A mixed method study design to explore the adherence of haematological cancer patients to oral anticancer medication in a multilingual and multicultural outpatient setting: The MADESIO protocol.

BACKGROUND: Patients with haematologic malignancies are increasingly treated by oral anticancer medications, heightening the challenge of ensuring optimal adherence to treatment. However, except for chronic myelogenous leukaemia or acute lymphoid leukaemia, the extent of non-adherence has rarely been investigated in outpatient settings, particularly for migrant population. With growing numbers of migrants in Belgium, identifying potential differences in drug use is essential. Also, previous research regarding social determinants of health highlight important disparities for migrant population. Difficulties in communication between health caregivers and patients from different cultural and ethnic backgrounds has been underlined. METHODS: Using a sequential mixed method design, the MADESIO protocol explores the adherence to oral anticancer medications in patients with haematological malignancies and among first and second generation migrants of varied origin. Conducted in the ambulatory setting, a first quantitative strand will measure adherence rates and associated risk factors in two sub-groups of patients with haematological malignancies (group A: first and second generation migrants and group B: non-migrants). The second qualitative strand of this study uses semi-structured interviews to address address the patients' subjective meanings and understand the statistical associations observed in the quantitative study (strand one). MADESIO aims to provide a first assessment of whether and why migrants constitute a population at risk concerning adherence to oral anticancer medications. DISCUSSION: Our protocol is designed to provide a comprehensive understanding of adherence in a specific population. The methodological choices applied allow to explore adherence among patients from diverse linguistic and cultural backgrounds. A particular emphasis has been paid to minimize the biases and increase the reliability of the data collected. Easily reproductible, the MADESIO design may help healthcare services to screen adherence to Oral anticancer medications and to guide providers in choosing the best strategies to address medication adherence of migrants or minority diverse population.

Breast cancer by migrant background in Belgium: Lower risk, but worse survival in women of non-European origin.

Foreign and native populations differ in terms of breast cancer outcomes. Studies rarely distinguish between premenopausal and postmenopausal breast cancer, although the risk profile is different; nor between migrants of the first and second generation (FG and SG), which is crucial to examine genetic and environmental influences on breast cancer. This research fills these gaps by investigating patterns in breast cancer incidence and survival in different migrant groups by menopausal and migrant generational status, taking various risk factors into account. To this end, individually linked data from the 2001 census, the Belgian Cancer Registry and the Crossroads Bank for Social Security are used. Age-standardised incidence rates and incidence rate ratios are calculated by migrant background group, stratified according to ages 30-50 (premenopausal) and 50-70 (postmenopausal). Incidence rate ratios are examined with and without taking reproductive factors and socioeconomic position (SEP) into account. Relative survival percentages and relative excess risks of dying among premenopausal and postmenopausal patients are computed with and without controlling for the stage at diagnosis and SEP. Premenopausal breast cancer is further examined by migrant generational status. Breast cancer incidence is lower among non-European migrants compared to Belgians. Keeping SEP and known risk factors constant reduces much, but not all of the observed discrepancies. A risk convergence between SG migrants and Belgians for the development of premenopausal breast cancer is observed. Premenopausal breast cancer survival is worse among Moroccan patients due to a higher stage at diagnosis. This disadvantage is concentrated in the FG.

A social network analysis of substance use among immigrant adolescents in six European cities.

BACKGROUND: Social integration and the health of adolescents with a migration background is a major concern in multicultural societies. The literature, however, has paid little attention to the wider determinants of their health behaviours, including the composition of their social networks. The aim of this study was to describe the composition of adolescents' social networks according to migration background, and to examine how social networks are associated with substance use. METHOD: In 2013, the SILNE study surveyed 11,015 secondary-school adolescents in 50 schools in six European cities in Belgium, Finland, Germany, Italy, the Netherlands, and Portugal, using a social network design. Each adolescent nominated up to five of their best and closest friends. Migration status was defined as first-generation migrants, second-generation migrants, and speaking another language at home. We computed two groups of network structural positions, the centrality of individual adolescents in networks, and the homophily of their social ties regarding migration (same-migration). Multilevel logistic regression was used to model the association between network structural position and smoking, alcohol use, and cannabis use. RESULTS: Compared with non-migrant adolescents, adolescents with migration backgrounds had similar relationship patterns. But almost half their social ties were with same-migration-background adolescents; non-migrants had few social ties to migrants. For adolescents with a migration background, a higher proportion of social ties with non-migrants was associated with increased use of cannabis (OR = 1.07, p = 0.03) and alcohol (OR = 1.08, p < 0.01), but not with increased smoking (p = 0.60). Popular migrant adolescents were at less risk of smoking, alcohol use, and cannabis use than popular non-migrant adolescents. CONCLUSION: Homophily of social ties by migration background is noticeable in European schools. The tendency of migrant adolescents to have same-migration social ties may isolate them from non-migrant adolescents, but also reduces their risky health behaviours, in particular cannabis and alcohol use.

Spinocerebellar ataxia type 10 in the South of Brazil: the Amerindian-Belgian connection / Ataxia espinocerebelar tipo 10 no sul do Brasil: a conexão Ameríndia-Belga

Spinocerebellar ataxia type 10 (SCA10) is a rare form of autosomal dominant ataxia found predominantly in patients from Latin America with Amerindian ancestry. The authors report the history of SCA10 families from the south of Brazil (the states of Paraná and Santa Catarina), emphasizing the Belgian-Amerindian connection.

A ataxia espinocerebellar tipo 10 (AEC10) é uma forma rara de ataxia cerebelar autossômica dominante, encontrada predominantemente em pacientes da América Latina, de origem Ameríndia. Os autores relatam a história de famílias com AEC10 do sul do Brasil (estados do Paraná e Santa Catarina), enfatizando a conexão Ameríndia-Belga.

Comparison of the clinical expression of patients with ankylosing spondylitis from Europe and Latin America.

OBJECTIVE: To compare the clinical, demographic, and serologic characteristics and the treatment of patients diagnosed with ankylosing spondylitis (AS) from Europe (EU) and Latin America (LA). METHODS: We included 3439 patients from national registries: the Spanish Registry of Spondyloarthritis (REGISPONSER), the Belgian registry (ASPECT), and the Latin American Registry of Spondyloarthropathies (RESPONDIA). We selected patients with diagnosis of AS who met the modified New York classification criteria. Demographic, clinical, disease activity, functional, and metrological measurement data were recorded. Current treatment was recorded. The population was classified into 2 groups: patients with disease duration < 10 years and those with disease duration ≥ 10 years. A descriptive and comparative analysis of variables of both groups was carried out. RESULTS: There were 2356 patients in EU group and 1083 in LA group. Prevalence of HLA-B27 was 71% in LA group and 83% in EU group (p < 0.001). We found a greater frequency of peripheral arthritis and enthesitis (p < 0.001) in the LA population; prevalence of arthritis was 57% in LA and 42% in EU, and for enthesitis, 54% and 38%. Except for treatment with anti-tumor necrosis factor (anti-TNF), the use of nonsteroidal antiinflammatory drugs (NSAID), corticosteroids, and disease-modifying antirheumatic drugs (DMARD), and the association of anti-TNF and methotrexate use showed a significant difference (p < 0.001) in the 2 populations. CONCLUSION: The principal differences in the clinical manifestations of patients with AS from EU and LA were the greater frequency of peripheral arthritis and enthesitis in LA group, the higher percentage of HLA-B27 in EU group, and the form of treatment, with a greater use of NSAID, steroids, and DMARD in the LA group.

Decline in breast cancer incidence in the Flemish region of Belgium after a decline in hormonal replacement therapy.

BACKGROUND: Breast cancer incidence rate in Belgian women was as high as 152.7 for 100 000 in 2003 (adjusted on European population). We made an estimation of the contribution of hormone replacement therapy (HRT) on breast cancer incidence from 1999 to 2005 in women aged 50-69 years in Flanders. METHODS: Breast cancer data were extracted from the Belgium Cancer Registry. Drug consumption was computed from drug sales data. The fraction of breast cancers attributable to HRT was calculated by year, using the relative risks of the Million Women Study in the UK. RESULTS: The proportion of women aged 50-69 years using HRT in Flanders increased since 1992, peaked at 20% in 2001, then decreased to 8% in 2008. The incidence of breast cancer in 100 000 women aged 50-69 years in Flanders increased from 332.8 in 1999 to 407.9 in 2003, then decreased to 366.1 in 2005; the variations were mostly noticeable for tumors <20 mm in size. The fraction of breast cancers attributed to HRT peaked at 11% in 2001 and decreased afterward. CONCLUSION: The high level of breast cancer observed in the years 2001-2003 in Flanders can be partly attributed to the use of HRT. Since participation to mammography screening of Flemish women aged 50-69 years was still on the rise in 2003 and never exceeds 62%, the decrease in breast cancer incidence was likely to be due to the decrease in HRT use and not to screening saturation.

Vitamin D deficiency and hyperparathyroidism in relation to ethnicity: a cross-sectional survey in healthy adults.

BACKGROUND: The study of vitamin D status at population level gained relevance since vitamin D deficiency was recently suggested to trigger chronic disease. AIM OF THE STUDY: We aimed to describe vitamin D status, its association with bone and mineral metabolism and risk factors for deficiency in adults over 40 years in Belgium. METHODS: We conducted a cross-sectional survey in a stratified random sample of 401 subjects aged between 40 and 60 years living in Brussels, and drawn from 4 different ethnic backgrounds: autochthonous Belgian, Moroccan, Turkish and Congolese. 25-Hydroxyvitamin D (25OHD), parathyroid hormone (PTH), osteocalcin, C-telopeptide and bone mineral density was measured. RESULTS: Three-hundred and six subjects (77%) showed 25OHD concentrations below 50 nmol/l,135 (34%) below 25 nmol/l and 18 (5%) below 12.5 nmol/l. The proportion of subjects with vitamin D deficiency was four times greater amongst those of Moroccan or Turkish descent compared with those of Congolese or Belgian descent. Moroccan subjects showed a significant higher PTH and bone marker concentrations compared to Belgian. Ethnicity, season and sex were independently associated with vitamin D deficiency in multivariate analysis. CONCLUSION: The prevalence of vitamin D deficiency is very high amongst the adult population of Brussels but immigrants are at greater risk. Given the established link between population health and adequate vitamin D status, a policy of vitamin D supplementation should be considered in these risk groups.

Clinical, biophysical and biochemical variables from African-heritage subjects with type 2 diabetes.

We compared the metabolic profile of two ethnic populations with type 2 diabetes, one from Bantu (n = 23; Ban) and the other from Belgian (n = 314) extraction followed at St Luc Hospital. Further comparison with a Belgian sub-cohort (n = 64; Be) matched for age (52 yrs) and sex distribution (M/F: 61/39%) showed no significant difference between Belgian and Bantu subjects with regards to diabetes duration (9 and 11 yrs; Ban and Be respectively), age at diabetes diagnosis (43 and 42 yrs), HbA1c (8.1 +/- 1.9 vs. 8.5 +/- 1.9%; NS), and achieved education level. BMI was lower in Ban (29 +/- 4 vs. 32 +/- 7 in Be; p < 0.02), as were body fat (33 +/- 12 vs. 37 +/- 11 kg; NS) and waist diameter (99 +/- 9 vs. 106 +/- 16 cm; p < 0.02). Forty-eight and 72% of Ban and Be were on metformin (p < 0.05), while insulin was given to 39 and 34%. Daily insulin dose was lower in Ban (0.31 +/- 0.20 vs. 0.47 +/- 0.18 IU.kg-1.24 h-1; p < 0.001). There was no difference in beta-cell function (% beta; normal: 100%) or insulin sensitivity (%S; normal: 100%) as determined with HOMA between groups. % beta (median [perc 25-75]) was 51 [23-119] and 67 [45-84] in Ban and Be, while %S was 32 [29-37] and 37 [27-45]. Smoking (past & current) prevalence was 5 and 47% in Ban and Be (p < 0.0001). Prevalence of micro- and macroangiopathy did not differ between groups, although Ban had more macroalbuminuria (29 vs. 9%; p < 0.05), and were more often treated with Ca(2+)-channel- and beta-blockers than Be subjects (36 and 39% vs. 16 and 8%; p = 0.07 and < 0.05, respectively). Fasting (F) and interprandial (IP) triglycerides (TG) were lower in Ban: 115 [81-149] vs. 189 [155-325] mg.dL-1 for F-TG and 127 [81-160] vs. 170 [128-305] mg.dL-1 for IP-TG (p < 0.0001), as was total cholesterol (201 +/- 53 vs. 223 +/- 40 mg.dL-1 (p < 0.05), despite lower use of hypolipidaemic drug (13 vs. 44%; p < 0.01). African-heritage subjects with type 2 diabetes have similar degree of diabetes control and complications, in the presence of leaner biophysical status, minimal tobacco exposure and lower fasting and interprandial triglycerides.

Isolated polycystic liver disease not linked to polycystic kidney disease 1 and 2.

Autosomal dominant polycystic liver disease occurs commonly in association with autosomal dominant polycystic kidney disease, types 1 and 2. It may also exist as a separate entity, genetically distinct from autosomal dominant polycystic kidney disease types 1 and 2, as has been recently established to exist in a Belgian family. We report here a large Argentinian family of Spanish-Belgian ancestry with autosomal dominant polycystic liver disease, where proximal and distal markers for both polycystic kidney disease 1 and 2 failed to demonstrate genetic linkage. The data support the notion that polycystic liver disease and autosomal dominant polycystic kidney disease may have separate chromosomal loci.

Human T-cell lymphotropic virus type 1 infection and tropical spastic paraparesis in Belgian expatriates.

A case of HTLV-1 associated tropical spastic paraparesis is described in a Belgian nun who had been working as a midwife in Central Africa. Occupational exposure was the only risk factor identified. Among 2,482 Belgian expatriates in tropical countries, 92% of whom had resided in sub-Saharan Africa for an average of 15.5 years, only one Belgian-born man was found seropositive for HTLV-1. He was married to an African woman and living in Central Africa for 23 years. The risk of HTLV-1 infection is low in Belgian expatriates and on its own does not support generalised anti-HTLV screening in autochthonous Belgian blood donors.

African histoplasmosis in a Belgian AIDS patient.

We describe an African histoplasmosis case in a 65-year-old Belgian living in Zaire for 46 years. Microscopic bone marrow examination showed Histoplasma. It was confirmed by cultures and hamster inoculation. Autopsy revealed a fungal dissemination by Histoplasma duboisii.

de la Chapelle dysplasia.

Since the description by de la Chapelle and colleagues of two sibs with a unique skeletal dysplasia, two additional cases have occurred, one in the original Finnish family and one sporadic patient born to unrelated parents of Belgian descent. The original Finnish family has later had a fourth child, a normal daughter who was found to be unaffected upon radiographic examination in the 19th week of gestation. These additional findings are compatible with recessive inheritance. Physical features common to these four patients include cleft palate, small thorax, moderately severe micromelia with small hands, and equinovarus deformity. In each case, the ulnae and fibulae were reduced to an almost triangular osseous remnant. Other long bones were short and bowed. Neonatal death occurred in all cases and may be attributed to a consistent triad of respiratory tract malformations: laryngeal stenosis, tracheobronchomalacia, and pulmonary hypoplasia. Clinical and radiographic features are sufficiently unique to distinguish de la Chapelle dysplasia from other disorders in the spectrum of neonatal lethal osteochondrodysplasias. Lacunar halos were identified as a distinctive histopathologic feature also observed in achondrogenesis but not in several other skeletal dysplasias.