[Management of musculoskeletal disorders in primary care medicine]. / Prise en charge des troubles musculosquelettiques en médecine de premier recours.

Musculoskeletal disorders (MSDs) are very common among the general and working Swiss population. The attending physician is often called upon to take care of patients with MSDs. To do this, it is necessary to take into account the contribution of professional and extra-professional factors in the etiology and/or the aggravation of these pathologies. At the same time, multidisciplinary collaboration provides help in treatment, prevention and issues of return and maintaining one's employment.

Les troubles musculosquelettiques (TMS) sont fréquents dans la population active et dans la population générale. Le médecin de famille est souvent amené à prendre en charge ces pathologies. Une prise en charge pluridisciplinaire, avec des spécialistes de rhumatologie et de santé au travail, est recommandée pour la prévention, le traitement et la gestion de la problématique du maintien d'une capacité de travail et du retour au poste après un arrêt de travail. Le travail pluridisciplinaire permet d'investiguer la contribution des facteurs professionnels et extraprofessionnels dans l'étiologie et/ou l'aggravation des TMS et de proposer une prise en charge adaptée.

[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.

[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.

Towards Reference Values for Malondialdehyde on Exhaled Breath Condensate: A Systematic Literature Review and Meta-Analysis.

Many pathological conditions and certain airway exposures are associated with oxidative stress (OS). Malondialdehyde (MDA) is an end-product of the oxidation of lipids in our cells and is present in all biological matrices including exhaled breath condensate (EBC). To use MDA as a biomarker of OS in EBC, a reference interval should be defined. Thus, we sought to summarize reference values reported in healthy adult populations by performing a systematic review and meta-analysis using a standardized protocol registered in PROSPERO (CRD42020146623). Articles were retrieved from four major databases and 25 studies with 28 subgroups were included. Defining the distribution of MDA measured in reference populations with a detection combined with a separation technique still represents a challenge due to the low number of studies available, different analytical methods used, and questionable methodological qualities of many studies. The most salient methodological drawbacks have been in data collection and reporting of methods and study results by the researchers. The lack of compliance with the recommendations of the European Respiratory Society and American Thoracic Society was the major limitation in the current research involving EBC. Consequently, we were unable to establish a reference interval for MDA in EBC.

Urinary Malondialdehyde (MDA) Concentrations in the General Population-A Systematic Literature Review and Meta-Analysis.

Oxidative stress has been associated with various inflammation-related human diseases. It is defined as an imbalance between the production and elimination of reactive oxygen species (ROS). ROS can oxidize proteins, lipids, and DNA, and some of these oxidized products are excreted in urine, such as malondialdehyde (MDA), which is considered a biomarker for oxidative damage of lipids. To interpret changes of this biomarker as a measure of oxidative species overproduction in humans, a background range for urinary MDA concentration in the general population is needed. We sought to establish urinary MDA concentration ranges for healthy adult populations based on reported values in the available scientific literature. We conducted a systematic review and meta-analysis using the standardized protocol registered in PROSPERO (CRD42020146623). EMBASE, PubMed, Web of Science, and Cochrane library databases were searched from journal inception up to October 2020. We included 35 studies (divided into 47 subgroups for the quantitative analysis). Only studies that measured creatinine-corrected urinary MDA with high-performance liquid chromatography (HPLC) with mass spectrometry (MS), fluorescence detection, or UV photometry were included. The geometric mean (GM) of urinary MDA concentration was 0.10 mg/g creatinine and 95% percentile confidence interval (CI) 0.07-0.12. Age, geographical location but not sex, and smoking status had a significant effect on urinary MDA concentrations. There was a significant increasing trend of urinary MDA concentrations with age. These urinary MDA values should be considered preliminary, as they are based on mostly moderate to some low-quality evidence studies. Although urinary MDA can reliably reflect excessive oxidative stress in a population, the influence of physiological parameters that affect its meaning needs to be addressed as well as harmonizing the chemical analytical methods.

Whole body biomechanical burden of healthcare workers: proposal for a complementary risk assessment and management tool (HOARA).

INTRODUCTION: We have developed a new tool, named Holistic Approach Risk Assessment (HOARA), to support occupational safety and health professionals (OSH) in risk assessment and management when evaluating the biomechanical load of healthcare workers. OBJECTIVES: The primary aim of the HOARA is to support OSH in risk assessment and management of biomechanical hazards in healthcare facilities. This tool ensures a superior level of analysis by targeting independently various body compartments during all activities completed throughout the work shift. These include: head, neck, back and upper and lower limbs. METHODS: For each body segment, ergonomic determinants were defined on the basis of previous literature, according to which task and job analyses were performed. Upon direct observation, ergonomic factors were given a score based on their temporal extent. Subsequently, action-body segment raw indices and weighted indices were calculated. RESULTS: Results of the application of the method are shown. Of note, a relational database was set up to improve its usability. CONCLUSIONS: From an occupational health perspective, the HOARA, integrated with other methods, is expected to allow a more effective management of human resources, especially when assigning workers to specific jobs or tasks. Overall, the HOARA will be instrumental in assessing the impact of fitness for work judgments on work organization and its resources, in compliance with the guidelines from the Società Italiana di Medicina del Lavoro (SIML).