Injury narratives in occupational safety and health prevention in Italy.

BACKGROUND: Storytelling is an effective information source when coupled with technical-scientific evidence. It can promote a structured relationship between evidence-based knowledge and field experience of workplace safety and prevention services (WSPS) inspectors. This is key to identifying the causes of workplace injuries and to set priorities for prevention strategies. AIMS: The main aim was to describe and report how story collection can be used for deriving validated indications for injury prevention. The specific objectives were to report the results of the creation and dissemination on the web of the story collection and the experience of setting up a community of practice (CoP) to develop preventive recommendations. METHODS: WSPS inspectors from local health boards in Piedmont (northwest Italy) were asked to write injury stories. They identified the key elements of their stories and developed a narrative of witness accounts to explore the critical issues identified during the investigation. In sessions with the CoP, the inspectors validated the indications for prevention elaborated in each story to reduce bias and standardize recommendations. RESULTS: Between 2012 and 2017, 60 WSPS inspectors wrote 53 injury stories which were collected and published on the institutional website. Twenty-two stories were selected for discussion during peer review sessions in the CoP and the indications for prevention were transformed as preventive solutions. CONCLUSIONS: Occupational safety and health prevention can benefit from a narrative-based approach that provides a more comprehensive look at health and safety by facilitating knowledge improvement and sharing.

[Integrated use of data bases to map manufacturing processes involving exposure to carcinogens in the Piedmont Region: the example of formaldehyde]. / Uso integrato di banche dati per la mappatura di lavorazioni con esposizione a cancerogeni nella Regione Piemonte: l'esempio della formaldeide.

BACKGROUND: Exposure to carcinogens is still widespread in working environments. For the purpose of defining priority of interventions, it is necessary to estimate the number and the geographic distribution of workers potentially exposed to carcinogens. It could therefore be useful to test the use of tools and information sources already available in order to map the distribution of exposure to carcinogens. Formaldehyde is suggested as an example of an occupational carcinogen in this study. OBJECTIVES: The study aimed at verifying and investigating the potential of 3 integrated databases: MATline, CAREX, and company databases resulting from occupational accident and disease claims (INAIL), in order to estimate the number of workers exposed to formaldehyde and map their distribution in the Piedmont Region. METHODS: The list of manufacturing processes involving exposure to formaldehyde was sorted by MIATline; for each process the number of firms and employees were obtained from the INAIL archives. By applying the prevalence of exposed workers obtained with CAREX, an estimate of exposure for each process was determined. A map of the distribution of employees associated with a specific process was produced using ArcView GIS software. RESULTS: It was estimated that more than 13,000 employees are exposed to formaldehyde in the Piedmont Region. The manufacture of furniture was identified as the process with the highest number of workers exposed to formaldehyde (3,130),followed by metal workers (2,301 exposed) and synthetic resin processing (1,391 exposed). CONCLUSION: The results obtained from the integrated use of databases provide a basis for defining priority of preventive interventions required in the industrial processes involving exposure to carcinogens in the Piedmont Region.

[Injury rates and severity during the construction of High Speed Train Track Torino-Novara: which are the expected risks?]. / Frequenza e gravità infortunistiche nei cantieri dell'alta velocità Torino-Novara: qual e il rischio infortunistico atteso?

BACKGROUND: Construction of the Torino-Novara High Speed Train Track (TAV) provided a unique opportunity to describe the magnitude of accidents on a major construction project for which complete data were available for 123 companies with over 10,000 employees. OBJECTIVES: To describe the rate and severity of accidents during the construction of TAV and to compare this with national indexes. The limits and critical points of the national surveillance system are discussed and solutions for responding to public occupational safety and health service needs are proposed. METHODS: 1,691 injuries with more than 3 lost work days were recorded between 2003 and 2005 by the TAV Surveillance System (Orme-TAV). Accident rate and severity indexes (Orme indexes) by year and occupation, were compared with indexes for Piedmont and Italy for the period 2002-04 provided by INAIL (National Institute for Insurance against Occupational Accidents and Diseases) for the Construction sector and the Road and Railway Construction sub-sector. A comparison with the accident rate of the same 123 firms calculated for all construction yards in Italy in 2003-04 (national indexes) was also made. RESULTS: Accident rates decreased from 152 in 2003 to 72 in 2005 per 1,000 workers, but were higher than the national indexes (the Orme indexes/national indexes ratio was 1.75 in 2003 and 1.67 in 2004). Accident severity indexes were lower than the national figures. DISCUSSION: Complete reporting, facilitated by the existence of a Surveillance System, yielded accident rates that were more reliable than those previously reported. Data suggest that the discrepancy is due to both underreporting and exposed worker assessment difficulties. The burden of on-site work-related accidents in the construction sector appears to be higher and more costly than what has been desumed from national data.

[Occupational mortality in the population employed at 1991 Census]. / La mortalità per professioni nella popolazione occupata al Censimento 1991.

BACKGROUND: Despite limitations and problems connected to occupational surveillance systems based on mortality data, mortality from specific causes continues to be a crucial indicator for evaluating the differences in health among various occupations. OBJECTIVES: To evaluate the potential of a surveillance system of occupational mortality based on census and mortality data obtained from ISTAT (Italian Central Statistics Institute). METHODS: By means of record-linkage between Census data and death records from ISTAT, occupational mortality was assessed during the twelve month period following the 1991 census, limited to subjects aged 18-64 years for whom occupational information was available. The study population consisted of deceased subjects, 19,527 of whom were men and 3,547 were women. A cross-sectional model was used to evaluate odds ratios for cause-specific mortality. The risk estimates were then compared to the results obtained in a previous analysis on Census data gathered in the 1981 census. RESULTS: Among the significantly increased risks observed both in 1981 and 1991, of particular interest are the excesses of mortality from liver cirrhosis in caretakers, janitors, and cleaning staff; and the excess of breast cancer in teachers. Mortality from cirrhosis in masons, porters, and waiters, and from violent causes in transport workers and bar and restaurant workers, was instead significantly in excess only in 1991. CONCLUSIONS: The data on mortality by occupation does not permit inferences about occupational risks, though they can be useful to highlight socio-economic differences in premature death in the employed segment of the population and to draw attention to possible trends over time.

[Risk of workplace injuries by occupation in Italy in the 1990's]. / Rischio di infortuni per professione in Italia negli anni novanta.

BACKGROUND: In Italy it is not possible to assess the incidence of workplace injuries by occupation due to the absence of denominator data. OBJECTIVES: To evaluate severe workplace injuries by occupation, age and gender, via discussion of the validity of the available methods and informative systems. METHODS: The database included injuries in the industrial and artisan sectors in Italy during the period 1995-1999, as classified by INAIL (National Institute for the Insurance against Occupational Accidents and Diseases). A proportional case-control study was used. Three types of severe injuries were analyzed: fatal (3,685), permanently disabling (88,254) and injuries resulting in temporary disability for more than 40 days (238,609). Controls were represented by minor injuries with temporary disability lasting between 8 and 13 days (512,643). The relative risks were calculated by occupation and stratified by age and sex. The control group was chosen in order to minimize distortions and represented a balance between empirical criteria based on the experience of safety technicians and the quality and limits of INAIL archives. RESULTS: Among men in some construction occupations (operators of construction equipment, crane operators and masons), and in truck drivers, farm workers, messengers, and miners there were elevated risks in all age groups and for all levels of injuries severity. The model was more problematic to apply to women because the control group was less representative of the work population at risk. CONCLUSIONS: The case-control study model produced results consistent with those in the international literature, even if the use of minor injuries as the control group gives partly distorted risk estimates. The results supply information for decision making and for allocating resources for prevention and safety.

[Severity of workplace injuries by occupation in Italy in the 1990's]. / Gravità degli infortuni in Italia negli anni novanta: indici per professione.

BACKGROUND: The indicators of severity commonly used for studying workplace injuries are somewhat limited. It is possible to use RIDIT Analysis (Relative to an Identified Distribution) as an alternative method OBJECTIVES: To order occupations in Italy by severity of workplace injuries and discuss the methodological problems and the outcomes from available administrative data. METHODS: The database included injuries defined by INAIL (National Institute for Insurance against Occupational Accidents and Diseases) in Italy in the period 1995-99 in the industrial and artisan sectors (1,647,220 events). RIDIT Analysis was applied using Bross analysis of ordinal data. A distribution of injuries in Italy for the same period on a six-level scale of severity was used as a reference. The RIDIT value for each occupation was calculated and stratified by age, sex, and occupational sector. RESULTS: Among men, the occupations in which injuries were more severe than the average in Italy were construction, transport, woodworking, and mining. Above-average injury severity among women was found in transport drivers, postwomen, messengers, and workers in performing arts, the food industry, and tourism. A positive relationship between age and severity of injury was observed in all occupations in both sexes. Average severity was higher among artisans. CONCLUSIONS: The method used allows ranking of occupations according to injury severity and should be systematically introduced into existing systems of surveillance so that data can be used to foster prevention and workplace safety.

[Risk of repeated injuries by economic activity in Italy in the 1990's]. / Infortuni ripetuti, rischio per professioni in Italia negli anni novanta.

BACKGROUND: Repetitive work injuries are a phenomenon that has not been sufficiently studied. Using data gathered by INAIL (National Institute for Insurance against Occupational Accidents and Diseases), it is possible to study the propensity of having a further injuries at the workplace after the first one. OBJECTIVES: To identify the risk of experiencing multiple injuries according to occupation, with discussion of how useful the available information systems are. METHODS: The data base includes workplace injuries, as classified by INAIL in Italy between 1994 and 2000 in the industrial and artisan sectors (2,162,702 subjects, ages 25-55). Selecting data on accidents occurring among 107,082 subjects who had experienced the first accident in 1996-99, in this cohort we assessed the occurrence of further accidents within two years in the same occupation, taking into account job mobility and factors eventually influencing underreporting (geographic area, age, severity of first accident and size of the enterprise). The risk for each occupation was computed stratifying by gender. RESULTS: There were significant differences between the first and successive accidents when examined by type, age group, severity of physical consequences and company size. Among men, the occupations showing higher risk were those already known to be at high risk for accidents: cleaning staff and refuse workers, foundry workers, masons, pilots, woodworkers, carpenters, transport workers, sailors, farmers, and miners. Among women the occupations most at risk were postwomen and messengers, cleaning staff and refuse workers, waitresses, cooks, bartenders, machine tool operators, woodworkers, and weavers in the textile industry. CONCLUSIONS: Among men, the risk of recurrent workplace accidents by occupation tends to reflect the frequency of the total accidents in each occupation. The results indicate that the study model employed is efficient and useful in providing risk profiles which allow identification of where to direct future studies, investigations, and preventive measures for each sex.

[About job classifications]. / Nota metodologica.

BACKGROUND: In the various existing information systems, the work-related variables (occupation, job position, and economic sector) are not always classified in the same manner. OBJECTIVES: To develop a classification of occupations and economic sectors that could be used for the majority of analyses of data on work-related morbidity and mortality. METHODS: The classification of occupations was created with the following criteria in mind: comparability with the currently used classification systems ISTAT (the National Institute of Statistics) 1971, 1981, 1991 and INAIL (the National Institute for Insurance Against Accidents & Diseases); a limited number of items, so as to ensure acceptable statistical power; maximum variance among groups and minimum variance within groups, in terms of the three dimensions of greatest interest for defining exhausting jobs. To this end, three groups of experts were consulted, one group of experts in the analysis of occupational differences in the occurrence of accidents and two groups of experts on occupational health. RESULTS: The three different sets of aggregates produced by the three groups of experts were combined into 56 items, referred to as the "Classification of occupations for the surveillance of differences in mortality and morbidity". CONCLUSIONS: The classification can be used in future analyses of occupational risks and injuries for the comparison of different information sources and time periods.