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Biomedical subjects

G De Backer

Publications and source records attributed to G De Backer.

At least 73 records · Page 4Linked to original sources
PubMed1999

Trends in mortality from cutaneous malignant melanoma in Belgium.

BACKGROUND AND METHODS: Changes over time of mortality rates from cutaneous malignant melanoma (CMM) in Belgium were analysed, based on people (n = 3695) aged 25-84 years, who died of CMM from 1954 to 1992. All data were collected from the Belgian National Institute of Statistics. For the log-linear analysis and calculation of the average annual change, only the data from 1973 to 1992 were considered. RESULTS: The age-adjusted mortality rates (per 10(5)) for the age group 25-84 years old increased from 0.5 in 1954 to 3.0 in 1992 in men, and from 0.8 in 1954 to 2.2 in 1992 in women. The average annual percentage change in men (-0.003%) was stable over the period 1973-1982, and increased to 4.4% over the period 1983-1992. In women, the average annual increase was 4.6% over the period 1973-1982, and continued to increase to 6.8% over the period 1983-1992. Log-linear analysis showed that the change in rates for both men and women was mainly due to an age-'drift' effect, contrary to the results of the average annual percentage change in men. CONCLUSION: The risk of dying from CMM increased in men and women continuously over the whole period, irrespective of birth cohort. In both men and women, there was approximately a 20% increase in CMM mortality per 5-year period.

Adult↗
PubMed1999

Effects of a low-intensity worksite-based nutrition intervention.

Male employees from four local worksites were recruited to participate in a short-term and low-intensity nutrition intervention which focused on promoting low-fat dietary habits. The sites were randomized to control conditions or to the intervention programme that consisted of an individualized health risk appraisal, group sessions, mass media activities and environmental changes. Participants were seen before and three months after intervention to measure blood lipids, nutrition knowledge and dietary changes. Eighty-three per cent of all eligible subjects were screened (n = 770) and follow-up measures were obtained for 82%. The score for nutrition knowledge improved significantly in the intervention group. There was also a net reduction in the intake of total calories and in the percentage of energy from total fat. Reported intake of carbohydrates and proteins increased. For all employees assessed, there were no changes in mean total cholesterol level or fatty acid composition. Only among participants with hypercholesterolemia was a significant reduction in blood cholesterol observed. This low-intensity intervention programme achieved some self-reported dietary changes and was successful (at least in part because statistical regression needs to be considered) in obtaining a more short-term beneficial cholesterol level in employees at higher cardiovascular risk.

Adult↗
PubMed1999

Under-registration of melanoma in Belgium: an analysis.

The overall underestimation of incident cancer cases in the Belgian National Cancer Registry is estimated at about 20-25%, with a probable larger under-registration among males. Melanoma incidence is suspected to be underestimated even further because of the hospital-based reporting system of the National Cancer Registry. To investigate the suspected underestimation of melanoma in Belgium, the official data were compared with international data on melanoma incidence and the results of a melanoma registration programme launched in the province of East Flanders. The Eindhoven Cancer Registry, which covers a registration area near the Belgian border, was used as a reference to calculate the expected number of melanomas in East Flanders for 1995. The results indicate an ongoing under-registration of melanoma cases by the National Cancer Registry. Based on the Eindhoven Cancer Registry data, the under-registration in East Flanders is estimated at 43% for males and 36% for females. The East Flanders registration programme apparently obtains a better registration in females. This is mainly due to a higher registration in the younger age groups. In these groups a higher proportion of in situ melanomas and a thinner median Breslow thickness of the invasive melanomas is observed.

Adolescent↗
PubMed1999

The melanoma burden in Belgium; premature morbidity and mortality make melanoma a considerable health problem.

The aim of this study was to investigate the impact of melanoma on public health in Belgium. Melanoma incidence and mortality rates were analysed relative to those of other cancers. These cancers were then evaluated for premature morbidity and mortality by studying age-specific incidence rates, years of potential life lost before 65, and years of potential life lost per death. Melanoma accounts for 1.23% of all incident cancer cases and 0.7% of all cancer deaths in Belgium. It is the seventeenth most common cancer in men and the sixteenth most common cancer in women. Compared with other, more frequent cancers, melanoma seems to affect patients at a younger age; in the 20-39 age group melanoma is the third most common cancer in both sexes. It is the second most important cancer in terms of years of potential life lost per death, preceded only by tumours of the central nervous system. These findings show that melanoma incidence and mortality rates are exceeded by many other cancers. Nevertheless, melanoma poses an important health problem because of its predilection for young and middle-aged people. We suspect that these observations are not specific for Belgium and will also apply to other European countries.

Adult↗
PubMed1999

QT dispersion is not related to infarct size or inducibility in patients with coronary artery disease and life threatening ventricular arrhythmias.

OBJECTIVE: To relate QT parameters to infarct size and inducibility during electrophysiological studies. DESIGN: Analysis of a prospective register. SETTING: University hospital. PATIENTS: 64 patients with coronary artery disease and documented life threatening ventricular arrhythmias. INTERVENTIONS: Measurements of QT-max, QTc-max, and QT dispersion (QT-d) on a simultaneous 12 lead ECG (50 mm/s). Estimation of myocardial infarct size with radionuclide left ventricular ejection fraction (LVEF), echocardiography (left ventricular end diastolic diameter, LVEDD), and a defect score based on a quantitative stress redistribution 201-thallium perfusion study. Electrophysiological study to assess inducibility. RESULTS: Mean (SD) QT parameters were: QT-max 440 (50) ms, QTc-max 475 (46) ms, and QT-d 47 (20) ms. Mean (SD) estimates of infarct size were: LVEF 34 (13)%, LVEDD 61 (9) mm, and defect score 18 (11). There was no significant correlation between any index of infarct size and QT parameters. QT parameters were not significantly different between patients with inducible (n = 57) and non-inducible arrhythmias (n = 7) (QT-max: 416 (30) v 443 (51) ms, p = 0.18; QTc-max 485 (34) v 473 (47) ms, p = 0.34; QT-d 47 (12) v 47 (21) ms, p = 0.73). Non-inducible patients had a significant lower defect score: 8 (9) v 19 (11), p = 0.02, but comparable LVEF: 38 (12)% v 34 (12)%, p = 0.58, and LVEDD: 54 (10) v 61 (8) mm, p = 0.13. CONCLUSIONS: QT parameters are not influenced by infarct size and do not predict inducibility during electrophysiological study in patients with coronary artery disease and malignant ventricular arrhythmias. In contrast, the amount of scar tissue determined by perfusion imaging is strongly correlated with inducibility.

Aged↗
PubMed1999

Trends in coronary heart disease in two Belgian areas: results from the MONICA Ghent-Charleroi Study.

SETTING: As part of the WHO-MONICA study, acute coronary events have been registered from 1983 until 1992 in the general population aged 25-69 years in two Belgian cities--Ghent in the northern Dutch speaking part of Belgium and Charleroi in the southern French speaking part. Registration of events was done according to an international standard protocol. OBJECTIVE: To study trends in total, fatal and non-fatal event rates and trends in case fatality rates in these two cities. MAIN RESULTS: Incidence of CHD was on average 50% higher in Charleroi compared with Ghent in both men and women (attack rate ratio Charleroi/Ghent was 1.5 in both sexes). In both men and women, diverging trends were observed between the two cities for total and non-fatal event rates, while parallel declining trends were observed in fatal event rates and in case fatality rates. In both sexes, total attack rates showed a significant decrease in Ghent and a significant increase in Charleroi. Also in the two sexes, attack rates of non-fatal events increased significantly in Charleroi and remained stable in Ghent. Attack rates of fatal events decreased significantly in men and women in Ghent and in men in Charleroi. Both "total" and "in hospital" case fatality rates declined significantly in both sexes in the two cities. CONCLUSIONS: Important differences in coronary heart disease (CHD) incidence and CHD trends between Ghent and Charleroi were observed. These differences and trends are interpreted in the context of existing and still growing differences in the overall socioeconomic situation between the north and the south of the country. On the other hand, the efficacy of medical treatment of CHD is comparable in the two regions, as reflected by similar figures and trends for case fatality rates.

Adult↗
PubMed1999

A comparison of lifestyle, genetic, bioclinical and biochemical variables of offspring with and without family histories of premature coronary heart disease: the experience of the European Atherosclerosis Research Studies.

BACKGROUND: Lifestyle, genetic, bioclinical and biochemical factors of European university students aged 18-26 years, with and without documented paternal histories of premature coronary heart disease, have been compared in the European Atherosclerosis Research Studies (EARS) I and II. OBJECTIVE: To highlight consistencies and inconsistencies between findings in the two studies. METHODS: All measurements were made according to strict protocols, by trained technicians using validated methods. The results for men in EARS I are compared with those from EARS II which was confined to men. RESULTS: In both studies we found no differences between cases and controls in lifestyle factors and bioclinical factors except that controls were taller. We found inconsistent differences between obesity indices and antecedents of arterial hypertension. In both studies we found consistent differences between cases and controls in levels of total cholesterol and apolipoprotein B, both levels being higher in cases. The lack of any difference between levels of high-density lipoprotein cholesterol and apolipoprotein A1 was also found consistently. Inconsistent differences were found for levels of triglycerides and apolipoprotein E. For most of the candidate genes that were studied, no differences between cases and controls were found, but different polymorphisms were associated with levels of lipids, apoproteins and fibrinogen independently of case-control status. Some of these associations were potentiated by lifestyle factors. The interaction between genetic and environmental factors is further illustrated with results from the association of apolipoprotein E polymorphism with the level of apolipoprotein B and a variety of other determinants of apolipoprotein B level. CONCLUSIONS: In the EARS studies a documented family history of premature coronary heart disease was mainly expressed in terms of biochemical factors that are determined both by nature and by nurture.

Adolescent↗
PubMed1999

Epidemiology of risk factors for hypertension: implications for prevention and therapy.

We review the present knowledge of risk factors for arterial hypertension. Both genetic and environmental factors as well as their interaction and biological plausibility are reviewed. Recent data confirm that the interaction of genetics with multiple environmental risk factors explains the high prevalence of hypertension in the industrialised countries. The most important modifiable environmental risk factors are high salt intake, alcohol intake, obesity and low physical activity. The role of stress in the aetiology of high blood pressure is still under investigation, but recent clinical experimental and epidemiological data have shed light on how stress could be related to hypertension. The implications for prevention and treatment are discussed both at the population and individual levels. The population approach involves a public health policy aiming at modification of the major risk factors. The individual approach involves nonpharmacological measures to prevent the development of hypertension and to treat high normal blood pressure and mild hypertension with no additional cardiovascular risk factors. Pharmacological treatment of hypertension in most individuals should use agents that have been proven to be effective in randomised controlled trials with 'hard' endpoints such as cardiovascular and cerebrovascular morbidity and mortality.

Female↗
PubMed1998

Prognostic value of ischemic electrocardiographic findings for cardiovascular mortality in men and women.

OBJECTIVES: The aim of this study was to investigate the independent prognostic value of ischemic electrocardiographic (ECG) findings for cardiovascular mortality and to evaluate a possible sex-differential in this regard. BACKGROUND: In previous reports, ST segment and T wave changes on the resting ECG were described as independent risk factors for development of coronary heart disease. Although more prevalent in women, they are often given less clinical importance than in men. METHODS: Ten-year follow-up data from the Belgian Interuniversity Research on Nutrition and Health study were used. The results presented here are based on ECGs of the 4,797 men and 4,320 women, aged 25 to 74 years, who were free of angina pectoris at the start of follow-up, had no history of myocardial infarction (MI) and showed no Q wave evidence of an old MI on their ECG. RESULTS: At baseline, the age-standardized prevalence of an "ischemic ECG" (Minnesota codes I3, IV1-3, V1-3 or VII1) was 8.4% in men and 10.6% in women. Cardiovascular mortality rates in men and women with an ischemic ECG were respectively 7.7 and 2.6 per 1,000 person-years, compared with 2.3 and 1.0 in those with no such ECG findings. After correction for the potential confounding effects of established cardiovascular disease (CVD) risk factors, the multivariately adjusted risk ratios were 2.45 (95% confidence interval [CI]: 1.70 to 3.53) for men and 2.16 (95% CI: 1.30 to 3.58) for women. Testing the interaction between an ischemic ECG and sex on CVD mortality revealed that the risk ratios were not significantly changed (p=0.95). The etiologic fraction of CVD deaths attributable to an ischemic ECG was estimated as 19.3% for men and 22.4% for women. Both men and women with major ischemic findings in their baseline electrocardiogram (Minnesota codes IV1,2, V1,2 or VII1) had a fourfold increased risk of CVD death. CONCLUSION: These results support the hypothesis that women with ischemic ECG findings are at the same increased risk for CVD mortality as men.

Adult↗
PubMed1998

Screening for breast cancer in Ghent, Belgium: first results of a programme involving the existing health services.

In 1992, a population-based breast cancer screening programme was initiated in the municipality of Ghent: all women aged 40-69 years were personally invited to attend a local radiology unit for a mammogram, after being examined by a general practitioner or gynaecologist of their choice. The results of history taking, clinical breast examination, first and second reading, further investigation and primary treatment were registered. In total, 24.3% of the eligible population was screened in the period 1992-1994. The recall and biopsy rates were 2.9% and 1.4%, respectively. The cancer detection rate was 8.1 per 1000 women screened. Of all cancers detected, 88.0% (66/75) were invasive. Of these, 35.9% (23/64) measured 10 mm or less in diameter. The benign to malignant biopsy ratio was 0.7. Apart from the low participation, these results suggest that the programme is effective, compared with reference standards and the results of other studies.

Adult↗
PubMed1998

Trends in the prevalence of obesity among Belgian men at work, 1977-1992.

OBJECTIVE: To assess trends in average body mass index (BMI) and the prevalence of obesity between 1977 and 1992, in middle-aged Belgian men at work. SUBJECTS: A subsample of men at work, aged 40-54 y extracted from the base-line data from four independent prospective studies, each representing a period (Physical Fitness Study (1977-1978), Belgian Interuniversity Research on Nutrition and Health (BIRNH) (1979-1984), Multinational Monitoring of Trends and Determinants in Cardiovascular Diseases (MONICA) (1986-1991) and ORCA (1992-1993)). DESIGN: Linear regression of the average body mass index (kg/m2) and logistic regression of the prevalence of obesity (BMI > or = 30kg/m2). Independent variables taken into account in multivariate analysis were: age, educational level, marital status and region. RESULTS: In this subsample of Belgian men at work, aged 40-54 y, prevalence of obesity increased from 9.2% in 1977-1978 to 14.5% in 1992-1993. This rise was present in each five-year age group, in both regions and in all educational groups, but strongest in the lowest educated. After adjustment for sociodemographic covariables, it was estimated that with regard to 1977-1978, the proportion of men with a BMI > or = 30 kg/m2 doubled over the 15-year period (odds ratio OR (95% confidence intervals, 95% CI)): 1.98 (1.40; 2.80). CONCLUSION: Keeping in mind that the trends have been calculated from data from four different studies, presenting some shortcomings, prevalence of obesity has increased between 1977-1992 in men aged 40-54 y at work. This rise is particularly pronounced in the lower educated groups.

Adult↗
PubMed1998

Prevalence, awareness, treatment and control of arterial hypertension in an elderly population in Belgium.

OBJECTIVE: To study the prevalence, awareness, treatment and control of arterial hypertension in the elderly population in Belgium. STUDY GROUP: An age- and sex-stratified sample of 2212 Belgian subjects aged 65 years or more, selected from the original cohort of the Belgian Interuniversity Research on Nutrition and Health (BIRNH) study; participation in this follow-up study was 72.6%. METHODS: Blood pressure (BP) was measured at home by trained technicians using a standard protocol. Isolated systolic hypertension (ISH) was defined as a systolic BP > or =160 mm Hg and a diastolic BP <95 mm Hg. Diastolic hypertension was defined as a diastolic BP > or =95 mm Hg. The total hypertensive population was defined as all those with ISH, diastolic hypertension and with BPs <160-95 mm Hg but currently taking antihypertensive drugs. Awareness and treatment status were investigated through a structured interview. RESULTS: The prevalence of arterial hypertension was 43.9%, higher in women than in men and increasing with age in women; elevated BP was found in 22.3 to 28.6% of the participants varying by age and sex. In the >75-year-old subjects this elevation was in two-thirds of the cases due to ISH; 84% of all female hypertensives were aware of the condition compared to 68% in men. Treatment advice had been given in a majority of the aware subjects and two-thirds of all treated persons was under control. Among a variety of independent variables and besides the gender difference, awareness was only related to smoking and to depression while control differed by region of residence. CONCLUSION: Arterial hypertension is highly prevalent in this elderly population; awareness and BP control are within acceptable ranges but there is still room for improvement, particularly in elderly men.

Age Distribution↗
PubMed1998

Trends in the prevalence, detection, treatment and control of arterial hypertension in the Belgian adult population.

OBJECTIVES: To discuss changes during the past decades in the prevalence and in the patterns of detection, treatment and control of arterial hypertension in the general Belgian population aged 25-64 years. DESIGN: Data from two cross-sectional cardiovascular disease risk factor surveys of the general population aged 25-64 years during the first and second halves of the 1980s (the Belgian Inter-university Research on Nutrition and Health study of 1980-1984 and the World Health Organization Multinational Monitoring of Trends and Determinants in Cardiovascular Diseases study of 1985-1992) are compared. PARTICIPANTS: Age-stratified and sex-stratified random samples from the general population yielded 9372 participants in the former study and 4904 participants in the latter. METHODS: In both studies, blood pressure measurements and other variables were collected in the same standardized way and by the same observers. RESULTS: For both sexes, overall age-standardized prevalences of hypertension (subjects with systolic blood pressure > or = 160 mmHg or diastolic blood pressure > or = 95 mmHg or currently being administered antihypertensive drug treatment) were found to be significantly (P< 0.001) higher in the former than they were in the latter study. A significant decline in population mean systolic blood pressure values was observed for both sexes on going from the former data to the latter (falls of 6.0 and 7.3 mmHg for men and women, respectively, P< 0.01). In log-linear models, adjusted for age, a highly significant (P< 0.0001) favourable shift in the population distribution over the various categories of detection, treatment and control of hypertension was observed. This trend exhibited a significant sex difference, however, there being a much more favourable trend for women. CONCLUSIONS: In Belgium, favourable trends in the prevalence and in the patterns of detection, treatment and control of arterial hypertension and in the levels of systolic blood pressure were observed. The so-called 'rule of halves' is no longer valid.

Adult↗
PubMed1998

Prognostic value of ECG findings for total, cardiovascular disease, and coronary heart disease death in men and women.

OBJECTIVE: To study abnormalities in the resting ECG as independent predictors for all cause, cardiovascular disease (CVD), and coronary heart disease (CHD) mortality in a population based random sample of men and women, and to explore whether their prognostic value is different between sexes. DESIGN AND SUBJECTS: An age and sex stratified random sample was selected from the total Belgian population aged 25 to 74 years. Baseline data were gathered and resting ECGs were classified according to Minnesota code criteria. The sample was then followed for at least 10 years with respect to cause specific death. Results are based on observations from 5208 men and 4746 women free from prevalent CHD at the start of the follow up period. RESULTS: Although the prevalence of major abnormalities in general was comparable between sexes, women had more ischaemic findings, ST segment changes, and abnormal T waves on their baseline ECG, while men showed more arrhythmias, bundle branch blocks, and left ventricular hypertrophy. Fitting the multiplicative effect on subsequent mortality between all ECG classifications under study and sex indicated that the prognostic value of ECG changes was equal in women and men. Independently of other risk factors and other major ECG changes, almost all ECG classifications were significantly related to all cause, CVD, and CHD mortality. The most predictive ECG findings for CVD death were ST segment depression (risk ratio (RR) 4.71), major ECG findings (RR 3.26), left ventricular hypertrophy (RR 2.79), bundle branch blocks (RR 2.58), T wave flattening (RR 2.47), ischaemic ECG findings (RR 2.35), and arrhythmias (RR 2.15). The prognostic value of major ECG findings for CVD and CHD death was more powerful than well established cardiovascular risk factors. CONCLUSIONS: Abnormalities in the baseline ECG are strongly associated with subsequent all cause, CVD, and CHD mortality. Their predictive value was similar for men and women.

Adult↗
PubMed1998

Misclassification of coronary heart disease in mortality statistics. Evidence from the WHO-MONICA Ghent-Charleroi Study in Belgium.

STUDY OBJECTIVE: To validate the Belgian vital statistics for coronary heart disease (CHD) on the basis of an independent acute myocardial infarction (AMI) register, carried out as part of the WHO-MONICA project. DESIGN: Records of fatal cases of AMI in the WHO-MONICA register were individually linked to the corresponding death certificates. SETTING: Since 1983, the WHO-MONICA Collaborating Centre Ghent/Charleroi registers all fatal and non-fatal AMI in the age group 25-69 years in two geographical areas, Ghent in the northern Dutch speaking part and Charleroi in the southern French speaking part of Belgium. Registration is done according to the MONICA protocol. The official vital statistics in Belgium are published on a yearly basis. They are essentially a reflection of the "underlying" causes of death, coded according to the 9th revision of the International Classification of Diseases (ICD). The study was undertaken in the period 1983-1991. MAIN RESULTS: Out of a total of 741 (Ghent) and 934 (Charleroi) well documented MONICA fatal cases of AMI, 492 (66.4%) and 641 (68.6%), respectively, were officially labelled as CHD (ICD code 410-414); 438 (59.1%) and 385 (41.2%), respectively, were officially labelled as AMI (ICD code 410). A substantial fraction of the MONICA AMI cases--27.1% in Ghent and 38.2% in Charleroi--was coded as "other forms of CHD" (ICD 411-414) or as "other forms of heart disease" (ICD 420-429). The remaining MONICA AMI cases--13.8% in Ghent and 20.6% in Charleroi--were classified in either very aspecific (for example, atherosclerosis, ICD 440) or totally unrelated ICD codes (for example, neoplasm, ICD 140-239). CONCLUSIONS: It is concluded from the results in this paper that a substantial part of all deaths caused by CHD in Belgium are labelled with incorrect ICD codes and are therefore misclassified in the official mortality statistics for Belgium. This is partly caused by a "drainage" of cases towards less specific CHD related ICD categories. A considerable fraction, however, seems to be absolutely misclassified.

Adult↗