Effects of a computerized psychological inoculation intervention on condom use tendencies in sub Saharan and Caucasian students : two feasibility trials

Objective: An effective method for preventing the Human Immunodeficiency Virus (HIV) is condom use. Yet, research shows limited effects of education on increasing condom use. This research examined the effects of psychological inoculation (PI) versus education on condom use -barriers and -tendencies, using a fully automatized online system. Design: Two randomized controlled trials. In Study 1, 59 Sub-Saharan students were included while Study 2 20 European students were included. In both studies, participants were randomly assigned to PI or control conditions. In Study 2, we additionally matched pairs on gender and condom barriers. In the PI, participants received challenging sentences they had to refute. Main outcome measures: An indirect condom use test (I-CUTE) and a condom use barriers questionnaire, assessed at baseline and a month later. Results: In Study 1, a significant increase in I-CUTE scores and no change in barriers was found in the PI condition. Controls did not change on either outcome. In Study 2, two sub-scales of condom barriers (concerning partner and satisfaction) were significantly decreased in the PI group, while in controls, barriers significantly increased over time. In both groups, I-CUTE scores tended to increase. Conclusions: These results replicate previous studies and extend them to a fully automatized system without counselors

Preferences of patients with advanced lung cancer regarding the involvement of family and others in medical decision-making

Objective: To explore the preferences of competent patients with advanced lung cancer regarding involvement of family and/or others in their medical decision-making, and their future preferences in case of loss of competence. Methods: Over 1 year, physicians in 13 hospitals in Flanders, Belgium, recruited patients with initial non-small-cell lung cancer, stage IIIb or IV. The patients were interviewed with a structured questionnaire every 2 months until the fourth interview and every 4 months until the sixth interview. Results: At inclusion, 128 patients were interviewed at least once; 13 were interviewed 6 consecutive times. Sixty-nine percent of patients wanted family members to be involved in medical decision-making and this percentage did not change significantly over time. One third of these patients did not achieve this preference. Ninety-four percent of patients wanted family involvement if they lost competence, 23% of these preferring primary physician control over decision-making, 41% shared physician and family control, and 36% primary family control. This degree of preferred family involvement expressed when competent did not change significantly over time at population level, but did at individual level; almost half the patients changed their minds either way at some point during the observation period. Conclusions: The majority of patients with lung cancer wanted family involvement in decision-making, and almost all did so in case of future loss of competence. However, as half of the patients changed their minds over time about the degree of family involvement they wanted if they lost competence, physicians should regularly rediscuss a patient's preferences

Is educational attainment related to end-of-life decision-making? A large post-mortem survey in Belgium

BACKGROUND: Educational attainment has been shown to influence access to and quality of health care. However, the influence of educational attainment on decision-making at the end of life with possible or certain life-shortening effect (ELDs ie intensified pain and symptom alleviation, non-treatment decisions, euthanasia/physician-assisted suicide, and life-ending acts without explicit request) is scarcely studied. This paper examines differences between educational groups pertaining to prevalence of ELDs, the decision-making process and end-of-life treatment characteristics. METHOD: We performed a retrospective survey among physicians certifying a large representative sample of Belgian deaths in 2007. Differences between educational groups were adjusted for relevant confounders (age, sex, cause of death and marital status). RESULTS: Intensified pain and symptom alleviation and non-treatment decisions are more likely to occur in higher educated than in lower educated patients. These decisions were less likely to be discussed with either patient or family, or with colleague physicians, in lower educated patients. A positive association between education and prevalence of euthanasia/assisted suicide (acts as well as requests) disappeared when adjusting for cause of death. No differences between educational groups were found in the treatment goal in the last week, but higher educated patients were more likely to receive opioids in the last day of life. CONCLUSION: There are some important differences and possible inequities between educational groups in end-of-life decision-making in Belgium. Future research should investigate whether the found differences reflect differences in knowledge of and adherence to patient preferences, and indicate a discrepancy in quality of the end of life

Dark Ages woodland recovery and the expansion of beech : a study of land use changes and related woodland dynamics during the Roman to Medieval transition period in northern Belgium

The results from analyses of botanical remains (pollen, wood, charcoal, seeds) from several archaeological features excavated in Kluizen (northern Belgium) are presented. The region was largely uninhabited until the Iron Age and Roman period when a rural settlement was established, resulting in small-scale woodland clearance. The site was subsequently abandoned fromc.AD 270 till the High Middle Ages. The results of the archaeological and archaeobotanical analyses provide information on changes in land use and resulting dynamics of woodland cover and composition betweenc.600 BC and AD 1200, with a spatial and temporal resolution unrivalled in northern Belgium. Especially the long period of woodland regeneration following abandonment of the site around AD 270, covering the Late Roman and Early Medieval period, could be reconstructed in detail. Abandoned fields were first covered with pioneer woodland (Salix,CorylusandBetula), thenQuercus-dominated secondary forest and finally a late-successional forest withFagus sylvatica,Carpinus betulusandIlex aquifolium, an evolution that took over 300 years. The results also indicate that the observed increase ofFagusduring the Early Middle Ages, which was never an important element in the woodland vegetation in northern Belgium before, was related to climatic changes rather than anthropogenic factors

Vroegmiddeleeuws Maalte onder The Loop. Een nieuwe blik op het grootschalig archeologisch onderzoek van de 7de- tot de 9de-eeuwse nederzetting in Sint-Denijs-Westrem (Gent, Oost-Vlaanderen)

Het syntheseonderzoek over de vroegmiddeleeuwse nederzetting op The Loop (Sint-Denijs- Westrem, Gent) had als doel om de resultaten van zeven verschillende archeologische opgravingen op The Loop, samen te brengen, te uniformiseren en voor het eerst deze dataset als geheel te onderzoeken. De nederzetting op The Loop (Sint-Denijs-Westrem, Gent) werd gesticht in het prille begin van de 7de eeuw en werd continu bewoond tot het midden van de 9de eeuw. De sporen van deze langdurige bewoning verspreiden zich over zon 2,5 ha. In totaal kunnen nu elf mogelijke hoofdgebouwen, twee grote bijgebouwen, veertien kleinere bijgebouwen, negentien waterputten, een uitgebreide omgrachting en talrijke andere sporen geïdentificeerd worden. Het bijzondere van deze vroegmiddeleeuwse nederzetting is de schaal waarop ze is vastgestelden opgegraven. Deze schaal is vrij uniek in Vlaanderen. Dendrochronologisch onderzoek van de waterputten zorgde voor een fijn chronologisch kader, waardoor de ontwikkeling van de nederzetting gedurende bijna drie eeuwen nauwgezet gevolgd kan worden. Een dergelijke resolutie was tot nu toe meestal onbereikbaar bij andere archeologisch onderzochte vroegmiddeleeuwse rurale nederzettingen. Volgens onderzoek op de hoofdgebouwen, waterputten en erven, in combinatie met historisch-geografisch en ecologisch onderzoek, werd de nederzetting bewoond door een familiegroep met generatielange, lokale tradities in de bouw van huizen, waterputten en erfinrichting. Het ging om een grotendeels zelfvoorzienende gemeenschap, gebaseerd op gemengde landbouw. Landschappelijk was ze ingebed tussen meersen, akkerland, bos en wastine. De nederzetting op The Loop bestaat in haar beginfases uit één tot twee gelijktijdige erven. Rond het midden van de 8ste eeuw wordt een grootschalige herinrichting van de nederzetting ondernomen, met de aanleg van een grote, open enclosure met daarin een erf. Deze inrichting wordt één fase later, tegen het einde van de 8ste eeuw, alweer verlaten. Historisch en vergelijkend archeologisch onderzoek linkt deze herinrichting aan een grootgrondbezitter. Waarschijnlijk werd de nederzetting in de 8ste of 9de eeuw het bezit van de Sint-Pietersabdij. Die legde surplusproductie op, die de nederzetting waarschijnlijk voldeed via varkensteelt. De precieze redenen achter de oprichting en opgave van de enclosure blijven onduidelijk. Waarschijnlijk werkten topdown en bottom-up processen hier samen. Na de opgave keert de nederzetting terug naar het karakter uit haar begindagen, tot ze verlaten wordt rond het midden van de 9de eeuw. Deze informatie is niet alleen uitermate relevant voor The Loop zelf, maar biedt ook een waardevolle en broodnodige kapstok om andere vroegmiddeleeuwse nederzettingen in de regio verder te onderzoeken. De verschillende nieuwe inzichten uit onderzoek bieden een wetenschappelijk verantwoorde blik op het dagdagelijkse leven op een vroegmiddeleeuwse boerderij ten zuiden van Gent. Een reeks van reconstructieschilderijen licht het bredere publiek in over deze nieuwe kennis

Epidemiology of intra-abdominal infection and sepsis in critically ill patients: "AbSeS", a multinational observational cohort study and ESICM Trials Group Project.

PURPOSE: To describe the epidemiology of intra-abdominal infection in an international cohort of ICU patients according to a new system that classifies cases according to setting of infection acquisition (community-acquired, early onset hospital-acquired, and late-onset hospital-acquired), anatomical disruption (absent or present with localized or diffuse peritonitis), and severity of disease expression (infection, sepsis, and septic shock). METHODS: We performed a multicenter (n = 309), observational, epidemiological study including adult ICU patients diagnosed with intra-abdominal infection. Risk factors for mortality were assessed by logistic regression analysis. RESULTS: The cohort included 2621 patients. Setting of infection acquisition was community-acquired in 31.6%, early onset hospital-acquired in 25%, and late-onset hospital-acquired in 43.4% of patients. Overall prevalence of antimicrobial resistance was 26.3% and difficult-to-treat resistant Gram-negative bacteria 4.3%, with great variation according to geographic region. No difference in prevalence of antimicrobial resistance was observed according to setting of infection acquisition. Overall mortality was 29.1%. Independent risk factors for mortality included late-onset hospital-acquired infection, diffuse peritonitis, sepsis, septic shock, older age, malnutrition, liver failure, congestive heart failure, antimicrobial resistance (either methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, extended-spectrum beta-lactamase-producing Gram-negative bacteria, or carbapenem-resistant Gram-negative bacteria) and source control failure evidenced by either the need for surgical revision or persistent inflammation. CONCLUSION: This multinational, heterogeneous cohort of ICU patients with intra-abdominal infection revealed that setting of infection acquisition, anatomical disruption, and severity of disease expression are disease-specific phenotypic characteristics associated with outcome, irrespective of the type of infection. Antimicrobial resistance is equally common in community-acquired as in hospital-acquired infection

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake