Caldi Fabrizio, Guglielmi Giovanni, Cristaudo Alfonso
U.O. Medicina Preventiva del Lavoro - Azienda Ospedaliero Universitaria Pisana.
Dipartimento di Ricerca Traslazionale e delle Nuove Tecnologie in Medicina e Chirurgia, Università di Pisa.
G Ital Med Lav Ergon. 2019 Mar;41(1):5-13.
The protection of the worker affected by neoplastic pathologies and his reintegration into work represent subjects of undoubted relevance for the occupational physician. Many are the workers affected by neoplastic diseases and more are those who are able to regain good living conditions and sufficient work capacity to be reintegrated into profitable work. Several rights are related to the assessment of a certain percentage of disability, the recognition of "Handicap in a serious situation", and others according to the requirements of the Italian law for the right to work of disabled people -L. 68/99 s.m.i.-.
The Occupational Physician manages the oncology patient through the targeted placement ex L. 68/99 s.m.i. or, more often, during the activity of health surveillance has to assess whether the job, considering the risks connected to it, is compatible with the conditions of biological validity of the worker, identifying, possibly, prescriptions or limitations.
In our experience, customized working plan is an operational methodology that has proved to be very useful. In practice, the Occupational Physician uses a method to help the back to work of the worker with disability, formalizing before the limits to the performance of the work activity. The assessment of fitness for work is related to a work plan presented by the employer, based on the indications of the occupational physician, based on disability (health conditions / worker's susceptibility) that modulates or avoids job tasks that could prove harmful or aggravating the health condition of the employee. Teleworking and smart working can also be considered among the possible protection measures.
Finally, it is useful to recall the role of INAIL for workers with a recognized neoplastic pathology related to work. With the Italian law 190/2014 art. 1, paragraph 166 are assigned to the INAIL the skills relating to the reintegration and work integration of people with disabilities from work with expenses for the INAIL. There are therefore a number of reference measures by the INAIL and the types of interventions for reintegration are identified..
保护受肿瘤疾病影响的工人并使其重新回到工作岗位，这对职业医生来说无疑是具有重要意义的课题。受肿瘤疾病影响的工人众多，而能够重新获得良好生活条件和足够工作能力以重新回到有益工作岗位的人则更多。根据意大利残疾人工作权利法（第68/99号法律，中小企业法）的要求，有多项权利与一定比例的残疾评估、“严重情况下的残疾认定”等相关。
职业医生通过第68/99号法律规定的定向安置来管理肿瘤患者，或者更常见的是，在健康监测活动期间，必须评估工作，考虑到与之相关的风险，是否与工人的生物有效性条件相兼容，并尽可能确定处方或限制。
根据我们的经验，定制工作计划是一种已被证明非常有用的操作方法。实际上，职业医生采用一种方法来帮助残疾工人重返工作岗位，在工作活动表现的限制之前进行形式化。工作适应性评估与雇主根据职业医生的指示提出的工作计划相关，该计划基于残疾情况（健康状况/工人易感性），调节或避免可能被证明对员工健康有害或加重其健康状况的工作任务。远程工作和智能工作也可被视为可能的保护措施。
最后，有必要回顾国家工伤事故保险协会（INAIL）对与工作相关的已确认肿瘤疾病工人的作用。根据意大利第190/2014号法律第1条第166款，国家工伤事故保险协会被赋予了与残疾人从工作中重新融入和工作整合相关的技能，并由国家工伤事故保险协会承担费用。因此，国家工伤事故保险协会有一些参考措施，并确定了重新融入的干预类型。
