[Active research on occupational diseases caused by biomechanical overload in construction: experience at the ASL of Bergamo]. / Ricerca attiva delle patologie professionali da sovraccarico biomeccanico in edilizia: l'esperienza dell'ASL di Bergamo.

The analysis of the national and international literature reveals a prevalence of around 20% of work-related musculoskeletal disorders in construction workers over 40 years of age. The chronic-degenerative disease in the muscular-skeletal system is important not only for the number of reported cases, but also for the seriousness of the symptoms, which are one of the main causes of evaluations of limited work-suability and unfitness for work. The aim of this study is to improve the quality of the diagnosis of occupational musculoskeletal illnesses and to ensure that the occupational physicians identify such disease, as prescribed by the Italian legislation about safety and health in workplaces. The research involved 57 construction companies located in the Bergamo's province, which employ, in aggregate, 833 workers. A sample of 479 workers, 40, or more, years old (403 Italians and 76 foreigners) was analysed. It was found out that 152 workers had some musculoskeletal disorders but only for 5 of them an occupational disease was already reported. It was necessary to ask the occupational physician for further clinical investigation for 60 employees, which revealed 29 new musculoskeletal occupational diseases in 19 workers. At the end of the study a total of 34 musculoskeletal occupational diseases were diagnosed in 22 workers: it was 4, 6% of the total sample investigated (n. 479) and 14% of those who already had problems (no 152). The results confirm the under-reporting of occupational musculoskeletal diseases in construction workers. The active research is a useful tool for the purposes of verifying the level of health surveillance carried out by occupational physicians. In fact the study highlighted that physicians seem not to be inclined to require additional clinical investigations and not always report occupational diseases.

Metallic elements in lung tissues: results of a meta-analysis.

Several studies have investigated the levels of metallic elements in the pulmonary tissues of healthy subjects, patients with lung diseases and occupationally exposed subjects. The present meta-analysis was aimed at both assessing the possible contribution of metal exposure to the development of lung diseases, including lung cancer, and evaluating systematically the role and the weight of variability factors affecting the results of such studies. A literature research covering the period 1980-2007 was conducted using the public database PubMed. A standard scoring method was elaborated with a minimum score of 5 for inclusion and evaluation. Selected papers underwent a meta-analytical assessment. Fifty-eight papers were retrieved, but 21 of them could not be admitted to further analysis, due to failure to achieve the minimum score. The main limitations of individual studies included: limited sample sizes, poor control of smoking habits and differences in subjects' ages, lung tissue topography, sampling methods, storage procedures and data analysis. Copper and zinc were the most represented elements (121.96 +/- 0.74 and 12.98 +/- 0.07 microg/g dry weight, respectively). Among toxic metals, the highest concentrations were observed for chromium and lead (2.42 +/- 0.12 and 2.14 +/- 0.04 microg/g, respectively). Tissue concentrations were similar in unaffected tissues from both controls and lung cancer patients, whereas they were lower in lung tumor samples. A considerable intra- and inter-individual variability was noted. Such a variability of measures, combined with the very low metal concentrations calls for the definition and use of standardized procedures of sample collection, storage, and analysis.