Years In Flanders Research Articles

O-109 Reproductive health education: collaborative design of a learning platform for secondary school education involving reproductive health experts, pupils, and teachers

Abstract Study question Which reproductive health information do pupils miss in their education and what is the optimal way of building a learning platform to close that gap? Summary answer Teachers and students alike would welcome a novel fertility education platform. Ideally, the platform should organize information based on the educational objectives for enhanced usability. What is known already Research on fertility awareness in the general population reveals lack of understanding among young people regarding crucial aspects of reproductive health, for example the age-related impact on fertility. Literature suggests that this knowledge gap should be addressed through diverse channels, including schools. Presently, school sexual education predominantly concentrates on preventing unwanted pregnancies and sexually transmitted diseases. Notably, the updated educational objectives in Flemish Secondary Education have recently incorporated the influence of lifestyle factors on fertility. Consequently, teachers have been urged to create novel instructional materials centered on this crucial theme. Study design, size, duration This mixed-method observational study encompassed a baseline measurement with open and closed questions among 1700 third-grade secondary education pupils. Additionally, it involved focus group discussions with 6 teachers and 24 pupils. The baseline measurement occurred between February and April 2022, while the focus group interviews took place in April and May 2022. Participants/materials, setting, methods A baseline measurement examined the knowledge of secondary school pupils aged between 15 and 19 years in Flanders (Belgium), explored current sexual education topics, their evaluations, and preferences for future reproductive health education. Focus group discussions investigated optimal delivery methods and structural frameworks for fertility learning materials. Main results and the role of chance Survey results revealed that most pupils desired more information on reproductive issues, with some expressing a preference for a dedicated weekly course. Over 50% noted the absence of discussions about infertility, IVF, and egg freezing topics in school and expressed a desire for more information, a sentiment that was echoed in the focus groups with pupils. Teachers, in their focus groups, favored an online platform with structured teaching materials aligned with learning goals. With anticipated new learning goals by September 2023, teachers welcomed fertility-specific learning materials. Their preference went out to versatile resources (videos, quizzes, infographics) rather than ready-made courses or presentations, providing flexibility in lesson integration. Considering these insights, the following platform was developed: www.allesovervruchtbaarheid.be/en. Ongoing refinement occurred through workshops where teachers provided feedback for further enhancements to meet their instructional needs. Limitations, reasons for caution A limited number of motivated teachers participated in the focus group discussions. Structured feedback collection has not taken place yet but is scheduled for February 2024. Wider implications of the findings Implementing fertility education in secondary schools poses challenges due to an overloaded curriculum. The introduction of new learning goals, including one on the impact of lifestyle on fertility, provided an opportune momentum to integrate a fertility education learning platform. Trial registration number not applicable

Changes in retail food environments around schools over 12 years in Flanders, Belgium

Abstract Background Food environments influence food preferences, in particular among children. Besides their homes, children spend most of their time in and around the school. This study mapped changes in retail food environments around primary and secondary schools in Flanders between 2008 and 2020. In addition, associations between those indicators and children's weight status were assessed. Methods The food environment near primary and secondary schools was mapped using three spatial indicators: 1) The density of different types of food retailers within 1000m road distance from the school entrance, 2) the percentage of schools with at least one food retailer of a certain type within 1000m road distance from the entrance, and 3) the median walking distance from the school entrance to the nearest food retailer of a certain type. Associations between the density of convenience stores, as well as fast food outlets around the schools and the weight status of the schools’ children were assessed using generalized linear models adjusted for level of urbanization, socio-economic status of children at school level and sex. Results Food environments near schools in Flanders were found to be unhealthy, with a significant increase in fast-food outlets and convenience stores between 2008 and 2020. Food environments near schools with a higher proportion of children from a poor socio-economic background were found more unhealthy than those near schools with a lower proportion of such children, regardless of the urbanization level. A significant positive association was found between the density of fast food outlets as well as convenience stores around primary schools and the weight status of children aged <6 years and 6-12 years. Conclusions Food environments around schools in Flanders became more unhealthy over time and were associated with children's weight status. The government therefor has the responsibility to create healthy food environments near schools to protect children's health. Key messages • The food environment near schools became more unhealthy between 2008 and 2020. • The food environment near schools was associated with younger children's weight status.

Impact of Heat Waves on Hospitalisation and Mortality in Nursing Homes: A Case-Crossover Study.

Climate change leads to more days with extremely hot temperatures. Previous analyses of heat waves have documented a short-term rise in mortality. The results on the relationship between high temperatures and hospitalisations, especially in vulnerable patients admitted to nursing homes, are inconsistent. The objective of this research was to examine the discrepancy between heat-related mortality and morbidity in nursing homes. A time-stratified case-crossover study about the impact of heat waves on mortality and hospitalisations between 1 January 2013 and 31 December 2017 was conducted in 10 nursing homes over 5 years in Flanders, Belgium. In this study, the events were deaths and hospitalisations. We selected our control days during the same month as the events and matched them by day of the week. Heat waves were the exposure. Conditional logistic regression models were applied. The associations were reported as odds ratios at lag 0, 1, 2, and 3 and their 95% confidence intervals. In the investigated time period, 3048 hospitalisations took place and 1888 residents died. The conditional logistic regression showed that odds ratios of mortality and hospitalisations during heat waves were 1.61 (95% confidence interval 1.10–2.37) and 0.96 (95% confidence interval 0.67–1.36), respectively, at lag 0. Therefore, the increase in mortality during heat waves was statistically significant, but no significant changes in hospitalisations were obtained. Our result suggests that heat waves have an adverse effect on mortality in Flemish nursing homes but have no significant effect on the number of hospitalisations.

Health Impact and Cost-Effectiveness of Implementing Gender-Neutral Vaccination With the 9-Valent Human Papillomavirus Vaccine in Belgium.

Background: Routine human papillomavirus (HPV) immunization in Belgium is currently regionally managed, with school-aged girls receiving the 9-valent HPV (9vHPV) vaccine in Flanders and Wallonia-Brussels with a national catch-up program for females only. This study will assess whether expanding these programs to gender-neutral vaccination (GNV) with the 9vHPV vaccine is a cost-effective strategy in Belgium. Methods: A validated HPV-type transmission dynamic model estimated the potential health and economic impact of regional vaccination programs, comparing GNV versus female-only vaccination (FOV) with the 9vHPV vaccine in individuals aged 11–12 years in Flanders, GNV with the 9vHPV vaccine versus FOV with the 2-valent HPV (2vHPV) vaccine in individuals aged 12–13 years in Wallonia-Brussels, and national catch-up GNV versus FOV with the 9vHPV vaccine for those aged 12–18 years. Vaccination coverage rates of 90, 50, and 50% in both males and females were used in the base cases for the three programs, respectively, and sensitivity analyses were conducted. All costs are from the third-party payer perspective, and outcome measures were reported over a 100-year time horizon. Results: GNV with the 9vHPV vaccine was projected to decrease the cumulative incidence of HPV 6/11/16/18/31/33/45/52/58-related diseases relative to FOV in both Flanders and Wallonia-Brussels. Further reductions were also projected for catch-up GNV with the 9vHPV vaccine, including reductions of 6.8% (2,256 cases) for cervical cancer, 7.1% (386 cases) and 18.8% (2,784 cases) for head and neck cancer in females and males, respectively, and 30.3% (82,103 cases) and 44.6% (102,936 cases) for genital warts in females and males, respectively. As a result, a GNV strategy would lead to reductions in HPV-related deaths. Both regional and national catch-up GNV strategies were projected to reduce cumulative HPV-related disease costs and were estimated to be cost-effective compared with FOV with incremental cost-effectiveness ratios of €8,062, €4,179, and €6,127 per quality-adjusted life-years in the three programs, respectively. Sensitivity analyses were consistent with the base cases. Conclusions: A GNV strategy with the 9vHPV vaccine can reduce the burden of HPV-related disease and is cost-effective compared with FOV for both regional vaccination programs and the national catch-up program in Belgium.

Motivations and Barriers for Using Speed Pedelecs for Daily Commuting

Speed pedelecs, electric bicycles that can provide pedal assistance up to 45 km/h, have seen rapid uptake over the past ten years in Flanders, Belgium, yet perceptions around motivators and barriers have not been studied and understood in detail. This paper reports on the qualitative experiences of 100 participants from 10 Flemish companies who replaced their commuting vehicle by a speed pedelec for up to three weeks. Focus groups provided data in the identification of the motivators and the barriers towards speed pedelecs in comparison to those for bicycles and pedelecs classified in nine categories. The results from the focus groups show notable differences in motivators for using speed pedelecs compared to bicycles and pedelecs—the higher available speed and range within a given timeframe, which provides the possibility of better time management. The mental benefits and the competitive aspect of commuting with a speed pedelec were identified as new motivators. The purchase cost and the perception of safety as barriers remain, with reliability, flexibility, and planning identified as new barriers.

Validity and Reproducibility of a Food Frequency Questionnaire for Dietary Factors Related to Colorectal Cancer.

Dietary factors play a major role in the development of colorectal cancer. This study evaluated the reproducibility and validity of a 109-food item Food Frequency Questionnaire (FFQ) to measure the consumption of foods and nutrients related to the development of colorectal cancer in a population aged ≥50 years in Flanders, Belgium. A semi-quantitative FFQ was administered two times in a period of two weeks to evaluate reproducibility (FFQ1 and FFQ2). The validity of the FFQ was assessed by comparing FFQ1 against the 3-day diary method (3 DD). A total of 162 respondents (mean age 57.5 years) provided data for the FFQ, of whom 156 also participated in the validity assessment. Mean differences in the intake of foods and nutrients between FFQ1 and FFQ2 were, overall, small and statistically insignificant. However, a higher estimation was observed by FFQ1 as compared to the 3-DD method for the majority of food groups and nutrient intake in the validity assessment. A systematic mean difference (g/day) was observed for eight food groups in the Bland–Altman agreement test; the largest was for fruit intake. Regarding the nutrients, a systematic mean difference was observed in calcium, fat, and vitamin D intake. Overall, the reproducibility of the FFQ was good, and its validity could be satisfactory for estimating absolute food and nutrient intakes and ranking individuals according to high and low intake categories.

From stageplay to screenplay to film – tragic to melodramatic: The case of The Broken Circle Breakdown

Abstract The Broken Circle Breakdown is one of the most successful theatre plays (2008) in recent years in Flanders. The film adaptation (2012) by Felix Van Groeningen was even more successful. Nevertheless, theatre play, screenplay and the final film differ considerably. This essay aims to reconstruct the genetic evolution of the screen idea from stage play to script to film. It tries to elucidate the dramaturgical choices made by the playwrights, screenwriters and last but in this case certainly not least, the editor, and how this influenced a shift from the tragic (play) towards the melodramatic (film). The adaptation thus can be described as what Jacques Rancière has called a ‘thwarted fable’.

Caring for Family Members Older Than 50 Years of Turkish and Northwest African Descent: The Meaning of Caregiving.

The first generation of immigrants to Belgium from Turkey and Northwest Africa are aging and at risk for developing cancer. Family members play an important role in both illness and old age. The objective of this study was to gain insight into experiences and perceptions of families with Turkish or Northwest African backgrounds who were caring for cancer patients older than 50 years in Flanders, Belgium. A qualitative research design with elements of constructivist grounded theory was used. Twenty-eight loosely structured interviews were conducted. Three researchers were involved in data analysis (researcher triangulation), and 6 conversations took place with experts. Cancer appeared to be a family matter. Caregiving had a strong moral meaning for all participants, particularly for children providing care to a parent. Caregiving could be described as "guiding": family members led the patient through, or familiarized the patient with, the healthcare system. There were strong differences in the extent to which family members believed they should provide care, as well as the kind of professional care considered desirable. Despite shared values of the importance of family and family caregiving, concrete ideas about caregiving differed considerably. The findings imply that shared cultural or religious normative values do not predict day-to-day care practices. This study provides new insights into the moral and practical meaning of caregiving, which will help professionals understand the roles adopted by family members. Furthermore, individualized approaches to care appear to be essential, because concrete ideas about informal caregiving differ strongly despite shared values.

Low historical rates of cuckoldry in a Western European human population traced by Y-chromosome and genealogical data.

Recent evidence suggests that seeking out extra-pair paternity (EPP) can be a viable alternative reproductive strategy for both males and females in many pair-bonded species, including humans. Accurate data on EPP rates in humans, however, are scant and mostly restricted to extant populations. Here, we provide the first large-scale, unbiased genetic study of historical EPP rates in a Western European human population based on combining Y-chromosomal data to infer genetic patrilineages with genealogical and surname data, which reflect known historical presumed paternity. Using two independent methods, we estimate that over the last few centuries, EPP rates in Flanders (Belgium) were only around 1–2% per generation. This figure is substantially lower than the 8–30% per generation reported in some behavioural studies on historical EPP rates, but comparable with the rates reported by other genetic studies of contemporary Western European populations. These results suggest that human EPP rates have not changed substantially during the last 400 years in Flanders and imply that legal genealogies rarely differ from the biological ones. This result has significant implications for a diverse set of fields, including human population genetics, historical demography, forensic science and human sociobiology.

Decline in breast cancer incidence in the Flemish region of Belgium after a decline in hormonal replacement therapy

BackgroundBreast cancer incidence rate in Belgian women was as high as 152.7 for 100 000 in 2003 (adjusted on European population). We made an estimation of the contribution of hormone replacement therapy (HRT) on breast cancer incidence from 1999 to 2005 in women aged 50–69 years in Flanders. MethodsBreast cancer data were extracted from the Belgium Cancer Registry. Drug consumption was computed from drug sales data. The fraction of breast cancers attributable to HRT was calculated by year, using the relative risks of the Million Women Study in the UK. ResultsThe proportion of women aged 50–69 years using HRT in Flanders increased since 1992, peaked at 20% in 2001, then decreased to 8% in 2008. The incidence of breast cancer in 100 000 women aged 50–69 years in Flanders increased from 332.8 in 1999 to 407.9 in 2003, then decreased to 366.1 in 2005; the variations were mostly noticeable for tumors <20 mm in size. The fraction of breast cancers attributed to HRT peaked at 11% in 2001 and decreased afterward. ConclusionThe high level of breast cancer observed in the years 2001–2003 in Flanders can be partly attributed to the use of HRT. Since participation to mammography screening of Flemish women aged 50–69 years was still on the rise in 2003 and never exceeds 62%, the decrease in breast cancer incidence was likely to be due to the decrease in HRT use and not to screening saturation.

References for growth and pubertal development from birth to 21 years in Flanders, Belgium

Background: Due to the secular trend in length and height, growth references need to be updated regularly. Reference charts that were until recently used in Belgium are based on samples collected more than 30 years ago, and references for body mass index (BMI) and pubertal development have not been established before.Aims: To establish contemporary cross-sectional reference charts for height, weight, BMI, head circumference, and pubertal development from birth to 21 years of age, based on a representative sample of children from Flanders, Belgium.Subjects and methods: 15 989 healthy subjects of Belgian origin, 0–25 years of age, were measured in 2002–2004. Growth curves were fitted with the LMS method, and percentiles for the pubertal development were estimated with generalized additive models on status quo data from 8690 subjects aged 6–22 years of age.Results: A positive secular trend in height and weight is observed in children above 5 years of age. Adult median height has increased by 1.2 cm/decade in boys and 0.8 cm/decade in girls; median weight by 0.9 kg/decade in boys, and 1.0 kg/decade in girls, and the weight distribution became more skewed. The BMI curve is comparable to that of other populations, except for higher percentiles. This reflects the increasing prevalence of overweight and obesity. Median age at menarche (13.0 years) has not advanced any more over the past 50 years. Median ages at menarche and B2 in girls and G2 or T4 in boys are comparable to other West European estimates, but approximately 10% enter G2/T4 before 9 years of age.Conclusions: The ongoing secular trend in height and weight makes growth charts previously used in Belgium obsolete. New representative charts for growth and pubertal development are introduced. For weight monitoring, it is advised that the now-available BMI growth charts are used.

How children view their travel behaviour: a case study from Flanders (Belgium)

Understanding the thoughts of contemporary children about travel and their opinions on different transport modes of transport may provide important answers for policy-makers on how to respond to current and future transport needs of children. Obviously, children do not act autonomously and their travel behaviours also strongly influence their parents’ travel behaviours. Therefore, a better understanding of children’s travel behaviours seems necessary. This paper reports the results of a large-scale, self-reporting survey ( N = 2546) that was conducted to examine the concept and meaning of travel and travel behaviour of children aged between 10 and 13 years in Flanders. It was found that children are able to complete a travel diary on their own, that their travel patterns differ and that the most important part of travelling for them is the social aspect.

References for growth and pubertal development from birth to 21 years in Flanders, Belgium

References for growth and pubertal development from birth to 21 years in Flanders, Belgium

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.

Bibliometric assessment of research performance in Flanders: policy background and implications

We illustrate the use of bibliometric tools in the evaluation of scientific research conducted at Flemish universities and publicly funded research organisations, and in the assessment of scientific‐technological performance in Flanders in the field of information technology. We sketch the policy background of a number of studies conducted during the past 6 years in Flanders. These studies have provided useful information to evaluators and policy makers in Flanders, and have generated indirect effects on policy decisions, as their outcomes were used in the policy debate to raise relevant questions, clarify concepts or distinctions, question assumptions or to substantiate impressions.