Public Health 6 (+ 3)

Last updated on June 18, 2021 at 15:17

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 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

  • (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

  • 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

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4 thoughts on “Public Health 6 (+ 3)”

    1. I wish I knew. I know someone who failed on it because they were asked to talk about transport risk and stuff, but I couldn’t find any information regarding it. You should ask someone at the department

  1. Hey there, what do you mean in topic 124 by “40% have been exposed to human sampling” ?

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