Belgium

This paper looks at the journey of eleven counsellors in marital counselling centres in French-speaking Belgium, from the creation of the centres in 1953, to the 1970s, when contraception became legal, and abortion became a public issue. At the time of Humanae Vitae, groups of volunteers, working within Catholic organisations where counselling took place, began to structure their activity around Carl Rogers’s ethics of client-centred therapy, placing their religious ideology in a secondary position to focus on the problems experienced by the couples and women they were receiving in the centres. These were often challenges they were experiencing themselves in their own lives. The reiteration of the Catholic orthodox view on contraception through Humanae Vitae marked a gap between the counsellors and the Church. This contribution questions the identity-related tension of Catholics working in conjugal counselling centres and the type of commitments they made to both the conjugal centre...

Objective.To report baseline and followup data on the first 438 patients with systemic sclerosis (SSc) included in the Belgian Systemic Sclerosis Cohort.Methods.According to LeRoy and Medsger’s classification, 73 patients with limited SSc (lSSc), 279 with limited cutaneous SSc (lcSSc), and 86 with diffuse cutaneous SSc (dcSSc) were included. History was collected and clinical examination, blood tests, and paraclinical investigations were repeated. The Disease Activity Score (DAS) and Disease Severity Score (DSS) of several organ systems were computed. An organ system was considered to demonstrate SSc if the corresponding DSS was ≥ 1.Results.At baseline, patients with dcSSc had more general, joint/tendon, muscle, gastrointestinal, and kidney involvement. Mean DLCO was below normal in patients with lSSc, indicating unsuspected lung involvement. Patients with anti-Scl-70 had more vascular, skin, joint/tendon, and lung involvement. Patients with anti-RNA polymerase III had more skin and...

Background: The objective of this study was to analyse the impact of acute surgery for native aortic valve endocarditis and its influence on the long-term prognosis after surgery. Methods: A total of 161 patients underwent aortic valve replacement for native active aortic valve endocarditis (NAAVE) during a 29-year period, from 1967 to 1995 (age range: 10 to 72 years; mean 48 ± 12). The main indication for surgery was progressive congestive heart failure (76%). Other indications were unbeatable sepsis (27%), peripheral or central emboli (12%) and, from 1978, echocardiographic evidence of friable, pedunculated vegetations (3%). Streptococcal and staphylococcal infections predominated. Concomitant procedures were performed in 27% of the patients, including mitral and tricuspid valve surgery and coronary bypass procedures. Results: Operative mortality was 8% in the majority of cases caused by heart failure or multiorgan failure. Multivariate logistic regression analysis identified NYHA class IV to be an independent predictor for postoperative death. Long-term survival for discharged patients was 75% at 10 years and 58% at 15 years, with a mortality rate of 3.6%/patient/year. Cox regression analysis identified the year of operation, trivalvular endocarditis and staphylococcal infection as independent predictors of survival. At 10 and 15 years after aortic valve replacement, 91% and 84% of the patients, respectively, were free of recurrent endocarditis. The presence of an abscess cavity at first operation was found to be predictive of recurrent endocarditis. Conclusions: Valve replacement for NAAVE offers a good chance for a cure and satisfactory long-term survival. Improvements in pre- and per-op-rative management of the very ill patient, and the use of allograft valves are likely to further improve long-term results. Finally, the presence of staphylococcal endocarditis requires long-term postoperative antibiotic therapy.

The continued professionalization of the humanitarian workforce requires sound underpinning by appropriate educational programs. The international disaster medicine and emergency health community requested the World Association for Disaster and Emergency Medicine (WADEM) develop international standards and guidelines for the education and training for disaster medicine. The Working Group of the WADEM Education Committee prepared and circulated an Issues Paper to structure input on this significant international task. Subsequently, the Working Group facilitated an Open International Meeting convened in Brussels, Belgium, 2004. The "Issues Paper" also was used as a framework to structure this International Meeting, which utilized case studies selected to represent the scope of disaster medicine, and prepared a meeting consensus on a framework for disaster health and for related educational programs. The two-day Brussels meeting attracted 51 participants from 19 countries, re...

La conférence s’attache à préciser les rapports entre enseignement de la citoyenneté et enseignement de la religion. Elle constate le changement de contexte de cette problématique qui remonte au XIXe siècle, mais dont les coordonnées sont tout à fait nouvelles. Nous vivons le « second désenchantement du monde », qui porte non sur la religion mais sur les idéaux modernes. La religion s’est repositionnée dans les sociétés sécularisées, ce dont témoigne la réorientation du cours de religion en Belgique francophone depuis les années 1970-1980. D’un côté, la religion a progressivement effectué une critique interne, articulée à l’expérience de la citoyenneté démocratique. D’un autre côté, la citoyenneté moderne constitue un discours et une pratiques incomplètes et insuffisantes sur le plan moral. Elle n’est émancipatrice que si elle reconnaît cette limite.  Les rapports entre citoyenneté et religion sont donc de limitation et de complémentarité réciproques.

The problem of poor compliance/adherence to prescribed treatments is very complex. Health professionals are rarely being asked how they handle the patient's (poor) therapy compliance/adherence. In this study, we examine explicitly the physicians' expectations of their diabetes patients' compliance/adherence. The objectives of our study were: (1) to elicit problems physicians encounter with type 2 diabetes patients' adherence to treatment recommendations; (2) to search for solutions and (3) to discover escape mechanisms in case of frustration. In a descriptive qualitative study, we explored the thoughts and feelings of general practitioners (GPs) on patients' compliance/adherence. Forty interested GPs could be recruited for focus group participation. Five open ended questions were derived on the one hand from a similar qualitative study on compliance/adherence in patients living with type 2 diabetes and on the other hand from the results of a comprehensive review ...

BACKGROUND: In longitudinal cohort studies, subjects may be lost to follow-up at any time during the study. This leads to attrition and thus to a risk of inaccurate and biased estimations. The purpose of this paper is to show how multiple imputation can take advantage of all the information collected during follow-up in order to estimate the cumulative probability P(E) of an event E, when the first occurrence of this event is observed at t successive time points of a longitudinal study with attrition.

METHODS: We compared the performance of multiple imputation with that of Kaplan-Meier estimation in several simulated attrition scenarios.

RESULTS: In missing-completely-at-random scenarios, the multiple imputation and Kaplan-Meier methods performed well in terms of bias (less than 1%) and coverage rate (range = [94.4%; 95.8%]). In missing-at-random scenarios, the Kaplan-Meier method was associated with a bias ranging from -5.1% to 7.0% and with a very poor coverage rate (as low as 0.2%). Multiple imputation performed much better in this situation (bias <2%, coverage rate >83.4%).

CONCLUSIONS: Multiple imputation shows promise for estimation of an occurrence rate in cohorts with attrition. This study is a first step towards defining appropriate use of multiple imputation in longitudinal studies.

Cardiac surgery in Jehovah&#39;s Witnesses may be challenging during the operation and postoperative period given their refusal of blood products. The aim of this study was to document our center&#39;s experience with Jehovah&#39;s Witnesses undergoing major cardiac surgery and to compare surgical outcomes with a matched control group. We retrospectively reviewed the demographic, perioperative, and in-hospital postoperative data for 31 Jehovah&#39;s Witness patients undergoing surgery from 1991 to 2012 and compared findings with a control group of 62 patients of the same sex and age, who underwent the same type of operations in the same period. Early mortality, major in-hospital morbidity, laboratory findings, and hospital stays were compared between groups. Demographic data were similar between groups, except that more patients in the Jehovah&#39;s Witness group had extracardiac arteriopathy compared with controls (p = 0.04). There was no difference in predicted mortality, calculat...

In a working group of the Belgian Hospital Physicists Association (BHPA), a new protocol has been developed for comprehensive testing of computed tomography scanners. The tests were selected to verify if the scanner is technically adequate, if preprogrammed patient protocols are up-to-date, and if exposure values displayed at the console are sufficiently correct. In addition, they will ensure that the participating medical physics expert (MPE) gets a full understanding of the system to enable him/her to guide optimization processes and allow automated patient dosimetry. Several new test procedures had to be developed. The tests go beyond the criteria identified in the EC guidance document radiation protection (RP) 91 and its successor RP 162. The results of the tests of the BHPA protocol are discussed in the light of the acceptability criteria in RP 91 and RP 162. It is concluded that the ensemble of tests in the BHPA protocol and in RP 162 provide very useful information on the sca...

Apres un rappel concernant l&#39;histoire des editions Marabout depuis l&#39;immediat apres-guerre, l&#39;article s&#39;interesse aux deux collections destinees a la jeunesse : &#39;Marabout Junior&#39; avec comme heros recurrent Bob Morane, et &#39;Marabout Mademoiselle&#39;, avec comme personnage principal Sylvie, hotesse de l&#39;air. C&#39;est ce personnage, cree en 1954 par l&#39;ecrivain Rene Philippe, qui retient ensuite toute l&#39;attention, en particulier parce que l&#39;etude s&#39;attache a la maniere dont cette serie destinee aux jeunes filles se fait l&#39;echo du monde colonial (le Congo belge), puis de la decolonisation et enfin du tiers-mondisme.