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Neurocysticercosis Prevalence and Characteristics in Communities of Sinda District in Zambia: A Cross-Sectional Study.
No full textBACKGROUND: This study aimed at describing the epidemiology of (neuro)cysticercosis as well as its clinical and radiological characteristics in a Taenia solium endemic district of Zambia.
METHODS: This was part of a cross-sectional community-based study conducted in Sinda district to evaluate an antibody-detecting T. solium point-of-care (TS POC) test for taeniosis and (neuro)cysticercosis. All TS POC cysticercosis positive (CC+) participants and a subset of the TS POC cysticercosis negative (CC-) received a clinical evaluation and cerebral computed tomography (CT) examination for neurocysticercosis (NCC) diagnosis and staging.
RESULTS: Of the 1249 participants with a valid TS POC test result, 177 (14%) were TS POC CC+ . Cysticercosis sero-prevalence was estimated to be 20.1% (95% confidence intervals [CI] 14.6-27.0%). In total, 233 participants received a CT examination (151 TS POC CC+ , 82 TS POC CC-). Typical NCC lesions were present in 35/151 (23%) TS POC CC+ , and in 10/82 (12%) TS POC CC- participants. NCC prevalence was 13.5% (95% CI 8.4-21.1%) in the study population and 38.0% (95% CI 5.2-87.4%) among people reporting epileptic seizures. Participants with NCC were more likely to experience epileptic seizures (OR = 3.98, 95% CI 1.34-11.78, p = 0.01) than those without NCC, although only 7/45 (16%) people with NCC ever experienced epileptic seizures. The number of lesions did not differ by TS POC CC status (median: 3 [IQR 1-6] versus 2.5 [IQR 1-5.3], p = 0.64). Eight (23%) of the 35 TS POC CC+ participants with NCC had active stage lesions; in contrast none of the TS POC CC- participants was diagnosed with active NCC.
CONCLUSION: NCC is common in communities in the Eastern province of Zambia, but a large proportion of people remain asymptomatic.</p
Exploring anxiety and depression trends: insights from the BELHEALTH cohort 2022-2024 in Belgium
No full textBackground: The swift impact of the COVID-19 pandemic and ensuing restrictions on the mental health of the Belgian population prompted the need for a sustainable system to monitor its evolution. Repeated COVID-19 surveys were conducted between 2020 and 2022 to address this issue, followed by the launch of the BELHEALTH cohort project. Our study aims to analyze the trajectory of anxiety and depression at the post-pandemic period, using data from five waves of the BELHEALTH longitudinal surveys from October 2022 to March 2024. High-risk groups and the potential of social support and resilience to mitigate anxiety and depression were explored.
Methods: The BELHEALTH follow-up cohort of around 7,300 Belgian residents uses online surveys to assess anxiety (with the GAD-7), and depression (with the PHQ-9). The analyses were performed using linear mixed models on the 3,676 individuals who participated in all five waves.
Results: Preliminary results indicated that more people were affected by anxiety in October 2022 (16%) compared to June 2023 (14%), while depression rates were lower in October 2022 (13%) compared to February 2023 (14%) and March 2024 (15%). However, the trajectory of mental health varied across demographic subgroups, with worse outcomes observed among unemployed and younger individuals, as well as those living alone, in the Walloon Region (South of Belgium). Overall, people with a low level of resilience or a low level of social support exhibited higher odds of experiencing depression.
Conclusions: Reducing these social inequities in mental health necessitates the development of structural prevention measures and interventions at the regional level. These measures should target factors such as unemployment, which is particularly prevalent among younger individuals and those living in Wallonia. Additionally, fostering protective factors such as social support and resilience is crucial for mitigating mental health inequalities over time.</p
Individual, interpersonal, and organisational factors associated with discrimination in medical decisions affecting people with a migration background with mental health problems: the case of general practice
No full textObjectives: Although people with a migration background (MB) have more unmet mental health needs than the general population, patients with a MB are still underrepresented in mental health care services. Provider bias towards these patients has been evidenced repeatedly but its driving factors remain elusive. We assessed the moderating effect of the individual (e.g. age and ethnicity), interpersonal (e.g. healthcare provider trust), and organisational (e.g. perceived workload) factors on general practitioners (GPs) differential decision-making regarding diagnosis, treatment, and referral for a depressed patient with or without a MB. Design: An experimental study was carried out in which GPs were shown one of two video vignettes featuring adult male depressed patients, one with a MB and the other without. Belgian GPs (n = 797, response rate was 13%) had to decide on their diagnosis, treatment, and referral. Analysis of variance and logistic regression were used to analyse the effect of a MB, adding interaction terms for the explanatory variables. Results: Overall, we found that there were ethnic differences in GPs’ decisions regarding diagnosis and treatment recommendations. GPs perceived the symptoms of the patient with a MB as less severe (F = 7.68, p < 0.01) and demonstrated a reduced likelihood to prescribe a combination of medical and non-medical treatments (F = 11.55, p < 0.001). Those differences increased in accordance with the GP’s age and perceived workload; at an interpersonal level, we found that differences increased when the GP thought the patient was exaggerating his distress.</p
REPORT FROM “X-treme Vision”: A JA TERROR BASELINE TABLETOP SIMULATION EXERCISE AT EUROPEAN LEVEL ON CROSS-SECTORAL COLLABORATION IN THE RESPONSE TO A BIOLOGICAL OR CHEMICAL TERROR ATTACK HELD IN MADRID, 15th June 2023
No full textOn the 15th of June 2023 in Madrid, thirty-four participants from health, security and civil protection sectors from 12 countries attended a tabletop exercise organised by the Spanish Ministry of Health, within the framework of Joint Action TERROR (WP6). Participants were guided to solve a two-part scenario in limited time: 1) a VX-release in the public transport at national level and 2) a mass gathering terror attack with VX at international level.
Sector-specific responses to the different injects were collected as well as gaps, good practices and proposed actions identified, with a focus on cross-sectoral collaboration. Specific preparedness and response actions were assessed by designated evaluators through a checklist.</p
INITIATIEF VOOR KWALITEITSVERBETERING EN EPIDEMIOLOGIE BIJ KINDEREN EN ADOLESCENTEN MET DIABETES (IKEKAD) Resultaten 2021
No full textIn dit rapport worden de resultaten beschreven van de acht audit bij de erkende pediatrische diabetescentra (hierna PDC’s genoemd). De audit verzamelde gegevens van 3619 patiënten met type 1 diabetes jonger dan 19 jaar die werden behandeld in 16 PDC’s. De gegevens hadden betrekking op de zorg in 2021. Het rapport focust zich op trends in de zorgkwaliteit en kenmerken van de onderzoekspopulatie in de periode 2008-2021. Er werden deze audit geen gegevens van patiënten met type 2 diabetes geregistreerd.
De belangrijkste bevindingen waren:
Sommige aspecten van de zorgkwaliteit, gemeten door een brede set van proces- en uitkomstindicatoren, verbeterden in de periode 2008-2021: er was een toename van de bloeddrukbepaling en een toename van het percentage patiënten dat de HbA1c-therapiedoelstellingen van 7,0%, 7,5% en 9,0% haalt, terwijl de cijfers voor HbA1c-bepaling (één of drie keer), en screening op coeliakie en schildklierauto-immuniteit waren over alle audits heen constant hoog (> 80%).
De verbetering van het HbA1c werd waargenomen in 13 van de 16 PDC’s en was grotendeels onafhankelijk van de kenmerken van de patiënt (geslacht, kerngezinstatus, …). Merk op dat bij de 3 CDP’s waar geen verbetering werd vastgesteld, de HbA1c-waarden tot de laagste behoorden in 2008.
De jaarlijkse screening op retinopathie nam in de periode 2008-2021 zowel bij de algemene als de doelpopulatie significant af.
Uit de resultaten is gebleken dat het aandeel patiënten met overgewicht sinds 2008 toeneemt. Volgens het OESO-rapport van 2019 werd deze trend echter ook in de algemene bevolking waargenomen en beide trends nemen op dezelfde manier toe. Met andere woorden, de toename van het aandeel jongeren met diabetes die overgewicht hebben, ontwikkelt zich in hetzelfde tempo als die van de populatie jongeren zonder diabetes (de trends in de twee populaties zijn niet significant verschillend).
De cijfers in verband met acute en chronische complicaties en de niveaus van de cardiovasculaire risicofactoren (behalve BMI) bleven in de periode 2008-2021 stabiel.
Tot besluit kunnen we stellen dat ondanks de beperkingen van het cross-sectionele karakter van het onderzoek en de beperkte follow-up, uit de zevende IKEKAD-audit is gebleken dat de gunstige evolutie op het vlak van HbA1c, een belangrijke indicator voor de zorgkwaliteit, zich voortzet. Aangezien er sinds 2013 meer gegevens worden verzameld (doordat alle patiënten die in aanmerking komen in de steekproef worden opgenomen in plaats van slechts 50%), zal het ook mogelijk worden het HbA1c-traject van individuele patiënten en de bepalende factoren te analyseren, wat ons meer aanwijzingen zal geven over de factoren waarop we ons moeten richten om de zorgkwaliteit bij pediatrische diabetespatiënten te verbeteren.</p
Clinical Guidance: Supporting the introduction of the HPV test in cervical cancer screening in Belgium
No full textIn Belgium, 641 women were diagnosed with invasive cervical cancer in 2022 (1) and 231 women died due to cervical cancer (2). Cervical cancer is mostly caused by the human papillomavirus (HPV), which is mainly transmitted through sexual contact. There are more than 150 types of HPV, a dozen of which can cause cervical cancer and are therefore called high-risk. High-risk HPV types (hrHPV) can be detected with DNA- or RNA-based HPV testing. The screening for cervical cancer in Belgium was performed until the end of 2024 by a 3-yearly cytological examination of a cervical smear. The HPV test was reimbursed only after an abnormal cytology result.
In December 2022, the Interministerial Conference decided (in line with the IMC’s earlier decisions during the previous reign) to switch from cytology to primary HPV screening for cervical cancer (from the age of 30 onwards) (3). This decision is based on available scientific evidence ranging from the 2015 KCE report 238 (4) to very recent analyses conducted by the World Health Organisation (WHO) (5, 6) and the International Agency for Research on Cancer (IARC) (7).
Moreover, adolescents (girls and boys) are vaccinated against the human papillomavirus through vaccination programmes organised by the federated entities. HPV vaccines are also reimbursed by the NIHDI for catch-up vaccination of adolescents up to the age of 19.</p
