Modelling the air quality benefits of EU climate mitigation policies using two different PM2.5-related health impact methodologies.

The EU, seeking to be a global leader in the fight against climate change, is moving ahead with ambitious policies to mitigate greenhouse gases emissions. In this context, the Fit for 55 package (FF55) is a set of proposals to revise and update EU legislation, to ensure that policies are in line with the climate goals of cutting emissions by at least 55% by 2030. Whilst these policies are designed for climate purposes, they will have positive side-effects (co-benefits) on air quality. Separately, additional policies are also in place to reduce emissions of related air pollutants and to improve air quality concentrations on EU territory. In this work, through a modelling study, we analyse the benefits of these policies via the health benefits arising from the resulting reductions in yearly average PM2.5 concentrations. Results are analysed by assessing and comparing morbidity and mortality impacts as computed using both the HRAPIE (Health risks of air pollution in Europe, WHO, as implemented in the CaRBonH model) and the GBD (Global Burden of Disease, as implemented in FASST-GBD model) approaches. Even when considering the uncertainty and variability in the results obtained using the two approaches, it is clear that EU policies can bring health and economic benefit in EU, with several Billions of Euro of benefits both in terms of morbidity and mortality indicators.

Effects of extreme meteorological conditions in 2018 on European methane emissions estimated using atmospheric inversions.

The effect of the 2018 extreme meteorological conditions in Europe on methane (CH4) emissions is examined using estimates from four atmospheric inversions calculated for the period 2005-2018. For most of Europe, we find no anomaly in 2018 compared to the 2005-2018 mean. However, we find a positive anomaly for the Netherlands in April, which coincided with positive temperature and soil moisture anomalies suggesting an increase in biogenic sources. We also find a negative anomaly for the Netherlands for September-October, which coincided with a negative anomaly in soil moisture, suggesting a decrease in soil sources. In addition, we find a positive anomaly for Serbia in spring, summer and autumn, which coincided with increases in temperature and soil moisture, again suggestive of changes in biogenic sources, and the annual emission for 2018 was 33 ± 38% higher than the 2005-2017 mean. These results indicate that CH4 emissions from areas where the natural source is thought to be relatively small can still vary due to meteorological conditions. At the European scale though, the degree of variability over 2005-2018 was small, and there was negligible impact on the annual CH4 emissions in 2018 despite the extreme meteorological conditions. This article is part of a discussion meeting issue 'Rising methane: is warming feeding warming? (part 2)'.

Air pollutant emissions from global food systems are responsible for environmental impacts, crop losses and mortality.

Food systems are important contributors to global emissions of air pollutants. Here, building on the EDGAR-FOOD database of greenhouse gas emissions, we estimate major air pollutant compounds emitted by different stages of the food system, at country level, during the past 50 years, resulting from food production, processing, packaging, transport, retail, consumption and disposal. Air pollutant estimates from food systems include total nitrogen and its components (N2O, NH3 and NOx), SO2, CO, non-methane volatile organic compounds (NMVOC) and particulate matter (PM10, PM2.5, black carbon and organic carbon). We show that 10% to 90% of air pollutant emissions come from food systems, resulting from steady increases over the past five decades. In 2018, more than half of total N (and 87% of ammonia) emissions come from food systems and up to 35% of particulate matter. Food system emissions are responsible for about 22.4% of global mortality due to poor air quality and 1.4% of global crop production losses.

Targeted whole exome sequencing and Drosophila modelling to unveil the molecular basis of primary ovarian insufficiency.

STUDY QUESTION: Can a targeted whole exome sequencing (WES) on a cohort of women showing a primary ovarian insufficiency (POI) phenotype at a young age, combined with a study of copy number variations, identify variants in candidate genes confirming their deleterious effect on ovarian function? SUMMARY ANSWER: This integrated approach has proved effective in identifying novel candidate genes unveiling mechanisms involved in POI pathogenesis. WHAT IS KNOWN ALREADY: POI, a condition occurring in 1% of women under 40 years of age, affects women's fertility leading to a premature loss of ovarian reserve. The genetic causes of POI are highly heterogeneous and several determinants contributing to its prominent oligogenic inheritance pattern still need to be elucidated. STUDY DESIGN, SIZE, DURATION: WES screening for pathogenic variants of 41 Italian women with non-syndromic primary and early secondary amenorrhoea occurring before age 25 was replicated on another 60 POI patients, including 35 French and 25 American women, to reveal statistically significant shared variants. PARTICIPANTS/MATERIALS, SETTING, METHODS: The Italian POI patients' DNA were processed by targeted WES including 542 RefSeq genes expressed or functioning during distinct reproductive or ovarian processes (e.g. DNA repair, meiosis, oocyte maturation, folliculogenesis and menopause). Extremely rare variants were filtered and selected by means of a Fisher Exact test using several publicly available datasets. A case-control Burden test was applied to highlight the most significant genes using two ad-hoc control female cohorts. To support the obtained data, the identified genes were screened on a novel cohort of 60 Caucasian POI patients and the same case-control analysis was carried out. Comparative analysis of the human identified genes was performed on mouse and Drosophila melanogaster by analysing the orthologous genes in their ovarian phenotype, and two of the selected genes were fruit fly modelled to explore their role in fertility. MAIN RESULTS AND THE ROLE OF CHANCE: The filtering steps applied to search for extremely rare pathogenic variants in the Italian cohort revealed 64 validated single-nucleotide variants/Indels in 59 genes in 30 out of 41 screened women. Burden test analysis highlighted 13 ovarian genes as being the most enriched and significant. To validate these findings, filtering steps and Burden analysis on the second cohort of Caucasian patients yielded 11 significantly enriched genes. Among them, AFP, DMRT3, MOV10, FYN and MYC were significant in both patient cohorts and hence were considered strong candidates for POI. Mouse and Drosophila comparative analysis evaluated a conserved role through the evolution of several candidates, and functional studies using a Drosophila model, when applicable, supported the conserved role of the MOV10 armitage and DMRT3 dmrt93B orthologues in female fertility. LARGE SCALE DATA: The datasets for the Italian cohort generated during the current study are publicly available at ClinVar database (http://www.ncbi.nlm.nih.gov/clinvar/): accession numbers SCV001364312 to SCV001364375. LIMITATIONS, REASONS FOR CAUTION: This is a targeted WES analysis hunting variants in candidate genes previously identified by different genomic approaches. For most of the investigated sporadic cases, we could not track the parental inheritance, due to unavailability of the parents' DNA samples; in addition, we might have overlooked additional rare variants in novel candidate POI genes extracted from the exome data. On the contrary, we might have considered some inherited variants whose clinical significance is uncertain and might not be causative for the patients' phenotype. Additionally, as regards the Drosophila model, it will be extremely important in the future to have more mutants or RNAi strains available for each candidate gene in order to validate their role in POI pathogenesis. WIDER IMPLICATIONS OF THE FINDINGS: The genomic, statistical, comparative and functional approaches integrated in our study convincingly support the extremely heterogeneous oligogenic nature of POI, and confirm the maintenance across the evolution of some key genes safeguarding fertility and successful reproduction. Two principal classes of genes were identified: (i) genes primarily involved in meiosis, namely in synaptonemal complex formation, asymmetric division and oocyte maturation and (ii) genes safeguarding cell maintenance (piRNA and DNA repair pathways). STUDY FUNDING/COMPETING INTEREST(S): This work was supported by Italian Ministry of Health grants 'Ricerca Corrente' (08C621_2016 and 08C924_2019) provided to IRCCS Istituto Auxologico Italiano, and by 'Piano Sostegno alla Ricerca' (PSR2020_FINELLI_LINEA_B) provided by the University of Milan; M.P.B. was supported by Telethon-Italy (grant number GG14181). There are no conflicts of interest.

Improved Constraints on Global Methane Emissions and Sinks Using δ 13C-CH4.

We study the drivers behind the global atmospheric methane (CH4) increase observed after 2006. Candidate emission and sink scenarios are constructed based on proposed hypotheses in the literature. These scenarios are simulated in the TM5 tracer transport model for 1984-2016 to produce three-dimensional fields of CH4 and δ 13C-CH4, which are compared with observations to test the competing hypotheses in the literature in one common model framework. We find that the fossil fuel (FF) CH4 emission trend from the Emissions Database for Global Atmospheric Research 4.3.2 inventory does not agree with observed δ 13C-CH4. Increased FF CH4 emissions are unlikely to be the dominant driver for the post-2006 global CH4 increase despite the possibility for a small FF emission increase. We also find that a significant decrease in the abundance of hydroxyl radicals (OH) cannot explain the post-2006 global CH4 increase since it does not track the observed decrease in global mean δ 13C-CH4. Different CH4 sinks have different fractionation factors for δ 13C-CH4, thus we can investigate the uncertainty introduced by the reaction of CH4 with tropospheric chlorine (Cl), a CH4 sink whose abundance, spatial distribution, and temporal changes remain uncertain. Our results show that including or excluding tropospheric Cl as a 13 Tg/year CH4 sink in our model changes the magnitude of estimated fossil emissions by ∼20%. We also found that by using different wetland emissions based on a static versus a dynamic wetland area map, the partitioning between FF and microbial sources differs by 20 Tg/year, ∼12% of estimated fossil emissions.

Food systems are responsible for a third of global anthropogenic GHG emissions.

We have developed a new global food emissions database (EDGAR-FOOD) estimating greenhouse gas (GHG; CO2, CH4, N2O, fluorinated gases) emissions for the years 1990-2015, building on the Emissions Database of Global Atmospheric Research (EDGAR), complemented with land use/land-use change emissions from the FAOSTAT emissions database. EDGAR-FOOD provides a complete and consistent database in time and space of GHG emissions from the global food system, from production to consumption, including processing, transport and packaging. It responds to the lack of detailed data for many countries by providing sectoral contributions to food-system emissions that are essential for the design of effective mitigation actions. In 2015, food-system emissions amounted to 18 Gt CO2 equivalent per year globally, representing 34% of total GHG emissions. The largest contribution came from agriculture and land use/land-use change activities (71%), with the remaining were from supply chain activities: retail, transport, consumption, fuel production, waste management, industrial processes and packaging. Temporal trends and regional contributions of GHG emissions from the food system are also discussed.

High-resolution array-CGH analysis on 46,XX patients affected by early onset primary ovarian insufficiency discloses new genes involved in ovarian function.

STUDY QUESTION: Can high resolution array-CGH analysis on a cohort of women showing a primary ovarian insufficiency (POI) phenotype in young age identify copy number variants (CNVs) with a deleterious effect on ovarian function? SUMMARY ANSWER: This approach has proved effective to clarify the role of CNVs in POI pathogenesis and to better unveil both novel candidate genes and pathogenic mechanisms. WHAT IS KNOWN ALREADY: POI describes the progression toward the cessation of ovarian function before the age of 40 years. Genetic causes are highly heterogeneous and despite several genes being associated with ovarian failure, most of genetic basis of POI still needs to be elucidated. STUDY DESIGN, SIZE, DURATION: The current study included 67 46,XX patients with early onset POI (<19 years) and 134 control females recruited between 2012 and 2016 at the Medical Cytogenetics and Molecular Genetics Lab, IRCCS Istituto Auxologico Italiano. PARTICIPANTS/MATERIALS, SETTING, METHODS: High resolution array-CGH analysis was carried out on POI patients' DNA. Results of patients and female controls were analyzed to search for rare CNVs. All variants were validated and subjected to a gene content analysis and disease gene prioritization based on the present literature to find out new ovary candidate genes. Case-control study with statistical analysis was carried out to validate our approach and evaluate any ovary CNVs/gene enrichment. Characterization of particular CNVs with molecular and functional studies was performed to assess their pathogenic involvement in POI. MAIN RESULTS AND THE ROLE OF CHANCE: We identified 37 ovary-related CNVs involving 44 genes with a role in ovary in 32 patients. All except one of the selected CNVs were not observed in the control group. Possible involvement of the CNVs in POI pathogenesis was further corroborated by a case-control analysis that showed a significant enrichment of ovary-related CNVs/genes in patients (P = 0.0132; P = 0.0126). Disease gene prioritization identified both previously reported POI genes (e.g. BMP15, DIAPH2, CPEB1, BNC1) and new candidates supported by transcript and functional studies, such as TP63 with a role in oocyte genomic integrity and VLDLR which is involved in steroidogenesis. LARGE SCALE DATA: ClinVar database (http://www.ncbi.nlm.nih.gov/clinvar/); accession numbers SCV000787656 to SCV000787743. LIMITATIONS, REASONS FOR CAUTION: This is a descriptive analysis for almost all of the CNVs identified. Inheritance studies of CNVs in some non-familial sporadic cases was not performed as the parents' DNA samples were not available. Addionally, RT-qPCR analyses were carried out in few cases as RNA samples were not always available and the genes were not expressed in blood. WIDER IMPLICATIONS OF THE FINDINGS: Our array-CGH screening turned out to be efficient in identifying different CNVs possibly implicated in disease onset, thus supporting the extremely wide genetic heterogeneity of POI. Since almost 50% of cases are negative rare ovary-related CNVs, array-CGH together with next generation sequencing might represent the most suitable approach to obtain a comprehensive genetic characterization of POI patients. STUDY FUNDING/COMPETING INTEREST(S): Supported by Italian Ministry of Health grants 'Ricerca Corrente' (08C203_2012) and 'Ricerca Finalizzata' (GR-2011-02351636, BIOEFFECT) to IRCCS Istituto Auxologico Italiano.

Novel insights on new particle formation derived from a pan-european observing system.

The formation of new atmospheric particles involves an initial step forming stable clusters less than a nanometre in size (<~1 nm), followed by growth into quasi-stable aerosol particles a few nanometres (~1-10 nm) and larger (>~10 nm). Although at times, the same species can be responsible for both processes, it is thought that more generally each step comprises differing chemical contributors. Here, we present a novel analysis of measurements from a unique multi-station ground-based observing system which reveals new insights into continental-scale patterns associated with new particle formation. Statistical cluster analysis of this unique 2-year multi-station dataset comprising size distribution and chemical composition reveals that across Europe, there are different major seasonal trends depending on geographical location, concomitant with diversity in nucleating species while it seems that the growth phase is dominated by organic aerosol formation. The diversity and seasonality of these events requires an advanced observing system to elucidate the key processes and species driving particle formation, along with detecting continental scale changes in aerosol formation into the future.

A balanced reciprocal translocation t(10;15)(q22.3;q26.1) interrupting ACAN gene in a family with proportionate short stature.

PURPOSE: Few examples of the involvement of a single gene in idiopathic short stature have been described until now. Our aim was to identify the causative gene of proportionate short stature in a large family showing co-segregation of the phenotype with the reciprocal translocation t(10;15)(q22;q24). METHODS: FISH mapping was carried out with BACs and long-range PCR probes to identify the smallest genomic regions harboring the translocation breakpoints. Real-Time RT-PCR was performed in blood after pre-amplification of target genes cDNA. RESULT: The affected family members presented with a final height of between - 2.41 and - 4.18 SDS and very mild skeletal dysmorphisms. Growth rates of the proband and of her cousin, whose childhood and pre-pubertal bone age corresponded to the chronological age, showed a poor growth spurt during treatment with rhGH. However, their adult height was greater than that of their untreated mothers, suggesting efficacy of GH therapy. Breakpoint mapping revealed that the translocation t(10;15)(q22.3;q26.1) disrupts, on 15q, the ACAN gene at intron 1, decreasing its transcriptional expression. CONCLUSIONS: This is the first description of a chromosome rearrangement disrupting ACAN and leading to its haploinsufficiency. ACAN loss of function should be considered a potential underpinning of short patients who display a poor growth spurt and belong to families with autosomal dominant segregation of proportionate short stature. Besides this core phenotype, literature review suggests that advanced bone age, early onset osteochondritis dissecans, osteoarthritis, intervertebral disc disease as well as craniofacial dysmorphisms can be important suggestive phenotypes in affected families.

EU effect: Exporting emission standards for vehicles through the global market economy.

Emission data from EDGAR (Emissions Database for Global Atmospheric Research), rather than economic data, are used to estimate the effect of policies and of the global exports of policy-regulated goods, such as vehicles, on global emissions. The results clearly show that the adoption of emission standards for the road transport sector in the two main global markets (Europe and North America) has led to the global proliferation of emission-regulated vehicles through exports, regardless the domestic regulation in the country of destination. It is in fact more economically convenient for vehicle manufacturers to produce and sell a standard product to the widest possible market and in the greatest possible amounts. The EU effect (European Union effect) is introduced as a global counterpart to the California effect. The former is a direct consequence of the penetration of the EURO standards in the global markets by European and Japanese manufacturers, which effectively export the standard worldwide. We analyze the effect on PM2.5 emissions by comparing a scenario of non-EURO standards against the current estimates provided by EDGAR. We find that PM2.5 emissions were reduced by more than 60% since the 1990s worldwide. Similar investigations on other pollutants confirm the hypothesis that the combined effect of technological regulations and their diffusion through global markets can also produce a positive effect on the global environment. While we acknowledge the positive feedback, we also demonstrate that current efforts and standards will be totally insufficient should the passenger car fleets in emerging markets reach Western per capita figures. If emerging countries reach the per capita vehicle number of the USA and Europe under current technological conditions, then the world will suffer pre-1990 emission levels.

ATRX mutation in two adult brothers with non-specific moderate intellectual disability identified by exome sequencing.

In this report, we describe two adult brothers affected by moderate non-specific intellectual disability (ID). They showed minor facial anomalies, not clearly ascribable to any specific syndromic patterns, microcephaly, brachydactyly and broad toes. Both brothers presented seizures. Karyotype, subtelomeric and FMR1 analysis were normal in both cases. We performed array-CGH analysis that revealed no copy-number variations potentially associated with ID. Subsequent exome sequence analysis allowed the identification of the ATRX c.109C>T (p.R37X) mutation in both the affected brothers. Sanger sequencing confirmed the presence of the mutation in the brothers and showed that the mother is a healthy carrier. Mutations in the ATRX gene cause the X-linked alpha thalassemia/mental retardation (ATR-X) syndrome (MIM #301040), a severe clinical condition usually associated with profound ID, facial dysmorphism and alpha thalassemia. However, the syndrome is clinically heterogeneous and some mutations, including the c.109C>T, are associated with a broad phenotypic spectrum, with patients displaying a less severe phenotype with only mild-moderate ID. In the case presented here, exome sequencing provided an effective strategy to achieve the molecular diagnosis of ATR-X syndrome, which otherwise would have been difficult to consider due to the mild non-specific phenotype and the absence of a family history with typical severe cases.

[Chemical risk management in health care settings]. / Gestione del rischio chimico in ospedale.

The aim of this review is pointing out the most relevant allergic and chemical risk factors in health care settings. Some tables summarize the main sensitizing agents, the most frequent allergic diseases and examples of alternative gloves and materials currently available. Some suggestions, to evaluate the allergic risk related to specific tasks in the different hospital departments, are given in order to underline possible failures and to plan focused preventive actions. The chemical hazard has been valued on the basis of the current exposure, which is significantly improved due to structural and technological changes adopted in almost all hospitals. However there are still some critical points due to the use of particularly toxic substances and new molecules, whose health effects should be carefully evaluated, and to a more extensive use of techniques and procedures previously limited to a few work realities.

[The movement computerized analysis as instrumental support for occupational doctors in evaluation of upper limb pathologies in engineering workers]. / L'analisi computerizzata del movimento come strumento di supporto al Medico del Lavoro nella valutazione dei disturbi muscolo-scheletrici degli arti superiori nel comparto metalmecanico.

The movement computerized analysis of upper limb is a valid support in the definition of residual functional capability and of specific work suitability in complex cases. This methodology of evaluation is able to correctly and objectively define the tridimensional ranges of motion of every patient's upper limb. This fact can be particularly useful for workers coming back to work after a work-related or a not work-related accident of for handicapped workers at the beginning of a new work activity. We report a research carried out using computerized analysis of motion of upper limbs in 20 engineering workers.

IVM--the first choice for IVF in Italy.

In March 2004, a new law was introduced in Italy to regulate assisted reproduction; at present it is impossible to use more than a maximum of three oocytes per IVF cycle, nor can embryos or prezygotes (2PN cells) be selected or cryopreserved. The prohibitions introduced by the new law have, on the one hand, reduced the expectations of success of current techniques and, on the other hand, stimulated clinicians and embryologists to work on new therapeutic strategies so as to offer the highest chances of success with the lowest risks. In-vitro maturation (IVM) of oocytes fits very well with these new requirements: ovarian stimulation is avoided and the handling of spare oocytes is facilitated. The IVM protocol is an intriguing alternative to conventional IVF techniques, since it removes the side-effects of drug stimulation, especially ovarian hyperstimulation syndrome, and it also reduces the costs of the entire procedure, both in terms of 'time consumption' and 'patient/society costs for drugs'. In the authors' IVF centre the IVM technique has been used for more than a year, with significant success in terms of maturation and fertilization rates, percentage of embryo transfers, number of pregnancies and, finally, healthy babies born.

[Effects of Maitland's manual mobilization on the thoracic spine]. / Auswirkungen einer manuellen Mobilisation nach Maitland auf die Brustwirbelsäule.

The goal of manual therapy is to decrease pain and to increase function of the spine and peripheral joints. The method introduced by Maitland is widely used in manual medicine. However, no objective changes in the mobility of the thoracic spine after performing manual mobilization have been published in the literature. The aim of this study is to reveal possible changes in the segmental mobility of the thoracic spine after posterior-anterior manipulations without thrust in comparison with a control group. In addition, significant changes within the treatment group were examined. Thirty-six volunteers were randomized into an intervention (16) and a control group (20). The intervention group was treated two times a week for three weeks. The control group received no treatment. The mobility was objectively measured by using Medimouse. No significant difference in the mobility of the thoracic spine could be shown within the intervention group and in comparison with the control group.

[Latex allergy in health care workers: frequency, exposure quantification, efficacy of criteria used for job fitness assessment]. / Allergia a latice nei lavoratori della sanità: frequenza, quantificazione dell'esposizione, efficacia di criteri per la formulazione del giudizio di idoneità.

BACKGROUND: The main purpose of this study was to evaluate the latex allergy prevalence in a large population of health care workers, to quantify latex exposure deriving from use of gloves and to verify the efficacy of job fitness evaluations in allergic workers. METHODS: In the period 2001-2002, latex allergy prevalence was evaluated in 1962 health care workers by means of a self-administered questionnaire, clinical evaluation and specific allergological tests. Also, the total protein content (by means of Lowry method modified EN455-3: 1996) and the antigenic latex proteins (by means of RAST inhibition) in 4 different types of gloves were measured. Job fitness assessments for latex allergic workers were made in accordance with the criteria established by the Italian Association of Preventive Medicine for Health Care Workers criteria. The efficacy was verified one year later. RESULTS: 1557 questionnaires out of 1962 (79.35%) were completed; 504 (32.4%) reported work-related symptoms, in particular 283 subjects had probable irritant contact dermatitis, 66 allergic contact dermatitis and 118 reported irregular non-specific symptoms related to the use of both vinyl and latex gloves; 20 subjects out of the remaining 37 had a latex allergy (1.3% out of the 1557 workers responding to the questionnaire), 8 subjects had only urticaria while 12 subjects had urticaria associated with respiratory symptoms and/or angioedema. The measurement of total protein and antigenic protein content showed the highest levels in powdered latex examination gloves, the lowest levels in surgical powder-free latex gloves. Low concentrations of antigenic proteins were also found in nitrile gloves. Job fitness evaluations were efficacious in 11 out of 20 workers, and inefficacious in 3 cases (6 workers had resigned). CONCLUSIONS: This study revealed a very low prevalence of latex allergy probably due to the fact that we examined an unselected population, and only symptomatic subjects were considered; moreover, in our hospital, vinyl examination gloves had been prevalently used during the last ten years. The criteria followed for job fitness assessment seem to be efficacious on the whole. In spite of a low prevalence of latex allergy, we found a high frequency of irritant contact dermatitis in the examined workers, mainly due to the lubricant powder in both synthetic and natural rubber gloves. Most workers made a complete recovery when they started using powder-free gloves. The high biocompatibility of powder-free gloves was confirmed by the measurement of total protein and latex antigenic protein content in the gloves used in the hospital. Moreover, it should be noted that latex antigenic proteins were also demonstrated in nitrile gloves, this is a relevant information since nitrile gloves are often used as an alternative in latex allergic workers.

[Skin disorders and job fitness assessment]. / Dermatopatie e giudizio di idoneità lavorativa specifica.

BACKGROUND: Assessment of fitness for employment represents the final phase of the risk evaluation and health surveillance carried out during pre-employment and periodical medical examination. Dermatoses are frequent diseases both in the general population and workers, therefore job fitness assessment for workers with skin problems will frequently fall within the occupational health area. The physician must verify whether or not the dermatosis is an occupational disease and must adopt preventive measures to avoid any worsening or relapse of the clinical situation due to occupational factors. OBJECTIVES: This article gives suggestions for correct management of occupational and non-occupational skin diseases in the workplace, with practical examples of job fitness assessment. METHODS: We first examined the role of the occupational physician in the evaluation of occupational risk factors that can induce work-related dermatoses or aggravate other dermatoses. We then discussed the factors that must be considered during assessment of fitness for employment when dermatoses are present. Finally, we examined practical examples of occupational or non-occupational dermatoses that can cause functional limitations, factors that can influence job fitness evaluation, and the possible role of allergological tests. RESULTS AND CONCLUSIONS: Several dermatoses can be aggravated or caused by occupational factors (e.g. atopic dermatitis, allergic contact dermatitis, irritant contact dermatitis, keratinization disorders, lichen planus, physical urticaria). Close cooperation between the dermatologist and the occupational physician is very important in order to make an etiological diagnosis that is necessary for the job fitness assessment. It is difficult to define definitive criteria for the assessment of fitness for employment; in this article only some suggestions are made and they can vary according to the different situations.