The EMPCAN study: protocol of a population-based cohort study on the evolution of the socio-economic position of workers with cancer.

BACKGROUND: 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. METHODS: 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. DISCUSSION: 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.

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.

Knowledge and perceptions of health and environmental risks related to artisanal gold mining by the artisanal miners in Burkina Faso: a cross-sectional survey.

INTRODUCTION: Artisanal gold mining is an activity ensuring the survival of about 700,000 families in Burkina Faso with a considerable contribution to the national economy. Techniques and chemicals used in the operation, have adverse impacts on health and the environment. Our study aims to evaluate the perceptions and knowledge of these different impacts among artisanal gold miners. METHODS: A cross-sectional survey was conducted in artisanal gold mines Bouda and Nagsene in the region of the North of Burkina Faso. Two hundred miners over 18 years of age were interviewed. RESULTS: All the participants have recognized that gold mining has health impacts and 88.5% felt these impacts as important with a significantly higher proportion among those with more than 3 years' seniority (p = 0.001). The environmental impacts were perceived as important by 64.5% of miners, with a significant difference according to the position (p = 0.004). Sixty percent (60%) of respondents could identify at least 3 of the 5 health impacts of gold mining listed and 49.5% acknowledged at least 3 impacts on the environment. The diggers had significantly more knowledge about the symptoms (p < 0.001). CONCLUSION: Study highlights the lack of knowledge of the Stampeders on the health and environmental impacts of artisanal gold mining. Findings might be used to develop more effective awareness campaigns in the future. Communication with diggers must focus on the risk perception because it appears that raising risk perceptions from low to high would have a major effect on behavior.

[Promoting the sustainable management of hospital waste in Kinshasa]. / Réflexion en faveur d'une gestion durable des déchets hospitaliers à Kinshasa.

The management of hospital waste is a high-risk practice in the hospitals of Kinshasa, the largest city of the Democratic Republic of the Congo, from the point of view of public health and the environment. A multi-criteria study carried out in 4 hospitals assessed the situation and put forward solutions.

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

BACKGROUND: 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. METHODS: 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. 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. CONCLUSIONS: 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.

Could Magnetic Fields Affect the Circadian Clock Function of Cryptochromes? Testing the Basic Premise of the Cryptochrome Hypothesis (ELF Magnetic Fields).

It 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.

Impact of heavy load activity on cardiovascular system: echocardiographic assessment of informal construction workers heart in Cameroon.

INTRODUCTION: Physiological cardiac hypertrophy and dilation are common findings in heavy physical load activity. We carried out this study to investigate the relationship between construction work and cardiac parameters adaptations, by comparing healthy masons to office workers on heart ultrasound. METHODS: The study was carried out on, 50 construction workers and 50 office workers matched for their weight, height and age. Systolic and Diastolic blood pressures, Left Ventricular diameter and thickness, Septum wall thickness and Left ventricular mass index were measured and calculated. RESULTS: Heart rate, systolic and diastolic blood pressures were lower in construction workers, as compared to office workers: respectively 63±7 bpm vs. 75±6 bpm (p = 0.000); 120.1±7 mmHg vs. 130.5±9 mmHg (p = 0.000) and 68.5±7 mmHg vs. 77.0 ±9 mmHg (p = 0.000). Construction workers had a thicker septum and posterior wall: respectively 10.3 ± 1.1 mm vs. 8.9 ± 0.9 mm (p = 0.000); and 9.0 ± 1.2 mm vs. 8.1 ± 0.8 mm (p = 0.000). CONCLUSION: Conclusion We deducted that heavy load work has an impact on the heart mensuration. The past occupational history has to be taken into consideration during initial medical assessing of a worker in for a new job so as to avoid erroneous conclusions.

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

INTRODUCTION: This study focuses on accidents in artisanal mining, to support policies improving miners' employability. MATERIALS AND METHODS: Based 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. RESULTS: During 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. DISCUSSION: Many 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. CONCLUSION: Tools 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.

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.

[Factors associated with the quality of well water and the prevalence of waterborne diseases in the municipality of Abomey-Calavi in Benin]. / Facteurs associés à la qualité de l'eau de puits et prévalence des maladies hydriques dans la commune d'Abomey-Calavi (Bénin).

The objective of this work is to assess the factors associated with the water quality of household wells, suggest solutions to improve it, and study the prevalence of water-borne diseases in this community. The quality of well water and the prevalence of waterborne diseases in the municipality were studied by analysis of the microbiological indicators currently used to assess drinking-water quality and the retrospective study of waterborne diseases treated in the local health centres. The wells surveyed were contaminated by Escherichia coli, Klebsiella pneumonia, Staphylococcus aureus, Salmonella spp, Clostridium perfringens and fecal streptococci, at prevalences of 12.5, 12.2, 12.2, 12.1, 12 and 11.1%, respectively. The high rates of diarrhea, urinary infections, typhoid fever and abdominal pain found in the retrospective study were consistent with the results of the well-water quality assessment. These results showed that human activity has strongly influenced water quality, especially the lack of sanitation in the different districts and neighbourhoods. Other factors affecting the vulnerability of well water include poor waste management by households, the low depth of the water table, the nature of the soil, and the permeability of the aquifer used. Improvement in water quality, sanitation, and personal hygiene will make it possible to reduce considerably the propagation of these diseases and several others. It is therefore important to provide these populations with the necessary equipment for an adequate drinking water supply, but also to promote health education to avoid water pollution. The search for solutions to these problems will lead to a plan for future action.

Heavy metal in hair samples of 109 non-industrial (miners) population in Katanga.

INTRODUCTION: This survey aims at proposing reference values of metals in the hair, in the copper-belt (Province of Katanga). MATERIALS AND METHODS: We ran a descriptive study, in an etiologic perspective, on a sample of non-industrial population, constituted by students of the University of Lubumbashi, healthy and without medical treatment (n  = 109). Hair samples were analyzed by Inductively Coupled Plasma Mass Spectrometry (ICP-MS). RESULTS: Twenty metals were identified and quantified: aluminium, antimony, silver, barium, cadmium, calcium, cerium, chromium, cobalt, copper, tin, iron, magnesium, manganese, mercury, molybdenum, nickel, lead, vanadium, and zinc. DISCUSSION: Regarding similar surveys ran upon european no-industrial populations, our results are ranging in the same percentiles. They spread out those percentiles only when our results were too close to quantification limits (silver, tin, mercury, nickel and vanadium). For certain metals, in particular aluminium, cadmium, chromium, cobalt, copper, manganese, molybdenum and lead, we have obtained higher contents. Several reasons can explain this specificity: ICP-MS sensitivity, analysis and preparation technique difference, diet difference or simply public health issues… CONCLUSION: Our results are close to others surveys' values. They can be validated as reference values for Katanga general population and used to highlight occupational exposure.

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

OBJECTIVE: While 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 METHOD: We 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. RESULTS: The 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. CONCLUSIONS: Hazards 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.

[Type of employment and occupational health in urban public transport in the city of Kinshasa]. / Type d'emploi et santé au travail dans le transport urbain collectif de la ville de Kinshasa.

The objective of this work was to highlight the impact of job type on the health of public transportation workers in the informal sector in Kinshasa. An exploratory cross-sectional study was conducted in a population of workers (n=390) with two types of jobs and employment status: permanent employment, the drivers (n=130) and precarious employment, receivers (n=130) and shippers (n=130). A health questionnaire was used for data collection. Odds ratios and confidence intervals at 95% were estimated by logistic regression. Adjusted odds ratios were higher respectively for receivers and shippers regarding complaints of weight loss, abnormal fatigue, headache and insomnia. These results suggest an association between the type of employment and the health of these workers. This differential impact could reflect the outcome associated with either the insecurity of the employment status or an increased level of harmful exposures.

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.