Making the Difference in Occupational Health: Three Original and Significant Cases Presented at ICOH Congresses in the 20th Century.

BACKGROUND: The aim of this study is to illustrate the historical role of the International Commission on Occupational Health (ICOH) congresses as an arena where national and international occupational medicine can dialogue and as the first example of scientific transferability of the research and prevention results that have had such an impact on global public health. METHODS: We used the ICOH Heritage Repository, in which ICOH congress proceedings (from the first congress in Milan in 1906 to the last congress, held in Dublin in 2018), are organised in an orderly way, updated and easily accessible according to open access logic. RESULTS: We describe studies by three physicians who submitted significant scientific work to ICOH congresses, one on the battle against ancylostomiasis (Volante, 1906), the second (Quarelli, 1928) on carbon disulphide poisoning, and the third (Viola, 1969) on the carcinogenicity of vinyl chloride monomer. Priority is given to Italian cases, on account of the authors' obvious familiarity with the issues. CONCLUSION: The visibility offered in ICOH conferences and their published proceedings has boosted the international spread of their findings, contributing to the scientific transferability of the research results and influencing the development of policies and prevention interventions that have had a great impact on global public health.

[About the asbestos and the Position Paper on asbestos of the Italian Society of Occupational Medicine]. / A proposito dell'amianto e del Position Paper della Società italiana di medicina del lavoro sull'amianto.

The SIML Position Paper dedicated to asbestos (PPA) is addressed (mainly) to competent practitioners (CP) for the purposes to provide a guidance about a set of items classified as markedly interesting: the actuality of asbestos exposure and the evaluation of the related risk; the diagnosis of the asbestos related diseases; the shape of the risk functions (namely about mesotheliomas); the causal relationship between exposure and disease; the medical surveillance of the workers currently and previously exposed. The scientific literature doesn't acknowledge the idea that nowadays in Italy the frequency of pleural mesotheliomas deriving from environmental asbestos from outdoor sources exposures is really a relevant item. Inside the SIML PPA the chapter concerning industrial hygiene and environmental monitoring themes shows inaccuracies and deficiencies, so resulting of scarce utility for the CPs that should be called for a more cooperative role in front of the employers. The arguments of the diagnosis of the asbestos related diseases is developed with an undue emphasis upon the differential histological diagnosis of asbestosis and, especially, of pleural mesothelioma: nosographic aspects that hardly are posed to the attention of the CP. A similar emphasis is posed towards the shape of the risk function for pleural mesothelioma, a theme absent from the current practice of the CP such as of other occupational practitioners. In conclusion, next to themes of undoubted interest for the PC, the SIML PPA dwells on the scrutiny of some topics representing critical elements of the current contrast between consultants and valuers in the context of criminal prosecutions: subjects having forensic relevance but far from the "application actuality" for the CP invoked in the PPA. A greater transparency, last but not least, was to have been posed, inside the SIML PPA, in the disclosure of the conflict of interests (COIs) of some Authors, declaring their consultancy in favour of companies.

What is the origin of the Italian term "medico competente"? / Da dove nasce il termine medico competente?

BACKGROUND: The meaning of the term "medico competente" - usually adopted in Italy to indicate the occupational physician - is little known. OBJECTIVES: To describe the origins of the word "medico competente" in Italy. METHODS: We conducted a comprehensive analysis of the Italian legislation from the end of the nineteenth century to the present day. RESULTS: In the United Kingdom, occupational physicians were originally named as "certifying surgeon" (1833) and "appointed surgeon" (1860). In Italy, the term "medico delegato" was introduced to indicate the physician who visited child laborers (1886), while the word "medico competente" was first used in some propaganda leaflets of the Clinica del Lavoro of Milan in 1910. This term was officially used in Italian legislation in 1927 and was preferred to "medico di fabbrica" (factory physician) in the post-World War II period. Since 1982, the term "medico competente" has started to be considered as a synonym of occupational physician in Italian laws. CONCLUSIONS: The name "medico competente" appears to derive from a legislative imposition rather than from a voluntary choice developed in a medical and scientific context. Nowadays, Italian occupational physicians should be stimulated to find scientific, ethical, and professional meanings in this term, so helping to enhance their figure in modern society.

[Solar ultraviolet radiation risk in outdoor workers: a specific project of Tuscany Region (Italy)]. / Rischio da radiazione solare ultravioletta nei lavoratori outdoor: piano mirato della Regione Toscana.

OBJECTIVE: The aims of Tuscany Regional project were: to study the sun protection attitude of outdoor workers; to measure solar ultraviolet (UV) exposure in work environment; to describe the frequency of photoaging, precancerous lesions, and skin cancers in outdoor workers; to collect information on solar ultraviolet radiation exposure from incident cases of Non-Melanoma Skin Cancer (NMSC) recruited from Tuscany Cancer Registry. DESIGN: Outdoor workers completed a questionnaire devoted to collect information on sun protection attitudes during a typical summer working week. Environmental and personal measurements were carried out. Expert dermatologists examined outdoor workers to assess the frequency of photoaging, precancerous lesions, and skin cancer. A structured questionnaire was mailed to incident cases of NMSC. Information were collected on personal habits and working history, focusing on solar ultraviolet radiation exposure. SETTING AND PARTICIPANTS: Agriculture, construction, quarrying and fishing activities were considered: 292 employees responded to questions about the type of clothing used in the morning and in the afternoon,while working outdoors; 637 outdoor workers underwent skin examination. We contacted 743 cases of NMSC occurred in 2004; 498 subjects accepted to participate in this study. RESULTS: The clothing worn by surveyed subjects was often inadequate compared to the high level of exposure to UV. The skin examination of 637 outdoor workers highlighted 2 melanomas, 7 epitheliomas and 35 actinic keratoses. Among the 498 cases of NMSC, 135 (27%) were diagnosed in outdoor workers. Most represented economic activity sectors were: agriculture, construction, transport, sports. CONCLUSION: The characterization of outside workers revealed unsatisfactory sun protection behaviours. Moreover, previously undetected skin cancers were diagnosed. The study on MNSC confirms the complexity of studying the exposure to UV radiation. The Tuscany Regional project provided useful information on the risk of solar ultraviolet radiation in outdoor workers. Prevention programs are needed.

[Introduction. The immediate and long term fortune of De Morbis Artificum Diatriba (1700-1713) by Bernardino Ramazzini]. / Introduzione. La "fortuna" immediata e di lunga durata del De Morbis Artificum Diatriba (1700 - 1713) di Bernardino Ramazzini.

No any other classical and modern medical text had a fortune comparable to the Ramazzini's De Morbis Artificum Diatriba. The number and distribution of new editions, translations, quotations and emulations illustrate the long-term fortune of the work. In the Eighteenth, Nineteenth and Twentieth centuries a "differential impact" of Ramazzini's De morbis developed all over Europe, due to different cultural, industrial and economical contexts in which the work conquered its fame. This article analyses in particular dictionaries and academic dissertations contributing, between XVlllth and XIXth centuries, to the spreading of Ramazzini's work.

[The occupational carcinogenic risk at present time in Italy. Continuity and discontinuity with the past: emerging issues and perspectives]. / Il rischio cancerogeno occupazionale oggi. Continuità e discontinuità con il passato prossimo: problemi emergenti e prospettive.

Here are recalled the most interesting elements in order to outline a history of cultural representation and application of the criteria to fight and control the effects and, eventually, the risks from carcinogens in the workplace in Italy in a period longer than a century. The roles of the actors of this process, such as social partners and institutions, are illustrated, and consequently the critical aspects of risks management and control at present starting from the description of two different scientific and ideological policies, the <> (TLV null) and the criteria required by current legislation, although in conflict between them but, at least in some cases, able to interact and, in some aspects, completing themselves. The critical points and some contradiction of the system are described and emphasis is placed on the imperative need to promote the risks primary prevention from carcinogens rather than possible other interests on the insurance and welfare fields.

[Asbestos: a long lasting tragedy. Useful considerations for a historical reconstruction of the most remarkable facts]. / Amianto: una tragedia di lunga durata. Argomenti utili per una ricostruzione storica dei fatti più rilevanti.

A thought back on the "epic of asbestos" scanning the fundamental steps, from the "discovery" of the adverse effects for the workers. A first phase, the "asbestosis one" concluded in Britain in the early thirties with the issue of a technical legislation is described. It was the first regulation shared by the Unions and the asbestos companies, some of which were or will then become leaders all over the world. The main effect of this legislation enforcement is the reduction of the exposure in some units of the asbestos textile industry; no effects were observed instead in other asbestos industrial divisions where it's consumption for insulations and asbestos cement increased massively. The second phase lasting approximately thirty years next sees together to a formidable diffusion of all the asbestos fibres including the crocidolite ones, advertised and accepted like "indispensable" for the economical and social development, an absolute leadership of the companies in the management of health effects information for the workers and therefore also those on the pulmonary cancerogenicity. Such selfish and aggressive leadership, receives in return from government, labour and consumers organizations just inertia, impotence and incredulity. This attitude will also continue in the third phase, beginning in the early sixties of the last century. The time period will be dominated by mesothelioma with all its new and terrible meanings, the dangerousness of asbestos exposure especially to the blue one even at lower levels than those observed in the past for other pathologies and the long latency before the appearance of the effects. Discussing about asbestos substitutes was out of the agenda, indeed just in the period where the mining and the consumption of asbestos touched the highest levels. The initiatives assumed in some countries like the auto limitation of the use of crocidolite and a more rigorous reduction of the occupational exposures will only turn out useful in order to lower the risk for asbestosis and, probably, the one for pulmonary tumour. In the United States, the judicial litigation for compensation between the workers and the companies begins. The same phenomenon will characterize also in the other countries industrializes the fourth phase of the epic, until our days; it is just in these years, and especially during the eighties, that industry starts thinking about the substitution of asbestos; the lively public debate will favour initiatives oriented to obtain economic compensation for damages caused by past occupational and environmental exposures. These legal actions will carry to bankruptcy all the asbestos companies and later to the ban of asbestos. The judicial debates will also uncover "confidential" information useful to better reconstruct the epic, to formulate more dispassionate historical judgments and to allow everyone on answering to more complex questions and more important than how much generally it was previously believed; all this should happen contextualizing the ages in which the scientific acquaintances on the effects of asbestos have been published and disproving prejudgments, able to affect some conclusions of the past.

The role of asbestos fiber dimensions in the prevention of mesothelioma.

A recent interpretation of the pathogenetic role of asbestos fiber size in the development of mesothelioma and in the possibility of mesothelioma prevention needs clarification. This point of view is based on a biased interpretation of the literature. Epidemiologic, experimental, and molecular evidence suggests that the arguments for the role of fiber size relative to dose, dose-response effect, and genetic susceptibility are scientifically unsound. Their proponent also states that means available in the past for the implementation of dust-control measures and/or personal protective equipment would not have contributed to reducing the frequency of mesothelioma among exposed subjects, an argument again based on invalid assumptions.

[The role of asbestos fibre dimensions in the pathogenesis and prevention of mesothelioma]. / Il ruolo della dimensione delle fibre di amianto nella patogenesi e nella prevenzione del mesotelioma.

The particular point of view, recently published by Gerolamo Chiappino, on the pathogenetic role of asbestos fibres size in the origin of mesothelioma and on the possibility of mesothelioma prevention until the middle of the '80s needs to be critically clarified. The suggestion of an exclusive role of ultrashort and ultrathin fibres in the origin of mesothelioma is based on a biased interpretation of the literature. A review of the epidemiological, experimental, and molecular literature suggests that Chiappino's statements on the role of dose, dose-response effect, and genetic susceptibility are scientifically unsound Chiappino states that, in the past, in the workplaces where use and exposure to asbestos were not stopped, any reduction in the intensity of exposure by means of dust control measures or personal protective equipment would not have contributed to reduce the frequency of mesothelioma. In the authors' opinion the underlying assumptions are invalid.

A history of union struggles for control of the work environment in Italy.

The article describes, from a diachronic perspective, the struggle to enhance workers' health conditions in Italy throughout the twentieth century. The authors adopt the workers' viewpoint, highlighting the relevance of trade unions' so-called "participatory model," and sketching the recent impact of European legislation on the country's laws.

The health of foreign workers in Italy.

At the beginning of 2002, there were 1,600,000 foreign-born persons living in Italy; the majority from countries outside Europe. Those residing in the country for working purposes were 800,680. Italy's shift to a tertiary and service-oriented economy has considerably modified the working market, concentrating demand at two extremes: on one hand, a highly specialized workforce, and on the other, a totally unqualified, mobile, and flexible one, which includes most immigrants.

[Mussolini's fight against occupational diseases (1922-1943): Italian leadership in the production of artificial silk]. / La lotta di Mussolini contro le malattie professionali (1922-1943). I lavoratori e il primato italiano nella produzione di seta artificiale.

After the end of the World War I Italy's economy was predominantly rural; industrialization had taken place only in the North-Western "Milan-Genoa-Turin triangle". Technological know-how and experience in developing the production cycles were scarce. The early experience in occupational medicine had been abruptly interrupted by the war. The attitudes of the Fascist regime with regard to work protection were ambiguous: work was claimed to be a sacred source of the national wealth worth being safeguarded by the regime, but the workers' potential to antagonize the regime was seen as a constant danger to public order. This scenery is well exemplified by a case study: Viscose-Ray-on Industry developed in synchrony with Mussolini's seizing power, in the early 20s. Thanks to the initiative of some manufacturers, Italy acquired a predominant role in this sector and became the second producer after the United States. Huge factories were created and complex equipment was imported from abroad. No attention was paid to health and safety at work. The major source of risk was carbon disulphide, used as a solvent in the production of xanthogenate starting from cellulose, the raw material; which produces progressive conditions following prolonged exposure. The slowness and the substantial inertia of the Fascist regime in the protection of workers' health contrasted with the reality in the Unit States, Italy's main competitor of Italy in the production of rayon. In order to exploit masses of workers, Fascism, unlike Nazism, needed no inferior "race": social discrimination was equally effective. Modern industrial development in Italy relied on masses of semiliterate farmers originating first from the Venetian region and later (after World War II) from Southern Italy. Shortly after 1945, during the so-called "Reconstruction-period", health protection developed slowly and circumspectly. National agencies supposed to have a proactive role in prevention, such as ENPI, confirmed their role as consultant of the employers for hygiene and prevention matters. Only the workers' fight around 1970 overcame the concept of the Corporative state introduced by the Fascism.