RISULTATI RICERCA

The article aims to analyze, from a gender perspective, the issue of health and safety at work trough the evolution of the legislation, and referring to a more complex picture related to others concepts as universality, diversity, inclusion and combating discrimination. Despite the delay on these issues, the perspective of the article is to achieve full legitimacy in the legal debate, to transform expectations and recommendations into stringent obligations. In this way the role of CUG, and in particular of the INAIL’s CUG, can be decisive for the organizational redefinition and for the security system management, in particular as its role of promoter of an effective prevention culture.

The gender issue is an emerging topic in occupational medicine, although still not sufficiently explored in the medical literature nor addressed by an appropriate Occupational Health and Safety (OH&S) legislation. The "classic mono-causal occupational disease" is nearly disappeared, replaced by the more and more frequent multi-factorial so-called "work-related diseases". These can be caused by a variable combination both of occupational and non-occupational factors. This change in the occupational diseases scenario requires a new multidisciplinary approach to the workplace prevention strategy, involving all different aspects of science, technology and policy. The adoption of gender as a new category of scientific investigation implies a novel holistic approach to research, based on the contamination and partially integration of the epistemological statutes and research methodologies of different scientific disciplines, also in order to support policy with more practical and effective instruments and knowledge. On the other hand, more efforts should be made to integrate public health care, OH&S policy with social welfare. Here the authors discuss about the implementation of the "gender-parameter" in some aspects of the OH&S Italian legislation, recently introduced by the 81/08 law, and briefly report on the state of the art of occupational medical literature with regard to gender differences.

In order to create a correct gender-sensitive risk assessment, hazards identification and exposure evaluation have to be led considering several inequalities related to gender differences. In this respect, authors put their attention to different occupational segregations (both horizontal and vertical) and to various hazards (injuries, chemical, physical, ergonomic, biological and psychosocial) to which female and male workers are submitted, to create a more realistic picture of all the risks which mostly affect safety and health at work. To generate a complete view of occupational risks, authors also consider the unequal domestic load distribution between male and female workers which takes the latters to be exposed to multiple hazards, both in domestic and working places. It also provides an overall picture of useful indications to a correct evaluation and to a proper risks management, to improve health and safety level of all workers.

With the Occupational Health and Safety Act (Legislative Decree 81/2008) Italy recognizes the gender as a relevant difference to ensure the equal protection for men and women at work. In the four years of the operation of this decree, we can detect a self-evident difficulty to translate this instruction into practice. Due to this delay, the Regional Directorate INAIL of Tuscany, to prevent that this part of the rule, related with the gender prevision, remain a dead letter, has promoted a research path on this subject. Within this framework, the paper aims, through the comparison with the literature and a coherent definition of the key concepts of the Legislative Decree, to provide a useful recommendation for a research design that should be both, theoretically aware and empirically oriented, in view of the translation of the Occupational Health and Safety Act into consistent guidelines.

The article, based on the critique of the neutrality of science, examines the transformations in the productive sphere with the presence of women; it analyses the obstacles and the consequences of this transformation for health and safety at work. Organizational models, welfare systems, business strategies and applications of law are contradictory and need to be revised, by applying, in the right size, the category of gender that can provide a significant heuristic contribution, especially to put into practice the prevention and integration of social and health care. Only in this way gender will not be a simple statistical variable, but it becomes a innovative interpretative key, that may be utilized to derive important implications for the promotion of quality of life.

The essay proposes some reflections concerning the protection of health and safety at workplaces by a gender-based perspective. Recent statistics and studies show a growing rate of accidents at work between working women, but for a long time the widespread approach to such topics has been gender-blind. The Author notes that is necessary to change such perspective, by adopting a renewed conception concerning these issues, which might be gender-oriented and might envisage the possible disparate impact of risks and accidents at work on women and men, looking also at how these could be related with the persistence of many difficulties for working women in managing the life/work balance.

Scientific literature widely demonstrated how of gender differences interact with social, cultural, environmental and neurobiological factors in the development of mental diseases such as mood, psychotic and anxiety disorders. Gender represents a factor that influences not only prevalence rates, but also the disorders’ clinical features, in addition to exposure to potential risk factors like the socioeconomic status. This paper analyses the state of the art on the gender differences reported in the major mental disorders, based on most recent epidemiological and clinical studies that also influenced the development of the latest edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5).

Gender difference in cancer susceptibility, incidence, prognosis and aggressiveness have been observed for several types of tumors. Environmental and occupational exposures along with hormonal and immunological differences may be responsible for the disparity between males and females. Tumor immune surveillance, a recognized major physiological mechanism against cancer development and progression, is largely sex-dependent with a great activity in females respect to males. However, up today, no clinical trial evaluating new drugs or treatment strategy have been performed in a gender-specific manner and our knowledge derived from subgroup analysis, especially for what concerns women population. In this review, the authors point out gender differences in cancer epidemiology, response to treatments, toxicity and tumors related side effects. Colorectal and lung cancers will also described in order to underline the main gender differences.

Obesity, physical inactivity and unhealthy diet are common risk factors in men and women for the development of diabetes. Yet some physiological and pathological conditions are unique to the women and these conditions can increase their risk of developing diabetes and its complications. In particular, the metabolic status during pregnancy may have important implications on their own well being as well as the one of their children. Therefore, it is necessary that these feature conditions become the object of screenings in order to identify women at high risk and implement effective preventative maneuvers. Though the quality and intensity of diabetes care in women does not appear to be inferior to that of men, their therapeutic response remains limited. Better understanding of gender-related pathophysiological, diagnostic, and therapeutic responses is needed in order to design specific approaches to improve outcomes in women. Women must consider the opportunity to change their eating habits and lifestyle in general, in an attempt to preserve themselves and their family.

Although women believe that cancer is their most important health problem, around 50% of women die for a cardiovascular disease. In addition, despite a different perception, cardiovascular disease is more prevalent in women than in men. The reason for this different incidence of cardiovascular disease between women and men is caused by the fact that fertile woman is protected by estrogen against the development of cardiovascular disease. In contrast, after menopause and the consequent decrease of plasma levels of estrogen, cardiovascular risk in women drammatically increases and, as a consequence, it causes the increase of the incidence of diseases such as myocardial infarction or stroke. Unfortunately, at the present time, no sure information is available about the best practice to prevent or cure cardiovascular disease in women. Most of therapeutical strategies derive from study conducted mainly in men. Studies specifically dedicated to women are only those aimed to evaluate the effect of estrogen replacement therapy on cardiovascular events in post menopausal women and all these studies have produced negative results. The hope for the future is that the new awareness of scientific community about the relevance of cardiovascular disease in women lead to develop specific trials which might give definitive answers for a more effective therapuetic approach.

The author summarizes the development of the concept of gender medicine, which is meant as a discipline aimed at optimizing medical research and patient care on the basis of the gender. The author then deals with the tools to undertake a specific education in gender medicine within the medical school and discusses the possibility to introduce this topic as an elective course. On the basis of the experience collected in Pisa University, statistical data are presented showing gender differences in medical school attendance and examination performance. Female students prevail in the number of candidates for admission and in the number of attending students. They get slightly better results in the clinical courses, which require direct interaction with patients. Therefore the author suggests that gender differences also affect medical education and its results. It is speculated that these differences may represent an opportunity to be exploited, rather than a defect to be corrected.

In this paper, referring to different theoretical approaches, we build an epistemological framework that allows the transition from the medicine gender to the use of this category in a multidimensional perspective of health. In particular, we examine the contributions of feminist reflection and some of the paradigms related to the criticism of scientific knowledge for a redefinition of our interpretive categories enabling them to assume the differences between men and women both biological and socio-cultural.