Research team

Expertise

Quantitative and qualitative research on alcohol, tobacco and illicit drug use in several groups: adolescents, students, elderly people. Breast and colorectal cancer screening.

Supporting the development of self-regulation in infants: a promising strategy in preventive mental health care. 01/10/2023 - 30/09/2027

Abstract

A major challenge of the newborn child is to learn to regulate internal states (physiological, emotional, and cognitive) and behavior. The child's self-regulation stems from successful co-regulation between the baby and its caregiver(s) and constitutes the basis of mental health. Regulation problems (RP) in early childhood are the seeds for emergent developmental psychopathology and for persistent mental health problems later in life. Given the increasing pressure on our mental health care system, targeting RP at an early age is a cost-effective prevention strategy. Based on growing empirical and clinical evidence, we hypothesize that child RP largely result from/persist through co-regulation difficulties within the child-parent dyad, which itself is largely impacted by stress and regulation difficulties in the parent. Hence, reducing stress and enhancing parents' regulation abilities may be the most optimal gateway for improving self-regulation in the child, thereby preventing future mental health problems. To date, however, there is a dearth of scientific research on this topic, both with respect to the (1) characterization, detection and understanding of regulation (problems) (WP1&2), and (2) the organization of preventive care around early regulation in young children (WP3&4). The current proposal will address these gaps in 4 work packages aimed at: (1) quantifying micro self- and co-regulation dynamics within a 'biobehavioral synchrony framework'; (2) understanding the prevalence and contextual risk and protective factors of RP; (3) pinpointing the missed opportunities in the preventive care for young children with RP and translating 3rd line clinical expertise to fill these gaps and (4) developing and testing a 0th/1st line health care program empowering parents in the co-regulation process with their child. Together with our committed stakeholders, this multidisciplinary project aims to be a game changer in the early prevention of mental health care.

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  • Research Project

Shared decision-making for lung cancer prevention: patient-steered development and evaluation of a patient and health care workers decision aid. 01/09/2023 - 31/08/2027

Abstract

Screening with a low dose CT scan could reduce lung cancer (LC) mortality by up to 20%. However, despite significant potential benefits, LC screening rates in countries where LC screening has been implemented have been described to be unacceptably low (1). Reasons for low success rates articulate that there is a lack of targeted and structured delivery approach to inform the to­be­screened population (eligible population) regarding the screening programme and a lack of shared decision­making, where the eligible population is informed about different relevant aspects which would inform his/her choice on whether or not to get screened (1). Success and compliance of any future LC screening programme in Belgium will therefore depend on whether the targeted screening population is adequately informed about the screening programme and whether they can make an informed choice as to whether they would take part in the screening programme. Informing the target LC screening candidates about the screening programme and aligning the final decision with their preferences is called shared decision-making (SDM). SDM can be facilitated by patient decision aids (PtDA), which are evidence­based tools in diverse formats (leaflets, brochures, videos, online applications) that serve to facilitate a shared and informed decision process between patients (where 'patient', in this case, refers to the targeted screening population) and healthcare providers (HCPs) and improve the congruence between patients' preferences and the decision. This project aims to provide evidence­based tools and recommendations for best practices in LC screening shared decision­making from a patient/screening candidate and clinician perspective.

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  • Research Project

Citizen Science project 'De Oorzaak' 01/08/2023 - 30/06/2025

Abstract

From noise-sensitive areas to oases of silence: with the large-scale citizen science project De Oorzaak, De Morgen (DM), the University Hospital Antwerp (UZA) and UAntwerpen are focusing on noise and noise perception in an urban environment. In 2024-2025, we will investigate how residents of different neighborhoods in Antwerp, Ghent and Leuven appreciate the environmental noise present. By means of questionnaires (subjective), smart sound sensors (objective) and medical research (UAntwerpen and UZA) we will classify which sounds are heard, what sound level these sounds have, how these sounds are experienced and what impact they have on health, stress, sleep and quality of life.

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Project type(s)

  • Research Project

Understanding and optimizing the preschool context in Flanders as a foundation for young children's mental health. 01/01/2023 - 31/12/2024

Abstract

The quality of formal childcare has been cited as an important determinant of young children's mental health, as it has been demonstrated that children's self-regulation abilities – resulting from repeated cycles of co-regulation in caregiving – hold extreme importance for their mental health, now and later in life. Given the high uptake of formal childcare in Flanders and the high enrollment rates of the youngest children, childcare teachers thus play an very important role in these co- and self-regulation processes. High job strains within the sector, however, put these services at risk of inducing stress and mental well-being problems among childcare teachers, possibly impacting the co-regulation processes. Fundamental research is scarce in measuring, disentangling and optimizing these relationships. In the current proposal, we will address these gaps using a mixed-method design focusing on 3 research objectives (ROs): (RO1) map the job characteristics that explain job strain in childcare teachers (structural quality), and investigate its association with childcare teachers' ensuing mental well-being, (RO2) examine the impact of childcare teachers' strain and ensuing mental well-being on their co-regulation attitudes and practices (process quality), and (RO3) explore effective strategies to structurally optimize both the structural and process quality of formal childcare.

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  • Research Project

Equity in breast cancer screening in Flanders: the necessity of tailored reminders for women with low socioeconomic status. 01/11/2022 - 31/10/2024

Abstract

The Flemish Breast Cancer Screening Program (BCSP) has been implemented in 2001, only 50% of eligible women were screened on average from 2016 to 2020. Moreover, women of low socioeconomic status (SES) were 40% less likely to participate in the BCSP than women of high SES. Misconceptions towards BCSP is one of the most prominent reasons for the non-participation in BCSP. To improve the equity of BCSP participation in Flanders, interventions targeting to tackle misconception towards BCSP for low-SES non-participants are needed. While a reminder to non-participants can improve participation in randomized controlled trials, participation in some countries that applied reminders in BCSP remains modest. The BCSP in Flanders has not introduced reminders also because of the lack of evidence of the cost-effectiveness of the reminders. For this project, a reminder tailored to tackle the misconception towards BCSP will be developed. Low-SES women who failed to respond to their latest invitation will get the reminder by mail. Knowledge, attitude towards BCSP, and participation in BCSP will be measured by a validated questionnaire before and after the reminder in a cross-over cohort study. The cost-effectiveness of the interventions will be evaluated with a validated micro-simulation model.

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Project type(s)

  • Research Project

Towards informed decisions in colorectal cancer screening (ORIENT). 15/08/2022 - 14/08/2024

Abstract

In Flanders (Belgian region), a colorectal cancer (CRC) screening programme has been in place since 2013 to reduce CRC incidence and related mortality1. Next to these benefits, cancer screening may cause harm for the participants such as interval cancers (CRC 16%2), a false sense of safety or anxiety due to false positives and adverse events of follow-up colonoscopy (e.g. bleeding, colon perforation). There is increasing international recognition that target groups for cancer screening have to be fully aware of the benefits and potential harms of screening in order to make an informed choice. In Flanders and a large part of the EU, this is currently not considered in full, as information shifts towards nudging the benefits of cancer screening. To what extent a person makes an informed decision about cancer screening with the given information is unknown in Flanders, as there are no measurement tools available. Additionally, there are no widespread tools that can support making an informed decision about CRC screening, such as a shared decision making (SDM) tool for general practitioners (GPs) and their vulnerable patients (both end-users in this project). GPs in Flanders have been asking for such a visual SDM tool regarding CRC screening for almost 2 years now (Personal communication, Domus medica*, 2021). At the same time, particularly the vulnerable population requires more accurate, clear and well balanced information which for them is currently not available, which could result in distrust and barriers to understanding the information (Personal communication, 10 stakeholder organisations, 2021). Therefore, the largest impact can be created for these end-users and the current health equity gap for cancer screening can be tackled. To tackle these long-lasting problems, the primary goal of this project is to develop and test an SDM tool through co-creation with the end-users tailored to their needs. Included in this tool, a personalised machine learning (AI) model will enable GPs and patients to discuss CRC on a more personal level regarding the patient's risk of CRC (risk-stratified SDM-tool). All this will be realised in the current daily practice of Flemish GPs with the support of Domus Medica. The primary outcome of the project is to assess the impact of the risk stratified SDM tool on patients' informed choice regarding CRC screening. Secondary outcomes are: 1) To assess the impact of the SDM tool on patients' attitude towards screening, intention to participate, decision conflict, confidence in decision making, anxiety about CRC and screening participation, perceptions about benefits and risk of screening and, 2) To assess GPs' experience with the SDM tool in terms of usability, time requirement, satisfaction with the tool and their perceptions about the effect of the tool on their patients. Current difficulties of reaching the vulnerable population by postal mail will be addressed via GPs. This project is considered high impact due to its scalability on the one hand and its clinical relevance towards the vulnerable population on the other. In the current CRC screening environment, this project will have an impact on the vulnerable population and through transferability of the SDM tool to the general population a possible ~ 900.000 annually invited persons could be reached. Transferability will be possible as the SDM tool will be created through Universal Design (accessible to everyone). *Domus Medica represents the interests of the general practitioners in Brussels and Flanders.

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Project type(s)

  • Research Project

Screening and early detection of colorectal cancer and breast cancer in liquid biopsies using a newly-developed multi-regional methylation assay. 01/11/2020 - 31/10/2024

Abstract

Colorectal cancer (CRC) and breast cancer are amongst the most common and deadliest cancers worldwide. Early detection through current screening programs for both cancers have reduced mortality, but important limitations of these methods, such as limited sensitivity, limited specificity and invasiveness, remain. There is a need for a new, minimally-invasive, cost-effective and very sensitive diagnostic test for screening and early cancer detection. Methylated circulating tumor DNA (metctDNA) biomarkers have shown great potential to discriminate between normal tissue and tumors. MetctDNA can be detected in a minimally-invasive manner using liquid biopsies, such as plasma. Currently, DNA methylation is studied using bisulfite conversion followed by next-generation sequencing or droplet digital PCR. However, disadvantages including DNA degradation, non-optimal sensitivity and specificity of subsequent techniques and limited multiplex capacities still need to be overcome. At this moment, there exists no efficient technique for the simultaneous analysis of several methylated regions in ctDNA in one assay. In our research group, we aim to develop a new, sensitive multi-region metctDNA based bisulfite-free detection technique. The technique will be used in this project to detect differential methylation signatures between normal tissue, pre-cancerous lesions and tumors. With this approach, we aim to develop a new and better assay for screening and detection of CRC and breast cancer.

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  • Research Project

International Research Network on Violence and Integrity in Sport 01/01/2020 - 31/12/2024

Abstract

Violence against children and adults in sport can be regarded as a wicked problem, as it involves many actors with different interests and responsibilities as well as a diversity of emotions ranging from anger to fear and anxiety (Stevens, 2019). The complexity of this problem, which appears to be prevalent in up to 44% of children participating in sport, necessitates a coordinated, interdisciplinary approach in order to fully understand how violence is perpetuated and dealt with in sport, both within individual countries and on the international level. To date, the knowledge base on the issue is limited, as the scientific community addressing these issues is relatively small, and the research field is in its infancy. The few researchers addressing this topic have predominantly been working in silos, and, consequently, initial studies have examined this issue with a singular discipline approach. Violence in sport is a multifaceted issue that has physical, psychological, social and organizational consequences. The fragmentation of the research efforts in this space thus far has limited the possibility of formulating a clear, collaborative and international agenda for future research. By bringing together the most active researchers from multiple disciplines in this field of study, the first International Research Network on Violence and Integrity in Sport (IRNOVIS) was established. IRNOVIS aims to maximize the scientific impact of research in order to better inform policy development and implementation as well as ethical governance. Specifically, this research network aims to develop an international research agenda to study violence and integrity in sport. By producing Position Statements, disseminating research findings and actively engaging in the international public debate about sport integrity and athlete protection, IRNOVIS aims to bring the field forward. IRNOVIS future activities, coordinated by the University of Antwerp, include yearly network meetings, guest lectures, an international conference, a Delphi study on expert opinion and joint research project applications.

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  • Research Project

Chair Reinier de Graaf Youth and Alcohol 01/01/2021 - 31/12/2023

Abstract

The aim of the Chair Reinier de Graaf Youth and Alcohol is threefold. Setting up the Alcohol Clinic (A) does not stand alone. This must be seen in conjunction with (B) conducting scientific research into alcohol abuse among young people and (C) generating awareness among youth and parents, the medical world and policymakers, but also sports clubs and schools. The objective within the framework of the "Reinier de Graaf Chair" is to contribute in Belgium to reducing alcohol abuse among young people on the basis of the following ambitions: (A) Setting up (a network of) alcohol clinics in Belgium. Setting up a first "Youth and Alcohol outpatient clinic" in Antwerp, followed by a phased expansion with several "Alcohol clinics" into a network similar to the Dutch 3-phase model, whereby quantitative ambitions are developed with regard to the youth and their parents / carers such as also psychodiagnostics. (B) Conducting scientific research into Alcohol Abuse among Young People in Belgium. The aim of this trajectory is to stimulate scientific research on Alcohol abuse among young people in Belgium. This research is necessary to gain a better understanding of alcohol abuse among young people in general, the (environmental) factors that play a role in this, to detect the damage to cognitive functions (early detection) and to determine the effectiveness of intervention programs. More importantly, scientific research lays the foundation for broadly creating awareness about alcohol abuse among young people. (C) Creating Awareness of Alcohol Abuse Among Young People. Where the Alcohol Policies focus on minimizing the damage after alcohol abuse and preventing recurrence by the youngster, creating awareness is mainly aimed at preventing alcohol abuse among young people. his is done by: • Supporting campaigns, helping to organize or participate in events and activities as well as providing healthcare information through common means of communication and national and local media outlets. • Establishing and maintaining contacts with representatives of institutions and agencies with objectives related to the issue of prevention of alcohol abuse among young people, for example ministries, the association for alcohol and drugs VAD, politics (in a broad sense), the health insurance companies, partners in the sports, education and the security chain. In this context it can be mentioned the collaboration that has already taken place between the Research Group Medical Sociology and Health Policy of the University of Antwerp on the one hand and the Province of Antwerp on the other, on specific research projects in which alcohol prevention was central. For example, there was a campaign about the willingness of young people to use self-tests to check whether they had drunk too much. Another campaign was to make young people aware of the dangers of driving with a driver while intoxicated. The Province of Antwerp has a special interest in the alcohol problem, which is made clear, among other things, by their so-called "WODCA actions" (Tackling Weekend Accidents Through Controls). • On behalf of the Flemish government, a study was conducted into "screening and brief intervention" for alcohol problems in students. A website was also set up for this purpose. This research was published in the Journal of Medical Internet Research.

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  • Research Project

The COVID-19 International Student Well-Being Study. 01/12/2020 - 30/11/2021

Abstract

This project aims to investigate the impact of the COVID-19 pandemic on well-being in higher-education students. Our research consists of three parts. In a first part we use the C19 ISWS dataset, which collected information on student well-being during the first wave of the COVID-19 pandemic, and this in more than 100 educational institutions from 26 countries. With this data we want to investigate (1) to what extent differences exist between the different countries and educational institutions, (2) how these differences can be related to the protective measures implemented by the governments, and (3) by the educational institutions. In a second part, we zoom in on the Belgian context, combining the Belgian sample of the C19 ISWS with information collected through focus groups with student representatives and members of the cells for innovation and quality of education. Not only do we want to identify at-risk groups, we also want to explain how the implemented measures had an impact on the student population and on these atrisk groups, as well as which coping mechanisms students used during the pandemic. The information from these two strands will be brought together to identify best practices that promote the well-being of the student population during future outbreaks.

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  • Research Project

The Prevalence of Interpersonal Violence against Children in Sport in Wallonia and Brussels 18/09/2020 - 01/05/2021

Abstract

In this study we investigate the prevalence of interpersonal violence against children in sport, using a self-report retrospective web-survey in a population of French speaking Belgians in Brussels and Wallonia between 18 and 30 years old.

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  • Research Project

Colorectal cancer screening in Flanders 01/12/2019 - 30/11/2022

Abstract

In a previous doctoral project on colorectal cancer (CRC) screening (Wessel van de Veerdonk, 'Colorectal cancer screening in Flanders: Towards an optimal performance'), a number of bottlenecks of the current Colorectal Cancer Screening were investigated, including (the lack of) personalized screening, interval cancers and inaccessibility for certain subgroups. The present doctorate will continue to work on mapping out the inaccessibility, using new available data. Recently, an exchange of data was realized between https:// Bevolkingsonderzoek.incijfers.be/jive and https://provincies.incijfers.be so that the Center for Cancer Detection (CCD) now has new data for a number of important parameters that provide a detailed insight into a number of determinants of participation in both the organized screening program and the so-called 'opportunistic screening'. It then concerns e.g. following determinants: population and household, prosperity and poverty, labor market position, level of education, income, participation in preventive health care, visiting a doctor, ... This data from the province is available at the level of the statistical sectors, the smallest administrative units for which data is available. Because this data can be linked to the data from the Colon Cancer screening program, it is possible to examine the relationship between these determinants and participation in preventive colon cancer screening. The major advantage of these linked data is that they are immediately available to the researcher and that they are "complete" (as opposed to data obtained through surveys). The candidate is very involved in statistical analyzes, so that the maximum can be achieved from the data. Ultimately, the intention is to be able to develop targeted interventions for those neighborhoods where participation within the organized program is lower and that can be focused on the determinants that prove to be the most important for those specific neighborhoods. This can be done much more focused than with the available analyses to date. In this way, the ultimate goal is to reduce social inequality for participation in preventive colon cancer research. There will also be collaboration with two other doctoral students who perform the same exercise for breast cancer screening and cervical cancer screening, respectively, so that it can be checked whether there are differences between the determinants of these three Flemish cancer screening programs. For example, it can also be explored which group of women with which profile participates in all three current population surveys, which group in none of the three and which group only in one or two of the three.

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  • Research Project

Multimorbidity and its cost in the Belgium health system. 01/10/2019 - 31/12/2023

Abstract

MultiMorbidity (MM), the concurrence of two or more chronic conditions, is a growing phenomenon in all countries, and more prevalent among vulnerable groups in society. Yet, research to understand and address the phenomenon has only recently taken off. In the Belgium context, the burden of multimorbidity, measured by disability, is highest for cardiovascular diseases with or without diabetes; chronic respiratory diseases and depression; neurological diseases and cancers. The prevalence of MM has risen from 8,9% in 1997 to 15,2% in 2018. How patients use health care for their different conditions is not well known, while this has implications for quality of care and cost. Best practices in health care organizations to manage multimorbidity are being documented, but implementation research on feasibility, cost and effectiveness is still patchy. The PhD aims to improve understanding the burden, management and cost of multimorbidity in the Belgium health system, from the patient and health system perspective. Two Research Questions will be examined: 1) What are patterns of health care utilisation and health care cost for people with multiple chronic conditions? 2) Which innovations to manage multimorbidity are implemented, and what is the feasibility acceptability and effectiveness and cost of implementation? Year 1 and 2 will be used to develop the research protocol, explore existing data and to do the analysis of RQ1. Year 2 and 3 will be used for RQ. At least drie peer reviewed articles will be written with the following topics: 1) health care utilization and cost for Belgium patients with multiple chronic conditions; 2) implementation analysis of pilots for integrated care for multimorbidity; and 3) cost-effectiveness of multimorbidity pilots in the Belgium health system.

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  • Research Project

Child Abuse in Sport: European Statistics. 01/01/2019 - 31/12/2021

Abstract

CASES is a collaborative partnership between 7 universities, 2 national sport agencies and 1 international sport federation. All partners have a demonstrable commitment to enhancing the safety of children in sport and protecting them from abuse. CASES will deliver a scientific study into the prevalence of child exploitation and abuse in sport in 6 EU countries. The team will also collaborate with individuals who have firsthand experience of abuse in sport at all stages of the project. The study will survey a representative sample of (approximately) 2000 individuals aged 18+ years in each partner country. The survey will focus particularly on the sport context in relation to experiences of sexual exploitation and abuse, but other forms of child maltreatment and abuse will be included. Participants are requested to report their experiences in retrospective, thus, comparisons of experiences during childhood and adulthood are possible. Following robust analysis of the data generated, the scientific team will write up the findings in a series of national reports, culminating in a Project Report that will provide comparative analysis across countries. The project will then develop educational resources with and for the sport sector aimed at enhancing understanding of this issue within its grassroots partners and affiliated bodies. Ultimately, the study aims to collect scientifically robust evidence that will provide insights pertinent to strategic efforts to prevent abuse in sport and to develop resources for the sport sector that will support their efforts to safeguard children's welfare.

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  • Research Project
  • Education Project

The misuse of prescription stimulants as cognitive enhancers among Flemish university and college students: the process of prescribing, supplying and acquiring. 01/10/2018 - 30/09/2021

Abstract

The university or college experience is often viewed as a time of transition, experimentation and risk-taking, especially with regard to substance misuse. While there has been an abundance of research on alcohol and marijuana misuse, other areas of this research field remain relatively unexplored, in particular the scientific knowledge on the misuse of prescription stimulants – generally prescribed to treat Attention Deficit (Hyperactivity) Disorders (AD(H)D) – by students as a means for performance enhancement. Exploratory research in Flanders reported a prevalence of up to 10% of Flemish students using prescription stimulants during the exams, resulting in considerable attention in the news media. However, there is a clear dearth in scientific knowledge on (1) which student groups are vulnerable to such drug misuse and why they misuse these stimulants (demand side) and (2) how these students access the prescription drugs (supply side). The proposed study aims to fill these research gaps and generate scientific knowledge on stimulant misuse in Flanders. From a theoretical point of view, a comprehensive theoretical model, the theory of triadic influence, will be used to disentangle the complex mechanisms through which the decision to misuse ADHD drugs can be explained. From a methodological point of view a comprehensive mixed-methods research design will be used focusing on three vital stakeholders: students, general practitioners and pharmacists.

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  • Research Project

Evaluation of the implementation of the local medical-pharmaceutisch consult in Belgium. 01/04/2018 - 31/12/2018

Abstract

Approach In order to evaluate the process of implementation and dissemination of MFO in Belgium, we work in three phases. In the first phase, we explore the views of policy makers and stakeholders regarding the current and future MFO. In a second phase we explore the experiences and opinions of pharmacists and GP's at the local level. And in the third phase, we undertake an action research to enhance the implementation of MFO in Belgium. Research questions  Fase 1: What are the views of policy makers and stakeholders on the current MFO policy and procedures?  Fase 2: What are the experiences of physicians and pharmacists in the local MFO?  Fase 3: How can the process of MFO be further enhanced?

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    • Research Project

    Colorectal cancer screening in Flanders. 01/12/2017 - 30/11/2019

    Abstract

    The Flemish colorectal cancer screening programme was implemented at the end of 2013. This screening programme is performing well with a high participation rate of more than 50%. Nevertheless, there is still room for improvement regarding several aspects. In the mean time, however, a lot of data are available which permit to perform analyses to find out in what area the screening programme can still be improved. With this doctoral thesis it is the intention to use the extensive data base of the Flemish colorectal cancer screening programme to find indicators that can lead to recommendations which, when implemented, will at the end result in an even better functioning cancer screeningn programme.

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    • Research Project

    For better health in university and college students: pin-pointing the interplay between social support, study stress, substance use and mental health across different study programs. 01/10/2017 - 30/09/2021

    Abstract

    Background: In contemporary Belgium, the university or college experience has become an important transitional period in the life course. Culturally, these years are viewed as a time of transition, experimentation and risk-taking. This transitional period in life is not without risk: increasing attention – especially in the United States – is given to the elevated stress levels that university and college students experience, which can be linked to increased substance use and mental health problems. However, little is known about the interrelationships between study stress, substance use and mental health among the Flemish student population – stressing the need for research on this relevant student health problem. In addition, students do not live and study in a social vacuum: they are surrounded by peers and embedded in study programs. This context can potentially alter the interrelationships between study stress, substance use and mental health problems: (1) social support as a potential buffer and (2) the characteristics of the study program as a driver for inter-study-program variance. Little is however known on the impact of these social and organizational factors on the described interrelationships. Objectives: The present BOF DOCPRO Bonus-project aims to address these shortcomings by examining the impact of student stress on both mental health problems and substance misuse, mediated by the on- and off-line social support available to the student and across different study programs. Methods: More specifically, we will (1) study the interrelationships between study stress, the use of three substances (stimulants, prescription sleeping pills and cannabis) and mental health problems using the 2017 Head in the Clouds dataset (expected n = approx. 20.000). (2) We will use Structural Equation Modelling to test which theoretical model best mimics the role of on- and off-line support in these interrelationships: a direct effect, an indirect effect (via study stress) or a buffer effect (impacting on the path between stress and substance use/mental health). (3) We will employ multiple group SEM to assess how these relationships differ across the different study programs: do differing levels of knowledge and competition impact on these interrelationships? The two latter research questions will be addressed using a newly gathered dataset among the students of the Association University and Colleges of Antwerp. Expected outcomes: The proposed study can have both theoretical and practical implications. Theoretically, it is the first study to explore the complex mechanisms underlying substance use and mental health problems among a large student population – with special attention for the role of social and organizational determinants. Practically, the resulting scientific knowledge potentially enables according effective preventative interventions to help students channel study stress and avoid detrimental health choices and mental health problems.

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    • Research Project

    Informed choice regarding systematic screening on cystic fibrosis in newborns: a qualitative research 01/09/2017 - 15/05/2018

    Abstract

    Het Vlaams bevolkingsonderzoek naar aangeboren aandoeningen (zie ook www.bevolkingsonderzoek.be), ook bekend als neonatale screening of 'de hielprik', wordt in Vlaanderen al meerdere decennia georganiseerd. Tot 2010 omvatte dit screeningsprogramma niet veel meer dan afnemen en analyseren van een bloedstaal bij baby's. Sinds 2012 is een beheersovereenkomst afgesloten met twee organisaties met terreinwerking (PCMA vzw en VCBMA) die instaan voor de uitvoering van het bevolkingsonderzoek met meer nadruk op fasen voorafgaand en volgend op de analyse van de stalen (communicatie, resultaatsmededeling, deskundigheidsbevordering van de verschillende betrokken zorgaanbieders) en op kwaliteitsbewaking. Op het gedroogd bloedstaal (de zogenaamde 'Guthrie-kaartjes') worden 11 aangeboren aandoeningen opgespoord, waaronder een aantal zeldzame ziekten. Momenteel wordt de implementatie van opsporen van mucoviscidose (Cystische Fibrose of CF) voorbereid. Mogelijk wordt deze lijst in de toekomst uitgebreid met nog meer ziekten. Het voorgestelde screeningsalgoritme bij neonataal opsporen van CF is getrapt, en omvat in de tweede trap DNA-analyse. Het zou de eerste aandoening zijn in het bevolkingsonderzoek waarbij DNA-analyse tot het screeningsalgoritme behoort. Door DNA-analyse en opsporen van een beperkt aantal mutaties en eventueel een aantal dragers, verandert de ethische dimensie van het bestaande bevolkingsonderzoek helemaal. Bovendien maakt het feit dat ouders een beslissing moeten nemen voor hun baby, de discussie nog delicater. De informatie die voorafgaand aan ouders wordt gegeven met het oog op het maken van een geïnformeerde keuze, blijft tot op heden beperkt tot een folder die in de materniteit aan de ouders wordt gegeven, vlak voordat het staal wordt afgenomen. Geen ideaal moment, want dan worden ouders doorgaans volledig in beslag genomen door de geboorte en de baby. Omdat informeren over dit bevolkingsonderzoek met 11 ziekten - die zowel bij burger als veel van de betrokken zorgverleners onbekend zijn - complex is, en screenen met een genetische test die complexiteit veel groter maakt, is het relevant te weten hoe (toekomstige) ouders hier tegenover staan. Ook het standpunt kennen van ouders over informed consent/dissent/opting in/opting out is noodzakelijk om een goede beleidsbeslissing te nemen. Welke informatie ouders willen krijgen, op welk moment, en op welke wijze, zijn belangrijke vragen waarop het antwoord mee richting kan geven aan een succesvolle communicatiestrategie bij implementatie van een bevolkingsonderzoek naar mucoviscidose. De resultaten van het onderzoek naar de informatienood zullen worden vertaald naar een werkwijze om over CF-screening te communiceren ten aanzien van toekomstige ouders en om een informed consent te verkrijgen.

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      Project type(s)

      • Research Project

      Evaluation of the implementation of the local medical-pharmaceutisch consult in Belgium 01/03/2017 - 31/05/2017

      Abstract

      Background In April 2015, a Royal Decree was published to set the rules for Medical-Pharmaceutical Consultation (Medisch-Farmaceutisch Overleg-MFO; Concertation Médico-Pharmaceutique-CMP) in Belgium. Although the idea of such a consultation has been on the agenda for some years, this was the first official attempt in Belgium to manage and financially support the concertation between general practitioners (GP) and pharmacists to improve pharmacotherapy. Approach In order to evaluate the process of implementation and dissemination of MFO in Belgium, we work in three phases. In the first phase, we explore the views of policy makers and stakeholders regarding the current and future MFO. In a second phase we explore the experiences and opinions of pharmacists and GP's at the local level. And in the third phase, we undertake an action research to enhance the implementation of MFO in Belgium. Research questions  Fase 1: What are the views of policy makers and stakeholders on the current MFO policy and procedures?  Fase 2: What are the experiences of physicians and pharmacists in the local MFO?  Fase 3: How can the process of MFO be further enhanced?

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        • Research Project

        The misuse of prescription stimulants as cognitive enhancers among Flemish university and college students: the process of prescribing, supplying and acquiring. 01/10/2016 - 01/12/2018

        Abstract

        The university or college experience is often viewed as a time of transition, experimentation and risk-taking, especially with regard to substance misuse. While there has been an abundance of research on alcohol and marijuana misuse, other areas of this research field remain relatively unexplored, in particular the scientific knowledge on the misuse of prescription stimulants – generally prescribed to treat Attention Deficit (Hyperactivity) Disorders (AD(H)D) – by students as a means for performance enhancement. Exploratory research in Flanders reported a prevalence of up to 10% of Flemish students using prescription stimulants during the exams, resulting in considerable attention in the news media. However, there is a clear dearth in scientific knowledge on (1) which student groups are vulnerable to such drug misuse and why they misuse these stimulants (demand side) and (2) how these students access the prescription drugs (supply side). The proposed study aims to fill these research gaps and generate scientific knowledge on stimulant misuse in Flanders. From a theoretical point of view, a comprehensive theoretical model, the theory of triadic influence, will be used to disentangle the complex mechanisms through which the decision to misuse ADHD drugs can be explained. From a methodological point of view a comprehensive mixed-methods research design will be used focusing on three vital stakeholders: students, general practitioners and pharmacists.

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        • Research Project

        Popping smart pills: prescription stimulant misuse by university and college students in Flanders. 01/01/2015 - 30/09/2016

        Abstract

        Background: From a large-scale survey among Flemish university and college students, it is known that a substantial part of these students (almost 7%) use stimulant drugs – mainly methylphenidates, such as Ritalin®, prescribed to treat ADHD – as a means for performance enhancement. Apart from the question of unfair competition during the exams, the misuse of prescription stimulants can also have detrimental psychological and physical health effects, rendering it a research priority. Although we have a view on the prevalence of the prescription stimulant misuse by students, almost nothing is known about the characteristics of these users, its impact on students' physical and mental well-being, and the sociological and psycho-social motives to misuse stimulants. In addition, there is a dearth of knowledge on the supply side of this public health problem. Research Objectives: The proposed study aims to fill the above-cited research gaps and generate scientific knowledge on the misuse of methylphenidates in Flanders using an innovative, comprehensive research design. In particular, the proposed research program aims to study (1) which students groups misuse these stimulants as well as the subsequent impact of this use on their well-being, (2) why these students perform this behavior and (3) how these students access the prescription drugs. Methods: The study uses an exploratory mixed methods research design comprising three phases, each addressing an above-cited research objective. Firstly, the available dataset from the quantitative survey among Flemish university and college students (n = 18,000) will be employed to identify the user population and measure their well-being (1). Secondly, a more focused quantitative and qualitative data gathering will be executed to identify the mechanisms underlying the misuse by testing two alternative conceptual models described in the literature (2). Finally, a web-survey among medical doctors and pharmacists will be employed to create scientific knowledge on the supply system of the research issue (3). Expected outcomes: The proposed study can have both theoretical and practical implications. Theoretically, it is the first study to explore the complex mechanisms underlying stimulant drug use among a large student population. Practically, the resulting scientific knowledge potentially enables according effective preventative interventions to steer students away from these detrimental health choices.

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        The development of a quality control instrument for the evaluation of New Medicines Counselling (NMC). 15/05/2014 - 15/01/2015

        Abstract

        This project represents a formal research agreement between UA and on the other hand IFEB. UA provides IFEB research results mentioned in the title of the project under the conditions as stipulated in this contract.

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          A new paradigm in drug use and human health risk assessment: sewage profiling at the community level (SEWPROF). 01/10/2012 - 30/09/2016

          Abstract

          SEWPROF aims to develop interdisciplinary and cross-sectoral research capability for the next generation of scientists working in the newly-emerging fileld of sewage epidemiology. It will provide an integrated approach towards public health monitoring at a community level based on innovative sewage epidemiology techniques.

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          Research on effects of prevention among sex workers. 01/10/2012 - 31/12/2012

          Abstract

          This project represents a formal research agreement between UA and on the other hand the Flemish Public Service. UA provides the Flemish Public Service research results mentioned in the title of the project under the conditions as stipulated in this contract.

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            WODCA - An exploratory study of the relationship between drivers/passengers who pass through the emergency service for care and their incidental intoxication by alcohol and drugs. 01/07/2012 - 30/09/2013

            Abstract

            This project represents a formal research agreement between UA and on the other hand the Province of Antwerp. UA provides the Province of Antwerp research results mentioned in the title of the project under the conditions as stipulated in this contract.

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              Breast cancer screening. 01/06/2012 - 31/08/2014

              Abstract

              This project represents a formal research agreement between UA and on the other hand Province of Antwerp. UA provides Province of Antwerp research results mentioned in the title of the project under the conditions as stipulated in this contract.

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                Evaluation of the Flemish 24 uur not smoking campaign (2012). 01/03/2012 - 31/12/2012

                Abstract

                This project represents a formal research agreement between UA and on the other hand VIGeZ. UA provides VIGeZ research results mentioned in the title of the project under the conditions as stipulated in this contract.

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                  Cancer and proactive medicine. 22/11/2011 - 31/12/2012

                  Abstract

                  This project represents a formal research agreement between UA and on the other hand the Flemish Public Service. UA provides the Flemish Public Service research results mentioned in the title of the project under the conditions as stipulated in this contract.

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                    SNIPE - Social norms intervention for the prevention of polydrug use. 01/03/2011 - 28/02/2013

                    Abstract

                    The overall goal of the project is to develop, implement and evaluate an E-health intervention based on social norms approach to reduce the use of licit (alcohol, especially binge drinking and smoking) drugs and to prevent the use of illicit (canabis, cocaine and synthetic drugs) drugs as well as poly-drug consumption in university and college student in six European countries.

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                      Evaluation of the Flemish 24 uur not smoking campaign (2011). 15/02/2011 - 31/12/2011

                      Abstract

                      This project represents a formal research agreement between UA and on the other hand VIGeZ. UA provides VIGeZ research results mentioned in the title of the project under the conditions as stipulated in this contract.

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                        • Research Project

                        Effects of prevention among sex workers. 01/02/2011 - 31/01/2012

                        Abstract

                        This project represents a formal research agreement between UA and on the other hand the Flemish Public Service. UA provides the Flemish Public Service research results mentioned in the title of the project under the conditions as stipulated in this contract.

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                          Preconditions and good practice for (re-) organize and implement screening for breast, cervical and colon cancer. 01/12/2010 - 30/11/2013

                          Abstract

                          This project represents a formal research agreement between UA and on the other hand the Flemish Public Service. UA provides the Flemish Public Service research results mentioned in the title of the project under the conditions as stipulated in this contract.

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                            The role of the different actors in controlling the costs of the medicine use in Belgium. 01/07/2010 - 30/06/2014

                            Abstract

                            In the area of production, distribution, payment, prescription and the use of medicines, several protagonists can be identified. Insight into the importance of and in the underlying relationships between these actors, and of the relative impact of these actors on the system as a whole, is necessary. In the European context, little research has been done on this subject. Knowledge on this subject is necessary for the survival of the health care system in Belgium.

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                              Evaluation of the participation of general practitioners at the interdisciplinary oncology institute (MOC) using a web-based application. 01/01/2010 - 31/12/2010

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                                Sensitization project WODCA for college and university students. 22/12/2009 - 30/04/2010

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                                  Development of the Alcohol recommendation. 01/07/2009 - 31/12/2010

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                                    Evaluation "Smokers deserve a reward ... if they do not smoke 24 hours". 01/06/2009 - 28/02/2010

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                                      Attractiveness generic packaging through Focus Group Discussions (FGD). 01/04/2009 - 31/12/2009

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                                        Bonus Breast Cancer Prevention in Region Zuiderkempen. 01/12/2008 - 30/06/2011

                                        Abstract

                                        This project represents a formal research agreement between UA and on the other hand the Flemish Public Service. UA provides the Flemish Public Service research results mentioned in the title of the project under the conditions as stipulated in this contract.

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                                          Drug use among female sex workers in Belgium (DRUSEB). 01/10/2008 - 31/12/2011

                                          Abstract

                                          This project represents a formal research agreement between UA and on the other hand the Federal Public Service. UA provides the Federal Public Service research results mentioned in the title of the project under the conditions as stipulated in this contract.

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                                            Evaluation of Crisis and Case Management. (ECCAM). 01/10/2008 - 31/07/2010

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                                              Research on the substitution distribution to drug users by general practicers in the city of Antwerp. 01/10/2008 - 31/12/2008

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                                                Pre- testing of a campaign in favour of the Flemish Tobacco Quit Line by means of Focus Group Discussions. 15/06/2008 - 31/08/2008

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                                                  E-interventions for students with hazardous or problematic alcohol use: A pilot study in Antwerp, Belgium. 01/04/2008 - 30/04/2009

                                                  Abstract

                                                  Title E-interventions for students with hazardous or problematic alcohol use: A pilot study in Antwerp, Belgium. Background In 2005, the University of Antwerp (UA) did an electronic survey on substance use among the student population of Antwerp. Results showed that 10% of the male student population has an indication of problematic alcohol use. Literature research shows that brief electronic interventions have a positive effect in reducing alcohol use of students and that students prefer electronic above face-to-face interventions. Methods A website was developed to motivate students with hazardous or problematic alcohol use to reduce their alcohol consumption and to stimulate their willingness to search for help. The website contains a questionnaire where students can test their alcohol use. The AUDIT (Alcohol Use Disorders Identification Test) was developed by the World Health Organization ¿WHO. AUDIT is a validated test with 10 questions assessing hazardous and harmful patterns of alcohol consumption. According to their answers, the students receive immediately a personal feedback. After the test, they get the possibility to send a mail to a student counsellor for questions, guidance or advice. The website is promoted by the student counsellors per campus by means of flyers, posters, an e-mail to all students, in student magazines and so on. Begin April 2008 the website www.eentjeteveel.be was launched in the UA and all Schools for Higher Education in Antwerp. Results After three weeks the site counted 2,000 visits. 41.9% show no risk of problematic alcohol use (AUDIT score of 0-7), 40.5% show a moderate risk (8-15), 9.7% a high risk (16-20) and 7.9% a very high risk (21-40). Of the people who scored more than 15, 46.0% stopped the test after receiving the feedback, 13.5% searched for information and 3.7% asked for guidance, an appointment or asked for advice. Conclusions The effect of the e-intervention on the problematic alcohol use of the Antwerp students will be evaluated in a survey.

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                                                    Evaluation of the federal information campaign drugs and alcohol. 05/03/2008 - 16/06/2008

                                                    Abstract

                                                    Background Between the 29th of January and the 25th of February 2008, a national information and prevention campaign was launched on television, big commercial pallets in the streets, newspapers and postal cards. By means of a True-False concept the campaign tried to make the theme "drug and alcohol" more discussible in the general Belgian public. Furthermore, it tried to make people think about it and prompt the public to inform themselves by exploring the suggested sources of information: a dedicated telephone line and a website. The campaign was evaluated to assess its effectiveness. Methods The first phase is the evaluation of the campaign in the general public. Following a detailed scenario, a telephonic questionnaire was held, proportionally spread over the different regions in Belgium. A cd-rom with 4,500,000 fixed phone number subscribers in Belgium was used to obtain a sample of 1,000 Belgians. To obtain a more representative group spread over all age groups, extra mobile phone numbers were added and 50 young people were interviewed on the street in Brussels and Antwerp. In the second phase we performed in-depth interviews to evaluate the promotion material of the campaign in people from health or youth sectors who used the material. Results The response on the telephonic questionnaires was: Of the 2687 called numbers 864 (32.2%) people responded, 1295 (48.4%) couldn't be reached and 446 (16.5%) people refused to participate. Of the 1,000 successful conversations, 188 (18.8%) saw the campaign. For 37% of them, the campaign incited them to think about their drug and alcohol use and that of their environment. 24.1% of the people who saw the campaign were incited to talk about their alcohol and drug use and that of their environment. First results from the in-depth interviews: campaign can use more humour or graphics and would be better if it lasted longer in time.

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                                                      Pilot project "population-based study into colorectal cancer". 01/03/2008 - 31/12/2010

                                                      Abstract

                                                      The European code for Cancer Control recommands a population-based approach for colorectal cancer screening. In February 2009 a pilot study for colorectal cancer screening will start in Flanders. The pilot study can be split up into two parts. The first part of the pilot study focusses on people with an average risk for colorectal cancer. All inhabitants from Schilde, Vosselaar and Borgerhout aged 50 to 74 will receive an invitation to participate in the screening study. For the second part of the study, persons from 40 to 74 years old that are close relatives (biological parents, children, brothers and sisters) to people with colorectal cancer will be involved. This part of the study will be organised from seven selected hospitals in the area. The aim of the study is to obtain information about potential participation rates for a screening programme in Flanders. We will gather information on the differences between two invitation strategies, on the (non)participants (e.g. geographic, age, etnicity and social-economic characteristics). Next, the performance of the test (percentage testpositives, positive predictive value, detection rate for polyps and invasive colorectal cancer) can be evaluated. In addition, the project will review the screening programme's feasibility (required colonoscopy capacity, compliance, processing the test and follow-up results) and provide data for health-economic simulation modelling purpose.

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                                                        Evaluation and satisfaction study vzw Katarsis. 01/03/2007 - 01/03/2008

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                                                          Determinants for the non-participation of women from the target group to the Flemish population study concerning breast cancer and the ways to influence the participation favorably. 01/12/2006 - 31/05/2008

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                                                            Use of drugs by the student population of Antwerp. 01/10/2006 - 31/12/2006

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                                                              Health inquiry 65+. 01/09/2006 - 31/08/2008

                                                              Abstract

                                                              This research project on the health of elderly people in Belgium will explore the potential of the data from the National Health Interview Survey 2004 (HIS) as a source of information on the health of persons aged 65 years and over. Moreover, proposals will be formulated for further research concerning this age group based on the available data of the HIS 2004.

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                                                                Controlling pharmaceutical costs in Belgium: which health care policies work and why (not)? 01/03/2006 - 31/12/2007

                                                                Abstract

                                                                The financial balance of the social security system in Belgium is threatened by the increasing costs of pharmaceuticals. By means of qualitative and quantitative research methods it will be explored which health care policies are effective in controlling these drug costs.

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                                                                  Evidence based drug prevention strategies in Flanders. 01/12/2004 - 30/09/2005

                                                                  Abstract

                                                                  The aim of the research is twofold. On the one hand, a literature study will reveal the existing drug prevention strategies. Special attention is given to their development, implementation, evaluation and evidence base. Also the current Flemish drug prevention situation will be described. On the other hand, a method will be developed that makes it possible to calculate the effects concerning health benefits (on population level) that can be expected when these strategies would be implemented in Flanders.

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                                                                    University Scientific Institute for Drug Problems: exploration and development of the academic network. 01/07/2004 - 31/12/2008

                                                                    Abstract

                                                                    The University Scientific Institute for Drug problems is an inter-university institute which aims at bringing together all efforts concerning prevention, drug assistance, research and acts of service having to do with the drugs theme in Flanders. Existing initiatives are supported and knowledge about the drugs theme is brought together to avoid shattered research funds and to achieve more valuable research results.

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                                                                      Alcohol and drug abuse treatment in the province of Antwerp: treatment entry and end of treatment. 01/01/2004 - 31/12/2005

                                                                      Abstract

                                                                      The drug policy of the federal government emphasizes the importance of collaboration and consultation between services for alcohol and drug abuse treatment and stimulates the development of functional collaboration networks. To support this process of change, it is important to have objective and comparable data in order to map the extent and nature of drug problems. On the initiative of the collaboration platforms 'Stedelijk Overleg Drugs Antwerpen (SODA)' in the city of Antwerp and the 'Overlegplatform Geestelijke Gezondheidszorg Provincie Antwerpen (OGGPA)' in the province of Antwerp, a registration research was set up within services for alcohol and drug abuse treatment in the province of Antwerp. This research is financed by the Province of Antwerp and is carried out by Ghent University (Department of Orthopedagogics) in collaboration with the University of Antwerp (University Institute for Drug Problems). The objective of this research is to gain insight into the number of clients in alcohol and drug abuse treatment, their characteristics and the way they make use of treatment services. The research consists of three phases. During one week all clients which are treated in one of the participating treatment services (day centres, centres for mental health care, psychiatric hospitals, psychiatric wards in general hospitals, medical-social reception centre, crisisintervention centre, centres for general welfare) will be registered. Secondly, during six months all clients asking for treatment (intakes) will be registered. During those first two phases, data will be collected within the following areas: socio-demographic and substance-related data, information regarding treatment history and finally also a number of data concerning the current treatment (first phase) or the decision taken after the intake conversation (second phase). Finally, during a period of twelve months registration forms will be filled out regarding the end of treatment for those clients that were registered during the first or the second phase of the research.

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                                                                        Flemish breast cancer screening programme. 01/01/2003 - 31/12/2016

                                                                        Abstract

                                                                        Breast cancer is one of the most important causes of potential years of life lost in women in Flanders. Several international studies show a substantial decrease in cause-specific mortality when women between 50 and 69 years of age undergo a two-yearly mammographic examination. Only a minority of the target group of Flemish women, has a preventive mammography performed. On the other hand, a lot of preventive mammographies is performed in women outside the target group. It is not surprising though, that breast cancer screening is one out of the five health targets of the Flemish Community. On the 15th of June, 2001, a Flemish breast cancer screening programme has started. By 2006, three out of four women from 50 to 69 years should have performed a preventive mammography and 80% of all preventive mammographies has to be performed within the target group. Besides the desired shift from preventive mammographies outside the target group to preventive mammographies within the target group, a lot of attention is given to the quality of the screening programme. Women who participate in the screening programme, are guaranteed that the co-operating radiologists comply with the severe European quality criteria: physical-technical (the apparatus) as well as where positioning (the radiologist) is concerned. Women belonging to the target group can have their preventive mammography performed for free. For the organisation of the Flemish screening programme, five Regional Screening Centres (RSC) are put into action. The RSC of Antwerp, belonging to the Centre for Cancer Prevention of the Research Group Epidemiology and Community Medicine (University of Antwerp), is one of them. A RSC is a reference centre taking care of the invitations and the information for women, information for physicians concerning the results of the preventive mammography, the double reading of the mammographies, the administrative follow-up of the medical path of screening positives and the scientific evaluation of the screening programme (according to an epidemiological protocol based on European guidelines). The tasks of the RSC are formalised in an agreement with the Flemish government. A few years ago, the so-called Logo's (Local health consultation) were established. Logo's are geographical entities between province and community level which have to promote the preventive health care in their region. In Flanders, 26 Logo's operate. Each Logo has to work together with a RSC to organise breast cancer screening. The Flemish community has chosen to organise breast cancer screenig by means of two `tracks'. Women are referred by their GP or gynaecologist in the first track or directly invited to a certified radiologist by het RSC (2nd track). The certified radiologists (private, hospital or mobile unit) perform the screening mammographies. The double reading, an essential part where quality assurance is concerned, is done by the RSC. In the case of abnormal results, the diagnostics is finalised and women are treated when necessary. In the latter case, gynaecologists, radiologists, oncologists, surgeons and pathologists are involved.

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                                                                          Illicit drug use in Antwerp (Belgium): A study in the Antwerp District Court, 1997. 01/12/1997 - 31/03/1998

                                                                          Abstract

                                                                          Of all illicit drug users who came into contact with the police between September 10 and December 10, 1997 and who were hooked within the legal district of Antwerp, a number of data were collected (age, sex, nationality, residence, previous drug-related contact with the law, substances used). These data were analysed and compared to those of other legal districts in Flanders and to earlier Antwerp data. Since this registration study started in 1990, a comparison over several years is possible.

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                                                                            Illicit drug use in Flanders (Belgium) : a study in Flemish district courts. 01/01/1997 - 31/12/1997

                                                                            Abstract

                                                                            Yearly registration of booked drug users shows that there is a yearly change in used products. Cannabis remains the most important illicit drug and the popularity of heroin and cocaine decreases. XTC and amphetamines become more and more important. The major part of the population is formed by men, but at the lowest age categories females contribute relatively more to the booked drug users. The mean age of the group of veralized drug users is 23 years. The proportion younger than 16 years is augmenting.

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                                                                              Health behaviour of primary school children in Aartselaar (Belgium). 01/07/1992 - 31/05/1993

                                                                              Abstract

                                                                              458 primary school children and 452 of their parents filled in a questionnaire concerning the health behaviour of the children (between 8 and 11 years of age). As well the hygiene, as the eating habits and physical practice were asked for.

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