Medical screening and Medical surveillance
Medical screening is a method for early detection and treatment of a potential disease or condition in people with no known signs and symptoms of that disease or condition. Thus, screening has a clinical focus—for instance, diabetes or cholesterol screening as a part of workers' wellness programs.
Medical surveillance is the periodic collection and analysis of health information data to identify problems that may be occurring in the workplace that require prevention, and to evaluate the effectiveness of existing prevention and intervention programs. Thus, it is used in a broader context than screening. Medical surveillance results provide opportunities for interventions to improve the work environment in order to ensure the health and safety of workers. Annual audiometric testing of workers exposed to loud noise is an example of medial surveillance for early detection and prevention of noise-induced hearing loss.
Fitness for Duty and Return to work
Fitness-for-Duty is the general term that assesses whether an employee can perform essential job functions. It may be required at pre-placement or during employment.
Return to work is usually applied to fitness-for-duty when a current employee has been absent from work due to injury or illness. There is a reasonable belief that the medical condition will impair the employee's ability to perform essential job functions.
Modified and Transitional Duty
Light duty, modified duty, and transitional duty are all often used synonymously because of their common goal to return the injured employee to work as soon as possible. However, in a stricter sense: modified duty means the employee can return to their usual and customary job with some modifications. For example, after a neck strain, an employee is allowed to return to work with the limitation of doing keyboard work for no more than two hours a day.
Transitional duty means the employee can no longer perform their usual and customary job because of medical restrictions. Therefore, the employee is given temporary transitional tasks until able to return to their regular job. For example, a warehouse worker with severe back strain may return to work temporarily doing a record-keeping job.
Aggravation and Exacerbation
An aggravation of an injury is the permanent enhancement or worsening of a prior underlying condition by a particular event or exposure. It usually implies a new incident producing additional impairment to a previously injured anatomical region. For instance, a worker with a history of a shoulder injury develops pain in the shoulder after lifting a heavy object at work and is diagnosed with rotator cuff tear of the shoulder.
An exacerbation is a temporary worsening of a prior condition by a particular event or exposure. It is a temporary flare-up of something related to a pre-existing condition but recedes to its former level within a reasonable time. It may be a temporary worsening of symptoms, such as pain, without changing an individual's underlying condition. For instance, a worker with a history of asthma may develop shortness of breath after exposure to excessive dust at work. Removing the worker to a safe place and providing treatment with an inhaler resolved their condition, and there was no change in spirometry results. This worker most likely had an exacerbation of asthma due to exposure to dust.
Work conditioning and Work hardening
Work conditioning is a daily job task simulation program, lasting 2 to 4 hours daily for 3 to 5 days per week. It is an intensive program designed to help patients regain their systemic and musculoskeletal functions. The therapist tailors activities, including mobility, strength, endurance, and motor control, so that the worker can tolerate specific tasks that will be expected upon return to work.
Work hardening has a similar goal, but is a more intense program lasting up to 8 hours daily for five days per week. It is prescribed to those workers who are seriously deconditioned after an impairment caused by an injury or disease. Work hardening is usually a multidisciplinary approach and uses occupational therapy, personal training, group therapy, cognitive interventions, and simulated or actual job-site training.
Impairment and Disability
Impairment "is a loss or abnormality of a psychological, physiological, or anatomical structure or function" (WHO). Impairments are conditions that interfere with an individual's activities of daily living," such as self-care and personal hygiene, standing and sitting, and social and work activities resulting from disease, illness, or injury.
Disability "is any restriction or lack (resulting from an impairment) of the ability to perform an activity in the manner or within the range considered normal for a human being" (WHO). A disabled person is a person with an impairment who experiences disability. In other words, it is an alteration of an individual's capacity to meet personal, social, or occupational demands because of an impairment.
Risk and Exposure
Risk is the probability or likelihood that an event will occur, e.g., that an individual will become ill or die within a stated period. For instance, the estimated annual occupational risk of HIV transmission is 0.27% for healthcare workers.
Exposure is any characteristic, event, or agent a person encounters that could affect the risk of developing the disease. Exposure is a dynamic process that varies from person to person, depending on the behavior, location, and varying from one type of exposure to another. For example, exposure to loud noise increases the risk of hearing loss among workers.
Exposure Monitoring and Biological Monitoring
Exposure monitoring is the process of estimating or measuring the magnitude, frequency, and duration of exposure to chemical, physical and biological agents in the work environment. It generally consists of collecting direct measurements or samples to be analyzed by a laboratory to determine the exposure of a worker to an agent. Monitoring workplace exposure aims to prevent workers from harmful agents, like chemicals, hazardous dust, noise, and pathogenic organisms.
Biological monitoring may be defined as a systematic or repetitive measurement and assessment of agents or their metabolites either in tissues or secretions to evaluate the uptake of a chemical (such as blood lead level) and the health risk involved to prevent workers from their detrimental effects. Since the intensity of a hazardous substance does not necessarily closely relate to the amount absorbed in the workers’ bodies, biological monitoring is essential, and complementary to exposure monitoring in protecting the workers’ health.
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