contribute to the anti-androgenic potency observed in the river sediment sample. With the GC/MS screening method applied here, no compounds with AR agonistic disrupting potencies could be identified. Seventy-one unidentified peaks, which represent potentially new endocrine disrupters, have been added to a database for future investigation.

Recommendations, which aim at standardising and rationalising clinical indications for the transfusion of fresh frozen plasma (FFP) in Belgium, were drawn up by a working group of the Superior Health Council. For this purpose the Superior Health Council organised an expert meeting devoted to "Transfusion Guidelines: Pathogen reduction, products and indications for the transfusion of plasma" in collaboration with the Belgian Haematological Society.The experts discussed the indications for the transfusion of FFP, pathogen reduction for FFP and the practical issues of administering FFP and plasma-derived concentrates. The recommendations formulated by the experts were validated by the working group with the purpose of harmonising FFP transfusion in Belgian hospitals.

The following recommendations, which aim at standardising and rationalising clinical indications for the transfusion of red cells in Belgium, were drawn up by a working group of the Superior Health Council. To this end, the Superior Health Council organised an expert meeting devoted to "Guidelines for the transfusion of red cells" in collaboration with the Belgian Hematological Society. The experts discussed the indications for red cell transfusions, the ideal red cell concentrate, the practical issues of administering red cells, and red cell transfusions in patients in a critical condition. The recommendations formulated by the experts were validated by the working group with the purpose of harmonising red cell transfusion in Belgian hospitals.

A methodology is developed to quantify the uncertainty in a pesticide leaching assessment arising from the spatial variability of non-georeferenced parameters. A Monte Carlo analysis of atrazine leaching is performed in the Dyle river catchment (Belgium) with pesticide half-life (DT50) and topsoil organic matter (OM) content as uncertain input parameters. Atrazine DT50 is taken as a non-georeferenced parameter, so that DT50 values sampled from the input distribution are randomly allocated in the study area for every simulation. Organic matter content is a georeferenced parameter, so that a fixed uncertainty distribution is given at each location. Spatially variable DT50 values are found to have a significant influence on the amount of simulated leaching. In the stochastic simulation, concentrations exist above the regulatory level of 0.1 microg L(-1), but virtually no leaching occurs in the deterministic simulation. It is axiomatic that substance parameters (DT50, sorption coefficient, etc.) are spatially variable, but pesticide registration procedures currently ignore this fact. Including this spatial variability in future registration policies would have significant consequences on the amount and pattern of leaching simulated, especially if risk assessments are implemented in a spatially distributed way.

The aetiology of Parkinson's disease (PD) is unknown and said to be multifactorial. We report on a retrospective epidemiological case control study, performed in Flanders during a 3-year period, investigating known and potential environmental risk factors for PD by means of questionnaires. We investigated 423 prevalent patients and 205 spouse-controls. We found familial occurrence in 15% of the patients, a mean age of onset of 58 years, and a clear male preponderance (male/female ratio 1.53). Our results suggest more nulliparity among female PD patients (95% CI: 1.08-5.76). We found a discrete clustering of patients in areas with intensive metallurgic frequently employed in metallurgy than controls (95% CI: 1.04-9.20). Furthermore, patients were clearly more exposed to zinc (95% CI: 1.51-90.90) and toluene (95% CI: 1.03 58.82). Male patients report more prostatectomy-surgery (95% CI: 1.54-17.24).

Objective: To compare work disability, sick leave, and productivity costs due to ankylosing spondylitis (AS) of three European countries., Methods: 216 patients with AS from the Netherlands, France, and Belgium participated in a two year observational study. Employment and work disability rates at baseline were adjusted for age and sex. Productivity costs were calculated by both the friction cost method and the human capital approach. The adjusted contributions of country to employment, work disability, and having an episode of sick leave were assessed by logistic regression and the contribution of the country to days of sick leave and costs by Cox proportional hazard analysis., Results: 209 patients completed the two years' follow up with sufficient data for cost analysis. Adjusted employment was 55% in the Netherlands as compared with 72% in both other countries and only in the Netherlands was it lower than expected in the general population. Adjusted work disability was 41%, 23%, and 9% in the Netherlands, France, and Belgium and in all countries was higher than expected in the general population. In those with a paid job, the mean number of days of sick leave per patient per year because of AS was 19 (range 0-130), six (range 0-77), and nine (range 0-60 ) in the Netherlands, France, and Belgium respectively. Applying the friction cost method to those with a paid job resulted in mean costs per patient per year of 1257 euros (range 0-7356), 428 euros (range 0-5979), and 476 euros (range 0-2354) in the Netherlands, France, and Belgium. Applying the human capital approach to the whole group resulted in mean costs per patient per year of 8862 euros (range 0-46 818), 3188 euros (range 0-43 550), and 3609 euros (range 0-34 320) in the three countries, respectively. After adjusting for sociodemographic and disease characteristics, living in the Netherlands, as compared with both other countries, was associated with a higher chance of being work disabled (odds ratio (OR)=3.82; 95% confidence interval (CI) 1.33 to 11.01), but not with the risk of having an episode of sick leave. Similarly, living in the Netherlands contributed independently to the number of days sick leave (OR=0.65; 95% CI 0.43 to 0.97), a higher amount of friction costs (OR=0.63; 95% CI 0.42 to 0.96), and a higher amount of human capital costs (OR=0.46; 95% CI 0.32 to 0.68)., Conclusion: There are remarkable differences in work status and productivity costs between the three European countries. This has implications for the generalisability of health economic studies.