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Occupational Lung Disease in Thailand Perspective from a Chest Physician

Occupational Lung Disease in Thailand Perspective from a Chest Physician. Nitipatana Chierakul Faculty of Medicine Siriraj Hospital Secretary General of The Thoracic Society of Thailand Consultant of Workmen ’ s Compensation Fund. SCOPE Magnitude Strength Weakness Opportunity

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Occupational Lung Disease in Thailand Perspective from a Chest Physician

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  1. Occupational Lung Disease in ThailandPerspective from a Chest Physician Nitipatana Chierakul Faculty of Medicine Siriraj Hospital Secretary General of The Thoracic Society of Thailand Consultant of Workmen’s Compensation Fund

  2. SCOPE • Magnitude • Strength • Weakness • Opportunity • Threat

  3. 1997-2000 2002-2004 145 32 No. submitted 91 12 No. considered 63 32 Percentage of decision (%) 45 42 Silicosis (%) 35 8 Byssinosis (%) 10 17 Occupational asthma (%) Bronchitis (%) 8 25

  4. Chronic Simple Silicosis FEV1 52 %, FVC 66 %, FEV1/FVC 55 %

  5. Progressive Massive FibrosisFEV1 35 %, FVC 48 %, FEV1/FVC 75 %

  6. Accelerated SilicosisFEV1 41 %, FVC 54 %, FEV1/FVC 82 %, DLCO 38 %

  7. Small Nodular Opacity FEV1 83 %, FVC 82 %, FEV1/FVC 87 %

  8. Small Nodular Opacity

  9. Mediastinal Node Calcification

  10. Mediastinal Node Calcification

  11. Air Trapping Inspiration Expiration

  12. Siriraj Occupational Lung Clinic Patient profiles : • Silicosis 46 • Byssinosis 5 • Occupational asthma 3

  13. Silicosis • Male : female 19 : 27 • Smoking : non-smoking 19 : 27 • Continue : discontinue 11 : 35 • TB : No TB 11 : 35 • Dead : alive 4 : 42

  14. Factors determining severity of FEV1

  15. Byssinosis • All 32 cases were female • Mostly were textile workers • Irreversible airflow obstruction in 11 cases • Post-shift drop of FEV1 in 2 cases • Clinical compatible in 19 cases

  16. Occupational Asthma • Glue 2 cases • Dye for clothing 2 cases • Cooking 2 cases • Wood dust 2 cases • Seafood packaging 2 cases • RADS from inadvertent burning of bitumen 1 case

  17. Occupational COPD • Metal fume 3 cases • Noxious gases 3 cases • Mixed inorganic dust 2 cases • Volatile agents 2 cases • Painter 1 case

  18. STRENGTH • Established guidelines for diagnosis and compensate evaluation since 1998 • Good support from the Workmen’s Compensation Fund, Social Security Office • Strong international support • Effective anti-smoking campaign

  19. WEAKNESS • No clearly context in the medical curriculum • Low awareness from physicians • Penumbra in the guidelines • Unease assess to the supporting system • Unfair amount of compensation • Upper limit of 60 months (80 % of salary) • Initial 35,000 Baht for treatment, and additional 50,000 Baht

  20. OPPORTUNITY • Collaboration between academic centers and professional organizations • Concerning of the new generation • Direction of the country towards sufficiency economy • Acceptance for civil politic and peaceful coexistence

  21. THREAT • Political driven of some profit-baring groups • Public over expectation for medical services • Complicated legal procedures • System for determining work-related illness by only one specialist

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