Depression and socio-economic risk factors: 7-year longitudinal population study.

BACKGROUND: Low socio-economic status is associated with a higher prevalence of depression, but it is not yet known whether change in socio-economic status leads to a change in rates of depression. AIMS: To assess whether longitudinal change in socio-economic factors affects change of depression level. METHOD: In a prospective cohort study using the annual Belgian Household Panel Survey (1992-1999), depression was assessed using the Global Depression Scale. Socio-economic factors were assessed with regard to material standard of living, education, employment status and social relationships. RESULTS: A lowering in material standard of living between annual waves was associated with increases in depressive symptoms and caseness of major depression. Life circumstances also influenced depression. Ceasing to cohabit with a partner increased depressive symptoms and caseness, and improvement in circumstances reduced them; the negative effects were stronger than the positive ones. CONCLUSIONS: The study showed a clear relationship between worsening socio-economic circumstances and depression.

[Utilization and under-utilization of health care in Belgium and other countries]. / La consommation de soins médicaux et les comportements de sous-consommation en Belgique et à l'étranger.

Utilization of health care is a major concern in the debates about public expenditures and the regulation of human health resources. Concerns regarding inappropriate services are regularly mentioned in Belgium. Our study aims at assessing the utilization of health care, with a particular focus on the impact of morbidity, and a possible sub-consumption behaviour. The probability of having had a medical encounter with a general practitioner or with a specialist during the latest year and the probability of a frequency of encounters higher than national average is assessed thanks to logistic regressions. The functional limitations and the chronic conditions (mainly the poly-pathology) are major factors related to patient encounters with medical doctors. In the future, the number of individuals suffering from functional limitations and/or chronic illness will increase due to the ageing of the population. The pressure on health expenditures will increase also if: the frequency of encounters is adequate, as recommended by the "guidelines" for some illnesses and, the frequency of encounters increases due to the evolution of other factors that have been put forward by our logistic regressions. However, any sub-consumptions cannot be simply labeled as additional real needs, because these are also linked to some characteristics of the patients. Consequently, problems of subconsumption cannot be easily solved just by increasing medical supply.

[Nature and magnitude of the need for dental care in Belgium: the point of view of dentists]. / Nature et ampleur des besoins en medecine dentaire en Belgique: le point de vue des dentistes.

In most countries, oral and dental problems (decay, gingivitis, parodontitis,..) are frequent and impact on overall health. Such problems can often be avoided and treated. Health professionals and patients become gradually more aware of the importance of oral health. Oral hygiene and other measures may prevent several problems, which is beneficial to individuals and to public health, since the consequences of oral diseases are very expensive for all. Our study aims to analyze the features of the profession and to assess their possible evolution in the future. The design of our study combines two approaches: a quantitative study -based on data of the national health insurance scheme regarding utilization of care- and a qualitative study based on deep-interviews of dentists. According to the latter, dental care is expensive for the patient and also for professionals. The workload becomes heavier because patients expect too much. It is expanding, due to longer life expectancy and to medical progress which enables to conserve natural dentition, thus requiring extra care for the surviving teeth. These factors explain the increase of dental services which we highlight for the last 20 years; for the future, most of services are expected to expand, mainly for elderly (65 + years), One exception is noticeable: a probable decrease of "traditional care" for young and adult populations (<65 years). The authorities should take these trends into account in order to cover such new requirements, while also introducing measures in order to limit potential undue demand. However, a few socioeconomic groups remain out of the care system: all disabled persons living in institutions (inter alia elderly in nursing homes); furthermore, the population of low socioeconomic status is unaware of the benefits of a good oral hygiene; professionals denounce these gaps of the system and suggest improvements. Education about oral hygiene should also be promoted; consequently, the profession of oral hygienist should obtain an official license.

[The opinions of Belgian physicians about their practice]. / Des médecins belges parlent de leur metier.

QUESTIONS: Considering the numerous changes in the health system, do medical doctors (MDs) feel difficulties in practising their profession? Are there complaints regarding the fact that the "medical chart" is in danger? Is Herzberg's theory about factors of satisfaction confirmed? METHOD: Qualitative analysis of MDs' spontaneous comments, stated at the end of a postal survey (MDs of the French speaking universities of Belgium, settled since 5 to 10 years or 15 to 20 years): 5 546 were contacted in 1999 and 2040 answered; 862 provided comments about their career and/or about their feelings regarding their profession (the latter theme had not been specifically addressed by the main survey). Most comments were issued by practitioners providing care: 296 general practitioners and 396 specialists; the remaining physicians perform other types of activities in the health system (prevention, teaching, research, management, ...): they number 170. RESULTS: A large diversity of careers; a few typical patterns are noticeable. Several satisfactions, which are largely outnumbered by the amount of complaints: onerousness, lack of collaboration, patients' requirements, bureaucracy, political interference, insufficient fees, lack of family- and private life and, mainly for specialists, shortcomings of training and problems with the hospital administration. Complaints about the medical chart are absent. Herzberg's theory holds true partially: among positive comments, "hygiene factors" are as frequent as aspects related to the content of work. INTERPRETATION: 1) The evolution of relations with the patients is probably not only due to the changes within the health sector; other factors are also to be scented, e.g the difficulty of a) bearing uncomfortable working conditions within an hedonistic culture and b) meeting the various challenges proposed by diverse paradigms regarding the norms of good practice. 2) The previous importance of the medical chart enters in conflict with worries more down to earth. 3) All the positive comments do not reflect a large satisfaction: some are rather relative, regarding an improvement compared with a worse situation in the past or with difficulties endured by colleagues.

Height of young men.

We analysed the height of young men in Belgium, using 613 257 records of medical examinations made prior to their conscription into the army (about 68% of the male population concerned). All analyses showed very significant associations. Height differed according to the region (-1.24cm in Wallonia, French-speaking and poorer) compared to Flanders (Dutch-speaking and richer), when "age-class" and year are taken into account. The smallest men lived in Hainaut (a deprived area), the tallest ones in Walloon Brabant (wealthy green suburbs of the capital). Height increased across time (+1.11cm, 1978-1990) and with "age-class" (+2.66cm, 18-26years), controlling for other factors. The increase in Brussels stops in 1983, probably due to other socio-demographic evolutions.