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See detailManagement of low back pain by occupational health physicians - the belgian guidelines
Mairiaux, Philippe ULg; Mazina, D. ULg

in Proceedings ICOH 2009 (2009, March)

Introduction With the support of the Belgian Health Care Knowledge Centre (KCE), a systematic review of the EBM literature concerning the management of low back pain (LBP) patients in the occupational ... [more ▼]

Introduction With the support of the Belgian Health Care Knowledge Centre (KCE), a systematic review of the EBM literature concerning the management of low back pain (LBP) patients in the occupational health (OH) context has been undertaken in order to issue good practices recommendations for occupational physicians (OP). Methods The guidelines development proceeded in three steps. First, an electronic search was performed to retrieve relevant guidelines and systematic reviews (SR) from 8 international databases. The identified guidelines were appraised using the AGREE method, while SR’s were appraised using the Cochrane Collaboration grid: 7 guidelines and 27 SR’s were selected. A draft of the intended Belgian guidelines was then validated by a group of Belgian OH experts. In a third step, the guidelines were adapted in a more practical format, thanks to a working group involving OP’s coming from 12 OH services and medical advisors (MA) from the sickness funds. Results Two documents have been published with the support of the Belgian Ministry of Labor. The guidelines document (50 p) summarizes the scientific evidence according to the OP main missions : background information to be given to employers and employees, evidence-based prevention policies to promote in the enterprises. As regard the health surveillance of workers, the guidelines consider three situations: periodic health surveillance, spontaneous examinations at the worker request, and return to work examinations after long duration sick leaves. Secondly, a management guide (19 p) is intended for employers and trade unions representatives. Discussion From a health care policy point of view, this study highlighted the major roles of the occupational physician and of the sickness funds medical adviser and stressed the need to better define those roles if decision makers want to tackle the low back pain problem and the economic consequences of the related sick leave. [less ▲]

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See detailImpact of participatory risk assessment approaches on occupational health professional's attitudes and practices
Mairiaux, Philippe ULg; Mazina, D. ULg; Roussel, Sandrine et al

Poster (2009, March)

Introduction In the last 10 years with the support of the Belgian Federal Public Service (FPS) for Employment and Labour and the European Social Fund, prevention advisors (PA) and occupational health ... [more ▼]

Introduction In the last 10 years with the support of the Belgian Federal Public Service (FPS) for Employment and Labour and the European Social Fund, prevention advisors (PA) and occupational health physicians (OP) have been invited to use new methods for risk assessment involving workers’ participation, namely the Sobane strategy, or the Risk/Toxtrainer methodology. This study aimed at evaluating these methods actual use among PA’s and OP’s, and its impact on representations and risk management practices. Methods A national postal survey was conducted in 2007 among a random sample (n=3340) of all professionals registered as PA (>6000) or OP (about 1000) by the FPS. The questionnaire explored those professionals’ familiarity with 12 different risk assessments methods, the nature of their interventions in enterprises, their representations about participation and collected demographic information. Results A total of 859 completed surveys (response rate: 25.7 %) could be analyzed. Among the methods studied, the Kinney-Wiruth accident risk analysis is the most familiar (54% regular users + 19% trained ones). The participatory methods are familiar (users + trained) to respectively 46 % (Sobane) and 11% (Risktrainer) of the respondents. When analyzing practices in enterprises, the professionals familiar with one of the participatory approaches are more often than the other professionals suggesting the use of participation in risk management to colleagues (84 vs 67.5% ; p<0.000) or to the employer (84 vs 73.5% ; p<0.000). Those professionals not familiar with the participatory approaches agree more often with the following statements: “PA role is more to inform than to listen” (p=0.005), “Participatory processes are raising unrealistic expectations among the staff” (p=0.002). Discussion This study shows that participatory risk assessment methods are gaining ground in Belgian enterprises. It also highlights the significant influence that information and training in those methods have had on risk management practices and the professionals’ representations. [less ▲]

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See detailImpact of participatory risk assessment approaches on occupational health professional's attitutdes and practices Proceedings ICOH 2009
Mairiaux, Philippe ULg; Mazina, D. ULg; Roussel, Sandrine et al

Poster (2009, March)

In the last 10 years with the support of the Belgian Federal Public Service (FPS) for Employment and Labour and the European Social Fund, prevention advisors (PA) and occupational health physicians (OP ... [more ▼]

In the last 10 years with the support of the Belgian Federal Public Service (FPS) for Employment and Labour and the European Social Fund, prevention advisors (PA) and occupational health physicians (OP) have been invited to use new methods for risk assessment involving workers’ participation, namely the Sobane strategy, or the Risk/Toxtrainer methodology. This study aimed at evaluating these methods actual use among PA’s and OP’s, and its impact on representations and risk management practices. Methods A national postal survey was conducted in 2007 among a random sample (n=3340) of all professionals registered as PA (>6000) or OP (about 1000) by the FPS. The questionnaire explored those professionals’ familiarity with 12 different risk assessments methods, the nature of their interventions in enterprises, their representations about participation and collected demographic information. Results A total of 859 completed surveys (response rate: 25.7 %) could be analyzed. Among the methods studied, the Kinney-Wiruth accident risk analysis is the most familiar (54% regular users + 19% trained ones). The participatory methods are familiar (users + trained) to respectively 46 % (Sobane) and 11% (Risktrainer) of the respondents. When analyzing practices in enterprises, the professionals familiar with one of the participatory approaches are more often than the other professionals suggesting the use of participation in risk management to colleagues (84 vs 67.5% ; p<0.000) or to the employer (84 vs 73.5% ; p<0.000). Those professionals not familiar with the participatory approaches agree more often with the following statements: “PA role is more to inform than to listen” (p=0.005), “Participatory processes are raising unrealistic expectations among the staff” (p=0.002). Discussion This study shows that participatory risk assessment methods are gaining ground in Belgian enterprises. It also highlights the significant influence that information and training in those methods have had on risk management practices and the professionals’ representations. [less ▲]

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See detailLombalgie au travail - Un guide pour l'employeur et les partenaires sociaux
Mairiaux, Philippe ULg; Mazina, D. ULg

Book published by Service Public Fédéral Emploi, Travail et Concertation Sociale (2008)

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See detailDeterminants of long duration sickness absence after an occupational back injury in the Belgian working population
Mairiaux, Philippe ULg; Mazina, D. ULg

Poster (2007, August)

Aims Occupational low-back injuries are a major cause not only of lost time but also of job loss and early retirement for health reasons. To promote the employability of an aging workforce, a better ... [more ▼]

Aims Occupational low-back injuries are a major cause not only of lost time but also of job loss and early retirement for health reasons. To promote the employability of an aging workforce, a better understanding of the prognostic factors for a long duration sick leave after such injuries is needed. The Belgian national database of work accidents was used to investigate these factors. Methods The data were retrieved from the Belgian Fund for Work Accidents (FAT) database over a three-year period (2001-2003). The population source involved all the workers under a job contract in the private sector recorded during that period as compensated cases for an accident that occurred at the workplace (n=558.276); 6,6% of those cases had the back as “location of injury”. Taking into account the calendar year system for counting time on benefits, the analysis was restricted to the 18936 workers who had reported a back injury during the first 6 months of each year. Eight factors (gender, age, region, professional category, size of enterprise, seniority, sector of activity and accident circumstances) were analyzed in relation with the duration of sick leave as attributed by the insurance company. For each factor, the relative prevalence of cases with more than 92 days of work absence (outcome variable) was compared using the Pearson’s 2 in the bivariate analysis. In the multivariate analysis, a Stepwise Logistic Regression was performed to obtain the final model. Results The proportion of back injured workers with more than 92 lost days was 6.8 % (CI 95%: 6.4-7.1). In the bivariate analysis, all the 8 factors under study, gender and seniority excepted, were correlated with sick leave duration. After adjustment for confounding factors, the final model involved 5 factors statistically associated to a long duration sick leave: age (older than 40 years : OR=1.45(1.25-1.68)); geographical location of company (Wallonia: OR=1.70(1.47-1.98); Brussels: OR=1.61(1.29-2.02)); professional category (blue collar: OR=1.71 (1.32-2.20)); circumstance of accident (falls : OR=1.26 (1.03-1.52); overexertion: OR=0.75(0.64-0.89)); and sector of activity (building industry: OR=1.47(1.22-1.78)). Discussion and conclusions This study showed that in the Belgian working population, 6.8 % of the compensated back injuries can be considered as chronic back pain cases. This figure is however likely to underestimate the actual incidence of the problem as the FAT statistics showed that 21.7% of the back injury claims were rejected by the insurers. The proportion of back injured workers with a long sick leave (chronic low back pain) is clearly related to the worker age, blue-collar status, accident precipitating cause, and some high-risk activities; these observations are in line with the literature. The observed regional differences in incidence could not be explained by a differential distribution of high risk sectors in the country; they are probably to be ascribed to cultural and social factors but these could not be studied on the basis of the variables recorded in the FAT database. In conclusion, this study shows that considerable prevention efforts have to be focused on some categories of workers with back injury, who are at risk for a long sickness absence leading to chronic low back pain. References 1. Nielens H., Van Zundert J., Mairiaux P., Gailly J., Van Den Hecke N., Mazina D., Camberlin C., Bartholomeeussen S., De Gauquier K., Paulus D., Ramaekers D. Chronic Low Back Pain. Good Clinical Practice (GCP). Bruxelles: Centre fédéral d'expertise des soins de santé (KCE); 2006. KCE reports 48B (D/2006/10.273/64). 2. Crook J, Milner R, Schultz IZ et al. Determinants of occupational disability following a low back injury: a critical review of the literature. [Review] [68 refs]. Journal of Occupational Rehabilitation.12:277-95, 2002. [less ▲]

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See detailNeonatal screening for sickle cell disease in Central Africa: a study of 1825 newborns with a new enzyme-linked immunosorbent assay test
Mutesa, Léon; Boemer, François ULg; Ngendahayo, Louis et al

in Journal of Medical Screening (2007), 14(3), 113-116

Objectives To evaluate the feasibility of systematic neonatal screening for sickle cell disease in the region of Great Lakes in Central Africa using a new approach with limited costs. Methods Between July ... [more ▼]

Objectives To evaluate the feasibility of systematic neonatal screening for sickle cell disease in the region of Great Lakes in Central Africa using a new approach with limited costs. Methods Between July 2004 and July 2006, 1825 newborn dried blood samples were collected onto filter papers in four maternity units from Burundi, Rwanda and the East of the Democratic Republic of Congo. We tested for the presence of haemoglobin C and S in the eluted blood by an enzyme-linked immunosorbent assay (ELISA) test using a monoclonal antibody. All ELISA-positive samples (multiple of the median (MoM) >= 1.5) were confirmed by a simple molecular test. The statistica software version 7.1 was used to create graphics and to fix the MoM cut-off, and the chi(2) of Pearson was used to compare the genotype incidences between countries. Results Of the 1825 samples screened, 97 (5.32%) were positive. Of these, 60 (3.28%) samples were heterozygous for Hb S, and four (0.22%) for Hb C; two (0.11%) newborns were Hb SS homozygotes. Conclusions The lower cost and the high specificity of ELISA test are appropriate for developing countries, and such systematic screening for sickle cell anaemia is therefore feasible. [less ▲]

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See detailThe Belgian guidelines for management of low back pain in occupational health
Mairiaux, Philippe ULg; Mazina, D. ULg

Poster (2007)

Aims As part of the promotion of a national strategy for the prevention and the management of acute and chronic low back pain (CLBP), the Belgian Health Care Knowledge Centre (KCE) funded a systematic ... [more ▼]

Aims As part of the promotion of a national strategy for the prevention and the management of acute and chronic low back pain (CLBP), the Belgian Health Care Knowledge Centre (KCE) funded a systematic review of the EBM literature concerning the management of LBP patients in the occupational health (OH) context. Taking account differences in regulations and practices within the health care system between EU countries1,2, this review aimed at issuing good practices recommendations applicable to the Belgian situation to prevent the transition from acute to chronic back pain and to avoid long duration absences from work. Methods The guidelines have been developed in three steps. First, an electronic search was performed for relevant guidelines and systematic reviews (SR) on the following databases: EMBASE, Medline, Cochrane Controlled Trials Register, NHS guidelines Finder, National Guidelines Clearing House, New Zealand Guidelines Group Search and Pedro database. The search strategy combined 3 groups of terms: low back pain, occupational medicine and the type of reference (practice guideline or SR). The identified guidelines were appraised using the AGREE method, while SR’s were appraised using the Cochrane Collaboration grid. In a second phase, the draft guidelines were submitted to a group of OH academics from the main Belgian universities. The revised version of the guidelines was then published in English in the KCE report 3. In a third step currently under way, the guidelines are adapted in a more practical format for facilitating their daily use by OH practitioners. This involves a working group of OH practitioners coming from 12 external prevention services and several large company OH services. The document will also be discussed with representatives of other health professionals (GP’s and medical advisors of the sickness funds). Results Scientific evidence from the 7 selected guidelines and from the 27 SR’s was organized according to the main missions of the occupational physician (OP) and medical adviser (MA). Which background information should be given to employers and employees when the OP is playing an adviser role? What evidence-based prevention policies (primary and secondary) should he/she promote in the enterprises? For the third mission of the OP, health surveillance of workers, the document considers three situations: periodic health surveillance, spontaneous examinations at the worker request, and return to work (RTW) examinations for workers absent for 28 days or more. The main conclusions are summarized in 4 tables under the format of key-points, each of those mentioning the quality of the evidence (using the Guyatt classification). Discussion and conclusions The key message for prevention of CLBP is the need for staying active and minimizing the time out of work. Evidence of high quality is in favor of a multidisciplinary approach using conservative treatments. One challenge is to avoid hospitalizations and especially surgery in CLBP patients. Those recommendations are relevant for all care settings, including the occupational environment. From a health care policy point of view, the project highlighted the major roles of the occupational physician and of the medical adviser and stressed the need to better define those roles if decision makers want to tackle the low back pain problem and the economic consequences of the related sick leave. References 1. Dutch Association of Occupational Medicine (NVAB). Management of low back workers by the occupational physician. Approved guidelines ; April 1999. 2. RCM-FOM. Occupational health guidelines for management of low back pain at work: Evidence Review and Recommendations. London, 2000. 3. Nielens H., Van Zundert J., Mairiaux P., Gailly J., Van Den Hecke N., Mazina D., Camberlin C., Bartholomeeussen S., De Gauquier K., Paulus D., Ramaekers D. Chronic Low Back Pain. Good Clinical Practice (GCP). Brussels: Belgian Health Care Knowledge Centre (KCE); 2006. KCE reports 48B (D/2006/10.273/64). [less ▲]

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