[Health surveillance of workers with prior exposure to asbestos. Application in the metallurgy/metal mechanical field]. / La sorveglianza sanitaria dei lavoratori con pregressa esposizione ad amianto. Una applicazione nel settore metallurgico-metalmeccanico.

To improve the health surveillance program for workers with a known previous exposure to asbestos in a big metallurgic-mechanical industry from Lombardy, the sources of risk and the different exposure levels hare been reconstructed based on specific jobs. The eligibility criteria and a specific work program including information and organization supports hare been established by a work group composed by health physicians, workers and industrial hygienists. The major goals of the program were: to listen and support each worker who perceives worries about his health status; to prevent, if possible, diseases, especially cancer, resulting from exposure; to document the existing injuries for legal compensation. The resulting actions consist of counselling; indication to follow an adequate life and work style; indication, based on specific request of worker, of sanitary checks of first or eventually second level.

[Carcinogens and the Law 626/94: examples of application related to Title VII]. / Cancerogeni e D.lgs 626/94: esempi di applicazione relativi al titolo 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.

[The concept of risk and its estimation]. / Il concetto di rischio e la sua stima.

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.

[The report on a divisional plan as an evaluation of results]. / Il rapporto su un piano di comparto come valutazione di risultato.

The adoption of norms of recommended practice (NRP) by industrial management (a fundamental step in ensuring a safer and healthier work environment, is in our opinion a suitable approach for evaluating primary prevention programmes. We tested this hypothesis in the shoe and leather goods manufacturing industry (55 facilities). An ordinal scale was defined for each variable taken into account by NRP and for other variables related to employers' actions. A score was assigned to every facility with reference to the starting and ending points of the programme. In this way we estimated the degree of variation, in time and among facilities, in adopting NRP.