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Cardiovascular risk factors in children from the Belgian province of Luxembourg. The Belgian Luxembourg Child Study.

The Province of Luxembourg is an area in Belgium with a high prevalence of risk factors for cardiovascular disease and non-insulin-dependent diabetes mellitus among adults. In the present study, children in the age groups 6-8, 8-10, and 10-12 years were selected at random from school classes (n = 1,028), with a participation rate of 70.3%. Anthropometric factors, blood pressure, and fasting blood glucose, plasma cholesterol, triglyceride, and insulin levels were measured in 1992. All anthropometric and metabolic variables increased with age, except for waist: hip circumference ratio in boys and cholesterol in girls. In the oldest group, girls who had passed menarche were taller and heavier and had greater skinfold, body mass index, insulin, and systolic blood pressure values but lower total cholesterol levels and waist: hip ratios than girls who had not passed menarche. Boys had lower skinfolds and higher waist: hip ratios than girls in all age groups, and were significantly shorter and lighter in the oldest age group. There was no difference in body mass index between the two sexes. Girls had higher triglyceride and insulin levels in the 10- to 12-year age group, lower blood glucose values in the 8-10 and 10-12 age groups, and lower diastolic blood pressures in the 8-10 age group. Obesity, blood glucose, triglycerides, insulin, and blood pressure were highly interrelated. Cholesterol, triglycerides, insulin, and blood pressure values were all among the highest of values previously reported in other studies. The deciles of body mass index above 50 appeared to be particularly elevated, suggesting that obesity, when present, was pronounced in this population of children. These findings suggest an accumulation of genetic susceptibility to cardiovascular disease and non-insulin-dependent diabetes mellitus in this stable, ethnically homogeneous, and rather isolated part of continental Europe.

Anthropometry↗

The incidence of type 1 (insulin-dependent) diabetes mellitus in subjects aged 0-19 years in Luxembourg: a retrospective study from 1977 to 1986.

A decrease in the incidence of Type 1 (insulin-dependent) diabetes mellitus in the age group 0-14 years has been observed from north to south over north-western Europe. To evaluate whether this trend could be found in Luxembourg (a small country between the Netherlands and France) we performed a retrospective study over a period of 10 years. Information concerning all Type 1 diabetic patients (aged 0-19 years at diagnosis), diagnosed between January 1, 1977 and December 31, 1986 was obtained through paediatricians, internists, general practitioners and the Luxembourg Diabetes Association (LDA). The LDA was used as the ascertainment group (to estimate the real number and incidence of Type 1 diabetes mellitus). During the study period 91 Type 1 diabetic patients aged between 0-19 years were diagnosed. An incidence of 11.2 was found in boys (0-19 years). Girls in the same age group showed a considerably lower incidence of 8.8. Standardised incidence (using as standard the world population) revealed an almost similar incidence in the Netherlands and Luxembourg (respectively 10.3 and 10.2) for the age group aged 0-14 years. In France a considerably lower incidence is found (3.6). To what extent different methodology contributes to the differences remains to be clarified. Further prospective studies are necessary to investigate the role of environmental and genetic factors.

Adolescent↗

Health technology assessment in Luxembourg.

Luxembourg's public health insurance is a compulsory insurance for all employees, self-employed professionals, farmers, and pensioners. It is financed through contributions of the insured people, as well as by state taxes. Providers of health care are mainly private nonprofit institutions and self-employed professionals. All healthcare procedures are defined in fee schedules determined by a common decision of the Ministers of Social Security and Health according to proposals of a board of experts. The relative value of a service is also determined by the corresponding fee schedule. Hospitals are financed by individual budgets negotiated between each hospital and the health insurance. These hospital budgets do not cover services provided in hospitals by medical specialists, who are reimbursed on a fee-for-service basis. A low on hospital planning and organization allows the government to restrict the installation in hospitals of very expensive equipment or of equipment for which there is only a limited need in Luxembourg hospitals. Until recently there has been limited interest in or use of health technology assessment (HTA). However, large hospital investments have provoked some interest in the last few years. The Ministry of Health has asked for some HTA studies when a concrete decision had to be taken. Luxembourg decision makers have become more aware that HTA may help them to become more informed about the short- and long-term consequences of the application of health technology.

Delivery of Health Care↗

Seroepidemiology of hepatitis A and hepatitis B virus in Luxembourg.

A prospective seroepidemiological survey was carried out in Luxembourg in 2000-2001 to determine the antibody status of the Luxembourg population against hepatitis A virus (HAV) and hepatitis B virus (HBV). One of the objectives of this survey was to assess the impact of the hepatitis B vaccination programme, which started in May 1996 and included a catch-up campaign for all adolescents aged 12-15 years. Venous blood from 2679 individuals was screened for the presence of antibodies to HAV antigen and antibodies to hepatitis B surface antigen (anti-HBs) using an enzyme immunoassay. Samples positive for anti-HBs were tested for antibody to hepatitis B core antigen (anti-HBc) using a chemiluminiscent microparticle immunoassay to distinguish between individuals with past exposure to vaccine or natural infection. The estimated age-standardized anti-HAV seroprevalence was 42.0% [95% confidence interval (CI) 39.8-44.1] in the population >4 years of age. Seroprevalence was age-dependent and highest in adult immigrants from Portugal and the former Yugoslavia. The age-standardized prevalence of anti-HBs and anti-HBc was estimated at 19.7% (95% CI 18.1-21.3) and 3.16% (95% CI 2.2-4.1) respectively. Anti-HBs seroprevalence exceeding 50% was found in the cohorts targeted by the routine hepatitis B vaccination programme, which started in 1996. Our study illustrates that most young people in Luxembourg are susceptible to HAV infection and that the hepatitis B vaccination programme is having a substantial impact on population immunity in children and teenagers.

Adolescent↗

HIV-1 subtypes in Luxembourg, 1983-2000.

OBJECTIVES: To study the prevalence of HIV-1 subtypes in Luxembourg between 1983 and 2000. To compare the drug susceptibility of non-B and B clade viruses and the prevalence of resistance-associated mutations and polymorphisms before antiretroviral treatment. DESIGN: A retrospective study on plasma samples of HIV-infected patients registered at the National Service of Infectious Diseases, Luxembourg, between 1983 and 2000. METHODS: Genotyping was performed by sequencing of the reverse transcriptase (RT) and protease coding region of the pol gene. Drug susceptibility was assessed in a recombinant virus assay. RESULTS: A total of 20.1% of the HIV-positive patients were infected with non-B subtypes, and since 1990 the proportion of non-B viruses has increased ninefold. Eleven out of 14 F1 subtypes occurred in patients native to Luxembourg. Major resistance mutations related to protease inhibitors (PI), nucleoside reverse transcriptase inhibitors (NRTI) and non-nucleoside reverse transcriptase inhibitors (NNRTI) occurred in less than 3% of treatment-naive viruses; however, 87% of the viruses had at least one PI-associated mutation. Natural polymorphism of the protease and RT coding region was observed more frequently among non-B than B viruses. Significantly more B viruses displayed resistance to the tested PI, NRTI and NNRTI (P = 0.044). CONCLUSION: The proportion of non-B viruses has increased dramatically since 1990. Non-B subtypes showed no decreased susceptibility to antiretroviral drugs, but displayed minor mutations and polymorphisms at higher frequency in their protease and RT coding region. In contrast, a significantly higher proportion of B viruses showed resistance to a range of antiretroviral drugs.

Adult↗

[Radiotherapy at the Grand Duchy of Luxembourg].

The Centre François Baclesse was created as National Radiotherapy Center in 2000. Oncology Radiotherapy has been developed in Luxembourg in parallel with existing medical and surgical oncology departments. Cancer is a Public Health problem in Luxembourg. More than 1800 new cases of cancer are diagnosed every year, out of wich 70 % will need radiotherapy at the time of the evolution of the disease. Technical platform and Human Resources available at this time are able to deliver high quality treatment. The activity reached a plateau in 2002 with almost 800 patients treated per year, whereas the theorical need for radiation oncology treatment is 1200 patients per year in Luxembourg. A large architectural project will add 2 new linear accelerators and will be finished by 2007-2008. Multidisciplinary oncological network has been developed together with cancer treatment units of 6 luxembourgish hospitals. Clinical Research is one of the missions of the Center. After the achievement of its extension, the Centre François Baclesse will be able to cover the need of the Regional, luxembourgish and cross-boarder patients pool, in line with an European approach in treating cancer.

Humans↗

[Research in Luxembourg from the legislative point of view].

Since the independence of the grand-duchy of Luxembourg in 1839 it has taken a long time with complicated procedures to develop research in our country. The creation of a society for research and conservation of historical monuments goes back to 1845 followed by the Society of Natural Sciences in 1850, then by the Medical Society in 1862. Those 3 societies were at the origin of the Institut Grand Ducal. The creation of a Luxembourg institute for scientific research (CLRS) on April 1977 allowed a first public financing for research. The law of March 9th 1987 defined the type of research in 3 different centers of Public Research (CRP). On May 31st 1999 the National Fund of Research (FNR) was born. The author presents the different positions of the Council of State concerning these projects. The creation of the University of Luxembourg by law on July 17th 2003 raised many problems of coordination, collaboration and competences. Some solutions of this imbroglio are suggested.

History, 19th Century↗

A breast cancer screening programme operating in a liberal health care system: the Luxembourg Mammography Programme, 1992-1997.

The national breast cancer screening programme in Luxembourg, the Mammography Programme (MP), was launched in 1992. Its primary goal was to set up an organised breast cancer screening with biennial invitation-reinvitation of women 50-64 years, 2-view mammography, technical quality assurance, double-reading procedures and close monitoring of performance. In 1994, the decision was taken by health authorities to only reimburse screening mammograms done within the MP. We evaluated the performance of 3 screening rounds that took place in 1992-1997. In 1992, 4,815 women had opportunistic screening and 4,790 attended the MP. In 1997, 861 women had opportunistic screening and 8,603 attended the MP. In 1997, the participation rate in the MP reached 50%. The referral rate in the MP was 10% for initial screening and 5% for subsequent screening. Echographic examinations accounted for 71% of referrals. Per 1,000 screened women, biopsy and cancer rates were 18.0 and 8.0 for initial screening and 10.3 and 5.8 for subsequent screening. Twenty-one percent of the breast cancers diagnosed in screened women were interval cancers. The age-adjusted proportion of tumours >20 mm was 56.1% before 1992, 45.1% for women not (yet) screened by the MP, 27.0% for interval cancers, 26.6% for initial screening and 12.0% for subsequent screenings. Tumour size distribution was similar to that observed in the Dutch Breast Cancer Screening Programme, 1990-1993, except that in the latter programme, no difference was observed between initial and subsequent screening. The Luxembourg experience shows that in a liberal health care system, a policy of organising the screening process by reimbursing only those mammograms done within the context of the organised screening programme can drastically reduce opportunistic screening. Further efforts in the Mammography Programme will aim at increasing participation and look at ways to decrease referrals to echography.

Aged↗

The epidemiology of the human rabies threat in the Grand Duchy of Luxembourg.

Epidemiological data were recorded and blood samples were obtained from a group of 297 individuals from Luxembourg who had been in contact with rabies-infected or -suspected animals from 1979 to 1985, and who had been vaccinated with a complete course of HDCS rabies vaccine. The majority of the subjects were farmers aged between 30 and 59. The most frequent source of infection was cattle, followed by foxes, sheep and cats. Dogs were in the fifth position only, probably as a direct result of obligatory vaccination of dogs in Luxembourg. Animal rabies was proven in 253 of the 297 cases; in 35 cases, rabies diagnosis was not confirmed, and in 9 cases the animals escaped. Concerning the mode of contact, most people (86%) reported having had contact which caused no skin lesions. Contact with skin lesion, i.e. by biting, scratching or scraping, was only reported in connection with dogs, cats and wild animals, whereas with cattle and other farm animals, contact was mostly without skin lesion. The hand was the part of the body (85%) most frequently involved. Sera were tested by an enzyme immunoassay for rabies antibodies. The results were unsatisfactory: 21.5% of the cases had no demonstrable antibodies and 15.2% had antibodies in low titre. No decline in antibody titre was found according to the time interval after vaccination. Therefore, the enzyme immunoassay does not appear to be optimal to determine long-term immunity.

Age Factors↗

Changes in diabetes prevalence and treatment in the last ten years in Luxembourg. A lesson from the United Kingdom prospective diabetes study?

OBJECTIVES: The aims of the study were to estimate the prevalence of diabetes in Luxembourg in 2002, to compare it to the prevalence reported in 1991 and to evaluate if prescription attitudes have changed since 1991. METHODS: The prevalence of diabetes was estimated using the drug sales data. The key parameters, total amount of antidiabetic drugs sold in one year and the average daily dose or Prescribed Daily Dose (PDD), have been obtained from the National Social Security Organization and by a standardized questionnaire sent to all general practitioners and all internists and endocrinologists of the country. RESULTS: The PDD was calculated on 2, 402 questionnaires on individual diabetic patients. By this means, the proportion of patients only treated with appropriate diet could also be obtained. Compared to 1991, the total amount of antidiabetic drugs showed a four-fold increase in metformine tablet prescriptions. A high percentage of combined treatments was found. The prevalence of diabetes in Luxembourg was found to be 3.05% of the total population. CONCLUSIONS: Compared to the status in 1991, prevalence of diabetes increased by 63%, which seems mainly due to type 2 diabetic patients as orally-treated diabetic patients almost doubled (2.11% vs 1.16%). A substantial change in prescriptions for diabetes has occurred, suggesting a positive influence of studies like the United Kingdom Prospective Diabetes Study (UKPDS).

Diabetes Mellitus↗

Seroprevalence of measles, mumps and rubella antibodies in Luxembourg: results from a national cross-sectional study.

A serological prevalence survey was carried out in Luxembourg during 2000-2001 to determine the antibody status of the Luxembourg population against vaccine-preventable infections. Blood samples of children and adolescents were collected prospectively in randomly selected schools. Samples of adults were obtained through volunteer patients of the national health laboratory or of the mandatory pre-nuptial test. Measles, mumps and rubella (MMR) virus antibody concentrations were measured using commercial ELISA tests. Age-standardized prevalence of measles, mumps and rubella virus antibodies was found to be 96.58, 75.40 and 95.69% respectively. Significant age-dependence of serology was observed for all three infections, with study participants born after the introduction of the MMR vaccine experiencing a gradual decline of antibodies following vaccination in childhood. Older study participants who were more likely to have antibodies from natural infection had consistently higher titres than younger individuals. Present vaccination coverage with MMR appears to be sufficient to prevent large local outbreaks of measles and rubella, but probably not mumps.

Adolescent↗

Seroprevalence and force of infection of varicella-zoster virus in Luxembourg.

A serological prevalence survey was carried out in Luxembourg during 2000-2001 to determine the antibody status of the Luxembourg population against vaccine-preventable infections including varicella-zoster virus (VZV). ELISA tests performed on 2679 sera indicated that 96 (3.6%) of the study population were seronegative. Age-specific seroprevalence rose rapidly from approximately 70% at age 4 years to 90% at age 6 years to 95% at age 12 years. Significant heterogeneity of seroprevalence was observed between the six different primary schools. For age groups 0-5, 6-11 and 12+ years, we estimated an annual force of infection of 0.361 [95% confidence interval (CI) 0.31-0.415)], 0.204 (95% CI 0.12-0.29) and 0.05 (95% CI 0.024-0.082) respectively. Our results indicate that transmission of VZV is highest in children below the age of 6 years and that much lower levels of VZV transmission occur in secondary schools and throughout adulthood.

Adolescent↗

Isotopic assessment of sources and processes affecting sulfate and nitrate in surface water and groundwater of Luxembourg.

Surface water and deep and shallow groundwater samples were taken from selected parts of the Grand-Duchy of Luxembourg to determine the isotopic composition of nitrate and sulfate, in order to identify sources and/or processes affecting these solutes. Deep groundwater had sulfate concentrations between 20 and 40 mg/L, delta34S(sulfate) values between -3.0 and -20.0 per thousand, and delta18O(sulfate) values between +1.5 and +5.0 per thousand; nitrate was characterized by concentrations varying between < 0.5 and 10 mg/L, delta15N(nitrate) values of approximately -0.5 per thousand, and delta18O(nitrate) values approximately +3.0 per thousand. In the shallow groundwater, sulfate concentrations ranged from 25 to 30 mg/L, delta34S(sulfate) values from -20.0 to +4.5 per thousand, and delta18O(sulfate) values from approximately +0.5 to +4.5 per thousand; nitrate concentrations varied between approximately 10 and 75 mg/L, delta15N(nitrate) values between +2.5 and +10.0 per thousand, and delta18O(nitrate) values between +1.0 and +3.0 per thousand. In surface water, sulfate concentrations ranged from 10 to 210 mg/L, delta34S(sulfate) values varied between -9.3 and +10.9 per thousand, and delta18O(sulfate) values between +3.0 and +10.7 per thousand were observed. Nitrate concentrations ranged from 10 to 40 mg/L, delta15N(nitrate) values from +6.5 to +12.0 per thousand, and delta18O(nitrate) values from -0.4 to +4.0 per thousand. Based on these data, three sulfate sources were identified controlling the riverine sulfate load. These are soil sulfate, dissolution of evaporites, and oxidation of reduced S minerals in the bedrock. Both groundwater types were predominantly influenced by sulfate from the two latter lithogenic S sources. The deep groundwater and a couple shallow groundwater samples had nitrate derived mainly from soil nitrification. All other sampling sites were influenced by nitrate originating from sewage and/or manure. A decrease in nitrate concentration observed along one of the rivers was attributed to denitrification. It appears that sulfate within Luxembourg's aquatic ecosystem is mainly of lithogenic origin, whereas nitrate is often derived from anthropogenic activities.

Environmental Monitoring↗

Medical exposure of the population from diagnostic use of ionizing radiation in luxembourg between 1994 and 2002.

A national evaluation on radiation doses from diagnostic procedures (x rays and nuclear medicine) was conducted in Luxembourg for the period 1994-2002 aiming at the estimation of the annual collective dose. The calculations were based on a survey of frequencies of more than 250 types of radiological examinations and included more than 425,000 patients. This evaluation ensured the practical implementation of Article 12 of the European Directive 97/43/EURATOM, which obliges the Member States to determinate the population dose from medical exposure. The results show an increase of the annual effective dose per capita from 1.59 mSv in 1994 to 1.98 mSv in 2002. The impact of computed tomography to dose received from medical use of radiation has dramatically increased in this time period. Luxembourg has one of the highest computed tomography examination rates compared to other health care level I countries. The following measures to minimize medical exposures were proposed in the study: medical physicists should have a more central role to play in patient dosimetry in interventional and diagnostic radiology, especially concerning computed tomography. Also, the implementation of an electronic "X-ray patient card" for all irradiated patients--except dental--and the use of the European referral criteria that give guidance and recommend investigations in various clinical settings can both help to decrease medical radiation exposures.

Adolescent↗

Thlaspi caerulescens on nonmetalliferous soil in Luxembourg: ecological niche and genetic variation in mineral element composition.

Forty-seven populations of Thlaspi caerulescens in Luxembourg were characterised for population size, soil mineral element composition and other habitat characteristics. Foliar concentrations of eight elements were assessed in 15 populations in the field and in eight populations cultivated in zinc (Zn)-cadmium (Cd)-nickel (Ni)-enriched soil. T. caerulescens favoured stony soil developed on steep, south-facing Emsian shale outcrops. All soil samples were nonmetalliferous. Soil pH ranged from 4.2 to 6.9. Field-growing plants had very high concentrations of heavy metals in the leaves (Zn, 3000-13 000 mg kg(-1); Cd, 11-44 mg kg(-1); Ni, 38-473 mg kg(-1)). Positive soil-plant correlations existed for Zn and Mn. In cultivation, significant genetic variation was found for biomass and six of eight mineral elements. For Cd and Zn, variation range among 48 half-sib families was two-fold (Cd, 183-334 mg kg(-1); Zn, 8030-16 295 mg kg(-1)). Most of the variation occurred among populations, consistent with the selfing mating system of those populations. There was a tight Zn-Cd genetic correlation (r = +0.83, P < 0.0001). The significance of the results to the conservation of T. caerulescens in Luxembourg is briefly discussed.

Ecosystem↗

[Science and medicine in 18th Century Luxembourg].

During the 18th century science and medicine are poorly developed in Luxembourg (present part of the former duchy). Leprosy is vanishing and black death belongs to the past, whereas dysentery, typhoid fever and other epidemical diseases are thriving. In some specific diseases people claim help from protective saints such as St. Hubert (rabies) and St. Willibrord or the Blessed Virgin Mary. Besides these aspects the paper gives a concise outline of the situation in Luxembourg during the 18th century concerning hospitals, physicians, pharmacists and popular medicine.

Catholicism↗

[The treatment of assisted reproduction--clinical and preclinical aspects, functioning of the Unit of Human Reproduction at the Central Hospital of Luxembourg].

Since a few years the OBGYN department at the Centre Hospitalier in Luxembourg has intensified its practice of ART with the introduction of a multidisciplinary team and a decentralized IVF program. While clinical investigations, cycle-monitoring and surgery, oocyte pick-up are commonly performed at the CHL, the biological supplement is transferred to next situated Belgian laboratories. As Luxembourg has no national bio-ethical law, we apply partly the French law of 1994.

Female↗