Chapter 1: Essentials of Environmental Health, Chapter 2: Essentials of Environmental Health, Chapter 3: Essentials of Environmental Health, Chapter 4, Chapter 5: Zoonotic and Vector Borne Diseases, Chapter 6: Toxic Metals and Elements, Chapter 7: Es...

Hygienist

-control of hazards that may affect workers as well as hazards that may impact the community - require training in the epidemiological and biology aspects of environmental health and also in toxicology

Epidemiological Triangle

-environment: the domain in which disease causing agents may exist, survive, originate - host: person or living animal that affords subsistence or lodgment to an infectious agent under natural conditions - agent: a factor whose presence/absence is essential for the occurrence of the disease ex) microbial agents responsible for zoonotic disease - toxic metals -airborne particles and gas

Professor Warren Winklestein (The 3 P's)

1. Pollution 2. Poverty 3. Population

2012 Deaths

1/4 of global deaths came from an unhealthy environment

Most populous countries

1950s: China, India, U.S., Japan, Russia 21st Century: Indonesia, Brazil, U.S., India, China 2050: India, China, U.S., Indonesia, Nigeria (Top 5)

The estimated global burden of disease (percentage) linked to environmental sources is: A. 55% to 70% B. 25% to 33% C. 35% to 50% D. 5% to 20%

25%to 33%

Currently, the number of years required for the world's population to double is approximately: A. 10 years B. 53 years C. 23 years D. 43 years

43 years

Sir Percival Pott, who wrote Chirurgical Observations: A. was the father of modern biostatistics. B. argued that the environment was associated with diseases such as malaria. C. was a London surgeon who identified an environmental cause of cancer. D. established postulates for transmission of infectious disease. E. was an English anesthesiologist who used natural experiments

A London Surgeon who identified an environmental cause of cancer

The Texas Sharpshooter Effect illustrates: A. one cause of spurious or chance clustering. B .a description of disease according to etiologic factors. C.a description of disease according to person variables. D. None of these is correct. E. a new insect pest that is invading the southwest.

A cause of spurious of chance clustering

Case Control Study

A type of epidemiological study where a group of individuals with the diseases, referred to as cases, are compared to individuals without the disease, referred to as controls -can examine many potential exposures - can only examine one or few outcomes

Environmental health science is concerned with agent, host, and environmental factors in disease (the epidemiologic triangle). Which statement is true about the triangle? A. The host is the person who affords lodgment of an infectious agent. B. Agent factors can include particles, toxic chemicals, and pesticides. C. Disease causality includes three major factors: agent, host, and environment. D. All are correct. E. The environment is the domain in which disease-causing agents may exist.

All are correct

The environment plays a role in human health through associations with which of the following? A. Chronic disease B. Disability C. Acute conditions D. Allergic Responses E. All of the above

All of the above

Which of the following are contributions of epidemiology to environmental health? A. Methodology for study designs B. Use of observational data C. Concern with populations D.Descriptive and analytic studies

All of the above

John Snow, in Snow on Cholera: A. was the father of modern biostatistics. B. argued that the environment was associated with diseases such as malaria. C. was a London surgeon who identified an environmental cause of cancer. D. established postulates for transmission of infectious disease. E. was an English anesthesiologist who used natural experiments

An English anesthesiologist who used natural experiments

Megacity

City with more than 10 million people (ex. New York, LA, Tokyo)

Environmental risk transition is most likely to be characterized by: A. increasing frequency of diarrhea caused by unsafe water. B. increases in acute respiratory diseases C. control of household risks and creation of a new set of problems. D. increasing levels of poor food, air, and water quality

Control of household risks and creation of a new set of problems

Who are most likely to be affected?

Elderly, people with disabilities and chronic disease, pregnant women, and children

Low incidence and prevalence

Example: childhood cancers-incidence of cancers among children is lower than adults

The 2009 swine flu outbreak was caused by the H5N1 virus True or False?

False. (H5N1 is the avian flu)

John Graunt

Father of Statistics

Hippocrates

Father of modern medicine

Paracelsus

Father of toxicology - dose responser relationship - notion of target organ specificity of chemicals

Which of the following historical figures was among the first to expound on the role of environmental factors in causing diseases?

Hippocrates

According to Healthy People 2020, which of the following is NOT an environmental objective for outdoor air quality? A. Reducing air toxic emissions to decrease the risk of adverse health effects B. Increasing the production of clean coal as an energy source C. Increasing use of alternative modes of transportation for work D.Reducing the number of days the AQI exceeds 100, weighted by population and AQI

Increasing the production of clean coal as a energy source

In 2050, the world's three most populous countries will be

India, China, the U.S.

Factors leading to urbanization

Industrialization Food availability Employment opportunities Lifestyle considerations Escape from political conflict

Reasons for the potential spread of avian influenza include which of the following? A. Intensive animal husbandry practices B. Demonstrated person-to-person transmission C. Restriction of international travel D. Both restriction of international travel and demonstrated person-to-person transmission

Intensive animal husbandry practices

The use of what measure as a study endpoint has several advantages, including the fact that it may be relevant to agents that have a subtle effect over a long time period?

Mortality

Urbanization

Movement of people from rural areas to cities - linked to numerous adverse implications for the health of populations, including increasing rates of morbidity and mortality

Which of the following outcomes is not usually associated with world population growth? A. Prosperity B. Urban crowding C. Poverty D. Pollution

Prosperity

Environmental health inspector

Responsible for monitoring and enforcing government regulations for environmental quality

Healthy Worker Effect

Selection Bias: Observation that employed populations tend to have a lower mortality experience than the general population

Case Study #2

Smoke stack emissions as a result of increase air pollution due to epidemiological studies

Confounding

Study Bias: "distortion of a measure of the effect of an exposure on an outcome due to the association of the exposure with other factors that influence the occurrence of the outcome"

Which of the following activities characterizes the epidemiological approach (as opposed to the clinical approach)? A. Treatment of a patient with lung cancer B. Study of cancer occurrence in populations C. None of these is correct. D. Description of a single individual's symptoms E. Diagnosis of a disease in a single individual

The study of cancer occurrence in populations

Compared with adults, children represent a group that is especially vulnerable to environmental hazards for the following reasons, except: A. They may be exposed more often to toxins in the outdoor air B. They may inadvertently ingest toxic substances. C. They spend more time indoors. D. They may be exposed more often to toxins in the soil.

They spend more time indoors

Difficulties in exposure assessment

This area is especially difficult in epidemiologic studies in environmental health

Long latency periods

Time interval between initial exposure to a disease-causing agent and the appearance of a disease

Ecological Study

a study in which the units of analysis are populations or groups of people rather than individuals ex) savage exposure to air pollution within a census tract and the average mortality in that census tract as well

Hippocrates

air, food, and water are the main causes of health problems

Point Prevalence

all cases of or deaths from a disease or health condition that exist at a particular point in time relative to a specific population

Intervention study

an investigation involving intentional change in some aspect of the status of the subjects Two types: - clinical trial: manipulation of the exposure variable and random assignment of subjects ex) Medical Research Council Vitamin Study and folic acid supplement - quasi-experimental: manipulation of the variable occurs but individual subjects are not randomly allocated to the study conditions ex) Newburgh vs. Kingston fluoridated water

Mesopotamia

ancient civilization that declined as a result of agricultural practices that caused soil erosion, buildup of salt in soil, and the filling of irrigation and other infectious diseases

Prevalence measures aid in:

assessing variations in disease occurrence, the development of hypotheses, and describing the scope of health problems.

New Epi

became more broad, identification of previously unrecognized exposures to known hazardous agents and the quantification of such risks, estimation and assessment

Texas Sharp Shooter Effect

cases can appear close together based on random variation

Environmental Risk Transition

changes in environmental risks that happen as a consequence of economic development in the less-developed regions of the world - diarrhea (poor water/sanitation/hygiene) - acute respiratory diseases (poor housing and indoor air pollution) Characterized by: control of household risks and creation of a new set of problems.

Demographic transition

changes in fertility, mortality, and makeup overtime Stage 1: most of population is young and fertility/mortality rates are high, pop=small Stage 2: drop in mortality rates, fertility still high, rapid increase in population Stage 3: dropping fertility rates

Cohort study

classifies subjects according to their exposure to a factor of interest and then observe them over time to document the occurrence of new cases (incidence) of disease or other health events - prospective or retrospective

Toxicologist

concerns the effect of poisons on both human and animal health medical, veterinary, forensic, and environmental applications

ecological model

determinants of health interact and are interlinked over the life course of individuals

Analytic Epidemiology

examines causal hypotheses regarding the associations between exposures and health conditions

Cross sectional study

examines the relationship between diseases and other variables of interest as they exist in a defined population at one particular time - prevalence - used to formulate hypotheses that can be followed up in analytic studies ex) asthma study in NJ

John Snow

father of epidemiology (cholera in London)

Old epi

focused on health effects such as the air we breathe, the water we drink and the food we eat

Polychlorinated biphenyls (PCBs)

halogenated compounds, become increasingly concentrated in foodstuffs, and can pose hazards as potential carcinogens

completed fertility rate

how many children of a certain cohort of women who have completed childbearing during childbearing years

Researcher/Research Analyst

individuals who have specialized training in environmental health conduct basic research on the risks associated with exposures to certain specific hazards and conduct statistical analyses of the impact of such exposures on human population

Case series study

information about patients who share a disease in common is gathered over time - weakest for making causal assertions - can be useful for developing hypotheses for further study - starting point for more complex investigations

Food Inspector/Food Safety Specialist

involved with the cleanliness and safety of foods and beverages consumed by the public

Limitations of Epidemiologic Studies

long latency periods low incidence and prevalence difficulties in exposure assessment nonspecific effects

Relative Risk

measure of association used in cohort studies

Case fatality rate

measure of the lethality of the disease - the number of deaths due to a specific disease within a specific time period

Natural Experiments

naturally occurring circumstances in which subsets of the population have different levels of exposure to a hypothesized causal factor in a situation resembling an actual experiment

Prevalence

number of existing cases of or deaths from a disease or health condition - measures the scope and distribution of health outcomes in the population

Environmental Lawyer

provide input to government agencies and may be involved in litigation concerning environmental health problems

Exposure

proximity and/or contact with a source of a disease agent in such a manner that effective transmission of the agent or harmful effects of the agent may occur

Vector control specialist

responsible for the enforcement of various public health laws, sanitary codes, and other regulations related to the spread of diseases by vectors

Epidemiological Transition

shift in pattern of morbidity and mortality from infectious to chronic diseases

Hill's Criteria of Causality

strength, consistency, specificity, temporality, biological gradient, plausibility, coherence

Toxicology

study of the adverse effects of chemicals on living organisms

Burden of disease

the impact of a disease in a population

Odds Ratio

the measure of association between exposure and outcome use in case-control studies - may provide more complete exposure data in comparison with case control

Cluster

the occurrence of cases of a disease close together in time and place

Descriptive epidemiology

the occurrence of disease in populations according to the classification by person, place, and time provides information: - setting priorities - identifying new hazards -formulating hypotheses for new occupational risks

Population at risk

the population who are capable of developing the disease

Occupational Health Physician/Occupational Health Nurse

the prevention and treatment top occupationally related illnesses and injuries

Risk assessment

the process of measuring risk

Incidence

the rate at which new events occur in a population

dose-response relationship

the response of organisms to exposures to toxic substances (s curve graph)

Environmental Epidemiology

the study of disease and health conditions that are linked to environmental factors

environmental health

the study of how environmental factors affect human health and quality of life

Epidemiology

the study of the distribution and determinants of health and diseases, morbidity, injuries, disability, and mortality in populations

Malthusian Predictions

theorized that the human population had the potential to grow exponentially Positive checks for population growth: - epidemics of disease - starvation - population reduction through warfare

Populations Dynamic

what influences demographic makeup and the growth/decline of populations

Case Study 1.1 Climate Change

- Challenging because the surrounding environment and the decisions that people make influence health - Climate change affects the social and environmental determinants of health: clean are, safe drinking water, sufficient food and secure shelter - 2030-2050: climate change is expected to cause 250,000 more deaths a year - Direct damage costs to health is estimated to be between $2-4 billion a year by 2030 -Areas with weak infrastructure (mostly developing countries) will least be able to respond -Reducing emissions of greenhouse gases through better transport, food, and energy can result in improved health and reduce air pollution

Why children are more at risk

- Immune systems and detoxifying organs are still developing and are not capable of fully responding to environmental toxins - They spend more times outdoors

Sir Pervical Pott

- London surgeon - first individual to describe the environmental cause of cancer - chimney sweeps and scrotal cancer - determined that chimney sweepers should bathe once a week

Three leading countries for receiving international migrants

- U.S. - Germany - Russia

Age groups most likely to affected by the environment

- children younger than 5 - children as old as 10 - older adults 50-75

How does epidemiology aid environmental health?

- concern with populations - use of observational data - methodology for study designs - descriptive and analytic studies

Asia

- declines in the amount of forest land - unintentional conversion of arable land to desert - rising levels of pollution (runoff into water)

Effects of megacities

- demands for energy, potable water, construction materials, food, sewage processing, and solid waste disposal

Reasons for migration

- economic betterment - migrant workers - force migration - political reasons

Controlling animals populations

- food availability - reproductive behavior - infectious diseases

Developing countries at a higher risk because

- the pursuit of natural resources has caused widespread deforestation of tropical rain forests and destruction of wildlife habitat - water contamination - air pollution - unsanitary food - crowding

Effects of rapid growth of the world's population

- urbanization - overtaxing carrying capacity - food insecurity - loss of biodiversity

Developed countries at a lower risk because

- wealthy nations provide better access to medical care and are better able to finance pollution controls

Nonspecific effects

An outcome that is associated with several environmental exposures

The risk of acquiring a given disease during a time period is best determined by which of the following?

The incidence rate for that disease in a given period of time