Surveillance, monitoring, and screening in occupational health.
Public Health & Preventive Medicine. Fourteenth Edition, Wallace RB, Doebbeling BN, Last JM, eds., Stamford, CT: Appleton & Lange, 1998 Jul; :669-673
Health examinations are performed in workplaces for several distinctly different purposes. For example, the most common purpose of the preplacement medical examination, which occurs after an offer of employment has been made but before an individual is placed on a specific job, is to determine if the individual has significant physical or mental impairment that would preclude the individual from performing specific essential duties related to a particular job. While this is one of the principal functions of the preplacement examination, the examination itself may be comprehensive, except in Minnesota due to a state law. One of the most common purposes of workplace health examinations and one that is most relevant to improving the health of the workforce is to identify toxic health effects at an earlier stage than they would be detected without the examination. This type of screening program is often initiated with a baseline examination and then followed with periodic follow-up examinations. The goal of this type of program is secondary prevention. It may benefit not only the individuals who may have diseases or toxic effects that are detected before they would have sought medical care, but may indirectly benefit other similarly exposed workers since the detection of work-related health effects should trigger an investigation of the workplace. Additionally, if excessive exposures are found, it should lead to efforts to reduce hazardous exposures or change unsafe working conditions. If large groups are tested, the test data can be analyzed to identify group trends. This can lead to the detection of more subtle changes than the evaluation of data solely on a case-by-case basis. This type of screening examination should be voluntary and is intended to benefit the individual worker who is screened. Therefore, the screening tests used in these periodic examinations should be evaluated to ensure that the tests are effective for screening objectives. A common adjunct to medical monitoring or screening is biological monitoring, which is the measurement of workplace agents or their metabolites in biological specimens, usually blood or urine, for the purpose of monitoring the level of exposure and adsorption. This approach to exposure assessment is particularly useful when adsorption is possible by dermal exposure. Biological monitoring should not be used to replace careful assessment of exposure conditions by other effective methods such as environmental air measurements.
Occupational-health; Health-programs; Medical-screening; Surveillance-programs; Health-hazards; Medical-examinations; Screening-methods; Screening-programs; Biological-monitoring; Legislation; Workplace-monitoring; Information-processing
Book or book chapter
Wallace-RB; Doebbeling-BN; Last-JM
Public Health & Preventive Medicine