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Injury and Illness Surveillance. Global Burden Non-fatal Occ Illness & Injury, WHO. TRAUMATIC INJURY. What is Occupational Surveillance?. Systematic monitoring of: Hazardous exposures Adverse health events FOR THE PURPOSE OF Prevention and control of: Occupational hazards
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Global Burden Non-fatal Occ Illness & Injury, WHO TRAUMATIC INJURY
What is Occupational Surveillance? • Systematic monitoring of: • Hazardous exposures • Adverse health events FOR THE PURPOSE OF • Prevention and control of: • Occupational hazards • Occupational diseases and injuries
Types of Prevention Primary – Target: those with potential for exposure; no disease yet. Goal: change exposure conditions Secondary – Target: those with early stage of disease, no symptoms yet Goal: reverse disease, delay symptom onset Tertiary – Target: those with clinical disease Goal: cure or control of disease.
Opportunities for Prevention Primary Secondary Tertiary Prevention Prevention Prevention time Healthy Asymptomatic Symptomatic Worker Disease Disease
Why might you start an occupational surveillance program? • Identify a problem and estimate its magnitude • Identify groups at risk • Monitor illness/injury trends in time and geography • Identify cases, workplaces, and industries for attention • Identify new illnesses • Identify new hazards
How might you use a surveillance program? • Prioritize health problems • Determine whether you need an intervention program • Evaluate progress, success, or failure of an intervention program • Provide planning data for cost-effectiveness and benefit analysis
Surveillance Techniques • Keep log of new injuries and illnesses • Examine existing databases for specific, sentinel diseases • Conduct questionnaire survey of workers • Conduct physical examinations • Conduct laboratory examinations • Conduct job hazard analysis
HAZARD BASED Characterize hazards Observation/checklist Monitor environment Test workers HEALTH BASED Acute or chronic injuries/illnesses List of insurance claims Death certificates Health questionnaire Physical examination Lab testing for disease markers How would you organize surveillance?
Techniques: Examine existing databases • Death certificates • Hospital Discharges • Laboratory reports • Workers compensation reports • National surveys • Clinics that treat workers
Techniques: Questionnaire Survey • Demographic variables • Work history: job tasks, hazards • Health history: current, prior • Symptoms • Social, confounding factors
Techniques: Physical examination • Respiratory • Skin • Others
Techniques: Laboratory Reports • Require labs to report abnormal results above a specific level (e.g., Pb>25mg/dl) • May tie lab certification to reporting • Set up reporting agency protocol (e.g., health department accepts reports on pre-made forms or electronically) • Decide what level will trigger an intervention
Techniques: Workplace investigation • Investigate and record information about fatal injuries (i.e., accident investigation) • Visit industries with a particular hazard • Require reporting of certain injuries and set up a mechanism for reporting, however do not have to get every event to have an effective surveillance program
What are the components of a surveillance system? • Gather information on exposure & disease • Analyze data • Disseminate data in an organized form • Use data to target or evaluate an intervention • On-going
Case Studies For each of the cases, ask these questions • What is the sentinel health event of interest • What is the best way to collect information about it? (consider cost, time it takes to collect, how you will use results) • How could you use these results?
Case One You have heard about a small, rural community where most of the adults work in agriculture. There is concern about pesticide poisoning among adults and children because housing is located right next to farms.
Case One • Sentinel event: pesticide poisoning • Collect information: • Questionnaire of community • Blood testing of community • Reports from local hospitals/clinics • Use results: • For example, design pre and mid season cholinesterase testing. Remove workers with decrease.
Case Two A scaffold fell off the side of a building on a windy day. Two workers were killed.
Case Two • Sentinel event: death • Collect information: • accident investigation • review logs or medical records of injuries • Use results: • Policy change to improve enforcement
Case Three A group of rubber workers notice that several of their co-workers have developed leukemia. They are concerned about the hazards of their industry.
Case Three • Sentinel event: Leukemia • Collect information: • medical records of workers, if possible • conduct survey of workers • compare rates to those expected • Use results: • If elevated rates, determine related exposure • reduce hazard • collect ongoing CBCs to follow trend; • inform workers of results of study