Christophe De Brouwer

Barriers and opportunities for return-to-work of cancer survivors: time for action—rapid review and expert consultation

BackgroundThe 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.MethodsA 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.ResultsForty-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.ConclusionsThe 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.

Health effects of extremely low-frequency magnetic fields: reconsidering the melatonin hypothesis in the light of current data on magnetoreception

The so‐called ‘Melatonin Hypothesis’ proposed that decreased nocturnal production of melatonin (MLT) might explain the increased risk of breast cancer that has been formerly attributed to extremely low‐frequency (ELF) magnetic fields (MF) of weak intensity. Although the risk of ELF MF upon breast cancer was later dismissed, repeated reports were published of partial inhibition of MLT secretion in rats under long‐term (≥ 4 weeks) exposure to weak ELF MF. Since 2004, however, this topic has not been experimentally studied any more. In the present study, we propose to go back to the MLT hypothesis and apply it to childhood leukemia, for which an increased risk has been robustly associated with residential exposure to ELF MF. Contrary to the original hypothesis, however, we do not consider decreased MLT levels, but disruption of circadian rhythmicity per se as the effector mechanism. Indeed, the role of the circadian timing system in the development of childhood leukemia has been well established. Motivation for going back to the MLT hypothesis comes from recent data that suggest magnetosensory disruption by ELF MF in mammals, and magnetosensitivity in humans, together with current evidence for an influence on circadian rhythmicity from disruption of non‐photic sensory stimuli of various natures. We thus suggest further study on circadian rhythmicity in humans (children if possible) under long‐term exposure to weak ELF MF. Copyright

Identification of hazards in the workplaces of Artisanal mining in Katanga.

ObjectiveWhile artisanal mining takes place in casual framework and with total ignorance of good practices, few studies have focused on the origin of hazards specific to each workplace constitutive of this exploitation facility. Nevertheless, this study is a condition of an efficient occupational health and safety control in this sector.Materials and MethodWe took the effort to identify different workplaces, as well as hazards specific to each of them, through the observation and analysis of the tasks, tools and the processes related to their use applied in the Ruashi artisanal mine.ResultsThe investigated exploitation facility consists of five workplaces: diggers (60% — in charge of mineralized gangue recovery); crushers; washers; hand-made furnace workers (in charge of various treatment processes); and loaders (in charge of packing the obtained material). Beside the risks common to these various workplaces and ensuing notably from the lack of hygiene and working in bad positions, operating in underground galleries, in particular, exposes diggers to the risks connected with collapsing parts of the mine, suffocation, dehydration or fine particles in the breathed air. Crushers are especially exposed to traumatism risks, notably ocular, and loaders are exposed to risks related to handling heavy loads. These risks are connected with the mining processes because, in spite of the similarity of tools, they appear less often in other forms of artisanal exploitation described in literature. It is notable in the case of crushing in sawed gas bottles where ocular trauma risk is decreased. It was also shown that humidification of work surface reduces dust particles emission into the air.ConclusionsHazards identification, through a tools and processes description, has the advantage of providing information on reducing the occurrence of these risks. It shows that this reduction is not necessarily a consequence of the activity mechanization degree.

Occupational accidents in artisanal mining in Katanga, D.R.C.

IntroductionThis study focuses on accidents in artisanal mining, to support policies improving miners’ employability.Materials and MethodsBased on a questionnaire administered in November 2009 to a sample of 180 miners from the artisanal mining of LUPOTO, in the Province of Katanga, we explored significant trends between the accidents and their consequences and behavioral or sociological variables.ResultsDuring the 12 months preceding the study, 392 accidents occurred, affecting 72.2% of miners. Tools handling represents 51.5%, of the accidents’ causes, followed by handling heavy loads (32.9%). Factors such as age, seniority or apprenticeship did not generate significant differences. Contusions were the most common injuries (50.2%), followed by wounds (44.4%). These injuries were located in upper limbs (50.5%) and in lower limbs (29.3%). 80.5% of miners were cared for by their colleagues and 50% of them could not work for more than 3 days. Physical sequelae were reported by 19% of the injured miners.DiscussionMany surveys related to accidents in the area of artisanal mining report such high frequency. The unsuitability of tools to jobs to be done is usually raised as one of the major causes of accidents. The lack of differentiation of the tasks carried out in relation to age is another factor explaining the lack of protective effect of seniority as it minimizes the contribution of experience in the worker’s safety. The apprenticeship reported is inadequate; it is rather a learning by doing than anything else. That is why it lacks protective effect. Low income combined with precariousness of artisanal mining are likely to explain the low level of work stoppages.ConclusionTools improvement associated with adequate training seem to be the basis of accident prevention. Availability of suitable medical care should improve artisanal miners’ recovery after accidents.

Could magnetic fields affect the circadian clock function of cryptochromes? Testing the basic premise of the cryptochrome hypothesis (ELF magnetic fields)

AbstractIt has been suggested that weak 50/60 Hz [extremely low frequency (ELF)] magnetic fields (MF) could affect circadian biorhythms by disrupting the clock function of cryptochromes (the “cryptochrome hypothesis,” currently under study). That hypothesis is based on the premise that weak (Earth strength) static magnetic fields affect the redox balance of cryptochromes, thus possibly their signaling state as well. An appropriate method for testing this postulate could be real time or short-term study of the circadian clock function of retinal cryptochromes under exposure to the static field intensities that elicit the largest redox changes (maximal “low field” and “high field” effects, respectively) compared to zero field. Positive results might encourage further study of the cryptochrome hypothesis itself. However, they would indicate the need for performing a similar study, this time comparing the effects of only slight intensity changes (low field range) in order to explore the possible role of the proximity of metal structures and furniture as a confounder under the cryptochrome hypothesis.

Quantification of Metal in the Hair of Copper Miners in Katanga Province, Democratic Republic of Congo

This study aims to demonstrate the exposure of artisanal miners to the contents of mineralised gangue and to assess whether the different workstations and their related operating processes potentiate such exposure. The population sampled (n=100) consisted of artisanal miners operating in the mine of Ruashi, in the south of the Katanga copper belt. We made use of hair as a biomarker and performed our analyses using ICP-MS. According to recommendations from the Agency for Toxic Substances and Disease Registry, we have compared our results to those of an unexposed population living in the same area in order to point out the occupational origins of such exposure. In our hair analysis, we identified and quantified 22 elements. For almost all of these elements, the artisanal miners had much higher values as compared to the control population. In addition, non-diggers had higher levels than diggers for almost all of the elements that could be directly linked to those present in the mineralised gangue. Median values obtained for the artisanal miners were systematically higher than those of the control population, reflecting a higher than normal exposure. Such differences between the two sample populations can only be explained by the occupational (mining) origin of exposure, since the living environment, hair nature, sampling method, and analysis techniques were the same for both populations. Medians within the miner samples showed different exposure profiles for non-diggers versus diggers, resulting from the fact that non-diggers were more exposed to the mineralised gangue. The results attest to the reality and the large extent to which artisanal miners in Katanga Province are exposed to chemical components of mineralised gangue. This exposure is more significant within the workstations related to the raw mineral processing phase as opposed to the extraction phase.

Education in environmental health of health care professionals: what needs to be done?

BACKGROUND Health professionals are key actors in environmental health. Taking on this role requires a certain degree of competence. That is the reason why education in environmental health of health care professionals became a major concern at international level, notably at WHO level. However, in the European Union only the individual Member States are responsible for organizing education and no official body seems to have started outlining recommendations on how to set up this kind of training. OBJECTIVES We set out to draw up some propositions for training in environmental health on the basis of the practice of educational institutions involved in training health care professionals. METHODS A survey was conducted in 934 educational institutions involved in training health care professionals in 11 European countries and in Canada. RESULTS Our data reveal that, whereas there are many establishments - nearly half of those that replied - engaged in educating health care professionals in environmental health, they do so in a great variety of ways, whether in terms of objectives, content, the number of teaching hours, or their target groups. Moreover, there is only limited evaluation of this training, which makes the question of recognition a very difficult one. CONCLUSIONS Numerous difficulties have been raised in relation to education in environmental health, both by trainers and trainees. Some solutions to these difficulties are suggested but the need of official guidelines keeps going.

How do social security schemes and labor market policies support the return-to-work of cancer survivors? A review article

Abstract Objective About 40% of new cancer diagnoses are detected among working age individuals. Cancer diagnosis and treatment have high impact on the work ability of workers and represent a real challenge for the healthcare and social security systems but also for employers and the labour market. This review aims at investigating the legal frameworks set up in EU Member States that support the retention and integration of workers with disability. Furthermore, we look at these initiatives or measures to see whether they fit the specific needs of workers with cancer. Methods We searched the PubMed database combining 4 key words: cancer, labour market, labour law and disability insurance or disability benefits. A total of 1.185 articles were found of which 10 were used for this review. In addition, grey literature, reports from the European Commission, the OECD and the WHO were searched and included in the material used for this review. Results Few peer reviewed articles discuss the impact of labor market law on the (re)integration of cancer survivors. Most measures and initiatives support workers with chronic diseases but present important limits when considering workers with cancer. Collaboration and coordination among health providers, social workers and employment decision makers is the mostly required and effective. Conclusion More research efforts should be made to systematically assess the impact of labor market and employment measures and initiatives on the (re)integration of workers with chronic diseases, with specific attention for workers with cancer. Legal frameworks need to be rethought for a better balance between productivity and equity, inclusion and social justice.

[Occupational accidents in urban public transit of the city province of Kinshasa, Democratic Republic of Congo: a descriptive cross-sectional study].

INTRODUCTION: le transport en commun urbain constitue un secteur ou les travailleurs sont tres exposes aux accidents du travail. Cette etude visait une description epidemiologique des accidents du travail dans le secteur informel du transport en commun a Kinshasa en vue d’apporter les pistes d’amelioration de la securite des travailleurs dans cette activite. METHODE: un questionnaire sur les accidents du travail, administre en Decembre 2012 a permis d’explorer les tendances significatives entre les accidents et leurs circonstances, leurs facteurs associes, leurs consequences au sein d’une population des travailleurs (n=472) du transport en commun a Kinshasa. RESULTAT: durant les 12 derniers mois precedant l’etude 76.5% des travailleurs ont connu au moins un accident du travail, 54,8% ont connu un arret d’au moins 1 jour. Les accidents lies a la circulation routiere etaient plus important suivis des chutes. Les facteurs ayant montre des differences significatives etaient le travail sous l’influence de l’alcool et le port des equipements de protection individuelle. Les plaies (46,3%) et les contusions (39,4%) etaient les lesions les plus courantes. Les membres superieurs (51,3%) et inferieurs (30,7%) etaient les plus atteints. 76,6% des travailleurs ont assume seuls leur prise en charge medicale. CONCLUSION: l’incidence des accidents du travail dans ce secteur est tres elevee. La mise en place d’une politique de prevention et gestion de differents facteurs associes ainsi qu’un systeme de declaration d’accidents est necessaire dans ce secteur. Les patrons ainsi que les politiques devraient veiller a une prise en charge medicale correcte pour des travailleurs accidentes.

Assessing factors associated with long-term work disability after cancer in Belgium: a population-based cohort study using competing risks analysis with a 7-year follow-up

Objectives The number of workers with cancer has dramatically increasing worldwide. One of the main priorities is to preserve their quality of life and the sustainability of social security systems. We have carried out this study to assess factors associated with the ability to work after cancer. Such insight should help with the planning of rehabilitation needs and tailored programmes. Participants We conducted this register-based cohort study using individual data from the Belgian Disability Insurance. Data on 15 543 socially insured Belgian people who entered into the long-term work disability between 2007 and 2011 due to cancer were used. Primary and secondary outcome measures We estimated the duration of work disability using Kaplan-Meier and the cause-specific cumulative incidence of ability to work stratified by age, gender, occupational class and year of entering the work disability system for 11 cancer sites using the Fine and Gray model allowing for competing risks. Results The overall median time of work disability was 1.59 years (95% CI 1.52 to 1.66), ranging from 0.75 to 4.98 years. By the end of follow-up, more than one-third of the disabled cancer survivors were able to work (35%). While a large proportion of the women were able to work at the end of follow-up, the men who were able to work could do so sooner. Being women, white collar, young and having haematological, male genital or breast cancers were factors with the bestlikelihood to be able to return to work. Conclusion Good prognostic factors for the ability to work were youth, woman, white collar and having breast, male genital or haematological cancers. Reviewing our results together with the cancer incidence predictions up to 2025 offers a high value for social security and rehabilitation planning and for ascertaining patients’ perspectives.