Ethnic disparities and morbidity in the Province of Antwerp, Belgium.

OBJECTIVE: This study aims to identify geographical disparities in perinatal mortality and morbidity in the province of Antwerp, Belgium. We performed a retrospective cohort study from an existing database. Data included from 1 January , 2000 to 31 December, 2009 and including all deliveries in the Province of Antwerp, Belgium. Collected outcome measures : fetal death, early and late neonatal death, preterm birth, low birth weight. Outcomes were analyzed according to postal code of the pregnant women's address. RESULTS: A total of 167.246 deliveries in sixty postal codes were analyzed and statistically significant differences (p<0.001) between postal codes for all outcome measures except for early and late neonatal death were detected. Generally postal codes tend to have either high or low prevalences for all perinatal outcomes and two postal code zones had a significantly worse perinatal outcome on all fields. Major differences in perinatal outcome exist within the well-defined area of the relatively small province of Antwerp, Belgium. CONCLUSION: Perinatal outcome is strongly influenced by maternal postal code even within a relatively affluent European region demonstrating persistent health inequalities and suggesting further research is necessary to explain these differences and create interventions to diminish inequalities.

[Information transmission to the community pharmacist after a patient's discharge from the hospital: setting up of a written medication discharge form, prospective evaluation of its impact, and survey of the information needs of the pharmacists]. / Transmission d'information au pharmacien d'officine après hospitalisation du patient: élaboration d'une feuille de transfert, évaluation prospective de son effet et enquête sur les besoins d'information des pharmaciens.

INTRODUCTION: Discharge from the hospital is a period at risk for the continuity of patient's medication (seamless pharmaceutical care). The community pharmacist is often the first health care professional seen by the patient after hospital discharge. The clinical pharmacist has potentially a key role in establishing an efficient information transfer from the hospital to the community pharmacy. OBJECTIVE: (1) To develop and, (2) to evaluate the impact of a structured discharge medication form prepared at hospital discharge by the clinical pharmacist and containing information items related to the medication regimen for the community pharmacist, and (3) to survey the information needs of the Belgian community pharmacists to ensure continuity of care after hospitalization. METHODS: (1) A structured discharge medication form has been developed based on a Literature review and on opinions expressed by community and clinical pharmacists, members of the Belgian Pharmaceutical Union (Association Pharmaceutique Belge) and an ethical committee. (2) A prospective study has been conducted with patients from geriatrics and orthopaedics wards of the University Hospital Dinant-Godinne returning home after hospital discharge with the discharge medication form to be given to their commuiity pharmacist; its use, the reasons for non-use, the perceived impact and the satisfaction of the community pharmacist have been assessed. (3) An on-line survey addressed to all Belgian community pharmacists evaluated their information needs. RESULTS: (1) The final version of the discharge medication form included key information items concerning the hospital, the patient, the discharge treatment (including the type of modifications made as compared to medications taken before admission), and on medication management at home. Some items were excluded because of Lack of perceived utility by pharmacists, confidentiality issues, and respect of patient's freedom of choice. (2) From the 71 medication forms given to patients, 48 were received by the community pharmacist. One quarter of respondents stated that they did not use the form, the main reason being that it was received after dispensing of the discharge treatment (n=6/11). The majority of the community pharmacists considered most of the information items as useful and the discharge medication form as being valuable for continuity of care. Requests for additional information were made (e.g., reason of admission and of treatment modifications, etc.). (3) The utility, benefits, and need for additional information items beyond what was included in the discharge medication form were highlighted by the respondents (n=309) of the national survey. Most of these respondents confirmed the value of the different information items included in the discharge medication form. CONCLUSION: The transmission of a structured medication form containing information about the medication regimen upon hospital discharge is of real interest and value for the community pharmacist because it goes beyond what is usually provided on a medical prescription. However, this discharge medication form should include more information items for effective pharmaceutical care.

T cell inflammatory response, Foxp3 and TNFRS18-L regulation of peripheral blood mononuclear cells from patients with nasal polyps-asthma after staphylococcal superantigen stimulation.

BACKGROUND: Staphylococcal superantigens may modulate airway inflammatory disease. OBJECTIVE: We assessed the effect of Staphylococcus aureus enterotoxin B (SEB) on T cell activation in patients with nasal polyps and asthma, and its possible link to aspirin hypersensitivity. METHODS: Leucocytes were isolated from five healthy subjects (controls), five asthmatics with nasal polyps without (NP-ATA) and five with aspirin-induced asthma (NP-AIA). Cells were incubated with increasing concentrations of SEB for 4 and 18 h. Release of T(H)1/T(H)2 cytokines was assessed by Cytometric Bead-Array. Foxp3 and TNFRS18-L expression were analysed by qPCR and flow cytometry. RESULTS: After 4 and 18 h, SEB significantly increased IFN-gamma, IL-4, TNF-alpha, IL-5 and IL-2 concentrations in supernatants of both NP polyp groups compared with controls. Baseline Foxp3 was significantly decreased in both NP-asthma groups. Incubation with SEB for 4 h induced a limited up-regulation of Foxp3 in NP-AIA patients, which was switched off consecutively. Foxp3 was significantly up-regulated in the control group after 18 h, but not in the NP-asthmatic groups. In parallel, TNFRS18-L mRNA significantly increased after 18 h in the NP-asthma groups compared with control subjects. This molecule was highly expressed in CD11c(+)CD14(+) cells and its levels increased after 18 and 24 h culture in the NP-asthma patients. CONCLUSION: SEB induces both T(H)1 and T(H)2 pro-inflammatory responses in patients with nasal polyps and asthma regardless of the presence of aspirin hypersensitivity. The nature of this response may be linked to a basal deficiency of Foxp3 observed in the NP-asthmatic patients and/or to the up-regulation of TNFRS18-L on monocytes/dendritic cell precursors.

[Urinary incontinence in the elderly: distinctive feature and management]. / Incontinence du sujet âgé: particularités et prise en charge.

Urinary incontinence is very common among the elderly and results in a series of personal and economic complications. This population is often very heterogeneous with the aetiologies or dependences which are not very obvious. It is thus important to carry out among these patients a total assessment which will make it possible to detect the affections or the dependence from which it suffers. The BGMST (Belgian Geriatric Minimum Screening Test) includes a series of non aggressive tests which will answer this need. The performance of urodynamic tests is not easily achieved in case of not very autonomous or intellectually little collaborating patients. The prescription of surgical treatments is not necessarily to reject (urge incontinence). With regard to drugs, a good knowledge of their metabolism, of their interferences with other treatments in progress, is important especially in the absence of literature taking into account this heterogeneous old population. The prescriptions must be regularly re-examined in order to avoid weakening of these patients. In addition, in the elderly, aetiologies of incontinence are often multiple and consequently its daily management becomes particularly difficult.

[How to improve the continuity of pharmacotherapy at hospital admission and discharge]. / Comment optimiser la continuité du traitement médicamenteux entre l'hôpital et le domicile?

The continuity of pharmacotherapy is of vital importance when patients move from one health care setting to another. Unfortunately, this continuity is not always guaranteed. The aim of this study is to propose solutions to enhance the continuity of pharmacotherapy at hospital admission and discharge. The study consists of a systematic review of the international literature and an analysis of seamless care initiatives in seven selected countries; a summary of Belgian data on problems as well as solutions with regard to continuity of care; a quantification of the extent of medication changes as a result of a hospital stay in Belgium; and a qualitative analysis of the perception of Belgian health care professionals (HCPs) on approaches to improve seamless care. The literature review yielded 15 papers of sufficient quality. However, this review did not generate definitive conclusions on the clinical impact and the cost-effectiveness of interventions aiming to enhance the continuity of pharmacotherapy. The most important initiatives that have been put in practice in foreign countries include the development and implementation of guidelines for HCPs; national information campaigns; education of HCPs; and the development of information technologies as to share patient and prescription data between settings of care. For Belgium, 66 seamless care initiatives were identified. The high number and variety of projects show the interest for this topic as well as the involvement of various HCPs from diverse settings in the development of solutions. Based on this research, and the solutions discussed in the focus groups, the following elements are proposed to enhance the continuity of pharmacotherapy: a national guideline governing the continuity of pharmacotherapy; a national campaign to sensitize HCPs and patients in this area; the availability of a comprehensive and up to date medication list for each patient; and electronic healthcare infrastructure that facilitates sharing of information.

[Ovarian stimulation and follicular puncture risks]. / Risques de la stimulation ovarienne et du prélèvement ovocytaire.

The ovarian stimulation and the follicular puncture in ART present risks which must be planned in order to better prevent them. These complications are the ovarian hyperstimulation syndrome, the thromboembolic and carcinologic risks; the anaesthetic, hemorrhagic and infectious risks of the punctures. The presence of an endometrioma can generate an increase in the infectious risk.

[Premature ovarian failure: which protocols?]. / L'insuffisance ovarienne débutante: quels protocoles?

This review shows the results of the various studies concerning the protocols applied to the women presenting a premature ovarian failure. Will be thus analyzed the natural cycles (or semi-natural), the increase in the dose of gonadotrophins, the clomiphene citrate and the anti-aromatases, the protocols with GnRH agonists long, short, stop or microdoses, the protocols with GnRH antagonists and the adjuvant treatments: aspirin, nitric oxyde, recombinant LH recombining, growth hormone and androgens. The interest of several protocols is to collect a sufficient number of oocytes (and thus of embryos to be transferred), making it possible to obtain reasonable rates of pregnancy. However, it arises that the rates of pregnancy observed among these women depend not only on their ovarian reserve and their age, but are also function of the type of infertility, of the cycle number and the uterus.

Wound healing after paranasal sinus surgery: neutrophilic inflammation influences the outcome.

AIMS: After failure of medical treatment, functional endoscopic sinus surgery (FESS) remains the best treatment for chronic sinusitis (CS) and nasal polyposis (NP). The precise mechanisms involved in wound healing after sinus surgery remain unclear. The aim of this study was to explore systematically the different histomorphological processes and cell populations involved in the wound repair of the paranasal mucosa. METHODS AND RESULTS: Biopsy specimens from patients operated on for CS and NP were collected 1, 2 and 6 months after surgery and compared with baseline and control specimens. A pathologist blinded to biopsy status evaluated the haematoxylin/eosin-stained sections for oedema, fibrosis and inflammatory reaction, and the immunohistochemical preparations for epithelial replication, myofibroblasts, macrophages, neutrophils and eosinophils. Samples from NP showed significantly more oedema than those from CS. At baseline, oedema showed a significant correlation with macrophages, neutrophils and eosinophils, while fibrosis was inversely correlated with neutrophils. During healing, after a short increase at month 1, oedema decreased. Fibrosis and myofibroblasts showed an inverse relationship. Finally, during the postoperative period, both macrophages and neutrophils were increased when compared with controls. CONCLUSIONS: The severity of the neutrophilic inflammation appears to influence the formation of fibrosis during wound repair after sinus surgery.

The fundamental radiation properties of normoxic polymer gel dosimeters: a comparison between a methacrylic acid based gel and acrylamide based gels.

Polymer gel dosimeters offer a wide range of applications in the three-dimensional verification of complex dose distributions such as in intensity-modulated radiotherapy. One of the major difficulties with polymer gel dosimeters is their sensitivity to oxygen, as oxygen inhibits the radiation-induced polymerization reaction. For several years, oxygen was removed from the gels by bubbling the sol with inert gases for several hours during the gel fabrication. Also, the gel had to be poured in containers with low oxygen permeability and solubility. Recently, it was found that these technical difficulties can easily be solved by adding an antioxidant to the gel. These gels are called 'normoxic' gels as they can be produced under normal atmospheric conditions. In this study several properties of polymer gel dosimeters have been investigated: the dose sensitivity, the temporal and spatial stability of the gel, the sensitivity of the dose response to temperature during irradiation and during MR imaging, the energy dependence and the dose-rate dependence. This study reveals that the normoxic polymer gel dosimeter based on methacrylic acid (nMAG) studied in this work has inferior radiation properties as compared to the polyacrylamide gelatine (PAG) gel dosimeters. It is shown that from the three different gel dosimeters investigated in this study, the nPAG gel dosimeter results in a less sensitive gel dosimeter but with superior radiation properties as compared to the nMAG gel dosimeter. The importance of investigating relevant radiation properties of gel dosimeters apart from the radiation sensitivity-prior to their use for dosimetric validation experiments-is illustrated and emphasized throughout this study. Other combinations of monomer and gelling agent may result in more reliable normoxic polymer gel dosimeters.

[Coasting and ovarian stimulation protocols in high-responder patients undergoing assisted conception]. / Le coasting et les protocoles de stimulation chez les hyperrépondeuses en AMP.

Over-responsive patients are at risk of ovarian hyperstimulation, which may lead to severe complications. The choice of ovarian stimulation protocol or the use of a coasting (gonadotrophins suspension) with its associated risk of too strong ovarian response will be discussed herein. As for in vitro fertilization stimulation protocols, the best are probably those which use steadily increasing low doses of gonadotrophins, associated to GnRH agonists (low-dose protocols) or those which complete a double hypophyseal inhibition (estro-progestative association and GnRH agonists). GnRH antagonists may also reduce the risk of ovarian hyperstimulation, by estradiol drop. Outside the context of in vitro fertilization GnRH continuous administration or low -dose gonadotrophin stimulation are the best options. A coasting will be performed when an excess follicle response is documented. Under strict hormonal follow-up and within four days it allows achieving a high rate of pregnancy with a lower risk of hyperstimulation. Compared to other therapies of hyperstimulation syndrome, the coasting allows to avoid cycle cancellation or freezing of all embryos.

Neutrophil-derived metalloproteinase-9 predicts healing quality after sinus surgery.

BACKGROUND: In a recent study, we have shown that gelatinase-B (metalloproteinase [MMP]-9) in nasal secretions can have both monitoring and predictive value on the healing outcome after functional endoscopic sinus surgery (FESS) to treat chronic rhinosinusitis (CRS) and nasal polyposis (NP). In this work, we aimed to explore the source of MMP-9 and the influence of inflammation on MMP-9 expression and release in nasal tissue and secretions during airway remodelling after surgery. METHODS: Biopsies from 23 patients operated by FESS for CRS or NP were collected 1, 3, and 6 months after sinus surgery. MMP-9 expression in the paranasal mucosa was correlated with healing quality, with MMP-9 concentrations in nasal fluid, and with histomorphologic findings (edema, fibrosis, alphasmooth muscle actin, CD-68, myeloperoxidase, EG2, and transforming growth factor [TGF]-beta1 stainings). RESULTS: MMP-9 concentrations in nasal fluid were paralleled by MMP-9 expression inside the extracellular matrix (ECM) after sinus surgery. MMP-9 expression in ECM was significantly correlated with healing quality (r = 0.378, P = .0181), and poor healers presented significantly more edema (P < .05). The amounts of MMP-9 in nasal fluid were significantly and independently predicted by the number of neutrophils (P = .0224) and macrophages (P = .0497) in the tissue. In contrast, MMP-9 expression was not related to fibrosis, number of myofibroblasts, or TGF-beta1 expression in ECM. CONCLUSIONS: MMP-9 expression is increased in the ECM during wound healing and parallels concentrations of MMP-9 in nasal fluids. Inflammatory cells represent the major source of increased MMP-9 expression, which is linked to poor healing quality.

Matrix metalloproteinases MMP-7, MMP-9 and their tissue inhibitor TIMP-1: expression in chronic sinusitis vs nasal polyposis.

BACKGROUND: Nasal polyps (NP) are characterized by pseudocyst formation, whereas the mucosa in chronic sinusitis (CS) only shows a limited oedema. Matrix metalloproteinases (MMPs) are a family of endopeptidases able to degrade the extracellular matrix. Differences in histological features between CS and NP might be related to the respective expression of MMPs and their tissue inhibitors (TIMPs). OBJECTIVE: The aim of this study was to investigate MMP-7, MMP-9 and TIMP-1 proteins in NP and CS in comparison with normal mucosa. METHODS: Nasal samples, obtained from controls (n = 10), from NP (n = 8) and from CS (n = 10), were analysed by immunohistochemistry and enzyme-linked immunosorbent assay (ELISA). RESULTS: In NP, compared with controls, staining for MMP-9 and MMP-7 appeared in blood vessels. Matrix metalloproteinase-9-positive inflammatory cells could be detected in increased numbers in pseudocyst formations. Concentrations of MMP-9 protein was found significantly increased in both CS and NP compared with controls, while MMP-7 was significantly increased in NP compared with controls and CS. Tissue inhibitors of metalloproteinase-1 protein was significantly increased in CS and NP when compared with controls. CONCLUSIONS: Chronic sinusitis and NP show different pattern of MMP-7/-9 and TIMP-1 expression. We suggest that this difference in regulation of enzymes is related to the respective tissue remodelling observed in both diseases.