Health risk assessment

From Wikipedia, the free encyclopedia
https://en.wikipedia.org/wiki/Health_risk_assessment

A health risk assessment (also referred to as a health risk appraisal and health & well-being assessment) is a questionnaire about a person's medical history, demographic characteristics and lifestyle. It is one of the most widely used screening tools in the field of health promotion and is often the first step in multi-component health promotion programs.

Definition

A health risk assessment (HRA) is a health questionnaire, used to provide individuals with an evaluation of their health risks and quality of life. Commonly a HRA incorporates three key elements – an extended questionnaire, a risk calculation or score, and some form of feedback, i.e. face-to-face with a health advisor or an automatic online report.

The Centers for Disease Control and Prevention define a HRA as: "a systematic approach to collecting information from individuals that identifies risk factors, provides individualised feedback, and links the person with at least one intervention to promote health, sustain function and/or prevent disease".

There is a range of different HRAs available for adults and children. Some target specific populations. For example, in the US, Medicare HRAs ask seniors about their ability to perform daily activities. Medicaid assessments ask questions about health-care access, availability of food, and living conditions. Most HRAs capture information relating to:

• Demographic characteristics – age, sex
• Lifestyle – exercise, smoking, alcohol intake, diet
• Personal and family medical history (in the US, due to the current interpretation of the Genetic Information Nondiscrimination Act, questions regarding family medical history are not permitted if there is any incentive attached to taking a HRA)
• Physiological data – weight, height, blood pressure, cholesterol
• Attitudes and willingness to change behaviour in order to improve health

The main objectives of a HRA are to:

• Assess health status
• Estimate the level of health risk
• Inform and provide feedback to participants to motivate behaviour change to reduce health risks

In the US, HRAs used as part of the Medicare Annual Wellness Visit help identify issues important to a senior's health and well-being. HRAs used as part of Medicaid enrollment help identify individuals with health problems that need immediate attention. The Community Preventive Services Task Force (CPSTF) recommends the use of HRAs in workplace settings when used in combination with health education, having found there is strong or satisfactory evidence that they help improve the following behaviors among employees:

• Tobacco
• Consuming too much alcohol
• Seat belts
• Fat consumption
• Blood pressure
• Absenteeism
• Healthcare services use
• Summary health risk estimates

History

The original concept of the HRA can be traced back to the decision by the assistant Surgeon General of the United States to conduct a study to determine the probable 10-year lifespan of individuals based on lifestyles and predisposed conditions. The project, led by Lewis C. Robbins, MD, of the Public Health Service, was the Framingham study. The study was based on in-depth longitudinal studies of 5,000 families in Framingham, Massachusetts, that continues to this day under funding from the National Institutes of Health.

Dr. Robbins left the Public Health Service and joined Methodist Hospital in Indianapolis where, working with Jack Hall, M.D., he developed the first set of health hazard tables. This culminated in the publication of How to Practice Prospective Medicine in 1970 – a guide for practising physicians, which outlined the health risk assessment questionnaire, risk computations and patient feedback strategies. During the 1960s, some researchers in California formed the Human Population Laboratory (HPL) to investigate factors contributing to quality of life. Inspired by a research article reporting on the HPL's Alameda County Study on the best lifestyle practices for good health, Don R. Hall, DrPH, developed a Health Age Assessment algorithm on a calculator while a masters student at Loma Linda University in 1972. In 1977, Hall coded his longevity calculations on a TRS-80, creating the first computerized health risk assessment. Within a year, he had programmed 12 health assessments on single topics such as nutrition, fitness, weight, and stress. In 1979, when personal desktop computers became readily available, he packaged all 12 assessments together on a floppy disk and marketed it as a comprehensive health risk assessment.

It was not until 1980, when the Centers for Disease Control and Prevention released a publicly available version, that the HRA became widely used, particularly in workplace settings. Health and Welfare Canada reviewed How to Practice Prospective Medicine and created a mainframe version of the book. The Centers for Disease Control became aware of this product and adapted it to the newly available personal computer. When Prudential Life Insurance also took an interest and asked to fund an update of the program, the CDC, which could not accept private project funding at the time, transferred ownership to the Carter Center at Emory University where it was updated from 1986 to 1987. The transfer and subsequent program were managed by Dr. Ed Hutchins, who had worked on the HRA in positions at the University of Pennsylvania and Charlotte-Mecklenburg Hospital. At Charlotte Mecklenburg, he secured a contract with the World Health Organization to create a mainframe product that could be used on an international basis. The HRA was managed as a not-for-profit product. Copies were distributed to every state health department, and liaisons were assigned to each to work with their staffs to evaluate related data. Over 2,000 copies of the software were distributed to users who requested it, and approximately 70 copies of the code were provided to for-profit companies that were interested in developing proprietary products. This proliferation coincided with the rapid growth in interest in corporate health promotion programs as awareness developed on health risks and for-profit vendors monetized the programs.

The Carter Center's interest shifted to Africa and Dr. Hutchins founded the Healthier People Network (HPN) in 1991 to continue the work. HPN raised funds to support the HRA, but additional funding was not forthcoming from government sources. As a result, the Carter Center and HPN could not underwrite basic supporting activities such as annual conferences and, over time, the State-based liaison network and associated intellectual capital atrophied as programs lost funding and liaisons moved on.

The use of HRAs and corporate wellness programs has been most prevalent in the United States, with comparatively slower growth elsewhere. However, there has been recent strong growth in corporate wellness outside the US, particularly in Europe and Asia.

Usage

Once an individual completes a HRA, they usually receive a report, detailing their health rating or score, often broken down into specific sub scores and areas such as stress, nutrition and fitness. The report can also provide recommendations on how individuals can reduce their health risks by changing their lifestyle.

In addition to individual feedback, HRAs are also used to provide aggregated data reporting for employers and organizations. These reports include demographic data of participants, highlight health risk areas and often include cost projections and savings in terms of increased healthcare, absence and productivity. Organization-level reports can then be used to provide a first step by which organizations can target and monitor appropriate health interventions within their workforce.

HRA delivery

The delivery of HRAs has changed over the years in conjunction with advances in technology. Initially distributed as paper-based, self-scoring questionnaires through on-site workplace health promotion sessions, HRAs are now most commonly implemented online. Other delivery methods include telephone, mail and face-to-face.

The advantages of online HRAs include:

• Tailoring – online HRAs can adapt content based on an individual's answers to the HRA questionnaire to provide a personalised, relevant and interactive user experience.
• Improved data management
• Reduced administrative costs
• Instant feedback

Efficacy

Extensive research has shown that HRAs can be used effectively to:

• Identify health risk factors
• Predict health-related costs
• Measure absenteeism and presenteeism
• Evaluate the efficacy and return on investment of health promotion strategies

There is also recent evidence to suggest that taking a HRA alone can have a positive effect on health behavior change and health status. However, it is generally accepted that HRAs are most effective at promoting behavior change when they form part of an integrated, multi-component health promotion program. Applied in this way, the HRA is used primarily as a tool to identify health risks within a population and then target health interventions and behavior change programs to address these areas.

Limitations

The limitations of a HRA are largely related to its usage and it is important to recognise that a HRA highlights health risks but does not diagnose disease and should not replace consultation with a medical or health practitioner.

Providers

There are reportedly over 50 different HRA providers in the market, offering a variety of versions and formats. Major vendors generally have National Committee for Quality Assurance (NCQA) Wellness and Health Promotion (WHP) Certification or Health Information Products (HIP) Certification.

Monochloramine

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Monochloramine 

 

Monochloramine

Names
Other names Chloramine Chloramide

Properties
Chemical formula	NH 2Cl
Molar mass	51.476 g mol−1
Appearance	Colorless gas
Melting point	−66 °C (−87 °F; 207 K)
Acidity (pKa)	14
Basicity (pKb)	15
Hazards
Occupational safety and health (OHS/OSH):
Main hazards	Corrosive acid
Ingestion hazards	Corrosive; nausea and vomiting
Inhalation hazards	Corrosive
Eye hazards	Irritation
Skin hazards	Irritation
GHS labelling:
Pictograms
Signal word	Danger
Hazard statements	H290, H314, H315, H319, H335, H372, H412
Precautionary statements	P234, P260, P261, P264, P270, P271, P273, P280, P301+P330+P331, P302+P352, P303+P361+P353, P304+P340, P305+P351+P338, P310, P312, P314, P321, P332+P313, P337+P313, P362, P363, P390, P403+P233, P404, P405, P501
NFPA 704 (fire diamond)	3 1 1 ACID
Lethal dose or concentration (LD, LC):
LD50 (median dose)	935 mg/kg (rat, oral)
Related compounds
Related compounds	Ammonia Dichloramine Nitrogen trichloride Fluoroamine

Monochloramine, often called chloramine, is the chemical compound with the formula NH₂Cl. Together with dichloramine (NHCl₂) and nitrogen trichloride (NCl₃), it is one of the three chloramines of ammonia. It is a colorless liquid at its melting point of −66 °C (−87 °F), but it is usually handled as a dilute aqueous solution, in which form it is sometimes used as a disinfectant. Chloramine is too unstable to have its boiling point measured.

Water treatment

See also: Chloramination

Chloramine is used as a disinfectant for water. It is less aggressive than chlorine and more stable against light than hypochlorites.

Drinking water disinfection

Chloramine is commonly used in low concentrations as a secondary disinfectant in municipal water distribution systems as an alternative to chlorination. This application is increasing. Chlorine (referred to in water treatment as free chlorine) is being displaced by chloramine—to be specific, monochloramine—which is much less reactive and does not dissipate as rapidly as free chlorine. Chloramine also has a much lower, but still active, tendency than free chlorine to convert organic materials into chlorocarbons such as chloroform and carbon tetrachloride. Such compounds have been identified as carcinogens and in 1979 the United States Environmental Protection Agency (EPA) began regulating their levels in US drinking water.

Some of the unregulated byproducts may possibly pose greater health risks than the regulated chemicals.

Due to its acidic nature, adding chloramine to the water supply may increase exposure to lead in drinking water, especially in areas with older housing; this exposure can result in increased lead levels in the bloodstream, which may pose a significant health risk. Fortunately, water treatment plants can add caustic chemicals at the plant which have the dual purpose of reducing the corrosivity of the water, and stabilizing the disinfectant.

Swimming pool disinfection

In swimming pools, chloramines are formed by the reaction of free chlorine with amine groups present in organic substances, mainly those biological in origin (e.g., urea in sweat and urine). Chloramines, compared to free chlorine, are both less effective as a sanitizer and, if not managed correctly, more irritating to the eyes of swimmers. Chloramines are responsible for the distinctive "chlorine" smell of swimming pools, which is often misattributed to elemental chlorine by the public. Some pool test kits designed for use by homeowners do not distinguish free chlorine and chloramines, which can be misleading and lead to non-optimal levels of chloramines in the pool water. There is also evidence that exposure to chloramine can contribute to respiratory problems, including asthma, among swimmers. Respiratory problems related to chloramine exposure are common and prevalent among competitive swimmers.

Though chloramine's distinctive smell has been described by some as pleasant and even nostalgic, its formation in pool water as a result of bodily fluids being exposed to chlorine can be minimised by encouraging showering and other hygiene methods prior to entering the pool, as well as refraining from swimming while suffering from digestive illnesses and taking breaks to use the bathroom.

Safety

US EPA drinking water quality standards limit chloramine concentration for public water systems to 4 parts per million (ppm) based on a running annual average of all samples in the distribution system. In order to meet EPA-regulated limits on halogenated disinfection by-products, many utilities are switching from chlorination to chloramination. While chloramination produces fewer regulated total halogenated disinfection by-products, it can produce greater concentrations of unregulated iodinated disinfection byproducts and N-nitrosodimethylamine. Both iodinated disinfection by-products and N-nitrosodimethylamine have been shown to be genotoxic, causing damage to the genetic information within a cell resulting in mutations which may lead to cancer.

Lead poisoning incidents

In the year 2000, Washington, DC, switched from chlorine to monochloramine, causing lead to leach from unreplaced pipes. The number of babies with elevated blood lead levels rose about tenfold, and by one estimate fetal deaths rose between 32% and 63%.

Trenton, Missouri made the same switch, causing about one quarter of tested households to exceed EPA drinking water lead limits in the period from 2017 to 2019. 20 children tested positive for lead poisoning in 2016 alone. In 2023, Virginia Tech Professor Marc Edwards said lead spikes occur in several water utility system switchovers per year, due to lack of sufficient training and lack of removal of lead pipes. Lack of utility awareness that lead pipes are still in use is also part of the problem; the EPA has required all water utilities in the United States to prepare a complete lead pipe inventory by October 16, 2024.

Synthesis and chemical reactions

Chloramine is a highly unstable compound in concentrated form. Pure chloramine decomposes violently above −40 °C (−40 °F). Gaseous chloramine at low pressures and low concentrations of chloramine in aqueous solution are thermally slightly more stable. Chloramine is readily soluble in water and ether, but less soluble in chloroform and carbon tetrachloride.

Production

In dilute aqueous solution, chloramine is prepared by the reaction of ammonia with sodium hypochlorite:

NH₃ + NaOCl → NH₂Cl + NaOH

This reaction is also the first step of the Olin Raschig process for hydrazine synthesis. The reaction has to be carried out in a slightly alkaline medium (pH 8.5–11). The acting chlorinating agent in this reaction is hypochlorous acid (HOCl), which has to be generated by protonation of hypochlorite, and then reacts in a nucleophilic substitution of the hydroxyl against the amino group. The reaction occurs quickest at around pH 8. At higher pH values the concentration of hypochlorous acid is lower, at lower pH values ammonia is protonated to form ammonium ions (NH⁺
₄), which do not react further.

The chloramine solution can be concentrated by vacuum distillation and by passing the vapor through potassium carbonate which absorbs the water. Chloramine can be extracted with ether.

Gaseous chloramine can be obtained from the reaction of gaseous ammonia with chlorine gas (diluted with nitrogen gas):

2 NH₃ + Cl₂ ⇌ NH₂Cl + NH₄Cl

Pure chloramine can be prepared by passing fluoroamine through calcium chloride:

2 NH₂F + CaCl₂ → 2 NH₂Cl + CaF₂

Decomposition

The covalent N−Cl bonds of chloramines are readily hydrolyzed with release of hypochlorous acid:

RR′NCl + H₂O ⇌ RR′NH + HOCl

The quantitative hydrolysis constant (K value) is used to express the bactericidal power of chloramines, which depends on their generating hypochlorous acid in water. It is expressed by the equation below, and is generally in the range 10⁻⁴ to 10⁻¹⁰ (2.8×10⁻¹⁰ for monochloramine):

${\displaystyle K=\frac{c_{{\text{RR}}^{\prime }\text{NH}}\cdot c_{\text{HOCl}}}{c_{{\text{RR}}^{\prime }\text{NCl}}}}$

In aqueous solution, chloramine slowly decomposes to dinitrogen and ammonium chloride in a neutral or mildly alkaline (pH ≤ 11) medium:

3 NH₂Cl → N₂ + NH₄Cl + 2 HCl

However, only a few percent of a 0.1 M chloramine solution in water decomposes according to the formula in several weeks. At pH values above 11, the following reaction with hydroxide ions slowly occurs:

3 NH₂Cl + 3 OH⁻ → NH₃ + N₂ + 3 Cl⁻ + 3 H₂O

In an acidic medium at pH values of around 4, chloramine disproportionates to form dichloramine, which in turn disproportionates again at pH values below 3 to form nitrogen trichloride:

2 NH₂Cl + H⁺ ⇌ NHCl₂ + NH⁺
₄

3 NHCl₂ + H⁺ ⇌ 2 NCl₃ + NH⁺
₄

At low pH values, nitrogen trichloride dominates and at pH 3–5 dichloramine dominates. These equilibria are disturbed by the irreversible decomposition of both compounds:

NHCl₂ + NCl₃ + 2 H₂O → N₂ + 3 HCl + 2 HOCl

Reactions

In water, chloramine is pH-neutral. It is an oxidizing agent (acidic solution: E° = +1.48 V, in basic solution E° = +0.81 V):

NH₂Cl + 2 H⁺ + 2 e⁻ → NH⁺
₄ + Cl⁻

Reactions of chloramine include radical, nucleophilic, and electrophilic substitution of chlorine, electrophilic substitution of hydrogen, and oxidative additions.

Chloramine can, like hypochlorous acid, donate positively charged chlorine in reactions with nucleophiles (Nu⁻):

Nu⁻ + NH₃Cl⁺ → NuCl + NH₃

Examples of chlorination reactions include transformations to dichloramine and nitrogen trichloride in acidic medium, as described in the decomposition section.

Chloramine may also aminate nucleophiles (electrophilic amination):

Nu⁻ + NH₂Cl → NuNH₂ + Cl⁻

The amination of ammonia with chloramine to form hydrazine is an example of this mechanism seen in the Olin Raschig process:

NH₂Cl + NH₃ + NaOH → N₂H₄ + NaCl + H₂O

Chloramine electrophilically aminates itself in neutral and alkaline media to start its decomposition:

2 NH₂Cl → N₂H₃Cl + HCl

The chlorohydrazine (N₂H₃Cl) formed during self-decomposition is unstable and decomposes itself, which leads to the net decomposition reaction:

3 NH₂Cl → N₂ + NH₄Cl + 2 HCl

Monochloramine oxidizes sulfhydryls and disulfides in the same manner as hypochlorous acid, but only possesses 0.4% of the biocidal effect of HClO.

Nitrogen trichloride

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Nitrogen_trichloride 

 

Nitrogen trichloride

Nitrogen, N   Chlorine, Cl
Names
Other names Trichloramine Agene Nitrogen(III) chloride Trichloroazane Trichlorine nitride

Properties
Chemical formula	NCl3
Molar mass	120.36 g·mol−1
Appearance	yellow oily liquid
Odor	chlorine-like
Density	1.653 g/mL
Melting point	−40 °C (−40 °F; 233 K)
Boiling point	71 °C (160 °F; 344 K)
Solubility in water	immiscible slowly decomposes
Solubility	soluble in benzene, chloroform, CCl4, CS2, PCl3
Structure
Crystal structure	orthorhombic (below −40 °C)
Molecular shape	trigonal pyramidal
Dipole moment	0.6 D
Thermochemistry
Std enthalpy of formation (ΔfH⦵298)	232 kJ/mol
Hazards
NFPA 704 (fire diamond)	2 0 4 OX
Autoignition temperature	93 °C (199 °F; 366 K)
Related compounds
Other anions	Nitrogen trifluoride Nitrogen tribromide Nitrogen triiodide
Other cations	Phosphorus trichloride Arsenic trichloride
Related chloramines	Monochloramine Dichloramine
Related compounds	Nitrosyl chloride

Nitrogen trichloride, also known as trichloramine, is the chemical compound with the formula NCl₃. This yellow, oily, and explosive liquid is most commonly encountered as a product of chemical reactions between ammonia-derivatives and chlorine (for example, in swimming pools). Alongside monochloramine and dichloramine, trichloramine is responsible for the distinctive 'chlorine smell' associated with swimming pools, where the compound is readily formed as a product from hypochlorous acid reacting with ammonia and other nitrogenous substances in the water, such as urea from urine.

Preparation and structure

The compound is prepared by treatment of ammonium salts, such as sal ammoniac with a chlorine source.

Intermediates in this conversion include monochloramine and dichloramine, NH₂Cl and NHCl₂, respectively.

Like ammonia, NCl₃ is a pyramidal molecule. The N-Cl distances are 1.76 Å, and the Cl-N-Cl angles are 107°.

Reactions and uses

The chemistry of NCl₃ has been well explored. It is moderately polar with a dipole moment of 0.6 D. The nitrogen center is basic but much less so than ammonia. It is hydrolyzed by hot water to release ammonia and hypochlorous acid.

${\displaystyle {\text{NCl}}_3^{}+3{\text{H}}_2^{}\text{O}⟶{\text{NH}}_3^{}+3\text{HOCl}}$

${\displaystyle {\text{NCl}}_3^{}}$ explodes to give ${\displaystyle {\text{N}}_2^{}}$ and chlorine gas.

${\displaystyle 2{\text{NCl}}_3^{}⟶{\text{N}}_2^{}+3{\text{Cl}}_2^{}}$

This reaction is inhibited for dilute gases.

Nitrogen trichloride can form in small amounts when public water supplies are disinfected with monochloramine, and in swimming pools by disinfecting chlorine reacting with urea in urine and sweat from bathers.

Nitrogen trichloride, trademarked as Agene, was at one time used to bleach flour, but this practice was banned in the United States in 1949 due to safety concerns.

Safety

Nitrogen trichloride can irritate mucous membranes—it is a lachrymatory agent, but has never been used as such. The pure substance (rarely encountered) is a dangerous explosive, being sensitive to light, heat, even moderate shock, and organic compounds. Pierre Louis Dulong first prepared it in 1812, and lost several fingers and an eye in two explosions. In 1813, an NCl₃ explosion blinded Sir Humphry Davy temporarily, inducing him to hire Michael Faraday as a co-worker. They were both injured in another NCl₃ explosion shortly thereafter.

Risk factor

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Risk_factor

In epidemiology, a risk factor or determinant is a variable associated with an increased risk of disease or infection.

Due to a lack of harmonization across disciplines, determinant, in its more widely accepted scientific meaning, is often used as a synonym. The main difference lies in the realm of practice: medicine (clinical practice) versus public health. As an example from clinical practice, low ingestion of dietary sources of vitamin C is a known risk factor for developing scurvy. Specific to public health policy, a determinant is a health risk that is general, abstract, related to inequalities, and difficult for an individual to control. For example, poverty is known to be a determinant of an individual's standard of health.

Risk factors may be used to identify high-risk people.

Correlation vs causation

Risk factors or determinants are correlational and not necessarily causal, because correlation does not prove causation. For example, being young cannot be said to cause measles, but young people have a higher rate of measles because they are less likely to have developed immunity during a previous epidemic. Statistical methods are frequently used to assess the strength of an association and to provide causal evidence, for example in the study of the link between smoking and lung cancer. Statistical analysis along with the biological sciences can establish that risk factors are causal. Some prefer the term risk factor to mean causal determinants of increased rates of disease, and for unproven links to be called possible risks, associations, etc.

When done thoughtfully and based on research, identification of risk factors can be a strategy for medical screening.

Terms of description

Mainly taken from risk factors for breast cancer, risk factors can be described in terms of, for example:

• Relative risk, such as "A woman is more than 100 times more likely to develop breast cancer in her 60s than in her 20s."
• Fraction of incidences occurring in the group having the property of or being exposed to the risk factor, such as "99% of breast cancer cases are diagnosed in women."
• Increase in incidence in the exposed group, such as "each daily alcoholic beverage increases the incidence of breast cancer by 11 cases per 1000 women."
• Hazard ratio, such as "an increase in both total and invasive breast cancers in women randomized to receive estrogen and progestin for an average of 5 years, with a hazard ratio of 1.24 compared to controls."

Example

At a wedding, 74 people ate the chicken and 22 of them were ill, while of the 35 people who had the fish or vegetarian meal only 2 were ill. Did the chicken make the people ill?

${\displaystyle Risk=\frac{\text{number of persons experiencing event (food poisoning)}}{\text{number of persons exposed to risk factor (food)}}}$

So the chicken eaters' risk = 22/74 = 0.297
And non-chicken eaters' risk = 2/35 = 0.057.

Those who ate the chicken had a risk over five times as high as those who did not, that is, a relative risk of more than five. This suggests that eating chicken was the cause of the illness, but this is not proof.

This example of a risk factor is described in terms of the relative risk it confers, which is evaluated by comparing the risk of those exposed to the potential risk factor to those not exposed.

General determinants

The probability of an outcome usually depends on an interplay between multiple associated variables. When performing epidemiological studies to evaluate one or more determinants for a specific outcome, the other determinants may act as confounding factors, and need to be controlled for, e.g. by stratification. The potentially confounding determinants varies with what outcome is studied, but the following general confounders are common to most epidemiological associations, and are the determinants most commonly controlled for in epidemiological studies:

• Age (0 to 1.5 years for infants, 1.5 to 6 years for young children, etc.)
• Sex or gender (Male or female)
• Ethnicity (Based on race)

Other less commonly adjusted for possible confounders include:

• Social status/income
• Geographic location
• Genetic predisposition
• Gender identity
• Occupation
• Overwork
• Sexual orientation
• Level of chronic stress
• Diet
• Level of physical exercise
• Alcohol consumption and tobacco smoking
• Other social determinants of health

Risk marker

A risk marker is a variable that is quantitatively associated with a disease or other outcome, but direct alteration of the risk marker does not necessarily alter the risk of the outcome. For example, driving-while-intoxicated (DWI) history is a risk marker for pilots as epidemiologic studies indicate that pilots with a DWI history are significantly more likely than their counterparts without a DWI history to be involved in aviation crashes.

History

The term "risk factor" was coined by former Framingham Heart Study director, William B. Kannel in a 1961 article in Annals of Internal Medicine.

Environmental disease

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Environmental_disease

In epidemiology, environmental diseases are diseases that can be directly attributed to environmental factors (as distinct from genetic factors or infection). Apart from the true monogenic genetic disorders, which are rare, environment is a major determinant of the development of disease. Diet, exposure to toxins, pathogens, radiation, and chemicals found in almost all personal care products and household cleaners, stress, racism, and physical and mental abuse are causes of a large segment of non-hereditary disease. If a disease process is concluded to be the result of a combination of genetic and environmental factor influences, its etiological origin can be referred to as having a multifactorial pattern.

There are many different types of environmental disease including:

• Disease caused by physical factors in the environment, such as skin cancer caused by excessive exposure to ultraviolet radiation in sunlight
• Disease caused by exposure to toxic or irritant chemicals in the environment such as toxic metals
• Disease caused by exposures to toxins from biologic agents in the environment, such as aflatoxicosis from molds that produce aflatoxin
• Disease caused by exposure to toxic social factors in the environment, such as racism
• Lifestyle disease such as cardiovascular disease, diseases caused by substance abuse such as alcoholism, and smoking-related disease

Environmental diseases vs. pollution-related diseases

Environmental diseases are a direct result from the environment. Meanwhile, pollution-related diseases are attributed to exposure to toxicants or toxins in the air, water, and soil. Therefore, all pollution-related disease are environmental diseases, but not all environmental diseases are pollution-related diseases. 

Urban-associated diseases

Urban areas are highly dense regions that currently hold ~50% of the global population, a number expected to grow to 70% by 2050, and produce over 80% of the global GDP. These areas are known to have a higher incidence of certain diseases, which is of particular concern given their rapid growth. The urban environment includes many risk factors for a variety of different environmental diseases. Some of these risk factors, for instance, air-pollution, are well known, while others such as altered microbial exposure are less familiar to the general public. For instance, asthma can be induced and exacerbated by combustion related pollution, which is more prevalent in urban areas. On the other hand, urban areas, compared to their rural counterparts, lack diverse microbial communities, which can help prevent the development of asthma. Both of these effects lead to a higher incidence of asthma in cities. Infectious diseases are also often more common in cities, as transfer between hosts is facilitated by high population densities. However, recent research shows that increased access to healthcare weakens the urban association with these diseases, and the net effect is still unclear. Many mental health disorders have also been associated with urban areas, especially in low socioeconomic areas. Increased levels of stress, air & light & noise pollution, and reduced "green" space are all urban-associated environmental effects that are adversely linked to mental health. Though urban areas are often correlated with dirtiness and disease, they are likely to have more access to higher quality health care which can lead to more positive health outcomes. This benefit will continue to grow as innovation in health technologies steadily rises. Taking this into account, while overall trends do exist, urban risk factors are nuanced and often city and context dependent.

Chemicals

Further information: Pollution; Hazardous waste; Toxicity class; Volatile organic compound; Plastic pollution; Organic dust toxic syndrome; Persistent, bioaccumulative and toxic substances; and Persistent organic pollutant

Metals

Further information: heavy metals, metal toxicity, Toxic heavy metal, Lead poisoning, Mercury poisoning, Zinc toxicity, Chromium toxicity, and cadmium poisoning

Poisoning by lead and mercury has been known since antiquity. Other toxic metals or metals that are known to evoke adverse immune reactions are arsenic, phosphorus, zinc, beryllium, cadmium, chromium, manganese, nickel, cobalt, osmium, platinum, selenium, tellurium, thallium, uranium, and vanadium.

Halogens

There are many other diseases likely to have been caused by common anions found in natural drinking water. Fluoride is one of the most common found in drier climates where the geology favors release of fluoride ions to soil as the rocks decompose. In Sri Lanka, 90% of the country is underlain by crystalline metamorphic rocks of which most carry mica as a major mineral. Mica carries fluoride in their structure and releases to soil when decomposes. In the dry and arid climates, fluoride concentrates on top soil and slowly dissolves in shallow groundwater. This has been the cause of high fluoride levels in drinking water where the majority of the rural Sri Lankans obtain their drinking water from backyard wells. High fluoride in drinking water has caused a high incidence of fluorosis among dry zone population in Sri Lanka. However, in the wet zone, high rainfall effectively removes fluoride from soils where no fluorosis is evident. In some parts of Sri Lanka iodine deficiency has also been noted which has been identified as a result of iodine fixation by hydrated iron oxide found in lateritic soils in wet coastal lowlands.

See also: Pool chlorine hypothesis

Organic compounds

Additionally, there are environmental diseases caused by the aromatic carbon compounds including : benzene, hexachlorocyclohexane, toluene diisocyanate, phenol, pentachlorophenol, quinone and hydroquinone.

Also included are the aromatic nitro-, amino-, and pyridilium-deratives: nitrobenzene, dinitrobenzene, trinitrotoluene, paramethylaminophenol sulfate (Metol), dinitro-ortho-cresol, aniline, trinitrophenylmethylnitramine (tetryl), hexanitrodiphenylamine (aurantia), phenylenediamines, and paraquat.

The aliphatic carbon compounds can also cause environmental disease. Included in these are methanol, nitroglycerine, nitrocellulose, dimethylnitrosamine, and the halogenated hydrocarbons: methyl chloride, methyl bromide, trichloroethylene, carbon tetrachloride, and the chlorinated naphthalenes. Also included are glycols: ethylene chlorhydrin and diethylene dioxide

Noxious gases

See also: passive smoking

Noxious gases can be categorized as : Simple asphyxiants, chemical asphyxiants, and irritant gases. The simple asphixiants are nitrogen, methane, and carbon dioxide. The chemical asphyxiants are carbon monoxide, sulfuretted hydrogen and hydrogen cyanide.

The irritant gases are sulfur dioxide, ammonia, nitrogen dioxide, chlorine, phosgene, and fluorine and its compounds, which include luroine and hydrofluoric acid, fluorspar, fluorapatite, cryolite, and organic fluorine compounds.

Categorization and surveillance

The U.S. Coast Guard has developed a Coast Guard-wide comprehensive system for surveillance of workplace diseases.

The American Medical Association's fifth edition of the Current Medical Information and Terminology (CMIT) was used as a reference to expand the basic list of 50 Sentinel Health Events (Occupational) [SHE(O)] published by the National Institute for Occupational Health and Safety (NIOSH), September, 1983.