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Background/Introduction: Thromboinflammation in severe COVID-19 is associated with disease severity and outcome. The kallikrein pathway is suggested to mediate thromboinflammation in COVID-19 by activating inflammatory pathways and contactmediated coagulation. Purpose(s): The DAWn-antico study investigates if a multitarget modulation of the thromboinflammatory response improves outcomes in hospitalized patients with severe COVID-19. Method(s): In this multicenter open-label randomized clinical trial (EudraCT 2020-001739-28), patients hospitalized with COVID- 19 were 1:2 randomized to receive standard of care (SOC) or SOC plus study intervention. The intervention consisted of aprotinin (2,000,000 IE IV four times daily) combined with low-molecular-weight heparin (LMWH;SC 50 IU/kg twice daily at the ward, 75 IU/kg twice daily at intensive care). Additionally, patients with predefined hyperinflammation received the interleukin-1- receptor antagonist anakinra (100mg IV four times daily). The primary outcome was time to a sustained 2-point improvement on the 7-point WHO ordinal scale for clinical status, or discharge. The trial was funded by Life Sciences Research Partners, Research Foundation Flanders (G0G4720N), and KU Leuven COVID-19 fund. Result(s): Between 24 June 2020 and 01 February 2021, 105 patients were randomized, and 102 patients were included in the full analysis set (intervention N=67 vs. SOC N=35). Twenty-five patients from the intervention group (37%) received anakinra. The intervention did not affect the primary outcome (HR 0.77 [CI 0.50;1.19], p=0.24) or mortality (intervention n=3 (4.6%) vs. SOC n=2 (5.7%), HR 0.82, [CI 0.14;4.94], p=0.83). There was one treatment-related adverse event in the intervention group (hematuria, 1.49%). There was one thrombotic event in the intervention group (1.49%) and one in the SOC group (2.86%), but no major bleedings. Conclusion(s): In hospitalized COVID-19 patients, modulation of thromboinflammation with high-dose aprotinin and LMWH with or without anakinra did not improve outcome in patients with moderate to severe COVID-19. (Disclosure: this RCT was presented at ISTH 2022 in London and will be published in Research and Practise in Thrombosis and Haemostasis).
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We are in an era of change, where climate, health, social and economic emergencies can no longer be ignored. Faced with the extent of these transitions, territories are in the front line. Through this paper, we will see what role territorial resilience plays in the regulation of territories in times of crisis and/or brutal shocks such as the Covid19 health crisis. As the main aim of this paper is to shed light on the factors of territorial resilience, we will then describe the different indicators that contribute to the approach to territorial resilience. Finally, we will establish the relevance of a systemic approach within this family of factors favoring territorial resilience. To do this, we will study the case of the Dunkirk territory and its systemic representation via the 'Toile' tool proposed by the Flanders-Dunkirk Region Urban Planning Agency (AGUR). © 2022 IEEE.
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In this article, we study how the COVID-19 pandemic has affected the housing inequalities between Flemish tenants and homeowners in terms of housing affordability, security and adequacy. Analyzing online survey data, we find that the pandemic increased the existing affordability gap in Flanders between homeowners and tenants. These differences between tenants and homeowners are explained by heterogeneous unemployment and income shocks. We find similar results for the differential impact on housing insecurity. Furthermore, relatively more tenants experience problems with the size of their dwelling due to the pandemic compared to homeowners. We find that these differences are best explained by the dwelling type as well as the household size, unemployment and work-from-home. The analysis shows that the COVID-19 crisis had a significant effect on the housing conditions of Flemish tenants and homeowners and exacerbated existing inequalities. © 2022 Informa UK Limited, trading as Taylor & Francis Group.
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To examine the prevalence of 12-month mood disorders and receipt of mental health treatment among a volunteer sample of higher education students during the 2nd and 3rd COVID-19 wave in the Flanders region. Web-based self-report surveys were obtained from 9101 students in higher education in the Flemish College Surveys (FLeCS) in Flanders, Belgium. As part of the World Health Organization's World Mental Health-International College Student Initiative, we screened for 12-month mood disorders (major depressive episode (MDE), mania/hypomania), and service use. We used poststratification weights to generate population-representative data on key socio-demographic characteristics. 50.6% of the respondents screened positive for 12-month mood disorders (46.8% MDE, of which 22.9% with very severe impact). Use of services was very low, with estimates of 35.4% for MDE, 31.7% for mania, and 25.5% for hypomania. Even among students with very severe disorders, treatment rates were never higher than 48.3%. Most common barriers for not using services were: the preference to handle the problem alone (83.4%) and not knowing where to seek professional help (79.8%). We found a high unmet need for mood problems among college students; though caution is needed in interpreting these findings given the volunteer nature of the sample. A reallocation of treatment resources for higher education students should be considered, particulary services that focus on innovative, low-threshold, and scalable interventions.
Subject(s)
COVID-19 , Depressive Disorder, Major , Mental Disorders , Humans , Mood Disorders , Mental Disorders/epidemiology , Mania , Prevalence , Surveys and QuestionnairesABSTRACT
The editorial board of 'Tijdschrift voor Geneeskunde en Gezondheidszorg' collected a series of opinion papers from a diversity of health care workers in Flanders (Belgium): family doctors and specialists, nurses, pharmacists, students, hospital administrators, health insurance companies, patient organizations and governmental institutions. This combined information allows identifying the weaknesses in the current Belgian health care system, towards translation into opportunities for optimization in the future. The most striking messages are: the prevention of the dehumanization of care for both patients and health care workers, an urgent extension of the network for mental health care, the implementation and integration of digital media and remote care, and the canalization of clinical information and instructions, governed by strong and decisive leadership. The uniformity of these messages, voiced from different angles of the Belgian health care system in the aftermath of the pandemic, makes a strong document of these combined opinion papers, a document that can be considered the clinical manifest of the health care worker in Flanders. Copyright © 2022 The authors.
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Objectives. Determining the psychological impact of the COVID-19 pandemic among physicians and mapping of the perceived sources of social support. Design. Secondary data analysis of a cross-sectional survey. Methods. From a repeated survey of health care workers in Flanders (Belgium) (n = 8,350), practicing physicians were retained (n = 873). The survey, conducted between April and June 2020 during the first wave of the pandemic in Belgium, questioned respondents about the perceived occurrence of 11 personal and 8 professional reactions during the last week and in normal circumstances. Using odds ratios, the relationship between the COVID-19 pandemic and the occurrence of these reactions was examined. Furthermore, the perceived sources of social support were listed and are descriptively presented. Results. For the 11 perceived personal reactions and 2 negative and 1 positive professional reaction, there is a significant association with the COVID-19 pandemic, namely a more frequent occurrence. Through the pandemic, significant differences have emerged between general practitioners and medical specialists with a more frequent occurrence of negative reactions in the general practitioner population. Respondents indicate that mental support is mainly found in their immediate environment and in colleagues outside their organization. Conclusion. The COVID-19 pandemic has a significant impact on the mental well-being of physicians. While the impact on general practitioners remains high throughout the crisis, some normalization among medical specialists is seen towards the end of the first wave. Long-term follow-up and initiatives regarding mental support for physicians are necessary. Copyright © 2022 Tijdschrift voor Geneeskunde en Gezondheidszorg. All rights reserved.
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Background: Thromboinflammation in severe COVID-19 is associated with disease severity and inferior outcome. Evidence suggests that the kallikrein pathway potentially plays a vital role in COVID-19 associated thromboinflammation as it both activates downstream inflammatory pathways and contact-mediated coagulation. Aim(s): To investigate whether modulation of this pronounced thromboinflammatory response can improve outcomes in hospitalized patients with severe COVID-19. Method(s): This multicenter randomized clinical trial was approved by the ethics committee and supported by the KU Leuven COVID-19 fund and Research Foundation Flanders (FWO). After informed consent, eligible patients were 1:2 randomized to receive standard of care (SOC) or SOC plus study intervention (figure 1). The intervention consisted of off-label -kallikrein-inhibiting -aprotinin combined with low molecular weight heparin (LMWH). Additionally, patients with predefined hyperinflammation were treated with the interleukin-1 receptor antagonist anakinra. The primary endpoint was time to sustain a 2-point improvement in the WHO ordinal scale for clinical status. Result(s): Three hospitals in Belgium included 102 patients (35 SOC vs. 67 intervention). Twenty-five patients from the intervention group (37%) were treated with anakinra. Patients had elevated D-dimers (mean 1012.4 mug/L;SD 991.9 mug/L) and C-reactive protein (mean 81.4 mg/L;SD 59.6 mg/L) at admission confirming baseline activation of coagulation and inflammatory pathways. During hospitalization, 37% of patients were admitted to the ICU (29% SOC vs. 42% intervention), and 20% needed invasive ventilation (12% SOC vs. 25% intervention). The intervention did not affect the time to sustained clinical improvement or hospital discharge (figure 2), nor secondary clinical endpoints. Except for D-dimers at day 3, there was no significant C-reactive protein or D-dimer reductions. There were no differences in treatment-related adverse events. Conclusion(s): In hospitalized COVID-19 patients, additional modulation of thromboinflammation with high-dose aprotinin and LMWH with or without anakinra was feasible and safe but did not improve clinical nor biochemical outcomes.
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Background: The role of community pharmacists has recently evolved from a medication to a patient-centered basis. Moreover, the pharmacist is one of the most accessible first line healthcare providers. Due to COVID-19, a growing need to support people with psychosocial needs, like suffering from family violence or mental health problems, was noted. Purpose: This pilot study evaluates the added value and feasibility of pharmacists' taking up a role in the detection and referral of patients with (unmet) mental and psychosocial needs. Therefore, a collaboration between community pharmacies and psychosocial organisations was set up and evaluated using quantitative and qualitative indicators. Method: A project named CAVAsa was launched in 70 community pharmacies situated in 9 primary care zones in Flanders (Belgium). In eptember 2021, all participating pharmacists were trained to detect psychosocial needs, to inform and help patients and to refer them to a Flemish Center for General Welfare Work (CAW) if needed. Posters and informative leaflets are used to support pharmacists and to inform patients. All patient contacts in the context of the project, going from giving advice to a referral, are registered on an online registration platform and will be fully analysed in January. Moreover, eight focus groups were held in November 2021 to explore the perspective of the participating pharmacists on the project. Findings: Up to date, 50 patient contacts in the context of CAVAsa have been registered. Patients are dominantly female and middle-aged, and the majority of patients' needs relate to family problems and/or mental health problems. The focus groups revealed that pharmacists are willing to take up this role because patient wellbeing and personal assistance are key values of community pharmacy. However, the high workload (partly due to the pandemic) is one of the most important barriers for registration and referral. Good cooperation, coordination and close involvement between the partners (project management, social workers and pharmacists) were shown to be vital. Conclusion: Despite the good position of the community pharmacist to detect psychosocial needs and the willingness of the participants, some barriers exist for the implementation, especially time constraints. COVID-19 made this extra challenging. Nevertheless, we decided to further promote the project and to train and include more pharmacists in the nearby future.
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The Tour of Flanders, a classic outdoor cycling event that opens the cycling season, was canceled due to the COVID-19 pandemic. However, a suitable replacement was created in its place, intended to offer people some solace during this lockdown period during which most recreational activities were suspended. This paper explains how the team managed to create an exciting mixed-reality (MR) racing event within a short period of time, given the limits of all social distance rules. It provides insights into how the real riders raced through a virtual landscape and how the viewers got to see this at home. This cloud-based production was performed exclusively with standard office IT equipment and well-known internet technologies. From idea to execution, the clock was ticking: the entire project was to be completed within a matter of days. © 2002 Society of Motion Picture and Television Engineers, Inc.
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Research shows that older people tend to not only be underrepresented on television (TV), but also to be represented within a number of fixed types. These correspond to cultural myths about ageing, which emphasise vulnerability and decline but also increasingly stress the individual's responsibility for successful ageing. This paper analyses the representation of older people on Flemish public TV, using qualitative content analysis to identify patterns of representation in a sample of 44 programmes broadcast in 2019 and 2020, including the first months of the COVID-19 pandemic. To complement our own analysis, we also interviewed eight experts on ageing. Our research shows that representations of older people on Flemish public TV tend to gravitate towards two types related to different age groups: vulnerable and passive old-old people (over 80 years old), particularly those in nursing homes who feature prominently in reporting on the COVID-19 pandemic;and dynamic and active young-old people (65-80 years old), connected to the ideals of successful ageing. The two predominant types correspond to cultural myths about ageing and are also connected to recurrent themes: sexual intimacy, loneliness and death. Our research highlights the need for a more diverse representation, reflecting the variety of individual life conditions and the functional age of older people.
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The coronavirus pandemic sent tremors throughout the news landscape. While the onset of the pandemic appeared to significantly increase news hunger, soon after, studies reported an uptick in what they termed "coronablocking": the conscious avoidance of coronavirus related news. Younger age groups in particular appeared more likely to engage in coronablocking. This article seeks to contribute to extant research by providing a textured account of how and why young news users avoid the news. To explore these questions, we conducted 25 in-depth interviews with Belgian news users under the age of 35. We propose that news avoidance practices are fluid, as news avoidance was often preceded by moments of increased news consumption, and inherently connected to the specific spatiotemporal context of users and enacted within their broader media repertoire. In our analysis, we discuss the user-identified characteristics which lead users to a 'tipping point', at which point they avoided the news to varying degrees by reconfiguring their media repertoire. Three types of reconfigurations are identified: tuning out news content, regulating the flow of information, and controlling the tone of voice, all of which underline users' agency in shaping their repertoires to avoid the news. [ FROM AUTHOR] Copyright of Journalism Studies is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
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During the COVID-19 pandemic, governments installed measures to contain the disease. Information about these measures was disseminated through news media. Nonetheless, many individuals did not abide by these guidelines. We investigated how perceived vulnerability to disease and personality characteristics related to support for public health measures. We analyzed survey data of 1000 Flemish (Belgium) adults, collected between March 17, 2020 and March 22, 2020. Older age, low educational attainment, gender (female) and work situation (no telecommuting) were associated with greater perceived vulnerability. Greater expectations of loneliness and more solidarity with our fellow men were associated with gender (female), younger age and work situation (telecommuting). Greater perceived vulnerability to disease was related to a greater belief that public health measures protect the population, but also to a critical stance towards the Belgian government's handling of the crisis. High agreeableness and high emotional stability were associated with respectively greater belief that health measures protect the population, and greater support for the government's crisis management. Watching television news was related to a greater belief that public health measures are necessary, and specifically consuming public television news increased support for public health measures. We discuss the implications for handling the COVID-19 pandemic.