Project Details

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.

Researcher(s)

• Promoter: Van Hal Guido

Research team(s)

• Social Epidemiology & Health Policy (SEHPO)

Project type(s)

• Research Project

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.

Researcher(s)

• Promoter: Van Hal Guido

Research team(s)

• Social Epidemiology & Health Policy (SEHPO)

Project website

Project type(s)

• Research Project

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.

Researcher(s)

• Promoter: Van Hal Guido
• Co-promoter: Peeters Marc

Research team(s)

• Social Epidemiology & Health Policy (SEHPO)

Project type(s)

• Research Project

Abstract

COOLSCHOOLS is a transdisciplinary applied urban research project that examines the transformative potential of nature-based solutions (NBS) to support the creation of climate shelters in European school environments. We assess how nature-based climate shelters can drive social-ecological transformations towards urban sustainability, climate resilience, social justice, and quality education at multiple urban scales (from schools to metropolitan region) and translate them into practical building capacity for school communities and beyond. Building on pioneering pilot NBS projects of school transformation in Barcelona, Brussels, Paris, and Rotterdam, COOLSCHOOLS unravels the specificities of each context and finds common patterns related to climate shelters transformation capacities, focusing on marginalized groups. Through participatory and co-creation methodologies, we propose an interdisciplinary approach that combines natural, bio-medical, social, and education sciences. To further promote a holistic approach to school climate shelters transformation capacities, we will actively disseminate the pilots' best practice and key learnings among city governments, urban planners, companies, school communities and other relevant stakeholders. The consortium's cross-sectoral composition ensures active multi-stakeholder involvement through an urban living lab and other co-engagement actions, that are planned to boost reflection and learning, and the wider use of COOLSCHOOLS outputs.

Researcher(s)

• Promoter: Casas Ruiz Lidia

Research team(s)

• Social Epidemiology & Health Policy (SEHPO)
• Laboratory of Applied Microbiology and Biotechnology (LAMB)

Project type(s)

• Research Project

Abstract

The effects of green spaces on respiratory health are unclear. Potential reasons for inconsistencies across studies are the study design (cross-sectional or short follow-ups), exposure measurement being limited to the residence, and limited consideration of potential mediators and modifiers (e.g. oxidative stress, maternal stress during pregnancy). Therefore, we propose a longitudinal study investigating the association of early life exposure to green spaces with respiratory outcomes up to adulthood. This project is based on a recently granted FWO project (see application). The project will use the PIPO birth cohort, containing information from birth to adolescence on the development of allergies, respiratory symptoms, lung function, anthropometrics, and allergic sensitization. This project will add an early adulthood (20-24y) follow-up to the PIPO-data. Addresses (residences, day care/school/work) will be linked to measures of land use and greenness (Corine Land Cover, NDVI, etc.), and air pollutants. Further, measures of oxidative stress (9y) will be done using existing samples. Using that data, we will consider mediation effects of air pollution, body mass index, and oxidative stress during childhood. Direct and indirect effects of early life exposure to green spaces will be assessed through mediation analyses.

Researcher(s)

• Promoter: Casas Ruiz Lidia

Research team(s)

• Social Epidemiology & Health Policy (SEHPO)
• Laboratory of Applied Microbiology and Biotechnology (LAMB)

Project type(s)

• Research Project

Abstract

The effects of green spaces on allergy and respiratory health are unclear. Potential reasons for inconsistencies across studies are the study design (cross-sectional or short follow-ups), exposure measurement being limited to the residence, and limited consideration of potential mediators and modifiers (e.g. oxidative stress, maternal stress during pregnancy). Therefore, we propose a longitudinal study investigating the association of early life exposure to green spaces with respiratory and allergic outcomes up to adulthood. The project will use the PIPO birth cohort, containing information on early life exposure to residential green spaces, and the development of allergies, respiratory symptoms, lung function anthropometrics, and allergic sensitization from birth to adulthood. This project will add an early adulthood (20-24y) follow-up to the PIPO-data. Addresses (residences, day care/school/work) will be linked to measures of land use and greenness (Corine Land Cover, NDVI, etc.), and air pollutants. Further, measures of oxidative stress (9y) and cortisol in newborn hair (maternal stress) will be done using existing samples. Using that data, we will consider mediation effects of air pollution, body mass index, maternal stress during pregnancy, and oxidative stress during childhood. Direct and indirect effects of early life exposure to green spaces will be assessed through mediation analyses, and effect modification by maternal stress during pregnancy will be tested.

Researcher(s)

• Promoter: Casas Ruiz Lidia

Research team(s)

• Social Epidemiology & Health Policy (SEHPO)
• Laboratory of Applied Microbiology and Biotechnology (LAMB)

Project type(s)

• Research Project

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.

Researcher(s)

• Promoter: Van Hal Guido

Research team(s)

• Social Epidemiology & Health Policy (SEHPO)

Project type(s)

• Research Project

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.

Researcher(s)

• Promoter: Van Hal Guido

Research team(s)

• Social Epidemiology & Health Policy (SEHPO)

Project type(s)

• Research Project

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.

Researcher(s)

• Promoter: Van Hal Guido
• Co-promoter: Vertommen Tine

Research team(s)

• Social Epidemiology & Health Policy (SEHPO)

Project type(s)

• Research Project

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.

Researcher(s)

• Promoter: Van Hal Guido

Research team(s)

• Social Epidemiology & Health Policy (SEHPO)

Project type(s)

• Research Project

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.

Researcher(s)

• Promoter: Van Hal Guido

Research team(s)

• Social Epidemiology & Health Policy (SEHPO)

Project website

Project type(s)

• Research Project
• Education Project

Abstract

Tuberculosis (TB) continues to be an important public health problem with more than 10 million new cases and over 1 million deaths annually. In low burden regions such as Flanders, immigration and drug resistance pose important hurdles to TB control efforts. Due to the challenges in the current diagnostic pathway, patients suffering from drug resistant TB often receive suboptimal treatment in the first months following their diagnosis, which can amplify drug resistance and lead to transmission of drug resistant strains in the community. Whole genome sequencing (WGS) of Mycobacterium tuberculosis as part of routine TB diagnosis is an attractive prospect as WGS rapidly interrogates the entire 4.4 Mbp M. tuberculosis genome. This information would generate the most comprehensive resistance profile for each patient and allow rapid initiation of the most effective and patient-friendly individualized treatment for each person diagnosed with active TB. Furthermore, WGS would not only contribute to diagnostics but also to public health surveillance, as the results of the WGS assay performed for diagnostic purposes will generate phylogenetic data for routine surveillance of transmission events and outbreak detection. Coupling genomic diagnostics and epidemiology would transform the approach to TB control in Flanders towards a 21st century innovative digital disease detection platform and surveillance system. WGS thus has great potential to become the future cornerstone of routine TB diagnosis, care and surveillance in Flanders. We propose to perform a pragmatic multicenter theragnostic trial of WGS of M. tuberculosis to streamline TB diagnosis, improve TB surveillance and optimize individualized treatment of drug resistant TB to improve treatment outcomes. A pragmatic trial undertaken in real-life conditions will generate the data required for policy development, facilitate the translation of results into routine practice and thus contribute to TB control in Flanders.

Researcher(s)

• Promoter: Van Rie Annelies
• Co-promoter: Beutels Philippe

Research team(s)

• Social Epidemiology & Health Policy (SEHPO)

Project type(s)

• Research Project

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.

Researcher(s)

• Promoter: Van Hal Guido
• Fellow: van de Veerdonk Wessel

Research team(s)

• Social Epidemiology & Health Policy (SEHPO)

Project type(s)

• Research Project

Abstract

Due to their biological, social and economic vulnerabilities, adolescent girls and young women (AGYW) continue to be at increased risk for HIV acquisition. We propose an implementation research study to optimize woman-empowered HIV prevention strategies for AGYW. Key to optimizing HIV prevention strategies is an improved understanding of the multilevel determinants (individual, familial, relationship and community-level) of uptake and adherence to HIV prevention strategies targeting AGYW. Funded through a DREAMS Innovation grant, Witkoppen Health and Welfare Centre, a primary health clinic in Johannesburg, South Africa, will enroll HIV-negative AGYW unaware of the HIV status of their sexual partner(s) in an implementation research study. AGYW will be offered free home-based HIV self-testing for their male partners. Interested AGYW will be given HIV test kits and AGYW whose partners test HIV-positive or AGYW who remain unaware of their partner(s) HIV status will be offered pre-exposure prophylaxis (PrEP). The proposed work will build upon the DREAMS Innovation study described above. Using mixed methods, we will evaluate multilevel determinants of uptake and adherence to the novel AGYW-empowered HIV prevention strategy. Quantitative secondary data collected by the DREAMS Innovation study will be complemented with qualitative interviews with AGYW and their male partners at each of the steps of the proposed HIV prevention cascade: AGYW acceptance of self-testing kits for partners; AGYW delivery of self-testing kits to their male partner(s); male partner acceptance of HIV self-testing; disclosure of HIV test results to AGYW; linkage to care of HIV positive male partners; PrEP uptake among eligible AGYW; and PrEP adherence. Our specific aims are as follows: Aim 1: Perform a mixed methods study of multi-level (individual, relationship and community) determinants of uptake of and adherence to each of the steps of the novel AGYW-empowered HIV prevention strategy. Analyses of the DREAMS Innovation cohort data will quantify uptake and adherence to each step, and multi-level modeling will allow for assessment of key determinants of engagement at each step of the prevention cascade. At each step, we will identify 6-8 AGYW and male partners who failed to complete the cascade step and perform in-depth interviews to explore reasons for not completing engagement in HIV prevention activities as well as facilitators of successful engagement in previous steps. Aim 2: Evaluate the impact of engagement in the HIV care cascade on changes in risk profiles among AGYW. Longitudinal changes in AGYW risk profiles will be described and the impact of engagement across the HIV prevention cascade on changes in AGYW risk profiles before and at the end of program participation evaluated.

Researcher(s)

• Promoter: Van Rie Annelies

Research team(s)

• Social Epidemiology & Health Policy (SEHPO)

Project type(s)

• Research Project

Abstract

This project represents a research contract awarded by the University of Antwerp. The supervisor provides the Antwerp University research mentioned in the title of the project under the conditions stipulated by the university.

Researcher(s)

• Promoter: Abrams Steven
• Promoter: Weyler Joost

Research team(s)

• Social Epidemiology & Health Policy (SEHPO)

Project type(s)

• Research Project