HYGIENE

1) Hygiene, environmental health and ecology. Hygiene as a main

prophylacgic branch in medicine. Main tasks and relation with the
other sciences.
Hygiene refers to the set of practice associated with the preservation of
health and healthy living. Hygienic means of prevention can be by using
engineering solutions simple technologies or even by personal hygiene
practice. Sanitation can be basic (household level) on site (collection and
treatment of aste in deposit) food (refer to food safety) enviromental
(enviromental factors that form links in disease transmission) ecological
(recycling methods).
In medicine hygiene practices are employed to reduce the incidence and
spreading of disease. This include isolation or quarantine of infectious
persons, sterilization of instruments, uses of protective clothes and barriers,
proper bandaging and dressing, safe disposal of medical waste. Sanitation is
the hygienic means of promoting health through prevention of human contact
with the hazards or wastes. Hazards can be physical microbiological biological
or chemical agents. Wastes can cause health problems are human and animal
feces solid waste domestic or industrial wastes and argicultural wastes.
Hygiene refers to the set of practice associated with the preservation of
health and healthy living. Hygienic means of prevention can be by using
engineering solutions simple technologies or even by personal hygiene
practice.
Sanitation can be basic (household level) on site (collection and treatment of
aste in deposit) food (refer to food safety) enviromental (enviromental factors
that form links in disease transmission) ecological (recycling methods).
Other uses of the term appear in phrases including: body hygiene, mental
hygiene, domestic hygiene, dental hygiene, and occupational hygiene, used in
connection with public health. Medical hygiene pertains to the hygiene
practices related to the administration of medicine, and medical care, that
prevents or minimizes disease and the spreading of disease. Medical hygiene
practices include: Isolation or quarantine of infectious persons or materials to
prevent spread of infection. Sterilization of instruments used in surgical

procedures. Use of protective clothing and barriers, such as masks, gowns,

caps, eyewear and gloves. Proper bandaging and dressing of injuries. Safe
disposal of medical waste. Disinfection of reusables (i.e. linen, pads,
uniforms). Scrubbing up, hand-washing, especially in an operating room, but
in more general health-care settings as well, where diseases can be
transmitted.

2) Global ecological problems.

Ecology is the scientific study of the interactions between organisms and their
environment also the study of ecosystems.
Global ecological problems are: air polution (means the presence of one or
more unwanted substances in air, the most frequently are sulphur oxides,
nitrogen oxides, volatile organic compounds and small dust particles), global
warming (greenhouse effect, the gases that are gathering above the earth by
adsorption and reflection of atmospheric and solar energy increase the planet
temperature), water pollution ( caused by chemical and pathogens result in
physical or biological change in the quality of the water that has a harmful
efect of any living organism that uses it, soil pollutions (caused by the
presence of man made chemicals or other alterations in the natural osil
enviromental usually underground storage, tanks, pestisides), urbanization
hygienic problems. Other problems are heavy metals, ozone toxicology,
overpopulation acid rain and rain forest destruction.

3) Air composition and air pollution. Sampling for determination of air

pollution. Monitoring of air pollution.
Air composition: air is mainly composed of nitrogen, oxygen, and argon,
which together constitute the major gases of the atmosphere. The remaining
gases are often referred to as trace gases,[1] among which are the greenhouse
gases such as water vapor, carbon dioxide, methane, nitrous oxide, and
ozone. Filtered air includes trace amounts of many other chemical
compounds. Many natural substances may be present in tiny amounts in an
unfiltered air sample, including dust, pollen and spores, sea spray,
and volcanic ash. Various industrial pollutantsalso may be present, such
as chlorine (elementary or in compounds), fluorine compounds,
elemental mercury, and sulfur compounds such as sulfur dioxide [SO2].

Air pollution is the presense in the atmosphere of substances generated by

the activities of man and interfere with the human health safety and comfort.
Sources are the automobiles the industries and some miscelaneous (natural
sources, pesticide, nuclear energy). Substances are inorganic pollutants
(carbon monoxide, dioxide nitrogen oxides, sulfur oxides), organic compounds
(hydrocarbons, ketons, organic acids), metalic contaminants (arsenic zinc
mercury), oxidants (ozone) and radio active compounds.
Sourses: automobiles (they emit: hydrocarbons, carbon momoxide, lead,
nitrogen oxides and particulate matter), industries (emit large amounts of air
pollutants: combustion of fuel to generate heat and power produces sulfur
dioxide, nitrogen oxides, hydrocarbons, dust, smoke and the carcinogenic 3,4
benzepyrenes). Miscellaneous- comprise natural sourses (wind, volcano, fungi,
bacteria), pesticide spraying, nuclear energy programs.
Substances that pollute the air are: inorganic pollutants (eg.carbon
monoxide), organic compounds (eg. Hydrocarbons), metallic contaminants
(eg. Zinc, lead, mercury), oxidants (e.g. ozone).
Air monitoring can be in personal or breathing zone and can be activeor
passive and by collecting media. They can be also used direct reading gas and
vapor monitors, detector tube systems, infrared spectrophotometers. There
are 2 approaches to air monitoring by air sampling for determination of
airborne contaminant levels: 1) personal, the collection device is placed near
the breathing zone of the worker. 2)sampling for evaluation of urban air.
Types of collection media: a) liquid media samplers b) solid sorbent tubes c)
passive monitors. One of the most widely used instruments is the direct
reading colorimetric indicator or detector tube.
Chemical analysis of sample: Filter sampling: prewighted filter is used for
airborne particulate matter(except asbestos).
Size selective device (such as cyclone) types of air sampling: 1) personal air
sampler 2)collected on a filter and weighted 3) collected in an appropriate
trapping medium and counted. Personal air sampling is preferred to evaluate
wokers exposure. Area or general room air samples. Biological rxn: lung
diseases (fibrosis, bronchitis, asthma, cancer), systemic rxns, allergic and
sensitization rxns (caused by inhalation or skin contact, bacterial and fungus
infections, irritation of nose and throat, damage of internal tissues (eg. Due to
radium)

4) Health effects of air pollution. Prevention and control of air

pollution.
Air pollution is the presense in the atmosphere of substances generated by
the activities of man and interfere with the human health safety and comfort.
Sources are the automobiles the industries and some miscelaneous (natural
sources, pesticide, nuclear energy). Substances are inorganic pollutants
(carbon monoxide, dioxide nitrogen oxides, sulfur oxides), organic compounds
(hydrocarbons, ketons, organic acids), metalic contaminants (arsenic zinc
mercury), oxidants (ozone) and radio active compounds.
Effects of air pollutants are in health (imediate or delayed, the immediate are
born by the respiratory system and result in acute bronchitis and delayed are
chronic bronchitis , asthma, lung cancer and allergies) social and economic
aspects (destruction of plant and animal life, damage to buildings, damage of
clothing and reduced visibility).
The health effects from air pollution can be divided in short term health
effects and long term health effects:
Short term health effects include irritation to the eye nose and throat
and upper respiratory infection such as bronchitis and pneumonia.
Other symptoms can include headaches nausea and allergic reactions.
Short term air pollution can be aggressive for patients with asthma and
emphysema.
Long term health effects can include chronic respiratory disease, lung
cancer, heart disease or even damage to the brain, nerves, liver, or
kidneys.
Control devices: mechanical collectors, electrostatic precipitators, scrubbers
(can remove gases and particulates), NO control by NO burners and elective
catalytic reduction, VOC abatement like biofilters absorptions flares and vapor
recovery systems.
Air monitoring can be in personal or breathing zone and can be active or
passive and by collecting media. They can be also used direct reading gas and
vapor monitors, detector tube systems, infrared spectrophotometers.
Prevention by: containment (prevention of escape of toxic substanced into
the ambient air) replacement, dilution, legislation and international actions.
Effects of air pollutants: 1) health aspects, 2) socioeconomic aspects.

Control: There are various air pollution control technologies and land use
planning strategies available to reduce air pollution. At its most basic level
land use planning is likely to involve zoning and transport infrastructure
planning. In most developed countries, land use planning is an important part
of social policy, ensuring that land is used efficiently for the benefit of the
wider economy and population as well as to protect the environment.
Efforts to reduce pollution from mobile sources includes primary regulation
(many developing countries have permissive regulations), expanding
regulation to new sources (such as cruise and transport ships, farm
equipment, and small gas-powered equipment such as lawn
trimmers, chainsaws, and snowmobiles), increased fuel efficiency (such as
through the use of hybrid vehicles), conversion to cleaner fuels (such
as bioethanol, biodiesel, or conversion to electric vehicles).

5) Dust (particulates). Critical exposure factors. Biological reactions.

Particulates (aerosols) are defined as solid particles or liqued droplets
dispersed in the air. Dusts fumes and smoke are solids while mists and fogs
are liquids.
Types: dust can be organic (synthetic or natural) and inorganic (metallic
nonmetallic).
Dust particles must ussually be smaller than 5m in order to enter the alveoli
al the larger particles become trapped in the nasal passage throat larynx
trachea and bronchi.
Particles can be collected for chemical analysis, filter sampling occur by
collecting particles on a preweighed filter a procedure called gravimetric. Dust
can be collected by personal air sampler, on a filter and weighed, on a
trapping medium and counted or by personal air sampling.
Biological reactions are: lung disease (fibrosis bronchitis asthma and cancer)
systemic reactions , allergic and sensitization reactions, bacterial and fungus
infections, irritation of the nose and throat, damage of internal tissues. Dust
containing crystaline can cause pneumoconiosis as result of chronic exposure.
Pneumoconiosis silicosis and asbestosis become disable after several years of
exposure.
Airborne particulates (aerosols) are defined as solid particles or liquid droplets
dispersed in the air. Dusts, fumes and smoke are dispersed solids, while mists
and fogs are dispersed liquids.

Critical exposure factors: 1) types of dust involved (organic or inorganic) 2)

length of exposure time (pneumoconiosis: silicosis and asbestosis) 3)
concentration of airborne dusts in the breathing zone exposed 4) the size of
particles (must be smalles than 5micrometers in order to enter alveoli).
Sampling: to determine the total quantity or the respirable fraction (size
selective sampling).

6) Hygienic characteristics of physical factors of the atmosphere.

Climate and weather.
Climate affects a living organism through individual factors: temperature, air
circulation and humidity, atmospheric pressure, cloudiness, intensity of solar
radiation. Each factor can by itself influence various functions of the human
organism (heat emission makes breathing difficult by impairing the
coordination of respiratory movements and their normal rhythm.) The
intensity of the biotropic effect is due to the quicker a quantitative change in
some factor occurs, the less time the organism has to adapt and the sharper
its response.
The threat of global climate change has the potential to cause large-scale
drought, increased incidence of disease, shortages of water and food, rising
sea levels, and increased extreme weather events. Air is mainly composed of
nitrogen (78%), oxygen (21%), and argon (0.9%), which together constitute
the major gases of the atmosphere. The remaining gases trace gases are the
greenhouse gases such as water vapor, carbon dioxide, methane, nitrous
oxide, and ozone. Filtered air includes trace amounts of many other chemical
compounds. Many natural substances may be present in tiny amounts in an
unfiltered air sample, including dust, pollen and spores, sea spray, and
volcanic ash. Various industrial pollutants also may be present, such as
chlorine (elementary or in compounds), fluorine compounds, elemental
mercury, and sulfur compounds such as sulfur dioxide

7) General approaches to measurement of atmospheric pressure, air

temperature, humidity and air velocity.
You can measure air velocity, the wind that's kicking up waves, etc., with a
device called an anemometer. A fixed anemometer is a permanent installation
on your vessel consisting of the impeller, the part that spins around and
actually samples the wind, and the wind-display unit. A handheld anemometer
is smaller, portable and can be used in most settings to obtain approximate
wind velocity readings.
Humidity is a term for the amount of water vapor in the air, and can refer to
any one of several measurements of humidity

Absolute humidity
Absolute humidity, on a volume basis, is the mass of water vapor, mw, per
cubic meter of total moist air, Vnet:

Absolute humidity ranges from 0 grams per cubic meter in dry air to 30
grams per cubic meter (0.03 ounce per cubic foot) when the vapor is
saturated at 30 C.
The absolute humidity changes as air pressure changes.
Relative humidity is normally expressed as a percentage and is calculated
by using the following equation, it is defined as the ratio of the partial
pressure of water vapor (H2O)
in the mixture to the saturated vapor
pressure of water
at a prescribed temperature.
.

Specific humidity
Specific humidity is the ratio of water vapor to dry air in a particular mass, and
is sometimes referred to as humidity ratio. Specific humidity ratio is expressed
as a ratio of grams of water vapor, mv, per kilogram of dry air ma [4] .
That ratio is defined as:

8) Thermal comfort. Physiological methods for thermal comfort

evaluation. Health effects of unfavorable thermal environment.
Human thermal comfort is defined as the state of mind that expresses
satisfaction with the surrounding environment. Thermal comfort is affected by
heat conduction, convection, radiation, and evaporative heat loss. Thermal
comfort is maintained when the heat generated by human metabolism is
allowed to dissipate, thus maintaining thermal equilibrium with the
surroundings. Any heat gain or loss beyond this generates a sensation of
discomfort.

Thermal comfort is very difficult to define because needed to be taken into

account a range of environmental and personal factors when deciding what
will make people feel comfortable. These factors make up what is known as
the human thermal environment.
So thermal comfort is not measured by air temperature, but by the number of
employees complaining of thermal discomfort.
EFFECTS
Progressive global warming exerts strong influence on the lives and on the
health of urban residents, many of who are weather sensitive people
(meteoropaths). In the temperate zone, air temperature changes largely
determine the seasonal oscillation of morbidity and mortality frequency.
During the warmer months, there is a noticeable increase in the unfavorable
occurrence of especially strong thermal stimuli (e.g., hot days) which can lead
to overheating of the human organism. On the other hand, the increasing
frequency of mild winters contributes to the appearance of weak and
moderate thermal stimuli, which in the case of the former, is a negative
phenomenon. Weak thermal stimuli are liable to make the human body
oversensitive and, thus lose the ability to adapt if stronger thermal stimuli
were to occur. Residents of large urban areas should be prepared for the
possibility of dynamic weather changes and should take thermal variability
into consideration with regards to spatial urban planning and socioeconomic
activities.

9) Heat stress indices developed through subjective and objective

testing of workers. Preventive measures and control of heat stress.
Heat stress is the load of heat that must be dissipated if the body is to remain
in thermal comfort. The guidelines currently used for worker exposure to
heat are based on indices developed through subjective and objective testing
of workers or from combinations of external heat measurements.
Two of the more commonly used indices are:
1. Web Bulb Globe Thermometer Index - ( WBGT)
2. Heat Stress Index (HSI)
Heat Stress Index (HSI)

The determination of HIS results in more knowledge about the environment

and possibility to perform efficient control measures than the use of the
WBGT. To calculate the HIS, measurements of the Wet Bulb (WB), the black
Globe Temperature(GT), the Dry Bulb temperature(DB) and the air velocity
are necessary for each jobsite, and estimation of the Metabolic rate (M) of the
workers.
In moderate environment mans thermoregulatory system will automatically
try to modify the skin temperature and the sweat secretion to maintain heat
balance.
Metabolic heat production can be modified by work practices and application
of labor reducing devices mechanization of the physical components of the
job, reduction of work time (reduce work day, increase rest time) to reduce
the duration of exposure to a hot environment, increased work force
Work and hygienic practices and administrative control
Situations in industries exist where the complete control of heat stress by
application of engineering controls may be technologically impossible or
impractical, where the level of heat stress can be unpredictable. In such cases
other solutions could be applied. Preventive practices include:
1. Limiting of modifying the duration of exposure time .
2. Enhancing the heat tolerance by heat acclimatization.
3. Adequate water supply to maintain the electrolyte balance
4. Protective clothing and equipment.
5. Protective devices goggles, shields, helmets.

10) Hygienic requirement of water supply. Surveillance of drinking

water quality.
The availability of water is essential for water hygiene and naturally, an easy
accessible water source facilitates the practice. But to ensure that water
hygiene is practiced daily the water source must be reliable both in quantity
and quality throughout the year.
Problems of poor water quality or low quantity discourage improved hygienic
behaviors.

The exact amount of water a human needs is highly individual, as it depends

on the condition of the subject, the amount of physical exercise, and on the
environmental temperature and humidity.
The reference daily intake for water is 3.5 litres per day for human males
older than 18, and 2.5 litres for human females older than 18 including water
contained in food, beverages, and drinking water. It is a common
misconception that everyone should drink two liters of water per day.
Treatment processes lead to the presence of some mineral nutrients.
Environmental water quality, also called ambient water quality, relates to
water bodies such as lakes, rivers, and oceans. Water quality standards for
surface waters vary significantly due to different environmental conditions,
ecosystems, and intended human uses. Toxic substances and high populations
of certain microorganisms can present a health hazard for non-drinking
purposes such as irrigation, swimming, fishing, rafting, boating, and industrial
uses.
These conditions may also affect wildlife, which use the water for drinking or
as a habitat. Modern water quality laws generally specify protection of
fisheries and recreational use and require, as a minimum, retention of current
quality standards.

11) Water sampling for physical and chemical examination and for
bacteriological examination.
Sample collection
More complex measurements are often made in a laboratory requiring a
water sample to be collected, preserved, transported, and analyzed at
another location. The process of water sampling introduces two significant
problems. The first problem is the extent to which the sample may be
representative of the water source of interest. Many water sources vary with
time and with location. The measurement of interest may vary seasonally or
from day to night or in response to some activity of man or natural
populations of aquatic plants and animals.
Water chemistry analyses are carried out to identify and quantify the
chemical components and properties of a certain water. This include pH,
major cations and anions, trace elements and isotopes.

Water chemistry analysis is used extensively to determine the possible uses a

water may have or to study the interaction it has with its environment. Water
chemistry analysis is often the groundwork of studies of water quality,
pollution, hydrology and geothermal waters.
Physical assessment:

pH
Temperature
Total suspended solids (TSS)
Turbidity
Total dissolved solids (TDS)

12) Purification of water. Disinfection of water.

Water purification is the process of removing undesirable chemicals,
biological contaminants, suspended solids and gases from contaminated
water. The goal is to produce water fit for a specific purpose. Most water is
purified for human consumption (drinking water) but water purification may
also be designed for a variety of other purposes, including meeting the
requirements of medical, pharmacology, chemical and industrial applications.
In general the methods used include physical processes such as filtration and
sedimentation, biological processes such as slow sand filters or activated
sludge, chemical processes such as flocculation and chlorination and the use
of electromagnetic radiation such as ultraviolet light.
The purification process of water may reduce the concentration of particulate
matter including suspended particles, parasites, bacteria, algae, viruses, fungi;
and a range of dissolved and particulate material derived from the surfaces
that water may have made contact with after falling as rain.
Other water purification techniques:
Boiling: Water is heated hot enough and long enough to inactivate or
kill micro-organisms that normally live in water at room temperature.
With the exception of calcium, boiling does not remove solutes of
higher boiling point than water and in fact increases their
concentration (due to some water being lost as vapour). Boiling does
not leave a residual disinfectant in the water. Therefore, water that has
been boiled and then stored for any length of time may have acquired
new pathogens.

 Granular Activated Carbon filtering: a form of activated carbon with a

high surface area, adsorbs many compounds including many toxic
compounds. Water passing through activated carbon is commonly used
in municipal regions with organic contamination, taste or odors. Many
household water filters and fish tanks use activated carbon filters to
further purify the water.
Distillation involves boiling the water to produce water vapour.
Disinfection is accomplished both by filtering out harmful micro-organisms
and also by adding disinfectant chemicals. Water is disinfected to kill any
pathogens which pass through the filters and to provide a residual dose of
disinfectant to kill or inactivate potentially harmful micro-organisms in the
storage and distribution systems. Possible pathogens include viruses, bacteria,
including Salmonella, Cholera, Campylobacter and Shigella, and protozoa,
including Giardia lamblia and other cryptosporidia. Following the introduction
of any chemical disinfecting agent, the water is usually held in temporary
storage often called a contact tank or clear well to allow the disinfecting
action to complete.
The most common disinfection method involves some form of chlorine or its
compounds such as chloramine or chlorine dioxide.
Other disinfection methods:
Chloramine disinfection (provides a longer-lasting residual)
Ozone disinfection (a very strong, broad spectrum disinfectant,
effectively inactivates harmful protozoa and all other pathogens)
Ultraviolet disinfection (effective at inactivating cysts, in low turbidity
water)
Hydrogen peroxide disinfection (works in a similar way to ozone, slowworking, phytotoxic in high dosage, and decreases the pH of the water
it purifies)

13) Soil pollution. Health effect of the soil pollution.

Soil pollution results from the build up of contaminants, toxic compounds,
radioactive materials, salts, chemicals and cancer-causing agents. The most
common soil pollutants are hydrocarbons, heavy metals (cadmium, lead,

chromium, copper, zinc, mercury and arsenic), herbicides, pesticides, oils, tars,
PCBs and dioxins.
Health effects: People living near polluted land have higher incidences of
migraines, nausea, fatigue, miscarriage and skin disorders. Long-term effects
of pollution include cancer, leukemia, reproductive disorders, kidney and liver
damage, as well as central nervous system failure. Children often suffer from
developmental problems and weakened immune systems.
Contaminated soil directly affects human health through direct contact with
soil or via inhalation of soil contaminants which have vaporized; potentially
greater threats are posed by the infiltration of soil contamination into
groundwater aquifers used for human consumption, sometimes in areas
apparently far removed from any apparent source of above ground
contamination. Health consequences from exposure to soil contamination
vary greatly depending on pollutant type, pathway of attack and vulnerability
of the exposed population. Chronic exposure to chromium and other metals,
petroleum, solvents, and many pesticide and herbicide formulations can be
carcinogenic, can cause congenital disorders, or can cause other chronic
health conditions. Industrial or man-made concentrations of naturallyoccurring substances, such as nitrate and ammonia associated with livestock
manure from agricultural operations, have also been identified as health
hazards in soil and groundwater.
Chronic exposure to benzene at sufficient concentrations is known to be
associated with higher incidence of leukemia. Mercury and cyclodienes are
known to induce higher incidences of kidney damage, some irreversible.
Organophosphates and carbamates can induce a chain of responses leading to
neuromuscular blockage. Many chlorinated solvents induce liver changes,
kidney changes and depression of the central nervous system.
If nothing is done to clean up soil pollution, water supplies could become
contaminated, threatening the human species. Sudden fires or explosions will
occur from underground landfill gases, pipelines and building structures may
corrode and once beautiful regions will turn into cesspools, experts warn

14) Urbanization- hygienic problems. Residential environment. Criteria

for healthful housing.
Urbanity and health involves the connection between urban life and the living
conditions affecting human health. Although urbanization allows more
accessibility to health services, it also creates health hazards. In poor parts of

the cities, health problems include inadequate water and sanitation, limited or
no waste disposal and poor air quality, as well as crowded living conditions
and general poverty. In such urban areas the air, land and water are often
contaminated, spreading disease.
Criteria for healthful housing- to provide physical protection and shelter; to
provide adequately for cooking, eating, washing and excretory functions;
design and maintain and use in a manner such as to prevent the spread of
communicable diseases; provide protection from hazards of exposure to noise
and pollution; to free from unsafe physical arrangements and from toxic
materials; encourages personal and community development, promotes social
relationships and by these means promotes mental health.

15) Housing standards. Requirements and criteria of good lighting:

measurement of lighting. Ventilation- types of ventilation and
standards.
Housing combines the idea of shelter with the complete development of
health and is equivalent to a definition of healthful housing. The definition
has three elements:

The physical structure or building that provides the shelter.

The necessary services, facilities, equipment and devices that are used
by an individual, for example, a bedroom for sleeping or a latrine for
human waste excretion.

The goal of housing is preserving ones health. This is the purpose of a physical
building and its immediate environment
Criteria for healthful housing: In order to understand further what housing is,
WHO has adopted four basic requirements:

satisfaction of physiological needs

protection against infection
protection against accidents
protection against psychological and social stresses.

Requirements of good lighting- if lighting conditions are not ideal the visual
apparatus is put to strain, which may lead to general fatigue and loss of
efficiency. For efficient vision following factors are essential: sufficiency,
distribution (uniform), absence of glare(glare is excessive contrast),
steadiness(source of light constant), color of light(soothing to eye).

Measurement of light- its Illumination- in units Lux(lx).

Ventilation- it implies not only the replacement of vitiated air by a supply of
fresh outdoor air but also control of the quality of incoming air with regard to
its temperature, humidity and purity with view to provide a thermal
environment thats comfortable and free from risk of infection.
Types of ventilation- 1) natural ventilation, 2) mechanical ventilation- it has:
Exhaust ventilation: in this system air is extracted or exhausted to outside by
exhaust fans usually electrical driven. Its widely used in industries to remove
dusts, fumes, etc. Plenum ventilation: in this system air is blown into room by
centrifugal fans so as to create a positive pressure, and displace the vitiated
air. Used in AC in buildings and factories. Balanced ventilation: combo of
exhaust and plenum. Air conditioning: affects both physical and chemical
conditions of atmosphere within any structure, factors are humidity,
temperature, air movement, dust, bacteria, odor and toxic gases.
Standards of ventilation- cubic space, floor space and air change (the no. of air
changes for hr. is calculated by dividing the total hourly air supply to room by
cubic space requirement).

16) Hospital hygiene. Hygienic requirements to hospitals (clinics) with

high epidemiological risk.
The main purpose of hospital hygiene is to prevent the nosocomial infections.
Nosocomial infections are infections which are a result of treatment in a
hospital or a healthcare service unit.
Hospital Hygiene could be divided in different parts. Isolation precautions are
designed to prevent transmission of microorganisms by common routes in
hospitals. Because agent and host factors are more difficult to control,
interruption of transfer of microorganisms is directed primarily at
transmission. Hand washing frequently is called the single most important
measure to reduce the risks of transmitting skin microorganisms from one
person to another or from one site to another on the same patient. Washing
hands as promptly and thoroughly as possible between patient contacts and
after contact with blood, body fluids, secretions, excretions, and equipment or
articles contaminated by them is an important component of infection control
and isolation precautions.

Gloves play an important role in reducing the risks of transmission of

microorganisms. Gloves are worn for three important reasons in hospitals.
First, gloves are worn to provide a protective barrier and to prevent gross
contamination of the hands when touching blood, body fluids, secretions,
excretions, mucous membranes, and non-intact skin. Second, gloves are worn
to reduce the likelihood that microorganisms present on the hands of
personnel will be transmitted to patients during invasive or other patient-care
procedures that involve touching a patient's mucous membranes and nonintact skin. Third, gloves are worn to reduce the likelihood that hands of
personnel contaminated with microorganisms from a patient or a fomite can
transmit these microorganisms to another patient. Sanitizing surfaces is an
often overlooked, yet critical component of breaking the cycle of infection in
health care environments. Modern sanitizing has been effective against
gastroenteritis, MRSA, and influenza. Use of hydrogen peroxide vapor has
been clinically proven to reduce infection rates and risk of acquisition.
Hydrogen peroxide is effective against endospore forming bacteria, such as
Clostridium difficile, where alcohol has been shown to be ineffective. Wearing
an apron during patient care reduces the risk of infection. The apron should
either be disposable or be used only when caring for a specific patient.

17) Prevention of hospital infections. Characteristics of the medical

work.
Prevention
Hospitals have sanitation protocols regarding uniforms, equipment
sterilization, washing, and other preventative measures. Thorough hand
washing and/or use of alcohol rubs by all medical personnel before and after
each patient contact is one of the most effective ways to combat nosocomial
infections. More careful use of antimicrobial agents, such as antibiotics, is also
considered vital.
Sterilization
Sterilization goes further than just sanitizing. Sterilizing kills all
microorganisms on equipment and surfaces through exposure to chemicals,
ionizing radiation, dry heat, or steam under pressure.
Isolation

Isolation precautions are designed to prevent transmission of microorganisms

by common routes in hospitals. Because agent and host factors are more
difficult to control, interruption of transfer of microorganisms is directed
primarily at transmission
Handwashing and gloving
Handwashing frequently is called the single most important measure to
reduce the risks of transmitting skin microorganisms from one person to
another or from one site to another on the same patient. Washing hands as
promptly and thoroughly as possible between patient contacts and after
contact with blood, body fluids, secretions, excretions, and equipment or
articles contaminated by them is an important component of infection control
and isolation precautions.
Surface sanitation
Sanitizing surfaces is an often overlooked, yet crucial component of breaking
the cycle of infection in health care environments. Modern sanitizing methods
such as NAV-CO2 have been effective against gastroenteritis, MRSA, and
influenza. Use of hydrogen peroxide vapor has been clinically proven to
reduce infection rates and risk of acquisition
Antimicrobial surfaces
Microorganisms are known to survive on inanimate touch surfaces for
extended periods of time.This can be especially troublesome in hospital
environments where patients with immunodeficiencies are at enhanced risk
for contracting nosocomial infections.
Aprons
Wearing an apron during patient care reduces the risk of infection.[citation needed]
The apron should either be disposable or be used only when caring for a
specific patient.
Mitigation
The most effective technique of controlling nosocomial infection is to
strategically implement QA/QC measures to the health care sectors and
evidence-based management can be a feasible approach.

18) Ionizing radiation. Radioprotection.

Ionizing (or ionising) radiation is radiation composed of particles that

individually can liberate an electron from an atom or molecule, producing
ions, which are atoms or molecules with a net electric charge. These tends to
be especially chemically reactive, and the reactivity produces the high
biological damage caused per unit of energy of ionizing radiation. The degree
and nature of such ionization depends on the energy and type of the
individual particles composing the radiation, and less upon the radiation
particle number. Used in medical, biological and sterilization applications.
Types: Alpha () radiation, Beta () radiation, consisting of electrons, is halted
by an aluminium plate. Gamma () radiation, Neutron (n) radiation.
Radiation protection
Radiation protection, sometimes known as radiological protection, is the
protection of people and the environment from the harmful effects of ionizing
radiation, which includes both particle radiation and high energy
electromagnetic radiation. Ionizing radiation is widely used in industry and
medicine, but presents a significant health hazard. It causes microscopic
damage to living tissue, resulting in skin burns and radiation sickness at high
exposures and statistically elevated risks of cancer, tumors and genetic
damage at low exposures.
Principles of radiation protection
Radiation protection can be divided into occupational radiation protection,
which is the protection of workers, medical radiation protection, which is the
protection of patients and the radiographer, and public radiation protection,
which is protection of individual members of the public, and of the population
as a whole.
There are three factors that control the amount, or dose, of radiation received
from a source. Radiation exposure can be managed by a combination of these
factors:
1. Time: Reducing the time of an exposure reduces the effective dose
proportionally. An example of reducing radiation doses by reducing the
time of exposures might be improving operator training to reduce the
time they take to handle a source.
2. Distance: Increasing distance reduces dose due to the inverse square
law.

3. Shielding: The term 'biological shield' refers to a mass of absorbing

material placed around a reactor, or other radioactive source, to
reduce the radiation to a level safe for humans.
There are four major ways to reduce radiation exposure to workers or to
population:

Shielding. Use proper barriers to block or reduce ionizing radiation.

Time. Spend less time in radiation fields.
Distance. Increase distance between radioactive sources and workers
or population.
Amount. Reduce the quantity of radioactive material for a practice.

19) Sick building syndrome.

Sick building syndrome (SBS) is a combination of ailments (a syndrome)
associated with an individual's place of work (office building) or residence.
Most of the sick building syndrome is related to poor indoor air quality.
Symptoms: sensory irritation of the eyes, nose, throat; neurotoxic or general
health problems; skin irritation; nonspecific hypersensitivity reactions; and
odor and taste sensations.
The causes of Sick Building Syndrome can be attributed to inadequate
ventilation, chemical contaminants from indoor or outdoor sources, as well as
biological contaminants. Many volatile organic compounds, which are
considered chemical contaminants, can cause acute effects on the occupants
of a building. "Bacteria, molds, pollen, and viruses are types of biological
contaminants," and can all cause SBS.
Prevention:

Roof shingle cleaning non pressure removal of algae, mold &

Gloeocapsa magma.
Pollutant source removal or modification to storage of sources.
Replacement of water-stained ceiling tiles and carpeting.
Use paints, adhesives, solvents, and pesticides in well-ventilated areas,
and use of these pollutant sources during periods of non-occupancy.
Increase the number of air exchanges.

20) Healthful nutrition. Nutrition among different groups. Nutrition in

children and adolescents. Nutrition in pregnancy and lactation.
Nutritional requirements.

Nutrition is the provision, to cells and organisms, of the materials necessary

(in the form of food) to support life. Many common health problems can be
prevented or alleviated with a healthy diet.
A healthy diet is one that helps maintain or improve general health. It is
important for lowering many chronic health risks, such as obesity, heart
disease, diabetes, hypertension and cancer.[1] A healthy diet involves
consuming appropriate amounts of all essential nutrients and an adequate
amount of water. Nutrients can be obtained from many different foods, so
there are numerous diets that may be considered healthy. A healthy diet
needs to have a balance of macronutrients (fats, proteins, and carbohydrates),
calories to support energy needs, and micronutrients to meet the needs for
human nutrition without inducing toxicity or excessive weight gain from
consuming excessive amounts.
Child Nutrition
A healthy diet helps children grow and learn. It also helps prevent obesity and
weight-related diseases, such as diabetes. The following guidelines will help
you give your child a nutritious diet:

five servings of fruits and vegetables a day

healthy sources of protein, such as lean meat, nuts and eggs
Serve whole-grain breads and cereals because they are high in fiber
Broil, grill or steam foods instead of frying them
Limited fast food and junk food
water and milk instead of sugary fruit drinks and sodas

Calcium
This mineral is important for healthy bone development
Folate
This vitamin is important for growth, but intake is low in some children,
especially those who skip breakfast because fortified cereals are a good
source of folate. Other sources include bread, green leafy vegetables and
pulses.
Iron
This mineral helps to keep red blood cells healthy.

Adolescent Nutrition
Life-long food habits are established during adolescence. During this
important time, there a high incidence of nutritional deficiencies and poor
eating habits. Immediate and long-term complications include obesity,
hyperlipidemia, osteoporosis, sexual maturation delays, and final adult height.
Development of eating disorders is prominent during this period. In addition,
the prevalence of obesity or risk of future obesity is increasing (30% of
children age 6-19 are overweight or at risk of being overweight). The highest
prevalence of nutritional deficiencies occur during adolescence.
Nutrition during pregnancy
The conception and the subsequent weeks afterwards is the time when it is at
its most vulnerable, as it is the time when the organs and systems develop
within. The energy used to create these systems comes from the energy and
nutrients in the mother's circulation, and around the lining of the womb, such
is the reason why correct nutrient intake during pregnancy is so important.
During the early stages of pregnancy, since the placenta is not yet formed,
there is no mechanism to protect the embryo from the deficiencies which may
be inherent in the mother's circulation. Thus, it is critical that an adequate
amount of nutrients and energy is consumed. Additionally, the frequent
consumption of nutritious foods helps to prevent nausea, vomiting, and
cramps. Supplementing one's diet with foods rich in folic acid, such as oranges
and dark green leafy vegetables, helps to prevent neural tube birth defects in
the baby. Consuming foods rich in iron, such as lean red meat and beans help
to prevent anemia and ensure adequate oxygen for the baby. A necessary
step for proper diet is to take a daily prenatal vitamins, that ensure their body
gets the vitamins and minerals it needs to create a healthy baby. These
vitamins contain folic acid, iodine, iron, vitamin A, vitamin D, zinc and calcium.
Nutritional requirements
The Department of Nutrition for Health and Development, in collaboration
with FAO, continually reviews new research and information from around the
world on human nutrient requirements and recommended nutrient intakes.
This is a vast and never-ending task, given the large number of essential
human nutrients. These nutrients include protein, energy, carbohydrates, fats
and lipids, a range of vitamins, and a host of minerals and trace elements.

21) Digestion and food absorption.

When food enters the mouth, its digestion starts by the action of mastication,
a form of mechanical digestion, and the contact of saliva. Saliva, which is
secreted by the salivary glands, contains salivary amylase, an enzyme which
starts the digestion of starch in the food. After undergoing mastication and
starch digestion, the food will now be in the form of a small, round mass,
called a Bolus (digestion). It will then travel down the esophagus and into the
stomach by the action of peristalsis. Gastric juice in the stomach starts protein
digestion. Gastric juice mainly contains hydrochloric acid and pepsin. As these
two chemicals may damage the stomach wall, mucus is secreted by the
stomach, providing a slimy layer that acts as a shield against the damaging
effects of the chemicals. At the same time protein digestion is occurring,
mechanical mixing occurs by peristalsis, which are waves of muscular
contractions that move along the stomach wall. This allows the mass of food
to further mix with the digestive enzymes. After some time, the resulting thick
liquid is called chyme. When the pyloric sphincter valve opens, chyme enters
the duodenum where it mixes with digestive enzymes from the pancreas, and
then passes through the small intestine in which digestion continues. When
the chyme is fully digested, it is absorbed into the blood. 95% of absorption of
nutrients occurs in the small intestine. Water and minerals are reabsorbed
back into the blood in the colon (large intestine). Some vitamins such as biotin
and vitamin K produced by bacteria in the colon are also absorbed into the
blood in the colon. Waste material is eliminated during defecation.

22) Macronutrients. Carbohydrates, proteins and lipids. Requirements,

functions and sources.
CARBONHYDRATES
A carbohydrate is an organic compound that consists only of carbon,
hydrogen, and oxygen. The carbohydrates (saccharides) are divided into four
chemical groupings: monosaccharides, disaccharides, oligosaccharides, and
polysaccharides.
Carbohydrates are not necessary building blocks of other molecules, and the
body can obtain all its energy from protein and fats. The brain and neurons
generally cannot burn fat for energy, but use glucose or ketones. Humans can
synthesize some glucose (in a set of processes known as gluconeogenesis)
from specific amino acids, from the glycerol backbone in triglycerides and in
some cases from fatty acids. Carbohydrate and protein contain 4 kilocalories

per gram, while fats contain 9 kilocalories per gram. In the case of protein, this
is somewhat misleading as only some amino acids are usable for fuel.
Foods high in carbohydrate include fruits, sweets, soft drinks, breads, pastas,
beans, potatoes, bran, rice, and cereals.
PROTEINS
They are biochemical compounds consisting of one or more polypeptides
typically folded into a globular or fibrous form, facilitating a biological
function.
Proteins are the chief actors within the cell, said to be carrying out the duties
specified by the information encoded in genes. With the exception of certain
types of RNA, most other biological molecules are relatively inert elements
upon which proteins act. When proteins bind specifically to other copies of
the same molecule, they can oligomerize to form fibrils; this process occurs
often in structural proteins that consist of globular monomers that selfassociate to form rigid fibers.
LIPIDS
Lipids constitute a broad group of naturally occurring molecules that include
fats, waxes, sterols, fat-soluble vitamins (such as vitamins A, D, E, and K),
monoglycerides, diglycerides, triglycerides, phospholipids, and others. The
main biological functions of lipids include energy storage, as structural
components of cell membranes, and as important signaling molecules.
Humans and other mammals have a dietary requirement for certain essential
fatty acids, such as linoleic acid (an omega-6 fatty acid) and alpha-linolenic
acid (an omega-3 fatty acid) because they cannot be synthesized from simple
precursors in the diet. Both of these fatty acids are 18-carbon polyunsaturated
fatty acids differing in the number and position of the double bonds. Most
vegetable oils are rich in linoleic acid (safflower, sunflower, and corn oils).
Alpha-linolenic acid is found in the green leaves of plants, and in selected
seeds, nuts, and legumes (in particular flax, rapeseed, walnut, and soy). Fish
oils are particularly rich in the longer-chain omega-3 fatty acids
eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).

23) Micronutrients. Vitamins. Minerals. Requirements, functions and

sources.

VITAMINS
A vitamin is an organic compound required as a vital nutrient in tiny amounts
by an organism.
Fat-soluble vitamins:
Vitamin A (Retinol, retinal, and four carotenoids including beta
carotene): Defficiency: Night-blindness, Hyperkeratosis. Sources;
Orange, ripe yellow fruits, leafy vegetables, carrots, pumpkin, squash,
spinach, liver
Vitamin D (Cholecalciferol) : Defficiency : Rickets. Sources : Fish, eggs,
liver, mushrooms
Vitamin E : Deficiency is very rare; mild hemolytic anemia in newborn
infants. Sources : Many fruits and vegetables
Vitamin K : Defficiency : Bleeding diathesis. Sources : Leafy green
vegetables such as spinach, egg yolks, liver
Water-soluble vitamins:
Vitamin B1 (thiamine): Defficiency : Beriberi, Wernicke-Korsakoff
syndrome. Sources:Brown rice, vegetables, potatoes, liver, eggs
Vitamin B2 (riboflavin): Defficiency : Ariboflavinosis Sources: Dairy
products, bananas, popcorn, green beans, asparagus
Vitamin B3 (niacin or niacinamide): Sources:Meat, fish, eggs, many
vegetables, mushrooms, tree nuts
Vitamin B5 (pantothenic acid): Defficiency:Paresthesia. Souces:Meat,
broccoli, avocados
Vitamin B6 : Anemiaperipheral neuropathy. 100 mg Impairment of
proprioception, nerve damage (doses > 100 mg/day) Souces:Meat,
vegetables, tree nuts, bananas
Vitamin B7 (biotin) : Dermatitis, enteritis Sources: Raw egg yolk, liver,
peanuts, certain vegetables

 Vitamin B9 (folic acid) : Megaloblast and Deficiency during pregnancy

is associated with birth defects, such as neural tube defects. Sources :
Leafy vegetables, pasta, bread, cereal, liver
Vitamin B12 (Cobalamin cobalt): Defficiency:Megaloblastic anemia.
Sources:Meat and other animal products
MINERALS
Calcium (Ca): Key constituent of bones and teeth; Essential for vital metabolic
processes such as nerve function, muscle contraction, and blood clotting.
Iron (Fe): Essential for transfer of oxygen between tissues in the body.
Sources:Eggs; Green (leafy) vegetables; Fortified foods (e.g. cereals, white
flour); Liver; Meat; Nuts; Offal; Peas; Whole grains. Magnesium (Mg):
Essential for healthy bones; Functioning of of muscle and nerve tissue.
Sources: Eggs; Green leafy vegetables;Fish , Milk , Nuts
Phosphorous (P): Constituent of bone tissue; Forms compounds needed for
energy conversion reactions (e.g. adenosine triphosphate - ATP).
Potassium (K): Main base ion of intracellular fluid; Necessary to maintain
electrical potentials of the nervous system - and so functioning of muscle and
nerve tissues. Sources: Cereals;Coffee; FreshFruits;Meat; Saltsubsitutes;Vegetables;Whole-grain flour.
Sodium (Na): Controls the volume of extracellular fluid in the body; Maintains
the acid-alkali (pH) balance in the body; Necessary to maintain electrical
potentials of the nervous system - and so functioning of muscle and nerve
tissues.
Manganese (Mn): Antioxidant properties; Fertility; Formation of strong
healthy bones, nerves, and muscles; Forms part of the enzyme copper-zince
superoxide dismutase (CuZn SOD) system. Sources: Avocados;Nuts; Pulses;
Tea;Vegetables;Whole-grain cereals.
Sulphur (S): Healing build-up of toxic substances in the body; Structural health
of the body (sulphur is a part of many amino acids incl. cysteine and
methionine) Healthy skin, nails & hair.

24) Food surveillance. Foods of vegetable origin. Cereals. Pulses

(legumes). Nuts. Vegetables. Fruits.

CEREALS
Cereals are grasses cultivated for the edible components of their grain
(botanically, a type of fruit called a caryopsis), composed of the endosperm,
germ, and bran. Cereal grains are grown in greater quantities and provide
more food energy worldwide than any other type of crop they are therefore
staple crops.
In their natural form (as in whole grain), they are a rich source of vitamins,
minerals, carbohydrates, fats, oils, and protein.
PULSES (LEGUMES)
A pulse is an annual leguminous crop yielding from one to twelve seeds of
variable size, shape, and color within a pod.
Pulses provide protein, complex carbohydrates, and several vitamins and
minerals. Like other plant-based foods, they contain no cholesterol and little
fat or sodium. Pulses also provide iron, magnesium, phosphorus, zinc and
other minerals, which play a variety of roles in maintaining good health.
Pulses are 20 to 25% protein by weight, which is double the protein content of
wheat and three times that of rice. Pulses have significant nutritional and
health advantages for consumers. They are the most important dietary
predictor of survival in older people of different ethnicities, legume
consumption was highly correlated with a reduced mortality from coronary
heart disease.
NUTS
A nut is a hard-shelled indehiscent fruit of some plants. Nuts are a composite
of the seed and the fruit, where the fruit does not open to release the seed
People who consume nuts regularly are less likely to suffer from coronary
heart disease (CHD). It can lower serum LDL cholesterol concentrations.
Although nuts contain various substances thought to possess cardioprotective
effects, scientists believe that their Omega 3 fatty acid profile is at least in part
responsible for the hypolipidemic response observed in clinical trials.
VEGETABLES
The nutritional content of vegetables varies considerably, though generally
they contain little protein or fat, and varying proportions of vitamins such as

Vitamin A, Vitamin K and Vitamin B6, provitamins, dietary minerals and

carbohydrates. Vegetables contain a great variety of other phytochemicals,
some of which have been claimed to have antioxidant, antibacterial,
antifungal, antiviral and anticarcinogenic properties. Some vegetables also
contain fiber, important for gastrointestinal function. Vegetables contain
important nutrients necessary for healthy hair and skin as well. A person who
refrains from dairy and meat products, and eats only plants (including
vegetables) is known as a vegan.
FRUITS
Fruits are generally high in fiber, water, vitamin C and sugars, although this
latter varies widely from traces as in lime, to 61% of the fresh weight of the
date. Fruits also contain various phytochemicals and which research indicates
are required for proper long-term cellular health and disease prevention.
Regular consumption of fruit is associated with reduced risks of cancer,
cardiovascular disease (especially coronary heart disease), stroke, Alzheimer
disease, cataracts, and some of the functional declines associated with aging.

25) Food surveillance. Foods of animal origin. Milk. Meat. Eggs. Fish.
MILK
Milk derived from cattle species is an important food. It has many
nutrients.Cow milk contains, on average, 3.4% protein, 3.6% fat, and 4.6%
lactose, 0.7% minerals and supplies 66 kcal of energy per 100 grams.
The amount of calcium from milk that is absorbed by the human body is
disputed. Calcium from dairy products has a greater bioavailability than
calcium from certain vegetables, such as spinach, that contain high levels of
calcium-chelating agents, but a similar or lesser bioavailability than calcium
from low-oxalate vegetables such as kale, broccoli, or other vegetables.
MEAT
All muscle tissue is very high in protein, containing all of the essential amino
acids, and in most cases is a good source of zinc, vitamin B12, selenium,
phosphorus, niacin, vitamin B6, choline, riboflavin and iron. Several forms of
meat are high in vitamin K2, which is only otherwise known to be found in
fermented foods with natto having the highest concentration. The fat content
of meat can vary widely depending on the species and breed of animal, the

way in which the animal was raised, including what it was fed, the anatomical
part of the body, and the methods of butchering and cooking. Wild animals
such as deer are typically leaner than farm animals, leading those concerned
about fat content to choose game such as venison
Red meat, such as beef, pork, and lamb, contains many essential nutrients
necessary for healthy growth and development in children. Nutrients in red
meat include iron, zinc, vitamin B12, and protein.
EGGS
Eggs add protein to a person's diet, as well as various other nutrients.
Chicken eggs are the most commonly eaten eggs. They supply all essential
amino acids for humans, and provide several vitamins and minerals, including
retinol (vitamin A), riboflavin (vitamin B2), folic acid (vitamin B9), vitamin B6,
vitamin B12, choline, iron, calcium, phosphorus and potassium. They are also
a single-food source of protein.
All of the egg's vitamin A, D, and E are in the egg yolk. The egg is one of the
few foods to naturally contain vitamin D. Choline is an important nutrient for
development of the brain, and is said to be important for pregnant and
nursing women to ensure healthy fetal brain development.
FISH
Research over the past few decades has shown that the nutrients and
minerals in fish, and particularly the omega 3 fatty acids found in pelagic
fishes, are heart-friendly and can make improvements in brain development
and reproduction. This has highlighted the role for fish in the functionality of
the human body.
Fish is the most common food to obstruct the airway and cause choking. Fish
can also cause poisoning, especially when the fish is caught in polluted areas.
There are issues with fish contaminated with heavy metals such as mercury
and lead, or by toxic chemicals such as those containing chlorine or bromine,
dioxins or PCBs. Fish that is to be eaten should be caught in unpolluted water.

26) Dietary Assessment of the Individual. Determination of the total

energy expenditure, BMI and nutrients requirement.

Dietary Assessment: A dietary assessment is an evaluation of information

related to an individual's food intake, supplement use, lifestyle and medical
history. Once the information is collected and organized, a practitioner can
assess and evaluate the nutritional status of that person. The assessment is
used to design a care plan that helps the individual maintain their current
status or outlined steps needed to attain a healthier status. It is important to
remember that people are individuals with unique needs and concerns and no
single assessment tool can accurately evaluate the totality of ones nutritional
status.
Total energy expenditure (TEE): is an important calculation in the
determination of the overall dietary and exercise practices of any person. The
amount of energy needed by anyone to meet the daily physical demands will
have two components: the amount of energy needed to maintain the body's
needs at rest, the basal energy expenditure expressed as the base metabolic
rate (BMR) and the needs generated by the daily activity levels, which include
employment, sport and any other activities.Different types of foods have
differing values. One gram of a carbohydrate will produce four calories of
energy. One gram of a protein will also produce four calories of energy. One
gram of fat produces nine calories of energy.
Energy ingested = Energy expended + energy stored
-energy equilibrium is when energy intake is equal to energy expenditure. No
energy stores are either formed or utilized. (Ein = Eout)
-positive energy balance is when intake of energy is greater than the energy
expended. The excess of energy is stored, mainly in form of fat causing the
weight gain. (Ein>Eout)
-negative energy balance is when energy intake is lower than the energy
expenditure.Energy from body stores is utilized and the body weight drops
down. The main causes are anorexia or excessive physical activity. (Ein<Eout)
Body mass index (BMI): is defined as the individual's body mass divided by
the square of his or her height. The formulae universally used in medicine
produce a unit of measure of kg/m2..
BMI = weight kg / height m2

BMI provided a simple numeric measure of a person's "thickness" or

"thinness", allowing health professionals to discuss over- and under-weight
problems more objectively with their patients. It is meant to be used as a
simple means of classifying sedentary (physically inactive) individuals, or
rather, populations, with an average body composition. For these individuals,
the current value settings are as follows: a BMI of 18.5 to 25 may indicate
optimal weight; a BMI lower than 18.5 suggests the person is underweight
while a number above 25 may indicate the person is overweight; a person
may have a BMI below 18.5 due to disease; a number above 30 suggests the
person is obese (over 40, morbidly obese).
Nutrients requirement: as for the nutrients requirement we find 3 types of
foods be distributed as follows: Proteins 10-15%, Fat: 15-30%, carbohydrate:
55-75%.
Recommended intake of protein for adults is 1,3g/kg of body mass, 12-14 % of
balanced diet, 50% must be taken from plants sources the rest from milk,
meat, eggs. For fats 6-10% should be in form of polyunsaturated acids and fat
intake should not exceed 10%.recommended amount of cholesterol is no
more than 300mg daily. Also amount for carbohydrates should not exceed
300 g per day except for an active person at least 400-600 g.

27) Assessment of Nutritional Status. Nutritional Assessment by

Anthrometric and Physiological Methods.
Nutritional status: is the balance between the intake of nutrients by an
organism and the expenditure of these in the processes of growth,
reproduction, and health maintenance. Nutritional status can be measured
also for individuals also for populations. We can assess the nutrition by two
methods: direct measure objective criteria and indirect use community health
indices that reflect nutritional influence.
-Indirect: ecological variables including crop production and economic factors
(social habits-population density).
-Direct: Anthropometry is a noninvasive method that assesses the size or
body composition of an individual. Is the measurement of body height, weight
and proportions. Anthropometrics are the objective measurements of body
muscle and fat. They are used to compare individuals, to compare growth in
the young, and to assess weight loss or gain in the mature individual. Weight

and height are the most frequently used anthropometric measurements and
skin fold measurements of several areas of the body are also taken. Other
anthropometric methods are head circumference, waist/hip ratio, mid arm
circumference. Biochemical methods are an essential part of nutritional
assessment. They are useful, precise, accurate for checking protein intake- to
support change of type of fat-the only way to gauge iodine intake. The
hemoglobin estimation is the most important test because besides anemia
informs about protein and trace element nutrition r urine microscopy for
albumin, sugar and blood. Biochemical data: Laboratory tests based on blood
and urine can be important indicators of nutritional status, but they are
influenced by nonnutritional factors as well. Lab results can be altered by
medications, hydration status, and disease states or other metabolic
processes, such as stress. As with the other areas of nutrition assessment,
biochemical data need to be viewed as a part of the whole.
Clinical and physiological methods are most practical method:
HAIR:
Spare and thin deficiency of zinc-biotin-protein
Coiled hair Vitamin C and vitamin A deficiency
MOUTH:
Glossitis Riboflavin, B12, folic acid
Leukoplakia Vitamin A, B
Bleeding Vitamin C, K, folic acid and niacin
EYES:
Night blindness Vitamin A deficiency
NAILS:
Transverse lines Protein deficiency
SKIN:
Pallor Iron, folic acid, Vitamin A
Follicular hyperkeratosis Vitamin B2, Vitamin A, zinc and folic acid

28) Assessment of Nutritional Status. Nutritional Assessment by

Clinical, Anthrometric and Biochemical Methods.
Nutritional status: is the balance between the intake of nutrients by an
organism and the expenditure of these in the processes of growth,
reproduction, and health maintenance. Nutritional status can be measured
also for individuals also for populations. We can assess the nutrition by two
methods: direct measure objective criteria and indirect use community health
indices that reflect nutritional influence.
-Indirect: ecological variables including crop production and economic factors
(social habits-population density).
-Direct: Anthropometry is a noninvasive method that assesses the size or
body composition of an individual. Is the measurement of body height, weight
and proportions. Anthropometrics are the objective measurements of body
muscle and fat. They are used to compare individuals, to compare growth in
the young, and to assess weight loss or gain in the mature individual. Weight
and height are the most frequently used anthropometric measurements and
skin fold measurements of several areas of the body are also taken. Other
anthropometric methods are head circumference, waist/hip ratio, mid arm
circumference. Biochemical methods are an essential part of nutritional
assessment. They are useful, precise, accurate for checking protein intake- to
support change of type of fat-the only way to gauge iodine intake. The
hemoglobin estimation is the most important test because besides anemia
informs about protein and trace element nutrition r urine microscopy for
albumin, sugar and blood. Biochemical data: Laboratory tests based on blood
and urine can be important indicators of nutritional status, but they are
influenced by nonnutritional factors as well. Lab results can be altered by
medications, hydration status, and disease states or other metabolic
processes, such as stress. As with the other areas of nutrition assessment,
biochemical data need to be viewed as a part of the whole.
Clinical and physiological methods are most practical method:
HAIR:
Spare and thin deficiency of zinc-biotin-protein
Coiled hair Vitamin C and vitamin A deficiency

MOUTH:
Glossitis Riboflavin, B12, folic acid
Leukoplakia Vitamin A, B
Bleeding Vitamin C, K, folic acid and niacin
EYES:
Night blindness Vitamin A deficiency
NAILS:
Transverse lines Protein deficiency
SKIN:
Pallor Iron, folic acid, Vitamin A
Follicular hyperkeratosis Vitamin B2, Vitamin A, zinc and folic acid

29) Restaurants. Sanitation of Eating Places and Foodstore. Hygiene.

Security.
So-called fast-food restaurants, usually operated in chains or as franchises and
heavily advertised, offer limited menus-typically comprising hamburgers, hot
dogs, fried chicken, or pizza and their complements and also offer speed,
convenience and familiarity to diners who may eat in the restaurant or take
their food home. Many school, work and institutional facilities provide space
for coin-operated vending machines that offer snacks and beverages.
Sanitation of Eating places and foodstore:
Kitchen personnel include chefs and cooks, who are responsible for preparing
and cooking food, pantry persons, who prepare the food for cooking and also
keep an inventory of stock and stewards, who are responsible for the cleaning
and maintenance of the kitchen area. Some common types of machinely used
in kitchens are meat grinderr,mixers, ice mac, depending on the amount of
leaked radiation and the length of exposure, microwave radiation can damage
sensitive human organs.The radiation can also damage medical equipment
implanted in the human body, such as pacemakers. Microwave ovens must be
kept free or food and grease spills around the doors and seals, since these

residues may prevent the oven doors from closing properly and lead to
leakage of microwaveshines and dishwashingmachines.
The following minimum standards have been suggested for Restaurants and
Eating Houses:
Location - not to be near any accumulation of filth or open drain,
stable, manure pit and other sources of nuisances.
Floors - to be higher than the adjoining land, made with impervious
material and easy to keep clean.
Rooms - (a) rooms where meals are served shall not be less than 100
sq. feet and shall provide accommodation for a maximum of 10
persons, (b) walls up to 3 feet should be smooth, corners to be
rounded; should be impervious and easily washable, (c) lighting and
ventilation - ample natural lighting facilities aided by artificial lighting
with good circulation of air are necessary.
Kitchen - floor space minimun 60 sq. feet, window opening to be 25 per
cent of floor area.
Ventilalors - 2 per cent of the floor area in addition to smoke pipes.
Storage of cooked food - separate room to be provided: for long
storage, control of temperature is necessary.
Storage of uncooked foodstuffs - perishable and non-perishable articles
to be kept separately, in rat-proof and vermin-proof space; for storage
of perishable articles temperature control should be adopted.
Furniture - should be reasonably strong and easy to keep clean and dry.
Water supply - to be an independent source, adequate, continuous and
safe.
Washing facilities - to be provided. Cleaning of utensils and crockery to
be done in hot water and followed by disinfection.
Hygiene and Security: Although the majority of freshly laid eggs are sterile
inside, the shells become contaminated by faecal matter from the hen.
Microorganisms including pathogenic Salmonella can penetrate a cracked
shell and enter the egg. Eggs should be disinfected with chlorine 2 per cent for
10 min. Fruits and vegetables constitute another important source for the
spread of pathogenic organisms, protozo and heilinths. These infections are a
serious menace to public health where sewage is used for growing vegetables.
The vegetables which are consumed raw in the form of salads pose a problem
in food sanitation. Vegetables should be washed before eating them raw.

Vegetables which are cooked are free from this danger. Food sanitation is a
series of protocols which are designed to prevent the contamination of food,
keeping it safe to eat. Numerous nations have specific laws in place
concerning food sanitation, along with lengthy lists of recommendations from
public health agencies. From the moment that food is harvested to the time
that it is eaten, it is vulnerable to cross-contamination with bacteria and other
substances which could be harmful. The key to food sanitation is keeping food
safe and clean, with all of the handlers observing personal hygiene to avoid
introducing harmful elements to food and complying with food sanitation
recommendations concerning safe holding temperatures for food, safe
cooking temperatures, sterilization of cutting boards and other implements
and so forth.

30) Foodborne diseases. Prevention of the Bacterial Diseases.

Foodborne disease is any illness resulting from the consumption of
contaminated food, pathogenic bacteria, viruses, or parasites that
contaminate food, as well as chemical or natural toxins such as poisonous
mushrooms. The delay between consumption of a contaminated food and
appearance of the first symptoms of illness is called the incubation period.
This ranges from hours to days, depending on the agent, and on how much
was consumed. If symptoms occur within 16 hours after eating the food, it
suggests that it is caused by a bacterial toxin or a chemical rather than live
bacterium. The long incubation period of many foodborne illnesses tends to
cause sufferers to attribute their symptoms to stomach flu. During the
incubation period, microbes pass through the stomach into the intestine,
attach to the cells lining the intestinal walls and begin to multiply there. Some
types of microbes stay in the intestine, some produce a toxin that is absorbed
into the bloodstream and some can directly invade the deeper body tissues.
Causes: foodborne illness usually arises from: improper handling, preparation,
or food storage.
Symptoms: typically begin several hours to several days after consumption
and depending on the agent involved, can include one or more of the
following: nausea, abdominal pain, vomiting, diarrhea, gastroenteritis, fever,
headache or fatigue.
Prevention: Prevention is mainly the role of the state, through the definition
of strict rules of hygiene and a public services of veterinary surveying of

animal products in the food chain, from farming to the transformation

industry and delivery (shops and restaurants). This regulation includes:
traceability: in a final product, it must be possible to know the origin of the
ingredients (originating farm, identification of the harvesting or of the animal)
and where and when it was processed; the origin of the illness can be tracked
and solved (and possibly penalized) and the final products can be removed
from the sale if a problem is detected; enforcement of hygiene procedures
like HACCP and the "cold chain"; power of control and of law enforcement of
veterinarians. At home, prevention mainly consists of good food safety
practices. Many forms of bacterial poisoning can be prevented even if food is
contaminated by cooking it sufficiently and either eating it quickly or
refrigerating it effectively. Many toxins, however, are not destroyed by heat
treatment.

31) Food Preservation. Low-temperature Preservation. Thermal

Processing. Fermentation and Pickling. Chemical Preservation.
Food preservation is the process of treating and handling food to stop or slow
down spoilage (loss of quality, edibility or nutritional value) and allow for
longer storage. Preservation usually involves preventing the growth of
bacteria, yeasts, fungi and other micro-organisms (although some methods
work by introducing benign bacteria, or fungi to the food), as well as retarding
the oxidation of fats which cause rancidity. Food preservation can also include
processes which inhibit visual deterioration that can occur during food
preparation; such as the enzymatic browning reaction in apples after they are
cut. Refrigeration preserves food by slowing down the growth and
reproduction of micro-organisms and the action of enzymes which cause food
to rot. The introduction of commercial and domestic refrigerators drastically
improved the diets of by allowing foods such as fresh fruit, salads and dairy
products to be stored safely for longer periods, particularly during warm
weather.
Freezing: is also one of the most commonly used processes commercially and
domestically for preserving a very wide range of food including prepared food
stuffs which would not have required freezing in their unprepared state. This
process does not destroy any nutrients, but some losses may occur during the
steps taken in preparation for freezing like washing, trimming, grinding.
Vacuum-packing stores food in a vacuum environment, usually in an air-tight
bag or bottle. The vacuum environment strips bacteria of oxygen needed for

survival, slowing spoiling. Vacuum-packing is commonly used for storing nuts

to reduce loss of flavor from oxidation. Salting or curing draws moisture from
the meat through a process of osmosis. Meat is cured with salt or sugar, or a
combination of the two. Nitrates and nitrites are also often used to cure meat
and contribute the characteristic pink color, as well as inhibition of
Clostridium botulinum.
Extrusion: in this process the food is heated, ground and pushed through
various kinds of screens to yield different shapes, usually bite-size or smaller,
like pieces of breakfast cereal.
Pickling is a method of preserving food in an edible anti-microbial liquid.
Pickling can be broadly categorized as chemical pickling for example, in
chemical pickling, the food is placed in an edible liquid that inhibits or kills
bacteria and other micro-organisms. Typical pickling agents include brine (high
in salt), vinegar, alcohol, and vegetable oil, especially olive oil but also many
other oils. Many chemical pickling processes also involve heating or boiling so
that the food being preserved becomes saturated with the pickling agent.
Common chemically pickled foods include cucumbers, peppers, corned beef,
herring and eggs, as well mixed vegetables such as piccalilli.
In fermentation pickling, the food itself produces the preservation agent,
typically by a process that produces lactic acid. Fermented pickles
include sauerkraut, nukazuke, kimchi, surstrmming and curtido. Some
pickled cucumbers are also fermented.
Chemical preservation: Preservative food additives can be antimicrobial;
which inhibit the growth of bacteria or fungi, including mold, or antioxidant;
such as oxygen absorbers, which inhibit the oxidation of food constituents.
Common antimicrobial preservatives include calcium propionate, sodium
nitrate, sodium nitrite, sulfites (sulfur dioxide, sodium bisulfite, potassium
hydrogen sulfite, etc.) and disodium EDTA. Antioxidants include BHA and BHT.
Other preservatives include formaldehyde (usually in solution), glutaraldehyde
(kills insects), ethanol and methylchloroisothiazolinone. Canning involves
cooking food, sealing it in sterile cans or jars and boiling the containers to kill
or weaken any remaining bacteria as a form of sterilization.

32) Diet and nutrition in disease. Nutrition Therapy for Diabetes.

Diabetics should focus on eating balanced meals three times per day, in
addition to healthy snacks two to three times daily. A balanced meal contains

average-sized portions of fats, carbohydrates and protein. The ratio between

carbohydrates, proteins and fats will help to balance blood glucose levels. A
healthy meal for a diabetic would consist of raw carrots or broccoli and
steamed or lightly grilled salmon. Diabetics need a good amount of healthy
carbohydrates such as carrots, beets, apples, cucumbers, dark green leafy
lettuce and other vegetables. Healthy sources of protein are lean turkey
breast, chicken breast and nutrient-rich fish like salmon and trout. Vegetable
sources of protein, such as soy beans or spirulina, are just as beneficial as
protein found in meat. The salmon will include protein and healthy fats and
the vegetables are a good source of healthy carbohydrates. A healthy snack
for a diabetic would be light string cheese or an apple. The sugar in apples and
many other fruits do not raise blood glucose levels because these sugars are
not refined and the fiber balances how the body processes this type of sugar.
However, diabetics should avoid fruit juices because the fiber has been
removed. Healthy fats such as omega-3 fatty acids are very beneficial for
people who suffer from diabetes. Good fats help to improve metabolism and
reduce inflammation in the body. People who suffer from diabetes have a
high level of inflammation in their body. Foods that include good fats are olive
oil, salmon oil, fish, nuts and eggs.

33) Nutrition Therapy for Gastrointestinal Diseases gastritis, ulcer,

colitis.
Nutrition for pancreatitis, hepatitis, gastritis, ulcer say about alcohol
beverages and tobacco most important not to assume, minimize aflatoxin,
eat at least 400 g per day fresh fruits and vegetables and maintain a stable
physical activity.
Foods to eat on a diet for ulcers or gastritis are found in most food groups and
should be eaten each day to maintain proper levels of nutrition. Even though
the diet should be a bland one, it is important to eat whole grains, proteins,
fruits and vegetables. Eating meals three times a day and drinking fat-free
milk rather than whole-fat milk to control acid in the stomach prevents
stomach acid from increasing. Also drink watered herbal teas, or fruit juices
that are low in acid like apple or grape. Drink plenty of water to clean out the
system and keep the body hydrated. For starches, eat at least six to 10
servings each day of rice, mashed potatoes, pasta or whole-grain bread. You
should eat two to four servings of fruits each day, such as apples, melon,
bananas or grapes, keeping in mind to avoid fruits with acids like citrus.

Likewise, two to four servings of vegetables including salad greens should be

eaten. Avoid broccoli, peppers and cabbage since they cause gas or other
stomach discomforts. Consume two to four servings of proteins each day,
whether from lean meats like poultry, cheese or peanut butter. Good choices
of foods with fiber include fruits, vegetables, whole grains and beans. Some
foods with fiber such as broccoli or cabbage should be avoided since they
cause gas. Foods that contain omega-3 and omega-6 fatty acids have been
shown to have a protective effect on damaged mucosal lining. Foods that
contain high amounts of these lipids include salmon, olive oil, nuts and seeds.
Colitis: Eat a low-carbohydrate, high-vegetable-protein diet. Baked or broiled
fish, chicken and turkey minus the skin are great sources of protein. Make
sure to include plenty of vegetables; steaming them makes digestion easier.
Include garlic for its healing and antibiotic properties. Drinking water, at least
eight full glasses daily, is necessary to make up for lost fluids if you are
experiencing diarrhea and to rid the body of toxins. Green drinks--powder or
liquids that contain nutrients from green vegetables)--or adding chlorophyll to
your water is good for digestion. Fruits should be eaten with meals and not on
an empty stomach. Avoid any acidic fruits such as oranges and grapefruits, but
do indulge in eating bananas, applesauce and canned fruits, which are milder.
Fruits juices should always be diluted with water and taken during meals or
shortly thereafter. Getting fiber into your diet is good for keeping the bowels
regular and formed. Go with grains that are well cooked and soluble. Such
foods as oat bran, brown rice, barley and lentils are good choices.

34) Nutrition Therapy for Cardiovascular Disease.

Foods high in saturated fats increase bad cholesterol, which builds up over
time to block arteries. Avoid foods high in saturated fats like fried foods. All
animal products contain cholesterol, so limit meat intake to very lean cuts in
portions no greater than 200gr per day. Eat fish twice per week or more.
Increase your intake of fresh fruits and vegetables and complex carbohydrates
including brown rice, whole-grain bread and whole-wheat pasta. Make more
foods from scratch, or choose frozen vegetables instead of canned to avoid
sodium. Reduce your sodium intake to between 1,500 to 2,300 milligrams per
day, depending on your doctor's recommendation. Use herbs and salt-free
herbal blends to season food instead of salt, soy sauce or Worcestershire
sauce. Ask your doctor before using salt substitutes because many contain
potassium, a mineral which may need to be limited based on your medical

condition. Instead of bacon and eggs for breakfast, choose a low-fat, highfiber breakfast with plenty of nutrition. Eat a bowl of high-fiber cold breakfast
cereal with a half cup of low-fat or non-fat dairy or soy milk. Cut up some
berries to top the cereal or eat half a grapefruit on the side, topped with a
packet of sugar substitute. If your calorie intake allows, add a slice or two of
whole-grain toast, topped with margarine that is labeled trans-fat free.
Traditional lunch choices like canned tuna and processed deli meats can
contain high amounts of sodium and fat. Avoid canned soups and frozen
entrees high in sodium. Have for lunch instead a mixed green salad with a
small amount of low-sodium, fat-free dressing such as raspberry vinaigrette.
Use cooked and chilled garbanzo beans or unsalted soy nuts to top your salad
instead of meat. Eat a bit of low-fat cheese or non-hydrogenated unsalted
peanut butter for protein. Add some sliced tomatoes, peppered instead of
salted. If you crave sweets, try a cup of sugar-free gelatin for dessert. Make
meat a part of the whole meal rather than the focus of it. Load your plate with
plenty of fresh steamed vegetables and whole-grain carbohydrates. Eat beef
only about two or three times per week. Other nights, choose a small lean
chicken breast or fresh fish fillet. Season it with garlic, lemon juice and herbs
such as basil or dill. Add a healthy portion of steamed fresh green beans,
topped with unsalted slivered almonds. Finish your meal by creating your own
brown rice side dish using diced peppers and onions, an herbal seasoning
blend and just a splash of white wine. Eat some fat-free, sugar-free pudding or
some non-dairy fruit sorbet for dessert.

35) Nutrition Therapy for pancreatitis, cholelythiasis, hepatitis.

Nutrition for pancreatitis, hepatitis, gastritis, ulcer say about alcohol
beverages and tobacco most important not to assume, minimize aflatoxin,
eat at least 400 g per day fresh fruits and vegetables and maintain a stable
physical activity.
A healthy diet must include some protein. For patients suffering from kidney
disease, this amount may be limited. Proteins are essential to growing and
repairing tissue, but protein leaves waste that must be cleaned by the kidneys.
Stage one, two and three kidney disease may reduce protein levels to only 15
percent of total caloric intake. A typical healthy diet for someone without
kidney disease contains 30 percent calories from protein. Later stages of the
disease decrease the protein levels even further to only 10 percent calories
from protein. Patients receiving dialysis may need to increase protein

consumption. Dialysis removes protein wastes from the blood, removing the
burden from the kidneys, but it also removes amino acids. Increasing your
protein intake during this stage of kidney disease and treatment will replace
lost nutrients. In later stages of kidney disease, potassium levels can become
elevated. High potassium levels can cause cardiac arrest and must be a dietary
concern for these patients. Potassium is found in many healthy foods such as
green, leafy vegetables and should only be restricted if blood levels are high.
The average diet contains much more sodium than most people need. On a
kidney disease diet, do not add extra salt to your food and keep sodium intake
at levels of 2,000 mg or less per day. Be wary of no-sodium salt substitutes on
a kidney disease diet. These products have high levels of potassium, which you
may have to restrict. There is no special diet for kidney disease. Every patient
has different nutritional needs. Kidney disease can strike patients who are
underweight, at their correct weight or overweight.
Kidney stones: Drink plenty of fluids - one study has shown that people who
drink more than 2 1/2 liters of water every day have almost a 40 percent
decrease in the risk of developing a stone than those who drank less water.
Limit consumption of grapefruit juice and cola drinks. Studies have shown that
these may actually increase the risk of developing stones. Adopt a diet high in
potassium and magnesium - these minerals decrease the likelihood of kidney
stones. Limit your calcium and salt intake.
Pancreatitis: It is important to eat foods high in B-vitamins and iron, like
whole grains and dark, leafy vegetables. For protein, it is better to eat fish
than red meat. The probiotics in yogurt help keep a balance in your digestive
system and can help heal acute pancreatitis. Antioxidants increasing your
intake antioxidants can help prevent pancreatitis and lessen its symptoms.
Antioxidants are found in some fruits and in green, leafy vegetables. We can
get antioxidants from multivitamins containing A, C, E and D as well as taking
flax seed oil or fish oils that contain omega-3 fatty acids.
Adequate caloric intake is important for treating Hepatitis to maintain the
weight or to regain any weight lost. Adequate caloric intake also spares
protein stores. Thirty calories per kilogram of body weight is recommended.
Eating several smaller meals throughout the day may help obtain all of the
calories needed. Adequate protein intake protects the liver against chemical
poisons and helps in healing. It is recommended to receive 1-1.2 grams per
kilogram body weight of protein per day. Eat plenty of cereals, breads, fruits

and vegetables. Eat at least five servings of fruits and vegetables each day.
Choose lean meats and low-fat dairy products. Healthy snacks can include
fresh or frozen fruits, raw vegetables, milk, yogurt, cheese, bagels, bread,
crackers, nuts and peanut butter. Hepatitis patients can benefit from vitamin
and mineral supplementation due to their antioxidant and healing properties.
Vitamin C (red and green peppers, oranges, strawberries, broccoli, etc.) helps
with immune function and tissue healing. Vitamin E (fortified cereals,
sunflower seeds, almonds, peanut butter, vegetable oils) and other
antioxidants help to neutralize free radical damage. Lecithin and choline
supplementation have been thought to prevent fatty liver. Lipoic acid is
thought to strengthen the affects of antioxidants and can be used to treat
liver disease, including Hepatitis C.

36) Food pollution. Pesticides. Heavy metals.

Food pollution means the presence in food or associated with food of toxic
chemicals (elements or compounds) and/or biological contaminants which are
not naturally present in food or are above their natural background levels (for
those chemicals which are naturally found in some foods). This may affect
each of us by causing mild to severe food-illnesses or, even worse,
contributing or causing the development of serious health problems such as
hormonal and metabolism problems, or even various types of cancer. Nervous
system problems may also be induced by food polluted with certain
pesticides. Additionally, in rare cases when highly polluted food is consumed,
serious food poisoning or death may occur almost immediately.
A list of risks to your health because of food pollution: 1. Improper cooking
methods will destroy vitamins. 2. Many drugs in foods, such as arsenic,
mercury, bicarbonate of soda, baking powder, bismuth tend to displace and
upset the function of enzymes (digesters) and great increase the wasteful
disposal of needed vitamins for your body's health. 3. Astringents, solvents
and emulsifiers drain out vitamins and minerals from the bloodstream and
tissues of the body. Premature aging is often traced to a depletion of needed
vitamins. 4. Preservatives, analgesics such as nicotine, alcohol, and aspirin
cancel out the beneficial functions of nutrients you so carefully select for your
body. 5. Antibiotics kill vitamin-producing organisms within the large intestine
creating havoc in the entire glandular and hormonal system which serves to
shape a person's character and personality. 6. Bleaching agents used in white
flour products destroy delicate nutrients and create faulty digestive problems.
7. Sulphuring of foods for preservation and use of sulphides to "freshen" the
appearance of foods are destructive to body tissues. They also create internal
mucus and toxic waste that accumulate and build internal toxemia. 8.
Insecticides and disinfectants are often absorbed and retained in foods and

create internal pollution. 9. Alkalin phosphatases, essential to your body to

metabolize sugars and starches, are destroyed or inhibited by chemicals in
foods. 10. Artificial colors and sweeteners are similar to coal tar dyes, inks,
paints, injections, and sprays. If combustion from such chemicals is polluting
our air, then you can imagine what is happening to foods that are entering
your system, when such foods have been subjected to the same
chemicalization as gasoline and floor varnish.
A pesticide is any substance or mixture of substances intended for preventing,
destroying, repelling or mitigating any pest. A pesticide may be a chemical
substance, biological agent (such as a virus or bacterium), antimicrobial,
disinfectant or device used against any pest.
Classification: Pesticides can be classified by target organism, chemical
structure, and physical state. Pesticides can also be classed as inorganic,
synthetic, or biologicals (biopesticides).
Symptoms: headache, tears in the eyes, runny nose, increased saliva,
vomiting, diarrhea, sweating, general weakness, muscle twitching, seizures,
shallow breathing, dizziness.
Treatment: There are basic management techniques that are applicable to
most acute poisonings, including skin decontamination, airway protection,
gastrointestinal decontamination and seizure treatment. The patient is
intubated and oxygen administered, if necessary. In more severe cases,
pulmonary ventilation must sometimes be supported mechanically. Seizures
are typically managed with lorazepam, phenytoin and phenobarbitol, or
diazepam (particularly for organochlorine poisonings).
Prevention: Accidental poisonings can be avoided by proper labeling and
storage of containers. When handling or applying pesticides, exposure can be
significantly reduced by protecting certain parts of the body where the skin
shows increased absorption, such as the scrotal region, underarms, face, scalp
and hands. Using chemical-resistant gloves has been shown to reduce
contamination by 33-86%.

37) Food connected diseases. Obesity. Anaemia, Hypovitaminosises.

Malnutrition.
Obesity is a medical condition in which excess body fat has accumulated to
the extent that it may have an adverse effect on health, leading to reduced life
expectancy and/or increased health problems. Body mass index (BMI), a

measurement which compares weight and height, defines people as

overweight (pre-obese) if their BMI is between 25 and 30 kg/m2, and obese
when it is greater than 30 kg/m2. At an individual level, a combination of
excessive food energy intake and a lack of physical activity are thought to
explain most cases of obesity.
Anaemia is a decrease in number of (RBCs) or less than the normal quantity
of hemoglobin in the blood. However, it can include decreased oxygenbinding ability of each hemoglobin molecule due to deformity or lack in
numerical development as in some other types of hemoglobin deficiency.
Because hemoglobin (found inside RBCs) normally carries oxygen from the
lungs to the capillaries, anemia leads to hypoxia (lack of oxygen) in organs.
Since all human cells depend on oxygen for survival, varying degrees of
anemia can have a wide range of clinical consequences.
-Microcytic anemia is primarily a result of hemoglobin synthesis
failure/insufficiency.
-Macrocytic anemia can be further divided into "megaloblastic anemia" (due
to a deficiency of either vitamin B12, folic acid or both), or "non-megaloblastic
macrocytic anemia.
-Normocytic anemia occurs when the overall hemoglobin levels are
decreased, but the red blood cell size (mean corpuscular volume) remains
normal.
Sources of iron: Fortified cereals, beans, lentils, beef, eggs. Other deficiencies
which can lead to anemia are less common, but do include vitamin B12 and
folic acid. B12 sources: Fish, poultry, meat, fortified cereals. Folic acid sources:
Dark, leafy vegetables; enriched and whole grain breads; fortified cereals.
Avitaminosis is any disease caused by chronic or long-term vitamin deficiency
or caused by a defect in metabolic conversion, such as tryptophan to niacin.
They are designated by the same letter as the vitamin. Conversely
hypervitaminosis is the syndrome of symptoms caused by over-retention of
fat-soluble vitamins in the body. Include: Vitamin A (sweet potato with peel,
carrots, spinach, fortified cereals) deficiency causes xerophthalmia or night
blindness. Thiamine B1 (whole grain, enriched, fortified products; bread;
cereals) deficiency causes beriberi. Niacin B3 (meat, fish, poultry, enriched
and whole grain breads, fortified cereals) deficiency causes pellagra. Vitamin
B12 deficiency leads to megaloblastic anemia and subacute combined

degeneration of spinal cord. Vitamin C (red and green peppers, kiwis, oranges,
strawberries, broccoli) deficiency leads to scurvy. Vitamin D (fish liver oils,
fatty fish, fortified milk products, fortified cereals; also, formed naturally as a
result of sunlight exposure) deficiency causes rickets. Vitamin K (green
vegetables like spinach, collards, and broccoli; brussels sprouts; cabbage)
deficiency causes impaired coagulation.
Malnutrition is the condition that results from taking an unbalanced diet in
which certain nutrients are lacking, in excess (too high an intake), or in the
wrong proportions. Major causes of malnutrition include poverty and food
prices, dietary practices and agricultural productivity, with many individual
cases being a mixture of several factors. Clinical malnutrition, such as in
cachexia, is a major burden also in developed countries. A lack of
breastfeeding can lead to malnutrition in infants and children. Fighting
malnutrition, mostly through fortifying foods with micronutrients (vitamins
and minerals), improves lives at a lower cost and shorter time than other
forms of aid.

38) Functional foods. Food additives.

Functional food The general category of functional foods includes processed
food or foods fortified with health-promoting additives, like "vitaminenriched" products. Products considered functional generally do not include
products where fortification has been done to meet government regulations
and the change is not recorded on the label as a significant addition ("invisible
fortification"). An example of this type of fortification would be the historic
addition of iodine to table salt, or Vitamin D to milk, done to resolve public
health problems such as rickets. Fermented foods with live cultures are
considered functional foods with probiotic benefits. Functional foods are part
of the continuum of products that individuals may consume to increase their
health and/or contribute to reducing their disease burden.
Food additives are substances added to food to preserve flavor or enhance its
taste and appearance. Some additives have been used for centuries; for
example, preserving food by pickling (with vinegar), salting, as with bacon,
preserving sweets or using sulfur dioxide as in some wines. Food additives can
be divided into several groups: Food acids are added to make flavors
"sharper", and also act as preservatives and antioxidants. Common food acids
include vinegar, citric acid, tartaric acid, malic acid, fumaric acid, and lactic
acid. Antioxidants such as vitamin C act as preservatives by inhibiting the

effects of oxygen on food, and can be beneficial to health. Colorings are added
to food to replace colors lost during preparation, or to make food look more
attractive. In contrast to colorings, color retention agents are used to preserve
a food's existing color. Flavors are additives that give food a particular taste or
smell, and may be derived from natural ingredients or created artificially.
Preservatives prevent or inhibit spoilage of food due to fungi, bacteria and
other microorganisms.

39) Occupational medicine, unfavourable factors of working condition.

Occupational diseases. Work physiology.
Unfavourable factors of work: mechanical hazards include: impact force
Collisions, falls from height, struck by objects, confined space Slips and trips,
falling on a pointed object, compressed air/high pressure fluids (such as
cutting fluid), entanglement equipment-related injury; chemical hazards
include: acidsBases, heavy metals (ex. lead,mercury), solvents, petroleum
(noxious gases/vapors), highly-reactive chemicals, fire, conflagration and
explosion hazards. Particulates Asbestos and other fine dust/fibrous
materials, Silica. Physical hazards: noise, vibration, lighting, barotrauma
(hypobaric/hyperbaric pressure), ionizing radiation, electricity, asphyxiation,
cold stress (hypothermia), heat stress (hyperthermia), dehydration (due to
sweating); biological hazards include: bacteria, virus, fungi (ex. mold), bloodborne pathogens, tuberculosis. Risk assessment: Identify the hazards, identify
all affected by the hazard and how, evaluate the risk, identify and prioritise
appropriate control measures.
Professional diseases: Asbestosis is a chronic inflammatory medical condition
affecting the parenchymal tissue of the lungs. It occurs after long-term, heavy
exposure to asbestos (ex. in mining). Its regarded as an occupational lung
disease. Sufferers have severe dyspnea (shortness of breath) and are at an
increased risk regarding several different types of lung cancer.
Pneumoconiosis is an occupational lung disease and a restrictive lung disease
caused by the inhalation of dust. Silicosis (also known as Potter's rot) is a form
of occupational lung disease caused by inhalation of crystalline silica dust, and
is marked by inflammation and scarring in forms of nodular lesions in the
upper lobes of the lungs. Byssinosis, also called "brown lung disease" or
"Monday fever", is an occupational lung disease caused by exposure to
cotton. Hypersensitivity pneumonitis (also called extrinsic allergic alveolitis,

EAA), is an inflammation of the alveoli within the lung caused by

hypersensitivity to inhaled organic dusts.
Work physiology: Capacity for physical work - an individuals physical
tolerance to physical work is usually determined by the capacity of his or her
cardiovascular and respiratory systems to deliver oxygen to the working
muscles and to metabolize chemically stored energy.

40) Occupational medicine. Physical factors noise, infra and ultra

sound, vibration, atmospheric pressure.
Noise Sound or a sound that is loud, unpleasant, unexpected, or undesired.
When speaking of noise in relation to sound, what is commonly meant is
meaningless sound of greater than usual volume. A loud activity may be
referred to as noisy. Noise pollution (or environmental noise) is displeasing
human, animal or machine created sound that disrupts the activity or balance
of human or animal life. Source of noise pollution: The source of most outdoor
noise worldwide is transportation systems, including motor vehicle noise,
aircraft noise and rail noise. Poor urban planning may give rise to noise
pollution, since side-by-side industrial and residential buildings can result in
noise pollution in the residential area. Other sources of indoor and outdoor
noise pollution are car alarms, emergency service sirens, office equipment,
factory machinery, construction work, groundskeeping equipment, barking
dogs, appliances, power tools, lighting hum, audio entertainment systems,
loudspeakers, and noisy people. Health effects: Noise health effects are both
health and behavioural in nature. Noise sound can damage physiological and
psychological health. Noise pollution can cause annoyance and aggression,
hypertension, high stress levels, tinnitus, hearing loss, sleep disturbances,
stress and hypertension, tinnitus. Chronic exposure to noise may cause noiseinduced hearing loss. Older males exposed to significant occupational noise
demonstrate significantly reduced hearing sensitivity than their non-exposed
peers.
Infrasound is sound that is lower in frequency than 20 Hz (Hertz) or cycles
per second, the normal limit of human hearing. Hearing becomes gradually
less sensitive as frequency decreases, so for humans to perceive infrasound,
the sound pressure must be sufficiently high. The ear is the primary organ for
sensing infrasound, but at higher levels it is possible to feel infrasound
vibrations in various parts of the body. Infrasound is characterized by an
ability to cover long distances and get around obstacles with little dissipation.

Human reaction to infrasound: 20 Hz is considered the normal low frequency

limit of human hearing. When pure sine waves are reproduced under ideal
conditions and at very high volume, a human listener will be able to identify
tones as low as 12 Hz. Below 10 Hz it is possible to perceive the single cycles
of the sound, along with a sensation of pressure at the eardrums. Infrasound
has been known to cause feelings of awe or fear in humans. Ultrasound is
cyclic sound pressure with a frequency greater than the upper limit of human
hearing. Although this limit varies from person to person, it is approximately
20 kilohertz (20,000 hertz) in healthy, young adults and thus, 20 kHz serves as
a useful lower limit in describing ultrasound. The upper frequency limit in
humans (approximately 20 kHz) is caused by the middle ear, which acts as a
low-pass filter. Ultrasonic hearing can occur if ultrasound is fed directly into
the skull bone and reaches the cochlea without passing through the middle
ear. Health effect: Occupational exposure to ultrasound in excess of 120 dB
may lead to hearing loss. Exposure in excess of 155 dB may produce heating
effects that are harmful to the human body, and it has been calculated that
exposures above 180 dB may lead to death.
Vibration refers to mechanical oscillations about an equilibrium point. The
oscillations may be periodic such as the motion of a pendulum or random
such as the movement of a tire on a gravel road. Heath effect: back pain,
decreased grip strength, decreased hand sensation and dexterity, finger
blanching or white fingers Carpal tunnel syndrome.

41) Occupational medicine. Chemical factors in working conditions

prophylactic measures. Hygienic characteristic of industrial and
agriculture work.
Chemical factors in working place:
Routes of entry inhalation, ingestion, skin absorption; inhalation is the
main route of entry.
Chemical agents can be classified into:
1) Metals-Lead, TEL, As, Hg, Cd, Ni , Co etc.
2) Aromatic Hydrocarbons-Benzene, Toluene,phenol etc.
3) Aliphatic Hydrocarbons-Methyl alcohol
4) Gases-*Simple asphyxiants: N2, CH4, CO2 * Chemical asphyxiants: CO, H2S,
HCN Irritant gases: Ammonia, SO2, Cl2, * Systemic poison: CS2
Prophylactic measures:

-History of exposure,
-Specific radiologic findings,
-High level quartz concentration in air of working environment,
-CT findings of nodal and PMF.
So it is a mix of history, clinical exam and investigations.
Industrial hygiene work is defined as the recognition, evaluation and control
of workplace hazards. Its origins are based on limiting personal exposures to
chemicals and have evolved to address the control of most other workplace
hazards including over-exposure to noise, heat, vibration and repetitive
motion. Industrial Hygiene (IH) is that science devoted to the anticipation,
recognition, measurement, evaluation and control of adverse occupational
stresses or agents which could cause sickness and impaired health among
workers and the community. The basic goal of IH (ex. occupational hygiene) is
to promote a safe and healthful work environment. Occupational exposure to
chemicals is still considered one of the most wide spread hazards in industry.
The use of engineering controls is the preferred method of limiting these
exposures. Dilution and capture ventilation are two important methods to
control occupational exposure. The design and position of hoods and vents,
and amount of air infiltration can substantially change exposure conditions.
Material Safety Data Sheets and other documentation provide a basis for
predicting adverse effects, disposal needs and fire and ignition concerns.

42) Work physiology capacity for physical work. Energy cost of work.
Work classification. Methods for matching people and their work.
Fatigue, Work/rest cycles.
People perform widely different tasks in daily work situation. Work
physiologists study the chanced appearing in functions of main organs and
systems (cardiovascular and respiratory) of workers at work and evaluate the
capacities and limitations of worker for performing physical work; they also
determine human tolerance to stresses produced by physical environment.
Capacity for physical work: an individuals physical tolerance to physical work
is usually determined by capacity of his or her cardiovascular and respiratory
systems to deliver oxygen to working muscles and to metabolize chemically
stored energy. Maximum oxygen uptake is often used to describe the upper
limit of this capacity. Men who are 20y have an average capacity of 3-3.5L/min

and women of same age have 2.3-2.8L/min and at 60y capacity is diminished
to about 2.2-2.5L/min for men and 1.8-2.0L/min for women. To determine
individuals tolerance to physical work following lung volumes and capacities:
Tidal volume is volume of gas inspired or expired during each respiration
cycle. Vital capacity is max. atm. of air can be exhaled from lung after max.
inspiration, its a sensitive index for estimation of work capacity. Forced
expiratory vol. in 1sec is vol. of air which can be forcibly expelled during the
first second of expiration.
Energy cost of work: totally the heaviest work that a young, fit man can
sustain for prolonged period is about 500kcal/hr, where as in industrial jobs
about 400-425kcal/hr. the average expenditure may be calculated by: M =
(M1T1 + M2T2 + MnTn)T-1
where M is the total energy cost; M1, M2 and so on are the energy costs of
individual tasks; t1, t2 and so on indicate the duration of the individual task;
and t is the total elapsed time.
Work classification: the work demands are usually rated from light to
extremely heavy in terms of energy expenditure per minute and relative heart
rate in beats per minute. Light work (with total energy expenditure 2.53kcal/min), medium work (3-5kcal/min), heavy work (5-7.5kcal/min), very
heavy work (7.5-10kcal/min), extremely heavy work (10-15kcal/min).
Matching people and their work: it is important to match human capabilities
with the related requirement of given job. If the job demands equal workers
capabilities or if they exceed them the person will be under much strain and
may not be able to perform task. The workers reaction is estimated as good
when increasing heart rate is accompanied with max. blood pressure. The
reaction is astenic when HR is increased, heartbeats are weak (insufficient
heart function). In case of disturbed elasticity of blood vessels reaction is
hypertonic the max. BP increases suddenly. In case of disturbed balance of the
autonomic nervous system and tonus of peripheral blood vessels is decreased
the reaction is dystonic.
Fatigue: its overexertion phenomenon that leads to a temporary decrease in
physical performance. Subjective feeling of fatigue is feeling tired and
detoriated mental and physical activities may result from it. The sensation of
fatigue has a protective function, feeling of fatigue forces one to avoid further
stress and allows recovery to take place. Many different factors can produce

fatigue they are: physical work intensity (static and dynamic work); lack of rest
or sleep; poor eating habits and psychological factors (worry, conflict,
monotony). The signs of chronic fatigue: increased irritability (intolerance);
tendency to depression; general weakness and dislike for work; nonspecific
physical complaints (headaches, giddiness, anorexia, insomnia).
Work / rest cycles: in order to avoid fatigue and especially the chronic fatigue,
rest pauses must be taken. Frequent short rest periods reduce cumulative
fatigue better than a few long breaks. A general principle for schedule
work/rest cycles is to break up excessively hard work into bouts of work that
are short or intermingling light tasks with heavy ones. The light, secondary
work task thus actually constitutes rest time from the heavy, primary task.
Sharpening tools or walking to get material and other interruptions can
provide productive respites from heavy work.

43) Industrial Toxicology. Role of the physical and chemical properties

of the substances. Action of toxic substances. Basis for workplace
standards. Pesticides. Occupational and environmental pesticide
exposure. Prevention.
Everyone is exposed on or off job to a variety of chemical substances; most do
not present a hazard under ordinary circumstances, but they all have the
potential for being injurious at some sufficiently high concentrations and level
of exposure. A toxic effect can be defined as any noxious effect on the body
reversible or irreversible, any chemically induced tumor, any teratogenic or
mutagenic effect or death as a result of contact with a substance via
respiratory tract, skin, eye, mouth, or any other route. All chemicals are toxic
to some degree.
There is sufficient information to complete health hazard assessment of less
than 2% of the chemicals produced commercially, while for only 14% of
chemicals is there sufficient information to support even a partial hazard
assessment. Toxicity is the ability of a substance to produce an unwanted
effect when the chemical has reached a sufficient concentration at a certain
site in the body. Hazard is the probability that this concentration in the body
will occur. Many factors contribute to determining the degree of hazard
route of entry, dosage, physiological state, environmental variables etc. There
are numerous classification systems available. The most popular consists of
two major classes: - inorganic chemicals (containing few carbon atoms) organic chemicals (their structure is based on carbon atoms). Chemical injury

can be local or systemic. Local injury is the result of direct contact of the
substance with tissue. A systemic effect is generalized and changes the normal
functioning of related organs operating as a system. A material cannot
produce systemic injury unless it gains entry into the bloodstream. Common
routes of entry are ingestion, skin (eyes) absorption and inhalation. Depending
on the substance and its specific properties, entry and absorption may occur
by more than one route. For instance, inhaling a solvent that can penetrate
skin. Where absorption into the bloodstream occurs, a toxicant may elicit
general effects or, more than likely, the critical injury will be localized in
specific tissue or organs. The results may be - acute (immediate) in the case of
gassing accidents, ex. chlorine, carbon monoxide (at high concentration),
hydrogen sulphide and nitric oxide, or - chronic (prolonged and cumulative)
as with exposure to chlorinated hydrocarbons, lead compounds, dust inducing
pneumoconiosis, paint spray and oil mists and fume, notably that from
welding operations.
Toxicity was previously defined as any harmful effect of a chemical on a target
organ.
Major types of health effects caused by toxic substances may be: - Systemic
toxicity serious, sometimes fatal poisoning that may occur after contact with
certain organophosphate pesticides, ingestion of high dose of tranquillizer
drugs or inhalation of organic solvents. Organ toxicity certain chemicals
have target organ specificity (harm a certain organ rather than others) often
because of biotransformation or bioconcentration. The route of exposure
might also be responsible for specific organ injury. - Liver toxicity most
chemicals are metabolized in the liver. Kidney toxicity many xenibiotics are
removed by glomerular filtration and tubular excretion, while essential
elements are reabsorbed in the tubuli. Skin toxicity allergic reactions can
occur in sensitive individuals while skin irritation can occur in anyone exposed
to a wide variety of irritating chemicals. Carcinogenity cancer occurs as a
consequence of multiple genetic and non-genetic events, leading to
uncontrolled proliferation of cells.

44) Industrial hygiene. Recognition, evaluation and control of

occupational health hazards. Inspection of the workplace visit to
plant.
Industrial Hygiene (IH) is that science devoted to the anticipation,
recognition, measurement, evaluation and control of adverse occupational

stresses or agents which could cause sickness and impaired health among
workers and the community. The basic goal of IH (ex. occupational hygiene) is
to promote a safe and healthful work environment. Occupational hygiene is
the science and art of anticipating, recognizing, evaluating and controlling
health hazards in the workplace. The purpose of this introduction is to
provide an understanding of the general principles of evaluating worker
exposures in the industrial environment. Elements: Anticipation, expectation
of potential health hazards is generally more difficult for the entry-level,
inexperienced occupational hygienist since skills in anticipation generally
increase with experience. Ability to recognize potential health hazards as well
as knowledge of scientific developments, new technologies and regulatory
requirements, etc.
Recognition, requires knowledge and understanding of workplace
environmental stresses and effects on health of the worker related to
processes and control measures; inventory of chemical, biological, and
physical hazards; potential chemical hazards are determined by toxicity and
also conditions of use. Involves collection of available information along with
the application of IH principles.
Evaluation, Involves observation as well as monitoring and use of analytical
methods required to detect the extent of exposure; decision-making process
resulting in an opinion on the degree of health hazards and/or stressors that
exist; determine significance (ex. subjective/objective judgment); extent of
potential health hazards based on comparisons of environmental
measurements with current governmental regulations and recommended
technical guidelines.
Control, involves the reduction of environmental stresses to levels that the
worker can tolerate without impairment of health or productivity; various
general control methods employed for accomplishments in an efficient and
effective manner.
Workplace monitoring: Document exposure levels either by measurement or
use of semi-quantitative methods. Strategy developed depends on the reason
for evaluation. Purpose is first. Sampling objectives: EITHER engineering
testing, surveillance, or control; OR compliance, health research, or
epidemiological purposes. Overall plan or framework for sampling that may
include the type and number of samples to be collected; the methods to be
used, and their accuracy, and the objectives for monitoring.

45) Methods of physical and neurological assessment of children and

adolescence.
-Investigation of human body in order to indicate changes in some functional
indicators (anthropometric ones) classified in:
Morphological: height, weight, circumferences of head and chest, widths,
lengths of the body.
Functional: mobility of chest muscles
-Growth and development periods of children: 1)Embryonic and fetus
development 2)Newborn infant 3)First year 4)Preschool years where in this
period infant gains at about 2kg and 6-8cm per year 5)early school years: This
is a period of gaining 3- 3,5 kg per year and 6 cm/year and head circumference
also increases between 5-12 years (51 cm to 54 cm).
-In neurodevelopment a 3 year old can crudely imitate drawing a cross and
when requested draw a head and stick extremities person. By 4-5 years the
child can make correctly proportional copies of figures including slanting lines.
By 6 year the child can translate abstract conceptions into figures.
Adolescence we see the sexual characteristics changes like pubic hair and
breasts in girls and pubic hair enlargement of penis and testes in boys. It can
be classified to:
-Early adolescence: where females FSH stimulates growth of the ovaries
which increases estrogens that produce the breastbud development,
thickening of the vaginal mucosa and increased pigmentation, slight
enlargement of clitoris and uterus. In males the testes enlarge as a result of an
increase the size of seminiferous tubules and number of Leydig and Sertoli
cells. The increase of testosterone causes enlargement of epididymis, seminal
vesicles and prostate. Scrotum thins and becomes hypervascular.
-Middle adolescence: age between 12,5 to 15 in boys and 12 to 14 to girls,
girls take up to 8cm in height and males 10 cm per year. Elongation of trunk
also occurs as well as parts of the body.
-Late adolescence: changes of secondary sexual characteristics and there is a
deeper voice in males.

46) Acceleration. Healthful knowledge.

-Investigation of human body in order to indicate changes in some functional

indicators (anthropometric ones) classified in:
Morphological: height, weight, circumferences of head and chest, widths,
lengths of the body.
Functional: mobility of chest muscles
-Growth and development periods of children: 1)Embryonic and fetus
development 2)Newborn infant 3)First year 4)Preschool years where in this
period infant gains at about 2kg and 6-8cm per year 5)early school years: This
is a period of gaining 3- 3,5 kg per year and 6 cm/year and head circumference
also increases between 5-12 years (51 cm to 54 cm).
-In neurodevelopment a 3 year old can crudely imitate drawing a cross and
when requested draw a head and stick extremities person. By 4-5 years the
child can make correctly proportional copies of figures including slanting lines.
By 6 year the child can translate abstract conceptions into figures.
Adolescence we see the sexual characteristics changes like pubic hair and
breasts in girls and pubic hair enlargement of penis and testes in boys. It can
be classified to:
-Early adolescence: where females FSH stimulates growth of the ovaries
which increases estrogens that produce the breastbud development,
thickening of the vaginal mucosa and increased pigmentation, slight
enlargement of clitoris and uterus. In males the testes enlarge as a result of an
increase the size of seminiferous tubules and number of Leydig and Sertoli
cells. The increase of testosterone causes enlargement of epididymis, seminal
vesicles and prostate. Scrotum thins and becomes hypervascular.
-Middle adolescence: age between 12,5 to 15 in boys and 12 to 14 to girls,
girls take up to 8cm in height and males 10 cm per year. Elongation of trunk
also occurs as well as parts of the body.
-Late adolescence: changes of secondary sexual characteristics and there is a
deeper voice in males.

47) Hygienic assessment of school program.

School hygiene or school hygiene education is a healthcare science, a form of
the wider school health education. School hygiene is a study of school

environment influence; it explores affection of schooling to mental and

physical health of students. The primary aims of school hygiene education is
to improve behavior through useful practices connected to personal, water,
food, domestic and public hygiene. Also, it aims to protect water and food
supplies and to safely manage environmental factors. Students, faculty and
staff should be instructed about the correct technique for hand washing,
including the importance of washing hands before eating or preparing food,
after touching any skin lesions (sores) and wounds or clothing contaminated
by drainage from lesions and wounds, and after using the toilet. Instructions
should include the following:
Turn on faucet and wet hands with running water.
Apply soap and spread across all surfaces of hands.
Scrub all surfaces of hands, including between each finger, for at least
20 seconds (saying the alphabet slowly will take at least 20 seconds).
Rinse hands under running water.
Dry hands with paper towels or air dryers.
If available, use a paper towel to turn off faucet handles.
Students, faculty and staff should be provided information about general
hygienic measures, including the following:
-Keep your hands clean by washing thoroughly with soap and water. Use an
alcohol hand gel when soap and water are not available.
-Avoid sharing eating and drinking utensils.
-Avoid sharing unwashed towels, washcloths, clothing, or uniforms.
-Avoid sharing personal items (ex. deodorant, razors).
-Change socks and underwear daily.
-Wash bed linens and pajamas regularly, at least once a week if feasible.
-Wash soiled bed linens and clothes with hot water and laundry detergent.
Drying clothes in a hot dryer, rather than air-drying, also helps kill bacteria in
clothes.
-Bath or shower with soap each day.
-Bath or shower with soap after every sports practice or competition.

-Keep cuts and abrasions clean and covered with clean, dry bandages until
healed.
-Follow your health care providers instructions on proper care of wounds.
-Avoid contact with other peoples wounds or material contaminated by
wounds.

48) Main diseases in school age.

Chickenpox is a highly contagious acute viral infection seen mainly in winter
and early spring. It is characterized by the appearance of a typical rash. The
distinctive lesions or vesicles look like small drops of water. Later, a red
swelling surrounds them. These lesions will crust over a period of 812 hours.
Usually, chickenpox is accompanied by severe itching. They start usually on
face and scalp and then spread to chest, abdomen, back and extremities. It
can be transmitted by direct contact with the infectious rash, by nasal
secretions or by contaminated articles. The disease is infectious for about 24
hours before the appearance of the rash and remains so until all lesions are
crusted (dried), usually 7 8 days.
Mumps is a viral infection that affects one or both of the parotid glands
situated just inside the angle of the jaw. Swelling of these glands is not usually
the first symptom. The child may feel unwell and have some discomfort at the
glands site. This is usually accompanied by difficulty in chewing and
swallowing, headache and fever. The virus is spread by airborne droplets and
an affected person is contagious for a week before and up to two weeks after
the symptoms appear.
Rubella is a contagious viral infection that is mostly seen in childhood. It is
spread by airborne droplets and by close contact with the infected person. It
can be transmitted from one week before onset of rash until one week after it
fades. It is a mild infection in general, but it may result in abortion, stillbirth,
or congenital defects in infants born to mothers who encountered the disease
during the first trimester of pregnancy. Its incubation period lasts for 14-21
days. There is a period of malaise, swollen painful lymph nodes and glands in
the neck and face. The characteristic rash that starts on the face and neck
quickly spreads to the trunk and extremities. The face becomes flushed.
Scarlet Fever is a contagious bacterial infection that lasts for a few days,
occurring frequently in winter and early spring, characterized by a pink-red

rash seen mostly over the trunk area and between skin folds and by a
distinguished strawberry -like appearing tongue. Also there is pharyngitis as
sore throat, swollen neck lymph nodes, difficulty in swallowing, headache,
malaise, fever, nausea and vomiting.
Lice (pediculosis) as often as it happens in school environments, lice are one
of the most widespread childhood communicable diseases. It is a common
occurrence among students and not a sign of unclean people or homes. Lice
are tiny parasites that live on humans hair and scalp. They hatch from the
eggs that are firmly attached to the hair shaft unlike dandruff. The primary
symptom of lice infestation is itching. Lice eggs are 2-4 mm in size, oval in
shape and gray to silvery in color. The egg hatches in about 10 days, with new
lice reaching adulthood in two weeks. The female louse is the size of a sesame
seed, can live for 20-30 days and can lay eggs up to six a day. They live by
biting and sucking on blood from the human scalp.

49) Geriatrics. Personal hygiene, lifestyle and nutrition of the elderly.

Geriatrics is a sub-specialty of internal medicine and family medicine that
focuses on health care of elderly people. It aims to
promote health by preventing and treating diseases and disabilities in older
adults. There is no set age at which patients may be under the care of
a geriatrician, or physician who specializes in the care of elderly people.
Home hygiene pertains to the hygiene practices that prevent or minimize
disease and the spreading of disease in home and in everyday life settings
such as social settings, public transport, the work place, public places etc.
Hygiene in home and everyday life settings plays an important part in
preventing spread of infectious diseases. It includes procedures used in a
variety of domestic situations such as hand hygiene, respiratory hygiene, food
and water hygiene, general home hygiene, care of domestic animals and
home healthcare. At present, these components of hygiene tend to be
regarded as separate issues, although all are based on the same underlying
microbiological principles. Preventing the spread of infectious diseases means
breaking the chain of infection transmission. Targeted hygiene is based on
identifying the routes of spread of pathogens in the home and applying
hygiene procedures at critical points at appropriate times to break the chain
of infection. The main sources of infection in the home are people (who are
carriers or are infected), foods (particularly raw foods) and water and
domestic animals. Additionally, sites that accumulate stagnant watersuch as

sinks, toilets, waste pipes, cleaning tools, face clothsreadily support

microbial growth and can become secondary reservoirs of infection, though
species are mostly those that threaten at risk groups. Germs (potentially
infectious bacteria, viruses etc.) are constantly shed from these sources via
mucous, faeces, vomit, skin scales, etc. The main highways for spread of
germs in the home are the hands, hand and food contact surfaces and
cleaning cloths and utensils. Germs can also spread via clothing and household
linens such as towels. Safe disposal of human waste is a fundamental need;
poor sanitation is a primary cause of diarrhoeal disease in low income
communities. Respiratory viruses and fungal spores are also spread via the air.
Good home hygiene means targeting hygiene procedures at critical points, at
appropriate times, to break the chain of infection ex. to eliminate germs
before they can spread further. Because the infectious dose for some
pathogens can be very small (10-100 viable units, or even less for some
viruses) and infection can result from direct transfer from surfaces via hands
or food to the mouth, nasal mucosa or the eye, 'hygienic cleaning' procedures
should be sufficient to eliminate pathogens from critical surfaces.
Hygienic cleaning can be done by mechanical removal (ex. cleaning) using a
soap or detergent. To be effective as a hygiene measure, this process must be
followed by thorough rinsing under running water to remove germs from the
surface. Using a process or product that inactivates the pathogens in situ.
Germ kill is achieved using a micro-biocidal product ex. a disinfectant or
antibacterial product or waterless hand sanitizer, or by application of heat.

50) Hygienic norms, healthful way of live. Health risk assessment.

A health risk assessment (HRA) is a health questionnaire, used to provide
individuals with an evaluation of their health risks and quality of life.
There are a range of different HRAs available, however most capture
information relating to:
-Demographic characteristics age, sex

Lifestyle exercise, smoking, alcohol intake, diet.

Personal and family medical history.
Physiological data weight, height, blood pressure, cholesterol.
Attitudes and willingness to change behaviour in order to improve
health.

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.
Benefits:
-Provide employees with a snapshot of their current health status.
-Enable individuals to monitor their health status over time.
-Provide employees with concrete information thus preparing them for
lifestyle change.
-Help individuals get involved with health coaching.
-Provide important information concerning employees' readiness to change.
-Help employers measure and monitor population health status.
-Provide employers with important information that can help them build
results-oriented health promotion programmes.
-Can provide employers with important information on productivity.
-Allow employers to evaluate changes in health behaviour and health risks
over time.
-Engage both employers and employees in the health management process.
Healthy way of life includes 5 key parts:
1. Daily regime that presupposes enough of sleeping hours, regular meals,
proper time for work and relax. All parts of your life organically and
significantly improve each other, when every of them are treated at right time
and in proper manner.
2. Healthy meal. What can be better than a well-balanced diet, which brings
your body exactly what it needs.
3. Being not addicted to bad habits - including in the list of bad habits
oversleeping and overeating. If some of your habits make good for your mind,
but the same time are bad for your body - something should be revised in

your lifestyle. Everything you do must bring harmoniously balanced benefits

for your mind, soul and body.
4. Keeping fit, which helps you to be in a good shape, to feel more energetic
after working out, to get rid of stress with the help of physical charge.
5. Good mood. It is very important to be in a good form physically and
mentally - positive mood is not just good emotions. Joy and good mood are
very powerful cleaning and healing energy for your mind, body and soul.