Belgian Federal Research Articles

Health data exchange, health data sharing and decentralised clinical data collections--recommendations from a Belgian expert group.

The Belgian Federal Health Authorities are willing to redefine their eHealth vision and to reformulate their strategy in consensus with healthcare professionals and other domain experts. The National Health Insurance Institute ordered end 2007 a study to a group of experts, representing the majority of the eHealth stakeholders. The aim of the study was to define the strategy to be followed regarding health data exchange, data sharing, decentralised clinical data collections and Electronic Health Records. The experts issued, June 2008, a description of the current standing regarding nationally available (or to be made available) services as well as a set of priorities (structural and technological ones) for the coming years. This paper presents the experts' recommendations and some translated excerpts of their report.

Strategic management: a tool for public management?

PurposeThe aim of this contribution is to propose a first overview of the strategic plans in the Belgian Federal Administration and to analyse the process of strategic planning itself.Design/methodology/approachIn the first part, the strategic plans are analysed in order to understand the intentions regarding various public policies. A content analysis will be provided in order to propose a typology or at least a comprehensive framework of the intentions. In the second part, the strategic process itself is investigated more into details on the basis of interviews of the presidents of the Federal Public Services. The contribution tries to formalise several behavioural hypotheses in accordance with a model of strategic action in a public context. Finally, the article concludes on the relation between intention and action.FindingsThree models characterize the management plans in Belgian federal administration: external polarization, internal polarization and balanced polarisation. Furthermore, the survey carried out confirms the existence of some effective behaviours of public top managers related to the nature of the public sector and to specific constraints. This result is fully coherent with behavioural assumptions formulated by a contextual model of strategic management. All these elements assess the possible divergence between the intentional strategy and the emergent strategies that would result from a more flexible behaviour.Research limitations/implicationsThis result is based on the strategic intentions and should be confronted with the later versions of the plans and even better with their achievements in order to distinguish intention and opportunity. Only this longitudinal study will allow final conclusions about the nature of the strategy really implemented in the federal administration to br drawn.Practical implicationsThe result of this research implies that “ideal” competences of public managers might differ from those requested for a private manager, especially regarding decision making (more incremental) and authority (more influential).Originality/valueThis contribution allows an evaluation of strategic process in the public sector as it is formulated by real actors, rather than by a mythical decision maker.

Profile‐based push models in manpower planning

AbstractA methodology is presented to deal with heterogeneity due to observable variables in modeling personnel systems. For a manpower system, a model based on personnel profiles is introduced. The proposed algorithm concerns an analysis of the evolution of personnel profiles under time‐discrete Markov assumptions. In this way, based on an historical personnel database, the estimation of transition probabilities of profiles as well as the computation of forecasts on the evolution of the manpower system can be found. Based on the presented procedure, a policy supporting software package has been developed for the Belgian Federal Government (research project financed by Federaal Wetenschapsbeleid). Copyright © 2007 John Wiley & Sons, Ltd.

Simulated impact of a fish based shift in the population n−3 fatty acids intake on exposure to dioxins and dioxin-like compounds

Due to the favourable health effects of LC n−3 PUFAs, marine products have been recognised as a food group of special importance in the human diet. However, seafood is susceptible to contamination by lipophilic organic pollutants. The objective of this study was to evaluate intake levels of PCDDs, PCDFs and dioxin-like PCBs, by a probabilistic Monte Carlo procedure, in relation to the recommendation on LC n−3 PUFAs given by Belgian Federal Health Council. Regarding the recommendation, two scenarios were developed differing in LC n−3 PUFAs intake: a 0.3 E% and a 0.46 E% scenario. Total exposure to dioxins and dioxin-like substances in the 0.3 E% LC n−3 PUFAs scenario ranges from 2.31 pg TEQ/kg bw/day at the 5th percentile, over 4.37 pg TEQ/kg bw/day at the 50th percentile to 8.41 pg TEQ/kg bw/day at the 95th percentile. In the 0.46 E% LC n−3 PUFAs scenario, 5, 50 and 95th percentile are exposed to 2.74, 5.52 and 9.98 pg TEQ/kg bw/day, respectively. Therefore, if the recommended LC n−3 PUFAs intake would be based on fish consumption as the only extra source, the majority of the study population would exceed the proposed health based guidance values for dioxins and dioxin-like substances.

A federal audit of the Belgian radiotherapy departments in breast cancer treatment

Background The Belgian Federal College of Radiotherapy carried out an external audit of breast cancer patient documentation in the 26 Belgian radiotherapy centres. The objective was to assess compliance with the recommendations regarding minimal requirements for documentation of radiotherapy prescription and administration. All centres volunteered to take part in this audit. Methods Two experienced radiation oncologists site-visited the departments over a 6 month period (Sept. 2003–Feb. 2004), with a list of items to be verified, including details on the surgery, the pathological report, details on systemic treatments, details on the radiotherapy prescription (and consistency with therapeutic guidelines) and delay surgery/radiotherapy. Findings Three hundred and eighty-nine patients files were reviewed, for a total of 399 breast cancers (10 patients with bilateral cancer). Mean age was 57.8 y (range 29–96). Breast conservative surgery (BCS) was used in 71%; radical mastectomy in 29%. A complete pathological report was present in all files but 2 (99.5% conformity). 5.2% were treated for DCIS, 61.6% for pT1, 28.2% for pT2 and 5% for pT3-4. Data regarding resection margins were specified to be free in 76.2%, tangential in 12% (within 2 mm) and positive for DCIS in 3.8% or invasive cancer in 1.5% (no information, on margins in 6.5%). The pT stage was always specified, and consistent with the macroscopic and microscopic findings. Hormonal receptors were routinely assessed (94.7%), as well as Her2neu (87.4%). Axillary surgery was carried out in 92%, either by sentinel node biopsy or by complete clearance, in which case the median number of nodes analysed was 12 for all centres together (7–17). All radiotherapy prescriptions were in line with evidence-based standards of therapy (i.e., irradiation of breast after BCS or after mamectomy (in case of pN+), but one. The mean delay between surgery and radiotherapy was 5.5 weeks (SD 11days). Conclusion There was a high degree of conformity of the various centres with the minimal requirements for documentation of radiotherapy prescription and administration of the Federal College of Radiotherapy. In addition, the quality of surgery (assessed by margin clearance) and of pathological reports was excellent, whatever the institution of origin (teaching vs. non-teaching, private vs. public). Belgian patients referred for radiotherapy are treated with great care. Prescriptions are based on pathological evidence, gathered through appropriate surgery. All indications were evidence-based; there was no overuse of radiotherapy in early breast cancer treatment.

‘Mr Police Officer, I thought cannabis was legal’—Introducing new policy regarding cannabis in Belgium: A story of good intentions and Babel

Over the last five years, the announced new policy on drugs, cannabis in particular, has been the subject of much debate within the Belgian Federal Government and between the government and the opposition parties. Unclear policies and poor public communication from the Federal Government, the competent minister and the other parties caused immense confusion about whether and when the possession of cannabis would be legal and what the criteria would be for prosecution when found possessing cannabis. This confusion has been illustrated by a survey by Gelders and Van Mierlo (2004) Legalized or not? Poor public communication causes confusion over the new cannabis policy in Belgium. Drugs: Education, Prevention and Policy, 2, 167–177. Aims: (1) to present the most relevant policy developments specifically from the last two years, and (2) to determine whether there is still confusion and to assess the knowledge of young people about current prosecution practices. Methods: (1) an analysis of policy documents and legal texts, and (2) a more up-to-date survey among 748 Belgian youngsters. Findings: only 35.1% answered the basic-knowledge questions correctly while 59.2% assessed the prosecution practice in an appropriate manner. Conclusion: there is still a lot of confusion regarding the current cannabis legislation and prosecution.

Two Hundred Years of Geological Mapping in Belgium, From D'omalius D'halloy to the Belgian Federal State

The career of Jean-Baptiste-Julien d'Omalius d'Halloy (1783-1875), commencing with brilliant scientific activities and proceeding to his attainment of the highest administrative and political positions, in itself demonstrates that he was an exceptional individual. His scientific career started with a long voyage through the French Empire and adjacent regions, during which he gained an understanding of the geological structure of most of Europe. The geological map he compiled based on his travel notes formed the basis of all future geological maps in the areas that he covered. After the independence of Belgium in 1830, André Dumont was made responsible for the mapping of the whole country, resulting in the publication of a 9-sheet map of Belgium in 1853 on a scale of 1:160.000. In 1878, Belgium decided to produce a more detailed map on the scale of 1:20.000, entrusting the work to Edouard Dupont., but as this appointment was controversial and the mapping at this scale was abandoned and than, the newly created Geological Survey of Belgium published a new 226-sheet map on a scale of 1:40.000. Starting from 1993, after the federalisation of the country, new geological maps of the regional states are mapped and produced.

Food safety surveillance through a risk based control programme: Approach employed by the Belgian Federal Agency for the safety of the food chain

Summary The principal responsibility of the Belgian Federal Agency for the Safety of the Food Chain (FASFC) is to guarantee the safety along the food chain. In order to accomplish this responsibility, the FASFC has developed an integrated official control program to check compliance with various regulations. The original methodology developed and applied by FASFC is presented. This methodology is based on risk evaluation, statistical tools and current scientific knowledge.

The European rescue of the federal state: How Europeanisation shapes the Belgian state

This article investigates the impact of European integration on the Belgian federal polity. In particular, we substantiate two propositions. First, we show that European integration stimulates Regions, Communities and central government to cooperate. Second, Europe prevents the central government level from disappearing. Europeanisation seems to have a centralising effect on some parts of the Belgian polity. In general, the constitutionally dual nature of the Belgian federation has, due to European influences, incrementally evolved into a practice of cooperation and joint decision-making. These conclusions are supported by an in-depth exploration of five policy areas: the overall domestic European coordination procedures, environmental policy, agricultural policy, social policy and the European treaty negotiations.

‘Will it stay or will it go?’ Federalism and the sustainability of Belgium

This article provides an overview of the federalisation of Belgium. It first discusses why Belgium acquired a federal character when the politics of the centre already recognised the multilingual character of the Belgian state. Subsequently the authors discuss the specificities of the Belgian federal system when it is placed in a comparative perspective. The presence of two different types of regions – Regions and Communities – the steering capacity of a small group of political elites reluctant to give up political control, the presence of institutional asymmetries, the initially dual nature of dividing competencies and the slow development of intergovernmental relations are highlighted as specific features of Belgian federalism. In the final section, the authors assess the assets and liabilities of federalism from the viewpoint of institutional stability. They argue that while Belgian federalism contains significant institutional shock absorbers and issues of common interest, the further unravelling of the centre in a confederal direction is more likely.

The politics of Belgium: Institutions and policy under bipolar and centrifugal federalism

This volume seeks to provide an integrated understanding of the Belgian political system through the prism of comparative politics. The transformation of the political system from a unitary into a federal system is used as a connecting theme linking the contributions. The volume is divided in two parts. The first part touches upon the sociological and institutional determinants of policy-making in Belgium, such as the dynamics of the Belgian federal system, the consociational features of the Belgian polity, the presence of a Belgian political culture (or of two distinct political cultures), the fragmentation of its party system and the role of political parties. The second part addresses policy performance and policy reform within the context of Belgian federalism, with a focus on divergence in policy performance and administrative practices, social security as a contentious federal policy area, policy failure and corruption and the impact of EU policies on the domestic federal order.

The opinion of Belgian government communication professionals on public communication about policy intentions: Pros/cons and conditions

Abstract This article examines the opinion of Belgian government communication professionals regarding the controversial governmental communication about policy not yet adopted by the competent authority (i.e. the legislature) (CNAP). Based on a semi-structured, face-to-face survey among thirty-two Belgian Federal and Flemish spokesmen, we gain insight into the conditions which governmental CNAP is allowed according to these practitioners. We also gain insight into their general opinion on CNAP as well as into their arguments for and against this kind of government communication. The most important pro-CNAP belief is that it keeps citizens from being presented with a fait accompli. The most important argument against CNAP is that it creates false expectations among citizens.

Competency Frameworks in The Belgian Governments: Causes, Construction and Contents

The Belgian Federal government and the Belgian Flemish government have picked up competency management as a multifaceted tool to suit their own visions of organizational change rather than simply responding to a new management trend in the private sector. Both governments have used it to foster both vertical and horizontal integration in their fragmented administrations, and to deal with problems of recruitment and retention of qualified personnel. The analysis presented here also reveals that the seemingly uniform use of ‘competency speak’ hides multiple dimensions that provide several solutions to different organizational problems. At the same time, the cases examined demonstrate how the new tools both serve and disconcert the diverse bureau-political interests of top civil servants, trade unions and Human Resource Management units. In addition, we examine how the new tools break with at least two traditional features of the highly formal and rigid career systems and the relatively low status of officials in the Belgian administrations.

Public information problems in the implementation of public policy: The long road of the reflecting license plate in Belgium

Abstract During the last ten years in Belgium, government information policies have put public information provisions at the center of policymaking. However, the contemporary daily practice of public information provision tends to be seen as incidental to the policymaking process. The introduction of the reflecting license plate in Belgium is a prime example of a case in which little attention has been paid to the quality of public information during the ongoing policy process. First, we define the notion, quality of public information, as a necessary condition for the successful implementation of policy objectives. We then chronologically outline the main policy intentions and decisions, and we describe the factors hindering the smooth introduction of the license plate, focusing on those related to information provision. Finally, we examine whether the current public management reform in the Belgian Federal administration can improve the quality of information supplied during the ongoing policy process.

Risk assessment of dietary acrylamide intake in Flemish adolescents

Acrylamide has recently been found in a range of heat treated food items. As it is a neurotoxic agent and a probable, human carcinogen (IARC 2A), human exposure to this chemical might constitute an important public health issue. The purpose of the study was to estimate the acrylamide intake in Flemish adolescents (based on 7-day food record) and to evaluate the possible health risks due to the exposure. The Belgian Federal Agency for the Safety of the Food Chain collected 150 food items from different supermarkets and restaurants to analyse the acrylamide level. The limit of quantitation was 30μg acrylamide/kg foodstuffs. Exposure modelling was based on Monte Carlo simulations. The estimated dietary intake of acrylamide per person given as the 5th, 50th and 95th percentile were 0.19, 0.51 and 1.09μg/kgbw/d. Bread, despite its low acrylamide content, is relevant as a source of acrylamide exposure at the lower percentiles. At higher percentiles the contribution of French fries and crisps is more important. It must be emphasised that the exposure assessment has several limitations. Risk of neurotoxicity seems negligible. The relevance of current intake levels in terms of cancer risk remains a subject of debate.

Enhanced levels of dioxins in eggs from free range hens; a fast evaluation approach

As a consequence of an initiative of the local authorities of the city of Antwerp (Belgium), dioxin levels were determined in eggs from free range hens owned by private owners in the Northern districts of Antwerp. The reasons for this survey stem from some fears that free range eggs could be contaminated by local environmental sources (e.g. soil, grass, earthworms) as a result of the presence in this area of intensive industrial and domestic activities. The analyses revealed high levels of PCDD/F in the home-produced eggs (average = 9.9 pg WHO-TEQ per g of fat; n = 15). An evaluation of the available results has been carried out by the Scientific Committee of the Belgian Federal Agency for the Safety of the Food Chain. From this evaluation, it appeared that the analysis of congener profiles was of limited use because all profiles were dominated by the OCDD congener, independently of the level of contamination. There were not enough indications allowing a causal link to be established between high dioxin levels in eggs and soil contamination and, on the other hand, it was assumed that other factors such as feeding habits, physiological state and egg laying rhythm of the hens could not be ruled out as potential causes of aggravation. A quick risk assessment led to the conclusion that the impact of this contamination is highly relevant for the consumer’s health due to the important contribution of such home-produced eggs in the estimations of total body burden.

Risky business: A risk-based methodology to measure organized crime

This paper describes the result of two studies on the development of a methodology to measure organized crime. The purpose of these studies, tasked by the Belgian Federal Police and Minister for Justice, was to provide a concrete and knowledge-based framework for the drafting of annual reports on organized crime that can give better answers to questions like ‘Is there much organized crime? Is the situation serious? Is it bad that there are more criminal groups now than in the past? Which criminal groups are the most dangerous?’. Two features provide a common thread that binds the methodology: the operating principle of the spectrum of enterprise and the application of a risk-based methodological process to the overall framework. The starting hypothesis is that organized crime is entrepreneurial in nature and that the dynamics of the market space provide the main environment and explanation for organized crime. The application of a risk-based methodology is founded on the recognition that the analysis of organized crime will always depend on imperfect information and resource limitations. Furthermore, the utility of a risk-based approach is seen in the provision of findings that are transparently arrived at with a clearly established framework for prioritization of decision-makers. The proposed methodology consists of three parts: environmental scanning, analysis of organizations and counter strategies and licit and illicit sector analysis.

Legalized or not? poor public communication causes confusion over the new cannabis policy in Belgium

During the last three years, the newly announced drug policy, specifically cannabis, has been the subject of debate between the Government and the opposition parties within the Belgian Federal Government. Public communication by the Federal Government and the competent ministers was incomplete, untimely, inconsistent, tendentious and polemical. This caused confusion when discussing whether and when the possession of cannabis would be legal as well as what the criteria might be for determining prosecution for possessing cannabis. This article shows the way in which political spin dealing with policy intentions can negatively influence the public's knowledge of the policies and the way it can interfere with informational activities. The article is based on an analysis of policy documents, legal texts, media reports, call reports from the Association for Alcohol and other Drug Problems, secondary survey data and our own survey.

Trust as a central paradigm for advisory science: the case of the Belgian nuclear phase-out

The Belgian parliament has decided to phase out the existing nuclear power plants as part of the government's strategy to achieve sustainable development. According to the authors, this nuclear phaseout can be regarded as belonging to a class of unstructured problems in science for policy-making, i.e. problems where there exists a debate on the scientific facts as well as on the values at stake. When society is confronted with unstructured problems, insights from recent risk research literature point at the overriding importance of trust in arrangements at the cutting edge of science and policy. We investigated the Belgian science–policy interface from the point of view of trust building, also guided by insights from interviews with members of the Belgian Federal Council for Sustainable Development. The results were analysed on three levels of discourse: the cognitive, the reflective and the design or planning discourse. On each level, flaws in the trust-building fabric could be demonstrated.

Setting up a common architecture for EPR in primary care: the Belgian experience.

A couple of years ago, the Belgian Federal Ministry of Health decided to back the development of a basic conceptual model for Electronic Patient Record (EPR) in primary care. Using consensus and modeling relational techniques, a working group of experts and experienced practitioners identified 7 key structuring concepts: Health Care Element, Health Approach, Contact, Subcontact, Service, Health Agent, Period. This model could roughly be seen as a restrictive sub-model of the current CEN proposal (prENV 13940) or as a first step to assess this CEN pre-Norm in Belgium. The conceptual model is already used in teaching activities and in a Belgian software labeling process.