Pelvic lymph node motion during cone-beam computed tomography guided stereotactic radiotherapy.

Background and purpose: Stereotactic body radiotherapy (SBRT) is increasingly applied for pelvic lymph node recurrence. Thus far, knowledge on pelvic lymph node motion during CBCT-guided SBRT is lacking and the applied margins vary between institutions. This study evaluated pelvic lymph node motion during CBCT-guided SBRT and assessed the currently applied PTV margins of 3 and 5 mm. Material and methods: In total, 45 pelvic lymph node metastases were included. One observer delineated 45 GTVs on planning CT, 224 GTVs on pre-fraction and 216 on post-fraction CBCT. The GTV centroid coordinates were derived from all images for inter- and intrafraction motion analysis. Additionally, we assessed the influence of treatment time and lesion location on lesion motion. The expected coverage of a 3-mm and 5-mm PTV margin was assessed using the inclusiveness index for GTVs on pre- and post-fraction CBCT. Results: Lymph node interfraction motion was limited to 5 mm in 96-97 % of fractions for all translational directions and intrafraction lesion motion was limited to 3 mm in 97-100 % of fractions. Para-rectal lesions (11 %) were associated with significantly larger inter- and intrafraction motion compared to other pelvic locations and treatment duration showed no correlation with lesion motion. The mean (sd) lesion inclusiveness index was 99 % (5 %) for the 5-mm PTV margin and 96 % (9 %) for the 3-mm margin. Conclusion: Pelvic lymph node motion during CBCT-guided stereotactic radiotherapy was within the widely applied PTV margin of 5 mm, providing an opportunity to reduce this margin for pelvic lymph node SBRT.

Evaluation of the fully automated, sample-to-result Seegene STARlet-AIOS platform for detection of SARS-CoV-2, influenza virus A, influenza virus B, and RSV.

Early, accurate, and bulk detection of respiratory pathogens is essential for patient management and infection control. STARlet-All-in-One System (AIOS) (Seegene) is a new, fully automated, sample-to-result, molecular diagnostic platform. This study describes the first evaluation of STARlet-AIOS, by testing the Allplex™ SARS-CoV-2 (AS) and Allplex™ SARS-CoV-2/FluA/FluB/RSV combination (AC) assays in comparison to the SARS-CoV-2 assays used at our institute. Over a 3-week period, all naso-/oropharyngeal specimens tested for SARS-CoV-2 using either GeneXpert, Panther, or in-house developed test (LDT) were tested on the AIOS using the AS or AC assays. In addition, retrospective cohorts of specimens containing SARS-CoV-2, influenza virus A, influenza virus B, and RSV were tested. Discrepant results were re-tested with another assay used in this study. Hands-on time (HOT) and turn-around time (TAT) of the different systems were monitored and compared. A total of 738 specimens were tested on the AIOS using the AS assay. In addition, 210 specimens were tested using the AC assay. Overall agreement for SARS-CoV-2 detection was established as 98.5% and 95.2% for the AS and AC assay, respectively. Retrospective testing revealed high agreements for all targets, except for influenza virus A (agreement of 87.5%). HOT of the system was comparable to the HOT of GeneXpert and Panther and TAT comparable to Panther and LDT. The AIOS proved to be a robust sample-to-result system with low HOT and moderate TAT. This study showed reliable detection of SARS-CoV-2, influenza virus B, and RSV, whereas detection of influenza virus A using the AC assay appeared to be suboptimal.

Born into an isolating world: family-centred care for babies born to mothers with COVID-19.

Background: The benefits of facilitating breastmilk feeding and close contact between mother and neonate (family-centred care; FCC) in the perinatal period are well-established. The aim of this study was to determine how the delivery of FCC practices were impacted for neonates born to mothers with perinatal SARS-CoV-2 infection during the COVID-19 pandemic. Methods: Neonates born to mothers with confirmed SARS-CoV-2 infection during pregnancy were identified from the 'EsPnIC Covid paEdiatric NeonaTal REgistry' (EPICENTRE) multinational cohort between 10 March 2020 and 20 October 2021. The EPICENTRE cohort collected prospective data on FCC practices. Rooming-in and breastmilk feeding practice were the main outcomes, and factors influencing each were determined. Other outcomes included mother-baby physical contact prior to separation and the pattern of FCC components relative to time and local site guidelines. Findings: 692 mother-baby dyads (13 sites, 10 countries) were analysed. 27 (5%) neonates were positive for SARS-CoV-2 (14 (52%) asymptomatic). Most sites had policies that encouraged FCC during perinatal SARS-CoV-2 infection for most of the reporting period. 311 (46%) neonates roomed-in with their mother during the admission. Rooming-in increased over time from 23% in March-June 2020 to 74% in January-March 2021 (boreal season). 330 (93%) of the 369 separated neonates had no FCC physical contact with their mother prior, and 319 (86%) were asymptomatic. Maternal breastmilk was used for feeding in 354 (53%) neonates, increasing from 23% to 70% between March-June 2020 and January-March 2021. FCC was most impacted when mothers had symptomatic COVID-19 at birth. Interpretation: This is the largest report of global FCC practice during the COVID-19 pandemic to date. The COVID-19 pandemic may have impacted FCC despite low perinatal transmission rates. Fortunately, clinicians appear to have adapted to allow more FCC delivery as the COVID-19 pandemic progressed. Funding: The National Health and Medical Research Council (Australia): Grant ID 2008212 (DGT), Royal Children's Hospital Foundation: Grant ID 2019-1155 (EJP), Victorian Government Operational Infrastructure Support Program.

Androgen Deprivation therapy for Oligo-recurrent Prostate cancer in addition to radioTherapy (ADOPT): study protocol for a randomised phase III trial.

BACKGROUND: More than 60% of oligo-recurrent prostate cancer (PCa) patients treated with metastasis-directed radiotherapy (MDRT) develop biochemical recurrence within 2 years. This recurrence rate emphasises the need for improved treatment and patient selection. In line with the treatment of primary PCa, the efficacy of MDRT may be enhanced when combined with androgen-deprivation therapy (ADT). Furthermore, the availability of PSMA PET/CT offers an excellent tool for optimal patient selection for MDRT. This phase III randomised controlled trial will investigate the role of the addition of ADT to MDRT in oligo-recurrent PCa patients selected with PSMA PET/CT to enhance oncological outcome. METHODS: Two hundred and eighty patients will be randomised in a 1:1 ratio to the standard treatment arm (MDRT alone) or the experimental arm (MDRT + 6 months ADT). Patients with biochemical recurrence after primary treatment of PCa presenting with ≤ 4 metastases will be included. The primary endpoint is the 2.5-year metastases progression-free survival (MPFS). Secondary endpoints are acute and late toxicity, quality of life, biochemical progression-free survival, overall survival, and the sensitivity of the PSMA PET/CT for detecting oligometastases at low PSA-levels. So far, between March 2020 and December 2021, one hundred patients have been included. DISCUSSION: This phase III randomised controlled trial will assess the possible benefit of the addition of 6 months ADT to MDRT on metastases progression-free survival, toxicity, QoL and survival in PCa patients with 1-4 recurrent oligometastatic lesions. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04302454 . Registered 10 March 2020.

Phase III randomised controlled trial on PSMA PET/CT guided hypofractionated salvage prostate bed radiotherapy of biochemical failure after radical prostatectomy for prostate cancer (PERYTON-trial): study protocol.

BACKGROUND: Salvage external beam radiotherapy (sEBRT) for patients with a biochemical recurrence (BCR) after radical prostatectomy provides a 5-year biochemical progression-free survival up to 60%. Multiple studies have shown that dose escalation to the primary prostate tumour improves treatment outcome. However, data is lacking on the role of dose escalation in the recurrent salvage setting. The main objective of the PERYTON-trial is to investigate whether treatment outcome of sEBRT for patients with a BCR after prostatectomy can be improved by increasing the biological effective radiation dose using hypofractionation. Moreover, patients will be staged using the PSMA PET/CT scan, which is superior to conventional imaging modalities in detecting oligometastases. METHODS: The PERYTON-study is a prospective multicentre open phase III randomised controlled trial. We aim to include 538 participants (269 participants per treatment arm) with a BCR after prostatectomy, a PSA-value of < 1.0 ng/mL and a recent negative PSMA PET/CT scan. Participants will be randomised in a 1:1 ratio between the conventional fractionated treatment arm (35 × 2 Gy) and the experimental hypofractionated treatment arm (20 × 3 Gy). The primary endpoint is the 5-year progression-free survival after treatment. The secondary endpoints include toxicity, quality of life and disease specific survival. DISCUSSION: Firstly, the high rate of BCR after sEBRT may be due to the presence of oligometastases, for which local sEBRT is inappropriate. With the use of the PSMA PET/CT before sEBRT, patients with oligometastases will be excluded from intensive local treatment to avoid unnecessary toxicity. Secondly, the currently applied radiation dose for sEBRT may be too low to achieve adequate local control, which may offer opportunity to enhance treatment outcome of sEBRT by increasing the biologically effective radiotherapy dose to the prostate bed. TRIAL REGISTRATION: This study is registered at ClinicalTrials.gov (Identifier: NCT04642027 ). Registered on 24 November 2020 - Retrospectively registered. The study protocol was approved by the accredited Medical Ethical Committee (METc) of all participating hospitals (date METc review: 23-06-2020, METc registration number: 202000239). Written informed consent will be obtained from all participants.

Source and Relevance of the BK Polyomavirus Genotype for Infection After Kidney Transplantation.

BACKGROUND: BK polyomavirus (BKPyV)-associated nephropathy (BKPyVAN) is a major threat for kidney transplant recipients (KTRs). The role of specific BKPyV genotypes/serotypes in development of BKPyVAN is poorly understood. Pretransplantation serotyping of kidney donors and recipients and posttransplantation genotyping of viremic recipients, could reveal the clinical relevance of specific BKPyV variants. METHODS: A retrospective cohort of 386 living kidney donor-recipient pairs was serotyped before transplantation against BKPyV genotype I-IV viral capsid protein 1 antigen, using a novel BKPyV serotyping assay. Replicating BKPyV isolates in viremic KTRs after transplantation were genotyped using real-time polymerase chain reaction and confirmed by means of sequencing. BKPyV serotype and genotype data were used to determine the source of infection and analyze the risk of viremia and BKPyVAN. RESULTS: Donor and recipient BKPyV genotype and serotype distribution was dominated by genotype I (>80%), especially Ib, over II, III and IV. Donor serotype was significantly correlated with the replicating genotype in viremic KTRs (P < .001). Individual donor and recipient serotype, serotype (mis)matching and the recipient replicating BKPyV genotype were not associated with development of viremia or BKPyVAN after transplantation. CONCLUSIONS: BKPyV donor and recipient serotyping and genotyping indicates the donor origin of replicating BKPyV in viremic KTRs but provides no evidence for BKPyV genotype-specific virulence.

[The use of the permanent sample (eps) to study the returnto- work after cancer. Challenges and opportunities for research]. / Utilisation de l'échantillon permanent (eps) pour l'étude du retour au travail après cancer. Défis et opportunités pour la recherche.

INTRODUCTION: The introduction of early cancer detection and the improvement in treatment efficacy have led to a significant increase in the survival and the prevalence of (ex) cancer patients. Approximately 40 % of new cancer cases are diagnosed every year in the working age population (20-64 years). Maintaining their quality of life results, among others, in their retain on the labour market. Even though it is necessary to realize the scale of the phenomenon and to plan interventions, no measure allows assessing the rate of return to work among of (ex) cancer patients in Belgium nowadays. METHODS: We observe during a five-year period the socio-professional status (inability, disability, unemployment or death) of 645 workers identified in the permanent sample (EPS), having had an oncological multidisciplinary consultation (MOC) in 2011. RESULTS: By the end of follow-up, 24 % of the workers were deceased. Among those who survived 26 % are unable to work, 12 % are unemployed and 63 % do not receive any social benefit. Women and young workers (20-44 years) seemed to have encountered difficulties the most. CONCLUSIONS: The results of this study allow giving a prudent first estimation of the return to work of socially insured Belgian citizens of almost 40 %, five years after the first MOC. Nevertheless, the structure of the EPS presents many limitations to the interpretation and reliability of results. We suggest some modifications of the EPS that might offer scientists better opportunities to improve the performance and reliability of such cohort studies.

INTRODUCTION: L'introduction de la détection précoce des cancers et l'amélioration de l'efficacité des traitements ont mené à une augmentation significative de la prévalence d'(ex) patients. A peu près 40 % des nouveaux cancers sont diagnostiqués chaque année dans la population active (20-64 ans). Le maintien de leur qualité de vie passe, notamment, par leur maintien sur le marché du travail. Bien que nécessaire pour évaluer l'ampleur du phénomène et planifier des interventions spécifiques, aucune mesure ne permet actuellement d'établir avec précision le taux de réinsertion professionnelle des travailleurs atteints de cancer en Belgique. Matériel et Méthodes : Nous observons durant cinq ans le statut socioprofessionnel (incapacité de travail, invalidité, chômage ou décès) de 645 travailleurs identifiés dans l'échantillon permanent (EPS) ayant eu une première consultation oncologique multidisciplinaire (COM) en 2011. Résultats : Au terme du suivi, 24 % des travailleurs sont décédés. Parmi les travailleurs ayant survécu, 26 % sont en incapacité de travail, 12 % sont au chômage et 63 % ne bénéficient d'aucun revenu de remplacement. Les femmes et les jeunes travailleurs (20-44 ans) semblent rencontrer le plus de difficultés pour le retour au travail. CONCLUSIONS: Les résultats de cette étude permettent d'avancer une première estimation du retour au travail des assurés sociaux belges atteints de cancer à un peu moins de 40 %, cinq ans après la première COM. Toutefois, la structure et les données de l'EPS présentent de nombreuses limites pour l'interprétation et la fiabilité des résultats. Nous suggérons quelques modifications des données de l'EPS qui offriront aux scientifiques des opportunités pour améliorer la réalisation et la fiabilité de telles études de cohorte.

Pretransplantation Donor-Recipient Pair Seroreactivity Against BK Polyomavirus Predicts Viremia and Nephropathy After Kidney Transplantation.

Kidney transplant donors are not currently implicated in predicting BK polyomavirus (BKPyV) infection in kidney transplant recipients. It has been postulated, however, that BKPyV infection originates from the kidney allograft. Because BKPyV seroreactivity correlates with BKPyV replication and thus might mirror the infectious load, we investigated whether BKPyV seroreactivity of the donor predicts viremia and BKPyV-associated nephropathy (BKPyVAN) in the recipient. In a retrospective cohort of 407 living kidney donor-recipient pairs, pretransplantation donor and recipient sera were tested for BKPyV IgG levels and correlated with the occurrence of recipient BKPyV viremia and BKPyVAN within 1 year after transplantation. Donor BKPyV IgG level was strongly associated with BKPyV viremia and BKPyVAN (p < 0.001), whereas recipient BKPyV seroreactivity showed a nonsignificant inverse trend. Pairing of high-BKPyV-seroreactive donors with low-seroreactive recipients resulted in a 10-fold increased risk of BKPyV viremia (hazard ratio 10.1, 95% CI 3.5-29.0, p < 0.001). In multivariate analysis, donor BKPyV seroreactivity was the strongest pretransplantation factor associated with viremia (p < 0.001) and BKPyVAN (p = 0.007). The proportional relationship between donor BKPyV seroreactivity and recipient infection suggests that donor BKPyV seroreactivity reflects the infectious load of the kidney allograft and calls for the use of pretransplantation BKPyV serological testing of (potential) donors and recipients.

Fusobacterium necrophorum, an emerging pathogen of otogenic and paranasal infections?

Fusobacterium necrophorum is a rare causative agent of otitis and sinusitis. Most commonly known is the classic Lemièrre's syndrome of postanginal sepsis with suppurative thrombophlebitis of the jugular vein. We report five patients diagnosed recently with a complicated infection with F. necrophorum originating from otitis or sinusitis. Two patients recovered completely, one patient died due to complications of the infection, one patient retained a slight hemiparesis and one patient had permanent hearing loss. Diagnosis and management are discussed. A possible factor in the emergence of F. necrophorum is proposed.

Viral loads and antiviral resistance of herpesviruses and oral ulcerations in hematopoietic stem cell transplant recipients.

Ulcerative oral mucositis and infection are frequent complications in hematopoietic stem cell transplant (HSCT) recipients. The aim of this study was to investigate the relationship between oral ulcerations and HSV-1, EBV and CMV excretion and the presence of aciclovir-resistant HSV-1 strains in HSCT recipients. This prospective observational study included 49 adult patients who underwent allogeneic HSCT. In total, 26 patients received myeloablative and 23 received non-myeloablative conditioning. Ulcerations on non-keratinized and keratinized oral mucosa were scored and oral rinsing samples were taken twice weekly. Viral loads were determined by real-time PCR. Samples from patients remaining HSV-1 positive despite antiviral treatment were studied for resistance to antivirals. Having an HSV-1 or EBV DNA-positive sample was a significant predictor for ulceration of keratinized mucosa. HSV-1 was a significant predictor for ulcerations on non-keratinized mucosa as well. Persistent HSV-1 infection occurred in 12 of 28 patients treated with antiviral medication and aciclovir-resistant HSV-1 was found in 5 persistent infections. In conclusion, HSV-1 is a predictor of ulcerations on non-keratinized as well as keratinized oral mucosa following HSCT. The role of EBV deserves further study. Persistent HSV-1 replication despite antiviral treatment is common and is due to resistance in 18% of treated patients.

Population inversion in a magnetized hydrogen plasma expansion as a consequence of the molecular mutual neutralization process.

A weakly magnetized expanding hydrogen plasma, created by a cascaded arc, was investigated using optical emission spectroscopy. The emission of the expanding plasma is dominated by H{α} emission in the first part of the plasma expansion, after which a sharp transition to a blue afterglow is observed. The position of this sharp transition along the expansion axis depends on the magnetic field strength. The blue afterglow emission is associated with population inversion of the electronically excited atomic hydrogen states n=4-6 with respect to n=3. By comparing the measured densities with the densities using an atomic collisional radiative model, we conclude that atomic recombination processes cannot account for the large population densities observed. Therefore, molecular processes must be important for the formation of excited states and for the occurrence of population inversion. This is further corroborated at the transition from red to blue, where a hollow profile of the excited states n=4-6 in the radial direction is observed. This hollow profile is explained by the molecular mutual neutralization process of H2+ with H⁻, which has a maximum production for excited atomic hydrogen 1-2 cm outside the plasma center.

Mixed-mode failure strength of implant-cement interface specimens with varying surface roughness.

Aseptic loosening at the implant-cement interface is a well-documented cause of failure in joint arthroplasty. Traditionally, the strength of the implant-cement interface is determined using uni-axial normal and shear loading tests. However, during functional loading, the implant fixation sites are loaded under more complex stress conditions. For this purpose, the strength of the implant-cement interface under mixed-mode tensile and shear loading conditions was determined in this study using interface specimens with varying interface roughness. For the lowest roughness value analyzed (R(a)=0.89 µm), the interface strength was 0.40-1.95 MPa at loading angles varying between pure tension and shear, whereas this was 4.90-9.90 MPa for the highest roughness value (R(a)=2.76 µm). The interface strength during pure shear (1.95-9.90 MPa) was substantially higher than during pure tension (0.58-6.67 MPa). Polynomial regression was used to fit a second-order interpolation function through the experimental interface strength data (R²=0.85; p<0.001), relating the interface strength (S [MPa]) to the interface loading angle (α [degrees]) and interface roughness (R(a) [µm]): S(α,R(a))=0.891R²(a)+0.001α²-0.189R(a)-0.064α-0.060. Finally, an interface failure criterion was derived from the interface strength measurements, describing the risk of failure at the implant-cement interface when subjected to a certain tensile and shear stress using only the interface strength in pure tensile and shear direction. The findings presented in this paper can be used in numerical models to simulate loosening at the implant-cement interface.

Evaluation of 99mTc-UBI 29-41 scintigraphy for specific detection of experimental multidrug-resistant Staphylococcus aureus bacterial endocarditis.

AIM: The aim of this paper was to test the ability of technetium-99m labelled synthetic peptide UBI 29-41 scintigraphy (99mTc-UBI 29-41), composed of the antimicrobial peptide ubiquicidin, specifically targets microorganisms in to discriminate between infected and uninfected endocarditis using a rat model previously validated. METHODS: 99mTc-UBI 29-41 scintigraphy was evaluated for its accumulation in infective endocarditis (IE) with multidrug resistant Staphylococcus aureus (MRSA) performed in an experimental rat model, resembling early endocarditis in humans. Serial planar scintigraphic and biodistribution analysis of infected vegetations are compared to rats with sterile vegetations. Heart-to-lung uptake ratios (T/NT ratios) were calculated in both with in-vivo scintigraphy and in ex vivo tissue samples. RESULTS: Bacterially infected vegetations were already observed at 15 min after injection of 99mTc-UBI 29-41 while no significant uptake was observed in sterile vegetations. Moreover, a good correlation (R2=0.819) was calculated between T/NT ratios of 99mTc-UBI 29-41 and the number of viable MRSA present in the infected vegetation. There was no correlation between the 99mTc-UBI 29-41 uptake and the weight of the vegetations in either case. CONCLUSION: In this experimental study in rats, planar 99mTc-UBI 29-41 scintigraphy permitted early and specific detection of MRSA induced endocarditis. Furthermore, accumulation of the tracer depends on the number of viable MRSA and not on the weight of the vegetation. This proof of principle offers much promise that 99mTc-UBI 29-41 scintigraphy can be a dedicated non-invasive imaging tool for the early detection of infective endocarditis. Finally, this model has to be further evaluated with state-of-the art small imaging modalities.

[Health problems in textile industry in Democratic Republic of Congo]. / Problèmes de santé dans l'industrie textile en République Démocratique du Congo.

The objective of this work was to highlight the influence of the occupational conditions on the textile sector workers' health in Democratic Republic of Congo (DRC). We conduct an exploratory cross-sectional study of two populations within a plant located at the North of the DRC: workers (N=114) and executive or employees (N=96). Our total sample data (N=210) were collected by a questionnaire focused on the procedures, the exposures and the effects on health. Odds ratio (OR) and confidence interval at 95% were estimated. For each significant diseases symptom, a regression model has been achieved in order to estimate OR adjusted for association of disease symptoms and occupational statute. Workers compared to employees present high frequencies and exposure rates for many diseases symptoms. These OR are respectively for cough (OR = 5.1; IC: 2.93-10.68); respiratory difficulty (OR = 2.9; IC: 1.42-6.42) thoracic pain (OR = 2.6; IC: 1.31-5.24); fever (OR = 2.4; IC: 1.27-4.50); upper limbs pain (OR = 4.8; IC: 2.55-8.80); neck-shoulder pain (OR = 3.8; IC: 2.02-7.31); ocular diseases (OR = 2.2; IC: 1.17-3.89) and cutaneous diseases (OR = 2.5; IC: 1.18-5.46). The OR related to the libido loss is highest (OR = 5.5; IC: 2.84-10.71). In the other hand, the OR of the neuropsychics disorders are lower than 1 in this comparison and are respectively of 0.5 (0.28-0.95) for tiredness; 0.2 (0.08-0.28) for the lack of concentration and 0.07 (0.04-0.18) for the stress. In conclusion, the frequencies and high OR observed attest differences of the health issues between the workers and employees whose causes could be under the live and work conditions. These results should be confronted with those of other studies in health at the work.

[Health impact of working conditions at the Ruashi mine in the Democratic Republic of Congo]. / Impact des conditions de travail sur la santé des artisans miniers de la Ruashi (République Démocratique du Congo).

OBJECTIVE: The purpose of this study was to evaluate the health impact of working conditions at the Ruashi mine in the Katanga Province in the Democratic Republic of Congo. MATERIALS AND METHODS: A cross-sectional etiological study was conducted in two cohorts including 100 miners and 109 students. Data necessary to allow comparison disease symptoms in the two cohorts were collected using a questionnaire. Odds ratios (OR) and 95% confidence intervals (95% CI) were estimated. A secondary analysis was performed to compare different mine workstations, i.e., diggers (n=61) versus non-diggers (n=39). Two logistical regression models were used to estimate adjusted OR and 95% CI for the association between occupation/workstation and disease symptoms. RESULTS: In comparison with students, miners exhibited higher frequencies for all symptoms even after adjustment. The highest ORs were observed for musculoskeletal disorders, i.e., low back pain (OR=36.5) and upper (OR = 20.7) or lower (OR = 18.3)] extremity pain. They were followed by respiratory disorders (OR = 5.91) and headache (OR = 5.34). CONCLUSION: The high exposure frequencies and OR's observed in this study underline the negative health impact of mine working conditions. Further occupational study will be needed to obtain and compare more data.

[Occupational physician roles]. / Les rôles du médecin du travail.

Occupational medicine is an important medical discipline in Belgium, with about one thousand of experts. Roles of the occupational physicians must be analyzed on the basis both of legal prescriptions and real practice. The examination of the roles of the occupational physician in various countries shows that regulation are an important legal framework from which he can deploy his practice. A contrario it is also the means which makes it possible to the unions and the management to force him. However the real roles are definitely broader than the regulations let understand, concerning very diverse fields which make this medical discipline a real preventive general medicine. It is less and less a public health discipline and approaches gradually in practice the clinical disciplines, in the sense that the singular colloquium, the knowledge of the particular work places and risks of every worker and the individualization of the action are its bases. On the other hand, fitness for work assessments and its procession of authoritarian medical and administrative acts, heritages of the public health, hardly efficient, should largely disappear from the prescriptions. It will allow for a wider deployment of the activity of the occupational physician towards the industrial organisations, by proposing the necessary adaptations of the work places, the limitations of exposure to harmful effects, the remediation of the psychosocial load, etc, through "preventive prescriptions". Complementarily, the population ageing imposes new solutions to rehabilitate the old workers, and this will be likely to modify, not only the medical approach in work environment, but also already imposes a closer cooperation with the general practitioner, which is likely to improve the action abilities of both medical disciplines.

[Relations between the occupational physician and the general practitioner]. / Les relations entre le médecin du travail et le médecin généraliste.

The occupational physician (OP) and the general practitioner (GP) both aim at maintaining and promoting public health. The attending physician is the physician who has been freely chosen by the patient whilst the occupational physician is assigned by the company. Although synergy between both professions might seem obvious, in reality it is not always so. The focus of the occupational physician's work is on the worker in his work place. Through health monitoring action and knowledge of jobs and positions, the occupational physician aims to contribute to the improvement of well-being at work. Medical examinations result in drafting a form stating the person's ability or inability to occupy his/her assigned job. In line with the required respect for the patient's rights and, hence, with his/her authorization, the GP may transmit the medical information the said GP deems useful to the OP, e.g. back-to-work medical examinations and pre-back-to-work medical consultations are opportunities to establish a contact between both practitioners in view of considering the possibilities of adapting the workplace situation at the time of resumption of work. The GP should know that there exists an appeal opportunity with the Office in charge of Monitoring Well-being at Work (Employment Federal Public Service) against a decision that by which the worker is not allowed to stay in his assigned work task. During the medical examinations the OP may endorse the action of the GP by strengthening the worker/patient's awareness of the fact that his/her health problems must be adequately taken into account and by organizing information sessions about general interest campaigns about, for instance, cardiovascular risk prevention or a campaign about quitting smoking or reducing alcohol consumption to a more sensible and reasonable level. Knowledge of delayed effects of professional exposure should be consolidated in GPs; the possibility of drawing attention to one's suspicions about occupational illnesses to the Fund for Occupational Illnesses must also again brought to mind. In order to establish a follow-up program on the health of patients beyond their professional activity, it is necessary to draft a "liaison document", between the OP and the GP, which identifies the professional risks workers/patients have been exposed to. In sum, it is important to provide GPs with means to identify the patient's OP and consolidate their knowledge of occupational medicine by organizing on-going training modules.

[The missions of the Occupational Diseases Fund. Under-claim and recognition of occupational lung cancer, in particular those related to asbestos]. / Les missions du Fonds des Maladies Professionnelles. La sous-déclaration des cancers respiratoires professionnels, en particulier dus a l'amiante.

The missions of the Occupational Diseases Fund are defined in application of the law regarding the insurance against occupational diseases. The workers covered by this law are granted several rights, such as a financial compensation in case of temporary or permanent disability, a further compensation if they have to be taken away from the risk in the workplace, the reimbursement of health care costs related to the occupational disease, or the payment of an annuity to the widow(er) if death is its ultimate consequence. Among the compensable diseases, we shall focus on lung cancer, and especially the one related to asbestos exposure. This type of cancer is clearly under-registrated in Belgium as in most countries of the European Union, leading to an insufficient number of cases entitled to compensation by our institution. In this instance, the insurance against occupational diseases and all related social advantages are hugely under-exploited in our country. It is our duty to increase doctors' awareness of the problem and spread accurate information to reverse this trend and provide occupational cancer cases with a legitimate compensation, in particular those related to asbestos. A wider knowledge of the occupational history of cancer patients, thanks to occupational physicians, and a better use of mineralogical analyses on lung samples, would improve this situation inacceptable on any level : medical, social or even human.