Study On Undercount Of Pneumoconiosis In Typical Healthcare Facilities

Occupational disease undercount study is one of the important contents of the public health surveillance system evaluation.It embodies the ability of the monitoring system to discover and confirm the occupational hazards.It is very important to carry out studies on undercount,to estimate the extent of undercount by exploring the accessibility of occupational healthcare services,the underreport and the misdiagnosis of the disease for us to improve the occupational disease surveillance system,to improve the efficiency of monitoring,to ensure accuracy of the monitoring system,to understand more of the distribution characteristics and trends,to found outbreaks and epidemic and so on.[purpose]The purpose of this survey is to investigate the extent of underestimation of pneumoconiosis,to understand the various factors and key procedures that lead to undercount,put forward improvement measures.[method]The literature research method was used to design the study.The clinical occupational disease method was used to estimate the extent of undercount by analyzing clinical cases in healthcare facilities in 2016,and the reasons of undercount were explored by questionnaire and interview.[result]The results showed that there were 821 positive cases in 4 healthcare facilities,of which 70 had diagnosed occupational pneumoconiosis;the others did not diagnosed occupational diseases,suspected occupational disease.The total misdiagnosis rate is 91.47%.2 hospitals without diagnostic qualification had no suspected cases diagnosed or reported,misdiagnosis rate is 100%.All of the 70 diagnosed cases have been reported.The reported information of the cases is matched with the real cases,the underreport rate is 0.The results of questionnaire survey showed that the awareness rate of occupational disease knowledge was 31.1%in the non-diagnosis physicians in general hospitals.The awareness rate of trained physician was higher than that of untrained physician.Physician in respiratory(100%)and infection(100%)department have more pneumoconiosis patients' visits.More than half of the physicians do not have the ability to distinguish differential diagnosis of occupational diseases.Physicians generally unaware of whether there is an occupational disease reporting system in their hospitals.69.7%of physicians believe that there was need for non-occupational disease diagnosis facilities to report occupational diseases.All of the pneumoconiosis diagnosis physicians have encountered suspected pneumoconiosis.The reason why the patients cannot be diagnosed was mainly because the imaging performance cannot reach the diagnostic criteria(73.9%),occupational history materials couldn't be obtained(69.6%)and patients take the initiative to stop the diagnosis(60.9%).There were pneumoconiosis diagnosis physicians who also can not distinguish differential diagnosis of pneumoconiosis.The reason why there is no report of suspected occupational disease is that there is no suspected occupational disease diagnostic criteria.96.2%of the diagnosed occupational pneumoconiosis patients'level of education is below junior high school,85.7%of them were engaged in mining industry.The awareness of materials required for diagnosis of occupational diseases is poor.68.5%of their main source of occupational disease knowledge is from their witness of others' experience.32.1%of them had visited the non-occupational disease diagnosis facilities.There were doctors ignore the symptoms of pneumoconiosis,and unaware of the diagnosis system.The result of interview showed that the diagnosis of floating workers is pretty hard,there were misdiagnosis in the un-certified occupational disease diagnose facilities,the resistance from the employer,the workers give up to diagnosis,and the underreport of the quasi-occupational disease were main reasons of underreport of occupational pneumoconiosis.[Conclusion]The survey shows that the current level of occupational pneumoconiosis undercount is prominent,and the undercount mainly occurred in the diagnosis of occupational pneumoconiosis.The undercount happened in the report-stage is rare.The undercount in the non-occupational disease diagnosis facilities were higher than that in occupational disease diagnosis facilities.The undercount is mainly affected by the diagnostic criteria,the ability of the physician to diagnose,the accessibility of patients to obtain the occupation history materials and the patients' chooses of whether to stop the diagnosis.It is proposed to further strengthen the training of occupational disease knowledge,to strengthen the occupational health monitoring,to conduct occupational disease diagnosis and occupational disease identification procedures step by step,to improve the sensitivity of occupational disease diagnosis standards,to make clear of the definition and diagnostic criteria of suspected occupational diseases,to strengthen the study of pneumoconiosis and specific biological marker,to apply variety of data sources for occupational disease surveillance.