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Francesco S. Violante M.D. Associate Professor of Occupational Medicine

Reflections on the Annual Report from the Italian National Institute of Insurance Against Occupational Accidents (INAIL). Francesco S. Violante M.D. Associate Professor of Occupational Medicine University of Bologna, Italy. Recorded Accidents (1).

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Francesco S. Violante M.D. Associate Professor of Occupational Medicine

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  1. Reflections on the Annual Report from the Italian National Institute of Insurance Against Occupational Accidents (INAIL) Francesco S. Violante M.D. Associate Professor of Occupational Medicine University of Bologna, Italy

  2. Recorded Accidents (1) INAIL records accidents and diseases only if: • they cause more than 3 days of sick leave • they are strictly linked to work

  3. Recorded Accidents (2) • INAIL records all the events that are reported to the Institute (reported events) • But because of INAIL’s legal role in insurance, it compensates only some of them (defined events)

  4. Reported vs. defined events • Major REGIONAL differences exist regarding the numbers of reported vs. compensated events. • The most reliable data are those regarding DEFINED events (that are sufficiently stable one year after the events were reported)

  5. Non-Recorded Accidents Non-recorded accidents include: • those causing an absence of 0-3 days • those only generically related to work • those not regarding industry, agriculture, commerce, services or the State

  6. Ateco91 • For classification purposes, INAIL adopts Ateco91 • The occupational sectors considered by Ateco91 may not necessarily coincide with other national and international classifications

  7. Accidents: denominator (1) • Currently calculated on the basis of the hypothetical number of exposed subjects • Obtained (according to Province and Occupational Sector) by the formula: Total salary paid in the year ---------------------------------------------- Mean daily salary x 300

  8. Accidents: denominator (2) …But: • The accidents related to some “special cathegories” of workers (apprentices, partners in fishers’ or porters’ cooperatives) are collected by INAIL, and their salary data are not known • This could determine underestimation of the number of exposed subjects

  9. Accidents: denominator (3) • To calculate properly prevalence and incidence, one should use proper denominators (number of working hours, number of exposed subjects) • the ISPESL project, SIPRE, is an attempt in this direction

  10. Limitations of INAIL Databank • Although Databank provides a lot of interesting data, they do not altogether coincide with prevention’s needs (e.g. one cannot cross form and material agent) • Thus, a reader cannot distinguish a road accident involving a truck from an accident involving a factory vehicle used for internal lifting • This leads to problems in understanding “why” (rather than “how”) the accidents occurred

  11. Strongpoints of INAIL Databank Nevertheless, INAIL Databank is: • Historically consolidated • Its data are processed according to consolidated methods • Its data constitute a valuable observatory for trends as regards time, place and different jobs

  12. The Annual Report • One of the strong points of INAIL is its Annual Report, which attempts to include other sources of data • This generates different prevalence and incidence indices using more correct denominators (e.g. number of exposed workers estimated by ISTAT)

  13. Recorded Occupational Diseases (ODs) • Inail records occupational ODs after being notified by a physician • … But, as with accidents, we can find a number of notified ODs (reported diseases) that are not compensated • Italian Law provides tables to guide INAIL for compensation of ODs

  14. Recorded ODs (2) • Few difficulties exist regarding information from compensation pathologies that Italian Legislation considers strictly linked to certain jobs (valid for) • But major difficulties exist for those work-related diseases (WRDs) that can also be of non-professional origin

  15. Underestimation of ODs • The sick worker is obliged to provide proof of the professional origin of his WRDs • This is the first reason for very likely underestimation of prevalence and incidence of at least some ODs in Italy

  16. ODs underestimation (2) • The second — but not secondary — reason for underestimation of ODs is due to a possible misunderstanding of the occupational origin of some pathologies (eg, carpal tunnel syndrome, lumbar disc hernia, tumors) • This can lead to insufficient notification to INAIL on the part of physicians

  17. OD surveillance systems • Like SENSOR in the USA, or SWORD in the UK, some local Italian surveillance systems (e.g. in Piedmont and Brescia) of WRDs and ODs have been helpful in discovering cases that were not reported to INAIL by physicians

  18. The Italian OD gap • We need to reduce the gap with other industrialized countries regarding notification and compensation of some ODs and WRDs • To do this, not only legislators, but also health professionals need to have more awareness of these problems

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