Cochlear implants in Belgium: Prevalence in paediatric and adult cochlear implantation.

OBJECTIVES: Belgium, and especially the northern region called Flanders, has been a centre of expertise in cochlear implants and early hearing screening for many years. Cochlear implants are reimbursed by the Belgian National Institute for Health and Disability (BNIHD) Insurance in adults and in children since October 1994. More than 20 years later, we would like to measure the prevalence of cochlear implants in adults and in children till now. MATERIALS AND METHODS: Based on scientific research data on the prevalence of severe to profound hearing loss in adults and in children and on the number of implantations from the data of the BNIHD, we could measure the percentages of paediatric and adult CI users in comparing to the number of CI candidates. RESULTS: The degree of utilisation of cochlear implantation varies considerably between the paediatric and the adult population. On average, 78% of deaf children are receiving cochlear implants, but in adults only 6.6% of CI candidates are receiving one. CONCLUSION: There are big differences in Belgium in utilisation of cochlear implants between adults and children. Because of the underutilisation of cochlear implants, especially in adults, we have to work on raising the general awareness of the benefits of cochlear implants, and its improvement in quality of life, based on cost-effectiveness data and on guidelines for good clinical practice.

Patient-Oriented SCORAD (PO-SCORAD): a new self-assessment scale in atopic dermatitis validated in Europe.

BACKGROUND: Patient-oriented medicine is an emerging concept, encouraged by the World Health Organization, to greater involvement of the patient in the management of chronic diseases. The Patient-Oriented SCORing Atopic Dermatitis (PO-SCORAD) index is a self-assessment score allowing the patient to comprehensively evaluate the actual course of atopic dermatitis (AD), using subjective and objective criteria derived mainly from the SCORAD, a validated AD severity clinical assessment tool. OBJECTIVES: To validate the PO-SCORAD index in a large European population of patients exhibiting all forms of AD severity by assessing its correlation with the SCORAD index. PATIENTS/METHODS: Four hundred and seventy-one patients (185 adults, 286 children) consulting for AD in hospitals from 9 European countries were recruited. The investigators and the patients used the SCORAD and PO-SCORAD scales, respectively, to assess AD severity at inclusion (D0) and 28 ± 7 days later (D28). RESULTS: Patient-Oriented SCORing Atopic Dermatitis and SCORAD scores were significantly correlated at D0 [r = 0.67 (95% CI: 0.62; 0.72), P < 0.0001]. Consistency was confirmed at D28, with a stronger linear correlation between both scales [r = 0.79 (95% CI: 0.75; 0.83), P < 0.0001]. Absolute changes from baseline in SCORAD and PO-SCORAD scores were also significantly correlated [r= 0.71 (95% CI: 0.64; 0.76), P < 0.0001]. Although no specific intervention was investigated, AD improved over the study, with a decrease of PO-SCORAD and SCORAD scores from D0 to D28 by -19.19% and -24.39%, respectively. The consistency of the correlations was similar in the adult and children groups. CONCLUSIONS: This study validated the use of PO-SCORAD to self-assess AD severity and demonstrated its good correlation with SCORAD.