Intergenerational transmission of paternal trauma among US Civil War ex-POWs.

We study whether paternal trauma is transmitted to the children of survivors of Confederate prisoner of war (POW) camps during the US Civil War (1861-1865) to affect their longevity at older ages, the mechanisms behind this transmission, and the reversibility of this transmission. We examine children born after the war who survived to age 45, comparing children whose fathers were non-POW veterans and ex-POWs imprisoned in very different camp conditions. We also compare children born before and after the war within the same family by paternal ex-POW status. The sons of ex-POWs imprisoned when camp conditions were at their worst were 1.11 times more likely to die than the sons of non-POWs and 1.09 times more likely to die than the sons of ex-POWs when camp conditions were better. Paternal ex-POW status had no impact on daughters. Among sons born in the fourth quarter, when maternal in utero nutrition was adequate, there was no impact of paternal ex-POW status. In contrast, among sons born in the second quarter, when maternal nutrition was inadequate, the sons of ex-POWs who experienced severe hardship were 1.2 times more likely to die than the sons of non-POWs and ex-POWs who fared better in captivity. Socioeconomic effects, family structure, father-specific survival traits, and maternal effects, including quality of paternal marriages, cannot explain our findings. While we cannot rule out fully psychological or cultural effects, our findings are most consistent with an epigenetic explanation

What health care for undocumented migrants in Belgium?

n/

International comparative study of low back pain care pathways and analysis of key interventions

Purpose Low back pain (LBP) is a major public health problem worldwide. Significant practice variation exists despite guidelines, including strong interventionist focus by some practitioners. Translation of guidelines into pathways as integrated treatment plans is a next step to improve implementation. The goal of the present study was to analyze international examples of LBP pathways in order to identify key interventions as building elements for care pathway for LBP and radicular pain. Methods International examples of LBP pathways were searched in literature and grey literature. Authors of pathways were invited to fill a questionnaire and to participate in an in-depth telephone interview. Pathways were quantitatively and qualitatively analyzed, to enable the identification of key interventions to serve as pathway building elements. Results Eleven international LBP care pathways were identified. Regional pathways were strongly organized and included significant training efforts for primary care providers and an intermediate level of caregivers in between general practitioners and hospital specialists. Hospital pathways had a focus on multidisciplinary collaboration and stepwise approach trajectories. Key elements common to all pathways included the consecutive screening for red flags, radicular pain and psychosocial risk factors, the emphasis on patient empowerment and self-management, the development of evidence-based consultable protocols, the focus on a multidisciplinary work mode and the monitoring of patient-reported outcome measures. Conclusion Essential building elements for the construction of LBP care pathways were identified from a transversal analysis of key interventions in a study of 11 international examples of LBP pathways

Endoscopic mucosal resection of laterally spreading lesions around or involving the appendiceal orifice: technique, risk factors for failure, and outcomes of a tertiary referral cohort (with video)

Endoscopic mucosal resection (EMR) of peri-appendiceal sessile laterally spreading lesions (PA-LSLs) is technically demanding due to poor endoscopic access to the appendiceal lumen and the thin colonic wall at the base of the cecum. We aimed to assess the feasibility and safety of EMR for PA-LSLs.Consecutive LSLs ≥20 mm and PA-LSLs ≥10 mm detected at 3 academic endoscopy centers from September 2008 until January 2017 were eligible. Prospective patient, procedural, and lesion data were collected. PA-LSLs were compared with LSLs in other colonic locations.Thirty-eight PA-LSLs were compared with 1721 LSLs. Referral for surgery without an attempt at EMR was more likely with PA-LSLs (28.9% vs 5.1%, P < .001) and those that involved a greater percentage of the appendiceal orifice (AO) were less likely to be attempted (P = .038). The majority (10/11) of PA-LSLs were not attempted due to deep extension into the appendiceal lumen; 2 of 11 of these surgical specimens contained invasive cancer. Once attempted, complete clearance of visible adenoma (92.6%[PA-LSL] versus 97.6%[LSL], p=.14), adverse events, and rates of adenoma recurrence did not vary significantly between PA-LSLs and LSLs. Seven of 7 patients with prior appendicectomy achieved complete adenoma clearance. There were no cases of post-EMR appendicitis. Twenty of 22 (91%) PA-LSLs eligible for surveillance avoided surgery to longest follow-up.EMR is a safe, effective and durable treatment for PA-LSLs when specific criteria are fulfilled. If the distal margin of the PA-LSL within the appendiceal orifice cannot be visualized or more than 50% of the circumference of the orifice is involved, surgery should be considered. Clinicaltrials.gov (NTC01368289)

Transformations professionnelles du métier d’assistant social au sein des Centres publics d’action sociale, en Belgique francophone

Notre propos vise à identifier au travers du vécu des travailleurs sociaux les transformations professionnelles qu’ils constatent quant à leur métier d’assistant social, les tensions qu’ils rencontrent sur le terrain et les stratégies qu’ils mettent en place. Nous le faisons au départ de l’observation que nous avons du fonctionnement des Centres publics d’action sociale (CPAS) en Région wallonne. Le métier d’assistant social en CPAS subit, depuis plus de vingt ans, une double évolution. La pr..

Verspreiding en implementatie van klinische richtlijnen in België : Synthese

18 p.ill.SYNTHESE 4 -- 1. DOEL EN INHOUD VAN DE STUDIE 6 -- 1.1. DELEN VAN DE STUDIE 6 -- 1.2. WAT IS EEN KLINISCHE PRAKTIJKRICHTLIJN? 7 -- 2. BEVINDINGEN UIT DE LITERATUUR: POSITIEF MAAR BEPERKT EFFECT VAN -- VERSPREIDINGSINTERVENTIES 7 -- 2.1. OP ZORGVERLENERS GERICHTE INTERVENTIES VOOR DE VERSPREIDING VAN -- RICHTLIJNEN . 7 -- 2.2. IMPACT OP KLINISCHE PRAKTIJK EN PATIËNTUITKOMSTEN . 9 -- 2.3. FACTOREN DIE HET EFFECT VAN DE VERSPREIDING VAN RICHTLIJNEN BEÏNVLOEDEN . 9 -- 2.4. VOORZICHTIGHEID BIJ HET INTERPRETEREN VAN DE RESULTATEN 10 -- 3. ONTWIKKELING VAN RICHTLIJNEN IN BELGIË: DE VOORBEREIDENDE STAP VÓÓR -- VERSPREIDING . 10 -- 3.1. KEUZE VAN DE ONDERWERPEN EN AUTEURSCHAP . 10 -- 3.2. LOKALE VERSUS GEÏMPORTEERDE RICHTLIJNEN . 10 -- 3.3. VALIDATIE: EEN BELANGRIJK MAAR DUBBELZINNIG CONCEPT 11 -- 3.4. OPVATTINGEN OVER BUDGETTEN ZIJN NIET DUIDELIJK 11 -- 4. HET COMPLEXE LANDSCHAP VAN VERSPREIDING VAN RICHTLIJNEN IN BELGIUM 11 -- 4.1. DE BELGISCHE LAPPENDEKEN VAN VERSPREIDING VAN RICHTLIJNEN 11 -- 4.2. SUGGESTIES VOOR EEN DOELTREFFENDE VERSPREIDING: INZICHTEN UIT DE LITERATUUR -- EN UIT DE INTERVIEWS 12 -- 5. MIDDELEN TOT VERBETERING . 13 -- 5.1. EEN UNIEK PLATFORM VOOR DE UITGEBREIDE VERSPREIDING VAN KLINISCHE -- PRAKTIJKRICHTLIJNEN IN BELGIË 13 -- 5.1.1. Eén coördinerend comité .13 -- 5.1.2. Eén gemeenschappelijke databank van kwaliteitsvolle richtlijnen 13 -- 5.2. DUIDELIJKE BOODSCHAPPEN, VERSCHILLENDE FORMATEN . 14 -- 5.3. LOKALE RICHTLIJNEN VERSUS EEN IMPORTSTRATEGIE 14 -- 5.4. EEN LABEL VOOR RICHTLIJNEN VAN HOGE KWALITEIT . 14 -- 5.5. ANDERE VOORWAARDEN VOOR SUCCES . 15 -- 5.5.1. Multimodale interventies die een voorzichtige overstap naar elektronische ondersteunende -- systemen inhouden . 15 -- 5.5.2. De houding van zorgverleners ten aanzien van EBM en richtlijnen 15 -- 5.5.3. Betrokkenheid van eindgebruikers en vertaling van informatie voor de patiënten . 15 -- 5.5.4. Budgetten . 15 -- 5.5.5. Een gezondheidszorgsysteem op één lijn met de filosofie van de richtlijnen 15 -- 6. DISCUSSIE 16 -- AANBEVELINGEN 1

Dissémination et mise en oeuvre des guides de pratique clinique en Belgique : Synthèse

18 p.ill.SYNTHÈSE 4 -- 1. OBJECTIF ET CONTENU DE L’ÉTUDE 6 -- 1.1. UNE ÉTUDE EN TROIS PARTIES 6 -- 1.2. QU’EST-CE QU’UN GUIDE DE PRATIQUE CLINIQUE ? 6 -- 2. LA LITTÉRATURE CONCLUT À UN EFFET POSITIF MAIS LIMITÉ DES INTERVENTIONS DE DISSÉMINATION 7 -- 2.1. INTERVENTIONS AUPRÈS DES PROFESSIONNELS POUR LA DISSÉMINATION DES GUIDES DE PRATIQUE CLINIQUE 7 -- 2.2. IMPACT SUR LA PRATIQUE CLINIQUE ET SUR LES RÉSULTATS AU NIVEAU DU PATIENT 9 -- 2.3. FACTEURS QUI INFLUENCENT L’EFFET PRODUIT PAR LA DISSÉMINATION DES GUIDES 9 -- 2.4. PRUDENCE LORS DE L’INTERPRÉTATION DES RÉSULTATS 10 -- 3. L’ÉLABORATION DE GUIDES EN BELGIQUE : UNE ÉTAPE PRÉLIMINAIRE AVANT LA DISSÉMINATION 10 -- 3.1. CHOIX DES THÈMES ET DES AUTEURS 10 -- 3.2. GUIDES ‘MAISON’ PAR RAPPORT AUX GUIDES IMPORTÉS 10 -- 3.3. VALIDATION : UN CONCEPT IMPORTANT MAIS AMBIGU 11 -- 3.4. DES CONSIDÉRATIONS BUDGÉTAIRES FLOUES 11 -- 4. LE PAYSAGE COMPLEXE DE LA DISSÉMINATION DES GUIDES DE PRATIQUE CLINIQUE EN BELGIQUE 11 -- 4.1. LA DISSÉMINATION DES GUIDES DE PRATIQUE CLINIQUE EN BELGIQUE : UN PATCHWORK11 -- 4.2. SUGGESTIONS POUR UNE DISSÉMINATION EFFICACE : ÉCLAIRAGES EXTRAITS DE LA LITTÉRATURE ET DES ENTRETIENS 12 -- 5. PISTES D’AMÉLIORATION 13 -- 5.1. UNE PLATE-FORME UNIQUE POUR UNE DISSÉMINATION GLOBALE DES GUIDES DE PRATIQUE CLINIQUE EN BELGIQUE 13 -- 5.1.2. Une base de données commune de guides de bonne qualité 13 -- 5.2. DES MESSAGES CLAIRS SOUS DES FORMATS DIVERS 14 -- 5.3. IMPORTER DES GUIDES DE PRATIQUE CLINIQUE ? 14 -- 5.4. UN LABEL POUR LES GUIDES DE BONNE QUALITÉ 14 -- 5.5. AUTRES CONDITIONS DE RÉUSSITE 15 -- 5.5.1. Interventions multifacettes impliquant une évolution prudente vers des systems électroniques 15 -- 5.5.2. Comportement des professionnels envers l’evidence-based medicine (EBM) et les guides 15 -- 5.5.3. Implication des utilisateurs et traduction de l’information pour les patients 15 -- 5.5.4. Budgets 15 -- 5.5.5. Un système de soins de santé en phase avec la philosophie des guides 15 -- 6. DISCUSSION 16 -- RECOMMANDATIONS 1

Use of the Belrai suite in rehabilitation care : Synthesis

14 p.ill.,FOREWORD 1 -- KEY MESSAGES 2 -- SYNTHESIS 4 -- 1 CONTEXT 5 -- 2 INTERRAI AND BELRAI 5 -- 3 RESULTS 8 -- 3.1 CAN THE INTERRAI/BELRAI SUITE BE USED FOR ASSESSING THE REHABILITATION NEEDS OF THE INDIVIDUAL PATIENT? 8 -- 3.1.1 Use of the interRAI/BelRAI suite in the specialised rehabilitation services (Sp services) 8 -- 3.1.2 Use of the interRAI/BelRAI suite in the Centres for Ambulatory Rehabilitation (CARs) 8 -- 3.1.3 InterRAI suite in relation to the International Classification of Functioning, Disability and Health (ICF) and Functional Independence Measurement (FIM) 8 -- 3.2 CAN THE INTERRAI/BELRAI SUITE ALSO BE USED TO ALLOCATE BUDGETS FOR REHABILITATION CARE? 9 -- 3.2.1 Case-mix financing 9 -- 3.2.2 Validation of the interRAI suite for calculation of a case-mix financing system 10 -- 4.NEXT STEPS 10 -- RECOMMENDATIONS 12 -- REFERENCES 1