Résumé
Unclear labor relationship is the most common challenging issue in occupational disease diagnosis. At present, there are three main errors in the understanding regarding labor relationship in the process of occupational disease diagnosis. Firstly, labor relationship does not need to be considered in occupational disease diagnosis. Secondly, labor relationship must exist in order to initiate the occupational disease diagnosis procedure. Lastly, there is an overreach in handling labor relationship issues beyond one's authority. Labor relationship is the basic and antecedent problem which cannot be avoided in occupational diseases diagnosis. While officially, labor relationship issue should be considered in occupational disease diagnosis, they are not a necessary condition. The occupational diseases diagnosis requires actual labor and employment relations. If the workers with actual labor-relation are suspected to have health injuries caused by occupational hazards in the workplace, they are eligible for occupational diseases diagnosis. But it is not the responsibility of health department to judge the labor relationship. When a dispute arises between a worker and an employer regarding labor relationship, the resolution of the relevant dispute shall be submitted to the human resources and social services department or the labor and personnel arbitration committee, or submitted to the court for adjudication according to law. In the process of occupational disease diagnosis, the two reasonable disposal procedures for verifying actual labor and employment relationship involve workers submitting evidence of their labor relationship with the employer, and the employer's verification. If the employer disputes the labor relationship as presented by the worker, the occupational disease diagnosis institution should inform the worker to apply for labor dispute arbitration. However, it is important to note that arbitration or mediation documents from the court cannot be used as evidence in occupational disease diagnosis.
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Objective To analyze the diagnosis cases of occupational benzene poisoning in gas station industry, and to explore the application of GC-MS technology in occupational disease diagnosis. Methods The epidemiological method was used to describe and analyze the occupational disease diagnosis of 15 gas station workers , and qualitative screening of occupational hazard factors was performed by GC-MS. Results All the 15 workers had more than one year's occupation history of oil refueling and unloading. The clinical manifestations were consistent with the characteristics of chronic benzene poisoning in diagnosis of occupational benzene poisoning. However, due to lack of evidence of occupational exposure to benzene and incomplete diagnostic data, occupational chronic benzene poisoning was not diagnosed. GC-MS technology was used to screen the occupational hazard factors in the gas station workplace, and benzene, n-pentane, n-hexane and so on were found. Conclusion GC-MS is recommended for qualitative screening of organic solvents such as benzene when diagnosing occupational diseases for gas station workers , so as to accurately identify occupational hazard factors in workplaces and provide reliable basis for diagnosis of occupational diseases.
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@#Improving the efficiency of occupational disease diagnosis and verification is conducive to protecting the rights and interests of workers, better realizing the legislative value pursuit of the Law of the People's Republic of China on the Prevention and Control of Occupational Diseases, and truly demonstrating the spirit of legal fairness and justice. In 2021, the Administration Measures for the Diagnosis and Verification of Occupational Disease was revised and implemented. The working procedures of occupational disease diagnosis are adjusted and optimized, and the efficiency of diagnosis of occupational disease is greatly improved. They include items such as new provisions specifying working time limits; optimize the working mode; the diagnosis of occupational disease attribution applies to presumptive causality is emphasized and the logical thinking of inversion of burden of proof is carried out. However, the work efficiency of occupational disease diagnosis does not make a great breakthrough in quality, mainly manifests in three aspects: difficult to confirm labor relationships, raising the threshold of occupational disease diagnosis, the administrative field investigation is empty and the diagnosis of occupational disease is complicated. There are many pre-procedures in occupational disease diagnosis, which restrict the efficiency of diagnosis. In the future, attention needs to be paid to promote the independent work of occupational disease diagnosis institutions, and through the revision of the Law of the People's Republic of China on the Prevention and Control of Occupational Diseases. Occupational disease diagnosis institutions should be empowered to confirm labor relationship, so as to lower the threshold of diagnosis of occupational disease and maximize the protection of the rights and interests of workers.
Résumé
Background China is facing enormous challenges of occupational disease prevention and control and high incidences of occupational diseases. Occupational disease diagnosis is an important part of occupational disease prevention and control. However, the current situation of occupational disease diagnosis service system in China is not optimistic. Relevant national laws, regulations, policies, and plans require to improve the current technical support system of occupational disease diagnosis and treatment, and to establish a sound occupational disease diagnosis, treatment, and rehabilitation network on the foundation of existing medical and health institutions. Objective To analyze the development status and existing problems of occupational disease diagnosis institutions in China, and propose countermeasures and suggestions. Methods All occupational disease diagnosis institutions in China were surveyed by questionnaire using comprehensive census. The Occupational Health Center of the National Health Commission organized the preparation of the questionnaire and the participation of all relevant institutions in the survey. All data collected in the survey were for the year 2020 and available as of December 31, 2020. The questionnaire covered the overall situation, service provided, staffing of certified physicians for providing occupational disease diagnosis, and instruments in selected categories of occupational disease diagnosis institutions. Results As of December 2020, there were 587 occupational disease diagnosis institutions in China; the highest average number of enterprises served by an occupational disease diagnosis institution was 39000, and that of employees served by an occupational disease diagnosis institution was 2.15 million in Chongqing. There were a total of 5809 physicians certified to diagnose occupational diseases in China, with 20.4 doctors per specified occupational disease prevention and treatment hospital, 9.5 doctors per general hospital, and 8.3 doctors per disease control and prevention center. Only 87.7% of the institutions were equipped with digital radiography (DR), 58.1% with computed tomography (CT), and 96.4% with pulmonary function meters; the equipment rate of computed radiography (CR) was only 6.5%, and that of CT was only 14.6% in all-level disease control and prevention centers; 45 disease control and prevention centers were not equipped with any common x-ray machine, CR, DR, or CT. Conclusion In the face of the still serious situation of prevention and treatment of occupational diseases, the overall distribution of institutions is uneven around China, the number of institutions in some regions is relatively insufficient, and the comprehensive capacity of centers for disease control and prevention at all levels needs to be improved. Strengthening comprehensive capacity building of occupational disease diagnosis institutions and training of relevant physicians would be helpful to ensure the accuracy and scientificity of diagnosis. At the national level, further increasing policy guidance and financial input would help occupational disease diagnosis institutions upgrade their techniques and service capacity, and protect workers' occupational health rights.
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Objective@#To investigate the epidemiological characteristics of suspected cases with occupational diseases and analyze the quality of occupational diseases report in Huzhou City from 2016 to 2020, so as to provide insights into supervision and early warning of occupational diseases.@*Methods@#The epidemiological data pertaining to suspected cases with occupational diseases reported in Huzhou City from 2016 to 2020 were retrieved from the Occupational Disease and Health Risk Factors Monitoring Information System of China Disease Prevention and Control Information System, including gender, age, type of job, industry category, enterprise size and diagnosis. The percentages of identification, diagnosis and definitive diagnosis were calculated, and the distribution and diagnosis of suspected cases with occupational diseases were descriptively analyzed among different regions, industry categories and enterprise sizes.@*Results@#A total of 264 398 people underwent occupational health examinations in Huzhou City from 2016 to 2020, and 322 suspected cases with occupational diseases were detected (12.18/104), including 179 cases with suspected pneumoconiosis (55.59%), 78 cases with suspected occupational ear, nose, throat and oral diseases (24.22%), 54 cases with suspected occupational poisoning (16.77%), 6 cases with suspected occupational skin diseases (1.86%), 3 cases with suspected occupational diseases caused by physical factors (0.93%) and 2 cases with other suspected respiratory diseases (0.62%). The 322 cases with suspected occupational diseases included 290 men (90.06%) and 32 women (9.94%), and had a mean age of (53.28±9.20) years. A total of 207 cases underwent occupational diseases diagnosis (64.29%), and 155 cases were definitively diagnosed with occupational diseases (74.88%). Among different counties (districts) in Huzhou City, the highest number of suspected cases with occupational diseases was reported in Changxing County (101 cases, 31.37%), with a diagnostic rate of 88.12%, and among all enterprises, the highest number of suspected cases with occupational diseases was reported in small enterprises (220 cases, 68.32%), with a diagnostic rate of 68.64%, while among all industry categories, the highest number of suspected cases with occupational diseases was reported in manufacture industry (228 cases, 70.81%), with a diagnostic rate of 56.14%. In addition, there was no suspected case with occupational diseases detected in agriculture, forestry, animal husbandry, fishery, wholesale/retail trade industry, or public administration, social security or social organizations.@*Conclusion@#Pneumoconiosis was the predominant type of suspected occupational diseases in Huzhou City from 2016 to 2020, and a low diagnostic rate was found. Improved supervision of occupational diseases control is strongly recommended among small enterprises to standardize the reporting system of suspected occupational diseases.
Résumé
As occupational health work enters a new era, the diagnosis and identification of occupational diseases, that are closely related to the protection of workers′ health rights, require higher and newer standards. In 2021, the National Health Commission of the People′s Republic of China revised and issued the Administrative Measures for the Diagnosis and Verification of Occupational Diseases to improve and perfect the original diagnosis and verification system of occupational diseases. These measures clarify the time limit for diagnosis of occupational diseases and shorten the time limit for identification of occupational diseases; and strengthen the main responsibility of the employer. This new system design is more operable. It embodies the management idea of Streamline administration, delegate power, combine decentralization, and optimize services. The language expression is more accurate and standardized. The revision of the Administrative Measures for Diagnosis and Verification of Occupational Disease is conducive to improving the efficiency of occupational disease diagnosis and protecting the rights and interests of workers. It is conducive to strengthening the supervision and management of occupational disease diagnosis institutions and occupational disease verification offices by administrative supervision and management departments. It is conducive to strengthening the responsibilities of employers. However, there are some problems: Article No. 28 sets up obstacles to the realization of legal value, which does not clearly stipulate the concept of new evidence. The effective time of this regulation has caused difficulties for occupational disease diagnosis institutions and occupational disease verification offices. It is recommended that this regulation can be further improved in the future revisions.
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OBJECTIVE: To analyze the clinical manifestations and diagnostic points of patients with peritoneal mesothelioma caused by occupational asbestos. METHODS: The clinical data of a female patient with peritoneal mesothelioma caused by occupational asbestos and the diagnosis of occupational diseases were retrospectively analyzed. RESULTS: In 2016, the patient was diagnosed and treated in a number of hospitals in a province due to chest and back pain, persistent cough, suffocation, and foamy sputum. After laparoscopic surgery, the peritoneal biopsy was taken for pathological analysis and diagnosed as peritoneal mesothelioma. In December 2016, she died due to a worsening of her condition and lung infection. The patient′s family requested occupational disease diagnosis in May 2017. After investigation and verification by the local occupational disease diagnosis agency and the Bureau of Industry and Information Technology, it was clear that the patient had a history of occupational exposure to asbestos for a total of 23 years and two months. In July 2018, she was retrospectively diagnosed as an occupational tumor(mesothelioma caused by asbestos). CONCLUSION: A clear history of occupational exposure to asbestos and histopathological examination are helpful for the diagnosis of occupational tumors(mesothelioma caused by asbestos).
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OBJECTIVE: To explore the essential conditions and principles of conclusion for suspected occupational disease in order to protect the rights and interests of worker. METHODS: In reference to the legal concept interpretation and the principle of rights remedy,suspected occupational disease was defined,and the related judging organizations,decision criteria and reporting procedures were analyzed. RESULTS: Suspected occupational disease might be defined as the disease state in a specific time period when the preliminary diagnosis of suspected occupational disease was made by the occupational health examination institutions or occupational disease diagnosis organizations,without definite diagnosis by the occupational disease diagnosis organizations and no conclusion of occupational disease diagnosis( identification). We recommended that the conclusion of suspected occupational disease should be made by the occupational health examination institution and occupational disease diagnosis organization according to the criteria of occupational disease diagnosis. The suspected occupational disease should be reported based on the regulation and standard of occupational disease diagnosis.CONCLUSION: The determination of suspected occupational diseases should be strict,and the medical institutions which can make diagnostic conclusion of suspected occupational disease and the relevant requirements should be clear. The diagnostic criteria of suspected occupational disease and reporting procedures should be standardized.
Résumé
OBJECTIVES: Pneumoconisis and noise-induced hearing loss(NIHL) have been reported as main occupational diseases by the Special Health Examination. The Industrial Accident Compensation Insurance has reported various work-related diseases, however, these two diseases occupied almost a half of compensated cases. Therefore, it was not well known about the status of occupational diseases other than pneumoconiosis, NIHL, and cardiocerebrovascular accident(CVA). This study was conducted to analyze claimed cases as an occupational disease, that was requested to the Korea Industrial Safety and Health Agency (KOSHA). METHODS: The local office of the Korea Labor Welfare Corporation(KLWC) has asked the KOSHA for confirmation of claimed cases as an occupational disease. We analyzed 379 cases requested from KLWC, the Ministry of Labor, employers, unions and occupational health agencies from 1992 to 1999. RESULTS: Male was 80. 7 % of the requested cases. Their mean age was 42 years old and 75. 5 % of them were more than 35 years old. The requested cases were increased rapidly from 25 cases in 1992 to 108 cases in 1999 and the accept rate was 50. 7 %. The majority of requested cases were respiratory diseases(22.4 %), cancers(18.5 %), Neuropsychiatric problems (14. 5 %), and musculoskeletal problems (13. 5 %). The accept rate was high in reproductive, respiratory, musculoskeletal and digestive disorders and low in neuropsychiatric, renal and otologic problems and occupational cancers. 73. 6 % of them were caused by chemical agents, especially 28. 5 % were by organic solvents. 67 % of them were clinically confirmed at university hospitals. A half of the cases were from KyongIn area, even the request came from the whole country. CONCLUSIONS: A claim was common in workers whose age was over 35 years old and exposure history was over 10 years. The respiratory diseases and neuropsychiatric disorders were still main problems in occupational health and occupational cancers was increasing even though its accept rate was not high yet.