SARS-CoV-2 Seroprevalence among Healthcare Workers after the First and Second Pandemic Waves.

Background: The Grand Hôpital de Charleroi is a large non-academic Belgian hospital that treated a large number of COVID-19 inpatients. In the context of this pandemic, all professions-combined healthcare workers (HCWs), and not only direct caregivers, are a frontline workforce in contact with suspected and confirmed COVID-19 cases and seem to be a high-risk group for exposure. The aim of our study was to estimate the prevalence of anti-SARS-CoV-2 antibodies in HCWs in our hospital after the first and second pandemic waves and to characterize the distribution of this seroprevalence in relation to various criteria. Methods: At the end of the two recruitment periods, a total of 4008 serological tests were performed in this single-center cross-sectional study. After completing a questionnaire including demographic and personal data, possible previous COVID-19 diagnostic test results and/or the presence of symptoms potentially related to COVID-19, the study participants underwent blood sampling and serological testing using DiaSorin's LIAISON® SARS-CoV-2 S1/S2 IgG test for the first phase and LIAISON® SARS-CoV-2 TrimericS IgG test for the second phase of this study. Results: In total, 302 study participants (10.72%) in the first round of the study and 404 (33.92%) in the second round were positive for SARS-CoV-2-IgG antibodies. The prevalence of seropositivity observed after the second wave was 3.16 times higher than after the first wave. We confirmed that direct, prolonged, and repeated contact with patients or their environment was a predominant seroconversion factor, but more unexpectedly, that this was the case for all HCWs and not only caregivers. Finally, the notion of high-risk contact seemed more readily identifiable in one's workplace than in one's private life. Conclusions: Our study confirmed that HCWs are at a significantly higher risk of contracting COVID-19 than the general population, and suggests that repeated contacts with at-risk patients, regardless of the HCWs' professions, represents the most important risk factor for seroconversion (Clinicaltrials.gov number, NCT04723290).

Improving early audiological intervention via newborn hearing screening in Belgium.

BACKGROUND: Newborn hearing screening programs aim to lower the ages at audiological intervention among hearing-impaired children. In Wallonia and Brussels (Belgium), audiological intervention data are not collected in the screening program, and the ages at initiating audiological care have never been assessed. This study aimed to assess the evolution in the ages at initiating audiological intervention in the context of a newborn hearing screening program implementation. METHODS: This population-based descriptive study used data from the Belgian healthcare billing database. The main outcomes were the children's ages at the initial audiological assessment, hearing-aid fitting, and cochlear implantation. Results were compared to the same outcomes from another Belgian regional program (Flanders) that was implemented one decade earlier. Annual birth cohorts from 2006 to 2011 were included in the study. RESULTS: In Wallonia-Brussels, the median ages for all outcomes tended to decrease over time but remained higher than in Flanders for each birth cohort. For all outcomes except the hearing-aid fitting, differences in median ages between the two regions became less pronounced during the study period. In 2006, < 23% of the children from Wallonia-Brussels received any audiological care before the age of 12 months and these proportions were approximately 2-fold greater in the subsequent birth cohorts. For all outcomes, early care (< 12 months) was typically delivered less frequently in Wallonia-Brussels, compared to the delivery in Flanders. These region-specific differences exhibited a decreasing trend over time, and statistically significant differences were less common in the later birth cohorts. CONCLUSIONS: We conclude that the hearing screening program in Wallonia and Brussels promoted earlier audiological intervention among hearing-impaired children. However, milestones recommended by experts for an early intervention were not totally encountered. We also recommend collecting audiological intervention data as part of this program, which can facilitate more accurate and regular program evaluation.

Organisation of newborn hearing screening programmes in the European Union: widely implemented, differently performed.

BACKGROUND: Implementation of newborn hearing screening programmes is widely recommended and programme organisational designs may differ in practice. The objective of this article was to establish an overview of the newborn hearing screening programmes in the 28 countries of the European Union on four topics (policy-decision, financing, general designs, organisational features). METHODS: National or regional programme coordinators completed an online self-administered questionnaire focusing on protocol description and programme organisation. RESULTS: Thirty-nine key informants, representing 24 countries, from national or regional levels completed the questionnaire. Newborn hearing screening programmes are or will be shortly implemented largely in the European Union countries. Levels of policy decision-making and organisational decisions are diverse (national, regional or combined). Designs of the programmes (number of steps before diagnosis referral, single or dual target group protocol) highly varied. However, common organisational elements were observed: hearing screening tests are often performed by nursing staff, in hospitals and early in life. This pattern does not apply when a screening protocol is specifically implemented for newborns with risk factor(s) for hearing impairment or admitted to neonatal intensive care units. Hearing test financing frequently involved public sources, including government and public health funds. CONCLUSION: Despite the same goal of early identification of hearing-impaired children, there is a high level of diversity in programmes, including policy decisions, financing, general designs and pragmatic organisational choices (e.g. professionals involved, location or time for screening, number of steps in the protocol). Further investigations should analyse these differences in relation to the programmes' contexts and outcomes.

Newborn hearing screening programme in Belgium: a consensus recommendation on risk factors.

BACKGROUND: Understanding the risk factors for hearing loss is essential for designing the Belgian newborn hearing screening programme. Accordingly, they needed to be updated in accordance with current scientific knowledge. This study aimed to update the recommendations for the clinical management and follow-up of newborns with neonatal risk factors of hearing loss for the newborn screening programme in Belgium. METHODS: A literature review was performed, and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system assessment method was used to determine the level of evidence quality and strength of the recommendation for each risk factor. The state of scientific knowledge, levels of evidence quality, and graded recommendations were subsequently assessed using a three-round Delphi consensus process (two online questionnaires and one face-to-face meeting). RESULTS: Congenital infections (i.e., cytomegalovirus, toxoplasmosis, and syphilis), a family history of hearing loss, consanguinity in (grand)parents, malformation syndromes, and foetal alcohol syndrome presented a 'high' level of evidence quality as neonatal risk factors for hearing loss. Because of the sensitivity of auditory function to bilirubin toxicity, hyperbilirubinaemia was assessed at a 'moderate' level of evidence quality. In contrast, a very low birth weight, low Apgar score, and hospitalisation in the neonatal intensive care unit ranged from 'very low' to 'low' levels, and ototoxic drugs were evidenced as 'very low'. Possible explanations for these 'very low' and 'low' levels include the improved management of these health conditions or treatments, and methodological weaknesses such as confounding effects, which make it difficult to conclude on individual risk factors. In the recommendation statements, the experts emphasised avoiding unidentified neonatal hearing loss and opted to include risk factors for hearing loss even in cases with weak evidence. The panel also highlighted the cumulative effect of risk factors for hearing loss. CONCLUSIONS: We revised the recommendations for the clinical management and follow-up of newborns exhibiting neonatal risk factors for hearing loss on the basis of the aforementioned evidence-based approach and clinical experience from experts. The next step is the implementation of these findings in the Belgian screening programme.

Main outcomes of a newborn hearing screening program in Belgium over six years.

OBJECTIVE: To present the outcomes of the newborn hearing screening program in Belgium (French-speaking area) since its implementation and to analyze its evolution between 2007 and 2012 in the neonatal population without reported risk factors for hearing loss. METHODS: The study was descriptive and based on a retrospective analysis of six annual databases (2007-2012) from the newborn hearing screening program. The main outcomes were identified: prevalence of reported hearing impairment; coverage rates (first and second test, follow-up); proportions of conclusive screening tests; referral rate. Each outcome was presented for the six years and by year of birth. Chi-squares were used to study differences in the various outcomes according to time. RESULTS: Over the six years, 264,508 newborns were considered as eligible for the screening. Hearing impairment was confirmed in 1.41‰ (n = 374) of them, with significant disparities from year to year, between 0.67‰ and 1.94‰. Analysis of the screening process showed that only 92.71% (n = 245,219) of the eligible newborns underwent a first hearing test. This coverage rate varied greatly over time: at the beginning, less than 90% of the newborns had a first test and it rose to almost 95%. After the two screening steps, 2.40% (n = 6340) of the newborns were referred to an ENT doctor; the referral rate slightly decreased during the first years of the program and then stabilized around 2.4%. Over the period, only 62.21% of the referred newborns had a follow-up; the follow-up rate was particularly low for the first year (44.91%) and then strongly increased (+19.52% in 2008) but never exceeded 70%. CONCLUSIONS: Outcome measures for the newborn hearing screening program in Belgium are lower than the benchmarks released by the Joint Committee on Infant Hearing. Nevertheless, the evolution of the outcome measures since the implementation of the program has been positive, particularly during the first years. At some point, most of the outcome measures decreased or at least did not change any further. The motivation and commitment of the professionals have to be supported in a variety of ways to improve outcome measures and thus, the quality of the program.

Putting newborn hearing screening on the political agenda in Belgium: local initiatives toward a community programme - a qualitative study.

BACKGROUND: The Kingdon model, based on the convergence of three streams (problem, policy, and politics) and the opening of a policy window, analyses the process by which a health issue is placed on the political agenda. We used this model to document the political agenda-setting process of the newborn hearing screening programme in Belgium. METHODS: A qualitative study based on a document review and on semi-directed interviews was carried out. The interviews were conducted with nine people who had played a role in putting the issue in question on the political agenda, and the documents reviewed included scientific literature and internal reports and publications from the newborn hearing screening programme. The thematic analysis of the data collected was carried out on the basis of the Kingdon model's three streams. RESULTS: The political agenda-setting of this screening programme was based on many factors. The problem stream included factors external to the context under study, such as the technological developments and the contribution of the scientific literature which led to the recommendation to provide newborn hearing screening. The two other streams (policy and politics) covered factors internal to the Belgian context. The fact that it was locally feasible with financial support, the network of doctors convinced of the need for newborn hearing screening, the drafting of various proposals, and the search for financing were all part of the policy stream. The Belgian political context and the policy opportunities concerning preventive medicine were identified as significant factors in the third stream. When these three streams converged, a policy window opened, allowing newborn hearing screening onto the political agenda and enabling the policy decision for its introduction. CONCLUSIONS: The advantage of applying the Kingdon model in our approach was the ability to demonstrate the political agenda-setting process, using the three streams. This made it possible to identify the many factors involved in the process. However, the roles of the stakeholders and of the context were somewhat inexplicit in this model.

Medical homes versus individual practice in primary care: impact on health care expenditures.

BACKGROUND: The medical home (MH) model has prompted increasing attention given its potential to improve quality of care while reducing health expenditures. OBJECTIVES: We compare overall and specific health care expenditures in Belgium, from the third-party payer perspective (compulsory social insurance), between patients treated at individual practices (IP) and at MHs. We compare the sociodemographic profile of MH and IP users. RESEARCH DESIGN: This is a retrospective study using public insurance claims data. Generalized linear models estimate the impact on health expenditures of being treated at a MH versus IP, controlling for individual, and area-based sociodemographic characteristics. The choice of primary care setting is modeled using logistic regressions. SUBJECTS: A random sample of 43,678 persons followed during the year 2004. MEASURES: Third-party payer expenditures for primary care, secondary care consultations, pharmaceuticals, laboratory tests, acute and long-term inpatient care. RESULTS: Overall third-party payer expenditures do not differ significantly between MH and IP users (€+27). Third-party payer primary care expenditures are higher for MH than for IP users (€+129), but this difference is offset by lower expenditures for secondary care consultations (€-11), drugs (€-40), laboratory tests (€-5) and acute and long-term inpatient care (€-53). MHs attract younger and more underprivileged populations. CONCLUSIONS: MHs induce a shift in expenditures from secondary care, drugs, and laboratory tests to primary care, while treating a less economically favored population. Combined with positive results regarding quality, MH structures are a promising way to tackle the challenges of primary care.

Seat belt use and social inequality in Belgium.

BACKGROUND: To search for and quantify the importance of socio-economic inequality in seat belt use in young Belgians (15-24 years old). METHODS: Using the data of the National Health Survey of Belgium (1997), socio-economic indicators were constructed combining characteristics of the individual and the household to which s/he 'belongs' (equivalent household income, employment, poverty, subjective poverty, and socio-economic insecurity) and the corresponding concentration curves and indices were calculated. RESULTS: Significant differences were found in seat belt use related to young people's socio-economic status. The failure to buckle up was concentrated most heavily in the least favoured socio-economic groups. Such inequality was a constant finding, although its magnitude varied according to the socio-economic indicator used, going from -0.142 for the variable 'occupational category of the household' to -0.028 for the variable 'poverty'. CONCLUSIONS: This finding of true socio-economic inequality in the use of seat belts by 15-24 year olds should prompt special vigilance in health promotion approaches aimed at changing behaviour. It also underlines the importance of being attentive to the socio-economic indicators that are chosen to quantify such inequality in intra- and inter-country comparisons.