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Publication History View all

  • Electromagnetic Biology and Medicine 11/2013;
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    British Journal of Cancer 11/2013;
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    ABSTRACT: Epidemiological studies on the effect of urban air pollution on childhood asthma have shown conflicting results and so far no consistent association has emerged. However, a common limitation in previous studies has been exposure misclassification leading to uncertainties in risk estimates.The aim of this study was to analyse the effects of long-term exposure to particulate matter (PM10) and nitrogen dioxide (NO2) on the prevalence of asthma and wheeze within a population-based birth cohort-the Manchester Asthma and Allergy Study (MAAS). The prevalence of asthma and current wheeze within the cohort (N=1185) was determined through parental questionnaires at ages 3, 5, 8 and 11 years. The typical monthly PM10 and NO2 exposure of each child was estimated through a novel microenvironmental exposure model from birth to age 11. The association between exposure and asthma or wheeze was analysed using generalised estimating equations and multiple logistic regression. The range of asthma prevalence was 15.2-23.3%, with the lowest prevalence at age 3 and the highest at age 5. The prevalence of current wheeze decreased from ages 3 to 8 (23.7-18%). The mean NO2 exposure decreased from the 1st year of life (21.7 µg/m(3)) to the 11th year of life (16.0 µg/m(3)). The mean PM10 exposure showed a smaller decrease (12.8 -10.7 µg/m(3)). The statistical analysis showed no significant association between the exposures and either outcome. No evidence of a significant association between long-term exposure to PM10 and NO2 and the prevalence of either asthma or wheeze was found.
    Journal of epidemiology and community health 09/2013;
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    ABSTRACT: BACKGROUND: Findings from previous studies on the effect of air pollution exposure on lung function during childhood have been inconsistent. A common limitation has been the quality of exposure data used and few studies have modelled exposure longitudinally throughout early life. OBJECTIVES: To study the long term effects of particulate matter with an aerodynamic diameter <10µm (PM10) and nitrogen dioxide (NO2) exposure on specific airway resistance (sRaw) and forced expiratory volume (FEV1) before and after bronchodilator treatment within the Manchester Asthma and Allergy Study (MAAS) birth cohort (N=1185). METHODS: Spirometry was performed during clinic visits at ages 3, 5, 8 and 11 years. Individual level PM10 and NO2 exposures were estimated from birth to age 11 through a microenvironmental exposure model. Longitudinal and cross-sectional associations were estimated using generalized estimating equations and multivariable linear regression models. RESULTS: Lifetime exposure to PM10 and NO2 was associated with significantly less growth in FEV1 (% predicted) over time, both before [-1.37% (95% CI: -2.52, -0.23) for a 1-unit increase in PM10 and -0.83% (95% CI: -1.39, -0.28) for a 1-unit increase in NO2] and after bronchodilator treatment [-3.59% (95% CI: -5.36, -1.83) and -1.20% (95% CI: -1.97, -0.43), respectively]. No association was found between lifetime exposure and sRaw over time. Cross-sectional analyses of detailed exposure estimates for the summer and winter prior to age 11 and lung function at age 11 indicated no significant associations. CONCLUSIONS: Long term PM10 and NO2 exposures were associated with small, but statistically significant, reductions in lung volume growth in children of elementary school age.
    Environmental Health Perspectives 06/2013;
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    ABSTRACT: Background Sickness certification causes problems for general practitioners (GPs). Difficulty with the assessment of capacity to work, conflict with patients and other non-medical factors have been shown to influence GPs' decision-making. Inadequate leadership and management of certification issues add to GPs' difficulties.AimsTo explore problems associated with sickness certification, as part of a larger mixed method research project exploring GPs' experiences and perceptions of sickness certification in Ireland.MethodsA qualitative study in an urban region of Ireland. A focus group of four male and four female GPs explored problems encountered by GPs in certifying sickness absence. Thematic data analysis was used.ResultsThree major themes emerged: perception of the sickness certification system, organization of health care and cultural factors in sickness absence behaviour. Employment structures in public and private sectors and lack of communication with other health care providers and employers were identified as complicating sickness certification.ConclusionsGPs encounter a complexity of issues in sick certification and are dissatisfied with their role in certifying sickness absence. Our results open the debate for policy change and development in Ireland.
    Occupational Medicine 05/2013;
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    ABSTRACT: Background: The complexity of a fitness for work consultation is well documented. General practitioners (GPs) find that such consultations often create conflict and they feel ill-prepared for the task. Objectives: We aimed to examine the consultation process in the fitness for work consultation and to report on the response of GPs to two hypothetical consultations of work related sickness absence, one of a psychological and one of a physical nature. Methods: Three areas of the consultation were examined; social/family circumstances, workplace history and information required assessing the severity of the condition. We used a randomized design using an online questionnaire completed by 62 GPs located in the Republic of Ireland. Analysis was conducted in NVivo 8 qualitative software using thematic and content analysis techniques. Results: GPs may be expected to collect and consider information relating to social, domestic, financial, lifestyle and workplace factors, including workload, job satisfaction, job strain, work ethic, inter staff relationships and employee support mechanisms. The mode of presentation may trigger specific information seeking in the consultation. Conclusion: GPs may evaluate fitness for work in a variety of ways depending on medical and non-medical factors. Further research should further examine the factors that may influence the GPs decision to prescribe sickness leave.
    The European journal of general practice 05/2013;
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    ABSTRACT: BACKGROUND: Tobacco specific nitrosamines such as 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) are genotoxic alkylating agents found within cigarette smoke that induce lung adenocarcinomas in animal models. In humans, adenocarcinomas originate most frequently in the lung periphery. The aim of this study was to determine whether peripheral lung has increased susceptibility to the genotoxic effects of alkylating agents by comparing DNA alkylation damage (N7-methylguanine: N7-meG) and repair (O(6)-alkylguanine DNA alkyltransferase: MGMT) in peripheral relative to central lung tissue. METHODS: Macroscopically normal lung tissue, resected from patients undergoing surgery for lung cancer, was sampled at equidistant points from central to peripheral lung along a bronchus. N7-meG levels were determined using an immunoslotblot technique and MGMT activity with a [32P]-labelled oligodeoxynucleotide cleavage assay. RESULTS: A total of 20 subjects were recruited, 12 males and 8 females with a mean age of 68.7± 5.8 years. There were 14 former and 6 current smokers with a mean smoking exposure of 34.0±18.3 packyears. N7-meG (mean 0.75±0.57/10(6)dG, n = 65 samples from 14 patients) and MGMT repair (geometric mean 9.57±1.62 fmole/μgDNA, n = 79 samples from 16 patients) were detected in all samples assayed. MGMT activity increased towards the lung periphery (r = 0.28, p=0.023; n=16) with a highly significant association in current (r = 0.53, p=0.008; n=6) but not former smokers (r = 0.13; p=0.41; n=10). No correlation was seen with N7-meG levels and lung position (r = -0.18; p=0.21; n=14). N7-meG levels were higher in current compared to former smokers reaching significance in two lung positions including peripheral lung (p=0.047). CONCLUSIONS: The findings in this study do not support the hypothesis that peripheral tissue is more susceptible to the genotoxic effects of alkylating agents than central lung tissue. In addition exposure to cigarette smoke reduced the level of MGMT in central bronchial tissue possibly through increased alkylating agent exposure.
    Chemico-biological interactions 05/2013;
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    ABSTRACT: OBJECTIVE: To investigate whether interventions implemented by the UK Health and Safety Executive addressing exposure to isocyanate-based spray paints in motor vehicle repair (MVR), flour dust in craft bakeries, rosin-based solder flux fume (RBSFF) in the electronics industry, metalworking fluids and wood dust coincided with a decline in incidence of work-related short latency respiratory disease (SLRD) or asthma in the target groups. METHOD: Changes in the incidence of SLRD reported to a UK-based surveillance scheme were compared using a longitudinal, negative binomial regression model with β distributed random effects. An interrupted time series design was used and comparisons according to inclusion or exclusion in the target group were made by including a statistical interactions expressed as a ratio of incidence rate ratios (RIRRs) in the model. RESULTS: The incidence of SLRD attributed to flour dust significantly increased relative to all other agents (RIRR: 1.10; 95% CI 1.06 to 1.16) whereas SLRD attributed to RBSFF significantly declined relative to all other agents (0.94; 0.90 to 0.99). No significant changes in the incidence of SLRD attributed to wood dust (1.03; 0.91 to 1.16) or spray paints (1.03; 0.95 to 1.11) relative to all other agents were observed. A higher proportion of reports originated from the industries targeted by the intervention for RBSFF (65/107; 61%) than spray painting (27/93; 27%) or wood dust (16/42; 38%). CONCLUSIONS: These data support a beneficial effect of interventions to reduce exposure to RBSFF but an increase in SLRD attributed to flour dust may indicate increased exposure or increased awareness of the problem.
    Occupational and environmental medicine 04/2013;
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    ABSTRACT: OBJECTIVE: The 2004 amendment to the Control of Substances Hazardous to Health 2002 regulations (COSHH 2004) introducing workplace exposure limits (WELs) was enacted in the UK in 2005. This study aimed to determine whether introducing this legislation coincided with a reduction in the incidence of work-related short latency respiratory disease (SLRD) attributed to the agents with a WEL. The second objective was to determine whether changes in legislation, WELs and market forces coincided with a reduction in the incidence of SLRD attributed to glutaraldehyde and latex. METHOD: Reports of SLRD made to the Surveillance of Work-related and Occupational Respiratory Disease scheme were used to estimate the change in incidence within reporters between two time periods (interrupted time series design) using a longitudinal, negative binomial regression model with β distributed random effects. A statistical interaction term was included in the model to make comparisons between the groups defined by suspected causal agent and/or occupation, essentially comparing two interrupted time series. Time periods were defined prospectively representing the changes in legislation or market forces. RESULTS: The introduction of the COSHH 2004 legislation in the UK coincided with a significant reduction in reports of SLRD attributed to agents with a WEL relative to those without a WEL (ratio of incidence rate ratios: 0.70; 95% CI 0.52 to 0.93) and a significant reduction in SLRD attributed to glutaraldehyde in healthcare workers (0.20; 0.07 to 0.57) and latex in all workers (0.37; 0.16 to 0.85). CONCLUSIONS: These data are consistent with a beneficial effect of legislation aiming to reduce workplace exposures.
    Occupational and environmental medicine 04/2013;
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    ABSTRACT: The British Occupational Hygiene Society, in collaboration with the Institute of Occupational Medicine, the University of Manchester, the UK Health and Safety Executive, and the University of Aberdeen hosted the 7th International Conference on the Science of Exposure Assessment (X2012) on 2 July-5 July 2012 in Edinburgh, UK. The conference ended with a special session at which invited speakers from government, industry, independent research institutes, and academia were asked to reflect on the conference and discuss what may now constitute the important highlights or drivers of future exposure assessment research. This article summarizes these discussions with respect to current and future technical and methodological developments. For the exposure science community to continue to have an impact in protecting public health, additional efforts need to be made to improve partnerships and cross-disciplinary collaborations, although it is equally important to ensure that the traditional occupational exposure themes are still covered as these issues are becoming increasingly important in the developing world. To facilitate this the 'X' conferences should continue to retain a holistic approach to occupational and non-occupational exposures and should actively pursue collaborations with other disciplines and professional organizations to increase the presence of consumer and environmental exposure scientists.
    Annals of Occupational Hygiene 04/2013; 57(3):280-285.
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