[Active epidemiological surveillance and prevention of diseases caused by biomechanical overload of the upper limbs: experience at a territorial service of occupational medicine].

Nowadays in the western countries, the Work Musculoscheletal Disorders (WMSDs) are the most relevant work-related diseases either for the large number of at-risk workers and for the high prevalence of cases among them. Among WMSDs, the Carpal Tunnel Syndrome (CTS) is considered a sentinel event in occupational medicine and epidemiological surveillance systems were set up to study its temporal occurrence and spatial spread. Surprisingly enough, in our country the epidemiology of the WMSDs is still unknown; although observations of important clusters of cases are increasing, these pathologies are still largely underreported by medical doctors. In the high industrialised province of Brescia, Northwestern Italy, only 1% of the 25.000 occupational disease, collected by the occupational medicine and prevention service of the National Health Service (SPSAL) since 1989 to 1997, were coded as WMSDs. Even if the notification of these work-related disorders is compulsory by low since 1973, up-to-now very few cases were reported to SPSALs, and consequently active prevention programs were very few too. For that reason, a project of active surveillance of WMSDs diagnosed on the general population was carried out to improve their identification and to evaluate the work-related etiological fraction as well as to address primary prevention projects. During 1997-1999 618 upper limb musculoskeletal disorders were collected from 2 orthopaedic hospital divisions where cases underwent surgical treatment. 369 of them were interviewed by telephone (253 female, 116 man) and 128 cases (34%) were classified as probable professionally exposed to some known hazard. Female were prevalent (71%), involved particularly in textile, garments, plastic, food production and domestic services. Among men, construction, metallurgic and mechanic were the more frequent jobs. 116 WMSDs were reported to the National Insurance Institute (INAIL). The collection of these WMSDs was the basis for specific communications to the firm manager(s) and to the factory's medical doctor(s) with the aim to make it easy: i) a good health surveillance to exposed workers; ii) a specific risk assessment; iii) carrying out prevention programs and adopting personal protection equipments. Some problems are focused concerning the underreporting of cases, the anamnesis information, the fate of interventions to face the problem in the workplaces. A possible implementation of this project is also discussed to avoid a WMSds surveillance unlinked prevention programs of occupational risks.