An educational intervention to improve knowledge about prevention against occupational asthma and allergies using targeted maximum likelihood estimation

Application of targeted maximum likelihood estimation in public health and epidemiological studies: a systematic review

PURPOSE

The targeted maximum likelihood estimation (TMLE) statistical data analysis framework integrates machine learning, statistical theory, and statistical inference to provide a least biased, efficient, and robust strategy for estimation and inference of a variety of statistical and causal parameters. We describe and evaluate the epidemiological applications that have benefited from recent methodological developments.

METHODS

We conducted a systematic literature review in PubMed for articles that applied any form of TMLE in observational studies. We summarized the epidemiological discipline, geographical location, expertize of the authors, and TMLE methods over time. We used the Roadmap of Targeted Learning and Causal Inference to extract key methodological aspects of the publications. We showcase the contributions to the literature of these TMLE results.

RESULTS

Of the 89 publications included, 33% originated from the University of California at Berkeley, where the framework was first developed by Professor Mark van der Laan. By 2022, 59% of the publications originated from outside the United States and explored up to seven different epidemiological disciplines in 2021-2022. Double-robustness, bias reduction, and model misspecification were the main motivations that drew researchers toward the TMLE framework. Through time, a wide variety of methodological, tutorial, and software-specific articles were cited, owing to the constant growth of methodological developments around TMLE.

CONCLUSIONS

There is a clear dissemination trend of the TMLE framework to various epidemiological disciplines and to increasing numbers of geographical areas. The availability of R packages, publication of tutorial papers, and involvement of methodological experts in applied publications have contributed to an exponential increase in the number of studies that understood the benefits and adoption of TMLE.

Occupational inhalant allergy in food handling occupations

PURPOSE OF REVIEW

Review article on recent developments on inhalant food allergens associated with occupational respiratory allergy and asthma.

RECENT FINDINGS

This review has found that occupational inhalant allergy in food handling occupations is a common and recognisable clinical entity (class 3 food allergy) in high-risk food occupations such as bakeries and seafood processing. Aerosolised food proteins from plant or animal food sources, additives and biological food contaminants cause occupational sensitization, rhinitis and asthma. The risk of allergy may be enhanced across the food value chain as a result of food processing techniques including the introduction of new food allergens in the food matrix. Occupational food allergy and asthma can be prevented by improved health-based exposure standards, workplace control measures, education and training activities, and early diagnosis accompanied with exposure reduction.

SUMMARY

Future studies need to focus on exposure-response studies to establish improved exposure limits especially for flour dust, the relevance of cooked vs raw foods in influencing risk, identifying and characterising major inhalant food allergens accompanied with component resolved diagnostic approaches, and evaluating the effectiveness of interventions for common high-risk food sensitizers causing occupational rhinitis and asthma.

[A questionnaire assessing knowledge level concerning occupational asthma]

INTRODUCTION

Screening for occupational asthma is should still be promoted. In order to improve the efficiency of any educational intervention we need to evaluate the patient's knowledge of the disease.

OBJECTIVES

The aims were to evaluate objectively the knowledge level of Tunisian asthmatic patients concerning occupational asthma using a self-questionnaire in Arabic Tunisian dialect, then to conduct a validation process of the questionnaire.

METHODS

We followed De Vellis's rules during all stages of redaction of the self-questionnaire. It contained 18 items allocated in 4 dimensions: knowledge about asthma; knowledge about occupational asthma; prognosis of occupational asthma; prevention of occupational asthma. A pre-test was conducted on 18 asthmatic patients to assess the clarity and comprehensibility of all the questions. The questionnaire was then applied to 107 asthmatic patients.

RESULTS

The statistical analysis proved the discrimination value in 14 of the 18 items. The internal consistency of the questionnaire was demonstrated by a KR20 index of 0.731. Factorial analysis of the principal components showed the reliability of the questionnaire and of its uni-dimensional structure. The statistical findings proved the positive correlation between the mean scores of all its dimensions.

CONCLUSIONS

Using this questionnaire in daily practice should inform health care providers about the level of knowledge of occupational asthma in the targeted population and improve the effectiveness of any further educational intervention.