Public Health 6 (+ 3)

Last updated on June 21, 2020 at 14:05

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.

I just (21/06/20) noticed that at the beginning of the semester, 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:

  • 105. Basic principles of ecology. Human environment, human ecology.
  • 106. Settlement health, transportation and health. Health effects of interiors, health and the built environment
  • 107. Environmental monitoring and protection. 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. Organization and levels of occupational health services. Work safety.
  • 112. Risk assessment, management and communication
  • 113. Occupational toxicology, chemical safety
  • 114. Occupational cancers
  • 115. Occupational noise and vibration exposures.
  • 116. Physical hazards: health effects of low and high temperature
  • 117. Physical hazards: disorders caused by noise and vibration and their prevention
  • 118. Chemical hazards: Industrial and agricultural toxicology of organic compounds
  • 119. Chemical hazards: Industrial and agricultural toxicology of inorganic compounds
  • 120. Psychosocial and biological hazards in the workplace
  • 121. Health effects of ionizing and non-ionizing radiations
  • 122. Ergonomic factors. Health effects of inorganic and organic dusts and their prevention
  • 123. New and emerging risks in occupational medicine
  • 124. Occupational diseases of health care workers and prevention. Occupational accidents.
  • 125. 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 biggest difference is that topic 106 now includes settlement and transport health, whatever that is. As far as I can see they’ve published no lectures or seminars on that subject, which makes it complete bullshit to ask it, of course. A friend of mine drew that topic and failed when they (obviously) didn’t know anything about settlement and transport health. They were asked about how many microrisk different transport types involved and stuff like that, if you want to research that topic on your own.

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

  • 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 NOx, 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
      • NOx
    • 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, NOx
      • 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
    • NOx, 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

  • 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

  • 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.

  • 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 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

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