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We draw on ethnographic fieldwork conducted in Brussels (Belgium) on the health care experiences of undocumented migrants. We explore the implications of the double position of the ethnographer, who is both a researcher and a practicing doctor. We describe how the intimate knowledge the ethnographer-cum-clinician holds about the health care system influenced and shaped the data collection, analysis and subsequent policy recommendations. We examine the ethical dilemmas in conducting research from an engaged position about care practices toward vulnerable populations in one's own professional field. We conclude with recommendations on how to challenge and interrupt complexities faced by multi-positioned ethnographers.

Background: Patients with haematologic malignancies are increasingly treated by oral anticancer medications, heightening the challenge of ensuring optimal adherence to treatment. However, except for chronic myelogenous leukaemia or acute lymphoid leukaemia, the extent of non-adherence has rarely been investigated in outpatient settings, particularly for migrant population. With growing numbers of migrants in Belgium, identifying potential differences in drug use is essential. Also, previous research regarding social determinants of health highlight important disparities for migrant population. Difficulties in communication between health caregivers and patients from different cultural and ethnic backgrounds has been underlined., Methods: Using a sequential mixed method design, the MADESIO protocol explores the adherence to oral anticancer medications in patients with haematological malignancies and among first and second generation migrants of varied origin. Conducted in the ambulatory setting, a first quantitative strand will measure adherence rates and associated risk factors in two sub-groups of patients with haematological malignancies (group A: first and second generation migrants and group B: non-migrants). The second qualitative strand of this study uses semi-structured interviews to address address the patients' subjective meanings and understand the statistical associations observed in the quantitative study (strand one). MADESIO aims to provide a first assessment of whether and why migrants constitute a population at risk concerning adherence to oral anticancer medications., Discussion: Our protocol is designed to provide a comprehensive understanding of adherence in a specific population. The methodological choices applied allow to explore adherence among patients from diverse linguistic and cultural backgrounds. A particular emphasis has been paid to minimize the biases and increase the reliability of the data collected. Easily reproductible, the MADESIO design may help healthcare services to screen adherence to Oral anticancer medications and to guide providers in choosing the best strategies to address medication adherence of migrants or minority diverse population., Competing Interests: The authors have declared that no competing interests exist.

We wanted to explore possible differences in disease presentation, frequency, and age of onset of dementia with Lewy bodies (DLB) between first-generation immigrants (FGI) and patients born in Belgium (PBIB). We conducted a retrospective study on all patients of our Memory Clinic between June 1, 2010 and January 31, 2020. A synucleinopathy was diagnosed in 150 of 2702 patients (5.5%): 91 received a diagnosis of DLB (3.4%). FGI were two times more likely to receive a diagnosis of DLB, due to a higher prevalence in North-Africans and Latin-Americans. Visual hallucinations were less frequent in North-Africans than in other immigrants. FGI were younger than PBIB and reported more often parasomnia. Our data suggest a higher risk for DLB in certain immigrant groups. Especially for North-African patients, a genetic factor can be suspected, namely mutations in Leucine-rich repeat kinase 2 (LRRK2). Memory clinics with a high rate of FGI may provide interesting data and insights into the prevalence of DLB, genetic and environmental differences.

This study aimed to relate school diversity approaches to continuity and change in teacher-student relationships, comparing Belgian-majority (N = 1,875, M age  = 14.56) and Turkish and Moroccan-minority adolescents (N = 1,445, M age  = 15.07). Latent-Growth-Mixture-Models of student-reported teacher support and rejection over 3 years revealed three trajectories per group: normative-positive (high support, low rejection) and decreasing-negative (moderate support, high-decreasing rejection) for both groups, increasing-negative (moderate support, low-increasing rejection) for minority, moderate-positive (moderate support, low rejection) for majority youth. Trajectories differed between age groups. Student and teacher perceptions of equality and multiculturalism afforded, and assimilationism threatened, normative-positive trajectories for minority youth. Diversity approaches had less impact on majority trajectories. Normative-positive trajectories were related to improved school outcomes; they were less likely, but more beneficial for minority than majority youth., (© 2020 The Authors. Child Development published by Wiley Periodicals LLC on behalf of Society for Research in Child development.)

When immigrant minorities engage in a new cultural context, their patterns of emotional experience come to change - a process we coined emotional acculturation . To date, research on emotional acculturation focused on the antecedents and consequences of changes in minorities' fit with the new culture. Yet, most minorities also continue to engage in their heritage culture. Therefore, the current research investigated which personal and situational factors afford minorities to maintain emotional fit with their heritage culture. Two studies compared the emotional patterns of Korean Americans ( n  = 49) with those of Koreans in Korea ( n  = 80), and the emotional patterns of Turkish Belgians ( n  = 144) with those of Turks in Turkey ( n  = 250), respectively. As expected, we found that although minorities did not fit the heritage emotional patterns as well as participants in their home countries, spending time with heritage culture friends and interacting in heritage culture settings explained within-group differences in minorities' heritage culture fit. Therefore, the current research shows that minorities' emotional patterns are not only cultivated, but also activated by their interactions in different socio-cultural contexts. Moreover, it provides further evidence for cultural frame-switching in the domain of emotion.

Foreign and native populations differ in terms of breast cancer outcomes. Studies rarely distinguish between premenopausal and postmenopausal breast cancer, although the risk profile is different; nor between migrants of the first and second generation (FG and SG), which is crucial to examine genetic and environmental influences on breast cancer. This research fills these gaps by investigating patterns in breast cancer incidence and survival in different migrant groups by menopausal and migrant generational status, taking various risk factors into account. To this end, individually linked data from the 2001 census, the Belgian Cancer Registry and the Crossroads Bank for Social Security are used. Age-standardised incidence rates and incidence rate ratios are calculated by migrant background group, stratified according to ages 30-50 (premenopausal) and 50-70 (postmenopausal). Incidence rate ratios are examined with and without taking reproductive factors and socioeconomic position (SEP) into account. Relative survival percentages and relative excess risks of dying among premenopausal and postmenopausal patients are computed with and without controlling for the stage at diagnosis and SEP. Premenopausal breast cancer is further examined by migrant generational status. Breast cancer incidence is lower among non-European migrants compared to Belgians. Keeping SEP and known risk factors constant reduces much, but not all of the observed discrepancies. A risk convergence between SG migrants and Belgians for the development of premenopausal breast cancer is observed. Premenopausal breast cancer survival is worse among Moroccan patients due to a higher stage at diagnosis. This disadvantage is concentrated in the FG., (© 2019 UICC.)

Background/aims: During dermatological forms development, one of the simplest non-invasive techniques used to evaluate cutaneous tolerance of formulations is to monitor the color changes using a tristimulus chromameter. Most published tolerance studies involving chromametric measurements are performed on Caucasian subjects. However, in the context of drug formulation for African-type populations, it is not always relevant to transpose tolerance results obtained on Caucasians populations to African-type ones due to histological ethnic differences of the skin. The goal of this work was to assess whether tristimulus chromameter can be used to highlight color variations following the application of dermatological topics on black skin in order to validate skin tolerance studies made on African-type subjects., Materials and Methods: After application of two commercial creams with opposite side effects (skin irritation and skin blanching) in both Africans and Caucasians populations, color variations were evaluated using a tristimulus chromameter in L * a * b * color system and compared between both populations. L * indicating color brightness, a * represents green and red directions and b * represents blue and yellow directions., Results: While skin irritation resulted in a significant increase of a * parameter in both studied populations, the skin blanching resulted in a decrease of a * associated with an increase of L * ., Conclusion: We established that tristimulus chromameter can be used to achieve in vivo skin tolerance study of dermatologic formulations in Africans despite their dark skin even though it appeared less sensitive. This study can speed up the development of dermatological forms dedicated to Africans and/or Caucasians subjects., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Gypsy Roma Travellers are Europe's largest ethnic minority group. Yet they remain one of the most stigmatised communities who have significant health inequalities. Whilst nurses have a role in promoting health access, there have been minimal studies exploring health care professionals' attitudes towards these communities and no studies exploring nursing students' perceptions., Objectives: To explore nursing students understanding, knowledge and perceptions of working with Gypsy Roma Travellers., Participants: 23 nursing students from across four European countries (UK, Spain, Belgium, Turkey) participated in the study. The students ages ranged between 19 and 32 year old, there was a mix of students between year one to year three of their programme and both male (n = 3) and female students (n = 19)., Methods: This qualitative research utilised focus groups and one to one interviews based at the four different universities, all following a pre-agreed interview schedule. Focus groups and interviews were conducted by the research team in the students' first language and later translated into English for analysis using thematic analysis. The COREQ criteria were used in the reporting of the study., Results: Four themes were identified which included: Exposure to Gypsy Roma Traveller Communities, Perceptions of Gypsy Roma Traveller cultures, Unhealthy lifestyles and culture and Nursing Gypsy Roma Travellers., Conclusions: Although personal and professional contact with Gypsy Roma Travellers was limited, most of the students' perceptions of these communities were negative. Nurse educational programmes need to embed transformational learning opportunities enabling student nurses to critically reflect upon values and beliefs of Gypsy Roma Travellers developed both before and during their nursing preparatory programme if they are to work effectively in a respectful, culturally sensitive way. There is also generally, a lack of research focussing upon healthcare professionals' attitudes towards these communities that needs to be explored through further research., (Crown Copyright © 2019. Published by Elsevier Ltd. All rights reserved.)

Background: Belgium has a long history of migration. As the migrant population is ageing, it is crucial thoroughly to document their health. Many studies that have assessed this, observed a migrant mortality advantage. This study will extend the knowledge by probing into the interaction between migrant mortality and gender, and to assess the role of socioeconomic position indicators in this paradox., Methods: Individually linked data of the 2001 Belgian Census, the National Register and death certificates for 2001-2011 were used. Migrant origin was based on both own and parents' origin roots. We included native Belgians and migrants from the largest migrant groups aged 25 to 65 years. Absolute and relative mortality differences by migrant origin were calculated for the most common causes of death. Moreover, the Poisson models were adjusted for educational attainment, home ownership and employment status., Results: We observed a migrant mortality advantage for most causes of death and migrant groups, which was strongest among men. Adjusting for socioeconomic position generally increased the migrant mortality advantage, however with large differences by gender, migrant origin, socioeconomic position indicator and causes of death., Conclusions: Adjusting for socioeconomic position even accentuated the migrant mortality advantage although the impact varied by causes of death, migrant origin and gender. This highlights the importance of including multiple socioeconomic position indicators when studying mortality inequalities. Future studies should unravel morbidity patterns too since lower mortality not necessarily implies better health. The observed migrant mortality advantage suggests there is room for improvement. However, it is essential to organize preventative and curative healthcare that is equally accessible across social and cultural strata.

Background: The incidence rate of Zika virus (ZIKV) infection in travellers from non-endemic areas to the Americas during the ZIKV outbreak in 2016 is unknown., Methods: Belgian adults who planned to travel to South America, Central America, and the Caribbean were recruited prospectively to study the incidence and characteristics of ZIKV. Demographic data and sera were collected at baseline. Participants were trained to collect capillary blood on filter paper (BFP). When ill during travel, the participants completed a questionnaire and they sampled BFP for post-hoc analysis. All symptomatic participants were screened for ZIKV using ZIKV-specific RT-PCR on serum or urine, or BFP, and antibody detection assays (ELISA). Follow-up sera of asymptomatic travellers, obtained at least 20 days post travel, were tested by ZIKV ELISA only. All positive ELISA results were subject to confirmation by virus neutralization testing (VNT)., Results: Forty-nine participants completed follow-up: 38 women and 11 men, with a median age of 32 years (range 19-64 years). Travel destinations were countries in South America (n=20), Central America (n=24), and the Caribbean (n=5). The total travel duration was 67.8 person-months. Illness was reported by 24 participants (49.0%). ZIKV infection was confirmed in nine cases, by RT-PCR (n=5) and by VNT (n=4). Only one of nine ZIKV cases (11.1%) was asymptomatic. The ZIKV incidence rate was 17.0% (95% confidence interval 7.8-32.2%) per month of travel., Conclusions: The ZIKV incidence rate in adult travellers from non-endemic countries to the epidemic territories during the 2016 outbreak was high. Asymptomatic ZIKV infection was rare in this population., (Copyright © 2018 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Lyme disease is an endemic zoonosis, the most prevalent tick-transmitted infection in temperate areas of Europe, North America and Asia. It is a multisystemic disease with cutaneous, musculoskeletal, neurologic and cardiac manifestations, according to the stage of the disease. We describe a case of late neuroborreliosis in an Erasmus programme student living in Porto. We discuss the importance of the epidemiological suspicion, the clinical approach, the diagnostic criteria and the most adequate treatment.

Objectives: The GO-MORE trial (NCT00975130) was a phase 3 study in 40 countries evaluating the efficacy and safety of golimumab as add-on therapy in biologic-naïve adults with active rheumatoid arthritis despite stable treatment with disease-modifying anti-rheumatic drugs. To inform local practice in Belgium and examine the role of baseline disease activity in treatment response, we compared the efficacy of golimumab in the Belgian subpopulation and the rest of the world., Methods: Baseline disease activity and six-month efficacy rates in the GO-MORE trial were compared for the Belgian subpopulation and the rest of the world by t-tests and chi-squared tests., Results: Except for functional impairment, all measures of baseline disease activity were significantly lower (p < 0.0001) in the Belgian population (n = 123) than in the rest of the world (n = 3157). At month six, the rate of good/moderate EULAR response was similar in Belgium and the rest of the world (78.9% vs. 82.2%; p = 0.34), but remission rates were higher in Belgium according to the DAS28-ESR (43.1% vs. 23.2%; p < 0.0001) and Simplified Disease Activity Index (22.0% vs. 13.8%; p = 0.01). Rates of low DAS28-ESR disease activity were also higher in Belgium (54.5% vs. 36.8%; p < 0.0001). Within the Belgian subpopulation, efficacy measures were not significantly different between patients with moderate (n = 73) and high baseline activity (n = 49). Rates of functional impairment at month six did not differ between the two populations., Conclusion: In the Belgian population of the GO-MORE trial, baseline disease activity was lower and six-month remission rates were higher than in the rest of the world.

Objective: While in general arousal increases with positive or negative valence (a so-called V-shaped relation), there are large differences among individuals in how these two fundamental dimensions of affect are related in people's experience. In two studies, we examined two possible sources of this variation: personality and culture., Method: In Study 1, participants (Belgian university students) recalled a recent event that was characterized by high or low valence or arousal and reported on their feelings and their personality in terms of the Five-Factor Model. In Study 2, participants from Canada, China/Hong Kong, Japan, Korea, and Spain reported on their feelings in a thin slice of time and on their personality., Results: In Study 1, we replicated the V-shape as characterizing the relation between valence and arousal, and identified personality correlates of experiencing particular valence-arousal combinations. In Study 2, we documented how the V-shaped relation varied as a function of Western versus Eastern cultural background and personality., Conclusions: The results showed that the steepness of the V-shaped relation between valence and arousal increases with Extraversion within cultures, and with a West-East distinction between cultures. Implications for the personality-emotion link and research on cultural differences in affect are discussed., (© 2016 Wiley Periodicals, Inc.)

Background: Social integration and the health of adolescents with a migration background is a major concern in multicultural societies. The literature, however, has paid little attention to the wider determinants of their health behaviours, including the composition of their social networks. The aim of this study was to describe the composition of adolescents' social networks according to migration background, and to examine how social networks are associated with substance use., Method: In 2013, the SILNE study surveyed 11,015 secondary-school adolescents in 50 schools in six European cities in Belgium, Finland, Germany, Italy, the Netherlands, and Portugal, using a social network design. Each adolescent nominated up to five of their best and closest friends. Migration status was defined as first-generation migrants, second-generation migrants, and speaking another language at home. We computed two groups of network structural positions, the centrality of individual adolescents in networks, and the homophily of their social ties regarding migration (same-migration). Multilevel logistic regression was used to model the association between network structural position and smoking, alcohol use, and cannabis use., Results: Compared with non-migrant adolescents, adolescents with migration backgrounds had similar relationship patterns. But almost half their social ties were with same-migration-background adolescents; non-migrants had few social ties to migrants. For adolescents with a migration background, a higher proportion of social ties with non-migrants was associated with increased use of cannabis (OR = 1.07, p = 0.03) and alcohol (OR = 1.08, p < 0.01), but not with increased smoking (p = 0.60). Popular migrant adolescents were at less risk of smoking, alcohol use, and cannabis use than popular non-migrant adolescents., Conclusion: Homophily of social ties by migration background is noticeable in European schools. The tendency of migrant adolescents to have same-migration social ties may isolate them from non-migrant adolescents, but also reduces their risky health behaviours, in particular cannabis and alcohol use., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Objectives: The aim of this study is to investigate the association between ethnic composition in school and the ethnic prejudice of teachers, controlling for the individual characteristics of teachers and their perceptions of pupils' teachability., Method: Multilevel analyses were carried out on data for 499 Flemish teachers in 44 Flemish (Belgian) secondary schools, collected through an online questionnaire. In this study, ethnic prejudice means a negative attitude to Moroccans, Turks, and Eastern Europeans. A scale was created by taking the mean scores for 18 items, with higher scores indicating greater ethnic prejudice (Quillian, 1995; Witte, 1999)., Results: Teachers with long-term higher education or a university diploma are shown to be less ethnically prejudiced than teachers with a lower level of education. Moreover, teachers who work at a school with a greater number of ethnic minority pupils, and at the same time evaluate their pupils as more teachable, are less ethnically prejudiced., Conclusions: These findings highlight the need for more research into the underlying processes, such as pupils' teachability, that influence the relationship between school characteristics and the ethnic prejudice of teachers. More knowledge about the context-specific factors and processes that mediate and/or moderate this relationship can increase the theoretical understanding of the development of ethnic prejudice. It can also highlight particular social characteristics, which can be the focus of social and organizational policy aimed at reducing ethnic prejudices. (PsycINFO Database Record, ((c) 2016 APA, all rights reserved).)

Can perceptions of equal treatment buffer the negative effects of threat on the school success of minority students? Focusing on minority adolescents from Turkish and Moroccan heritage in Belgium (Mage  = 14.5; N = 735 in 47 ethnically diverse schools), multilevel mediated moderation analyses showed: (a) perceived discrimination at school predicted lower test performance; (b) experimentally manipulated stereotype threat decreased performance (mediated by increased disengagement); (c) perceived equal treatment at school predicted higher performance (mediated by decreased disengagement); and (d) personal and peer perceptions of equal treatment buffered negative effects of discrimination and stereotype threat. Thus, (situational) stereotype threat and perceived discrimination at school both undermine minority student success, whereas perceived equal treatment can provide a buffer against such threats., (© 2016 The Authors. Child Development © 2016 Society for Research in Child Development, Inc.)

How do minority adolescents' personal acculturation preferences and peer norms of acculturation affect their social inclusion in school? Turkish and Moroccan minority adolescents (N = 681) reported their preferences for heritage culture maintenance, mainstream culture adoption, and their experiences of peer rejection as a key indicator of adjustment problems. Additionally, we aggregated peer acculturation norms of maintenance and adoption within ethnically diverse classrooms (N = 230 in 50 Belgian schools), distinguishing between co-ethnic (Turkish or Moroccan classmates only, N = 681) and cross-ethnic norms (also including N = 1,930 other classmates). Cross-ethnic peer-group norms (of adoption and maintenance) and co-ethnic norms (of maintenance, marginally) predicted minority experiences of peer rejection (controlling for ethnic composition). Moreover, misfit of minorities' own acculturation preferences with both cross-ethnic and co-ethnic peer-group norms was harmful. When cross-ethnic norms stressed adoption, 'integrationist' minority youth - who combined culture adoption with maintenance - experienced most peer rejection. Yet, when co-ethnic peers stressed maintenance, 'assimilationist' minority youth experienced most rejection. In conclusion, acculturation misfit with peer-group norms is a risk factor for minority inclusion in ethnically diverse environments., (© 2016 The British Psychological Society.)

Background: Recent cross-cultural comparisons between Asian and Western cultures have shown that ageism arises more from the lack of availability of social and economic resources for older adults than from the culture itself. We tested this assumption by conducting a survey among people living in a least developed country compared with those living in a developed country., Participants and Methods: Twenty-seven Belgians living in Belgium, 29 Burundians living in Belgium, and 32 Burundians living in Burundi were included in this study. Their attitudes toward older adults were assessed using several self-reported measures., Results: Statistical analyses confirmed that older people are more negatively perceived by Burundians living in Burundi than by Burundians and Belgians living in Belgium, whose attitudes did not differ from each other., Conclusion: Consistent with our hypothesis, our results suggest that the level of development of a country and more particularly the lack of government spending on older people (pension and health care systems) may contribute to their younger counterparts perceiving them more negatively.

Background: In general, vulnerable populations experience more problems in accessing health care. This also applies to the Roma-population. In the City of Ghent, Belgium, a relatively large group of Roma resides more or less permanently. The aim of this study is to explore the barriers this population encounters in their search for care., Methods: In this qualitative study using in-depth interviews the barriers to health care for the Roma in Ghent are explored. We interviewed 12 Roma and 13 professionals (volunteers, health care providers,...) who had regular contact with the Roma-population in Ghent. For both groups purposive sampling was used to achieve maximal variation regarding gender, age, nationality and legal status., Results: The Roma-population in Ghent encounters various barriers in their search for care. Financial constraints, not being able to reach health care and having problems to get through the complexity of the system are some of the most critical problems. Another important finding is the crucial role of trust between patient and care provider in the care-giving process., Conclusion: Roma share several barriers with other minority groups, such as: financial constraints, mobility issues and not knowing the language. However, more distinctive for this group is the lack of trust in care providers and health care in general. As a result, restraint and lack of communication form serious barriers for both patient and provider in their interaction. In order to ensure equitable access for Roma, more emphasis should be on establishing a relationship of mutual respect and understanding.

Background: The Belgian HIV epidemic is largely concentrated among men who have sex with men and Sub-Saharan Africans. We studied the continuum of HIV care of those diagnosed with HIV living in Belgium and its associated factors., Methods: Data on new HIV diagnoses 2007-2010 and HIV-infected patients in care in 2010-2011 were analysed. Proportions were estimated for each sequential stage of the continuum of HIV care and factors associated with attrition at each stage were studied., Results: Of all HIV diagnosed patients living in Belgium in 2011, an estimated 98.2% were linked to HIV care, 90.8% were retained in care, 83.3% received antiretroviral therapy and 69.5% had an undetectable viral load (<50 copies/ml). After adjustment for sex, age at diagnosis, nationality and mode of transmission, we found lower entry into care in non-Belgians and after preoperative HIV diagnoses; lower retention in non-Belgians and injecting drug users; higher retention in men who have sex with men and among those on ART. Younger patients had lower antiretroviral therapy uptake and less viral suppression; those with longer time from diagnosis had higher ART uptake and more viral suppression; Sub-Saharan Africans on ART had slightly less viral suppression., Conclusions: The continuum of HIV care in Belgium presents low attrition rates over all stages. The undiagnosed HIV-infected population, although not precisely estimated, but probably close to 20% based on available survey and surveillance results, could be the weakest stage of the continuum of HIV care. Its identification is a priority along with improving the HIV care continuum of migrants.

Spinocerebellar ataxia type 10 (SCA10) is a rare form of autosomal dominant ataxia found predominantly in patients from Latin America with Amerindian ancestry. The authors report the history of SCA10 families from the south of Brazil (the states of Paraná and Santa Catarina), emphasizing the Belgian-Amerindian connection.

Patients with HIV not only have to deal with the challenges of living with an incurable disease but also with the dilemma of whether or not to disclose their status to their partners, families and friends. This study explores the extent to which sub-Saharan African (SSA) migrant women in Belgium disclose their HIV positive status, reasons for disclosure/non-disclosure and how they deal with HIV disclosure. A qualitative study consisting of interviews with twenty-eight SSA women with HIV/AIDS was conducted. Thematic content analysis was employed to identify themes as they emerged. Our study reveals that these women usually only disclose their status to healthcare professionals because of the treatment and care they need. This selective disclosure is mainly due to the taboo of HIV disease in SSA culture. Stigma, notably self-stigma, greatly impedes HIV disclosure. Techniques to systematically incorporate HIV disclosure into post-test counseling and primary care services are highly recommended.

In this article we propose looking into some factors for Civic Participation and the intention to continue to participate among local (Study I) and immigrant (Study II) young people living in Belgium and Germany. In Study I, 1,079 young people (M(age) = 19.23, 44.9% males) completed a self-report questionnaire asking about their Civic Participation. Multiple linear regressions reveal (a) evidence of a pool of variables significantly linked to Civic Participation: Institutional Trust, Collective-Efficacy, Parents' and Peers' Support, Political Interest, Motivations and (b) that Civic Participation, along with the mediation of the Participation's Efficacy, explains the Intention to Continue to Participate. An explanatory model was constructed on participation and the Intention to Continue to Participate on behalf of the native youth. This model is invariant between the two countries. In Study II, 276 young Turkish immigrants (M(age) = 20.80, 49.3% males) recruited in Belgium and Germany filled out the same questionnaire as in Study I. The same analysis was conducted as for Study I, and they provided the same results as the native group, highlighting the invariance of the model between natives and immigrants. Applicative repercussions are discussed.

In view of the possible negative mental health outcomes of antigay violence and the limited understanding of how lesbian, gay, and bisexual (LGB) men and women cope with such experiences, this study examined the coping and social support-seeking strategies that victims adopt. In 2012, in-depth interviews were conducted with 19 Flemish sexual minority victims of violence. These in-depth interviews show that antigay violence can generate profound negative outcomes. However, the respondents employed a range of coping strategies, of which four were discerned: (1) avoidance strategies, (2) assertiveness and confrontation, (3) cognitive change, and (4) social support. Applying a diverse set of coping strategies and actively attaching meaning to negative experiences helps victims of antigay violence to overcome negative effects such as fear, embarrassment, or depressive feelings. However, the presence of a supportive network seems an important condition in order for these positive outcomes to occur.

Objective: To compare the clinical, demographic, and serologic characteristics and the treatment of patients diagnosed with ankylosing spondylitis (AS) from Europe (EU) and Latin America (LA)., Methods: We included 3439 patients from national registries: the Spanish Registry of Spondyloarthritis (REGISPONSER), the Belgian registry (ASPECT), and the Latin American Registry of Spondyloarthropathies (RESPONDIA). We selected patients with diagnosis of AS who met the modified New York classification criteria. Demographic, clinical, disease activity, functional, and metrological measurement data were recorded. Current treatment was recorded. The population was classified into 2 groups: patients with disease duration < 10 years and those with disease duration ≥ 10 years. A descriptive and comparative analysis of variables of both groups was carried out., Results: There were 2356 patients in EU group and 1083 in LA group. Prevalence of HLA-B27 was 71% in LA group and 83% in EU group (p < 0.001). We found a greater frequency of peripheral arthritis and enthesitis (p < 0.001) in the LA population; prevalence of arthritis was 57% in LA and 42% in EU, and for enthesitis, 54% and 38%. Except for treatment with anti-tumor necrosis factor (anti-TNF), the use of nonsteroidal antiinflammatory drugs (NSAID), corticosteroids, and disease-modifying antirheumatic drugs (DMARD), and the association of anti-TNF and methotrexate use showed a significant difference (p < 0.001) in the 2 populations., Conclusion: The principal differences in the clinical manifestations of patients with AS from EU and LA were the greater frequency of peripheral arthritis and enthesitis in LA group, the higher percentage of HLA-B27 in EU group, and the form of treatment, with a greater use of NSAID, steroids, and DMARD in the LA group.

Evidence drawn from nineteenth-century Belgian population registers shows that the presence of similarly aged siblings competing for resources within a household increases the probability of death for children younger than five, even when controlling for the preceding birth interval and multiple births. Furthermore, in this period of Belgian history, such mortality tended to cluster in certain families. The findings suggest the importance of segmenting the mortality of siblings younger than five by age group, of considering the presence of siblings as a time-varying covariate, and of factoring mortality clustering into analyses.

Although the diffusion of fertility behavior between different social strata in historical communities has received considerable attention in recent studies, the relationship between the diffusion of fertility behavior and the diffusion of people (migration) during the nineteenth century remains largely underexplored. Evidence from population registers compiled in the Historical Database of the Liège Region, covering the period of 1812 to 1900, reveals that migrant couples in Sart, Belgium, from 1850 to 1874 and from 1875 to 1899 had a reduced risk of conception. The incorporation of geographical mobility, as well as the migrant status of both husbands and wives, into this fertility research sheds light not only on the spread of ideas and behaviors but also on the possible reasons why the ideas and behaviors of immigrants might have been similar to, or different from, those of a native-born population.

Objectives: To examine if and to what extent ethnic differences in diabetes-related mortality are associated with differences in education and housing status., Methods: The data consist of a cohort study linking the 2001 census to emigration and mortality data for the period 2001-05. The study population comprises all Belgian and North African inhabitants of the Brussels-Capital Region (BCR) aged 25-74. Age-standardized mortality rates (ASMRs) (direct standardization) and mortality rate ratios (MRRS) (Poisson regression) are computed., Results: North Africans have a higher diabetes-related mortality compared to Belgians. The ASMRs for North African and Belgian women are 54.8 (95% confidence interval (CI) 31.5-78.2) and 23.8 (95% CI 20.3-27.3), respectively. These differences in diabetes-related mortality largely disappear when differences in education are taken into account. The MRRs for North African versus Belgian origin drop from 1.62 (95% CI 1.11-2.37) to 1.19 (95% CI 0.73-1.93) in men and from 3.35 (95% CI 2.08-5.41) to 1.88 (95% CI 0.95-3.69) in women., Conclusions: Differences in education play an important part in the excess diabetes-related mortality among North Africans in the BCR.

Objective: Turkish immigrants have been found to report more somatic complaints compared to western majority groups. The present study investigates the combination of two cultural explanations (somatization versus psychologization and emotion mediation) with two acculturative explanations (acculturative stress versus acculturative transition) to explain these differences., Design: In total, 144 Turkish immigrants, 353 Belgian majority members, and 222 Turkish majority members were asked to report the last three emotional episodes they encountered and to rate them on 24 emotion terms and 17 somatic sensations., Results: Turkish majorities scored higher on all somatic factors, anxiety-sadness, and self-conscious emotions followed by Turkish immigrants and Belgian majorities. Furthermore, path analysis showed (partial) mediation effects of anxiety-sadness and self-conscious factors on the differences in the somatic factors between Belgian and Turkish majorities., Conclusion: These results indicate that the somatic differences do not result from a trade-off between somatization and psychologization, but that emotions mediate differences in somatic processes to a large extent. It was also found that differences between Turkish immigrants and Belgian majority members are to be attributed to acculturative transition, rather than to acculturative stress.

Missense mutations were identified in the Grb10-Interacting GYF Protein-2 gene (GIGYF2), located in the chromosomal region 2q36-q37, in familial Parkinson disease (PD) patients of European descent. To determine the contribution of GIGYF2 mutations in an extended (N=305) Belgian series of both familial and sporadic PD patients, we sequenced all 32 coding and non-coding exons of GIGYF2. In three sporadic PD patients we identified two novel heterozygous missense mutations (c.1907A>G, p.Tyr636Cys and c.2501G>A, p.Arg834Gln), that were absent from control individuals (N=360). However, since we lack genetic as well as functional data supporting their pathogenic nature, we cannot exclude that these variants are benign polymorphisms. Together, our results do not support a role for GIGYF2 in the genetic etiology of Belgian PD., (Copyright © 2009 Elsevier Inc. All rights reserved.)

In times of low divorce rates (such as the nineteenth century and early twentieth century), the authors expect higher social strata to have the highest divorce chances as they are better equipped to break existing barriers to divorce. In this article, the authors analyze data from marriage certificates to assess whether there was a positive effect of occupational class on divorce in Belgium (Flanders) and the Netherlands. Their results for the Netherlands show a positive association between social class and divorce, particularly among the higher cultural groups. In Flanders, the authors do not find this, but they observe a negative association between illiteracy and divorce, an observation pointing in the same direction.

During the belle époque, Belgium was a trend-setting nation in many domains, including motorised sports. Belgian automobile racers and pilots shattered world records and became international stars. Striking was the shift in sports. Indeed, around 1896, sporting members of the leisure class stepped from the bicycle into the automobile and, around 1908, from the automobile into the airplane. Although these motorised sports were extremely expensive, this article shows that sportsmen and sportswomen from the working class could achieve upward social mobility through their performances. The achievements of these motorised pioneers had a major impact and wide-ranging significance. They laid the foundations for the expansion of the automobile industry and the emergence of civilian and military aviation.

In historiography there is a tendency to see the Great War as marking the end of scientific optimism and the period that followed the war as a time of discord. Connecting to current (inter)national historiographical debate on the question of whether the First World War meant a disruption from the pre-war period or not, this article strives to prove that faith in scientific progress still prevailed in the 1920s. This is shown through the use of Belgium as a case study, which suggests that the generally adopted cultural pessimism in the post-war years did not apply to the public rhetoric of science in this country. Diverse actors -- scientists, industrialists, politicians, the public opinion, and the military staff -- declared a confidence in science, enhanced by wartime results. Furthermore, belief in science in Belgium was not affected by public outcry over the use of mustard gas, unlike in the former belligerent countries where the gas became an unpleasant reminder of how science was used during the war. Even German science with its industrial applications remained the norm after 1918. In fact, the faith in science exhibited during the pre-war years continued to exist, at least until the 1920s, despite anti-German sentiments being voiced by many sections of Belgian society in the immediate aftermath of the war.

The electoral and political consequences of suburbanisation recently regained interest in the Anglo-Saxon literature, pointing to a growing polarisation between city and suburban fringe. This paper analyses these processes in the Antwerp urban region and shows the development of a similar electoral divide that is supported by the political parties involved. These observations add to the existing evidence that city–suburban polarisation in Belgium cannot be simply equated with the Anglo-Saxon experience, where a complete suburban fencing off from the city is observable. Rather, because of the comparatively limited development of functions in the Belgian suburbs, a suburban discourse emerges that focuses on safe and accessible cities for the suburban user, yet without much reference to its present inhabitants.

Economic, social, political, and demographic processes changed Western European cities strongly during the nineteenth century. Especially during this time, the northern part of Belgium (Flanders) became highly urbanized. Investigating the long-term development of the marriage pattern in the cities of Antwerp, Aalst, and Ghent gives a detailed picture of the evolution of the urban marriage pattern. In this article, specific emphasis is on gender, social, and migration distinctions. The results confirm that there is a male-female difference and variation among various social and migrant groups in the age at first marriage during the period 1800-1906. Moreover, regional differences are also visible. In the port city of Antwerp, massive immigration caused a unique evolution in the age at first marriage during the last decades of the nineteenth century, which did not appear in the textile cities of Aalst and Ghent during this time.

The immigration policies adopted by Western European states during the interwar period were marked by increasing restriction, especially after 1933. One notable exception to this was the relatively generous treatment afforded to women who were prepared to take up employment as domestic servants. This article looks at the reasons behind this anomaly and compares the responses of three states that were in the front line of the refugee efflux from Germany and Eastern Europe in the years leading up to the Second World War.

Background: Breast cancer incidence rate in Belgian women was as high as 152.7 for 100 000 in 2003 (adjusted on European population). We made an estimation of the contribution of hormone replacement therapy (HRT) on breast cancer incidence from 1999 to 2005 in women aged 50-69 years in Flanders., Methods: Breast cancer data were extracted from the Belgium Cancer Registry. Drug consumption was computed from drug sales data. The fraction of breast cancers attributable to HRT was calculated by year, using the relative risks of the Million Women Study in the UK., Results: The proportion of women aged 50-69 years using HRT in Flanders increased since 1992, peaked at 20% in 2001, then decreased to 8% in 2008. The incidence of breast cancer in 100 000 women aged 50-69 years in Flanders increased from 332.8 in 1999 to 407.9 in 2003, then decreased to 366.1 in 2005; the variations were mostly noticeable for tumors <20 mm in size. The fraction of breast cancers attributed to HRT peaked at 11% in 2001 and decreased afterward., Conclusion: The high level of breast cancer observed in the years 2001-2003 in Flanders can be partly attributed to the use of HRT. Since participation to mammography screening of Flemish women aged 50-69 years was still on the rise in 2003 and never exceeds 62%, the decrease in breast cancer incidence was likely to be due to the decrease in HRT use and not to screening saturation.

The health benefits of consuming organic compared to conventional foods are unclear. This study aimed at evaluating the nutrient and contaminant intake of adults through consumption of organic versus conventional vegetables, namely carrots, tomatoes, lettuce, spinach and potatoes. A probabilistic simulation approach was used for the intake assessment in two adult populations: (1) a representative sample of Belgians (n=3245) and (2) a sample of Flemish organic and conventional consumers (n=522). Although significant differences in nutrient and contaminant contents were previously found between organic and conventional vegetables, they were inconsistent for a component and/or vegetable. These findings were translated here into inconsistent intake assessments. This means that the intake of specific nutrients and contaminants can be higher or lower for organic versus conventional vegetables. However, when considering the consumption pattern of organic consumers, an increase in intake of a selected set of nutrients and contaminants is observed, which are explained by the general higher vegetable consumption of this consumer group. In public health terms, there is insufficient evidence to recommend organic over conventional vegetables. The general higher vegetable consumption of organic compared to conventional consumers outweighs usually the role of differences in nutrient and contaminant concentrations between organic and conventional vegetables., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

The study uses examinations and other documents produced in the course of a large-scale investigation undertaken by the central authorities of the Austrian Netherlands in the 1760s on the transportation of about thirty children from Brussels to the Parisian foundling house by a Brussels shoemaker and his wife. It combines the rich archival evidence with sparse indications in the literature to demonstrate that long-distance transports of abandoned children were a common but historiographically neglected by-product of the ambiguities of foundling policies in eighteenth-century Europe and provides insight into the functioning of the associated networks and the motives of parents, doctors, midwives, transporters, and local officials involved.

This essay touches upon questions about the use of food as an identity marker, the nature of local food, and the influence of foreign food. Since 1830, Belgium witnessed two international food waves that alternated with two local food waves, both opposing as well as using each other's characteristics. In this process, local food was continuously redefined. Belgium reveals a relationship between local and foreign food both in the sense of incorporation and exclusion. Foreign food always influenced local cooking and eating. The opposition between the “self” and the “other” is at times strongly upheld: local food is labeled as “our,” “authentic,” “national,” or “regional” (the “self”) to make the difference with “their,” “artificial,” or “international” (the “other”). This classification of foodways as national/regional is used to forge sentiments of belonging, especially in Belgium where strong separatist political feelings lead to intense regional reactions.

Minors travelling without their parent(s) or guardian are an increasing phenomenon. Although their travel objectives might differ importantly, varying from holiday purposes to migration objectives, an important subgroup of them might be at risk to fall into exploitative circumstances, such as human trafficking. Studying the group of minors travelling alone arriving at Brussels Airport (Belgium), this research investigates the population's characteristics, the procedures used, and the risks some of these minors run of falling into exploitative situations. Firstly, registration revealed that tens of thousands minors travelling alone arrive at Brussels Airport each year, with an important part of them coming from African countries. Secondly, participant observations showed that detection of possible cases of human trafficking is a very complex issue, resulting in the alarming hypothesis that many cases of trafficking of minors travelling alone might not be detected during their journey or at their arrival at the airport.

Background: The study of vitamin D status at population level gained relevance since vitamin D deficiency was recently suggested to trigger chronic disease., Aim of the Study: We aimed to describe vitamin D status, its association with bone and mineral metabolism and risk factors for deficiency in adults over 40 years in Belgium., Methods: We conducted a cross-sectional survey in a stratified random sample of 401 subjects aged between 40 and 60 years living in Brussels, and drawn from 4 different ethnic backgrounds: autochthonous Belgian, Moroccan, Turkish and Congolese. 25-Hydroxyvitamin D (25OHD), parathyroid hormone (PTH), osteocalcin, C-telopeptide and bone mineral density was measured., Results: Three-hundred and six subjects (77%) showed 25OHD concentrations below 50 nmol/l,135 (34%) below 25 nmol/l and 18 (5%) below 12.5 nmol/l. The proportion of subjects with vitamin D deficiency was four times greater amongst those of Moroccan or Turkish descent compared with those of Congolese or Belgian descent. Moroccan subjects showed a significant higher PTH and bone marker concentrations compared to Belgian. Ethnicity, season and sex were independently associated with vitamin D deficiency in multivariate analysis., Conclusion: The prevalence of vitamin D deficiency is very high amongst the adult population of Brussels but immigrants are at greater risk. Given the established link between population health and adequate vitamin D status, a policy of vitamin D supplementation should be considered in these risk groups.

The authors describe the four patients in the first known Belgian family with autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS). A novel homozygous missense mutation, NM&#95;014363.3: c.3491T>A in exon 9, of the SACS gene was identified in the present family, which results in an original amino acid of methionine to lysine substitution at amino acid residue 1164 (p.M1164K). Although the cardinal clinical features, i.e., spastic ataxia with peripheral neuropathy, in our patients were similar to those in Quebec patients, our patients exhibited some atypical clinical features, e.g., teenage-onset and absence of retinal hypermyelination. The present family is from Wallonia, and there could be shared ethnicity with the families of Charlevoix-Saguenay.

The relationship between dissociative tendencies, as measured with the Dissociative Experiences Scale and its amnesia, absorption/imaginative involvement, and depersonalization/derealization subscales, and HPA axis functioning was studied in 2 samples of undergraduate students (N = 58 and 67). Acute stress was induced by means of the Trier Social Stress Test. Subjective and physiological stress (i.e., cortisol) responses were measured. Individuals high on the depersonalization/derealization subscale of the Dissociative Experiences Scale exhibited more pronounced cortisol responses, while individuals high on the absorption subscale showed attenuated responses. Interestingly, subjective stress experiences, as indicated by the Tension-Anxiety subscale of the Profile of Mood States, were positively related to trait dissociation. The present findings illustrate how various types of dissociation (i.e., depersonalization/derealization, absorption) are differentially related to cortisol stress responses.

Dutch and Belgian immigrants in California have a high rate of unresolved attachment status compared to nonimmigrant Californians, unrelated to their length of time in the United States, to their marriage status, or to their reasons for immigration. In this study, the author analyzes attachment at the representational level by comparing coherence in responses of 69 immigrants (29 men and 40 women) and 30 nonimmigrants (12 men and 18 women) to drawings in the Adult Attachment Projective (AAP; C. George & M. L. West, 2001; C. George, M. L. West, & O. Pettem, 1999). Analysis of variance indicates that being unresolved with regard to attachment is linked to greater perception of danger in general, and to a lower ability to resolve danger once perceived. Resolution of danger in story responses to AAP images shows that the immigrant group is most troubled by images of departure and isolation, but nonimmigrants are most disturbed by images of illness.

Influenced by results for the Second World War, recent research on forced labour in Imperial Germany during the Great War has stressed continuities of racial discrimination against East European workers. While agreeing that prisoners of war (POWs) from Russia were discriminated against, I reject the view that this led to a significantly worse mortality regime for the group as a whole. Using the same raw data, I calculate annual rates which show that the mortality of POWs from Russia was only slightly higher than that of French and Belgian POWs but much lower than that of British and Italian POWs and of Belgian civilian deportees. I argue that this unexpected outcome is explained by the fact that the POWs who came early into German captivity faced a lower risk of being employed in urban industrial areas, with their much more unfavourable food and disease environment.