Association between urban environment and mental health in Brussels, Belgium.

BACKGROUND: Mental health disorders appear as a growing problem in urban areas. While common mental health disorders are generally linked to demographic and socioeconomic factors, little is known about the interaction with the urban environment. With growing urbanization, more and more people are exposed to environmental stressors potentially contributing to increased stress and impairing mental health. It is therefore important to identify features of the urban environment that affect the mental health of city dwellers. The aim of this study was to define associations of combined long-term exposure to air pollution, noise, surrounding green at different scales, and building morphology with several dimensions of mental health in Brussels. METHODS: Research focuses on the inhabitants of the Brussels Capital Region older than 15 years. The epidemiological study was carried out based on the linkage of data from the national health interview surveys (2008 and 2013) and specifically developed indicators describing each participant's surroundings in terms of air quality, noise, surrounding green, and building morphology. These data are based on the geographical coordinates of the participant's residence and processed using Geographical Information Systems (GIS). Mental health status was approached through several validated indicators: the Symptom Checklist-90-R subscales for depressive, anxiety and sleeping disorders and the 12-Item General Health Questionnaire for general well-being. For each mental health outcome, single and multi-exposure models were performed through multivariate logistic regressions. RESULTS: Our results suggest that traffic-related air pollution (black carbon, NO2, PM10) exposure was positively associated with higher odds of depressive disorders. No association between green surrounding, noise, building morphology and mental health could be demonstrated. CONCLUSIONS: These findings have important implications because most of the Brussel's population resides in areas where particulate matters concentrations are above the World Health Organization guidelines. This suggests that policies aiming to reduce traffic related-air pollution could also reduce the burden of depressive disorders in Brussels.

Residing in urban areas with higher green space is associated with lower mortality risk: A census-based cohort study with ten years of follow-up.

BACKGROUND: Epidemiological studies suggest that residing close to green space reduce mortality rates. We investigated the relationship between long-term exposure to residential green space and non-accidental and cardio-respiratory mortality. METHODS: We linked the Belgian 2001 census to population and mortality register follow-up data (2001-2011) among adults aged 30 years and older residing in the five largest urban areas in Belgium (n = 2,185,170 and mean follow-up time 9.4 years). Residential addresses were available at baseline. Exposure to green space was defined as 1) surrounding greenness (2006) [normalized difference vegetation index (NDVI) and modified soil-adjusted vegetation index (MSAVI2)] within buffers of 300 m, 500 m, and 1000 m; 2) surrounding green space (2006) [Urban Atlas (UA) and CORINE Land Cover (CLC)] within buffers of 300 m, 500 m, and 1000 m; and 3) perceived neighborhood green space (2001). Cox proportional hazards models with age as the underlying time scale were used to probe into cause-specific mortality (non-accidental, respiratory, COPD, cardiovascular, ischemic heart disease (IHD), and cerebrovascular). Models were adjusted for several sociodemographic variables (age, sex, marital status, country of birth, education level, employment status, and area mean income). We further adjusted our main models for annual mean (2010) values of ambient air pollution (PM2.5, PM10, NO2 and BC, one at a time), and we additionally explored potential mediation with the aforementioned pollutants. RESULTS: Higher degrees of residential green space were associated with lower rates of non-accidental and respiratory mortality. In fully adjusted models, hazard ratios (HR) per interquartile range (IQR) increase in NDVI 500 m buffer (IQR: 0.24) and UA 500 m buffer (IQR: 0.31) were 0.97 (95%CI 0.96-0.98) and 0.99 (95%CI 0.98-0.99) for non-accidental mortality, and 0.95 (95%CI 0.93-0.98) and 0.97 (95%CI 0.96-0.99) for respiratory mortality. For perceived neighborhood green space, HRs were 0.93 (95%CI 0.92-0.94) and 0.94 (95%CI 0.91-0.98) for non-accidental and respiratory mortality, respectively. The observed lower mortality risks associated with residential exposure to green space were largely independent from exposure to ambient air pollutants. CONCLUSION: We observed evidence for lower mortality risk in associations with long-term residential exposure to green space in most but not all studied causes of death in a large representative cohort for the five largest urban areas in Belgium. These findings support the importance of the availability of residential green space in urban areas.

Epidemiological, clinical and mycological study of dermatomycosis in diabetic patients.

BACKGROUND: Dermatomycosis are fungal infections of the skin and/or phanera, which are often benign but can have an impact on the vital and functional prognosis in diabetic patients. AIM: The aim of our work was to study the epidemiological, clinical and mycological profile of dermatomycosis in diabetic patients. METHODS: This was a retrospective descriptive study carried out in the Parasitology-Mycology Laboratory of Charles-Nicolle Hospital over a three-year period (2016-2018). We collected diabetic patients who were referred for suspected dermatomycosis. RESULTS: Dermatomycosis was confirmed in 799 of the 1007 diabetic patients referred to our laboratory (79.34%) and in 1055 lesions among the 1344 sites sampled (78.50%). Among patients with dermatomycosis, a female predominance was observed with a sex- ratio=0.83. The mean age of the patients was 57.11 [2-82]. The patients with type 2 diabetes were the most affected (86.35%) (p=0.038). The mean duration of lesion progression was 5.0±5.5 years. The most common dermatomycoses were toenail onychomycoses (59.62%), followed by fingernail onychomycoses (15.26%), plantar keratoderma (10.24%), and intertrigo in small skin folds (5.59%). Dermatophytes were the most frequently isolated fungi (80.1%; p<0.001), with predominance of Trichophyton rubrum (78.8%). Candida albicans was the most frequently isolated yeast (11.8%). CONCLUSIONS: Dermatomycosis are common in diabetic patients. Although they are often benign, these fungal infections can engage the functional prognosis or even become life-threatening in case of diabetes. Mycological diagnosis is necessary in case of clinical suspicion in order to confirm the diagnosis, guide the treatment and avoid complications.

Avian mite bites acquired from pigeons: Report of three cases and review of the literature.

BACKGROUND: Skin lesions caused by avian mite bites are uncommon and often misdiagnosed. They are usually caused by bites from avian mites that have infested domestic poultry or birds nesting in or near human habitation. We report three cases of human skin lesions from avian mites infesting pigeons. OBSERVATIONS: Three persons working in the same place developed similar skin pruritic papules simultaneously. The diagnosis remained unknown until Dermanyssus gallinae (chicken mite) was found on the computer's table of the three individuals workplace, situated near a window where pigeons used to live. Antihistaminic treatment was carried out with a skin disinfestation. In two cases, symptoms resolved after one week of treatment. In the third case, corticosteroids were needed. CONCLUSIONS: Avian mite bites skin lesions can remain unrecognized or misdiagnosed. Inquiry about contact with pigeons or poultry may be helpful in patients with nonspecific skin lesions.

Urban environment and mental health: the NAMED project, protocol for a mixed-method study.

INTRODUCTION: Mental health issues appear as a growing problem in modern societies and tend to be more frequent in big cities. Where increased evidence exists for positive links between nature and mental health, associations between urban environment characteristics and mental health are still not well understood. These associations are highly complex and require an interdisciplinary and integrated research approach to cover the broad range of mitigating factors. This article presents the study protocol of a project called Nature Impact on Mental Health Distribution that aims to generate a comprehensive understanding of associations between mental health and the urban residential environment. METHODS AND ANALYSIS: Following a mixed-method approach, this project combines quantitative and qualitative research. In the quantitative part, we analyse among the Brussels urban population associations between the urban residential environment and mental health, taking respondents' socioeconomic status and physical health into account. Mental health is determined by the mental health indicators in the national Health Interview Survey (HIS). The urban residential environment is described by subjective indicators for the participant's dwelling and neighbourhood present in the HIS and objective indicators for buildings, network infrastructure and green environment developed for the purpose of this project. We assess the mediating role of physical activity, social life, noise and air pollution. In the qualitative part, we conduct walking interviews with Brussels residents to record their subjective well-being in association with their neighbourhood. In the validation part, results from these two approaches are triangulated and evaluated through interviews and focus groups with stakeholders of healthcare and urban planning sectors. ETHICS AND DISSEMINATION: The Privacy Commission of Belgium and ethical committee from University Hospital of Antwerp respectively approved quantitative database merging and qualitative interviewing. We will share project results with a wide audience including the scientific community, policy authorities and civil society through scientific and non-expert communication.

Residential green space, air pollution, socioeconomic deprivation and cardiovascular medication sales in Belgium: A nationwide ecological study.

Green space may improve cardiovascular (CV) health, for example by promoting physical activity and by reducing air pollution, noise and heat. Socioeconomic and environmental factors may modify the health effects of green space. We examined the association between residential green space and reimbursed CV medication sales in Belgium between 2006 and 2014, adjusting for socioeconomic deprivation and air pollution. We analyzed data for 11,575 census tracts using structural equation models for the entire country and for the administrative regions. Latent variables for green space, air pollution and socioeconomic deprivation were used as predictors of CV medication sales and were estimated from the number of patches of forest, census tract relative forest cover and relative forest cover within a 600 m buffer around the census tract; annual mean concentrations of PM2.5, BC and NO2; and percentages of inhabitants that were foreign-born from lower- and mid-income countries, unemployed or had no higher education. A direct association between socioeconomic deprivation and CV medication sales [parameter estimate (95% CI): 0.26 (0.25; 0.28)] and inverse associations between CV medication sales and green space [-0.71 (-0.80; -0.61)] and air pollution [-1.62 (-1.69; -0.61)] were observed. In the regional models, the association between green space and CV medication sales was stronger in the region with relatively low green space cover (Flemish Region, standardized estimate -0.16) than in the region with high green space cover (Walloon Region, -0.10). In the highly urbanized Brussels Capital Region the association tended towards the null. In all regions, the associations between CV medication sales and socioeconomic deprivation were direct and more prominent. Our results suggest that there may be an inverse association between green space and CV medication sales, but socioeconomic deprivation was always the strongest predictor of CV medication sales.

[Vulvovaginal trichomoniasis: epidemiology, clinical and parasitological characteristics]. / Trichonomose vulvovaginale: Etude épidémiologique, Clinique et parasitilogique.

BACKGROUND: Trichomonas vaginalis infection is the most prevalent nonviral sexual transmitted infection. The World Health Organization estimates that its prevalence is 170 million cases worldwide each year. In women, he represents the third cause of vaginitis. AIM: to determine the prevalence, to evaluate predisposing factors and to study the clinical and parasitological characteristics of vulvovaginal trichomoniasis in a Tunisian population during a period of 18 months. METHODS: This is a transversal study concerning 924 women. We administered a questionnaire to obtain information about the possible risk factors of vulvovaginal trichomoniasis. Vaginal swabs were collected with the help of sterile transportable cotton swabs, followed by microscopic examination. Data were statistically analyzed. RESULTS: Trichomonas vaginalis infection was diagnosed in 3,5% of cases. The study various potential risk factors showed that trichomoniasis was significatively associated with multiple partners, long-term corticotherapy. However, the pregnancy was a protector factor. CONCLUSION: The research for factors allows not only to explain the appearance of this infection but also, and especially, to establish a disease prevention to avoid their second offense or, at best their arisen in women at risk.

Bis(4-amino-pyridinium) dichromate(VI).

The asymmetric unit of the title salt, (C5H7N2)2[Cr2O7], contains four independent cations and two independent dichromate anions. The crystal structure consists of discrete dichromate anions with an eclipsed conformation stacked in layers parallel to (010) at y = 1/4 and y = 3/4. These layers are linked via 4-amino-pyridinium cations by N-H⋯O and weak C-H⋯O hydrogen bonds, forming a three-dimensional supra-molecular network. In addition, π-π inter-actions are present in this structure; the shortest distance separating mean planes through 4-amino-pyridinium cations is 3.679 (6) Å.

Propane-1,2-di-ammonium chromate(VI).

In the title mol-ecular salt, (C3H12N2)[CrO4], each chromate anion accepts six N-H⋯O and C-H⋯O hydrogen bonds from nearby propane-1,2-di-ammonium cations. Three of the four O atoms of the chromate anion accept these bonds; the remaining Cr-O bond length is notably shorter than the others. In the crystal, the anions and cations stack in layers lying parallel to (100): the hydrogen-bonding pattern leads to a three-dimensional network.

Visceral leishmaniasis after kidney transplantation: report of a new case and a review of the literature.

Visceral leishmaniasis (VL) is a parasitic disease, caused by protozoa of the genus Leishmania, transmitted by the phlebotomies sand fly. In the last 20 years, the increasing frequency of organ transplantations and the improvement of associated immunosuppressive treatments have led to the recognition of several cases of VL complicating organ transplantation. Actually, less than 100 cases of VL after kidney transplantation are reported in the literature. In this context, VL is fatal without antileishmanial treatment which constitutes a difficult challenge. We report a case of VL in Tunisian renal transplant recipient treated successfully by liposomal amphotericin B (Ambisome®, Gilead Sciences Inc). Also, we review the epidemiological, clinical, biological and therapeutic aspects of VL associated with renal transplantation reported in the literature. Our report identifies that VL should be suspected in renal transplant recipients presenting unexplained fever, splenomegaly and pancytopeny. It also suggests a serological testing for leishmaniasis in the pre-operative check-up of transplant patients and donors living or traveling in endemic areas of leishmaniasis. Moreover, recipients should be tested regularly for leishmaniasis after transplantation. Liposomal amphotericin B may be considered the treatment of choice of VL, since it has a lower incidence of side effects.

[Anemia caused by parasites]. / Les anémies d'origine parasitaire.

Anemia is a major public health problem and concerns the World Health Organization. It is more common in developing countries particularly in South Asia and Africa. The causes of anemia are varied and parasites can cause it. We propose to study the anemia caused by parasites after a brief hematology and pathophysiology of anemia in general.

Propane-1,3-diammonium dichromate(VI).

The title compound, (C(3)H(12)N(2))[Cr(2)O(7)], consists of a discrete dichromate anion with an eclipsed conformation and a propane-1,3-diammonium cation. Both kinds of ions have a mirror plane passing through the bridging O atom and the central methyl-ene C atom of the Cr(2)O(7) (2-) and C(3)H(12)N(2) (2+) moieties, respectively. Anions and cations are alternately stacked to form columns parallel to the b axis. Ions are linked by intra- and inter-column hydrogen bonds of types N-H⋯O and C-H⋯O, involving O atoms of the dichromate anions as acceptors, and ammonium or methyl-ene groups as donors.

Is there any change in the prevalence of intestinal and urinary parasitosis among "non-permanent resident" students in Tunisia ?

BACKGROUND: Intestinal parasitosis are cosmopolitan affections, often related to the fecal peril. However urinary bilharziosis is a disease eliminated in Tunisia. As part of monitoring the emergence and re-emergence of intestinal parasitosis and urinary bilharziasis, foreign students benefit from parasitological systematic monitoring stool and urine during their enrollment to the University. AIM: To study the prevalence of various intestinal parasitosis and urinary bilharziasis among non permanent resident students in Tunisia. METHODS: A retrospective survey was carried at the Laboratory of Parasitology- Mycology of Charles Nicolle Hospital of Tunis during the inscription period of 6 university years 2005-2010. 328 students profited from a parasitological examination of stool and urine. RESULTS: 144 students (43.9%) harbored intestinal parasites. More than one parasite was detected in 69 students (47.9%). Intestinal protozoa were the majority of identified parasites (96.9%). 9.7% of identified parasites were pathogenic. Three cases (0.91%) of urinary bilharziasis were diagnosed. CONCLUSION: The prevalence of intestinal and urinary parasitism among the "non-permanent residents" students in Tunisia has not changed. This justifies a systematic parasitologic monitoring for students coming from areas of high endemicity of parasitosis in order to avoid the introduction of these.

[Procedure and indications of stool examination in parasitology]. / Procédure et indications d'un examen parasitologique des selles.

Intestinal parasites are a public health problem in the world especially in tropical and subtropical countries. Despite the improvement in living standards and healthy conditions, these parasitoses remain relatively frequent in Tunisia. Stool specimen examination keeps the fundamental test for screening and diagnosis. It is to directly search the parasite. Respect for the right procedure of collection of stool is an essential step for the reliability and proper interpretation of results of this examination.

First case of subcutaneous dermatomycoses in a Tunisian renal transplant patient.

BACKGROUND: Dermatophytes are keratinophilic and usually infect the corneal layer of the epidermis and appendages On the occasion of immunosuppression, such as solid organ transplant, they can invade deeper tissues or cause an infection of the skin and subcutaneous disseminated. AIM: To report the first observation of subcutaneous dematophytosis in a Tunisian renal transplant patient. CASE REPORT: A 29-year-old man had an erythematous lesion of 2 cm at the front of the left leg. He was treated with prednisone and tacrolimus. The skin lesion was has been neglected. The outcome was the occurrence of oozing whose mycological examination showed numerous hyphae and culture was positive for Microsporum canis. Initial treatment was voriconazole, but an interaction with tacrolimus has shortened the duration of treatment to 1 month. Three months later, the lesion became deeper, and then a biopsy was performed. The mycological examination showed the same appearance, previously described. The patient was put on fluconazole by adjusting the doses of tacrolimus and then underwent surgical excision of the lesions. The evolution after 4 months of antifungal treatment was favorable. CONCLUSION: The increasing incidence of immunosuppressive therapy has given rise to unusual clinical forms of invasive and sometimes serious fungal agents whose pathogenicity is usually limited. Clinicians should be mindful of superficial fungal infections of the skin in a renal transplant patient.