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Blake H, Chaplin WJ, Wainwright E, Taylor G, McNamee P, McWilliams D, Abbott-Fleming V, Holmes J, Fecowycz A, Walsh DA, Walker-Bone K. The Web-Based Pain-at-Work Toolkit With Telephone Support for Employees With Chronic or Persistent Pain: Protocol for a Cluster Randomized Feasibility Trial. JMIR Res Protoc 2023; 12:e51474. [PMID: 37902814 PMCID: PMC10644198 DOI: 10.2196/51474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 08/19/2023] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND Chronic or persistent pain affects one's ability to work or be productive at work, generating high societal and economic burden. However, the provision of work-related advice and support for people with chronic pain is variable or lacking. The Pain-at-Work (PAW) Toolkit was cocreated with people who live with pain, health care professionals, and employers. It aims to increase knowledge about employee rights and how to access support for managing a painful chronic condition in the workplace and provides advice on lifestyle behaviors that facilitate the management of chronic pain. OBJECTIVE We aimed to establish the feasibility of conducting a definitive cluster randomized controlled trial comparing access to the PAW Toolkit and telephone support calls from an occupational therapist (PAW) with treatment as usual (ie, standard support from their employer). Our primary outcomes are establishing parameters of feasibility, acceptability, usability, and safety of this digital workplace health intervention. We will assess the candidate primary and secondary outcomes' feasibility and test research processes for a definitive trial. METHODS This is an open-label, parallel 2-arm pragmatic feasibility cluster randomized controlled trial with exploratory health economics analysis and a nested qualitative interview study. We aim to recruit 120 participants from at least 8 workplace clusters (any type, >10 employees) in England. The recruitment of workplaces occurs via personal approach, and the recruitment of individual participants is web based. Eligible participants are vocationally active adults aged ≥18 years with internet access and self-reporting chronic pain interfering with their ability to undertake or enjoy productive work. A restricted 1:1 cluster-level randomization is used to allocate employment settings to PAW or treatment as usual; participants are unblinded to group allocation. Following site- and individual-level consent, participants complete a web-based baseline survey (time 0), including measures of work capacity, health and well-being, and health care resource use. Follow-up is performed at 3 months (time 1) and 6 months (time 2). Feasibility outcomes relate to recruitment; intervention fidelity (eg, delivery, reach, uptake, and engagement); retention; and follow-up. Qualitative evaluation (time 2) is mapped to the Capability, Opportunity, Motivation-Behavior model and will explore intervention acceptability to employees and employers, along with individual and contextual factors influencing the delivery and uptake of the intervention. RESULTS Ethics approval was obtained in March 2023. Trial recruitment began in June 2023. CONCLUSIONS The PAW Toolkit is the first evidence-based digital health intervention aimed at supporting the self-management of chronic or persistent pain at work. This study will inform the design of a definitive trial, including sample size estimation, approaches to cluster site identification, primary and secondary outcomes' selection, and the final health economic model. Findings will inform approaches for the future delivery of this digital health intervention. TRIAL REGISTRATION ClinicalTrials.gov NCT05838677; https://clinicaltrials.gov/study/NCT05838677. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/51474.
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Affiliation(s)
- Holly Blake
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, United Kingdom
- NIHR Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Wendy J Chaplin
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, United Kingdom
| | - Elaine Wainwright
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
| | - Gordon Taylor
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Paul McNamee
- Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Daniel McWilliams
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, United Kingdom
- NIHR Nottingham Biomedical Research Centre, Nottingham, United Kingdom
- Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | | | - Jain Holmes
- Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Aaron Fecowycz
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - David Andrew Walsh
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, United Kingdom
- NIHR Nottingham Biomedical Research Centre, Nottingham, United Kingdom
- Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Karen Walker-Bone
- School of Public Health and Preventive Medicine, Monash University, Australia, United Kingdom
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Gittins M, Carder M, Seed MJ, Iskandar I, Daniels SAM, van Tongeren M. Improving trends estimates for specific work-related ill-health conditions when excess zeros are present in a voluntary health reporting scheme. Occup Environ Med 2023; 80:280-286. [PMID: 37012047 DOI: 10.1136/oemed-2022-108627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 02/28/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Trends in occupational disease incidence are estimated in voluntary reporting schemes such as The Health and Occupational Reporting (THOR) Network in the UK. Voluntary reporting schemes request responses even if no cases are observed to reduce uncertainty in non-response. This may result in false zeros that bias trends estimates. Analysis using zero-inflated models is unsuitable for specific health outcomes due to overestimates of the excess zeros. Here, we attempt to account for excess zeros while investigating condition-specific trends. METHODS Zero-inflated negative binomial (ZINB) models were fitted to three THOR work-related ill health surveillance schemes Occupational Skin Disease Surveillance (437 reporters between 1996 and 2019), Occupational Physicians Reporting Activity (1094 between 1996 and 2019) and Surveillance of Work-Related and Occupational Respiratory Disease (878 between 1999 and 2019). The probability associated with a response being a false zero was estimated and applied in weighted negative binomial (wgt-NB) models fitted to specific ill-heath conditions. Three ill-health conditions from the three THOR schemes were considered; contact dermatitis, musculoskeletal and asthma, respectively. RESULTS Wgt-NB models approximately estimated the incidence rate ratios reported by the ZINB models (eg, EPIDERM; ZINB=0.969, NB=0.963, wgt-NB=0.968) for all health outcome annual trends. This was consistent for specific health outcomes which also tended towards the null (eg, contact dermatitis; NB=0.964, wgt-NB=0.969), indicating potentially overestimated downward trends. Though as the ratio of excess zeros to true zeros decreased in rarer health outcomes, the influence on trends also decreased. CONCLUSIONS Through weighting, we were able to adjust for excess zeros in health outcome-specific trends estimates. Though uncertainty is still present in underlying reporter behaviour meaning caution should be applied with interpretation of any results.
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Affiliation(s)
- Matthew Gittins
- Centre for Biostatistics, The University of Manchester Faculty of Biology Medicine and Health, Manchester, UK
| | - Melanie Carder
- Centre for Occupational and Environmental Health, The University of Manchester Faculty of Biology Medicine and Health, Manchester, Manchester, UK
| | - Martin J Seed
- Centre for Occupational and Environmental Health, The University of Manchester Faculty of Biology Medicine and Health, Manchester, Manchester, UK
| | - Ireny Iskandar
- Centre for Occupational and Environmental Health, The University of Manchester Faculty of Biology Medicine and Health, Manchester, Manchester, UK
| | - Sarah Ann Michelle Daniels
- Centre for Occupational and Environmental Health, The University of Manchester Faculty of Biology Medicine and Health, Manchester, Manchester, UK
| | - Martie van Tongeren
- Centre for Occupational and Environmental Health, The University of Manchester Faculty of Biology Medicine and Health, Manchester, Manchester, UK
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Barber CM, Cullinan P, Feary J, Fishwick D, Hoyle J, Mainman H, Walters GI. British Thoracic Society Clinical Statement on occupational asthma. Thorax 2022; 77:433-442. [DOI: 10.1136/thoraxjnl-2021-218597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hulls PM, Money A, Agius RM, de Vocht F. Work-related ill-health in radiographers. Occup Med (Lond) 2018; 68:354-359. [PMID: 29788277 DOI: 10.1093/occmed/kqy076] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background In the UK in 2015/16, 1.3 million workers self-reported a work-related illness (WRI) of which an estimated 41% were due to musculoskeletal disorders (incidence rate 550 cases per 100000 people) and 37% were related to stress, anxiety and depression. Little is known about the incidence of WRIs in radiographers. Aims To analyse the medically reported incidence of WRIs among radiographers in the UK between 1989 and 2015. Methods Incident cases reported by physicians to The Health and Occupation Research (THOR) network through its specialist schemes from 1989 to 2015 were analysed, using the Labour Force Survey as denominator where appropriate. Results In total, 218 cases (966 estimated cases) were reported. Of these 190 were in women. The mean age was 40.2 (20-91 years) SD ± 11.8 years. Most cases were reported to the Occupational Physicians Reporting Activity (OPRA) scheme (n = 92). A skin diagnosis was the most frequently reported (n = 77), followed by musculoskeletal (n = 60). Within the EPIDERM scheme, radiographers had the highest incidence rate when compared to all other occupations. Conclusions Radiographers had a higher incidence of WRI compared to all other occupations. The most frequently reported WRI was skin conditions. The observed increase in incidence is likely to be due to the increase in the number of radiographers over that time period, although there was no evidence that WRI within radiographers are declining.
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Affiliation(s)
- P M Hulls
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - A Money
- Centre for Occupational and Environmental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - R M Agius
- Centre for Occupational and Environmental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - F de Vocht
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Zhou AY, Carder M, Gittins M, Agius R. Work-related ill health in doctors working in Great Britain: incidence rates and trends. Br J Psychiatry 2017; 211:310-315. [PMID: 28935663 DOI: 10.1192/bjp.bp.117.202929] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 07/13/2017] [Accepted: 07/14/2017] [Indexed: 11/23/2022]
Abstract
BackgroundDoctors have a higher prevalence of mental ill health compared with other professional occupations but incidence rates are poorly studied.AimsTo determine incidence rates and trends of work-related ill health (WRIH) and work-related mental ill health (WRMIH) in doctors compared with other professions in Great Britain.MethodIncidence rates were calculated using an occupational physician reporting scheme from 2005-2010. Multilevel regression was use to study incidence rates from 2001 to 2014.ResultsAnnual incidence rates for WRIH and WRIMH in doctors were 515 and 431 per 100 000 people employed, respectively. Higher incidence rates for WRIH and WRMIH were observed for ambulance staff and nurses, respectively. Doctors demonstrated an annual average incidence rates increase for WRIH and WRMIH, especially in women, whereas the other occupations demonstrated a decreasing or static trend. The difference in trends between the occupations was statistically significant.ConclusionsWRIH and WRMIH incidence rate are increasing in doctors, especially in women, warranting further research.
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Affiliation(s)
- Anli Yue Zhou
- Anli Yue Zhou, MBChB, MA, MRCP, Melanie Carder, PhD, Centre for Occupational and Environmental Health, Centre for Epidemiology, Division of Population Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester; Matthew Gittins, PhD, Centre for Biostatistics, Centre for Epidemiology, Division of Population Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester; Raymond Agius, MD, DM, FRCP, FRCPE, FFOM, Centre for Occupational and Environmental Health, Centre for Epidemiology, Division of Population Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Melanie Carder
- Anli Yue Zhou, MBChB, MA, MRCP, Melanie Carder, PhD, Centre for Occupational and Environmental Health, Centre for Epidemiology, Division of Population Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester; Matthew Gittins, PhD, Centre for Biostatistics, Centre for Epidemiology, Division of Population Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester; Raymond Agius, MD, DM, FRCP, FRCPE, FFOM, Centre for Occupational and Environmental Health, Centre for Epidemiology, Division of Population Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Matthew Gittins
- Anli Yue Zhou, MBChB, MA, MRCP, Melanie Carder, PhD, Centre for Occupational and Environmental Health, Centre for Epidemiology, Division of Population Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester; Matthew Gittins, PhD, Centre for Biostatistics, Centre for Epidemiology, Division of Population Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester; Raymond Agius, MD, DM, FRCP, FRCPE, FFOM, Centre for Occupational and Environmental Health, Centre for Epidemiology, Division of Population Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Raymond Agius
- Anli Yue Zhou, MBChB, MA, MRCP, Melanie Carder, PhD, Centre for Occupational and Environmental Health, Centre for Epidemiology, Division of Population Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester; Matthew Gittins, PhD, Centre for Biostatistics, Centre for Epidemiology, Division of Population Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester; Raymond Agius, MD, DM, FRCP, FRCPE, FFOM, Centre for Occupational and Environmental Health, Centre for Epidemiology, Division of Population Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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Zhou AY, Carder M, Hussey L, Gittins M, Agius R. Differential reporting of work-related mental ill-health in doctors. Occup Med (Lond) 2017; 67:522-527. [PMID: 29016829 DOI: 10.1093/occmed/kqx109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Evidence suggests that the medical profession is reluctant to report mental ill-health despite its high prevalence. Aims To compare differential reporting patterns in the incidence of work-related mental ill-health (WRMIH) affecting doctors with selected comparison occupational groups, as determined by surveillance by general practitioners (GPs), specialist psychiatrists and occupational physicians (OPs). Methods New cases of medically reported WRMIH were reported prospectively between 2006 and 2009 by GPs, psychiatrists and OPs as part of The Health and Occupation Research (THOR) network. For GP and psychiatry reporting schemes, incidence rates (IRs) for doctors, nurses, teachers, corporate managers and protective service workers were calculated using information from the Labour Force Survey as the denominator. In OP surveys, participating reporters provided denominator information to calculate IRs for doctors, nurses and teachers. Results Average annual IRs expressed per 100000 person/years employed as reported by GPs, psychiatrists and OPs, respectively, were: doctors (309, 971, 430), nurses (891, 208, 670), teachers (1040, 136, 210) and for GPs and psychiatrists, respectively, were: protective service workers (1432, 721) and corporate managers (428, 90). Psychiatrists reported a higher incidence of WRMIH in doctors, whereas GPs reported higher incidences of WRMIH in other occupations (chi-squared test, P < 0.001). Conclusions The distribution of the incidence of new cases reported across different schemes suggests a differential reporting pattern of WRMIH in doctors. The higher IR for doctors in psychiatrist-reported WRMIH could be due to factors such as disease severity and bypassing formal referral channels.
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Affiliation(s)
- A Y Zhou
- Centre for Occupational and Environmental Health, Centre for Epidemiology, Division of Population Health, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK
| | - M Carder
- Centre for Occupational and Environmental Health, Centre for Epidemiology, Division of Population Health, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK
| | - L Hussey
- Centre for Occupational and Environmental Health, Centre for Epidemiology, Division of Population Health, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK
| | - M Gittins
- Centre for Biostatistics, Centre for Epidemiology, Division of Population Health, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK
| | - R Agius
- Centre for Occupational and Environmental Health, Centre for Epidemiology, Division of Population Health, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK
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The Health and Occupation Research Network: An Evolving Surveillance System. Saf Health Work 2017; 8:231-236. [PMID: 28951798 PMCID: PMC5605884 DOI: 10.1016/j.shaw.2016.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 12/06/2016] [Accepted: 12/12/2016] [Indexed: 11/23/2022] Open
Abstract
Vital to the prevention of work-related ill-health (WRIH) is the availability of good quality data regarding WRIH burden and risks. Physician-based surveillance systems such as The Health and Occupation Research (THOR) network in the UK are often established in response to limitations of statutory, compensation-based systems for addressing certain epidemiological aspects of disease surveillance. However, to fulfil their purpose, THOR and others need to have methodologic rigor in capturing and ascertaining cases. This article describes how data collected by THOR and analogous systems can inform WRIH incidence, trends, and other determinants. An overview of the different strands of THOR research is provided, including methodologic advancements facilitated by increased data quantity/quality over time and the value of the research outputs for informing Government and other policy makers. In doing so, the utility of data collected by systems such as THOR to address a wide range of research questions, both in relation to WRIH and to wider issues of public and social health, is demonstrated.
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Gittins M, McNamee R, Holland F, Carter LA. Accounting for reporting fatigue is required to accurately estimate incidence in voluntary reporting health schemes. J Clin Epidemiol 2017; 81:77-85. [DOI: 10.1016/j.jclinepi.2016.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 09/05/2016] [Accepted: 09/12/2016] [Indexed: 10/21/2022]
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Carder M, Bensefa-Colas L, Mattioli S, Noone P, Stikova E, Valenty M, Telle-Lamberton M. A review of occupational disease surveillance systems in Modernet countries. Occup Med (Lond) 2015; 65:615-25. [DOI: 10.1093/occmed/kqv081] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Money A, Carder M, Noone P, Bourke J, Hayes J, Turner S, Agius R. Work-related ill-health: Republic of Ireland, Northern Ireland, Great Britain 2005-2012. Occup Med (Lond) 2014; 65:15-21. [PMID: 25324486 DOI: 10.1093/occmed/kqu137] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Data on work-related ill-health (WRIH) in the Republic of Ireland is inconsistent. AIMS To compare the incidence of WRIH in the Republic of Ireland (ROI), Northern Ireland (NI) and Great Britain (GB) reported by clinical specialists in skin and respiratory medicine and by specialist occupational physicians (OPs). METHODS Analysis of data reported to three surveillance schemes in The Health and Occupation Research (THOR) network in ROI and corresponding UK schemes. RESULTS Contact dermatitis was the most frequently reported skin disease in the three areas. Asthma was the most frequently-reported respiratory disease in the ROI, while asbestos-related cases predominate in GB and NI. Mental health disorders, followed by musculoskeletal disorders were reported most frequently by OPs. Annual average incidence rates for skin disease were 2 per 100000 employed (95% confidence interval [CI] 1.9-2.8) in the ROI and 7 per 100000 for GB (95% CI 4.8-9.4). Unadjusted incidence rates for respiratory disease were 1 (95% CI 0.3-1) and 8 (95% CI 6.1-10.7) per 100000 in the ROI and GB, respectively; adjusted for reporter non-response, these figures increased to 15 (95% CI 11.3-19.6) and 32 (95% CI 28.4-35.6) per 100000 respectively. CONCLUSIONS This is the first paper to include THOR data on WRIH from the ROI, NI and GB. Consistent and dedicated data collection in the ROI via the THOR schemes is viable and important in the light of a deficit of occupational ill-health data. Sustained efforts to improve participation are underway.
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Affiliation(s)
- A Money
- Centre for Occupational and Environmental Health, Centre for Epidemiology, Institute of Population Health, University of Manchester, Manchester M13 9PL, UK,
| | - M Carder
- Centre for Occupational and Environmental Health, Centre for Epidemiology, Institute of Population Health, University of Manchester, Manchester M13 9PL, UK
| | - P Noone
- Health Service Executive, Dublin North East, Ireland
| | - J Bourke
- South Infirmary-Victoria Hospital, Cork, Ireland
| | - J Hayes
- Cavan Monaghan Hospital, Lisdaran, Cavan, Ireland
| | - S Turner
- Centre for Occupational and Environmental Health, Centre for Epidemiology, Institute of Population Health, University of Manchester, Manchester M13 9PL, UK
| | - R Agius
- Centre for Occupational and Environmental Health, Centre for Epidemiology, Institute of Population Health, University of Manchester, Manchester M13 9PL, UK
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