Flemish Population Research Articles

Internal exposure of Flemish teenagers to environmental pollutants: Results of the Flemish Environment and Health Study 2016-2020 (FLEHS IV).

The Flemish Environment and Health Study (FLEHS) collects information on internal exposure to a broad range of environmental chemicals in the general population in Flanders, the Northern region of Belgium. The aim is to establish biomonitoring exposure distributions for the general population in support of public health and environmental policy, environmental risk assessment and risk management decisions. In 2017-2018, urine and blood samples were collected from 428 teenagers by a stratified clustered two stage randomized design. Samples were analyzed for a broad range of biomarkers related to exposure to chlorinated and newer pesticides, brominated and organophosphate flame retardants (BFR/OPFR), polychlorinated biphenyls (PCBs), bisphenols, phthalates and alternative plasticizers, per-and polyfluoroalkyl substances (PFAS), polycyclic aromatic hydrocarbons (PAHs), benzene, metals and trace elements. The geometric mean levels and percentiles of the distribution were estimated for each biomarker, for the whole study population and following stratification for sex, the household educational attainment and the residence area's urbanicity. Geometric means of biomarkers of lead, dichlorodiphenyltrichloroethane (DDT), PCBs, PAHs, regulated phthalates and bisphenol A (BPA) were lower than in the previous FLEHS cycles. Most biomarker levels were below health-based guidance values (HB-GVs). However, HB-GVs of urinary arsenic, blood lead, blood cadmium, sum of serum perfluorooctane sulfonate (PFOS) and perfluoro-1-hexanesulfonate (PFHxS) and the urinary pyrethroid metabolite (3-PBA) were exceeded in respectively 25%, 12%, 39.5%, 10% and 22% of the teenagers. These results suggest that the levels of exposure in the Flemish population to some environmental chemicals might be of concern. At the same time, we noticed that biomarkers for BPA substitutes, metabolites of OPFRs, an expanded list of PFAS, glyphosate and its metabolite could be measured in substantial proportions of participants. Interpretation of these levels in a health-risk context remains uncertain as HB-GVs are lacking. Household educational attainment and residential urbanicity were significant exposure determinants for many biomarkers and could influence specific biomarker levels up to 70% as shown by multiple regression analysis. The research consortium also took care of the broader external communication of results with participants, policy makers, professional groups and civil society organizations. Our study demonstrated that teenagers are exposed to a wide range of chemicals, it demonstrates the success of public policies to reduce exposure but also points to concern and further priorities and needs for follow up.

Social preferences for adopting new vaccines in the national immunization program: A discrete choice experiment

Governments regularly have to decide whether new vaccines should be adopted in their national immunization program. These choices imply complex trade-offs of epidemiological, medical and socio-economic criteria. We investigated how the population in Flanders (Belgium) wants their government to set vaccine-funding priorities. In December 2019, we executed a discrete choice experiment in a sample of the Flemish population (N = 1636). In total, we analysed 16 360 choices between vaccines competing for funding, described in terms of eight characteristics. Using a panel mixed logit model, we quantified the relative importance of each characteristic and investigated differences in preferences across respondent groups. The observed vaccine priorities were different from those that would be identified through cost-effectiveness analysis. People valued the health impact from infectious diseases differently than their weight expressed in QALYs would suggest. Mortality and frequently occurring mild illness were valued higher, whereas lasting morbidity received lower weight. Contribution of the vaccine to disease eradication and uncertainty in vaccine effectiveness were both highly influential factors. Health equity impact was also important whereas the economic impact of the disease did not matter at all. Our results can be used to incorporate public values into vaccine decision-making.

Prevalence and associated risk factors of HIV infections in a representative transgender and non-binary population in Flanders and Brussels (Belgium): Protocol for a community-based, cross-sectional study using time-location sampling.

HIV prevalence and sexual risk have been estimated very high for transgender people. However, the limited sampling and data collection methods used in current research on transgender people potentially led to overrepresentation and generalisation of people at risk for HIV. Current HIV prevalence estimates in transgender populations are generalised from studies mainly focusing on transgender women engaging in sex work. Moreover, studies focusing on non-binary people, who identify with a broad range of identities beyond the traditional male and female gender identities, are scarce. To estimate the HIV prevalence rate in the Flemish and Brussels (Belgium) transgender population, including transgender women, transgender men and non-binary people, and to identify the associated risk factors. In this community-based cross-sectional study, self-identified transgender and non-binary (TGNB) people will be recruited through a two-stage time-location sampling approach. First, community settings in which TGNB people gather will be mapped to develop an accurate sampling frame. Secondly, a multistage sampling design is applied involving a stratification based on setting type (healthcare facilities vs outreach events), a selection of clusters by systematic sampling and a simple random selection of TGNB people within each cluster. Participants will complete an electronic self-reported survey to measure sociological, sexual and drug-using behaviors (risk factors) and oral fluid aliquots will be collected and tested for HIV antibodies. Logistic regression models will be used to evaluate risk factors independently associated with HIV infection. The presented study is registered at ClinicalTrials.gov (NCT04930614). This study will be the first to investigate the HIV prevalence rates and associated risk behaviors in an accurate representation of the TGNB population in a Western European country. The findings will globally serve as a knowledge base for identifying subgroups at risk for becoming infected with HIV within TGNB people and to set up targeted prevention programs.

Open-Angle Glaucomatous Optic Neuropathy Is Related to Dips Rather Than Increases in the Mean Arterial Pressure Over 24-H.

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 5 largest MAP dips/increases over 24-h, henceforth called dips/blips. In the Maracaibo Aging Study (MAS), 93 participants aged ≥40 y (women, 87.1%; mean age, 61.9 y) 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. In the MAS, 26 participants 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 mm Hg; -21.0 vs. -18.0 mm Hg absolute or 0.79 vs. 0.81 relative dip 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 ≤ 0.025). Blips did not associate with OAG. The case-control study replicated the MAS observations. 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.

Cross-Sectional Study of Headache in Flemish Children and Adolescents.

Background: Although headache is common in pediatrics, data for the Flemish population are missing. We explored headache-prevalence, and its association with communication-technology (CT) and physical activity (PA) in Flemish children and adolescents. Methods: A cross-sectional exploratory school-based questionnaire study was designed. Flemish boys and girls (5-18 years) completed a symptom-questionnaire. Primary outcomes: sociodemographic background, headache-prevalence, headache-characteristics, CT-use and PA characteristics (self-report). Secondary outcomes: associations between headache-characteristics, age, gender, and CT-use and PA-characteristics. Results: Four hundred twenty-four questionnaires were analysed: 5-7-years: n = 58; 8-11-years: n = 84; 12-15-years: n = 137; 16-18-years: n = 145. Fifty-five percent suffered from headache. Prevalence increased with age. More 16-18-year girls versus boys had headache. CT-use was the main headache-provocateur. Headache prevalence was significantly higher in a frequently physical active population. Conclusion: Our results suggest presence of headache in Flemish children and adolescents. PA-level associates with headache prevalence. However, children and adolescents with headache did not report more CT-use compared to controls.

The urinary proteomic profile of arterial stiffness in the general population

Abstract Background Although arterial stiffness is an independent predictor of cardiovascular outcomes, its physiopathology remains unclear. Purpose This study aimed to investigate the urinary proteomic profile of aortic stiffness and provide insights into pathogenetic processes of arterial stiffness by pathway analysis. Methods In 669 participants (mean age, 50.5 years; 48.9% men) randomly recruited from the Flemish population, we measured carotid-femoral pulse wave velocity (PWV) by applanation tonometry. The proteomics of urine samples was quantified by using capillary electrophoresis coupled mass spectrometry. The proteomic data were analysed by the orthogonal projections to latent structures, a supervised dimensional reduction statistic method and summarised as a urinary proteomic (UP) score. Results The mean values were 7.56±2.02 m/s for PWV and 7.59±1.95 unit for the UP score. PWV was significantly associated with the UP score before and after adjustment for the potential covariates (β coefficient: 0.81 and 0.75, respectively; p<0.001). The significant proteins in the urinary proteomic profile consisted of 43 kinds of proteins, including collagen I, II and III, fibrinogen, matrix Gla-protein, apolipoprotein A-I and A-VI. The pathways annotated by the significant proteins mainly involved in fibrosis, signal conduction, platelet activation and aggregation. Conclusions In conclusion, the urinary proteomic profile could be a new biomarker of aortic stiffness and the altered proteins may link to the underlying mechanisms and holds the potential to discover novel therapeutic targets for arterial stiffness. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): The Internal Funds KU Leuven (STG-18-00379) Distribution and CorrelationThe Enrichment Pathways

Cotton and Surgical Face Masks in Community Settings: Bacterial Contamination and Face Mask Hygiene.

During the current COVID-19 pandemic, the use of face masks has become increasingly recommended and even mandatory in community settings. To evaluate the risk of bacterial cross-contamination, this study analyzed the bacterial bioburden of disposable surgical masks and homemade cotton masks, and surveyed the habits and face mask preferences of the Flemish population. Using culture approaches and 16S rRNA gene amplicon sequencing, we analyzed the microbial community on surgical and/or cotton face masks of 13 healthy volunteers after 4 h of wearing. Cotton and surgical masks contained on average 1.46 × 105 CFU/mask and 1.32 × 104 CFU/mask, respectively. Bacillus, Staphylococcus, and Acinetobacter spp. were mostly cultured from the masks and 43% of these isolates were resistant to ampicillin or erythromycin. Microbial profiling demonstrated a consistent difference between mask types. Cotton masks mainly contained Roseomonas, Paracoccus, and Enhydrobacter taxa and surgical masks Streptococcus and Staphylococcus. After 4 h of mask wearing, the microbiome of the anterior nares and the cheek showed a trend toward an altered beta-diversity. According to dedicated questions in the large-scale Corona survey of the University of Antwerp with almost 25,000 participants, only 21% of responders reported to clean their cotton face mask daily. Laboratory results indicated that the best mask cleaning methods were boiling at 100°C, washing at 60°C with detergent or ironing with a steam iron. Taken together, this study suggests that a considerable number of bacteria, including pathobionts and antibiotic resistant bacteria, accumulate on surgical and even more on cotton face masks after use. Based on our results, face masks should be properly disposed of or sterilized after intensive use. Clear guidelines for the general population are crucial to reduce the bacteria-related biosafety risk of face masks, and measures such as physical distancing and increased ventilation should not be neglected when promoting face mask use.

The effect of a case-finding app on the detection rate of atrial fibrillation compared with opportunistic screening in primary care patients: protocol for a cluster randomized trial

BackgroundAtrial fibrillation is a cardiac arrhythmia commonly encountered in a primary care setting. Current screening is limited to pulse palpation and ECG confirmation when an irregular pulse is found. Paroxysmal atrial fibrillation will, however, still be difficult to pick up. With the advent of smartphones, screening could be more cost-efficient by making use of simple applications, lowering the need for intensive screening to discover (paroxysmal) atrial fibrillation.Methods/designThis cluster randomized trial will examine the effect of using a smartphone-based application such as FibriCheck® on the detection rate of atrial fibrillation in a Flemish general practice population. This study will be conducted in 22 primary care practices across the Flanders region of Belgium and will last 12 months. Patients above 65 years of age will be divided in control and intervention groups on the practice level. The control group will be subjected to standard opportunistic screening only, while the intervention group will be prescribed the FibriCheck® app on top of this opportunistic screening. The difference in detection rate between control and intervention groups will be calculated at the end of the study.We will use the online platform INTEGO for pseudonymized data collection and analysis, and risk calculation.DiscussionSmartphone applications might offer a way to cost-effectively screen for (paroxysmal) atrial fibrillation in a primary care setting. This could open the door for the update of future screening guidelines.Trial registrationClinicalTrials.gov NCT04545723. Registered on September 10, 2020.

Age- and gender-related differences in verbal semantic processing: the development of normative electrophysiological data in the Flemish population

ABSTRACT Categorical and associative relationships among words are two key forms of semantic knowledge. In this study, we examined ageing and gender effects on the processing of both types of semantic relationships by using the event-related potential technique. Moreover, we aimed to develop normative electrophysiological data for clinical purposes. One hundred and ten healthy subjects were divided among three age groups and subjected to two auditory word priming paradigms. Early auditory processing was influenced by increasing age as shown by larger P1 amplitudes and by delayed onsets of the N1 and P2. Conversely, ageing effects on the main N400 effect were limited to an increased right hemispheric lateralisation pattern for associative relationships. Gender effects could be demonstrated, with women showing larger P2 amplitudes and larger semantic priming effects in comparison to men. The interpretation of these findings is discussed and the practical utility of the obtained normative data is emphasised.

Glomerular function in relation to fine airborne particulate matter in a representative population sample

From 1990 until 2017, global air-pollution related mortality increased by 40%. Few studies addressed the renal responses to ultrafine particulate [≤ 2.5 µm (PM2.5)], including black carbon (BC), which penetrate into the blood stream. In a Flemish population study, glomerular filtration estimated from serum creatinine (eGFR) and the urinary albumin-to-creatinine ratio were measured in 2005–2009 in 820 participants (women, 50.7%; age, 51.1 years) with follow-up of 523 after 4.7 years (median). Serum creatinine, eGFR, chronic kidney disease (eGFR < 60 mL/min/1.73 m2) and microalbuminuria (> 3.5/> 2.5 mg per mmol creatinine in women/men) were correlated in individual participants via their residential address with PM2.5 [median 13.1 (range 0.3–2.9) μg/m3] and BC [1.1 (0.3–18) μg/m3], using mixed models accounting for address clusters. Cross-sectional and longitudinally, no renal outcome was associated with PM2.5 or BC in models adjusted for sex and baseline or time varying covariables, including age, blood pressure, heart rate, body mass index, plasma glucose, the total-to-HDL serum cholesterol ratio, alcohol intake, smoking, physical activity, socioeconomic class, and antihypertensive treatment. The subject-level geocorrelations of eGFR change with to BC and PM2.5 were 0.13 and 0.02, respectively (P ≥ 0.68). In conclusion, in a population with moderate exposure, renal function was unrelated to ultrafine particulate.

Urinary Peptidomics to Address Age-Related Disabilities

Background: The Global Burden Disease 2019 report called for innovation in addressing age-related disabilities. The current study aimed at identifying and validating a urinary peptidomic profile (UPP) differentiating healthy from unhealthy ageing in the general population, to test the UPP predictor in patients, and to search for targetable molecular pathways. 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 internal validation datasets; 219 were examined once and constituted the independent validation dataset. The UPP was assessed by capillary electrophoresis coupled with mass spectrometry. Statistical methods included linear and proportional hazard regression. Pathway exploration rested on the Reactome and KEGG databases. The multidimensional UPP signature reflecting ageing was further validated in patients with diabetes, COVID-19 or chronic kidney disease. Findings: With correction for multiple testing and multivariable adjustment, chronological age (C‑age) was associated with 210 sequenced peptides mainly showing 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 internal and independent validation datasets, the trained model explained 76·3%, 54·4% and 65·3% of C‑age. Compared with the derivation data, the UPP-predicted C‑age was greater (pInterpretation: Ageing is associated with a specific UPP signature, reflecting fibrosis and ECM remodelling. UPP‑age was associated with risk factors and adverse health outcomes in the population and with accelerated ageing in patients. Innovation in addressing disability should overcome the ontology of diseases and focus on shared disease mechanisms, in particular the bodywide ageing associated fibrosis and ECM remodelling.Funding: European Research Council, Ministry of the Flemish Community, OMRON Healthcare. Declaration of Interest: HM is the co-founder and co-owner of Mosaiques-Diagnostics GmbH, Hannover, Germany, and AL is an employee of Mosaiques Diagnostics. All other authors declare no conflict of interestEthical Approval: The Flemish Study on Environment, Genes and Health Outcomes (FLEMENGHO) complies with the Helsinki declaration and is registered at the Belgian Data Protection Authority (reference number III 11/1234/13; 22 August 2013). The ethics committee of the University Hospital Leuven, Belgium, approved the secondary use of FLEMENGHO data (national registration number, B32220083510).

Abstract PS7-32: Age of first full term pregnancy and other reproductive factors affect mammographic breast density in postmenopausal women

Abstract The objective of this study is to determine the role of age at first full term pregnancy (FFTP), and mammographic breast density (MBD) in postmenopausal women. For this purpose women, age 50-69y, participating in the Flemish (Belgium) population based breast cancer screening program were invited to participate in the study during their visit at the mammography department in the University Hospital Leuven (UZLeuven) or at the mobile unit of their hometown. A self-administered questionnaire providing detailed information on lifestyle and environmental exposure was completed by the participants. In this analysis 1,034 women were included (mean age of 59.1 years (range: 49.2 to 69.8). The three parameters of MBD were the percentage glandular tissue of the total breast volume (GLAND), the ratio of the glandular tissue volume compared to the whole breast volume or Volumetric Breast Density (VBD) and the BI-RADS density classification (VolparaDataManager®, USA). The first two parameters (GLAND and VBD) were transformed according to the natural logarithm to improve normality. These two parameters were linked with the FFTP via a piecewise linear regression (PLR) model using the NLIN procedure in SAS (version 9.4, SAS Institute, Cary, NC, USA). For the BI-RADS, we used ordinal logistic regression analysis. All models were corrected for a priori chosen variables: age at menarche, the ever use of oral contraceptive pill (OC), hormonal use at menopause, age at MBD measurement, and the body mass index at participation. Estimates are provided as a % change (95% confidence intervals [CI]).The average age at FFTP was 26.1 years (5th-95th percentile: 20 to 34). The PLR model estimated the breakpoint in our analysis at a FFTP of 25.7 years (95% CI: 22.3 to 29.1). For the woman with a FFTP younger than 25.7 years, the association between GLAND or VBD and FFTP is statistically not significant. For woman with a FFTP above 25.7 years, each year increase in FFTP was associated with 1.3% increase in GLAND (95% CI: 0.0% to 2.5%) and 1.5% increase in VBD (95% CI: 0.2% to 2.8%). Analysis of the BI-RADS showed similar results, the odds of belonging to a higher BI-RADS classification (e.g. from class 1 to class 2) increased with 5.4% (95% CI: 0.0% to 11.0%) for each year increase in FFTP age after the age of 25.7 years. Among other reproductive factors such as age at menarche, for every year delay there is 3.5% higher GLAND (95% CI: 1.4 % to 5.6%) and 2.5% higher VBD (95% CI: 0.5% to 4.6%) and the ever use of OC resulted in 10.0 % decrease in GLAND (95% CI: -18.8% to -0.2%) and 10.2% decrease in VBD (95%CI:-19.1% to -0.3%).In conclusion, this study is to our knowledge the first one to show that mammographic breast density is significantly increased when pregnancy takes place after 25.7 years of age. Later age at menarche is increasing and use of oral contraceptive is reducing mammographic breast density at postmenopause. (This study was supported by a Grant of the Breast Cancer Organization Think Pink of Belgium, the Department of Breast Radiology and Mobile Unit of the University Hospital Leuven, the Centre of Environmental Sciences and the Centre of Biostatistics of the Hasselt University, and NIH Grant CA06927 to FCCC, PA, USA). Citation Format: Magda Johanna Vandeloo, Kristof Y. Neven, Liesbeth M. Bruckers, Jose Russo, Liesbeth Vancoillie, Esmee M. Bijnens, Eliane Kellen, Tim S. Nawrot, Chantal Van Ongeval. Age of first full term pregnancy and other reproductive factors affect mammographic breast density in postmenopausal women [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-32.

Network Analysis to Identify Communities Among Multiple Exposure Biomarkers Measured at Birth in Three Flemish General Population Samples.

Introduction: Humans are exposed to multiple environmental chemicals via different sources resulting in complex real-life exposure patterns. Insight into these patterns is important for applications such as linkage to health effects and (mixture) risk assessment. By providing internal exposure levels of (metabolites of) chemicals, biomonitoring studies can provide snapshots of exposure patterns and factors that drive them. Presentation of biomonitoring data in networks facilitates the detection of such exposure patterns and allows for the systematic comparison of observed exposure patterns between datasets and strata within datasets.Methods: We demonstrate the use of network techniques in human biomonitoring data from cord blood samples collected in three campaigns of the Flemish Environment and Health Studies (FLEHS) (sampling years resp. 2002–2004, 2008–2009, and 2013–2014). Measured biomarkers were multiple organochlorine compounds, PFAS and metals. Comparative network analysis (CNA) was conducted to systematically compare networks between sampling campaigns, smoking status during pregnancy, and maternal pre-pregnancy BMI.Results: Network techniques offered an intuitive approach to visualize complex correlation structures within human biomonitoring data. The identification of groups of highly connected biomarkers, “communities,” within these networks highlighted which biomarkers should be considered collectively in the analysis and interpretation of epidemiological studies or in the design of toxicological mixture studies. Network analyses demonstrated in our example to which extent biomarker networks and its communities changed across the sampling campaigns, smoking status during pregnancy, and maternal pre-pregnancy BMI.Conclusion: Network analysis is a data-driven and intuitive screening method when dealing with multiple exposure biomarkers, which can easily be upscaled to high dimensional HBM datasets, and can inform mixture risk assessment approaches.

Experiencing and supporting institutional regionalization in Belgium: a normative and interpretive policy feedback perspective

Regionalization has been a defining feature of European politics since the 1970s. Previous work has studied political drivers of the movements of competences to the subnational level, including the role of citizens’ preferences. Yet, we still know little about how these new divisions of competences between government levels have impacted the development of public opinion about this division. The article builds on the literature on policy feedback and argues that institutional regionalization may both directly and indirectly affect support for regionalization through normative and interpretive effects. To empirically qualify these expectations, the article uses eight cross sections of the Flemish and Walloon populations in Belgium (1991–2019). This approach explains differences in support for regionalization between citizens that were socialized in different institutional and regional contexts. The analyses show that Walloons who came of age in the context of more institutional regionalization tend to be more supportive of regionalization. In Flanders, in contrast, support for regionalization is most consistently and substantially explained by regional and Belgian identification. However, our analyses show no support for the expectation that coming of age in a more regionalized Belgium is associated with a greater sense of regional identification.

Burdens in mental health recovery: Causal beliefs and their relation to stigma and help seeking recommendations

Lay attitudes are often seen as potential barriers to mental health recovery. But apart from perceiving them as potential barriers, they can also play an important role in stimulating individuals to consult (in)formal help sources, in particular through the process of help referral. Where existing research mainly focusses on actual help seeking behaviour, this study will focus on lay publics' referral behaviour. This study analyses the relation between causal beliefs and stigmatising attitudes and social distance on the one hand, and (in)formal help seeking recommendations on the other. Data from a survey carried out in 2019, assessing the attitudes of Public Health Insurance Provider (HIP) members towards mental health problems, was used. Part of the survey questions was based on a quantitative quasi-experimental design, using hypothetical written vignettes. The weighted data represent a sample of the adult Flemish population (22-94 years, N = 5675). Multiple linear regression analysis was used to examine the relation between causal beliefs and stigma, while binominal logistic regression analysis was used to investigate the relation between causal beliefs and help seeking recommendations. The results reveal that causal beliefs significantly associate with stigma, measured by stigmatising attitudes and social distance: personal- or biogenetic beliefs associate with more stigma, where psychosocial beliefs associate with less stigma. Concerning help seeking recommendations, psychosocial beliefs associate with recommending psychological or psychotherapeutic care, biogenetic beliefs associate with advising help from general practitioners and suggesting psychiatric help, while personal beliefs negatively associate with recommending formal help. Meanwhile, biogenetic beliefs associate with less informal help seeking recommendations (e.g. family, friends and online self-help), where personal beliefs associate with more informal help seeking recommendations and psychosocial beliefs only associate with online help referral. This study highlights the importance of causal beliefs in affecting public stigma and help seeking recommendations.

Male age interferes with embryo growth in IVF treatment.

Does male age affect embryo growth or quality in couples undergoing IVF treatment? Advanced paternal age (APA) is negatively associated with the chance of an optimal eight-cell embryo on the third day of development. Literature shows that APA is associated with decreased sperm quality and fecundity. However, the effect of male age on embryo growth in an IVF setting remains inconclusive. Literature concerning male influences on IVF success is scarce and approaches used to analyse embryo outcomes differ by study. This study was part of the longitudinal Epigenetic Legacy of Paternal Obesity (ELPO) study for which fathers and mothers were followed from pre-pregnancy until the birth of their child. Couples were recruited from April 2015 to September 2017. A total of 1057 embryos from 87 couples were studied. Dutch-speaking couples planning to undergo an IVF treatment were recruited at the Leuven University Fertility Center in Flanders, Belgium. Anthropometrics were documented and compared to the general Flemish population. Semen characteristics, pregnancy rates and the following embryo characteristics were recorded: number of blastomeres, symmetry and percentage fragmentation. Statistical modelling was applied taking into account correlation of within-cycle outcomes and use of multiple cycles per couple. We observed a significant inverse association between APA and a key determinant for scoring of embryo quality: older men were less likely to produce an embryo of eight blastomeres at Day 3, compared to younger fathers; odds ratio for the effect of 1 year equals 0.960 (95% CI: 0.930-0.991; P = 0.011). Our finding remained significant after adjusting for female age and male and female BMI. Degree of fragmentation and symmetry were not significantly related to male age. Because of the study's small sample size and its monocentric nature, a larger study is warranted to confirm our results. In addition, distribution of BMI and level of education were not representative of the general Flemish population. Although we corrected for BMI status, we do not exclude that obesity may be one of the determinants of infertility in our study population. Furthermore, it is known from other European countries that a higher education eases access to fertility treatment. Hence, caution should be taken when interpreting our findings from a fertility setting to the general population. We suggest a heightened need for future research into male age and its potential effects on embryo growth, embryo quality and ART outcomes. Clinical decision-making and preventative public health programmes would benefit from a better understanding of the role of men, carried forward by the Paternal Origins of Health and Disease (POHaD) paradigm. We hope the current finding will encourage others to examine the role of the sperm epigenome in embryo development according to paternal age. This work was supported by a research grant from KU Leuven University (OT/14/109). The authors declare no competing financial, professional or personal interests. KU Leuven S57378 (ML11309), B322201523225.

Support for Regionalization in Federal Belgium: The Role of Political Socialization

AbstractRegionalization, in the form of a dispersion of political power away from national political centers to regional governments, has been a defining feature of European politics since the 1970s. The article focuses on how institutional regionalization changed citizens’ attitudes about the division of competences between the central and regional level. It argues that regional institutions and policies exert a socializing effect on citizens’ preference in favor of these institutions through a mechanism of adaptive preferences. First, attitudes are studied across cohorts in a single population to test whether cohorts that came of age in a context of more institutional regionalization are more favorable towards regional decision-making than cohorts that came of age in a centralized state. The analyses indeed show evidence for a socializing effect of institutional regionalization. Second, the article shows how regional elites’ discourses may moderate the relationship between institutional regionalization and citizens’ attitudes about regionalization. We study Belgium as a crucial case. We use five cross-sectional datasets of the Flemish and Walloon populations during the course of increased regionalization in Belgium (1991–2007).

Barriers and facilitators to participate in the colorectal cancer screening programme in Flanders (Belgium): a focus group study

ABSTRACT Objective In Flanders (Belgium), a population-based colorectal cancer (CRC) screening programme offers a faecal immunochemical test (FIT) biennially to Flemish citizens aged 50–74 years. A FIT uptake of only 51,5% in 2018 is significantly lower among men, lower income groups and among people with other than the Belgian nationality. The objective of this study was to identify attitudes, barriers and facilitators to participate in the Flemish CRC screening programme. Methods Qualitative study using focus group discussions (FGDs) with non-participants in the Flemish CRC screening programme. Four FGDs were held with non-migrant Flemish population groups, and four were held with Turkish migrants (41 participants). Results Feeling healthy, fear of cancer and embarrassment to talk about CRC screening emerged as common barriers in all FGDs. Having other priorities (non-migrant group) and a lack of understanding mainly due to a language barrier (Turkish migrants) differed between the two groups. Providing face-to-face information, information in group and GP recommendation were perceived as important facilitators to CRC screening in both groups. More publicity and making CRC screening more of a routine (non-migrant group) and offering translated information (Turkish migrants) were the suggested facilitators that differed between the groups. Conclusions Several common and some group-specific barriers and facilitators appeared to play a role in the decision to participate in the CRC screening programme. In order to improve informed decision making and participation in the CRC screening programme in Flanders, the options of more GP involvement, targeted information events, and adapted reminder letters are currently being explored.

Stereotypes, Who to Blame? Exploring Individual-Level Determinants of Flemish Voters’ Political Gender Stereotypes

The gender of political candidates is associated with particular personality traits, capacities and opinions. The extent to which voters apply these political gender stereotypes to their evaluation of political candidates is influenced by both contextual- and individual-level attributes. This article, based on an experimental study conducted among a representative sample of the Flemish (Belgian) population, examines the individual-level determinants of voters’ political gender stereotypes. Our results indicate that political gender stereotypes are only present to a limited extent in Flanders, even among the most likely groups such as older and lower educated voters. Furthermore, stereotype reliance is generally not conditioned by individual-level determinants. Most importantly, the finding that respondents’ perceptions of female candidates is primarily based on their level of agreement with the content of the presented policy position, demonstrates that other cues outweigh the importance of candidate gender.

Highly Frequent MAPT p.R406W Carriers with a Nonconforming FTD Phenotype in the Belgian Flemish Population (1127)

Highly Frequent MAPT p.R406W Carriers with a Nonconforming FTD Phenotype in the Belgian Flemish Population (1127)