Činioci životne sredine kao pokazatelji uticaja na zdravlje ljudi

Abstract

Achieving and maintaining good health and prosperity requires a clear and harmonized environment. Studying the environment to protect human health aims to determine the type of pollutants and to monitor their impact on humans. Pollutants include the chemical, physical and microbiological pollutants. It is believed that the best way of studying the interaction between the population and the environment is the method that allows selection of representative, easily measurable and routinely controlled environmental indicators and health status. The World Health Organization recommends "DPSEEA" (Driving Force, Pressure, State, Exposure, Effect and Action) system. "DPSEEA" describes a closed circuit system of interdependent factors of the environment and human health which can be defined as a cause _ effect model. Application of "DPSEEA" system to assess the influence factors of the environment on human health is defined by studying the air quality of the environment, water and sanitation, noise and health, housing, traffic accidents, chemical accidents, and radiation. The use of complex indicators by "DPSEEA" system in our country so far has been used to assess the environmental situation, but not for systematic assessment of the impact factors of the environment on human health. AIM: Aims of the research are based on determining the type of microbiological, physical and chemical hazards in the environment of Novi Sad, exposure of the population and assess the impact of identified hazards to human health, as well as determining the significance of the application of environmental factors as indicators of impacts on human health. METHODOLOGY: Identifying hazards present in the environment of the City of Novi Sad (air quality, drinking water quality, noise) in 2006 were carried out based on the statutory methodology for sampling, microbiological, physical and chemical analysis and preparation of expert opinions on the hazards present in the environment. There were sampled, analyzed and professionally studied 9936 air samples, 6474 samples of drinking water and 648 individual measurements of daily levels of noise. Determination of population-level exposure to environmental noise survey was conducted by applied poll concerning subjective population experience of noise and subjective assessment of noise impact on human health, based on 1079 valid completed questionnaires. Assessment of exposure to microbial, physical and chemical hazards from the environment and determine the impact of identified hazards from the environment on human health is determined in accordance with the "DPSEEA" methodology by using the 15 indicators. To assess the impact of air, water and noise on human health following indicators have been considered: Air_Exl, Air_El, Air_E2, Air_E3, WatSan_S2,WatSan_S3, WatSan_Exl, WatSan_Ex2, WatSan_Ex3, WatSan_Ex4, WatSan_El,WatSan_E2, WatSan_E3, Noise_El and Noise_E2. The questionnaire of the population of the subjective experience of noise and subjective assessment of noise impact on human health was conducted with the help of specially composed questionnaire, based on national surveys conducted. RESULTS: Out of the 15 indicators of "DPSEEA" system in our research 87 percents is considered accessible, 67 percents quality and 73 percents usable. Monitoring of air quality in the City of Novi Sad in 2006 indicates that average annual concentrations of sulfur dioxide (<2 µg/ m3), soot (2.96 µg / m3) and nitrogen oxides (8.36 µg /m3) does not exceed the legally permitted level, while the mean annual concentration of the total suspended particles (174.13 µg/m3) exceeds the prescribed value of 148.76 percents. The research showed that the population, or subpopulations of the City of Novi Sad were exposed to total suspended particles from the air (73.65 µg/m3) at two measuring locations (urban and industrial) of the same day in 2006, where the subpopulations of the urban area measuring statistically highly significant (p=0.008) exposed to pollutants from the air (76.36 µg/m3) compared to subpopulations of the industrial measurement point (48.24 µg/m3). Assessment of the effects of pollutants from the air on human health in the City of Novi Sad found that the expected total number of deaths were dependent on short-term presence and concentration of suspended particulate matter PMIO in the air of 131 (95 percents CI 114-148), or 3.6 percents of deaths cases in 2006 can be linked to short-term presence of suspended particulate matter PMIO in the air. The expected number of deaths from cardiopulmonary disease (MKB 10:JOO-99 and MKB 1 0:120-25) in people aged above 30, dependent on long-term presence and concentration of suspended particles PM25 in the air of 42 (95 percents CI, 36-75), or 1.81 percents of deaths from cardiopulmonary disease in people aged above 30 in 2006 can be linked to long-term presence of suspended particles PM25 in the air. The expected number of deaths from respiratory diseases (MKB 1 0:100-99) of children under five were dependent on short-term presence and concentration of suspended particulate matter PMIO in the air of 0.036 (95 percents CI 0.031-0.040), or 3.6 percents of deaths from respiratory diseases in children under five in 2006 can be linked to shortterm presence of suspended particulate matter PMIO in the air. Increase in the average population exposure to suspended particles in 10 µg/m3 in the City of Novi Sad, increases the expected total number of deaths from 131 to 146, increases the expected number of deaths from cardiopulmonary disease (MKB 10:JOO-99 and MKB 1 0:120-25) in people aged above 30 from 42 to 47 and increases the expected number of deaths from respiratory diseases (MKB 10:JOO-99) of children under five years from 0.036 to 0.04, not statistically significant (p>0.05). Reducing the average population exposure to suspended particles in 10 µg/m3 in the City of NoviSad, reducing the expected total number of deaths from 131 to 115, the expected number of deaths from cardiopulmonary disease (MKB 10:JOO-99 and MKB 1 0:120-25) in people aged above 30 with 42 to 37 and expected number of deaths from respiratory diseases (MKB 1 0:JOO-99) of children under five years from 0.036 to 0.03, statistically significant Cp>0.05). Increase the total suspended particles (TSP) In air of the City of Novi Sad for 10 µg/m causes the Increase rate of total mortality in 0.047 without statistical significance (p=0.29299) and increased rates of mortality from cardiopulmonary disease (MKB 10:JOO-99 and MKB 10:120-25) of people aged above 30 to 0.016, with no statistical significance . The decrease of total suspended particles (TSP) in air of the City of Novi Sad for 10 µg/m3 induced reduction of total mortality rate of 0.051 with no statistical significance (p=0.26355) and the reduction of mortality from cardiopulmonary disease (MKB 10:JOO-99 and MKB 1 0:120-25) of people aged above 30 years to 0.016 with no statistical significance (p=OA04055). By monitoring the presence of microbiological and physical-chemical hazards in treated drinking water from the water plant and water system of central water supply infrastructure and sewerage in the City of Novi Sad in 2006 showed the absence of microbiological and physical-chemical hazards in 94.50 percents (p<0.05, 95 percents CI) of controlled samples from a total of 6474 samples of treated drinking water. Identified hazards in 356 (5.50 percents) controlled samples of purified drinking water originating from the water plant and water system of central water supply infrastructure and sewerage in the City of Novi Sad in 2006 were the microbiological in 90 (1.39 percents) (p<0.05, 95 percents CI) and physical-chemical in 266 (4.11 percents) (p<0.05, 95 percents CI) of controlled samples.The results showed that 94.74 percents of No vi Sad population is available of safe drinking water (p<0.05, 95 percents CI) and 88.82 percents of Novi Sad population has resolved the question of removal of liquid waste (p<0.05, 95 percents CI). There are no microbiological, physical and chemical hazards in the drinking water in Novi Sad that contribute to the development of the water transmitted disease. Chance of microbiological, physical and chemical hazards from drinking water may be a contributory factor 4 percents diarrhea (MKB 10: A09, A02, A04, A05, A07, A08) in children aged up to five. Daily monitoring of noise levels in the City of Novi Sad in 2006 indicates that the average annual equivalent daily noise level (LAeq) in the City of Novi Sad is 68.91dB(A), which is 3.91 dB(A) more than the national and specific standards (65 dB(A)). Determined LAeq of 68.91 dB(A) in the environment of the City of Novi Sad in 2006 was the contributory factor for the incidence of ischemic heart disease (MKB 1 0:120-25) of the adult population in 13.79 percents of cases, respectivly in 1581 cases of the outpatient morbidity and 477 cases of the hospital morbidity. Daily level of noise in the range 65-69 dB(A) in relation to permanent residence in the environment of Novi Sad in exposed population is 38.77 percents, with a contributory factor morbidity from ischemic heart disease (MKB 1 0:120-25) in exposed adult population is 8.26 percents. Estimated exposure to the surveyed population of Novi Sad daily level of noise in the range 70-74 dB (A), in relation to the residence, was 61.23 percents and a contributory factor morbidity from ischemic heart disease (MKBI0:120-25) in exposed adult population amounted to 15.97 percents. Comparing the subjective assessment of the surveyed residents about the most important source of environmental noise, it was found that most respondents (47 percents) considered that the traffic was the most important source of environmental noise, followed by the noise from the neighborhood (23 percents), noise from construction work (21 percents), noise from restaurants (14 percents), noise from the lifts and other electrical wiring (11 percents) and noise originating from industrial facilities (8 percents). Comparing the subjective assessment of the surveyed residents about the traffic as the most significant source of environmental noise, statistically significant differences were found in determining the significance of traffic as a source of noise among all subjects (p=0.0000 11), females (p=0.000016) and age of all subjects (p=0.0066). Noise originating from road traffic makes the need for replacement of housing among the 46 percents of respondents, interfere with television 44 percents of respondents, interferes with reading the newspaper 45 percents of respondents, interferes with conversation 46 percents of respondents, interferes with daily rest 68 percents of respondents, interferes with mental work 59 percents of respondents, causes significant subjective symptoms during the day 41 percents of respondents and interferes with sleep at night 43 percents of respondents. Conducted survey research finds that daily levels of environmental noise in the city of Novi Sad are disturbing 44 percents of the population and a very disturbing 23 percents of the population. CONCLUSION: The conducted research indicates that the use of "DPSEEA" system to assess the impact of environmental factors on human health is easy and effective way of presenting the results of the interdependence of health and environmental conditions in the City of Novi Sad. Using "DPSEEA" system in our research has found that the microbiological and physicalchemical hazards in treated drinking water originating from the central city water supply have no impact on the health of people who are connected and use the same water and that the physical and chemical hazards present in the air and environment (noise) affect the human health. It was also found that there is a mutual dependency factor of the environment and the incidence of morbidity and mortality in the population of acute and chronic respiratory diseases, diseases transmitted by water and from cardiovascular disease and that environmental factors as indicators of impacts on human health are important for prevention and promotion of health among the people.