Belgian Situation Research Articles

Multi-criteria decision-making framework on process water treatment of minimally processed leafy greens

The use and application possibilities of the multi-criteria decision analysis (MCDA) methodology, as a decision support tool in food safety risk management was demonstrated in a case study on the washing of minimally processed leafy greens, a multidimensional food safety decision problem involving public health, economic, environmental and socio-cultural aspects. The washing procedure remains a critical step in the production chain of ready-to-eat leafy vegetables, as the process water could act as a vector for cross-contamination of pathogens. The use of chemical sanitizers in produce wash water is scattered over EU member states and regulations remain unharmonized. The most appropriate washing methodology was determined, for the Belgian situation, based on an evaluation of weighted criteria, following the PROMETHEE II algorithm. Hereto multiple sources of information were consulted, including scientific and grey literature, expert evaluations and information provided by vegetable processing companies. Data generated over the past 10 years and published in scientific literature were selected and aggregated into probabilistic distributions using @Risk® software. An online stakeholder consultation, organized in Belgium, had the aim to measure stakeholders' preferences. The MCDA case study indicated that washing leafy greens in potable (ice) water, should be considered the most appropriate method for the Belgian case. The MCDA methodology can be applied for building evidence-based risk management decisions in the field of food safety, as it provides a transparent framework for the collection of evidence and the inclusion of stakeholders' interests.

Hydrogen fuel and the Belgian transport sector: A critical assessment from an environmental and sustainable development perspective

This study provides an in-depth analysis of the potential role of hydrogen (H2) in the Belgian transport sector in the context of sustainable and environmentally friendly growth. This paper starts by examining the energy-climate roadmap and the emission mitigation programme defined by the Belgian federal government in the context of environmental sustainability. Then, the Belgian situation is critically evaluated in light of the needs for H2 fuel in the transport sector, as well as issues about a roadmap on environmental considerations for a sustainable future, while preserving the country's economic stakes. There are several key advances in this direction, especially as H2 is seen as one of the best viable options for sustained development, unlike other possibilities. This paper also highlights some limitations that make it difficult to accelerate the transition to a sustainable H2 energy future. Although there are many interests in favour of an advanced and non-polluting transport system, there are differing views on the approach to be taken in political decision-making at national level. Therefore, this study will help public authorities to better integrate environmental and sustainability issues in the context of a transition to a comprehensive hydrogen economy in the current transport sector.

Belgian observational survival data (incidence years 2004–2017) and expenditure for innovative oncology drugs in twelve cancer indications

BackgroundThe Food and Drug Administration and European Medicines Agency typically approve market access for cancer drugs based on surrogate end-points, which do not always translate into substantiated improvements in outcomes that matter the most to patients, i.e. survival and quality of life. These drugs often, also, have a high price tag. We assessed whether there was an increase in cancer drug expenditure for a broad selection of indications, and whether this correlates with increased overall survival. MethodsThis cohort study used Belgian Cancer Registry data from 125,692 patients (12 cancer indications, incidence period 2004–2017), which was linked to reimbursement and survival data. This reliably represents the Belgian situation. One-to-five year observed survival probability, median survival time, oncology drug expenditure and mean oncology drug cost per patient were reviewed. FindingsIn almost all indications, total expenditure and average treatment cost for oncology drugs increased over the years (2004–2017). In contrast, mixed findings are observed for the evolution in overall survival probability and median survival time. While an absolute improvement in the 3-year survival probability of about 10% is noticed in non-small-cell lung cancer and chronic myeloid leukaemia, improvements in about half of the other indications are limited or even absent. InterpretationThe Belgian observational data indicate that assuming ‘innovative’ oncology drugs always add value in terms of improved survival is often unjustified. The literature also highlights the problem of using surrogate end-points, and the lack of comparative evidence showing an added value of oncology drugs for both survival and quality of life at market approval or during the post-marketing phase. Comparative studies should be conducted in the pre-marketing phase that are suitable for registration purposes, aid reimbursement decisions and support physicians and patients when making treatment decisions.

Adhésion au plan de soins : repenser le parcours du patient asthmatique en Belgique

One of the main recommendations to improve chronic asthmatic patients' adhesion to their treatment is the implementation of a coordinated care pathway aiming at facilitating disease management by the patient while meeting his needs and expectations. To study through a critical literature review and a short survey how this care pathway can be set up and adapted to the Belgian context. A model including the three healthcare levels in Belgium was developed. The first level is mainly formed by general practitioners while the second and third are centralized around a structure called asthma clinic. This latter would provide a full asthma assessment, its chronic follow-up and treatment for severe asthma. Roles of healthcare professionals working with the asthmatic patient were identified and described. This model is discussed in the light of the present Belgian situation according to different plans: asthma management, effective interdisciplinary communication, advanced nurse practitioner's role implementation. Although the Belgian context is currently not suitable enough for allowing this new nursing function to arise, our model lays the foundations of a system which is adapted to complexity of Belgium, follows from validated experiences on international scene, and offers an answer to chronic asthmatic patient's needs and expectations.

Intranational film industries: a quantitative analysis of contemporary Belgian cinema

ABSTRACT This article presents a quantitative analysis of Belgian fiction film production between 2000 and 2019. Analysing an extensive database, it explores the current state of Belgian cinema, which is characterised on the one hand by a strong international dimension, and on the other hand by two largely separate intranational industries: a Flemish and a francophone Belgian film industry. Despite the persistent gap between the two industries, a certain rapprochement seems to be manifesting recently. This industrial analysis is preceded by an exploration of the conceptual and practical difficulties and limitations that arise when trying to determine whether a film can be labelled (partly) ‘Belgian’, ‘Flemish’ and/or ‘francophone Belgian’. Emanating from the complexity of the Belgian situation, these difficulties reveal some of the theoretical contradictions of the concept of national cinema. As such, departing from a quantitative study of Belgian cinema, this article also provides an original contribution to ongoing debates on the concept of national cinema.

Monitoring trucks to reveal Belgian geographical structures and dynamics: From GPS traces to spatial interactions

Despite the fact that freight transport has a huge impact on the economy and the environment, Belgian datasets have always been scarce or restricted to very small a-spatial samples. Spatial data collected in Belgium for toll-paying trucks are here examined, and geographical structures and dynamics are extracted from this massive dataset. The originality of this dataset is its exhaustivity and its real-time approach: the location of all the trucks circulating in Belgium is collected every 30 s.The paper first relates to the methodology applied when using and transforming big data generated by On Board Units GNSS (cleaning, transforming and pre-processing). Second, it maps and comments on the movements (traffic) and stops of trucks within the whole country, providing a clear picture of the Belgian situation, useful for regional planners and logistics companies. Finally, the flows of trucks observed between Belgian locations enable the country to be divided into mathematical communities of places that interact the most. Analyses are performed for sub-categories based on the country of registration, underlining the spatial specificities of freight transit in Belgium. This exploratory spatial data analysis enables to reveal not only multi-level spatial structures associated with urban hierarchies and the transport infrastructure, but also firm locations or political organizations and to consider the complexity and interconnectivity of any measure taken for a more sustainable future. With a clear methodological framework to cope with the data pre-processing, this paper opens the way to various potential applications linked with freight transportation in Belgium.

Preparedness and Responses Faced during the COVID-19 Pandemic in Belgium: An Observational Study and Using the National Open Data.

This study aimed to descript the Belgian COVID-19 responses process according to the WHO’s (World Health Organization) Health Emergency and Disaster Risk Management Framework (Health EDRM Framework) and to present the measures taken and epidemic impact in the different phases of COVID-19 in Belgium. The WHO’s EDRM Framework was used for reviewing the Belgian Public health emergency preparedness and responses in the context of COVID-19. Information on the measures taken was collected through the literature review including all government’s communication, reports, and scientific papers. All epidemic data were extracted from a national open database managed and published by the Sciensano. Additionally, two authors closely followed the Belgian situation since the beginning of the pandemic and updated the data every day. During the COVID-19 pandemic, the anti-epidemic strategy was mainly to avoid medical resources exceeding the upper limit. Belgium issued a series of emergency decrees to limit the spread of the virus. An existing structure of “federal-region-municipal” as the framework of public health emergency preparedness and response was adapted. The emergency response process in Belgium was divided into four phases: information-evaluation-coordination-decision-making at the region level and the final decision-making at the federal level. Belgium also implemented a phased plan in the process of setting up and lifting the lockdown. However, it was vulnerable in early response, due to the shortage of medical equipment supplies in general, and more particularly for the long term care facilities (LTCFs). Belgium has achieved an intensive cooperation between stakeholders based on an existing multisectoral emergency organization framework. Legislation, medical insurance, and good communication also played a role in limiting the spread of viruses. However, the authorities underestimated the risk of an epidemic and did not take quarantine measures among people suspected affected by SARS-COV-2 in the early stages, resulting in insufficient medical equipment supply and a large number of deaths in the LTCF. The implementation of the lockdown measure in Belgium also encountered obstacles. The lockdown and its exit strategy were both closely related to the pandemic situation and social and economic life. The authorities should strengthen information management, improve the public awareness of the measures, and find out the balance points between the social and economic life and infection control measures.

Recommendations for the treatment of epilepsy in adult and pediatric patients in Belgium: 2020 update

To guide health care professionals in Belgium in selecting the appropriate antiepileptic drugs (AEDs) for their epilepsy patients, a group of Belgian epilepsy experts developed recommendations for AED treatment in adults and children (initial recommendations in 2008, updated in 2012). As new drugs have become available, others have been withdrawn, new indications have been approved and recommendations for pregnant women have changed, a new update was pertinent. A group of Belgian epilepsy experts (partly overlapping with the group in charge of the 2008/2012 recommendations) evaluated the most recent international guidelines and relevant literature for their applicability to the Belgian situation (registration status, reimbursement, clinical practice) and updated the recommendations for initial monotherapy in adults and children and add-on treatment in adults. Recommendations for add-on treatment in children were also included (not covered in the 2008/2012 publications). Like the 2008/2012 publications, the current update also covers other important aspects related to the management of epilepsy, including the importance of early referral in drug-resistant epilepsy, pharmacokinetic properties and tolerability of AEDs, comorbidities, specific considerations in elderly and pregnant patients, generic substitution and the rapidly evolving field of precision medicine.

Clustering in defence-related procurement: the case of a Belgian naval construction cluster

ABSTRACTThis paper examines the importance of closer co-operation in defence-related procurement. Led by the decision that Belgium will lead the procurement of 12 Mine CounterMeasures Vessels (MCMV), the case of a potential Belgian naval construction cluster is discussed. The feasibility of a potential cluster is investigated by looking at key elements of a successful naval construction cluster, the Dutch naval construction cluster, and comparing those key elements to the current Belgian situation. Forming a sustainable Belgian naval construction cluster will be difficult. Most of the procurement process of the MCMVs is set on a European tender. In the long run, due to the absence of both a launching customer and leader firms, no party is able to carry the cluster with investments and knowledge spill-overs. In order to keep public support for large defence-related investments, clustering around the MCMV integration system and proactive cluster support is recommended.

How to overcome political and legal barriers to the implementation of a drug consumption room: an application of the policy agenda framework to the Belgian situation

BackgroundFor more than 30 years, drug consumption rooms (DCRs) have been implemented in Western countries. DCRs are supported by a large body of evidence about public safety and public health effectiveness. However, a political consensus has never been achieved in Belgium on amending the existing law that explicitly penalises the supply of a room for facilitating drug use. Despite this adverse legal and policy framework, a DCR opened in the city of Liège in 2018. In this case report, we applied the theoretical framework proposed by Shiffman and Smith for policy agenda setting, in order to describe and assess how political and legal barriers were overcome in the process of opening the DCR.Case presentationFor some years, fieldworkers and some city policymakers argued for DCR implementation in Belgium, but without gaining the support of the national authorities, mainly for ideological reasons. In order to address this debate, a feasibility study of DCR implementation in Belgian cities was commissioned. At the national level, an institutional debate took place about the political responsibility for DCRs as a public health intervention, as health care is mainly a matter of regional policy. The lack of consensus led to a situation of political deadlock. Meanwhile, the publication of the study report and the context of local elections offered an opportunity for Liège authorities to reignite the local debate on DCRs. At the local level, law enforcement, care professionals, residents, users, and the press were all involved in the implementation process. Therefore, a local consensus was formed and despite the absence of any national legal change, the DCR opened 1 month before the local elections. It has been working without major medical or legal incident since then. Incidentally, the mayor of Liège was re-elected.ConclusionsAlthough the lack of a legal framework may engender instability and affect longer-term effectiveness, the DCR implementation in Liège was successful and was based on a local consensus and effective communication rather than on an appropriate legal framework. The experience provides lessons for other cities that are considering opening a DCR despite an adverse legal and political context.

Digital (dis)connectivity in fraught contexts: The case of gay refugees in Belgium

The key role of digital and mobile media for refugees is increasingly acknowledged, but while the literature on the topic tends to celebrate the advantages of digital media, it is important to also acknowledge limitations. Thus, the focus on the creation and maintenance of connections through digital media may obscure experiences and practices of disconnection. This is certainly the case for forced migrants with non-normative sexual orientations, for whom experiences of homophobia within the family and ethno-cultural community in the country of origin may extend to fraught situations in the country of residence. As with digital media in general, it is important to consider the ‘offline’ social and cultural conditions determining online media uses. This article focuses on the specific challenges for lesbian, gay, bisexual, transgender and queer refugees, both in general and in Belgium, drawing on desk research and expert interviews, as well as nine in-depth interviews with gay-identifying male refugees. While the refugees are relatively positive about the Belgian situation, they do identify a number of challenges. They use digital media to stay connected to family and other people in the country of origin, but often this connection has become difficult. Social media and dating sites also offer a way to connect to other gay men, but these connections can be equally fraught, particularly in the country of origin for danger of exposure but also in Belgium as social media transcend national boundaries. For this reason, some participants created new or parallel profiles, to keep their gay lives disconnected from their family lives. Overall, then, digital media are a tool not only of connection but also of strategic disconnection for gay refugees.

Optimal configuration, design and control of a binary geothermal combined heat-and-power plant

In this paper, a two-step design optimization framework is developed for four low-temperature geothermal combined heat-and-power plant configurations. The economic comparison, including off-design performance, has not been done before. The optimization tool is applied for an existing district heating system and for geothermal and meteorological conditions which are based on the Belgian situation. It is concluded that a combined heat-and-power plant results in an economically profitable project (net present value of 3.46 MEUR), whereas the stand-alone electrical power plant does not (net present value of −3.65 MEUR). Furthermore, the design for the series set-up is optimal, and the best connections during operation are the series and parallel connections for low and high heat demands, respectively. Also, a less detailed (high-level) control optimization model is developed for this series set-up, based on the part-load operating maps which are calculated from the detailed two-step optimization model results. The calculation time is much faster (∼milliseconds) and the errors on the total revenues are smaller than 0.1%. The goal of this high-level model is to optimize the amounts of heat and electricity to produce, so that the plant can be used as a flexibility tool in energy markets driven by price signals for heat and electricity.

Design and off-design optimization procedure for low-temperature geothermal organic Rankine cycles

In this paper, a two-step optimization methodology for the design and off-design optimization of low-temperature (110–150 °C) geothermal organic Rankine cycles (ORCs) is proposed. For the investigated conditions—which are based on the Belgian situation—we have found that the optimal ORC design is obtained for design parameter values for the environment temperature and for the electricity price which are both higher than the respective yearly-averaged values. However, the net present value is negative (−12.62 MEUR) which indicates that the low-temperature (130 °C) geothermal electric power plant is not economically attractive for the investigated case. Nevertheless, and demonstrated by the results of a detailed sensitivity analysis, a low-temperature geothermal power plant might be economically feasible for geological sites with a higher brine temperature or in a country with a more favorable economic situation; e.g., with higher electricity prices (∼70 EUR/MWh). The novelty of our paper is the development of a thermoeconomic design optimization strategy for low-temperature geothermal ORCs, accounting for the off-design behavior already in the design stage. The generic methodology is valid for low-temperature geothermal ORCs (with MW scale power output) and includes detailed thermodynamic and geometric component models, is based on hourly data rather than monthly-averaged data and accounts for economics.

First- and second-line bevacizumab in ovarian cancer: A Belgian cost-utility analysis.

BackgroundCurrently, in Belgium, bevacizumab is reimbursed for ovarian cancer patients, based on a contract between the Minister and the manufacturer including confidential agreements. This reimbursement will be re-evaluated in 2018.ObjectiveTo support the reimbursement reassessment by calculating the cost-effectiveness of bevacizumab: (1) in addition to first-line chemotherapy; (2) in the treatment of recurrent ovarian cancer (platinum-sensitive or platinum-resistant).MethodsA health economic model has been developed for the Belgian situation according to the Belgian guidelines for economic evaluations. The lifetime Markov model was set up from the perspective of the health care payer (government and patient), including direct healthcare related costs. Results are expressed as the extra costs per quality-adjusted life year (QALY). Calculations were based on results of four international trials. Both probabilistic and one-way sensitivity analyses were performed.ResultsIncremental cost-effectiveness ratios (ICERs) of first-line bevacizumab are on average 158 000/QALY (GOG-0218 trial) and 443 000/QALY (ICON7 trial). The most favourable scenario is based on the stage IV subgroup of the GOG-0218 trial (€52 000/QALY). Since subgroup findings are often exploratory and require confirmatory studies, results of the economic evaluation based on this subgroup analysis should be considered with caution. For second-line bevacizumab, ICERs are on average €587 000/QALY (OCEANS trial) and €172 000/QALY (AURELIA trial). Sensitivity analysis shows that results are most sensitive to the price of bevacizumab.ConclusionFrom a health economic perspective, ICERs of bevacizumab are relatively high. The most favourable results are found for first-line treatment of stage IV ovarian cancer patients. Price reductions have a major impact on the estimated ICERs. It is recommended to take these findings into account when re-evaluating the reimbursement of bevacizumab in ovarian cancer.

TrIAS, leveraging citizen science data to monitor invasive species in Belgium

Reducing the damage caused by invasive species requires a community approach informed by rapidly mobilized data. Even if local stakeholders work together, invasive species do not respect borders, and national, continental and global policies are required. Yet, in general, data on invasive species are slow to be mobilized, often of insufficient quality for their intended application and distributed among many stakeholders and their organizations, including scientists, land managers, and citizen scientists. The Belgian situation is typical. We struggle with the fragmentation of data sources and restrictions to data mobility. Nevertheless, there is a common view that the issue of invasive alien species needs to be addressed. In 2017 we launched the Tracking Invasive Alien Species (TrIAS) project, which envisages a future where alien species data are rapidly mobilized, the spread of exotic species is regularly monitored, and potential impacts and risks are rapidly evaluated in support of policy decisions (Vanderhoeven et al. 2017). TrIAS is building a seamless, data-driven workflow, from raw data to policy support documentation. TrIAS brings together 21 different stakeholder organizations that covering all organisms in the terrestrial, freshwater and marine environments. These organizations also include those involved in citizen science, research and wildlife management. TrIAS is an Open Science project and all the software, data and documentation are being shared openly (Groom et al. 2018). This means that the workflow can be reused as a whole or in part, either after the project or in different countries. We hope to prove that rapid data workflows are not only an indispensable tool in the control of invasive species, but also for integrating and motivating the citizens and organizations involved.

Belgian guidelines for non-occupational HIV post-exposure prophylaxis 2017

ABSTRACTWe present the updated Belgian guidelines for the use of non-occupational HIV post-exposure prophylaxis (NONOPEP). This document is inspired by UK guidelines 2015, adapted to the Belgian situation and approved by all AIDS reference centers in Belgium. When recommended, NONOPEP should be initiated as soon as possible, preferably within 24 h of exposure but can be offered up to 72 h. The duration of NONOPEP should be 28 days. These current guidelines include epidemiologic estimations, which can be used to calculate the risk of infection after a potential exposure and help to decide whether or not to start prophylaxis. We review which medications to use in the context of the last Belgian NONOPEP convention, provide a checklist for initial assessment, and make recommendations for monitoring individuals receiving NONOPEP.

Alzheimer's disease and driving: review of the literature and consensus guideline from Belgian dementia experts and the Belgian road safety institute endorsed by the Belgian Medical Association.

Alzheimer's disease (AD) is a highly prevalent condition and its prevalence is expected to further increase due to the aging of the general population. It is obvious that the diagnosis of AD has implications for driving. Finally, driving discussions are also emotionally charged because driving is associated with independence and personal identity. However, it is not clear how to implement this in clinical practice and the Belgian law on driving is rather vague in its referral to neurodegenerative brain diseases in general nor does it provide clear-cut instructions for dementia or AD compared to for example driving for patients with epilepsy and as such does not prove to be very helpful. The present article reviews what is known from both literature and existing guidelines and proposes a consensus recommendation tailored to the Belgian situation agreed by both AD experts and the Belgian Road Safety Institute endorsed by the Belgian Medical Association. It is concluded that the decision about driving fitness should be considered as a dynamic process where the driving fitness is assessed and discussed early after diagnosis and closely monitored by the treating physician. The diagnosis of AD on itself definitely does not imply the immediate and full revocation of a driving license nor does it implicate a necessary referral for a formal on-road driving assessment. There is no evidence to recommend a reduced exposure or a mandatory co-pilot. A MMSE-based framework to trichotomise AD patients as safe, indeterminate or unsafe is presented. The final decision on driving fitness can only be made after careful history taking and clinical examination, neuropsychological, functional and behavioral evaluation and, only for selected cases, a formal assessment of driving performance.

The Meaning of Pilgrimage (Hajj): Re-shaping the Pious Identity of Belgian Turkish Muslims

ABSTRACTThis article examines how Belgian Muslims of Turkish origin interact with the hajj (pilgrimage) and the meaning of the pilgrimage for Muslims living in Belgium. It focuses upon the space of pilgrimage rituals, identifies the motivations for the practice of the pilgrimage and attempts to explain how the ‘canonical meaning’ of the hajj, which is considered unchanging, is adopted in the new Belgian situation and how pilgrims regard it. The physical practice of pilgrimage constitutes an interesting area through which to depict how Belgian Muslims of Turkish origin experience the sacred journey that shapes their religious understanding and their identity. The article’s findings are based on interviews and observations in 2012 and 2014. The author visited mosques during hajj information sessions and spoke with imams, but the fieldwork was carried out among pilgrims who had visited Mecca for their hajj and ʿumra..

An experience in training international health professionals in people-centred care: the imperative of bridging health and social perspectives

Introduction/Problem statement: Providing quality health care remains a challenge in many low and middle-income countries. The challenges are two-fold: quality of care is often narrowly defined in biomedical terms or technical effectiveness and, health care delivery systems are fragmented in poorly connected subsystems such as preventive and curative care, primary care and disease control programs, health and social care. Additionally, health care providers, health managers and policy makers are mostly trained within a biomedical health framework and often lack experience with people-centred and integrated care.Description /Aim of the intervention: The Institute of Tropical Medicine in Antwerp, Belgium, attempts to address this training gap in its international one-year Master in Public Health programme (1). Every year about forty experienced health professionals from Africa, Asia, Latin America and Europe are taught concepts and models pertaining to the analysis, planning, organization and evaluation of local health systems and their interactions with social services in the four-week course component on “Local Health Systems”. This course endorses people-centred and integrated health and social care as cornerstones of quality health care and aims to enable its participants to understand the strengths and weaknesses of dominant biomedical paradigms and to develop a more holistic vision on health care. Students are expected to use comprehensive models for the analysis of (local) health systems and the organization of health services.To reach these learning outcomes the course uses methods for adult learning that emphasize a participatory approach. The diversity of the participants, in terms of professional experience and academic background, constitutes a unique and rich opportunity for meaningful exchanges and experiential learning. The concepts and models on people-centred and integrated health and social care are taught through different learning activities such as interactive lectures, critical reading of scientific papers and real life case studies introduced by a Belgian general practitioner. In parallel, students are coached in a personal assignment in which they analyse the quality of health care in a local health system in their own or a known context. In this application participants are expected to gain further insights and develop a set of analytical skills from the exchange with their peers, coaches and lecturers.Beyond classroom learning, participants are also given the chance to observe the process of people-centred care in first-line health services and to interview key stakeholders such as doctors, nurses, social workers and psychologists in various Belgian municipalities. This study visit also includes the Public Centres of Social Welfare and other frontline social services. The objective of the visit is to illustrate the complementarity of the health and social sub-sectors in ensuring global and integrated health care. Participants are made aware of the need to go beyond exclusive biomedical answers to adequately address the problems people present with at general practice level.The participants are assessed in several activities: first, they present and discuss their personal analysis of a known local health system with peers and staff; after the study visits they share their analysis of the quality of care and the contribution of the social welfare system to people-centred health system; and finally the participants identify lessons from the Belgian situation that are relevant to their own local health systems and share these reflections in individual blogs. The presentations in the seminars and the blog writing exercise facilitate meaningful interactions amongst participants whilst enhancing their communication skills.Findings/Highlights: Following the training, most participants understand the comprehensive and systemic characteristics of people-centred and integrated health care; as well as the importance of including the social sector when organizing health services at local level. Interesting statements obtained from feedback sessions and blogs are: _“ I experienced a shift in the way I think about the organization of health services to provide quality health care”_,“From the site visit […] I think there are four important elements that promote PCC (people-centred care): sufficient time, qualified personnel, privacy and looking beyond the bio-medical aspects (e.g. social security issues and system barriers) of a patient’s suffering ….”Conclusions: Adequate public health training that broadens the vision on quality of care and allows the development of comprehensive analytical skills can contribute reducing barriers to implementing people-centred and integrated health care. Although the findings obtained during this course are useful, more research is required to define the most desirable skills mix that public health professionals and caregivers should possess.

Reference centres for adults with rare and complex cancers – Policy recommendations to improve the organisation of care in Belgium

BackgroundRare and/or complex cancers call for a very specific expertise and adequate infrastructure. In Belgium, every hospital with a programme in oncology can deliver care for adults with rare and/or complex cancer types, without having demonstrated a specific know-how to adequately manage these patients. Therefore, the Minister of Health ordered a scenario for the organisation of care for adults with rare and/or complex cancers, taking into account the current Belgian situation and relevant foreign experience. MethodsCombined methods were used in this study: a literature review, the consultation of stakeholders, in depth discussions in 14 multidisciplinary groups leading to concrete proposals for several rare/complex cancers and the consultation of a panel of expert pathologists. ResultsThe core recommendation is the set-up of shared care networks around reference centres, with multidisciplinary teams of recognised expertise in specific rare/complex cancers. The definition of minimum caseloads for hospitals and medical specialists, the evaluation of the quality of care, a model of diagnostic confirmation and the set-up of a national portal website which provides information on rare and/or complex cancers and reference centres are highly recommended. ConclusionIt is no longer practicable, efficient or ethical that every hospital or every practitioner continues to offer care for every rare/complex cancer. Improving the quality of rare/complex cancer care requires to concentrate expertise and sophisticated infrastructure in reference centres. Furthermore, the formation of networks between reference centres and peripheral centres will allow a delivery of care combining expertise and proximity. The next step is the translation of the recommendations into policy decisions. It is very well realised that this will take some courage and that a certain degree of resistance will have to be surmounted, but eventually, the best interest of the patient should prevail.