[Current level of information about sickle cell disease among medical students at Brussels, Belgium]. / Évaluation du niveau d'information sur la drépanocytose des étudiants en médecine à Bruxelles, Belgique.

AIM: The increasing prevalence of sickle cell disease (SCD) is an important issue in Belgium due to migrations from high prevalence areas. It has become the most common genetic disease in Belgium. The impact is important in terms of health service delivery, especially since Belgian physicians have little experience with the disease. This study was designed to determine the current level of knowledge about SCD among medical students at the Louvain's Catholic University, Brussels. METHOD: This study was part of a larger cross-sectional and descriptive study carried out at the Louvain's Catholic University in December 2010. Data were collected from medical students using self-administered structured questionnaires. RESULTS: In this study, 152 students were enrolled. All respondents had heard about SCD, the majority during their medical school curriculum. All students (100%) thought SCD is an African disease. A majority recognized that SCD is a serious illness and that it is linked with malaria. Anemia was the most frequently cited symptoms (98.0%) followed by splenomegaly (77.5%). Only 51% reported pain as a symptom. A majority knew they would have patients with the disease in their future career but only 2.3% of students considered specializing in the field of SCD. Using criteria for scoring information delivery, awareness about SCD was among the lowest in Belgium. CONCLUSION: For Belgian medical students, SCD is an exotic disease. Too little information about SCD is delivered. Continuing medical education about SCD can be recommended for medical students in Belgium.

Job strain in relation to body mass index: pooled analysis of 160 000 adults from 13 cohort studies.

BACKGROUND: Evidence of an association between job strain and obesity is inconsistent, mostly limited to small-scale studies, and does not distinguish between categories of underweight or obesity subclasses. OBJECTIVES: To examine the association between job strain and body mass index (BMI) in a large adult population. METHODS: We performed a pooled cross-sectional analysis based on individual-level data from 13 European studies resulting in a total of 161 746 participants (49% men, mean age, 43.7 years). Longitudinal analysis with a median follow-up of 4 years was possible for four cohort studies (n = 42 222). RESULTS: A total of 86 429 participants were of normal weight (BMI 18.5-24.9 kg m(-2) ), 2149 were underweight (BMI < 18.5 kg m(-2) ), 56 572 overweight (BMI 25.0-29.9 kg m(-2) ) and 13 523 class I (BMI 30-34.9 kg m(-2) ) and 3073 classes II/III (BMI ≥ 35 kg m(-2) ) obese. In addition, 27 010 (17%) participants reported job strain. In cross-sectional analyses, we found increased odds of job strain amongst underweight [odds ratio 1.12, 95% confidence interval (CI) 1.00-1.25], obese class I (odds ratio 1.07, 95% CI 1.02-1.12) and obese classes II/III participants (odds ratio 1.14, 95% CI 1.01-1.28) as compared with participants of normal weight. In longitudinal analysis, both weight gain and weight loss were related to the onset of job strain during follow-up. CONCLUSIONS: In an analysis of European data, we found both weight gain and weight loss to be associated with the onset of job strain, consistent with a 'U'-shaped cross-sectional association between job strain and BMI. These associations were relatively modest; therefore, it is unlikely that intervention to reduce job strain would be effective in combating obesity at a population level.

[A patient-centered approach to tuberculosis control in Burkina Faso]. / L'approche centrée sur le patient pour la lutte contre la tuberculose au Burkina Faso.

BACKGROUND: The Burkina Faso health system is divided into 55 health districts (DS), each with more than 10 primary care health centers (CSPS) that comprise the first level of the health care system. For this study, we chose two intervention districts (one rural, one urban) and two control districts. OBJECTIVE: To evaluate the impact of the patient-centered approach to tuberculosis control on the detection and treatment of tuberculosis. METHOD: This intervention, defined in a consensus process by various participants in tuberculosis management, was implemented in two districts (one rural and one urban). Study outcomes were measured before and after the intervention in two intervention districts and two control districts. RESULTS: The proportion of patients suspected of tuberculosis who chose sputum sampling in the CSPS was higher in the rural district (Gorom-Gorom) than in the urban one (Pissy): 46% versus 18.7% (p < 0.001). Detection improved more in the intervention than control districts (59% versus 20%). The increase in diagnosis was better in the intervention districts than in their matched control districts (46% versus 5% in the rural district; 75% versus 32% in the urban district). The treatment success rate was better in the rural district's decentralized CSPSs than in its CDTs (Gorom-Gorom) (61.8% vs 52.8%), while the reverse was true in the urban district (Pissy) (75% vs 83.1%). CONCLUSION: Detection of new tuberculosis cases increased throughout this study. Improvement in treatment regularity was limited. A longer intervention is needed to evaluate the effects of this approach on treatment results.

Trends in cannabis use and its determinants among teenagers in the French-speaking community of Belgium.

BACKGROUND: Cannabis consumption among teenagers has undergone dramatic changes in Europe since the beginning of the 1990s. A number of behaviors associated with cannabis consumption, such as tobacco smoking, excessive drinking and truancy are developing too, each in their own way. METHODS: To assess the evolution over time of the various types of cannabis consumption (both ever and weekly consumption) in relation to these determinants (age, sex, studies chosen, truancy, tobacco smoking and recurrent intoxication), we have analyzed the cross-sectional study on Health Behaviour in School-Aged Children in the French-speaking Belgian Community (12-17 years) since 1994. We used logistic models to analyze the evolution of the various types of cannabis consumption and to identify the associated factors. Finally, in order to demonstrate time trends, we tested for each type of consumption in the interactions between the significant predictive variables in each model and the survey year (1994-1998-2000). RESULTS: Rates of ever use, past 30-day use and weekly use among the ever users have been increasing from 1994 to 2002 and reached, respectively, 22.0%, 11.6%, 6.8% and 32.9%. Cannabis ever use rose more noticeably among the general education students (adjusted OR (95%CI)): 3.08 (2.66-3.57) and among the truants: 4.57 (3.39-6.14). Weekly cannabis smoking rose most especially among the truants: 1.92 (1.34-2.78). CONCLUSION: Truants should constitute a priority target for the prevention of cannabis consumption, while the phenomenon of truancy must be moreover examined in depth in order to more thoroughly identify the appropriate prevention programs organized both in and outside of the school environment.

Sexual functioning in a population-based study of men aged 40-69 years: the good news.

The aim of the study was to provide cross-sectional data on age-related sexual functioning of men aged 40-69 y. The study was a randomised age-stratified community-based sample survey. In all, 799 men from two comparable middle-sized areas of Belgium participated in the study. Trained male nurses visited each participant at home and conducted a structured interview during which the participants filled out the International Index of Erectile Function (IIEF). The main outcome measures were scores on the IIEF questionnaire at item level. This study showed that 69% of the sample attempted to have intercourse during the past 4 weeks with an age-related increase in the proportion of sexually inactive men (11% at age 40-49 y; 25% at age 50-59 y; 52% at age 60-69 y; P=0.0001). Almost 90% of sexually active men reported to be able to get and keep an erection until completion of intercourse, to ejaculate with a feeling of orgasm, and reported to be satisfied with their sexual partner relation and their overall sex life. About 75% of sexually active men reported to be (very) highly confident about their erectile functioning. Only 15% of sexually inactive men reported a high to very high frequency and strong to very strong level of sexual desire. Whereas 26% still reported high to very high confidence in their erectile capacity, 34% reported to be moderately to (very) satisfied with their sexual life. This study showed that sexuality still matters at middle to high age and that it deserves to be regarded as an important and continuing aspect of the overall adaptation to getting older.

Psychosocial factors of coronary heart disease in women: a review.

Although coronary heart disease is the leading cause of death in women in most industrialized countries, much less research has been carried out on this topic to date than in men. This article gives an overview of psychosocial factors of coronary heart disease in women, focussing on psychosocial risk factors for coronary heart disease in women such as socioeconomic status, employment status, chronic troubling emotions, social support and bereavement/widowhood. A second focus lies on psychosocial adjustment in women once coronary heart disease has become manifest, i.e. well-being, return to work, sexual activity and rehabilitation outcome after a myocardial infarction or coronary artery bypass grafting. Via a computerized literature research in Medline, Psychlit and Sociofile over the period 1980-1994 all studies on these topics were collected and reviewed. Comparatively more research has been undertaken on psychosocial risk factors for than on psychosocial adjustment to coronary heart disease in women. Low social class, low educational attainment, the double loads of work and family, chronic troubling emotions and lack of social support emerge as documented risk factors in women. Regarding psychosocial adjustment to coronary heart disease in women, there is a paucity of data, and studies including large samples of women and adjusting for gender are warranted. Psychosocial adjustment in women after a myocardial infarction seems to be worse than in men, whereas results on adjustment after coronary artery bypass grafting are inconclusive. Return to work rates after myocardial infarction or coronary artery bypass grafting are significantly lower in women than in men. Data on sexual activity of women after myocardial infarction or coronary artery bypass grafting are scarce, and there seems to be a complete lack of physician counseling on this topic. Studies on rehabilitation outcome report poorer programme uptake, poorer adherence and significantly higher drop-out rates for women than for men, yet those women who complete cardiac rehabilitation show the same or even greater functional improvements than men.

Ischemic heart disease and regional variations of socio-cultural characteristics in Belgium.

Ischemic heart disease (IHD) can be considered as a 'cultural disease'. It is surprising to see how IHD is differentially distributed in Belgium on both sides of the linguistic frontier, with higher prevalence, incidence and mortality rates in the South as compared to the North. Therefore, various socio-cultural characteristics have been under investigation in two samples of middle-aged men, in order to determine the most discriminative ones, according to the subjects' cultural belonging. The largest differences are found in the professional activities area, suggesting that stress related to profession might be responsible for the geographical distribution of the disease.

A double blind study of 2 mg versus 4 mg nicotine-gum in an industrial setting.

In a double blind randomised trial to aid smoking cessation a 2 mg nicotine gum (n = 101) was compared with a 4 mg gum (n = 98), in smokers of at least 15 cigarettes/day. The trial involved blue and white collar workers and took place at their working place (industrial setting). Intervention during the one year follow-up period was minimal. At 3 months 36.2% of the 2 mg nicotine gum group reported to have stopped smoking, against 44.8% in the 4 mg group (non-significant difference). At one year in the 2 and 4 mg groups respectively 22.3 and 32.2% reported smoking abstinence (non significant difference). However in a sub-group with a higher nicotine-dependence score, only 18.5% were abstainers at one year in the 2 mg nicotine gum group against 32.9% in the 4 mg nicotine gum, which is a significant difference at the p = 0.05 level. This is however a post-hoc finding and should be taken with caution.

Blood pressure distribution and electrolytes excretion in a sample of the Nepalese population.

This paper presents the distribution of the blood pressure in a sample of 355 Nepalese citizens and the Na+ and K+ content in 180 morning urine spots. The blood pressure distribution suggests that this sample has the characteristics of a "low blood pressure population". The Na+/K+ ratio in the urine spots is relatively high (mean +/- S.D.: 4.6 +/- 3.4). Hypotheses concerning these contradictory findings are proposed.

Prevention of coronary heart disease: health knowledge, health attitude and fat consumption in a random sample of Belgian physicians.

Health knowledge, health attitude and fat consumption has been explored in a random sample of 2150 Belgian physicians below age 71; the response rate was 60.7%. Health knowledge, health attitude and fat consumption are significantly intercorrelated. Comparing general practitioners (G.Ps) to specialists, non significant differences were observed in terms of health knowledge whereas health attitude was more positive in G.Ps who, on the other hand, had a lower saturated fat intake score. Dutch speaking physicians had a higher health knowledge score whereas their fat intake score was significantly lower (less saturated fats) compared to their French counterparts. Differences in eating patterns between the French and Dutch speaking Belgian population are also observed in Belgian physicians.

[Levels of low birth-weight in Europe: registration problems and effects of medical interventions]. / Les taux d'insuffisance pondérale à la naissance en Europe: problèmes d'enregistrement et effets des interventions médicales.

The rate of low birthweight births, percentage of live births weighing less than 2500 grams is one of the perinatal health indicators recommended by the World Health Organisation. A review of the literature has revealed numerous problems related to this indicator. Some countries, including France and the Netherlands do not collect birthweight data. Elsewhere, there are more than 10% "unknown birthweight". The poorest registration is for birthweights below 1000 grams. Exclusion of babies who were registered as stillborn, when in fact they died shortly after birth can cause underregistration of low birthweights. Conversely, inclusion of true stillbirths will bring on an overestimation of low birthweight rate. Some countries have too few births to deliver accurate rates. Rates of medical interventions, such as infertility treatment and elective induction should be taken into account when analyzing differences between countries. Improvement in quality of registration and caution in the use of this indicator are warranted.

[The Belgian Heart Disease Prevention Project (author's transl)]. / Le Projet Belge de Prévention des Affections Cardio-vasculaires.

The Belgian Heart Disease Prevention Project is a controlled multifactorial preventive trial. It is basal on the well-documented epidemiologic notion of major coronary risk-factors: hypercholesterolemia, hypertension, smoking and obesity. This Project has been executed in industries, in males aged 40-59 yrs at the base-line screening. It is part of the WHO European Collaborative Trial including the United-Kingdom, Italy, Poland and Spain. This trial should verify a double work-hypothesis: 1 degree it is possible to modify significantly the coronary risk profile in middle-aged males through a comprehensive intervention program, 2 degrees this modification should, in turn, significantly reduce total mortality as compared to a control group. The authors discuss the pros and cons of a preventive trial in industry and review the numerous problems raised by the difficulties in modifying well-established life-styles as well as those related to the follow-up morbidity and mortality. Final screening took place in 1979-80 and results regarding incidence should be available by 1981.

[Evaluation of technics used to define type 'A' pattern, in the Belgian Prevention Project of cardiovascular diseases (author's transl)]. / Validation de techniques d'évaluation du profil comportemental 'A' utilisées dans le 'Projet Belge de Prévention des affections cardiovasculairs' (P.B.P.)

In order to define the Rosenman and Friedman type A pattern three technics where used: the Bortner scale, the Jenkins Acitivity Survey (J.A.S.) and the interview. These are part of the base-line data recorded during the screening of a belgian male population aged 40 to 59 at entry of a controlled trial for the multifactorial prevention of cardiovascular diseases. The J.A.S. and the Bortner scale are evaluated in relation to the interview. Extremes of type A and B are less prevalent in our study compared to the Western Collaborative Group Study. Both the J.A.S. and the Bortner scale are very satisfactory in predicting type A and B pattern. The Bortner scale predicts the pattern in 78% of the subjects, by the method of weighted scores. The validation of this classification method, on a second sample, gives an accurate classification in 75% of the subjects. The J.A.S. predicts, the pattern in relation to the interview in 78% of the subjects; again the validation of the classification method, on a second sample, gives a correct classification in 70% of the subjects.

Behavioural and psychosocial correlates of nondipping blood pressure pattern among middle-aged men and women at work.

The underlying pathogenetic mechanisms of nondipping blood pressure (BP) pattern are not completely understood. Especially the role of psychosocial correlates remains unclear. The aim was to assess the association between nondipping BP pattern, behavioural and psychosocial factors in a sample of working men and women. The study sample included 167 working men and women aged 40-64 years from the BELSTRESS cohort. Socio-demographic, behavioural and psychosocial factors were assessed by self-administered questionnaires. Participants were medically examined and underwent an ambulatory BP monitoring during 24 h. Nondipping was defined when the average nocturnal decline in BP was <10%. The prevalence of nondipping for both systolic and diastolic BP was 7.8%. Nondipping was not significantly related to smoking, alcohol consumption and leisure time physical activity. A crude significant association was observed between nondipping and sleep problems. After adjusting for gender, education and body mass index, the risk for nondipping was associated with job strain, living alone, being unsatisfied about the contact with one's children, depressive symptoms and vital exhaustion. Nondipping BP pattern was consistently related to psychosocial factors in this study: positive associations were observed with measures of job strain, poor private life support (living alone and being unsatisfied about the contact with one's children) and mental health problems (depressive symptoms and vital exhaustion).