Prevention of silica health effects in Italy: current challenges for the Occupational Health and Safety Unit of the Italian National Health Service.

BACKGROUND: Since its foundation in 2002, the Italian Silica Network (NIS), a collaborative network of professionals and public authorities, has been engaged in several aspects of research, control, and prevention of silica exposure and effects, and also in support for compensation claims for silica-related occupational health effects in Italy. METHODS: We start with a report on the NIS point of view concerning the recent scientific results (from epidemiology and laboratory studies), including those carried out by NIS in cooperation with Italian universities and other public agencies. This is followed by a description of the data on silica exposure in different Italian workplaces and guidelines for the management of occupational exposure to silica, as developed by two model regional programmes for the ceramics industry, metal foundries and tunnel excavation. RESULTS: The NIS initiatives highlighted the persistence of workplace conditions posing a significant risk for silica-related health effects, particularly in small industries and workshops. Experimental work has also shown that a number of physical and chemical factors affect the bioreactivity of silica particles. CONCLUSION: Based on NIS experience, it appears clear that currently conditions exist in Italy so as to positively contribute to the WHO Programme for the eradication of silicosis and the other diseases related to silica exposure. In order to achieve this goal, a coordinated and wide-ranging effort is required to reduce the wide gap in specific prevention activities, particularly in small industries and workshops, where high levels of silica exposure sometimes occur.

[Judgement of fitness to work and forensic-medical aspects]. / Giudizio di idoneità e aspetti medico-legali.

The occupational physician, specifically trained in radiation protection, has to consider different criteria, such as psycho-physical ability, biological fitness and worker's validity to formulate judgement of fitness to work in exposure to ionizing radiation (IR). According to National Legislations (D.Lgs. 230/95; DM 488/2001), there are different possible outcomes about fitness to work criteria: absolutely fit to work, partially fit to work, not fit to work and medical examination before workers exposed to IR's retirement; besides, the occupational physician has to pay particular attention to evaluate individual hypersusceptibility conditions. Stochastic somatic diseases require a "not fit to work" judgement, an occupational disease complaint to the Insurance Institute and a report obligation. Forensic-medical ascertainment of diseases caused by radiation exposure needs different criteria, particularly for stochastic effects. The most suitable criterion, applied to attribute etiologic role in stochastic effects, is "Probability of Causation" theory, deriving from scientific literature evidence. This theory is an epidemiology-based method conceived to evaluate the probability of a linkage between a specified cancer and an exposure. Judgement of fitness to work in case of neoplasia partial or complete remission should be based on objective considerations, giving particular importance to the human and social aspects.

[Health surveillance guidelines after the European directive on electromagnetic fields]. / Linee guida di sorveglianza sanitaria dopo la Direttiva Europea sui campi elettromagnetici.

Directive 2004/40/CE of the European Parliament points out what an occupational physician has to do in case of scientifically evident effects of electromagnetic fields, meaning for evident effects, those one based on the agreement of the scientific community about their causal agents. The Directive, instead doesn't mention physician's tasks in case of possible effects for the exposure to occupational risk. Health surveillance is the estimation of the worker's state of health and it is indispensable to elaborate an evaluation of job-fitness. The clinical test must include the anamnesis, the medical examination and some diagnostic checks (diagnostic laboratory outline), which supply the occupational physician with a complete clinical picture showing any latent pathology or any conditions of individual hypersusceptibility. Anamnestic and clinical data are collected with a standardized system, all the several frequencies of the electromagnetic spectrum are analysed and the diagnostic protocols concerning eyes, skin, and hematopoietic system are established. Also data of periodical medical examinations and "minimum" complementary checks are established: for ELF, radiofrequencies and microwaves a medical examination with a hematological and biochemicals analysis and eye test and electrocardiogram are necessary every two years. Every occupational physician engaged in health surveillance has to keep up with the evolution of the scientific knowledge and he must observe the possible health damages for workers exposed to electromagnetic radiations: this is a deontological responsibility of the occupational physicians to respect the "precautionary principle".

[The point of view of the Italian Association of Medical Radioprotection: proposal of the Italian C.E.M. Observatory]. / Il punto di vista dell'Associazione Italiana di Radioprotezione Medica: proposta di Osservatorio italiano C.E.M.

Taking in consideration the suggested guide-lines for the health-surveillance on workers exposed to N.I.R. and in particular to ELF and radio-frequency, a work-group of A.I.R.M. suggests the constitution of an italian network for electro-magnetic fields. An observatory will be founded to value the professional exposures and the undue situations of risk, a parallel one will take the census of the workers subdivided into classes for exposure levels, pathologies or symptomatologies imputable to electro-magnetic fields. This suggestion is addressed to the national environmetal hygienists and occupational physicians that are interested.