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The aim of this paper is to examine if and how the reclassification of platform workers from self-employment status to employment status can provide them with adequate social security protection. Little is known about how this transition would guarantee platform workers adequate social protection within the social protection scheme for employees. National social security schemes, in particular income replacement benefit schemes, often (still) depart from the standard employment relationship, leading to lower protection for atypical work forms. Platform workers combine several of the characteristics of atypical forms of work, such as low earnings, irregular working patterns and working. Integrating platform workers into employee social security schemes faces additional challenges due to the online nature of their work, algorithmic management, high levels of unpaid labor, and employer identification difficulties. This paper focuses on unemployment protection, as EU Member States struggle to provide adequate protection for workers with irregular work patterns and income fluctuations, in the case of (short term) income replacement benefits. By constructing nine ideal work patterns reflective of diverse nature of platform work and current practices among platform work, we analyse how different types of 'employed' platform workers may fare within the legislation of three EU countries (Belgium, Italy, and the Netherlands). This approach allows us to assess the applicability of unemployment protection to different working patterns among 'employed' platform workers, considering formal, effective, and adequate access to unemployment schemes as outlined in the Council Recommendation on access to social protection for workers and the self-employed (2019). [ABSTRACT FROM AUTHOR]

BACKGROUND: Do-it-yourself technologies such as 3D printing offer interesting opportunities for creating custom-made assistive devices for people with disabilities. Although these opportunities are increasingly acknowledged, it remains unclear how 3D printing technology should be implemented in assistive devices delivery processes. OBJECTIVE: In three separate action research projects carried out in Belgium, Italy and The Netherlands, workflows were designed and evaluated that incorporate 3D printing as a standard option for providing clients with suitable assistive devices. METHODS: In this paper we describe and compare the three workflows that were conceived simultaneously, yet independently from each other. RESULTS: Based on the evaluations of these workflows, and the experiences of the researchers who developed the workflows, we provide recommendations for implementing 3D printing as a common approach in assistive device delivery processes in practice. Most importantly, designing and manufacturing should be done by means of a client-centered co-creation process by interdisciplinary teams of clinicians, clients, and 3D printing experts. We provide several recommendations for facilitating and supporting collaborations within such teams. CONCLUSIONS: The three workflows presented in this paper are strikingly similar and therefore provide a convincing starting point for interdisciplinary design teams who wish to embark on 3D printing custom-made assistive devices. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic immensely impacted care provision, including quality of care in general practice. This paper aimed: (1) to assess how Belgian general practices acted upon the six dimensions of quality of care during COVID-19; (2) to study differences between the three Belgian regions; and (3) to benchmark the performance of the Belgian practices against the performance in other European countries. Methods: The data collected from 479 Belgian practices during 2020–2021 using an online survey as part of the international cross-sectional PRICOV-19 study were analyzed. Hereby, descriptive statistics, chi-squared tests, and binary logistic regression analyses were performed. Thirty-four survey questions related to the six dimensions of quality of care were selected as outcome variables. The adjusted regression models included four practice characteristics as covariates: practice type, being a teaching practice for GP trainees, multidisciplinarity of the team, and payment system. Results: Belgian practices made important organizational changes to deliver high-quality care during COVID-19. Most practices (n = 259; 56.1%) actively reached out to vulnerable patients. Limitations to the practice building or infrastructure threatened high-quality care in 266 practices (55.5%). Infection prevention measures could not always be implemented during COVID-19, such as using a cleaning protocol (n = 265; 57.2%) and providing a separate doctor bag for infection-related home visits (n = 130; 27.9%). Three hundred and sixty practices (82.0%) reported at least one safety incident related to a delayed care process in patients with an urgent condition. The adjusted regression analysis showed limited significant differences between the Belgian regions regarding the quality of care delivered. Belgian practices demonstrated varied performance compared to other European countries. For example, they excelled in always checking the feasibility of isolation at home but reported more patient safety incidents related to timely care than at least three-quarters of the other European countries. Conclusions: Future studies using different design methods are crucial to investigate which country and practice characteristics are associated with delivering high-quality care. [ABSTRACT FROM AUTHOR]

This paper investigates different uses of the Journal Impact Factor (JIF) in national journal rankings and discusses the merits of supplementing metrics with expert assessment. Our focus is national journal rankings used as evidence to support decisions about the distribution of institutional funding or career advancement. The seven countries under comparison are China, Denmark, Finland, Italy, Norway, Poland, and Turkey—and the region of Flanders in Belgium. With the exception of Italy, top‐tier journals used in national rankings include those classified at the highest level, or according to tier, or points implemented. A total of 3,565 (75.8%) out of 4,701 unique top‐tier journals were identified as having a JIF, with 55.7% belonging to the first Journal Impact Factor quartile. Journal rankings in China, Flanders, Poland, and Turkey classify journals with a JIF as being top‐tier, but only when they are in the first quartile of the Average Journal Impact Factor Percentile. Journal rankings that result from expert assessment in Denmark, Finland, and Norway regularly classify journals as top‐tier outside the first quartile, particularly in the social sciences and humanities. We conclude that experts, when tasked with metric‐informed journal rankings, take into account quality dimensions that are not covered by JIFs. [ABSTRACT FROM AUTHOR]

The circumplex version of the Impact Message Inventory (IMI-C) is one of the few existing diagnostic devices for the assessment of 'objective' (inter-subjective) countertransference. The IMI-C purports to assess eight categories of countertransference reactions along the circumference of the interpersonal circle, conceptualized as blends of the two basic dimensions of affiliation (AFF) and control (CON): dominant (D), hostile-dominant (HD), hostile (H), hostile-submissive (HS), submissive (H), friendly-submissive (FS), friendly (F) and friendly-dominant (FD). As a measure of objective (or 'inter-subjective') countertransference, a crucial test for the IMI-C is its ability to produce scores that are generalizable across different therapists involved with the same patients. In four previous psychometric studies, the 'objectivity' of countertransference reactions was examined with a Dutch paper-and-pencil IMI-C version. In the present study, the generalizability of countertransference reactions across therapists was tested with a computer-delivered IMI-C. Results obtained with the electronic IMI-C format were compared with the findings of the paper-and-pencil version. Similar to the four prior studies, D and HD were the comparatively most generalizable classes of countertransference reactions among the eight categories. Both the AFF and CON main dimensions scores were substantially generalizable across therapists. From different perspectives of analysis, more favorable results were obtained with the computer-delivered IMI-C in comparison to the paper-and-pencil-version for (a) five of the eight countertransference classes (D, HD, F, FS, FD) and also for (b) the AFF main dimension. The computer-based IMI-C appears to be a promising tool for assessing objective countertransference reactions. Copyright © 2010 John Wiley & Sons, Ltd. Key Practitioner Message: • Your countertransference reactions are likely to be partly patient-induced ('objective'). • Countertransference reactions can conveniently be classified in terms of the interpersonal circle. • The computer-based IMI-C is a user-friendly clinical instrument for the assessment of patient-induced countertransference reactions. [ABSTRACT FROM AUTHOR]

In this article the various descriptions and interpretations of professional autonomy, as have been given in the articles from Belgium, Italy and the UK are subjected to a further analysis. The implicit claim that professional autonomy of physicians is beneficial for the health of patients is scrutinized and is proven to be untrue and invalid. The conclusion is that professional autonomy is more directed at the interests of physicians than of those of patients and deserves no special place in health care. [ABSTRACT FROM AUTHOR]

The prevalence of Attention-Deficit/Hyperactivity Disorder (ADHD) diagnoses and medication use has increased over time around the world, but significant regional differences remain. This paper aims to determine and explain disparities in ADHD prevalence and medication use among school-aged children in two distinct school systems, in Flanders (Belgium) and Québec (Canada). We present detailed descriptive and comparative analyses of data from 35 schools, 114 teachers, and 1046 parents (children) that were collected as part of a comparative international project. The data concern teacher and parent suspicions, teachers' ratings of ADHD-related behaviors in children, teachers' views of medication use, and teachers' beliefs about ADHD. The results show that, compared with Flanders, Québec had significantly more children diagnosed with ADHD and more frequent suspicions of ADHD in children by teachers and parents. We refer to the conceptual, institutional, and interactional levels of medicalization to interpret our findings and conclude that social and cultural readings of children's behaviors differ greatly between regions. Medicalization of children's behaviors is more common in Québec than in Flanders. [ABSTRACT FROM AUTHOR]

Administrative law is a legal field usually famous for its close links with specific historic features of domestic legal systems. However, states increasingly cooperate on a range of pressing issues (e.g. immigration, cybercrime, international corruption, etc.) relying heavily on administrative cooperation. Equally, lawyers are increasingly mobile, changing jobs and countries over the course of their career. These combined evolutions should encourage to revisit how legal education provides young lawyers with tools to facilitate their critical skills. This paper shows that comparative administrative law remains very much an untapped resource to provide these skills. It offers a survey (using a questionnaire) of French and Belgian private/public universities and administrative courts. This empirical methodology is supported by historical and theoretical analysis of the past, present and future of comparative administrative law. Belgian and French legal education includes modules entitled "comparative administrative law" in the academic curriculum. They also develop other tools such as double degrees ("bi-licence" and "bi-maîtrise") for their students to gain a better understanding of another administrative law system. Beyond these similarities, France and Belgian legal education have their specificities. For instance, Belgian administrative law is often taught from a comparative law perspective which is not necessary the case in France. Whereas Belgian administrative judges develop strategies to learn from the Netherlands, their neighbor, in their daily work a comparative approach, it was rarely the case for the French Conseil d'Etat until the recent set up of an expert unit in comparative law (Cellule de droit comparé). All in all, and although such tools are still few, this paper highlights the diversity of ways in which students are encouraged to become more familiar with foreign legal systems. [ABSTRACT FROM AUTHOR]

Background: The objective of this paper is to explore whether IPV 12 months before and/or during pregnancy is associated with poor psychosocial health.Methods: From June 2010 to October 2012, a cross-sectional study was conducted in 11 antenatal care clinics in Belgium. Consenting pregnant women were asked to complete a questionnaire on socio-demographics, psychosocial health and violence in a separate room. Overall, 2586 women were invited to participate and we were able to use data from 1894 women (73.2%) for analysis. Ethical clearance was obtained in all participating hospitals.Results: We found a significant correlation between IPV and poor psychosocial health: within the group of women who reported IPV, 53.2% (n = 118) had poor psychosocial health, as compared to 21% (n = 286) in the group of women who did not report IPV (P < 0.001). Lower psychosocial health scores were associated with increased odds of reporting IPV (aOR 1.55; 95% CI 1.39-1.72), with adjustments made for the language in which the questionnaire was filled out, civil/marital status, education and age. In other words, a decrease of 10 points on the psychosocial health scale (total of 140) increased the odds of reporting IPV by 55 %. When accounting for the 6 psychosocial health subscales, the analysis revealed that all subscales (depression, anxiety, self-esteem, mastery, worry and stress) are strongly correlated to reporting IPV. However, when accounting for all subscales simultaneously in a logistic regression model, only depression (aOR 0.87; 95 % CI 0.84-0.91) and stress (aOR 0.85; 95 % CI 0.77-095) remained significantly associated with IPV. The association between overall psychosocial health and IPV remained significant after adjusting for socio-demographic status.Conclusion: Our research corroborated that IPV and psychosocial health are strongly associated. Due to the limitations of our study design, we believe that future research is needed to deepen understanding of the multitude of factors involved in the complex interactions between IPV and psychosocial health. [ABSTRACT FROM AUTHOR]

Objectives: This study compares the follow-up rates of non-normal cervical screening samples between Denmark and Flanders (Belgium) to illuminate whether organizational differences between the health systems might affect the follow-up rates, e.g. sending of reminders in Denmark since 2012 compared to Flanders with no such system in place. Methods: The study population included 48,082 Danish women and 22,271 Flemish women who received abnormal or inadequate primary screening results from 2014 to 2016. The participants were followed for 24 months, and the timeliness and appropriateness of the recommended follow-up, according to national guidelines, were evaluated. Results: After 18 months over 90% of the Danish women had received some form of follow-up, while in Flanders, this level is achieved only for those who test positive for human papillomavirus. The analysis also revealed that 10–28% of follow-ups were performed too early, with Danish women showing the highest proportions. In both regions, general practitioners (GPs) exhibited better follow-up rates compared to gynaecologists, with gynaecologists displaying a tendency towards earlier re-testing than recommended. Conclusions: An important factor influencing the follow-up rate may be the sending of reminders in Denmark since 2012, as the follow-up rates in general were higher in this period. It is noteworthy that a reminder system is currently being implemented in Flanders and further studies on the potential effects should be studied. Additionally, the organization of the health system might influence the follow-up rate, as engaging the GP for screening in Denmark may have had a positive effect. [ABSTRACT FROM AUTHOR]

This study utilizes data, spanning 2016-2021, from the Belgian Ageing Studies and presents a typology of older internet users based on nine internet activities. Two-step Cluster Analysis and Latent Class Analysis revealed three groups: (1) "Basic users" primarily engage in information search and mailing, (2) "Allrounders" participate in nearly all internet activities and (3) "Selective users" are intermediary, predominantly using the internet for information search, mailing, e-banking and communication with (grand)children. These clusters varied in sociodemographic characteristics, with "Allrounders" being younger, more educated, wealthier and predominantly male, compared to "Selective users" and "Basic users," respectively. [ABSTRACT FROM AUTHOR]

Background: In Belgium, Cannabis Social Clubs (CSCs) collectively organize the cultivation and distribution of cannabis for the personal use of their members. In this paper we seek to improve understanding of the motivations and practices of cannabis growers operating within CSCs, shedding light on the cultivation process.Methods: We draw on data gathered through face-to-face semi-structured interviews with the directors of seven active Belgian CSCs (n = 21) and CSC growers (n = 23). These data are complemented by additional fieldwork and a review of policies relating to CSCs', including bylaws and growing protocols.Findings: The Belgian CSCs rely on single and multiple in-house grower arrangements. Most CSC growers had been cultivating cannabis prior to joining their current CSC, albeit growing in different contexts (non-commercial and commercial). The CSC growers discussed both ideological and pragmatic motives for operating within a CSC. Cultivation took place indoors and followed organic practices. Despite their small-scale (20 plants on average), the grow sites used specialized equipment. The growers reported receiving financial compensation to cover production costs.Conclusion: This paper offers new insights into a particular sector of domestic cannabis cultivation - CSC growers and their practices within those collectives - which has not been studied previously. The Belgian CSCs have decentralized production among small-scale grow sites, at a size comparable to that found in other small-scale cultivation studies. In terms of motivations and practices, CSC growers share some features typically ascribed to small-scale cannabis cultivators. At the same time, CSC growers seemed particularly engaged with the CSC model and willing to adhere to the (self-)regulated practices developed by the organizations. This had implications for the way cultivation was organized and for the role of the grower within the CSC. [ABSTRACT FROM AUTHOR]

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Objective. Specific neck exercises are recommended in the rehabilitation of chronic nonspecific neck pain (CNNP). They are unfortunately often accompanied by acute pain flare-ups. Global exercises might be a beneficial addition, as they activate endogenous analgesia without overloading painful structures. However, it is still unclear which type of exercise is most effective. This randomized controlled trial was done to evaluate the effect of an online blended program of global and specific neck exercises, compared to programs including only 1 of both types of exercise. Methods. Forty-eight patients with CNNP were randomized into 3 groups. Online questionnaires were collected at baseline, at midtreatment, immediately after treatment, and at the 3-month follow-up. Quantitative sensory testing and actigraphy were assessed at baseline and after treatment. Linear mixed-model analyses were performed to evaluate treatment effects within and between groups. Neck pain-related disability after treatment was considered the primary outcome. Results. No time x treatment interaction effects were found. All groups improved in neck pain-related disability, pain intensity, self-reported symptoms of central sensitization, local pain sensitivity, physical activity, and pain medication use. No effects were found on quality of life, sleep quality, depression, anxiety, stress, widespread pain sensitivity, health economics, or actigraphy measurements. A higher global perceived effect was reported after performing the blended program, compared to the other groups. Conclusion. A blended exercise program was not superior to the stand-alone programs in reducing disability. Nevertheless, the global perceived effect of this type of exercise was higher. Future research necessitates larger sample sizes to adequately explore the optimal type of exercise for patients with CNNP. Impact. Exercise therapy should be an important part of the rehabilitation of patients with CNNP, regardless of the type of exercise. [ABSTRACT FROM AUTHOR]

The paper presents a comparative analysis of the development and present state of compensation for victims of catastrophes in Belgium and the Netherlands. These two neighbouring countries have both seen legislative changes in this field in recent years, albeit with different outcomes. The paper thus analyses to what extent the two compensation scheme structures allow for conclusions as to the comparative benefits of a comprehensive insurance scheme for natural disasters. From the perspective of law and economics, the evolution of private insurance and public intervention through compensation funds, the preference for private or public solutions and the actual financing of these are examined. Drawing on practical experience, such as the case of flood risks, the solutions are tested in view of incentive-based financing. The paper concludes that the private insurance market is more developed in Belgium than it is in the Netherlands, where the reform process has not yet ended. [ABSTRACT FROM AUTHOR]

Background: The purpose of this paper is to analyse the utilization of formal and informal home care among older patients with cancer (OCP) and to compare this with middle-aged patients with cancer (MCP) and older patients without cancer (ONC). Additionally, we examined predictors of transitions towards formal care one year after a cancer diagnosis.Methods: OCP and MCP had to be recruited within three months after a cancer diagnosis and have an estimated life expectancy over six months. ONC consisted of patients without known cancer, seen by the general practitioner. Formal and informal care were compared between the patient groups at baseline, i.e. shortly after a cancer diagnosis and changes in care were studied after one year.Results: A total of 844 patients were evaluable for formal care at baseline and 469 patients (56%) at follow-up. At baseline, about half of older adults and 18% of MCP used formal care, while about 85% of cancer patients and 57% ONC used informal care. Formal care increased for all groups after one year though not significantly in OCP. The amount of informal care only changed in MCP which decreased after one year. Cancer-related factors and changes in need factors predict a transition towards formal care after a cancer diagnosis.Conclusions: A cancer diagnosis has a different impact on the use of formal and informal care than ageing as such. The first year after a cancer diagnosis is an important time to follow-up on the patients' needs for home care. [ABSTRACT FROM AUTHOR]

Recent work with samples of black and white urban American women showed a clear behavioral sequence relating age at menarche to age at first intercourse to age at first birth. This paper shows that the linking of ages at menarche, intercourse, marriage, and first birth is a pattern which occurs in very diverse cultures. We present confirmatory data from the United States, Belgium, and Pakistan, and from Malay and Chinese women in Malaysia. We interpret our findings as indicating a biological process leading to (a) social interpretations of readiness for reproduction, and (b) persisting biological differences between early and late maturing women. [ABSTRACT FROM AUTHOR]

Despite the growing consensus on the benefits of initiating palliative care early in the disease trajectory, it remains unclear at what point palliative care needs emerge. This study investigates quality of life and unmet palliative care needs at three phases in the cancer trajectory, curative, life-prolonging and most advanced (prognosis <6 months/no further disease-modifying treatment). We collected self-reported data from 620 patients with cancer in the University Hospital of Ghent, Belgium. They completed a questionnaire on quality of life (using the EORTC QLQ-C30) and unmet care needs within the domains of palliative care. We used European reference values of the EORTC QLQ-C30 to compare the mean scores with a norm group. The groups further on in the cancer trajectory reported statistically and clinically poorer functioning compared with earlier phases, also when controlled for the effects of sex, age or type of cancer. Higher symptom burdens for fatigue, pain, dyspnoea and appetite loss were found in groups further into the trajectory, p < .001. Patients in the curative phase experienced physical symptoms and had clinically worse functioning than a European reference group. This paper demonstrates the ongoing need for oncologists to address the broader palliative care needs of patients from diagnosis onwards. [ABSTRACT FROM AUTHOR]

This study compares the mental health care, psychotropic drugs and social service use of divorced people (re-partnered or single) with that of married people. This paper questions whether the availability of informal support facilitates or substitutes for formal care seeking. Data from the Divorce in Flanders survey of 2009–2010 are used. Logistic regression analyses are performed separately for women (N= 3450) and men (N= 3020). Greater use of mental health care, psychotropic drugs and social services by single divorced men is explained by their higher need for care, while divorced women (especially single divorced) more frequently contact a general practitioner (GP), a psychiatrist, or a psychologist, regardless of their mental health, socio-economic background and informal support. Women who have support from non-family members are more inclined to use social services and to contact a GP, while support from family members is only positively related to GP consultations. With regard to men, informal support from non-family members positively influences each type of formal care seeking. Our results suggest that non-family members (and only among women, family members as well) can provide help and advice about seeking professional mental health care and social services, but they do not have an influence on psychotropic drug use. [ABSTRACT FROM AUTHOR]

Objective: To compare soft-tissue complications following implantation of different bone conduction hearing devices. Methods: Adults who underwent implantation of different bone conduction hearing devices, between January 2008 and December 2016, were included in the study. Five groups were identified depending on the soft-tissue approach: (1) split-thickness skin flap with use of dermatome; (2) Sheffield 'S'-shaped incision with skin thinning; (3) linear incision without skin thinning (hydroxyapatite-coated abutment); (4) 'C'-shaped full-thickness incision for passive transcutaneous bone conduction hearing devices; and (5) post-aural incision for active transcutaneous bone conduction hearing devices. The main outcome measures were different soft-tissue complications. Results: The study comprised 120 patients (group 1 = 20 patients, group 2 = 35, group 3 = 35, group 4 = 20, and group 5 = 10). Soft tissue related problems were encountered in 55 per cent of patients from group 1, 26 per cent in group 2, 3 per cent in group 3, and 0 per cent in groups 4 and 5. Conclusion: There was a reduction in soft tissue related complications with reduced soft-tissue handling. In addition, there was a shift from an initial skin-penetrating (percutaneous) approach to a non-skin-penetrating (transcutaneous) approach. [ABSTRACT FROM AUTHOR]

In 2021, the federal government of the United States expanded a set of income transfers that led to strong reductions in child poverty. This research note uses microdata from more than 50 countries and U.S. data spanning more than 50 years to place the 2021 child poverty rate in historical and international perspective. We demonstrate that whether using the Supplemental Poverty Measure (SPM), relative poverty measures, or an absolute poverty measure, the U.S. child poverty rate in 2021 was at its lowest level since at least 1967. The U.S. tax and transfer system reduced the 2021 SPM child poverty rate by more than 75% relative to the pre-tax/transfer child poverty rate; this reduction was three times the mean reduction effect between 1967 and 2019. These policy changes improved the country's standing from having a relative poverty rate twice that of Germany's in 2019 to the same as Germany's in 2021. Moreover, the U.S. progressed from reducing child poverty at less than half the rate of Norway in 2019 to a rate comparable to Norway in 2021. However, the U.S. success was temporary: after the expiration of the 2021 income provisions, the child poverty rate doubled and returned to being higher than in most other high-income countries. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to investigate the effect of pain neuroscience education compared to biomedical pain education after breast cancer surgery on (1) work status, (2) time until work resumption, and (3) change in return-to-work expectations up to 18 months post-surgery. Methods: Participants were randomly assigned to either pain neuroscience education (intervention group) or biomedical pain education (control group) in addition to a standard physical therapy program after surgery for breast cancer. The first four months following surgery, one to two physiotherapy sessions and three educational sessions were scheduled. After, two educational sessions and two physiotherapy sessions were held at six and eight months postoperatively. All outcomes were assessed at four, six, eight, 12 and 18 months postoperatively. Results: At 12 months, in the intervention group, 71% of the women returned to work compared to 53% in the control group (18% points difference, 95%CI:-0.1 to 35;p = 0.07). At 18 months, the differences decreased to 9% points, 95%CI:-26 to 7;p = 0.35). Neither time until work resumption (p = 0.46) nor change in estimation of own ability to return to work up to 18 months postoperatively (p = 0.21) significantly differed between both groups. Conclusion: No significant differences were found regarding return to work outcomes between women receiving pain neuroscience education versus biomedical pain education after breast cancer surgery. Further research is warranted to explore the potential role of pain neuroscience education in return-to-work interventions following breast cancer surgery. [ABSTRACT FROM AUTHOR]

Non-take-up of means-tested benefits is a widespread phenomenon which undermines the effectiveness and fairness of social policies. The digitalisation of the welfare state creates new opportunities for proactively contacting people who are potentially entitled to benefits, but do not take up their social rights. In this study, we report on how new data flows were used to reach out to potential beneficiaries of the Increased Reimbursement of health care, a programme targeted at low-income households in Belgium. By randomizing the period in which potential beneficiaries were contacted, we were able to identify a three- to four-fold increase in take-up among those contacted as a result of the outreaching activities. Households that did not respond to the intervention, the never takers, have lower pre-intervention healthcare expenditures. This suggests that non-take-up was reduced primarily among those who would expect to benefit most from receiving the Increased Reimbursement. Exploiting the combination of rich administrative data with experimental evidence, we also find that early responders are mostly older and have higher historic health expenditures than late responders. Furthermore, results point to the need for balancing well the inclusiveness of the intervention with an increased number of applications by ineligible people. [ABSTRACT FROM AUTHOR]

Studies that focus on the effects of both the division of household chores and of financial contributions on the mental health of couples are scarce. This paper expands on previous research by paying attention to the variation of this relationship among three types of households: Male breadwinner, one-and-a-half-earner and dual-earner. Using paired data from the 10th wave of the Panel Study of Belgian Households, collected in 2001, we perform separate linear regressions for men (N = 1054) and women (N = 1054). The results suggest that in one-and-a-half-earner households, women's employment has a negative effect on their partner's depression level and that in dual-earner households, the effect of women's employment is only negative if men are not the major breadwinner. Crossover effects of depression between partners seem to mediate part of the aforementioned associations. [ABSTRACT FROM AUTHOR]

The effects of urban and indoor air pollution on human health are a major environmental concern for all, but not much has been researched in the developing world. Specifically, quantitative data on the occurrence of volatile organic compounds (VOCs) – main contributors to air pollution – in Asia and Africa are scarce compared to the availability of data in the developed world. This paper presents one of the first studies focusing on the analysis and occurrence of VOCs in Vietnam and Ethiopia, which constitutes part of the novelty of this work. A spectrum of 34 VOCs was measured at eight different urban sites in Ghent (Belgium), Hanoi (Vietnam), Jimma and Addis Ababa (Ethiopia) during three sampling campaigns from September 2008 to September 2010. Sampling was done in an active way by means of sorbent tubes filled with Tenax TA. The analysis was done by TD-GC-MS using internal standard calibration. Data were interpreted and compared in terms of (i) individual, subgroup and total VOCs concentration (TVOCs), (ii) indoor-to-outdoor (I/O) concentration ratios, (iii) source identification by diagnostic ratio and/or correlation coefficients, and (iv) ozone formation potential (OFP) at outdoor sites based on up-to-date maximum incremental reactivity (MIR). I/O concentration ratios varied between 0.2 and 30, with big differences noticed with respect to the type of VOC(s) considered and the type of outdoor sampling location. The highest TVOC concentrations were measured in street samples with maximum values of 54 µg/m3in Ghent, 507 µg/m3in Hanoi and 318 µg/m3in Addis Ababa illustrating the large difference in ambient air quality levels. This is also reflected in the arithmetic mean OFP values (µg/m3) of 82, 1308 and 596 in Ghent, Hanoi and Addis Ababa, respectively. Results of this study could be helpful to support formulation of national policy with regard to ambient air quality. [ABSTRACT FROM AUTHOR]

Since the 1990s, the establishment and recognition of representative bodies for Muslim communities in Western European countries have been an important political and social topic. In many immigration countries in Europe, there were a variety of initiatives. In this article, we shall discuss to what extent particular church–state regimes are crucial to the understanding of the genealogy of these representative Muslim organizations. Four countries in Europe, including Belgium, France, Germany, and the UK, are studied in a comparative manner. These countries have very different church–state regimes which makes it possible to explore how and if the emergence of several Muslim councils was structured by pre-existing church–state practices and arrangements. After an introduction and a description of the research hypotheses, the paper provides first a brief overview of the church–state relations in the four European nations and then outlines the genealogy of their Muslim representative bodies. Finally, the similarities and differences among these institutions are discussed in the light of three research hypotheses. In conclusion, we are able to demonstrate that, contrary to general belief, it is largely not the case that the emergence of various Muslim councils in the different states was structured by pre-existing church–state arrangements. [ABSTRACT FROM AUTHOR]

Introduction: This paper presents the validation of the French version of the Addenbrooke's Cognitive Examination Revised (ACE-R). Methods: The variability of the 3 versions of the ACE-R (A, B and C), performed by the same observer, hence mainly 2 or 3 times on 119 patients showing no progression, was first calculated by Cronbach's alpha coefficient, t test and linear regression. The alpha coefficients of the 3 versions were obtained showing that the ACE-R versions can be considered as one, and an analysis of the interobserver variability was performed by Cohen's kappa coefficient, t test and linear regression on 12 patients. Eventually, we performed a receiver operating characteristic (ROC) analysis to compare the sensitivities and specificities to detect dementia of the ACE, the ACE-R and Mini Mental State Examination on 319 consecutive patients. Results: The ROC areas of sensitivities and specificities of the ACE and ACE-R were very similar. Two cutoffs were identified at 83/100 and 89/100 with a specificity to normality of 98.6% if the ACE-R score was ≥83 and a sensitivity to dementia of 98.4% if the ACE-R score was ≤89. Conclusion: ACE-R in French is as reliable and valid as the original version to detect dementia. Copyright © 2012 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

This paper investigated the effects of a paternalistic and empowering leadership style on organizational citizenship behaviour ( OCB) in an experimental design using 100 Turkish and 100 Dutch students who held part-time jobs. Confirming our expectations, a paternalistic leadership style had a more positive effect on job dedication and organizational support in Turkey than in the Netherlands. Contradicting our expectations, an empowering leadership style did not have a more positive effect on any of the OCB dimensions in the Netherlands than it did in Turkey. However, in the Netherlands an empowering leadership style had a stronger effect on interpersonal facilitation, job dedication, and organizational support than a paternalistic leadership style. Paternalistic and empowering leadership styles both had positive effects on OCB dimensions in Turkey. As expected, collectivism moderated the relationship between paternalistic leadership style and other oriented OCB (i.e., interpersonal facilitation). Specifically, people who had more collectivistic tendencies were more positively influenced by a paternalistic leader than people who had low collectivistic tendencies in both countries. However, individualism did not have any moderating effects on the relationship between empowering leadership style and self-oriented OCB (i.e., job dedication). Our findings are relevant for understanding the effects of leadership styles and cultural orientations on self- versus other-oriented OCB in Turkey and the Netherlands. [ABSTRACT FROM AUTHOR]

Videotape is an increasingly used tool in cross-national studies of mathematics teaching. However, the means by which videotaped lessons are coded and analysed remains an underdeveloped area with scholars adopting substantially different approaches to the task. In this paper we present an approach based on generic descriptors of mathematics learning objectives. Exploiting live observations in five European countries, the descriptors were developed in a bottom-up recursive manner for application to videotaped lessons from four of these countries, Belgium (Flanders), England, Hungary and Spain. The analyses showed not only that the descriptors were consistently operationalised but also that they facilitated the identification of both similarities and differences in the ways in which teachers conceptualise and present mathematics that resonated with the available literature. In so doing we make both methodological and theoretical contributions to comparative mathematics research in general and debates concerning the national mathematics teaching script in particular. [ABSTRACT FROM AUTHOR]

Auditors' liability is a hot topic nowadays. Due to the increased risks of auditors and the lack of appropriate insurance, a limitation of auditors' liability seems appropriate. Based on the economic study of the London Economics, the European Commission issued a consultation paper to discuss a European harmonization of auditors' liability. But to harmonize a liability cap on auditors, one needs to examine not only the economic implications, but also the legal restraints and differences of auditors' liability regimes within the European Union. This paper shows that there are large discrepancies concerning auditor's liability towards third parties within the legal systems of the European Union. In Belgium, an auditor is liable towards each interested party. However, the public role of an auditor is not acknowledged in the United Kingdom, the Netherlands and Germany. In those countries the purpose of audited statements is to fulfil the auditor's duty to the shareholders collectively and not to the stockholders as individual parties or third parties. In Germany, the Netherlands and the United Kingdom, an auditor has to encompass a special duty of care towards the third party to be liable. Only a special relationship of the auditor towards a third party could imply auditor's liability toward those parties. This element wasn't discussed in the London Economics Study. However, these findings could have a major impact on the debate to harmonize an auditor's liability cap because the more parties can pursue an auditor, the more damage can be claimed and the higher the liability cap needs to be fixed. [ABSTRACT FROM AUTHOR]

Aims: To describe the monthly self‐scheduling process in nursing homes (NH), to determine how specific organizational design characteristics (including interpersonal relationships and leadership style) influence this process, and to examine the effect on individual, team, and organization‐related outcomes. Design: A multiple case study using an organizational design perspective as the overarching theoretical and explanatory framework. Methods: Data collection was performed in four Belgian NH during Spring 2019 using semi‐structured interviews (n = 39), documents, and observations. Open, axial, and selective coding was used for the data reduction process, and a within‐case and cross‐case analysis was performed. The COREQ checklist was used for reporting the findings. Results: One group (two NH) used self‐scheduling because it corresponds with their decentralized organizational design. Together with a motivating head nurse and additional resources during the core phase of the process, this led to positive outcomes. In contrast, another group used self‐scheduling under the assumption that it would solve the mismatch between their organizational design and other organizational problems, which resulted in less positive work attitudes. Conclusion: Self‐scheduling should match the organizational structure and culture. Additional resources and an adaptive leadership style can help mobilize and support employees. Future research may use quantitative methods to confirm positive outcomes. Impact This study contributes to the rare literature on self‐scheduling in NHs by focusing on the monthly self‐scheduling process and by including an organizational design perspective. NH management can become informed of different self‐scheduling methodologies and the impact of specific organizational characteristics on this process. Head nurses can become aware that they need to adapt their leadership style to obtain improved outcomes. Patient or Public Contribution: Three members of the study team met with several caregivers during field visits to conduct interviews and to observe the monthly self‐scheduling process. [ABSTRACT FROM AUTHOR]

Purpose: Many countries have developed hospital-at-home (HAH) models to bring hospital services closer to home. Although some countries already have a long tradition of HAH for adults, paediatric HAH has been developed more recently. Specificities of paediatric care make it difficult to directly extend an adult HAH model to the paediatric population. The objective of this study is to compare the organisation of paediatric HAH in four countries: France, Australia (states of Victoria and New South Wales), the Netherlands and Belgium. Ultimately, lessons can be drawn for further development in the countries analysed and/or for implementation in other countries. Design/methodology/approach: Legal documents and other grey literature were analysed to describe the legal context for the provision of paediatric HAH in the selected countries. In addition, semi-structured in-depth interviews were conducted with key informants from paediatric HAH organisations in these countries, addressing the following topics: historical background, legal framework, functioning of HAH models, workforce, number of services, profile of children, type of care activities, funding, coordination with other providers and quality of care. Results were reviewed by a content expert from the respective country. Findings: Organisational differences were highlighted in terms of coordinating actor (hospital or home nursing care services), decision-making process, range of clinical conditions treated, territorial organisation, qualifications and expertise of the team members, medical expertise, financing, responsibilities, etc. Originality/value: There is no single preferred model for the provision of HAH care for children. There is a large variety in almost all aspects of organisation. There are, however, also some common characteristics across the different models. Notably, paediatric expertise of nurses within the HAH team was considered indispensable in all programmes. [ABSTRACT FROM AUTHOR]

There are many studies which implement and assess existing measurement manners and document the progress of entities towards the circular economy (CE) at various levels, or present or propose new possibilities of measurement. The majority of them refer to the micro level. The aim of this paper is to conduct a multidimensional comparative analysis of the implementation of circular economy by EU countries. After an in-depth critical analysis of the literature, CE indicators which were proposed by the European Commission were adopted as a basis. Owing to the research population-Member States of the European Union (EU-28), focusing on the said indicators was declared reasonable in all aspects. The classification of EU countries according to the level of their advancement in the concept of CE was adopted as a main research task. In order to do so, a relevant index of development of circular economy was created (IDCE). This will allow us, inter alia, to trace changes in the spatial differentiation of advancement of the EU countries in implementing CE over the years, to identify CE implementation leaders as well as countries particularly delayed in this regard. The comparative analysis was conducted by means of statistical methods. On the basis of the analyses, it was concluded that among all EU countries, those of the old EU are the most advanced in terms of CE. The analysis confirmed significant rising trends for IDCE only in the case of Belgium and The Netherlands. [ABSTRACT FROM AUTHOR]

This paper serves two purposes, First, we argue that radial efficiency measures are inappropriate for the Free Disposal Hull (FDH) technology, and we provide a comparative analysis of alternative nonradial measures. In particular, using information on Belgian local government expenditures and output indicators we implement various radial and nonradial measures on the FDH reference technology, and we investigate to which extent these efficiency measures imply different distributions and rankings. Second, we analyze the patterns of measured technical efficiency implied by the various indices. Specifically, we investigate whether different measures make any substantial difference for the explanation of the calculated inefficiencies. The empirical results suggest that more important differences in rankings exist between radial and nonradial measures than between different nonradial alternatives moreover, the radial and the nonradial efficiency measures dc yield a somewhat different pattern of explanation. [ABSTRACT FROM AUTHOR]

Tobacco smoking uptake is still a major public health concern, especially among youngsters living in vulnerable situations. Finding optimal ways to engage youngsters in smoking prevention is important. Compared to traditional settings such as schools, social work settings providing sports-based and recreational activities (SR-settings) tend to reach and engage youngsters more. This study aimed to gain insight into the reasons for smoking uptake among youngsters living in vulnerable situations and the conditions through which SR-settings are potentially beneficial for smoking prevention initiatives. Data were collected in two SR-settings in Flanders, Belgium, by means of five focus group discussions and six individual interviews with youngsters (n  = 38, mean age = 12.9 ± 2.61 years, 69.7% boys) and eight individual interviews with youth workers (n  = 8, mean age = 27.5 ± 7.95 years, 87.5% men). A thematic analysis (TA) approach was applied to analyse the data. Besides individual factors, such as attitudes towards smoking, the desire to be part of a group and conformity to group norms seem to be important drivers of smoking uptake among youngsters in vulnerable situations. The presence of powerful role models in SR-settings with whom youngsters identify may counteract group norms by encouraging healthy behaviour. SR-settings seem suitable for questioning perceptions of vulnerable youngsters, unlike other settings where they may struggle to be heard. The conditional characteristics of SR-settings, such as authentic group processes, having meaningful roles, and being heard, make these contexts promising venues for smoking prevention efforts among vulnerable youngsters. Youth workers who have established trusting relationships with youngsters seem well-suited to communicate smoking prevention messages. A participatory approach, in which youngsters are involved in developing smoking prevention programs, is desirable. [ABSTRACT FROM AUTHOR]

Background: In this study, we investigate how socio‐demographic characteristics (age, gender and education) and informal care relationship characteristics (e.g., time spent on care, number of informal caregivers, professional care) are linked with informal care burden during the COVID‐19 pandemic. In addition, we expect this burden to differ by personality characteristics, degree of resilience, and—in this specific context—perceived the COVID‐19 threat. Method: We used the fifth wave of a longitudinal study to identify 258 informal caregivers. These online survey data came from a five‐wave longitudinal study in Flanders, Belgium that ran from April 2020 to April 2021. Data were representative of the adult population by age and gender. Analyses include t‐tests, ANOVA, SEM and binomial logistic regression. Results: We found that the informal care burden was strongly linked with a socio‐economic gradient, time investment changes in care since the start of the pandemic, and whether there was more than one informal caregiver. Personality traits such as agreeableness and openness to experience, and the perceived threat of COVID‐19 were also related to care burden. Conclusions: During the pandemic, informal caregivers were put under extra considerable pressure: restrictive government measures sometimes led to the temporary suspension of some or all professional care for persons with care needs, which may have resulted in a growing psychosocial burden. We recommend that, in the future, the focus should be on supporting the mental wellbeing and social participation of caregivers along with measures to protect caregivers and their relatives from COVID‐19. Support structures for informal caregivers should be kept running during crises now and in the future, but it is also important to adopt a case‐by‐case basis to consider support for informal caregivers. [ABSTRACT FROM AUTHOR]

Background: Advance care planning supports patients to reflect on and discuss preferences for future treatment and care. Studies of the impact of advance care planning on healthcare use and healthcare costs are scarce. Aim: To determine the impact on healthcare use and costs of an advance care planning intervention across six European countries. Design: Cluster-randomised trial, registered as ISRCTN63110516, of advance care planning conversations supported by certified facilitators. Setting/participants: Patients with advanced lung or colorectal cancer from 23 hospitals in Belgium, Denmark, Italy, the Netherlands, Slovenia and the UK. Data on healthcare use were collected from hospital medical files during 12 months after inclusion. Results: Patients with a good performance status were underrepresented in the intervention group (p < 0.001). Intervention and control patients spent on average 9 versus 8 days in hospital (p = 0.07) and the average number of X-rays was 1.9 in both groups. Fewer intervention than control patients received systemic cancer treatment; 79% versus 89%, respectively (p < 0.001). Total average costs of hospital care during 12 months follow-up were €32,700 for intervention versus €40,700 for control patients (p = 0.04 with bootstrap analyses). Multivariable multilevel models showed that lower average costs of care in the intervention group related to differences between study groups in country, religion and WHO-status. No effect of the intervention on differences in costs between study groups was observed (p = 0.3). Conclusions: Lower care costs as observed in the intervention group were mainly related to patients' characteristics. A definite impact of the intervention itself could not be established. [ABSTRACT FROM AUTHOR]

In this paper we question whether prior cross-national differences in food attitudes still exist and if so, to what extent. Due to societal evolutions such as sedentarism and globalization, international variations in food attitudes may not be as pronounced as currently believed. A cross-sectional web-based survey was carried out in the United States, the United Kingdom, France and Belgium. A total of 2167 respondents (52% women; mean age = 39.0 years, SD = 11.4) participated. To successfully combat obesity, a joint approach focusing on food choice and physical activity is required; therefore we included behavioral measures by means of choice tasks for these two important drivers. Further, the extent to which respondents subscribe to the unhealthy = tasty intuition, together with health and taste interest were investigated. Socio-demographic information and self-reported heights and weights were also incorporated. Logistic regressions were fitted with weight status as the dependent variable and the attitudinal and behavioral measures as independent variables. Our findings indicate that having a higher interest in healthy eating decreases the chance of being overweight (odds = 0.88) and believing that unhealthy food is tasty significantly increases the chance of being obese by 1.18 times. Overall, we find that food attitudes have largely converged across the countries we investigated. [ABSTRACT FROM AUTHOR]

Recent developments in the media industries have signalled the need for public service media (PSM) organizations to reposition themselves in order to reach audiences, and also secure financial sustainability and programming rights. In repositioning themselves, PSM have increasingly embraced some of the core characteristics of platforms by developing a central video-on-demand (VOD) service as portal to PSM services, investing in exclusive content and using data to create richer user experiences and gain insights into audience practices. However, this 'platformization' process comes with both challenges and opportunities to reach the public service remit. This article conducts an analysis of the on-demand portals of PSM, to uncover how platformization is reshaping the PSM core remit and values, and how these are transposed in online services and offerings. The research employs a comparative case study analysis of five VOD services of PSM in Western and Northern Europe: Belgium-Flanders (VRT.NU), Belgium-Wallonia (RTBF Auvio), Finland (Yle Areena), Ireland (RTÉ Player) and Norway (NRK TV). The results discuss three main categories: interfaces and features, strategies for catalogue and content curation, and tools for discoverability and prominence. [ABSTRACT FROM AUTHOR]

Recent Continental European scholarship has identified a problematic Anglocentric bias running through the field of comparative plural policing studies. It has sought to counter this bias by emphasizing a series of divergent plural policing trajectories between the more market-friendly countries in the Anglosphere and the more state-centric countries in Continental Europe. While acknowledging the significance of this corrective, we argue that it tends to overemphasize the levels of divergence between these two regions. We substantiate this claim by examining the rise of the private security industry and its regulation by the state in the UK (representing the Anglosphere) and Belgium (representing Continental Europe). Interpreting historical and contemporary data through Sabatier and Weible's advocacy coalition framework, which focuses on the cut and thrust of democratic politics, we observe how in both countries this important dimension of the plural policing landscape is characterized not by counterposed market-friendly and state-centric trajectories, but rather by a complex mix of state–market interactions. In other words, the dynamics of private security regulation are more state-centric in the UK and more market-friendly in Belgium than recent Continental European scholarship suggests. Moreover, we illustrate how, under conditions of post-financial crisis austerity, the overarching pattern is, if anything, one of convergence towards a common set of political dynamics. This is an important finding that not only makes an original contribution towards private security regulation scholarship but also encourages us to question the nature of Anglocentric bias within comparative plural policing studies. [ABSTRACT FROM AUTHOR]

Purpose Return to work is a complex and challenging process which takes various forms in different contexts. The aim of this study is to explore and compare cross-country differences in stakeholders' experiences and views on actors, policies and practices relevant for return to work after long-term sickness absence. The comparative exploration is done in six countries with various legislative backgrounds, welfare and social dialogue systems. Methods Using a purposive sample, six multidisciplinary stakeholders group discussions were conducted in six countries: Belgium, Estonia, Ireland, Italy, Romania and Slovakia. A total of 51 individuals comprised of social partners, policymakers or representatives of public bodies and patient associations participated. An interpretative phenomenological analysis was employed to derive the most important themes in the discussions. Results Five major themes emerged from the group discussions. A graphic model is proposed to emphasize the variety of frameworks and processes across countries. Conclusions The core part of the return to work process is the dynamic relation between legislation, stakeholders and practices, which is influenced by broader national and societal factors. The cross-country variation in legislations, stakeholders and practices can be understood as a continuum, from low to high structuring, development and comprehensiveness. Although social dialogue appears to have a role in return to work process with variation across countries, it is not always on top of the agenda of social partners. [ABSTRACT FROM AUTHOR]

Aim: To use normalization process theory (NPT) to build a strategy for the implementation of goal-oriented care (GOC) in primary care in Flanders, Belgium. Background: GOC is a possible approach to more coordinated and integrated care and tailors care to patients' personal life goals. The concept has gained interest among policy makers and researchers, but the main drivers for successful implementation are the primary healthcare professionals (PHCPs) who need to see added value of GOC in order to embed it into their daily practice. NPT, developed to understand the processes of implementing new ways of organizing care, offers a useful lens to understand adoption of GOC in primary care practice. Method: PHCPs (n = 131) who participated in a 2-hour community meeting on GOC were asked to complete the Normalization MeAsure Development survey. This 23-item survey is based on NPT and describes participants' views about how an intervention would impact their work, their expectations about it, and whether it could become a routine part of their work. Findings: The NPT constructs coherence (sense-making work) and cognitive participation (relational work) showed positive tendency toward implementation of GOC. The participants had an initial understanding on GOC and there was much interest in supporting and start working with this approach. The other constructs collective action (operational work) and reflexive monitoring (appraisal work) will need further efforts to trigger implementation. A common ground is needed to integrate GOC as a common practice which can be achieved by intensive interprofessional collaboration. [ABSTRACT FROM AUTHOR]

Determining traits correlated with invasiveness in order to identify potentially invasive species remains a priority in the field of invasion ecology. In trees, relative growth rate (RGR), specific leaf area (SLA), or plant height under optimal growing conditions have been identified as performance traits allowing pioneer exotic species to outcompete native species. However, few studies investigated the link between these traits and invasiveness on a continuous scale. Here, we compare the RGR, SLA, height, shoot–root ratio, and number of leaves of seedlings of eight maple species (Acer spp.) with their invasiveness at the global level. Seedlings were grown in non-limiting conditions indoor in Gembloux, Belgium and harvested after 2, 4, or 8 weeks. Global invasiveness was quantified using a combination of the number of regions and countries invaded in the GBIF database, the number of citations in the Global Compendium of Weeds (GCW), and the risk score estimated in the GCW. RGR, SLA, height, and number of leaves after 8 weeks were positively correlated with invasiveness. We conclude that invasive maple species could benefit from an acquisitive strategy and that high growth and light capture also favor invasiveness of shade-tolerant species. Finally, we recommend a close monitoring of Acer rufinerve in Western Europe due to its high RGR and SLA, comparable to other highly invasive maple species. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is to evaluate the socio‐economic outcomes of survivors of childhood acute lymphoblastic leukaemia (ALL). Methods: Childhood ALL adult survivors, enrolled in EORTC trials between 1971 and 1998 in France and Belgium, were invited to fill out a questionnaire with information about their socio‐economic situation (living with a partner, having a university degree, having a job, working part time and history of having a paid job). The outcomes were compared with two matched control populations. Results: Among 1418 eligible patients, 507 (35.8%) participated, including 39 (8%) and 61 (12%) patients who received a haematopoietic stem cell transplantation (HSCT) and a cranial radiotherapy (CRT), respectively. The median time to follow‐up was 20 years, and median age was 25 years. Survivors showed a socio‐economic level at least as good as controls. HCST and CRT were associated with a higher probability of not obtaining a bachelor degree (respectively OR = 3.49, 95% CI: 1.46–8.35 and OR = 2.31, 95% CI: 1.04–5.15), HSCT was associated with unemployment (OR = 2.89, 95% CI: 1.09–7.65) and having a relapse was associated with a higher probability of not having a partner (OR = 1.88, 95% CI: 1.01–3.51) adjusting for confounders. Conclusion: Childhood ALL survivors showed a high level of socio‐economic participation. HCST and CRT were associated with poorer functioning. [ABSTRACT FROM AUTHOR]

The aims of the present study were to incorporate and to validate the electronic capture of participant-related outcomes into the Oral Survey-B System, which was originally developed for the electronic capture of clinical data. The validation process compared the performances of electronic and handwritten data captures. The hypothesis of noninferiority would be established if participants performed electronic data capture of the questionnaire survey with an effectiveness of at least 95% of that of handwritten data capture. In this multicenter, randomized, one-period crossover study design, participants (n = 261) were allocated to start with either electronic or handwritten data capture. The incorporation of the electronic self-completed questionnaire into the Oral Survey-B System was successful. The validation of the electronic questionnaire was performed by participants aged from 18 to 75 years. The interrater reliability of participants performing electronic and handwritten data capture of nonclinical assessments per questionnaire and per entry showed a kappa value of 0.72 (95% CI: 0.53-0.94). The noninferiority of electronic data capture in relation to that of the handwritten data capture and transfer was shown (p < 0.0001; 95% CI: 1.47-2.99). In conclusion, the electronic capture of participant-related outcomes with the Oral Survey-B System, originally designed for capture of clinical data, was validated. The electronic data capture was accurate and limited the number of errors. The participants were able to perform electronic data capture effectively, supporting its implementation in further National Oral Health Surveys. With the consideration of participant preference and time savings, this could lead to the implementation of electronic data capture worldwide in National Oral Health Surveys. [ABSTRACT FROM AUTHOR]

Background: Shared decision making is nowadays acknowledged as an essential step when deciding on starting renal replacement therapy. Valid risk stratification of prognosis is, besides discussing quality of life, crucial in this regard. We intended to validate a recently published risk stratification model in a large cohort of incident patients starting renal replacement therapy in Flanders.Methods: During 3 years (2001-2003), the data set collected for the Nederlandstalige Belgische Vereniging voor Nefrologie (NBVN) registry was expanded with parameters of comorbidity. For all incident patients, the abbreviated REIN score(aREIN), being the REIN score without the parameter "mobility", was calculated, and prognostication of mortality at 3, 6 and 12 month after start of renal replacement therapy (RRT) was evaluated.Results: Three thousand four hundred seventy-two patients started RRT in Flanders during the observation period (mean age 67.6 ± 14.3, 56.7 % men, 33.6 % diabetes). The mean aREIN score was 4.1 ± 2.8, and 56.8, 23.1, 12.6 and 7.4 % of patients had a score of ≤4, 5-6, 7-8 or ≥9 respectively. Mortality at 3, 6 and 12 months was 8.6, 14.1 and 19.6 % in the overall and 13.2, 21.5 and 31.9 % in the group with age >75 respectively. In RoC analysis, the aREIN score had an AUC of 0.74 for prediction of survival at 3, 6 and 12 months. There was an incremental increase in mortality with the aREIN score from 5.6 to 45.8 % mortality at 6 months for those with a score ≤4 or ≥9 respectively.Conclusion: The aREIN score is a useful tool to predict short term prognosis of patients starting renal replacement therapy as based on comorbidity and age, and delivers meaningful discrimination between low and high risk populations. As such, it can be a useful instrument to be incorporated in shared decision making on whether or not start of dialysis is worthwhile. [ABSTRACT FROM AUTHOR]

Background and Aim: Injury severity scores are important in the context of developing European and national goals on traffic safety, health-care benchmarking and improving patient communication. Various severity scores are available and are mostly based on Abbreviated Injury Scale (AIS) or International Classification of Diseases (ICD). The aim of this paper is to compare the predictive value for in-hospital mortality between the various severity scores if only International Classification of Diseases, 9th revision, Clinical Modification ICD-9-CM is reported.Methodology: To estimate severity scores based on the AIS lexicon, ICD-9-CM codes were converted with ICD Programmes for Injury Categorization (ICDPIC) and four AIS-based severity scores were derived: Maximum AIS (MaxAIS), Injury Severity Score (ISS), New Injury Severity Score (NISS) and Exponential Injury Severity Score (EISS). Based on ICD-9-CM, six severity scores were calculated. Determined by the number of injuries taken into account and the means by which survival risk ratios (SRRs) were calculated, four different approaches were used to calculate the ICD-9-based Injury Severity Scores (ICISS). The Trauma Mortality Prediction Model (TMPM) was calculated with the ICD-9-CM-based model averaged regression coefficients (MARC) for both the single worst injury and multiple injuries. Severity scores were compared via model discrimination and calibration. Model comparisons were performed separately for the severity scores based on the single worst injury and multiple injuries.Results: For ICD-9-based scales, estimation of area under the receiver operating characteristic curve (AUROC) ranges between 0.94 and 0.96, while AIS-based scales range between 0.72 and 0.76, respectively. The intercept in the calibration plots is not significantly different from 0 for MaxAIS, ICISS and TMPM.Discussion: When only ICD-9-CM codes are reported, ICD-9-CM-based severity scores perform better than severity scores based on the conversion to AIS. [ABSTRACT FROM AUTHOR]

Background: Uptake of advance care planning in routine nursing home care is low. Through extensive literature review, theoretical development, and stakeholder involvement, we developed the ACP+ intervention. Aims: To evaluate the effects of ACP+ on the knowledge and self-efficacy (confidence in own skills) of nursing home care staff concerning advance care planning. Design: Cluster randomized controlled trial, conducted between February 2018 and January 2019 (NCT03521206, clinicaltrials.gov). ACP+ is a multicomponent intervention aimed at training and supporting nursing home staff and management in implementing advance care planning in nursing home practice through a train-the-trainer approach over 8 months. Fourteen nursing homes were randomized using a matched-pairing strategy, seven received ACP+, seven followed usual practice. Analyses (intention-to-treat) involved linear mixed models. Setting/participants: Nursing homes in Flanders (Belgium). Results: 694 of 1017 care staff (68% response rate) at baseline and 491 of 989 care staff (50%) post-intervention (8 months) returned questionnaires. Post-intervention, care staff's self-efficacy concerning advance care planning was significantly higher in the intervention than in the control group (baseline-adjusted mean difference 0.57; 95% CI 0.20–0.94; p = 0.003; Cohen's d = 0.30). Advance care planning knowledge (95% CI 0.95–1.15; p = 0.339; ratio: 1.04) did not differ significantly between groups. Conclusions: The ACP+ intervention for nursing homes improved care staff's self-efficacy but not their knowledge concerning advance care planning. Considering the comprehensive and multi-component approach used, these effects were smaller than expected. Reasons for this may be related to the chosen follow-up period, outcomes and measurements, or to the intervention itself and its implementation. [ABSTRACT FROM AUTHOR]