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1.  Severe acute respiratory infections during the influenza A(H1N1)2009 pandemic in Belgium: first experience of hospital-based flu surveillance 
Archives of Public Health  2010;68(3):87-93.
Introduction
In September 2009, as part of the surveillance during the Influenza A(2009) pandemic, Bel-gium introduced a web-based surveillance system aimed at recording hospitalisations and deaths attributable to Influenza in real time.
Methods
We present the web-based application developed for the pandemic as well as a descriptive analysis of Severe Acute Respiratory Infection (SARI) cases reported through this system.
Results
From 1 September to 31 December 2009, 1723 SARI-related hospitalisations potentially due to influenza were reported in Belgium. The median age of the patients was 29 years (range: < 1 year-99 years). Among SARI-hospitalised patients 68% were aged less than 45 years, 10.6% were vaccinated with the seasonal influenza vaccine and 7.5% with the pandemic influenza vaccine. No deaths were recorded.
Conclusions
This first experience showed the feasibility of getting real-time information from hospitals during a public health crisis. However, the absence of death detected through the system highlighted the importance of better defining the severity of the hospital cases.
doi:10.1186/0778-7367-68-3-87
PMCID: PMC3463031
SARI; hospitalisation; surveillance; influenza A(H1N1)2009; epidemiology
2.  Blood lead levels in the Kinshasa population: a pilot study 
Archives of Public Health  2010;68(1):30-41.
Objective
Leaded gasoline and lead paints are still in use in the Democratic Republic of Congo but data on blood lead levels in the general population are not available. We evaluated the Pb impregnation in children and adults (0 - 70 years old) in Kinshasa.
Methods
Blood lead was measured by atomic absorption in a sample of 485 healthy people (268 men and 217 women) living in Kinshasa between May 2003 and June 2004.
Results
Geometric mean blood lead was 120 µg/L (95% CI: 115-125), with a higher concentration in men than in women (127 vs 114 µg/L, p = 0.01). Sixty-three percent of children aged less than 6 years old presented blood lead levels above the 100 µg threshold. In the adult population, occupations with a potential risk of exposure to gasoline (car mechanics or garage owners, taxi drivers, conveyors and gas pump attendants) were associated with an extra blood lead of about 65µg/L.
Conclusion
This study indicates a relatively important Pb impregnation of the Kinshasa population. It demonstrates the existence of a major public health issue requiring corrective actions and the implementation of an appropriate regulation.
doi:10.1186/0778-7367-68-1-30
PMCID: PMC3436702
Leaded gasoline; Kinshasa; human exposure; saturnism; blood lead
3.  Influenza A(H1N1)2009 pandemic chronology of the events in Belgium 
Archives of Public Health  2010;68(2):48-52.
doi:10.1186/0778-7367-68-2-48
PMCID: PMC3463025
Belgium; chronology; epidemiology; influenza A virus H1N1 subtype; pandemic
4.  Virological surveillance of the influenza A(H1N1)2009 pandemic: the role of the belgian national influenza centre 
Archives of Public Health  2010;68(2):68-75.
doi:10.1186/0778-7367-68-2-68
PMCID: PMC3463022
Surveillance; Influenza; diagnosis; PCR
5.  Timeliness of syndromic influenza surveillance through work and school absenteeism 
Archives of Public Health  2010;68(3):115-120.
In this paper, we investigate the usefulness of work and school absenteeism surveillance as an early warning system for influenza. In particular, time trends in daily absenteeism rates collected during the A(H1N1)2009 pandemic are compared with weekly incidence rates of influenza-like illness (ILI) obtained from the Belgian Sentinel General Practitioner (SGP) network. The results indicate a rise in absenteeism rates prior to the onset of the influenza epidemic, suggesting that absenteeism surveillance is a promising tool for early warning of influenza epidemics. To convincingly conclude on the usefulness of absenteeism data for early warning, additional data covering several influenza seasons is needed.
doi:10.1186/0778-7367-68-3-115
PMCID: PMC3463027
School absenteeism; worker absenteeism; influenza; influenza A virus; H1N1 subtype
7.  Influenza surveillance in children: first experiences with the Belgian Paediatric Surveillance system 'PediSurv' 
Archives of Public Health  2010;68(3):94-99.
doi:10.1186/0778-7367-68-3-94
PMCID: PMC3463030
Influenza; paediatrics; A(H1N1)2009; epidemiology
8.  Surveillance of influenza-like illness in Belgian nursing homes 
Archives of Public Health  2010;68(3):100-108.
doi:10.1186/0778-7367-68-3-100
PMCID: PMC3463032
Nursing homes; surveillance; influenza; A(H1N1)2009; influenza-like illness; seasonal flu
10.  Surveillance of the 2009 flu pandemic in Belgium 
Archives of Public Health  2010;68(2):45-47.
doi:10.1186/0778-7367-68-2-45
PMCID: PMC3463023
11.  Confirmation diagnosis of influenza A(H1N1)2009 by Belgian sentinel laboratories during the epidemic phase 
Archives of Public Health  2010;68(2):76-82.
doi:10.1186/0778-7367-68-2-76
PMCID: PMC3463024
Influenza; A(H1N1)pandemic; epidemiology; laboratory diagnosis
12.  Clinical surveillance of the influenza A(H1N1)2009 pandemic through the network of sentinel general practitioners 
Archives of Public Health  2010;68(2):62-67.
doi:10.1186/0778-7367-68-2-62
PMCID: PMC3463021
Sentinel surveillance; family practice; Influenza; Influenza A virus; H1N1 Subtype
14.  Lessons learned from the 2009 influenza A(H1N1) pandemic at EU level 
Archives of Public Health  2010;68(3):85-86.
doi:10.1186/0778-7367-68-3-85
PMCID: PMC3463029
15.  Differences in the perception of a mass media information campaign on drug and alcohol consumption 
Archives of Public Health  2010;67(4):161-168.
The two-month mass media campaign in Belgium on drug and alcohol consumption "Alcohol and other drugs. The facts and fictions" initiated in January 2008 has been evaluated shortly after by a phone survey. This article reports some indicators on the public awareness of the campaign, and the differences in the perception according to age groups and education levels.
About 1,000 respondents (n = 1,002) accepted to participate in the campaign evaluation. Response rate is 37.1%. Global perception of the campaign - measured by the capacity to identify the campaign adequately - is 18.8%. This perception varies between age groups and education levels: 30% of the youngest age group (14-35 yrs) have seen the campaign, 13% of people aged 56 and over (p<0.001). The lower the education level, the lower the probability to have seen the campaign (11% in the lowest group, 25% in the highest one, p<0.001).
Among the respondents who have seen the campaign, newspapers are the most often cited media for the oldest age groups. Inversely, young people have mainly identified the campaign on street boards or on post cards.
The privileged type of media is also function of the education level. People belonging to the lowest educational level report more often to have seen the campaign on TV (85% vs 51% in the highest group, p<0.01), while the reverse is true for seeing the campaign via the newspapers or the street boards.
The results indicate that there are socio-economic variations in the perception of the campaign. In health promotion, reaching lower socio-economic groups still remains a real challenge. Channels for such campaigns have to be carefully chosen to reach their target groups and ask to be complemented with community based interventions.
doi:10.1186/0778-7367-67-4-161
PMCID: PMC3436676
16.  Melanoma incidence trends in Limburg after screening and prevention campaigns 
Archives of Public Health  2010;68(1):1-13.
Background
Malignant melanoma is a skin cancer of which the incidence is said to be raising in recent years. Prevention may result in decrease of the incidence. Early detection may result in the detection of earlier stages of the disease. In Limburg a combined campaign of prevention and screening has been performed in recent years and its effects should be evaluated.
Objectives
To study time trends of malignant melanoma incidence and the evolution of stages of detected melanomas and to relate them to interventions in previous years.
Methods
An ongoing multi-faceted intervention, including information as well as screening invitations (Euromelanoma project) was implemented in 1999. Time trends of malignant melanoma were studied on the basis of data from the Limburg Cancer Registry (LIKAR) of 1996-2005. Stages were studied on the basis of an additional clinical registration completed by pathologists and dermatologists.
Results
Over the years 1996-2005, the crude incidence rate of malignant melanoma was 6.8/100,000 patient-years in males and 11.6 in females, with a European standardized incidence rate (ESR) of 6.4 in males and 10.5 in females. The incidence progressively increased with age.
In males, the ESR initially decreased, followed by a significant increase from 3.0 in 1998 to 7.6 in 2005. On average this is a yearly increase of 0.5 per 100,000 persons (p= 0.04). In females the curve fluctuates, resulting in almost similar rates in 1996 and 2004 (p = 0.85), but with a sudden increase from 9.2 to 15.8 between 2004 and 2005.
Neither the Breslow nor the Clarck classification showed any significant change over the registration period. The proportion of lymph node invasion, metastasis and ulcerations did not change.
Discussion
With the exception of a small and clinically irrelevant increase in ESR in males, no changes over time were detected in incidence or stage distribution. The effect of the intervention seems limited.
doi:10.1186/0778-7367-68-1-1
PMCID: PMC3436700
Melanoma; screening; incidence trends
17.  The socio-economic distribution of health-related occupational stressors among wage-earners in a Post-Fordist labour market 
Archives of Public Health  2010;68(1):14-29.
Unequal exposure to occupational stressors is a central pathway towards socio-economic health inequalities in working populations. This paper assesses the differential exposure of such stressors within the population of Flemish wage-earners. Our focus is on differences in gender, age, skill levels, occupational and social class positions.
Method
The analyses are based on the "Flemish Quality of Labour Monitor 2004" (Vlaamse Werkbaarheidsmonitor 2004), a cross-sectional representative sample (N = 11,099) of 16- to 65-year-old wage-earners, living in Flanders. The investigated health-related working conditions are: high quantitative, emotional and physical demands, frequent repetitive movements, atypical work schedules, frequent overtime work and schedule changes, low job autonomy, task variation and superior-support, high job insecurity and exposure to bullying. The distribution of the working conditions is assessed by means of standard logistic regression analyses. Also gender specific analyses are performed.
Results
At least two clusters of health-related occupational stressors can be identified. On the one hand, high physical demands, atypical schedules, low control over the work environment and high job insecurity are more common in manual, unskilled and subordinate workers. On the other hand, high quantitative and emotional demands, as well as schedule unpredictability are characteristic of higher skilled, professional and managerial employees.
Conclusion
Since little empirical information on the socio-economic distribution of various health-related occupational stressors is available for Flanders, our results are important for obtaining more insight into the pathways linking occupational health risks to socio-economic health inequalities in the Flemish wage-earning population.
doi:10.1186/0778-7367-68-1-14
PMCID: PMC3436701
Age distribution; Belgium; gender; health inequality; occupational health; occupational groups; social class; socio-economic factors
19.  Evidence-based prevention of cannabis use in flanders is there a role for health economic evaluation? 
Archives of Public Health  2010;67(4):146-160.
Objectives
Cannabis is a popular drug in Flanders, in spite of the fact that the prevention of its use lists high on the Flemish political agenda. The Flemish Government aims to prevent cannabis use efficiently and in achieving this, a health economic analysis could be helpful. The possibilities and limitations of applying economic evaluation techniques to the prevention of substance (ab)use, are discussed in this paper.
Methods
A thorough literature search, interviews with key persons, an internet search and an analysis of unpublished reports and documents was performed.
Results
The interrelation between various forms of substance use, and of the array of strategies to prevent this (including the costs thereof), seems to demand a joint evaluation of multiple substances.
Conclusions
More than methodological difficulties, the general lack of knowledge on age- and time-specific health and income effects caused by various forms of substance (ab)use, currently makes the evidence-based evaluation of prevention of cannabis use in Flanders a virtually impossible undertaking.
doi:10.1186/0778-7367-67-4-146
PMCID: PMC3436675
Belgium; cannabis; evidence-based medicine; medical economics; prevention; programme effectiveness
20.  Stimulant medication use among Flemish students: results from an exploring secondary data analysis1965-2005 
Archives of Public Health  2010;67(4):169-178.
Background/Aim
Recent media coverage in the Flemish media in Belgium reinforced the general public opinion on medication use among students, suggesting an alarming magnitude and a rising trend, with the use of stimulants as a specific element for enhancing study performances. These assumptions needed scientific verification, which we intended to do with this study.
Method
Secondary data analysis was conducted on four Belgian studies on medication use among students from 1965, 1969, 1993 and 2005. The 2005 survey data are also used to give an insight in prevalence and frequency of use during exams and in other periods and to widen the scope to poly-substance use.
Main Findings
All studies show prevalence figures for stimulant medication use under 10%. Prevalence and frequency of use is highest during exam periods. No gender differences were found for stimulant medication use. Living status on the other hand is an influential factor: students living away from the parental home report higher prevalence rates than students still living in their parents' house. Prescription regulations seem to have a declining impact on the most popular products.
Conclusions/Discussion
Students' medication use, more particularly during exam periods, appears to be an all-time reality in Flanders. No indications for a rising trend were found. Although the extent of stimulant medication use is relatively limited, a small minority shows more risky consumption patterns: daily use of stimulant medication (incl. risky side effects) during exam periods and higher prevalence of poly-substance use. More research is needed, particularly on the most consumed products (e.g. methylphenidates) and on the supplying sources of this medication.
doi:10.1186/0778-7367-67-4-169
PMCID: PMC3436677
Students; substance abuse; central stimulants; residence characteristics; gender
21.  Cannabis-Related treatment demands in Belgium: a socio-demographic and treatment seeking profile 
Archives of Public Health  2010;67(4):179-193.
Aims
Most people appear to stop using cannabis when getting older, but a certain subgroup becomes cannabis dependent, has problems in various life areas and needs treatment. Our aim is to compare a number of sociodemographic and treatment seeking variables between treatment seekers with primary cannabis problems and those with primary alcohol, opiate, amphetamine or cocaine problems. Understanding how primary canna-bis users seeking treatment differ from other treatment seekers may assist clinicians in better tailoring treatment processes to clients' needs.
Methods
For this purpose, intake information on 1,626 persons seeking treatment in one of 16 treat-ment agencies in the province of Antwerp (Belgium) was registered via an on-line web application. Primary cannabis users seeking treatment were compared with primary alcohol, opiate, amphetamine and cocaine users by means of bivariate analyses (Chi-square tests and analyses of variance), followed by four logistic regression analyses.
Findings
14.5% of all clients used cannabis as their primary drug. Compared to primary alcohol, opiate, amphetamine or cocaine users seeking treatment, cannabis users seeking treatment appeared to be more often male, younger than 30 years old, Belgian and student. They are often referred to treatment by police or justice and 43.6% of them can be considered single-substance users. Multivariate analyses showed that besides age and sex, using no other substances than the primary drug and being registered in outpatient facilities only were significant determinants for being a primary cannabis user seeking treatment.
Conclusions
Primary cannabis users can clearly be differentiated from other drug users seeking treatment. Although cannabis plays an important part in a polydrug use pattern, persons who have cannabis as their primary drug often use only this one substance. Since they regularly have brief contacts with treatment agencies, more research is needed to measure the effect of this brief intervention.
doi:10.1186/0778-7367-67-4-179
PMCID: PMC3436678
Cannabis; Treatment Demand; Substance Abuse Treatment; Drug Use; Demographics
22.  Determinants of relapse and re-admission among alcohol abusers after intensive residential treatment 
Archives of Public Health  2010;67(4):194-211.
Little information is available in Belgium on the number and characteristics of alcohol abusers who contact treatment agencies and on the effectiveness of these services. International research has identified some determinants of relapse and recovery after treatment, but additional research is needed in order to better tailor services to the needs of service users.
This study aimed at measuring abstinence and relapse among alcohol abusers (n = 249) after intensive, residential treatment in specialized units in five Belgian psychiatric hospitals. Six month outcomes concerning substance use, psychological health, social support and integration were studied using the EuropASI. Logistic regression analyses were performed to identify predictors of relapse and readmission.
Significant reductions in the severity of alcohol and psychological problems were observed, but six months after the initial treatment episode more than half of all respondents (54%) had been using alcohol regularly. The domains 'psychiatric problems' and 'patients' personal perspectives' were the best predictors of relapse and readmission. Also, 'patients' living situations' predicted relapse. Specific variables that independently predicted relapse were 'satisfaction with day activities' and 'number of days with problems due to alcohol'. Less severe psychiatric problems at the start of treatment and more severe psychiatric problems and negative feelings of wellbeing at the time of follow-up were independent predictors of readmission.
We conclude that treatment agencies need to recognize the relapsing nature of alcohol abuse and have to organize their services from a continuing care perspective, including specific attention for individuals' psychological needs and day/leisure activities.
doi:10.1186/0778-7367-67-4-194
PMCID: PMC3436679
Alcohol abuse; treatment; relapse; recovery; continuity of care; aftercare; case management

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