Physician's involvement in the smoking cessation process of their patients. Results of a 1998 survey among 4,643 Belgian physicians.

This report relates to the 1,667 responses to a selfadministered mail-back questionnaire sent by BELTA to a sample of 4,643 physicians (17.3% current smokers) who are in professional contact with patients (response rate: 35.9%). Links between active smoking and disease are considered as well-demonstrated by 98.8% physicians and for passive smoking by 85.3%, for foetal consequences of smoking during pregnancy by 96.4%. Nicotine dependence is admitted by 83.3%. Interaction of smoking with drug metabolism is insufficiently known. Modulation of the specific approach of smoking cessation, according to the various stages of the cessation cycle, to the level of nicotine dependence and to the psychological status of the smoker is not sufficiently perceived by the physicians. Patient's smoking status is systematically determined by less than half the physicians, of whom nearly 90% claim to inform their smoking patients on smoking-related risks, and 84.2% to tackle the problem of cessation. The intervention is mostly limited to a firm advice, completed by nicotine replacement for a maximum of 50% of smokers (especially gum and patch). Referral to specialized structures is unfrequent (between 10 and 20%). Follow up after cessation is clearly deficient. In this retrospective study of their activity patterns, physicians' reports may reflect their intentions rather than their actual practices. We conclude that smoking issues and cessation techniques should be more intensively taught both at graduate and postgraduate levels, in order to obtain a more active behaviour of health professionals against smoking.

Tuberculosis in asylum seekers in Belgium. VRGT (Flemish Lung and Tuberculosis Association).

Countries with a low incidence of tuberculosis have recently been faced with the problem of tuberculosis (TB) in asylum seekers from countries with a high TB prevalence. We report on the tuberculosis case notification rate (TBCNR) in Belgium in 1993, and on the results of active screening in a group of asylum seekers. The TBCNR in Belgium in 1993 increased slightly to 14.9 per 100,000, mainly due to the nonindigenous population. The highest TBCNR (312 per 100,000) was reported among the 26,882 asylum seekers staying in Belgium in 1993. Of all new asylum seekers admitted in 1993, 4,794 agreed to undergo radiographic screening for TB at entry, of whom 123 had a chest radiograph which was suspect. Among the 123, 67 could be further investigated, and, of these, 19 cases (28%) of active TB were detected; this represents a TBCNR of 396 per 100,000 when referred to the 4,794 asylum seekers screened. In addition, 56 asylum seekers with suspect chest radiograph were lost to further investigation. From the present results it appears that: 1) in Belgium, asylum seekers constitute an important risk group for TB, with a TBCNR after screening which is approximately 30 times that in the indigenous population; and 2) there is a deficient follow-up after first screening, generating the risk of transmission of TB within the community. Our recommendations are, therefore, that in all asylum seekers screening for tuberculosis should be mandatory and follow-up of active tuberculosis should be regulated.

Prevention of transmission of tuberculosis in hospitals; a survey of practices in Belgium, 1995.

In July 1995, a questionnaire survey was made of nosocomial tuberculosis (TB) prevention practices in Belgian hospitals. Of 122 respondents (response rate: 64%), 93% had hospitalized at least one TB patient, and 11% at least one multi-resistant TB case, during 1994. Effective prevention measures were not uniformly applied: only 96% isolated contagious TB patients, and only 84% isolated patients suspected of contagious T.B. In six hospitals, TB patients and those with human immunodeficiency virus (HIV) were mixed. Wearing of masks by personnel entering a TB patient's room was routine in 96%, but in only 24% of these was the mask adequate for filtering 1 micron particles. Moreover, some centres made use of seemingly unnecessary measures, for example routine use of disposable crockery (50%) and enhanced room cleaning (66%). Expensive prevention measures were rarely applied: UV lamps in 12%; HEPA filters in air conditioning in 2%. Tuberculin skin testing at some stage of employment, was routinely performed by 82% of respondents, but varied according to the type of personnel: doctors and temporary staff were significantly under-assessed. Lowest conversion rates among staff were observed in hospital with the least TB admissions but high rates were observed in hospitals of all sizes. The risk of acquiring TB in Belgian hospitals exists and precautions taken to prevent transmission are not sufficient. The situation could be improved by following national guidelines and a general adoption of proven effective practices, and by abandoning expensive and ineffective measures.

Second primary lung cancer in Flanders: frequency, clinical presentation, treatment and prognosis.

Patient and tumour characteristics of 23 patients presenting with a second primary lung cancer were analysed and compared with 534 patients with radically resected stage 1 non-small cell lung cancer (NSCLC). None of these characteristics is associated with a higher occurrence rate for second primary lung cancer. Prognosis in the latter patients is significantly worse than after resection of a 'solitary' NSCLC: the median survival time (MST) after resection of the first tumour is 50 months; after diagnosis of the second tumour only 14 months. Surgically retreated patients have a prognosis that is similar to that after resection of a 'solitary' NSCLC. No separate independent prognostic factors responsible for this survival difference could be isolated. Squamous histology and central location are associated with a longer recurrence free survival time. We conclude that the occurrence of a second primary lung cancer can not be predicted based on patient or tumour characteristics and that only surgical retreatment offers a chance of long survival in these patients.

[Tuberculosis: multidrug-resistance in Belgium in 1992 and 1993]. / Tuberculose: la multirésistance en Belgique en 1992 et 1993.

The "Belgian TB Multidrug Resistance Working Group" determined in collaboration with 28 laboratories carrying out antibiograms for mycobacteria, the prevalence and incidence of multidrug resistance in Belgium in 1992-1993. During this period, respectively 14 (1.1%) and 17 (1.3%) cases of multidrug resistance (i.e. resistance to at least isoniazid and rifampicin, according to the W.H.O. definition), were detected by these laboratories. Since 9 new cases of multidrug resistance were detected in 1992 and 10 in 1993, the incidence of multidrug resistance in Belgium can be estimated at 0.1 per 100.000 inhabitants. Among these 19 new cases, 2 are confirmed as primary resistance cases.