Feelings about the timing of first sexual intercourse and health-related quality of life among adolescents.

BACKGROUND: Early sexual intercourse (SI) may have long-lasting negative impacts on health-related quality of life (HRQoL). So far, these impacts have been studied using age for defining early SI instead of feelings about its timing. The present study examined the association between feelings about the timing of first SI and current HRQoL. METHODS: Data came from the 2014 cross-sectional Health Behaviour in School-aged Children (HBSC) study in French-speaking Belgium. Among participants aged 16-20 years who already had SI, 1778 were included in analyses. Univariate and multivariate logistic regressions were performed, including potential confounders. RESULTS: One quarter of adolescents (26.4%) had poor HRQoL, 19.8% expressed a negative feeling about the timing of first SI and 19.6% did not think about it. Compared with adolescents who thought first SI happened at the right time or wished it had happened sooner, adolescents who had a negative feeling about the timing and those who did not think about it were more likely to have a poor HRQoL (cOR = 1.67 (1.28-2.17) and cOR = 1.37 (1.05-1.80), respectively). After adjustment, associations were no more significant (aOR = 1.22 (0.91-1.63) and aOR = 1.22 (0.91-1.64)). Sex disparity in expressing a negative feeling mostly explained the difference between crude and adjusted analyses. CONCLUSION: Further research is needed to better understand such a complex relationship. The high proportion of adolescents having poor HRQoL and negative feeling about the timing of first SI shows how important it is to find out effective prevention for both domains.

Evaluation of compliance with isotretinoin PPP recommendations and exploration of reasons for non-compliance: Survey among French-speaking health care professionals and patients in Belgium.

PURPOSE: To evaluate awareness of and compliance in Belgium by French-speaking health care professionals and patients with the isotretinoin safety recommendations regarding its teratogenic risk. METHOD: Survey using online questionnaires, delivered from December 2014 to March 2015 for patients, pharmacists, dermatologists, and GPs and delivered again from September 2015 to October 2015 for GPs. RESULTS: Questionnaires were completed by 24 dermatologists, 24 GPs, 58 pharmacists, and 33 female patients. The pregnancy prevention programme was poorly known by health care professionals (23.6%) and patients (15.2%). Health care professionals informed women of childbearing age in depth about the teratogenic risk (98.3% of pharmacists and 100.0% of GPs and dermatologists) and the importance of an effective contraceptive method (87.9% and 100.0%, respectively). Patients were less informed about the pregnancy test (25.9% and 14.6%) and the need to use a second contraceptive method (29.3% and 27.1%). The low compliance with the last 2 recommendations was due to a lack of adoption by health care professionals regarding the need for these recommendations if female patients have an effective contraceptive method and the pregnancy risk is discussed in detail with them. CONCLUSION: The effectiveness of the pregnancy prevention programme recommendations should be reconsidered by an expert committee. Justifications should be added to effective recommendations to increase their adoption by health care professionals and patients.

Improving early audiological intervention via newborn hearing screening in Belgium.

BACKGROUND: Newborn hearing screening programs aim to lower the ages at audiological intervention among hearing-impaired children. In Wallonia and Brussels (Belgium), audiological intervention data are not collected in the screening program, and the ages at initiating audiological care have never been assessed. This study aimed to assess the evolution in the ages at initiating audiological intervention in the context of a newborn hearing screening program implementation. METHODS: This population-based descriptive study used data from the Belgian healthcare billing database. The main outcomes were the children's ages at the initial audiological assessment, hearing-aid fitting, and cochlear implantation. Results were compared to the same outcomes from another Belgian regional program (Flanders) that was implemented one decade earlier. Annual birth cohorts from 2006 to 2011 were included in the study. RESULTS: In Wallonia-Brussels, the median ages for all outcomes tended to decrease over time but remained higher than in Flanders for each birth cohort. For all outcomes except the hearing-aid fitting, differences in median ages between the two regions became less pronounced during the study period. In 2006, < 23% of the children from Wallonia-Brussels received any audiological care before the age of 12 months and these proportions were approximately 2-fold greater in the subsequent birth cohorts. For all outcomes, early care (< 12 months) was typically delivered less frequently in Wallonia-Brussels, compared to the delivery in Flanders. These region-specific differences exhibited a decreasing trend over time, and statistically significant differences were less common in the later birth cohorts. CONCLUSIONS: We conclude that the hearing screening program in Wallonia and Brussels promoted earlier audiological intervention among hearing-impaired children. However, milestones recommended by experts for an early intervention were not totally encountered. We also recommend collecting audiological intervention data as part of this program, which can facilitate more accurate and regular program evaluation.

Intensive Enteral Nutrition Is Ineffective for Patients With Severe Alcoholic Hepatitis Treated With Corticosteroids.

BACKGROUND & AIMS: Severe alcoholic hepatitis (AH) is a life-threatening disease for which adequate oral nutritional support is recommended. We performed a randomized controlled trial to determine whether the combination of corticosteroid and intensive enteral nutrition therapy is more effective than corticosteroid therapy alone in patients with severe AH. METHODS: We enrolled 136 heavy consumers of alcohol (age, 18-75 y) with recent onset of jaundice and biopsy-proven severe AH in our study, performed at 18 hospitals in Belgium and 2 in France, from February 2010 through February 2013. Subjects were assigned randomly (1:1) to groups that received either intensive enteral nutrition plus methylprednisolone or conventional nutrition plus methylprednisolone (controls). In the intensive enteral nutrition group, enteral nutrition was given via feeding tube for 14 days. The primary end point was patient survival for 6 months. RESULTS: In an intention-to-treat analysis, we found no significant difference between groups in 6-month cumulative mortality: 44.4% of patients died in the intensive enteral nutrition group (95% confidence interval [CI], 32.2%-55.9%) and 52.1% of controls died (95% CI, 39.4%-63.4%) (P = .406). The enteral feeding tube was withdrawn prematurely from 48.5% of patients, and serious adverse events considered to be related to enteral nutrition occurred in 5 patients. Regardless of group, a greater proportion of patients with a daily calorie intake less than 21.5 kcal/kg/day died (65.8%; 95% CI, 48.8-78.4) than patients with a higher intake of calories (33.1%; 95% CI, 23.1%-43.4%) (P < .001). CONCLUSIONS: In a randomized trial of patients with severe AH treated with corticosteroids, we found that intensive enteral nutrition was difficult to implement and did not increase survival. However, low daily energy intake was associated with greater mortality, so adequate nutritional intake should be a main goal for treatment. ClinicalTrials.gov number: NCT01801332.

Organisation of newborn hearing screening programmes in the European Union: widely implemented, differently performed.

BACKGROUND: Implementation of newborn hearing screening programmes is widely recommended and programme organisational designs may differ in practice. The objective of this article was to establish an overview of the newborn hearing screening programmes in the 28 countries of the European Union on four topics (policy-decision, financing, general designs, organisational features). METHODS: National or regional programme coordinators completed an online self-administered questionnaire focusing on protocol description and programme organisation. RESULTS: Thirty-nine key informants, representing 24 countries, from national or regional levels completed the questionnaire. Newborn hearing screening programmes are or will be shortly implemented largely in the European Union countries. Levels of policy decision-making and organisational decisions are diverse (national, regional or combined). Designs of the programmes (number of steps before diagnosis referral, single or dual target group protocol) highly varied. However, common organisational elements were observed: hearing screening tests are often performed by nursing staff, in hospitals and early in life. This pattern does not apply when a screening protocol is specifically implemented for newborns with risk factor(s) for hearing impairment or admitted to neonatal intensive care units. Hearing test financing frequently involved public sources, including government and public health funds. CONCLUSION: Despite the same goal of early identification of hearing-impaired children, there is a high level of diversity in programmes, including policy decisions, financing, general designs and pragmatic organisational choices (e.g. professionals involved, location or time for screening, number of steps in the protocol). Further investigations should analyse these differences in relation to the programmes' contexts and outcomes.

Newborn hearing screening programme in Belgium: a consensus recommendation on risk factors.

BACKGROUND: Understanding the risk factors for hearing loss is essential for designing the Belgian newborn hearing screening programme. Accordingly, they needed to be updated in accordance with current scientific knowledge. This study aimed to update the recommendations for the clinical management and follow-up of newborns with neonatal risk factors of hearing loss for the newborn screening programme in Belgium. METHODS: A literature review was performed, and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system assessment method was used to determine the level of evidence quality and strength of the recommendation for each risk factor. The state of scientific knowledge, levels of evidence quality, and graded recommendations were subsequently assessed using a three-round Delphi consensus process (two online questionnaires and one face-to-face meeting). RESULTS: Congenital infections (i.e., cytomegalovirus, toxoplasmosis, and syphilis), a family history of hearing loss, consanguinity in (grand)parents, malformation syndromes, and foetal alcohol syndrome presented a 'high' level of evidence quality as neonatal risk factors for hearing loss. Because of the sensitivity of auditory function to bilirubin toxicity, hyperbilirubinaemia was assessed at a 'moderate' level of evidence quality. In contrast, a very low birth weight, low Apgar score, and hospitalisation in the neonatal intensive care unit ranged from 'very low' to 'low' levels, and ototoxic drugs were evidenced as 'very low'. Possible explanations for these 'very low' and 'low' levels include the improved management of these health conditions or treatments, and methodological weaknesses such as confounding effects, which make it difficult to conclude on individual risk factors. In the recommendation statements, the experts emphasised avoiding unidentified neonatal hearing loss and opted to include risk factors for hearing loss even in cases with weak evidence. The panel also highlighted the cumulative effect of risk factors for hearing loss. CONCLUSIONS: We revised the recommendations for the clinical management and follow-up of newborns exhibiting neonatal risk factors for hearing loss on the basis of the aforementioned evidence-based approach and clinical experience from experts. The next step is the implementation of these findings in the Belgian screening programme.

Fluid intake survey among schoolchildren in Belgium.

BACKGROUND: In childhood, inadequate fluid intakes can lead on the short term, to reduced physical and cognitive performances. However, few data are available on the fluid intake among schoolchildren in Belgium. The main aim of this study is to evaluate total fluid intake provided by different types of beverages in a sample of Belgian schoolchildren, in order to assess the percentage of individuals complying with the European Food Safety Authority recommendations for total fluid intake. A secondary aim was to characterize the study population in terms of determinants of the total fluid intake requirements. METHODS: A child friendly "fluids and liquid food" diary was used to prospectively record the volume and frequency of beverage consumption over 7 days from 1045 schoolchildren. This diary also recorded the practice of physical activity. An adequate fluid intake was defined as an intake ≥ 75% of the age-specific adequate intake recommended by the EFSA. RESULTS: The median (P25-P75) of habitual daily fluid intake was 864 (608-1104) ml/day, with 355 (194-579) coming from drinking water. This habitual daily fluid intake varied significantly among the three investigated EFSA groups (girls and boys aged from 8 years, girls from 9 to 13 and boys from 9 to 13), except for the drinking water (P = 0.906). The highest medians of fruit juice, sugar-sweetened beverages and milk and derivatives were found among boys of 9-13. Only 9.5% of the children had an adequate fluid intake, with a value of 19.2% among the 8 years old girls and boys, 7.0% among girls of 9-13 and 8.4% among boys of 9-13. In the whole sample, 27.7% of the children declared to drink less than 3-4x/day, 56% drunk water less than 2x/day and 7.7% drunk no water at all. Every day, 27.1% and 34.1% of the children drank respectively one fruit juice and one sugar-sweetened beverage. CONCLUSION: Belgian schoolchildren have an inadequate total fluid intake. Given the potential health consequences, interventions involving parents and school environment to promote water consumption seem pertinent.

Assessment of medication adherence and responsible use of isotretinoin and contraception through Belgian community pharmacies by using pharmacy refill data.

PURPOSE: The aims of the study were to evaluate medication adherence and the influencing factors for isotretinoin and contraception (oral, patches, and rings) and to evaluate the concomitant use of contraception and isotretinoin. METHODS: Reimbursed prescription data from January 2012 to August 2015 of all patients in Belgium were received from Pharmanet-National Institute for Health and Disability Insurance. Medication adherence was measured according to the medication possession ratio. The influence of gender and age was analyzed using the Mann-Whitney test and the Spearman coefficient correlation. The independence between adherence to contraception and adherence to isotretinoin was analyzed using the Pearson chi-square test of independence. Persistence was defined as the number of days between initiation and presumed end of treatment. The Kaplan-Meier method was used to plot the medication persistence curves, and the log-rank test was used to compare the curves. The concomitant use of contraception and isotretinoin was analyzed using descriptive statistics. RESULTS: The medication possession ratio was ≥0.8 for 46.1% of patients receiving isotretinoin and for 74.0% of women using contraception. For isotretinoin, this percentage decreased as the number of attempts increased (29.8% for the second attempt and 19.8% for more than two attempts). Men seemed more adherent than women, and a weak negative correlation between adherence and age was observed. The adherence data of isotretinoin and contraception were independent. The median persistence for isotretinoin treatment was 139 days (interquartile range 71-209) and was higher for men. Among women between 12 and 21 years old taking isotretinoin, 63.8% received at least one contraceptive prescription. However, 15.7% of women taking isotretinoin adhered to the use of contraception 1 month before, during, and 1 month after treatment. CONCLUSION: Medication adherence to isotretinoin and contraception and compliance with the isotretinoin safety recommendation could be improved. Health service interventions, using pharmacy refill data, should be delivered to ensure patient safety and strict adherence to contraception when under isotretinoin treatment.

Hyperarousal during sleep in untreated, major depressed subjects with prodromal insomnia: A polysomnographic study.

In primary insomnia, specific dynamics of hyperarousal are evident during the night. Similarly, in major depression, many elements also favor of the presence of hyperarousal. Thus, it would be interesting to investigate if hyperarousal presents the same dynamic in major depression. Polysomnographic data from 30 healthy controls, 66 patients with major depression and prodromal insomnia, and 86 primary insomnia sufferers recruited from the sleep laboratory database were studied for whole night and thirds of the night. Insomnia sufferers and patients with depression exhibit a similar polysomnographic pattern both for whole night (increased sleep latency and WASO and reduced SWS and REM) and thirds of night (increased WASO at first and last thirds, reduced SWS in first third, and reduced in REM in first and last third). No alterations were detected during the second third of the night. Just as in primary insomnia, the hyperarousal phenomenon is found mainly in major depression with prodromal insomnia during the sleep-onset period and the first and last thirds of the night, but lesser during the second third of the night. These specific dynamics of hyperarousal may aid in the understanding of the particular relationship between insomnia and depression.

Hyperarousal during sleep in untreated primary insomnia sufferers: A polysomnographic study.

Because some evidence favors the hyperarousal model of insomnia, we sought to learn more about the dynamics of this phenomenon during sleep. Polysomnographic data from 30 normative subjects and 86 untreated primary insomnia sufferers recruited from the database of the sleep laboratory were studied for whole nights and in terms of thirds of the night. Untreated primary insomnia sufferers had an increased sleep latency and excess of WASO, together with a deficit in REM and NREM sleep during the entire night. In terms of thirds of the night, they presented a major excess of WASO during the first and last thirds of the night but an excess of lesser importance during the middle third. A deficit in SWS was found during the first third of the night, but for REM, the deficit was present during both the first and last thirds. Primary insomnia sufferers had no SWS or REM deficit during the second third of the night. We found that the hyperarousal phenomenon occurs mainly during the sleep-onset period of the first and last thirds of the night and is less important during the middle third. These results open new avenues for understanding the pathophysiology of primary insomnia.

Are life-saving anticancer drugs reaching all patients? Patterns and discrepancies of trastuzumab use in the European Union and the USA.

BACKGROUND: The development of trastuzumab is considered to be one of the greatest improvements in breast cancer treatment in recent years. This study aims to evaluate changes in the uptake of trastuzumab over the last 12 years and to determine whether its use is proportional to patient needs in the European Union and the USA. METHODS: Using national registry data, the number of new cases of HER2-positive breast cancer patients per year was estimated. The number of likely trastuzumab treatments per year was estimated using trastuzumab procurement data for each country. RESULTS: Western Europe and the USA show increasing procurement level of trastuzumab over the years studied, reaching proportional of use of trastuzumab few years after its marketing authorization in the early 2000's. After the approval in the adjuvant setting, in the year 2006, it was observed underuse of trastuzumab given the increase of the number of patients in need of treatment. Proportional use was shortly met after a couple of years. Few countries in Eastern Europe acquired the needed quantity of trastuzumab, with procurement levels starting to increase only after approval in the adjuvant setting in 2006. CONCLUSION: Significant differences in trastuzumab procurement are observed between Western Europe, the USA and Eastern Europe, with the latter geographic region acquiring insufficient amounts of the drug required to treat all patients in need.

Pilot study of risk factors associated with cardiovascular disease in northern and southern Cameroonians.

AIM: The aim of the study was to evaluate whether the risk factors for cardiovascular disease (CVD) are similar in the northern and southern regions of Cameroon. METHODS: The participants answered a questionnaire concerning their lifestyle. Anthropometric and blood pressure measurements were evaluated in 192 individuals and biochemical parameters in 50 randomly selected volunteers. RESULTS: Northerners displayed low alcohol and tobacco consumption, little practice of sport but physically demanding professions, and consumption of soybean, refined palm and other polyunsaturated oils. Southerners consumed alcohol, practiced sport, had intellectually based professions, and consumed crude and refined palm oils. Waist circumference and body mass index were higher in the southerners compared to the northerners. Blood glucose levels, and systolic and diastolic blood pressures were higher among the northerners than the southerners. Among the southerners, there were positive correlations between total cholesterol levels and systolic or diastolic blood pressure, low-density lipoprotein cholesterol and blood glucose levels or diastolic blood pressure, triglyceride levels and systolic blood pressure. CONCLUSION: Providing region-adapted, health-related advice for northern and southern Cameroonians would contribute to reducing risk factors for CVD.

Does the presence of siblings affect the results produced by a surveillance system of child mistreatment? Comparisons of several commonly-used statistical methods.

BACKGROUND: Over time, the circumstances encountered in case of child mistreatment, can be quite complex and then, can lead to methodological questions for the analysis of the data. Based on data coming from 395 children hospitalized, alone (66.1 %) or in siblings (33.9 %), in a pediatric ward between 2007 and 2012 for mistreatment or because of a severe risk of mistreatment, the aims of this paper were to quantify the degree of similarity between sibling members, to study the differences between children hospitalized alone or with siblings and to compare four statistical methods (logistic regression and GEE, both without and with robust standard error) for the analyses of the associated factors of mistreatment. RESULTS: Almost all intracluster correlation coefficients were large, meaning that the sibling's members have a higher degree of similarity between them. The odds ratios were not exactly the same between the two models and the robust standard errors where almost always higher than the model-based standard errors in both logistic and GEE models leading to wider confidence intervals. CONCLUSION: Because many of the intra-siblings correlations observed were relatively strong, the failure to take this cluster dependency into account had a substantial effect on the statistical analyses. Methods taking into account the cluster dependency are widely available in statistical software and strongly recommended.

[Cost evaluation of hospital inpatient stays induced by injuries due to falls for elderly people]. / Évaluation économique des lésions associées aux chutes des personnes âgées vivant à domicile.

Thirty percent of people aged 65 and older, living at home fall at least once a year. Few economic data are available in Belgium on this issue. We evaluated the cost borne by social security. 823 inpatient stays aged 65 and more, from home and admitted for injuries after a fall were selected. We observe an average (SD) age of 81 years. The proportion of women is 76%. 75% of admissions are related to fractures. 18% of patients are 'institutionalized' after falls. The death rate is 6%. The median (Q1-Q3) of cost is € 4.182 (2.385-6.820), for a length of stay median (Q1-Q3) of 11 days (4-25). The cost of hospital stays is estimated at €135 millions. Based on population projections, the cost could be estimated at € 243 millions in 2050. The overall cost of the treatment of these lesions is much more important, because costs are also generated after the hospitalization.

Epidemiology of injuries in Belgium: contribution of hospital data for surveillance.

OBJECTIVES: Investigating injuries in terms of occurrences and patient and hospital stay characteristics. METHODS: 17370 stays, with at least one E code, were investigated based on data from 13 Belgian hospitals. Pearson's chi-square and Kruskal-Wallis tests were used to assess the variations between distributions of the investigated factors according to the injury's types. RESULTS: Major injuries were accidental falls, transport injuries, and self-inflicted injuries. There were more men in the transport injuries group and the accidental falls group was older. For the transport injuries, there were more arrivals with the support of a mobile intensive care unit and/or a paramedic intervention team and a general practitioner was more implicated for the accidental falls. In three-quarters of cases, it was a primary diagnostic related to injury and poisoning which was made. The median length of stay was nearly equal to one week and for accidental falls, this value is three times higher. The median cost, from the social security point of view, for all injuries was equal to € 1377 and there was a higher median cost within the falls group. CONCLUSION: This study based on hospitals data provides important information both on factors associated with and on hospital costs generated by injuries.