%0 Journal Article %J Arch Public Health %D 2020 %T The Belgian health examination survey: objectives, design and methods. %A Diem Nguyen %A Pauline Hautekiet %A Finaba Berete %A Elise Braekman %A Rana Charafeddine %A Stefaan Demarest %A Sabine Drieskens %A Lydia Gisle %A Lize Hermans %A Jean Tafforeau %A Johan Van der Heyden %X

Background: In 2018 the first Belgian Health Examination Survey (BELHES) took place. The target group included all Belgian residents aged 18 years and older. The BELHES was organized as a second stage of the sixth Belgian Health Interview Survey (BHIS). This paper describes the study design, recruitment method and the methodological choices that were made in the BELHES.

Methods: After a pilot period during the first quarter of the BHIS fieldwork, eligible BHIS participants were invited to participate in the BELHES until a predefined number ( = 1100) was reached. To obtain the required sample size, 4918 eligible BHIS participants had to be contacted. Data were collected at the participant's home by trained nurses. The data collection included: 1) a short set of questions through a face-to-face interview, 2) a clinical examination consisting of the measurement of height, weight, waist circumference, blood pressure and for people aged 50 years and older handgrip strength and 3) a collection of blood and urine samples. The BELHES followed as much as possible the guidelines provided in the framework of the European Health Examination Survey (EHES) initiative. Finally 1184 individuals participated in the BELHES, resulting in a participation rate of 24.1%. Results for all the core BELHES measurements were obtained for more than 90% of the participants.

Conclusion: It is feasible to organize a health examination survey as a second stage of the BHIS. The first successfully organized BELHES provides useful information to support Belgian health decision-makers and health professionals. As the BELHES followed EHES recommendations to a large extent, the results can be compared with those from similar surveys in other EU (European Union) member states.

%B Arch Public Health %V 78 %8 2020 %G eng %R 10.1186/s13690-020-00428-9 %0 Journal Article %J Eur J Public Health %D 2020 %T Validity of self-reported mammography uptake in the Belgian health interview survey: selection and reporting bias. %A Finaba Berete %A Johan Van der Heyden %A Stefaan Demarest %A Rana Charafeddine %A Jean Tafforeau %A Herman Van Oyen %A Bruyère, Olivier %A Françoise Renard %K MAMMOGRAPHY %K Reimbursement Mechanisms %K Self-reported %X

BACKGROUND: The validity of self-reported mammography uptake is often questioned. We assessed the related selection and reporting biases among women aged 50-69 years in the Belgian Health Interview Survey (BHIS) using reimbursement data for mammography stemming from the Belgian Compulsory Health Insurance organizations (BCHI).

METHODS: Individual BHIS 2013 data (n = 1040) were linked to BCHI data 2010-13 (BHIS-BCHI sample). Being reimbursed for mammography within the last 2-years was used as the gold standard. Selection bias was assessed by comparing BHIS estimates reimbursement rates in BHIS-BCHI with similar estimates from the Echantillon Permanent/Permanente Steekproef (EPS), a random sample of BCHI data, while reporting bias was investigated by comparing self-reported versus reimbursement information in the BHIS-BCHI. Reporting bias was further explored through measures of agreement and logistic regression.

RESULTS: Mammography uptake rates based on self-reported information and reimbursement from the BHIS-BCHI were 75.5% and 69.8%, respectively. In the EPS, it was 64.1%. The validity is significantly affected by both selection bias {relative size = 8.93% [95% confidence interval (CI): 3.21-14.64]} and reporting bias [relative size = 8.22% (95% CI: 0.76-15.68)]. Sensitivity was excellent (93.7%), while the specificity was fair (66.4%). The agreement was moderate (kappa = 0.63). Women born in non-EU countries (OR = 2.81, 95% CI: 1.54-5.13), with high household income (OR = 1.27, 95% CI: 1.02-1.60) and those reporting poor perceived health (OR = 1.41, 95% CI: 1.14-1.73) were more likely to inaccurately report their mammography uptake.

CONCLUSIONS: The validity of self-reported mammography uptake in women aged 50-69 years is affected by both selection and reporting bias. Both administrative and survey data are complementary when assessing mammography uptake.

%B Eur J Public Health %8 2020 Nov 23 %G eng %R 10.1093/eurpub/ckaa217 %0 Journal Article %J European Journal of Nutrition %D 2019 %T Consumption of ultra-processed food products and diet quality among children, adolescents and adults in Belgium %A Stefanie Vandevijvere %A Karin De Ridder %A Thibault Fiolet %A Sarah Bel %A Jean Tafforeau %B European Journal of Nutrition %V 58 %8 Jan-12-2019 %G eng %N 8 %R 10.1007/s00394-018-1870-3 %0 Journal Article %J European Journal of Nutrition %D 2019 %T Consumption of ultra-processed food products and diet quality among children, adolescents and adults in Belgium %A Stefanie Vandevijvere %A Karin De Ridder %A Thibault Fiolet %A Sarah Bel %A Jean Tafforeau %K 2014-2015 %K Belgium %K food consumption survey %K ultraprocessed food %B European Journal of Nutrition %V 58 %8 Jan-12-2019 %G eng %N 8 %R 10.1007/s00394-018-1870-3 %0 Journal Article %J European Journal of Public Health %D 2019 %T Contribution of chronic conditions to gender disparities in health expectancies in Belgium, 2001, 2004 and 2008 %A Renata T C Yokota %A Nusselder, Willma J %A Robine, Jean-Marie %A Jean Tafforeau %A Françoise Renard %A Deboosere, Patrick %A Herman Van Oyen %K chronic diseases %K DISABILITY %K Gender %K HEALTH EXPECTANCY %K inequality %K trend %X

Background: We aimed to investigate the contribution of chronic conditions to gender differences in disability- free life expectancy (DFLE) and life expectancy with disability (LED) in Belgium in 2001, 2004 and 2008.

Methods: Data on disability and chronic conditions from participants of the 2001, 2004 and 2008 Health Interview Surveys in Belgium were used to estimate disability prevalence by cause using the attribution method. Disability prevalence was applied to life tables to estimate DFLE and LED using the Sullivan method. Decomposition techniques were used to assess the contribution of mortality and disability and further of causes of death and disability to gender disparities in DFLE and LED.

Results: Higher LE, DFLE and LED were observed for women compared with men in all years studied. A decrease in the gender gap in LE (2001: 5.9; 2004: 5.6; 2008: 5.3) was observed in our cross- sectional approach followed by a decrease in gender differences in DFLE (2001: 1.9; 2004: 1.3; 2008: 0.5) and increase in LED (2001: 4.0; 2004: 4.4; 2008: 4.8). The higher LED in women was attributed to their lower mortality due to lung/larynx/trachea cancer, ischaemic heart diseases, and external causes (2001 and 2004) and higher disability prevalence due to musculoskeletal conditions (2008). Higher DFLE was observed in women owing to their lower mortality from lung/larynx/trachea cancer, ischaemic heart diseases, digestive cancer and chronic re- spiratory diseases.

Conclusion: To promote healthy ageing of populations, priority should be given to reduce the LED disadvantage in women by targeting non-fatal diseases, such as musculoskeletal conditions.

%B European Journal of Public Health %V 29 %8 2/2019 %G eng %N 1 %& 82 %R 10.1093/eurpub/cky105 %0 Journal Article %J Archives of Public Health %D 2019 %T Contribution of chronic diseases to educational disparity in disability in France: results from the cross-sectional “disability-health” survey %A Clémence Palazzo %A Renata T C Yokota %A Jean Tafforeau %A François Ravaud %A Cambois, Emmanuelle %A Serge Poiraudeau %A Herman Van Oyen %A Wilma J. Nusselder %K attribution method %K chronic diseases %K DISABILITY %K educational attainment %K GALI %K Global activity limitation Indicator %K Socioeconomic status %X

Background

This study aimed 1) to assess whether the contribution of chronic conditions to disability varies according to the educational attainment, 2) to disentangle the contributions of the prevalence and of the disabling impact of chronic conditions to educational disparities.

Methods

Data of the 2008–09 Disability Health Survey were examined (N = 23,348). The disability indicator was the Global Activity Limitation Indicator (GALI). The attribution method based on an additive hazard model was used to estimate educational differences in disabling impacts and in the contributions of diseases to disability. Counterfactual analyses were used to disentangle the contribution of differences in disease prevalence vs. disabling impact.

Results

In men, the main contributors to educational difference in disability prevalence were arthritis (contribution to disability prevalence: 5.7% (95% CI 5.4–6.0) for low-educated vs. 3.3% (3.0–3.9) for high-educated men), spine disorders (back/neck pain, deformity) (3.8% (3.6–4.0) vs. 1.9% (1.8–2.1)), chronic obstructive pulmonary diseases (2.4% (2.3–2.6) vs. 0.6% (0.5–0.7)) and ischemic heart /peripheral artery diseases (4.1% (3.9–4.3) vs. 2.4% (2.2–3.0)). In women, arthritis (9.5% (9.1–9.9) vs. 4.5%, (4.1–5.2)), spine disorders (4.5% (4.3–4.7) vs. 2.1% 1.9–2.3) and psychiatric diseases (3.1% (3.0–3.3) vs. 1.1% (1.0–1.3)) contributed most to education gap in disability. The educational differences were equally explained by differences in the disease prevalence and in their disabling impact.

Conclusions

Public health policies aiming to reduce existing socioeconomic disparities in disability should focus on musculoskeletal, pulmonary, psychiatric and ischemic heart diseases, reducing their prevalence as well as their disabling impact in lower socioeconomic groups.

%B Archives of Public Health %V 77 %8 Jan-12-2019 %G eng %& 2 %R 10.1186/s13690-018-0326-9 %0 Journal Article %J PLoS One %D 2019 %T Determinants of unit nonresponse in multi-mode data collection: A multilevel analysis. %A Finaba Berete %A Johan Van der Heyden %A Stefaan Demarest %A Rana Charafeddine %A Lydia Gisle %A Elise Braekman %A Jean Tafforeau %A Molenberghs, Geert %X

BACKGROUND: Multi-mode data collection is widely used in surveys. Since several modes of data collection are successively applied in such design (e.g. self-administered questionnaire after face-to-face interview), partial nonresponse occurs if participants fail to complete all stages of the data collection. Although such nonresponse might seriously impact estimates, it remains currently unexplored. This study investigates the determinants of nonresponse to a self-administered questionnaire after having participated in a face-to-face interview.

METHODS: Data from the Belgian Health Interview Survey 2013 were used to identify determinants of nonresponse to self-administered questionnaire (n = 1,464) among those who had completed the face-to-face interview (n = 8,133). The association between partial nonresponse and potential determinants was explored through multilevel logistic regression models, encompassing a random interviewer effect.

RESULTS: Significant interviewer effects were found. Almost half (46.6%) of the variability in nonresponse was attributable to the interviewers, even in the analyses controlling for the area as potential confounder. Partial nonresponse was higher among youngsters, non-Belgian participants, people with a lower educational levels and those belonging to a lower income household, residents of Brussels and Wallonia, and people with poor perceived health. Higher odds of nonresponse were found for interviews done in the last quarters of the survey-year. Regarding interviewer characteristics, only the total number of interviews carried out throughout the survey was significantly associated with nonresponse to the self-administered questionnaire.

CONCLUSIONS: The results indicate that interviewers play a crucial role in nonresponse to the self-administered questionnaire. Participant characteristics, interview circumstances and interviewer characteristics only partly explain the interviewer variability. Future research should examine further interviewer characteristics that impact nonresponse. The current study emphasises the importance of training and motivating interviewers to reduce nonresponse in multi-mode data collection.

%B PLoS One %V 14 %8 2019 %G eng %N 4 %R https://doi.org/10.1371/journal.pone.0215652 %0 Journal Article %J European Journal of Public Health %D 2019 %T Do sociodemographic characteristics associated with the use of CAM differ by chronic disease? %A Sabine Drieskens %A Jean Tafforeau %A Stefaan Demarest %B European Journal of Public Health %8 2019-03-08 %G eng %0 Report %D 2019 %T Enquête de santé 2018 : Connaissances et pratiques préventives en santé. Résumé des résultats %A Finaba Berete %A Stefaan Demarest %A Rana Charafeddine %A Lydia Gisle %A Sabine Drieskens %A Elise Braekman %A Diem Nguyem %A Johan Van der Heyden %A Lize Hermans %A Jean Tafforeau %G eng %0 Report %D 2019 %T Enquête de santé 2018 : Dépistage du cancer %A Finaba Berete %A Stefaan Demarest %A Jean Tafforeau %G eng %0 Report %D 2019 %T Enquête de santé 2018 : Santé et qualité de vie. Résumé des résultats %A Rana Charafeddine %A Johan Van der Heyden %A Stefaan Demarest %A Sabine Drieskens %A Diem Nguyem %A Jean Tafforeau %A Lydia Gisle %A Elise Braekman %A Finaba Berete %G eng %0 Report %D 2019 %T Enquête de santé 2018 : Santé subjective %A Jean Tafforeau %A Sabine Drieskens %A Rana Charafeddine %A Johan Van der Heyden %G eng %0 Report %D 2019 %T Enquête de santé 2018 : Style de vie. Résumé des résultats %A Lydia Gisle %A Sabine Drieskens %A Rana Charafeddine %A Stefaan Demarest %A Elise Braekman %A Diem Nguyem %A Johan Van der Heyden %A Finaba Berete %A Lize Hermans %A Jean Tafforeau %G eng %0 Report %D 2019 %T Enquête de santé 2018 : Vaccination %A Finaba Berete %A Jean Tafforeau %A Stefaan Demarest %A Sabine Drieskens %G eng %0 Journal Article %J Eur J Public Health %D 2019 %T Is the European Health Interview Survey online yet? Response and net sample composition of a web-based data collection. %A Elise Braekman %A Rana Charafeddine %A Stefaan Demarest %A Sabine Drieskens %A Jean Tafforeau %A Johan Van der Heyden %A Van Hal, Guido %K European health interview survey %K health interview survey %K sample composition %K unit response rate %X

BACKGROUND: The European Health Interview Survey (EHIS) provides cross-national data on health status, health care and health determinants. So far, 10 of the 30 member states (MS) opted for web-based questionnaires within mixed-mode designs but none used it as the sole mode. In the context of future EHIS, the response rate and net sample composition of a web-only approach was tested.

METHODS: A Belgian study with a target sample size of 1000 (age: 16-85) was organized using the EHIS wave 3 model questionnaire. The sample was selected according to a multistage, clustered sampling procedure with geographical stratification. Field substitution was applied; non-participating households were replaced by similar households regarding statistical sector, sex and age. There was one reminder letter and a €10 conditional incentive.

RESULTS: Considering all substitutions, a 16% response rate was obtained after sending one reminder. Elderly, Brussels Capital inhabitants, people living without a partner and those with a non-Belgian nationality were less responding. By design, there were no differences between the initial and final net sample regarding substitution characteristics. Nevertheless, people living without a partner, non-Belgians and lower educated people remain underrepresented.

CONCLUSION: There was a low response rate, particularly for some population groups. The response rate was lower than those of MS using mixed-mode designs including web, especially these comprising interviewer-based approaches. Despite the long and complex questionnaire, there was a low break off rate. So far, web-only data collection is not an acceptable strategy for population-based health surveys but efforts to increase the response should be further explored.

%B Eur J Public Health %8 2019-11-07 %G eng %N ckz206 %R 10.1093/eurpub/ckz206 %0 Report %D 2019 %T Gezondheidsenquête 2018: Gezondheid en kwaliteit van leven. Samenvatting van de resultaten %A Johan Van der Heyden %A Rana Charafeddine %A Stefaan Demarest %A Sabine Drieskens %A Diem Nguyen %A Jean Tafforeau %A Lydia Gisle %A Elise Braekman %A Finaba Berete %G eng %0 Report %D 2019 %T Gezondheidsenquête 2018: Kennis over gezondheid en gezondheidspreventie. Samenvatting van de resultaten %A Stefaan Demarest %A Finaba Berete %A Rana Charafeddine %A Lydia Gisle %A Sabine Drieskens %A Elise Braekman %A Diem Nguyem %A Johan Van der Heyden %A Lize Hermans %A Jean Tafforeau %G eng %0 Report %D 2019 %T Gezondheidsenquête 2018: Levenstijl. Samenvatting van de resultaten %A Sabine Drieskens %A Lydia Gisle %A Rana Charafeddine %A Stefaan Demarest %A Elise Braekman %A Diem Nguyem %A Johan Van der Heyden %A Finaba Berete %A Lize Hermans %A Jean Tafforeau %G eng %0 Report %D 2019 %T Gezondheidsenquête 2018: Subjectieve gezondheid %A Jean Tafforeau %A Sabine Drieskens %A Rana Charafeddine %A Johan Van der Heyden %G eng %0 Report %D 2019 %T Gezondheidsenquête 2018: Vaccinatie %A Finaba Berete %A Jean Tafforeau %A Stefaan Demarest %A Sabine Drieskens %G eng %0 Report %D 2019 %T Gezondheidsenquête 2018: Vroegtijdige opsporing van kanker %A Finaba Berete %A Jean Tafforeau %A Stefaan Demarest %G eng %0 Journal Article %J Archives of Public Health %D 2019 %T Habitual food consumption of the Belgian population in 2014-2015 and adherence to food-based dietary guidelines %A Sarah Bel %A Karin De Ridder %A Thérésa Lebacq %A Cloë Ost %A Teppers, Eveline %A Koenraad Cuypers %A Jean Tafforeau %K NUTRITION; nutritional guidelines; Belgium %B Archives of Public Health %G eng %0 Journal Article %J Arch Public Health %D 2019 %T Habitual food consumption of the Belgian population in 2014-2015 and adherence to food-based dietary guidelines. %A Sarah Bel %A Karin De Ridder %A Thérésa Lebacq %A Cloë Ost %A Teppers, Eveline %A Koenraad Cuypers %A Jean Tafforeau %K 2014-2015 %K Adolescents %K adults %K CHILDREN %K food consumption survey %X

Background: Between 2014 and 2015 a second National Food Consumption Survey was conducted in Belgium in order to evaluate the habitual food consumption in the general Belgian population and to compare it with food-based dietary guidelines (FBDG) and results of the 2004 Food Consumption Survey.

Methods: A representative sample of the Belgian population was randomly selected from the National Population Register following a multistage stratified sampling procedure. Information on dietary intake was collected from 3146 subjects between 3 and 64 year old through two non-consecutive 24-hour dietary recalls using GloboDiet®. In addition, a self-administered food frequency questionnaire was completed. The distribution of habitual food consumptions and proportion of persons who did not meet the recommendations were estimated with SPADE.

Results: For most of food groups analysed, the habitual consumption did not comply with FBDG. The consumption of nutrient-poor and energy-dense foods (e.g. alcohol, soft drinks and snacks) was excessive (35% of total energy intake), while the consumption of most other food groups was below the minimum recommended. A large majority of the population had an inadequate consumption of dairy products (98%), vegetables (95%), fruit (91%), potatoes, rice and pasta (88%) bread and cereals (83%) and water and sugar-free drinks (73%). Males had higher consumption of most food groups than females, thereby complying more often with FBDG. For all food groups, except dairy products and fruit, the consumption increased with age. The proportion of individuals meeting FBDG was the highest among young children (3-5 years) and the worst among adolescents aged 14-17 years old. Habitual consumption remained stable between 2004 and 2014 in the population aged 15-64 years old for all food groups except for increased consumption of water and sugar-free drinks (1180 to 1289 g/d) and decreased consumption of spreadable and cooking fat (27 to 19 g/d), red meat (34 to 25 g/d) and bread and cereals (173 to 142 g/d).

Conclusions: The habitual food consumption of the Belgian population (3-64 years) in 2014-2015 deviates largely from FBDG, particularly among adolescents aged between 14 and 17 years old. Few improvements were observed between 2004 and 2014 in the population between 15 and 64 years old. Further efforts are therefore necessary to improve dietary habits in Belgium, in order to prevent and reduce diet-related diseases.

%B Arch Public Health %V 77 %8 2019 %G eng %R 10.1186/s13690-019-0343-3 %0 Journal Article %J Archives of Public Health %D 2019 %T Habitual food consumption of the Belgian population in 2014-2015 and adherence to food-based dietary guidelines %A Sarah Bel %A Karin De Ridder %A Thérésa Lebacq %A Cloë Ost %A Teppers, Eveline %A Koenraad Cuypers %A Jean Tafforeau %B Archives of Public Health %V 77 %8 Jan-12-2019 %G eng %N 1 %R 10.1186/s13690-019-0343-3 %0 Generic %D 2019 %T Integrating web-based data-collection in the framework of the European Health Interview Survey %A Elise Braekman %A Rana Charafeddine %A Stefaan Demarest %A Sabine Drieskens %A Johan Van der Heyden %A Jean Tafforeau %A Van Hal, Guido %K health interview survey; web based survey %B 8th Conference of the European Survey Research Association %G eng %0 Journal Article %J BMC Med Res Methodol %D 2019 %T Mixing mixed-mode designs in a national health interview survey: a pilot study to assess the impact on the self-administered questionnaire non-response. %A Elise Braekman %A Sabine Drieskens %A Rana Charafeddine %A Stefaan Demarest %A Finaba Berete %A Lydia Gisle %A Jean Tafforeau %A Johan Van der Heyden %A Van Hal, Guido %K health interview survey %K Item non-response %K Mixed-mode %K Self-administered questionnaire %K Unit response %K Web %X

BACKGROUND: Many population health surveys consist of a mixed-mode design that includes a face-to-face (F2F) interview followed by a paper-and-pencil (P&P) self-administered questionnaire (SAQ) for the sensitive topics. In order to alleviate the burden of a supplementary P&P questioning after the interview, a mixed-mode SAQ design including a web and P&P option was tested for the Belgian health interview survey.

METHODS: A pilot study (n = 266, age 15+) was organized using a mixed-mode SAQ design following the F2F interview. Respondents were invited to complete a web SAQ either immediately after the interview or at a later time. The P&P option was offered in case respondents refused or had previously declared having no computer access, no internet connection or no recent usage of computers. The unit response rate for the web SAQ and the overall unit response rate for the SAQ independent of the mode were evaluated. A logistic regression analysis was conducted to explore the association of socio-demographic characteristics and interviewer effects with the completed SAQ mode. Furthermore, a logistic regression analysis assessed the differential user-friendliness of the SAQ modes. Finally, a logistic multilevel model was used to evaluate the item non-response in the two SAQ modes while controlling for respondents' characteristics.

RESULTS: Of the eligible F2F respondents in this study, 76% (107/140) agreed to complete the web SAQ. Yet among those, only 78.5% (84/107) actually did. At the end, the overall (web and P&P) SAQ unit response rate reached 73.5%. In this study older people were less likely to complete the web SAQ. Indications for an interviewer effect were observed as regard the number of web respondents, P&P respondents and respondents who refused to complete the SAQ. The web SAQ scored better in terms of user-friendliness and presented higher item response than the P&P SAQ.

CONCLUSIONS: The web SAQ performed better regarding user-friendliness and item response than the P&P SAQ but the overall SAQ unit response rate was low. Therefore, future research is recommended to further assess which type of SAQ design implemented after a F2F interview is the most beneficial to obtain high unit and item response rates.

%B BMC Med Res Methodol %V 19 %8 2019 Nov 21 %G eng %N 1:212 %R 10.1186/s12874-019-0860-3 %0 Journal Article %J The Journal of Nutrition %D 2019 %T A novel approach to optimize vitamin D intake in Belgium through fortification based on representative food consumption data %A Isabelle Moyersoen %A Brecht Devleesschauwer %A Dekkers, Arnold %A Janneke Verkaik-Kloosterman %A Karin De Ridder %A Stefanie Vandevijvere %A Jean Tafforeau %A Herman Van Oyen %A Lachat, Carl %A Van Camp, John %K Food intake %K NUTRITION %K Vitamin %K vitamine D %B The Journal of Nutrition %G eng %R 10.1093/jn/nxz119 %0 Generic %D 2019 %T Predictors of nursing-home entry for elders in Belgium %A Finaba Berete %A Stefaan Demarest %A Rana Charafeddine %A Jean Tafforeau %A Herman Van Oyen %A Bruyère, O %A Johan Van der Heyden %X

Background: Due to the aging of the population the demand for long-term care services is expected to rise during the coming years. For a better planning of health care resources policy makers have to be aware of risk factors associated to nursing home entry (NHE). The present study aims to identify predictors of NHE in a representative sample of Belgian community dwelling older residents. Methods: Date from the participants of the Belgian health interview survey (BHIS) 2013 aged 65 years and over were individually linked with longitudinal data from the Belgian compulsory health insurance data (BCHI) over a 5-year period (2012- 2017). Institutionalized BHIS participants were excluded, resulting in a final database of 1,927 individuals. A multivariate Cox proportional hazards model was fit to estimate the hazard of NHE. The model examined the hazard of NHE over the follow-up period in function of predisposing, enabling and need variables observed at baseline. All analyses were done using SAS 9.3 taking into account the survey design settings. Results: Over the follow-up period, 169 out of 1,927 individuals entered in NH (56% males, mean age = 74.70.25). Significant predictors of NHE were older age (hazard ratio (HR) = 2.40, CI = 1.23-4.67 and HR = 6.19, 95% CI = 2.75- 13.92, respectively for 75-84 years and 85+ years compared to 65-74 years), living condition (HR = 4.28, 95% CI = 1.01- 18.19 for living alone), severity of limitation in ADLs (HR = 2.61, 95% CI = 1.39-4.88 for moderate limitation and HR = 2.40, 95% CI = 1.10-5.26 for severe limitation, compared to those without limitation). Conclusions: Apart from age and living condition, the ADLs limitations were the strongest predictors of NHE. Public health action to reduce NHE of older people should first of all focus on preventive action at middle age which will reduce activity limitations at later age. Key messages: Risk profiles for NHE are highly dependent individuals. NH should be more specialized with qualified professionals.

%B European Journal of Public Health %I European Journal of Public Health %C Marseille, France %V 29 %8 November 2019 %G eng %N Supplement_4 %R 10.1093/eurpub/ckz186.701 %0 Generic %D 2018 %T Assessing polypharmacy in the general older population: comparison of findings from a health survey and health insurance data %A Johan Van der Heyden %A Françoise Renard %A Finaba Berete %A Jean Tafforeau %A Brecht Devleesschauwer %K chronic conditions %K health survey %K medicine use %K Polypharmacy %B European Congress of Epidemiology %C Lyon, France %G eng %0 Generic %D 2018 %T Assessing the validity of self reported breast cancer screening coverage in the belgian health interview survey %A Finaba Berete %A Johan Van der Heyden %A Stefaan Demarest %A Jean Tafforeau %A Herman Van Oyen %A Bruyère, Olivier %A Françoise Renard %K breast %K cancer %K SCREENING %K VALIDATION %B European Congress of Epidemiology %C Lyon %G eng %0 Generic %D 2018 %T Association between diseases and non-conventional therapy use, Belgian Health Interview Survey %A Sabine Drieskens %A Stefaan Demarest %A Johan Van der Heyden %A Jean Tafforeau %B European Public Health Conference %C Lubjana %8 nov 2018 %G eng %0 Generic %D 2018 %T Comparing administrative and survey data for ascertaining chronic disease prevalence %A Finaba Berete %A Stefaan Demarest %A Jean Tafforeau %A Herman Van Oyen %A Bruyère, Olivier %A Johan Van der Heyden %K chronic condition %B Journée Doctorale en santé Publique, Université de Liège %C Liège, Belgique %G eng %0 Journal Article %J European Journal of Nutrition %D 2018 %T Consumption of ultra-processed food products and diet quality among children, adolescents and adults in Belgium %A Stefanie Vandevijvere %A Karin De Ridder %A Thibault Fiolet %A Sarah Bel %A Jean Tafforeau %K Belgium %K Food intake %K NUTRITION %K ultra-processed food %B European Journal of Nutrition %G eng %0 Journal Article %J European Journal of Public Health %D 2018 %T Contribution of chronic conditions to gender disparities in health expectancies in Belgium, 2001, 2004 and 2008 %A Renata T C Yokota %A Nusselder, Willma J %A Robine, Jean-Marie %A Jean Tafforeau %A Françoise Renard %A Deboosere, Patrick %A Herman Van Oyen %K causes of death %K causes of morbidity %K DISABILITY %K Gender %K HEALTH EXPECTANCY %K inequity %K Life expectancy %X

Background

We aimed to investigate the contribution of chronic conditions to gender differences in disability-free life expectancy (DFLE) and life expectancy with disability (LED) in Belgium in 2001, 2004 and 2008.

Methods

Data on disability and chronic conditions from participants of the 2001, 2004 and 2008 Health Interview Surveys in Belgium were used to estimate disability prevalence by cause using the attribution method. Disability prevalence was applied to life tables to estimate DFLE and LED using the Sullivan method. Decomposition techniques were used to assess the contribution of mortality and disability and further of causes of death and disability to gender disparities in DFLE and LED.

Results

Higher LE, DFLE and LED were observed for women compared with men in all years studied. A decrease in the gender gap in LE (2001: 5.9; 2004: 5.6; 2008: 5.3) was observed in our cross-sectional approach followed by a decrease in gender differences in DFLE (2001: 1.9; 2004: 1.3; 2008: 0.5) and increase in LED (2001: 4.0; 2004: 4.4; 2008: 4.8). The higher LED in women was attributed to their lower mortality due to lung/larynx/trachea cancer, ischaemic heart diseases, and external causes (2001 and 2004) and higher disability prevalence due to musculoskeletal conditions (2008). Higher DFLE was observed in women owing to their lower mortality from lung/larynx/trachea cancer, ischaemic heart diseases, digestive cancer and chronic respiratory diseases.

Conclusion

To promote healthy ageing of populations, priority should be given to reduce the LED disadvantage in women by targeting non-fatal diseases, such as musculoskeletal conditions.

%B European Journal of Public Health %8 Mar-06-2019 %G eng %R 10.1093/eurpub/cky105 %0 Journal Article %J European Journal of Public Health %D 2018 %T Contribution of chronic conditions to smoking differences in life expectancy with and without disability in Belgium %A Renata T C Yokota %A Nusselder, Willma J %A Robine, Jean-Marie %A Jean Tafforeau %A Rana Charafeddine %A Lydia Gisle %A Deboosere, Patrick %A Herman Van Oyen %K Chronic disease %K disabilities %K Disability-free life expectancy %K HEALTH EXPECTANCY %K Life expectancy %K mortality %K SMOKING %X

Background

Smoking is the leading cause of premature mortality and morbidity. This study aimed at assessing the impact of smoking on life expectancy (LE) and LE with (LED) and without disability (DFLE). We further estimated the contribution of disability and mortality and their causes to differences in LED and DFLE by smoking.

Methods

Data on disability, chronic conditions, and smoking from 17 148 participants of the 1997, 2001, 2004 Belgian Health Interview Surveys were used to estimate causes of disability using the attribution method. A 10-year mortality follow-up of survey participants was used. The Sullivan method was applied to estimate LED and DFLE. The contribution of disability and mortality and of causes of disability and death to smoking differences in LED and DFLE was assessed using decomposition methods.

Results

Never smokers live longer than daily smokers. DFLE advantage at age 15 of +8.5/+4.3 years (y) in men/women never compared with daily smokers was the result of lower mortality (+6.2y/+3y) and lower disability (2.3y/1.3y). The extra 0.3y/1.6y LED in never smokers was due to lower mortality (+2.6y/+2.9y) and lower disability (−2.3y/−1.3y). Lower mortality from lung/larynx/trachea cancer, chronic respiratory, and ischaemic heart diseases was the main contributor to higher LED and DFLE in never smokers. Lower disability from musculoskeletal conditions in men and chronic respiratory diseases in women increased LED and DFLE in never smokers.

Conclusions

Mortality and disability advantage among never smokers contributed to longer DFLE, while mortality advantage contributed to their longer LED.

%B European Journal of Public Health %V 28 %8 Dec-06-2018 %G eng %N 5 %R 10.1093/eurpub/cky101 %0 Journal Article %J Arch Public Health %D 2018 %T Correction of self-reported BMI based on objective measurements: a Belgian experience %A Sabine Drieskens %A Stefaan Demarest %A Sarah Bel %A Karin De Ridder %A Jean Tafforeau %K BMI %B Arch Public Health %V 76 %8 2018-02-05 %G eng %N 10 %0 Journal Article %J Nutrients %D 2018 %T Do current fortification and supplementation programs assure adequate intake of fat-soluble vitamins in Belgian infants, toddlers, pregnant women, and lactating women? %A Isabelle Moyersoen %A Lachat, Carl %A Koenraad Cuypers %A Karin De Ridder %A Brecht Devleesschauwer %A Jean Tafforeau %A Stefanie Vandevijvere %A Margot Vansteenland %A Bruno De Meulenaer %A Van Camp, John %A Herman Van Oyen %K Avitaminosis %K Child Nutritional Physiological Phenomena %K Child, Preschool %K Diet Surveys %K Dietary Supplements %K Female %K Food, Fortified %K Humans %K Infant %K Infant Nutritional Physiological Phenomena %K Infant, Newborn %K Lactation %K Male %K Maternal Nutritional Physiological Phenomena %K nutritional status %K Pregnancy %K Recommended Dietary Allowances %K Solubility %K Vitamin A %K Vitamin D %K Vitamin E %K Vitamin K %K Vitamins %X

Adequate intakes of fat-soluble vitamins are essential to support the growth and development of the foetus, the neonate, and the young child. By means of an online self-administered frequency questionnaire, this study aimed to evaluate the intake of vitamins A, D, E, and K in Belgian infants ( = 455), toddlers ( = 265), pregnant women ( = 161), and lactating women ( = 165). The contribution of foods, fortified foods, and supplements on the total intake was quantified. 5% of toddlers, 16% of pregnant women, and 35% of lactating women had an inadequate vitamin A intake. Conversely, excessive vitamin A intakes were associated with consumption of liver (products). Furthermore, 22% of infants were at risk for inadequate vitamin D intake due to the lack of prophylaxis, while consumption of highly dosed supplements posed a risk for excessive intakes in 6%-26% of infants. Vitamin D intake in pregnant women and lactating women was inadequate (median of 51%, respectively, 60% of the adequate intake). In all groups, the risk for inadequate intake of vitamin E and K was low. Contribution of fortified foods to vitamin A, D, E, and K intake was minor, except in toddlers. National fortification strategies should be investigated as an alternative or additional strategy to prevent vitamin D and A deficiency. There is a need to revise and set uniform supplement recommendations. Finally, non-users of vitamin D prophylaxis need to be identified for targeted treatment.

%B Nutrients %V 10 %8 2018 Feb 16 %G eng %N 2 %R 10.3390/nu10020223 %0 Generic %D 2018 %T Do current fortification and supplementation programs assure adequate intake of vitamin A, D, E and K in Belgium? %A Isabelle Moyersoen %A Karin De Ridder %A Brecht Devleesschauwer %A Stefanie Vandevijvere %A Koenraad Cuypers %A Jean Tafforeau %A A. Dekkers %A M Van Sleemland %A Bruno De Meulenaer %A Herman Van Oyen %A Lachat, Carl %A Van Camp, John %K NUTRITION %K Vitamin %B Belgian Nutrtion Society annual conference %C Brussels %G eng %N Belgian Nutrition Society %0 Journal Article %J Human Genomics %D 2018 %T The genetic structure of the Belgian population %A Jimmy Van den Eynden %A Tine Descamps %A Els Delporte %A Nancy Roosens %A Sigrid C.J. De Keersmaecker %A Vanessa De Wit %A Joris Robert Vermeesch %A Goetghebeur, Els %A Jean Tafforeau %A Stefaan Demarest %A Marc Van den Bulcke %A Herman Van Oyen %K genetic variability %K population genomics %K public health genomics %B Human Genomics %V 12 %8 Jan-12-2018 %G eng %N 1 %R 10.1186/s40246-018-0136-8 %0 Journal Article %J The Journal of Nutrition %D 2018 %T Joint Data Analysis in Nutritional Epidemiology: Identification of Observational Studies and Minimal Requirements %A Pinart, Mariona %A Nimptsch, Katharina %A Bouwman, Jildau %A Lars O Dragsted %A Yang, Chen %A De Cock, Nathalie %A Lachat, Carl %A Perozzi, Giuditta %A Canali, Raffaella %A Lombardo, Rosario %A Massimo D'Archivio %A Michèle Guillaume %A Anne-Françoise Donneau %A Stephanie Jeran %A Jakob Linseisen %A Christina Kleiser %A Ute Nöthlings %A Janett Barbaresko %A Heiner Boeing %A Stelmach-Mardas, Marta %A Thorsten Heuer %A Laird, Eamon %A Walton, Janette %A Paolo Gasparini %A Antonietta Robino %A Luis Castaño %A Gemma Rojo-Martínez %A Jordi Merino %A Luis Masana %A Marie Standl %A Holger Schulz %A Elena Biagi %A Eha Nurk %A Matthys, Christophe %A Gobbetti, Marco %A De Angelis, Maria %A Eberhard Windler %A Birgit-Christiane Zyriax %A Jean Tafforeau %A Pischon, Tobias %B The Journal of Nutrition %V 148 %8 Mar-02-2020 %G eng %N 2 %R 10.1093/jn/nxx037 %0 Journal Article %J PLoS One %D 2018 %T Measurement agreement of the self-administered questionnaire of the Belgian Health Interview Survey: Paper-and-pencil versus web-based mode. %A Elise Braekman %A Finaba Berete %A Rana Charafeddine %A Stefaan Demarest %A Sabine Drieskens %A Lydia Gisle %A Molenberghs, Geert %A Jean Tafforeau %A Johan Van der Heyden %A Van Hal, Guido %K health interview surveys %K Internet %K Measurement effects %K Paper %X

Before organizing mixed-mode data collection for the self-administered questionnaire of the Belgian Health Interview Survey, measurement effects between the paper-and-pencil and the web-based questionnaire were evaluated. A two-period cross-over study was organized with a sample of 149 employees of two Belgian research institutes (age range 22-62 years, 72% female). Measurement agreement was assessed for a diverse range of health indicators related to general health, mental and psychosocial health, health behaviors and prevention with kappa coefficients and intraclass correlation (ICC). The quality of the data collected by both modes was evaluated by quantifying the missing, 'don't know' and inconsistent values and data entry mistakes. Good to very good agreement was found for all categorical indicators with kappa coefficients superior to 0.60, except for two mental and psychosocial health indicators namely the presence of a sleeping disorder and of a depressive disorder (kappa≥0.50). For the continuous indicators high to acceptable agreement was observed with ICC superior to 0.70. Inconsistent answers and data-entry mistakes were only occurring in the paper-and-pencil mode. There were no less missing values in the web-based mode compared to the paper-and-pencil mode. The study supports the idea that web-based modes provide, in general, equal responses to paper-and-pencil modes. However, health indicators based upon factual and objective items tend to have higher measurement agreement than indicators requiring an assessment of personal subjective feelings. A web-based mode greatly facilitates the data-entry process and guides the completing of a questionnaire. However, item non-response was not positively affected.

%B PLoS One %V 13 %8 2018 %G eng %N 5 %R 10.1371/journal.pone.0197434 %0 Journal Article %J International Journal of Epidemiology %D 2018 %T Methods to assess the contribution of diseases to disability using cross-sectional studies: comparison of different versions of the attributable fraction and the attribution method %A C. Palazzo %A Renata T C Yokota %A J. Ferguson %A Jean Tafforeau %A J.F. Ravaud %A Herman Van Oyen %A W.J. Nusselder %K attributable fraction %K attribution %K contribution %K DISABILITY %K Diseases %B International Journal of Epidemiology %8 Jan-01-2018 %G eng %R 10.1093/ije/dyy222 %0 Journal Article %J Archives of Public Health %D 2017 %T The added value of food frequency questionnaire (FFQ) information to estimate the usual food intake based on repeated 24-hour recalls %A Cloë Ost %A Karin De Ridder %A Jean Tafforeau %A Herman Van Oyen %K 24-hour recall %K episodically consumed foods %K FFQ %K food consumption survey %K food frequnecy questionnaire %K never-consumers %K Spade %K statistical modeling methods %K usual intake %X

Background

Statistical methods to model the usual dietary intake of foods in a population generally ignore the additional information on the never-consumers. The objective of this study is to determine the added value of Food Frequency Questionnaire (FFQ) data allowing distinguishing the never-consumers from the non-consumers while modeling the usual intake distribution.

Methods

Three food items with a different proportion of never-consumers were selected from the database of the Belgian food consumption survey of 2004 (N = 3200). The usual intake distribution for these food items was modeled with the Statistical Program for Analysis of Dietary Exposure (SPADE) and modeling parameters were extracted. These parameters were used to simulate (a) a new database with two 24-h recalls per respondent and (b) a “true” usual intake distribution. The usual intake distribution from the new database was obtained by modeling the 24-h recalls with SPADE, once without and once with the inclusion of the FFQ data on the never-consumers. Ratios were calculated for the different percentiles of the usual intake distribution: the modeled usual intake (g/day) (for both SPADE with and without the inclusion of FFQ data on never-consumers) was divided by the corresponding percentile of the simulated “true” usual intake (g/day). The closer the ratio is to one, the better the model fits the data.

Results

Inclusion of the FFQ information to identify the never-consumers did not improve the estimation of the higher percentiles of the usual intake distribution. However, taking into account this FFQ information improved the estimation of the lower percentiles of the usual intake distribution even when the proportion of never-consumers was low.

Conclusions

The inclusion of FFQ information to identify the never-consumers is beneficial when interested in the whole usual intake distribution or in the lower percentiles only, no matter how low the proportion of never-consumers for that food item may be. However, when interest is only in the higher percentiles of the usual intake distribution, inclusion of FFQ information to identify the never-consumers will have no benefit.

%B Archives of Public Health %V 75 %8 Jan-12-2017 %G eng %N 1 %R 10.1186/s13690-017-0214-8 %0 Journal Article %J Eur J Public Health %D 2017 %T Additional weighting for education affects estimates from a National Health Interview Survey. %A Johan Van der Heyden %A De Bacquer, Dirk %A Lydia Gisle %A Stefaan Demarest %A Rana Charafeddine %A Sabine Drieskens %A Jean Tafforeau %A Herman Van Oyen %A Van Herck, Koen %K Adult %K Aged %K Aged, 80 and over %K Belgium %K bias %K Data Interpretation, Statistical %K Educational Status %K Female %K health surveys %K Humans %K Male %K middle aged %X

BACKGROUND: National Health Interview Surveys are used to produce country-wide results for a substantial number of health indicators. However, if some educational groups are underrepresented in the sample, estimates may be biased. This study investigated the impact of the use of post-stratification weights that adjust for the population distribution by education on estimates from the Belgian Health Interview Survey 2013.

METHODS: For 25 health-related indicators that match the European Core Health Indicator shortlist, estimates were computed using two different sets of post-stratification weights: one based on age group, gender and province only and the other one including also education. The Census 2011 was used as auxiliary data source. Statistical differences between the two estimates were assessed with the Delta method.

RESULTS: If education is not included as post-stratification weighting factor, low educational groups (ISCED 0-2) represent 31.1% of the total study population aged 25 years and older. If education is taken into account this proportion rises to 40.3%. The use of post-stratification weights adjusting for the population distribution by education has an impact on several survey estimates. The most pronounced effect is an increase in the estimated proportion of people with diabetes (+0.73%; 95% CI 0.19-1.27; relative increase +11.6%), asthma (+0.52%; 95% CI, 0.06-0.98; relative increase +12.4%) and difficulties to cover their health expenses (+2.31%; 95% CI, 1.52-3.10; relative increase +9.4%).

CONCLUSIONS: Including education in the calculation of post-stratification weights reduces bias due to educational differences in survey participation. Auxiliary information used to calculate post-stratification weights for national health surveys should include education.

%B Eur J Public Health %V 27 %P 892-897 %8 2017 Oct 01 %G eng %N 5 %1 https://www.ncbi.nlm.nih.gov/pubmed/28204447?dopt=Abstract %R 10.1093/eurpub/ckx005 %0 Generic %D 2017 %T BelPHG-21: a pilot study on genetic variability in the Belgian population %A Tine Descamps %A Els Delporte %A J Vermeesch %A Els Goetghebeur %A Clement, Lieven %A Jean Tafforeau %A Stefaan Demarest %A Herman Van Oyen %A Marc Van den Bulcke %A Jimmy Van den Eynden %K public health genomics %B European Public Health Conference %C Stockholm %G eng %0 Generic %D 2017 %T Comparison of the population attributable fraction, average attributable fraction and attribution method to assess the contribution of specific diseases to disability in cross-sectional studies %A Clémence Palazzo %A Renata T.C. Yokota %A Jean Tafforeau %A Herman Van Oyen %A Nusselder, Wilma %K attribution method %K DISABILITY %K PAF %K population attributabble fraction %B WEON 2017: Epidemiological Methods for Implementation Research %C Antwerpen, Belgium %G eng %0 Journal Article %J Archives of Public Health %D 2017 %T Contribution of chronic conditions to functional limitations using a multinomial outcome: results for the older population in Belgium and Brazil %A Renata T.C. Yokota %A Wilma J. Nusselder %A Robine, Jean-Marie %A Jean Tafforeau %A Deboosere, Patrick %A Lenildo Moura %A Silvânia S. Caribé de Araújo Andrade %A Shamyr S. Castro %A Herman Van Oyen %K ADL %K Belgium %K Brazil %K chronic diseases %K Functional limitations %K multinomial %K noncommunicable diseases %K survey %X

Background

The global phenomenon of population ageing is creating new challenges in both high and middle income countries, as functional limitations are expected to increase with age. The attribution method has been proposed to identify which conditions contribute most to disability using cross-sectional data. Although the original method was based on binary outcomes, we recently proposed an extension to multinomial responses, since different disability levels are often investigated in surveys. This is the first application of the extended method to evaluate differences in the contribution of chronic conditions to functional limitations in the older population of Brazil and Belgium.

Methods

Representative data from individuals aged ≥65 years who participated in the 2008 or 2013 Health Interview Surveys in Belgium (N = 4521) or in the 2008 National Household Sample Survey in Brazil (N = 28,437) were analysed. Individuals were classified as without, moderate or severe functional limitations, based on three activities of daily living: eating, showering, and toileting. Six chronic conditions common to the surveys – diabetes, heart diseases, musculoskeletal conditions, depression, chronic respiratory diseases, and cancer – were included in the analysis. Separate multinomial additive hazards models by gender for each country were fitted.

Results

The prevalence of moderate functional limitations was larger in men in Brazil (8.4%) compared to Belgium (6.0%) and similar in women (approximately 12.0%). Conversely, the severe prevalence in men was similar in the two countries (around 8.0%) and higher in women from Belgium (16.6%) than from Brazil (9.1%). Musculoskeletal conditions were the main contributors to the prevalence of functional limitations in men and women in Belgium but only in men and women with moderate functional limitations in Brazil. Depression and heart diseases contributed most to the severe prevalence of functional limitations in men and women in Brazil, respectively.

Conclusions

Our findings provide a better understanding of differences in the prevalence of different levels of functional limitations in Brazil and Belgium. These differences can be related to differences in socioeconomic conditions, health care access and quality, disease diagnosis, stage of epidemiology transition, life expectancy, and the prevalence of lifestyle risk factors in the two countries.

%B Archives of Public Health %V 75 %8 Jan-12-2017 %G eng %N 1 %R 10.1186/s13690-017-0235-3 %0 Generic %D 2017 %T Contribution of chronic conditions to gender disparities in life expectancy and health expectancies in Belgium, 1997-2013 %A Renata Yokota %A Nusselder, Wilma %A Robine, Jean-Marie %A Jean Tafforeau %A Françoise Renard %A Deboosere, Patrick %A Herman Van Oyen %B WEON 2017 : Epidemiological Methods for Implementation Research %G eng %0 Generic %D 2017 %T Correcting the self-reported BMI doesn't impact the socio-economic inequalities in obesity %A Sabine Drieskens %A Stefaan Demarest %A Sarah Bel %A Karin De Ridder %A Jean Tafforeau %K BMI %K VALIDATION %B European Public Health Conference %C Stockholm %8 nov 2017 %G eng %0 Journal Article %J Archives of Public Health %D 2017 %T Educational inequalities in premature mortality by region in the Belgian population in the 2000s %A Françoise Renard %A Brecht Devleesschauwer %A Gadeyne, Sylvie %A Jean Tafforeau %A Deboosere, Patrick %K Belgium %K Educational inequalities %K Health inequalities %K Premature mortality %X

Background

In Belgium, socio-economic inequalities in mortality have long been described at country-level. As Belgium is a federal state with many responsibilities in health policies being transferred to the regional levels, regional breakdown of health indicators is becoming increasingly relevant for policy-makers, as a tool for planning and evaluation. We analyzed the educational disparities by region for all-cause and cause-specific premature mortality in the Belgian population.

Methods

Residents with Belgian nationality at birth registered in the census 2001 aged 25–64 were included, and followed up for 10 years though a linkage with the cause-of-death database. The role of 3 socio-economic variables (education, employment and housing) in explaining the regional mortality difference was explored through a Poisson regression. Age-standardised mortality rates (ASMRs) by educational level (EL), rate differences (RD), rate ratios (RR), and population attributable fractions (PAF) were computed in the 3 regions of Belgium and compared with pairwise regional ratios. The global PAFs were also decomposed into the main causes of death.

Results

Regional health gaps are observed within each EL, with ASMRs in Brussels and Wallonia exceeding those of Flanders by about 50% in males and 40% in females among Belgian. Individual SE variables only explained up to half of the regional differences. Educational inequalities were also larger in Brussels and Wallonia than in Flanders, with RDs ratios reaching 1.8 and 1.6 for Brussels versus Flanders, and Wallonia versus Flanders respectively; regional ratios in relative inequalities (RRs and PAFs) were smaller. This pattern was observed for all-cause and most specific causes of premature mortality. Ranking the cause-specific PAFs revealed a higher health impact of inequalities in causes combining high mortality rate and relative inequality, with lung cancer and ischemic heart disease on top for all regions and both sexes. The ranking showed few regional differences.

Conclusions

For the first time in Belgium, educational inequalities were studied by region. Among the Belgian, educational inequalities were higher in Brussels, followed by Wallonia and Flanders. The region-specific PAF decomposition, leading to a ranking of causes according to their population-level impact on overall inequality, is useful for regional policy-making processes.

%B Archives of Public Health %V 75 %8 Jan-12-2017 %G eng %N 44 %R 10.1186/s13690-017-0212-x %0 Journal Article %J Archives of Public Health %D 2017 %T Fat soluble vitamin intake from the consumption of food, fortified food and supplements: design and methods of the belgian Vitadek-study %A Isabelle Moyersoen %A Stefaan Demarest %A Sarah Bel %A Karin De Ridder %A Jean Tafforeau %K Food intake %K vitamine D %K Vitamins %B Archives of Public Health %G eng %0 Journal Article %J Arch Public Health %D 2017 %T Fat-soluble vitamin intake from the consumption of food, fortified food and supplements: design and methods of the Belgian VITADEK study. %A Isabelle Moyersoen %A Stefaan Demarest %A Karin De Ridder %A Jean Tafforeau %A Lachat, Carl %A Van Camp, John %X

BACKGROUND: The adequacy of micronutrient intake is a public health concern, as both insufficient and excessive intake levels may result in adverse health effects. Data on dietary intake are needed to evaluate potential problems regarding inadequate intake at population level and to formulate effective public health and food safety recommendations. Assessing the intake of micronutrients in population subgroups such as infants, toddlers, pregnant and lactating women is challenging and requires specific approaches. This paper describes the Belgian VITADEK study, developed to assess fat-soluble vitamin intake from the consumption of food, fortified foods and supplements in four vulnerable groups namely infants, toddlers, pregnant and lactating women.

METHODS: Subjects were selected according to a multi-stage stratified sampling design with a selection of clusters proportionate to the population size. Recruitment occurred in collaboration with Belgian child health consultation centres and obstetric clinics. Participants were asked to complete a self-administered online food frequency questionnaire (FFQ) or to answer the questionnaire by phone if online participation was not possible. The questionnaire was tailored to the specific diet of the different target populations. In order to capture vitamin intake from the consumption of foods, fortified foods and supplements, a market study was conducted to take an inventory of the fortified foods and supplements available on the Belgian market. The food list of the FFQ was based on both this inventory and the top 90% food groups that contribute to fat-soluble vitamin intake. Since fortification differs at brand level, food groups and subgroups were split up to the level of the brand of foods. Brand pictures were used as mnemonics to facilitate the recall of the consumed food items and portion pictures were used to facilitate the reproduction of the consumed portion sizes. Finally a composition table was compiled allowing for the computation of vitamin intake from all sources providing as such more accurate estimates of fat-soluble vitamin intake.

DISCUSSION: The results will allow assessing inadequate micronutrient intake by comparison of vitamin intake with dietary reference values. The data will further allow describing the most contributing food groups as well as the contribution of fortified foods and supplements to total vitamin intake. The data will enable evaluating whether infants, toddlers, pregnant and/or lactating women are reached by the actual Belgian fortification and supplementation programmes. Finally the retrieved data will reveal the potential for voluntary fortification and the need for future fortification and supplementation programmes.

%B Arch Public Health %V 75 %P 31 %8 2017 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/28523125?dopt=Abstract %R 10.1186/s13690-017-0199-3 %0 Journal Article %J Eur J Public Health %D 2017 %T Is a Health Interview Survey an appropriate tool to assess domestic violence? %A Sabine Drieskens %A Stefaan Demarest %A D'Hoker, Nicola %A Ortiz, Barbara %A Jean Tafforeau %X

Background: The aim of this study is to assess if a Health Interview Survey (HIS) targeting the general population is an appropriate tool to collect valid data on domestic violence. Studying item non-response on the question on domestic violence and its association with socio-demographic and health characteristics compared with victims of domestic violence can contribute to this.

Methods: Cross-sectional data from the Belgian HIS 2013 were analysed. A question whether the perpetrator of a violent event was a member of the respondents' household was embedded in a general topic on violence in the self-administered questionnaire. This study is limited to people aged 15+ that at least completed the first question of this topic. Socio-demographic characteristics of item non-respondents and of victims of domestic violence were explored and the association with health status was assessed through ORs calculated via logistic regression.

Results: The year prevalence of domestic violence is 1.1%. Although the question on domestic violence yields a high level of non-response (62%), this does not hinder the further completion of the questionnaire. When compared with victims of domestic violence, those not responding on the question on the perpetrator have better (mental) health. When compared with those not being victim of domestic violence, victims report poorer physical and mental health.

Conclusion: An HIS can be an appropriate tool to assess domestic violence in the general population and its association with health. However, a solution should be found for the high item non-response on the question on the perpetrator of the violent event.

%B Eur J Public Health %V 27 %P 903-909 %8 2017-06-14 %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/28633419?dopt=Abstract %R 10.1093/eurpub/ckx078 %0 Journal Article %J Nutrients %D 2017 %T Intake of Fat-Soluble Vitamins in the Belgian Population: Adequacy and Contribution of Foods, Fortified Foods and Supplements. %A Isabelle Moyersoen %A Brecht Devleesschauwer %A Dekkers, Arnold %A Karin De Ridder %A Jean Tafforeau %A Van Camp, John %A Herman Van Oyen %A Lachat, Carl %X

A key challenge of public health nutrition is to provide the majority of the population with a sufficient level of micronutrients while preventing high-consumers from exceeding the tolerable upper intake level. Data of the 2014 Belgian food consumption survey (n = 3200) were used to assess fat-soluble vitamin (vitamins A, D, E and K) intake from the consumption of foods, fortified foods and supplements. This study revealed inadequate intakes for vitamin A, from all sources, in the entire Belgian population and possible inadequacies for vitamin D. The prevalence of inadequate intake of vitamin A was lowest in children aged 3-6 (6-7%) and highest in adolescents (girls, 26%; boys, 34-37%). Except for women aged 60-64 years, more than 95% of the subjects had vitamin D intake from all sources below the adequate intake (AI) of 15 μg/day. The risk for inadequate intake of vitamins K and E was low (median > AI). Belgian fortification and supplementation practices are currently inadequate to eradicate suboptimal intakes of vitamins A and D, but increase median vitamin E intake close to the adequate intake. For vitamin A, a small proportion (1-4%) of young children were at risk of exceeding the upper intake level (UL), while for vitamin D, inclusion of supplements slightly increased the risk for excessive intakes (% > UL) in adult women and young children. The results may guide health authorities when developing population health interventions and regulations to ensure adequate intake of fat-soluble vitamins in Belgium.

%B Nutrients %V 9 %8 2017 Aug 11 %G eng %N 8 %1 http://www.ncbi.nlm.nih.gov/pubmed/28800115?dopt=Abstract %R 10.3390/nu9080860 %0 Journal Article %J Nutrients %D 2017 %T Intake of Fat-Soluble Vitamins in the Belgian Population: Adequacy and Contribution of Foods, Fortified Foods and Supplements %A Isabelle Moyersoen %A Brecht Devleesschauwer %A Dekkers, Arnold %A Karin De Ridder %A Jean Tafforeau %A Van Camp, John %A Herman Van Oyen %A Lachat, Carl %K Food intake %K Vitamin D %K Vitamins %B Nutrients %V 9 %G eng %N 8 %& 860 %0 Generic %D 2017 %T Measurement equivalence of the Belgian health interview auto-questionnaire: paper-based versus web-based mode. %A Elise Braekman %A Rana Charafeddine %A Stefaan Demarest %A Sabine Drieskens %A Jean Tafforeau %A Van Hal, Guido %K Adult %K Belgium %K Female %K health surveys %K Humans %K Internet %K Male %K Paper %K Sample Size %K Self Administration %K Surveys and Questionnaires %X

Before organizing mixed-mode data collection for the self-administered questionnaire of the Belgian Health Interview Survey, measurement effects between the paper-and-pencil and the web-based questionnaire were evaluated. A two-period cross-over study was organized with a sample of 149 employees of two Belgian research institutes (age range 22-62 years, 72% female). Measurement agreement was assessed for a diverse range of health indicators related to general health, mental and psychosocial health, health behaviors and prevention with kappa coefficients and intraclass correlation (ICC). The quality of the data collected by both modes was evaluated by quantifying the missing, 'don't know' and inconsistent values and data entry mistakes. Good to very good agreement was found for all categorical indicators with kappa coefficients superior to 0.60, except for two mental and psychosocial health indicators namely the presence of a sleeping disorder and of a depressive disorder (kappa≥0.50). For the continuous indicators high to acceptable agreement was observed with ICC superior to 0.70. Inconsistent answers and data-entry mistakes were only occurring in the paper-and-pencil mode. There were no less missing values in the web-based mode compared to the paper-and-pencil mode. The study supports the idea that web-based modes provide, in general, equal responses to paper-and-pencil modes. However, health indicators based upon factual and objective items tend to have higher measurement agreement than indicators requiring an assessment of personal subjective feelings. A web-based mode greatly facilitates the data-entry process and guides the completing of a questionnaire. However, item non-response was not positively affected.

%B WEON 2017 : Epidemiological Methods for Implementation Research %8 2017 %G eng %N Nederlandse Epidemiologie Vereniging %0 Journal Article %J BMC Health Serv Res %D 2017 %T Migrant's access to preventive health services in five EU countries. %A Rosano, Aldo %A Dauvrin, Marie %A Buttigieg, Sandra C %A Ronda, Elena %A Jean Tafforeau %A Dias, Sonia %X

BACKGROUND: Preventive health services (PHSs) form part of primary healthcare with the aim of screening to prevent disease. Migrants show significant differences in lifestyle, health beliefs and risk factors compared with the native populations. This can have a significant impact on migrants' access to health systems and participation in prevention programmes. Even in countries with widely accessible healthcare systems, migrants' access to PHSs may be difficult. The aim of the study was to compare access to preventive health services between migrants and native populations in five European Union (EU) countries.

METHODS: Information from Health Interview Surveys of Belgium, Italy, Malta, Portugal and Spain were used to analyse access to mammography, Pap smear tests, colorectal cancer screening and flu vaccination among migrants. The comparative risk of not accessing PHSs was calculated using a mixed-effects multilevel model, adjusting for potential confounding factors (sex, education and the presence of disability). Migrant status was defined according to citizenship, with a distinction made between EU and non-EU countries.

RESULTS: Migrants, in particular those from non-EU countries, were found to have poorer access to PHSs. The overall risk of not reporting a screening test or a flu vaccination ranged from a minimum of 1.8 times (colorectal cancer screening), to a high of 4.4 times (flu vaccination) for migrants. The comparison among the five EU countries included in the study showed similarities, with particularly limited access recorded in Italy and in Belgium for non-EU migrants.

CONCLUSIONS: The findings of this study are in accordance with evidence from the scientific literature. Poor organization of health services, in Italy, and lack of targeted health policies in Belgium may explain these findings. PHSs should be responsive to patient diversity, probably more so than other health services. There is a need for diversity-oriented, migrant-sensitive prevention. Policies oriented to removing impediments to migrants' access to preventive interventions are crucial, to encourage more positive action for those facing the risk of intersectional discrimination.

%B BMC Health Serv Res %V 17 %P 588 %8 2017 Aug 23 %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/28830423?dopt=Abstract %R 10.1186/s12913-017-2549-9 %0 Journal Article %J Adv Nutr %D 2017 %T Perspective: Essential Study Quality Descriptors for Data from Nutritional Epidemiologic Research. %A Yang, Chen %A Pinart, Mariona %A Kolsteren, Patrick %A Van Camp, John %A De Cock, Nathalie %A Nimptsch, Katharina %A Pischon, Tobias %A Laird, Eamon %A Perozzi, Giuditta %A Canali, Raffaella %A Hoge, Axelle %A Stelmach-Mardas, Marta %A Dragsted, Lars Ove %A Palombi, Stéphanie Maria %A Dobre, Irina %A Bouwman, Jildau %A Clarys, Peter %A Minervini, Fabio %A De Angelis, Maria %A Gobbetti, Marco %A Jean Tafforeau %A Coltell, Oscar %A Corella, Dolores %A De Ruyck, Hendrik %A Walton, Janette %A Kehoe, Laura %A Matthys, Christophe %A De Baets, Bernard %A De Tré, Guy %A Bronselaer, Antoon %A Rivellese, Angela %A Giacco Rosalba %A Lombardo, Rosario %A De Clercq, Sofian %A Hulstaert, Niels %A Lachat, Carl %X

Pooled analysis of secondary data increases the power of research and enables scientific discovery in nutritional epidemiology. Information on study characteristics that determine data quality is needed to enable correct reuse and interpretation of data. This study aims to define essential quality characteristics for data from observational studies in nutrition. First, a literature review was performed to get an insight on existing instruments that assess the quality of cohort, case-control, and cross-sectional studies and dietary measurement. Second, 2 face-to-face workshops were organized to determine the study characteristics that affect data quality. Third, consensus on the data descriptors and controlled vocabulary was obtained. From 4884 papers retrieved, 26 relevant instruments, containing 164 characteristics for study design and 93 characteristics for measurements, were selected. The workshop and consensus process resulted in 10 descriptors allocated to "study design" and 22 to "measurement" domains. Data descriptors were organized as an ordinal scale of items to facilitate the identification, storage, and querying of nutrition data. Further integration of an Ontology for Nutrition Studies will facilitate interoperability of data repositories.

%B Adv Nutr %V 8 %P 639-651 %8 2017 Sep %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/28916566?dopt=Abstract %R 10.3945/an.117.015651 %0 Journal Article %J J Epidemiol Community Health %D 2017 %T Trends in educational inequalities in premature mortality in Belgium between the 1990s and the 2000s: the contribution of specific causes of deaths. %A Françoise Renard %A Gadeyne, Sylvie %A Brecht Devleesschauwer %A Jean Tafforeau %A Deboosere, Patrick %X

BACKGROUND: Reducing socioeconomic inequalities in mortality, a key public health objective may be supported by a careful monitoring and assessment of the contributions of specific causes of death to the global inequality.

METHODS: The 1991 and 2001 Belgian censuses were linked with cause-of-death data, each yielding a study population of over 5 million individuals aged 25-64, followed up for 5 years. Age-standardised mortality rates (ASMR) were computed by educational level (EL) and cause. Inequalities were measured through rate differences (RDs), rate ratios (RRs) and population attributable fractions (PAFs). We analysed changes in educational inequalities between the 1990s and the 2000s, and decomposed the PAF into the main causes of death.

RESULTS: All-cause and avoidable ASMR decreased in all ELs and both sexes. Lung cancer, ischaemic heart disease (IHD), chronic obstructive pulmonary disease (COPD) and suicide in men, and IHD, stroke, lung cancer and COPD in women had the highest impact on population mortality. RDs decreased in men but increased in women. RRs and PAFs increased in both sexes, albeit more in women. In men, the impact of lung cancer and COPD inequalities on population mortality decreased while that of suicide and IHD increased. In women, the impact of all causes except IHD increased.

CONCLUSION: Absolute inequalities decreased in men while increasing in women; relative inequalities increased in both sexes. The PAFs decomposition revealed that targeting mortality inequalities from lung cancer, IHD, COPD in both sexes, suicide in men and stroke in women would have the largest impact at population level.

%B J Epidemiol Community Health %V 71 %P 371-380 %8 2017 Apr %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/27885048?dopt=Abstract %R 10.1136/jech-2016-208370 %0 Generic %D 2016 %T Access to preventive health services of migrants in five EU countries %A Rosano, Aldo %A Sandra Buttigieg %A Marie Dauvrain %A Ronda, Elena %A Jean Tafforeau %K accessibility %K Europe %K preventive health care %B European Public Health Association conference %C Vienna %G eng %0 Journal Article %J PLoS One %D 2016 %T Contribution of Chronic Conditions to the Disability Burden across Smoking Categories in Middle-Aged Adults, Belgium. %A Renata T C Yokota %A Nusselder, Wilma Johanna %A Robine, Jean-Marie %A Jean Tafforeau %A Deboosere, Patrick %A Herman Van Oyen %K Adult %K Belgium %K Chronic disease %K Disabled Persons %K Female %K Humans %K Male %K middle aged %K SMOKING %X

INTRODUCTION: Smoking is considered the single most important preventable cause of morbidity and mortality worldwide, contributing to increased incidence and severity of disabling conditions. The aim of this study was to assess the contribution of chronic conditions to the disability burden across smoking categories in middle-aged adults in Belgium.

METHODS: Data from 10,224 individuals aged 40 to 60 years who participated in the 1997, 2001, 2004, or 2008 Health Interview Surveys in Belgium were used. Smoking status was defined as never, former (cessation ≥2 years), former (cessation <2 years), occasional light (<20 cigarettes/day), daily light, and daily heavy (≥20 cigarettes/day). To attribute disability to chronic conditions, binomial additive hazards models were fitted separately for each smoking category adjusted for gender, except for former (cessation <2 years) and occasional light smokers due to the small sample size.

RESULTS: An increasing trend in the disability prevalence was observed across smoking categories in men (never = 4.8%, former (cessation ≥2 years) = 5.8%, daily light = 7.8%, daily heavy = 10.7%) and women (never = 7.6%, former (cessation ≥2 years) = 8.0%, daily light = 10.2%, daily heavy = 12.0%). Musculoskeletal conditions showed a substantial contribution to the disability burden in men and women across all smoking categories. Other important contributors were depression and cardiovascular diseases in never smokers; depression, chronic respiratory diseases, and diabetes in former smokers (cessation ≥2 years); chronic respiratory diseases, cancer, and cardiovascular diseases in daily light smokers; cardiovascular diseases and chronic respiratory diseases in men and depression and diabetes in women daily heavy smokers.

CONCLUSIONS: Beyond the well-known effect of smoking on mortality, our findings showed an increasing trend of the disability prevalence and different contributors to the disability burden across smoking categories. This information can be useful from a public health perspective to define strategies to reduce disability in Belgium.

%B PLoS One %V 11 %P e0153726 %8 2016 %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/27105185?dopt=Abstract %R 10.1371/journal.pone.0153726 %0 Generic %D 2016 %T Contribution of Chronic Conditions to the Disability Burden using a Multinomial Outcome: Results for the Older Population in Belgium and Brazil, 2013 %A Renata Yokota %A Nusselder, Wilma %A Jean Marie Robine %A Jean Tafforeau %A Deboosere, Patrick %A de Moura, Lenildo %A S. Suely Caribe de Arajo Andrade %A Herman Van Oyen %K Belgium %K Brazil %K chronic condition %K diability %B European Public Health Association conference %C Vienna %G eng %0 Report %D 2016 %T Enquête de consommation alimentaire 2014-2015 %A Karin De Ridder %A Sarah Bel %A Brocatus, Loes %A Cloë Ost %A Teppers, Eveline %A Jean Tafforeau %P 211 %8 2016 %G eng %& 1 %0 Journal Article %J J Gerontol A Biol Sci Med Sci %D 2016 %T Impact of Chronic Conditions and Multimorbidity on the Disability Burden in the Older Population in Belgium. %A Renata T C Yokota %A Johan Van der Heyden %A Nusselder, Wilma Johanna %A Robine, Jean-Marie %A Jean Tafforeau %A Deboosere, Patrick %A Herman Van Oyen %K Activities of daily living %K Aged %K Aging %K Belgium %K Cardiovascular Diseases %K Chronic disease %K comorbidity %K Cost of Illness %K Disability Evaluation %K Female %K health surveys %K Humans %K Male %K middle aged %K Musculoskeletal Diseases %K prevalence %K Respiratory Tract Diseases %X

BACKGROUND: The increase in longevity along with a high prevalence of chronic conditions contribute to increased disability burden. Despite the high occurrence of multimorbidity observed in advanced ages, most studies are restricted to the investigation of individual diseases. In this study, we assessed the impact of chronic conditions and multimorbidity on the disability burden in the older population in Belgium.

METHODS: Data from 9,482 participants in the 2001, 2004, or 2008 Belgian Health Interview Surveys aged 55 years or older were analyzed. Disability was defined based on the Global Activity Limitation Indicator (GALI). To attribute disability to single chronic conditions and disease pairs, a multiple additive hazard model was fitted.

RESULTS: Musculoskeletal conditions (45.3%), chronic respiratory diseases (11.2%), and cardiovascular diseases (10.2%) diseases were the most frequent conditions. Cardiovascular diseases, the co-occurrence of chronic respiratory diseases and depression, neurological diseases, cancer, and the combination of diabetes and cardiovascular diseases were the top five disabling conditions. The disability prevalence in the older population in Belgium was 35.6% (confidence interval =35.0; 36.2%). The most important contributors to the disability burden were musculoskeletal, cardiovascular, and chronic respiratory diseases.

CONCLUSIONS: The present findings provide a deeper understanding of the role of chronic conditions and multimorbidity on the disability burden in the older population in Belgium. Although the disease pairs showed a low contribution to the disability burden, their occurrence presented a high impact on disability. Prevention strategies to tackle disability should target the main contributors to the disability burden and the most disabling conditions/disease pairs, especially in the clinical practice.

%B J Gerontol A Biol Sci Med Sci %V 71 %P 903-9 %8 2016 Jul %G eng %N 7 %1 http://www.ncbi.nlm.nih.gov/pubmed/26774118?dopt=Abstract %R 10.1093/gerona/glv234 %0 Generic %D 2016 %T Misreporting of energy intake in the belgian food consumption surveys (2004-2014) %A Sarah Bel %A Karin De Ridder %A Jean Tafforeau %K bias %K BMI %K Diet %K energy %K exposure %K food consumption survey %K Food intake %K intake %K methods %K NUTRITION %K Obesity %K Recall %X

Background

Dietary assessment based on self-reported or proxy-reported data is often prone to misreporting, including both under- and over-reporting. Evaluation of this bias is crucial for correct interpretation of dietary exposure.

Methods

The prevalence and characteristics of misreporting of energy intake was investigated among 3096 participants (3-64 years old) in the Belgian National Food Consumption Survey 2014 (FCS2014). Information on food intake was collected with two non-consecutive 24-hour dietary recalls (GloboDiet®). Objective measures were obtained for anthropometric parameters. Misreporting was assessed using the Goldberg method. Additionally, the prevalence and size of underreporting was compared with FCS2004 for participants aged 15-64.

Results

Overall in 2014, 24.3% of participants underreported, 75.2% were plausible reporter and 0.5% overreported. Females underreported more often than males (OR 1.37; 95% CI 1.16-1.63). Under-reporting was less common in children (3-9 years) where parents reported dietary intake, than in adolescents (10-17 years) (OR 0.17; CI 0.12-0.26) and adults (18-64 years) (OR 0.49; CI 0.26-0.95) who self-reported. Obese participants underreported more often than overweight (OR 1.92; CI 1.45-2.55), normal weight (OR 3.71; CI 2.84-4.84) or underweight participants (OR 5.57; CI 3.37-9.21). Low educational level (OR 1.44; CI 1.21-1.71) and energy-restricted diet (OR 3.81; CI 2.40-6.03) increased the odds of under-reporting. The prevalence of underreporting was higher in 2014 (34%) than in 2004 (28%), but excluding under-reporters resulted in both FCS in an increase of the mean habitual energy intake of 300 kcal/day at population level. Further comparison with FCS2004 will be presented.

Conclusions

Underreporting of energy intake was associated with individual characteristics such as sex, age, BMI, educational level and diet. Proxy-reporting by parents resulted in less underreporting than self-reporting in adolescents and adults.

%B European Public Health Conference %C Vienna %G eng %0 Journal Article %J Archives of Disease in Childhood %D 2016 %T Neonatal thyroid-stimulating hormone concentration and psychomotor development at preschool age %A Trumpff, Caroline %A De Schepper, Jean %A Vanderfaeillie, Johan %A Vercruysse, Nathalie %A Herman Van Oyen %A Moreno-Reyes, Rodrigo %A Jean Tafforeau %A Stefanie Vandevijvere %K Child %K Cohort study %K Psychomotor development %K TSH %B Archives of Disease in Childhood %V 101 %8 Jun-12-2017 %G eng %N 12 %R 10.1136/archdischild-2015-310006 %0 Journal Article %J Arch Dis Child %D 2016 %T Neonatal thyroid-stimulating hormone concentration and psychomotor development at preschool age. %A Trumpff, Caroline %A De Schepper, Jean %A Vanderfaeillie, Johan %A Vercruysse, Nathalie %A Herman Van Oyen %A Moreno-Reyes, Rodrigo %A Jean Tafforeau %A Stefanie Vandevijvere %K Belgium %K Child %K Child, Preschool %K Congenital Hypothyroidism %K Developmental Disabilities %K Female %K Humans %K Infant %K Infant, Newborn %K Male %K Neuropsychological Tests %K Prospective Studies %K Psychomotor Disorders %K thyrotropin %X

OBJECTIVE: Thyroid hormones are essential for normal brain development. The aim of this study is to assess if high concentration of thyroid stimulating hormone (TSH) that is below the clinical threshold (5-15 mIU/L) at neonatal screening is linked to psychomotor development impairments in the offspring at preschool age.

DESIGN: A total of 284 Belgian preschool children 4-6 years old and their mothers were included in the study. The children were randomly selected from the total list of neonates screened in 2008, 2009 and 2010 by the Brussels newborn screening centre. The sampling was stratified by gender and TSH range (0.45-15 mIU/L). Infants with congenital hypothyroidism (>15 mIU/L), low birth weight and/or prematurity were excluded. Psychomotor development was assessed using the Charlop-Atwell scale of motor coordination. The iodine status of children was determined using median urinary iodine concentration. Socioeconomic, parental and child potential confounding factors were measured through a self-administered questionnaire.

RESULTS: TSH level was not significantly associated with total motor score (average change in z-score per unit increase in TSH is 0.02 (-0.03, 0.07), p=0.351), objective motor score (p=0.794) and subjective motor score (p=0.124). No significant associations were found using multivariate regression model to control confounding factors.

CONCLUSIONS: Mild thyroid dysfunction in the newborn-reflected by an elevation of TSH that is below the clinical threshold (5-15 mIU/L)-was not associated with impaired psychomotor development at preschool age.

%B Arch Dis Child %V 101 %P 1100-1106 %8 2016 Dec %G eng %N 12 %1 http://www.ncbi.nlm.nih.gov/pubmed/27402733?dopt=Abstract %R 10.1136/archdischild-2015-310006 %0 Journal Article %J Front Endocrinol (Lausanne) %D 2016 %T No Association between Elevated Thyroid-Stimulating Hormone at Birth and Parent-Reported Problem Behavior at Preschool Age. %A Trumpff, Caroline %A De Schepper, Jean %A Vanderfaeillie, Johan %A Vercruysse, Nathalie %A Jean Tafforeau %A Herman Van Oyen %A Stefanie Vandevijvere %X

OBJECTIVES: Mild level of iodine deficiency during pregnancy may reduce maternal thyroid hormone production and supply to the fetus hence affecting brain neurodevelopment. The aim of the present study was to investigate the association between elevated neonatal thyroid-stimulating hormone (TSH) level (>5 mU/L), used as a marker of maternal mild iodine deficiency during late pregnancy, and behavioral development of preschool children.

METHODS: This retrospective cohort study included 310 Belgian mothers and their children aged 4-5 years old with TSH levels in the range of 0.45-15 mU/L at birth. The TSH level was measured in dried blood spots on filter paper collected by heel stick 3-5 days after birth. Low birth weight, prematurely born children, or children with congenital hypothyroidism were excluded. The degree of behavioral problems was evaluated using the Child Behavior Check List (CBCL) for age 1½-5 years questionnaire. Relevant socioeconomic, maternal, and child factors were also collected.

RESULTS: TSH concentrations and CBCL scores were not associated both in univariate analysis and when adjusting for confounding factors in multivariate analysis.

DISCUSSION: Elevated TSH concentrations measured at birth was not associated with behavioral development scores.

%B Front Endocrinol (Lausanne) %V 7 %P 161 %8 2016 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/28066326?dopt=Abstract %R 10.3389/fendo.2016.00161 %0 Journal Article %J Arch Public Health %D 2016 %T Physical activity and sedentary behavior in Belgium (BNFCS2014): design, methods and expected outcomes. %A Lebacq, Thérésa %A Cloë Ost %A Sarah Bel %A Brocatus, Loes %A Teppers, Eveline %A Koenraad Cuypers %A Jean Tafforeau %A De Ridder, Karin A A %X

BACKGROUND: There is strong evidence to indicate that regular moderate intensity physical activity is associated with health benefits. Furthermore, sedentary behavior has been related with an increased risk for all-cause mortality. The accurate measurement of physical activity and sedentary behavior is therefore vital to evaluate their health impact and provide evidence for the development of public health recommendations. This paper describes the methodology used for assessing physical activity and sedentary behavior in the Belgian population in the context of the Belgian National Food Consumption Survey 2014 (BNFCS2014).

RESULTS: Data about physical activity and sedentary behavior were collected as part of the cross-sectional BNFCS2014 between February 2014 and May 2015. A nationally-representative sample of children (3-9 years) and adolescents (10-17 years) were asked to wear an accelerometer (Actigraph® GT3X) during their waking hours for 7 consecutive days. Data were recorded in 15-second epochs and respondents with at least 2 valid week days (i.e., 10 h of wear-time) and 1 valid week-end day (i.e., 8 h of wear-time) were retained for the analyses. The Evenson cut points were used to assess the time spent in each physical activity intensity level: sedentary, low, moderate and vigorous. Complementary, diaries were provided to register the activities performed when the accelerometer was removed; these activities were added to the measures provided by the accelerometers. In addition, age-specific self-reported questionnaires (ToyBox and FPAQ) were completed to provide contextual information about the type of activities performed. Due to financial constraints, physical activity in adults (18-64 years) was assessed and described through the self-reported International Physical Activity Questionnaire (IPAQ long version) only.

CONCLUSION: Data were collected in the context of the BNFCS2014 to provide a comprehensive picture of the physical activity and sedentary behavior in the Belgian population, with a special focus on children (3-9 years) and adolescents (10-17 years). Levels of physical activity and sedentary behavior can be compared to international guidelines and analyzed according to several background variables, such as age, gender, Body Mass Index, education level and region. Such results are aimed to underpin future policies in the field of physical activity.

%B Arch Public Health %V 74 %P 44 %8 2016 %G eng %1 https://www.ncbi.nlm.nih.gov/pubmed/27777766?dopt=Abstract %R 10.1186/s13690-016-0156-6 %0 Journal Article %J Arch Public Health %D 2016 %T Physical activity and sedentary behavior in Belgium (BNFSC2014): design, methods and expected outcomes %A Thérésa Lebacq %A Cloë Ost %A Sarah Bel %A Brocatus, Loes %A Teppers, Eveline %A Koenraad Cuypers %A Jean Tafforeau %A Karin De Ridder %B Arch Public Health %V 74 %8 2016 %G eng %N 44 %0 Journal Article %J Arch Public Health %D 2016 %T Protocol of the Belgian food consumption survey 2014: objectives, design and methods. %A Sarah Bel %A Van den Abeele, Sofie %A Lebacq, Thérésa %A Cloë Ost %A Brocatus, Loes %A Stiévenart, Charlotte %A Teppers, Eveline %A Jean Tafforeau %A Koenraad Cuypers %X

BACKGROUND: Dietary patterns are one of the major determinants as far as health and burden of disease is concerned. Food consumption data are essential to evaluate and develop nutrition and food safety policies. The last national food consumption survey in Belgium took place in 2004 among the Belgian population aged 15 years and older. Since dietary habits are prone to change over time a new Belgian National Food Consumption Survey (BNFCS2014) was conducted in 2014-2015.

METHODS: The BNFCS2014 is a cross-sectional study. A representative sample (n = 3200) of the Belgian population aged 3 to 64 years old was randomly selected from the National Population Register following a multistage stratified sampling procedure. Data collection was divided equally over the four seasons and days of the week in order to incorporate seasonal effects and day-to-day variation in food intake. Information on food intake was collected in adults with two non-consecutive 24-h dietary recalls (using the GloboDiet® software). In children food intake was collected with two non-consecutive one-day food diaries followed by a completion interview with GloboDiet. Additional data on socio-demographic characteristics, eating habits, lifestyle, food safety (at household level), physical activity and sedentary behaviour were collected with a face-to-face questionnaire using a computer-assisted personal interviewing technique. In the time between the two visits, participants were asked to complete a self-administered food frequency questionnaire and health questionnaire. Height, weight and waist circumference were measured. In addition, children and adolescents were asked to wear an accelerometer and keep a logbook for seven consecutive days to objectively measure physical activity and sedentary behaviour.

CONCLUSION: The main objective of the BNFCS2014 is to evaluate the habitual food, energy and nutrient intake in the Belgian population and to compare these with recommendations from the national dietary guidelines. A second objective is to monitor eating habits and food safety aspects of the food consumption in Belgium. The results of this dietary monitoring survey, together with the information on the level of physical activity, may underpin future nutrition, food safety and physical activity policies at national and European level.

%B Arch Public Health %V 74 %P 20 %8 2016 %G eng %1 https://www.ncbi.nlm.nih.gov/pubmed/27186370?dopt=Abstract %R 10.1186/s13690-016-0131-2 %0 Journal Article %J BMC Med Res Methodol %D 2016 %T Regional differences in the validity of self-reported use of health care in Belgium: selection versus reporting bias. %A Johan Van der Heyden %A Rana Charafeddine %A De Bacquer, D %A Jean Tafforeau %A Van Herck, K %X

BACKGROUND: The Health Care Module of the European Health Interview Survey (EHIS) is aimed to obtain comparable information on the use of inpatient and ambulatory care in all EU member states. In this study we assessed the validity of self-reported information on the use of health care, collected through this instrument, in the Belgian Health Interview Survey (BHIS), and explored the impact of selection and reporting bias on the validity of regional differences in health care use observed in the BHIS.

METHODS: To assess reporting bias, self-reported BHIS 2008 data were linked with register-based data from the Belgian compulsory health insurance (BCHI). The latter were compared with similar estimates from a random sample of the BCHI to investigate the selection bias. Outcome indicators included the prevalence of a contact with a GP, specialist, dentist and a physiotherapist, as well as inpatient and day patient hospitalisation. The validity of the estimates and the regional differences were explored through measures of agreement and logistic regression analyses.

RESULTS: Validity of self-reported health care use varies by type of health service and is more affected by reporting than by selection bias. Compared to health insurance estimates, self-reported results underestimate the percentage of people with a specialist contact in the past year (50.5 % versus 65.0 %) and a day patient hospitalisation (7.8 % versus 13.9 %). Inversely, survey results overestimated the percentage of people having visited a dentist in the past year: 58.3 % versus 48.6 %. The best concordance was obtained for an inpatient hospitalisation (kappa 0.75). Survey data overestimate the higher prevalence of a contact with a specialist [OR 1.51 (95 % CI 1.33-1.72) for self-report and 1.08 (95 % CI 1.05-1.15) for register] and underestimate the lower prevalence of a contact with a GP [ORs 0.59 (95 % CI 0.51-0.70) and 0.41 (95 % CI 0.39-0.42) respectively] in Brussels compared to Flanders.

CONCLUSION: Cautiousness is needed to interpret self-reported use of health care, especially for ambulatory care. Regional differences in self-reported health care use may be influenced by regional differences in the validity of the self-reported information.

%B BMC Med Res Methodol %V 16 %P 98 %8 2016 Aug 16 %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/27528010?dopt=Abstract %R 10.1186/s12874-016-0198-z %0 Report %D 2016 %T Voedselconsumptiepeiling 2014-2015. Rapport 4: de consumptie van voedingsmiddelen en de inname van voedingstoffen %A Sarah Bel %A Jean Tafforeau %A Karin De Ridder %A Brocatus, Loes %A Koenraad Cuypers %A Thérésa Lebacq %A Isabelle Moyersoen %A Cloë Ost %A Teppers, Eveline %K België %K CONSUMPTION %K food consumption survey %K nutrient intake %K NUTRITION %X

Voeding en eetgewoonten zijn van groot belang voor de volksgezondheid. Ze zijn namelijk belangrijke factoren voor de ontwikkeling van niet-overdraagbare aandoeningen, zoals diabetes, hart- en vaatziekten en kanker. Om een voedingsbeleid te kunnen opstellen aangepast aan de behoeften van de Belgische bevolking is het dus noodzakelijk om een correct en recent beeld te hebben van de voedingsconsumptie en eetgewoonten in België. De laatste Voedselconsumptiepeiling uitgevoerd in België dateert van 2004. Aangezien eetgewoonten evolueren doorheen de jaren, was het nodig om deze gegevens te actualiseren. Daarom werd er op initiatief van de Minister van Sociale Zaken en Volksgezondheid en de Federale Overheidsdienst (FOD) Volksgezondheid, Veiligheid van de Voedselketen en Leefmilieu een tweede Voedselconsumptiepeiling opgestart in 2014. Deze studie werd georganiseerd, gecofinancierd en uitgevoerd door het Wetenschappelijk Instituut Volksgezondheid (WIV-ISP). De Voedselconsumptiepeiling 2014-2015 heeft als algemene doelstelling om de voedingsconsumptie, de eetgewoonten en de lichaamsbeweging van de Belgische bevolking tussen de 3 en 64 jaar te beschrijven. Dit onderzoek heeft als voordeel dat, voor het eerst in België, er gegevens zijn verzameld bij kinderen (3-9 jaar) en adolescenten (10-17 jaar). Deze gegevens zijn cruciaal voor het uitwerken van preventieve maatregelen aangepast aan deze kwetsbare leeftijdsgroepen.

%I WIV-ISP %C Brussels, Belgium %P 1551 %8 2016 %G eng %M D/2016/2505/27 %0 Generic %D 2016 %T Worse or better ? The challenge of measuring inequality changes in premature mortality in Belgium %A Françoise Renard %A Gadeyne, Sylvie %A Brecht Devleesschauwer %A Jean Tafforeau %A Patrick De Boosere %K Health inequalities %K mortality %K Premature mortality %B European Public Health Association conference %C Vienna %G eng %0 Generic %D 2015 %T Contribution of chronic diseases to mild and severe disability burden in Belgium %A Renata T C Yokota %A Stefaan Demarest %A Johan Van der Heyden %A Jean Tafforeau %A W.J. Nusselder %A Deboosere,P. %A Herman Van Oyen %K Belgium %K burden %K chronic %K chronic condition %K Chronic disease %K chronic diseases %K Congresses %K contribution %K disabilities %K DISABILITY %K disease %K Diseases %K epidemiology %K European %K functional limitation %K Mild %K mobility %B European Congress of Epidemiology %C Maastricht %8 0/0/2015 %G eng %N / %1 38016 %2 / %R http://dx.doi.org/10.1186/s13690-015-0083-y %0 Journal Article %J BMC Public Health %D 2015 %T Contribution of chronic diseases to the disability burden in a population 15 years and older, Belgium, 1997-2008. %A Renata T C Yokota %A Nicolas Berger %A Nusselder, Wilma J %A Robine, Jean-Marie %A Jean Tafforeau %A Deboosere, Patrick %A Herman Van Oyen %K Activities of daily living %K ADOLESCENT %K Adult %K Aged %K Aged, 80 and over %K ARTHRITIS %K Belgium %K Chronic disease %K Cost of Illness %K cross-sectional studies %K Disabled Persons %K Female %K health surveys %K Humans %K Male %K middle aged %K Mobility Limitation %K Musculoskeletal Diseases %K prevalence %K Quality of Life %K Young adult %X

BACKGROUND: Age-associated disability reduces quality of life in older populations and leads to wide-range implications for social and health policy. The identification of diseases that contribute to the disability burden is crucial to the development of prevention and intervention strategies to reduce disability. In this study, we assessed the contribution of chronic diseases to the prevalence of disability in Belgium.

METHODS: Data from 35,837 individuals aged 15 years or older who participated in the 1997, 2001, 2004, or 2008 Belgian Health Interview Surveys were used. Disability was defined as difficulties in doing at least one of six activities of daily living (transfer in and out of bed, transfer in and out of chair, dressing, washing hands and face, feeding, and going to the toilet) and/or mobility limitations (ability to walk without stopping less than 200 m). Multiple additive regression models were fitted separately for men and women to estimate the age-specific background disability rate (experienced by everyone, independent of the presence of specific diseases) and disease-specific disability rates (disability rate in subjects who reported selected chronic diseases).

RESULTS: Musculoskeletal, cardiovascular, and respiratory diseases were the main contributors to the disability burden in Belgium. Musculoskeletal diseases were the most prevalent diseases in men and women in all age groups. Neurological diseases and stroke were the most disabling diseases, i.e. caused the highest level of disability among the diseased individuals, in all age groups for men and women, respectively. Back pain was the main cause of disability in men aged 15 to 64 years, while heart attack was the major contributor to the disability prevalence in men aged 65 or older. Likewise, arthritis was the main cause of disability among women across all age groups. Depression was also an important contributor in young subjects (15-54 years). Cancer was not an important contributor to the disability prevalence in Belgium.

CONCLUSIONS: To reduce the burden of disability in Belgium, interventions should target musculoskeletal, cardiovascular and respiratory diseases especially among elderly. Furthermore, attention should also be given to depression in young individuals.

%B BMC Public Health %V 15 %P 229 %8 2015 Mar 07 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/25879222?dopt=Abstract %R 10.1186/s12889-015-1574-z %0 Journal Article %J Arch Public Health %D 2015 %T Contribution of chronic diseases to the mild and severe disability burden in Belgium. %A Renata T C Yokota %A Johan Van der Heyden %A Stefaan Demarest %A Jean Tafforeau %A Nusselder, Willma J %A Deboosere, Patrick %A Herman Van Oyen %X

BACKGROUND: Population aging accompanied by an increased longevity with disability has raised international concern, especially due to its costs to the health care systems. Chronic diseases are the main causes of physical disability and their simultaneous occurrence in the population can impact the disablement process, resulting in different severity levels. In this study, the contribution of chronic diseases to both mild and severe disability burden in Belgium was investigated.

METHODS: Data on 21 chronic diseases and disability from 35,799 individuals aged 15 years or older who participated in the 1997, 2001, 2004, or 2008 Belgian Health Interview Surveys were analysed. Mild and severe disability were defined based on questions related to six activities of daily living and/or mobility limitations. To attribute disability by severity level to selected chronic diseases, multiple additive hazard models were fitted to each disability outcome, separately for men and women.

RESULTS: A stable prevalence of mild (5 %) and severe (2-3 %) disability was observed for the Belgian population aged 15 years or older between 1997 and 2008. Arthritis was the most important contributor in women with mild and severe disability. In men, low back pain and chronic respiratory diseases contributed most to the mild and severe disability burden, respectively. The contribution also differed by age: for mild disability, depression and chronic respiratory diseases were important contributors among young individuals, while heart attack had a large contribution for older individuals. For severe disability, neurological diseases and stroke presented a large contribution in young and elderly individuals, respectively.

CONCLUSIONS: Our results indicate that the assessment of the contribution of chronic diseases on disability is more informative if different levels of disability are taken into consideration. The identification of diseases which are related to different levels of disability - mild and severe - can assist policymakers in the definition and prioritisation of strategies to tackle disability, involving prevention, rehabilitation programs, support services, and training for disabled individuals.

%B Arch Public Health %V 73 %P 37 %8 2015 %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/26240753?dopt=Abstract %R 10.1186/s13690-015-0083-y %0 Generic %D 2015 %T Determinants of second-stage recruitment in the Belgian Health Interview Survey %A Stefaan Demarest %A Jean Tafforeau %A Johan Van der Heyden %K association %K Belgian %K Belgium %K conference %K determinant %K DETERMINANTS %K European %K health %K Health inequalities %K Health inequality %K health interview survey %K health survey %K Iceland %K inequalities %K inequality %K Interview %K Interview survey %K Non-participants %K PARTICIPANTS %K recruitment %K Research %K survey %K survey research %B European Survey Research Association conference %C Reykjavik, Iceland %8 0/0/2015 %G eng %N ? %1 37975 %2 ? %0 Journal Article %J Arch Public Health %D 2015 %T Development of the European Health Interview Survey - Physical Activity Questionnaire (EHIS-PAQ) to monitor physical activity in the European Union. %A Finger, Jonas D %A Jean Tafforeau %A Lydia Gisle %A Oja, Leila %A Ziese, Thomas %A Thelen, Juergen %A Mensink, Gert B M %A Lange, Cornelia %X

BACKGROUND: A domain-specific physical activity questionnaire (EHIS-PAQ) was developed in the framework of the second wave of the European Health Interview Survey (EHIS). This article presents the EHIS-PAQ and describes its development and evaluation processes.

METHODS: Research institutes from Belgium, Estonia and Germany participated in the Improvement of the EHIS (ImpEHIS) Grant project issued by Eurostat. The instrument development process comprised a non-systematic literature review and a systematic HIS/HES database search for physical activity survey questions. The developed EHIS-PAQ proposal was reviewed by survey experts. Cognitive testing of the EHIS-PAQ was conducted in Estonia and Germany. The EHIS-PAQ was further tested in a pilot survey in Belgium, Estonia and Germany in different modes of data collection, face-to-face paper and pencil interview (PAPI) and computer assisted telephone interview (CATI).

RESULTS: The EHIS-PAQ is a rather pragmatic tool aiming to evaluate how far the population is physically active in specific public health relevant settings. It assesses work-related, transport-related and leisure-time physical activity in a typical week. Cognitive testing revealed that the EHIS-PAQ worked as intended. The pilot testing showed the feasibility of using the EHIS-PAQ in an international health interview survey setting in Europe. It will be implemented in all 28 European Union Member States via European Union implementing regulation in the period between 2013 and 2015. This will be a first opportunity to get comparable data on domain-specific physical activity in all 28 EU MS and to publish indicators at the EU level.

CONCLUSIONS: The EHIS-PAQ is a short, domain-specific PA questionnaire based on PA questions which have been used in large-scale health interview surveys before. It was designed by considering the respondents' perspective in answering PA questions.

%B Arch Public Health %V 73 %P 59 %8 2015 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/26634120?dopt=Abstract %R 10.1186/s13690-015-0110-z %0 Report %D 2015 %T Enquête de santé 2013, rapport 1 : état de santé et bien-être %A Johan Van der Heyden %A Rana Charafeddine %A Sabine Drieskens %A Stefaan Demarest %A Lydia Gisle %A Jean Tafforeau %K Belgium %K chronic condition %K de %K DISABILITY %K enquête de santé %K ET %K Functional status %K Health status %K HIS %K Mental health %K pain %K Quality of Life %K rapport %K santé %K sick leave %K subjective health %I Scientiic Institute of Public Health %C Brussels %V 1 %P 1115 %8 0/0/2015 %G eng %1 37823 %& 1 %0 Report %D 2015 %T Enquête de santé 2013, rapport 2 : comportements de santé et style de vie %A Lydia Gisle %A Stefaan Demarest %A Sabine Drieskens %A Johan Van der Heyden %A Rana Charafeddine %A Jean Tafforeau %K addiction %K alcohol %K Belgium %K de %K Drug use %K enquête de santé %K ET %K Fruits %K HIS %K NUTRITION %K nutritional habits %K nutritional status %K Obesity %K oral health %K Overweight %K Physical activity %K rapport %K santé %K SEXUAL BEHAVIOUR %K SMOKING %K style %K vegetables consumption %I Scientiic Institute of Public Health %C Brussels %V 2 %P 796 %8 0/0/2015 %G eng %1 37824 %& 1 %0 Report %D 2015 %T Enquête de santé 2013, rapport 3 : Utilisation des services de santé et des services sociaux %A Sabine Drieskens %A Stefaan Demarest %A Johan Van der Heyden %A Rana Charafeddine %A Lydia Gisle %A Jean Tafforeau %K accessibility %K alternative care %K Belgium %K de %K dentist %K emergency unit %K enquête de santé %K ET %K GENERAL PRACTITIONER %K health care %K HIS %K hospital admission %K medical drug %K medicines %K paramedics %K patient experience %K rapport %K santé %K Service %K Services %K SPECIALIST %K utilisation %I WIV-ISP %C Brussels %V 3 %P 992 %8 0/0/2015 %G eng %1 37825 %& 1 %0 Report %D 2015 %T Enquête de santé 2013, rapport 4 : environnement physique et social %A Rana Charafeddine %A Stefaan Demarest %A Sabine Drieskens %A Lydia Gisle %A Johan Van der Heyden %A Jean Tafforeau %K Accidents %K Belgium %K de %K enquête de santé %K environment %K Environnement %K ET %K exposure %K HIS %K informal care %K lodging %K PASSIVE SMOKING %K rapport %K santé %K SOCIAL %K social health %K VIOLENCE %I Scientiic Institute of Public Health %C Brussels %V 4 %P NA %8 0/0/2015 %G eng %1 37826 %& 1 %0 Report %D 2015 %T Enquête de santé 2013, rapport 5 : prévention %A Stefaan Demarest %A Rana Charafeddine %A Sabine Drieskens %A Johan Van der Heyden %A Lydia Gisle %A Jean Tafforeau %K AIDS %K ATTITUDES %K Belgium %K breast %K cancer %K cardiovascular %K cervix %K Cholesterol %K Colonoscopy %K COLORECTAL %K de %K enquête de santé %K feacal occult blood testing %K Glycemia %K HIS %K HIV %K HPV %K hypercholesterolemia %K Hyperglycemia %K Hypertension %K Immunisation %K INFLUENZA %K KNOWLEDGE %K MAMMOGRAPHY %K pneumoccocus %K prevention %K rapport %K santé %K SCREENING %K Vaccination %I Scientiic Institute of Public Health %C Brussels %V 4 %P 148 %8 0/0/2015 %G eng %1 37827 %& 1 %0 Journal Article %J Arch Public Health %D 2015 %T Factors associated with excessive polypharmacy in older people. %A Walckiers, Denise %A Johan Van der Heyden %A Jean Tafforeau %X

BACKGROUND: Older people are a growing population. They live longer, but often have multiple chronic diseases. As a consequence, they are taking many different kind of medicines, while their vulnerability to pharmaceutical products is increased. The objective of this study is to describe the medicine utilization pattern in people aged 65 years and older in Belgium, and to estimate the prevalence and the determinants of excessive polypharmacy.

METHODS: Data were used from the Belgian Health Interview Survey carried out in 2008. Each respondent was asked to show to the interviewer all medicines that he/she had taken in the 24 h prior to the interview. Excessive polypharmacy was defined as the use of nine different kind of medicines or more in the past 24 h; the relation with the Region of residence, age, gender and additional factors, such as socioeconomic status, living situation, health status and contacts with health services, was explored through multivariate models.

RESULTS: Eight percent of the older people (65 years or more) belong to the excessive polypharmacy group. Factors most strongly associated with excessive polypharmacy are: having a longstanding illness, chronic condition or handicap, at least 1 contact with a general practitioner in past 2 months and self-reported depression during the last year. Ninety percent of persons in the excessive polypharmacy group are taking medicines active on the cardiovascular system.

CONCLUSIONS: In order to optimize the use of medicines, it is necessary to find a balance between adequate treatment of diseases and avoiding adverse effects of medicines. Interventions should aim to increase awareness among healthcare professionals and patients; they should focus on general practitioners and patients with cardiovascular diseases, those suffering from depression and those aged 80 years and over. Monitoring excessive polypharmacy in the older population remains important. Further studies should explore more in depth other and more specific determinants of excessive polypharmacy.

%B Arch Public Health %V 73 %P 50 %8 2015 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/26557365?dopt=Abstract %R 10.1186/s13690-015-0095-7 %0 Journal Article %J Archives of Public Health %D 2015 %T Factors associated with excessive polypharmacy in older people %A Walckiers, Denise %A Johan Van der Heyden %A Jean Tafforeau %K Belgium %K medicine use %K multimorbidity %B Archives of Public Health %V 73 %8 Jan-12-2015 %G eng %N 1 %R 10.1186/s13690-015-0095-7 %0 Report %D 2015 %T Gezondheidsenquête 2013. Rapport 1: Gezondheid en Welzijn %A Johan Van der Heyden %A Rana Charafeddine %A Stefaan Demarest %A Sabine Drieskens %A Lydia Gisle %A Jean Tafforeau %G eng %0 Report %D 2015 %T Gezondheidsenquête 2013. Rapport 2: Gezondheidsgedrag en leefstijl %A Lydia Gisle %A Stefaan Demarest %A Rana Charafeddine %A Sabine Drieskens %A Johan Van der Heyden %A Jean Tafforeau %G eng %0 Report %D 2015 %T Gezondheidsenquête 2013. Rapport 3: Gebruik van gezondheids- en welzijnsdiensten %A Sabine Drieskens %A Lydia Gisle %A Rana Charafeddine %A Stefaan Demarest %A Johan Van der Heyden %A Jean Tafforeau %G eng %0 Report %D 2015 %T Gezondheidsenquête 2013. Rapport 4: Fysieke en sociale omgeving. %A Rana Charafeddine %A Lydia Gisle %A Johan Van der Heyden %A Jean Tafforeau %E Stefaan Demarest %E Sabine Drieskens %K EN %K gezondheidsenquête %K HIS %K rapport %I WIV-ISP %C Brussel %V D/2015/2505/20 %P 418 %8 0/0/2015 %G eng %1 37832 %& 1 %0 Report %D 2015 %T Gezondheidsenquête 2013. Rapport 5: Preventie %A Stefaan Demarest %A Rana Charafeddine %A Sabine Drieskens %A Lydia Gisle %A Johan Van der Heyden %A Jean Tafforeau %G eng %0 Generic %D 2015 %T Health care trajectories and medication consumption of substance users in treatment: linking TDI and IMA databases (Belgium) %A Karin De Ridder %A Jérôme Antoine %A L. Gremeaux %A E Plettinckx %A Peter Blanckaert %A Jean Tafforeau %K Belgium %K care %K conference %K CONSUMPTION %K Database %K Databases %K drug addiction %K epidemiology %K health %K health care %K HEALTH-CARE %K medical drugs %K method %K methods %K TDI %K treatment %K Users %B Methods in Epidemiology Conference %C Leuven %8 0/0/2015 %G eng %N ? %1 37974 %2 2015 %0 Generic %D 2015 %T Impact of smoking on the contribution of chronic diseases to the disability burden in Belgium, 1997-2008 %A Renata T C Yokota %A Johan Van der Heyden %A Jean Tafforeau %A W.J. Nusselder %A Robine,J.M. %A Herman Van Oyen %K 2001 %K 2004 %K 2008 %K a %K Activities of daily living %K Activity %K ADL %K age %K AGE GROUP %K AGE GROUPS %K Age-group %K Aged %K an %K ARTHRITIS %K AS %K Attack %K Back %K Back Pain %K Belgian %K Belgium %K burden %K cause %K chronic %K Chronic disease %K chronic diseases %K CI %K conditions %K conference %K contribution %K data %K dépression %K disabilities %K DISABILITY %K disease %K Diseases %K European %K function %K Gender %K Group %K hazard %K health %K health interview survey %K health interview surveys %K Heart %K heart attack %K Heart-attack %K HIS %K Impact %K incidence %K Increase %K Individuals %K Interview %K Interview survey %K IS %K limitation %K Limitations %K living %K Low Back Pain %K MEN %K method %K methods %K mobility %K Mobility Limitation %K MODEL %K models %K morbidity %K mortality %K Multiple %K older %K ON %K pain %K prevalence %K public %K public health %K Public-health %K relative %K Respiratory %K Respiratory disease %K respiratory diseases %K result %K results %K severity %K smokers %K SMOKING %K specific %K status %K Strategies %K Strategy %K study %K survey %K surveys %K top %K WHO %K WOMEN %K young %X Smoking is considered the single most important preventable cause of morbidity and mortality worldwide. Moreover, smoking can increase the incidence and severity of disabling conditions. In this study, the aim was to assess the impact of smoking on the contribution of chronic diseases to the disability burden in Belgium. %B European Public Health Conference %C Milan %8 0/10/2015 %G eng %N ? %1 38014 %2 18/06/2015 %0 Journal Article %J Archives of Public Health %D 2015 %T Mapping the cause-specific premature mortality reveals large between-districts disparity in Belgium, 2003-2009 %A Françoise Renard %A Deboosere,P. %A Jean Tafforeau %K a %K age %K ALL %K association %K at %K Belgium %K cause specific %K cause-specific %K Class %K Clustering %K conditions %K conference %K Correlation %K Correlations %K data %K Design %K Discussion %K disparities %K distribution %K district %K Ecological %K ECONOMIC %K European %K Expectancy %K Flanders %K Flemish %K Geographical %K Geographical-distribution %K health %K Health indicator %K HEALTH POLICIES %K HEALTH POLICY %K Heterogeneity %K Impact %K Income %K Income inequality %K Indicator %K inequalities %K inequality %K intervention %K interventions %K IS %K LEVEL %K Life %K Life expectancy %K Male %K males %K mapping %K method %K methods %K mortality %K Mortality rate %K Mortality rates %K Mortality-rates %K observed %K ON %K Paper %K pattern %K PATTERNS %K period %K POISSON %K Poisson regression %K POLICIES %K POLICY %K POPULATION %K premature %K Premature mortality %K PROGRESSION %K public %K public health %K Public-health %K RATES %K Ratio %K Ratios %K region %K regional %K regression %K Research %K result %K results %K scale %K Socio economic %K Socio-economic %K Socioeconomic %K Statistics %K Still %K Test %K unemployment %X Background: Belgium has a well-known regional pattern in life expectancy with higher life expectancy in the northern Flemish region. The aim of this paper is to analyse in how far this pattern is reproduced in premature mortality (1-<75 yr) in males, a health indicator sensitive to both health policy interventions and socio-economic conditions. Methods: Data on mortality, population and unemployment are provided by Statistics Belgium. We used maps to explore the geographical patterns of premature mortality, and look at the ecological association with socio-economic characteristics at the district level: age-adjusted premature mortality rates in males were computed and mapped at district level for the periods 1993-1997 and 2005-2009. Rates are grouped into classes with a geometrical progression of 1.1 and are represented with a diverging scale of colours. The disparity between districts was measured with the decile ratio (P90/P10). The association with the geographical distribution of unemployment was examined both visually and tested with a Poisson regression.Results: The clear geographical pattern with lower premature mortality rates in the North (Flanders) is confirmed. The highest premature mortality rates are observed in the South-West districts. The pattern is persistent over the 2 periods, with more heterogeneity in the 2005-2009 period, the between-district decile ratios being 1.56 and 1.75 respectively in the 1 %B Archives of Public Health %V 73 %8 0/0/2015 %G eng %N 13 %1 38004 %R http://dx.doi.org/10.1186/s13690-015-0060-5 %0 Journal Article %J Nutr Res %D 2015 %T Neonatal thyroid-stimulating hormone level is influenced by neonatal, maternal, and pregnancy factors. %A Trumpff, Caroline %A Stefanie Vandevijvere %A Moreno-Reyes, Rodrigo %A Jean Vanderpas %A Jean Tafforeau %A Herman Van Oyen %A De Schepper, Jean %K Adult %K Belgium %K Child, Preschool %K Cohort Studies %K Female %K Humans %K Infant, Newborn %K Male %K mothers %K Neonatal Screening %K Pregnancy %K Retrospective Studies %K thyrotropin %X

The percentage of newborns with a neonatal whole blood thyroid-stimulating hormone (TSH) greater than 5 mIU/L has been used as an indicator of iodine deficiency at the population level. However, TSH levels in newborns may be influenced by many factors other than iodine status. The objective of this study was to identify neonatal, maternal, and pregnancy-related determinants of neonatal TSH levels in a retrospective cohort study. The study sample included 313 Belgian mothers and their 4- to 5-year-old children. The children had a neonatal TSH concentration between 0 and 15 mIU/L at neonatal screening, and blood samples were collected 3 to 5 days after birth. Children with suspected congenital hypothyroidism (neonatal TSH level >15 mIU/L), prematurely born (i.e., <37 weeks), or with a low birth weight (i.e., <2500 g) were excluded. Information about maternal and birth-related determinants was collected from the neonatal screening center via a self-administered questionnaire filled in by the mother together with the child's health booklet. Higher TSH levels were found in spring and winter compared to summer and autumn (P = .011). Higher TSH levels were associated with lifetime smoking behavior (up to child birth) in the mother (P = .005), lower weight gain during pregnancy (P = .014), and longer pregnancies (P = .003). This study showed that several neonatal, maternal, and pregnancy-related determinants are influencing neonatal TSH level.

%B Nutr Res %V 35 %P 975-81 %8 2015 Nov %G eng %N 11 %1 http://www.ncbi.nlm.nih.gov/pubmed/26428622?dopt=Abstract %R 10.1016/j.nutres.2015.09.002 %0 Journal Article %J Nutrients %D 2015 %T Thyroid-Stimulating Hormone (TSH) Concentration at Birth in Belgian Neonates and Cognitive Development at Preschool Age. %A Trumpff, Caroline %A De Schepper, Jean %A Vanderfaeillie, Johan %A Vercruysse, Nathalie %A Herman Van Oyen %A Moreno-Reyes, Rodrigo %A Jean Tafforeau %A Jean Vanderpas %A Stefanie Vandevijvere %K Belgium %K Child %K Child Development %K Child, Preschool %K Cognition %K Cohort Studies %K Confounding Factors (Epidemiology) %K Deficiency Diseases %K Female %K Humans %K Infant, Newborn %K Intellectual Disability %K Intelligence %K Iodine %K Male %K mothers %K Neonatal Screening %K Pregnancy %K Pregnancy Complications %K Prenatal Nutritional Physiological Phenomena %K Retrospective Studies %K Severity of Illness Index %K thyrotropin %X

The main objective of the study was to investigate the effect of MID during late pregnancy, assessed by the thyroid-stimulating hormone (TSH) concentration at neonatal screening, on cognitive development of preschool children. A retrospective cohort study including 311 Belgian preschool children of 4-6 years old was conducted. Children were selected at random from the total list of neonates screened in 2008, 2009, and 2010 by the Brussels new-born screening center. Infants with congenital hypothyroidism, low birth weight, and/or prematurity were excluded from the selection. The selected children were stratified by gender and TSH-range (0.45-15 mIU/L). Cognitive abilities were assessed using Wechsler Preschool and Primary Scale of Intelligence-third edition. In addition, several socioeconomic, parental, and child confounding factors were assessed. Neonatal TSH concentration-a surrogate marker for MID-was not associated with Full Scale and Performance IQ scores in children. Lower Verbal IQ scores were found in children with neonatal TSH values comprised between 10-15 mIU/L compared to lower TSH levels in univariate analysis but these results did not hold when adjusting for confounding factors. Current levels of iodine deficiency among pregnant Belgian women may not be severe enough to affect the neurodevelopment of preschool children.

%B Nutrients %V 7 %P 9018-32 %8 2015 Nov 02 %G eng %N 11 %1 http://www.ncbi.nlm.nih.gov/pubmed/26540070?dopt=Abstract %R 10.3390/nu7115450 %0 Generic %D 2015 %T Validity of self-reported use of health care in the European Health Interview Survey %A Johan Van der Heyden %A De Bacquer,D. %A Jean Tafforeau %A Rana Charafeddine %A Van Herck,K. %K 2008 %K a %K adjustment %K Agreement %K ALL %K Ambulatory Care %K an %K AS %K Belgian %K Belgian population %K Belgium %K Brussels %K care %K CI %K Concordance %K conference %K CONTACT %K Covariate %K data %K data sources %K Day patient hospitalisation %K dentist %K differences %K EHIS %K EU %K European %K EUROSTAT %K Flanders %K GP %K Guidelines %K health %K health care %K health insurance %K health interview survey %K HEALTH-CARE %K HIS %K hospitalisation %K Indicator %K Indicators %K INFORMATION %K Inpatient hospitalisation %K insurance %K Interview %K Interview survey %K IS %K Kappa %K Linkage %K Logistic %K logistic regression %K Logistic-regression %K method %K methods %K multinomial %K ON %K outcome %K past %K Patient %K People %K POPULATION %K probability %K public %K public health %K Public-health %K questions %K RANGE %K region %K regional %K regression %K result %K results %K self reported %K self reported health %K Self-reported %K Self-reported health %K Selfreported Health %K Service %K SPECIALIST %K State %K States %K study %K survey %K Type %K Underreporting %K use %K use of health care %K validity %K Wallonia %X The Health Care Module of the European Health Interview Survey (EHIS) is aimed to obtain comparable information on the use of inpatient and ambulatory care in all EU member states. The aim of this study was to assess the validity of self-reported information on the use of health care, collected according to the Eurostat guidelines, in the Belgian population.MethodsSelf-reported use of health care, based on EHIS questions, was compared with registered information on reimbursed health care through a linkage of data from the Belgian Health Interview Survey 2008 with data from the compulsory Belgian health insurance. Outcome indicators included the probability of a contact with a GP, specialist, dentist and a physiotherapist, as well as inpatient and day patient hospitalisation. The concordance between the two data sources was assessed by calculating the percentage of agreement and Cohen's kappa. Correlates of over and underreporting were investigated via a multinomial logistic regression.ResultsCompared to health insurance data, the survey results underestimated the percentage of people with a specialist contact in the past year (50.5% versus 65.0%) and a day patient hospitalisation (7.8% versus 13.0%). Inversely, survey results overestimated the percentage of people having visited a dentist in the past year: 58.3% versus 48.6%. The best concordance was obtained for an inpatient hospitalisation (kappa 0.75). The validity of self-reported use of health care varied by region. After adjustment for a range of covariates, overreporting a contact with a GP in the past year occurred significantly more often in Brussels (OR 1.93; 95% CI 1.37-2.73) and Wallonia (OR 1.55; 95% CI 1.14-2.11) than in Flanders.ConclusionThe validity of self-reported use of health care, based on EHIS questions, varies by type of health service. Regional differences in the use of self-reported health care may be influenced by regional differences in the validity of the self-reported information. %B European Public Health Conference %C Milan %8 0/10/2015 %G eng %N ? %1 38011 %2 18/06/2015 %0 Journal Article %J Int J Public Health %D 2014 %T Association between variables used in the field substitution and post-stratification adjustment in the Belgian health interview survey and non-response. %A Johan Van der Heyden %A Stefaan Demarest %A Van Herck, Koen %A De Bacquer, Dirk %A Jean Tafforeau %A Herman Van Oyen %K Adult %K Aged %K Belgium %K Bias (Epidemiology) %K Data Interpretation, Statistical %K Female %K health surveys %K Humans %K Interviews as Topic %K Logistic Models %K Male %K middle aged %K Young adult %X

OBJECTIVES: Field substitution and post-stratification adjustment have been proposed to reduce non-response bias in population surveys. We investigated if variables involved in those techniques in the Belgian health interview survey 2004 are associated with non-response and assessed the impact of field substitution and post-stratification adjustment on the survey results.

METHODS: Data were obtained from all selected households (n = 12.204). The association between non-response and the selected variables was explored through multilevel logistic regression models with municipality and statistical sector as random effects.

RESULTS: All investigated variables were significantly related with non-response. Especially households that could not be contacted differed substantially from those who participated. Only post-stratification had a clear impact on the survey results.

CONCLUSIONS: Even if variables used in the field substitution procedure of health surveys are strongly associated with non-response, the impact of field substitution on the survey results may be minimal, either because there was no bias of relevance or it was not captured. The usefulness of field substitution to correct for non-response bias in population health surveys seems to be quite limited.

%B Int J Public Health %V 59 %P 197-206 %8 2014 Feb %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/23619721?dopt=Abstract %R 10.1007/s00038-013-0460-7 %0 Journal Article %J Arch Public Health %D 2014 %T Is the different time trend (1997-2008) of the obesity prevalence among adults in the three Belgian regions associated with lifestyle changes? %A Sabine Drieskens %A Johan Van der Heyden %A Stefaan Demarest %A Jean Tafforeau %X

BACKGROUND: Obesity is a major public health issue with increasing prevalence among adults. However, in Belgium the regional time trends (1997-2008) differed: the prevalence of obesity increased in the Flemish and Brussels Regions, but remained stable in the Walloon Region, the latter still showing the highest prevalence. The purpose of the present study is to explore if the different time trends of obesity prevalence in the three Belgian regions is associated with lifestyle changes.

METHODS: We used data from four successive cross-sectional waves (1997, 2001, 2004 and 2008) of the Belgian Health Interview Survey. The study was restricted to the adult population, resulting in samples of respectively 8,071, 9,391, 10,319 and 8,831 individuals. In line with the WHO definition, obesity was defined as having a BMI ≥ 30. Differences in regional trends of obesity were investigated through stratified analyses. The association between obesity and survey year, adjusted for lifestyle factors (alcohol consumption, smoking, fruit and vegetables consumption and leisure time physical activity), was assessed via logistic regression models. Interactions were added to the models to explore if the association between lifestyle factors and obesity varied over time.

RESULTS: Obesity was associated with daily alcohol use in the Brussels (OR 0.66, 95% CI 0.50-0.88) and Walloon Regions (OR 0.8, 95% CI 0.6-0.9), with lower tendencies of being obese for daily drinkers. The probability of being obese was lower among smokers in the Flemish (OR 0.7, 95% CI 0.6-0.8) and Walloon Regions (OR 0.7, 95% CI 0.6-0.9) than among non-smokers. A lack of leisure time physical activity was associated with the probability of being obese in all regions (Brussels Region: OR 1.6, 95% CI 1.3-1.8; Flemish Region: OR 1.6, 95% CI 1.4-1.9; Walloon Region: OR 1.8, 95% CT 1.6-2.1). This association decreased significantly between 1997 and 2008 only in the Walloon Region.

CONCLUSION: The decreasing association between obesity and a lack of leisure time physical activity in the Walloon Region between 1997 and 2008 could indicate that there is an increasing awareness of risk factors for obesity in the Walloon population, which may have resulted in a more favourable evolution of the obesity epidemic.

%B Arch Public Health %V 72 %P 18 %8 2014-06-02 %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/24949198?dopt=Abstract %R 10.1186/2049-3258-72-18 %0 Journal Article %J Arch Public Health %D 2014 %T Premature mortality in Belgium in 1993-2009: leading causes, regional disparities and 15 years change. %A Françoise Renard %A Jean Tafforeau %A Deboosere, Patrick %X

BACKGROUND: Reducing premature mortality is a crucial public health objective. After a long gap in the publication of Belgian mortality statistics, this paper presents the leading causes and the regional disparities in premature mortality in 2008-2009 and the changes since 1993.

METHODS: All deaths occurring in the periods 1993-1999 and 2003-2009, in people aged 1-74 residing in Belgium were included. The cause of death and population data for Belgium were provided by Statistics Belgium , while data for international comparisons were extracted from the WHO mortality database. Age-adjusted mortality rates and Person Year of Life Lost (PYLL) were calculated. The Rate Ratios were computed for regional and international comparisons, using the region or country with the lowest rate as reference; statistical significance was tested assuming a Poisson distribution of the number of deaths.

RESULTS: The burden of premature mortality is much higher in men than in women (respectively 42% and 24% of the total number of deaths). The 2008-9 burden of premature mortality in Belgium reaches 6410 and 3440 PYLL per 100,000, respectively in males and females, ranking 4th and 3rd worst within the EU15. The disparities between Belgian regions are substantial: for overall premature mortality, respective excess of 40% and 20% among males, 30% and 20% among females are observed in Wallonia and Brussels as compared to Flanders. Also in cause specific mortality, Wallonia experiences a clear disadvantage compared to Flanders. Brussels shows an intermediate level for natural causes, but ranks differently for external causes, with less road accidents and suicide and more non-transport accidents than in the other regions. Age-adjusted premature mortality rates decreased by 29% among men and by 22% among women over a period of 15 years. Among men, circulatory diseases death rates decreased the fastest (-43.4%), followed by the neoplasms (-26.6%), the other natural causes (-21.0%) and the external causes (-20.8%). The larger decrease in single cause is observed for stomach cancer (-48.4%), road accident (-44%), genital organs (-40.4%) and lung (-34.6%) cancers. On the opposite, liver cancer death rate increased by 16%. Among female, the most remarkable feature is the 50.2% increase in the lung cancer death rate. For most other causes, the decline is slightly weaker than in men.

CONCLUSION: Despite a steady decrease over time, international comparisons of the premature mortality burden highlight the room for improvement in Belgium. The disadvantage in Wallonia and to some extent in Brussels suggest the role of socio-economic factors; well- designed health policies could contribute to reduce the regional disparities. The increase in female lung cancer mortality is worrying.

%B Arch Public Health %V 72 %8 2014 %G eng %N 1 %R 10.1186/2049-3258-72-34 %0 Journal Article %J Archives of Public Health %D 2014 %T Premature mortality in Belgium in 1993-2009: leading causes, regional disparities and 15 years change %A Françoise Renard %A Jean Tafforeau %A Deboosere, Patrick %K Belgium %K Cause of Death %K mortality %K prematute mortality %X

Background

Reducing premature mortality is a crucial public health objective. After a long gap in the publication of Belgian mortality statistics, this paper presents the leading causes and the regional disparities in premature mortality in 2008–2009 and the changes since 1993.

Methods

All deaths occurring in the periods 1993–1999 and 2003–2009, in people aged 1–74 residing in Belgium were included.

The cause of death and population data for Belgium were provided by Statistics Belgium , while data for international comparisons were extracted from the WHO mortality database.

Age-adjusted mortality rates and Person Year of Life Lost (PYLL) were calculated. The Rate Ratios were computed for regional and international comparisons, using the region or country with the lowest rate as reference; statistical significance was tested assuming a Poisson distribution of the number of deaths.

Results

The burden of premature mortality is much higher in men than in women (respectively 42% and 24% of the total number of deaths). The 2008–9 burden of premature mortality in Belgium reaches 6410 and 3440 PYLL per 100,000, respectively in males and females, ranking 4th and 3rd worst within the EU15. The disparities between Belgian regions are substantial: for overall premature mortality, respective excess of 40% and 20% among males, 30% and 20% among females are observed in Wallonia and Brussels as compared to Flanders. Also in cause specific mortality, Wallonia experiences a clear disadvantage compared to Flanders. Brussels shows an intermediate level for natural causes, but ranks differently for external causes, with less road accidents and suicide and more non-transport accidents than in the other regions.

Age-adjusted premature mortality rates decreased by 29% among men and by 22% among women over a period of 15 years. Among men, circulatory diseases death rates decreased the fastest (-43.4%), followed by the neoplasms (-26.6%), the other natural causes (-21.0%) and the external causes (-20.8%). The larger decrease in single cause is observed for stomach cancer (-48.4%), road accident (-44%), genital organs (-40.4%) and lung (-34.6%) cancers. On the opposite, liver cancer death rate increased by 16%.

Among female, the most remarkable feature is the 50.2% increase in the lung cancer death rate. For most other causes, the decline is slightly weaker than in men.

Conclusion

Despite a steady decrease over time, international comparisons of the premature mortality burden highlight the room for improvement in Belgium. The disadvantage in Wallonia and to some extent in Brussels suggest the role of socio-economic factors; well- designed health policies could contribute to reduce the regional disparities. The increase in female lung cancer mortality is worrying.

%B Archives of Public Health %V 72 %8 Jan-12-2014 %G eng %N 1 %& 34 %R 10.1186/2049-3258-72-34 %0 Journal Article %J Arch Public Health %D 2014 %T Protocol of the PSYCHOTSH study: association between neonatal thyroid stimulating hormone concentration and intellectual, psychomotor and psychosocial development at 4-5 year of age: a retrospective cohort study. %A Trumpff, Caroline %A Vanderfaeillie, Johan %A Vercruysse, Nathalie %A De Schepper, Jean %A Jean Tafforeau %A Herman Van Oyen %A Stefanie Vandevijvere %X BACKGROUND: Several European countries, including Belgium, still suffer from mild iodine deficiency. Thyroid stimulating hormone (TSH) concentration in whole blood measured at birth has been proposed as an indicator of maternal iodine status during the last trimester of pregnancy. It has been shown that mild iodine deficiency during pregnancy may affect the neurodevelopment of the offspring. In several studies, elevated TSH levels at birth were associated with suboptimal cognitive and psychomotor outcomes among young children. This paper describes the protocol of the PSYCHOTSH study aiming to assess the association between neonatal TSH levels and intellectual, psychomotor and psychosocial development of 4-5 year old children. The results could lead to a reassessment of the recommended cut-off levels of 5 > mU/L used for monitoring iodine status of the population. METHODS: In total, 380 Belgian 4-5 year old preschool children from Brussels and Wallonia with a neonatal blood spot TSH concentration between 0 and 15 mU/L are included in the study. For each sex and TSH-interval (0-1, 1-2, 2-3, 3-4, 4-5, 5-6, 6-7, 7-8, 8-9 and 9-15 mU/L), 19 newborns were randomly selected from all newborns screened by the neonatal screening centre in Brussels in 2008-2009. Infants with congenital hypothyroidism, low birth weight and prematurity were excluded from the study. Neonatal TSH concentration was measured by the Autodelphia method in dried blood spots, collected by heel stick on filter paper 3 to 5 days after birth. Cognitive abilities and psychomotor development are assessed using the Wechsler Preschool and Primary Scale of Intelligence - third edition - and the Charlop-Atwell Scale of Motor coordination. Psychosocial development is measured using the Child Behaviour Check List for age 1½ to 5 years old. In addition, several socioeconomic, parental and child confounding factors are assessed. CONCLUSIONS: This study aims to clarify the effect of mild iodine deficiency during pregnancy on the neurodevelopment of the offspring. Therefore, the results may have important implications for future public health recommendations, policies and practices in food supplementation. In addition, the results may have implications for the use of neonatal TSH screening results for monitoring the population iodine status and may lead to the definition of new TSH cut-offs for determination of the severity of iodine status and for practical use in data reporting by neonatal screening centres %B Arch Public Health %V 72 %P 27 %8 2014 %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/25180082?dopt=Abstract %R 10.1186/2049-3258-72-27 %0 Journal Article %J Journal of Public Health %D 2014 %T Reliability and validity of a global question on self-reported chronic morbidity %A Johan Van der Heyden %A De Bacquer, Dirk %A Jean Tafforeau %A Van Herck, Koen %K chronic condition %K health survey %K morbidity %K validity %B Journal of Public Health %V 22 %8 Jan-08-2014 %G eng %N 4 %& 371 %R 10.1007/s10389-014-0624-9 %0 Generic %D 2013 %T Is the different time evolution (1997-2008) of the obesity prevalence in the three Belgian regions related to lifestyle changes? %A Sabine Drieskens %A Johan Van der Heyden %A Stefaan Demarest %A Jean Tafforeau %K Belgian %K Belgium %K BMI %K Change %K Changes %K conference %K European %K Evolution %K health %K HIS %K IS %K LIFESTYLE %K lifestyle change %K NUTRITION %K Obesity %K prevalence %K public %K public health %K Public-health %K region %K time %K time trend %B European Public Health Conference %C Brussels %8 0/0/2013 %G eng %1 36396 %2 14/11/2013 %0 Generic %D 2013 %T Interviewer variability in response rates in the Belgian Health Interview Survey %A Johan Van der Heyden %A Stefaan Demarest %A Jean Tafforeau %K 2004 %K 2008 %K adjustment %K age %K AGE GROUPS %K Age-group %K ALL %K an %K approach %K approaches %K Area %K AS %K Belgian %K Belgium %K CI %K composition %K Congresses %K CONSUMPTION %K CONTACT %K Countries %K Covariate %K data %K Database %K education %K effect %K effects %K epidemiology %K European %K Face %K face-to-face %K Failure %K Fieldwork %K Follow %K Follow up %K FOLLOW-UP %K Gender %K Group %K health %K health interview survey %K health interview surveys %K Health status %K Health-status %K HIS %K household %K households %K Housing %K Impact %K improve %K Increase %K INFORMATION %K Interview %K Interview survey %K IS %K IT %K LEVEL %K Life %K LIFE STYLE %K life-style %K Logistic %K logistic regression %K Logistic-regression %K medical %K medical consumption %K MODEL %K models %K Motivation %K multilevel %K national %K National Health Interview Survey %K National-health %K nationality %K neighbourhood %K Non response %K Non-response %K nonresponse %K ODDS RATIO %K older %K ON %K Participation %K person %K POPULATION %K PROGRAM %K Questionnaire %K random %K random-effects %K RATES %K Ratio %K Ratios %K recruitment %K REFUSAL %K Register %K REGISTRIES %K Registry %K regression %K Regression model %K residence %K response %K response rate %K response rates %K result %K results %K Sample %K sampling %K sampling frame %K Score %K Secondary %K SELECTED %K self-administered %K Self-administered questionnaire %K sex %K STANDARD %K status %K Strategies %K Strategy %K study %K style %K survey %K surveys %K training %K Type %K VARIABILITY %K variables %K variation %K variations %K WHO %K young %X In the Belgian HIS, information is gathered on the health status, life style and medical consumption of a representative sample of the population through a face to face interview and a self-administered questionnaire. The national population register is used as the sampling frame. Interviewers are recruited all over the country and have to pass through a standard training program. As in many other surveys unit non-reponse is an important concern. Compared to other national health interview surveys, unit non-response in the Belgian HIS is quite high. Moreover, it seems to increase. Between 1997 and 2008 the household refusal rate, calculated as the number of households who refused participation among those who were contacted, has risen from 39% to 45%. It is generally agreed that the motivation, training and follow up of the interviewers may have an important impact on the non-response. The impact of the interviewer on the response-rate can be explored by assessing to which extent response rates vary between interviewers after controlling for respondents' characteristics which may be related to non-response. The aim of this study was to verify if household's non-response varies significantly among interviewers and if there is a link between interviewer's characteristics and non-response. This was investigated separately for contact failure and refusal rate.Data were used from the HIS 2004, in which 10.013 households were selected for participation and 264 interviewers carried out the fieldwork. Information on age, sex and nationality of the household's reference person, household composition and place of residence was obtained from the national population registry. Information on the housing type and characteristics of the residential area was collected during the fieldwork. The household database was merged with data on the interviewer's gender, age and educational attainment. Non-reponse was explored by using multilevel logistic regression models with interviewer's characteristics as dependent variables, household characteristics as covariates and household's neighbourhood and interviewer as random effects. After adjustment for household characteristics and neighbourhood the proportion of non participating households is lower among interviewers belonging to the older age groups. Compared to the reference group of youngest interviewers (<45 years) the odds ratio for refusal is 0,67 (95% CI 0,60-0,75) for interviewers between 45 and 64 years and 0,46 (95% CI 0,35-0,61) for interviewers of 65+ years. The odds ratios for contact failure are respectively 0,69 (95% CI 0,59-0,81) and 0,62 (95% CI 0,41-0,92). Interviewers with tertiary education have significantly lower refusal rates than interviewers with only secondary education (OR 0,88; 95% CI 0,79-0,99). The variation of contact failure and refusal rates by interviewer remains significant after adjustment for household and interviewer characteristics.Our results indicate that in the Belgian HIS, non-response varies substantially among interviewers. Neither characteristics of the household, nor characteristics of the interviewer can explain this variation completely, but it is striking that older and high educated interviewers score better. If adjustment is made for characteristics that have an important impact on the response rate (such as the type of household, the neighbourhood, etc.) we would not expect large variations in response rate by interviewer. Large variations may indicate that there is a difference in the approach interviewers follow to contact the selected households and convince them to participate. The response rate in the Belgian HIS could probably be improved by putting more effort in the recruitment, training and follow up of interviewers, targeting specifically young interviewers and interviewers with a lower education level. Focusing the recruitment of interviewers on higher educated persons in the age groups above 45 years may also be a strategy to improve the response rate. %B European Congress of Epidemiology %C Aarhus %8 0/0/2013 %G eng %N ? %1 35760 %2 15/07/2013 %0 Report %D 2013 %T La consommation de médicaments non-remboursés en Belgique; une étude utilisant les données de l'enquête de santé belge 2008 %A Mimilidis,H. %A Johan Van der Heyden %A Stefaan Demarest %A Jean Tafforeau %K 2008 %K Belge %K Belgique %K Belgium %K de %K EN %K health care consumption %K HIS %K LE %K médicament %K medicines %K santé %I WIV-ISP %C Bruxelles %V PHS 2013/011 %P NA %8 0/0/2013 %@ D/2012/2505/85 %G eng %1 35495 %2 PHSreport 2013-011 %& 1 %0 Report %D 2013 %T La consommation de médicaments non-remboursés en Belgique; une étude utilisant les données de l'enquête de santé belge 2008: supplément sur l'estimation du coût lié à la consommation de certains groupes de médicaments non remboursés %A Mimilidis,H. %A Johan Van der Heyden %A Stefaan Demarest %A Jean Tafforeau %K 2008 %K Belge %K Belgique %K Belgium %K de %K EN %K health care consumption %K HIS %K LE %K médicament %K medicines %K OTC medicine %K santé %I WIV-ISP %C Bruxelles %V PHS 2013/011 %P NA %8 0/0/2013 %G eng %1 33578 %2 PHSreport 2013-011 %& 1 %0 Journal Article %J Arch Public Health %D 2013 %T Methodological basics and evolution of the Belgian health interview survey 1997-2008. %A Stefaan Demarest %A Johan Van der Heyden %A Rana Charafeddine %A Sabine Drieskens %A Lydia Gisle %A Jean Tafforeau %X

BACKGROUND: The Belgian Health Interview Survey (BHIS) is organised every 4 to 5 years and collects health information from around 10,000 individuals in a face-to-face setting. This manuscript describes the methodological choices made in the sampling design, the outcomes of the previous surveys in terms of participation rates and achieved targets and the factors to be accounted for in data-analysis.

METHODS: The BHIS targets all persons residing in Belgium with no restrictions on age or nationality. Trimestral copies of the National Population Registry are used as the sampling frame. To select the respondents, a multistage sampling design is applied involving a geographical stratification, a selection of clusters, a selection of households within each cluster and a selection of respondents within each household. Using matched substitution of non-participating households assures the realisation of the predefined net-sample.

RESULTS: For each BHIS the required number of participants is achieved, including the years when an oversampling of provinces and of the elderly occurred. The sampling design guarantees that the survey is implemented in large cities as well as in small municipalities. A growing problem is related to the sampling frame: it is increasingly subject of deterioration, especially in the Brussels-Capital Region.

CONCLUSIONS: The methodological approach developed for the first BHIS proves to be accurate and was kept nearly unchanged throughout the following surveys. Fieldwork substitution contributes to a considerable extent to the success of the fieldwork but yields in higher percentages of non-participation. The sampling design requires special attention when analysing the data: the unequal selection probability, e.g. due to the non-proportional stratification at the regional level, necessitates the use of weights. The BHIS is progressively embedded in the European Health Survey, a process that doesn't jeopardise the comparability of the Belgian results throughout time.

%B Arch Public Health %V 71 %P 24 %8 2013 Sep 18 %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/24047278?dopt=Abstract %R 10.1186/0778-7367-71-24 %0 Journal Article %J J Trace Elem Med Biol %D 2013 %T Mild iodine deficiency in pregnancy in Europe and its consequences for cognitive and psychomotor development of children: a review. %A Trumpff, Caroline %A De Schepper, Jean %A Jean Tafforeau %A Herman Van Oyen %A Vanderfaeillie, Johan %A Stefanie Vandevijvere %K Child %K Cognition Disorders %K Europe %K Female %K Humans %K Iodine %K Pregnancy %K Prenatal Exposure Delayed Effects %K Psychomotor Disorders %X

Despite the introduction of salt iodization programmes as national measures to control iodine deficiency, several European countries are still suffering from mild iodine deficiency (MID). In iodine sufficient or mildly iodine deficient areas, iodine deficiency during pregnancy frequently appears in case the maternal thyroid gland cannot meet the demand for increasing production of thyroid hormones (TH) and its effect may be damaging for the neurodevelopment of the foetus. MID during pregnancy may lead to hypothyroxinaemia in the mother and/or elevated thyroid-stimulating hormone (TSH) levels in the foetus, and these conditions have been found to be related to mild and subclinical cognitive and psychomotor deficits in neonates, infants and children. The consequences depend upon the timing and severity of the hypothyroxinaemia. However, it needs to be noted that it is difficult to establish a direct link between maternal iodine deficiency and maternal hypothyroxinaemia, as well as between maternal iodine deficiency and elevated neonatal TSH levels at birth. Finally, some studies suggest that iodine supplementation from the first trimester until the end of pregnancy may decrease the risk of cognitive and psychomotor developmental delay in the offspring.

%B J Trace Elem Med Biol %V 27 %P 174-83 %8 2013 Jul %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/23395294?dopt=Abstract %R 10.1016/j.jtemb.2013.01.002 %0 Journal Article %J Eur J Public Health %D 2013 %T Socio-economic differences in participation of households in a Belgian national health survey. %A Stefaan Demarest %A Johan Van der Heyden %A Rana Charafeddine %A Jean Tafforeau %A Herman Van Oyen %A Van Hal, Guido %K ADOLESCENT %K Adult %K Belgium %K Bias (Epidemiology) %K Data collection %K Educational Status %K Family Characteristics %K Female %K health surveys %K Humans %K Male %K middle aged %K Socioeconomic Factors %K Young adult %X

BACKGROUND: Socio-economic inequalities in health survey participation can jeopardize the extrapolation of the survey findings to the total population. Earlier research, based on aggregated data, showed that in Belgium less-educated people with poor health were less likely to participate in a health survey. In this article, the association by socio-economic status and household non-response in a health survey is examined.

METHODS: A linkage between the Belgian Health Survey 2001 with Census 2001 enabled us to evaluate the participation by socio-economic status.

RESULTS: We observed that the socio-economic position was a determinant of health survey participation: participation rate was significantly lower in households with a lower socio-economic profile.

CONCLUSION: Socio-economic inequalities in participation can introduce a bias in the health survey findings. Strategies targeting improvement of the participation of lower socio-economic groups need to be considered.

%B Eur J Public Health %V 23 %P 981-5 %8 2013 Dec %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/23183496?dopt=Abstract %R 10.1093/eurpub/cks158 %0 Journal Article %J Eur J Publ Health %D 2013 %T Using multiple inequality indices to assess changes in social inequalities for breast cancer screening in Belgium %A Françoise Renard %A Stefaan Demarest %A Herman Van Oyen %A Jean Tafforeau %K 2001 %K 2008 %K ALL %K AS %K at %K Attributable %K Belgian %K Belgium %K breast %K breast cancer %K breast cancer screening %K Breast-cancer %K cancer %K cancer screening %K Change %K Changes %K comparing %K contribution %K data %K Educational level %K Educational-level %K Evolution %K Fraction %K Group %K health %K Health inequalities %K health interview survey %K HIS %K identify %K Impact %K index %K inequalities %K inequality %K Interview %K Interview survey %K IS %K LEVEL %K mammographic %K measure %K measures %K measuring %K method %K methods %K Multiple %K national %K national screening %K objectives %K PAF %K period %K POPULATION %K prevalence %K programme %K Ratio %K relative %K Relative index of inequality %K result %K results %K RII %K SCREENING %K slope index %K SOCIAL %K Social inequalities %K Social inequality %K Socio economic %K Socio-economic %K Socioeconomic %K Socioeconomic position %K survey %K uptake %X Objectives: To identify changes in social inequalities for mammograms uptake in Belgium over the period1997-2008 using multiple indices, and to assess the contribution of the national breast cancer screeningprogramme in these changes. Methods: Data were obtained from four waves of the Belgian Health InterviewSurvey. The socio-economic position was defined by the educational level. Inequalities were measured both withpairwise measures comparing extreme educational groups (prevalence difference and prevalence ratio), and withindices measuring the total inequality impact at population level: the Population Attributable Fraction (PAF), theRelative Index of Inequality (RII) and the Slope Index of Inequality (SII). Results: All indices show a substantialdecrease in inequalities in mammographic uptake between 1997 and 2008. For the indices of total impact (PAF, RII,SII), the change occurred between the first two waves (1997 and 2001) and stabilized afterwards, while forpairwise indices the evolution continued over the whole period. Conclusion: Using multiple indices ofinequality is necessary for a more complete understanding of the changes: total impact inequality indicesshould always complement simple pairwise measures. The inequalities in mammograms uptake, as measuredwith total impact indices, only decreased before the start of the national screening programme %B Eur J Publ Health %V 24 %P 275 - 280 %8 29/7/2013 %G eng %N 2 %1 35764 %& 275 %R http://dx.doi.org/ %0 Journal Article %J Eur J Public Health %D 2013 %T Using multiple measures of inequalities to study the time trends in social inequalities in smoking. %A Rana Charafeddine %A Stefaan Demarest %A Johan Van der Heyden %A Jean Tafforeau %A Herman Van Oyen %K ADOLESCENT %K Adult %K Aged %K Belgium %K Educational Status %K Female %K Humans %K Longitudinal Studies %K Male %K middle aged %K Poverty %K Risk Factors %K sex factors %K SMOKING %K social class %K Young adult %X

BACKGROUND: The time trends in social inequalities in smoking have been examined in a number of international publications; however, these studies have rarely used multiple measures of health inequalities simultaneously. Also the analytical approach used often did not account, as recommended, for the changes in the relative distribution of social groups and the changes in the absolute level of the health outcome within social groups.

METHODS: Data from four successive waves of the Belgian Health Interview Survey (1997, 2001, 2004, 2008) were used to study the time trends in educational inequalities in daily smoking for those aged between 15 and 74 years. We estimated two measures of relative inequalities: the OR and the relative index of inequality; and two measures of absolute inequalities: the population attributable fraction and the slope index of inequality. Three of these measures (relative index of inequality, population attributable fraction, slope index of inequality) account for the change in the relative size of the social groups over time.

RESULTS: The four measures of inequality were consistent in showing significant inequalities among educational groups. The time trends, however, were less consistent. Measures of trends in relative inequalities witnessed a small linear increase. However, no substantial over time change was observed with the measures of absolute inequalities.

CONCLUSION: The time trends in social inequalities in smoking varied according to the measure of inequality used. This study confirms the importance of using multiple measures of inequalities to understand and monitor social inequalities in smoking.

%B Eur J Public Health %V 23 %P 546-51 %8 2013 Aug %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/22711785?dopt=Abstract %R 10.1093/eurpub/cks083 %0 Journal Article %J Vlaams tijdschrift voor Diabetologie %D 2012 %T Diabetesprevalentie in België: vergelijking van beschikbare data %A Johan Van der Heyden %A Mimilidis,H. %A Bartholomeeusen,S. %A Vanthomme,K. %A Viviane Van Casteren %A Jean Tafforeau %K België %K Belgium %K data %K diabetes %K morbidity %K prevalence %K Register %B Vlaams tijdschrift voor Diabetologie %V 2 %P 6 - 8 %8 0/0/2012 %G eng %1 36412 %& 6 %0 Generic %D 2012 %T Educational inequalities in Healthy Life Years in Belgium: Are there regional variations? %A Nicolas Berger %A Rana Charafeddine %A Jean Tafforeau %A Herman Van Oyen %K Belgium %K Health inequalities %K Healthy %K healthy life %K Healthy Life Years %K HLY %K inequalities %K inequality %K Life %K regional %K regional variations %K variation %K variations %B 24th REVES Meeting %I NA %C NA %8 0/5/2012 %G eng %N REVES %1 33657 %2 25-27/05/2012 %0 Report %D 2012 %T Espérance de vie en bonne santé par région et par niveau socio économique en Belgique %A Nicolas Berger %A Rana Charafeddine %A Jean Tafforeau %A Herman Van Oyen %K Belgique %K Belgium %K de %K EN %K ET %K Health inequalities %K healthy life expectancy %K HIS %K HLE %K LE %K morbidity %K mortality %K PAR %K PARTICIPANTS %K promotion %K santé %K Wallonia %I WIV-ISP %C Brussels %V PHS 039 %P NA %8 0/0/2012 %@ D/2012/2505/44 %G eng %1 35910 %& 1 %0 Generic %D 2012 %T The European Health Survey Information Database (EUHSID) %A Tuomi-Nikula,A. %A Ahonen,S. %A Koponen,P. %A Jean Tafforeau %K Database %K European %K health %K health survey %K HES %K HIS %K INFORMATION %K survey %B European Health Examination Survey %I National Public Health Institute of Finland %8 0/3/2012 %G eng %1 32844 %0 Generic %D 2012 %T Evolution of social inequalities after the introduction of a breast cancer screening program. Conference Proceeding of the 5th International Congres of Epidemiology of Adelf-Epiter, Brusselss 2012 %A Françoise Renard %A Stefaan Demarest %A Jean Tafforeau %K 2001 %K 2008 %K 2012 %K Absolute %K Aged %K ALL %K AS %K association %K at %K Belgium %K breast %K breast cancer %K breast cancer screening %K Breast-cancer %K cancer %K cancer screening %K Categories %K Change %K Changes %K conference %K Coverage %K data %K differences %K Discussion %K Educational level %K Educational-level %K epidemiology %K Evolution %K Fraction %K FR_CV %K Gini coefficient %K Group %K health %K Health inequalities %K health interview survey %K health interview surveys %K Improvement %K Income %K Increase %K inequalities %K inequality %K International %K Interview %K Interview survey %K IQ %K IT %K Less %K LEVEL %K levels %K linear regression %K mammographic %K mammographic screening %K measure %K measures %K method %K methods %K national %K national screening %K objectives %K observed %K ODDS RATIO %K PAF %K period %K prevalence %K PROGRAM %K proxies %K Proxy %K RATES %K Ratio %K Reduction %K regression %K relative %K result %K results %K RII %K RR %K SCREENING %K SCREENING PROGRAM %K self reported %K Self-reported %K SES %K SOCIAL %K Social inequalities %K Social inequality %K Socio economic %K socio economic inequalities %K Socio economic status %K Socio-economic %K socio-economic inequality %K Socio-economic status %K Socioeconomic %K Socioeconomic inequalities %K Socioeconomic status %K status %K study %K survey %K surveys %K TESTING %K time %K trend %K trends %K WOMEN %K work %X Introduction: Opportunistic breast cancer screening associated with a better coverage for highest socio-economic status (SES) existed in Belgium before the introduction of a national screening program in 2001-2002. This work examined the changes in the mammographic coverage by SES and the changes in SE-inequalities since 1997.Methods: Data were obtained from the Health Interview Surveys (1997-2001-2004-2008). The mammographic coverage rate was computed for women aged 50-69. Educational levels (EL) were used as proxies for SES. SE-inequality for mammographic coverage was estimated with absolute and relative disparity measures (absolute differences and ratio of the lowest versus highest EL-prevalence), regression indices (the SII and RII), and the Population-Attributable Fraction (PAF). The evolution over time of the indices was measured by testing for the differences between the first and the last survey year, and by fitting a weighted linear regression.Results: In each EL a substantial increase in the coverage was observed over time. The relative increase of prevalence (absolute increase in prevalence between 2 years divided by the prevalence in the first year) between 1997 and 2008 was larger in the 2 less educated groups (respectively + 62.8% and +92.75% increase from initial value) than in the more educated groups (+ 33% and +19%). All inequality indices reflected a change towards less inequality: the absolute prevalence difference (lowest vs highest) decreased with 55% (p=0.13), the RR of being screened (lowest vs highest) increased with 40% (p=0.07) , the PAF decreased with 72% (p<0.01) , the RII increased with 76% (p=0.07) and the SII decreased with 52% (p=0.13). However, for most of the indices, no linear trend in SE-inequalities could be observed: only between 1997 and 2001 these inequalities seem to have been reducedDiscussion and Conclusions: Since 1997, the prevalence rates of mammographic coverage increased for every EL. At the beginning of the study period - before the introduction of the screening program - a reduction of SE-inequality could be observed. The figures reflect little improvement since its introduction. %B NA %S Revue Epidémiologique et Santé Publique %I ADELF (Association des Epidémiologistes de Langue Française) congress %C Brussels %V 60S %P S55 %8 0/0/2012 %G eng %N NA %1 33561 %2 NA %& S55 %0 Book %D 2012 %T Highlights of the Belgian Health Interview survey 2008 %A Rana Charafeddine %A Stefaan Demarest %A Sabine Drieskens %A Lydia Gisle %A Jean Tafforeau %A Johan Van der Heyden %K Belgian %K Belgium %K grey litt %K health %K health interview survey %K health promotion %K Interview %K Interview survey %K LIFESTYLE %K Pr_KCE_performance_health promotion %K survey %7 100 %I WIV-ISP %C Brussels, Belgium %P 100 %8 0/0/2012 %@ D/2012/2505/09 %G eng %1 33089 %& 1 %0 Report %D 2012 %T Inégalités sociales de santé en Wallonie et à Bruxelles, Enquêtes de Santé par Interview 1997-2008 %A Nicolas Berger %A Jean Tafforeau %K Belgium %K Bruxelles %K de %K EN %K ET %K Health inequalities %K inégalités sociales %K Interview %K PAR %K santé %K Wallonie %I WIV-ISP %C Bruxelles %V PHS 038 %P 22 %8 0/0/2012 %@ D/2012/2505/47 %G eng %1 35909 %& 1 %0 Generic %D 2012 %T Inégalités sociales en espérance de vie sans incapacité par région en Belgique %A Nicolas Berger %A Rana Charafeddine %A Jean Tafforeau %A Herman Van Oyen %K 2001 %K 2010 %K an %K Belge %K Belgique %K Belgium %K Bruxelles %K ce %K de %K Discussion %K EN %K ET %K EVSI %K femme %K Health inequalities %K healthy life expectancy %K HIS %K HIS 2001 %K inégalités sociales %K Interview %K LE %K morbidité %K mortalité %K national %K PAR %K PARTICIPANTS %K promotion %K registre %K santé %K situation %K sullivan %K Wallonie %X En Belgique, l'essentiel des politiques sociales de santé relèvent du niveau fédéral (à l'exception de la prévention et la promotion de la santé) tandis que les situations macro-économiques diffèrent sensiblement entre les régions. Cette étude vise à analyser et comparer les inégalités socio-économiques en matière d'espérances de vie sans incapacité (EVSI) entre les trois régions belges.MéthodologieL'estimation des EVSI par statut socio-économique (SSE) nécessite des données de mortalité et d'incapacité par SSE. Les taux de mortalité par niveau d'éducation (utilisé comme indicateur du SSE)sont calculés en couplant les données des 10.758 participants adultes de l'enquête de santé par interview (HIS) de 2001 avec des données du Registre National afin de vérifier leur statut vital (et d'émigration) jusqu'à fin 2010. Les données de morbidité par niveau d'éducation proviennent du HIS 2001. Les EVSI à 25 ans sont calculées par la méthode Sullivan. RésultatsD'importantes inégalités dans l'EVSI par SSE sont constatées. Dans chaque région, les personnes les plus éduquées peuvent s'attendre à vivre plus longtemps sans incapacité que les personnes les moins éduquées. Cette différence est de l'ordre de 10 et 7 ans respectivement chez les hommes et les femmes en Flandre et en Wallonie, et de 7 et 9 ans à Bruxelles.DiscussionCes résultats corroborent des études précédentes sur les inégalités en EVSI au niveau régional menées par couplage avec des données du recensement. Bien que les niveaux d'EVSI diffèrent entre régions, les inégalités sociales sont similaires. La réduction de ces inégalités reste un défi tant national que régional. %B NA %I ADELF (Association des Epidémiologistes de Langue Française) congress %C Bruxelles %8 0/0/2012 %G eng %N NA %1 33562 %2 NA %0 Journal Article %J Eur J Publ Health %D 2012 %T International differences in self-reported health measures in 33 major metropolitan areas in Europe %A Gray,L. %A Merlo,J. %A Mindell,J. %A Hallqvist,J. %A Jean Tafforeau %A O'Reilly,D. %A Regidor,E. %A Naesse,O. %A Kelleher,C. %A Helakorpi,S. %A Lange,C. %A Leyland,A.H. %K ALL %K Antwerp %K Area %K Areas %K assessment %K at %K Belgium %K Class %K Comparison %K comparisons %K composition %K Countries %K data %K Data collection %K differences %K distress %K education %K Europe %K European %K factors %K Finland %K Flanders %K general %K Germany %K health %K Health inequalities %K Health inequality %K health survey %K HIS %K illness %K illnesses %K Individuals %K inequalities %K inequality %K International %K Ireland %K IS %K LEVEL %K levels %K measure %K measures %K method %K methods %K Monitoring %K multilevel %K national %K National-health %K Obesity %K ON %K POPULATION %K Populations %K protocol %K PSYCHOLOGICAL %K PSYCHOLOGICAL DISTRESS %K region %K result %K results %K sampling %K self reported %K SOCIAL %K social class %K social classes %K Social-class %K Socio economic %K Socio-economic %K Socioeconomic %K study %K subjective health %K survey %K survey data %K Sweden %K UK %K urban %K use %X Background: %B Eur J Publ Health %V 22 %P 40 - 47 %8 1/2/2012 %G eng %1 30194 %& 40 %R http://dx.doi.org/ %0 Generic %D 2012 %T People's beliefs about reasons for taking anxiolytics, hypnotics and sedatives %A Johan Van der Heyden %A Lydia Gisle %A Jean Tafforeau %K 2008 %K addiction %K age %K Age-group %K Aged %K ALL %K an %K Anxiety %K anxiolytics %K AS %K association %K ATC %K Belgian %K belief %K Beliefs %K Case %K Cognitive %K COGNITIVE FUNCTION %K Complaints %K CONSUMPTION %K contribution %K dépression %K depressive %K Depressive Disorder %K Disorder %K DRUG %K drugs %K education %K effect %K effects %K ELDERLY %K Explanation %K factors %K function %K Gender %K Group %K health %K health interview survey %K HIS %K hypnotics %K Hypnotics and Sedatives %K INFORMATION %K institution %K Interview %K Interview survey %K Interviews %K IS %K IT %K KNOWLEDGE %K Less %K living %K Logistic %K logistic regression %K Logistic-regression %K medical drug %K Medicine %K medicines %K method %K methods %K Monitoring %K MUSCULOSKELETAL %K n %K need %K needs %K old %K older %K ON %K pain %K People %K POPULATION %K proxies %K Proxy %K PSYCHOLOGICAL %K psychotropic drugs %K regression %K report %K result %K results %K sedatives %K Side effects %K Side-effects %K stress %K survey %K Tension %K use %K WHO %X BackgroundAnxiolytics, hypnotics and sedatives are commonly used psychotropic drugs. The consumption of these medicines needs careful monitoring as they may have important side effects, such as addiction and reduced alertness. An appropriate use of psychotropic drugs presupposes that people are aware of the reason for taking them. This contribution explores the reasons people report for using these drugs and investigates factors associated with incorrect beliefs or no knowledge about the purpose of taking them.MethodsThe Belgian health interview survey 2008 collected information on all medicines used by the respondents 24 hours prior to the interview. For each medicine, respondents were asked for which purpose they had taken it. The reasons to take anxiolytics (ATC N05B) and hypnotics or sedatives (ATC N05C) were explored for the population aged 15 years and older (n = 8335), excluding proxy interviews. Using the indicated psychotropic drugs for complaints other than sleeping problems, stress, depressive disorder, anxiety, musculoskeletal tension and pain, and atypical psychological complaints was regarded as an incorrect belief. Factors associated with incorrect beliefs or no knowledge were studied through logistic regression.Results8,6% of the population used a hypnotic, sedative or anxiolytic in the 24 hrs prior to the interview. The main reported reasons for using these drugs were sleeping problems (51,5%), stress (24,3%) anxiety (13,4%) and depression (5,7%). In 7,2% of the cases, the reason for taking the drug was unknown or incorrect. Incorrect and lack of knowledge was associated with use of an anxiolytic versus a hypnotic or sedative (OR 3,2; 95%CI 1,9-5,4), being older than 65 yrs old (OR 2,3; 95%CI 1,1-5,0), living in an institution for elderly (OR 3,5; 95%CI 1,2-10,5) and polypharmacy (OR 2,1; 95%CI 1,1-4,0). No association was found with gender, education and cognitive function.ConclusionMost respondents give a plausible explanation for the purpose of using an anxiolytic and hypnotic or sedative. This is less the case for older people, especially those who live in institutions. Inappropriate use of these drugs is mainly a problem in this age group. More efforts are needed to inform also older people of the reason why they use psychotropic drugs. %B ? %I European Public Health Association annual conference %C Malta %8 0/0/2012 %G eng %N ? %1 33634 %2 ? %0 Report %D 2012 %T Questionnaire development in the context of the European health interview survey %A Lydia Gisle %A Mimilidis,H. %A Jean Tafforeau %E Johan Peeters %K Context %K Development %K European %K health %K health interview survey %K Interview %K Interview survey %K Questionnaire %K report %K survey %K WIV-ISP %I WIV-ISP %C Brussels %P 44 - 45 %8 0/0/2012 %G eng %1 36397 %& 44 %0 Conference Proceedings %D 2012 %T Social inequalities in Healthy Life Years by region of Belgium %A Nicolas Berger %A Rana Charafeddine %A Jean Tafforeau %A Herman Van Oyen %E Johan Peeters %K Belgium %K Healthy %K healthy life %K Healthy Life Years %K inequalities %K inequality %K Life %K region %K report %K SOCIAL %K Social inequalities %K Social inequality %K WIV-ISP %I WIV-ISP %C Brussels %P 39 - 40 %8 0/0/2012 %G eng %1 35911 %& 39 %0 Journal Article %J Eur J Publ Health %D 2012 %T Socio-economic differences in participation of households in a Belgian national health survey %A Stefaan Demarest %A Johan Van der Heyden %A Rana Charafeddine %A Jean Tafforeau %A Herman Van Oyen %A Van Hal,G. %K 2001 %K article %K association %K Belgian %K Belgium %K bias %K Bruxelles %K census %K data %K determinant %K differences %K electronic %K FR_Art %K Group %K health %K health survey %K household %K households %K Improvement %K inequalities %K inequalities in health %K inequality %K Institute %K IS %K journal %K Less %K Linkage %K method %K methods %K national %K National Health Survey %K National-health %K need %K Non response %K Non-response %K nonresponse %K observed %K ON %K Participation %K People %K POPULATION %K profile %K public %K public health %K Public-health %K Research %K result %K results %K Socio economic %K socio economic inequalities %K Socio economic status %K Socio-economic %K Socio-economic differences %K Socio-economic inequalities in health %K socio-economic inequality %K Socio-economic status %K Socioeconomic %K Socioeconomic differences %K Socioeconomic inequalities %K Socioeconomic position %K Socioeconomic status %K status %K Strategies %K Strategy %K Surveillance %K survey %K US %X BACKGROUND: Socio-economic inequalities in health survey participation can jeopardize the extrapolation of the survey findings to the total population. Earlier research, based on aggregated data, showed that in Belgium less-educated people with poor health were less likely to participate in a health survey. In this article, the association by socio-economic status and household non-response in a health survey is examined. METHODS: A linkage between the Belgian Health Survey 2001 with Census 2001 enabled us to evaluate the participation by socio-economic status. RESULTS: We observed that the socio-economic position was a determinant of health survey participation: participation rate was significantly lower in households with a lower socio-economic profile. CONCLUSION: Socio-economic inequalities in participation can introduce a bias in the health survey findings. Strategies targeting improvement of the participation of lower socio-economic groups need to be considered %B Eur J Publ Health %V 23 %P 981 - 985 %8 26/11/2012 %G eng %N 6 %1 35530 %& 981 %R http://dx.doi.org/10.1093/eurpub/cks158 %0 Journal Article %J Eur J Public Health %D 2010 %T Multiple risk behaviour: increasing socio-economic gap over time? %A Sabine Drieskens %A Herman Van Oyen %A Stefaan Demarest %A Johan Van der Heyden %A Lydia Gisle %A Jean Tafforeau %K ADOLESCENT %K Adult %K Alcoholism %K Belgium %K cross-sectional studies %K Educational Status %K Feeding Behavior %K Female %K Health behavior %K Humans %K LIFE STYLE %K Male %K prevalence %K Risk-Taking %K Sedentary Lifestyle %K sex factors %K SMOKING %X

BACKGROUND: Unhealthy behaviours often occur in combination. In this study the relationship between education and lifestyle, defined as a cluster of risk behaviours, has been analysed with the purpose to assess socio-economic changes in multiple risk behaviour over time.

METHODS: Cross-sectional data from the Belgian Health Interview Surveys 1997, 2001 and 2004 were analysed. This study is restricted to persons aged ≥ 15 years with information on those health behaviours and education (n = 7431, n = 8142 and n = 7459, respectively). A lifestyle index was created based on the sum of the four unhealthy behaviours: smokers vs. non-smokers, risky versus non-risky alcohol use, sedentaryness vs. physically active and poor vs. healthy diet. The lifestyle index was dichotomized as low (0-2) vs. high (3-4). For the assessment of socio-economic inequalities in multiple risk behaviour, summary measures as Odds Ratio (OR) and Relative Index of Inequality (RII) were calculated using logistic regression, stratified by sex.

RESULTS: Of the adult population, 7.5% combined three to four unhealthy behaviours. Lower educated men are the most at risk. Besides, the OR among men significantly increased from 1.6 in 2001 to 3.4 in 2004 (P = 0.029). The increase of the OR among women was less pronounced. The RII, on the other hand, did not show any gradient, neither for men nor for women.

CONCLUSION: Multiple risk behaviour is more common among lower educated people. An increasing polarization in socio-economic inequalities is assessed from 2001 to 2004 among men. Therefore, health promotion programmes should focus on the lower socio-economic classes and target risk behaviours simultaneously.

%B Eur J Public Health %V 20 %P 634-9 %8 2009-11-23 %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/19933780?dopt=Abstract %R 10.1093/eurpub/ckp185 %0 Journal Article %J Thyroid %D 2010 %T Projected reduction in healthcare costs in Belgium after optimization of iodine intake: impact on costs related to thyroid nodular disease. %A Stefanie Vandevijvere %A Annemans, Lieven %A Herman Van Oyen %A Jean Tafforeau %A Moreno-Reyes, Rodrigo %K ADOLESCENT %K Adult %K Aged %K Aged, 80 and over %K Belgium %K Cost-Benefit Analysis %K cross-sectional studies %K denmark %K Female %K Forecasting %K health care costs %K Humans %K hyperthyroidism %K Iodine %K Male %K middle aged %K prevalence %K Thyroid Nodule %K Young adult %X

BACKGROUND: Several surveys in the last 50 years have repeatedly indicated that Belgium is affected by mild iodine deficiency. Within the framework of the national food and health plan in Belgium, a selective, progressive, and monitored strategy was proposed in 2009 to optimize iodine intake. The objective of the present study was to perform a health economic evaluation of the consequences of inadequate iodine intake in Belgium, focusing on undisputed and measurable health outcomes such as thyroid nodular disease and its associated morbidity (hyperthyroidism).

METHODS: For the estimation of direct, indirect, medical, and nonmedical costs related to thyroid nodular diseases in Belgium, data from the Federal Public Service of Public Health, Food Chain Safety and Environment, the National Institute for Disease and Disability Insurance (RIZIV/INAMI), the Information Network about the prescription of reimbursable medicines (FARMANET), Intercontinental Marketing Services, and expert opinions were used. These costs translate into savings after implementation of the iodization program and are defined as costs due to thyroid nodular disease throughout the article. Costs related to the iodization program are referred to as program costs. Only figures dating from before the start of the intervention were exploited. Only adult and elderly people (≥18 years) were taken into account in this study because thyroid nodular diseases predominantly affect this age group.

RESULTS: The yearly costs due to thyroid nodular diseases caused by mild iodine deficiency in the Belgian adult population are ∼€38 million. It is expected that the iodization program will result in additional costs of ∼€54,000 per year and decrease the prevalence of thyroid nodular diseases by 38% after a 4-5-year period. The net savings after establishment of the program are therefore estimated to be at least €14 million a year.

CONCLUSIONS: Optimization of iodine intake in Belgium should be quite cost effective, if only considering its impact on nodular thyroid disease. There are likely added benefits relating to more optimal thyroid hormone influenced brain development that are more difficult to estimate but may be even more important.

%B Thyroid %V 20 %P 1301-6 %8 2010 Nov %G eng %N 11 %1 http://www.ncbi.nlm.nih.gov/pubmed/21062196?dopt=Abstract %R 10.1089/thy.2010.0133 %0 Journal Article %J Int J Public Health %D 2009 %T Does a national screening programme reduce socioeconomic inequalities in mammography use? %A Puddu, Marina %A Stefaan Demarest %A Jean Tafforeau %K Aged %K Belgium %K breast %K cancer %K Female %K Forecasting %K Health Education %K health inequaities %K health surveys %K Humans %K MAMMOGRAPHY %K Mass Screening %K middle aged %K ODDS RATIO %K SCREENING %K Socioeconomic Factors %K Utilization Review %X

OBJECTIVES: To investigate possible changes in socioeconomic inequalities in mammography use among women aged 50-69 years between the start of the Belgian national screening programme in 2001 and three years later (2004), and to assess if the implementation of an organised screening programme has been successful in reducing socioeconomic inequalities in the uptake of mammography.

METHODS: Data was obtained from the 2001 and 2004 Health Interview Survey. Data were analysed by logistic regression with educational level as proxy for the socioeconomic status. The gradient of socioeconomic inequalities was estimated with the relative index of inequality.

RESULTS: Despite a substantial increase in the use of mammography from 59% in 2001 to 71% in 2004, a variation in the coverage according to educational level was detected: women with lower education were less likely to undergo mammography than those with higher education [(OR 1.93 (95% CI 1.21-3.09 in 2001 and 2.21 (95% CI 1.37-3.56) in 2004].

CONCLUSIONS: Socioeconomic inequalities in breast screening uptake seem to persist 3 years after the implementation of the national screening programme. Although the national programme improved the coverage, it could not counteract the socioeconomic gradients in the use of mammography. Additional work is needed to identify effective methods of decreasing socioeconomic inequalities in mammography use.

%B Int J Public Health %V 54 %P 61-8 %8 2009 %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/19247577?dopt=Abstract %R 10.1007/s00038-009-8105-6 %0 Journal Article %J Public Health %D 2009 %T Food consumption patterns among adolescent and young adult smokers. %A Lydia Gisle %A Herman Van Oyen %A Stefaan Demarest %A Jean Tafforeau %K ADOLESCENT %K Belgium %K cross-sectional studies %K Educational Status %K Feeding Behavior %K Female %K Humans %K Logistic Models %K Male %K nutritional status %K risk %K SMOKING %K Surveys and Questionnaires %K Young adult %B Public Health %V 123 %P 632-4 %8 2009 Sep %G eng %N 9 %1 http://www.ncbi.nlm.nih.gov/pubmed/19747704?dopt=Abstract %R 10.1016/j.puhe.2009.07.016 %0 Journal Article %J Pharmacoepidemiol Drug Saf %D 2009 %T Gender differences in the use of anxiolytics and antidepressants: a population based study. %A Johan Van der Heyden %A Lydia Gisle %A Hesse, E %A Stefaan Demarest %A Sabine Drieskens %A Jean Tafforeau %K ADOLESCENT %K Adult %K Aged %K Anti-Anxiety Agents %K Antidepressive Agents %K Belgium %K Drug Utilization Review %K Female %K Humans %K Logistic Models %K Male %K Mental health %K middle aged %K Population Surveillance %K Sex Characteristics %K Young adult %X

PURPOSE: In the majority of studies on determinants of use of anxiolytics and antidepressants a substantially higher consumption is observed among women than among men. We investigated gender differences in the association between the use of anxiolytics and antidepressants and mental health and explored if there are indications of gender differences in inappropriate use of these medicines.

METHODS: Data were from the 2004 Belgian Health Interview Survey, a nationally representative sample of the Belgian population. The analysis was restricted to the population of 15 years and older (n = 11,220). The probability of use of anxiolytics and antidepressants was assessed through logistic regression models by gender and through models including the interaction between gender and mental health.

RESULTS: The association between the use of antidepressants and mental health did not vary substantially between men and women. Among men the use of anxiolytics showed a strong association with sleeping problems, but not with depressive disorders. Among women the use of anxiolytics was significantly associated with the three mental health conditions that were investigated: depressive disorder, anxiety, and sleeping problems.

CONCLUSIONS: The link between mental health and use of anxiolytics differs by gender. Some indications exist for gender differences in inappropriate use of anxiolytics, whereas this does not hold true for the use of antidepressants. Further efforts are needed to increase the awareness of prescribers, policy makers, and the general public on the appropriate use of anxiolytics, especially among women and in the older population.

%B Pharmacoepidemiol Drug Saf %V 18 %P 1101-10 %8 2009 Nov %G eng %N 11 %1 http://www.ncbi.nlm.nih.gov/pubmed/19688727?dopt=Abstract %R 10.1002/pds.1827 %0 Journal Article %J Med Inform Internet Med %D 2006 %T Interactive analysis of Belgian vital statistics on the Internet. %A Sabine Drieskens %A Herman Van Oyen %A Jean Tafforeau %A Lafontaine, Marie-France %K ADOLESCENT %K Adult %K Aged %K Aged, 80 and over %K Belgium %K Child %K Child, Preschool %K Female %K Humans %K Infant %K Infant, Newborn %K Internet %K Male %K middle aged %K mortality %K Vital Statistics %X

The purpose of the Centre for Operational Research in Public Health (CORPH) is to optimize the accessibility to health information, thus making it possible to measure and follow up the health status of the Belgian population. The Standardized Procedures for Mortality Analysis (SPMA) software was developed in order to facilitate the use of vital statistics for health policy-makers and scientific researchers. Nowadays, SPMA is available on the Internet, because accessibility to health information is crucial. SPMA serves via a system of menus as the interface between databases (population, birth, and mortality) on one hand and statistical procedures on the other hand. Users can choose the parameters such as year, cause of death, geographical level, and statistical indicator, and so dynamic reports are produced 'on demand'. These procedures are available for the following modules: overall mortality, specific cause mortality, and perinatal statistics. Analysis can be carried out for one specific year or for a period over time. Pre-defined procedures accessible through menus make SPMA user-friendly, as it can be used without any preliminary knowledge of the statistical package. Tables, charts, or maps display the results. Users need only an Internet browser to access the application.

%B Med Inform Internet Med %V 31 %P 237-45 %8 2006 Dec %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/17135056?dopt=Abstract %R 10.1080/14639230500512499 %0 Journal Article %J Health Policy %D 2003 %T Socio-economic differences in the utilisation of health services in Belgium. %A Johan Van der Heyden %A Stefaan Demarest %A Jean Tafforeau %A Herman Van Oyen %K ADOLESCENT %K Adult %K Aged %K Belgium %K cross-sectional studies %K Family Characteristics %K Female %K Health Care Surveys %K health services %K Health status %K Humans %K Male %K middle aged %K Patient Acceptance of Health Care %K probability %K social class %X

OBJECTIVE: To investigate socio-economic differences in the use of health services in Belgium and to explore to what extent eventual socio-economic inequalities are explained by differences in demographic determinants and health needs.

DESIGN: Data was obtained from the 1997 Belgian national Health Interview Survey. In this survey information was collected on the health status, the life style and the medical consumption of a representative sample of the Belgian non-institutionalised population consisting of 8560 Belgian inhabitants aged 15 years and over.

RESULTS: Lower socio-economic groups make more often use of the general practitioner and nursing care at home and are more often admitted to hospital than persons with a high socio-economical status. There is, however, no socio-economic gradient when the health status is taken into account. On the opposite, persons with a higher socio-economic status report more often a visit to a specialist, a physiotherapist or a dentist. For the health services for which this was investigated no association was found between socio-economic status and the volume of the use of health services.

CONCLUSIONS: There are in Belgium still important socio-economic gradients in the use of some health services. These differences may be due to socio-economic inequities but could also indicate that the existing health facilities are not always used in an optimal way. Patient factors may be more important than supply factors in explaining the differential use of health services. Further research needs to focus on socio-economic differences in the reasons, the outcome and the quality of the provided care.

%B Health Policy %V 65 %P 153-65 %8 2003 Aug %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/12849914?dopt=Abstract %0 Journal Article %J Soz Praventivmed %D 2001 %T The impact of hearing disability on well-being and health. %A Herman Van Oyen %A Jean Tafforeau %A Stefaan Demarest %K ADOLESCENT %K Adult %K Aged %K Aged, 80 and over %K Belgium %K cross-sectional studies %K Female %K Health status %K Humans %K Male %K middle aged %K Persons With Hearing Impairments %K Quality of Life %K Social Adjustment %X

OBJECTIVES: The aim of the paper is to assess the significance of hearing disability as a public health problem through its association with multiple negative health outcomes: subjective health perception, mental health and social well-being.

METHODS: The data come from the participants of the 1997 national health survey in Belgium, who were 15 years and older (n = 8,560). The presence and severity of the hearing disability was estimated through self-reporting. The association of hearing disability with the studied health outcomes was assessed using logistic regression while controlling for confounding factors such as age, sex, co-morbidity and socio-economic status.

RESULTS: The prevalence of hearing disability is 7% in the population 15 years and older. The prevalence of subjective ill health (Odds Ratio (OR): 1.32), mental ill health (OR: 1.51), and a low appreciation of the social contacts (OR: 1.73) was higher in subjects with hearing disability. No association was found between hearing disability and the frequency of social contacts or with the functional content of the social contacts.

CONCLUSIONS: Given the health and social consequences of hearing disability, increased public health attention, including both strategies for prevention, for identification and treatment, is warranted.

%B Soz Praventivmed %V 46 %P 335-43 %8 2001 %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/11759341?dopt=Abstract %0 Journal Article %J Archives of Public Health %D 1997 %T The Belgian Health Interview Survey %A Herman Van Oyen %A Jean Tafforeau %A H Hermans %A Quataert, P %A E Schiettecatte %A L Lebrun %A L Bellamammer %K Belgium %K health interview survey %X

In 1997 a Health Interview Survey takes place in Belgium.  A total of 10 000 individuals will be interviewed.  The individuals are selected within families which are selected by a multistage sampling procedure from the National Register.  The individuals are questionned on a variety of health related domains: general health perception, morbidity and functional status, use of health services, life style and socio-economic characteristics.  The paper gives a general description of the objectives, the questionnaire (content and development), the sampling procedure and the pilot study.

%B Archives of Public Health %V 55 %8 1997 %G eng %N 1-2 %& 1 %0 Generic %D 0 %T Contribution of chronic conditions to smoking differences in life expectancy and health expectancies in Belgium, 1997-2013 %A Renata Yokota %A Nusselder, Wilma %A Robine, Jean-Marie %A Jean Tafforeau %A Rana Charafeddine %A Deboosere, Patrick %A Herman Van Oyen %G eng