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Adams R, Jordan R, Adab P, Barrett T, Bevan S, Cooper L, DuRand I, Hardy P, Heneghan N, Jolly K, Jowett S, Marshall T, O'Hara M, Rai K, Rickards H, Riley R, Sadhra S, Tearne S, Walters G, Sapey E. Enhancing the health of NHS staff: eTHOS - protocol for a randomised controlled pilot trial of an employee health screening clinic for NHS staff to reduce absenteeism and presenteeism, compared with usual care. Pilot Feasibility Stud 2022; 8:155. [PMID: 35897113 PMCID: PMC9326142 DOI: 10.1186/s40814-022-01095-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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 06/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Staff absenteeism and presenteeism incur high costs to the NHS and are associated with adverse health outcomes. The main causes are musculoskeletal complaints and mental ill-health, which are potentially modifiable, and cardiovascular risk factors are also common. We will test the feasibility of an RCT to evaluate the clinical and cost-effectiveness of an employee health screening clinic on reducing sickness absenteeism and presenteeism. METHODS This is an individually randomised controlled pilot trial aiming to recruit 480 participants. All previously unscreened employees from four hospitals within three UK NHS hospital Trusts will be eligible. Those randomised to the intervention arm will be invited to attend an employee health screening clinic consisting of a screening assessment for musculoskeletal (STarT MSK and STarT Back), mental (PHQ-9 and GAD-7) and cardiovascular (NHS Health Check if aged ≥ 40, lifestyle check if < 40 years) health. Screen positives will be given advice and/or referral to recommended services. Those randomised to the control arm will receive usual care. Participants will complete a questionnaire at baseline and 26 weeks; anonymised absenteeism and staff demographics will also be collected from personnel records. The co-primary outcomes are as follows: recruitment, referrals and uptake of recommended services in the intervention arm. Secondary outcomes include the following: results of screening assessments, uptake of individual referrals, reported changes in health behaviours, acceptability and feasibility of intervention, indication of contamination and costs. Outcomes related to the definitive trial include self-reported and employee records of absenteeism with reasons. Process evaluation to inform a future trial includes interviews with participants, intervention delivery staff and service providers receiving referrals. Analyses will include presentation of descriptive statistics, framework analysis for qualitative data and costs and consequences presented for health economics. DISCUSSION The study will provide data to inform the design of a definitive RCT which aims to find an effective and cost-effective method of reducing absenteeism and presenteeism amongst NHS staff. The feasibility study will test trial procedures, and process outcomes, including the success of strategies for including underserved groups, and provide information and data to help inform the design and sample size for a definitive trial. TRIAL REGISTRATION ISRCTN reference number 10237475 .
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Affiliation(s)
- Rachel Adams
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Rachel Jordan
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Peymané Adab
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Tim Barrett
- Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK
| | - Sheriden Bevan
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Lucy Cooper
- Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK
| | - Ingrid DuRand
- Hereford County Hospital, Stonebow Road, Hereford, HR1 2ER, UK
| | - Pollyanna Hardy
- National Perinatal Epidemiology Unit Clinical Trials Unit, University of Oxford, Oxford, UK
| | - Nicola Heneghan
- School of Sport, Exercise and Rehabilitation, University of Birmingham, Birmingham, B15 2TT, UK
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Sue Jowett
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Tom Marshall
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Margaret O'Hara
- Public and Patient Involvement and Engagement, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK
| | - Kiran Rai
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Hugh Rickards
- Institute of Clinical Sciences, University of Birmingham, Birmingham, B15 2TT, UK.,National Centre for Mental Health, Barberry Building, 25 Vincent Drive, Birmingham, B15 2FG, UK
| | - Ruth Riley
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Steven Sadhra
- Institute of Clinical Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Sarah Tearne
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Gareth Walters
- Birmingham Heartlands Hospital, Bordesley Green East, Birmingham, B9 5SS, UK
| | - Elizabeth Sapey
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2TT, UK.,Respiratory Medicine and General Internal Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, B15 2TH, UK
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Ubhi M, Dubey S, Gordon C, Adizie T, Sheeran T, Allen K, Jordan R, Sadhra S, Adams J, Daji R, Reynolds JA, Kumar K. Understanding the impact of systemic lupus erythematosus on work amongst South Asian people in the UK: An explorative qualitative study. Lupus 2021; 30:1492-1501. [PMID: 34092136 PMCID: PMC8283190 DOI: 10.1177/09612033211022816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
SLE has a range of fluctuating symptoms affecting individuals and their ability to work. Although South Asian (SA) patients are at increased risk of developing SLE there is limited knowledge of the impact on employment for these patients in the UK. Understanding ethnicity and disease-specific issues are important to ensure patients are adequately supported at work. Semi-structured interviews were conducted with patients of SA origin to explore how SLE impacted on their employment. Thematic analysis was used to analyse the data which are reported following COREQ guidelines. Ten patients (8 female; 2 male) were recruited from three rheumatology centres in the UK and interviewed between November 2019 and March 2020. Patients were from Indian (n = 8) or Pakistani (n = 2) origin and worked in a range of employment sectors. Four themes emerged from the data: (1) Disease related factors; (2) Employment related factors; (3) Cultural and interpersonal factors impacting on work ability; (4) Recommendations for improvement. Patients’ ability to work was affected by variable work-related support from their hospital clinicians, low awareness of SLE and variable support from their employers, and cultural barriers in their communities that could affect levels of family support received. These findings highlight the need for additional support for SA patients with SLE in the workplace.
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Affiliation(s)
- Mandeep Ubhi
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Shirish Dubey
- University Hospitals Coventry, Coventry, UK.,Warwickshire NHS Trust, Warwick, UK
| | - Caroline Gordon
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.,Sandwell and West Birmingham NHS Trust, West Bromwich, UK
| | | | - Tom Sheeran
- Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Kerry Allen
- School of Social Policy, University of Birmingham, Birmingham, UK
| | - Rachel Jordan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Steven Sadhra
- Institute of Occupational and Environmental Medicine, University of Birmingham, Birmingham, UK
| | - Jo Adams
- Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | | | - John A Reynolds
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.,Sandwell and West Birmingham NHS Trust, West Bromwich, UK
| | - Kanta Kumar
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
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Skaaby S, Flachs EM, Lange P, Schlünssen V, Marott JL, Brauer C, Çolak Y, Afzal S, Nordestgaard BG, Sadhra S, Kurmi O, Bonde JPE. Occupational inhalant exposures and longitudinal lung function decline. Eur Respir J 2021; 58:13993003.04341-2020. [PMID: 33958430 DOI: 10.1183/13993003.04341-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 04/11/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Stinna Skaaby
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Esben Meulengracht Flachs
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Peter Lange
- Section of Epidemiology, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark.,Department of Respiratory Medicine, Copenhagen University Hospital - Herlev Gentofte, Herlev, Denmark.,Copenhagen City Heart Study, Copenhagen University Hospital Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,Copenhagen General Population Study, Copenhagen University Hospital - Herlev and Gentofte Hospital, Herlev, Denmark
| | - Vivi Schlünssen
- Department of Public Health, Danish Ramazzini Centre, University of Aarhus, Aarhus, Denmark.,National Research Center for the Working Environment, Copenhagen, Denmark
| | - Jacob Louis Marott
- Copenhagen City Heart Study, Copenhagen University Hospital Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,Copenhagen General Population Study, Copenhagen University Hospital - Herlev and Gentofte Hospital, Herlev, Denmark
| | - Charlotte Brauer
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Yunus Çolak
- Department of Respiratory Medicine, Copenhagen University Hospital - Herlev Gentofte, Herlev, Denmark.,Copenhagen General Population Study, Copenhagen University Hospital - Herlev and Gentofte Hospital, Herlev, Denmark.,Department of Clinical Biochemistry, Copenhagen University Hospital - Herlev and Gentofte Hospital, Herlev, Denmark
| | - Shoaib Afzal
- Copenhagen General Population Study, Copenhagen University Hospital - Herlev and Gentofte Hospital, Herlev, Denmark.,Department of Clinical Biochemistry, Copenhagen University Hospital - Herlev and Gentofte Hospital, Herlev, Denmark
| | - Børge G Nordestgaard
- Copenhagen City Heart Study, Copenhagen University Hospital Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,Copenhagen General Population Study, Copenhagen University Hospital - Herlev and Gentofte Hospital, Herlev, Denmark.,Department of Clinical Biochemistry, Copenhagen University Hospital - Herlev and Gentofte Hospital, Herlev, Denmark
| | - Steven Sadhra
- Institute of Occupational and Environmental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Om Kurmi
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK.,Division of Respirology, Department of Medicine, McMaster University, Hamilton, Canada
| | - Jens Peter Ellekilde Bonde
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark.,Section of Epidemiology, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
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Ubhi M, Dubey S, Reynolds J, Gordon C, Adizie T, Sheeran T, Allen K, Jordan R, Sadhra S, Adams J, Daji R, Kumar K. P159 Factors associated between SLE and work amongst South Asian people: an explorative qualitative study. Rheumatology (Oxford) 2021. [DOI: 10.1093/rheumatology/keab247.155] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Aims
Systemic lupus erythematosus (SLE) affect patients from minority ethnic backgrounds, with many patients experiencing symptoms that affect their daily lives despite receiving long-term controller medication. Work is a large part of most people’s lives, yet little has been explored into how people from minority ethnic backgrounds cope at work whilst living with SLE. We conducted a study to understand the impact of SLE on working lives of South Asian patients. The aim was to identify and develop support mechanisms that could assist them with remaining at work.
Methods
Semi-structured interviews were conducted with ten patients of South Asian origin with SLE to explore their work experiences. Patients were recruited from three rheumatology centres in the West Midlands, UK and were interviewed between November 2019 and March 2020. Interviews were audio-recorded and typed by an independent transcribing company. Returned transcripts were analysed using thematic analysis and QSR NVivo 12 software was used to organise and manage the data.
Results
The majority (n = 8) of patients were female. Eight patients were from an Indian background, and two were from a Pakistani background. Half of all patients were educated to degree level. The age range of patients was 23 - 58 years old (S.D = 10.79), and disease duration varied between 3 months-33 years (S.D = 9.52). All patients had permanent jobs; six were in full-time employment, and four were in part-time employment. Four main themes emerged from the data: 1) Disease related factors; impacting work ability; 2) Employment related factors; impacting work ability; 3) Personal and cultural related factors; impacting work ability; 4) Recommendations for improvement were made by patients.
Conclusion
In this novel study we highlight patients’ experiences of being at work. This study reports low awareness of SLE and mixed support in the workplace. Patients discussed work to varying degrees with their clinicians and needed further information for employers that was not available nor provided by their clinicians. The study reports cultural barriers in understanding SLE that could lead to lack of family support to remain in employment. Moreover, recommendations made in this study require further investigation and could be used by clinicians and Lupus UK to support patients of South Asian origin at work.
Disclosure
M. Ubhi: None. S. Dubey: None. J. Reynolds: None. C. Gordon: None. T. Adizie: None. T. Sheeran: None. K. Allen: None. R. Jordan: None. S. Sadhra: None. J. Adams: None. R. Daji: None. K. Kumar: None.
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Affiliation(s)
- Mandeep Ubhi
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UNITED KINGDOM
| | - Shirish Dubey
- Department of Rheumatology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UNITED KINGDOM
| | - John Reynolds
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UNITED KINGDOM
| | - Caroline Gordon
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UNITED KINGDOM
| | - Tochukwu Adizie
- Department of Rheumatology, Royal Wolverhampton NHS Trust, UK, Wolverhampton, UNITED KINGDOM
| | - Tom Sheeran
- Department of Rheumatology, Royal Wolverhampton NHS Trust, UK, Wolverhampton, UNITED KINGDOM
| | - Kerry Allen
- School of Social Policy, University of Birmingham, Birmingham, UNITED KINGDOM
| | - Rachel Jordan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UNITED KINGDOM
| | - Steven Sadhra
- Institute of Occupational and Environmental Medicine7, University of Birmingham, Birmingham, UNITED KINGDOM
| | - Jo Adams
- Faculty of Health Sciences, University of Southampton, Birmingham, UNITED KINGDOM
| | | | - Kanta Kumar
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UNITED KINGDOM
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Chaudhary N, Yadav SN, Kalra SK, Pathak S, Gupta BK, Shrestha S, Patel M, Satia I, Sadhra S, Bolton CE, Kurmi OP. Prognostic factors associated with small for gestational age babies in a tertiary care hospital of Western Nepal: A cross-sectional study. Health Sci Rep 2021; 4:e250. [PMID: 33614985 PMCID: PMC7883381 DOI: 10.1002/hsr2.250] [Citation(s) in RCA: 3] [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: 07/08/2020] [Revised: 01/07/2021] [Accepted: 01/21/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Small for gestational age (SGA) is common among newborns in low-income countries like Nepal and has higher immediate mortality and morbidities. OBJECTIVES To study the prevalence and prognostic factors of SGA babies in Western Nepal. METHODS A cross-sectional study (November 2016-October 2017) was conducted in a tertiary care hospital in Western Nepal. Socio-demographic, lifestyle factors including diet, and exposures including smoking and household air pollution in mothers who delivered newborns appropriate for gestational age (AGA), SGA and large for gestational age (LGA) were recorded. Logistic regression was carried out to find the odds ratio of prognostic factors after adjusting for potential confounders. RESULTS Out of 4000 delivered babies, 77% (n = 3078) were AGA, 20.3% (n = 813) were SGA and 2.7% (n = 109) were LGA. The proportion of female-SGA was greater in comparison to male-SGA (n = 427, 52.5% vs n = 386, 47.5%). SGA babies were born to mothers who had term, preterm, and postterm delivery in the following proportions 70.1%, 19.3%, and 10.6%, respectively. The average weight gain (mean ± SD) by mothers in AGA pregnancies was 10.3 ± 2.4 kg, whereas in SGA were 9.3 ± 2.4 kg. In addition to low socioeconomic status (OR 1.9, 95% CI 1.1, 3.2), other prognostic factors associated with SGA were lifestyle factors such as low maternal sleep duration (OR 5.1, CI 3.6, 7.4) and monthly or less frequent meat intake (OR 5.0, CI 3.2, 7.8). Besides smoking (OR 8.8, CI 2.1, 36.3), the other major environmental factor associated with SGA was exposure to household air pollution (OR 5.4, 4.1, 6.9) during pregnancy. Similarly, some of the adverse health conditions associated with a significantly higher risk of SGA were anemia, oligohydramnios, and gestational diabetes. CONCLUSIONS SGA is common in Western Nepal and associated with several modifiable prognostic factors.
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Affiliation(s)
- Nagendra Chaudhary
- Department of PediatricsUniversal College of Medical SciencesBhairahawaNepal
| | - Shree Narayan Yadav
- Department of PediatricsUniversal College of Medical SciencesBhairahawaNepal
- Department of PediatricsChitwan Medical CollegeBharatpurNepal
| | - Suresh Kumar Kalra
- Department of PediatricsUniversal College of Medical SciencesBhairahawaNepal
| | - Santosh Pathak
- Department of PediatricsChitwan Medical CollegeBharatpurNepal
| | - Binod Kumar Gupta
- Department of PediatricsUniversal College of Medical SciencesBhairahawaNepal
| | - Sandeep Shrestha
- Department of PediatricsUniversal College of Medical SciencesBhairahawaNepal
| | - Matthew Patel
- The Royal College of Surgeons in IrelandDublinIreland
| | - Imran Satia
- Division of Respirology, Department of MedicineMcMaster UniversityHamiltonOntarioCanada
| | - Steven Sadhra
- Institute of Clinical SciencesCollege of Medical and Dental Sciences, University of BirminghamBirminghamUK
| | - Charlotte Emma Bolton
- NIHR Nottingham Biomedical Research CentreSchool of Medicine, University of NottinghamNottinghamUK
| | - Om Prakash Kurmi
- Division of Respirology, Department of MedicineMcMaster UniversityHamiltonOntarioCanada
- Faculty of Health and Life SciencesUniversity of CoventryCoventryUK
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Skaaby S, Flachs EM, Lange P, Schlünssen V, Marott JL, Brauer C, Nordestgaard BG, Sadhra S, Kurmi O, Bonde JPE. Chronic productive cough and inhalant occupational exposure-a study of the general population. Int Arch Occup Environ Health 2021; 94:1033-1040. [PMID: 33559749 DOI: 10.1007/s00420-020-01634-2] [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: 06/19/2020] [Accepted: 12/15/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE Occupational inhalant exposures have been linked with a higher occurrence of chronic productive cough, but recent studies question the association. METHODS We included participants from two general population studies, the Copenhagen City General Population Study and the Copenhagen City Heart Study, to assess contemporary (year 2003-2017) and historical (1976-1983) occupational inhalant hazards. Job titles one year prior to study inclusion and an airborne chemical job-exposure matrix (ACE JEM) were used to estimate occupational exposure. The association between occupational exposures and self-reported chronic productive cough was studied using generalized estimating equations stratified by smoking status and cohort. RESULTS The population consisted of 5210 working individuals aged 20-65 from 1976 to 1983 and 64,279 from 2003 to 2017. In smokers, exposure to high levels of mineral dust, biological dust, gases & fumes and the composite variable vapours, gases, dusts or fumes (VGDF) were associated with chronic productive cough in both cohorts with odds ratios in the range of 1.2 (95% confidence interval, 1.0;1.4) to 1.6 (1.2;2.1). High levels of biological dust were only associated with an increased risk of a chronic productive cough in the 2003-2017 cohort (OR 1.5 (1.1;2.0)). In non-smokers, high levels of VGDF (OR 1.5 (1.0;2.3)) and low levels of mineral dust (OR 1.7 (1.1;2.4)) were associated with chronic productive cough in the 1976-1983 cohort, while no associations were seen in non-smokers in the 2003-2017 cohort. CONCLUSION Occupational inhalant exposure remains associated with a modestly increased risk of a chronic productive cough in smokers, despite declining exposure levels during the past four decades.
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Affiliation(s)
- Stinna Skaaby
- Department of Occupational and Environmental Medicine, Bispebjerg Frederiksberg Hospital, Copenhagen University Hospital, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark.
| | - Esben Meulengracht Flachs
- Department of Occupational and Environmental Medicine, Bispebjerg Frederiksberg Hospital, Copenhagen University Hospital, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark
| | - Peter Lange
- Institute of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark.,Department of Medicine, Herlev Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark.,Copenhagen City Heart Study, Bispebjerg Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark.,Copenhagen General Population Study, Herlev Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Vivi Schlünssen
- Department of Public Health, Danish Ramazzini Centre, University of Aarhus, Aarhus, Denmark.,National Research Center for the Working Environment, Copenhagen, Denmark
| | - Jacob Louis Marott
- Copenhagen City Heart Study, Bispebjerg Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark.,Copenhagen General Population Study, Herlev Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Charlotte Brauer
- Department of Occupational and Environmental Medicine, Bispebjerg Frederiksberg Hospital, Copenhagen University Hospital, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark
| | - Børge G Nordestgaard
- Copenhagen City Heart Study, Bispebjerg Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark.,Copenhagen General Population Study, Herlev Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark.,Department of Clinical Biochemistry, Herlev Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Steven Sadhra
- Institute of Occupational and Environmental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Om Kurmi
- Division of Respirology, Department of Medicine, McMaster University, Hamilton, Canada
| | - Jens Peter Ellekilde Bonde
- Department of Occupational and Environmental Medicine, Bispebjerg Frederiksberg Hospital, Copenhagen University Hospital, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark.,Institute of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
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Skaaby S, Flachs EM, Lange P, Schlünssen V, Marott JL, Brauer C, Nordestgaard BG, Sadhra S, Kurmi O, Bonde JPE. Occupational exposures and exacerbations of asthma and COPD-A general population study. PLoS One 2020; 15:e0243826. [PMID: 33370308 PMCID: PMC7769267 DOI: 10.1371/journal.pone.0243826] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 11/27/2020] [Indexed: 11/28/2022] Open
Abstract
Purpose Recent studies suggest that occupational inhalant exposures trigger exacerbations of asthma and chronic obstructive pulmonary disease, but findings are conflicting. Methods We included 7,768 individuals with self-reported asthma (n = 3,215) and/or spirometric airflow limitation (forced expiratory volume in 1 second (FEV1)/ forced expiratory volume (FVC) <0.70) (n = 5,275) who participated in The Copenhagen City Heart Study or The Copenhagen General Population Study from 2001–2016. Occupational exposure was assigned by linking job codes with job exposure matrices, and exacerbations were defined by register data on oral corticosteroid treatment, emergency care unit assessment or hospital admission. Associations between occupational inhalant exposure each year of follow-up and exacerbation were assessed by Cox regression with time varying exposure and age as the underlying time scale. Results Participants were followed for a median of 4.6 years (interquartile range, IQR 5.4), during which 870 exacerbations occurred. Exacerbations were not associated with any of the selected exposures (high molecular weight sensitizers, low molecular weight sensitizers, irritants or low and high levels of mineral dust, biological dust, gases & fumes or the composite variable vapours, gases, dusts or fumes). Hazards ratios ranged from 0.8 (95% confidence interval: 0.7;1.0) to 1.2 (95% confidence interval: 0.9;1.7). Conclusion Exacerbations of obstructive airway disease were not associated with occupational inhalant exposures assigned by a job exposure matrix. Further studies with alternative exposure assessment are warranted.
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Affiliation(s)
- Stinna Skaaby
- Department of Occupational and Environmental Medicine, Bispebjerg Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
- * E-mail:
| | - Esben Meulengracht Flachs
- Department of Occupational and Environmental Medicine, Bispebjerg Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Peter Lange
- Section of Epidemiology, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Medicine, Herlev Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
- Copenhagen City Heart Study, Bispebjerg Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
- Copenhagen General Population Study, Herlev Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Vivi Schlünssen
- Department of Public Health, Environmental, Work and Health, Danish Ramazzini Centre, University of Aarhus, Aarhus, Denmark
- National Research Center for the Working Environment, Copenhagen, Denmark
| | - Jacob Louis Marott
- Copenhagen City Heart Study, Bispebjerg Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
- Copenhagen General Population Study, Herlev Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Charlotte Brauer
- Department of Occupational and Environmental Medicine, Bispebjerg Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Børge G. Nordestgaard
- Copenhagen City Heart Study, Bispebjerg Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
- Copenhagen General Population Study, Herlev Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
- Department of Clinical Biochemistry, Herlev Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Steven Sadhra
- Institute of Occupational and Environmental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Om Kurmi
- Faculty of Health and Life Sciences, Coventry University, Coventry, United Kingdom
- Division of Respirology, Department of Medicine, McMaster University, Hamilton, Canada
| | - Jens Peter Ellekilde Bonde
- Department of Occupational and Environmental Medicine, Bispebjerg Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
- Section of Epidemiology, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
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8
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Jain A, Aggarwal A, Adams J, Jordan RE, Sadhra S, Dubey S, Allen K, Kumar K. Delay in seeking medical help in patients with rheumatoid arthritis in India: A qualitative study. Int J Rheum Dis 2020; 23:1707-1718. [PMID: 33068335 DOI: 10.1111/1756-185x.14001] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/16/2020] [Accepted: 09/21/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Rheumatoid arthritis (RA) is an autoimmune disease with varied articular and extra-articular manifestations. In developing countries such as India patients with RA often delay seeking medical advice which may impact prognosis and disease burden. AIM To explore perceptions and experiences of patients living in India in seeking medical help for their RA symptoms. METHODS Clinician-diagnosed RA participants from different socioeconomic backgrounds were interviewed using a semi-structured topic guide. Participants were purposively selected and interviewed following an iterative approach. All interviews were recorded and transcribed by an independent company and analyzed using a thematic framework. Findings were reported in accordance with consolidated criteria for reporting qualitative research guidelines. RESULTS Twenty participants (13 male, 7 female) with median age 40 years (35.7-46.5) were recruited. Three overarching themes demonstrating participants' experiences and reasons for delay in seeking medical help were identified. (1) "Symptoms perspectives and delay in participants' journey" narrated participants' experiences of having RA symptoms, how these were perceived, rationalized and led to delay. (2) "Participants' experience of the healthcare system" illustrated delay in referral, reaching diagnosis and treatment initiation highlighting their experiences with the health system. (3) "Recommendations for improving care" where participants made recommendations for reducing the delay at local and national levels. CONCLUSION This is the first qualitative study which explored perceptions and experiences of RA patients in India resulting in delay. Improved provision of rheumatology care, effective referral system and greater involvement of government at local and national levels are needed to improve the delay in seeking medical help for Indian patients.
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Affiliation(s)
- Avinash Jain
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Amita Aggarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Jo Adams
- School of Health Sciences, Faculty of Environment and Life Sciences, University of Southampton, UK
| | - Rachel E Jordan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Steven Sadhra
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Shirish Dubey
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Kerry Allen
- School of Social Policy, University of Birmingham, Birmingham, UK
| | - Kanta Kumar
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
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Patel M, Shrestha MK, Manandhar A, Gurung R, Sadhra S, Cusack R, Chaudhary N, Ruit S, Ayres J, Kurmi OP. Effect of exposure to biomass smoke from cooking fuel types and eye disorders in women from hilly and plain regions of Nepal. Br J Ophthalmol 2020; 106:141-148. [DOI: 10.1136/bjophthalmol-2020-316766] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/27/2020] [Indexed: 02/02/2023]
Abstract
Background/AimTo study the association between exposure to biomass smoke from cooking fuels andi cataract, visual acuity and ocular symptoms in women.MethodsWe conducted a community-based cross-sectional study among women (≥20 years and without a previous diagnosis of cataract, ocular trauma or diabetes or those taking steroids) from hilly and plain regions of Nepal. Eligible participants received an interview and a comprehensive eye assessment (cataract development, visual acuity test and ocular symptoms). Participants’ data on demographics, cooking fuel type and duration of use, and cooking habits were collected. We addressed potential confounders using the propensity score and other risk factors for ocular diseases through regression analysis.ResultsOf 784 participants, 30.6% used clean fuel (liquefied petroleum gas, methane, electricity) as their primary current fuel, and the remaining 69.4% used biomass fuels. Thirty-nine per cent of the total participants had cataracts—about twofold higher in those who currently used biomass fuel compared with those who used clean fuel (OR=2.27; 95% CI 1.09 to 4.77) and over threefold higher in those who always used biomass. Similarly, the nuclear cataract was twofold higher in the current biomass user group compared with the clean fuel user group (OR=2.53; 95% CI 1.18–5.42) and over threefold higher among those who always used biomass. A higher proportion of women using biomass had impaired vision, reported more ocular symptoms compared with those using clean fuel. Severe impaired vision and blindness were only present in biomass fuel users. However, the differences were only statistically significant for symptoms such as redness, burning sensation, a complaint of pain in the eye and tear in the eyes.ConclusionsCataract was more prevalent in women using biomass for cooking compared with those using clean fuel.
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van der Plaat D, De Matteis S, Sadhra S, Jarvis D, Cullinan P, Minelli C. Interaction between VGDF exposure and antioxidant genes on COPD in UK Biobank. Genes Environ 2020. [DOI: 10.1183/13993003.congress-2020.4921] [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: 11/05/2022] Open
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Jain A, Aggarwal A, Adams J, Jordan RE, Sadhra S, Dubey S, Allen K, Kumar K. Work productivity loss among rheumatoid arthritis patients in India: a qualitative study. Rheumatol Adv Pract 2019; 3:rkz046. [PMID: 32016165 PMCID: PMC6988515 DOI: 10.1093/rap/rkz046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 11/04/2019] [Indexed: 01/09/2023] Open
Abstract
Objective The aim was to explore the extent to which RA impacts work productivity in patients living with RA in India. Methods Face-to-face semi-structured interviews took place with 13 male and seven female patients attending outpatient clinics at Sanjay Gandhi Postgraduate Institute of Medical Sciences, India, living with RA. Patients who were currently working were recruited. Data were audio recorded, transcribed by an independent translation company and analysed using the framework method of thematic analysis. Results Four themes that explained patients’ experiences of coping with work whilst having RA were identified. These were as follows: balancing act of work and RA, in which participants expressed their day-to-day struggle of living with RA and coping at work; workplace adaptation after RA, in which participants shared insights into communicating with employers and their efforts to adapt at the workplace; support from others and information to manage RA and work, in which participants considered seeking support from different sources that would help them cope at work and understand RA; and wanting a better support mechanism, in which participants made recommendations that could help them to cope at work. Conclusion This is the first study to explore the impact of RA on patients’ work productivity in India. Patients might have different support needs compared with previous studies in other countries. Patients seem to be adopting additional coping strategies not addressed by current interventions or country systems, which might not be sufficient to support patients in remaining employed. Patients made future recommendations.
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Affiliation(s)
- Avinash Jain
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Amita Aggarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Jo Adams
- School of Health Sciences, Faculty of Environment and Life Sciences, University of Southampton, Southampton
| | | | - Steven Sadhra
- Institute of Clinical Sciences, University of Birmingham, Birmingham
| | - Shirish Dubey
- University Hospital Coventry and Warwickshire NHS Trust, Coventry
| | - Kerry Allen
- School of Social Policy, University of Birmingham, Birmingham, UK
| | - Kanta Kumar
- Institute of Clinical Sciences, University of Birmingham, Birmingham
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De Matteis S, Jarvis D, Darnton A, Hutchings S, Sadhra S, Fishwick D, Rushton L, Cullinan P. The occupations at increased risk of COPD: analysis of lifetime job-histories in the population-based UK Biobank Cohort. Eur Respir J 2019; 54:13993003.00186-2019. [DOI: 10.1183/13993003.00186-2019] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 04/21/2019] [Indexed: 11/05/2022]
Abstract
Occupational exposures are important, preventable causes of chronic obstructive pulmonary disease (COPD). Identification of COPD high-risk jobs is key to focus preventive strategies, but a definitive job-list is unavailable.We addressed this issue by evaluating the association of lifetime job-histories and lung function data in the population-based UK Biobank cohort, whose unprecedented sample size allowed analyses restricted to never-smokers to rule out the most important confounder, tobacco smoking. COPD was spirometrically defined as forced expiratory volume in 1 s/forced vital capacity ratio below the lower limit of normal. Lifetime job-histories were collected via OSCAR (Occupations Self-Coding Automatic Recording), a new validated online tool that automatically codes jobs into the UK Standard Occupational Classification v.2000. Prevalence ratios for COPD by employment duration in each job compared to lifetime office workers were estimated using robust Poisson regression adjusted for age, sex, centre and smoking. Only associations confirmed among never-smokers and never-asthmatics were considered reliable.From the 116 375 participants with complete job-histories, 94 551 had acceptable/repeatable spirometry data and smoking information and were included in the analysis. Six occupations showed an increased COPD risk among never-smokers and never-asthmatics; most of these also with positive exposure-response trends. Interesting new findings included sculptors, gardeners and warehouse workers.COPD patients, especially never-smokers, should be asked about their job-history for better disease management. Focussed preventive strategies in COPD high-risk jobs are warranted.
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Schumacher L, Armaou M, Rolf P, Sadhra S, Sutton AJ, Zarkar A, Grunfeld EA. Usefulness and engagement with a guided workbook intervention (WorkPlan) to support work related goals among cancer survivors. BMC Psychol 2017; 5:34. [PMID: 28978353 PMCID: PMC5628479 DOI: 10.1186/s40359-017-0203-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 09/08/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Returning to work after cancer is associated with improved physical and psychological functioning, but managing this return can be a challenging process. A workbook based intervention (WorkPlan) was developed to support return-to-work among cancer survivors. The aim of this study was to explore how participants using the workbook engaged with the intervention and utilised the content of the intervention in their plan to return-to-work. METHODS As part of a feasibility randomised controlled trial, 23 participants from the intervention group were interviewed 4-weeks post intervention. Interviews focussed on intervention delivery and data was analysed using Framework analysis. RESULTS Participants revealed a sense of empowerment and changes in their outlook as they transitioned from patient to employee, citing the act of writing as a medium for creating their own return-to-work narrative. Participants found the generation of a return-to-work plan useful for identifying potential problems and solutions, which also served as a tool for aiding discussion with the employer on return-to-work. Additionally, participants reported feeling less uncertain and anxious about returning to work. Timing of the intervention in coordination with ongoing cancer treatments was crucial to perceived effectiveness; participants identified the sole or final treatment as the ideal time to receive the intervention. CONCLUSIONS The self-guided workbook supports people diagnosed with cancer to build their communication and planning skills to successfully manage their return-to-work. Further research could examine how writing plays a role in this process. TRIAL REGISTRATION Current Controlled Trials ISRCTN56342476 . Retrospectively registered 14 October 2015.
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Affiliation(s)
- Lauren Schumacher
- Coventry University, Centre for Innovative Research Across the Life Course, Coventry, UK
| | - Maria Armaou
- Coventry University, Centre for Innovative Research Across the Life Course, Coventry, UK
| | - Pauline Rolf
- Coventry University, Centre for Innovative Research Across the Life Course, Coventry, UK
| | - Steven Sadhra
- University of Birmingham, Occupational and Environmental Medicine, Institute of Clinical Sciences, Birmingham, UK
| | | | - Anjali Zarkar
- University Hospitals Birmingham National Health Service Foundation Trust, Oncology, Queen Elizabeth Hospital, Birmingham, UK
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Sadhra S, Kurmi OP, Sadhra SS, Lam KBH, Ayres JG. Occupational COPD and job exposure matrices: a systematic review and meta-analysis. Int J Chron Obstruct Pulmon Dis 2017; 12:725-734. [PMID: 28260879 PMCID: PMC5327910 DOI: 10.2147/copd.s125980] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The association between occupational exposure and COPD reported previously has mostly been derived from studies relying on self-reported exposure to vapors, gases, dust, or fumes (VGDF), which could be subjective and prone to biases. The aim of this study was to assess the strength of association between exposure and COPD from studies that derived exposure by job exposure matrices (JEMs). Methods A systematic search of JEM-based occupational COPD studies published between 1980 and 2015 was conducted in PubMed and EMBASE, followed by meta-analysis. Meta-analysis was performed using a random-effects model, with results presented as a pooled effect estimate with 95% confidence intervals (CIs). The quality of study (risk of bias and confounding) was assessed by 13 RTI questionnaires. Heterogeneity between studies and its possible sources were assessed by Egger test and meta-regression, respectively. Results In all, 61 studies were identified and 29 were included in the meta-analysis. Based on JEM-based studies, there was 22% (pooled odds ratio =1.22; 95% CI 1.18–1.27) increased risk of COPD among those exposed to airborne pollutants arising from occupation. Comparatively, higher risk estimates were obtained for general populations JEMs (based on expert consensus) than workplace-based JEM were derived using measured exposure data (1.26; 1.20–1.33 vs 1.14; 1.10–1.19). Higher risk estimates were also obtained for self-reported exposure to VGDF than JEMs-based exposure to VGDF (1.91; 1.72–2.13 vs 1.10; 1.06–1.24). Dusts, particularly biological dusts (1.33; 1.17–1.51), had the highest risk estimates for COPD. Although the majority of occupational COPD studies focus on dusty environments, no difference in risk estimates was found for the common forms of occupational airborne pollutants. Conclusion Our findings highlight the need to interpret previous studies with caution as self-reported exposure to VGDF may have overestimated the risk of occupational COPD.
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Affiliation(s)
- Steven Sadhra
- Institute of Occupational and Environmental Medicine, University of Birmingham, Edgbaston, Birmingham
| | - Om P Kurmi
- Nuffield Department of Population Health, Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Sandeep S Sadhra
- Institute of Occupational and Environmental Medicine, University of Birmingham, Edgbaston, Birmingham
| | - Kin Bong Hubert Lam
- Nuffield Department of Population Health, Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Jon G Ayres
- Institute of Occupational and Environmental Medicine, University of Birmingham, Edgbaston, Birmingham
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Tagiyeva N, Sadhra S, Mohammed N, Fielding S, Devereux G, Teo E, Ayres J, Graham Douglas J. Occupational airborne exposure in relation to Chronic Obstructive Pulmonary Disease (COPD) and lung function in individuals without childhood wheezing illness: A 50-year cohort study. Environ Res 2017; 153:126-134. [PMID: 27940105 DOI: 10.1016/j.envres.2016.11.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 11/24/2016] [Accepted: 11/25/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Evidence from longitudinal population-based studies relating occupational exposure to the full range of different forms of airborne pollutants and lung function and airway obstruction is limited. OBJECTIVE To relate self-reported COPD and lung function impairment to occupational exposure to different forms of airborne chemical pollutants in individuals who did not have childhood wheeze. METHODS A prospective cohort study was randomly selected in 1964 at age 10-15 years and followed up in 1989, 1995, 2001 and 2014 (aged 58-64) by spirometry and respiratory questionnaire. Occupational histories were recorded in 2014 and occupational exposures assigned using an airborne chemical job exposure matrix. The risk of COPD and lung function impairment was analyzed in subjects, who did not have childhood wheeze, using logistic and linear regression and linear mixed effects models. RESULTS 237 subjects without childhood wheeze (mean age 60.6 years, 47% male) were analyzed. There was no association between any respiratory outcomes and exposure to gases, fibers, mists or mineral dusts and no consistent associations with exposure to fumes. Reduced FEV1 was associated with longer duration (years) of exposure to any of the six main pollutant forms - vapors, gases, dusts, fumes, fibers and mists (VGDFFiM) with evidence of a dose-response relationship (p-trend=0.004). Exposure to biological dusts was associated with self-reported COPD and FEV1<Lower Limit of Normal (LLN) (adjusted odds ratio [95%CI] 4.59 [1.15,18.32] and 3.54 [1.21,10.35] respectively), and reduced FEF25-75% (adjusted regression coefficients [95% CIs] -9.11 [-17.38, -0.84] respectively). Exposure to vapors was associated with self-reported COPD and FEV1<LLN (adjOR 6.46 [1.18,35.37] and 4.82 [1.32,17.63]). Longitudinal analysis demonstrated reduced FEV1 and FEF25-75% associated with exposure to biological dusts or vapors. CONCLUSIONS People with no history of childhood wheezing who have been occupationally exposed to biological dusts or vapors or had longer duration of lifetime exposure to any VGDFFiM are at a higher risk of reduced lung function at age 58-64 years. Occupational exposure to biological dusts or vapors also increased the risk of self-reported COPD.
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Affiliation(s)
- Nara Tagiyeva
- School of Dentistry, University of Central Lancashire, Preston PR1 2EH, UK.
| | - Steven Sadhra
- Occupational and Environmental Medicine, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Nuredin Mohammed
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Shona Fielding
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB25 2ZG, UK
| | - Graham Devereux
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB25 2ZG, UK
| | - Ed Teo
- Academic Clinical Programme for Medicine, Singapore General Hospital, Outram Road, Singapore 169608, Singapore
| | - Jon Ayres
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - J Graham Douglas
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB25 2ZG, UK
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Cooke R, Sadhra S. Vascular hand-arm vibration syndrome-magnetic resonance angiography. Occup Med (Lond) 2016; 66:756. [PMID: 27994081 DOI: 10.1093/occmed/kqw107] [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: 11/14/2022] Open
Affiliation(s)
- Roger Cooke
- Consultant in Occupational Medicine, Hon. Senior Lecturer .,Senior Lecturer in Occupational Health, Institute of Occupational & Environmental Medicine, College of Medicine and Dentistry, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Steven Sadhra
- Consultant in Occupational Medicine, Hon. Senior Lecturer.,Senior Lecturer in Occupational Health, Institute of Occupational & Environmental Medicine, College of Medicine and Dentistry, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
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Matharoo J, Arshad A, Sadhra S, Norton-Wangford R, Jawad M. S126 How does knowledge, perceptions and attitudes towards shisha pipe smoking vary amongst university students? Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.132] [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: 11/04/2022]
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Carmichael F, Fenton SJH, Pinilla-Roncancio MV, Sing M, Sadhra S. Workplace health and wellbeing in construction and retail. International Journal of Workplace Health Management 2016. [DOI: 10.1108/ijwhm-08-2015-0053] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The purpose of this paper is to explore the nature of the health and wellbeing issues faced within the construction and retail sectors and the difficulties faced in addressing these issues.
Design/methodology/approach
– This is a small, qualitative pilot study based on in-depth, semi-structured interviews with a purposively sampled group of representatives with expert knowledge from seven firms in the construction sector and three firms in the retail sector.
Findings
– Health and safety concerns in construction were pervasive. Causes were strongly tied to industry practice and structures such as short-term and sub-contracting as well as long hours and a masculine culture. In the retail establishments concerns tended to be more holistic, focusing on wellbeing and encompassing work satisfaction. Industry leaders in construction are proactive in trying to address these issues, particularly in regard to safety. The multi-dimensionality of the concept of workplace wellbeing implies the need for a holistic approach to interventions.
Research limitations/implications
– This research was initiated as a pilot study, as part of a wider project in collaboration with a business partner, and is limited by the sample size.
Practical implications
– These findings should be incorporated into sector specific research on workplace wellbeing and occupational health initiatives.
Social implications
– Workplace wellbeing programmes need to be constructed holistically as wellbeing is a multi-dimensional concept encompassing quality of life as well as effects of work on health.
Originality/value
– An in-depth study with industry experts that increases knowledge of the underlying causes of workplace health and wellbeing issues in construction and retail and the barriers to addressing them.
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De Matteis S, Jarvis D, Hutchings S, Darnton A, Fishwick D, Sadhra S, Rushton L, Cullinan P. Occupations associated with COPD risk in the large population-based UK Biobank cohort study. Occup Environ Med 2016; 73:378-84. [DOI: 10.1136/oemed-2015-103406] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 03/02/2016] [Indexed: 11/04/2022]
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Sadhra S, Fishwick D, Kurmi O, Chambers H, Lam K, Hutchings S, Jarvis D, De Matteis S, Rushton L, Ayres J, Cullinan P. S2 Development Of A Job Exposure Matrix For Soc 2000 Listings To Identify Occupational Causes Of Copd. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.8] [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: 11/04/2022]
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Kalirai K, Adab P, Jordan R, Ayres J, Sadhra S. M147 Feasibility Of Delivering An Occupational Health Intervention Aimed At Improving Work Productivity, Among Working Copd Patients. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.442] [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: 11/03/2022]
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22
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Kurmi OP, Semple S, Devereux GS, Gaihre S, Lam KBH, Sadhra S, Steiner MFC, Simkhada P, Smith WCS, Ayres JG. The effect of exposure to biomass smoke on respiratory symptoms in adult rural and urban Nepalese populations. Environ Health 2014; 13:92. [PMID: 25374400 PMCID: PMC4232609 DOI: 10.1186/1476-069x-13-92] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [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: 06/18/2014] [Accepted: 10/28/2014] [Indexed: 05/22/2023]
Abstract
BACKGROUND Half of the world's population is exposed to household air pollution from biomass burning. This study aimed to assess the relationship between respiratory symptoms and biomass smoke exposure in rural and urban Nepal. METHODS A cross-sectional study of adults (16+ years) in a rural population (n = 846) exposed to biomass smoke and a non-exposed urban population (n = 802) in Nepal. A validated questionnaire was used along with measures of indoor air quality (PM2.5 and CO) and outdoor PM2.5. RESULTS Both men and women exposed to biomass smoke reported more respiratory symptoms compared to those exposed to clean fuel. Women exposed to biomass were more likely to complain of ever wheeze (32.0 % vs. 23.5%; p = 0.004) and breathlessness (17.8% vs. 12.0%, p = 0.017) compared to males with tobacco smoking being a major risk factor. Chronic cough was similar in both the biomass and non-biomass smoke exposed groups whereas chronic phlegm was reported less frequently by participants exposed to biomass smoke. Higher PM2.5 levels (≥2 SDs of the 24-hour mean) were associated with breathlessness (OR = 2.10, 95% CI 1.47, 2.99) and wheeze (1.76, 1.37, 2.26). CONCLUSIONS The study suggests that while those exposed to biomass smoke had higher prevalence of respiratory symptoms, urban dwellers (who were exposed to higher ambient air pollution) were more at risk of having productive cough.
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Affiliation(s)
- Om P Kurmi
- />Clinical Trials Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF UK
| | - Sean Semple
- />Scottish Centre for Indoor Air, Division of Applied Health Sciences, School of Medicine, University of Aberdeen, Aberdeen, AB24 3FX UK
| | - Graham S Devereux
- />Department of Child Health, Royal Aberdeen Children’s Hospital, University of Aberdeen, Aberdeen, AB25 2ZG UK
| | - Santosh Gaihre
- />Scottish Centre for Indoor Air, Division of Applied Health Sciences, School of Medicine, University of Aberdeen, Aberdeen, AB24 3FX UK
| | - Kin Bong Hubert Lam
- />Institute of Occupational and Environmental Medicine, University of Birmingham, Birmingham, B15 2TT UK
| | - Steven Sadhra
- />Institute of Occupational and Environmental Medicine, University of Birmingham, Birmingham, B15 2TT UK
| | - Markus FC Steiner
- />Scottish Centre for Indoor Air, Division of Applied Health Sciences, School of Medicine, University of Aberdeen, Aberdeen, AB24 3FX UK
| | - Padam Simkhada
- />School of Health and Related Research, University of Sheffield, Sheffield, S10 2TN UK
| | - William CS Smith
- />School of Medicine and Dentistry, University of Aberdeen, Aberdeen, AB24 3FX UK
| | - Jon G Ayres
- />Institute of Occupational and Environmental Medicine, University of Birmingham, Birmingham, B15 2TT UK
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Abstract
BACKGROUND Military musicians increasingly fulfil front line roles. Existing literature suggests that musicians are at greater risk of hearing loss than the general population. It is important to ascertain whether these findings apply to military musicians if they are to be placed in operational acoustically hazardous environments. AIMS To compare hearing loss between groups of British Army musicians and with their administrative (non-musician) counterparts. METHODS Routine health surveillance audiometric data for a group of military musicians were compared with military administrative staff during the first 8-12 years of their careers. Structured interviews were used to identify those meeting the study inclusion criteria (8 year minimum service, no significant, relevant medical history, no previous extraordinary loud noise exposure, service within study employment group throughout military career), and to clarify the instrument played. RESULTS Eighty-four musicians and 44 administrators participated. Using the Health & Safety Executive's (HSE's) age- and gender-correcting system, 12 (14%) musicians and 9 (20%) non-musicians had a deterioration in hearing. The overall odds ratio for developing hearing loss in musicians was 0.65 (95% CI 0.25-1.68). Compared with woodwind instrumentalists, the odds ratio for hearing loss in brass instrumentalists was 2.00 (95% CI 0.85-3.44) and for percussionists 1.83 (95% CI 0.77-2.90). CONCLUSIONS The findings suggest that military musicians are at no greater risk of hearing loss than their administrative counterparts after 8-12 years in service. This may represent a healthy-worker effect. There is no statistically significant differential risk of hearing loss between different instrumental groups.
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Affiliation(s)
- M L Patil
- Occupational Medicine, MOD (Army), Camberley, Surrey GU15 4NP, UK.
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Abstract
BACKGROUND Occupational exposure to ultraviolet (UV) radiation from welding is considered a risk factor for cataract and other eye disorders, but the evidence for such effects is limited. AIMS To identify any increased risk of developing cataract from metal arc welding and to investigate the associated risk factors. METHODS A cross-sectional study was carried out on male welders and control subjects (not engaged in welding) from five fabrication and construction companies in Port Harcourt, Nigeria. A questionnaire was used to gather information regarding their demography and lifestyle, along with their occupational, medical and ocular histories. Cataract was identified by external examination and ophthalmoscopy. RESULTS A total of 117 welders and 105 controls participated. There was no statistically significant increase in the risk of cataract in welders after adjusting for age, smoking status, family history of cataract, outdoor work and history of eye injury. There was a strong association between work-related eye-injury history and cataract. Only 60% of welders were wearing eye protection when the eye injury occurred. The majority of the eye injuries (72%) occurred during welding and grinding operations. CONCLUSIONS The findings of this study suggest that the main occupational risk factor for cataract was a history of eye injuries. The role of UV (or optical) radiation appeared to be less important than impact eye injuries associated with welding-allied processes. It is therefore important that welders are provided with different types of eye protection and are informed about which type should be used, and when, so that they can be protected against optical and impact injuries.
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Affiliation(s)
- Y Megbele
- Institute of Occupational and Environmental Medicine, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
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Sakunkoo P, Chaiear N, Chaikittiporn C, Sadhra S. Concentrations and Size Distribution of Inhalable and Respirable Dust Among Sugar Industry Workers. Asia Pac J Public Health 2011; 23:967-79. [DOI: 10.1177/1010539510365099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There has been very limited information regarding bagasse exposure among workers in sugar industries as well as on health outcomes. The authors determined the occupational exposure of sugar industry workers in Khon Kaen to airborne bagasse dust. The size of the bagasse dust ranged from 0.08 to 9 µm with the highest size concentration of 2.1 to 4.7 µm. The most common size had a geometric mean diameter of 5.2 µm, with a mass concentration of 6.89 mg/m3/log µm. The highest mean values of inhalable and respirable dust were found to be 9.29 mg/m3 from February to April in bagasse storage, 5.12 mg/m3 from May to September, and 4.12 mg/m3 from October to January. Inhalable dust concentrations were 0.33, 0.47, and 0.41 mg/m3, respectively. Workers are likely to be exposed to high concentrations of bagasse dust and are at risk of respiratory diseases. Preventive measures, both in the form of engineering designs and personal protective devices, should be implemented.
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Affiliation(s)
| | | | | | - Steven Sadhra
- Institute of Occupational and Environmental Medicine, University of Birmingham, England, UK
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Abstract
SUMMARY BACKGROUND This is the first study in Ghana in the Obuasi gold mines where the silica content of the respirable dust is 10%, less than in previously studied gold mines, with only 23% of the miners having ever smoked. OBJECTIVES The study was to assess the prevalence of respiratory impairment in the Ghanaian gold miner and to quantify the effects of the respirable dust on pulmonary function DESIGN A cross sectional epidemiological study METHOD The study was carried out using MRC respiratory symptoms questionnaire, spirometry, and personal respirable dust measurements. RESULTS A total of 1236 miners were studied. The mean age was 39.7 +/-5.8 (SD) years with a mean of 12.6 +/- 6.7 (SD) years underground service and a mean total cumulative exposure to dust of 10.34 +/-5.61 (SD) mg.m(-3).years. The prevalence of chronic bronchitis was 21.2% and not clearly related to cumulative exposure. MRC breathlessness grade>/=2 was 31.3%, significantly related to cumulative respirable dust exposure after adjustment of age and smoking. There was however significant reduction in FEF(25-75%) with increasing dust exposure and an interaction with ever smoking. There was no correlation between cumulative exposure to respirable dust and FEV(1) % predicted in any group, suggesting that exposure to respirable silica at a mean level of 0.06 mg/m(3) had no deleterious effect on FEV(1) in a population with little tuberculosis, good housing and a low level of cigarette smoking. CONCLUSION The prevalence of chronic bronchitis in the Ghanaian gold mine is related more to smoking than any occupational factors.
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Affiliation(s)
- Fy Bio
- University Health Services, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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28
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Abstract
The most significant potentially carcinogenic substances arising from a state-of-the-art clinical waste incinerator (CWI) and vehicle emissions were identified as polychlorinated dibenzo-p-dioxins, polycyclic aromatic hydrocarbons (PAHs), benzene, 1-butadiene, arsenic, cadmium, chromium and nickel. Long-term exposures of the notional maximum exposed individual (MEI) in the local environment, together with aggregate emissions from transport of clinical waste, were estimated. Mass emission rates of PAHs from the CWI to air were compared with previously published estimates of mass emissions to land from CWI bottom ash. Aggregate emissions from road transport of clinical waste were of a similar order to stack emissions from incineration. Mass emissions of PAHs to landfill generally greatly exceeded those from stack emissions. Emissions associated with operation of the CWI present a negligible contribution to overall cancer risk from PAHs and other carcinogens. Uncertainty in the quantitative risk estimates presented here is discussed in the context of these findings.
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Affiliation(s)
- Andrew Wheatley
- Department of Community Medicine, Faculty of Medicine and Health Sciences, UAE University, Al Ain, United Arab Emirates.
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Abstract
A cross-sectional study on wood dust exposure and respiratory health effects was conducted at one of the largest rubberwood sawmills in Thailand. All workers (N = 340) from all jobs on a day shift were recruited for personal sampling. Overall, the personal inhalable dust (n = 742) and respirable dust (n = 241) of full-shift samples were collected from 27 job titles. These data were used to classify workers into high, moderate, and low exposure groups based on the concentrations found in each job. Static samples were also collected to determine the particle size distribution. Geometric means (GM) are used to present the concentrations of the rubber wood dust. Inhalable dust concentrations were clearly high, ranging between 0.2 to 59.4 mg/m3 and with GM of 4.7 mg/m3. The GM of inhalable dust in each job title enabled classification of the workers into three exposure groups: (1) high exposure; >5 mg/m3, (2) moderate exposure; 2.0-5.0 mg/m3, and (3) low exposure; 0.18-1.9 mg/m3. Among the high exposure group, the highest GM inhalable dust concentrations were found in sawing green lumber (12.8 mg/m3) and cutting dry lumber (7.3 mg/m3). The respirable dust concentrations were generally low, in the range of 0.1 to 6.0 mg/m3 with a GM of 0.5 mg/m3. The largest percentage of dust in major operations belonged to the thoracic fraction; 50% cutoff diameter was smaller than 9 mum. The size distribution of wood dust indicated a high proportion in the large particle sizes.
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Affiliation(s)
- Nutjaree Saejiw
- School of Allied Health Science and Public Health, Walailak University, Thasala, Nakhon Si Thammarat, Thailand.
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Abstract
AIMS To study serial peak expiratory flow (PEF) responses in a group of symptomatic detergent enzyme-exposed workers. METHODS Workers were recruited from a biological detergent formulating and packaging company. Those with occupational asthma symptoms and/or specific IgE to a detergent enzyme were asked to complete 2 hourly PEF measurements for 4 weeks. Outputs from the Oasys program (Oasys score, rest-work score and rest-work difference in diurnal variation) assessed PEF response. These were then related to the levels of sensitization and current occupational exposure to detergent enzymes. RESULTS In all, 67/72 workers returned PEF records; 97% were able to return a record with at least four readings per day and 87% at least 3 weeks in length. Of total, 79% (n = 27) of those with a final diagnosis of occupational asthma had peak flow records confirming the disease using Oasys. PEF response was similar in those with high, medium and low levels of exposures and those with negative, low-moderate and high specific IgE levels. CONCLUSIONS The Oasys program is a sensitive tool for the diagnosis of detergent enzyme occupational asthma, but the levels of exposure and specific IgE sensitization to enzymes do not affect the magnitude of PEF response in symptomatic workers.
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Affiliation(s)
- Vicky C Moore
- Occupational Lung Disease Unit, Department of Respiratory Medicine, Birmingham Heartlands Hospital, Birmingham, UK.
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Sorahan T, Pang D, Esmen N, Sadhra S. Urinary concentrations of toxic substances: an assessment of alternative approaches to adjusting for specific gravity. J Occup Environ Hyg 2008; 5:721-723. [PMID: 18777412 DOI: 10.1080/15459620802399997] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Alternative approaches of adjusting urinary concentration of cadmium for differences in specific gravity of biological samples were assessed. The main analysis used 2922 cadmium-in-urine samples collected in the period 1968-1989 from workers at a UK nickel-cadmium battery facility. Geometric means of cadmium-in-urine, adjusted and unadjusted for specific gravity, were obtained for 21 different values of specific gravity ranging from 1.010 to 1.030. There was a highly significant positive trend (P < 0.001) of unadjusted cadmium-in-urine with specific gravity. Conventional adjustment for specific gravity led to a highly significant negative trend (P < 0.001) of adjusted cadmium-in-urine with specific gravity, SG. An approach proposed by Vij and Howell, involving the introduction of a z coefficient, led to satisfactory adjustment. Conventional adjustment of specific gravity leads to overcompensation of the confounding effects of specific gravity. An alternative method is available and should probably be adopted when interpreting urine biological samples for all chemical substances.
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Affiliation(s)
- Tom Sorahan
- Institute of Occupational and Environmental Medicine, University of Birmingham Edgbaston, Birmingham, England.
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32
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Jin Y, Deddens JA, Saejiw N, Chaiear N, Ngoencharee J, Sadhra S, Coble JB, Vermeulen RCH, Ji BT, Xue S, Dosemeci M, Lu W, Zheng W, Gao YT, Blair A, Chow WH, Rothman N, Kromhout H, Fransman W, de Vocht F, van Wendel de Joode B, Neitzel RL, Daniell WE, Davies HW, Sheppard L, Seixas NS, Teschke K, Johnson P, Trask C, Chow Y, Village J, Koehoorn M. Exposure assessment 2. Occup Environ Med 2007. [DOI: 10.1136/oem.64.12.e18] [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: 11/03/2022]
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Bio FY, Sadhra S, Jackson C, Burge PS. Low back pain in underground gold miners in ghana. Ghana Med J 2007; 41:21-5. [PMID: 17622335 PMCID: PMC1890537] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
SUMMARY BACKGROUND Biomechanical lumbo-spinal strain and intense physical work are the characteristic hallmarks of mining work. OBJECTIVES To determine the prevalence and predisposing factors for Low Back Pain (LBP) among male underground gold miners at the Obuasi gold mine in Ghana. METHODS This is a cross sectional study on 280 male underground gold miners from June to October 2001 with a structured questionnaire administered through interviews. RESULTS The twelve months prevalence of low back pain among miners was 67%. The mean age of the workers was 40 years (+/- 5.6, ranging from 27 to 53 years). Increasing age was significantly associated with low back pain, (P=0.05) OR 2.07 (95% CI 0.99 to 4.34) after adjustment for smoking and occupation. Prevalence of LBP was highest among workers performing engineering (82%) duties. Heavy physical work (77%), was identified as a major cause of LBP, which could be prevented by the use of lifting aids (16%). CONCLUSION The prevalence of low back pain in this group is comparable with that obtained from other studies in Africa and Europe. Training and education as a means of reducing LBP was suggested by just a few of the respondents.
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Affiliation(s)
- FY Bio
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Author for correspondence
| | - S Sadhra
- Institute of Occupational and Environmental Medicine, The University of Birmingham, B15 2TT, UK
| | - C Jackson
- School of Health and Policy Studies, University of Central England in Birmingham, UK
| | - PS Burge
- Department of Respiratory Medicine, Birmingham Heartlands Hospital, Birmingham, UK
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Sadhra S, Wheatley AD. Polycyclic aromatic hydrocarbon emissions from clinical waste incineration. Chemosphere 2007; 66:2177-84. [PMID: 17113623 DOI: 10.1016/j.chemosphere.2006.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2006] [Revised: 08/22/2006] [Accepted: 09/01/2006] [Indexed: 05/12/2023]
Abstract
Since the introduction of the Environmental Protection Act in the UK, there are few reports of PAH emissions from clinical waste incinerators (CWIs) operating to improved performance standards. The main aim of this study is to determine PAH emissions from a state-of-the-art CWI focusing on the effects of reactive gases and operating variables on emissions. This was carried out by collection of stack samples over three phases of operation. At stack conditions, most PAHs are predicted to be in the vapour phase. Reactive losses of PAHs were closely correlated by rank with expected reactivities from laboratory studies. Estimates of emissions incorporating sampling losses were derived, although no correlation was found between PAH losses and the modest levels of reactive stack gases. PAH concentrations were one to two orders of magnitude lower than earlier reports from incinerators without effective air pollution control equipment (APCE). The low levels of carbon monoxide recorded were not correlated with any PAHs. This study demonstrates the impact of efficient combustion conditions and APCE on PAH emissions from a CWI.
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Affiliation(s)
- S Sadhra
- Institute of Occupational and Environmental Medicine, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
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35
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Wheatley AD, Sadhra S. Use of Fluorescence Emission Spectra for the Routine Identification of Polycyclic Aromatic Hydrocarbons in Liquid Chromatography. J LIQ CHROMATOGR R T 2006. [DOI: 10.1080/10826079808003595] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- A. D. Wheatley
- a Institute of Occupational Health University of Birmingham , Birmingham, B15 2TT, UK
| | - S. Sadhra
- a Institute of Occupational Health University of Birmingham , Birmingham, B15 2TT, UK
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Abstract
There is currently no OEL for diesel fumes in the UK. This study reports parallel measurements of airborne levels of diesel fume pollutants in nine distribution depots where diesel powered fork-lift trucks (FLTs) were in use. Correlations between individual pollutants are assessed as well as their spatial distribution. Samples were collected on board FLTs and at background positions at nine distribution depots. Substances measured and the range of exposures by site were: respirable dust (n = 76) GM </= 80-179 micro g/m(3); elemental carbon (n = 79) GM = 7-55 micro g/m(3); organic carbon (n = 79) GM = 11-69 micro g/m(3); ultrafine particles (n = 17) range = 58-231 x 10(3) particles/cm(3); selected particulate phase polycyclic aromatic hydrocarbons (PAHs) (n = 14) range = 6-37 ng/m(3). In addition, a tracer method based on ultrafine particle measurements was used to estimate the spatial distribution of total carbon and PAHs at the sites monitored. The spatial distribution was found to be reasonably uniform. Major diesel fume aerosol components were, in general, well correlated (r = 0.62-0.97). CO(2) measurements were also made and found to be below the HSE guideline of 1000 p.p.m., with most levels below 600 p.p.m.
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Affiliation(s)
- A D Wheatley
- Institute of Occupational Health, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
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Wheatley AD, Sadhra S. Polycyclic aromatic hydrocarbons in solid residues from waste incineration. Chemosphere 2004; 55:743-749. [PMID: 15013679 DOI: 10.1016/j.chemosphere.2003.10.055] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2003] [Revised: 10/28/2003] [Accepted: 10/31/2003] [Indexed: 05/24/2023]
Abstract
Polycyclic aromatic hydrocarbons (PAH) levels in solid residues from clinical waste incineration were measured using HPLC with fluorescence detection. PAH mass emission rates and emission rates as a function of waste burned are also reported. For bottom ash, PAH levels and physical properties were found to be quite consistent. Levels of high molecular mass PAHs were comparable to levels previously reported in the literature when adjusted for differences in sample preparation techniques. However, levels of low molecular mass PAHs were considerably elevated in this study. Possible reasons for this finding include the composition of the waste, combustion conditions and methods of sample preparation. In contrast, no PAHs were found in fly ash, an unexpected finding which is probably attributable to matrix effects resulting from a surfeit of lime in the fly ash. Factors effecting the partitioning of PAHs and their environmental fate are also discussed.
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Affiliation(s)
- A D Wheatley
- Institute of Occupational Health, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
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Abstract
BACKGROUND There is limited research concerning how small companies in particular, respond to health and safety messages. AIMS To understand individuals' knowledge and beliefs about chemical risks and to compare these with those of experts. METHODS The use of chromic acid in particular, and also other chemicals associated with chrome plating were studied. All chromium plating firms were based in the West Midlands. The methodology involved initial face to face interviews (n = 21) with chromium platers, structured questionnaires (n = 84) to test the prevalence of beliefs identified in the interviews, an expert questionnaire, and a workshop to discuss findings. The responses of platers were compared with those of occupational health and safety experts. RESULTS Although chromium platers appeared to understand the short term adverse effects of the chemicals to which they are exposed, their understanding of long term, or chronic effects appeared to be incomplete. They had good knowledge of acute effects based primarily on experience. Platers were aware of the hazardous nature of the chemicals with which they work, but did not draw distinction between the terms "hazards" and "risks". They had difficulties articulating the effects of the chemicals and how exposure might occur; although it is inappropriate to equate this with lack of knowledge. A significant minority of platers displayed deficiencies in understanding key technical terms used in Safety Data Sheets. CONCLUSIONS This study provides a method which can be used to gain some understanding of workers' knowledge and beliefs about risks that they are exposed to in the workplace. The study also identifies gaps between the platers' knowledge and beliefs and those of experts. New risk information needs to be designed which addresses the information needs of platers using language that they understand.
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Affiliation(s)
- S Sadhra
- Institute of Occupational Health, University of Birmingham, UK.
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Sadhra S, Jackson CA, Ryder T, Brown MJ. Noise exposure and hearing loss among student employees working in university entertainment venues. Ann Occup Hyg 2002; 46:455-63. [PMID: 12176760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
OBJECTIVES Most studies to date on sound levels in entertainment establishments have concentrated on exposure levels for the attending public, rather than employees who may be at greater risk of hearing loss. Of particular concern are young employees. The aim of this pilot study was to (i) estimate typical sound levels in different areas where amplified music was played, (ii) measure temporary threshold shift (TTS) and (iii) estimate the dependence of hearing threshold shifts on measured noise levels. METHODS This study focused on students working part-time (up to 16 h/week) in music bars and discotheques in a university entertainment venue. All 28 staff were invited to participate in the study. Pre- and post-exposure audiometry was used to determine hearing threshold at both high and low frequencies. Personal dosemeters and static measurements were made to assess noise levels and frequency characteristics. A questionnaire was used to determine patterns of noise exposure and attitudes to noise levels and hearing loss. RESULTS Of the 28 student employees working in the three areas, 14 (50%) agreed to take part in the study, giving 21 pre- and post-shift audiograms. The mean personal exposure levels for security staff were higher than those of bar staff, with both groups exceeding 90 dB(A). The maximum peak pressure reading for security staff was 124 dB. Although TTS values were moderate, they were found to be highly significant at both low and high frequencies and for both ears. Twenty-nine per cent of subjects showed permanent hearing loss of more than 30 dB at either low or high frequencies. The correlation between TTS and personal exposure was higher at 4 kHz than the low and high frequencies. CONCLUSIONS Contemporary music may be an important yet little considered contributor to total personal noise exposure, especially amongst young employees. Employees need to be better informed of risks of hearing loss and the need to report changes in hearing acuity. Suggestions are made on strategies for improving the assessment of noise exposure in entertainment venues.
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Affiliation(s)
- S Sadhra
- Institute of Occupational Health, University of Birmingham, University Road West, Edgbaston, UK
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Abstract
The first series of three workers who developed occupational asthma following exposure to airborne chloramines in indoor chlorinated swimming pools is reported. Health problems of swimmers in indoor pools have traditionally been attributed to the chlorine in the water. Chlorine reacts with bodily proteins to form chloramines; the most volatile and prevalent in the air above swimming pools is nitrogen trichloride. Two lifeguards and one swimming teacher with symptoms suggestive of occupational asthma kept 2-hourly measurements of peak expiratory flow at home and at work, analysed using the occupational asthma system (OASYS) plotter, and/or had specific bronchial challenge testing to nitrogen trichloride, or a workplace challenge. Air measurement in one of the pools showed the nitrogen trichloride levels to be 0.1-0.57 mg x m(-3), which was similar to other studies. Two workers had peak expiratory flow measurements showing occupational asthma (OASYS-2 scores 2.88 and 3.8), both had a positive specific challenge to nitrogen trichloride at 0.5 mg x m(-3) with negative challenges to chlorine released from sodium hypochlorite. The third worker had a positive workplace challenge. Swimming-pool asthma due to airborne nitrogen trichloride can occur in workers who do not enter the water because of this chloramine. The air above indoor swimming pools therefore needs to be assessed and managed as carefully as the water.
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Affiliation(s)
- K M Thickett
- Dept of Respiratory Medicine, Heartlands Hospital, Birmingham, UK.
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Abstract
OBJECTIVES As part of a consultancy project on occupational health, the Delphi method was used to identify research priorities in occupational health in Malaysia. METHODS Participation was sought from government ministries, industry, and professional organisations, and university departments with an interest in occupational and public health. Two rounds of questionnaires resulted in a final list of priorities, with noticeable differences between participants depending on whether they worked in industry or were from government organisations. RESULTS The participation rate of 71% (55 of 78) was obtained for the first questionnaire and 76% (72 of 95) for the second questionnaire. The participants identified occupational health problems for specific groups and industries as the top research priority area (ranked as top priority by 25% of participants). Ministry of Health participants placed emphasis on healthcare workers (52% ranking it as top priority), whereas those from industry identified construction and plantation workers as groups, which should be accorded the highest priority. Evaluation of research and services was given a low priority. CONCLUSIONS The priorities for occupational health determined with the Delphi approach showed differences between Malaysia, a developing country, and findings from similar European studies. This may be expected, as differences exist in stages of economic development, types of industries, occupational activities, and cultural attitudes to occupational health and safety. Chemical poisonings and workplace accidents were accorded a high priority. By contrast with findings from western countries, workplace psychosocial problems and musculoskeletal injuries were deemed less important. There also seemed to be greater emphasis on adopting interventions for identified problems based on experience in other countries rather than the need to evaluate local occupational health provisions.
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Affiliation(s)
- S Sadhra
- Institute of Occupational Health, University of Birmingham, Edgbaston, Birmingham B15 2 TT, UK.
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Chaiear N, Sadhra S, Jones M, Cullinan P, Foulds IS, Burge PS. Sensitisation to natural rubber latex: an epidemiological study of workers exposed during tapping and glove manufacture in Thailand. Occup Environ Med 2001; 58:386-91. [PMID: 11351054 PMCID: PMC1740139 DOI: 10.1136/oem.58.6.386] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To estimate the prevalence of sensitisation to natural rubber latex in latex tappers and latex glove factory workers, and to relate this to airborne exposure to latex. METHODS Five hundred workers employed in three latex glove factories, 314 tappers, and 144 college students (control group) were studied. The workers in the glove factories were classified into three exposure groups; high, moderate, and low. Personal exposures to natural rubber latex aeroallergens were measured by immunoassay. Symptom questionnaires and skin prick tests with latex allergens (Stallergènes 1:200 w/v) and other common environmental allergens were performed. The criterion for positivity was a wheal reaction at least 3 mm in diameter greater than that to a diluent control. RESULTS The geometric mean (GM) concentration of latex in air was 15.4 microg/m(3) for those employed in glove stripping, glove inspections, and packing of powdered gloves. The moderate exposure glove manufacturing group and the tappers had GM concentrations of 2.3 and 2.4 microg/m(3) respectively, compared with United Kingdom users of latex powdered gloves,who had GM concentrations of 0.5 microg/m(3). The prevalence of sensitisation to latex in the tappers and latex glove factory workers was 1.3% and 1.7% respectively. No positive cases were found among the college students. Workers who showed a positive skin prick test to latex were more likely to be atopic. Work related respiratory and dermatological symptoms were found in about 20% of each population studied, but were not related to the presence of positive latex prick tests. CONCLUSIONS This study suggests that in the Thai latex industries, latex sensitisation is rare despite high concentrations of airborne exposure and is less prevalent than in the healthcare sector in Europe where skin exposure is greater.
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Affiliation(s)
- N Chaiear
- Community Medicine Department, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand.
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43
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Sri-akajunt N, Sadhra S, Jones M, Burge PS. Natural rubber latex aeroallergen exposure in rubber plantation workers and glove manufacturers in Thailand and health care workers in a UK hospital. Ann Occup Hyg 2000; 44:79-88. [PMID: 10717259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
OBJECTIVES To estimate personal airborne natural rubber latex (NRL) concentrations for three occupational exposure groups; rubber plantation workers and NRL glove manufacturers in Thailand and health care workers in the UK. To utilise these data to classify the populations into appropriate exposure groups for the exposure-response analysis in the epidemiological study on latex allergy. METHODS Two rubber plantations (110 workers), three NRL glove manufacturing factories (583 workers) in Thailand and one UK hospital (490 workers) were selected for the study. A preliminary workplace survey was carried out at each workplace in order to assign job titles subjectively in to high, moderate or low exposure groups for the purpose of sample selection. Between 5 and 20% of workers from each group for the three populations were then selected randomly for personal measurement of latex airborne allergens. Personal sampling was conducted using a 25 mm PTFE filter loaded in to an IOM sampling head at 2 l. min(-1). NRL aeroallergens were measured by an inhibition assay with NRL-specific IgE antibodies from NRL-sensitised people. RESULTS A total of twenty-two personal samples were collected from plantation workers, sixty-one samples from the glove manufacturer employees and twenty seven from health care workers. The highest geometric mean (GM) NRL aeroallergen concentration was found in the glove manufacturing factories (7.3 microg m(-3)), followed by the rubber plantations (2.4 microg m(-3)) and the UK hospital (0.46 microg m(-3)). Amongst the NRL glove factories, the NRL aeroallergen concentrations were highest for those conducting the following tasks; glove stripping, glove inspections and packing of powdered gloves. The GM NRL aeroallergen for these tasks were in the range of 12.9 to 17.8 microg m(-3). CONCLUSIONS In the process from tapping and manufacture of latex gloves through to their use the highest exposure to NRL aeroallergens is likely to occur in the manufacturing factories. Exposure to aeroallergens for the plantation workers was considered to be moderate and that of health care workers to be low.
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Affiliation(s)
- N Sri-akajunt
- Institute of Occupational Health, University of Birmingham, Birmingham, UK
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44
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Abstract
Commercial preparations of colophony (rosin) used for patch testing are made from unmodified rosin in pet. and may be stored for some considerable time before being used. This would be satisfactory if the composition and dermatological activity of the preparations were both reproducible and stable, but investigations by the authors have shown that the resin acids undergo progressive and substantial oxidation and that the dermatological activity of the preparations increases significantly with time. This may be a cause of inconsistent patch test results unless the composition can be stabilized. Gas liquid chromatography (GLC) analysis of a raw rosin sample and its commercial patch test preparation has shown that they both contained the same resin acids, but the concentration of the abietic type resin acids was found to be lower in the patch test preparations. The degradation of resin acids is due to their atmospheric oxidation, which may occur during the preparation and storage of the commercial rosin patch test preparation. The susceptibility of individual resin acids to atmospheric oxidation was demonstrated by analysing a sample of raw Portuguese gum rosin, which was then left exposed to air and light. Most of the resin acids were found to undergo oxidation at a rate which gradually diminished. More importantly, it is presumed that the concentration of oxidized resin acids increased correspondingly, and these have been shown to be more dermatologically active than the unoxidised resin acids. The rate of decrease of resin acid concentration was found to be in the following order: neoabietic>levopimaric and palustric>abietic>dehydroabetic acid. The pimaric type resin acids were found to be relatively inert to atmospheric oxidation when compared with the abietic type resin acids. Patch testing with the resulting partly oxidized Portuguese rosin produced positive reactions at a 35% higher frequency than the raw Portuguese rosin. The study demonstrates that the allergic potential of unmodified rosin may increase with exposure to air and light. It is therefore recommended that rosin preparations are analysed routinely as part of a quality control programme, which will enable better validation and comparison of patch test results from different dermatological centres. Since the oxidized resin acids are the main allergens in unmodified rosin, it is important that the concentration of the oxidized resin acids is kept high as well as constant in commercial patch test preparations.
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Affiliation(s)
- S Sadhra
- Institute of Occupational Health, University of Birmingham, Edgbaston, UK
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Sadhra S, Gray CN, Foulds IS. High-performance liquid chromatography of unmodified rosin and its applications in contact dermatology. J Chromatogr B Biomed Sci Appl 1997; 700:101-10. [PMID: 9390719 DOI: 10.1016/s0378-4347(97)00293-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Rosin is a well recognised skin sensitiser and is also amongst the most common causes of occupational asthma. Due to its complex chemical composition, it is difficult to isolate its many components and this has hindered progress in the identification of the specific respiratory and contact allergens it contains. This paper reports the application of high-performance liquid chromatography and other analytical techniques to the isolation and identification of contact allergens in complex mixtures such as rosin. HPLC methods were developed in order to isolate as many rosin components as possible and these were then patch tested on rosin sensitive individuals. The structure of the most dermatologically active component was then determined using mass spectrometry, nuclear magnetic resonance and infrared techniques. An HPLC method has also been developed which will enable the identification of rosin in commercial products, providing a valuable tool for determining the cause of rosin contact allergy. Furthermore, mass spectral data for the common abieitic-type resin acids are compiled which were used to confirm the identification of the HPLC resin acid peaks and have not been reported previously.
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Affiliation(s)
- S Sadhra
- Institute of Occupational Health, University of Birmingham, Edgbaston, UK
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46
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Sadhra S, Foulds IS, Gray CN. Identification of contact allergens in unmodified rosin using a combination of patch testing and analytical chemistry techniques. Br J Dermatol 1996; 134:662-8. [PMID: 8733367 DOI: 10.1111/j.1365-2133.1996.tb06966.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
In order to investigate the contact allergens in the unmodified colophony (rosin) used in routine patch testing, preparative chromatographic techniques were used to separate its components which were then patch tested on colophony-sensitive individuals. The chemical structure of the dermatologically active components was elucidated using mass spectrometry, nuclear magnetic resonance and infra-red techniques. The study shows that oxidized resin acids are stronger sensitizers than the resin acids themselves, the most potent contact allergen being 7-oxydehydroabietic acid (purity 92%). At naturally occurring concentrations (relative to abietic acid) all unoxidized resin acids were found to play an insignificant part, individually, in colophony dermatitis, except abietic acid (purity 99%), which was found to be a weak but important allergen. The commercial Trolab abietic acid preparation (unknown purity) was found to be dermatologically more active than purified abietic acid.
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Affiliation(s)
- S Sadhra
- Institute of Occupational Health, University of Birmingham, Edgbaston, U.K
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47
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Abstract
An ion-exchange fractionation technique for the separation of total resin acid and neutral fractions of unmodified colophony is described. The allergic potential of these fractions was assessed by patch testing colophony-sensitive individuals, and this showed that both the neutral components and the resin acids play an important role in colophony sensitization. A greater frequency of positive reactions was obtained using the 60% colophony patch test preparation compared with the currently recommended 20% colophony preparation. Furthermore, some individuals were found to produce positive reactions to only the neutral components in colophony. We suggest that the use of a colophony patch test battery comprising resin acids, neutrals, oxidized resin acid and some colophony derivatives, will facilitate detection of colophony-sensitive individuals. Moreover, we consider that this will help to provide a better estimate of the prevalence of colophony dermatitis, which is currently underestimated.
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Affiliation(s)
- S Sadhra
- Institute of Occupational Health, University of Birmingham, Edgbaston, U.K
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48
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Abstract
Colophony (rosin) is a widespread natural product obtained form species of the pine family Pinaceae. One of the most important uses of unmodified rosin is in electronic solder fluxes while the main areas of use of chemically modified rosin are paper sizing, adhesives, paints, varnishes, printing inks and plasticisers. Colophony is well recognized as a skin sensitizer and is also the third highest cause of occupational asthma. However, the specific allergens involved particularly in occupational asthma have not been comprehensively assessed or identified. This paper reviews method of colophony production, its uses and health effects and discusses the important issue of its chemical analysis and the choice of a suitable marker for monitoring colphony fume.
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Affiliation(s)
- S Sadhra
- Institute of Occupational Health, University of Birmingham, U.K
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Sadhra S, Foulds I, Gray C. Investigation of the sensitizing capacity of resin acids and neutrals in unmodified colophony using gas liquid chromatography. Contact Dermatitis 1990. [DOI: 10.1111/j.1600-0536.1990.tb05054.x] [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: 11/30/2022]
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Abstract
A carpet factory worker, exposed to a number of different dyes, developed a severe hand dermatitis. The handling of warm, wet and freshly-dyed yarn with unprotected hands was thought to have caused the onset of dermatitis. Patch testing indicated that the patient was sensitive to only one of the dyes handled, namely Synacril Red 3B liquid, which is based on the single dyestuff Basic Red 22 (CI 11055). Chemical analysis revealed the dyestuff to be of high purity (greater than 95%), suggesting that sensitization was caused by the Basic Red 22 dyestuff itself and not by an avoidable impurity.
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Affiliation(s)
- S Sadhra
- Institute of Occupational Health, University of Birmingham, UK
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