An Van Nieuwenhuyse

Pain-related fear predicts disability, but not pain severity : a path analytic approach of the fear-avoidance model

Two studies are reported that tested the fear‐avoidance (FA) model using path analytic techniques. In study 1, 429 employees with back pain at baseline and back pain at 18 months follow‐up completed questionnaires assessing sociodemographic information, pain severity, negative affect, pain‐related fear, and disability. Results indicated that pain severity at baseline predicted pain‐related fear and disability at follow‐up, and that pain‐related fear is rather a consequence than an antecedent of pain severity. Results further revealed that the disposition to experience negative affect has a low impact upon pain severity and disability, and is best viewed as a precursor of pain‐related fear. Study 2 included 238 employees without back pain at baseline, but who developed back pain at 1 year follow‐up. A similar model as in study 1 was tested. Overall, results are in line with those of study 1. Results are discussed in terms of theoretical relevance and clinical implications.

Short-Term Effect of Pollen and Spore Exposure on Allergy Morbidity in the Brussels-Capital Region

Belgium is among the European countries that are the most affected by allergic rhinitis. Pollen grains and fungal spores represent important triggers of symptoms. However, few studies have investigated their real link with disease morbidity over several years. Based on aeroallergen counts and health insurance datasets, the relationship between daily changes in pollen, fungal spore concentrations and daily changes in reimbursable systemic antihistamine sales has been investigated between 2005 and 2011 in the Brussels-Capital Region. A Generalized Linear Model was used and adjusted for air pollution, meteorological conditions, flu, seasonal component and day of the week. We observed an augmentation in drug sales despite no significant increase in allergen levels in the long term. The relative risk of buying allergy medications associated with an interquartile augmentation in pollen distributions increased significantly for Poaceae, Betula, Carpinus, Fraxinus and Quercus. Poaceae affected the widest age group and led to the highest increase of risk which reached 1.13 (95% CI [1.11–1.14]) among the 19- to 39-year-old men. Betula showed the second most consistent relationship across age groups. Clear identification of the provoking agents may improve disease management by customizing prevention programmes. This work also opens several research perspectives related to impact of climate modification or subpopulation sensitivity.

Cytological screening for cervical cancer in the province of Limburg, Belgium

Cervical cancer screening in Belgium is mainly opportunistic with periodic attempts to organize it according to the European guidelines. In the province of Limburg (north-east Belgium), a cervical cytology registry was set up in collaboration with local cytopathological laboratories, provincial health authorities and the Limburg Cancer Registry. Laboratories regularly communicated coded results of Pap smears from women residents in Limburg to the provincial cytological registry. All individual records contained a virtually unique identifying code allowing the study of longitudinal histories and linkage with the cancer registry. The screening coverage (percentage of women with a Pap smear in a defined period), the prevalence and incidence of squamous intraepithelial lesions and changes over time and geographical area were evaluated using a database of more than 600 000 Pap smear interpretations between 1996 and 2005. In 2000, 47% of women aged between 25 and 64 years had at least one Pap smear recorded in the last 3 years, and the average number of smears screened for each woman was 1.5. On account of incomplete registration, the coverage was 8% lower than estimated from health insurance data. The modal screening interval was in the range of 12–14 months; the first quartile, median and third quartile were 355, 440 and 676 days, respectively. Over the 10 years, 82% of the target population had their Pap smear recorded. The prevalence of cytological abnormalities was 3.7% (atypical squamous cells of undetermined significance: 2.2%, atypical glandular cells of undetermined significance: 0.1%, low-grade squamous intraepithelial lesion: 1.1%, high-grade squamous intraepithelial lesion or more serious lesions: 0.4%), but varied substantially among laboratories. The prevalence of atypical squamous cells of undetermined significance and low-grade squamous intraepithelial lesion increased significantly over time. Pathologists from Limburg have pioneered cytology registration in the context of opportunistic screening in Belgium. The estimated screening coverage was slightly underestimated. Obligatory registration, use of a uniform terminology and linkage with population and follow-up data are needed to give a cytology registry its full role in an organized screening programme.

Direct cost saving potential in medication costs due to a reduction in outdoor air pollution for the Brussels Capital Region.

INTRODUCTION The adverse health effects of exposure to air pollution have been well-established and include mortality, hospital admissions, emergency department visits, etc, but also less severe outcomes such as medication use and purchase. The economic impact, an additional motivator for policy, has been studied primarily for the more severe outcomes. METHODS Purchase data of reimbursed medications typically prescribed for asthma and chronic obstructive pulmonary disease, were obtained through the mandatory Belgian health insurance system. A time series analyses approach was used to model daily sales on daily air pollution concentrations (NO2, PM10 and PM2.5) for residents of the Brussels Capital Region as a whole. In addition, a higher geographical resolution of both sales and pollutant concentrations allowed for a multi-sector approach. Annual savings were estimated for the scenario of a 10% reduction in each of the pollutants. RESULTS Medication purchase was significantly associated with NO2 concentrations, leading to an annual cost saving potential of € 107,845 [95%CI: € 71,483-€ 143,823] in R03 sales (WHO classification for drugs of obstructive airway diseases). Saving potentials of PM10 and PM2.5 were not significant. Estimates were not sensitive to the geographical resolution, however, higher precision can be obtained with higher resolution data, subject to the condition that the number of sales is sufficiently large.

Thyroid cancer incidence around the Belgian nuclear sites: Surrogate exposure modelling

BACKGROUND In a recent ecological study among residents living around Belgian nuclear sites (the NUCABEL study), significant increased incidences of thyroid cancer were observed around the two nuclear facilities with industrial and research activities (Mol-Dessel and Fleurus), prompting further research. METHODS The data from the NUCABEL study were reanalysed to test the hypothesis of a gradient in cancer incidence with increasing levels of exposure from these sites using three measures of surrogate exposure, being (i) residential proximity, (ii) prevailing wind directions and (iii) simulated dispersion of radioactive discharges. Single-site focussed hypothesis tests were complemented with Generalized Additive Models to estimate the exposure-response relationships. RESULTS For Mol-Dessel, the results of the focussed hypothesis tests were far from significant. For Fleurus, the p-values were much closer to significance with p=0.05 for Bithells Linear Risk Score using radioactive discharge estimates as surrogate. CONCLUSIONS The re-analyses refute an association with the nuclear facilities for the site of Mol-Dessel. For the site of Fleurus, one of Europes major production sites of radio-iodines, the results were less conclusive and further research suggests itself.

Comparative long-term trend analysis of daily weather conditions with daily pollen concentrations in Brussels, Belgium

A clear rise in seasonal and annual temperatures, a gradual increase of total radiation, and a relative trend of change in seasonal precipitation have been observed for the last four decades in Brussels (Belgium). These local modifications may have a direct and indirect public health impact by altering the timing and intensity of allergenic pollen seasons. In this study, we assessed the statistical correlations (Spearman’s test) between pollen concentration and meteorological conditions by using long-term daily datasets of 11 pollen types (8 trees and 3 herbaceous plants) and 10 meteorological parameters observed in Brussels between 1982 and 2015. Furthermore, we analyzed the rate of change in the annual cycle of the same selected pollen types by the Mann-Kendall test. We revealed an overall trend of increase in daily airborne tree pollen (except for the European beech tree) and an overall trend of decrease in daily airborne pollen from herbaceous plants (except for Urticaceae). These results revealed an earlier onset of the flowering period for birch, oak, ash, plane, grasses, and Urticaceae. Finally, the rates of change in pollen annual cycles were shown to be associated with the rates of change in the annual cycles of several meteorological parameters such as temperature, radiation, humidity, and rainfall.

Heat and health in Antwerp under climate change: Projected impacts and implications for prevention

Background Excessive summer heat is a serious environmental health problem in several European cities. Heat-related mortality and morbidity is likely to increase under climate change scenarios without adequate prevention based on locally relevant evidence. Methods We modelled the urban climate of Antwerp for the summer season during the period 1986–2015, and projected summer daily temperatures for two periods, one in the near (2026–2045) and one in the far future (2081–2100), under the Representative Concentration Pathway (RCP) 8.5. We then analysed the relationship between temperature and mortality, as well as with hospital admissions for the period 2009–2013, and estimated the projected mortality in the near future and far future periods under changing climate and population, assuming alternatively no acclimatization and acclimatization based on a constant threshold percentile temperature. Results During the sample period 2009–2013 we observed an increase in daily mortality from a maximum daily temperature of 26 °C, or the 89th percentile of the maximum daily temperature series. The annual average heat-related mortality in this period was 13.4 persons (95% CI: 3.8–23.4). No effect of heat was observed in the case of hospital admissions due to cardiorespiratory causes. Under a no acclimatization scenario, annual average heat-related mortality is multiplied by a factor of 1.7 in the near future (24.1 deaths/year CI 95%: 6.78–41.94) and by a factor of 4.5 in the far future (60.38 deaths/year CI 95%: 17.00–105.11). Under a heat acclimatization scenario, mortality does not increase significantly in the near or in the far future. Conclusion These results highlight the importance of a long-term perspective in the public health prevention of heat exposure, particularly in the context of a changing climate, and the calibration of existing prevention activities in light of locally relevant evidence.

Respiratory medication sales and urban air pollution in Brussels (2005 to 2011).

BACKGROUND We investigated the associations between daily sales of respiratory medication and air pollutants in the Brussels-Capital Region between 2005 and 2011. METHODS We used over-dispersed Poisson Generalized Linear Models to regress daily individual reimbursement data of prescribed asthma and COPD medication from the social security database against each subjects residential exposure to outdoor particulate matter (PM10) or NO2 estimated, by interpolation from monitoring stations. We calculated cumulative risk ratios (RR) and their 95% confidence intervals (CI) for interquartile ranges (IQR) of exposure for different windows of past exposure for the entire population and for seven age groups. RESULTS Median daily concentrations of PM10 and NO2 were 25μg/m(3) (IQR=17.1) and 38μg/m(3) (IQR=20.5), respectively. PM10 was associated with daily medication sales among individuals aged 13 to 64y. For NO2, significant associations were observed among all age groups except >84y. The highest RR were observed for NO2, among adolescents, including three weeks lags (RR=1.187 95%CI: 1.097-1.285). CONCLUSION The associations found between temporal changes in exposure to air pollutants and daily sales of respiratory medication in Brussels indicate that urban air pollution contributes to asthma and COPD morbidity in the general population.

Human biomonitoring on heavy metals in Ath: methodological aspects

The municipality of Ath is characterised by the presence, in its center, of two non-ferrous metal industries whose emissions make local residents concerned for their health. Therefore, authorities of the Walloon Region and the municipality of Ath undertook biomonitoring to assess the impact of those industrial emissions on heavy metal body burden in humans.This paper describes the study design and methodology used to carry out this human biomonitoring.A random sampling was done in the general population, in two areas of Ath: an area centered around the industries and a peripheral area. The target population was children (2.5-11 years) and adults (40-60 years) without occupational exposure. The three-stage sampling procedure consisted of a mixture of both mail and telephone recruitment. Firstly, 3259 eligible people, identified from a population register, were mailed an introductory letter. In a second stage, eligible individuals were contacted by phone to propose them to participate in the study. They were randomly contacted until the required sample size was obtained. In the third stage, a second mail was sent to those who agreed to participate with a questionnaire to be filled out. Finally, biological samples (blood and urine) from 278 persons were collected. The final participation rate of this study was 24%.This sampling procedure, especially designed for the purpose of this biomonitoring study in Ath, allowed us to recruit a sample representative of the population of children and adults of Ath, reaching the expected sample size in a short period of time.

Silicone Wristband Passive Samplers Yield Highly Individualized Pesticide Residue Exposure Profiles

Monitoring human exposure to pesticides and pesticide residues (PRs) remains crucial for informing public health policies, despite strict regulation of plant protection product and biocide use. We used 72 low-cost silicone wristbands as noninvasive passive samplers to assess cumulative 5-day exposure of 30 individuals to polar PRs. Ethyl acetate extraction and LC-MS/MS analysis were used for the identification of PRs. Thirty-one PRs were detected of which 15 PRs (48%) were detected only in worn wristbands, not in environmental controls. The PRs included 16 fungicides (52%), 8 insecticides (26%), 2 herbicides (6%), 3 pesticide derivatives (10%), 1 insect repellent (3%), and 1 pesticide synergist (3%). Five detected pesticides were not approved for plant protection use in the EU. Smoking and dietary habits that favor vegetable consumption were associated with higher numbers and higher cumulative concentrations of PRs in wristbands. Wristbands featured unique PR combinations. Our results suggest both environment and diet contributed to PR exposure in our study group. Silicone wristbands could serve as sensitive passive samplers to screen population-wide cumulative dietary and environmental exposure to authorized, unauthorized and banned pesticides.