National survey on workplace safety and prevention services: regional differences. / Indagine nazionale sui servizi di prevenzione e sicurezza negli ambienti di lavoro: differenze regionali.

BACKGROUND: Occupational Safety and Health (OSH) Services, with inspections and support activities to workers and to enterprises, have a relevant role in the field of safety and health in the workplace. OBJECTIVES: The aim of this study, part of the INSuLa Project, is to realize a national survey about risk perception of OSH and awareness about OSH issues in the context of the Italian OSH legislative framework (Legislative Decree 81/08 and subsequent modifications and integrations) implementation, with involvement of the OSH Services operators. METHODS: The Survey involved a representative national sample of the OSH Services operators. After an analysis of background literature and a comparison with Operating Units involved in the Project, an ad hoc questionnaire was developed and administered to the sample to evaluate the topics of the Survey. RESULTS: The study has been conducted on a sample of 678 OSH Services operators. The Survey showed in Italy an important organizational and procedural inhomogeneity perceived by OSH Services operators. CONCLUSIONS: This study highlighted the relevance perceived by OSH Services operators to develop a system of safety culture dissemination to reduce accidents at work and improve the management of occupational risks (traditional and emerging).

[The INSuLa Project: the survey of training needs in the SPSAL(Service for Prevention and Safety in the Work Environment)]. / Progetto INSuLa: I'indagine sul fabbisogno formative degli SPSAL.

According to Italian Legislative Decree 81/2008 and subsequent modifications the Regions and Autonomous Provinces have a innovative and complex role: 1) to regulate and coordinate the total prevention system and 2) to develop interventions/initiatives through regional/local occupational safety and health (OSH) department using not only inspections and controls but education, training and support. Recommendations also include consolidating the role of actors involved in preventing risks to occupational health throughout occupational safety and health education and training, keys for a successful process to improve prevention system. As result of changing world of work and OSH legislation the INSuLa project has creating a national survey involving of all Italian prevention system actors, in order to evaluate implementation and impact of the actual regulations. According to overall objective of the INSuLA project, for the first time in Italy, we studied about operators in regional/local OSH department. The purpose of this paper is to show and recognize the individual learning paths, the perception of adequacy education degree, the exploring criticalities andthe training needs.

[Occupational health and safety risk: role of the occupational health physician and of the public occupational health and safety services in the workplace]. / Il Medico Competente e la vigilanza sulla volutazione dei rischi nei luoghi di lavoro.

DLgs 626/94 adopted European Directives and changed the Italian field of safety and health at work, involving the Occupational Health Physician in the risk assessment. The actual DLgs 81/08 remarked this role underlying many legal responsibilities. The aim of this paper is to analyse and discuss both the generic and the specific involvement of the Occupational Health Physician in risk assessment and management in the workplace and the role of the Public Occupational Health and Safety Services in the control of the professional duties of Occupational Health Physician dealing with risk assessment and health surveillance.

[The new methodology to produce instruments for updating occupational physician proposed by Italian Society of Occupational Medicine and Industrial Hygiene (SIMLII)]. / Gli strumenti di orientamento e aggiornamento del Medico del Lavoro della Società Italiana di Medicina del Lavoro e Igiene Industriale (SIMLII): criteri e metodi di produzione.

Starting from the experience of last five years, during which 24 guide liens about the most important aspects of Occupational Physician activity have been produced, the Italian Society of Occupational Medicine and Industrial Hygiene (SIMLII) delegated a specific working group for updating the methodology to be adopted for guide lines and other instruments for improving and standardizing the current activity in our professional field. SIMLII produced in the context of the specific Education and Accreditation Programme for occupational physicians prepared from 2002 25 guide lines or other informative instruments on the most important and controversial themes in which our discipline is involved. They were considered and treated to meet the need to improve and standardise activities and to modify the current approach of occupational physicians and aimed not only at improving the effectiveness of preventive actions but also at constantly adopting rigorous methodologies based where possible on evidence based or on consensus procedures. The Directive of SIMLII was firmly convinced about the opportunity-necessity to critically evaluate the experience carried out during the last years, at the light of the National Program for Guide Lines edited By Italian National Health Institute since 2002 and which concerns preparation, dissemination, updating, implementation of guide lines in Medicine. The guide lines were defined as rational critical effective aid addressed to professionals and patients for health services organization. Relevant was the new Framework Act for the occupational safety and health (Decreto legislativo 81/08) too signed by the President of the Italian Republic on April 9, 2008, which for the first time includes and defines in a legislative act the different possible instruments (technical normative, good practices, guide lines). In this paper we present the new methodology defined by our Society for producing the different kind of instruments such as guide lines, consensus conference reports, technology assessments, good practices statements guide lines focusing as the main aspects those related to definitions, argument choice, working group and coordinator identification, producing methods, evidence evaluation, grading, quality evaluation using AGREE method, dissemination procedure, the conflict of interest and the possible use for distance formation procedure focusing the recommendations that take a practical-applicative approach.

Levels of agreement of nerve conduction studies and symptoms in workers at risk of carpal tunnel syndrome.

OBJECTIVE: Information is required on levels of agreement between different sets of median nerve conduction studies (NCS) and symptoms of carpal tunnel syndrome (CTS) in at-risk subjects. METHODS: We performed a reanalysis of an extensive data set from a population of 114 "highly exposed" meat workers (without prior diagnosis of CTS), who were interviewed for the presence of current symptoms typical of CTS and systematically submitted to median NCS. RESULTS: Agreement between presence/absence of symptoms and NCS normal/abnormal findings ranged from 81% for wrist sensory latency (WSL) to 49% for motor conduction velocity wrist-to-palm (MCV-WP) in the nondominant hands (from 60% to 50%, respectively, in the dominant hands). Mean values of WSL, sensory conduction velocity-WP (SCV-WP), wrist motor latency, MCV-WP, and the SCV-WP/SCV-elbow-to-wrist ratio all showed significant differences between symptomatic and asymptomatic workers. In nondominant hands, these parameters all reached significant P values at chi-squared tests for kappa coefficients of agreement, the best kappa coefficients being 0.57 for WSL and 0.40 for SCV-WP. However, in the dominant hand only SCV-WP reached significance (kappa coefficient=0.20). CONCLUSIONS: Given the importance of the dominant hand in working populations, these data support use of SCV-WP (or WSL) as an informative NCS parameter for occupational studies on CTS.

Different case definitions to describe the prevalence of occupational carpal tunnel syndrome in meat industry workers.

OBJECTIVES: The aim of this study was to assess the prevalence of carpal tunnel syndrome (CTS) in a group of meat industry workers, using typical symptoms, median nerve conduction studies (NCSs) and their combinations. In the case definition including the NCSs, we tested the electrodiagnostic reference values derived from the general healthy population and from the asymptomatic study population. METHODS: One-hundred fourteen workers were examined by clinical interviews and median NCSs. RESULTS: The prevalence of CTS varied from 11% to 53%, with a progressive reduction passing from symptoms to NCSs to the their combinations. The prevalence was identical and the highest at the same time (53%) considering the case definitions based only on the symptoms and only on the NCSs with Kimura's reference values. Using the asymptomatic workers' electrodiagnostic reference values, alone or in combination with symptoms, the prevalence of CTS was the lowest (respectively, 15% and 11%). CONCLUSIONS: In the epidemiological studies, median NCSs should be considered desirable, if not essential, for confirming a clinical diagnosis, most of all in the longitudinal studies. In the future of CTS diagnosis, attention should be paid to the electrodiagnostic reference values that are discriminating to confirm the presence or not of the disease.