One year of laboratory-based COVID-19 surveillance system in Belgium: main indicators and performance of the laboratories (March 2020-21).

BACKGROUND: With the spread of coronavirus disease 2019 (COVID-19), an existing national laboratory-based surveillance system was adapted to daily monitor the epidemiological situation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the Belgium by following the number of confirmed SARS-CoV-2 infections, the number of performed tests and the positivity ratio. We present these main indicators of the surveillance over a one-year period as well as the impact of the performance of the laboratories, regarding speed of processing the samples and reporting results, for surveillance. METHODS: We describe the evolution of test capacity, testing strategy and the data collection methods during the first year of the epidemic in Belgium. RESULTS: Between the 1st of March 2020 and the 28th of February 2021, 9,487,470 tests and 773,078 COVID-19 laboratory confirmed cases were reported. Two epidemic waves occurred, with a peak in April and October 2020. The capacity and performance of the laboratories improved continuously during 2020 resulting in a high level performance. Since the end of November 2020 90 to 95% of the test results are reported at the latest the day after sampling was performed. CONCLUSIONS: Thanks to the effort of all laboratories a performant exhaustive national laboratory-based surveillance system to monitor the epidemiological situation of SARS-CoV-2 was set up in Belgium in 2020. On top of expanding the number of laboratories performing diagnostics and significantly increasing the test capacity in Belgium, turnaround times between sampling and testing as well as reporting were optimized over the first year of this pandemic.

Health Data for Research Through a Nationwide Privacy-Proof System in Belgium: Design and Implementation.

BACKGROUND: Health data collected during routine care have important potential for reuse for other purposes, especially as part of a learning health system to advance the quality of care. Many sources of bias have been identified through the lifecycle of health data that could compromise the scientific integrity of these data. New data protection legislation requires research facilities to improve safety measures and, thus, ensure privacy. OBJECTIVE: This study aims to address the question on how health data can be transferred from various sources and using multiple systems to a centralized platform, called Healthdata.be, while ensuring the accuracy, validity, safety, and privacy. In addition, the study demonstrates how these processes can be used in various research designs relevant for learning health systems. METHODS: The Healthdata.be platform urges uniformity of the data registration at the primary source through the use of detailed clinical models. Data retrieval and transfer are organized through end-to-end encrypted electronic health channels, and data are encoded using token keys. In addition, patient identifiers are pseudonymized so that health data from the same patient collected across various sources can still be linked without compromising the deidentification. RESULTS: The Healthdata.be platform currently collects data for >150 clinical registries in Belgium. We demonstrated how the data collection for the Belgian primary care morbidity register INTEGO is organized and how the Healthdata.be platform can be used for a cluster randomized trial. CONCLUSIONS: Collecting health data in various sources and linking these data to a single patient is a promising feature that can potentially address important concerns on the validity and quality of health data. Safe methods of data transfer without compromising privacy are capable of transporting these data from the primary data provider or clinician to a research facility. More research is required to demonstrate that these methods improve the quality of data collection, allowing researchers to rely on electronic health records as a valid source for scientific data.

Roadbook for the implementation of next-generation sequencing in clinical practice in oncology and hemato-oncology in Belgium.

In the field of oncology research, next-generation sequencing has contributed significantly to the discovery of DNA mutations associated with diagnosis and prognosis. It also aids in the development of targeted therapies to specific mutations and the rise of personalized medicine. As part of molecular diagnostics in cancer patients, analysis by next-generation sequencing is becoming part of routine clinical practice. The introduction of this complex technology in a healthcare system comes with multiple challenges and requires a clear action plan. Such an action plan, as outlined in this paper, was developed in Belgium and includes steps in ensuring the quality and indications of NGS testing, installing data registration and tackling ethical issues. A final step is to perform a pilot study to control the access, quality, harmonization and expertise in DNA testing. This action plan can serve as a guide for similar initiatives by other countries to facilitate NGS implementation in clinical practice.

The influence of maternal cortisol and emotional state during pregnancy on fetal intrauterine growth.

BACKGROUND: This exploratory study investigates the influence of maternal cortisol and emotional state during pregnancy on fetal intrauterine growth (IUG). We expected higher basal cortisol levels, or more depressive and anxious complaints during pregnancy, to be associated with slower IUG and lower birth weight. METHODS: A total of 91 pregnant women were recruited from the antenatal clinic and were seen once each trimester. In addition to psychological assessments, a diurnal cortisol profile was derived from saliva samples. IUG was evaluated using ultrasound. RESULTS: In mid-pregnancy (trimester (T)2), basal cortisol levels significantly predicted the variance of weight (proportion of variance in growth variable explained (PVE) = 11.6%) and body mass index (BMI) at birth (PVE = 6.8%). In late pregnancy (T3) emotional state, particularly depressive symptoms (BMI at birth: PVE = 6.9%; ponderal index (PI) at birth: PVE = 8.2%; head circumference at T3: PVE = 10.3%; head circumference at birth PVE = 9.1%) and attachment (BMI at birth: PVE = 6.9%; PI at birth: PVE = 7.2%) had an influence on growth. Analysis of growth between T2 and T3 showed that attachment and cortisol in T3 had an influence on the variation in increase in estimated fetal weight (PVE = 12.5-8.6%). CONCLUSION: These data indicate basal cortisol levels were more important in T2 whereas emotional state was more important in T3.

Three self-report questionnaires of the early mother-to-infant bond: reliability and validity of the Dutch version of the MPAS, PBQ and MIBS.

In this study, we investigated the reliability and validity of three self-report questionnaires measuring the early emotional bond between a mother and her newborn infant: the Maternal Postpartum Attachment Scale (MPAS), the Postpartum Bonding Questionnaire (PBQ) and the Mother-to-Infant Bonding Scale (MIBS). In a monocentric prospective observational cohort study, 263 mothers completed the MPAS, the PBQ and the MIBS at 8-12 and at 20-25 weeks postpartum. The participants also completed measures of mental health and, during their pregnancy, measures of recalled parental bonding, adult romantic attachment, antenatal attachment and social desirability. In our study, the internal reliabilities of the PBQ and the MPAS were high at 8-12 weeks postpartum but dropped significantly at 20-25 weeks postpartum. Moderately strong correlations between the scales of the PBQ, the MPAS and the MIBS supported their construct validity. Further, weak correlations were found with social desirability and adult attachment representations, whereas moderate correlations were found with antenatal feelings of attachment and antenatal attitudes to motherhood. Finally, maternal feelings of bonding were also moderately associated with maternal mood. Overall, our findings suggest that the MPAS, the PBQ and the MIBS provide a reliable and valid indication of the early emotional tie between a woman and her newborn infant.

Reliability and validity of the Dutch version of the maternal antenatal attachment scale.

In this study, we investigated the psychometric qualities of the Dutch version of the Maternal Antenatal Attachment Scale (MAAS). In a monocentric prospective observational cohort study, 403 expectant mothers completed a booklet with questionnaires in the first (T1), second (T2), and third (T3) pregnancy trimesters. In addition to the MAAS (T1-T3), the following measures were used: the Marlowe-Crowne Social Desirability Scale (T1), the Parental Bonding Inventory (T1), the Relationship Questionnaire (T1) the Facilitator scale and the Regulator scale (T3), the Edinburgh Postnatal Depression Scale (T1-T3) and the Pregnancy Related Anxiety Questionnaire (T1-T3). In this study, the mean of the MAAS scales increased as the pregnancy progressed. Good internal reliabilities were found for the Total MAAS scale, the Quality subscale and the Preoccupation subscale. Small-to-moderate correlations were found with social desirability, maternal orientation, parental care and adult attachment. Maternal mood was weakly associated with the quality but not with the intensity of the maternal attachment feelings. Overall, our findings suggest that the Dutch version of the Maternal Antenatal Attachment Scale is a reliable and valid measure of the early emotional tie between a pregnant woman and her unborn child.

Depressive symptomatology in pregnant and postpartum women. An exploratory study of the role of maternal antenatal orientations.

Little is known about how an expecting woman's view of pregnancy, the child, and motherhood relates to antenatal and postpartum depressive symptomatology. In this study, we investigated the influence of the maternal orientations, as described by Raphael-Leff (Psychological processes of childbearing. The Anna Freud Centre, London, 2005), on the prevalence of depressive symptoms in pregnant and postpartum women. Four hundred three pregnant women participated in a longitudinal study and completed the EPDS and the HADS-D in each pregnancy trimester and between 8 to 12 and 20 to 25 weeks postpartum. In addition, measures of maternal orientation (PPQ), personality (NEO-FFI), coping styles (UCL), adult attachment (RQ), and parental bonding (PBI) were completed antenatally. Bivariate and multivariate analyses revealed that Neuroticism and the Regulator orientation are positively associated with the EPDS and HADS-D in both pregnant and postpartum women. These associations decreased in strength but remained significant after controlling for previous responses on the EPDS and HADS-D. Small negative associations were found between the Facilitator orientation and the HADS-D scores during pregnancy and the early postpartum period. However, this association did not hold its statistical significance within the hierarchical multiple regression models. The maternal orientations have a small but significant and independent contribution in the variance of depressive symptomatology in pregnant and postpartum women.

Anxiety in pregnant and postpartum women. An exploratory study of the role of maternal orientations.

BACKGROUND: Little is known about why some women are anxious during pregnancy but not in the postpartum period, or vice versa. We aimed to determine the influence of maternal antenatal orientations (Raphael-Leff, J. (2005) Psychological Processes of Childbearing, London, The Anna Freud Centre.) on the prevalence of general anxiety symptoms and specific anxiety in pregnant and postpartum women. METHODS: Four hundred and three pregnant women participated in a longitudinal study and completed general (HADS-A) and specific (PRAQ, MSAS) anxiety questionnaires and measures of maternal antenatal orientations, personality traits, cognitive and behavioural coping styles and attachment. RESULTS: Higher scores on the neuroticism and regulator orientation scale consistently predicted higher scores on the general and pregnancy related anxiety measures. Also, an interaction effect was found between the regulator scale and the neuroticism scale on the general anxiety symptoms and pregnancy related anxiety. Finally, the facilitator orientation scale and the neuroticism scale, predicted maternal separation anxiety in the postpartum period. CONCLUSION: Women differ in the risk factors, the nature and timing of heightened anxiety during the transition to motherhood. The anxieties of women tending to the regulator orientation are pregnancy related, whereas women tending to the facilitator orientation fear the separation from their child in the postpartum period.

Women's mental health before, during, and after pregnancy: a population-based controlled cohort study.

BACKGROUND: Common mental health disorders like depressive and anxiety disorders are frequent in antenatal and postpartum women. However, no agreement about the prevalence of these disorders and the course of women's mental health during the transition to motherhood exists. This study compared women's mental health before, during, and after pregnancy with a control group of nonpregnant women. METHODS: Three hundred and twenty-four women were assessed before, during, and after their pregnancy with the 12-item version of the General Health Questionnaire (GHQ-12). A control group of 324 women who did not deliver during 3 subsequent years was assessed with the GHQ-12 at corresponding time-points. RESULTS: No differences in GHQ-12 mean scores, prevalence, and incidence of common mental health disorders between the study and control groups were found. No differences in prevalence and incidence rates within each group were found. The presence of a common mental health disorder before pregnancy or in early pregnancy predicted common mental health disorders in the postpartum period. CONCLUSIONS: Common mental health disorders are frequent during pregnancy and the postpartum period, but pregnant or postpartum women are not more at risk than those who are not pregnant or who did not deliver.