A retrospective analysis of the histology of resected polyps and colonoscopy quality parameters in Belgium

Background and aims

adenoma detection rate is a well known quality parameter for colonoscopy. However recently other quality parameters have emerged. We wanted to evaluate the histology of the resected polyps, different quality indicators of colonoscopy and post colonoscopy colorectal cancer (PCCRC) in Belgium and analyzed data about colonoscopies performed between 2008-2015.

Methods

Reimbursement data on colorectal related medical procedures from the Intermutualistic Agency were linked with data on clinical and pathological staging of colorectal cancer and with histologic data of resected polyps available at the Belgian Cancer Registry over a period covering 8 years (2008-2015).

Results

298,246 polyps were resected in 294,923 colonoscopies, of which 275,182 were adenomas (92 %) and 13,616 were SSLs (4%). There was a significant but small correlation between the different quality parameters and PCCRC. Post colonoscopy colorectal cancer rate after 3 years was 7.29 %. There were marked geographic differences in Belgium concerning adenoma detection rate, sessile adenoma detection rate and post colonoscopy colorectal cancer.

Conclusion

Most resected polyps were adenomas, only a small percentage involved sessile serrated lesions. There was a significant correlation between adenoma detection rate and other quality parameters, and a small but significant correlation between PCCRC and the different quality parameters. The lowest post colonoscopy colorectal cancer rate was reached with an ADR of 31.4 % and a SSL-DR of 1.2 %.

Acute Alcohol intoxication in Belgian adolescents: a retrospective hospital chart study

Background

Binge drinking by adolescents in Belgium is an increasing problem, according to emergency physicians who have recently alerted society about the increasing numbers of adolescents admitted to hospital due to acute alcohol intoxication (AAI). Until now, only estimations of the prevalence of AAI in adolescents are known and research about potential risk factors has not yet been conducted in Belgium.

Methods

To gain more insight into the prevalence, medical characteristics, and context of AAI, a retrospective study in hospitals in the city of Antwerp was conducted. Medical charts of 10 to 18-year-old patients admitted with AAI between 2015 and 2021 were investigated and analysed.

Results

Between 2016 and 2021, 547 adolescents with AAI were admitted to 5 of the 8 hospitals in Antwerp. In the University Hospital of Antwerp (n = 177) mean age at admittance was 15.9 years. Older patients had a significantly higher BAC than younger patients (U:2357, 1, p-value: <0.001). In 10% of the patients combined drug use was proven and in this group, BAC was significantly lower (U:209, 1, p-value: <0.001). 60% of the patients were transmitted to the hospital by ambulance and in 31% the ambulance was assisted by specialised medical care. In 18% of the cases, the police were involved. The results of the other hospitals are not yet known at the time of submission but will be presented at the EPH conference.

Conclusions

According to the data so far, younger patients and patients with comorbid drug use are admitted with a lower BAC, which could be seen as a potential risk factor. This should be considered in developing preventive measures like sensitization. Moreover, in a noteworthy percentage, ambulances, specialized care, and police are involved, which contributes to high medical and social costs. However, data addressing demographics and the context of AAI were mostly missing. Therefore, prospective research is required to further investigate potential risk factors for AAI.

Key messages

• A significant amount of adolescents with AAI are admitted in the city of Antwerp every year, with a mean age of 15.9 years old, which is below the legal alcohol age.

• Considering the high prevalence of AAI and the major impact it has on adolescents health and medical and social costs, it is necessary to decrease the prevalence of binge drinking in adolescents.

Irregular screening participation increases advanced stage breast cancer at diagnosis: A population-based study

OBJECTIVE

To evaluate the effect of irregular screening behaviour on the risk of advanced stage breast cancer at diagnosis in Flanders.

METHODS

All women aged 50-69 who were invited to the organized breast cancer screening and diagnosed with breast cancer before age 72 from 2001 to 2018 were included. All prevalent screen and interval cancers within 2 years of a prevalent screen were excluded. Screening behaviour was categorized based on the number of invitations and performed screenings. Four groups were defined: regular, irregular, only-once, and never attenders. Advanced stage cancer was defined as a stage III + breast cancer. The association between screening regularity and breast cancer stage at diagnosis was evaluated in multivariable logistic regression models, taking age of diagnosis and socio-economic status into account.

RESULTS

In total 13.5% of the 38,005 breast cancer cases were diagnosed at the advanced stage. Compared to the regular attenders, the risk of advanced stage breast cancer for the irregular attenders, women who participated only-once, and never attenders was significantly higher with OR_adjusted:1.17 (95%CI:1.06-1.29) and OR_adjusted:2.18 (95%CI:1.94-2.45), and OR_adjusted:5.95 (95%CI:5.33-6.65), respectively.

CONCLUSIONS

In our study, never attenders were nearly six times more likely to be diagnosed with advanced stage breast cancer than regular attenders, which was much higher than the estimates published thus far. An explanation for this is that the ever screened women is a heterogeneous group regarding the participation profiles which also includes irregular and only-once attenders. The benefit of regular screening should be informed to all women invited for screening.

Depressive symptoms in higher education students during the first wave of the COVID-19 pandemic. An examination of the association with various social risk factors across multiple high- and middle-income countries

Higher-education students face substantial risks for developing depressive symptoms during the COVID-19 pandemic or experiencing exacerbated pre-existing depressive symptoms. This study uses data from the COVID-19 International Student Well-Being Study, which collected data through a non-representative convenience sample in 125 higher-education institutions (HEI) across 26 high- and middle-income countries (N: 20,103) during the first wave of the COVID-19 pandemic. It describes the prevalence of depressive symptoms in higher-education students. We find substantial cross-national variation in depressive symptoms, with lowest mean levels established in the Nordic countries and France, while highest mean levels of depressive symptoms were found in Turkey, South Africa, Spain and the USA. Elevated risk for depressive symptoms was found in female students, students with fewer social support resources and in a more disadvantaged socioeconomic position, and students with a migrant background. COVID-19 related stressors, such as reduced social contact, increased financial insecurity, and academic stress explained a relatively larger proportion of the variance in depressive symptoms compared to non-COVID-19 related stressors. This finding shows that not the pandemic itself, but rather the secondary effects of the pandemic relate to students' mental health. Our results enable HEIs to be better equipped to target groups that are particularly at risk during a pandemic.

Assessment of the COVID-19 related knowledge and its association with perceived worries of COVID-19 infection and severe illness among higher education students in 26 countries: A cross-sectional study

Background

During COVID-19, various public health measures such as physical distancing and distance learning are being implemented. As a consequence, higher education (HE) students face social as well as mental trauma at a crucial developmental stage in their lives. Having inadequate COVID-19 related knowledge can lead to an exaggerated worrying as well as to negative COVID-19 outcomes. Our study aims to assess COVID-19 related knowledge and its association with perceived worries among HE students.

Methods

Between April 27 & July 7, 2020, a cross sectional survey, called COVID-19 International Students Well-being Study (C19 ISWS) was conducted in HE institutions in 26 countries. A stratified convenience sampling technique was used to select HE institutions. An online questionnaire was distributed to HE students to investigate behaviour and mental well-being. Descriptive, bivariate and mixed effect logistic regression analysis were conducted using R software. Perceived worries of COVID-19 infection as well as of severe COVID-19 illness (outcome measures) were studied.

Results

Over 127,000 students from more than 100 HE institutions in 26 countries filled out the questionnaire. 97,495 (76.5%) respondents have never acquired COVID-19 (our study population). 70,365 (72.1%) of these respondents were female. The most frequent correct response to COVID-19 related knowledge questions among respondents was observed about having the virus without having symptoms (94.3%). The odds of being worried of contracting severe COVID-19 illness among respondents with poor knowledge is 1.15 (95%CI:1.11,1.18).

Conclusions

COVID related knowledge was independently associated with perceived worries of contracting severe COVID-19 illness. We recommend scaling up of awareness creation campaigns to increase the comprehensive and timely COVID-19 related knowledge in order to tackle exaggerated perceived worries of severe COVID-19 illness among HE students.

The COVID-19 International Student Well-being Study

Background

We will present the COVID-19 International Student Well-being Study (C19 ISWS). The C19 ISWS is a cross-sectional multi-country study that collected data on higher education students during the first wave of the COVID-19 outbreak (spring 2020).

Methods

The dataset allows to describe (1) the living conditions, financial conditions and academic workload before and during the COVID-19 outbreak, (2) the current level of mental well-being and changes in healthy lifestyles, (3) perceived stressors, (4) resources (e.g., social support and economic capital), (5) COVID-19 related knowledge, and (6) attitudes towards COVID-19 measures implemented by the government and higher education institution (HEI). The dataset additionally includes information about COVID-19 measures taken by the government and HEI that were in place during the period of data collection.

Results

As a large international consortium of 26 countries and 110 higher education institutions (HEIs), we successfully developed and executed an online student survey during or directly after the initial peak of the Covid-19 pandemic.

Conclusions

The collected data provide a comprehensive and comparative dataset on student well-being. In this article, we present the rationale for this study, the development and content of the survey, the methodology of data collection and sampling, and the limitations of the study. In addition, we highlight the opportunities that the dataset provides for advancing social science research on student well-being during the COVID-19 pandemic in varying policy contexts. Thus far, this is the first cross-country student well-being survey during the COVID-19 pandemic, resulting in a unique dataset that enables high priority and socially relevant research.

Factors associated with organized and non-organized colorectal cancer screening

Background

Data on non-organized colorectal cancer screening using fecal occult blood tests (FOBTs) is currently lacking. We identified factors associated with organized and non-organized FOBT screening.

Methods

Data of 308 municipalities in Flanders (6.6 million residents, 57% of Belgium) during 2015-2017 were analyzed. Logistic regression with generalized estimating equations was used to assess associations between municipal characteristics and organized and non-organized screening coverages.

Results

Median organized screening coverage increased (36.4% to 40.1%) while non-organized screening coverage decreased (4.8% to 3.3%) in 2015-2017. Organized screening coverage was negatively associated with average income (OR = 0.97, 95%CI: 0.96-0.98) and percentage of people with a non-Belgian/Dutch nationality (OR = 0.962, 95%CI: 0.957-0.967). More older people (70-74) in the target screening population were related to lower coverages by both organized (OR = 0.98, 95%CI: 0.97-0.99) and non-organized screening (OR = 0.98, 95%CI: 0.96-0.999). Education level was positively associated with organized screening coverage (OR = 1.010, 95%CI: 1.008-1.011). While GP visit was positively associated with both organized and non-organized screening coverages, average number of patients per GP and having a global medical dossier handled by preferred GP showed more pronounced associations with non-organized screening (OR = 1.021, 95%CI: 1.016-1.026 and OR = 1.025, 95%CI: 1.018-1.031, respectively) compared to organized screening coverage.

Conclusions

Higher average income, lower average education level, more older people and people with foreign nationality were associated with lower organized screening coverage. GP involvement showed a positive association with non-organized screening. It seems that some GPs and screening-invited individuals are still not fully aware of the benefits of organized screening. Available instruments in screening programs should be optimized to fill this gap in knowledge.

Key messages

We identified factors associated with both organized and non-organized colorectal cancer screening using fecal occult blood tests (FOBTs). Based on this knowledge, strategies can be developed to promote screening among non-participants and encourage non-organized participants to switch to organized screening.

Coverage determinants of breast cancer screening in Flanders: an evaluation of the past decade

Background

Breast cancer (BC) is the most common cancer in women in the developed world. In order to find developing cancers in an early stage, BC screening is commonly used. In Flanders, screening is performed in and outside an organized breast cancer screening program (BCSP). However, the determinants of BC screening coverage for both screening strategies are yet unknown.

Objective

To assess the determinants of BC screening coverage in Flanders.

Methods

Reimbursement data were used to attribute a screening status to each woman in the target population for the years 2008–2016. Yearly coverage data were categorized as screening inside or outside BCSP or no screening. Data were clustered by municipality level. A generalized linear equation model was used to assess the determinants of screening type.

Results

Over all years and municipalities, the median screening coverage rate inside and outside BCSP was 48.40% (IQR: 41.50–54.40%) and 14.10% (IQR: 9.80–19.80%) respectively. A higher coverage rate outside BSCP was statistically significantly (P < 0.001) associated with more crowded households (OR: 3.797, 95% CI: 3.199–4.508), younger age, higher population densities (OR: 2.528, 95% CI: 2.455–2.606), a lower proportion of unemployed job seekers (OR: 0.641, 95% CI: 0.624–0.658) and lower use of dental care (OR: 0.969, 95% CI: 0.967–0.972).

Conclusion

Coverage rate of BC screening is not optimal in Flanders. Women with low SES that are characterized by younger age, living in a high population density area, living in crowded households, or having low dental care are less likely to be screened for BC in Flanders. If screened, they are more likely to be screened outside the BCSP.

Excessive gaming behaviour in primary school children in Belgium

Background

The use of electronic devices (smartphones, laptops,...) has gradually become a common activity among primary school children. Especially children's excessive use of elec-tronic games has been increasingly considered an important Public Health issue. This study explored the effects of personal and social factors on gaming behaviour in primary school children.

Methods

A survey was conducted in primary school children in Flanders (Belgium), 2016. Overall 8,444 children, mainly 9 to 11 years old, were included. First, descriptive and bivariate analyses were conducted. Subsequently, a multinominal logistic regression was performed to analyse gaming behaviour.

Results

Overall, 27% (n = 2,277), 25% (n = 2,108), 29% (n = 2,453) and 19% (n = 1,606) of the participating children showed a low, moderate, frequent and very frequent level of gaming behaviour, respectively. Gender differences were statistically significant, with boys showing more moderate, frequent and very frequent gaming behaviour. Further, chances for gaming were higher among children with a more frequent consumption of high sugar content soda, chips and candies.

Conclusions

More frequent gaming in boys can already be observed in primary school. How-ever, further research is needed to explore the development of this behaviour over longer time periods. Further results might provide useful information for developing effective prevention strategies concerning excessive gaming behaviour among primary school children.

Key messages

Excessive gaming behaviour is already present in 9 to 11 years old children. It might be useful to develop effective prevention strategies regarding excessive gaming in primary school children.

Response patterns in the Belgian health interview survey: web versus face-to-face mode

Background

Potential is seen in web data collection for population health surveys due to a combination of its cost-effectiveness and ease of implementation and the increased internet penetration rates. Nonetheless, web modes may lead to lower and more selective unit response rates than traditional modes such as face-to-face (F2F) interviewing and hence may increase bias in the measured indicators. This research assesses the response patterns of a web versus F2F study.

Methods

A Belgian health interview survey by web (BHISWEB; net sample=1010) was organized parallel to the traditional F2F BHIS 2018 (BHIS2018; net sample=11611; subsample used in this study=2748). Socio-demographic data on invited individuals were obtained from the national register and census linkages. To address the high item-missingness on education level deriving from the census, multiple imputation (m = 20) was applied. Unit response rates considering the different sampling probabilities of both surveys were calculated. Logistic regression analyses examined the impact of mode (web vs. F2F) and interactions between mode and socio-demographic characteristics on unit response.

Results

The unit response rate was significantly lower in the BHISWEB (18.0% (95% CI: 17.0-19.1)) than in the BHIS2018 (43.1% (95% CI: 41.5-44.7)). A lower web versus F2F response rate was found among all socio-demographic groups, however, this lower web response was less pronounced among youngsters, people cohabiting with household members, higher educated people and native Belgians.

Conclusions

The F2F unit response rate was generally higher, yet for certain groups the difference between web versus F2F was smaller. It is therefore worthwhile to experiment with adaptive mixed-mode designs to optimize resources without increasing selection bias; e.g. only inviting socio-demographic groups more eager to participate online for web surveys (e.g. youngsters) while remaining to focus on increasing the F2F response rates for other groups.

Key messages

The advantages of web versus F2F interviewing come against its considerable lower unit response rate. Differences in unit non-response between web and F2F vary between socio-demographic groups.

Tobacco smoking and binge drinking among university students in three European countries, 2009-2017

Background

Attention is needed on students as high levels of substance use are often part of the university experience. The aim of the study is to identify the trend of tobacco smoking and binge drinking among university students (US) of Belgium, France and the Netherlands over a 9 years period.

Methods

Three repeated cross-sectional studies in US were performed in 2009-10, 2012-13 and 2016-17 in university of Antwerp (Belgium), Amsterdam (the Netherlands) and Rouen (France). US between 18 and 25 voluntarily filled out a self-administered anonymous questionnaire. The socio-demographic characteristics (age, gender, curriculum, job and accommodation) of the US were collected. Tobacco smoking and binge drinking in the previous 12 months were also collected. The trend test of Cochran-Armitage was used for comparisons.

Results

In 2010, 1388 US were included in Antwerp, 1907 in Amsterdam, and 1137 in Rouen. In 2013, 1665 US were included in Antwerp, 3590 in Amsterdam, and 1488 in Rouen. In 2016, 2347 US were included in Antwerp, 4157 in Amsterdam, and 1011 in Rouen. Female gender was 63.4% in Antwerp, 68.7% in Amsterdam and 65.4% in Rouen. The prevalence of tobacco smoking was respectively in 2010, 2013 and 2016: in Antwerp: 31.0%, 33.5% and 27.6% (p = 0.008); in Amsterdam: 13.7%, 16.5% and 17.0% (p = 0.003); in Rouen: 21.3%, 23.7% and 23.5% (p = 0.21). The prevalence of binge drinking (more than once a month) was respectively in 2010, 2013 and 2016: in Antwerp: 16.2%, 12.3% and 16.7% (p = 0.30); in Amsterdam: 26.5%, 27.4% and 26.5% (p = 0.82); in Rouen: 8.6%, 16.6% and 7.1% (p = 0.44).

Conclusions

Risk behaviours as tobacco smoking and binge drinking in US show a different prevalence according to country. Tobacco smoking decreases in two countries and frequent binge drinking did not change during the 9 years period. Further analyses need to be conducted taking into account the curriculum and the socio-demographic characteristics.

Key messages

Risk behaviours as tobacco smoking and binge drinking in university students show a different prevalence according to the European country. Binge drinking does not worsen for 9 years among university students.

Risk factors for hazardous drinking in university students from South Africa and Belgium

Background

Previous studies have associated certain risk factors with hazardous drinking in students. However, big cultural and geographical differences exist regarding alcohol use. In this study, we compare the alcohol use and hazardous drinking in Belgian (BE) and South African (SA) university students.

Methods

An online survey assessing alcohol use among university students in South Africa (University of KwaZulu-Natal) and Belgium (University of Antwerp) was conducted, using the shortened version of the Alcohol Use Disorder Identification Test (AUDIT-C). For male students a cut-off point of 5 was used for hazardous drinking and for female students a score of 4. In total, 499 students were included in the study (250 BE and 249 SA students). A comparative analysis between both universities was performed for men and women separately with a Pearson chi-square test or Mann-Whitney U test. Furthermore, the association between hazardous drinking and several exposure variables was explored using multivariable logistic regression analysis.

Results

A significant higher amount of male (94.8%) as well as female (92.4%) BE students drank alcohol in the last year compared to the male (66.2%) and female (67.8%) SA students (p &lt; 0.001). Additionally, a significant higher amount of BE students were hazardous drinkers, compared to the SA students (p &lt; 0.001). Multivariate analysis showed that male BE students were approximately five times more likely to be hazardous drinkers than male SA students (OR = 5.057, 95% CI 1.378-18.556; p = 0.015). Female BE students were over twice more likely to be hazardous drinkers than female SA students (OR = 2.371, 95% CI 0.846-6.644; p = 0.099).

Conclusions

BE students drink significantly more alcohol and a significant higher proportion of BE students were hazardous drinkers compared to SA students. Qualitative research in both groups has been conducted to get more insight into the reasons of these differences and will also be presented at the Conference.

Key messages

When studying alcohol use (disorders) in university students, it is of utmost importance to take into account the socio-cultural context. After finding quantitatively assessed differences in alcohol use (disorder) across different socio-cultural settings, it is evenly important to find out about the reasons why.

Parameters influencing the quality of colonoscopy in Belgium : a critical evaluation

BACKGROUND AND STUDY AIMS

In relation to recent implementation of colorectal cancer screening programs at the regional level, quality assessment of colonoscopy gains more interest in Belgium. In order to evaluate quality indicators of colonoscopies in Belgium, we retrospectively analysed data about colonoscopies performed between 2002-2010.

PATIENTS AND METHODS

Coded data concerning number of medical procedures and polypectomy were provided by the Intermutualistic Agency (IMA). This database was used to calculate different quality indicators such as polyp detection rate (PDR), use of sedation, amount of procedures and time interval according to physician and center type.

RESULTS

Considerable differences in polyp detection rate (PDR) exist between different physicians and centers. Mean PDR significantly correlated with the number of colonoscopies performed each year. A minimum of 106 colonoscopies per year was identified to maintain competence. Recuperation rate for polyps was low, and time intervals between colonoscopies were generally too short in comparison to European and international guidelines.

CONCLUSIONS

In absence of a central colonoscopy registry in Belgium, our results were based on reimbursement data. Other quality parameters, although accuracy is questionable (eg. bowel cleansing and withdrawal time) are not systematically registered. Despite these difficulties, we were able to demonstrate that a minimum amount of 106 colonoscopies per year is necessary to maintain competence. The results from this large database can be used as a foundation to work out a quality colonoscopy bundle.

First results of the Flemish colorectal cancer screening program : start-up- period late 2013

BACKGROUND AND AIMS

Investigation of the first participation rate and follow-up results of the Flemish colorectal cancer screening program.

PATIENTS AND METHODS

In 2013 five age cohorts with an even age between 66 and 74 year old (n=243 335) were invited by mail to return a completed iFOBT. Participants who tested positive (≥75ng/ml) were referred to a follow-up colonoscopy.

RESULTS

Participation rate was 48.4% (n=117 774). Overall positivity rate was 10.1%, and 78.1% of those tested positive underwent a colonoscopy. The positive predictive value of colonoscopy for CRC was 8.2%, for advanced adenoma 16.9% and for non-advanced adenoma 36.5%.

CONCLUSIONS

Based on the EU-guidelines 35% was expected as participation for a first screening round, thus a participation rate of 48.4% is more than acceptable for a first screening year. The high positivity rate can partly be explained by including only the older ages in the start-up-period and by the first year of mass screening in Flanders. (Acta gastroenterol. belg., 2016, 79, 421-428).

An exploration of attitudes towards breast cancer screening in orthodox Jewish women in Antwerp--Belgium

OBJECTIVE

To explore determinants of participation in breast cancer screening in orthodox Jewish women living in Antwerp, Belgium, and to uncover their opinions and attitudes towards screening, and thereby to detect ways to optimize participation.

STUDY DESIGN

Focus group discussions were performed during the last months of 2011 and the first half of 2012 to explore motivation to participate or not in breast cancer screening. Groups consisted of five to seven women. Inclusion criteria were: being female, considering oneself as orthodox Jewish, aged between 50 and 69 years.

RESULTS

Three focus group discussions with in a total of 20 women had taken place. All participants in the focus group discussions had a screening mammography taken on a regular base. All participants agreed that the social cohesion between Jewish orthodox women and the importance that is given to healthcare within the Jewish tradition are important contributors to their participation in a breast cancer screening program. Pain, lack of information during the exam, lack of confidence in the quality of the exam, perceived problems when the examining doctor/technician is male, and fear of the results are mentioned as barriers. The participants, however, state that these were not important enough to result in non-participation. Barriers could be diminished by information sessions specifically aimed at orthodox Jewish women.

CONCLUSION

This qualitative research demonstrates a generally positive attitude of orthodox Jewish women living in Antwerp, Belgium, towards mammographic breast cancer screening. Increased and repeated structured information sessions are likely to improve breast cancer awareness in this population.

Factors contributing to the low participation rate of Turkish women to a breast cancer screening program in Antwerp, Belgium

OBJECTIVES

To explore possible factors explaining a low participation rate to breast cancer screening for Turkish women living in Antwerp, Belgium, and to develop ways to increase participation rate.

MATERIAL AND METHODS

The authors used focus group discussions with Turkish women to explore their reasons to participate or not to participate in breast cancer screening. Groups consisted of four to six women. Inclusion criteria were: being female, having a Turkish origin, and age between 50 and 69 years. For each focus group, one Turkish women was invited and asked to invite five other women meeting the inclusion criteria.

RESULTS

Three focus group discussions with in total 17 women have taken place. Six women had participated to all consecutive invitations for breast cancer screening. One woman had participated once, but not the next time she was invited. Ten women had never participated to screening mammography, although some of them had undergone diagnostic mammography. In all three focus groups, insufficient knowledge of the Dutch language, the unavailability of a professional interpreter, being careless about healthcare, and a negative influence of the husband, were the main reasons not to participate in breast cancer screening. Invitation letters are not read because they are in a language the woman does not understand. Less frequently mentioned obstacles were being on a holiday or being sick on the day of the scheduled mammography, fear of pain, considering an examination useless when not having any symptoms, being anxious for a positive result, and the physical distance to the screening center. Receiving an invitation in Turkish and knowing that a person speaking Turkish will be available at the screening center were proposed as possible measures to improve participation.

CONCLUSION

The single most important reason why Turkish women living in Antwerp, Belgium, do not participate in breast cancer screening was a language problem; other reasons were a lack of knowledge concerning breast cancer screening and not worrying about breast cancer. The language barrier in this population of older women can possible be overcome by Turkish speaking personnel at the screening centers.

Quantifying independent risk factors for failing to rescreen in a breast cancer screening program in Flanders, Belgium

BACKGROUND

Mammographic screening may reduce breast cancer mortality by about 20%, provided participation is high and women screen regularly. We quantified independent risk factors for failing to rescreen and built a model to predict how rescreening rates change if these risk factors would be modified.

METHODS

Multivariate analysis was used to analyze data from a prospective study which included a self-administered questionnaire and rescreening status 30months after a t0 mammogram, using a random sample of women 50-67years (Belgium 2010-2013).

RESULTS

A false positive result at the most recent past mammogram (Odds Ratio=5.0, 95% Confidence Interval 3.6-6.8), an interval until new invitation greater than 25months (Odds Ratio=4.8 for >29months, 95% Confidence Interval 2.9-8.1), waiting times in the mammography unit >1h (Odds Ratio=2.1, 95% Confidence Interval 1.2-3.7) and difficulties in reaching the unit (Odds Ratio=2.5, 95% Confidence Interval 1.4-4.4) were the strongest independent predictors for failing to rescreen. The area under the curve of the receiver operating characteristic analysis was 0.705 for the model development stage and 0.717 for the validation stage and goodness-of-fit was good.

CONCLUSIONS

Maintaining an invitation cycle of maximum 25months, limiting waiting time in the mammography unit and lowering the number of false positives could increase breast cancer screening compliance.

Illicit substance use among university students from seven European countries: a comparison of personal and perceived peer use and attitudes towards illicit substance use

OBJECTIVE

To compare European students' personal use and approval of illicit substance use with their perceptions of peer behaviours and attitudes, and investigate whether perceptions of peer norms are associated with personal use of illicit substances and attitudes.

METHOD

This study used baseline data from the Social Norms Intervention for the prevention of Polydrug usE (SNIPE) project involving 4482 students from seven European countries in 2012. Students completed an online survey which included questions on personal and perceived peer illicit substance use and personal and perceived peer attitude towards illicit substances.

RESULTS

8.3% of students reported having used illicit substances at least once in their life. 49.7% of students perceived that the majority of their peers have used illicit substances more frequently than themselves. The perception was significantly associated with higher odds for personal illicit substance use (OR: 1.97, 95% CI: 1.53-2.54). The perception that the majority of peers approve illicit substance use was significantly associated with higher odds for personal approval of illicit substance use (OR: 3.47, 95% CI: 2.73-4.41).

CONCLUSION

Students commonly perceived that their peers used illicit subtances more often than themselves. We found an association between the perceived peer norms/attitudes and reported individual behaviour/attitudes.

Social motives for drinking in students should not be neglected in efforts to decrease problematic drinking

High heavy drinking prevalence persists in students. Recently, drinking motivation received a lot of attention as an important determinant. Enhancement and coping motives are mostly positively related and conformity motives are mostly negatively related with heavy drinking. Relations are less clear for social motives. This study aimed at gaining more insight in the role of drinking motives in heavy drinking students. Overall, 15 897 Belgian university and college students (mean age: 20.7, SD = 2.6) anonymously participated in an online survey. Logistic regressions tested relationships between motives and problematic drinking (>weekly drinking, ≥monthly binge drinking and being at risk for problematic drinking by the Alcohol Use Disorders Identification Test [AUDIT]). Social motives had the highest prevalence, followed by enhancement, coping and conformity motives. Men engaged more in problematic drinking and reported more motives, except for coping. Enhancement, coping and social-motivated students have higher chances for problematic drinking, while the opposite is true for conformity-motivated students. Although this study found a similar ranking of motives as in other studies, a relationship between problematic drinking and all motives, including social motives, was revealed. This might indicate the different functions of social motives in heavy drinking in different cultures/sub-populations and countries. This finding is relevant for the development of interventions.

[Opinions and attitudes of Flemish pharmacists and general practitioners towards INN prescribing. A survery in Antwerp and East Flanders]

INTRODUCTION

Since 2002 in Belgium, physicians are allowed to prescribe by International Non-proprietary Name (INN). In 2005, the conditions for this decree were set. Examples from other countries have shown that INN prescribing can significantly contribute to controlling pharmaceutical expenditures. The share of INN prescriptions remains low in Belgium (7% in 2011).

OBJECTIVE

To formulate an answer to the question: what are the opinions and attitudes of pharmacists and general practitioners [GP's] with regards to INN prescribing?

METHOD

In the winter of 2011-2012, a questionnaire with closed-ended questions was send to pharmacists and GP's in the provinces of Antwerp and East-Flanders, through training days and personal visits. Pharmacists and GP's scored a list of statements with a 5-point Likert scale. The themes of the statements related to: delivering INN prescriptions, legislation, impact on expenditures, choices regarding patient concerns and interprofessional relations.

RESULTS

In total, 353 questionnaires were completed and returned of which 228 165%1 were by pharmacists and 125 (35%1 by GP's. Although both declared to be sufficiently up to date with regulations to prescribe (84%) or to deliver (95%] a INN prescription, only 13% of the pharmacists said all prescription they receive contain the correct information. Less GP's [36%) than pharmacists (82%] feel aided by their software program when prescribing or delivering an INN prescription. GP's rely mostly on NIHDI (National Institute for Health and Disability Insurance) as the main source for information on INN prescribing, pharmacists rely on the [Local) pharmacists association. The pharmacists and GP's in the study who relied on NIHDI as main information source, were less aware of legislation concerning INN [N2, p<0,05] than those who rely on the local professional association [N2, p<0,0001]. All pharmacists in the study said to consider the patients medication history when delivering an INN prescription for chronic treatment. However, 57% of the GP's preferred not to prescribe by INN for the reason that they are not sure whether the pharmacist will always consider the patients medication history in case of an INN prescription. Although the GP's showed certain motivation to prescribe by INN, it was no greater than for generic prescribing. And INN prescribing has no added value compared to generic prescribing, according to the GP's. For the pharmacists, INN prescribing does contain an opportunity. With the increase in numbers of dosages and sorts of packaging of generic products, it becomes more and more difficult for pharmacists to manage their stock. In case of an INN prescription, the pharmacist can choose between the different packages in his stock. This offers opportunities especially for acute conditions.

CONCLUSION

INN prescribing is a good example of where the collaboration between pharmacists and GP's still contains a lot of opportunities, as well for the two professions, as the government and the patient in terms of controlling the pharmaceutical expenditures. Also the education for pharmacist or GP can further contribute to the sensitization of INN prescribing. In practice, there remain a number of issues and differences in opinions between pharmacists and general practitioners regarding INN prescribing. GP's feel few motivation to prescribe by INN and the government has put no imperative demands towards prescribers. Further evaluation of the practicaL feasibility of the current conditions for prescribing and delivering INN prescriptions is needed.

Potential impact of policy regulation and generic competition on sales of cholesterol lowering medication, antidepressants and acid blocking agents in Belgium

BACKGROUND

Pharmaceutical expenditures are increasing as a proportion of health expenditures in most rich countries. Antidepressants, acid blocking agents and cholesterol lowering medication are major contributors to medicine sales around the globe.

METHODS

We aimed to document the possible impact of policy regulations and generic market penetration on the evolution of sales volume and average cost per unit (Defined Daily Doses and packages) of antidepressants, acid blocking agents and cholesterol lowering medication. We extracted data from the IMS health database regarding the public price and sales volume of the antidepressants (selective serotonin reuptake inhibitors (SSRI's), monoamine oxidase inhibitors (MAOl's) and tricyclic and remaining antidepressants (TCA's)), acid blocking agents (proton pump inhibitors (PPl's) and H2 receptor antagonists) and cholesterol lowering medication (statins and fibrates) in Belgium between 1995 and 2009. We describe these sales data in relation to various national policy measures which were systematically searched in official records.

RESULTS

Our analysis suggests that particular policy regulations have had immediate impact on sales figures and expenditures on pharmaceuticals in Belgium: changes in reimbursement conditions, a public tender and entry of generic competitors in a reference pricing system. However, possible sustainable effects seem to be counteracted by other mechanisms such as marketing strategies, prescribing behaviour, brand loyalty and the entry of pseudogenerics. It is likely that demand-side measures have a more sustainable impact on expenditure.

CONCLUSION

Compared with other European countries, generic penetration in Belgium remains low. Alternative policy regulations aimed at enlarging the generic market and influencing pharmaceutical expenditures deserve consideration. This should include policies aiming to influence physicians' prescribing and a shared responsibility of pharmacists, physicians and patients towards expenditures.

A pivotal role for the general practitioner in a mixed mammographic screening model

BACKGROUND

A mixed mammographic screening model presents a country or region with a complex problem. Promoting a significant shift within the target population from opportunistic breast cancer screening to participation in an organised screening programme offers many advantages. The objective was to explore the role of GPs as potential mediators by assessing their specific knowledge, attitudes, and experience on breast cancer and mammographic screening.

METHODS

A detailed questionnaire was mailed in 2007 to 1500 GPs randomly sampled from the GP population in the province of Antwerp, Belgium. Levels of knowledge on epidemiology and screening, opinions and attitudes on systematic mammographic screening, and experience with breast cancer and mammography were evaluated.

RESULTS

We received 317 completed questionnaires, 21.1% of the contacted GPs. General knowledge on basic concepts of mammographic screening was average, while the response to an open question on the differences between screening and opportunistic mammography was very limited. More than half of the participants had a positive or realistic attitude towards many aspects of systematic screening, and had satisfactory experience with breast cancer patients in their daily practice (about 82% saw one to four new cases a year). Many (72%) were favourably disposed towards systematic screening organised by the government.

CONCLUSION

The answers of the GPs suggest a promising potential with regard to the official breast cancer screening programme. Many participants presented qualifications, which could contribute to a change from the mixed model in favour of the official screening system. A number of gaps, however, need to be filled and there is a continuing need to educate physicians on principles and risks and benefits of systematic screening of the target group.