The goals of the Fernald Medical Monitoring Program (FMMP) are to provide health screening and health promotion benefits to eligible participants, and to collect information for subsequent epidemiological (descriptive) analyses. In order to achieve thee goals, the FMMP hHas been designed to achieve four specific objectives, as follows:

1.Maintain ongoing contact with participants.
2.Monitor and document the significant previously identified health problems.
3.Monitor and document changes in health status among participants at regular intervals.
4.Provide health screening and health promotion services to participants regular intervals.

PROCEDURES

The ongoing re-examination monitoring program includes the following:

1.Consent to Participate

The first step is to understand and sign the consent for the physical examination and testing. Participants are sent a copy of the consent to review before their examination. Participants may indicate any part of the examination or testing that they do not wish to have done. No examination or tests can be performed until consent is given. Participants will be asked to sign the consent when they arrive.

2.Questionnaire

Participants are asked to complete a health questionnaire yearly. If they indicate that significant changes have occurred in their health status (during the interval since the last questionnaire or examination), we request a "release of information" from them in order to obtain vital medical information for their records. For instance, if a participant had a new diagnosis since the last examination, we request copies of the hospital discharge summary, pathology reports, and surgical reports. In this way we can update their record. If a participant does not wish to have an examination and testing, we still ask them to complete the questionnaire.

3.Focused History and Physical Examination by the Physician

Participants will be offered a screening health examination every two years during the anniversary month of their initial examination. The nursing staff measure weight, height, blood pressure, and pulse rate. The physician asks questions about their health problems and symptoms and performs a focused physical examination of their skin, thyroid gland, lymph nodes, mouth, heart, chest, and abdomen, Adult women are offered a breast examination and a pelvic examination and Pap smear. Adult men and women over 45, years of age are offered a rectal exam. Adult men are offered a testicular exam and men over 45 years of age are offered a prostate exam. Vision and hearing testing is also offered.

4.Laboratory Tests

Screening laboratory tests are performed which include red and white blood cell counts, blood salts, kidney function, blood sugar, and cholesterol. Men 50 years of age and older are offered the Prostate Specific Antigen (PSA) test, a screening test for prostate cancer. Urine tests for sugar, protein, and blood are offered to all adults 45years of age and older. All participants with known diabetes are offered a hemoglobin A1c test which measures how well their blood sugar has been controlled. A small amount of the blood drawn may be frozen for possible additional testing in the future.

Participants are asked to fast for 10 hours before their blood tests. Participants should take their blood pressure medication with a small amount of water before they come. Participants are advised to bring other medications with them to take after their blood has been drawn. Food is provided after the blood draw.

5.Other Tests

Chest x-rays are offered to all adults 40 years of age and older and adults under 40 years of age who smoke.

EKG (electrocardiogram) heart tracings are offered to all adults 40 years of age and older.

Mammograms will be offered each year to women 40 years of age and older.

All adults 45 years and older will be offered testing of stool for invisible blood (hemoccultR).

Additional follow-up testing may be offered to participants in selected circumstances when the results of screening tests are ambiguous (e.g. mammography).

INFORMATION PARTICIPANTS WILL RECEIVE

After the medical examination participants receive a letter from the FMMP examining physician summarizing his or her findings and recommendations for follow-up. Letters are sent by first-class mail about 4-5 weeks after their examination. With the letter, participants will receive copies of the laboratory test results and an explanation of the lab tests that were done. If the participant authorizes us to do so, a copy of their letter and results will be mailed to their physician.

One of our staff may contact the participant by phone following their examination to notify them of abnormal test results of concern. These results can be faxed to their physician if the participant authorizes us to do so.

Participants may call the office at 874-1074 to find out their blood and urine test results. We will have these results about 48 hours after testing. We will not have the chest x-ray or mammography results for about two weeks.

A satisfaction questionnaire postcard is enclosed with their examination and testing results. We ask participants to fill out the satisfaction questionnaire postcard and return it: in this way, we will know the participant has received their results and can let us know how we are doing. Each returned postcard is reviewed and appropriate follow-up is done if needed. The participant will be called if more information is needed.