[Storytelling in prevention: the case-study of accidents at work. How the narrative method can enhance the prevention of occupational injuries.] / Narrare per prevenire: il caso degli infortuni sul lavoro.Come il metodo narrativo può valorizzare la prevenzione degli infortuni lavorativi.

OBJECTIVE: This article aims to analyze the elements of the narrative which, applied to investigations of accidents at work, transform them into stories, making the dynamics of accidents clearer, more complete and emotionally engaging and also capable of being transferred to a non-experts audience. METHOD: The theoretical reference identified for the analysis of the accident histories is the work of the Lithuanian semiologist Algirdas Julien Greimas. The title, the dimensions of space and time, the characters (according to the actantial model), the point of view, the structure of the story (following the canonical narrative scheme), and the moral of the tale are the elements of the narration analyzed in this article. RESULTS: This article illustrates how the dynamics of accidents can lend themselves to being told according to the typical categories of narration and textual organization, resulting in them being enriched with important elements for the communication of prevention and the learning of safe behaviour. The accident investigation that becomes history takes on important characteristics also in terms of communication: the contents become clearer, more accessible and more engaging. Unlike traditional surveys, injury stories, through the elements of the narrative and in particular with the addition of indications for prevention, become an efficient learning and sharing tool valid in training contexts, and the contents effectively usable in practice of prevention workers. CONCLUSIONS: The narration applied to accidents at work, allowing for greater attention to the elements of the context, relationships and the emotional sphere of the various actors involved, is able to bring out more clearly the important and various factors that can contribute to causing an accident, becoming thus an effective tool for the transfer of indications for prevention.

[A system for collecting historical professional exposures in the workplace in Piedmont (ESP ALP).] / Un sistema per la catalogazione delle esposizioni storiche professionali negli ambienti di lavoro in Piemonte (ESP ALP).

SUMMARY: Background. ARPA Piemonte carries out occupational exposure measurements of chemical agents in workplace environment to support the Occupatonal Health and Safety Units of Local Health Boards for the assessment of the exposure level of dangerous chemical. Data are reported in internal documents, but are not available for other purposes. Objectives. Organize the occupational exposure measures collected by ARPA Piemonte, in order to facilitate their availability, in accordance with the indications of the European Foundation for the Improvement of Living and Working Conditions. Methods. An application in a relational database environment was defined and developed to collect and structure information relating to companies, interventions, tasks and / or monitored sampling points, samples and measurements performed. Results. Data on chemical exposure related to interventions carried out by ARPA Piemonte in the period from 2005 to part of 2020 have been collected in the ESP ALP application. ESP ALP contains information about 161 companies, 193 interventions, 815 sampling points, 3.490 samples and 18.576 measurements and information on companies obtained from the 2011 Census of Economic Activities and the archives of the National Institute for Insurance against Accidents at Work (INAIL). Discussion. We verified the feasibility of retrieving and organizing the information collected in past years in an integrated environment that facilitates its processing and use. Finally, we confirm the usefulness of collaboration between multidisciplinary professionals.

The Community of Practice: A Method for Cooperative Learning of Occupational Health and Safety Inspectors.

BACKGROUND: Workplace injuries in Italy still occur despite laws and safety norms. We need to understand the causes rooted in the context and social conditions, and need to improve the practice of Occupational Safety and Health (OSH) inspectors of the Workplace Safety and Prevention Services (WSPS) of the Italian regional health boards. The aims of this study were to describe the setting up of a Community of Practice (CoP) for the production of best practices for injury prevention and to evaluate the motivation of OSH inspectors for participating in the CoP and the effects of CoP participation on their professional practice. METHODS: Two workplace injury stories underwent peer review during each CoP meeting. We evaluated the CoP using a focus group and a questionnaire. RESULT: Between 2014 and 2021, the CoP met in 18 workshops. Over the 8-year period, the CoP grew from 20 to 150 participants. Overall, 30 stories underwent peer review and were published on the institutional website. The focus group participants stated that the reasons why they participated in the CoP were the need to share experience and to tackle new challenges. CONCLUSION: The CoP was found to be useful for improving professional practice by strengthening professional identity and contributing to the production of new knowledge.

Psychosocial empowerment-based interventions for smoking reduction: concepts, measures and outcomes. A systematic review.

Although empowerment is a widely used concept in health-related areas, its definition remains unclear. While there is evidence for the effectiveness of empowerment interventions in improving some psychosocial factors linked to health (e.g. patient self-care strategy, coping skills, access and effective use of health services) and some health outcomes like mental health and HIV/AIDS-related behaviour, other data appear to contradict this. Moreover, concepts, measures, and outcomes related to empowerment are operationalized in different ways. Using the case of tobacco control programmes, we wanted to explore: (a) how research on smoking reduction/prevention has conceptualized empowerment; (b) which measures and instruments have been used to assess behaviour outcomes and the empowerment process. We hypothesized that the transformative potential that characterizes empowerment is marginally considered.A total of 18 studies reporting on the effect of prevention interventions on smoking and/or empowerment outcomes were reviewed. Two kinds of study were distinguished: (a) studies reporting behaviour outcomes without data about the impact on empowerment; (b) studies analysing the empowerment process. Among this latter type, some studies did not provide information about the specific behaviour (smoking), while others examined the impact of intervention on both smoking and empowerment. In about half of all studies, empowerment strategies were found to be effective in improving smoking outcomes, while no differences were found between intervention and control groups in the remaining studies. The present review suggests that pragmatic definitions of empowerment need to be developed in order to promote its transferability and evaluation.

The community of practice as a place of prevention: the value of collective knowledge in occupational safety. / La communità di pratica come luogo di prevenzione: il valore della conoscenza collettiva nella sicurezza sul lavoro.

BACKGROUND: Occupational Health and Safety (OSH) inspectors of the Health Units of Piedmont Region wrote 47 case histories based on data gathered from injury investigations as part of the project "From the injury investigation reports to case histories: creation of a collection of case histories on occupational injuries". Afterwards a Community of Practice (CoP) was initiated with the aim of sharing recommendations for prevention of occupational injuries. OBJECTIVE: The aims of the article are: 1) to describe the implementation process of the CoP; 2) to evaluate the benefits of CoP regarding the improvement of professional practice of OSH inspectors. METHODS: Two injury case histories were peer reviewed during each meeting of the CoP. A focus group was set up to evaluate benefits of CoP. Seven OSH inspectors participated in this focus group. RESULTS: Eight CoP meetings were organized and about 70 OSH inspectors participated. Fourteen stories were peer reviewed and eight were published on www.dors.it. Operators involved in the focus groups reported that the main reasons for participation in the CoP were the need to compare and tackle new challenges. The criticalities are tied to the turnover of the participants and to the lack of recognition by management. Most of the operators felt it was too early to include professionals such as Workers' Safety Representatives and Prevention and Safety Service Managers in the CoP due to their different professional roles. CONCLUSIONS: OSH inspectors reported professional benefits of CoP experience. We believe that this approach might be transferred, integrated and developed in other regions and included in the next national prevention plan.

Narratives of work injuries as a basis for improving preventive measures.

BACKGROUND: Many authors consider narrative descriptions of injuries gathered by OSH inspectors extremely important in identifying causes, setting priorities and drawing up intervention strategies. Narratives provide additional insight regarding complex behaviour, attitudes and interactions, which help to understand the decision patterns and the context of the injury. Storytelling is an effective way of sharing and remembering information. OBJECTIVE: The main aim was to describe the experience of collecting stories from injury investigation reports, backed up by systematic prevention guidelines, that will improve information sharing by means of a knowledge transfer method based on storytelling. METHODS: OSH operators from Health Units, who were invited to provide the injury stories, were enrolled through educational workshops aimed at selecting the injuries to relate following the sentinel event approach, using an effective style of writing, identifying the key elements of the story and using witnesses' narratives to study in depth the critical points identified during the investigation. RESULTS: 110 OSH operators voluntarily joined the project between 2012 and first half of 2015. 33 injury stories were collected, discussed and published on Dors' website http://www.dors.it/storiedinfortunio. CONCLUSIONS: The results show that prevention and protection measures do indeed benefit from a narrative-based approach, so that health and safety can be viewed in a more comprehensive way by facilitating knowledge improvement and sharing.

[MATline, a job-exposure matrix for the prevision of exposure to carcinogens: new functions and potential applications]. / MATline, una matrice lavorazione-esposizione per la previsione delle esposizioni a cancerogeni in Italia: nuove funzioni e potenziali utilizzi.

MATline, the job-exposure matrix for carcinogenic agents, is a data bank free accessible online. It provides data as classification and toxicological properties of carcinogenic agents, and a list of industrial processes with potential exposure to each carcinogen agent, and an up-to-date estimation of the number of activities and workers related to the industrial process on Regional basis. It also lists the target organs for which a causal relationship with the agent has been established. MATline was recently updated with the new classifications introduced by Regulation EC No. 1272/2008 (CLP). The Authorisation List or the Restriction of the Registration, Evaluation, Authorization of Chemicals (REACh) regulation specifically mark chemicals. The matrix is helpful for professionals in the public health sector to identify in advance the potential sources of exposure, and prioritise intervention plans; for occupational physicians to help identifying causes of occupational cancer cases; for health professionals in the private sector to address chemical risks; for company physicians to validate health surveillance plans; for trade unions to independently check formation contents provided to workers potentially exposed to such risks.

[Integrated use of data bases to map manufacturing processes involving exposure to carcinogens in the Piedmont Region: the example of formaldehyde]. / Uso integrato di banche dati per la mappatura di lavorazioni con esposizione a cancerogeni nella Regione Piemonte: l'esempio della formaldeide.

BACKGROUND: Exposure to carcinogens is still widespread in working environments. For the purpose of defining priority of interventions, it is necessary to estimate the number and the geographic distribution of workers potentially exposed to carcinogens. It could therefore be useful to test the use of tools and information sources already available in order to map the distribution of exposure to carcinogens. Formaldehyde is suggested as an example of an occupational carcinogen in this study. OBJECTIVES: The study aimed at verifying and investigating the potential of 3 integrated databases: MATline, CAREX, and company databases resulting from occupational accident and disease claims (INAIL), in order to estimate the number of workers exposed to formaldehyde and map their distribution in the Piedmont Region. METHODS: The list of manufacturing processes involving exposure to formaldehyde was sorted by MIATline; for each process the number of firms and employees were obtained from the INAIL archives. By applying the prevalence of exposed workers obtained with CAREX, an estimate of exposure for each process was determined. A map of the distribution of employees associated with a specific process was produced using ArcView GIS software. RESULTS: It was estimated that more than 13,000 employees are exposed to formaldehyde in the Piedmont Region. The manufacture of furniture was identified as the process with the highest number of workers exposed to formaldehyde (3,130),followed by metal workers (2,301 exposed) and synthetic resin processing (1,391 exposed). CONCLUSION: The results obtained from the integrated use of databases provide a basis for defining priority of preventive interventions required in the industrial processes involving exposure to carcinogens in the Piedmont Region.

Risk factors for upper extremity musculoskeletal symptoms among call center employees.

OBJECTIVES: To investigate the prevalence of musculoskeletal symptoms in the upper extremity (UE) in a sample of Italian call center (CC) operators, and the relationship between the symptoms and potential workplace risk factors. METHODS: During 2005-2006, 775 workers from seven CCs in the Turin area participated in a questionnaire survey of exposure to ergonomic, organizational and psychosocial factors at work, socio-demographics, lifestyle, symptoms and diseases. Musculoskeletal symptoms were defined as self-reported musculoskeletal symptoms in the UE during the previous 28 days, for which a physician was consulted and/or drugs were taken. Relative risks were estimated through Poisson regression models with the Huber-White sandwich estimator of variance. RESULT: Overall, 45% of workers reported UE symptoms in the last four weeks. Symptoms in the neck were the most prevalent (39%), followed by the shoulder (22%), hand-wrist (10%) and elbow (4%). Among workplace risk factors, neck-shoulder symptoms were associated with low job control, elevated noise, poor desk lighting and impossibility to lean back while sitting; whereas elbow-hand/wrist symptoms were associated with short intervals between calls, insufficient working space, lack of forearm support, job insecurity and long seniority in the CC industry. CONCLUSIONS: The high prevalence of UE symptoms in this sample was similar to that reported by other studies conducted in this industry. Our results confirm previously reported associations, such as poor characteristics of the workstation and psychological stressors. The striking difference between the set of risk factors for neck-shoulder and elbow/wrist-hand symptoms indicates that the two regions should be investigated separately.

[Testing of interventions for prevention of heat wave related deaths: results among frail elderly and methodological problems]. / Sperimentazione di interventi di prevenzione di danni alla salute da ondate di calore: risultati sulla popolazione anziana fragile e problemi metodologici.

OBJECTIVE: to evaluate the impact of a programme based on soft home care services and an offer of social caretaking, compared to one based only on soft home care, for the prevention of heat-related health events among clinically and/or functionally frail elderly. DESIGN: cluster randomised controlled trial. SETTING AND PARTICIPANTS: the study population included 2,612 persons over 75 years of age living alone in the city of Turin, North-West Italy, who were classified as clinically (hospitalization with specific diagnoses before summer 2004) and/or functionally (were receiving a disability pension) frail. MAIN OUTCOME MEASURES: a programme' s impact was evaluated on the basis of the hospitalizations and deaths that occurred during summer 2004, using gender-specific multilevel logistic regression models, controlling first for age and then also for education and income. RESULTS: among males, a weak protection against emergency hospitalization was observed within the group randomised to soft home care services and offer of social caretaking, compared to the only soft home care group (OR=0.33, 95% CI=0.11; 0.96). Among females, the programme including social caretaking seemed to lower the overall risk of hospitalization (OR=0.96, 95% CI=0.93; 0.98). CONCLUSION: this study has two important public health implications: first, it highlights the potential impact of programmes based on both soft home care and offer of social caretaking; second, it helps to raise awareness, both among health/social work and in the community, of the need for protection during summer periods for the elderly.

[Working conditions and health problems among call-centre operators: a study on self-reported data in the Piedmont Region (Italy)]. / Condizioni lavorative e problemi di salute negli operatori dei call center: uno studio su dati autoriferiti nella regione Piemonte.

BACKGROUND: Currently, about 250,000 workers are employed in the call-centre sector in Italy. The nature and the organization of the work exposes workers to a variety of psychosocial and ergonomic hazards, with a potential impact on physical and psychological health. OBJECTIVE: The aim of the study was to investigate working conditions and health status among call-centre operators, in order to estimate the prevalence of exposure to psychosocial and ergonomic risk factors, and of potentially work-related health problems. METHODS: Workers from seven call-centres operating in the Torino area were invited to participate in the survey. During the period 2005-2006, 775 subjects working in telecommunications (70%), telemarketing (14%) and finance (16%) completed a standardized questionnaire on socio-demographics and lifestyle, working conditions, symptoms and diseases. RESULTS: Poor microclimatic conditions, elevated noise, high levels of exposure to psychosocial factors and a high prevalence of unfavourable ergonomic working conditions were observed With regard to health conditions, the mental health index was lower than that expected for the Italian population. Overall, 60%, of the subjects reported headache, 57% musculoskeletal symptoms and 46% voice disorders, for which they consulted a physician and/or took medication. CONCLUSION: A high proportion of call-centre operators were exposed to organizational and psychosocial risk factors, while the self-reported prevalence of potentially work-related health conditions was also high, as has been reported by other authors. Although further epidemiological studies are needed to meaningfully evaluate these associations, it also appears necessary to implement interventions on the most frequently encountered hazards in this sector.

MATline: a job-exposure matrix for carcinogenic chemicals.

MATline is a tool that can be used to predict which industrial processes can be expected to involve the use of a substance that is considered carcinogenic as documented in the literature. The database includes agents carrying risk phrases R45, R49 and R40 according to the method of classification adopted by the EU and/or agents in categories 1, 2A and 2B as classified by the International Agency for Research on Cancer (IARC). Each agent is associated with a list of industrial processes coded according to the tariff headings used by the National Institute of Insurance against Occupational Injuries and Diseases (Istituto Nazionale per l'Assicurazione contro gli Infortuni sul Lavoro, INAIL). The main sources of information are the IARC Monographs and databases available through the National Library of Medicine's TOXNET portal. The matrix currently includes 600 carcinogenic agents, 23 classes of agents and some 7000 links between agents and industrial processes. MATline can be viewed on the www.dors.it website.

[Food safety: short guide to Internet resources]. / Sicurezza alimentare: breve guida alle risorse presenti sul Web.

This report provides a brief overview of several reliable Internet resources concerning food toxicology. Some helpful resources have been identified on the basis of quality criteria and relevance. Only international and European sources, presenting an English or an Italian version, have been considered. The report includes four topic areas: the first provides a brief description of international resources, the second focuses on European ones, the third provides a description of Italian websites and the last one is a short overview of some specialized databanks available on Web.

Food safety: a guide to Internet resources.

This report provides a brief overview of several reliable Internet resources concerning food toxicology. Some helpful Internet resources have been identified on the basis of quality criteria, of their relevance and the languages availability. The report includes four topic areas, the first provides a brief description of international resources, the second focuses on European resources, the third provides a description of some national resources and the last is a short overview of some databanks available on web.

[Description of home accidents in Piedmont based on current information sources]. / Descrizione degli incidenti domestici in Piemonte a partire dalle fonti informative correnti.

OBJECTIVE: To analyse data from existing sources to assess the distribution over space and time of home accidents in Piedmont. DESIGN: Analysis of distribution of causes of hospitalisation and deaths following a home accident. SETTING: For non-fatal accidents, we reviewed the database of hospital discharge records (HDR), which includes data from all hospitals in the region. For fatal accidents, we reviewed the data on deaths provided by the Italian National Institute of Statistics (ISTAT). PARTICIPANTS: All patients hospitalised for "home accidents" for the period 1999-2001 and deaths due to "external causes of injury and poisoning" and from these excluded transport accidents, homicides, and suicides for the period 1982-1999. RESULTS: The most commonly reported reasons for hospitalisation following a home accident were: fracture for 15-64 year-old age-group and for persons aged 65 years or more (60.7% and 86% respectively) and intracranial transmatism for 0-14 year-old age group (33%). Regarding fatal accidents, the mortality rate per 100,000 was 3.6 among 0-14 year-olds, and 145.1 among the persons aged 65 years or more. The most common cause of death was chocking for 0-14 year-old age-group and falls for the person aged 65 years or more (32.2% and 86.3% respectively). There is an excess of mortality in the geographical areas of Western Alps of Piemonte. CONCLUSION: In Piedmont, existing sources can be used to estimate the distribution of the most serious home accidents i.e., those resulting in hospitalisation or death. The sources we reviewed in this study are, at the moment, the only ones available to quantify and describe the phenomenon over space and time.