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In this article we reflect upon the evolution from the Belgian trans law of 2007 to those of 2017 and beyond, giving adult citizens the possibility to have their self-determined gender legally recognised. The 2019 ruling of the Belgian Constitutional Court, condemning the Belgian State for being discriminatory against gender fluid and gender non-binary persons regarding their legal gender recognition, requires the Belgian government to either add a third legal option or to abolish gender registration altogether. We analyse the definitions of sex and gender that underlie the two trans laws of 2007 and 2017 and the Constitutional Court ruling of 2019 and then confront them with the experiences of trans people based on a national transgender survey (Motmans, Wyverkens, & Defreyne, 2017). The confrontation between legal texts and lived experiences clearly shows the promises and pitfalls states face when striving for gender recognition procedures. [ABSTRACT FROM AUTHOR]

Background: Older people in the emergency department (ED) represent a growing population and increasing proportion of the workload in the ED. This study investigated the support for frail older people in the ED, by exploring the collaboration between the geriatric services (GS) and the EDs in Belgian hospitals.Methods: An electronic cross-sectional survey in all Belgian hospitals with an ED (n = 100) about care aspects, collaboration, education and infrastructure for older patients in the ED was collected. Descriptive analyses were performed at national level.Results: Forty-nine of 100 surveys were completed by the GS. The heads of the ED returned only 12 incomplete questionnaires and these results are therefore not reported. Twenty-six of the 49 heads of GSs (53%) indicated that there was an agreement, mainly informal, between the geriatric and the emergency department concerning the management of older people on the ED. A geriatrician was available for specific problems, by phone or in person, in 96% of the EDs during daytime on weekdays. Almost all responding hospitals (96%) had an inpatient geriatric consultation team, of which 85% was available for specific problems at the ED, by phone or bedside during the daytime on weekdays. Twenty-nine heads of the GSs (59%) reported that older patients were screened at ED admission during the day to identify 'at risk' patients. The results of the screening were used in the context of further treatment (76%), to decide on hospital admission (27%), or to justify admission on a geriatric ward (55%). In the year preceding the survey, 25% of the responding hospitals had organised geriatric training for ED healthcare workers. Thirty-four heads of the GS (69%) felt that the infrastructure of the ED was insufficient to give high-quality care for older persons.Conclusion: Collaborations between EDs and GS are emerging in Belgium, but are currently rather limited and not yet sufficiently embedded in the ED care. Exploratory studies are necessary to identify how these collaborations can be improved. [ABSTRACT FROM AUTHOR]

Background: General Practitioners (GPs) are well placed to care for patients with (chronic) substance use problems. This pilot was carried out to study the feasibility and usefulness of a continuous surveillance of substance use problems among general practice patients. The objectives were (i) to describe variables with missing values exceeding 1% and whether patients were reported without substance-related problems; (ii) the profile and the magnitude of the patient population that is treated for substance use problems. Methods: Observational study by the Belgian Network of Sentinel General Practices (SGP) in 2013. Baseline (at the first encounter) and 7-month follow-up data were reported of all patients treated for substance use problems. Two main measurements were type of substance use and patient status at follow-up. Multiple logistic regression analysis was used to examine patient status at follow-up. Results: Of 479 patients, 47.2% had problems with alcohol alone, 20.3% with prescription drugs, 16.7% with illicit drugs other than heroin or methadone and 15.9% with heroin or methadone. Problems with alcohol alone were more prevalent in Flanders (53.0%; 95% confidence interval (CI) 46.8-59.1%) than in Wallonia-Brussels (39.8%; 95% CI 33.1-46.8%), while problems with heroin or methadone were more prevalent in Wallonia-Brussels (27.0%; 95% CI 21. 1-33.5%) than in Flanders (7.1%; 95% CI 4.3-10.9%). At follow-up, 32.8% of the patients had dropped out, 29.0% had discontinued GP treatment and 38.2% had continued GP treatment. Overall, 32.4% of 479 patients had continued GP treatment for substance use problems during the study period. In Wallonia-Brussels, this proportion was higher (42.7%; 95% CI 35.9-49.6%) than in Flanders (24.3%; 95% CI 19.2-29.8%). Conclusions: A continuous surveillance of the general practice population treated for substance use problems seems to be feasible and useful. The latter is suggested by the specific profile and the relative magnitude of the population. Inter-regional health system differences should be taken into account to estimate the epidemiology of substance use problems among general practice patients. [ABSTRACT FROM AUTHOR]

STUDY QUESTION What is the effect of a legal limitation of the number of embryos that can be transferred in an assisted reproductive technology (ART) cycle on the multiple delivery rate? SUMMARY ANSWER The Belgian national register shows that the introduction of reimbursement of ART laboratory costs in July 2003, and the imposition of a legal limitation of the number of embryos transferred in the same year, were associated with a >50% reduction of the multiple pregnancy rate from 27 to 11% between 2003 and the last assessment in 2010, without any reduction of the pregnancy rate per cycle. WHAT IS KNOWN ALREADY Individual Belgian IVF centres have published their results since the implementation of the law, and these show a decrease in the multiple pregnancy rate on a centre by centre basis. However, the overall national picture remains unpublished. STUDY DESIGN, SIZE, DURATION Cohort study from 1990 to 2010 of all ART cycles in Belgium (2685 cycles in 1990 evolving to 19 110 cycles in 2010), with a retrospective analysis from 1990 to 2000 and prospective online data collection since 2001. PARTICIPANTS/MATERIALS, SETTING, METHODS Registration evolved from paper written reports per centre to a compulsory online registration of all ART cycles. From 2001 up to mid-2009, data were collected from Excel spread sheets or MS Access files into an MS Access database. Since mid-2009, data collection is done via a remote and secured web-based system (www.belrap.be) where centres can upload their data and get immediate feedback about missing data, errors and inconsistencies. MAIN RESULTS AND THE ROLE OF CHANCE National Belgian registration data show that reimbursement of IVF laboratory costs in July 2003, coupled to a legal limitation in the number of embryos transferred in utero, were associated with a 50% reduction of the multiple pregnancy rate from 27 to 11% without reduction of the pregnancy rate per cycle, and with an increase in the number of fresh and frozen ART cycles due to improved access to treatment. LIMITATIONS, REASONS FOR CAUTION There is potential underreporting of complications of ART treatment, pregnancy outcome and neonatal health. WIDER IMPLICATIONS OF THE FINDINGS Over the 20 years of registration, the pregnancy rate has remained constant, despite the reduction in the number of embryos transferred, optimization of laboratory procedures and stimulation protocols, introduction of quality systems and implementation of the EU Tissue Directive over the period 2004–2010. STUDY FUNDING/COMPETING INTEREST(S) No external funding was sought for this study. None of the authors has any conflict of interest to declare. [ABSTRACT FROM AUTHOR]

Background: In Europe, a comparable scope of training in GP can be observed especially in the field of knowledge. This feasibility study determines if a knowledge test is suitable in the context of a neighboring country. Methods: A Dutch knowledge multiple choice test was used after validation of its content in Flanders (Belgium) in the academic year 2010-2011. Satisfaction with the test format was assessed. The test was taken by general practice trainees and trainers. Group scores of trainees in year 1, 2 and 3 and their trainers were compared to Dutch participants as a control group. Results: 80 percent of the items in the Dutch test were transferable to Flanders (Belgium). Flemish participants (Belgium) liked the test format. The scores of all Belgian participants groups were lower than the Dutch participants. Conclusion: The results among 1278 participants show that the use of the Dutch knowledge multiple-choice test is feasible in a neighboring country. At present, the individual scores can not be used for high stake decisions for trainees in Flanders (Belgium). If countries collaborate in the area of assessing GPs trainees, there would be an economical benefit due to increased efficiency. It would also lead to greater international integration of the discipline. [ABSTRACT FROM AUTHOR]

Data on the civil registration of all births and deaths recorded in 1987 in Belgium were analysed following WHO rules. The following statistics with significant regional variations were recorded: 2.5% of teenage pregnancies, 7% of late pregnancies (≥35 years), 6.1% of low birth weights and 5.3% of preterm deliveries. Preterm birth rates did not improve during the last decade and are higher than in neighbouring countries. Infant mortality rate is 9.74 per 1000. This rate has remained unchanged since the early 1980s but the relative importance of post-neonatal mortality is increasing. Congenital anomalies account for 26% of all infant deaths followed by the sudden infant death syndrome (17%). Maternal conditions such as eclampsia are related to 29% of the infants' deaths. [ABSTRACT FROM AUTHOR]