Correction of self-reported BMI based on objective measurements: a Belgian experience.

BACKGROUND: Based on successive Health Interview Surveys (HIS), it has been demonstrated that also in Belgium obesity, measured by means of a self-reported body mass index (BMI in kg/m2), is a growing public health problem that needs to be monitored as accurately as possible. Studies have shown that a self-reported BMI can be biased. Consequently, if the aim is to rely on a self-reported BMI, adjustment is recommended. Data on measured and self-reported BMI, derived from the Belgian Food Consumption Survey (FCS) 2014 offers the opportunity to do so. METHODS: The HIS and FCS are cross-sectional surveys based on representative population samples. This study focused on adults aged 18-64 years (sample HIS = 6545 and FCS = 1213). Measured and self-reported BMI collected in FCS were used to assess possible misreporting. Using FCS data, correction factors (measured BMI/self-reported BMI) were calculated in function of a combination of background variables (region, gender, educational level and age group). Individual self-reported BMI of the HIS 2013 were then multiplied with the corresponding correction factors to produce a corrected BMI-classification. RESULTS: When compared with the measured BMI, the self-reported BMI in the FCS was underestimated (mean 0.97 kg/m2). 28% of the obese people underestimated their BMI. After applying the correction factors, the prevalence of obesity based on HIS data significantly increased (from 13% based on the original HIS data to 17% based on the corrected HIS data) and approximated the measured one derived from the FCS data. CONCLUSIONS: Since self-reported calculations of BMI are underestimated, it is recommended to adjust them to obtain accurate estimates which are important for decision making.

Regional differences in the validity of self-reported use of health care in Belgium: selection versus reporting bias.

BACKGROUND: The Health Care Module of the European Health Interview Survey (EHIS) is aimed to obtain comparable information on the use of inpatient and ambulatory care in all EU member states. In this study we assessed the validity of self-reported information on the use of health care, collected through this instrument, in the Belgian Health Interview Survey (BHIS), and explored the impact of selection and reporting bias on the validity of regional differences in health care use observed in the BHIS. METHODS: To assess reporting bias, self-reported BHIS 2008 data were linked with register-based data from the Belgian compulsory health insurance (BCHI). The latter were compared with similar estimates from a random sample of the BCHI to investigate the selection bias. Outcome indicators included the prevalence of a contact with a GP, specialist, dentist and a physiotherapist, as well as inpatient and day patient hospitalisation. The validity of the estimates and the regional differences were explored through measures of agreement and logistic regression analyses. RESULTS: Validity of self-reported health care use varies by type of health service and is more affected by reporting than by selection bias. Compared to health insurance estimates, self-reported results underestimate the percentage of people with a specialist contact in the past year (50.5 % versus 65.0 %) and a day patient hospitalisation (7.8 % versus 13.9 %). Inversely, survey results overestimated the percentage of people having visited a dentist in the past year: 58.3 % versus 48.6 %. The best concordance was obtained for an inpatient hospitalisation (kappa 0.75). Survey data overestimate the higher prevalence of a contact with a specialist [OR 1.51 (95 % CI 1.33-1.72) for self-report and 1.08 (95 % CI 1.05-1.15) for register] and underestimate the lower prevalence of a contact with a GP [ORs 0.59 (95 % CI 0.51-0.70) and 0.41 (95 % CI 0.39-0.42) respectively] in Brussels compared to Flanders. CONCLUSION: Cautiousness is needed to interpret self-reported use of health care, especially for ambulatory care. Regional differences in self-reported health care use may be influenced by regional differences in the validity of the self-reported information.

Gender differences in the use of anxiolytics and antidepressants: a population based study.

PURPOSE: In the majority of studies on determinants of use of anxiolytics and antidepressants a substantially higher consumption is observed among women than among men. We investigated gender differences in the association between the use of anxiolytics and antidepressants and mental health and explored if there are indications of gender differences in inappropriate use of these medicines. METHODS: Data were from the 2004 Belgian Health Interview Survey, a nationally representative sample of the Belgian population. The analysis was restricted to the population of 15 years and older (n = 11,220). The probability of use of anxiolytics and antidepressants was assessed through logistic regression models by gender and through models including the interaction between gender and mental health. RESULTS: The association between the use of antidepressants and mental health did not vary substantially between men and women. Among men the use of anxiolytics showed a strong association with sleeping problems, but not with depressive disorders. Among women the use of anxiolytics was significantly associated with the three mental health conditions that were investigated: depressive disorder, anxiety, and sleeping problems. CONCLUSIONS: The link between mental health and use of anxiolytics differs by gender. Some indications exist for gender differences in inappropriate use of anxiolytics, whereas this does not hold true for the use of antidepressants. Further efforts are needed to increase the awareness of prescribers, policy makers, and the general public on the appropriate use of anxiolytics, especially among women and in the older population.

Socio-economic differences in the utilisation of health services in Belgium.

OBJECTIVE: To investigate socio-economic differences in the use of health services in Belgium and to explore to what extent eventual socio-economic inequalities are explained by differences in demographic determinants and health needs. DESIGN: Data was obtained from the 1997 Belgian national Health Interview Survey. In this survey information was collected on the health status, the life style and the medical consumption of a representative sample of the Belgian non-institutionalised population consisting of 8560 Belgian inhabitants aged 15 years and over. RESULTS: Lower socio-economic groups make more often use of the general practitioner and nursing care at home and are more often admitted to hospital than persons with a high socio-economical status. There is, however, no socio-economic gradient when the health status is taken into account. On the opposite, persons with a higher socio-economic status report more often a visit to a specialist, a physiotherapist or a dentist. For the health services for which this was investigated no association was found between socio-economic status and the volume of the use of health services. CONCLUSIONS: There are in Belgium still important socio-economic gradients in the use of some health services. These differences may be due to socio-economic inequities but could also indicate that the existing health facilities are not always used in an optimal way. Patient factors may be more important than supply factors in explaining the differential use of health services. Further research needs to focus on socio-economic differences in the reasons, the outcome and the quality of the provided care.

The impact of hearing disability on well-being and health.

OBJECTIVES: The aim of the paper is to assess the significance of hearing disability as a public health problem through its association with multiple negative health outcomes: subjective health perception, mental health and social well-being. METHODS: The data come from the participants of the 1997 national health survey in Belgium, who were 15 years and older (n = 8,560). The presence and severity of the hearing disability was estimated through self-reporting. The association of hearing disability with the studied health outcomes was assessed using logistic regression while controlling for confounding factors such as age, sex, co-morbidity and socio-economic status. RESULTS: The prevalence of hearing disability is 7% in the population 15 years and older. The prevalence of subjective ill health (Odds Ratio (OR): 1.32), mental ill health (OR: 1.51), and a low appreciation of the social contacts (OR: 1.73) was higher in subjects with hearing disability. No association was found between hearing disability and the frequency of social contacts or with the functional content of the social contacts. CONCLUSIONS: Given the health and social consequences of hearing disability, increased public health attention, including both strategies for prevention, for identification and treatment, is warranted.

Prevalence, awareness, treatment and control of arterial hypertension in an elderly population in Belgium.

OBJECTIVE: To study the prevalence, awareness, treatment and control of arterial hypertension in the elderly population in Belgium. STUDY GROUP: An age- and sex-stratified sample of 2212 Belgian subjects aged 65 years or more, selected from the original cohort of the Belgian Interuniversity Research on Nutrition and Health (BIRNH) study; participation in this follow-up study was 72.6%. METHODS: Blood pressure (BP) was measured at home by trained technicians using a standard protocol. Isolated systolic hypertension (ISH) was defined as a systolic BP > or =160 mm Hg and a diastolic BP <95 mm Hg. Diastolic hypertension was defined as a diastolic BP > or =95 mm Hg. The total hypertensive population was defined as all those with ISH, diastolic hypertension and with BPs <160-95 mm Hg but currently taking antihypertensive drugs. Awareness and treatment status were investigated through a structured interview. RESULTS: The prevalence of arterial hypertension was 43.9%, higher in women than in men and increasing with age in women; elevated BP was found in 22.3 to 28.6% of the participants varying by age and sex. In the >75-year-old subjects this elevation was in two-thirds of the cases due to ISH; 84% of all female hypertensives were aware of the condition compared to 68% in men. Treatment advice had been given in a majority of the aware subjects and two-thirds of all treated persons was under control. Among a variety of independent variables and besides the gender difference, awareness was only related to smoking and to depression while control differed by region of residence. CONCLUSION: Arterial hypertension is highly prevalent in this elderly population; awareness and BP control are within acceptable ranges but there is still room for improvement, particularly in elderly men.

Perception of risk, choice of maternity site, and socio economic level of twin mothers.

The objective of this study was to determine if access to high level health facility (level 3 perinatal center) is related to socio-economic level of the mother and to her perception of risk for a twin birth. A retrospective questionnaire was administrated to the mothers of twins during the first post parum days in each of the 27 maternity sites within a defined geographical district near Paris (Hauts de Seine). The survey instrument was designed to precisely characterize the socioeconomic status of the parents, to measure the perceived risk for the twins expressed by the mother, to measure the relationship between the choice of a maternity site (level 1, 2 or 3) by socioeconomic level, and to measure the fetal and neonatal death rates by socioeconomic status. The opinion of mothers of twins about specific risk for her and for her children is very different by socioeconomic levels, as is the choice of level 3. This is discussed with the rates of fetal and neonatal death rates by socioeconomic level. In the absence of a policy of regionalization of perinatal care, the discriminant factor for access to high level care (level 3 maternity site) is the socioeconomic level.

Regional inequities in health expectancy in Belgium.

Mortality differs substantially between the Flemish and Walloon regions is Belgium. The question remains as to whether the health status of both populations varies in a similar way. The difference in healthy life expectancy, an indicator of population health, between the Flemish and Walloon regions was therefore assessed. In 1989-1990 a cross-sectional survey in the general population was performed in which 2640 persons were selected by a multistage random process. Perceived health status was determined through a validated question: "On the whole, how would you describe your health for the moment? Would you say it is very good/good/fair/rather bad/bad?" The prevalence of "being in good health (very good to fair)" was combined with mortality data (Sullivan method) to estimate the healthy life expectancy (HLE), and the following results were found. Among males, life expectancy (LE) and HLE at age 15 was 58.9 years and 56.5 years in the Flemish region, compared with 56.6 and 50.2 years in the Walloon region. At age 65, LE and HLE in the Flemish region was 14.3 and 13.3 years, and only 13.2 and 9.2 years in the Walloon region. Women at age 15 had an LE and HLE in the Flemish region of 65.2 years and 61.3 years, compared to 63.9 and 58.1 years in the Walloon region. At age 65, both the LE and the HLE in the Flemish region were higher, with LE at 18.5 versus 17.7 years, and HLE at 16.0 versus 14.3 years. Similar results were obtained when the criteria of "being in good health" were restricted to those indicating their health to be very good or good. In conclusion, the data indicate that the population in the Walloon region not only has a shorter life but apparently also has a shorter healthy life. Research is needed to explain what proportion of these differences can be attributed to differences in the prevalence of diseases, cultural differences and socio-economic differences.

Social groups and prevention of preterm births in a population of twin mothers.

Prenatal care was equally distributed to all twin pregnant women of the district of Haut de Seine in France in 1989-91, without differences by socio-economic level. No difference in rates of preterm births and very early preterm births (26-31 weeks) was measured by socioeconomic level among twin pregnancies.

Is prevention of preterm births in twin pregnancies possible? Analysis of the results of a prevention program in France (1989-1991).

OBJECTIVES: A policy aimed at the prevention of early preterm births in twin pregnancies has been evaluated. The prevention program included: early diagnosis of twinning, information of the mothers about the risk of prematurity, attempts to restrain physical activity and early work leave prescription when indicated. STUDY DESIGN: Cohort study of all twin births in a given geographical area (Hauts-de-Seine district); 546 mothers with pregnancy duration of > or = 26 weeks were included; 1088 newborns were followed up to the 28th day of life. RESULTS: The recommended prevention program is largely used (88% of early diagnosis of twinning, 62% of the women informed and 73% of prescription for reduced physical activity). The very preterm (26-28 weeks) and early preterm (< or = 32 weeks) birth rates are low: 1.5 and 8.5%, respectively. The stillbirth rate is 11 per thousand and the neonatal mortality rate (0-27 days) is 10 per thousand live births, with a persistent difference between the first and the second twin. CONCLUSION: The present study demonstrates the open access and acceptability of the prevention policy; in addition, the perinatal outcomes are better than those of comparable published cohorts.

Suicide and attempted suicide reported by general practitioners in Belgium, 1990-1991.

In 1990-1991 the Belgian sentinel network of general practitioners recorded suicide and suicide attempts within their practices. The annual attempted suicide rate is estimated at 13.0 cases per 10,000 inhabitants. The highest incidence rates are found among women and young people. The annual suicide rate is estimated at 2.3 cases per 10,000 inhabitants, with the highest rates in men and in elderly people. The highest incidence rates of suicide attempts as well as of suicide are found among divorced people. About 30% of the attempters and committers made at least one earlier attempt. Drug overdose and hanging are the most frequently used methods, respectively when attempting and committing suicide. About 60% of both committers and attempters contacted their general practitioner within a period of 1 month preceding the attempt. Nearly half of the attempters and of the committers were treated for a mental disorder in the year preceding the attempt.

Changes in Chad: the results of a KAP survey.

PIP: This, the 1st KAP survey to be conducted in Chad, surveyed 1222 women aged 12-49 at 6 health or social centers in N'Djamena in 1988, and summarized the information obtained from 21 focus groups. The sujbects were 25 years old on average; 94% were in union; 33% were in polygamous marriages, usually older women. 8% of Muslims and 17% of Christians were in a consensual union. Educational achievement was higher among younger women and Christians. 49% had income from the informal economy. Most valued the economic advantages of large families, which they believed resided in ancestors. Some noted the poulation pressures of urban living. 27% stated they were pregnant. Fertility was lower among Christians and those in monogamous marriages. Women of higher socioeconomic status had more children. Average age of 1st pregnancy was 16 years, lower in Muslims and uneducated women. Average weaning age was 17.8 months; average postpartum abstinence was 4.6 months, longer among Christians. The mean desired birth spacing interval was 26 months. 89% desired more children. The average ideal family size was 7.25, 8.6 for those 29 years old. The concept of birth planning was new to most, and ocnsidered a European idea contrary to African traditions. 31% could name a modern birth control method, increased to 58% with prompting, but only 3.2% had used one, and 1.3% were currently using. The cost of modern contraceptives is prohibitive for Chadians whose average GNP is $129. 56% expressed an interest on modern contraception for spacing, indicating a large unmet need.^ieng