Belgian Experience Research Articles

Translating the COVID-19 epidemiological situation into policies and measures: the Belgian experience.

The COVID-19 pandemic led to sustained surveillance efforts, which made unprecedented volumes and types of data available. In Belgium, these data were used to conduct a targeted and regular assessment of the epidemiological situation. In addition, management tools were developed, incorporating key indicators and thresholds, to define risk levels and offer guidance to policy makers. Categorizing risk into various levels provided a stable framework to monitor the COVID-19 epidemiological situation and allowed for clear communication to authorities. Although translating risk levels into specific public health measures has remained challenging, this experience was foundational for future evaluation of the situation for respiratory infections in general, which, in Belgium, is now based on a management tool combining different data sources.

Near Adult Height and Body Mass Index Changes in Growth Hormone Treated Short Children with Noonan Syndrome: The Belgian Experience

Introduction: A variable near adult height (NAH) outcome after growth hormone (GH) therapy in Noonan syndrome (NS) patients with short stature has been reported. The main objective of this study was to evaluate NAH and body mass index (BMI) evolution in a large Belgian cohort of NS patients treated for short stature. The secondary objectives were to investigate whether sex, genotype, the presence of a thoracic deformity, and/or a heart anomaly might affect NAH and to validate the recently developed NAH prediction model by Ranke et al. Methods: Clinical and auxological data of GH treated short NS patients born before 2001 were extracted from the national Belgrow registry. NAH was available in 54 (35 male) genotyped NS using a gene panel of 9 genes, showing pathogenic variants in PTPN11 in 32 and in SOS1 in 5 patients, while in 17 patients gene panel analysis was inconclusive (no-mutation group). Results: After a median (P10; P90) duration of 5.4 (2.2; 10.3) years of GH therapy with a median dose of 0.05 mg/kg/day NS patients reached a median NAH of −1.7 (−3.1; −0.8) SDS. Median total height gain was 1.1 (0.1; 2.3) SDS. Sex, genotype, and the presence of a thoracic or cardiac malformation did not correlate with NAH or total height gain. Linear regression modelling revealed that height SDS at start (β = 0.90, p β = 0.27; p = 0.005), birth weight SDS (β = 0.15; p = 0.051), age at start (β = 0.07; p = 0.032) were independently associated with NAH SDS. Median BMI SDS increased significantly (p Conclusion: Long-term GH therapy at a dose of 0.05 mg/kg/day in short NS patients is effective in improving adult height and BMI, irrespective of the genotype and presence or absence of cardiac and or thoracic anomalies.

Unilateral versus simultaneous bilateral total hip arthroplasty. The Belgian experience.

A retrospective data analysis was performed on 468 patients who underwent either UTHA (418 patients) or SBTHA (50 patients) using a direct anterior approach between June 2016 and December 2020. Apart from SBTHA patients being significantly younger, there was no significant preoperative difference in demographics, comorbidities, surgical variables and biological values between the two groups. Primary outcomes were 90-days emergency room (ER) visit and readmission, as well as 90-days minor and major complications. Secondary outcomes were length of stay (LOS), operative time and blood loss. 90-days ER visit (p=0.244), 90- days readmission (p=0.091), overall complications rate (p=0.376), minor complications (p=0.952) and major complications (p=0.258) were not statistically different between the two groups. Operative time and average LOS were significantly longer in the SBTHA group (p<0.001). Blood loss was significantly higher (p<0.001) in the SBTHA group. However, no difference in the transfusion rate between the two groups was observed (p=0.724). Complication rate, 90- days hospital readmission and 90-days ER visit were similar between the two groups. This study shows that performing SBTHA is a safe, effective, and doesn't carry additional risks for patients with bilateral symptomatic osteoarthritis.

Clinical, virological, and operational aspects of a single-center Belgian experience with in-hospital infusions of casirivimab/imdevimab and sotrovimab for mild/moderate COVID-19

ABSTRACT Objectives To describe the clinical and virological characteristics of COVID-19 patients treated in a hospital with casirivimab/imdevimab and sotrovimab between June 2021 and April 2022 and to report the logistics for administering these monoclonal antibodies (mAbs). METHODS All COVID-19 adult patients treated with mAbs at CHU Charleroi (Belgium) were included. A multidisciplinary monoclonal antibodies team (MMT) was dedicated to identify eligible patients and coordinate the administration of mAbs in a temporary structure created within the hospital. Results A total of 69 COVID-19 patients were treated with casirivimab/imdevimab (11.6%) and sotrovimab (88.4%) within a median of 4 days of symptom onset, mainly during the Omicron B.1.1.529 period (71%); no severe adverse events occurred. Thirty-eight (55%) were outpatients, and among the 31 inpatients, 42% were nosocomial COVID-19. The median age was 65 years [IQR, 50–73], and 53.6% were male. The most common risk factors for progression to severe COVID-19 were immunosuppression (72.5%), arterial hypertension (60.9%) and age>65 years (47.8%). One fifth were SARS-CoV-2-unvaccinated patients. The median Belgian MASS score for patient prioritization was 6 [IQR, 4–8]. On Day 29, 10.5% of the outpatients were hospitalized, and 1.4% were admitted to an intensive care unit (ICU); there were no COVID-19-related deaths. General practitioners referred 19.4% of the outpatients. Conclusions In our experience, mAbs were prescribed in very high-risk patients with no adverse events, few progressions to severe COVID-19, and no related deaths. Our MMT has improved coordination of COVID-19 treatment and contribute to enhance communication with primary care.

Management of a Focal Introduction of ASF Virus in Wild Boar: The Belgian Experience

African swine fever (ASF) is a fatal disease of suids that was detected in wild boar in Belgium in September 2018. The measures implemented to stop the spread and eliminate the African swine fever virus consisted of creating restriction zones, organising efficient search and removal of carcasses, constructing wire fences, and depopulating wild boar in the area surrounding the infected zone. The ASF management zone included the infected and the white zones and covered 1106 km² from which 7077 wild boar have been removed. A total of 5338 wild boars have been qPCR-tested and 833 have been detected ASF-positive. The search effort amounted to 60,631 h with a main focus on the infected zone (88%). A total of 277 km of fences have been set up. The main cause of mortality in the infected zone was the virus itself, while hunting, trapping, and night shooting were used together to reduce the wild boar density in the surrounding white zones. After continuous dispersion of the virus until March 2019, the epidemic wave stopped, and the last fresh positive case was discovered in August 2019. Hence, Belgium was declared free of the disease in November 2020.

Uporedna studija jugoslovenskog i belgijskog statusa pod patronatom Velike Britanije u toku Drugog svetskog rata

The study of the Yugoslav-Belgian relations during the Second World War aims to present the position of two de-estated emigrant apparatuses under the auspices of the British diplomacy through a comparative analysis, starting from short-term war operations and the evacuation of two structures abroad, the issue of gold reserves and the royal issue, to the political, military and material aspect of the given relations in the later war period. The parallel consideration of the Yugoslav and Belgian experience in dealing with the interests of the United Kingdom tends to demystify the stereotypes already established regarding the international position of the Yugoslav Government in exile.

Clinical application of multigene panel testing for bleeding, thrombotic, and platelet disorders: a 3-year Belgian experience

BackgroundThe international study ThromboGenomics has evaluated the diagnostic rate using a targeted multigene panel test for the screening of inherited bleeding, thrombotic and platelet disorders. ObjectivesWe retrospectively analyzed the results of the implementation of genetic testing for inherited bleeding, thrombotic and platelet disorders in Belgian clinical practice and evaluated possible reclassification of reported variants. Patients/methodsWe implemented a Thrombosis-Hemostasis multigene panel test using whole exome sequencing to diagnose 487 patients recruited by 27 different Belgian hospitals with the implementation of stringent laboratory accreditation standards and by studying up to 100 diagnostic-grade genes. ResultsThis Thrombosis-Hemostasis multigene panel test was able to detect at least one genetic variant in 58% of the 487 patients of which 50% were (likely) pathogenic variants and the others were variants of unknown significance. Polygenic variants were detected in 65 patients (13%). A multi-step workflow for results discussion by multidisciplinary team meetings and patients’ recalls for segregation studies and additional laboratory testing was set up. Variants were also submitted to the GoldVariants database from the International Society on Thrombosis and Haemostasis (ISTH). The aim of these approaches is to optimize variant interpretation and to (re)classify variants of unknown significance as (likely) pathogenic or (likely) benign. ConclusionsThe growing implementation of multigene panel tests in clinical diagnostics comes with difficulties in interpreting genetic results. Additional efforts are needed to continuously optimize the diagnostic outcome.

Intervention strategies for renewed living ecologies. The Belgian experience

Demolition-reconstruction interventions and deep renovation interventions are the main strategies implemented with the aim of adapting the existing residential heritage. In particular, the deep renovation interventions are at the centre of a cultural debate, as evidenced by the research carried out on large modernist peripheral settlements. In this context, it is interesting to investigate how this approach can be applied to those historic urban tissues and smaller centres that strongly characterise the Italian and European territory. Starting from the analysis of several case studies identified in the Belgian context, the work codifies archetypes of intervention on technological units and analyses their limits and potential of application to the Italian context with the aim of opening a debate between conservation approaches and adaptation approaches.

How to Integrate Patient-Centered Measures in Routine Care: Lessons from Belgian Experiences

BACKGROUND Against the treatment gap and the long delays in seeking treatment for mental health problems, primary care psychology (PCP) was added to reimbursed outpatient mental health services in the Belgian healthcare system. PURPOSE Within the Evaluation of Primary Care Psychology study (EPCAP), which provides evaluation of the measure of reimbursement of PCP, the objectives were: (1) To describe the patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) of patients treated with PCP and (2) formulate guidelines to integrate patient-related findings and experiences within community mental health services. METHOD 428 patients participated in an online survey at the start of their PCP treatment in Belgium and after 3 and 6 months. Besides sociodemographic characteristics, DSM-5 mental disorders, suicidality, and service use, they were questioned about their findings (PROMs) and experiences (PREMs). RESULTS Almost 90% met the criteria of a lifetime as a 12-month DSM-5 mental disorder or STB at the start of PCP treatment. Both subjective well-being and the proportion of patients who had positive experiences regarding their PCP treatment increased with 46% resp. 23.2% after 3 months and remained stable after 6 months. CONCLUSION Although PCP in Belgium serves a clinical patient population with high proportions of lifetime and 12-month mental disorders and suicidality, their subjective well-being increased after 3 months and remained stable after 6 months. Despite differences between groups of patients, PCP seems to have a positive effect on subjective well-being of these patient in short term. Integration of PROMs and PREMs into PCP were recommended.DisclosureNo significant relationships.

Impact of COVID-19 on telemedicine in diabetes management: the Belgian experience

We will briefly review the history of telemedicine. Then we will look at its various applications, including teleconsultation, which is only one part of telemedicine. Belgium had not evolved much in the field of teleconsultation. It was only during the COVID-19 pandemic that this possibility was quickly made available to caregivers, and therefore to patients. We will discuss how the Belgian authorities were able to speed up the possibility of using this branch of telemedicine. We will focus more specifically on the care of diabetic patients, particularly in our institution, the University Hospital of Liège in Belgium. Finally, we will discuss the limits and prospects of telemedicine, particularly in the field of diabetology.

Are Business Policy Measures in Response to the COVID-19 Pandemic to Be Equally Valued? An Exploration According to SMEs Owners’ Business Expectations

A variety of public economic policy measures have been designed and implemented in an effort to enable SMEs to limit damages resulting from the adverse sanitary and economic shocks associated with COVID-19. The originality of our study is to propose a rating of the various economic policy measures, the rating being expressed by SMEs owners conditional to their business expectations. In so doing, our contribution is to highlight the policy measures to be implemented in order to support resilient and ambitious ventures with the most positive prospects, which are likely to contribute the most to economic recovery. We exploit an original and rich dataset derived from a survey conducted in May 2020 among a representative sample of more than 2100 Belgian (Walloon) SMEs. The Belgian experience is remarkable because the wide variety of measures it undertook echoes many of the measures taken by OECD countries. Our results suggest that the respondents have an overall positive evaluation of the various economic and social policy measures implemented by the Belgian authorities. More importantly, the rating by SME owners with the most favorable expectations are, however, significantly different than their counterpart. Measures helping firms to maintain their workforce are particularly highly rated by firms with the best prospects. It also appears that those firms prefer short-term and transitory measures.

Evolution of patient characteristics in the era of biologic treatment of psoriatic arthritis: 18-year Belgian experience from the Leuven Spondyloarthritis Biologics Cohort (BioSPAR)

ObjectivesBiologic treatments have revolutionized the management of PsA by significantly improving clinical manifestations and preventing structural damage. Both result in better quality of life and improved physical functioning. Since the introduction of the first TNF inhibitor (TNFi) in the early 2000s, therapeutic options for PsA are increasing steadily, and a new generation of biologics, including anti-IL-17 and anti-IL-23 strategies, allows distinct targeted approaches. The purpose of this study was to investigate whether the demographic, clinical and disease characteristics of PsA patients who are selected for first-line biologic treatment has changed over time since the introduction of biologics.MethodsPatients with a clinical diagnosis of PsA were included in the KU Leuven BioSPAR registry, a prospective cohort of SpA and PsA patients treated with biologics and targeted synthetic DMARDs (tsDMARDs), such as apremilast and Janus kinase inhibitors. Demographics, prior DMARD use, disease characteristics and disease activity parameters were recorded at the initiation of biologic treatment and subsequently every 3 months for the first 2 years and later every 6 months. The patient data were compared in three treatment periods, corresponding to availability of the first and second generation of TNFi and the third generation of biologics.ResultsAnalysis of 185 Caucasian patients with PsA from our prospective cohort showed longer disease duration and higher disease activity, with higher tender joint count, swollen joint count and CRP in the first period compared with the later time periods. The demographic characteristics and prior DMARD use did not change over time. Skin and nail psoriasis were more frequent in earlier compared with the later treatment periods. The bio-DMARD survival rate was similar in the early and later treatment periods.ConclusionThe population of patients selected for treatment escalation has changed over time since the introduction of biologics. Our results suggest that with years of experience, PsA patients might be considered earlier and for therapy intensification in patients with less active disease in comparison to profiles in the early days of biologic treatment.

Footballers’ sports selection and game orientation in Belgium

The current stage of development of Ukrainian football requires a software solution to a number of complex problems related to improving the quality of the game and increasing the competitiveness of Ukrainian teams in the international arena. In this context, it is essential to address topical issues of sports selection and game orientation of players at all industry levels. We believe that the study of the best Belgian experience in building and organizing a system of sports selection and game orientation of players can fill the necessary information and methodological gap in understanding the deep processes of success in modern high-achievement sports. Therefore, the purpose of this research is to determine the features of the organization and conduct of the process of sports selection and game orientation of Belgian football players. The Belgian Royal Football Association has created a well-thought-out and structured system of education, upbringing, training, improvement and development of playing opportunities for young footballers from the age of 6. The use of game and competitive methods of "nurturing" football talents is the basis of the Belgian theoretical and methodological approach. Simultaneously with the development of creative game potential, the emphasis is on the harmonious growth of football personalities. Clear structuring of training and competitive requirements - the basis of successful performances of the national teams of Belgium in the international arena. The success of the Belgian national football team in recent years is undeniable. The country of 11 million people with only 34 professional football clubs has managed to nurture the "golden football generation".

Outpatient total hip arthroplasty : the future?

With advancements in minimally invasive surgical technique, pain management and rehabilitation proto- cols, and prevention of post-operative complications, outpatient total hip arthroplasty became a realistic goal. This study reports our experience of performing outpatient total hip arthroplasty assessing its feasi- bility and safety. Between December 2015 and January 2018, 52 outpatient total hip arthroplasties were performed. We implemented a peri-operative management proto- col that included education, improved analgesia and rapid rehabilitation. Patients were asked about any complications they had experienced after surgery and about the perception of their experience as outpatient. Any early post-operative emergency department visits, acute office appointments or hospital re-ad- missions were registered. Fifty-one of 52 patients (98,1%) enrolled in the study met the discharge criteria and achieved their goal of going home on the day of surgery, and only one patient (1,9%) required an overnight stay. There were two visits to the emergency room, with one hospital re-admission (1,9%) on the night of the surgery. There were no major post-discharge complications in the short-term follow-up (minimum of three months). Only one patient (1,9%) reported a significantly negative experience. With this first Belgian experience reporting on out- patient primary total hip arthroplasty, our data demonstrate that early discharge does not result in excessive re-admissions or other post-discharge complications due to an early discharge. This study suggests that total hip arthroplasty can be performed safely and successfully in appropriately selected patients and that patients who experienced that ambulatory protocol declared themselves highly satisfied.

Sativex\xae (nabiximols) cannabinoid oromucosal spray in patients with resistant multiple sclerosis spasticity: the Belgian experience

BackgroundThis retrospective study evaluates patient-reported outcomes in patients with multiple sclerosis (MS) spasticity who were treated with a cannabinoid oromucosal spray (Sativex®, USAN name: nabiximols) after not sufficiently responding to previous anti-spasticity medications.MethodsOf 276 patients from eight centers in Belgium who began treatment prior to 31 December 2017, effectiveness assessment data were available for 238 patients during the test period of 4 to 8/12 weeks, and for smaller patient cohorts with continued treatment for 6/12 months.ResultsMean 0–10 spasticity Numerical Rating Scale (NRS) scores improved from 8.1 at baseline to 5.2 (week 4), 4.6 (week 8) and 4.1 (week 12). Mean EuroQoL Visual Analogue Scale (EQ VAS) scores increased from 39 at baseline to 52 (week 4), 57 (week 8) and 59 (week 12). Mean NRS and EQ VAS scores remained in the same 12 weeks’ range in patients with longer-term data. The average dose of cannabinoid oromucosal spray was 6 sprays/day. Most of the 93 out of 276 patients, with initial prescription (33.7%), who discontinued treatment by week 12 did so within the first 8 weeks, mainly due to lack of effectiveness. By week 12, 171 (74%) of the 230 effectiveness evaluable patients reported a clinically meaningful response, corresponding to ≥30% NRS improvement. The tolerability of cannabinoid oromucosal spray was consistent with its known safety profile.ConclusionsMore than 60% of the patients with MS who started add-on treatment with cannabinoid oromucosal spray reported a clinically relevant symptomatic effect and continued treatment after 12 weeks.

How the European in vitro diagnostic regulation could negatively impact the European response to the next pandemic: an urgent call for action before May 2022

Abstract The Corona Virus Disease 2019 (COVID-19) pandemic has demonstrated that the ability for laboratories to quickly set up and implement labdeveloped tests (LDTs) is essential to respond to an emerging health crisis. The Regulation on in vitro diagnostic medical devices (IVDR) could, however, profoundly impact our ability to respond to a future pandemic since the IVDR could significant restrict the use of LDTs. We address using the example of the current pandemic a number of LDT implementing issues problems which should be addressed. We conclude that the COVID-19 pandemic illustrates that commercial tests cannot cover all patient needs under any given circumstance and that sufficient degrees of freedom for laboratories to ensure their expertise to develop and implement LDTs ultimately benefit European citizens.

Impact of antithrombotics on the fecal immunochemical test for colorectal cancer screening : a multi-center Belgian experience.

Impact of antithrombotics on the fecal immunochemical test (FIT) for colorectal cancer (CRC) screening remains unclear. Patients undergoing colonoscopy for positive FIT in 2015 were assessed at 3 Belgian centers. Significant findings were advanced polyps (AP) (sessile serrated, tubular or villous adenomas >1cm or high-grade dysplasia) and CRC. False positive FIT and detection of AP/CRC with antithrombotics were calculated. 510 patients (64% male, median (IQR) age 63.2 (60.2 - 66.4) years) were included. Colorectal pathology in 371/510 (73%) was associated with male gender (70% vs. 48% ; p= .0001) and family history (16% vs. 8% ; p= .02). Antithrombotics in 125/510 (25%) were associated with male gender (78% vs. 59% ; p= .0001), older age (65.2 (62.2-70.3) vs. 62.3 (58.7-66.3) years ; p= .0001) and GI-symptoms (18% vs. 11% ; p= .04). False positive FIT (25% vs. 28% ; p= .52) and detection of AP (42% vs. 36% ; p=.27) or CRC (6% vs. 5% ; p= .69) were similar in patients with vs. no antithrombotics. Use of antithrombotics did not predict a higher chance of colorectal pathology after adjusting for confounders. Although antithrombotics were prescribed more frequently in male and older patients, detection of AP/CRC was similar. Despite increased GI symptoms, false positive FIT was similar with antithrombotics.

Universal newborn hearing screening: the Belgian experience

Abstract Issue Worldwide 466 million people suffer from hearing loss (HL), of whom 34 million children. Early detection of HL in newborns through screening and subsequent intervention significantly improve their developmental and psychosocial outcome. The WHA adopted a resolution on prevention of deafness and HL (2017), urging the member states 'to develop, implement and monitor screening programs for early identification of ear diseases'. Population based newborn hearing screening (PNHS) by automated otoacoustic emission (AOAE) and/or automated auditory brainstem response (AABR) is considered good practice. Description of the Problem Flanders (FL): PNHS by AABR at the age of 2-3 weeks (pass/refer), repeated in case of 'refer'. At 2x 'refer', referral to a tertiary hearing center. French speaking community (FSC): newborns with risk factors for congenital HL are immediately referred to ENT. Others undergo AOAE at day 2-3 (pass/refer with retest in case of 'refer'). At 2x 'refer', referral to ENT for AABR. German speaking community: no data available. Results Coverage rate: FL (birth cohort 2014): 96-98%. FSC (birth cohort 2016): 94.9% of newborns without risk factors had a 1st test. 8.7% of newborns with risk factors didn't have any test. Detection rate/1000 tested newborns FL: 2.1 newborns with congenital HL. FSC: 2.33 newborns with HL (0.30 perceptive/0.36 permanently conductive/0.75 temporary conductive/0.1 conductive NOS/0.06 mixed type/0.77 NOS). Lessons Belgium has at least 2 quality PNHS programs. Due to program differences (different tests/age of testing/registration/financing) in depth comparative analysis on their performance, outcome and cost effectiveness is currently lacking (future perspective). Key messages PNHS is common in high income countries, but is not yet integrated worldwide. In the light of the 2017 WHA resolution Belgium might inspire regions and countries starting up PNHS. An in depth comparative analysis of the current Belgian PNHS programs is needed.

Continuous surveillance of invasive pneumococcal disease is key

In the Lancet Infectious Diseases, Stefanie Desmet and colleagues1 report interesting data on the Belgian experience of pneumococcal conjugate vaccination (PCV) for infants. Belgium has the rather exceptional situation of sequential use of the seven-valent PCV (PCV7), 13-valent PCV (PCV13), and ten-valent PCV (PCV10) in their childhood immunisation programme. The Article describes the changes in serotype-specific incidence of invasive pneumococcal disease in children following the switch from PCV13 to PCV10 in 2015–16.

The impact of COVID-19 on rehabilitation: the Belgian experience.

The impact of COVID-19 on rehabilitation: the Belgian experience.