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Alumni Dispatches

Mauro Carino

MD, MPH '80

Occupational Health and the Italian Sofa Industry

Mauro Carino I was involved in a research project supported by a grant from the Italian Ministry of Health in cooperation with the National Health Service in Bari, Italy, and IRCCS Policlinico, Mangiagalli and Regina Elena Foundation EPM-CEMOC of Milan on upper extremity work-related musculoskeletal disorders in a production district of the upholstered furniture industry.

This ‘sofa district’ is widely represented with approximately 14,000 workers and 500 plants in a large geographic area of Southern Italy. In this territory, mostly in the Puglia Region,16 percent of the upholstered furniture worldwide is produced. Advanced technology in the cycle of production is combined with performance of the workers with arm-hand intensive tasks and high job demand.

The aim of the study included risk assessment of repetitive strain and movements of the upper limb in a representative sample of the plants through the OCRA index (Occupational Repetitive Actions, reference method chosen for International Organization for Standardization-ISO and European Committee for Standardization-CEN standards), analysis of prevalence and incidence annual rates over a four-year period in the groups of workers exposed at risk with normalized medical data collected by a network of occupational health physicians, definition of possible interventions with improvement of ergonomics solutions, education and information programs shared in the whole district.

A total population of more than 5,000 subjects was investigated. Arm-hand and shoulder disorders affected mainly leather-cutting operators, frame outfitters and seamstresses, and among all the factors influencing risk (frequency, force, posture, additional risk factors, pauses) posture seems to play a significant role. In particular, the women in the study demonstrated a predisposition for the onset of carpal tunnel syndrome.

Based on the obtained pattern of evidence of this specific risk in the sofa district, the Italian National Agency for Injuries and Occupational Diseases recently started a large education and training campaign in the whole district, taking into consideration that about 10 percent of the total workforce per year may switch jobs, still remaining in the same district (workforce mobility). Among strategies and initiatives taken in order to implement a set of standards of health and safety at work in the whole upholstered manufacturing industry, district education and information play a fundamental role.

Training techniques using participatory methods and worker empowerment philosophy have proven valuable.There is a demonstrated need for the use of education for action, promoting the involvement of workers and labor unions in different levels of problem solving in the workplace. Appropriate emphasis is given to the learner involvement and to train-the-trainer approaches. A broad range of professionals are involved (Leading-Edge Health Education Issues, Nova Science Publisher, New York 2008).

Upper extremity work-related musculoskeletal disorders impose a substantial economic burden in compensation cost, lost wages and productivity in a large area of the Italian sofa industry. This project is a cooperative effort between different institutions of research, universities, the national health insurance agency, territorial departments and numerous privately owned firms, and the project showed evidence that companies have to face a significant occupational risk in the same district.

A participated approach together with a network communication system was considered essential for successful prevention. Plants of different sizes share cross-training and information programs, insurance incentives, and support the possibility of transferring to small firms “best practices” from high quality risk assessment, managerial experiences and ergonomic interventions in equipment design, work procedures and organizational characteristics of large companies. Although automation will characterize work in the future, manual labor will remain important for the recognized quality of Italian manufacturing products.

Mauro Carino currently works as Physician in Charge for the medical surveillance program at the Occupational Health Unit, National Health Service, Bari, Italy.

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