Factors in removing job restrictions for cancer survivors in the United Kingdom Royal Air Force

PurposeTo identify personal, occupational and clinical factors associated with the lifting of restrictions on duties among Royal Air Force (RAF) personnel who have returned to work after surviving primary cancer treatment. MethodsA retrospective cohort of 205 RAF personnel aged 18–58 with cancer diagnosed between 2001 and 2011 was followed-up until May 2012. Personal, occupational, and clinical information was extracted from occupational health and primary care records. Predictors of the lifting of (a) employment restrictions on UK duties at 18 months after diagnosis and (b) the lifting of all deployment restrictions at the end of the study were analysed using logistic and Cox regression models. Results At 18 months, 62% of the cancer survivors had restrictions on their UK duties lifted. The positive independent predictors of unrestricted UK duties are testicular cancer (OR 5.34; 95% CI 1.21–23.6) and no treatment being required (16.8; 1.11–255.2). The lifting of all employment restrictions and return to full deployability was achieved by 41% of the participants (median time 2.1 years), with testicular cancer (HR 2.69; 95% CI 1.38–5.26) and age at diagnosis (1.05; 1.01–1.09) being the positive independent predictors of faster lifting of all restrictions. ConclusionDiagnostic group, prognosis and type of treatment are not the only predictor of employment outcome after cancer. Patient-centred factors such as smoking, age, fatigue, job status, job type and length of employment are also important predictors of return to pre-morbid job function in cancer survivors in the RAF

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Tuberculosis risk from exposure to solid fuel smoke: a systematic review and meta-analysis.

BACKGROUND: Studies, particularly from low-income and middle-income countries, suggest that exposure to smoke from household air pollution (HAP) may be a risk factor for tuberculosis. The primary aim of this study was to quantify the risk of tuberculosis from HAP and explore bias and identify possible causes for heterogeneity in reported effect sizes. METHODS: A systematic review was conducted from original studies. Meta-analysis was performed using a random effects model, with results presented as a pooled effect estimate (EE) with 95% CI. Heterogeneity between studies was assessed. RESULTS: Twelve studies that considered active tuberculosis and reported adjusted effect sizes were included in the meta-analyses. The overall pooled EE (OR, 95% CI) showed a significant adverse effect (1.43, 1.07 to 1.91) and with significant heterogeneity between studies (I(2)=70.8%, p<0.001). When considering studies of cases diagnosed microbiologically, the pooled EE approached significance (1.26, 0.95 to 1.68). The pooled EE (OR, 95% CI) was significantly higher among those exposed only to biomass smoke (1.49, 1.08 to 2.05) when compared with the use of kerosene only (0.70, 0.13 to 3.87). Similarly, the pooled EE among women (1.61, 0.73 to 3.57) was greater than when both genders were combined (1.39, 1.01 to 1.92). There was no publication bias (Egger plot, p=0.136). Significant heterogeneity was observed in the diagnostic criteria for tuberculosis (coefficient=0.38, p=0.042). CONCLUSIONS: Biomass smoke is a significant risk factor for active tuberculosis. Most of the studies were small with limited information on measures of HAP

Tuberculosis risk from exposure to solid fuel smoke: a systematic review and meta-analysis.

BACKGROUND: Studies, particularly from low-income and middle-income countries, suggest that exposure to smoke from household air pollution (HAP) may be a risk factor for tuberculosis. The primary aim of this study was to quantify the risk of tuberculosis from HAP and explore bias and identify possible causes for heterogeneity in reported effect sizes. METHODS: A systematic review was conducted from original studies. Meta-analysis was performed using a random effects model, with results presented as a pooled effect estimate (EE) with 95% CI. Heterogeneity between studies was assessed. RESULTS: Twelve studies that considered active tuberculosis and reported adjusted effect sizes were included in the meta-analyses. The overall pooled EE (OR, 95% CI) showed a significant adverse effect (1.43, 1.07 to 1.91) and with significant heterogeneity between studies (I(2)=70.8%, p<0.001). When considering studies of cases diagnosed microbiologically, the pooled EE approached significance (1.26, 0.95 to 1.68). The pooled EE (OR, 95% CI) was significantly higher among those exposed only to biomass smoke (1.49, 1.08 to 2.05) when compared with the use of kerosene only (0.70, 0.13 to 3.87). Similarly, the pooled EE among women (1.61, 0.73 to 3.57) was greater than when both genders were combined (1.39, 1.01 to 1.92). There was no publication bias (Egger plot, p=0.136). Significant heterogeneity was observed in the diagnostic criteria for tuberculosis (coefficient=0.38, p=0.042). CONCLUSIONS: Biomass smoke is a significant risk factor for active tuberculosis. Most of the studies were small with limited information on measures of HAP

Occupational COPD and job exposure matrices: a systematic review and meta-analysis

Steven Sadhra,1 Om P Kurmi,2 Sandeep S Sadhra,1 Kin Bong Hubert Lam,2 Jon G Ayres1 1Institute of Occupational and Environmental Medicine, University of Birmingham, Edgbaston, Birmingham, 2Nuffield Department of Population Health, Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK 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&ndash;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&ndash;1.33 vs 1.14; 1.10&ndash;1.19). Higher risk estimates were also obtained for self-reported exposure to VGDF than JEMs-based exposure to VGDF (1.91; 1.72&ndash;2.13 vs 1.10; 1.06&ndash;1.24). Dusts, particularly biological dusts (1.33; 1.17&ndash;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. Keywords: COPD, occupation, airborne substances, job exposure matrice

Factors in removing job restrictions for cancer survivors in the United Kingdom Royal Air Force

PurposeTo identify personal, occupational and clinical factors associated with the lifting of restrictions on duties among Royal Air Force (RAF) personnel who have returned to work after surviving primary cancer treatment. MethodsA retrospective cohort of 205 RAF personnel aged 18–58 with cancer diagnosed between 2001 and 2011 was followed-up until May 2012. Personal, occupational, and clinical information was extracted from occupational health and primary care records. Predictors of the lifting of (a) employment restrictions on UK duties at 18 months after diagnosis and (b) the lifting of all deployment restrictions at the end of the study were analysed using logistic and Cox regression models. Results At 18 months, 62% of the cancer survivors had restrictions on their UK duties lifted. The positive independent predictors of unrestricted UK duties are testicular cancer (OR 5.34; 95% CI 1.21–23.6) and no treatment being required (16.8; 1.11–255.2). The lifting of all employment restrictions and return to full deployability was achieved by 41% of the participants (median time 2.1 years), with testicular cancer (HR 2.69; 95% CI 1.38–5.26) and age at diagnosis (1.05; 1.01–1.09) being the positive independent predictors of faster lifting of all restrictions. ConclusionDiagnostic group, prognosis and type of treatment are not the only predictor of employment outcome after cancer. Patient-centred factors such as smoking, age, fatigue, job status, job type and length of employment are also important predictors of return to pre-morbid job function in cancer survivors in the RAF.</p

Knowledge, attitudes, and perceptions towards waterpipe tobacco smoking amongst college or university students: a systematic review

Background Despite evidence for the harms of waterpipe tobacco smoking (WTS), its use is increasing amongst college and university students worldwide. This systematic review aims to assess the knowledge of, attitudes towards and perceptions of WTS among college or university students. Methods We electronically searched MEDLINE, EMBASE, CINAHL, PSYCHINFO and ISI the Web of Science in October 2018, restricting our search to studies published since January 1990. We included studies among university or college students that used qualitative or quantitative methods, and addressed either knowledge, attitudes, or perceptions towards WTS. We excluded studies where WTS could not be distinguished from other forms of tobacco use and studies reported as abstracts where the full text could not be identified. Data were synthesised qualitatively and analysed data by region (global north/ south), and by reasons for use, knowledge of health hazards, how knowledge influences use, perceptions towards dependence, and policy knowledge. Results Eighty-six studies were included; 45 from the global north and 41 from the global south. Socio-cultural and peer influences were major contributing factors that encouraged students to initiate WTS. Furthermore, WTS dependence had two components: psychological and social. This was compounded by the general perception that WTS is a less harmful, less addictive and more sociable alternative to cigarette smoking. Knowledge of WTS harms failed to correlate with a reduced risk of WTS use, and some students reported symptoms of WTS addiction. A large proportion of students believed that quitting WTS was easy, yet few were able to do so successfully. Finally, students believed current public health campaigns to educate on WTS harms were inadequate and, particularly in the global north, were not required. Conclusion Reasons for WTS amongst university students are multi-faceted. Overall, interventions at both the individual and community level, but also policy measures to portray a message of increased harm amongst students, are required. Additional studies are necessitated to understand temporal changes in students’ beliefs, thus allowing for better targeted interventions

Birmingham COPD Cohort: a cross-sectional analysis of the factors associated with the likelihood of being in paid employment among people with COPD

Kiran K Rai,1 Rachel E Jordan,1 W Stanley Siebert,2 Steven S Sadhra,3 David A Fitzmaurice,1 Alice J Sitch,1 Jon G Ayres,1,3 Peyman&eacute; Adab1 1Institute of Applied Health&nbsp;Research, 2The Department of Business and Labour Economics, 3Institute of Clinical Sciences, University of Birmingham, Edgbaston, Birmingham,&nbsp;UK Background: Employment rates among those with chronic obstructive pulmonary disease (COPD) are lower than those without COPD, but little is known about the factors that affect COPD patients&rsquo; ability to work. Methods: Multivariable analysis of the Birmingham COPD Cohort Study baseline data was used to assess the associations between lifestyle, clinical, and occupational characteristics and likelihood of being in paid employment among working-age COPD patients. Results: In total, 608 of 1,889 COPD participants were of working age, of whom 248 (40.8%) were in work. Older age (60&ndash;64 years vs 30&ndash;49 years: odds ratio [OR] =0.28; 95% confidence interval [CI] =0.12&ndash;0.65), lower educational level (no formal qualification vs degree/higher level: OR =0.43; 95% CI =0.19&ndash;0.97), poorer prognostic score (highest vs lowest quartile of modified body mass index, airflow obstruction, dyspnea, and exercise (BODE) score: OR&nbsp;=0.10; 95% CI =0.03&ndash;0.33), and history of high occupational exposure to vapors, gases, dusts, or fumes (VGDF; high VGDF vs no VGDF exposure: OR =0.32; 95% CI =0.12&ndash;0.85) were associated with a lower probability of being employed. Only the degree of breathlessness of BODE was significantly associated with employment. Conclusion: This is the first study to comprehensively assess the characteristics associated with employment in a community sample of people with COPD. Future interventions should focus on managing breathlessness and reducing occupational exposures to VGDF to improve the work capability among those with COPD. Keywords: chronic obstructive pulmonary disease, work, employed, breathlessness, severity, VGDF, U

Occupations associated with COPD risk in the large population-based UK Biobank cohort study

Objectives: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Exposure to occupational hazards is an important preventable risk factor but the contribution of specific occupations to COPD risk in a general population is uncertain. Our aim was to investigate the association of COPD with occupation in the UK population.Methods: In 2006-2010, the UK Biobank cohort recruited 502 649 adults aged 40-69 years. COPD cases were identified by prebronchodilator forced expiratory volume in 1 s/forced vital capacity&lt;lower limit of normal according to American Thoracic Society (ATS)/ European Respiratory Society (ERS) guidelines. Current occupations were coded using the Standard Occupational Classification (SOC) 2000. Prevalence ratios (PRs) and 95% CIs of COPD for each SOC-coded job were estimated using a robust Poisson model adjusted for sex, age, recruitment centre and lifetime tobacco smoking. Analyses restricted to never-smokers and non-asthmatics were also performed.Results: Of the 353 occupations reported by 228 614 current working participants, several showed significantly increased COPD risk. Those at highest COPD risk were seafarers (PR=2.64; 95% CI 1.59 to 4.38), coal mine operatives (PR=2.30; 95% CI 1.00 to 5.31), cleaners (industrial: PR=1.96; 95% CI 1.16 to 3.31 and domestic: PR=1.43; 95% CI 1.28 to 1.59), roofers/tilers (PR=1.86; 95% CI 1.29 to 2.67), packers/bottlers/canners/fillers (PR=1.60; 95% CI 1.15 to 2.22), horticultural trades (PR=1.55; 95% CI 0.97 to 2.50), food/drink/tobacco process operatives (PR=1.46; 95% CI 1.11 to 1.93), floorers/wall tilers (PR=1.41; 95% CI 1.00 to 2.00), chemical/related process operatives (PR=1.39; 95% CI 0.98 to 1.97), postal workers/couriers (PR=1.35; 95% CI 1.15 to 1.59), labourers in building/woodworking trades (PR=1.32; 95% CI 1.04 to 1.68), school mid-day assistants (PR=1.32; 95% CI 1.01 to 1.74) and kitchen/catering assistants (PR=1.30; 95% CI 1.10 to 1.53). Associations were similar in analyses restricted to never-smokers and non-asthmatics.Conclusions: Selected occupations are associated with increased COPD risk in a large cross-sectional population-based UK study. Further analyses should confirm the extent to which these associations reflect exposures still of concern and where strengthened preventive action may be needed.</p