André-Robert Grivegnee

Costs induced by hip fractures: a prospective controlled study in Belgium. Belgian Hip Fracture Study Group.

Abstract: The economic burden of hip fractures is thought to be important, but the excess medical costs they induce remain largely unknown. We assessed the direct medical costs induced by hip fractures during and after hospitalization. Hospital costs of 170 consecutive Belgian women with hip fracture were gathered. During the year following discharge, all medical costs were collected for the 159 hip fracture women who survived the acute hospitalization stay. A similar collection of data was performed on a comparison group of 159 age-and residence-matched women without a history of hip fracture. The mean cost of the acute hospital stay was C8667, and the mean 1-year hip-fracture-related extra costs after hospitalization was C6636. During the year following the acute hospital stay, 19% of the hip fracture women and 4% of the comparison women were newly admitted to nursing homes (p<0.001). Although health care costs increased with age, hip-fracture-related extra costs after hospitalization seemed similar in those below or above 81 years old. These extra costs amounted to C7710 in women not living in nursing homes at the time of fracture, and to C3479 in women who lived in nursing homes. Health or mental status before hip fracture seemed not to affect extra costs. Taking into account the higher mortality of women with hip fracture, the extra costs during the acute hospital stay and during the 1-year follow-up amounted to a mean C 15151. In conclusion, both acute hospital stays and subsequent medical care contribute significantly to medical costs induced by hip fractures.

Sunscreen use and intentional exposure to ultraviolet A and B radiation : a double blind randomized trial using personal dosimeters

A previous randomized trial found that sunscreen use could extend intentional sun exposure, thereby possibly increasing the risk of cutaneous melanoma. In a similarly designed trial, we examined the effect of the use of sunscreens having different sun protection factor (SPF) on actual exposure to ultraviolet B (UVB) and ultraviolet A (UVA) radiation. In June 1998, 58 European participants 18–24 years old were randomized to receive a SPF 10 or 30 sunscreens and were asked to complete daily records of their sun exposure during their summer holidays of whom 44 utilized a personal UVA and UVB dosimeter in a standard way during their sunbathing sessions. The median daily sunbathing duration was 2.4 hours in the SPF 10 group and 3.0 hours in the SPF 30 group (P = 0.054). The increase in daily sunbathing duration was paralleled by an increase in daily UVB exposure, but not by changes in UVA or UVB accumulated over all sunbathing sessions, or in daily UVA exposure. Of all participants, those who used the SPF 30 sunscreen and had no sunburn spent the highest number of hours in sunbathing activities. Differences between the two SPF groups in total number of sunbathing hours, daily sunbathing duration, and daily UVB exposure were largest among participants without sunburn during holidays. Among those with sunburn, the differences between the two groups tended to reduce. In conclusion, sunscreens used during sunbathing tended to increase the duration of exposures to doses of ultraviolet radiation below the sunburn threshold.

Sun exposure and sun protection in young European children: an EORTC multicentric study

Most European children experience exposure to the sun during the summer holidays. The aim of this study was to examine the behaviour of European children when in the sun during their holidays. In 1995-1997, a total of 631 young children were recruited during a multicentric study in Belgium, Germany, France and Italy. For each holiday period from birth, parents gave detailed information on sun exposure and child behaviour. Predictors and trends over time of sun protection were investigated. Forty percent of children were exposed to sunlight in the first and 86% in the sixth year of life. At the same time, the number of children who experienced sunburns rose from 1 to 23%. In the whole period of 6 years, only 8% of children always wore trousers and shirt when in the sun, while 25% children always used a sunscreen. The proportion of sun-exposed children who used sunscreen was stable with age (approximately 50%), while those who always wore trousers and shirts dropped from 46% (1st year) to 19% (6th year). Multinomial logistic regression showed that sunscreen use, but not the wearing of clothes was associated with sun-sensitivity. In summary, sun exposure increases steadily, while sun protection decreases in the first 6 years of life in our cohort of children. In this cohort, use of a sunscreen was much more frequent than the wearing of clothes and a reduction in sun exposure.

Transformation zone location and intraepithelial neoplasia of the cervix uteri

We examined the relationship between the frequency of premalignant lesions of the cervix and location of the transformation zone on the cervix among 8758 women as assessed using cervicography. An endo- and exocervical smear test was performed at the same time. Women with smear test classified CIN I or more were recalled and any abnormal area was biopsied under colposcopy. The transformation zone was located on the exocervix in 94% of women younger than 25 years old; as age increased, the proportion of women with a transformation zone located on the exocervix steadily decreased to reach less than 2% after 64 years old. As compared with women having a transformation zone in the endocervical canal, the age-adjusted likelihood of discovering a histologically proven dysplastic lesion was 1.8 times more frequent among women with a transformation zone located on the exocervix (95% confidence interval 1.1-2.9). This higher frequency seemed not attributable to a lower sensitivity of the smear test when the transformation zone was hidden. The results also showed that deliveries tended significantly to maintain the transformation zone on the exocervix. Parity is a known risk factor for cervix cancer, but the mechanism by which it favours malignant lesions remain unknown. Our results suggest that with increasing numbers of livebirths, the transformation zone is directly exposed for longer periods to external agents involved in dysplastic lesions.

The body site distribution of melanocytic naevi in 6–7 year old European children

The number and size of melanocytic naevi are the main predictors of cutaneous melanoma. Naevus development per unit of skin surface is greatest during childhood. We assessed the body distribution of naevi 2–4.9 mm and ⩾ 5 mm in 649 European children aged 6–7 years old from Brussels (Belgium), Bochum (Germany), Lyon (France) and Rome (Italy). The numbers of naevi 2–4.9 mm and naevi ⩾ 5 mm were strongly correlated, especially on the trunk. For naevi 2–4.9 mm, the highest relative densities were found on the face, back, shoulders and the external surface of the arms. The lowest relative densities were found on the hands, legs, feet and abdomen. The relative density of naevi ⩾ 5 mm was higher on the trunk than on any other body site. Similar body distributions were observed in both sexes and at each centre. The body site distribution of naevi 2–4.9 mm seemed to parallel the usual sun exposure patterns of young European children. It is suggested that the development of naevi ⩾ 5 mm might be a marker of the vulnerability of melanocytes to the harmful effects of solar radiation. Vulnerability would be maximal on the back, and would decrease from proximal to distal skin areas, with melanocytes of the hands and feet having the lowest vulnerability. The number of naevi acquired on a specific area of skin would result from the combined effects of local vulnerability to solar radiation and local sun exposure history. The origin of acquired body site differences in the susceptibility of melanocytes to ultraviolet radiation is unknown, although it seems to parallel the body site density of sensory innervation.

Number and size of nevi are influenced by different sun exposure components: implications for the etiology of cutaneous melanoma (Belgium, Germany, France, Italy).

Objective: The solar wavelength involved in melanoma occurrence remains unknown. Sunburns and latitude gradient are indicators of greater exposure to the ultraviolet B radiation. We examined the associations between the components of holiday sun exposure with numbers of small (2–4.9 mm) and large nevi (≥5 mm) in young children. Methods: Information about each holiday period from birth to interview was recorded from parents of 628 6–7-year-old children in four European countries. Sun exposure was characterized using four different components: cumulative duration of holidays, number of holiday periods, sunburn episodes and latitude gradient between habitual living place and holiday places. Results: Individual susceptibility to sunlight, cumulative duration and number of holiday periods were moderately associated with increasing number of small but not of large nevi. The number of small nevi together with sunburn history and latitude gradient were strong predictors of large nevi number. In contrast, sunburn history and latitude gradient were not associated with small nevi. Conclusions: Exposure to high doses of ultraviolet B radiation would be implicated in the formation of large nevi, while solar radiation other than the ultraviolet B could be implicated in the development of small nevi in children. Given that numbers of large nevi are strong predictors of melanoma in children and adolescents, these results agree with the hypothesis that high ultraviolet B doses are needed for melanoma occurrence, but probably not for nevi formation.

Causes of death among Belgian professional military radar operators: A 37-year retrospective cohort study

Concerns have been raised about the safety of the electromagnetic (microwave) emissions of radars, as well as about the ionizing radiation that is emitted on short distances (<2 m) by devices in the radars producing the microwaves. We retrospectively compared the cause specific mortality of 4,417 Belgian professional male military personnel who served in anti‐aircraft radar units in Germany between 1963 and 1994 to the cause specific mortality of 2,932 Belgian military personnel who served at the same time in the same place in battalions not equipped with radars. Mean follow‐up was 26 years in the 2 groups. Age‐adjusted rate ratio (RR) and 95% confidence intervals were derived from a Poisson regression model. Four hundred twenty‐four deaths in the battalions groups and 271 deaths in the control battalions occurred (RR = 1.04 (0.96–1.14)). For specific causes of deaths, RRs were 1.22 (1.03–1.47) for neoplasms and 3.51 (1.19–10.3) for symptoms, signs and ill defined conditions. RRs for other causes of death were not significantly different from 1.00. Among deaths from neoplasms, RR for hemolymphatic cancer was 7.22 (1.09–47.9). RRs for other causes of cancer deaths were not significantly different from 1.00. The results for specific tumor types were all based on very small numbers. The RR for cancer increased with decreasing age and suggested that the RR for cancer increased with the duration of stay in radar battalions. In conclusion, exposure of professional military personnel to anti‐aircraft radars that existed in Western Europe from the 1960s until the 1990s may have resulted in an increase in the incidence of hemolymphatic cancers. It remains to be established whether this increase is due to microwaves generated by radars or ionizing radiation produced by electronic devices producing the microwaves.

Breakfast frequency and fruit and vegetable consumption in Belgian adolescents A cross‐sectional study

Purpose – Several cross‐sectional studies reported that breakfast skipping and a poor consumption of fruits and vegetables are associated with overweight and obesity‐related morbidities. In this respect healthy eating habits such as regular breakfast and a sufficient intake of fruit and vegetables are two important items to prevent childhood and adolescent obesity. The purpose of this study is to determine the breakfast frequency and the fruit and vegetable consumption in Belgian adolescents.Design/methodology/approach – A cross‐sectional study using pupils contacted by nurses in schools during an information session about female hygiene. On that occasion all pupils (boys and girls) completed a questionnaire concerning their eating habits. Subjects were boys (n = 1390) and girls (n = 3610) between 12 and 15 years of age from the main three educational programmes (general, technical and occupational programme).Findings – Socio‐economic status significantly influenced breakfast frequency with differences be...

All-Cause Mortality Among Belgian Military Radar Operators: A 40-Year Controlled Longitudinal Study

Background: It has been suggested that exposure to radiofrequency/microwaves radiations could be associated with greater health hazards and higher mortality. Methods: The all-cause mortality of 27,671 Belgian militaries who served from 1963 until 1994 in battalions equipped with radars for anti-aircraft defence was studied over the period 1968–2003. End of the seventies, technical modifications brought to the shielding of the micro-wave generators resulted in a reduction in irradiations. A control group was formed by 16,128 militaries who served during the same period in the same military area but who were never exposed to radars. Administrative procedures for identifying militaries and their vital status were equivalent in the radar and the control groups. Results: The age-standardized mortality ratio (SMR) in the radar battalions was 1.05 (95% CI: 0.95–1.16) in professional militaries, and 0.80 (95% CI: 0.75–0.85) in conscripts. In professional militaries no difference in mortality was found according to duration (less than, or five years or more) or to period of service (before 1978 or after 1977). Conclusions: During a 40-year period of observation, we found no increase in all-cause mortality in Belgian militaries who were in close contact with radar equipments of anti-aircraft defence battalions.

A versatile knowledge-based clinical imaging annotation system for breast cancer screening

Medical information is evolving towards more complex multimedia data representation, as new imaging modalities are made available by sophisticated devices. Features such as segmented lesions can now be extracted through analysis techniques and need to be integrated into clinical patient data. The management of structured information extracted from multimedia has been addressed in knowledge based annotation systems providing methods to attach interpretative semantics to multimedia content. Building on these methods, we develop a new clinical imaging annotation system for computer aided breast cancer screening. The proposed system aims at more consistent, efficient and standardised data mark-up of digital and digitalised radiology images. The objective is to provide detailed characterisation of abnormalities as an aid in the diagnostic task through integrated annotation management. The system combines imaging analysis results and radiologist diagnostic information about suspicious findings by mapping well-established visual and low-level descriptors into pathology specific profiles. The versatile characterisation allows differentiating annotation descriptors for different types of findings. Our approach of semi-automatic integrated annotations supports increased quality assurance in screening practice. This is achieved through detailed and objective patient imaging information while providing user-friendly means for their manipulation that is oriented to relieving the radiologists workload.