'Breaking the silence' : sexual victimisation in an old age psychiatry patient population in Flanders

Background: Sexual violence (SV) is linked to mental health problems in adulthood and old age. However, the extent of sexual victimisation in old age psychiatry patients is unknown. Due to insufficient communication skills in both patients and healthcare workers, assessing SV in old age psychiatry patients is challenging. Methods: Between July 2019 and March 2020, 100 patients at three old age psychiatry wards across Flanders participated in a face-to-face structured interview receiving inpatient treatment. The participation rate was 58%. We applied the WHO definition of SV, encompassing sexual harassment, sexual abuse with physical contact without penetration, and (attempted) rape. Outcomes: In 57% of patients (65% F, 42% M) SV occurred during their lifetime and 7% (6% F, 9% M) experienced SV in the past 12-months. Half of the victims disclosed their SV experience for the first time during the interview. Only two victims had disclosed SV to a mental health care professional before. Interpretation: Sexual victimisation appears to be common in old age psychiatry patients, yet it remains largely undetected. Although victims did reveal SV during a face-to-face interview to a trained interviewer, they do not seem to spontaneously disclose their experiences to mental health care professionals. In order to provide tailored care for older SV victims, professionals urgently need capacity building through training, screening tools and care procedures

Toxicity Ranking and Toxic Mode of Action Evaluation of Commonly Used Agricultural Adjuvants on the Basis of Bacterial Gene Expression Profiles

The omnipresent group of pesticide adjuvants are often referred to as “inert” ingredients, a rather misleading term since consumers associate this term with “safe”. The upcoming new EU regulation concerning the introduction of plant protection products on the market (EC1107/2009) includes for the first time the demand for information on the possible negative effects of not only the active ingredients but also the used adjuvants. This new regulation requires basic toxicological information that allows decisions on the use/ban or preference of use of available adjuvants. In this study we obtained toxicological relevant information through a multiple endpoint reporter assay for a broad selection of commonly used adjuvants including several solvents (e.g. isophorone) and non-ionic surfactants (e.g. ethoxylated alcohols). The used assay allows the toxicity screening in a mechanistic way, with direct measurement of specific toxicological responses (e.g. oxidative stress, DNA damage, membrane damage and general cell lesions). The results show that the selected solvents are less toxic than the surfactants, suggesting that solvents may have a preference of use, but further research on more compounds is needed to confirm this observation. The gene expression profiles of the selected surfactants reveal that a phenol (ethoxylated tristyrylphenol) and an organosilicone surfactant (ethoxylated trisiloxane) show little or no inductions at EC20 concentrations, making them preferred surfactants for use in different applications. The organosilicone surfactant shows little or no toxicity and good adjuvant properties. However, this study also illustrates possible genotoxicity (induction of the bacterial SOS response) for several surfactants (POEA, AE, tri-EO, EO FA and EO NP) and one solvent (gamma-butyrolactone). Although the number of compounds that were evaluated is rather limited (13), the results show that the used reporter assay is a promising tool to rank commonly used agricultural adjuvants based on toxicity and toxic mode of action data

Inter-method reliability of the modified Rankin Scale in patients with subarachnoid hemorrhage

BACKGROUND AND OBJECTIVES: The modified Rankin Scale (mRS) is one of the most frequently used outcome measures in trials in patients with an aneurysmal subarachnoid hemorrhage (aSAH). The assessment method of the mRS is often not clearly described in trials, while the method used might influence the mRS score. The aim of this study is to evaluate the inter-method reliability of different assessment methods of the mRS. METHODS: This is a prospective, randomized, multicenter study with follow-up at 6 weeks and 6 months. Patients aged ≥ 18 years with aSAH were randomized to either a structured interview or a self-assessment of the mRS. Patients were seen by a physician who assigned an mRS score, followed by either the structured interview or the self-assessment. Inter-method reliability was assessed with the quadratic weighted kappa score and percentage of agreement. Assessment of feasibility of the self-assessment was done by a feasibility questionnaire. RESULTS: The quadratic weighted kappa was 0.60 between the assessment of the physician and structured interview and 0.56 between assessment of the physician and self-assessment. Percentage agreement was, respectively, 50.8 and 19.6%. The assessment of the mRS through a structured interview and by self-assessment resulted in systematically higher mRS scores than the mRS scored by the physician. Self-assessment of the mRS was proven feasible. DISCUSSION: The mRS scores obtained with different assessment methods differ significantly. The agreement between the scores is low, although the reliability between the assessment methods is good. This should be considered when using the mRS in clinical trials. TRIAL REGISTRATION: www.trialregister.nl; Unique identifier: NL7859. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00415-021-10880-4

Implementation of a program for type 2 diabetes based on the Chronic Care Model in a hospital-centered health care system: "the Belgian experience"

Background: Most research publications on Chronic Care Model (CCM) implementation originate from organizations or countries with a well-structured primary health care system. Information about efforts made in countries with a less well-organized primary health care system is scarce. In 2003, the Belgian National Institute for Health and Disability Insurance commissioned a pilot study to explore how care for type 2 diabetes patients could be organized in a more efficient way in the Belgian healthcare setting, a setting where the organisational framework for chronic care is mainly hospital-centered. Methods: Process evaluation of an action research project (2003-2007) guided by the CCM in a well-defined geographical area with 76,826 inhabitants and an estimated number of 2,300 type 2 diabetes patients. In consultation with the region a program for type 2 diabetes patients was developed. The degree of implementation of the CCM in the region was assessed using the Assessment of Chronic Illness Care survey (ACIC). A multimethod approach was used to evaluate the implementation process. The resulting data were triangulated in order to identify the main facilitators and barriers encountered during the implementation process. Results: The overall ACIC score improved from 1.45 (limited support) at the start of the study to 5.5 (basic support) at the end of the study. The establishment of a local steering group and the appointment of a program manager were crucial steps in strengthening primary care. The willingness of a group of well-trained and motivated care providers to invest in quality improvement was an important facilitator. Important barriers were the complexity of the intervention, the lack of quality data, inadequate information technology support, the lack of commitment procedures and the uncertainty about sustainable funding. Conclusion: Guided by the CCM, this study highlights the opportunities and the bottlenecks for adapting chronic care delivery in a primary care system with limited structure. The study succeeded in achieving a considerable improvement of the overall support for diabetes patients but further improvement requires a shift towards system thinking among policy makers. Currently primary care providers lack the opportunities to take up full responsibility for chronic care

FLAMINGO: calibrating large cosmological hydrodynamical simulations with machine learning

To fully take advantage of the data provided by large-scale structure surveys, we need to quantify the potential impact of baryonic effects, such as feedback from active galactic nuclei (AGN) and star formation, on cosmological observables. In simulations, feedback processes originate on scales that remain unresolved. Therefore, they need to be sourced via subgrid models that contain free parameters. We use machine learning to calibrate the AGN and stellar feedback models for the FLAMINGO (Fullhydro Large-scale structure simulations with All-sky Mapping for the Interpretation of Next Generation Observations) cosmological hydrodynamical simulations. Using Gaussian process emulators trained on Latin hypercubes of 32 smaller volume simulations, we model how the galaxy stellar mass function (SMF) and cluster gas fractions change as a function of the subgrid parameters. The emulators are then fit to observational data, allowing for the inclusion of potential observational biases. We apply our method to the three different FLAMINGO resolutions, spanning a factor of 64 in particle mass, recovering the observed relations within the respective resolved mass ranges. We also use the emulators, which link changes in subgrid parameters to changes in observables, to find models that skirt or exceed the observationally allowed range for cluster gas fractions and the SMF. Our method enables us to define model variations in terms of the data that they are calibrated to rather than the values of specific subgrid parameters. This approach is useful, because subgrid parameters are typically not directly linked to particular observables, and predictions for a specific observable are influenced by multiple subgrid parameters

Effect of sitagliptin on cardiovascular outcomes in type 2 diabetes

BACKGROUND: Data are lacking on the long-term effect on cardiovascular events of adding sitagliptin, a dipeptidyl peptidase 4 inhibitor, to usual care in patients with type 2 diabetes and cardiovascular disease. METHODS: In this randomized, double-blind study, we assigned 14,671 patients to add either sitagliptin or placebo to their existing therapy. Open-label use of antihyperglycemic therapy was encouraged as required, aimed at reaching individually appropriate glycemic targets in all patients. To determine whether sitagliptin was noninferior to placebo, we used a relative risk of 1.3 as the marginal upper boundary. The primary cardiovascular outcome was a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for unstable angina. RESULTS: During a median follow-up of 3.0 years, there was a small difference in glycated hemoglobin levels (least-squares mean difference for sitagliptin vs. placebo, -0.29 percentage points; 95% confidence interval [CI], -0.32 to -0.27). Overall, the primary outcome occurred in 839 patients in the sitagliptin group (11.4%; 4.06 per 100 person-years) and 851 patients in the placebo group (11.6%; 4.17 per 100 person-years). Sitagliptin was noninferior to placebo for the primary composite cardiovascular outcome (hazard ratio, 0.98; 95% CI, 0.88 to 1.09; P<0.001). Rates of hospitalization for heart failure did not differ between the two groups (hazard ratio, 1.00; 95% CI, 0.83 to 1.20; P = 0.98). There were no significant between-group differences in rates of acute pancreatitis (P = 0.07) or pancreatic cancer (P = 0.32). CONCLUSIONS: Among patients with type 2 diabetes and established cardiovascular disease, adding sitagliptin to usual care did not appear to increase the risk of major adverse cardiovascular events, hospitalization for heart failure, or other adverse events

Diminution du taux d&#039;examen des pieds dans les Cliniques du Diabète en Belgique: résultats d&#039;audits réalisés dans le cadre d&#039;un programme d&#039;audit-feedback mis en place pour améliorer la qualité des soins

&lt;p&gt;&lt;strong&gt;But:&lt;/strong&gt; Evaluer comment les Cliniques du Diabète Reconnues Belges réalisent l’examen annuel des pieds, qui leur est prescrit et l’impact de 13 ans d’effort du programme d’audit-feedback mis en place pour améliorer la qualité des soins.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Méthodes:&lt;/strong&gt; Revue des résultats des 4 audits réalisés en 2001, 2006, 2011 et 2014. Pour chaque audit, un échantillon de 10% des patients est déterminé (2519, 2317, 3528 et 3750 patients en 2001, 2006, 2011 et 2014 respectivement). La &amp;nbsp;population consiste en diabétiques de type 1 (T1DM) et de type 2 (T2DM) âgés de plus de 18 ans et traités par un minimum de 2 injections d’insuline par jour, suivis dans un peu plus de 100 centres. Le taux d’examen des pieds (palpation des pouls et test de la sensibilité au monofilament) est comptabilisé pour les patients dont la durée du diabète est ≥5 ans. &amp;nbsp;&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Résultats / Discussion:&lt;/strong&gt; En 2014, l’âge moyen et la durée moyenne du diabète étaient de 48 et 17 ans pour les T1DM et de 66 et 14 ans pour les &amp;nbsp;T2DM. Chez les T1DM, le taux d’examen des pieds était de 73.7, 90.4, 88.0 et &amp;nbsp;80.0% en 2001, 2006, 2011 et 2014 respectivement (tous &amp;nbsp;p&amp;lt;0.05 vs. 2014). Pour les T2DM, les taux correspondants étaient de 76.8, 89.2, 86.4 et 79.2% (p&amp;lt;0.05 pour 2006 et 2011 vs. 2014). En 2014, 83.6% (n=1163) des patients «&amp;nbsp;à risque&amp;nbsp;» (antécédent d’ulcère, d’amputation ou de pontage vs angioplastie périphérique) ont été examinés, versus 76.5% (n=10 603) des patients non «&amp;nbsp;à risque&amp;nbsp;» (p&amp;lt;0.001). Les taux étaient plus élevés si l’hôpital disposait d’une clinique du Pied Diabétique (CPD), 81.3% (n=6 165) versus 77.6% (n=5 601) (p&amp;lt;0.001 vs. hôpital sans CPD). En envisageant seulement les &amp;nbsp;patients&amp;nbsp; «&amp;nbsp;à risque&amp;nbsp;», pour 89.4% (n=651) leurs pieds ont été examinés dans les centres avec CPD versus 81.3% (n=512) dans les centres sans CPD (p&amp;lt;0.001).&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; Des audits périodiques des Cliniques du Diabète Belges Reconnues ont montré un déclin significatif du taux d’examen des pieds depuis 2006. Les audits et les feedback comprenant une analyse comparative anonyme n’ont pas pu prévenir ce déclin. Ces résultats suggèrent que les efforts de dépistage ne sont pas adressés à la&amp;nbsp; population adéquate. Les soignants qui travaillent dans un hôpital disposant d’une Clinique du Pied Diabétique pourraient être plus conscients de la gravité des problèmes du pied diabétique et adapter leur dépistage en conséquence. Des efforts sont nécessaires pour comprendre et dépasser les barrières qui empêchent la réalisation correcte des examens du pied diabétique.&lt;/p&gt;</p