Carbon monoxide poisoning remains a leading cause of accidental poisoning worldwide (both at home and at work), and it is also a cause of suicidal poisoning. Such poisoning can arise following prolonged exposure to low levels of CO or following brief exposure to high concentrations of the gas. In fact, despite exposure limits, high safety standards, and the availability of CO alarms, nearly 50,000 people in the United States visit the emergency department each year due to poisoning. Additionally, CO poisoning in the United States causes up to 500 deaths each year. Despite the widespread nature of this form of poisoning, known about for centuries and whose damage mechanisms have been recognized (or rather hypothesized about) since the 1800s, early recognition, especially of late complications, and treatment remain a medical challenge. A well-designed therapeutic diagnostic process is necessary so that indication for hyperbaric or normobaric therapy is correctly made and so that patients are followed up even after acute exposure to diagnose late complications early. Furthermore, it is necessary to consider that in the setting of emergency medicine, CO poisoning can be part of a differential diagnosis along with other more frequent conditions, making its recognition difficult. The last thirty years have been marked by a significant increase in knowledge regarding the toxicity of CO, as well as its functioning and its importance at physiological concentrations in mammalian systems. This review, taking into account the significant progress made in recent years, aims to reconsider the pathogenicity of CO, which is not trivially just poisonous to tissues. A revision of the paradigm, especially as regards treatment and sequelae, appears necessary, and new studies should focus on this new point of view.

Post-traumatic stress disorder (PTSD) may arise after events involving a risk to physical integrity or to life, one’s own or that of others. It is characterized by intrusive symptoms, avoidance behaviors, and hyper-excitability. Outside certain categories (e.g., military and police), the syndrome is rarely described in the occupational setting. We report here five unusual cases of work-related PTSD, diagnosed with an interdisciplinary protocol (occupational health visit, psychiatric interview, psychological counselling and testing): (1) a 51 yr-old woman who had undergone three armed robbery attempts while working in a peripheral post office; (2) a 53 yr-old maintenance workman who had suffered serious burns on the job; (3) a 33 yr-old beauty center receptionist after sexual harassment and stalking by her male employer; (4) a 57 yr-old male psychiatrist assaulted by a psychotic outpatient; (5) a 40 yr-old woman, sales manager in a shoe store, after physical aggression by a thief. All patients required psychiatric help and pharmacological treatment, with difficulty of varying degrees in resuming work. We conclude that PTSD can develop even in professional categories generally considered to be at low risk. In such cases, a correct interdisciplinary diagnostic approach is fundamental for addressing therapy and for medico-legal actions.

Occupational stress can exceed the workers' individual capacity to adapt, and cause psychopathological conditions, including adjustment disorder (AD) and post-traumatic stress disorder (PTSD), for which medico-legal reporting is mandatory by law. Since the early 2000s, an interdisciplinary diagnostic protocol has been in use at our Institute to address patients towards an appropriate therapeutic path, in order to promote their psychological well-being and work reintegration. In 2017, the protocol was updated and expanded. The current version (MaSD-2) includes: occupational medicine examination, psychological counselling, psychiatric interview, and psychodiagnostic testing: Short-Negative Acts Questionnaire (S-NAQ), Cognitive Behavioral Assessment 2.0 (CBA-2.0), SCID (Structured Clinical Interview for DSM: Diagnostic and Statistical Manual of Mental Disorders), Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF), Maugeri Stress Index - Reduced form (MAST-R). Between 2017 and 2019, we used the MasD-2 to assess, for suspected psychopathological work-related problems, 198 patients (120 women and 78 men; mean age I SD: 47.9 ≤ 9.0 years). Nine (4.5%), already examined with the original version of the protocol, received diagnostic confirmation (2 cases of paranoid personality disorder, 7 of work-related anxiety-depressive disorder). Of the other 189 subjects, three (1.6%) were not affected by psychiatric disease, 12 (6.3%) had a psychiatric disorder (e.g., anxiety disorder, mood disorder, personality disorder) independent of work, 160 (84.7%) a work-related anxiety and or depressive disorder. DA was identified in 12 cases (6.3%), and two patients (1.1%) were diagnosed with DA in pre-existent DPTS, for a total of 14 medico-legal reports of occupational disease. Compared to the past, the case record presents a much higher percentage of psychiatric disorders related to occupational stress. This may be due to a greater sensitivity of the new diagnostic protocol, and to a better selection of the patients referred to us. Women and tertiary workers continue to be at greater risk, with significant involvement of health professionals. Diagnoses of DA and DPTS remain rare, confirming the need for a rigorous and cautious interdisciplinary approach, aimed at selecting the cases for which to start medico-legal procedures. Finally, the study calls for adequate preventive measures.

Background: Our previous experience with the “CardioWork” protocol (activated in 2005) demonstrated the usefulness of the interaction between occupational physician and cardiologist to facilitate work resumption after invasive heart procedures and subsequent rehabilitation, adapting the work tasks of the patients to the changed physical capabilities. Objectives: We surveyed the health conditions and employment status of the subjects previously studied, years after their completion of the protocol in order to verify its effectiveness over a long period of time. Methods: We contacted 125 patients included in the protocol from 2005 to 2011: 4 were deceased; 101 (94 males and 7 females; mean age: 49.2 years) participated in the study. We collected clinical data (from the hospital computer archive), as well as information on prescriptions compliance and occupation (by interview). Respondents were also asked to give a subjective judgment on their health, their re-employment, and the usefulness of the indications regarding job fitness. Results: In addition to the high survival rate, the survey showed maintenance of satisfactory clinical conditions (good left ventricular function, exercise tolerance, rare cardiological relapses, few sick-leave days), adherence to prescriptions, high employment rate, high level of subjective satisfaction. Conclusions: The study confirms the importance of appropriate rehabilitation after acute cardiac event, and the need for an interdisciplinary approach involving the occupational physician. By following this strategy, patients not only can return to work early, satisfactorily and with minimal risks, but they also tend to keep their work and to reach retirement age in good health.