[The role of the occupational physician in the assessment of accident risk]. / Il ruolo del medico competente nella valutazione del rischio infortunistico.

The prevention of accidents at work in Italy is a target still to be reached for the safety of workers in workplaces, despite the innovative provisions introduced by the Legislative Decree 81/08 and the decrease of the number of total and fatal accidents occurred in the period 2001-2008, as reported in the statistics of the Italian Workers' Compensation Authority (INAIL). The occupational physician performs a very important role in the accident risk assessment, based on his biomedical and ergonomic knowledge. His role is carried out during the phase of safety risk assessment, contributing to assess plants, machines, tools, personal protective equipments, to be used by the workers. His knowledge of the health status of workers, acquired by medical surveillance and aimed to prevent accidents by providing the fitness for work evaluation in relation to the presence of diabetes mellitus, musculoskeletal diseases, sleep disorders, or to the assumption of hypnotic drugs, when the employee works at height or as driver such as in the transport or construction industry, is not less important. Unfortunately, this latter role of the occupational physician is limited because the Italian Safety Legislation does not provide for the sanitary surveillance of all the workers employed in factories.

[Sleep disorders in cement workers]. / I disturbi del sonno nei lavoratori dell'industria del cemento.

Obstructive Sleep Apnea Syndrome (OSAS) and Excessive Daytime Sleepiness (EDS) are sleep disorders which can increase cardiovascular risk. An health survey was performed on the cement workers to estimate the prevalence of sleep disorders and to investigate occupational, personal and health risk factors that could influence it. A total of 761 male workers, employed at 10 different cement plants of South Italy and Sicily, were examined. All subjects gave informed consent to take part in the survey. The following questionnaires were administered: Berlin Questionnaire to estimate the high risk of OSAS, Epworth Sleepiness Scale for EDS, a questionnaire posing questions about working conditions, personal characteristic, lifestyle, past history of disease and present illness. Statistical analysis was performed with the statistical package SPSS. The prevalence of high risk of OSAS and of EDS resulted respectively in 24.2% and 3.4% of workers. Sleep disorders detected with the two questionnaires were significantly associated. A positive and significant association between OSAS and respectively age, time of employment, BMI, ex-smoker status, neck, waist or hip circumferences, chronic fatigue and arterial hypertension was observed. Subjective variables regarding working conditions (job interest, evaluation oforganization of work and job satisfaction) and alcohol consumption were not associated with the high risk of OSAS. Shift work (2 and 3 shifts) was not associated with the high risk of OSAS. An healthy worker effect was observed for workers who changed from shift work (2 or 3 shifts) to fixed daytime work. For them, this change to fixed daytime work was conditioned by chronic disease like hypertension and obesity. EDS was not dependent, associated or correlated with any of the occupational, personal or pathologic variables investigated in the study. In conclusion the research showed no relationship between working conditions, particularly shift work, and the high risk of OSAS, and the influence of obesity in determining the high risk of OSAS, itself a potential cardiovascular risk factor. The interest of occupational physician has been focused on introducing in health surveillance also measures of health promotion regarding sleep disorders with the aim of preserving health condition in workers.