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Jacobson MA, Blanc PD, Tulsky J, Tilly M, Meister R, Huen W, McNicholas JE. Risk of subsequent SARS-CoV-2 infection among vaccinated employees with or without hybrid immunity acquired early in the Omicron-predominant era of the COVID-19 pandemic. Am J Ind Med 2024; 67:334-340. [PMID: 38316635 DOI: 10.1002/ajim.23570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 01/24/2024] [Accepted: 01/24/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Hybrid immunity, from COVID-19 vaccination followed by SARS-CoV-2 infection acquired after its Omicron variant began predominating, has provided greater protection than vaccination alone against subsequent infection over 1-3 months of observation. Its longer-term protection is unknown. METHODS We conducted a retrospective cohort study of COVID-19 case incidence among healthcare personnel (HCP) mandated to be vaccinated and report on COVID-19-associated symptoms, high-risk exposures, or known-positive test results to an employee health hotline. We compared cases with hybrid immunity, defined as incident COVID-19 during the first 6 weeks of Omicron-variant predominance (run-in period), to those with immunity from vaccination alone during the run-in period. Time until COVID-19 infection over 13 subsequent months (observation period) was analyzed by standard survival analysis. RESULTS Of 5867 employees, 641 (10.9%, 95% confidence interval [CI]: 10.1%-11.8%) acquired hybrid immunity during the run-in period. Of these, 104 (16.2%, 95% CI: 13.5%-19.3%) experienced new SARS-CoV-2 infection during the 13-month observation period, compared to 2177 (41.7%, 95% CI: 40.3%-43.0%) of the 5226 HCP without hybrid immunity. Time until incident infection was shorter among the latter (hazard ratio: 3.09, 95% CI: 2.54-3.78). CONCLUSIONS In a cohort of vaccinated employees, Omicron-era acquired SARS-CoV-2 hybrid immunity was associated with significantly lower risk of subsequent infection over more than a year of observation-a time period far longer than previously reported and during which three, progressively more resistant, Omicron subvariants became predominant. These findings can inform institutional policy and planning for future COVID-19 additional vaccine dosing requirements for employees, for surveillance programs, and for risk modification efforts.
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Affiliation(s)
- Mark A Jacobson
- Department of Medicine, Division of Occupational, Environmental, and Climate Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
- Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Paul D Blanc
- Department of Medicine, Division of Occupational, Environmental, and Climate Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Jacqueline Tulsky
- Department of Medicine, Division of Occupational, Environmental, and Climate Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
- Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Monica Tilly
- Department of Medicine, Division of Occupational, Environmental, and Climate Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Raymond Meister
- Department of Medicine, Division of Occupational, Environmental, and Climate Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Will Huen
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - James E McNicholas
- Department of Medicine, Division of Occupational, Environmental, and Climate Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
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Garshick E, Redlich CA, Korpak A, Timmons AK, Smith NL, Nakayama K, Baird CP, Ciminera P, Kheradmand F, Fan VS, Hart JE, Koutrakis P, Kuschner W, Ioachimescu O, Jerrett M, Montgrain PR, Proctor SP, Wan ES, Wendt CH, Wongtrakool C, Blanc PD. Chronic respiratory symptoms following deployment-related occupational and environmental exposures among US veterans. Occup Environ Med 2024; 81:59-65. [PMID: 37968126 PMCID: PMC10872566 DOI: 10.1136/oemed-2023-109146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/30/2023] [Indexed: 11/17/2023]
Abstract
OBJECTIVES Characterise inhalational exposures during deployment to Afghanistan and Southwest Asia and associations with postdeployment respiratory symptoms. METHODS Participants (n=1960) in this cross-sectional study of US Veterans (Veterans Affairs Cooperative Study 'Service and Health Among Deployed Veterans') completed an interviewer-administered questionnaire regarding 32 deployment exposures, grouped a priori into six categories: burn pit smoke; other combustion sources; engine exhaust; mechanical and desert dusts; toxicants; and military job-related vapours gas, dusts or fumes (VGDF). Responses were scored ordinally (0, 1, 2) according to exposure frequency. Factor analysis supported item reduction and category consolidation yielding 28 exposure items in 5 categories. Generalised linear models with a logit link tested associations with symptoms (by respiratory health questionnaire) adjusting for other covariates. OR were scaled per 20-point score increment (normalised maximum=100). RESULTS The cohort mean age was 40.7 years with a median deployment duration of 11.7 months. Heavy exposures to multiple inhalational exposures were commonly reported, including burn pit smoke (72.7%) and VGDF (72.0%). The prevalence of dyspnoea, chronic bronchitis and wheeze in the past 12 months was 7.3%, 8.2% and 15.6%, respectively. Burn pit smoke exposure was associated with dyspnoea (OR 1.22; 95% CI 1.06 to 1.47) and chronic bronchitis (OR 1.22; 95% CI 1.13 to 1.44). Exposure to VGDF was associated with dyspnoea (OR 1.29; 95% CI 1.14 to 1.58) and wheeze (OR 1.18; 95% CI 1.02 to 1.35). CONCLUSION Exposures to burn pit smoke and military occupational VGDF during deployment were associated with an increased odds of chronic respiratory symptoms among US Veterans.
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Affiliation(s)
- Eric Garshick
- Pulmonary, Allergy, Sleep, and Critical Care Medicine Section, Medical Service, VA Boston Healthcare System, West Roxbury, Massachusetts, USA
- Harvard Medical School, Brigham and Women's Hospital Channing Division of Network Medicine, Boston, Massachusetts, USA
| | - Carrie A Redlich
- Occupational and Environmental Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Anna Korpak
- Seattle Epidemiologic Research and Information Center, Department of Veteran Affairs Office of Research and Development, VA Puget Sound Health Care System Seattle Division, Seattle, Washington, USA
| | - Andrew K Timmons
- Seattle Epidemiologic Research and Information Center, Department of Veteran Affairs Office of Research and Development, VA Puget Sound Health Care System Seattle Division, Seattle, Washington, USA
| | - Nicholas L Smith
- Seattle Epidemiologic Research and Information Center, Department of Veteran Affairs Office of Research and Development, VA Puget Sound Health Care System Seattle Division, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Karen Nakayama
- Seattle Epidemiologic Research and Information Center, Department of Veteran Affairs Office of Research and Development, VA Puget Sound Health Care System Seattle Division, Seattle, Washington, USA
| | | | - Paul Ciminera
- Health Services Policy and Oversight, Office of the Assistant Secretary of Defense for Health Affairs, Washington, District of Columbia, USA
| | - Farrah Kheradmand
- Department of Medicine, Michael E DeBakey VA Medical Center, Houston, Texas, USA
- Baylor College of Medicine, Houston, Texas, USA
| | - Vincent S Fan
- VA Puget Sound HCS Seattle Division, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Jaime E Hart
- Harvard Medical School, Brigham and Women's Hospital Channing Division of Network Medicine, Boston, Massachusetts, USA
- Department of Environmental Health, Harvard T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Petros Koutrakis
- Department of Environmental Health, Harvard T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Ware Kuschner
- VA Palo Alto Health Care System, Palo Alto, California, USA
- Stanford University School of Medicine, Stanford, California, USA
| | - Octavian Ioachimescu
- Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin, USA
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Michael Jerrett
- University of California Los Angeles Jonathan and Karin Fielding School of Public Health, Los Angeles, California, USA
| | - Phillipe R Montgrain
- VA San Diego Healthcare System, San Diego, California, USA
- Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Susan P Proctor
- US Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
| | - Emily S Wan
- Pulmonary, Allergy, Sleep, and Critical Care Medicine Section, Medical Service, VA Boston Healthcare System, West Roxbury, Massachusetts, USA
- Harvard Medical School, Brigham and Women's Hospital Channing Division of Network Medicine, Boston, Massachusetts, USA
| | - Christine H Wendt
- Pulmonary, Allergy, Critical Care, and Sleep Medicine, Minneapolis VA Medical Center, Minneapolis, Minnesota, USA
- University of Minnesota, Minneapolis, Minnesota, USA
| | - Cherry Wongtrakool
- Atlanta VA Medical Center, Decatur, Georgia, USA
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Paul D Blanc
- San Francisco VA Health Care System, San Francisco, California, USA
- Division of Occupational, Environmental, and Climate Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA
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Seedahmed MI, Albirair MT, Whooley MA, Koth LL, Blanc PD, Arjomandi M. Response. Chest 2024; 165:e25-e26. [PMID: 38199743 PMCID: PMC10925540 DOI: 10.1016/j.chest.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 08/01/2023] [Indexed: 01/12/2024] Open
Affiliation(s)
- Mohamed I Seedahmed
- Medical Service, Pittsburgh Veterans Affairs Healthcare System, Pittsburgh, PA; Division of Pulmonary, Critical Care, Allergy and Immunology, and Sleep, University of Pittsburgh, Pittsburgh, PA; Medical Service, San Francisco Veterans Affairs Healthcare System, San Francisco, CA.
| | | | - Mary A Whooley
- Medical Service, San Francisco Veterans Affairs Healthcare System, San Francisco, CA; Measurement Science Quality Enhancement Research Initiative, San Francisco Veterans Affairs Healthcare System, San Francisco, CA; Departments of Medicine, University of California San Francisco, San Francisco, CA
| | - Laura L Koth
- Departments of Medicine, University of California San Francisco, San Francisco, CA
| | - Paul D Blanc
- Medical Service, San Francisco Veterans Affairs Healthcare System, San Francisco, CA; Departments of Medicine, University of California San Francisco, San Francisco, CA
| | - Mehrdad Arjomandi
- Medical Service, San Francisco Veterans Affairs Healthcare System, San Francisco, CA; Departments of Medicine, University of California San Francisco, San Francisco, CA
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Seedahmed MI, Albirair MT, Whooley MA, Koth LL, Blanc PD, Arjomandi M. Screening for Exposure to Beryllium Among US Veterans With a Diagnosis of Sarcoidosis, 2002-2020. Chest 2023; 164:1253-1256. [PMID: 37364853 PMCID: PMC10792292 DOI: 10.1016/j.chest.2023.05.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 05/31/2023] [Accepted: 05/31/2023] [Indexed: 06/28/2023] Open
Affiliation(s)
- Mohamed I Seedahmed
- Medical Service, San Francisco Veterans Affairs Healthcare System, San Francisco, CA; Department of Medicine, University of California San Francisco, San Francisco, CA.
| | | | - Mary A Whooley
- Medical Service, San Francisco Veterans Affairs Healthcare System, San Francisco, CA; Department of Medicine, University of California San Francisco, San Francisco, CA; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA; Measurement Science Quality Enhancement Research Initiative, San Francisco Veterans Affairs Healthcare System, San Francisco, CA
| | - Laura L Koth
- Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Paul D Blanc
- Medical Service, San Francisco Veterans Affairs Healthcare System, San Francisco, CA; Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Mehrdad Arjomandi
- Medical Service, San Francisco Veterans Affairs Healthcare System, San Francisco, CA; Department of Medicine, University of California San Francisco, San Francisco, CA
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Abstract
PURPOSE OF REVIEW Military personnel deployed to Southwest Asia and Afghanistan were potentially exposed to high levels of fine particulate matter and other pollutants from multiple sources, including dust storms, burn pit emissions from open-air waste burning, local ambient air pollution, and a range of military service-related activities that can generate airborne exposures. These exposures, individually or in combination, can have adverse respiratory health effects. We review exposures and potential health impacts, providing a framework for evaluation. RECENT FINDINGS Particulate matter exposures during deployment exceeded U.S. National Ambient Air Quality Standards. Epidemiologic studies and case series suggest that in postdeployment Veterans with respiratory symptoms, asthma is the most commonly diagnosed illness. Small airway abnormalities, most notably particularly constrictive bronchiolitis, have been reported in a small number of deployers, but many are left without an established diagnosis for their respiratory symptoms. The Promise to Address Comprehensive Toxics Act was enacted to provide care for conditions presumed to be related to deployment exposures. Rigorous study of long-term postdeployment health has been limited. SUMMARY Veterans postdeployment to Southwest Asia and Afghanistan with respiratory symptoms should undergo an exposure assessment and comprehensive medical evaluation. If required, more advanced diagnostic considerations should be utilized in a setting that can provide multidisciplinary expertise and long-term follow-up.
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Affiliation(s)
- Eric Garshick
- Pulmonary, Allergy, Sleep and Critical Care Medicine Section, Veterans Affairs Boston Healthcare System; Harvard Medical School and Brigham and Women’s, Boston, Massachusetts
| | - Paul D. Blanc
- San Francisco VA Medical Center, UC San Francisco School of Medicine, San Francisco; Division of Occupational and Environmental Medicine, Department of Medicine, University of California San Francisco, California, USA
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Falvo MJ, Sotolongo AM, Osterholzer JJ, Robertson MW, Kazerooni EA, Amorosa JK, Garshick E, Jones KD, Galvin JR, Kreiss K, Hines SE, Franks TJ, Miller RF, Rose CS, Arjomandi M, Krefft SD, Morris MJ, Polosukhin VV, Blanc PD, D'Armiento JM. Consensus Statements on Deployment-Related Respiratory Disease, Inclusive of Constrictive Bronchiolitis: A Modified Delphi Study. Chest 2023; 163:599-609. [PMID: 36343686 PMCID: PMC10154857 DOI: 10.1016/j.chest.2022.10.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/10/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The diagnosis of constrictive bronchiolitis (CB) in previously deployed individuals, and evaluation of respiratory symptoms more broadly, presents considerable challenges, including using consistent histopathologic criteria and clinical assessments. RESEARCH QUESTION What are the recommended diagnostic workup and associated terminology of respiratory symptoms in previously deployed individuals? STUDY DESIGN AND METHODS Nineteen experts participated in a three-round modified Delphi study, ranking their level of agreement for each statement with an a priori definition of consensus. Additionally, rank-order voting on the recommended diagnostic approach and terminology was performed. RESULTS Twenty-five of 28 statements reached consensus, including the definition of CB as a histologic pattern of lung injury that occurs in some previously deployed individuals while recognizing the importance of considering alternative diagnoses. Consensus statements also identified a diagnostic approach for the previously deployed individual with respiratory symptoms, distinguishing assessments best performed at a local or specialty referral center. Also, deployment-related respiratory disease (DRRD) was proposed as a broad term to subsume a wide range of potential syndromes and conditions identified through noninvasive evaluation or when surgical lung biopsy reveals evidence of multicompartmental lung injury that may include CB. INTERPRETATION Using a modified Delphi technique, consensus statements provide a clinical approach to possible CB in previously deployed individuals. Use of DRRD provides a broad descriptor encompassing a range of postdeployment respiratory findings. Additional follow-up of individuals with DRRD is needed to assess disease progression and to define other features of its natural history, which could inform physicians better and lead to evolution in this nosology.
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Affiliation(s)
- Michael J Falvo
- Airborne Hazards and Burn Pits Center of Excellence, Department of Veterans Affairs New Jersey Health Care System, East Orange, NJ; New Jersey Medical School, Rutgers-The State University of New Jersey, Newark, NJ.
| | - Anays M Sotolongo
- Airborne Hazards and Burn Pits Center of Excellence, Department of Veterans Affairs New Jersey Health Care System, East Orange, NJ; New Jersey Medical School, Rutgers-The State University of New Jersey, Newark, NJ
| | - John J Osterholzer
- Pulmonary Section, Department of Medicine, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI; Division of Pulmonary and Critical Care, Department of Medicine, University of Michigan, Ann Arbor, MI
| | - Michelle W Robertson
- Airborne Hazards and Burn Pits Center of Excellence, Department of Veterans Affairs New Jersey Health Care System, East Orange, NJ
| | - Ella A Kazerooni
- Department of Radiology, University of Michigan, Ann Arbor, MI; Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Judith K Amorosa
- Department of Radiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; University Radiology Group, East Brunswick, NJ
| | - Eric Garshick
- Pulmonary, Allergy, Sleep, and Critical Care Medicine Section, Veterans Affairs Boston Healthcare System, Boston, MA; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA
| | - Kirk D Jones
- Department of Anatomic Pathology, University of California, San Francisco, CA
| | - Jeffrey R Galvin
- Department of Radiology and Nuclear Medicine (Chest Imaging), University of Maryland School of Medicine, Baltimore, MD
| | - Kathleen Kreiss
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, WV
| | - Stella E Hines
- Divisions of Occupational and Environmental Medicine and Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD; VA Maryland Health Care System, Baltimore Veterans Affairs Medical Center, Baltimore, MD
| | - Teri J Franks
- Department of Pulmonary and Mediastinal Pathology, Joint Pathology Center, Department of Defense, Silver Spring, MD
| | - Robert F Miller
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Cecile S Rose
- Division of Environmental and Occupational Health Sciences, National Jewish Health, Denver, CO; Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Denver, CO
| | - Mehrdad Arjomandi
- Department of Anatomic Pathology, University of California, San Francisco, CA; Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, CA
| | - Silpa D Krefft
- Division of Environmental and Occupational Health Sciences, National Jewish Health, Denver, CO; Division of Pulmonary and Critical Care Medicine, Veterans Administration Eastern Colorado Health Care System, Aurora, CO; Division of Pulmonary and Critical Care Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Michael J Morris
- Pulmonary/Critical Care Service, Department of Medicine, Brooke Army Medical Center, JBSA-Sam Houston, Fort Sam Houston, TX
| | | | - Paul D Blanc
- Department of Anatomic Pathology, University of California, San Francisco, CA; Division of Occupational and Environmental Medicine, University of California, San Francisco, CA; Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Jeanine M D'Armiento
- Center for LAM and Rare Lung Disease, Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, NY
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Ronsmans S, Blanc PD. Colinet-Caplan Syndrome: History of an Outbreak of Autoimmune Disease in Scouring Powder Workers. Ann Intern Med 2023; 176:260-265. [PMID: 36623284 DOI: 10.7326/m22-2630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The first modern description linking rheumatoid arthritis to occupational dust exposure is generally attributed to the British physician Anthony Caplan. In 1953, Caplan reported on a "peculiar" nodular pattern on chest radiographs of Welsh coal miners with rheumatoid arthritis that differed from the typical coal workers' pneumoconiosis. However, as early as 1950, the Belgian rheumatologist Émile Colinet described a similar case of rheumatoid arthritis and concomitant pulmonary opacities in a 30-year-old woman with silica exposure. Soon after, he published a second case. Although this condition initially was called Colinet-Caplan syndrome in the Francophone biomedical literature, Colinet's name was later dropped from the eponym. Because Colinet never clearly described the specific occupational context of his cases, Caplan syndrome has been misconstrued as uniquely a disease of coal miners. We attempted to reconstruct the working conditions of Colinet's patients and found that they were packing Vim, a silica-based scouring powder, at the Savonneries Lever Frères factory in Brussels, Belgium. Colinet's cases were only the first 2 in a series of reports of rheumatoid arthritis and other autoimmune diseases, mainly among young women, in those who worked in the production of silica-based scouring powder between the 1930s and 1980s across Europe. The largest outbreak involved 32 cases of autoimmune disease among 50 former workers of a Spanish scouring powder manufacturing facility. After silica in scouring powders was replaced with less hazardous materials later in the 20th century, no further cases have been reported. Although scouring powder disease is a historical phenomenon, autoimmune disorders linked to occupational exposure to silica and coal dust have not disappeared but instead are reemerging among those who work with silica-based artificial stone and in other dusty trades.
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Affiliation(s)
- Steven Ronsmans
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium (S.R.)
| | - Paul D Blanc
- Division of Occupational and Environmental Medicine, University of California, San Francisco, San Francisco, California (P.D.B.)
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Jacobson MA, Hart C, Huen W, Suarez Guardado G, Villanueva A, Whitman J, Blanc PD. A Rapid Nucleic Acid Amplification Test-Based, Conditional Release-to-Work Policy for Health Care Personnel With Symptoms Consistent With COVID-19. J Occup Environ Med 2023; 65:125-127. [PMID: 36240750 PMCID: PMC9897112 DOI: 10.1097/jom.0000000000002733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Most health care personnel (HCP) reporting symptoms consistent with COVID-19 illness are assessed by high-accuracy SARS-CoV-2 assays performed in clinical laboratories, but the results of such assays typically are not available until the following day. METHODS This is an observational study over 16 weeks of a rapid nucleic acid amplification test (NAAT) performed at point of contact. The benchmark for comparison was a simultaneously obtained specimen assayed by a routine NAAT assay performed in a clinical laboratory. RESULTS There were 577 paired rapid and routine NAAT results. Rapid test positive predictive value was 90.0% (95% confidence interval = 88.8%-91.2%), and negative predictive value was 95.2% (95% confidence interval = 93.5%-96.9%). The rapid test avoided an estimated 160 to 184 lost work shifts over 4 months. CONCLUSIONS A rapid NAAT test-based strategy proved effective in safely clearing symptomatic employees without infection for earlier return to work.
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Trupin L, Schmajuk G, Ying D, Yelin E, Blanc PD. Response. Chest 2022; 162:e288. [PMID: 36344146 DOI: 10.1016/j.chest.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 07/05/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Laura Trupin
- Departments of Medicine at the University of California San Francisco, San Francisco, CA
| | - Gabriela Schmajuk
- Departments of Medicine at the University of California San Francisco, San Francisco, CA; Departments of Medicine San Francisco Veterans Administration Health Care System, San Francisco, CA
| | - David Ying
- Departments of Medicine James A. Haley Veterans' Hospital, Tampa, FL
| | - Edward Yelin
- Departments of Medicine at the University of California San Francisco, San Francisco, CA
| | - Paul D Blanc
- Departments of Medicine at the University of California San Francisco, San Francisco, CA; Departments of Medicine San Francisco Veterans Administration Health Care System, San Francisco, CA.
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Blanc PD, Trupin L, Yelin EH, Schmajuk G. Assessment of Risk of Rheumatoid Arthritis Among Underground Hard Rock and Other Mining Industry Workers in Colorado, New Mexico, and Utah. JAMA Netw Open 2022; 5:e2236738. [PMID: 36251293 PMCID: PMC9577677 DOI: 10.1001/jamanetworkopen.2022.36738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
IMPORTANCE Respirable silica exposure has been strongly and consistently linked to rheumatoid arthritis (RA) among foundry workers, persons in the construction trades, stone crushers and drillers, and coal miners. However, risk of RA in hard rock mining has not been thoroughly investigated. OBJECTIVE To analyze occupational risk of RA in hard rock miners in Colorado, New Mexico, and Utah. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional survey study estimated the association between mining industry work and reported RA in a random-digit telephone survey of men 50 years or older living in selected counties with elevated levels of pneumoconiosis mortality (N = 1988). The survey was conducted between January 12 and May 4, 2021. EXPOSURES Underground hard rock and other mining and related mineral-processing occupations. MAIN OUTCOMES AND MEASURES Report of a clinician diagnosis of RA further defined by treatment with corticosteroids or disease-modifying antirheumatic drugs. Risk was estimated using logistic regression. RESULTS The analytic sample of 1988 men (survey response rate, 11.1% of all contacts) had a mean (SD) age of 68.6 (10.1) years. Underground hard rock mining was reported by 118 (5.9%); underground mining of other types, predominantly coal mining (no concomitant hard rock), 62 (3.1%); and surface mining or ore processing (no underground), 262 (13.2%). Adjusting for age and smoking and accounting for nonmining silica exposure, mining employment was associated with increased odds of corticosteroid-treated RA (n = 89) (odds ratio, 4.12 [95%, 2.49-6.81]). The odds were similar for RA treated with disease-modifying antirheumatic drugs (n = 80) (odds ratio, 3.30 [95% CI, 1.93-5.66]). CONCLUSIONS AND RELEVANCE In this cross-sectional survey study, workers in hard rock and other underground mining and surface mining occupations experienced 3- to 4-fold increased odds of RA. These findings suggest that clinicians should consider patients with relevant work exposures as at higher risk for developing RA.
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Affiliation(s)
- Paul D. Blanc
- Department of Medicine, University of California, San Francisco
- Department of Medicine, San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - Laura Trupin
- Department of Medicine, University of California, San Francisco
| | - Edward H. Yelin
- Department of Medicine, University of California, San Francisco
| | - Gabriela Schmajuk
- Department of Medicine, University of California, San Francisco
- Department of Medicine, San Francisco Veterans Affairs Health Care System, San Francisco, California
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11
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Trupin L, Schmajuk G, Ying D, Yelin E, Blanc PD. Military Service and COPD Risk. Chest 2022; 162:792-795. [PMID: 35469853 DOI: 10.1016/j.chest.2022.04.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 02/03/2023] Open
Affiliation(s)
- Laura Trupin
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, CA
| | - Gabriela Schmajuk
- San Francisco Veterans Affairs Health Care System, San Francisco, CA
| | | | - Edward Yelin
- Division of Rheumatology, Department of Medicine, Russell/Engleman Rheumatology Research Center, and Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA
| | - Paul D Blanc
- San Francisco Veterans Affairs Health Care System, San Francisco, CA; Division of Occupational and Environmental Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA.
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12
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Kaul B, Lee JS, Glidden DV, Blanc PD, Zhang N, Collard HR, Whooley MA. Agent Orange Exposure and Risk of Idiopathic Pulmonary Fibrosis among U.S. Veterans. Am J Respir Crit Care Med 2022; 206:750-757. [PMID: 35559726 PMCID: PMC9799114 DOI: 10.1164/rccm.202112-2724oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 05/13/2022] [Indexed: 01/02/2023] Open
Abstract
Rationale: There is limited literature exploring the relationship between military exposures and idiopathic pulmonary fibrosis (IPF). Objectives: To evaluate whether exposure to Agent Orange is associated with an increased risk of IPF among veterans. Methods: We used Veterans Health Administration data to identify patients diagnosed with IPF between 2010 and 2019. We restricted the cohort to male Vietnam veterans and performed multivariate logistic regression to examine the association between presumptive Agent Orange exposure and IPF. We conducted sensitivity analyses restricting the cohort to army veterans (highest theoretical burden of exposure, surrogate for dose response) and a more specific case definition of IPF. Fine-Gray competing risk models were used to evaluate age to IPF diagnosis. Measurements and Main Results: Among 3.6 million male Vietnam veterans, 948,103 (26%) had presumptive Agent Orange exposure. IPF occurred in 2.2% of veterans with Agent Orange exposure versus 1.9% without exposure (odds ratio, 1.14; 95% confidence interval [CI], 1.12-1.16; P < 0.001). The relationship persisted after adjusting for known IPF risk factors (odds ratio, 1.08; 95% CI, 1.06-1.10; P < 0.001). The attributable risk among exposed veterans was 7% (95% CI, 5.3-8.7%; P < 0.001). Numerically greater risk was observed when restricting the cohort to 1) Vietnam veterans who served in the army and 2) a more specific definition of IPF. After accounting for the competing risk of death, veterans with Agent Orange exposure were still more likely to develop IPF. Conclusions: Presumptive Agent Orange exposure is associated with greater risk of IPF. Future research should validate this association and investigate the biological mechanisms involved.
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Affiliation(s)
- Bhavika Kaul
- Department of Medicine and
- Measurement Science Quality Enhancement Research Initiative, San Francisco Veterans Affairs Healthcare System, San Francisco, California; and
| | - Joyce S. Lee
- Department of Medicine, University of Colorado, Aurora, Colorado
| | - David V. Glidden
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | | | - Ning Zhang
- Measurement Science Quality Enhancement Research Initiative, San Francisco Veterans Affairs Healthcare System, San Francisco, California; and
| | | | - Mary A. Whooley
- Department of Medicine and
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
- Measurement Science Quality Enhancement Research Initiative, San Francisco Veterans Affairs Healthcare System, San Francisco, California; and
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13
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Kolaitis NA, Gao Y, Soong A, Greenland JR, Hays SR, Golden JA, Venado A, Leard LE, Shah RJ, Kleinhenz ME, Katz PP, Kukreja J, Blanc PD, Smith PJ, Singer JP. Depressive symptoms in lung transplant recipients: trajectory and association with mortality and allograft dysfunction. Thorax 2022; 77:891-899. [PMID: 35354643 DOI: 10.1136/thoraxjnl-2021-217612] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 03/08/2022] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Most studies observing an association between depressive symptoms following lung transplantation and mortality are limited to depressive symptom measurement at a single time point, unrelated to allograft function. We aimed to test the association of depressive symptoms over multiple assessments with allograft dysfunction and with mortality. METHODS We assessed depressive symptoms before and serially up to 3 years after lung transplantation in lung transplant recipients. We quantified depressive symptoms with the Geriatric Depression Scale (GDS; range 0-15; minimally important difference (MID): 2). We quantified changes in GDS using linear mixed effects models and tested the association with mortality using Cox proportional hazards models with GDS as a time-dependent predictor. To determine if worsening in GDS preceded declines in lung function, we tested the association of GDS as a time-dependent predictor with the lagged outcome of FEV1 at the following study visit. RESULTS Among 266 participants, depressive symptoms improved early after transplantation. Worsening in post-transplant GDS by the MID was associated with mortality (HR 1.25, 95% CI 1.05 to 1.50), and in lagged outcome analyses with decreased per cent predicted FEV1 (Δ, -1.62%, 95% CI -2.49 to -0.76). Visual analyses of temporal changes in GDS demonstrated that worsening depressive symptoms could precede chronic lung allograft dysfunction. CONCLUSIONS Depressive symptoms generally improve after lung transplantation. When they worsen, however, there is an association with declines in lung function and mortality. Depression is one of the few, potentially modifiable, risk factors for chronic lung allograft dysfunction and death.
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Affiliation(s)
- Nicholas A Kolaitis
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Ying Gao
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Allison Soong
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - John R Greenland
- Department of Medicine, University of California San Francisco, San Francisco, California, USA.,Medicine, San Francisco VA Medical Center, San Francisco, California, USA
| | - Steven R Hays
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Jeffrey A Golden
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Aida Venado
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Lorriana E Leard
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Rupal J Shah
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Mary Ellen Kleinhenz
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Patricia P Katz
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Jasleen Kukreja
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Paul D Blanc
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Patrick J Smith
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Jonathan Paul Singer
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
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14
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Gandhi SA, Welch T, Jones KD, Cummings KJ, Styles L, Blanc PD, Harrison RJ. Rare case of occupational pulmonary hemorrhage in a firefighter. Respir Med Case Rep 2022; 39:101722. [PMID: 35993005 PMCID: PMC9389297 DOI: 10.1016/j.rmcr.2022.101722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 07/25/2022] [Indexed: 11/30/2022] Open
Abstract
Alveolar hemorrhage associated with physical exertion, known as exercise-induced pulmonary hemorrhage (EIPH), is a rare condition linked to strenuous exertion. This can be an unusual form of respiratory and occupational illness. We present the case of a healthy firefighter who developed fatal pulmonary hemorrhage after participating in a strenuous physical training exercise regimen. This case represents a severe presentation of EIPH, which results from the disruption of the pulmonary blood-gas barrier as a result of strenuous exertion. Clinicians caring for those in vocations and recreation involving extremely vigorous exercise should be aware that such activities can cause EIPH.
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Affiliation(s)
- Sheiphali A. Gandhi
- Department of Medicine, Division of Occupational and Environmental Medicine, University of California San Francisco, San Francisco, CA, USA
| | - T.J. Welch
- Public Health Institute, Oakland, CA, USA
| | - Kirk D. Jones
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA
| | - Kristin J. Cummings
- Occupational Health Branch, California Department of Public Health, Richmond, CA, USA
| | - Laura Styles
- Public Health Institute, Oakland, CA, USA
- Occupational Health Branch, California Department of Public Health, Richmond, CA, USA
| | - Paul D. Blanc
- Department of Medicine, Division of Occupational and Environmental Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Robert J. Harrison
- Department of Medicine, Division of Occupational and Environmental Medicine, University of California San Francisco, San Francisco, CA, USA
- Occupational Health Branch, California Department of Public Health, Richmond, CA, USA
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15
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Blanc PD, Balmes JR, Redlich C. Occupational Exposures in Nontuberculous Mycobacterial Pulmonary Disease. Chest 2022; 162:e106-e107. [PMID: 35940661 DOI: 10.1016/j.chest.2022.03.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 11/21/2022] Open
Affiliation(s)
- Paul D Blanc
- Division of Occupational and Environmental Medicine, Department of Medicine, School of Medicine, University of California San Francisco, San Francisco, CA.
| | - John R Balmes
- Division of Occupational and Environmental Medicine, Department of Medicine, School of Medicine, University of California San Francisco, San Francisco, CA
| | - Carrie Redlich
- Divisions of Occupational and Environmental Medicine (GIM) and Pulmonary Medicine, Department of Medicine, School of Medicine, Yale University, New Haven, CT
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16
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Blanc PD. Review of: Art and Occupation, A Collection of Articles Exploring Images of Work. Occupational Medicine 2008-2018. Mike McKiernan [Matador, Leicestershire UK, 2022, 239 pages]. J Occup Environ Med 2022; 64:e521. [PMID: 37812669 DOI: 10.1097/jom.0000000000002594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Paul D Blanc
- Division of Occupational and Environmental Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA
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17
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Torén K, Naidoo RN, Blanc PD. Pneumococcal pneumonia on the job: Uncovering the past story of occupational exposure to metal fumes and dust. Am J Ind Med 2022; 65:517-524. [PMID: 35352358 PMCID: PMC9311681 DOI: 10.1002/ajim.23352] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 03/18/2022] [Accepted: 03/18/2022] [Indexed: 11/09/2022]
Abstract
The objectives of this study are to elucidate the early history of risk for pneumococcal pneumonia from occupational exposure to metal fumes and dusts, and to demonstrate the importance of searching older literature when performing reviews. We performed manual searching for articles in the Library of the Surgeon General's Office (the precursor to Index Medicus), in the Hathi Trust database, in PubMed, andby screening reference lists in literature appearing before the introduction of PubMed. An early body of literature, from the 1890s onward, recognized that pneumonia was linked to "Thomas slag," a steel industry byproduct containing iron, manganese, and lime. Researchers, mainly in Germany, showed that workers in metal-dust-exposed occupations, especially using manganese, manifested an increased incidence of pneumococcal pneumonia. An outbreak of pneumococcal pneumonia in the 1930s implicated manganese fume in its etiology. In the immediate post-World War II period, there was a brief flurry of interest in pneumonia from exposure to potassium permanganate that was soon dismissed as a chemical pneumonitis. After a hiatus of two decades, epidemiologic investigations drew attention to the pneumonia risks of welding and related metal fume exposure, bringing renewed interest to the forgotten role of pneumococcal pneumonia as an occupational disease. Occupational or environmental inhalation of manganese, iron, or irritants may be causally related to increased pneumococcal pneumonia risk. In particular, the risk associated with manganese seems to be overlooked in recent literature. An important conclusion is the importance of obtaining additional evidence through a deeper assessment of the literature in a broad historical context.
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Affiliation(s)
- Kjell Torén
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden,Department of Occupational and Environmental MedicineSahlgrenska University HospitalGothenburgSweden,Discipline of Occupational and Environmental HealthUniversity of KwaZulu‐NatalDurbanSouth Africa
| | - Rajen N. Naidoo
- Discipline of Occupational and Environmental HealthUniversity of KwaZulu‐NatalDurbanSouth Africa
| | - Paul D. Blanc
- Department of Medicine, Division of Occupational and Environmental MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
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18
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Kiok M, Guntur S, Blanc PD, Lozato O, Domingo G, Kosnik R, Ugbaja CE, Chan N, Ramos A, Domeracki S. Increased Bloodborne Pathogen Exposure Hotline Utilization During the COVID-19 Pandemic: An Unexpected Phenomenon. Workplace Health Saf 2022; 70:278-284. [PMID: 35575040 DOI: 10.1177/21650799211073526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Mitigating bloodborne pathogen exposure (BBPE) risk among healthcare workers is a major focus of hospital-based occupational health programs. The COVID-19 pandemic has placed added demands on occupational health services for healthcare workers. Its impact on BBPE incidence is unreported. Methods: As part of quality improvement efforts, we examined BBPE case incidence at two affiliated health centers during a 24-month period, 12 months preceding and following the COVID-19 pandemic onset. We used Year 1 to Year 2 change in incidence at the larger health center as the referent value to generate predicted incidence rates at the study health center. We tested the ratio of observed to predicted values at the study health center as a Poisson variable to its expectation. We defined a BBPE consistent with the Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens Standard. Results: The BBPE case incidence at Health Center One (HC1), totaled 46 cases in Year 1, increasing 19% to 55 cases in Year 2. The cumulative incidence at Health Center Two (HC2), the referent facility, was 664 cases in Year 1, declining 24% to 503 in Year 2. The ratio of 55 events at HC1 to the expected incidence of 35, based on the experience at HC2, was 1.6 (p < .05). Discussion/Applications to Practice: The incidence of BBPE events at HC1 paradoxically increased during the COVID-19 pandemic, contrasting to the expected decrease that we observed at HC2. These data suggest that during times of increased stress to employee healthcare delivery from an infectious disease outbreak, the burden of ongoing practice demands may increase.
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Affiliation(s)
- Matthew Kiok
- San Francisco Veterans Affairs HealthCare System.,University of California San Francisco
| | - Sandeep Guntur
- San Francisco Veterans Affairs HealthCare System.,University of California San Francisco
| | - Paul D Blanc
- San Francisco Veterans Affairs HealthCare System.,University of California San Francisco
| | | | | | | | | | - Noreen Chan
- San Francisco Veterans Affairs HealthCare System
| | - Alan Ramos
- San Francisco Veterans Affairs HealthCare System
| | - Sandra Domeracki
- San Francisco Veterans Affairs HealthCare System.,University of California San Francisco
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19
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Blanc PD. Becoming disenthralled with our conventional understanding of occupational lung disease. Respirology 2022; 27:383-384. [DOI: 10.1111/resp.14273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 04/20/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Paul D. Blanc
- Division of Occupational and Environmental Medicine, Department of Medicine University of California San Francisco San Francisco California USA
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20
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Lopez A, Kosnik R, Blanc PD, Taylor BR, Guntur S. Testing for SARS-CoV-2 in Symptomatic Vaccinated and Unvaccinated Health Care Workers During the Delta Variant Surge. J Occup Environ Med 2022; 64:179-181. [PMID: 34775397 PMCID: PMC8808761 DOI: 10.1097/jom.0000000000002431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Infection with SARS- CoV- 2 in health care workers (HCWs) challenges employee health services. METHODS We analyzed telephone Coronavirus Disease 2019 (COVID-19) hotline data over 8 weeks in 2021 during SARS- CoV- 2 Delta variant surge. We calculated COVID-19 case rates among persons-under-investigation (PUIs) for illness at two health care centers (HCs). RESULTS There were 41 COVID-19 cases among the 285 PUIs (14.4%) at the study HC and 549 (16.9%) of 3244 at the comparison HC. At the study HC, 11.7% of vaccinated PUIs versus 36.6% of unvaccinated PUIs were COVID-19 positive. The COVID-19 positivity rates among vaccinated and unvaccinated PUIs at the comparison HC were 16.1% and 33.3%, respectively. DISCUSSION In the SARS-CoV-2 Delta variant surge, COVID-19 test positivity rates among unvaccinated symptomatic HCWs are dramatically elevated. Aggressive testing of HCW PUIs is particularly critical during periods of disease upsurge.
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Affiliation(s)
- Anthony Lopez
- Division of Occupational and Environmental Medicine, Department of Medicine, San Francisco Veterans Affairs Health Care System (Mr Lopez, Dr Blanc, Dr Guntur); Division of Occupational Medicine, Department of Medicine, University of California San Francisco (Dr Kosnik, Dr Blanc, Dr Guntur); and Office of Population Health, University of California San Francisco Medical Center (Dr Taylor), University of California San Francisco, San Francisco, California
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21
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Schmajuk G, Trupin L, Yelin EH, Blanc PD. Dusty trades and associated rheumatoid arthritis in a population-based study in the coal mining counties of Appalachia. Occup Environ Med 2022; 79:308-314. [PMID: 34987082 DOI: 10.1136/oemed-2021-107899] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 12/01/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We previously showed increased coal mining-associated risk of rheumatoid arthritis (RA). Using additional survey data, we sought to delineate this risk further. METHODS We used data from two cross-sectional, random-digit-dial, population-based surveys (males;≥50 years) in selected counties in the Appalachian region of the inland, mid-Atlantic USA with elevated pneumoconiosis mortality. Surveys ascertained age, smoking, coal mining and non-coal silica exposure jobs. In a subset, we surveyed ergonomic exposures, scored by intensity. We queried diagnosis of RA, corticosteroid use, and, in a subset, use of disease modifying antirheumatic drugs (DMARDs). Multivariable logistic regression modelled RA risk (defined by glucocorticoid or DMARDs use) associated with coal mining employment, other silica exposure, smoking status, and age and ergonomic exposures. RESULTS We analysed data for 2981 survey respondents (mean age 66.6 years; 15% current, 44% ex-smokers). The prevalence of glucocorticoid-treated and DMARD-treated RA was 11% and 4%, respectively. Glucocorticoid-treated RA was associated with coal mining (OR 3.5; 95% CI 2.5 to 4.9) and non-coal mining silica exposure (OR 3.2; 95% CI 2.4 to 4.4). For DMARD-treated RA, the odds associated with coal mining and other silica remained elevated: OR 2.3 (95% CI 1.18, 4.5) and OR 2.7 (95% CI 1.51, 5.0), respectively. In the same model, the highest intensity ergonomic exposure also was associated with increased odds of RA (OR 4.3; 95% CI 1.96 to 9.6). CONCLUSIONS We observed a strong association between coal mining and other silica-exposing dusty trades and RA. Clinicians and insurers should consider occupational histories in the aetiology of RA.
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Affiliation(s)
- Gabriela Schmajuk
- Medicine, Veterans Health Administration, San Francisco, California, USA.,Medicine, University of California San Francisco, San Francisco, California, USA
| | - Laura Trupin
- Medicine, University of California San Francisco, San Francisco, California, USA
| | - Edward H Yelin
- Medicine, University of California San Francisco, San Francisco, California, USA
| | - Paul D Blanc
- Medicine, Veterans Health Administration, San Francisco, California, USA .,Medicine, University of California San Francisco, San Francisco, California, USA
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22
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Torén K, Blanc PD, Naidoo R, Murgia N, Stockfelt L, Schiöler L. Cumulative occupational exposure to inorganic dust and fumes and invasive pneumococcal disease with pneumonia. Int Arch Occup Environ Health 2022; 95:1797-1804. [PMID: 35262802 PMCID: PMC9489545 DOI: 10.1007/s00420-022-01848-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/24/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE Occupational exposure to inorganic dust and fumes in the year preceding disease has been associated with increased pneumococcal pneumonia risk, but the impact of prior cumulative exposure has not been characterized. METHODS We studied 3184 cases of invasive pneumococcal disease with pneumonia. The case index date was the day the infection was diagnosed. We selected six controls for each case from the Swedish population registry; each control was assigned the index date of their corresponding case. We linked job histories to a job-exposure matrix to calculate a cumulative exposure index, intensity-years, by multiplying the duration (maximum 5 years) of each exposure with the level of exposure (0 for unexposed, 1 for low and 4 for high). We used conditional logistic analyses to estimate the odds ratio (OR) of invasive pneumococcal disease with pneumonia adjusted for comorbidities, educational level, income and other occupational exposures. RESULTS Taking other occupational exposures into account, greater than 5 intensity-years of exposure to silica dust or to fumes was each associated with increased odds for invasive pneumococcal disease with pneumonia (OR 2.53, 95% CI 1.49-4.32) and (OR 2.24, 95% CI 1.41-3.55), respectively. Five intensity-years or less of exposure to silica dust or fumes manifested lower odds (OR 1.45, 95% CI 1.20-1.76) and (OR 1.05, 95% CI 0.94-1.16), respectively. CONCLUSION This study adds evidence that the risk of pneumococcal pneumonia increases with increasing cumulative exposure to dust and fumes, indicating the importance of cumulative exposure.
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Affiliation(s)
- Kjell Torén
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 414, 405 30, Gothenburg, Sweden. .,Discipline of Occupational and Environmental Health, University of KwaZulu-Natal, Durban, South Africa.
| | - Paul D. Blanc
- Division of Occupational and Environmental Medicine, Department of Medicine, University of California, San Francisco, CA USA
| | - Rajen Naidoo
- Discipline of Occupational and Environmental Health, University of KwaZulu-Natal, Durban, South Africa
| | - Nicola Murgia
- Section of Occupational Medicine, Respiratory Diseases and Toxicology, University of Perugia, Perugia, Italy
| | - Leo Stockfelt
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 414, 405 30 Gothenburg, Sweden ,Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Linus Schiöler
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 414, 405 30 Gothenburg, Sweden
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23
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Blanc PD. The past as prologue: How the history of occupational illness and injury teaches us about today. Saf Health Work 2022. [DOI: 10.1016/j.shaw.2021.12.705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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24
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Vinnikov D, Blanc PD, Raushanova A, Beisbekova A, Abraham JL, Zlobina Y. Exposure to respirable dust among workers fabricating aluminium trihydroxide-containing synthetic countertops. Sci Rep 2021; 11:21219. [PMID: 34707188 PMCID: PMC8551245 DOI: 10.1038/s41598-021-00814-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/11/2021] [Indexed: 11/23/2022] Open
Abstract
The aim of this study is to characterize personal exposure of workers to respirable particulate matter (PM) generated in cutting and other fabrication activities when fabricating acryl polymer/aluminium trihydroxide synthetic countertops. We collected 29 personal full-day samples of respirable PM from three workers in a small private workshop. We tested differences between- and within-worker variances of mass concentrations using the Kruskall-Wallis test. We used segmented regression to test the means and medians 15-min interval concentrations changes over time and to identify a breakpoint. Respirable PM concentrations ranged nearly 100-fold, from 0.280 to 25.4 mg/m3 with a median of 2.0 mg/m3 (1-min concentrations from 13,920 data points). There were no statistical difference in daily median or geometric mean concentrations among workers, whereas the concentrations were significantly higher on days with three versus two workers present. The 15-min median concentrations (n = 974 measures) increased until 2.35 h (beta 0.177; p < 0.05), representing a 0.70 mg increase in exposure per hour. This was followed by a plateau in concentrations. The high levels of respirable PM we observed among workers fabricating aluminium trihydroxide-containing synthetic countertops highlight an unmet early prevention need.
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Affiliation(s)
- Denis Vinnikov
- Al-Farabi Kazakh National University, 71 al-Farabi avenue, 050040, Almaty, Kazakhstan. .,Peoples' Friendship, University of Russia, RUDN University), Moscow, Russian Federation.
| | - Paul D Blanc
- University of California San Francisco, San Francisco, CA, USA
| | - Aizhan Raushanova
- Al-Farabi Kazakh National University, 71 al-Farabi avenue, 050040, Almaty, Kazakhstan
| | - Arailym Beisbekova
- Al-Farabi Kazakh National University, 71 al-Farabi avenue, 050040, Almaty, Kazakhstan.,Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | | | - Yelena Zlobina
- Al-Farabi Kazakh National University, 71 al-Farabi avenue, 050040, Almaty, Kazakhstan
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25
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Vinnikov D, Tulekov Z, Blanc PD. Fractional exhaled NO in a metalworking occupational cohort. Int Arch Occup Environ Health 2021; 95:701-708. [PMID: 34626220 DOI: 10.1007/s00420-021-01801-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/22/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Secondary metalworking carries exposure to relatively heavy levels of respirable particulate. We investigated the extent to which metalworking is associated with increased exhaled nitric oxide (FeNO), an established inflammatory biomarker. METHODS We studied 80 metalworking factory employees in Kazakhstan. Informed by industrial hygiene data, we categorized them into three groups: (1) machine operators (41%); (2) welders or assemblers (33%); and (3) all others, including administrative and ancillary staff (26%). Participants completed questionnaires covering occupational history, smoking, home particulate sources, respiratory symptoms, and comorbidities. We measured exhaled carbon monoxide (CO), exhaled fractional nitric oxide (FeNO), and spirometric function. We used mixed-effects modeling to test the associations of occupational group with FeNO, adjusted for covariates. RESULTS The median age was 51.5 (interquartile range 20.5) years; 7% were women. Occupational group (p < 0.01), daily current cigarette smoking intensity (p < 0.05), and age (p < 0.05), each was statistically associated with FeNO. Welders, or assemblers (Group 2), who had intermediate particulate exposure, manifested significantly higher exhaled FeNO compared to machinists (Group 1, with the highest particulate exposure) and all others (Groups 3, the lowest particulate): adjusted Group 2 mean 44.8 ppb (95% confidence interval (CI) 33.8-55.9) vs. Group 1 24.6 ppb (95% 20.5-28.7) and Group 3, 24.3 ppb (95% CI 17.7-30.9). Secondhand smoking and height were not associated with FeNO. CONCLUSION In a metalworking industrial cohort, welders/assemblers manifested significantly higher levels of FeNO. This may reflect respiratory tract inflammation associated with airborne exposures specific to this group.
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Affiliation(s)
- Denis Vinnikov
- Al-Farabi Kazakh National University, 71 al-Farabi avenue, 050040, Almaty, Kazakhstan. .,Peoples' Friendship University of Russia (RUDN University), Moscow, Russian Federation.
| | - Zhangir Tulekov
- Al-Farabi Kazakh National University, 71 al-Farabi avenue, 050040, Almaty, Kazakhstan
| | - Paul D Blanc
- University of California San Francisco, San Francisco, CA, USA
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Naidoo RN, Blanc PD, Torén K. History of work-related diseases as a tool to protect the health of workers. Ind Health 2021; 59:204-203. [PMID: 34261822 PMCID: PMC8426542 DOI: 10.2486/indhealth.1-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Rajen N Naidoo
- Discipline of Occupational and Environmental Health, University of KwaZulu-Natal, South Africa
| | - Paul D Blanc
- Division of Occupational and Environmental Medicine, Department of Medicine, University of California San Franciso, USA
| | - Kjell Torén
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
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Chien A, Domeracki S, Guntur S, Taylor K, Lu CM, Lampiris H, Blanc PD. Association between household exposure and cycle threshold in COVID-19 infected health care workers. J Occup Med Toxicol 2021; 16:29. [PMID: 34348733 PMCID: PMC8335465 DOI: 10.1186/s12995-021-00321-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/27/2021] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE Household SARS-COV-2 contact constitutes a high-risk exposure for health care workers (HCWs). Cycle threshold (Ct) of reverse transcriptase-polymerase chain reaction testing provides an estimate of COVID-19 viral load, which can inform clinical and workplace management. We assessed whether Ct values differed between HCWs with COVID-19 with and without household exposure. METHODS We analyzed HCW COVID-19 cases whose Ct data could be compared. We defined low Ct at a cut-point approximating a viral load of 4.6 × 106 copies per ml. Logistic regression tested the association of household exposure and symptoms at diagnosis with a low Ct value. RESULTS Of 77 HCWs with COVID-19, 20 were household exposures cases and 34 were symptomatic at testing (7 were both household-exposed and symptomatic at testing). Among household exposures, 9 of 20 (45%) manifested lower Ct values compared to 14 of 57 (25%) for all others. In a bivariate model, household exposure was not statistically associated with lower Ct (Odds Ratio [OR] 1.20; 95% Confidence Interval [CI] 0.97-1.51). In multivariable modelling both household exposure (OR] 1.3; 95% CI 1.03-1.6) and symptoms at diagnosis (OR 1.4; 95% CI 1.15-1.7) were associated with a low Ct value. DISCUSSION Household exposure in HCWs with newly diagnosed COVID-19 was associated with lower Ct values, consistent with a higher viral load, supporting the hypothesis that contracting COVID-19 in that manner leads to a greater viral inoculum.
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Affiliation(s)
- Ai Chien
- Occupational and Employee Health Section and Infectious Disease Section, Medical Service and Laboratory Medicine Service, San Francisco Veterans Affairs Health Care System, 4150 Clement St., San Francisco, CA, 94121, USA
- Division of Occupational and Environmental Medicine, Department of Medicine, University of California San Francisco, San Francisco, USA
| | - Sandra Domeracki
- Occupational and Employee Health Section and Infectious Disease Section, Medical Service and Laboratory Medicine Service, San Francisco Veterans Affairs Health Care System, 4150 Clement St., San Francisco, CA, 94121, USA
- Occupational and Environmental Health Nursing, Community Health Systems, School of Nursing, University of California San Francisco California, San Francisco, USA
| | - Sandeep Guntur
- Occupational and Employee Health Section and Infectious Disease Section, Medical Service and Laboratory Medicine Service, San Francisco Veterans Affairs Health Care System, 4150 Clement St., San Francisco, CA, 94121, USA
- Division of Occupational and Environmental Medicine, Department of Medicine, University of California San Francisco, San Francisco, USA
| | - Kristopher Taylor
- Occupational and Employee Health Section and Infectious Disease Section, Medical Service and Laboratory Medicine Service, San Francisco Veterans Affairs Health Care System, 4150 Clement St., San Francisco, CA, 94121, USA
| | - Chuanyi M Lu
- Occupational and Employee Health Section and Infectious Disease Section, Medical Service and Laboratory Medicine Service, San Francisco Veterans Affairs Health Care System, 4150 Clement St., San Francisco, CA, 94121, USA
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, USA
| | - Harry Lampiris
- Occupational and Employee Health Section and Infectious Disease Section, Medical Service and Laboratory Medicine Service, San Francisco Veterans Affairs Health Care System, 4150 Clement St., San Francisco, CA, 94121, USA
- Division of Infectious Disease, Department of Medicine, University of California San Francisco, San Francisco, USA
| | - Paul D Blanc
- Occupational and Employee Health Section and Infectious Disease Section, Medical Service and Laboratory Medicine Service, San Francisco Veterans Affairs Health Care System, 4150 Clement St., San Francisco, CA, 94121, USA.
- Division of Occupational and Environmental Medicine, Department of Medicine, University of California San Francisco, San Francisco, USA.
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Ying D, Schmajuk G, Trupin L, Blanc PD. Inorganic Dust Exposure During Military Service as a Predictor of Rheumatoid Arthritis and Other Autoimmune Conditions. ACR Open Rheumatol 2021; 3:466-474. [PMID: 34085777 PMCID: PMC8281049 DOI: 10.1002/acr2.11273] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE Rheumatoid arthritis (RA) and other autoimmune (AI) conditions are associated with inorganic dust exposure. Many military activities are likely to entail inorganic dust exposures. We wished to identify associations between prior military dust exposure and RA and other AI conditions. METHODS We studied persons from a roster of Army, Navy, Air Force, or Marine Corps personnel who had served in Operation Enduring Freedom and Operations Iraqi Freedom and New Dawn. We linked military occupational codes to a job exposure matrix assigning dust exposure likelihood. We used the Veterans Affairs Health Care System (VAHCS) electronic health care records to identify cases of RA, systemic lupus erythematosus (SLE), systemic sclerosis (SSc), vasculitis, and inflammatory myositis. Generalized estimating equations modeled risk of RA and other AI conditions associated with dust exposure, taking into account military service branch, age at first VAHCS encounter, sex, race/ethnicity, smoking status, and years of military service. RESULTS Of 438 086 veterans (68% ever-smokers), 44% were classified with likely or somewhat likely dust exposure. Cases included 1139 cases with RA, 467 cases with SLE, and 180 cases with other AI diseases (SSc, vasculitis, or inflammatory myositis). Military dust exposure was associated with increased odds of RA (odds ratio [OR] = 1.10; 95% confidence interval [CI] = 1.003-1.20) and increased odds of SSc, vasculitis, or inflammatory myositis (OR = 1.23; 95% CI = 1.14-1.34) but was protective for SLE (OR = 0.81; 95% CI = 0.76-0.88). CONCLUSION Dust exposure during past military service comprises an occupational and environmental risk factor for RA and other AI diseases. This is potentially relevant for prevention activities.
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Affiliation(s)
- David Ying
- San Francisco Veterans Affairs Health Care System, San Francisco, California, John Muir Health, Walnut Creek, California, and University of California at San Francisco
| | - Gabriela Schmajuk
- San Francisco Veterans Affairs Health Care System, San Francisco, California, and University of California at San Francisco
| | | | - Paul D. Blanc
- San Francisco Veterans Affairs Health Care System, San Francisco, California, and University of California at San Francisco
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Abstract
BACKGROUND Health care workers (HCWs) experience increased occupational risk of contracting COVID-19, with temporal trends that might inform surveillance. METHODS We analyzed data from a Veterans Affairs hospital-based COVID-19 worker telephone hotline collected over 40 weeks (2020). We calculated the proportion of COVID-19+ cases among persons-under-investigation (PUIs) for illness compared to rates from a nearby large university-based health care institution. RESULTS We observed 740 PUIs, 65 (8.8%) COVID-19+. Time trends were similar at the study and comparison hospitals; only for the first of 10 four-week observation periods was the ratio for observed to expected COVID-19+ significant (P < 0.001). DISCUSSION These data suggest that employee health COVID-19+ to PUI ratios could be utilized as a barometer of community trends. Pooling experience among heath care facilities may yield insights into occupational infectious disease outbreaks.
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Affiliation(s)
- James E McNicholas
- Division of Occupational and Environmental Medicine, Department of Medicine, University of California, San Francisco, California (Dr McNicholas, Dr Kosnik, Dr Blanc, and Dr Guntur); Division of Occupational Medicine, San Francisco Veterans Affairs Health Care System, San Francisco, California (Dr McNicholas, Dr Blanc and Dr Guntur); Office of Population Health, UCSF Medical Center, University of California San Francisco, San Francisco, California (Dr Taylor)
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Gandhi SA, Cohen RA, Blanc PD, Go LHT. Early radiographic pneumoconiosis is associated with impaired exercise gas exchange among coal miners with normal resting spirometry. Am J Ind Med 2021; 64:453-461. [PMID: 33768567 DOI: 10.1002/ajim.23247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/21/2021] [Accepted: 02/22/2021] [Indexed: 11/10/2022]
Abstract
RATIONALE We sought to determine if radiographic pneumoconiosis predicts abnormal gas exchange during exercise in coal mine workers with preserved resting lung function. METHODS We analyzed data from former coal miners seen between 2006 and 2014 in a single clinic specializing in black lung evaluations. We limited the analysis to those with normal resting spirometry and an A-a gradient at peak exercise ≥10 mmHg. We used multivariable logistic regression to estimate predictors of A-a gradient widened to >150% of the reference value. We focused on chest radiographs consistent with pneumoconiosis, taking into account higher silica exposure mining activities and years underground, and adjusting for cigarette smoking, obesity, and coronary artery disease. RESULTS Of 5507 miners, we analyzed data for 742 subjects with normal spirometry and all key clinical variables available, of whom 372 (50.1%) had radiographic evidence of pneumoconiosis. All but 21 had small opacity profusion of less than 2/1. The median A-a gradient at peak exercise was 108% of reference value (interquartile range, 81%-141%). In the multivariable analysis, radiographic pneumoconiosis was associated with increased odds of widened A-a gradient (odds ratio [OR], 2.47; 95% confidence interval [CI], 1.7-3.7). Limited to 660 subjects with normal diffusing capacity for carbon monoxide, the odds were similarly increased (OR, 3.20; 95% CI, 1.5-3.6). DISCUSSION Among coal miners with preserved resting lung function, radiographic evidence of early pneumoconiosis more than doubled the odds of abnormal exercise physiology. Impairment in pneumoconiosis occurs in early disease and may only be evident on exercise testing.
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Affiliation(s)
- Sheiphali A. Gandhi
- Department of Medicine, Division of Occupational and Environmental Medicine University of California San Francisco San Francisco California USA
| | - Robert A. Cohen
- Environmental and Occupational Health Sciences, School of Public Health University of Illinois at Chicago Chicago Illinois USA
- Division of Pulmonary and Critical Care Medicine Northwestern University Feinberg School of Medicine Chicago Illinois USA
| | - Paul D. Blanc
- Department of Medicine, Division of Occupational and Environmental Medicine University of California San Francisco San Francisco California USA
| | - Leonard H. T. Go
- Environmental and Occupational Health Sciences, School of Public Health University of Illinois at Chicago Chicago Illinois USA
- Division of Pulmonary and Critical Care Medicine Northwestern University Feinberg School of Medicine Chicago Illinois USA
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31
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Garshick E, Blanc PD. Military Deployment and Respiratory Symptoms: Some Answers, Many Questions. Chest 2021; 157:1407-1408. [PMID: 32505302 DOI: 10.1016/j.chest.2020.02.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 02/13/2020] [Indexed: 11/19/2022] Open
Affiliation(s)
- Eric Garshick
- Pulmonary, Allergy, Sleep and Critical Care Medicine Section, Department of Medicine, VA Boston Healthcare System and Harvard Medical School, West Roxbury, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA.
| | - Paul D Blanc
- Occupational and Environmental Medicine, San Francisco VA Health Care System, San Francisco, CA; Department of Medicine, University of California San Francisco School of Medicine, San Francisco, CA
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32
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Melamed J, Gerona R, Blanc PD, Takamoto P, Conner S, Goodnough R. Gamma-Butyrolactone Overdose Potentially Complicated by Co-Ingestion of Industrial Solvent N-Methyl-2-Pyrrolidone. J Anal Toxicol 2021; 45:322-324. [PMID: 32672803 DOI: 10.1093/jat/bkaa076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 04/27/2020] [Accepted: 05/17/2020] [Indexed: 11/14/2022] Open
Abstract
Gamma-hydroxybutyrate (GHB) is misused as an intoxicant, either alone or concurrently with other substances. Because GHB is illegal, the precursor chemicals 1,4-butanediol and gamma-butyrolactone are also misused for the same effect, either through pre-ingestion alteration or endogenous metabolism to GHB. We describe a case of a 50-year-old man with a history of polysubstance misuse who experienced an overdose of GHB from gamma-butyrolactone ingestion. The patient also co-ingested a common industrial solvent, N-methyl-2-pyrrolidone (NMP). This co-ingested substance raised theoretical concern of metabolism to a GHB congener, underscoring that the emergence of new psychoactive substance use patterns requires ongoing vigilance and toxicologic confirmation.
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Affiliation(s)
- Jonathan Melamed
- Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California, Clinical Toxicology and Environmental Biomonitoring Lab, 2340 Sutter St Rm S-271, San Francisco, CA, USA 94115
| | - Roy Gerona
- Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California, Clinical Toxicology and Environmental Biomonitoring Lab, 2340 Sutter St Rm S-271, San Francisco, CA, USA 94115
| | - Paul D Blanc
- Division of Occupational and Environmental Medicine, Department of Medicine, School of Medicine, University of California, 350 Parnassus Ave Suite 609, San Francisco, CA 94117, USA.,California Poison Control System, San Francisco Division, California Poison Control System at Zuckerberg San Francisco General Hospital and Trauma Center UCSF Box 1369, San Francisco, CA 94143, USA
| | - Paul Takamoto
- Department of Pharmaceutical Services, School of Pharmacy, University of California, 505 Parnassus, M-39, San Francisco, CA 94117, USA.,Department of Emergency Medicine, University of California, 505 Parnassus Ave, L-126, San Francisco, CA 94143, USA
| | - Stephanie Conner
- Division of Hospital Medicine, Department of Medicine, University of California, 533 Parnassus Avenue Suite U127, box 0131, San Francisco, CA 94143, USA
| | - Robert Goodnough
- Department of Emergency Medicine, Baylor College of Medicine, Henry J.N. Taub Department of Emergency Medicine, 1504 Taub Loop, Houston, Texas 77030, USA
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Andersson M, Blanc PD, Torén K, Järvholm B. Smoking, occupational exposures, and idiopathic pulmonary fibrosis among Swedish construction workers. Am J Ind Med 2021; 64:251-257. [PMID: 33547652 DOI: 10.1002/ajim.23231] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/08/2021] [Accepted: 01/20/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Cigarette smoking and occupational exposures each have been reported to increase the risk of idiopathic pulmonary fibrosis (IPF), a disease previously considered of unknown origin. We investigated the risk of IPF mortality associated with combined smoking and occupational exposures. METHODS A registry study of Swedish construction workers (N = 389,132), linked baseline smoking and occupational data with registry data on cause of death and hospital care diagnoses. Occupation was classified by the likelihood of exposure to vapors, gases, dusts, or fumes using a job-exposure matrix. Those likely exposed to asbestos or silica were excluded from the analysis. Age-adjusted relative risks [RRs] were calculated using Poisson regression. Follow-up observation began at age 40 and ended at age 89. RESULTS Heavy smokers at baseline who were exposed to inorganic dusts during their working life had an increased risk of IPF mortality (RR 1.70; 95% confidence interval [CI] 1.11-2.60), while there was no statistically increased risk in the other exposure groups. There were dose-response relationships between smoking at baseline and IPF mortality among both unexposed and dust exposed workers, with similar risk for dust exposed and unexposed, except among baseline heavy smokers, where workers exposed to inorganic dust manifested the highest risk (RR 4.22; 95% CI 2.69-6.60). Excluding workers with chronic obstructive pulmonary disease or emphysema did not affect the results substantively. CONCLUSION A clear dose-response relationship was seen between smoking at baseline and IPF, supporting a causal relationship. Occupational exposure to inorganic dusts, excluding silica and asbestos, was associated with increased risk of IPF in baseline heavy current smokers.
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Affiliation(s)
- Martin Andersson
- Department of Public Health and Clinical Medicine Sustainable Health, Umeå University Umeå Sweden
| | - Paul D. Blanc
- Department of Medicine, Division of Occupational and Environmental Medicine University of California San Francisco San Francisco California USA
| | - Kjell Torén
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Occupational and Environmental Medicine Sahlgrenska University Hospital Gothenburg Sweden
| | - Bengt Järvholm
- Department of Public Health and Clinical Medicine Sustainable Health, Umeå University Umeå Sweden
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Kolaitis NA, Gao Y, Soong A, Greenland JR, Hays SR, Golden J, Leard LE, Shah RJ, Kleinhenz ME, Katz PP, Venado A, Kukreja J, Blanc PD, Singer JP. Primary graft dysfunction attenuates improvements in health-related quality of life after lung transplantation, but not disability or depression. Am J Transplant 2021; 21:815-824. [PMID: 32794295 DOI: 10.1111/ajt.16257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 07/17/2020] [Accepted: 07/31/2020] [Indexed: 01/25/2023]
Abstract
Disability, depressive symptoms, and impaired health-related quality of life (HRQL) are common among patients with life-threatening respiratory compromise. We sought to determine if primary graft dysfunction (PGD), a syndrome of acute lung injury, attenuates improvements in patient-reported outcomes after transplantation. In a single-center prospective cohort, we assessed disability, depressive symptoms, and HRQL before and at 3- to 6-month intervals after lung transplantation. We estimated the magnitude of change in disability, depressive symptoms, and HRQL with hierarchical segmented linear mixed-effects models. Among 251 lung transplant recipients, 50 developed PGD Grade 3. Regardless of PGD severity, participants had improvements in disability and depressive symptoms, as well as generic-physical, generic-mental, respiratory-specific, and health-utility HRQL, exceeding 1- to 4-fold the minimally clinically important difference across all instruments. Participants with PGD Grade 3 had a lower magnitude of improvement in generic-physical HRQL and health-utility than in all other participants. Among participants with PGD Grade 3, prolonged mechanical ventilation was associated with greater attenuation of improvements. PGD remains a threat to the 2 primary aims of lung transplantation, extending survival and improving HRQL. Attenuation of improvement persists long after hospital discharge. Future studies should assess if interventions can mitigate the impact of PGD on patient-reported outcomes.
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Affiliation(s)
- Nicholas A Kolaitis
- Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of California, San Francisco, California, USA
| | - Ying Gao
- Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of California, San Francisco, California, USA
| | - Allison Soong
- Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of California, San Francisco, California, USA
| | - John R Greenland
- Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of California, San Francisco, California, USA
| | - Steven R Hays
- Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of California, San Francisco, California, USA
| | - Jeffrey Golden
- Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of California, San Francisco, California, USA
| | - Lorriana E Leard
- Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of California, San Francisco, California, USA
| | - Rupal J Shah
- Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of California, San Francisco, California, USA
| | - Mary Ellen Kleinhenz
- Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of California, San Francisco, California, USA
| | - Patricia P Katz
- Division of Rheumatology, Department of Medicine, School of Medicine, University of California, San Francisco, California, USA
| | - Aida Venado
- Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of California, San Francisco, California, USA
| | - Jasleen Kukreja
- Division of Thoracic Surgery, Department of Surgery, School of Medicine, University of California, San Francisco, California, USA
| | - Paul D Blanc
- Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of California, San Francisco, California, USA
| | - Jonathan P Singer
- Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of California, San Francisco, California, USA
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Vinnikov D, Tulekov Z, Romanova Z, Krugovykh I, Blanc PD. Smoking practices in relation to exhaled carbon monoxide in an occupational cohort. BMC Public Health 2020; 20:1894. [PMID: 33298031 PMCID: PMC7725030 DOI: 10.1186/s12889-020-09997-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 12/01/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Exposure to carbon monoxide (CO) remains a leading occupational hazard in firefighters, but cigarette and waterpipe smoking likely contributes to the other sources of CO in such workers. The aim of this study was to estimate the contribution of self-reported active cigarette smoking, waterpipe use, and potential job-related sources of CO to the level of exhaled CO in firefighters. METHODS We surveyed the personnel of 18 fire stations (N = 842), median age 28 years, who participated at an annual screening not timed to coincide with recent firefighting. We surveyed smoking and waterpipe history, exposure to secondhand smoke (SHS), use of coal for health and biomass for cooking and time since last exposure to firefighting in the workplace. We measured exhaled CO with an instantaneous reading device (piCO Smokerlyzer). We used multivariable regression models to test the association of time since last smoked cigarette (≤12 h) and waterpipe (≤12 h) and time since last fire (≤6 h) with exhaled CO. RESULTS In analysis limited to men (93.5% of all surveyed), 42% were daily cigarette; 1% were waterpipe smokers; 94% were exposed to SHS, 29% used coal for heating and 4% used biomass for cooking. The median CO was 4 (interquartile range 3;8) ppm. Age (beta 0.74 per 10 years, p < 0.001), use of biomass fuel for cooking (beta 1.38, p = 0.05), cigarette smoked in the last 12 h (beta 8.22, p < 0.001), waterpipe smoked in the last 12 h (beta 23.10, p < 0.001) were statistically associated with CO, but not time since last fire (≤6 h) (beta 4.12, p = 0.12). There was a significant interaction between older age and firefighting for exhaled CO (p = 0.03). CONCLUSIONS Cigarette and recent waterpipe smoking are associated with increased exhaled CO in firefighters. Firefighting itself was a less potent contributor to exhaled CO when measured at an annual screening, but an age interaction was manifested.
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Affiliation(s)
- Denis Vinnikov
- Al-Farabi Kazakh National University, 71 Al-Farabi Avenue, Almaty, Kazakhstan 050040
- Peoples’ Friendship University of Russia (RUDN University), 6 Miklukho-Maklaya Street, Moscow, Russian Federation 117198
- National Research Tomsk State University, 36 Lenin Avenue, Tomsk, Russian Federation 634050
| | - Zhangir Tulekov
- Al-Farabi Kazakh National University, 71 Al-Farabi Avenue, Almaty, Kazakhstan 050040
| | - Zhanna Romanova
- Al-Farabi Kazakh National University, 71 Al-Farabi Avenue, Almaty, Kazakhstan 050040
| | - Ilya Krugovykh
- Al-Farabi Kazakh National University, 71 Al-Farabi Avenue, Almaty, Kazakhstan 050040
| | - Paul D. Blanc
- University of California San Francisco, Suite 609, 350 Parnassus Avenue, San Francisco, CA 94117 USA
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36
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Barnes H, Olin AC, Torén K, McSharry C, Donnelly I, Lärstad M, Iribarren C, Quinlan P, Blanc PD. Occupation versus environmental factors in hypersensitivity pneumonitis: population attributable fraction. ERJ Open Res 2020; 6:00374-2020. [PMID: 33043057 PMCID: PMC7533383 DOI: 10.1183/23120541.00374-2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 07/01/2020] [Indexed: 12/28/2022] Open
Abstract
Background Despite well-documented case series of hypersensitivity pneumonitis (HP), epidemiological data delineating relative contributions of risk factors are sparse. To address this, we estimated HP risk in a case-referent study of occupational and nonoccupational exposures. Methods We recruited cases of HP by ICD-9 codes from an integrated healthcare delivery system (IHCDS) and a tertiary medical care centre. We drew referents, matched for age and sex, from the IHCDS. Participants underwent comprehensive, structured telephone interviews eliciting details of occupational and home environmental exposures. We employed a hierarchical analytic approach for data reduction based on the false discovery rate method within clusters of exposures. We measured lung function and selected biomarkers in a subset of participants. We used multivariate logistic regression to estimate exposure-associated odds ratios (ORs) and population attributable fractions (PAFs) for HP. Results We analysed data for 192 HP cases (148 IHCDS; 44 tertiary care) and 229 referents. Occupational exposures combined more than doubled the odds of developing HP (OR 2.67; 95% CI 1.73–4.14) with a PAF of 34% (95% CI 21–46%); nonoccupational bird exposure also doubled the HP odds (OR 2.02; 95% CI 1.13–3.60), with a PAF of 12% (3–21%). Lung function and selected biomarkers did not substantively modify the risk estimates on the basis of questionnaire data alone. Discussion In a case-referent approach evaluating HP risk, identifiable exposures accounted, on an epidemiological basis, for approximately two in three cases of disease; conversely, for one in three, the risk factors for disease remained elusive. Occupational and environmental factors account for two in three cases of HP. The contributions of risk factors vary markedly depending on case referral source. This could affect clinical ascertainment of cause and the implementation of preventative actions.https://bit.ly/3feAa6P
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Affiliation(s)
- Hayley Barnes
- Division of Pulmonary and Critical Care, Dept of Medicine, University of California, San Francisco, CA, USA.,Central Clinical School, Monash University, Melbourne, Australia
| | - Anna-Carin Olin
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.,Dept of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kjell Torén
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.,Dept of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Iona Donnelly
- Dept of Immunology, University of Glasgow, Glasgow, UK
| | - Mona Lärstad
- Dept of Internal Medicine/Respiratory Medicine and Allergology, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Patricia Quinlan
- Division of Occupational and Environmental Medicine, Dept of Medicine, University of California, San Francisco, CA, USA
| | - Paul D Blanc
- Division of Pulmonary and Critical Care, Dept of Medicine, University of California, San Francisco, CA, USA.,Division of Occupational and Environmental Medicine, Dept of Medicine, University of California, San Francisco, CA, USA
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Kolaitis NA, Calabrese DR, Ahearn P, Venado A, Florez R, Lei HL, Isaak K, Henricksen E, Martinez E, Chong T, Shah RJ, Leard LE, Kleinhenz ME, Golden J, De Marco T, Greenland JR, Kukreja J, Hays SR, Blanc PD, Singer JP. Tacrolimus trough monitoring guided by mass spectrometry without accounting for assay differences is associated with acute kidney injury in lung transplant recipients. Am J Health Syst Pharm 2020; 76:2019-2027. [PMID: 31696925 DOI: 10.1093/ajhp/zxz243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Tacrolimus is a nephrotoxic immunosuppressant historically monitored via enzyme-based immunoassay (IA). After 2011, the 2 largest laboratory companies in the United States implemented tacrolimus quantification by liquid chromatography-mass spectrometry (LC-MS); this method excludes metabolites, potentially resulting in lower quantified drug concentrations. We sought to determine if tacrolimus therapeutic drug monitoring via LC-MS, as performed using trough targets originally derived from IA values, influences clinical outcomes. METHODS In a single-center retrospective cohort study of lung transplant recipients, risks of acute kidney injury, acute renal failure, and new-onset diabetes after transplantation, as well as chronic lung allograft dysfunction-free survival, were compared in 82 subjects monitored by LC-MS and 102 subjects monitored by IA using Cox proportional hazard models adjusted for age, sex, baseline renal function, and race. RESULTS LC-MS-based monitoring was associated with a greater risk of acute kidney injury (adjusted hazard ratio, 1.65; 95% confidence interval, 1.02-2.67). No statistically significant differences in risks of acute renal failure and new-onset diabetes after transplantation were observed. CONCLUSION Although LC-MS provides a more accurate representation of the blood concentration of the parent compound tacrolimus exclusive of metabolite, established cut points for tacrolimus dosing may need to be adjusted to account for the increased risk of renal injury.
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Affiliation(s)
- Nicholas A Kolaitis
- Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, CA
| | - Daniel R Calabrese
- Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, CA
| | - Patrick Ahearn
- Division of Nephrology, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, CA
| | - Aida Venado
- Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, CA
| | - Rebecca Florez
- School of Pharmacy and School of Medicine, University of California, San Francisco, San Francisco, CA
| | - Huey-Ling Lei
- Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, CA
| | - Karolina Isaak
- Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, CA
| | - Erik Henricksen
- School of Pharmacy and School of Medicine, University of California, San Francisco, CA
| | - Emily Martinez
- Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, CA
| | - Tiffany Chong
- Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, CA
| | - Rupal J Shah
- Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, CA
| | - Lorriana E Leard
- Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, CA
| | - Mary Ellen Kleinhenz
- Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, CA
| | - Jeffrey Golden
- Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, CA
| | - Teresa De Marco
- Division of Cardiology, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, CA
| | - John R Greenland
- Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, CA, and Division of Pulmonary and Critical Care Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, CA
| | - Jasleen Kukreja
- Division of Thoracic Surgery, Department of Surgery, University of California, San Francisco, School of Medicine, San Francisco, CA
| | - Steven R Hays
- Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, CA
| | - Paul D Blanc
- Division of Pulmonary and Critical Care and Division of Occupational and Environmental Medicine, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, CA
| | - Jonathan P Singer
- Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, CA
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Venado A, Kolaitis NA, Huang CY, Gao Y, Glidden DV, Soong A, Sutter N, Katz PP, Greenland JR, Calabrese DR, Hays SR, Golden JA, Shah RJ, Leard LE, Kukreja J, Deuse T, Wolters PJ, Covinsky K, Blanc PD, Singer JP. Frailty after lung transplantation is associated with impaired health-related quality of life and mortality. Thorax 2020; 75:669-678. [PMID: 32376733 DOI: 10.1136/thoraxjnl-2019-213988] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 04/01/2020] [Accepted: 04/15/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Lung transplantation and related medications are associated with pathobiological changes that can induce frailty, a state of decreased physiological reserve. Causes of persistent or emergent frailty after lung transplantation, and whether such transplant-related frailty is associated with key outcomes, are unknown. METHODS Frailty and health-related quality of life (HRQL) were prospectively measured repeatedly for up to 3 years after lung transplantation. Frailty, quantified by the Short Physical Performance Battery (SPPB), was tested as a time-dependent binary and continuous predictor. The association of transplant-related frailty with HRQL and mortality was evaluated using mixed effects and Cox regression models, respectively, adjusting for age, sex, ethnicity, diagnosis, and for body mass index and lung function as time-dependent covariates. We tested the association between measures of body composition, malnutrition, renal dysfunction and immunosuppressants on the development of frailty using mixed effects models with time-dependent predictors and lagged frailty outcomes. RESULTS Among 259 adults (56% male; mean age 55.9±12.3 years), transplant-related frailty was associated with lower HRQL. Frailty was also associated with a 2.5-fold higher mortality risk (HR 2.51; 95% CI 1.21 to 5.23). Further, each 1-point worsening in SPPB was associated, on average, with a 13% higher mortality risk (HR 1.13; 95% CI 1.04 to 1.23). Secondarily, we found that sarcopenia, underweight and obesity, malnutrition, and renal dysfunction were associated with the development of frailty after transplant. CONCLUSIONS Transplant-related frailty is associated with lower HRQL and higher mortality in lung recipients. Abnormal body composition, malnutrition and renal dysfunction may contribute to the development of frailty after transplant. Confirming the role of these potential contributors and developing interventions to mitigate frailty may improve lung transplant success.
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Affiliation(s)
- Aida Venado
- Medicine, University of California San Francisco, San Francisco, California, USA
| | - Nicholas A Kolaitis
- Medicine, University of California San Francisco, San Francisco, California, USA
| | - Chiung-Yu Huang
- Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Ying Gao
- Medicine, University of California San Francisco, San Francisco, California, USA
| | - David V Glidden
- Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Allison Soong
- Medicine, University of California San Francisco, San Francisco, California, USA
| | - Nicole Sutter
- Medicine, University of California San Francisco, San Francisco, California, USA
| | - Patricia P Katz
- Medicine, University of California San Francisco, San Francisco, California, USA
| | - John R Greenland
- Medicine, University of California San Francisco, San Francisco, California, USA.,Medicine, VA Medical Center, San Francisco, California, USA
| | - Daniel R Calabrese
- Medicine, University of California San Francisco, San Francisco, California, USA
| | - Steven R Hays
- Medicine, University of California San Francisco, San Francisco, California, USA
| | - Jeffrey A Golden
- Medicine, University of California San Francisco, San Francisco, California, USA
| | - Rupal J Shah
- Medicine, University of California San Francisco, San Francisco, California, USA
| | - Lorriana E Leard
- Medicine, University of California San Francisco, San Francisco, California, USA
| | - Jasleen Kukreja
- Surgery, University of California San Francisco, San Francisco, California, USA
| | - Tobias Deuse
- Surgery, University of California San Francisco, San Francisco, California, USA
| | - Paul J Wolters
- Medicine, University of California San Francisco, San Francisco, California, USA
| | - Kenneth Covinsky
- Medicine, University of California San Francisco, San Francisco, California, USA
| | - Paul D Blanc
- Medicine, University of California San Francisco, San Francisco, California, USA
| | - Jonathan P Singer
- Medicine, University of California San Francisco, San Francisco, California, USA
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Blanc PD, Annesi-Maesano I, Balmes JR, Cummings KJ, Fishwick D, Miedinger D, Murgia N, Naidoo RN, Reynolds CJ, Sigsgaard T, Torén K, Vinnikov D, Redlich CA. The Occupational Burden of Nonmalignant Respiratory Diseases. An Official American Thoracic Society and European Respiratory Society Statement. Am J Respir Crit Care Med 2020; 199:1312-1334. [PMID: 31149852 PMCID: PMC6543721 DOI: 10.1164/rccm.201904-0717st] [Citation(s) in RCA: 222] [Impact Index Per Article: 55.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Rationale: Workplace inhalational hazards remain common worldwide, even though they are ameliorable. Previous American Thoracic Society documents have assessed the contribution of workplace exposures to asthma and chronic obstructive pulmonary disease on a population level, but not to other chronic respiratory diseases. The goal of this document is to report an in-depth literature review and data synthesis of the occupational contribution to the burden of the major nonmalignant respiratory diseases, including airway diseases; interstitial fibrosis; hypersensitivity pneumonitis; other noninfectious granulomatous lung diseases, including sarcoidosis; and selected respiratory infections. Methods: Relevant literature was identified for each respiratory condition. The occupational population attributable fraction (PAF) was estimated for those conditions for which there were sufficient population-based studies to allow pooled estimates. For the other conditions, the occupational burden of disease was estimated on the basis of attribution in case series, incidence rate ratios, or attributable fraction within an exposed group. Results: Workplace exposures contribute substantially to the burden of multiple chronic respiratory diseases, including asthma (PAF, 16%); chronic obstructive pulmonary disease (PAF, 14%); chronic bronchitis (PAF, 13%); idiopathic pulmonary fibrosis (PAF, 26%); hypersensitivity pneumonitis (occupational burden, 19%); other granulomatous diseases, including sarcoidosis (occupational burden, 30%); pulmonary alveolar proteinosis (occupational burden, 29%); tuberculosis (occupational burden, 2.3% in silica-exposed workers and 1% in healthcare workers); and community-acquired pneumonia in working-age adults (PAF, 10%). Conclusions: Workplace exposures contribute to the burden of disease across a range of nonmalignant lung conditions in adults (in addition to the 100% burden for the classic occupational pneumoconioses). This burden has important clinical, research, and policy implications. There is a pressing need to improve clinical recognition and public health awareness of the contribution of occupational factors across a range of nonmalignant respiratory diseases.
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40
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Mudan A, Copan L, Wang R, Pugh A, Lebin J, Barreau T, Jones RL, Ghosal S, Lee M, Albertson T, Jarrett JM, Lee J, Betting D, Ward CD, De Leon Salazar A, Smollin CG, Blanc PD. Notes from the Field: Methylmercury Toxicity from a Skin Lightening Cream Obtained from Mexico - California, 2019. MMWR Morb Mortal Wkly Rep 2019; 68:1166-1167. [PMID: 31856147 PMCID: PMC6936160 DOI: 10.15585/mmwr.mm6850a4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Torén K, Blanc PD, Naidoo RN, Murgia N, Qvarfordt I, Aspevall O, Dahlman-Hoglund A, Schioler L. Occupational exposure to dust and to fumes, work as a welder and invasive pneumococcal disease risk. Occup Environ Med 2019; 77:57-63. [PMID: 31848233 PMCID: PMC7029234 DOI: 10.1136/oemed-2019-106175] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/31/2019] [Accepted: 11/21/2019] [Indexed: 12/18/2022]
Abstract
Objectives Occupational exposures to metal fumes have been associated with increased pneumonia risk, but the risk of invasive pneumococcal disease (IPD) has not been characterised previously. Methods We studied 4438 cases aged 20–65 from a Swedish registry of invasive infection caused by Streptococcus pneumoniae. The case index date was the date the infection was diagnosed. Six controls for each case, matched for gender, age and region of residency, were selected from the Swedish population registry. Each control was assigned the index date of their corresponding case to define the study observation period. We linked cases and controls to the Swedish registries for socioeconomic status (SES), occupational history and hospital discharge. We applied a job–exposure matrix to characterise occupational exposures. We used conditional logistic analyses, adjusted for comorbidities and SES, to estimate the OR of IPD and the subgroup pneumonia–IPD, associated with selected occupations and exposures in the year preceding the index date. Results Welders manifested increased risk of IPD (OR 2.99, 95% CI 2.09 to 4.30). Occupational exposures to fumes and silica dust were associated with elevated odds of IPD (OR 1.11, 95% CI 1.01 to 1.21 and OR 1.33, 95% CI 1.11 to 1.58, respectively). Risk associated with IPD with pneumonia followed a similar pattern with the highest occupational odds observed among welders and among silica dust exposed. Conclusion Work specifically as a welder, but also occupational exposures more broadly, increase the odds for IPD. Welders, and potentially others with relevant exposures, should be offered pneumococcal vaccination.
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Affiliation(s)
- Kjell Torén
- Occupational and Environmental medicine, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden .,Department of Occupational and Environmental Health, University of KwaZuluNatal, Durban, South Africa
| | - Paul D Blanc
- Division of Occupational and Environmental Medicine, Department of Medicine, University of California, San Francisco, California, United States
| | - Rajen N Naidoo
- Department of Occupational and Environmental Health, University of KwaZuluNatal, Durban, South Africa
| | - Nicola Murgia
- Section of Occupational Medicine, Respiratory Diseases and Toxicology University of Perugia, Perugia, Italy
| | - Ingemar Qvarfordt
- Department of Infection Prevention and Control, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Olov Aspevall
- Unit for Surveillance and Coordination, Public Health Agency, Solna, Stockholm, Sweden
| | - Anna Dahlman-Hoglund
- Department of Occupational and environmental medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Linus Schioler
- Occupational and Environmental medicine, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Blanc PD, Redlich CA. Reply to Lee and Strek: Occupational Burden in Chronic Respiratory Disease: Call for Recognition, Training, and Data Capture. Am J Respir Crit Care Med 2019; 200:1559. [PMID: 31343269 PMCID: PMC6909838 DOI: 10.1164/rccm.201907-1379le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Paul D Blanc
- University of California, San FranciscoSan Francisco, Californiaand
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43
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Affiliation(s)
- Paul D. Blanc
- Division of Occupational and Environmental MedicineUniversity of California San Francisco San Francisco CA USA
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44
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Abstract
Transient shoulder pain is a common complaint following intramuscular vaccine administration into the deltoid. More severe vaccination-associated shoulder complications comprising of weakness and decreased range of motion are categorized under the construct "shoulder injury related to vaccine administration" (SIRVA) that subsumes both subjective and objective findings consistent with injury. We describe the presentation and management of a case of SIRVA in a health care worker following seasonal influenza vaccine administration as part of a hospital-based employee health program and review the relevant biomedical literature. We present a case from a single medical center. All data were collected by professionals in occupational health by interviewing, performing physical examinations, and reviewing medical records associated with the injured worker. Severe pain and limited range of shoulder motion developed following an influenza vaccination that was administered using a poorly positioned, larger than recommended needle. Magnetic resonance imaging (MRI) demonstrated moderate glenohumeral joint effusion and synovitis, with fluid accumulating in the subscapularis recess within 1 week of injury. At 8 months after initial injury, MRI showed persistent mild tenosynovitis of the long head of the biceps tendon, interval accumulation of a large glenohumeral joint effusion, and infraspinatus tendinitis with subjacent reactive bone marrow edema. The affected worker experienced work restrictions but had no complete lost workdays to date due to the injury. Occupationally related SIRVA is a preventable adverse event that should be considered in workplace vaccine administration programs, and appropriate education and training provided to vaccine administrators to address this.
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Affiliation(s)
| | - Paul D Blanc
- University of California, San Francisco.,San Francisco VA Health Care System
| | - Sandra J Domeracki
- University of California, San Francisco.,San Francisco VA Health Care System
| | - Sandeep Guntur
- University of California, San Francisco.,San Francisco VA Health Care System
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Abstract
Pomalidomide, previously used to treat multiple myeloma, has been reported to cause acute pulmonary toxicity that improves with drug discontinuation. We present a case of delayed pneumonitis with persistent fibrosis associated with pomalidomide. A 61-year-old male treated with pomalidomide and corticosteroids presented with acute on chronic dyspnea, profound hypoxemia, and ground glass opacities on computerized tomographic imaging. Corticosteroid taper and discontinuation of pomalidomide resulted in clinical improvement, but with substantial residual pulmonary fibrosis. Given the temporal improvement, but not resolution, following discontinuation of an agent with an established propensity for lung injury, we attribute this presentation to pomalidomide toxicity.
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Affiliation(s)
| | - E C Callahan
- Department of Anesthesia, University of California, San Francisco (UCSF), San Francisco, California
| | - J K Brown
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Veterans Affairs Medical Center, and Department of Medicine, UCSF, San Francisco, California
| | - B Elicker
- Departments of Radiology and Biomedical Imaging
| | - B Ley
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine
| | - P D Blanc
- Division of Occupational and Environmental Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
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Schmajuk G, Trupin L, Yelin E, Blanc PD. Prevalence of Arthritis and Rheumatoid Arthritis in Coal Mining Counties of the United States. Arthritis Care Res (Hoboken) 2019; 71:1209-1215. [PMID: 30875457 DOI: 10.1002/acr.23874] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 03/05/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Exposure to inhaled mineral dust, in particular silica, is associated with increased odds of rheumatoid arthritis (RA) and other autoimmune diseases. We studied the association of RA with work-related coal and silica exposure in the Appalachian region of the US. METHODS We carried out a random-digit dialed telephone survey in selected counties in Appalachia that had elevated coal workers' pneumoconiosis mortality. Our study cohort included men ages ≥50 with any employment history, and we assessed exposure to coal mining employment, other work-related dust, and ergonomic factors. We ascertained self-reported physician diagnosis of any arthritis and of RA with glucocorticoid treatment. We used multivariable logistic regression analysis to estimate the odds ratios (ORs) and associated population attributable fraction (PAF) estimates. RESULTS Among the 973 men who met study entry criteria (mean ± SD ages 66 ± 10 years; 54% ever smokers), 266 (27%) reported coal mining work and 189 (19%) reported other work-related silica exposure. There were 517 men (53%), who reported any arthritis and 112 (12%) whose disease met the study definition of RA. Adjusting for covariates, coal mining was associated with elevated odds of RA (OR 3.6 [95% confidence interval (95% CI) 2.1-6.2]), which accounted for a PAF of 33% (95% CI 26-40%) of the men studied. For any arthritis, the coal mining-associated OR was 2.3 (95% CI 1.6-3.2), with an associated PAF of 20% (95% CI 14-25%). CONCLUSION In this population of older males living in a coal mining region, we estimated that 20% of arthritis and 33% of RA may be attributable to coal mining work.
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Affiliation(s)
- Gabriela Schmajuk
- University of California, San Francisco and the San Francisco Veterans Affairs Health Care System, San Francisco, California
| | | | | | - Paul D Blanc
- University of California, San Francisco and the San Francisco Veterans Affairs Health Care System, San Francisco, California
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47
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Greenland JR, Wang P, Brotman JJ, Ahuja R, Chong TA, Kleinhenz ME, Leard LE, Golden JA, Hays SR, Kukreja J, Singer JP, Rajalingam R, Jones K, Laszik ZG, Trivedi NN, Greenland NY, Blanc PD. Gene signatures common to allograft rejection are associated with lymphocytic bronchitis. Clin Transplant 2019; 33:e13515. [PMID: 30849195 DOI: 10.1111/ctr.13515] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 02/04/2019] [Accepted: 02/14/2019] [Indexed: 12/28/2022]
Abstract
Lymphocytic bronchitis (LB) precedes chronic lung allograft dysfunction. The relationships of LB (classified here as Endobronchial or E-grade rejection) to small airway (A- and B-grade) pathologies are unclear. We hypothesized that gene signatures common to allograft rejection would be present in LB. We studied LB in two partially overlapping lung transplant recipient cohorts: Cohort 1 included large airway brushes (6 LB cases and 18 post-transplant referents). Differential expression using DESeq2 was used for pathway analysis and to define an LB-associated metagene. In Cohort 2, eight biopsies for each pathology subtype were matched with pathology-free biopsies from the same subject (totaling 48 samples from 24 subjects). These biopsies were analyzed by multiplexed digital counting of immune transcripts. Metagene score differences were compared by paired t tests. Compared to referents in Cohort 1, LB demonstrated upregulation of allograft rejection pathways, and upregulated genes in these cases characterized an LB-associated metagene. We observed statistically increased expression in Cohort 2 for this LB-associated metagene and four other established allograft rejection metagenes in rejection vs paired non-rejection biopsies for both E-grade and A-grade subtypes, but not B-grade pathology. Gene expression-based categorization of allograft rejection may prove useful in monitoring lung allograft health.
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Affiliation(s)
- John R Greenland
- Medical Service, Veterans Affairs Health Care System, San Francisco, California.,Department of Medicine, University of California, San Francisco, California
| | - Ping Wang
- Department of Medicine, University of California, San Francisco, California
| | - Joshua J Brotman
- Department of Medicine, University of California, San Francisco, California
| | - Rahul Ahuja
- Medical Service, Veterans Affairs Health Care System, San Francisco, California
| | - Tiffany A Chong
- Department of Medicine, University of California, San Francisco, California
| | | | - Lorriana E Leard
- Department of Medicine, University of California, San Francisco, California
| | - Jeffrey A Golden
- Department of Medicine, University of California, San Francisco, California
| | - Steven R Hays
- Department of Medicine, University of California, San Francisco, California
| | - Jasleen Kukreja
- Department of Surgery, University of California, San Francisco, California
| | - Jonathan P Singer
- Department of Medicine, University of California, San Francisco, California
| | - Raja Rajalingam
- Department of Surgery, University of California, San Francisco, California
| | - Kirk Jones
- Department of Pathology, University of California, San Francisco, California
| | - Zoltan G Laszik
- Department of Pathology, University of California, San Francisco, California
| | - Neil N Trivedi
- Medical Service, Veterans Affairs Health Care System, San Francisco, California.,Department of Medicine, University of California, San Francisco, California
| | - Nancy Y Greenland
- Department of Pathology, University of California, San Francisco, California
| | - Paul D Blanc
- Medical Service, Veterans Affairs Health Care System, San Francisco, California.,Department of Medicine, University of California, San Francisco, California
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Lytras T, Kogevinas M, Kromhout H, Carsin AE, Antó JM, Bentouhami H, Weyler J, Heinrich J, Nowak D, Urrutia I, Martínez-Moratalla J, Gullón JA, Vega AP, Raherison Semjen C, Pin I, Demoly P, Leynaert B, Villani S, Gíslason T, Svanes Ø, Holm M, Forsberg B, Norbäck D, Mehta AJ, Probst-Hensch N, Benke G, Jogi R, Torén K, Sigsgaard T, Schlünssen V, Olivieri M, Blanc PD, Watkins J, Bono R, Buist AS, Vermeulen R, Jarvis D, Zock JP. Occupational exposures and incidence of chronic bronchitis and related symptoms over two decades: the European Community Respiratory Health Survey. Occup Environ Med 2019; 76:222-229. [PMID: 30700596 DOI: 10.1136/oemed-2018-105274] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 12/05/2018] [Accepted: 12/21/2018] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Chronic bronchitis (CB) is an important chronic obstructive pulmonary disease (COPD)-related phenotype, with distinct clinical features and prognostic implications. Occupational exposures have been previously associated with increased risk of CB but few studies have examined this association prospectively using objective exposure assessment. We examined the effect of occupational exposures on CB incidence in the European Community Respiratory Health Survey. METHODS Population samples aged 20-44 were randomly selected in 1991-1993, and followed up twice over 20 years. Participants without chronic cough or phlegm at baseline were analysed. Coded job histories during follow-up were linked to the ALOHA Job Exposure Matrix, generating occupational exposure estimates to 12 categories of chemical agents. Their association with CB incidence over both follow-ups was examined with Poisson models using generalised estimating equations. RESULTS 8794 participants fulfilled the inclusion criteria, contributing 13 185 observations. Only participants exposed to metals had a higher incidence of CB (relative risk (RR) 1.70, 95% CI 1.16 to 2.50) compared with non-exposed to metals. Mineral dust exposure increased the incidence of chronic phlegm (RR 1.72, 95% CI 1.43 to 2.06). Incidence of chronic phlegm was increased in men exposed to gases/fumes and to solvents and in women exposed to pesticides. CONCLUSIONS Occupational exposures are associated with chronic phlegm and CB, and the evidence is strongest for metals and mineral dust exposure. The observed differences between men and women warrant further investigation.
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Affiliation(s)
- Theodore Lytras
- Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Manolis Kogevinas
- Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Hans Kromhout
- IRAS, University of Utrecht, Utrecht, The Netherlands
| | - Anne-Elie Carsin
- Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Josep Maria Antó
- Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Hayat Bentouhami
- Department of Epidemiology and Social Medicine (ESOC), Faculty of Medicine and Health Sciences, StatUA Statistics Centre, University of Antwerp, Antwerp, Belgium
| | - Joost Weyler
- Department of Epidemiology and Social Medicine (ESOC), Faculty of Medicine and Health Sciences, StatUA Statistics Centre, University of Antwerp, Antwerp, Belgium
| | - Joachim Heinrich
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Centre, German Centre for Lung Research, University Hospital of Ludwig-Maximilians-University, Munich, Germany
| | - Dennis Nowak
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Centre, German Centre for Lung Research, University Hospital of Ludwig-Maximilians-University, Munich, Germany
| | - Isabel Urrutia
- Pulmonology Department, Galdakao Hospital, Galdakao, Spain
| | - Jesús Martínez-Moratalla
- Servicio de Neumología, Complejo Hospitalario Universitario, Albacete, Spain.,Facultad de Medicina Albacete, University of Castilla-La Mancha, Ciudad Real, Spain
| | | | - Antonio Pereira Vega
- Pulmonology and Allergy Clinical Unit, University Hospital Juan Ramón Jiménez, Huelva, Spain
| | - Chantal Raherison Semjen
- Inserm, Bordeaux Population Health Research Center, Team EPICENE, UMR 1219, Université de Bordeaux, Bordeaux, France
| | - Isabelle Pin
- Department of Pédiatrie, CHU de Grenoble Alpes, Grenoble, France.,U1209, IAB, Team of Environmental Epidemiology applied to Reproduction and Respiratory Health, INSERM, Grenoble, France.,Université Grenoble Alpes, Grenoble, France
| | - Pascal Demoly
- University Hospital of Montpellier, Montpellier, France.,Sorbonne Universités, Paris, France
| | - Bénédicte Leynaert
- Inserm UMR 1152-Equipe Epidémiologie, Université Paris Diderot, Paris, France
| | - Simona Villani
- Section of Epidemiology and Medical Statistics, Department of Health Sciences, University of Pavia, Pavia, Italy
| | - Thorarinn Gíslason
- Department of Respiratory Medicine and Sleep, Landspitali University Hospital, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Øistein Svanes
- Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Mathias Holm
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Bertil Forsberg
- Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Dan Norbäck
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Amar J Mehta
- Office of Research and Evaluation, Boston Public Health Commission, Boston, Massachusetts, USA
| | - Nicole Probst-Hensch
- Department Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Geza Benke
- Monash Centre for Occupation and Environmental Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rain Jogi
- Lung Clinic, Tartu University Hospital, Tartu, Europe
| | - Kjell Torén
- Section of Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Torben Sigsgaard
- Section for Environment, Occupation and Health, Department of Public Health, Danish Ramazzini Center, Aarhus University, Aarhus, Denmark
| | - Vivi Schlünssen
- Section for Environment, Occupation and Health, Department of Public Health, Danish Ramazzini Center, Aarhus University, Aarhus, Denmark.,National Research Center for the Working Environment, Copenhagen, Denmark
| | - Mario Olivieri
- Unit of Occupational Medicine, University Hospital of Verona, Verona, Italy
| | - Paul D Blanc
- San Francisco Veterans Affairs Medical Center, University of California San Francisco, San Francisco, California, USA
| | - John Watkins
- School of Medicine, Cardiff University, Cardiff, Wales, UK.,Public Health Wales, Cardiff, Wales, UK
| | - Roberto Bono
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - A Sonia Buist
- Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | | | - Deborah Jarvis
- School of Medicine, Cardiff University, Cardiff, Wales, UK.,Public Health Wales, Cardiff, Wales, UK.,Department of Public Health and Pediatrics, University of Turin, Turin, Italy.,Population Health and Occupational Disease, National Heart and Lung Institute, MRC-PHE Centre for Environment and Health, Imperial College London, London, UK.,MRC-PHE Centre for Environment and Health, Imperial College London, London, UK
| | - Jan-Paul Zock
- Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Paulin LM, Smith BM, Koch A, Han M, Hoffman EA, Martinez C, Ejike C, Blanc PD, Rous J, Barr RG, Peters SP, Paine R, Pirozzi C, Cooper CB, Dransfield MT, Comellas AP, Kanner RE, Drummond MB, Putcha N, Hansel NN. Occupational Exposures and Computed Tomographic Imaging Characteristics in the SPIROMICS Cohort. Ann Am Thorac Soc 2018; 15:1411-1419. [PMID: 30339479 PMCID: PMC6322018 DOI: 10.1513/annalsats.201802-150oc] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 07/23/2018] [Indexed: 12/16/2022] Open
Abstract
RATIONALE Quantitative computed tomographic (CT) imaging can aid in chronic obstructive pulmonary disease (COPD) phenotyping. Few studies have identified whether occupational exposures are associated with distinct CT imaging characteristics. OBJECTIVES To examine the association between occupational exposures and CT-measured patterns of disease in the SPIROMICS (Subpopulations and Intermediate Outcome Measures in COPD Study). METHODS Participants underwent whole-lung multidetector helical CT at full inspiration and expiration. The association between occupational exposures (self-report of exposure to vapors, gas, dust, or fumes [VGDF] at the longest job) and CT metrics of emphysema (percentage of total voxels < -950 Hounsfield units at total lung capacity), large airways (wall area percent [WAP] and square-root wall area of a single hypothetical airway with an internal perimeter of 10 mm [Pi10]), and small airways (percent air trapping [percent total voxels < -856 Hounsfield units at residual volume] and parametric response mapping of functional small-airway abnormality [PRM fSAD]) were explored by multivariate linear regression, and for central airway measures by generalized estimating equations to account for multiple measurements per individual. Models were adjusted for age, sex, race, current smoking status, pack-years of smoking, body mass index, and site. Airway measurements were additionally adjusted for total lung volume. RESULTS A total of 2,736 participants with available occupational exposure data (n = 927 without airflow obstruction and 1,809 with COPD) were included. The mean age was 64 years, 78% were white, and 54% were male. Forty percent reported current smoking, and mean (SD) pack-years was 49.3 (26.9). Mean (SD) post-bronchodilator forced expiratory volume in 1 second (FEV1) was 73 (27) % predicted. Forty-nine percent reported VGDF exposure. VGDF exposure was associated with higher emphysema (β = 1.17; 95% confidence interval [CI], 0.44-1.89), greater large-airway disease as measured by WAP (segmental β = 0.487 [95% CI, 0.320-0.654]; subsegmental β = 0.400 [95% CI, 0.275-0.527]) and Pi10 (β = 0.008; 95% CI, 0.002-0.014), and greater small-airway disease was measured by air trapping (β = 2.60; 95% CI, 1.11-4.09) and was nominally associated with an increase in PRM fSAD (β = 1.45; 95% CI, 0.31-2.60). These findings correspond to higher odds of percent emphysema, WAP, and air trapping above the 95th percentile of measurements in nonsmoking control subjects in individuals reporting VGDF exposure. CONCLUSIONS In an analysis of SPIROMICS participants, we found that VGDF exposure in the longest job was associated with an increase in emphysema, and in large- and small-airway disease, as measured by quantitative CT imaging.
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Affiliation(s)
- Laura M. Paulin
- Department of Medicine, Dartmouth-Hitchcock Medical Center/Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Benjamin M. Smith
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York
- Translational Research in Respiratory Diseases Program, Department of Medicine, McGill University Health Centre Research Institute, Montreal, Quebec, Canada
| | - Abby Koch
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - MeiLan Han
- Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Eric A. Hoffman
- Department of Radiology, University of Iowa, Iowa City, Iowa
| | - Carlos Martinez
- Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Chinedu Ejike
- Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Paul D. Blanc
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Jennifer Rous
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - R. Graham Barr
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Stephen P. Peters
- Department of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Robert Paine
- Department of Medicine, University of Utah, Salt Lake City, Utah
| | - Cheryl Pirozzi
- Department of Medicine, University of Utah, Salt Lake City, Utah
| | - Christopher B. Cooper
- Department of Medicine, University of California, Los Angeles, Los Angeles, California
| | | | | | | | - M. Brad Drummond
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Nirupama Putcha
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Nadia N. Hansel
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
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50
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Torén K, Andersson M, Olin AC, Blanc PD, Järvholm B. Airflow limitation classified with the fixed ratio or the lower limit of normal and cause-specific mortality - A prospective study. Respir Med 2018; 144:36-41. [PMID: 30366582 DOI: 10.1016/j.rmed.2018.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 09/29/2018] [Accepted: 10/01/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND There is controversy as to whether airflow limitation should be defined as forced expiratory volume in 1 s (FEV1)/vital capacity (VC) < 0.7 or as FEV1/VC< the lower limit of normal (LLN). The aim was to examine whether different definitions of airflow limitation differ in predicting mortality. METHODS Longitudinal prospective study of a national cohort of Swedish workers (199,408 men; 7988 women), aged 20-64 years with spirometry without bronchodilation at baseline followed from 1979 until death, or censorship at 2010. Airflow limitation (AL) by Global Obstructive Lung Disease criteria, ALGOLD, was defined as FEV1/VC < 0.7; ALLLN as FEV1/VC < LLN. All all-cause, COPD and cardiovascular disease mortality was analyzed among men and women in relation to ALGOLD and ALLLN, adjusted for age and smoking. RESULTS Among men, all-cause mortality risks were similar by airflow limitation criteria: ALGOLD RR = 1.32, 95% CI 1.26-1.38; ALLLN, RR = 1.37, 95% CI 1.31-1.44. The risk estimates were also similar by airflow limitation definition for cardiovascular mortality and for COPD mortality. Among women, all-cause mortality was also similar by airflow limitation criteria, but significantly higher as compared to men: ALGOLD RR = 2.10, 95% CI 1.66-2.66; ALLLN, RR = 2.09, 95% CI 1.66-2.62. Also cardiovascular and COPD mortality by airflow limitation criteria was significantly higher among women as compared to men. CONCLUSIONS Defined either as FEV1/VC < 0.7 or as FEV1/VC < LLN, airflow limitation predicted excess mortality risk of similar magnitude. Mortality in relation to airflow limitation was higher among women compared to men.
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Affiliation(s)
- Kjell Torén
- Section of Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg, Box 414, SE-405 30, Gothenburg, Sweden; Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Box 414, SE-405 30, Gothenburg, Sweden.
| | - Martin Andersson
- Department of Occupational and Environmental Medicine, Institute of Clinical Medicine and Public Health, University of Umeå, SE-901 87, Umeå, Sweden
| | - Anna-Carin Olin
- Section of Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg, Box 414, SE-405 30, Gothenburg, Sweden; Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Box 414, SE-405 30, Gothenburg, Sweden
| | - Paul D Blanc
- Division of Occupational and Environmental Medicine, Department of Medicine, University of California, PO 0924, San Francisco, CA, USA
| | - Bengt Järvholm
- Department of Occupational and Environmental Medicine, Institute of Clinical Medicine and Public Health, University of Umeå, SE-901 87, Umeå, Sweden
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