Public Health 6 (+ 3)

Page created on May 18, 2020. Last updated on June 14, 2022 at 21:03

Topics 1 – 104 are public health 1, 2, 4 and 5. Public health 3 itself is not included (just check the topic list) but many of the public health 6 topics are basically the same as public health 3.

The department published a slightly modified topic list for public health 6 (+3) topics in a news post in Neptun Meet Street, without updating the topic list in the course information. According to that post, this is the current topic list for public health 6 (spring 2021):

• 105. Basic principles of ecology. Human environment, human ecology.
• 106. Health effects of interiors, health and the built environment
• 107. Health effects of global environmental issues
• 108. Air pollutants and their health effects
• 109. Health effects of microbiological and chemical water pollutants, water quality testing
• 110. Health effects of soil contamination. Health effects and management of waste water, wastes and hazardous wastes
• 111. Risk assessment, management and communication
• 112. Occupational toxicology, chemical safety
• 113. Occupational cancers
• 114. Physical hazards: disorders caused by noise and vibration and their prevention
• 115. Chemical hazards: Industrial and agricultural toxicology of organic compounds
• 116. Chemical hazards: Industrial and agricultural toxicology of inorganic compounds
• 117. Psychosocial and biological hazards in the workplace
• 118. Health effects of ionizing and non-ionizing radiations
• 119. Ergonomic factors. Health effects of inorganic and organic dusts and their prevention
• 120. Occupational diseases of health care workers and prevention. Occupational accidents.
• 121. Migration and catastrophes, medical and occupational health considerations

This is slightly different than the topic list from the course information, which I followed when making these topics. The good news is that some topics are no longer part of the topic list.

If you want an additional source for public health-related matters, https://iloencyclopaedia.org/ appears to be a good source.

105. Basic principles of ecology. Human environment, human ecology.

• Ecology is the study of interactions between organisms and the environment
• Supra-individual organization levels in ecology
  • Populations – groups of individuals
  • Communities – interactions of populations which interact
  • Ecosystem – the sum of communities and the environment
• The Gaia hypothesis = the biosphere (ecosystems) and the physical components of the Earth are closely integrated and form a complex interacting system
• The tragedy of the commons
  • The tragedy of the commons is a situation where people act independently in a way which is good for them, but because everyone does that, it ends up being bad for everyone
  • Example
    • A shared, common (“the commons”) land is discovered
    • Many farmers want to exploit the new land and put cattle there
    • The carrying capacity of the new land is blown, and none of the farmers can use the land anymore
    • Because everyone wanted to exploit the land for themselves, nobody could exploit it
  • This is relevant in human population growth
• The prisoner’s dilemma
  • The prisoner’s dilemma is a situation where two prisoners who are not allowed to communicate with each other are independently interrogated
  • If one of the prisoners betrays the other, the betraying prisoner will go free while the other serves a long sentence
  • If both prisoners betray the other, both prisoners will serve long sentences
  • If none of the prisoners betray each other, both prisoners will serve short sentences
  • The conclusion is that the action which is best for them both (not betraying) is not the same action which is best for them individually (betraying)
  • This is relevant in global climate change
    • All countries will benefit from preventing climate change in the long run, but no individual country wants to prevent it (due to cost)
• Interactions among populations
  • Predation – one organism kills and eats another
  • Parasitism – a relationship between two organisms where one benefits at the expense of the other
  • Competition – populations compete against each other
  • Coexistence/symbiosis – populations coexist, sometimes by helping each other
• Every ecosystem is made up of three components
  • Producers – organisms which create food from inorganic matter
  • Consumers – those who consume the food producers produce, directly or indirectly
  • Decomposers/reducers – break down waste and dead organisms
• Meadows model
  • A model of human population growth
  • This model says that the world will eventually reach a point where natural resources aren’t enough to sustain the world, and the population will collapse
  • The model is continuously updated
• Human ecology
  • Humans are consumers in the ecosystem, sitting on top of the food chain
  • We depend on producers and decomposers
  • Unique for humans; we can change the environment
    • Mining
    • Pollution
    • Mechanical and chemical degradation
    • Production of xenobiotics, like drugs
    • We remove natural environment and replace it with our artificial environment
  • Relevant questions regarding human ecology
    • Can the environment be transformed to carry the accelerated population growth?
    • Can the growth be decreased to meet the carrying capacity of the environment?
    • Can the ecosystems work normally under the present conditions?

106. Health effects of interiors, health and the built environment

• Interior health is important, as most people spend as much as 90% of their time indoor
• Indoor air pollutants is often much higher than regulation levels
• Indoor pollutants (see also topic 108)
  • Radon
    • From the soil and building materials
    • Radon causes 3 – 15% of all lung cancers
    • Radon is the second most important cause of lung cancer after smoking
    • Radon is a cancer initiator and promotor
    • Prevention
      • Increase ventilation
      • Sealing floor and walls
  • HCHO (formaldehyde)
    • From insulation, furniture, tobacco smoke
  • Asbestos
    • From insulation
  • PAH (polyaromatic hydrocarbons)
    • From tobacco smoke
  • Allergens
    • From house dusts, animal dander
• Sick building syndrome
  • A condition where people suffer from symptoms from the building they work or live in
  • The cause often remains unidentified, but symptoms improve or disappear when preventative measures are taken
  • Can have many possible causes
    • Biological agents
      • Bacteria
        • Legionella is often found in stale water sources
      • Viruses
      • Fungi
      • Pollen
      • Dust mites
        • Glycyphagus domesticus
      • Insects
      • Animal dander
    • Artificial light
    • Infrasound
    • Carbon dioxide
    • Carbon monoxide
      • Inside levels can be very high in the afternoon
      • Source: garages
    • Formaldehyde
      • Found in many building products, like particle boards, plywood, glue, etc.
    • Second-hand tobacco smoke
    • Volatile organic compounds (VOC)
      • From furniture, paint, adhesives, solvents, carpets, spray cans, construction materials, etc.
    • Psychosocial factors
      • Nocebo effect
  • Symptoms
    • Headache
    • Stuffy nose
    • Sneezing
    • Dry cough
    • Nausea
    • Tiredness
    • Etc.
  • Preventative measures for sick building syndrome
    • Eliminate tobacco smoke
    • Provide adequate ventilation
    • Maintain the ventilation system properly
    • Remove sources of pollution

107. Environmental monitoring and protection. Health effects of global environmental issues

• (This topic is slightly different since the 2021 spring topic list. See the top of the page.)
• Environmental monitoring
  • Air sampling
  • Soil sampling
  • Water quality monitoring
  • Microbiological monitoring
  • Measurement of noise
  • Measurement of radiation
• Environmental protection
  • Waste management
  • Ensure sustainable use of resources without degrading environment
  • Prevent and control degradation of environment
  • Promote international cooperation
  • Use eco-friendly resources
  • Decrease pollution
• Health effects of global environmental issues
  • Global climate change
    • Extreme heat
    • More natural disasters
    • Increased sea levels
    • Altered patterns of vector-borne disease, like malaria
    • More variable rainfall patterns
    • Increased air pollution
  • The ozone layer
    • A layer of ozone in the upper atmosphere
    • It absorbs 99% of the sun’s UVC and UVB
    • Damaged by NO_x, CFC11, CFC12
    • A large movement to ban ozone-damaging gases in 1970s – 1980s halted and reversed the “ozone hole”
  • Biodiversity loss
    • Causes decline in the ecosystem
  • Freshwater contamination
    • Freshwater is threatened by pollution, increased consumption, deforestation, and climate change
    • Increases risk of water-borne diseases, lack of clean water, etc.
  • Land degradation
    • Due to climate change, pollution, etc.
    • Increases risk of malnutrition, water and food-borne diseases, lack of clean water, etc.

108. Air pollutants and their health effects

• PCB = polychlorinated biphenyl
  • Used as a fluid in electronics
  • Production has been banned for many years, but because it lasts for long, it can still be found in old electronics and the environment
  • Symptoms of toxicity, collectively known as Yusho disease
    • Chloracne – a severe form of acne
    • Hepatotoxicity
    • Foetal abnormalities
    • Cancer
• PCP = pentachlorophenol
  • Use as pesticide, disinfectant
  • Symptoms of toxicity
    • Hyperthermia (by uncoupling oxidative phosphorylation)
    • Damage to liver, kidneys, lung, CNS, etc.
• TCA = 1,1,1-trichloroethane
  • Is used as a solvent
  • It’s an ozone-depleting substance and is therefore being phased out
  • Symptoms of toxicity
    • Similar to those of ethanol
    • Foetal abnormalities
• Greenhouse gases
  • The greenhouse effect traps heat from the sun on the surface of the earth
  • Major greenhouse gases
    • CO₂ – 55%
    • CFC11, CFC12 (fluoromethanes)
    • Methane
    • NO_x
  • The greenhouse effect drives climate change
• Smog
  • Smog is a combination of smoke and fog
  • Industrial smog = London smog = reducing smog
    • A sulphurous smog (contains sulphurs)
    • From burning coal or oil at power plants
    • Is chemically reducing
  • Photochemical smog = Los Angeles smog = oxidizing smog
    • From car emissions
    • Requires sunlight
    • Contains ozone, VOC, NO_x
    • Is chemically oxidizing
    • Can form acid rain
• Ozone (O₃)
  • Is formed in the upper atmosphere when sunlight acts on oxygen (O₂)
  • Concentrations higher than 0,1 ppm is toxic
• Particles
  • Mostly from cars, wood-burning and industries
  • Types
    • Dust
    • Fibres
      • Asbestos
    • Nanoparticles
  • Deposition in lungs
    • Particles > 5 µm are trapped in upper airways
    • Particles 1 – 5 µm are trapped in the bronchi
    • Particles < 1 µm are trapped in the alveoli
  • Health issues
    • Irritation of eyes
    • Coughing
    • Allergies
    • Chronic obstructive pulmonary disease
    • Pneumoconiosis (interstitial lung fibrosis)
    • Asbestos -> mesothelioma
• Pollutants which are present both indoor and outdoor
  • NO_x, CO, CO₂
    • From fuel burning, metabolic activity, tobacco smoke
  • Particles, aerosols
    • From combustion, tobacco smoke, condensation
  • VOC (volatile organic compounds)
    • From fuel burning, painting, metabolic activity, pesticides, solvents, cosmetics, etc.
    • Formaldehyde, benzene, styrene, etc.
  • Spores
    • From fungi, moulds
• Prevention of air pollution
  • Primordial prevention
  • Countries must cooperate to reduce air pollution
  • Separating industrial from residential areas
  • Facilitate public transport, biking or walking instead of driving

109. Health effects of microbiological and chemical water pollutants, water quality testing

• Natural ingredients of water
  • Iodine, fluoride, calcium, magnesium, sodium, etc.
  • The calcium and magnesium content of water determines its hardness
    • Hardness should be around 5 – 35 degrees
  • High sodium intake increases risk for hypertension
  • Fluoride in water
    • Protects against dental caries
    • Too high level gives dental fluorosis, fragile bones
    • Level should be 0,7 – 1,2 mg/L
    • Fluoridation of drinking water may be necessary to reach optimal level
• Chemical water pollutants
  • Toxins from algae
  • Pesticides (mercury or chloroorganic)
    • Minamata disease – due to organic mercury
      • Causes neurological symptoms
  • Fertilizers (nitrate)
    • Nitrate toxicity can lead to methaemoglobinaemia / blue baby syndrome
      • Especially in infants and those with methaemoglobin reductase deficiency
    • Nitrate inhibits iodide uptake -> endemic goiter
    • Prevention: addition of methylene blue to the water
  • Arsenic
  • Oil
  • PAHs
  • Detergents
• Microbiological water pollutants
  • Bacterial
    • Campylobacter jejuni, campylobacter coli
    • Pathogenic e. coli
    • Salmonella typhi
    • Shigella spp, yersinia enterocolitica
    • Pseudomonas aeruginosa
    • Legionella pneumophila
  • Viruses
    • Adenovirus
    • Enterovirus
    • Hepatitis A
    • Norovirus
    • Rotavirus
  • Protozoa
    • Entamoeba histolytica
    • Giardia lamblia
  • Worms
    • Dracunculus medinensis
  • Water-born outbreaks
    • Legionella is the major cause of water-born outbreaks
    • Criteria
      • Many cases at the same time in one distribution area
      • Pathogens detectable in water or biological sample
      • No new cases after closing the distribution system
      • No new cases after disinfection
• Water quality testing
  • Dissolved oxygen
  • pH
  • Nitrates
  • Total dissolved solids
  • Hardness
  • Faecal coliform bacteria
    • These are not pathogens, but they indicate the presence of other pathogens
    • They are so-called indicator organisms
  • Phosphorous

110. Health effects of soil contamination. Health effects and management of wastewater, wastes and hazardous wastes

• Health effects of soil contamination
  • According to the European hazard symbols, chemical which are dangerous to the soil and environment are noted by the letter N
  • Sources of soil contamination
    • Landfills
    • Deforestation
    • Pesticides, fertilizers
    • Acid rain
  • Biotic factors of soil with health impact
    • Geohelminths
    • Protozoa
    • Bacteria
  • Chemical factors of soil with health impact
    • Heavy metals
      • Arsenic
      • Lead
      • Mercury
    • Mineral oils
    • Pesticides
    • Fertilizers
    • Iodide
    • Organic chemicals
    • Isotopes
  • Many soil pollutants are carcinogenic, neurotoxic, hepatotoxic, etc.
• Health effects and management of wastewater, wastes and hazardous wastes
  • Wastewater = water used by humans which is returned to the environment
  • Hazardous wastes
    • Organic solvents
    • Heavy metals
    • Paints
    • Oil
    • Pesticides
    • Plastics
  • Health hazards of waste accumulation
    • Epidemics of cholera, diarrhoea, dysentery, etc.
    • Carcinogenesis
    • Teratogenesis
    • CNS toxicity
  • Waste management
    • Waste must be properly collected and transported, and later treated or safely disposed of

111. Risk assessment, management, and communication

• Risk assessment
  • = assessing the health risk of a policy, action, or intervention
  • Involves:
  • Identification of the hazard
  • Evaluation of the dose-response relationship
    • Compounds can follow a deterministic dose-response relationship or a stochastic dose-response relationship
    • Deterministic dose-response relationship
      • = means that as the dose is increased past a certain threshold (LOAEL), the severity of the effect increases
      • Most compounds have this type of relationship
      • The highest dose at which there is no observed effect is the NOAEL (no observed adverse effect level)
      • The lowest dose at which there is an observed effect is the LOAEL (lowest observed adverse effect level)
    • Stochastic dose-response relationship
      • = means that there is no safe dose threshold, and as the dose increases the probability (not the severity) of the effect increases
      • Even at an exposure of 1 molecule, the adverse effect can occur (albeit with extremely low probability)
      • Carcinogenic compounds have this type of relationship
      • There is no upper limit of safe dose, so instead we use the ALARA principle (as low as reasonably achievable)
  • Evaluation of human exposure
    • Estimate concentration in the environment
    • Perform measurements of the environment and biological samples
      • Many chemicals have biomarkers which can be measured in the urine
  • Characterization of the risk
    • The unit of risk is microrisk (µR)
      • 1 µR refers to one case of adverse effect per 1 million people
    • The highest acceptable risk for the general population is 1 µR/life
    • The highest acceptable risk for the working population is 10 µR/year
      • Because the working population is overall healthier than the general population
    • Reference dose (RfD) = (NOAEL or LOAEL) / (UF1 x UF2 x … x MF)
      • RfD is the maximum acceptable dose to be exposed to
      • This formula allows for extrapolation of results from animal studies to humans
      • UF and MF are uncertainty factors
• Risk management
  • = planning and implementation of actions to reduce or eliminate health risk
  • Preventative measures (in sequence)
    • Improve manufacturing practice
      • For example, change the manufacturing process to one with less risk
    • Use better working tools
    • Use less hazardous chemicals
    • Collective safety
    • Rearrange work
      • Decrease working hours
    • Use personal safety equipment
      • This should only be used is all other measures fail
      • This is because workers tend to not use safety equipment correctly (because they’re uncomfortable), so it’s not an effective way of preventing risk
• Risk communication
  • = communicating the risk to the exposed people

112. Occupational toxicology, chemical safety

• Occupational toxicology
  • The maximum working time in occupational exposure to hazardous compounds is:
    • 8 hours per day, 5 days per week, 240 shifts per year
  • Measurement of toxicity – by LD₅₀ (the dose which kills 50%)
  • Toxicity according to timeframe
    • Acute toxicity – within 24 hours
    • Subacute toxicity – between 24 hours and 90 days
    • Chronic toxicity – later than 90 days
  • Elimination of organic toxic materials
    • Phase 1 of biotransformation – oxidation
      • By CYP450
    • Phase 2 of biotransformation – conjugation with glucuronic acid, acetyl, etc.
    • Phase 3 – excretion by kidney or liver
  • Elimination of heavy metals
    • Phase 1 – expression of metallothionein genes
      • These genes code for proteins which bind to the heavy metals
    • Phase 2 – excretion or storage of the metal-protein complex
  • Pesticides
    • Used in agriculture, wood preservation, pest control, over the counter, etc.
    • Occupational exposure
      • Pesticide synthesis workers
      • Agricultural workers
      • Pest control workers
    • Absorbed through skin, respiratory tract, GI tract
    • Persist for many months in the body
    • Examples
      • Organophosphates – Irreversibly inhibit acetylcholinesterase – cause cholinergic crisis
      • N-methyl carbamates – reversible inhibit acetylcholinesterase
      • DDT – a volatile organic compound (VOC)
• Chemical safety
  • The CAS registry
    • A registry which contains every chemical substance known
    • Contains information about the substances
    • Currently contains more than 150 million
  • Material safety data sheet
    • Follows all dangerous chemicals
    • Provides all relevant information, like possible hazards, how to handle safely, etc.
    • European hazard symbols
      • Used until 2015 – nowadays the Globally Harmonised System is used instead
      • E – explosive
      • F – highly flammable
      • O – oxidizing
      • T – toxic
      • Xn – harmful
      • Xi – irritating
      • C – corrosive
      • N – dangerous for the environment
  • R phrases (risk phrases)
    • Codes which correspond to specific risks
    • R1 – explosive when dry
    • R45 – may cause cancer
    • etc.
  • S phrases (safety phrases)
    • Codes which correspond to specific safety rules
    • S24 – avoid contact with skin
    • Etc.

113. Occupational cancers

• General about occupational cancers
  • International Agency for Research on Cancer – IARC
    • Involved in occupational cancer research
    • Evaluates and classifies chemicals, occupations, physical effects, industrial processes, according to their carcinogenetic potential
      • Group 1 – definitely carcinogenic
        • 113 substances
        • Alcohol
        • Smoking
        • UV radiation
        • Processed meat
      • Group 2A – probably carcinogenic
        • Red meat
        • Fried food
      • Group 2B – possibly carcinogenic
        • Coffee
        • Welding fumes
      • Group 3 – not classifiable as carcinogenic
        • Due to lack of enough evidence
        • Magnetic fields
        • Tea
      • Group 4 – probably not carcinogenic
        • Only 1 substance
  • Annually registered cases of occupation cancer in Hungary – 10 to 30 cases
    • Massive underreporting
  • CAREX database – holds data on the occupational carcinogen exposure in Europe
  • Occupational cancer is the main cause of occupational death in Europe
  • Occupational cancer accounts for 8% of cancers
  • 23% of the workforce is exposed to occupational carcinogens on a daily basis
  • Most frequent occupational carcinogenic exposures
    • Solar (UV) radiation
    • Tobacco smoke
    • Silica crystals
    • Diesel exhaust
  • Cancer initiators
    • One-time exposure is sufficient
    • Bind to DNA and cause mutations
    • Irreversible effect
    • Examples
      • PAH
      • Tobacco
      • Nitrosamines
  • Cancer promoters
    • Repeated exposure is necessary
    • No carcinogenic effect without an initiator
    • Does not bind to DNA
    • Reversible effect
    • Examples
      • DDT
      • PCB
      • Tobacco smoke
  • Carcinogens are stochastic, i.e. there is no “safe” level of exposure to the carcinogens, and the probability of cancer increases with dose
  • Many environmental carcinogens are also encountered in occupations, so the distinction between environmental and occupational carcinogens is not always straight forward
    • Aflatoxin, cyclophosphamide, UV radiation, PAH, etc.
  • Most frequent occupational cancers
    • Lung and pleura
    • Bladder
    • Skin
• Lung cancer
  • Occupations
    • Miners
    • Construction workers
    • Shipyard workers
  • Occupational carcinogens
    • Asbestos
    • Radon
    • PAHs
    • Arsenic
  • Prevention of asbestos exposure
    • Find out where asbestos is
    • Only qualified workers should remove it
    • It’s more dangerous to remove it than to leave it (as that releases it into the air)
    • Use HEPA filters
• Bladder cancer
  • Slow acetylators (slow NAT2) have higher risk
  • Occupations
    • Dye industry
    • Leather industry
    • Rubber industry
  • Occupational carcinogens
    • Benzidine
    • Naphthylamine
    • Anillin dye
• Skin cancer
  • Occupations
    • Outside workers (agriculture, etc.)
  • Occupational carcinogens
    • Arsenic
    • UV
  • Prevention
    • Protective clothing
    • Sunscreen
• Leukaemia
  • Occupational carcinogen
    • Benzene

114. Physical hazards: health effects of low and high temperature

• (This topic is removed since the 2021 spring topic list. See the top of the page.)
• Health effects of low temperature
  • Sources
    • Natural conditions
    • Ice plants
    • Freezers
  • Disorders
    • Frostbite
      • Cold, pale, skin
      • Fingers, toes
    • Trench foot
      • Necrosis, gangrene
• Health effects of high temperature
  • Sources
    • Natural conditions
    • Boilers
    • Ovens
  • Disorders
    • Heat rash (miliaria rubra) = itchy rash
    • Heat cramps = cramps in the legs
    • Heat exhaustion = dizziness, fainting
    • Heat stroke

115. Physical hazards: disorders caused by noise and vibration and their prevention

• Disorders caused by noise
  • Humans hear from 20 – 20 000 Hz
  • Normal conversation is 60 dB
  • Chronic exposure > 85 dB may cause hearing loss
    • Higher noise causes hearing loss faster
    • High frequency sounds are more damaging than low frequency sounds
  • The phon scale
    • For the human ear and brain, not only the sound pressure level (the decibel) but also the frequency matters.
    • Unlike the normal decibel scale, the phon scale is standardized to one frequency
    • While the normal decibel scale measures sound intensity, the phon scale measures perceived sound intensity
  • Hearing loss
    • Usually occurs at 4 kHz first
    • Hearing loss is measured in decibels
    • Types
      • Temporary threshold shift
        • Recovers after 16 – 48 hours
      • Permanent threshold shift
        • Never recovers
    • Clinical features
      • Difficulty hearing words in noisy environment
      • Tinnitus
      • Need to look at person to understand words
  • Other disorders cause by noise
    • Hypertension
    • Cardiovascular disease
    • Poor cognitive performance
    • Sleep disturbance
  • Prevention
    • Primordial
      • Change environment and city structure
      • Place non-residential land between noise source and receiver
      • Place barriers between noise source and receiver
    • Primary
      • Reduce noise production
        • According to regulations, the average 8-hour noise level during a workday should be less than 80 dB
      • Increase distance between noise source and receiver
      • Use hearing protection
    • Secondary
      • Regular screening
• Disorders caused by non-audible sounds
  • Ultrasound can kill furred animals
    • The energy is absorbed in the fur
  • Infrasound can cause headache, nausea, fatigue and hypotension
• Disorders caused by vibration
  • Segmental vibration – vibration of a part of the body
    • Due to usage of vibrating tools
    • Commonly seen in manual workers, dentists, road workers
    • Causes hand-arm vibration syndrome
      • = a secondary form of Raynaud syndrome
  • Whole body vibration
    • Due to riding machinery, etc.
    • Causes fatigue, irritability, disorders of the spine, etc.
  • Prevention
    • Use tools which vibrate less
    • Avoid cold
    • Anti-vibration gloves
    • Spend less time vibrating

116. Chemical hazards: Industrial and agricultural toxicology of organic compounds

• POP = persistent organic pollutant
  • = Organic compounds which are resistant to environmental degradation
    • Most are chlorinated
  • Initially contained 12 compounds, nowadays more
    • Originally called the “dirty dozen”
    • DDT, PCBs, aldrin, chlordane, dieldrin, endrin, heptachlor, hexachlorobenzene, mirex, toxaphene, dioxins, furans
    • Many POPs are pesticides, solvents, drugs, and industrial chemicals
    • DDT is used against malaria mosquitoes
  • Share 4 characteristics
    • Very toxic
    • Persistent in the environment (decay very slowly)
    • Lipophilic (accumulate in fat)
    • Can evaporate and travel long distances
  • These compounds accumulate in the environment and have adverse effects on health and the environment
    • These compounds accumulate through the food chain and eventually end up in our diet
  • Humans are mostly exposed through diet or occupation
  • Health consequences
    • Endocrine dysfunction
    • Reproductive system dysfunction
    • Carcinogenesis
  • 2001 Stockholm convention called for eliminating their production and use

117. Chemical hazards: Industrial and agricultural toxicology of inorganic compounds

• Heavy metals
  • Arsenic
    • Sources
      • Pesticides
      • Contaminated water
    • Acute symptoms
      • Vomiting
      • Abdominal pain
    • Chronic symptoms
      • Hyperkeratosis on soles and palms
      • Neuropathy
      • SCC of skin
      • Hyperpigmentosis (black foot disease)
      • Bladder cancer
  • Lead
    • Jobs at risk
      • Working with lead products
      • Shooting ranges
      • Welding
      • Soldering
      • Construction
    • Measured by blood lead levels
    • Acute symptoms
      • Abdominal pain
    • Chronic symptoms
      • Polyneuropathy
      • Anaemia
      • Nephropathy
  • Mercury
    • Sources
      • Often inhaled as fumes
      • Certain fish (tuna, swordfish)
    • Chronic symptoms
      • Peripheral neuropathy
      • Neuropsychiatric disorders
  • Cadmium
    • Sources
      • Food contamination
      • Cigarette smoke
      • Paint
    • Acute symptoms
      • Acute respiratory failure
    • Chronic symptoms
      • Osteomalacia
      • Kidney damage

118. Psychosocial and biological hazards in the workplace

• Psychosocial hazards in the workplace
  • Work-related stress is one of the most frequent health risks in workers in Europe
  • Psychosocial risk factors of workers
    • Excessive workload
    • Long working hours
    • Conflicting demands
    • Lack of influence over their own work
    • Poor management
    • Psychological and sexual harassment
    • Discrimination
  • Prevention
    • Primary
      • Eliminating the risks themselves
    • Secondary
      • Regularly ask workers if they have any complaints
    • Tertiary
      • Training employees to better handle their work situation
      • Providing employees with coping tools
      • Prove opportunities for treatment and recovery
• Biological hazards in the workplace
  • Two types
    • Allergens or toxic agents which cause occupational diseases in respiratory tract and skin
    • Microorganisms which causes zoonoses or other infectious disease
  • In food industry, agriculture, working with animals, health care workers, working with wastes, laboratories, etc.
  • Groups of biological hazards
    • 1 – cannot cause human disease
    • 2 – able to cause preventable or treatable human disease
    • 3 – causes severe preventable or treatable human disease
    • 4 – causes severe non-preventable and untreatable human disease
  • Biosafety level (BSL)
    • A set of precautions required to isolate dangerous biological agents in a lab
    • Biosafety level 1
      • Lowest level
      • Lowest levels of precautions
      • For non-pathogenic E. coli, staphylococci, etc.
    • Biosafety level 2
      • For hepatitis viruses, HIV, pathogenic E. coli, staphylococci, etc.
    • Biosafety level 3
      • For M. tuberculosis, SARS-Cov-2, Yersinia pestis, etc.
    • Biosafety level 4
      • Highest level
      • Highest levels of precautions
      • For Ebola virus, Marburg virus, Lassa virus, etc.
  • Prevention
    • Risk assessment and reduction
    • Workers must be informed on risks and trained
    • Regular health surveillance
      • Workers with symptoms should stay home
    • Vaccination
    • Proper hygiene
    • Personal protective equipment (PPE)
      • Gloves
      • Masks
      • Face masks
      • etc.

119. Health effects of ionizing and non-ionizing radiations

• Basics of radiation
  • Alpha radiation consists of helium nuclei
  • Beta radiation consists of electrons
  • Gamma radiation consists of photons (electromagnetic radiation)
• Units related to radiation
  • Gray (Gy) = absorbed dose
  • Sievert (Sv) = equivalent/effective dose
• Ionizing radiation
  • Mostly gamma rays
  • Alpha and beta radiation has low penetrating power and therefore only causes disease if inhaled
    • Radon can be inhaled, and it gives alpha radiation
  • Natural sources of ionizing radiation
    • Radioactive disintegration (mainly from uranium)
    • Cosmic radiation
    • Radioactive potassium
    • Radon occurs naturally in soil
  • Occupations with high ionizing radiation exposure
    • Jobs in nuclear medicine
    • Miners
    • Pilots
    • Gas and oil industry
  • Health effects of ionizing radiation
    • Deterministic effects
      • Vomiting
      • Skin burns
    • Stochastic effects
      • Cancer
• Non-ionizing radiation
  • Ultraviolet
    • UVA
      • Least energy
      • Mostly related to premature aging
      • Less related to cancer
    • UVB
      • Mostly related to sunburns
      • Highly related to cancer
    • UVC
      • Highest energy
      • 99% is absorbed by the ozone layer, preventing UVC from reaching us
    • Occupations with UV exposure
      • Outdoor workers
    • Health effects
      • Erythema
      • Premature ageing
      • Skin cancer
      • Outdoor workers have the highest UV exposure
  • Infrared
    • Occupations with IR radiation exposure
      • Bakers
      • Glass blowers
      • Blacksmiths
    • Health effects
      • Corneal and conjunctival burns
      • Retinal injury
      • Cataract
  • Laser
    • Skin problems
    • Eye problems

120. Ergonomic factors. Health effects of inorganic and organic dusts and their prevention

• Ergonomics
  • = how the workplace and equipment can be best used for comfort, safety, and productivity
    • Physical ergonomics = how the body responds to work
    • Cognitive ergonomics = how the mind responds to work
    • Organizational ergonomics = how work organization can be optimized
  • Applying ergonomics improves productivity, reduces cost, improves quality of work, and reduces absence
  • Especially musculoskeletal disorders can be prevented by ergonomics
    • Back pain
    • Carpal tunnel syndrome
    • Tennis elbow
  • The work should adapt to the worker, not opposite
  • Principles of applying ergonomics
    • Work in neutral posture
    • Reduce excessive force
    • Keep everything within reach
    • Work at proper height
    • Reduce excessive motion
    • Minimize fatigue and static load
    • Minimize pressure points
    • Provide clearance
    • Move, exercise, and stretch
    • Maintain a comfortable environment
  • Example: Nurses give surgeons their tools, so that the surgeons don’t lose their focus
• Health effects of inorganic and organic dusts
  • Inorganic dusts
    • Coal dust – causes Coal Worker’s Pneumoconiosis
      • In coal workers
      • Often asymptomatic
    • Silica – causes silicosis
      • In ceramics, glassblowing, mining, etc.
    • Asbestos – causes asbestosis (= mesothelioma)
      • Working with products containing asbestos, like isolation, car breaks, etc.
  • Organic dusts
    • Cotton dust – causes byssinosis
      • In cotton workers
    • Tobacco – causes “tobaccosis” (= lung cancer, COPD)
    • Grain dust – causes Farmer’s Lungs
  • Prevention
    • Proper ventilation
    • Masks

121. New and emerging risks in occupational medicine. Occupational diseases of health care workers and prevention. Occupational accidents.

• (This topic is slightly different since the 2021 spring topic list. See the top of the page.)
• New and emerging risks in occupational medicine
  • New and emerging risk = new and increasing risk
  • New risk =
    • Caused by new technology or processes
    • Old issue newly considered to be a risk
  • Increasing risk =
    • The number of hazards leading to the risk is growing
    • The likelihood of exposure to the hazard is increasing
    • The effect of the hazard on health is getting worse
  • As the world of work changes, due to globalization, technical innovation, automation, and ageing, new and emerging risks occur
  • New and emerging physical risks
    • Physical inactivity -> metabolic diseases, musculoskeletal disorders
    • Increased computer and mobile device use
  • New and emerging psychosocial risks
    • Job insecurity
    • Increased physical and emotional demands at work
    • Difficult work-life balance
• Occupational diseases of health care workers
  • Health care workers are exposed to many sources of infection
    • Collecting and processing biological material
    • Performing invasive procedures
    • Taking care of patients
    • Disinfecting or otherwise touching contaminated equipment
  • Health hazards
    • Infectious diseases
      • Airborne infections (TB, MMR, influenza, etc.)
      • Faecal-oral transmission (salmonella, shigella, E. coli, etc.)
      • Direct contact (HSV, S. aureus, Pseudomonas, etc.)
    • Heavy lifting
    • Long working hours
    • Radiation
    • Noise
  • Prevention
    • Risk assessment and reduction
    • Workers must be informed on risks and trained
    • Regular health surveillance
      • Workers with symptoms should stay home
    • Vaccination
    • Proper hygiene
    • Personal protective equipment (PPE)
      • Gloves
      • Masks
      • Face masks
      • etc.
• Occupational accidents
  • Safety = working in such a way that health is not jeopardised
  • Most non-fatal and fatal occupational accidents occur on industrial sites, especially construction
  • Many fatal accidents are due to losing control of a machine, tool, or equipment
  • Prevention
    • Proper training and use of machines, tools, equipment
    • Use of protection (helmet, goggles, face shields, protective shoes)

122. Migration and catastrophes, medical and occupational health considerations

• General about migration
  • 3,5% of the world population lives outside their home country
  • Legal migration
    • Healthy migrant effect = legal migrants are usually young and healthy people and therefore healthier than the population they migrate to
  • Illegal/irregular migration
  • Nearly half of migrants are hoping to find work
  • Migrants are essential to uphold the population in Europe as the fertility rate is low
• Health considerations of immigration into EU
  • Most immigrants are from Syria, Afghanistan, Iraq, etc.
  • The prevalence of certain diseases may be many times higher in the country of origin than the host country
    • TB, AIDS, etc.
  • Certain diseases from the country of origin may be much less common in the host country
    • This makes it less likely that physicians will recognize the disease
    • There will also be less experience in treating the disease
  • Certain diseases may manifest differently in different ethnicities
    • For example, varicella in blacks
  • Migrant reception centres are good places for outbreaks
    • Measles, pertussis, cholera, etc.
    • Due to under-immunization, poor hygiene, close contact, etc.
  • Vaccine-preventable diseases (VPD)
    • Communicable diseases which are eradicated in the host country but not in the country of origin
    • Diphtheria, pertussis, measles, poliomyelitis, etc.
    • Some of the countries which are the only ones in the world with certain VPDs have large out-migration
      • For example, Sudan and Afghanistan have many cases of poliomyelitis
    • Due to anti-vaccination movements the vaccine coverage of certain diseases (especially measles) is poor in certain regions of the EU, providing good grounds for an outbreak
    • The vaccination coverage of many countries of origin is poor
      • HAV, HBV, polio
  • Vaccination of children of foreign nationality
    • Migrant children who stay in Hungary for more than 3 months should receive the outstanding, age-appropriate vaccinations according to the national schedule
    • Not all countries include migrants and refugees in their national immunization programmes
  • Health care workers should be completely immunized according to their national schedule
  • Upon entry, the migrants only undergo a brief ectoparasite screening before being placed in the community
    • Reception centre in Debrecen is an exception; they undergo more rigorous screening of STDs, HIV, salmonella, HBV, HCV, TB, etc.
• Migrant and occupational health
  • Includes both occupational health issues of the migrant workforce and the occupation health of those working with migrants
  • Occupational health of those working with migrants
    • Department of Public Health at POTE has since 2013 conducted research in national migrant infrastructure and the occupational health of staff who work with migrants
      • 40% of the study population are sometimes exposed to human samples (blood, urine, faeces) at work
      • 35 – 50% of the study population experienced verbal violence regularly
      • 50% of the study population said that they have poor awareness of symptoms of infectious disease
      • When asked about mode of transmission of certain infectious diseases, only 45% could answer more than 75% of the questions correctly
  • Occupational health of the migrant workforce
    • Migrant workers are subject to uncertainty, poor working conditions, low wages
    • They’re often overqualified for their low-skilled jobs
      • Migrants are overrepresented in low-wage, low-skill jobs
    • They have little knowledge of their employment rights
    • Migrant workers are overrepresented in industrial accidents and occupational diseases like hearing loss, silicosis, musculoskeletal disorders, etc.
    • An Italian journalist pretended to be a Romanian illegal worker in a tomato field in Italy
      • He had no water or electricity and lived in poor hygienic conditions
      • He worked 14 hours a day
      • Two men slept on one mattress on the floor
      • Men had to provide the boss a woman to screw in order to get a job
    • Prevention/improvement
      • Provide migrants with information on their employment rights
      • Protect the health and working conditions of migrants
      • Provide better integration of migrants and their families
      • Train health workers on working with migrants