[The regions' contribution to assessment of work-related stress: an operative guide]. / Il contributo delle Regioni sulla valutazione del rischio stress lavoro-correlato: la guida operativa.

In order to formulate indications for work-related stress assessment established by Italian health and safety regulation (D.Lgs. 81/2008), the interregional technical committee has instituted a working group to define an operative guide. The guide indicates the elements that must be considered in the evaluation, criteria and methods for the assessment, the minimum requirements for the evaluation instruments, and the specific contents of the risk assessment document.The medical surveillance and the role of health and safety local authorities are also considered. The risk assessment must examine work organization indicators and the direct or indirect effects of work-related stress, like morbility, frequent accidents, changing job requests, legal actions, etc. Detecting subjective factors is a second step of the assessment, which must be carried out if the work organization indicators show considerable work-related stress problems, and only in the companies which employ more then ten workers.

[Register of exposed to carcinogens]. / Registro di esposizione a cancerogeni.

Law Decree 626/94 already provided for the "register of exposed subjects" to be implemented by employer once the presence of cancerogenic agents falling into the definition of the norm itself have been assessed in working activities. The lack of an effective decree identifying the models and modalities of register keeping has led so far to an exposure under-evaluation. Of course the coming into force of Ministerial Decree 155/2007, almost at the same time as the new body of regulations made up by Law Decree 81/2008, stimulated the addressees to proceed with setting an exposure register to be forwarded to the National Institute for Occupational Safety and Prevention (ISPESL) and to the competent inspection authority. Starting for the regulations, the authors will go through the register forms and information flow management.

[The occupational and active research, diagnosis and reporting of occupational diseases]. / Il Medico Competente e la ricerca attiva, diagnosi e denuncia delle malattie professionali.

The Occupational Doctor plays a key role on the protection of workers safety and prevention of occupational and work-related disease. His training and his need of updating, due to the constant transformation of work, the evolution of technology and the medical progress, set him in the center of all activities carried out to protect health in workplaces. The Occupational Doctor should devote special attention to the working anamnesis as well as to the pathological anamnesis both close and remote. He should also pay attention to semeiotics. Another important element is the relationship between the Occupational Doctor and the Doctor of General Medicine (MMG); this synergy is of vital importance in protecting health and in investigating diseases whether occupational or not. D.Lgs. 81/08 emphasizes this synergy, in fact name and phone number of Doctor of General Medicine is compulsory in Case History. Major source of information for all form of prevention is the survey of occupational disease which is a tool for epidemiological control. The use of a systematic collection of data, of protocols, of guidelines and of scientific evidence is the basis for identifying occupational diseases, their diagnosis and subsequent denunciations. This is the line suggested in MAL PROF informative system, made for registration of work-related diseases, and which is important, with other instruments, in realizing an integrated informative system for prevention in workplace. The Covenant for the Protection of Health and Prevention in Workplaces (DPCM 17/12/2007) indicates the strategic objectives of the National Health System for the consolidation and development of the existing system and of the programs promoting health and safety. These include the growth of the culture of prevention and of the epidemiological control of occupational diseases. The Occupational Doctor has an important role because he can identify the early onset of diseases during the working age and start all forms of prevention and health promotion. In the case of diagnosis of a suspected professional disease the Occupational Doctor has three distinct obligations. The first is to report to the legal authority (C.P.P. art. 365). The second requirement is the declaration of the occupational disease (D.P.R. 1124/65 art. 139) and the third is to issue the first certificate of occupational disease for compensation insurance (D.P.R. 1124/65 artt. 53, 251).

[The activity of the Service for Prevention and Safety in Workplaces of the Health Local Agency of Rome C towards the "competent physicians" in the enterprises of the territory]. / L'attività del Servizio Prevenzione e Sicurezza Ambienti di Lavoro della A.S.L Roma C nei confronti dei medici competenti della aziende del territorio.

In the past seven years the Service for Prevention and Safety in Workplaces of the Health Local Agency of Rome C set out some activities towards the occupational physicians (so-called "competent physicians") of three different kinds: control and surveillance, institutional activities on demand and activities for quality improvement. In the first ambit we conducted some investigations on the procedures of the workers' medical surveillance and the role of competent physicians in the risk evaluation inside three different intervention projects (monitoring the enforcement of the D.Lgs. 626/94; intervention on the chemical risk, intervention in the car repair shops). In the second ambit we analysed 92 notifications of occupational diseases and we dealt with 27 appeals against the judgement of the fitness to work. In the third ambit we made 19 meetings on various subjects: correct procedures in medical surveillance, quality in diagnostic examinations, the enforcement of new regulations. We report the results of these interventions which let us identify the most common criticalities in the activity of the competent physicians, but also to face them with a new approach based more on peer review instead of control and surveillance.

[Biological and chemical risks in haemodialysis centres]. / Il rischio biologico e chimico in emodialisi.

Haemodialysis technique was introduced in 1965 for people afflicted to chronic renal insufficiency, permitting them to survive. The method purifies patient blood who is connected to the equipment by tubes. The equipment uses saline solutions and water and it operates by osmotic pressure and by filtration. In this paper biological and chemical occupational risks are analysed. Main biological risks are caused by haematic viruses such as HIV, HBV, HCV. Chemical risks are mainly caused by disinfection products such as acid, basic and saline solutions. Workers exposed to chemical and biological risks are nursing staff, doctors, assistants, maintenance men. The paper analyses these risks and it shows prevention and protection solutions to reduce significantly the risks. The S.Pre.S.A.L. (Prevention and Protection Service in Work Places) operators of ASL RMC (Health Local Agency of Rome) visited six haemodialysis centres situated in Rome in the ASL RMC territory. They verified the application of safety and healthy measures by use of a check list about risk assessment, the lay-out, the equipment, the preventive and protective measures and the application of law. Experimental data were organized in relation of legislative accomplishments and technical measures. The aim of our work was to improve workers' safety in the haemodialysis centres, proposing the better technical solutions to realise this objective.

Short term respiratory effects of acute exposure to chlorine due to a swimming pool accident.

OBJECTIVE: Acute exposure to chlorine causes lung damage, and recovery may proceed slowly for several weeks. The short term respiratory effects of acute chlorine inhalation during a swimming pool accident were examined. METHODS: A total of 282 subjects (134 children, aged <14 years) inhaled hydrogen chloride and sodium hypochlorite during an accident caused by a malfunction of the water chlorinating system in a community pool in Rome in 1998. Most people received bronchodilators and cortisone at the emergency room; five children were admitted to hospital. A total of 260 subjects (92.2%) were interviewed about duration of exposure (<3, 3--5, >5 minutes), intensity of exposure (not at all or a little, a moderate amount, a lot), and respiratory symptoms. Lung function was measured in 184 people (82 children) after 15--30 days. The effects of exposure to chlorine were analysed through multiple linear regression, separately in adults and in children. RESULTS: Acute respiratory symptoms occurred among 66.7% of adults and 71.6% of children. The incidences were highest among those who had chronic respiratory disease and had a longer duration of exposure. In about 30% of the subjects, respiratory symptoms persisted for 15--30 days after the accident. Lung function levels were lower in those who reported a high intensity of exposure than in those who reported low exposure, both in children and in adults (mean (95% confidence interval (95% CI)) differences in forced expiratory volume in 1 second (FEV(1,)) were -109 (-310 to 93) ml, and -275 (-510 to -40) ml, respectively). CONCLUSION: Persistent symptoms and lung function impairment were found up to 1 month after the incident. Although community pool accidents happen rarely, the medical community needs to be alerted to the possible clinical and physiological sequelae, especially among susceptible people.