Laurea Magistrale in Medicina e Chirurgia - sede di Torino

The aim of the Occupational Medicine module is to provide information and knowledge on diseases (injuries and illnesses) deriving from the risks from chemical, physical, biological, ergonomic and psychosocial agents present in the workplace. The student will have to learn the methods and techniques to correctly collect a working history (anamnesis) adequate to assess the environmental and occupational risks and possible relationships with other factors (genetic, demographic, socioeconomic) associated with the state of health or illness, and the non-specific effects of occupational risk factors, particularly for chronic degenerative diseases. The fundamental aspects of the aetiological diagnosis in occupational medicine, of the epidemiology of work-related diseases, of the classification of the most frequent occupational diseases and accidents at work will be discussed. The main tools and methods of analysis and assessment of work risk will be provided (environmental monitoring, biological monitoring, health surveillance, exposure guide values ​​and exposure limit values). For the various chemical, physical, biological and ergonomic risk factors, the occupational, environmental and individual sources, the main clinical pictures, instrumental assessments, diagnosis and prevention will be illustrated. In addition, some aspects related to information and education on occupational risks, legislative framework on safety and health in the workplace, primary and secondary prevention of occupational diseases, and the role and tasks of the competent doctor will be discussed.

The aim of the Forensic Medicine module is to provide theoretical and practical bases to: 1) address the medical legal problems of the medical profession using the fundamental notions of law; 2) to face the medical legal problems deriving from the ascertainment of the reality and chronology of death; 3) objectivating and diagnosing forensic pathology, such as damage from: blunt means; white weapon; firearm, electricity; thermal variations; mechanical asphyxia and their classification; 4) to expose and discuss essential concepts of assistance and social security; 5) know the problems of disciplinary, criminal, civil and administrative responsibility of the healthcare professional.

KNOWLEDGE AND UNDERSTANDING ABILITY

 At the end of the course students will be able to:

- know the main risk factors in work activities;

- define the criteria for protecting health and workers' rights

- identify the causes, pathogenetic and pathophysiological mechanisms of the most common occupational diseases;

- define the constituent elements to carry out a risk analysis;

- define the methods of health surveillance of workers;

- discuss a correct diagnostic approach to formulate a diagnosis of occupational disease;

- know the clinical pictures of the main occupational and work-related diseases;

- discuss the obligations of general practitioners and specialists in the workplace

- know the fundamental notions of criminal law, classify crimes, their subjective and objective elements;

- know the rules regarding the imputability and the rules concerning the abuse of alcoholic and narcotic substances;

- know the laws of the penal code concerning crimes against: life and individual safety (murder, infanticide, murder of the consenting, euthanasia, instigation and aid to suicide, beatings, injuries, abandonment of minor and incapable persons, failure to rescue ); personal freedom (sexual violence);

- know the doctor's qualifications as "public official", "public service appointee", "performing a public necessity service" and the different duties connected with them;

- know the conditions that legitimize the obligatory medical treatments and the norms that foresee them, the consent to the medical act; the requirements that make this consent valid, the information of the patient and the judicial authority (report, report, certificate, expert opinion, advice);

- know and understand the principles governing professional responsibility, guilt assessment, ascertaining responsibility.

ABILITY TO APPLY KNOWLEDGE AND UNDERSTANDING

 At the end of the lessons the students will be able to:

- interpret the causes, pathogenetic and physiopathological mechanisms of the most common occupational diseases;

- carry out a complete medical history;

- apply the constituent elements to carry out a risk analysis in the workplace;

- describe the health surveillance methods of workers exposed to risk factors;

- use the knowledge acquired for a correct diagnostic approach in the formulation of the diagnosis of occupational disease or work-related diseases

- know the clinical pictures of the main occupational diseases and the medical-legal implications that belong to the non-specialist doctor;

- interpret the reports of the most common instrumental investigations and the results of biological monitoring

- apply the criteria and methods of ascertaining death in relation to the mortuary police system and the law on transplants, recognize and describe post-mortal phenomena, evaluate the elements useful for identifying the living and the corpse;

- describe, interpret, diagnose injuries of medical-legal interest caused by: asphyxia, electricity, heat, blunt instrument, white weapon, firearm.

- to expose and discuss essential concepts of preventive and insurance medicine, both public and private: accident at work, occupational disease, pensionable invalidity and old age, civil disability, assistance from the national health service.

There are no additional activities to those described

PROGRAM OF OCCUPATIONAL MEDICINE

1. General concepts (define the relationships between work and health status, indicate the possible non-specific effects of work risk factors, especially for chronic-degenerative diseases):
2. a) clinical diagnosis and etiological diagnosis in occupational medicine, specificity of work history;
3. b) epidemiology of work-related and occupational diseases;
4. c) classification of the most frequent diseases by chemical, physical, biological, biomechanical and psychosocial agents;
5. d) accidents at work.

2. Legislative framework, primary and secondary prevention of occupational disease; normative sources of occupational medicine and medical obligations.

3. Main tools and methods of analysis and assessment and risk management:
4. a) Definitions of danger, risk, exposure and susceptibility:
5. b) Risk assessment and management: environmental monitoring; biological monitoring; health surveillance;

- the guide values ​​for interpreting the environmental monitoring data: OELs, TLVs, MAK

- the guide values ​​for interpreting biological monitoring: reference values, action levels, limit values ​​that can be used at individual or at group level;

4. The principles of environmental and occupational toxicology:
5. a) toxicokinetics: absorption, distribution, metabolism and excretion;
6. b) toxicodynamics: the main mechanisms of action;
7. c) the concepts of dose, effect and response, of dose-effect relationship and dose-response:

- interpretative models (deterministic, multifactorial, multistage);

- individual susceptibility and health surveillance.

5. Main chemical risk factors (occupational, environmental and individual sources, main clinical pictures, biological monitoring, instrumental and laboratory tests, diagnosis, prevention and possible therapy):
6. a) metal elements: lead, mercury, chromium, arsenic, cadmium, nickel, manganese;
7. b) organic solvents: aliphatic and aromatic hydrocarbons, substituted hydrocarbons (chlorinated, alcohols, aldehydes, ketones, glycols, carbon disulfide);
8. c) pesticides

6. Occupational cancer:
7. a) epidemiology, risk factors, relationship with exposure; b) pathogenetic theories and the role of occupational factors; c) diagnosis and legal aspects for the main tumors with a high etiological fraction.

7. Main respiratory diseases (risk factors, main clinical pictures; instrumental tests; laboratory tests; diagnosis; prevention and possible therapy): a) acute and chronic irritation of the upper airways and bronchial tracts; b) pneumoconiosis and asbestos-related diseases; c) occupational asthma, extrinsic allergic alveolitis; d) chronic obstructive pulmonary disease.

8. The main physical risk factors (occupational, environmental and individual sources; relevant clinical pictures; instrumental assessments; diagnosis; prevention): a) noise; b) microclimate; c) ionizing and non-ionizing radiation; d) vibrations.

9. Irritative and allergic work-related dermopathies, laboratory tests, prevention diagnosis and possible therapy.

10. Disorders and pathologies due to biomechanical risk factors (load handling, repetitive movements and incongruous postures).

11. Risk factors related to work organization and work station:
12. a) Work-related stress; b) Shift work and night work.

PROGRAM of FORENSIC MEDICINE

The Medical Deontology (CDM 2014): the duties of the doctor, information and consent; advance directives; certification; Complaints and mandatory health treatments.

Legal aspects of the profession: legal qualifications; the crime and the causal relationship. The eligibility. Exemptions and the state of necessity. Crimes against life (murder, murder of the consenting; aid and instigation to suicide; infanticide) and against individual safety (beatings, personal injuries); the abandonment of minor or incapable persons; the omission of aid; sexual violence, maltreatment; the protection of confidentiality: privacy, professional secrecy and professional secrecy.

The obligations towards the Judicial Authority: report and report. Technical consultancy and forensic expert opinion.

Special legislation: Protection of procreation and maternity (L. 194/1978; L. 40/2004).

Necroscopic Medicine.

Forensic pathology.

Social Security (INAIL, INPS, privileged pension) and Assistance (SSN, Transplantation, Civil Invalidity).
The professional responsibility of the healthcare professional (disciplinary, civil, criminal, administrative accounting).