HCL-PHS 121 Final Exam ch 11-13

Foodborne illnesses covered in class

• e. coli

• salmonellosis

• botulism

• trichinosis

• clostridium perfringens

• staphylococcus aureus

• taeniasis

• hepatitis a (HAV)

• norovirus

• mad cow disease

e. coli

• acute disease hemorrhagic colitis

  • linked to bloody diarrhea

• major outbreaks in hamburger chains from uncooked meat

• in the US, 73,000 cases and 61 deaths annually

• Chipotle outbreak

Salmonellosis

caused by bacterial agent salmonella

• raned among the most frequent types of foodborne illnesses in the US

• approximately 1 million cases (reported and nonreported) are estimated to occur each year

salmonellosis sources

• wild and domestic animal reservoirs

• animals used for human consumption

  • poultry

  • swine

  • cattle

• pet animals

  • cats

  • dogs

  • turtles

• some animals are chronic carriers

  • animals and birds

salmonellosis is transferred by

• environmental surfaces at work and at home from raw meats, poultry, and seafood

• animal feces

• contaminated water and soil

botulism

caused by infectious agent clostridium botulinum

• grows in anaerobic environment

  • spores are able to survive in foods that have been incorrectly or minimally processed

• produces potent toxin that affects the nervous system

Trichinosis

associated with eating meat that contains a roundworm from the genus trichinella

• classic agent of trichinosis: Trichinella spiralis

  • found in many carnivorous and omnivorous animals

• about 10,000 cases of trichinosis occur every year

• disease is often mistaken for the flu

• treatment is steroids and other drugs to be started asap

• cook meat to 140-160 F

Clostridium perfringens

• about 1 million cases each year in the US

• 2nd most frequent bacterial cause of foodborne illness

• occurs commonly in the environment, especially in areas contaminated with feces

• found in the intestines of humans and animals

Staphylococcus aureus

• causes a foodborne intoxication with rapid onset 

• elaborates a toxin that is resistant to cooking at high temperatures

• can trhive in an environment that has heavy concentrations of salt and sugar

  • ham is a frequent vehicle

• linked to foods that have not been stored in a safe temperature range

• present in the nasal passages and throats and on the hair and skin of 50% or more of healthy individuals

Taeniasis

• a parasitic disease caused by tapeworms

• organisms may induce human illness following consumption of raw or undercooked, infected beef or pork

hepatitis a (HAV)

common foods

• shellfish 

• salads

common mode for contamination of foods

• HAV-infected workers in food processing plants and restaurants

• incidence in US: approximately 1,600 cases annually

Norovirus

• transmitted easily within closed environments such as a cruise ship

• may be brought on board by passengers who fall ill just before embarking on a cruise

• crew members and shipboard environmental contamination may act as disease reservoirs

How you can get norovirus

providing care, changing diapers, shaking hands, or touching contaminated surfaces then touching your mouth

then you become ill

mad cow disease

• bovine spongiform encephalopathy (BSE)

  • neurological disease in cattle

  • ultimately fatal

  • transmissible among cattle

Different dimensions of solid waste

• recycling

• landfilling

• composting

• combustion/incineration

recycling

• process of collecting and reprocessing a resource so it can beused again

• advantages

  • reduces greenhouse gas emissions

  • decreases the amount of materials shipped to landfills

  • opens up new manufacturing employment opportunities

  • prevents pollution generated by the use of new materials

  • preserves natural resources

  • saves energy

landfilling

• dangers associated with landfills

  • air pollution and groundwater contamination could arise from landfills not being sealed properly

  • leachates may include

    • toxic heavy metals

    • solvents and cleaning agents

  • gaseous emissions from landfills

    • methane, volatile organic compounds (VOC) and other gases

      • methane vented from landfills poses a fire hazard and is a greenhouse has

      • VOC emissions

        • potentially carcinogenic

dangers associated with landfills: gaseous emissions

• methane, volatile organic compounds (VOC) and other gases

  • methane vented from landfills poses a fire hazard and is a greenhouse has

  • VOC emissions

    • potentially carcinogenic

    • may cause complaints about odors and symptoms or respiratory irritation

composting

• the aerobic biological decomposition of organic materials to produce a stable humus-like product

  • biodegradation is a natural, ongoing biological process that is a common occurrence in both human-made and natural environments

  • produces a useful material that resembles soil and that can be used in gardening

combustion/incineration

• can be used to generate energy while reducing the volume and weight of waste

• no attempt is made to separate trash into components

  • at high temperatures, glass and aluminum in the trash melt

• metals from the residues of combustion can be recycled into scrap metal

  • removing ash deposited in landfills

Prevention of occupational disease as it relates to OSHA

• public health surveillance is defined as “the ongoing systemic collection, analysis, and interpretation of health data essential to the planning, implementation, and evaluation of public health practices, closely integrated with the timely dissemination of these data to those who need to know.”

• surveillance systems are essential to enhance safety and health of the workplace and provide the foundation for epidemiologic studies of adverse health outcomes in the workplace

• OSHA is one of the US federal agencies collaborating in surveillance programs

What is mad hatter’s disease

• back in the day when they used to make fur on hats

• people inhaling the fumes of the mercury-containing solutions 

• neuropsychiatric syndrome is characterized by symptoms that include irritability, personality change, loss of self-confidence, depression, memory loss, and reduced ability to concentrate

Foodborne illness

same as foodborne disease but not the same as food poisoning

• illness caused by foods that have been consumed

• the major causes include toxins formed bt bacterial growth in the intestines or in food itself and by infections with bacteria and other microbes following the ingestion of contaminated food

Foodborne intoxicants

toxins formed by bacterial growth in the intestines or in food itself

foodborne infections

infections with bacteria and other microbes following the ingestion of contaminated food

outbreak

occurrence of a similar illness among two or more people which an investigation linked to consumption of a common meal or food items; except for botulism (one case is an outbreak)

Preservatives

added to foods to prevent the proliferation of microbes such as bacteria, yeasts, and molds

additives

• intentional (direct) additives

• incidental (indirect) additives

• Malicious additives

Intentional (direct) additives

added to foods to improve quality

Incidental (indirect) additives

may be present in foods as a result of unintentional contamination during packing, storage, handling

malicious additives

substances such as poisons that saboteurs introduce into foods for various reasons

antioxidants

• prevent fatty acids from acquiring a rancid taste

• prevent some foods from turning brown

• reduces the loss of vitamins

purpose of using antimicrobials in meats

• for disease prevention and growth enhancement

• it is given to an entire collection of animals (like chickens on a poultry farm or fish raised in pens), for the purpose of curing disease among the sick animals and preventing disease among the remainder

• regarding the use of antimicrobials for growth enhancement of animals, antimicrobials increase the efficiency of feeds by reducing the amount of feeds that animals require

Be able to explain the purpose of public health surveillance (explain the importance of the pyramid from the bottom up)

INSERT IMAGE

Principle of hazard analysis of critical control points

system for reducing the risk of foodborne illness

• using HACCP, foods are monitored from the time of harvest to the time of consumption

• Began in the 1950s

hazard analysis of critical control points steps

1. perform a hazard analysis

2. decide on the critical control points (CCPs)

3. Determine the critical limits

4. establish procedures to monitor the critical control points

5. Establish correction actions

6. Establish verification procedures

7. establish a record keeping system

Delaney Clause and its interpretation 

prohibited the use of additives, including pesticides, that had been determined to cause cancer in human beings and animals

Regulation of medical waste, who is responsible

EPA has assumed the primary role od regulating medical wastes by applying guidance acquired from the MWTA (Medical Waste Tracking Act of Congress)

Preferred method of safe disposal of hazardous wastes

• incineration

  • discarding them on the surface of the land

  • storing them into slurry ponds

  • dumping them into landfills or into the ocean

Legislation as it relates to hazardous waste sites

• The Medical Waste Tracking Act (MWTA) of 1988 expired in 1991. The law was created in response to the public’s concerns about potentially hazardous medical wastes such as used syringes and needles that were washing up on the shorelines of several Eastern states. The MWTA provided a 2-year time period during which the EPA was directed to develop regulations for management of medical wastes. When the MWTA ended, the EPA decided that the risk of medical waste was far greater to medical workers than to the general public

Landfill design and major components

4 major parts:

• bottom liner

• system for collecting leachates

  • water that collects contaminants as it trickles through wastes, pesticides, or fertilizers

• cover

• appropriate location that minimized the contamination of groundwater by materials released by the site

Significance of Love Canal

• former site for disposal of toxic wastes

• later used for residential construction

• identified with hazardous chemical exposures and their possible harmful influences on human health

• led to the creation of the superfund

Source reduction and activities involved

• number one on the EPA’s hierarchy for management of MSW, most environmentally preferred strategy

• reducing waste at the source

• components include:

  • waste reduction

  • waste recycling

recycling includes

• e-waste

• plastic

• metal

• glass

• paper

• organic

Solid waste management’s 4 main dimensions

• recycling

• landfilling

• composting

• combustion/incineration

hierarchy of favored management top to bottom

• source reduction and reuse

• recycling and composting

• energy recovery

• treatment and disposal

incineration

• can be used to generate waste while reducing the volume and weight of waste

• no attempt is made to separate trash into components

  • at high temperatures, glass and aluminum in the trash melt

• metals from the residues of combustion can be recycled into scrap metal

  • removing ash deposited in landfills

Rhazes connection to occupational medicine

used occupational classifications in medical case descriptions (ca. 850-923)

Paracelsus connection to occupational medicine

wrote a book on occupational diseases (1493-1531)

Bernadino Ramazzini

• father of occupational medicine

• described manifestations of occupational diseases

• publishes his book De Morbis artificum

  • which highlighted the risks of hazardous chemicals, dusts, and metals used in the workplace

Origin of occupational health

recognition of occupational risks from mining occurred during Greek and Roman times

Triangle Shirtwaist Company fire

• occurred on March 25, 1911, in NYC

• 146 women died within 15 minutes

• doors were locked and fire escapes were nonfunctional

Gauley brigde disaster

• covered a time span that began in 1931

• caused by exposure of unprotected workers to high levels of silica dust

• resulted in 1,500 cases of silicosis and 1,000 deaths

Nonfatal Occupational Injuries and Illnesses (Private Industry)

• during 2002, 4.7 mil? newly reported cases

• since 2002, number has continued to decline

• during 2015. 1,153,490 cases were reported

  • leading cause of injuries: strains and sprains

Prevention of occupational disease and guidelines

• engineering controls

• modification of work practices

• administration controls

• personal protective equipment

• guidelines

Engineering controls

• quieter machinery

• installation of protective guards

• improved building ventilation

Modification of work practices

• safety education and training programs

Administration controls

• organization of work shifts and rotation of employees

Personal protective equipment (PPE)

apparatuses designed to protect employees from serious workplace injuries or illnesses resulting from contact with chemical, radiological, physical, electrical, mechanical or other workplace hazards

• devices to protect against airborne hazards such as respirators

• devices to protect hearing such as ear muffs and plugs

• protective eyewear such as goggles, face shields, safety glasses, and full face respitators

guidelines for limitation of exposures

Organizations and government agencies have established guidelines for limitation of exposures. These standards make use of the terms threshold limit values (TLVs), biological exposure indices (BEIs), permissible exposure limits (PELs), and maximum allowable concentrations (MACs)

TLVs

airborne concentrations of substances and represents conditions under which it is believed that nearly all workers may be unaffected. Guidelines for TLVs are published by the American Conference of Governmental Industrial Hygienists (ACGIH) for use by trained industrial hygienists to assist them in decision-making regarding safe exposure levels to chemicals and physical agents in the workplace

BEIs

a measure of the amount of chemical absorbed into the body. Also published annually by the ACGIH

PELs

an OSHA standard that is subject specific and has the supporting documentation for promulgation and enforcement of occupational health regulations. PELs denote an allowable exposure level in the workplace air that is averaged over an eight-hour shift. This type of average is called a time-weighted average (TWA). PEKs refer to airborne concentration of substances, although they may also refer to dermatologic exposures

MACs

define permissible levels of exposure to chemicals

Specific occupationally associated diseases and conditions

• allergic and irritant dermatitis (contact dermatitis)

• Occupational associated respiratory diseases

  • COPD

  • Pneumonoconiosis

  • Asbestosis

  • Coal Worker’s Pneumoconiosis (Black Lung Disease)

  • Silicosis

• Fertility and Pregnancy abnormalities

• Hearing loss caused by noise

• Infectious diseases

• Musculoskeletal disorders

  • Carpal tunnel syndrome

  • back injuries

• Work-related injuries and fatalities

• Job stress and associated conditions

COPD

also called chronic lower respiratory disease (CLRD) and includes chronic and unspecified bronchitis, emphysema, asthma, and other chronic lower respiratory diseases

• 3rd leading cause of death in US in 2014

• about 15-19% of cases of COPD and asthma can be linked to occupational exposures

• Asthma has become the most frequently diagnosed occupational respiratory disease in occupational medicine clinics

• Occupational exposures may exacerbate preexisting asthma

• COPD is related to workplace exposure to dust

Pneumonoconiosis

the accumulation of dust in the lungs and the tissue reactions to its presence, where dustis an aerosol composed of solid inanimate particles.

• Can result in fibrosis of the lungs

  • asbestos

  • cotton dust

  • silica-containing dusts

  • coal dust

Asbestosis

a type of pulmonary fibrosis associated with exposure to asbestos, the name assigned to six different fibrous minerals in nature. Asbestosis results from inhalation of large amounts of asbestos fibers over long periods of time.

• occurs mainly among workers exposed to asbestos and uncommon among the general population

• related to declines in pulmonary function and increased risk of lung cancer, especially among smokers

Coal workers’ pneumoconiosis (black lung disease)

• potentially fatal lung disease that is associated with breathing coal dust, which then becomes deposited in the lungs. Over time, the lungs of persons who are afflicted with CWP lose their elasticity, causing respiration to become increasingly difficult

Silicosis

a condition caused by inhaling respirable crystalline silica dust

• the three major forms of silicosis are chronic silicosis, accelerated silicosis and acute silicosis

• workers encounter this during sandblasting, cutting tiles, and masonry and grinding cement

• symptoms include coughing, shortness of breath, weight loss

• causes lungs and lymph nodes to swell

• may result in pulmonary fibrosis, loss of lung function, and connective tissue disease

• persons with silicosis are at high risk of tuberculosis

• additional complications are lung cancer and respiratory failure

chronic silicosis

associated with long-term exposures to silica at low levels over a period of more than 20 years

accelerated silicosis

a rapidly progressing form that is associated with exposure to large amounts of silica during short time periods (5-15 years)

acute silicosis

caused by very heavy exposures to silica during short time periods; in this case, onset can be as soon as a year’s time

fertility and pregnancy related abnormalities

include dysfunctions that affect fetuses and infants

• birth defects

• prematurity

• low birth weight

• spontaneous abortions

• developmental disabilities

4,000 chemicals have been tested for adverse reproductive effects

• lead, solvents, ionizing radiation, anti-cancer drugs

hearing loss caused by noise

• occurs very commonly and takes a major toll on construction workers such as carpenters, as well as among employees in manufacturing

• about 33% of individuals exposed to noise at work had auditory impairment in comparison with 20% of those not exposed

• high levels of potentially dangerous job-related noise can impact up to 22 million workers each year in the US

• Each year workers’ comp for disability from hearing loss costs an estimated 242 million

• a logarithmic scale that uses decibels (dBs) measures the strength of sound. HL are hearing levels and SPL is sound pressure level.

  • Threshold of hearing is 0 dB/HL

  • sounds at 85 dB/SPL can produce slight hearing loss

  • Brief exposure to sounds at 100 dB/SPL can cause severe, permanent hearing loss

Infectious diseases

• healthcare workers are at an increased risk of exposure to hepatitis virus and HIV, particularly through accidental needle sticks, direct patient contact, and contact with blood and blood products

• public utility workers may be exposed to the hazards of disease carried in raw sewage

• agricultural workers are at increased risk of exposure to zoonotic disease agents contained in the soil

• social service workers and corrections personnel may be exposed to tuberculosis

• clinical laboratory specialists may be exposed to infectious agents from specimens including blood-borne pathogens, viruses, and bacterial agents

• mortuary workers are exposed to a range of microbial agents as human bodies are embalmed or exhumed from burial sites

• adult film industry workers are at risk from a range of bloodborne and sexually transmitted infections

Musculoskeletal disorders

Musculoskeletal disorder (MSD) refers to an injury or disorder of the muscles, nerves, tendons, joints, cartilage, or spinal discs. These conditions occur widely in the work environment

• a total of 356,910 cases if MSDs were reported in 2015 among workers in the private industry

• MSDs accounted for 31% of nonfatal occupational injury and illness cases requiring time away from work

• Over 300,000 cases of MSDs were reported in 2008

  • Of this total, 74% were caused by strains, sprains, and tears

• Carpal tunnel syndrome and back injuries are examples od MSDs

Carpal tunnel syndrome

condition associated with compression or squeezing of the median nerve, which runs from the forearm to the palm of the hand through the carpal tunnel of the wrist

• CTS may produce symptoms of numbness or pain in the wrist and hand

• may call for long periods of recuperation and absence from work

• related to repetitive work activities with the hand and wrist, one of the work domains with a high frequency of CTS is the meat packing industry

• The use of computer keyboards for an extended time periods has also been an identified risk factor for CTS

back injuries

• over 200,000 back related injuries or illnesses among private, state, and local government employers. Such injuries resulted in a median of 8 days from work

• back injuries accounted for 17% of all the occupational injuries and illnesses that require time away from work in 2015

• repetitive movements that affect the back

• remaining sedentary for long periods

• putting too much strain on the back

• nurses at high risk

  • 38% of nurses reported to have sustained back injuries

• laborers, carpenters, and drivers also at high risk

work-related injuries and fatalities

• cost billions of dollars in medical expenses, reduced productivity, and other costs annually

• injuries are defined as the result of energy applied to the human body in such a manner that the energy exceeds the body’s physiological tolerance

• nearly 5,000 workplace deaths in 2015

  • leading causes:

  • motor vehicles

  • homicides

  • machines

  • falls

  • electrocutions

  • falling objects

• the National Traumatic Occupational Fatalities (NTOF) Surveillance System was implemented by NIOSH in the 1980s to conduct a census of death certificate-based information in order to perform descriptive and analytic epidemiologic analyses of causes of job-related mortality 

• Second source of occupational mortality is the BLS Census of Fatal Occupational Injuries (CFOI), which collects information from various state and federal data sources

Job stress

the harmful physical and emotional responses that occur when the requirements of the job do not match the capabilities, resources, or needs of the worker

• may lead to poor health or even injury

• millennials experience it most and boomers face it moderately

• possible contributor to both impaired mental health status and poor physical health status

sources of job stress include

• work overload — long hours, high pressure, deadlines

• job dissatisfaction

• job insecurity due to fear of layoff, changes in the nature of work, global competition, and deregulation of labor

• workers lack control over their environment and conditions of employment; i.e. employment insecurity and shift work are associated with work-related stress

• assembly line work that involves repetitive tasks

• dealing with members of the public who may be abusive

• inadequate compensation and lack of benefits such as health insurance

job strain

arises from employment that combines low control over the decision-making process with high physiological demands. The association between job strain and the risk of morbidity and mortality from coronary heart disease and cardiovascular disease is a focus of research on the physical health consequences of stress