预防医学职业及环境疾病的救治方法

OutlineOccupationalhealthOccupationalinjuryOccupationalmedicineasaspecialtyOccupationalhealthcareandmanagementNotificationorsurveillanceofoccupationalinjuryanddiseasesFromadhocsystemtoprevention,compensation,returntowork(PCR)integrationinTaiwanPCRmodelandperspectiveHealthWHOcharter:Healthisastateofcompletephysical,mentalandsocialwell-beingandnotmerelytheabsenceofdiseaseorinfirmityOccupationalandenvironmentalfactorsinthehealthcircleNOTES:AdaptedfromDahlgrenandWhitehead,1991.Thedottedlinesdenoteinteractioneffectsbetweenandamongthevariouslevelsofhealthdeterminants(Worthman,1999).OverthelifespanLivingandworkingconditionsmayinclude:•Psychosocialfactors•Employmentstatusandoccupationalfactors•Socioeconomicstatus(income,education,occupation)•Thenaturalandbuiltcenvironments•Publichealthservices•HealthcareservicesOccupationalHealthStatusrapidproliferationofnewindustrialmaterials,newproductionmethods,andnewcommercialproductslittleattentiontotheneedandassessmentoftheirimpactforthehumanhealthandenvironmentThenewlyusedchemicalsdevelopedbyindustriesareevenseldomtestedfortoxicityforanimalsorhumansOccupationalHealthStatuspracticingphysicianstaketheburdenofdiagnosing,treatingandifpossiblepreventingwork-relatedillnessorinjuryEventhemedicalandbiologicalprofessionalsareexposedtomicrobialagents,includingbacteria,virus,fungiandparasitesOccupationalinfectioncouldoccuraftercontactwithinfectedpersons,withinfectedanimalorhumantissue,secretions,orexcretionsOccupationalHealthStatus“ergonomics”orhumanfactorengineeringhasbeenintroducedintotheworkplaceworkers’healthproblemarisefromdesignsofworkstations,tools,equipmentsorworkproceduresphysicalagentssuchasnoiseorvibration,heatorcold,andionizingornon-ionizingradiationfourstepsofindustrialhygiene--anticipation,recognition,evaluation,andcontrolofhealthhazardstoreduceoccupationalhazardOccupationalHealthStatusworkstress-increasinglyimportanthealthproblem;theabilitytopredictastressresponseormakediagnosisofworkstressrelatedpsychologicalandphysiologicaldisabilityispoorthenumberofcompensationclaimofworkrelatedcirculatorydiseaseincreasedworkplacewellnessandoccupationalhealtheducationprogramevolvedquitsmoking,healthydiet,exercise,stressmanagementandcardiovasculardiseasepreventionOccupationalmortality-diseasemorethaninjuryrelatedtooccupation30LWC300Recordable30,000NearMisses300,000At-RiskBehaviorsFatality,DisablingInjury123%Circul.7%Respir.32%Cancer17%Comm.dis.19%Accidents1%0%1%CommunicablediseasesCancerRespiratoryDiseasesCirculatorydiseasesMentalDisordersDigestivesystemsdiseasesGenitourinarysystemAccidentsandviolenceDeathsattributedtoworkILOTaiwan’soccupationaldiseaseunderestimated19901991199219931994199519961997Taiwan46262719143146142Singapore9401,07089790099913451,5211,054Korea1,3281,4139181,1201,5291,424HongKong24493248272369327Japan11,41511,95110,8429,6309,9159,230Thailand------6211612551Malaysia775022,942SouthAustralia2,9952,8412,8243,145StatisticsofAsianoccupationaldisease1990-1997OccupationalHealthStatusInTaiwanthereisstillaunderreportingofoccupationaldisease,accordingtoBureauofLaborInsurance(BLI)statistics,ifpneumoconiosisisexcluded,thenumberofoccupationaldiseaseislessthantwohundredcasesperyearinrecenttwodecadeswhichisaroundoneintenoroneinahundredofexpectednumber,aftercomparisonwithneighboringcountries,suchasJapan,KoreaSingapore,orUSAOccupationalinjuryTaiwaneseworkerssufferedanestimated36,000fractures,amputations,lacerations,andhundredsofeyeinjuryandburnsoutofoccupationalcauses.Themostcommonoccupationalinjuriesinvolvemusculoskeletalsystemormusculoskeletaldiseasesstrain,sprain,tendonitis,bursitis,myositis,arthritis-usuallyproducedbyrepeatedmovementandmusclestrain.Gradualincreaseofoccupationalinjurytemporarydisabilitycases(1990~2002,BLI)01000020000300004000050000600007000080000900001000001100001200001300001400001500001600001700001800001900002000002100002200002300002400002500002600002700002800002900003000001990199119921993199419951996199719981999200020012002YearNumberOccupationalinjuriesanddiseasesActualpaymentforinjuriesanddiseasesNationalHealthInsuranceOccupationalInjuryAccordingtoBLI,thepercentageofoccupationalinjurywithtemporarydisabilityisaboutonefourthofordinaryinjuriesamongworkerstrendofincreasedoccupationalinjuryanddisease–esp.,afterNationalHealthInsuranceSystemenactedin1995incurmorethan6billionNT$indirectworkerscompensationcostsindirectcost:productiondelays,damagetoequipment,andrecruitingandtrainingreplacementworkersestimatedtobefivetimes,orabout30billionNT$Increasedpercentageofoccupationalinjuryamongtotalinjuryrelatedtemporarydisability(1990～2002,BLI)0%10%20%30%40%50%60%70%80%90%100%1990199119921993199419951996199719981999200020012002YearOccupationalinjuriesanddiseasesActualpaymentforinjuriesanddiseasesOccupationalInjuryWorkers’compensationbenefits-permanenttotaldisability,temporarytotaldisability,permanentpartialdisability,temporarypartialdisability,andsurvivor’sbenefits.InTaiwan,onlylumpsumbutnoannuitypaidtotheinsuredworker.Duringrehabilitationperiod