[Occupational dermatoses: management for general practitioners and an interdisciplinary collaboration model]. / Dermatoses professionnelles : démarche diagnostique pluridisciplinaire et outil de dépistage au cabinet.

Dermatoses are among the most frequent diseases related to working conditions. Nevertheless, there is an under-reporting of occupational diseases and the management of patients with either a possible occupational dermatosis or a condition aggravated by work which could be improved. The aim of this article is to present the most common occupational dermatoses, a multidisciplinary diagnostic approach to them and to propose a screening tool for occupational exposures.

Les dermatoses sont parmi les maladies les plus fréquentes en lien avec les conditions de travail. Néanmoins, il existe une sous-déclaration en maladie professionnelle et la prise en charge des patients atteints, soit d'une possible dermatose professionnelle, soit d'une condition aggravée par le travail, qui pourrait être améliorée. L'objectif de cet article est de présenter les dermatoses professionnelles les plus communes et une démarche diagnostique pluridisciplinaire et de proposer un outil de dépistage des expositions professionnelles à risque.

[Occupational cancers: essentials for the general practioners]. / Cancers professionnels : l'essentiel pour le médecin au cabinet.

Given the frequency of cancers, prevention is based on knowledge of the causes. Experts estimate the proportion of cancers attributable to work at around 5 %. If it is shown that exposure at work is involved, the patient can claim compensation for an occupational disease. In order for the occupational origin to be identified, it is important to know which jobs/sectors of activity are possibly at risk. The aim of this article is to present the six main cancer sites for which a link with occupational exposure has been documented, to specify the causes of the under-reporting of occupational cancers, the role of the treating physician working in a multidisciplinary network, and the tools and practical advice for optimizing the support to patients/their relatives.

Face à la fréquence des cancers, la prévention repose sur la connaissance des étiologies. Des experts estiment la part des cancers attribuables au travail autour de 5 %. Si l'on démontre qu'une exposition au travail est en cause, le patient peut prétendre à une indemnisation en maladie professionnelle. Pour que l'origine professionnelle puisse être identifiée, il est important de savoir quels métiers/secteurs d'activité sont possiblement à risque. L'objectif de cet article est de présenter les 6 principaux sites de cancers pour lesquels un lien avec des expositions professionnelles est documenté, de préciser les causes de la sous-déclaration des cancers professionnels, le rôle du médecin traitant travaillant en réseau pluridisciplinaire, ainsi que les outils et les conseils pratiques pour optimiser l'accompagnement des patients/leurs proches.

[Surgical treatment of proximal femur metastases]. / Traitement chirurgical des métastases du fémur proximal.

Aging of the population results in an increase of the incidence of cancer and bone metastases. The proximal femur is one of the most frequent locations of bone metastases. A pathological fracture has a major impact on the quality of life and potentially on survival. In case of impending fracture, prophylactic fixation is therefore strongly recommended. The management of metastases of the proximal femur depends on multiple parameters, life expectancy and fracture risk being the most important ones. If survival is estimated to be less than 6 weeks, surgery is generally not indicated. Beyond 6 weeks, surgical indication essentially depends on location of the metastases on the proximal femur and the presence of a fracture.

L'augmentation de l'espérance de vie s'accompagne d'une croissance de l'incidence des cancers et des métastases osseuses. Le fémur proximal est un des sites les plus fréquents de métastases osseuses. Une fracture pathologique dans cette localisation a un impact majeur sur la qualité de vie et potentiellement sur la survie du patient. Un traitement chirurgical prophylactique est ainsi recommandé en cas de risque de fracture imminente. La prise en charge des métastases fémorales proximales se décide en fonction de multiples paramètres, dont la survie théorique et le risque de fracture sont les plus importants. Si la survie est estimée à moins de 6 semaines, une chirurgie n'est en général pas indiquée. Au-delà, l'indication chirurgicale dépend essentiellement de la localisation des lésions et de la présence d'une fracture associée.

[Sarcoma centres : a necessary tool in the management of patients and for research.] / Centre des sarcomes : un nouvel outil pour améliorer la prise en charge du patient et soutenir la recherche.

Sarcomas are rare diseases, the treatment of which requires an appropriate technical plateform and a broad spectrum of multidisciplinary specialists. Many are initially treated by unplanned excision, and then referred to specialized centres. Secondary treatments may lead to higher complication rates and local recurrence, with lower functional outcome, life quality and possibly overall survival. In order to improve the accessibility for referral to a specialist centre, the coordination of clinical and research activities, and the quality of the management of sarcomas in general, Lausanne University Hospital (CHUV) has opened a Sarcoma centre on October 1st 2016. The objective of the present paper is to illustrate the concept and provide useful clinical recommendations.

Les sarcomes sont des maladies rares, dont la prise en charge multidisciplinaire nécessite un plateau technique important. Ils font souvent l'objet d'une excision initiale accidentelle, nécessitant une reprise en milieu spécialisé, avec un risque majoré de complications et de récidive locale, un impact sur la fonction, voire la survie. La prise en charge des sarcomes est réservée aux centres de référence, où il est souvent difficile pour le praticien de trouver un interlocuteur à qui adresser un patient ou demander un avis. Pour les cliniciens et les chercheurs, il est souvent compliqué de coordonner les activités. Pour en améliorer la prise en charge globale, le CHUV a donc créé un centre des sarcomes, inauguré le 1er octobre 2016. Le présent article a pour but d'illustrer cette problématique et de rappeler quelques données cliniques utiles.

Work-Related Mental Health Problems in Switzerland.

OBJECTIVE: The study identifies work-related risk factors that are relevant to mental health and quantifies their influence. This allows estimation of risk levels for individual workplaces and of the proportion of occupational causation in the emergence of mental health problems. METHODS: Swiss Health Survey data, containing information on several potential risk factors and health indicators that cover aspects of mental health, were used in multiple multivariate logistic regression analyses. RESULTS: Stress was the predominant risk factor, followed by exposure to violence, unergonomic work processes, and work that conflicted with family life. Hotel and restaurant industries and health and social services had high exposure to risk factors. One of 20 workplaces was deemed high-risk based on an odds ratio >4. CONCLUSIONS: Up to one-third of mental health problems within the active workforce may have highly predominant occupational causation.

Should systemic sclerosis be recognised as an occupational disease in Switzerland?

Systemic sclerosis is a rare autoimmune disease characterised by a multifactorial aetiology involving a gene–environment interaction. Despite the growing epidemiological arguments for odds ratio (OR) data showing an association with occupational exposure, systemic sclerosis is not currently included in the list of recognised occupational diseases in Switzerland, unlike other northern European countries. Future recognition will be conditional on the demonstration of a strong association between the disease and occupational exposure in the scientific literature. The present article’s main goal is to present five cases of systemic sclerosis investigated for possible occupational aetiologies during occupational pathology consultations at the Institute for Work and Health, in Lausanne. The occupational aetiologies of these cases are discussed against the background of a literature review of publications from the past 20 years in order to determine whether recognition as an occupational disease is possible within Switzerland’s legal framework. Epidemiological studies of systemic sclerosis have identified strong associations with occupational factors such as exposure to silica and solvents, with ORs >2, and weaker associations with epoxy resins and welding fumes. Other occupational exposures are also known to induce systemic sclerosis-like diseases, such as vinyl chloride disease and toxic oil syndrome. All five patients had been exposed to either silica, solvents, or both. Given their exposure and the data in the literature, four patients had their cases declared to their accident insurance companies and two of them were recognised as suffering from an occupational disease by the Swiss National Accident Insurance Fund. Our literature review enabled us to design a short questionnaire to help general practitioners and rheumatologists to identify those patients with systemic sclerosis who are likely to have their illness recognised as an occupational disease.