[The organisation of prevention among Ravenna's seaport.] / L'organizzazione della prevenzione nel porto di Ravenna.

SUMMARY: The port work presents specific risk factors in relation to the types of production which take place in it, and to the specific organisation it is managed by. The port of Ravenna is a big commercial one and it has a canal-port structure. Objectives. This work is intended to illustrate the interventions of prevention led by AUSL Romagna within the port. Methods. The methodology of research and presentation of the interventions is inspired to the criteria of prevention based on evidence. Results. Among all the activities conducted, those that associate actions of control with actions of promotion of change are presented: the procedure of planning the interventions for the enhancement of safety in the port of Ravenna; the assessment all'ondeggiaof the risk linked to the movements of the ships, because of the undulation during the operations of loading and unloading; the innovative ways of surveillance; the interventions of promotion and control on of the asssessment and management of silica risk; the surveillance in the cargo holds, as places with scarce ventilation and danger of contamination; the specific plan for safety. Conclusions. As it correlates actions of control and frequent moments of discussion with the spokesmen of the factories, and the shared definition and diffusion of the tools for the assessment of risk, the model of prevention presented in this review proves to be one of the most apt to guarantee the endurance of the measures of prevention and protection adopted, aiming at the health and safety of the workers in the port.

[Mortality study update of workers exposed to vinyl chloride in plants located in Ferrara and Ravenna (Emilia-Romagna Region, Northern Italy)]. / Aggiornamento dello studio di mortalità nelle coorti di lavoratori ex esposti a cloruro di vinile monomero a Ferrara e Ravenna.

OBJECTIVES: to update the mortality study of subjects exposed to vinyl chloride in the phases of synthesis of the monomer and polymerization in the plants of Ferrara and Ravenna (Emilia-Romagna Region, Northern Italy). DESIGN: both for the whole cohort and for the two plants, standardized mortality ratios (SMRs), with 95% confidence intervals (95%CI), were calculated for different death causes, then stratified by duration and latency, periods of the beginning of work and cumulative exposure (ppm-years). SETTING AND PARTICIPANTS: the cohort includes 1,540 subjects (469 in Ferrara hired from 1953 to 1999; 1,071 in Ravenna hired from 1959 to 2000), with at least six months of work. RESULTS: by the end of the follow-up (31.12.2013), 348 deaths occurred. Overall observed mortality, contrasted to that expected based on Emilia-Romagna Region mortality rates, appeared to be lower than expected in the whole cohort (348 cases, SMR: 0.85; 95%CI 0.77-0.95) and in Ravenna (173 cases, SMR: 0.71; 95%CI 0.61-0.83). Mortality for all neoplasms was in excess in Ferrara (79 cases, SMR: 1.27; 95%CI 1.02-1.58), but lower than expected in Ravenna (83 cases, SMR: 0.80; 95%CI 0.64-0.99). An excess in mortality was observed in the whole cohort (16 cases, SMR: 1.74; 95%CI 1.07-2.85) and in Ferrara for liver cancer (7 cases, SMR: 2.12; 95%CI 1.02-4.46), and only in Ferrara for respiratory tract cancer (30 cases, SMR: 1.45; 95%CI 1.02-2.07) and larynx cancer (4 cases, SMR: 3.35; 95%CI 1.26-8.92). In the whole cohort, SMR for liver cancer was in excess since a cumulative exposure of 5,000 ppm-year and 12 cases belong to the job title of autoclave workers (12 cases, SMR 4.6; 95%CI 2.6-8.0), duration of work higher than 20 years (8 cases, SMR 2.4; 95%CI 1.2-4.9), and latency higher than 40 years (7 cases, SMR 2.5; 95%CI 1.2-5.2). The excess in mortality for lung cancer is statistically significant for and with cumulative exposure higher than 7,330 ppm-years (6 cases, SMR 3.2 95%CI 1.4-7.0). There are not excesses among subjects hired after 1971. CONCLUSIONS: the study findings confirm and expand the ones of previous studies. It was not possible to apply a best evidence approach to the study of liver cancer, and consequently it is not possible to distinguish between hepatic angiosarcoma and hepatocellular carcinoma. The evidence of a causal link between vinyl chloride exposure and liver cancer is anyhow confirmed. The causal link between vinyl chloride exposure and lung cancer must be further investigated.