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Journal of Postgraduate Medicine, Vol. 52, No. 3, July-September, 2006, pp. 172-173 Expert's Comments The interesting concept of applying the WHO STEPS data collection approach to the industrial setting Choi BCK Department of Public Health Sciences, University of
Toronto, Toronto, Department of Epidemiology and Community Medicine,
University of Ottawa, Ottawa, Ontario Code Number: jp06058 Related article: jp06056, jp06057 The World Health Organization (WHO) for years has been promoting a STEP wise approach (STEPS) to chronic disease risk factor surveillance.[1] The STEPS approach involves data collection in 3 steps: using a questionnaire (step 1); then moving to simple physical measurements (step 2); and then recommending the collection of blood samples for biochemical assessment (step 3).[2] This paper,[3] by applying the WHO STEPS approach to an industrial setting, is an interesting concept that may lead to some significant progress in occupational health research. Too often occupational health research has concentrated on studying the health effects of only industrial exposures, while neglecting the health effects from non-occupational behavioural risk factors. Using data from STEPS in combination with occupational exposure data can be a worthwhile effort to better advance chronic disease prevention and control in the workplace. Because of the cost in step 3, this paper recommends biochemical assessment only for individuals "at risk" (defined as having more than 3 risk factors in steps 1 and 2).[3] The number of risk factors, instead of the actual risk factors, is increasingly being used in public health to measure chronic disease risks.[4],[5] The study found that the risk factor profile of the workers from step 1 included: low intake of fruits and vegetables (< 500 g/day) (100%); tobacco use (any form) (31%); physical inactivity (sedentary throughout the day) (17%), and alcohol use (5%); and from step 2: sub-optimal blood pressure (>120/80) (66%), and elevated body mass index (>23) (65%). Among the 34% of the workers who were "at risk" (more than 3 risk factors), their biochemical risk factor profile from step 3 was: high blood cholesterol (>190 mg/dl) (41%) and diabetes (fasting blood sugar> 125 mg/dl) (19%). The suboptimal intake of fruits and vegetables is remarkable, especially given that the majority (91%) of the workers are vegetarians. In fact their mean fruit and vegetable consumption was only 190 g (fewer than 2 servings) per day. Other data on non-occupational risk factors, for example, 61% of the workers were engaged in long hours in a sedentary office environment, and 73% had a high waist to hip ratio (>0.9), can influence the attribution of chronic diseases to industrial exposures. It is expected that applying the WHO STEPS approach to occupational health studies will bear fruits. However, it is a pity that only 56% of the workers "at risk" of chronic diseases agreed to give blood samples for biochemical assessments. References
Copyright 2006 - Journal of Postgraduate Medicine |
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