Protocol for evaluating a workplace intervention within the framework of consultations for suffering at work in French-speaking Switzerland.

Psychosocial suffering involves diverse human, social and economic costs. Some 34.4% of workers in Switzerland report chronic stress related to their jobs. Medical consultations for suffering at work aim to maintain-or renew-patients' abilities to make decisions and act following a diagnosis of psychological suffering related to their work; they also aim to help workers return to their workstations or remain there. Workplace interventions by consulting occupational physicians can go beyond the subjective issues: they can be offered to employees, in anticipation of a return to work when this appears feasible from the outset. To qualitatively evaluate perceptions of workplace interventions and identify their effects by collecting the verbatim statements of employees and their employers. Qualitative single-centre study of workplace interventions conducted by the Consultation Service for Suffering at Work's occupational physicians for patients seen between January 2015 to December 2017. Nineteen workplace interventions took place, out of 184 different consultations. The verbatim statements of employees and their employers will be collected over a variable timeframe, using semi-structured face-to-face interviews. These will then be recorded, transcribed and analysed. Fourteen patients refused the workplace intervention. Their professional path will be collected for comparison and exploratory purposes. This exploratory research project will provide a better understanding of the issues surrounding work-related psychological suffering and of which strategies support patients most effectively

Protection of pregnant women at work in Switzerland: implementation and experiences of maternity protection legislation

Objectives. Like most industrialized countries, Switzerland has introduced legislation to protect the health of pregnant workers and their unborn children from workplace hazards. This study aims to assess legislation’s degree of implementation in the French-speaking part of Switzerland and understand the barriers to and resources supporting its implementation. Methods. Data were collected using mixed methods: (1) an online questionnaire send to 333 gynecologist-obstetricians (GOs) and 637 midwives; (2) exploratory semi-structured interviews with 5 workers who had had a pregnancy in the last 5 years. Results. Questionnaire response rates were 32% for GOs and 54% for midwives. Data showed that several aspects of the implementation of maternity protection policies could be improved. Where patients encounter workplace hazards, GOs and midwives estimated that they only received a risk assessment from the employer in about 5% and 2% of cases, respectively. Preventive leave is underprescribed: 32% of GOs reported that they “often” or “always” prescribed preventive leave in cases involving occupational hazards; 58% of GOs reported that they “often” or “always” prescribed sick leave instead. Interviews with workers identified several barriers to the implementation of protective policies in workplaces: a lack of information about protective measures and pregnancy rights; organizational problems triggered by job and schedule adjustments; and discrepancies between some safety measures and their personal needs. Conclusions. Results demonstrate the need to improve the implementation and appropriateness of maternity protection legislation in Switzerland. More research is required to identify the factors affecting its implementation

Traumatologie de la personne âgée : une urgence nutritionnelle ? [Elderly orthopedic patients: Is nutritional support needed?]

La fracture de hanche chez la personne âgée reste un problème de santé publique. Elle est la conséquence d'une chute neuf fois sur dix et survient chez des personnes fragilisées par une ostéoporose, une sarcopénie, une dénutrition. Dans un service de traumatologie, la dénutrition protéino-énergétique est fréquente. Présente dès l'admission chez environ un patient sur deux, elle va souvent s'aggraver pendant le séjour hospitalier et favoriser la survenue de complications. Une prise en charge nutritionnelle doit impliquer une équipe multidisciplinaire qu'il faut coordonner. Elle doit être envisagée précocement pendant le séjour hospitalier et privilégier la voie orale. L'assistance nutritionnelle sous forme de CNO a prouvé son efficacité dans la réduction de la morbidité postopératoire. Son impact sur la mortalité, sur le pronostic fonctionnel et social reste discuté. Il faudra attendre l'étude de nouvelles cohortes dans lesquelles la compliance au traitement est nettement améliorée avant de conclure de manière définitive

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