Objective:To report the surveillance results of the distribution and antimicrobial resistance profile of clinical isolates in Anhui province.Methods:Surveillance data from 94 members of the Anhui Antimicrobial Resistance Surveillance Network（HuiNet）from October 2023 to September 2024 were collected，the major drug-resistant bacteria and the resistance to commonly used antibiotics were analyzed. WHONET 5.6 and SPSS 25.0 software were used for data analysis.Results:Among 240 339 clinical strains，Gram-negative bacteria accounted for 75.0%（180 153 strains）. The detected bacteria mainly include Escherichia coli（ n=53 587，22.3%）， Klebsiella pneumoniae（ n=39 774，16.5%）， Pseudomonas aeruginosa（ n=25 505，10.6%）， Staphylococus aureus（ n=19 438，8.1%）， Acinetobacter baumannii complex（ n=14 239，5.9%），and so on. The prevalence of methicillin-resistant Staphylococcus aureus（MRSA）and methicillin-resistant coagulase-negative Staphylococcus aureus（MRCNS）were 37.7%（7 112/18 853）and 73.9%（13 221/17 895），respectively. No vancomycin- and teicolanin-resistant Staphylococcus were detected. The prevalence of carbapenem-resistant Escherichia coli（CREC）and Klebsiella pneumoniae（CRKP）were 1.9%（971/51 991）and 12.3%（4 864/39 414），respectively. The resistance rate of CRKP to tigecycline and polycolistin B was 7.7% and 7.9%，respectively. The prevalence of carbapenem-resistant Acinetobacter baumannii（CRAB）complex and Pseudomonas aeruginosa（CRPA）were 57.9%（8 222/14 198）and 18.2%（4 569/25 052），respectively，with low resistance to polycolistin B（2.0% and 7.2%，respectively）. The detection rates of MRSA，MRCNS，CRAB complex，third-generation cephalosporin-resistant Escherichia coli（3GC-R-EC）and quinolone-resistant Escherichia coli（QREC）in northern Anhui were the highest（46.8%，77.1%，65.6%，57.6% and 55.5%，respectively），which were higher than those in central and southern Anhui（ χ2=107.858 and 566.202，5.950 and 142.223，39.254 and 289.137，135.402 and 449.114，39.142 and 185.114， P<0.05 or <0.01），and the detection rates in central Anhui were higher than those in southern Anhui（ χ2=272.031，102.717，162.409，118.891 and 66.889，all P<0.001）. The detection rates of CRKP，CRPA and thirdgeneration cephalosporinresistant Klebsiella pneumoniae（3GC-R-KP）in central Anhui were the highest（16.7%，21.7% and 32.0%，respectively），which were higher than those in northern and southern Anhui（ χ2=229.656 and 439.377，156.599 and 65.818，77.386 and 232.568，all P<0.001）. The detection rates of CREC，3GC-R-EC and QREC were the highest in the elderly（2.2%，54.0% and 56.4%，respectively），which were higher than those in children and adults（ χ2=8.034 and 13.150，17.032 and 103.437，438.353 and 183.099，all P<0.01）. The detection rates of CRKP and 3GC-R-KP in neonates were the highest（20.6% and 56.9%，respectively），which were significantly higher than those in children，adults and the elderly（ χ2=38.869，8.337 and 7.921；65.517，55.525 and 49.214，all P<0.01），and the detection rate of 3GC-R-KP in the elderly was higher than that in children and adults（ χ2=14.122 and 7.501，both P<0.01）. The detection rates of CRAB complex，CRPA，CREC，CRKP and 3GC-R-KP in tertiary hospitals were higher than those in secondary hospitals（ χ2=25.606，16.501，5.820，33.116 and 117.086， P<0.05 or <0.01）. Except for MRSA，vancomycin-resistant Enterococcus faecium and QREC，the detection rates of major drug-resistant bacteria in intensive care unit（ICU）were the highest（all P<0.001）. From 2019 to 2024，the detection rates of MRSA，MRCNS，CRKP，CRAB complex and CRPA all showed a slow decreasing trend（ χ2=42.319，122.779，340.381，83.512 and 81.668，all P<0.001）. Conclusions:The situation of antimicrobial resistance in Anhui province shows a downward trend，but it is still serious，especially in northern and central Anhui. It is necessary to pay attention to the bacterial resistance particularly for the elderly，newborns，children and ICU.

Objective To analyze the monitoring status of occupational hazard factors in key industry workplaces in a city of the Pearl River Delta area from 2019 to 2023. Methods A total of 1 548 enterprises in 12 key industries of the city were selected as the research subjects using the judgmental sampling method. Their monitoring data for dust, chemical factors, and noise, along with the occupational health management status of the enterprises were analyzed. Results Among the 1 548 enterprises, large and medium-sized enterprises accounted for 2.7% and 13.4%, while small and micro enterprises accounted for 83.9%. A total of 474 enterprises exceeded the national limit in the detection of occupational hazard factors, with an exceedance rate of 30.6%. The rates of workers exposed to occupational hazard factors, dust, chemical factors, and noise were 29.4%, 6.9%, 21.0%, and 13.0%, respectively, all showing a downward trend year by year (all P<0.05). The training rates for occupational health among enterprise managers, responsible persons, and workers were 84.1%, 84.2%, and 91.2%, respectively. The detection rates for abnormal occupational health examinations among workers exposed to dust, chemical factors, and noise were 0.2%, 0.3%, and 0.5%, respectively. The setting rates of warning signs and warning instructions among enterprises for dust, chemical toxins, and noise were 87.3%, 91.1%, and 89.5%, respectively. The setting rates for dust, toxic chemical, and noise control facilities were 72.4%, 75.4%, and 46.0%, with effectiveness rates of 70.5%, 56.6%, and 55.2%, respectively. The distribution rates of personal protective dust masks, gas masks, and noise earplugs/earmuffs were 91.9%, 83.8%, and 86.4%, with wearing rates of 80.8%, 70.5%, and 76.4%, respectively. The detection rates of exceeding national limits for dust, chemical factors, and noise in the work site of occupational hazard factors were15.2%, 1.0%, and 21.6%, respectively. The detection rates of exceeding national limits for dust, chemical factors, and noise in the workplace of occupational hazard factors were 2.4%, 2.5%, and 12.3%, respectively. The exceedance rate for noise in work site showed an upward trend year by year (P<0.01). Conclusion Occupational disease prevention and control work in the key industries of this city needs strengthening. It is essential to further enhance the regular monitoring and preventive measures of occupational hazard factors in enterprises, improve protective measures, strengthen the use of personal protective equipment, and enhance occupational health training and supervision, to effectively reduce the risk of occupational diseases and protect workers' occupational health rights.

Objective:To report the surveillance results of the distribution and antimicrobial resistance profile of clinical isolates in Anhui province.Methods:Surveillance data from 94 members of the Anhui Antimicrobial Resistance Surveillance Network（HuiNet）from October 2023 to September 2024 were collected，the major drug-resistant bacteria and the resistance to commonly used antibiotics were analyzed. WHONET 5.6 and SPSS 25.0 software were used for data analysis.Results:Among 240 339 clinical strains，Gram-negative bacteria accounted for 75.0%（180 153 strains）. The detected bacteria mainly include Escherichia coli（ n=53 587，22.3%）， Klebsiella pneumoniae（ n=39 774，16.5%）， Pseudomonas aeruginosa（ n=25 505，10.6%）， Staphylococus aureus（ n=19 438，8.1%）， Acinetobacter baumannii complex（ n=14 239，5.9%），and so on. The prevalence of methicillin-resistant Staphylococcus aureus（MRSA）and methicillin-resistant coagulase-negative Staphylococcus aureus（MRCNS）were 37.7%（7 112/18 853）and 73.9%（13 221/17 895），respectively. No vancomycin- and teicolanin-resistant Staphylococcus were detected. The prevalence of carbapenem-resistant Escherichia coli（CREC）and Klebsiella pneumoniae（CRKP）were 1.9%（971/51 991）and 12.3%（4 864/39 414），respectively. The resistance rate of CRKP to tigecycline and polycolistin B was 7.7% and 7.9%，respectively. The prevalence of carbapenem-resistant Acinetobacter baumannii（CRAB）complex and Pseudomonas aeruginosa（CRPA）were 57.9%（8 222/14 198）and 18.2%（4 569/25 052），respectively，with low resistance to polycolistin B（2.0% and 7.2%，respectively）. The detection rates of MRSA，MRCNS，CRAB complex，third-generation cephalosporin-resistant Escherichia coli（3GC-R-EC）and quinolone-resistant Escherichia coli（QREC）in northern Anhui were the highest（46.8%，77.1%，65.6%，57.6% and 55.5%，respectively），which were higher than those in central and southern Anhui（ χ2=107.858 and 566.202，5.950 and 142.223，39.254 and 289.137，135.402 and 449.114，39.142 and 185.114， P<0.05 or <0.01），and the detection rates in central Anhui were higher than those in southern Anhui（ χ2=272.031，102.717，162.409，118.891 and 66.889，all P<0.001）. The detection rates of CRKP，CRPA and thirdgeneration cephalosporinresistant Klebsiella pneumoniae（3GC-R-KP）in central Anhui were the highest（16.7%，21.7% and 32.0%，respectively），which were higher than those in northern and southern Anhui（ χ2=229.656 and 439.377，156.599 and 65.818，77.386 and 232.568，all P<0.001）. The detection rates of CREC，3GC-R-EC and QREC were the highest in the elderly（2.2%，54.0% and 56.4%，respectively），which were higher than those in children and adults（ χ2=8.034 and 13.150，17.032 and 103.437，438.353 and 183.099，all P<0.01）. The detection rates of CRKP and 3GC-R-KP in neonates were the highest（20.6% and 56.9%，respectively），which were significantly higher than those in children，adults and the elderly（ χ2=38.869，8.337 and 7.921；65.517，55.525 and 49.214，all P<0.01），and the detection rate of 3GC-R-KP in the elderly was higher than that in children and adults（ χ2=14.122 and 7.501，both P<0.01）. The detection rates of CRAB complex，CRPA，CREC，CRKP and 3GC-R-KP in tertiary hospitals were higher than those in secondary hospitals（ χ2=25.606，16.501，5.820，33.116 and 117.086， P<0.05 or <0.01）. Except for MRSA，vancomycin-resistant Enterococcus faecium and QREC，the detection rates of major drug-resistant bacteria in intensive care unit（ICU）were the highest（all P<0.001）. From 2019 to 2024，the detection rates of MRSA，MRCNS，CRKP，CRAB complex and CRPA all showed a slow decreasing trend（ χ2=42.319，122.779，340.381，83.512 and 81.668，all P<0.001）. Conclusions:The situation of antimicrobial resistance in Anhui province shows a downward trend，but it is still serious，especially in northern and central Anhui. It is necessary to pay attention to the bacterial resistance particularly for the elderly，newborns，children and ICU.

Objective: To explore the impact of five-flavor Sophora flavescens enteric-coated capsules (FSEC) on the intestinal flora of rats with ulcerative colitis (UC), so as to provide the reference for the mechanism of FSEC in treating UC. Methods: Forty SPF-grade Wistar rats were randomly divided into the control group, the model group, the mesalazine group and the FSEC group. Except the control group (0.9% sodium chloride solution), the other 3 groups used 3% dextran sulfate sodium (DSS) for 7 days to establish UC model. After successful modeling, the control group and the model group were given 2 mL/kgbw of 0.9% sodium chloride solution by gavage for 2 weeks, while the mesalazine group and the FSEC group were given 2 mL/kgbw of mesalazine suspension (0.2 g/kg) and FSEC granule suspension (2.16 g/kg), respectively. Pathological changes of colon tissue were observed after hematoxylin-eosin (HE) staining. Rat fecal samples were collected, and 16S rDNA high-throughput sequencing and bioinformatics analysis were performed on intestinal flora. The α and β diversity of intestinal flora among the four groups were compared, and the dominant flora was screened using LEfSe analysis. Results: Compared with the control group, the model group showed a significant loss of colonic crypts and a large infiltration of inflammatory cells. Compared with the model group, the mesalazine group and the FSEC group exhibited a slight loss of colonic crypts, a small amount or an absence inflammatory cell infiltration, and improved tissue damage. The α-diversity analysis showed that compared with the control group, the Chao1 and Shannon indices in the model group increased, while the Simpson index decreased; compared with the model group, the Chao1 and Shannon indices in the mesalazine group and the FSEC group decreased, and the Simpson index increased（all P<0.05）. The β-diversity analysis showed that the sample distance between the FSEC group and the control group were more closer than that between the model group and the control group. LEfSe analysis results showed that the dominant bacteria in the model group were mainly from the Alistipes and Oscillospira. In the FSEC group, the dominant bacteria were from the Ruminococcus and Prevotella. Conclusion FSEC can improve the structures of intestinal flora, increase the abundance of beneficial bacteria such as Ruminococcus and Prevotella, reduce the abundance of pathogenic bacteria such as Alistipes, and alleviate the inflammatory response in UC rats.

ObjectiveTo establish a managing mode for illegal and irregular acts of occupational medical examination (OME) institutions to the requirements of the new situation. Methods The OME institutions from the “Guangdong Province Key Occupational Disease Monitoring and Management Platform” were selected as the study subjects using the judgment sampling method. The clues of suspected illegal and irregular acts of OME institutions were found and submitted to the local health commission for investigation and managed according to the case information monitoring and on-site quality assessment. The OME institutions found to have illegal and irregular acts were filed and investigated according to the national law after investigation and verification. A “follow-up inspection” was conducted on five OME institutions for closed loop management. Results A total of 12 OME institutions were found to have suspected illegal and irregular acts, including seven institutions that did not meet the filing requirements for effective personnel, five institutions that conducted projects beyond the scope without filing to the provincial health authorities within 15 work days from the start of the project, and two institutions that failed to fulfill the obligation of informing and reporting to the health authorities, employers, and workers as required. After submitting relevant clues and evidence to the local health commission for investigation and management, seven institutions were not given penalty, and five institutions were given administrative penalties including two institutions were fined and warned, and three institutions were warned. No illegal or irregular acts were found in the five institutions inspected during the “follow-up inspection”. Conclusion It is beneficial to explore the managing mode of “clue discovery, clue submission, investigation and disposal, follow-up inspection” for OME institutions suspected of illegal and irregular acts, which helps urge OME institutions to work in accordance with laws and regulations and effectively protect the legitimate rights and interests of workers' occupational health.

Objective:To analyse the distribution and antimicrobial resistance profile of clinical bacterial isolates in Anhui province.Methods:Surveillance data was collected from 83 members of the Anhui Antimicrobial Resistance Surveillance Network（HuiNet）during October 2022 to September 2023，to analyze the resistance of major bacteria to commonly used antibiotics and the detection of clinically common drug-resistant bacteria. The data was analyzed using WHONET 5.6 and SPSS 25.0 software.Results:A total of 201 647 clinical bacteria isolates were collected，with Gram-negative bacteria accounting for 74.8%（150 847/201 647）. The most prevalent Gram-positive bacterial strains were Staphylococus aureus（32.8%，16 648/50 800），followed by Staphylococcus epidermidis（14.0%，7 098/50 800）， Enterococcus faecalis（10.7%，5 458/50 800）， Enterococcus faecium（9.1%，4 613/50 800）and Staphylococcus hominis（7.4%，3 778/50 800）；the most prevalent Gram-negative bacterial strains were Escherichia coli（28.9%，43 577/150 847），followed by Klebsiella pneumoniae（22.5%，34 006/150 847）， Pseudomonas aeruginosa（14.7%，22 171/150 847）， Acinetobacter baumannii complex（9.4%，14 194/150 847）and Enterobacter cloacae（3.5%，5 235/150 847）. The prevalence of methicillin-resistant Staphylococcus aureus（MRSA）and methicillin-resistant coagulase-negative Staphylococcus aureus（MRCNS）were 39.5%（6 442/16 325）and 75.7%（12 343/16 312），respectively. No vancomycin- and teicolanin-resistant Staphylococcus were detected. The prevalence of vancomycin-resistant Enterococcus faecium and Enterococcus faecalis were 0.5% and 0.6%，respectively. The prevalence of carbapenem-resistant Escherichia coli and Klebsiella pneumoniae（CR-KPN）were 1.9%（805/42 956）and 11.7%（3 950/33 761），respectively. The resistance rate of CR-KPN to tigecycline was 3.9%. The prevalence of carbapenem-resistant Pseudomonas aeruginosa（CR-PAE）and Acinetobacter baumannii（CR-ABA）complex were 18.4%（3 936/21 447）and 62.9%（8 649/13 744），respectively，with low resistance rate to polycolistin B（6.9% and 1.7%，respectively）. The detection rates of MRSA，CR-ABA complex，third-generation cephalosporin-resistant Escherichia coli（CTX/CRO-R-ECO）and quinolone-resistant Escherichia coli（QNR-ECO）in northern Anhui were the highest（50.3%，72.9%，59.2% and 55.6%，respectively），which were higher than those in central and southern Anhui（ χ2=112.734 and 575.069，132.747 and 233.885，93.986 and 471.209，60.062 and 230.669，all P<0.001），and the detection rate in central Anhui was higher than that in southern Anhui（ χ2=278.671，29.219，207.395 and 80.267，all P<0.001）. The detection rates of CR-KPN and thirdgeneration cephalosporinresistant Klebsiella pneumoniae（CTX/CRO-R-KPN）in central Anhui were the highest（15.5% and 33.3%，respectively），which were higher than those in northern and southern Anhui（ χ2=156.237 and 325.533，76.928 and 180.686，all P<0.001），and the detection rate in northern Anhui was higher than that in southern Anhui（ χ2=32.202 and 25.539， P<0.001）. The detection rates of CTX/CRO-R-ECO and QNR-ECO were the highest in the elderly（55.2% and 55.8%，respectively），which were higher than those in children，and young and middle aged adults（ χ2=23.906 and 120.575，376.404 and 196.612， P<0.001）. The detection rate of CTX/CRO-R-KPN in neonates was the highest（57.1%），which was significantly higher than that in children，adults and the elderly（ χ2=46.141，38.843 and 32.093， P<0.001），and the detection rate in the elderly was higher than that in children and adults（ χ2=13.604 and 13.471， P<0.001）. The detection rates of MRSA and MRCNS were the highest in children（42.8% and 77.8%，respectively），which were higher than those in adults（ χ2=21.766 and 10.704， P<0.001）. Except MRSA and vancomycin-resistant Enterococcus faecium and faecalis，the detection rates of major drug-resistant bacteria in tertiary hospitals were higher than those in secondary hospitals（ P<0.05 or <0.01）. Conclusion:In 2023，the situation of antimicrobial resistance in Anhui province was serious，especially in northern and central Anhui，and targeted drug resistance control measures should be taken according to the monitoring results. At the same time，it is necessary to pay attention to the bacterial resistance in the elderly，newborns and children，and strengthen the rational use of antibiotics by clinicians to curb the spread of drug-resistant bacteria.

[Objective]To summarize Professor CHAI Kequn's clinical experience in the treatment of breast cancer based on his theory of four principles and four laws of TCM prevention and treatment of cancer.[Methods]Professor CHAI Kequn's understanding of breast cancer was analyzed through medical records,and his clinical experience in treating breast cancer with the theory of four principles and four laws was expounded and vertified by clinical medical records.[Results]Professor CHAI Kequn belives that breast cancer is related to liver,spleen,kidney and Yin cold toxic evil,with liver Qi stagnation as the main pathogenesis,so it is paticularly important to soothe liver and eliminate depression and regulate spirit throughout the whole process,and put foward the treatment method of"speech therapy".Professor CHAI Kequn uses the four principles of Fuzheng as the foundation,limited dispelling evil,the whole process of regulating the spirit and treatment based on syndromes,and the four laws of strengthening spleen and kidney,resolving phlegm and detoxification,soothing liver and resolving stagnation and warming Yang to conduct channels for syndrome differentiation and treatment.Under the guidance of the four printiples,soothing liver and resolving stagnation was used as treatment method,and combined with the treatment of strengthening spleen and kidney,resolving phlegm and detoxification,the clinical effect was remarkable.[Conclusion]By expounding the connotation of the four principles and the four laws and their application in clinical diagnosis of breast cancer,it is concluded that Professor CHAI Kequn's treatment of breast cancer focuses on soothing liver and elimanating depression,and increases or decreases the srugs according to the changes of the syndromes,which has guiding significance for the clinical treatment of breast cancer.

As the management system of Occupational Medical Examination (OME) institutions is moving to a record-filing model, the traditional management approach might not fulfill the current policy requirements. There is a pressing need for development of high-quality occupational health management system. In this context, the Guangdong Provincial Occupational Health Examination Quality Control Center (hereinafter referred to as the "Provincial Quality Control Center") pioneered the integration of the Performance Excellence Model (PEM) framework into the macro-quality management of OME institutions in Guangdong Province. In light of the current research gaps in the field of macro-quality management for OME institutions, the Provincial Quality Control Center, based on the core principles and standards of PEM, has closely aligned with the professional characteristics of occupational health examinations. The established macro-quality management innovation in OME institutions in Guangdong Province consists of seven dimensions: strategic direction, leadership development, identification of key management subjects, data analysis and management, human resources allocation, process optimization, and the application of quality control outcomes. This system has provided a robust impetus for the ongoing improvement of quality control efforts. The initial implementation of PEM demonstrated notable improvements in macro-quality management for OME institutions. Moving forward, the Provincial Quality Control Center will continue to strengthen the development of key technical personnel, innovate training models, harness the advantages of big data technology, restate and upgrade the system continuously, and refine the macro-quality management mechanisms of OME institutions to ensure that the health rights and interests of workers and employers are effectively safeguarded and enhanced.

Objective: To analyze the status of occupational medical examination (OME) institutions in Guangdong Province and the critical control points affecting their future development. Methods: A total of 211 OME institutions registered in Guangdong Province were selected as the research subjects. Their current statue was investigated, and the risk assessment of their future development was carried out based on hazard analysis and critical control point theory. Results: The OME institutions were mainly concentrated in the Pearl River Delta, accounting for 72.0%. The public and private medical and health institutions accounted for 70.6% and 29.4% respectively. The filing rates of different OME categories from high to low in the order were physical factors, chemical factors, dust, other, radiation factors, biological factors (P<0.01), and the filing rates were 89.6%, 88.6%, 84.8%, 63.0%, 7.1% and 1.0%, respectively. The rates of excellence in the field assessment from high to low in the order were hearing atlas analysis personnel, lung function examination operators, chest film reading personnel, chief examination physician, technical director, quality director (P<0.01), and the rates of excellence were 49.4%, 26.2%, 20.6%, 10.8%, 8.2% and 4.6%, respectively. A total of 37 institutions did not submit OME information, of which 23 institutions did not carry out OME work after filing. The required diagnosis rate and confirmed diagnosis rate of suspected occupational diseases in 2020 were 34.3% and 55.3%, respectively. In 2021, the detection rate of suspected occupational diseases was only 1.1‰. Among the institutions with biological monitoring records, 64.1% did not participate in external quality assessment program in laboratory, and the unqualified rate of 38 participating institutions was 55.3%. The risk assessment results show that the future development of OME institutions needs to focus on private institutions, institutions that have not reported OME information, institutions that have missed diagnosis and missed reporting of suspected occupational diseases, institutions that have not participated in external quality assessment program in laboratory and core personnel such as quality managers, technical leaders, and main inspection physicians. Conclusion: OME institutions in Guangdong Province show the characteristics of centralized filing category, centralized filing region and centralized filing institution nature. Combined with the potential risks of OME institutional capacity building, it is necessary to implement classified management, strengthen information construction, supervision and management, implement post responsibilities, and promote the high-quality development of OME institutions.

The Prevention and Control of Occupational Diseases Law revised in 2017 abolished the qualification test and approval for occupational health examination institutions, and replaced it with record management. The record does not belong to any type of administrative permit and does not require the premise of “general prohibition”. Its core idea is that “the public law actively acts as an obligation”, which does not prohibit administrative counterpart from carrying out specific tasks, mainly information collection, supervision and management of follow-ups, and emphasizes on simplifying procedures, improving working efficiency and stimulating market vitality. It is a strategic measure of the government's reform on “release, control and service”. It has the functional significance of alleviating information asymmetry, cultivating market credit mechanism and reflecting the government's flexible supervision and management mechanisms. However, China has not yet unified legislation on record management, and individuals on the theoretical and practical circles have different understandings on the concept, operation principle, and management effectiveness of the record management. There are practical dilemmas in the record management of occupational health examination institutions, such as alienation of record management into licensing, insufficient regulation of record management procedures, and weak in-process and post-process supervision and management capabilities. It is suggested to clarify the legal nature of record management, unify and improve the record management procedures, and improve in-process and post-process supervision and management capabilities. By building a legal, scientific and systematic regulation for the record management of occupational health examination institutions, adhering to the unity of “discharge” and “control”, it could effectively safeguard the legitimate rights and interests of occupational health examination institutions, workers and employers.