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Glenn Leemans,1 Dirk Vissers,1 Kris Ides,2– 4 Paul Van Royen5 1Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium; 2Cosys-Lab, Flanders Make, University of Antwerp, Antwerp, Belgium; 3Laboratory of Experimental Medicine and Pediatrics, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium; 4Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium; 5Department of Family Medicine and Population Health, University of Antwerp, Wilrijk, BelgiumCorrespondence: Glenn Leemans, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, Wilrijk, 2610, Belgium, Tel +32 495 34 84 59, Email glenn.leemans@student.uantwerpen.beBackground: Chronic obstructive pulmonary disease (COPD) is a complex and heterogeneous condition that requires multidisciplinary management. In Belgium, the treatment of COPD is mainly managed by general practitioners (GPs). Several clinical practice guidelines (CPGs) recommend the use of non-pharmacological treatments, such as pulmonary rehabilitation, and interdisciplinary care for COPD patients. Although considerable research has been devoted to addressing the multitude of reasons for the lack of adherence to these aspects of the CPGs, less attention has been paid to understanding the perspectives and attitudes of GPs that lead to this suboptimal implementation.Purpose: This study aimed to 1) explore Belgian GPs’ perceptions regarding COPD management in a primary care setting and 2) collect their views on the importance of pulmonary rehabilitation and interprofessional care in COPD management.Methods: A descriptive study, conducted between August 2014 and May 2015, used interviews from a sample of 30 Flemish GPs. Data were analyzed following the principles of thematic analysis.Results: COPD management was patient-centered, focusing on immediate symptom relief and reducing future risks through pharmacotherapy and proper patient education. Deviations from the CPGs were noted, with only a few GPs performing spirometry themselves. Conditions to prescribe respiratory physiotherapy were not well known. Some GPs remained unconvinced about the (cost-)effectiveness of respiratory physiotherapy despite the fast-expanding scientific evidence. Interprofessional care was limited to GP-respiratory physician (re)-referral and communication. GPs showed a reactive attitude towards interprofessional collaboration for non-pharmacological therapies, which is not in line with the proactive approach recommended in CPGs.Conclusion: GPs managed COPD patients mainly by reducing symptoms with pharmacological therapy. Integrated care regarding non-pharmacological treatments was not well implemented due to the obstacles in interprofessional collaboration. Future care models incorporating personalized care planning could provide a solution to manage COPD’s complex healthcare demands.Keywords: asthma/COPD management, family medicine, non-pharmacologic treatment, pulmonary rehabilitation, interdisciplinary care, thematic analysis

Abstract Background Global public health action to address noncommunicable diseases (NCDs) requires new approaches. NCDs are primarily prevented and managed in the community where there is little investment in digital health systems and analytics; this has created a data chasm and relatively silent burden of disease. The nascent but rapidly emerging area of precision public health offers exciting new opportunities to transform our approach to NCD prevention. Precision public health uses routinely collected real-world data on determinants of health (social, environmental, behavioural, biomedical and commercial) to inform precision decision-making, interventions and policy based on social position, equity and disease risk, and continuously monitors outcomes – the right intervention for the right population at the right time. This scoping review aims to identify global exemplars of precision public health and the data sources and methods of their aggregation/application to NCD prevention. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) was followed. Six databases were systematically searched for articles published until February 2021. Articles were included if they described digital aggregation of real-world data and ‘traditional’ data for applied community, population or public health management of NCDs. Real-world data was defined as routinely collected (1) Clinical, Medication and Family History (2) Claims/Billing (3) Mobile Health (4) Environmental (5) Social media (6) Molecular profiling (7) Patient-centred (e.g., personal health record). Results were analysed descriptively and mapped according to the three horizons framework for digital health transformation. Results Six studies were included. Studies developed population health surveillance methods and tools using diverse real-world data (e.g., electronic health records and health insurance providers) and traditional data (e.g., Census and administrative databases) for precision surveillance of 28 NCDs. Population health analytics were applied consistently with descriptive, geospatial and temporal functions. Evidence of using surveillance tools to create precision public health models of care or improve policy and practice decisions was unclear. Conclusions Applications of real-world data and designed data to address NCDs are emerging with greater precision. Digital transformation of the public health sector must be accelerated to create an efficient and sustainable predict-prevent healthcare system.

Continuous Glucose Monitoring (CGM) has improved the diabetes follow up. The use of CGM can be expected to reduce the long-term complications of diabetes. To achieve this, education of physicians and diabetic individuals is essential. The latest CGMs have alarms to improve glycemic control by avoiding hypoglycemia and hyperglycemia, hence the importance of proper setting of these alarms. Although useful to signal these events, we have noted that these alarms do not necessarily meet with unanimity in consultations… Are alarms considered a comfort or a possible disturbance ?

Glenn Leemans,1,2 Dennis Belmans,2 Cedric Van Holsbeke,2 Vladimir Kushnarev,3 Jason Sugget,3 Kris Ides,1 Dirk Vissers,1 Wilfried De Backer4 1Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Wilrijk, Belgium; 2FLUIDDA nv, Antwerp, Kontich, Belgium; 3Trudell Medical International, London, Ontario, Canada; 4Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Wilrijk, BelgiumCorrespondence: Glenn LeemansFaculty of Medicine and Health Sciences University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Antwerp, BelgiumTel +32 495 34 84 59Email glenn.leemans@uantwerpen.bePurpose: Chronic obstructive pulmonary disease (COPD) patients are prone to suffer from chronic bronchitis, which ultimately affects their quality of life and overall prognosis. Oscillating positive expiratory pressure (oPEP) devices are designed to aid in the mucus clearance by generating positive pressure pulses in the airways. The main aim of this study was to analyze the impact of a specific oPEP device – Aerobika® – on top of standard of care medication in COPD patients’ lung dynamics and drug deposition.Patients and Methods: In this single-arm pilot study, patients were assessed using standard spirometry tests and functional respiratory imaging (FRI) before and after a period of 15± 3 days of using the oPEP device twice daily (before their standard medication).Results: The utilization of the oPEP device led to a significant increase of 2.88% in specific airway volume after two weeks (1.44 (SE: 0.18) vs 1.48 (SE: 0.19); 95% CI = [0.03%,5.81%]; p=0.048). Moreover, the internal airflow distribution (IAD) was affected by the treatment: patients’ changes ranged from − 6.74% to 4.51%. Furthermore, IAD changes at the lower lobes were also directly correlated with variations in forced expiratory volume in one second and peak expiratory flow; conversely, IAD changes at the upper lobes were inversely correlated with these clinical parameters. Interestingly, this change in IAD was significantly correlated with changes in lobar drug deposition (r2=0.30, p< 0.001).Conclusion: Our results support that the Aerobika device utilization leads to an improved airflow, which in turn causes a shift in IAD and impacts the drug deposition patterns of the concomitant medication in patients with COPD.Keywords: mucus hypersecretion, airway clearance techniques, functional respiratory imaging, internal airflow distribution, drug deposition

BackgroundDigital health in hospital settings is viewed as a panacea for achieving the “quadruple aim” of health care, yet the outcomes have been largely inconclusive. To optimize digital health outcomes, a strategic approach is necessary, requiring digital maturity assessments. However, current approaches to assessing digital maturity have been largely insufficient, with uncertainty surrounding the dimensions to assess. ObjectiveThe aim of this study was to identify the current dimensions used to assess the digital maturity of hospitals. MethodsA systematic literature review was conducted of peer-reviewed literature (published before December 2020) investigating maturity models used to assess the digital maturity of hospitals. A total of 29 relevant articles were retrieved, representing 27 distinct maturity models. The articles were inductively analyzed, and the maturity model dimensions were extracted and consolidated into a maturity model framework. ResultsThe consolidated maturity model framework consisted of 7 dimensions: strategy; information technology capability; interoperability; governance and management; patient-centered care; people, skills, and behavior; and data analytics. These 7 dimensions can be evaluated based on 24 respective indicators. ConclusionsThe maturity model framework developed for this study can be used to assess digital maturity and identify areas for improvement.

Like any employee, teachers’ well-being, commitment and performance are influenced by their working conditions. Nonetheless, most research focuses on teachers’ characteristics overlooking the work context. This article describes the associations between teachers’ working conditions and student outcomes —mathematics achievement and motivation— by applying the Model of Job Demands and Resources to data from six middle-income countries which participated in TIMSS 2015: Botswana, Chile, Hungary, Kazakhstan, Lithuania, and Thailand. The results show that teachers’ perception of having high job demands can be associated with lower student outcomes, while teachers’ perception of having high resources can be associated with better student outcomes. Interesting differences between countries and variables are highlighted.

This article conceptualises the notion of “social investment’ within the context of social protection and active labour market policies. This paradigm is confronted to the neoliberal ‘making work pay’ paradigm and the conservative workfare doctrine build on the idea that a stronger work ethos needs to be inculcated through reduced rights and more duties. The social investment paradigm advocates generous social protection combined with enabling investments and is thus perfectly congruent with social inclusion objectives. The empirical analysis shows remarkably small effects of both types of policies in the past 15 years: ALMPs have had small positive effects on employment, but also on exits into inactivity. The most positive employment effect of ALMPs is a redistribution of employment opportunities towards older, female and less educated groups. The Re-inVEST research analyses in-depth participatory case studies of policies targeting disadvantaged groups in different European countries, using an ‘enriched’ social investment model, building on a human rights and capabilities approach. The findings indeed show very wide differences in quality – and a lot of room for improvement. In order to improve their effectiveness as well as inclusiveness, the right to decent ALMPs should be put on the policy agenda.

The purpose of this study was to examine the effect of Android-based DM diet education program on changes in eating behavior and blood glucose levels. The study design used in this study was a cluster randomized control trial with a pre-post intervention. The study involved 33 DM patients in the intervention group and 37 patients in the DM control group. The proportion of female subjects was higher than male subjects in the treatment group. Nutrition education intervention, with application media, significantly increased DM disease severity perception score (p = 0.000), expectations of DM treatment (p = 0.000), eating habits practice (p = 0.025), and fasting blood sugar examination (p = 0.414). However, compared to counseling, the increase in perception of the severity of DM disease was significantly different, but for DM treatment expectation perceptions, the practice of eating habits, and fasting blood sugars were not significantly different. Despite increased disease severity perception scores, DM treatment expectations, practice of eating habits, and fasting blood sugar checks in the application group were higher than in the extension group. Thus, the use of both nutritional education intervention methods has a positive impact on increasing perceptions of severity, treatment expectations, practice of eating habits, and fasting blood sugar of DM type 2 patients.

Antimicrobial resistance (AMR) data from humans are mostly collected from clinical isolates, whereas from livestock data also exist from colonizing pathogens. In Germany, livestock data are collected from clinical and nonclinical isolates. We compared resistance levels of clinical and nonclinical isolates of Escherichia coli from weaning and fattening pigs with clinical outpatient isolates of humans from urban and rural areas. We also studied the association of AMR with available antimicrobial use (AMU) data from humans and pigs. Differences between rural and urban isolates were minor and did not affect the comparison between human and pig isolates. We found higher resistance levels to most antimicrobials in human isolates compared to nonclinical isolates of fattening pigs. Resistance to ampicillin, however, was significantly more frequent in clinical isolates of fattening pigs and in clinical and nonclinical isolates of weaning pigs compared to isolates from humans. The opposite was observed for ciprofloxacin. Co-trimoxazole resistance proportions were higher in clinical isolates of weaning and fattening pigs as compared to isolates from humans. Resistance proportions were higher in clinical isolates than in nonclinical isolates from pigs of the same age group and were also higher in weaner than in fattening pigs. Significant associations of AMU and AMR were found for gentamicin resistance and aminoglycoside use in humans (borderline) and for ampicillin resistance in clinical isolates and penicillin use in fattening pigs. In summary, we found significant differences between isolates from all populations, requiring more detailed analyses supported by molecular data and better harmonized data on AMU and AMR.

Abstract Perceptions of users regarding the accessibility of childcare services have been under-researched. The present study addresses this gap by looking into the effect of systemic level characteristics of the ECEC system on the perceived accessibility of childcare at the individual level. Perceived accessibility is composed of perceived affordability, availability, quality and physical accessibility of these services. The socio-ecological model at the micro-level and the model of institutional setting of ECEC (provision, regulation and financing) at the macro-level are combined in multilevel analyses. Our finding is that childcare is perceived to be more accessible in countries that (1) do not allow private commercial profit-making ECEC services for 3–6-year-old children, (2) adopt a unitary ECEC system where services for 0–3-year-olds and 3–6-year-olds are harmonised and (3) provide generous public support per 0–5-year-old child in the ECEC system. The latter has an even stronger effect on families with an income below average.

Kris Ides,1–3 Wim Vos,3,4 Lieve De Backer,2,3 Dirk Vissers,1,2 Rita Claes,2,3 Glenn Leemans,1,2 Kevin Ongena,1 Oswald Peters,5 Wilfried De Backer1–31Department of Health Science, Artesis University College of Antwerp, Merksem, 2Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, 3Department of Respiratory Medicine, Antwerp University Hospital, Edegem, 4FluidDa.nv, Groeningerlei, Kontich, Belgium, 5AZ Monica, Antwerp, BelgiumObjective: Chest physiotherapy enhances sputum evacuation in COPD patients. It can be applied as a single technique or as a combination of techniques including intrapulmonary percussive ventilation (IPV). Recently developed assessment techniques may provide new insights into the effect of airway clearance techniques.Participants: Five moderate to severe COPD patients (three females and two males; mean forced expiratory volume in 1 second of 39.49% predicted) who were admitted in the hospital for an acute exacerbation were included in this study.Methods: A novel imaging technique was used, together with other conventional techniques, to visualize the short-term effects of a single IPV treatment in COPD patients.Results: No significant changes were noted in the lung function parameters or arterial blood gases measured within 1 hour after the end of the IPV session. Computed tomography images detected changes in the airway patency after the IPV treatment compared with before treatment. Local resistances, calculated for the three-dimensional models, showed local changes in airway resistance.Conclusion: The effects of a single IPV session can be visualized by functional imaging. This functional imaging allows a calculation of changes in local airway resistance and local changes in airway volume in COPD patients without affecting conventional lung function parameters.Keywords: IPV, lung function, forced oscillation technique, physical therapy, airway clearance technique

L De Backer¹, W Vos², B Dieriks¹, D Daems¹, S Verhulst¹, S Vinchurkar², K Ides¹, J De Backer², P Germonpre¹, W De Backer¹1Antwerp University Hospital, Department of Respiratory Medicine, 2FluidDa, Antwerp, BelgiumIntroduction: Noninvasive ventilation (NIV) is a well-established treatment for acute-on-chronic respiratory failure in hypercapnic COPD patients. Less is known about the effects of a long-term treatment with NIV in hypercapnic COPD patients and about the factors that may predict response in terms of improved oxygenation and lowered CO2 retention.Methods: In this study, we randomized 15 patients to a routine pharmacological treatment (n = 5, age 66 [standard deviation ± 6] years, FEV1 30.5 [±5.1] %pred, PaO2 65 [±6] mmHg, PaCO2 52.4 [±6.0] mmHg) or to a routine treatment and NIV (using the Synchrony BiPAP device [Respironics, Inc, Murrsville, PA]) (n = 10, age 65 [±7] years, FEV1 29.5 [±9.0] %pred, PaO2 59 [±13] mmHg, PaCO2 55.4 [±7.7] mmHg) for 6 months. We looked at arterial blood gasses, lung function parameters and performed a low-dose computed tomography of the thorax, which was later used for segmentation (providing lobe and airway volumes, iVlobe and iVaw) and post-processing with computer methods (providing airway resistance, iRaw) giving overall a functional image of the separate airways and lobes.Results: In both groups there was a nonsignificant change in FEV1 (NIV group 29.5 [9.0] to 38.5 [14.6] %pred, control group 30.5 [5.1] to 36.8 [8.7] mmHg). PaCO2 dropped significantly only in the NIV group (NIV: 55.4 [7.7] → 44.5 [4.70], P = 0.0076; control: 52.4 [6.0] → 47.6 [8.2], NS). Patients actively treated with NIV developed a more inhomogeneous redistribution of mass flow than control patients. Subsequent analysis indicated that in NIV-treated patients that improve their blood gases, mass flow was also redistributed towards areas with higher vessel density and less emphysema, indicating that flow was redistributed towards areas with better perfusion. There was a highly significant correlation between the % increase in mass flow towards lobes with a blood vessel density of >9% and the increase in PaO2. Improved ventilation–perfusion match and recruitment of previously occluded small airways can explain the improvement in blood gases.Conclusion: We can conclude that in hypercapnic COPD patients treated with long-term NIV over 6 months, a mass flow redistribution occurs, providing a better ventilation–perfusion match and hence better blood gases and lung function. Control patients improve homogeneously in iVaw and iRaw, without improvement in gas exchange since there is no improved ventilation/perfusion ratio or increased alveolar ventilation. These differences in response can be detected through functional imaging, which gives a more detailed report on regional lung volumes and resistances than classical lung function tests do. Possibly only patients with localized small airway disease are good candidates for long-term NIV treatment. To confirm this and to see if better arterial blood gases also lead to better health related quality of life and longer survival, we have to study a larger population.Keywords: noninvasive ventilation, COPD, imaging

The aim of this study is to assess the capacity gaps and requirements of Earth observation (EO) and related technologies for malaria vector control and management in the Lubombo Spatial Development Initiative regions of South Africa, Swaziland and Mozambique. In order to achieve the core objective of this study, available EO data (including main characteristics and resources required to utilize them) and their potential applications for malaria epidemiology are reviewed. In addition, a survey was conducted to assess the availability of human and facility resources to operate EO and related technologies for control and management of the malaria control programs in these countries resulting in an analysis of capacity gaps, priorities and requirements. Earth observation in malaria vector control and management has two different applications: i) collection of relevant remotely sensed data for epidemiological use; and ii) direct support of ongoing malaria vector control activities. All malaria control programs and institutions recognize the significance of EO products to detect mosquito vector habitats, to monitor environmental parameters affecting mosquito vector populations as well as house mapping and distribution of information supporting residual spray planning and monitoring. It was found that only the malaria research unit (MRU) of the medical research council (MRC) in South Africa and the national malaria control program (MCP) in Swaziland currently have a fully functional geographic information systems (GIS), whereas the other surveyed MCPs in South Africa and Mozambique currently do not have this in place. Earth observation skills only exist in MRU of MRC, while spatial epidemiology is scarce in all institutions, which was identified as major gap. The survey has also confirmed that EO and GIS technologies have enormous potential as sources of spatial data and as analytical frameworks for malaria vector control. It is therefore evident that planning and management require capacity building with respect to GIS, EO and spatial epidemiology.

Malaria affects about half of the world’s population, with the vast majority of cases occuring in Africa. National malaria control programmes aim to reduce the burden of malaria and its negative, socioeconomic effects by using various control strategies (e.g. vector control, environmental management and case tracking). Vector control is the most effective transmission prevention strategy, while environmental factors are the key parameters affecting transmission. Geographic information systems (GIS), earth observation (EO) and spatial modelling are increasingly being recognised as valuable tools for effective management and malaria vector control. Issues previously inhibiting the use of EO in epidemiology and malaria control such as poor satellite sensor performance, high costs and long turnaround times, have since been resolved through modern technology. The core goal of this study was to develop and implement the capabilities of EO data for national malaria control programmes in South Africa, Swaziland and Mozambique. High- and very high resolution (HR and VHR) land cover and wetland maps were generated for the identification of potential vector habitats and human activities, as well as geoinformation on distance to wetlands for malaria risk modelling, population density maps, habitat foci maps and VHR household maps. These products were further used for modelling malaria incidence and the analysis of environmental factors that favour vector breeding. Geoproducts were also transferred to the staff of national malaria control programmes in seven African countries to demonstrate how EO data and GIS can support vector control strategy planning and monitoring. The transferred EO products support better epidemiological understanding of environmental factors related to malaria transmission, and allow for spatio-temporal targeting of malaria control interventions, thereby improving the cost-effectiveness of interventions.

This article considers how countries differ in the opinions that citizens hold about the fairness of the social and educational system. From the literature, we derive a typology of four educational “regimes”, based on differences in educational system, labour market and welfare state design. We then use data from the ISSP (2009) to investigate how much weight respondents attribute to ascribed characteristics (e.g., being born in a wealthy family) and individual responsibility (e.g., working hard) to explain success in life or at school. We also examine how these judgments relate to the educational background of the respondents. We consider how these patterns correspond to the existing knowledge on social and economic inequality and what this means for the legitimacy of the social system.

Students of Turkish descent suffer various forms of discrimination in education in Flanders (the northern part of Belgium). Nevertheless, few studies have documented how these discrimination experiences are situated within structures of ethnic inequality in education. Adopting a critical race theory approach, experiences of Turkish Belgian university students were analysed to expose deficit assumptions towards ethnic minorities and push against inequity in education. The accounts of students show the exclusionary treatment they were exposed to despite the dominating discourses of colorblindness in education. Students' experiences with peers highlight the pervasiveness of racism that targeted ethnic minority students based on their ethnic and social class background. Lack of minority representation, ubiquitous microaggressions, and exclusionary curriculum shape students' experiences at university context and affirm White normativity. These findings highlight the urgency of challenging against systems and structures of racism in education. The implications for research and practice are detailed in the concluding section.

There is some scepticism about the effectiveness of equity funding policies (EFPs). However, many studies focus only on one particular EFP in one education system. The present paper draws lessons from a review of the North American and European literature. In general, EFPs did not always meet the expectations of policymakers and educational agents. Five potential causes emerge from our review: (1) Matthew effects in the baseline resourcing of schools; (2) the ineffective use of additional resources; (3) ineffective targeting; (4) flaws in monitoring and evaluation; and (5) the general social and educational context in which EFPs are implemented.