This study was designed to validate the Dutch Physical Activity Questionnaires for Children (PAQ-C) and Adolescents (PAQ-A).

Background: To date, there is no screening programme for colorectal cancer (CRC) in Flanders, Belgium. However, The European Code Against Cancer (2003) recommends a population-based approach for CRC screening. This study aimed to obtain information about potential participation rates for a population-based screening programme for CRC in Flanders, and to compare two invitation strategies. Methods: In 2009, a trial programme for CRC screening was set up in three Flemish areas for all average-risk people aged 50–74 years, using an immunochemical faecal occult blood test (iFOBT) with a cut-off value set at 75 ng/ml of haemoglobin. The faecal sampling set was sent at random by post (mail group) or provided by the general practitioner (GP group). Results: In total, 19,542 people were invited to participate. Of these, 8229 provided a faecal sample, resulting in an overall participation rate of 42.1%. Participation by mail and through the GP was 52.3% (95% CI, 51.3–53.2) and 27.7% (95% CI, 26.7–28.6), respectively. The difference of 24.6% was statistically significant (95% CI, 23.3–25.9, p < 0.001). Before the reminder letter was sent and the other invitation strategy was offered, the overall participation rate was 26.5% (n = 5176); 36.4% (95% CI, 35.5–37.4) for the mail group and 16.6% (95% CI, 15.8–17.3) for the GP group. The odds of participating in CRC screening was almost three times higher for people invited by mail as opposed to people invited through a GP (OR = 2.96, 95% CI, 2.78–3.14, p < 0.001). Women were more likely to participate in CRC screening than men (OR = 1.22, 95% CI, 1.15–1.30, p < 0.001). In addition, we found that inhabitants from residential (OR = 1.98, 95% CI, 1.85–2.11) and rural (OR = 2.90, 95% CI, 2.66–3.16) areas were more likely to participate than those in urban areas. Of the 8229 people who submitted a faecal sample, 435 (5.3%) had a positive iFOBT, and of those, CRC was diagnosed in 18 (5.7%) individuals. Compliance for follow-up colonoscopy was 72.9%, and did not differ between the mail (72.4%, 95% CI, 67.5–77.3) and GP groups (74.3, 95% CI, 66.2–82.5). Conclusion: Inviting people for CRC screening by means of a direct-mail invitation, and including a faecal sampling set (iFOBT), results in much higher participation rates than inviting people through the GP.

Background Short-term changes in air pollution exposure in children may be associated with transient increases in exhaled nitric oxide (NO), a marker of airway inflammation. Also, children living in areas with high air pollution levels and/or high traffic densities appear to have chronically increased levels of exhaled NO. No studies have simultaneously addressed the long-term and short-term associations between traffic-related air pollution and exhaled NO. Objectives To investigate associations between exhaled NO in school children and both short-term changes in outdoor PM 10 and long-term traffic exposures. Methods Offline exhaled NO measurements were conducted in 812 children from nine Dutch schools within 400 m of motorways. Daily levels of particulate matter with a 50% cut-off aerodynamic diameter of 10 μm (PM 10 ) were obtained from background monitoring stations. Long-term exposure to traffic-related air pollution was assessed using specific traffic-related characteristics such as total, car and truck motorway traffic and the distances of the children's homes and schools from the motorway. Results A positive association was found between ambient PM 10 concentrations on the day of exhaled NO measurement and exhaled NO (adjusted geometric means ratio (95% CI) 2.24 (1.37 to 3.65)) over the range of daily PM 10 concentrations of 44 μg/m 3 ), which was largely attributable to a pollution peak associated with high particulate matter emissions from traditional Easter fires. There were suggestive associations between exhaled NO and traffic counts only in children with asthma, which were not statistically significance. Conclusions Short-term changes in ambient PM 10 largely attributable to biomass burning are associated with increased levels of exhaled NO.

PURPOSE:In this paper we investigate the reasons for non-participation in a trial programme for colorectal cancer (CRC) screening in Flanders. Besides, the feasibility and possibilities of a full-blown screening programme in Flanders are examined, given the context of a low participation rate in breast cancer screening. METHODS:A trial programme for CRC screening was set up for all average-risk persons aged 50 to 74 years in three Flemish regions to obtain information about potential participation rates, and to compare two invitation strategies. Faecal samples were analysed for precursors of CRC using an immunochemical faecal occult blood test (iFOBT). A questionnaire was administered to participants and non-participants of the trial programme to find out whether and to what extent the taking of a sample of one's own stool is a taboo. This could be of great importance concerning the participation rate. RESULTS:In total, 19,542 persons were invited to participate in the trial programme for CRC screening, of whom 18,541 were found to be eligible. The overall participation rate was 44.3%. The three regions varied in participation rates: with 60.9% in the most rural region to 34.3% in the most urban region. Of 2,000 questionnaires sent to participants, 1,385 were returned (69.3%). The response in the non-participants was 43.2%i (691 questionnaires of 1,600 returned). CONCLUSIONS:A population-based screening programme for colorectal cancer by means of an iFOBT proves to be feasible, since adequate participation rates were obtained and because of the absence of a 'stool taboo' in Flanders.

Objective: Literature indicates a decline in patient-centredness in medical students, especially during clinical clerkships. We examined the impact of preclinical communication skills training (CST) on students' development of patient-centred attitudes and attitudes toward CST during clerkships.Methods: We prospectively compared two cohorts before and after clerkships: one cohort (n = 48) had not received CST, whereas the other (n = 37) had received a five-year CST. We assessed the impact using five validated questionnaires.Results: Communication trained students slightly but significantly declined in patient-centred attitudes (3/4 scales) and attitudes toward CST during clerkships, whereas the scores of the untrained students remained stable (5/5 scales). Both cohorts did not differ in attitudes before clerkships. In the trained cohort, males mostly showed a sharper decline than females. In the total group (n = 85), females demonstrated higher attitude scores toward CST, and in 1/4 scales measuring patient-centred attitudes.Conclusion: This cohort study suggests that CST might make students more vulnerable to decline in attitude scores during clerkships.Practice implications: These remarkable findings, contrary to what educators would expect to result from their efforts, challenge medical education to address the new questions that are raised about the validity of the questionnaires, the impact of CST and the learning processes involved in the development of patient-centredness. (C) 2011 Elsevier Ireland Ltd. All rights reserved.

In this article, we explore the relationship between participating at the breast cancer screening programme in the city of Antwerp and the socio-economic status of the neighbourhood the women reside in. To this end, social and demographic characteristics that might explain the variance in the participation rate were listed. A logistic multilevel analysis was performed. In general, 13,415 women (37.8%) took part in the screening programme in Antwerp. The difference in participation rate of women living in privileged and underprivileged areas is 9.3%. The neighbourhoods are defined as statistical sectors. Statistical sectors with a high percentage people above 65 years and couples with children tend to have a higher attendance, whereas the percentage of foreigners has a negative influence. There is a need to discover the specific causes of the lower participation rate in the underprivileged areas and how one can cope with this problem. Further research is also needed where the assessment of the socio-economic status is concerned.

The validity of traffic intensity near the home as an estimate for the personal long-term exposure to traffic-related air pollution in an adult population was tested. Personal and near-home outdoor exposure to PM2.5, soot, NO, NO2, and NOx was monitored four to five times during 48 h periods in older adults. A group of 23 participants lived in high traffic intensity streets (>10000 vehicles/(24 h)), and 22 lived in low traffic intensity streets. The relation between average personal exposure and traffic intensity at the residential address was explored by taking indoor sources into account. Large differences in the measured outdoor concentrations between locations in high traffic and low traffic intensity streets were found for soot (68%), NO (127%), and NOx (35%). Differences were smaller for PM2.5 (14%) and NO2 (22%). Slightly elevated ratios were found for personal exposure to soot (1.15; 95% confidence interval (CI), 1.01-1.30)when comparing adults living in high traffic intensity streets with adults living in low traffic intensity streets. For NO, increased personal exposure (1.16) was seen for the same comparison, but this difference failed to reach statistical significance (CI, 0.80-1.66). Traffic intensity on the street of residence predicted personal exposure to soot but not to PM2.5 or nitrogen oxides. Traffic intensity may not correlate well to personal exposure and accordingly substantial misclassification of exposure may occur when traffic intensity is used as an exposure indicator in epidemiological studies. Time spent in traffic and spending time outdoors were associated with increased personal exposure of soot and PM2.5, but not NOx.

Background: Outdoor concentrations of soot and nitrogen dioxide (NO,) outside of schools have been associated with children's respiratory and eye symptoms. We assessed how adjustments for measurement error affect these associations.Methods: Concentrations of air pollutants outside children's schools were validated by personal measurements of exposure to traffic-related air pollution. We estimated prevalence ratios of 4 health outcomes (current wheeze, conjunctivitis, phlegm, and elevated total serum immunoglobulin E) using school outdoor measurements, and then adjusted for measurement error using the personal exposure data and applying a regression calibration method. The analysis adjusting for measurement error was carried out using a main study/external validation design.Results: Adjusting for measurement error produced effect estimates related to soot and NO, that were 2 to 3 times higher than in the original study. The adjusted prevalence ratio for current phlegm was 5.3 (95% confidence interval = 1.2-23) for a 9.3 mu g/m(3) increase in soot, and 3.8 (1.0-14), for a 17.6 mu g/m(3) increase in NO2, compared with the original results of 2.2 (1.3-3.9) and 1.8 (1.1-2.8), respectively. Corrections were of similar magnitude for the prevalence of current wheeze, current conjunctivitis, and total elevated total immunoglobulin E.Conclusions: The estimated effects of outdoor air pollution on respiratory and other health effects in children may be substantially attenuated when based on exposure measurements outside schools instead of personal exposure.

Several studies have investigated the health of children attending schools located near busy roads. In this study, we have measured personal exposure to traffic-related pollutants in children to validate exposure classification based on school location. Personal exposure to PM2.5, soot, NOx and NO2 was measured during four 48-h periods. The study involved 54 children attending four different schools, two of which were located within 100m of a major road (one ring road and one freeway) and the other two were located at a background location in the city of Utrecht, The Netherlands. Outdoor monitoring was conducted at all school sites, during the personal measurements. A questionnaire was administered on time activity patterns and indoor sources at home. The outdoor concentration of soot was 74% higher at the freeway school compared to its matched background school. Personal exposure to soot was 30% higher. For NOx the outdoor concentration was 52% higher at the freeway school compared to its background school. The personal concentration of NOx was 37% higher for children attending the freeway school. Differences were smaller and insignificant for PM2.5 and NO2. No elevated personal exposure to air pollutants was found for the children attending the school near the ring road. We conclude that the school's proximity to a freeway can be used as a valid estimate of exposure in epidemiological studies on the effects of the traffic-related air pollutants soot and NOx in children.

Several recent studies suggest an association between long-term exposure to traffic-related air pollution and health. Most studies use indicators of exposure such as outdoor air pollution or traffic density on the street of residence. Little information is available about the validity of these measurements as an estimate of long-term personal exposure to traffic-related air pollution. In this pilot study, we assessed outdoor and personal exposure to traffic-related air pollution in children living in homes on streets with different degree of traffic intensity. The personal exposure of 14 children aged 9-12 years to 'soot', NO(x) (NO and NO(2)) was assessed in Amsterdam between March and June 2003. Each child's personal exposure was monitored during four repeated 48-h periods. Concurrently, in- and outdoor NO(x) measurements were carried out at the school and at the home of each participating child. Measurements were supplemented by a questionnaire on time activity patterns and possible indoor sources. Flow-controlled battery operated pumps in a made-to-fit backpack were used to sample personal exposure to 'soot', determined from the reflectance of PM(2.5) filters. Exposure to NO(x) was assessed using Ogawa passive samplers. Children living near busy roads were found to have a 35% higher personal exposure to 'soot' than children living at an urban background location, despite that all children attended the same school that was located away from busy roads. Smaller contrasts in personal exposure were found for NO (14%), NO(2) (15%) and NO(x) (14%). This finding supports the use of 'living near a busy road' as a measure of exposure in epidemiological studies on the effects of traffic-related air pollution in children.