2557

(Guidance for Environmental Medicine Services)

:
0 2590 4393
:
0 2590 4388
:
env-med@googlegroups.com
:

5 6
11000

..

2557

..
...

..

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2557
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.....
.........................................................................................................................................................
1 1
2 30
3 36
3.1 . 36
3.2 .............................................................................................. 37
3.3 .. 41
4 .. 45
5 . 60
6 .. 70
6.1 (HIA). 70
6.2 . 84
6.3 . 94
.
........................................................................................................................................................
............................................................................................................................................... ............

1
..
2 .
3 ..
4
5
6 .
7 (HIA) .
8 Merseyside model

23
25
39
47
50
64
72
79

1 ... 2
2 /. 3
3 /. 4
4 /.. 4
5 . 5
6 . 32
7 .. 33
8 Dahlgren Whitehead model. 80

- 1

1
1.1)

(Environmental Medicine)

1.2)

- 2

1.3)

1. (.)
(.) (.)

2.
(.) (.)
(.) (..)

1.4)




0201.032/ 29
31 2555

1.

- 3

2. /

2 /

- 4

3 /

4 /1

- 5

1.5)


(Area sampling)
(Personal sampling)

( , 2555)

- 6

- SO2 CO H2S Ammonia
-

-
- (PPE) N95

- 7

1.6)
1.

1.1
1.2
1.3

2.

2.1
2.2
2.3

3.

3.1
3.2

4.

4.1

-
-
4.2
- HIA
-
(.)
(.)

5.

5.1

5.2

5.3
5.4

- 8

(HIA)


(Health risk assessment and management)
(Policy development) (Quality assurance)
5
1
1.1
1.2
1.3
2
2.1
2.2
2.3
3
3.1
3.2
4
4.1
-
-
4.2
- HIA
-
5
5.1

5.2
5.3
5.4

- 9

1
1.1





4

1. (Hazard Identification)

2. (Exposure Assessment)

3. (Dose-Response Assessment)

4. (Risk Characterization)
(Uncertainties)


3 ( 3 )
1.2.




6
1.
2.
3.
4.
5.
6. ( 3 )

- 10

1.3







1.3.1

1.3.2

1.3.3 /
/

1.3.4

1.3.5


1.3.6

2
2.1
[Centers for
Disease Control and Prevention (CDC)] 4
1)


2)

- 11

3)

4)

2.2

2.2.1
2.2.2
-

-
2.2.3
2.2.4
- (

)
- (


)
-
2.2.5
2.2.6
-
-

2.2.7

- 12

2.2.8

2.2.9
2.3

(Course of disease)



( Primary prevention)
2
(1) (2)
(1) (disease prevention)

1.

2.

3.

4.

5.
6.

7.
(CFC)
8.
9.

10.

- 13

1.

2.

3.

4.

5.

6.
7.

8.

9.

10.
70

1.
2.

3.

4.


5.
6.
7.
8.
9.
10.

- 14

1.

2.
3.

4.
2

5.

6.
10

7.

8.

9.

1.


2. 5 R
- Reduce
- Reuse
- Repair
- Reject
- Recycle

3.
-
-
-

- 15

4.

5.
6.
7.

(2) (health promotion)






(Secondary prevention)

(1) (2)



(1) (early detection)
(symptom) (sign)
(health effect)

(2) (early treatment) (symptom)
(sign)

(Tertiary prevention)

- 16

3
3.1



3.1.1
-

-
-
-
3.1.2 (Pattern) (Outbreak) /
/
3.1.3

3.1.4 Biomarkers
screening

3.2

(Passive Surveillance)



506/2 () (en-occ)




OPD

- 17

ICD-10 ICD-10:
Y/97

Data Center
4





(HIA)

2
4.1.

4.1.1




/
4.1.2


3

- 18

(Public0Health0Emergency)00
4
1) (Seriousness of the public health impact)
2) (Unusual or unexpected nature of the event)
3) (potential for the event to spread)
4) (the risk that restrictions to travel or trade)
( 6)
4.2

HIA
4.2.1 HIA
(HIA)




(HIA)
( Evidence-based
recommendations)

HIA


()

- 19

4.2.2



5




5.1
/

/
1.

2.



3.
100%

4.

- 20

1.
2.
3.
4.
5.

1.

2.

3.
-

-

-
** **
4. ()
-
-
-
-
-
-
5.

6.



AIC

- 21

7.

8.

-
-
-
-
-
-
-
-
9.

10.

5.2

5.3

1.
1.1
1.2
1.4
2.
2.1
2.2
2.3
2.4

- 22

3.
3.1
3.2
3.3
4.
4.1
5.4

1.
2.

3.

4. (Environmental0Risk
Assessment) (Risk0Perception)
(Risk Communication)
5.
6.
7.

8.
9. (linkage analysis)
10.

1

- 23

-

-

- PCU

-

-

- /

- 24

- /

- /

-

-

- 25

1.7)

/

2
2

-

-

- /

-
-

-

- /

-

PCU
-

-
PCU
-

/ -
()

-


(

)
-

- 26

- (CPG)


(

)
-

-

/

- -
(
-

- 27

-
-

- -

-

(



)
(
-
)

-

-

- 28

-

/

- 29

1.7)

(Environmental
Medicine Service)

(Environmental
diseases)

(multifactorial)

(Health Risk Assessment)

- 30

2
2.1)


1.
()


2.




3.




(Exposure history)


2



(Genetic polymorphism)
(gene-environment interaction)

- 31

2.2)

( )


-
-
-

-

-
-
- ( )

()
-
-
-
-
-

- 32

6 (: WHO,2003)

2.3)


(WHO,1993)

- 33

2.4)
1. (Sources)
2. (Exposure)
3. (Health Effect)

1. (Sources)
(Traditional hazards): (Briggs et al, 1996, WHO)




(Emergency response)

- 34

(Modern hazards): (Briggs et al, 1996, WHO)

2. (Exposure)

- (Geographical variation)
- (Temporal variations)
-
- (Pollutant combinations)

- (Localized point sources)

- (Line sources)
- (Diffuse sources)
3. (Health Effect)
-
-

- :
-

- 35

2.5)
1
2

1
()
-
-
- Biomarker
mesothelioma
2
( )
-

-

3
( )
-
-
-
Multiple chemical sensitivity, Sick Building Syndrome

- 36

3
3.1

4
(Environmental Protection Agency EPA)
1. (Hazard Identification)

2. (Exposure Assessment)

3. (Dose-Response Assessment)

4. (Risk Characterization)
(Uncertainties)


3

1. (Hazard Identification)

- (Epidemiological Studies)

- (In Vivo Animal Bioassays)

- 37

- (Short-Term In Vitro Cell

and Tissue Culture Tests) (1)

(2)
(3)


- (Structure-Activity Relationship Analysis)


2. (Exposure Assessment)



3. (Dose-Response Assessment)




(Regression Analysis)

4. (Risk Characterization)

- 3
-
-
-

3.2

- 38

6
1.
2.
3.
4.
5.
6.

-

-

-
-

( 3 )

- 39

()

(Accutane)

16 17 7 10

- 40

8 10

(Focus group interview)

(In-depth interview)

( )






24

- 41

3.3)

(Risk communication)
( Risk assessment, Risk management
Risk communication Risk analysis
risk
assessment
risk management (stakeholders)
(negative consequence)

(Hazard) (Risk) (risk perception)
(risk assessor) (risk manager)

3
1. (Informing)



2. (Persuading)

3. (Consulting)
()

- 42

(Trust confidence)

(risk mitigation options)

-

-
-

-
-
-
-
-

-
(risk perception)

- 43

- (Stakeholder engagement)

7 Cs of Efficiency Communication
- (Credibility)
(sender) (Receiver)

3 (expertise) (Trustworthiness)
(Attractiveness)
- (Context)

- (Content)

- (Clarity)


- (Continuity and consistency)

- 44

- (Channels)

- (Capability of audience)

- know the audience

- Involve scientific experts

- Establish expertise in communication

- Be0a0credible0source0of0information

- Share responsibility
stakeholder

- Differentiate between scientific and value judgment
(facts) (values)
- Assure transparency


- Put the risk to perspective

Risk

- 45

:
-

-
-
-
-
-
-

Centers for Disease Control

and Prevention (CDC) 4
1)


2)

3)

4)

- 46

1)


1.1






1.2


/


- (Active surveillance)




- (Passive surveillance)



-
3
( 4)
(
)

- 47

2)


2
2.1 () (
)









(Sub-group
analysis)

- 48

2.2

(Linkage analysis of environment and health)


Regression0 Multiple0linear0regression,
Binary0logistic0regression,
Poisson regression

(Point-source)
(Surrogate data)

( )
Spatial analysis

3)


2





3

(Data generator)
(User)

3

- 49

(
)
4)

3
4.1

4.2


4.3







5

- 50

5
AQI

0-50

51-100

101-200

201-300

300

3
( )

1.
2.
-

- 51

3.
4.
- (

)
- (


)
-
5.
6.
-
-

7.

8.

9.

- 52

1 (initial contact)

(caller)

1.

2.

3. (
)
()

4.

-
-

- 53

-


5.

6.

7.


8.

1.
2.

2 (assessment)
1
2


2
3
1. ( 2)

- 54

2. ( 2)

3. ( 2)
(case-finding)
(des-creative epidemiology)

2 (preliminary evaluation)

1.

2.
(case verification)

3. (reference population)

4. (denominator)

standardized morbidity/mortality rate
proportional mortality rate

- 55

1.

2.

3.

2 (case evaluation)
(to verify the diagnosis)
( 2)

1.

2.

3.

1.
( 2)
2
2.

3.

- 56

2 (occurrence evaluation)

1.
2.
(space-time boundaries)
3.
4.
5.

6. (exposure)

7.


2

1.
3
2.


3.

- 57

3 (major feasibility study)

1.

2.


3. - (case-control)

4.

5.
6.

7.

8.

1.
4

2.

- 58

4 (etiogical investigation)

IMRD (introduction method, results, discussion)

- 59

- 60

1.

2.

3.
(reportable disease)
( . 506)

1.
2.

3.

(Community intervention)
(environmental remediation)

- 61

1.
2.

-
-
-


(Molecular epidemiology)

1. (Chief complaint)




2. (Onset)

3. /
(Temporal pattern of symptoms)
4. (Palliative and provocative factors)
5. (Current exposure)
(past exposure) (exposure history)

- 62

6.

7.

8.
(Industrial hygienist)

(Sound clinical judgment)
(common etiologies)
(multifactorial nature)
(exposure estimate)

ATSDR (Agency for Toxic Substances and Disease Registry) NIOSH

3
1. (Exposure survey)
1.1
-

- (typical work day)

-
-
1.2
-
-
-
-
- (lockout devices)
-
-
- (drills)
-

- 63

2.
-

-
(occupational
exposure)







(general ventilation) (local ventilation)
(local exhaust hood)
(timing of first symptom)




3.
-
-

-
-
-
-
-
-
-

(passive smoking)
-
-

- 64

(non - occupational exposure)

2

6

6
/

, , ,
Carbon tetrachloride, methylene chloride, vinyl chloride
Cadmium, lead, mercury, chlorinated hydrocarbon solvents
Carbon monoxide, noise, cigarette smoke, physical stress,
carbon disulfide nitrates, methylene chloride
Methylmercury, carbon monoxide, lead, ethylene oxide
Arsenic, benzene, nitrates, radiation
Tetrachloroethylene, mercury, arsenic, toluene, lead, methanol,
noise, viny Chloride

(Complete blood count)
(urinalysis) (liver function test) (blood
urea nitrogen, creatinine)

- 65

(Nerve conduction velocity)
(neurophysiological tests)
(psychological tests)

2
1.

2. (Outcome)

1 52 3

2
(Mild angina attack)
Angina pectoris
3 0.4
2
120/85 , 80 20

(complete blood count)
(erythrocyte sedimentation rate)
(1)
(2)

2 4

1 latex-based paint 60
Acrodydia
24 65
2 950 ppm

- 66

(EPA 300 ppm) phenyl mercuric acetate

3 11
(acute respiratory symptoms)
2
(ice hockey) (indoor arena)


131 48

(ice surfacing machine)

(internal combustion engine)
Carboxyhemogobin 10-20%
( 2% 5-10% )


1.5 ppm ( OSHA 1 ppm STEL = short-term
exposure limit 15 ) 150 ppm
( 30 ppm )

4 3 1
2 3 grand mal
(tortilla) 2-3 2-3 17
4
5

( )

- 67

Tortilla
, cyclodiene

5 67
70
./. 6



(Glazing)

6 52
, , 12
2 4 7

3-4

400 26 28 19
10

(- = potable)


(cross-connected) ethylene
glycol ethylene glycol
() () ethylene glycol

- 68

7 8

18-32
1-2

(Green tobacco disease)

(neuromuscular junction)

8 3

3





( hand-to-mouth activity )

chelating agents

informal sector

- 69

1.









2.

- 70

6
6.1) (HIA)

(World Health Organization; WHO)

(Right to Health)
.. 2550
5

()
10

11



()






(Environmental Impact Assessment: EIA)
.. 2518
.. 2518 .. 2521
EIA .. 2535 ...
(EIA)
(.)

- 71

(EIA)
4
()

(Health Impact Assessment: HIA)

67
.. 2550
( )



(HIA)




(HIA)
(Evidence-based
recommendations)

(World Health Organization: WHO)

(HIA)

(HIA) (HIA)
( HIA)
2
1
(HIA in EIA) HIA EIA HIA EIA

- 72

HIA
(Liverpool)
World Bank (WB), Asian Development Bank (ADB)
2
(HIA for HPP) HIA EIA HIA
HIA


HIA
(Manchester) WHO, UNEP
HIA in EIA for HPP
HIA (Strategic environmental Assessment)
(HIA)
HIA 10 HIA


(HIA) 7
7 (HIA)

(SEA)

()

HIA

(
)

- 73

-
-
-
-
-

- ( )

-

-

-
-

(HIA)
(HIA)
WHO 2
1. Health Impact Assessment for Healthy Public Policy (HIA for HPP)

..2550
(.) (.)
(.) (.)
(.)
... .. 2550 HIA

- 74

HIA for HPP

- HIA



- HIA
(.)
IHIA 2551

HIA

HIA

- HIA HPP-HIA
HIA



HIA

-
25 (5)
.. 2550

2. Health Impact Assessment in Environmental Impact Assessment: HIA in EIA

(.)
EIA
3.

HIA in EIA HIA for HPP
4. Training
HIA
3 4

- 75

HIA in EIA
- EIA

-


- .. 2550
67 2 .. 2550 HIA

.. 2550 5, 10, 11
.. 2550 67 2 ()
HIA
HIA ( HIA )
/

67 2

HIA
HIA

HIA



HIA directly health-related
directly health-related
HIA EIA
EIA (HIA)
80

.. 2552 25 (5)
.. 2550
(5) 4

- 76

1.
67 2 2550 (HIA in EIA = EHIA)
2.

3.
11 (. 2550)
4.

3 (Community Health Impact Assessment: CHIA)

(HIA in EIA) 2552
5
1. (Screening)


2. (Scoping)

2.1 Public scoping

3. (Appraisal)



4.
(Reviewing) (Decision making)
()

4.1 Public review

HIA /
5. (Monitoring and evaluation)

- 77

(16) HIA in EIA

HIA
/

(M&E)

Monitoring and evaluation

HIA
1.





2.

()

- 78

3
1) (Health Risk Model)
2) (Comprehensive Standard)
3) (Local-based Approach)

1. (Health Risk Model)

(Health hazards) (Health risks)

(Causal relation)

2. (Comprehensive Standard)
(Human well-being)


(Comprehensive standard)
Merseyside model
Dahlgren Whitehead model
2.1 Merseyside model
(University of Liverpool)
6 /

Merseyside model 8

- 79

8 Merseyside model

2.2 Dahlgren Whitehead model

5 8

- 80

8 Dahlgren Whitehead model

1)

2)

3)

4)


5)


Merseyside model
() (
) ()

3. (Local-Based Approach)

- 81

HIA

()
..2550 67
.. 2550 3
1. 2.
3.

(EIA)


16 52
HIA
HIA
HIA 1


HIA



HIA
HIA

HIA
1. (1)
(2)
/
(.)
2.
/
3.
(monitoring &
Evaluation)

- 82

HIA


()

4 1
1.
(Public scoping 1)

2.
(Public review: 3)

3.

4. / (
)

- 83

EHIA

(Monitoring
&Evaluation)


2
1 : (Public scope: 1)

5
4


Focus group


2 : (Public review 3

/

/

- 84

6.2)
(Public Health Emergency-PHE)
2 4
1.
2.
3.
4.



-
-
-
-
-
-
-
-
-
(Public health Emergency response)
/

1.
2.
3.

SRRT

SRRT

SRRT
()

SRRT

-
-
-
-
-
-

SRRT
( SRRT )

- CAMEO, ALOHA, MARPLOT,

ARCVIEW
- Google Earth

SRRT
( SRRT )

(
)

SRRT
( SRRT )

SRRT
SRRT

- 85

- 86

1. ( ) /

2.

3. ( ) /
4. / ( )
5. ( ) P&P area-based

/

1. /

-

- 10
National Fire Protection Association (NFPA)
5
0 4
-
media

-


-
(EP) EMS
-

- 87

2. / 2
2.1
2.2
-

SRRT
/

3.
- 1
-
4. SRRT SRRT

SRRT

()

SRRT

-
-
-
(safety officer)
-

15

SRRT
SRRT
SRRT

1)

(
)

2) Major Incident Medical

- SRRT Management and Support : The
Approach at the Scene
- SRRT
Practical
th
(5 Impression 2006)
env-occ ( 1 )
- SRRT ( 3 )
- SRRT
SRRT
SRRT
SRRT

SRRT

- 88

- 89

1.
- SRRT SRRT

-

- SRRT ()
15
SRRT
2.
- SRRT

(safety officer) zone

- SRRT
- SRRT

- / ( )
3.
(.)

1.
-
/
SRRT
-
( GPS )
-

- SRRT
- 15 SRRT

- 90

2. SRRT
- SRRT 1 safety officer
zoning


- SRRT 3
(cold zone)


-
15
-

- 91

SRRT
( SRRT )

SRRT

(After Action Review AAR)

SRRT
( SRRT )

SRRT
SRRT

SRRT
SRRT

SRRT
SRRT

1. SRRT
-
-
-
-
-
2. (After Action Review AAR) SRRT

3. SRRT
4.

- 92

5.

1. /
-

SRRT


-

CBC UA
CBC 6
2

2.
-


- /

-
3. (After Action Review AAR)

- /

- 93

- ( SRRT, EMS, )

/ SRRT
SRRT
-


-
- ()

- 94

6.3)

3
1.
(1)

(2)

(3)

(4)

2.

.. 2535 .. 2504
.. 2484 .. 2507
.. 2535
3.

- 95

1.

2.

1.

2.

- 96

3.


.. 2542

..2540


15 ( ( 2) .. 2541
... ..2540)


. (Air Quality Index: AQI). Available at:
http://www.pcd.go.th/info_serv/air_aqi.htm.
() .
http://www.thia.in.th/uploads/HIA_2.pdf [12 2555]
HIA
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 .2557. (Risk Communication)

.

. (2557). (60 )
2557 . 3 2557.
HIA , http://www.thia.in.th/welcome/content/1, 1 2 2555
Abbing EWR. HIA and National Policy in the Netherlands: In Health Impact Assessment:Concepts,
theory, techniques, and applications; Kemm J, Parry J, Palmer S, eds. UK: Oxford University
Press, 2004: 177-80
American Lung Association. Solvents in the Workplace. Available at:
http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=23040.
Banken R. HIA of Policy in Canada: In Health Impact Assessment:Concepts, theory, techniques, and
applications; Kemm J, Parry J, Palmer S, eds. UK: Oxford University Press, 2004: 165-75
Bowen C. HIA and Policy Development in London: Using HIA as a Tool to Integrate Health
Considerations into Strategy: In Health Impact Assessment:Concepts, theory, techniques, and
applications; Kemm J, Parry J, Palmer S, eds. UK: Oxford University Press, 2004: 235-42
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