Fundamentals, basic terms of environmental health (hygiene in Central European context) and introduction to environmental toxicology.

Basic terms and definitions of hygiene and epidemiology, a short history of the Institute. A detailed explanation of terms such as primary prevention, prevention of diseases by influencing living conditions versus increasing human resistance against unfavourable environmental factors (adaptation, acclimatization, induction of tolerance) or against infection (non-specific and specific immunity, vaccination as an effective tool for infection prevention), a role of government in health protection. Health promotion, importance of individual's responsibility for own health (MONICA, CINDI, and other programs). Secondary and tertiary prevention. Forms, objectives, practice.

Man and environment versus importance of lifestyle for human health (individual's, social groups' and populations'). Local problems (industry and transport, chemization of agriculture and xenobiotics in a food basket) and global ones (salination of soil, desertification, acid precipitation, tropical forest devastation, urbanization). Natural, cultivated, artificial, indoor environment and health of man. Minamata disease, yusho disease, itai-itai, black triangle of Europe.
Biological monitoring of environmental pollution and human exposure to xenobiotics. Technical approach to this problem - monitoring networks, legislature. Biological exposure tests, basic terminology and importance of biological limits for toxicants, pollutants in environmental and occupational settings. Practical examples: styrene, trichloroethylene, and alcylating agents. Organophosphorous pesticides, toxic metals. Cytogenetic analyses of peripheral blood lymphocytes. DNA and haemoglobin, albumin adducts detection.

Delayed health effects of xenobiotics. Prenatal exposure. Dose/effect dependence in classical poisons and genotoxic/carcinogenic substances/factors. Mutagenicity, genotoxicity, carcinogenicity, teratogenicity and allergenicity. Delayed effects as a basis for risk assessment of human exposure to environmental xenobiotics and adverse physical factors. Gene mutagenicity (phenylketonuria, galactosemia, chondrodystrophia, haemophilia) chromosomal aberrations-activation oncogens, degenerative diseases/conditions (atherosclerosis, acceleration of ageing). Chromosomal mutations of genome type, aneuploidy, hypo/hyperploidy (syndromes: Down, Turner, Klinefelter). Teratogenic effects (rubella, ionising radiation). Carcinogenicity versus allergenicity of xenobiotics, their presence in environmental and occupational settings.

Maximum acceptable concentrations, threshold limits values, acceptable daily intake. Principles of their establishment - acute, subchronic, chronic laboratory testing, safety coefficients, pilot and follow up epidemiological studies, informed consent, ethical issues. Hygienic standards/limits of separate substances, exposure to mixtures, complex versus combined exposure. MAC/TLV of carcinogenic substances and other xenobiotics (examples: VCM and styrene) - problems in interpretation of animal experimental data versus toxicity to humans. Examples of problems and practical applications in hygienic (environmental) toxicology. Selected examples: manganese, arsenic, beryllium, lead, mercury, cadmium and polyhalogenated hydrocarbons.

Physical factors of environment
Noise - Physical substance: sound and noise, acoustic pressure, frequency, level, infrasound, ultrasound. Biological effects: specific, local effects (higher levels), systems effects (lower levels). Informative content of the sound, masking, highest sensitivity of human ear. Types of noise: steady, variable, high frequency, with tone components, impulsive. Measuring: steady noise, variable noise. Evaluation limit value. Selected basic values of noise for the Czech Republic. Noise in outdoor space, occupational environment, appartment houses and civil constructions. Prevention and protection: removal of the sources of noise, closing of the source of noise, increasing of distance of noise sources, limitation of time of exposure to noise, use of suitable personal protection aids.
Vibrations (mechanical swinging of elastic environment) - Biological effects: local - vessels, nerves (pneumatic tools, forest saws etc.), general - systems. Vibrations of the frequency lower than 1 Hz - kinetoses. Prevention and protection: shortening the time of exposure to vibrations, protection also against cold and dampness, protective aids, preventive medical examinations, increasing of the risk - vasoactive materials or smoking.
Non-ionising radiation - radio waves (natural, artificial), microwaves (generators, warming ovens, plasma of high temperature), radar waves (radio locators). Physical substance: electrostatic field, magnetic field + electrodynamic field, electromagnetic field - not bound to electric charges, unidirectional currents, alternating currents. Biological effects: thermal, non-thermal. Principles of health protection: time protection, protection by distance, protection by screening (Faraday cages).
Lighting - Day (natural) lighting: factor of day illumination, evenness of lighting, combined day lighting, day lighting map (isophots), limit value of the day illumination factor. Artificial lighting: luminosity, evenness of artificial lighting, artificial lighting map, limit values of luminosity, combined artificial lighting (central and local lighting), temperature of chromatisms. Mixed lighting (simultaneous lighting by day light and supplementing artificial lighting). Disturbing dazzles: dazzle by critical brightness = an absolute dazzle - direct sunshine, electric arcs etc., transitory dazzles - a sudden switch on the light, dazzle by contrast = a relative dazzle - filament of the bulb and surrounding wall.
UV-radiation - Biological effects: UVA, UVB, UVC radiation; Clinical findings: local effects on skin and eye, general (systems) effects, histopathological changes, biochemical and immunologic effects, effect on DNA, carcinogenic effects, germicidal effects, curative effects. Prevention and protection: lower the time exposure, sun filters, glasses.
Ionising radiation - Main sources of ionising radiation exposure in peace conditions. Methods of optimisation X-ray diagnostic and therapy: technical arrangement, organizational arrangement. Principles of protection against radiation: distance, shielding, time. Principles of protection against radioactivity contamination. (Radio) active patient - which received radionuclide. Individual monitoring of persons in external irradiation risk. Individual monitoring of persons in inner contamination risk. Health contra-indications to work in external irradiation risk.
Climatic factors (factors determining human thermal comfort): Climatic elements: air temperature, air humidity, a speed of air streaming, intensity of infrared radiation. Men associated elements: objective (energy issue, thermal resistance of clothes), subjective (adaptation mechanisms, health and psychic conditions, conditions of an organism). Measured quantities: air humidity, air streaming, IR radiation, energy issue - spreadsheet method, thermal resistance of clothes. Evaluation: optimal thermal load, long-term bearing load, short-term bearing load.
Group diagnostics - selected collection, comparison collection or basic collection. Standard deviation method: somatometric examination of school and pre-school age children. Gaussian (normal) distribution, standard deviation, practical exercise on PC.

Indoor/outdoor pollution, sick building syndrome.
Pollution of indoor environment: Building - related difficulties and their causes, especially allergies and asthma and risk factors for them indoors; Non-specific disorders like humidifier fever, hypersensitivity pneumonitis, sick building syndrome, multiple chemical sensitivity syndrome, electrical sensitivity syndrome; Toxic reaction (moulds)
Infectious diseases - viral, bacterial, fungal [real building-related illnesses], Cancer - especially problems with radon in buildings. Known risk factors of these problems, how to prevent disorders cause by the pollution of indoor environment and how to treat either a building (elimination of some equipment), or the patient.

Outdoor factors and pollution: Chemical factors - inorganic compounds (NOx, SO2, CO, CO2) ozone; organic compounds (VOCs, formaldehyde, PAHs); outdoor pollution in students’countries - health hazards and possible ways, how to solve these problems.

Pollution of indoor environment: Building - related difficulties and their causes, especially allergies and asthma and risk factors for them indoors. Non-specific disorders like humidifier fever, hypersensitivity pneumonitis, sick building syndrome, multiple chemical sensitivity syndrome, electrical sensitivity syndrome. Toxic reaction (moulds). Infectious diseases - viral, bacterial. Cancer - especially problems with radon in buildings. Risk factors of the above issues, their prevention and treatment of building and the patient.
Medical approach to outdoors and indoor physical factors: Temperature and humidity. Other physical factors (noise, lighting, and vibration...). Chemical factors - inorganic compounds (NOx, SO2, CO, CO2), ozone. Organic compounds (VOCs, formaldehyde, PAHs). Problems of outdoor pollution in students' countries, associated health risks and their solution.

Tobacco dependence
Epidemiology (prevalence, morbidity and mortality in our country and in the World, trends), different kinds of tobacco use, definitions, passive smoking, environmental tobacco smoke, light cigarettes.
Principle of smoking - psycho behavioural and social dependence, nicotine (drug) dependence, nicotine withdrawal syndrome, Fagersto