1. Work related diseases and training element Helena Taskinen & Ahe Vilkis

2. Work related diseases and training: Objectives I -V I: Training curriculum on work-related and occupational diseases II: Training of the OHS personnel, family physicians and other specialists on work related and occupational diseases III: Training for trainers IV: Subnetwork on Occupational Health and Safety Training Institutions V: Registration of occupational diseases

3. I: Training curriculum on work-related (WRD) and occupational diseases (OD), 1 AIMS: Training curriculum for OHS physicians, family physicians, other physicians and trainers of trainers ACTIVITIES: 3 meetings with CC (AV, EM, RK) and MS (HT, K-PM) experts

4. I: Training curriculum, 2 RESULTS: Curriculum for physicians specializing in Occupational medicine/health services meets the EU/UEMS criteria Training of OH nurses (physiotherapists etc.) was included only in the Tallinn 2,5 years course Curriculum for training on WRDs/ODs proposed

5. I: Training curriculum, 3 EU/ UEMS (European Union of Medical Specialist) requirements for specialist training:  6 years of basic medical training  theoretical and practical instruction  full time course (or equivalent part-time training) supervised by the competent authorized bodies  in university centre, in a teaching hospital or in a health establishment approved by the competent authorized bodies  minimum length: 4 years after graduation

6. I: Training curriculum, 4 Proposal for training on WRDs/ODs in curriculum of graduate students in medicine, in specialists training of family physicians and other relevant specialities 8 credits = 80 h September–May 2004/2005 2 days course in each month Diagnostics of occupational lung, ear, nose and throat, skin, neurological, eye, musculo-skeletal diseases and prevention Tartu University, department of Public Health

7. Recommendations The additional need of OH physicians is 90-137 Tartu University produces 4 OH physicians a year The estimates for the future need in order to achieve 50% OHS is 150–200 OH physicians Presently there are 63 registered OH physicians in Estonia More residents (10/year) at TU or Tallinn course (2,5 yrs) restarted If training is increased, more trainer resources are needed Training of OH nurses should be established

8. II: Training of OHS personnel and family physicians AIMS: training on WRDs/ODs to the OHS personnel, family physicians and other clinical specialists geographical and professional coverage 46 training days for about 20 participants (920 trainee days) were planned Good practices RESULTS: 26 training days for 1556 participants, (85 to 146 per course), 2776 trainee days

9. Activities: Training courses Skin diseases (3 d) Lung diseases (6 d) Cancer (1 d) Intoxications (2 d) Nose, ear and throat diseases (2 d) Neurological diseases (2 d) Vibrations dis. (1 d) Musculo-skeletal diseases (3d) Psychiatric dis. (1 d) Work ability ass. (1 d) Reproductive hazards (2 d) Infectious diseases (2 d)

10. Participants by profession occ. health physicians, and residents 77 family physicians 68 physicians 36 lung and nose, throat spec, allerg. spec. 26 gynecologists 29 neurologists 15 dermatologists 10 radiologists 5 other specialist and residents 42 nurses, midwifes, physiotherapists 79 disability experts 21 others 23 TOTAL 431

11. Participants from public organisations Estonian Border Guard 2 Estonian Brodacasting Company 1 Estonian Civil Aviation Administration 1 Estonian Defence Forces 11 Estonian Police Board 3 Health Care Board (MoSA) 1 Labour Inspectorate (MoSA) 3 National Institute For Health Development 8 Occupational Health Centre (MoSA) 3 Social Insurance Board (MoSA) 21 Social Policy Information and Analysis Department (MoSA) 1 Tallinn Pedagogical College 1 Tallinn Prison 2 Tallinn Technical University 3 Tallinn's Children's Hospital 2 Tartu University 18

12. Participants from private organisations: East Tallinn Central Hospital 31 Ida-Viru County Central Hospital 1 Jõgeva Hospital 2 Järvamaa Hospital 4 Kallavere Hospital 3 Kohtla-Järve Hospital 2 Narva Hospital 1 North Estonian Regional Hospital 39 Pärnu Hospital 8 Rakvere Hospital 2 Sillamäe Hospital 1 South-Estonian Hospital 2 Tallinn Emergency Medical Service 2 Tartu University Hospital 39 Valga Hospital 3 Viljandi Hospital 5 West-Tallinn Central Hospital 28 Limited liability companies 75 Ltd. 69 Self-employed entrepreneurs 33

13. Results (continued) of obj. II. Training Visit and training of Estonian 12 experts at FIOH clinics in Finland for 2-4 days Distribution of the Good Occupational Health Practice guidelines book, introduction of good practices at the courses

14. Evaluation questionnaire eas used

15. III. Training for trainers AIM: to provide the trainers with skills for adult training 2 courses for trainers ACTIVITIES: Course 1: training needs were characterized (what is important to train). 8 participants how to form good chain of treatment for patients with ODs Course 2: the methods for planning training were lectured and exercised. 21 participants participants from the Network in training (obj.IV) were trained also (plan for 24 hrs course)

16. Training for trainers, 2 29 CC trainee days were achieved (18 days were planned) CONCLUSIONS: The results were used in building the curriculum for the 24 hours’ course and for occupational health curriculum of the specialist training of physicians and for other OHS personnel. The trainers know how to prioritize the teaching topics (what to teach) and some essential methods for planning and realising the training (how to teach). Training is likely to improve the recognition of ODs at all levels of health services

17. IV: Subnetwork on Occupational Health and Safety Training AIM: to provide an infrastructure for harmonization and development of OH&S training ACTIVITIES: 2 meetings, where goals/tasks were set and activities were planned

18. The tasks of the Subnetwork Web strategy network directory inventory and assessment of training materials development of training packages list of lecturers participation in train-the-trainer events marketing of OHS training

19. Benchmarks of Subnetwork All the planned meetings were conducted (the third in the connection with training for trainers) A subsecretariat for "Improvement of the program of the 24-h course" was nominated Secretariat organized meetings; next goals: Organizing train-the-trainer education Development of training packages for specific subjects Network meetings to be continued 1-2 x /year

20. V: Registration of occupational diseases AIM: to develop a system for recognizing and registering occupational diseases Plan: Consultations concerning establishment of registry and systems for follow-up of occupational diseases ACTIVITIES: Two consultations were coducted, as planned Benchmarks were achieved

21. Notification: Two Registries Estonian Act on Occupational Health and Safety (paragraph 23): the employer notifies the regional office of the Labour Inspectorate of ODs, on the basis of physician’s notificaton also notification other work-related diseases can be notified to OHC

22. Discussions Problems, e.g. lack of law on insurance for occ. accidents and ODs handling the cases at court registering ODs in the WRD registry European Union list of ODs was compared to the Estonian list

23. Recommendations The number of trained OHS physicians should meet the needs in the country: increase to 10 residents (now 4) Training of OH nurses and other professionals should be organised/ stabilised OHS physicians should have a license from the Estonian Health Insurance Fund to be able to diagnose ODs (be a link of the chain) Legislation on insurances for occupational accidents and diseases should be framed and launched Registration of ODs and WRDs should be guided to be done correctly The position of the OHC should be stabilised and provided with reasonable resources

24. The Goals Were Exceeded