Flemish Population Research Articles

Contextualized Experiences and Predictors of Condom Use in a Flemish Population: A Mixed Methods Study

Contextualized Experiences and Predictors of Condom Use in a Flemish Population: A Mixed Methods Study

Measuring laypeople’s notions of intersex in the Netherlands and Flanders

Abstract Introduction In emancipation policy, the ‘I’ is often added to the LGBTI+-acronym. Yet it is still unknown to what extent this term is known and understood by the general population, and what attitudes toward intersex (people) are. In the current study, we describe the construction and development of the Intersex Knowledge and Attitudes Scale (IKAS), as well as the results from this baseline measurement in the Dutch and Flemish population. Methods The IKAS was developed after a carefully documented stepped process of literature scan, expert consultations, and pretesting. A representative sample of 2,003 respondents (1,000 Dutch and 1,003 Flemish) participated in the study. To determine the dimensionality of the scale, we performed EFA and CFA with measurement invariance constraints. We also performed a baseline measurement of knowledge and attitudes towards intersex people in the general population, and determined predictors of attitudes toward intersex people in regression analyses. Results Two-thirds of the sample had no (correct) knowledge of the term intersex. Even among the intersex respondents, only one person was aware of the term intersex. The average attitude was moderately positive to neutral. Having a female gender or birth sex, an advanced level of education, lower importance of religion, belonging to a minority group, more tolerant gender beliefs, and preexisting knowledge on the topic all resulted in more positive attitudes. Conclusions Both in Flanders and the Netherlands there still is room for improvement in terms of knowledge and attitudes towards intersex people. More knowledge may lead to more understanding, so that intersex people can be more open. Second, it is recommended to challenge beliefs of sex and gender as binary categories, because people who have less issues with people who do not entirely fall in these categories, also have more accepting attitudes toward intersex people. Key messages • It is vital to include intersex in monitoring studies of population attitudes, to be able to genuinely incorporate the ‘I’ in LGBTI+ in emancipation policies. • To increase acceptance of intersex people in society, knowledge about intersex in the general population should be expanded, and acceptance of people who do not fit into the binary should be promoted.

Capturing the fusion of two ancestries and kinship structures in Merovingian Flanders

The Merovingian period (5th to 8th cc AD) was a time of demographic, socioeconomic, cultural, and political realignment in Western Europe. Here, we report the whole-genome shotgun sequence data of 30 human skeletal remains from a coastal Late Merovingian site of Koksijde (675 to 750 AD), alongside 18 remains from two Early to Late Medieval sites in present-day Flanders, Belgium. We find two distinct ancestries, one shared with Early Medieval England and the Netherlands, while the other, minor component, reflecting likely continental Gaulish ancestry. Kinship analyses identified no large pedigrees characteristic to elite burials revealing instead a high modularity of distant relationships among individuals of the main ancestry group. In contrast, individuals with >90% Gaulish ancestry had no kinship links among sampled individuals. Evidence for population structure and major differences in the extent of Gaulish ancestry in the main group, including in a mother-daughter pair, suggests ongoing admixture in the community at the time of their burial. The isotopic and genetic evidence combined supports a model by which the burials, representing an established coastal nonelite community, had incorporated migrants from inland populations. The main group of burials at Koksijde shows an abundance of >5 cM long shared allelic intervals with the High Medieval site nearby, implying long-term continuity and suggesting that similarly to Britain, the Early Medieval ancestry shifts left a significant and long-lasting impact on the genetic makeup of the Flemish population. We find substantial allele frequency differences between the two ancestry groups in pigmentation and diet-associated variants, including those linked with lactase persistence, likely reflecting ancestry change rather than local adaptation.

Testing the person-positivity bias in a political context: Voters’ affective responses to (non-)personalized individual political actors versus collective political actors

The person-positivity bias states that evaluations of real-life individuals are more positive compared to evaluations of collectivities or impersonal objects. This paper aims to test the prevalence of a person-positivity bias in a political context in two respects: (1) we examine whether voters develop stronger negative affective reactions towards other-minded collective actors (i.e. political parties) compared to individual actors (i.e. politicians), and (2) we investigate whether the provision of personalized individuating information tempers the development of negative feelings towards politicians. A survey experiment conducted among a representative sample of the Flemish population (N = 1200) reveals patterns of vertical affective polarization. However, our study did not find significant evidence that voters dislike other-minded collective actors more than other-minded individual politicians. Also the extent to which individual MPs are personalized has little effect on voters' affective evaluations. Taken together, this study highlights that ideological (dis)agreement is primarily steering voters’ evaluation of political actors.

The last of the maculineans: can we save the emblematic Alcon Blue butterfly Phengaris alcon under climate change when its habitat continues to deteriorate?

In the NW-European region of Flanders (northern Belgium), wet heathlands harbour several threatened species among which the emblematic Alcon Blue butterfly Phengaris alcon is rapidly declining. Since 1990, the number of occupied grid cells in Flanders has decreased from 61 to only six in 2023, a decline of 90%. Due to the loss of many populations, the mean distance between populations tripled from 9 km in the period 1950–1990 to 27 km now. Site-wide egg counts in one of the strongholds of the Alcon Blue in Flanders revealed a strong increase after some initial intensive care conservation measures in the 2000s, but since 2013 a steep decline of 99% has been observed. The standardised egg counts in the remaining six Flemish populations (i.e., monitoring within the framework of the Natura2000 reporting) showed a yearly decrease of 18% since 2016. Despite increased conservation attention and targeted management since the end of the 1990s, the current situation of P. alcon in Belgium is more precarious than ever. Causes of this rapid decline are manifold and they are likely to be amplified by extreme weather conditions caused by climate change. More efficient intensive care measures and more intense cooperation across national borders are now quickly required to regionally preserve this habitat specialist with a unique eco-evolutionary profile.Implications for insect conservation By analysing the causes of the decline of the threatened Alcon Blue butterfly in Flanders, we suggest management and policy measures in an attempt to conserve this and other threatened heathland species in a highly anthropogenic region.

Survey data linking coastal visit behaviours to socio-demographic and health profiles

Coastal destinations are highly popular for leisure, yet the effects of spending time at the coast on mental and physical health have remained underexplored. To accelerate the research about the effects of the coast on health, we compiled a dataset from a survey on a sample (N = 1939) of the adult Flemish population about their visits to the Belgian coast. The survey queried the number of days spent at the coast in the previous year or before and the following characteristics of their visits: how often they performed specific activities, which of the 14 municipal seaside resorts they visited, who they were with, what they mentally and physically experienced, and what reasons they had for not visiting the coast more often. The respondents’ geo-demographic (including residential proximity to the coast), socio-economic, and health profile was also collected. We anticipate that investigations on the data will increase our understanding about the social structuring of coastal visits and give context to the effects of the coast on human health.

High genetic diversity but limited gene flow in Flemish populations of the crested newt, Triturus cristatus

Habitat destruction and fragmentation are among the major causes of amphibian decline. We investigated to what extent geographic distance and barriers affect the genetic composition of the crested newt, Triturus cristatus in Flanders (North Belgium), causing inbreeding or loss of genetic diversity. Data from seven microsatellite loci and 170 individuals from seven metapopulations up to 180km apart revealed heterozygosities of 0.53 to 0.67 within populations and moderate levels of genetic divergence between populations (FST values from 0.074 to 0.141, harmonic means of Dest between 0.070 and 0.189). In all Flemish meta-populations, more than 90% of the individuals from a given geographic region were assigned to the same genetic cluster indicating
 little genetic exchange, even in De Panne where the two populations Oosthoek and Westhoek are only a few kilometres apart. Such sub-structuring on a micro-scale has also been described in other amphibians. Unique alleles in most populations further support the probability that genetic drift has already led to some isolation. With the exception of the Oosthoek population, however, we found no significant evidence for bottlenecks. Connectivity within pool clusters seems essential to the maintenance of genetic diversity in crested newts as is indicated by our findings from Tommelen, the population with the largest number of pools in close proximity, which also shows the highest levels of heterozygosity (He and Ho) and the second highest number and richness of alleles. In conclusion, our study indicates that dispersal and migration rates between the Flemish populations of Triturus cristatus are limited at the geographic scale studied here but that habitat fragmentation has not yet led to a significant loss of genetic diversity of the studied Flemish populations, possibly because crested newts are relatively long-lived, fragmentation of their habitat is relatively recent in Flanders, and most investigated pools are still connected at the local scale.

Characterization of type-specific HPV prevalence in a population of persistent cutaneous warts in Flanders, Belgium

Cutaneous warts are benign skin lesions caused by the human papillomavirus (HPV). Even though they are considered benign, they can have a considerable impact on the quality of life and cause serious illness in certain immunocompromised populations. Studies have shown that the efficacy of wart treatment is dependent on the causative HPV type. Therefore, in this article, we aim to determine the HPV genotype-specific prevalence in cutaneous warts of a Flemish population as part of the Omnivirol-Salycilic acid randomized controlled trial. Swab samples of cutaneous warts (n = 269) were collected during enrollment. The DNA extraction was performed on the automated NucliSENS® easyMAG® system (bioMérieux). The samples were analyzed with two separate in-house PCR assays capable of detecting the most prevalent cutaneous HPV types (i.e. wart-associated HPV qPCR) as well as the most relevant mucosal types (i.e. RIATOL qPCR assay). In total, the type-specific prevalence of 30 distinct HPV genotypes was determined. The beta-globin gene was used as a cellularity control and for viral load quantification. Data concerning wart persistence, previous treatment, wart type, and other relevant wart and patient characteristics was collected through a baseline questionnaire. The study population consisted mostly of persistent warts considering that 98% (n = 263) of the sampled skin lesions were older than six months and 92% (n = 247) had undergone previous treatment. The most prominent wart type was the mosaic verruca plantaris (42%, n = 113). The most prevalent HPV types were cutaneous HPV types 27 (73%, n = 195), 57 (63%, n = 169), and 2 (42%, n = 113). Only 2% (n = 6) of the lesions was HPV negative. The highest median viral loads were observed with HPV27 and 57 (i.e. 6.29E+04 and 7.47E+01 viral copies per cell respectively). The multivariate analysis found significant associations between wart persistence and certain wart types, the number of warts, and HPV genotypes. Based on these findings, persistent warts are more likely to: (1) be verruca vulgaris, verruca plantaris simple or mosaic, (2) to manifest as multiple warts, (3) and to be negative for HPV type 2 or 4. These characteristics can be useful in the clinical setting for future risk stratification when considering treatment triage and management.Trial registration: NCT05862441, 17/05/2023 (retrospectively registered).

The psychophysiological reactivity to beaches vs. to green and urban environments: insights from a virtual reality experiment

Coastal environments effectively reduce perceived levels of stress. However, little is known about whether coastal environments influence physiological parameters of stress, whether these influences differ from those of urban and green environments, and whether these effects depend on the level of precedent stress. The current study exposed 164 participants (18-65y, 68% female) from the Flemish population to two 16-minute virtual reality exposures (i.e. beach vs. green or urban) via a randomized crossover design, during which the heart rate, high-frequency heart rate variability (HF-HRV), skin conductance responses (SCR), mean arterial pressure (MAP), breathing rate, and upper trapezius muscle tone were monitored. Self-reported measures of stress were also taken. General linear mixed models analyzed for each parameter whether the change over time differed per exposed environment and by the level of stress in the past week (from ‘low’ to ‘moderate’ levels), while controlling for study design and participant related covariates. Results show that beaches caused lower breathing rates than urban environments and lower SCR than green environments. The upper trapezius muscle tone showed complex patterns, and the heart rate, HF-HRV, and MAP did not react differently to the beach than to the urban and green environments. The individuals’ level of stress in the past week did not affect these differences much. Self-reported measures showed that, under moderate stress, beaches decreased the negative mood and perceived stress, whereas green environments did not and urban environments generally had more adverse effects on the negative mood, perceived stress, positive mood, and perceived quality for relaxation. This study demonstrates that beaches slow down breathing and reduce the sympathetic nervous system activity, and highlights the benefits of beaches for health and wellbeing. The results mark the importance of considering diverse physiological pathways of stress and the individuals’ precedent stress.

Disclosure of genetic risk in the family: A survey of the Flemish general population

ObjectivesResults from genomic sequencing often have implications not just for patients but also for their relatives. To date, there are no studies in Belgium exploring whether potential relatives would want to be informed of a genetic risk in the family and their preferences on different approaches to disclosure. MethodsWe surveyed the attitudes of the Flemish general population (n = 407) towards receiving genetic information from their family members, including attitudes towards breaches in confidentiality, preferences for who communicates genetic risk and how the information is communicated, and policy approaches to nondisclosure. ResultsMost participants wanted to be informed of their genetic risk and receive genetic testing to confirm their diagnosis. Most preferred to be informed of genetic risk by a close family member, but that when given the choice between a distant family member and a clinician, most participants preferred to be contacted by a clinician. ConclusionIn Belgium there is currently no clear legal pathway for clinicians to directly initiate contact with at-risk relatives, but the responses from members of the Flemish population analyzed in this study indicate that this approach to disclosure of genetic risk deserves further consideration. Our findings indicate that the general population would support legislation allowing clinicians to inform relatives even in cases where the patient did not want to inform them. As this is not currently allowed in Belgium, policy alternatives should be considered.

Zero-Car Households: Urban, Single, and Low-Income?

This article unravels, by employing two binary logistic regressions, the socio-economic profiles of zero-car households in Flanders (Belgium) and sheds light on their residential environment. The employed dataset contains information regarding the socio-economic status and car ownership of all individuals with a home address in Flanders. Furthermore, the study explores the proportion and size of voluntarily car-free and car-less households due to constraints within the Flemish population. It does so by classifying zero-car households based on a spatial typology and the income decile these households belong to. Results indicate that zero-car households are overrepresented at the bottom of the income distribution and are overwhelmingly single. Children’s presence contributes to the likeliness that a household owns a car. The spatial typology (urbanised, suburban, or rural) and the presence of public transport are minor but remain significant contributors. The main contribution of this article is that it highlights that despite the evidence that zero-car households are strongly present in urban areas, the share of zero-car households living in remote areas may not be underestimated. For the total population in Flanders, 5.47% of households may face problems due to their residential location and lack of a car, which comes on top of dealing with modest or low household budgets. Almost 37% of the zero-car population lives in an urbanised area and has a low income. This corresponds with 8.4% of the Flemish population. This group likely experiences a latent demand for car ownership. The households we can confidently identify as car-free, deliberately and voluntarily living without a car, are a minority group and account for approximately 5% of the Flemish population. The article concludes with the notion that involuntarily carlessness can be considered a proxy for vulnerability. However, urban planning centred around proximity, accompanied by housing policy that benefits low-income groups, can act as a buffer against transport vulnerability.

Valuation of health benefits of green-blue areas for the purpose of ecosystem accounting: a pilot in Flanders, Belgium

In recent years, a vast amount of scientific literature has highlighted the benefits of nearby green space for physical and mental health, but the large variation in scope, methods and indicators used in these studies hampers the assessment of these benefits in the context of natural capital accounting. To our knowledge, this paper is one of the first studies to quantify and value these benefits in the context of natural capital accounting. A method was developed and applied to the Flemish Region in Belgium for 2013 and 2016. The physical supply and use accounts for health are based on a set of selected dose-effect relationships that quantify the impact of the availability of greenspace on seven specific indicators for physical and mental health, including mortality, cardio-vascular diseases, diabetes and depression. The indicator for green-blue areas is the percentage of green-blue areas in total land use, calculated for 0.5, 1 and 3 km radius from the residence, based on detailed land-use maps (10 m x 10 m) for Flanders, Belgium. The base-line data for mortality and illness are average data for the Flemish Region. These health impacts are weighted using Daly's (disability-adjusted life years) and aggregated. The total health benefits due to the availability of green-blue areas for the total Flemish population was estimated at almost 85,000 DALYs. This is 27% of the estimated total burden of disease in Flanders in 2016 for the seven selected diseases. The monetary accounts are based on a detailed assessment for mortality and morbidity of three different cost components, i.e. avoided medical costs (e.g. hospitalisation) and avoided absenteeism and welfare loss due to suffering and reduced life expectancy. Productivity gains from avoided absenteeism is valued, based on statistics on absenteeism for specific diseases for and labour market data from Belgium and account for 52% of the total monetary value of green spaces. Cost of illness is valued, based on market data and illness specific studies for Belgium or Europe and account for 36% of total values. Welfare gains from increased life expectancy are valued on the basis of European studies for the VOLY (value of a life year lost), based on the simulated exchange value for the willingness-to-pay for increased life expectancy. This accounts for 12% of the total monetary value of green space. The total monetary benefits amount to 464 Euro per inhabitant per year or 3 billion Euro per year for Flanders. This corresponds to 1.3% of the GDP, which reflects the importance of these benefits. The methodology is incomplete as not all health indicators are covered, mainly due to a lack of dose-effect relationships. The research priority for potential users of the accounts is a better indicator for contact with green space that does differentiate between ecosystems, their quality, accessibility or their use. This requires more systematic health impact studies that take these elements into account, as well as more systematic data on the daily use of green space by citizens. In the meantime, an additional set of condition accounts on these elements can be used, especially to follow changes in quality and use of green-blue areas over time.

A Cross-Sectional Study on the Acceptability of Implementing a Lung Cancer Screening Program in Belgium

Lung cancer is the most common and deadliest cancer in the world, and its incidence is expected to grow. Nonetheless, this growth can be contained through smoking cessation programs and effective lung cancer screening programs. In 2018, Belgium had the seventh highest incidence of lung cancer in the world, with lung cancer incidence accounting for 11.8% of all cancers diagnosed and 23.8% of all cancer-related deaths that same year. The aims of this study were to determine the overall acceptability of a lung cancer screening program in the Flemish population and to determine the main factors that would influence the overall acceptability of such a program. A questionnaire-based cross-sectional study was performed in the Flemish population and distributed online and on paper. The results are presented with the variables of interest and the main outcome, i.e., the acceptability of participating in such a program if implemented. Odds ratios were used to compare acceptability between subgroups. A multivariate regression model was used to determine the key factors that would have the largest impact on the level of acceptability and, thus, on the possible efficiency of such a program. This study estimated that acceptability of participating in a lung cancer screening program was 92%. Irrespective of the smoking status, levels of acceptability were higher than 89%. The key factors which could significantly influence the acceptability of a lung cancer screening program were individuals with low education, low protective factor knowledge and total knowledge, and lung cancer screening reimbursement, which were significantly associated with acceptability (0.01, 0.001, 0.01, and 0.05 respectively). Low protective factor knowledge decreased the log odds of acceptability 3.08-fold. In conclusion, the acceptability of implementing a lung cancer screening program in Flanders seems to be extremely high and would be well received by all. When implementing such a program, policymakers should aim for it to be reimbursed, campaigns should be gender-specific, focused on those with lower educational and socioeconomic status, and there should be investment in increasing total knowledge about lung cancer and knowledge about protective factors.

A urinary proteomic marker indicative of premature ageing.

Background: The Global Burden Disease 2019 report called for innovation in addressing age-related disabilities. Here we aimed to identify and validate a urinary peptidomic profile (UPP) differentiating healthy from unhealthy ageing in the general population, to test the UPP predictor in independent patient cohorts, and evaluate whether environmental exposures affect the UPP ageing profile. Methods: In a Flemish population study (n=778; 50.8% women; age, 16.2-82.1 years), 559 participants were examined twice and made up the derivation and time-shifted validation datasets; 219 were examined once and constituted the synchronous validation dataset. The UPP was assessed by capillary electrophoresis coupled with mass spectrometry. Statistical methods included linear and proportional hazard regression. The multidimensional UPP signature reflecting ageing was validated in patients with diabetes, COVID-19 or chronic kidney disease. In addition, the UPP ageing signature was associated with residential-modelled chronic air pollution exposure (particulate matter, black carbon, and nitrogen dioxide) Findings: With correction for multiple testing and multivariable adjustment, chronological age (C-age) was associated with 210 sequenced peptides mainly showing the downregulation of collagen fragments. The trained model relating C-age to UPP, derived by elastic net regression, included 54 peptides from 17 proteins. In the derivation and the time-shifted and synchronous validation datasets, the trained model explained 76.3%, 54.4% and 65.3% of C-age. Compared with the C-age, the predicted UPP-age was greater (P<0.0001) in patients with diabetes (50.8 vs 56.9), COVID-19 (53.2 vs 58.5) or chronic kidney disease (CKD; 54.6 vs 62.3). In the Flemish population, independent of C-age, UPP-age was significantly associated with various risk markers related to cardiovascular, metabolic and renal function, and inflammation. In participants with a low vitamin K status, ambient air pollution was associated with a higher UPP-age of 2.00 to 2.22 years per IQR increment (P≤0.0073). Over 12.4 years, the incidence of total and cardiovascular mortality and osteoporosis was associated with UPP-age, independent of C-age, with hazard ratios per 10-year higher UPP-age of 1.54 (95% CI, 1.22–1.95), 1.72 (1.20–2.47) and 1.40 (1.06–1.85), respectively (P≤0.018). Interpretation: The UPP signature indicative of ageing was associated with risk factors, environmental air pollution exposure, and adverse health outcomes in the population and with accelerated ageing in patients and reflects fibrosis and extracellular matrix (ECM) remodelling. Innovation in addressing disability should overcome the ontology of diseases and focus on shared disease mechanisms, in particular the ageing-related fibrotic degeneration.

Per- and polyfluoroalkyl substances (PFAS) and neurobehavioral function and cognition in adolescents (2010–2011) and elderly people (2014): results from the Flanders Environment and Health Studies (FLEHS)

BackgroundPFAS are persistent, bioaccumulative compounds repelling water, oil and stains which are widely used. There is mounting evidence linking exposure to a range of adverse health outcomes including renal, hepatic, immunotoxic, reproductive, endocrine disrupting and carcinogenic effects. PFAS possibly also induce neurobehavioral and developmental effects. Within Flanders Environment and Health Studies (FLEHS) internal exposure to PFAS and relevant health effects are assessed since 2008.ResultsAdolescents 14–15 y (2010–2011) living in an industrially contaminated area (without known PFAS contamination) and adults 50–65 y (2014) randomly sampled from the general Flemish population using a stratified clustered multi-stage design, were recruited. For the adolescents perfluorooctane sulfonate (PFOS) and perfluorooctanoic acid (PFOA) were measured in serum, for the adults PFOS, PFOA, perfluorohexane sulfonate (PFHxS), perfluorononanoic acid (PFNA) and perfluorobutane sulfonate (PFBS). In adolescents the Neurobehavioral Evaluation System (NES3) computerized battery of tests developed to study the neurological effects of an exposure to environmental agents was applied. The adults did the Stroop test, the NES3 Continuous Performance Test and the NES3 Digit Span Test. In adolescents sleepiness, masculinity and femininity were assessed via the Epworth Sleepiness Scale and Personal Attributes Questionnaires, respectively. In adolescents PFOA was associated with significantly increased somnolence, and PFOS with a significant inverse association with boys’ femininity and with girls’ masculinity. In adolescents, PFAS were also associated with a marginal decrease in sustained attention (PFOS) and cognitive performance (PFOA) and a significant decrease in short-term memory (PFOS). However, in older adults PFOS was associated with a significant increase in the capacity to pay attention and PFHxS with a significant increase in sustained attention.ConclusionOur observations point to neurobehavioral and cognitive effects of PFAS. The neurobehavioral effects might in part result from the changes in sex hormone levels that have been reported to be associated with internal exposure to PFAS. Interestingly, whereas in relation to cognition some adverse effects were recorded for adolescents, for elderly persons our observations rather suggest possible weak positive effects with respect to cognition. Our observations might be in line with the view that PFAS have many, sometimes contrasting health effects.

Quality of life in patients and caregivers after aneurysmal subarachnoid hemorrhage: a Flemish population study.

Background and aimsAneurysmal subarachnoid hemorrhages (aSAH) have high mortality and morbidity. However, the impact on Quality of Life (QoL) of patients remains poorly documented, and data on primary caregiver burden is even scarcer. MethodsThis is a single center, cross-sectional study performed at the Antwerp University Hospital, Belgium. We included aSAH patients during follow-up at the outpatient clinic and assessed the QoL, by using the Stroke Specific Quality of Life scale (SSQoL). Caregiver burden was evaluated by the Caregiver Strain Index (CSI). The aSAH severity and functional outcome (at 90 days) were assessed, respectively, by mFisher score and modified Ranking Scale (mRS). Statistical analysis was performed using SPSS version 27. ResultsIn total, 22 aSAH patients were included, on average 15.5 (range 4–45) months after the aSAH. The SSQoL score was 3.7 ± 0.7, with a mean psychosocial domain score of 3.2 ± 0.8 and physical domain of 4.2 ± 0.8. Psychosocial factors, especially decreased energy levels and cognitive impairment, had a negative impact on the QoL (p = 0.02 en p = 0.05). No association was found between QoL and mFisher, nor between QoL and mRS. Fifteen primary caregivers completed the CSI. Only 3 (20%) of them reported a high care burden (CSI > 6), although changes in daily life and personal plans were reported, respectively, by 73% (n = 11) and 67% (n = 10) of caregivers. We only found a correlation between the mFisher score and CSI (p = 0.01).ConclusionOur results emphasize that there is an important psychosocial impact on the QoL of patients after aSAH, and their primary caregivers. More research is warranted.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13760-022-02085-x.

Clinicopathological characteristics and disease chronicity in native kidney biopsies in Flanders.

The Flemish Collaborative Glomerulonephritis Group (FCGG) registry provides complete population data on kidney disease epidemiology in the region of Flanders (Belgium), as it captures all native kidney biopsies performed in its population of 6.5 million inhabitants. From 2017 until 2019, 2054 adult kidney biopsies were included from 26 nephrology centers (one biopsy per patient). Data on nephrotic and nephritic syndrome were available in 1992 and 2026 biopsies, respectively. In a subgroup of 898 biopsies containing ≥10 glomeruli from 2018 to 2019, disease chronicity was graded using the Mayo Clinic Chronicity Score (MCCS). The association between clinical variables and MCCS was determined using simple and multiple linear regression models. Nephrotic syndrome (present in 378 patients, 19.0%) was most frequently caused by minimal change disease in younger patients (18-44 years), membranous nephropathy in older patients (45-74 years) and amyloidosis in the elderly (>75 years). Nephritic syndrome (present in 421 patients, 20.8%) was most frequently caused by immunoglobulin A nephropathy (IgAN) in younger patients (18-64 years) and ANCA-associated vasculitis (AAV) in older patients (>64 years). AAV and IgAN were the most frequent underlying diagnoses in biopsies in which crescents were identified. In multivariable analysis, acute and chronic kidney disease and diagnoses of diabetic kidney disease, nephrosclerosis and hyperoxaluria/hypercalcemic nephropathy were associated with the highest MCCS increases. The FCGG registry validates data from previous Western European registries and provides a snapshot of disease chronicity in the whole biopsied Flemish population.

Urinary matrix Gla protein is associated with mortality risk in Flemish population: A prospective study.

BackgroundVascular calcification is strongly related to the risk of mortality and cardiovascular (CV) diseases. In vascular calcification, matrix Gla protein (MGP), a small vitamin K-dependent protein, is an important mineralization inhibitor. Recent studies showed that circulating MGP is associated with mortality risk. However, the longitudinal association between urinary excretion of MGP and all-cause mortality was not established.Materials and methodsUrinary MGP was measured in 776 randomly recruited Flemish population (mean age: 51.2 years; 50.9% women) at baseline (during 2005–2010) using capillary electrophoresis coupled with mass spectrometry. Plasma inactive MGP [desphospho-uncarboxylated MGP (dp-ucMGP)] levels were quantified in 646 individuals by ELISA kits. Mortality status was ascertained through the Belgian Population Registry until 2016. The longitudinal association with mortality was determined by the multivariate-adjusted Cox proportional hazards regression models. The multivariate linear regression models were used to identify determinants of urinary MGP level.ResultsOver the 9.2 years, 47 (6.06%) participants died, including 15 CV deaths. For a doubling of urinary MGP, the hazard ratios (HRs) were 1.31 (95% CI: 1.01–1.69, P = 0.040) for all-cause mortality and 2.05 (95% CI: 1.11–3.79, P = 0.023) for CV mortality with adjustment for covariates, including estimated glomerular filtration rate and urine microalbumin. The addition of urinary MGP to the basic models improved the reclassification as suggested by the increased net reclassification improvement [64.01% (95% CI: 32.64–98.63)] and integrated discrimination improvement [2.33% (95% CI: 0.24–4.71)]. Circulating inactive MGP, total cholesterol, urine microalbumin, and smoking were significantly associated with urinary MGP levels (P ≤ 0.041), independent of sex and age.ConclusionElevated urinary MGP was associated with an increased risk of all-cause mortality and CV mortality and improved the risk reclassification for all-cause mortality. These findings suggested that urinary MGP might be useful in mortality risk assessment in the general population. However, these observations need to be replicated in larger studies with a longer follow-up time.

Geographical variation of COVID-19 vaccination coverage, ethnic diversity and population composition in Flanders

The vaccination coverage in Flanders is high, but some regions show lower vaccination willingness as compared to the overall vaccination coverage. Beginning November of 2021, the vaccination rate in Flanders was above 93% in age groups above 45 years, and around 85% in the age groups 12 to 44 years. Apart from Flanders as a whole, focus here is on the health sector Maasland, which has a slightly lower vaccination rate, especially in the age groups 12 to 44 years. In the Maasland region, located on the eastern border of Flanders, there are between 1% and 10% less vaccinated individuals than expected according to the vaccination rate in the whole of Flanders, with lowest vaccination rates in the south of the Maasland region. We study the impact of ethnic diversity in the population, population composition with respect to the ethnicity of individuals (in the sense of how the local population composition differs from the Flemish average), and socio-economic status on the vaccination rate at the level of the statistical sector, apart from the effect of age. We explain the statistical methods to investigate geographical differences and illustrate how one can deal with incomplete information in vaccination registries. Ethnic diversity in a region is associated with lower vaccination rates, as is a lower regional socio-economic status. The composition of the population in Maasland is associated with a 35% reduction in the odds to get vaccinated as compared to the overall Flemish population.

OPEN-ANGLE GLAUCOMATOUS OPTIC NEUROPATHY IS RELATED TO DIPS RATHER THAN INCREASES IN THE MEAN ARTERIAL PRESSURE OVER 24-H

Objective: Mean arterial pressure (MAP) drives ocular perfusion. Excessive 24-h MAP variability relates to glaucoma, however, whether this is due to dips or increases in the blood pressure (BP) is undocumented. We investigated the association of open-angle glaucoma (OAG) in relation to the five largest MAP dips/increases over 24-h, henceforth called dips/blips. Design and method: In the Maracaibo Aging Study (MAS), 93 participants aged 40y or older (women, 87.1%; mean age, 61.9y) underwent baseline ophthalmological and 24-h ambulatory BP monitoring assessments. OAG was the presence of optic nerve damage and visual field defects. Statistical methods included logistic regression and the generalized R2 statistic. For replication, 48 OAG cases at the Leuven Glaucoma Clinic were matched with 48 controls recruited from Flemish population. Results: In MAS, 26 had OAG. OAG compared to non-OAG participants experienced longer and deeper dips (116.5 vs. 102.7 minutes; to 60.3 vs. 66.6 mmHg; 21.0 vs. 18.0 mmHg absolute or 0.79 vs. 0.81 relative dips compared to the preceding reading). The adjusted odds ratios associated with dip measures ranged from 2.25 (95% confidence interval [CI], 1.31–4.85; P = 0.009) to 3.39 (95% CI, 1.36 8.46; P = 0.008). On top of covariables and 24 MAP level/variability, the dip measures increased the model performance (P values below 0.025). Blips did not associate with OAG. The case-control study replicated the MAS observations. Conclusions: Dips rather than increases in the 24-h MAP level were associated with increased risk for OAG. An ophthalmological examination combined with 24-h BP monitoring might be precautious steps required in normotensive and hypertensive patients at risk of OAG.