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Definitions
Environmental Epidemiology the study of environmental factors that influence the distribution of diseases in the human population Occupational Epidemiology the study of workplace exposures on the frequency and distribution of diseases and injuries in the population
Non-Infectious Diseases -No single necessary agent One-to-one correspondence between agent and disease very rare
-
agent-disease relationship
-Causes
latency period
Infectious Diseases
-Single
Non-Infectious Diseases
-May
-Usually
disease
produce acute
-Acquired -Dx
-Dx
Environmental Hazards
1. Site and location (earthquakes, flood, wind, storms, drought) 2. Biological (animal, insect, microbiological, vegetation) 3. Chemical (poisons and toxins, allergens, irritants) 4. Physical (vibration, radiation, forces and abrasion, humidity) 5. Psychological (stress, boredom, anxiety, discomfort, depression) 6. Sociological (overcrowding, isolation)
2.
3. 4.
5.
6.
Identify etiologic factors Monitoring trends and changes on health consequences/impact Planning, management and evaluation of programs (projections and risk assessment) Communicate information regarding environmental hazards Basis for establishing safety standards or thresholds Others (eg. Elucidating mechanisms of toxicity, describe dose-response relationships)
Lung diseases Cancer Skin disorders Infectious diseases Reproductive disorders Musculo-skeletal disorders Severe traumatic injuries Hearing loss
Biological Monitoring
The systematic collection of biological specimens (blood, urine, breath, fingernails, hair, saliva) for the purpose of estimating exposure to environmental agents and hence determine the risk of disease before it occurs Interpretation - requires detailed knowledge of the kinetics and metabolism of chemicals Limitations: due to the rapid excretion of certain chemicals, only the most recent exposure to them are measurable; may reflect recent exposure or cumulative exposure
Medical Screening
The periodic examination (clinical or laboratory) to detect diseases (or health problems) present among apparently healthy subjects Issues: validity, predictive values, costeffectiveness, acceptability of procedure
3.
Exposures are usually measured quantitatively Dimensions of exposure: level, duration, levelduration combined Current Vs. long term exposures a. Acute Effects current exposures are relevant (e.g. London smog epidemic in 1952) b. Cumulative Effects
8. Dose-Response Relationship Response the proportion in an exposed group that develops a specific effect
Environmental Exposures
Doses are at concentrations far below those experienced by workers who are directly handling the materials Will require larger population for study in order to detect the smaller health effects likely to result Problems with confounding variables may be more serious Estimation of exposure doses is complicated by the lack of routine data on air and water pollution
Environmental Exposures
Use of place of residence as surrogate for exposure may lead to exposure misclassification because population may be highly mobile Common to use ecologic data or correlational studies Longer exposure of residents to household toxin compared to workers Children are more susceptible than working adults since they have faster metabolism and absorption of the toxin
Risk Assessment
The use of epidemiological methods and principles to estimate the potential health risks of industrial or agricultural development projects, both before they are implemented and while they are in operation. Used to predict potential health problems in the use of new chemicals or technologies
2.
3.
Identify which environmental hazard may be created by the technology or project under study (Hazard Identification) Analyze the type of health effect that each hazard may cause (Hazard Assessment) Measure or estimate the actual exposure levels for the people potentially affected, including the general population and the work force (Measure Actual Exposure) - Use data on environmental and biologic monitoring, relevant hx of exposure and changes over time
BURDEN OF NCDs
rising trends in non-communicable diseases as a result of demographic and epidemiological changes, as well as economic globalization increase in life expectancy combined with changes in lifestyles are leading to epidemics of noncommunicable diseases (NCD), mainly cardiovascular diseases, cancer and diabetes In 1998, NCD accounts for 63% of global deaths 43% of all DALY globally were attributed to NCD
Non-Communicable Diseases
Includes all traditionally defined NCDs such as CVD, cancer, chronic respiratory diseases, mental health as well as injuries and violence In all WHO regions (except sub-Saharan Africa), NCDs today constitute the largest contributor to burden
NCDs accounted for 60% of all deaths in 1999 and 43% of all DALYs with injuries adding 9% of all deaths and 14% of all DALYs By 2020, 10 out the top 15 causes of DALYs lost will be attributable to NCDs, mental health and injuries/violence
The top five positions will be occupied by Ischemic Heart Disease, depression, road traffic injuries, cerebrovascular disease and Chronic Obstructive Pulmonary Disease (COPD) 15th place: trachea, bronchus and lung cancers (better known as tobacco cancers)
GROUP OF NCDs
Cancers Lifestyle-related (CVD, diabetes) Injury (unintentional, intentional) Genetic disorders Disabling disorders Occupational disorders Nutritional conditions Endocrine disorders Substance abuse
I. NATURAL HISTORY
A. CHARACTERISTICS OF THE AGENT
e
Chronicity
function
of the long latency period slow disease process adaptive responses to stresses (may be detrimental over the long term)
CD can be chronic (e.g. rheumatic heart disease) NCD can be acute (e.g. chemical poisoning)
B. General environmental
C. Lifestyle and Illness
OCCUPATIONAL
- chemical - metals and naturally occurring minerals
agent factors to be considered size and shape of particles route of exposure free or compound form organic vs inorganic form liquid or vapor form
environmental factors
conditions
in the work environmental that will influence the likelihood that workers will come in contact with an agent general cleanliness and ventilation lighting, temperature
Host factors
lifestyle
behaviors that may increase the risk of disease from occupational exposure to an agent genetic constitution
ENVIRONMENTAL
sources of exposure contamination of air, water and soil by industrial activities or inadequate waste disposal lower dose of exposure than in occupational environments pesticides housing materials automobile exhausts radiation
Investigating environmental exposures dose data on levels of exposure mobility of subjects confounders additional considerations wide range of ages length of exposure meterological conditions seasonal effects
LIFESTYLE
- poverty, stress, exercise, drug and alcohol use, nutrition
CONTROL OF NCD
A. PRIMARY PREVENTION
- removal of agent from environmental or minimizing the amount of agent present - Protection of the susceptible host from exposure
B. SECONDARY PREVENTION
- screening tests
C. TERTIARY PREVENTION
- lifestyle modification
A small core of risk factors explains the increases in CVD, certain cancers and their closely linked conditions of obesity, type II diabetes:
A substantial proportion of chronic respiratory diseases and death are driven by tobacco use Alcohol is obviously a major contributor to all causes of injuries and violence
There are 1.2 billion smokers in the world with smoking rates in 13 to 15 year olds being about 20% in diverse cities from developed and developing countries
Tobacco causes 4 million deaths per year, a figure that will increase to 10 million per year by the late 2020s The public health impact is widespread and increasing fast in developing countries
Alcohol Use
increases in many developing countries with continued very high rates of binge drinking in many east and central European countries.
Obesity
has tripled in youth in several Chinese cities, and rapidly increased over the last 15 years in the major cities of countries like Malaysia, Brazil, Indonesia and South Africa But these have occurred as underweight persists in the rural areas Often underweight is common in the same neighborhoods as obesity is increasing Thus both being underweight and being overweight are associated with poverty
Obesity (cont)
Epidemics of obesity and type II diabetes have been well documented in most Pacific Island States and are probably fuelled by a combination of factors:
increased
imports of high fat foods particularly cheap off-cuts as well as increased consumption of sodas in societies where physical activity levels have plummeted.
Devastating economic impact of diabetes complications are recently being determined for several of these countries
Mental health: 450 million people who suffer from mental or neurological disorders or from psychosocial problems such as those related to alcohol and drug abuse