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The dynamics of the dune toe along the urbanised 65 km macro‐tidal coast of Belgium has been examined based on (bi‐)annual cross‐shore profiles derived from airborne LiDAR surveys conducted between 2000 and 2019. Results indicate that the average dune toe level is located at +5.9 m Tweede Algemene Waterpassing (TAW, Belgian Ordnance Datum), which is 1 m lower than the conventional dune toe level. However, this level is not static but rather increasing over time with an average rate of 2.3 cm/year, making it comparable with coastal areas along western Europe. Both landward retreat and seaward progradation of the dune toes are observed, with rates up to 2 m/year. The analysis revealed that dune growth is primarily facilitated by the development of incipient or embryonic dunes, new foredunes and modifications to the stoss slope of the original dune profile. Half of the sea‐fronting dunes were observed to be developed by brushwood fences, which had a positive effect on dune growth. At some locations, incipient dune development and shoreline progradation were observed seaward of old foredunes. Other dune regions were characterised by natural dune blowouts and management activities for recreational purposes. Dune toe reinforcements were implemented in the west to stabilise the dune toe and prevent erosion by waves. However, it was noted that if the adjacent beach accreted because of natural growth or periodic nourishment, incipient dunes could form in front of the reinforcement. [ABSTRACT FROM AUTHOR]

Verwaest, T.; Houthuys, R.; Roest, B.; Dan, S., and Montreuil, A.-L., 2020. A coastline perturbation caused by natural feeding from a shoreface-connected ridge (headland Sint-André, Belgium). In: Malvárez, G. and Navas, F. (eds.), Global Coastal Issues of 2020. Journal of Coastal Research, Special Issue No. 95, pp. 701-705. Coconut Creek (Florida), ISSN 0749-0208. This paper explains how a local seaward perturbation, headland Sint-André, in the straight sandy coastline of Belgium can persist for centuries. The diffusive longshore transport gradients on the beach are counterbalanced by a sediment supply from off-shore via a shoreface-connected ridge. A UNIBEST-CL+ 1D coastline model is set up to describe the genesis of this coastline feature. From the size and shape of the perturbation and taking into account the diffusivity caused by the longshore transport gradients, the average sand supply from offshore is estimated to be 55,000 m3/year and it is hindcasted that the connection of the ridge to the coastline occurred between 300 and 400 years ago. [ABSTRACT FROM AUTHOR]

Objectives:The ability to manage one's life with some degree of independence, to fulfill basic obligations, and to participate in social activities are social functions that delineate the core of ‘social health’. We examine to what extent clients of community care in Europe (n= 2884) complete such activities despite their cognitive problems. We focus on mildly and moderately impaired people, aged 65+ years. Methods:Data were collected using the interRAI HC-Assessment in IBenC-project. We tested the association between participants' capacity and performance in three LADLs (instrumental activities of daily living) and their cognitive performance and specific memory problems. Results:About 30% of home care clients in Europe suffer from mild-to-moderate cognitive impairment. Their relatively independent coping with requirements of routine activities is strongly determined by overall cognitive performance. Specific memory functions seem unimportant, except for procedural memory. It is striking that all clients, and particularly those with mild-to-moderate cognitive impairment, interact mostly with close relatives and friends. Mild-to-moderate cognitive limitations do not hinder clients from coping semi-independently with routine requirements. Discussion:When considering the influence of cognitive function on clients' capacity and performance in everyday activities and social relations, a comprehensive construct of cognitive function has to be applied. [ABSTRACT FROM PUBLISHER]

Background: The European population is aging. The main drivers of public spending on health care for people of 65 years and older are hospital admission and admission to long-term care facilities. High quality community care can be a cost-effective and quality solution to respond to the impact of ageing populations on health-care systems. It is unclear how well countries are equipped to provide affordable and quality community care. The aim of this article is to describe and compare community care delivery with care-dependent older people in Europe. Methods: This study is conducted within the European Union-financed IBenC project [Identifying best practices for care-dependent elderly by Benchmarking Costs and outcomes of community care (FP7)] in which six European countries are involved. To compare the community care delivery with care-dependent older people in these countries, we performed a systematic comparison of macro indicators using metadata complemented with data from multinational surveys. Results: Data on the following dimensions are described and compared: population of the country, governmental expenditures on health, sources of community health services funding, governmental vision and regulation on community care, community care organisations and care professionals, eligibility criteria for and equity in receiving care and the involvement of informal care. Conclusion: Because of the variations in the European community care contexts, the growing demand for community care as a cost-effective and quality solution to the care burden of aging populations will have country-specific impacts. When learning from other countries' best practices, in addition to researchers, policy makers should take full account of local and national care contexts. [ABSTRACT FROM AUTHOR]

Background: Morphine is worldwide the analgesic of first choice after cardiac surgery in children. Morphine has unwanted hemodynamic and respiratory side effects. Therefore, post-cardiac surgery patients may potentially benefit from a non-opioid drug for pain relief. A previous study has shown that intravenous (IV) paracetamol is effective and opioid-sparing in children after major non-cardiac surgery. The aim of the study is to test the hypothesis that intermittent IV paracetamol administration in children after cardiac surgery will result in a reduction of at least 30% of the cumulative morphine requirement.Methods: This is a prospective, multi-center, randomized controlled trial at four level-3 pediatric intensive care units (ICUs) in the Netherlands and Belgium. Children who are 0-36 months old will be randomly assigned to receive either intermittent IV paracetamol or continuous IV morphine up to 48 h post-operatively. Morphine will be available as rescue medication for both groups. Validated pain and sedation assessment tools will be used to monitor patients. The sample size (n = 208, 104 per arm) was calculated in order to detect a 30% reduction in morphine dose; two-sided significance level was 5% and power was 95%.Discussion: This study will focus on the reduction, or replacement, of morphine by IV paracetamol in children (0-36 months old) after cardiac surgery. The results of this study will form the basis of a new pain management algorithm and will be implemented at the participating ICUs, resulting in an evidence-based guideline on post-operative pain after cardiac surgery in infants who are 0-36 months old.Trial Registration: Dutch Trial Registry ( www.trialregister.nl ): NTR5448 on September 1, 2015. Institutional review board approval (MEC2015-646), current protocol version: July 3, 2017. [ABSTRACT FROM AUTHOR]

The prevalence of different geriatric syndromes in older home care (HC) recipients is yet to be determined. Dizziness is often regarded as a geriatric syndrome. The natural course of dizziness in older people is still unknown, because of a lack of longitudinal studies. The objective of this study was to investigate the prevalence and persistence of dizziness in HC recipients. Prospective cohort study. Home care organizations in 6 European countries participating in the EU-funded Identifying best practices for care-dependent elderly by Benchmarking Costs and outcomes of community care (IBenC) project. 2616 community-dwelling long-term HC recipients aged 65 years or older. Data were collected at baseline and 6 and 12 months by using the interRAI Home Care instrument (interRAI-HC). Dizziness status was assessed by the number of days people experienced dizziness in the last 3 days (0-3) and later dichotomized for analyses (present or not in the last 3 days). Dizziness persistence was defined as the odds for dizzy people at baseline to also report dizziness at subsequent follow-up moments, compared with people who were not dizzy at baseline. The pattern of dizziness was descriptively analyzed in recipients who completed all measurements. Generalized estimating equations analysis was used to determine the persistence of dizziness symptoms. The prevalence of dizziness of 2616 eligible HC recipients at baseline was 25.1%, ranging from 16.2% (Belgium) to 39.7% (Italy). The majority of dizzy recipients at baseline also experienced dizziness after 6 and 12 months (79.1%). Dizziness persistence was high at 6 months [odds ratio (OR) 57.8, 95% confidence interval (CI) 43.1-77.5] and at 12 months (OR 30.2, 95% CI 22.3-41.1). Dizziness in older HC recipients in Europe is common, and dizziness persistence is high. This warrants a more active approach in treating dizziness in older HC recipients. [ABSTRACT FROM AUTHOR]

Oral health is known to be associated with general health, but longitudinal relationships between oral health and general health indicators have not yet been fully explored in international research. The sample consisted of 3 longitudinal databases: a sample from Belgium from the Protocol 3 project (n = 8359), a combined sample from 6 European countries (n = 2501) from the IBenC study (Belgium, Finland, Iceland, Germany, Italy, and the Netherlands), and a sample from New Zealand (n = 15,012). All clients were 65 years or older and received long-term home care services. Bayesian models were used to analyze the associations between 3 oral health indicators (chewing difficulty, nonintact teeth, and dry mouth) and 4 aspects of general health (activities of daily living functioning, cognition, depression, and health instability). In addition, the models explored the associations between current oral health and general health status and future oral health and general health status. Clients who had poorer oral health had a higher risk of suffering from poor general health. Especially chewing difficulty was associated with all general health indicators in all data sets (odds ratios > 1). Dry mouth and nonintact teeth showed significant associations with almost all general health indicators. Additionally, having poor oral health (respectively general health) was predictive of poor general health (respectively oral health) at future assessments (significant cross-lagged parameters). The results point out the need of the inclusion of oral health assessment and advice from dentists or oral health practitioners into the multidisciplinary conversation. In addition, identifying older people with oral health problems is essential in order to provide treatment and monitoring. Raising awareness for oral health is important, and policy makers should foster oral health promotion and care for older adults in order to keep them in good health. [ABSTRACT FROM AUTHOR]

Objectives: For better characterizing the effect of anti-CD20 therapy, we analysed the use of rituximab in Belgian patients experiencing auto-immune haemolytic anaemia (AIHA) and immune thrombocytopenic purpura (ITP)., Design: We performed a retrospective multicentric analysis of patients with AIHA and ITP treated with rituximab in Belgium., Setting: Haematological departments were invited to fill in a questionnaire about patient and disease characteristics., Subjects: All patients with AIHA and ITP, both primary and secondary to other diseases, who received one or more courses of rituximab during their disease course were included. Sixty-eight courses of rituximab in 53 patients with AIHA and 43 courses in 40 patients with ITP were analyzed., Intervention: Response rates, duration of response and factors predictive for response were assessed., Results: All patients were given rituximab after failing at least one previous line of treatment, including splenectomy in 19% and 72.5% of AIHA-patients and ITP-patients respectively. Overall response rates were 79.2% in AIHA and 70% in ITP, with a median follow-up since first rituximab administration of 15 months (range 0.5-62) in AIHA and 11 months (range 0-74) in ITP. Progression free survival at 1 and 2 years were 72% and 56% in AIHA and 70% and 44% in ITP. In this retrospective analysis we were not able to identify pretreatment characteristics predictive for response to rituximab. Nine patients with AIHA and three patients with ITP were given one or more additional courses of rituximab. Most of these patients, who had responded to a previous course, experienced a new response comparable to the previous one, both in terms of quality and of duration of response. Finally, the outcome of patients who failed to respond to rituximab therapy was poor both in terms of response to subsequent therapy and in terms of survival., Conclusions: This study confirms that rituximab induces responses in a majority of previously treated patients with AIHA and ITP. Response duration generally exceeds 1 year. Retreatment with rituximab in responding patients is most often successful. The outcome of patients who fail on rituximab is poor. We were not able to identify pretreatment patient characteristics predicting for response.