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This is a summary of the results of a research work, born from a collaboration between multiple Italian bodies and published by the Italian Workers' Compensation Authority (Inail) in March 2024: Second report on maritime workers. Activities and risk factors of sea workers.To disseminate the contents, the work offers a global overview of safety and health in the sector: with an analysis of accidents in the sector (which also involves some remarks on the event reporting form), workers' risk perception is examined and occupational diseases monitored through the MalProf system, managed by the Inail Research Sector and the local health authorities. Finally, an in-depth study is dedicated to exposure to asbestos on ships.

Copyright of Giornale Italiano di Medicina del Lavoro ed Ergonomia is the property of Giornale Italiano di Medicina del Lavoro ed Ergonomia Editorial Board and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Giornale Italiano di Medicina del Lavoro ed Ergonomia is the property of Giornale Italiano di Medicina del Lavoro ed Ergonomia Editorial Board and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Giornale Italiano di Medicina del Lavoro ed Ergonomia is the property of Giornale Italiano di Medicina del Lavoro ed Ergonomia Editorial Board and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of La Medicina del Lavoro is the property of Mattioli 1885 SpA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Sino-nasal cancer (SNC) are rare tumours with an elevated occupational etiological fraction, due both to well-established risk factors (wood and leather) and to more rare carcinogens. We evaluated the assessment for workers' compensation performed by the Italian Authority (INAL) in a case-series of occupational SNC (N = 45). We observed an elevated proportion of cases that were recognised as occupational, overall (36 on 39) and for any histotype. INAIL tended to recognize as professional not only patients with exposure to wood and leather but also cases with a documented exposure to formaldehyde, metal, polycyclic hydrocarbons. Significant differences across Italian macro-regions appeared, when the amount of worker compensation was investigated.

Even if NHIL gives already right to economic compensation, our Insurance aimed to real functional compensation, to reduce handicap in everyday life. Together with Professor Giordano, Audioprosthesists' Association and Manufacturers' representatives, INAIL Medical Superintendence started in 2003 a study on this problem, involving some of his forensic physician and ENT staff; in 2007-2009 INAIL issued directives innovating and planning the rules in prosthesis provision, not only acoustical ones. In 2010 started an experimental protocol to rule hearing aid provision in all INAIL centers, throughout Italy. Authors present first results of this protocol in Lombardy, related to previous and national ones.

The occupational allergens are estimated to determine 1 out 10 cases of asthma in adult workers. In Italy very low cases are compensated by the Italian National Insurance Against Professional Disease (INAIL), that legally recognized 90 cases in 1996 and only 9 cases in 2000. A real negative trend in making diagnosis and compensating workers for occupational asthma is due to three main causes. (1) Delayed diagnosis. Lack of protocols or lack of accuracy in applying them. Scarce collaboration of the general practitioners. (2) Unsatisfactory bill on compensation that misunderstands moderate asthma under drug control and asthma with scarce symptoms and occasional therapy. (3) Lack of prevention in industrial medicine. Occupational doctors play a role more relevant in legal activities than in clinical ones.

European and Italian data show a marked under ascertainment of occupational cancers: only a small proportion is recognized, although for the majority of them the etiological fraction attributable to the workplace is high. Since more than 20 years Patronato INCA is active in order to reduce this gap. Its commitment to spread scientific knowledge has paralleled the action intended to make social security rules more favourable to workers, as well as to improve hygiene and safety in the workplace. Particular attention has been given to updating both the Italian list of occupational diseases for which notification is compulsory (which includes all Group I carcinogens according to IARC) and the Italian tables of occupational diseases. The latter are of particular relevance to the Patronato because, within the Italian norms, causality is approached in different terms according to whether a disease is or is not included in the tables. Together with changing the tables, a theoretical elaboration regarding causality, as required by multifactorial diseases such as occupational cancer, has been carried out. Such a constant commitment to bring to the surface occupational diseases is based on the belief that the right to compensation of workers who turned ill because of the work is important, and even more on the belief that identification of occupational diseases is most important for primary prevention.

The aim of this study is to evaluate the outcome of 302 occupational diseases in building workers detected by UOOML Ospedali Riuniti of Bergamo and notified to INAIL from 2000 to 2005. The 41.3% of cases were accepted as work-related. Among remaining cases (58.7%), INAIL rejected 40.9% for lack or absence of documentation. 59.1% for no adhesion to legal medicine criteria. By analysis of occupational diseases detected in the last 5 years, we found an increase of muscle-skeletal disorders, for which, now, diagnostic procedure and insurance evaluation are difficult. This work shows a wide gap between reported occupational diseases of buildings workers and compensation given by INAIL. These results underlines the need of comparison among involved institutions in order to standardize statistical and diagnostic instruments.

Objective: To his study describes the geographical distribution of pleural cancer deaths and asbestosis cases from 1980 to 2000 in Sardinia Region (Italy). For both conditions regionwide registration systems have been available for a relatively long time and allow the identification of statistically significant clusters., Design: For each town we have estimated Standardized Mortality Ratios (SMRs) for pleural cancer and Standardized Incidence Ratios (SIRs) for asbestosis. Expected cases were estimated from age- and gender specific rates in Sardinia. SatScan software was used to identify clusters and to verify their statistical significance., Setting: Sardinia Region (Italy)., Main Outcome Measures: Standardized mortality and incidence rates respectively for pleural cancers and asbestosis cases and territorial clusters., Results: The most important cluster of pleural cancer was identified in the area defined by Carloforte, Calasetta, Portoscuso and Sant'Antioco municipalities (Southwestern Sardinia) with 15 observed cases (p value= 0.003). Other clusters were detected in the municipality of La Maddalena (11 observed cases against 1.91, expected p value= 0.008) and in Southern Sardinia between Cagliari and Sarroch (p value= 0.018). The town of Marrubiu is clearly the most important cluster (p value= 0. 001) with 6 asbestosis cases in the period., Conclusions: These results indicate the urgency of the epidemiological surveillance of asbestos related diseases in Sardinia. The active search for incident cases of malignant mesothelioma in the whole Region and the analysis of modalities of asbestos exposure (according to national guidelines) is an indispensable tool for the primary prevention of occupational, environmental and domestic exposures from unknown asbestos sources of contamination.

The evaluation of the damage to biological and relational capacities of the subject is the novel approach of the Italian Insurance Regulation Decree N(o) 38/2000 for compensating occupational asthma (OA). In this study we aimed to apply retrospectively the novel rating system to mild OA. From a data base of 201 diagnosis of OA collected in the 1987-97 decade 85 eligible consecutive cases of mild asthma according to the criteria of NIH/WHO guidelines on asthma were studied. Records on compensation were documented for 41 subjects. The average difference between novel scales and the actual rating individually assessed by Italian National Agency for compensation through criteria used at that time was 45.6 +/- 20%. The average difference between novel scales and rating calculated with guidelines considering the measurement of non-specific bronchial hyperreactivity developed by international experts and American Thoracic Society, endorsed by American Medical Association, was 41.5 +/- 12%. Within the actual rating individually assessed with previous Italian Insurance criteria no significant relationship (r=-0.20, p=0.2) was shown with bronchial responsiveness to methacoline expressed as provocative dose causing a 20% fall in FEV1 (PD20FEV1 microg of mch). A significant (p<0.05) relationship was observed with age at the time of OA diagnosis (r=0.37, p=0.017) and with duration of exposure (r=0.34, p=0.034). This study suggests that scales of the Insurance Regulation Decree N(o) 38/2000 grading mild OA underevaluate biological damage/impairment with reference both to previous practice in Italy and to international criteria guidelines. Among the parameters of evaluation methacoline challenge should be considered an adequate tool in measuring biological damage in OA for medicolegal purpose.

The present study compares the data of pleural mesothelioma (PM) patients resident in the province of Genoa (Italy) who, in the period 1994-1996, applied to the Italian National Insurance Institute for Work Accident (INAIL), for workers' compensation for asbestos-related diseases due to occupational exposure, with the dataset of PM patients collected by the Mesothelioma Registry of Liguria (REM) in the same period and in the same area. As PM is a malignant tumor of a prevalently occupational origin, it is recognized and acknowledged as such by INAIL when clinical and etiological characteristics are matched. Objectives of this study were to describe observed PM cases, to evaluate completeness of collected data and differences between those who requested compensation and those who did not. The REM describes the incidence of PM among Ligurian residents, proposing patients with a specific questionnaire to assess occupational, environmental and indoor asbestos exposures. The REM collected 199 new cases of PM among the residents of both the city of Genoa (1994-96) and the province of Genoa (1995-96). In the same period, INAIL received 48 (24%) applications for compensation. Among these, 43 subjects were included in a subgroup of 98 patients registered in the REM as cases with definite diagnosis and ascertained asbestos exposure; 32 were awarded compensation, while 11 are under evaluation. The data collected by REM do not show proven asbestos exposure and/or PM diagnosis for five other subjects (two compensated and three under judgment). This study reveals that: a) only a 24% of the patients with a diagnosis of PM and asbestos exposure apply for compensation; b) an exchange of information among institutions involved in primary prevention, in the evaluation of occupational exposures to carcinogens and in insurance compensation is useful.

A working group for the surveillance of mesothelioma was established in the Romagna Region of Italy. For the present report of the early data on compensation, 94 cases notified to the Romagna Cancer Registry between 1986 and 1994 (mean age, 66.7 years; male: female ratio, 1.8; frequency of pleural location, 76%; frequency of cyto-histologic confirmation, 79%) were considered. Information on asbestos exposure, occupational history, and compensation status was obtained from the patients or their relatives, the general practitioners, the local occupational health services, the National Institute of Social Insurance, the National Board for Insurance against Industrial Accidents (INAIL), and the Trade Unions. Asbestos exposure was associated with 42/94 cases (45%). Of these, 11 (26%) had been reported to INAIL. All such cases had cyto-histological confirmation. The greater frequency of reporting was found among cases known to the occupational health service (7/7) as well as those with definite, documented asbestos exposure (9/13). Only two cases had been reported by hospital physicians. Seven cases were compensated. In addition to cyto-histological confirmation, also the male sex, patient's age under the mean of 66, pleural location, and documented asbestos exposure were found to be prerequisites for compensation. Not only in these subgroups but also among cases known to the occupational health service as well as those diagnosed in 1990-94, most cases reported were compensated. These early data suggest that a more accurate diagnostic process as associated with prompt notification to the occupational health service for thorough assessment of asbestos exposure may improve the compensation process.

This paper is aimed at describing and characterizing occupational injuries which do not receive compensation (minor injuries), and at evaluating the differences between compensated and non compensated injuries with reference to type and site of the lesion. Data were collected in a car manufacturing plant and covered the period 1984-1991. Information regarding all kinds of occupational accidents were extracted, following a standardized procedure, from different paper forms compiled by health personnel within the factory (physicians and nurses). Due to the large amount of information registered, a sampling scheme was adopted which considered the same three months every two years, previously selected to cover the entire observation period (1984-85, 1987-88, 1990-91). In addition, to evaluate che adequacy of the sampling procedures for the compensated injuries only, the resulting sampled distributions of the relevant variables were compared with the totality of the injuries. 7,299 events occurred in the sampled months, which corresponded to 652.59 occupational accidents per million hours worked: 8.97% of them caused absence from work lasting more than three days (compensated cases), 3.59% caused a less than three workday loss (LTTWL cases), and the great majority (87.44%) did not cause any absence from work (first aid cases). The frequency index of the total number of accidents did not change over time, but the three categories of injuries did change: for example, first aid cases had their maximum frequency during the middle period (with a peak of 93.21% in March 1987) and their minimum during the last period (73.28% in June 1991). An opposite pattern occurred for accidents which caused absence from work. Type and site of the lesions differed among the three categories of occupational accidents. For example, cuts/lacerations were observed in 48% of first aid cases, 30% of compensated cases, and 15% of LTTWL cases. On the contrary, injuries due to extraneous bodies and contusions which were the most frequent category for LTTWL cases with, respectively, 28% and 25% of the cases, represented only 10% and 13% of first aid cases. With respect to the site of the lesion, hands had the highest frequency index both for first aid (56%) and compensated (39%) cases, and eyes were most affected (36%) among LTTWL cases. With respect to compensated injuries, a notable correspondence of the distributions of the relevant variables between the sample and the whole population was evident, also when considering separate individual subperiods.(ABSTRACT TRUNCATED AT 400 WORDS)

Taste disorders can a rise from lesions of peripheral receptors, taste control pathways or cortical area involvement. Among peripheral lesions, trauma of the tongue and oropharynx are the most common. Iatrogenic lesions of facial and glossopharingeal nerves are very important in Forensic Medicine, while there are different opinions about taste alterations due to head injuries; hypogeusia associated to smell disorders are found in 0.4-0.5% of patient after head trauma with good prognosis (90% healing) while qualitative disorders are more common (30%). The Authors describe clinical methodologies for taste evaluation and their application in Forensic Medicine. Forensic estimation of taste disorders con be classified by two main groups: study of cause relation between the occurrence and damage and quantitative valuation of the damage in three different juridical ambits: Penal, Civil, Insurance and foresight. In Penal Right taste damages could be classified among personal lesion crimes and can be classified as serious (permanent injury of taste) ore very serious (complete lost of taste function). Italian Legislation equipare the 5 sense organs. In Civil Right evaluation the so-called "biologic damage" and working ability are considered; this means very different evaluations. In the most recent baremes, generic damage is estimated by different Authors from 0 to 10% while with regard to specific working capacity, common evaluation criteria does not exist. In Insurance taste disorders evaluation is based only on working ability and not on biologic damage. In the previdenzial ambit, taste disorders are not even included in the most recent tables of permanent invalidity estimation. The Authors propose new and more efficacious valutation criteria for taste disorders in all ambits, hoping for more interest in the Forensic aspects of taste, a too often forgotten sensory function.

The authors have examined 1478 burned or scalded patients of the Plastic Surgery Institute of the University of Parma from 1967 to 1976; they have considered particularly 92 cases who showed more than 20% of burned skin. For these patients they have considered many data of medico-legal interest in order to facilitate the estimate of the personal damage in penal and civil law.