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In clinical practice, many drug therapies are associated with prolongation of the QT interval. In literature, estimation of the risk of prescribing drug-induced QT prolongation is mainly executed by means of logistic regression; only one paper reported the use of machine learning techniques. In this paper, we compare the performance of both techniques on the same dataset. High risk for QT prolongation was defined as having a corrected QT interval (QTc) ≥ 450 ms or ≥ 470 ms for respectively male and female patients. Both conventional statistical methods (CSM) and machine learning techniques (MLT) were used. All algorithms were validated internally and with a hold-out dataset of respectively 512 and 102 drug-drug interactions with possible drug-induced QTc prolongation. MLT outperformed the best CSM in both internal and hold-out validation. Random forest and Adaboost classification performed best in the hold-out set with an equal harmonic mean of sensitivity and specificity (HMSS) of 81.2% and an equal accuracy of 82.4% in a hold-out dataset. Sensitivity and specificity were both high (respectively 75.6% and 87.7%). The most important features were baseline QTc value, C-reactive protein level, heart rate at baseline, age, calcium level, renal function, serum potassium level and the atrial fibrillation status. All CSM performed similarly with HMSS varying between 60.3% and 66.3%. The overall performance of logistic regression was 62.0%. MLT (bagging and boosting) outperform CSM in predicting drug-induced QTc prolongation. Additionally, 19.2% was gained in terms of performance by random forest and Adaboost classification compared to logistic regression (the most used technique in literature in estimating the risk for QTc prolongation). Future research should focus on testing the classification on fully external data, further exploring potential of other (new) machine and deep learning models and on generating data pipelines to automatically feed the data to the classifier used. [ABSTRACT FROM AUTHOR]

Although people with a migration background (MB) have more unmet mental health needs than the general population, patients with a MB are still underrepresented in mental health care services. Provider bias towards these patients has been evidenced repeatedly but its driving factors remain elusive. We assessed the moderating effect of the individual (e.g. age and ethnicity), interpersonal (e.g. healthcare provider trust), and organisational (e.g. perceived workload) factors on general practitioners (GPs) differential decision-making regarding diagnosis, treatment, and referral for a depressed patient with or without a MB. An experimental study was carried out in which GPs were shown one of two video vignettes featuring adult male depressed patients, one with a MB and the other without. Belgian GPs (n = 797, response rate was 13%) had to decide on their diagnosis, treatment, and referral. Analysis of variance and logistic regression were used to analyse the effect of a MB, adding interaction terms for the explanatory variables. Overall, we found that there were ethnic differences in GPs' decisions regarding diagnosis and treatment recommendations. GPs perceived the symptoms of the patient with a MB as less severe (F = 7.68, p < 0.01) and demonstrated a reduced likelihood to prescribe a combination of medical and non-medical treatments (F = 11.55, p < 0.001). Those differences increased in accordance with the GP's age and perceived workload; at an interpersonal level, we found that differences increased when the GP thought the patient was exaggerating his distress. This paper showed that lower levels of trust among GPs' towards their migrant patients and high GP workloads contribute to an increased ethnic bias in medical decision-making. This may perpetuate ethnic inequalities in mental health care. Future researchers should develop an intervention to decrease the ethnic inequities in mental health care by addressing GPs' trust in their migrant and ethnic minority patients. [ABSTRACT FROM AUTHOR]

Research shows that older people tend to not only be underrepresented on television (TV), but also to be represented within a number of fixed types. These correspond to cultural myths about ageing, which emphasise vulnerability and decline but also increasingly stress the individual's responsibility for successful ageing. This paper analyses the representation of older people on Flemish public TV, using qualitative content analysis to identify patterns of representation in a sample of 44 programmes broadcast in 2019 and 2020, including the first months of the COVID-19 pandemic. To complement our own analysis, we also interviewed eight experts on ageing. Our research shows that representations of older people on Flemish public TV tend to gravitate towards two types related to different age groups: vulnerable and passive old-old people (over 80 years old), particularly those in nursing homes who feature prominently in reporting on the COVID-19 pandemic; and dynamic and active young-old people (65–80 years old), connected to the ideals of successful ageing. The two predominant types correspond to cultural myths about ageing and are also connected to recurrent themes: sexual intimacy, loneliness and death. Our research highlights the need for a more diverse representation, reflecting the variety of individual life conditions and the functional age of older people. [ABSTRACT FROM AUTHOR]

According to self-determination theory, individual well-being is universally dependent upon the satisfaction of three basic psychological needs: autonomy, competence and relatedness. This study set out to further elucidate the relationship between basic psychological need satisfaction (BPNS) and well-being across age by (i) more closely examining the age distribution of BPNS, and (ii) investigating whether BPNS is comparably associated with well-being across all ages, as predicted by the universality assumption, while taking into account variability in other demographic factors. A general population sample of Dutch speaking adults from The Netherlands and Belgium (N = 1709; Mage = 48.6 years, SD = 19.0, range 18–97) filled out a cross-sectional online or paper-and-pencil survey questionnaire, providing self-reports of BPNS and well-being, using the Basic Psychological Need Satisfaction and Frustration Scale and Mental Health Continuum-Short Form, respectively. Data analyses consisted of initial visual inspection using LOESS smoothed curve plotting, and subsequent model testing using multiple regression analyses. When correcting for other demographic factors, results showed a positive linear relationship between age and autonomy satisfaction, no significant relationship between age and competence satisfaction, and a slight positive cubic relationship between age and relatedness satisfaction (initial 'peak', followed by a slight decline and 'dip', and steady rise for later ages). All basic psychological needs factors were positively linked to well-being in all domains, with associations generally comparable between adults of different ages, thus lending support to the universality assumption of self-determination theory. Despite distinct age distributions, all three basic psychological needs seem important for maintaining a sense of well-being throughout life. [ABSTRACT FROM AUTHOR]

Background: Belgium was one of the countries that was struck hard by COVID-19. Initially, the belief was that we were 'all in it together'. Emerging evidence showed however that deprived socioeconomic groups suffered disproportionally. Yet, few studies are available for Belgium. The main question addressed in this paper is whether excess mortality during the first COVID-19 wave followed a social gradient and whether the classic mortality gradient was reproduced. Methods: We used nationwide individually linked data from the Belgian National Register and the Census 2011. Age-standardized all-cause mortality rates were calculated during the first COVID-19 wave in weeks 11-20 in 2020 and compared with the rates during weeks 11-20 in 2015-2019 to calculate absolute and relative excess mortality by socioeconomic and -demographic characteristics. For both periods, relative inequalities in total mortality between socioeconomic and -demographic groups were calculated using Poisson regression. Analyses were stratified by age, gender and care home residence. Results: Excess mortality during the first COVID-19 wave was high in collective households, with care homes hit extremely hard by the pandemic. The social patterning of excess mortality was rather inconsistent and deviated from the usual gradient, mainly through higher mortality excesses among higher socioeconomic groups classes in specific age-sex groups. Overall, the first COVID-19 wave did not change the social patterning of mortality, however. Differences in relative inequalities between both periods were generally small and insignificant, except by household living arrangement. Conclusion: The social patterning during the first COVID-19 wave was exceptional as excess mortality did not follow the classic lines of higher mortality in lower classes and patterns were not always consistent. Relative mortality inequalities did not change substantially during the first COVID-19 wave compared to the reference period. [ABSTRACT FROM AUTHOR]

In recent decades, many European governments have passed pension reforms to incentivise participation in private pension plans. However, we still have minimal understanding of whether participation in such plans is concentrated in certain groups or spread uniformly across society, or what their stability over time is. To illuminate the social selectivity of these plans and potential changes in that selectivity over time, we analyse six waves of the Survey of Health, Ageing and Retirement in Europe (SHARE) in ten European countries: Austria, Belgium, Czech Republic, Denmark, France, Germany, Italy, Spain, Sweden and Switzerland. Specifically, we focus on participation gaps in individual and occupational plans of workers across six dimensions: gender, education, age, social class, income, and risk preference. The results indicate large and persistent social divides in participation rates. As expected, rates are significantly higher among workers who are not close to retirement, those with an upper service occupation and those with high income. Importantly, these divides did not shrink significantly over the period considered – 2006 to 2021. Social selectivity is not consistently smaller in contexts of more mature private pension provision, whereas it is consistently smaller in countries with more generous public pensions. [ABSTRACT FROM AUTHOR]

Background: Mobile Ecological Momentary Assessment (EMA) is increasingly used to gather intensive, longitudinal data on behavioral nutrition, physical activity and sedentary behavior and their underlying determinants. However, a relevant concern is the risk of non-random non-compliance with mobile EMA protocols, especially in older adults. This study aimed to examine older adults' compliance with mobile EMA in health behavior studies according to participant characteristics, and prompt timing, and to provide recommendations for future EMA research. Methods: Data of four intensive longitudinal observational studies employing mobile EMA to understand health behavior, involving 271 community-dwelling older adults (M = 71.8 years, SD = 6.8; 52% female) in Flanders, were pooled. EMA questionnaires were prompted by a smartphone application during specific time slots or events. Data on compliance (i.e. information whether a participant answered at least one item following the prompt), time slot (morning, afternoon or evening) and day (week or weekend day) of each prompt were extracted from the EMA applications. Participant characteristics, including demographics, body mass index, and smartphone ownership, were collected via self-report. Descriptive statistics of compliance were computed, and logistic mixed models were run to examine inter- and intrapersonal variability in compliance. Results: EMA compliance averaged 77.5%, varying from 70.0 to 86.1% across studies. Compliance differed among subgroups and throughout the day. Age was associated with lower compliance (OR = 0.96, 95%CI = 0.93–0.99), while marital/cohabiting status and smartphone ownership were associated with higher compliance (OR = 1.83, 95%CI = 1.21–2.77, and OR = 4.43, 95%CI = 2.22–8.83, respectively). Compliance was lower in the evening than in the morning (OR = 0.82, 95%CI = 0.69–0.97), indicating non-random patterns that could impact study validity. Conclusions: The findings of this study shed light on the complexities surrounding compliance with mobile EMA protocols among older adults in health behavior studies. Our analysis revealed that non-compliance within our pooled dataset was not completely random. This non-randomness could introduce bias into study findings, potentially compromising the validity of research findings. To address these challenges, we recommend adopting tailored approaches that take into account individual characteristics and temporal dynamics. Additionally, the utilization of Directed Acyclic Graphs, and advanced statistical techniques can help mitigate the impact of non-compliance on study validity. [ABSTRACT FROM AUTHOR]

This study utilizes data, spanning 2016-2021, from the Belgian Ageing Studies and presents a typology of older internet users based on nine internet activities. Two-step Cluster Analysis and Latent Class Analysis revealed three groups: (1) "Basic users" primarily engage in information search and mailing, (2) "Allrounders" participate in nearly all internet activities and (3) "Selective users" are intermediary, predominantly using the internet for information search, mailing, e-banking and communication with (grand)children. These clusters varied in sociodemographic characteristics, with "Allrounders" being younger, more educated, wealthier and predominantly male, compared to "Selective users" and "Basic users," respectively. [ABSTRACT FROM AUTHOR]

Background: Oral disorders are still a major global public health challenge, considering their perpetuating and chronic nature. Currently, there is no direct index to measure the quality of care on a population scale. Hence, we aim to propose a new index to measure the quality of care for oral disorders worldwide. Methods: We generated our database using the data from the Global Burden of Disease (GBD) study 2017. Among different variables such as prevalence, incidence, years lived with disability, and disability-adjusted life years, we utilised principal component analysis (PCA) to determine the component that bears the greatest proportion of information to generate the novel quality of care index (QCI) for oral disorders. Results: Global QCI for oral disorders gradually increased from 1990 to 2017 (from 70.5 to 74.6). No significant gender disparity was observed during this period, and the gender disparity ratio (GDR) was considered optimal in 1990 and 2017. Between 1990 and 2017, the age-standardised QCI for all oral disorders increased in all the SDI regions. The highest QCI for all oral disorders in 2017 belonged to high-middle SDI countries (=80.24), and the lowest YLDs rate was seen in the low SDI quintile. In 1990, the quality of care in European, Central Asian, and Central and South American countries was in the lowest quintiles, whereas the North American, East Asian, Middle Eastern, and some African countries had the highest quality of dental care. Maynmar (=100), Uganda (=92.5), Taiwan (=92.0), China (=92.5), and the United States (=89.2) were the five countries with the highest age-standardised QCI. Nicaragua (=41.3), Belgium (=40.2), Venezuela (=38.4), Sierra Leone (=30.5), and the Gambia (=30.3) were the five countries with the least age-standardised QCI values. Conclusion: The quality of care for all oral disorders showed an increasing trend on a global scale from 1990 to 2017. However, the QCI distribution was not homogenous among various regions. To prevent the exacerbation of imminent disparities in this regard, better attention to total tooth loss in high-income countries and prioritising primary healthcare provision in low-income countries are recommended for oral disorders. [ABSTRACT FROM AUTHOR]

This experiment with 363 Irish and Flemish men aged 19 to 30 years (M = 23.56, SD = 2.36) investigated exposure to different male model ads (i.e. muscular, slim, plus-size, overall diversity, and no models) on well-being (i.e. body image, low body fat and muscularity attitudes, self-objectification, and self-esteem) and advertising outcomes (i.e. ad attitudes, brand attitudes, and purchase intent). Moderation effects of country and masculinity (i.e. dominance, winning) were investigated. The diversity condition generated more positive effects for low body fat attitudes than the muscular, slim, and no model conditions. Yet, no differences appeared for this outcome between the diversity and plus-size condition. No effects for the other well-being and advertising variables were found. Moderation analyses revealed higher purchase intent in the slim condition for men high in dominance. No effects were found for country and winning. Findings suggest that non-idealized models have protective effects for some men. [ABSTRACT FROM AUTHOR]

Background: The Flemish Collaborative Glomerulonephritis Group (FCGG) registry is a population-based kidney biopsy registry that has been including all native kidney biopsies performed in children in Flanders (Belgium), since 2017. Methods: From 2017 to 2020, 148 pediatric (< 18 years) native kidney biopsies were included. Each biopsy received a histopathological and final nephrological diagnosis, and concordance between both was assessed. Disease chronicity, summarized by the Mayo Clinic Chronicity Score, was determined on 122 biopsies with > 5 glomeruli. Results: Kidney biopsy rate was high (29.0 biopsies per million children per year), median age was 10.0 years (IQR 5.8–14.7), and boys predominated (56.1% males). A total of 140 biopsies (94.6%) showed a representative pathology result. Glomerular disease was most prevalent, with IgA nephropathy/IgA vasculitis (43 biopsies, 29.1%) and minimal change disease (MCD) (29 biopsies, 19.6%) being the overall most frequent diagnoses. In general, diagnostic concordance was high (80.7%). In Alport syndrome and focal segmental glomerulosclerosis (FSGS), concordance was lower, as the nephrological diagnosis was often determined by results of genetic analysis. Nephrotic syndrome was the most frequent indication for kidney biopsy (31.8%) and was mainly caused by MCD and FSGS. The degree of disease chronicity on kidney biopsies was generally low, although 27.3% of biopsies with a diagnosis of FSGS showed moderate-to-severe chronic damage. Conclusions: The presented epidemiological findings validate data from previous European registry studies and may inspire kidney biopsy registries worldwide to implement novel features such as clinicopathological concordance and chronicity grading. [ABSTRACT FROM AUTHOR]

Introduction: Despite the relevance of advance care planning (ACP) for people with dementia, its uptake in this population is particularly low. Several challenges for ACP in dementia have been identified from physicians' perspectives. However, the literature available mainly includes general practitioners and focuses exclusively on the context of late-onset dementia. This is the first study to inquire physicians from four highly relevant specialisms in dementia care, with a focus toward potential specificities based on patients' age. The research question of this study is: "What are physicians' experiences with and perspectives on discussing ACP with people with young- and/or late-onset dementia?". Methods: Five online focus groups were conducted with 21 physicians (general practitioners, psychiatrists, neurologists and geriatricians) in Flanders, Belgium. Verbatim transcripts were analyzed through the qualitative method of constant comparative analysis. Results: Physicians believed that the societal stigma related to dementia influences people's reaction to their diagnosis, at times characterized by catastrophic expectations for the future. In this regard, they explained that the topic of euthanasia is sometimes addressed by patients very early in the disease trajectory. Respondents paid ample attention to actual end-of-life decisions, including DNR directives, when discussing ACP in dementia. Physicians felt responsible for providing accurate information on both dementia as a condition, and the legal framework of end-of-life decisions. Most participants felt that patients' and caregivers' wish for ACP was more driven by who their personality than by their age. Nonetheless, physicians identified specificities for a younger dementia population in terms of ACP: they believed that ACP covered more domains of life than for older persons. A high consistency regarding the viewpoints of physicians from differing specialisms was noted. Discussion: Physicians acknowledge the added value of ACP for people with dementia and especially their caregivers. However, they face several challenges for engaging in the process. Attending to specific needs in young-onset, in comparison to late-onset dementia, requires ACP to entail more than solely medical domains. However, a medicalized view on ACP still appears to be dominant in practice as opposed to its broader conceptualization in academia. [ABSTRACT FROM AUTHOR]

Purpose: Proximal humeral fractures (PHF) comprise approximately five percent of all fractures and this percentage will continue to increase due to the aging population with accompanying osteoporosis. Most PHF can be treated conservatively; however, in displaced fractures, surgical treatment is recommended. Retrospective analyses of large groups or even populations are important as they can contribute to the needs of the community. The aim of this study was to assess the epidemiology and management of PHF fixation in Belgium based on the most recently available data from the last 5 years. Methods: The governmental organization National Institute of Health and Disability Insurance provided a population-based database with all PHF treated surgically or nonoperatively. This database was retrospectively assessed. The data included age, sex, region of residence, year and treatment strategy for every patient. Healthcare expenses were also provided. Results: A total of 62,290 PHF were identified in Belgium between 2014 and 2018. The incidence was 111 per 100,000 persons/year. The highest incidence was observed in females and people older than 80 years. The average proportion of osteosynthesis was calculated at 21%. The Belgian government spent on average more than two million euros each year on PHF treatment. Conclusion: The overall incidence of PHF increased by 12% over the last 5 years. The majority were treated nonoperatively in Belgium. [ABSTRACT FROM AUTHOR]

Feeling threatened by terrorism can be associated with mental health problems and behavioural changes. However, few studies look at the association in the long-term. Using a survey, the population in Brussels, Belgium was studied using a representative database delivered by the national post service. The Patient Health Questionnaire-4 (PHQ-4) assessed mental health, and self-made questions avoidance behaviour. 170 people answered: 60% women and 50% higher educated, 28.2% between 56 and 65 years and 62.4% had a partner. 43.5% felt threatened by the terrorist attacks and 45.9% experienced no mental health problems. Both terrorist threat (p < 0.001) and avoidance behaviour (p < 0.001) significantly predicted PHQ-4 scores, while controlling for gender, age, social support, education level, and traumatic events. There is a relation between terrorist threat and anxiety/depressive symptoms 2.5 years after the last study on terrorist threat in Brussels, but it has weakened. Avoidance behaviour seems to be more present than threat. [ABSTRACT FROM AUTHOR]