[E-learning and occupational medicine: results of one experience in Italy]. / E-learning e Medicina del Lavoro: risultati di una sperimentazione in Italia.

In Italy, there is at present a certain drive in order to make e-learning for Continuous Medical Education (CME) to take off, even though a normative framework for distance CME has not been completely defined yet. This paper describes the phases of course supply and usage of an e-learning system in the occupational medicine area in Italy. The system provides 10 courses for occupational physicians and one course for nurses, physiotherapists and occupational physiotherapists. During the span of time of 11 months, 2034 users have registered to the website and 1804 of them enrolled themselves into at least one course, for a total number of 5183 course enrolments, with a mean number of course enrolments per person of about 3, and 3710 courses were successfully concluded. This study points out on one hand a wide request for this kind of educational sessions, and on the other hand good results in terms of knowledge acquisition. Since the present experimental project was aimed at contributing to the definition of the normative framework for distance education for CME, it can be expected that e-learning for CME in Italy will get off the ground in the near future.

[Usability study of an e-learning system for CME in occupational medicine: preparatory analysis and remedial actions]. / Studio di usabilità di un sistema di e-learning per l'educazione continua in Medicina del Lavoro: analisi preliminare e azioni correttive.

This paper describes the activities carried out in order to make an e-learning system for CME be a good tool in terms of usability. The following steps are described:--the needs analysis of the potential users;--the prototype of the e-learning system that has been set up;--the usability evaluation of the prototype by a sample often users before and after the implementation of the identified remedial actions. The obtained results support the hypothesis of an effective usage of the system in the near future. The follow-up of real users' usage, through the tracing facilities of the e-learning platform, will confirm or reject our hypothesis.

[Judgment on work capacity of a health worker with schizophrenia]. / Giudizio di idoneità lavorativa in un operatore sanitario affetto da schizofrenia.

We show the case of a worker affected with schizophrenia who was declared by the psychiatrist fit to work. The "Medico Competente" on the contrary, on the basis of his studies and in particular on his deep knowledge of the features of the office and the place where that worker works, decides that he is not fit to do that job. This judgement is confirmed by the "ASL-Collegio Medico". The case we described emphasizes in a very strong way what is written in the item 17, paragraph 1, letter a of the D.Lgs 626/94, which extends the judgement of the fitness to work given by the "Medico Competente" even to the psychic sphere of the worker.

[VDT and work: descriptive epidemiologic research]. / VDT e lavoro: indagine epidemiologica descrittiva.

We report the statistical elaboration of some data pertinent to a population of workers professionally exposed to VDT. These first data also confirm that the length of the use of VDT doesn't influence the judgement of fitness to work.

[Judgement of fitness to work in a health worker with schizophrenia]. / Giudizio di idoneità lavorativa in un operatore sanitario affetto da schizofrenia.

We show the case of a worker affected with schizophrenia who was declared by the psychiatrist fit to work. The "Medico Competente" on the contrary decides that he is not fit to do that job and his judgement is also confirmed by the "ASL-Collegio Medico" according to the D.Lgs 626/94, item 17, which extends the judgement of the fitness to work given by the "Medico Competente" even to the psychic sphere of the worker.

[Phenomenon of occupational accidents in hospitals: a retrospective study with reference to introduction of preventive measures and safety specified by D.Lgs 626/94]. / Il fenomeno infortunistico in ospedale: studio retrospettivo con riferimento all'introduzione delle misure preventive e di sicurezza previste dal D.Lgs 626/94.

The work analyzes the phenomenon of the professional accidents in the Policlinico S. Matteo in Pavia, in the quadrenium 1995-1998 to appraise the effects of the application of the D. Lgs 626/94. The obtained data highlight an aggregative diminution of the number of accidents in the biennium 1997-1998 in comparison with the previous biennium 1995-1996. The reduction of the phenomenon of professional accidents is linked substantially with a diminution of the number of accidents with biologic risk. In the quadrennium considered no case of serum conversion has been recorded. It doesn't result significantly altered the number of events of professional accidents linked with the manual handling of loads and with different traumatisms without biological risk. It is highlighted the necessity of more and more close collaboration between the operators of the prevention and the workers.

[Evaluation of trends in occupational pathology in clinical cases]. / Valutazione della tendenza della patologia occupazionale in una casistica clinica.

The study considered all patients admitted to the 1st Division of Occupational Medicine, Department of Preventive, Occupational and Community Medicine of the University of Pavia between January 1st 1989 and December 31st 1995 with a diagnosis of occupational disease. It was useful in illustrating the evolution of occupational disease as regards both changes in etiology and in the symptoms and systems involved. A decrease in the number of occupational diseases diagnosed from 1993 to 1995 was revealed, but it is difficult to draw any significant conclusions from these data since the need for hospitalization when diagnosing this type of disease has diminished greatly. Changes in legislation which have obliged employers to take precise preventive measures could also be partly responsible for this downward trend. The patients were, in almost all cases, at an initial stage of their disease. This is reassuring as far as the therapeutic and legal need for an early diagnosis is concerned. However, it remains unknown how often the causal relationship between work and disease was not suspected and therefore how many cases did not arrive to observation. Finally, the study confirmed the disappearance of some occupational diseases, such as benzene intoxication, common in the past, and the increase in "emerging" pathologies like allergies.

[Employment and alcohol: analysis of a clinical casuistic]. / Lavoro e alcol: analisi di una casistica clinica.

The relationship between alcohol and work was studied in a group of 537 voluntary patients (393 male and 144 female) admitted to the department of Medicina del Lavoro, Pavia University for alcohol rehabilitation. The highest incidence of alcohol abuse was found in non-working subjects (pensioners, unemployed, housewives) although the start of excessive drinking takes place after beginning a working activity; a cause-effect relationship between these two factors can not be clearly determined, however. It is true that the stress provoked by this new condition (introduction to the work experience) can, in certain subjects, be a contributing factor in alcohol abuse. The increasingly lower age of initiation to alcohol reconfirms the need for prevention and instruction even at scholastic level. We can deduce how no working condition, low age and low education can constitute makers of risk for alcohol abuse.

[Acute alcoholic myopathy]. / Miopatia alcolica acuta.

A case of acute alcoholic myopathy in a subject with a 20 year history of alcohol abuse is described. The condition emerged during an episode of delirium tremens and had a quickly deadly outcome. The rapid evolution of the clinical situation accompanied by variation in the biohumoral indices (CPK, LDH, myoglobin) is stressed and although this prevented from obtaining anatomopathological samples of the rhabdomyolisis, the specific diagnosis was made with reasonable certainty. The onset of the condition was not foreseeable because of the absence of an accurate history of the subject's alcohol abuse on his admission and of significant biohumoral data indicating the existence of an alcohol correlated pathology.

[The psychosocial problems in a population of emigrant Italian workers]. / Problematiche psicosociali in una popolazione di lavoratori italiani emigrati.

The psycho-social problems of a group of 365 Italian emigrants to Switzerland, admitted to psychiatric hospitals, were studied. It was found that non professional subjects (housewives, unemployed, retired) and manual workers (builders, waiters, factory workers) were more likely to suffer from psycho-social disorders. Only 11.1% of those studied had received a secondary education, therefore it could be assumed that subjects having a low technical and cultural level were less prepared, psychologically, for their new situation and were thus more susceptible to psycho-social disorders. The most frequent diagnoses were found to be: affective disorders, alcohol addiction, opiate addiction and schizophrenia. The study revealed that emigrants ran a greater risk of first time admittance to psychiatric wards whereas the local population had a greater number of relapses. In conclusion it is stressed that assistance with an aim to improve work, social and relationship conditions and to integrate the emigrants into their host society can reduce some forms of psycho-social disorders.

[Indoor pollution: a report of 2 clinical cases of occult carbon monoxide poisoning]. / Inquinamento indoor: presentazione di due casi clinici di ossicarbonismo occulto.

A large part of the general population is potentially exposed to excessive concentrations of carbon monoxide (CO), both in the domestic and work environment. Beside acute, often fatal poisoning, the possibility of occult intoxication should be considered; this condition can affect people who are often unaware of the existence of a toxic exposure in their homes or work places. We describe two non-smoking patients, husband and wife, 53 and 57 years old, respectively, who suffered cephalea, nausea and neurobehavioural disturbances during a period of approximately one year; these symptoms were reported to improve or disappear on several occasions during the patients' absence from home. Careful anamnesis suggested a protracted exposure to nonlethal concentrations of CO contaminating the patients' bed-chamber from the misfunctioning flue of the heating system. It was not possible to measure carboxyhaemoglobinemia until approximately 24 hours since the last presumptive exposure. The levels found were therefore relatively low (4-5%), yet higher than the reference values for normal non-smoking subjects. Carboxyhaemoglobin concentrations almost returned into the normal range during the period of hospitalization. These two cases exemplify how low level CO exposure may cause aspecific pathological manifestations that are often misdiagnosed or overlooked.

[Alcohol and work: comments on a clinical case load]. / Alcol e lavoro: considerazioni su una casistica clinica.

The relationship between alcohol and work was studied in a group of 260 voluntary patients (186 male and 74 female) admitted to the unit of Medicina del Lavoro, Pavia University for alcohol rehabilitation. The highest incidence of alcohol abuse was found in non-working subjects (pensioners, unemployed, housewives) although the start of excessive drinking takes place after beginning a working activity; a cause-effect relationship between these two factors can not be clearly determined, however. It is true that the stress provoked by this new condition (introduction to the work experience) can, in certain subjects, be a contributing factor in alcohol abuse. The increasingly lower age of initiation to alcohol reconfirms the need for prevention and instruction even at scholastic level.