15 results found
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.
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
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
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
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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