Introduction to Hygiene
HEPM 1
RNDr. Sylva Rödlová, Ph.D
Institute of General Hygiene
Time schedule D1
General hygiene department
Date
day
time
code group
type
place
theme
Jonáš Introduction, hygienic propaedeutics
posl 1
29.09.14 Mo
13,30
15,00
D1
1-4
lecture
06.10.14 Mo
13,30
15,00
D1
1-4
sem
327
20.10.14 Mo
08,00
09,30
D1
1.4
lecture
327
03.11.14
Mo
09,45
11,15
D1
03.11.14
Mo
13,30
15,00
D1
lecturer
Σ
RNDr. Sylva Rödlová
2
Hygiene requirements for health-care
facilities
RNDr. Sylva Rödlová
2
Ecology I
RNDr. Sylva Rödlová
2
1.4
Burian
Ecology II
lecture posl 2
RNDr. Sylva Rödlová
2
1.4
lecture
RNDr. Sylva Rödlová
2
327
Ecology III
Presentation of lectures on faculty web
Field excursion – summer semester
Central waste water treatment plant Prague
or
Crematorium Strašnice
Excursion register – in summer semester
Voluntary course – field trip to Czech karst (in progress now)
Course end – credit
for excursion (possibly essay)
Credit from Sylva Rödlová
What is HEPM?
Hygiene, epidemiology and preventive medicine
Not only diagnosis and therapy, but also preventive
approaches, above all primary prevention, are integral parts
of medicine.
Primary prevention
remotion of potential health hazards from the environment prior to
population exposure. Support of protective lifestyle
Secondary prevention
active search for disease sympotms, use of biomarkers of
exposure/effects (screening programmes) with the intention to
find early signal of exposure or reversible effects and to avoid
irreversible changes, timeous diagnosis
Tertiary prevention
remedy for patients, reduction of disease progression (treatment,
rehabilitaion)
Health status determinants
EXTERNAL
Lifestyle
(50-60 %)
smoking, inadequate nutrition, alcohol, drugs and
medicament abuse, low physical activity, sexual behavior,
high level of psychosocial stress
Environment
(20 %)
chemical, physical, biological factors, air, water, soil pollution,
food chain contamination, etc
Health care
(20 %)
insufficient prevention, late diagnostics, inadequate
treatment, pure compliance
Health status determinants
INTERNAL
Individual susceptibility (heritability, health status,
age, gender etc.)
Environment – Gene- interaction
SOCIOECONOMICAL
education, income, interpersonal relationships etc.
Optimal health
Health is a state of complete physical, mental and social
well-being and not merely the absence of disease or
infirmity (definition of WHO, 7.4.1948)
+ decreasing of mortality, morbidity and handicap because of illness and increasing
of health level (WHO, 2001)
Hygiene (Hygiea = goddess of health)
Science about preservation of health, the influence of
environmental factors on human health.
Environmental health
(Environmental medicine)
Branch of public health that is concerned with all aspects of the
natural and built environment that may affect human health.
Knowledge of interaction of human body with the environment
by means of inherited and built-in biologic mechanisms and systems
What is environmental health?
Environmental health comprises those aspects of human
health and disease that are determined by factors in the
environment. It also refers to the theory and practice of
assessing and controlling factors in the environment that can
potentially affect health.
As used by WHO/Europe, environmental health includes both
the direct pathological effects of chemicals, radiation and
some biological agents, and the effects (often indirect) on
health and wellbeing of the broad physical, psychological,
social and aesthetic environment.
(Based on Environment and Health, the European Charter and Commentary, Frankfurt, 1989)
10 greatest global health risks
(WHO, 2002)
•
•
•
•
•
•
•
•
•
•
Being underweight
Unsafe sex
Iron deficiency
Indoor smoke from solid fuels
Unsafe water, sanitation, and
hygiene
High blood pressure
Tobacco consumption
Alcohol consumption
High cholesterol
Obesity
Developing countries
Developed countries
WHO and healthy environment
-developing countries
• Worldwide, 13 million deaths could be prevented every year
by making our environments healthier.
• In children under the age of five, one third of all disease is
caused by the environmental factors such as unsafe water
and air pollution.
• Every year, the lives of 4 million children under 5 years –
mostly in developing countries – could be saved by
preventing environmental risks such as unsafe water and
polluted air.
• In developing countries, the main environmentally caused
diseases are diarrheal disease, lower respiratory
infections, unintentional injuries, and malaria.
• Better environmental management could prevent 40% of
deaths from malaria, 41% of deaths from lower respiratory
infections, and 94% of deaths from diarrhoeal disease
WHO and healthy environment
– developed countries
• In developed countries, healthier environments could
significantly reduce the incidence of cancers,
cardiovascular diseases, asthma, lower respiratory
infections, musculoskeletal diseases, road traffic injuries,
poisonings, and drownings.
• Environmental factors influence 85 out of the 102
categories of diseases and injuries listed in The world health
report.
• Much of this death, illness and disability could be
prevented through well targeted interventions such as
promoting safe household water storage, better hygiene
measures and the use of cleaner and safer fuels.
• Other interventions that can make environments healthier
include: increasing the safety of buildings; promoting safe,
careful use and management of toxic substances at home
and in the workplace; and better water resource management.
Environmental factors (stressors)
• Physical factors
climate, indoor microclimate, ionizing and non-ionizing
radiation, solar radiation, noise, vibration
• Chemical factors
acute, chronic, specific effects, delayed effects,
transplacental exposure
• Biological factors
microorganisms, fungies, cyanobacteriae, algae and their
toxins, plants, insect, animals, human being
Environmental media
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•
•
•
•
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Outdoor and indoor air
Water – drinking water, bathing waters, waste waters
Water sediment
Soil
Biota
Food chains
Environmental media
Environmental stressors
Generaly, the majority of the environmental
stressor can have both positive and negative
effects depending on the dose and the ability
of individuum to compensate negative effects
(adaptation, genetic background etc.)
You will receive more information in the next years
of your study (risk assessment, health impact
assessment, genetic polymorphism etc.)
Environmental epidemiology
Study of relationship between environmental
stressors and population health
• Environmental indicators
simplified compounds in environmental media
characterized the levels of more complicated
komplex environmental pollution
• Health indicators
demographic data (mortality, morbidity)
Physical factors in the environment
Solar radiation:
Positive: vitamin D production, well-being
Negative: increase of skin cancer, ageing of skin,
cataract…
Noise:
Damage of hearing (occupational exposure, noisy disco)
Systemic effect (general population) – disorder of
vegetative system – increase of blood pressure,
disorder of concentration during the work or study,
sleeping problems, increased risks of neuroses
Physical factors in the environment
Vibration
Mostly at occupational exposure (e.g. pneumatic drill,
dentist drill), but also in the ordinary living conditions
(kinetosis due to transport – seasickness).
Ionizing radiation
Disasters (nuclear power plants)
Occupational exposure (radiotherapy, radiodiagnostics)
Exposure of patients
Natural exposure from cosmos
Effects: deterministic (dose-dependent with threshold
stochastic (probability is increasing after the first
dose – carcinogenicity)
Chemical stressors
Environmental chemical contaminants represent largescale adverse health effects dependent on toxicological
characteristics of appropriate compounds, dose
(amount) and biotransformation (detoxication) capacity
of human body.
Paracelsus 15. – 16. Century
Father of toxicology
„Dosis facit venenum“
Chemical stressors
Acute - subacute – chronic intoxications
Simple or repeated exposure
Adverse effects with threshold
Delayed effects (mutagenic, carcinogenic) without
threshols
Organ-specific effects: kidney or liver damage,
embryotoxicity, damage of fetal development, endocrine
system disruption, immunotoxicity
Source of exposure:
Occupation – polluted air, water,
food - hobbies
Adverse health effects of environmental factors
• Delayed effects (mutagenic, carcinogenic)
• Allergenic (pollen, household dust, mites, household
cleaning compounds, etc…..)
• Reproduction disorders (polycyclic aromatic
hydrocarbons - PAHs, persistent organic pollutants POPs)
• Developmental toxicity (Pb, polychlorinated biphenyls
– PCBs, dioxins etc.)
• Endocrine disrupting chemicals (POPs, PAH, Cd,
zearalenon - mycotoxins)
• Neurotoxicity (Hg, As, Pb, PCB, dioxins)
Fate of chemicals in the environment
Source: industry, traffic, heating, agriculture
Polluted medium: preferentially air, surface or waste
waters
Pollutants in the air can interact and generate new
structures, they move to sediments, soil,
Food chain: soil, water, air – vegetation – herbivorous
animals – omnivorous animals - human
Sources of air pollution
Global transport
Types of problems susceptible to study and
evaluation by environmental epidemiology
• Air pollution, outdoor and indoor
• Occupational exposure
• Surface and ground water pollution (consumers,
recreation)
• Use of pesticides in agriculture, food contamination
• Health effect of radiation (ionizing, nonionizing)
• Effects of cigarette smoking, interaction with
occupational or environmental exposure
• Heavy metals and trace chemicals in the environment
• Health impact of urbanization (megapolis)
• Health effects of traffic, motor vehicles, injuries
Endocrine disrupting chemicals (EDC) as
environmental pollutants and their health
effects
Definition
Endocrine disruptors are environmental chemicals
that alter gene activity during sensitive
developmental periods when cells differentiation is
occurring, and irreversibly disrupt the functioning
of disrupt cells.
Potential health effects from the
population point of view
Incidence of breast carcinoma has been increasing about 1
% yearly (this type of carcinoma is usually hormonally
dependent)
increasing tendencies are observed in the incidence of:
endometriosis
cryptorchidism
prostate carcinoma
testicular cancer
hypospadia
What compounds belong to EDC
(endocrine disrupting compounds)?
DDT and similar obsolete pesticides
Polychlorinated biphenyles
Dioxins
Flame retardants
Phthalates
2013 Study on EDCs by UNEP (United Nations
Environmental programme) and WHO (World Health
Organization)
Long-term health effects
in general population
Children are the most sensitive and vulnerable population
group (ED-compounds can cross the placenta and are
present in human milk)
Neurotoxicity
Reproduction disorders
Hypothyreosis
Worsening of psychomotoric development of children
……….
However, the adverse health changes are mostly transitional.
Global regulation of persistent chlorinated
organic compounds
Stockholm convention May 22, 2001
Annex Chemicals
A. Elimination: Aldrin (pesticide), Chlordane
(pesticide/termiticide), Dieldrin (pesticide), Endrin (pesticide),
Heptachlor (pesticide/termiticide), Hexachlorobenzene
(pesticide), Mirex (pesticide), Toxaphene (pesticide),
Polychlorinated biphenyls (industrial chemical)
B. Restriction: DDT (disease vector control, intermediate in
production of dicofol)
C. Unintentional: Production Polychlorinated dibezo-p-dioxins
and dibenzofurans, Hexachlorobenzene, Polychlorinated
biphenyls
International Society for Environmental Epidemiology
(ISEE)
WHO/Europe
European Environmental Protection Agency
APHEIS: Air pollution and Health: a European Informative
System
EFSA (European Food Safety Agency)
Environmental Health Indicator System
International environmental health (USA)
U.S. EPA (Environmental Protection Agency) – www.epa.gov
ATSDR (Agency for Toxic Substances and Disease Registry) federal public health agency of the U.S. Department of Health and Human
Services. Atlanta
(responsible for public health assessment of hazardous waste sites,
specific hazardous substances, health surveillance and registries,
applied research in public health assessment, information development and
dissemination, education and training concerning hazardous substances)
International Environmental Health Subcommittee coordinates:
ATSDR, NCEH (Nat. Center Environ. Health), NIOSH (Nat. Inst. Occup.
Safety and Health), CDC (Centers for Disease Control and Prevention)
NIEHS (Nat. Inst. Environ. Health and Science), NIH (Nat. Inst. Health), FDA,
EPA, OSHA (Occ. Safety and Health Administration)
Environmental health policy
1977 - WHO : Starting of Program Health for all till 2000
1984 – European burreau of WHO: acceptance of Program
1989 – Conference of ministries of environment and health in
Frankfurt am M.: acceptance of European Charta
1994 – 2. Conference of ministries of environment and health in Helsinki:
European program Health for All
National Environmental Health Action Plans
WHO: Health for all in 21th Century
2002 – acceptance in individual states (in CR)
2004 - Conference of ministries of environment and health in Budapest.
2006 - CEHAPE – Children Environmental Health Action Plan in
Europe
2004 - 10 – European environmental health action plan
2009 – European Human biomonitoring project
Environmental Health Projects
EU: Action plan on Environment and Health
National Environmental Health Action Plans (NEHAP)
Local Environmental Health Action Plans (LEHAP)
EC Strategy on Health and Environment:
Outdoor and indoor air pollutants quality
Noise
Indoor environment and housing conditions
Water quality contamination
Elmg fields and radiation
Chemical exposures
http:europa.eu.int/comm/health/
Health protection
health promotion tools
• Repressive measures:
Legislation (acts, regulations, limit values, biologically
important values OEL (occupational exposure limit), ADI
(acceptable daily intake), TDI (tolerable daily intake) etc.)
• Recommendable (advisory) measures:
proper lifestyle, optimal nutrition, right behavior in
problematic environmental situations, support of
breastfeeding, physical activity etc.
Risk communication with public
Explanation the problem, its importance and necessary of
possible preventive measures. Vertical and horizontal
feedback.
Environmental health in the 21st century
To prevent diseases, not only to cure them
Better understanding of human risk through integration
of the scientific disciplines:
Toxicology, epidemiology, genetics, public health
Information (data) – understanding (knowledge)
To control the right things to the right levels
Toxicogenomics, genomics (environmental effects on genes and
gene products), other - omics
Biomarkers at the molecular level (molecular dosimetry,
molecular epidemiology)
Environmental effects on cell function, communication, regulation
Thank you for your attention
sylva.rodlova@lf3.cuni.cz