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The activity of the occupational physician (OP) in the enterprise has as its purpose the protection of the health of workers and consists of two main areas: health surveillance and risk assessment. Every day thle OP have to take into account both the results of clinical diagnostic investigation and the outcomes of the estimation of occupational exposure to risk factors by making a right mix between what is proven by scientific evidence and professional experience. He also knows that its effectiveness is closely linked to the contribution of other figures ofprevention in the company. In the scientific literature, the authors are unanimous in considering the effective actions to reduce exposure to risk, risk behaviors, injuries, occupational illnesses, disability, absenteeism. The use of indicators of effectiveness and / or appropriateness for the enhancement of its contribution, especially as a consultant in the field ofprevention and health protection in the compmany and then with anmt active role in corporate governance of prevention, are a must and no longer postponed, as well as the development of tools that document in formal terms, its contributioni (annual health report, the definition of risk profiles). I, this paper, by analyzing the results of specific experiences in the surveillance of construction workers, drivers and bakers, the authors want to emmphasize the contribution of the OP.

Background and Objectives: In this work the authors analyse the results of the clinical evaluation of patients affected by suspected work related musculo-skeletal disorders (WMSDs), observed throughout 2008-2009 in the specific ambulatory of Occupational Medicine Division of Ospedali Riuaniti di Bergamo. The aim is to illustrate the epidemiological relevance of upper limb (UL) WMSDs., Methods: We observed 430 patients (mean age 46,9 years, DS 9,3; mean working seniority 29 years, DS 10,4), investigating 600 disorders in diferent musculoskeletal segments. Most of the patients (66%) got to the division for a clinical consultation requested by general practitioners, 29,8% by occupational physicians, 4,2% by national insurance for occupational injuries and diseases (INAIL)., Results: Most of the patients (38,4%) were employed in construction industry. Among the 600 disorders investigated, 34,5% was at lumbar spine, 74,5% was at upper limb. The clinical diagnosis was already clear at the first consultation for 81,6% of subjects with low back pain and for 56,5% of patients with upper limb disorders; for the others was necessary to prescribe some instrumental exams or specialistic (neurologic, physiatric, orthopaedic) medical examination. We concluded for a diagnosis of WMSDs in 48,3% of the 600 cases: the percentage is 50,2% if we consider only disorders at lumbar spine and 52,5% among disorders at upper limb. The most frequent reason of refusing occupational aetiology, in the cases of low back pain, was the concomitant presence of other diseases at the segment; on the contrary, for the cases of upper limb disorders, was the lack of correlation between type of disease and professional exposure., Discussion: All physicians demonstrate a high attention about upper limb disorders, topical subject of great epidemiological interest. General practitioners and occupational physicians have to take more advantage of diagnostic support and clinical evaluations offered by Occupational Medicine Divisions an Universities about WMSDs. In consideration of the dificulties to diagnose upper limb disorders and proving correlation with professional exposure is useful to promote specific courses for general practitioners and occupational physicians.

On the basis of the data drawn by national and international literature and the introduction of legislation concerning "alcohol and alcohol-related problems" authors studied alcohol consumption in a group of 512 building workers during the periodic health surveillance examination (years 2011-2012). Another group of 209 construction workers were examined for alcohol concentration in expired air and during work on building sites. In the first group, 62.1% of workers refers to drink alcoholic beverages; we found GGT and CTD alterations in about 1/3 of workers who reported high alcohol consumption. Alcohol tests in building sites demonstrated that alcohol consumption during pauses in work is still common.

The aim of this study is to show the results obtained from measuring energy expenditure (EE) during work, through portable devices, in a group of male construction workers. After defining cardio-respiratory parameters in laboratory, authors applied to all subjects an heart rate monitor for measuring the heart rate (HR) and, at the same time, a calorimeter for measuring energy expenditure (EE). To analyse data obtained, authors calculate the Relative Aerobic Strain (RAS), both for the measurements of EE and for HR detected. Results confirm that in many of the typical activities of construction industry, in particular in those characterised by an higher component of manual engagement compared to foreman, workloads are exceeding limits of the probable threshold fatigue (33% of RAS), both for energy expenditure than for HR measured.

The aim of our research is to study respiratory and dermatologic diseases (irritative and allergic) in a cohort of workers exposed to vegetal esters based metal cutting fluids of the latest generation. A cohort of 81 workers (mean age 34.5 years, seniority 17.4 years), with mean exposure to vegetal esters based metal cutting fluids of 2.8 years, has been subjected to clinical evaluations. The investigation did not reveal any disease or disorder of the respiratory system, any folluculitis or any allergic contact dermatitis caused by sensitization to vegetal esters based metal cutting fluids. On the contrary we documented 5 cases of irritant contact dermatitis, even if favored by an improper use of protection devices. According to early results, the introduction of vegetal esters based metal cutting fluids seems to reduce the risk to the worker's health. A longitudinal surveillance is still needed to confirm that even in the medium and long-term sensitizations will not occur.

Unlabelled: The risk factors for the development of cutaneous neoplasms are well-known (skin type, ultraviolet rays, familiar occurrence, etc.) and the exposure to ultraviolet light is probably the most important one. Construction workers, due to the characteristics of the work performed (outdoor work), are exposed to UV rays for most of their workday, often in association with the exposure to chemicals (PAHs, solvents) with a role in promoting skin carcinogenesis. The construction industry is therefore a true "test" for the prevention of skin cancer., Materials and Methods: description of skin cancer in the construction workers subject to medical surveillance at the "Territorial Joint Committee of Bergamo" (8 basal cell cancers, 1 squamous cell carcinomas and 4 melanomas)., Purpose: review of the medical literature data, evaluation of the exposure to multiple risk factors, prevention proposals in a professional field where the "culture of tanning" is still widespread.

From 2008 to 2011, according to an experimental protocol, 490 truck drivers (mean age 42.5, seniority 26.1 years) were subjected to visits and health check-up. The prevalence of work-related diseases was 4.7%: 15 cases of hearing loss and 8 of lumbosacral disease. In the 9.2% it was necessary to give some restrictions to the truck drivers' fitness to work (because of musculoskeletal disease, heart disease, diabetes etc), 0.8% was judged permanently unfit. We have found also 1% with positive drug test. Health check-up has allowed the diagnosis of many unknown or not controlled disease, first of all metabolic and cardiovascular diseases, which could have been a role in increasing accident or in reducing future workers' fitness to work. In the implementation of health surveillance programs, the occupational physicians must not forget that to ensure adequate safety standards is necessary to evaluate not only drugs assumption, but also the psychological and physical integrity of truck drivers, planning appropriate tests and medical examinations.

Construction is strategic in Italy and worldwide, on top for employees number and turnover but also for occupational accidents and diseases. The building site is at high risk and it is difficult to maintain good levels of safety: in recent years they have had an improvement, but the economic crisis did not favour it. The knowledge in the field of prevention is not as widespread as it would be necessary and as requested (OSHA - UE). The Occupational Physician, engaged in risk assessment and management of medical services, must protect the health of workers at high risk for health, aging and performing tiring work, without adequate vocational training and culture, often in precarious conditions of health and lifestyle at risk. There are good experiences around the world and in Italy. Implementation of research in technology and ergonomics, materials and the tools, reduction of workload are needed, improvement of building site organization, of knowledge about health effects, the rehabilitation and reintegration to work. The procedures and processes should improve productivity and at the same time be safer and less dangerous and the lows should be more fitting with the specific characteristics of the construction industry.

The authors analyse 493 hospital cases in 356 workers from the construction industry, came to observation for musculoskeletal disorders (average age 48, 2 years, SD 9; work seniority 32, 2 years, SD 9, 7; work seniority in construction industry 27, 3 years, SD 12, 4). The evaluation was required in 305 subjects (85.7% of the sample) to investigate one or more suspected WMDS; in 51 subjects (14.3% of the sample) to express an opinion on fitness to work or residual work capacity. Investigations led to diagnosis of 479 musculoskeletal disorders; the districts most affected are spine and upper limb. 64.7% of the musculoskeletal disorders was evaluated to be work-related, the percentage rises to 68% when considering only cases sent for evaluation of suspected WMDS. The most frequent reasons to exclude relation between the musculoskeletal disorders and work were an high age at diagnosis, presence of comorbidity or outcome of trauma, a disease mismatch exposure.

The construction industry is characterized by a high number of fatal and nonfatal injuries and even higher prevalence of work-related diseases. The aim of this work is to analyze the results of a research project that has among its objectives the study of the prevalence of work-related diseases and the fitness to work in construction industry. In the period 2003-2011 were evaluated 2069 construction workers, from 218 companies (average age 37.9 years, mean seniority 21.1 years, 17.1 in the construction industry). The prevalence of work-related diseases was 14.06%, in the first place the noise-induced hearing loss, followed by musculoskeletal disorders and entrapment neuropathies. The 24.7% of fitness to work was influenced by the presence of limitations, the 0.6% of the population was not suitable for the specific task. The prevalence of work-related diseases in construction industry is high, with a peak among the elderly, but also significant occurrence among young people. It is important the percentage of the population with health problems that limit the fitness to work.

Many factors of organizational, technical, social and human are involved in determining occupational injury. The purpose of this study was to evaluate how the characteristics of the human factor can influence the accident phenomenon. From records of the construction firms involved in the project "Protection of health on construction sites" promoted by CPT Bergamo and Occupational Medicine of Bergamo Hospital were extracted data on lifestyle of workers involved in occupational injuries in the period 2007-2011. The indicators of lifestyles used were the smoking status, alcohol consumption and drugs, body mass index (BMI), physical activity.

Aim of this study was to estimate prevalence of resting electrocardiogram (ECG) abnormalities in men with high physical work demand, like construction workers and the prevalence of secondary related cardiovascular examinations. Several guidelines for cardiovascular risk management recommend an ECG in patients with cardiovascular risk but there are no clear indications about the frequency of resting ECG during evaluation for fitness for work. The results of our study confirm the presence of age-related ECG abnormalities with a similar stratified prevalence distribution in all age-classes. Our fundings intend to contribute to further discussion in occupational health policies and periodical medical evaluations.

Unlabelled: Occupational contact dermatitis is the most represented skin disease within the broad spectrum of occupational dermatoses, that also include skin cancers, skin infections and "scleroderma like disease." The scientific literature has long noted an increase in dermatological disease in the construction industry., Materials and Methods: retrospective evaluation (2003-2011), in a group of construction workers followed by the 'Territorial Joint Committee of Bergamo', of the prevalence of allergic and irritant contact dermatitis., Discussion and Conclusions: The following report confirms the literature data and reaffirms the need for a careful medical surveillance, as a result of a strict cooperation between the different professionals involved (company physicians, dermatologists/allergists, family physicians).

The authors analyze 147 hospital cases of workers from the mechanical working sector, came to observation for musculoskeletal disorders (average age 44.8 years, SD 9.9; work seniority 26.7years, SD 10.5). There has been diagnosed 70 work-related musculoskeletal disorders: 20 lumbosacral spine diseases, 20 disorders of the shoulder, 20 hand-wrist disorders, 9 diseases of the elbow, 1 pathology of the knee. The lumbosacral spine diseases were more frequent among workers engaged in maintenance or carpentry works. Disorders of the shoulders were a homogeneous distribution among all groups of workers, suggesting that the risk is widespread. The hand-wrist disorders were almost exclusively confined to those involved in finishing and assembly operations.

This work analyzes the activities carried out by a plaster construction worker, describing the data obtained from the assessment of risk for upper limb biomechanical overload, through the application of checklist and the OCRA method, and the operator's energy expenditure, measured using portable calorimeter. By analyzing the pattern of energy expenditure in relation to the actions performed we observe a direct correlation between posture, force employed, and metabolic rate. The activity of plastering involves biomechanical overload of upper extremity and high energy expenditure.

In Italy, almost 18% of the immigrants work in the construction industry, the principal sector of occupation for such workers. In the province of Bergamo, during 2009-2010, 29.5% of workers in construction industry were immigrants. According to the protocol proposed by SIMLII, during 2009 910 workers underwent health surveillance, 708 were Italians, 202 immigrants. The prevalence of occupational diseases was related to years of service in construction industry and not to the origin of the workers. Nationality was not related with limitations in fitness for work. As regards lifestyles, particularly for smoking, alcohol drinking, drug consumption (declared and tested), immigrant workers showed a more virtuous behaviour than the Italians. According to the data issued by the local health authority, immigrant workers were most frequently involved in fatal accident at work than Italians. Therefore, there is a compelling call for action aimed at safety and prevention in workplaces, together with specific education for immigrants.

The aim of this work is to discuss about the role of the occupational physician in the prevention of the accidents in construction industry. Using the experience of 12 years of surveillance of workers in Bergamo province, the authors analyse the "human factors" which may influence the risk to have an accident, and the role of the physicians not only for the early diagnosis of work-related diseases, but also for the formulation of correct fitness to work, which consider accidents' prevention. Health conditions, psychological elements, fatigue and life style are some of the most important "human factors" which can amplify the accident phenomenon in construction industry. Our experience demonstrates that the occupational physicians can operate in preventive way on these factors, formulating correct fitness to work, giving their collaboration in the risk evaluation and management, suggesting runs of rehabilitation and recovery for the workers who need it, promoting information meetings related to the correct life habits.

The aim of this work is to describe a model for the evaluation of chemical risk, according to the legislative decree 25/2002, planned by U.O.O.M.L. "Ospedali Riuniti di Bergamo", in collaboration with "Gruppo Industriali Chimici dell'Unione Industriali-Provincia di Bergamo" and applied in 19 Chemical Industries of the Province of Bergamo. The objective of the model is the rationalization of the procedures to ponder the levels of exposure and to value different typologies of risk using and manipulating chemical substances with the purpose to optimize the relationship among the attention for safety, workers health and the employment of resources.

The aim of this work is to analyse the prevalence of occupational diseases in construction industry, comparing the results of the first years of health surveillance (1996-2000) and today's situation. We compare the prevalence of occupational diseases observed in 1348 workers during the period 1996-2000 (mean age 36,4 years, DS 11,8; mean experience in construction industry 16,9 years, DS 12,3) and the one observed in 795 different workers during 2006 (mean age 38,8 years, DS 11,1; mean experience in construction industry 18 years, DS 16,6). The prevalence of occupational diseases is respectively 12.09% and 12.83%. But analysing the single pathology it's possible to observe important differences between the two groups. In the workers observed in 2006 there is a significant reduction in prevalence of hearing loss caused by chronic exposure to noise and in prevalence of vascular disease caused by hand-arm vibrations: respectively from 94,9 to 79,2 cases/1000 workers and from 6,7 to 2.6 cases/1000 workers. Musculoskeletal diseases instead are increased from 11,1 to 37,7 cases/1000 workers, showing more attention to the problem, better diagnostics ability and more recognition by public insurance agency for occupational diseases.

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.

In this work it's briefly described the experience in planning and realizing of first aid at work courses for workers of the building trade, realized by the UOOML in collaboration with CPT and CPTA of Bergamo. In particular this is a report of the activity of planning and realization of courses in the months from February till September 2004.

A "customer satisfaction" research about the approving of the sanitary watching activities provided by the "Comitato paritetico territoriale" of Bergamo and the Department of Occupational Medicine of "Ospedali Riuniti" in Bergamo, comprehensive of the diferent points of view by the different subjects involved in the process, in order to estimate and improve the facilities provided.

The rule in force and the Guide-Lines concerning the topic point out specific duties for the Occupational Physician; the most important is certainly health survey, which is organized in several formal medical actions; another Occupational Physician's relevant activity is the "collaboration to the risk assessment". Because of the complexity of the construction building industry and because of the central role of the Occupational Physician in health care, the problems which he has to face are two: firstly he has to improve the knowledge about specific risks of the construction building industry; secondly he must adapt his specialistic knowledge, including the methodology acquired during the school training, to the specific organization conditions and risk of the field.

The aim of this work is to expose the results obtained with the application of a model about efficacy in occupational medicine proposed by ALMLII. In particular we discuss the validity of some indicators of efficacy used in a large group of construction workers during health surveillance, in order to verify effectiveness and appropriateness of an occupational medicine service, as a part of the whole prevention and safety system.

The aim of this project is to value, through a specific questionnaire, the effectiveness and utility of the professional training among the construction workers responsible of the First Aid. 48 construction firms, in Province of Bergamo, were examined and 100 first aid responsible were tested through to the questionnaire. The 21% of the subjects performed a practical first aid intervention. The 84% considers the professional training courses to be globally satisfactory, and one third underlines the necessity of an annual refresher course. This study tends to confirm the validity of this program of professional training, particularly in the construction trade, that is characterized by a high accidents rate.

This work shows the results of a study about variation of the judgement of the fitness to specific work in the construction industry in a year. In the 8.6% of the cases, after a year from the previous examination, it was necessary to express new limitations to the job activity mainly because of the presence of illness of the musculoskeletal or cardiovascular system. Considering only workers aged over 35 years, the percentage of variation after a year grows to 12.3%.

Because of the casual assumption of PCBs through contaminated foods produced by the family farm (meat, milk and by-product), 27 subjects (14 female and 13 male), whit a mean age of about 31 years (range 2-77), were submitted to a medical check-up. The results confirm the exposure of all the patients, related to the intake-level of contaminated foods, and the presence of a correlation between the age and plasmatic levels of PCBs, about which the authors discuss the possible reasons.