Health protection of health care workers from the prospective of ethics, science and good medical practice. Opinions from stakeholders in health care settings.

Fitness for work (FFW) in health care workers poses multidisciplinary challenges because of management problems scientific and ethical implications and the implementation of preventive interventions in health care settings. All the relevant stakeholders, including the General Manager, Medical Director, worker's representative, the person responsible for prevention and protection, forensic medicine expert, the person responsible for prevention and health safety at public administration level, commented on: danger to third parties; FFW formulation; human resource management; stress; professional independence; role of the person responsible for prevention and protection and of the person responsible for prevention at public administration level; professional responsibilities. Opinions are reported regarding the main problems related to the role of the Occupational Physician in FFW formulation, such as the difficult balance between autonomy and independence, limited turnover and aging of workforce, need of confidentiality and respect for professional status of the HCW prevalence of susceptibility conditions, rights and duties of stakeholders. The most significant result was the request by the Lombardy Region for more quality in risk assessment and health surveillance; to maintain uniform conduct over all the local health authorities, to allow the board in charge of examining appeals against FFW to fully cooperate with the occupational physician; due attention to the person/worker; the opportunity to convene referral boards for complex FFW management; the challenge of stress management and the need for an observatory for psychological discomforts; the importance of the ICOH Code of Ethics and avoidance of conflicts of interests; the need for individual risk assessment and risk management; the concept of sharing responsibilities and of a real multidisciplinary approach.

[Ordinary epidemiology: pleural mesothelioma and asbestos]. / Storie di ordinaria epidemiologia: mesotelioma pleurico ed asbesto.

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.

Medical monitoring of dioxin clean-up workers.

The effectiveness of the safety measures established to protect clean-up workers from 2,3,7,8-tetrachlorodibenzo-para-dioxin (TCDD) exposure during clean-up operations of the most highly TCDD-contaminated area following the Seveso accident was evaluated. Clean-up workers (N = 36) and referent subjects (N = 36) underwent a 2-yr prospective controlled study aimed at detecting whether specific clinical and biochemical outcomes differed between the two groups. No cases of overt TCDD-related clinical disease occurred (i.e., chloracne, liver disease, peripheral neuropathy, porphyria cutanea tarda), and no clear-cut differences in biochemical outcomes between clean-up and reference workers were detected. The safety measures that were taken together with worker's compliance during clean-up operations were effective in preventing acute health effects. The safety, industrial hygiene, and health monitoring programs which were established following the Seveso accident should be applied as a minimum in similar situations.

Mortality and coronary events in two Italian MONICA areas: area Latina and area Brianza.

In Italy three areas have been enrolled in the MONICA Project, two being located in Northern Italy (Area Brianza and Area Friuli) and one in Central Italy (Area Latina). This report concerns the comparison of the first year mortality and registration data of two areas, Area Latina (1983) and Area Brianza (1985), for men and women aged 25-64. In Area Latina, the age-standardized mortality rates for all causes, for all coronary heart disease, and for stroke are respectively 483, 83 and 42 per 100,000 for males, and 252, 14 and 32 per 100,000 for females. In Area Brianza, the age-standardized mortality rates for all causes, for all coronary heart disease, and for stroke are respectively 541, 94 and 38 per 100,000 for males, and 249, 19 and 24 per 100,000 for females. For males the attack rate for coronary events is similar in Area Latina and Area Brianza but the distribution of events in the several diagnostic categories is different. For females the coronary attack rate is higher in Area Latina than in Area Brianza. The implications of these data are discussed mainly from the methodological point of view.

Potential 2,3,7,8-tetrachlorodibenzo-p-dioxin exposure of Seveso decontamination workers: a controlled prospective study.

In 1976, an explosion at the Industrie Chimiche-Meda-Società Azionaria (ICMESA) plant in Meda, near the Italian town of Seveso, released a cloud of aerosol containing 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), which contaminated the surrounding area. Clean-up of the highly polluted area of Seveso started on May 1980: in order to avoid exposure to significant levels of TCDD, safety measures are being used, but a potential exposure cannot be ruled out. A prospective study was set up at the beginning of the clean-up procedures, and laboratory tests are being used to evaluate trends among the decontamination workers. A reference group who met eligibility criteria at the preemployment examination was selected from employees of the same firm employing the decontamination was selected from employees of the same firm employing the decontamination workers. Medical examinations and laboratory tests have been performed on both the exposed and nonexposed groups at the same facilities. Analysis of the first follow-up period did not show any remarkable changes in a battery of laboratory tests of the exposed and nonexposed groups.