Lowering the legal alcohol limit in Belgium: Potential effects on the number of traffic victims.

BACKGROUND: Since 1994, the legal limit of Blood Alcohol Concentration (BAC) is 0.5 g/L for the general drivers' population in Belgium. Since 2015, this limit has been lowered to 0.2 g/L for professional drivers. So far, no specific limitation has been adopted for novice drivers in Belgium. Recently, two bills were submitted to the House of Representatives: the first one proposed to impose a zero-limit for every driver, the second one proposed to restrict this zero-limit only to novice drivers. OBJECTIVE: The present study evaluated the potential impact of the two bills that aim to reduce the legal BAC limit from 0.5 to zero, either for all drivers or for novice drivers only. We elaborated three scenarios related to the BAC categories for which lowering the legal BAC limit to zero would affect drink-driving behaviour: "Targeted BAC levels" scenario assumed that the new policy would impact only the specifically targeted BAC category, i.e., drivers in the category BAC below 0.5 g/L. "Extended impact" scenario corresponded to the "Targeted BAC levels" scenario to which we added a "halo effect" on drivers in the BAC category "0.5 g/L ≤ BAC < 0.8 g/L". "Broad range impact" scenario corresponded to the "Extended impact" scenario to where we extended the "halo effect" to drivers in the BAC category "0.8 g/L ≤ BAC < 1.2 g/L". METHODS: The effect estimates were based on firstly, scientific literature on risks related to drink-driving at different BAC-levels, secondly data on crashes in Belgium and thirdly data on drink-driving behaviour in Belgium and in other European countries. RESULTS: In case of a zero limit for all drivers, an annual reduction can be expected of 10 to 17 fatalities (i.e., a decrease of 2.4% to 3.9%), 8 to 20 severe injuries (i.e., a decrease of 0.3% to 0.8%) and 135 to 315 slight injuries (i.e., a decrease of 0.4% to 0.8%). In case a zero limit is only applied to novice drivers, an annual decrease can be expected by 2 to 4 fatalities (i.e., a decline of 3.7% to 6.2%), 8 to 16 serious injuries and 135 to 262 slight injuries (i.e., a decline of 1.7% to 3.2% in both cases). DISCUSSION: There is no clear evidence on which of the three scenarios would be the most plausible. As the relative risk of a car crash increases strongly with the BAC level, the success of either measure will strongly depend on its ability to also affect drink driving at concentrations that are forbidden already. This also means that most of the casualties could be prevented if compliance with current rules increased.

Self-Reported Health and Patterns of Romantic Love in Adolescents from Eight European Countries and Regions.

Purpose: Sexual minority youth (SMY) are at increased risk of poor health, but it remains unclear whether this phenomenon is universal. In this study, nationally representative samples of 15-year olds from eight European countries and regions were investigated to test if adolescents who have been in love with same- or both-gender partners report poorer health than those exclusively in love with opposite-gender partners or who have never been in love. Methods: A subsample of 13,674 adolescents participating in the 2014 Health Behaviour in School-aged Children (HBSC) study was used. We conducted binary logistic regression, adjusted for gender, region, and relative family affluence, to analyze associations between self-reported romantic love, multiple psychosomatic symptoms, and poor self-rated health. Results: Adolescents reporting same-gender love (adjusted odds ratio [aOR] = 1.50, 95% confidence interval [CI]: 1.11-2.02) and both-gender love (aOR = 3.57, 95% CI: 2.65-4.83) had significantly higher odds for multiple psychosomatic symptoms than those who reported opposite-gender love. Similarly, both SMY groups had higher odds of poor self-rated health (aOR = 2.95, 95% CI: 1.64-5.31 and aOR = 3.08, 95% CI: 1.79-5.31, respectively). Those who reported that they have never been in love had significantly lower odds for multiple symptoms. Adjustment for sociodemographic variables and stratifying by gender did not substantially change the odds ratios. Conclusion: Adolescents in love with same- and both-gender partners reported poorer subjective health outcomes than those in love with opposite-gender partners or who reported never being in love, suggesting that SMY health inequalities are found across various European countries and regions.

Romantic Attraction and Substance Use in 15-Year-Old Adolescents from Eight European Countries.

Sexual minority youth are at higher risk of substance use than heterosexual youth. However, most evidence in this area is from North America, and it is unclear whether the findings can be generalized to other cultures and countries. In this investigation, we used data from the 2014 Health Behaviour in School-aged Children (HBSC) study to compare substance use in same- and both-gender attracted 15-year-old adolescents from eight European countries (n = 14,545) to that of their peers who reported opposite-gender attraction or have not been romantically attracted to anyone. Both-gender attracted, and to a lesser extent, same-gender attracted adolescents were significantly more likely to smoke cigarettes, consume alcohol, get drunk and use cannabis, or be involved in multiple substance use in the last 30 days compared to their opposite-gender attracted peers. Those adolescents who have not been in love had significantly lower odds for substance use than all other youth. The pattern of results remained the same after adjusting for country, gender and family affluence. These findings are compatible with the minority stress and romantic stress theories. They suggest that sexual minority stigma (and love on its own) may contribute to higher substance use among adolescents in European countries.

Socioeconomic Disparities in Diet Vary According to Migration Status among Adolescents in Belgium.

Little information concerning social disparities in adolescent dietary habits is currently available, especially regarding migration status. The aim of the present study was to estimate socioeconomic disparities in dietary habits of school adolescents from different migration backgrounds. In the 2014 cross-sectional "Health Behavior in School-Aged Children" survey in Belgium, food consumption was estimated using a self-administrated short food frequency questionnaire. In total, 19,172 school adolescents aged 10-19 years were included in analyses. Multilevel multiple binary and multinomial logistic regressions were performed, stratified by migration status (natives, 2nd- and 1st-generation immigrants). Overall, immigrants more frequently consumed both healthy and unhealthy foods. Indeed, 32.4% of 1st-generation immigrants, 26.5% of 2nd-generation immigrants, and 16.7% of natives consumed fish ≥two days a week. Compared to those having a high family affluence scale (FAS), adolescents with a low FAS were more likely to consume chips and fries ≥once a day (vs.

Feelings about the timing of first sexual intercourse and health-related quality of life among adolescents.

BACKGROUND: Early sexual intercourse (SI) may have long-lasting negative impacts on health-related quality of life (HRQoL). So far, these impacts have been studied using age for defining early SI instead of feelings about its timing. The present study examined the association between feelings about the timing of first SI and current HRQoL. METHODS: Data came from the 2014 cross-sectional Health Behaviour in School-aged Children (HBSC) study in French-speaking Belgium. Among participants aged 16-20 years who already had SI, 1778 were included in analyses. Univariate and multivariate logistic regressions were performed, including potential confounders. RESULTS: One quarter of adolescents (26.4%) had poor HRQoL, 19.8% expressed a negative feeling about the timing of first SI and 19.6% did not think about it. Compared with adolescents who thought first SI happened at the right time or wished it had happened sooner, adolescents who had a negative feeling about the timing and those who did not think about it were more likely to have a poor HRQoL (cOR = 1.67 (1.28-2.17) and cOR = 1.37 (1.05-1.80), respectively). After adjustment, associations were no more significant (aOR = 1.22 (0.91-1.63) and aOR = 1.22 (0.91-1.64)). Sex disparity in expressing a negative feeling mostly explained the difference between crude and adjusted analyses. CONCLUSION: Further research is needed to better understand such a complex relationship. The high proportion of adolescents having poor HRQoL and negative feeling about the timing of first SI shows how important it is to find out effective prevention for both domains.

Country-Level Gender Equality and Adolescents' Contraceptive Use in Europe, Canada and Israel: Findings from 33 Countries.

CONTEXT: Although an association between gender equality and contraceptive use has been confirmed among adult samples, few studies have explored this relationship among adolescents. An examination of whether adolescents' contraceptive use is more prevalent in countries with higher levels of gender equality is needed to fill this gap. METHODS: Nationally representative data from 33 countries that participated in the 2013-2014 Health Behaviour in School-Aged Children study and country-level measures of gender equality-using the 2014 Global Gender Gap Index-were analyzed. Multilevel multinomial logistic regression analyses were employed to assess associations between gender equality and contraceptive use (condom only, pill only and dual methods) at last intercourse as reported by 4,071 females and 4,110 males aged 14-16. RESULTS: Increasing gender equality was positively associated with contraceptive use among both males and females. For every 0.1-point increase on the equality scale, the likelihood of condom use at last intercourse rose (odds ratio, 2.1 for females), as did the likelihood of pill use (6.5 and 9.6, respectively, for males and females) and dual method use (2.1 and 5.6, respectively). Associations with pill use and dual use remained significant after national wealth and income inequality were controlled for. Overall, associations were stronger for females than for males. CONCLUSIONS: More research is needed to identify potential causal pathways and mechanisms through which gender equality and adolescents' contraceptive use may influence one another.

Environmental correlates of physical activity among children 10 to 13 years old in Wallonia (Belgium).

BACKGROUND: In Belgium, as in many other countries, the juvenile practice of physical activity is insufficient. A growing attention has been paid to environmental factors that may influence physical activity but with inconsistent findings. This study aims to estimate the association between daily life environment characteristics and physical activity among children 10 to 13 years old in Wallonia (Belgium). METHODS: Data were collected using a self-administered questionnaire among 1940 children (HBSC survey). Associations between factors related to the children's living environment and physical activity (vigorous physical activity (VPA) ≥ twice a week; global physical activity (GPA) defined as VPA ≥ twice a week and moderate-to-vigorous physical activity ≥1 h/day) were estimated using logistic regressions adjusted for potential confounders. RESULTS: Nearly three-quarters of the children practiced VPA ≥ twice a week, but only one in five practiced GPA consistent with recommendations. After adjustment, children living in a neighborhood with playgrounds or parks were more likely to achieve a recommended level of GPA (OR: 1.34 [1.04-1.73]), as were children who reported that other youngsters were present in their neighborhood with whom they could play outside (OR: 1.50 [1.12-1.99]). The presence of neighborhood children was also positively associated with VPA (OR: 1.80 [1.42-2.29]); in stratified analyses, the association was significant only among boys (OR: 1.95 [1.34-2.82]). Moreover, and only in girls (OR: 1.66 [1.10-2.49]), a feeling of safety in one's neighborhood was positively associated with VPA. No association was found between VPA and the existence of a yard or a garden at home to go playing outside. CONCLUSION: Our results argue for developing actions aimed at creating living environments more favorable to children's daily physical activity. More specifically, they help better understand the environment of Belgian children and thus contribute to better identify their needs.

Perceived social support from teachers and classmates does not moderate the inverse association between body mass index and health-related quality of life in adolescents.

PURPOSE: The current study investigated the association between body mass index (BMI) and health-related quality of life (HRQoL) among a large and non-clinical sample of adolescents, and tested the possible moderating effect of perceived teacher and classmate support on this association. METHODS: French-speaking Belgian adolescents (n = 11,342) self-reported height and weight, HRQoL (KIDSCREEN-10), as well as their perception of teacher and classmate relationships. Adjusting for sociodemographics, linear regression analyses with HRQoL as the outcome variable were performed for boys and girls separately. Interactions between BMI and teacher support, and between BMI and classmate support were included to examine the effect of this support on the association between BMI and HRQoL. RESULTS: Obesity was associated with lower HRQoL for boys (ß = - 2.14, p = 0.002) and for girls (ß = - 2.96, p = 0.001), while only overweight girls showed a significant impaired HRQoL compared with normal-weight ones (ß = - 0.94, p = 0.01). In both sexes, lower perceived teacher and classmate support was associated with lower HRQoL. Interactions between BMI and perceived teacher relationships, and between BMI and perceived classmate relationships, were not significant for boys as for girls. CONCLUSIONS: Perceived school-related social support constitutes an important dimension of adolescent well-being, suggesting the relevance of considering it for promoting greater HRQoL in overweight and obese youth. Future studies are needed to confirm the absence of moderating effect of this support and explore its effect on other weight-related factors, like body image, weight misperception and bullying, associated with decreased HRQoL in adolescents.

Negative feelings about the timing of first sexual intercourse: findings from the Health Behaviour in School-aged Children study.

OBJECTIVES: This study investigates the association between negative feelings about the first intercourse timing and sociodemographic and contextual factors. We hypothesized that girls and adolescents with an older first sexual partner will be more likely to report negative feelings and that prevalence of those feelings will vary across countries. METHODS: Adolescents (N = 6073, mean age = 15.6 ± 0.34), from Bulgaria, France, Ireland, and Scotland, taking part in the 2013/2014 HBSC study, were asked about sexual initiation, their age and partner's age at first intercourse, and their feeling about the timing of first intercourse. RESULTS: One-fifth of the 1321 adolescents who had had sexual intercourse reported negative feelings about the first intercourse timing. Girls, adolescents from low affluent families, and those with an older first partner were more likely to report negative feelings. However, after adjustment for covariates, only girls and those from less affluent families had significantly higher odds of reporting negative feelings. CONCLUSIONS: Sexual education programmes need to explicitly address decision-making around timing of first intercourse in order to reduce negative feelings, with a special attention to gender and social inequalities.

Love and Dating Patterns for Same- and Both-Gender Attracted Adolescents Across Europe.

Sexual orientation is a multidimensional phenomenon, which includes identity, behavior, and attraction. The attraction component, however, is less studied than the other two. In this article, we present the development of a two-item measure to identify adolescents who prefer same- and both-gender partners for love and dating. The questions were administered to nationally representative samples of 15-year-old adolescents in eight European countries and regions participating in the Health Behaviour in School-aged Children (HBSC) cross-national study. The distribution of attraction, as operationalized by preference for the gender of love and dating partners, was similar across countries. These questions offer an alternative or supplementary approach to identify same- and both-gender attracted youth, without administering questions related to sexual identity.

Sexual Health questions included in the Health Behaviour in School-aged Children (HBSC) Study: an international methodological pilot investigation.

BACKGROUND: This paper describes the methodological developments of the sexual health items included in the Health Behaviour in School-aged Children (HBSC) study since their mandatory inclusion in the study in 2002. The current methodological, ethical and pedagogical challenges in measuring young people's sexual health behaviours are discussed along with the issues associated with the sexual health items introduced to the HBSC study in 2002. The development and piloting of new cross-national items for use in the 2013/14 HBSC data collection are presented and discussed. METHODS: An international pilot study was undertaken to determine the impact of these proposed changes. Questionnaires and classroom discussion groups were conducted in five pilot countries in 2012/2013 (France, Hungary, Ireland, Portugal and Romania) with a total of 612 school-aged children (age M = 15.55 years, SD = 0.95). RESULTS: The majority of participants in each country provided positive feedback about the appropriateness of the questions. Some small cross-national differences were found in the self-reported quantitative data relating to the appropriateness of the questions (χ2 = 22.831, df = 9, p = .007, V = .117). Qualitative feedback suggests that for the vast majority of students the phrasing and age-targeting of the questions were considered appropriate. With the exception of a small number of respondents who commented on the clarity and/or personal nature of the content, no specific issues with the questions were identified. CONCLUSIONS: These findings provide guidance on the answerability (including the extent of missing and inconsistent data), understandability, acceptability (including in different cultures) and relevance of questions to potential participants. The findings from the pilot study suggest that in general, the questions are understandable, acceptable, and of a high priority to the target population, and that the simplification has significantly reduced the proportion of missing data. The new developments thus enhance the capacity of the questions to measure cross-nationally, sensitive aspects of young people's sexual behaviour. These questions were included in the 2013/2014 round of the HBSC survey and will continue to be used to monitor trends in adolescent sexual health and behaviours, and to inform and influence health services and health education policy and practice at local, national and international levels.

Well-being, gender, and psychological health in school-aged children.

BACKGROUND: Despite being a well-documented phenomenon, gender differences in psychological health complaints in adolescence are poorly understood. The purpose of this study was to test factors related to well-being as explanatory factors of gender differences in psychological complaints (feeling low, irritability or bad temper, nervousness, and sleeping difficulties) in adolescence. METHODS: This study was based on the 9(th) Health Behaviour in School-aged Children (HBSC) study, conducted in 2010 in the Wallonia-Brussels Federation, Belgium, on 9-24 year olds. Using logistic regression analyses, we studied gender differences in psychological complaints through well-being factors (life satisfaction, self-confidence, helplessness, and body image), across age categories, and examined the variation of female excess after taking into account each factor. RESULTS: The four well-being factors together explained more than half of the female excess in feeling low. However, there were still significant gender differences in feeling low for children over 13. Among 13 to 15-year-olds, there were no gender differences in irritability after adjustment. An important decrease in gender differences in nervousness was observed in the multivariate analyses, although there was still significant female excess in nervousness increasing from 13 years old. After full adjustment, only gender differences in sleeping difficulties among 13-15-year-olds remained significant. For all psychological complaints studied, self-confidence caused the most important decrease in gender difference. CONCLUSIONS: This study showed that factors related to well-being could mediate the association between gender and psychological complaints, and pointed to the importance of taking into account well-being factors in the analyses of the aetiology of gender differences in psychological complaints. However, our results suggested that future research should explore additional explanations for gender differences in psychological complaints.

Honey bee diet in intensive farmland habitats reveals an unexpectedly high flower richness and a major role of weeds.

In intensive farmland habitats, pollination of wild flowers and crops may be threatened by the widespread decline of pollinators. The honey bee decline, in particular, appears to result from the combination of multiple stresses, including diseases, pathogens, and pesticides. The reduction of semi-natural habitats is also suspected to entail floral resource scarcity for bees. Yet, the seasonal dynamics and composition of the honey bee diet remains poorly documented to date. In this study, we studied the seasonal contribution of mass-flowering crops (rapeseed and sunflower) vs. other floral resources, as well as the influence of nutritional quality and landscape composition on pollen diet composition over five consecutive years. From April to October, the mass of pollen and nectar collected by honey bees followed a bimodal seasonal trend, marked by a two-month period of low food supply between the two oilseed crop mass-flowerings (ending in May for rapeseed and July for sunflower). Bees collected nectar mainly from crops while pollen came from a wide diversity of herbaceous and woody plant species in semi-natural habitats or from weeds in crops. Weed species constituted the bulk of the honey bee diet between the mass flowering crop periods (up to 40%) and are therefore suspected to play a critical role at this time period. The pollen diet composition was related to the nutritional value of the collected pollen and by the local landscape composition. Our study highlights (1) a food supply depletion period of both pollen and nectar resources during late spring, contemporaneously with the demographic peak of honey bee populations, (2) a high botanical richness of pollen diet, mostly proceeding from trees and weeds, and (3) a pollen diet composition influenced by the local landscape composition. Our results therefore support the Agri-Environmental Schemes intended to promote honey bees and beekeeping sustainability through the enhancement of flower availability in agricultural landscapes.

[Ebola virus disease and accredited specialist health institutions]. / Maladie à virus Ebola et établissement de santé référent habilité.

Ebola virus disease (EVD) went in the space of a few months from being a forgotten tropical disease to a global "health emergency". The scope of this Ebola virus epidemic (Zaire strain), which has broken out in West Africa, its spread and the high number of deaths reported among frontline health workers are unprecedented. This article describes how a specialist hospital deals with imported cases of EVD.

[Use of a standard format to describe the activity of hospital-based palliative care team: a lever for improving end of life care]. / Suivi d'indicateurs dans le bilan d'activité d'une équipe mobile de soins palliatifs: un levier pour l'amélioration des pratiques.

INTRODUCTION: Early integrated palliative care is recommended in patients with incurable disease. Despite their development, hospital-based palliative care teams (PCT) are introduced late in the course of standard oncology care. The objective of this study is to describe the activity of an academic hospital-based PCT, using a standard format, which integrates indicators of early introduction and quality of end of life care, thus allowing a systematic analysis of its practice. METHODS: The annual activity of the PCT is described from 2007 to 2012. Data are collected for each patient prospectively by the team: reasons for referral and activities of PCT, performance status and chemotherapy at the time of first referral, visit to emergency and admission to ICU. RESULTS: The number of patients referred to the PCT increased from 337 patients in 2007 to 539 in 2012, among whom 90% were cancer patients, 84% at metastatic stage. Relief of symptoms was the most frequent reason for referral. In 2012, 280 (64%) patients were receiving chemotherapy and 41% had a PS≤2 at the time of first referral. Half patients died each year (270 in 2012); 17% of these received chemotherapy in their last 14 days of life, 3% visited emergency room twice and 13% were admitted in ICU, once during their last month of life, 48% died in hospice or at home. CONCLUSION: The use of a standard format to describe the activity of hospital-based PCTs, the timing of their introduction and the quality of care is feasible. The generalization of this format for monitoring to assess the curative medicine interface/palliative could be a lever for improving the integration of palliative care.

Oxidative stability of bovine serum albumin- and sodium caseinate-stabilized emulsions depends on metal availability.

Proteins often stabilize food emulsions and are also able to promote or delay lipid oxidation in complex systems. The purpose of this work was to investigate the relationship between metal ion availability and oxidative stability of oil-in-water emulsions stabilized by bovine serum albumin (BSA) or sodium caseinate (NaCas). Emulsions with similar and stable droplet size distributions were prepared with stripped sunflower oil (30 vol %) and protein solutions (20 g L(-)(1); pH = 6.5). In the absence of the water-soluble metal chelator EDTA, oxygen uptake, conjugated dienes, and volatile compounds developed faster in NaCas-stabilized emulsions than in those prepared with BSA. This effect is attributed to the chelating properties of NaCas and to electrostatic interactions that attract some metal ions at the interface where they could initiate lipid oxidation. When EDTA (100 muM) was present, oxidation was delayed to a greater extent in emulsions made with NaCas than in BSA stabilized emulsions. These conditions probably enabled NaCas to exert free-radical-scavenging activity.