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Background: Burnout is related to huge costs, for both individuals and organizations and is recognized as an occupational disease or work-related disorder in many European countries. Given that burnout is a major problem it is important to measure the levels of burnout in a valid and reliable way. The Burnout Assessment Tool (BAT) is a newly developed self-report questionnaire to measure burnout. So far, studies concerning the psychometric properties of the original version of the Burnout Assessment Tool (BAT) including 23 items show promising results and suggest that the instrument can be used in many different settings. For various reasons there is a need of a shorter instrument. For example, burnout questionnaires are typically included in employee surveys to evaluate psychosocial risk-factors, which according to the European Occupational Safety and Health Framework Directive, should be carried out in organizations on a regular basis. The aims of this paper are to develop a shorter version of the BAT, including only 12 items (BAT12) and to evaluate its construct validity and differential item functioning regarding age, gender and country.Methods: Using data from representative samples of working populations in the Netherlands and Belgium (Flanders) a shorter version of the BAT was developed by combining quantitative (Rasch analysis) and qualitative approaches (item content analysis and expert judgements). Construct validity of the new BAT12 was evaluated by means of Rasch analysis.Results: In an iterative procedure, deleting one item from each subscale at each step, a short version of the BAT - BAT12 was developed. The BAT12 fulfils the measurement criteria according to the Rasch model after accounting for local dependency between items within each subscale. The four subscales can be combined into a single burnout score.Conclusion: The new BAT12 developed in the present study maintains the breath of item content of the original version of the BAT. The new BAT12 has sound psychometric properties. The scale works invariantly for older and younger, women and men and across two countries. A shorter version of the BAT is timesaving compared to the BAT23 and can be used in e.g. employee surveys. [ABSTRACT FROM AUTHOR]

Background: Work hours are an important aspect of one's job and these in turn have the potential to impact people's well-being. Much research investigating the link between working hours and well-being uses cross-sectional data. Longitudinal studies, especially those studying the same subjects changing their working time, can study the impact of work time more clearly. Using panel data, this study aims to explore the impact of a reduction in working time on three domains of well-being: general well-being, job-related well-being (positive work experience) and work-family well-being (work-family conflict). In addition, our study offers insights into the role of concomitant changes in work and private circumstances of employees as we investigate whether the impact of shorter working hours for well-being is mediated by changes in the participants' and circumstances related to paid and unpaid work resources. Method: An organization of about 60 (female) employees trialed a shorter workweek for one calendar year in 2019. All full-time employees reduced their hours. The part-time working employees can be used as a control group. Panel data (survey and time-use diary data) of a 30-h workweek trial in Belgium was collected in four waves over two years in a pre- and post-intervention design. Change over time (waves) was analyzed through multilevel growth models. Result: A decrease in work-family conflict was observed during the shorter workweek. Part of this decrease is explained by concomitant changes in work and private circumstances, such as sufficiency in free time, schedule control, and satisfaction with work pressure. Positive work experience and general well-being tend to have decreased during the shorter workweek, although this could partly be explained by other organizational changes and not by the reduction in working hours per se. Schedule control helped suppress these somewhat negative effects of organizational changes on positive work experience. Conclusion: Reduced working hours have the largest and most positive impact on work-family conflict. The feeling of having enough leisure time contributes to this increased well-being. Especially for women, who were the majority in this study, a reduction in working time might be beneficial as they often bear more responsibility for household work and care tasks. Next to the duration of working time, schedule control/autonomy has an important impact on well-being. [ABSTRACT FROM AUTHOR]

Background: Mid-March 2020, Belgium went in lockdown to combat the COVID-19-pandemic. Having to provide school-based day care and adapt to online teaching, while all social, cultural and sports events and activities were cancelled, secondary school teachers' physical activity (PA) and sedentary behaviour (SB) may have been affected considerably. This study investigates the impact of the first Belgian lockdown on PA and SB in Flemish secondary school teachers. Methods: This prospective cohort study was conducted throughout the 2019–2020 school year. PA and SB measured in March/April 2020 were compared with a pre-lockdown measurement in January/February 2020. Other pre-lockdown measurements (September/October 2019 and November/December 2019) and one other during-lockdown measurement (May/June 2020) allowed us to control for confounding. Validated questionnaires were used to assess participants' PA and SB. Generalized linear mixed models were applied in R. Results: Among 624 participants (77·2% females, 43·3 ± 10·3 years), increases were observed for total PA (+ 108 min/week; p = 0·047), moderate PA (+ 217 min/week; p = 0·001), domestic and garden PA (+ 308 min/week; p < 0·0001) and leisure-time PA (+ 131 min/week; p < 0·0001), whereas work-related PA (-289 min/week; p < 0·0001) and active transportation (-38 min/week; p =0·005) decreased. No differences were observed for walking (p = 1·0) and vigorous PA (p = 0·570). Increases were found for total SB (+ 972 min/week; p < 0·0001), work-related SB (+ 662 min/week; p < 0·0001) and leisure-time SB (+ 592 min/week; p = 0·0004), whereas transport-related SB (-290 min/week; p < 0·0001) decreased. Conclusion: During the lockdown, we found in our sample that Flemish secondary school teachers showed an increase in SB that was 9 times as high as their PA increase. As a government, education network or school, it is crucial to sensitize, promote, and facilitate sufficient MVPA and/or walking, but likewise to discourage SB during pandemic-induced lockdowns. [ABSTRACT FROM AUTHOR]

The trajectory of COVID-19 epidemic waves in the general population of Belgium was analysed by defining quantitative criteria for epidemic waves from March 2020 to early 2023. Peaks and starting/ending times characterised nine waves numerated I to IX based on the daily reported incidence number (symbol INCID) and three "endemic" interval periods between the first four waves. The SIR compartmental model was applied to the first epidemic wave by fitting the daily prevalence pool (symbol I) calculated as the sum of the daily incidence rate and estimated number of subjects still infectious from the previous days. The basic reproductive number R0 was calculated based on the exponential growth rate during the early phase and on medical literature knowledge of the time of generation of SARS-CoV-2 infection. The first COVID-19 wave was well fitted by an open SIR model. According to this approach, dampened recurrent epidemic waves evolving through an endemic state would have been expected. This was not the case with the subsequent epidemic waves being characterised by new variants of concern (VOC). Evidence-based observations: 1) each epidemic wave affected less than a fifth of the general population; 2) the Vth epidemic wave (VOC Omicron) presented the greatest amplitude. The lack of recurrence of the same VOC during successive epidemic waves strongly suggests that a VOC has a limited persistence, disappearing from the population well before the expected proportion of the theoretical susceptible cohort being maximally infected. Fitting the theoretical SIR model, a limited persistence of VOCs in a population could explain that new VOCs replace old ones, even if the new VOC has a lower transmission rate than the preceding one. In conclusion, acquisition of potential defective mutations in VOC during an epidemic wave is a potential factor explaining the absence of resurgence of a same VOC during successive waves. Such an hypothesis is open to discussion and to rebuttal. A modified SIR model with epidemic waves of variable amplitude related not only to R0 and public health measures but also to acquisition of defective fitting in virus within a population should be tested. [ABSTRACT FROM AUTHOR]

Environmental stress represents an important burden on health and leads to a considerable number of diseases, hospitalisations, and excess mortality. Our study encompasses a representative sample size drawn from the Belgian population in 2016 (n = 11.26 million, with a focus on n = 11.15 million individuals). The analysis is conducted at the geographical level of statistical sectors, comprising a total of n = 19,794 sectors, with a subset of n = 18,681 sectors considered in the investigation. We integrated multiple parameters at the finest spatial level and constructed three categories of environmental stress through clustering: air pollution, noise stress and stress related to specific land-use types. We observed identifiable patterns in the spatial distribution of stressors within each cluster category. We assessed the relationship between age-standardized all-cause mortality rates (ASMR) and environmental stressors. Our research found that especially very high air pollution values in areas where traffic is the dominant local component of air pollution (ASMR + 14,8%, 95% CI: 10,4 – 19,4%) and presence of industrial land (ASMR + 14,7%, 95% CI: 9,4 – 20,2%) in the neighbourhood are associated with an increased ASMR. Cumulative exposure to multiple sources of unfavourable environmental stress (simultaneously high air pollution, high noise, presence of industrial land or proximity of primary/secondary roads and lack of green space) is associated with an increase in ASMR (ASMR + 26,9%, 95% CI: 17,1 – 36,5%). [ABSTRACT FROM AUTHOR]

Background: Disability and chronic conditions both have an impact on health expenditures and although they are conceptually related, they present different dimensions of ill-health. Recent concepts of disability combine a biological understanding of impairment with the social dimension of activity limitation and resulted in the development of the Global Activity Limitation Indicator (GALI). This paper reports on the predictive value of the GALI on health care expenditures in relation to the presence of chronic conditions. Methods: Data from the Belgian Health Interview Survey 2008 were linked with data from the compulsory national health insurance (n = 7,286). The effect of activity limitation on health care expenditures was assessed via cost ratios from multivariate linear regression models. To study the factors contributing to the difference in health expenditure between persons with and without activity limitations, the Blinder-Oaxaca decomposition method was used. Results: Activity limitations are a strong determinant of health care expenditures. People with severe activity limitations (5.1%) accounted for 16.9% of the total health expenditure, whereas those without activity limitations (79.0%), were responsible for 51.5% of the total health expenditure. These observed differences in health care expenditures can to some extent be explained by chronic conditions, but activity limitations also contribute substantially to higher health care expenditures in the absence of chronic conditions (cost ratio 2.46; 95% CI 1.74-3.48 for moderate and 4.45; 95% CI 2.47-8.02 for severe activity limitations). The association between activity limitation and health care expenditures is stronger for reimbursed health care costs than for out-of-pocket payments. Conclusion: In the absence of chronic conditions, activity limitations appear to be an important determinant of health care expenditures. To make projections on health care expenditures, routine data on activity limitations are essential and complementary to data on chronic conditions. [ABSTRACT FROM AUTHOR]

Background: When conducting COVID-19 contact tracing, pre-defined criteria allow differentiating high-risk contacts (HRC) from low-risk contacts (LRC). Our study aimed to evaluate whether contact tracers in Belgium followed these criteria in practice and whether their deviations improved the infection risk assessment. Method: We conducted a retrospective cohort study in Belgium, through an anonymous online survey, sent to 111,763 workers by email. First, we evaluated the concordance between the guideline-based classification of HRC or LRC and the tracer's classification. We computed positive and negative agreements between both. Second, we used a multivariate Poisson regression to calculate the risk ratio (RR) of testing positive depending on the risk classification by the contact tracer and by the guideline-based risk classification. Results: For our first research question, we included 1105 participants. The positive agreement between the guideline-based classification in HRC or LRC and the tracer's classification was 0.53 (95% CI 0.49–0.57) and the negative agreement 0.70 (95% CI: 0.67–0.72). The type of contact tracer (occupational doctors, internal tracer, general practitioner, other) did not significantly influence the results. For the second research question, we included 589 participants. The RR of testing positive after an HRC compared to an LRC was 3.10 (95% CI: 2.71–3.56) when classified by the contact tracer and 2.24 (95% CI: 1.94–2.60) when classified by the guideline-based criteria. Conclusion: Our study indicates that contact tracers did not apply pre-defined criteria for classifying high and low risk contacts. Risk stratification by contact tracers predicts who is at risk of infection better than guidelines only. This result indicates that a knowledgeable tracer can target testing better than a general guideline, asking for a debate on how to adapt the guidelines. [ABSTRACT FROM AUTHOR]

Background Educational attainment has been shown to influence access to and quality of health care. However, the influence of educational attainment on decision-making at the end of life with possible or certain life-shortening effect (ELDs ie intensified pain and symptom alleviation, non-treatment decisions, euthanasia/physician-assisted suicide, and life-ending acts without explicit request) is scarcely studied. This paper examines differences between educational groups pertaining to prevalence of ELDs, the decision-making process and end-of-life treatment characteristics. Method We performed a retrospective survey among physicians certifying a large representative sample of Belgian deaths in 2007. Differences between educational groups were adjusted for relevant confounders (age, sex, cause of death and marital status). Results Intensified pain and symptom alleviation and non-treatment decisions are more likely to occur in higher educated than in lower educated patients. These decisions were less likely to be discussed with either patient or family, or with colleague physicians, in lower educated patients. A positive association between education and prevalence of euthanasia/assisted suicide (acts as well as requests) disappeared when adjusting for cause of death. No differences between educational groups were found in the treatment goal in the last week, but higher educated patients were more likely to receive opioids in the last day of life. Conclusion There are some important differences and possible inequities between educational groups in end-of-life decision-making in Belgium. Future research should investigate whether the found differences reflect differences in knowledge of and adherence to patient preferences, and indicate a discrepancy in quality of the end of life. [ABSTRACT FROM AUTHOR]

Background: In Europe, progress in the development of health policies that address the needs of migrants and ethnic minorities has been slow. This is partly due to the absence of a strategic commitment by the health authorities. The Ministry of Public Health commissioned the ETHEALTH (EThnicity & HEALTH) group to formulate relevant recommendations to the public authorities with a view to reducing health inequalities among ethnic minorities. This paper describes the political process and the outcomes of the ETHEALTH expert group. Results: After ten meetings, the ETHEALTH group came up with 46 recommendations, which were presented at a national press conference in December 2011. Target groups concerned by these recommendations covered both irregular migrants and migrants entitled to the national insurance coverage. Recommendations were supported by the need of combining universal approaches to health care with more specific approaches. The scope of the recommendations concerned health care as well as prevention, health promotion and access to health care. When analysing the content of the recommendations, some ETHEALTH recommendations were not fully measurable, and time-related; they were, however, quite specific and realistic within the Belgian context. The weak political commitment of an executive agency was identified as a major obstacle to the implementation of the recommendations. Conclusions: The ETHEALTH group was an example of scientific advice on a global health issue. It also demonstrated the feasibility of coming up with a comprehensive strategy to decrease ethnic health inequalities, even in a political context where migration issues are sensitive. Two final lessons may be highlighted at the end of the first phase of the ETHEALTH project: firstly, the combination of scientific knowledge and practical expertise makes recommendations SMART; and, secondly, the low level of commitment on the part of policymakers might jeopardise the effective implementation of the recommendations. [ABSTRACT FROM AUTHOR]

Background: There are insufficient research reports on the wide-scale dissemination of effective whole-community physical activity (PA) programs. The purpose of this paper is to evaluate the impact of the wide-scale dissemination of '10,000 Steps', using the RE-AIM framework. Methods: Dissemination efforts targeted a large region of Belgium and were concentrated on media strategies and peer networks of specific professional organizations, such as local health promotion services. Heads of department of 69 organizations received an on-line survey to assess project awareness, adoption, implementation and intended continuation of '10,000 Steps'. On the individual level, 755 citizens living in the work area of the organizations were interviewed for project awareness and PA levels. Measures were structured according to the REAIM dimensions (reach, effectiveness, adoption, implementation, maintenance). Independent sample t and chisquare tests were used to compare groups for representativeness at the organizational and individual level, and for individual PA differences. Results: Of all organizations, 90% was aware of '10,000 Steps' (effectiveness - organizational level) and 36% adopted the project (adoption). The global implementation score was 52%. One third intended to continue the project in the future (maintenance) and 48% was still undecided. On the individual level, 35% of citizens were aware of '10,000 Steps' (reach). They reported significantly higher leisure-time PA levels than those not aware of '10,000 Steps' (256 ± 237 and 207 ± 216 min/week, respectively; t = -2.8; p < .005) (effectiveness - individual level). When considering representativeness, adoption of '10.000 Steps' was independent of most organizational characteristics, except for years of experience in PA promotion (7.6 ± 4.6 and 2.9 ± 5.9 years for project staff and non-project staff members, respectively; t = 2.79; p < 0.01). Project awareness in citizens was independent of all demographic characteristics. Conclusions: '10,000 Steps' shows potential for wide-scale dissemination but a supportive linkage system seems recommended to encourage adoption levels and high quality implementation. [ABSTRACT FROM AUTHOR]

Background: During the COVID-19 pandemic, the CoMix study, a longitudinal behavioral survey, was designed to monitor social contacts and public awareness in multiple countries, including Belgium. As a longitudinal survey, it is vulnerable to participants' "survey fatigue", which may impact inferences. Methods: A negative binomial generalized additive model for location, scale, and shape (NBI GAMLSS) was adopted to estimate the number of contacts reported between age groups and to deal with under-reporting due to fatigue within the study. The dropout process was analyzed with first-order auto-regressive logistic regression to identify factors that influence dropout. Using the so-called next generation principle, we calculated the effect of under-reporting due to fatigue on estimating the reproduction number. Results: Fewer contacts were reported as people participated longer in the survey, which suggests under-reporting due to survey fatigue. Participant dropout is significantly affected by household size and age categories, but not significantly affected by the number of contacts reported in any of the two latest waves. This indicates covariate-dependent missing completely at random (MCAR) in the dropout pattern, when missing at random (MAR) is the alternative. However, we cannot rule out more complex mechanisms such as missing not at random (MNAR). Moreover, under-reporting due to fatigue is found to be consistent over time and implies a 15-30% reduction in both the number of contacts and the reproduction number ( R 0 ) ratio between correcting and not correcting for under-reporting. Lastly, we found that correcting for fatigue did not change the pattern of relative incidence between age groups also when considering age-specific heterogeneity in susceptibility and infectivity. Conclusions: CoMix data highlights the variability of contact patterns across age groups and time, revealing the mechanisms governing the spread/transmission of COVID-19/airborne diseases in the population. Although such longitudinal contact surveys are prone to the under-reporting due to participant fatigue and drop-out, we showed that these factors can be identified and corrected using NBI GAMLSS. This information can be used to improve the design of similar, future surveys. [ABSTRACT FROM AUTHOR]

Background: Since 2014, Belgium's Superior Health Council has recommended pneumococcal vaccination for adults aged 19–85 years at increased risk for pneumococcal diseases with a specific vaccine administration sequence and timing. Currently, Belgium has no publicly funded adult pneumococcal vaccination program. This study investigated the seasonal pneumococcal vaccination trends, evolution of vaccination coverage and adherence to the 2014 recommendations. Methods: INTEGO is a general practice morbidity registry in Flanders (Belgium) that represents 102 general practice centres and comprised over 300.000 patients in 2021. A repeated cross-sectional study was performed for the period between 2017 and 2021. Using adjusted odds ratios computed via multiple logistic regression, the association between an individual's characteristics (gender, age, comorbidities, influenza vaccination status and socioeconomic status) and schedule-adherent pneumococcal vaccination status was assessed. Results: Pneumococcal vaccination coincided with seasonal flu vaccination. The vaccination coverage in the population at risk decreased from 21% in 2017 to 18.2% in 2018 and then started to increase to 23.6% in 2021. Coverage in 2021 was highest for high-risk adults (33.8%) followed by 50- to 85-year-olds with comorbidities (25.5%) and healthy 65- to 85-year-olds (18.7%). In 2021, 56.3% of the high-risk adults, 74.6% of the 50+ with comorbidities persons, and 74% of the 65+ healthy persons had an adherent vaccination schedule. Persons with a lower socioeconomic status had an adjusted odds ratio of 0.92 (95% Confidence Interval (CI) 0.87–0.97) for primary vaccination, 0.67 (95% CI 0.60–0.75) for adherence to the recommended second vaccination if the 13-valent pneumococcal conjugate vaccine was administered first and 0.86 (95% CI 0.76–0.97) if the 23-valent pneumococcal polysaccharide vaccine was administered first. Conclusion: Pneumococcal vaccine coverage is slowly increasing in Flanders, displaying seasonal peaks in sync with influenza vaccination campaigns. However, with less than one-fourth of the target population vaccinated, less than 60% high-risk and approximately 74% of 50 + with comorbidities and 65+ healthy persons with an adherent schedule, there is still much room for improvement. Furthermore, adults with poor socioeconomic status had lower odds of primary vaccination and schedule adherence, demonstrating the need for a publicly funded program in Belgium to ensure equitable access. [ABSTRACT FROM AUTHOR]

Background: A global shift towards more healthy and sustainable diets is necessary for the prevention of obesity and chronic diseases, as well as for the growing pressure on our ecosystems. Given that parents are important actors in affecting dietary behaviors of their children, developing intervention strategies targeting families and their practices is promising to reach positive behavior change among children. Also, it is important to tailor these interventions to the needs of parents with different socioeconomic statuses (SES), given that health inequalities continue to grow. This study aims to investigate perspectives of lower and higher SES parents on the usability and acceptability of various innovative intervention strategies. Methods: Fourteen focus groups and four individual interviews (n = 78, nlowerSES = 17; nhigherSES = 61) were conducted in Belgium. A semi-structured interview guide was used to facilitate the discussions. The interviews were recorded, transcribed, and analyzed via thematic content analysis using NVivo. Results: To encourage healthy and sustainable food choices, interventions via online food shopping platforms and nudging strategies in grocery stores were mostly cited by higher SES parents, but these were less applicable for lower SES parents as they buy less online and mainly consider the price of products. Mobile applications that provide inspiration for healthy and sustainable recipes and easily accessible shopping lists received moderate support among lower and higher SES parents. Furthermore, both lower and higher SES parents showed interest in meal boxes delivered at home, but lower SES parents have not yet tried such meal boxes because of their higher prices. Still, both groups of SES parents mentioned many advantages of these meal boxes, such as the convenience and time-saving component, as well as the cooking inspiration aspect. Conclusion: Our study reveals the preferences of lower and higher SES parents for practical intervention strategies, providing insight in what features these strategies should have to be acceptable and useful. Hence, the findings can inform the development of a tailored family-based intervention strategy to improve parental food choices in favor of increased health and sustainability. [ABSTRACT FROM AUTHOR]

Background: In the current labour system many workers are still exposed to heavy physical demands during their job. In contrast to leisure time physical activity (LTPA), occupational physical activity (OPA) is associated with an increased risk of cardiovascular diseases and all-cause mortality, termed "the physical activity (PA) health paradox". In order to gain more insight into the PA health paradox, an exploration of structural preventive measures at the workplace is needed and therefore objective field measurements are highly recommended. The objective of this paper is to provide an overview of the protocol of the Flemish Employees' Physical Activity (FEPA) study, including objective measurements of PA, heart rate (HR) and cardiorespiratory fitness (CRF) to gain more insight into the PA health paradox.Methods: A total of 401 workers participated in the FEPA study across seven companies in the service and production sector in Belgium. The participants comprised 167 men and 234 women, aged 20 to 65 years. OPA and LTPA were assessed by two Axivity AX3 accelerometers on the thigh and upper back. Ambulatory HR was measured by the Faros eMotion 90° monitor. Both devices were worn during two to four consecutive working days. In addition, CRF was estimated by using the Harvard Step Test. Statistical analyses will be performed using Pearson correlation, and multiple regression adjusted for possible confounders.Discussion: This study aims to provide a better insight in the PA health paradox and the possible buffering factors by using valid and objective measurements of PA and HR (both during LTPA and OPA) over multiple working days. The results of the study can contribute to the prevention of cardiovascular disease by providing tailored recommendations for participants with high levels of OPA and by disseminating the results and recommendations to workplaces, policy makers and occupational health practitioners. [ABSTRACT FROM AUTHOR]

Background: Policymakers worldwide took measures to limit the spread of the COVID-19-virus. While these sanitary measures were necessary to fight the spread of the virus, several experts warned for a significant impact on mental health and a potential increase in domestic violence. To study the impact of the COVID-19 measures in Belgium, and the factors influencing the occurrence of domestic violence, we set up the study on relationships, stress, and aggression. In this study, we evaluate the prevalence of domestic violence victimization during the COVID-19 lockdown in Belgian children aged zero to seventeen years and the associations of the parents' financial status, relationships, mental health, and previous victimization to the child's victimization.Methods: A stepwise forward binary logistic regression was used to analyse the association between multiple risk factors of domestic violence and victimization of the respondent's child. The respondent being an assailant, the respondent's age, and the age of the children in the household were added as moderators.Results: In this model an association with domestic child abuse was found for the age of the respondent, the household's size, the presence of children between zero and five years in the household, the perceived stress level of the respondent, and victimization of the respondent during the first wave of the sanitary measures, as well as victimization before the COVID-19 pandemic. None of the interacting effects were found to be significant.Conclusion: It is advisable to make extra efforts to improve well-being when maintaining sanitary measures by providing appropriate assistance and helping households struggling with increased or acute stress to install positive coping strategies - especially in larger households with children between six and 17 years. Besides, our findings draw attention to the clustering of risk of child and adult violence exposure in lockdown situations as well as to the potential cumulative impact of exposure to violence across the lifespan and across generations. It is key to invest in training healthcare workers and staff at schools to screen for and assess risks of domestic violence development and ongoing or past occurrence in order to detect, refer and follow-up on families at risk. [ABSTRACT FROM AUTHOR]

Background: This study aimed to estimate annual health care and lost productivity costs associated with excess weight among the adult population in Belgium, using national health data.Methods: Health care costs and costs of absenteeism were estimated using data from the Belgian national health interview survey (BHIS) 2013 linked with individual health insurance data (2013-2017). Average yearly health care costs and costs of absenteeism were assessed by body mass index (BMI) categories - i.e., underweight (BMI < 18.5 kg/m2), normal weight (18.5 ≤ BMI < 25 kg/m2), overweight (25 ≤ BMI < 30 kg/m2) and obesity (BMI ≥ 30 kg/m2). Health care costs were also analysed by type of cost (i.e. ambulatory, hospital, reimbursed medication). The cost attributable to excess weight and the contribution of various other chronic conditions to the incremental cost of excess weight were estimated using the method of recycled prediction (a.k.a. standardisation).Results: According to BHIS 2013, 34.7% and 13.9% of the Belgian adult population were respectively affected by overweight or obesity. They were mostly concentrated in the age-group 35-65 years and had significantly more chronic conditions compared to the normal weight population. Average total healthcare expenses for people with overweight and obesity were significantly higher than those observed in the normal weight population. The adjusted incremental annual health care cost of excess weight in Belgium was estimated at €3,329,206,657 (€651 [95% CI: €144-€1,084] and €1,015 [95% CI: €343-€1,697] per capita for individuals with overweight and obesity respectively). The comorbidities identified to be the main drivers for these incremental health care costs were hypertension, high cholesterol, serious gloom and depression. Mean annual incremental cost of absenteeism for overweight accounted for €242 per capita but was not statistically significant, people with obesity showed a significantly higher cost (p < 0.001) compared to the normal weight population: €2,015 [95% CI: €179-€4,336] per capita. The annual total incremental costs due to absenteeism of the population affected by overweight and obesity was estimated at €1,209,552,137. Arthritis, including rheumatoid arthritis and osteoarthritis, was the most important driver of the incremental cost of absenteeism in individuals with overweight and obesity, followed by hypertension and low back pain.Conclusions: The mean annual incremental cost of excess weight in Belgium is of concern and stresses the need for policy actions aiming to reduce excess body weight. This study can be used as a baseline to evaluate the potential savings and health benefits of obesity prevention interventions. [ABSTRACT FROM AUTHOR]

Background: The burden of cardiovascular diseases (CVDs) greatly varies between and within countries. Low- and middle-income countries (LMICs) and vulnerable communities of high-income countries (HIC) share disproportionately higher burden. Evidence is limited on the level of CVD knowledge and risk perception in vulnerable communities. Hence, in this study, we assessed the level of CVD knowledge, risk perception and change intention towards physical activity and healthy diet among vulnerable communities in Antwerp, Belgium and Nottingham, England. Furthermore, we investigated the socioeconomic disparities particularly in the Antwerp setting.Method: A cross-sectional study was performed among 1,424 adults (958 in Antwerp and 466 in Nottingham) aged 18 or older among selected vulnerable communities. Districts or counties were selected based on socioeconomic and multiple deprivation index. A stratified random sampling was used in Antwerp, and purposive sampling in Nottingham. We determined the level of CVD knowledge, risk perception and intention towards a healthy lifestyle in Antwerp and Nottingham using a percentage score out of 100. To identify independent socioeconomic determinants in CVD knowledge, risk perception, intention to PA and healthy diet, we performed multilevel multivariable modeling using the Antwerp dataset.Results: The mean knowledge percent score was 75.4 in Antwerp and 69.4 in Nottingham, and only 36.5% and 21.1% of participants respectively, had good CVD knowledge (scored 80% or above). In the multivariable analysis using the Antwerp dataset, level of education was significantly associated with (1) CVD knowledge score (Adjusted β = 0.11, 95%CI: 0.03, 0.18), (2) risk perception (0.23, 95%CI: 0.04, 0.41), (3) intention to physical activity (PA) (0.51, 95%CI: 0.35, 0.66), and (4) healthy diet intention (0.54, 95%CI: 0.32, 0.75). Furthermore, those individuals with a higher household income had a better healthy diet intention (0.44, 95%CI: 0.23, 0.65). In contrast, those who were of non-European origin scored lower on intention to have a healthy diet (-1.34, 95%CI:-2.07, -0.62) as compared to their European counterparts. On average, intention to PA was significantly higher among males (-0.43, 95%CI:-0.82, -0.03), whereas females scored better on healthy diet intention (2.02, 95%CI: 1.46, 2.57).Conclusions: Knowledge towards CVD risks and prevention is low in vulnerable communities. Males have a higher intention towards PA while females towards a healthy diet and it also greatly varies across level of education. Moreover, those born outside Europe and with low household income have lower healthy diet intention than their respective counterparts. Hence, CVD preventive interventions should be participatory and based on a better understanding of the individuals' socioeconomic status and cultural beliefs through active individual and community engagement. [ABSTRACT FROM AUTHOR]

Background: Every year, volunteers of the Belgian Red Cross provide onsite medical care at more than 8000 mass gathering events and other manifestations. Today standardized planning tools for optimal preventive medical resource use during these events are lacking. This study aimed to develop and validate a prediction model of patient presentation rate (PPR) and transfer to hospital rate (TTHR) at mass gatherings in Belgium.Methods: More than 200,000 medical interventions from 2006 to 2018 were pooled in a database. We used a subset of 28 different mass gatherings (194 unique events) to develop a nonlinear prediction model. Using regression trees, we identified potential predictors for PPR and TTHR at these mass gatherings. The additional effect of ambient temperature was studied by linear regression analysis. Finally, we validated the prediction models using two other subsets of the database.Results: The regression tree for PPR consisted of 7 splits, with mass gathering category as the most important predictor variable. Other predictor variables were attendance, number of days, and age class. Ambient temperature was positively associated with PPR at outdoor events in summer. Calibration of the model revealed an R2 of 0.68 (95% confidence interval 0.60-0.75). For TTHR, the most determining predictor variables were mass gathering category and predicted PPR (R2 = 0.48). External validation indicated limited predictive value for other events (R2 = 0.02 for PPR; R2 = 0.03 for TTHR).Conclusions: Our nonlinear model performed well in predicting PPR at the events used to build the model on, but had poor predictive value for other mass gatherings. The mass gathering categories "outdoor music" and "sports event" warrant further splitting in subcategories, and variables such as attendance, temperature and resource deployment need to be better recorded in the future to optimize prediction of medical usage rates, and hence, of resources needed for onsite emergency medical care. [ABSTRACT FROM AUTHOR]

Background: Mental health disorders appear as a growing problem in urban areas. While common mental health disorders are generally linked to demographic and socioeconomic factors, little is known about the interaction with the urban environment. With growing urbanization, more and more people are exposed to environmental stressors potentially contributing to increased stress and impairing mental health. It is therefore important to identify features of the urban environment that affect the mental health of city dwellers. The aim of this study was to define associations of combined long-term exposure to air pollution, noise, surrounding green at different scales, and building morphology with several dimensions of mental health in Brussels.Methods: Research focuses on the inhabitants of the Brussels Capital Region older than 15 years. The epidemiological study was carried out based on the linkage of data from the national health interview surveys (2008 and 2013) and specifically developed indicators describing each participant's surroundings in terms of air quality, noise, surrounding green, and building morphology. These data are based on the geographical coordinates of the participant's residence and processed using Geographical Information Systems (GIS). Mental health status was approached through several validated indicators: the Symptom Checklist-90-R subscales for depressive, anxiety and sleeping disorders and the 12-Item General Health Questionnaire for general well-being. For each mental health outcome, single and multi-exposure models were performed through multivariate logistic regressions.Results: Our results suggest that traffic-related air pollution (black carbon, NO2, PM10) exposure was positively associated with higher odds of depressive disorders. No association between green surrounding, noise, building morphology and mental health could be demonstrated.Conclusions: These findings have important implications because most of the Brussel's population resides in areas where particulate matters concentrations are above the World Health Organization guidelines. This suggests that policies aiming to reduce traffic related-air pollution could also reduce the burden of depressive disorders in Brussels. [ABSTRACT FROM AUTHOR]

Background: National public health agencies are required to prioritise infectious diseases for prevention and control. We applied the prioritisation method recommended by the European Centre for Disease Prevention and Control to rank infectious diseases, according to their relative importance for surveillance and public health, to inform future public health action in Belgium.Methods: We applied the multi-criteria-decision-analysis approach. A working group of epidemiologists and statisticians from Belgium (n = 6) designed a balanced set of prioritisation criteria. A panel of Belgian experts (n = 80) allocated in an online survey each criteria a weight, according to perceived relative importance. Next, experts (n = 37) scored each disease against each criteria in an online survey, guided by disease-specific factsheets referring the period 2010-2016 in Belgium. The weighted sum of the criteria's scores composed the final weighted score per disease, on which the ranking was based. Sensitivity analyses quantified the impact of eight alternative analysis scenarios on the top-20 ranked diseases. We identified criteria and diseases associated with data-gaps as those with the highest number of blank answers in the scoring survey. Principle components of the final weighted score were identified.Results: Working groups selected 98 diseases and 18 criteria, structured in five criteria groups. The diseases ranked highest were (in order) pertussis, human immunodeficiency virus infection, hepatitis C and hepatitis B. Among the five criteria groups, overall the highest weights were assigned to 'impact on the patient', followed by 'impact on public health', while different perceptions were identified between clinicians, microbiologists and epidemiologists. Among the 18 individual criteria, 'spreading potential' and 'events requiring public health action' were assigned the highest weights. Principle components clustered with thematic disease groups. Notable data gaps were found among hospital-related diseases.Conclusions: We ranked infectious diseases using a standardised reproducible approach. The diseases ranked highest are included in current public health programs, but additional reflection for example about needs among risk groups is recommended. Cross-reference of the obtained ranking with current programs is needed to verify whether resources and activities map priority areas. We recommend to implement this method in a recurrent evaluation cycle of national public health priorities. [ABSTRACT FROM AUTHOR]

Background: The objective of this work was to analyse the prevalence trends of multimorbidity among European community-dwelling adults.Methods: A temporal series study based on waves 1, 2, 4, 5, 6 and 7 of the Survey of Health, Ageing and Retirement in Europe (SHARE) was conducted, and community-dwelling participants aged 50+ (n = 274,614) from 15 European countries were selected for the period 2004-2017. Prevalence, adjusted by age, Average Annual Percentage Change (APC) and 95% confidence interval (95% CI) were all calculated. Trend analyses were realised by period, age groups and groups of diseases.Results: The results showed a large variability in the prevalence of multimorbidity in adults aged 50 and over among European countries. Increase in the prevalence of multimorbidity in the countries of central Europe (Austria, Belgium, Czech Republic, France, Germany and Switzerland) and Spain in both sexes, and in the Netherlands among men. Stability was observed in northern and eastern European countries. Musculoskeletal and neurodegenerative groups showed more significant changes in the trend analyses.Conclusions: This information can be useful for policy makers when planning health promotion and prevention policies addressing modifiable risk factors in health. [ABSTRACT FROM AUTHOR]

Background: Monovalent meningococcal C conjugate vaccine (MCCV) was introduced into the routine immunization program in many countries in Europe and worldwide following the emergence of meningococcal serogroup C (MenC) in the late 1990s. This systematic literature review summarizes the immediate and long-term impact and effectiveness of the different MCCV vaccination schedules and strategies employed.Methods: We conducted a systematic literature search for peer-reviewed, scientific publications in the databases of MEDLINE (via PubMed), LILACS, and SCIELO. We included studies from countries where MCCV have been introduced in routine vaccination programs and studies providing the impact and effectiveness of MCCV published between 1st January 2001 and 31st October 2017.Results: Forty studies were included in the review; 30 studies reporting impact and 17 reporting effectiveness covering 9 countries (UK, Spain, Italy, Canada, Brazil, Australia, Belgium, Germany and the Netherlands). Following MCCV introduction, significant and immediate reduction of MenC incidence was consistently observed in vaccine eligible ages in all countries with high vaccine uptake. The reduction in non-vaccine eligible ages (especially population > 65 years) through herd protection was generally observed 3-4 years following introduction. Vaccine effectiveness (VE) was mostly assessed through screening methods and ranged from 38 to 100%. The VE was generally highest during the first year after vaccination and waned over time. The VE was better maintained in countries employing catch-up campaigns in older children and adolescents, compared to routine infant only schedules.Conclusions: MCCV were highly effective, showing a substantial and sustained decrease in MenC invasive meningococcal disease. The epidemiology of meningococcal disease is in constant transition, and some vaccination programs now include adolescents and higher valent vaccines due to the recent increase in cases caused by serogroups not covered by MCCV. Continuous monitoring of meningococcal disease is essential to understand disease evolution in the setting of different vaccination programs. [ABSTRACT FROM AUTHOR]

Background: Research on inequalities in cervical cancer screening (CCS) participation has overlooked the distinction between 'never-' and 'under-screeners' while different socioeconomic and demographic determinants may underlie 'non-' and 'under-' screening participation. This study examines socioeconomic and demographic inequalities in never and under CCS participation. We compare cross-national prevalence and trends among these two groups in Switzerland and Belgium, two countries with similar opportunistic CCS strategy but different healthcare systems.Methods: Data on 38,806 women aged 20-70 from the Swiss Health Interview Survey (1992-2012) and 19,019 women aged 25-64 from the Belgian Health Interview Survey (1997-2013), both population-based cross-sectional nationally representative surveys, was analysed. Weighted adjusted prevalence ratios were estimated with multivariate Poisson regressions.Results: Over the studied period, never screening prevalence was about 15% in both Switzerland and Belgium and under screening prevalence about 14.0%. Socioeconomic gradients were found among both never- and under-screeners. Higher income women had lower never and under screening prevalence in Switzerland and a similar gradient in education was observed in Belgium. Importantly, distinct socioeconomic and demographic determinants were found to underlie never and under screening participation. Never screening was significantly higher among foreign nationals in both countries and this association was not observed in under screening. Never screening prevalence was lower among older age groups, while under screening increased with older age. Over time, age inequalities diminished among never- and under- screeners in Switzerland while educational inequalities increased among never-screeners in Belgium.Conclusion: Findings revealed that determinants of screening inequalities differed among never- and under-screeners and hence these should be addressed with different public health strategies. Crucially, socioeconomic and demographic inequalities were more pronounced among never-screeners who appeared to face more structural and persistent inequalities. Differences between the two countries should also be noted. The more liberal-type Swiss healthcare systems appeared to shape income-related screening inequalities, while education appeared to be a stronger determinant of never- and under-screening in Belgium. [ABSTRACT FROM AUTHOR]

Background: Serological surveillance, based on the measurement of the presence of specific antibodies in a given population, can be used in addition to traditional and routine disease surveillance methods. The added value of this has been largely documented for vaccine-preventable diseases, but to a lesser extent for vector-borne diseases. This study aimed to evaluate the utility of seroprevalence data as additional source of information on the epidemiology of Lyme borreliosis in Belgium.Methods: In total, 3215 residual blood samples collected in 2013-2015 were analysed with Liaison® Borrelia IgG kit (DiaSorin S.p.A, Saluggia, Italy). Positive and equivocal results were further examined with immunoblotting (recomLine Borrelia IgG kit, Mikrogen, Neuried, Germany). Crude prevalence estimates of equivocal and seropositive results were calculated and further adjusted accounting for clustered sampling and standardized for age, sex and population per province, according to the Belgian population structure in 2014. The effect of age, sex and region on seropositivity was assessed using log-binomial regression.Results: The overall weighted national seroprevalence for Borrelia burgdorferi sensu lato, adjusted for clustered sampling, age, sex and province was 1.06% (95%CI 0.67-1.67). Although not statistically significant, the highest prevalences were observed in men and in those younger than 15 years or older than 59 years of age. At provincial level, the seroprevalence estimates do not follow the geographical distribution of tick bites and diagnoses of Lyme borreliosis as detected through other surveillance systems.Conclusions: Although the use of residual samples for seroprevalence estimates has several advantages, it seems to be a limited tool for serological surveillance of Lyme borreliosis in Belgium, other than follow-up of trends if repeated over time. A population-based sampling strategy might provide a more representative nationwide sample, but would be very time intensive and expensive. Seroprevalence studies within risk groups or risk areas in Belgium could provide a useful alternative approach to complement routine surveillance data of Lyme borreliosis. [ABSTRACT FROM AUTHOR]

Background: In this longitudinal study the complex interplay between both job strain and bullying in relation to sickness absence was investigated. Following the "work environment hypothesis", which establishes several work characteristics as antecedents of bullying, we assumed that job strain, conceptualized by the Job-Demand-Control model, has an indirect relation with long-term sickness absence through bullying.Methods: The sample consisted of 2983 Belgian workers, aged 30 to 55 years, who participated in the Belstress III study. They completed a survey, including the Job Content Questionnaire and a bullying inventory, at baseline. Their sickness absence figures were registered during 1 year follow-up. Long-term sickness absence was defined as at least 15 consecutive days. A mediation analysis, using structural equation modeling, was performed to examine the indirect association of job strain through bullying with long-term sickness absence. The full structural model was adjusted for several possible confounders: age, gender, occupational group, educational level, company, smoking habits, alcohol use, body mass index, self-rated health, baseline long-term sickness absence and neuroticism.Results: The results support the hypothesis: a significant indirect association of job strain with long-term sickness absence through bullying was observed, suggesting that bullying is an intermediate variable between job strain and long-term sickness absence. No evidence for the reversed pathway of an indirect association of bullying through job strain was found.Conclusions: Bullying was observed as a mediating variable in the relation between job strain and sickness absence. The results suggest that exposure to job strain may create circumstances in which a worker risks to become a target of bullying. Our findings are generally in line with the work environment hypothesis, which emphasizes the importance of organizational work factors in the origin of bullying. This study highlights that remodeling jobs to reduce job strain may be important in the prevention of bullying and subsequent sickness absence. [ABSTRACT FROM AUTHOR]

Background: As the snacking pattern of European adolescents is of great concern, effective interventions are necessary. Till now health promotion efforts in children and adolescents have had only limited success in changing adolescents' eating patterns and anthropometrics. Therefore, the present study proposes an innovative approach to influence dietary behaviors in youth based on new insights on effective behavior change strategies and attractive intervention channels to engage adolescents. This article describes the rationale, the development, and evaluation design of the 'Snack Track School' app. The aim of the app is to improve the snacking patterns of Flemish 14- to 16-year olds.Methods: The development of the app was informed by the systematic, stepwise, iterative, and collaborative principles of the Intervention Mapping protocol. A four week mHealth intervention was developed based on the dual-system model with behavioral change strategies targeting both the reflective (i.e., active learning, advance organizers, mere exposure, goal-setting, monitoring, and feedback) and automatic processes (i.e., rewards and positive reinforcement). This intervention will be evaluated via a controlled pre-post design in Flemish schools among 1400 adolescents.Discussion: When this intervention including strategies focused on both the reflective and automatic pathway proves to be effective, it will offer a new scientifically-based vision, guidelines and practical tools for public health and health promotion (i.e., incorporation of learning theories in intervention programs).Trial Registration: NCT02622165 registrated November 15, 2015 on clinicaltrials.gov. [ABSTRACT FROM AUTHOR]

Background: Although female sex workers (FSWs) are a well-known high-risk group for Human Papillomavirus (HPV) infections, few tailored intervention programmes for HPV have been established worldwide. The lack of reliable data on the prevalence of HPV and related cervical lesions hampers the establishment of evidence-based intervention programmes. The objectives of this study were to describe the prevalence of high-risk Human Papillomavirus (hrHPV) infections and abnormal pap smears in FSWs compared to a control group in Antwerp, Belgium.Methods: HPV genotyping and cytology data were analysed from routine Pap smear tests that were collected from both FSWs and the general population (1334 samples for each group) between June 2006 and June 2010. Within the laboratory database, all FSWs were matched 1:1 for age and testing date to determine the ORs of hrHPV genotypes, DNA and cytology outcome.Results: The prevalence of hrHPV DNA in FSWs was 41.7 % compared to 19.8 % in the age-matched controls with an overall OR of 2.8 (95 % CI: 2.3-3.4). Significant differences were observed in all age groups, and the most significant differences were observed in the cohort under 21 years of age (prevalence of 64.4 % in FSWs versus 14.8 % in controls; OR 10.3 (95 % CI: 5.0-21.2). Significantly more cervical lesions were observed in FSWs, particularly in the 17- to 21-year old age group (OR for LSIL or HSIL: 10.3 (95 % CI: 3.2-33.8). In both groups, HPV 16 was the most prevalent at 12.1 and 6.6 % in the FSW and control groups, respectively. HPV 18 was the 8(th) and 7(th) most frequent genotype at 5.0 and 2.5 % in the FSW and control groups, respectively.Conclusions: FSWs have a significantly higher prevalence of hrHPV and more abnormal Pap smears than does the general population in Antwerp, Belgium. The hrHPV prevalence in FSWs is similar to that reported in the literature. The need for tailored intervention programmes should be investigated further. [ABSTRACT FROM AUTHOR]

Background: Recent research has illustrated the need for cross-sector partnerships to tackle multidimensional problems such as health inequalities and sport and physical activity promotion. Capacity building is based on partnerships and has demonstrated effectiveness in tackling these multidimensional problems. This study aims to explain how cross-sector partnerships build capacity at the practitioner, organisational and partnership levels. The subject of this study is a community sport program (CSP) that aims to increase sport participation rates and physical activity levels.Methods: The study examined multiple cases in four disadvantaged communities in Antwerp, Belgium where the CSP was implemented. Forty-four face-to-face interviews were held with leaders from sport, social, health, culture and youth organisations that collaborated with the CSP.Results: Thirteen elements of cross-sector partnerships were identified as critical to building capacity at each of the different levels. These include: process evaluation, trust, mutuality, policy support, partner complementarity and fit, diversity of activities and period of collaboration-time. Trust in turn was fostered by a longer period of collaboration-time, better personal contact, clearer coordination and an external focus. Policy support was developed by support of partners and establishing clear metrics of success.Conclusion: Insight into the key elements of cross-sector partnerships that build capacity is given and several practical recommendations are suggested for practitioners and policy makers. [ABSTRACT FROM AUTHOR]

Background: The evidence that inspires and fosters communication skills, teaching programmes and clinical recommendations are often based on national studies which assume, implicitly, that patients' preferences towards doctors' communication style are not significantly affected by their cultural background. The cross-cultural validity of national results has been recognized as a potential limitation on how generally applicable they are in a wider context. Using 35 country-specific focus group discussions from four European countries, the aim of the present study is to test whether or not national cultures influence lay people's preferences towards doctors' style of communication.Methods: Lay people preferences on doctor's communication style have been collected in Belgium, the Netherlands, the United Kingdom and Italy. Each centre organized between eight and nine focus groups, where participants (n = 259) were asked to comment on a video of a simulated medical interview. The discussions were audiotaped, transcribed and coded using a common framework (Guliver Coding System) that allowed for the identification of different themes.Results: The frequency distribution of the topics discussed highlights lay people's generally positive views towards most part of doctors interventions. The regression model applied to the Guliver categories highlighted slight national differences and the existence of a cross-cultural appreciation, in particular, of five types of intervention: Doctors attitudes (both Task-Oriented and Affective/Emotional), Summarizing, Structuring and Providing solution.Conclusion: Lay panels valued doctors' communication style in a similar manner in the countries selected. This highlights the existence of a common background, which in the process of internationalization of heath care, might foster the implementation of cross-national teaching programmes and clinical guidelines. [ABSTRACT FROM AUTHOR]

Background: Prisoners constitute a high-risk population, particularly for infectious diseases. The aim of this study was to estimate the level of infectious risk in the prisons of five different European countries by measuring to what extent the prison system adheres to WHO/UNODC recommendations.Methods: Following the methodology used in a previous French survey, a postal/electronic questionnaire was sent to all prisons in Austria, Belgium, Denmark and Italy to collect data on the availability of several recommended HIV-HCV prevention interventions and HBV vaccination for prisoners. A score was built to compare adherence to WHO/UNODC recommendations (considered a proxy of environmental infectious risk) in those 4 countries. It ranged from 0 (no adherence) to 12 (full adherence). A second score (0 to 9) was built to include data from a previous French survey, thereby creating a 5-country comparison.Results: A majority of prisons answered in Austria (100 %), France (66 %) and Denmark (58 %), half in Belgium (50 %) and few in Italy (17 %), representing 100, 74, 89, 47 and 23 % coverage of the prison populations, respectively. Availability of prevention measures was low, with median adherence scores ranging from 3.5 to 4.5 at the national level. These results were confirmed when using the second score which included France in the inter-country comparison. Overall, the adherence score was inversely associated with prison overpopulation rates (p = 0.08).Conclusions: Using a score of adherence to WHO/UNODC recommendations, the estimated environmental infectious risk remains extremely high in the prisons of the 5 European countries assessed. Public health strategies should be adjusted to comply with the principle of equivalence of care and prevention with the general community. [ABSTRACT FROM AUTHOR]

Background European men who have sex with men (MSM) continue to be disproportionally affected by the human immunodeficiency virus (HIV). Several factors are contributing to the rates of new HIV infections among MSM. The aim of this study was to investigate the potential role of travel behaviour and sexual mobility in the spread of HIV and sexually transmitted infections (STI) among European MSM. Methods Belgian data from the first pan-European MSM internet survey EMIS was used (n=3860) to explore individual and contextual determinants of sexual behaviour among MSM, who resided in Belgium at the time of data collection and who reported having had sexual contact abroad in the last 12 months. Descriptive and bivariate analyses were performed. Odds ratios and 95% confidence intervals were calculated by means of logistic regression. Results MSM who practiced unprotected anal intercourse UAI during their last sexual encounter abroad were less likely to be living in a large city (OR:0.62, 95% CI:0.45-0,86, p<0.01) and more likely to be HIV positive (OR: 6.20, 95% CI:4.23-9.06, p<0.001) ), to have tested HIV positive in the last 12 months (OR:3.07, 95% CI:1.07-8.80, p<0.05), to have been diagnosed with any STI in the last 12 months (OR:2.55; 95% CI:1.77-3.67, p<0.05), to have used party drugs (OR:2.22, 95% CI :1.59-3.09, p<0.001), poppers (OR:1.52, 95% CI:1.07-2.14, p<0.001) and erection enhancing substances (OR:2.23, 95% CI:1.61-3.09, p<0.001) compared to MSM who did not have UAI with their last sexual partner abroad. Men having had UAI in the last 12 months were more likely to have done so in a neighbouring country of Belgium (OR: 1.66, 95% CI:1.21-2.29, p<0.001). Different sexual behavioural patterns related to condom use and drug use were identified according to HIV test status among travelling men. Conclusions The results of this study provide evidence for the role of international mobility and sexual behavior while travelling, in the spread of HIV and STI among MSM in Europe. Further, the findings underline the need for development of European cross-border HIV and STI interventions with coherent messages and prevention policies for MSM. [ABSTRACT FROM AUTHOR]

Bakckground: The first aim was to examine the effect of the UP4FUN pilot intervention on children's total sedentary time. The second aim was to investigate if the intervention had an effect on children's physical activity (PA) level. Finally, we aimed to investigate demographic differences (i.e. age, gender, ethnicity, living status and having siblings) between children in the intervention group who improved in sedentary time and PA at post-test and children in the intervention group who worsened in sedentary time and PA at post-test. Methods: The six weeks UP4FUN intervention was tested in a randomized controlled trial with pre-test post-test design with five intervention and five control schools in Belgium and included children of the 5th and 6th grade. The children wore accelerometers for seven days at pre- and post-test. Analyses included children with valid accelerometer data for at least two weekdays with minimum 10h-wearing time and one weekend day with 8h-wearing time. Result: Final analyses included 372 children (60% girls, mean age = 10.9 ± 0.7 years). There were no significant differences in the change in sedentary time or light PA between intervention and control schools for the total sample or for the subgroup analyses by gender. However, children (specifically girls) in the intervention group had a higher decrease in moderate-to-vigorous PA than children in the control group. In the intervention group, children who lived with both parents and children with one or more siblings were less likely to reduce sedentary time after exposure to the intervention. Older children, girls and children who lived with both parents were less likely to increase light PA after the intervention. Conclusion: The UP4FUN intervention did not result in an effect on children's sedentary time. Based on the high amounts of accelerometer-derived sedentary time in this age group, more efforts are needed to develop strategies to reduce children's sedentary time. [ABSTRACT FROM AUTHOR]

The article discusses a study which examines the health promotion and intervention programs that consider the benefits of physical activity and healthy eating in individuals with mental disorders in sheltered housing. It details the design of the study through a cluster preference randomized controlled trial in a sheltered housing in Belgium. It describes the baseline findings on the effectiveness and cost-effectiveness based on the unhealthy condition of the study population.

The article focuses on the study which investigates several facts related to the use of alcohol and cannabis. These includes, the effects of education type, when it is used as a proxy of one's social status, clear differences will exist between students from different types of education, regardless of students' familial socioeconomic background and that the effects of education type differ according to their cultural background.

The article presents a study investigating the relationship between physical environmental factors and older adults' walking and cycling for transportation and recreation. As mentioned, urban residents were found to be more likely to walk for transportation daily compared to semi-urban and rural residents. It is also mentioned that, daily cycling for transportation was less prevalent among urban compared to semi-urban residents.

Background: In adult research, neighborhood walkability has been acknowledged as an important construct among the built environmental correlates of physical activity. Research into this association has only recently been extended to adolescents and the current empirical evidence is not consistent. This study investigated whether neighborhood walkability and neighborhood socioeconomic status (SES) are associated with physical activity among Belgian adolescents and whether the association between neighborhood walkability and physical activity is moderated by neighborhood SES and gender. Methods: In Ghent (Belgium), 32 neighborhoods were selected based on GIS-based walkability and SES derived from census data. In total, 637 adolescents (aged 13-15 year, 49.6% male) participated in the study. Physical activity was assessed using accelerometers and the Flemish Physical Activity Questionnaire. To analyze the associations between neighborhood walkability, neighborhood SES and individual physical activity, multivariate multi-level regression analyses were conducted. Results: Only in low-SES neighborhoods, neighborhood walkability was positively associated with accelerometerbased moderate to vigorous physical activity and the average activity level expressed in counts/minute. For active transport to and from school, cycling for transport during leisure time and sport during leisure time no association with neighborhood walkability nor, with neighborhood SES was found. For walking for transport during leisure time a negative association with neighborhood SES was found. Gender did not moderate the associations of neighborhood walkability and SES with adolescent physical activity. Conclusions: Neighborhood walkability was related to accelerometer-based physical activity only among adolescent boys and girls living in low-SES neighborhoods. The relation of built environment to adolescent physical activity may depend on the context. [ABSTRACT FROM AUTHOR]

Background: We investigated dynamic patterns and predictors of HPV vaccination initiation in Flanders (Belgium) by girls aged 12 to 18, between 2007 and 2009, the period immediately after the introduction of the HPV vaccines on the Belgian market. During this period the initiative for vaccination was taken by the girl, her family or the general practitioner/pediatrician/gynecologist. Methods: We used a Cox regression model with time constant and time varying predictors to model hazard rates of HPV vaccination initiation. The sample existed of 117,151 female members of the National Alliance of Christian Mutualities, the largest sickness fund in Flanders. Results: The study showed that the hazard of HPV vaccination initiation was higher (1) for older girls, (2) for girls with a more favorable socio-economic background, (3) under more generous reimbursement regimes (with this effect being more pronounced for girls with weak socioeconomic backgrounds), (4) for girls that were informed personally about the reimbursement rules. Conclusions: When the initiative for HPV vaccination lies with the girls, their families or the physicians (no organized setting) the uptake of the vaccines is affected by both individual and organizational factors. [ABSTRACT FROM AUTHOR]

The article offers information on a study conducted by the authors related to sedentary behaviours, television viewing time and internet use of adults in Ghent, Belgium. It states that participants answered mail-out survey about sedentary behaviors and their potential socio-demographic and home environmental correlates. It highlights that age, self-efficacy and educational level were most important correlates.

Background: Although the incidence of the use of life-ending drugs without explicit patient request has been estimated in several studies, in-depth empirical research on this controversial practice is nonexistent. Based on face-to-face interviews with the clinicians involved in cases where patients died following such a decision in general practice in Belgium, we investigated the clinical characteristics of the patients, the decision-making process, and the way the practice was conducted.Methods: Mortality follow-back study in 2005-2006 using the nationwide Sentinel Network of General Practitioners, a surveillance instrument representative of all GPs in Belgium. Standardised face-to-face interviews were conducted with all GPs who reported a non-sudden death in their practice, at home or in a care home, which was preceded by the use of a drug prescribed, supplied or administered by a physician without an explicit patient request.Results: Of the 2690 deaths registered by the GPs, 17 were eligible to be included in the study. Thirteen interviews were conducted. GPs indicated that at the time of the decision all patients were without prospect of improvement, with persistent and unbearable suffering to a (very) high degree in nine cases. Twelve patients were judged to lack the competence to make decisions. GPs were unaware of their patient's end-of-life wishes in nine cases, but always discussed the practice with other caregivers and/or the patient's relatives. All but one patient received opioids to hasten death. All GPs believed that end-of-life quality had been "improved considerably".Conclusions: The practice of using life-ending drugs without explicit patient request in general practice in Belgium mainly involves non-competent patients experiencing persistent and unbearable suffering whose end-of-life wishes can no longer be ascertained. GPs do not act as isolated decision-makers and they believe they act in the best interests of the patient. Advance care planning could help to inform GPs about patients' wishes prior to their loss of competence. [ABSTRACT FROM AUTHOR]

Background: This study compares prevalence and types of medical end-of-life decisions between the Dutch-speaking and French-speaking communities of Belgium. This is the first nationwide study that can make these comparisons and the first measurement after implementation of the euthanasia law (2002). Methods: We performed a mortality follow-back study in 2005-2006. Data were collected via the nationwide Sentinel Network of General Practitioners, an epidemiological surveillance system representative of all Belgian GPs. Weekly, all GPs reported the medical end-of-life decisions among all non-sudden deaths of patients in their practice. We compared the northern Dutch-speaking (60%) and southern French-speaking communities (40%) controlling for population differences. Results: We analysed 1690 non-sudden deaths. An end-of-life decision with possible lifeshortening effect was made in 50% of patients in the Dutch-speaking community and 41% of patients in the French-speaking community (OR 1.4; 95%CI, 1.2 to 1.8). Continuous deep sedation until death occurred in 8% and 15% respectively (OR 0.5; 95%CI, 0.4 to 0.7). Community differences regarding the prevalence of euthanasia or physician-assisted suicide were not significant. Community differences were more present among home/care home than among hospital deaths: non-treatment decisions with explicit life-shortening intention were made more often in the Dutch-speaking than in the French-speaking community settings (OR 2.2; 95%CI, 1.2 to 3.9); while continuous deep sedation occurred less often in the Dutch-speaking community settings (OR 0.5; 95%CI, 0.3 to 0.9). Conclusion: Even though legal and general healthcare systems are the same for the whole country, there are considerable variations between the communities in type and prevalence of certain end-of-life decisions, even after controlling for population differences. [ABSTRACT FROM AUTHOR]

Background: Reliable studies of the incidence and characteristics of medical end-of-life decisions with a certain or possible life shortening effect (ELDs) are indispensable for an evidence-based medical and societal debate on this issue. This article presents the protocol drafted for the 2007 ELD Study in Flanders, Belgium, and outlines how the main aims and challenges of the study (i.e. making reliable incidence estimates of end-of-life decisions, even rare ones, and describing their characteristics; allowing comparability with past ELD studies; guaranteeing strict anonymity given the sensitive nature of the research topic; and attaining a sufficient response rate) are addressed in a post-mortem survey using a representative sample of death certificates. Study design: Reliable incidence estimates are achievable by using large at random samples of death certificates of deceased persons in Flanders (aged one year or older). This entails the cooperation of the appropriate administrative authorities. To further ensure the reliability of the estimates and descriptions, especially of less prevalent end-of-life decisions (e.g. euthanasia), a stratified sample is drawn. A questionnaire is sent out to the certifying physician of each death sampled. The questionnaire, tested thoroughly and avoiding emotionally charged terms is based largely on questions that have been validated in previous national and European ELD studies. Anonymity of both patient and physician is guaranteed through a rigorous procedure, involving a lawyer as intermediary between responding physicians and researchers. To increase response we follow the Total Design Method (TDM) with a maximum of three follow-up mailings. Also, a nonresponse survey is conducted to gain insight into the reasons for lack of response. Discussion: The protocol of the 2007 ELD Study in Flanders, Belgium, is appropriate for achieving the objectives of the study; as past studies in Belgium, the Netherlands, and other European countries have shown, strictly anonymous and thorough surveys among physicians using a large, stratified, and representative death certificate sample are most suitable in nationwide studies of incidence and characteristics of end-of-life decisions. There are however also some limitations to the study design. [ABSTRACT FROM AUTHOR]

Background: This open, multicentre, observational survey investigated how physicians diagnose neuropathic pain (NeP) by applying the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) scale, and how neuropathic pain conditions are managed in daily practice in Belgium. Methods: Physicians were asked to complete the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) scale for diagnosing NeP, and to fill out a questionnaire regarding the management of NeP, together with a questionnaire evaluating the impact of pain on sleep and daily life. Data on 2,480 pain patients were obtained. A LANSS score ≥ 12 (meaning NeP is most probably present) was reported for 1,163 patients. Pathologies typically associated with NeP scored above 12 on the LANSS scale, contrary to pathologies generally considered as being of non-neuropathic origin. Results: Over 90% of the patients with a LANSS score ≥ 12 reported that the pain impaired sleep. A high impact on social, family and professional life was also recorded. Additional examinations were performed in 89% of these patients. Most patients were taking multiple drugs, mainly paracetamol and non-steroidal anti-inflammatory drugs, indicating that physicians generally tend to follow treatment guidelines of chronic nociceptive pain, rather than the specific ones for NeP. Specific neuropathic guidelines rather recommend the use of anti-epileptic drugs, tricyclic antidepressants or weak opioids as first-line treatment. Conclusion: In our survey, application of the LANSS scale lead to pronounced treatment simplification with fewer drug combinations. Awareness about NeP as well as its specific treatment recommendations should be raised among healthcare providers. We concluded that the LANSS screening scale is an interesting tool to assist physicians in detecting NeP patients in routine clinical care. [ABSTRACT FROM AUTHOR]

Background: Diet is an essential determinant of health. Among the health determinants, we find access problems that are summarized as food insecurity. While such food insecurity has been studied in other countries and correlated to several health problems, it has been scarcely assessed in Belgium. The purpose of this work was to determine the factors of food insecurity existing within the Belgian population.Method: From November 2016 to February 2017, a qualitative study using semi-structured interviews with 19 adults present attending the waiting rooms of six Public Social Action Centers in French-speaking Belgium, analyzed by grounded theory.Results: In Belgium, for given food preferences and needs, food insecurity could be summarized as inadequacy between necessary and available resources within two dimensions: at the access level, for financial, temporal, informational, and freedom of action, and at the food use level, for temporal factors, material, knowledge, and skills. In these situations of inadequacy, participants reported finding either strategies to restore balance, or being forced to alter the quality or quantity of their diet.Conclusion: While several factors of food insecurity may exist in Belgium, it appears essential that the first line of care these factors into consideration, since they could interfere with care and health, and because the first line of care is ideally placed to inform and refer the patients in question. Several courses of action are proposed in this work, which must still be confirmed by other studies. [ABSTRACT FROM AUTHOR]

Background: Belgium has a large migrant community that is increasingly ageing. As migrants may have faced environmental and social exposures before, during and after migration, they may have experienced an accelerated epidemiological transition. Studying mortality differentials between the migrant and native population may therefore allow for a better understanding of the aetiology of diseases. While many studies have assessed migrant mortality, few have looked into the role of gender or the trend over time. Therefore, this study aims to probe into mortality differences between the native and migrant population for all major causes of death (COD) during the 1990s and 2000s. We will discriminate between all major migrant groups and men and women as they have different migration histories.Methods: Individually linked data of the Belgian Census, the National Register and death certificates for the periods 1991-1997 and 2001-2008 were used. Migrant origin was based on both own and parents' origin, hereby maximizing the population with migrant roots. We included native Belgians and migrants from the largest migrant groups aged 25 to 65 years. Both absolute and relative mortality differences by migrant origin were calculated for the most common COD.Results: We generally observed a migrant advantage for overall, cause-specific and cancer-specific mortality, with infection-related cancer mortality being the only exception. The effect was particularly strong for lifestyle-related COD, non-western migrants, and men. Over time, mortality declined among native Belgian men and women, yet remained stable for several migrant groups. This converging trend was largely due to smoking and reduced reproductive behaviour among migrants.Conclusions: The migrant mortality advantage stresses that there is room for improvement in the area of health in Belgium. Since the largest differences between native Belgians and migrants were observed for lifestyle-related diseases, and there is a tendency towards convergence of mortality over time, primary prevention tackling the most vulnerable groups remains crucial. Moreover, efforts should be made to ensure equal access to health care among the social and cultural strata. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Although alcohol is socially accepted in most Western societies, studies are clear about its associated negative consequences, especially among university and college students. Studies on the relationship between alcohol-related consequences and both beverage type and drinking onset, however, are scarce, especially in a European context. The aim of this research was, therefore, twofold: (1) What is the relationship between beverage type and the negative consequences experienced by students? and (2) Are these consequences determined by early drinking onset? We will examine these questions within the context of a wide range of alcohol-related consequences.Methods: The analyses are based on data collected by the inter-university project 'Head in the clouds?', measuring alcohol use among students in Flanders (Belgium). In total, a large dataset consisting of information from 19,253 anonymously participating students was available. Negative consequences were measured using a shortened version of the Core Alcohol and Drug Survey (CADS_D). Data were analysed using negative binomial regression.Results: Results vary depending on the type of alcohol-related consequences: Personal negative consequences occur frequently among daily beer drinkers. However, a high rate of social negative consequences was recorded for both daily beer drinkers and daily spirits drinkers. Finally, early drinking onset was significantly associated with both personal and social negative consequences, and this association was especially strong between beer and spirits drinking onset and social negative consequences.Conclusions: Numerous negative consequences, both personal and social, are related to frequent beer and spirits drinking. Our findings indicate a close association between drinking beer and personal negative consequences as well as between drinking beer and/or spirits and social negative consequences. Similarly, early drinking onset has a major influence on the rates of both personal and social negative consequences. The earlier students started drinking, the more negative consequences they experienced during college or university. Several (policy) interventions are discussed. This study is the first to incorporate detailed information on both beverage type and drinking onset, and its associated negative consequences, as measured by the CADS_D, in a large student population. [ABSTRACT FROM AUTHOR]

Background: Suicidal ideation, or thinking about death and suicide, is common across all layers of society. The aim of this paper is to add to the understanding of suicidal ideation in the general population, as well as help-seeking behaviors and perceived unmet mental health needs among those who report suicidal thoughts., Methods: The research is part of a representative population-based survey study of mental wellbeing in Antwerp (Flanders, Belgium) carried out in 2021. A total of 1202 participants between 15 and 80 years old answered the Ask Suicide-Screening Questions (ASQ), and an additional question about suicide plans. Participation was by invitation only and possible online or via a postal paper questionnaire. Univariate and multivariate logistic regression analyses were used to explore the association between both current suicidal ideation and self-reported lifetime suicide attempt with the sociodemographic factors age, gender, educational level, origin and financial distress. Moreover, formal care use for mental health was examined among those experiencing suicidal ideation, and logistic regression analyses were used to assess associated sociodemographic factors. Finally, perceived unmet mental health needs were assessed among suicide ideators., Results: The point-prevalence of suicidal ideation was 8.6% and was higher among younger age groups and individuals reporting financial distress. The lifetime-prevalence of suicide attempts is 6.5% and was higher in younger people and individuals with a primary educational level and with financial distress. About half (45.6%) of those with suicidal ideation consulted a professional for mental health problems in the past twelve months. Men and those with a primary educational level were less likely to seek help. Half of suicide ideators without care use perceived some need for mental health care, and a third of suicide ideators who used care perceived the obtained help as insufficient, resulting in a population prevalence of 3.6% suicide ideators with a fully or partially perceived unmet need., Conclusions: The prevalence of suicide attempts, suicidal ideation and unmet needs among suicide-ideators is high in this Belgian sample. Mental health care need perception in suicide ideators needs further investigation., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: Although migrants constitute an important proportion of the European population, little is known about migrant sexual health. Existing research mainly focuses on migrants' sexual health risks and accessibility issues while recommendations on adequate sexual health promotion are rarely provided. Hence, this paper explores how refugees, asylum seekers and undocumented migrants in Belgium and The Netherlands define sexual health, search for sexual health information and perceive sexual health determinants., Methods: Applying Community-based Participatory Research as the overarching research approach, we conducted 223 in-depth interviews with refugees, asylum seekers and undocumented migrants in Belgium and The Netherlands. The Framework Analysis Technique was used to analyse qualitative data. We checked the extensiveness of the qualitative data and analysed the quantitative socio-demographic data with SPSS., Results: Our results indicate that gender and age do not appear to be decisive determinants. However, incorporated cultural norms and education attainment are important to consider in desirable sexual health promotion in refugees, asylum seekers and undocumented migrants in Belgium and The Netherlands. Furthermore, our results demonstrate that these migrants have a predominant internal health locus of control. Yet, most of them feel that this personal attitude is hugely challenged by the Belgian and Dutch asylum system and migration laws which force them into a structural dependent situation inducing sexual ill-health., Conclusion: Refugees, asylum seekers and undocumented migrants in Belgium and The Netherlands are at risk of sexual ill-health. Incorporated cultural norms and attained education are important determinants to address in desirable sexual health promotion. Yet, as their legal status demonstrates to be the key determinant, the prime concern is to alter organizational and societal factors linked to the Belgian and Dutch asylum system. Refugees, asylum seekers and undocumented migrants in Belgium and The Netherlands should be granted the same opportunity as Belgian and Dutch citizens have, to become equally in control of their sexual health and sexuality.

Background: Improvements in treatment have resulted in an increasing number of cancer survivors potentially being able to return to work after medical treatment. In this paper we focus on the considerations regarding return to work (RTW) of breast cancer absentees in the Belgian context and how these considerations are related to reactions from their social environment., Methods: A qualitative study was performed to understand the RTW considerations of Belgian breast cancer absentees who had undergone breast cancer surgery in 2006. Twenty-two participants (mean age 46) were included and interviewed between May 2008 and August 2009 in their personal environment. An in-depth analysis (Grounded Theory) took place using the Qualitative Analysis Guide of Leuven (Quagol)., Results: Before the actual RTW, breast cancer employees try to build an image of the future resumption of work based on medical grounds and their knowledge of the workplace. Four matters are considered prior to RTW: (i) women want to leave the sick role and wish to keep their job; (ii) they consider whether working is worth the effort; (iii) they reflect on their capability; and (iv) they have doubts about being accepted in the workplace after returning. These inner thoughts are both product and input for the interaction with the social environment. The whole process is coloured by uncertainty and vulnerability., Conclusion: Our study demonstrated that mental preparation for RTW is not a linear process of improvement. It shows a detailed picture of four types of considerations made by breast cancer survivors before they actually resume work. Vulnerability appears to be an overarching theme during mental preparation. As the social environment plays an important role, people from that environment must become more aware of their influence on decreasing or increasing a woman's vulnerability while preparing for RTW.

Background: Growing attention is given to the effects of health promotion programs targeting physical activity and healthy eating in individuals with mental disorders. The design of evaluation studies of public health interventions poses several problems and the current literature appears to provide only limited evidence on the effectiveness of such programs. The aim of the study is to examine the effectiveness and cost-effectiveness of a health promotion intervention targeting physical activity and healthy eating in individuals with mental disorders living in sheltered housing. In this paper, the design of the study and baseline findings are described., Methods/design: The design consists of a cluster preference randomized controlled trial. All sheltered housing organisations in the Flanders region (Belgium) were asked if they were interested to participate in the study and if they were having a preference to serve as intervention or control group. Those without a preference were randomly assigned to the intervention or control group. Individuals in the intervention group receive a 10-week health promotion intervention above their treatment as usual. Outcome assessments occur at baseline, at 10 and at 36 weeks. The primary outcomes include body weight, Body Mass Index, waist circumference, and fat mass. Secondary outcomes consist of physical activity levels, eating habits, health-related quality of life and psychiatric symptom severity. Cost-effectiveness of the intervention will be examined by calculating the Cost-Effectiveness ratio and through economic modeling.Twenty-five sheltered housing organisations agreed to participate. On the individual level 324 patients were willing to participate, including 225 individuals in the intervention group and 99 individuals in the control group. At baseline, no statistical significant differences between the two groups were found for the primary outcome variables., Discussion: This is the first trial evaluating both the effectiveness and cost-effectiveness of a health promotion intervention targeting physical activity and healthy eating in mental health care using a cluster preference randomized controlled design. The baseline characteristics already demonstrate the unhealthy condition of the study population., Trial Registration: This study is registered at clinicaltrials.gov - NCT 01336946.