Work-related injuries in children and adolescents represent a negative indication of more general inequities of the society in which events occur. Their characteristics are not well described, particularly in Italy, and this paper is aimed at highlighting some fundamental aspects of these injuries. The case in point is represented by the injuries that received compensation and occurred in the Lombardy Region (Italy) between 1984 and 1989 and involved people under the age of eighteen. The injuries occurring in the same period and area in workers over eighteen were used for comparison. Work related injuries in minors were more frequent in crafts activities than in industry, but their gravity (in terms of deaths or permanent consequences) was lower than in the corresponding adult workers. Ninety percent of the events in young workers occurred in males, in each age category, and about 5% of the cases pertains to very young workers (less than 15 years). Cuts/lacerations are the most frequent type of lesion (49.9%) and the hands represent the site most frequently involved (55.5%). The great majority of the observed injuries pertains to a limited number of economic activity sectors: about 75% of the cases occurred in ten sectors. Metal manufacturing, construction and machine production scored first, with interesting correlations with the same sectors in adult workers. Ten specific occupations represent over fifty percent of the cases, with mechanics and bricklayers at the top. The description of the accident in terms of mode of occurrence and the agents involved was less informative and not specific.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents, Occupational↗

PubMedDate not supplied

[Mucociliary clearance and respiratory function in foundry workers].

The aim of the study was to establish whether changes occur in respiratory function, particularly mucociliary clearance, among second fusion smeltery workers. The research covered 93 male smelters employed in steel forming and casting and 116 male workers of an electric power station, considered as non-exposed. Physiological, pathological and occupational histories of all subjects under study were available. An ECCS respiratory symptoms questionnaire was administered to all subjects ad the two groups also underwent a general medical examination, a spirometry and a chest X-ray. During the medical examination sputum was collected from the subjects to measure mucus transport rate on frog palate, expressed as Normalised Frog Palate Transport Rate (NFPTR). For the environmental research, dust, fumes and gas samplings were taken either at a fixed station or by means of personal dosimeters. Environmental research revealed very low concentrations of respiratory irritants (total dust: 0.2-6.8 mg/m3; respirable dust: 0.1-4.9 mg/m3; total silica: < 2-15.5%; respirable silica: < 0.004-0.3 mg/m3; iron: 0.008-0.085 mg/m3; chromium and manganese: < 0.001 mg/m3; fumes and gases: well below the TLV. The two groups were homogeneous with regard to age and smoking habits. Exposed workers showed rales, dyspnoea and spontaneous phlegm more frequently than non-exposed workers. NFPTR alterations were checked in 49 out of 81 exposed and in 18 out of 81 non-exposed subjects (chi squared = 22.9; p < 0.001). Stratification of the results according to smoking habits further confirmed the strong association between occupational exposure and NFPTR alterations. Smelters showed significantly lower mean NFPTR values compared to non-exposed subjects; also, the mean value of NFPTR in the exposed was below 0.70, which is considered the lowest individual limit in normal subjects. The only variable which explains a large part of the variability of NFPTR is past work in a smeltery rather than in an electric power station. The spirometries showed that only the mean PEF values were significantly lower among the exposed. Stratified analysis of the results according to smoking habits in the two groups revealed a close association between smeltery work and reduction of PEF to under 80% of the ECCS 1983 theoretical values, independently of smoking habits. We also compared the mean PEF values, both as measured values and as percent values of the ECCS 1983 theoretical values, stratified for occupational exposure and smoking; the results again showed that differences between these mean values were mainly due to current or past work in the foundry.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

PubMedDate not supplied

[Analysis of correlated data: problems and examples in industrial medicine].

In occupational health we are frequently faced with data that are not independent, but to recognize the lack of such an independence is not yet a common practice. To help researchers in the field to treat correlated data in a proper way this paper has two aims: to highlight practical situations in which the data are not independent and to show the main differences between a statistical analysis which does consider the correlation appropriately and one which doesn't. As to the first aim, four typical examples are discussed: repeated measurements in the same subject (e.g., cells in which the number of sister chromatid exchanges is counted); health effects observed in multiple organs (e.g., visual impairment in both eyes); evaluation of prevention programs (e.g., exposure assessment to styrene before and after environment remediation); longitudinal studies of health effects (e.g., changes over time of pulmonary function parameters). With respect to the second aim a practical exercise is described completely. Measurements of exposure to a toxic substance in two different departments before and after environment remediation are evaluated with statistical tools which both do and do not consider the correlation between such measurements. Differences in the results obtained, with particular reference to indices of variability (e.g., standard errors), point toward the need of analysing correlated data with appropriate statistical tools that take correlation into account.

Analysis of Variance↗

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[Mortality rate and its statistical properties].

The rate is an epidemiologic measure which has a widespread use in describing the occurrence of diseases. In this paper, with a didactic approach, the definition of the mortality (morbidity) rate is introduced following two ways of reasoning: firstly, in the context of survival analysis, as an instantaneous conditional probability of failure (either disease or death) (instantaneous risk) and, secondly, as a traditional measure of rapidity of change in time. We then proceed to highlight the differences, in terms of definition, interpretation, and application, between the concepts of rate and risk. As a next step the statistical properties of the rate are explored and it is explained why the variability of the measure is simply associated with the numerator (events) and not with the denominator (person-times) of the rate. In this context the Poisson distribution is commonly considered the probability distribution which better describes the statistical variability of the observed events, and examples of such a distribution are presented. When the number of deaths is sufficiently elevated the Poisson distribution can be adequately approximated by the Gauss distribution, which is simpler and in common use in occupational medicine, and formulas are presented to compute mean and variance of the rate in this situation. When the number of deaths is small a suggestion is made of making a log transformation of the rate (or of the deaths) before using the Gauss distribution: formulas are proposed for this situation, too. As a practical application of the statistical properties presented and as a concluding example, a confidence interval for the rate is computed. Numerical and graphical comparisons of the results deriving from the use of different formulas are described.

Confidence Intervals↗

PubMedDate not supplied

[Minor injuries: little known aspects of occupational accidents].

This paper is aimed at describing and characterizing occupational injuries which do not receive compensation (minor injuries), and at evaluating the differences between compensated and non compensated injuries with reference to type and site of the lesion. Data were collected in a car manufacturing plant and covered the period 1984-1991. Information regarding all kinds of occupational accidents were extracted, following a standardized procedure, from different paper forms compiled by health personnel within the factory (physicians and nurses). Due to the large amount of information registered, a sampling scheme was adopted which considered the same three months every two years, previously selected to cover the entire observation period (1984-85, 1987-88, 1990-91). In addition, to evaluate che adequacy of the sampling procedures for the compensated injuries only, the resulting sampled distributions of the relevant variables were compared with the totality of the injuries. 7,299 events occurred in the sampled months, which corresponded to 652.59 occupational accidents per million hours worked: 8.97% of them caused absence from work lasting more than three days (compensated cases), 3.59% caused a less than three workday loss (LTTWL cases), and the great majority (87.44%) did not cause any absence from work (first aid cases). The frequency index of the total number of accidents did not change over time, but the three categories of injuries did change: for example, first aid cases had their maximum frequency during the middle period (with a peak of 93.21% in March 1987) and their minimum during the last period (73.28% in June 1991). An opposite pattern occurred for accidents which caused absence from work. Type and site of the lesions differed among the three categories of occupational accidents. For example, cuts/lacerations were observed in 48% of first aid cases, 30% of compensated cases, and 15% of LTTWL cases. On the contrary, injuries due to extraneous bodies and contusions which were the most frequent category for LTTWL cases with, respectively, 28% and 25% of the cases, represented only 10% and 13% of first aid cases. With respect to the site of the lesion, hands had the highest frequency index both for first aid (56%) and compensated (39%) cases, and eyes were most affected (36%) among LTTWL cases. With respect to compensated injuries, a notable correspondence of the distributions of the relevant variables between the sample and the whole population was evident, also when considering separate individual subperiods.(ABSTRACT TRUNCATED AT 400 WORDS)

Accidents, Occupational↗

PubMedDate not supplied

[Variations over time in the accident rate in an automobile manufacturing plant].

This paper describes some characteristics of occupational injuries occurring in a car manufacturing plant during the period 1984-1991. Data regarding all kinds of injuries (not only those which received compensation) were extracted from records compiled by health personnel within the factory according to a sampling scheme that considered the same three months every two years. In addition, all injuries which caused absence from work lasting more than three days were evaluated (without sampling). To compute frequency indexes, the number of hours worked each month/year were obtained. Roughly 650 occupational injuries per million hours worked occurred in the whole population without appreciable changes over time: about 90% of the events did not cause absence from work. For two-thirds of the injuries that caused absence from work, the absence lasted more than three days. More than 50% of the injuries involved the hands; the eyes and arms followed with lower percentages. Cuts/lacerations comprised 45% of all injuries, followed by contusions and foreign bodies. Over time, the frequency index of foreign bodies in the eyes diminished, whereas muscular disorders increased, mainly in the last period. Compensated injuries were particularly elevated in the final period and lowest in the middle: this pattern is attributable only to events with temporary consequences. The increase in the incidence of injuries in the last period was observed in all categories of duration of absence but the decrease of incidence in the middle period concerned only events with shorter duration (less than fourteen days' absence). These trends can be partially attributed to the changes in health management within the factory (recognition and first aid) which occurred in the time period considered. Some combinations of site and type of lesion (i.e., foreign bodies in the eyes) showed a decrease over time both for index of frequency and mean duration of absence; others had a particular pattern: decrease in frequency and increase in mean duration of absence in the middle period, followed by an opposite pattern in the last period (i.e., cuts/lacerations of the hands); some others showed a decrease both for frequency and duration of absence (sprains/strains of the vertebral column muscles).

Absenteeism↗

PubMedDate not supplied

[The mortality of female workers exposed to PCBs].

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Air Pollutants, Occupational↗

PubMedDate not supplied

[90 years ago, at Milan, founding of the ICOH (International Commission on Occupational Health)].

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History, 20th Century↗

PubMedDate not supplied

[The law 626/94 and epidemiology].

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Italy↗

PubMedDate not supplied

[The concept of risk and its estimation].

The concept of risk, in relation to human health, is a topic of primary interest for occupational health professionals. A new legislation recently established in Italy (626/94) according to European Community directives in the field of Preventive Medicine, called attention to this topic, and in particular to risk assessment and evaluation. Motivated by this context and by the impression that the concept of risk is frequently misunderstood, the present paper has two aims: the identification of the different meanings of the term "risk" in the new Italian legislation and the critical discussion of some commonly used definitions; and the proposal of a general definition, with the specification of a mathematical expression for quantitative risk estimation. The term risk (and risk estimation, assessment, or evaluation) has mainly referred to three different contexts: hazard identification, exposure assessment, and adverse health effects occurrence. Unfortunately, there are contexts in the legislation in which it is difficult to identify the true meaning of the term. This might cause equivocal interpretations and erroneous applications of the law because hazard evaluation, exposure assessment, and adverse health effects identification are completely different topics that require integrated but distinct approaches to risk management. As far as a quantitative definition of risk is of concern, we suggest an algorithm which connects the three basic risk elements (hazard, exposure, adverse health effects) by means of their probabilities of occurrence: the probability of being exposed (to a definite dose) given that a specific hazard is present (Pr(e[symbol: see text]p)), and the probability of occurrence of an adverse health effect as a consequence of that exposure (Pr(d[symbol: see text]e)). Using these quantitative components, risk can be defined as a sequence of measurable events that starts with hazard identification and terminates with disease occurrence; therefore, the following formal definition of risk is proposed: the probability of occurrence, in a given period of time, of an adverse health effect as a consequence of the existence of an hazard. In formula: R(d[symbol: see text]p) = Pr(e[symbol: see text]p) x Pr(d[symbol: see text]e). While Pr(e[symbol: see text]p) (exposure given hazard) must be evaluated in the situation under study, two alternatives exist for the estimation of the occurrence of adverse health effects (Pr(d[symbol: see text]e)): a "direct" estimation of the damage (Pr(d[symbol: see text]e) through formal epidemiologic studies conducted in the situation under observation; and an "indirect" estimation of Pr(d[symbol: see text]e) using information taken from the scientific literature (epidemiologic evaluations, dose-response relationships, extrapolations, ...). Both conditions are presented along with their respective advantages, disadvantages, and uncertainties. The usefulness of the proposed algorithm is discussed with respect to commonly used applications of risk assessment in occupational medicine; the relevance of time for risk estimation (both in the term of duration of observation, duration of exposure, and latency of effect) is briefly explained; and how the proposed algorithm takes into account (in terms of prevention and public health) both the etiologic relevance of the exposure and the consequences of exposure removal is highlighted. As a last comment, it is suggested that the diffuse application of good work practices (technical, behavioral, organizational, ...), or the exhaustive use of check lists, can be relevant in terms of improvement of prevention efficacy, but does not represent any quantitative procedure of risk assessment which, in any circumstance, must be considered the elective approach to adverse health effect prevention.

Humans↗

PubMedDate not supplied

[Analysis of correlated data in occupational medicine: examples with binary data].

In a previous paper in this Journal we presented and discussed examples of analysis of correlated data when the response variable was continuous and normally distributed (the measurement of exposure to a toxic substance was the case in point). In this paper we extend the analysis and the discussion to take into account categorical (binary) variables (described in terms of proportions or odds); to favour the comprehension of the analogies (and discrepancies) between the two contexts we have fully developed an example that mimics the situation presented in the previous paper. Marginal, conditional, random effects and transitional models for correlated data are introduced in practical terms; the meaning of the different estimates obtained are interpreted for epidemiological purposes; the disadvantages of not considering correlation in the analysis are explained and the complexities connected to this type of analysis are fully appreciated. It is concluded that correlated data are very frequently encountered in occupational settings and that an appropriate analysis is necessary. This analysis requires sophisticated computer programs and statistical expertise, particularly in the case of categorical data.

Cluster Analysis↗

PubMedDate not supplied

[Ordinary epidemiology: pleural mesothelioma and asbestos].

This paper describes a practical experience which took place in a Health District of the Lombardy Region (Northern Italy). This experience was motivated by the publication, on a newspaper, of the results of an epidemiological study which reported the nationwide geographical distribution of the mortality data for pleural mesothelioma during the period 1980-1987. The presence of excesses of pleural mesothelioma cases in two municipalities of Health District captured the attention of some field operators which decided to start working on the topic. Using all information available in the District all cases of pleural mesothelioma occurring during the period 1978-1993 in the two municipalities were identified; possible sources of both occupational and environmental asbestos exposure in the area were identified; and the next-of-kin of the cases was interviewed so as to gain information on the history of possible exposure to asbestos of the cases. For thirteen (out of seventeen) deaths the next-of-kin accepted to be interviewed and for them results are reported: the information presented describes gender, smoking habits, and an evaluation of the potential for exposure to asbestos both of occupational and environmental origin. We discuss the value importance of the experience, with particular emphasis on: a) the routine activities of the Services participating in the study; b) the resources employed; c) the use of epidemiological methods and tools; d) the primary prevention activities originated in the area; e) the personal motivations hat such experiences are capable to convey.

Aged↗

PubMedDate not supplied

[Carcinogens and the Law 626/94: examples of application related to Title VII].

This paper is aimed at describing the state of the art with respect to the application of law 626/94, particularly with reference to the activities connected with the use of carcinogens at the workplace. To understand what is going on and what practical activities have been established we found it useful to look for practical examples in the field of carcinogenic risk assessment. We interviewed many colleagues and experts in a non-random sample of situations, and this paper briefly describes the methodological problems encountered and some specific results emerging from eight experiences. The examples described regard both large and small factories, in different fields of activity (chemical and pharmaceutical industries, transport, power production, ...), with different attitudes and traditions with regard to carcinogenic risk assessment, and also with different specific results in terms of risk evaluation. Two among the eight examples reported directly involved the activities performed by private consultants or territorial Public Services active in the field of prevention. The paper concludes with the indication of the problems encountered in the collection of information and with the suggestion that such experiences should be freely presented in the literature, thus offering an opportunity of public discussion and evaluation.

Carcinogens, Environmental↗

PubMedDate not supplied

[Seveso. Dioxin: an example of environmental medicine. Epidemiologic data as guidelines for health programming].

The 1976 dioxin accident in Seveso, Italy, represented a major environmental health problem for the population of the surrounding territory and a challenge for the entire regional area and the health and scientific institutions. The role of occupational health and of epidemiology in the incident investigation and management is discussed. Of major relevance was the consideration of all the different component factors of the interested environment, from chemical pollution to cultural attitudes and psycho-social stressors. Scientific research was helpful in elucidating the incompletely known toxic effects of dioxin and the complex mechanism of cancer induction by this widespread pollutant of our industrialized environments. The experience gained in Seveso was also useful in prompting national and international legislation concerning major industrial accidents, and the lessons learned contributed to the content of this legislation. Preparedness to these events requires mapping of the potential sources of these accidental occurrences and the monitoring of the social and health characteristics of the possibly affected populations. In the Lombardy Region, the numerous epidemiological investigations performed and the expertise implemented for the study and the control of the accident consequences, formed the basis on which the Regional Epidemiology Surveillance System established.

Accidents, Occupational↗