Publications
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Maqsood R, Schofield S, Bennett AN, et al., 2024, The influence of physical and mental health mediators on the relationship between combat-related traumatic injury and ultra-short-term heart rate variability in a U.K. military cohort: a structural equation modeling approach, Military Medicine: international journal of AMSUS, Vol: 189, Pages: e758-e765, ISSN: 0026-4075
Introduction:Combat-related traumatic injury (CRTI) adversely affects heart rate variability (HRV). The mediating effect of mental and physical health factors on the relationship between CRTI, its severity and HRV has not been previously studied and investigated.Materials and Methods:A cross-sectional mediation analysis of the ArmeD SerVices TrAuma and RehabilitatioN OutComE (ADVANCE) prospective cohort study was performed. The sample consisted of injured and uninjured British male servicemen who were frequency-matched based on their age, rank, role-in-theater, and deployment to Afghanistan (2003-2014). CRTI and injury severity (the New Injury Severity Scores [NISS] [NISS < 25 and NISS ≥ 25]) were included as exposure variables. HRV was quantified using the root mean square of successive differences (RMSSD) obtained using pulse waveform analysis. Depression and anxiety mediators were quantified using the Patient Health Questionnaire and Generalized Anxiety Disorder, respectively. Body mass index and the 6-minute walk test (6MWT) represented physical health measures. Two mediation pathways between exposure and outcome variables were examined in comparison with the uninjured group using structural equation modeling.Results:Of 862 servicemen, 428 were injured and 434 were uninjured with the mean age at assessment of 33.9 ± 5.4 (range 23-59) years. Structural equation modeling revealed that depression, anxiety, and body mass index did not significantly mediate the relationship between injury/injury severity and RMSSD. However, the 6MWT significantly mediated the relationship between CRTI and RMSSD (27% mediation). The indirect effect of 6MWT on the relationship between injury severity (NISS ≥ 25 vs. uninjured) and RMSSD was −0.06 (95% CI: −0.12, −0.00, P < .05).Conclusions:The findings suggest that greater physical function may improve HRV following CRTI. Longitudi
Boos CJ, Schofield S, Bull AMJ, et al., 2023, The relationship between combat-related traumatic amputation and subclinical cardiovascular risk, International Journal of Cardiology, Vol: 390, Pages: 1-7, ISSN: 0167-5273
BackgroundThe relationship between acute combat-related traumatic injury (CRTI) to coronary flow reserve (CFR) and subclinical cardiovascular risk have not been examined and was the primary aim of this study.Methods and resultsUK combat veterans from the ADVANCE cohort study (UK-Afghanistan War 2003–14) with traumatic limb amputations were compared to injured non-amputees and to a group of uninjured veterans from the same conflict. Subclinical cardiovascular risk measures included fasted blood atherogenic index of plasma (AIP), triglyceride-glucose index (TyG; insulin resistance), the neutrophil-lymphocyte ratio (NLR) and high-sensitivity C-reactive protein (hs-CRP; vascular inflammation), body mass index (BMI) and visceral fat volume (dual-energy X-ray absorptiometry) and 6-min walk distance (6MWD; physical performance). The subendocardial viability ratio (SEVR), to estimate CFR, was calculated using arterial pulse waveform analysis (Vicorder device). In total 1144 adult male combat veterans were investigated, comprising 579 injured (161 amputees, 418 non-amputees) and 565 uninjured men. AIP, TyG, NLR, hs-CRP, BMI, total body fat and visceral fat volume were significantly higher and the SEVR and 6MWD significantly lower in the amputees versus the injured-non-amputees and uninjured groups. The SEVR was lowest in those with above knee and multiple limb amputations. CRTI (ExpB 0.96; 95% CI 0.94–0.98: p < 0.0001) and amputation (ExpB 0.94: 95% CI 0.91–0.97: p < 0.0001) were independently associated with lower SEVR after adjusting for age, rank, ethnicity and time from injury.ConclusionCRTI, traumatic amputation and its worsening physical deficit are associated with lower coronary flow reserve and heightened subclinical cardiovascular risk.
Nolan CM, Schofield SJ, Maddocks M, et al., 2023, Change in gait speed and adverse outcomes in patients with idiopathic pulmonary fibrosis: a prospective cohort study, Respirology, Vol: 28, Pages: 649-658, ISSN: 1323-7799
BACKGROUND AND OBJECTIVE: Gait speed is associated with survival in individuals with idiopathic pulmonary fibrosis (IPF). The extent to which four-metre gait speed (4MGS) decline predicts adverse outcome in IPF remains unclear. We aimed to examine longitudinal 4MGS change and identify a cut-point associated with adverse outcome. METHODS: In a prospective cohort study, we recruited 132 individuals newly diagnosed with IPF and measured 4MGS change over 6 months. Death/first hospitalization at 6 months were composite outcome events. Complete data (paired 4MGS plus index event) were available in 85 participants; missing 4MGS data were addressed using multiple imputation. Receiver-Operating Curve plots identified a 4MGS change cut-point. Cox proportional-hazard regression assessed the relationship between 4MGS change and time to event. RESULTS: 4MGS declined over 6 months (mean [95% CI] change: -0.05 [-0.09 to -0.01] m/s; p = 0.02). A decline of 0.07 m/s or more in 4MGS over 6 months had better discrimination for the index event than change in 6-minute walk distance, forced vital capacity, Composite Physiologic Index or Gender Age Physiology index. Kaplan-Meier curves demonstrated a significant difference in time to event between 4MGS groups (substantial decline: >-0.07 m/s versus minor decline/improvers: ≤-0.07 m/s; p = 0.007). Those with substantial decline had an increased risk of hospitalization/death (adjusted hazard ratio [95% CI] 4.61 [1.23-15.83]). Similar results were observed in multiple imputation analysis. CONCLUSION: In newly diagnosed IPF, a substantial 4MGS decline over 6 months is associated with shorter time to hospitalization/death at 6 months. 4MGS change has potential as a surrogate endpoint for interventions aimed at modifying hospitalization/death.
Maqsood R, Schofield S, Bennett AN, et al., 2023, Relationship between combat-related traumatic injury and ultrashort term heart rate variability in a UK military cohort: findings from the ADVANCE study, BMJ Military Health, Pages: 1-6, ISSN: 2633-3767
INTRODUCTION: Combat-related traumatic injury (CRTI) has been linked to an increased cardiovascular disease (CVD) risk. The long-term impact of CRTI on heart rate variability (HRV)-a robust CVD risk marker-has not been explored. This study investigated the relationship between CRTI, the mechanism of injury and injury severity on HRV. METHODS: This was an analysis of baseline data from the ArmeD SerVices TrAuma and RehabilitatioN OutComE (ADVANCE) prospective cohort study. The sample consisted of UK servicemen with CRTI sustained during deployment (Afghanistan, 2003-2014) and an uninjured comparison group who were frequency matched to the injured group based on age, rank, deployment period and role in theatre. Root mean square of successive differences (RMSSD) was measured as a measure of ultrashort term HRV via <16 s continuous recording of the femoral arterial pulse waveform signal (Vicorder). Other measures included injury severity (New Injury Severity Scores (NISS)) and injury mechanism. RESULTS: Overall, 862 participants aged 33.9±5.4 years were included, of whom 428 (49.6%) were injured and 434 (50.3%) were uninjured. The mean time from injury/deployment to assessment was 7.91±2.05 years. The median (IQR) NISS for those injured was 12 (6-27) with blast being the predominant injury mechanism (76.8%). The median (IQR) RMSSD was significantly lower in the injured versus the uninjured (39.47 ms (27.77-59.77) vs 46.22 ms (31.14-67.84), p<0.001). Using multiple linear regression (adjusting for age, rank, ethnicity and time from injury), geometric mean ratio (GMR) was reported. CRTI was associated with a 13% lower RMSSD versus the uninjured group (GMR 0.87, 95% CI 0.80-0.94, p<0.001). A higher injury severity (NISS ≥25) (GMR 0.78, 95% CI 0.69-0.89, p<0.001) and blast injury (GMR 0.86, 95% CI 0.79-0.93, p<0.001) were also independently associated with lower RMSSD. CONCLUSION: These results suggest an inverse association between CR
Graham NSN, Blissitt G, Zimmerman K, et al., 2023, ADVANCE-TBI study protocol: traumatic brain injury outcomes in UK military personnel serving in Afghanistan between 2003 and 2014 - a longitudinal cohort study, BMJ Open, Vol: 13, ISSN: 2044-6055
INTRODUCTION: Outcomes of traumatic brain injury (TBI) are highly variable, with cognitive and psychiatric problems often present in survivors, including an increased dementia risk in the long term. Military personnel are at an increased occupational risk of TBI, with high rates of complex polytrauma including TBI characterising the UK campaign in Afghanistan. The ArmeD SerVices TrAuma and RehabilitatioN OutComE (ADVANCE)-TBI substudy will describe the patterns, associations and long-term outcomes of TBI in the established ADVANCE cohort. METHODS AND ANALYSIS: The ADVANCE cohort comprises 579 military personnel exposed to major battlefield trauma requiring medical evacuation, and 566 matched military personnel without major trauma. TBI exposure has been captured at baseline using a standardised interview and registry data, and will be refined at first follow-up visit with the Ohio State Method TBI interview (a National Institute of Neurological Disorders and Stroke TBI common data element). Participants will undergo blood sampling, MRI and detailed neuropsychological assessment longitudinally as part of their follow-up visits every 3-5 years over a 20-year period. Biomarkers of injury, neuroinflammation and degeneration will be quantified in blood, and polygenic risk scores calculated for neurodegeneration. Age-matched healthy volunteers will be recruited as controls for MRI analyses. We will describe TBI exposure across the cohort, and consider any relationship with advanced biomarkers of injury and clinical outcomes including cognitive performance, neuropsychiatric symptom burden and function. The influence of genotype will be assessed. This research will explore the relationship between military head injury exposure and long-term outcomes, providing insights into underlying disease mechanisms and informing prevention interventions. ETHICS AND DISSEMINATION: The ADVANCE-TBI substudy has received a favourable opinion from the Ministry of Defence Research Eth
Dyball D, Bennett AN, Schofield S, et al., 2023, The underlying mechanisms by which PTSD symptoms are associated with cardiovascular heath in male UK military personnel: The ADVANCE cohort study, JOURNAL OF PSYCHIATRIC RESEARCH, Vol: 159, Pages: 87-96, ISSN: 0022-3956
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Dyball D, Bennett AN, Schofield S, et al., 2022, Post-traumatic growth amongst UK armed forces personnel who were deployed to Afghanistan and the role of combat injury, mental health and pain: the ADVANCE cohort study, PSYCHOLOGICAL MEDICINE, ISSN: 0033-2917
Dyball D, Bennett A, Schofield S, et al., 2022, Mental health outcomes of male UK military personnel deployed to Afghanistan and the role of combat-injury: The ADVANCE cohort study, The Lancet Psychiatry, Vol: 9, Pages: 547-554, ISSN: 2215-0366
Background: The long-term psychosocial outcomes of UK Armed Forces personnel who sustained serious combat-injuries during deployment to Afghanistan are largely unknown. This study hypothesised that the rates of probable Post Traumatic Stress Disorder (PTSD), depression, anxiety and mental health multimorbidity will be greater among a representative sample of ex-/serving military personnel with combat injuries compared to a matched sample of uninjured ex-/serving military personnel.Methods: 579 combat-injured and a comparison group of 565 uninjured male UK Armed Forces ex-/serving personnel, frequency-matched by age, rank, regiment, deployment, and role on deployment were included in this analysis. Participants had a median age of 33 (IQR 30, 37) at time of assessment. 90·3% identified as white and 9·7% were from all other ethnic groups. Participants completed a comprehensive health assessment including both physical health assessment and self-reported mental health measures.Results: The rates of PTSD (16·9% vs 10·5%; Adjusted Odds Ratio (AOR) 1·67 (95% Confidence Interval (CI) 1·16, 2·41), depression (23·6% vs 16·8%; AOR 1·46 (95%CI 1·08, 2·03), anxiety (20·8% vs 13·5%; AOR 1·56 (95%CI 1·13, 2·24) and mental health multimorbidity (15·3% vs 9·8%; AOR 1·62 (95%CI 1·12, 2·49) were greater in the injured versus uninjured group respectively. Minimal differences in odds of reporting any poor mental health outcome were noted between the amputation injury subgroup and the uninjured group, whereas up to double the odds were noted for the non-amputation injury subgroup.Interpretation: Serious physical combat-injuries are associated with poor mental health outcomes. However, type of injury influences this relationship. Regardless of injury, this cohort represents a group who present with greater rates of PTSD compared to the
Nolan CM, Polgar O, Schofield SJ, et al., 2022, Pulmonary rehabilitation in idiopathic pulmonary fibrosis and COPD: a propensity matched real-world study, Chest, Vol: 161, Pages: 728-737, ISSN: 0012-3692
BACKGROUND: The adherence to and clinical efficacy of pulmonary rehabilitation in idiopathic pulmonary fibrosis (IPF), particularly in comparison to people with chronic obstructive pulmonary disease (COPD), remains uncertain. The objectives of this real-world study were to compare the responses of patients with IPF with a matched group of patients with COPD undergoing the same supervised, outpatient pulmonary rehabilitation program, and to determine whether pulmonary rehabilitation is associated with survival in IPF. RESEARCH QUESTION: Do people with IPF improve to the same extent with pulmonary rehabilitation as a matched group of individuals with COPD, and are non-completion of and/or non-response to pulmonary rehabilitation associated with one-year all-cause mortality in IPF? STUDY DESIGN AND METHODS: Using propensity score matching, 163 patients with IPF were matched 1:1 with a control group of 163 patients with COPD referred to pulmonary rehabilitation. We compared between-group pulmonary rehabilitation completion rates and response. Survival status in the IPF cohort was recorded over one-year following pulmonary rehabilitation discharge. Cox proportional-hazards regression explored the association between pulmonary rehabilitation status and all-cause mortality. RESULTS: Similar pulmonary rehabilitation completion rates (IPF: 69%; COPD: 63%; p=0.24) and improvements in exercise response were observed in both groups with no significant mean (95% confidence interval (CI)) between-group differences in incremental shuttle walk (ISW) change (2 (-18 to 22) meters). Pulmonary rehabilitation non-completion (hazard ratio (HR) (95%CI) 5.62 (2.24 to 14.08)) and non-response (HR (95%CI) 3.91 (1.54 to 9.93)) were independently associated with increased one-year all-cause mortality in IPF. INTERPRETATION: Compared with a matched group of patients with COPD, this real-word study demonstrates that patients with IPF have similar completion rates and magnitude of response to pul
Kabir T, Schofield S, Fitzgerald B, et al., 2022, Assessment and outcomes of firefighter applicants with possible asthma., Occupational Medicine, Vol: 72, Pages: 118-124, ISSN: 0962-7480
BACKGROUND: Firefighter applicants (FFAs) with a history of asthma may be refused entry to the fire service because of potentially putting themselves and others at risk. AIMS: We undertook a service evaluation to identify respiratory and employment outcomes of FFAs with a history of asthma who had undergone additional respiratory assessment at our specialist occupational lung disease clinic during 2005-19. METHODS: We reviewed FFA medical records and categorized them as having either no current asthma or definite/probable asthma at the time of clinic assessment. 'No current asthma' was defined as negative non-specific bronchial hyper-responsiveness (BHR) to histamine/methacholine, and no symptoms or treatment within the 2 years before clinic. 'Definite/probable current asthma' was defined as either positive BHR, or negative BHR with symptoms and/or treatment within the previous 2 years. Around 1 year later, we contacted FFAs to enquire about their application outcome and current respiratory symptoms. RESULTS: Data were available on 116 applicants; of whom, 45% (n = 52) had definite/probable current asthma and were significantly more likely to be older, atopic to common aeroallergens, report atopic disease and have a lower forced expiratory volume in one second/forced vital capacity ratio compared with applicants with no current asthma. Only two individuals' applications were rejected due to asthma. At follow-up, just 2 (2%) of the 90 operational firefighters reported any recent trouble with asthma. CONCLUSIONS: A history of asthma alone is not sufficient to determine current asthma in FFAs. Even with a diagnosis of current asthma, FFAs are mostly successful in their application to join the fire service.
Boos C, Schofield S, Cullinan P, et al., 2022, Association between combat-related traumatic injury and cardiovascular risk, Heart, Vol: 108, Pages: 367-374, ISSN: 1355-6037
Objective The association between combat-related traumatic injury (CRTI) and cardiovascular risk is uncertain. This study aimed to investigate the association between CRTI and both metabolic syndrome (MetS) and arterial stiffness.Methods This was a prospective observational cohort study consisting of 579 male adult UK combat veterans (UK-Afghanistan War 2003–2014) with CRTI who were frequency-matched to 565 uninjured men by age, service, rank, regiment, deployment period and role-in-theatre. Measures included quantification of injury severity (New Injury Severity Score (NISS)), visceral fat area (dual-energy X-ray absorptiometry), arterial stiffness (heart rate-adjusted central augmentation index (cAIx) and pulse wave velocity (PWV)), fasting venous blood glucose, lipids and high-sensitivity C reactive protein (hs-CRP).Results Overall the participants were 34.1±5.4 years, with a mean (±SD) time from injury/deployment of 8.3±2.1 years. The prevalence of MetS (18.0% vs 11.8%; adjusted risk ratio 1.46, 95% CI 1.10 to 1.94, p<0.0001) and the mean cAIx (17.61%±8.79% vs 15.23%±8.19%, p<0.0001) were higher among the CRTI versus the uninjured group, respectively. Abdominal waist circumference, visceral fat area, triglycerides, estimated insulin resistance and hs-CRP levels were greater and physical activity and high-density lipoprotein-cholesterol lower with CRTI. There were no significant between-group differences in blood glucose, blood pressure or PWV. CRTI, injury severity (↑NISS), age, socioeconomic status (SEC) and physical activity were independently associated with both MetS and cAIx.Conclusions CRTI is associated with an increased prevalence of MetS and arterial stiffness, which are also influenced by age, injury severity, physical activity and SEC. The longitudinal impact of CRTI on clinical cardiovascular events needs further examination.
Bennett AN, Dyball DM, Boos CJ, et al., 2020, Study protocol for a prospective, longitudinal cohort study investigating the medical and psychosocial outcomes of UK combat casualties from the Afghanistan war: the ADVANCE Study., BMJ Open, Vol: 10, Pages: 1-11, ISSN: 2044-6055
INTRODUCTION: The Afghanistan war (2003-2014) was a unique period in military medicine. Many service personnel survived injuries of a severity that would have been fatal at any other time in history; the long-term health outcomes of such injuries are unknown. The ArmeD SerVices TrAuma and RehabilitatioN OutComE (ADVANCE) study aims to determine the long-term effects on both medical and psychosocial health of servicemen surviving this severe combat related trauma. METHODS AND ANALYSIS: ADVANCE is a prospective cohort study. 1200 Afghanistan-deployed male UK military personnel and veterans will be recruited and will be studied at 0, 3, 6, 10, 15 and 20 years. Half are personnel who sustained combat trauma; a comparison group of the same size has been frequency matched based on deployment to Afghanistan, age, sex, service, rank and role. Participants undergo a series of physical health tests and questionnaires through which information is collected on cardiovascular disease (CVD), CVD risk factors, musculoskeletal disease, mental health, functional and social outcomes, quality of life, employment and mortality. ETHICS AND DISSEMINATION: The ADVANCE Study has approval from the Ministry of Defence Research Ethics Committee (protocol no:357/PPE/12) agreed 15 January 2013. Its results will be disseminated through manuscripts in clinical/academic journals and presentations at professional conferences, and through participant and stakeholder communications. TRIAL REGISTRATION NUMBER: The ADVANCE Study is registered at ISRCTN ID: ISRCTN57285353.
Feary J, Cannon J, Fitzgerald B, et al., 2020, Follow-up survey of patients with occupational asthma., Occupational Medicine, Vol: 70, Pages: 231-234, ISSN: 0962-7480
BACKGROUND: Occupational asthma (OA) is often associated with a poor prognosis and the impact of a diagnosis on an individual's career and income can be significant. AIMS: We sought to understand the consequences of a diagnosis of OA to patients attending our clinic. METHODS: Using a postal questionnaire, we surveyed all patients attending our specialist occupational lung disease clinic 1 year after having received a diagnosis of OA due to a sensitizer (n = 125). We enquired about their current health and employment status and impact of their diagnosis on various aspects of their life. Additional information was collected by review of clinical records. RESULTS: We received responses from 71 (57%) patients; 77% were referred by an occupational health (OH) provider. The median duration of symptoms prior to referral was 18 months (interquartile range (IQR) 8-48). At 1 year, 79% respondents were no longer exposed to the causal agent. Whilst the unexposed patients reported an improvement in symptoms compared with those still exposed (82% versus 53%; P = 0.023), they had poorer outcomes in terms of career, income and how they felt treated by their employer; particularly those not currently employed. Almost all (>90%) of those still employed had been referred by an OH provider compared with 56% of those currently unemployed (P = 0.002)x. CONCLUSIONS: The negative impact of OA on people's careers, livelihood and quality of life should not be underestimated. However, with early detection and specialist care, the prognosis is often good and particularly so for those with access to occupational health.
Schofield SJ, Woods A, Szram J, et al., 2019, COPD and breathlessness in older workers predict economic inactivity; A prospective cohort study, American Journal of Respiratory and Critical Care Medicine, Vol: 200, Pages: 1228-1233, ISSN: 1073-449X
RATIONALE: There is an aspiration to retain increasing numbers of older workers in employment and strategies to achieve this need to make provision for the increasing prevalence of chronic diseases with age. There is a consistent body of cross-sectional evidence that suggests that patients with chronic obstructive pulmonary disease are more likely to have adverse employment outcomes. OBJECTIVES: We report the findings of the first longitudinal study of this issue. METHODS: We recruited full-time employed men and women in their 50's and followed them for a period of 18 months; we examined, after adjustment for potential confounders, the associations between breathlessness and airway obstruction at baseline and loss of employment in the intervening period. MEASUREMENTS AND MAIN RESULTS: Among participants responding to the follow up questionnaire (1656/1773 (93%)), the majority (78.5%) continued in full-time employment, but 10.6% were in part-time employment and 10.9% were no longer in paid employment. The adjusted risk of loss of employment was significantly increased for those with moderate or severe chronic obstructive pulmonary disease (RR 2.89, 95% ci 1.80-4.65) or breathlessness (3.07, 2.16-4.37) at baseline. There was no evident modification by sex or by manual/non-manual work. CONCLUSIONS: Airway obstruction and breathlessness are independently associated with premature loss from the workforce in older workers; these observations provide strong support to the available cross-sectional evidence and suggest that interventions to help those with chronic obstructive pulmonary disease who wish to remain in work need to be tested.
Feary JR, Schofield SJ, Canizales J, et al., 2019, Laboratory animal allergy is preventable in modern research facilities, European Respiratory Journal, Vol: 53, ISSN: 0903-1936
BACKGROUND: Historical data suggest 15% of laboratory animal workers develop IgE sensitisation and 10% symptoms of laboratory animal allergy (LAA), including occupational asthma. Individually ventilated cages (IVC) are replacing conventional open cages; we sought to evaluate their impact on the development of LAA. METHODS: We surveyed 750 laboratory animal workers and measured airborne Mus m 1 (mouse allergen) levels in seven UK institutions. We compared the prevalence of sensitisation to mouse proteins (by specific IgE assay or skin prick test) and of work-related allergic symptoms in IVC-only and open cage units. MEASUREMENTS AND MAIN RESULTS: Full shift Mus m 1 levels were lower in IVC than open cage units (geometric mean 1.00 ng·m-3 (95% confidence interval: 0.73-1.36) versus8.35 ng·m-3 (6.97-9.95); p<0.001) but varied eight-fold across the IVC units (GM range: 0.33-4.12 ng·m-3). Primary analyses on data from 216 participants with <3 years' exposure to mice revealed a lower prevalence of sensitisation in those working in IVC compared with conventional cage units (2.4% (n=2) versus9.8% (n=13); p=0.052). Sensitisation in IVC units varied from 0% to 12.5%; the use of fitted respiratory protection was less common in IVC units where prevalence of sensitisation was higher. Work-related allergy symptoms were more frequently reported by mouse sensitised individuals (46.7% versus 10.9%, p<0.001); and only by those working in open cage units. CONCLUSION: In contemporary practice, LAA is now largely preventable with the use of IVC systems and the judicious use of appropriate respiratory protection.
Pierotti L, Schofield SJ, Collett D, et al., 2018, Traffic-related air pollution and solid organ transplant failure in Great Britain: A retrospective cohort study, Journal of Transport and Health, Vol: 10, Pages: 124-131, ISSN: 2214-1405
Background: Limited evidence suggests that exposure to traffic related air pollution is associated with graft failure among lung transplant recipients. We explored associations between pollution and transplant failure among lung and other solid organ transplant recipients in Great Britain through a retrospective cohort study. Methods: All patients who received a lung, heart, liver, or kidney transplant between 2000 and 2008 in Great Britain were included, as recorded in the National Health Service Blood and Transplant (NHSBT) register and followed to March 2015. Using residential addresses at time of transplant we calculated distance to nearest (major) road and modelled annual average exposures to airborne nitrogen oxides and particulate matter of diameter ≤10µm and ≤2.5µm for each transplant recipient. All-cause mortality or graft failure (kidney) during follow up was the main outcome; median follow-up was around 10 years for each organ type. We fitted Cox regression models with adjustment for age, sex, year of transplant and donor age/smoking status. Results: 780 lung, 1213 heart, 3650 liver and 11966 graft kidney transplant patients were analysed. We did not find any consistent associations between mortality or graft failure and any of the analysed air pollutants or road metrics. Although, exposure to particulate matter was associated with renal transplant failure in univariable analyses but not after adjustment for confounders. Conclusions: Our analysis does not confirm previously reported associations between traffic-related air pollution exposure and the risk of transplant failure.
Schofield SJ, Doughty VL, van Stiphout N, et al., 2016, Assisted conception and the risk of CHD: a case-control study, Cardiology in the Young, Vol: 27, Pages: 473-479, ISSN: 1467-1107
Epidemiological studies suggest a higher prevalence of congenital malformations in children conceived through assisted reproductive technologies. There are a few studies that address CHD specifically and most have examined data from registries. We examined the relationship between CHD and assisted conception using data collected in a specialist paediatric cardiac service in the United Kingdom. Between April, 2010 and July, 2011, the parents of children attending paediatric cardiology clinics at the Royal Brompton Hospital, London, were invited to complete a questionnaire that enquired about the nature of their child's conception, the route for their original referral, and a number of potential confounding exposures. "Cases" were defined as children diagnosed with one or more carefully defined CHDs and "controls" as those with normal hearts. Of 894 new attendees with complete data, half of them were cases (n=410, 45.9%). The overall prevalence of assisted conception was 5.4% (n=44). Logistic regression analysis demonstrated a non-significant increase in the crude odds for the use of assisted reproduction (odds ratio 1.21, 95% confidence interval 0.66-2.22) in this group. After adjustment for gestation, parity, year of birth, and maternal age, the odds ratio reduced (odds ratio 0.95, 95% confidence interval 0.48-1.88). Increased rates of assisted conception were observed in a number of CHD subgroups, although no significant differences were found. These findings do not suggest an overall association between CHD and assisted reproduction in this population.
Marongiu A, Hasan O, Ali A, et al., 2016, Are welders more at risk of respiratory infections? Findings from a cross-sectional survey and analysis of medical records in shipyard workers: the WELSHIP project, Thorax, Vol: 71, Pages: 601-606, ISSN: 1468-3296
Background Exposure to welding fume increases the risk of pneumococcal infection; whether such susceptibility extends to other respiratory infections is unclear. We report findings from a survey and from medical consultation data for workers in a large shipyard in the Middle East.Methods Between January 2013 and December 2013, we collected cross-sectional information from 529 male workers variously exposed to welding fume. Adjusted ORs for respiratory symptoms (cough, phlegm, wheezing, shortness of breath and ‘chest illness’) were estimated using multivariable logistic regression. Subsequently, we examined consultation records from 2000 to 2011 for 15 954 workers who had 103 840 consultations for respiratory infections; the associations between respiratory infections and levels of welding exposure were estimated using a count regression model with a negative binomial distribution.Results 13% of surveyed workers reported respiratory symptoms with a higher prevalence in winter, particularly among welders. The adjusted OR in welders versus other manual labourers was 1.72 (95% CI 1.02 to 3.01) overall and 2.31 (1.05 to 5.10) in winter months; no effect was observed in summer. The risk of consultation for respiratory infections was higher in welders than in manual labourers, with an adjusted incidence rate ratio of 1.45 (1.59 to 1.83) overall, 1.47 (1.42 to 1.52) in winter and 1.33 (1.23 to 1.44) in summer (interaction, p<0.001).Conclusions The observation that respiratory symptoms and consultations for respiratory infection in welders are more common in winter may indicate an enhanced vulnerability to a broad range of infections. If confirmed, this would have important implications for the occupational healthcare of a very large, global workforce.
Howarth H, Schofield S, Cannon J, et al., 2015, Prevalence of cross-reactive carbohydrate determinants in UK bakers, CLINICAL AND EXPERIMENTAL ALLERGY, Vol: 45, Pages: 1613-1615, ISSN: 0954-7894
Kon SSC, Jones SE, Schofield SJ, et al., 2015, Gait speed and readmission following hospitalisation for acute exacerbations of COPD: a prospective study, Thorax, Vol: 70, Pages: 1131-1137, ISSN: 1468-3296
Jones M, Jeal H, Schofield S, et al., 2014, Rat-specific IgG and IgG(4) antibodies associated with inhibition of IgE-allergen complex binding in laboratory animal workers, Occupational and Environmental Medicine, Vol: 71, Pages: 619-623, ISSN: 1470-7926
Objectives The relationship between exposure torodent allergens and laboratory animal allergy iscomplex; at highest allergen exposures there is anattenuation of sensitisation and symptoms which areassociated with increased levels of rat-specificimmunoglobulin (Ig)G and IgG4 antibodies. We set outto examine whether the increased levels of rat-specificIgG and IgG4 antibodies that we have previouslyobserved at high allergen exposure in our cohort oflaboratory animal workers play a functional role throughblockage of the binding of IgE–allergen complex bindingto CD23 receptors on B cells.Methods Cross-sectional survey of laboratory animalworkers (n=776) in six UK pharmaceutical companieswere surveyed. IgE–allergen complex binding to B cellswas measured in 703 (97.9%) eligible employees; theirexposure was categorised by either job group or numberof rats handled daily.Results We observed a significant decrease inIgE–allergen complex binding to B cells with increasingquartiles of both rat-specific IgG and IgG4 antibodies(p<0.001). IgE–allergen complex binding to B cells waslower in workers with high allergen exposure, andsignificantly so (p=0.033) in the subgroup with highestexposures but no work-related chest symptoms.Conclusions These findings demonstrate a functionalrole for rat-specific IgG/G4 antibodies in laboratoryanimal workers, similar to that observed in patientstreated with high dose immunotherapy who becomeclinically tolerant, suggesting a potential explanation forthe attenuation of risk at highest allergen exposures.
Marongiu A, Hasan O, Ali A, et al., 2014, 0407 An old trade with an unanswered question: does arc-welding fume exposure increase the risks of obstructive pulmonary diseases? First findings from the WELSHIP cross-sectional study., Occup Environ Med, Vol: 71 Suppl 1
OBJECTIVES: Increasingly, global manufacturing is shifting to emerging economies and with it the use of arc-welding for applications in different industries. The chronic respiratory adverse effects resulting from exposure to gases and ultrafine metal particles in welding fume are incompletely understood. We aimed to measure the prevalence of arc-welding related pulmonary obstructive outcomes by analysing data collected in a shipyard in the Middle East. METHOD: Between January and December 2013, through cross-sectional survey, we collected spirometry data and behavioural, occupational and respiratory symptoms information from a random sample of male shipyard workers; 397 were exposed to welding fume and 127 were non-exposed. The sample was selected from a total population of about 8000 employees, by frequency matching for ethnicity and age relatively to full-time welders ('highly' exposed). RESULTS: Of the 580 workers invited, 26 subsequently left their job; of the remainder, 95%(524) agreed to participate. The participants, from the Indian subcontinent (90%) or Philippines (10%), had a median age of 38 years. Ever smoking was reported by 37%, with full-time welders reporting the lowest proportion of current smoking, 18%(24/131). Overall, 13% reported respiratory symptoms with a higher prevalence in the winter months. Post-bronchodilator spirometry data were available for 91% of workers. Mean values for FEV1 and FVC were 2.87L and 3.48L, with no statistically significant differences across exposure groups (p-values: 0.71 and 0.48). CONCLUSIONS: These preliminary results need to be explored further in relation to smoking, past and current occupational exposure. This population, it is hoped, will form the basis for a longitudinal study.
Jones M, Schofield S, Jeal H, et al., 2014, Respiratory protective equipment reduces occurrence of sensitization to laboratory animals, OCCUPATIONAL MEDICINE-OXFORD, Vol: 64, Pages: 104-108, ISSN: 0962-7480
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- Citations: 10
Szram J, Schofield SJ, Cosgrove MP, et al., 2013, Welding, longitudinal lung function decline and chronic respiratory symptoms: a systematic review of cohort studies, EUROPEAN RESPIRATORY JOURNAL, Vol: 42, Pages: 1186-1193, ISSN: 0903-1936
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- Citations: 46
Upchurch S, Harris JM, Cullinan P, 2010, Temporal changes in UK birth order and the prevalence of atopy, ALLERGY, Vol: 65, Pages: 1039-1041, ISSN: 0105-4538
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- Citations: 7
Brant A, Upchurch S, van Tongeren M, et al., 2009, Detergent protease exposure and respiratory disease: case-referent analysis of a retrospective cohort, OCCUPATIONAL AND ENVIRONMENTAL MEDICINE, Vol: 66, Pages: 754-758, ISSN: 1351-0711
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- Citations: 14
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