Sherihane Bensemmane

OBJECTIVE: To describe site-level ICU organizational policies and implementation of pain, agitation, and delirium (PAD) best practices before the COVID-19 pandemic, and perceived changes during the pandemic. DESIGN: International site-level questionnaire study. SETTING: Participating sites completed a standardized electronic Case Report Form between January 5, 2022 and March 31, 2023. PATIENTS/CENTERS: Ninety-three ICUs caring for adult patients from 79 hospitals across 27 countries in North America, South America, and Europe. INTERVENTIONS: Each ICU submitted data on site characteristics, staffing, implementation of PAD protocols and assessment tools prepandemic, and perceived changes during the COVID-19 pandemic. Descriptive statistics and multivariable logistic regressions were performed using R. MEASUREMENTS AND MAIN RESULTS: Of 93 ICUs, 63% were university-affiliated, and 59% reported a closed physician staffing model. Most managed mixed patient populations (78%), with a nurse-to-patient ratio for ventilated patients of 1:2 (45%) or 1:1 (39%). Physiotherapists and pharmacists were available in 83% and 68% of ICUs, respectively. Over 75% reported routine use of validated PAD scales, most commonly Richmond Agitation Sedation Scale (86%), Confusion Assessment Method for ICU (59%), and Numeric Rating Scale (44%). Protocols were most available for spontaneous breathing trials (60%) and sedation (58%), followed by delirium (53%), mobilization (47%), and pain (46%). University affiliation and 1:1 nurse staffing was associated with reported use of delirium or mobilization protocols. The presence of a weaning protocol was associated with higher odds of daily sedation interruption (adjusted odds ratio [aOR] 3.80; 95% CI, 1.43–10.89; p = 0.009), and use of sedation protocols (aOR 5.95; 95% CI, 2.29–16.86; p < 0.001). Nearly one-half of ICUs reported drug shortages during the pandemic, and 62% prohibited any visitation. CONCLUSIONS: ICU organizational structures and reported PAD practices vary widely worldwide. Despite international guidelines, many ICUs lack consistent implementation of evidence-based sedation, analgesia, and delirium management strategies.

Breast cancer is the commonest cancer in women, and screening can allow earlier-stage diagnosis. While there are European recommendations on the age-range and frequency of breast cancer screening, participation in these programmes varies substantially, and this could be due to differences in how they are organised and implemented. The role that primary healthcare professionals play in the process is unclear.We aimed to describe the breast cancer screening programmes in European countries and investigate how primary healthcare professionals are involved in this screening process. A cross-sectional survey in 32 countries. Key informants with relevant expertise answered online questions about the characteristics of their screening programmes and general practitioners' (GPs') roles in this. Responses were refined through an iterative consensus process. Data were examined to identify patterns in GP engagement. We found important differences between European breast cancer screening systems. While most had population-based screening, four countries relied on opportunistic screening. In 15 countries GPs had little or no involvement in the process of breast cancer screening, and in 13 countries GPs had some involvement, including identifying eligible patients, issuing referrals, and following-up results. Screening uptake rates tended to be higher in countries with well-established population-based screening programmes which give little or no GP involvement. Few countries linked GP engagement to incentives or performance measures. Countries with lower screening uptake should consider either enhancing GP involvement or transitioning to a structured, population-based screening system. Further research should explore how best to integrate primary care within national screening strategies.

In Belgium, the COVID-19 Barometer in General Practices (cBGP), a semi-automated tool, was rapidly set up to support the surveillance of COVID-19 by extracting data from the Electronic Medical Records (EMR) of General Practitioners (GPs). Hence, the cBGP enabled a high GP participation rate and the rapid follow-up of COVID-19. Concurrently, the instrument collected data on Influenza-like Illness (ILI) as an early marker of COVID-19 activity. This extraction-based surveillance system could take over the registration of ILI cases currently done by the Belgian Sentinel General Practitioners network (SGP). In order to identify the most suitable alternative for effective and long-term surveillance of ILI, the current study is investigating the contribution and limitations of using the code-based cBGP as a replacement for the questionnaire-based SGP system to monitor the syndrome. An observational retrospective study covering 3 influenza seasons from 2021 to 2024 is being carried out. Both qualitative and quantitative outcome measures are determined to gather evidence on the systems’ performance, based on nine attributes namely: Data Quality, ILI Incidence, Sensitivity, Representativeness, Timeliness, Acceptability, Simplicity, Stability and Flexibility. The methodological framework relies on the Centers for Disease Control and Prevention (CDC) guidelines for evaluating public health surveillance systems and the Simple Multi-Attribute Rating Technique (SMART) is used to facilitate the decision-making process of an appropriate alternative. Three alternatives are given a value according to the score and the weight-related importance of attributes by a group of experts. The alternative with the higher endorsement is then considered as the preferable one and recommendations for implementation are formulated. This combined approach, which blends performance analysis and multi-criteria decision analysis, allows for a sound and reproducible comparison of systems. Moreover, while the Covid-19 pandemic has accelerated the development of a national code-based system, this study aims to start redefining the role of the barometer in insuring robust disease surveillance. This protocol could serve as a basis for validating other syndromic surveillance data from extraction-based systems in primary care.

Background: Long COVID, with its multisystemic manifestations, poses a substantial burden on health systems. Nevertheless, evidence regarding Long COVID patients’ perspectives, perceived health outcomes and care experiences in Belgium remains limited. Methods: OECD’s Patient-Reported Indicator Surveys (PaRIS) collected patient-reported outcome and experience measures (PROMS and PREMs) from individuals aged 45+ with chronic conditions. In Belgium, 4,687 primary care patients provided self-reported data between March 2023 and January 2024. This study explores the associated clinical and sociodemographic factors, care outcomes and experiences of adults with Long COVID in Belgium, by comparing respondents with and without Long COVID. Multivariate models were used to examine the clinical and sociodemographic determinants of Long COVID, and mixed-effects models were applied to compute the 10 key PROM and PREM indicators following the PaRIS10 methodology, accounting for the hierarchical structure of the data (patients nested within GP practices). Results: Overall, 50% (N=2,359) had a previous COVID-19 infection diagnosis, and over one in four (26%) of them reported Long COVID-related symptoms lasting 2 months or longer after COVID-19 infection (N=605, 12.9% overall prevalence). Higher risk of Long COVID was associated with being female, aged 45-54, lower educated, having multiple chronic conditions and higher BMI. Long COVID adults reported significant lower PROM scores for general health, wellbeing, physical and mental health compared to non-Long COVID respondents. Those with Long COVID symptoms lasting at least 1 year reported even poorer outcomes, particularly in general health, wellbeing and physical health. PREMs showed no significant differences between Long COVID and non-Long COVID respondents overall. However, trust in healthcare system and person-centred care was significant lower when Long COVID patients still had these long-term symptoms at survey time. Conclusions: In Belgium, adults with Long COVID report poorer health outcomes and less positive care experiences compared with those without Long COVID. These findings point to the substantial burden associated with Long COVID and to gaps in the current healthcare response to this emerging condition. Strengthening dedicated care pathways, improving coordination across services, and ensuring clear communication and support for patients will be essential to better address the needs of people living with Long COVID.

Background: The COVID-19 pandemic has underlined the essential role of primary healthcare (PHC) in epidemiological surveillance and public health decision-making. Across Europe, the integration of electronic health records (EHRs) and the sentinel networks have been pivotal in monitoring COVID-19. However, the lack of standardized PHC indicators for COVID-19 hinders the comparability of data among countries. Objective: To establish a consensus on a set of standardized PHC activity indicators related to the COVID-19 pandemic for 31 countries, enhancing the capability of health authorities to make informed decisions and prepare for future health crises. Methods: A two-round eDelphi study was conducted using a structured web-based survey, following the CREDES guidelines, to achieve consensus among a panel of 164 experts from the Eurodata study. 86 Indicators were selected based on their availability during the current pandemic, with participants rating the relevance and utility of proposed indicators. Results: Of the 22 initial indicators, seven received consensuses for inclusion, while two remained contentious after the second round. The study found significant discrepancies in the awareness of sentinel networks and accessibility to PHC data. The consensus emphasized the necessity for indicators to be standardized, reproducible, and easily extractable from databases, with recommendations for disaggregation by age, sex, and vaccination status. Conclusion: Key COVID-19 indicators for PHC were identified, reflecting a consensus among healthcare professionals. Further cooperation between PHC providers and national public health authorities is warranted both on the national and the international level to harmonized healthcare indicators in response to future health emergencies.

The COVID-19 vaccination campaign in several European countries involved collaboration between public health and Primary Health Care (PHC). To highlight the role of PHC professionals in the COVID-19 vaccination rollout, specifically in terms of vaccine administration, communication and contributing to vaccination population coverage. A descriptive retrospective study of the COVID-19 vaccination campaign across 28 European countries was conducted, covering data from December 2020 to November 2021. Data were collected by key informants recruited from each country, who were health professionals involved in their national vaccination campaigns. Utilising an ad-hoc semi-structured questionnaire, information was gathered on organisation, communication strategies, priority groups, vaccine types, and vaccination pathways in PHC. PHC participated in communication strategies in 10 out of 28 countries, and vaccination was voluntary in most of them. The priority groups for vaccination varied across Europe, and the availability of vaccines in PHC differed between countries within the European Union (EU) and non-EU countries. The BioNTech Pfizer vaccine was the most widely available vaccine in most countries, followed by Moderna and AstraZeneca. PHC administered COVID-19 vaccines to the population, being the nurses the most involved, followed by general practitioners. Vaccination appointments were available online in 18/28 or by phone in 15/28, direct appointments at health centres were available in 8/28. In several countries, healthcare professionals who administered vaccines were given extra compensation for their role. PHC professionals played a crucial role in the successful distribution and administration of COVID-19 vaccines in European countries.

Aim: The current study aims at describing sexually transmitted infections (STI) surveillance data collected from 2015 to 2020 as well as investigating patients’ characteristics and risk factors in the sample population. Background: Reported STI cases are continuously increasing in Europe. In Belgium, 94.1% of citizens have a regular general practitioner (GP) or are affiliated to a general practice. By using GPs for surveillance, STIs can be monitored in the general population. Between January 2015 and December 2020, the Sentinel General Practitioners (SGP) network retrospectively reported five STIs: chlamydia, gonorrhoea, genital warts, herpes, and syphilis. Methods: In the SGP network database on STIs, participating GPs report on case-by-case basis through paper or online registration forms. We performed descriptive statistics, X² test and logistic regression using SAS^® 9.4. Multivariate multiple logistic regression was performed to investigate the relationship between STIs and patients’ characteristics. Findings: During the study period, 1009 cases were reported, corresponding to an episode-based incidence estimated at 121 per 100,000 inhabitants. The majority of patients (59.8%) were men, and 83.6% were under age 30. Among female patients 92.7% had heterosexual contacts whereas 64.4% of male patients did. Women were more likely to be diagnosed with chlamydia (odds ratio [OR] 1.56; 95% confidence interval [CI] 1.12–2.17) and herpes (OR 1.72, 95% CI 1.04–2.86) than men. In this study, STI surveillance data were in agreement with literature. Continuous surveillance through the SGP network remains an important tool to obtain information about populations at risk and STI incidence in the general population.

Herpes zoster (HZ) is caused by reactivation of the varicella-zoster virus. The life-time risk of developing HZ is similar to 30%. Management of HZ can be challenging due to limited efficacy of oral antivirals on pain control, and neuropathic pain that may require aggressive management. Post-herpetic neuralgia (PHN) can cause substantial pain and occurs in up to one-quarter of patients with HZ. Up to 48,000 HZ cases are estimated to occur annually in Belgium, estimated to cost almost 7 million euros in treatment. The recombinant zoster vaccine (RZV, Shingrix, GSK) was approved in Europe in 2017. In 2022, the Belgian Superior Health Council recommended vaccination with RZV for immunocompetent adults aged >= 60 years, and immunocompromised patients aged >= 16 years, including those receiving immunosuppressive therapy, in particular Janus kinase inhibitors. RZV showed high age-independent efficacy in preventing HZ infection and in clinical trials that has since been confirmed in real-world effectiveness studies. In clinical trials, protection was sustained for at least 10 years after vaccination. As of 1 November 2023, RZV is reimbursed for three immunocompromised patient groups aged >= 18 years: malignancy treated in the past 5 years, HIV infection, and organ or haematological stem cell transplantation or are a transplant candidate. HZ is vaccine-preventable and RZV provides a highly effective tool for HZ prevention. While reimbursement for some at-risk groups is welcomed, reimbursement currently falls well short of Superior Health Council recommendations. Adult immunisation strategies should be promoted to achieve high vaccination coverage against HZ, contributing to healthy aging in Belgium. [GRAPHICS] .

Background: Physical activity (PA) reduces 19.5% of the attributable burden of chronic diseases (CDs), i.e. healthy life years lost due to morbidity and mortality. In addition, 29.5% of Belgians self-declared having at least one chronic disease. Moreover, almost 30% of the population above 15 years old is at health risk due to physical inactivity. Evidence shows physical activity on prescription (PAP) has a positive impact on PA level and metabolic health. General Practitioners (GPs) can use PAP as a prevention intervention. In Belgium, overall 94,1% of citizens have a referring General Practitioner (GP) or are affiliated with a general practice. There is no national policy on PAP, only a regional policy in Flanders. Therefore, the aim of the study is to investigate the perception and the (potential) provision of PAP by Belgian GPs. Methods: A cross-sectional survey was conducted in Belgian GPs between January and end of March 2023. The survey has 41 (ordinal or multiple choice) questions. Descriptive statistics were performed. Results: 134 GPs completed the survey of which 56% were female. 66.4% work in Flanders, 19.4% in Wallonia and 14.2% in Brussels-Capital region. Among respondents, 44% only discuss the benefits of PA with patients with a CD. Interestingly, less than 2% never discuss PA. 86.8% (would) prescribe if patients’ health status would be remedied by increasing PA, while 35.8% (would) use PAP if patients are inactive, regardless of their health status. About 75% identified chronic disease and exercise initiation as incentives for PAP. 41% would refer to PA (motivational) coaches, 55.2% to (adapted) PA courses. Lack of training (12.7%), time (49.3%), and knowledge of local PA offer (74%) were cited as barriers to using PAP. Conclusions: The majority of responding GPs linked PAP with CD. Although there is no national implementation and regulation of PAP, GPs used (were ready to use) PAP in their practice. However, several barriers still hinder the use of PAP. Key messages: • PAP is identified by Belgian GPs as a non-medical therapeutic strategy to counter health risks due to inactivity. • There is a need to harmonise and facilitate PAP in Belgian primary care.

Background Reported Sexually transmitted infections (STI) cases are continuously increasing in Europe. In Belgium, 94,1% of citizens have a regular general practitioner (GP) or are affiliated to a general practice. By using GPs for surveillance, STIs can be monitored in the general population. Between January 2015 and December 2020, the Sentinel General Practitioners (SGP) network retrospectively reported 5 STIs: chlamydia, gonorrhea, genital warts, herpes, syphilis. The current study describes STI surveillance data collected from 2015 to 2020 as well as investigate patients’ characteristics and risk factors in the sample population. Methods In the SGP network database on STIs, participating GPs report on case-by-case basis through paper or online registration forms. We performed descriptive statistics, X² test and logistic regression using SAS®9.4. Multivariate multiple logistic regression was performed to investigate the relationship between STIs and patients’ characteristics . Results During the study period, 1009 cases were reported, corresponding to an episode-based incidence estimated at 121 per 100 000 inhabitants. The majority of patients (59.8%) were men, and 83.6% were under age 30. Among female patients 92.7% had heterosexual contacts whereas 64.4% of male patients did. Women were more likely to be diagnosed with chlamydia (OR 1.56; 95% CI 1.12–2.17) and herpes (OR 1.72, 95% CI 1.04–2.86) than men. Conclusions In this study, STI surveillance data were in agreement with literature. Continuous surveillance through the SGP network remains an important tool to obtain information about populations at risk and STI incidence in the general population.