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Impact of substance type and patient characteristics on the choice of treatment setting for substance use disorder in Belgium
No full textBackground: Specialised addiction treatment centers (SAC) and general mental health centers (GMHC) both offer care to people with substance use disorders (SUD) in Belgium, but these sectors often operate in parallel, with little collaboration. This fragmented system may lead to inefficiencies, particularly in the treatment of individuals with dual diagnoses. Despite the recognized challenges, there is limited understanding of the factors that influence whether patients with SUD are treated in SAC or GMHC.
Objectives: This observational study has two main objectives: METHODS: The study used routinely collected data from treatment centers in Belgium from 2019 (Belgian Treatment Demand Indicator). Logistic regression evaluated the weight of drug use and sociodemographic variables for people entering treatment for SUD for the first time (n = 8322). A random forest algorithm was used to study all patients’ orientation toward both sectors, across all treatment episodes (n = 29,658).
Results: The study found that the primary substance significantly influences sector choice. Patients using illicit substances like cannabis, opiates, cocaine, and stimulants are 6-12 times more likely to be treated in an SAC than those using alcohol. Factors such as income source and referral source (e.g. self-referral, general practitioner, etc) also significantly impact patient orientation.
Conclusion: These findings highlight the need for better integration between SAC and GMHC to adequately address the complex needs of people with SUD, especially with dual diagnosis.</p
RESULTATS DE LA 8EME CAMPAGNE NATIONALE DE PROMOTION DE L'HYGIENE DES MAINS DANS LES HOPITAUX DU GRAND-DUCHE DU LUXEMBOURG
No full textPolicy brief: The need for a regional action plan for suicide prevention in Wallonia
No full textSuicide is a critical societal and public health concern, with far-reaching impacts on individuals and their loved ones, and society as a whole. Evidence from cross-sectional data of the Belgian Health and Well-being Cohort (BELHEALTH) shows 13% of people living in Wallonia reported having had suicide ideations in 2023. This requires urgent attention and the creation of a regional action plan for suicide prevention in Wallonia, focussing on evidence-based universal, selective and indicated suicide prevention.</p
Sample preparation methods for elemental analysis in electronic cigarette aerosols: a critical review
No full textIn the last decade, e-cigarettes have been marketed as a less harmful alternative to classical tobacco
smoking and are currently being used by millions of people. An e-cigarette consists of an e-liquid and
a heating device, generating an aerosol that the user can inhale. Recently, several studies have shown
that metals and metalloids, including As, Cd, and Pb, known carcinogens, were present in these aerosols.
To ensure the accuracy of dose-toxicity estimations, it is essential to have access to reliable and
reproducible methods for estimating the dose in question. Although more standardization
methodologies were introduced in the analysis of metal(loid)s from aerosols, a huge divergence in
sample preparation can be found in the literature. This work aimed to provide an overview of the sample
preparation methods used to quantify these metal(loid)s. Therefore, a literature search was conducted in
September 2024, that followed the PRISMA guidelines. Among the 48 articles selected, a wide variability
in sample preparation was observed, specifically variations in aerosol generation characteristics and
collection techniques. Despite the widespread use of methods as filters and impingers, many studies
failed to validate critical steps such as aerosol recovery, blank corrections, and the extent of matrix
effects. In addition, poor inorganic methodological practices were often applied, such as excessive use
of glass materials for aerosol collection or other sample preparation steps. Therefore, further
standardization of methodologies is urgently needed to improve the reliability of metal quantification in
e-cigarette aerosols, which could potentially enhance regulatory frameworks and facilitate the routine
analysis of e-cigarette emissions.</p
Residential tree canopy configuration and mortality in 6 million Swiss adults: a longitudinal study
No full textBackground
Residential exposure to trees has been associated with reduced mortality risks. We hypothesise that in addition to tree canopy cover, tree canopy configuration also plays a role in exposure–mortality relationships. As there is limited evidence on this hypothesis, especially longitudinal evidence, we performed a nationwide study to investigate the residential tree canopy configuration–mortality associations in the Swiss population.
Methods
In this longitudinal study, the tree canopy cover and configuration metrics within 500 m of individuals’ residences were quantified using high-resolution tree canopy data (1 × 1 m) from 2010 to 2019. We developed single-exposure and multi-exposure time-varying Cox regression models to estimate the associations between the different exposure metrics and natural-cause and cause-specific mortality in Swiss adults (aged from 20 years to 90 years). Mortality and census data were taken from the Swiss National Cohort (SNC). We estimated the hazard ratios (HRs) and corresponding 95% CIs per IQR increase in the metrics adjusting for personal sociodemographic and contextual covariates. We also explored the effect modification by tree canopy cover, PM10, air temperature, urbanisation level, age, sex, and area-based local socioeconomic position.
Findings
Our analyses included 6 215 073 individuals from the SNC between 2010 and 2019. In the fully adjusted single-exposure models, we observed protective associations between natural-cause mortality risk and tree canopy cover (IQR 12·4%, HR 0·979 [95% CI 0·975–0·983]) and configuration metrics describing the aggregation (6·3%, 0·831 [0·823–0·840]), and connectedness (2·9%, 0·946 [0·938–0·953]); and detrimental associations with two metrics describing the fragmentation (211 patches per 100 ha, 1·073 [1·066–1·080]) and shape complexity (1·9, 1·094 [1·089–1·100]) of patches. The associations were generally preserved with other common causes of death. According to the multi-exposure models, the HR (95% CI) for the combination of one IQR decrease in aggregation and one IQR increase in fragmentation and shape complexity was 1·366 (1·343–1·390). Analyses on modification effects suggested a stronger association in people living in areas with a higher level of tree canopy cover, PM10 concentration, air temperature, and urbanisation level.
Interpretation
Aggregated, connected, and less fragmented forested greenspaces might offer stronger health benefits than isolated, fragmented ones, but are difficult to implement in cities. Our study provided valuable insights into optimising forested greenspaces and highlighted future directions for the planning and management of urban forests towards healthy and green cities.</p
Directive Scientifique : Soutenant l'introduction du test HPV pour le dépistage du cancer du col de l'utérus en Belgique
No full textEn Belgique, 641 femmes ont été diagnostiquées avec un cancer du col de l’utérus invasif en 2022 (1) et 231 femmes sont décédées en raison d’un cancer du col de l’utérus (2). Le cancer du col de l’utérus est principalement dû à une infection par le papillomavirus humain (HPV) qui se transmet essentiellement lors de rapports sexuels. Il existe plus de 150 types de HPV dont une douzaine sont susceptibles d’être à l’origine d’un cancer du col de l’utérus et sont donc appelés HPV à haut risque. Les types de HPV à haut risque (HPV-HR) peuvent être détectés par un test de dépistage HPV à ADN ou à ARN. Le dépistage du cancer du col de l’utérus était menée, en Belgique, jusqu’à fin 2024 par la réalisation d’un examen cytologique tous les trois ans par frottis du col de l’utérus. Le test de dépistage HPV était remboursé uniquement en cas de résultat cytologique anormal.
En décembre 2022, la Conférence interministérielle Santé publique a décidé (conformément aux décisions antérieures de la CIM au cours de la législature précédente) de passer de l’examen cytologique au dépistage primaire du HPV pour le cancer du col de l’utérus (à partir de l’âge de 30 ans) (3). Cette décision se fonde sur des preuves scientifiques disponibles, allant du rapport 238 du KCE de 2015 (4) aux analyses très récentes menées par l’Organisation Mondiale de la Santé (OMS) (5, 6) et le Centre International de Recherche sur le Cancer (CIRC) (7).
En outre, aujourd’hui les adolescents (filles et garçons) sont vaccinés contre le papillomavirus humain dans le cadre de programmes de vaccination organisés par les entités fédérées. Les vaccins HPV sont, également, remboursés par l’INAMI en cas de vaccination de rattrapage chez les adolescents jusqu’à 19 ans.</p
Assessing particle count in electron microscopy measurements of nanomaterials to support regulatory guidance
No full textIn the European Union, nanomaterials are regulated through different pieces of sectoral legislation.This legislation often requires risk assessments and thus reliable characterization data, for whichregulatory guidance generally recommend electron microscopy. The guidance provides best practicesfor measurements but lacks requirements on how many particles to measure. Using transmissionelectron microscopy data of nanomaterials, a strategy based on repeated subsampling is proposedto establish, for different particle size and shape measurands, mathematical relationships betweenparticle count and precision, and subsequently to determine the minimum particle count. Our resultsconfirm that the minimum particle count generally depends on the width of the size and shapedistributions and that the median of the distribution can be determined with the highest precisioncompared to other percentiles. Upon combining the precision uncertainty related to particle numberwith uncertainties from other sources, such as sample preparation, calibration and trueness, wereach an optimal particle count above which additional particle measurements only yield negligibleimprovements to the combined measurement uncertainty. Our findings offer an experimentalapproach for determining the minimum particle count to measure particle size and shape by electronmicroscopy. It enables efficient analyses and facilitates compliance with legislation addressingnanomaterials across various application domains.</p