Projected reduction in healthcare costs in Belgium after optimization of iodine intake : impact on costs related to thyroid nodular disease

Background: Several surveys in the last 50 years have repeatedly indicated that Belgium is affected by mild iodine deficiency. Within the framework of the national food and health plan in Belgium, a selective, progressive, and monitored strategy was proposed in 2009 to optimize iodine intake. The objective of the present study was to perform a health economic evaluation of the consequences of inadequate iodine intake in Belgium, focusing on undisputed and measurable health outcomes such as thyroid nodular disease and its associated morbidity (hyperthyroidism). Methods: For the estimation of direct, indirect, medical, and nonmedical costs related to thyroid nodular diseases in Belgium, data from the Federal Public Service of Public Health, Food Chain Safety and Environment, the National Institute for Disease and Disability Insurance (RIZIV/INAMI), the Information Network about the prescription of reimbursable medicines (FARMANET), Intercontinental Marketing Services, and expert opinions were used. These costs translate into savings after implementation of the iodization program and are defined as costs due to thyroid nodular disease throughout the article. Costs related to the iodization program are referred to as program costs. Only figures dating from before the start of the intervention were exploited. Only adult and elderly people (>= 18 years) were taken into account in this study because thyroid nodular diseases predominantly affect this age group. Results: The yearly costs due to thyroid nodular diseases caused by mild iodine deficiency in the Belgian adult population are similar to(sic)38 million. It is expected that the iodization program will result in additional costs of similar to(sic)54,000 per year and decrease the prevalence of thyroid nodular diseases by 38% after a 4-5-year period. The net savings after establishment of the program are therefore estimated to be at least (sic)14 million a year. Conclusions: Optimization of iodine intake in Belgium should be quite cost effective, if only considering its impact on nodular thyroid disease. There are likely added benefits relating to more optimal thyroid hormone influenced brain development that are more difficult to estimate but may be even more important

Contribution of chronic conditions to the disability burden across smoking categories in middle-aged adults, Belgium

Introduction : Smoking is considered the single most important preventable cause of morbidity and mortality worldwide, contributing to increased incidence and severity of disabling conditions. The aim of this study was to assess the contribution of chronic conditions to the disability burden across smoking categories in middle-aged adults in Belgium. Methods : Data from 10,224 individuals aged 40 to 60 years who participated in the 1997, 2001, 2004, or 2008 Health Interview Surveys in Belgium were used. Smoking status was defined as never, former (cessation >= 2 years), former (cessation = 20 cigarettes/day). To attribute disability to chronic conditions, binomial additive hazards models were fitted separately for each smoking category adjusted for gender, except for former (cessation <2 years) and occasional light smokers due to the small sample size. Results : An increasing trend in the disability prevalence was observed across smoking categories in men (never = 4.8%, former (cessation >= 2 years) = 5.8%, daily light = 7.8%, daily heavy = 10.7%) and women (never = 7.6%, former (cessation >= 2 years) = 8.0%, daily light = 10.2%, daily heavy = 12.0%). Musculoskeletal conditions showed a substantial contribution to the disability burden in men and women across all smoking categories. Other important contributors were depression and cardiovascular diseases in never smokers; depression, chronic respiratory diseases, and diabetes in former smokers (cessation >= 2 years); chronic respiratory diseases, cancer, and cardiovascular diseases in daily light smokers; cardiovascular diseases and chronic respiratory diseases in men and depression and diabetes in women daily heavy smokers. Conclusions : Beyond the well-known effect of smoking on mortality, our findings showed an increasing trend of the disability prevalence and different contributors to the disability burden across smoking categories. This information can be useful from a public health perspective to define strategies to reduce disability in Belgium

Educational inequalities in premature mortality by region in the Belgian population in the 2000s

Background: In Belgium, socio-economic inequalities in mortality have long been described at country-level. As Belgium is a federal state with many responsibilities in health policies being transferred to the regional levels, regional breakdown of health indicators is becoming increasingly relevant for policy-makers, as a tool for planning and evaluation. We analyzed the educational disparities by region for all-cause and cause-specific premature mortality in the Belgian population. Methods: Residents with Belgian nationality at birth registered in the census 2001 aged 25-64 were included, and followed up for 10 years though a linkage with the cause-of-death database. The role of 3 socio-economic variables (education, employment and housing) in explaining the regional mortality difference was explored through a Poisson regression. Age-standardised mortality rates (ASMRs) by educational level (EL), rate differences (RD), rate ratios (RR), and population attributable fractions (PAF) were computed in the 3 regions of Belgium and compared with pairwise regional ratios. The global PAFs were also decomposed into the main causes of death. Results: Regional health gaps are observed within each EL, with ASMRs in Brussels and Wallonia exceeding those of Flanders by about 50% in males and 40% in females among Belgian. Individual SE variables only explained up to half of the regional differences. Educational inequalities were also larger in Brussels and Wallonia than in Flanders, with RDs ratios reaching 1.8 and 1.6 for Brussels versus Flanders, and Wallonia versus Flanders respectively; regional ratios in relative inequalities (RRs and PAFs) were smaller. This pattern was observed for all-cause and most specific causes of premature mortality. Ranking the cause-specific PAFs revealed a higher health impact of inequalities in causes combining high mortality rate and relative inequality, with lung cancer and ischemic heart disease on top for all regions and both sexes. The ranking showed few regional differences. Conclusions: For the first time in Belgium, educational inequalities were studied by region. Among the Belgian, educational inequalities were higher in Brussels, followed by Wallonia and Flanders. The region-specific PAF decomposition, leading to a ranking of causes according to their population-level impact on overall inequality, is useful for regional policy-making processes

Study of the Histology of Leafy Axes and Male Cones of Glenrosa carentonensis sp. nov. (Cenomanian Flints of Charente-Maritime, France) Using Synchrotron Microtomography Linked with Palaeoecology

International audienceWe report exceptionally well-preserved plant remains ascribed to the extinct conifer Glenrosa J. Watson et H.L. Fisher emend. V. Srinivasan inside silica-rich nodules from the Cenomanian of the Font-de-Benon quarry, Charente-Maritime, western France. Remains are preserved in three dimensions and mainly consist of fragmented leafy axes. Pollen cones of this conifer are for the first time reported and in some cases remain connected to leafy stems. Histology of Glenrosa has not previously been observed; here, most of internal tissues and cells are well-preserved and allow us to describe a new species, Glenrosa carentonensis sp. nov., using propagation phase-contrast X-ray synchrotron microtomography, a non-destructive technique. Leafy axes consist of characteristic helically arranged leaves bearing stomatal crypts. Glenrosa carentonensis sp. nov. differs from the other described species in developing a phyllotaxy 8/21, claw-shaped leaves, a thicker cuticle, a higher number of papillae and stomata per crypt. Pollen cones consist of peltate, helically arranged microsporophylls, each of them bearing 6–7 pollen sacs. The new high resolution tomographic approach tested here allows virtual palaeohistology on plants included inside a dense rock to be made. Most tissues of Glenrosa carentonensis sp. nov. are described. Lithological and palaeontological data combined with xerophytic features of Glenrosa carentonensis sp. nov. suggest that this conifer has been adapted to survive in harsh and instable environments such as coastal area exposed to hot, dry condition

Construction of a set of vectors allowing inducible production of siRNA in Schizosaccharomyces pombe.

RNA interference (RNAi) is a sequence-specific gene silencing mechanism. It is induced by the formation of dsRNA that are recognised by the Dicer complex and processed into 21-23 long oligonucleotides called siRNA (short interfering RNA). Subsequently, RISC (RNA-Inducing Silencing Complex) binds siRNA that targets the complex towards its homologous mRNA (DYKXHOORN et al., 2003) which is eventually degraded. In contrast to budding yeast, the entire pathway is conserved in the fission yeast Schizosaccharomyces pombe, making it a valuable organism to both study physiological RNAi and to use it as a inducible gene knock-down tool. In an attempt to apply this method in the fission yeast, we are using three different approaches to produce siRNA. In each case, a vector containing a regulatable promoter activated in presence of tetracycline (tTA') (GOSSEN et al., 1995) is generated and the ura4 marker required for growth on medium lacking uracil serves as reporter. First, a vector expressing the full lenght antisens RNA of ura4 (800 nucleotides) (RAPONI and ARNDT, 2003) is used. Second, we are trying to generate much shorter dsRNA where both strands are linked by either a short hairpin of 25 nucleotides (BRUMMELKAMP et al., 2002) or a longer one of 350 nucleotides (SCHRAMKE and ALLSHIRE, 2003). The ability of these different dsRNA to induce silencing of ura4 will be presented

Intake of fat-soluble vitamins in the Belgian population : adequacy and contribution of foods, fortified foods and supplements

A key challenge of public health nutrition is to provide the majority of the population with a sufficient level of micronutrients while preventing high-consumers from exceeding the tolerable upper intake level. Data of the 2014 Belgian food consumption survey (n = 3200) were used to assess fat-soluble vitamin (vitamins A, D, E and K) intake from the consumption of foods, fortified foods and supplements. This study revealed inadequate intakes for vitamin A, from all sources, in the entire Belgian population and possible inadequacies for vitamin D. The prevalence of inadequate intake of vitamin A was lowest in children aged 3-6 (6-7%) and highest in adolescents (girls, 26%; boys, 34-37%). Except for women aged 60-64 years, more than 95% of the subjects had vitamin D intake from all sources below the adequate intake (AI) of 15 mu g/day. The risk for inadequate intake of vitamins K and E was low (median > AI). Belgian fortification and supplementation practices are currently inadequate to eradicate suboptimal intakes of vitamins A and D, but increase median vitamin E intake close to the adequate intake. For vitamin A, a small proportion (1-4%) of young children were at risk of exceeding the upper intake level (UL), while for vitamin D, inclusion of supplements slightly increased the risk for excessive intakes (% > UL) in adult women and young children. The results may guide health authorities when developing population health interventions and regulations to ensure adequate intake of fat-soluble vitamins in Belgium

The added value of food frequency questionnaire (FFQ) information to estimate the usual food intake based on repeated 24-hour recalls

Background: Statistical methods to model the usual dietary intake of foods in a population generally ignore the additional information on the never-consumers. The objective of this study is to determine the added value of Food Frequency Questionnaire (FFQ) data allowing distinguishing the never-consumers from the non-consumers while modeling the usual intake distribution. Methods: Three food items with a different proportion of never-consumers were selected from the database of the Belgian food consumption survey of 2004 (N = 3200). The usual intake distribution for these food items was modeled with the Statistical Program for Analysis of Dietary Exposure (SPADE) and modeling parameters were extracted. These parameters were used to simulate (a) a new database with two 24-h recalls per respondent and (b) a "true" usual intake distribution. The usual intake distribution from the new database was obtained by modeling the 24-h recalls with SPADE, once without and once with the inclusion of the FFQ data on the never-consumers. Ratios were calculated for the different percentiles of the usual intake distribution: the modeled usual intake (g/day) (for both SPADE with and without the inclusion of FFQ data on never-consumers) was divided by the corresponding percentile of the simulated "true" usual intake (g/day). The closer the ratio is to one, the better the model fits the data. Results: Inclusion of the FFQ information to identify the never-consumers did not improve the estimation of the higher percentiles of the usual intake distribution. However, taking into account this FFQ information improved the estimation of the lower percentiles of the usual intake distribution even when the proportion of never-consumers was low. Conclusions: The inclusion of FFQ information to identify the never-consumers is beneficial when interested in the whole usual intake distribution or in the lower percentiles only, no matter how low the proportion of never-consumers for that food item may be. However, when interest is only in the higher percentiles of the usual intake distribution, inclusion of FFQ information to identify the never-consumers will have no benefit

Contribution of chronic diseases to the disability burden in a population 15 years and older, Belgium, 1997-2008.

BACKGROUND: Age-associated disability reduces quality of life in older populations and leads to wide-range implications for social and health policy. The identification of diseases that contribute to the disability burden is crucial to the development of prevention and intervention strategies to reduce disability. In this study, we assessed the contribution of chronic diseases to the prevalence of disability in Belgium. METHODS: Data from 35,837 individuals aged 15 years or older who participated in the 1997, 2001, 2004, or 2008 Belgian Health Interview Surveys were used. Disability was defined as difficulties in doing at least one of six activities of daily living (transfer in and out of bed, transfer in and out of chair, dressing, washing hands and face, feeding, and going to the toilet) and/or mobility limitations (ability to walk without stopping less than 200 m). Multiple additive regression models were fitted separately for men and women to estimate the age-specific background disability rate (experienced by everyone, independent of the presence of specific diseases) and disease-specific disability rates (disability rate in subjects who reported selected chronic diseases). RESULTS: Musculoskeletal, cardiovascular, and respiratory diseases were the main contributors to the disability burden in Belgium. Musculoskeletal diseases were the most prevalent diseases in men and women in all age groups. Neurological diseases and stroke were the most disabling diseases, i.e. caused the highest level of disability among the diseased individuals, in all age groups for men and women, respectively. Back pain was the main cause of disability in men aged 15 to 64 years, while heart attack was the major contributor to the disability prevalence in men aged 65 or older. Likewise, arthritis was the main cause of disability among women across all age groups. Depression was also an important contributor in young subjects (15-54 years). Cancer was not an important contributor to the disability prevalence in Belgium. CONCLUSIONS: To reduce the burden of disability in Belgium, interventions should target musculoskeletal, cardiovascular and respiratory diseases especially among elderly. Furthermore, attention should also be given to depression in young individuals