Flemish Regions Research Articles

Patterns of alcohol use in Belgium, 2013-2020

Abstract Despite numerous efforts worldwide to reduce the harmful effects of alcohol, its impact on health remains significant, contributing significantly to the loss of healthy life years. In Belgium, alcohol use is still a major public health concern, ranking among the highest in alcohol consumption across Europe. This study aims to use available nationally representative data to estimate and evaluate the time trends of alcohol use patterns in Belgium from 2013 to 2018. We used repeated cross-sectional survey data from the Belgian Health Interview Survey (BHIS), which includes self-reported alcohol use and sociodemographic data, to create a time series of annual consumption from 2013 to 2018. This included current and former drinkers, and lifetime abstainers by year, sex, region, and age groups. We applied a Bayesian hierarchical model, using the Integrated Nested Laplace Approximation to create the time series and forecast trends for 2020. In Belgium, the prevalence of current drinking remained at a similar level of 80% from 2013 to 2020, with similar rates observed in the Flemish (FL) and Walloon (WA) regions. However, the Brussels-Capital region (BR) had a slightly lower prevalence of 70%. Trends remained relatively stable across all regions during this period. The national level of former drinkers increased from 5% in 2013 to 8% in 2020, with BR and FL showing similar increases, while WA experienced a decline. Abstainer rates rose from 15% in 2013 to 19% in 2020 nationally, with varying increases in each region. Specifically, abstainer rates in FL increased from 13% to 17% and in WA from 14% to 20%, while BR saw an increase from 19% to 22%. Overall, declining trends were evident, with men exhibiting higher prevalence rates across all categories. Time trends from the BHIS reveal consistent and high use of alcohol in Belgium over 7 years, emphasizing the ongoing public health challenge. Urgent policy interventions are needed to reduce the impact of alcohol on health Key messages • Alcohol use in Belgium is still a pressing public health issue, with high prevalence rates of current drinking in the population. Different patterns of alcohol use can be seen between regions. • Understanding the role of alcohol on population health as an attributable burden can improve health monitoring.

Caring neighbourhoods in Belgium: lessons learned on the development, implementation and evaluation of 35 caring neighbourhood projects.

In recent years, there has been a rise in international (care) movements that prioritise community-centred initiatives such as age-friendly communities, compassionate communities or integrated community care. Although these movements have different focal points, they share common features: seeking to address systemic failures in (care) services, value the participation of end-users, focus on unmet (care) needs, through a local, neighbourhood-oriented approach. In the Flemish and Brussels regions notably the concept of Caring Neighbourhoods is experiencing rapid growth. The objective of the present study is to examine the development and implementation of 35 Caring Neighbourhood initiatives in Flanders and Brussels (Belgium) to explore the added value of such projects, as well as the crucial elements for creating Caring Neighbourhoods. Thirty-five caring neighbourhood projects were examined by means of five focus group interviews with project coordinators (n = 34) and five focus group interviews with neighbourhood residents (n = 27), using participant-generated photo elicitation. The focus group sessions were recorded, transcribed and data were labelled using an inductive analytical framework, following the steps of reflexive thematic analysis. The analysis of the 35 Caring Neighbourhoods showed that fostering connections was key in building Caring Neighbourhoods: connections among residents, connections between residents and care and support services and among care services themselves. The three primary ways to connect people were through activities, places and people. Also, the role of the Caring Neighbourhood coordinator is highlighted as key, which should focus on weaving existing resources, facilitating and coaching instead of organising. Altogether, the projects brought meaning and value to participants' lives, enhancing overall life satisfaction and well-being, with an emphasis on physical and psychosocial care and support. Through critically reflecting on our results and other research, we call on researchers to pay increased attention in research on community-centred care initiatives to death, dying and grief, equity and social justice and the need for both warm and cold solidarity.

Key performance indicators of COVID-19 contact tracing in Belgium from September 2020 to December 2021.

The goal of tracing, testing, and quarantining contacts of infected individuals is to contain the spread of infectious diseases, a strategy widely used during the COVID-19 pandemic. However, limited research exists on the effectiveness of contact tracing, especially with regard to key performance indicators (KPIs), such as the proportion of cases arising from previously identified contacts. In our study, we analyzed contact tracing data from Belgium collected between September 2020 and December 2021 to assess the impact of contact tracing on SARS-CoV-2 transmission and understand its characteristics. Among confirmed cases involved in contact tracing in the Flemish and Brussels-Capital regions, 19.1% were previously identified as close contacts and were aware of prior exposure. These cases, referred to as 'known' to contact tracing operators, reported on average fewer close contacts compared to newly identified individuals (0.80 versus 1.05), resulting in fewer secondary cases (0.23 versus 0.28). Additionally, we calculated the secondary attack rate, representing infections per contact, which was on average lower for the 'known' cases (0.22 versus 0.25) between December 2020 and August 2021. These findings indicate the effectiveness of contact tracing in Belgium in reducing SARS-CoV-2 transmission. Although we were unable to quantify the exact number of prevented cases, our findings emphasize the importance of contact tracing as a public health measure. In addition, contact tracing data provide indications of potential shifts in transmission patterns among different age groups associated with emerging variants of concern and increasing vaccination rates.

Scale-up of a chronic care model-based programme for type 2 diabetes in Belgium: a mixed-methods study

BackgroundType 2 diabetes (T2D) is an increasingly dominant disease. Interventions are more effective when carried out by a prepared and proactive team within an organised system — the integrated care (IC) model. The Chronic Care Model (CCM) provides guidance for its implementation, but scale-up of IC is challenging, and this hampers outcomes for T2D care. In this paper, we used the CCM to investigate the current implementation of IC in primary care in Flanders (Belgium) and its variability in different practice types.MethodsBelgium contains three different primary-care practice types: monodisciplinary fee-for-service practices, multidisciplinary fee-for-service practices and multidisciplinary capitation-based practices. Disproportional sampling was used to select a maximum of 10 practices for each type in three Flemish regions, leading to a total of 66 practices. The study employed a mixed methods design whereby the Assessment of Chronic Illness Care (ACIC) was complemented with interviews with general practitioners, nurses and dieticians linked to the 66 practices.ResultsThe ACIC scores of the fee-for-service practices — containing 97% of Belgian patients — only corresponded to basic support for chronic illness care for T2D. Multidisciplinary and capitation-based practices scored considerably higher than traditional monodisciplinary fee-for-service practices. The region had no significant impact on the ACIC scores. Having a nurse, being a capitation practice and having a secretary had a significant effect in the regression analysis, which explained 75% of the variance in ACIC scores. Better-performing practices were successful due to clear role-defining, task delegation to the nurse, coordination, structured use of the electronic medical record, planning of consultations and integration of self-management support, and behaviour-change intervention (internally or using community initiatives). The longer nurses work in primary care practices, the higher the chance that they perform more advanced tasks.ConclusionsBesides the presence of a nurse or secretary, also working multidisciplinary under one roof and a capitation-based financing system are important features of a system wherein IC for T2D can be scaled-up successfully. Belgian policymakers should rethink the role of paramedics in primary care and make the financing system more integrated. As the scale-up of the IC varied highly in different contexts, uniform roll-out across a health system containing multiple types of practices may not be successful.

The benefits of being a multi-capital: The economic impact of the international and European institutions and interest groups

Brussels is known worldwide for hosting (most of) the European institutions as well as several other international organisations like North Atlantic Treaty Organization (NATO). Besides the symbolic political value, their presence has an economic impact because of their administrative activities and staff remunerations. Estimating the economic impact poses two main challenges. First, the supranational nature of these organisations makes it challenging to quantify the size of these institutions and related bodies because country-based statistical systems hardly account for transnational organisations. Second, as these institutions and organisations mainly rely on taxpayers’ funding, policymakers need transparent estimates to assess the implications of their decisions as well as for a matter of accountability. For these purposes, a meticulous data collection is carried out, and transparent assumptions are used to estimate the local economic multiplier effect of these activities accounting for operational expenditures, employees’ consumption as well as (Belgian) taxes and saving. The results show that the economic impact for the Brussels-Capital Region lies between 23% and 26% of regional turnover and 19% and 20% of employment, while interregional spillovers are estimated being around 1.5% to 1.7% of regional turnover and 0.6% to 0.7% of employment for both Flemish and Walloon regions.

Spatio-temporal monitoring and modelling of birch pollen levels in Belgium

In Belgium, ~ 10% of the people is estimated to suffer from allergies due to pollen emitted by the birch family trees. Timely information on forthcoming pollen exposure episodes using a forecasting system can allow patients to take preventive measures. To date, the only available information on pollen concentrations in Belgium comes from five stations that monitor daily airborne birch pollen concentrations, but real-time and detailed spatial information is lacking. Pollen transport models can both quantify and forecast the spatial and temporal distribution of airborne birch pollen concentrations if accurate and updated maps of birch pollen emission sources are available and if the large inter-seasonal variability of birch pollen is considered. Here we show that the SILAM model driven by ECMWF ERA5 meteorological data is able to determine airborne birch pollen levels using updated maps of areal fractions of birch trees, as compared to the pollen observations of the monitoring stations in Belgium. Forest inventory data of the Flemish and Walloon regions were used to update the default MACCIII birch map. Spaceborne MODIS vegetation activity combined with an updated birch fraction map and updated start and end dates of the birch pollen season were integrated into SILAM. The correlation (R2) between SILAM modelled and observed time series of daily birch pollen levels of 50 birch pollen seasons increased up to ~ 50%. The slopes of the linear correlation increased on average with ~ 60%. Finally, SILAM is able to capture the threshold of 80 pollen grains m−3 exposure from the observations.

Regional variation in the pronunciation of /s/ in the Dutch language area

Abstract This paper reports on an explorative sociophonetic study of the phoneme /s/ in the Dutch language area. Our aim is to investigate the regional variation in the realisation of this phoneme, and to test experimentally the observation of ) that /s/ is sometimes pronounced more like [ ʃ ], especially in the Randstad area (called s-retraction). One hundred native speakers of Dutch produced nineteen monosyllabic words containing /s/ in different syllabic contexts. The speakers were born and raised in one of five regions of the Dutch language area (West Flanders, Flemish Brabant, Netherlands Limburg, South Holland and Groningen). Spectral centre of gravity (CoG) and duration were used to measure the degree of s-retraction. CoG values turned out to be significantly lower (consistent with more retraction) in the regions in The Netherlands than in the Flemish regions. Speakers from South Holland produced significantly shorter /s/ than the other speakers. In conclusion, /s/ shows patterns of regional variation that are not fully in line with the observation forwarded by ). The difference between the Flemish and Dutch regions shows that s-retraction is found in an area larger than the Randstad, possibly pointing towards a North-South pattern of variation.

Geographies of asthma medication purchase for pre-schoolers in Belgium

BackgroundWheezing among children below the age of six (pre-schoolers) is common and often triggered by environmental factors. Moreover, evidence on which to base recommendations for its management is limited, resulting in high numbers of prescriptions and costs. This study aims to describe the spatial differences in asthma medication sales for children aged 0 to 5 years in Belgium, and to evaluate the correlations with socio-economic and environmental factors..MethodsThis ecological study includes information on prescribed and sold asthma medication (R03 ATC code) for all the pre-schoolers registered in Belgium, aggregated at the municipality and smaller administrative levels, in 2014. A case was defined as a pre-schooler having purchased prescribed R03 medication at least once in 2014. We mapped the number of cases, the prevalence of medication purchase (n cases/n registered pre-schoolers) and the costs per case (€) at different administrative levels. We used symbol maps for the number of cases and choropleth maps for prevalence and costs per case using Jenks discretization at the municipal level, and standard deviation at finer scales. Finally, we calculated Pearson correlations of medication prevalence and costs per case with socio-economic (population density and area median income), and environmental (PM10, pig density and green spaces) factors.ResultsThe number of medication purchases was large in cities. The prevalence of purchase was higher in the French- than in the Flemish-speaking region, showing a sharp linguistic border. The cost per case was concentrated in one specific region in the north-west of Belgium. We found inverse correlations of prevalence of purchase with area median income and PM10 concentrations, and positive moderate correlations with green spaces and pig density. The costs per case were weakly but positively correlated with PM10 concentrations and green spaces, and moderately with pig density.ConclusionsIn Belgium, the geographical distribution of purchases of prescribed asthma medication for pre-schoolers is only weakly correlated with some environmental factors. The existence of clear differences in prevalence of purchase between Flemish and French-speaking regions suggests that the observed geographical distribution is strongly driven by regional differences in medical practice.

Starting from scratch: prevalence, methods, and functions of non-suicidal self-injury among refugee minors in Belgium

BackgroundAs many refugee minors have gone/go through stressful life experiences and uncertainty, one might expect mental health issues, including self-injury. However, literature on non-suicidal self-injury (NSSI) in refugee minors is scarce. This study explores the prevalence, methods, and functions of NSSI in refugee minors in Belgium, and compares research results to the existing literature on NSSI in Western adolescents.MethodsData were obtained from 121 refugee minors (mean age = 16.12, SD = 1.23; range 14–18 years) through schools located in the Flemish and Brussels-Capital regions of Belgium. The sample consists of 39.7% girls and 60.3% boys. Self-report questionnaires were used to explore socio-economic data, NSSI behaviour (e.g. The Brief Non-Suicidal Self-injury Assessment Tool; BNNSI-AT) and emotional and behavioural difficulties (The Strengths and Difficulties Questionnaire; SDQ). Non-parametric Chi square tests were used for statistical comparisons of the obtained data as well as independent-sample t-tests and Fisher’s exact tests.ResultsResults show a lifetime NSSI prevalence rate of 17.4%. Being accompanied or not, having both parents around, or living in an asylum centre did not influence NSSI prevalence. An average of 2.65 methods of NSSI was applied (SD = 2.50; range 1–9). The mean number of functions per person was six (SD = 4.97, range 0–16), with automatic functions reported the most. The data do point towards a greater psychological strain, with 68.4% reporting more than five acts of NSSI. Results of the SDQ’s Total Difficulties Scale and, more specifically, of the Emotional Problems, Conduct Problems, Peer Problems and Impact Scales indicate a substantial risk of clinically significant problems within the NSSI group. The Peer Problems and Impact Scales also point towards a high risk for suicidality amongst self-injuring refugees.ConclusionsPrevalence rates, methods and functions are comparable to Western samples. However, the higher incidence of the NSSI and the results on the SDQ also emphasise the vulnerability of refugee minors.

Spatial synchronicity in recruitment of Atlantic cod (Gadus morhua) stocks off Newfoundland and Labrador and the Flemish Cap

Spatial synchronicity in recruitment was examined for Atlantic cod (Gadus morhua) in the Newfoundland and southern Labrador (NL) and Flemish Cap regions. Recruitment was estimated using a cohort strength model for survey indices of abundance at pre-exploitation ages, and spatio-temporal covariation in recruitment was then examined. Patterns of recruitment synchrony were generally consistent with management boundaries. However, there were some exceptions that suggest structure at the sub-stock level and mixing across adjacent stock boundaries. In particular, we observed weak correlations between the eastern and western 3Ps RV (Research Survey) recruitment indices. We also observed strong correlations between the eastern 3Ps RV and the fall and spring 3NO RV recruitment indices, as well as fairly strong correlations between the southern 3L, central 3KL, and 3Ps sentinel GN and LT recruitment indices. Correlations between the summer 3M RV recruitment indices and all other survey recruitment indices included in our analysis were generally very weak, as was expected. We demonstrate that survey recruitment indices can be used to identify either areas of potential sub-stock structure or mixing or areas where recruitment drivers may be operating across or differentially within stock management boundaries. Hence, our results should improve the design of future stock structure research, and provide useful new information for fisheries management.

Barriers and Facilitators towards an Integrated Chronic Care Model as experienced by primary care health providers

Background : The highly increased prevalence of chronic conditions challenges the actual health care systems. The Flemish governments has adopted the Chronic Care Model as the mainframe for health policy changes. However until now, there was no major practice change in the way how health care is provided in primary care. Most providers continue to work in the classic way on their own with few multidisciplinary contacts, presence of silos between primary and secondary care, lack of planned population management, little use of existing guidelines... Therefore, the Flemish government ordered Domus Medica, the Flemish General Practice professional organisation, to develop an action research project. The aim of the project was 1. To promote and spread the chronic care model amongst Flemish health care workers; 2. To evaluate both barriers and facilitators towards its implementation. Method : Domus Medica organised a large survey in 16 Flemish regions. Therefore it put up 1 national and 16 regional steering committees. Each regional steering had to involve as many health care workers in the process as possible. Each committee was free to use its own methods. In total, six different methods were used: electronic survey, survey on paper, face to face interviews, workshops, seminars and ‘world cafes’. Most regions used a ‘mixed method’ approach. Each region had to write down the results into a report. The collected reports were analysed. Barriers and facilitators were listed for each region and then brought together. This ‘long’ list was analysed by an expert who used the ‘Implementation model’ (Grol, Wensing) to filter the most relevant items. These results were fed back for validation towards the involved stakeholders: respondents had to mark their agreement on a Likert scale from 1 (strongly disagree) to 4 (strongly agree). Only those items that obtained a score of 3 or 4 by more than 70% of all respondents were selected. This lead to a ‘short list’ summed up according to the pillars of the Chronic Care Model. Finally the results were thoroughly discussed leading to a report with recommendations. Results : 598 people responded to the written surveys and interviews and 943 people participated to the workshops, seminars and world cafes. There was some overlap but in total, more than 1300 different persons participated including about 400 General Practitioners and nurses and 200 physiotherapists and pharmacists. 166 people participated in the validation process. The ‘long list’ contained 349 barriers and 167 facilitators and the short ‘short list’ 63 barriers and 39 facilitators. The report for the Flemish Minister of health contained 17 core recommendations. Main barriers remain the concept of patient empowerment and health promotion, multidisciplinary teamwork, integration and continuity between hospital and primary care and between health care and social welfare. Evidence Based Medicine is inadequately acquired, especially by non-physicians. ICT is experienced as the necessary tool for integration and communication. However in practice it is a source of major concern because systems are often unstable, necessary knowledge to use the systems and to resolve technical problems are lacking and ICT investment is both expensive and time consuming. Two major structural barriers that hamper all evolution towards integrated chronic care were put forward: the payment system that enables a comfortable revenue by fee for service and unfitted organisational structures in primary care, both at micro level (too small business units) as at meso-level (a patchwork of different organisations with overlapping competences). Finally, health care providers would like to be more involved in government initiatives and campaigns. Major facilitators put forward were the existing and well developed health services as well as the recent initiatives to promote chronic care and spread ICT. As such, the existing structures and initiatives must be considered as the basement of future change. The professional commitment of the providers towards their patients and the open mind towards the upcoming change were also put forward as essential facilitators. Finally, providers experience the patients’ tendencies to more empowerment and independence as a positive evolution. Discussion : The strength of this project is the involvement of a large number of Flemish primary care providers into a movement for better chronic care. It also listed essential barriers towards its implementation as well as key facilitators. Its major weakness is its scope, only based on the experience of primary health care providers without involvement of neither social workers, nor secondary care and expert opinion. However, the project enabled a landmark report for the Ministry of Health with key recommendations to successful future nation-wide implementation of chronic care.

Un poil plus près du ciel. Sainteté, ascèse et excès pileux à la fin du Moyen Âge

Occupying a central position in late mediaeval texts and images, the body appears as a privileged locus for the expression of saintliness. Glorious or suffering, it thus distinguishes the saint from the common mortal. For certain hermit saints (Onuphrius, Mary the Egyptian) or androgynous saints (Wilgefort), the excessive hairiness described in the hagiography also may play a major role in the corporal degradation or vilification that accompanies renunciation and spiritual fulfillment. In images, excessive pilosity also masks the limits between humanity and animality, or between masculine and feminine. However, the serial study of images brings to light more complex uses and treatments of hairiness in German and Flemish regions in the 15th century. While the hairy covering of certain hermits offers the spectator a veritable corporeal miracle, the beard of Saint Wilgefort makes her a singular alter Christus. The body of Mary Magdalen in German iconography, both hidden and revealed by excessive pilosity, is sometimes treated sensually, underlining the reconciliation of the body and spirit in the perspective of the mystic marriage.

Coherent mapping for integrated water management in Brussels

Like many cities, Brussels faces increasing water issues like urbanization spreading and stresses on the water resources. Integrated Water Management (IWM) in urban planning tackles these problems focusing on the landscape features, but requires extensive cartographic data. Since 2010, different platforms offer cartographic data for the Brussels and Flemish regions, but these initiatives are independent and often not coherent. This article analyses the potentials and deficiencies of these cartographic data through two transboundary examples: the catchments of the Brussels area and the Molenbeek catchment. The article highlights how non-concordance and non-accessibility of the data constrain the application of IWM and other urban planning issues in transboundary areas.

High Y-chromosomal diversity and low relatedness between paternal lineages on a communal scale in the Western European Low Countries during the surname establishment

There is limited knowledge on the biological relatedness between citizens and on the demographical dynamics within villages, towns and cities in pre-17th century Western Europe. By combining Y-chromosomal genotypes, in-depth genealogies and surname data in a strict genetic genealogical approach, it is possible to provide insights into the genetic diversity and the relatedness between indigenous paternal lineages within a particular community at the time of the surname adoption. To obtain these insights, six Flemish communities were selected in this study based on the differences in geography and historical development. After rigorous selection of appropriate DNA donors, low relatedness between Y chromosomes of different surnames was found within each community, although there is co-occurrence of these surnames in each community since the start of the surname adoption between the 14th and 15th century. Next, the high communal diversity in Y-chromosomal lineages was comparable with the regional diversity across Flanders at that time. Moreover, clinal distributions of particular Y-chromosomal lineages between the communities were observed according to the clinal distributions earlier observed across the Flemish regions and Western Europe. No significant indication for genetic differences between communities with distinct historical development was found in the analysis. These genetic results provide relevant information for studies in historical sciences, archaeology, forensic genetics and genealogy.

Is the different time trend (1997-2008) of the obesity prevalence among adults in the three Belgian regions associated with lifestyle changes?

BackgroundObesity is a major public health issue with increasing prevalence among adults. However, in Belgium the regional time trends (1997–2008) differed: the prevalence of obesity increased in the Flemish and Brussels Regions, but remained stable in the Walloon Region, the latter still showing the highest prevalence. The purpose of the present study is to explore if the different time trends of obesity prevalence in the three Belgian regions is associated with lifestyle changes.MethodsWe used data from four successive cross-sectional waves (1997, 2001, 2004 and 2008) of the Belgian Health Interview Survey. The study was restricted to the adult population, resulting in samples of respectively 8,071, 9,391, 10,319 and 8,831 individuals. In line with the WHO definition, obesity was defined as having a BMI ≥ 30. Differences in regional trends of obesity were investigated through stratified analyses. The association between obesity and survey year, adjusted for lifestyle factors (alcohol consumption, smoking, fruit and vegetables consumption and leisure time physical activity), was assessed via logistic regression models. Interactions were added to the models to explore if the association between lifestyle factors and obesity varied over time.ResultsObesity was associated with daily alcohol use in the Brussels (OR 0.66, 95% CI 0.50-0.88) and Walloon Regions (OR 0.8, 95% CI 0.6-0.9), with lower tendencies of being obese for daily drinkers. The probability of being obese was lower among smokers in the Flemish (OR 0.7, 95% CI 0.6-0.8) and Walloon Regions (OR 0.7, 95% CI 0.6-0.9) than among non-smokers. A lack of leisure time physical activity was associated with the probability of being obese in all regions (Brussels Region: OR 1.6, 95% CI 1.3-1.8; Flemish Region: OR 1.6, 95% CI 1.4-1.9; Walloon Region: OR 1.8, 95% CT 1.6-2.1). This association decreased significantly between 1997 and 2008 only in the Walloon Region.ConclusionThe decreasing association between obesity and a lack of leisure time physical activity in the Walloon Region between 1997 and 2008 could indicate that there is an increasing awareness of risk factors for obesity in the Walloon population, which may have resulted in a more favourable evolution of the obesity epidemic.

Towards a city-regional policy in Flanders from the bottom up

This article deals with the governance challenges related to equitable funding of public services that are used by residents of a city region regardless of where they pay their taxes. Focusing on spill-over effects of leisure policies in two Flemish city regions, this article shows how various services to some extent are consumed by residents of municipalities other than the provider of these services. Mechanisms for costs and benefits are not readily available, and the analysis illustrates a more general kind of dilemma related to public service provision in dense and interlinked areas such as the fringes of city regions.

High burden of breast cancer in Belgium: recent trends in incidence (1999-2006) and historical trends in mortality (1954-2006).

IntroductionIn Belgium, breast cancer mortality has been monitored since 1954, whereas cancer incidence data have only been made available for a few years. In this article we update historical trends of breast cancer mortality and describe the recent breast cancer incidence.MethodsIncidence data were extracted from the Belgium Cancer Registry from 2004 to 2006 for the Walloon and Brussels Regions and Belgium, and from 1999 to 2006 for the Flemish Region. The Directorate-general Statistics and Economic information provided the mortality data for the years 1954-1999 and 2004. The regional authorities of the Flemish and Brussels Regions provided the mortality data for the years 2000-2003 and 2005-2006.ResultsIn 2004, the World age-standardised breast cancer incidence for the whole of Belgium was 110 per 100, 000 person-years for all ages; and 172, 390 and 345 per 100, 000 person-years for the 35-49, 50-69, and 70+ age groups, respectively. The incidence rate was slightly higher in each age group in the Brussels Region. In Flanders, where the incidence could be observed during a longer period, an increase was observed until 2003 in the 50-69 age group, followed by a decrease. To the contrary, in the oldest age group, incidence continued to rise over the whole period, whereas no change in incidence was observed between 1999 and 2006 in the 35-49 age group.Mortality increased until the late 1980s and afterwards decreased in all regions and in age groups younger than 70. In women of 70 years and older, the decline began later.ConclusionsThe burden of breast cancer in Belgium is very high. In 2004, Belgium ranked first for the age-standardised incidence rate in Europe for all ages combined and in the 35-49 and 50-69 age groups. The impact of the known risk factors and of mammographic screening should be further studied. The mortality rate in Belgium ranked lower than incidence, suggesting favourable survival. Plausible explanations for the discrepancy between incidence and mortality are discussed.

Screening for colorectal cancer: sense and sensibilities

Purpose In this paper we investigate the reasons for non-participation in a trial programme for colorectal cancer (CRC) screening in Flanders. Besides, the feasibility and possibilities of a full-blown screening programme in Flanders are examined, given the context of a low participation rate in breast cancer screening. Methods A trial programme for CRC screening was set up for all average-risk persons aged 50 to 74 years in three Flemish regions to obtain information about potential participation rates, and to compare two invitation strategies. Faecal samples were analysed for precursors of CRC using an immunochemical faecal occult blood test (iFOBT). A questionnaire was administered to participants and non-participants of the trial programme to find out whether and to what extent the taking of a sample of one's own stool is a taboo. This could be of great importance concerning the participation rate. Results In total, 19,542 persons were invited to participate in the trial programme for CRC screening, of whom 18,541 were found to be eligible. The overall participation rate was 44.3%. The three regions varied in participation rates: with 60.9% in the most rural region to 34.3% in the most urban region. Of 2,000 questionnaires sent to participants, 1,385 were returned (69.3%). The response in the non-participants was 43.2%i (691 questionnaires of 1,600 returned). Conclusions A population-based screening programme for colorectal cancer by means of an iFOBT proves to be feasible, since adequate participation rates were obtained and because of the absence of a ‘stool taboo’ in Flanders.

Regiolectisering en de opkomst van tussentaal in Vlaanderen

In this paper we will investigate the relation between regiolect formation and the emergence of tussentaal (‘interlanguage’) in Flanders. More in particular, we will try to find out to what extent tussentaal is the product of regiolect formation as defined by Hoppenbrouwers (1990) and Hinskens (1993, 1996). In all Flemish regions a supra-regional interlanguage is gaining ground, with an indisputable Brabantic character. As for the intra-regional communication, the situation is different in the three regions under consideration. In the Brabantic region the traditional dialects are on the decline, except for the Antwerp city dialect, which – more than any other dialect – contributes to the formation of the Brabantic regiolect. In the West-Flemish region the traditional dialects are still fairly vital, but nevertheless a West-Flemish regiolect seems to be emerging too. In the East-Flemish region people tend to switch directly from the traditional dialects to the interlanguage. There seems to be no such thing as an East-Flemish regiolect. This regiospecific dynamics between dialect, regiolect (if any) and interlanguage makes for a very complex situation of language variation in Flanders today.

PDB48 COST-EFFECTIVENESS OF 2 DIABETES HEALTH CARE PROGRAMMES IN BELGIUM

OBJECTIVE: A multifaceted quality improvement programme for the care of diabetes was implemented in two different Flemish regions (Aalst and Leuven) and with slightly different modalities. The overall objective of the programmes was to improve adherence to evidence-based guidelines on diabetes in primary care physicians. The aim of this study was to assess the cost-effectiveness of the programmes compared to regular care in both regions.