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Buntinx F, Lebeau A, Gillot L, Baudin L, Ndong Penda R, Morfoisse F, Lallemand F, Vottero G, Nizet C, Nizet JL, Blacher S, Noel A. Single and combined impacts of irradiation and surgery on lymphatic vasculature and fibrosis associated to secondary lymphedema. Front Pharmacol 2022; 13:1016138. [PMID: 36330083 PMCID: PMC9622766 DOI: 10.3389/fphar.2022.1016138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/03/2022] [Indexed: 11/13/2022] Open
Abstract
Lymphedema (LD) refers to a condition of lymphatic dysfunction associated with excessive fluid accumulation, fibroadipose tissue deposition and swelling. In industrialized countries, LD development mainly results from a local disruption of the lymphatic network by an infection or cancer-related surgery (secondary LD). In the absence of efficient therapy, animal models are needed to decipher the cellular and molecular mechanisms underlying LD and test putative drugs. In this study, we optimized and characterized a murine model of LD that combines an irradiation of the mice hind limb and a radical surgery (lymph node resection associated to lymphatic vessel ligation). We investigated the respective roles of irradiation and surgery in LD formation by comparing their impacts, alone or in combination (with different intervention sequences), on eight different features of the pathology: swelling (paw thickness), indocyanine green (ICG) clearance, lymphatic vasculature remodeling, epidermal and dermal thickening, adipocyte accumulation, inflammatory cell infiltration and collagen deposition. This study supports the importance of radiation prior to surgery to experimentally induce a rapid, severe and sustained tissue remodeling harboring the different hallmarks of LD. We provide the first experimental evidence for an excessive deposition of periostin (POSTN) and tenascin-C (TNC) in LD. Through a computerized method of digital image quantification, we established the spatial map of lymphatic expansion, as well as collagen, POSTN and TNC deposition in papillary and reticular dermis of lymphedematous skins. This mouse model is available to study the patho-physiology of LD and test potential therapeutic targets.
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Van Den Broeke C, De Burghgraeve T, Ummels M, Gescher N, Deckx L, Tjan-Heijnen V, Buntinx F, van den Akker M. Occurrence of Malnutrition and Associated Factors in Community-Dwelling Older Adults: Those with a Recent Diagnosis of Cancer Are at Higher Risk. J Nutr Health Aging 2018; 22:191-198. [PMID: 29380845 DOI: 10.1007/s12603-017-0882-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES In older adults, nutritional health is essential for good quality of life and living independently at home. Especially in cancer patients, malnutrition is common and known to complicate treatment. This study aims to evaluate the nutritional status and its associated factors in community-dwelling older adults with and without cancer. DESIGN This is an observational study. SETTING This study focuses on older community-dwelling people. PARTICIPANTS This study included older people with and without cancer (≥70 years). Cancer patients included patients with a new diagnosis of breast, lung, prostate, or colorectal cancer. MEASUREMENTS Data collection included measures of nutritional status, quality of life, depression, fatigue, distress and functional status. We used multivariate logistic regression analysis to assess the association between personal characteristics and malnutrition. RESULTS Data were available for 657 people; 383 people without cancer and 274 with a cancer diagnosis. Overall, malnutrition was detected in 245 (37.5%) people; in cancer patients this was 66.1%. Multivariate analysis showed that having cancer (OR 14.4, 95% CI: 8.01 - 23.3), being male (OR 2.38, 95% CI: 1.49 - 3.70), having depression (OR 13.5, 95% CI: 6.02-30.0), distress (OR 2.60, 95% CI: 1.55 - 4.37) and impaired instrumental activities of daily living (IADL) (OR 2.63, 95% CI: 1.63 - 4.24) were associated with a higher risk of malnutrition. CONCLUSION The prevalence of malnutrition in community-dwelling older people is high, particularly in patients with cancer. Benchmarking and routine screening of older patients may be helpful strategies to increase awareness of (risk of) malnutrition among professionals.
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Schroyen S, Missotten P, Jerusalem G, Van den Akker M, Buntinx F, Adam S. Association between self-perception of aging, view of cancer and health of older patients in oncology: a one-year longitudinal study. BMC Cancer 2017; 17:614. [PMID: 28865449 PMCID: PMC5581442 DOI: 10.1186/s12885-017-3607-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 08/24/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Identifying older people affected by cancer who are more at risk of negative health outcomes is a major issue in health initiatives focusing on medical effectiveness. In this regard, psychological risk factors such as patients' perception of their own aging and cancer could be used as indicators to improve customization of cancer care. We hypothesize that more negative self-perception of aging (SPA) and view of cancer could be linked to worse physical and mental health outcomes in cancer patients. METHODS One hundred one patients diagnosed with cancer (breast, gynecological, lung or hematological) were followed for 1 year. They were evaluated on four occasions (baseline, 3, 6 and 12 months after the baseline). Their SPA, view of cancer and health (physical and mental) were assessed at each time of evaluation. RESULTS Negative SPA and/or view of cancer at baseline are associated with negative evolution of patients' physical and mental health. Moreover, when the evolution of SPA and cancer view were taken into account, these two stigmas are still linked with the evolution of mental health. In comparison, only a negative evolution of SPA was linked to worse physical health outcomes. CONCLUSIONS Such results indicate that SPA and view of cancer could be used as markers of vulnerability in older people with cancer.
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Arain A, Bourgeois S, de Galocsy C, Henrion J, Deltenre P, d'Heygere F, George C, Bastens B, Van Overbeke L, Verrando R, Bruckers L, Mathei C, Buntinx F, Van Vlierberghe H, Francque S, Laleman W, Moreno C, Janssens F, Nevens F, Robaeys G. Belgian experience with triple therapy with boceprevir and telaprevir in genotype 1 infected patients who inject drugs. J Med Virol 2015; 88:94-9. [PMID: 26121975 DOI: 10.1002/jmv.24308] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2015] [Indexed: 01/08/2023]
Abstract
No data have been reported yet on treatment outcome in persons who inject drugs (PWID) infected with hepatitis C virus treated with boceprevir or telaprevir in combination with peginterferon (Peg IFN) and ribavirin (RBV). Additionally, there are concerns about the safety of boceprevir and telaprevir in some subgroups of patients with hepatitis C (HCV). In a cohort of HCV patients infected with genotype 1 in Belgium, treatment outcome of patients infected due to IV drug use was analyzed and compared with patients who have no history of substance use. The study population consisted of 179 patients: 78 PWID and 101 controls treated with boceprevir (n = 79) or telaprevir (n = 100) additional to Peg IFN and RBV; 53 (30%) had advanced disease (F3, F4) and 79 (44%) had an antiviral therapy previously. There were no significant differences in the baseline characteristics between both groups, except that PWID patients were more frequently infected with genotype 1a (67% vs 21%), were younger and were predominantly male. Psychiatric complaints during follow-up occurred more frequently in the PWID patients: 24% versus 11% (P = .02). Treatment failure for other reasons than absence of viral response was 70% and 64% in PWID and non-PWID respectively. The sustained viral response (SVR) rates were similar in both groups (71% in PWID vs 72% in non-PWID); with a non-inferiority test with -5% margin there is a difference of -1% (95% CI [-15%, 13%]) and P = 0.30. There are no reasons to exclude PWID from treatment with boceprevir, telaprevir and novel antiviral therapies.
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Goderis G, Van Casteren V, Bossuyt N, De Clercq E, Moreels S, Vanthomme K, Wens J, Bartholomeeusen S, Buntinx F. Starting a Care Trajectory precedes improved glycaemic control in patients with formerly uncontrolled Diabetes Mellitus Type 2: results from a retrospective registry based study in Belgium. Eur J Public Health 2013. [DOI: 10.1093/eurpub/ckt126.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Thompson M, Van den Bruel A, Verbakel J, Lakhanpaul M, Haj-Hassan T, Stevens R, Moll H, Buntinx F, Berger M, Aertgeerts B, Oostenbrink R, Mant D. Systematic review and validation of prediction rules for identifying children with serious infections in emergency departments and urgent-access primary care. Health Technol Assess 2012; 16:1-100. [PMID: 22452986 DOI: 10.3310/hta16150] [Citation(s) in RCA: 148] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Although the vast majority of children with acute infections are managed at home, this is one of the most common problems encountered in children attending emergency departments (EDs) and primary care. Distinguishing children with serious infection from those with minor or self-limiting infection is difficult. This can result in misdiagnosis of children with serious infections, which results in a poorer health outcome, or a tendency to refer or admit children as a precaution; thus, inappropriately utilising secondary-care resources. OBJECTIVES We systematically identified clinical features and laboratory tests which identify serious infection in children attending the ED and primary care. We also identified clinical prediction rules and validated those using existing data sets. DATA SOURCES We searched MEDLINE, Medion, EMBASE, Cumulative Index to Nursing and Allied Health Literature and Database of Abstracts of Reviews of Effects in October 2008, with an update in June 2009, using search terms that included terms related to five components: serious infections, children, clinical history and examination, laboratory tests and ambulatory care settings. We also searched references of included studies, clinical content experts, and relevant National Institute for Health and Clinical Excellence guidelines to identify relevant studies. There were no language restrictions. Studies were eligible for inclusion if they were based in ambulatory settings in economically developed countries. REVIEW METHODS Literature searching, selection and data extraction were carried out by two reviewers. We assessed quality using the quality assessment of diagnostic accuracy studies (QUADAS) instrument, and used spectrum bias and validity of the reference standard as exclusion criteria. We calculated the positive likelihood ratio (LR+) and negative likelihood ratio (LR-) of each feature along with the pre- and post-test probabilities of the outcome. Meta-analysis was performed using the bivariate method when appropriate. We externally validated clinical prediction rules identified from the systematic review using existing data from children attending ED or primary care. RESULTS We identified 1939 articles, of which 35 were selected for inclusion in the review. There was only a single study from primary care; all others were performed in the ED. The quality of the included studies was modest. We also identified seven data sets (11,045 children) to use for external validation. The most useful clinical features for ruling in serious infection was parental or clinician overall concern that the illness was different from previous illnesses or that something was wrong. In low- or intermediate-prevalence settings, the presence of fever had some diagnostic value. Additional red flag features included cyanosis, poor peripheral circulation, rapid breathing, crackles on auscultation, diminished breath sounds, meningeal irritation, petechial rash, decreased consciousness and seizures. Procalcitonin (LR+ 1.75-2.96, LR- 0.08-0.35) and C-reactive protein (LR+ 2.53-3.79, LR- 0.25-0.61) were superior to white cell counts. The best performing clinical prediction rule was a five-stage decision tree rule, consisting of the physician's gut feeling, dyspnoea, temperature ≥ 40 °C, diarrhoea and age. It was able to decrease the likelihood of serious infections substantially, but on validation it provided good ruling out value only in low-to-intermediate-prevalence settings (LR- 0.11-0.28). We also identified and validated the Yale Observation Scale and prediction rules for pneumonia, meningitis and gastroenteritis. LIMITATIONS Only a single study was identified from primary-care settings, therefore results may lack generalisability. CONCLUSIONS Several clinical features are useful to increase or decrease the probability that a child has a serious infection. None is sufficient on its own to substantially raise or lower the risk of serious infection. Some are highly specific ('red flags'), so when present should prompt a more thorough or repeated assessment. C-reactive protein and procalcitonin demonstrate similar diagnostic characteristics and are both superior to white cell counts. However, even in children with a serious infection, red flags will occur infrequently, and their absence does not lower the risk. The diagnostic gap is currently filled by using clinical 'gut feeling' and diagnostic safety-netting, which are still not well defined. Although two prediction rules for serious infection and one for meningitis provided some diagnostic value, we do not recommend widespread implementation at this time. Future research is needed to identify predictors of serious infection in children in primary-care settings, to validate prediction rules more widely, and determine the added value of blood tests in primary-care settings. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Van Pottelbergh G, Bartholomeeusen S, Buntinx F, Degryse J. The evolution of renal function and the incidence of end-stage renal disease in patients aged >=50 years. Nephrol Dial Transplant 2011; 27:2297-303. [DOI: 10.1093/ndt/gfr659] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Schoenmakers B, Buntinx F, De Lepeleire J. The primary care physician and Alzheimer’s disease: an international position paper. J Nutr Health Aging 2011; 15:595-6. [PMID: 21919279 DOI: 10.1007/s12603-011-0135-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Brinkman MT, Kellen E, Zeegers MP, van Dongen MCJMS, Dagnelie PC, Muls E, Buntinx F. Validation of the IMMIDIET food frequency questionnaire in an adult Belgian population: a report from the Belgian case-control study on bladder cancer risk. Acta Clin Belg 2011; 66:18-25. [PMID: 21485759 DOI: 10.2143/acb.66.1.2062509] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We evaluated the performance of the IMMIDIET food frequency questionnaire (FFQ) used to collect dietary data for the Belgian case-control study on bladder cancer. Thirty-seven men and women aged 50 years and older were recruited from the University Hospital in Leuven, Belgium. Participants completed the IMMIDIET FFQ, a 7-day diet diary and a 24-hour diet recall. Median intakes and inter-quartile ranges were calculated for 27 foods and nutrients from each dietary assessment method. All dietary factors were log-transformed and adjusted for energy using the nutrient density method. Pearson correlation coefficients were used to compare the different dietary assessment methods. Bland-Altman plots were also used to assess levels of agreement between the dietary methods. Energy, fruit and vegetable intake estimates were higher from the IMMIDIET FFQ compared with the two reference methods.The highest deattenuated correlations between the FFQ and 7-day diary were meat (0.58), bread (0.44), fruit (0.38) and fish (0.38). The highest deattenuated correlations between the FFQ and 24-hour recall were for fruit (0.72), fat (0.48), alcohol (0.44), cholesterol (0.42), monounsaturated fatty acid (0.42) and polyunsaturated fatty acid (0.41). Generally, correlation was lower for the micro-nutrients except for phosphorus (0.42), vitamin C (0.41) and calcium (0.40). The IMMIDIET FFQ is an appropriate instrument to measure usual dietary intake for the Belgian case-control study on bladder cancer risk. Further investigation of nutritional assessment methods is necessary.
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Brinkman MT, Kellen E, Zeegers MP, van Dongen MCJM, Dagnelie PC, Muls E, Buntinx F. VALIDATION OF THE IMMIDIET FOOD FREQUENCY QUESTIONNAIRE IN AN ADULT BELGIAN POPULATION: A REPORT FROM THE BELGIAN CASE-CONTROL STUDY ON BLADDER CANCER RISK. Acta Clin Belg 2011. [DOI: 10.1179/acb.66.1.2062509] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Vanstraelen D, Deleu H, Van Robays J, Dhollander D, Cloes E, Lousberg D, Kuipers G, Adriaens B, Mebis J, Mathei C, Buntinx F. Melanoma incidence trends in Limburg after screening and prevention campaigns. Arch Public Health 2010. [PMCID: PMC3436700 DOI: 10.1186/0778-7367-68-1-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Malignant melanoma is a skin cancer of which the incidence is said to be raising in recent years. Prevention may result in decrease of the incidence. Early detection may result in the detection of earlier stages of the disease. In Limburg a combined campaign of prevention and screening has been performed in recent years and its effects should be evaluated. Objectives To study time trends of malignant melanoma incidence and the evolution of stages of detected melanomas and to relate them to interventions in previous years. Methods An ongoing multi-faceted intervention, including information as well as screening invitations (Euromelanoma project) was implemented in 1999. Time trends of malignant melanoma were studied on the basis of data from the Limburg Cancer Registry (LIKAR) of 1996-2005. Stages were studied on the basis of an additional clinical registration completed by pathologists and dermatologists. Results Over the years 1996-2005, the crude incidence rate of malignant melanoma was 6.8/100,000 patient-years in males and 11.6 in females, with a European standardized incidence rate (ESR) of 6.4 in males and 10.5 in females. The incidence progressively increased with age. In males, the ESR initially decreased, followed by a significant increase from 3.0 in 1998 to 7.6 in 2005. On average this is a yearly increase of 0.5 per 100,000 persons (p= 0.04). In females the curve fluctuates, resulting in almost similar rates in 1996 and 2004 (p = 0.85), but with a sudden increase from 9.2 to 15.8 between 2004 and 2005. Neither the Breslow nor the Clarck classification showed any significant change over the registration period. The proportion of lymph node invasion, metastasis and ulcerations did not change. Discussion With the exception of a small and clinically irrelevant increase in ESR in males, no changes over time were detected in incidence or stage distribution. The effect of the intervention seems limited.
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Muyer MT, Buntinx F, Mapatano MA, De Clerck M, Truyers C, Muls E. Mortality of young patients with diabetes in Kinshasa, DR Congo. Diabet Med 2010; 27:405-11. [PMID: 20536511 DOI: 10.1111/j.1464-5491.2010.02961.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS As data on mortality of young patients with diabetes is not available in the Democratic Republic of Congo (DRC), we studied mortality rates, the influence of some determinants and causes of death. METHODS A retrospective review of standardized medical records of all patients with diabetes aged<or=30 years at diagnosis who were enrolled between 1994 and 2004 in a large, integrated healthcare network in Kinshasa, DRC. Diabetes was diagnosed clinically. As resources for classification according to type of diabetes were not available, the study sample was a mixed-type cohort. Death was established by review of medical records and by community interview. Mortality was recorded until 2007. Overall mortality rates and 95% confidence intervals (CI) were calculated. Kaplan-Meier survival and Cox regression analyses were performed to study the influence of determinants. RESULTS Of the patients, 17.4% (159/915) died, mostly during the first 5 years of follow-up. Mean yearly mortality was 3.62/100 patient-years (95% CI 3.1-4.2). Independent predictors were male gender [hazard ratio (HR) 0.66 (95% CI 0.5-0.9) for females vs. males] and age at diagnosis (HR 0.97 (95% CI 0.94-0.99) per increase of 1 year]. Major causes of death were ketoacidosis (38%) and infection (12%). Cause of death was unknown in 31% of cases. CONCLUSIONS One out of six patients died, most within 5 years after diagnosis. Death occurred more frequently at home, in male patients and in subjects aged<or=20 years. The major cause of death was ketoacidosis.
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Paquay L, De Lepeleire J, Milisen K, Ylieff M, Buntinx F. A randomized clinical trial using an educational intervention demonstrated no effect on interobserver agreement on assessments of functional status. Arch Public Health 2009. [PMCID: PMC3463016 DOI: 10.1186/0778-7367-67-3-128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aim To evaluate the effect of an educational intervention on interobserver agreement of assess-ments of functional status performed by registered nurses and care assistants in a nursing home and to compare interobserver agreement in persons with and without cognitive impairment. Background High accuracy of assessments of functional status in care settings for older persons is needed for the efficacy of the planning and the evaluation of the nursing care. Method Randomized clinical trial. Six registered nurses and six care assistants were randomized to participate in an educational session about assessment instruments for functional status (intervention) or in a session about falls in the elderly (control). Each of the registered nurses and care assistants performed assessments on the same thirty-four residents using the Belgian Evaluation Scale (BES) and the AGGIR instrument. The kappa statistic (κ) for multiple observers (and its 95% confidence interval) was the main outcome measure. Findings At baseline, interobserver agreement for BES total score was: κ = 0.43 (0.35-0.51) in the intervention group and κ = 0.48 (0.39-0.57) in the control group. At the second assessment, agreement measures were: κ = 0.48 (0.41-0.57) in the intervention group and κ = 0.58 (0.50-0.66) in the control group. Results for AGGIR total scores were similar. Conclusion Interobserver agreement of assessments on nursing home residents was moderate and did not improve significantly after an educational session.
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Buntinx F, Paquay L, Ylieff M, De Lepeleire J. Progression and improvement after mild cognitive impairment. Arch Public Health 2009. [PMCID: PMC3436696 DOI: 10.1186/0778-7367-67-1-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective We studied progression to dementia and improvement rates of mild cognitive impairment (MCI) to help clinicians decide whether or not to screen older people for MCI. Method Prospective cohort study in which 156 vulnerable patients with (n = 24) and without (n = 132) MCI are followed and reassessed after two years with MMSE and Camdex. Results Nine (38%) out of 24 patients initially diagnosed with MCI and 20 (15%) out of 132 considered normal or depressed progressed to dementia within two years. This results in a relative risk of progression of 2.48 (95% confidence interval = 1.29-4.77), a sensitivity of 31% (95%CI = 16-51) and a predictive value of 38% (95%CI = 20-59). Out of 24 people with MCI at baseline, 8 (33%; 95%CI = 16-55) had improved at follow-up. Conclusion The low sensitivity of MCI for subsequent occurrence of dementia and the high improvement rate found in our study as well as by others, and the absence of a proven therapy, provide cumulative evidence against screening for MCI.
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Maes L, Cosyns P, Buntinx F. [Fitting proof]. VERHANDELINGEN - KONINKLIJKE ACADEMIE VOOR GENEESKUNDE VAN BELGIE 2009; 71:373-380. [PMID: 20232789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Randomised controled trials (RCT's) and meta analyses of RCT's are known as the best research designs to evaluate if interventions are doing more good than bad. Some interventions can not be evaluated by RCT's because of the heterogeneity of the problems, the cost of the evaluation study or ethical arguments against the study. This is often the case with population based interventions. A typical example is suicide prevention. The shortcomings of the "classic" research designs for the evaluation of suicide prevention are discussed and feasible solutions are suggested for future research.
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Robaeys G, Wichers MC, De Bie J, Koek GH, Buntinx F, Van Os J. Does antidepressant medication in patients with hepatitis C undergoing interferon alpha treatment reduce therapeutic efficacy? Gut 2009; 58:145; author reply 145-6. [PMID: 19091833 DOI: 10.1136/gut.2008.156919] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
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Missotten P, Squelard G, Ylieff M, Di Notte D, Paquay L, De Lepeleire J, Buntinx F, Fontaine O. Relationship between quality of life and cognitive decline in dementia. Dement Geriatr Cogn Disord 2008; 25:564-72. [PMID: 18544978 DOI: 10.1159/000137689] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/08/2008] [Indexed: 11/19/2022] Open
Abstract
AIMS We aimed to examine the association of cognitive decline with quality of life (QoL) in dementia compared to controls and to determine variables associated with QoL. METHODS Every subject was placed within a specific group depending on their designation by the Mini Mental State Examination and evaluated by the Alzheimer's Disease Related Quality of Life (ADRQL) and clinical assessments. RESULTS QoL for the mild dementia group was lower (p = 0.08) than that of controls. The very severe dementia group had a significantly lower QoL than the other dementia groups, which all had similar ADRQL scores. The only predictor of ADRQL scores was found to be the behavioral and psychological symptoms of dementia. CONCLUSION There is no direct relationship between cognitive decline and QoL.
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Kellen E, Zeegers MP, Bruckers L, Buntinx F. The investigation of a geographical cluster of bladder cancer. Acta Clin Belg 2008; 63:313-20. [PMID: 19186563 DOI: 10.1179/acb.2008.061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Previous analyses of the Limburg Cancer registry (LIKAR) indicated the existence of a geographical cluster of bladder cancer incidence, particularly transitional cell carcinomas, amongst males in the surrounding area of the Belgian cities Hasselt and Alken. In subsequent ecologic analyses no risk factors were identified which could explain the existence of this cluster. Therefore, an epidemiological case-control study has been performed in the province of Limburg to explore the possible determinants of the cluster. The following cluster determinants were investigated: socio-demographic characteristics, life style factors, occupational and environmental exposures, and genetic predisposition. A weight was assigned to all the study subjects. Secondly, we used unconditional logistic regression to calculate crude odd ratios (ORs) and 95% confidence intervals (CIs) for each source of exposure and bladder cancer. Thirdly, we used a multivariate logistic regression analysis which included all the parameters found to be significant at the 0.1 significance level in the univariate analysis. Although some of the specific odds ratios decreased compared with the crude results, the overall excess did not change specifically. In conclusion, we were not able to identify a clear-cut explanation for the existence of the geographical cluster. We therefore recommend an increased surveillance of bladder cancer incidence for 3 to 5 years. If the "excess" of cancer cases has occurred due to random variation, the rate will return to the "expected" range in the next years. If the rate remains elevated, further studies may need to be performed using investigative tools that are not available currently.
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Matheï C, Van Dooren S, Lemey P, Van Damme P, Buntinx F, Vandamme AM. The epidemic history of hepatitis C among injecting drug users in Flanders, Belgium. J Viral Hepat 2008; 15:399-408. [PMID: 18248334 DOI: 10.1111/j.1365-2893.2007.00950.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
We employed recently developed statistical methods to explore the epidemic behaviour of hepatitis C subtype 1a and subtype 3a among injecting drug users (IDUs) in Flanders, Belgium, using new gene sequence data sampled among two geographically distinct populations of IDUs. First the extent of hepatitis C transmission across regions/countries was studied through calculation of association indices. It was shown that viral exchange had occurred between both populations in Flanders as well as across international borders. Furthermore, evidence was found suggestive of subtypes 1a and 3a predominantly circulating in subpopulations of Flemish IDUs, exhibiting different degrees of travelling/migration behaviour. Secondly, through coalescent-based analysis the viral epidemic history of the hepatitis C subtype 1a and 3a epidemics was inferred. Evidence was found for different dynamic forces driving both epidemics. Moreover, results suggested that the hepatitis C subtype 3a epidemic has reached a steady state, while the hepatitis C 1a epidemic has not, which therefore might become the predominant subtype among IDUs.
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Kellen E, Putte GV, Van Steen A, Cloes E, Lousbergh D, Buntinx F, Van Limbergen E. Interval cancers in the beginning years of the breast cancer screening programme in the Belgian province of Limburg. Acta Clin Belg 2008; 63:179-84. [PMID: 18714848 DOI: 10.1179/acb.2008.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE To assess the occurrence of interval breast cancers among those women who attended the mammography screening programme in the Belgian province of Limburg. Interval cancers are tumours that are being diagnosed before the next scheduled screening round and are related to the sensitivity and the screening interval. METHODS Biennial screening is provided to all women aged 50-69. The records of the screening programme were linked to those of the cancer registry. The interval cancer rate, expressed as a proportion of the underlying (expected) breast cancer incidence rate was calculated. The observed interval cancer incidence is the number of interval cancers per 10,000 'negative' screening tests. RESULTS The interval cancer rate in the first year was 25.37% for all cancers (ductal carcinoma in situ included) and 21.7% when the analysis was restricted to invasive tumours. Proportional incidence of interval cancer in the second year after screening was 12.02% for all cancers. CONCLUSION In conclusion, the interval cancer rates in the Belgian province of Limburg were compatible with the European guidelines. However, increasing the recall rate in our programme and systematically reviewing the interval cancers may improve the quality of the programme even further.
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Mapatano MA, Muyer MC, Buntinx F, De Clerck M, Okitolonda W, Bieleli IA, Muls E. Obesity in diabetic patients in Kinshasa, Democratic Republic of Congo. Acta Clin Belg 2007; 62:293-7. [PMID: 18229461 DOI: 10.1179/acb.2007.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE To assess the distribution of Mass Index (BMI) and the prevalence of obesity at the time of diagnosing diabetes in the primary health care network in Kinshasa, Democratic Republic of Congo (DRC), from 1993 to 1999. METHODOLOGY A total of 4967 patients with diabetes were classified according to BMI, age at diagnosis (< 30 years versus > or = 30 years), sex and subsequent treatment (insulin treated versus non-insulin treated). WHO criteria were used to define diabetes and obesity. RESULTS One diabetic patient in 4 was underweight (26.4%). The prevalence of obesity was 8.1%. Undernutrition was more prevalent in male patients aged < 30 years at diagnosis and, in contrast, obesity was more prevalent in patients aged > or = 30 years at diagnosis, especially among women. CONCLUSION Undernutrition is highly prevalent at the time of diagnosis in young diabetic patients in Kinshasa. The overall prevalence of obesity at diagnosis is relatively low, except in women diagnosed at > or = 30 years of age. Prospective studies are needed in the Democratic Republic of Congo to characterize secular trends of undernutrition and obesity in order to improve preventive and management strategies.
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Mathei C, Shkedy Z, Denis B, Kabali C, Aerts M, Molenberghs G, Van Damme P, Buntinx F. Evidence for a substantial role of sharing of injecting paraphernalia other than syringes/needles to the spread of hepatitis C among injecting drug users. J Viral Hepat 2006; 13:560-70. [PMID: 16901287 DOI: 10.1111/j.1365-2893.2006.00725.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In industrialized countries, transmission of hepatitis C occurs primarily through injecting drug use. Transmission of hepatitis C in injecting drug users is mainly associated with the sharing of contaminated syringes/needles, although evidence for risk of hepatitis C infection through sharing of other injecting paraphernalia is increasing. In this paper, the independent effects of sharing paraphernalia other than syringes/needles have been estimated. The prevalence and force of infection were modelled using three serological data sets from drug users in three centres in Belgium as a function of the sharing behaviour. It was found that sharing of materials other than syringes/needles indeed seemed to contribute substantially to the spread of hepatitis C among injecting drug users.
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Matheï C, Wollants E, Verbeeck J, Van Ranst M, Robaeys G, Van Damme P, Buntinx F. Molecular epidemiology of hepatitis C among drug users in Flanders, Belgium: association of genotype with clinical parameters and with sex- and drug-related risk behaviours. Eur J Clin Microbiol Infect Dis 2005; 24:514-22. [PMID: 16133411 DOI: 10.1007/s10096-005-1376-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The aim of this study was to determine the genotypic variation of hepatitis C among drug users in Flanders and to relate the distribution of genotypes to the characteristics of the population. Hepatitis C virus RNA (HCV-RNA) quantification and genotyping was performed on stored samples from 161 anti-HCV-positive injecting and non-injecting drug users. Information on sociodemographic status, drug-related risk behaviour and sexual risk behaviour was available for each drug user. HCV-RNA was present in 152 of 161 samples (94.4%). Genotype 1 was predominant (48.7%), followed by genotype 3 (41.2%), genotype 4 (8.8%) and genotype 2 (1.4%). In the multivariate analysis, lack of a history of injecting drug use was confirmed as a statistically significant predictor for infection with genotype 1. Predictors for infection with genotype 3 were the presence of anti-HBc antibodies and a history of injecting drug use. Being tattooed emerged as a statistically significant predictor for infection with genotype 4. The 94.4% prevalence of HCV-RNA among anti-HCV-positive drug users was considerably higher than the 54-86% chronicity rate found globally among HCV-infected patients. The results of this study suggest the existence of separate transmission networks for injecting drug users and non-injecting drug users. Finally, the results suggest that tattooing practices play a role in the spread of HCV among drug users.
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Hannes K, Van Royen P, Aertgeerts B, Buntinx F, Ramaekers D, Chevalier P. [Systemic validation of clinical practice guidelines: the AGREE network]. REVUE MEDICALE DE LIEGE 2005; 60:949-56. [PMID: 16457396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
INTRODUCTION Over recent decades, the number of available clinical practice guidelines has enormously grown. Guidelines should meet specific quality criteria to ensure good quality. There is a growing need for the developement of a set of criteria to ensure that potential biases inherent in guideline development have been properly addressed and that the recommendations for practice are valid and reliable. AIM The AGREE-collaboration is an international network that developed an instrument to critically appraise the methodological quality of guidelines. AGREE promotes a clear strategy to produce, disseminate and evaluate guidelines of high quality. METHOD In the first phase of the international project the AGREE-instrument was tested in 11 different countries. Based on this experience the instrument was refined and optimised. In the second phase it was disseminated, promoted and evaluated in 18 participating countries. Belgium was one of them. RESULTS The Belgian partner in the AGREE-project developed 3 workshops and established 13 validation committees to validate guidelines from Belgian developer groups. We collected 33 questionnaires from participants of the workshops and the validation committees, in which we asked for primary experiences and information on the usefulness and applicability of the instrument. We were also interested in the shortcomings of the instrument and potential strategies to bridge them. DISCUSSION More efforts should be made to train methodological experts to gain certain skills for a critical appraisal of clinical practice guidelines. Promoting the AGREE-instrument will lead to a broader knowledge and use of quality criteria in guideline development and appraisal. CONCLUSION The development and dissemination of an international list of criteria to appraise the quality of guidelines will stimulate the development of methodologically sound guidelines. International comparisons between existing guidelines will lead to a better collaboration between guideline developers throughout the world.
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Devroey D, Van Casteren V, Buntinx F. Lower stroke death rates in patients receiving blood pressure lowering therapy before the onset of a stroke. Cent Eur J Public Health 2005; 13:176-9. [PMID: 16419381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
The objective of this study was to compare stroke death rates among patients with and without blood pressure lowering treatment before the onset of the stroke. During two consecutive years all patients with acute stroke were recorded by 178 Belgian general practitioners of the sentinel network. In total 511 patients with acute stroke were recorded. The death rate after one month was found significantly higher among the untreated patients (33%; n = 84) compared to those receiving blood pressure lowering treatment (23%; n = 61) (p = 0.007). Blood pressure lowering treatment before the onset of stroke had a beneficial effect on survival in a backward stepwise logistic regression (OR 0.38; 95% CI 0.20-0.72). In conclusion, stroke mortality is significantly lower among patients receiving blood pressure lowering treatment before the onset of stroke compared to those without blood pressure lowering treatment.
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