Coping with menopausal symptoms: An internet survey of Belgian postmenopausal women.

OBJECTIVES: An internet survey was performed to obtain data on the current use in Belgium of hormone replacement therapy and alternative treatments for the alleviation of menopausal symptoms. A supplementary aim was to assess the use of opt-in internet opinion panels (TalkToChange, http://www.talktochange.com, and GMI, http://www.gmi-mr.com/global-panel) as a potential new way to obtain data on menopausal issues. STUDY DESIGN: Data were collected via an internet platform from 696 postmenopausal women aged 45-60 years. OUTCOME MEASURES: Respondents were asked questions about their socio-demographic profile, their experience of the menopause, the burden of the menopause, its impact on their quality of life and the treatment of menopausal symptoms (if any). RESULTS: The opt-in internet opinion panels proved a quick way (19days) to obtain reliable information with a low error margin (3.7%). The online survey collected detailed socio-demographic data. Almost all of the women (98%) had heard about the menopause before. Sixty-one percent perceived the menopause as a temporary phase (17% thought it lasted for one or two years and 44% thought it lasted for three to five years) and only 39% realized the menopause would last for the rest of their life. Twenty-three percent of the women reported any kind of impact of the menopause on their quality of life. However, for the other 77% the menopause had resulted in complaints. No differences according to the women's age, level of education or professional status were found in this respect. Sixty-nine percent of the women had 'ever' used some type of treatment for menopausal symptoms and 53% were currently using a treatment. Forty percent of those with more than three symptoms were currently untreated. Of those who were not on hormone replacement therapy (HRT), 61% would not consider taking it (54% were 'strongly opposed' and 7% simply 'opposed'), while 8% would consider asking their doctor for HRT. Among those women who were opposed to HRT, 25% indicated that they were afraid of the increased risk of breast cancer, 34% cited cardiovascular risks and 26% were worried about weight gain. In this Belgian sample, HRT was used significantly more often by French-speaking women (32%) than by Dutch-speaking women (9%) (OR 4.4, p<0.0001). The alternatives to HRT had a high satisfaction rate among users. Relaxation techniques, regular physical activity, acupuncture and avoiding stress had satisfaction rates similar to that with HRT. It was not possible to compare the alternatives in the same women. Nor was it possible to assess whether more pronounced symptoms required a specific treatment. CONCLUSION: Opt-in internet opinion panels proved a quick and efficient way to gather data on menopausal issues in Belgium. Despite the high levels of awareness and knowledge, there is some confusion concerning the duration of the menopause, and its common perception as a temporary condition is likely to mean that the menopausal burden is substantially underestimated. Many symptomatic women are untreated.

Evaluating the implementation fidelity of a multicomponent intervention for oral health promotion in preschool children.

This study evaluates the process of implementation of a longitudinal intervention program to promote oral health in preschool children in Flanders, Belgium. As the program was implemented in an existing preventive health care organization, the study also evaluates this setting as the context for implementation. Qualitative and quantitative methods were used to evaluate implementation fidelity, based on Carroll's theoretical framework of implementation fidelity (Carroll et al., Implementation Science 2:40, 2007). Questionnaire data from participants and health workers were analyzed, and document analyses were performed to compare registrations of the actions with the planning manual. Results were mixed. Whereas more than 88 % of all parents attended all home visits, only 57 % received at least 9 of the 11 planned consultations. Fifty-two percent of the families received all supporting materials, and on average, 73 % of all attending families received all information at a contact as described in the manual. Moderating factors such as the adequate use of facilitators and high participant responsiveness had a positive impact on implementation fidelity, whereas the quality of delivery differed to a great extent between the nurses who were involved during the entire intervention period and those who gave only a few sessions. Implementing an intervention in an existing well-baby program has many advantages, although lack of time presents a challenge to implementation fidelity. The results of this process evaluation allow a better understanding of the contribution of implementation fidelity to the effectiveness of health promotion programs.

Measuring determinants of oral health behaviour in parents of preschool children.

OBJECTIVE: The aim of this study was to develop a valid and reliable measure for oral health behaviour and its determinants in five-year-old Flemish children, based on the Theory of Planned Behaviour (TPB) and to test its predictive validity. METHODS: 1157 parents of five-year-olds completed a questionnaire measuring three behaviours related to oral health among children (dietary habits, oral hygiene, dental attendance) and their determinants (attitude, subjective norms, perceived behavioural control, intention). The sample was randomly split in two halves and principal component analyses were performed on one half sample to identify the factor structure. Confirmatory factor analyses were performed on the remaining half sample to obtain a cross-validation. Predictive validity was tested using multiple regression analyses. RESULTS: For each behaviour four component structures reflecting the TPB-dimensions, accounting for 44% to 55% of the variance were retrieved and confirmed in the cross-validation. Internal consistency (Cronbach's alpha) of the scales ranged from 0.52 to 0.80. A sizeable percentage of variance of intentions and behaviours was explained by the model. CONCLUSIONS: The TPB components were significant predictors of intentions and behaviours. These findings argue for the reliability and validity of the questionnaire for exploring determinants underlying parental oral health behaviour.

Oral health and oral health-related behaviour in preschool children: evidence for a social gradient.

This study aims to investigate the social gradient in the reported oral health-related behaviour and oral health status of preschool children. Participants were 1,057 children born between October 2003 and July 2004 in Flanders, Belgium. Oral health examinations were performed by trained dentists when the children were 3 and 5 years old (respectively, in 2007 and 2009); data on dietary habits, oral hygiene habits and dental attendance of the children were obtained through structured questionnaires completed by the parents. Maternal educational level, measured in four categories, was used as a proxy of socio-economic status. Logistic and ordinal regressions showed a social gradient for the oral health-related behaviours: a lower educational level of the mother was related to a higher consumption of sugared drinks between meals and to a lower brushing frequency and dental attendance of the child. Children from low-educated mothers also had seven times more chance to present with caries experience than children from mothers with a bachelor degree. Contrary to the expectations, there was a deviation from the gradient in 3-year-olds from the highest educational group showing an increased risk for caries experience (OR = 3.84, 95 % CI = 1.08-13.65). Conclusion. Already in very young children, a graded relationship is observed between socio-economic position, oral health and related behaviours. The results suggest that different approaches are required to promote oral health during early childhood depending on the mother's educational background. As children from the highest social group also have an increased caries risk, specific techniques may be needed.

Effects of time and socio-economic status on the determinants of oral health-related behaviours of parents of preschool children.

The oral health-related beliefs of parents have an important impact on the oral health status of their children; however, they are not stable over time. This study aimed to assess the changes, over time, in the determinants of parental oral health-related behaviour based on the Theory of Planned Behaviour and to investigate socio-economic inequalities. The cohort consisted of the parents - mainly the mothers - of 1,057 children born in 2003 and 2004 in Flanders (Belgium). According to the Theory of Planned Behaviour, validated questionnaires, completed at children's birth and at age 3 and 5 yr, assessed parental attitudes, social norms, perceived behavioural control, and intention towards three behaviours: dietary habits, oral hygiene habits, and dental attendance. Linear mixed-model analyses were applied. Positive parental attitudes towards oral health-related behaviours increased between birth and 3 yr of age, whereas the scores for subjective norms and intentions decreased. Scores remained stable for children between three and 5 yr of age. Highly educated mothers had significantly higher scores for attitudes, perceived behavioural control, and intentions than less-educated mothers. Health promotion campaigns should take these natural changes and inequalities of dental beliefs into account when developing and evaluating interventions.

Palliative care physicians' religious / world view and attitude towards euthanasia: a quantitative study among flemish palliative care physicians.

AIMS: To Study the religious and ideological views and practice of Palliative Care physician towards Euthanasia. MATERIALS AND METHODS: An anonymous self administered questionnaire approved by Flemish Palliative Care Federation and its ethics steering group was sent to all physicians(n-147) working in Flemish Palliative Care. Questionnaire consisted of three parts. In first part responded were requested to provide demographic information. In second part the respondents were asked to provide information concerning their religion or world view through several questions enquiring after religious or ideological affiliation, religious or ideological self-definition, view on life after death, image of God, spirituality, importance of rituals in their life, religious practice, and importance of religion in life. The third part consisted of a list of attitudinal statements regarding different treatment decisions in advanced disease on which the respondents had to give their opinion using a five-point Likert scale.99 physician responded. RESULTS: WE WERE ABLE TO DISTINGUISH FOUR CLUSTERS: Church-going physicians, infrequently church-going physicians, atheists and doubters. We found that like the Belgian general public, many Flemish palliative care physicians concoct their own religious or ideological identity and feel free to drift away from traditional religious and ideological authorities. CONCLUSIONS: In our research we noted that physicians who have a strong belief in God and express their faith through participation in prayer and rituals, tend to be more critical toward euthanasia. Physicians who deny the existence of a transcendent power and hardly attend religious services are more likely to approve of euthanasia even in the case of minors or demented patients. In this way this study confirms the influence of religion and world view on attitudes toward euthanasia.