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Background Precision medicine represents a paradigm shift in health systems, moving from a one-size-fits-all approach to a more individualized form of care, spanning multiple scientific disciplines including drug discovery, genomics, and health communication. This study aims to explore the contextual factors influencing the equitable implementation of precision medicine in Belgium for incorporating precision medicine into routine cancer care within the Belgian health system. Methods As part of a foresight study, our approach evaluates critical factors affecting the implementation of precision oncology. The study scrutinizes contextual, i.e. demographic, economic, societal, technological, environmental, and political/policy-related (DESTEP) factors, identified through a comprehensive literature review and validated by a multidisciplinary group at the Belgian Cancer Center, Sciensano. An expert survey further assesses the importance and likelihood of these factors, illuminating potential barriers and facilitators to implementation. Results Based on the expert survey, five key elements (rising cancer rates, dedicated healthcare reimbursement budgets, increasing healthcare expenditures, advanced information technology solutions for data transfer, and demand for high-quality data) are expected to influence the equitable implementation of precision medicine in routine cancer care in Belgium in the future. Conclusions This work contributes to the knowledge base on precision medicine in Belgium and public health foresight, exploring the implementation challenges and suggesting solutions with an emphasis on the importance of comparative analyses of health systems, evaluation of health technology assessment methods, and the exploration of ethical issues in data privacy and equity. [ABSTRACT FROM AUTHOR]

Background The European Union has used Healthy Life Years (HLY) as an indicator to monitor the health of its aging populations. Scholarly and popular interest in HLY across countries has grown, particularly regarding the ranking of countries. It is important to note that HLY is based on self-assessments of activity limitations, raising the possibility that it might be influenced by differences in health reporting behaviours between populations, a phenomenon known as differential item functioning (DIF). Methods We estimated DIF-adjusted HLY at age 50 for Belgium, France, Germany, Greece, Italy, the Netherlands, Spain, and Sweden to determine the extent to which differences in HLY might be influenced by reporting heterogeneity across countries. We used anchoring vignettes, taken from the 2004 Survey of Health, Ageing and Retirement in Europe, to estimate DIF-adjusted prevalence rates of activity limitations measured by the Global Activity Limitations Indicator (GALI). The Sullivan method was used to calculate DIF-adjusted HLY. Results Changes in HLY before and after adjustment ranged from a 1.20-year decrease for men in Italy to a 1.61-year increase for women in Spain. Adjustment for DIF produced changes in the rankings of the countries by HLY, with upward and downward movements of up to three positions. Conclusion Our results show that DIF is likely to affect HLY estimates, thereby posing a challenge to the validity of comparisons of HLY across European countries. The findings suggest that HLY should be used to monitor population health status within a country, rather than to make comparisons across countries. [ABSTRACT FROM AUTHOR]

Background: Mental health, particularly among young adults, has been severely affected during the COVID-19 pandemic, partially because of both forced social isolation measures and loneliness. Numerous papers on the short-term consequences of lockdown measures reported high psychological distress, as well as an increase of depressive and anxiety symptoms and psychotropic drug use. This study evaluated potential risk and protective factors, such as resilience, loneliness, social and family context, in order to detect vulnerable individuals. Methods: This prospective longitudinal study was carried out in a two phase survey: the first one, during lockdown in Spring 2020 (T1), and, the second one, in Summer 2020 (T2), when restrictive measures were slackened. The main outcomes included the Resilience Scale for Adults (RSA) and the University of California Los Angeles (UCLA) Loneliness Scale. The secondary outcomes included mental health care needs (MHCN), use of psychotropic drugs and family and social contacts. Results: This study evaluated risks and protective factors in mental health in 825 emerging adults aged from 18 to 25 years old in Belgium and in Italy. Participants were divided into three groups according to their MHCN before and after lockdown measures. 5% of the participants experienced an increase in MHCN at T1, including the start of a psychotropic treatment. At T1, statistically significant differences were found in mean RSA total scores and RSA Perception of Self scores between groups. At T2, the group who experienced an increase in MHCN displayed a significant decrease of mean loneliness scores compared with the other groups. This decrease is linearly correlated with resilience competencies. Conclusions: The COVID-19 pandemic and its associated restrictive measures cause a negative impact on youth’s mental health, particularly among vulnerable individuals. Resilience and social contacts are protective factors that need to be taken into account. [ABSTRACT FROM AUTHOR]

Background The extent to which patients are involved in their care can be influenced by hospital policies and interventions. Nevertheless, the implementation of patient participation and involvement (PPI) at the organisational (meso) level has rarely been assessed systematically. The aim of this study was to assess the occurrence of PPI practises in hospitals in Belgium, France, Germany and Luxembourg and to analyze if, and to what extent, the hospital vision and the presence of a patient committee influence the implementation of PPI practises. Methods A cross-sectional study was carried out using an online questionnaire in hospitals in the border regions of the four countries. The data were analyzed for differences between regions and the maturity of PPI development. Results Full responses were obtained from 64 hospitals. A wide range of practices were observed, the degree of maturity was mixed. A majority of hospitals promoted patient partnership in the hospital's philosophy of care statement. However, the implementation of specific interventions for PPI was not found uniformly and differences could be observed between the countries. Conclusions Hospitals in the region seem to be motivated to include patients more fully, however, implementation of PPI interventions seems incomplete and only partially integrated into the general functioning of the hospitals. The implementation of the concept seems to be more mature in the francophone part of the region perhaps due, in part, to a more favourable political context. [ABSTRACT FROM AUTHOR]

Background There is increasing interest in the association between psychological distress and time spent in sedentary behaviour (e.g. sitting), a highly prevalent behaviour in modern society. The limited evidence is mixed and mainly based on studies using self-reported sedentary time. Few studies have investigated device-based total sedentary time in its association with distress. None, however, have examined device-based domain-specific sedentary time in relation to psychological distress. The aim of this study was to investigate whether device-based total and domain-specific sedentary behaviour were associated with psychological distress. Methods Flemish employees (n  = 401; 20–64 years; 42.6% male; 83.6% had a 'physically active occupation') of seven organizations in service and production sectors participated. Sedentary behaviour (exposure) was assessed by two Axivity AX3 accelerometers (one placed on the thigh and one placed between the shoulders) for two to four consecutive working days. Based on diary completion, domain-specific sedentary behaviour (leisure vs. work) was assessed. The 12-item General Health Questionnaire was used to assess psychological distress (outcome). Adjusted hierarchical multiple regression models were conducted to report on the associations between total and domain-specific sedentary behaviour and psychological distress. Results About 35% of the sample had high levels of distress and average total sedentary time was 7.2 h/day. Device-based total sedentary behaviour [ B = −0.009, 95% confidence interval (CI), −0.087 to 0.068], leisure-time (B  = 0.001, 95% CI, −0.017 to 0.018) and work-related (B  = 0.004, 95% CI, −0.006 to 0.015) sedentary behaviour were not significantly associated with psychological distress. Conclusion This cross-sectional study examining the association between device-based total and domain-specific sedentary behaviour and psychological distress among employees showed a lack of significant findings. [ABSTRACT FROM AUTHOR]

The article offers European Public Health News (EUPHA) briefs. The European Commission has set their research priorities for Horizon 2020 which costs them a new 80 billion euros research programme. EUPHA office has been benefited from a Dutch Ministry of Health grant at the beginning of EUPHA and was on the top of their membership fees. Social investment package was adopted by the social investment package of EUPHA commission on February 20.

Background The European Health Interview Survey (EHIS) provides cross-national data on health status, health care and health determinants. So far, 10 of the 30 member states (MS) opted for web-based questionnaires within mixed-mode designs but none used it as the sole mode. In the context of future EHIS, the response rate and net sample composition of a web-only approach was tested. Methods A Belgian study with a target sample size of 1000 (age: 16–85) was organized using the EHIS wave 3 model questionnaire. The sample was selected according to a multistage, clustered sampling procedure with geographical stratification. Field substitution was applied; non-participating households were replaced by similar households regarding statistical sector, sex and age. There was one reminder letter and a €10 conditional incentive. Results Considering all substitutions, a 16% response rate was obtained after sending one reminder. Elderly, Brussels Capital inhabitants, people living without a partner and those with a non-Belgian nationality were less responding. By design, there were no differences between the initial and final net sample regarding substitution characteristics. Nevertheless, people living without a partner, non-Belgians and lower educated people remain underrepresented. Conclusion There was a low response rate, particularly for some population groups. The response rate was lower than those of MS using mixed-mode designs including web, especially these comprising interviewer-based approaches. Despite the long and complex questionnaire, there was a low break off rate. So far, web-only data collection is not an acceptable strategy for population-based health surveys but efforts to increase the response should be further explored. [ABSTRACT FROM AUTHOR]

Background Tobacco-control policies have been suggested to reduce smoking among adolescents. However, there is limited evidence on the real-world costs of implementation in different settings. In this study, we aimed at estimating the costs of school smoking bans, school prevention programmes and non-school bans (smoking bans in non-educational public settings, bans on sales to minors and bans on point-of-sale advertising), implemented in Finland, Ireland, the Netherlands, Belgium, Germany, Italy and Portugal, for 2016. Methods We retrospectively collected costs related to the inspection, monitoring and sanctioning activities related to bans and educational activities related to smoking prevention programmes. We used an 'ingredients-based' approach, identifying each resource used, quantity and unit value for one full year, under the state perspective. Costs were measured at national, regional, local and school-level and were informed by data on how these activities were performed in reality. Results Purchasing power parities adjusted-costs varied between €0.02 and €0.74 (average €0.24) per person (pp) for bans implemented outside schools. Mean costs of school smoking bans ranged from €3.31 to €34.76 (average €20.60), and mean costs of school educational programmes from €0.75 to €4.65 (average €2.92). Conclusions It is feasible to estimate costs of health policies as implemented in different settings. Costs of the tobacco control policies evaluated here depend mainly on the number of person-hours allocated to their implementation, and on the scale of intervention. Non-school bans presented the lowest costs, and the implementation of all policies cost up to €36 pp for 1 year. [ABSTRACT FROM AUTHOR]

Background Complementary and alternative medicine (CAM) is oftenused to alleviate the discomfort, disability and pain involved in many chronic diseases. Besides this, females, middle-aged and higher educated people are also known to use CAM the most. This study explores whether the sociodemographic characteristics associated with CAM use differ by type of disease. Methods The following data were taken from the Belgian Health Interview Survey 2013 for the individuals aged 15+ years (n = 8942): sociodemographic characteristics, past 12-month diseases (using a list) and contact with a homeopath, chiropractor, acupuncturist and/or osteopath (CAM-therapists) in the past year. The association between CAM use and disease, controlled for gender, age, education and conventional medicine use, was assessed through logistic regressions. When interactions with the sociodemographic characteristics were found, stratified regressions were conducted. Results People with musculoskeletal diseases [odds ratio (OR) = 2.6], allergy (OR = 1.4) and severe headache (OR = 1.5) had higher odds of using CAM in the past year with statistical significance. For musculoskeletal diseases, the odds of using CAM was higher, with statistical significance, for every sociodemographic subclass. For allergy, CAM use was higher among men, people aged 45+ years and lower educated people, while for severe headache CAM use was higher among women, people aged 45+ years and higher educated people, all with statistical significance. Conclusions Sociodemographic characteristics associated with CAM use differ by diseases. The role of CAM in disease management cannot be ignored. Making physicians aware for which disease CAM is used and by whom, may facilitate disease management. [ABSTRACT FROM AUTHOR]

Background Decreasing gender differences in mental health are found largely in countries in which the roles of men and women have improved in terms of opportunities for employment, education, child care and other indicators of increasing gender equality. In this study, we examine how European welfare regimes influence this association between mental health and the social roles that men and women occupy. Methods The EU-World Mental Health data are used, which covers the general population in 10 European countries (n = 37 289); Countries were grouped into four welfare regions: Liberal regime (Northern Ireland), Bismarckian regime (Belgium, Germany, the Netherlands and France), Southern regime (Spain, Italy, Portugal) and Central-Eastern regime (Romania and Bulgaria). The lifetime prevalence of mood, anxiety and alcohol disorders was determined by using the Composite International Diagnostic Interview 3.0. Overall prevalence rates along with odds ratios by means of bivariate logistic regression models are calculated to compare the presence of common mental disorders in women versus men per welfare regime. Results Overall prevalence of common mental disorders is highest in the Liberal regime and lowest in the Central/Eastern regime. The gender gap in mental disorders is largest in the Southern regime and smallest in the Liberal regime. Marital status and certain employment positions help to explain variation in mental disorders across and within welfare regimes. Conclusion Most prominent pathways linking gender to mental ill-health being are related to marital status and certain employment positions. However, these pathways also show substantial variation across welfare regimes. [ABSTRACT FROM AUTHOR]

Background Health literacy (HL) is an important determinant of health and health behaviours, and there is a need to monitor HL levels among all population groups. It is therefore essential to develop instruments to assess HL during childhood and adolescence. The aim of this study was to examine the cross-national measurement invariance of the instrument Health Literacy for School-aged Children (HLSAC) in four European countries. Methods The data were collected via standardized self-administered anonymous questionnaires within classrooms in Finland, Poland, Slovakia, and Belgium. There were in total 1468 respondents (aged 13, N = 690; aged 15, N = 778). The HLSAC instrument was used to measure the subjective HL of adolescents in each country. A multigroup confirmatory factor analysis was applied to test measurement invariance. Results Configural and metric invariance was established, but scalar invariance did not hold. However, the instrument exhibited high internal consistency (α = 0.85) and showed adequate fit with the data. Moreover, the partial invariance allowed comparison of mean values across the countries in question. There were significant mean value differences between countries and age-groups. Conclusions HL mean values (as assessed via the HLSAC instrument) can be compared across countries. The instrument has utility for large-scale international HL studies on adolescents. [ABSTRACT FROM AUTHOR]

Background Opioids, antipsychotics and hypnotics are recommended for comfort care in dying. We studied their prescription during the last 3 days in residents deceased in the long-term care facility (LTCF). Methods In a retrospective, cross-sectional survey in Belgium, England, Finland, Italy, the Netherlands and Poland, LTCFs, selected by proportional stratified random sampling, reported all deaths over the previous 3 months. The nurse most involved in the residents' care reviewed the chart for opioid, antipsychotic and hypnotic prescription, cause of death and comorbidities. Multivariable logistic regression was performed to adjust for resident characteristics. Results Response rate was 81.6%. We included 1079 deceased residents in 322 LCTFs. Opioid prescription ranged from 18.5% (95% CI: 13.0–25.8) of residents in Poland to 77.9% (95% CI: 69.5–84.5) in the Netherlands, antipsychotic prescription from 4.8% (95% CI: 2.4–9.1) in Finland to 22.4% (95% CI: 14.7–32.4) in Italy, hypnotic prescription from 7.8% (95% CI: 4.6–12.8) in Finland to 47.9% (95% CI: 38.5–57.3) in the Netherlands. Differences in opioid, antipsychotic and hypnotic prescription between countries remained significant (P < 0.001) when controlling for age, gender, length of stay, cognitive status, cause of death in multilevel, multivariable analyses. Dying from cancer showed higher odds for receiving opioids (OR 3.51; P < 0.001) and hypnotics (OR 2.10; P = 0.010). Conclusions Opioid, antipsychotic and hypnotic prescription in the dying phase differed significantly between six European countries. Further research should determine the appropriateness of their prescription and refine guidelines especially for LTCF residents dying of non-cancer diseases. [ABSTRACT FROM AUTHOR]

Background: National Health Interview Surveys are used to produce country-wide results for a substantial number of health indicators. However, if some educational groups are underrepresented in the sample, estimates may be biased. This study investigated the impact of the use of post-stratification weights that adjust for the population distribution by education on estimates from the Belgian Health Interview Survey 2013. Methods: For 25 health- related indicators that match the European Core Health Indicator shortlist, estimates were computed using two different sets of post-stratification weights: one based on age group, gender and province only and the other one including also education. The Census 2011 was used as auxiliary data source. Statistical differences between the two estimates were assessed with the Delta method. Results: If education is not included as post-stratification weighting factor, low educational groups (ISCED 0-2) represent 31.1% of the total study population aged 25 years and older. If education is taken into account this proportion rises to 40.3%. The use of post-stratification weights adjusting for the population distribution by education has an impact on several survey estimates. The most pronounced effect is an increase in the estimated proportion of people with diabetes (+0.73%; 95% CI 0.191.27; relative increase+11.6%), asthma (+0.52%; 95% CI, 0.06-0.98; relative increase+12.4%) and difficulties to cover their health expenses (+2.31%; 95% CI, 1.52-3.10; relative increase+9.4%). Conclusions: Including education in the calculation of post-stratification weights reduces bias due to educational differences in survey participation. Auxiliary information used to calculate post-stratification weights for national health surveys should include education. [ABSTRACT FROM AUTHOR]

Background: European societies are rapidly ageing and becoming multicultural. We studied differences in overall and cause-specific mortality between migrants and non-migrants in Belgium specifically focusing on the older population. Methods: We performed a mortality follow-up until 2009 of the population aged 50 and over living in Flanders and the Brussels-Capital Region by linking the 2001 census data with the population and mortality registers. Overall mortality differences were analysed via directly age-standardized mortality rates. Cause-specific mortality differences between non-migrants and various western and non-western migrant groups were analysed using Poisson regression models, controlling for age (model 1) and additionally controlling for socio-economic status and urban typology (model 2). Results: At older ages, most migrants had an overall mortality advantage relative to non-migrants, regardless of a lower socio-economic status. Specific migrant groups (e.g. Turkish migrants, French and eastern European male migrants and German female migrants) had an overall mortality disadvantage, which was, at least partially, attributable to a lower socio-economic status. Despite the general overall mortality advantage, migrants experienced higher mortality from infectious diseases, diabetes-related causes, respiratory diseases (western migrants), cardiovascular diseases (non-western female migrants) and lung cancer (western female migrants). Conclusion: Mortality differences between older migrants and non-migrants depend on cause of death, age, sex, migrant origin and socio-economic status. These differences can be related to lifestyle, social networks and health care use. Policies aimed at reducing mortality inequalities between older migrants and non-migrants should address the specific health needs of the various migrant groups, as well as socio-economic disparities. [ABSTRACT FROM AUTHOR]

The article offers information on obesity research in Europe. One study evaluated the compliance to food-based dietary guidelines in Belgium using data from the Belgian Food Consumption Survey. Another paper presented a comparison of physical activity in preschool children and adolescents in the Czech Republic in relation to health recommendations.

Background: The European population is aging. The main drivers of public spending on health care for people of 65 years and older are hospital admission and admission to long-term care facilities. High quality community care can be a cost-effective and quality solution to respond to the impact of ageing populations on health-care systems. It is unclear how well countries are equipped to provide affordable and quality community care. The aim of this article is to describe and compare community care delivery with care-dependent older people in Europe. Methods: This study is conducted within the European Union-financed IBenC project [Identifying best practices for care-dependent elderly by Benchmarking Costs and outcomes of community care (FP7)] in which six European countries are involved. To compare the community care delivery with care-dependent older people in these countries, we performed a systematic comparison of macro indicators using metadata complemented with data from multinational surveys. Results: Data on the following dimensions are described and compared: population of the country, governmental expenditures on health, sources of community health services funding, governmental vision and regulation on community care, community care organisations and care professionals, eligibility criteria for and equity in receiving care and the involvement of informal care. Conclusion: Because of the variations in the European community care contexts, the growing demand for community care as a cost-effective and quality solution to the care burden of aging populations will have country-specific impacts. When learning from other countries' best practices, in addition to researchers, policy makers should take full account of local and national care contexts. [ABSTRACT FROM AUTHOR]

Background: Both media use and cancer knowledge have been identified as important predictors of a healthy lifestyle. However, little is known about the interplay between these two variables, and about differences between cancer diagnosed and non-diagnosed consumers of media and knowledge. This study investigated the relationship between media use (television and internet exposure) and lifestyle choices of cancer diagnosed and non-diagnosed individuals, and looked at the influence of cancer knowledge on this relationship. Methods: A cross-sectional, quantitative survey (the Leuven Cancer Information Survey) was administered to 621 cancer diagnosed and 1387 non-diagnosed individuals, aged 16-88 years old in Flanders (Belgium). Bivariate analyses, hierarchical linear regression analyses and advanced moderation and mediation analyses were conducted. Results: Internet exposure was not a predictor of lifestyle choices. Television exposure, however, was a negative predictor of healthy lifestyle choices. Moreover, television exposure was a direct negative predictor of cancer knowledge, which in turn positively predicted lifestyle choices. However, no differences were found in the investigated relationships between the two subsamples. Conclusion: These results indicate that higher levels of television exposure coincide with less cancer knowledge and with less healthy lifestyle choices. It offers a pathway for intervention by suggesting that improving cancer knowledge through television might positively affect lifestyle choices. [ABSTRACT FROM AUTHOR]

Background: The aim was to study the impact of psychosocial risk factors on long-term sickness absence due to mental health problems (LSA-MH) or musculoskeletal disorders (LSA-MSD) in 2983 Belgian middle-aged workers. Methods: Data were collected from 1372 male and 1611 female workers in the Belstress III study. Considered psychosocial risk factors were job demands, job control, social support, job strain, efforts, rewards, effort–reward imbalance and bullying. Prospective registered sickness absence data were collected during 12 months follow-up; the causes for long-term sickness absence episodes of at least 15 consecutive days were obtained by contacting the general practitioner of the worker. Multiple logistic regression models were used to investigate the relationship between the psychosocial risk factors and LSA-MH and LSA-MSD. Results: Higher levels of rewards at baseline were independently and significantly associated with a lower risk for LSA-MH. Higher levels of control were associated with a lower risk for LSA-MSD during follow-up. Higher job demands and efforts were significantly related to a lower risk for LSA-MSD. Finally, bullying was significantly and independently related to both LSA-MH and LSA-MSD during the follow-up period. Conclusions: These results suggest that psychosocial risk factors are related to LSA-MH and LSA-MSD, of which especially bullying seems to be a potent stressor. [ABSTRACT FROM AUTHOR]

Objectives: To identify changes in social inequalities for mammograms uptake in Belgium over the period 1997–2008 using multiple indices, and to assess the contribution of the national breast cancer screening programme in these changes. Methods: Data were obtained from four waves of the Belgian Health Interview Survey. The socio-economic position was defined by the educational level. Inequalities were measured both with pairwise measures comparing extreme educational groups (prevalence difference and prevalence ratio), and with indices measuring the total inequality impact at population level: the Population Attributable Fraction (PAF), the Relative Index of Inequality (RII) and the Slope Index of Inequality (SII). Results: All indices show a substantial decrease in inequalities in mammographic uptake between 1997 and 2008. For the indices of total impact (PAF, RII, SII), the change occurred between the first two waves (1997 and 2001) and stabilized afterwards, while for pairwise indices the evolution continued over the whole period. Conclusion: Using multiple indices of inequality is necessary for a more complete understanding of the changes: total impact inequality indices should always complement simple pairwise measures. The inequalities in mammograms uptake, as measured with total impact indices, only decreased before the start of the national screening programme. [ABSTRACT FROM AUTHOR]

Background: The aim of the present study was to assess the relative validity of a self-administered qualitative food frequency questionnaire (FFQ) applied in the Belgian food consumption survey. Methods: Comparison of food consumption data from an FFQ with 7-day estimated diet records (EDR) was made in a sample of 100 participants (aged 15–90 years). The FFQ comprised a total of 50 foods. Both FFQ and EDR foods were categorized into 15 conventional food groups. Results: De-attenuated Spearman rank correlation coefficients between the FFQ and the EDR ranged from −0.16 for potatoes and grains to 0.83 for alcoholic beverages, with a median of 0.40 for all 15 food groups. The proportion of participants classified in the same tertile of intake by the FFQ and EDR ranged from 32% for potatoes and grains to 76% for alcoholic beverages. Extreme classification into opposite tertiles was <10% for milk and soy products, alcoholic beverages, fried restgroup foods and fats. Conclusion: Notwithstanding the short nature and the absence of portion size questions, the FFQ appears to be reasonably valid in both genders and across different age categories for most food groups. However, for the food groups bread and cereals, potatoes and grains, and sauces, estimates should be interpreted with caution because of poor ranking agreement. [ABSTRACT FROM AUTHOR]

Background: When explaining the use of care, the context of the care gains importance. This article focuses on the influence of the municipality on the lives of the elderly regarding the usage of different forms of care, whereas controlling for the effect of individual characteristics. Methods: Two databases on the individual characteristics of elderly Flemish people living at home were combined with a database on municipal characteristics. The effect of municipal characteristics was measured through multi-level logistic regression. Results: A higher mean income per inhabitant and a lower number of inhabitants/100 km2 have a positive effect on the use of informal home care. The use of home care services is positively influenced by a higher family care index and an increasing relative number of hours of domestic care provided in the municipality. Receiving care from a general practitioner, medical specialist, dentist, emergency department, community nurse, physiotherapist, home aid, day-care centre or hospital with overnight stay is not influenced by the municipality’s characteristics. The use of public welfare services, meals-on-wheels programs or hospital outpatients’ services, however, are affected by the municipality, but cannot be fully explained by the model. Conclusion: The municipality that an elderly person lives in has an impact on the amount and the types of care an elderly person receives. Persons with similar care needs and similar individual characteristics can receive very different care when they live in different municipalities. This is quite a challenging finding for researchers, as well as for care providers and policy makers. [ABSTRACT FROM PUBLISHER]

Background: The objective of this study was to examine the relationship between exposure to television news messages about cervical cancer and women’s vulnerability perceptions and fear. Methods: Five-hundred women aged 18–85 years were randomly recruited to participate in a survey-interview. A standardized questionnaire assessed risk perception, fear of cervical cancer, exposure to cervical cancer messages in television news and a number of potential confounders such as demographics and trait anxiety. Results: Results from multinomial regression analyses showed that women who had been occasionally exposed to cervical cancer messages were two times more likely to be very afraid of getting cervical cancer. Women who had been frequently exposed were three times more likely to be very afraid and three times more likely to be extremely afraid. Women who had been regularly exposure to cervical cancer messages were also three times more likely to perceive a moderate risk and seven times more likely to perceive a large risk of being diagnosed with cervical cancer. Conclusion: These results suggest that television news may be an effective means for health education. [ABSTRACT FROM AUTHOR]

Background: Ethnic-minority health is a public health priority in Europe. This study compares strategies for tackling ethnic inequalities in health from two countries, Scotland and Belgium. Methods: We compared the countries using the Whitehead framework. Official policy documents were retrieved and reviewed and two databases related to immigrant health policies were also used. Ethnic inequalities in health were compared using the UK and Belgian Censuses of 2001. We analysed the recognition of the problem, the policies and the services and described ethnic health inequalities. Results: Scotland has recognized the problem of ethnic inequalities in health, thanks to better data and the Scottish Government has come up with a bold strategy. Belgium is a later starter, unable to properly monitor ethnic inequalities. In addition, there is no clear government commitment to tackling either health inequalities or ethnic inequalities in health. Both countries provide health-care services to ethnic minority groups through the mainstream services, although ethnic minority groups have more choice in Belgium than in Scotland. Overall, ethnic heath inequalities are lower in Scotland than in Belgium. Conclusion: Scotland has provided a more advanced and comprehensive response to tackling ethnic inequalities in health than Belgium. It has acknowledged that discrimination exists and that ethnic minority groups may have different needs. Belgium still assumes non-discrimination in health care and effectively denies the need for policy to tailor services to meet these needs. In Scotland, public organizations have been made accountable for promoting equality in health. This is an important contribution to European health policy. [ABSTRACT FROM AUTHOR]

Background: For those of working age, results are inconclusive when exploring the health impact of providing care. Moreover, population data is lacking and the impact of welfare policies on the caregivers’ health has not been yet analysed. Methods: Associations between general health and care giving, adjusting for differences in employment and socio-economic position, were explored for working age adults using logistic regression models. Data came from the 2001 British census (n = 1 361 222, 5% sample) and from the 2001 Belgian census (n = 4 368 637). The final model was stratified by employment status, given the significant interaction between caregiving and employment status. Results: In both countries, when compared with those providing no care, men and women providing ≥20 h of care per week had an increased risk of poor health. This increased risk was attenuated after adjustment for socio-economic position and particularly after adjustment for differences in employment status. However after stratifying by employment status, a dose response relationship between time spent caring and poor health was observed for the employed and unemployed, but not for the economically inactive. Conclusions: Despite contrasting welfare systems, employment status plays an important role in the association between caring and health in both countries. For the economically active, providing more care increases the risk of poor health. Whilst formal employment may be good for general health, having to informally care whilst in formal employment may have a detrimental health impact. [ABSTRACT FROM PUBLISHER]

Background: All asylum seekers (AS) in Belgium are entitled to health care coverage while awaiting a decision regarding a refugee status. However, in practice, numerous public institutions oversee the governance, the distribution of funding and the practical organisation of health care. As a result, AS have currently no guarantee of receiving the health care they need. Methods: In 2017-2019, a 5-step approach was used. Firstly, 3 data sources were combined to identify major problems and possible options to solve it (literature, interviews, and existing databases). Secondly, these options were submitted to a large panel of Belgian experts, field workers and policymakers through an online survey (n = 171). Survey results and nonconsensual results were discussed in a 3rd step with 35 field workers, experts, and policymakers. In a 4 step, individual interviews were conducted with stakeholders likely to be affected by the different options. In a final step, all stakeholders attended a final meeting following by an online consultation to validate the final options. Results: Stakeholders agreed on 3 basic principles that should sustain a reform of health care for AS: respecting the current legal framework, ensuring equity among all AS and supporting administrative simplification. Three different models of access emerged with 2 options regarding the governance of health care for AS and 3 options for the distribution of the funding. Each model was assessed regarding its impact on the identified problems and the respect of the 3 basic principles. Besides, 8 quick-wins at the system level and 6 at the organisation level were proposed. Conclusions: Despite the involvement of the policymakers, no consensus was found at the end of the research. Final decision will then remain in the hands of the policymakers. Key messages: In Belgium, access to health care for asylum seekers is impeded by the numerous public institutions involved. Equity between asylum seekers should be guaranteed by an appropriate governance and an adequate distribution of funding. [ABSTRACT FROM AUTHOR]

On 3 April 1990, a new abortion law was passed in Belgium, replacing the one from 1867. This change took approximately 20 years and resulted from a strong political debate, a number of proposals for legal reforms and from prosecutions of physicians, social workers and women having performed terminations of pregnancies (TOP). During this period, health professionals set up a sort of ‘illegal reform programme’. They were not only successful in organizing decentralized, accessible and non-profit TOP facilities, but also effective in producing the first data sets to monitor TOP requests in the country. In this way, they modified TOP medical activity and practice and participated greatly in changing abortion from a situation characterized by secrecy and danger before 1970, to a medical activity legalized after 1990. Legal TOP statistics published since 1990 cannot be explained without taking into account this period of transition where spedflc features of the following situation were prepared. [ABSTRACT FROM AUTHOR]

Data on the civil registration of all births and deaths recorded in 1987 in Belgium were analysed following WHO rules. The following statistics with significant regional variations were recorded: 2.5% of teenage pregnancies, 7% of late pregnancies (≥35 years), 6.1% of low birth weights and 5.3% of preterm deliveries. Preterm birth rates did not improve during the last decade and are higher than in neighbouring countries. Infant mortality rate is 9.74 per 1000. This rate has remained unchanged since the early 1980s but the relative importance of post-neonatal mortality is increasing. Congenital anomalies account for 26% of all infant deaths followed by the sudden infant death syndrome (17%). Maternal conditions such as eclampsia are related to 29% of the infants' deaths. [ABSTRACT FROM AUTHOR]

In the article, the authors discuss the need to regulate and control the proliferation of illegal marijuana in Belgium as of June 2019. Other topics include the proliferation of marijuana with high tetrahydrocannabinol (THC) content in the country, its adverse effects to young people, as well as the need to implement the strategies in regulating tobacco and alcohol in the control of marijuana use in the country.