General Belgian Population Research Articles

General Practice Care for Patients with Rare Diseases in Belgium. A Cross-Sectional Survey.

There are almost no studies about rare diseases in general practice. This study examined care characteristics of active rare disease patients in the Belgian Network of Sentinel General Practices (SGP) and the importance of rare diseases in general practice by its caseload, general practitioner (GP)–patient encounter frequency and nationwide prevalence. The SGP reported data about: (i) the number of active rare disease patients in 2015; and (ii) characteristics of one to three most recently seen patients. Rare diseases were matched against Orphanet (www.orpha.net). GP encounter frequency and patients’ age were compared to the total general practice population. Details from 121 active patients (median age: 44, interquartile range (IQR) 24–60) showed that for 36.9% the GP had been the first caregiver for the rare disease and for 35.8% the GP established a diagnostic referral. GPs rated their knowledge about their patients’ disease as moderate and used Orphanet for 14.9% of patients. Any active rare disease patients (median: 1, IQR 0–2) were reported by 66 of 111 SGP. Compared to the total general practice population, the mean GP encounter frequency was higher (7.3; 95% confidence intervals (CI) 6.1–8.5 versus 5.4; 95% CI 5.4–5.4). The prevalence of rare diseases in the Belgian general practice population was estimated at 12.0 (95% CI 10.3–13.9) per 10,000. This study acknowledges the important role of GPs in rare disease care. Knowledge and use of Orphanet by GPs could be improved.

Fifty Shades of Belgian Gray: The Prevalence of BDSM-Related Fantasies and Activities in the General Population

BackgroundBondage and discipline, dominance and submission, and sadism and masochism (BDSM) is gaining popularity through the mainstream media. Nevertheless, very little is known about the prevalence of BDSM-related fantasies and activities in the general population. AimTo determine the prevalence of BDSM fantasies and behavioral involvement in four different age groups of the general population in Belgium. MethodsBy use of a cross-sectional survey questionnaire, the level of interest in several BDSM-related activities was investigated in a sample representative of the general Belgian population (N = 1,027). The questionnaire evaluated interest in 54 BDSM activities and 14 fetishes. Self-identification as BDSM practitioner, situational context of BDSM practice, age at awareness of these interests, and transparency to others were queried. OutcomesIndividual item scores and summary scores on four BDSM categories were included in the analyses. ResultsA high interest in BDSM-related activities in the general population was found because 46.8% of the total sample had ever performed at least one BDSM-related activity and an additional 22% indicated having (had) fantasies about it. Interestingly, 12.5% of the total population indicated performing at least one BDSM-related activity on a regular basis. When asked whether they saw themselves as being interested in BDSM, 26% stated this to be the case and 7.6% self-identified as BDSM practitioners. Interests in dominant and submissive activities were comparable and, remarkably, were highly intercorrelated. BDSM and fetish interests were significantly higher in men than in women. The older group (48–65 years) had significantly lower BDSM scores compared with their younger peers. Of participants with a BDSM interest, 61.4% became aware of it before 25 years of age. Clinical ImplicationsThere is a high level of interest in BDSM in the general population, which strongly argues against stigmatization and pathologic characterization of these interests. Strengths and LimitationsThis is the first thorough study concerning prevalence of interest in and fantasies about a wide range of BDSM-related activities in the general population worldwide. Although our findings tend to argue against it, we cannot completely rule out participation bias introduced by non-interest in the non-completers. In addition, some topics might have been subject to interpretation by the respondents. ConclusionInterest in BDSM is present in most of the general population. Further research is needed to destigmatize it by confirming BDSM as a leisurely preference rather than a psychiatric affliction.Holvoet L, Huys W, Coppens V, et al. Fifty Shades of Belgian Gray: The Prevalence of BDSM-Related Fantasies and Activities in the General Population. J Sex Med 2017;14:1152–1159.

What predicts stigmatisation about schizophrenia? Results from a general population survey examining its underlying cognitive, affective and behavioural factors

Stigmatisation towards individuals diagnosed with schizophrenia (SZ individuals) remains an important problem, yet few studies to date have examined a theoretically comprehensive set of predictors of stigmatisation. This study aimed to evaluate cognitive, emotional and behavioural aspects of stigmatisation towards SZ individuals in the Belgian general population in order to better understand its underlying factors. A sample of 544 participants completed online questionnaires assessing common stereotypes regarding schizophrenia, desired social distance, level of contact and the Behaviours from Intergroup Affect and Stereotypes map. Most respondents believed SZ individuals are unpredictable and have a poor prognosis. Around 10% believed that they are dangerous. The most frequently reported emotions were pity and fear. Around 65% of the sample indicated that they would have positive behavioural reactions (passive/active facilitation). Around 33% of the sample indicated that they would distance themselves from SZ individuals, and around 20% would flee if in contact with a SZ individual. Fear and stereotypes of dangerousness and incompetence best predicted these fleeing and avoidance reactions. Fear was also explained by stereotypes of dangerousness and unpredictability. These factors should be accounted for when developing anti-stigma campaigns. The effect of contact should be further investigated.

A population screening programme for atrial fibrillation: a report from the Belgian Heart Rhythm Week screening programme.

Despite the increased prevalence of atrial fibrillation (AF), data for the implementation of nationwide screening programmes are limited. The aim of this national screening study was to increase nationwide awareness about AF and stroke risk, to determine the prevalence of AF in Belgian general population using an ECG handheld machine and its feasibility to identify new AF cases. We analysed data obtained from 5 years of the 'Belgian Heart Rhythm Week' screening programme. All subjects were screened using a one-lead ECG handheld machine. Among 65 747 subjects screened, AF was recorded in 911, with an overall prevalence of 1.4% [95% confidence interval (CI) 1.2-1.6%]. High thrombo-embolic risk, as assessed by CHA2DS2-VASc score ≥2, was recorded in 69% of AF subjects. In subjects with high thrombo-embolic risk, only 5.4% were treated with oral anticoagulant (OAC) and 5.8% were treated with OAC and antiplatelet drugs. Among recorded AF cases, the use of the ECG handheld machine allowed identification of 603 new AF patients (1.1%, 95% CI 0.9-1.3%). Factors associated with incident AF were chronic heart failure (P < 0.001), age (P < 0.001), diabetes mellitus (P < 0.001), previous stroke (P < 0.001), vascular disease (P < 0.001), and male sex (P < 0.001). In this Belgian national screening programme, prevalence of AF was 1.4%. The use of an ECG handheld machine is feasible to identify a significant number of new AF cases, most with a high thrombo-embolic risk. Given the low OAC use recorded, greater efforts in AF detection and treatment are urgently needed to reduce the burden of stroke associated with this common arrhythmia.

Activity limitations predict health care expenditures in the general population in Belgium.

BackgroundDisability and chronic conditions both have an impact on health expenditures and although they are conceptually related, they present different dimensions of ill-health. Recent concepts of disability combine a biological understanding of impairment with the social dimension of activity limitation and resulted in the development of the Global Activity Limitation Indicator (GALI). This paper reports on the predictive value of the GALI on health care expenditures in relation to the presence of chronic conditions.MethodsData from the Belgian Health Interview Survey 2008 were linked with data from the compulsory national health insurance (n = 7,286). The effect of activity limitation on health care expenditures was assessed via cost ratios from multivariate linear regression models. To study the factors contributing to the difference in health expenditure between persons with and without activity limitations, the Blinder-Oaxaca decomposition method was used.ResultsActivity limitations are a strong determinant of health care expenditures. People with severe activity limitations (5.1%) accounted for 16.9% of the total health expenditure, whereas those without activity limitations (79.0%), were responsible for 51.5% of the total health expenditure. These observed differences in health care expenditures can to some extent be explained by chronic conditions, but activity limitations also contribute substantially to higher health care expenditures in the absence of chronic conditions (cost ratio 2.46; 95% CI 1.74-3.48 for moderate and 4.45; 95% CI 2.47-8.02 for severe activity limitations). The association between activity limitation and health care expenditures is stronger for reimbursed health care costs than for out-of-pocket payments.ConclusionIn the absence of chronic conditions, activity limitations appear to be an important determinant of health care expenditures. To make projections on health care expenditures, routine data on activity limitations are essential and complementary to data on chronic conditions.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1607-7) contains supplementary material, which is available to authorized users.

The gender gap in mental health service use.

This study examines why men engage less in mental health service use, by studying how gender is performed in interactions, following the doing gender perspective. We hypothesize that seeking help for mental illness may constitute a gendered role conflict among men since help seeking is associated with femininity. Therefore, we expect that men will recommend reliance on self-care options to other men, and in cases in which professional treatment is recommended, they will prefer medication to psychotherapy. We also expect that men will report greater stigmatizing attitudes. The survey Stigma in a Global Context-Belgian Mental Health Study (2009) conducted interviews of a representative sample of the Belgian general population (N=743). The vignette technique, depicting depressive and schizophrenic symptoms, was used. Multiple linear and logistic models were estimated in SPSS. In male vignettes, self-care is more likely to be recommended, both by male and female respondents. Men are less likely to acknowledge the helpfulness of psychotherapy and women rate psychotherapy as less helpful when judging a man compared to a woman. Men rate tranquilizers as more helpful for other males than that women do for other females. Furthermore, male respondents seem to ascribe more shame and blame to the situation. The gender gap in mental health service use is due not only to men and their negative attitudes toward help seeking, but also to structured social norms that are reconstructed in interactions. Women also contribute to the maintenance of masculinity norms.

Estimated daily intake and cumulative risk assessment of phthalate diesters in a Belgian general population

The daily intakes (DI) were estimated in a Belgian general population for 5 phthalates, namely diethyl phthalate (DEP), di-n-butyl phthalate (DnBP), di-iso-butyl phthalate (DiBP), butylbenzyl phthalate (BBzP) and di-2-ethylhexyl phthalate (DEHP), based on the urinary measurements of their corresponding metabolites. DI values ranged between <LOD and 59.65μg/kg bw/day depending on the congener, and were globally higher for children than adults. They were compared to acceptable levels of exposure (tolerable daily intakes) to evaluate the hazard quotients (HQ), which highlight an intake above the dose considered as safe for values greater than 1. If very few of our Belgian participants exceeded this threshold for phthalates considered individually, 6.2% of the adults and 25% of the children showed an excessive hazard index (HI) which took into account the cumulative risk of adverse anti-androgenic effects. These results are of concern since these HI were based on only 3 phthalates (DEHP, DiBP and DnBP), and showed a median of 0.55 and 0.29 for children and adults respectively. The comparison with previously determined dietary intakes demonstrated that for DEHP, food intake was nearly the only route of exposure while other pathways occurred mainly for the other studied phthalates.

Public Stigma and Self-Stigma: Differential Association With Attitudes Toward Formal and Informal Help Seeking

Individuals in need of psychiatric treatment often avoid seeking help because of stigma. This study examined the impact of two stigma dimensions on help-seeking attitudes. Perceived public stigma refers to discrimination and devaluation by others, and anticipated self-stigma refers to internalization of negative stereotypes about people who seek help. Data were from the 2009 Stigma in a Global Context-Belgian Mental Health Study, in which face-to-face interviews were conducted with a representative sample of the general Belgian population. The study reported here included 728 respondents who received a vignette depicting major depression or schizophrenia. Perceived public stigma and anticipated self-stigma were measured with validated instruments. Respondents' attitudes toward help seeking were measured by the importance they assigned to care from formal and informal providers: general practitioners, psychiatrists, psychologists, family members, or friends. Multiple linear regression models were estimated. Respondents with higher levels of anticipated self-stigma attached less importance to care provided by general practitioners or psychiatrists, and those with higher levels of perceived public stigma rated informal help seeking as less important. The gender and the ethnicity of the person and respondents' sociodemographic characteristics had relatively little effect on help-seeking attitudes. Anticipated self-stigma and perceived public stigma appeared to have a differential impact on attitudes toward formal and informal help seeking. Internalization of negative stereotypes was negatively associated with the perceived importance of care from medical providers (general practitioners and psychiatrists). Awareness of stereotypes held by others deterred respondents from acknowledging the importance of informal care.

Measurement of Urinary Biomarkers of Parabens, Benzophenone-3, and Phthalates in a Belgian Population

Parabens, benzophenone-3 (BP3), and phthalates are commonly used as antimicrobial conservator, UV-filter, and plasticizer, respectively, and are thought to exhibit endocrine disrupting properties. These endocrine disrupting activities have been recently assumed to lead to cutaneous malignant melanoma. Humans are exposed to these chemicals through different sources such as food, personal care products, or cosmetics. In this study, we measured urinary levels of 4 parabens, BP3, and 7 metabolites of phthalates in samples collected from 261 participants living in and around Liege (Belgium). The analyses were carried out by liquid chromatography tandem mass spectrometry (LC-MS/MS) using isotopic dilution. To the best of our knowledge, this is the first time that the urinary levels of these 3 classes of chemicals are reported for the same general population in Belgium. Most of the parabens, the BP3, and all the phthalate metabolites were detected in 82.8 to 100.0% of the samples. For most of these chemicals, the exposure patterns significantly differ not only between children and adults, but also between males and females, especially with higher concentrations of parabens and phthalate metabolites in female and children subjects, respectively.

Demographic and dietary predictors of urinary bisphenol A concentrations in adults in Israel

To date, there is scarce data on levels of exposure to bisphenol A (BPA) in the general population in Israel and the region. The goal of the current study was to measure urinary levels of BPA in the general adult population in Israel and to determine the demographic and dietary predictors of exposure. We recruited 249 individuals (ages 20-74) from five different regions in Israel. We collected urine samples and questionnaire data including detailed dietary data and analyzed urine samples for BPA concentrations. Eighty nine percent of the study population had urinary BPA concentrations equal to or above the level of quantification (0.3 μg/L). Median creatinine adjusted BPA urinary concentrations in the study population (2.3 μg/g) were slightly higher than those reported for the general population in the US (1.76 μg/g) and Canada (1.47 μg/g), and were comparable to those reported for the general population in Belgium (2.25 μg/g) and Korea (2.09 μg/g). BPA concentrations were higher in Jews compared to Arab and Druze (prevalence ratio (PR)=2.34; 95%CI 1.56-3.49), in individuals with higher education (PR=1.70, 1.11-2.62), in individuals consuming mushrooms (PR=2.08, 1.07-4.05), and in smokers (PR=1.43, 1.00-2.05). We found that the general adult population in Israel is widely exposed to BPA. Our findings on higher BPA levels in Jews compared to Arabs and Druze and in individuals with higher education highlights the fact that predictors of BPA exposure vary across populations.

Medicalizing versus psychologizing mental illness: what are the implications for help seeking and stigma? A general population study

This study contrasts the medicalized conceptualization of mental illness with psychologizing mental illness and examines what the consequences are of adhering to one model versus the other for help seeking and stigma. The survey "Stigma in a Global Context-Belgian Mental Health Study" (2009) conducted face-to-face interviews among a representative sample of the general Belgian population using the vignette technique to depict schizophrenia (N = 381). Causal attributions, labeling processes, and the disease view are addressed. Help seeking refers to open-ended help-seeking suggestions (general practitioner, psychiatrist, psychologist, family, friends, and self-care options). Stigma refers to social exclusion after treatment. The data are analyzed by means of logistic and linear regression models in SPSS Statistics 19. People who adhere to the biopsychosocial (versus psychosocial) model are more likely to recommend general medical care and people who apply the disease view are more likely to recommend specialized medical care. Regarding informal help, those who prefer the biopsychosocial model are less likely to recommend consulting friends than those who adhere to the psychosocial model. Respondents who apply a medical compared to a non-medical label are less inclined to recommend self-care. As concerns treatment stigma, respondents who apply a medical instead of a non-medical label are more likely to socially exclude someone who has been in psychiatric treatment. Medicalizing mental illness involves a package deal: biopsychosocial causal attributions and applying the disease view facilitate medical treatment recommendations, while labeling seems to trigger stigmatizing attitudes.

Urinary levels of bisphenol A, triclosan and 4-nonylphenol in a general Belgian population

Bisphenol A, triclosan and 4-nonylphenol are among the endocrine disruptors which are widely used in daily products. In this study, we reported total urinary levels of bisphenol A, triclosan and 4-nonylphenol, in order to evaluate the baseline contamination of a general population in Belgium. Bisphenol A and triclosan were detected in respectively 97.7% and 74.6% of the samples examined demonstrating that the general Belgian population is extensively exposed to both chemicals. On the other hand, 4-nonylphenol was not detected in any urine samples analyzed, suggesting either low exposure, inadequate biomarker, or that urine is an inappropriate biological matrix for assessing exposure to nonylphenol commercial mixtures. Geometric mean concentration was determined for bisphenol A at 2.55μg/l and for triclosan at 2.70μg/l. No significant difference was observed between levels and gender for both bisphenol A and triclosan. When classified by age, the 20–39year group showed the highest triclosan levels, while all age groups seemed to be similarly exposed to bisphenol A. Both bisphenol A and triclosan urinary levels were not correlated with creatinine excretion in our healthy population, questioning the relevance of the creatinine adjustment in reporting these chemical levels. Bisphenol A levels in urine of people living in the same home and collected on the same time were fairly correlated, confirming the assumption that dietary intake would be the primary route of exposure. Triclosan urinary levels were not correlated with bisphenol A levels.

Computational and molecular approaches for predicting unreported causal missense mutations in Belgian patients with haemophilia A

Haemophilia A (HA) is caused by widespread mutations in the factor VIII gene. The high spontaneous mutation rate of this gene means that roughly 40% of HA mutations are private. This study aimed to describe the approaches used to confirm private disease-causing mutations in a cohort of Belgian HA patients. We studied 148 unrelated HA families for the presence of intron 22 and intron 1 inversion by Southern blotting and polymerase chain reaction (PCR). Multiplex ligation-dependent probe amplification (MLPA) assay was used to detect large genomic rearrangements. Detection of point mutations was performed by DNA sequencing. Predicting the causal impact of new non-synonymous changes was studied by two general strategies: (i) molecular approaches such as family cosegregation, evaluation of the implicated codon based on phylogenic separated species and absence of the mutation in the general Belgian population, and (ii) bioinformatics approaches to analyse the potential functional consequences of missense mutations. Among the 148 HA patients, in addition to common intron 22 and intron 1 inversions as well as large deletions or duplications, 67 different point mutations were identified, of which 42 had been reported in the HAMSTeRS database, and 25 were novel including 10 null variants for which RNA analyses confirmed the causal effect of mutations located in a splice site consensus and 15 missense mutations whose causality was demonstrated by molecular approaches and bioinformatics. This article reports several strategies to evaluate the deleterious consequences of unreported F8 substitutions in a large cohort of HA patients.

Q Fever in Woolsorters, Belgium

Q Fever in Woolsorters, Belgium

Substance use disorders in Belgium: the need to study rarely investigated high impact disorders

Substance use disorders in Belgium: the need to study rarely investigated high impact disorders

Chronic kidney disease: a new opportunity for better cardiovascular risk stratification

Chronic kidney disease: a new opportunity for better cardiovascular risk stratification

A multivariate time series approach to projected life tables

AbstractThe method of mortality forecasting proposed by Lee and Carter describes a time series of age‐specific log‐death rates as a sum of an independent of time age‐specific component and a bilinear term in which one of the component is a time‐varying factor reflecting general change in mortality and the second one is an age‐specific parameter. Such a rigid model structure implies that on average the mortality improvements for different age groups should be proportional, regardless of the calendar period: a single time factor drives the future death rates. This paper investigates the use of multivariate time series techniques for forecasting age‐specific death rates. This approach allows for relative speed of decline in the log death rates specific to the different ages. The dynamic factor analysis and the Johansen cointegration methodology are successfully applied to project mortality. The inclusion of several time factors allows the model to capture the imperfect correlations in death rates from 1 year to the next. The benchmark Lee–Carter model appears as a special case of these approaches. An empirical study is conducted with the help of the Johansen cointegration methodology. A vector‐error correction model is fitted to Belgian general population death rates. A comparison is performed with the forecast of life expectancies obtained from the classical Lee–Carter model. Copyright © 2009 John Wiley &amp; Sons, Ltd.

Measurement equivalence of the CES-D 8 in the general population in Belgium: a gender perspective

International research consistently finds gender differences in depression, but do women genuinely experience more complaints or are the findings contaminated by group-specific elements unrelated to depression but affecting its measurement? The study of gender differences in depression depends on the measurement quality of the instrument used to evaluate depression. In the present study we test the measurement equivalence of a shorter version of a commonly used instrument in mental health research, the Center for Epidemiologic Studies - Depression Scale (CES-D), using data from the Belgian sample of the third round of the European Social Survey (N = 1794). Evidence for measurement invariance can be established within the multigroup confirmatory factor analysis framework. This method allows us to evaluate a nested hierarchy of hypotheses to test different levels of cross-group measurement invariance: configural, metric, scalar and residual invariance, and clarifies under what conditions meaningful comparisons between the male and female respondents can be made. The best fitting factor model is then used to estimate the 'true' prevalence of depressive symptoms for both groups. In our study measurement equivalence is established at all levels, indicating that the current depression scale allows defensible quantitative gender comparisons. Our data also confirm the epidemiological finding that women report more complaints of depression than men.

The individual and societal effects of non-psychotic serious mental disorders on earnings in Belgium

Purpose The purpose of this study is to examine the association between non-psychotic serious mental disorders and earnings in the general population of Belgium on both the individual- and society-level. Subjects and methods Data stem from a cross-sectional population study of the non-institutionalized adult (between 18 and 64) population from Belgium ( N = 863). The third version of the Composite International Diagnostic Interview (CIDI-3.0) was administered to assess 12-month non-psychotic serious mental disorders and annual earnings. Multivariate approaches were used to estimate the observed and estimated annual earnings for persons with serious mental disorders, controlling for sociodemographic variables and alcohol disorders. Results On the individual-level, 12-month serious mental disorders significantly predicted the probability of having any earnings (OR = 0.32; 95%CI = 0.14–0.74). Respondents with serious mental disorders had 12-month earnings of 5969€ less than expected in the absence of serious mental disorders. Taking into account the prevalence of serious mental disorders (i.e. 4.9%), the society-level effects of serious mental disorders in 2002 can be estimated at about 1797 million € per year for the Belgian general population. Discussion Non-psychotic serious mental disorders had considerable impact on annual earnings. Conclusion This is the first study in Belgium that addresses the association between mental illness and earnings. Serious mental disorders are associated with individual- and societal-level impairments and loss of human capital.

Dyspeptic symptoms in the general population: a factor and cluster analysis of symptom groupings

Both dyspeptic and gastro-oesophageal reflux-like symptoms are frequent in the general population, but their degree of overlap is unknown. In severe functional dyspepsia (FD), symptoms are organized in factors associated with pathophysiological mechanisms. The aims of this study were: (i) to assess the prevalence of dyspeptic symptoms with and without overlapping reflux symptoms in the general population and their impact on daily life and on healthcare utilization; and (ii) to compare symptom groupings in the general population to FD patients. A total of 2025 subjects, representative of the Belgian general population, were used in this study. The subjects were submitted to a questionnaire with validated questions on their dyspeptic and reflux symptoms and with evaluators of impact on daily life and use of healthcare resources. Significant dyspeptic symptoms were found in 417 (20.6%). Overlapping reflux symptoms were present in 141 (33.8%). In this group, symptoms were more frequent and more severe. Dyspeptic symptoms induced weight loss (12.7%) and absenteeism (12.4%), affected daily life (61.2%) and generated use of healthcare resources, such as medical consultations (61.4%) and medication (70.9%). Factor analysis revealed a three-component structure with factor 1 including fullness, bloating and early satiety, factor 2 including nausea and vomiting and factor 3 including discomfort, pain, belching and reflux. If forced in a four-factor model, the analysis separates belching as independent factor. Dyspeptic symptoms are frequent in the general population, with overlapping reflux symptoms and increased symptom burden in about a third.