Respiratory symptoms and lung function impairment in underground gold miners in Ghana

Background: This is the first study in Ghana in the Obuasi gold mines where the silica content of the respirable dust is 10%, less than in previously studied gold mines, with only 23% of the minershaving ever smoked. Objectives: The study was to assess the prevalence of respiratory impairment in the Ghanaian gold miner and to quantify the effects of the respirable dust on pulmonary functionDesign: A cross sectional epidemiological study Method: The study was carried out using MRC respiratory symptoms questionnaire, spirometry, and personal respirable dust measurements.Results: A total of 1236 miners were studied. The mean age was 39.7 ±5.8 (SD) years with a mean of 12.6 ± 6.7 (SD) years underground service and a mean total cumulative exposure to dust of 10.34±5.61 (SD) mg.m-3.years. The prevalence of chronic bronchitis was 21.2% and not clearly related to cumulative exposure. MRC breathlessness grade≥2 was 31.3%, significantly related to cumulativerespirable dust exposure after adjustment of age and smoking. There was however significant reduction in FEF25-75% with increasing dust exposure and an interaction with ever smoking. There was no correlation between cumulative exposure to respirable dust and FEV1 % predicted in any group, suggesting that exposure to respirable silicaat a mean level of 0.06 mg/m3 had no deleterious effect on FEV1 in a population with little tuberculosis, good housing and a low level of cigarette smoking. Conclusion: The prevalence of chronic bronchitisin the Ghanaian gold mine is related more to smoking than any occupational factor

Workplace wellbeing programmes and their impact on employees and their employing organisations: a scoping review of the evidence base

This report constitutes a scoping literature review that identifies and critically examines the evidence base surrounding health and wellbeing programmes conducted in the workplace and their impact on employees and their employing organisations. The review drew on a broad range of sources covering multiple sectors. However, the report additionally highlights evidence that relates specifically to the retail and construction industries. The review offers an analysis of the current evidence base and discusses the implications of implementing different types of workplace health and wellbeing schemes. Some recommendations for supporting and promoting the health and wellbeing of employees in organisations are made on the basis of this review and, where gaps in knowledge are identified, recommendations for further research are made

Development of an occupational airborne chemical exposure matrix

Background Population-based studies of the occupational contribution to chronic obstructive pulmonary disease generally rely on self-reported exposures to vapours, gases, dusts and fumes (VGDF), which are susceptible to misclassification. Aims To develop an airborne chemical job exposure matrix (ACE JEM) for use with the UK Standard Occupational Classification (SOC 2000) system. Methods We developed the ACE JEM in stages: (i) agreement of definitions, (ii) a binary assignation of exposed/not exposed to VGDF, fibres or mists (VGDFFiM), for each of the individual 353 SOC codes and (iii) assignation of levels of exposure (L; low, medium and high) and (iv) the proportion of workers (P) likely to be exposed in each code. We then expanded the estimated exposures to include biological dusts, mineral dusts, metals, diesel fumes and asthmagens. \ud Results We assigned 186 (53%) of all SOC codes as exposed to at least one category of VGDFFiM, with 23% assigned as having medium or high exposure. We assigned over 68% of all codes as not being exposed to fibres, gases or mists. The most common exposure was to dusts (22% of codes with >50% exposed); 12% of codes were assigned exposure to fibres. We assigned higher percentages of the codes as exposed to diesel fumes (14%) compared with metals (8%). Conclusions We developed an expert-derived JEM, using a strict set of a priori defined rules. The ACE JEM could also be applied to studies to assess risks of diseases where the main route of occupational exposure is via inhalation

The effect of exposure to biomass smoke on respiratory symptoms in adult rural and urban Nepalese populations

Peer reviewedPublisher PD

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

Repurposing Treatments to Enhance Innate Immunity. Can Statins Improve Neutrophil Functions and Clinical Outcomes in COPD?

Drug classes used in the treatment of Chronic Obstructive Pulmonary Disease (COPD) have not changed for many years, and none to date have shown disease-modifying activity. Statins are used to help reduce cardiovascular risk, which is high in many patients with COPD. Their use has been associated with improvements in some respiratory manifestations of disease and reduction in all-cause mortality, with greatest reductions seen in patients with the highest inflammatory burden. The mechanism for these effects is poorly understood. Neutrophils are key effector cells in COPD, and correlate with disease severity and inflammation. Recent in vitro studies have shown neutrophil functions are dysregulated in COPD and this is thought to contribute both to the destruction of lung parenchyma and to the poor responses seen in infective exacerbations. In this article, we will discuss the potential utility of statins in COPD, with a particular emphasis on their immune-modulatory effects as well as presenting new data regarding the effects of statins on neutrophil function in vitro

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

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