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3.  Economic crisis on public health 
Archives of Public Health  2009;67(3):97-99.
PMCID: PMC3463018
5.  A longitudinal study on the Ghislenghien disaster in Belgium: strengths and weaknesses of the study design and influence on response rate 
Archives of Public Health  2009;67(3):116-127.
A longitudinal study was conducted in order to assess the impact of the Ghislenghien disaster (Belgium) on physical, mental and social health, and to evaluate the prevalence of Post-Traumatic Stress Disorder (PTSD) in the affected population.
To describe the set up of the study, to report on the strengths and weaknesses of the methodology employed and its influence on response rate. To clarify the importance of the study for the management of disasters.
The study included adults (≥ 15 years) and children (8-14 years) at risk of developing adverse health effects related to the disaster. Subjects were connected to the disaster through their geographical or professional proximity as well as connections through relatives. Questionnaires were sent by regular mail 5 months and 14 months after the disaster. Pearson Chi square tests were used to investigate whether the response rate at 14 months depended on the exposure classification.
The response rate at household level was respectively 18% (n = 607 families) and 56% (n = 338 families) 5 months and 14 months after the disaster. Response rate at the follow up period did not significantly differ by exposure classification.
This paper discusses the difficulties and challenges encountered during the design of the study. It discusses the determinants of response in relation to disaster related characteristics. It further provides an overview of lessons learnt and the significance of the study for the management of large scale emergencies.
PMCID: PMC3463017
Technological disaster; exposure classification; gas explosion; longitudinal study; response rate
6.  Description of cervical cancer mortality in Belgium using Bayesian age-period-cohort models 
Archives of Public Health  2009;67(3):100-115.
To correct cervical cancer mortality rates for death cause certification problems in Belgium and to describe the corrected trends (1954-1997) using Bayesian models.
Cervical cancer (cervix uteri (CVX), corpus uteri (CRP), not otherwise specified (NOS) uterus cancer and other very rare uterus cancer (OTH) mortality data were extracted from the WHO mortality database together with population data for Belgium and the Netherlands.
Different ICD (International Classification of Diseases) were used over time for death cause certification. In the Netherlands, the proportion of not-otherwise specified uterine cancer deaths was small over large periods and therefore internal reallocation could be used to estimate the corrected rates cervical cancer mortality. In Belgium, the proportion of improperly defined uterus deaths was high. Therefore, the age-specific proportions of uterus cancer deaths that are probably of cervical origin for the Netherlands was applied to Belgian uterus cancer deaths to estimate the corrected number of cervix cancer deaths (corCVX).
A Bayesian loglinear Poisson-regression model was performed to disentangle the separate effects of age, period and cohort.
The corrected age standardized mortality rate (ASMR) decreased regularly from 9.2/100 000 in the mid 1950s to 2.5/100,000 in the late 1990s. Inclusion of age, period and cohort into the models were required to obtain an adequate fit. Cervical cancer mortality increases with age, declines over calendar period and varied irregularly by cohort.
Mortality increased with ageing and declined over time in most age-groups, but varied irregularly by birth cohort. In global, with some discrete exceptions, mortality decreased for successive generations up to the cohorts born in the 1930s. This decline stopped for cohorts born in the 1940s and thereafter. For the youngest cohorts, even a tendency of increasing risk of dying from cervical cancer could be observed, reflecting increased exposure to risk factors. The fact that this increase was limited for the youngest cohorts could be explained as an effect of screening.
Bayesian modeling provided similar results compared to previously used classical Poisson models. However, Bayesian models are more robust for estimating rates when data are sparse (youngest age groups, most recent cohorts) and can be used to for predicting future trends.
PMCID: PMC3463015
Cervical cancer; trend analysis; mortality; Bayesian analysis; age-cohort-period modelling
7.  A randomized clinical trial using an educational intervention demonstrated no effect on interobserver agreement on assessments of functional status 
Archives of Public Health  2009;67(3):128-141.
To evaluate the effect of an educational intervention on interobserver agreement of assess-ments of functional status performed by registered nurses and care assistants in a nursing home and to compare interobserver agreement in persons with and without cognitive impairment.
High accuracy of assessments of functional status in care settings for older persons is needed for the efficacy of the planning and the evaluation of the nursing care.
Randomized clinical trial. Six registered nurses and six care assistants were randomized to participate in an educational session about assessment instruments for functional status (intervention) or in a session about falls in the elderly (control). Each of the registered nurses and care assistants performed assessments on the same thirty-four residents using the Belgian Evaluation Scale (BES) and the AGGIR instrument. The kappa statistic (κ) for multiple observers (and its 95% confidence interval) was the main outcome measure.
At baseline, interobserver agreement for BES total score was: κ = 0.43 (0.35-0.51) in the intervention group and κ = 0.48 (0.39-0.57) in the control group. At the second assessment, agreement measures were: κ = 0.48 (0.41-0.57) in the intervention group and κ = 0.58 (0.50-0.66) in the control group. Results for AGGIR total scores were similar.
Interobserver agreement of assessments on nursing home residents was moderate and did not improve significantly after an educational session.
PMCID: PMC3463016
Assessment; nursing; nursing home; reliability; randomized clinical trial; Belgian Evaluation Scale; Autonomie Gérontologie Groupe Iso-Ressources (AGGIR)
8.  Type 2 diabetes in Belgians of Turkish and Moroccan origin 
Archives of Public Health  2009;67(2):62-87.
To compare the prevalence of type 2 diabetes in adults aged 35 to 74 years of the Turkish and Moroccan communities in Belgium with the prevalence in native Belgians. To examine the determinants and specific mechanisms responsible for differences in diabetes between these communities.
Both objectives were examined using the Health Interview Surveys of 1997, 2001 and 2004. Stepwise logistic regression analyses were performed with diabetes as the outcome variable. The variables 'age', 'sex', 'ethnic origin', 'body mass index', 'lack of physical activity', 'educational attainment' and 'income' were introduced in the model in consecutive steps.
In 35- to 74-year-olds, the prevalence of type 2 diabetes is higher in Belgians of Tur-kish and Moroccan origin than in native Belgians. In native Belgian men, the prevalence amounts to 5.0%. In 35- to 74-year-old men of Turkish and Moroccan origin, the diabetes prevalence is 5.8% and 6.5% respectively. 4.3%, 18.7% and 11.9% of the women of Belgian, Turkish and Moroccan origin respectively suffer from diabetes. In men, differences in the prevalence of diabetes are strongly reduced after controlling for lack of physical activity and educational attainment. In women, differences remain high, although they become smaller after accounting for BMI and educational attainment.
In men, the differences in diabetes prevalence are explained by lifestyle factors and educational attainment. In women, the community differences in diabetes prevalence persist, although lifestyle factors and educational attainment play an important part in understanding these differences.
PMCID: PMC3463009
Belgium; body mass index; diabetes mellitus; immigrants; Morocco; physical exercise; socio-economic factors; Turkey
9.  The increase in physical performance and gain in lean and fat mass occur in prepubertal children independent of mode of school transportation. One year data from the prospective controlled Pediatric Osteoporosis Prevention (POP) Study 
Archives of Public Health  2009;67(2):88-96.
The aim of this 12-month study in pre-pubertal children was to evaluate the effect of school transportation on gain in lean and fat mass, muscle strength and physical performance.
Ninety-seven girls and 133 boys aged 7-9 years from the Malmö Pediatric Osteoporosis Prevention Study were included. Regional lean and fat mass were assessed by dual energy X-ray absorptiometry, isokinetic peak torque of knee extensors and flexors by a computerised dynamometer and physical performance by vertical jump height. Level of physical activity was assessed by accelerometers. The 12-month changes in children who walked or cycled to school were compared with changes in those who travelled by bus or car.
There were no differences in baseline or annual changes in lean or fat mass gain, muscle strength or physical performance between the two groups. All children reached the internationally recommended level of 60 minutes per day of moderate or high physical activity by accelerometers.
The choice of school transportation in pre-pubertal children seems not to influence the gain in lean and fat mass, muscle strength or functional ability, probably as the everyday physical activity is so high that the mode of school transportation contributes little to the total level of activity.
PMCID: PMC3463010
Accelerometers; active commuting; body composition; fat mass; lean mass; muscle strength; physical activity; vertical jump height
10.  Noise nuisance and health inequalities in Belgium: a population study 
Archives of Public Health  2009;67(2):52-61.
Lower socioeconomic groups are more likely to live in contaminated environments. This may partly explain socioeconomic health inequalities.
Does noise nuisance contribute to socio-economic inequalities in subjective health?
This research is based on the last Belgian census data carried out in 2001. We work on a 10% sample of the Belgian population. The data are processed through bivariate and multivariate analyses. We model poor subjective health in relation to exposure to noise nuisance and several socio-economic variables.
The risk of poor subjective health increases with noise nuisance and is higher in lower socio-economic groups. Noise nuisance does contribute to health inequalities, particularly regarding type of housing and activity. These relations are stronger in urban areas.
Noise nuisance affects the subjective health status and contributes to health inequalities, particularly in urban areas. This suggests that public policies, particularly those related to environmental planning, should be driven also by environmental equity considerations.
PMCID: PMC3463011
Health inequalities; noise nuisance; socio-economic factors; subjective health; urban health
11.  Measurement equivalence of the CES-D 8 in the general population in Belgium: a gender perspective 
Archives of Public Health  2009;67(1):15-29.
International research consistently finds gender differences in depression, but do women genuinely experience more complaints or are the findings contaminated by group-specific elements unrelated to depression but affecting its measurement? The study of gender differences in depression depends on the measurement quality of the instrument used to evaluate depression. In the present study we test the measurement equivalence of a shorter version of a commonly used instrument in mental health research, the Center for Epidemiologic Studies - Depression Scale (CES-D), using data from the Belgian sample of the third round of the European Social Survey (N = 1794). Evidence for measurement invariance can be established within the multigroup confirmatory factor analysis framework. This method allows us to evaluate a nested hierarchy of hypotheses to test different levels of cross-group measurement invariance: configural, metric, scalar and residual invariance, and clarifies under what conditions meaningful comparisons between the male and female respondents can be made. The best fitting factor model is then used to estimate the 'true' prevalence of depressive symptoms for both groups. In our study measurement equivalence is established at all levels, indicating that the current depression scale allows defensible quantitative gender comparisons. Our data also confirm the epidemiological finding that women report more complaints of depression than men.
PMCID: PMC3436693
Depression; factor analysis; gender; validation; psychometrics
12.  Access to mental health for asylum seekers in the European Union. An analysis of disparities between legal rights and reality 
Archives of Public Health  2009;67(1):30-44.
The article explores some of the issues surrounding access to mental health care for asylum seekers, using Belgium as a case in point. Asylum and immigration issues have become increasingly pressing in Europe, with member states seeking a common European Asylum System and establishing minimum standards for the reception of asylum seekers. The EU measures have fallen short of providing and implementing clear guidelines. Significant discrepancies continue to exist between member states, notably policies on health care for refugees, and in particular mental healthcare. Access to mental health care is identified as crucial, yet for many the right to access is theoretical only, and in reality care is often inaccessible. Access should refer not only to the availability, but also the quality and efficacy of care. Refugees are a particularly vulnerable population, and access in the fullest sense of the term should be an essential element in the reception of asylum seekers.
PMCID: PMC3436694
Asylum seeker; refugee; mental health; reception conditions
13.  Progression and improvement after mild cognitive impairment 
Archives of Public Health  2009;67(1):7-14.
We studied progression to dementia and improvement rates of mild cognitive impairment (MCI) to help clinicians decide whether or not to screen older people for MCI.
Prospective cohort study in which 156 vulnerable patients with (n = 24) and without (n = 132) MCI are followed and reassessed after two years with MMSE and Camdex.
Nine (38%) out of 24 patients initially diagnosed with MCI and 20 (15%) out of 132 considered normal or depressed progressed to dementia within two years. This results in a relative risk of progression of 2.48 (95% confidence interval = 1.29-4.77), a sensitivity of 31%
(95%CI = 16-51) and a predictive value of 38% (95%CI = 20-59). Out of 24 people with MCI at baseline, 8 (33%; 95%CI = 16-55) had improved at follow-up.
The low sensitivity of MCI for subsequent occurrence of dementia and the high improvement rate found in our study as well as by others, and the absence of a proven therapy, provide cumulative evidence against screening for MCI.
PMCID: PMC3436696

Results 1-13 (13)