Health Examination Surveys and Human Biomonitoring – the added value of combined studies

Health Examination Surveys (HES) are health surveys where information collected by questionnaire is complemented with information obtained through physical measurements, such as blood pressure and anthropometric measurements, and through clinical analysis of biological samples. Between 2000 and 2017, 15 European countries have conducted a national HES and in many countries smaller, regional or disease specific surveys have been carried out. Portugal is one of the countries that has recently conducted a first National Health Examination Survey (INSEF), which collected interview and anthropometric data and blood samples in a nationally representative sample of 4911 individuals aged between 25 and 74 years old. Human Biomonitoring (HBM) is a scientific approach used to assess individual human exposure to environmental chemicals by measuring substances, their metabolites or reaction products in biological specimens. Many countries have established HBM programs to monitor the chemical exposures of their populations. HES and HBM studies are very similar in terms of the infrastructure and procedures necessary for their implementation, as in either type of studies data is collected through fieldwork, which constitutes one of the largest expenditures for such studies. Combined studies could then result in more costeffective ways to conduct health and environmental monitoring. Some countries, like the USA, Canada, Germany, Belgium and France have already recognized the potential to combine these two types of studies and have successfully implemented surveys with both components. However, in practice, the opportunity for adding an HBM module to a health study and vice versa is rarely used. Reasons for this may be multifarious and may differ from country to country, and between different study settings. Within the HBM4EU project the advantages and obstacles of combined studies are being evaluated and feasibility studies will be conducted in order to identify practical/logistic, financial and scientific benefits and short comings.No âmbito do projeto HBM4EU, da qual fazem parte a Fundação para a Ciência e Tecnologia, I.P. (FCT), o Instituto Nacional de Saúde Dr. Ricardo Jorge, I.P. (INSA), a Direção Geral de Saúde (DGS) e a Agência Portuguesa do Ambiente, I.P. (APA), em parceria com a Faculdade de Medicina, Universidade de Lisboa (FMUL) e a Escola Superior de Tecnologia da Saúde Lisboa (ESTeSL), Instituto Politécnico de Lisboa.N/