Guido Van Hal

Epidemiology of Noise-Induced Tinnitus and the Attitudes and Beliefs towards Noise and Hearing Protection in Adolescents

Background and objectives Previous research showed an increase of noise-induced symptoms in adolescents. Permanent tinnitus as a consequence of loud music exposure is usually considered as noise-induced damage. The objective was to perform an epidemiological study in order to obtain prevalence data of permanent noise-induced tinnitus as well as temporary tinnitus following noise exposure in a young population. In addition the attitudes and beliefs towards noise and hearing protection were evaluated in order to explain the use/non-use of hearing protection in a young population. Methods A questionnaire was completed by 3892 high school students (mean age: 16.64 years old, SD: 1.29 years). The prevalence of temporary and permanent tinnitus was assessed. In addition the ‘Youth Attitudes to Noise Scale’ and the ‘Beliefs About Hearing Protection and Hearing Loss’ were used in order to assess the attitudes and beliefs towards noise and hearing protection respectively. Results The prevalence of temporary noise-induced tinnitus and permanent tinnitus in high school students was respectively 74.9% and 18.3%. An increasing prevalence of temporary tinnitus with age was present. Most students had a ‘neutral attitude’ towards loud music and the use of hearing protection was minimal (4.7%). The limited use of hearing protection is explained by a logistic regression analysis showing the relations between certain parameters and the use of hearing protection. Conclusions Despite the very high prevalence of tinnitus in such a young population, the rate of hearing protection use and the knowledge about the risks of loud music is extremely low. Future preventive campaigns should focus more on tinnitus as a warning signal for noise-induced damage and emphasize that also temporary symptoms can result in permanent noise-induced damage.

Socio-economic differences in participation of households in a Belgian national health survey

BACKGROUND Socio-economic inequalities in health survey participation can jeopardize the extrapolation of the survey findings to the total population. Earlier research, based on aggregated data, showed that in Belgium less-educated people with poor health were less likely to participate in a health survey. In this article, the association by socio-economic status and household non-response in a health survey is examined. METHODS A linkage between the Belgian Health Survey 2001 with Census 2001 enabled us to evaluate the participation by socio-economic status. RESULTS We observed that the socio-economic position was a determinant of health survey participation: participation rate was significantly lower in households with a lower socio-economic profile. CONCLUSION Socio-economic inequalities in participation can introduce a bias in the health survey findings. Strategies targeting improvement of the participation of lower socio-economic groups need to be considered.

The true cost of the economic crisis on psychological well-being: a review

The recent economic crisis has led to many negative consequences, not the least having to do with the mental health and well-being of the populations involved. Although some researchers say it is still too early to speak about a relationship between the economic crisis and a rise in mental health problems resulting in suicides, there is solid evidence for the existence of such a relationship. However, several moderating or mediating mechanisms can also play a role. The main reactions of most policy makers to the economic crisis are (severe) austerity measures. These measures seem to have, however, a detrimental effect on the mental health of the population: Just when people have the highest need for mental help, cost-cutting measures in the health care sector lead to a (substantial) drop in the supply of services for the prevention, early detection, and cure of mental health problems. Policy makers should support moderating mechanisms such as financial and psychological coping and acculturation and the role of primary health care workers in the early detection of suicidal thoughts, suicide attempts, and suicide in times of economic recession. Several examples show that the countries best off regarding the mental health of their populations during the economic crisis are those countries with the strongest social safety net. Therefore, instead of cutting back on health care and social welfare measures, policy makers should in the future invest even more in social protection measures during economic crises.The recent economic crisis has led to many negative consequences, not the least having to do with the mental health and well-being of the populations involved. Although some researchers say it is still too early to speak about a relationship between the economic crisis and a rise in mental health problems resulting in suicides, there is solid evidence for the existence of such a relationship. However, several moderating or mediating mechanisms can also play a role. The main reactions of most policy makers to the economic crisis are (severe) austerity measures. These measures seem to have, however, a detrimental effect on the mental health of the population: Just when people have the highest need for mental help, cost-cutting measures in the health care sector lead to a (substantial) drop in the supply of services for the prevention, early detection, and cure of mental health problems. Policy makers should support moderating mechanisms such as financial and psychological coping and acculturation and the role of primary health care workers in the early detection of suicidal thoughts, suicide attempts, and suicide in times of economic recession. Several examples show that the countries best off regarding the mental health of their populations during the economic crisis are those countries with the strongest social safety net. Therefore, instead of cutting back on health care and social welfare measures, policy makers should in the future invest even more in social protection measures during economic crises.

Population-based screening for colorectal cancer using an immunochemical faecal occult blood test: A comparison of two invitation strategies

BACKGROUND To date, there is no screening programme for colorectal cancer (CRC) in Flanders, Belgium. However, The European Code Against Cancer (2003) recommends a population-based approach for CRC screening. This study aimed to obtain information about potential participation rates for a population-based screening programme for CRC in Flanders, and to compare two invitation strategies. METHODS In 2009, a trial programme for CRC screening was set up in three Flemish areas for all average-risk people aged 50-74 years, using an immunochemical faecal occult blood test (iFOBT) with a cut-off value set at 75 ng/ml of haemoglobin. The faecal sampling set was sent at random by post (mail group) or provided by the general practitioner (GP group). RESULTS In total, 19,542 people were invited to participate. Of these, 8229 provided a faecal sample, resulting in an overall participation rate of 42.1%. Participation by mail and through the GP was 52.3% (95% CI, 51.3-53.2) and 27.7% (95% CI, 26.7-28.6), respectively. The difference of 24.6% was statistically significant (95% CI, 23.3-25.9, p<0.001). Before the reminder letter was sent and the other invitation strategy was offered, the overall participation rate was 26.5% (n=5176); 36.4% (95% CI, 35.5-37.4) for the mail group and 16.6% (95% CI, 15.8-17.3) for the GP group. The odds of participating in CRC screening was almost three times higher for people invited by mail as opposed to people invited through a GP (OR=2.96, 95% CI, 2.78-3.14, p<0.001). Women were more likely to participate in CRC screening than men (OR=1.22, 95% CI, 1.15-1.30, p<0.001). In addition, we found that inhabitants from residential (OR=1.98, 95% CI, 1.85-2.11) and rural (OR=2.90, 95% CI, 2.66-3.16) areas were more likely to participate than those in urban areas. Of the 8229 people who submitted a faecal sample, 435 (5.3%) had a positive iFOBT, and of those, CRC was diagnosed in 18 (5.7%) individuals. Compliance for follow-up colonoscopy was 72.9%, and did not differ between the mail (72.4%, 95% CI, 67.5-77.3) and GP groups (74.3, 95% CI, 66.2-82.5). CONCLUSION Inviting people for CRC screening by means of a direct-mail invitation, and including a faecal sampling set (iFOBT), results in much higher participation rates than inviting people through the GP.

Unhealthy drinking in the Belgian elderly population: prevalence and associated characteristics

BACKGROUND Knowledge about alcohol consumption patterns and alcohol problems among the Belgian elderly population is scarce. The aims of this study were to explore alcohol consumption patterns and alcohol problems among the Belgian elderly population aged ≥ 65 years living at home, and to determine their association with socio-demographic characteristics, health status and socio-economic status. METHODS In this cross-sectional study based on a representative sample of 4825 non-institutionalized Belgian elderly people (≥ 65 years) in the Belgian Health Interview Surveys 2001 and 2004, alcohol consumption patterns and alcohol problems were estimated according to age, gender, survey year, living situation, frequency of social contacts, smoking status, and socio-economic status. RESULTS In all, 50.4% of the sample were non- or occasional drinkers, 29.1% were moderate drinkers, 10.4% at-risk drinkers, 4.6% heavy drinkers and 5.5% problematic drinkers. In total, 20.5% of the Belgian elderly population drank in excess of the National Institute on Alcohol Abuse and Alcoholism guidelines, and 4.7% had an alcohol problem according to the CAGE. In addition, 81.3% of the elderly people who consume alcohol used prescribed medications in the past 2 weeks. After adjustment for risk factors we found that, compared with moderate drinking, unhealthy drinking was significantly associated with age, gender, frequency of social contacts, health status and socio-economic status. CONCLUSIONS Belgian health policy should be aware of the high level of at-risk drinkers in the elderly population and the underdetection and misdiagnosis of alcohol problems in this age group. An increased attention in public health initiatives among the Belgian elderly population is needed.

A feasibility trial to examine the social norms approach for the prevention and reduction of licit and illicit drug use in European University and college students

BackgroundIncorrect perceptions of high rates of peer alcohol and tobacco use are predictive of increased personal use in student populations. Correcting misperceptions by providing feedback has been shown to be an effective intervention for reducing licit drug use. It is currently unknown if social norms interventions are effective in preventing and reducing illicit drug use in European students. The purpose of this paper is to describe the design of a multi-site cluster controlled trial of a web-based social norms intervention aimed at reducing licit and preventing illicit drug use in European university students.Methods/DesignAn online questionnaire to assess rates of drug use will be developed and translated based on existing social norms surveys. Students from sixteen universities in seven participating European countries will be invited to complete the questionnaire. Both intervention and control sites will be chosen by convenience. In each country, the intervention site will be the university that the local principal investigator is affiliated with. We aim to recruit 1000 students per site (baseline assessment). All participants will complete the online questionnaire at baseline. Baseline data will be used to develop social norms messages that will be included in a web-based intervention. The intervention group will receive individualized social norms feedback. The website will remain online during the following 5 months. After five months, a second survey will be conducted and effects of the intervention on social norms and drug use will be measured in comparison to the control site.DiscussionThis project is the first cross-national European collaboration to investigate the feasibility of a social norms intervention to reduce licit and prevent illicit drug use among European university students.Final trial registration numberDRKS00004375 on the ‘German Clinical Trials Register’.

Hepatitis B vaccination in Africa: mission accomplished?

Hepatitis B more than ever holds a prominent position among the most notorious infectious diseases on a global scale and remains an actual threat to the world population. However, not all countries or continents are equally affected. Sub-Saharan Africa for example is a high-endemic region, with carrier rates of hepatitis B surface antigen (HBsAg) 8% among certain population groups, representing a significant burden to the health and development of a number of societies.

The potential influence of various initiatives to improve rational prescribing for proton pump inhibitors and statins in Belgium

Background: Proton pump inhibitors (PPIs) and statins have been among the top three most prescribed medicines in Belgium for more than a decade. Multiple demand-side measures have been introduced to improve rational prescribing generally, as well as for these two classes. Objectives: First, assessing the influence of general and specific reforms introduced in Belgium since 1997 on utilization and expenditure of the PPIs and statins. Second, suggesting additional measures to further improve rational prescribing based on experiences in other European countries. Methods: A retrospective observational study for assessing the influence of multiple initiatives in Belgium on utilization and expenditure of the PPIs and statins from 1997 to 2009 was carried out. Data were extracted from the administrative database Pharmanet. Utilization was measured in terms of defined daily doses (DDDs) and DDDs/thousand inhabitants per day. Results: Multiple reforms, including co-payments and reference pricing, appreciably enhanced rational prescribing for both PPIs and statins following generic availability. There was an eightfold increase in PPI utilization between 1997 and 2009, but only a twofold increase in reimbursed expenditure, helped by decreasing expenditure/DDD for the PPIs from €1.91 in 1997 to €0.52 in 2009. Similarly, a 20-fold increase was observed in statin utilization between 1997 and 2009, but only a fivefold increase in reimbursed expenditure, helped again by reimbursed expenditure/DDD decreasing from €2.05 in 1997 to €0.57 in 2009. Reduced co-payments for larger packs enhanced their prescription. Conclusion: Multiple reforms influenced utilization patterns and expenditure for the PPIs and statins, as well as the pack sizes dispensed. Additional demand-side measures are needed to further enhance rational prescribing, which can build on the experiences in other countries. These can be potentially transferred to other classes.

Healthcare utilisation among the Belgian elderly in relation to their socio-economic status

OBJECTIVES To analyse the association between healthcare utilisation of elderly persons (65 and over) in Belgium in terms of contacts with GP or specialist and the socio-economic indicators household income, highest educational level within the household, and housing tenure. METHODS A cross-sectional study based on 4494 non-institutionalised elderly participants in the Belgian Health Interview Surveys of 2001 and 2004. Socio-economic gradients in contacts (yes or no) with a GP or specialist were explored, based on the socio-behavioural model of Andersen, a conceptual framework that includes the most important determinants of healthcare utilisation. Three multivariate models were constructed using multiple logistic regression. RESULTS After adjustment for age, sex, health status (self-assessed health, functional restrictions, and comorbidity), region, and living situation, initial differences in contacts with a GP and specialist between the different socio-economic groups disappeared among the elderly. On the other hand, contacts with a specialist remain dependent on SES in the younger population. CONCLUSIONS Adjustment for the determinants of healthcare utilisation among the Belgian elderly nullified the socio-economic gradients in contacts with a GP and specialist that initially existed. The results point to a potential link with the Belgian social and health policy.

Readiness signs used to define the proper moment to start toilet training: A review of the literature†‡

Confusion exists about when to start toilet training, which causes stress and anxiety. Another consequence can be the actual postponement of the toilet training process, which has created extra social problems. Therefore, in this review we will focus on the proper moment to start toilet training, more specific on readiness signs. This will clarify on which topics further research is necessary. We searched databases for publications on toilet training. Next, we gathered information about the normal development of healthy children and at which age skills needed for each readiness sign are acquired. Twenty‐one readiness signs were found. Our results show that there is no consensus on which or how many readiness signs to use. Depending on the readiness sign, the moment to start toilet training can vary a lot. More studies are needed to define which readiness signs are most important and how to detect them easily. Neurourol. Urodynam. 31:437–440, 2012.