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AbstractBelgium exhibits a complex governmental structure with overlapping yet fragmented healthcare service responsibilities across various levels. The past decade has been characterized with major political reforms, and a continuing road towards deinstitutionalization, enhancing care intensity, and fortifying primary care services. This article provides a concise overview of recent epidemiological trends in Belgium, the organizational landscape of mental healthcare, the roles and financing mechanisms of key institutions and professions, and a selection of specific topics such as euthanasia. Mental healthcare has ascended on the political agenda with a declaration of interest to eliminate a historical underfunding. This is urgent because over one fifth of the adult population struggles with mental issues on a yearly basis, with suicide rates 50 to 60% above the European average. Beyond the individual toll, there is a burning societal impact, reflected in the 7.4 billion euro directly spend within the healthcare sector, alongside substantial additional costs incurred through social security and productivity losses. Policy measures are needed to tackle contemporary challenges such as the attraction, recruiting and retention of skilled healthcare personnel, ensuring equitable remuneration across institutions and professions, and addressing critical areas such as forensic, transcultural, and transition psychiatry. [ABSTRACT FROM AUTHOR]

Summary: Background: The frequency of family meals has been suggested as a protective factor against obesity among children. Objective: This study aimed to investigate the cross‐sectional and longitudinal associations between family meals frequency and children's overweight/obesity in families at high risk of type 2 diabetes (T2D) across six European countries. Methods: 989 parent–child dyads (52% girls and 72% mothers) were included. Participants completed validated measures to assess the frequency of family meals and anthropometrics. Multivariable regression models were applied to examine the longitudinal associations between family meals frequency and overweight/obesity in children. Logistic regression was performed to predict the odds of having overweight/obesity depending on changes in family meals frequency over a two‐year follow‐up period. Analyses were stratified for children's sex. Results: High frequency of family breakfasts and/or dinners was inversely associated with children's BMI in boys and girls at T2. Results showed decreased odds of overweight/obesity at follow‐up among both boys (OR = 0.65; 95% CI 0.41, 0.96) and girls (OR = 0.53; 95% CI 0.31, 0.87) who consumed minimum of three times family breakfasts and/or family dinners a week at baseline. An increase in family breakfasts and/or dinners frequency was associated with lower odds of overweight/obesity in both boys and girls at follow‐up. Conclusion: A high frequency of family breakfasts and/or dinners but not lunch during childhood is associated with lower odds of overweight/obesity development in children from families at high risk of T2D. The promotion of family meals could help in preventing the development of overweight/obesity among children. [ABSTRACT FROM AUTHOR]

Aims Although life expectancy in adults with congenital heart diseases (CHD) has increased dramatically over the past five decades, still a substantial number of patients dies prematurely. To gain understanding in the trajectories of dying in adults with CHD, the last year of life warrants further investigation. Therefore, our study aimed to (i) define the causes of death and (ii) describe the patterns of healthcare utilization in the last year of life of adults with CHD. Methods and results This retrospective mortality follow-back study used healthcare claims and clinical data from BELCODAC, which includes patients with CHD from Belgium. Healthcare utilization comprises cardiovascular procedures, CHD physician contacts, general practitioner visits, hospitalizations, emergency department (ED) visits, intensive care unit (ICU) admissions, and specialist palliative care, and was identified using nomenclature codes. Of the 390 included patients, almost half of the study population (45%) died from a cardiovascular cause. In the last year of life, 87% of patients were hospitalized, 78% of patients had an ED visit, and 19% of patients had an ICU admission. Specialist palliative care was provided to 17% of patients, and to only 4% when looking at the patients with cardiovascular causes of death. Conclusions There is a high use of intensive and potentially avoidable care at the end of life. This may imply that end-of-life care provision can be improved. Future studies should further examine end-of-life care provision in the light of patient's needs and preferences, and how the healthcare system can adequately respond. [ABSTRACT FROM AUTHOR]

Aim: To scrutinize the economic impact of different care levels, such as shared care, in the follow-up of adult congenital heart disease (ACHD) patients. Methods: The BELgian COngenital heart disease Database combining Administrative and Clinical data (BELCODAC) was analyzed. Patients (N = 6579) were categorized into five care levels based on their cardiac follow-up pattern between 2006 and 2010. Medical costs, hospitalizations, and emergency department visits were measured between 2011 and 2015. Results: In patients with moderate lesions, highly specialized cardiac care (HSC; exclusive follow-up by ACHD specialists) and shared care with predominantly specialized cardiac care (SC+) were associated with significantly lower medical costs and resource use compared to shared care with predominantly general cardiac care (SC−) and general cardiac care (GCC). In the patient population with mild lesions, HSC was associated with better economic outcomes than SC− and GCC, but SC+ was not. HSC was associated with fewer hospitalizations (− 33%) and less pharmaceutical costs (− 46.3%) compared to SC+. Patients with mild and moderate lesions in the no cardiac care (NCC) group had better economic outcomes than those in the GCC and SC− groups, but post-hoc analysis revealed that they had a different patient profile than patients under cardiac care. Conclusion: More specialized care levels are associated with better economic outcomes in patients with mild or moderate lesions in cardiac follow-up. Shared care with strong involvement of ACHD specialists might be a management option to consider. Characteristics of patients without cardiac follow-up but good medium-term economic prospects should be further scrutinized. [ABSTRACT FROM AUTHOR]

Background: The clinical and economic burden of type 2 diabetes mellitus on society is rising. Effective and efficient preventive measures may stop the increasing prevalence, given that type 2 diabetes mellitus is mainly a lifestyle-driven disease. The Feel4Diabetes-study aimed to tackle unhealthy lifestyle (unhealthy diet, lack of physical activity, sedentary behaviour, and excess weight) of families with a child in the first grades of elementary school. These schools were located in regions with a relatively low socio-economic status in Belgium, Bulgaria, Finland, Greece, Hungary and Spain. Special attention was paid to families with a high risk of developing type 2 diabetes mellitus. Methods: The aim of this paper is to describe the detailed methodology of the intervention's cost-effectiveness analysis. Based on the health economic evaluation of the Toybox-study, both a decision analytic part and a Markov model have been designed to assess the long-term (time horizon of 70 year with one-year cycles) intervention's value for money. Data sources used for the calculation of health state incidences, transition probabilities between health states, health state costs, and health state utilities are listed. Intervention-related costs were collected by questionnaires and diaries, and attributed to either all families or high risk families only. Conclusions: The optimal use of limited resources is pivotal. The future results of the health economic evaluation of the Feel4Diabetes-study will contribute to the efficient use of those resources. [ABSTRACT FROM AUTHOR]

AbstractPurposeMethodsResultsConclusions\nIMPLICATIONS FOR REHABILITATIONSeveral high-income countries install Cash-for-Care Schemes (CCSs) by granting budgets to care users. However, little quantitative evidence exist on empowerment and client-centered care levels, due to a lack of validated scales. This research aimed to validate the Psychological Empowerment Scale (PE scale) and Client-Centered Care Questionnaire (CCCQ) in budget holders with disabilities.A survey was developed based on a literature review and experts and budget holders input. Principal Axis Factoring with direct oblimin rotation, Cronbach’s Alpha, and hypotheses testing with socio-demographic and budget characteristics as independent variables, and PE scale and CCCQ as dependent, were undertaken to assess both scales’ internal consistency and validity.A convenience sample of 224 Flemish (proxy) budget holders completed the survey. Our analysis showed a two-factor solution for both scales; for the PE scale consisting of “meaning” and “competence,” and “self-determination” and “impact,” for CCCQ consisting of items 1–7 (conduct by caregiver) and items 8–15 (autonomy). Cronbach’s Alpha of both scales was 0.94. The majority of our hypotheses were confirmed.The findings show that both scales are valid and internally consistent, meaning that they can be further tested in a respondent sample of people with disabilities and in other care contexts.In light of the current trends in the (health)care sector to stimulate empowerment and client-centered care in care users, the monitoring of this experience is important.The Psychological Empowerment Scale (PE scale) measures empowerment by means of four cognitions (meaning, competence, impact, and self-determination), while the Client-Centered Care Questionnaire (CCCQ) measures the level of client-centered care.The PE scale and CCCQ are valid and internally consistent in our sample of (proxy) budget holders with disabilities.In light of the current trends in the (health)care sector to stimulate empowerment and client-centered care in care users, the monitoring of this experience is important.The Psychological Empowerment Scale (PE scale) measures empowerment by means of four cognitions (meaning, competence, impact, and self-determination), while the Client-Centered Care Questionnaire (CCCQ) measures the level of client-centered care.The PE scale and CCCQ are valid and internally consistent in our sample of (proxy) budget holders with disabilities. [ABSTRACT FROM AUTHOR]

During the past years, several smartphone applications have been developed for radiation detection. These applications measure radiation using the smartphone camera complementary metaloxide-semiconductor sensor. They are potentially useful for data collection and personal dose assessment in case of a radiological incident. However, it is important to assess these applications. Six applications were tested by means of irradiations with calibrated X-ray and gamma sources. It was shown that the measurement stabilises only after at least 10-25 min. All applications exhibited a flat dose rate response in the studied ambient dose equivalent range from 2 to 1000 μSv h-1. Most applications significantly over-or underestimate the dose rate or are not calibrated in terms of dose rate. A considerable energy dependence was observed below 100 keV but not for the higher energy range more relevant for incident scenarios. Photon impact angle variation gave a measured signal variation of only about 10 %. [ABSTRACT FROM AUTHOR]

Food parenting practices (FPPs) have an important role in shaping children's dietary behaviors. This study aimed to investigate cross-sectional and longitudinal associations over a two-year follow-up between FPP and dietary intake and compliance with current recommendations in 6- to 11-year-old European children. A total of 2967 parent-child dyads from the Feel4Diabetes study, a randomized controlled trial of a school and community-based intervention, (50.4% girls and 93.5% mothers) were included. FPPs assessed were: (1) home food availability; (2) parental role modeling of fruit intake; (3) permissiveness; (4) using food as a reward. Children's dietary intake was assessed through a parent-reported food frequency questionnaire. In regression analyses, the strongest cross-sectional associations were observed between home availability of 100% fruit juice and corresponding intake (β = 0.492 in girls and β = 0.506 in boys, p < 0.001), and between parental role modeling of fruit intake and children's fruit intake (β = 0.431 in girls and β = 0.448 in boys, p < 0.001). In multilevel logistic regression models, results indicated that improvements in positive FPPs over time were mainly associated with higher odds of compliance with healthy food recommendations, whereas a decrease in negative FPP over time was associated with higher odds of complying with energy-dense/nutrient-poor food recommendations. Improving FPPs could be an effective way to improve children's dietary intake. [ABSTRACT FROM AUTHOR]

Positive influences of family members have been associated with a high probability of children's daily breakfast consumption. Therefore, the aim of this study was to scrutinize the association of breakfast routines between mothers and their children. The baseline data of the Feel4Diabetes-study was obtained in 9760 children (49.05% boys)–mother pairs in six European countries. A parental self-reported questionnaire gauging the frequency of breakfast consumption and of breakfast´ foods and beverages consumption was used. Agreement in routines of mothers and their children's breakfast consumption was analyzed in sex-specific crosstabs. The relationship of breakfast routine and food groups' consumption between mothers and their children was assessed with analysis of covariance. The highest proportion of children who always consumed breakfast were those whose mothers always consumed it. Children consuming breakfast regularly had a higher intake of milk or unsweetened dairy products and all kind of cereal products (low fiber and whole-grain) than occasional breakfast consumers (p < 0.05). The strong similarity between mothers and children suggests a transfer of breakfast routine from mothers to their children, as a high proportion of children who usually consume breakfast were from mothers also consuming breakfast. All breakfast foods and beverages consumption frequencies were similar between children and their mothers. [ABSTRACT FROM AUTHOR]