Incidence rate, predictors and outcomes of interruption of HIV care: nationwide results from the Belgian HIV cohort.

OBJECTIVES: We aimed to study the incidence rate, predictors and outcomes of HIV care interruption (HCI) in Belgium. METHODS: We analysed data for adult patients with at least two HIV care records in the Belgian HIV cohort between 1 January 2007 and 31 December 2016. An HCI episode was defined as 1 year without an HIV care record. The HCI incidence rate was analysed using Poisson regression, return to HIV care using a cumulative incidence function with death as a competing risk, and viral load (VL) status upon return to HIV care using logistic regression. RESULTS: We included 16 066 patients accounting for 78 625 person-years of follow-up. The incidence rate of HCI was 5.3/100 person-years [95% confidence interval (CI) 5.1-5.4/100 person-years]. The incidence of return to HIV care after HCI was estimated at 77.5% (95% CI 75.7-79.2%). Of those who returned to care, 43.7% had a VL ≤ 200 HIV-1 RNA copies/mL, suggesting care abroad or suboptimal care (without an HIV-related care record) in Belgium during the HCI, and 56.3% returned without controlled VL and were therefore considered as having experienced a real gap in HIV care; they represented 2.3/100 person-years of follow-up. Factors individually associated with HCI were no antiretroviral therapy (ART) uptake, lower age, injecting drug use, non-Belgian nationality, male gender, not being a man who has sex with men, a shorter time since HIV diagnosis, no high blood pressure and CD4 count < 350 cells/µL. CONCLUSIONS: This study highlights the need to investigate return to care and viral status at return, to better understand HCI. Identified predictors can help health care workers to target patients at higher risk of HCI for awareness and support.

Perceived utility and feasibility of pathogen genomics for public health practice: a survey among public health professionals working in the field of infectious diseases, Belgium, 2019.

BACKGROUND: Pathogen genomics is increasingly being translated from the research setting into the activities of public health professionals operating at different levels. This survey aims to appraise the literacy level and gather the opinions of public health experts and allied professionals working in the field of infectious diseases in Belgium concerning the implementation of next-generation sequencing (NGS) in public health practice. METHODS: In May 2019, Belgian public health and healthcare professionals were invited to complete an online survey containing eight main topics including background questions, general attitude towards pathogen genomics for public health practice and main concerns, genomic literacy, current and planned NGS activities, place of NGS in diagnostic microbiology pathways, data sharing obstacles, end-user requirements, and key drivers for the implementation of NGS. Descriptive statistics were used to report on the frequency distribution of multiple choice responses whereas thematic analysis was used to analyze free text responses. A multivariable logistic regression model was constructed to identify important predictors for a positive attitude towards the implementation of pathogen genomics in public health practice. RESULTS: 146 out of the 753 invited public health professionals completed the survey. 63% of respondents indicated that public health agencies should be using genomics to understand and control infectious diseases. Having a high level of expertise in the field of pathogen genomics was the strongest predictor of a positive attitude (OR = 4.04, 95% CI = 1.11 - 17.23). A significantly higher proportion of data providers indicated to have followed training in the field of pathogen genomics compared to data end-users (p < 0.001). Overall, 79% of participants expressed interest in receiving further training. Main concerns were related to the cost of sequencing technologies, data sharing, data integration, interdisciplinary working, and bioinformatics expertise. CONCLUSIONS: Belgian health professionals expressed favorable views about implementation of pathogen genomics in their work activities related to infectious disease surveillance and control. They expressed the need for suitable training initiatives to strengthen their competences in the field. Their perception of the utility and feasibility of pathogen genomics for public health purposes will be a key driver for its further implementation.

How can we monitor the impact of national health information systems? Results from a scoping review.

BACKGROUND: National health information (HI) systems provide data on population health, the determinants of health and health system performance within countries. The evaluation of these systems has traditionally focused on statistical practices and procedures, and not on data use or reuse for policy and practice. This limits the capacity to assess the impact of HI systems on healthcare provision, management and policy-making. On the other hand, the field of Knowledge Translation (KT) has developed frameworks to guide evidence into practice. METHODS: A scoping review of the KT literature to identify the essential mechanisms and determinants of KT that could help monitor the impact of HI systems. RESULTS: We examined 79 publications and we identified over 100 different KT frameworks but none of these were focused on HI systems per se. There were specific recommendations on disseminating evidence to stakeholders at the institutional and organizational level, and on sustaining the use of evidence in practice and the broader community setting. CONCLUSIONS: We developed a new model, the HI-Impact framework, in which four domains are essential for mapping the impact of national HI systems: (i) HI Evidence Quality, (ii) HI System Responsiveness, (iii) Stakeholder Engagement and (iv) Knowledge Integration. A comprehensive impact assessment of HI systems requires addressing the use of HI in public health decision-making, health service delivery and in other sectors which might have not been considered previously. Monitoring Stakeholder Engagement and Knowledge Integration certifies that the use of HI in all policies is an explicit point of assessment.

Changes in health in Belgium, 1990-2016: a benchmarking analysis based on the global burden of disease 2016 study.

BACKGROUND: Despite increasing of the Belgian health expenditures, several indicators related to population health showed poor results. The objectives of this study were to perform an in-depth analysis of the secular trend of Belgian health status using the Global Burden of Disease (GBD) 2016 study results for Belgium, and to compare these results with other European countries. METHODS: We collected results of the Global Burden of Disease 2016 study through the GBD results and visualization tools. We benchmarked Belgian GBD results with the other initial members of the European Union (EU15). RESULTS: Belgium performed significantly better in 2016 than in 1990 in terms of age-standardized (AS) Year of Life Lost (YLL) rates but not significantly different in terms of AS Year Lived with Disability (YLD) and Disability-Adjusted Life Year (DALY) rates. The contribution of AS YLDs to total of AS DALYs increased from 1990 (42%) to 2016 (54%). Although AS YLD and DALY rates did not seem to differ between Belgium and the EU15 from 1990 to 2016, the ranking of Belgium among the EU15 in terms of AS DALY and YLL rates was worse in 2016 than in 1990. Belgium had significantly higher AS YLL rates for lower respiratory infections (B: 264 AS YLLs [95% uncertainty interval [UI] 231-301] per 100,000; EU15: 188 AS YLLs [95%UI 168-212] per 100,000), chronic obstructive pulmonary disease (B: 368 AS YLLs [95%UI 331-407] per 100,000; EU15: 285 AS YLLs [95%UI 258-316] per 100,000) and tracheal, bronchus, and lung cancer (B: 785 AS YLLs [95%UI 699-879] per 100,000; EU15: 613 AS YLLs [95%UI 556-674] per 100,000). CONCLUSION: Belgium's ranking among the EU15 in terms of AS YLL and DALY rates decreased from 1990 to 2016. Significant health gains appear possible by acting on risk factors directly linked to a significant part of the Belgian burden of diseases, i.e., alcohol and tobacco consumption, and high body mass index. National burden of disease estimates can help defining Belgian health targets and are necessary as external validity of GBD results is not always guaranteed.

Short-term health effects in the general population following a major train accident with acrylonitrile in Belgium.

BACKGROUND: Following a train derailment, several tons of acrylonitrile (ACN) exploded, inflamed and part of the ACN ended up in the sewage system of the village of Wetteren. More than 2000 residents living in the close vicinity of the accident and along the sewage system were evacuated. A human biomonitoring study of the adduct N-2-cyanoethylvaline (CEV) was carried out days 14-21 after the accident. OBJECTIVES: (1) To describe the short-term health effects that were reported by the evacuated residents following the train accident, and (2) to explore the association between the CEV concentrations, extrapolated at the time of the accident, and the self-reported short-term health effects. METHODS: Short-term health effects were reported in a questionnaire (n=191). An omnibus test of independence was used to investigate the association between the CEV concentrations and the symptoms. Dose-response relationships were quantified by Generalized Additive Models (GAMs). RESULTS: The most frequently reported symptoms were local symptoms of irritation. In non-smokers, dose-dependency was observed between the CEV levels and the self-reporting of irritation (p=0.007) and nausea (p=0.007). Almost all non-smokers with CEV concentrations above 100pmol/g globin reported irritation symptoms. Both absence and presence of symptoms was reported by non-smokers with CEV concentrations below the reference value and up to 10 times the reference value. Residents who visited the emergency services reported more symptoms. This trend was seen for the whole range of CEV concentrations, and thus independently of the dose. DISCUSSION AND CONCLUSION: The present study is one of the first to relate exposure levels to a chemical released during a chemical incident to short-term (self-reported) health effects. A dose-response relation was observed between the CEV concentrations and the reporting of short-term health effects in the non-smokers. Overall, the value of self-reported symptoms to assess exposure showed to be limited. The results of this study confirm that a critical view should be taken when considering self-reported health complaints and that ideally biomarkers are monitored to allow an objective assessment of exposure.

Energy and macronutrient intakes in Belgium: results from the first National Food Consumption Survey.

Belgium until recently lacked a systematic survey of dietary habits of its inhabitants. The present study evaluated dietary composition in Belgium with respect to energy and macronutrient intakes. Information on food intake was collected using a repeated non-consecutive 24 h recall (2-8 weeks apart) with the validated software package EPIC-SOFT, in combination with a FFQ (self-administered) covering sixty food items. The database of consumed food items was linked to food composition data. Usual macronutrient intake was estimated by the Nusser method. A representative sample of the Belgian population was randomly selected from the national register following a multi-stage procedure. Information on dietary intake was obtained from 3245 subjects aged 15 years and older. Mean energy percentage (E %) of total fat (37.9 E %) and SFA (16.0 E %) was higher than the dietary reference intakes (DRI). Mean E % of total carbohydrates (45.8 E %) was lower than the DRI, while mean E % of mono/disaccharides was 20.3. Total fat and SFA intakes were higher and total carbohydrate and sugar intakes were lower in the older age categories than in the younger age categories. The percentage of energy from SFA intake was lower and that from carbohydrates was higher than that found in an earlier Belgian study. Further efforts are necessary to improve dietary macronutrient intake, taking into account differences in age categories. In addition, it will be important to monitor its changes regularly using trend analyses.

Socioeconomic inequalities in lung cancer mortality in 16 European populations.

OBJECTIVES: This paper aims to describe socioeconomic inequalities in lung cancer mortality in Europe and to get further insight into socioeconomic inequalities in lung cancer mortality in different European populations by relating these to socioeconomic inequalities in overall mortality and smoking within the same or reference populations. Particular attention is paid to inequalities in Eastern European and Baltic countries. METHODS: Data were obtained from mortality registers, population censuses and health interview surveys in 16 European populations. Educational inequalities in lung cancer and total mortality were assessed by direct standardization and calculation of two indices of inequality: the Relative Index of Inequality (RII) and the Slope Index of Inequality (SII). SIIs were used to calculate the contribution of inequalities in lung cancer mortality to inequalities in total mortality. Indices of inequality in lung cancer mortality in the age group 40-59 years were compared with indices of inequalities in smoking taking into account a time lag of 20 years. RESULTS: The pattern of inequalities in Eastern European and Baltic countries is more or less similar as the one observed in the Northern countries. Among men educational inequalities are largest in the Eastern European and Baltic countries. Among women they are largest in Northern European countries. Whereas among Southern European women lung cancer mortality rates are still higher among the high educated, we observe a negative association between smoking and education among young female adults. The contribution of lung cancer mortality inequalities to total mortality inequalities is in most male populations more than 10%. Important smoking inequalities are observed among young adults in all populations. In Sweden, Hungary and the Czech Republic smoking inequalities among young adult women are larger than lung cancer mortality inequalities among women aged 20 years older. CONCLUSIONS: Important socioeconomic inequalities exist in lung cancer mortality in Europe. They are consistent with the geographical spread of the smoking epidemic. In the next decades socioeconomic inequalities in lung cancer mortality are likely to persist and even increase among women. In Southern European countries we may expect a reversal from a positive to a negative association between socioeconomic status and lung cancer mortality. Continuous efforts are necessary to tackle socioeconomic inequalities in lung cancer mortality in all European countries.

Community transmission of influenza A (H1N1)v virus at a rock festival in Belgium, 2-5 July 2009.

On 6 July 2009 the Belgian enhanced surveillance system for influenza-like illness among travellers returning from influenza A(H1N1)v affected areas detected a case linked to a rock festival which took place on 2-5 July. The health authorities implemented communication and control measures leading to the detection of additional cases. This paper describes the outbreak and its impact on the management of the influenza pandemic in Belgium.

[Prevention of psychiatric disorders and suicide in the Belgium population older than 60 years. Results of the European Study on Epidemiology of Mental Disorders (ESEMeD)]. / Het voorkomen van psychische stoornissen en suïcidaliteit in de Belgische bevolking ouder dan 60 jaar. Resultaten van de European Study on Epidemiology of Mental Disorders (ESEMeD).

PURPOSE: This study aimed to examine the 12-month and lifetime prevalence rates of pure and comorbid mental disorders (mood, anxiety and alcohol disorders) in Belgian home-dwelling elderly. METHODS: A representative random sample of 665 non-instutionalized older adults (60+) from Belgium was interviewed in 2000 and 2001. DSM-IV disorders were assessed by interviewers trained to use a revised version of the World Mental Health Composite International Diagnostic Interview (WMH-CIDI) of the World Health Organization. RESULTS: Twenty percent of the respondents reported a lifetime history of at least one mental disorder; 5% met criteria for a a mental disorder in the past twelve months. Mood and anxiety disorders were the most common mental disorders. Almost 5% of the respondents reported suicidal ideation in their lifetime, while 0.22% had suicidal ideation in the past twelve months preceding the interview. CONCLUSIONS: Mental disorders are not uncommon in the Belgian home-dwelling elderly. The results of this study imply that in 2000-2001 at least five percent of the older adults living in the community had at least one mental disorder. Two in thousand older adults reported suicidal ideations in the 12 months preceding the interview.

Socioeconomic differences in the prevalence of common chronic diseases: an overview of eight European countries.

BACKGROUND: Few studies have compared socioeconomic inequalities in the prevalence of both fatal and non-fatal diseases. This paper aims to give the first international overview for several common chronic diseases. METHODS: Micro-level data were pooled from non-standardized national health surveys conducted in eight European countries in the 1990s. Surveys ranged in size from 3700 to 41 200 participants. The prevalence of 17 chronic disease groups were analysed in relation to education. Standardized prevalence rates and age-adjusted odds ratios (ORs) were calculated. RESULTS: Most diseases showed higher prevalence among the lower education group. Stroke, diseases of the nervous system, diabetes, and arthritis displayed relatively large inequalities (OR > 1.50). No socioeconomic differences were evident for cancer, kidney diseases, and skin diseases. Allergy was more common in the higher education group. Relative socioeconomic differences were often smaller among the 60-79 age group as compared with the 25-59 age group. Cancer was more prevalent among the lower educated in the 25-59 age group, but among the higher educated in the 60-79 age group. For diabetes, hypertension, and heart disease, socioeconomic differences were larger among women as compared with men. Inequalities in heart disease were larger in northern European countries as compared with southern European countries. CONCLUSION: There are large variations between chronic diseases in the size and pattern of socioeconomic differences in their prevalence. The large inequalities that are found for some specific fatal diseases (e.g. stroke) and non-fatal diseases (e.g. arthritis) require special attention in equity-oriented research and policies.

[The impact of mental disorders on daily functioning in the Belgian community. Results of the study "European Study on Epidemiology of Mental Disorders" (ESemeD)]. / Impact des troubles mentaux sur le fonctionnement quotidien de la population belge. Résultats de l'etude "European Study on Epidemiology of Mental Disorders" (ESemeD).

AIMS: This study reports the impact of mental disorders on daily functioning in the Belgian population. MATERIAL AND METHOD: A representative sample of 2419 non-institutionalised Belgian adults (18+) was interviewed between 2001 and 2002 using the Composite International Diagnostic Interview of the World Mental Health Surveys of the World Health Organisation (WMH-CIDI). Common mental disorders (mood, anxiety, and alcohol disorders--according to DSM-IV) and functional disabilities (according to the World Health Organization Disablement Assessment Scale--WHO-DAS-2) were assessed. RESULTS: Mood and anxiety disorders were associated with substantial levels of disability: social, emotional and physical domains were affected. Mood disorders were found to exert the largest impact in different domains of daily functioning, although the social life was most affected. Anxiety disorders were, on the contrary, more associated with emotional and physical discomfort. Persons with a alcohol disorder reported a substantially low impact on their daily functioning. CONCLUSIONS: Mental disorders affect several domains of daily functioning, with considerable limitations in personal and social life, but also with dramatic cutbacks in work productivity.

[Psychotropic drug use in the Belgian non-institutionalized population]. / Consommation de médicaments psychotropes dans la population belge. Résultats de l'European Study of the Epidemiology of Mental Disorders (ESEMeD).

OBJECTIVE: To assess psychotropic drug utilization in the general population of Belgium, and the pattern of use in individuals with mental disorders. METHOD: A representative random sample of non-institutionalized inhabitants from Belgium aged 18 or older (n = 2419) were interviewed between April 2001 and June 2002. Individuals were asked about any psychotropic drug use in the past 12 months, even if they used the drug(s) just once. The interview took place by means of the World Mental Health Composite International Diagnostic Interview (WMH-CIDI). RESULTS: Slightly more than 19% reported that they had used any psychotropic drug in the past 12 months; 11% had a 12-month mental disorder. The extent of psychotropic drug utilization varied according to the nature of the disorders: 60% in mood disorders, 53% in alcohol disorders, and 39% in anxiety disorders. Thirty nine percent of the respondents with a mood disorder consumed an antidepressant drug in the past year; 23% of the respondents with an anxiety disorder consumed an anxiolytic drug in the past 12 months. Among those who reported that they used antidepressants, selective serotonin reuptake inhibitors were most commonly consumed (SSRI). CONCLUSION: These data do not provide evidence for any over-consumption of psychopharmacological agents in Belgium. By contrast, they question the appropriateness of pharmacological treatments, in which under-treatment seems to be coupled with a high use of non-specific medications.

Cervical cancer screening in Belgium.

A description is given of the burden of cervical cancer and the status of screening in Belgium until 1998. Screening is essentially opportunistic and generally performed at yearly intervals. A programme for organised screening - promoting one cervical smear every 3 years for women aged between 25 and 64 years - is being set up in the Flemish Region alone. Important progress has been made concerning the development of technical guidelines on the collection of an adequate Papanicolaou (Pap) smear, uniform terminology for the cytological report and the follow-up of positive tests. The implementation of the programme is confined to the provinces that are instructed to make women and physicians aware of the screening policy. The establishment of a screening register, allowing for individualised invitation of women, was hampered by strict privacy laws and by the heterogeneity of software used for data entry in cytological laboratories. The impact of the Flemish programme was further limited since the reimbursement of smear taking by a gynaecologist or a general practitioner (GP) and the cytological reading are not conditioned by the respect of guidelines. This is due to the fact that the organisation of preventive healthcare and the financing of medical activities concerns distinct authorities. The coverage of the target population is good in Flanders (82.3% according to certain estimates), but is achieved at the expense of an important amount of over-screening. The coverage is lower in the Walloon and the Capital Region. Rationalisation of the policy regarding cancer screening involving all concerned authorities of the country is necessary.

Cervical cancer mortality in Belgium, 1955-1989. A descriptive study.

This study describes trends in cervical cancer mortality among women in Belgium from 1954 to 1989. Data are analysed by means of the standardised mortality rate, age- and cohort-specific mortality rates and standardised cohort mortality ratios. The age-standardised mortality rate decreased progressively from 6.3/100,000 women-years in the first period (1955-1959) to 3.8/100,000 in 1985-1989, indicating a decline of 39.7% over the seven quinquennial periods. A decrease was observed in almost all age groups between 30 and 69 years. In the last 15 years, no further decline, but even a discrete increase, occurred for the age categories younger than 50 years. The successive cohorts born between 1915 and 1939 expressed a continuing lower risk of cervical cancer mortality. This trend was not observed for the most recent generations, for whom even a slight increase of the standardised cohort mortality ratio could be distinguished.

Weight gain variation in infants of an impoverished community: Bellanse, Haiti.

Maintaining adequate growth remains one of the most difficult tasks for infants in developing countries. A cohort of rural infants (n = 354), median age four months, were weighed every 6-7 weeks over an 18-month period. Some 179 infants (51%) with weight information over at least 12 months were included in the study. The association between weight gain up to 6 months of age, and between 6 and 23 months of age, and factors amenable to prevention were assessed using weighted multiple linear regression. Infants whose mothers understood the 'Road to Health' chart had a weight gain that was 123 g/month (95% confidence interval (CI): 2-245) higher up to six months of age and 31 g/month (95% CI: 6-57) higher between 6 and 23 months of age compared to infants whose mothers did not seem to understand the chart. The weight gain between 6 and 23 months was also 28 g/month (95% CI: 3-54) higher for infants fully vaccinated at 11 months compared to not fully vaccinated children. It was 47 g/month (95% CI: 16-78) higher for infants living in two-parent families compared to children of a single-parent family. The results of the study suggest that maternal comprehension of the 'Road to Health' chart may contribute to more adequate weight gain.

PIP: Maintaining adequate growth remains 1 of the most difficult tasks for infants in developing countries. A cohort of 354 rural infants with a median age of 4 months were weighed every 6-7 weeks over an 18-month period. Some 179 of them (51%) with weight information over at least 12 months were included in the study. The association between weight gain up to 6 months of age and between 6-23 months of age, and factors amenable to prevention were assessed using weighted multiple linear regression. Infants whose mothers understood the "Road to Health" chart had a weight gain that was 123 g/month (95% confidence interval [CI]: 2-245) higher up to 6 months of age and 31 g/month (95% CI: 6-57) higher between 6-23 months of age compared to infants whose mothers did not seem to understand the chart. The weight gain between 6-23 months was also 28 g/month (95% CI: 3-54) higher for infants fully vaccinated at 11 months compared to not fully vaccinated children. It was 47 g/month (95% CI: 16-78) higher for infants living in 2-parent families compared to children from a single-parent household. The results of the study suggest that maternal comprehension of the "Road to Health" chart may contribute to more adequate weight gain.

Behavioural changes following lesions of the orbital prefrontal cortex in male rats.

Bilateral lesions were made, confined to the orbitofrontal part of the prefrontal cortex (OF) of male WEZOB rats at 3 different ages (30, 45 and 60 days) and behavioural changes were studied in adulthood. In a test situation for intermale aggression OF-lesioned animals showed a higher level of aggression than their control-operated opponents. Such changes were not witnessed in encounters with male rats of the less aggressive Wistar strain which emphasizes the importance of the choice of the opponents in tests for agonistic behaviour. OF lesioning did not interfere with male sexual behaviour. When tested in an open field, activity scores of OF-lesioned animals exceeded those of the control group. OF lesioning resulted in a slight but significant long-term weight reduction, 2-3 months following surgery, in comparison with the control group. However, a severe reduction in food intake (aphagia), immediately after the operation, was not observed. Increase in both aggression and locomotor activity was seen in all 3 age groups, and data do not support the hypothesis that sparing of function had occurred in the 30-day operates, as compared with the 60-day operates. However, the duration of allogrooming bouts per approach in the social agonistic situation did show a pattern depending on the lesion momentum: prepubertal OF lesions resulting in less frequent approaches and grooming bouts of longer duration. These findings are explained in terms of perseverative tendencies following OF lesions.

Sexual behavior in female rats born in all-female litters.

Females born in all-female litters and females stemming from predominantly male litters were compared for masculine (mounting) and feminine sexual behavior (lordosis) under various dosages of estradiol followed by progesterone and under testosterone stimulation. Estradiol did not affect mounting levels in these groups. A critical dose level was established at 0.25 mg/animal of estradiol for both groups with respect to receptive behavior. Testosterone treatment reliably stimulated mounting in these females, but no differences were determined with respect to the litter composition in utero. The results are considered as a critical and negative finding with regard to the possibility that testosterone stemming from male littermates in utero affects the female's sexual development.

Suppression of active sleep by chronic treatment with chlorimipramine during early postnatal development: effects upon adult sleep and behavior in the rat.

In an attempt to study the possible role of active sleep in brain development, male rats were injected twice daily with chlorimipramine, a potent monoamine reuptake blocker, from 1 week to 3 weeks of postnatal age. AS was reduced to less than 10% of total sleep time, the level found in mature rats. Most of the AS reduction was compensated for by quiet sleep but a slight increase in wakefulness also occurred, owing to brief interruptions of sleep at times when AS was expected. In adulthood, the AS-deprived rats showed a higher percentage of AS than did the controls, due to an increase in frequency and duration of AS epochs. Moreover, many of the epochs contained abnormally frequent and strong jerky body movements and rapid-eye-movements, reminiscent of neonatal AS patterns. In addition, the amplitude of hippocampal theta waves during AS was greater than in control rats. The chlorimipramine-treated rats also showed behavioral abnormalities in later life. On the open field test exploratory behavior was much reduced, while increased rearing and defecation occurred. Masculine sexual performance was severely deficient, primarily due to the low level of intromissions and ejaculations. Experimental animals performed less efficiently than controls on a temporal learning task (differential reinforcement of low response rate) and responded more rapidly on a spatial task (left-right alternation learning). These results demonstrate that early interference with the functioning of monoaminergic systems can have long-lasting physiological and behavioral consequences. Furthermore, they are consistent with the hypothesis that AS is an important factor in normal brain development.

Cervical cancer screening in the Flemish region (Belgium): measurement of the attendance rate by telephone interview.

In November and December 1995 a computer assisted telephone interview (CATI) was organized in order to measure the rate of participation in cervical cancer screening among a sample of 1,477 women between 18 and 69 years old, residing in the Flemish Region and selected by random digit dialling. Associations between screening status and a set of explanatory variables (demographic, socioeconomic determinants and exposition to primary risk factors for cervical cancer) were studied by logistic regression modelling. The screening coverage meaning the percentage of women screened less than 3 years ago, increases sharply up to 25 years and remains higher than 85% up to 40 years; from then it decreases progressively. Socioeconomically deprived groups and single women are less likely to have a smear taken. Notable regional differences exist. Over-screening (interval between Papanicolaou smears less than 3 years) is an important phenomenon among screened women especially within the younger age groups. The prevalence of risk factors (sexual intercourse at young age, multiple sex partners, contraceptive pill use, smoking) has increased over time but women at higher risk are generally better screened. This survey provides useful baseline information necessary to monitor the achievement of some main objectives, formulated by the Europe Against Cancer programme and also included in Flemish public health policy.