DEPARTMENT OF HYGIENE, EPIDEMIOLOGY AND PUBLIC HEALTH. COURSE IN HYGIENE AND EPIDEMIOLOGY FOR 3 RD YEAR MEDICAL STUDENTS.

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1 DEPARTMENT OF HYGIENE, EPIDEMIOLOGY AND PUBLIC HEALTH. COURSE IN HYGIENE AND EPIDEMIOLOGY FOR 3 RD YEAR MEDICAL STUDENTS. The name of unit In chich the subject is realized: Department of Hygiene, Epidemiology and Public Health śołnierska 48 Street Szczecin Phone number: Phone/Fax: Head of Departament: Dr hab. n. med. Alicja Walczak Total hours: 55 hours include: 7 hours of lectures 48 hours of workshops ECTS points: 5 Goals of teaching Hygiene and epidemiology : Knowledge of environmental factors affecting population s health. Knowledge of means of protection from environmental diseases. Knowledge of capabilities needed in protection from diseases and in health promotion in the practice of a physician. Knowledge of rules of nutrition of healthy people in different stages of life. Knowledge of rules of dietetic therapy supporting the pharmacological treatment. To help ensure that students develop appropriate knowledge of basic principles related to conducting and interpreting epidemiologic studies to fulfill their public health and occupational responsibilities to their communities, as well as to individual patients. FORMS OF ACTIVITIES Subject Hygiene and epidemiology is carried out in the 5th and 6th semesters in forms of seminars, workshops, colloquiums and examination. Includes in total 55 hours. 1. Lectures. There are 7 hours of lectures in the 6 th semester. 2. Workshops. Each class consists of 2 hours of workshops. During workshops students are obliged to perform determinations, to describe the chosen features of materials or presented examples, to solve the analysed problems and to draw appropriate conclusions. 3. Colloquiums. The material in hygiene and epidemiology is controlled during 7 colloquiums (3 in 5 th semester and 4 in 6 th semester) as tests with single choice questions. Students who got the mark 2 should do the retake test within 2 weeks after the announcement of the test results. 4. Exam. The final verification of students knowledge conducted as a test consisting of single and multiple choice questions. The exam has two retakes. 1

2 Lectures: 7 hours PROGRAM OF HYGIENE AND EPIDEMIOLOGY COURSE 1. Global determinants of health. Climate factors and public health. 2. Rules of healthy nutrition. Dietetic therapy in chosen diseases. 3. Calendar of obligatory immunization. Nonobligatory vaccination and tropical diseases. Workshops: 48 hours (2 hours per each subject): 1. Hospital hygiene. The principles of hygiene in hospital environment. Methods of cleaning, disinfection and sterilization. Disposal of waste. Protective barriers. The rules of decontamination. Hand washing techniques. Measures to be taken following occupational exposure to potentially infectious biological material. Workshop: Preparation of disinfectant for disinfection of instruments. Preparing and conducting the aseptic and antiseptic procedure concerning wound cleaning and disinfecting. Decontamination of blood split on the floor. Waste disposal (biological and non-biological material). Decontamination of instruments. Discussing the management of occupational blood exposure and creating the exposure protocol. 2. Measurements and their hygienic interpretation of noise level. Definition of noise. Basic parameters describing noise exposure (sound pressure, sound pressure level, sound intensity, sound power, duration). Classification of noise. Allowable noise levels for houses and the environment. Auditory and non-auditory effects of excessive noise. Nomogram of human ear sensitivity. Methods of hearing protection. Analysis of audiograms showing Noise Induced Hearing Loss (NIHL). Workshop: Measurement of noise level with the use of Sound Level Meter (SLM): measurement of noise level in the silent room, measurement of noise level from vacuum cleaner, determination the acoustic pattern of vacuum cleaner noise estimation the possible effects on worker. Analysis of audiograms. 3. Measurements and their hygienic interpretation of microclimatic factors. The impact of climate and climate change on public health. The health effects of exposure to low and high atmospheric pressure. Exposure to heat and cold: burns and frostbites (classification). The influence of microclimatic factors (solar radiation, air temperature, air humidity, air velocity) on human health and comfort. Indices and methods of evaluation of the integrated microclimate effects (cooling power, effective temperature). Workshop: Cold and heat stress evaluation: calculation of Wind Chill Index (WCI) and Wet Bulb Globe Temperature (WBGT). Measurements and interpretation of temperature and relative humidity. Calculation and interpretation of some chosen microclimate indices in a seminar room: effective temperature (ET), Predicted Mean Vote (PMV) and Predicted Percentage of Dissatisfied (PPD). 2

3 4. Occupational hygiene: light and lighting assessment. The electromagnetic spectrum, visible radiation and light. Terms and definitions associated with lighting: daylight factor, illuminance, luminance, candela, lux, lumen. Types of lamps and luminaries. Daylight factor. Lighting systems. Hygienic requirements and indices of natural and artificial lighting. Illuminance meter (luxmeter). The effects of colors. Workshop: Measurements and interpretation of parameters of natural and artificial lighting. 5. Occupational hygiene: ergonomic assessment of energy expenditure, ergonomic evaluation of computer workstation. Rules of safe heavy objects lifting. Definitions of and domains within ergonomics. Ergonomics and occupational hygiene. Risk factors associated with the development of work-related upper limb disorders (WRULDs). Control measures: workplace design, workplace layout (4 basic principles) Workshop: Performing the PWC 170 test with the use of cycle ergometer. Calculating energy expenditure in the work of physician. Ergonomic evaluation of computer workstation in the seminar room. 6. The assessment of exposure to particulate matter: industrial dusts. Assessment of exposure to chosen environmental allergens. Particulate matter: definition, classification. The state of particulate matter pollution. Definitions of allergens. Sources of aeroallergens. Features of allergenic pollen. House dust mites as a source of common indoor allergens. Workshop: 1. Microscopic evaluation of chosen pollen grains and the preparation of one s own listing of pollens. 2. Making one s own recommendations regarding limiting/minimizing the exposure of hypersensitive people to aeroallergens of plant origin. 3. The evaluation of exposure to feces of house dust mites with the use of ACAREX test. 4. Of the given list of methods limiting the exposure to allergens of house dust mites students choose methods which are: a) essential, b) desirable and c) of questionable effectiveness. 7. Environmental and occupational toxicology. Terms and definitions associated with toxicology: dose, threshold dose, toxicity, LD50, dose-effect, dose-response, NOEL, LOEL, NOAEL, LOAEL. Hygienic norms for some chosen toxic substances. Toxicity of mercury, pesticides, carbon monoxide and nitric compounds. Risk assessment procedure. Reference dose (RfD). Workshop: Determinations of reference doses for chosen toxic substances. 8. Chemical and biological pollution of water. The effectiveness of water treatment. Water from physiological point of view. Water from ecological point of view. Stages of public water treatment. Acceptable levels of chemicals in the drinking water. Water-related infectious disease. Water contaminants and cancer. Physical, chemical and biological parameters of drinking water. Workshop: Determination of nitrates, nitrites, chlorine, chlorides, copper, water hardness, ph and total dissolved solids (TDS) in a given water samples. 9. Food hygiene and safety. Rules of proper nutrition. Basic nutritional elements: proteins, fats, carbohydrates, macro- and microelements and vitamins. Protein composition and quality. 3

4 Recommended norms for daily food intake. Artificial substances in food and their influence on health status. Workshop: Calculation of energy requirements for individuals in relation to age, sex and physical activity. 10. Analysis and evaluation of some chosen diets. Types of diets. Dietetic therapy supporting the pharmacological treatment. Nutrition and civilisation diseases. Sanitary supervision on food quality and outdoor feeding. Workshop: Quantitative method for evaluation of different diets. 11. Biological hazards. Blood-borne pathogens. Other potentially infectious materials (OPIM) HCV,HBV,HIV. Risk identification, clinical course of infection,routes of contamination, preventive protocols. Vaccinations. Workshop: assessment of individual risk of a health care workers exposed to bloodborne patrhogens.reporting protocol. Preventive procedures. Different scenarios. 12. Health promotion programs. Evaluation of students projects. 13. Introduction to epidemiology. Measuring health and disease. Comparing disease and death rates. Workshop: general and specific crude rates of disease frequency. Case - fatality, mortality and life expectancy. Birth and years of potential lost. Time and secular trends in mortality and morbidity, accounting of selected rates. 14. Absolute and relative comparisons. Crude and standardized epidemiological rates. Health status of populations in Europe. Workshop: accounting of standardized mortality rates. 15. Types of epidemiological studies. Observations and experiments in epidemiology. Observational studies: descriptive, cross-sectional, case-control and cohort study. Workshop: applications, advantages and disadvantages of different observational studies. 16. Potential errors in epidemiological studies. Random and systematic error. Types of bias. Confounding; methods commonly used to control confounding at the design and analysis stage. Internal and external validity of an epidemiological study. Workshop: how to deal with random and systematic error in epidemiological studies various examples from different study designs. 17. Screening. Definition and types of screening. Criteria for screening. Characteristics of a diagnostic test. Factors determining the effectiveness of screening. Workshop: calculating sensitivity, specificity, PPV and NPV from a 2x2 table using hypothetical examples from medical literature. 18. Communicable disease: epidemiology surveillance and response. Chain of infection. Infectious disease process control and prevention strategies. The burden of communicable disease. Epidemic and endemic disease. Investigation and control of communicable disease epidemics. Workshop: The epidemiological investigation in various food-borne outbreaks. 4

5 19. Experimental epidemiology. Randomized controlled, field and community trials. Workshop: applications, advantages and disadvantages of experimental study. 20. Causation in epidemiology. The concept of cause: sufficient or/and necessary; a causal pathway; single and multiple causes; factors in causation. Establishing a cause of a disease: temporal relationship, plausibility, consistency, strength, dose-response relationship, reversibility. From association to causation: deriving inferences from epidemiologic studies. Workshop: assessment of the evidence suggesting Helicobacter pylori as a causative agent of duodenal ulcer. 21. Clinical epidemiology. Epidemiology and prevention of selected chronic illnesses. Risk factors of cancers. Workshop: physical examination of breast tumor. 22. Evidence Based Medicine (EBM). Definition of EBM. Use of EBM in medical practice. Standards and guidelines. Features of meta-analysis. Workshop: understanding and calculations basic measures of EBM, such as number needed to treat and likelihood ratios. 23. Planning a research project. First steps in practical epidemiology: choosing a project, writing the protocol, doing the research, analysing the data, getting published. Workshop: how to prepare a questionnaire: types and sequence of questions, language, layout, graphics; questionnaires versus interviews; pre-testing. 24. Weighting the evidence: Critical reading of published reports. What is the research question of the study? If valid, are the results relevant to my work? What kind of study is this? What is the study population? Are the methods well described? How are the data presented? Is there a statistically significant difference between groups? Is it due to any chance or bias? Workshop : Final evaluation: critical analysis of epidemiological research papers. Textbooks: 1. Kerry Gardiner, J. Malcolm Harrington: Occupational Hygiene. Third Edition. Blackwell Publishing, Cassens BJ.: Preventive Medicine and Public Health. 3. Rothman KJ. Epidemiology. An introduction. Oxford University Press Farmer R., Lawson R. Epidemiology and Public Health Medicine. Blackwell Publishing, Gordis L. Epidemiology. Elsevier Saunders Beaglehole R, Bonita R, Kjellstrom T. Basic epidemiology. WHO Geneva Jekel JE, Katz DL, Elmore JG, Wild DMG. Epidemiology, Biostatistics and Preventive Medicine 3rd Ed. Elsevier Saunders Knowledge, capabilities and students competence after finishing the course in Hygiene and epidemiology. 1. Knowledge of the principles of hygiene in hospital environment. 2. Knowledge of methods of examination and of evaluation of factors creating microclimate. Knowledge of cold and heat stress indices. 3. Knowledge of health effects of noise exposure. Methods of prevention. 5

6 4. Knowledge of main outdoor and indoor air pollutants, their effects on human health and methods of exposure assessment. 5. Capability for the assessment of human s exposure to harmful substances present in drinking water and of evaluation of water for drinking purposes. 6. Knowledge of hygienic requirements and indices of daylight and artificial lighting. 7. Knowledge of influence of workplace environment on human health. Capability of ergonomic evaluation of workplace. 8. Knowledge of hazardous factors in workplace environment. Knowledge and use of basic toxicological definitions. Toxicological risk evaluation. 9. Familiarity with the basic principles of epidemiology, including incidence, prevalence, confounding and bias, causality by proximate and underlying determinants, and basic study designs, including the research hierarchy for practice of evidence-based medicine. 10. Capable for planning a population-based survey in community or clinical practice, including concepts of target population, random sampling, inference, and generalisation, as well as practical aspects of ethics, proposal writing, questionnaire design, quality control of data entry, data analysis, descriptive statistics, followed by interpretation of the data. 11. Capable of rapidly and efficiently retrieving and assessing scientific evidence for medical and public health practice from peer-reviewed publications and internet sources. 6