Environmental Medicine

Environmental Medicine......Page 4
Contents......Page 6
Contributors......Page 10
Preface......Page 14
Part 1: Background to Environmental Medicine......Page 16
An introduction to environmental medicine......Page 18
Environmental exposures......Page 22
Protecting human health......Page 23
Burden of disease......Page 30
Risk reduction......Page 33
References......Page 36
Part 2: Methodology......Page 38
Introduction......Page 40
Epidemiological methods......Page 41
Design issues......Page 47
Application of findings......Page 53
References......Page 55
Other resources......Page 58
Historical perspective......Page 59
Scope......Page 60
Data sources/providers......Page 61
Level of ascertainment: 'active' and 'passive' surveillance......Page 63
Operational issues......Page 64
Analysis of surveillance data......Page 66
References......Page 68
Sources of information for characterizing hazards and risks......Page 71
Emergence of a formal risk paradigm......Page 73
Exposure characterization......Page 75
Characterizing exposure (dose)-response relationships......Page 76
Evaluating threshold exposure-response relationships......Page 77
Characterization of hazards from carcinogens......Page 79
Cumulative risk......Page 81
Examples of hazard and risk characterization......Page 82
Threshold of toxicological concern......Page 92
The registration, evaluation, authorization and restriction of chemical substances regulation......Page 93
Risk management......Page 95
Summary......Page 96
References......Page 97
What is exposure?......Page 101
Case study 1: inhalation exposure - personal exposure to fine particulate air pollution in Kuala Lumpur, Malaysi......Page 103
Matching the exposure metric to the health effect......Page 105
Biomonitoring......Page 106
Exposure modelling......Page 107
Case study 2: estimating exposures from a point source......Page 108
Case study 3: estimation of exposure to pesticides residues from food......Page 110
Conclusion......Page 112
Recommended reading......Page 113
Long-range modelling......Page 114
Dispersion in cities......Page 116
The outbreaks......Page 117
Identification of contributory factors......Page 118
Control measures......Page 119
References......Page 120
Measurement of chemical transmission routes......Page 121
Modelling of chemical transmission routes......Page 122
References......Page 123
The application of geospatial technologies to medical studies......Page 124
7. Measuring the atmosphere......Page 126
Hazardous air pollutants and air quality standards......Page 127
Airborne particulate matter......Page 128
Monitoring networks......Page 129
Measurement of individual atmospheric components......Page 130
References......Page 132
Contamination of water and soil environments......Page 134
Historical perspective......Page 136
Measurement methods and protocols......Page 137
Uncertainty......Page 138
Conclusion and future challenges......Page 139
References......Page 140
Paart 3: Health Effects......Page 142
Section A: Diseases from respiratory exposure to non-infectious agents......Page 144
Anatomy......Page 146
Innervation of the lung......Page 147
Particles......Page 148
Clearance of gases and particles from the airways......Page 149
Defensive mechanisms in the lung and pathways of lung injury......Page 150
References......Page 153
Pollutants, sources and exposures......Page 156
Assessing the health effects of air pollutants......Page 157
Mechanisms of the effects of air pollutants......Page 162
Summary......Page 163
References......Page 164
Antecedents......Page 168
Types of point-source epidemiological study......Page 169
Methodological issues in epidemiological studies around point sources......Page 174
Public health approaches......Page 175
References......Page 176
Impacts of volcanic eruptions......Page 179
Eruptions......Page 180
Management of volcanic activity......Page 181
Other resources......Page 182
Definition and classification......Page 183
Allergens and environmental factors......Page 184
Mechanisms......Page 185
Co-morbidity......Page 186
Management......Page 187
References......Page 190
Summer hypersensitivity pneumonitis/alveolitis......Page 193
Exposure to composting emissions and health......Page 194
Introduction......Page 196
Sources of indoor air pollutants in developed countries......Page 197
Exposure to chemical air pollutants indoors......Page 198
Setting guidelines for domestic indoor air quality......Page 202
Conclusion......Page 203
References......Page 204
Further resources......Page 205
Composition of biomass smoke......Page 206
Measurement of exposure to biomass smoke......Page 207
Health effects of biomass smoke exposure......Page 208
Management of exposure to biomass smoke......Page 214
References......Page 215
Section B: Respiratory diseases from infectious agents......Page 218
Introduction......Page 220
Clinical and epidemiological characteristics of SARS......Page 221
Superspreaders and nosocomial transmission......Page 222
Infection control......Page 223
Acknowledgements......Page 224
References......Page 225
Virology, classification and animal reservoirs......Page 228
The history of epidemics and pandemics......Page 229
Epidemiology of seasonal influenza......Page 230
Epidemiology of pandemic influenza......Page 231
References......Page 232
Avian influenza......Page 235
2009 Pandemic influenza A/H1N1......Page 236
Characteristics of Legionnaires’ disease......Page 239
Legionella spp.......Page 240
Public health and control measures......Page 241
References......Page 243
Other resources......Page 246
Burkholderia species and the rhizosphere......Page 247
Q fever......Page 248
Psittacosis (captive birds)......Page 249
Aspergillosis......Page 250
Cryptococcosis......Page 252
Coccidioidomycosis......Page 254
Histoplasmosis......Page 255
References......Page 256
The cabin environment......Page 259
Diseases and air travel......Page 260
Tuberculosis......Page 261
Pandemic influenza......Page 262
Fume events......Page 264
References......Page 265
Environmental opportunistic pathogenic mycobacteria......Page 267
Treatment of mycobacterial disease......Page 268
Why are mycobacteria in the environment?......Page 269
References......Page 270
Section C: Diseases related to exposure to non-infectious material......Page 272
Contamination during food production......Page 274
Contamination introduced during food processing......Page 282
Estimating dietary intake and exposure to contaminants......Page 284
Summary......Page 285
References......Page 286
Plant biotoxins......Page 291
Ricin and abrin......Page 294
Mushroom biotoxins......Page 295
Marine biotoxins......Page 297
Xenobiotics......Page 298
References......Page 301
Water contaminants - occurrence and health issues......Page 305
Guidelines and standards for drinking water quality......Page 309
References......Page 310
Pesticide usage......Page 312
Exposure routes......Page 313
Health effects......Page 315
References......Page 318
Potential exposure to lead......Page 324
Health effects of lead exposure......Page 331
Medical management of lead exposure......Page 332
References......Page 333
Mercury......Page 340
Exposures and temporal trends......Page 342
Biomonitoring of cadmium exposure......Page 343
Adverse health effects......Page 344
References......Page 345
Aluminium......Page 348
Manganese......Page 349
Introduction and environmental sources......Page 351
Toxicokinetics......Page 352
Adverse health effects......Page 353
References......Page 354
General sources of fluoride......Page 357
Environmental exposure to fluoride......Page 358
Human health consequences of excess fluoride intake......Page 359
Control of exposure to fluoride......Page 360
References......Page 361
30. Toxicity of ingested radionuclides......Page 363
Biokinetic and dosimetric models......Page 364
Marie Curie - the discovery of polonium and radium......Page 365
Techa River residents......Page 366
Polonium as a poison......Page 367
References......Page 368
Section D: Diseases related to the ingestion of infectious agents......Page 372
Gastrointestinal pathogens......Page 374
Other bacterial infections......Page 382
Parasitic infections transmitted by food and water......Page 383
Long-term sequelae......Page 384
Barriers to infection and immune response......Page 385
References......Page 386
32. The causes of waterborne disease......Page 388
Waterborne pathogens......Page 389
The incidence of endemic waterborne disease......Page 390
Topical issues in waterborne disease......Page 391
References......Page 393
A brief history of cholera pandemics......Page 395
Cholera in a globalizing world......Page 396
References......Page 398
Cyanobacteria (blue-green algae)......Page 399
Dinoflagellates and diatoms......Page 400
References......Page 402
35. Enteric viruses......Page 403
Water......Page 405
Prevention......Page 406
References......Page 407
Intestinal nematodes......Page 409
Tissue nematodes......Page 411
Cestodes......Page 412
Trematodes......Page 414
References......Page 415
Mycobacterium avium subspecies paratuberculosis, Johne's disease and Crohn's disease......Page 417
Section E: Vector and skin-borne diseases......Page 418
Basic principles......Page 420
Risk and exposure to risk......Page 421
Relevant aspects of the environment......Page 422
Conclusion......Page 423
References......Page 424
Types of flavivirus......Page 426
Flaviviruses transmitted by ticks......Page 427
Flaviviruses transmitted by mosquitoes......Page 430
References......Page 436
39. Trypanosomes, leishmania and lymphatic filariasis......Page 439
Trypanosomiasis......Page 440
Leishmaniasis......Page 442
Lymphatic filariasis......Page 443
References......Page 445
Warfare......Page 449
Non-enteric bacterial infections......Page 451
Enteric bacterial pathogens......Page 455
Helminths......Page 456
Investigation of flies and infectious diseases......Page 457
References......Page 458
Agents......Page 462
Diagnosis and treatment......Page 463
References......Page 465
Ebola and Marburg viruses......Page 467
Lassa virus......Page 470
References......Page 472
Section F: Nosocomial diseases - hospitals and institutions......Page 476
43. Clostridium difficile......Page 478
Clostridium difficile in animals and the general environment......Page 479
Clostridium difficile in the hospital environment......Page 480
References......Page 481
Antibiotic resistance in the hospital environment......Page 483
The interface between the hospital environment and the community......Page 484
Strategies to reduce antibiotic resistance in hospitals......Page 485
References......Page 486
Section G: Accidental and deliberate environmental contamination......Page 488
Overview of hazardous mat......Page 490
Generic emergency procedures......Page 492
Overview of the toxicology and treatment of some chemical warfare agents......Page 496
References......Page 500
46. Management of chemical incidents......Page 502
The pre-event phase......Page 505
The acute phase......Page 506
The post-incident phas......Page 511
References......Page 512
Section H: Diseases influenced by climate......Page 514
Heat......Page 516
Cold......Page 519
References......Page 524
48. Global climate change......Page 525
Climate, weather and climate change exposures......Page 526
Methods for estimating the current impact of weather and climate on health......Page 527
Methods for estimating the future impact of climate change on health......Page 528
Current state of knowledge about health effects of climate change......Page 530
Detection and attribution of health effects to observed climate change......Page 532
References......Page 533
49. Adaptation to climate change......Page 536
Areas for action on adaptation......Page 537
Role of health agencies in adaptation......Page 538
Health systems to support the management of extreme events......Page 539
Health systems to support medium- and long-term adaptation......Page 541
Conclusion......Page 543
References......Page 544
Section I: Pressure......Page 546
The pressurized environment......Page 548
The underwater environment......Page 553
References......Page 559
Overview......Page 562
Air travel......Page 564
Travel to high altitude......Page 569
References......Page 574
Section J: Land......Page 578
Key contaminants......Page 580
How do pollutants behave in soils?......Page 581
Exposure......Page 582
Risk assessment......Page 584
References......Page 587
Disposal as a process......Page 589
Waste management......Page 592
Assessing and managing exposures......Page 593
Summary......Page 595
References......Page 596
Section K: Radiant energy......Page 598
Characterization, quantification and measurement of exposures......Page 600
Interaction with biological tissues......Page 601
Studies in humans......Page 602
References......Page 604
Introduction to extremely-low-frequency EMFs......Page 605
Exposures......Page 606
Acute effects......Page 607
Chronic effects......Page 608
References......Page 612
56. Radon: health effects of environmental exposures......Page 614
Radiation doses from radon......Page 615
Evidence on the risks of radon exposure......Page 616
Exposure to radon in dwellings......Page 621
References......Page 623
Quantifying sound exposure......Page 625
Measuring the effects of noise......Page 628
Effects of noise on health......Page 629
Noise control......Page 635
References......Page 636
Section L: Genetic, environmental and infectious causes of cancer......Page 638
Cancer causation, mechanisms and prevention......Page 640
Arsenic in drinking water......Page 641
Aflatoxins and viral hepatitis......Page 643
Mesothelioma from asbestos and related fibres......Page 644
Polycyclic aromatic hydrocarbons......Page 645
Endemic nephropathy and associated urothelial cancer......Page 646
References......Page 647
Part 4: Environment and the People......Page 650
Exposure-effect relationships: drawing on epidemiological models......Page 652
Attribution and causality in the individual context......Page 653
Special diagnostic subsets: pathognomonic processes, occupational diseases and psychological disorders......Page 654
Taking a clinical environmental health history......Page 655
Specific exposures for targetted assessment......Page 656
Management considerations......Page 657
References......Page 658
Overview......Page 660
‘Measuring’ public perceptions of risk......Page 661
More recent approaches to public risk perception......Page 663
References......Page 664
61. Environmental law......Page 666
The European Community......Page 667
Noise pollution......Page 669
Air pollution......Page 670
Waste and contaminated land......Page 671
References......Page 672
62. Policy development......Page 674
Policy and the evidence base after the smog episodes of 1952 and 1962......Page 675
The development of strategies in the UK and Europe......Page 676
Policy instruments that reduce emissions......Page 677
Future developments in air quality management policies......Page 678
References......Page 680
Health impact assessment......Page 681
The HIA process......Page 682
HIA in the context of other approaches......Page 683
An overview of environmental HIA......Page 684
An example: environmental HIA of outdoor air pollution......Page 688
Acknowledgements......Page 690
References......Page 691
A......Page 694
B......Page 695
C......Page 696
D......Page 699
E......Page 700
G......Page 702
H......Page 703
I......Page 704
L......Page 706
M......Page 707
O......Page 708
P......Page 709
R......Page 710
S......Page 711
U......Page 713
V......Page 714
Z......Page 715