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This 14 page Study Guide was uploaded by Emily Zeng on Wednesday November 5, 2014. The Study Guide belongs to 311 at University of Washington taught by Dr. Treser in Fall. Since its upload, it has received 106 views. For similar materials see ENVH in Public Health at University of Washington.
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Date Created: 11/05/14
ENVH Health Introduction to Environmental Health Study Guide for Progress Assessment Test 1 Format 40 multiple choice and 12 short essay questions Lesson 1 Introduction 0 Know the definition of environmental health and how it is related to other disciplines 0 Environmental Health the study of the adverse effects of environmental factors and conditions on human health and wellbeing and the development and implementation of prevention and control strategies and programs 0 Environmental health evolved out of two lineages 1 Medicine 2 Engineering 0 Relationship to related disciplines Public health is the umbrella term that encompasses medicine environmental protection health services laboratory services and ecolo environmental science D all work in terms of o ulation and revention since e 1 Periodic Famine Extreme scarcity of food over a periodic time Caused by crop failure population unbalance or government policies 2 Vectorborne Diseases Illness caused by infectious microbe that is transmitted to people by blood sucking arthropods 3 Combat Lesson 2 Ecology 0 Know the definition of ecology and how this discipline relates to Environmental Health 0 Ecology The study of the abundance and distribution of species and their relationship to the environment Literal meaning study of house 0 Know the basic principles of ecology ecosystems limiting factors biotic communities and biological succession biogeochemical cycles and ecological pyramids food chainswebs pyramids of energy 0 Ecosystems Functional units of nature that show how biotic living organisms interact with their abiotic nonliving environment 0 Limiting Factors Environmental conditions that limit or control where an organism can live Too much of a limiting factor can be bad as well D limits of tolerance range between ecological minimum and maximum 0 Water 0 Food 0 Temperature 0 Disease 0 Air 0 Biotic Communities A natural grouping of different kinds of plants and animals within any given habitat There are populations within a biotic community O Biome Terrestrial communities of the world recognized by the distinctive life forms of their dominant species 0 Biological Succession Forest destroyed by res pioneer species reemerge and regenerate soil trees die without leaving descendants forest remains unchanged as long as no destruction 0 Biogeochemical Cycles The cycling of earth materials through living systems and back to the earth gaseous vs sedimentary Help retain vital nutrients in forms usable by plants and animals All living organisms dependent on energy and inorganic materials that are continuously circulated through the ecosystem 0 Food chainswebs Producers plants store sunlight in form of chemical energy Consumers Herbivores consumers convert 10 of energy from plant into animal tissue Decomposers help recycle life 0 Energy cycles Sun ultimate source of energy Photosynthesis convert solar energy into chemical energy Nitrogen cycle buming of fossil fuels to release gas nitrogen into atm decomposition of nitrogen into ammonia o How do we measure environmental impact I P X A X T 0 Environmental Impact Population X Af uence X Technology 0 Where do environmental threats come from Know how human population growth in uences regional and global ecosystems 1 Increased Population 2 Modem Technology a Mass production of crops Lesson 3 amp 4 Population amp Limits to Growth 0 Understand and be able to discuss world population growth using the concept of doubling time and the implications of the worst case projection ie the limits to growth 0 Doubling Time the time required for a population to double in size 0 Growth Rate Birth rate Death Rate 0 With an annual growth rate of 23 the pop Of Pakistan will double in just 30 years and to maintain present standards of living everything in Pakistan needs to be doubled in 30 years D improving living standards 0 Population Explosion 0 Know some of the differences in causes of death in ancient human populations versus civilized human populations and the origins of disease 0 Homosapiens Appear Periodic Famine Vectorbome Diseases Combat O Towns and Cities Appear Contagious Crowd Diseases Nutritional De ciencies 0 Industrial Revolution Industrial Chemical Toxins Ovemutrition 0 Timeline and Origins of Disease Agriculture 0 Stockpiling of food supplies stationary farmers D rodents o Contamination of Water supplies 0 Sewage and solid waste disposal Animal Husbandry 0 Living in close proximity to animals D exposure to zoonotic diseases Development of Cities 0 Larger populations D problems with food and water supplies Wastewater and garbage disposal Urbanization o Concentrate people migration of workers D spread of pathogens Trade 0 New trade routes linking people D spread of pathogens War 0 Large concentrations of men traveling through routes D pathogens Volkerwanderungen 0 Europe from the collapse of the Roman Empire to the Middle ages D spread of pathogens Clothing 0 Protects skin against vectors but also harbors eas Religious Rites o Concentrates people may practice unsanitary behaviors Late 20 Century 0 Preventable diseases Heart and circulatory cancers COPD accidents pneumonia and in uenza Pathogenic ability to cause disease Infectious spreads Virulent harmful 0 How do We measure life expectancy and how does this vary across different populations 0 Life Expectancy expected average number of years of life remaining at a given age measured by putting population of people who are alive in ages and calculating the proportion of people in the age groups that died in the year then use a fictitious cohort of 1000 people and see how many people die based on expected proportions At age 1 exposed to risks experienced by 1 year olds Average length of life of fictitious group based on mortality risks 0 Japan has the highest life expectancy US is behind even though We spend the most on medical care Overall LE varies depending on public health measures 0 Be able to explain the Club of Rome and its importance Know the ve key trends used in the Limits to Growth computer model 0 Club of Rome global thinktank that deals with intemational political issues released The Limits to Growth report on the exponential population growth compared to the arithmetic food supply growth based on a computer model 0 Five Key Trends Population Growth Food Production Resource Consumption Industrial Production Pollution 0 Be able to discuss population growth how various population growth models e g Limits to Growth might predict different health outcomes on a global scale 0 TLG Predicted Health Outcomes Within 100 years society will run out of nonrenewable resources leading to a collapse of the economic system decreased food production and increasing death rate This can only be avoided by limiting population and pollution Criticisms too pessimistic doesn t account for technological advances and social and political factors 0 Logistic Population Growth LPG Predicted Health Outcomes Population grows logistically and will level off instead of increasing exponentially O Pollution waste disposal conserving resources energy etc Lesson 5 Toxicology 0 Know the definition of toxicology O Toxicology the study of the adverse effects of chemicals xenobiotics on living organisms O Toxicant chemical introduced into the environment by humanmade pollutants o m a naturally occurring poison made by an living organism biological origin 0 Be able to explain the doseresponse relationship and interpret doseresponse curves 0 Doseresponse relationship measures the change in response related to the magnitude of the stressor toxicant with a constant exposure time 0 For essential nutrients like vitamins too little and too much of the substance can cause irreversible damage 0 For nonnutritional toxic substances a continuous increasing dose will eventually cross the threshold of safety and then lead to irreversible damage I i n G E V H I N 391 R mEI39E 39E39t 39 H393quotl9quot Hf MaMIJmum 9E g i39 39i39f39E 5f7iI3 E Ed e ett rarmgE 0 Wi Ehll TEa5i hg A i 1 I ezluse quotH i I E 39l I f E quot I1 0gf as n E E E Al I 2 I I pQe 5 II n I 5 I u I 391 IIIE ia i irg l2IIIu E 39II Know the routes of exposure and how this relates to ADME Absorption Distribution Metabolismbiotransformation Excretionelimination 0 Direct Exposure Oral through the mouth when a person eats drinks or smokes Dermal skin contact Respiratory inhaled 0 Indirect Exposure Contamination of drinking water Contamination of soilhouse dust Contamination of indoor air 0 Absorption The amount of xenobiotic absorbed into the body depends on 0 Amount and duration of exposure 0 Route of exposure 0 Chemical prop Of substance 0 Solubility Water VS fatsoluble 0 Size 0 Distribution Chemicals are generally distributed throughout the body to tissues and organs Via the blood Distribution is determined by a compound s chemical properties 0 Lipophilic fatsoluble xenobiotics will deposit in fatty tissues bioaccumulative chemicals 0 Hydrophilic watersoluble xenobiotics will be more easily excreted in urine 0 MetabolismBiotransformation A set of enzymes in the body are responsible for metabolizing nutrients toxicants and drugs The LIVER is especially rich in these enzymes but they are present in many tissues The goal of biotransformation is to metabolize the xenobiotic into a form that may be excreted usually by making it more Watersoluble Biotransformation has the potential to be good or bad 0 Xenobiotics are usually converted into inactive metabolites which may then be excreted O In some cases biotransformation generates more reactivetoxic metabolites Genetic variability in biotransformation enzymes may make certain individualspopulations more susceptible to or protected from a particular exposure ex Asians can t biotransforrn alcohol as well lacking enzyme 0 Know the four types of toxicology testsinformation used to determine enviromnental health to humans structural activity acute and chronic tests and epidemiology 0 Structural activity the relationship between the structure of a chemical and its biological activity identifying the chemical group responsible allows for chemical synthesis 0 Acute tests Done on animals and then used to estimate toxicity to humans some results can be found from direct human contact ex suicide overdose etc 0 Chronic tests Done on animals by having three groups with different diets 1 Control 2 Dose expected to have no effect 3 Dose expected to have chronic effect over a long time period and then examining organ damage afterwards O Epidemiology Study of distribution rates and determinants causes of health effects diseases and injuries in human populations 0 Be able to discuss chemical interactions biological halflife and single versus repeated doses o Chemical Interactions Additive 235 sum Synergistic 2320 combination of two more toxic Potentiation O2lO nontoxic potentiates ability of another Antagonism 44O cancel each other out o Biological halflife time it takes for the body to eliminate half of the substance o Single vs Repeated doses A single dose fades over time whereas repeated dose has an accumulative response 0 Give examples of several health effects associated with exposure to speci c chemical agents in the environment eg asbestos smoking lead arsenic etc Chemical Agent Health Effects Polychlorinated Biphenyls PCBs 0 Liver disorders miscarriage low birth type of synthetic organic chemical that is used i rate abnormal cell multiplication acne industrialized setting Dioxin TCDD O Acne interferes with immune function chemical toxin byproduct of herbicides fetal toxicity cancer hormones muscle aches psychiatric effects Asbestos 0 Death disabling disease 0 Know what an LDSO is what it can and cannot tell you 0 L0 the amount of the chemical administered in one dose that is required to kill 50 of a population of test animals within a 14day period The lower the LDSO the more acutely toxic the chemical is Acute toxicity testing is restricted to population of lab animals so results used to estimate LD for humans aren t exact humans might be less or more sensitive However human data can be collected from death by overdose 0 Be able to discuss the concepts of acute and chronic exposures 0 Acute toxicity chemical s ability to cause harm as a result of onetime exposure to a relatively large amount of the substance 0 Chronic toxicity chemical s ability to impair health when repeated lowdose exposure to the chemical occurs over a long time period 0 Often there is no correlation between acute and chronic toxicity symptoms and also no connection in their relative toxicity 0 Be able to de ne the terms threshold LOAEL and NOAEL and margin of safety 0 Threshold the dose below which no response is observed 0 NOAEL no observable adverse effect level 0 LOAEL lowest observable adverse effect level 0 Margin of Safety space between LD and effective response curve LD ED Lesson 6 Risk Assessment 0 Understand what risk is Risk Hazard x Exposure 0 Hazard Identi ed through laboratory or human studies I Physical Strength mechanism I Chemical Potency mechanism I Biological Infectivity pathogenicity virulence 0 Exposure Identi ed through environmental data and knowledge of the population of interest I Route of Exposure Air water food soil I Route of Entry Inhalation ingestion dermal absorption I Dose 0 Understand the concepts of risk assessment risk management and risk communication and be able to explain how these are used in the practice of environmental health 0 Risk Assessment the systematic scienti c evaluation of potential adverse effects resulting from human exposures to hazardous agents or situations ex chemical biological and physical which allows us to prioritize program activities and remediation efforts and estimate their effectiveness I Framework Hazard Identi cation Is there a potential problem 0 DoseResponse Assessment What is the problem 0 Exposure Assessment Who has the problem 0 Risk Characterization How bad is the problem 0 Risk Management Development of regulatory options control substitute inform evaluation of public health economic social political context for risk management options based on results of risk assessments with engineering data I What should we do about the problem 0 Risk Communication Interactive process of exchange of information and opinions on risk among risk assessors risk managers and stakeholders I Who and what do we tell I Use uncomplicated clear and active language that is culturally sensitive 0 Know and be able to explain the main methods used in hazard identi cation pros and cons 0 Structure Activity Analysis System paper chemistry basic lab tests Time Required days to weeks rapid process Basis chemicals with like structures will exhibit similar toxic effects Results structure resembles positive or does not resemble negative structure of known toxic agent Conclusion chemical may be a toxic agent 0 Short Term Tests System bacteria yeast cultured cells intact animals Time Required 1 day to 18 months Basis chemical interactions with critical cellular components can be measured in simple biological systems Results chemical causes positive or does not cause negative a response known to be caused by other toxicants Conclusion chemical is a potentially toxic agent 0 Chronic Bioassays System intact animals Time Required 2 to 5 years carcinogenicity 2 months to 2 years developmentalreproductive tox Basis chemical that causes toxicity in animals may cause toxicity in humans Results chemical causes positive or does not cause negative increased incidence of toxic effects Conclusion chemical does cause toxic effect in that species and is a potentially toxic agent in humans 0 Epidemiology Studies System humans Time Required months to lifetime Basis chemicals that cause toxic effects can be detected in studies of human populations Results chemical is associated positive or is not associated negative with an increased incidence of adverse effect Conclusion chemical is recognized as a toxic agent in humans 0 Know the two types of dose response curves threshold vs nonthreshold O DoseResponse Assessment a determination of how much of an agent is required to cause a toxic effect and prediction of exposure levels at which risk is likely to be negligible or nonexistent I Use uncertainty factor to deal with uncertainty divide by 10 for species difference divide by 10 for human variability Threshold NonThreshold O Noncarcinogen O Carcinogens O NOAEL concentrations below which no adverse effect occurs 0 No safe dose only acceptable risk which is 10 4 l0 6 0 Brie y be able to explain the steps you would go through to conduct an exposure assessment O Identify affected population I Focus on sensitive population Calculate the amount frequency length of time and entry of exposure I Inhalation ingestion dermal absorption Identify route of exposure I Air water food soil Expected dose sum of all exposures I Dose given in amount of contaminant bodyweight time Indirect Methods I Environmental monitoring I Fate and transport migration computer models I Resident questionnaire surveys Direct Methods I Personal workplace monitoring I Biologic markers 0 Blood or urine 0 Understand the differences between risk assessment management and communication Risk Assessment Risk Management Risk Communication 0 Unbiased scientific approach to assessing risk 0 Interactive process of exchange of informatioi and opinions on risk among risk assessors risk managers and stakeholders 0 Incorporates the results of risk assessment factors in societal values legal mandates other considerations 0 Know the risk management philosophies in particular the process of costbenefit analysis 0 CostBenefit a systematic attempt to compare the costs with the anticipated benefits of a technology product substance or process I List adverse consequences cost I List benefits gainsvalue I Compare cost versus bene ts I Advantages exible easily scrutinized OOOOOO I Disadvantages all consequences can not be anticipated assigning price tags is difficult Revealed Preferences Natural Standards Expressed Preferences Count the Bodies Engineering Solutions BAT Delaney Approach any food additive found to cause cancer in lab animals must be banned this cause was repealed 0 Understand how public perception of risk plays a role in risk communication O O O O O Human response to risk is not always rational Level of risk play a little role in acceptability to public Emotional response often makes it difficult to communicate risk People apply personal values when evaluating risk Ex voluntary vs involuntary risks immediate vs delayed effects common vs rare events etc Lesson 7 Epidemiology 0 Know the definition of Epidemiology O Epidemiology Study of distribution rates and determinants causes of health effects diseases and injuries in human populations 0 Understand what is meant by the terms prevalence and incidence of disease O O Disease Prevalence The proportion of a population with the disease at a chosen point in time Ex Prevalence per 1000 Rp Number of cases Total population Ct P xl000 at a specific time Disease Incidence Rate The number of new cases of diseases that occur during a period of time in a population at risk for developing the disease Ex per 1000 Ri New cases Population at risk Cn P x1000 over specific time period 0 Know and explain the distribution factors of disease person place time O O O Person Age sex race occupation education etc Place Geographic Longitude amp Latitude geologic climatic Geopolitical Urban rural industry pollution Time Episodic cyclical secular 0 Be able to identify what an agent host and environment are and how they are related O O Disease Agent Virulence infectivity addictive qualities etc Human Host Genetic susceptibility resiliency nutritional status PhysiologicalAge gender ethnicity previous diseases immunity geneticpredisposition Behavioral Education occupation lifestyle etc Enviromnent Public health sanitation social context availability of health care Physical Enviromnent Geochemical factors geology amp geography topographyclimate and weather Biological factors habitat life forms nutrientsfood webs Built Environment Provisions of Basic Necessities food amp water sanitation amp hygiene Shelter from Elements Exclusion of Agents Vectors and pests 0 Agent is present in environment human host is exposed to agent infectious diseases evolve with human populations infectivity pathogenicity virulence 0 Explain the importance of strati cation by age or other factors in analysis of epidemiologic data Strati cation Process of or result of separating a sample into several subsamples according to speci ed criteria such as age groups socioeconomic status race gender etc o This is important to the analysis of epidemiologic data because epidemiologic studies are specific to distribution person place and time and determinants agent host environment 0 Know the three types of diseasecausing agents biological chemical amp physical with examples 0 Biological Agents Microorganisms Bacteria viruses Helminths plants and animals 0 Chemical Agents Inorganic chemicals heavy metals organic compounds solvents and pesticides 0 Physical Agents Sharps force noise radiation ionizing and nonionizing 0 Know the three most important modes of transmission 0 Direct Person Person Contact 0 Indirect Vehicles food water air fomites 0 Vector Insects or other organisms that transmit pathogenic fungus virus or bacterium Lesson 8 Disease Transmission and Control 0 Explain the balance between agent host and environment 0 For example Occupational injury is likely to occur when there is a susceptible host worker who is inadequately protected is in a hazardous environment unsupervised inadequate culture of safety with a dangerous agent chemical biological or physical hazard 0 Be able to give several examples of infectious and environmental disease transmitted through the environment and how humans are exposed to the causative agent o Infectious and environmental diseases Aids tuberculosis Lassa fever Legionaires Disease toxic shock syndrome Ebola virus hantvirus Ecoli 0157 H7 food poisoning and SARS severe acute respiratory syndrome Bird u strain of in uenza H5Nl HlNl Swine u O Causative Agents Polluted air and water excessive levels or noise sunshine nuclear weapon fallout overcrowded slums toxic waste dumps inadequate or overly adequate diet stress food contaminations medical x rays drugs cigarettes unsafe working conditions etc I Summary Fostered by poor living conditions and spread through contaminated food and water bacterial viral and parasitic pathogens have been responsible for the vast majority of human deaths from time immemorial until early 20th century 0 Be able to describe in detail the four major ways we can modify human behavior as a way of preventing and controlling disease 0 Modifying the Enviromnent 1 Engineering Controls Tactic 1 Substitution Substitute agent with new compound or process Tactic 2 Treatment Somehow make the agent less harmful or eliminating it Ex Chlorinating water supply to eliminate bacteria Tactic 3 Isolation Ex Nuclear powerradiation We encase nuclear reactors in concrete lead and steel Tactic 4 Shielding Ex Lap apron for x rays at the dentist moon suits O Modifying Behavior 2 LegalRegulatory Controls Statutes Rules and regulations Enforcement programs Private sector control 3 Administrative Controls Planning Supervision Makes sure things are being carried out Biological monitoring Finding out things about the employee so that the work environment can be tailored to them or vice versa Controversial because for ex pregnant women and matemity leave should women have a choice Work scheduling 4 Education Education Training Safety Campaigns Administrative priority 0 Be able to describe the four general engineering control strategies used to mitigate environmental health hazards and be able to give an example for each 0 Look at examples above Lesson 9 Water Quality 0 Be able to describe the hydrologic cycle and explain why it is important to the practice of environmental health O 0 Be able to describe the issues surrounding global Water availability and use and sources of drinking water 0 Only 3 of the Earth s water is fresh the other 97 is saltwater And only less than 1 of that freshwater is available 0 40 of World s population lives in regions with water stress 0 Be able to understand the subsurface water environment and issues with groundwater contamination 0 Water becomes contaminated through industrial use and pollutants to surface runoff Point Source Pollution Pollution directly from a source of water waste water treatment plants factories Nonpoint Source Pollution Pollutants that runn of or seep into water from a broad area of land runoff from agriculture 0 Be able to identify the major waterbome diseases of the US and be able to describe the causes of such waterborne disease outbreaks 0 Causes Ingestion and skin absorption Contamination of drinking water supplies ex pipes Water contact Indirect Drought oods insanitary conditions Direct Disease Chemical Contamination Agriculture industry transportation residential Fecal contamination human wastes livestock wildlife Soil Bacteria minerals etc radioactive elements Waterbome Diseases in the United States I From drinking water I From recreational waters 0 Majority of outbreaks and outbreak associated illnesses were linked to community water systems and occurred in systems that used ground water sources 0 Be able to list the steps involved in drinking water treatment for both surface and groundwater systems and describe the purpose for the major steps in the process 0 Water Treatment I Source water amp collection system I Treatment plant I Distribution system I Consumer 0 Surface Drinking Water Treatment Goes in this order Reservoir pumping equipment aerator filter chemical addition occulation station settling basin filter gallerystorage disinfection pumping equipment storage reservoir to your neighborhood 0 Ground Drinking Water Treatment Goes in this order Well disinfection storage reservoir to your neighborhood Usually NO filtering just disinfection 0 Be familiar with how recreational surface water is regulated by the Clean Water Act and the key terminology in the Safe Drinking Water Act 0 Clean Water Act Is to ensure the preservation of water quality I States set their own measures for standards if not met impaired 0 Safe Drinking Water Act Key Terminology I Maximum Contaminant Level Goal MCLG Level at which no known or anticipated adverse effects occur and which allows for an adequate margin of safety not enforceable I Maximum Contaminant Level MCL Level which is as close to maximum contaminant level goal as is feasible enforceable I Treatment Technique Instead of establishing MCL if it is not economically or technologically feasible to ascertain the level of the contaminant enforceable OOOO Lesson 10 amp 11 Waste Water 0 Be able to describe how sewage is treated including primary secondary and tertiary municipal wastewater treatment processes 0 Primary I Screening Blocks out trash I Sedimentation Stuff that gets past screening 0 Secondary I Biological Oxidation of wastes trickling lter aeration activated sludge sludge stuff that gets stuck at the bottom I Disinfection O Tertiary Advanced treatment I Nutrient removal by Chemical Coagulation Reserve osmosis A little more costly Activated Carbon Supercharged piece of wood 0 Be able to describe a typical gravity onsite sewage system OSS and how they work 0 On site sewage system consists of two basic components I Septic Tank Most often made by concrete but may be made of plastic or fiberglass Size range from 750 gallons and up Provide adequate retention time for separation of solids from liquids Provides anaerobic breakdown of solids Solids sink to bottom and form sludge layer Greases fats and oils oat to the top and form scum layer I Dispersal and disposal component or drain eld 0 Be able to apply the quotengineering control strategiesquot to particular situations in order to reduce the risk of waterbome disease outbreaks
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