Personal Health Exam

Health is affected by the quality of the environment

• Environmental Health:

  • Study and management of environment conditions that affect our health and well-being

• Environmental Hazards:

  • Factors or conditions that increase the rise of human injury, disease, or death

  • Regulatory measures address environment assaults

Air Pollution:

• Air pollution – contamination of air by substances in great enough amounts to harm
  living organisms
  • Can be natural or manmade
  • Major sources in U.S. – transportation, electrical power plants fueled by oil and coal, industry

Primary pollutants – emanate directly from source
• Industrial smog
• Secondary pollutants – formed when primary pollutants react with another atmospheric component
• Photochemical smog - pollutants interact with sunlight
• Ozone (O3) – Builds up due to thermal inversion – warm air settles above cool air and prevents it frClean Air Act (CAA) – federal law that provides the government with authority to address interstate air pollution
• Environmental Protection Agency
(EPA) - federal agency primarily responsible for setting, maintaining, and enforcing environmental standards
• Criteria pollutants – Air pollutants of greatest concern

Air Quality Index (AQI) – an index that indicates the level of pollution in the air and the associated health risk

Greenhouse gases – Transparent to visible light, but absorb infrared radiation leading to global warming on rising

Air Quality Index:

Good: 0-50

Moderate: 51-100

Unhealthy for sensitive groups: 101-150

Unhealthy: 151-200

Very healthy: 201-300

Hazardous: >300

Indoor Air Pollutants

• Asbestos – naturally occurring mineral fiber
• Biogenic pollutants – airborne biological organisms (bacteria, mold, mildew, pollen, insect waste, animal dander)
• Combustion by-products – gases and particulates from candles, incense, wood stoves, gas ranges, etc. )
• Volatile organic compounds (VOC’s) – Building materials are often sources
• Formaldehyde – Found in a lot of consumer products/ carcinogenic
• Radon – an odorless naturally occurring gas that seeps into homes from ground/ carcinogenic
• Environmental tobacco smoke - mainstream smoke, sidestream smoke, passive smoking

Protecting Indoor Air

People spend 50-90% of indoors
• Sick building syndrome– describes a situation where the indoor air quality causes ill health in occupants
• No federal indoor clean air act but some states, counties and municipalities have their own laws

Smoking ordinances: Clean, uncontaminated water is essential for life
• Waterborne disease examples – cholera, typhoid fever, dysentery
• Responsible for 1.5 million deaths worldwide each year
• 26% of the world's population, lacked access to safe drinking water in 2022 (United Nations)
• U.S. – 100% of the population has access to clean water and sanitation
• Waterborne disease outbreaks still occur

Sources of Water

Surface water - streams, rivers, lakes, reservoirs

Groundwater - under surface of the ground

Aquifers - porous, water-saturated layers of underground bedrock, sand, and gravel that can yield economically significant amounts of water

Water Pollution

Water pollution – includes any physical or chemical change in water that can harm living organisms or make water unfit for other uses
• Point source pollution
• Pollution that can be traced to a single source
• Nonpoint source pollution
• All pollution that occurs through runoff, seepage, or falling of pollutants into water
• Runoff – water than flows over land surfaces picking up contaminants as it flows, typically from precipitation

Biological - living organisms or their products (Polio, Hepatitis, parasites, Giardia, E. coli,
Salmonella, etc.)
• Nonbiological – lead, copper, arsenic, industrial solvents, pesticides, endocrine disrupting
chemicals, pharmaceuticals, personal care products, etc.

Waterborne Disease Outbreak

Waterborne Disease Outbreak (WBDO) - At least 2 people epidemiologically linked to recreational or drinking water by location, time, and illness
• Drinking water outbreaks have declined in recent years, but outbreaks from recreational exposure have increased
• Four causes of water safety supply deterioration:
1. population growth
2. chemical manufacturing
3. reckless land use practices, and mismanagement
4. irresponsible disposal of hazardous wastes

Most municipalities use surface water, others use groundwater
• Needs to be treated/disinfected
• Responsible for providing water that is chemically and bacteriologically safe while
keeping the water aesthetically pleasing
Wastewater – What remains after humans have used water for domestic or commercial purposes
• Wastewater treatment – Improves the quality to the point where it can be released back into the environment Regulated by EPA
• Primary wastewater treatment – Allow sediments to settle to bottom of a large tank (sludge forms on bottom and scum on top)
• Secondary wastewater treatment – aerobic bacteria and O2 are mixed in with the clarified wastewater which helps the organic waste break down
• Tertiary wastewater treatment – Involves filtration through sand and carbon filters and disinfection (chlorine or UV light)

Septic tank – watertight tank
Absorption field – a system of trenches where perforated pipes are surrounded by gravel
• System must be:
• Located in appropriate soil
• Properly constructed and inspected prior to being buried
• Maintained regularly

Clean Water Act (CWA) – the federal law aimed at ensuring all rivers are swimmable and
fishable and that limits the discharge of pollutants in US waters to Zero
• Watershed – the area of land where all of the water that is under it or drains off of it goes
into the same place.
• Safe Drinking Water Act (SDWA) – the federal law that regulates the safety of drinking water
Target organism – the organism (pest) for which the pesticide is intended

Nontarget organisms – all other susceptible organisms in the environment, for which the pesticide was not intended

Solid waste – garbage, refuse, sludge, discarded solid materials
• 95%+ traced to agriculture, mining and gas and oil production, industry; <5% MSW
• Municipal solid waste (MSW)
• Generated by households, businesses, institutions located within municipalities
• Create 4.4 pounds MSW per person/day
• Hazardous waste – has properties that make it dangerous

Resource Conservation and Recovery Act of 1976 (RCRA) – first comprehensive law to address collection and disposal of solid and hazardous waste
• Solid waste management – the collection , transportation, and disposal of solid waste
• Focuses on:
• Source reduction (most desirable!)
• Recycling
• Composting
• Sanitary landfills (Must be constructed so that leachates do not contaminate surrounding ground)
• Combustion (incineration Natural Hazards (natural disasters) – naturally occurring phenomenon or event that produces or releases energy in amounts that exceed human
endurance, causing injury, disease, or death
Carrying Capacity -the maximum population of a particular species that a
given habitat can support over a given period of time

• Overpopulation and crowding

Aging

GERONTOLOGY – MULTIDISCIPLINARY STUDY OF THE BIOLOGICAL AND SOCIAL PROCESSES OF AGING AND THE ELDERLY
GERIATRICS – BRANCH OF MEDICINE CONCERNED WITH MEDICAL PROBLEMS AND CARE FOR THE ELDERLY
GERIATRICIAN – A PHYSICIAN SPECIALIZING IN THE CARE OF PDemography – the study of a population and those variables bringing about change in that population

The number of elders in the United States is on the rise, and they are more energetic than previous cohorts
Fertility rate – number of births per 1,000 women of childbearing age (15-44) in the population during a specific time period
• Baby Boomers – 1946-1964
• Mortality rates
• Life expectancy has continued to increase; significant increase in 20th century
• Migration
• Movement of people from one country to another can affect population size
• Historically, population there has been growth in U.S. due to migration
Number of divorced elders continues to rise
• New concerns: lack of retirement benefits, insurance, lower net worth assets

1970 – 25% of elders lived in poverty
2010 – 9% lived in poverty
2023 – 11.3% lived in poverty
• Major sources of income
• Social Security (reported by 87% of elders)
• Income from assets (reported by 53%)
• Private pensions (reported by 28%)
• Government employee pensions (reported by 14%)
• Earnings (reported by 26%)
Respite care - planned short-term care, usually for the purpose of relieving a full-time informal caregiver
Senior centers - congregation for fellowship, meals, education, and recreation

Death and Dying
Living will
- Decisions about resuscitation, mechanical ventilation, tube feeding, dialysis, medications, palliative care, organ donationLiving trust
- a legal agreement in which the testator's assets, including bank accounts, home, securities, etc., can be transferred and handled by an individual, including the testator, or corporation, such as a trust or bank.

The Bereavement services are provided to surviving family and loved ones

• Learning how to cope with the death of someone through the grieving process

• Accepting and/or letting go of someone who has died
  

• Palliative care
   Focused on improving patients’ quality of life
   Sometimes used to ease pain of treatment, but often it’s provided as part of the dying process

• Palliative care
   Does not require a terminal illness for palliative care benefits
   Includes care for side effects associated with chemotherapy and other treatments

• Hospice care
   Requires a terminal illness diagnosis
   Does not include care for treatments or cures

  Living donors: One kidney; one lung; or a portion of the liver,
  pancreas, or intestine
  

  Cardiovascular Disease
  Cardiovascular disease has been the #1 killer of both men and women since 1921
  Immune system attempts to repair damage: debris an and cholesterol can form a plaque

• Blockage in an artery of the brain = stroke

• Blockage in a coronary artery = heart attack

Coronary heart disease is most common CVD
 Plaque  partial obstruction angina chest pain
 May lead to myocardial infarction (heart attack) which can lead to cardiac arrest (total stoppage of heart function) and deatherol can form a plaque

Cerebrovascular Accident (CVA) or Stroke - Caused by sudden impairment of cerebral circulation

• Hemorrhagic stroke: bleeding into brain (10%)

• Ischemic stroke: blood clot obstructs flow (90%)

• TIA (transient ischemic attack) – mini stroke, temporary obstruction

  Peripheral artery disease: caused by atherosclerotic plaque that occurs in peripheral arteries (mainly legs and pelvis)

Blood Pressure:

Normal - Less than 120 and Less than 80

Elevated - 120-129 and Less than 80

High Blood Pressure (Hypertension) Stage 1 - 130-139 or 80-89

High Blood Pressure (Hypertension) Stage 2 - 140 or higher or 90 or higher

Hypertensive Crisis -Higher than 180 and/or Higher than 120

Diabetes Mellitus: Diabetes mellitus is an endocrine disorder characterized by high
blood sugar

• Caused by inadequate production of insulin, insulin resistance, or both

Diabetes Type I
 Islet cells in the pancreas are destroyed usually by autoimmune process
 Pancreas does not produce insulin (endogenous insulin)
 "juvenile diabetes" or "insulin-dependent diabetes”
Diabetes Type II
 “adult onset diabetes”
 Cells are resistant to action of insulin (insulin resistant)
  Pancreas works harder
  Insulin levels rise (often leading to fat storage)
  Pancreas eventually wears out
Gestational Diabetes
 During pregnancy
 Hormonal changes cause insulin resistance

If glucose cannot get into the cells, hyperglycemia (high glucose levels in the
blood) develops
 Kidneys attempt to excrete excess
glucose by passing it into the urine,
resulting in:
 Polyuria - excessive urination
 Glycosuria – Glucose in urine
 Polydipsia – excessive thirst
 Polyphagia – excessive hunger

Hypoglycemia – low blood glucose
• Diabetic ketoacidosis – life threatening
• Dental
• Pregnancy – birth defects and miscarriage

Diabetes 2

Previously called adult-onset diabetes mellitus(AODM)
and non-insulin dependent diabetes mellitus (NIDDM)
 Insulin is produced but the body’s cells do not respond
effectively: insulin resistance

Metabolic Syndrome

Must have three or more of the following:
 Elevated blood pressure (≥130/85 mmHg)
 Elevated blood sugar (FBS ≥100 mg/dL)
 Elevated triglycerides (≥150 mg/dL)
 Waist circumference ≥40 inches in men or ≥35 inches in women
 A low HDL of ≤ 50mg/dL in women or ≤ 40 mg/dL in men

Cancer : refers to a group of diseases with similar underlying process

Known carcinogens (cause oxidative stress)
 Lifestyle factors (nutrition, tobacco use, alcohol use, physical activity, etc.)
 Naturally occurring exposures (ultraviolet light, radon gas, infectious agents, etc.)
 Medical treatments (radiation and medicines including chemotherapy, hormone drugs, drugs that suppress the immune system, etc.)
 Workplace exposures

Three stages
Initiation: The initial stage of tumor formation involving transformation of cellular DNA
Promotion: Cells are activated by a promoting agent to multiply and form a new growth (neoplasm)
Progression: Cells aggregate and grow leading to a tumor – may be benign or malignant

Metastasis – the spread of cancer cells to distant sites
 Lymphatic system
 Circulatory system
 Nearby body cavities
 Malignant – cancerous
 Benign – non cancerous

Tumors are named according to tissue where they arise + “-oma”
• Carcinomas: epithelial tissue (85% of all cancers)
• Sarcomas: connective tissue
• Adenocarcinoma – gland cells
• Lymphomas: lymphatic system
• Neuroblastoma – immature cells of nervous system (children)
• Melanoma – Skin
• Leukemias: bone marrow/ blood

Used by 25 – 50 % of cancer patients
 Complementary therapies are typically noninvasive, inexpensive, and useful in controlling symptoms and improving quality of life during treatment
 Alternative therapies are used as a substitute for conventional anticancer treatment and may be harmful or ineffective
 Integrative oncology is emerging as the preferred term to differentiate between unproven therapy that is potentially unsafe and therapies that are more evidence based

Skin cancer: two major types
 Non-melanomatous
 The most commonly occurring cancer
 Basal cell carcinoma – non-melanomatous skin cancer that arises in the base layer of cells of the epidermis
 Squamous Cell Carcinoma – a type of non-melatomatous skin cancer that arises from the surface layer of cells of theepidermis

Prostate cancer
 Most common invasive cancer in men
 Second leading cause of cancer deaths in all men except Asian/Pacific Islanders

Colorectal cancer
 Colon cancer usually starts as benign polyp
 Third most common occurring invasive cancer

Sigmoidoscopy and colonoscopy (endoscopic procedures) can significantly reduce incidence and mortality from colorectal cancer.