[Manual lifting and manual transport: risk assessment and prevalence of work-related diseases in construction companies in Basilicata]. / Movimentazione manuale dei carichi e trasporto manuale: valutazione del rischio e prevalenza di patologie correlate nelle imprese edili lucane.

BACKGROUND: The Basilicata Regional Headquarters of the Italian Institute for Insurance against Occupational Accidents and Disease (INAIL) and the Basilicata association of small building enterprises (Edilcassa di Basilicata) promoted a research project to assess the risk of manual lifting and manual transport in construction enterprises in the Basilicata Region and estimate the prevalence of related diseases. METHODS: Manual lifting risk assessment was performed by calculating the VLI of 204 working days in as many building workers. Manual transport risk assessment was carried out comparing the weights transported (on the 204 days tested) with the reference values of the "Snoock and Ciriello" tables. RESULTS: Manual Ifting risk was present on 195 of the 204 days, with an average value of VLI equal to 2.1 (min 0.4, max 8.5), with higher values in the restructuring sector (VLI average of 2.3, min 0.4, max 8.5), and no significant differences between the different tasks. Manual transport risk was present on 129 of the 204 days, with average values of 1.2 (min 0.2, max 3.3), with no significant differences between the different tasks analyzed For both risks additional factors were present that were not analyzed by the methods of assessment used (for manual lifting: 8.8% of the geometries in the critical area; for manual transport: 39% of transport on shoulders, 42.5% on a route with uneven surface and 31.9% on a sloping route), so it is likely that the actual risk is greater than that indicated by the synthetic indices of exposure. The medical questionnaire showed from the case histories that 148 out of 546 subjects were positive for the threshold forpain or discomfort in the lumbosacral spine area and 99 out of 546 subjects reported suffering from an already diagnosed herniated spinal disk. Only 18% of osteoarticular diseases was reported to the Insurance Institute, al though there was widespread awareness that the diseases in question might be related to work. Diseases of the spine were responsible for 1.9% of absenteeism, equal to 30-40% of total absenteeism ofworkers enrolled in "Edilcassa di Basilicata". CONCLUSIONS: The method used provides a solid basis for evaluating the two risks in the construction industry, where employment is subject to extreme organizational, environmental and structural (machines, tools, operators involved) variability. Employment in the construction industry involves significant exposure to the two risks, counting for 30-40% of total absenteeism in this sector.

A simple tool for preliminary hazard identification and quick assessment in craftwork and small/medium enterprises (SME).

During the last Congress of the International Ergonomics Association (IEA), Beijing, August 2009, an international group was founded aimed at developing a "toolkit for MSD prevention" within IEA and in collaboration with World Health Organization (WHO). Possible users of toolkits are: members of health and safety committees, health and safety representatives, line supervisors; labor inspectors; health workers implementing basic occupational health services; occupational health and safety specialists.According to ISO standard 11228 series and the new Draft CD ISO 12259-2009: Application document guides for the potential user, a computer software ( in Excel®) was create dealing with hazard "mapping" in handicraft The proposed methodology, using specific key enters and quick assessment criteria, allows a simple ergonomics hazard identification and risk estimation. Thus it makes possible to decide for which professional hazards a more exhaustive risk assessment will be necessary and which professional consultant should be involved (occupational physician, safety engineer, industrial hygienist, etc.).

Biomechanical overload in multiple tasks with weekly and annual cycle: practical experiences in the field of cleaning and packaging of fruit.

The OCRA method is the reference method chosen in ISO (ISO 11228-3) and CEN (EN 1005-5) standards regarding risk assessment and management of upper limbs repetitive movements and exertions. The method consists of two specific tools (OCRA index and OCRA checklist). In this paper special attention will be devoted to the procedures for the analysis of multiple repetitive tasks.When computing the OCRA index (checklist score) considering the presence of more than one repetitive task, a "traditional" procedure has been previously proposed. This approach, whose results could be defined as "time weighted average", seems to be appropriate when considering rotations among tasks that are performed almost once every hour. On the contrary, when rotation among repetitive tasks is less frequent the "time weighted average" approach could result into an underestimation of the exposure level. For those scenarios an alternative approach is based on a concept that the most stressful task is the minimum starting point. A peculiar procedure allows to exactly estimate the resulting index within this range of minimum to maximum values. It is possible to apply this approach also for job rotation with weekly or monthly or annual cycle typical of agriculture, supermarket, cleaning sectors. This paper shows criteria and results in two working situation: cleaning (weekly cycle) and packaging of fruit (annual cycle).

[From complexity to simplification: contribution of the EPM Research Unit to producing a toolkit for risk assessment and management of biomechanical overload and WMSDs prevention]. / Dalla complessità alla semplificazione: il contributo dell'Unità di Ricerca EPM ad un toolkit per la valutazione e gestione del rischio da sovraccarico meccanico e la prevenzione dei WMDSs.

BACKGROUND: When studying musculoskeletal disorders and their connection with working conditions (WMSDs), several factors of different nature (mechanical, organizational, psychophysical, individual) and their interrelationship have been considered important in general models for epidemiologic surveys and risk assessment and management. Hence the necessity of a "holistic" (that is to say complex, global, multifactorial and interdisciplinary) approach to MSD prevention, especially when establishing technical norms, guidelines and strategic plans of action at national or international level. On the other hand, considering the widespread presence of these factors and WMSDs in many working contexts, there is a great demand by OSH agencies and operators to develop "simple" tools for risk assessment and management, usable also by non-experts in both developed and developing countries. OBJECTIVES: Both these needs are perfectly justified but are also to a certain extent in conflict. How can we address the problem, i.e., simplify complexity? METHODS AND CRITERIA: The proposals are based on two essential criteria: 1) Act on a step-by-step approach using basic tools first and more complex tools only when necessary. 2) Take into account the complexity and the presence of multiple influencing factors at every step (even if with different degrees of in-depth analysis). The proposals are mainly developed within the framework of an IEA-WHO collaboration initiative for a "Toolkit for MSD prevention" but they are also derived from other converging issues (i.e. ISO application document of LSO series 11228 on manual handling). RESULTS: The proposals consider: 1) A Basic Step devoted to preliminary occupational hazard identification and priority check by operative "key enter" questions (at this step all potential hazards--including those influencing WMSDs--should be considered). This step also can be carried out by non-experts with limited training. 2) First Step, focused on WMSDs risk factors, consisting of a "quick assessment" and mainly addressed to identifying 3 possible conditions: acceptable/no consequences; high risk present/redesign urgently needed; a more detailed analysis (via tools proposed in second step) is necessary. This step can also be carried out by non-experts with only limited training. 3) Second Step, where recognized tools (i.e. from international standards or guidelines) for risk (of WMSDs) estimation are used as a consequence of the first step outcome. Examples of such tools are "adaptations" of the Revised NIOSH Lifting Equation, Liberty Mutual Psychophysical Tables, OCRA Checklist, etc. These tools should be able to adequately take account of most of the influencing factors. For some particular working sectors (i.e. agriculture) these tools need to be specifically adapted. For particular working sectors a database could be envisaged where the most common tasks (with their "variants") are "intrinsically" evaluated by experts and could provide non-experts with the relevant knowledge to be applied to the specific work context. This step can be carried out only by persons with some sort of specific training.

[Development of simple tools for risk identification and prevention of WMSDs (work related muscular-skeletal disorders): application experience in small and craft industries]. / Sviluppo di strumenti valutativi semplici per la individuazione delle sorgenti di rischio lavorativo e la prevenzione dei disturbi muscolo scheletrici: esperienze di applicazione nel lavoro artigianale e nella piccola impresa.

When studying WMSDs, multiple factors of different nature (mechanical, organizational, psychosocial, individual) and their interrelationship are considered relevant; consequently, the need for a "holistic" approach to MSD prevention was established. However, in recent years, considering the widespread presence of WMSDs in various work contexts there is a strong demand from OSH agencies and operators to develop "simple" tools for risk assessment and management, usable also by non-experts both in developed and developing countries, and in particular in craft industries and SME (small-medium enterprises). The World Health Organization (WHO) promoted the development of "toolkits" for different occupational risks and diseases; in outlining a toolkit (for WMSDs prevention), WHO defines this as "a set of practical risk assessment procedures and related management guidance documents, including advice on simple risk control options". The "Ergonomics of Posture and Movement" Research Unit (EPM) is very much involved in the WHO project for developing a "toolkit for MSD prevention" (as well as in similar issues promoted by ISO or UE); attention was consequently focused on craft industries, small enterprises and "difficult" work sectors (i.e. agriculture, fisheries, construction). In these sectors simple tools, procedures and software were developed and applied, that could facilitate WMSDs risk assessment and management. This issue of "La Medicina del Lavoro" is entirely devoted to selected papers regarding the above proposals and experience, especially in craft industries. The opening paper is a basic methodological contribution presenting a procedure and a tool (with relative software) that is useful for the identification of a number of occupational risks by means of special "key-enters"; the same tool, with special regard to WMSDs, defines criteria for a "quick risk assessment" which is mainly aimed at identifying 3 possible conditions: Acceptable (no remedial actions needed); High risk present (redesign is urgently needed); More detailed analysis is necessary, using proper tools for risk estimation (derived from recognized literature, international standards and/or guidelines) A series of practical applications in different craft industry contexts are then presented: the selection of the papers took into account that, apart from producing specific results on "risk mapping", they gave a detailed analysis of production cycles" in work sectors that are often "neglected" in OSH literature. Other application experience in similar work contexts using a quite similar approach will, for reasons of space, be reported in future volumes of this journal. Finally, in the web sites of the journal (http://www.lamedicinadellavoro. it/) and of the EPM Research Unit (http.//www.epmresearch.org), the reader will find (only on-line) papers and information regarding updates on the use of the "OCRA Checklist" that is now also proposed in a simpler version (OCRA mini-checklist) that can be applied specially in the sectors considered here and whenever production is "variable".

[A preliminary mapping methodology for occupational hazards and biomechanical risk evaluation: presentation of a simple, computerized tool kit for ergonomic hazards identification and risk assessment]. / La pre-mappatura dei disagi e dei pericoli professionali e la valutazione e gestione del rischio da sovraccarico biomeccanico: presentazione di uno strumento di analisi semplice e informatizzato (toolkit) e delle sue modalità di utilizzo.

BACKGROUND AND OBJECTIVES: During the last Congress of the International Ergonomics Association (IEA), Beijing, August 2009, an international group was founded with the task of developing a "toolkit for MSD prevention" under the IEA and in collaboration with the World Health Organization. The possible users of toolkits are: members of health and safety committees; health and safety representatives; line supervisors; foremen; workers; government representatives; health workers providing basic occupational health services; occupational health and safety specialists. METHODS: According to the ISO standard 11228 series and the new Draft CD ISO 12259-2009: Application document guides for the potential user, our group developed a preliminary "mapping" methodology of occupational hazards in the craft industry, supported by software (Excel). RESULTS AND CONCLUSION: The proposed methodology, using specific key enters and quick assessment criteria, allows a simple ergonomics hazards identification and risk estimation to be made. It is thus possible to decide for which occupational hazards a more exhaustive risk assessment will be necessary and which occupational consultant should be involved (occupational physician, safety engineer, industrial hygienist, etc.).

Designing reasonable accommodation of the workplace: a new methodology based on risk assessment.

If working tasks are carried out in inadequate conditions, workers with functional limitations may, over time, risk developing further disabilities. While several validated risk assessment methods exist for able-bodied workers, few studies have been carried out for workers with disabilities. This article, which reports the findings of a Study funded by the Italian Ministry of Labour, proposes a general methodology for the technical and organisational re-design of a worksite, based on risk assessment and irrespective of any worker disability. To this end, a sample of 16 disabled workers, composed of people with either mild or severe motor disabilities, was recruited. Their jobs include business administration (5), computer programmer (1), housewife (1), mechanical worker (2), textile worker (1), bus driver (1), nurse (2), electrical worker (1), teacher (1), warehouseman (1). By using a mix of risk assessment methods and the International Classification of Functioning (ICF) taxonomy, their worksites were re-designed in view of a reasonable accommodation, and prospective evaluation was carried out to check whether the new design would eliminate the risks. In one case - a man with congenital malformations who works as a help-desk operator for technical assistance in the Information and Communication Technology (ICT) department of a big organisation - the accommodation was actually carried out within the time span of the study, thus making it possible to confirm the hypotheses raised in the prospective assessment.

[Premapping of risks: guide to inspection by occupational physician]. / Premappatura dei rischi: guida al sopralluogo del medico competente.

Art. 25 of Law Decree 81/08 sets obligation for occupational physician to collaborate with employer for risk assessment (also in view of health surveillance planning) and to inspect "workplaces at least once a year or at different times according to risk assessment". Hence, collaboration to risk assessment, periodical inspection at workplace and definition of health surveillance protocols are extremely important in occupational physician's activity also in view of preventive effectiveness. An easily readable information technology tool is developed, in the frame of the most recent WHO activities: a toolkit for rapid and complete identification of the presence of possible risk inductors. This tool, already tested in several crafts, can be easily used also by occupational physician during periodical inspection.

[Working hypothesis of simplified techniques for the first mapping of occupational hazards in handicraft. First part: ergonomics hazards]. / Ipotesi di tecniche semplificate per la prima mappatura dei rischi professionali nel settore artigiano. Prima parte: rischi legati all'ergonomia.

During the last Congress of the International Ergonomics Association (IEA), Beijing - China August 2009, in collaboration with World Health Organization an international group for developing a "toolkit for MSD prevention" was founded. Possible users of toolkits are: members of a health and safety committee; health and safety representatives; line supervisors; foremen; workers; government representatives; health workers implementing basic occupational health services; occupational health and safety specialists. According with ISO standard 11228 series and their ISO Application document for the Key enters and Quick Assessment (green/red conditions), our group developed a first mapping methodology of occupational hazards in handicraft, working with the support of the information technology (Excel). This methodology, utilizing specific key enters and quick evaluation, allows a simple risk estimation. So it is possible to decide for which occupational hazards will be necessary an exhaustive assessment and to which professional consultant it is better to direct them to (worker's doctor, engineer, chemical, etc.).

[Risk assessment of work-related upper limb musculoskeletal disorders in thirty factories in the upholstered furniture industry]. / Valutazione del rischio da movimenti e sforzi ripetuti degli arti superiori in trenta aziende del comparto del mobile imbottito.

BACKGROUND: One of the most common procedures for risk assessment of upper limb work-related musculoskeletal disorders (UL-WMSDs) in Italy is the OCRA synthetic index, which is recommended as the preferred method in the ISO standard 11228-3. OBJECTIVE: The aim of the survey was to assess the risk of UL-WMSDs due to repetitive strain and movements in thirty factories of the sofa industry located in a large geographic area of southern Italy. METHODS: The most characteristic working tasks of the manufacturing process were studied: filling preparation workers, leather-cutting operators, sewing and upholstery-assembly workers. The single tasks were carried out almost exclusively manually, with features of a handicraft approach. Data were collected through questionnaires and video tape recordings in each factory. The mean value of the OCRA index of every group of factories was calculated by weighting the values of the index of each single task group with the number of the workers. RESULTS: Figures obtained in the different factories showed values of the OCRA index ranging between 4 and 15. A 2,9 OCRA value was attributed to a low exposure group. CONCLUSIONS: Even though the work tasks analyzed were characterized by long duration of the manufacturing cycle (between 5 and 60 min), a particular but rigorous application of the OCRA procedures made it possible for a detailed risk assessment to be made for each of the working groups analysed.

[Ocra Method: development of a new procedure for analysis of multiple tasks subject to infrequent rotation]. / Metodo Ocra: messa a punto di una nuova procedura per l'analisi di compiti multipli con rotazioni infrequenti.

In the Ocra methods (Ocra index and Ocra Checklist), when computing the final indices (Ocra index or checklist score), in the case of more than one repetitive task a "traditional" procedure was already proposed, the results of which could be defined as "time-weighted average". This approach appears to be appropriate when considering rotations among tasks that are performed very frequently, for instance almost once every hour (or for shorter periods). However, when rotation among repetitive tasks is less frequent (i.e. once every 1 1/2 or more hours), the "time-weighted average" approach could result in an underestimation of the exposure level (as it practically flattens peaks of high exposures). For those scenarios an alternative approach based on the "most stressful task as minimum" might be more realistic. This latter approach has already been included in the NIOSH approach for multiple sequential lifting tasks and, given the recent availability in the Ocra method of more detailed duration multipliers (practically one different Du(M) for each different step of one hour of duration of the repetitive task), it is now possible to define a particular procedure to compute the complex Ocra Multitask Index (cOCRA) and the complex Checklist Score (cCHESCO) for the analysis of two or more repetitive tasks when rotations are infrequent (rotations every 1 1/2 hours or more). The result of this approach will be at least equal to the index of the most stressful task considered for its individual daily duration and at the most equal to the index of the most stressful task when it is (only theoretically) considered as lasting for the overall daily duration of all examined repetitive tasks. The procedure is based on the following formula: Complex Ocra Multitask Index = Ocra(1(Dum1) + (Delta ocra1xK) where 1,2,3,...,N = repetitive tasks ordered by ocra index values (1 = highest; N = lowest) computed considering respective real duration multipliers (Dum(i)). ocra1 = ocra index of task, considering Dum(1). Dum(i) = duration multiplier for task(i) real duration. Dum(tot) = duration multiplier for total duration of all repetitive tasks. delta ocra1 = highest ocra index among N tasks considering Dum(tot) (ocra(i max)) - ocra index of task1 considering Dum1. K = (ocra(1 max)*FT1) + (ocra(2 max)*FT2) + ... + (ocra (N)*FT(N)) over (ocra(i max)). ocral,Nm(1,N MAX) = index of tasks 1 to Ncons idering Dum,, (tot)7=Fr(i) c tion of Time (values from 0 to 1) of task; wi(i)h respect to the total repetitive time.

[Working tasks with upper limbs repetitive movements: analysis of different methods for risk assessment]. / Attività lavorative comportanti movimenti ripetitivi a carico degli arti superiori: confronto di diversi metodi di valutazione del rischio.

A review of different methods for the risk assessment of upper limbs repetitive movements is carried out mainly referring to a recent ISO standard (ISO 11228-3). This standard establishes ergonomic recommendations for tasks involving manual handling of low loads at high frequency (repetitive work). It is a "voluntary" standard and provides information for all professionals involved in occupational prevention as well as in job and product design. It refers to a four-step approach, involving both risk assessment and risk reduction (hazard identification, risk estimation, risk evaluation and risk reduction). General reference is made to a general model reported in a Consensus Document published by the IEA Technical Committee "Musculoskeletal Disorders", with the endorsement of ICOH. Apart from risk identification, the standard addresses and suggests several methods for a simple risk estimation (i.e. Plibel, Osha Checklist, Upper Limb Expert Tool, Qec, Checklist Ocra). If the risk estimation results in the 'yellow' or 'red' zone, or if the job is composed by two or more repetitive tasks, a more detailed risk assessment is recommended. For a detailed risk assessment, the OCRA method is suggested as "preferred"; however, other methods (STRAIN INDEX; HAL-TLV-ACGIH) can also be used. The applicative limits of the methods mentioned above, considering the purposes of the standard, are shortly discussed together with their recent scientific updates and applicative perspectives. The standard, with the suggested risk assessment procedures and methods, represents a useful tool for all OSH operators involved in the application of European and National legislation regarding the prevention of UL WMSDs.

Outcome and tolerability of topiramate in brain tumor associated epilepsy.

Epilepsy in brain tumor patients is often refractory to pharmacological treatments and can complicate the therapeutic management of these patients. We conducted a prospective, observational study. The aim of this study was to investigate the efficacy and tolerability of topiramate (TPM) in brain tumor associated epilepsy. We studied 47 patients with brain tumors and epilepsy. The entire group was administered AEDs. TPM was the first therapeutic choice in 14 patients, while in the remaining 33 patients previous AEDs were modified and TPM was introduced due to side effects or inefficacy of the first drug. Follow-up ranged from 3 to 48 months (mean 16.5 months). Considering the final follow-up of each patient who assumed TPM for at least 3 months, we observed 45 patients: 25 were seizure free (55.6%), 9 had a reduction of seizure frequency (SF) higher than 50% (20%) and 11 were stable (24.4%). TPM responder rate was 75.6%. Three patients (6.4%) discontinued TPM for severe side effects (1 after 4 months and 2 after 1 month) and 4 (8.5%) had mild and reversible side effects. In the group of patients who had been in therapy with other AEDs prior to entering the study (n = 33), 19 patients had side effects (57.6%). During follow-up, the haematological parameters were in the normative ranges. Tumor-related seizures are difficult to control with AEDs; the precise reasons for this difficulty are not yet clear. Using TPM, we obtained good seizure control with a low incidence of side effects.

Updating reference values and predictive models of the OCRA method in the risk assessment of work-related musculoskeletal disorders of the upper limbs.

A database has been established combining existing data for 23 groups of workers with different level of exposure to repetitive movements of the upper limbs. For all groups, data were available regarding an exposure index (OCcupational Repetitive Actions - OCRA index) and clinically determined UL-WMSDs outcomes (PA = Prevalence of workers affected by one or more UL-WMSDs; PC = Prevalence of single diagnosed cases of an UL-WMSDs). Using these data, new critical values of the OCRA index have been estimated for discriminating different exposure levels (green, yellow, red areas) and new forecasting models of expected PA and PC in exposed populations based on OCRA exposure indexes. The new critical values of the OCRA index were estimated by an original approach in which data for the effect variable (PA) in a reference population not exposed to the relevant risks are combined with the regression function between OCRA and PA. The best simple regression functions between OCRA exposure indexes and health outcomes variables (PA; PC) were researched to obtain forecasting models of effects starting from exposure. Discussion of the results obtained considers their intrinsic limitations, as they are based on prevalence studies, as well as providing recommendations and cautions in the use of the proposed classification system and forecasting models when the OCRA method is applied.

New procedure for assessing sequential manual lifting jobs using the revised NIOSH lifting equation.

A sequential manual lifting job is defined as a job where workers rotate between a series of manual lifting rotation slots or elements at specified time intervals during the course of a work shift. The original NIOSH lifting equation lacked a method for assessing the physical demands of these types of jobs. This paper presents the sequential lifting index (SLI), a new conceptual method for assessing the physical demands for sequential manual lifting jobs. The new method is similar to the composite lifting index (CLI) method that was provided by NIOSH for assessing multi-task jobs. The SLI method expands upon the methods originally provided by NIOSH by providing a simple method for estimating the relative magnitude of physical stress for sequential manual lifting jobs. It should also be useful in assisting safety and health specialists to prioritize or rank hazardous jobs within a plant.

[Occupational safety and health in hospitals of Regione Lombardia. Are there differences among public, private nonprofit and private profit hospitals?]. / Sicurezza occupazionale e salute negli ospedali della Regione Lombardia. Ci sono differenze tra ospedali pubblici e privati, profit e no profit?

In 2006 an extensive survey took place in all hospitals of Lombardia, to assess, through inspections, the safety conditions and the efficiency of the organisations invested to assure that. During these inspections were evaluated 6 safety sections and hospital organization and efficiency, by means of a questionnaire. The aim was to assess the internal consistency of questionnaire sections, the presence of differences of such scores among public, private non-profit and profit hospitals and the correlations among safety scores and among these latter and efficiency indexes. Significant differences for size factors and efficiency indexes have been pointed out among different types of hospitals. Instead, safety scores showed good internal consistency and have been resulted statistically significant correlated in most cases. For all types of hospital have been observed high values for safety scores, with exception of occupational health service, better organized in public hospitals, and of safety conditions of worker from external agencies, which have been displayed low. This last consideration stick out the need to pay more attention to safety conditions of these workers.

Early post-operative MRI: correlation with progression-free survival and overall survival time in malignant gliomas.

Forty-seven patients with Glioblastoma (42) and Anaplastic Astrocytoma (5) were studied with MR 24 hrs after surgery. In order to evaluate the role of early MR in defining the extent of surgical resection and its relation with the prognosis of malignant glioma patients, three categories of surgical resection were considered: gross total, sub-total and partial resection. The results were correlated with progression-free survival (PFS) and overall survival (ST). As demonstrated by early-MR, gross total resection was performed in 17 patients, sub-total and partial resection in 19 and 11 patients, respectively. The PFS was 6 months in gross total resection, 6 and 3 months in sub-total and in partial resection, respectively. The median survival time was 16 months in total resection patients, 13 months and 7 months in sub-total resection and partial resection patients, respectively. The study confirms that early-MR has to be considered an accurate technique for monitoring the extension of malignant glioma surgical resection and shows a good correlation between early-MR findings, PFS and ST.

[Work-related musculoskeletal disorders and diseases of the arm]. / Disturbi e patologie muscoloscheletriche dell'arto superiore correlati con il lavoro.

Among work-related diseases, musculoskeletal disorders of the upper extremities have obtained increasing attention in recent last decades. Because of their relevance, the Italian Society of Occupational Medicine and Industrial Hygiene has decided to draw up a set of National Guidelines on the subject. This paper discusses their production and contents, including definitions, rationale, physiopathogenesis, occupational physician's contribution to biomechanical overload risk evaluation, medical surveillance of exposed workers.