CHAPTER 3

EPIDEMIOLOGIC AND TOXICOLOGIC

ASPECTS OF OCCUPATIONAL HEALTH
AND SAFETY
EPIDEMIOLOGY
-the study of the occurrence and
distribution of health-related states or
events in specified population, including
the study of the determinants influencing
such states, and the application of this
knowledge to control the problems.
Descriptive epidemiologic
-is one that characterizes the amount
and distribution of disease within a
population.
-a descriptive study is concerned with
and designed only to describe the existing
distribution of variable without much
regard to causal relationships or other
hypotheses.
CLUSTERING
-refers to closely grouped series of events or cases of a
disease or other health-related phenomena with well-defined
distribution patterns in relation to time or place or both.

CANCER CLUSTERS
-the occurrence of a greater than expected number of
cancer cases among a group of people in a defined geographic
area over a specific time period.
ANALYTIC EPIDEMIOLOGY
-explores the determinant of disease that is,
the cause of relatively high or low frequencies
of disease in specific population.
OCCUPATIONAL EPIDEMIOLOGY
-the study of the effects of workplace exposures on
the frequency and distribution of diseases and injuries
in the population.

Objective and uses of occupational epidemiology

1.prevention through identifying the consequences
of workplace exposures on health.
2. result from specific settings to reduce or to
eliminate hazards in the population at large.
PREVALENCE
-the number of affected persons present in the population at a specific time divided
by the number of persons in the population at that time.
INCIDENCE
-the number of instances of illnesses commencing, or of persons falling ill, during a
given a specified population.
RATE
-is a measure with a numerator and a denominator, in which the denominator
involve of measure of time. the numerator consist of the frequency of a disease over a
specified period of time the denominator is a unit of size of population.
INCIDENCE RATE
-is formed by dividing the number of new cases that occur during a time of period
by the number of individual in the population at risk.
DATE RATE
-is an estimate of the proportion of a population that dies during a specified period.
AGE-SPECIFIC AND CAUSE-SPECIFIC RATES
-specific rates are a type of rate based on a particular subgroup of the population
defined.
-cause-specific rate is a rate specifies events, such as deaths, specific mortality
rate.
RATE ADJUSMENT AND STANDARDIZATION
-are summary measure of the rate of morbidity or mortality
in population; statistical procedures have been applied to
remove the effect of differences in composition of the various
population.
AGE STANDARDIZATION
-is a statistical procedure that remove the influence of age
from a measure .
STANDARDIZED MORTALITY RATIO
-is the ratio of the observed mortality in a population to the
expected mortality.
EPIDEMIOLOGIC TRIANGLE
-it is helpful for explaining the occurrence of
work-related adverse health outcomes.
-epidemiologic triangle provides one of the
fundamental public health conceptions of
disease causality.
3 MAJOR FACTOR

1. agent
which in the occupational setting includes hazardous microbes, physical
hazard, and potentially dangerous chemicals.
2. Environment
refers to the domain in which the disease-causing agent may exist, survive,
or originate.
external environment-is the sum total of influences that are not part of
the host and comprises physical, climatologic, biologic, social, and
economic component.
physical environment-includes temperature and humidity in the work
setting as well as weather, which is a salient factor for people who work
outdoors.
social environment-is the totality of the behavioral, personality,
attitudinal, and cultural characteristics of a group of people.
3. Host
the host is individual worker, but it also can include family members of the
worker and larger community.
EPIDEMIOLOGIC RESEARCH METHOD USED IN OCCUPATIONAL HEALTH AND SAFETY
-include the selection of appropriate data source, choice of study design, factors needed to
ascertain causal linkage between exposures and outcome, and the potential influence of bias.

OCCUPATIONAL HEALTH DATA SOURCES

-a variety of data source are used in occupational health research; surveillance data,
survey, worker exposure data, information from employment records, and vital statistic data.
-these data may be used as information for specific epidemiologic research design;
*public health surveillance data taken from surveillance system.-public health surveillance
is the ongoing systematic 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.
*population survey-information from workers in a single company or a larger population,
health outcomes, duration of employment, and types of exposure.
*exposure measurement- source of exposure information include data that have been
collected by monitoring instrument placed in the work environment and by personal monitors
worn by employees.
*employment records- this data source is useful for verifying duration of employment and
exposures on the job site.
*vital statistics data- an example of vital statistics data is death certificate
records, in which the death is examined in relation to occupational factors.
STUDY DESIGN
-this types of studies can be subdivided
into hypothesis-generating design and
hypothesis-testing research.
CROSS-SECTIONAL STUDIES
-is a study that examines the relationship between
disease and other variables of interest as they exist in
a defined population at one particular time.
ECOLOGIC STUDIES
-a study in which the units of analysis
are populations groups of people rather
than individual.
CASE-CONTROL STUDIES
-subjects who participate in the study
are defined on the basis of the presence
or absence of an outcome of interest.
COHORT STUDIES
-classifies subjects according to their
exposure to a factor of interest and then
observes them over time to document the
occurrence of new cases of disease or other
health events.
EXPERIMENTAL STUDIES
-is one in which an investigator manipulates
a factor, such as an exposure of interest, and
randomizes study participants to the exposure
or control conditions of the study.
EPIDEMIOLOGIC COMCEPTS CAUSALITY
-analytic studies in the field of occupational
epidemiology explore association between exposures
that occur on the job and health outcomes.
-these exposures may be though of as agent factor
in occupational environment.
STENGTH
-strong associations support a causal
relationship between a factor and a
disease.
CONSISTENCY
-an example of consistency comes from
research on the relationship between
smoking and lung cancer, with this
relationship having been found repeatedly
in many retrospective and prospective
studies.
SPECIFICITY
-is one that is constrained to a
particular disease-exposure
relationship.
TEMPORALITY
-the temporality criterion specifies that
we must observe the causes before the
effect; hill states that we cannot put the
cart before the horse.
BIOLOGICAL GRADIENT
-shows a linear in the
association between exposure and
disease.
PLAUSIBILITY
-states that an association
must be biologically plausible
from the standpoint of
contemporary biological
knowledge.
COHERENCE
-the coherence criterion suggests
that the cause and effect
interpretation of our data should not
seriously conflict with the generally
known facts of the natural history and
biology of the disease.
BIAS IN OCCUPATIONAL HEALTH
RESEARCH
-bias is defined as the
systematic of results or inference
from truth.
-processes leading to such
deviation.
OTHER TYPES OF BIAS

RECALL BIAS
-refers to the fact cases me remember an exposure more clearly than
control.
-is particularly relevant to case-control studies.
SELECTION BIAS
-defined as distortion that result from procedures used to select
subjects and from factors that influence participation in the study.

HEALTHY WORKER EFFECT

-refers to the observation that employed populations tends to have a
lower mortality experience than the general population.
-it is a form of bias that may reduce the validity of exposure data when
employed persons are chosen as research subjects in studies of
occupational health.
CONFOUNDING
-the term confounding denotes the
distortion of a measure of the effect of an
exposure on an outcome due to the
association of the exposure with other
factors that influence the occurrence of
the outcome.
WEKNESS OF OCCUPATIONAL
EPIDEMIOLOGIC RESEARCH
-occupational epidemiology as is
true of other branches of
epidemiology, is challenged by the
need to obtain accurate exposure
information.
TOXICOLOGY
-toxicology called by the science of
poisons.
-is the parent discipline of
occupational toxicology .
-the study of the adverse effects of
chemicals on living organism.
OCCUPATIONAL TOXICOLOGY
-applies the principles and
methodology of toxicology to
chemical and biological hazards
encountered at work.
EXAMPLE USED IN TOXICOLOGY
1.TOXICITY
-defined as a degree to which a substance can harm
human or animal.
2.TOXICANT
-are toxic substances that are human-made or
result from human activity.
3.TOXIN
-usually refers to a toxic substance made by living
organisms including reptiles, insects, plant, and
microorganisms.
IMPORTANT TOXICOLOGIC CONCEPTS
1.DOSE
-refers to the amount of substance administered at one time
-the dose is expressed as a concentration of a substance in the body.
2.LETHAL DOSE 50
-the dosage causing death in 50% of exposed animals.
3.DOSE-RESPONSE RRELATIONSHIP
-refers to a type of correlative association between an exposure and an effect.
4.DOSE-RESPONSE CURVE
-a dose response curve maps associations between exposure and effect.
-the curve is used to assess the effect of exposure to a chemical or toxic
substance upon an organism.
5.THRESHOLD
-refers to a lowest dose at which a particular response may occur.
-it is nuclear whether exposure to toxic chemical at low levels is sufficient to
produce any health response.
6.LATENCY
-refers to the time period between a initial exposure and measurable response.
EFFECTS OF CHEMICAL MIXTURE
1.ADDITIVE
-means that the combination of two or more chemicals
produces an effect that is equal to their individual effect added
together.
2.ANTAGONISTIC
-denotes an instance in which one chemical cancels out the
effect of another when the two are administered at the same
time.
3.SYNERGISTIC
-refers to situation in which the combined effect of several
exposure greater than the sum of the individual effect.
WORKPLACE EXPOSURE LIMITS
-in most situation, workplace exposures
to hazardous agent are higher than the
exposures of the general public to the
same agents.
OCCUPATIONAL EXPOSURE LIMITS
-apply to acceptable levels of airborne
hazardous agent.
-expressed as acceptable ambient
concentration levels for chemical and
biologic agent.
SOME WORKPLACE EXPOSURE STANDARDS MAKE USE THE TERMS
1.THRESHOLD LIMIT VALUE
-refers to airborne concentration of substances and
represents conditions under which it is believed that nearly all
workers may be unaffected.
2.BIOLOGICAL EXPOSURE INDICES
-provide a measure of the amount of chemical absorbed into
the body.
3.Permissible exposure limits
-are OSHA(occupational safety and health administration)
standards that are subject specific and that provide supporting
documentation for promulgation and enforcement of
occupational health regulation.
ODOR THRESHOLD
-is the lowest concentration of a chemical at
which an odor can be detected.
-this concentration varies from person to
person as a result of individual
sensitivity to odors.
TOXICOLOGY AND RISK ASSESSMENT
1.TOXICOLOGY
-is a complex field that makes a plethora of contributions to
occupational health.
2.RISK ASSESSMENT
-identification of hazards associated with chemicals and
other toxic substances.
-dose-response assessment
-exposure assessment
-risk characterization
-risk management