[Reassessment of burden of occupational fatal injuries in Italy, 1951-2017]. / Rivalutazione del carico di danni dovuti agli infortuni mortali sul lavoro in Italia, 1951-2017.

BACKGROUND: occupational injuries in Italy are registered primarily by the Italian National Institute for insurance against accidents at work (Inail); its statistics show the number of events by consequence type (temporary, permanent, fatal). Data prior to 2001 include fatalities only if benefits were paid to survivors entitled to compensation, typically spouse and/or children. OBJECTIVES: to estimate the number of fatal injuries occurred to workers without survivors entitled to compensation, not considered in INAIL statistics for the period 1951-2000; to evaluate years lived with disability (YLD) years of life lost (YLL), disability-adjusted life years (DALY) caused by all occupational injuries occurred in Italy, period 1951-2016. DESIGN: evaluation of the stability of the ratio among fatal accidents with and without survivors, along the period of observation (2001-2017); retrospective application of such ratio to data related to the period 1951-2000; linkage of individual injury data to Global Burden of Disease injury categories and calculation of corresponding YLLs, YLDs, DALYs; calculation of mean values by main type of consequences (temporary, permanent, fatal); application of above means to Italian data 1951-2017. SETTING AND PARTICIPANTS: occupational injuries compensated by Inail in Italy, 1951-2017. MAIN OUTCOME MEASURES: number of injuries, YLDs, YLLs, DALYs. RESULTS: fatal occupational injuries, not considered in official statistics for the period 1951-2000, are estimated to be 26,218 cases, corresponding to 1.4 millions of YLLs. In the same period, total occupational injuries (with temporary, permanent or fatal consequences) correspond to 11.5 millions of DALYs, fatal component corresponded to 5.1 millions of YLLs. CONCLUSIONS: Estimated total number of fatal occupational injuries in 1951-2000 is 28% higher than official Inail data. Considering YLLs, such increase rises up to 37%. Such difference reflects younger mean age and consequent longer life expectancy of workers without survivors. Considering DALYs, the increase is 14%. Throughout the period 1951-2017, a progressive reduction of the burden of injury is observed. At the same time a qualitative change is observed, with reduction from 55% to 30% of YLL/DALY ratio.

Evaluation of the impact of heat stress on the occurrence of occupational injuries: Meta-analysis of observational studies.

BACKGROUND: Growing evidence indicates that the exposure to high heat levels in the workplace results in health problems in workers. A meta-analysis was carried out to summarize the epidemiological evidence of the effects of heat exposure on the risk of occupational injuries. METHODS: A search strategy was conducted to retrieve studies on the effects of climate change on occupational injury risk. Among the 406 identified, 5 time-series and 3 case-crossover studies were selected for meta-analysis. RESULTS: Pooled risk estimates for time-series and case-crossover studies combined, and then separated, were 1.005 (95%CI: 1.001-1009), 1.002 (95%CI: 0.998-1.005), and 1.014 (95%CI: 1.012-1.017), respectively. Subgroup analyses found increased risks (not statistically significant) for male gender, age <25 years and agriculture. CONCLUSIONS: The present findings can orient further research to assess the effects of heat at workplace and consequently to establish better health policies for managing such exposure in at-risk regions.

Workplace health promotion.

Workplace Health Promotion (WHP-Workplace Health Promotion) is aimed at improving the workers' well-being and health, so as to guarantee conditions of greater psycho-physical well-being and work capacity for a future elderly population. Cost-benefit analysis studies indicate that the return of profits compared to the invested capital (Return of investment - ROI) can be very good. To conduct WHP's activities successfully, the continuous and convinced commitment of all corporate subjects is required. WHP interventions must not represent alternative paths to those of Prevention and Safety, nor represent "discount" tools with respect to regulatory obligations. It is essential that there be clarity in the roles played by public institutions operators (USL / ASL / ATS) who, in various capacities and in various sectors, are involved. At the moment, in terms of WHP, the regions have responded differently and in any case the difficulties in applying the WHP to SMEs have become evident. Whatever the approach, WHP's actions must take into account the end-point, ie the health gain of the workers involved due to the specific effect of the action promoted and for this reason the programs must provide an adequate follow-up, which becomes an element indispensable for any proposal. Health promotion in the "work" context has, with respect to more traditional contexts (such as school or community), undoubtedly peculiarities, which require a specific training of "health promoters" engaged in this field.

Impact of climate change on occupational health and productivity: a systematic literature review focusing on workplace heat.

BACKGROUND: With climate change, mean annual air temperatures are getting hotter and extreme weather events will become more and more common in most parts of the world. OBJECTIVES: As part of the EU funded project HEAT-SHIELD we conducted a systematic review to summarize the epidemiological evidence of the effects of global warming-related heat exposure on workers' health and productivity. METHODS: Three separate searches, focused, respectively, on: i) heat-related illness (HRI), cardiovascular, respiratory and kidney diseases; ii) traumatic injuries; and iii) vector-borne diseases or vectors distribution, were conducted in PubMed. EMBASE was also consulted to retrieve relevant studies focused on the health effects of climate change. A fourth search strategy to assess the effects on work productivity was conducted both in PubMed and in the SCOPUS database. RESULTS: A significant proportion of studies reported findings regarding the Mesoamerican nephropathy issue. This is a disease occurring especially among young and middle-aged male sugarcane workers, without conventional risk factors for chronic kidney disease. For injuries, there is a reversed U-shaped exposure-response relationship between Tmax and overall daily injury claims. Outdoor workers are at increased risk of vector-borne infectious diseases, as a positive correlation between higher air temperatures and current or future expansion of the habitat of vectors is being observed. As for productivity, agriculture and construction are the most studied sectors; a day with temperatures exceeding 32°C can reduce daily labour supply in exposed sectors by up to 14%. CONCLUSIONS: The present findings should inform development of further research and related health policies in the EU and beyond with regard to protecting working people from the effects of workplace heat during climate change.

Effects of the work limitations on the career path of a cohort of health workers. / Efetti delle limitazioni impartitie dal Medico Competente sul percorso lavorativo di una coorte di lavoratori della sanità.

BACKGROUND: The median age of the workforce, and of healthcare workers in particular, is increasing, resulting in a reduced work capacity. This may prompt the occupational physician to issue fitness for work limitations. OBJECTIVES: To examine the health surveillance data collected over 20 years on the employees of a large healthcare institution to identify the effects of the limitations imposed on their career paths. METHODS: The database of health surveillance records gathered over the years was analysed using the same dedicated software. Fourteen types of limitations were classified via a "text mining" treatment. 3,653 subjects were selected, divided in two groups (A: with a limitation and B: without limitation) comprised of 655 and 2,998 subjects, respectively. The subjects were then ranked on the basis of departments and tasks involved. We also evaluated the number of departmental changes for each worker and the corresponding rate of change for the three groups A, B and B post-limitation. RESULTS: Limitations have been increasing in parallel with the aging of workers, in particular those relating to Manual Load Handling/Posture (MLH/P). The limitations due to Allergy/Latex lasted longer, and in a greater proportion than MLH/P, particularly when compared to the limitation for Shift Work and those for "Other Limitations" that were shrinking faster. CONCLUSIONS: There is a clear relationship between certain types of limitations/prescriptions and workers' ages. It is necessary to carry out an assessment of the association with the work performed in order to implement age management strategies aimed at maintaining work capacity in aging workers.

Reduction of excavation face collapse risk in tunnelling.

Two large road tunnels, recently developed near Florence, showed instabilities of the excavation face which subsequently caused sixteen collapses. Due to the risk for workers' safety, the public authority for occupational health and safety (ASL) has monitored the failure rate and other background variables in order to assess the possible correlations between risk reductions, its own actions, and those of the various safety actors involved. OBJECTIVES: To evaluate if the interventions carried out by the design team were able to reduce the risks of collapse and which of the ASL actions and/or which other factors were more effective in changing the attitudes of the parties involved, leading to a more expensive but safer project variant. RESULTS: After adoption of the second of two project variants, no more collapses were observed. No correlation was found between trend of ASL inspections and observed variation of collapse rate. Conversely, the adoption of strongly coercive measures and investigation reporting by local media coincided with periods of risk reduction, even if the low number of events does not allow for statistical evaluation. CONCLUSIONS: These findings appear to be coherent with the ratio of the cost of penalties related to health and safety infringements (thousands of euros) to the overall cost of the safer project variant (a hundred times greater).  The safer variant required 7% more labour but avoided forced interruptions caused by the collapses, allowing a 13% faster excavation rate.

Delphi consensus on the monitoring tools of main individual risk factors for chronic diseases by the company doctor. / Ricerca di consenso Delphi sugli strumenti per il monitoraggio da parte del medico competente dei principali fattori di rischio individuali per malattie croniche.

BACKGROUND: Data on individual risk factors for chronic diseases (smoking, physical activity, body mass) are collected by company physicians in heterogeneous ways. This makes comparisons, researches and evaluations difficult. OBJECTIVES: The aim of the study was to find a consensus on evaluation tools for chronic diseases risk factors and for health promotion programs in workplaces that could be performed by company physicians during their clinical activity. METHODS: A first set of tools, proposed by a working group of occupational physicians in Bergamo, was submitted through the Delphi technique to a national expert panel of 22 persons including recognized national experts in specific fields and occupational physicians skilled in health promotion. RESULTS: In three Delphi rounds, the panel selected a set of tools to monitor the main individual risk factors for chronic diseases (smoking, alcohol, physical activity, nutrition, stress and mental health) as well as general data related to the worker and his job. CONCLUSIONS: The use of these specific tools, collected in a homogeneous format, should be recommended to all Italian company physicians, in particular those who work in WHP-programs, in order to allow analysis, comparison and evaluation of health promotion programs effectiveness at a national level.

Air temperature exposure and outdoor occupational injuries: a significant cold effect in Central Italy.

OBJECTIVE: To investigate the short-term effect of air temperature on outdoor occupational injuries (out_OI) in Central Italy, also by taking different geographical factors and employment sectors of workers into account. METHODS: Out_OI for all of Tuscany (Central Italy), from 2003 to 2010 (n=162,399), were provided by the National Institute of Insurance for Occupational Illness and Injury. Representative daily meteorological data of the geographical area under study were obtained from the European Reanalysis-interim climatological reanalysis archive. Relationships between short-term changes in air temperature and out_OI were studied through Generalised Additive Models. RESULTS: The exposure-response curves of out_OI and short-term changes in air temperature generally showed significant out_OI increases when cold conditions occurred. The air temperature breakpoint corresponded to the 10th centile (-0.8°C) of the air temperature time series used in this study: a 1°C decrease in temperature below the 10th centile corresponded to a 2.3% (CI 1.3% to 3.3%) increase of out_OI throughout all of Tuscany. The cold effect was strongest in plain areas, especially when out_OI occurred in vehicles other than cars. No relationships of injuries with temperature extremes were observed in workers who generally spend half or most of their time outdoors, such as construction, land and forestry workers. However, these latter outdoor workers showed significant linear associations of injuries with typical (far-from-extreme) temperatures. CONCLUSIONS: This large population-based study highlights the significant and independent effects of short-term air temperature changes (especially cold) in triggering out_OI. These findings represent the first step towards developing a geographically differentiated, operative outdoor-temperature-occupational-health warning system aimed at preventing outdoor work injuries.

Incidence rates of surgically treated rhegmatogenous retinal detachment among manual workers, non-manual workers and housewives in Tuscany, Italy.

PURPOSE: Candidate risk factors for idiopathic rhegmatogenous retinal detachment (RRD) include heavy manual handling (requiring Valsalva's maneuver). We assessed incidence rates of surgically treated idiopathic RRD among manual workers, non-manual workers and housewives resident in Tuscany, Italy. METHODS: We retrieved all hospital discharge records bearing a principal diagnosis corresponding to RRD coupled with retinal surgery for any resident of Tuscany during 1997-2009. After elimination of repeated admissions and patients with coexistent, associated conditions (including recent trauma), subjects aged 25-59 years were classified as manual workers, non-manual workers or housewives. Population data were extracted from the 2001 census. RESULTS: We identified 1,946 eligible cases (1,142 men). Among men, manual workers experienced a 1.8-fold higher age-standardized rate per 100,000 person-years than non-manual workers [17.4 (95 % confidence interval (CI) 16.1-18.7) vs. 9.8 (95 % CI 8.8-10.8)]. Age-standardized rates among women were 1.9-fold higher for manual workers [11.1 (95 % CI 9.8-12.3)] and 1.7-fold higher for housewives [9.5 (95 % CI 8.3-10.8)] than in non-manual workers [5.7 (95 % CI 4.8-6.6)]. CONCLUSIONS: This large population-based study suggests that manual workers are affected by idiopathic RRD requiring surgical treatment more often than non-manual workers. The higher rates of surgically treated RRD experienced by manual workers are in accord with the hypothesis that heavy manual handling may have a causal role.

[Fatal injuries at work in Tuscany Region (Central Italy): content analysis of newspapers]. / Infortuni mortali sul lavoro in Toscana: analisi dei contenuti informativi della stampa quotidiana.

OBJECTIVES: to describe how journalists report events such as fatal accidents work through the newspapers. DESIGN: analysis of the textual content of titles and texts, using qualitative and quantitative techniques. SETTING AND PARTICIPANTS: 184 articles related to 180 work-related fatalities occurred in Tuscany Region (Central Italy) in the period 2008-2009 were examined. MAIN OUTCOME MEASURES: frequency of citation of significant adjectives relating to the use of frames in titles was measured; frequency of citation of the laquo;subjects attended the venue for office tasksraquo; and laquo;subjects whose statements are reported in relation to the eventraquo; in relation to the circumstances of the event and some available demographic features was also evaluated. RESULTS: compared to texts, titles of the articles are characterized by higher frequency of adjectives that describe the emotional intensity. Articles describing tractors or road accidents and articles that describe sudden deaths are shorter than the others. Among the subgroups of subjects quoted in the text of the articles, health authorities are less mentioned in the articles dealing with road accidents, while they are more common in those due to falls from a height, where also social forces which issue statements to the press are more frequently mentioned. The analysis of co-occurrences visually shows which activities are carried out by these subgroups of subjects in the texts of the selected articles. CONCLUSION: the study shows the message that is conveyed to the public by the mass medium newspaper. Hopefully, in the future, following results of similar studies, it will be easier focusing awareness and transmission of information, which are essential for prioritization process of public health initiatives to be taken. This study was preliminary in nature, opening a field of interest so far little practised in our Country.

[Efficacy--appropriateness]. / Efficacia - Appropriatezza.

I discuss the meaning and differences between the Appropriateness and Efficacy in the prevention of occupational risks and damage. It is argued that to be "appropriate" an intervention should be suitable, keeping with the circumstances, while the intervention that achieves the goal is "effective". In practice, the appropriateness is very used in the field of clinical medicine, with reference to the treatment, while in the prevention it is usual to use with greater frequency the term of effectiveness.

[Requirements of the system for registering occupational diseases: experience in comparison]. / Requisiti dei sistemi di registrazione delle malattie professionali: esperienze a confront.

The main characteristics of the OSH monitoring systems in use in Europe are described. We refer the results of a survey carried out in six different European countries using the ODIT tool for assessing the quality of these recordings.

[The post-mortem external examination in Italy: critical issues and perspectives]. / Il medico necroscopo e la rilevazione delle morti apparenti: criticità e prospettive future.

The purpose of the postmortem external examination is to ascertain death and authorize burial. Requirements regarding external postmortem examinations and the tasks of physicians having this specific duty, vary in different regions of Italy. In this study, we analyzed the rationale and role of physicians performing post mortem external examinations. The role of physicians ascertaining death should be enhanced and they should play a bigger role in the identification and verification of the cause of death. A reorganization of post-mortem procedures also appears necessary.

Carpal tunnel syndrome among ewe dairy farmers in Sardinia, Italy.

BACKGROUND: The region of Sardinia, Italy is known internationally for the production of cheeses made from ewe's milk. Although the use of automated milking equipment is available in ewe dairy operations, traditional hand milking is still performed on many ewe farms. The purpose of this study was to evaluate the prevalence of carpal tunnel syndrome (CTS) among farmers that manually milk ewes. METHODS: Worker demographics, upper limb symptoms, and electrophysiologic studies were obtained on 76 ewe farmers recruited from a random sample of 109 in northern Sardinia. Characteristic hand symptoms and electrophysiologic studies were used in the case definition of CTS. RESULTS: Of the 76 farmers evaluated, 42 (55.3%) fit the case definition of CTS in at least one hand. Assuming that all non-respondents did not have CTS, the CTS prevalence ratio would have been 38.5% (42/109) among the randomized sample of ewe farmers. CONCLUSIONS: These findings suggest that CTS is a significant occupational health issue for ewe farmers that continue the traditional methods of manual milking. The recent trend in automated ewe milking machines may help reduce the prevalence of CTS among the next generation of Italian ewe farmers.

PubMed search strings for the study of agricultural workers' diseases.

BACKGROUND: Several optimized search strategies have been developed in Medicine, and more recently in Occupational Medicine. The aim of this study was to identify efficient PubMed search strategies to retrieve articles regarding putative occupational determinants of agricultural workers' diseases. METHODS: We selected the Medical Subjects Heading (MeSH) term agricultural workers' diseases and six MeSH terms describing farm work (agriculture, agrochemicals NOT pesticides, animal husbandry, pesticides, rural health, rural population) alongside 61 other promising terms. We estimated proportions of articles containing potentially pertinent information regarding occupational etiology to formulate two search strategies (one "more specific," one "more sensitive"). We applied these strategies to retrieve information on the possible occupational etiology among agricultural workers of kidney cancer, knee osteoarthritis, and multiple sclerosis. We evaluated the number of needed to read (NNR) abstracts to identify one potentially pertinent article in the context of these pathologies. RESULTS: The "more specific" search string was based on the combination of terms that yielded the highest proportion (40%) of potentially pertinent abstracts. The "more sensitive" string was based on use of broader search fields and additional coverage provided by other search terms under study. Using the "more specific" string, the NNR to find one potentially pertinent article were: 1.1 for kidney cancer; 1.4 for knee osteoarthritis; 1.2 for multiple sclerosis. Using the sensitive strategy, the NNR were 1.4, 3.6, and 6.3, respectively. CONCLUSION: The proposed strings could help health care professionals explore putative occupational etiology for agricultural workers' diseases (even if not generally thought to be work related).

Hidden effectiveness? Results of hand-searching Italian language journals for occupational health interventions.

OBJECTIVE: To compare the yield of hand-searching with optimised electronic search strategies in retrieving occupational health (OH) intervention studies published in a language other than English. METHODS: The authors systematically hand-searched and screened reports of OH intervention studies published in Italian in peer-reviewed scientific journals between 1990 and 2008. The authors evaluated how many of them met the Cochrane Occupational Safety and Health Review Groups (OSHRG) definition of being an OH intervention study and how many potentially relevant studies retrieved by hand-searching would not be found by PubMed alone using the OSHRG's most specific and most sensitive search strings. RESULTS: Hand-searching retrieved 25 articles (reporting 27 studies), including nine not indexed in MEDLINE. Most studies (81%, 22/27) had a before-after design and only one was a randomised trial. The OSHRG's most sensitive search string retrieved all 16 articles published in the Italian language journals that were indexed in MEDLINE, while the most specific search strategy retrieved nine articles (56%, 9/16). The most specific search string showed a lower 'number needed to read' value than the most sensitive one (60 vs 132). CONCLUSIONS: These findings suggest that a sensitive electronic search strategy may be able to find most of the OH interventions published in languages other than English that are indexed in MEDLINE. Hand-searching of important national journals not indexed in MEDLINE should be considered when conducting particularly in-depth research.

[Comparison between two different Disability Weights calculations: the case of occupational injuries]. / Confronto fra due metodologie di calcolo dei pesi di disabilità: l'esempio degli infortuni sul lavoro.

AIM: To introduce the concept of DALYs (Disability Adjusted Life Years), in order to calculate the burden of occupational injuries and to compare the disability weights methodology applied by the National Institute for Insurance against Accidents at Work (INAIL) to occupational injuries, with respect to the methodology adopted by the World Health Organization in the Global Burden of Disease Study (GBD), in order to facilitate, on a regional-national basis, the future application of estimates of Burden of Disease due to this phenomenon, based on data available from the NHS. DESIGN: In the first part of the present study, a comparison between the theoretical GBD methodology, based on Disability Weights, and the INAIL methodology based on Gradi di inabilità (Degree of Disability) (GI) described in the table of impairments is made, using data on occupational injuries occurred in Tuscany from 2001 to 2008. Given the different criteria adopted by WHO and INAIL for the classification of injuries sequelae, in the second part, two equations described in the literature have been applied in order to correct systematic biases. RESULTS: In the INAIL dataset, all types of injuries, though often small in scale, have cases with permanent consequences, some of them serious.This contrasts with the assumptions of the WHO, that, apart from the cases of amputation, reduces the possibility of lifelong disabilities to a few very serious categories. In the case of femur and skull fractures, the proportion of lifelong cases is considered by WHO similar to the proportion that in the INAIL dataset is achieved after narrowing the threshold of permanent damage to cases with GI ≥ 33. In the case of amputations and spinal cord injuries, for which the WHO assumes a priori that all cases have lifelong consequences, on the contrary, the greater similarity between the assumptions and the empirically observable reality is obtained after extending the threshold of permanent damage to all cases with even minimal sequelae.The comparison between the WHO DW and INAIL GI, possible only in relation to injuries resulting in permanent damage, shows that in case of injuries of greater severity, INAIL GI are generally lower than the WHO DW. In the case of less serious injuries, INAIL gives instead higher values. The length of temporary disabilities recorded by INAIL is systematically higher than that estimated by WHO. CONCLUSIONS: These initial comparisons between the WHO methodology and the cases evaluation performed by INAIL show that the Italian system, based on the gathering of all relevant aspects related to each case, has the potential to utilize and synthesize a greater amount of information.However, wide limits of uncertainty still remain and further empirical findings are needed in order to compare the two systems in terms of precise determination of the DW, the length of disabilities and variations of mortality related to injuries.

[Work and health since Italian unification to now: achievements, needs, and directions from historiography]. / Salute e Lavoro dall'Unità d'Italia ad oggi: risultati, lacune e indicazioni delle ricerche a carattere storico.

The authors describe the status-of-the-Art of History of Workers' Health and Occupational Medicine in Italy. Attention is focused on the periods between the peaks of interest, widely known by contemporary historians. It seems clear that less known periods are, however, often essential to understanding the onset times of "peaks", and to profile along time attitude and results achieved by the society on health issues in the workplace. In all periods doctors play a predominant role, while the presence of other professionals that instead had a leading role in the history of other industrialized countries, is downsized.

Search strings for the study of putative occupational determinants of disease.

OBJECTIVE: To identify efficient PubMed search strategies to retrieve articles regarding putative occupational determinants of conditions not generally considered to be work related. METHODS: Based on MeSH definitions and expert knowledge, we selected as candidate search terms the four MeSH terms describing 'occupational disease', 'occupational exposure', 'occupational health' and 'occupational medicine' (DEHM) alongside 22 other promising terms. We first explored overlaps between the candidate terms in PubMed. Using random samples of abstracts retrieved by each term, we estimated the proportions of articles containing potentially pertinent information regarding occupational aetiology in order to formulate two search strategies (one more 'specific', one more 'sensitive'). We applied these strategies to retrieve information on the possible occupational aetiology of meningioma, pancreatitis and atrial fibrillation. RESULTS: Only 20.3% of abstracts were retrieved by more than one DEHM term. The more 'specific' search string was based on the combination of terms that yielded the highest proportion (40%) of potentially pertinent abstracts. The more 'sensitive' string was based on the use of broader search fields and additional coverage provided by other search terms under study. Using the specific string, the numbers of abstracts needed to read to find one potentially pertinent article were 1.2 for meningioma, 1.9 for pancreatitis and 1.8 for atrial fibrillation. Using the sensitive strategy, the numbers needed to read were 4.4 for meningioma, 8.9 for pancreatitis and 10.5 for atrial fibrillation. CONCLUSIONS: The proposed strings could help health care professionals explore putative occupational aetiology for diseases that are not generally thought to be work related.