In a randomized trial of patients with severe AH treated with corticosteroids, we found that intensive enteral nutrition was difficult to implement and did not increase survival. However, low daily energy intake was associated with greater mortality, so adequate nutritional intake should be a main goal for treatment. ClinicalTrials.gov number: NCT01801332.

Despite the initiatives to standardize public health policies of the EU-27, health expenditure continues to be higher in Western European countries and this is associated with better cancer outcome in these countries.

BackgroundUnderstanding the risk factors for hearing loss is essential for designing the Belgian newborn hearing screening programme. Accordingly, they needed to be updated in accordance with current scientific knowledge. This study aimed to update the recommendations for the clinical management and follow-up of newborns with neonatal risk factors of hearing loss for the newborn screening programme in Belgium.MethodsA literature review was performed, and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system assessment method was used to determine the level of evidence quality and strength of the recommendation for each risk factor. The state of scientific knowledge, levels of evidence quality, and graded recommendations were subsequently assessed using a three-round Delphi consensus process (two online questionnaires and one face-to-face meeting).ResultsCongenital infections (i.e., cytomegalovirus, toxoplasmosis, and syphilis), a family history of hearing loss, consanguinity in (grand)parents, malformation syndromes, and foetal alcohol syndrome presented a ‘high’ level of evidence quality as neonatal risk factors for hearing loss. Because of the sensitivity of auditory function to bilirubin toxicity, hyperbilirubinaemia was assessed at a ‘moderate’ level of evidence quality. In contrast, a very low birth weight, low Apgar score, and hospitalisation in the neonatal intensive care unit ranged from ‘very low’ to ‘low’ levels, and ototoxic drugs were evidenced as ‘very low’. Possible explanations for these ‘very low’ and ‘low’ levels include the improved management of these health conditions or treatments, and methodological weaknesses such as confounding effects, which make it difficult to conclude on individual risk factors. In the recommendation statements, the experts emphasised avoiding unidentified neonatal hearing loss and opted to include risk factors for hearing loss even in cases with weak evidence. The panel also highlighted the cumulative effect of risk factors for hearing loss.ConclusionsWe revised the recommendations for the clinical management and follow-up of newborns exhibiting neonatal risk factors for hearing loss on the basis of the aforementioned evidence-based approach and clinical experience from experts. The next step is the implementation of these findings in the Belgian screening programme.Electronic supplementary materialThe online version of this article (doi:10.1186/s12887-015-0479-4) contains supplementary material, which is available to authorized users.

BackgroundIn childhood, inadequate fluid intakes can lead on the short term, to reduced physical and cognitive performances. However, few data are available on the fluid intake among schoolchildren in Belgium. The main aim of this study is to evaluate total fluid intake provided by different types of beverages in a sample of Belgian schoolchildren, in order to assess the percentage of individuals complying with the European Food Safety Authority recommendations for total fluid intake. A secondary aim was to characterize the study population in terms of determinants of the total fluid intake requirements.MethodsA child friendly “fluids and liquid food” diary was used to prospectively record the volume and frequency of beverage consumption over 7 days from 1045 schoolchildren. This diary also recorded the practice of physical activity. An adequate fluid intake was defined as an intake ≥ 75% of the age-specific adequate intake recommended by the EFSA.ResultsThe median (P25-P75) of habitual daily fluid intake was 864 (608–1104) ml/day, with 355 (194–579) coming from drinking water. This habitual daily fluid intake varied significantly among the three investigated EFSA groups (girls and boys aged from 8 years, girls from 9 to 13 and boys from 9 to 13), except for the drinking water (P = 0.906). The highest medians of fruit juice, sugar-sweetened beverages and milk and derivatives were found among boys of 9–13. Only 9.5% of the children had an adequate fluid intake, with a value of 19.2% among the 8 years old girls and boys, 7.0% among girls of 9–13 and 8.4% among boys of 9–13. In the whole sample, 27.7% of the children declared to drink less than 3-4x/day, 56% drunk water less than 2x/day and 7.7% drunk no water at all. Every day, 27.1% and 34.1% of the children drank respectively one fruit juice and one sugar-sweetened beverage.ConclusionBelgian schoolchildren have an inadequate total fluid intake. Given the potential health consequences, interventions involving parents and school environment to promote water consumption seem pertinent.

Demographic changes in the world population will cause a significant increase in the number of new cases of cancer. To handle this challenge, societies will need to adapt how they approach cancer prevention and treatment, with changes to the development and uptake of innovative anticancer drugs playing an important role. However, there are obstacles to implementing innovative drugs in clinical practice. Prior to being incorporated into daily practice, the drug must obtain regulatory and reimbursement approval, succeed in changing the prescription habits of physicians, and ultimately gain the compliance of individual patients. Developing an anticancer drug and bringing it into clinical practice is, therefore, a lengthy and complex process involving multiple partners in several areas. To optimize patient treatment and increase the likelihood of implementing health innovation, it is essential to have an overview of the full process. This review aims to describe the process and discuss the hurdles arising at each step.

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The effectiveness of the pregnancy prevention programme recommendations should be reconsidered by an expert committee. Justifications should be added to effective recommendations to increase their adoption by health care professionals and patients.

Despite the same goal of early identification of hearing-impaired children, there is a high level of diversity in programmes, including policy decisions, financing, general designs and pragmatic organisational choices (e.g. professionals involved, location or time for screening, number of steps in the protocol). Further investigations should analyse these differences in relation to the programmes' contexts and outcomes.