In 2014, a group of undocumented migrants started a hunger strike in Brussels. The medical monitoring was mainly done by young, committed health professionals with no prior experience of medical monitoring of people on hunger strike. Following the hunger strike, two focus groups were organized to assess the experiences of the health professionals during the medical monitoring of the hunger strike. Their main motivation for assisting was wanting to help the people on hunger strike but they were also curious about the living conditions among undocumented migrants and the reasons behind starting the strike. They were puzzled by the paradox of hunger strikers putting their life at risk in order to get a better life and obtain a residence permit. They felt conflicted about their own role as a caregiver: they did not know how to deal with patients who did not comply with medical advice, they struggled to build a relationship of mutual trust and feared that they would end up being instrumentalized by the hunger strikers or their environment. Afterwards, some of the health professionals were deeply touched by the experience and there were reports of symptoms of secondary traumatic stress such as re-experiencing and avoidance. During the focus group's discussions, the respondents made suggestions on how to improve the medical monitoring in the event of any future hunger strikes.

Background In 2014, in Brussels, a group of undocumented migrant workers started a hunger strike. A loophole in Belgian migration law allows very sick people to stay in the country to recuperate. Undocumented migrants jeopardize their health to be able to obtain a temporary permit and a way out of misery. The monitoring of the hunger strike was done by young, committed but inexperienced health professionals.Methods At the end of the hunger strike, two focus groups were held to find out the dilemmas confronting the health professionals.Results Eighteen out of 29 health professionals participated. They mentioned their curiosity to gain new insights into living conditions among undocumented people and the reasons why they started the strike. They were puzzled by the paradox of wanting to die to get a better life and refusing medical advice. They wondered about their role and commitment as a caregiver. Some were deeply touched by the experience and reacted emotionally while others deepened their engagement. Symptoms of Secondary Traumatic Stress, such as re-experiencing and avoidance were observed. The participants themselves also proposed improvements to the monitoring. Conclusions Even though only a small number of health professionals were questioned, we detected a lot of preoccupations and contradictions in their reactions. To be able to process these a close follow-up and evaluation of the monitoring of a hunger strike is mandatory. We also propose that prevention, early detection and treatment of Secondary Traumatic Stress should become part of formal medical education.

Since the beginning of the 21st century, the living conditions of undocumented migrant workers in Belgium have deteriorated drastically. In Brussels, after various social actions, undocumented people began squatting and occupying public buildings to make their struggle visible to society. Desperate, some seized the possibility of a loophole in Belgian law that permits ill persons to have access to a temporary residence permit and started hunger striking. Confronted with consecutive strikes, medical teams of voluntary health professionals faced a big dilemma. A search of the medical literature yielded information about the overall and specific tasks of health professionals during hunger strikes in custodial and hospital settings, but no scientific guidelines were found to address the specific problems the team was confronted with. Information was collected about 15 hunger strikes over a period of seven years, involving the participation of 1,158 strikers. This article describes the medical, organizational, and ethical difficulties encountered in the follow-up of hunger strikes in non-custodial settings, including those associated with the establishment of a health-care structure, operation with very limited resources, and communication with the media and other health professionals.

Five years after a hunger strike of undocumented migrant workers, participants were interviewed to find out about the long term consequences and what the post-factum evaluation of their participation was. A longitudinal observational study was set up, interviewing 46 of the 100 ex-hunger strikers and combining quantitative and qualitative research. This grassroots study shows that one out of six did not derive any benefit from their participation. Half regretted their participation, especially the ones who lost again their legal permit, mentioning health consequences and the fact that their situation hadn't improved. Given the growing number of asylum seekers around the world who are being refused legal permits, hunger strikes will remain a pressing topic. Health professionals, confronted with this possible health and life threatening action, should be informed about the long term impact of voluntary fasting on body and mind of ex-participants.

Domestic work can be perceived to be ‘dirty work’ in several ways: it is associated with dirt handling, low occupational prestige, and domestic workers have a servile relationship to their clients/employers. This stigma may negatively affect domestic workers' sense of self, and thus coping strategies appear to be critical. In this article, we explore the coping strategies that moderate the relation between the stigma of dirty work and domestic workers' sense of self, based on the analyses of 43 interviews with domestic workers in Belgium. By using a social stress approach in which stigma is considered a stressor, our results reveal a range of maladaptive and adaptive coping strategies that contribute to a negative or a more positive sense of self. Four main categories of coping strategies are discussed: confronting or countering perceptions and behaviours, occupational ideologies, social weighting and defensive tactics. The first two categories are adaptive coping strategies; the last two can be adaptive or maladaptive. We also reveal that workers used adaptive and maladaptive coping strategies simultaneously, leading to mixed implications for their sense of self.

BACKGROUND: Precarious employment is becoming an increasingly important social determinant of health inequalities among workers. The way in which contemporary employment arrangements and their health consequences are addressed in empirical research is mostly based on the contract-related or employment instability dimension. A broader conceptual approach including various important characteristics of the degrading of employment conditions and relations is needed.OBJECTIVE: The general objective of this paper is to empirically test a new multidimensional construct for measuring precarious employment in an existing database. Special focus is on the social distribution of precarious employment.METHODS: A subsample of 21,415 participants in the EU-27 from the Fourth European Working Conditions Survey-2005 was analysed. A cross-sectional study of the social distribution of precarious employment was conducted through the analysis of proportional differences according to gender, social class and credentials for the European Union as a whole and within each country. The 8 dimensions of the employment precariousness construct were represented by 11 indicators.RESULTS: In general, women, workers without supervisory authority, those with fewer credentials, and those living in Eastern and Southern European countries suffer the highest levels of precarious employment. Exceptionally, men, workers with supervisory authority and those with the highest credentials suffer the highest levels of long working hours, schedule unpredictability and uncompensated flexible working times.CONCLUSIONS: This article offers the first validation for an innovative multidimensional conceptualisation of employment precariousness applied to the analysis of existing survey data, showing the unequal distribution of precarious employment across the European labour force. This set of indicators can be useful for monitoring precarious employment.

BACKGROUND:When examining risk factors for inadequate antenatal care, the assessment of antenatal care hardly considers the content and timing of interventions during pregnancy. This study aims to provide information about the importance of predisposing, enabling and pregnancy-related determinants on the received content and timing of antenatal care.METHODS:In the Brussels Metropolitan Region, 333 women were consecutively recruited at the beginning of their pregnancies. Antenatal care use was recorded prospectively. A classification system measuring the content and timing of care during pregnancy (CTP) divided the women into four categories. Ordinal regression analyses were applied to define unadjusted and adjusted odds ratios (ORs), measuring the effect of different determinants on being assigned to a higher CTP category.RESULTS:A total of 10.2% of the women had an inadequate, 8.4% an intermediate, 36% a sufficient and 45.3% an appropriate antenatal care trajectory. Adjusted ORs showed a lower likelihood of being assigned to a higher CTP category for lower educated women (OR: 0.58; 95% CI 0.37-0.92), women of Maghreb origin (OR: 0.38; 95% CI 0.22-0.66) and women with a higher discontinuity of care (OR: 0.56; 95% CI 0.34-0.90).CONCLUSIONS:When controlling for confounders, no enabling determinants were found that affect the content and timing of care in pregnancy. Although antenatal care is equally available to all women, predisposing and pregnancy-related factors were related to the likelihood of completing an appropriate antenatal care trajectory. Besides stimulating knowledge about the importance of antenatal care in less-educated and Maghreb women, supporting continuity of care during pregnancy might result in higher levels of received antenatal care.

BACKGROUND:Antenatal care can play an important role in the prevention of preterm birth. Evaluation of antenatal care is usually based on the number of visits rather than the content of care, using tools such as the Adequacy of Prenatal Care Use index. This article presents an analysis of the relation between specific elements of antenatal care and the risk of preterm birth compared with considering the number of visits only.METHODS:A prospective cohort study was conducted in the Brussels Metropolitan Region. In all, 333 women were consecutively recruited at the beginning of their antenatal care trajectory and followed until birth. Information on timing and content for every visit was recorded by structured interview. A new tool was developed to measure the antenatal care trajectory, which included Content and Timing of care in Pregnancy (CTP). Odds ratios (OR) (adjusted and unadjusted) for preterm birth were calculated for the Adequacy of Prenatal Care Use and CTP model.RESULTS:The number of visits alone was not associated with preterm birth. In contrast, a significant association was found between the content and timing of care and preterm birth. Compared with the CTP lowest ('inadequate') category, women in the CTP 'sufficient' (OR 0.30; 95% CI 0.09-0.94) and CTP 'appropriate' (OR 0.21; 95% CI 0.06-0.68) category had a lower risk.CONCLUSIONS:This study suggests that measurement of the content and timing of care of antenatal care using the new CTP tool is a better assessment of the risk of preterm birth than assessment of the number of antenatal visits alone.

Research into issues of deafness is characterised by the dominance of the medical model of disability. Although social and cultural-linguistic models have received increasing attention from scholars, they have been used mainly in theoretical debate. Empirical application has been limited. Based on our comprehensive research project into the care-related decisions of parents of congenitally deaf children in Flanders, Belgium, an explanatory model for care-related parental decisions was constructed, which transcends the specific findings generated by our studies. This model is presented and discussed in this paper. Illustrations are provided based on our empirical findings.

Introduction/Background* Dostarlimab is a humanized programmed death-1 (PD-1) receptor monoclonal antibody that blocks interaction with the PD-1 ligands. GARNET (NCT02715284) is a phase 1 study assessing antitumor activity and safety of dostarlimab monotherapy in patients with solid tumors. Dostarlimab has shown antitumor activity in patients with mismatch repair deficient (dMMR) and mismatch repair proficient (MMRp) advanced and recurrent endometrial cancer (EC). Here we report on the time of onset of treatment-related adverse events (TRAEs) and immune-related (ir) TRAEs over the course of dostarlimab treatment in patients with dMMR (cohort A1) and MMRp (cohort A2) EC in the GARNET trial. Methodology Patients with advanced or recurrent dMMR or MMRp EC that progressed on or after a platinum regimen received 500 mg of dostarlimab every 3 weeks for 4 cycles, then 1000 mg every 6 weeks (Q6W) until disease progression or discontinuation. Result(s)* A total of 126 patients with dMMR EC and 145 patients with MMRp EC were included in the safety population. Few TRAEs were seen in ≥10% of patients: fatigue (17.3%), diarrhea (14.4%), nausea (13.7%), and asthenia (11.1%). The majority of cases occurred during cycles 1–3, with a peak occurrence at cycle 1 for all 4 TRAEs. Hypothyroidism was the only irTRAE seen in ≥5% of patients, and 94% of cases occurred between cycles 2 and 8, with a peak occurrence seen at cycle 4. irTRAEs that were seen in ≥1% of patients included diarrhea (4.1%), amylase increased (2.2%), aspartate aminotransferase increased (2.2%), alanine aminotransferase increased (1.8%), colitis (1.5%), hyperglycemia (1.5%), lipase increased (1.5%), adrenal insufficiency (1.1%), and hyperthyroidism (1.1%). Conclusion* When analyzed over the dMMR and MMRp EC safety population of the GARNET trial, dostarlimab has an acceptable safety profile with manageable adverse events. irTRAEs and TRAEs were seen in a low percentage of patients and were seen more frequently earlier in the time course of dostarlimab treatment. No increase in the rate of TRAEs or irTRAEs was seen when changing to the 1000-mg Q6W dose. C, cycle; dMMR, mismatch mutation repair deficient; ir, immune-related; MMRp, mismatch mutation repair proficient; TRAE, treatment-related adverse event; W, weeks

The infant mortality rate (IMR) is one of the most important indicators of the socioeconomic and of the health status of a community and is considered as an index of differentials in health and socioeconomic condition in a community. This article was aimed to determine the relationship between socio-economic differences (literacy rate, unemployment, poverty, Gross Domestic Product (GDP), early marriage, consanguineous marriage) and infant mortality in the Arab World during the last two decades. Statistical analysis was performed on data extracted from the United Nations children's fund (UNICEF) and world health organization (WHO). The results of this study showed a decline in infant mortality rate (IMR) among Arab countries. There was an inverse association between infant mortality and literacy. Poverty, GDP and early marriage had a significant relationship with infant mortality. Despite the falling in infant mortality rate, the rate of infant mortality is still high in the Arab World. Key words: Socioeconomic differences, infant mortality, Arab World.

The objective of this study is to examine the early care trajectories of congenitally deaf children from a parental perspective, starting with universal neonatal hearing screenings. The analysis using a three-dimensional care trajectory concept is aimed at developing a basic typology of postscreening care trajectories. Children with severe/profound hearing loss, registered in the Flanders’ (Belgium) universal neonatal hearing screening program, born between 1999 and 2001. Thematic content analysis of qualitative data collected retrospectively from participant's parents. Two basic types of care trajectories emerged; based on differences in care-use in the phase of further diagnosis and related parental experiences. Subtypes resulted from events related to cochlear implantation. Five trajectory phases were identified: screening, further diagnosis, care and technology, cochlear implantation, and reduction of care and were characterized by specific parental experiences such as confusion, disbelief, disappointment, and uncertainty. Those experiences relate to care professionals' acts and communication and the child's functional evolution. Early care interventions could benefit from coordinated transition between phases, parent support throughout the care trajectory, and a broad approach to deafness in professionals' communication.

The objective of this study is to analyze parental perspectives concerning the use of (re)habilitation services after Universal Newborn Hearing Screening (UNHS). A qualitative study design was used involving children with moderate-to-profound hearing loss who were born between 1999 and 2001 and who are registered in the UNHS program in Flanders, Belgium. Parents of these children were interviewed using a topic list and a chronological scheme to register meaningful events while using (re)habilitative services. Subsequently, thematic content analysis was applied to the transcripts of the interviews. Analysis found that differences exist in parental experiences and some parents who were referred directly from UNHS to an ear, nose, and throat department were left with feelings of uncertainty and anxiety, creating an obstacle in the care trajectory for their child. The parental perception of diagnosis/care was also a cause for delay. Parents considered educational support at home, after UNHS, important. Results indicate that implementation of a UNHS program is in itself insufficient to ensure early intervention, and that adequate support is needed during the early care trajectory to avoid delay and parental distress.

BACKGROUND:Current measures of antenatal care use are limited to initiation of care and number of visits. This study aimed to describe the development and application of a tool to assess the adequacy of the content and timing of antenatal care.METHODS:The Content and Timing of care in Pregnancy (CTP) tool was developed based on clinical relevance for ongoing antenatal care and recommendations in national and international guidelines. The tool reflects minimal care recommended in every pregnancy, regardless of parity or risk status. CTP measures timing of initiation of care, content of care (number of blood pressure readings, blood tests and ultrasound scans) and whether the interventions were received at an appropriate time. Antenatal care trajectories for 333 pregnant women were then described using a standard tool (the APNCU index), that measures the quantity of care only, and the new CTP tool. Both tools categorise care into 4 categories, from 'Inadequate' (both tools) to 'Adequate plus' (APNCU) or 'Appropriate' (CTP). Participants recorded the timing and content of their antenatal care prospectively using diaries. Analysis included an examination of similarities and differences in categorisation of care episodes between the tools.RESULTS:According to the CTP tool, the care trajectory of 10,2% of the women was classified as inadequate, 8,4% as intermediate, 36% as sufficient and 45,3% as appropriate. The assessment of quality of care differed significantly between the two tools. Seventeen care trajectories classified as 'Adequate' or 'Adequate plus' by the APNCU were deemed 'Inadequate' by the CTP. This suggests that, despite a high number of visits, these women did not receive the minimal recommended content and timing of care.CONCLUSIONS:The CTP tool provides a more detailed assessment of the adequacy of antenatal care than the current standard index. However, guidelines for the content of antenatal care vary, and the tool does not at the moment grade over-use of interventions as 'Inappropriate'. Further work needs to be done to refine the content items prior to larger scale testing of the impact of the new measure.

Background: Infant death rate has declined over the past decades, yet remains high in Palestine. The topic of infant death is well researched and for the first time in Palestine. The objective of our study is to assess the level of awareness and health behaviour of mothers and how this behaviour has affected infant mortality. Methods: Person to person interviews were done with 550 mothers of infants (275 cases and 275 controls) in the Gaza Strip. Stillbirths were excluded. Binary logistic regression analyses were used to identify the relationship of health behavioural factors and infant mortality. Result: The study showed that infant mortality risks were higher in mothers exposed to passive smoking. Infant mortality was lower for infants receiving exclusive breastfeeding. There was also a significant association between the sleeping position of the baby and infant mortality. Conclusion: The findings underscore the importance of explicit attention to health education. A well-organized consultation and health promotion approach should focus on couples whose child has died, in order to combat infant mortality.

The study examined factors in deaf parents' decision between cochlear implantation (CI) and traditional hearing aids for their child. The subjects were 6 Flemish children ages 5-9 years with severe/profound congenital hearing loss, with at least 1 deaf parent. The researchers, who conducted thematic content analysis of qualitative data collected through parent interviews, found that with the exception of a family with 1 hearing parent, parents gave priority to Deaf identity, sign language, and ethical issues in deciding between CI and hearing aids. Medical risks were also mentioned. The researchers conclude that the decision-making processes of the parents involved factors that have also been found among hearing parents, as well as aspects that have not been reported to play a role in hearing parents' decision making. A further conclusion is that deaf parents' perspective merits attention in professional practice and empirical research.

In this study, it is investigated whether a typology can be imposed upon a sample of wage-earners, based on their exposure to a broad number of occupational stressors: quantitative, emotional, and physical demands, repetitive movements, atypical schedules, low job control, relationships with superiors, job insecurity, and bullying behaviour. Also associations between this typology and measures of emotional problems (EP) and musculoskeletal complaints (MC) are tested. Logistic regression and a latent class cluster analysis are performed on a representative sample of 10,074 Flemish (Belgian) employees. Five clusters are revealed: “low stress”, “high stress”, “manual-passive”, “human contact”, and “high demand”. These clusters are showing a clear socioeconomic distribution and distinct associations with EP and MC—with the “high stress cluster” being the most problematic. Health-damaging occupational stress clusters are prevalent at both higher and lower socioeconomic positions. This is suggesting a complex relationship between occupational stressors and socioeconomic health variations.

In this study, focus is on the mechanisms linking credentialed skills and social class relations to five dimensions of occupational stressors and three self-reported health outcomes: persistent fatigue, musculoskeletal complaints and emotional wellbeing. We test for direct health associations of skills/class. Moreover, indirect health associations of skills/class, through differential exposure to occupational stressors and effect modifications of the occupational stressors, are tested. A modified LISREL analysis is applied to a representative cross-sectional sample of 11,099 Flemish wage-earners. The direct health effects of credentialed skills/class are limited, but they are clearly indirectly related to the self-reported health outcomes through differential exposure to occupational stressors. The indirect mechanisms point to both reinforcing and moderating effects on socio-economic health inequalities. Two cases of effect modification are also observed: social class modifying the association between control and persistent fatigue; and skills affecting the association between the quality of social relations and emotional wellbeing. Differential exposure to occupational stressors is a crucial mechanism linking skills/class to socio-economic health inequalities. Direct effects and effect modification of class/skills are relevant, but of limited importance. One of the effect modifications found suggests that a specific focus on contradictory class positions might be warranted in future research.

BACKGROUND:Antenatal care has a positive effect on pregnancy, both clinically and psychologically, but consensus about the optimal number of antenatal visits is lacking. This study aims to provide insight into the dynamics of the number of antenatal visits a woman receives. Independent effects of predisposing, enabling and pregnancy-related determinants are examined.METHODS:Women were recruited in nine clinical centres in the Brussels Metropolitan region. Antenatal care use was measured prospectively. A Poisson regression model was applied to measure the independent effect of individual determinants on the number of antenatal visits.RESULTS:Data on antenatal care trajectories in 333 women were collected. The multivariate analyses showed that women with a Maghreb or Turkish origin had 14% fewer visits compared with European (EU15) women. More highly educated women had 22% more visits compared with those with a low education. Women with a high income had 14% more antenatal visits compared with those with a low income. Fewer antenatal visits were observed in multiparae (15%), women initiating care after 14 weeks of gestation (31%), women without medical risks during the pregnancy (12%) and in women with a continuity of care index of 50% or more (12%). More visits were observed in delivering after week 37 (22% increase).CONCLUSIONS:Predisposing and enabling factors have to be considered when antenatal care programmes are evaluated in a metropolitan area. Variations in the number of antenatal visits show that socially vulnerable women are more at risk of having fewer visits.