Need for a new workplace safety and health (WSH) strategy for the fourth Industrial Revolution.

We are on the cusp of the fourth Industrial Revolution which promises to revolutionize the way we live and work. Throughout history, as society and technology progress, so too have our workplace safety and health (WSH) strategies in regard to better knowledge and enhanced regulation. In this paper, we argue for a new WSH 4.0 strategy which requires us to adopt an adaptive and highly responsive approach to promote Total Worker Health in the face of rapid technological advancements and changes in employment relationships. To do so, we propose a multi-pronged strategy comprising (i) adaptive WSH solutions in regard to surveillance, risk assessment, and control measures leveraging on new technologies; (ii) effective multi-stakeholder dialogues for collaborative and sustainable solutions; (iii) an anticipatory WSH governance framework based upon shared values and cooperative responsibility; and (iv) professional development among WSH practitioners. This new WSH 4.0 strategy will enable WSH professionals to remain effective in this coming Industrial Revolution.

[Occupational health and safety in the port and the government of social processes and economic development]. / Salute e sicurezza sul lavoro in ambito portuale e governo dei processi sociali e di sviluppo economico.

SUMMARY: The paper aims to present the methodology applied by the Port System Authority of the Eastern Adriatic Sea from 2016 on to tackle aspects threatening the old and no-more replicable "rules" governing the Trieste Port Community social and economic equilibrium and which had generated an endemic reporting of occupational diseases. The methodology is based on the integration between port operation models and occupational health and safety requirements, in particular occupational ergonomics. By consolidating synergies with all Port stakeholders, the Authority carried out document and on-site surveys which detected the most relevant weaknesses of the system, considered already outdated. Thus, the Authority defined and adopted regulations to promote Port workers' welfare and protect marginalized workers' dignity; furthermore, the Authority applied technical measures to stop the process which would have caused new cases of the same occupational diseases. The Authority improvement action plan provides for a central role for occupational health physicians who will be asked to define shared minimum requirements to develop sanitary protocols for those port jobs exposed to similar risks in terms of quality and magnitude.

[Risk assessment and its appropriateness supporting the physician in the certification of a suspected occupational disease.] / La valutazione dei rischi e la sua appropriatezza a supporto del medico nella certificazione di sospetta tecnopatia.

OBJECTIVES: The topic of appropriateness was defined as the new frontier of development of health interventions. RH Brook in an Editorial published in the BMJ in 1994 defines the appropriateness "… an intervention for which the expected benefits are greater (with a sufficient margin) the possible negative consequences … excluding economic considerations". In workplaces the goal of appropriateness should cover not only the actions of health surveillance and health protocols, but also and primarily all stages of the risk assessment process. METHODS: Only through an assessment of occupational risks that aims to identify, evaluate and measure the real professional risk factors in specific working environments, it is possible to meet the requirements of effectiveness, efficiency and protection of ethical principles in the identification of priorities (according to values of person, community and society) that represent the size of the appropriateness of an intervention. At the same time, the risk assessment should provide to the occupational pyisician instruments to study with scientific, justifiable and reproducible criteria the possible correlation between damage to the worker's health and the occupational risk factors. RESULTS: In the process of reporting of suspected technopathy, both for prevention purposes (according to art. 139 of Presidential Decree 1165/68, art. 10 of Legislative Decree 38/00 and DM 10 June 2014), both for insurance purposes (according to art. 53 of Presidential Decree 1165/68 and Ministerial Decree 9 April 2008), it should be considered two indispensable judgment elements to study the correlation between the disease and the work: on the one hand the level (measured or estimated) of the occupational risk factors; on the other hand the appropriateness of the risks assessment compared to the best and most current scientific evidence (Evidence Based Medicine - EBM), according to technical standards and specific guidelines. CONCLUSIONS: Our study underlines the importance of appropriateness in the risk assessment process to analyze the correlation between the exposure to specific occupational hazards and the suspected technopathy.

[Taking Care of Asylum Seekers: Occupational Health Aspects with a Special Focus on Vaccination]. / Arbeitsmedizinische Aspekte und Impfschutz beim Umgang mit Asylbewerbern.

Employees and volunteers often feel insecure about the potential transmission of infectious diseases when taking care of asylum seekers. It could be shown that overall only a minor risk of infection emanates from asylum seekers. However, aspects of occupational health and vaccination should be kept in mind.Besides the standard vaccination the Standing Committee on Vaccination (STIKO) recommends for occupational indication, which is given for employees and volunteers in asylum facilities, vaccination against hepatitis A, hepatitis B, polio (if the last vaccination was more than 10 years before) as well as influenza (seasonal).According to the German Occupational Safety and Health Act taking care of the employer has to determine which exposures might occur at the workplace (risk assessment) and define necessary protection measures. Depending on task and exposure when taking care of asylum seekers different acts (e. g. biological agents regulation) and technical guidelines for the handling biological agents (e. g. TRBA 250 or TRBA 500) have to be applied.The Bavarian Health and Food Safety Authority (LGL) has published several information sheets regarding "asylum seekers and health management" for employees and volunteers from the non-medical as well as the medical area (www.lgl.bayern.de search term "Asylbewerber"). With theses publications insecurities in taking care of asylum seekers should be prevented. Furthermore the employer gets support in the implementation of legal obligations to ensure occupational safety for the employees.

Return to Work after a Work Accident: Is Coordination between the Occupational Physician and the Insurance Physician Possible? / Retour à l'emploi après un accident de travail : une coordination entre médecin du travail et médecin-conseil d'assurance est-elle possible ?

Occupational physicians and insurance physicians each have their own roles in managing the consequences of work accidents and their interaction is pivotal in the administrative and clinical process of return to work. We wanted to analyse the barriers and facilitators of this collaboration in Belgium.A qualitative study was conducted based on individual interviews of a sample of insurance physicians and occupational physicians working in French-speaking Belgium. This sample was selected to represent all insurance companies and most prevention and protection services operating on the territory. The interview scheme was designed to explore the various dimensions of the RDIC model (Resource Dependence Institutional Collaboration) of collaboration between professionals.This study highlighted certain obstacles to collaboration, related to the mutual perception of the 2 professions, ignorance of the other profession's work context, lack of independent resources blocking the willingness to cooperate (sufficient time, fees). Some facilitating factors were also identified : occupational physicians' willingness to cooperate, a positive attitude towards the ability to cooperate, as well as proposals for immediate improvement of some factors. Collaboration between these 2 professions has rarely been studied and the results of the present study provide tracks for improvement that can be applied in the short or medium term to enable those two categories of physicians to be better organized and more efficient in managing disability consequences of work accidents.

[Rheumatic diseases and work ability]. / Malattie reumatiche e capacità lavorativa.

Musculoskeletal diseases are tile most frequent cause of pain in the working population. Rheumatic diseases are chronic illnesses, cause of functional impairnment, relevant working disability and absence from work; however, affected patients maintain a significant functional ability. In this context, the "Fit for work" project, operating in Italy since 2012, promotes the management of chronic musculoskeletal conditions through the realization, also in our country, of a rheumatic medical assistance network in behalf of workers affected by rheumatic diseases and other musculoskeletal disabiliting conditions.

[Health surveillance and suitability: the role of the company physician in maintaining work ability]. / Sorveglianza sanitaria e idoneità: ruolo del medico competente a sostegno della capacità lavorativa.

The ageing workforce is one of the major issues in Europe. Ageing has an important effect on work ability, especially in manual jobs where physical demand is high. Musculoskeletal disorders are the most common health problems among European workers and are able to affect work ability. In order to increase the employment rate of people aged 45-65, measures to sustain work ability and proper age management should be promoted: return to work strategies include adjustment of the job to the worker's health conditions and abilities. The contribution of health surveillance.programs in the management of workers affected by musculoskeletal disorders is discussed.

[Efficiency of health surveillance in occupational medicine]. / Efficacia della sorveglianza sanitaria in Medicina del Lavoro.

Medical surveillance is one of the primary instruments in occupational health activities and is considered essential to maintain employees' good health. However, the efficacy of medical surveillance has not been sufficiently tested. The aim of this review was to evaluate the usefulness of medical surveillance, using available literature on Pubmed for the period 2005 to 2014. Although on the basis of a small number of studies, our conclusion is that medical surveillance could be considered effective. Apart from the case of occupational asthma, it must be emphasised that the number of evaluation studies is small, especially in some areas, as well as the one of biomechanical overload.

[Overdiagnosis and defensive medicine in occupational medicine]. / Overdiagnosis e medicina difensiva in Medicina del Lavoro.

In clinical medicine since some years overdiagnosis is giving rise to growing attention and concern. Overdiagnosis is the diagnosis of a "disease" that will never cause symptoms or death during a patient's lifetime. It is a side effect of testing for early forms of disease which may turn people into patients unnecessarily and may lead to treatments that do no good and perhaps do harm. Overdiagnosis occurs when a disease is diagnosed correctly, but the diagnosis is irrelevant. A correct diagnosis may be irrelevant because treatment for the disease is not available, not needed, or not wanted. Four drivers engender overdiagnosis: 1) screening in non symptomatic subjects; 2) raised sensitivity of diagnostic tests; 3) incidental overdiagnosis; 4) broadening of diagnostic criteria for diseases. "Defensive medicine" can play a role. It begs the question of whether even in the context of Occupational Medicine overdiagnosis is possible. In relation to the double diagnostic evaluation peculiar to Occupational Medicine, the clinical and the causal, a dual phenomenon is possible: that of overdiagnosis properly said and what we could define the overattribution, in relation to the assessment of a causal relationship with work. Examples of occupational "diseases" that can represent cases of overdiagnosis, with the possible consequences of overtreatment, consisting of unnecessary and socially harmful limitations to fitness for work, are taken into consideration: pleural plaques, alterations of the intervertebral discs, "small airways disease", sub-clinical hearing impairment. In Italy the National Insurance for occupational diseases (INAIL) regularly recognizes less than 50% of the notified diseases; this might suggest overdiagnosis and possibly overattribution in reporting. Physicians dealing with the diagnosis of occupational diseases are obviously requested to perform a careful, up-to-date and active investigation. When applying to the diagnosis of occupational diseases, proper logical criteria should be even antecedent to a good diagnostic technique, due to social outcome for the worker.

Twenty year development of occupational diseases in the Czech Republic: medical and geographical aspects.

The study analysed occupational diseases in the Czech Republic from the viewpoint of occupational medicine and medical geography. It used a dataset consisting of 32,646 cases of occupational diseases reported during the period of 1994-2013. The descriptive part of the study analysed occupational diseases according to their spatial distribution, occurrence in different branches of economic activities, employees' gender, and according to chapters of the List of occupational diseases. The incidence of occupational diseases showed an overall decreasing trend, which can be related to several factors--transformation of the national economy (shift from heavy industry to manufacturing industry and services), an improvement in access to occupational healthcare services, increased responsibility of employers for safe working conditions, but also a concealment of health problems by employees for fear of losing job. An exception to the decreasing trend is the automotive industry, in which the upward trend in occupational diseases occurrence was noted. The analytical part of the study focused on the relation between unemployment and occupational diseases incidence rates in different regions of the Czech Republic. In most regions, a statistically significant inverse association was shown between the rate of unemployment and occupational disease incidence. The situation is described in more detail for the Moravia-Silesia and Ustí nad Labem Regions and the Capital City of Prague, wherein a statistically significant inverse association was shown between the rate of unemployment and occupational disease incidence. The theory of marginal utility can explain the phenomenon. To certain degree of health problems, employees tend to prefer employment stability, especially if the unemployment is on rise in their region. On the other hand, if losing their job, they often try to claim benefits connected with occupational diseases.

[Rare cardiovascular diseases in the context of occupational health care]. / Rzadkie choroby ukladu krazenia w kontekscie opieki profilaktycznej nad pracownikiem.

In Poland like in other European countries a favorable trend towards reducing morbidity and mortality from cardiovascular disease has been observed. Nevertheless they are still one of the most important health problems in the population, responsible for nearly half of all deaths, including premature deaths. They also affect the quality of life in terms of health and socio-economic development, limiting the possibility of taking and/or continuing employment. Nowadays, cardiovascular diseases have become more common among young, professionally active people. Their professional activity, work organization and exposure to a broad range of occupational factors and environmental conditions may significantly influence the development and course of the cardiovascular disease. The aim of the study was to present the relationship between occupation and some rarer diseases and cardiovascular pathologies, as well as those in which this relationship has not as yet been fully evidenced, however, they may play an important role in workers' health care. In this paper tako-tsubo cardiomyopathy, aortic aneurysm, aortic dissection, pericardial tamponade, Brugada syndrome and sudden cardiac death are discussed. In addition, the authors indicate new issues emerging along with the development of modern diagnostic and therapeutic techniques in cardiology, such as the care of patients with implanted pace-maker and the use of automated external defibrillators. These issues are presented in the context of their relationship with the occupation, taking into account the activities possibly to be undertaken under preventive care programs.

Managing occupational risk in creative practice: a new perspective for occupational health and safety.

There has been little recognition of the fact that creative production operates in a somewhat different environment and timeframe to that associated with traditional industries. This has resulted in the application of an orthodox, generic or ``one size fits all'' framework of Occupational Health and Safety (OHS) systems across all industries. With the rapid growth of ``creative industry,'' certain challenges arise from the application of this "generic" strategy, mainly because the systems currently employed may not be entirely suitable for creative practice. Some OHS practitioners suggest that the current OHS paradigm is failing. This paper questions the appropriateness of applying a twentieth century OHS model in the present industrial context, and considers what framework will best provide for the well-being of creative workers and their enterprise in the twenty-first century. The paper questions the notion of "Risk" and the paradox associated with "Risk Management," particularly in the context of the creative process. Clearly, risk taking contributes to creative enterprise and effective risk management should accommodate both risk minimization and risk exploitation.

International environmental and occupational health: From individual scientists to networked science Hubs.

For the past 16 years, the International Training and Research in Environmental and Occupational Health program (ITREOH) has supported projects that link U.S. academic scientists with scientists from low- and middle-income countries in diverse research and research training activities. Twenty-two projects of varied duration have conducted training to enhance the research capabilities of scientists at 75 institutions in 43 countries in Asia, Africa, Eastern Europe, and Latin America, and have built productive research relationships between these scientists and their U.S. partners. ITREOH investigators and their trainees have produced publications that have advanced basic sciences, developed methods, informed policy outcomes, and built institutional capacity. Today, the changing nature of the health sciences calls for a more strategic approach. Data-rich team science requires greater capacity for information technology and knowledge synthesis at the local institution. More robust systems for ethical review and administrative support are necessary to advance population-based research. Sustainability of institutional research capability depends on linkages to multiple national and international partners. In this context, the Fogarty International Center, the National Institute of Environmental Sciences and the National Institute for Occupational Safety and Health, have reengineered the ITREOH program to support and catalyze a multi-national network of regional hubs for Global Environmental and Occupational Health Sciences (GEOHealth). We anticipate that these networked science hubs will build upon previous investments by the ITREOH program and will serve to advance locally and internationally important health science, train and attract first-class scientists, and provide critical evidence to guide policy discussions.