This study analyzes the legal application of a dispute over employer identification in a case of occupational heat illness caused by part-time work to clarifying matters related to employer determination in occupational disease diagnosis using a case analysis method and factual reconstruction. The analysis is based on relevant civil laws and regulations, occupational disease diagnosis laws and regulations, and jurisprudential theories. The occupational disease diagnostic institution identified the part-time employer as responsible for the patient′s heat illness, which was both reasonable and lawful. This attribution safeguarded the rights of the worker, the primary employer, and the part-time entity. In occupational disease diagnosis, attention should be paid to de facto employment relationship, and the principle of "accountability lies with the actual employer at the time of the incident" should be followed to standardize employer identification. The health administrative department has supervisory responsibilities over occupational disease diagnoses. Workers′ compensation rights can be protected through the advance payment mechanism for work-related injury insurance. It is recommended to further improve internal procedures for occupational disease diagnosis, strengthen the dissemination of relevant laws and regulations and enhance the capabilities of occupational disease diagnosis physicians, to further protect workers' occupational health and their associated legal rights.

Objective To analyze the factors influencing the occupational health literacy (OHL) level among workers in key industries from the perspectives of both individual workers and enterprises. Methods A total of 32 336 front-line workers from 12 key industries in the secondary industry in Guangdong Province were selected as the research subjects by a stratified cluster random sampling method. Their OHL level was investigated using Occupational Health Literacy Questionnaire of National Key Populations, and the influencing factors were analyzed. Results The OHL level of the research subjects was 48.5%. The OHL level of the research subjects in four dimensions from high to low was basic knowledge of occupational health protection, occupational health practice and behavior, legal knowledge of occupational health, and basic skills of occupational health protection (80.7%, 61.2%, 48.3% and 29.5%, respectively). The multivariable logistic regression analysis showed that the OHL level of female workers was lower than that of males (P<0.05). Lower OHL was also associated with older age, lower education level, lower personal monthly income of workers (all P<0.01). The workers with length of service < 3 years and ≥ 20 years had lower OHL level than those with length of service 3-<10 years and 10-<20 years, respectively (all P<0.05). Workers in larger enterprises had higher OHL levels (all P<0.01). The OHL level of workers in the sixth category of industries with occupational injuries had higher occupational injury risks than those in the third and fourth categories (all P<0.05). The OHL levels of workers in state-owned enterprises, private enterprises, foreign-funded enterprises, and other enterprises were higher than that of workers in public institutions (all P<0.05). Conclusion The influencing factors of workers′ OHL in key industries of the secondary industry include individual factors (gender, age, education level, personal monthly income, length of service) and enterprise factors (enterprise size, enterprise nature and industry injury risk category). Female, older workers, those with lower education or income, and those with short length of service represent priority groups for OHL interventions, while small and micro enterprises are priority units for future workplace health promotion intervention.

Objective To analyze a case of violations by an occupational medical examination (OME) institution and to explore the key control points for the supervision and management of OME institutions, as well as the core role of quality assessment in this context. Methods An OME institution suspected of illegal activities was used as the study subject. Retrospective analysis was conducted. Clues of suspected violations were identified by an on-site quality assessment. After investigation and verification by the local health authorities, legal action was taken against the institution for its violations. Results During an on-site quality assessment, the Guangdong Province OME quality control expert group discovered that the OME institution violated regulations, including unqualified personnel file, exceeding the scope of services category, issuing false reports, failing to report suspected occupational diseases on time, and failing to notify workers about suspected occupational diseases as required. The evidence was then submitted to the Guangdong Province OME Quality Control Center, which subsequently forwarded the case to local health administration department for filing and investigation. After the investigation, penalties were imposed on the OME institution for its illegal activities. Conclusion The key supervision and inspection points in the quality assessment of OME institutions include personnel file configuration, the quality control management system and its implementation, the quality of OME reports, and information reporting. Quality assessment plays a pivotal role in ensuring the legal and compliant practice of OME institutions, safeguarding the health rights and interests of workers, and enhancing the overall standard of the OME industry.

Objective: To explore the association between greenness surrounding school and aggression among primary school students, and to explore the potential mediating roles of social support, loneliness, particulate matter (PM2.5) and Nitrogen Dioxide (NO2) in this association, in order to provide a scientific reference for preventing and ameliorating aggressive behaviors of primary school students. Methods: The data was used from a survey of children and adolescents conducted in 2015. The Chinese version of the Buss-Warren Aggression Questionnaire was used to assess total and subtypes of aggression, and the mean values of normalized difference vegetation index (NDVI) of 100 m, 500 m, 1 000 m circular buffers surrounding school were used to indicate the participants greenness exposure. PM2.5 and NO2 datas were obtained from the China High Air Pollutants Dataset.Generalized Linear Mixed Models were used to assess the associations of greenness surrounding school with total and subtypes of aggression. Results: Per IQR increment of NDVI-500 m [OR(95%CI)=1.09(1.03-1.15)] and NDVI-1 000 m[OR(95%CI)=1.07(1.02-1.13)] were positively correlated with physical aggression among primary school children, and per IQR increment of NDVI-100 m [OR(95%CI)=0.94(0.90-0.99)], NDVI-500 m [OR(95%CI)=0.93(0.89-0.98)] and NDVI-1 000 m [OR(95%CI)=0.95(0.91-1.00)] were negatively associated with verbal aggression (P<0.05). Mediation analyses revealed that social support partially mediated the association between the NDVI-500 m and physical aggression (mediation ratio:18.0%) and verbal aggression (mediation ratio:-8.3%) among primary school students, and loneliness partially mediated the association between the NDVI-500 m and physical aggression and verbal aggression among elementary school students effects, with proportion mediated ratios of -10.0% and 21.0%, respectively (P<0.05). Conclusions Exposure to school surrounding greenness is likely to associated with physical aggression and verbal aggression in primary school students, and social support and loneliness may partially mediate these associations.

Objective:To compare clinical characteristics,treatment patterns and physiological indicators in bipolar disorder(BD)patients with different age of onset.Methods:Totally 380 patients with DSM-5 BD were se-lected in this study.Psychiatrists diagnosed the patients using the Mini International Neuropsychiatric Interview.The clinical information questionnaire and the Global Assessment of Functioning scale were utilized to collected clinical characteristics,treatment status,and physiological indicators.The onset age of BD was divided into 21 and 35 years as cut-off points.Multivariate logistic regression and linear regression were used to analyze related factors.Results:Among the 380 patients with BD,199 cases were early-onset group(52.4％),121 cases were middle-onset group(31.8％),and 60 cases were late-onset group(15.8％).There were 26.6％of patients in the early-onset group in-itially diagnosed as depression,23.1％in the middle-onset group,and 11.7％in the late-onset group.Multivariate analysis revealed that compared to the early-onset group of BD,the middle-onset(OR=2.22)and late-onset(OR=4.99)groups had more risk to experience depressive episodes,and the late-onset group(OR=6.74)had 6.74 times of risk to suffer from bipolar Ⅱ disorder.Additionally,patients in the middle-onset(β=-1.52)and late-on-set(β=-4.29)groups had shorter durations of delayed treatment,and those in the middle-onset(β=-1.62)and late-onset(β=-3.14)groups had fewer hospitalizations.Uric acid levels were lower in both the middle-onset(β=-28.39)and late-onset(β=-31.47)groups,and total cholesterol level was lower in the middle-onset group(β=-0.23).Conclusion:Patients with BD in different age of onset show significant differences in clinical charac-teristics,treatment conditions and physiological indicators.

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.

ObjectiveTo explore the effect of occupational stress on work-related musculoskeletal disorders (WMSDs) in electronics manufacturing workers. Methods A total of 392 front-line workers in two electronic manufacturing enterprises in Guangdong Province were selected as the research subjects using the judgment sampling method. The prevalence of WMSDs and the level of occupational stress of the research subjects were investigated using the Musculoskeletal Disorders Questionnaire and the Core Occupational Stress Scale. Results The total WMSDs detection rate was 39.5%, and the multi-site WMSDs detection rate was 30.6%. The detection rate of occupational stress was 14.8%. The total WMSDs detection rate and multi-site WMSDs detection rate in the occupational stress group were higher than those in the non-occupational stress group (65.5% vs 35.0%, 56.9% vs 26.0%, both P<0.01). Binary logistic regression analysis result showed that the risk of WMSDs in the occupational stress group was higher than that in the non-occupational stress group after adjusting the effect of confounding factors such as age, gender, job type and work days per week (P<0.01). Conclusion The occupational stress may increase the risk of WMSDs in electronics manufacturing workers. Reducing the level of occupational stress among workers in electronic manufacturing enterprises is beneficial for reducing the risk of WMSDs.

Objective To analyze the long-term outcome of modified Morrow surgery (interventricular septal cardiomyectomy) in the treatment of hypertrophic obstructive cardiomyopathy (HOCM) in children. Methods The clinical data of the children with HOCM (aged≤14 years) who underwent modified Morrow surgery from January 2010 to August 2022 in Guangdong Provincial People's Hospital were retrospectively analyzed, including changes in hospitalization status, perioperative period, and long-term 15-lead electrocardiogram and echocardiography. Results A total of 29 patients were collected, including 22 males and 7 females, aged 10.00 (5.00, 12.00) years. Five (17.9%) patients had New York Heart Association (NYHA) heart function grade Ⅲ or Ⅳ. Ventricular septal cardiomyectomy was performed in all patients. All 29 patients survived and their cardiac function recovered after operation. Before discharge, right bundle branch block was observed in 2 patients and left bundle branch block in 6 patients. After surgery, in the left ventricular septal cardiomyectomy, the left atrial diameter decreased (P＜0.001), left ventricular end-systolic diameter increased (P=0.009), the peak pressure gradient of left ventricular outflow tract decreased (P＜0.001), and the thickness of ventricular septum decreased (P＜0.001). The systolic anterior motion of mitral valve disappeared and mitral regurgitent jet area decreased (P＜0.001). The flow velocity and peak pressure gradient of right ventricular outflow tract also decreased in the patients who underwent right ventricular septal cardiomyectomy. The average follow-up of the patients was 69.03±10.60 months. All the patients survived with their NYHA cardiac function grading Ⅰ or Ⅱ. No new-onset arrythmia event was found. Echocardiography indicated that the peak pressure gradient of the left ventricular outflow tract remained low (P<0.001). Moderate mitral regurgitation occurred in 2 patients, and left ventricular outflow tract obstruction with moderate mitral regurgitation occurred in 1 patient after simple right ventricular septal cardiomyectomy. Conclusion Right ventricular or biventricular obstruction is frequent in the children with HOCM and they usually have more symptoms before surgery. Modified Morrow surgery can effectively relieve outflow tract obstruction and improve their cardiac function. The long-term outcome is satisfactory. However, the posterior wall of the left ventricle remains hypertrophic. Also, there is an increased risk of a conduction block.

Objective To analyze the problems found in the on-site quality assessment of occupational medical examination (OME) institutions in Guangdong Province. Methods A total of 150 OME institutions were selected as the research subjects from Guangdong Province in 2023 using a random number table method. The on-site quality assessment was conducted by listening to reports, meeting discussion, on-site inspection, data review and human-machine assessment. The relevant assessment results were analyzed. Results Occupational disease prevention and treatment institutes (institutes, centers) and disease control and prevention centers (hereinafter referred to as "occupational prevention institutions"), public hospitals, and private institutions accounted for 8.7%, 51.3%, and 40.0% respectively. The top three categories of registered inspections were physical factors, chemical factors and dust, accounted for 98.0%, 96.7% and 96.0%, respectively, among the 150 OME institutions. A total of 1 063 rectification items were identified, and the average number of rectification items identified per occupational prevention institutions, public hospitals and private institutions was four, six and nine, respectively. The rectification rates of the four modules of quality assessment from high to low were OME work quality control, quality management system, organizational structure, and OME information reporting, accounted for 53.2%, 23.3%, 13.7% and 9.7%, respectively. The coincidence rate from high to low of occupational reporting of noise-exposure, dust-exposure, and other hazard-exposure was 92.5%, 91.1%, and 93.4%, respectively. The on-site failure rate of quality control director, technical director, chief physician, pneumoconiosis film reader, audiometry reader and pulmonary function examination operator accounted for 15.3%, 12.7%, 8.0%, 6.7%, 6.0% and 2.7%, respectively. Institutions capable of conducting registered and partially registered OME accounted for 90.7% and 6.0%, respectively. The five institutions that were unable to conduct registered OME were private institutions. A total of five private institutions were found to be suspected of illegal and irregular activities. Conclusion The problems of OME in the on-site quality assessment of OME institutions in Guangdong Province were mainly quality control. Private institutions had more prominent problems in various aspects. It is necessary to strengthen the training of key personnel such as technical directors, quality control directors, and chief physicians.

Objective:To describe the detail sampling design,weighting,instruments,filed procedures and quality control methods of the epidemiological survey on dementia among community residents in Tongliao City.Methods:A three-stage disproportionate probability sampling design was used to investigate the inhabitants aged 65 years and over in Tongliao City,Inner Mongolia Autonomous Region.The 10/66 Dementia Research Group(10/66 DRG)assessment instruments were used to diagnose dementia,using computer-assisted personal interview mode in the selected older people.Comprehensive quality control methods were implemented throughout the field-work.Results:A total of 166 villages or communities were sampled from nine counties or districts in Tongliao Cit-y.Totally 4 345 older people were interviewed with 96.2％response rate.By calculating sampling design weights,non-response adjustment weights and post-stratification adjustment weights,these weights were multiplied and per-formed trimming adjustment and standardization adjustment to generate final weights.The 171 interviewers were well-trained and qualified to carry out filed interview.Quality control methods included computer data check,audio record check,and telephone check in order to ensure the quality of the survey.Conclusion:This survey is imple-mented using a rigorous sampling design and timely quality control methods,and uses the 10/66 DRG assessment instruments with satisfactory international validity and reliability as survey instruments,which has international cross-cultural comparability.It provides a valid and feasible methodology of epidemiological survey on dementia for further studies in different regions in China.