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The Food We Eat DR. REEMA KARASNEH Introduction  More than 200 known diseases are transmitted through food  Food is the vehicle, and the agents can be:  viruses, bacteria, parasites, toxins, metals, and prions.  Food can be contaminated at several points  between farm or...

The Food We Eat DR. REEMA KARASNEH Introduction  More than 200 known diseases are transmitted through food  Food is the vehicle, and the agents can be:  viruses, bacteria, parasites, toxins, metals, and prions.  Food can be contaminated at several points  between farm or factory and the consumer  This can result in an outbreak of foodborne disease. Foodborne disease outbreak (FBDO)  It is the occurrence of two or more cases of a similar illness resulting from the ingestion of food  In 2011–2012  1,632 FBDOs  29,112 cases of illness  1,930 hospitalizations  68 deaths Causing agents for FBDO  Bacteria  Chemical  Salmonella (14%)  Scombroid toxin/histamine  Clostridium perfingens  Ciguatoxin  Escherichia coli  Mushroom toxins  Campylobacter  Bacillus  Parasites  Shigella  Cyclospora  Giardia  Viruses  Calicivirus -Norovirus (31%)  Hepatitis A Common food vehicles  Poultry (4%)  Fish (4%)  Dairy (3%)  Fruits (2%)  Vegetable row crops (2%)  Leading factors that contributes to FBDOs  Inadequate cooking temperatures  Improper holding temperatures for foods (bacterial outbreaks)  Unsanitary conditions or practices at the point of service  E.g., Failure to wash hands (norovirus outbreaks)  Drinking raw (non-pasteurized) milk (bacterial outbreaks)  Contaminated equipment  Obtaining food from an unsafe source (such as shellfish from polluted waters).  Growing, Processing, and Distributing Our Food Safely  Greater efforts need to be made to make sure that plants and animals are free from harmful biological and chemical agents during growing, harvesting, and processing of food products before they reach retail outlets and food service establishments.  Petroleum-based chemical fertilizers, herbicides, and insecticides are applied  Health concerns with agricultural chemicals (e.g., Pesticides)  Risk of unintentional poisoning where chemicals are stored and used  Residues reaching food workers and consumers Pesticides  Pest: any organism (plant, animal, or microbe) that has an adverse effect on human interests  Weeds, termites, mold  Pesticides: are natural or synthetic chemicals that have been developed and manufactured for the purpose of killing pests  Pesticides are used in agriculture:  It is estimated that pests destroy about 37% of the food crop before it reaches the marketplace  Without the use of agricultural chemicals, farm production would be greatly decreased  Pesticides for pest control  Target organism (target pest): the organism (or pest) for which a pesticide is applied  Nontarget organisms: all other susceptible organisms in the environment, for which a pesticide was not intended  E.g., Weed killers: kill the weeds and (nontarget) flowers and ornamental plants  E.g., Rodenticides (rat poison):kill domestic animals  The most commonly used pesticides:  Herbicides (pesticides that kill plants)(46%)  Insecticides (pesticides that kill insects)(10%)  Pesticide poisoning  Poisonings occur when the pesticides are:  Consumed orally, Inhaled, In contact with the skin  Most susceptible populations:  Young children: consume orally when left within their reach  Adults: Workers who apply the pesticides because of careless practice:  Eating food without washing hands after handling pesticides  Mouth-siphoning to transfer pesticides from one container to another  Applying pesticides while one’s skin is exposed  Spilling the pesticide on one’s body  Fail to read pesticide’s label  Exposure to pesticides  The effects of exposure to pesticides depend on  Pesticide type, dose, route, and duration of exposure  Characteristics of the person exposed  Types of exposure:  Acute (single, high-level exposure)  Chronic (repeated exposure over an extended period of time).  Health effects of pesticides poisonings  Signals of poisoning  Headaches, weakness, rashes, fatigue, dizziness  More serious effects include  Respiratory problems, Convulsions, Coma, Death  Chronic effects  Cancer  Mutations  Birth defects  Food Safety  Risk for foodborne illness may be reduced by  Following safe food-handling practices  Avoiding consumption of certain unsafe foods  unpasteurized milk and milk products  raw or undercooked oysters, eggs, ground beef, fish, or poultry.  Guidelines for preventing foodborne disease transmission at home are simple and straightforward (see Box 14.3) Eating behaviors  Drivers for eating habits  Taste: Humans have biological preferences toward foods that are sweet, salty, and fatty  induce changes to the brain structure like those induced by addictive narcotics  Emotions: Food delivers a sense of enjoyment: Satisfaction, happiness, and comfort  Price: People seek foods that are less expensive  Convenience: demand for accessible, affordable, quick, and easy-to- prepare meals  Health and Nutrition: foods that will help improve well-being and physical health, lose weight, and manage health conditions  Culture and Familiarity: Food is a powerful cultural identifier, reflecting unique values and beliefs related to food cultivation, production, preparation, and consumption  Environment: Food availability affects food selection (Foods readily available to consumers)  Marketing: Artificially stimulating people to feel hungry and overconsume. Nutrition, Eating Habits, and Health  Heart Disease  It is the leading cause of death in developed countries for men and women  It is most prevalent among populations with unhealthy diets, individuals who smoke, obese individuals, and among those who are not physically active.  Following a healthy dietary pattern can decrease the risk of multiple chronic diseases.  The dietary patterns that are protective against heart disease are also protective against hypertension:  Risk factor for heart disease  Leading cause of kidney disease  Dietary patterns linked to heart disease  Dietary patterns that increase  Dietary patterns that lower the the risk of heart disease: risk of heart disease:  Animal foods  Fruits  Refined carbohydrates  Vegetables  Red meat  Whole grains  Processed meat  Fish (especially omega-3 fatty acid– containing varieties)  High-sodium processed foods  Chicken (when substituted for  Sweets and desserts red meat)  High-fat dairy products  Nuts and legumes  Sugar-sweetened beverages  Cancer  Diet associated with increased  Diet protects against several risk of cancer: types of cancer:  High fat diet(saturated fat and  Diets rich in omega-3 fats omega-6 fats)  beans and legumes  red meat, charbroiled meat, fried meats  Diets rich in fiber  whole grains, fruits, vegetables  High calories diet  Refined carbohydrates, sugar  Alcohol  Stroke  Nutrients that increase the risk  Nutrients that decrease the risk of stroke of stroke:  trans fat, sodium, and  Antioxidants (olive oil, omega-3– saturated fat. rich fish)  Diets that increase the risk of  Folate stroke are  Fiber  Animal protein  Potassium  Fried foods  Flavonoids (fruits, vegetables  Butter tea, cocoa, and chocolate)  whole milk  Carotenoids (yellow and red fruits and vegetables)  Alcohol  Type 2 Diabetes  Nutrients that increase the risk of  Nutrients that protects against type 2 diabetes: type 2 diabetes:  total fat, trans fats, and saturated  Omega-3 fatty acids (from fish) fats  Fruits  High-calorie diet  Vegetables  Diet that increase the risk of type  Whole grains 2 diabetes  Legumes  Processed and red meat  Full-fat dairy products  Refined grains (white bread, white rice, non-whole-grain pancakes, muffins, etc.)  Desserts, and sweets  Sugar-sweetened beverages Obesity  Obesity is caused by consuming calories beyond one’s daily needs and not being physically active enough.  Energy gap: calories consumed above and beyond what the body burns  One hundred to four hundred extra calories per day.  Obesity is driven by biological, cultural, and social factors contributing to limited opportunities for physical activity and an abundance of high-calorie foods. Health effects of obesity  Premature death  Type 2 diabetes  Hypertension  Dyslipidemia  Heart disease (may lead to heart attack)  Stroke  Gall bladder disease  Sleep apnea  Arthritis  Several kinds of cancer Benefits of Healthy Eating Habits Certain diets and dietary patterns are linked to reductions in risk for chronic disease and improved health outcomes. HEALTH PROMOTION What is Health Promotion all about?  Objectives - Define the term “Health promotion” -Identify the key principles of health promotion -- Be familiar with Media as a role player in health promotion -- Be familiar with different types of intervention activities What is Health Promotion all about? It is the process of enabling people to increase control over and improve their health. (Ottawa H.P. Charter). It is a process which empowers families and communities to improve their quality of life, and achieve and maintain health and wellness. It emphasizes not only prevention of disease but the promotion of positive good health.  What is Health Promotion all about? It is a positive concept emphasizing personal, social, political and institutional resources, as well as physical capacities. Health promotion is any combination of health, education, economic, political, spiritual or organizational initiative designed to bring about positive attitudinal, behavioral, social or environmental changes advantageous to improving the health of populations.  Health Promotion  Process enabling individually and collectivelly increase control over determinants of their health, and improve health status. (WHO, 1998). Determinants of Health  Life style (50%)  Environment including cultural, economic, social and physical conditions of life (20%)  Genetic background (20%)  Health care system (10%)  What is Health Promotion all about? Health promotion is directed towards action on the determinants or causes of health. Health promotion, therefore, requires a close co- operation of sectors beyond health services, reflecting the diversity of conditions which influence health. Government at both local and national levels has a unique responsibility to act appropriately and in a timely way to ensure that the ‘total’ environment, which is beyond the control of individuals and groups, is conducive to health. PRINCIPLES OF HEALTH PROMOTION The key principles of health promotion as determined by WHO are as follows: Health promotion involves the population as a whole in the context of their everyday life, rather than focusing on people at risk from specific diseases. 8 PRINCIPLES OF HEALTH PROMOTION Health promotion is directed towards action on the determinants or cause of health. This requires a close co- operation between sectors beyond health care reflecting the diversity of conditions which influence health. 9 PRINCIPLES OF HEALTH PROMOTION Health promotion aims particularly at effective and actual public participation. This requires the further development of problem-defining and decision-making life skills, both individually and collectively, and the promotion of effective participation mechanisms. 10 PRINCIPLES OF HEALTH PROMOTION Health promotion combines diverse, but complementary methods or approaches including communication, education, legislation, economic measures, organizational change, community change, community development and spontaneous local activities against health hazards. 11 PRINCIPLES OF HEALTH PROMOTION Health promotion is primarily a societal and political scheme and not medical service, although health professionals have an important role in advocating and enabling health promotion. 12 Health Promotion includes … Promoting healthy lifestyles. Getting people involved in their own health care. Creating an environment that makes it possible to live a healthy life. Recognition of lifestyle diseases as major causes of illness and death. Strengthening community participation. Examples of preventable health problems related to lifestyle Chronic non-communicable diseases such as diabetes and hypertension. These are major causes of illness and death. They are related to… Overweight and obesity. Unhealthy diet. Insufficient physical activity. HIV/AIDS is related to unsafe sexual lifestyle, and causes many deaths.  Intersectoral approach Health Promotion brings together many sectors to work towards the achievement and maintenance of health and wellness. The Health sector alone cannot achieve a healthy society. All sectors, both government and non-government, need to work together. Health Promotion can provide the link between the various sectors. Within Health the various disciplines also need to work together towards wellness. Some non-health sectors with an input into Health Promotion… Education/ schools Agriculture Community Services Sport Media Non-Governmental Organizations (NGO’s) Community groups Youth Private sector Health sectors with an input into Health Promotion Environmental Health Nutrition Community nursing Mental Health Dental Epidemiology Hospital (secondary) care School of Nursing Occupational therapy Some other sectors which are important Legal Public Works Housing Water Authority GIU Local Council Alternative medicine Formulating healthy public policy Promotes healthy policies in all sectors , e.g healthy workplaces, schools, homes, buildings, villages and communities. Health aspect should be thought of and included in the policies of the various sectors. Health Policies should also emphasize the prevention and promotion. Reorienting health services Since lifestyle is linked to many of today’s health problems, prevention and promotion should decrease the burden on secondary (curative) health care. Greater emphasis and resources placed on health promotion and primary health care. Less emphasis on purchase of high tech. equipment for secondary health care. Equity in health care. Empowering communities to achieve well-being Involvement of the community in health decisions, a multisectoral and participatory approach. Provide communities with the information and tools to take actions to improve health and well-being. Creating supportive environments Healthy physical, social and economic environment. All development activities should aim for a healthy environment – healthy buildings, roads, workplaces, homes, surroundings and schools. Developing /increasing personal health skills Information and education for personal and family health. Take account of values, beliefs and attitudes of the community. Continuous process at all stages of life. Guided and supported in developing skills Building alliances with special emphasis on the media Media key players, influence on health of people. Partnership with media ensures their collaboration and that correct information is passed on.  MASS MEDIA IN HEALTH PROMOTION DEFINITION OF SOME TERMS MASS MEDIA: Any printed or audio-visual material designed to reach a mass audience. This includes newspapers, magazines, radio, television, billboards, exhibition, display, posters and leaflets MESSAGE A cultural communication encoded in signs and symbols  WHAT THE MASS MEDIA CAN AND CANNOT DO The mass media can: Raise consciousness about health issues Help place health on the public agenda Convey simple information Change behavior if other enabling factors are present.  WHAT THE MASS MEDIA CAN AND CANNOT DO The mass media cannot: Convey complex information Teach skills Shift people’s attitudes or beliefs. If messages are presented which challenge basic beliefs, it is more likely that the message will be ignored, dismissed or interpreted to mean something else. Change behaviour in the absence of other enabling factors.  FACTORS IMPORTANT TO MEDIA EFFECTIVENESS CREDIBILITY: The source must be trusted and reliable CONTEXT: The message should be relevant to the receiver CONTENT: The message must be meaningful  FACTORS IMPORTANT TO MEDIA EFFECTIVENESS CLARITY: The receiver must be able to understand the message CONTINUITY: The message should be consistent without being boring HEALTH PROMOTION INTERVENTIONS  INTERVENTION:- WHAT DOES IT MEAN? Interventions are activities used by programme planners to bring about outcomes identified in the programme objectives. These activities are sometimes referred to as treatments. An intervention may be made up of a single activity but it is more common for planners to use a variety of activities to make up an intervention for a programme.  SELECTING APPROPRIATE INTERVENTION ACTIVITIES Selection should be based on a sound rationale as opposed to chance and the intervention should be both effective and efficient. The following questions will serve as a guide: 1. Do the intervention activities fit the goals and objectives of the programme? 2. At what level(s) of influence will the intervention be focused?  SELECTING APPROPRIATE INTERVENTION ACTIVITIES 3. Are the activities based on an appropriate theory? 4. Are the necessary resources available to implement the intervention selected?  TYPES OF INTERVENTION ACTIVITIES 1. Communication activities 2. Educational activities 3. Behaviour modification activities 4. Environmental change activities 5. Regulatory activities 6. Community advocacy activities  TYPES OF INTERVENTION ACTIVITIES 7. Incentives and disincentives 8. Health status evaluation activities 9. Social activities 10. Technology-delivered activities  1. COMMUNICATION ACTIVITIES Useful in helping reach the many goals and objectives of health promotion programmes such as: Increasing awareness and knowledge Changing and reinforcing attitudes Maintaining interest Providing cues for action Demonstrating simple skills  2. EDUCATIONAL ACTIVITIES Those usually associated with formal education in courses, seminars and workshops. includes educational methods such as lecture, discussion, group work, computerized instruction, etc…  3. BEHAVIOUR MODIFICATION ACTIVITIES Often used in intra-personal level communication and include techniques intended to help those in the target population experience a change in behaviour.  3. BEHAVIOUR MODIFICATION ACTIVITIES Emphasis placed on a specific behaviour that one might want to increase or decrease. particular attention given to changing the events that are antecedent or subsequent to the behaviour that is to be modified.  4. ENVIRONMENTAL CHANGE ACTIVITIES Measures that alter or control the legal, social, economic and physical environment. changes are characterized by changes in those things “around” individuals that may influence their awareness, knowledge, attitudes, skills or behaviour.  4. ENVIRONMENTAL CHANGE ACTIVITIES Activities to provide a “forced choice” situation (e.g. selection of food and drinks in vending machines and canteens changed to include only “healthy food”.  5. REGULATORY ACTIVITIES Include executive orders, laws, ordinances, policies, position statements, regulations, and formal and informal rules. Classified as mandated or regulated activities to guide individual. Example: Pre-marriage test.  5. REGULATORY ACTIVITIES this type of activity can get people to change their behaviour when other strategies have failed.  6. COMMUNITY ADVOCACY ACTIVITIES Are used to influence social change Is a process in which the people of the community become involved in the institutions and decisions that will have an impact on their lives.  7. INCENTIVES AND DISINCENTIVES Use of incentives and disincentives to influence health outcomes is a common type of activity. Activity is based on many health behaviour theories - suggest that anticipation of rewards increases the probability of an individual engaging in desired health behaviour.  7. INCENTIVES AND DISINCENTIVES For the activity to work, the planner needs to match the incentives with the needs, wants, or desires of the target population.  7. INCENTIVES AND DISINCENTIVES Just as incentives can be used to get people involved in behaviour change, disincentives can be used to discourage a certain behaviour (e.g. tax on cigarettes, surcharge on health insurance for smokers, fines for not wearing safety- belts).  8. HEALTH STATUS EVALUATION ACTIVITIES Aimed at making those in the target population more aware of their current health status. Activities involved the completion of a health risk appraisal form, self-screening, clinical screening (Example: self- breast examination).  9. SOCIAL ACTIVITIES Social support is important for behaviour change people find it much easier to change a behaviour if those around them provide support or are willing to be partners in the behaviour change process. social support could work as in incentive.  10. TECHNOLOGY-DELIVERED ACTIVITIES Traditional delivery of many health education and health promotion programmes - face-to- face contact between provider and target population. With technology programmes are now delivered through a variety of ways – internet and computer-assisted instruction. Telephone-delivered intervention activities – individual-initiated or outreach. IMPORTANT AREAS FOR CONSIDERATION IN HEALTH PROMOTION Building a Creating supportive healthy public environments policy Strengthening community action Developing Reorientating personal skills health services 51 PHYSICAL ACTIVITY BEHAVIORS DR. REEMA KARASNEH  Introduction  Physical activity: any bodily movement produced by skeletal muscles that requires energy expenditure  walking, climbing stairs, and housework  Exercise: a subset of physical activity that is planned, structured, and repetitive and has a final or an intermediate objective to improve or maintain physical fitness level  “lifestyle activity,” the incorporation of physical activity into everyday life, such as taking the stairs, doing yard work or housework, brisk walking, and recreational activities.  Physical inactivity is the fourth leading risk factor for global mortality, causing an estimated 3.2 million deaths each year  Types of physical activity  Aerobic (endurance) activity  muscle-strengthening activities  bone-strengthening activities  stretching activities  Muscle and bone-strengthening activities can be aerobic if heart rate increases (e.g., running, jumping jacks, speed walking).  Aerobic (endurance) activity  Any activity that uses the large muscle groups in the body to increase heart rate and benefit the strength of the cardiovascular system  It is most beneficial for the strength of the cardiovascular system (heart and lungs) and includes activities that move the large muscle groups in the body (arms and legs).  Examples: running, jumping, bicycling, dancing, and walking.  Muscle-strengthening activities  Any activity that improves muscular strength, power, and endurance  Examples: lifting weights, climbing stairs, and doing push-ups.  Bone-strengthening activities  Any activity that improves bone density by causing impact on the musculoskeletal system  Examples: jumping rope, running, walking, and resistance training.  Stretching activities  Any activity in which a specific muscle or tendon is lengthened in an effort to improve flexibility and joint mobility  Examples: general stretching and yoga. Recommended Physical Activity Levels  Benefits of Physical Activity  Increases energy expenditure helping to maintain energy balance and maintaining a desirable body weight.  Improves self-esteem  Improves mental activity  Improves energy levels  Improves learning  Improves memory  Improves mood  Sedentary Behavior  There is a consistent relationship between sedentary behavior and mortality and weight gain from childhood to adulthood.  Time spent being sedentary was linked to an increased risk for  Site-specific cancers  Diabetes  Cardiovascular disease  Symptomatic gallstone disease  Mental disorders  Hypertension Sedentary time  Adults Seven to ten hours time spent each day  In front of the television  Workplace sitting  Poor health outcomes  Youths Five to ten hours each day  2-4 hrs/day  Sedentary screen-based behaviors  the 2008 Physical Activity Guidelines for Americans  Promoted addressing sedentary behaviors, limiting the amount of sedentary time for children and adults  Objectives specifically addressing sedentary and screen time for children and adolescents:  No television or videos on an average weekday for children ages zero to two  No more than two hours daily of television, videos, or video games for children ages two years to twelfth grade  No more than two hours daily of computer use or computer game playing outside of school (for non-school work) for children ages two years to twelfth grade Physical Activity Behaviors and Barriers  There are multiple variables affecting a person’s decision to be physically active  Individual factors  The built environment  The social context  Individual-examples  If the norm within the home is to spend the evenings and weekends watching TV instead of playing or being active, family members are more likely to be sedentary.  If people do not feel they have the time or that physical activity is not important or fun, they will be less likely to be physically active.  Built Environment  Refers to human-made surroundings that provide the setting for human activity; the human-made space in which people live, work, and recreate on a day-to-day basis  Physical activity levels have been affected by:  Decline of physically active occupations  Increases in labor-saving devices  a machine, gadget, etc, that reduces (human) effort, hard work or labour  Housing choices  Increases in automobile use  Social Environment  Social learning theory: a theory of behavior that suggests personal, environmental, and behavioral factors continuously interact to influence a person’s behavior, along with past experiences and actions of other  Examples of social environments that support being physically active:  Workplace has groups of people who informally get together to walk or participate in recreational physical activity during breaks  If teachers incorporate physical activity into learning activities  Families play or go out for walks together  Efforts and Initiatives to Increase Physical Activity  People will be physically active if there are opportunities that are convenient, appealing, and social.  Methods to promote physical activity:  Technology  Tracking Activity  Virtual Social Support  Education Programs in Work Sites, Schools, and Communities  Technology  Social support is a critical element in successful behavior change.  People are using smartphones, the Internet, and online applications to :  Manage their health and fitness  Locate and participate in group physical activities  Join virtual health or fitness-focused groups to stay accountable  New and yet-to-be-developed technological tools will likely continue to support increased physical activity among children and adults.  Tracking Activity  Many people build accountability into their physical activity through virtual or online tracking,  GPS devices  Applications  Other devices  These tools enable people to monitor, track, and share physical activities.  Virtual Social Support:  Many sites offer members the opportunity to network with one another, access information and resources, ask questions, and post comments and questions in online forums.  The CDC has developed and promoted social media tools to support overweight and obesity prevention activities, including e-cards, badges, podcasts, and online videos, all of which are free.  Education Programs in Work Sites, Schools, and Communities  There are many opportunities to connect people with opportunities for physical activity where they live, work, and play.  The key is to minimize barriers and provide a variety of activities while promoting what is available.  Because adults spend most of their waking hours at their jobs, and children at school, work site and school settings provide opportunities for captive audiences.  Work sites  Work sites are small communities well positioned to encourage participation and engagement in physical activity programming and education.  Work site policies can significantly affect employee levels of physical activity  Allowing employees to participate in physical activity while on the job  Offering flexible work hours  Providing physical activity incentives (gym membership subsidies, gift cards, recognition, etc.)  Education for employees at the workplace is useful in increasing physical activity.  Providing follow-up consultation by health educators, coaches, or nurses after employees complete a health risk assessment, employees are able to set goals and better monitor their progress (  Schools  Schools remain an important setting for delivering physical education programs and encouraging children to be physically active.  Evidence indicates that children who are physically active  Tend to perform better academically  Have improved attendance patterns  Are more focused  Better behaved in the classroom Strategies to Prevent Obesity The Air We Breathe UNDERSTANDING THE IMPACT OF AIR QUALITY ON HEALTH Introduction  Health is directly influenced by the environment. In this lecture, we will explore how the air we breathe impacts our health, covering both outdoor and indoor air quality. Recent events, such as the Amazon rainforest fires and ongoing air quality crises in major cities, highlight the urgent need to address air pollution globally. Health and Environment  Health is affected by the quality of the environment  Air we breathe  Water we drink  Food we eat  Environmental health  The study and management of environmental conditions that affect the health and well-being of humans  Environmental hazards  Factors or conditions in the environment that increase the risk of human injury, disease, or death. The Air We Breath Regulation of outdoor air Outdoor air pollution quality Indoor air pollutants Protecting indoor air Outdoor Air Pollution  Air pollution is a global concern with both natural and human-made sources.  For example, the 2019 Amazon rainforest fires released vast amounts of carbon dioxide, affecting air quality worldwide.  Major cities like Delhi experience hazardous air pollution levels during certain seasons.  Efforts to regulate outdoor air quality, such as the Paris Agreement and WHO guidelines, are essential in combating these issues.  Outdoor Air Pollution  Air pollution:  Contamination of the air that interferes with the comfort, safety, and health of living organisms  Contaminants (Pollutants)  Substances—gases, liquids, or solids— found in amounts great enough to harm humans, the environment, or that alter climate  Originate from  Natural sources (dust storms, forest fires, and volcanic eruptions)  Human sources 1. Mobile sources ( motor vehicles) 2. Stationary sources (power plants and factories) Types of pollutants 1. Primary pollutant 2. Secondary pollutants  Primary pollutants  Air pollutant emanating directly from transportation, power and industrial plants, and refineries  Include  Carbon monoxide: is a colourless, odourless and tasteless toxic gas produced by the incomplete combustion of carbonaceous fuels such as wood, petrol, charcoal, natural gas and kerosene.  carbon dioxide,  sulfur dioxide: is a colourless gas with a sharp odour. It is produced from the burning of fossil fuels (coal and oil) and the smelting of mineral ores that contain sulfur.  nitrogen oxides,  hydrocarbons  Particulate matter (PM): PM is a common proxy indicator for air pollution. There is strong evidence for the negative health impacts associated with exposure to this pollutant. The major components of PM are sulfates, nitrates, ammonia, sodium chloride, black carbon, mineral dust and water.  Secondary pollutant  Air pollutant formed when primary air pollutants react with sunlight and other atmospheric components to form new harmful compounds  Nitrogen dioxide (NO2) (NO+Oxygen): s commonly released from the combustion of fuels in the transportation and industrial sectors  Nitric acid  Nitrate salts  Sulfur trioxide  Sulfate salts  Sulfuric acid  Peroxyacyl nitrates  Ozone (hydrocarbons (HC) and nitrogen oxides (NOx)): Ozone at ground level – not to be confused with the ozone layer in the upper atmosphere – is one of the major constituents of photochemical smog Health Impact of Air Pollutants  Different air pollutants affect human health in various ways:  PM2.5: Fine particulate matter that penetrates deep into the lungs, leading to respiratory and cardiovascular diseases.  NOx: Contributes to respiratory problems and exacerbates asthma.  O3 (Ozone): Can cause chest pain, coughing, throat irritation, and worsen chronic respiratory diseases.  Case Study: Increased mortality rates during high pollution events (e.g., London Smog of 1952).  Effects of air pollution 1. Acute health problems  Burning eyes  Shortness of breath  Increased incidences of respiratory illness (e.g. colds, coughs, nose irritation)  Death 2. Chronic health problems  Chronic bronchitis  Emphysema  Increased incidence of bronchial asthma attacks  Lung cancer  Policies reducing air pollution  Most sources of outdoor air pollution are well beyond the control of individuals and this demands concerted action by local, national and regional level policy-makers working in sectors like energy, transport, waste management, urban planning and agriculture.  There are many examples of successful policies that reduce air pollution:  for industry: clean technologies that reduce industrial smokestack emissions; improved management of urban and agricultural waste, including capture of methane gas emitted from waste sites as an alternative to incineration (for use as biogas);  for energy: ensuring access to affordable clean household energy solutions for cooking, heating and lighting;  for transport: shifting to clean modes of power generation; prioritizing rapid urban transit, walking and cycling networks in cities as well as rail interurban freight and passenger travel; shifting to cleaner heavy-duty diesel vehicles and low-emissions vehicles and fuels, including fuels with reduced sulfur content;  for urban planning: improving the energy efficiency of buildings and making cities more green and compact, and thus energy efficient;  for power generation: increased use of low-emissions fuels and renewable combustion-free power sources (like solar, wind or hydropower); co-generation of heat and power; and distributed energy generation (e.g. mini-grids and rooftop solar power generation);  for municipal and agricultural waste management: strategies for waste reduction, waste separation, recycling and reuse or waste reprocessing, as well as improved methods of biological waste management such as anaerobic waste digestion to produce biogas, are feasible, low-cost alternatives to the open incineration of solid waste – where incineration is unavoidable, then combustion technologies with strict emission controls are critical; and  for health-care activities: putting health services on a low-carbon development path can support more resilient and cost-efficient service delivery, along with reduced environmental health risks for patients, health workers and the community. In supporting climate friendly policies, the health sector can display public leadership while also improving health service delivery.  Indoor Air Pollutants  Sources 1. Building and insulation materials 2. Biogenic pollutants 3. Combustion by-products 4. Volatile organic compounds 5. Radon gas 6. Environmental tobacco smoke  1. Building and insulation materials Asbestos  A naturally occurring mineral fiber identified as a class A carcinogen by the Environmental Protection Agency (EPA)  Used as insulation and fireproofing material  Insulate pipes, walls, and ceilings in older buildings  It is a component of floor and ceiling tiles  It was sprayed in structures for fireproofing.  It is harmless if intact and left alone, but, when disturbed, inhaled airborne fibers can cause serious health problems  2. Biogenic pollutants  Airborne biological organisms or their particles or gases or other toxic materials that can produce illness  Bacteria (carried by people, animals, and soil and plant debris)  Viruses( transmitted by people and animals)  Molds (fungi that spread and reproduce by making spores)  Pollens  Insect parts  Animal dander  Health effects of biogenic pollutants  Enter the human body by being inhaled  Trigger allergic reactions (asthma)  Cause infectious illnesses (e.g., influenza and measles)  Release disease-producing toxins  Symptoms:  Sneezing, watery eyes, coughing, shortness of breath, dizziness, lethargy, fever, digestive problems  Susceptible populations:  Children, elderly people, people with breathing problems, allergies, or lung diseases  Control:  Minimize exposure by controlling the relative humidity level in home or office  Reduce airborne biogenic pollutants by removing standing water, and any wet or water-damaged materials from around the home 3. Combustion by-products  Gases and particulates generated by burning  Include:  Gases (e.g., CO, NO2, and SO2)  Particulates (e.g., Ash and soot)  Sources:  Fireplaces, wood stoves, kerosene heaters, candles, incense, second-hand tobacco smoke, improperly maintained gas stoves and furnaces.  Health effects:  Prolonged exposure to these substances can cause serious illness and possibly death  4. Volatile organic compounds (VOCs)  Compound that exists as vapor over the normal range of air pressures and temperatures  The health effects of these chemicals vary with  Concentration  One’s length of exposure  Acute symptoms include  Irritation of the eyes and respiratory tract  Headaches  Dizziness  Memory impairment  Some of these chemicals are known or suspected carcinogens Sources of VOCs include  Construction materials (e.g., Insulation and paint)  Structural components (e.g., Vinyl tile and sheet rock)  Furnishings (e.g., Drapes and upholstery fabric)  Cleansers and solvents (e.g., Liquid detergent and furniture polish)  Personal care products (e.g., Deodorant and eyeliner pencils)  Insecticides/pesticides  Electrical equipment (e.g., Computers)  Combustion of wood and kerosene  Formaldehyde (CH2O)  A water-soluble gas used in aqueous solutions in hundreds of consumer products  It is one of the most ubiquitous VOCs  Exposure occurs when it evaporates from  Wood products (plywood and particle board (it is a component of the glue that binds these products together)  Grocery bags  Wallpaper  Carpet  Insulation  Wall panelling  Wallboard  Symptoms and control of formaldehyde exposure  Exposure to formaldehyde can cause  Watery eyes  Burning in the eyes and throat  Difficulty in breathing  Precipitation of asthma attacks in susceptible people  Cancer (carcinogen)  Protection  Use exterior-grade products that emit less formaldehyde  Increase ventilation in the home  Use a dehumidifier and air conditioning to control humidity  Keep temperature at moderate levels in the home to reduce formaldehyde emissions 5. Radon  A naturally occurring colorless, tasteless, odorless, radioactive gas formed during the radioactive decay of uranium-238  It is the number one cause of lung cancer among non- smokers and the second leading cause of lung cancer overall  Responsible for about 21,000 lung cancer deaths every year.  It seeps into a home from surrounding soil, rocks, and water and through openings such as cracks, drains, and sump pumps.  Exposure to radon is preventable  Every home and office building should be tested for radon  Inexpensive and easy test  6. Environmental tobacco smoke (ETS) (second-hand smoke)  ETS includes  Mainstream smoke: the smoke inhaled and exhaled by the smoker  Side stream tobacco smoke: the smoke that comes off the end of a burning tobacco product  Passive smoking: The involuntary inhalation of ETS by nonsmokers  ETS exposure  Hundreds of toxic agents and more than 40 carcinogens are in second-hand smoke including:  CO, NO2, CO2, Hydrogen cyanide, Formaldehyde, Nicotine, Suspended particles  ETS adverse health effects  Cancer  Heart disease  Stroke  Adverse prenatal consequences and postnatal health conditions in infants  Intrauterine growth retardation, low birth weight ,preterm delivery, orofacial clefts, respiratory tract infections, behavioral and cognitive abnormalities  Young children  Coughing, wheezing, breathlessness, increased risk of developing asthma, disruptive behavioral disorders ETS control  Protecting Indoor Air  People spend 50-90% of time indoors  Indoor air pollution may be more harmful to human health than outdoor air pollution  No federal indoor clean air act  Smoking ordinances  Air Pollution and Climate Change  Air pollution and climate change are closely linked:  Greenhouse Gases: Emissions from fossil fuels contribute to both air pollution and global warming.  Feedback Loop yb noitullop ria etabrecaxe serutarepmet desaercnI :.goms dna serifdliw fo ycneuqerf eht gnisaercni  Mitigation: etamilc fo ecap eht wols osla nac noitullop ria gnicudeR.egnahc  Air Quality Index (AQI)  The Air Quality Index (AQI) is a measure used to communicate how polluted the air currently is or how polluted it is forecast to become.  AQI Levels:  0 to 50: Good  51 to 100: Moderate  101 to 150: Unhealthy for Sensitive Groups  151 to 200: Unhealthy  201 to 300: Very Unhealthy  301 to 500: Hazardous  Real-world Examples:  Beijing, China: Frequent high AQI levels (200+)  Los Angeles, USA: Moderate to Unhealthy levels (50-150)  Helsinki, Finland: Typically Good levels (0-50)  Innovations in Air Quality Monitoring  Emerging technologies in air quality monitoring:  Satellite-Based Monitoring: Provides real-time data on air quality over large areas.  Low-Cost Sensors: Affordable devices that can be deployed in communities to monitor local air quality.  Wearable Technology: Personal devices that track exposure to air pollution, helping individuals minimize their risks. Regulatory Frameworks  Overview of global and local regulations on air quality:  Clean Air Act (USA): Landmark legislation that has significantly reduced air pollution since its enactment in 1963.  European Union Air Quality Standards: Set limits for pollutants like NO2, PM10, and SO2 across member states.  WHO Guidelines: Provide recommendations for air quality levels to protect human health.  Public Health Campaigns  Examples of effective public health campaigns aimed at reducing air pollution exposure:  'Breathe Life' Campaign: A global campaign by WHO to raise awareness about air pollution and its effects on health.  Local Initiatives: Cities like Delhi have implemented odd-even vehicle rationing to reduce smog.  Role of Education: Community engagement and public education are crucial in improving air quality. Future Challenges and Opportunities  Challenges in mitigating air pollution in developing countries:  Rapid Urbanization: Leads to increased emissions from transportation and industry.  Economic Constraints: Limited resources for implementing air quality control measures.  Opportunities:  Interdisciplinary Approaches: Combining public health, environmental science, and policy to develop comprehensive solutions. Alcohol, Tobacco, and Other Drugs DR. REEMA KARASNEH  Introduction  Use, misuse, and abuse of mind-altering substances predates recorded historyEarly civilizations may have used drugs as a vehicle to communicate with spirits  Drives for drug-taking  Experimental or social, a temporary departure from a natural, nondrugged physical and mental state  A misguided attempt to self-medicate or to cope with personal problems such as depression, loneliness, guilt, or low self-esteem  A conscious choice; these people have become chronic drug abusers or drug dependent.  Chronic alcohol and other drug abuse or dependence is regarded as destructive behavior in most cultures  Affects individuals and the surrounding community Scope of the Current Drug Problem  More deaths, illnesses, and disabilities can be attributed to the abuse of alcohol, tobacco, and other drugs than to any other preventable health condition  Economic costs include:  Direct costs (health care, premature death, impaired productivity)  Indirect costs (crime and law enforcement, courts, jails, social work)  Health threats of alcohol and drug abuse  Abusers of alcohol and other drugs represent a threat to  Themselves and their families  They put themselves and their families at risk for physical, mental, and financial ruin  develop a psychological and/or physical dependence (a physiological state in which discontinued drug use results in clinical illness)  If the drug is an illegal one, its use constitutes criminal activity and may carry with it the added risks of arrest  The community  They have greater health care needs, suffer more injuries, and are less productive than those who are not abusers  Loss of economic opportunity and productivity  Social and economic destruction  They may perpetrate more violent acts that result in economic loss, injury, and death Definitions  Drug: substance other than food that when taken in small quantities, alters one’s physical, mental, or emotional state  Psychoactive drug: Drugs that alters sensory perceptions, mood, thought process, or behaviour  Drug use: nonevaluative term referring to drug-taking behavior in general; any drug-taking behavior  Drug misuse: inappropriate use of legally purchased prescription or non-prescription drugs  E.g., One discontinues the use of a prescribed antibiotic before the entire prescribed dose is completed  E.g., One takes four aspirin rather than two as specified on the label  Definitions  Drug abuse: use of a drug when it is detrimental to one’s health or well-being  Taking a prescription or non-prescription drug for a purpose other than that for which it is medically approved  one takes a prescription diet pill for its mood-altering effects (stimulation)  Continued use of a legal drug with the knowledge that it is hazardous to one’s health (e.g. cigarette smoking)  Drug dependence: When one feels the that a particular drug is necessary for normal functioning  Chemical dependence: a psychological and sometimes physical state characterized by a craving for a drug  Psychological dependence: a psychological state characterized by an overwhelming desire to continue use of a drug  Physical dependence: discontinuation of drug use results in clinical illness. Factors that Contribute to Substance Abuse  Risk factors : factors that increase the probability of drug use  Protective factors: factors that lower the probability of drug use  People with a high number of risk factors are said to be vulnerable to drug abuse or dependence  People who have few risk factors and more protective factors are said to be resistant to drug abuse  Risk and protective factors can be genetic or environmental  Inherited Risk Factors  Most research related to drug dependence and inherited risk is on alcoholism  Research has shown genetic and biological markers may predispose someone to increased susceptibility to develop alcohol-related problems Environmental Risk Factors  Personal factors  Home and family life  School and peer groups  Sociocultural environment Personal factors  Personality traits  Impulsiveness  Depressive mood  Susceptibility to stress  Personality disturbances  It is difficult to determine the degree to which these factors are inherited or are simply the product of the family environment. Home and Family Life  Factors contribute to drug experimentation by children and adolescents  Family structure  Family dynamics (e.g., Deaths and divorces)  Quality of parenting  The failure of parents to provide an environment conducive to the development of interpersonal skills (communication skills, independent living skills, and learning to get along with others)  can result in the loss of self- esteem increase in delinquency, nonconformity, and sociopathic behavior personal risk factors for alcohol and drug abuse  Family problems  Family attitudes toward alcohol and drug use influence adolescents’ beliefs and expectations about the effects of drugs. School and Peer Groups  Perceived and actual drug use by peers  Influences attitudes and choices by adolescents  Influence expectations for a drug  e.g., Alcohol maybe perceived as “a ‘magic elixir’ that can enhance social and physical pleasure, power and aggression and social competence”  Sociocultural Environment  The notion of environmental risk includes the effects of sociocultural and physical settings on drug-taking behavior.  Environmental risk for drug-taking can stem from one’s immediate neighbourhood or from society at large  Opportunities for community interventions  Drug-prevention education programs  Treatment availability  Increasing taxes on tobacco products and alcoholic beverages  Types of Drugs Abused and Resulting Problems  Legal drugs  Alcohol, nicotine, nonprescription (over-the-counter) drugs, prescription drugs  Controlled substances and illegal (illicit) drugs  Marijuana, narcotics, cocaine and crack cocaine, hallucinogens, stimulants, depressants, inhalants Legal Drugs  Can be legally bought and sold in the marketplace  Includes drugs that can be  Closely regulated  Morphine  Lightly regulated  Alcohol and tobacco  Not regulated at all  Caffeine Alcohol  Number one drug problem in the United States  The number of those who abuse it  The number of injuries and injury deaths it causes  The amount of money spent on it  Its social and economic costs to society through broken homes and lost wages.  Alcohol use is reinforcing in two ways  It lowers anxieties  Produces a mild euphoria Alcohol community problems  Underage drinking: drinking by those younger than 21 years  Problem drinker: one for whom alcohol consumption results in a medical, social, or other type of problem  Alcoholism: a disease characterized by impaired control over drinking, preoccupation with drinking, and continued use of alcohol despite adverse consequences  Blood alcohol concentration (BAC): The percentage of concentration of alcohol in the blood (car accidents)  Fetal Alcohol Spectrum Disorders (FASD): a range of disorders caused by prenatal exposure to alcohol.  fetal alcohol syndrome (FAS), fetal alcohol effects (FAE), alcohol-related neurodevelopmental disorder (ARND), and alcohol- related birth defects (ARBD)  Nicotine  Nicotine is the psychoactive and addictive drug present in tobacco products:  Cigarettes  E-cigarettes: electronic nicotine delivery systems (ENDS); a liquid that contains nicotine and other ingredients is heated into an aerosol that is then inhaled by the user  Cigars  Chewing tobacco  Pipe tobacco The consequences of tobacco use on individuals and communities  It is the single most preventable cause of disease, disability, and death  Its use increase risks for heart disease, lung cancer, chronic obstructive lung disease, stroke, emphysema, and other conditions including premature death  Economic cost: due to lost productivity and health care costs.  Environmental tobacco smoke (ETS) or secondhand smoke: tobacco smoke in the ambient air  Over-the-Counter Drugs (nonprescription drugs)  Over-the-counter (OTC) drugs: drugs (except tobacco and alcohol) that can be legally purchased without a physician’s prescription  Internal analgesics such as aspirin, acetaminophen, and ibuprofen  Cough and cold remedies  Emetics  Laxatives  Mouthwashes  Vitamins  Most OTC only provide symptomatic relief, not a cure  Regulated by Food and Drug Administration (FDA)  A federal agency charged with ensuring the safety and efficacy of all prescription and non-prescription drugs  OTC misuse and abuse  Examples of OTC misuse are  Not following the dosage directions  Using the drugs after their expiration date  Examples of OTC drug abuse  Taking of laxatives or emetics to lose weight or to avoid gaining weight  Appetite suppressants  Stimulants  Nasal sprays  Common cold OTC products that contain pseudoephedrine (used to manufacture methamphetamine)  Problems with OTC drug misuse and abuse:  Symptoms that should be brought to the attention of a physician remain unreported  Those who abuse these drugs may become dependent  Abuse of OTC drugs may establish a pattern of dependency that predisposes the abuser to developing dependent relationships with prescription drugs or illicit drugs.  Prescription Drugs  Can be purchased only with a physician’s prescription because they have serious side effects for some people  Regulated by the FDA  Types of misuse include  Not following the dosage directions  Using the drugs after their expiration date  The giving of one person’s prescription drug to another  Prescription drugs abuse  Prescription drugs  Stimulants (amphetamines)  depressants(Valium)  prescription opioid pain relievers (fentanyl, Morphine, codeine)  Certain prescription drugs have higher potential for abuse (greater risk of developing dependence) than stronger or more concentrated OTC drugs  Dependence try to obtain duplicate prescriptions from other physicians or steal the drugs from hospitals or pharmacies  Overdose Death  Overdoses involving prescription opioids  The increase in overdoses involving prescription opioids is influenced by several factors.  First, prescription opioids are potent pain relievers, with similar effects to heroin.  Their potency makes them highly addictive.  Use of prescription opioids is a risk factor for heroin use; some prescription opioid users may progress to heroin  Second, when mixed with illicit drugs, such as cocaine and heroin, they can be lethal.  Third, they have been increasingly available.  Other consequences for prescription drug misuse and abuse  Puts an additional strain on our already overburdened emergency departments  Lead to the development of drug-resistant strains of pathogens  When patients fail to complete the entire antibiotic treatment (i.e., 3 days of a 10-day prescription), some of the bacteria survive and multiply, reinfecting the body with drug-resistant organisms.  When this strain of the disease is transmitted to another, the antibiotic treatment fails.  New drugs are then needed to treat these patients.  As drug misuse continues to occur, bacteria become resistant to multiple drugs.  Multidrug- resistant tuberculosis (MDR-TB)  community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections.  the dangers of drug misuse and the need to continue to develop new antibiotics for the treatment of bacterial infections. Occupational Health DR. REEMA KARASNEH  Occupational Health  Is the promotion and maintenance of the highest degree of physical, mental and social well-being of workers in all occupations by preventing departures from health, controlling risks and the adaptation of work to people, and people to their jobs.  Occupational disease / or illness  Is any abnormal condition or disorder, other than one resulting from an occupational injury, caused by factors associated with employment.  It includes acute or chronic illnesses or disease that may be caused by  Inhalation  Absorption  Ingestion  Direct contact  It is typically identified when it is shown that it is more prevalent in a given body of workers than in the general population, or in other worker populations  An occupational injury  Is any injury, such as a cut, fracture, sprain, or amputation, which results from a work- related event or from a single, instantaneous exposure in the work environment  WHO occupational health  WHO recognizes that occupational health is closely linked to public health and health systems development  The Occupational Health Program, together with its partners, aims at addressing a large number of determinants of workers' health  Risks for disease and injury in the work environment  Social and individual factors  Access to health services  The workplace is a suitable setting for protecting and promoting the health of workers and their families  Importance of Occupational Safety and Health to the Community  Hazardous agents in the workplace affect not only workers but also those outside the worksite.  Soil and groundwater contamination with solids and liquids or air pollution with industrial gases and dusts  Clothing and vehicle contamination  Asbestos workers whose wives and children became exposed to asbestos from these sources  Electronic waste recyclers who unknowingly exposed their families to lead dust from their workplace  The risk of exposure to a chemical or nuclear energy source, which was originally limited to the workplace, became a community-wide risk  Occupational safety and health  Occupational safety and health is a cross-disciplinary area concerned with protecting the safety, health and welfare of people engaged in work or employment  As a secondary effect, it may also protect  Co-workers  family members  Employers  Customers  Suppliers  Nearby communities  Other members of the public who are impacted by the workplace environment  It may involve interactions among many subject areas, including  Occupational medicine  Occupational (or industrial) hygiene  Public health  Safety engineering  Chemistry  Health physics  Ergonomics  Toxicology  Epidemiology  Environmental health  Industrial relations  Public policy  Sociology  Occupational health psychology.  Occupational Hygiene  Is the discipline of anticipating, recognizing, evaluating and controlling health hazards in the working environment with the objective of protecting worker health and well-being and safeguarding the community at large  Although using strict and rigorous scientific methodology Occupational Hygiene often requires professional experience or 'Art' in determining the potential for exposures in workplace and environmental studies  Occupational Accident  The employer is responsible for ensuring a safe system of work is in place and therefore must take action to prevent accidents from occurring or recurring  Not all accidents result in injury or damage  Determining where, why and how accidents occur is fundamental to understanding the causation and implementing preventive measures  Scope of the Problem  Fatalities have declined significantly over past 85 years  Reporting of illness versus injury  Even though more workplace injuries are reported than workplace illnesses, the estimated number of deaths is higher for workplace illnesses  Economic impact  Economic impact  An employee who is injured is likely to suffer  Financial loss  Disfigurement  Disability  Pain  Death  Injuries may have devastating long-term consequences on  Individual's personal life, social and other activities  Injured person's family and friends  The employer should be concerned with accident prevention because the direct and indirect costs associated with accidents can endanger a company's competitiveness  Financial losses due to increased insurance premiums  Lost production or disruption to production schedules  Damage to equipment and plant  Loss of time for other employees (eg, supervisors) during the accident investigation  Training of replacement employees  Examples of Occupational Diseases  Asbestosis  among asbestos miners and those who work with friable asbestos insulation.  Black lung  (Coal worker's pneumoconiosis) among coal miners  Byssinosis  among workers in parts of the cotton textile industry  Carpal tunnel syndrome  among persons who work in the poultry industry and who do data entry  Lead poisoning  affecting workers in many industries that processed or employed lead or lead compounds  Radiation sickness  among persons who work in the nuclear industry  Common workplace hazard groups  Workplace hazards are often grouped into:  Environmental hazards  Physical hazards  Physical agents  Mechanical hazards  Chemical agents  Biological hazards  Ergonomical hazards  Psychosocial issues Environmental hazards  Environmental hazards include:  Asphyxiation  Dehydration  Environmental agents include:  Cold stress (hypothermia)  Heat stress (hyperthermia)  Particulate inhalation  Physical hazards  Physical hazards include :  Collisions  Confined space  Slips  Falls from height  Electricity  Standing in line of fire  Physical agents  Physical agents include:  Noise  Vibration  Lighting  Ionizing and nonionizing radiation  Mechanical hazards  Mechanical hazards include :  Compressed air/high pressure fluids (such as cutting fluid)  Crushing  Cutting  Entanglement  Equipment-related injury  Friction and abrasion  Impact  Moving parts  Shearing  Stabbing and puncture  Biological hazards  Biological hazards include:  Bacteria  Virus  Fungi  Mold  Blood-borne pathogens  Tuberculosis  Chemical agents  Chemical agents include:  Acids  Bases  Heavy metals  Lead  Solvents  Petroleum  Particulates  Asbestos and other fine dust/fibrous materials  Silica  Fumes (noxious gases/vapors)  Highly-reactive chemicals  Ergonomics  Is a physical factor that harms the musculoskeletal system  Repetitive movement  Manual handling  Workplace/job/task design  Uncomfortable workstation height  Poor body positioning  Psychosocial issues  Psychosocial issues include:  Work-related stress  excessive working time  overwork  Violence from outside the organisation  Bullying  emotional, verbal, …, etc.  Mobbing  Control of Occupational Hazard  A control program consists of  all steps necessary to protect workers from exposure to a substance or system  the procedures required to monitor worker health and their exposure to hazards  A written workplace hazard control program should outline  which methods are being used to control the exposure  how these controls will be monitored for effectiveness  Main ways to control a hazard  Elimination (including substitution)  Engineering Controls  Includes designs or modifications to plans, equipment, ventilation systems, and processes that reduce the source of exposure  Administrative Controls  Limit exposure time  Alter work practices  Personal Protective Equipment  equipment worn by individuals to reduce exposure such as contact with chemicals or exposure to noise.  These methods are also known as the "hierarchy of control" because they should be considered in the order presented (it is always best to try to eliminate the hazard first, etc)  Where are controls used?  Controls are usually placed:  At the source (where the hazard "comes from”)  Along the path (where the hazard "travels")  The worker  Control by Elimination & Substitution  Elimination is the process of removing the hazard from the workplace  It is the most effective way to control a risk because the hazard is no longer present  It is the preferred way to control a hazard and should be used when ever possible  Substitution occurs when a new chemical or substance is used instead of another chemical  Grouped with elimination because you are removing the first substance or hazard from the workplace  Its goal is to choose a new chemical that is less hazardous than the original.  Examples of administrative controls  Administrative controls limit workers' exposures by  Scheduling shorter work times in contaminant areas  Scheduling maintenance and other high exposure operations for times when few workers are present (such as evenings, weekends)  Using job-rotation schedules that limit the amount of time an individual worker is exposed to a substance  Using a work-rest schedule that limits the length of time a worker is exposure to a hazard  These control measures have many limitations because the hazard itself is not actually removed or reduced  Administrative controls are not generally favored because  can be difficult to implement and maintain  not a reliable way to reduce exposure  Work Practices  Work practices are also a form of administrative controls  In most workplaces, even if there are well designed and well-maintained engineering controls present, safe work practices are very important  Some elements of safe work practices include:  Developing and implementing standard operating procedures  Training and education of employees about the operating procedures as well as other necessary workplace training  Keeping equipment well maintained  Preparing and training for emergency response for incidents such as spills, fire or employee injury  Establishing and maintaining good housekeeping programs  Cleanliness, keeping work areas neat and orderly, maintaining halls and floors free of slip hazards, removing of waste materials (e.g., paper, cardboard) and other fire hazards from work areas, the adequacy of storage facilities, and maintenance  help control or eliminate workplace hazards  a basic part of incident and fire prevention The Water We Use DR. REEMA KARASNEH  Introduction  Clean, uncontaminated water is essential for life and health.  Challenges to health  The scarcity of potable water -11% of the world's population  Lack of basic sanitation (the inability to properly treat wastewater) –one third of the world’s population  Health effects of consumption of contaminated water  Outbreaks of waterborne diseases (e.g., Cholera, typhoid fever, dysentery,…, etc.)  Responsible for 1.5 million deaths worldwide each year  Sanitation: The practice of establishing and maintaining healthy or hygienic conditions in the environment Sources of Water  Surface water : Precipitation that does not infiltrate the ground or return to the atmosphere by evaporation;  Water in streams, rivers, lakes, reservoirs  Groundwater: Water located under surface of the ground  Aquifers  Porous, water-saturated layers of underground bedrock, sand, and gravel that can yield economically significant amounts of water  Only 0.003% of earth’s water is available for human use  Much of this is hard to reach and too costly to be of practical value.  Sources of Water Pollution  Water pollution – includes any physical or chemical change in water that can harm living organisms or make water unfit for other uses (e.g., drinking, domestic use, recreation, fishing, industry, agriculture, or transportation)  The sources of water pollution fall into two categories 1. Point source pollution 2. Nonpoint source pollution  Point source pollution  Pollution that can be traced to a single source  It discharges pollutants into the water through pipe, ditch, or culvert  E.g., release of pollutants from a factory or sewage treatment plant  Relatively easy to identify, control, and treat  Nonpoint source pollution  All pollution that occurs through runoff, seepage, or falling of pollutants into water where the source is difficult or impossible to identify  Examples include  Runoff of water from cities, highways, and farms resulting from rain events (called storm-water runoff)  Seepage of leachates from landfills, and acid rain  It is a greater problem than point source pollution  It is often difficult to track the actual source of pollution and, therefore, to control it Types of Water Pollutants  Biological pollutants  Pathogens or undesirable living organisms  Nonbiological pollutants  Non-living hazardous materials (e.g., chemicals) Biological Pollutants of Water  They are living organisms or their products that make water unsafe for human consumption.  Parasites, Bacteria, Viruses  Pathogens enter the water mainly through human and other animal wastes that were disposed of improperly or without being treated before their disposal  These biological wastes spread viruses, bacteria, and parasites into rivers, lakes, reservoirs, and drinking water supplies, where they can cause human illness.  Waterborne viral agents and the diseases they cause  poliomyelitis virus (polio)  hepatitis A virus (hepatitis) Waterborne bacteria and the diseases they cause  Escherichia coli (gastroenteritis)  Legionella spp. (legionellosis)  Salmonella typhi (typhoid fever)  Shigella spp. (shigellosis or bacillary dysentery)  Vibrio cholerae (cholera) Waterborne parasites  Entamoeba histolytica (amebiasis or amebic dysentery)  Giardia lamblia (giardiasis)  Cryptosporidium parvum (cryptosporidiosis)  Sources of biological pollutants  Runoff from animal farms that contain manure  Failed septic systems that leach untreated or only partially treated human fecal waste to groundwater and surface water  Combined sewer overflow that discharges a mix of untreated storm-water and human sewage to rivers or streams  Storm-water runoff from cities, highways, and towns, which carries animal and human fecal waste left on land surfaces  nonbiological pollutants of water  Heat: the degradation of water quality by any process that changes ambient water temperature.  Thermal pollution is the rise or drop in the temperature of a natural body of water caused by human influence.  A common cause of thermal pollution is the use of water as a coolant by power plants and industrial manufacturers. When water used as a coolant is returned to the natural environment at a higher temperature, the sudden change in temperature decreases oxygen supply and affects the ecosystem.  Radioactive contaminants  Uranium, thorium and actinium are three NORM (Naturally Occurring Radioactive Materials) series that contaminate water resources. A small amount of radiation is found in all types of water but the extended amount of radiation is harmful to human health.  Nuclear weapon investigation, nuclear calamities, nuclear power houses and dumping of radioactive waste are major sources of contamination  Inorganic chemicals  lead, copper, and arsenic  Organic chemicals  Industrial solvents (Trichloroethylene (TCE))  Pesticides (Dichlorodiphenyltrichloroethane (DDT))  Herbicides (Atrazine)  Specialty chemicals (polychlorinated Biphenyls (PCBs))  Dioxin (TCDD): a by-product of improper incineration of paper products and chlorinated plastics Types of Nonbiological pollutants with health concerns  Endocrine-disrupting chemicals (EDCs): a chemical that interferes in some way with the body’s endocrine (hormone) system  Pharmaceuticals and personal care products (PPCPs): synthetic chemicals found in everyday consumer health care products and cosmetics  Endocrine-disrupting chemicals (EDCs)  These include:  Pesticides  Commercial chemicals  Environmental contaminants  Can disrupt, imitate, or block the body’s normal hormonal activity, causing developmental or reproductive problems  Adverse reproductive outcomes  Effects on the thyroid and brain  Evidence for this has been found in certain wildlife species.  Pharmaceuticals and personal care products (PPCPs)  These include  Prescription and over-the-counter drugs  Cosmetics (soaps, shampoos)  Fragrances  Sunscreens  Diagnostic agents  Biopharmaceuticals  PPCPs have been detected in water supplies around the world, and their effects on human health are the subject of scientific investigations  PPCPs get into our water sources when they are flushed down our toilets and washed down our drains and transported to our wastewater treatment plants, where they are discharged, mostly unchanged, into rivers and streams  Waterborne disease outbreak (WBDO)  A disease in which at least two persons experience a similar illness after the ingestion of drinking water or after exposure to water used for recreational purposes and epidemiological evidence implicates water as the probable source of the illness  Location, Time, Illness  Illnesses are described  Acute gastroenteritis illnesses  Skin disorders  Acute respiratory illnesses  Others: keratitis, conjunctivitis, otitis, bronchitis, meningitis, meningoencephalitis, hepatitis, leptospirosis, and combined illnesses causes of WBDOs associated with recreational water  Parasites  Bacteria  Viruses  Chemicals/toxins  Unidentified  Ensuring the Safety of Our Water  Proper treatment of water intended for drinking and a properly maintained distribution system for that water  Proper construction and maintenance of water-associated recreation facilities.  The enactment and enforcement of well-conceived water quality regulations  Wastewater treatment and sanitation Treatment of Water for Domestic Use  Domestic water use includes water for drinking, cooking, washing dishes and laundry, bathing, flushing toilets, and outdoor use (such as watering lawns and gardens).  It usually include: 1. Removing solids: through coagulation, flocculation, and filtration. 2. Disinfection: Chlorine, sodium hypochlorite, ozone, or other disinfectant is added to the water to kill remaining viruses, bacteria, algae, and fungi. 3. Fluoridation: helps prevent dental decay.  Wastewater Treatment (liquid waste or sewage)  Wastewater: the aqueous mixture that remains after water has been used or contaminated by humans  Consists of about 99.9% water and 0.1% suspended and dissolved solids.  Human feces, soap, paper, garbage, grindings (food parts)  Sources:  homes, schools, commercial buildings, hotels/motels, hospitals, industrial plants, and other facilities connected to the sanitary sewer system.  Wastewater treatment : the process of improving the quality of wastewater (sewage) to the point that it can be released into a body of water without seriously disrupting the aquatic environment, causing health problems in humans, or causing nuisance conditions Controlled Substances and Illicit (Illegal) Drugs DR. REEMA KARASNEH   Marijuana  Opium, morphine, & heroin Controlled  Cocaine Substances  Hallucinogens and Illicit  Stimulants (Illegal)  Depressants  Anabolic drugs Drugs  Inhalants  Controlled Substances and Illicit (Illegal) Drugs  Controlled substances are those regulated by the Controlled Substances Act of 1970 (CSA), officially called the Comprehensive Drug Abuse Control Act of 1970.  Drugs belong to schedule I  They have no accepted medical uses  Drugs belong to schedule II  Drugs belong to schedule III They do have medical uses  Drugs belong to schedule IV  Drugs belong to schedule V  Schedules II to V of the Act depending upon their:  Potential for abuse  Risk of causing dependence  Schedule I drugs  They have a high potential for abuse  no acceptable standards of safe use.  These are considered illicit (illegal) drugs.  They cannot be cultivated, manufactured, bought, sold, or used within the confines of the law.  Over 150 drugs are listed in this category, including heroin and marijuana  Schedule II drugs  Include a variety of very powerful compounds that have specific medical uses but have a high risk for potential abuse.  Included in this category  Opium derivatives  Morphine, fentanyl, oxycodone, and methadone.  Stimulants  amphetamine and methamphetamine  Depressants  amobarbital, pentobarbital, secobarbital, and phencyclidine  other drugs Schedule III drugs  They have medical uses and exhibit a lower risk of potential abuse than Schedule II drugs.  Included are  less concentrated forms of certain Schedule II drugs  Many of the anabolic steroids. Schedule IV drugs  They exhibit even less potential for abuse than Schedule III drugs.  Included are many milder stimulants and depressants. Schedule V drugs  They are primarily very dilute concentrations of opium or opiates used in such medicines as cough syrups  Marijuana  Products derived from hemp plant- Cannabis sativa  Pot” and the related products, hashish and hash oil  Most abused illicit drug in the U.S.  The products are most commonly used by smoking but can also be ingested.  Marijuana as a concern  Although marijuana abuse has declined, it remains a concern for several reasons:  First, it is illegal, and therefore brings the user into contact with those involved in illegal activities.  Second, the act of smoking is detrimental to one’s health.  Third, marijuana smoking often occurs in conjunction with the drinking of alcohol or the use of other drugs.  The effects of polydrug use (the use of more than one drug at a time) may be more serious than those of single-drug use.  Last, as is true of all drugs, the adolescent who uses marijuana is delaying the accomplishment of developmental tasks such as attaining an adult self-identity, achieving independence, and developing the interpersonal skills necessary for successful independent living.  Health effects of marijuana  Acute effects –  Reduced concentration  Slowed reaction time  Impaired short-term memory  Impaired judgment  Marijuana use in combination with other drugs can be especially dangerous because drugs in combination may affect the brain differently  Chronic effects –  Damage to the respiratory system by the smoke itself  Development of amotivational syndrome (chronic psychiatric disorder)  A pattern of behavior characterized by apathy, loss of effectiveness, and a more passive, introverted personality  Evidence of the dependence- producing nature of marijuana  Long-term marijuana users experience physiological and psychological withdrawal symptoms.  Although these “unpleasant behavioral symptoms are less obvious than those for heroin or alcohol, they are significant and do perhaps contribute to continued drug use.  The number of persons seeking admission to treatment programs.  Those who smoke marijuana are more likely to use other, more addictive drugs.  For example, 89% of those who use cocaine first used cigarettes, alcohol, and marijuana  Synthetic Marijuana  Another cause for concern is the manufacture, distribution, and use of synthetic marijuana or synthetic cannabinoids.  Synthetic marijuana: is a category of drugs that are chemically produced and have properties similar to THC (Tetrahydrocannabinol), the psychoactive ingredient found in marijuana.  It poses a serious threat to public health.  It has the potential for abuse and other adverse health effects, and its long- term effects are still unknown.  Some users have reported immediate effects similar to those of marijuana  Others reported symptoms such as rapid heart rate, increased blood pressure, hallucinations, agitation, and vomiting  Narcotics: Opium, Morphine, Heroin, and Others  Narcotics  Drugs derived from or chemically related to opium that reduce pain and induce stupor, such as morphine  Opium and its derivatives, morphine and heroin, come from the oriental poppy plant, Papaver somniferum.  These narcotics numb the senses and reduce pain have a high potential for abuse  The narcotic that is most widely abused is heroin, a derivative of morphine.  Health problems of Narcotics  Narcotics produce euphoria, analgesia, and drowsiness.  If use continues Tolerance: physiological and enzymatic adjustments that occur in response to the chronic presence of drugs, which are reflected in the need for ever-increasing doses  means that larger and larger doses are required to achieve the same euphoria and numbing as the initial dose  Whereas tolerance develops rapidly to the euphoric effects, the depressing effects on respiration may continue to increase with dose level, increasing the risk of a fatal overdose.   As the cost of the drug habit becomes higher, the abuser usually attempts to quit This results in withdrawal symptoms because the body has become physically dependent upon the drug  Changing lifestyle for heroin addicts  Heroin addicts have a difficult time changing their lifestyle for several reasons:  The addiction itself, both physical and psychological.  The underlying psychosocial problems  poor self-image, lack of job skills, and absence of supporting family and friends.  Mistrust official programs set up to help them  poor health mentally and physically.  Because the duration of action of heroin is only 4 to 5 hours, the addict is usually too concerned with  finding the next dose  recovering from the previous one to be productive in the community.  Adverse effects of heroin addiction to community  The addict must obtain money to purchase heroin, and the price of the habit can be very high—as much as $200 per day The money is usually obtained illegally  Epidemics of bloodborne diseases  injection users are at high risk for becoming infected with HIV and hepatitis viruses  Epidemics of sexually transmitted diseases  gonorrhea, syphilis, chlamydia, herpes, and AIDS.  Cocaine and Crack Cocaine  Cocaine  the psychoactive ingredient in the leaves of the coca plant, Erythoxolyn coca, which, when refined, is a powerful stimulant/ euphoriant  Cocaine is a stimulant; that is, it increases the activity of the central nervous system.  It is a very powerful euphoriant/stimulant and very addictive  Purified forms of cocaine –  Salt (white powder)  Dried paste (crack)  Hallucinogens  Drugs that produce profound distortions of the senses  They produce illusions, hallucinations, changes in perceptions  These effects are due to synesthesia – impairment of mind characterized by a sensation that senses are mixed (mixing of the senses)  They include both  Naturally derived drugs  Mescaline, from the peyote cactus  Psilocybin and psilocin, from the psilocybe mushroom  Synthetic drugs  Such as lysergic acid diethylamide (LSD)  Hallucinogens adverse effects  Adverse effects:  tolerance  overdose deaths (rare)  “bad trips” (unpleasant experiences)  Permanent visual disturbances.  Because there are no legal sources for these drugs, users are always at risk for taking fake, impure, or adulterated drugs. Stimulants  Drug that increases the activity of the central nervous system  Amphetamines (Schedule II prescription ): group of synthetic drugs that act as stimulants  Amphetamine  Dextroamphetamine  Methamphetamine: the amphetamine most widely abused  Dextromethamphetamine  Methylphenidate: used to treat attention deficit hyperactivity disorder (The drug is often diverted from its intended use and abused by those for whom it was not prescribed)  Methcathinone  Stimulants' health effects  These drugs cause the release of high levels of the neurotransmitter dopamine, which stimulates brain cells.  Tolerance builds quickly, so abusers must escalate their doses rapidly.  Chronic abusers can develop:  Tremors and confusion  Aggressiveness  Paranoia.  The long-term effects include:  Memory loss  Permanent brain damage.  Depressants  These include:  Barbiturates: depressant drugs based on the structure of barbituric acid  Benzodiazapines: nonbarbiturate depressant drugs  Methaqualone: an illicit depressant drug  They slow down the central nervous system  May lower anxiety and loss of inhibitions  produce the feeling of a “high”  Its use leads to the development of  Tolerance  grater and greater doses to feel the same effects that the previous dose provided  Strong physical dependence (abstinence results in severe clinical illness )  abusers of these substances must often rely on medical assistance during detoxification and recovery. Anabolic Drugs  Anabolic drugs: compound, structurally similar to the male hormone testosterone, that increases protein synthesis and thus muscle building   Protein-building drugs  They are classified as schedule III drugs  They include:  Anabolic/androgenic steroids (AS)  Testosterone  Human growth hormone (HGH)  They have some legitimate medical uses  Rebuilding of muscles after starvation or disease  The treatment of dwarfism  Abused by athletes and body builders  increasing muscle mass, strength, and endurance  Side effects of anabolic drugs  Acute and chronic side effects  Men  Acne  Gynecomastia (the development of breasts)  Baldness  reduced fertility  Women  Masculinizing: development of a male physique  Increased body hair  Failure to ovulate (menstrual irregularities)  A deepening of the voice  Long-term abuse of anabolic steroids can result in psychological dependence, making the discontinuation of use very difficult.  Inhalants  Inhalants: Breathable substances that produce mind-altering effects  They include  Paint solvents, motor fuels, cleaners, glues, aerosol sprays, cosmetics, and other types of vapor  Often drug choice of young  Easy availability  Low cost  The primary effect of most of the inhalants is depression.   The user may at first experience a reduction of anxieties and inhibitions, making the user feel high.   Continued use may result in hallucinations and loss of consciousness.  Many of these chemicals are extremely toxic to the kidneys, liver, and nervous system. Prevention and Control of Drug Abuse  Requires  knowledge of the causes of drug-taking behavior  Sources of illicit drugs  Drug laws  Treatment programs  Community organizing skills  Persistence  Cooperation of various individuals and agencies  Levels of Prevention  Primary prevention: Programs are aimed at those who have never used drugs, & their goal is to prevent or forestall the initiation of drug use  Secondary prevention: programs are aimed at those wh