Ethics policies on euthanasia in hospitals--A survey in Flanders (Belgium)

OBJECTIVE: To determine the prevalence, development, stance, and communication of written institutional ethics policies on euthanasia in Flemish hospitals. METHODS: Cross-sectional mail survey of general directors of all hospitals (n=81) in Flanders, Belgium. RESULTS: Of the 81 hospitals invited to participate, 71 (88%) completed the questionnaire. Of these, 45 (63%) had a written ethics policy on euthanasia. The Belgian Act on Euthanasia and centrally developed guidelines of professional organisations were the most frequently mentioned reasons for and sources used in developing ethics policies on euthanasia in hospitals. Up to one-third of hospitals reported that they developed the policy upon request from physicians or nurses, or after being confronted with a euthanasia request. Development and approval of institutional ethics policies occurred within a multidisciplinary context involving clinicians, ethicists, and hospital administrators. The majority of hospitals restrictively applied the euthanasia law by introducing palliative procedures in addition to legal due care criteria. Private Catholic hospitals, in particular, were more likely to be restrictive: euthanasia is not permitted or is permitted only in exceptional cases (in accordance with legal due care criteria and additional palliative care procedures). The majority of hospitals took the initiative to communicate the policy to hospital physicians and nurses. CONCLUSIONS: Since the enactment of the Belgian Act on Euthanasia in 2002, the debate on how to deal with euthanasia requests has intensified in Flemish hospitals. The high prevalence of written institutional ethics policies on euthanasia and other medical end-of-life decisions is one possible outcome of this debate.     

Content analysis of euthanasia policies of nursing homes in Flanders (Belgium)

Objectives To describe the form and content of ethics policies on euthanasia in Flemish nursing homes and to determine the possible influence of religious affiliation on policy content. Methods Content analysis of euthanasia policy documents. Results Of the 737 nursing homes we contacted, 612 (83%) completed and returned the questionnaire. Of 92 (15%) nursing homes that reported to have a euthanasia policy, 85 (92%) provided a copy of their policy. Nursing homes applied the euthanasia law with additional palliative procedures and interdisciplinary deliberations. More Catholic nursing homes compared to non-Catholic nursing homes did not permit euthanasia. Policies described several phases of the euthanasia care process as well as involvement of caregivers, patients, and relatives; ethical issues; support for caregivers; reporting; and procedures for handling advance directives. Conclusion Our study revealed that euthanasia requests from patients are seriously considered in euthanasia policies of nursing homes, with great attention for palliative care and interdisciplinary cooperation.     

Ethics policies on euthanasia in hospitals—A survey in Flanders (Belgium)

ObjectiveTo determine the prevalence, development, stance, and communication of written institutional ethics policies on euthanasia in Flemish hospitals.MethodsCross-sectional mail survey of general directors of all hospitals (n = 81) in Flanders, Belgium.ResultsOf the 81 hospitals invited to participate, 71 (88%) completed the questionnaire. Of these, 45 (63%) had a written ethics policy on euthanasia. The Belgian Act on Euthanasia and centrally developed guidelines of professional organisations were the most frequently mentioned reasons for and sources used in developing ethics policies on euthanasia in hospitals. Up to one-third of hospitals reported that they developed the policy upon request from physicians or nurses, or after being confronted with a euthanasia request. Development and approval of institutional ethics policies occurred within a multidisciplinary context involving clinicians, ethicists, and hospital administrators. The majority of hospitals restrictively applied the euthanasia law by introducing palliative procedures in addition to legal due care criteria. Private Catholic hospitals, in particular, were more likely to be restrictive: euthanasia is not permitted or is permitted only in exceptional cases (in accordance with legal due care criteria and additional palliative care procedures). The majority of hospitals took the initiative to communicate the policy to hospital physicians and nurses.ConclusionsSince the enactment of the Belgian Act on Euthanasia in 2002, the debate on how to deal with euthanasia requests has intensified in Flemish hospitals. The high prevalence of written institutional ethics policies on euthanasia and other medical end-of-life decisions is one possible outcome of this debate.     

Ethics policies on euthanasia in nursing homes: a survey in Flanders, Belgium

In many European countries there is a public debate about the acceptability and regulation of euthanasia. In 2002, Belgium became the second country after the Netherlands to enact a law on euthanasia. Although euthanasia rarely occurs, the complexity of the clinical-ethical decision making surrounding euthanasia requests and the need for adequate support reported by caregivers, means that healthcare institutions increasingly need to consider how to responsibly handle euthanasia requests. The development of written ethics policies on euthanasia may be important to guarantee and maintain the quality of care for patients requesting euthanasia. The aim of this study was to determine the prevalence, development, position, and communication of written ethics policies on euthanasia in Flemish nursing homes. Data were obtained through a cross-sectional mail survey of general directors of all Catholic nursing homes in Flanders, Belgium. Of the 737 nursing homes invited to participate, 612 (83%) completed the questionnaire. Of these, only 15% had a written ethics policy on euthanasia. Presence of an ethics committee and membership of an umbrella organization were independent predictors of whether a nursing home had such a written ethics policy. The Act on Euthanasia and euthanasia guidelines advanced by professional organizations were the most frequent reasons (76% and 56%, respectively) and reference sources (92% and 64%, respectively) for developing ethics policies on euthanasia. Development of ethics policies occurred within a multidisciplinary context. In general, Flemish nursing homes applied the Act on Euthanasia restrictively by introducing palliative procedures in addition to legal due care criteria. The policy was communicated to the consulting general practitioner and nurses in 74% and 89% of nursing homes, respectively. Although the overall prevalence of ethics policies on euthanasia was low in Flemish nursing homes, institution administrators displayed growing awareness of bearing responsibility for stimulating dialogue and reflection about how to deal with euthanasia requests within their institution.     

Seroprevalence of Bordetella pertussis antibodies in Flanders (Belgium)

To determine age-dependent pertussis immune response in the Flemish population, antibody levels to pertactin (PRN), pertussis toxin (PT) and filamentous hemagglutinin (FHA) were measured in serum samples from 1622 healthy 1-100-year-old subjects. For anti-PRN and anti-PT antibodies, peaks in GMTs were seen in infancy and again in the 10-15-year age group. After age of 20 years, anti-PRN GMT declined rapidly over a decade, followed by a slower decline. Anti-FHA GMT tended to rather increase progressively with age. These data confirm waning of vaccine-induced antibody levels and suggest pertussis resurgence during adolescence and young adulthood. These results support a pertussis booster vaccination policy for adolescents and adults.     

Cultural differences affecting euthanasia practice in Belgium: one law but different attitudes and practices in Flanders and Wallonia

Since 2002, Belgium has had a national law legalising euthanasia. The law prescribes several substantive due care requirements and two procedural due care requirements, i.e. consultation with an independent physician and reporting of euthanasia to a Federal Control Committee. A large discrepancy in reporting rates between the Dutch-speaking (Flanders) and the French-speaking (Wallonia) parts of Belgium has led to speculation about cultural differences affecting the practice of euthanasia in both regions. Using Belgian data from the European Values Study conducted in 2008 among a representative sample of the general public and data from a large-scale mail questionnaire survey on euthanasia of 480 physicians from Flanders and 305 from Wallonia (conducted in 2009), this study presents empirical evidence of differences between both regions in attitudes towards and practice of euthanasia. Acceptance of euthanasia by the general population was found to be slightly higher in Flanders than in Wallonia. Compared with their Flemish counterparts, Walloon physicians held more negative attitudes towards performing euthanasia and towards the reporting obligation, less often labelled hypothetical cases correctly as euthanasia, and less often defined a case of euthanasia having to be reported. A higher proportion of Flemish physicians had received a euthanasia request since the introduction of the law. In cases of a euthanasia request, Walloon physicians consulted less often with an independent physician. Requests were more often granted in Flanders than in Wallonia (51% vs 38%), and performed euthanasia cases were more often reported (73% vs 58%). The study points out some significant differences between Flanders and Wallonia in practice, knowledge and attitudes regarding euthanasia and its legal requirements which are likely to explain the discrepancy between Wallonia and Flanders in the number of euthanasia cases reported. Cultural factors seem to play an important role in the practice of (legal) euthanasia and the extent to which legal safeguards are followed.     

Social inequalities in perinatal and infant mortality in the northern region of Belgium (the Flanders)

BACKGROUND: The study was intended to analyse the independent effect of some facets of the socio-economic status of both parents on perinatal, neonatal and post-neonatal mortality in the northern region of Belgium (the Flanders). METHOD: Perinatal data collected by the Study Centre for Perinatal Epidemiology were linked with socio-economic data collected by the district council. Mothers aged > or =25 years are included in the study. RESULTS: 50796 births were analysed. 452 infants died either before birth or during the first year of life. 52% of the foeto-infantile mortality occurred before birth and 57% of the infant mortality in the first week of life. The educational level was strongly related to foetal (p<0.001) and, to a lesser degree, to early-neonatal mortality (p=0.001). Employment did not correlate with any mortality item. Except for foetal mortality, the strongest correlation was always observed for maternal rather than paternal social items. In a logistic regression model, foetal mortality, perinatal mortality and infantile mortality remained strongly correlated with the educational level of the mother. Infant mortality beyond the first week of life was not correlated with any aspect of the social status of the parents. CONCLUSIONS: The educational level of the mother is the single most important determinant of infantile mortality in the Flanders representing the totality of hospital births by mothers aged > or =25 years in 1999 in the Flanders. KEY POINTS: Study Question: Does education, profession and actual employment of both parents, independently operates discrimination in the outcome of pregnancy up to one year? Results: Maternal education is the only significant and independent determinant of foetal as well as neonatal and foeto-infantile mortality. Results: The status of the mother is by far more important than that of the father in determining the outcome of pregnancy.     

Pros and cons of an illicit drug users' registration system by means of judicial data in Flanders (Belgium)

The main objective of this study was to evaluate the advantages and shortcomings of a new kind of registration of illicit drug users in Flanders, Belgium. Data about the profile of drug users who have come into contact with the law were collected by examining the records kept by the District Courts. On the one hand, published data on illicit drug users in Flanders are scarce. On the other hand, a lot of unused judicial information is available. All District Courts in Flanders (n=13) and Brussels (n=1) participated in the study. The data show that a simple registration of verbalised drug users with a short questionnaire can provide useful information for prevention campaigns and police investigation and shows the importance of prevention programmes starting at school. Notwithstanding some shortcomings, the illicit drug users' registration system by means of judicial data in Flanders forms a solid basis upon which an integrated registration of illicit drug use can be built.     

Timeliness of infant vaccination and factors related with delay in Flanders,Belgium

Achieving high vaccination coverage is a necessary, but not a sufficient indicator of the quality of a vaccination programme, in terms of control and prevention of childhood infectious diseases. For optimal protection of infants, timeliness of vaccination is increasingly recognized as another important target.     

The difficult quest for data on "vanishing" vaccine-preventable infections in Europe: the case of measles in Flanders (Belgium)

We aimed to describe the impact of vaccination on the epidemiology of measles infection in Flanders (Belgium), to document probable vaccination coverage based on this evidence, compare these epidemiological data with those generated by a mathematical model and estimate the costs of morbidity from measles. In contrast to previous analyses, we included the costs of long-term care for sequelae due to encephalitis and subacute sclerosing panencephalitis (SSPE). We estimated the direct health care costs per average measles case at 227, 212, 210, 200 and 194 for the age groups of 0-4, 5-9, 10-14, 15-19 and > or=20 years, respectively. Excluding long-term care lowers these estimates by 22-51%, depending on the age group. By including indirect time costs, we arrive at total costs per measles case of 320, 305, 210, 200 and 625, respectively. In addition to registering vaccination coverage more rigorously in the future, it seems necessary to undertake seroprevalence studies to document the age-specific immunity to measles. By using such information, current vaccination strategies can be adapted to prevent future outbreaks and to help eliminate measles from Europe in an efficient way. We noted throughout that many of the data sources are flawed. Better and accessible data bases are required to improve the reliability of similar studies in the future.     

浦东新区医疗机构连续2年医院感染现患率调查分析

目的了解浦东新区医疗机构的医院感染现患情况。方法选取浦东新区的10所医疗机构作为监测点医院,各监测医院分别于2013年11月和2014年11月中的某一日作为调查日开展医院感染横断面调查。比较不同级别医院医院感染现患情况。 结果2013、2014年医院感染现患率分别为4.04%、3.75%,差异无统计学意义（χ2=0.709,P=0.400）。 一、二、三级医院现患率2013年分别为：0.66%、3.32%、4.60%,2014年分别为：0、3.52%、4.01%,每年不同级别医院现患率比较差异均有统计学意义（均P＜0.05）。医院感染现患率较高的科室为神经外科、血液科、重症监护病房（ICU）和老年科。各科室两年现患率比较,ICU现患率上升明显,由10.09%上升至18.78%（χ2=3.921,P=0.048）,老年科下降明显,由10.07%下降至5.02%（χ2=5.698,P=0.017）。医院感染部位主要为下呼吸道（36.72%）、上呼吸道（9.96%）和泌尿道（12.89%）。2013年检出病原菌172株,2014年检出177株,以G-菌为主（占60.74%）,其次为G+菌（占26.37%）和真菌（占12.89%）。两次调查相比,医院感染病原菌构成比较差异无统计学意义（χ2=5.819,P=0.830）。结论浦东新区各级医疗机构中三级医院医院感染现患率最高;ICU现患率上升比较明显;感染部位以下呼吸道为主;感染病原菌以G-菌为主。     

2014年贵州省医疗机构住院患者医院感染和社区感染现患率调查

目的了解贵州省医疗机构住院患者医院感染与社区感染现状,以及抗菌药物使用情况。方法2014年9月对贵州省174所二级及二级以上医疗机构住院患者感染情况进行横断面调查。结果共调查68 419例住院患者,实查率为99.65%。发生医院感染1 581例、1 684例次,医院感染现患率为2.31％、例次现患率为2.46％,发生社区感染18 571例、19 191例次,社区感染现患率为27.14％、例次现患率为 28.05％;医院感染和社区感染现患率最高的科室分别为综合ICU、儿科非新生儿组。医院感染部位和社区感染部位比较差异有统计学意义（χ2=17 325.44,P＜0.01）;医院感染和社区感染的病原菌均以大肠埃希菌为主。调查日抗菌药物使用率为39.82%,使用率最高的为综合ICU（80.47%）和儿科（76.67%）。用药目的以治疗用药为主［18 386例（67.48%）］,联合用药以单一用药为主［21 672例（79.55%）］。治疗使用抗菌药物者病原菌培养送检率为31.76%。结论此次调查有助于了解贵州省医院感染和社区感染高发科室、高发部位,以及治疗使用抗菌药物患者病原学送检情况,为进一步的预防与控制医院感染提供依据。