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Introduction to Surveillance

“In 1998, experts in Japan, Europe, and the United States called for a program of surveillance at workplaces and monitoring at national and regional levels in order to identify the extent of work-stress related health problems and to provide baselines against which to evaluate intervention efforts. They recommended that workplaces measure both workplace stressors and health problems known to result from such stressors [11].

In the United States, occupational and environmental medicine clinics can play a key role in such surveillance efforts. In addition to clinical care, such clinics conduct research, and provide patient education, industrial hygiene and ergonomics services, and social work and support groups [12]. Thus, a team approach is recommended in which epidemiologists work together with clinicians, health educators, ergonomists, psychologists, and other health professionals to identify high-risk workplaces and jobs, facilitate the provision of clinical care, and design and implement workplace interventions.

The surveillance team needs to discover whether the current occupation(s) is high risk; whether workers are exposed to any workplace physical, chemical, work schedule or psychosocial risk factors for disease; and whether any such have been increasing over time [13]. Questionnaires, such as the Job Content Questionnaire [14], the Effort-Reward Imbalance Questionnaire [15], and the Occupational Stress Index [16], can help measure job characteristics and job stressors. Workplace screenings should be conducted for biomedical risk factors, such as high blood pressure [17]. Such surveillance can help to identify clusters of work-related hypertension and help target work sites for primary and secondary prevention programs.

Another key part of surveillance is taking an occupational history of workers to see how long they have been facing workplace risk factors for disease, and what types of risk factors [18]. Such surveillance would be an important part of the newly developing field of occupational cardiology, which would link cardiologists, health promotion experts, and occupational health specialists. In addition to efforts described above, they would develop return-to-work guidelines for cardiac patients, including workplace modifications, and expand the use of ambulatory (portable) monitors to measure blood pressure or heart rate [19].”

11. The Tokyo Declaration, Journal of the Tokyo Medical University, 56:6, pp. 760-767, 1998.

12. Herbert, R., B. Plattus, L. Kellogg, et al., The Union Health Center: A Working Model of Clinical Care Linked to Preventive Occupational Health Services, American Journal of Industrial Medicine, 31, pp. 263-273, 1997.

13. Belkic, K., P. Schnall, and M. Ugljesic, Cardiovascular Evaluation of the Worker and Workplace: A Practical Guide for Clinicians, Occupational Medicine: State of the Art Reviews, 15:1, pp. 213-222, 2000.

14. Karasek, R. A., G. Gordon, C. Pietrokovsky, et al., Job Content Instrument: Questionnaire and User’s Guide, University of Southern California/University of Massachusetts, Lowell, Los Angeles/Lowell, MA, 1985.

15. Siegrist, J. and R. Peter, Measuring Effort-Reward Imbalance at Work: Guidelines, University of Dusseldorf, Dusseldorf, 1996.

16. Belkic, K., C. Savic, T. Theorell, and S. Cizinsky, Work Stressors and Cardiovascular Risk: Assessment for Clinical Practice. Part I, National Institute for Psychosocial Factors and Health. Section for Stress Research, Karolinska Institute, WHO Psychosocial Center, Stockholm, 1995.

17. Schnall, P. and K. Belkic, Point Estimates of Blood Pressure at the Worksite, Occupational Medicine: State-of-the-Art Reviews, 15:1, pp. 203-208, 2000.

18. Schnall, P., K. Belkic, P. Landsbergis, et al., Hypertension at the Workplace-Often an Occult Disease: The Relevance and Potential in Japan for Work Site Surveillance?, Japanese Journal of Stress Science, 15:3, pp. 152-174, 2000.

19. Belkic, K., P. Schnall, P. Landsbergis, and D. Baker, The Workplace and CV Health: Conclusions and Thoughts for a Future Agenda, Occupational Medicine: State of the Art Reviews, 15:1, pp. 307-322, 2000.

Taken from: Schnall PL, Dobson M, Rosskam E, Editors Unhealthy Work: Causes, Consequences, Cures. Baywood Publishing, 2009.

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