Table Of ContentEnvironmental Medicine
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Environmental Medicine
Jon G. Ayres BSc MBBS MD FRCP FRCPE FFOM FRCPSG
Professor of Environmental and Respiratory Medicine,
School of Health and Population Sciences,
University of Birmingham, UK
Roy M. Harrison OBE BSc PhD DSc CChem FRSC
FRMetS Hon MFPH HonFFOM
Queen Elizabeth II Birmingham Centenary Professor of
Environmental Health, Division of Environmental Health &
Risk Management, University of Birmingham, UK
Gordon L. Nichols PhD MSB CBiol FRSPH
Consultant Epidemiologist, Gastrointestinal, Emerging
and Zoonotic Infections Department, Centre for
Infections, Health Protection Agency, London, UK
Robert L. Maynard CBE FRCP FRCPath FBTS
Honorary Professor of Environmental Medicine,
University of Birmingham, UK
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Contents
Certain topics have been covered in shorter form, rather than as a full chapter. These are indicated in the contents list by a box
symbol: . These boxes occur throughout the book but are usually linked to main chapters in the same broad subject area.
Contributors ix
Preface xiii
PART 1 BACKGROUND TO ENVIRONMENTAL MEDICINE 1
1 Environmental medicine in context 3
Jon G. Ayres, Roy M. Harrison, Robert L. Maynard, Roger O. McClellan and Gordon L. Nichols
PART 2 METHODOLOGY 23
2 Epidemiological methods for attributing illness 25
Susan Hodgson, Fu-Meng Khaw
3 The surveillance and monitoring of diseases and agents 44
Mike Catchpole
4 Hazard and risk: assessment and management 56
Roger O. McClellan
5 Chemical exposure assessment 86
Sean Semple, John W. Cherrie
Short-range person-to-person modelling David Carruthers 99
Long-range modelling David Carruthers 99
Dispersion in cities David Carruthers 101
6a Mapping out the causes of infectious diseases: a case study on the multiple factors involved in
Salmonella Enteritidis infections 102
Gordon L. Nichols
6b Mapping the causes and transmission routes of chemicals 106
Mathew R. Heal
The application of geospatial technologies to medical studies
David R. Green 109
7 Measuring the atmosphere 111
Mathew R. Heal
8 Measuring the water and soil environments 119
Michael O. Rivett , Kevin D. Privett, Robert W. Ivens
PART 3 HEALTH EFFECTS 127
Section A: Diseases from respiratory exposure to non-infectious agents 129
9 Deposition, absorption and mechanisms of action of gases and particles in the lung 131
John A.S. Ross, Frank J. Kelly
10 Health effects of air pollution: acute and chronic 141
Ian Litchfield, Douglas W. Dockery, Jon G. Ayres
11 Point sources 153
Josep M. Antó
12 Volcanoes 164
Peter J. Baxter
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vi Contents
13 Environmental allergens 168
Moisés A. Calderón, Pablo Rodríguez del Río, Nara T. Orban
Summer hypersensitivity pneumonitis/alveolitis Lisa Hill, Jon G. Ayres 178
Exposure to composting emissions and health Peter Sykes 179
14 Indoor air pollution in developed countries 181
Isabella Myers, Robert L. Maynard
15 Indoor air pollution in developing countries 191
Om P. Kurmi, Jon G. Ayres
Section B: Respiratory diseases from infectious agents 203
16 Nosocomial transmission and control of SARS 205
Benjamin J. Cowling, Steven Riley, Wing Hong Seto, Gabriel M. Leung
17 Epidemic and pandemic influenza 213
Jonathan S. Nguyen-Van-Tam
Avian influenza Jonathan S. Nguyen-Van-Tam 220
2009 Pandemic influenza A/H1N1 Jonathan S. Nguyen-Van-Tam 221
18 Legionnaires’ disease 224
John V. Lee, Gordon L. Nichols
Burkholderia species and the rhizosphere T.L. Pitt 232
Q fever Jon G. Ayres 233
Psittacosis (captive birds) Robert M. Smith 234
19 Aspergillosis, mucormycosis, cryptococcosis, coccidioidomycosis and histoplasmosis 235
Elizabeth M. Johnson
20 Diseases of air travel 244
David L. Hagen
21 Environmental mycobacteria 252
Joseph O. Falkinham III
Section C: Diseases related to exposure to non-infectious material 257
22 Chemical transmission through the food chain 259
Janet A.M. Kyle, Geraldine McNeill
23 Biotoxins and xenobiotics 276
Sally Bradberry, Allister Vale
24 Drinking water safety and standards for drinking water 290
John Fawell
25 Pesticides: herbicides, insecticides and rodenticides 297
Finlay D. Dick
26 Lead 309
Brian L. Gulson
Mercury Lisa Hill, Jon G. Ayres 325
27 Cadmium 327
Paul Cullinan
Aluminium Finlay D. Dick 333
Manganese Michael Aschner 334
28 Arsenic 336
Paul Cullinan, Geoff H. Pigott
29 Fluorine 342
Peter J. Baxter
30 Toxicity of ingested radionuclides 348
John Harrison
Section D: Diseases related to the ingestion of infectious agents 357
31 The sources and environmental origins of gastrointestinal pathogens 359
Gordon L. Nichols, Kåre Mølbak
32 The causes of waterborne disease 373
Paul R. Hunter
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Contents vii
33 Cholera 380
Kelley Lee, Adam Kamradt-Scott
34 Human health risks from toxic cyanobacteria, dinoflagellates and diatoms 384
Gordon Nichols
35 Enteric viruses 388
Jim Gray, Miren Iturriza-Gómara
36 The oral acquisition of nematode, cestode and trematode parasites 394
Simon Brooker, Jeroen H.J. Ensink
Mycobacterium avium subspecies paratuberculosis, Johne's disease and Crohn’s disease 402
John Hermon-Taylor
Section E: Vector and skin-borne diseases 403
37 Environmental factors that affect vector-borne pathogen transmission 405
Sarah E. Randolph
38 Flavivirus epidemiology, evolution, dispersal and survival: the influence of anthropology 411
Ernest A. Gould, Stephen Higgs
39 Trypanosomes, leishmania and lymphatic filariasis 424
Edwin Michael
40 Disease transmission by non-biting flies 434
Gordon L. Nichols
41 Tick-borne diseases – changing patterns and effective interventions 447
Cairns Smith, Mutuku A. Mwanthi
42 Haemorrhagic fevers: the natural reservoirs of Ebola, Marburg and Lassa viruses 452
Lorenzo Pezzoli, Natasha S. Crowcroft
Section F: Nosocomial diseases – hospitals and institutions 461
43 Clostridium difficile 463
J. S. Brazier
44 The emergence of antibiotic resistance in the hospital environment 468
Alan Johnson
Section G: Accidental and deliberate environmental contamination 473
45 CBRN contamination 475
Robert P. Chilcott
46 Management of chemical incidents 487
Virginia Murray
Section H: Diseases influenced by climate 499
47 Heat and cold 501
William R. Keatinge
48 Global climate change 510
Sari Kovats, Anthony J. McMichael
49 Adaptation to climate change 521
Giovanni Leonardi
Section I: Pressure 531
50 The hyperbaric environment 533
John A.S. Ross
51 Air travel and altitude 547
Yvonne Nussbaumer-Ochsner, Konrad E. Bloch
Section J: Land 563
52 Contaminated land and health 565
Andrew Kibble, David Russell
53 Disposal of diseased animals 574
Simon Pollard
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viii Contents
Section K: Radiant energy 583
54 Radiofrequency radiation 585
David Coggon
55 Power-frequency electric and magnetic fields 590
Leeka Kheifets, John Swanson
56 Radon: health effects of environmental exposures 599
Gerald M. Kendall
57 Noise 610
Andy Moorhouse
Section L: Genetic, environmental and infectious causes of cancer 623
58 Environmental carcinogenesis 625
David H. Phillips, Stan Venitt
PART 4 ENVIRONMENT AND THE PEOPLE 635
59 Is this patient suffering as a result of an environmental exposure? 637
Ware G. Kuschner, Paul D. Blanc
60 Public perception of risk 645
Sarah Damery
61 Environmental law 651
Francis McManus
62 Policy development 659
Martin Williams
63 Health impact assessment 666
Fintan Hurley, Salim Vohra
Index 679
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Contributors
Josep M. Antó MD PhD David Carruthers PhD
Director, Centre for Research in Environmental Epidemiology Technical Director, Cambridge Environmental Research
(CREAL), Barcelona; Professor of Medicine, Universitat Pompeu Consultants Ltd, Cambridge, UK
Fabra, Barcelona; Affiliated Researcher, Municipal Institute of
Mike Catchpole MB BS MSc FRCP FFPHM
Medical Research (IMIM-Hospital del Mar), Barcelona; Director,
Deputy Director, Health Protection Agency Centre for Infections,
CIBER Epidemiología y Salud Pública (CIBERESP), Spain
Colindale Avenue, London, UK
Michael Aschner PhD John W. Cherrie BSc (Hons) PhD FFOH
Department of Pediatrics, Pharmacology and the Kennedy Center
Research Director, Institute of Occupational Medicine,
for Research on Human Development, Vanderbilt University
Edinburgh, UK; Honorary Reader, Department of Environmental
School of Medicine, Nashville, Tennessee, USA
and Occupational Medicine, University of Aberdeen, UK
Jon G. Ayres BSc MBBS MD FRCP FRCPE FFOM FRCPSG
Robert P. Chilcott CBiol FIBiol
Professor of Environmental and Respiratory Medicine, Institute of
Professor, Principal Toxicologist and Group Leader, CBRN and
Occupational and Environmental Medicine, School of Health and
Chemical Toxicology, Centre for Emergency Preparedness and
Population Sciences, University of Birmingham, UK
Response, Porton Down, Salisbury, Wiltshire, UK
Peter J. Baxter MD MSc FRCP FFOM
Consultant Physician in Occupational and Environmental David Coggon OBE MA PhD DM FRCP FFOM FFPH FMedSci
Professor of Occupational and Environmental Medicine,
Medicine, University of Cambridge and Addenbrooke’s
University of Southampton, UK
NHS Trust Hospital, Cambridge, UK
Paul D. Blanc MD MSPH Benjamin J. Cowling PhD
Assistant Professor, Department of Community Medicine and
Professor and Chief, Division of Occupational and Environmental
School of Public Health, Li Ka Shing Faculty of Medicine,
Medicine, Department of Medicine and Cardiovascular Research
University of Hong Kong
Institute, University of California, San Francisco, USA
Konrad E. Bloch MD Natasha S. Crowcroft MA MSc MD(Cantab) MRCP FFPH
Director, Surveillance and Epidemiology, Ontario Agency for
Professor, Pulmonary Division, University Hospital of Zurich,
Health Protection and Promotion, Canada; Honorary Consultant,
Switzerland
Health Protection Agency, UK; Associate Professor, Laboratory
Sally Bradberry BSc MD MRCP Medicine and Pathobiology and Dalla Lana School of Public
Assistant Director, National Poisons Information Service
Health, University of Toronto, Ontario, Canada
(Birmingham Unit) and West Midlands Poisons Unit, City
Hospital, Birmingham UK Paul Cullinan MD FRCP FFOM
Professor in Occupational and Environmental Respiratory Disease,
Jon S. Brazier PhD MSc CBiol MiBiol SRCS
Imperial College, London, UK
Consultant Clinical Scientist and Head of Anaerobe Reference
Laboratory, NPHS Microbiology Cardiff, University Hospital of Sarah Damery PhD
Wales, Cardiff, UK Research Fellow, Primary Care Clinical Sciences, School of Health
and Population Sciences, University of Birmingham, UK
Simon Brooker DPhil
Reader, London School of Hygiene and Tropical Medicine, Finlay D. Dick MD MRCGP MFOM
London, UK; Wellcome Trust Research Fellow, Kenya Medical Clinical Senior Lecturer in Occupational Medicine, Section of
Research Institute–Wellcome Trust Research Programme, Population Health, Division of Applied Health Sciences, School of
Nairobi, Kenya Medicine and Dentistry, University of Aberdeen, UK
Moisés A. Calderón MD PhD Douglas W. Dockery ScD
Clinical Research Fellow. National Heart and Lung Institute. Professor of Environmental Epidemiology, Chair, Department of
Imperial College Faculty of Medicine; and Royal Brompton Environmental Health, Harvard School of Public Health, Boston,
Hospital, London, UK Mass., USA
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