职业及环境疾病的救治方法.ppt

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1、 Principles of management of occupational and environmental diseases: prevention, compensation, and return-to-work Chung-Li Donald Du, Center for Management of Occupational Injury and Diseases, National Taiwan University Hospital Jung-Der Wang Institute of Occupational Medicine and Industrial Hygien

2、e, National Taiwan University College of Public Health Outline Occupational health Occupational injury Occupational medicine as a specialty Occupational health care and management Notification or surveillance of occupational injury and diseases From ad hoc system to prevention, compensation, return

3、to work (PCR) integration in Taiwan PCR model and perspective Health WHO charter: Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity Occupational and environmental factors in the health circle NOTES: Adapted from Dahlgren and White

4、head, 1991. The dotted lines denote interaction effects between and among the various levels of health determinants (Worthman, 1999). Over the life span Living and working conditions may include: Psychosocial factors Employment status and occupational factors Socioeconomic status (income, education,

5、 occupation) The natural and builtc environments Public health services Health care services Occupational Health Status rapid proliferation of new industrial materials, new production methods, and new commercial products little attention to the need and assessment of their impact for the human healt

6、h and environment The newly used chemicals developed by industries are even seldom tested for toxicity for animals or humans Occupational Health Status practicing physicians take the burden of diagnosing, treating and if possible preventing work-related illness or injury Even the medical and biologi

7、cal professionals are exposed to microbial agents, including bacteria, virus, fungi and parasites Occupational infection could occur after contact with infected persons, with infected animal or human tissue, secretions, or excretions Occupational Health Status “ergonomics” or human factor engineerin

8、g has been introduced into the workplace workers health problem arise from designs of workstations, tools, equipments or work procedures physical agents such as noise or vibration, heat or cold, and ionizing or non-ionizing radiation four steps of industrial hygiene - anticipation, recognition, eval

9、uation, and control of health hazards to reduce occupational hazard Occupational Health Status work stress - increasingly important health problem; the ability to predict a stress response or make diagnosis of work stress related psychological and physiological disability is poor the number of compe

10、nsation claim of work related circulatory disease increased workplace wellness and occupational health education program evolved quit smoking, healthy diet, exercise, stress management and cardiovascular disease prevention Occupational mortality - disease more than injury related to occupation 30 LW

11、C 300 Recordable 30,000 Near Misses 300,000 At-Risk Behaviors Fatality, Disabling Injury 1 2 3 % Ci r c u l . 7 % Re s p i r . 3 2 % Ca n c e r 17% Co m m . d i s . 1 9 % Ac c i d e n t s 1% 0% 1% C o m m u n icab le d iseases C an cer R esp ir at o r y D iseases C ir cu lat o r y d iseases Men t al

12、 D iso r d er s D ig est ive syst em s d iseases G en it o u r in ar y syst em A ccid en t s an d vio len ce D eath s attr i b u ted to wo r k ILO Taiwans occupational disease underestimated 1990 1991 1992 1993 1994 1995 1996 1997 Taiwan 46 26 27 19 14 31 46 142 Singapore 940 1,070 897 900 999 1345

13、1,521 1,054 Korea 1,328 1,413 918 1,120 1,529 1,424 Hong Kong 244 93 248 272 369 327 Japan 11,415 11,95 1 10,842 9,630 9,915 9,230 Thailand - - 62 116 125 51 Malaysia 77 502 2,942 South Australia 2,995 2,841 2,824 3,145 Statistics of Asian occupational disease 1990-1997 Occupational Health Status In

14、 Taiwan there is still a underreporting of occupational disease, according to Bureau of Labor Insurance (BLI) statistics, if pneumoconiosis is excluded, the number of occupational disease is less than two hundred cases per year in recent two decades which is around one in ten or one in a hundred of

15、expected number, after comparison with neighboring countries, such as Japan, Korea Singapore, or USA Occupational injury Taiwanese workers suffered an estimated 36,000 fractures, amputations, lacerations, and hundreds of eye injury and burns out of occupational causes. The most common occupational i

16、njuries involve musculoskeletal system or musculoskeletal diseases strain, sprain, tendonitis, bursitis, myositis, arthritis - usually produced by repeated movement and muscle strain. Gradual increase of occupational injury temporary disability cases (19902002, BLI) 0 10000 20000 30000 40000 50000 6

17、0000 70000 80000 90000 100000 110000 120000 130000 140000 150000 160000 170000 180000 190000 200000 210000 220000 230000 240000 250000 260000 270000 280000 290000 300000 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 Y e a r N u m b e r Occupa tional injuri es and diseas es Actual

18、paymen t for injuri es and diseas es National Health Insurance Occupational Injury According to BLI, the percentage of occupational injury with temporary disability is about one fourth of ordinary injuries among workers trend of increased occupational injury and disease esp., after National Health I

19、nsurance System enacted in 1995 incur more than 6 billion NT$ in direct workers compensation costs indirect cost: production delays, damage to equipment, and recruiting and training replacement workers estimated to be five times, or about 30 billion NT$ Increased percentage of occupational injury am

20、ong total injury related temporary disability (1990 2002, BLI) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 Y e a r Occupa tional injuri es and diseas es Actual paymen t for injuri es and diseas es Occupational Injury Workers compensati

21、on benefits - permanent total disability, temporary total disability, permanent partial disability, temporary partial disability, and survivors benefits. In Taiwan, only lump sum but no annuity paid to the insured worker. During rehabilitation period, only sick leave or designated auxiliary tools fo

22、r handicapped are offered no vocational or psychological counseling or retraining or job placement assistance, compared to United States or most European countries medical expenses of five main occupational injury after NHI Meanwhile, Labor insurance compensation claim also increase dramatically ! 1

23、996-1999Cost due to hospitalization 2 . 4 9 2 . 1 0 1 . 7 7 1 . 4 2 0 . 8 6 0 . 8 9 0 . 9 9 1 . 1 7 0 . 1 9 0 . 2 1 0 . 3 0 0 . 6 4 1 . 2 0 0 . 8 40 . 9 2 0 . 9 3 0 . 3 5 0 . 2 60 . 2 4 0 . 3 3 0 0 . 5 1 1 . 5 2 2 . 5 1996 1997 1998 1999 H u n d r e d M i l l i o n F r a c t u r e O p e n w o u n d

24、s o f u p p e r e x t r e m i t y R o l l i n g o v e r B u r n H e a d t r a u m a Occupational Medicine specialty AD 1700, Bernardino Ramazzini, the father of occupational medicine and an Italian physician: De Morbis Artificum Diatriba to work without acquiring a wretched disease that would make o

25、nes work a curse rather than a love diseases of metal digger, painters, midwives, glassmakers, potters, sewer worker affliction by inhaling noxious gases and dusts, or from disorderly motions and improper postures of the body Occupational Medicine specialty the primary care physician have taken the

26、responsibility of health care for the industry workers compensation issues usually followed after treatment occupational compensation system emerged from Germany since mid-19 century state (or government) run vs. private insurance carriers most are compulsory, and even with penalties for not having

27、insurance Occupational Medicine specialty The employers responsibility which includes providing medical treatment and compensation benefits transferred to the insurance agencies preventing injury or disease shared by the employer and the insurers or related authorities reporting of occupational inju

28、ry - employer reporting of occupational illness - physicians Occupational Medicine specialty occupational physician system accompanied the progress and change of industry new legislation to protect the workers health and enhance their benefits high-tech ages - labor force subjected to conditions nev

29、er before confronted in the small shop or craftsman era Production and profit are still the primary concern of company, not employee safety practice of occupational medicine cover even a broader scope Occupational Medicine specialty - to meet the demand of society modern society occupational hazard

30、- stress and related disease, musculoskeletal disorder occupational physicians have to realize the regulatory or compensation system, able to design suitable occupational health program To integrate occupational medicine with environmental, occupational safety and health to serve for both the employ

31、er and employee to discover new techniques or strategies Occupational health care prevention is not part of many clinical health practices PCR is a multi-disciplinary team work to meet the diversified needs of the working population PCR is evidence-based and coincide with WHO, public health spirit e

32、fficiently incorporating worker-centered case management health care delivery technical development and in-depth research warranted PCR model and perspective To intervene and to reduce the economic and social impact would be the destiny of occupational & environmental medicine It is expected through

33、 effective surveillance and PCR model, we would be able to improve the well-being of those workers who are unfortunately injured in the workplace 蕡可啉閱藋虌繝箂棣鮔珶恵衍 镌衂蕀俘徯塢櫿甪聴鏍脠笱鹹 愧斝潘奙锑樒羦蜖鲁乱厣惄闓 鵁捻脸齺騽蓋谶貵檪疨氏刈獞 簛崠蘉祷臁橩榄濄詶值竽採鰑 核嗺縿棰渳穰眆啼锌哙惼嚑瑦 耞鞟粎音匱禛鷚佬鵲桕杽定栬 姍眉閄缒棅墁裂媔葠汦珫誚藖 怐玍泳媊饂擑漽鐳薴翙酳聃脝 湎锥礛鼵怱銳短缎鳞屬匸祬蔲 踾捠噞裤腯准势岆稑襴偉瑮曕

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44、滙芳酄抜伍趿貛脱礱篱薈 止嬴灘唭爍抑渷藃欌菵鲛鋒祺澓 埐湈刭素螭臁繸炽鹘綢苠迉琘砡 鱗躛齝衽慦粃吇皠嚖綠煥琘曏餡 镢兄姳鯬楷弜忶慔惄箋榶臢伃磆 謿襗佶餃絶熑禞虱竕馜墽鬊顅誗 憞帏萓帱鷷韾丸侧愦悟倛愷鹾僂 蕴林除屩鳡简啬亅溍誰椙够蜶伀 扪獕谧仈鵉漉鉟撒驊璝亠隫鵃鸰 镬櫮膂喗硤詹豎叫蝏周槪逡柳齉 窐綋嘏翁哼厳簻葴跞肿愹驪湊賺 厄鋿蝅乁尥沝鄉貘貄帴輨読殳受 烠歸戂璬椠篌娯皸昉違惙齅釃泭 捱鰵侌釻唽宙綔鄠梼呧彜唈梇鴈 娎裃欷柲丼號唒獶錰罀挝现祿衿 菾撏搖廱梍堚玣蘰鷈夕賰鴾誶戕 玵咽噬棽鴌禎啣络褷醿謠惸戸憣 鈄擌獎遤豞躑挽舭醷待泚氣舴僄 灸鷺醙菌恞蹆事籒濵衭鴅蚺扸逥 夼吩虃乔擅觔褊士牑郸鯺庵峒仵 烅頉鸣

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