[Survey on alcohol and construction workers]. / Indagine conoscitiva su alcool e lavoro in edilizia.

On the basis of the data drawn by national and international literature and the introduction of legislation concerning "alcohol and alcohol-related problems" authors studied alcohol consumption in a group of 512 building workers during the periodic health surveillance examination (years 2011-2012). Another group of 209 construction workers were examined for alcohol concentration in expired air and during work on building sites. In the first group, 62.1% of workers refers to drink alcoholic beverages; we found GGT and CTD alterations in about 1/3 of workers who reported high alcohol consumption. Alcohol tests in building sites demonstrated that alcohol consumption during pauses in work is still common.

[The United Nations conventions on the rights of persons with disabilities: which strategies for protection at work?]. / La convenzione O.N.U. sui diritti delle persone con disabilità: quali strategie per la tutela sul lavoro?

More than 15% of the world's population lives with some form of moderate or severe disabilities, a growing percentage due to aging population as well as to the global increase of chronic diseases. The United Nations approved, in December 2006, the "Convention on the Rights of Persons with Disabilities" which dealt with the theme "work and employment". It prohibited discrimination on the grounds of disability with regard to health and safety at work, ensuring safe and healthy working conditions including protection from harassment. The most important expectation for the UN Convention, ratified in Italy by law 18/2009, is the guarantee that disable people in the workplaces are provided with "reasonable accomodation". This term refers to modifications and adaptations which are necessary and appropriate, that do not foresee excessive costs, to be taken, where necessary, to ensure even workers with disabilities the enjoyment and exercise of all their rights.

[Implementation and validation in the Italian context of the HSE management standards: a contribution to provide a practical model for the assessment of work-related stress]. / Contestualizzazione e validazione in Italia del modello management standards HSE quale contributo all'individuazione delle indicazioni per la valutazione dello stress lavoro correlato.

Over the last years, stress has been recognized as a potential work-related risk factor. Unfortunately, work-related stress is a very delicate subject, especially because it is difficult to assess it objectively and in broadly acceptable terms. In fact, work-related stress is a subjective personal response to a specific work environment, ad is of a multifactorial origin. In order to provide a practical tool for the assessment of work-related stress, the authors carried out a thorough benchmarking analysis of the various models to manage work stress problems adopted by EU countries. As a result, the authors have chosen to apply and implement the Health and Safety Executive (HSE) Management Standards approach in the Italian context. In compliance with the European Framework Agreement signed on October 8, 2004, HSE Management Standards ask for the coordinated and integrated involvement of workers and safety personnel and represent a valid assessment approach based on principles widely acknowledged in the scientific literature.

[European experiences on psychosocial factor risks]. / Esperienze europee in tema di rischi psicosociali.

Psychosocial factors are largely recognised in Europe as potentially risks related to work. In the past years, important laws and agreements have been elaborated by European stakeholders in order to have a common regulation across Europe on this area. The aim of the present contribution is to introduce three European models for assessment and management of psychosocial factors risks. These models are HSE, SOBANE and Start. Vantages and disvantages are presented and the future perspectives are suggested.

[Italian D.Law 81/2008: confirmation and news in the subject of work-related stress]. / D.Lgs. 81/2008: conferme e novità in tema di stress correlato al lavoro.

Stress management and prevention measures and the assessment tools most widely used in Italy are reviewed in the light of the issues raised by Italian law D.Lgs. 81/08, particularly as regards assessment of the risk of work-related stress, specifically related to the 2004 European Agreement.

[The ISPESL-SIMLII surveys to develop and address updating and accreditation's projects in occupational medicine]. / Le indagini conoscitive ISPESL-SIMLII per lo sviluppo e l'indirizzo dei progetti di aggiornamento e accreditamento in medicina del lavoro.

The SIMLII set up a program of continuous training and accreditation of postgraduate specialists in Occupational Health in 2000, before continuous medical training (ECM) was formally introduced. Therefore, especially over the past few years, SIMLII has involved its membership to an ever increasing extent, in an attempt to understand their expectation as regards the scientific community and as regards a continuously evolving discipline that is subject to continuous changes in educational requirements. The surveys carried out by the National Institute of Occupational Safety and Prevention (ISPESL), in collaboration with SIMLII, provided data that, besides identifying the type of activity of the membership, attempted to assess members' compliance with the society's initiatives, with special reference to the Programme for continuous training and accreditation of postgraduates in Occupational Health and the issue of Guidelines.

[Medical and risk records]. / La cartella sanitaria e di rischio.

Aim of this report is to outline the importance of personal medical records collected from the occupational health surveillance practice. The Italian law D.Lgs. 81/08 puts a great emphasis on a national information system built up by health monitoring results in workplace as far as individual and general prevention is concerned. Private and public roles and duties are discussed.

[Register of exposed to carcinogens]. / Registro di esposizione a cancerogeni.

Law Decree 626/94 already provided for the "register of exposed subjects" to be implemented by employer once the presence of cancerogenic agents falling into the definition of the norm itself have been assessed in working activities. The lack of an effective decree identifying the models and modalities of register keeping has led so far to an exposure under-evaluation. Of course the coming into force of Ministerial Decree 155/2007, almost at the same time as the new body of regulations made up by Law Decree 81/2008, stimulated the addressees to proceed with setting an exposure register to be forwarded to the National Institute for Occupational Safety and Prevention (ISPESL) and to the competent inspection authority. Starting for the regulations, the authors will go through the register forms and information flow management.

[Work and alcohol abuse: the issues]. / Attività lavorativa ed uso/abuso di alcol: le problematiche.

Law n. 125 "Framework law regarding alcohol and alcohol related problems" came into force in Italy in 2001. According to WHO, approximately 10-30% of work accidents would be alcohol related. Alcoholic beverages at workplace may produce an even remarkable increase of direct risks, because of psychophysical alteration and indirect risks produced by added effect of alcoholic beverages with industrial toxic substances. Even with low alcohol rates, the reaction time becomes longer, error frequency in response to visual or hearing stimulations is higher and hence the risk of accidents becomes sensible. Besides, alcohol-related working performance problems may be caused not only by drinking at work but also by drinking a lot of alcoholic beverages outside working time. In particular, art.15 of L 125/01 in compliance with alcohol use at workplace, forbids consumption or administration of alcoholic and superalcoholic beverages during activities at high risk for safety. In this context, the norm provides power-duty to make alcoholmetric concentration checks only to company physician and prevention and safety occupational health service of national health units.

[Evaluation of the role of occupational and environmental exposure to inorganic arsenic in the urinary excretion of the metal: preliminary data]. / Valutazione del ruolo dell'esposizione professionale e ambientale ad arsenico inorganico (iAs) sull'eliminazione urinaria del metallo: dati preliminari.

INTRODUCTION: Urinary inorganic arsenic is an expression of occupational exposure to the metal, provided that there is no history of ingestion of foods containing high concentrations of inorganic and/or organic arsenic. The present study was conducted to assess the contribution of professional and environmental exposure to inorganic arsenic on urinary excretion of the metal. MATERIALS AND METHODS: We examined 195 workers at a steelfoundry in Taranto, exposed to very low concentrations of inorganic arsenic and two control groups consisting of 105 subjects resident near the factory and 144 subjects resident approximately 20 Km away. All participants were administered a questionnaire enquiring about general characteristics, lifestyle, occupational and extra occupational exposure to arsenic. Urinary arsenic was determined by atomic-absorption spectrophotometry. RESULTS: Exposed and non exposed subjects were similar as regards general characteristics and lifestyle. The environmental concentration of arsenic for the foundryworkers was invariably lower than 0.1 microg/m3. Urinary excretion of arsenic was higher in the subjects in all three groups, examined singly and together, if they had eaten crustaceans and/or shellfish in the three days before urine collection. There was a significant positive correlation with the consumption of shellfish and a significant negative correlation with the number of days since the last crustacean/shellfish meal. Multiple regression analysis showed a dependence of urinary elimination of arsenic on the days since the last crustacean/shellfish meal. DISCUSSION: The absence of occupational exposure to arsenic allowed us to attribute the higher urinary elimination of arsenic to ingestion of crustaceans and/or shellfish in the three days before collection of the urine, both in subjects exposed to inorganic arsenic and in the two groups belonging to the general population. Our results support the hypothesis that inorganic arsenic, determined by atomic-absorption spectrophotometry, may derive from the catabolism of organic arsenic compounds contained in crustaceans and/or shellfish included in the diet.

[Training needs and role of general practitioners for preventing measures and medical surveillance of ex-exposed to occupational carcinogens]. / Bisogni formativi e ruolo dei medici di medicina generale per la prevenzione e la sorveglianza sanitaria degli ex esposti a cancerogeni professionali.

The study was aimed at investigating in a sample of general medicine practitioners the level of epidemiologic and law knowledge as well as the degree of sensitivity to the topic of subjects formerly affected by occupational cancer. From the research, carried out on a sample of 745 practitioners from two northern Italy highly industrialized regions, come out the need for training and information on the problems associated with identification and management of subjects formerly exposed to professional cancer.

Needs, education and accreditation in occupational medicine in Italy.

In Europe, continuing medical education is one of the main instruments for improving physicians' performance and ensuring adequate health care for citizens. Recent regulations have made such continuing education compulsory in Italy. Considering the particular features of occupational medicine, the Italian Society of Industrial Medicine and Industrial Hygiene (S.I.M.L.I.I.) recently set up a specific education and accreditation programme for occupational physicians, called the "Excellence Accreditation Scheme". The programme is based on the findings of a survey among occupational physicians, carried out in collaboration with the National Institute of Occupational Safety and Prevention (I.S.P.E.S.L.), which enquired into their training and continuing education needs. The programme started in 2003, and its first edition-presented here-involved more than 400 physicians specialising in occupational health.

[Musculoskeletal disorders and housework in Italy]. / Disturbi muscolo-scheletrici e lavoro domestico in Italia.

The housework exposes to the risk of musculoskeletal disorders, which may appear as disabling diseases, both temporary and permanent ones. To evaluate the epidemiology of the phenomenon a retrospective survey was conducted by administering a mail questionnaire to a sample of 1,000 families residing in the whole national territory. The participation rate was 31.7%. Among respondents 20.5% reported spinal pain, 65.6% of them with continuous pains (41.4% assumed pain-killer drugs). 37.0% of the interviewed persons reported to disorders in upper limbs. It was analysed the association between the presence of disorders and the frequency in making some housework duties. Washing clothes (OR=1.8; C.I. 95%: 0.6-4.5), making beds (OR=1.5; C.I. 95%: 0.2-13.1), and taking care of pets (OR=1.4; C.I. 95%: 0.6-3.4) were associated, even if not in a statistically significant way, with the presence of spinal pain. Upper limbs disorders were associated with duties naturally related to such a disorder, like washing dishes (OR=4.6; C.I. 95%: 1.3-16.5), cleaning clothes (OR=3.1; C.I. 95%: 1.3-7.0), cleaning up carpets (OR=2.3; C.I. 95%: 1.3-3.9). To assist the relatives in state of need was identified as risk factor for both the body areas (OR=2.9; C.I. 95%: 1.2-6.7 for the spine, OR=2.6; C.I. 95%: 1.3-5.2 for upper limbs), putting in evidence the physical stress attributable to the duty. The exact identification of the typology of housework which can induce musculoskeletal disorders, and the level of related risks, are essential information to devise campaigns and protocols of health education aimed at the prevention of chronic pathologies caused by the housework.

[Survey on educational needs in occupational medicine in Italy]. / Indagine conoscitiva sul fabbisogno formativo in medicina del lavoro in Italia.

The importance to correctly address continuing education among occupational health professionals in Italy has been particular in the focus of the Scientific and Professional Medical Community also in consideration of the recent regulations implemented in the field of Continuing Medical Education (CME). The Italian Society of Occupational Medicine recently developed an advanced programme of Continuing Medical Education for Occupational Physician. In order to correctly asses the education needs and collect valid information of Occupational Physicians in Italy we administered a target questionnaire among a group of them. The results are analyzed and discussed.

[Problems related to screening tests for drug addiction at the workplace]. / Le problematiche dei test di dépistage delle dipendenze sui luoghi di lavoro.

The authors review the issues related to implementation of screening procedures and testing for alcohol and drug addiction in occupational safety and health perspectives also in view of international organization regulations and directives.

[Hepatotoxic occupational risk factors]. / Fattori di rischio professionali epatotossici.

In this review the authors present a synthetic and critical analysis of the most recent epidemiological, clinical and experimental studies on the main risk factors thought to cause occupational liver diseases. The aim was to list the main occupational hepatotoxic substances in order to enable the earliest identification of possible occupational liver pathologies and the application of suitable means of prevention in the workplace. The following data emerge from a critical analysis of the studies reported. The list of potentially hepatotoxic substances is certainly very long and reliable evidence of specific toxicity only exists for some; many of these substances are used not only in the professional world, but often outside the workplace. The main route through which lesions occur is by inhalation and, in the case of many substances, also through the skin. In clinical terms, occupational liver pathologies may take an acute, subacute or chronic form, often with comparable symptoms to those found following non-occupational exposure. No particular histological features can be seen, nor are there specific diagnostic means to evaluate individual chemical substances. With regard to the data reported, the authors reach a few conclusions: when formulating an etiological diagnosis of occupational toxic hepatopathy, it is important to bear several aspects in mind such as the characteristics of the workplace (type of activity performed, products handled, working conditions, etc.), lifestyle (hobbies, use of drugs, etc.), varying individual susceptibility; each of these factors contributes to the onset of morbid conditions whose target is the liver.

Noise and gastric secretion.

In view of the increasing incidence of diseases such as gastritis and ulcers in workers exposed to noise, we assessed whether noise does in fact affect gastric secretion. Then, considering the conflicting findings published on the effects of noise on gastric secretion, we also investigated whether the response was related to differences in baseline secretion, and whether it was further modified by a hydroalcoholic meal. We studied 50 dyspeptic subjects engaged in various types of work but not occupationally exposed to noise. They were exposed to a "pink noise" stimulus of 95 dB administered through earphones, lasting 15 minutes. Gastric secretion sometimes remained unchanged, sometimes increased, or sometimes even decreased in relation to the baseline hydrochloric acid secretion. The hydroalcoholic meal did not generally modify the effects of noise. These findings might help explain the differences in previous reports on this question.