Estimating past inhalation exposure to asbestos: a tool for risk attribution and disease screening

Introduction: Late presentation is common in mesothelioma. Reliable assessment of past exposure to asbestos is a necessary first step for risk attribution and for the development of a future screening programme. Such a programme could maximise access to trials of novel therapies and would pave the way for development of novel chemoprophylaxis strategies. This paper describes a method for individual exposure reconstruction along with data from a validation study. Methods: The exposure assessment method uses only descriptive information about the circumstances of the work that could be obtained from questioning the worker. The assessment is based on the tasks carried out and includes parameters for substance emission potential, activity emission potential, the effectiveness of any local control measures, passive emission, the fractional time the asbestos source is active and the efficiency of any respiratory protection worn. Results: There was a good association between the estimated and measured exposure levels. Pearson’s correlation coefficient between the log-transformed measurements and estimates from the model was 0.86, and 95% of the estimated individual values were within about a factor of ten of the associated measured value. The method described would be suitable for pre-selecting individuals at high risk of malignant pleural mesothelioma for screening using appropriate tools and/or enrolment in clinical trials of chemo-prophylaxis. Discussion: This method is of potential clinical value in developing novel treatment approaches for mesothelioma. Pilot studies to test this approach are urgently needed

Tackling structural inequalities to reduce concussion-related dementia in sportspeople

In contrast with the neuropathological evidence accumulating on Chronic Traumatic Encephalopathy (CTE) [1] and its relation to concussion and the severe clinical consequences, the evidence coming from the sport research is not always consistent. For example, a recent study conducted among former elite English rugby players, the BRAIN study, found no overall evidence of an association between number of concussions suffered when playing and cognitive function at an older age [2]. The study, featuring an in depth evaluation of cognitive function, found an increased risk of poorer cognition in those who suffered three or more concussions compared to none, but only after age 70-75 years. This suggests the presence of an association which is delayed compared to that found in previous studies conducted among French, Scottish, and New Zealand rugby players [3].</p

Estimating the number of asbestos-related lung cancer deaths in Great Britain from 1980 to 2000.

INTRODUCTION: Inhalation of asbestos fibres is known to cause two main kinds of cancer-mesothelioma and lung cancer. While the vast majority of mesothelioma cases are generally accepted as being caused by asbestos, the proportion of asbestos-related lung cancers is less clear and cannot be determined directly because cases are not clinically distinguishable from those due to other causes. The aim of this study was to estimate the number of asbestos-related lung cancers among males by modelling their relative lung cancer mortality among occupations within Great Britain in terms of smoking habits, mesothelioma mortality (as an index of asbestos exposure) and occupation type (as a proxy for socio-economic factors). METHODS: Proportional mortality ratios for lung cancer and mesothelioma for the 20-year period from 1980 to 2000 (excluding 1981) were calculated for occupational groups. Smoking indicators were developed from three General Household Surveys carried out during the 1980s and 1990s. Poisson regression models were used to estimate the number of asbestos-related lung cancers by estimating the number of lung cancer deaths in each occupation assuming no asbestos exposure and subtracting this from the actual predicted number of lung cancer deaths. RESULTS: The effect of asbestos exposure in predicting lung cancer mortality was weak in comparison to smoking habits and occupation type. The proportion of current smokers in occupational groups and average age at which they started smoking were particularly important factors. Our estimate of the number of asbestos-related lung cancers was between two-thirds and one death for every mesothelioma death: equivalent to between 11 500 and 16 500 deaths during the time period studied. CONCLUSIONS: Asbestos-related lung cancer is likely to have accounted for 2-3% of all lung cancer deaths among males in Great Britain over the last two decades of the 20th century. Asbestos-related lung cancers are likely to remain an important component of the total number of lung cancer deaths in the future as part of the legacy of past asbestos exposures in occupational settings

Mesothelioma mortality in Great Britain from 1968 to 2001.

BACKGROUND: The British mesothelioma register contains all deaths from 1968 to 2001 where mesothelioma was mentioned on the death certificate. AIMS: To present summary statistics of the British mesothelioma epidemic including summaries by occupation and geographical area. METHODS: Standardized mortality ratios (SMRs) were calculated for local authorities, unitary authorities and counties. Temporal trends in SMRs were also examined. Proportional mortality ratios (PMRs) were calculated using the Southampton (based on the 1980 standard occupational classification) coding scheme. Temporal trends in PMRs were also examined. RESULTS: The annual number of mesothelioma deaths has increased from 153 in 1968 to 1848 in 2001. Current deaths in males account for about 85% of the cases. The areas of West Dunbartonshire (SMR 637), Barrow-in-Furness (593), Plymouth (396) and Portsmouth (388) have the highest SMRs over the period 1981-2000. The occupations with the highest PMRs are metal plate workers (PMR 503), vehicle body builders (526), plumbers and gas fitters (413) and carpenters (388). CONCLUSIONS: These data reinforce earlier findings that geographical areas and occupations associated with high exposure to asbestos in the past continue to drive the mesothelioma epidemic in Great Britain. However, the trends over time suggest a change in the balance of risk away from traditional asbestos exposure industries to industries where one could describe the exposure as secondary, such as plumbers and gas fitters, carpenters, and electricians

Challenges to and facilitators of occupational epidemiology research in the UK

This study investigated the challenges and facilitators of occupational epidemiology (OE) research in the UK, and evaluated the impact of these challenges. Semi-structured in-depth interviews with leading UK-based OE researchers, and a survey of UK-based OE researchers were conducted. Seven leading researchers were interviewed, and there were 54 survey respondents. Key reported challenges for OE were diminishing resources during recent decades, influenced by social, economic and political drivers, and changing fashions in research policy. Consequently, the community is getting smaller and less influential. These challenges may have negatively affected OE research, causing it to fail to keep pace with recent methodological development and impacting its output of high-quality research. Better communication with, and support from other researchers and relevant policy and funding stakeholders was identified as the main facilitators to OE research. Many diseases were initially discovered in workplaces, as these make exceptionally good study populations to accurately assess exposures. Due to the decline of manufacturing industry, there is a perception that occupational diseases are now a thing of the past. Nevertheless, new occupational exposures remain under-evaluated and the UK has become reliant on overseas epidemiology. This has been exacerbated by the decline in the academic occupational medicine base. Maintaining UK-based OE research is hence necessary for the future development of occupational health services and policies for the UK workforce

The BRAIN-Q, a tool for assessing self-reported sport-related concussions for epidemiological studies

Objectives: The BRAIN-Q is a tool aimed at maximising the accuracy, and minimising measurement error, for retrospectively assessing concussions. This paper reports agreement of the BRAIN-Q tool when compared to extant questionnaire questions, and reproducibility when compared with its telephonic version (tBRAIN-Q). Method: The BRAIN-Q entails a 3-stage process: defining concussion, creating a visual timeline with life events, and establishing detailed characteristics for each reported concussion. It was designed to be administered in-person by trained personnel, and was used in the BRAIN Study. Its performance was compared with the MSK Study which previously collected a few questions in a broader self-administered questionnaire; and with the tBRAIN-Q Recall, its telephonic version. Results: 101 participants were included; of these, nine were re-assessed with the tBRAIN-Q. Compared to the BRAIN-Q, the agreement with the MSK-Q for rugby-related concussion was 86.7% (kappa 0.6). Rugby-related concussion with loss of consciousness showed lower agreement (82.0% (kappa 0.6)). The comparison between the BRAIN-Q and the tBRAIN-Q showed a good reproducibility. Conclusions: The BRAIN-Q is a relatively easy tool to administer in face-to-face assessments, it showed an optimal reproducibility, it includes a well-established definition of concussion, and is used to collect detailed information on each concussion allowing for a number of subgroup analyses (e.g. by severity, by age, by context). The BRAIN-Q is easily adaptable to other sporting setting