群体性职业病诊断鉴定事件的反思

<正>2002年5月1日颁布实施的《中华人民共和国职业病防治法》(以下简称《职业病防治法》,对我国用人单位及其劳动者、职业病诊断、鉴定和职业病病人保障等有了明确规定。为了规范职业病诊断鉴定,加强职业病诊断鉴定管理工作, 更多还原     

职业病诊断问题与对策

职业病诊断是一项法制性和技术性很强的工作。但在职业病诊断过程中存在诸多问题,如职业病危害接触史材料提供、职业病诊断机构选择、临床诊断后再申请职业病诊断等。为保障劳动者健康权益,进一步规范职业病诊断与鉴定工作,现结合工作实际,特就职业病诊断中存在的问题提出一些建议,为政府部门制订相关政策提供科学依据。     

群体性急性职业中毒诊断与鉴定案例的分析及思考

通过分析一起群体性急性中毒职业病诊断、鉴定、调查、取证过程,提出目前职业病诊断鉴定中面临的企业违规操作,使用三无产品,现场调查取证困难,从事职业病诊疗的医疗机构不为大众所知,企业和工人缺乏对职业病诊断鉴定资质机构的了解,缺少对群体性职业病认定的法律、法规等问题,建议加强执法力度,保障劳动者权益,完善职业病诊断与鉴定网络及群体性职业病诊断与鉴定程序。     

北京市职业病诊断鉴定存在问题探讨及对策研究

《中华人民共和国职业病防治法》颁布已经8年了。北京市职业病诊断鉴定管理工作办公室依法、依靠职业病诊断鉴定委员会专家建立了首都职业病诊断鉴定技术服务平台,为首都社会经济建设和保障广大劳动者健康做出了重要贡献。目前已经诊断鉴定了100多个疑难案例,受到业内人士及申请人的认可。尽管如此,仍需不断地总结、反思,结合我国经济社会发展的重大政策措施,不间断的学习卫生改革发展的内容以及我国现行的重要的卫生政策,联系职业病防治法及实时更新卫生科学知识,用适宜技术来保障对人民群众职业病诊断鉴定服务工作的质量和水平。     

加强职业病诊断鉴定管理工作

保护劳动者健康和相关权益是《职业病防治法》赋予卫生监督部门的责任和义务,而加强职业病诊断鉴定管理工作是劳动者相关权益得到保护的具体体现,因此,做好职业病诊断鉴定管理工作就保护了劳动者相关权益,反之劳动者相关权益就要受到侵害。下面就某公司劳动者职业病诊断问题谈一下体会。2003年3月13日,某公司职工柴某某之父反映其子在工作中因接触煤油、稀料、油漆等职业病危害物质5     

运用法律法规解决职业病诊断与鉴定工作中的疑难问题

正2011年和2013年,国家重新修订实施的《中华人民共和国职业病防治法》(以下简称《防治法》)及《职业病诊断与鉴定管理办法》(以下简称《管理办法》),明确了监管部门在职业病诊断与鉴定过程中的相关责任,针对劳动者特别是农民工的问题明确了争议解决的途径,消除了劳动者申请职业病诊断与鉴定的门槛。本文旨在就职业病诊断与鉴定中经常发生的纠纷和争议,结合本人运用《防治法》和《管理办法》解决工作中的疑难问题进行汇总,供职业病诊断与鉴定机构及同行借鉴,以便进一步做好职业病诊断与鉴定工作。     

一起厨师“中暑”死亡病例职业病诊断及问题分析

依据发生在餐饮业的一起"中暑"死亡病例,对职业病诊断和2级鉴定过程中涉及程序、管理体制和救济机制方面进行分析。建议职业病诊断和鉴定立法的举证责任,应转移给各种类型的用人单位,调查认定程序应该合理、合法,并实施多途径的救济手段,保护劳动者合法权益。     

职业病诊断与鉴定若干问题探讨

卫生部2002年3月颁布的《职业病诊断与鉴定管理办法》(下称办法),进一步明确用人单位、劳动者、职业病诊断机构和卫生行政部门在职业病诊断鉴定方面的权利和义务。《办法》在维护劳动者健康权益和便民利民方面,显示了保护弱者和人性化的特征。如劳动者可以在用人单位所在地或本人居住地申请职业病诊断;职业病诊断鉴定费用由用人单位承担;用人单位不得解除或终止与患有疑似职业病的劳动者签订的劳动合同;职业病病人除享有工伤社会保险外,有权向用人单位提出民事赔偿等。     

一起历经3年的职业性噪声聋诊断及鉴定案例分析

通过回顾一起历经3年的职业性噪声聋诊断及鉴定案例, 探讨当前在职业性噪声聋诊断和鉴定工作中存在的问题, 为做好职业性噪声聋诊断与鉴定工作提供参照。经职业卫生学调查, 该劳动者从事维修工作, 每日实际噪声暴露时间为5~6 h, 劳动者作业场所8 h等效声级范围为55.1~85.6 dB (A)。2014年离岗后多次纯音听力检查结果重复性差, 客观听力检查结果不支持职业性噪声聋诊断。该劳动者虽经过诉讼、诊断及两级鉴定, 但最终结论为无职业性噪声聋。建议进一步完善《职业病诊断与鉴定管理办法》相关程序及实施细则, 限制不属于疑似职业病的劳动者申请诊断鉴定, 避免少数劳动者为了争取利益, 滥用申请职业病诊断鉴定的权利, 从而减少人力、财力及时间的浪费, 同时也能保障真实职业病患者的权益。     

法定职业病诊断思路解析

我国现行的法律法规规定,法定职业病诊断必须遵循程序合法、技术合理的原则,任何违反《职业病防治法》中规定的流程要点和国家职业卫生标准中的判定原则,都将是无效的职业病诊断结论。通过解析法定职业病诊断程序合法、技术合理的要点,认为劳动者职业病诊断维权困难的症结在于提供溯源材料和确认材料的真实性。而溯源材料也是职业病诊断医师确定劳动者是否患有法定职业病的关键性依据之一。建议参照我国香港地区职业伤害赔付制度,使职业病诊断职责划分更清晰合理。     

Medical costs and sources of payment for work-related injuries among Hispanic construction workers

OBJECTIVE: To assess medical costs of occupational injuries and sources of payment among Hispanic and non-Hispanic construction workers. METHODS: More than 7000 construction workers, including 1833 Hispanic workers were examined using the Medical Expenditure Panel Survey, 1996 to 2002. Univariate and multivariate analyses were conducted using SUDAAN. RESULTS: Annually, work-related injuries in construction cost $1.36 billion (2002 dollars), with 46% paid by workers' compensation. Compared with non-Hispanic workers, Hispanic workers were 53% more likely to have medical conditions resulting from work-related injuries, but 48% less likely to receive payment for medical costs from workers' compensation (P < 0.05). CONCLUSIONS: This study suggests an urgent need to reform the current workers' compensation system to reduce the burden shifted to injured workers and society. Such reforms should include easier access and more assistance for Hispanic and other immigrant workers.     

职业病预防与工伤保险

从工伤保险的预防、赔偿和康复三大功能角度,在理论、法律和实践三方面论述职业病防治与工伤保险的关系;针对职业病防治特殊性提出利用费率杠杆加强职业病防治,整合职业病诊断鉴定与劳动能力鉴定程序,维持对职业病患者长期的合理保障以及分享利用职业病防治信息等建议。     

签署不当工伤赔偿协议后农民工维权问题刍议

“毒苹果”事件中，苹果股份有限公司（Apple Inc．）的两家供应商公司被质疑强迫正己烷中毒员工签署“先离职后赔偿”的“霸王条款”，暴露了我国大陆农民工职业病维权难的问题。故特从农民工维权难的原因、不当“工伤赔偿协议”的有效性评价及签订协议后如何维权等几方面进行探讨，以供广大农民工及职业卫生与安全相关工作人员参考。     

Occupational health in China

China has been experiencing rapid industrialization and economic growth, resulting in a transformed industrial structure and expansion of the labor force. Occupational health and safety services, nonexistent before 1949, have made remarkable advances over the past decades. However, these services face greater challenges, consisting of both traditional and new occupational health problems. Poorly regulated work environments often lacking health services in recently developed and thriving small-scale industries and joint venture enterprises have created increasing risks for occupational diseases and work-related injuries. A special strategy based on cooperation among and contributions from the legal, administrative, social, economic, and scientific communities is critical to achieving the ultimate goal of control and prevention of these occupational health problems.     

Infectious disease risks associated with occupational exposure: a systematic review of the literature

Employees in different types of work may be intentionally or accidentally exposed to biological agents. Improved risk assessment is needed to identify opportunities to prevent work-related infectious disease. The objective of the current study was to perform a systematic literature review of work-related infectious disease to assist in the identification of occupational infectious disease risks. A literature search of papers on work-related infectious disease published between 1999 and 2008 yielded 1239 papers of which 242 met the selection criteria and were included in the review. The results of the systematic literature review were arranged in a matrix of occupational groups and exposure pathways. Increased risk from infectious diseases appeared to be concentrated in specific professions. Healthcare workers, workers in contact with animals, laboratory workers and refuse workers seem to have the highest risk of infection by a variety of pathogens. However, pathogens reported to be associated with closely related professions were different, indicating qualitative under-reporting. Arranging the results of this systematic review on work-related infectious diseases in a matrix of occupational groups and exposure pathways allowed the reliable identification of exposure hazards for specific occupational groups beyond currently reported diseases.     

Access to medical care for occupational disorders: difficulties and disparities

Despite state laws guaranteeing full insurance coverage for work-related disorders, many injured workers have difficulty obtaining access to appropriate medical care. Barriers to access arise because: patients are unable to prove that their conditions are caused occupationally; they are discouraged by employers from reporting occupational injuries; workers' compensation insurance carriers aggressively contest claims; and other reasons. Evidence suggests that minority subpopulations of workers are most affected. Overcoming these barriers will require a multifaceted approach involving regulatory oversight, participation of workers in the design of health plans and the selection of providers, and specific measures to detect and prohibit discriminatory care.     

Factors associated with self-assessed work ability

BACKGROUND: Symptoms and health problems caused or aggravated by work are common. In order to study perceived work ability and associated factors, including those related to work, a closer analysis was undertaken in an occupational health setting. AIMS: This study aimed to analyse self-assessed work ability and its determinants in employees seeking medical advice, with special emphasis on work-related factors. METHODS: During 723 illness-related visits to occupational physicians, questionnaires covering personal data, main health problems, their work relatedness, duration and effect on work ability were completed by the employee and physician. Factors associated with self-assessed work ability were studied in a multinomial logistic regression model. RESULTS: The majority of employees considered themselves as being able or partially able to work despite the health problem. Independent predictors of impaired work ability were mental or musculoskeletal disorders, self-assessed work relatedness of the disease, older age, blue-collar work and short duration of the symptoms. If the patient was convinced about the benefits of work-related interventions, the risk for disability was significantly reduced. CONCLUSIONS: Special attention should be paid to the recognition and modification of potential work-related causes of disability. In addition, patients with partial work ability should be encouraged to stay at work instead of taking sick leave. For effective disability management, accommodated work and other evidence-based interventions are needed at the workplace.     

血液透析与腹膜透析的卫生经济学研究概述

目的 比较血液透析与腹膜透析人群的费用、效果及其影响因素，分析其疾病经济负担，剖析现行医疗保险补偿模式对透析技术的影响，进而为临床合理应用透析技术及透析相关政策的调整和完善提供参考依据。方法 采用回顾性调查方法，对首次透析时间在1995-1998年间的上海市6所医院155例血液透析患者和223例腹膜透析患者的费用和效果进行比较。用多元回归法分析费用的影响因素，用COX回归方法分析死亡风险的影响因素，用Logistic回归法分析生命质量的影响因素。回顾性调查210例存活者的疾病负担。运用政策分析法分析补偿模式对透析技术应用的影响。结果 血液透析与腹膜透析人群的死亡风险、生命质量以及医疗费用并无显著差异，而统计描述差异是由于两类人群透析初始的健康状况不均衡造成的。透析人群疾病伤残程度很高，疾病经济负担沉重，负债透析的现象普遍。结论 医疗保险对腹膜透析与血液透析的费用补偿方式差异，造成血液透析技术的过度利用，进一步加重了各方费用的负担。因此，有必要从筹资、补偿模式、供方医疗行为规范等方面调整和完善透析相关政策。     

Status of occupational cancer in Lithuania

Because industrialization in Lithuania started only about 50 years ago, occupational cancer is only now becoming an important issue. This article describes the situation of occupational cancer in Lithuania: research, exposures to carcinogens, regulation, and legal practice. Epidemiologic studies of work-related cancers have shown increased risks among cement, textile, and asbestos-cement workers. In 1997, 28% of employed workers in Lithuania were exposed to carcinogens. A legislation system regulating exposures to carcinogens, harmonized with European Directives, has recently been created. In 1995-2003, there were 5,652 new cases of occupational diseases. However, occupational cancers are seriously underdiagnosed--only one case of cancer was diagnosed as occupational. Establishment of a system that would enable diagnosis, certification, and compensation of cases of occupational neoplasms is essential in Lithuania.     

Patients with occupational contact dermatitis in Israel: quality of life and social implications

One of the most common occupational diseases is skin disease caused as a result of contact with work-related materials or exacerbated by them. Although occupational-related skin disease is a common condition, it is not considered to be a serious one and, therefore, has not received satisfactory attention in the psycho-social literature or in the social work profession. In our study, 70 occupational contact dermatitis (OCD) patients were interviewed by telephone regarding psychological, social, economic, and subjective issues related to the disease. All patients reported to be affected in their daily living activities, self-image, economic status, and in their interpersonal relationships in the family. Our study seeks to highlight the problems of this population group and serve as a vehicle to facilitate patient's rights.