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Background: Nursing home residents, a frail and old population group, respond poorly to primary mRNA COVID-19 vaccination. A third dose has been shown to boost protection against severe disease and death in this immunosenescent population, but limited data is available on the immune responses it induces.Methods: In this observational cohort study, peak humoral and cellular immune responses were com-pared 28 days after the second and third doses of the BNT162b2 mRNA COVID-19 vaccine in residents and staff members of two Belgian nursing homes. Only individuals without evidence of previous SARS-CoV-2 infection at third dose administration were included in the study. In addition, an extended cohort of residents and staff members was tested for immune responses to a third vaccine dose and was mon-itored for vaccine breakthrough infections in the following six months. The trial is registered on ClinicalTrials.gov (NCT04527614).Findings: All included residents (n = 85) and staff members (n = 88) were SARS-CoV-2 infection naive at third dose administration. Historical blood samples from 28 days post second dose were available from 42 residents and 42 staff members. Magnitude and quality of humoral and cellular immune responses were strongly boosted in residents post third compared to post second dose. Increases were less pro-nounced in staff members than in residents. At 28 days post third dose, differences between residents and staff had become mostly insignificant. Humoral, but not cellular, responses induced by a third dose were predictive of subsequent incidence of vaccine breakthrough infection in the six months following vaccination.Interpretation: These data show that a third dose of mRNA COVID-19 vaccine largely closes the gap in humoral and cellular immune response observed after primary vaccination between NH residents and staff members but suggest that further boosting might be needed to achieve optimal protection against variants of concern in this vulnerable population group.(c) 2023 Published by Elsevier Ltd.

The COVID-19 pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has presented itself as one of the most important health concerns of the 2020's, and hit the geriatric population the hardest. The presence of co-morbidities and immune ageing in the elderly lead to an increased susceptibility to COVID-19, as is the case for other influenza-like illnesses (ILI) or acute respiratory tract infections (ARI). However, little is known, about the impact of a previous or current infection on the other in terms of susceptibility, immune response, and clinical course. The aim of the "Prior Infection with SARS-COV-2" (PICOV) study is to compare the time to occurrence of an ILI or ARI between participants with a confirmed past SARS-CoV-2 infection (previously infected) and those without a confirmed past infection (naïve) in residents and staff members of nursing homes. This paper describes the study design and population characteristics at baseline., info:eu-repo/semantics/published

Background: Long-term absenteeism continues to rise in Belgium and musculoskeletal disorders (MSDs) have been considered a primary cause. However, there is still uncertainty about the prevalence of MSDs, and about the contribution of work-related factors in the etiology of MSDs. SALTSA, which was developed in 2001, is a European diagnostic criterion document that aims to standardize the reporting of work-related upper limb MSDs (ULMSDs). The purpose of this work-site study was to implement SALTSA in daily occupational health practice and to determine the prevalence of ULMSDs in a Belgian company. Methods: During health examinations, occupational health nurses and an occupational health physician screened employees in a company with ergonomically high-risk activities for the occurrence of ULMSDs using the SALTSA protocol. In order to explore associations between ULMSDs and lifestyle and work-related factors, bivariate and logistic regression analyses were performed. Findings: Three hundred and eight (94.0%, 308/328) employees were screened resulting in an ULMSD prevalence of 20.5% (95% CI = [16.0–25.3]). Rotator cuff syndrome was the most common condition. Prevalence varied significantly between men (9.6%, 95% CI = [5.6–14.9]) and women (35.0%, 95% CI = [26.9–43.9]). Being female ( p < .001) and working in the cabling assembly unit ( p = .002) were found to be significant predictors of ULMSDs. Conclusion/Application to Practice: By using the SALTSA protocol in occupational health practices, ULMSDs can be screened unequivocally, enabling comparisons between different occupational sectors and countries. Occupational health nurses can play an important role in detecting and screening MSDs among workers.

Vibrotactile feedback training may be used as a complementary strategy to reduce time in demanding postures in manual handling. This study evaluated the short- and medium-term effects of concurrent posture-correction vibrotactile feedback training on trunk inclination exposure in real manual sorting work. Fifteen warehouse workers completed the training and the follow-up sessions. Trunk inclination angles were recorded using the ambulatory Smart Workwear System. Questionnaires were used for assessing system usability, perceived physical exertion, and work ability. The results showed reduced time in trunk inclination30°,45°, and60°, and reductions in the 90th, 95th, and 99th percentile trunk inclination angles, when receiving feedback and immediately after feedback withdrawal. No significant reduction was retained after one and three weeks. The wearer's comfort was scored high, and the feedback did not increase the perceived cognitive demands. No significant effects attributed to changed trunk inclination exposure were observed for perceived physical exertion or work ability. The training program has the potential of contributing to reduced trunk inclination exposure in the short term. Future studies are needed to evaluate if improvements in the feedback training can transfer the short-term results to retained median- and long-term effects.

Massive Open Online Courses (MOOCs) offer a flexible method of providing education to large numbers of people around the world. This study aimed to develop and pilot test a mini MOOC in order to teach knowledge and skills in occupational epidemiology.Using instructional design principles, an open online course was developed.Four modules have been designed and delivered in a pilot version requiring an 8-hour time commitment. Thirty postgraduate students evaluated different aspects of the MOOC. They appreciated the active learning approach, gave high rates of approval for learning effects and structure but would welcome more feedback and interaction.Although students were satisfied, developing the MOOC entailed a considerable amount of time. A multi-institutional approach and international collaboration would be beneficial to improve the present MOOC and develop new ones.

BackgroundResidents of nursing homes (NH) are at high risk of COVID-19 related morbidity and death and may respond poorly to vaccination because of old age and frequent comorbidities.MethodsForty residents and forty staff members either naïve or previously infected with SARS-CoV-2 were recruited in two NH in Belgium before immunization with two doses of 30µg BNT162b2 mRNA vaccine at day 0 and day 21. Binding antibodies (Ab) to SARS-CoV-2 receptor binding domain (RBD), spike domains S1 and S2, RBD Ab avidity, and neutralizing Ab against SARS-CoV-2 wild type and B.1.351 variant were assessed at days 0, 21, 28, and 49.ResultsSARS-CoV-2 naïve residents had lower Ab responses to BNT162b2 mRNA vaccination than naïve staff. These poor responses involved lower levels of IgG to all domains of the vaccine antigen, lower avidity of RBD IgG, and lower levels of Ab neutralizing the vaccine strain. No naïve resident had detectable neutralizing Ab to the B.1.351 variant. High and comparable Ab responses were observed in residents and staff previously infected with SARS-CoV-2. Clustering analysis revealed that poor vaccine responders not only included naïve residents but also naïve staff, emphasizing the heterogeneity of responses to mRNA vaccination in the general population.ConclusionsThe poor Ab responses to mRNA vaccination observed in infection naïve residents and in some naïve staff members of NH suggest suboptimal protection against breakthrough infection, especially with variants of concern. Adapted vaccination regimens may be needed to provide optimal protection against COVID-19 to vulnerable populations.SummaryPoor antibody responses to COVID-19 mRNA vaccination were observed in SARS-CoV-2 infection naïve residents and some naïve staff members of nursing homes. This suggests suboptimal protection against breakthrough infection, especially with variants of concern, and the need for adapted vaccination regimens.

Background: COVID-19 has presented itself as one of the most important health concerns of 2020. The geriatric population is arguably hit the hardest by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The ”Prior Infection with SARS-COV-2” (PICOV) study investigates both residents and staff members from nursing homes. The primary aim of the study is to compare the time to occurrence of an influenza-like illness (ILI) or acute respiratory infection (ARI) between participants with a confirmed past SARS-CoV-2 infection and those without an infection. This paper details the study design, sampling scheme, biological measurements, and population characteristics at baseline.Methods: In 26 Belgian nursing homes, all eligible residents and staff members with or without a past SARS-CoV-2 infection (ratio 40/60) were invited to participate. Consent was obtained from 1,375 participants and 1,226 completed the baseline questionnaire. Prevalence of symptoms during a prior SARS-CoV-2 infection was compared between residents and staff members with χ2 statistics.Results: Nursing home residents (both with and without a prior SARS-CoV-2 infection) systematically reported fewer symptoms than staff members. Moreover, results from prior nasopharyngeal RT-qPCR and baseline serology show that antibody development after a SARS-CoV-2 infection differs between residents and staff members.Conclusions: We can postulate that disease development and symptoms is different between a geriatric and younger population. Therefore, the occurrence and severity of a future ILI and/or ARI might vary from resident to staff.

OBJECTIVES: Assess the performance of five SARS-CoV-2 rapid serological tests (RST) using finger prick (FP) blood on-site to evaluate their usability for exposure assessment in population-based seroprevalence studies. STUDY DESIGN: Since cross-reactivity with common cold human coronaviruses occurs, serological testing includes a risk of false-positive results. Therefore, the selected cohort for RST-validation was based on combined immunoassay (presence of specific antibodies) and RT-qPCR (presence of SARS-CoV-2) data. RST-performance for FP blood and serum was assessed by performing each RST in two groups, namely SARSCoV- 2 positive (n=108) and negative healthcare workers (n=89). Differences in accuracy and positive and negative predictive values (PPV, NPV) were calculated for a range (1-50%) of SARS-CoV-2 prevalence estimates. RESULTS: The OrientGene showed overall acceptable performance, with sensitivities of 94.4% and 100%, and specificities of 96.6% and 94.4%, using FP blood and serum, respectively. Although three RST reach optimal specificities (100%), the OrientGene clearly outperforms in sensitivity. At a SARS-CoV-2 prevalence rate of 40%, this RST outperforms the other tests in NPV (96.3%) and reaches comparable PPV (94.9%). Although the specificity of the Covid-Presto is excellent when using FP blood or serum (100% and 97.8%, respectively), its sensitivity decreases when using FP blood (76.9%) compared to serum (98.1%). CONCLUSIONS: Performances of the evaluated RST differ largely. Only one out of five RST (OrientGene) had acceptable sensitivity and specificity using FP blood. Therefore, the latter could be used for seroprevalence studies in a high-prevalence situation. The OrientGene, which measures anti-RBD antibodies, can be valuable after vaccination as well. ispartof: JOURNAL OF CLINICAL VIROLOGY vol:142 ispartof: location:Netherlands status: published

OBJECTIVE: To identify early symptoms allowing rapid appraisal of infection with SARS-CoV-2 among healthcare workers of a large Belgian hospital. METHODS: Healthcare workers with mild symptoms of an acute respiratory tract infection were systematically screened on clinical characteristics of corona virus disease 2019 (COVID-19). A nasopharyngeal swab was taken and analyzed by real-time Reverse-Transcription-Polymerase-Chain-Reaction (rRT-PCR). RESULTS: Fifty percent of 373 workers tested COVID-19 positive. The symptoms cough (82%), headache (78%), myalgia (70%), loss of smell or taste (40%), and fever more than or equal to 37.5 °C (76%) were significantly higher among those infected. CONCLUSION: Where each individual symptom contributes to the clinical evaluation of possible infection, it is the combination of COVID-19 symptoms that could allow for a rapid diagnostic appraisal of the disease in a high prevalence setting. Early transmission control is important at the onset of an epidemic. ispartof: JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL MEDICINE vol:63 issue:1 pages:27-31 ispartof: location:United States status: published

Objectives Few studies focus on out-of-hospital cardiac arrests in the occupational setting. Therefore, this study describes the presence and use of an automated external defibrillator (AED) at Belgian workplaces during the period 2012-2014. Material and methods A self-constructed questionnaire was developed and sent to internal prevention counselors. Results In total, 767 companies filled out the questionnaire. An AED was available in 48.8% of the companies. Presence mainly depended on the number of persons present in the company (both workers and non-workers (e.g., visitors, clients)) and on some occupational cardiovascular risks but was often not based on a well-conducted risk analysis. Training of workers and AED maintenance were provided appropriately. An AED was used for shocking 23 times of which 10 persons survived. Conclusions Acquiring an AED in the occupational setting is seldom based on a well-conducted risk analysis. Therefore, instructions and criteria are needed to come to a rational decision. Furthermore, a registry on AED utilization in the workplace (e.g., with data on long-term survival) should be set up. Int J Occup Med Environ Health 2018;31(5):603-611.

De incidentie in België van erythema migrans in het kader van de ziekte van Lyme-borreliose (LB) bedroeg 9,8 diagnoses per 10.000 inwoners in 2015 en neemt nog toe. Boswachters, natuur- en terreinwerkers zijn hoogrisicoberoepsgroepen want zij werken in het tekenseizoen van maart tot oktober. Preventiemogelijkheden worden niet steeds toegepast. De onderzoeksvraag luidde: wat zijn de factoren die het al dan niet toepassen van preventieve maatregelen beïnvloeden?

OBJECTIVE: The aim of this study was to evaluate changes in knowledge, attitude, and preventive practices of students regarding occupational hazards before and after entering clinical training. METHODS: A self-administered questionnaire was used to follow up a cohort of Belgian medical students in 2014 and 2015. Inquiries about students' characteristics, awareness, knowledge, and practices of protective measures were included. Descriptive and multivariable analyses were performed. RESULTS: Overall, 249 (94%) students completed the preclinical questionnaire and 147 (56%) responded on both occasions. Our findings revealed that student awareness and knowledge scores were inadequate but increased after admission as trainees. Students with an accidental blood contact (n = 43) showed no better knowledge of postexposure management than those without such an incident. CONCLUSIONS: The observed lack of awareness and knowledge regarding occupational hazards among students provides an opportunity to improve basic education and training environments.

Background: Nonadherence in cancer patients taking oral anticancer drugs is common. Reasons for nonadherence are still not really understood as influencing factors are often complex, dynamic, and interrelated. Objective: A qualitative study was conducted to gain insight into (non-)adherence behavior in patients taking oral tyrosine kinase inhibitors by exploring (1) processes and factors influencing (non-)adherence and (2) their interrelatedness. Methods: Semistructured interviews were held with 30 patients of different ages and with different types of cancer. A grounded theory approach was used. Results: Three foci were found when dealing with oral tyrosine kinase inhibitors: (1) a focus on survival, (2) a focus on quality of life, and (3) a balance between survival and quality of life. The process of adherence was determined by a set of complex and interrelated influencing factors: treatment-related side effects, hope, anxiety, trust, and feedback mechanisms. Conclusions: This qualitative study gives insight into processes and factors influencing (non-)adherence behavior in patients taking oral tyrosine kinase inhibitors. The results of this study can help healthcare professionals understand why patients taking oral tyrosine kinase inhibitors do not always adhere to their therapy. Implications for Practice: Conditions should be created by which patients get maximum opportunity to establish a balance between survival and quality of life. An open climate and a trust-based relationship should be established in which patients feel comfortable to openly discuss their therapy and the difficulties they experience.

Introduction An economic and demographic transition with an ageing workforce, evolving work organisation and new emerging risks is combined with a shortage of Occupational Physicians (OPs). This study aims to propose recommendations for future occupational health surveillance (OHS) and the role of OPs. Methods First, the PubMed, EU-OSHA and International Labour Organisation databases were screened for literature from 2006 to August 31, 2016, concerning OHS, return-to-work policies and risk management systems in Europe, Japan, Canada and other OECD countries. Second, a standardised mail survey was delivered to all members of the Belgian Professional Association of OPs. Results The literature review showed that European directives legally inspired countries to adapt their legislations and develop strategic OHS plans. Nevertheless, the comparison of OHS in different countries shows a varied landscape. The response rate of the survey was 54% (n=262). The results prompt a paradigm shift: Within 5 years, OPs must focus more on return–to–work (96.3%; 95% CI: 93.2% to 98.1%) and risk analyses (84.9%; 95% CI: 79.9% to 88.8%) while training occupational nurses (ONs) to execute routine occupational health examinations (46%; 95% CI: 39.8% to 52.4%). Similarly, a more standardised and multidisciplinary approach to risk assessment should be developed (74.7%; 95% CI: 68.8% to 79.8%). By 2030, OPs would be more specialised in toxicology, disability management, ionising radiation, etc. (42.2%; 95% CI: 36.2% to 48.5%), and ONs would be trained on risk assessments (74.8%; 95% CI: 68.9% to 79.9%) and health promotion (98%; 95% CI: 95.3% to 99.1%). OPs disagree that general practitioners (GPs) could solely execute occupational health examinations (81.7%; 95% CI: 76.4% to 86.1%). Discussion The role of OPs must be part of a trend toward evidence-based OHS (i.e., studying the effectiveness and efficiency of ‘fitness for the job assessments’), disability management and engagement with a wide network of stakeholders (such as ONs, GPs and health insurance organisations).

Introduction The increase in long-term (>1 month) absenteeism is a major challenge for Belgian companies. Over the last 10 years, long-term absenteeism increased from 3.1% to 5.13%. Consequently, absenteeism has become a key element in the human resource management strategy of many organisations. The aim of this study was to assess factors influencing long-term absenteeism among employees. Methods A questionnaire was developed by a team of experts in the field of occupational health, to assess factors influencing long-term absenteeism. The questionnaire comprised 28 items covering four main topics: employee characteristics (e.g., age), absenteeism (e.g., absenteeism rate, causes of absenteeism), work-related features (e.g., employment satisfaction, stressors, social support, job control), and lifestyle (e.g., smoking). Employees were invited to fill out the questionnaire online by their employee organisations in Belgium. Results From January to March 2017, a total of 1913 employees (50.2% male, 49.8% female) filled out the questionnaire. The survey revealed that over the last year, about one out of five of the respondents had been on unscheduled sick leave for at least two weeks. Almost 10% of the respondents considered themselves at risk for sick-leave ≥1 month during the next year. Of these, 53% believed that physical reasons would be the cause for the absence, and 38% cited psychological reasons. The following variables were found to be positively associated (p Discussion The results of this study present insights into factors associated with the risk of long-term absenteeism. They provide a starting point for actions both at an organisational and individual level targeted at reducing and preventing long-term absenteeism.

Introduction Unemployment is common among people with schizophrenia and contributes most to the economic cost of the condition. This study was aimed at (1) reviewing the available tools to facilitate the vocational rehabilitation of workers with schizophrenia and (2) describing their specific opportunities. Methods A search of PubMed for original, peer-reviewed articles published from 2006 until January 31, 2016, yielded 643 citations. Exclusion criteria were patients less than 18 years or older than 65 years of age, patients with additional diagnoses, studies conducted in developing countries, lack of an adequate study design, systematic reviews or case studies, no work related studies, and other major analytic inadequacies. The remaining 24 articles were assessed in qualitative synthesis using the Scottish Intercollegiate Guidelines Network (score ≥2+), Critical Appraisal Skills Program or Prediction Model Risk of Bias Assessment Tool checklists. Results Only seven quantitative and one qualitative study could be included. The number of study participants with schizophrenia varied substantially (n=7 in the qualitative study, n=100 in the largest quantitative study). Most studies were conducted in the United States (n=5), as well as two in Canada and one in Japan. Cognitive remediation programs (Neurocognitive Enhancement Therapy) combined with supported employment were significantly more effective (p Discussion Combining cognitive remediation programs with supported employment programs significantly improved the vocational outcomes of workers with schizophrenia, especially for those with lower community functioning. Participation in competitive employment was also promoted by shorter initial working hours, higher education and disclosure of disabilities. Future prospective, longitudinal research with larger samples, in stratified baseline conditions, is needed.

Introduction Since 2002, long-term absenteeism in Belgium has steadily increased each year. In 2016, 5.13% of the Belgian working population was on sickness absence for >1 month. In Belgium, sickness-absence benefits are paid by the employer in the first month and subsequently by social security. To increase the RTW chances among employees with long-term absenteeism, Mensura Occupational Health Services (OHS) developed return calls. Methods Mensura OHS developed the following procedure: Companies with long–term absentee employees complete an online intake form for each employee on long–term absence (>1 month). A trained professional (nurse) from Mensura OHS calls the employees on long–term sickness absence and uses a telephone protocol to collect data on their sickness–absence reasons and desire to receive RTW support. Employees willing to receive support from Mensura OHS are referred to voluntary consultations with an occupational physician (OP). The OP evaluates the possibility of starting a reintegration program or further sickness absence. The employer receives individual and group reports (in accordance with confidentiality regulations and privacy–protection laws), including recommendations. Mensura OHS reviews the results and discusses possible solutions with the employer. Results By the end of 2017, return calls will be evaluated by: Comparing the anticipated sick leave date with the actual return to work date Mapping the long–term evolution of absenteeism in companies By the ICOH 2018 Congress, preliminary results will be available. Discussion Return calls can establish a proactive, constructive approach to increase the chances of successful reintegration of employees on sick absence. The results may inform targeted strategic-policy advice to reduce and prevent long-term absenteeism in companies.

Introduction Since 2001, Belgian absenteeism has increased steadily, especially long-term absenteeism. In 2016, the percentage of employees on sick leave for ≤1 month was 2.13%; the percentage of those on sick leave for >1 month was 5.13%. Consequently, absenteeism has become an important element in the human resources (HR) management strategies of many organisations. The aim of this study was to describe sick-leave policies of Belgian companies. Methods A questionnaire was developed by a team of experts in the field of occupational and organisational health to assess sick-leave policies and HR management strategies. The questionnaire included four main topics (33 items): company characteristics (e.g., absenteeism rate), organisational features (e.g., hierarchical structure), sick-leave policy (e.g., presence of a procedure to stay in touch with absentees, possibility for adjusted work), and communication (e.g., communicating absenteeism rates to employees). Companies were randomly selected by sector from a database of 49 852 companies affiliated with Mensura Occupational Health Services (Belgium). An external research agency phoned those responsible for HR in each company. Results From January to March 2017, 2230 companies from nine sectors, were phoned. Most companies had 0–20 employees (n=1807), 388 had 21–200 employees, and 35 had >200 employees. More than half (55%) didn’t know their absenteeism rate. Only 34% had strictly defined procedures and agreements concerning absenteeism. In 22% of the companies, policies on prevention and protection at work were defined; these policies were linked to sick-leave policies in only 40% of these companies. In 62% of the companies, there was no possibility for adjusted work. Discussion The results of this study provide a solid basis for performing targeted actions to raise awareness of the importance of a well-established sick-leave policy. To increase return-to-work chances for employees with long-term absenteeism, sick-leave policies should be integrated in companies’ overall health, safety, and well-being policies.

Introduction Bus drivers are exposed to whole body vibration (WBV) and postural stress, both risk factors for low back pain (LBP). The study aimed to (1) assess WBV exposure and (2) evaluate the effect of an intervention to reduce LBP. Methods Exposure to WBV was assessed by measuring vibration levels (i.e., weighted root mean square acceleration [Aw] and vibration dose value [VDV]) in nine buses. For the intervention study, a toolbox presentation including ergonomic and lifestyle advice and an exercise program was instructed interactively to bus drivers. Two questionnaires (pre– and post–intervention) were constructed based on the VIBRISKS questionnaire to evaluate the effect of the intervention on LBP prevalence and to assess associated risk factors (e.g., manual material handling, seating posture, and WBV). The bus drivers’ motivation to change driving behaviour was also evaluated. Results The vibration levels never exceeded the exposure limits [Aw: 1.15 m/s 2 , VDV: 21 m/s 1 .75 ]. Only in one bus, the Aw (0.56 m/s 2 ), were the levels slightly higher than the action limit [0.5 m/s 2 ]. Four buses had a VDV (9.56 m/s 1 .75 , 13.0 m/s 1 .75 , 10.7 m/s 1 .75 and 11.0 m/s 1 .75 ) that exceeded the action limit [9.1 m/s 1 .75 ]. Sixty and 47 bus drivers participated in the pre– and post–intervention, respectively. The prevalence of LBP in the previous seven days decreased significantly (p=0.02). The score on correct lifting techniques was a significant determinant (p=0.046) in predicting LBP in the previous seven days (OR=0.32, 95% CI: 0.10 to 0.98). There was a significant post–intervention increase in knowledge about correct seating posture (p=0.001), and 95.5% of the bus drivers were willing to maintain their behavioural change. Discussion WBV exposure should be frequently evaluated to maintain below action-limit levels. Although this study revealed a significant reduction in LBP prevalence in the previous seven days, further research is needed in a randomised controlled trial design.

Introduction Since 2008, Belgian workers on ≥4 weeks’ sick leave have been allowed to voluntarily visit occupational physicians (OP) before returning to work. In 2015, OPs affiliated with Mensura occupational health services (OHS) performed only 0.73% (n=2,603) of these visits. Especially in small companies, visits before returning to work were limited. Often, employers were unaware of the opportunity to visit OPs during sick leave. In a large Belgian company, an initiative to encourage visits before returning to work was introduced with the aim to increase the chances of earlier resumption of work. Methods In 2015, a large pharmaceutical company employing >1000 workers implemented the following procedure: The company informed workers on>6 months’ sick leave of the opportunity to voluntarily visit OPs. Workers expected to be on longer sick leave were informed about visits before returning to work and the possibility of (adjusted) work resumption. Results In 2015, 9.71% (n=103) of the consultations with the OP were visits before returning to work. The most frequent causes of long-term sick leave (documented in 73 of 103 cases) were: Orthopaedic diagnoses (excluding spine and back pain): 39.7% (n=29) Psychological causes: 19.2% (n=14) Spine and back pain: 12.3% (n=9) Serious/chronic diseases: 6.8% (n=5) Other: 21.9% (n=16) In the 73 documented cases, 44 workers were eligible to resume work, while for 61% (n=27), an early return, which was executed with or without adjustments, was recommended. Conclusion This study demonstrated the importance of promoting visits to an OP before returning to work. In the future, OHS could facilitate return to work by supporting companies in implementing sick-leave policy. Contacting workers on sick leave and offering opportunities for visits prior to return to work could create added value for employees and employers.

Background The organization of psychosocial care is rather complex, and its provision diverse. Access is affected by the acceptance and attitude of patients and professional caregivers toward psychosocial care. Objectives The aims of this study were to examine when patients with cancer experience quality psychosocial care and to identify circumstances in collaboration that contribute to patient-perceived positive psychosocial care. Methods This study used a qualitative design in which semistructured interviews were conducted with patients, hospital workers, and primary health professionals. Results Psychosocial care is often requested but also refused by patients with cancer. Based on this discrepancy, a distinction is made between psychosocial support and psychosocial interventions. Psychosocial support aims to reduce the chaos in patients' lives caused by cancer and is not shunned by patients. Psychosocial interventions comprise the formal care offered in response to psychosocial problems. Numerous patients are reluctant to use psychosocial interventions, which are often provided by psychologists. Conclusion Psychosocial care aims to assist patients in bearing the difficulties of cancer and its treatment. Patients prefer informal support, given often in conjunction with physical care. Implications for practice This study confirms the important role of nurses in promoting psychosocial care. Patients perceive much support from nurses, although nurses are not considered to be professional psychosocial caregivers. Being perceived as approachable and trustworthy offers nurses a significant opportunity to bring more intense psychosocial interventions within reach of cancer patients.

Background Healthcare provider (HCP) activities and attitudes towards patients strongly influence medication adherence. The aim of this study was to assess current clinical practices to support patients in adhering to treatment with oral anticancer agents (OACA) and to explore clues to improve the management of medication adherence. Methods A cross-sectional, observational study among HCPs in (haemato-)oncology settings in Belgium and the Netherlands was conducted in 2014 using a composite questionnaire. A total of 47 care activities were listed and categorised into eight domains. HCPs were also asked about their perceptions of adherence management on the items: insight into adherence, patients’ communication, capability to influence, knowledge of consequences and insight into causes. Validated questionnaires were used to assess beliefs about medication (BMQ) and shared decision making (SDM-Q-doc). Results In total, 208 HCPs (29% male) participated; 107 from 51 Dutch and 101 from 26 Belgian hospitals. Though a wide range of activities were reported, certain domains concerning medication adherence management received less attention. Activities related to patient knowledge and adverse event management were reported most frequently, whereas activities aimed at patient’s self-efficacy and medication adherence during ongoing use were frequently missed. The care provided differed between professions and by country. Belgian physicians reported more activities than Dutch physicians, whereas Dutch nurses and pharmacists reported more activities than Belgian colleagues. The perceptions of medication adherence management were related to the level of care provided by HCPs. SDM and BMQ outcomes were not related to the care provided. Conclusions Enhancing the awareness and perceptions of medication adherence management of HCPs is likely to have a positive effect on care quality. Care can be improved by addressing medication adherence more directly e.g., by questioning patients about (expected) barriers and discussing strategies to overcome them, by asking for missed doses and offering (electronic) reminders to support long-term medication adherence. A multidisciplinary approach is recommended in which the role of the pharmacist could be expanded. Electronic supplementary material The online version of this article (doi:10.1186/s12885-017-3110-2) contains supplementary material, which is available to authorized users.

Context Symptom control is an essential part of palliative care and important to achieve optimal quality of life. Studies showed that patients with all types of advanced cancer suffer from diverse and often severe symptoms. Research focusing on older persons is scarce because this group is often excluded from studies. Consequently, it is unclear which symptoms older palliative care patients with cancer experience and what is the prevalence of these symptoms. To date, no systematic review has been performed on the prevalence of symptoms in older cancer patients receiving palliative care. Objectives The objective of this systematic review was to search and synthesize the prevalence figures of symptoms in older palliative care patients with cancer. Methods A systematic search through multiple databases and other sources was conducted from 2002 until April 2012. The methodological quality was evaluated. All steps were performed by two independent reviewers. A meta-analysis was performed to pool the prevalence of symptoms. Results Seventeen studies were included in this systematic review. Thirty-two symptoms were identified. The prevalence of these symptoms ranged from 3.5% to 77.8%. The most prevalent symptoms were fatigue, excretory symptoms, urinary incontinence, asthenia, pain, constipation, and anxiety and occurred in at least 50% of patients. Conclusion There is a high degree of uncertainty about the reported symptom prevalence because of small sample sizes, high heterogeneity among studies, and the extent of instrument validation. Research based on rigorous methods is needed to allow more conclusive results.

Het Europees Agentschap voor veiligheid en gezondheid op het werk (EU-OSHA) ontwikkelde een e-guide met tips en praktische informatie voor elk Europees land om duurzaam werken en gezond ouder worden te bevorderen. De e-guide werd in 2016 gelanceerd als deel van de EU-OSHA campagne 2016-2017: Gezond werk, voor alle leeftijden. In 2015 werd een exploratieve studie uitgevoerd in Belgie ter voorbereiding van de nationale e-guide om na te gaan hoe bedrijven de gezondheid van oudere werknemers bevorderen, hoe omgegaan wordt met vergrijzing en wat hun noden zijn.

Background & aims: Malnutrition is a common problem in the elderly living in nursing homes. A clear understanding of associated factors is missing. The aim of this study was to evaluate prevalence of malnutrition and to determine factors independently associated with malnutrition in this setting. Methods: A cross-sectional, multi-centre study was conducted in 23 nursing homes in Flanders, Belgium. The nutritional status was assessed using the Mini Nutritional Assessment (MNA). Data on possible associated factors were collected using validated scales. Results: The study included 1188 elderly residents; 38.7% were at risk for malnutrition and 19.4% were malnourished. The presence of a wound/pressure ulcer, a recent hospitalization (

Review questions/objective The overall aim of this systematic review will be to find and synthesise the best available evidence regarding the prevalence of symptoms in elderly persons with incurable cancer. The following questions will be addressed: 1. Which symptoms do elderly people with incurable cancer experience? 2. What is the point prevalence of the identified symptoms in the elderly with incurable cancer? 3. Is there a difference in the prevalence of symptoms in different subgroups (subgroups such as, but not limited to, cancer stage and cancer type)? Inclusion criteria Type of participants This review will consider studies including adults older than 65 years and suffering from incurable cancer. All quantitative studies with reported data that are appropriate for the estimation of the prevalence of interest for this review will be included. Consideration will be given to ensuring the inclusion of studies with an appropriate sample size for the estimation of prevalence. Type of outcomes Studies reporting on the point prevalence of symptoms (physical, psychological, social, spiritual) or reporting a proportion or number of patients with the symptom will be considered for inclusion. In intervention studies in which symptoms are possibly affected by that intervention, only baseline measurements will be used.

Background The European Agency for Safety and Health at Work (EU-OSHA) is developing an online e-guide, which will provide tips and practical information for each EU country (in their national language(s)) on ageing and occupational health and safety. The e-guide will be launched in 2016 as part of the EU-OSHA campaign on Healthy Workplaces for all ages. The e-guide will present evidence, tools and practical examples of how companies can take action and effectively promote sustainable employability. Methods As part of the development of the e-guide, a cross-sectional study was conducted to survey Belgian employers in April 2015 to determine their specific needs concerning older workers’ occupational health and safety issues. Researchers from Milieu Ltd. (Brussels, Belgium), the consultancy company coordinating the e-guide project, and Mensura Occupational Health Services (Brussels, Belgium) developed a 13-item questionnaire. The survey addressed the needs and importance given to sustainable employability of older workers in Belgian companies and evaluated corporate knowledge regarding relevant national policies. The questionnaire was distributed electronically to the management of 22,084 private-sector companies affiliated with Mensura. Results Ten percent (n = 2133) of recipients opened the e-mail, and 37 % (n = 790) of these completed the questionnaire. In 89 % of the responding companies, sustainable employability of workers aged ≥55 years plays an important role; 70 % have no active sustainable employability policy/initiative; 18 % experience difficulties promoting sustainable employability; and 86 % indicate no need for support to promote sustainable employability. Respondents noted the following health complaints among workers aged ≥55 years: work-related health problems (31 %), stress (26 %), work agreements/type of work (17 %), work/life balance (15 %), and career development and/or training (9 %). Topics concerning health and well-being of workers aged ≥55 years requiring the most attention include motivation (30 %) and adaptation of the workplace to their health requirements (26 %). Conclusions The e-guide should raise further awareness among employers about the importance of implementing an active sustainable employability policy to prolong working life in a healthy and productive way. The e-guide should also include tools to address work-related health problems and stress, motivation, and adaptation of the workplace to the health requirements of workers aged ≥55 years.

Contains fulltext : 170850.pdf (Publisher’s version ) (Closed access) Background Little is known about healthcare providers' (HCPs) perceptions of adherence management of oral anticancer agents (OACA). The study aims to explore HCPs perceptions of OACA and adherence. Methods A cross-sectional, multi-center observational study among HCPs in hemato-oncology settings in Belgium and the Netherlands was conducted. Physicians, nurse practitioners, nurses and pharmacists were asked to complete questionnaires on their perception of patient adherence and its management (PAMQ) and their beliefs about OACA (BMQ-Specific). Physicians were also asked to complete a questionnaire on their perception of shared decision making (SDM-Q-Doc). Results The sample consisted of 254 HCPs. Variations were found between HCPs on the PAMQ: 56%, 50%, 28% and 23% of, respectively, physicians, nurse practitioners, nurses and pharmacists reported to know the level of adherence of their patients and 59%, 53%, 43% and 10% of, respectively, physicians, nurse practitioners, nurses and pharmacists think that patients discuss adherence with them. 70%, 82%, 63% and 62% of, respectively, physicians, nurse practitioners, nurses and pharmacists reported to have knowledge of causes of non-adherence, while 78%, 87%, 76% and 80% of them reported to have knowledge of consequences of non-adherence. 81%, 92%, 83% and 67% of, respectively, physicians, nurse practitioners, nurses and pharmacists felt able to influence adherence. Lower concerns beliefs were associated with a higher total score on the PAMQ [beta (SE)=-0.85 (0.24); CI -1.33--0.38]. Physicians scored a mean of 75 on the SDM-scale. Conclusions A considerable part of the HCPs states they do not know the adherence of their patients, nor do they think patients discuss adherence with them. However, they feel to have knowledge of adherence and perceive to be able to influence adherence of their patients.

Non-adherence and non-persistence in breast cancer patients taking antihormonal therapy (AHT) is common. However, the complex patterns and dynamics of adherence and persistence are still not fully understood. This study aims to give insight into the process of (non-)adherence and (non-)persistence by researching influencing factors and their interrelatedness in breast cancer patients taking AHT by means of a qualitative study with semi-structured interviews. The sample consisted of 31 breast cancer patients treated with AHT. Purposive and theoretical sampling and the constant comparison method based on a grounded theory approach were used. Expectations regarding the impact of AHT, social support from family and friends, and recognition from healthcare professionals were found to influence the process of non-adherence and non-persistence. The results of this study can help healthcare professionals understand why breast cancer patients taking AHT do not always adhere to or persist in taking the therapy and may facilitate patient-tailored interventions.

Voor de 54ste keer vonden de Belgische Nationale Dagen voor Arbeidsgeneeskunde plaats, georganiseerd door De Belgische Beroepsvereniging voor Arbeidsgeneesheren (BBvAg). Locatie: Brussel. Datum: 12 en 13 november 2015.

Introduction Le maintien au travail est essentiel pour preserver, tant les travailleurs que les entreprises, de consequences dommageables. En effet, si les premiers, confrontes a des problemes de sante en raison d’une maladie, courent un plus grand risque de perdre leur emploi, l’absenteisme de longue duree, quant a lui, aurait coute 1000 € par travailleur et par jour aux secondes en 2014. Dans ce contexte, le modele de Loisel constitue un cadre de reference approprie pour concevoir les actions de prevention de l’incapacite de longue duree. D’apres ce modele, le medecin generaliste joue un role important dans ce processus en tant que prescripteur de l’arret de travail. En effet, par la relation de confiance qu’il entretient avec le travailleur, il est idealement place pour le motiver a se preparer a retourner au travail. Methodologie Le processus d’elaboration des pages web comprenait cinq phases. Si, dans une premiere phase, la liste des thematiques prioritaires a aborder dans le document ont ete identifies et valides par les partenaires medecins generalistes, une premiere version du contenu des pages web demandees a, quant a lui, ete elabore dans un deuxieme temps. La troisieme phase du projet concernait la validation, par les associations professionnelles de medecins generalistes et de medecins du travail, de la premiere version du contenu des pages web. Au terme de celle-ci, les remarques et suggestions des ces diverses associations ont ete integrees, donnant lieu a l’edition d’une seconde version des pages web qui, a son tour, a ete soumise, pour validation, aux partenaires medecins generalistes. Sur cette base, la version finale a ete mise au point et annexee au rapport final de l’etude. Resultats Notre equipe de recherche a elabore des pages web sensibilisant les medecins generalistes a la prise en compte de la dimension « travail » dans l’approche des situations cliniques et les sensibilisant egalement sur l’utilite d’une prise de contact avec le medecin du travail, et ce notamment en vue d’optimiser un retour au travail reussi. Conclusions Ce projet a conduit a la redaction de pages web expliquant la medecine du travail aux medecins generalistes. Reprenant 14 thematiques distinctes, elles se veulent constituer un outil pratique pour favoriser la communication de ces derniers avec les medecins du travail, et ce afin d’augmenter le nombre de retour au travail reussi de nos patients-travailleurs.

Background and aims The use of oral anticancer drugs has increased in modern oncology treatment. The move from intravenous treatments towards oral anticancer drugs has increased the patients’ own responsibility to take oral anticancer drugs as being prescribed. High rates of non-adherence to oral anticancer drugs have been reported. A systematic literature review was conducted to gain insight into determinants and associated factors of non-adherence and non-persistence in patients taking oral anticancer therapy. Review methods PubMed, Cochrane, Web of Science and Cinahl were systematically searched for studies focusing on determinants and associated factors of medication non-adherence and non-persistence to oral anticancer drugs. The methodological quality of the included studies was assessed by two independent reviewers. No studies were excluded based on the quality assessment. Results Twenty-five studies were included and systematically reviewed. The quality of the studies was moderate. Associated factors influencing medication non-adherence and non-persistence to oral anticancer drugs are multifactorial and interrelated. Older and younger age, and the influence of therapy related side effects were found to be predominant factors. Conclusion Non-adherence and non-persistence to oral anticancer drug therapy are complex phenomena. More qualitative research is needed to facilitate the development of patient tailored complex interventions by exploring patients’ needs and underlying processes influencing medication non-adherence and non-persistence to oral anticancer drugs.

De studiedag werd dit jaar op 21 mei georganiseerd te Leuven door de Vlaamse Wetenschappelijke Vereniging voor Arbeidsgezondheidskunde (VWVA). De dag stond in het teken van ‘Gezond langer werken’, een thema dat brandend actueel is. Onlangs heeft de federale regering groen licht gegeven om de officiele pensioenleeftijd op te trekken naar 67 jaar. Dit heeft gevolgen voor werknemers en biedt uitdagingen voor de arbeidsgeneeskunde. Onderstaand gaan we in op drie lezingen.

Systeemsclerose (SSc) is een zeldzame multisystemische bindweefselziekte die, voor vele mensen met de ziekte, het potentieel om een betaalde job te verrichten beperkt. Decumans proefschrift focust op jobparticipatie bij mensen met SSc.