Doctor Antonia Maria Guglielmin takes stock of some data relating to accidents and occupational diseases, on the occasion of the World Day of Safety and Health at Work and of Asbestos Victims which occurs on 28 April each year. Guglielmin is director of the operational unit for prevention and safety in the workplace (Psal) of the local health authority of Ferrara.
The Emilia Romagna Region has established the network for assistance to patients with malignant pleural mesothelioma, a disease related to exposure to asbestos, through the establishment of a dedicated diagnostic therapeutic care path.
“Accident at work” is defined as a harmful event from a violent cause that occurs instantly at work. The “professional disease” is established over time, following prolonged exposure to a harmful factor of a physical, chemical or organizational nature (not infectious, because infectious diseases of professional origin are included among accidents) and which can occur at distance of time from the beginning of the exposure, even when it has ceased. This is particularly evident in asbestos-related tumor pathologies, such as malignant pleural mesothelioma (Mm), resulting from exposures that date back up to 40 years and which affect people not only of advanced age.
Unfortunately in our country until the ban, which occurred in April 1994 following law 257/92, exposure was significant and this caused, starting from the end of the 80s of the last century, a progressive increase in deaths caused by the disease, which still has a low life expectancy from the moment of diagnosis. And the peak – says the Bepi Ferro Asbestos Victims Foundation – is expected in the three-year period 2022-2024. According to Inail data, every year asbestos already causes almost 4,500 deaths, plus another 1,500 deaths, especially wives who washed work overalls soiled with fibres.
“The processing carried out by the Regional Observatory on accidents at work (Oreil) of the Emilia Romagna Region – underlines Dr. Guglielmin – starting from the monthly Inail open data, extracted on 30 January 2024, highlights a reduction in the complaints presented in Ferrara in for the year 2023 by 23% (-7.6% regional average data) and -11.8% compared to the previous three-year period (2020-2022): -1.7% regional average data. While awaiting the publication by Inail of the data relating to accidents reported and recognized in 2023 and a confirmation of the decreasing trend in our territory and in the average regional data, it should unfortunately be remembered that in 2023 they occurred in the Province of Ferrara three fatal accidents. Even in these cases, as in many other tragedies resulting in death as a result of the accident, the manner of occurrence (fall from a height; crushing under a tractor due to overturning) appears to be avoidable and predictable”. Despite this, even last year more than 1000 fatal accidents occurred in our country, and the trend – albeit slightly decreasing after 2020 – seems to remain above 1000 cases per year”.
“In 2022 – continues the professional – 185 occupational diseases were reported and recognized in Ferrara, 68% of which affected the osteo-muscular system and connective tissue (alterations of the intervertebral discs, tendinitis, carpal tunnel syndrome, etc.) resulting from biomechanical overload which currently represents the most reported and recognized pathology throughout the national territory (data extracted from Sirp – Emilia Romagna Region, Regional Information System for prevention in the workplace). The Inail open data processing of Ciip (Italian inter-associative council for prevention) “Interactive database on accidents at work and occupational diseases” fed and constantly updated with public data distributed by Inail, highlight an increase of approximately 50% in the number of occupational diseases reported in Ferrara in the year 2023, with a prevalence of diseases affecting the musculoskeletal system”.
“The increase in reported mesotheliomas appears to be important – continues Guglielmin – which from these calculations would appear to be equal to 19 cases, compared to the eight cases of the previous year. In recent years there has been an increase in the incidence of malignant mesothelioma in Italy and in many other industrialized countries due to the long latency time between the onset of exposure and the onset of the disease, the lengthening of life and the improvement of diagnostic techniques . Starting from 1996 in the Emilia-Romagna Region, the production sectors most involved in the onset of MM were: building construction (subjects distributed uniformly throughout the Region); construction/repair of railway rolling stock (cases mostly resident in the provinces of Bologna and Reggio Emilia); metalworking industry, sugar factories/other food industries (132 of the 168 cases, residents in the provinces of Bo, Fe, Ra, Pr, Fc), production of reinforced concrete products (107 of the 137 cases resident in the province of RE). ReNaM data (National Mesothelioma Registry) indicates, however, that among the most involved sectors, in addition to construction (16.2%) and the metalworking industry (8.8%), the textile industry (6.3) and shipbuilding (6.0%)”.
The operational unit for prevention and safety in the workplace (Uoc Psal) of the Local Health Authority of Ferrara (related to the public health department directed by Dr. Clelia de Sisti) acts as a reference for companies, the union, workers and workers, workers’ representatives for safety and, more generally, for all stakeholders to provide information and assistance on risk factors, on the prevention measures that can be adopted, on legislative and regulatory provisions, giving priority to the topics of the Targeted Prevention Plans (Pmp) of the current “Regional Prevention Plan”.
At the occupational medicine clinic of the Operational Unit, health assessments are carried out upon request by workers, general practitioners and specialist doctors in order to diagnose or exclude the presence of an illness attributable to the work activity carried out and to direct to the most appropriate insurance/social security path. Another purpose is the expression of a judgment of suitability for the specific job, upon appeal against the judgment of suitability expressed by the Competent Doctor presented by employers or workers. Health care and information assistance is also ensured for former residents of the area exposed to asbestos, according to national and regional guidelines.
Various professional pathologies can derive from causes of work-related and non-work-related origin: it is increasingly important to combine the prevention measures implemented by companies with the promotion of the adoption of healthy lifestyles, such as physical activity, the abolition of smoking and alcohol, a healthy diet. For this reason, the Uuo Psal of the Local Health Authority of Ferrara promotes the regional project “Workplaces that promote health” among local companies through meetings, encouraging the training of competent doctors in the method of the motivational approach to change and making available of information materials. The institutional collaborations with Itl, Inail, Inps, Unife, trade union and business associations, bilateral bodies are important, in order to plan and coordinate actions that encourage quality work in the area.
The operational unit also carries out registration and analysis activities of occupational tumors (in particular mesotheliomas, nose-sinus tumors) and of all occupational diseases for the purposes of national pathology registers. On the basis of national and regional indications and at the request of the Judicial Authority, the technicians and doctors of the Operational Unit carry out control activities on local companies, in particular in the construction and agricultural sectors (sectors characterized by the highest incidence of accidents), to verify the adoption of measures aimed at preventing accidents and occupational diseases.
Despite the cessation of the use of asbestos, there is still a risk of occupational exposure in the removal of materials containing asbestos. A careful control activity is carried out on all work plans presented by companies authorized for the removal of asbestos and through inspections on construction sites in order to verify that the measures envisaged for the prevention of exposure to airborne asbestos fibers are actually adopted . For the purposes of justice, but also insurance, social security and prevention, the technicians and doctors of the service carry out investigations into accidents and occupational diseases with the direction and delegation of the Judicial Authority.
An important role in the diagnosis of malignant pleural mesothelioma is played by the pathological anatomy operational unit (director Giovanni Lanza; pleuropulmonary pathology contact doctor Deborah Gabriele) which has the task of carrying out the histological diagnosis after microscopic evaluation of the biopsy material obtained mainly via thoracoscopic. The diagnosis of mesothelioma is complex and often requires the use of numerous immunohistochemical analyzes to differentiate mesothelioma from other primary or metastatic neoplasms and from reactive mesothelial proliferative processes. The pathologist also has the task of evaluating histological and biomolecular parameters of prognostic significance and predictive of response to therapies.
