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  • Open Access
    Authors: 
    Sarah Galdiolo; Anthony Mauroy; Lesley Liliane Verhofstadt;
    Publisher: SAGE Publications
    Country: Belgium

    This 5-wave longitudinal study aimed to monitor the feeling of we-ness and separateness over one year of the COVID-19 pandemic by examining partners’ natural pronoun usage when reporting couple interactions. Compared to the start of the pandemic, a general decline of we-ness was found after one year. Moreover, the changes in couple we-ness were non-linear, resulting in an increase at the end of the strict lockdown, followed by a decrease. No change in couple separateness was found.

  • Open Access English
    Authors: 
    Adam Windak; Katarzyna Nessler; Esther Van Poel; Claire Collins; Ewa Wójtowicz; Liubove Murauskiene; Kathryn Hoffmann; Sara Willems;
    Countries: Lithuania, Poland, Belgium

    COVID-19 proved that primary care (PC) providers have an important role in managing health emergencies, such as epidemics. Little is known about the preparedness of primary care practice infrastructure to continue providing high quality care during this crisis. The aim of this paper is to describe the perceived limitations to the infrastructure of PC practices during COVID-19 and to determine the factors associated with a higher likelihood of infrastructural barriers in providing high quality care. This paper presents the results of an online survey conducted between November 2020 and November 2021 as a part of PRICOV-19 study. Data from 4974 practices in 33 countries regarding perceived limitations and intentions to make future adjustments to practice infrastructure as a result of the COVID-19 pandemic were collected. Approximately 58% of practices experienced limitations to the building or other practice infrastructure to provide high-quality and safe care during the COVID-19 pandemic, and in 54% making adjustments to the building or the infrastructure was considered. Large variations between the countries were found. The results show that infrastructure constraints were directly proportional to the size of the practice. Better pandemic infection control equipment, governmental support, and a fee-for-service payment system were found to be associated with a lower perceived need for infrastructural changes. The results of the study indicate the need for systematic support for the development of practice infrastructure in order to provide high-quality, safe primary care in the event of future crises similar to the COVID-19 pandemic.

  • Open Access
    Authors: 
    Hannah De Laet; Yanni Verhavert; Kristine De Martelaer; Evert Zinzen; Tom Deliens; Elke Van Hoof;
    Publisher: Frontiers Media SA
    Country: Belgium

    BackgroundDue to the COVID-19 pandemic, schools were closed, teachers had to teach from home and after a while, they had to return to the classroom while the pandemic was still on-going. Even before the pandemic, teachers were already more at risk for burn-out syndrome compared to the general population. Furthermore, not much research pertaining to this population has been carried out during the pandemic and so the impact of the pandemic on teachers' risk of burn-out syndrome and recovery need remains unclear. The aim of the current study was to fill this knowledge gap and map out the impact on risk of burn-out syndrome and recovery need at different time points during the pandemic.Methods and findingsAt baseline, 2,167 secondary school teachers in Flanders were included in this prospective study. Questionnaire data were obtained at ten different time points between September 2019 and August 2021. To assess risk of burn-out syndrome and its dimensions, the Utrecht Burn-out Scale for Teachers was administered. Need for recovery was assessed using questions adopted from the Short Inventory to Monitor Psychosocial Hazards. The results revealed an initial positive effect of the first lockdown (Mar/Apr 2020) with a decrease in risk of burn-out syndrome [Odds ratio (OR) Jan/Feb 2020–Mar/Apr 2020 = 0.33, p < 0.001], emotional exhaustion (EMM Jan/Feb 2020–Mar/Apr 2020 = −0.51, p < 0.001), depersonalization (EMM Jan/Feb 2020–Mar/Apr 2020 = −0.13, p < 0.001) and recovery need [Estimated marginal mean (EMM) Jan/Feb 2020–Mar/Apr 2020 = −0.79, p < 0.001]. No significant effect on personal accomplishment was found (p = 0.410). However, as the pandemic went on, higher risk of burn-out syndrome, emotional exhaustion, depersonalization and recovery need, and lower personal accomplishment were observed.ConclusionsDespite the initial positive impact on risk of burn-out syndrome, its dimensions and recovery need, a negative long-term impact of the COVID-19 pandemic became visible. This study highlights once again the importance for interventions to reduce teachers' risk of burn-out syndrome, especially in such difficult times as a pandemic.

  • Open Access English
    Authors: 
    Van Beckhoven, Dominique; Serrien, Ben; Montourcy, Marion; Verhofstede, Chris; Van den Bossche, Dorien; Libois, Agnes; De Geyter, Deborah; Martin, Thierry; Van den Eynde, Sandra; Vuylsteke, Bea; +7 more
    Publisher: BioMed Central
    Country: Belgium

    Abstract Background To gain insight into the impact of the COVID-19 pandemic and containment measures on the HIV epidemic and services, this study aims to describe HIV trends in 2020 and compare them with previous years. Methods Belgian national HIV surveillance data 2017–2020 were analysed for trends in HIV testing, HIV diagnoses, VL measurements, ART uptake and PrEP purchase. Descriptive statistics from 2020 are compared to annual averages from 2017 to 2019 (proportional difference, %). Results In 2020, 725 HIV infections were diagnosed in Belgium (− 21.5% compared to 2019). The decline was most pronounced during the first lockdown in April–May but also present in July–December. The number of HIV tests performed decreased by 17.6% in 2020, particularly in March–May and October–December (− 57.5% in April and -25.4% in November 2020 compared to monthly 2017–19 numbers). Diagnosis of acute HIV infections decreased by 47.1% in 2020 (n = 27) compared to 2019 (n = 51). Late HIV diagnoses decreased by 24.7% (95% CI [− 40.7%; -9.7%]) in 2020 compared to 2019. Of patients in care in 2019, 11.8% interrupted HIV care in 2020 compared to 9.1% yearly in the 3 previous years. The number of HIV patients with VL monitoring per month dropped in March–May 2020, whilst proportions of VL suppression and ART coverage remained above 86% and 98.5% respectively in 2020. PrEP purchases, number of purchasers and starters dropped during April–May 2020 (respectively − 45.7%, − 47.4%, − 77.9% in April compared to February 2020). Conclusions The significant decrease in HIV diagnoses in Belgium in 2020 coincided with the COVID-19 pandemic and following containment measures, particularly in April–May during the first lockdown. A slowdown of HIV transmission due to reduced HIV risk exposure is suggested by the halving in diagnosis of acute HIV infections in March-December 2020 compared to the previous year, and the adaptive decrease in PrEP use and PrEP initiation from April onwards. Despite a slight increase in HIV care interruptions, the indicators of quality of HIV care remained stable. Access to prevention, testing and care for all people living with HIV and at risk of acquiring HIV is a priority during and after times of pandemic.

  • Open Access English
    Authors: 
    Conway Morris, Andrew; Kohler, Katharina; De Corte, Thomas; Ercole, Ari; De Grooth, Harm-Jan; Elbers, Paul W. G.; Povoa, Pedro; Morais, Rui; Koulenti, Despoina; Jog, Sameer; +197 more
    Publisher: Springer Science and Business Media LLC
    Countries: United Kingdom, Netherlands, Belgium

    BACKGROUND: The COVID-19 pandemic presented major challenges for critical care facilities worldwide. Infections which develop alongside or subsequent to viral pneumonitis are a challenge under sporadic and pandemic conditions; however, data have suggested that patterns of these differ between COVID-19 and other viral pneumonitides. This secondary analysis aimed to explore patterns of co-infection and intensive care unit-acquired infections (ICU-AI) and the relationship to use of corticosteroids in a large, international cohort of critically ill COVID-19 patients. METHODS: This is a multicenter, international, observational study, including adult patients with PCR-confirmed COVID-19 diagnosis admitted to ICUs at the peak of wave one of COVID-19 (February 15th to May 15th, 2020). Data collected included investigator-assessed co-infection at ICU admission, infection acquired in ICU, infection with multi-drug resistant organisms (MDRO) and antibiotic use. Frequencies were compared by Pearson's Chi-squared and continuous variables by Mann-Whitney U test. Propensity score matching for variables associated with ICU-acquired infection was undertaken using R library MatchIT using the "full" matching method. RESULTS: Data were available from 4994 patients. Bacterial co-infection at admission was detected in 716 patients (14%), whilst 85% of patients received antibiotics at that stage. ICU-AI developed in 2715 (54%). The most common ICU-AI was bacterial pneumonia (44% of infections), whilst 9% of patients developed fungal pneumonia; 25% of infections involved MDRO. Patients developing infections in ICU had greater antimicrobial exposure than those without such infections. Incident density (ICU-AI per 1000 ICU days) was in considerable excess of reports from pre-pandemic surveillance. Corticosteroid use was heterogenous between ICUs. In univariate analysis, 58% of patients receiving corticosteroids and 43% of those not receiving steroids developed ICU-AI. Adjusting for potential confounders in the propensity-matched cohort, 71% of patients receiving corticosteroids developed ICU-AI vs 52% of those not receiving corticosteroids. Duration of corticosteroid therapy was also associated with development of ICU-AI and infection with an MDRO. CONCLUSIONS: In patients with severe COVID-19 in the first wave, co-infection at admission to ICU was relatively rare but antibiotic use was in substantial excess to that indication. ICU-AI were common and were significantly associated with use of corticosteroids. Trial registration ClinicalTrials.gov: NCT04836065 (retrospectively registered April 8th 2021). European Society of Intensive Care Medicine ACM is supported by a Clinician Scientist Fellowship from the Medical Research Council (MR/V006118/1) Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347

  • Open Access
    Authors: 
    Tim Boogaerts; Xander Bertels; Bram Pussig; Maarten Quireyns; Louis Toebosch; Natan Van Wichelen; Catalina Dumitrascu; Catherina Matheï; Lies Lahousse; Bert Aertgeerts; +3 more
    Publisher: Elsevier BV
    Country: Belgium

    Wastewater-based epidemiology (WBE) is a complementary approach to monitor alcohol consumption in the general population. This method measures concentrations of xenobiotic biomarkers (e.g., ethyl sulphate) in influent wastewater (IWW) and converts these to population-normalized mass loads (PNML, in g/day/1000 inhabitants) by multiplying with the flow rate and dividing by the catchment population. The aims of this case study were to: (i) investigate temporal trends in alcohol use during the COVID-19 pandemic; and (ii) measure the effect of policy measures on alcohol consumption. Daily 24-h composite IWW samples (n = 735) were collected in the wastewater treatment plant of the university city of Leuven (Belgium) starting from September 2019 to September 2021. This is the first study that investigates alcohol use through WBE for a continuous period of two years on a daily basis. Mobile phone data was used to accurately capture population fluxes in the catchment area. Data was evaluated using a time series based statistical framework to graphically and quantitatively assess temporal differences in the measured PNML. Different WBE studies observed temporal changes in alcohol use during the COVID-19 pandemic. In this study, the PNML of ethyl sulphate decreased during the first lockdown phase, potentially indicating that less alcohol was consumed at the Leuven area during home confinement. Contrastingly, alcohol use increased after the re-opening of the catering industry. Additionally, a decrease in alcohol use was observed during the exam periods at the University of Leuven and an increase during the holiday periods. The present study shows the potential of WBE to rapidly assess the impact of some policy measures on alcohol consumption in Belgium. This study also indicates that WBE could be employed as a complementary data source to fill in some of the current knowledge gaps linked to lifestyle behavior. ispartof: Environment International vol:170 ispartof: location:Netherlands status: Published online

  • Open Access
    Authors: 
    Frits van Charante; Anneleen Wieme; Petra Rigole; Evelien De Canck; Lisa Ostyn; Lucia Grassi; Dieter Deforce; Aurélie Crabbé; Peter Vandamme; Marie Joossens; +3 more
    Publisher: Elsevier BV
    Country: Belgium

    In patients with acute respiratory failure, mechanical ventilation through an endotracheal tube (ET) may be required to correct hypoxemia and hypercarbia. However, biofilm formation on these ETs is a risk factor for infections in intubated patients, as the ET can act as a reservoir of microorganisms that can cause infections in the lungs. As severely ill COVID-19 patients often need to be intubated, a better knowledge of the composition of ET biofilms in this population is important. In Spring 2020, during the first wave of the COVID-19 pandemic in Europe, 31 ETs were obtained from COVID-19 patients at Ghent University Hospital (Ghent, Belgium). Biofilms were collected from the ET and the biofilm composition was determined using culture-dependent (MALDI-TOF mass spectrometry and biochemical tests) and culture-independent (16S and ITS1 rRNA amplicon sequencing) approaches. In addition, antimicrobial resistance was assessed for isolates collected via the culture-dependent approach using disc diffusion for 11 antimicrobials commonly used to treat lower respiratory tract infections. The most common microorganisms identified by the culture-dependent approach were those typically found during lung infections and included both presumed commensal and potentially pathogenic microorganisms like Staphylococcus epidermidis, Enterococcus faecalis, Pseudomonas aeruginosa and Candida albicans. More unusual organisms, such as Paracoccus yeei, were also identified, but each only in a few patients. The culture-independent approach revealed a wide variety of microbes present in the ET biofilms and showed large variation in biofilm composition between patients. Some biofilms contained a diverse set of bacteria of which many are generally considered as non-pathogenic commensals, whereas others were dominated by a single or a few pathogens. Antimicrobial resistance was widespread in the isolates, e. g. 68% and 53% of all isolates tested were resistant against meropenem and gentamicin, respectively. Different isolates from the same species recovered from the same ET biofilm often showed differences in antibiotic susceptibility. Our data suggest that ET biofilms are a potential risk factor for secondary infections in intubated COVID-19 patients, as is the case in mechanically-ventilated non-COVID-19 patients.

  • Open Access
    Authors: 
    Matthieu Guillot; Angelo Furno; El-Houssaine Aghezzaf; Nour-Eddin El Faouzi;
    Publisher: Elsevier BV
    Country: Belgium

    Transportation networks are sized to efficiently achieve some set of service objectives. Under particular circumstances, such as the COVID-19 pandemic, the demand for transportation can significantly change, both qualitatively and quantitatively, resulting in an over-capacitated and less efficient network. In this paper, we address this issue by proposing a framework for resizing the network to efficiently cope with the new demand. The framework includes a model to determine an optimal transportation sub-network that guarantees the following: (i) the minimal access time from any node of the urban network to the new sub-network has not excessively increased compared to that of the original transportation network; (ii) the delay induced on any itinerary by the removal of nodes from the original transportation network has not excessively increased; and (iii) the number of removed nodes from the transportation network is within a preset known factor. A solution is optimal if it induces a minimal global delay. We modelled this problem as a Mixed Integer Linear Program and applied it to the public bus transportation network of Lyon, France, in a case study. In order to respond to operational issues, the framework also includes a decision tool that helps the network planners to decide which bus lines to close and which ones to leave open according to specific trade-off preferences. The results on real data in Lyon show that the optimal sub-network from the MILP model can be used to feed the decision tool, leading to operational scenarios for network planners.

  • Publication . Article . Other literature type . 2022
    Open Access English
    Authors: 
    Tim Stakenborg; Joren Raymenants; Ahmed Taher; Elisabeth Marchal; Bert Verbruggen; Sophie Roth; Ben Jones; Abdul Yurt; Wout Duthoo; Klaas Bombeke; +34 more
    Publisher: ELSEVIER ADVANCED TECHNOLOGY
    Country: Belgium

    The SARS-CoV-2 pandemic has highlighted the need for improved technologies to help control the spread of contagious pathogens. While rapid point-of-need testing plays a key role in strategies to rapidly identify and isolate infectious patients, current test approaches have significant shortcomings related to assay limitations and sample type. Direct quantification of viral shedding in exhaled particles may offer a better rapid testing approach, since SARS-CoV-2 is believed to spread mainly by aerosols. It assesses contagiousness directly, the sample is easy and comfortable to obtain, sampling can be standardized, and the limited sample volume lends itself to a fast and sensitive analysis. In view of these benefits, we developed and tested an approach where exhaled particles are efficiently sampled using inertial impaction in a micromachined silicon chip, followed by an RT-qPCR molecular assay to detect SARS-CoV-2 shedding. Our portable, silicon impactor allowed for the efficient capture (>85%) of respiratory particles down to 300 nm without the need for additional equipment. We demonstrate using both conventional off-chip and in-situ PCR directly on the silicon chip that sampling subjects' breath in less than a minute yields sufficient viral RNA to detect infections as early as standard sampling methods. A longitudinal study revealed clear differences in the temporal dynamics of viral load for nasopharyngeal swab, saliva, breath, and antigen tests. Overall, after an infection, the breath-based test remains positive during the first week but is the first to consistently report a negative result, putatively signalling the end of contagiousness and further emphasizing the potential of this tool to help manage the spread of airborne respiratory infections. ispartof: BIOSENSORS & BIOELECTRONICS vol:217 ispartof: location:England status: published

  • Open Access English
    Authors: 
    Kamil Demircan; Thilo Samson Chillon; Tommy Bracken; Ilaria Bulgarelli; Irene Campi; Gijs Du Laing; Samira Fafi-Kremer; Laura Fugazzola; Alejandro Abner Garcia; Raban Heller; +14 more
    Publisher: Frontiers Media SA
    Countries: Belgium, France

    IntroductionCertain trace elements are essential for life and affect immune system function, and their intake varies by region and population. Alterations in serum Se, Zn and Cu have been associated with COVID-19 mortality risk. We tested the hypothesis that a disease-specific decline occurs and correlates with mortality risk in different countries in Europe.MethodsSerum samples from 551 COVID-19 patients (including 87 non-survivors) who had participated in observational studies in Europe (Belgium, France, Germany, Ireland, Italy, and Poland) were analyzed for trace elements by total reflection X-ray fluorescence. A subset (n=2069) of the European EPIC study served as reference. Analyses were performed blinded to clinical data in one analytical laboratory.ResultsMedian levels of Se and Zn were lower than in EPIC, except for Zn in Italy. Non-survivors consistently had lower Se and Zn concentrations than survivors and displayed an elevated Cu/Zn ratio. Restricted cubic spline regression models revealed an inverse nonlinear association between Se or Zn and death, and a positive association between Cu/Zn ratio and death. With respect to patient age and sex, Se showed the highest predictive value for death (AUC=0.816), compared with Zn (0.782) or Cu (0.769).DiscussionThe data support the potential relevance of a decrease in serum Se and Zn for survival in COVID-19 across Europe. The observational study design cannot account for residual confounding and reverse causation, but supports the need for intervention trials in COVID-19 patients with severe Se and Zn deficiency to test the potential benefit of correcting their deficits for survival and convalescence.

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535 Research products, page 1 of 54
  • Open Access
    Authors: 
    Sarah Galdiolo; Anthony Mauroy; Lesley Liliane Verhofstadt;
    Publisher: SAGE Publications
    Country: Belgium

    This 5-wave longitudinal study aimed to monitor the feeling of we-ness and separateness over one year of the COVID-19 pandemic by examining partners’ natural pronoun usage when reporting couple interactions. Compared to the start of the pandemic, a general decline of we-ness was found after one year. Moreover, the changes in couple we-ness were non-linear, resulting in an increase at the end of the strict lockdown, followed by a decrease. No change in couple separateness was found.

  • Open Access English
    Authors: 
    Adam Windak; Katarzyna Nessler; Esther Van Poel; Claire Collins; Ewa Wójtowicz; Liubove Murauskiene; Kathryn Hoffmann; Sara Willems;
    Countries: Lithuania, Poland, Belgium

    COVID-19 proved that primary care (PC) providers have an important role in managing health emergencies, such as epidemics. Little is known about the preparedness of primary care practice infrastructure to continue providing high quality care during this crisis. The aim of this paper is to describe the perceived limitations to the infrastructure of PC practices during COVID-19 and to determine the factors associated with a higher likelihood of infrastructural barriers in providing high quality care. This paper presents the results of an online survey conducted between November 2020 and November 2021 as a part of PRICOV-19 study. Data from 4974 practices in 33 countries regarding perceived limitations and intentions to make future adjustments to practice infrastructure as a result of the COVID-19 pandemic were collected. Approximately 58% of practices experienced limitations to the building or other practice infrastructure to provide high-quality and safe care during the COVID-19 pandemic, and in 54% making adjustments to the building or the infrastructure was considered. Large variations between the countries were found. The results show that infrastructure constraints were directly proportional to the size of the practice. Better pandemic infection control equipment, governmental support, and a fee-for-service payment system were found to be associated with a lower perceived need for infrastructural changes. The results of the study indicate the need for systematic support for the development of practice infrastructure in order to provide high-quality, safe primary care in the event of future crises similar to the COVID-19 pandemic.

  • Open Access
    Authors: 
    Hannah De Laet; Yanni Verhavert; Kristine De Martelaer; Evert Zinzen; Tom Deliens; Elke Van Hoof;
    Publisher: Frontiers Media SA
    Country: Belgium

    BackgroundDue to the COVID-19 pandemic, schools were closed, teachers had to teach from home and after a while, they had to return to the classroom while the pandemic was still on-going. Even before the pandemic, teachers were already more at risk for burn-out syndrome compared to the general population. Furthermore, not much research pertaining to this population has been carried out during the pandemic and so the impact of the pandemic on teachers' risk of burn-out syndrome and recovery need remains unclear. The aim of the current study was to fill this knowledge gap and map out the impact on risk of burn-out syndrome and recovery need at different time points during the pandemic.Methods and findingsAt baseline, 2,167 secondary school teachers in Flanders were included in this prospective study. Questionnaire data were obtained at ten different time points between September 2019 and August 2021. To assess risk of burn-out syndrome and its dimensions, the Utrecht Burn-out Scale for Teachers was administered. Need for recovery was assessed using questions adopted from the Short Inventory to Monitor Psychosocial Hazards. The results revealed an initial positive effect of the first lockdown (Mar/Apr 2020) with a decrease in risk of burn-out syndrome [Odds ratio (OR) Jan/Feb 2020–Mar/Apr 2020 = 0.33, p < 0.001], emotional exhaustion (EMM Jan/Feb 2020–Mar/Apr 2020 = −0.51, p < 0.001), depersonalization (EMM Jan/Feb 2020–Mar/Apr 2020 = −0.13, p < 0.001) and recovery need [Estimated marginal mean (EMM) Jan/Feb 2020–Mar/Apr 2020 = −0.79, p < 0.001]. No significant effect on personal accomplishment was found (p = 0.410). However, as the pandemic went on, higher risk of burn-out syndrome, emotional exhaustion, depersonalization and recovery need, and lower personal accomplishment were observed.ConclusionsDespite the initial positive impact on risk of burn-out syndrome, its dimensions and recovery need, a negative long-term impact of the COVID-19 pandemic became visible. This study highlights once again the importance for interventions to reduce teachers' risk of burn-out syndrome, especially in such difficult times as a pandemic.

  • Open Access English
    Authors: 
    Van Beckhoven, Dominique; Serrien, Ben; Montourcy, Marion; Verhofstede, Chris; Van den Bossche, Dorien; Libois, Agnes; De Geyter, Deborah; Martin, Thierry; Van den Eynde, Sandra; Vuylsteke, Bea; +7 more
    Publisher: BioMed Central
    Country: Belgium

    Abstract Background To gain insight into the impact of the COVID-19 pandemic and containment measures on the HIV epidemic and services, this study aims to describe HIV trends in 2020 and compare them with previous years. Methods Belgian national HIV surveillance data 2017–2020 were analysed for trends in HIV testing, HIV diagnoses, VL measurements, ART uptake and PrEP purchase. Descriptive statistics from 2020 are compared to annual averages from 2017 to 2019 (proportional difference, %). Results In 2020, 725 HIV infections were diagnosed in Belgium (− 21.5% compared to 2019). The decline was most pronounced during the first lockdown in April–May but also present in July–December. The number of HIV tests performed decreased by 17.6% in 2020, particularly in March–May and October–December (− 57.5% in April and -25.4% in November 2020 compared to monthly 2017–19 numbers). Diagnosis of acute HIV infections decreased by 47.1% in 2020 (n = 27) compared to 2019 (n = 51). Late HIV diagnoses decreased by 24.7% (95% CI [− 40.7%; -9.7%]) in 2020 compared to 2019. Of patients in care in 2019, 11.8% interrupted HIV care in 2020 compared to 9.1% yearly in the 3 previous years. The number of HIV patients with VL monitoring per month dropped in March–May 2020, whilst proportions of VL suppression and ART coverage remained above 86% and 98.5% respectively in 2020. PrEP purchases, number of purchasers and starters dropped during April–May 2020 (respectively − 45.7%, − 47.4%, − 77.9% in April compared to February 2020). Conclusions The significant decrease in HIV diagnoses in Belgium in 2020 coincided with the COVID-19 pandemic and following containment measures, particularly in April–May during the first lockdown. A slowdown of HIV transmission due to reduced HIV risk exposure is suggested by the halving in diagnosis of acute HIV infections in March-December 2020 compared to the previous year, and the adaptive decrease in PrEP use and PrEP initiation from April onwards. Despite a slight increase in HIV care interruptions, the indicators of quality of HIV care remained stable. Access to prevention, testing and care for all people living with HIV and at risk of acquiring HIV is a priority during and after times of pandemic.

  • Open Access English
    Authors: 
    Conway Morris, Andrew; Kohler, Katharina; De Corte, Thomas; Ercole, Ari; De Grooth, Harm-Jan; Elbers, Paul W. G.; Povoa, Pedro; Morais, Rui; Koulenti, Despoina; Jog, Sameer; +197 more
    Publisher: Springer Science and Business Media LLC
    Countries: United Kingdom, Netherlands, Belgium

    BACKGROUND: The COVID-19 pandemic presented major challenges for critical care facilities worldwide. Infections which develop alongside or subsequent to viral pneumonitis are a challenge under sporadic and pandemic conditions; however, data have suggested that patterns of these differ between COVID-19 and other viral pneumonitides. This secondary analysis aimed to explore patterns of co-infection and intensive care unit-acquired infections (ICU-AI) and the relationship to use of corticosteroids in a large, international cohort of critically ill COVID-19 patients. METHODS: This is a multicenter, international, observational study, including adult patients with PCR-confirmed COVID-19 diagnosis admitted to ICUs at the peak of wave one of COVID-19 (February 15th to May 15th, 2020). Data collected included investigator-assessed co-infection at ICU admission, infection acquired in ICU, infection with multi-drug resistant organisms (MDRO) and antibiotic use. Frequencies were compared by Pearson's Chi-squared and continuous variables by Mann-Whitney U test. Propensity score matching for variables associated with ICU-acquired infection was undertaken using R library MatchIT using the "full" matching method. RESULTS: Data were available from 4994 patients. Bacterial co-infection at admission was detected in 716 patients (14%), whilst 85% of patients received antibiotics at that stage. ICU-AI developed in 2715 (54%). The most common ICU-AI was bacterial pneumonia (44% of infections), whilst 9% of patients developed fungal pneumonia; 25% of infections involved MDRO. Patients developing infections in ICU had greater antimicrobial exposure than those without such infections. Incident density (ICU-AI per 1000 ICU days) was in considerable excess of reports from pre-pandemic surveillance. Corticosteroid use was heterogenous between ICUs. In univariate analysis, 58% of patients receiving corticosteroids and 43% of those not receiving steroids developed ICU-AI. Adjusting for potential confounders in the propensity-matched cohort, 71% of patients receiving corticosteroids developed ICU-AI vs 52% of those not receiving corticosteroids. Duration of corticosteroid therapy was also associated with development of ICU-AI and infection with an MDRO. CONCLUSIONS: In patients with severe COVID-19 in the first wave, co-infection at admission to ICU was relatively rare but antibiotic use was in substantial excess to that indication. ICU-AI were common and were significantly associated with use of corticosteroids. Trial registration ClinicalTrials.gov: NCT04836065 (retrospectively registered April 8th 2021). European Society of Intensive Care Medicine ACM is supported by a Clinician Scientist Fellowship from the Medical Research Council (MR/V006118/1) Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347

  • Open Access
    Authors: 
    Tim Boogaerts; Xander Bertels; Bram Pussig; Maarten Quireyns; Louis Toebosch; Natan Van Wichelen; Catalina Dumitrascu; Catherina Matheï; Lies Lahousse; Bert Aertgeerts; +3 more
    Publisher: Elsevier BV
    Country: Belgium

    Wastewater-based epidemiology (WBE) is a complementary approach to monitor alcohol consumption in the general population. This method measures concentrations of xenobiotic biomarkers (e.g., ethyl sulphate) in influent wastewater (IWW) and converts these to population-normalized mass loads (PNML, in g/day/1000 inhabitants) by multiplying with the flow rate and dividing by the catchment population. The aims of this case study were to: (i) investigate temporal trends in alcohol use during the COVID-19 pandemic; and (ii) measure the effect of policy measures on alcohol consumption. Daily 24-h composite IWW samples (n = 735) were collected in the wastewater treatment plant of the university city of Leuven (Belgium) starting from September 2019 to September 2021. This is the first study that investigates alcohol use through WBE for a continuous period of two years on a daily basis. Mobile phone data was used to accurately capture population fluxes in the catchment area. Data was evaluated using a time series based statistical framework to graphically and quantitatively assess temporal differences in the measured PNML. Different WBE studies observed temporal changes in alcohol use during the COVID-19 pandemic. In this study, the PNML of ethyl sulphate decreased during the first lockdown phase, potentially indicating that less alcohol was consumed at the Leuven area during home confinement. Contrastingly, alcohol use increased after the re-opening of the catering industry. Additionally, a decrease in alcohol use was observed during the exam periods at the University of Leuven and an increase during the holiday periods. The present study shows the potential of WBE to rapidly assess the impact of some policy measures on alcohol consumption in Belgium. This study also indicates that WBE could be employed as a complementary data source to fill in some of the current knowledge gaps linked to lifestyle behavior. ispartof: Environment International vol:170 ispartof: location:Netherlands status: Published online

  • Open Access
    Authors: 
    Frits van Charante; Anneleen Wieme; Petra Rigole; Evelien De Canck; Lisa Ostyn; Lucia Grassi; Dieter Deforce; Aurélie Crabbé; Peter Vandamme; Marie Joossens; +3 more
    Publisher: Elsevier BV
    Country: Belgium

    In patients with acute respiratory failure, mechanical ventilation through an endotracheal tube (ET) may be required to correct hypoxemia and hypercarbia. However, biofilm formation on these ETs is a risk factor for infections in intubated patients, as the ET can act as a reservoir of microorganisms that can cause infections in the lungs. As severely ill COVID-19 patients often need to be intubated, a better knowledge of the composition of ET biofilms in this population is important. In Spring 2020, during the first wave of the COVID-19 pandemic in Europe, 31 ETs were obtained from COVID-19 patients at Ghent University Hospital (Ghent, Belgium). Biofilms were collected from the ET and the biofilm composition was determined using culture-dependent (MALDI-TOF mass spectrometry and biochemical tests) and culture-independent (16S and ITS1 rRNA amplicon sequencing) approaches. In addition, antimicrobial resistance was assessed for isolates collected via the culture-dependent approach using disc diffusion for 11 antimicrobials commonly used to treat lower respiratory tract infections. The most common microorganisms identified by the culture-dependent approach were those typically found during lung infections and included both presumed commensal and potentially pathogenic microorganisms like Staphylococcus epidermidis, Enterococcus faecalis, Pseudomonas aeruginosa and Candida albicans. More unusual organisms, such as Paracoccus yeei, were also identified, but each only in a few patients. The culture-independent approach revealed a wide variety of microbes present in the ET biofilms and showed large variation in biofilm composition between patients. Some biofilms contained a diverse set of bacteria of which many are generally considered as non-pathogenic commensals, whereas others were dominated by a single or a few pathogens. Antimicrobial resistance was widespread in the isolates, e. g. 68% and 53% of all isolates tested were resistant against meropenem and gentamicin, respectively. Different isolates from the same species recovered from the same ET biofilm often showed differences in antibiotic susceptibility. Our data suggest that ET biofilms are a potential risk factor for secondary infections in intubated COVID-19 patients, as is the case in mechanically-ventilated non-COVID-19 patients.

  • Open Access
    Authors: 
    Matthieu Guillot; Angelo Furno; El-Houssaine Aghezzaf; Nour-Eddin El Faouzi;
    Publisher: Elsevier BV
    Country: Belgium

    Transportation networks are sized to efficiently achieve some set of service objectives. Under particular circumstances, such as the COVID-19 pandemic, the demand for transportation can significantly change, both qualitatively and quantitatively, resulting in an over-capacitated and less efficient network. In this paper, we address this issue by proposing a framework for resizing the network to efficiently cope with the new demand. The framework includes a model to determine an optimal transportation sub-network that guarantees the following: (i) the minimal access time from any node of the urban network to the new sub-network has not excessively increased compared to that of the original transportation network; (ii) the delay induced on any itinerary by the removal of nodes from the original transportation network has not excessively increased; and (iii) the number of removed nodes from the transportation network is within a preset known factor. A solution is optimal if it induces a minimal global delay. We modelled this problem as a Mixed Integer Linear Program and applied it to the public bus transportation network of Lyon, France, in a case study. In order to respond to operational issues, the framework also includes a decision tool that helps the network planners to decide which bus lines to close and which ones to leave open according to specific trade-off preferences. The results on real data in Lyon show that the optimal sub-network from the MILP model can be used to feed the decision tool, leading to operational scenarios for network planners.

  • Publication . Article . Other literature type . 2022
    Open Access English
    Authors: 
    Tim Stakenborg; Joren Raymenants; Ahmed Taher; Elisabeth Marchal; Bert Verbruggen; Sophie Roth; Ben Jones; Abdul Yurt; Wout Duthoo; Klaas Bombeke; +34 more
    Publisher: ELSEVIER ADVANCED TECHNOLOGY
    Country: Belgium

    The SARS-CoV-2 pandemic has highlighted the need for improved technologies to help control the spread of contagious pathogens. While rapid point-of-need testing plays a key role in strategies to rapidly identify and isolate infectious patients, current test approaches have significant shortcomings related to assay limitations and sample type. Direct quantification of viral shedding in exhaled particles may offer a better rapid testing approach, since SARS-CoV-2 is believed to spread mainly by aerosols. It assesses contagiousness directly, the sample is easy and comfortable to obtain, sampling can be standardized, and the limited sample volume lends itself to a fast and sensitive analysis. In view of these benefits, we developed and tested an approach where exhaled particles are efficiently sampled using inertial impaction in a micromachined silicon chip, followed by an RT-qPCR molecular assay to detect SARS-CoV-2 shedding. Our portable, silicon impactor allowed for the efficient capture (>85%) of respiratory particles down to 300 nm without the need for additional equipment. We demonstrate using both conventional off-chip and in-situ PCR directly on the silicon chip that sampling subjects' breath in less than a minute yields sufficient viral RNA to detect infections as early as standard sampling methods. A longitudinal study revealed clear differences in the temporal dynamics of viral load for nasopharyngeal swab, saliva, breath, and antigen tests. Overall, after an infection, the breath-based test remains positive during the first week but is the first to consistently report a negative result, putatively signalling the end of contagiousness and further emphasizing the potential of this tool to help manage the spread of airborne respiratory infections. ispartof: BIOSENSORS & BIOELECTRONICS vol:217 ispartof: location:England status: published

  • Open Access English
    Authors: 
    Kamil Demircan; Thilo Samson Chillon; Tommy Bracken; Ilaria Bulgarelli; Irene Campi; Gijs Du Laing; Samira Fafi-Kremer; Laura Fugazzola; Alejandro Abner Garcia; Raban Heller; +14 more
    Publisher: Frontiers Media SA
    Countries: Belgium, France

    IntroductionCertain trace elements are essential for life and affect immune system function, and their intake varies by region and population. Alterations in serum Se, Zn and Cu have been associated with COVID-19 mortality risk. We tested the hypothesis that a disease-specific decline occurs and correlates with mortality risk in different countries in Europe.MethodsSerum samples from 551 COVID-19 patients (including 87 non-survivors) who had participated in observational studies in Europe (Belgium, France, Germany, Ireland, Italy, and Poland) were analyzed for trace elements by total reflection X-ray fluorescence. A subset (n=2069) of the European EPIC study served as reference. Analyses were performed blinded to clinical data in one analytical laboratory.ResultsMedian levels of Se and Zn were lower than in EPIC, except for Zn in Italy. Non-survivors consistently had lower Se and Zn concentrations than survivors and displayed an elevated Cu/Zn ratio. Restricted cubic spline regression models revealed an inverse nonlinear association between Se or Zn and death, and a positive association between Cu/Zn ratio and death. With respect to patient age and sex, Se showed the highest predictive value for death (AUC=0.816), compared with Zn (0.782) or Cu (0.769).DiscussionThe data support the potential relevance of a decrease in serum Se and Zn for survival in COVID-19 across Europe. The observational study design cannot account for residual confounding and reverse causation, but supports the need for intervention trials in COVID-19 patients with severe Se and Zn deficiency to test the potential benefit of correcting their deficits for survival and convalescence.

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