Il medico di medicina generale (MMG) che certifica la malattia per fini lavorativi stabilisce non la prognosi clinica della malattia e il tempo necessario al paziente per la guarigione, bensì la sua rilevanza rispetto all’idoneità al lavoro specifico svolto. Oltre alle difficoltà diagnostiche a cui il MMG, come qualunque altro medico, può trovarsi di fronte, egli deve anche fare i conti con alcune problematiche specifiche legate alla certificazione di malattia ai fini lavorativi, e cioè il falso malato, il malato immaginario e il malato vero che vuole lavorare.

(1) Presidente Nazionale Sindacato Nazionale Autonomo Medici Italiani (SNAMI)

Drug-drug interactions (DDIs) are an important issue of clinical pharmacology. A drug interaction occurs when the amount or the action of a drug is altered by the administration of another drug or multiple drugs. The result of a DDI can be the onset of an adverse drug reaction (ADR), the lack or the reduction of efficacy or the increase of a pharmacological effect. Apart from pharmaceutical interactions, DDIs are generally classified as pharmacokinetic or pharmacodynamic, according to the underlying mechanism. The majority of known DDIs involve the drug metabolism. The main risk factors for DDIs are age, polypharmacy, self-medication, concomitant diseases, narrow therapeutic range and dosage. In the literature most of the studies on DDIs focused on potential interactions and most data about the epidemiology of actual DDIs are related to the out-inpatient settings with different incidences.
In general the incidence of actual DDIs is lower than that of potential ones, however DDIs represent a significant proportion of ADRs, since the absolute number of patients involved is high. The use of specific suggestions and recommendations could be effective in the reduction of ADRs from DDIs.

(1) Sezione di Farmacologia, Dipartimento di Sanità Pubblica e Medicina di Comunità, Università degli Studi di Verona, Verona
(2) Sezione di Medicina Legale, Dipartimento di Sanità Pubblica e Medicina di Comunità, Università degli Studi di Verona, Verona

INTRODUCTION. This paper has analyzed the Post-Traumatic Stress Disorder (PTSD) in order to address clinical and psychopathogenetic aspects of the disorder. An extensive literature supports the presence of a strong link between childhood trauma and dissociative symptoms, indicating this link as the primary or predominant source of PTSD. In addiction, several studies have shown that – exposed to the same traumatic conditions – not all people develop a Post Traumatic Stress Disorder, a problem not addressed by clinical research.
METHODS. The study aimed at verifying the existence of a correlation between childhood traumatic memories (sexual, psychological, and emotional abuse, exposure to family violence), and the further development of this anxiety disorder. Moreover, the research wanted to obtain a psychopathology profile of PTSD. Subjects were required to fill the Minnesota Multiphasic Personality Inventory (MMPI), including the PTSD-Keane scale, and some MMPI special scales.
RESULTS. This research has verified a statistical relationship (logistic regression) between traumatic childhood events and the development of the Post Traumatic Stress Disorder. In addition, the results obtained from the sample of psychiatric patients indicate a strong disorganization of the personality of patients with PTSD symptomatology.
DISCUSSION. The data show that childhood trauma organize a basic vulnerability.

(1) Dipartimento di Psichiatria ASL5, La Spezia

Work-related stress is the adverse reaction people have to excessive pressures or other types of demand placed on them at work. Its prevalence is growing, probably because of changes in the workplace and work organization related to globalization. Its definition, diagnosis and aetiology are difficult to delimitate. The Authors report an analysis, based on data of the Pisa Centre, on possible causes of this disorder. The analysis highlights that most of the cases of work-related stress are related to the presence of adjustment disorders and suggests that in many cases this disorder may represent the first step of other psychiatric disorders related to occupational stress. From a legal point of view, it’s difficult to establish standard and objective criteria in order to classify this disorder as a professional disease.

(1) Azienda Ospedaliero-Universitaria Pisana, Ambulatorio per il Disadattamento Lavorativo U.O. Medicina Preventiva del Lavoro, Pisa

The surgical patients’ path in the operating block is characterised by the transition through different rooms and by the management by several workers of the medical staff. The number of required steps may affect the efficiency of the system, and new engineering methods are underway in order to improve
the overall management of surgical interventions.
The case of the hospital of Forlì is here analysed: the introduction of a technological system, involving a personal digital assistant, is here described, together with the outcomes obtained by means of this tool. Of paramount importance are the results obtained, i.e. the reduction of the unscheduled interventions, the decrease in the overtime work, and the zeroing of the major mistakes.

(1) Data Manager, AUSL Forlì
(2) Anestesista, UO Anestesia e Rianimazione, AUSL Forlì
(3) Direttore Dipartimento Emergenza, AUSL Forlì
(4) Direttore Medicina Legale e Gestione del Rischio, AUSL Ravenna; già Risk Manager AUSL Forlì