Belgian Women Research Articles

558 POSTER A systematic review of the natural history of high risk HPV among adult women

Early effects of HPV (human papillomavirus) vaccination are reflected by changes observable in young women attending cervical cancer screening.The SEHIB study included HPV geno-typing of ∼6000 continuous and 650 pathological cervical cell specimen as well as biopsies, collected from women in Belgium in 2010–2014. Data were linked to vaccination status.HPV vaccination offered protection among women aged <30 years against infection with HPV16 (vaccine effectiveness [VE] = 67%, 95% CI: 48–79%), HPV18 (VE = 93%, 95% CI: 52–99%), and high-risk HPV (VE = 16%, 95% CI: 2–29%). Vaccination protected also against cytological lesions. Vaccination protected against histologically confirmed lesions: significantly lower absolute risks of CIN1+ (risk difference [RD] = −1.6%, 95% CI: −2.6% to −0.7%) and CIN3+ associated with HPV16/18 (RD = −0.3%, 95% CI −0.6% to −0.1%). Vaccine effectiveness decreased with age. Protection against HPV16 and 18 infection was significant in all age groups, however no protection was observed against cytological lesions associated with these types in age-group 25–29.The SEHIB study demonstrates the effectiveness of HPV vaccination in Belgian young women in particular in age group 18–19. Declining effectiveness with increasing age may be explained by higher tendency of women already exposed to infection to get the vaccine.

Assessment of menstrual blood loss in Belgian users of a new T-shaped levonorgestrel-releasing intrauterine system

Objective This study was conducted to evaluate the effect of a T-shaped levonorgestrel-releasing intrauterine system (Femilis™, LNG IUS) on the amount of menstrual blood loss (MBL) in women with and without menorrhagia. The daily release of the LNG IUS was approximately 20 μg. Materials and Methods In 60 Belgian women, less than 48 years of age at study enrollment, using the Femilis™ LNG IUS for 4 to more than 30 months, MBL was assessed with the visual assessment technique. Twenty-eight women had normal menstrual periods at baseline (menstrual score <185) and 32 women had idiopathic menorrhagia (menstrual score ≥185). Results Menstrual blood loss scores dropped significantly during the observation period in all women except one. The median menstrual score at baseline in women with normal menstrual bleeding was 140 (range 80–160) and dropped to a median score of 5 (range 0–150) at follow-up, a decrease of 96%. In the 32 women with menorrhagic bleeding at baseline, menstrual flow dropped from a median score of 232 (range 185–450) at baseline to a median score of 3 (range 0–50) at follow-up, a decrease of 99%. Twenty women developed amenorrhea (33%): 10 in the group of women with normal menstruation and 10 in those women with menorrhagia. Most of the remaining women had oligomenorrhea requiring the use of a few panty-liners only. In one woman, MBL did not decrease, thus requiring further evaluation. Conclusion The impact on MBL of this new 20 μg/day LNG-releasing IUS confirms other studies with devices releasing the same or lower amounts of LNG. The strong endometrial suppression is the principal mechanism explaining the effect on MBL. The strong effect on MBL of this contraceptive method offers an important health benefit and improvement in quality of life, particularly in women with heavy bleeding and anemia, as other treatment modalities are less effective, more costly, more invasive or not readily available.

The Seroepidemiology of Human T-Lymphotropic Viruses

Up to 20 million persons are infected with the human retroviruses human T-lymphotropic virus (HTLV)-I and HTLV-II globally. Most data on the seroprevalence of HTLV-I and HTLV-II in Europe are from studies of low-risk blood donors or high-risk injection drug users (IDUs). Little is known about the general population. A prospective anonymous study of HTLV-I and HTLV-II seroprevalence among 234,078 pregnant women in Belgium, France, Germany, Italy, Portugal, Spain, and the United Kingdom was conducted. Maternal antibody status was determined by standard methods using sera obtained for routine antenatal infection screens or eluted from infant heel prick dried blood spots obtained for routine neonatal metabolic screens. Anti-HTLV-I/II antibodies were detected and confirmed in 96 pregnant women (4.4 per 10,000, 95% confidence interval [CI]: 3.5-5.2). Of these, 73 were anti-HTLV-I, 17 were anti-HTLV-II, and 6 were specifically anti-HTLV but untyped. The seroprevalence ranged from 0.7 per 10,000 in Germany to 11.5 per 10,000 in France. Pregnant women better reflect the general population than blood donors or IDUs. The seroprevalence of HTLV-I and HTLV-II in Western Europe is 6-fold higher among pregnant women (4.4 per 10,000) than among blood donors (0.07 per 10,000). These data provide a robust baseline against which changes in HTLV-I and HTLV-II seroprevalence in Europe can be measured.

Birthweight differences among infants of North African immigrants and Belgians in Belgium

Infants of North African immigrants are reported to have higher birthweights than their Belgian counterparts. It is unclear what mechanism contributes to this difference. Analyses were based on a hospital-based cohort of 1,162 women. Infants of North African immigrants were less likely to be born preterm, compared to infants of Belgian women. After adjusting for sociodemographic and maternal factors, the estimated difference in mean birthweight was 74 g (p=0.05). When limited to term births, this difference was 28 g (p=0.42). The difference in mean birthweight between North African and Belgian infants was explained by differences in preterm birth and other risk factors.

Single-Step Maternal Serum Screening for Trisomy 21 in the Era of Combined or Integrated Screening

Single-step maternal serum screening (MSS) in the first (1MSS) or second (2MSS) trimester at maternal age ≧35 years was evaluated in the North Belgian region Flanders, where difficulties are encountered in the general introduction of combined or integrated screening algorithms. The fetal aneuploidy screening database of General Medical Laboratory AML in Antwerp was searched for 2MSS tests between 1992 and 1999 (α-fetoprotein, β-human chorionic gonadotropin (β-HCG) and unconjugated estriol, cut-off 1:300) and for 1MSS tests between 1999 and 2003 (free β-HCG and pregnancy-associated plasma protein A, cut-off 1:85). At ≧35 years, the detection rate for trisomy 21 (DR) was 93.8% (15/16) for 2MSS and the screen-positive rate (SPR) was 24.5% (504/2061). For 1MSS, these figures were 85.7% (6/7) and 17.7% (109/615) respectively. To detect one trisomy 21, missed by MSS at ≧35 years of age, an additional number of 1,557 and 506 primary invasive procedures would be needed for 2MMS and 1MSS respectively. We conclude that the performance of bothsingle-step 1MSS and 2MSS at maternal age ≧35 years in Flanders is excellent, even without the combination with ultrasound parameters or integration of first and second trimester parameters. The simplicity of both methods allows to consider them valuable options for fetal aneuploidy screening at advanced maternal age, until high quality combined or integrated screening is accessible to all pregnant women in Belgium.

Endometriosis and “dioxins”: Preliminary data on Italian and Belgian Women

Endometriosis and “dioxins”: Preliminary data on Italian and Belgian Women

Assessment of menstrual blood loss in Belgian users of the frameless copper-releasing IUD with copper surface area of 200 mm 2 and users of a copper-levonorgestrel-releasing intrauterine system

Objective This study was conducted to evaluate the effect of a miniaturized frameless copper IUD (GyneFix® 200 small) and a copper-levonorgestrel (GynePlant™) intrauterine system (IUS) on the amount of menstrual blood loss (MBL). Methods In 60 Belgian women using GyneFix 200 and 21 using GynePlant, MBL was assessed with the visual assessment technique. Results MBL scores in GyneFix 200 users did not change from baseline during the mean observation period of 31 months. In GynePlant users, mean MBL scores decreased by at least 50% in all but one user. Conclusion The impact of copper IUDs on MBL can be minimized by reducing the surface area of the foreign body. Reduction of MBL, without causing amenorrhea, can be obtained by adding levonorgestrel.

Dioxin-like compounds and endometriosis: a study on Italian and Belgian women of reproductive age

Compounds with dioxin-like toxicity are suspected to adversely affect human reproduction even at current background exposures. Endometriosis, a gynecological disorder often associated with infertility, has been hypothesized to be linked to dioxins and similar chemicals, a hypothesis supported by the outcome of experimental studies on animal models. Endometriosis severity and incidence in Belgium is one of the highest of the world: in this country, the general population exposure to dioxin-like compounds has been, on average, higher than in most industrialized countries. Here we show the results of a pilot case–control study carried out on 22 Italian and 18 Belgian women of reproductive age, with and without endometriosis. No significant differences were found in dioxin-like compound body burdens between cases and controls on a country basis, whereas the body burdens of the Italian women resulted to be significantly lower than that of the Belgian. In particular, total TEQs in Italian and Belgian women without endometriosis were respectively 18 and 45 pg WHO-TE/g lb.

Three-year efficacy and acceptability of the GyneFix® 200 intrauterine system

Objective This study was conducted to evaluate the efficacy of a “mini” version of the frameless intrauterine system (IUS; GyneFix®), which has a copper surface area of approximately 200 mm 2. The small GyneFix version consists of four copper cylinders instead of six and is only 2 cm long. Materials and methods A total of 392 insertions were performed in an open nonrandomized study in parous (76%) and nulligravid/nulliparous (24%) women in Belgium and China. This interim analysis reports on 13,699 women-months of use. All women were followed-up for a minimum of 12 months, up to 3 years and longer. Results Four pregnancies occurred with the GyneFix 200 IUS in this study, of which one occurred after unnoticed expulsion of the device, yielding a cumulative failure rate of 0.48 at 3 years. The cumulative removal rate for medical reasons was 1.65 at 3 years and the expulsion rate was 0.39. These low event rates resulted in a high continuation of use (93.92 at 3 years). Neither perforations nor pelvic inflammatory disease cases were encountered in this study. Conclusion The present study suggests that the GyneFix 200 IUS is highly effective and probably as effective as the standard GyneFix IUS. This is attributed to the anchoring of the device to the fundus of the uterus, promoting its contraceptive action. The total surface area of the device, releasing a maximum amount of copper ions, is the fundamental difference between it and conventional IUDs and is probably essential in obtaining the high contraceptive efficacy seen in this study. The small total surface area of the GyneFix 200 IUS also minimizes menstrual bleeding and is an improvement over larger types of conventional IUDs, as indicated by the low removal rate for abnormal bleeding with the small GyneFix.

Increased serum polychlorobiphenyl levels in Belgian women with adenomyotic nodules of the rectovaginal septum

The sum of bulk polychlorobiphenyl levels was significantly higher in women with rectovaginal adenomyosis than in women with endometriosis and controls.

Use of benzodiazepine drugs and perceived job stress in a cohort of working men and women in Belgium. Results from the BELSTRESS-study

The aim of the Belstress Study was to see whether use of benzodiazepines is associated with perceived job stress as measured by Karasek's job-strain model. This model has as its central tenet that the most adverse health outcomes are to be expected in high strain jobs characterized by high job demands and low job control. An extension of the model states that the most noxious combination is high job demands, low control and low social support at work. Sample subjects were recruited from 25 Belgian companies between 1994 and 1998, and cover a wide range of occupations. A 5.6% of 16,094 men and 9.3% of 5012 women aged 35–59 years report use of benzodiazepines during the last month. A clear association is displayed between self-reported use of benzodiazepines and a high strain job compared to a low strain job (men: OR=1.93, 99% CI=1.4–2.6; women: OR=1.66, 99% CI=1.0–2.7), after adjustment is made for socio-demographic confounders (age, level of education, occupational group, employment sector, living situation). The independent association with quartile level of job demands is a striking feature (men: OR of highest quartile compared to lowest quartile group=1.91, 99% CI=1.4–2.6; women: OR=1.99, 99% CI=1.3–3.1). In men, an inverse association with quartile level of job control is observed (OR= 0.65, 99% CI=0.5–0.9) whereas in women a clear tendency in that direction is displayed (OR=0.62, 99% CI=0.4–1.1). The association with low social support is less clear; an independent association between use of benzodiazepines and iso-strain was observed particularly in men.

Relationship of perceived job stress to total coronary risk in a cohort of working men and women in Belgium.

To examine the relationships of job strain and iso-strain psychosocial work environment exposures to 'total coronary risk' (TCR) in a cohort of male and female workers in Belgium. The sample consists of 15,079 men and 4639 women aged 35-59 years employed in a wide range of occupations and free of any self-reported personal history of CHD. Karasek's job strain model was used to define high strain (high demands and low control), low strain, active and passive jobs. Iso-strain was defined as the combination of a high strain job with low worksite social support, and is compared to the other combinations. Total coronary risk is a composite measure based on a Framingham function assessing the risk of developing coronary heart disease (CHD) within the next 10 years; high and low levels of TCR were defined. Logistic regressions in each gender were applied to explore relationships, adjusting for age, level of education, occupational class and sector of employment. In male workers, the age-adjusted prevalence of high TCR is highest in (1) in the lowest quartile group of job control and (2) in the 'high strain' group. The multivariate logistic regressions comparing high strain, active and passive work exposures to low strain work did not indicate a significant association with high TCR. Likewise, iso-strain jobs were neither found to be associated with high TCR. Our cross-sectional analysis provides no support for the hypothesis that the psychosocial work environment is strongly associated with the TCR estimate in healthy workers.

623 Dioxins and endometriosis: Preliminary results of an on-going investigation on Italian and belgian women

623 Dioxins and endometriosis: Preliminary results of an on-going investigation on Italian and belgian women

European psychometric validation of the CONTILIFE: a Quality of Life questionnaire for urinary incontinence.

To validate 5 language versions (French, Dutch, German, English and Danish) of CONTILIFE, a urinary incontinence-specific measure of Quality of Life (QoL). CONTILIFE was administered to Belgian, Danish, English, French, German, and Dutch women with genuine stress incontinence. The internal consistency, the construct and clinical validity, and the responsiveness to change over time were assessed using standardised procedures. 505 women filled in the CONTILIFE at baseline. Quality of completion was good. The mean number of missing data varied between 0.33 (1.17%) and 0.94 (3.36%) according to the country. Internal consistency was good for all dimensions except for the Effort Activities dimension. Construct validity was good for the Danish, French and pooled sample, and acceptable for English, German and Dutch samples. The distribution of QoL scores differed according to the number of urinary leaks (p<0.007). 477 women completed the questionnaire twice with a 28-day interval. Responsiveness to clinical improvement was good (/ES/> or =0.50) except for the Sexuality and Well-Being dimensions. In this international European study, CONTILIFE matched the psychometric requirements to be used as a valid, reliable, and sensitive measure of the QoL of the patients. The Daily Activities, Effort Activities, Self-Image and Emotional Consequences dimensions are the most relevant and valid dimensions for purposes of comparison.

Aristolochic acid and 'Chinese herbs nephropathy': a review of the evidence to date.

Chinese herbs nephropathy (CHN) is a rapidly progressive interstitial nephropathy reported after the introduction of Chinese herbs in a slimming regimen followed by young Belgian women. It is characterised by early, severe anaemia, mild tubular proteinuria and initially normal arterial blood pressure in half of the patients. Renal histology shows unusual extensive, virtually hypocellular cortical interstitial fibrosis associated with tubular atrophy and global sclerosis of glomeruli decreasing from the outer to the inner cortex. Urothelial malignancy of the upper urinary tract develops subsequently in almost half of the patients. Suspicion that the disease was due to the recent introduction of Chinese herbs in the slimming regimen was reinforced by identification in the slimming pills of the nephrotoxic and carcinogenic aristolochic acid (AA) extracted from species of Aristolochia. This hypothesis was substantiated by the identification of premutagenic AA-DNA adducts in the kidney and ureteric tissues of CHN patients. Finally, induction of the clinical features (interstitial fibrosis and upper urothelial malignancy) typical of CHN in rodents given AA alone removed any doubt on the causal role of this phytotoxin in CHN, now better called aristolochic acid nephropathy (AAN). AAN is not restricted to the Belgian cases. Similar cases have been observed throughout the world, but AA is sometimes incriminated on the basis of the known content of AA in the herbs. The possibility remains that in some individuals in whom AA has not been demonstrated, other phytotoxins might be implicated. Biological and morphological features of AAN are strikingly similar to those reported in another fibrosing interstitial nephropathy of still unknown aetiology, Balkan endemic nephropathy (BEN). Interestingly, AA was incriminated as the cause of BEN many years ago, a hypothesis yet to be fully explored. The intake of AA and the presence of tissular AA-DNA adducts in patients with an unequivocal diagnosis of BEN remains to be demonstrated. The tragic phenomenon of CHN, recognised only 10 years ago, has been at the root of significant research and progress both in nephrology and oncology. It has provided a fascinating opportunity to understand the link between a fibrosing interstitial nephropathy and urothelial carcinoma. It allows the categorisation of interstitial nephritis on the basis of histological findings, of initiating toxic substances and of associated clinical features. Finally, it has led to the withdrawal in several countries of a previously unsuspected carcinogenic and nephrotoxic substance.

Efficacy of a mini version of the frameless GyneFix intrauterine system (IUS) with effective copper surface area of 200 mm 2

This study was conducted to evaluate the efficacy of a ‘mini’ version of the frameless intrauterine system (IUS) (GyneFix) that has a copper surface area of approximately 200 mm 2. The GyneFix-mini consists of four copper cylinders instead of six and is only 2 cm long. A total of 301 insertions were performed in an open nonrandomized pilot study in parous (77%) and nulligravid/nulliparous (23%) women in Belgium and China. This interim analysis reports on 4110 women-months of use. All women were followed-up for a minimum of 12 months. Two pregnancies occurred with the mini GyneFix IUS in this study. However, only one occurred with the device in situ. The cumulative removal rate for medical reasons (bleeding and pain) was 0.39 at 1 year. The expulsion rate was 1.04. These low event rates resulted in a high continuation rate (95.02 at 1 year). Neither perforations nor pelvic inflammatory disease cases were encountered in this study. This study indicates that only a minimal amount of copper, positioned in the upper part of the uterine cavity, is sufficient to provide a high contraceptive effect. This is made possible by anchoring the active contraceptive substance to the fundus of the uterus. The fact that 100% of the copper surface area of the frameless IUS is available for copper release is an additional advantage.

Spontaneous pregnancies in couples who discontinued intracytoplasmic sperm injection treatment: a 5-year follow-up study

Objective: To analyze the occurrence of deliveries after spontaneous conception in patients who have discontinued unsuccessful intracytoplasmic sperm injection (ICSI) treatment. Design: Cohort follow-up study. Setting: Tertiary referral center. Patient(s): Between July 1992 and December 1993, 200 Belgian women younger than 37 years underwent 433 consecutive unsuccessful ICSI cycles with freshly ejaculated sperm and eventually discontinued their treatment. Intervention(s): Ultrasound-guided oocyte retrieval and ICSI. Main Outcome Measure(s): Delivery after 25 weeks following a spontaneous pregnancy. Result(s): The mean age at the time of the last oocyte pick-up was 31.0 ± 3.9 years. The mean time interval between the last ICSI and the end of the follow-up period was 47.7 ± 12.1 months. Twenty-three spontaneous pregnancies ending in delivery after 25 weeks were observed (11.5%). The cumulative delivery rate reached a plateau of 10% after 36 months of follow-up. The mean time interval (from last oocyte retrieval) for spontaneous pregnancy to occur after discontinuing ICSI treatment was 20.2 ± 13.7 months. Proportional hazards analysis showed that delivery rate was reduced by 2.0% per year of infertility. Conclusion(s): This study suggests that duration of infertility appears to be predictive of the likelihood of live delivery after spontaneous conception following an unsuccessful ICSI treatment.

The Impact of Residential Segregation on Participation in Associations: The Case of Moroccan Women in Belgium

This article discusses the impact of residential segregation on Moroccan minority women's participation in associations. Three neighbourhood contexts in and around the city of Antwerp, Belgium are compared. P. H. Collins' matrix of domination is used to distinguish the main dominance structures: male dominance, situation as a minority and Islam. Two activities that contribute to Moroccan women's integration in society are studied: ethno-religious associations and Dutch language courses. Participation is most advanced in the ethnic neighbourhood, while living in a small ethnic community or living isolated in the suburbs proves less conducive to integration. Most surprising is that women living in the suburbs are affected by the same restrictions and dominance structures as women in an ethnic neighbourhood.

Secular and Religious Nationalism among Young Turkish Women in Belgium: Education May Make the Difference

In this article, I examine the role that education plays in influencing Turkish immigrant girls' choice between a more secular and a more religious nationalism. Their choice can be linked to the existence of strong forms of nationalism within their country of origin and to the concrete reality of the immigrant context. Education proves to play a decisive role for immigrant girls in defining their places within a specific nationalistic worldview and, as a result, within Western society.

Polymorphisms of the VDR, ER and COLIA1 genes and osteoporotic hip fracture in elderly postmenopausal women.

In view of the reported associations between osteoporosis and polymorphisms of the vitamin D receptor (VDR), collagen Ialpha1 (COLIA1) and estrogen receptor (ER) genes, an association study was performed between VDR, COLLIA1, and ER genotypes and bone mineral density, biochemical markers of bone turnover and hip fracture occurrence in Belgian older postmenopausal women. The gene polymorphisms were evaluated by restriction fragment length polymorphism analyses, using the restriction enzymes BsmI (VDR), AccB7I (COLIA1), and PvuII and XbaI (ER), respectively. As expected, bone mineral density and biochemical analyses demonstrated significant differences between hip fracture patients and elderly controls. However, no significant differences in genotype distributions or allele frequencies were observed between the cases (n = 135, age 78 +/- 9 years) and controls (n = 239, age 76 +/- 4 years) for any of the gene polymorphisms. Stratification of both study populations according to VDR, COLIA1 or ER genotype did not reveal any statistically significant difference in bone density or bone turnover between subgroups with different genotypes. In conclusion, despite its limited statistical power the outcome of this study does not support the hypothesis of a major contribution of the VDR, COLIA1 or ER polymorphisms to explain variations in bone mineral density or bone turnover, or to identify elderly women at risk of osteoporotic hip fracture.