Efficacy of strategies to increase participation in cervical cancer screening: GPs offering self-sampling kits for HPV testing versus recommendations to have a pap smear taken - A randomised controlled trial.

Background: Cervical cancer is preventable by early detection and treatment of pre-cancerous lesions. The current screening policy in Belgium (3-yearly cytology on Pap smears) covers 60% of the target population. Offering self-samples by GPs can overcome barriers for women who are currently not screened. Methods: Women aged 25­64 who did not have a Pap smear since three years and consulted a GP practice in a Flemish municipality between November 2014 and April 2015 were allocated in a 1:1 ratio to either the intervention arm where women were given a vaginal self-sampling kit or control arm where women were encouraged to make an appointment for having a Pap smear taken by a clinician. Results: Eighty-eight consenting women were randomised. 35 (78%) out of 45 women in the self-sampling arm participated in screening compared to 22 (51%) out of 43 women in the control arm (p = 0.009). This difference remained significant after adjusting for covariates (age category, education level, time interval since last Pap smear, past Pap smear-taker). Conclusion: GPs offering self-sampling kits resulted in a high participation. Larger trials should confirm this effect and evaluate feasibility of this approach.4. The authors would also like to include the following sentence in the acknowledgement "The laboratory AML (Antwerp, Belgium) is acknowledged for the free HPV testing on the self-samples."

The use of traditional and complementary medicine among patients with multiple sclerosis in Belgium.

Introduction. Conventional treatment of multiple sclerosis (MS) is often disappointing. As a result, some of these patients seek salvation in traditional and complementary medicine (T&CM). The aim of this study is to describe how many patients with MS use T&CM and what their motives and expectations are in doing so. Methods. Ninety-nine patients with diagnosed MS, attending the service of ambulatory revalidation of the National Clinic for Multiple Sclerosis in Melsbroek (Belgium) were included in February 2004 in this retrospective study. All patients had MS resulting in motoric or psychosocial symptoms. The disability was not quantified for this study. Participants were interviewed by means of a structured questionnaire on their current treatment of MS including T&CM. Results. In total 44% of the participants had experiences with T&CM. The most frequently used T&CM were homeopathy and acupuncture. Participants using conventional treatment were more satisfied with the support (p=0.006) and the treatment outcome (0.018) than T&CM users. The use of T&CM was not related to gender, education, living conditions, causal treatment such as disease modifying-therapy (DMT), grade of disability or subtype of the disease. Conclusion. Patients diagnosed with MS seek hope in T&CM such as homeopathy or acupuncture. The results of this study suggest that MS patients need more professional support in their personal search for alternative therapies. Key point. 50% of patients diagnosed with multiple sclerosis search relief in traditional and complementary medicine such as homeopathy or acupuncture. These patients often feel compelled to try every opportunity to heal, often stimulated or urged on by friends or relatives. Multiple sclerosis patients are more satisfied with their conventional treatment than with the traditional and complementary medicine.

Influence of physical activity and interest for food and sciences versus weight disorders in children aged 8 to 18 years.

INTRODUCTION: Being overweight and obesity are a growing problem and are often related to a lack of physical activity among younger people. This study aims to describe the prevalence of weight disorders in Belgian schoolchildren. Secondly, this study examines the association between physical activity, weight disorders and the interest in food and sciences. METHODS: We examined 525 children aged between 8 and 18 years old, who attended the Brussels Food Fair or the Belgian Science Day in 2013. They completed a standardized questionnaire about lifestyle and physical activity. Their weight, height, blood pressure and waist circumference were measured. The physical condition of participants was estimated using the Ruffier test. RESULTS: The average age of all participants was 11.2 years (95% CI: 8.7-13.7), the prevalence of being overweight and obesity was 16.3% and 5.4%, respectively. For all participants in the representative group the affiliation to a sports club was associated with a normal weight (P < 0.05). According to this study, the kind of transportation to school (foot/bike or car/bus) had no effect on their body mass index (BMI). Neither was there a significant relationship between the physical activity of the children and the result of their Ruffier test. CONCLUSIONS: The prevalence of being overweight and obesity in children aged 8 to 18 years is alarming. Membership to a sports club was linked significantly to a normal weight and a lower prevalence of being overweight and obesity.

Comparison of health-seeking characteristics of German and Belgian university students.

Introduction. The aim of this study was to determine whether the use of primary health care differs between students enrolled in Belgian and German government-funded universities. The secondary aim of the study was to determine the factors that might explain such a difference. Methods. Participants were recruited through all Belgian and German government-funded universities. Because not all the universities agreed to participate, recruiting was also done through social media groups of the universities. An anonymous online survey was used for data collection. Results. In total, 2238 completed surveys were evaluated, of which 544 from students in Belgium and 1694 from students in Germany. In Belgium, more students had a family physician (87%) as compared to the students in Germany (73%) (p < 0.001). During the two months prior to the study, 37% of the Belgian students and 35% of the German students attended a family physician (p = 0.37). More German students attended a specialist (40%) as compared to the Belgian students (24%) (p<0.001). The German students also attended the emergency department more frequently (6%) as compared to their Belgian counterparts (3%) (p = 0.004). Conclusion. Belgian university students were more likely to attend a primary care physician than the German students. The health care seemed to be better organized for Belgian students and they were more satisfied with the delivered care.

Palliative care needs at different phases in the illness trajectory: a survey study in patients with cancer.

Despite the growing consensus on the benefits of initiating palliative care early in the disease trajectory, it remains unclear at what point palliative care needs emerge. This study investigates quality of life and unmet palliative care needs at three phases in the cancer trajectory, curative, life-prolonging and most advanced (prognosis <6 months/no further disease-modifying treatment). We collected self-reported data from 620 patients with cancer in the University Hospital of Ghent, Belgium. They completed a questionnaire on quality of life (using the EORTC QLQ-C30) and unmet care needs within the domains of palliative care. We used European reference values of the EORTC QLQ-C30 to compare the mean scores with a norm group. The groups further on in the cancer trajectory reported statistically and clinically poorer functioning compared with earlier phases, also when controlled for the effects of sex, age or type of cancer. Higher symptom burdens for fatigue, pain, dyspnoea and appetite loss were found in groups further into the trajectory, p < .001. Patients in the curative phase experienced physical symptoms and had clinically worse functioning than a European reference group. This paper demonstrates the ongoing need for oncologists to address the broader palliative care needs of patients from diagnosis onwards.

Place of residence after a stroke: results of the registration by the Belgian Sentinel Network of general practitioners.

BACKGROUND: Stroke is a major health problem worldwide. The health consequences for the survivors are not to be underestimated. The increased care needs after a stroke result often in a change of residence or an institutionalisation. The aim of the study is to provide an overview in the changes of the place of residence in the first year after stroke. METHODS: A nationwide observational registration by 199 and 189 family physicians (respectively in 2009 and 2010) working in sentinel practices. All cerebrovascular events that occurred in 2009 and 2010 were recorded. Follow-up was provided 1, 6 and 12 month(s) after the initial registration. RESULTS: In total 326 patients were diagnosed with a stroke and 87% were hospitalized. At the time of the event 83% of the patients lived at home and one year after the event 80% did (p = 0.366). Older age (p = 0.008), originally living in a nursing home (p = 0.009) and speech problems (p = 0.003) and incontinence (p = 0.017) were the most important determinants for institutionalisation in a nursing home after one year. CONCLUSION: There is a high proportion of the Belgian stroke survivors that can return home after the initial hospitalization. Mainly older patients with severe disabilities did not return to their home.

Prevalence of persistent lipid abnormalities in statin-treated patients: Belgian results of the Dyslipidaemia International Study (DYSIS).

AIM: A substantial number of cardiovascular events are not prevented by statin therapy, which is still regarded as the first-line therapy for hyperlipidaemia. Insights into the prevalence of lipid abnormalities of statin-treated patients in Belgium are lacking and may shed light on an unmet medical need for optimal use of current lipid-lowering therapies. This study aims to assess the prevalence and types of persistent lipid abnormalities in patients receiving statin therapy in a real-life primary care setting in Belgium. METHODS: This cross-sectional cohort study was designed to estimate the prevalence of specific lipid abnormalities in statin-treated patients in Belgium. Total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides were recorded from the patients' medical record. Patient's total cardiovascular risk and corresponding lipid treatment goals were defined based on the recent European Society of Cardiology/European Atherosclerosis Society recommendations. RESULTS: Overall, 56.2% of the statin-treated patients were not at goal for LDL-C. Low HDL-C (< 40 mg dl(-1) in men, < 45 mg dl(-1) in women) and elevated triglycerides (> 150 mg dl(-1) ) were seen in 16.3% and 29.0% of patients, respectively. Very high-risk patients were more likely to have LDL-C not at goal (71.4% of them), while 60.0% of high-risk patients and 34.1% of moderate-risk patients were not at goal for LDL-C. Use of ezetimibe (10 mg) was strongly associated with meeting LDL-C goals (OR 16.9, p < 0.0001). CONCLUSION: In Belgium, lipid abnormalities remained highly prevalent despite statin treatment, with more than half of all patients not reaching their LDL-C treatment goal. This finding clearly indicates that more aggressive lipid-lowering treatment is required in clinical daily practice to achieve the goals of the current guidelines.

Association of objective health factors with self-reported health.

OBJECTIVES: There is a strong relationship between subjective health and mortality, level of functional ability and medical consumption. The aim of this study was to describe the correlation of objective health-related factors with self-reported health (SRH) of a sample of the Belgian population. METHODS: Participants were recruited during an exhibition at the Brussels Exhibition Centre. They completed a visual analogue scale assessing their SRH. Medical history and health related parameters of the participants were recorded. RESULTS: In total 974 visitors participated. From the multivariate analysis we found an association between low SRH and diabetes (OR 0.23-0.80), increased body mass index (OR 0.52-0.74), coronary heart disease (OR 0.28-0.97), smoking (OR 0.38-0.89), speaking Dutch (OR 0.40-0.92), not knowing length (OR 0.36-0.99), family history of breast cancer (OR 0.41-0.94), family history of coronary heart disease (OR 0.45-095) and aging (OR 0.84-0.99). Following a cholesterol-lowering diet was associated with a high SRH (OR 1.10-2.44). CONCLUSIONS: Most of the factors associated with low SRH are known and confirm what has previously been reported in literature. However, the associations between low SRH and not knowing your length, speaking Dutch or having afamily history of breast or colon cancer, as well as the association between high SRH and being on a cholesterol-lowering diet are interesting new findings.

Uncontrolled hypertension among black Africans in the city of Brussels: a case-control study.

AIM: The aim of this study is to identify determinants that are associated with uncontrolled hypertension among black Africans in the city of Brussels. DESIGN: A not-matched case-control study. METHODS: Seventy-five black Africans were assigned to a case group with uncontrolled hypertension and a control group with controlled hypertension. Demographic characteristics, lifestyle and compliance were recorded as well as their blood pressure. Compliance in patients was evaluated by means of the Morisky Medication Adherence Scale-4 (MMAS-4). RESULTS: The mean age of the case group was 52 years (SD 7.8) and for the control group 49 years (SD 6.2). Almost 60% were women. Uncontrolled hypertension was associated with obesity (p = 0.01) and sedentary lifestyle (p = 0.034). About 50% of women were obese and 70% of these had uncontrolled hypertension. Patients with type 2 diabetes had a 4.5 times higher risk for uncontrolled hypertension and lower compliance to the medication regimen compared to non-diabetics. Patients were often treated with diuretics (29%), renin-angiotensin inhibitors (25%), and calcium-channel inhibitors (23%). According to the MMAS4-score uncontrolled patients had an intermediate compliance and the controlled patients had a high compliance. CONCLUSIONS: Black obese women and diabetics had the highest risk for uncontrolled hypertension. Compliance was significantly lower among uncontrolled patients.

Methylphenidate as a treatment for stuttering: a case report.

INTRODUCTION: A randomized placebo controlled trial with methylphenidate (MPH) was set up to identify the effects of MPH on cognition in healthy young adults (ea. without attention deficit hyperactivity disorder, ADHD). Subjects repeatedly performed tests of the immediate and delayed memory and vigilance tasks after administration of placebo or 20 mg MPH. CASE PRESENTATION: We report the case of an 18 year old man who participated in the study. He suffered from stuttering since childhood. During the study phase he reported a remarkable relief of the stuttering after the intake of 20 mg MPH. CONCLUSIONS: For D-amphetamine the beneficial effect on stuttering has been demonstrated but it was never implemented in clinical practice because of important adverse events. MPH, an amphetamine analogue, doesn't present these side effects. For this reason, MPH seems to merit further investigation in a randomized-controlled trial as a possible agent in the treatment of stuttering.Methylphenidate, Stuttering.

A comparison between Moroccan and Belgian type-2 diabetic patients.

The aim of this study was to compare diabetes parameters and complications among Moroccan and Belgian type 2 diabetic patients living in Belgium. In two general practices 62 Belgian and 95 Moroccan diabetic patients aged between 40 and 70 were included. The mean fasting plasma glucose (FPG) was 31% higher in the Moroccan group (186 mg/dL) than in the Belgian group (142 mg/dL) (p < 0.001). Compared with 7.6% in the Belgian group, mean HbA1c was also significantly higher in the Moroccan group (8.7%) (p < 0.001). In the Moroccan group 43% showed at least one of the four major diabetic complications compared to 33% in the Belgian group (p = 0.21). Among Moroccan patients retinopathy occurred in 15%, nephropathy in 32%, neuropathy in 21% and foot problems in 18%.

Knowledge and attitudes about vaccinations among adolescents.

PURPOSE: The aim of this study was to investigate among adolescents in Antwerp their knowledge about vaccination and to describe their information sources, motives and barriers for vaccination. METHODS: In March 2009, adolescents aged between 14 and 17 years from three schools with a mixed Belgian and immigrant population in Antwerp completed a written questionnaire concerning vaccination. The questionnaire was already used and validated in a study in five European countries: France, Italy, Spain, Germany and the United Kingdom. RESULTS: In total 186 adolescents completed the questionnaire. Most of them (93%) knew that vaccination is a method to prevent disease. Most adolescents knew about the existence of vaccines against tetanus (94%), hepatitis B (91%) and human papillomavirus (87%). The most important sources for information were the family physician (83%), the school (79%) and the parents (70%). Their knowledge about vaccinations was not related to courses about vaccination at school. CONCLUSIONS: The physician, the school and the parents play a key role in the vaccination of adolescents. Our results are in many aspects similar to those in the other European countries.

The incidence and first-year mortality of heart failure in Belgium: a 2-year nationwide prospective registration.

AIMS: The aim of this study is to determine the incidence and mortality of heart failure (HF) in Belgium. METHODS: Data were prospectively collected during a 2-year period by a nationwide network of sentinel practices. All adult patients for whom, for the first time the diagnosis of HF was clinically suspected were registered. Patients were finally included if the diagnosis of HF was confirmed after 1 month. RESULTS: The yearly incidence of confirmed HF in the Belgian adult population was estimated to be 194 patients per 100,000 inhabitants (95% CI: 172-218). At diagnosis, the median age of the patients with confirmed HF was 79 years: 82 years for women and 76 years for men (p < 0.0001). For the population aged 55 years or more, the yearly incidence of HF was 502 (95% CI: 444-565) with no significant difference between men and women. At diagnosis, most of the patients were classified as NYHA III (50%), 27% as NYHA IV and 20% as NYHA II. Six months after the initial diagnosis, the mortality was 19% and after 12 months it was 26%. CONCLUSION: In Belgium, yearly 15,643 new patients of HF are diagnosed (95% CI: 13,861-17,590). HF is fatal for more than one quarter of the patients in the first year after the diagnosis.

Forced vital capacity and forced expiratory volume in six seconds as predictors of reduced total lung capacity.

The present study aims to derive guidelines that identify patients for whom spirometry can reliably predict a reduced total lung capacity (TLC). A total of 12,693 lung function tests were analysed on Caucasian subjects, aged 18-70 yrs. Restriction was defined as a reduced TLC. Lower limits of normal (LLN) for TLC were obtained from the European Respiratory Society recommended reference equations. Reference equations from the National Health and Nutrition Examination Survey III were used for forced vital capacity (FVC) and forced expiratory volume in six seconds (FEV(6)). The performance of FVC and FEV(6) to predict the presence of restriction was studied as follows: 1) using two-by-two (2x2) tables; and 2) by logistic regression analysis. Both analyses were performed in obstructive (defined as forced expiratory volume in one second (FEV(1))/FVC or FEV(1)/FEV(6) 100% pred (males) or >85% pred (females). In obstructive patients, spirometry cannot reliably diagnose a concomitant restrictive defect, but it can rule out restriction for patients with forced vital capacity or forced expiratory volume in six seconds >85% pred (males) or >70% pred (females).

The incidence of home accidents is going down in Belgium.

The objective of the present study was to estimate the incidence of home accidents in Belgium in 2002 and to compare them with the results of 1996. The Belgian network of general practitioners (GPs) is a national network of GPs who collect and report data on selected conditions, including home accidents. The data about home accidents were recorded by 181 GPs in 1996 and by 150 GPs in 2002. The standardized incidence of home accidents decreased from 2935 per 100,000 inhabitants in 1996 (95% CI 2846 - 3026) to 2669 in 2002 (95% CI 2588 - 2751). This corresponds to a decrease of 9% (p < 0.001). A decrease of 14% was observed in the Flemish Community (p < 0.001). The reduction was very important (36%) among women aged between 75 and 89 years (p < 0.001). In the French community the decrease was not significant. The incidence of home accidents observed in general practice decreased in Belgium, especially in the Flemish Community.

Lower stroke death rates in patients receiving blood pressure lowering therapy before the onset of a stroke.

The objective of this study was to compare stroke death rates among patients with and without blood pressure lowering treatment before the onset of the stroke. During two consecutive years all patients with acute stroke were recorded by 178 Belgian general practitioners of the sentinel network. In total 511 patients with acute stroke were recorded. The death rate after one month was found significantly higher among the untreated patients (33%; n = 84) compared to those receiving blood pressure lowering treatment (23%; n = 61) (p = 0.007). Blood pressure lowering treatment before the onset of stroke had a beneficial effect on survival in a backward stepwise logistic regression (OR 0.38; 95% CI 0.20-0.72). In conclusion, stroke mortality is significantly lower among patients receiving blood pressure lowering treatment before the onset of stroke compared to those without blood pressure lowering treatment.

The results of dietary advice on lipoprotein levels among patients attending for lipid-lowering drugs.

The aim of this study was to evaluate the changes in fasting lipoproteins levels before and after a dietary advice among the patients attending for a lipid-lowering treatment. In total 286 patients attending for reimbursement of a lipid-lowering drug were recorded at two regional health insurance offices. Lipid levels measured at least three months after the dietary advice were compared with those before the dietary advice. The mean age of the included patients was 61 years. The average fasting total cholesterol (TC) was 7.4 mmol/l before the dietary advice as well as after the dietary advice. Fasting TC did not decrease with the dietary advice in 51% of the included patients. In the logistic regression not one of the studied factors was correlated with a successful dietary advice. Half of the patients receiving lipid-lowering drugs in Belgium were not able to decrease their TC with dietary advice before the initiation of the treatment.

Primary prevention of coronary heart disease in general practice: a cross sectional population study.

The aim of this study was to assess the interventions by general practitioners on cardiovascular risk factors among persons without a history of cardiovascular disease attending for a cardiovascular check-up. All inhabitants of three Belgian towns aged between 45 and 64 years were invited for a cardiovascular check-up and blood test. Of all the attending persons without a history of cardiovascular disease (n = 898), 51% received at least one prescription, diet or health advice: 28% for hyperlipidaemia, 23% for physical activity, 22% for caloric intake, 9% for blood sugar, 5% for blood pressure and 4% for smoking. Interventions on lipoproteins, blood sugar and smoking habits were significantly more often proposed to persons with a medium or high cardiovascular risk compared to those at low cardiovascular risk. For persons at low cardiovascular risk, therapeutic lifestyle changes are often not advised, and isolated risk factors often remain untreated.