Does an occupational physician have a duty to carry out general clinical assessments?

An occupational physician is employed to be responsible for the overall assessment of workers' health risks and all work-related pathological situations which creates an unusual doctor-patient relationship. The duties of the occupational physician are also very limited as is their professional responsibility. However, the boundaries of the occupational physician's duties and responsibilities are not always clear. The purpose of this article is to answer the following question: Does the occupational doctor have a duty to carry out general clinical evaluations (not work-related) of the patient?

[Decisions on the state of health of employees and applicants for work with the use of ICT media]. / Wydawanie orzeczen o stanie zdrowia pracowników i osób ubiegajacych sie o prace z wykorzystaniem teleinformatycznych srodków przekazu.

BACKGROUND: The applicable law permits the use of information and communications technology (ICT) media in the process of providing health services, including preventive examinations. The right to perform preventive examinations using ICT should not be identified with an absolute obligation in this respect. An occupational medicine doctor may refuse to perform a preventive examination remotely if the specificity of medical activities and patient safety require personal contact with the doctor. The state of the epidemic prompted the legislator to adopt solutions enabling employees to continue working on the basis of an invalid decision, provided that it expired after March 7, 2020. The obligation to perform preventive examinations has been suspended, as a result of which their conduction during the epidemic is pointless. However, the obligations of the employee and the employer must be fulfilled in this respect immediately, but not later than within 60 days from the date of the epidemic cancellation. MATERIAL AND METHODS: The study uses the method of analyzing the currently applicable legal provisions allowing the use of ICT in the provision of health services. In addition, regulations governing the possibility of obliging employees to work remotely during the epidemic were also analyzed, together with the non-performance of preventive examinations and admissibility of work under a decision which had expired before March 7, 2020. RESULTS: Current legal regulations are ambiguous and cause interpretation difficulties. The possibility of issuing decisions as a result of preventive examinations is a potential risk of liability for doctors who do not have specialist knowledge in the field of occupational medicine. CONCLUSIONS: The solutions of the Act on COVID-19 regarding the performance of preventive examinations introduce new rights and obligations for employees and employers as well as doctors. Their implementation is necessary due to the purpose of the newly introduced regulations, whose task is to minimize the risk of the COVID-19 infection. At the same time, it is necessary to adopt a unified position with regard to the rights and obligations of doctors issuing decisions for the purposes specified in the Labor Code. Med Pr. 2021;72(1):19-27.

[Diagnostic difficulties and legal analysis of potential claims to occupational medicine specialists based on a case of unrecognizable cardiac angiosarcoma]. / Trudnosci diagnostyczne i analiza prawna potencjalnych roszczen wobec lekarza medycyny pracy na przykladzie nierozpoznanego naczyniakomiesaka serca.

The article presents a case of sudden death of a 56-year-old woman at the workplace, caused by a very rare primary cardiac tumor. The patient's family reported a crime to the prosecutor's office suggesting participation of third parties in causing the death or malpractice in physical examinations before the death. A review of clinical data concerning cardiac angiosarcoma, available in electronic databases (e.g., Web of Science, PubMed), was presented, which could be useful in the practice of occupational medicine specialists. A legal analysis of potential claims to occupational medicine specialist in the case of failure to recognize primary cardiac tumors was also included in the article. Med Pr. 2020;71(6):757-64.

[Medico-legal considerations and occupational medicine issues regarding the targeted employment of disabled persons: regulatory review, current social and medical operational guidelines and current application phenomena]. / Considerazioni medico-legali e di medicina del lavoro in merito al collocamento lavorativo mirato dei soggetti disabili: disamina normativa, attuali orientamenti operativi socio-sanitari ed odierne fattualità applicative.

SUMMARY: The Authors examine developments in Italian legislation concerning compulsory work placements for disabled people, comparing them to those of other countries, and focusing in particular on the operational aspects of the assessment committees set up under Italian legislative decree 68/1999; these commissions are tasked with a global assessment of the disabled individual, using multiple socio-health and occupational medicine perspectives, as well as through a conclusive medico-legal assessment. The work focuses on the delicate role played by these committees in adequately weighing up the residual working capacity of the disabled individual in order to place him/her in the most appropriate and least aggravating workplace in terms of the disorders they are affected by; this is possible by transferring the socio-work profile drawn up by the evaluation committee into the context of the labour market. Finally, the Authors try to highlight how this task has become even more difficult due to the economic and labour crises that have affected several of the employment sectors in Italy in recent years.

[Assessment of Asbestos-related Occupational Diseases: Socio-medical and Legal Aspects]. / Sozialmedizinische und sozialjuristische Aspekte in der Zusammenhangsbegutachtung asbestbedingter Berufskrankheiten.

Occupational diseases are certain diseases designated as such by law. Whereas the medical conditions are described in guidelines, their recognition is based on judicial administrative procedures. Establishing causality is based on requirements of social law. The basic socio-legal concepts are mentioned and the principles of causality in asbestos-related occupational diseases are listed. Exemplary social court judgments are cited. Judgements may not infrequently differ from the medical point of view. The aim of this article is to describe the correct use of social medical understanding in order to carry out adequate assessment of occupational diseases, which implements the legal requirements.

Socialized occupational medicine in Israel: past, present, and future.

Occupational health in Israel is unique as it was originally established as a socialized service which anchored in extensive legislation and is accessible to all employees and employers without copayment. We review historical processes and legal basis that led to current structure of public occupational medicine services in Israel. Some of these go back a century and others extend way back to biblical times. Representative case studies from the field are used to illustrate its scope of practice. Legislative changes that exempted the employers from participation in financing occupational health have led to severe budget cuts, jeopardizing the future provision and key principles of occupational healthcare. We discuss future aspects of recommended development vectors for policy making that will preserve the structure of occupational health services and benefits it offers to all workers in Israel.

La formación y conocimiento en Medicina del Trabajo como piedra angular en el desarrollo de esta especialidad / No disponible

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La Dirección de Higiene y Seguridad del Trabajo en torno a las tensiones por la delimitación de su función en el Estado peronista / The Dirección de Higiene y Seguridad del Trabajo: tensions around the demarcation of its function in the Peronist State

A mediados del siglo pasado, durante los gobiernos de Juan Domingo Perón (1946-1952/1952-1955), el Estado argentino atravesó profundas transformaciones. En el seno del Poder Ejecutivo, se diseñaron nuevas áreas de incumbencia, entre ellas la de Trabajo y Previsión, con la creación de la Secretaría en 1943 y del Ministerio, seis años más tarde. La organización interna de esta repartición estatal contempló la construcción de una dirección que pretendía incidir en la definición y control de las condiciones de seguridad e higiene en los establecimientos laborales, a cargo del Dr. Leopoldo Bard, una figura de extensa trayectoria profesional y política. Esto representó fricciones con la Secretaría de Salud Pública por asegurar el bienestar, la salud y la productividad de los trabajadores, como parte de un objetivo más abarcativo que buscaba desarrollar servicios sanitarios para la mayoría de la población. Pero también significó la apelación a saberes vinculados a la medicina del trabajo, un campo profesional de contornos poco precisos, atravesado por la relación entre varios perfiles profesionales. Mediante el análisis de publicaciones especializadas y estatales, este trabajo propone, en primer lugar, trazar un panorama sobre la conformación de un campo de la medicina del trabajo en la Argentina de la primera mitad del siglo XX, para luego enfocarse en algunos de los avatares de la organización y funcionamiento de la Dirección de Higiene y Seguridad del Trabajo del área de Trabajo y Previsión durante el primer peronismo

During Peron's presidencies (1946-1952/1952-1955), the Argentinean State underwent a period of profound transformation. The Executive Power became more complex with the development of new areas of intervention, including the creation of the Secretaría de Trabajo y Previsión in 1943 and then of the Ministry six years later. The organization of this area included the construction of an approach designed to influence and control safety and health conditions in a wide range of work settings. This endeavor was led by Dr. Leopoldo Bard, a figure with considerable professional and political experience. The process created tensions with the Secretaría de Salud Pública, because both departments had an interest in the preservation of workers' health as part of a wider strategy to develop health services for the majority of the population. It also represented the utilization of knowledge linked to occupational medicine, still a poorly-defined field in mid-20th century Argentina, in which various professions met and exchanged their expertise. Through analysis of specialist and state publications, this article first reconstructs some highlights of the process by which the field of occupational medicine was shaped during the first decades of the 20th century. It then focuses on the organization and functioning of the Dirección de Higiene y Seguridad del Trabajo of the Trabajo y Previsión area during the years of the so-called First Peronism

La Sección de Medicina del Trabajo de la Unión Europea de Médicos Especialistas (UEMS) / No disponible

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Discrepancies in the evaluation of incapacity for work in a patient with epidermolysis bullosa acquisita between public pension fund and occupational medicine expert raise the issue of competencies.

Abstrat A 50-year-old female patient suffering from a severe form of epidermolysis bullosa acquisita (EBA) took legal action against the Croatian Pension Insurance Institute (CPII) in an attempt to overturn their assessment that she was no longer capable of working as a seamstress but still capable of doing administrative jobs. Her claim was that she was not capable of doing any job at all. She was first diagnosed EBA in 2000, and the disease progressed slowly with intermittent remissions. In 2012, skin erosions appeared on her feet, followed by the loss of all toenails and lesions and infiltrations on the tongue and oral mucosa. Her whole body was covered in oozing wounds, she was in pain, and parts of her skin would stick to fabric while changing clothes or bandages. The most recent findings showed oesophageal stricture. She can consume only liquid food and is on the waiting list for receiving a feeding tube. The occupational health expert witness confirmed that the patient was generally incapable of work and was fighting her life. The judge and CPII lawyers fully accepted this report and the earlier assessment was overturned. To avoid incompetent assessments of working (in)capacity in the future, CPII and similar institutions should engage occupational medicine specialists to work in their assessment teams.

Burnout syndrome as an occupational disease in the European Union: an exploratory study.

The risk of psychological disorders influencing the health of workers increases in accordance with growing requirements on employees across various professions. This study aimed to compare approaches to the burnout syndrome in European countries. A questionnaire focusing on stress-related occupational diseases was distributed to national experts of 28 European Union countries. A total of 23 countries responded. In 9 countries (Denmark, Estonia, France, Hungary, Latvia, Netherlands, Portugal, Slovakia and Sweden) burnout syndrome may be acknowledged as an occupational disease. Latvia has burnout syndrome explicitly included on the List of ODs. Compensation for burnout syndrome has been awarded in Denmark, France, Latvia, Portugal and Sweden. Only in 39% of the countries a possibility to acknowledge burnout syndrome as an occupational disease exists, with most of compensated cases only occurring in recent years. New systems to collect data on suspected cases have been developed reflecting the growing recognition of the impact of the psychosocial work environment. In agreement with the EU legislation, all EU countries in the study have an action plan to prevent stress at the workplace.

International legal regulation of impact of occupational injuries and diseases on agricultural workers' health.

INTRODUCTION: Agricultural workers' health depends on many factors: working conditions, security arrangements, medicine, quality of drugs, the environment, etc. Occupational injuries and diseases are also among the factors that can negatively affect their health. THE AIM: To analyze provisions of the international legislation and scientific literature concerning existence of restrictions on impact of occupational injuries and diseases on agricultural workers' health. MATERIALS AND METHODS: International acts, data of international organizations and conclusions of scientists have been examined and used in the study. The article also integrates information from scientific journals and monographs from a medical and legal point of view with scientific methods. This article is based on dialectical, comparative, analytic, synthetic and comprehensive research methods. Impact of occupational injuries and diseases on agricultural workers' health has been studied within the system approach, as well as analysis and synthesis. CONCLUSIONS: The level of occupational morbidity, traumatism and above all standard of agricultural workers' health depends on the way of occupational safety organization. Working conditions and safety in agricultural industry and therefore the appropriate standard of health remain unsatisfactory in many countries.

[Is burnout a syndrome or an occupational disease? Instructions for occupational physicians]. / Il burnout è una sindrome o una malattia professionale? Istruzioni per i medici del lavoro.

Since Herbert Freudenberger described Burnout Syndrome (BOS) in 1974, thousands of scientific papers have been published on this syndrome and this trend does not seem to diminish. After being internationally known as a syndrome characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment in helping professions, its construct has been criticized, questioned, and subjected to profound modifications. To date, however, in Italy and in many other Countries it is not possible to diagnose this syndrome, because World Health Organization, in its last ICD-10, did not indicate any clinical criteria to diagnose it. Unfortunately, not even in the recent DSM- 5 by American Psychiatric Association, contrary to what was expected, BOS found room as a specific psychiatric disorder. As a consequence, framing this syndrome from a medical-legal point of view is still widely debated from scholars.

Training in Occupational Medicine: Jurisprudential Malfunctions in the Italian System and European Perspectives.

BACKGROUND: To practice occupational health in Europe, a medical doctor must qualify in occupational medicine. This requires a period of postgraduate specialist medical training lasting a minimum of four years, in conformity with European regulations, to obtain a certificate of completion of training which is then mutually recognized within the entire European Union. DISCUSSION: In 2002 an Italian law allowed doctors specialized in public health medicine and legal/forensic medicine to also practice as consultants in occupational medicine in the country. However a subsequent law in 2008 determined that only physicians specialized in occupational medicine could freely practice as consultants in this discipline. The other two categories (consultants in public health medicine and consultants in legal/forensic medicine) were required to undertake additional training (a Master course) to qualify as consultants in occupational medicine. CONCLUSIONS: Doctors who entered postgraduate training in public health or legal/forensic medicine before 2008, with the option to practice also as consultants in occupational medicine upon completion of their training, suffered an unprecedented and legally questionable retroactive application of this new law which stripped them of previously acquired rights. Moreover, even after qualifying by undertaking this extra training in occupational medicine, the latter two categories of doctors do not have their training recognized in other member states of the European Union. To disallow the rights of doctors qualified in occupational medicine to work as consultants in the latter medical discipline elsewhere within the European Union seems a clear violation of professional rights and, as such, legal action could be taken to submit this issue to European attention.

Trasplantes de órganos y su incidencia sobre la relación laboral. Especial referencia a la situación de Incapacidad Permanente de las personas trasplantadas / Organ transplantation and its impact on employment. Special reference to the situation of permanent disability of transplanted people

Muy pocas veces se han analizado desde un punto de vista jurídico los efectos que el trasplante de órganos puede desplegar en el ámbito del Derecho del Trabajo y de la Seguridad Social. En el presente trabajo se exponen las principales medidas de contenido socio-laboral actualmente vigentes destinadas a ofrecer una protección especial a este tipo de pacientes, a través de las que se trata de evitar que esta situación desencadene el abandono prematuro e involuntario de la vida activa (AU)

The effects of organ transplantation have been rarely addressed from a legal perspective in the Labor and Social Security Law. This paper analyzes the current, main social and labor regulations, designed to provide special protection to transplanted patients, which prevent the premature and involuntary abandonment of working life (AU)

[The attention of Istituto Superiore di Sanità to the sex/gender differences in workers health prevention and promotion.] / L'attenzione dell'Istituto Superiore di Sanità alle differenze di sesso/genere nella prevenzione e promozione della salute dei lavoratori.

OBJECTIVES: Gender medicine is a multi-faceted field of investigation integrating various aspects of psycho-social and biological sciences but it mainly deals with the impact of the gender on human physiology, pathophysiology, and clinical features of diseases. In Italy, the Decree Law 81/2008 recently introduced the gender issue in the risk assessment at the workplaces. METHODS: This review briefly describes our current knowledge on gender medicine and on the Italian legislation in risk management. Public or private scientific institutions should be the first to pay attention to the safety of their workers, who are simultaneously subjected to biological, chemical and physical agents. The Istituto Superiore di Sanità (ISS) is beginning a project funded by INAIL, to monitor the hepatitis B, measles, rubella, mumps, pertussis, chickenpox, tetanus vaccines immune coverage in health care workers in Italy. RESULTS: The analysis of the collected data will be disaggregated for men and women and statistically analyzed with respect to the time intervals from vaccination. CONCLUSIONS: The results could provide useful elements to implement prevention and health surveillance programs in occupational medicine.

[The complaint of suspected occupational disease: news, critical issues and applicative suggestions]. / La denuncia di sospetta tecnopatia: novità e criticità normative, suggerimenti applicativi.

OBJECTIVES: The Legislative Decree n. 151 of 14 September 2015 lays down new provisions concerning the DPR 1124/65. The major developments occur with Article 53 of Presidential Decree 1124/65, which transfer the obligation to send the medical certificate, attached to the report of accident and occupational disease, from the employer to the physician - "every physician lends immediate assistance to an injured worker or to a worker that suffers from an occupational disease" - using telematic systems, either directly or through the health facilities. There are however residual critical issues not easily overcome by the general pratictioner or by the physician not specialist in occupational medicine, because of the impossibility of knowing the real occupational causative agents of disease and the production cycle. So, the general practitioner cannot properly study the link between damage to health and work. In addition, there are no indications for diseases not included by tables (DM 09.04.2008) and lists (DM 10.06.2014), which should be evaluated about the possible occupational origin. Moreover, there is no indication of reporting for the pathologies present in the tables of occupational diseases, but not included in the lists of the DM 10.06.2014, and for the diseases with nosological differences between the tables of occupational diseases and lists, as well as those that the doctor believed to be linked to exposure at work, although not included in the two documents (tables or lists). To date, there are other technical critical issues that the legislation seems to overlook. In any of the laws reported (and even in the recent legislation) is mentioned the key element essential to evaluate, according to technical and scientific criteria, the first occupational origin attribution of a suspected technopathy: the results of an appropriate and specific risk assessment of the recognized causative agent. METHODS: We propose an operational way to create a technical and sustainable system of reporting suspicious technopathies. RESULTS: This system should be based on the figure and the role of occupational physician, both as a "competent" physician, according to the Legislative Decree n. 81/08 (in Italy), both as a doctor inserted in the community and hospital health services (in Lombardy these services are organized in the Health Protection Agencies - ATS - and in the Operative Unit Hospital of Occupational Medicine (UOOML of socio-territorial health companies - ASST). CONCLUSIONS: Complementarily, an organized reporting system should be based on risk assessment (according to art. 17 of Legislative Decree n. 81/08). Other aims are to overcome outdated practices, create a constant channel of dialogue between the territorial and the hospital health centers, send and capture in a structured and efficient way reports of technopathy, track all occupational disease reports and create a dedicated archive.