Establishment of a work-related diseases surveillance system in Taiwan, Republic of China

Interventions to increase the reporting of occupational diseases by physicians

BACKGROUND

Under-reporting of occupational diseases is an important issue worldwide. The collection of reliable data is essential for public health officials to plan intervention programmes to prevent occupational diseases. Little is known about the effects of interventions for increasing the reporting of occupational diseases.

OBJECTIVES

To evaluate the effects of interventions aimed at increasing the reporting of occupational diseases by physicians.

SEARCH METHODS

We searched the Cochrane Occupational Safety and Health Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (PubMed), EMBASE, OSH UPDATE, Database of Abstracts of Reviews of Effects (DARE), OpenSIGLE, and Health Evidence until January 2015.We also checked reference lists of relevant articles and contacted study authors to identify additional published, unpublished, and ongoing studies.

SELECTION CRITERIA

We included randomised controlled trials (RCTs), cluster-RCTs (cRCTs), controlled before-after (CBA) studies, and interrupted time series (ITS) of the effects of increasing the reporting of occupational diseases by physicians. The primary outcome was the reporting of occupational diseases measured as the number of physicians reporting or as the rate of reporting occupational diseases.

DATA COLLECTION AND ANALYSIS

Pairs of authors independently assessed study eligibility and risk of bias and extracted data. We expressed intervention effects as risk ratios or rate ratios. We combined the results of similar studies in a meta-analysis. We assessed the overall quality of evidence for each combination of intervention and outcome using the GRADE approach.

MAIN RESULTS

We included seven RCTs and five CBA studies. Six studies evaluated the effectiveness of educational materials alone, one study evaluated educational meetings, four studies evaluated a combination of the two, and one study evaluated a multifaceted educational campaign for increasing the reporting of occupational diseases by physicians. We judged all the included studies to have a high risk of bias.We did not find any studies evaluating the effectiveness of Internet-based interventions or interventions on procedures or techniques of reporting, or the use of financial incentives. Moreover, we did not find any studies evaluating large-scale interventions like the introduction of new laws, existing or new specific disease registries, newly established occupational health services, or surveillance systems. Educational materialsWe found moderate-quality evidence that the use of educational materials did not considerably increase the number of physicians reporting occupational diseases compared to no intervention (risk ratio of 1.11, 95% confidence interval (CI) 0.74 to 1.67). We also found moderate-quality evidence showing that sending a reminder message of a legal obligation to report increased the number of physicians reporting occupational diseases (risk ratio of 1.32, 95% CI 1.05 to 1.66) when compared to a reminder message about the benefits of reporting.We found low-quality evidence that the use of educational materials did not considerably increase the rate of reporting when compared to no intervention. Educational materials plus meetingsWe found moderate-quality evidence that the use of educational materials combined with meetings did not considerably increase the number of physicians reporting when compared to no intervention (risk ratio of 1.22, 95% CI 0.83 to 1.81).We found low-quality evidence that educational materials plus meetings did not considerably increase the rate of reporting when compared to no intervention (rate ratio of 0.77, 95% CI 0.42 to 1.41). Educational meetingsWe found very low-quality evidence showing that educational meetings increased the number of physicians reporting occupational diseases (risk ratio at baseline: 0.82, 95% CI 0.47 to 1.41 and at follow-up: 1.74, 95% CI 1.11 to 2.74) when compared to no intervention.We found very low-quality evidence that educational meetings did not considerably increase the rate of reporting occupational diseases when compared to no intervention (rate ratio at baseline: 1.57, 95% CI 1.22 to 2.02 and at follow-up: 1.92, 95% CI 1.48 to 2.47). Educational campaignWe found very low-quality evidence showing that the use of an educational campaign increased the number of physicians reporting occupational diseases when compared to no intervention (risk ratio at baseline: 0.53, 95% CI 0.19 to 1.50 and at follow-up: 11.59, 95% CI 5.97 to 22.49).

AUTHORS' CONCLUSIONS

We found 12 studies to include in this review. They provide evidence ranging from very low to moderate quality showing that educational materials, educational meetings, or a combination of the two do not considerably increase the reporting of occupational diseases. The use of a reminder message on the legal obligation to report might provide some positive results. We need high-quality RCTs to corroborate these findings.Future studies should investigate the effects of large-scale interventions like legislation, existing or new disease-specific registries, newly established occupational health services, or surveillance systems. When randomisation or the identification of a control group is impractical, these large-scale interventions should be evaluated using an interrupted time-series design.We also need studies assessing online reporting and interventions aimed at simplifying procedures or techniques of reporting and the use of financial incentives.

The impact of occupational health service network and reporting system in Taiwan

BACKGROUND

Underreporting occupational disease cases has been a long-standing problem in Taiwan, which hinders the progress in occupational health and safety. To address this problem, the government has founded the Network of Occupational Diseases and Injuries Service (NODIS) for occupational disease and injury services and established a new Internet-based reporting system.

OBJECTIVES

The aims of this study are to analyze the possible influence of the NODIS, comprised of Center for Occupational Disease and Injury Services and their local network hospitals, on compensable occupational diseases and describe the distribution of occupational diseases across occupations and industries from 2005 to 2010 in Taiwan.

METHODS

We conducted a secondary analysis of two datasets, including the NODIS reporting dataset and the National Labor Insurance scheme's dataset of compensated cases. For the NODIS dataset, demographics, disease distribution, and the time trends of occupational diseases were analyzed. The data of the Labor Insurance dataset was used to calculate the annual incidence of compensated cases. Furthermore, the annual incidence of reported occupational diseases from the NODIS was further compared with the annual incidence of compensable occupational diseases from the compensated dataset during the same period.

RESULTS

After the establishment of the NODIS, the two annual incidence rates of reported and compensable occupational disease cases have increased by 1.2 and 2.0 folds from 2007 to 2010, respectively. The reason for this increased reporting may be the implementation of the new government-funded Internet-based system. The reason for the increased compensable cases may be the increasing availability of hospitals and clinics to provide occupational health services. During the 2008-2010 period, the most frequently reported occupational diseases were carpal tunnel syndrome, lumbar disc disorder, upper limb musculoskeletal disorders, and contact dermatitis.

CONCLUSIONS

The new network and reporting system was successful in providing more occupational health services, providing more workers with compensation for occupational diseases, and reducing underreporting of occupational diseases. Therefore, the experience in Taiwan could serve as an example for other newly developed countries in a similar situation.

Occupational Health Nursing Practice, Education, and Research in Taiwan

This article describes occupational health nursing practice, education, research, and future perspectives in Taiwan. It also provides a brief overview of major occupational health and safety problems, laws and regulations, and organizations in Taiwan.

Surveillance and occupational health

This report explains the basics of two important uses of surveillance data: determining the magnitude of a specific occupational health or injury problem and examining temporal trends to determine whether the problem is increasing or decreasing. Types of data available for the purpose and some of their strengths and weaknesses are described. The utility of surveillance data is illustrated with examples from surveillance of acute injuries, musculoskeletal disorders, lead overexposures, and hazard surveillance data sets. Increasingly, surveillance systems may be used to evaluate the effectiveness of interventions. Surveillance is most important in times of rapid change in the economy and when resources for prevention may be limited. Both conditions are common in the world today.