EHSC7060 T2

• Persistent thermal inversion
• Significant industrial and domestic pollutant emissions
• Resulted in high ground-level concentrations that caused acute illness and death

• Primary - sulfur dioxide, carbon monoxide, nitrogen oxides, lead
• Secondary - ozone, some particulate matter

• volatile organic compounds (VOCs)
• metals
• aldehydes
• semivolatile organic compounds (SVOCs)
• diesel exhaust
• 188 total

• Can irritate lung airways and cause inflammation
• Symptoms - wheezing, coughing, painful breathing/breathing difficulties
• Repeated exposure may lead to permanent lung damage
• Anyone who spends time outdoors during the summer is at risk

• ER visits for people with heart and lung disease
• Leads to: aggravated asthma, increases in respiratory symptoms like coughing and difficulty breathing/painful breathing, chronic bronchitis, decreased lung function, and premature death
• Settles on soil and water and changes the nutrient and chemical balance
• Causes: erosion and staining of structures

• Direct - cars, tractors, fire --> direct release of particles
• Indirect - sun, aerosols, products of pure combustion, water vapor, solvents --> reaction --> indirect formation of particles

• poisonous to all people at high levels
• can affect people with heart disease, and the central nervous system
• Sources: industrial process, fuel combustion, misc., nonroad vehicles & engines, onroad vehicles

• can cause temporary breathing difficulty for people with asthma
• can aggravate existing heart disease
• reacts with other chemicals in the air to form sulfate particles which can increase respiratory symptoms and siease, difficulty in breathing and premature death
• Major cause of reduced visibility in the US
• SO₂ and nitrogen oxides react with other substances to form acids
• Sources: metal processing, nonroad engines & vehicles, all other, fuel combustion - industrial & other, fuel combustion - electrical utilities

• Involved in the formation of ground-level ozone, which can trigger serious respiratory problems
• Reacts to form nitrate particles, acid aerosols, as well as NO₂ which can cause respiratory problems also
• Contribute to the formation of acid rain
• Contribute to atmospheric particles that cause visibility impairment
• Contribute to global warming
• Sources: all other, industrial/commercial/residential, motor vehicles

• Cause damages to the kidneys, liver, brain & nerves, and may lead to osteoporosis & reproductive disorders
• Can cause seizures, mental retardation, behavioral disorders, memory problems, and mood changes
• Causes high blood pressure & heart disease, and leads to anemia
• Sources: other, nonroad, fuel combustion, waste disposal, metal processing

• similar to cigarette smoke
• polycyclic aromatic hydrocarbons
• benzenes
• aldehydes
• respirable particulate matter
• carbon monoxide

• acute respiratory infections
• chronic obstructive pulmonary disease
• asthma
• low birth weight
• nasopharyngeal and laryngeal cancers
• tuberculosis
• diseases of the eye

• Particulate matter with aerodynamic diameter less than 2.5 micrometers
• Penetrate deep into the lungs and may reach the alveolar region, potentially interfering with gas exchange

• better combustion
• improvements in ventilation
• lower emissions levels
• potentially shorter cooking time

• less smoke
• less wood use
• reduced cough
• lower blood pressure
• less eye irritation
• fewer headaches
• less lower back pain

• Exhales CO & %COHb - measures effects of smoke exposure
• Exhaled NO - pulmonary inflammation, immune system function
• Total hemoglobin - oxygen transport efficiency
• Blood lead - possibly released in wood smoke, development effects

• small study populations
• short term study
• between-home variation

"safe food, if handled properly at all steps of production through consumption, is reliable unlikely to cause illness or injury"

• 1. to provide necessary nutrients for growth, health, and survival
• 2. no toxic or adverse health effects
• 3. should not be contaminated by known food safety hazards

biological, chemical, or physical agents that are reasonably likely to cause human illness or injury in the absence of their control

• microbial pathogens
• - infections - growth of disease-causing microorganism
• - intoxications - toxins produced by a microorganism

• food additives
• agricultural components
• - pesticides, antibiotics, and growth hormones
• industrial chemicals
• - cleaners and sanitizers
• - equipment related - oils, gasolines, lubricants
• natural and environmental contaminants
• - mycotoxins
• - heavy metals Pb, Hg

glass, wood, plastic, stones, metals, bones

• foodborne intoxications & infections
• illnesses acquired by consumption of contaminated food (not food poisoning)
• acute and chronic

the occurrence of a similar illness among 2 or more people which an investigation linked to a consumption of a common meal or food item in a defined time period, except for botulism

• A major cause of morbidity (& mortality)
• Affects 76 million in the US a year
• Causes 9000 deaths annually with an economic cost of $5 billion
• Causes adverse birth outcomes, chronic illnesses & disabilities

• bacterial
• chemical
• parasitic
• viral
• unknown

• About 40,000 cases and nearly 600 deaths each year in the US
• Food contaminated with salmonella typhi or salmonella saintpaul
• Since Apr 2008, 1442 persons infected in 43 states, DC & Canada, at least 286 persons hospitalized, possibly 2 died
• Jalapeno and Serrano peppers from Mexico and Tomatoes are major sources of contamination
• Peanut butter & products

• 73000 cases and nearly 60 deaths in the US each year
• Beef, milk, juice & vegetables (lettuce & spinach) contaminated
• Waterborne transmission
• Fresh spinach produced in Salinas, CA
• Shredded iceberg lettuce from Taco Bell

• food contaminated with listeria monocytogenes
• about 2500 persons become seriously ill each year, 500 die
• 1/3 cases happen in pregnant women
• newborns suffer the serious effects
• vulnerable - persons with weakened immune systems (patients, the elderly)
• uncooked meats and vegetables and some processed food were sources of contamination

• botulism - foodborne intoxication caused by clostridium botulinum
• staphylococcus aureus intoxication - exotoxin
• shigellosis - shigella bacteria
• hepatitis A
• norovirus
• prions
• parasitic foodborne illnesses

• food-derived naturally occurring toxicants and carcinogens (biotoxins, plants, animals)
• toxic additives
• toxicants generated during food processing & cooking
• food allergens
• unavoidable food contaminants

toxic agents mainly produced by fungi genera

• aflatoxins - liver, lung, colorectal
• fumonisms - liver, kidney, esophageal
• ocharatoxins - kidney, urinary tract
• zearalenon - esophageal, breast
• sterigmatocystin - liver

• intentionally added ingredients
• up to 32 categories based on their functions
• natural products or synthetic chemicals

• colors & coloring agents - aromatic amines or aromatic azo
• preservatives - antimicrobial agents, antioxidants
• sweeteners - saccharin
• flavors & flavor enhancers - monosodium glutamate

• determination of exposure levels
• 1. the foods to which the substance is added
• 2. the level of use in such food
• 3. the purpose for which the substance is used
• 4. the population expected to consume the substance

Estimated daily intake = the concentration of the substance in that food x the daily intake

Assignment of concern level based on structure activity (I to III)

• I - short term tests (toxicity & mutagenicity)
• II - subchronic feeding study (rodent & nonrodent), short term carcinogenic potential, multigenerational reproductive study (teratogenic study)
• III - longterm feeding study (rodent & nonrodent), short term carcinogenic potential, carcinogenicity study in 2 rodents, multigenerational reproductive study (teratogenic study)

• marine toxins
• mushroom toxins
• heavy metals
• pesticides
• antibiotics
• growth hormones

• US FDA
• USDA
• US Dept of Homeland Security
• US EPA
• CDC
• US Customs and Board Protection

• Center for Food Safety & Applied Nutrition
• - office of food safety
• - food protection plan
• Center for Veterinary Medicine
• Food Defense and Terrorism Program

• food safety and inspection service
• animal and plant health inspection service
• agricultural research service
• food and nutrition information center

Centers for Food Safety & Security

• food safety unit
• office of pesticide programs
• office of water

• food safety office
• foodborne outbreak response and surveillance unit
• national center for infectious diseases
• - emerging infectious diseases

most common biological hazard in US food

salmonella, escherichia coli O157:H7, listeria monocytogenes

• Almost $2 trillion of imported products enter US & will triple by 2015
• About 15% of these imported products are food and ingredients for human and animal consumption
• FDA regulates $417 billion worth of domestic foods, and $49 billion worth of imported food each year
• USDA regulates imported meat, poultry, and some egg products
• Mexico & Canada are 2 major food exporters
• China is growing - major supplier of seafood, canned vegetables, fruit juices, honey, etc.

• unintentional contamination
• unavoidable contaminants
• heavy metals, chlorinated hydrocarbons,
• nitrosamines & N-nitroso substances
• foodborne molds & mycotoxins, microbial
• avoidable contaminants
• pesticide residues, hormones & drugs in animals
• deliberate adulteration - illegal use of chemicals or drugs

• a product taken by mouth that contains a "diet ingredient" intended to supplement the diet
• include vitamins, minerals, herbs/other botanicals, amino acids, enzymes, organ tissues, glandulars, metabolites
• can be extracts or concentrates in many forms

• untruthful labeling and advertising
• misleading claims
• -health claims
• -structure/function claims
• -nutrient content claims
• fake products
• potential toxicity and toxicosis
• -contamination
• -adulteration with illegal drugs

• prevention - develop scientific and analytical tools to better identify and understand risks and the effectiveness of control measures
• intervention - using targeted risk-based inspections and testing to monitor preventive measures through use of modern detection technology system for targeting and conducting inspection and surveillance
• response - responding rapidly when problems are identified to inform consumers and to limit economic hardship to the affected industries

• 1. creates and up to date registry of all food facilities serving American customers
• 2. generates resources to support FDA oversight of food safety
• 3. prevents food safety problems before they occur
• 4. requires safety plans for fresh produce
• 5. increases inspections of food facilities
• 6. improves traceability of food
• 7. enhances safety of imported food
• 8. expands lab testing capacity
• 9. provides strong, flexible enforcement tools
• 10. creates fast-track import process for food meeting security standards
• 11. enhances the safety of infant formula
• 12. advances the science of food safety
• 13. enhances FDA's ability to block unsafe food from entering the food supply
• 14. directs FDA to assess the use of carbon monoxide in certain foods
• 15. enhances transparency of GRAS program
• 16. requires country-of-origin labeling and disclosure

• Toxicants known to be characteristic of the host and donor species
• the potential that food allergens will be transferred from one food source to another
• the concentration and bioavailability of important nutrients for which a food crop is ordinarily consumed
• the safety and nutritional value of newly introduced proteins
• the identity, composition and nutritional value of modified carbohydrates or fats & oils

• food is more complex and variable in composition than all other environmental substances
• food safety is different due to the nature and chemical complexity of food
• different issues in food safety around the world due to social, economical, and political systems
• traditional food safety (microbial and toxicological) methods and protocols challenged by new problems and technology

• PS - discrete, identifiable source
• can be regulated - discharge limits, effluent receiving water testing
• ex. industrial discharge, WWTP discharge, CAFOs, holding ponds

• NPS - diffuse pollution - multiple and/or nondiscrete sources
• difficult to monitor, regulate and control

• 1948 - Water Pollution Control Act
• 1972 - Clean Water Act

• drinking water
• human contact
• aquatic life - warm/cold water species, habitat
• agricultural water supply
• industrial water supply
• multiple uses

• relate to - protection of designated use, portion/characteristics of aquatic organisms, FW or marine?
• Numeric criteria consists of - concentration, exposure duration, recurrence interval, specific environmental conditions

• effluent standards
• industry requirements for permitting - pretreatment and self-monitoring
• enforced by EPA

• calculation of the max amount of a single pollutant that a surface water can receive and still meet water quality standards
• includes PS & NPS pollution

• 1914 - US Public Health Service
• 1974 - Safe Drinking Water Act

• #1 NPS pollution problem in US
• causes - construction, erosion from agricultural fields, deforestation

• decreased infiltration
• decreased groundwater flow to stream
• stream bank erosion
• increased runoff

• effects on resident organisms
• - smother benthic organisms
• - irritate/clog gills
• - reduce visibility
• effects on surface waters
• - silt deposition, clogged transportation channels
• - transport associated metals, nutrients, bacteria to water
• human health ramifications
• - contaminated DW supplies
• - increased cost of water purification

• industry
• agriculture
• animal waste
• detergents & soap

• urban - WWTP effluents
• stormwater
• sewer overflows
• light industry
• untreated sewage
• industrial waste

• rural - animal wastes (CAFOs)
• fertilizer runoff
• woodlots

• cultural eutrophication
• primary effects - algal blooms, low DO, shift to anaerobic decomposition
• secondary effects - population shifs

• changes the type of biota that can survive
• - loss of low DO intolerant organisms
• - increases in low DO tolerant organisms
• decreases rate of aerobic decomposition
• increases anaerobic decomposition

• 4 million cases worldwide
• 2.2 million deaths per year
• - 90% are children < 5
• - 80% are children < 2
• 1 in 200 children die from diarrhea worldwide
• 88% of diarrheal disease due to unsafe water, inadequate sanitation, and hygiene

• Safe Drinking Water Act - regulated pathogens
• Federal Water Pollution Control Act
• - Clean Water Act
• - BEACH Act

• bacteria
• eukaryotes
• viruses

• aeromonas hydrophilia
• cyanobacteria
• helicobacter pylori
• mycobacterium avium intracellulare

• acanthamoeba
• microsporidia (enterocytozoon & septata)

• adenoviruses
• caliciviruses
• coxsackieviruses
• echoviruses

• Goals:
• 1. eliminate discharge of pollutants
• 2. achieve WQ levels that are fishable and swimmable
• Attainment:
• 1. nationwide use of secondary treatment
• 2. development of national permit system
• Priorities for discharge
• - reducing BOD (biological oxygen demand)
• - suspended solid
• - toxic contaminants

added pathogen indicators for all coastal (recreational) waters

• 1. occurs simultaneously with pathogens
• 2. cannot grow in the environment
• 3. more resistant to disinfection and treatment than are pathogens
• 4. easy to isolate and count
• 5. can isolate from all types of water
• 6. not subject to antimicrobial action in the environment
• 7. only found in sewage (human feces)
• 8. found in higher numbers than pathogens
• 9. the density of the indicator should relate to the degree of contamination
• 10. the density of the indicator should relate to a specific health hazard or type of pollution

• 1st major shift in regulation policy for pathogens since CWA
• Evaluating WHO & EU approaces
• New rapid detection assays
• Predictive Modeling

• common in older cities
• stormwater and sewer lines are the same - if it rains, then treatment plants can't handle the volume and release untreated sewage
• overflow events vary by season - every rain event, threshold events
• reduce events by building holding tanks

• increase in malnutrition
• increase in number of people who die or contract a disease or illness from extreme weather conditions
• increase in the frequency of cardiorespiratory diseases from changes in air quality
• change in the range of infectious disease vectors
• reduction of cold related deaths
• increase in the burden of diarrheal diseases

• 1. invites the proliferation of rodents and insects
• 2. becomes a source of contamination to ground water
• 3. pollutes ambient air when combusted
• 4. facilitates the spread of debris around the dumping site
• 5. lowers property values about the site
• 6. encourages the spread of disease from microorganisms and toxic chemicals

• forbade open dumping and introduced the concept of the sanitary landfill
• the definition of hazardous waste in RCRA includes any discarded material that may pose a substantial threat or potential danger to human health or the environment when improperly handled

• source reduction (including reuse of products and backyard composting of yard trimmings)
• recycling of materials (including composting)
• waste combustion (preferably with energy recovery) and landfilling

• materials in MSW include paper and paperboard, yard trimmings, food wastes, plastics, glass, metal, and food wastes
• excludes municipal sludge, industrial non-hazardous waste, construction and demolition waste, agricultural waste, oil and gas waste, and mining wastes (everything that is landfilled in Subtitle D landfills)

• US produces 11 billion tons of solid waste each year
• Agricultural Waste - 50%
• Residues produced by mining and primary metal processing - 30%
• industrial waste - 400 million metric tons/year (3.6%)
• municipal waste - 200 million metric tons/year (1.8%) or 2 kg/person/day

• removal of solid waste is the responsibility of the government
• must develop and enforce regulations that protect the public health by proper collection and disposal

• Collection vehicles often include manually loaded compacting bodies which increases the capacity of the load that can be carried, and facilitates emptying at the disposal site
• A transfer station is a site where solid waste is concentrated before taken to a processing facility or a sanitary landfill
• Most often involves compaction by placing the waste into a metal channel where a ram compresses the waste into a roll-off collection container

• Landfill - 55.5%
• Recovery for recycling (including composting) - 27.3%
• Combustion - 17.2%

• 
• the bottom liners may be composed of one or more layers of clay or a synthetic flexible membrane (or some combination of both)

• burrowing and soil-dwelling animals, roots of vegetation
• precipitation, freeze-thaw cycles, wind
• uneven settling, migration of chemicals of objects
• exposure to sunlight

• Southeast - 35.9%
• West - 34.8%
• Midwest - 20.5%
• Northeast - 8.7%

• Activities that reduce the amount of the toxicity of wastes prior to entering the waste stream
• - products package reuse
• - package or product redesign that reduces material or toxicity
• - reducing use by modifying practices

the act of removing materials from MSW for a productive use

• Materials recycling facilities (MRFs) prepare recyclables for marketing
• a magnet removes steel objects, and recyclables are sorted manually
• glass bottles are separated into clear, brown, and green glass, and ground into small smooth pellets called cutlets

• 1. conserve resources by reducing the need for virgin and nonrenewable materials
• 2. reduce the amount of pollution by using secondary materials that require less energy to process
• 3. save energy by using recycled materials, since less is required for processing

• most of the recovery appears to be in paper and paperboard, accounting for nearly 57% of the material recovered
• this is followed by yard trimmings and food wastes which are composted (19.7%) and metals at 11.1%

• a controlled process of degrading organic matter by microorganisms into a humus-like material
• the composting material is often low in plant nutrients but is useful for conditioning soil by improving soil porosity and aeration and increasing water retention

• being used for wetlands mitigation, land reclamation, storm filtrates, soil amendments, mulches, and low-grade fertilizers
• the market penetration of compost is likely to increase when combined with education on the benefits of compost use

• combustion with the production of energy is called waste-to-energy (WTE)
• combustion of MSW without energy recovery is called incineration

• WTE plants are generally mass burn, although many incorporate recycling activities that remove noncombustible items such as metals and glass prior to burning
• the facility is designed in stages to minimize emissions
• Combustion --> Energy Recovery --> Pollution Control

• discarded solids or liquids with substances that are fatal in low concentrations, toxic, carcinogenic, mutagenic, or teratogenic - includes corrosive, explosive, reactive, and flammable materials
• US industries generate about 265 million metric tons of officially classified toxic wastes each year
• chemical and petroleum industries are the biggest sources of toxins

• 1. defining what wastes are hazardous
• 2. tracking wastes to the point of disposal
• 3. assuring that treatment, storage, and disposal (TSD) facilities meet minimum national standards
• 4. making certain TSDs are properly maintained after closure and that facility operators are financially responsible for hazardous waste releases that occur

amendments made to RCRA in 1984 that significantly expanded its regulatory powers

• 1. reducing the production of waste by reducing the amount generated or recycling/reusing the hazardous material after its generation
• 2. reducing the volume and/or hazard of the waste
• 3. long-term storage or disposal

• 1. eliminating or substituting raw materials for less hazardous ones
• 2. changing the manufacturing process to reduce or eliminate hazardous waste
• 3. separating or segregating waste at the source to prevent the contamination of non-hazardous waste

• landfills
• deep-well injection
• surface impoundments

• "superfund"
• authorized the federal government to spend $1.6 billion over a 5 yr period for emergency clean-up activities
• US EPA identifies potentially responsible parties (PRPs)
• liability rules applied include - retroactive liability, joint and several liability, and strict liability

• the USEPA established a hazard-ranking system (HRS) based on the estimated hazard potential of the hazardous waste site
• the factors used to make this estimate include the waste characteristics, the distance to the local population, surface water, groundwater, and drinking water supplies
• environmental groups and concerned citizens say RCRA was not being vigorously enforced
• Superfund Amendments and Reauthorization Act of 1986 (SARA) - increased the program's funding and provided new and stricter standards
• nearly 3,000 hazardous waste sites that have come under Superfund authority
• More than 1300 of these sites are on the USEPA's National Priority List (NPL)

multidisciplinary approach to the recognition, diagnosis, treatment, and prevention and control of work-related diseases, injuries and other conditions

EH - encompasses a wide array of determinants that can affect a person's health, including OH

• Industrial hygiene
• Occupational toxicology
• Occupational epidemiology
• Occupational medicine
• Regulatory Science

handle occupational hazards - anticipation, recognition, evaluation, and control

use the principles and methodology of toxicology to study adverse health effects and mechanisms of occupational hazards encountered at workplace

statistical analysis on frequency and occurrence of occupational disease, including biomonitoring and surveillance

diagnose and treat occupational illnesses or injuries

laws and regulations

• Over 40% of US workers are women, not accounting for full-time homemakers
• Approx 14% of American workers belong to unions
• Most US workers are employed by small or moderate-sized firms that do not employ physicians or other health professionals to provide health & safety
• Approx 2400 US physicians have been certified in Occupational Medicine by the American Board of Preventive Medicine

• An estimate 10 million work-related injuries and 430,000 new work-related illnesses occur each year in the US
• There may be 100,000 or more work-related deaths in the US each year
• 5,400 traumatic occupational fatalities occur in the US each year
• Highest rate are in mining, construction, and agriculture
• Each day in the US - avg of 9000 workers sustain disabling injuries on the job, 16 workers die from workplace injury, and 137 die from work-related diseases
• The number of occupational disease injuries reported is much lower

• Costs of occupational injuries were $145 billion/year
• Costs of occupational illnesses were $26 billion/year
• Total of $171 billion
• $33 billion for HIV
• $57 billion for Alzheimer's disease
• $164 billion for circulatory diseases
• $171 billion for cancer

• 1. Recognized as being related to work
• 2. Medical attention received, but relationship of illness to work not recognized
• 3. Symptoms, but no medial attention sought
• 4. Affected, but no symptoms

• Government role
• - Federal Coal Mine Safety and Health Act
• - Occupational Safety and Health Act (establishment of NIOSH)
• Occupational safety and health education
• Social and ethical questions
• Advances in technology
• The environmental movement
• Globalization of the economy

• Most people who are employed work in the informal sector of the economy - mainly in agriculture or in small-scale industries
• High rates of unemployment, often 25%+
• Workers are at greater risk of occupational hazards b/c
• - lower rates of education and literacy
• - unfamiliarity with work processes and exposure
• - high prevalence of endemic disease and malnutrition
• - inadequate infrastructure and human resources to recognize,
• diagnose, treat, and prevent and control work-related illnesses
• and injuries
• Wages are low - annual per capita income is $500 or less
• Vulnerable populations - women, children, migrants (floating populations)

• Also called occupational disease causing agents
• Industrial hazards - chemicals
• Degreasing solvents
• Acids, bases, other corrosive substances
• Metals
• Fumes & vapors
• Poison gases
• Chemical manufacture

• acids, bases, other corrosive substances
• cleaning/degreasing solvents
• tar/asphalt
• paint, varnish, paint remover fumes
• particulates
• used oil
• exhaust fumes

• metals
• particulates
• radiation

• A - pesticides (neurotoxicants, carcinogens, thyroid toxins)
• ammonia - irritant, nerve toxin
• nitrite - methemoglobin

L

• 1. establishing causality - difficult
• 2. occupational risk-assessment process
• In vitro assays
• Animal toxicology studies - identifying adverse effects, providing mechanistic data, establishing dose response relationships, and aiding the process of establishing standards
• Human challenge studies - verifying findings from animal studies, establishing biomarkers of exposure
• Case report
• Epidemiology studies - cross-sectional, cohort, case-control

• occupational vs. non-occupational exposures - are you on/off the job?
• latency periods - diseases from chemical exposure may be manifested many years after acute exposure or require many years of chronic exposure
• multifaceted etiology - there are many things which can cause a disease, figuring out which one is not easy

• cancer
• cardiovascular disorders
• eye disorders
• hearing impairment
• hematologic disorders
• hepatic disorders
• musculoskeletal disorders - low back pains, neck and upper extremity symptoms
• neuropsychiatric disorders
• renal and urinary tract disorders
• reproductive disorders
• respiratory disorders - fibrosis (silicosis, asbestosis, and pneumoconiosis), occupational asthma, pulmonary edema
• skin disorders - contact dermatitis

• The main goal of screening is early detection and treatment of disease
• Other goals include evaluation of the adequacy of exposure control and other means of primary prevention, detection of previously unrecognized health effects suspected on the basis of toxicologic and other studies, and suitable job placement
• Screening methods include questionnaires, physical examinations, and lab tests
• Should be simple, noninvasive, safe, rapid, and relatively inexpensive

• Use of lab for biomonitoring and clinical testing
• Proper workplace exposure assessment
• Concerns with ethical, legal, and socioeconomic factors
• The occupational history
• - description of all jobs held, both past and present
• - a review or work exposures in these jobs
• - information on the timing of symptoms in relation to work
• - epidemiology of symptoms or illnesses among coworkers
• - info on nonwork factors

• controlling risks at the source
• identifying new risks at the earliest possible time
• delivering the best level of theurapeutic care and rehabilitation for workers who are ill or injured
• preventing recurrence of disease and injury in other workers who are exposed to similar risks
• ensuring that affected workers receive economic compensation legally due them
• discovering new relationships between work exposure and disease

• the systematic and ongoing collection, analysis, and dissemination of information on disease, injury, or hazard for the prevention of morbidity and mortality
• different from "medical surveillance" which is focused on the interview and examination of the individual
• Two kinds:
• case-based
• rate-based

• to identify illnesses, injuring, and hazards that represent new opportunities for prevention
• to define the magnitude and distribution of the problem in the workplace
• to track trends in the magnitude of the problem as a rudimentary method of assessing the effectiveness of prevention efforts
• to target (identify) categories of occupations, industries, and specific worksites that require attention in the form of consultations, educational efforts, or inspections of compliance with established regulations
• to publicly disseminated information so that wise personal and societal decisions can be made

• designed to deter or avoid the occurrence of occupational disease or injury
• a carefully designed occupational surveillance program, using both case- and rate-based approaches

• designed to identify and adequately treat a disease or injury process as soon as possible
• the selection and use of screening and monitoring tests that are appropriate to identify workplace risks

• designed to treat a disorder when it has advanced beyond its early stages so as to avoid complication and limit disability
• the correct diagnosis and approach to treatment of a worker with an occupational illness or injury is essential to maximize opportunities for protection

• Personal protective equipment (PPE)
• Level A - self-contained breathing appartus with oxygen tank, thick rubber seamless suit - for highly toxic substances that may be present as gases or vapors and readily penetrate skin
• Level B - thin but chemical-impervious suit with or without hood, rubber gloves, boots, full face respirator (high performance filter but not air supply)
• Level C - label coats, overalls, face shield, eye protection, gloves, apron, may or may not require full/half-face respirator, surgical or dusk mask, shoe covers
• Level C - no special PPE other than uniform

• ventilation
• fume hoods
• shileding
• glove boxes
• dosimeters and mointors
• warning sirens
• mechanized/robotic handling of materials for highly toxic or radioactive materials

• limitations on duration and frequency that a person is allowed to work with a chemical or physical hazard or in a hazardous area, or limitations on distance from hazard
• monitoring - environmental, biological
• training and hazard communication

• any substance or mixture of substances intended for preventing, destroying, repelling or mitigating pests
• specific chemical or biological agents deliberately added to the environment for the purpose of killing or injuring some form of life
• Pests can be insects, rodents, weeds, a host of other unwanted organisms

• relies on the target species they act on
• insecticides
• herbicides
• fungicides
• rodenticides
• acaricides/miticides
• molluscides
• larvicides
• pediculocides - lice
• plant growth regulators
• reppellents
• attractants

• In developing world, excessive loss of food crops to insects or other pests may contribute to starvation, and use of pesticides have a favorable cost-benefit relationship
• in the developed world, use of pesticides makes production of abundant, inexpensive, and attractive fruits and vegetables, as well as grain
• pesticides are widely used in forestry, during reforestation, as well as the clearing of roadways, train tracks, and utilities surroundings
• in the urban settings, pesticides are used in the home and garden area to control insects, weeds, and other pests

• play a major role in the control of vector-borne diseases
• help to control various common diseases - malaria, yellow fever, etc
• balance between benefits and risks is still a challenge for the use and ban of certain pesticides (ex. DDT)

• via oral or dermal routes, or by inhalation
• oral exposure - suicidal or accidental, due to improper storage
• dermal and respiratory acute exposure for works involved in the production, transportation, mixing and loading, and application of pesticides
• chronic low dose exposure occurred as consumption of pesticide residues in food or as contaminants in drinking water

3 million poisonings and 220,000 deaths each year worldwide

• cancer risks -occupational, general population risks
• susceptible populations, especially for children
• endocrine disruptors for reproductive and developmental toxic effects

• awareness that the misuse of pesticides may pose potential health hazards
• Federal Insecticide, Fungicide and Rodenticide Act
• Federal Food, Drug, and Cosmetic Act - establishes max allowable levels of pesticide residues in food and animal feed
• Food Quality and Protection Act - continuing the expedite review for pesticides that may provide reduced risk for human health, nontarget species and the environment; exclude pesticide residues from the definition of food additives; assess special risks of pesticides to infant and children

• physical and mechanical interventions - use of techniques or materials
• biological control agents - use, manipulation and conservation of living organisms, usually natural enemies
• transgenic species
• chemical pesticide application - least harmful to the environment and human health

• DDT belongs to persistent organic pollutants (POPs), accumulates in ecosystems for years, and bioconcentrates as it moves up the food chain
• Has been shown to cause reproductive failure and other adverse outcomes in other species beyond target insect species
• May disrupt reproductive and endocrine functions and neurological development
• Potentially carcinogenic
• Continued use will result in insect resistance
• Alternatives are available

• has very low acute toxicity for humans and evidence for human carcinogenicity and other adverse effects is weak, in contrast the burden of mortality and morbidity from malaria is enormous
• relatively inexpensive compared to alternatives
• easy to mix and apply, thereby eliminating the need for training and supervision - practical for widespread use
• malaria and other vector-borne disease have surged in many areas following the phaseout of DDT
• now used for house spraying, a selective approach that requires much less volume than the previous agricultural and area spraying, which results in a much lower environmental load

• "pollutants"
• Toxins - substances that poison or harm a living organism
• Carcinogen - a substance known to cause cancer
• Endocrine disrupter - an agent that binds with hormones, blocking their normal function
• Teratogen - an agent causing malformation of a fetus through the mother

• Additive - linear relationship (2+3=5)
• Synergistic - effect is way bigger than either one alone (3+3=30)
• Potentiation - no effect unless in the presence of the other (0+4=12)
• Antagonism - decrease toxicity by adding one to another (2+7=4)

• bioaccumulation - when an organism is exposed to a substance over a period of time, accumulating higher levels of the substance in the body
• biomagnification - when organisms low on the food chain (prey) are consumed by organisms higher on the food chain (predators), increasing the levels of toxic agent in the predator

• naturally occurring
• by-products of industry, transportation, and other human activities

• Arsenic
• Chromium
• Cobalt
• Copper
• Iron
• Magnesium
• Manganese
• Molybdenum
• Nickel
• Selenium
• Tin
• Vanadium
• Zinc

• Aluminum
• Beryllium
• Cadmium
• Lead
• Mercury
• Nickel
• Plutonium
• Silver
• Thallium
• Titanium
• Uranium

• In solution, metals give up electrons to be net positive in charge
• as pH decreases, mobility and bioavailability increases
• ionization is influenced by environmental factors and differences amount metals, making generalities difficult
• biotransformation - speciation and conversion of metals by organisms
• microorganisms (& plants) can be used to transform metals into less toxic forms

• inhalation is a primary route for occupational exposure
• oral ingestion is another significant route, esp in children
• Drinking water is a primary source of metals
• blood flow largely determines rate and distribution of metals
• non-enzymatic proteins bind and inactivate metals, and are later excreted
• chelation therapy - agents given to organisms to bind metals

• many metals bind to sulfhydryl (-SH) groups
• metals inhibit enzyme activity by displacing essential metals & disrupt cell membrane integrity
• chronic exposure can lead to carcinogenicity
• several metals attack the CNS
• each metal has a unique mechanism of action to induce carcinogenicity

• biomarkers can be induced proteins, RNAs, or even the metals
• blood shows current/recent exposure
• hair & fingernails show longer-term exposure