Ophiolitic outcrops, naturally occurring asbestos exposure and mortality risk from malignant mesothelioma in Calabria (Southern Italy).

OBJECTIVES: Naturally occurring asbestos from ophiolitic outcrops can pose a health risk to the resident population. Some studies have documented this risk of exposure in many areas around the world. The aim of the study is to estimate the possible impact on health caused by asbestos outcrops present in some areas of Calabria, a region of southern Italy. STUDY DESIGN: The design of the study is observational and uses routinely collected data on employment, compensations and mortality. METHODS: Data from archives of mortality in the period 2005-2015 were selected. Standardized mortality ratio (SMR) for malignant mesothelioma (MM) by municipalities of residence with reference to the regional population was estimated assuming a Poisson distribution of the data. Administrative archives of companies' employment records and occupational disease compensation data were used to exclude occupational origin cases. RESULTS: A total of 163 cases of MM were identified. Statistically significant excess risks (P-value <0.05) were observed for several municipalities, some of which were located in areas where asbestos outcrops had previously been identified. Significant SMRs vary between 44.0 and 5.2. The mean age at death in the areas at risk of ophiolitic outcrops ranges from 65.4 to 77.1 years, and the gender ratio (male/female) ranges from 0.66 to 1.3. CONCLUSIONS: Monitoring of areas most involved in the risk of environmental contamination from ophiolitic outcrops is highly suggested. Full implementation of the local MM surveillance system is strongly encouraged. Further investigations are recommended to specifically identify the cause of exposure and confirm the hypothesis of a causal association with asbestos naturally occurring in these risk areas.

Toxoplasmosis and knowledge: what do the Italian women know about?

Toxoplasmosis is a worldwide zoonotic infectious disease caused by Toxoplasma gondii. This infection is estimated to affect about a third of the world's population. The aim of this study was to evaluate the knowledge of Italian women about toxoplasmosis and its forms of transmission, clinical manifestations, diagnosis and prevention through two different modalities (e-research and traditional research). In a cross-sectional study, 808 Italian women were interviewed, using a self-administered questionnaire, through two different modalities: an e-research or web survey and a traditional paper research and 84% reported to have heard about toxoplasmosis, but from most of the sample, it resulted that the knowledge of the protozoan disease was superficial and incomplete.The assessment of the dimensionality related to the toxoplasmosis knowledge's instrument showed that the scale is composed by two stable and reliable factors which explain 58.6% of the variance: (a) the basic knowledge (α = 0.83), which explains the 45.2% of the variance and (b) the specialist knowledge (α = 0.71), which explains the 13.4% of the variance. The variance and the multiple linear regression data analysis showed significant predictors of correct basic knowledge of toxoplasmosis: the highest age, the highest degree of study, to have previously contracted illness or to know someone who had contracted it, to be working or to be housewives. In conclusion, this study showed limited awareness of toxoplasmosis and suggested the implementation of effective education and learning programs. The results also showed that online data collection, in academic research, might be a valid alternative to more traditional (paper-and-pencil) surveys.

Gender differences and occupational factors for the risk of obesity in the Italian working population.

BACKGROUND: Obesity is a multifactorial condition and a major risk factor associated with several non-communicable diseases, such as cardiovascular disease, and with a higher risk of premature death and disability. Sex-specific factors have key roles and must be taken into consideration in studying occupational factors associated with the risk of obesity. The aim of this study was to investigate gender differences in body mass index (BMI) in a large cohort representative of Italian workers and, correlating this index with several demographic and occupational variables, to verify sex- and work-dependent differences in the risk of obesity. METHODS: We utilized data from INSuLa, a cross-sectional, nationally representative survey of the Italian worker population conducted in 2013 by the Italian Workers' Compensation Authority to investigate health and safety at work. Analyses were run on a sample of 8000 Italian workers, aged from 16 to 64 years. Logistic regression models were employed to assess gender differences in the relation between occupational characteristics and BMI. We adjusted for age, education, variables related to health protection at work, and chronic conditions and diseases. RESULTS: There were several significant differences in the BMI between males and females, linked to some occupational factors. For instance, female shift workers were 1.32 times (95% CI 1.11-1.57) more likely to be overweight or obese than normal-weight workers, and this association was maintained when controlling for confounders. The likelihood of overweight or obesity among women who worked 1-2 night shifts per week was significantly higher - 1.5-1.6 times - than those on day shifts. CONCLUSIONS: Gender-specific differences in occupational factors associated with the risk of obesity are useful with a view to characterizing this risk and helping identify workplace-targeted intervention strategies.

The Working Life of People with Degenerative Cerebellar Ataxia.

The aim of the present study was to characterize and analyze the most important individual and organizational variables associated with job accommodation in subjects with degenerative cerebellar ataxia by administering a series of international and validated work activity-related scales. Twenty-four workers (W) and 58 non-workers (NW) were recruited: 34 with autosomal dominant ataxia and 48 with autosomal recessive ataxia (27 with Friedreich ataxia and 21 with sporadic adult-onset ataxia of unknown etiology). The severity of ataxia was rated using the Scale for the Assessment and Rating of Ataxia. Our results showed that the ataxic W were predominantly middle-aged (41-50 years), high school graduate, and married men with a permanent work contract, who had been working for more than 7 years. The W with ataxia exhibited a good level of residual working capacity, irrespective of gender, age range, and duration of the disease, and they were observed to have a low or average-to-low job stress-related risk. Supporting patients with ataxia to find an appropriate job is an important priority because about 78% of NW search for a job and W and NW have the same potential work abilities (no relevant differences were found in terms of disease characteristics, gender, and work resilience). In this view, introducing NW to work-life may have a potential rehabilitative aspect. Findings of this study highlight that equal job opportunities for subjects affected by cerebellar ataxia are recommended.

Prognostic factors for return to work in patients affected by chronic low back pain: a systematic review.

Chronic low back pain (LBP) represents a leading cause of absenteeism from work. An accurate knowledge of complex interactions is essential in understanding the difficulties of return to work (RTW) experienced by workers affected by chronic LBP. This study aims to identify factors related to chronic LBP, the worker, and the psycho-social environment that could predict and influence the duration of an episode of sick leave due to chronic LBP.Studies reporting the relation between prognostic factors and absenteeism from work in patients with LBP were included. The selected studies were grouped by prognostic factors. The results were measured in absolute terms, relative terms, survival curve, or duration of sick leave. The level of evidence was defined by examining the quality and the appropriateness of findings across studies in terms of significance and direction of relationship for each prognostic factor.A total of 20 studies were included. Prognostic factors were classified in clinical, psycho-social, and social workplace, reaching a total of 31 constructs. Global conditions with less favorable repercussions on worker's lives resulted in a delay in time to RTW. Older age, female, higher pain or disability, depression, higher physical work demands, and abuse of smoke and alcohol have shown strong level of evidence for negative outcomes.High global health well-being, great socioeconomic status, and good mental health conditions are decisive in RTW outcomes. Interventions that aim at RTW of employee's sick-listed with LBP should focus on psycho-social aspects, health behaviors, and workplace characteristics.

[The United Nations conventions on the rights of persons with disabilities: which strategies for protection at work?]. / La convenzione O.N.U. sui diritti delle persone con disabilità: quali strategie per la tutela sul lavoro?

More than 15% of the world's population lives with some form of moderate or severe disabilities, a growing percentage due to aging population as well as to the global increase of chronic diseases. The United Nations approved, in December 2006, the "Convention on the Rights of Persons with Disabilities" which dealt with the theme "work and employment". It prohibited discrimination on the grounds of disability with regard to health and safety at work, ensuring safe and healthy working conditions including protection from harassment. The most important expectation for the UN Convention, ratified in Italy by law 18/2009, is the guarantee that disable people in the workplaces are provided with "reasonable accomodation". This term refers to modifications and adaptations which are necessary and appropriate, that do not foresee excessive costs, to be taken, where necessary, to ensure even workers with disabilities the enjoyment and exercise of all their rights.

[Air transport biomechanical risk: reduced mobility passengers' handling]. / Rischio biomeccanico nel settore del trasporto aereo: la movimentazione manuale dei passeggeri a ridotta mobilità (PRM).

As the airport traffic increases there is a continuous increase of passengers with different motor disabilities. Disabled passenger's assistance causes a biomechanical overload in airport workers. Some disabled passengers are classified by IATA as WCHC (wheel chair in cabin or Charlie). Our study, was performed in one of the most important Italian airport on Charlie passengers (about 10% of all assistances). We identified four critical points: 1) wheelchair and baggage moving (unstable load), 2) inclined ramps with worker's backwards steps and braked wheelchair to prevent passenger tipping or falling, 3) transfer from standard wheelchair to bicycle wheelchair, specifically designed for the aisle; 4.) transfer from bicycle wheelchair to aircraft seat. The last two points required sometimes to lift passengers over the armrest and positioning them on a window side seat, causing a serious increase of biomechanical load. For each critical point we have proposed technical and organizational measures to reduce airport worker's biomechanical risk.

The contribution of Enrico C. Vigliani (1907-1992) to the international development of occupational medicine and industrial hygiene.

BACKGROUND: One of the last century's greatest personalities in Occupational Medicine was Enrico Carlo Vigliani (1907-1992), director of the "Clinica del Lavoro" in Milan (1942-1977), editor-in-chief of "La Medicina del Lavoro" (1942-1991), Secretary-Treasurer and then President of the "Permanent Commission and International Association on Occupational Health" (1957-1981), the original nucleus of the ICOH. OBJECTIVES: The 20th anniversary of his death provides us with the opportunity to discuss the role of this brilliant scholar in the international development of Occupational Medicine and Industrial Hygiene. METHODS: A comprehensive analysis of Vigliani's scientific works was conducted. In addition, his close collaborators and pupils were interviewed. RESULTS: In the 1930s, as a young doctor, Vigliani, first in the world, demonstrated the effect of lead on porphyrin metabolism. Afterwards he conducted pioneering studies on occupational oncology (benzene-induced leukaemia, bladder cancer due to aromatic amines, asbestos-related tumours), pathogenesis of silicosis, encephalopathy in carbon disulfide poisoning, byssinosis and metal fume fever, so influencing international research and the implementation of preventive measures against these conditions. Vigliani's scientific authority was widely recognized internationally, as confirmed by his role in ICOH. During his period of active service, the Commission developed from an academic institution to a more open association, substantially increasing its membership. Furthermore, he contributed to establishing subcommittees devoted to specific topics (now called "scientific committees"), one of the strengths of the present Commission. CONCLUSIONS: Vigliani's contribution to the development of Occupational Health may be considered as an expression of his genial eclecticism which ranged from clinical medicine to the environment.

Walking strategies of visually impaired people on trapezoidal- and sinusoidal-section tactile groundsurface indicators.

The visual system in walking serves to perceive feedback or feed-forward signals. Therefore, visually impaired persons (VIP) have biased motor control mechanisms. The use of leading indicators (LIs) and long canes helps to improve their walking efficiency. The aims of this study were to compare the walking efficiency of VIP on trapezoidal- and sinusoidal-section LIs using an optoelectronic motion analysis system. VIP displayed a significantly longer stance phase, a shorter swing phase and shorter step and stride lengths when they walked on the sinusoidal LI than when they walked on the trapezoidal LI. Compared with the trapezoidal LI, VIP walking on the sinusoidal LI displayed significantly lower joint ranges of motion. The centre of mass lateral displacement was wider for VIP walking on the sinusoidal LI than on the trapezoidal LI. Some significant differences were also found in sighted persons walking on both LIs. In conclusion, the trapezoidal shape enabled visually impaired subjects to walk more efficiently, whereas the sinusoidal shape caused dynamic balance problems. STATEMENT OF RELEVANCE: These findings suggest that VIP can walk more efficiently, with a lower risk of falls, on trapezoidal-section than on sinusoidal-section LIs. These results should be considered when choosing the most appropriate ground tactile surface indicators for widespread use.

[The contribution of surveillance systems of occupational diseases and mesothelioma in environmental health studies]. / Il contributo dei sistemi di registrazione delle malattie professionali e dei mesoteliomi negli studi su ambiente e salute.

National surveillance systems of occupational diseases may contribute to evaluate the work-related component of diseases investigated in SENTIERI Project. For a description of SENTIERI, refer to the 2010 Supplement of Epidemiology & Prevention devoted to SENTIERI Project. The National Workers Compensation Authority (INAIL) archives all occupational diseases claims (more than 230 000 in the period 2000-2007) and is in charge of their compensation. The Italian National Mesothelioma Register (ReNaM) and the Sinonasal Cancer Register (ReNaTuNS) record high occupational etiological fraction neoplasms (i.e. mesothelioma and sinonasal cancers). The former has identified more than 10 000 mesothelioma cases until now, and covers almost the whole country; the latter is active only in three Italian regions, Piemonte, Lombardia and Toscana. The monitoring of cancer sites at lower occupational etiological fraction is based on a record-linkage procedure between population-based cancer registries and employment history data, available at the Italian National Institute for Social Security (INPS). Finally, the informative system Mal.Prof collects and classifies all the diseases possibly related to the work environment reported by the Prevention Services of the Local Health Units.

[Walking efficiency of blind people on trapezoidal and sinusoidal section tactile leading indicators]. / L'efficienza del cammino di soggetti non vedenti su piste tattili trapezoidali e sinusoidali.

Gait of visually impaired subjects (VIS) is worse than that of sighted ones. VIS can use tactile ground surface indicators to optimize their walking efficiency. Aim of the study was to compare VIS walking efficiency on either trapezoidal and sinusoidal shape leading indicators. VIS walking on the sinusoidal leading indicators showed a worsening of the time-distance parameters (a longer stance phase, a shorter swing phase and shorter step and stride lengths), reduced lower limb joint excursions and increased center of mass oscillations. In conclusion sinusoidal tactile indicators induce a stiffening of joints and a loss of balance with an increased risk of fall.

[Work-related stress: comparing two assessment methods]. / Stress lavoro-correlato: due metodi di valutazione a confronto.

Aim of the study is to compare and evaluate the possible integration of two methods of work-related stress risk assessment: the "subjective/perceptive" ISPESL-HSE and the "objective/intersubjective" VIS. Four different types of companies were examined: public education, social services, forestry work, agricultural machinery industry. Both VIS and HSE showed a different level of risk among the companies, with a good overlap of the results obtained with the two different methods of investigation. They also integrate each other in eliciting a better and more articulated study of work-related stress risk.

Applicability of urinary benzene to biological monitoring of occupational and environmental exposure to very low benzene concentrations.

OBJECTIVE: To verify whether urinary benzene is an applicable biomarker of occupational exposure to very low concentrations of benzene, considering the influence of cigarette smoke and benzene-toluene co-exposure. MATERIALS AND METHODS: 23 filling station attendants with occupational exposure to benzene and 31 controls were analyzed. Occupational and environmental exposure was monitored and t,t-muconic acid (t,t-MA), S-phenylmercapturic acid (SPMA), urinary benzene and creatinine in the urine samples were tested. RESULTS: Occupational exposure to benzene and toluene was significantly higher in the filling station attendants than in the controls, whereas t,t-MA, SPMA and urinary benzene were not different in the two groups. Instead, the smoker group showed significantly higher values for the above biomarkers than the non-smoker group, each of which included both exposed workers and controls. SPMA was dependent on airborne benzene and cigarette smoking, and urinary benzene only on cigarette smoking, while t,t-MA was not dependent on either of these variables. CONCLUSIONS: At very low concentrations of occupational exposure to benzene, urinary benzene is less valid than SPMA as a biomarker, even if both are strongly influenced by smoking habit. Abstention from smoking should therefore be recommended for at least two hours before urine collection.

[The impact of nanotechnologies in the world of work: a challenge for the occupational medicine]. / L'impatto delle nanotecnologie nel mondo del lavoro: le sfide per medicina del lavoro.

Since the beginning of the 21st century the nanotechnologies have grown enormously, judging simply by the number of products now on the market and the funds dedicated to research and development. In 2014 there may be as many as ten million people--about 11% of the total manufacturing sector's workforce--employed in processes using nanotechnologies. Although the whole scientific community has now put its back into narrowing the gaps in scientific knowledge, and promoting research with a view to tackling the potential risks of nanotechnologies, we are still far from any firm agreement. In order to respond to these needs the research in occupational medicine will have to focus on the key questions that are still open, especially those on risk assessment to safeguard the health of the increasing numbers of workers who will be employed in these various sectors. These questions centre on toxicity and health effects, extent of translocation to target organs and importance of dermal exposure.

[The Italian Society of Occupational Medicine and Industrial Hygiene: one hundred years of history]. / La Società Italiana di Medicina del Lavoro e di Igiene Industriale: cento anni di storia.

This research project, in conjunction with the SIMLII foundation's 80th anniversary, is aimed to reconstruct the historical chronology of the institutional life of the Society: the Directive bodies, the by-laws, the main steps of the scientific activity, especially the Congresses of Occupational Health. The research will also analyze the most important elements of historical context explaining Society's evolution: the relationships between SIMLII and political-institutional and legislative framework, social and economic changes, medical science's evolution and the university teaching and research, and finally the interactions with the international context. The research covers the years since the first national meeting of Occupation Health, in 1907, in which scientific activity was particularly intense, although the foundation was officially only in 1929. The investigation of the documentation after the 2nd World War is aimed at reconstructing the reborn of the international relations and the social, cultural and economic changes occurred between 1968 and 1978 and the deep impact on industrial relations and the enactment of the "Statuto dei lavoratori" in 1970 and the Health Reform in 1978.

[Implementation and validation in the Italian context of the HSE management standards: a contribution to provide a practical model for the assessment of work-related stress]. / Contestualizzazione e validazione in Italia del modello management standards HSE quale contributo all'individuazione delle indicazioni per la valutazione dello stress lavoro correlato.

Over the last years, stress has been recognized as a potential work-related risk factor. Unfortunately, work-related stress is a very delicate subject, especially because it is difficult to assess it objectively and in broadly acceptable terms. In fact, work-related stress is a subjective personal response to a specific work environment, ad is of a multifactorial origin. In order to provide a practical tool for the assessment of work-related stress, the authors carried out a thorough benchmarking analysis of the various models to manage work stress problems adopted by EU countries. As a result, the authors have chosen to apply and implement the Health and Safety Executive (HSE) Management Standards approach in the Italian context. In compliance with the European Framework Agreement signed on October 8, 2004, HSE Management Standards ask for the coordinated and integrated involvement of workers and safety personnel and represent a valid assessment approach based on principles widely acknowledged in the scientific literature.

[The register of exposed workers to carcinogens: legislative framework and data analysis]. / Il registro dei lavoratori esposti ad agenti cancerogeni: quadro legislative e analisi dei dati.

BACKGROUND: On the basis of the law which introduced the registration of occupational exposures to carcinogens (Legislative Decree 626/94), the National Institute for Occupational Safety and Prevention designed and implemented an information system for collecting and recording such information. The Ministry of Health Decree No 155/2007, which established the procedures for record keeping and transmission of registers of exposed workers, regulated the legislative fJamework in this field. OBJECTIVES: The aim of the study was to illustrate some of the major legislative issues and toprovide summary statistics, after one year of entry into force of this Decree. METHODS: The main information to record is: the carcinogenic agents used, the type of occupational exposure and data on the environmental measurements. Descriptive statistical analysis were carried out, by sector of economic activity, carcinogen agent and worker's occupation. RESULTS: As at 31 December 2008 the information recorded, altogether, covered: 6000 firms, 79,000 workers, 164,000 exposures and 100,000 measurements. Most of the exposures occurred in the manufacturing and construction industries and in commercial activities. CONCLUSIONS: Such surveillance system, established as a result of the institution of exposure registers, makes it possible to plan analytical studies, both for monitoring the effects of exposure, even at low doses, and for assessing the prevention and protection measures. It is hoped that the recent readjustment law (Legislative Decree 81/2008) will promote awareness of all subjects involved in the recording procedures (employers, physicians, local health units, research institutes, etc.), thus increasing the quality and coverage of data transmission.

[Well-being in call centres: a multidisciplinary approach to research and evaluation]. / Il benessere nei call center: un approccio multidisciplinare di ricerca e valutazione.

BACKGROUND: The topics of stress and well-being in call centres are the focus of many different disciplines. This article presents the definition and start-up phases of the "Well-being in Telecom Italia Call Centres" project, which was coordinated and supervised by an interdisciplinary scientific committee composed of members from different universities. To address the topic of individual well-being in the organizational context means considering all the main factors that can affect wellbeing. OBJECTIVES: For this reason, the study assessed the topic from three different view-points (psychological/sociological/cultural, physical/chemical/biological, organizational/technological/work-related) in order to obtain an accurate as possible picture of the complex well-being dynamics. METHODS: The study plan shows that merging qualitative methods (interviews, observations, focus-groups) and quantitative methods (questionnaires, physiological response to perceived stress) was a central concern for the research team. RESULTS: The collected data highlighted important differences between psychological and physical well-being and discomfort according to the different kinds of call centre, the respondents'gender and working hours. CONCLUSIONS: This method enabled us to define the specific features of call centre environments, leading to a definition of work in the centres as an activity with high psychological uncertainty, where rigid rules coexist with demands of high levels of flexibility and competence, and suggesting the importance of specific organizational measures in order to improve well-being.

[The surveillance of occupational risks. Problems and perspectives of the recent legislative framework after the national preliminary survey]. / I dati sanitari aggregati e di rischio dei lavoratori sottoposti a sorveglianza sanitaria. Risultati preliminari dello studio pilota nazionale sulle comunicazioni ex art. 40. D.lgs 81/2008.

BACKGROUND: Legislation in Italy concerning health, safety and prevention at the workplace recently established a new data communication standard OBJECTIVES: The findings are reported of a specific survey on 18 Local Health Units (ASL) over the entire Italian territory, aimed at identifying the critical points in data management and analyze the available information. METHODS: The occupational health physician for each company must collect and transmit information on the number of workers submitted to health surveillance protocols to the Local Health Unit. Information must be divided by risk factor and gender Local health Units then transmit the data to the Regions and finally to the Italian National Institute for Occupational Safety and Prevention (ISPESL). RESULTS: A sample of 22.977 companies was studied, providing information on about 410,009 workers undergoing health surveillance protocols. Carrying or moving heavy loads, exposure to noise, VDU and chemical substances were the most frequent risk factors. The difference between genders was significant in risk allocation, with exposures to VDU and biological agents prevalently among females. CONCLUSIONS: The information thus collected suffered from a lack of data organization and completeness in the sample under study, but nevertheless provides preliminary evidence of a map of occupational risks on a national basis, confirming the potential for the new law (D.Lgs 81/2008) to investigate health safety and prevention at the workplace.