Christophe de Brouwer

Water-related diseases are among the infectious diseases that represent a major public health challenge in developing countries. This study aimed to assess the prevalence of waterborne diseases and the factors associated with their occurrence in the commune of Aplahoué, located in southwestern Benin. A cross-sectional analytical study was conducted among 125 households selected through simple random sampling in the commune. Data analysis was performed using regression models and Chi-square tests with SPSS version 27.0, considering a p-value below 5% as statistically significant. This study revealed an overall prevalence of waterborne diseases of 45.6% at the household level and 16.6% at the individual level. Malaria was the most prevalent waterborne disease (8.4%), followed by diarrhea (6.3%). Multivariate analysis identified a history of waterborne diseases and hospitalization due to waterborne diseases as significant independent risk factors for the occurrence of new waterborne diseases. It is, therefore, critical to improve access to safe drinking water, promote better hygiene and sanitation practices, and strengthen health education through effective communication to foster behavioral change within the community.

The improvements in cancer control led to an increase in the number of cancer survivors, notably, in the working age population (16–64 years). There is a strong need to assess and understand their reintegration on the labour market, which underlines and ensures their social integration and quality of life. The objectives of the EMPCAN study is therefore to measure the scale of return-to-work after cancer and to identify the determining factors, allowing for the implementation of an adequate socio-professional support. We requested data from the Belgian Cancer Registry and the Crossroad Bank for Social Security. We included all socially insured Belgian workers diagnosed between 2004 and 2011 with colorectal, breast, head & neck, prostate, testis, lung and corpus uteri cancer. The end of (administrative) follow-up was 31st December 2012. We include demographic, health-related and work-related factors in the analysis and observed how these factors interplay to determine the working status. After having solved legal, ethical and technical issues for the coupling, we will perform survival analysis with competing risks using the Fine and Gray model; we will also perform a multistate model using transitions probabilities; and finally, a group-based modeling for longitudinal data using the ‘proc traj’ package in SAS. The results of the EMPCAN study will allow the provision of an evidence-based support to professional reintegration policies. It will also bring some key features for the prediction of the cancer-related social security needs. Besides the raise of awareness among health professionals and policy makers, this study could lead to a better planning and organization of vocational rehabilitation programs.

The spread of early detection and the improvement of cancer treatment have led to an increased prevalence of cancer survivors, including in the working age population. Return-to-work (RTW) of cancer survivors has become a key issue for national cancer control plans. This study aims (1) to identify the factors that have an impact on RTW of cancer survivors and to draw a risk profile supporting health professionals in the screening of those at risk for barriers of RTW and (2) to sharpen these results with input from health, social security and academic Belgian experts and to provide evidence-based recommendations that facilitate RTW of cancer survivors. A rapid review was conducted, based on the methodology elaborated by The Knowledge to Action Research Programme and researchers from the University of York, including a quality assessment of retained studies. Next, the Delphi method was used to organize a consultation with experts in order to discuss, validate and complement the results. Forty-three out of 1860 studies were included. We identified nine risk factors grouped into four categories: socio-demographic, disease and treatment-related, work-related, and personal and subjective factors. Experts suggested dividing them into two even groups: factors which are modifiable and those which are not. The awareness of health professionals regarding the identified factors, a better assessment of work capacities, clarity on the rights and obligations of employers and workers alike, and the setup of a positive discrimination employment policy for cancer survivors were acknowledged as factors facilitating RTW of cancer survivors. The awareness of health professionals regarding barriers of RTW may improve the early identification of cancer survivors at risk for prolonged time to RTW and may allow early supportive intervention. Social and employment policies should be better tailored to support both employers and cancer survivors in the RTW process, providing incentives to positively discriminate cancer survivors on prolonged sick leave.

The purpose of this study was to evaluate the health impact of working conditions at the Ruashi mine in the Katanga Province in the Democratic Republic of Congo. A cross-sectional etiological study was conducted in two cohorts including 100 miners and 109 students. Data necessary to allow comparison disease symptoms in the two cohorts were collected using a questionnaire. Odds ratios (OR) and 95% confidence intervals (95% CI) were estimated. A secondary analysis was performed to compare different mine workstations, i.e., diggers (n=61) versus non-diggers (n=39). Two logistical regression models were used to estimate adjusted OR and 95% CI for the association between occupation/workstation and disease symptoms. In comparison with students, miners exhibited higher frequencies for all symptoms even after adjustment. The highest ORs were observed for musculoskeletal disorders, i.e., low back pain (OR=36.5) and upper (OR = 20.7) or lower (OR = 18.3)] extremity pain. They were followed by respiratory disorders (OR = 5.91) and headache (OR = 5.34). The high exposure frequencies and OR's observed in this study underline the negative health impact of mine working conditions. Further occupational study will be needed to obtain and compare more data.

Occupational medicine is an important medical discipline in Belgium, with about one thousand of experts. Roles of the occupational physicians must be analyzed on the basis both of legal prescriptions and real practice. The examination of the roles of the occupational physician in various countries shows that regulation are an important legal framework from which he can deploy his practice. A contrario it is also the means which makes it possible to the unions and the management to force him. However the real roles are definitely broader than the regulations let understand, concerning very diverse fields which make this medical discipline a real preventive general medicine. It is less and less a public health discipline and approaches gradually in practice the clinical disciplines, in the sense that the singular colloquium, the knowledge of the particular work places and risks of every worker and the individualization of the action are its bases. On the other hand, fitness for work assessments and its procession of authoritarian medical and administrative acts, heritages of the public health, hardly efficient, should largely disappear from the prescriptions. It will allow for a wider deployment of the activity of the occupational physician towards the industrial organisations, by proposing the necessary adaptations of the work places, the limitations of exposure to harmful effects, the remediation of the psychosocial load, etc, through "preventive prescriptions". Complementarily, the population ageing imposes new solutions to rehabilitate the old workers, and this will be likely to modify, not only the medical approach in work environment, but also already imposes a closer cooperation with the general practitioner, which is likely to improve the action abilities of both medical disciplines.

The occupational physician (OP) and the general practitioner (GP) both aim at maintaining and promoting public health. The attending physician is the physician who has been freely chosen by the patient whilst the occupational physician is assigned by the company. Although synergy between both professions might seem obvious, in reality it is not always so. The focus of the occupational physician's work is on the worker in his work place. Through health monitoring action and knowledge of jobs and positions, the occupational physician aims to contribute to the improvement of well-being at work. Medical examinations result in drafting a form stating the person's ability or inability to occupy his/her assigned job. In line with the required respect for the patient's rights and, hence, with his/her authorization, the GP may transmit the medical information the said GP deems useful to the OP, e.g. back-to-work medical examinations and pre-back-to-work medical consultations are opportunities to establish a contact between both practitioners in view of considering the possibilities of adapting the workplace situation at the time of resumption of work. The GP should know that there exists an appeal opportunity with the Office in charge of Monitoring Well-being at Work (Employment Federal Public Service) against a decision that by which the worker is not allowed to stay in his assigned work task. During the medical examinations the OP may endorse the action of the GP by strengthening the worker/patient's awareness of the fact that his/her health problems must be adequately taken into account and by organizing information sessions about general interest campaigns about, for instance, cardiovascular risk prevention or a campaign about quitting smoking or reducing alcohol consumption to a more sensible and reasonable level. Knowledge of delayed effects of professional exposure should be consolidated in GPs; the possibility of drawing attention to one's suspicions about occupational illnesses to the Fund for Occupational Illnesses must also again brought to mind. In order to establish a follow-up program on the health of patients beyond their professional activity, it is necessary to draft a "liaison document", between the OP and the GP, which identifies the professional risks workers/patients have been exposed to. In sum, it is important to provide GPs with means to identify the patient's OP and consolidate their knowledge of occupational medicine by organizing on-going training modules.

The missions of the Occupational Diseases Fund are defined in application of the law regarding the insurance against occupational diseases. The workers covered by this law are granted several rights, such as a financial compensation in case of temporary or permanent disability, a further compensation if they have to be taken away from the risk in the workplace, the reimbursement of health care costs related to the occupational disease, or the payment of an annuity to the widow(er) if death is its ultimate consequence. Among the compensable diseases, we shall focus on lung cancer, and especially the one related to asbestos exposure. This type of cancer is clearly under-registrated in Belgium as in most countries of the European Union, leading to an insufficient number of cases entitled to compensation by our institution. In this instance, the insurance against occupational diseases and all related social advantages are hugely under-exploited in our country. It is our duty to increase doctors' awareness of the problem and spread accurate information to reverse this trend and provide occupational cancer cases with a legitimate compensation, in particular those related to asbestos. A wider knowledge of the occupational history of cancer patients, thanks to occupational physicians, and a better use of mineralogical analyses on lung samples, would improve this situation inacceptable on any level : medical, social or even human.

Residential radon seems to represent a major health hazard. The studies, which investigate the pulmonary risk of cancer caused by radon, are of different nature and their results are divergent. Thus, there persist scientific uncertainties concerning the real size of this risk. The application of the precautionary principle is based on an analysis of these uncertainties. Studies on miners, studies concerning residential radon (at individual and ecological level), as well as experimental data allow for the organisation of the uncertainty of each one of these specific approaches taking into account their proper limitations. The first risk that is linked to radon is the risk of pulmonary cancer. Miner occupational exposure studies appear compatible with the results of case-control studies concerning residential radon. However, the case-control studies, where the risk appears more present, are contradicted by ecological studies, often not very convincing about the existence of a risk. The case-control studies have an intrinsic advantage over the ecological studies because they limit the classification errors by the individualization of the relation-exposure effect. In addition, the experimental data are not in contradiction with the existence of effects for very small exposures. Consequently, the inherent scientific uncertainties of the totality of these data, can be classified and permit the application of the precautionary principle in a better proportioned way. The utilisation of the precautionary principle implies the necessity to limit, as far as possible, the exposure to residential radon. Precautionary principle is based on the debated hypothesis of no threshold linear relation between radon exposition and health consequences. This relation has been established on professional and residential exposures. The implementation of this epidemiological model shows the "residential radon" risk as the second cause of pulmonary cancer and responsible of about 10% of these specific cancers.

The new european directive concerning the radiation protection 96/29/Euratom is currently being transposed in national regulations. This directive is registered in a historical context. This context allows us to understand how it is realised and what philosophy underlies the actual structure and its possible shortcomings. Current developments of the radiobiology and the radio-epidemiology, notably important modifications of our knowledge about natural irradiation, the attention for genetic fragile populations and relationships between irradiation and cancer are likely to modify our perception of the radiation protection.