rubrica

Lavoro

  • Dario Consonni1

  1. Clinica del lavoro, Milano

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Ricerca del 15 ottobre 2010

Per leggere (e utilizzare in proprio) questa ROUTINE di ricerca clicca qui

Database: Ovid MEDLINE(R) <1996 to September Week 1 2010>
Strategia di ricerca:  (Occupational Exposure [MESH] or Occupational Diseases [MESH] or Occupational Health [MESH] or Workplace [MESH] or Accidents, Occupational  [MESH] or Employment [MESH] ) AND (Italy [MESH] or italy [termine libero])
Database: Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations Strategia di ricerca: occupation* (ricerca nel campo abstract) and italy (ricerca nel campo institution)
Limiti: da gennaio 2010 a  15 settembre 2010

Di ogni articolo è disponibile l'abstract. Per visualizzarlo basta cliccare sul titolo.

1. Pira E.  Piolatto G.  Negri E.  Romano C.  Boffetta P.  Lipworth L.  McLaughlin JK.  La Vecchia C.  Bladder cancer mortality of workers exposed to aromatic amines: a 58-year follow-up. Journal of the National Cancer Institute.  102(14):1096-9, 2010 Jul 21.

Abstract
We previously investigated bladder cancer risk in a cohort of dyestuff workers who were heavily exposed to aromatic amines from 1922 through 1972. We updated the follow-up by 14 years (through 2003) for 590 exposed workers to include more than 30 years of follow-up since last exposure to aromatic amines. Expected numbers of deaths from bladder cancer and other causes were computed by use of national mortality rates from 1951 to 1980 and regional mortality rates subsequently. There were 394 deaths, compared with 262.7 expected (standardized mortality ratio = 1.50, 95% confidence interval = 1.36 to 1.66). Overall, 56 deaths from bladder cancer were observed, compared with 3.4 expected (standardized mortality ratio = 16.5, 95% confidence interval = 12.4 to 21.4). The standardized mortality ratio for bladder cancer increased with younger age at first exposure and increasing duration of exposure. Although the standardized mortality ratio for bladder cancer steadily decreased with time since exposure stopped, the absolute risk remained approximately constant at 3.5 deaths per 1000 man-years up to 29 years after exposure stopped. Excess risk was apparent 30 years or more after last exposure.

Commento a cura di Benedetto Terracini
L'epidemia di cancro della vescica tra gli operai dell'IPCA di Ciriè ha fatto storia, per la sua drammaticità, per il fatto che sia venuta alla luce grazie alla iniziativa dei lavoratori stessi e per avere rappresentato (negli anni settanta) la prima circostanza in cui l'epidemiologia dei tumori è arrivata in un tribunale italiano. La fabbrica produceva coloranti a base di amine aromatiche, comprese 2-naftilamina e benzidina. Una équipe internazionale ha ora aggiornato al 2003 lo studio formale retrospettivo di mortalità nella coorte di 590 dipendenti, vivi nel 1946 o assunti successivamente. Il riferimento per il calcolo degli SMR sono i tassi di mortalità nella popolazione italiana (dato lo stile di vita nel basso Canavese fino a pochi decenni fa, la scelta ha probabilmente comportato una sottostima degli attesi). Complessivamente sono state identificate 394 morti contro 262.7 attese. Per 56 operai il certificato di morte attribuiva il decesso a cancro vescicale (3.4 attese). E' interessante l'eccesso di morti per tumori diversi da quello vescicale (107 contro 73.6 attesi) e in particolare per cancro della laringe (11/2.7) e dell'intestino (14/7.1). Secondo una prassi abbastanza diffusa nell'accademia, il nome e l'ubicazione della fabbrica non vengono menzionati. Ignorando i principi etici della comunicazione del rischio e dei rapporti tra mondo della ricerca e mondo reale, gli autori tengono invece a precisare che lo studio non ha comportato alcun contatto diretto con i lavoratori.

2. d'Errico A.  Caputo P.  Falcone U.  Fubini L.  Gilardi L.  Mamo C.  Migliardi A.  Quarta D.  Coffano E. Risk factors for upper extremity musculoskeletal symptoms among call center employees. Journal of Occupational Health  52(2):115-24, 2010 Apr 20.

Abstract
OBJECTIVES:
To investigate the prevalence of musculoskeletal symptoms in the upper extremity (UE) in a sample of Italian call center (CC) operators, and the relationship between the symptoms and potential workplace risk factors.
METHODS
: During 2005-2006, 775 workers from seven CCs in the Turin area participated in a questionnaire survey of exposure to ergonomic, organizational and psychosocial factors at work, socio-demographics, lifestyle, symptoms and diseases. Musculoskeletal symptoms were defined as self-reported musculoskeletal symptoms in the UE during the previous 28 days, for which a physician was consulted and/or drugs were taken. Relative risks were estimated through Poisson regression models with the Huber-White sandwich estimator of variance.
RESULT:
Overall, 45% of workers reported UE symptoms in the last four weeks. Symptoms in the neck were the most prevalent (39%), followed by the shoulder (22%), hand-wrist (10%) and elbow (4%). Among workplace risk factors, neck-shoulder symptoms were associated with low job control, elevated noise, poor desk lighting and impossibility to lean back while sitting; whereas elbow-hand/wrist symptoms were associated with short intervals between calls, insufficient working space, lack of forearm support, job insecurity and long seniority in the CC industry.
CONCLUSIONS
: The high prevalence of UE symptoms in this sample was similar to that reported by other studies conducted in this industry. Our results confirm previously reported associations, such as poor characteristics of the workstation and psychological stressors. The striking difference between the set of risk factors for neck-shoulder and elbow/wrist-hand symptoms indicates that the two regions should be investigated separately.

Commento a cura di Dario Consonni
Uno studio di epidemiologia occupazionale riguardante una realtà lavorativa relativamente nuova. Gli autori hanno valutato il rapporto tra fattori lavorativi ergonomici e organizzativi e disturbi muscolo-scheletrici, separatamente per il distretto collo-spalla e gomito-polso-mano in operatori di call-center. Dal punto di vista della metodologia statistica, è da notare l’uso della regressione di Poisson con errore standard robusto per stimare i rischi relativi.

3. Bonzini M.  Tripodi A.  Artoni A.  Tarantini L.  Marinelli B.  Bertazzi PA.  Apostoli P.  Baccarelli A. Effects of inhalable particulate matter on blood coagulation. Journal of Thrombosis & Haemostasis.  8(4):662-8, 2010 Apr.

Abstract
BACKGROUND: Particulate matter (PM) exposure has been linked to increased risk of cardiovascular disease, possibly resulting from hypercoagulability and thrombosis. Lung and systemic inflammation resulting from PM inhalation may activate blood coagulation, but mechanisms for PM-related hypercoagulability are still largely unknown.
OBJECTIVES: To identify coagulation mechanisms activated by PM in a population with well-characterized exposure.
METHODS:
We measured prothrombin time (PT), activated partial thromboplastin time, endogenous thrombin potentials (ETPs) with/without exogenous triggers and with/without soluble thrombomodulin, tissue-type plasminogen activator (t-PA) antigen, D-dimer and C-reactive protein (CRP) in 37 workers in a steel production plant with well-characterized exposure to PM with aerodynamic diameter of of < 1 mum (PM(1)) and coarse PM (PM(10) - PM(1)). Blood samples were collected from each subject on the first (baseline) and last (postexposure) day of a 4-day work week. We analyzed differences between baseline and postexposure levels using a paired Student's t-test. We fitted multivariate mixed-regression models to estimate the associations of interquartile range PM(1) and coarse PM exposure with parameter levels.
RESULTS
: None of the parameters showed any significant changes from baseline in postexposure samples. However, exposure levels were associated with shorter PT (beta[PM(1)] = -0.33 s, P = 0.08; beta[PM(coarse)] = - 0.33 s, P = 0.01), and higher ETP without exogenous triggers and with thrombomodulin (beta[PM(1)] = + 99 nm min, P = 0.02; beta[PM(coarse)] = + 66 nm min, P = 0.05), t-PA (beta[PM(1)] = + 0.72 ng mL(-1), P = 0.01; beta[PM(coarse)] = + 0.88 ng mL(-1), P = 0.04), and CRP (beta[PM(1)] = + 0.59 mg L(-1), P = 0.03; beta[PM(coarse)] = + 0.48 mg L(-1), P = 0.01).
CONCLUSIONS
: PM exposure did not show any short-term effect within the week of the study. The association of PM exposure with PT, ETP and CRP provides some evidence of long-term effects on inflammation and coagulation.

4. Cammarota G.  Masala G.  Cianci R.  Palli D.  Bendinelli B.  Galli J.  Pandolfi F.  Gasbarrini A.  Landolfi R. Reflux symptoms in wind instrument players. Alimentary Pharmacology & Therapeutics.  31(5):593-600, 2010 Mar.

Abstract
BACKGROUND
: An occupation-related susceptibility of orchestral wind instrument players to gastro-oesophageal reflux was hypothesized. AIM: To compare reflux symptoms reported by wind instrument players with those reported by players of other instruments.
METHODS
: A questionnaire was distributed to 1083 musicians (414 wind instrument players and 669 players of other instruments) from 21 Italian orchestras to obtain information on reflux symptoms in the year preceding the survey.
CONCLUSION:
In light of the findings, efforts are urgently needed to identify research and knowledge transfer priorities related to workers' health and safety on an international scale using a standardized method in order to obtain comparable results, avoid wasteful duplication of resources, and reduce occupational accidents and illness.

5. Scarselli A.  Vonesch N.  Melis P.  Massari S.  Tomao P.  Marinaccio A.  Iavicoli S. Biological risk at work in Italy: results from the National Register of Occupational Exposures. Industrial Health.  48(3):365-9, 2010.

Abstract
The aim of this study is to analyze the information on workers and exposures to biological agents in Italy, collected by the National Institute for Occupational Safety and Prevention in the period 1994-2008 on the basis of a regulation. Employers are asked to identify the biological agents and to report data on employees exposed to biological hazards. Biological agents included in the system belong to risk group 3 and 4 of the European Union classification, and are grouped by family and transmission type. Data analyzed in this study regard 90 firms (28% in "Laboratory analysis clinics" economic activity) and 2,194 workers exposed to biological agents in the period 1994-2008. The most frequent biological agent reported is Salmonella typhi, while the one which counted more exposures is Mycobacterium tuberculosis. Nonetheless the incompleteness of Italian legislative framework about "exposure registers" to biological agents in the workplace, the identification of large groups of workers "at risk" can contribute to undertake epidemiological studies aimed at the prevention of occupational infection diseases.

6. Sossai D. Puro V. Chiappatoli L. Dagnino G. Odone B. Polimeri A. Ruzza L. Palombo P. Fuscoe MS. Scognamiglio P. Using an intravenous catheter system to prevent needlestick injury. Nursing Standard. 24(29):42-6, 2010 Mar 24-30.

Abstract
AIM : To identify the effect of a sharps awareness campaign and the introduction of a safety catheter device on the annual incidence of needlestick injuries between 2003 and 2007.
METHOD: In 2003, a sharps awareness campaign began in San Martino Hospital in Genoa, Italy. In 2005, a safety catheter was introduced and healthcare workers were trained in its use. Data for all occupational accidents from 2003 to 2007 were collected and analysed.
RESULTS: After introduction of the sharps awareness campaign and use of safety catheters, reported incidents of sharps injuries involving catheters fell from 19 in 2004 to two in 2007 and in neither of those two cases were needlestick prevention devices used. Overall, the rate of needlestick injuries was 24.1 per 100,000 cases when conventional catheters were used and 0.4 per 100,000 cases with safety catheters.
CONCLUSION: The sharps awareness campaign and newly adopted needlestick prevention device may have contributed to the prevention of percutaneous injuries caused by catheters. Until the onset of the campaign, the reported annual incidence of needlestick injuries was six. This increased to a peak of 19 reported injuries in 2004, which could be attributed to improved reporting effected by the campaign.

7. Pillastrini P. Mugnai R. Bertozzi L. Costi S. Curti S. Guccione A. Mattioli S. Violante FS. Effectiveness of an ergonomic intervention on work-related posture and low back pain in video display terminal operators: a 3 year cross-over trial. Applied Ergonomics. 41(3):436-43, 2010 May.

Abstract
This study investigated the effectiveness of a workstation ergonomic intervention for work-related posture and low back pain (LBP) in Video Display Terminal (VDT) workers. 100 VDT workers were selected to receive the ergonomic intervention, whereas 100 were assigned to a control group. The two groups were then crossed-over after 30 months from baseline. Follow-ups were repeated at 5, 12, and 30 months from baseline and then at 6 months following crossover. Outcomes: Work-related posture and LBP point-prevalence using the Rapid Entire Body Assessment method and a Pain Drawing, respectively. The ergonomic intervention at the workstation improved work-related posture and was effective in reducing LBP point-prevalence both in the first study period and after crossover, and these effects persisted for at least 30 months. In conclusion, our findings contribute to the evidence that individualized ergonomic interventions may be able to improve work-related posture and reduce LBP for VDT workers.

Commento a cura di Dario Consonni
Un interessante esempio studio di intervento in ambito lavorativo (frequente) associato a una appropriata valutazione epidemiologica (situazione purtroppo infrequente). Gli autori hanno sottoposto una serie di interventi ergonomici individualizzati a una valutazione di efficacia tramite disegno cross-over. Sebbene apparentemente oneroso, questo approccio consente di ottenere informazioni utili per la prevenzione basata sulle prove (evidence-based prevention).

8. Consonni D. De Matteis S. Lubin JH. Wacholder S. Tucker M. Pesatori AC. Caporaso NE. Bertazzi PA. Landi MT. Lung cancer and occupation in a population-based case-control study. American Journal of Epidemiology. 171(3):323-33, 2010 Feb 1.

Abstract
The authors examined the relation between occupation and lung cancer in the large, population-based Environment And Genetics in Lung cancer Etiology (EAGLE) case-control study. In 2002-2005 in the Lombardy region of northern Italy, 2,100 incident lung cancer cases and 2,120 randomly selected population controls were enrolled. Lifetime occupational histories (industry and job title) were coded by using standard international classifications and were translated into occupations known (list A) or suspected (list B) to be associated with lung cancer. Smoking-adjusted odds ratios and 95% confidence intervals were calculated with logistic regression. For men, an increased risk was found for list A (177 exposed cases and 100 controls; odds ratio = 1.74, 95% confidence interval: 1.27, 2.38) and most occupations therein. No overall excess was found for list B with the exception of filling station attendants and bus and truck drivers (men) and launderers and dry cleaners (women). The authors estimated that 4.9% (95% confidence interval: 2.0, 7.8) of lung cancers in men were attributable to occupation. Among those in other occupations, risk excesses were found for metal workers, barbers and hairdressers, and other motor vehicle drivers. These results indicate that past exposure to occupational carcinogens remains an important determinant of lung cancer occurrence.

Commento a cura di Dario Consonni
Si tratta di uno studio in cui gli autori hanno stimato la quota di tumori polmonari attribuibili all’esposizione a cancerogeni professionali. Il lavoro è stato condotto all’interno di uno studio caso-controllo di popolazione di notevoli dimensioni denominato EAGLE (Enviroment And Genetics in Lung cancer Epidemiology) condotto in Lombardia in collaborazione tra Università di Milano, 13 Ospedali, e il National Cancer Institute (USA).

9. Camerino D. Sandri M. Sartori S. Conway PM. Campanini P. Costa G. Shiftwork, work-family conflict among italian nurses, and prevention efficacy. Chronobiology International. 27(5):1105-23, 2010 Jul.

Abstract
Shiftwork may be a demanding situation because it raises problems for reconciling work and nonwork activities; as such, this conflict may be mitigated by designing and implementing effective preventative actions at the workplace. There is a paucity of research directly examining the impact of work schedules and preventative measures at work on work-family conflict. Hence, the authors posed the following questions in their study: What is the impact of different work schedules on work-family conflict? Is a preventative culture associated with less work-family conflict? Is work-family conflict associated with specific health and well-being indicators and if so, how does work-family conflict affect well-being as compared with other potential determinants? A subset of 750 nurses (approximately 10% of total workforce) were randomly selected from a larger sample. Nurses completed the Italian version of the NEXT questionnaire plus newly developed items to create an index on occupational safety and health prevention at work. Data were explored using two data mining techniques, Random Forests and Bayesian Networks, and modeled using hierarchical linear regression models. In all, 664 (88.5% of sample) nurses answered the questionnaire. The authors found that different work schedules had a differential impact on work-family conflict. In addition, effective risk communication between workers and people in charge of safety and health, and participation in preventative activities, quantitative workload, performing tasks not belonging to the nursing profession, and the number of weekends/month spent at work were all strongly associated with work-family conflict. The variable "time schedules" also acted as an effect modifier in the relationship between effective communication and participation in preventative activities and work-family conflict. In addition, quantitative demands played a role as a mediator (30% of total effect) in the relationship between effective communication and participation in preventative activities and work-family conflict. Work-family conflict was significantly associated with burnout, sleep, and presenteeism; its association with burnout was higher than other precursors. Shift schedules that involved night work implied different workload demands, less effective communication, and participation in preventative activities than the other work schedules considered. The presence of a preventative culture directly reduced work-family conflict and indirectly via reduction of work demands. The authors conclude that the development of a preventative culture among irregular and night shiftworkers can be effective in reducing work-family conflict, while positively increasing well-being and job performance.

10. Pavanello S. Mastrangelo G. Placidi D. Campagna M. Pulliero A. Carta A. Arici C. Porru S. CYP1A2 polymorphisms, occupational and environmental exposures and risk of bladder cancer. European Journal of Epidemiology. 25(7):491-500, 2010 Jul.

Abstract
Cytochrome P4501A2 (CYP1A2) is a key enzyme for activation of bladder carcinogens. Polymorphisms in the 5'-noncoding promoter region of CYP1A2 gene [mainly -2467T/delT(rs35694136) and -163C/A(rs762551)], are crucial in modifying CYP1A2 activity in smokers. Within the framework of a hospital-based case/control study, we investigated the relationship between CYP1A2 polymorphisms, occupational/environmental exposures and bladder cancer (BC) risk. The study population included 185 BC cases and 180 non-cancer controls, all Caucasian males. Data were collected on lifetime smoking, coffee drinking, dietary habits and lifetime occupation, with particular reference to exposure to aromatic amines (AAs) and polycyclic aromatic hydrocarbons (PAHs). A case-only design was applied to study the interaction between CYP1A2 -2467T/delT (or -163C/A) and occupational and environmental factors. Multiple logistic regression showed a significantly increased risk among heavy smokers (> or =50 packyears; OR 5.6, 95% CI: 2.5-12.5) and heavy coffee drinkers (>5 cups/day; OR 3.1, 95% CI: 1.2-7.9). Exposure to AAs showed a significant trend of BC risk with increasing cumulative exposure (CE) (P = 0.04), with heavy smoking as possible confounder. A decreased risk was noted for large leaf vegetable consumption, with significant trend from 3 times/week (P = 0.008). The case-only analysis showed an interaction between -2467T/delT and tobacco smoking >25 packyears (P = 0.04); no interaction was detected between such polymorphisms and coffee consumption, dietary habits and occupational exposure to AAs. No effects were shown with -163C/A genotype as well as no overall effect of CYP1A2 by itself on BC risk. This is the first study suggesting that CYP1A2 -2467T/delT modifies the effect of cigarette smoking on BC risk.

11. Zurlo MC. Pes D. Siegrist J. Validity and reliability of the effort-reward imbalance questionnaire in a sample of 673 Italian teachers. International Archives of Occupational & Environmental Health. 83(6):665-74, 2010 Aug.

Abstract
PURPOSE: This study explores the explicative potential of effort-reward imbalance Model to unveil the dimensions involved in teacher stress process and analyses the psychometric characteristics of the Italian version of the ERI Questionnaire (Siegrist, J Occup Health Psychol 1:27-43, 1996) with respect to a homogeneous occupational group: Italian school teachers.
METHODS: The Italian version of the ERI Questionnaire was submitted to 673 teachers randomly drawn from a cross-section of school types. Internal consistency, reliability, discriminative validity, and factorial structure were evaluated. Predictive validity was explored with respect to a measure of perceived strain, the Crown-Crisp Experiential Index. Discriminative validity was explored with respect to age, gender, education, type of school, the presence/absence of physical pains in the last 12 months before the survey, and teachers' intention to leave the profession.
RESULTS: Item-total correlations are for all items included between 0.30 and 0.80 (p
CONCLUSIONS: This preliminary analysis of the reliability and validity of the Italian version of the ERI Questionnaire reveals that it constitutes a useful and reliable measure to analyse work-related stress with respect to the school setting. The validity of the ERI model to describe the dimensions involved in teacher's stress and to highlight those associated to leaving intentions and to several physical and psychological strain outcomes in Italian school teachers has been confirmed.

12. Rondinone BM. Boccuni F. Iavicoli S. Trends and priorities in occupational health research and knowledge transfer in Italy. Scandinavian Journal of Work, Environment & Health. 36(4):339-48, 2010 Jun.

Abstract OBJECTIVES: In 2000-2001, the Italian National Institute for Occupational Safety and Prevention (ISPESL) carried out a survey to identify the research priorities in the field of occupational safety and health (OSH). The present study, carried out in 2007-2008, was a follow-up designed to (i) review the themes identified earlier, (ii) detect emerging issues linked to new risks and forms of work, and (iii) look for any shifts in focus. The survey was extended to cover not only research but also the concept of knowledge transfer.
METHODS: In the first round, ISPESL distributed questionnaires to the heads of both university occupational medicine departments and prevention departments in local national health units (known as ASL in Italy) asking respondents to identify OSH priority themes. In the latest survey covering both research and the need for knowledge transfer, the same experts were asked to rank the importance of the earlier-identified topics and list any emerging issues in the OSH field.
RESULTS: The two most important themes identified were "work accidents" and "occupational carcinogenesis". In the overall sample and among ASL experts, they received the 1st and 2nd highest mean scores. The university respondents also prioritized them but in reverse order. Some of the new priority topics included: risks associated with nanotechnologies; assessment of psychosocial and organizational risks; migration and work; and cost-benefit analysis of prevention.
CONCLUSION: In light of the findings, efforts are urgently needed to identify research and knowledge transfer priorities related to workers' health and safety on an international scale using a standardized method in order to obtain comparable results, avoid wasteful duplication of resources, and reduce occupational accidents and illness.

13. Scarselli A. Vonesch N. Melis P. Massari S. Tomao P. Marinaccio A. Iavicoli S. Biological risk at work in Italy: results from the National Register of Occupational Exposures. Industrial Health. 48(3):365-9, 2010.

Abstract
The aim of this study is to analyze the information on workers and exposures to biological agents in Italy, collected by the National Institute for Occupational Safety and Prevention in the period 1994-2008 on the basis of a regulation. Employers are asked to identify the biological agents and to report data on employees exposed to biological hazards. Biological agents included in the system belong to risk group 3 and 4 of the European Union classification, and are grouped by family and transmission type. Data analyzed in this study regard 90 firms (28% in "Laboratory analysis clinics" economic activity) and 2,194 workers exposed to biological agents in the period 1994-2008. The most frequent biological agent reported is Salmonella typhi, while the one which counted more exposures is Mycobacterium tuberculosis. Nonetheless the incompleteness of Italian legislative framework about "exposure registers" to biological agents in the workplace, the identification of large groups of workers "at risk" can contribute to undertake epidemiological studies aimed at the prevention of occupational infection diseases.

 

14. Spadea T.  Zengarini N.  Kunst A.  Zanetti R.  Rosso S.  Costa G. Cancer risk in relationship to different indicators of adult socioeconomic position in Turin, Italy. Cancer Causes & Control.  21(7):1117-30, 2010 Jul.

Abstract
OBJECTIVE:
To determine the magnitude of social inequalities in cancer incidence according to different socioeconomic indicators and to assess the independent role of each indicator.
METHODS:
Data from the Turin Longitudinal Study and the Piedmont Cancer Registry (1985-1999) were used to analyse the relationship of cancer incidence with three dimensions of individual socioeconomic position (education, occupation, and material living conditions) and with an area-based deprivation index. Multivariate Poisson regression models were used to estimate both relative risks and relative indexes of inequality (RIIs).
RESULTS:
Results showed an independent role of all the socioeconomic indicators. The overall gradients of inequalities, expressed by the RIIs for total cancer incidence, varied from 9 to 26% among men; among women, we estimated a 22% protection at the bottom of the educational hierarchy, and a 12% gradient for decreasing ease of living conditions. For most cancer sites, socioeconomic position in early adult life was as important as later socioeconomic position, while the area-based deprivation index played only an additional role.
CONCLUSIONS:
Different socioeconomic indicators pinpoint to a series of specific risk factors that are related to specific phases of the life course. Individual level data, rather than ecological data, is preferred to accurately monitor social inequalities in cancer risk.

15. Cecchini M.  Colantoni A.  Massantini R.  Monarca D. The risk of musculoskeletal disorders for workers due to repetitive movements during tomato harvesting. Journal of Agricultural Safety & Health 16(2):87-98, 2010 Apr.

Abstract
Tomatoes are the most common crop in Italy. The production cycle requires operations in the field and factory that can cause musculoskeletal disorders due to the repetitive movements of the upper limbs of the workers employed in the sorting phase. This research aims to evaluate these risks using the OCRA (occupational repetitive actions) index method This method is based firstly on the calculation of a maximum number of recommended actions, related to the way the operation is performed, and secondly on a comparison of the number of actions effectively carried out by the upper limb with the recommended calculated value. The results of the risk evaluation for workers who manually sort tomatoes during harvest showed a risk for the workers, with an exposure index greater than 20; the OCRA index defines an index higher than 3.5 as unacceptable. The present trend of replacing manual sorting onboard a vehicle with optical sorters seems to be appropriate to reduce the risk of work-related musculoskeletal disorders (WMSDs) and is supported from both a financial point of view and as a quality control measure