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Describe the contributions of Ramazzini, Hamilton and Pott to occupational and environmental health (also know approximate year and nationality of the above persons)
- Bernardo Ramazzini (Italian physician - 1600s):
- -regarded as the “father of industrial medicine”
- -published first comprehensive book on industrial medicine - “The Diseases of Workmen”, with accurate descriptions of the occupational diseases of many of the trades of his time
- -suggested adding the question “What is your occupation?” when interviewing patients
- -influenced the field of industrial hygiene through his assertion that occupational diseases should be studied in the work environment rather than in hospital wards
- Alice Hamilton (American physician - 1900s)
- -lived at Hull House, founded by social reformer Jane Addams. Studied occupational disease in the U.S. in the early 1900s.
- -First major champion of occupational health in the U.S.
- -Social reformer - showed evidence of links between illness and exposure to toxins to mine owners, factory managers, and state officials in Chicago
- -Directed the Illinois Occupational Disease Commission
- -Key proponent of legislation establishing early forms of occupational health regulation and worker’s compensation
- -First female professor at Harvard Medical School (and later in the School of Public Health)
- Percivall Pott (English physician - 1700s)
- -Found an association between exposure to soot and scrotal cancer in chimney sweeps.
- -First link between occupation and cancer and first demonstration that environmental exposures can cause cancer.
Definition of environmental health (and how it fits into field of public health)
- -Environmental health most broadly defined as the subfield of public health assessing and controlling the impacts of the environment on the health of man, and the impact of man on the health of the environment
- -Public health can be defined as ‘not merely the absence of disease but as the presence of physical, mental and social well-being (WHO)
Name some events that contributed to increasing concern about chemicals and radiation since the 1940s
- -Atomic bombs
- -Silent spring - bioaccumulation of chemicals
- -Love Canal
- -Increase in man-made chemicals
Outline distinctions between a) the inner vs. the outer environment , b) the personal vs the ambient environment
The human body has barriers that separate the external world and environmental hazards from the “inner environment”: the skin (dermal route of exposure), lungs (inhalation route), GI tract (ingestion route)
- Inner environment: inside body
- Outer environment: outside of body
- Personal environment: shaped by hygiene, diet, sexual practices, exercise, use of drugs and alcohol, medical care, but also ‘microenvironmental’ concentrations of pollutants; unique to each person; may contribute more to overall health of the person than the ambient environment
- Ambient environment: examples include the outside air, water coming from the tap (people generally have very little control over these environments)
Describe barriers to entry into the body, for toxic chemicals and biohazards, and explain why lungs are so susceptible to environmental exposures
are so sensitive to environmental exposures because they have a very large surface area, thin cell walls to facilitate gas exchange, and there is a large volume of air breathed every day (20 cubic meters is avg for adult); the GI tract also has a large surface area; the skin is least vulnerable but can be penetrated by lipid soluble compounds and compounds that mimic transported compounds
- -Gas molecules: are much smaller than particles water soluble gases deposit in the upper airways (formaldehyde) less soluble gases go further to the deep lung (nitrogen dioxide, ozone)
- -Particules: size is very important to toxicity. large particles do not enter the nose/mouth (>30 m, m = micrometer = 10-6 meter), particles > 10 m are removed by the nose, smaller particles < 10 m can penetrate to the tracheobronchial region (called PM10, particulate matter less than 10 micrometers)
- -small particles: (< 2. 5 m) (called PM2.5) can penetrate and deposit to the alveolar region (air exchange region) and very small particles (ultrafine particles) can translocate to the bloodstream
- Protective mechanisms:
- Lungs: nose, cilia, mucus, macrophages, coughing, sneezing
- GI: vomiting, diarrhea, cell sloughing
- Skin: thick, cell turnover, waxy barrier
- Circulatory system: detoxify, excrete through urine/feces/breath/sweat/etc.
Discuss the regulatory implications of the division of the environment into liquid, solid and gaseous environments
The environment is often defined by area and regulated by an agency (air, water, hazardous waste, etc.) and rarely considers total exposure. Attempts to control are solution in one area (media) can create pollution in another area.
e.g. pollution control - new pollution (incineration of solid waste > air pollution; scrubbers to remove contaminants from air > solid waste)
Be able to classify a stressor as a chemical, physical, biological or socioeconomic factor in the environment
- Chemical: examples include toxic waste, pesticides, food additives, industrial production
- Physical: examples include noise, radiation (such as EMF), workplace engineering, heat, cold
- Biological: examples include disease organisms in food and water, organisms transmitted by animals, organisms spread from person to person, and bloodborne pathogens
- Socioeconomic: stress, lack of access to medical care, poor nutrition
Describe difficulties in assessing human exposures
- Systems approach to studying environmental health - 4 steps:
- SOURCE: Determine the source and nature of an environmental contaminate account for multiple sources and pathways, and for physical or chemical changes in the environment
- EXPOSURE: Assess how and in what form each comes into contact with people exposure assessment, consider multiple routes
- EFFECTS: Measure the effects possible quantitative relationships between exposure level and effects (work with epidemiologists, physicians, biologists, toxicologists, etc.)
- CONTROLS: Apply controls when and where appropriate set acceptable limits for exposure, decide when and where to monitor, decide to ban a substance
- SOURCE: (e.g. emissions from a cool fired power plant) requires knowledge of environmental fate, ‘source apportionment’
- EXPOSURE: (e.g. how much particulate is in the air during time child has recess) big data gap, focus of environmental health training, expensive, needs knowledge of average and non-average exposure, multiple routes of entry, concentration varies over space and time, measurements may be external (e.g. air) or biological (e.g. blood samples)
- EFFECTS: (e.g. asthma exacerbation)
- extrapolate from animals or cell systems to humans, mixed exposures, long latency, multiple causes for same disease
- CONTROLS: (e.g. required clean technology on power plant exhaust)
- controls may be physical (e.g. clean technology) or administrative (e.g. having kids go outside at a different time); there are social and political issues
Describe differences between concentration, external exposure levels , and
- Concentration: How much is in the environmental media (food, water, food)?
- -ppm for gases, ug/m3 (microgram/cubic meter) for air, ug/g for water
- Exposure: How much contacts the boundaries of the person (workplace exposure measurements better measure actual exposure for a person, as opposed to general measurements in city)
- Dose: how much is absorbed into the body (concentration x time x penetration or retention)
- Biologically effective dose: how much got to target tissue such as bone marrow
Define environmental justice, and be able to discuss the question : why would
poor and minority groups have higher exposures to toxic chemicals and physical and biological hazards?
- Principles of environmental justice:
- -To avoid, minimize, or mitigate disproportionately high and adverse human health and environmental effects, including social and economic effects, on minority populations and low-income populations.
- -To ensure the full and fair participation by all potentially affected communities in the decision-making process.
- -To prevent the denial of, reduction in, or significant delay in the receipt of benefits by minority and low-income populations.
- EPA definition of environmental justice:
- -Environmental Justice is the fair treatment and meaningful involvement of all people regardless of race, color, national origin, or income with respect to the development, implementation, and enforcement of environmental laws, regulations, and policies.
- -EPA has this goal for all communities and persons across this Nation.
- -It will be achieved when everyone enjoys the same degree of protection from environmental and health hazards and equal access to the decision-making process to have a healthy environment in which to live, learn, and work.
Define industrial hygiene (name the four parts)
- Anticipation, recognition, evaluation, and control of environmental factors or stresses arising in or from the workplace that may cause sickness, impaired health and well-being, or significant discomfort among workers or community members - includes physical, chemical, and biological hazards in the workplace.
- -Prevention of occupational diseases: chronic physical hazards, acute and chronic chemical hazards, biological hazards
- -Anticipation and recognition: draw on toxicology, epidemiology, occupational medicine, experience, regulations (Material Safety Data Sheet, MSDS)
Four leading causes of death by industry AND top four overall causes of death
- Four leading causes of death by industry:
- -transportation/comm/public utilities
- Top 4 causes of death:
- -machine-related (struck by object or equipment)
Identify the critical predictors of disease induced by exposure to dusts (4)
- -Type of dust
- -Length of exposure
- -Size of dust (tiny dust that gets deeper into your lungs is worse)
Describe why confined spaces pose a hazard and what can be done to address this problem
Hazards of confined spaces: lack of O2, toxic gases, mechanical suffocation
Control measures: measure atmosphere before entry, have extensive training on normal procedures AND rescue procedures, have SCBA gear available (+ Lock-out/Tag-out)
Describe pneumoconiosis (dust-induced lung disease) and examples: silicosis, byssinosis and asbestosis and with what industries/substances these diseases are associated.
Pneumoconiosis is lung disease caused by dust.
-Coal workers pneumoconiosis
: “black lung” from coal mining
: “brown lung” cotton dust
- -Asbestosis: asbestos
- -caused by asbestos fibers
- -mining, insulation, ship-building/repair, brake shops (brake linings)
- -progressive fibrosis of the lung
- -asbestos also causes mesothelioma - a cancer of the pleural lining of the lung (so rare that it is ascribed dot asbestos exposure automatically)
- -Silicosis: quartz dust or sand
- -crystalline silica, usually quartz
- -standard is based on percent quartz and size of dust
- -mining, tunneling, sand-blasting
- -progressive fibrosis of the lung
Distinguish between an audiogram of a person with noise induced hearing loss and hearing loss from other causes, and to be able to broadly recognize noise levels
(Slides 28 and 29 in Lecture 2 ppt) - noise leads to sensorineural hearing loss which results in a decrease in hearing at a higher pitch/frequency (higher voices, etc) - the hearing loss from noise loss can be distinguished on an audiogram because loss begins at about 4000 hz
- -Noise is measured in dB (decibles) - sound pressure level relative to reference level, log scale
- -Standard is 90 dB TWA 8 hours (estimates: 21-29% of workers will suffer hearing loss at this level, compared with 5015% at 85 dB, very few at 80 dB)
The year and main provisions of the OSH Act
- Occupational Safety and Health Act (OSH Act) - 1970
- -Established the federal Occupational Safety and Health Administration (OSHA) to set and enforce standards
- -Established the National Institute for Occupational Safety and Health (NIOSH) to conduct research and carry out site-specific health hazard evaluations
- -Requires the U.S. Secretary of Labor to set a standard that “most adequately assures, to the extent feasible, on the basis of the best available evidence, that no employee will suffer material impairment of health or functional capacity, even if such employee has regular exposure to the hazard dealt with by such standard for the period of his working life.”
California equivalent agency responsible for workplace safety and health regulation and enforcement
Cal-OSHA (Division of Occupational Safety and Health)
Federal agencies responsible for workplace safety and environmental health research
- -Occupational Safety and Health Administration (OSHA) - set and enforce standards/laws (under DOL)
- -National Institute for Occupational Safety and Health (NIOSH) to conduct research and carry out site-specific health hazard evaluations (under CDC/NIH)
Describe components of the evaluation process in assessing workplace exposures
Includes measuring exposures through visual or instrumental monitoring of a site. Focuses on quantifying the degree of exposure.
- Walkthrough, written data, measurement
- -measurement in air: personal measurements (immediate vicinity of individual workers), area measurements (part of the workplace)
- -dermal measurement: amount skin exposed to
- -biological monitoring: (samples such as hair, saliva, blood, or urine are collected from potentially exposed individuals and analyzed for either the compound of interest or a metabolite of that compound)
Describe key ways to measuring exposure in the workplace
- -Direct reading instruments: real-time measurements of a parameter of interest (temperature, noise, radiation, airborne pollutants, specific compounds, etc.)
- -Sample collection instruments: collect samples for later analysis (e.g. when multiple airborne components are present or further analysis is desired
Describe and prioritize control measures for workplace hazards
Reduction of risk to health and safety through administrative or engineering measures.
- Best to worst ways:
- elimination or substitution (replacing a hazardous material or process with a less hazardous one)
- process or equipment modification (isolation - containing or limiting access to the hazardous process)
- local exhaust ventilation (esp. for chemical and heat-related hazards)
- PPE - personal protective equipment (e.g. respirators, gloves, glasses, hats, harnesses, boots)
(Administrative strategies such as rotating workers through dangerous jobs to limit any individual’s aggregate exposure - such as to radiation - sometimes have a role as well.)
(Regulations, compare to internal company standards, specific programs in place for confined space entry, medical monitoring, hearing protection)
Define ergonomic problems and known risk factors
- -Repetitive strain injuries
- -Musculoskeletal disorders
- Risk factors:
- -static, awkward postures
- -fast rate of movement
- -forceful movements
- -no control over job rate (e.g. have to keep up with rate of machine)
Describe why teenage workers and low-income workers might be more at risk on the job, and why small businesses may be where a lot of exposures currently occur.
- -Socioeconomically disadvantaged workers: More likely than other groups to be employed in physically demanding jobs with inherent hazards, such as construction, framework, mining, or meat packing.
- -U.S. child labor laws include exceptions for youths working in agriculture (and enforcement programs are weak)
- -Small businesses with 10 or fewer employees are exempt from routine OSHA inspections
Describe worker’s compensation and give reasons why this arose.
- Walsh-Healey Public Contracts Act 1936 - led to workers’ comp???
- -establishes minimum wage, max hours, and safety and health standards for work on contracts > $10,000 for the manufacturing or furnishing of materials, supplies, articles, or equipment to the U.S. government or District of Columbia
Workers’ compensation - a form of insurance providing wage replacement and medical benefits to employees injured in the course of employment in exchange for mandatory relinquishment of the employee’s right to sue his or her employer for the tort of negligence.
Describe a worker’s ‘right-to-know’ and an MSDS?
- Toxic Substances Control Act, 1976: Provides EPA with authority to require reporting, record-keeping and testing requirements for chemicals (NOT food, drugs, cosmetics, and pesticides)
- -TSCA provided workers with right-to-know, MSDS:
- Hazards Communication Act:
- -Requires manufacturers and employers to disclose information regarding chemical exposures to their employers - under this act employers need to make available material safety data sheets - MSDS (now SDS - Hazard Communication Standard revised in 2012, improved layout) - these sheets list chemical ingredients and basic information on associated health risks for all potentially toxic substances used in the workplace