Introduction to HygieneIntroduction to Hygiene HEPM 1 HEPM 1

RNDr. Sylva Rödlová, Ph.DRNDr. Sylva Rödlová, Ph.D

Institute of General HygieneInstitute of General Hygiene

Time schedule D1General hygiene department

Date day time code group type place theme lecturer Σ

29.09.14 Mo13,30 15,00

D 1 1-4 lectureJonáš posl 1

Introduction, hygienic propaedeutics RNDr. Sylva Rödlová 2

06.10.14 Mo13,30 15,00

D 1 1-4 sem 327Hygiene requirements for health-care facilities

RNDr. Sylva Rödlová 2

20.10.14 Mo08,00 09,30

D 1 1.4 lecture 327 Ecology I RNDr. Sylva Rödlová 2

03.11.14 Mo09,45 11,15

D 1 1.4 lecture

Burian posl 2

Ecology II RNDr. Sylva Rödlová 2

03.11.14 Mo13,30 15,00

D 1 1.4 lecture 327 Ecology III RNDr. Sylva Rödlová 2

Presentation of lectures on faculty web

Field excursion – summer semesterCentral 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 medicineNot 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 active search for disease sympotmssearch for disease sympotms, u, use of biomarkers of se of biomarkers of exposure/effects exposure/effects (screening programmes) (screening programmes) with the intention to find with the intention to find early signal of exposure or reversible effects and to avoid irreversible early signal of exposure or reversible effects and to avoid irreversible changeschanges, timeous diagnosis, timeous diagnosis

Tertiary prevention

remedyremedy for patients, reduction of disease progression (treatment, for patients, reduction of disease progression (treatment, rehabilitaion) rehabilitaion)

Health status determinantsEXTERNALEXTERNAL

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

INTERNALINTERNAL

Individual susceptibility Individual susceptibility (heritability, health status, (heritability, health status, ageage, gender, gender etc.) etc.)

Environment – Gene- interactionEnvironment – Gene- interaction

SOCIOECONOMICAL SOCIOECONOMICAL

education, income, interpersonal relationships etceducation, income, interpersonal relationships etc..

Optimal healthOptimal healthHealth is a state of complete physical, mental and social Health is a state of complete physical, mental and social well-being and not merely the absence of disease or well-being and not merely the absence of disease or infirmityinfirmity (definition of WHO, 7.4.1948)(definition of WHO, 7.4.1948)

+ decreasing of mortality, morbidity and handicap because of illness and increasing of health level (WHO, 2001)(WHO, 2001)

Hygiene Hygiene (Hygiea = goddess of health)(Hygiea = goddess of health)Science about preservation of health, the Science about preservation of health, the iinfluence of nfluence of environmental factorenvironmental factorss on human healthon human health. .

Environmental Environmental health health (Environmental m(Environmental medicineedicine))

Branch of public health 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?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 environmentWHO and healthy environment-developing countries-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 In developing countries, the main environmentally caused main environmentally caused diseasesdiseases are are diarrheal disease, lower respiratory infections, diarrheal disease, lower respiratory infections, unintentional injuriesunintentional injuries, and , and malaria.malaria.

• Better environmental management could prevent 40% of Better environmental management could prevent 40% of deaths from malaria, 41% of deaths from lower respiratory deaths from malaria, 41% of deaths from lower respiratory infections, and 94% of deaths from diarrhoeal disease infections, and 94% of deaths from diarrhoeal disease

WHO and healthy environment WHO and healthy environment – developed countries– developed countries

• In developed countries, In developed countries, healthier environments healthier environments could could significantly significantly reduce the incidence of cancers, reduce the incidence of cancers, cardiovascular diseases, asthma, lower respiratory cardiovascular diseases, asthma, lower respiratory infections, musculoskeletal diseasesinfections, musculoskeletal diseases, road traffic injuries, , road traffic injuries, poisonings, and drowningspoisonings, and drownings..

• Environmental factors influence 85 Environmental factors influence 85 out of the 102 out of the 102 categories of diseases and injuries listed in categories of diseases and injuries listed in The world health The world health report.report.

• Much of this Much of this death, illness and disabilitydeath, illness and disability could be could be prevented throughprevented through well targeted well targeted interventionsinterventions such as such as promoting safe household water storage, better hygiene promoting safe household water storage, better hygiene measures and the use of cleaner and safer fuels.measures and the use of cleaner and safer fuels.

• Other interventions that can Other interventions that can make environments healthier make environments healthier include: increasing the safety of buildings; promoting safe, include: increasing the safety of buildings; promoting safe, careful use and management of toxic substances at home careful use and management of toxic substances at home and in the workplace; and better water resource management.and in the workplace; and better water resource management.

Environmental factors (stressors)

• Physical factors climate, climate, indoor indoor microclimate, ionizing and non-ionizing microclimate, ionizing and non-ionizing

radiation, solar radiation, noise, vibrationradiation, solar radiation, noise, vibration

• Chemical factorsChemical factors acute, chronic, specific effects, delayed effects, acute, chronic, specific effects, delayed effects,

transplacental exposuretransplacental exposure

• Biological factorsBiological factorsmicroorganisms, fungies, cyanobacteriae, algae and their microorganisms, fungies, cyanobacteriae, algae and their

toxins, plants, insect, animals, human beingtoxins, plants, insect, animals, human being

Environmental mediaEnvironmental media

• Outdoor and indoor airOutdoor and indoor air• Water – drinking water, bathing watersWater – drinking water, bathing waters, waste waters, waste waters• Water sedimentWater sediment• SoilSoil• BiotaBiota• Food chains 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 epidemiologyEnvironmental epidemiology

Study of relationship between environmental stressors and population health

• Environmental indicatorsEnvironmental indicators simplified compounds simplified compounds in environmental media in environmental media

characterized the levels of more complicated characterized the levels of more complicated komplex environmental pollutionkomplex environmental pollution

• Health indicators Health indicators demographic datademographic data (mortality, morbidity)(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

VibrationMostly at occupational exposure (e.g. pneumatic drill,

dentist drill), but also in the ordinary living conditions (kinetosis due to transport – seasickness).

Ionizing radiationDisasters (nuclear power plants)Occupational exposure (radiotherapy, radiodiagnostics)Exposure of patientsNatural exposure from cosmosEffects: deterministic (dose-dependent with threshold stochastic (probability is increasing after the first

dose – carcinogenicity)

Chemical stressorsChemical stressors

Environmental chemical contaminants represent large-scale 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 stressorsChemical stressors

Acute - subacute – chronic intoxicationsAcute - subacute – chronic intoxications

Simple or repeated Simple or repeated exposureexposure

Adverse effects with Adverse effects with tthresholdhreshold

Delayed effects Delayed effects (mutagenic, carcinogenic) without threshols(mutagenic, carcinogenic) without threshols

Organ-specific effectsOrgan-specific effects: : kidney or liver damage, kidney or liver damage, embryotoxicity, damage of embryotoxicity, damage of fetal development, endocrinefetal development, endocrine system disruption, immunotoxicitysystem disruption, immunotoxicity

Source of exposureSource of exposure::

Occupation – polluted air, water, Occupation – polluted air, water,

food - hobbiesfood - hobbies

Adverse health effects of environmental factorsAdverse health effects of environmental factors

• Delayed effects Delayed effects (m(mutagenic, carcinogenicutagenic, carcinogenic))• Allergenic Allergenic (pollen, household dust, mites, household (pollen, household dust, mites, household

cleaning compounds, etc…..)cleaning compounds, etc…..)• Reproduction disorders Reproduction disorders (polycyclic aromatic (polycyclic aromatic

hydrocarbons - PAHs, persistent organic hydrocarbons - PAHs, persistent organic pollutantspollutants - - POPs)POPs)

• Developmental toxicity Developmental toxicity (Pb, polychlorinated biphenyls (Pb, polychlorinated biphenyls – PCBs, dioxins etc.)– PCBs, dioxins etc.)

• Endocrine disrupting chemicals Endocrine disrupting chemicals (POPs, PA(POPs, PAHH, Cd, , Cd, zearalenon - zearalenon - mmycotoxins)ycotoxins)

• NeurotoxicityNeurotoxicity (Hg, As, Pb, PCB, dioxins) (Hg, As, Pb, PCB, dioxins)

Fate of chemicals in the environmentFate of chemicals in the environment

SourceSource: : industry, traffic, heating, agricultureindustry, traffic, heating, agriculture

Polluted mediumPolluted medium:: preferentially air, preferentially air, surface or surface or waste waste waterswaters

Pollutants in the air can Pollutants in the air can interact and generate new interact and generate new structuresstructures, they , they movemove to sediments, soil, to sediments, soil,

Food chainFood chain:: soil, water, air – vegetation – herbivorous soil, water, air – vegetation – herbivorous animals – omnivorous animals - human animals – omnivorous animals - human

Sources of air pollution

Global transportGlobal transport

Types of problems susceptible to study Types of problems susceptible to study

and evaluationand evaluation by environmental by environmental epidemiologyepidemiology

• Air pollution, outdoor and indoorAir pollution, outdoor and indoor• Occupational exposureOccupational exposure• Surface and ground Surface and ground water pollution water pollution (consumers, (consumers,

recreation)recreation)• Use of Use of pesticides pesticides in agriculture, food contaminationin agriculture, food contamination• Health effect of Health effect of radiationradiation (ionizing, nonionizing) (ionizing, nonionizing)• Effects of Effects of cigarette smokingcigarette smoking, interaction with , interaction with

occupational or environmental exposureoccupational or environmental exposure• Heavy metals Heavy metals and and trace chemicals trace chemicals in the environmentin the environment• Health impact of Health impact of urbanizationurbanization (megapolis) (megapolis)• Health effects of Health effects of traffic, motor vehicles, injuriestraffic, motor vehicles, injuries

Endocrine disrupting chemicals (EDC)Endocrine disrupting chemicals (EDC) as as environmental pollutants and their health environmental pollutants and their health

effectseffects

DefinitionDefinition

Endocrine disruptors are Endocrine disruptors are environmental chemicals environmental chemicals that that alter gene activity alter gene activity during sensitive during sensitive developmental periods when developmental periods when cells differentiation cells differentiation is is occurring, and occurring, and irreversibly disrupt the functioning irreversibly disrupt the functioning of disrupt cells.of disrupt cells.

Potential health effects from the Potential health effects from the population point of viewpopulation point of view

Incidence of breast carcinoma has been increasing about 1 Incidence of breast carcinoma has been increasing about 1 % yearly (this type of carcinoma is usually hormonally % yearly (this type of carcinoma is usually hormonally dependent)dependent)

increasing tendencies increasing tendencies are observedare observed in in the incidence of: the incidence of:

endometriosisendometriosis

cryptorchidismcryptorchidism

prostate carcinomaprostate carcinoma

testicular cancertesticular cancer

hypospadiahypospadia

What compounds belong to EDC What compounds belong to EDC (endocrine disrupting compounds)?(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

ChildrenChildren are the are the most sensitive and vulnerable most sensitive and vulnerable population population group (ED-compounds can cross the placenta and are group (ED-compounds can cross the placenta and are present in human milk)present in human milk)

NeurotoxicityNeurotoxicity

Reproduction disordersReproduction disorders

HypothyreosisHypothyreosis

Worsening of psychomotoric development Worsening of psychomotoric development of childrenof children

………………..

However, the adverse health changes are mostly transitional.However, the adverse health changes are mostly transitional.

Global regulation Global regulation of persistent chlorinated of persistent chlorinated organic compoundsorganic compounds

Stockholm convention Stockholm convention May 22, 2001May 22, 2001AnnexAnnex ChemicalsChemicals• EliminationElimination: : Aldrin (pesticide), Chlordane Aldrin (pesticide), Chlordane

(pesticide/termiticide), Dieldrin (pesticide), Endrin(pesticide/termiticide), Dieldrin (pesticide), Endrin (pesticide), (pesticide), Heptachlor (pesticide/termiticide), Hexachlorobenzene Heptachlor (pesticide/termiticide), Hexachlorobenzene (pesticide), Mirex(pesticide), Mirex (pesticide), Toxaphene(pesticide), Toxaphene (pesticide), (pesticide), Polychlorinated biphenyls (industrial chemical)Polychlorinated biphenyls (industrial chemical)

• RestrictionRestriction: : DDTDDT (disease vector control, intermediate in (disease vector control, intermediate in production of dicofol) production of dicofol)

• UnintentionalUnintentional:: Production Polychlorinated dibezo-p-dioxins Production Polychlorinated dibezo-p-dioxins and dibenzofurans, Hexachlorobenzene, Polychlorinated and dibenzofurans, Hexachlorobenzene, Polychlorinated biphenylsbiphenyls

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)International environmental health (USA)

U.S. EPA U.S. EPA (Environmental Protection Agency)(Environmental Protection Agency) – www.epa.gov – www.epa.gov

ATSDRATSDR (Agency for Toxic Substances and Disease Registry) (Agency for Toxic Substances and Disease Registry) - - federal public health agency of the U.S. Department of Health and Human federal public health agency of the U.S. Department of Health and Human Services.Services. Atlanta Atlanta

(responsible for (responsible for public health assessment public health assessment of hazardous waste sites, of hazardous waste sites, specific hazardous substancesspecific hazardous substances, , health surveillance and registrieshealth surveillance and registries, , applied research in public health assessment, information development and applied research in public health assessment, information development and dissemination, education and training concerning hazardous substances)dissemination, education and training concerning hazardous substances)

International Environmental Health Subcommittee International Environmental Health Subcommittee coordinates:coordinates:

ATSDR, NCEH (Nat. Center Environ. Health), NIOSH (Nat. Inst. Occup. ATSDR, NCEH (Nat. Center Environ. Health), NIOSH (Nat. Inst. Occup. Safety and Health), CDC (Centers for Disease Control and Prevention) Safety and Health), CDC (Centers for Disease Control and Prevention) NIEHS (Nat. Inst. Environ. Health and Science), NIH (Nat. Inst. Health), FDA, NIEHS (Nat. Inst. Environ. Health and Science), NIH (Nat. Inst. Health), FDA, EPA, OSHA (Occ. Safety and Health Administration)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 ProjectsEU: 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 qualityNoiseIndoor environment and housing conditions Water quality contamination Elmg fields and radiation Chemical exposures

http:europa.eu.int/comm/health/

Health protection Health protection health promotion toolshealth promotion tools

• Repressive measuresRepressive measures: : Legislation (acts, regulations, limit values, biologically Legislation (acts, regulations, limit values, biologically

important values important values OEL (occupational exposure limit),OEL (occupational exposure limit), ADI ADI (acceptable daily intake)(acceptable daily intake), TDI, TDI (tolerable daily intake) (tolerable daily intake) etc.)etc.)

• Recommendable (advisory) measuresRecommendable (advisory) measures:: proper lifestyle, optimal nutrition, right behavior in proper lifestyle, optimal nutrition, right behavior in

problematic environmental situations, support of problematic environmental situations, support of breastfeeding, physical activity etc. breastfeeding, physical activity etc.

Risk communication with public Risk communication with public Explanation the problem, its importance and necessary oExplanation the problem, its importance and necessary off

possible preventive measures. Vertical and horizontal possible preventive measures. Vertical and horizontal feedback.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