Bernardino Ramazzini's De Morbis Artificum Diatriba on Workers' Health-the Birth of a New Discipline.

This paper provides a picture of the observations made over three hundred years ago by Bernardino Ramazzini (1633-1714) in light of current topical issues ranging from health problems related to work and lifestyle habits to the current burdensome COVID-19 pandemic. The main aspects of his work consist of descriptions of disorders linked to environmental risks, suggestions for measures for risk protection, and recommendations for healthy living. This paper focuses on Ramazzini's most relevant achievements by (1) analyzing the episodes that stimulated the composition of his main work and highlighting some observations on which current epidemiological and toxicological studies are based; (2) reviewing his work showing not only the systematic descriptions of work-related illnesses caused by occupational factors but also his sound etiological and physiopathological contributions to the field of occupational lung diseases, breast cancer, and environmental disorders; and (3) remarking on his main observations in the fields of risk prevention and health promotion, also in the light of some highly topical issues related to unhealthy lifestyle habits and the COVID-19 pandemic.

The 1711 rinderpest in Bernardino Ramazzini's XIII Oration and the COVID-19 public health emergency: facts and common aspects.

Although Bernardino Ramazzini is usually regarded only as the father of occupational medicine, his approach to fight the devastating rinderpest epidemic in 1711 is worth mentioning in the light of the public health emergency represented by Coronavirus Disease-2019 (COVID-19). This commentary (i) focuses on Ramazzini's xiii oration describing that event, (ii) analyses the approach suggested to fight the cattle epidemic and economic threats, (iii) highlights some similar aspects between the 1711 rinderpest epidemic and the current COVID-19 pandemic (team expertise, contagion transmissibility, drug treatment, preventive measures, decision timeliness).

[Ethical values and virtues of the Diatriba. A tribute to Bernardino Ramazzini on the tercentenary of his death (1714)]. / Virtù e valori etici della Diatriba. Un tributo a Bernardino Ramazzini in occasione del trecentesimo anniversario della morte (1714).

Based on Hyppocratic values of ancient medicine, Ramazzini's way of thinking prefigures the social medicine that was to be an achievement of the Enlightenment. This contribution aims at analyzing the ethical aspects of the Diatriba. The preface already contains elements that constitute the ethical manifesto of Ramazzini. He shows compassion ("...we must admit that the workers in certain arts and crafts sometimes derive from them grave injuries"), expresses gratitude ("we owe this to the wretched condition of the workers from whose manual toil...so many benefits accrue"), demonstrates a sense of justice ("...in our own time also laws have been passed in well-ordered cities to secure good conditions for the workers; so it is only right that the art of medicine should contribute its portion for the benefit and relief of those for whom the law has shown such foresight") and demonstrates his willingness to be helpful to workers ("...I have tried to unearth in the shops of craftsmen...to suggest medical precautions for the prevention and treatment of such diseases as usually affect the workers"). The ethical contribution of Ramazzini, however, goes far beyond these noble and heartfelt words, demonstrating his intellectual and moral depth. In fact, alongside comments and suggestions, quotations and proposals, information and warnings, the Magister offers a framework for his beliefs on the attitude that the physician should adopt. Prudence and moderation inspire his recommendations when he speaks directly and indirectly to workers; irony and sarcasm pervade his thoughts when he talks to his colleagues, fairness and integrity inspire his remarks to authorities. Although current practice is based on ethical rules dating back to more recent times, the ethical vision of the Magister, that is admirable for its honesty, originality and depth, is in some respects still relevant today.

Bernardino Ramazzini and women workers' health in the second half of the XVIIth century.

In the second half of the XVIIth century, pre-industrial society made extensive use of women's work. In his treatise, Diseases of Workers, published in 1700, Bernardino Ramazzini explored health conditions of women employed in different production sectors, describing their health problems and providing advice and remedies. This paper aims at reviewing his observations for women employed in different occupations, entailing exposure to dangerous materials and ergonomically challenging works.

[The course of study in occupational medicine in a European perspective]. / La formazione dello specialista in medicina del lavoro in una prospettiva europea.

The present renewment of the education and training process of the Italian postgraduate schools of specialization involves the need to implement a network of formative structures including teaching resources and to adjust the formative standard for acquiring new professional competence. This contribute aims at comparing some aspects of the course of study in occupational medicine on European level, analysing the standard of competence, describing some critical aspects of the harmonization of the processes in different countries, and pointing out the OBJECTIVE of the World Health Assembly's global plan of action on workers' health aiming at extending the concept of workers' health.

Focusing ethical dilemmas of evidence-based practice in SMF-exposed MRI-workers: a qualitative analysis.

PURPOSE: To analyze ethical dilemmas for occupational health physicians and other stakeholders involved in the implementation of a surveillance program in workers exposed to static magnetic fields (SMF) used in magnetic resonance imaging. METHODS: The ethical analysis was carried out according to the model proposed by Westerholm and others, which takes into account two elements: (i) the stakeholders involved in the decision process and (ii) the ethical principles of beneficence, autonomy and justice. The analysis is based on the assessment of ethical costs (violating the consistent principle) and ethical benefits (fulfillment of the consistent principle) for workers, employers, occupational health physicians, community, workers' representatives and medical inspectors. RESULTS: According to the European Directive 2004/40/EC (Official Journal of the European Union, Luxemburg), employers must ensure that health surveillance is carried out to prevent adverse health effects in SMF-exposed workers. However, limited scientific evidence on health effects from SMF influences the decision of undertaking appropriate health surveillance. The uncertainties entail a number of ethical conflicts, such as the choice of reliable indicators, the interpretation of abnormal data, the complexity of the decision-making process resulting in a fitness judgment and the diversion of funds for more effective practices. CONCLUSIONS: The analysis shows that the decision-making process aiming at the provision of evidence-based health surveillance to SMF-exposed workers is characterized by controversial ethical costs and ethical benefits for workers and the other stakeholders.

Job-related risk of latent tuberculosis infection in a homogeneous population of hospital workers in a low incidence area.

BACKGROUND: Few comprehensive tuberculin surveys were carried out in a homogeneous population of health care workers (HCWs) in a low incidence area to assess the risk of tuberculosis (TB) infection by different occupational groups and units. METHODS: Community and occupational factors and tuberculin skin test (TST) reactivity were determined in 1,755 HCWs. RESULTS: The overall prevalence of tuberculin reactivity was 6%. Predicting factors for TST reactivity were age >47 years (OR = 2.88), history of household TB contact (OR = 2.41), years of work as HCW (OR = 2.57), physician (OR = 1.88), and working in microbiology (OR = 4.94), dialysis/nephrology (OR = 2.00), gynecology/obstetrics (OR = 2.01). In a multiple regression model working in microbiology [OR = 4.16 (1.27-13.6)], dialysis/nephrology [OR = 2.52 (1.36-4.65)], gynecology/obstetrics [OR = 2.46 (1.24-4.86)] and age >47 years [OR = 1.98 (1.14-3.46)] were significant predictors for infection. CONCLUSIONS: A higher risk of latent infection can be demonstrated in well-defined groups of HCWs.

[Occupational medicine: practice and ethical requirements of the new law on health and safety in the workplace (legislative decree 81/2008)]. / Attività del medico competente e obblighi etici secondo il nuovo testo unico sulla sicurezza sul lavoro (decreto legislativo 81/2008).

Decisions in occupational health may involve ethical conflicts arising from conflicts between stakeholders' interests. Codes of ethics can provide a practical guide to solve dilemmas. The new law on health and safety in the workplace in Italy (decree 81/2008) states that occupational health practice must comply with the code of ethics of the International Commission on Occupational Health. The universally acknowledged ethical principles of beneficience/nonmaleficience, autonomy and justice, which are the basis of the Charter of fundamental rights of the European Union, inspired this code. Although the code is not a systematic textbook of occupational health ethics and does not cover all possible aspects arising from the practice, making decisions based on it will assure their effectiveness and compliance with ethical principles, besides the formal respect of the law.

Scientific research of senior Italian academics of occupational medicine: a citation analysis of products published during the decade 2001-2010.

This article analyzes 10 years of scientific publications among senior Italian academics in occupational medicine by means of citation analysis. Articles published during the decade 2001-2010 were analyzed by means of Elsevier's Scopus. Scientific performance was assessed by means of 9 different indices (including total number of papers, total citations, h-index). Most papers were submitted to journals of allergy and respiratory medicine, biochemistry, and toxicology. Only 11.9% of the 1,689 papers were published in journals of occupational medicine. The authors' h-index was 10.1 (mean) and 9.5 (median) for the overall production. Productivity was associated with number of contributing authors. Most papers cover topics in the mainstream of other disciplines, evidencing that journals of occupational medicine do not play a primary role in the scientific panorama of medical sciences. This could imply consequences for the discipline.

From risk-based health surveillance to health promotion: an evidence-based experience in a health care setting.

In the European countries the health surveillance may be provided as a part of the national health system intervention. In Italy, the legislative Decree (626/94) makes the health surveillance compulsory for all those workers who are exposed to occupational risks. The aim of this study was to describe the introduction of preventive and protective measures, according to the new regulations, in the teaching hospital of the University of Modena. The population examined in 2000 included 1523 workers. Specific health surveillance protocols were prepared on the grounds of the risk characteristics based on the scientific evidence and on the risk perception. The intervention was oriented towards health promotion. The subjects were classified into 10 groups according to the risk characteristics. The percentage of workers ranged from 4% to 42%, depending on the exposure-related health changes. Moreover, the study explored some of the health surveillance benefits: an improvement in worker's satisfaction, an improvement in relationship between stakeholders, an early detection of health changes and a sickness absence reduction after the influenza vaccination program.

Bernardino Ramazzini's early observations of the link between musculoskeletal disorders and ergonomic factors.

Bernardino Ramazzini (1633-1714) systematically studied the relationship between work and diseases. He realized that it was not possible to ascribe all workers' diseases to chemicals or physical agents and foresaw that other factors were involved. He observed that common diseases could originate following the maintenance either of prolonged stationary postures or of unnatural postures (e.g. bakers, workers who stand, sedentary worker, scribes, weavers) or following activities requiring heavy muscular performance (e.g. porters and woodworkers). Furthermore, Ramazzini recognized the need to undertake measures to prevent disorders from repetitive motions and manual lifting and anticipated the now accepted advice of moderation and recommendations of reduction of work duration for a number of hard jobs requiring a standing position or severe muscular effort. From his early writings therefore it is evident that Ramazzini realized the importance of assessing the ergonomic factors associated with the occurrence of work-related musculoskeletal disorders.