Questions

Question 1

20. Monitoring Of environmental factors and biological monitoring

Answer 1

• Affected by air pollutants weather conditions and surface waters
• Traditionally use of animals like canaries or mice in Coalmines or cats on fishing boats
• Human exposure assessment done with blood and urine (Suitable for recent exposure); Saliva for IG and Lysozymes
• Breast milk for lipophilic xenobiotics during pregnancy
• hair analysis easier to collect transport and store but difficult removal of external contamination; Useful to assess long time or past exposure

Question 2

22. Air quality and health, air pollution Health impact Emission, Imission, smog

Answer 2

Air pollution of occurs indoor and outdoor is a major environmental related health treat causing range of respiratory cardiovascular diseases

• Mostly occur indoors (Carbon monoxide lethal, tabcoo the most common)
• Outdoor pollution due to swelling of cities and increased combustion of fossil fuels, Long list of pollutants like sulphur dioxide and nitrogen oxides, carbon monoxide
• black smog also called London smog occurs due to inversion with fog and resulting high concentration of sulphur dioxide (Does not exist in this form anymore but similar as winter smog)
• Most important condition to produce reduction smog is an inversion found in river on mountain vallies
• Summer Smog also called photochemical or oxidative; occurs is in summer at temperatures above 25 -> Nitrogen dioxide and hydrocarbons undergo chemical reactions forming peroxiacetylnitartes

Question 3

23. Health issues of traffic emission

Answer 3

Cars source of nitrogen dioxide and hydrocarbons leading to photochemical smog (summer)

• noise

Question 4

34. Potable water quality, quality requirements, hygienic limits

Answer 4

Standard for drinking water asset as follows:

• No pathogenic microbes and toxic materials
• Suitable composition including some trace elements
• Suitable organoleptic qualities: temperature 10 to 12°, pH 6 to 8, Sufficient clarity, refreshing taste, absence of smell and colour
• upper nitrate limit is 15 mg/L (newborns at least) As it can cause methaemoglobinaemia

Question 5

32. Water sources, portable water treatment, distribution, health safety, accidents

Answer 5

Three originals of water:

• Rainwater only in exceptions use of drinking water
• Groundwater best source good quality; Open surface called phreatic and close surface called artesian; Best quality has passage water
• Surface water often used a source; Always needs treatment due to fluctuation of physical and chemical and microbiological quality; self purifying capacity through the dilution sedimentation and sunlight
• Water treatment:
  1. ) Simple sedimentation reservoir: Clarification with chemicals as aluminium sulphate causing formation of micelles (Positive and negative charges); Called coagulation process
  2. )Filtration of water in sand filters
  3. ) Chlorination now used as most common way to make water safe
  4. ) Other methods include treatment by ozone and treatment by ultraviolet radiation

-Pipeline water Distribution
Pipes should be located above sewage and waste water pipes, As well as adequate pressure should be maintained to decrease chance of contamination

Question 6

36. Health risk of waste and soil prevention

Answer 6

By direct contact or indirectly via contaminated water, soil, food chain, vector transmission
-Common microbes E. coli, cholera, shigella, viral hepatitis and several parasites
- Chemical water contamination by pesticides, nitrogen dioxide
- Human waste management:
On sites to store entry in excreta e.g. septic tanks
Off side systems to transport excreter to other locations for treatment, disposal or use (Poorly developed in third world countries)

Waste water treatment

• Primary waste water treatment done by pre-treatment Including physical movement of large chunks, neutralization of toxic industrial chemicals, filtration by sand traps and collection in sedimentary reservoirs
• Secondary waste water treatment is done by anaerobic treatment (Conversion by anaerobic microorganisms forming sludge, Used on agricultural sites) and aerobic treatment removing organic matter and microorganisms by aerobic microorganisms
• tertiary waste water treatment is expensive and involves processes as precipitation filtration and chlorination

Solid waste:

• landfills: Problems with inflammable materials and favourable environment for breeding rodents and insects acting as biological vectors for various diseases (for prevention use of desinsection and deratisation)
• others: Composting, industrial fermentation or incineration

Question 7

52. Chemical substances in the indoor environment, health risk, prevention

Answer 7

• Sources of pollutants:
  Inadequate cleaning, insufficient ventilation, pollutants emitted from sources inside, contamination from outside, biological contamination due to moisture
• Inorganic chemical pollution:
  1. ) Carbon dioxide, symptoms above 3% above 6% fatal
  2. ) Carbon monoxide, due to inefficient combustion
  3. ) Nitrogen dioxide, produced during combustion and high temperature, highly irritating to mucus membrane, can cause variety of respiratory diseases
  4. ) Sulphur dioxide, mainly outdoors due to combustion of fossil fuels
• Organic chemical pollution
  1.) Volatile organic compounds, Released by allsorts of materials in indoor environment,
  Can result in acute and chronic health affects of CNS mucus membranes liver and kidney damage, many are known to be carcinogens or mutagens
  2.) Formaldehyde, By combustion including cigarette smoking, strong irritant of mucus membrane, can provoke asthmatic attack or allergic reactions
  3.) Polynuclear aromatic hydrocarbons, Presence of at least one benzene ring, carcinogenic potential, generally produced by combustion of fossil fuels

Question 8

31. Physical factors in the indoor environment, health impacts, prevention

Answer 8

• Airborne particulate matter: Complex mixture of organic and inorganic substances, coarse particles (Deposit in nasopharyngeal region) and fine particles (Deposit in thoracica region)
  1. ) Asbestos, used in insulation materials, provenly carcinogenic
  2. ) Man made mineral fibre, manufactured from glass rock or other minerals, cause mechanical irritation, carcinogenic only in high doses
  3. ) Radon, a radioactive noble gas, main source is soil or subsoil, sometimes building material, proven carcinogen
  4. )Biological agents, include mites, dander from pets, fungi, bacteria

Question 9

51. Radon and it’s decay products, health effects, prevention

Answer 9

Radioactive noble Gas,
Only gaseous element of the radioactive chain
From a health perspective radon 222 reach indoor concentrations of concern
Significant decay products: Polonium 218 -polonium 214 -> after formation they attach to aerosol particles -> From there carry by indoor air into the lungs
Sometimes building material can be source of radon

Question 10

6. Health risk of exposure to noise levels and types of noise

Answer 10

Sound which can be annoying or disturbing to some individual and may have damaging effect

Types of noise

• Steady-state, does not change more than five dB
• Fluctuating, change more than five dB
• High frequency, sometimes higher than 8 kHz
• Noise with tone components
• Impulsive, usually series of impulses

Levels
Above 120 dB damages cells and tissue, above 90 dB dangerous for organ of hearing, above 60 dB vegetative system, above 30 dB nervous system and psychic state
Acceptable are 85 dB an occupational environment, 40 dB an apartment houses, 50 dB in outer space

Question 11

7. Health risk of noise, specific and systematic effects of noise, prevention and protection

Answer 11

Specific
Hearing loss, perceptive disturbance of hearing, professional hearing loss, presbyacusis, acute damage to hearing

General
Sleep disturbance, increased blood pressure, fatigue, above 85 dB stress reaction, affect on psychic states

Prevention and protection

• Occupational entry examination including hearing test
• Remove the source of noise
• Encase the source of noise
• Increase the distance and reduce the time of exposure
• Use of suitable personal protection aids

Question 12

10. Humidity microclimate, thermal comfort

Answer 12

Thermal comfort is an individual feeling

Affected by three factors
- Environmental factors as temperature (19-23),
humidity(Concentration of water vapour in air, expressed as a percentage),
airspeed (>0,2m/s),
intensity of heat radiation
- Objective individual factors, activity, thermal resistance of clothes
- Subjective individual factors as adaptation, health state, stress, hunger

Cooling mechanisms include convection, conduction, heat radiation, evaporation (If air temperature equals or exceeds skin temperature)

Question 13

8. Health risk of exposure to vibration, prevention

Answer 13

Vibration is an oscillatory motion

Effects depend on characteristic of vibration(Amplitude, frequency), exposure type, factors related to worker

Biological effects
- General include tiredness
- Local effects referred as whole-body vibration:
> Spine most sensitive to vibration causing low back pain
> Hand arm vibration syndrome, associated with raynaud syndrome (damage of vessel and nerves)
> Bone and joint disorders like decalcification osteoarthritis
> Neurological and muscular disorders
> Sensory effects including vision leading to
motion sickness, hearing, tactile perception

Prevention and protection
- Engineering solutions, gloves, protection against coldness and dampness, job rotation schedule, avoid smoking, preventive medical examinations

Question 14

13. Health risk of exposure to non-ionising radiation, prevention

Answer 14

Are natural component of environment, from artificial or natural sources, can have a negative effect especially when intensity is increased or changed

Fall into three categories

• Radio waves by broadcasting and television
• Microwaves by generators
• Radio waves by radio locators

Effects
Electric and magnetic components may produce non-specific neuropsychic disturbances
At high intensity thermal phenomena are possible
High frequency can change growth of bacteria, inactivation of viruses

Protection and prevention follow same principles as in ionising radiation

Question 15

19. Daylight and artificial illumination, glare

Answer 15

Daylight, best source of light, coming from top and lateral sides, ideally if used in factory halls, studios, etc

Artificial light, not a natural component, mostly missing dynamism of daylight, it’s spectral composition, cannot be considered equal to daylight

Disturbing dazzle

• Absolute dazzle, critical brightness, brightness of field is so high that sight cannot adapt (Direct sunshine)
• Transitory dazzle is caused by sudden change of brightness and adaptation takes longer than the change of brightness e.g. light is switched on suddenly
• Dazzled by contrast or relative dazzle, If ratio between two surfaces of various brightnesses is really high, eye cannot adapt and permanent dazzle arises

Question 16

14. Health risk of exposure to UV radiation, prevention, Ozone layer depletion

Answer 16

Below 400 nm

Local effects affect skin and eye, causing snow blindness known as UV keratitis, malignant melanoma

General effects include hypertension, activity stimulation of hypothesis, thyroid gland and vegetative nervous system
As well as fever, chills, malaise, irritation, nausea, headache all due to increase histamine levels in blood

Curative in bactericidal effects
UVA used in dermatology as treatment, UVC radiation used in health facilities

Prevention and protection
Limiting time of exposure, lotions with effect of sun filters, eye protection

Ozone layer depletion by use of freons (Fluorine chlorine hydrocarbons) in cooling aggregates and pressure sprays

Question 17

11. Health risk of exposure to ionising radiation, stochastic and nonstochastic affect (see picture)

Answer 17

Three different types of ionising radiation including alpha, beta and gamma radiation

Unit of activity is bequerel, unit of absorbed dose is gray

• Mutations of germinal and somatic cells
• 1st degree: Acute post irradiation syndrome 1-2Gy, Symptoms include nausea, vomiting, diarrhoea, Malaise
• 2nd degree: Haematopoietic syndrome, 4 to 5 Gy, granulocytopenia is observed
• 3rd degree: Gastrointestinal syndrome, after 6 to 8 Gy, reflects by vomiting diarrhoea due to damage to mucosa and small vessels
• 4th degree: Cerebrovascular form ~ 50 G
• Skin injury, usually seen as erythematous dermatitis, 3-5 Gy
• Effects on embryo and foetus, in first three weeks after conception greatest reparative capacity

Question 18

12. Principles of protection against ionising radiation, workplace and occupational categories

Answer 18

Goal is to eliminate deterministic affects and reduce incidence of stochastic effects
Basic principles:
- Practice should be justified, dose limits are required, exposure is to be kept low as possible
- Radiation protection at workplace include principles of shielding, limited time of contact, distance from the source, proper ventilation isolation systems
- Radiation protection of public is a difficult matter, radioactive waste disposal by fixing in bitumen or glass, isolating in anticorrosive barrels, putting them in underground construction in suitable geological structures

Question 19

1. Hygiene, definition, history, health protection and promotion

Answer 19

Greek goddess of health called Hygeia
- Hygiene is the science of health preservation
- former Czechoslovakia one of the 1st to start antipolio mass vaccination and eradication of smallpox
- Jon Snow is founder of epidemiology by conducting classic study for transmission of cholera in London
- Raška was head of contagious diseases at WHO headquarters -> Smallpox eradication
- Max von Pettenkoffer -> sand filtration for water, hygiene institute in munich
- Robert Koch discoverer of anthrax, cholera, tuberculosis
- Health protection and promotion as constituents of primary prevention
- Health promotion (WHO)= the process of enabling people to increase control over, and to
improve, their health
- prevention: primary, secondary, tertiary

Question 20

38. Proteins, Lipids, Carbohydrates, role in nutrition

Answer 20

Proteins

• 0.8 g/ kilogram of bodyweight
• can be complete, usually of animal origin containing all essential amino acids or incomplete, mostly from plant original deficient in at least one essential amino acid
• functions include building tissue, specific physiological roles like immune system, plasma protein, precursor of acetylcholine, and sometimes provide energy
• Deficiency leads to malnutrition, impaired immunity, inadequate growth, impairment of enzymes, changed hormonal functions, impairment of spermatogenesis
• Excess can lead to impaired kidney and liver function, accompanied by substantial intake of fat

Lipids

• Include saturated, unsaturated and cholesterol
• Requirement 3.0 g of animal and 0.4 g of vegetable fat per kilogram of bodyweight, cholesterol 300 mg a day
• Main function is to provide and store energy, other function includes caring of fat-soluble vitamins, protection and supportive structure, control of body temperature, main part of cell membranes, cholesterol as a precursor of bile and adrenal and gonadal hormones

Carbohydrates

• Optimum intake 4 to 6 g per kilogram of bodyweight
• Mostly from starch, stored as glycogen
• ultimatively broken down to glucose to provide energy, other function to prevent breaking down of beds and proteins to prevent excessive production of toxic metabolites
• Excessive intake leading to glucose intolerance, hyperlipidaemia and dental cariers
• Dietary fibre plant substance like Celulose which is resistant to human digestion, various health effects, 30 g a day

Question 21

39. Mineral substance, role in nutrition

Answer 21

• Potassium important for muscle contraction, nerve impulses, osmotic pressure and heart rhythm
  > Present in all plant foods
  > Deficiency leads to spasms and headache
• Phosphorus important component for bones teeth and some enzymes
  > Present in all foods especially protein rich foods
• Magnesium essential for biosynthetic processes like like glycolysis, maintenance of electrical potential, enzyme activator
  > Green leaves, potato, nuts
• Sodium essential for osmotic pressure, acid-base balance, muscle and nerve function
  > Table salt, meat, eggs
  > Muscle weakness, paralysis, impaired heart function
• Calcium from the bones in tears, heart function, blood clotting
  > Milk, leafy green vegetables
  > Osteomalacia, Tachycardia, impaired blood clotting

Question 22

40. Trace elements, role in nutrition

Answer 22

• Copper a constituent of enzymes, Iron binding of haemoglobin, immune function
  > Organ meats, seafood, nuts and seeds
  > In malnourished children anaemia and impaired immmutiy
• Fluoride for bones and teeth formation
  > Tea and some fish
  > caries and poor bone
• Iodine component of thyroid hormones
  > Fish and seafood, eggs, milk
  > Cretinism, goiter, miscarriages and mental retardation
• Iron a constituent of haemoglobin, myoglobin and anti-oxidant of enzymes
  > Meat, eggs, vegetables, whole-grain
  > Anaemia, fatigue, impaired psychomotor development

-Selenium positively influences immunity, maybe anticarcinogenic
> Seafood, grains
> Decreased lymphocytes, Keshan disease (Cardiomyopathy leading to heart failure in China)

• Zinc involved in enzyme reaction and tissue growth and healing
  > Meat, eggs and seafood
  > Growth retardation, impaired immune function

Question 23

41. Vitamins, role in nutrition

Answer 23

Fat soluble vitamins can be stored and function is related to structural activities
- Vitamin A component of retinal pigment, bone and tooth development, antioxidant, immune function
> Retinol from liver and milk products, carotene from fruits and vegetables
> Night blindness, skin changes, infection risk

• Vitamin D participates in metabolism of calcium and phosphorus
  > Fish, egg yolk, sunlight
  > Ricketts and osteomalacia
• Vitamin K important in coagulation
  > Green leafy vegetables, oils, gut bacteria
  > Haemorrhagic disease of the newborn and bleeding

Water soluble vitamins include B complex (Mainly co-enzyme factor in cell metabolism) and Vitamin C as vital structural agent
- Vitamin C is antioxidant, iron absorption, collagen formation
> Fruits and vegetables
> Scurvy with gum bleeding, impaired healing, decreased immunity, fatigue

• Vitamin B12 participates in hematopoesia and peripheral nervous system
  > Meat, fish, eggs, cheese
  > pernicious Anaemia and neuropathy
• Vitamin B1 as coenzyme for carbohydrate metabolism
  > Cereals, pork, milk, nuts and seeds
  > Berri berri and Korsakoff
• Vitamin B9 called folic acid, in variety of foods, macrocytic anaemia, glossitis

Question 24

49. Malnutrition, preventing

Answer 24

• Nearly 30% of humanity suffering from some form of malnutrition
• Protein energy malnutrition especially in early lives causing development disorders and high motility of children in developing countries
• In industrialised countries massive global epidemic of obesity, up to 50% of population in some countries, possible cause of some cancer
• Iodine deficiency disorder causing preventable brain damage in foetus and infant, Causing Goater, miscarriage, mental retardation and other; Intervention by universal salt iodisation
• Vitamin A deficiency causing visual impairment and blindness, susceptibility to infection (Especially diarrhoea in children), increased vulnerability to anaemia
  > Vitamin A supplementation common in many countries
• Iron deficiency as one of the most common affecting all countries
  > In infants causing impaired psychomotor development, in adults fatigue, in pregnant women foetal morbidity
• Folate deficiency causes megaloblastic anaemia and associated with neural tube defects
• Calcium deficiency leading to osteoporosis
• Selenium deficiency leading to Keshan disease
• Zinc deficiency resulting in hypogonadism, dwarfism and immune dysfunction

Question 25

42. Main food groups and their role in nutrition

Answer 25

1. ) Cereals
   - provide about 2/3 of energy and protein
   - Rich in starch and vitamin B
   - Important source of minerals, vitamins and fibre
   - Beri beri vitamin B1 deficiency, if only rice
2. ) Legumes
   - Include peas, lentils, beans, good source of protein and energy, low but variable fats, good source of minerals and vitamin B
3. ) Vegetables
   - Potato is great source of energy in the form of starch, some protein and vitamin C especially before cooking
   - Leafy vegetables contain carotenoids, vitamin C and folates as well as potassium, magnesium and trace elements
4. ) Fruits
   - Mixture of glucose, sucrose, fructose, contain vitamin C as well as carotenoids
5. ) Meat
   - Composition is dependent on ratio of fat to lean
   - Major source of protein and fats as well as potassium, magnesium, iron, and other trac elements as well as vitamins (B12); vitamins are present in the fat
6. ) Fish and seafood
   - Good quality protein with low amount of fat and major source of iodine
7. ) Eggs
   - Ideal composition of protein, cholesterol, wide range of vitamins and minerals
8. ) Milk and milk products
   - Some important proteins as casein; lactose, fat soluble and water soluble vitamins, especially vitamin B’s

Question 26

46. Role of microorganisms in food

Answer 26

• Access to food by infected animals, fecal oral route, other possible ways
• Or pathogens are destroyed by heat but contamination afterwards possible or insufficient heating

Bacterial infections
- Campylobacter, salmonella, St. aureus, E. coli, Cholera, clostridium

Viral infections include rotavirus and viral hepatitis a

Parasitic infections include taenia solium and saginata, Giardia and Entamoeba histolytica

Question 27

43. Food additives

Answer 27

Substance added for technological purposes including organoleptic properties

• Chemical preservatives, which inhibit bacterial or mould growth, sulphur dioxide (Food intolerance in some) and sodium nitrate to prevent c. Botulinum
• Colours for a visual appearance, use of organic dyes and caramels
• Flavouring agents, including aldehydes, esters, alcohols and acids; Mono sodium glutamate not allowed for children in Czech Republic
• sweeteners especially for diabetes mellitus patients; Saccharine and can cause bladder tumours, now sorbitol and maltitol mostly used
• Emulsifiers and stabilisers to stabilise texture of food usually lecithin (emulsifier) and modifies starches as stabilisers
• Antioxidants to prevent rancidity of food using tocopherol; ascorbic acid to prevent darkening of apple juice

Question 28

47. Dietary guidelines for general population

Answer 28

• Eat variety of foods, especially vegetables 3 to 4 servings a day
• maintain ideal weight by a adequate energy intake as well as exercise
• Decrease consumption of fat especially Ananias fat, select lean meats
• Eat more sources of fibre (Prevents bowel disease, improves blood glucose)
• Avoid too much sugar
• Avoid too much salt, below 6 g
• Alcohol in moderation
• Drink adequate amount of fluids, 2 to 2.5 L mostly water

Question 29

44. Food contaminants, entry into the food chain, prevention, food safety authorities

Answer 29

• Natural food toxicity include
  > inherent (Usually present in food as ciguatoxin in fish)
  > Consumer sensitive especially gluten or other allergies
  > Contamination by bacteria e.g. toxins of S.aureus
  > Mycotoxins, aflatoxin of aspergillus (hepatic cancer)
  >Mutagens and carcinogens by grilling, roasting and frying
• Food contaminants
  > Pesticides and weedkillers, organophosphorus pesticides can disrupt endocrine system
  > Antibiotics no direct adverse effects but indirectly bacterial resistance to antibiotics
  > Fungicides, skin lesions observed once in Turkey
  > Industrial, especially heavy metals as mercury, cadmium and lead
  > Radioactive fallout which is concentrated in milk and meat
  > Plastic and heavy metal in fish

Question 30

24. Health impact of work. Work related diseases, prevention

Answer 30

Occupational disease can be due to chemical agents, physical factors, work related infections or stress

1.) Chemical agents, reacting depends on length, pattern and concentration of exposure as well as individual factors
- Include four major categories
a) Gases
> Local irritants inflaming mucosal surfaces up to breathlessness and cardiorespiratory failure
> Simple asphyxiant, diluting atmospheric oxygen as methane and carbon dioxide; Patient seems intoxicated
> Chemical asphyxiants, interfere with oxygenation of tissue, as carbon monoxide and hydrogen sulphide (blocks cytochrome and also irritates eyes and mucosa, typical rotten egg smell)
> Prevention of exposure and quick treatment with administrations of oxygen and antidote

b) Metals
> Mercury poisoning, ingestion causing nausea, vomiting, bloody diarrhoea and kidney damage
> Inhalation to erethism (Known as mad as a hatter disease), With depression, anxiety and other, possible permanent neurological damage
> Nickel linked to lung and nasal cancer; Arsenic to skin and lung cancer

c) Organic compounds
> Pesticides as organophosphates inhibit Cholinesterase, leading to parasympathetic overactivity
> Hydrocarbons;
-Gasoline and other petroleum products leading to dizziness, weakness, nausea and irritation of lung and skin up to skin cancer;
-Benzene similar but on top bone marrow depression; Some can cause bladder cancer as napthylamine
- Carbon tetrachloride causing liver damage
- vinylchloride causing raynauds

d) Dust ~> pneumoconicoses

2. ) Physical agents
   - Temperature -> miners cramp, heatstroke, chilblains (inflammatory swelling), frostbites, and loss of fingers and toes, hypothermia

• other include:
  Noise, vibration, muscle cramps and tendosynovitis, illumination, ionising radiation, non-ionising radiation

3. ) Disorders due to infectious agents
   - Anthrax and brucellosis in any jobs having contact with animals
   - Contaminated material should be bagged, labelled and disposed
4. ) Psychological factors
   - Problems are boredom and mental stress, prevent boredom by refreshment and relaxation breaks and other stimuli; mental stress by exercise, vaccation, therapy

Question 31

2. Health risk of dust and aerosols, prevention

Answer 31

• Dependent on composition, size, and amount of dust particles and length of exposure
• pneumoconiosis:
  > coal workers, generally benign, but eventually progressive massive fibrosis
  > Silicosis an aggressive form of pulmonary fibrosis, routine chest x-ray for diagnosis, tuberculosis possible
  > Asbestosis, signs on x-ray late, rapid progression, low exposure is sufficient, carcinogenic
• Plants and animals dust can induce asthma for example cotton workers develop byssinosis
• Farmers lung caused by allergic reaction to fungal spores
• other health risks include: cancer, systemic poisoning, infection, ischemic heart disease
• Only treatment is avoiding exposure and protective equipment

Question 32

9. Health effects of abnormal atmospheric pressure, prevention.

Answer 32

Increased pressure:
> Decompression sickness (caisson disease) results from too high or too low atmospheric pressure
- Fat soluble nitrogen dissolves in body fluids and tissues if the compression to rapid it forms bubbles in tissues causing pain in limbs, breathlessness, headache, collapse, coma up to death (seen in divers)
- Similar with high altitudes in unpressurized aircraft
- Emergency treatment by rapid re-compression in compression chamber

Decreased pressure:

• hypoxia
• acute mountain sickness, neurological unspecific symptoms and shortness of breath
• chronic mountain sickness, excessive erythropesis leading to pulmonary HTN
• high altitude pulmonary and cerebral edema

Question 33

55. Child and adolescent health

Answer 33

1.) Pregnancy
- Perinatal conditions are significant
>malnutrition in pregnant woman in low income countries
>presence of parasitic worms in developing countries
> in high income countries congenital abnormalities as well as premature birth and exposure to harmful chemicals causing mental retardation in development disabilities

2.) Infancy and early childhood Is a critical period
> 98% of all neonatal death in developing countries; Most death due to preventable and treatable conditions as pneumonia, diarrhoea, malaria, measles, malnutrition
> Child have high metabolic requirements therefore a greater risk of exposure to pathogens and pollutants (Chemical pollutants in breast milk)
> Too much task on women preventing them to care for children properly
> Appropriate feeding practice for psychosocial development

3.)Children of school age
> Immunisation with vaccines essential
> Developed countries asthma due to pollution and childhood cancers as leukemia are a major concern

4.) Adolescence
> Cause of death due to accidents and risky behaviour
> Reproductive health as major concern!!!
> Mental health becomes an issue
> Substance abuse and suicide

Question 34

60. Tobacco use epidemic

Answer 34

• Smoking is most common preventable cause of death
• in Czech Republic 22,000 deaths a year
• Causes 25% of cardiovascular diseases, 30% of cancer, 75% of chronic respiratory diseases
• 22% of population over 15 years smoke in Czech Republic 30% smokers, decreasing the elderly, increasing among teens and youth
• Starts with psychosocial dependence in teenage years afterwards physical drug dependence due to dopamine
• Fagerström test for nicotine dependence

Question 35

61. Tobacco control, role of doctors in prevention and treatment

Answer 35

- Five A method
> Ask about smoking
> Advised to stop
> Assess motivation to quit
> Assist by pharmacotherapy in form of nicotine replacement therapy(Start with high dose of nicotine and gradually reduce) and or bupropion(12 weeks) 
> Arrange follow-up

• 4 R method
  > Relevance, help patient to find motivation to quit smoking
  > Risk, discuss potential risks as acute like asthma, long-term like infarcts and cancer, environmental as risk for children
  > Rewards, help patient to find benefits
  > Repetition, by follow-ups

Question 36

62. Passive smoking

Answer 36

• Discomfort and short-term effects like me because irritation and headache
• Same diseases as active smoking
• Several hundred deaths in Czech Republic every year
• Environmental tobacco smoke (ETS) causes conjunctival and upper respiratorily way irritation as well as myocardial infarction, middle ear inflammation, asthma especially in children and sudden infant death syndrome in pregnant as well as birth defects, abortion, ectopic pregnancies
• ETS can be assessed in smokers blood, saliva and urine

Question 37

64. Epidemiology, definition, practical impact

Answer 37

• Is the study of distribution and determinants of disease in population
• Tries to:
  > Establish association between exposure and disease rates
  > To measure the extent to which risk to level of exposure changes
  > To observe if association is truly casual, or just consequence or bias or chance
• Covers immunisation, monitoring of disease, poverty, smoking, nutrition
• involves:
  > Estimating occurrence of disease
  > Monitoring trends in disease
  > Comparing experience of disease

Question 38

75. Measure the frequency of disease, death, and related phenomena. Frequency indicators. Confidence interval

Answer 38

• Three important elements in all measures of disease occurrence are cases, population, time
• Definition of cases may be discret -disease is present or absent-, or continues as in blood pressure etc
• Prevalence is existing cases at defined point of time, ranges between 0 and 1
• Incident is concerned with new cases
  > Risk is probability of new occurrence in initially disease-free population
  > Rate is measure of frequency of occurrence relating number of new cases to person time at risk
• Measures of frequency includes crude death rate, specific age rates, infant mortality rates(Under one year deaths divided by number of live births), maternal mortality rate (Death of women that are pregnant or within 42 days of end of pregnancy), survival rate

Question 39

65. Epidemiological method of work, types of studies

Answer 39

• Divided into observational (observe and measure effect of disease rates of exposure of interest )and experimental studies (experimenter allocate subject to different exposure and observes outcome)
• Observational further divided into descriptive (describing the distribution of disease) and analytical studies (trying to relate outcome to exposure)
• Descriptive include case report(Study individuals), correlation studies which equal ecologic studies(All basic data surveyed at population level) and cross-sectional studies (Detects absence or presence of exposure to the observed risk factor and occurrence of the disease at same time)
• ## Analytical studies include case-control studies (usually done retrospectively, for rare diseases) and cohort studies

Question 40

67. Analytical studies, types and basic characteristics

Answer 40

1. ) Ecological studies
   - Studies average exposure of population and compare to rate of outcome for the population
   - Association between outcome and exposure, measured as correlation coefficient
   - Only conclusion we can draw relate to that population; No association at individual level

2.) Cross-sectional studies
- Measured prevalence of exposure and prevalence of disease
- Easily conducted, quick and cheap
- Do not measure incidence of disease
- Used if there is no previous registry of
disease

3. ) Cohort studies
   - Follows exposed and unexposed group over times
   - Compares incident rate of exposed to an unexposed group
   - Several health outcomes at same time can be observed, study rare exposures; but long time, expensive, not suitable for rare diseases
4. ) Case control studies
   - For rare diseases when cohort too difficult
   - Compares exposures in these cases versus healthy controls from the same population
   - Can evaluate many different exposures and quick but can only look at one outcome

Question 41

69. Errors in epidemiological studies. Accuracy, reliability, validity. Bias and confounding factors

Answer 41

• Bias is in this systematic error resulting in incorrect estimate of association between exposure and outcome (While chance is a random error which is not systematic)
  > selection bias
  > Information bias; Including interview, recall and misclassification bias
• Confounding is if observed association is due to -partially or complete- a third factor
• Reliability is about how close repeated measurements are to each other. You can consider the reliability of a measurement, or of the entire experiment
• accuracy of an experiment is how close the final result is to the correct or accepted value. The closer it is, the more accurate the experiment
• Validity relates to the experimental method and how appropriate it is in addressing the aim of the experiment/ study

Question 42

89. Vaccination and immunisation

Answer 42

• Immunity is ability to tolerate presence of material indigenous to body and eliminate foreign
• Active immunity produced by persons own immune system, usually permanent
• Passive immunity products injected to human, protection disappears over time
  > Homologous pooled hyperimmune globulins a.k.a. Ig’s for a post exposure prophylaxis of hepatitis A and measles
  > Homologus human hyperimmune globulins For post exposure prophylaxis of hepatitis B, rabies, tetanus
  > Homologous hyperimmune serum, antitoxin usually from horses against botulism and diptheria, but serum sickness

Question 43

90. Types and kinds of vaccines, reactions to vaccination, contraindications

Answer 43

• Active immunity, discovered by Edward Jenner, vacca = cow
• Live attenuated vaccines are weak and in order to produce immune response
  > Not in immunodeficient patients , polio observed to return to original pathological form
  > Ab from any source can interfere with vaccine
  > Must be handled and stored carefully
  > Used for measles, mumps, rubella, yellow fever and varicella
• Inactivated vaccines, are not a life and cannot replicate
  > Usually not affected by circulating antibodies
  > Require multiple doses and sometimes boosting if Ab titres decrease
  > For influenza, rabies, hepatitis a
  and tickborne encephalitis
• Polysaccharide vaccine
  > For pneumococcal disease and meningococcal and haemophilus influenza
  > Used not to be effective in children but now conjugation to induce T-cell dependent immunity
• no Contraindication to simultaneous administration of any vaccines except yellow fever and cholera
• Some live vaccines should be separated by four weeks
• Do not decrease interval between doses of multidose vaccine

-Adverse reaction
> Local are most common including pain, swelling and redness usually with inactivated vaccines, Not allergic called Arthus reaction
> Systemic adverse reactions including fever, malaise, myalgia, headache, usually following live vaccines,usually mild
> Allergic reaction, to other component of vaccine, may be dangerous, but very rare

• Contra indication if adverse reaction seen before, pregnancy, immunosuppressive

Question 44

59. Cancer risk factors

Answer 44

• Second place of causes of death especially developed countries
• Main risk factor is age
• lung cancer by smoking, passive exposure to tobacco, asbestos, some metals, radon, ionising radiation
• breast cancer most frequent cancer in women, highest incidence in North America, lifestyle factors like childbearing, breastfeeding, obesity, alcohol; Oral contraceptive use not clear, genetics
• Colorectal cancer rare in developing countries, risk factors are obesity, lack of exercise and polyposis of colon
• cervical cancer strongly associated to human papilloma virus, vaccine available
• Stomach cancer usually in Asian countries, only known factor is H. pylori
• Liver cancer has hepatitis B and C, aflatoxin and alcohol abuse

Question 45

68. Interventional studies, types and basic characteristics

Answer 45

• Always prospective by direct control of researchers who determine exposure mode (treatment)
• include clinically controlled study detecting various effects of a specific treatment and preventive studies which monitors risk reduction

Question 46

76. Measures of association, causality, relative risk, odds ratio, attributable risk

Answer 46

• Association is the relationship between two or more variables, can be positive or negative, or direct and indirect (confounding)
• causality Is the relationship between exposure to risk factor and health impact, prior elimination of coincidence, bias and confounding and compliance with causality criteria (Association strengths, justification, specificity, dose and effect relationship and so on)
  > The greater the risk ratio and odds ratio, the more likely the relationship is causal
• Risk ratio is ratio of probability of an event in an unexposed group to a non-exposed
  > 1 = no difference between groups
  > <1 = Less likely in experimental then in control group
  > <1= More likely an experimental group then in the control
• Odds ratio quantifies how strongly presence or absence of A is associated to presence/absence of B
• Attributable risk is difference in rate of a condition between an exposed and an exposed group
  > Population attributable risk is the reduction in incidence that would be observed if population was completely unexposed

Question 47

50. Food safety requirements for catering establishments

Answer 47

• Responsibility lies with business operator
• Based on good manufacturing practice (GMP) , Including good hygiene factors (GHP) and hazard analyses critical control point(HACCP), a system part of the GMP and GHP
• HACCP has three principles:
  > Identifying of any hazards by critical control points
  > Establishing a critical limits, monitoring procedures and corrective actions
  > Documenting the activities

Question 48

78. Process of infection spread and its characteristics

Answer 48

• mode can be either direct or indirect

1. ) Direct transmission
   - By contact, most veneral diseases
   - by droplet, influenza and parainfluenza
   - Transplacentally, torch infection
   - Pernatally, during birth by streptococci
2. ) Indirect transmission
   - Mediated by contaminated objects
   - Transmission by inoculation, infected instruments and equipment, hepatitis B and C
   - Transmission by air example diptheria, pertussis, tuberculosis
   - Transmission by alimentary way, Including transmission by water or by food
   - Vector- born, Malaria, tularaemia, plaque
   - Transmission by contaminated soil, tetanus

Question 49

79. Source and susceptible organism in process of infection transmission

Answer 49

• Source of infection is either person or animal, sometimes outer milieu (Mycoses)
• Person can be source
  > During incubation period of disease example hepatitis A and B
  > Sick person
  > Convalescent, in pertussis
• Animals Can be source of infection and transmitted to a person, called zoonoses,
  Examples include sheep, goats, cats, deers
• Carriers: short-term salmonella, long-term typhoid fever

- Susceptible individual host are influenced by:
> Immunity
> Age and time of infection
> Other diseases
> Nutritional status
> Habits like smoking

Question 50

85. Anti-epidemic preventive and repressive measures

Answer 50

• Preventive measures in order to prevent occurrence and spread of infections, include:
  > Improvement of Hygenic level of population, water, rubbish, nourishment
  > Vaccination
  > Registration and control of carriers
  > Prophylactic disinfection (Public places, medical facilities, pasteurisation of milk)
  > Medical education
• Anti-epidemic measures having a repressive character:
  > Early and correct diagnosis of disease
  > Notification and isolation of the sick
  > Epidemiological investigation in the focus of infection

-Anti-epidemic Regime includes:
> Quarantine measures
> Focus disinfecting
> Chemoprophylaxis example antibiotics or antimalarial drugs
> Hygiene and education

Question 51

86. • 87. Disinfection and sterilisation, methods and efficiency review

Answer 51

• Sterilisation means liquidation of all forms of microorganisms even spores
• Disinfection means liquidation of pathogenic microorganisms
  Methods:
• Physical methods include
  > heat; Sterilisation done by hot air or steam with high-pressure
  > Radiation, by UV light for disinfection and beta and gamma rays for sterilisation
• Chemical methods
  > Sterilisation by formaldehyde in pressure appliances above 60°C; Thermal labil objects ethyleneoxyde at 55°C
  > Disinfection uses various effects of various chemical substances including akalis and acids, oxides, alcohols, heavy metal
  compounds, aldehydes
• Efficiency review by:
  > Physical testing, monitor a temperature and pressure
  > Physical chemical and chemical testing utilising change of colour depending on temperature and length of exposure or concentration of disinfectant substance
  > Biological testing done by steroid tampon or impression of object or nutrient medium

Disinfectant substance should not cause damage, should be selective, not cause allergies, be inexpensive

Question 52

88. Nosocomial infection

Answer 52

• Occurring in connection with stay at medical establishment
• Can be specific due to certain procedure or non-specific
• Affects 4 to 7% of people
• Aetiology due to gram + (Staphylococcus, streptococcus), gram - (pseudomonas, klebsiella, Enterobacter), Viral (HSV and EBV), mycosis (Candida)
• Source of infection are Patients, personal, visitors, rodents
• Transmission is direct or indirect via airway, implantation and inoculation, alimentary
• Preventive measures include sterilisation, disinfectant, change used bedlinen, single use, antibiotics, Hygenic principles, Procedures in appropriate places

Question 53

37. Endocrine disruptors

Answer 53

• Are hormonaly active substances which are similar to structure of hormones, may occupy receptors, may modify receptors, impair pathways, are connected with metabolic diseases like diabetes and reduction of sperm
• Included
  1.) Brominated flame retardant (BFR)
  > to make products less flammable
  > are persistent and bioaccumulative and toxic to humans
  > Similar to thyroid hormones and affinity to CNS and reproductive system

2.) Plastic softners
> In all kinds of products, may contaminate food
> Prohibited in toys and bottles for babies
> Dangerous for little boys, can cause feminisation

3.) Bisphenol A
> Used in inner coating of food cans and water tanks
> Carcinogenity not proven but prohibited in contact with food, especially in food with high content of fat

Question 54

26.Categorisation of working operations, risk factors and parameters

Answer 54

Category

• 1= Minimal health risk, optimal working condition
• 2= Acceptable level, load level factor is acceptable
• 3= Considerable level, load level of factors exceeds exposure limits
• 4= highly exceeds exposure limits, occupational disease present

Question 55

3. Health risks of exposure to chemical substances, prevention

Answer 55

• routes of entry can be inhalation, injection, ingestion, absorption
• can be classified into:
  > asphyxiants
  > irritants
  > Narcotics and anesthetics
  > Carcinogens
  > Teratogens
  > sentizisers
• avoid or decrease contact, Vitamins to for ROS protection

Question 56

5. Delayed effects of chemicals, prevention

Answer 56

1. ) Mutagenic ?
   - somatic include teratogenic, cancer, cell aging
   - gametic sterility, congential defects, abortions
2. ) Carcinogenic
3. ) Teratogenic, especially first 8 weeks, can be chemical (nitrosamines, PBC), physical (radiation), biological (drugs, infecions)
4. ) Allergic effects

- prevention include:
> education about it
> risk communication
> labelling of those substances
> personal protection
> appropriate frst aid

Question 57

15. Laser, health risk and protection

Answer 57

• light amplification by stimulated emission radiation

-

Question 58

16. Whole physical burden

Answer 58

• includes 4 types:
  > heavy work (usually lower back pain)
  > repetitive work (neck, shoulder, wrist complaints)
  > static work (prolonged standing or akward positions)
  > sedentary work

- prevention
> surveillance and monitoring
> rest periods during shifts
> shorter shifts
> special tools

Question 59

17. Local muscular strain /high forces, static positions, repeated motions, prevention

Answer 59

• can be divided into:
• musculoskeletal disorder including humeral epicondylitis, tendinitis, bursitis
• compression of peripheral nerves (carpal tunnel)
• repetitive motion disorder (carpal, bursitis, humeral epicondylitis)
• static posture

diagnosis by frequency:

1. Carpal tunnel syndrome (overload or vibration)
2. Humeral epicondylitis lateral (due to overload)
3. Vasoneuritis (due to vibrations)
4. Humeral epicondylitis medial (due to overload)
5. Snapping finger due to overload

prevention: surveillance and monitoring, limiting risk factors, implementation of technologies facilitating work

Question 60

Hygiene limit issues

Answer 60

1. Threshold limit value (TLV) of a chemical substance = the level to which it is believed a
   worker can be exposed daily for a working lifetime without adverse health effects

• Time weighted average {TLV-TWA- PEL)= average exposure on the basis of a 8h/day, 40h/
  week work schedule [Permissible exposure limit]
• Short-term exposure limit (TLV-STEL)= spot exposure for a duration of 15 minutes, that can-
  not be repeated more than 4 times per day
• Ceiling limit (TLV-C-NPK-p)= absolute exposure limit that should not be exceeded at any time
• TLVs for physical agents include those for noise exposure , vibration, ionizing and
  non-ionizing radiation exposure and heat and cold stress

2 .Biological limit values (BLV’s) = limits of amount of substances to which a worker can be exposed without a hazard to health or well being as determined by measuring the workers’ tissues, fluids or exhaled breath.

3. Occupational exposure limit: upper limit on acceptable concentration of a hazardous substance in workplace air for a particular material or class of materials

Question 61

25. Risk analysis at work, principles of risk assessment and management, risk communication and perception

Answer 61

Principles
1.) Risk assessment: Hazard identification, Risk evaluation
- includes: Measurements of concentrations and intensi-
ties of working condition factors for which a hygiene limit is given.
Identification of any kind and type of biological agent,
which is hazardous for human health

2. ) Risk management:
   - Identify hazard
   - Evaluate (concentration , TLV)
   - Risk elimination
   - Risk Minimization (use alternatives)

3.) Risk Control (implement changes technical proce-
dures e.g. ventilation, better organization of work, pre-
ventive medical exams)

4. ) Risk Protection
5. ) Disaster Avoidance

Risk communication= the interactive process of exchange of information and opinions among individuals,
groups, and institutions concerning risk or potenial risk to human health or the environment

Risk perception = the concept of risk based on feelings. These personal feelings come more into play here than facts and numbers and perception varies from
one individual to another
- People’s concerns must seriously be taken into consideration when you are communicating about risks

Question 62

28. Occupational risk factors of the medical care/service, prevention possibilities

Answer 62

1. ) Biological: all kinds of infections, even mold and scabies
2. ) Physical hazards: radiation, workplace violence, musculoskeletal
3. ) Physiological stress (burnout)

4.) Chemical hazards
> desinfectants causing irritation or occupational asthma
> Laser
> Latex allergies