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Applicare appieno i principi del gender main-streaming, in accordo alle indicazioni della Comunità Europea, alla tutela della salute e sicurezza nei luoghi di lavoro significa in pratica rivedere tutti gli aspetti della prevenzione sotto l'ottica di genere, vale a dire tenendo in considerazione le differenze di sesso e di genere tra lavoratori e lavoratrici non solo come determinanti della salute, ma ancor più nel caso specifico come determinanti del rischio. In questo passaggio evolutivo il ruolo del medico competente è particolarmente importante. In questo lavoro vengono proposti alcuni strumenti operativi che possono concretamente implementare l'ottica di genere nei diversi ambiti della prevenzione, nei quali il medico competente ha un ruolo di primo piano, se non esclusivo, quali la valutazione dei rischi, la formazione e la sorveglianza sanitaria.

E' stata condotta una revisione della letteratura per evidenziare quali tra le patologie lavoro-correlate esprimano differenze di sesso/genere negli outcome di salute e focalizzare i principali limiti degli studi in tale ambito. La ricerca, effettuata su PubMed mediante stringa specifica, ha identificato 4828 articoli (periodo 1997-2017) di cui 381 eleggibili ai fini della revisione (4-22% a seconda della patologia). Tra questi, il 68% hanno evidenziato differenze di sesso/genere negli outcome di salute che nella maggior parte dei casi sembrano dovute ad una diversa esposizione e/o ad una segregazione lavorativa, piuttosto che a differenze biologiche. Pochi studi tuttavia pongono tale valutazione tra gli obiettivi della ricerca e i risultati non vengono quasi mai discussi e raramente vengono formulate ipotesi sulle eventuali differenze osservate. Appare necessario utilizzare metodologie di ricerca e disegni degli studi in grado di rilevare e spiegare la complessità descritta e utili a definire adeguate strategie preventive.

A literature review was performed to highlight which work-related diseases express sex/gender differences in health outcomes and focus the main limits of studies in this field. The research, carried out on PubMed by specific search string, identified 4828 articles (1997-2017period) of which 381 are eligible for review (4-22%, depending on the disease). Among them, 68% reported sexlgender differences in health outcomes, which in most cases appear to be due to different exposure and/or work segregation rather than to biological differences. However, few studies place this assessment among the research goals and results are almost never discussed and hypothesis are seldom formulated about any observed differences. It seems necessary to use research methodologies and study design Thai can detect and explain the described complexity and useful in defining appropriate preventive strategies.

Even though a relationship between farmer work and the development of brain tumors was suggest by the scientific literature, a small number of italian studies investigate on the impact of this job on the cancer morbidity of farmer population. The informations about this case-control study were obtained from patients recruited in the Neurosurgical Department of the University-Hospital of Pisa, Italy, from 1990 to 2000. One hundred and seventy-four, newly diagnosed cases of brain tumors (glioma and meningiomas, histologically confirmed), were recruited, such as 522 controls (with other non tumoral neurologic diseases: trauma, etc), by matching cases and controls (1:3), for age (± 5 years) and gender. Cases and controls were interviewed in the Neurosurgical Department, University-Hospital of Pisa, Italy, and the occupational histories of cases and controls were compared. Cases and controls have showed a statistically significant difference, based on their occupation (agricultural vs. non-agricultural). We observed a significant association among brain tumors and rural activity in evaluated patients (P=0.008). Further studies regarding this population group are needed, to determine the causes for the increased risk of this cancer, particularly in regions where there is an intense agricultural activity and where pesticides are used. Furthermore, a subsequent reevaluation in other patients collected in more recent years will be needed to evaluate the trend of this association.

Genes involved in the carcinogenetic mechanisms underlying malignant pleural mesothelioma (MPM) are still poorly characterized. So far, mesothelin (MSLN) has aroused the most interest. It encodes for a membrane glycoprotein, frequently over-expressed in various malignancies such as MPM, and ovarian and pancreatic cancers. It has been proposed as a diagnostic and immunotherapeutic target with promising results. However, an alternative therapeutic approach seems to rise, whereby synthetic molecules, such as antisense oligonucleotides, could be used to inhibit MSLN activity. To date, such a gene-level inhibition has been attempted in two studies only, both on pancreatic and ovarian carcinoma cell lines, with the use of silencing RNA approaches. With regard to MPM, only one cell line (H2373) has been employed to study the effects of MSLN depletion. Indeed, the knowledge on the role of MSLN in MPM needs expanding. Accordingly, we investigated the expression of MSLN in a panel of three MPM cell lines, i.e., NCI-H28, Mero-14, and IstMes2; one non-MPM cell line was used as reference (Met5A). MSLN knock-down experiments on MSLN-overexpressing cells were also performed through silencing RNA (siRNA) to verify whether previous findings could be generalized to a different set of cell cultures. In agreement with previous studies, transient MSLN-silencing caused decreased proliferation rate and reduced invasive capacity and sphere formation in MSLN-overexpressing Mero-14 cells. Moreover, MSLN-siRNA combined with cisplatin, triggered a marked increase in apoptosis and a decrease in proliferation as compared to cells treated with each agent alone, thereby suggesting a sensitizing effect of siRNA towards cisplatin. In summary, our findings confirm that MSLN should be considered a key molecular target for novel gene-based targeted therapies of cancer.