Ear- and hearing-related impact on quality of life in children with cleft palate : development and pretest of a health-related quality of life (HRQOL) instrument

Objectives: To investigate to what extent middle ear problems and associated hearing loss affect quality of life (QoL) of children born with a cleft palate. Methods: Fifty-five children aged between 6 and 18 years, born with non-syndromic cleft palate +/- cleft lip (CP/L) were included. A new health-related quality of life (HRQOL) questionnaire was generated with consideration of the following domains of QoL: communication, hearing loss, physical symptoms, limitation of activities and socio-emotional impact. Results: Major psychosocial problems were not reported in the majority of children as a result of their ear and hearing problems. However, according to their parents, 2 out of 3 children, had difficulty speaking clearly and understandably. These communication problems led to behavioural problems and social isolation in 1 out of 5 children. Scholastic achievement was negatively influenced by two factors: hearing loss and sleep disturbance due to ear problems. Conclusions: To our knowledge this is the first study to quantitatively measure the ear- and hearing-related impact on QoL in children born with CP/L. Large-scale, multicentre studies are needed to further research and expand on the findings of this pilot study

Medication adherence among Turkish type-2 diabetics in Belgium: results from a qualitative study

Abstract title: Medication adherence among Turkish type-2 diabetics in Belgium: results from a qualitative study. Aim: Prevalence of diabetes in Belgium is 2 to 3 times higher among people from Turkish descent. Medication adherence, an essential element of the diabetic regimen, appears to be lower among nonwhite ethnic groups. This study identifies factors influencing medication adherence among Turkish type-2 diabetics living in Belgium. Methods: Since this topic hasn’t been studied before we conducted an explorative, qualitative study using semi-structured in-depth interviews with the aid of an interpreter. The topicslist was based on insights from the literature and conversations with Turkish diabetics and health care workers and was slightly adjusted after the first interviews. 21 Turkish type-2 diabetics living in Belgium were selected using theoretical sampling. Respondent’s most recent HbA1c-values were also collected. Interviews lasted between 2 and 5 hours, were audio-taped, fully transcribed and translated. Thematic analysis was conducted by the first two authors with different educational backgrounds (sociologist/pharmacist). The first phase was a detailed, thematic analysis of the individual cases, in the second phase an analysis across cases, distinguishing adherers from non-adherers, identified factors influencing medication adherence. NVivo 8 was used for managing, coding and analysing the qualitative data. Results: Factors influencing medication adherence among type-2 diabetics from Turkish descent include knowledge of and attitudes towards diabetes and antidiabetics, health and medication beliefs, social support from health care providers and family members, the nature of the patient-provider relationship, perceptions of health care worker’s expertise and social roles in daily life. A typology was constructed identifying different constellations of factors that distinguish adherers from non-adherers. Implications for clinical practice are discussed. Conclusion: This qualitative study identifies factors influencing medication adherence among type-2 Turkish diabetics living in Belgium and provides a typology, distinguishing adherers from non-adherers, that may guide clinical practice. Results from this qualitative study will be tested in a future, quantitative study

Medication adherence among Turkish type-2 diabetics in Belgium: results from a qualitative study

Abstract title: Medication adherence among Turkish type-2 diabetics in Belgium: results from a qualitative study. Aim: Prevalence of diabetes in Belgium is 2 to 3 times higher among people from Turkish descent. Medication adherence, an essential element of the diabetic regimen, appears to be lower among nonwhite ethnic groups. This study identifies factors influencing medication adherence among Turkish type-2 diabetics living in Belgium. Methods: Since this topic hasn’t been studied before we conducted an explorative, qualitative study using semi-structured in-depth interviews with the aid of an interpreter. The topicslist was based on insights from the literature and conversations with Turkish diabetics and health care workers and was slightly adjusted after the first interviews. 21 Turkish type-2 diabetics living in Belgium were selected using theoretical sampling. Respondent’s most recent HbA1c-values were also collected. Interviews lasted between 2 and 5 hours, were audio-taped, fully transcribed and translated. Thematic analysis was conducted by the first two authors with different educational backgrounds (sociologist/pharmacist). The first phase was a detailed, thematic analysis of the individual cases, in the second phase an analysis across cases, distinguishing adherers from non-adherers, identified factors influencing medication adherence. NVivo 8 was used for managing, coding and analysing the qualitative data. Results: Factors influencing medication adherence among type-2 diabetics from Turkish descent include knowledge of and attitudes towards diabetes and antidiabetics, health and medication beliefs, social support from health care providers and family members, the nature of the patient-provider relationship, perceptions of health care worker’s expertise and social roles in daily life. A typology was constructed identifying different constellations of factors that distinguish adherers from non-adherers. Implications for clinical practice are discussed. Conclusion: This qualitative study identifies factors influencing medication adherence among type-2 Turkish diabetics living in Belgium and provides a typology, distinguishing adherers from non-adherers, that may guide clinical practice. Results from this qualitative study will be tested in a future, quantitative study

The impact of drop-out in cardiac rehabilitation on outcome among coronary artery disease patients

Background: The effect of adherence to cardiac rehabilitation (CR) on outcome is not clear. Therefore, we aimed to assess the impact of drop-out for non-medical reasons of CR on event-free survival in coronary artery disease (CAD). Methods: A total of 876 patients who attended CR after acute coronary syndrome (ACS), percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) were included. Drop-out was defined as attending 50% of the training sessions. A combined endpoint of all-cause mortality and rehospitalization for a cardiovascular event was used to specify event-free survival. Differences in clinical characteristics were assessed and parameters with p<0.10 were entered in a multiple Cox regression analysis. Results: A total of 15% died or had a cardiovascular event during a median follow-up period of 33 months (interquartile range 24, 51). Overall, 17% dropped out before finishing half of the program. Patients who withdrew prematurely had a risk twice as high for a cardiovascular event or death (hazard ratio 1.92, 95% confidence interval 1.28-2.90) than those who attended more than half of the sessions. Both ACS (2.36, 1.47-3.58) and PCI (2.20, 1.22-3.96), as primary indicators for CR, were associated with an adverse outcome and also a prior history of chronic heart failure (CHF) remained negatively associated with event-free survival (3.67, 1.24-10.91).Finally, the presence of hyperlipidemia was independently related to a worse outcome (1.48, 1.02-2.16). Conclusions: Drop-out for non-medical reasons was independently associated with a negative outcome in CAD. Therefore, underlying factors for drop-out should gain more attention in future research and should be taken into account when organizing CR

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

The CORDEX.be initiative as a foundation for climate services in Belgium

The CORDEX.be project created the foundations for Belgian climate services by producing high-resolution Belgian climate information that (a) incorporates the expertise of the different Belgian climate modeling groups and that (b) is consistent with the outcomes of the international CORDEX ("COordinated Regional Climate Downscaling Experiment") project. The key practical tasks for the project were the coordination of activities among different Belgian climate groups, fostering the links to specific international initiatives and the creation of a stakeholder dialogue. Scientifically, the CORDEX.be project contributed to the EURO-CORDEX project, created a small ensemble of High-Resolution (H-Res) future projections over Belgium at convection-permitting resolutions and coupled these to seven Local Impact Models. Several impact studies have been carried out. The project also addressed some aspects of climate change uncertainties. The interactions and feedback from the stakeholder dialogue led to different practical applications at the Belgian national level