Review of the occupational health and safety of Britain’s ethnic minorities

This report sets out an evidence-based review on work-related health and safety issues relating to black and minority ethnic groups. Data included available statistical materials and a systematic review of published research and practice-based reports. UK South Asians are generally under-represented within the most hazardous occupational groups. They have lower accident rates overall, while Black Caribbean workers rates are similar to the general population; Bangladeshi and Chinese workers report lowest workplace injury rates UK South Asian people exhibit higher levels of limiting long-term illness (LLI) and self reported poor health than the general population while Black Africans and Chinese report lower levels. Ethnic minority workers with LLI are more likely than whites to withdraw from the workforce, or to experience lower wage rates. Some of these findings conflict with evidence of differentials from USA, Europe and Australasia, but there is a dearth of effective primary research or reliable monitoring data from UK sources. There remains a need to improve monitoring and data collection relating to black and ethnic minority populations and migrant workers. Suggestions are made relating to workshops on occupational health promotion programmes for ethnic minorities, and ethnic minority health and safety 'Beacon' sites

Novel strategies for the identification of biomarkers of non-Hodgkin lymphoma: evidence from the European Prospective Investigation into Cancer (EPIC)

Non-Hodgkin’s Lymphomas (NHL) represent the eighth most common cancer in Western Europe. Yet despite their widespread prevalence and high mortality rate relatively little is known about the aetiology of these hematological malignancies. Consequently NHL represents an ideal candidate for the discovery of biomarkers lying along the causal pathway. Such biomarkers would allow the improved identification of risk factors and high risk individuals, as well as an enhanced understanding of lymphomageneisis. However, to date there has been little progress in determining validated predictive biomarkers of NHL. This thesis attempts to address some of the issues that have previously hampered the study of NHL through novel strategies of biomarker identification utilising novel methodologies, technologies and statistical techniques. The thesis comprises a nested case-control study within the European Prospective investigation into Cancer (EPIC) cohort and is split into two parts: the ‘validation of biomarkers’ and the ‘integration of biomarkers’. The most exciting finding was the identification of a novel biomarker for Follicular lymphoma based on the t(14;18) translocation which comprises a previously unknown pre-disease condition. Although no other predictive biomarkers were identified this work represents a ‘proof-of-principle’ for the use profile regression in the study of highly dimensional complex datasets, and the possibility of using mass-spectrometry derived metabolic profiles in the study of lymphoma. Part two of the thesis confirmed that the use of the ‘meet-in-the-middle’ approach was a valuable and feasible method for studying the complete causal pathway from risk factor to disease. Together these results highlight potential avenues for further study of NHL and confirm the utility of a number of novel strategies that can aid such work. Additionally it informs on some of the likely challenges that will be involved.Open Acces

The experience of long-term survival following allogeneic blood and marrow transplant (BMT) in New South Wales (NSW), Australia

Allogeneic blood and marrow transplant (BMT) is widely used for the treatment of life threatening malignant and non-malignant diseases in both adults and children. While it provides many patients with their best opportunity for survival it is associated with significant long-term and late mortality and morbidity. The aim of this study was to obtain comprehensive data regarding the late sequelae of BMT in an Australian setting, and to use that data to identify gaps in service provision provided to this vulnerable and high-risk group. BMT survivors aged over 18 and transplanted between 2000-2012 in NSW were eligible to participate. Survivors completed a cross sectional survey instrument which included: the Sydney Post BMT Study survey, the FACT-BMT (V4), the Chronic GvHD Activity Assessment Self Report, the Lee Chronic GvHD Symptom Scale, DASS21, the Post Traumatic Growth Inventory and the Fear of Recurrence Scale. Of the 669 BMT recipients alive at study sampling, 583 were contactable and 441 (66% of total eligible, 76% of those contacted) returned the survey. The most common problems reported were chronic GVHD (69.3%) sexual dysfunction (57%; 51% males & 66% females), vaccine preventable diseases (41.5%), tooth decay (36.8%), iron overload (32.5%), taste alterations (30.9%) osteoporosis/osteopeania (29.1%), cataracts (28.9%), hypertension (29%), high cholesterol (24.0%), secondary malignancy (24.5%), depression (23.3%), anxiety (20.6%), altered smell (20.7%) poor appetite (20.2%), and diabetes (14.3%). High risk health behaviours such as smoking, drinking (>14 standard drinks/week), and not being ‘sun smart’, were reported by 7.5%, 7.7% and 22.9% of survivors respectively. Almost 50% were overweight or obese. Regular exercise was reported by 45.1% of respondents. Adherence with cancer screening following BMT was low; 32.4% bowel cancer check, 63.4% PAP smear 53.5% mammogram, 52.3% skin cancer check, 36.2% prostate cancer check. Full time employment post BMT decreased from 64% to 32.5% and those in the lowest income strata increased from 21% to 36%. Ill-health as the cause for not working increased almost 4-fold pre to post-transplant. When asked about preferences for long-term care approximately 75% wished to have their follow-up in their BMT centre or in an expert facility linked to their BMT centre. This study provides the most comprehensive account of the experience of survival following BMT in Australia. Survivors experience a high incidence and a broad range of physiological and psycho-social late effects of BMT, many of which are not currently addressed. Importantly, BMT also has a major financial impact on survivors with many no longer engaged in full-time employment and/or experiencing a decline in socioeconomic status and having difficulties with social reintegration. These results reaffirm the need for continuing education, and policy and practice reform

Nutritional Factors and the Risk of Non-Hodgkin Lymphoma among Palestinians

Background: The incidence of Non-Hodgkin Lymphoma (NHL) increased worldwide during the second half of the last century and then stabilized during the nineties but subsequently increased. Environmental factors and dietary habits have been reported to play an important role in the etiology of NHL by influencing the immune system. However, no such data are available from Palestine. Objectives: To participate in establishing a platform to study B-NHL in Palestine and further to examine the association between dietary factors and the risk of B-NHL among Palestinian B-NHL patients versus controls. Design: Case-control study. Methods: A case-control study was conducted between 2009-2013 including 306- histological confirmed B-NHL cases and 392 cancer-free controls among adult Palestinians recruited from three major Palestinian hospitals in the West Bank and Jerusalem which have an oncology department in addition to Hadassah Hospital in West Jerusalem. In the primary study analysis, an imbalance was encountered in the regional distribution of cases and controls in the central area. In order to correct for this imbalance, I recruited 71 controls from the primary health care centers in Jericho, Ramallah and Al-Azaria on the basis of frequency matched case-control study in terms of age and gender and region. The study participants were administered a questionnaire which is based on the international Epi-Lymph questionnaire, which focuses on demographic characteristics, types of environmental exposure and on diet and nutritional intake, specifically meat, milk, dairy,vegetables and fruits. Blood samples were also collected from participants for the purpose of DNA purification and viral serology testing. The overall data-base was used to study the association between nutritional factors and the risk of NHL. The data was analyzed by Statistical Package for the SocialSciences(SPSS)and associations were examined by multivariate logistic regression. For food intake analysis, the median value for each food group was calculated from overall distribution of the study population in order to use the value below the median as a reference value to detect associations by logistic regression. Results: High consumption of meat (OR=1.8; 95% CI: 0.8-4.3) and milk (OR=1.3; 95% CI: 0.7-2.6) was found to be positively associated with the risk of B-NHL. Vegetable intake was also positively associated with the risk of B-NHL (OR=1.3; 95% CI: 0.4-4). Similarly, dairy products were significantly associated with an increased risk of B-NHL (OR=2.3; 95% CI: 1.2-4.4). In contrast, a significantly inverse association was encountered between fish consumption and B-NHL risk (OR=0.4; 95% CI: 0.2-0.8), and an inverse association was found between the consumption of fruits and B-NHL risk (OR=0.7; 95% CI: 0.2-2.1). Conclusion:The results of this study showed that dietary intake may affect the risk of NHL as positive associations were found with meat, milk, dairy products and vegetables consumption, while an inverse association with fish and fruits consumption was encountered. Keywords: dietary factors, non-Hodgkin lymphoma, case–control study, Palestine

The Epidemiology of Non-Communicable Diseases Lifestyle Risk Factors in Tanzanian Population Groups

Background: The burden of non-communicable diseases (NCDs) is a global public health concern which so far has claimed more than 36 million lives worldwide. Four key lifestyles namely insufficient fruit and vegetable (FV) intake, insufficient physical activity (PA), harmful alcohol use and tobacco smoking are responsible for majority of the NCD disability adjusted life years (DALYs) (52.1%), whereas the rest are attributed to genetic and occupational risks. Low and middle income countries (LMIC) like Tanzania succumb to almost the entire NCD burden (>90%), while still being overwhelmed by the burden of communicable diseases amidst a debilitated health care system. Moreover, epidemiological evidence for aiding NCD interventions is least available in LMIC. In the absence of effective responses, the death toll may reach 44 million by 2020. This study is in line with the global call to address lifestyle risks through the “25 x 25” risks by the WHO coordinated leadership of “The Lancet NCD Action Group and NCD Alliance”. The “25 x 25” risks seeks to reduce 25% of lifestyle risks by the year 2025. Hence this study explores a semi-urban setting in Southern Tanzania to describe how far unhealthy practices have manifested different socio-demographic population groups and its relevance to the burden of NCDs; and from that proposes suitable public health responses. Methods: This study employed a cross sectional design from the MZIMA open community cohort round 1 (2012-2013) and round 2 (2013-2014). The MZIMA cohort is lodged into the Ifakara Urban Health and Demographic Surveillance System (IU-HDSS). The WHO STEPS tool was adopted to answer questions on how often fruits and vegetables (FV) were consumed, in what portions and by whom and this information eventually was used to describe patterns of FV insufficiency. This work was able to describe fruit intake and vegetable intake patterns individually and thereby establish the respective intake limitations and importance in the overall population FV insufficiency. Furthermore, the study was also able to explore patterns of physical activity under the domain activities of “work”, “travel” and “recreation or leisure”. Moreover, intensities of activities described as “vigorous” and “moderate” were deduced and thereby the overall population moderate to vigorous physical activity (MVPA) was also deduced in a gender specific manner. In addition, the WHO STEPS tool was also used to establish alcohol use patterns in respect to frequency of alcohol consumption, amount of alcohol consumed, and type of alcohol consumed in different population groups with special interest on understanding the burden of heavy episodic drinking (HED) and use of local brew. Patterns of tobacco smoking captured as never, ever and daily smokers were useful in establishing associations with other lifestyle risks. Logistic regression models assessed the relation between NCD risky lifestyles and specific contextual factors also defined as social determinants. Results: This study found that FV insufficiency was widely prevalent (82%), with vegetables being consumed daily by almost half of the population but in small portions, and with youth being most deprived. Use of fruits was found to be limited by indicators of low social economic status (SES). We also found that three quarters of the population were active enough, but majority among them were active to moderate intensity (59.5%) only. In a resource poor semi-urban setting were farming is still the most prevalent economic activity, dominance of moderate over vigorous intensity physical activity should be given closer monitoring because it could be a signal of a population becoming less active. It is such subtle changes in physical activity that eventually may lead to drop in the overall MVPA and consequently risk of insufficient PA and sedentary lifestyle. In addition, gender specific influence of age on physical activity was clear and statistically relevant. Young men were more likely to be more active than young women, but in old age the opposite was true. Moreover, people with high SES were more likely to be insufficient in PA than those with low SES. This study also found that HED was widespread (91.3%) among all drinkers with no significant gender or SES difference. Local brew (47.9%) was no longer the most popular alcoholic drink when compared to previous studies. Moreover, more women and youth binge drinkers consumed commercial alcoholic beverages. Furthermore, 25% of drinkers were also smokers which is an important predisposition to head and neck cancers. Conclusion: This study contributes evidence to the global and national NCD research agenda, suggesting that the burden of NCD risky lifestyle in Southeastern Tanzania is substantial and highly complex within its context. This includes widespread insufficient FV, predominant moderate MVPA and alarming patterns of alcohol abuse that are further aggravated by the burden of smoking. These are quantitative findings which can be further strengthened by qualitative explorations to shed light on mechanization of NCD risky lifestyles in the study setting. The lifestyle profiles observed in this study demand urgent public health responses particularly targeting the specific needs of those socio-economically deprived as a matter of priority. Targeted public health action and priority setting and against specific risky lifestyles should further consider gender and age difference in vulnerability. These findings emphasis the need for active health education campaigns on the public health importance of NCDs and WHO lifestyle recommendations while promoting and facilitating environments for easy access to healthy choices. A string of promotional environments to strengthen specific healthy choices have been proposed. This includes introduction of indigenous vegetables into mainstream marketing and evidence-based farming to improve vegetable consumption. It is also proposed to explore the possibility of replacing expensive fruits with nutrient rich herbs and spices locally available and accessible to the majority at affordable prices. Others include infrastructural and policy adjustments necessary to support more population physical activity and FV intake. The study also proposes ways of strengthening the political environment for more successful implementation of the NCD policies, NCD regulations and the NCD research agenda. In addition, the study also describes the potential for using the existing national revenue collection system, health system, police, social welfare offices, law firms and others as platforms for monitoring patterns of healthy choices and its health and social impact across different geographic settings and population groups country wide

Epidemiology of oral cancer from a socioeconomic perspective

Tackling health inequalities is a policy priority. Research on cancer and particularly oral cancer aetiology has somewhat overlooked this area, in favour of pursuing genetic and 'lifestyle' risk factors. The over-arching aim of this thesis was to investigate the epidemiology of oral cancer in relation to individual socioeconomic status (SES), area-based socioeconomic circumstances, and socioeconomic inequalities. Descriptive epidemiology studies undertaken demonstrated that the burden of oral cancer was increasing across the UK, especially in Scotland, and a socioeconomic gap was widening with those from more deprived communities having significantly greater and increasing incidence of the disease. A systematic review and meta-analysis of the world literature showed that low compared to high SES was associated with significantly elevated risk of oral cancer independent of behavioural factors. A local case-control study provided unclear findings when individual- and area-based socioeconomic factors were explored together; however, a framework for future analyses was developed. In totality, this thesis suggests that public health policy to address the overall rising incidence and widening inequalities of oral cancer needs to acknowledge the complexity of the risk factors; in addition, the findings provide evidence to steer policy, which focus on lifestyles factors towards an integrated approach incorporating measures designed to tackle the root causes of disadvantage

Exploring orAL cAncer Risk behaviouRs of Indian imMigrants in Australia : a mixed-methods study to inform preventative strategies (the ALARRM study)

The broad aim of this mixed methods study was to explore oral cancer risk behaviours of Indian immigrants and identify preventative strategies to raise oral cancer awareness. The specific aims were to examine the self-reported oral cancer knowledge, attitudes, and practices of Indian immigrants in Australia and perceived barriers and facilitators in adopting preventative strategies. Similarly, the oral cancer-related knowledge, attitudes, and clinical practices of General Practitioners (GPs) were investigated along with their perceived barriers and facilitators in promoting preventative strategies in Australia. This thesis is presented as a series of five published papers. Two publications are presented as the literature review and the remaining three papers are from the qualitative and quantitative results. The ALARRM study has provided valuable insight into the under-researched area of oral cancer risk in Australia. It has revealed varying levels of knowledge about oral cancer among the sample of Indian immigrants, particularly around risk factors like alcohol and areca nut use as well as oral cancer-related signs/symptoms. Positive attitudes about preventative oral health practices were evident, although some participants were involved in oral cancer risk practices. The findings have also highlighted the lack of adequate information regarding oral cancer being provided in primary health care settings and uncertainty around the scope of practice of GPs in this area. GPs play a vital role as primary health care providers and are a gateway to access specialist health services. However, a lack of relevant oral health training is making it difficult for GPs to actively promote oral cancer prevention. The overall findings suggest the need for the formulation of community-centred oral cancer preventative and awareness strategies along with capacity building of primary health care professionals. Steps taken on a policy level could also help in reducing oral cancer incidence. Further research through larger studies and a more representative sample is warranted to xxi explore this area in Australia and confirm the study findings. Greater knowledge in this area will help inform the development of culturally sensitive and tailored strategies to raise awareness of oral cancer risk among the growing Indian immigrant population in Australia

Efficacy of Homoeopathy for Improving the Quality of Life in Oral Cancer Patients

INTRODUCTION: The quality of life is an indicator of improvement of the cancer treatment which includes analysis of the life quality as a parameter of cancer management. This clinical study was aimed at checking the effectiveness of homoeopathic medicines in improving the quality of life in oral cancer patients using before and after value. MATERIALS AND METHODS: A sample of 30 cases above 18 yrs of age suffering from oral cancer were selected from the OPD/ IPD of Sarada Krishna Homoeopathic Medical College Hospital and its peripheral health centers. The cases were taken in pre structured standardised Sarada Krishna chronic case record and medicines were selected based on totality. Before giving the medicine life quality score was marked using the quality of life chart (EORTC QLQ H&N 43) which is specific for head and neck region cancer. After the administration of Homoeopathic medicines, the cases were regularly assessed on a monthly basis or as per the need of the case at least six months and the prognosis were assessed. Paired “t” test was applied for analysing the difference before and after treatment. RESULT AND CONCLUSION: According to the improvement of quality of life after treatment, the study population is categorised under the headings Aggravation (0%), No change (13.33%), No significant improvement (3.33%), Mild improvement (36.67%), Moderate improvement (20%), Marked improvement (26.67%). The statistical analysis shows that, the Stat t value 7.53., proving the result that homoeopathic medicines have significant effect in improving quality of life of patients with oral cancer

Dietary intake and factors affecting vitamin D status of Middle Eastern people in the UK

Vitamin D is derived through the action of solar ultraviolet B radiation on skin and from a limited number of natural food sources, fortified foods and supplements. It is well known that vitamin D plays an active role for calcium and phosphorus absorption but there is also growing evidence of an association between vitamin D insufficiency and various chronic diseases. Middle Eastern populations are known to be at risk of vitamin D deficiency due to a diet low in vitamin D and low sunshine exposure. Obesity is also a risk factor since vitamin D is sequestered in body fat. This thesis examined dietary intake of vitamin D, obesity and other risk factors for deficiency in Middle Eastern people in the UK. A questionnaire based survey was undertaken with 242 Middle Eastern respondents. A total of 85% of the sample was estimated to have a vitamin D intake <5 µg/d. Other risk factors for vitamin D insufficiency included covering skin from sunlight (84% females); low use of supplements (18.5%) and being overweight or obese (49% males and 44% females). Vitamin D intake was lowest in those with primary (1.8 µg/d) and secondary school (2.1 µg/d) education compared to higher education (3.6 µg/d). The survey was followed by dietary assessment of 28 Iraqi adults using repeat 24 hour recalls. The results concurred with the survey: mean intake of vitamin D was (3.2±4.4 µg/d) and 78.5% were overweight or obese. Finally, overweight participants were recruited to observe the effect of fat loss on vitamin D status. Serum 25(OH)D concentrations was measured in Middle Eastern (n=12) and Caucasian adults (n=24). Firstly seasonal changes were observed between October and January (with no weight loss). Then participants were advised on weight reduction to observe the effect of fat loss on serum 25(OH)D. Vitamin D deficiency (<25 nmol/l) was observed in 67% of the Middle Eastern group in October increasing to 92% in January. Of the 36 participants, only 17 lost ≥1kg of fat mass between January and April. No difference was found in serum 25(OH)D between those that lost fat mass and those that did not, and no correlation was found between the amount of fat lost and change in 25(OH)D. In the total sample, there was a negative association between serum 25(OH)D and waist circumference and waist-hip ratio, but no correlation was found between 25(OH)D and fat mass, thus indicating a relationship with visceral fat stores rather than total fat mass.Ministry of the Higher Education and scientific research/Ira