Anxiety and depression in people with post-COVID condition: a Belgian population-based cohort study three months after SARS-CoV-2 infection.

PURPOSE: Since the onset of the COVID-19 pandemic, most research has focused on the management of the acute symptoms of the disease. Yet some people tend to experience symptoms beyond the acute phase, defined as Post-COVID-19 Condition (PCC). This study aims to assess the impact of COVID-19 and PCC on anxiety and depression. METHODS: This is a prospective longitudinal cohort study among the Belgian adult population with recent SARS-CoV-2 infection for which contact tracing was initiated. A total of 3127 people were followed-up just after their infection and three months later (from April 2021 to January 2022). Anxiety and depression were assessed at the two stages using the GAD-7 (Generalized Anxiety Disorder) and the PHQ-9 (Patient Health Questionnaire). RESULTS: Three months after infection, participants with PCC (50%) had an increased probability of having both anxiety and depressive symptoms (p < 0.001). The proportion with anxiety and depressive symptoms at three months were significantly higher in people with PCC (11% and 19%) compared to people without persistent COVID symptoms (3.8% and 4.2%) and to a matched sub-sample not infected with SARS-CoV-2 (6.5% and 4.3%). Having at least one acute COVID-19 symptom (p < 0.001), experiencing financial loss following the infection (p < 0.001), and different PCC symptoms were associated with anxiety and depressive symptoms worsening over time. CONCLUSIONS: This study showed that three months after a SARS-CoV-2 infection, one in two people suffer from PCC with significant consequences for their mental health. Follow-up on mental health must therefore have an important place in people suffering from PCC.

The health and economic burden of musculoskeletal disorders in Belgium from 2013 to 2018.

INTRODUCTION: Low back pain (LBP), neck pain (NKP), osteoarthritis (OST) and rheumatoid arthritis (RHE) are among the musculoskeletal (MSK) disorders causing the greatest disability in terms of Years Lived with Disability. The current study aims to analyze the health and economic impact of these MSK disorders in Belgium, providing a summary of morbidity and mortality outcomes from 2013 to 2018, as well as direct and indirect costs from 2013 to 2017. METHODS: The health burden of LBP, NKP, OST and RHE in Belgium from 2013 to 2018 was summarized in terms of prevalence and disability-adjusted life years (DALY) using data from the Belgian health interview surveys (BHIS), the INTEGO database (Belgian registration network for general practitioners) and the Global Burden of Diseases study 2019. The economic burden included estimates of direct medical costs and indirect costs, measured by cost of work absenteeism. For this purpose, data of the respondents to the BHIS-2013 were linked with the national health insurance data (intermutualistic agency [IMA] database) 2013-2017. RESULTS: In 2018, 2.5 million Belgians were affected by at least one MSK disorder. OST represented the disorder with the highest number of cases for both men and women, followed by LBP. In the same year, MSK disorders contributed to a total of 180,746 DALYs for female and 116,063 DALYs for men. LBP appeared to be the largest contributor to the health burden of MSK. Having at least one MSK disorder costed on average 3 billion € in medical expenses and 2 billion € in indirect costs per year, with LBP being the most costly. CONCLUSION: MSK disorders represent a major health and economic burden in Belgium. As their burden will probably continue to increase in the future, acting on the risk factors associated to these disorders is crucial to mitigate both the health and economic burden.

Association between SARS-CoV-2 variants and post COVID-19 condition: findings from a longitudinal cohort study in the Belgian adult population.

BACKGROUND: While many studies on the determinants of post-COVID-19 conditions (PCC) have been conducted, little is known about the relationship between SARS-CoV-2 variants and PCC. This study aimed to assess the association between different SARS-CoV-2 variants and the probability of having PCC three months after the infection. METHODS: This study was a longitudinal cohort study conducted between April 2021 and September 2022 in Belgium. In total, 8,238 adults with a confirmed SARS-CoV-2 infection were followed up between the time of their infection and three months later. The primary outcomes were the PCC status three months post infection and seven PCC symptoms categories (neurocognitive, autonomic, gastrointestinal, respiratory, musculoskeletal, anosmia and/or dysgeusia, and other manifestations). The main exposure variable was the type of SARS-CoV-2 variants (i.e. Alpha, Delta, and Omicron), extracted from national surveillance data. The association between the different SARS-CoV-2 variants and PCC as well as PCC symptoms categories was assessed using multivariable logistic regression. RESULTS: The proportion of PCC among participants infected during the Alpha, Delta, and Omicron-dominant periods was significantly different and respectively 50%, 50%, and 37%. Participants infected during the Alpha- and Delta-dominant periods had a significantly higher odds of having PCC than those infected during the Omicron-dominant period (OR = 1.61, 95% confidence interval [CI] = 1.33-1.96 and OR = 1.73, 95%CI = 1.54-1.93, respectively). Participants infected during the Alpha and Delta-dominant periods were more likely to report neurocognitive, respiratory, and anosmia/dysgeusia symptoms of PCC. CONCLUSIONS: People infected during the Alpha- and Delta-dominant periods had a higher probability of having PCC three months after infection than those infected during the Omicron-dominant period. The lower probability of PCC with the Omicron variant must also be interpreted in absolute figures. Indeed, the number of infections with the Omicron variant being higher than with the Alpha and Delta variants, it is possible that the overall prevalence of PCC in the population increases, even if the probability of having a PCC decreases.

Post COVID-19 condition and health-related quality of life: a longitudinal cohort study in the Belgian adult population.

BACKGROUND: Since the onset of the COVID-19 pandemic, most research has focused on the acute phase of COVID-19, yet some people experience symptoms beyond, referred to as post COVID-19 conditions (PCC). However, evidence on PCC and its impacts on health-related quality of life (HRQoL) is still scarce. This study aimed to assess the impact of COVID-19 and PCC on HRQoL. METHODS: This is a longitudinal cohort study of the Belgian adult population with recent SARS-CoV-2 infection. In total, 5,727 people were followed up between the time of their infection and three months later. HRQoL was measured with the EQ-5D-5L questionnaire before and during the infection and three months later. Linear mixed regression models were built to assess the longitudinal association between participants' characteristics and the evolution of their HRQoL. RESULTS: This study found a significant decline in HRQoL during the SARS-CoV-2 infection in comparison to the situation before (ß=-9.91, 95%CI=-10.13;-9.85), but no clinically important difference three months after the infection compared to the situation before, except among people reporting PCC (ß=-11.15, 95%CI=-11.72;-10.51). The main symptoms of PCC with a significant negative impact on the different dimensions of HRQoL were fatigue/exhaustion (21%), headache (11%), memory problems (10%), shortness of breath (9%), and joint (7%) or muscle pain (6%). The dimension of HRQoL most negatively affected by several PCC symptoms was pain/discomfort. CONCLUSIONS: With the growing number of people infected with SARS-CoV-2, PCC and its impact on HRQoL are becoming important public health issues. To allow people with PCC to recover and to limit its detrimental impact on HRQoL, it is essential to manage its various heterogeneous symptoms using a multidisciplinary approach.

The direct disease burden of COVID-19 in Belgium in 2020 and 2021.

BACKGROUND: Burden of disease estimates have become important population health metrics over the past decade to measure losses in health. In Belgium, the disease burden caused by COVID-19 has not yet been estimated, although COVID-19 has emerged as one of the most important diseases. Therefore, the current study aims to estimate the direct COVID-19 burden in Belgium, observed despite policy interventions, during 2020 and 2021, and compare it to the burden from other causes. METHODS: Disability-adjusted life years (DALYs) are the sum of Years Lived with Disability (YLDs) and Years of Life Lost (YLLs) due to disease. DALYs allow comparing the burden of disease between countries, diseases, and over time. We used the European Burden of Disease Network consensus disease model for COVID-19 to estimate DALYs related to COVID-19. Estimates of person-years for (a) acute non-fatal disease states were calculated from a compartmental model, using Belgian seroprevalence, social contact, hospital, and intensive care admission data, (b) deaths were sourced from the national COVID-19 mortality surveillance, and (c) chronic post-acute disease states were derived from a Belgian cohort study. RESULTS: In 2020, the total number of COVID-19 related DALYs was estimated at 253,577 [252,541 - 254,739], which is higher than in 2021, when it was 139,281 [136,704 - 142,306]. The observed COVID-19 burden was largely borne by the elderly, and over 90% of the burden was attributable to premature mortality (i.e., YLLs). In younger people, morbidity (i.e., YLD) contributed relatively more to the DALYs, especially in 2021, when vaccination was rolled out. Morbidity was mainly attributable to long-lasting post-acute symptoms. CONCLUSION: COVID-19 had a substantial impact on population health in Belgium, especially in 2020, when COVID-19 would have been the main cause of disease burden if all other causes had maintained their 2019 level.

The non-fatal burden of cancer in Belgium, 2004-2019: a nationwide registry-based study.

BACKGROUND: The importance of assessing and monitoring the health status of a population has grown in the last decades. Consistent and high quality data on the morbidity and mortality impact of a disease represent the key element for this assessment. Being increasingly used in global and national burden of diseases (BoD) studies, the Disability-Adjusted Life Year (DALY) is an indicator that combines healthy life years lost due to living with disease (Years Lived with Disability; YLD) and due to dying prematurely (Years of Life Lost; YLL). As a step towards a comprehensive national burden of disease study, this study aims to estimate the non-fatal burden of cancer in Belgium using national data. METHODS: We estimated the Belgian cancer burden from 2004 to 2019 in terms of YLD, using national population-based cancer registry data and international disease models. We developed a microsimulation model to translate incidence- into prevalence-based estimates, and used expert elicitation to integrate the long-term impact of increased disability due to surgical treatment. RESULTS: The age-standardized non-fatal burden of cancer increased from 2004 to 2019 by 6 and 3% respectively for incidence- and prevalence-based YLDs. In 2019, in Belgium, breast cancer had the highest morbidity impact among women, followed by colorectal and non-melanoma skin cancer. Among men, prostate cancer had the highest morbidity impact, followed by colorectal and non-melanoma skin cancer. Between 2004 and 2019, non-melanoma skin cancer significantly increased for both sexes in terms of age-standardized incidence-based YLD per 100,000, from 49 to 111 for men and from 15 to 44 for women. Important decreases were seen for colorectal cancer for both sexes in terms of age-standardized incidence-based YLD per 100,000, from 105 to 84 for men and from 66 to 58 for women. CONCLUSIONS: Breast and prostate cancers represent the greatest proportion of cancer morbidity, while for both sexes the morbidity burden of skin cancer has shown an important increase from 2004 onwards. Integrating the current study in the Belgian national burden of disease study will allow monitoring of the burden of cancer over time, highlighting new trends and assessing the impact of public health policies.

Past, present, and future trends of overweight and obesity in Belgium using Bayesian age-period-cohort models.

BACKGROUND: Overweight and obesity are one of the most significant risk factors of the twenty-first century related to an increased risk in the occurrence of non-communicable diseases and associated increased healthcare costs. To estimate the future impact of overweight, the current study aimed to project the prevalence of overweight and obesity to the year 2030 in Belgium using a Bayesian age-period-cohort (APC) model, supporting policy planning. METHODS: Height and weight of 58,369 adults aged 18+ years, collected in six consecutive cross-sectional health interview surveys between 1997 and 2018, were evaluated. Criteria used for overweight and obesity were defined as body mass index (BMI) ≥ 25, and BMI ≥ 30. Past trends and projections were estimated with a Bayesian hierarchical APC model. RESULTS: The prevalence of overweight and obesity has increased between 1997 and 2018 in both men and women, whereby the highest prevalence was observed in the middle-aged group. It is likely that a further increase in the prevalence of obesity will be seen by 2030 with a probability of 84.1% for an increase in cases among men and 56.0% for an increase in cases among women. For overweight, it is likely to see an increase in cases in women (57.4%), while a steady state in cases among men is likely. A prevalence of 52.3% [21.2%; 83.2%] for overweight, and 27.6% [9.9%; 57.4%] for obesity will likely be achieved in 2030 among men. Among women, a prevalence of 49,1% [7,3%; 90,9%] for overweight, and 17,2% [2,5%; 61,8%] for obesity is most likely. CONCLUSIONS: Our projections show that the WHO target to halt obesity by 2025 will most likely not be achieved. There is an urgent necessity for policy makers to implement effective prevent policies and other strategies in people who are at risk for developing overweight and/or obesity.

Meaningful activities during COVID-19 lockdown and association with mental health in Belgian adults.

BACKGROUND: The spread of COVID-19 has affected people's daily lives, and the lockdown may have led to a disruption of daily activities and a decrease of people's mental health. AIM: To identify correlates of adults' mental health during the COVID-19 lockdown in Belgium and to assess the role of meaningful activities in particular. METHODS: A cross-sectional web survey for assessing mental health (General Health Questionnaire), resilience (Connor-Davidson Resilience Scale), meaning in activities (Engagement in Meaningful Activities Survey), and demographics was conducted during the first Belgian lockdown between April 24 and May 4, 2020. The lockdown consisted of closing schools, non-essential shops, and recreational settings, employees worked from home or were technically unemployed, and it was forbidden to undertake social activities. Every adult who had access to the internet and lived in Belgium could participate in the survey; respondents were recruited online through social media and e-mails. Hierarchical linear regression was used to identify key correlates. RESULTS: Participants (N = 1781) reported low mental health (M = 14.85/36). In total, 42.4% of the variance in mental health could be explained by variables such as gender, having children, living space, marital status, health condition, and resilience (ß = -.33). Loss of meaningful activities was strongly related to mental health (ß = -.36) and explained 9% incremental variance (R2 change = .092, p < .001) above control variables. CONCLUSIONS: The extent of performing meaningful activities during the COVID-19 lockdown in Belgium was positively related to adults' mental health. Insights from this study can be taken into account during future lockdown measures in case of pandemics.

Does Pain Neuroscience Education and Cognition-Targeted Motor Control Training Improve Cervical Motor Output? Secondary Analysis of a Randomized Clinical Trial.

BACKGROUND: In the context of interventions aimed at reducing pain, disability, and maladaptive pain cognitions in chronic neck pain, it is hypothesized that patients who have greater symptom reduction possibly also demonstrate greater improvement in cervical motor output. Therefore, the aim of this study was to examine the effect of pain neuroscience education plus cognition-targeted motor control training on cervical motor output. METHODS: Impairments in cervical motor output were measured in 64 subjects with chronic neck pain using standardized tests. Cervical muscle strength, cervical mobility, balance, and cervical neuromuscular control were derived. To assess the differences between groups in response to treatment, a random-intercept linear mixed-models analysis, applying a diagonal covariance matrix, was used. RESULTS: A significant treatment × time interaction effect was found for neuromuscular control of the deep cervical flexors, favoring the experimental treatment at 3 months' follow-up (mean group difference: 1.982; 95% confidence interval 0.779, 3.185; large effect size d = 0.82). Significant main effects of time were found for the neuromuscular capacity of scapulothoracic muscles and for cervical mobility. No significant effects were found for balance, cervical muscle strength, or endurance of cervical flexors. CONCLUSION: Pain neuroscience education combined with cognition-targeted motor control training is not more effective than biomedically focused education and exercise therapy for improving cervical motor output in people with chronic neck pain. Our findings question the relative importance of factors such as pain, disability, and maladaptive pain cognitions on cervical motor output and the need to address it in treatment.

Associations between brain morphology and motor performance in chronic neck pain: A whole-brain surface-based morphometry approach.

Changes in brain morphology are hypothesized to be an underlying process that drive the widespread pain and motor impairment in patients with chronic neck pain. However, no earlier research assessed whole-brain cortical morphology in these patients. This case-control study assesses group-differences in whole-brain morphology between female healthy controls (HC; n = 34), and female patients with chronic idiopathic neck pain (CINP; n = 37) and whiplash-associated disorders (CWAD; n = 39). Additionally, the associations between whole-brain morphology and motor performance including balance, strength, and neuromuscular control were assessed. Cortical volume, thickness, and surface area were derived from high resolution T1-weighted images. T2*-weighted images were obtained to exclude traumatic brain injury. Vertex-wise general-linear-model-analysis revealed cortical thickening in the left precuneus and increased volume in the left superior parietal gyrus of patients with CINP compared to HC, and cortical thickening of the left superior parietal gyrus compared to HC and CWAD. Patients with CWAD showed a smaller cortical volume in the right precentral and superior temporal gyrus compared to HC. ANCOVA-analysis revealed worse neuromuscular control in CWAD compared to HC and CINP, and in CINP compared to HC. Patients with CWAD showed decreased levels of strength and sway area compared to CINP and HC. Partial correlation analysis revealed significant associations between the volume of the precentral gyrus, and neuromuscular control and strength together with an association between the volume of the superior temporal gyrus and strength. Our results emphasize the role of altered gray matter alterations in women with chronic neck pain, and its association with pain and motor impairment.

The Belgian physiotherapy reimbursement criteria for fall prevention fails in screening appropriately fall-prone community-dwelling older adults.

OBJECTIVES: The incidence of falling in older adults has remained unchanged over the past decades, despite evidence-based prevention initiatives. Therefore, it is appropriate to reflect on the current screening approach for preventive initiatives. The objective of this study was to determine whether the multifactorial algorithm proposed by Lusardi et al. (2017) exhibits superior predictive validity compared to the currently employed algorithm by the Belgian National Institute for Health and Disability Insurance (NIHDI). METHODS: The current study includes a secondary analysis of data collected from a falls-related study in the Department of Rehabilitation Sciences at Ghent University to compare the predictive validity of the two algorithms. Sensitivity, specificity, positive and negative predictive value and area under the curve (AUC) were calculated to ascertain which algorithm is more accurate. RESULTS: The database included a total of 94 community-dwelling older adults (mean age 76 years ±7.4, 35% male). Thirty-nine participants experienced at least one fall in the 8 month follow up. Lusardi's approach has a higher sensitivity score (89.7% compared to 10.3%) and negative predictive value (89.9% compared to 61.1%), but a lower specificity score (61.8% compared to 100%) and positive predictive value (62.2% compared to 100%) than the NIHDI approach. The AUC is 0.76 for Lusardi's approach and 0.55 for the NIHDI approach. CONCLUSION: The use of the multifactorial algorithm proposed by Lusardi et al. may be significant and more accurate in identifying adults at risk to falls. Further research is needed particularly with a larger, more heterogenous group of older adults.

Rising socioeconomic disparities in childhood overweight and obesity in Belgium.

BACKGROUND: Childhood overweight, especially obesity, significantly impacts children's health and poses an increased risk of adult-onset diseases. This study aims to analyse the evolution of childhood overweight and obesity in Belgium from 1997 to 2018 and assess its variation across parental socioeconomic status (SES). METHODS: The Health Interview Survey, a cross-sectional survey representative of the Belgian population, has been conducted since 1997, with the latest survey conducted in 2018. This study focuses on children aged 2-17 years. Body Mass Index (BMI, kg/m²) was derived from self-reported data, supplemented with proxy reports for children under 15 years old. Overweight and obesity were classified using age/sex-specific cut-off points. Highest parental educational level served as the indicator of SES. In addition to reporting the overall prevalence and the 95% confidence interval (95%CI) of childhood overweight and obesity by year, this study examines the absolute difference in prevalence between SES groups (low minus high) and calculates the Odds Ratio (OR, adjusted for age and sex) to evaluate the relative difference. RESULTS: The overall prevalence of childhood overweight rose from 13.6% (95%CI = 11.2-16.1%) in 1997 to 18.9% (95%CI = 16.3-21.5%) in 2018; while it remained stable for obesity, fluctuating between 5.4% and 6.3% over the same period. This increase was more pronounced among children with low SES compared to those with high SES. Consequently, the absolute difference between children with low and high SES increased over time from 8.0% points (pp) in 1997 to 14.9 pp in 2018 for overweight, and from 3.1 pp to 6.8 pp for obesity. In terms of relative inequalities, overall, children with low SES exhibited significantly higher odds of overweight and of obesity than those with high SES (OR varying between 2 à 3 for overweight and between 2 and 4 for obesity). CONCLUSIONS: The escalating disparities over time highlight SES as a significant risk factor for childhood overweight and obesity. Addressing these inequalities requires interventions such as providing healthy meals and increasing sports opportunities at school. Additionally, it is recommended to regulate fast food outlets near schools and limit unhealthy food marketing, particularly because children with low SES are more exposed to such influences.

Assessing mental health from registry data: What is the best proxy?

OBJECTIVE: Medical registries frequently underestimate the prevalence of health problems compared with surveys. This study aimed to determine the registry variables that can serve as a proxy for variables studied in a mental health survey. MATERIALS AND METHODS: Prevalences of depressive symptoms, anxiety and psychoactive medication use from the 2018 Belgian Health Interview Survey (HIS) were compared with same-year prevalences from INTEGO, a Belgian primary care registry. Participants aged 15 and above were included. We assessed correlation using Spearman's rho (SR), and agreement using the intraclass correlation coefficient (ICC). We also calculated the limits of agreement (LOAs) for each comparison. HIS questions about depressive symptoms, anxiety and psychoactive medication use were compared with the following variables from INTEGO: symptom codes, diagnosis codes, free text, antidepressant/benzodiazepine prescriptions and the combinations symptom + diagnosis codes and symptom + diagnosis codes + free text, wherever relevant. RESULTS AND DISCUSSION: Correlation between the HIS and INTEGO was generally high, except for anxiety. Agreement ranged from fair to poor, but increased when combining certain variables, by including free text, or by increasing the prescription frequency to resemble chronic use. Agreement remained poor when comparing questions about anxiety. Prevalences from INTEGO were mostly underestimates. CONCLUSION: The external validity of medical registries can be poor, especially compared with survey data. A considerate choice of variables and prescription chronicity is needed to accurately use a registry as a surveillance tool for mental health.

Suffering from chronic tinnitus, chronic neck pain, or both: Does it impact the presence of signs and symptoms of central sensitization?

Chronic subjective tinnitus is a prevalent symptom, which has many similarities with chronic pain. Central sensitization is considered as a possible underlying mechanism of both symptoms. Central sensitization has already been investigated in chronic pain populations but not in patients with chronic subjective tinnitus. Therefore, the main objective of this cross-sectional study was to compare signs and symptoms, indicative for central sensitization, in tinnitus patients with and without chronic idiopathic neck pain, patients with chronic idiopathic neck pain only, and healthy controls. Also, differences in psychological and lifestyle factors, possibly influencing the association between central sensitization and tinnitus, were examined as well as correlations between signs and symptoms of central sensitization, and tinnitus, pain, psychological and lifestyle factors. Differences in signs and symptoms of central sensitization were examined using the self-report Central Sensitization Inventory and QST protocol (local and distant mechanical and heat hyperalgesia, conditioned pain modulation). Tinnitus, pain, psychological and lifestyle factors were evaluated using self-report questionnaires. Symptoms of central sensitization and local mechanical hyperalgesia were significantly more present in both tinnitus groups, compared to healthy controls, but were most extensive in the group with chronic tinnitus+chronic idiopathic neck pain. Distant mechanical hyperalgesia, indicative for central sensitization, was only observed in the group with both chronic tinnitus+chronic idiopathic neck pain. This group also displayed a significantly higher psychological burden and poorer sleep than patients with chronic tinnitus only and healthy controls. Signs and symptoms of central sensitization were also shown to be associated with tinnitus impact, pain-related disability, psychological burden and sleep disturbances. This study shows preliminary evidence for the presence of central sensitization in patients with chronic tinnitus+chronic idiopathic neck pain. This could be explained by the higher perceived tinnitus impact, psychological burden and sleep problems in this group. Trial registration: This study is registered as NCT05186259 (www.clinicaltrials.gov).

Measurement properties of a computer adaptive device, the Senscoordination 3D Cervical Trainer, to assess cervical range of motion in people with neck pain.

INTRODUCTION: Clinicians commonly assess cervical range of motion (ROM) in patients with neck pain. Recently, a new instrument has been developed, the Senscoordination 3D Cervical Trainer (SCT), designed to measure neck ROM in addition to joint position error, static and dynamic balance performance, and performance on a 'neuro muscular control test'. This study aims to assess the interrater reliability, concurrent validity, and responsiveness of the SCT using the CROM device as a comparator. METHODS: One hundred patients with non-specific neck pain were included and their active cervical ROM was measured in a random order by two raters in succession using both devices simultaneously at baseline and after personalised physiotherapy management, at 12 week follow up. Convergent validity and responsiveness were quantified by a Pearson correlation coefficient. The intraclass correlation coefficient (ICC) was used to calculate the test-retest reliability of the SCT. The smallest detectable change (SDC) was calculated per movement direction and for the total range of motion. RESULTS: The correlation between the measures obtained with the CROM device and the SCT was high (0.97 or 0.98 depending on direction of movement). Interrater reliability was high for all directions (ICC ranging from 0.81 to 0.97). The SDC ranged from 6.9 for left cervical rotation to 12.2 for right cervical rotation. At the follow up, correlation between the change score on the CROM device and the SCT was high (0.86-0.94 depending on the direction of movement). CONCLUSION: The SCT is a valid, reliable and responsive instrument for measuring cervical ROM.

Investigating years of life lost in Belgium, 2004-2019: A comprehensive analysis using a probabilistic redistribution approach.

INTRODUCTION: Information on years of life lost (YLL) due to premature mortality is instrumental to assess the fatal impact of disease and necessary for the calculation of Belgian disability-adjusted life years (DALYs). This study presents a novel method to reallocate causes of death data. MATERIALS AND METHODS: Causes of death data are provided by Statistics Belgium (Statbel). First, the specific ICD-10 codes that define the underlying cause of death are mapped to the GBD cause list. Second, ill-defined deaths (IDDs) are redistributed to specific ICD-10 codes. A four-step probabilistic redistribution was developed to fit the Belgian context: redistribution using predefined ICD codes, redistribution using multiple causes of death data, internal redistribution, and redistribution to all causes. Finally, we used the GBD 2019 reference life table to calculate Standard Expected Years of Life Lost (SEYLL). RESULTS: In Belgium, between 2004 and 2019, IDDs increased from 31 to 34% of all deaths. The majority was redistributed using predefined ICD codes (14-15%), followed by the redistribution using multiple causes of death data (10-12%). The total number of SEYLL decreased from 1.83 to 1.73 million per year. In 2019, the top cause of SEYLL was lung cancer with a share of 8.5%, followed by ischemic heart disease (8.1%) and Alzheimer's disease and other dementias (5.7%). All results are available in an online tool https://burden.sciensano.be/shiny/mortality2019/ . CONCLUSION: The redistribution process assigned a specific cause of death to all deaths in Belgium, making it possible to investigate the full mortality burden for the first time. A large number of estimates were produced to estimate SEYLL by age, sex, and region for a large number of causes of death and every year between 2004 and 2019. These estimates are important stepping stones for future investigations on Disability-Adjusted Life Years (DALYs) in Belgium.

Upstream Determinants of Overweight and Obesity in Europe.

PURPOSE OF REVIEW: To review the upstream determinants of overweight and obesity in Europe, including food and built environments, and political, commercial, and socioeconomic determinants. RECENT FINDINGS: Overweight and obesity affect 60% of European adults, and one in three children, and are more common in individuals with low compared to high socioeconomic position (SEP). Individuals in low SEP groups are more exposed to unhealthy built and food environments, including higher exposure to unhealthy food marketing. Industries influencing the food system have much economic power, resulting in ignoring or silencing the role of ultra-processed foods and commercial practices in weight gain. Overall, effective policies to address overweight and obesity have been insufficiently implemented by governments. To accelerate implementation, strengthened political commitment is essential. Policies must also focus on the upstream, structural, and systemic drivers of overweight and obesity; be comprehensive; and target socioeconomic inequalities in diets and physical activity.

Certainty of the Global Burden of Disease 2019 Modelled Prevalence Estimates for Musculoskeletal Conditions: A Meta-Epidemiological Study.

Objectives: To describe and assess the risk of bias of the primary input studies that underpinned the Global Burden of Disease Study (GBD) 2019 modelled prevalence estimates of low back pain (LBP), neck pain (NP), and knee osteoarthritis (OA), from Australia, Brazil, Canada, Spain, and Switzerland. To evaluate the certainty of the GBD modelled prevalence evidence. Methods: Primary studies were identified using the GBD Data Input Sources Tool and their risk of bias was assessed using a validated tool. We rated the certainty of modelled prevalence estimates based on the GRADE Guidelines 30-the GRADE approach for modelled evidence. Results: Seventy-two primary studies (LBP: 67, NP: 2, knee OA: 3) underpinned the GBD estimates. Most studies had limited representativeness of their study populations, used suboptimal case definitions and applied assessment instruments with unknown psychometric properties. The certainty of modelled prevalence estimates was low, mainly due to risk of bias and indirectness. Conclusion: Beyond the risk of bias of primary input studies for LBP, NP, and knee OA in GBD 2019, the certainty of country-specific modelled prevalence estimates still have room for improvement.

Remarkable fungal biodiversity on northern Belgium bats and hibernacula.

Bats can be affected by fungal pathogens such as Pseudogymnoascus destructans, the causative agent of the white-nose syndrome. Their body surface can also be colonized by fungal commensals or carry transient fungal species and participate in their dispersal. In this study, 114 bat specimens belonging to seven species were sampled from various locations in northern Belgium. Culture-based methods revealed an important mycological diversity, with a total of 209 different taxa out of the 418 isolates. Overall, a mean of 3.7 taxa per bat was recorded, but significant differences were observed between sampling sites and seasons. The mycobiomes were dominated by cosmopolitan and plant-associated species, in particular from the genera Cladosporium, Penicillium, and Aspergillus. Other species known to be related to bats or their environment, such as Apiotrichum otae, were also retrieved. Sampling of hibernacula indicated that diverse fungal species can inhabit these sites, including a yet undescribed Pseudogymnoascus species, distinct from Ps. destructans, namely, Ps. cavicola.