M Carder

Publications of M Carder

• Has European Union legislation to reduce exposure to chromate in cement been effective in reducing the incidence of allergic contact dermatitis attributed to chromate in the UK?

  Authors: S J Stocks, R McNamee, S Turner, M Carder, R M Agius

  Occupational and environmental medicine. 08/2011; 69(2):150-2.

  Hexavalent chromate (chromate) in cement is a well-recognised cause of allergic contact dermatitis (ACD). Consequently in January 2005, following European Union legislation (EU Directive 2003/53/EC),Hexavalent chromate (chromate) in cement is a well-recognised cause of allergic contact dermatitis (ACD). Consequently in January 2005, following European Union legislation (EU Directive 2003/53/EC), the use or supply of cement containing >2 ppm of chromate was prohibited in the UK (COSHH 2004). This analysis of work-related ill-health surveillance aims to evaluate the effectiveness of this legislation. Changes in the incidence of work-related ACD cases returned to The Health and Occupation Reporting network by dermatologists were analysed taking in to account attribution to chromate and occupation. There was a significant decline in the incidence of both ACD attributed to chromate (incidence rate ratio 0.48, 95% CI 0.36 to 0.64) and ACD not-attributed chromate (0.76, 95% CI 0.69 to 0.85) between the time period preceding the EU legislation (2002-2004) and the postlegislation period (2005-2009). However, the decline in ACD attributed to chromate was significantly greater (p=0.006). This decline was further increased in workers potentially exposed to cement (incidence rate ratio 0.37, p=0.001). The majority of the decline in incidence occurred during 2005. The timing of this significant decline in the UK incidence of chromate attributed ACD, and the greater decline in workers potentially exposed to cement strongly suggests that the EU Directive2003/53/EC was successful in reducing exposure to chromate in cement in the UK.

• Occupation and work-related ill-health in UK construction workers.

  Authors: S J Stocks, S Turner, R McNamee, M Carder, L Hussey, R M Agius

  Occupational medicine (Oxford, England). 07/2011; 61(6):407-15.

  Construction workers are at increased risk of work-related ill-health (WRI) worldwide. To compare the incidence of medically reported WRI in occupations within the UK construction industry accordingConstruction workers are at increased risk of work-related ill-health (WRI) worldwide. To compare the incidence of medically reported WRI in occupations within the UK construction industry according to job title. We calculated standardized incidence rate ratios (SRRs) using WRI cases for individual job titles returned to The Health and Occupation Reporting network by clinical specialists and UK population denominators. We counted frequencies of reported causal exposures or tasks reported by clinical specialists, occupational physicians and general practitioners. We found significantly increased incidence of WRI compared with other workers in the same major Standard Occupational Classification, i.e. workers with similar levels of qualifications, training, skills and experience, for skin neoplasia in roofers (SRR 6.3; 95% CI: 3.1-13.1), painters and decorators (2.1; 95% CI: 1.2-3.6) and labourers in building and woodworking trades (labourers, 6.6; 95% CI: 3.2-13.2); contact dermatitis in metal workers (1.4; 95% CI: 1.1-1.7) and labourers (1.6; 95% CI: 1.1-2.3); asthma in welders (3.8; 95% CI: 2.8-5.0); musculoskeletal disorders in welders (1.7; 95% CI: 1.1-2.8), road construction operatives (6.1; 95% CI: 3.8-9.6) and labourers (2.5; 95% CI: 1.7-3.7); long latency respiratory disease (mesothelioma, pneumoconiosis, lung cancer, non-malignant pleural disease) in pipe fitters (4.5; 95% CI: 3.2-6.2), electrical workers (2.7; 95% CI: 2.4-3.2), plumbing and heating engineers (2.3; 95% CI: 1.9-2.7), carpenters and joiners (2.7; 95% CI: 2.3-3.1), scaffolders (12; 95% CI: 8-18) and labourers (3.3; 95% CI: 2.6-4.1). UK construction industry workers have significantly increased risk of WRI. These data in individual construction occupations can be used to inform appropriate targeting of occupational health resources.

• Surveillance for work-related audiological disease in the UK: 1998-2006.

  Authors: A Money, M Carder, S Turner, L Hussey, R Agius

  Occupational medicine (Oxford, England). 06/2011; 61(4):226-33.

  Noise-induced hearing loss (NIHL) from prolonged occupational exposure to noise continues to rank among the top worldwide work-related ill-health problems. To provide an overview of incident casesNoise-induced hearing loss (NIHL) from prolonged occupational exposure to noise continues to rank among the top worldwide work-related ill-health problems. To provide an overview of incident cases based on work-related audiological ill-health data collected over a 9-year period from occupational physicians (OPs), audiological physicians (APs), general practitioners and otorhinolaryngologists. Analysis of numerator data reported by physicians to surveillance schemes within The Health and Occupation Reporting network (THOR). The actual cases were multiplied by the sampling ratio to provide estimated numerator numbers, followed by calculation of incidence rates using denominator data derived from the Labour Force Survey and from surveys of participating OPs. Two thousand five hundred and eighty-two estimated cases (2584 estimated diagnoses) were received from OPs (Occupational Physicians Reporting Activity [OPRA]), and 2192 estimated cases (3208 estimated diagnoses) of work-related audiological ill-health were received from consultant APs [Occupational Surveillance Scheme for Audiological physicians (OSSA)] from 1998 to 2006. Cases where the causal agent was noise exposure (NIHL and tinnitus) made up of 95 and 97% of all cases reported to OPRA and OSSA, respectively. The annual average incidence rate for noise-induced audiological disorders was 7.9 [95% confidence interval (CI) 4.6-11.1] per 100 000 persons employed (OPRA) and 0.8 (95% CI 0.7-1.0) per 100 000 persons employed (OSSA). Workers with the highest incidence were older males employed in public administration and defence and the manufacture of metals. THOR data show that diagnoses related to work-related noise exposure (NIHL/tinnitus), as reported to THOR, remain important health problems, despite preventive measures being in place.

• Improving estimates of specialist-diagnosed, work-related respiratory and skin disease.

  Authors: M Carder, R McNamee, S Turner, L Hussey, A Money, R Agius

  Occupational medicine (Oxford, England). 11/2010; 61(1):33-9.

  Work-related skin and respiratory disease still constitute an important part of the work-related ill-health (WRIH) burden of Great Britain (GB). It is therefore important to be able to accuratelyWork-related skin and respiratory disease still constitute an important part of the work-related ill-health (WRIH) burden of Great Britain (GB). It is therefore important to be able to accurately quantify the true incidence of these two groups of disease. To improve the accuracy of the methodology to estimate clinical specialist incidence rates, with a focus on skin and respiratory disease. Specifically, we sought to estimate the number of additional cases not captured by voluntary surveillance through The Health and Occupation Reporting (THOR) network and provide a better estimation of the true incidence of work-related skin and respiratory disease in GB. Cases not captured by THOR in 2005-2007 due to non-participation of eligible clinical specialists and due to <100% response rates by THOR participants were estimated, and the numerator adjusted accordingly. Adjusted incidence rates were calculated using Labour Force Survey data as the denominator. During 2005-2007, 62% of skin cases and 60% of GB respiratory cases were likely to have been captured by THOR. After adjustment, dermatologist-derived incidence rates for skin disease were raised from 9 to 14 per 100,000 employed, while those for respiratory disease were raised from 10 to 17 per 100,000 employed. We have provided a significant improvement in the surveillance-based methodology used to estimate the number of cases of WRIH captured by THOR and hence enabled more accurate estimations of GB incidence rates for clinical specialist-reported WRIH.

• Medically reported work-related ill-health in the UK agricultural sector.

  Authors: S J Stocks, S Turner, M Carder, L Hussey, R McNamee, R M Agius

  Occupational medicine (Oxford, England). 08/2010; 60(5):340-7.

  Self-reported work-related ill-health (WRI) statistics suggest that agricultural workers in the UK are at an increased risk of musculoskeletal disorders (MSD), skin and respiratory disease. However,Self-reported work-related ill-health (WRI) statistics suggest that agricultural workers in the UK are at an increased risk of musculoskeletal disorders (MSD), skin and respiratory disease. However, there is little comprehensive medically reported information on WRI in the UK agricultural sector. Cases of WRI within the UK from 2002 to 2008, as reported to The Health and Occupation Reporting (THOR) network by occupational physicians, clinical specialists and general practitioners, were analysed. Directly standardized incidence rate ratios (SRRs) for the agricultural sector versus all other sectors were calculated for dermatological, musculoskeletal, respiratory and psychological illness, using as the standard population the UK working population as estimated from the Labour Force Survey. During 2002-08, 471 cases within the agricultural sector were reported to THOR (2% of all cases). Based on reports by clinical specialists, male agricultural workers aged <65 years had significantly raised SRRs for MSD (2.3, 95% CI 1.6-3.3), allergic alveolitis (32, 95% CI 19-51), asthma (1.9, 95% CI 1.2-3.0) and skin neoplasia (7.9, 95% CI 5.8-10.9) and a significantly reduced SRR for asbestos-related respiratory disease (0.4, 95% CI 0.2-0.7). Reports of mental ill-health in agricultural workers were low. These medically reported incidence data provide information on WRI in the UK agricultural sector. Consistent with other sources, there are increased risks for asthma, allergic alveolitis and MSD and a reduced risk for mental ill-health. The raised incidence of skin cancer requires confirmation and further comparison with reliable estimates of the incidence in the UK workforce.

• The incidence of medically reported work-related ill health in the UK construction industry.

  Authors: S J Stocks, R McNamee, M Carder, R M Agius

  Occupational and environmental medicine. 08/2010; 67(8):574-6.

  Self-reported work-related ill health (SWI) data show a high incidence of occupational ill health and a high burden of cancer attributable to occupational factors in the UK construction industry.Self-reported work-related ill health (SWI) data show a high incidence of occupational ill health and a high burden of cancer attributable to occupational factors in the UK construction industry. However, there is little information on the incidence of medically reported work-related ill health (WRI) within this industry. This study aims to examine the incidence of WRI within the UK construction industry. Standardised incidence rate ratios (SRRs) were used to compare incidence rates of reports of medically certified work-related ill health returned to The Health and Occupation Reporting network (THOR) within the UK construction industry with all other UK industries combined. Male UK construction industry workers aged under 65 years had significantly raised SRRs for respiratory (3.8, 95% CI 3.5 to 4.2), skin (1.6, 1.4 to 1.8) and musculoskeletal disorders (MSD; 1.9, 1.6 to 2.2). These SRRs were further raised for those working within a construction trade. The increased SRRs for skin disease within male construction industry workers were due to contact dermatitis (1.4, 1.2 to 1.6) and neoplasia (4.2, 3.3 to 5.3). For respiratory disease, the increased SRRs were due to non-malignant pleural disease (7.1, 6.3 to 8.1), mesothelioma (7.1, 6.0 to 8.3), lung cancer (5.4, 3.2 to 8.9) and pneumoconiosis (5.5, 3.7 to 8.0), but the SRRs for asthma (0.09, 0.06 to 0.11) and mental ill health (0.3, 0.1 to 0.4) were significantly reduced. The significantly raised SRRs for medically reported MSD and significantly reduced SRRs for mental ill health in construction workers confirm self-reported UK data. These SRRs provide a baseline of the incidence of WRI in the UK construction industry from which to monitor the effects of changes in policy or exposures.

• Do all occupational respiratory sensitisers follow the united airways disease model?

  Authors: M J Seed, M Carder, M Gittins, R M Agius

  Thorax. 08/2009; 64(7):642-3.

• Interacting effects of particulate pollution and cold temperature on cardiorespiratory mortality in Scotland.

  Authors: M Carder, R McNamee, I Beverland, R Elton, M van Tongeren, G R Cohen, J Boyd, W Macnee, R M Agius

  Occupational and environmental medicine. 04/2008; 65(3):197-204.

  OBJECTIVES: To determine whether the effect of black smoke on cardiorespiratory mortality is modified by cold temperatures. METHODS: Poisson regression models were used to investigate theOBJECTIVES: To determine whether the effect of black smoke on cardiorespiratory mortality is modified by cold temperatures. METHODS: Poisson regression models were used to investigate the relationship between lagged black smoke concentration and daily mortality, and whether the effect of black smoke on mortality was modified by cold temperature for three Scottish cities from January 1981 to December 2001. MAIN RESULTS: For all-cause respiratory and non-cardiorespiratory mortality, there was a significant association between mortality and lagged black smoke concentration. Generally the maximum black smoke effect occurred at lag 0, although these estimates were not statistically significant. A 10 mugm(-3) increase in the daily mean black smoke concentration on any given day was associated with a 1.68% (95% CI 0.72 to 2.65) increase in all-cause mortality and a 0.43% (95% CI -0.97 to 1.86), 5.36% (95% CI 2.93 to 7.84) and 2.13% (95% CI 0.82 to 3.47) increase in cardiovascular, respiratory and non-cardiorespiratory mortality, respectively, over the ensuing 30-day period. The effect of black smoke on mortality did not vary significantly between seasons (cool and warm periods). For all-cause, cardiovascular and non-cardiorespiratory mortality the inclusion of interaction terms did not improve the models, although for all-cause and non-cardiorespiratory mortality there was a suggestion for interaction between temperature and recent black smoke exposure. CONCLUSIONS: The results of this study suggested a greater effect of black smoke on mortality at low temperatures. Since extremes of cold and particulate pollution may coexist, for example during temperature inversion, these results may have important public health implications.

• The incidence of occupational skin disease as reported to The Health and Occupation Reporting (THOR) network between 2002 and 2005.

  Authors: S Turner, M Carder, M van Tongeren, R McNamee, S Lines, L Hussey, A Bolton, M H Beck, M Wilkinson, R Agius

  The British journal of dermatology. 11/2007; 157(4):713-22.

  BACKGROUND: Estimated incidence rates for occupational skin disease in the U.K. are provided by voluntary surveillance schemes involving dermatologists and occupational physicians. These rates allowBACKGROUND: Estimated incidence rates for occupational skin disease in the U.K. are provided by voluntary surveillance schemes involving dermatologists and occupational physicians. These rates allow monitoring of occupational dermatoses, and intervention planning aimed at reducing workplace risks. OBJECTIVES: To summarize occupational skin disease reported to The Health and Occupation Reporting (THOR) network (2002-2005), and to provide baseline information for comparison with future studies of occupational skin disease in the U.K. and beyond. METHODS: Incidence rates for occupational dermatoses were calculated using THOR data as numerators, and Labour Force Survey data or information from the most recent U.K. survey on provision of occupational physician services as denominators. RESULTS: In the U.K. (2002-2005) the average annual incidence rate of work-related skin disease reported to THOR by dermatologists was 91.3 [95% confidence interval (CI) 81.8-101.1] per million, and by occupational physicians was 316.6 (95% CI 251.8-381.3) per million. Most reports were of contact dermatitis: dermatologists 68.0 (95% CI 59.8-76.2) per million, occupational physicians 259.7 (95% CI 200.8-318.6) per million. CONCLUSIONS: Information produced by THOR is an important source for calculating incidence rates of occupational skin disease. A range of reporting groups should also be used when building an overall picture of occupational skin disease incidence in the U.K.

• The lagged effect of cold temperature and wind chill on cardiorespiratory mortality in Scotland.

  Authors: M Carder, R McNamee, I Beverland, R Elton, G R Cohen, J Boyd, R M Agius

  Occupational and environmental medicine. 11/2005; 62(10):702-10.

  AIMS: To investigate the lagged effects of cold temperature on cardiorespiratory mortality and to determine whether "wind chill" is a better predictor of these effects than "dry bulb" temperature.AIMS: To investigate the lagged effects of cold temperature on cardiorespiratory mortality and to determine whether "wind chill" is a better predictor of these effects than "dry bulb" temperature. METHODS: Generalised linear Poisson regression models were used to investigate the relation between mortality and "dry bulb" and "wind chill" temperatures in the three largest Scottish cities (Glasgow, Edinburgh, and Aberdeen) between January 1981 and December 2001. Effects of temperature on mortality (lags up to one month) were quantified. Analyses were conducted for the whole year and by season (cool and warm seasons). MAIN RESULTS: Temperature was a significant predictor of mortality with the strongest association observed between temperature and respiratory mortality. There was a non-linear association between mortality and temperature. Mortality increased as temperatures fell throughout the range, but the rate of increase was steeper at temperatures below 11 degrees C. The association between temperature and mortality persisted at lag periods beyond two weeks but the effect size generally decreased with increasing lag. For temperatures below 11 degrees C, a 1 degrees C drop in the daytime mean temperature on any one day was associated with an increase in mortality of 2.9% (95% CI 2.5 to 3.4), 3.4% (95% CI 2.6 to 4.1), 4.8% (95% CI 3.5 to 6.2) and 1.7% (95% CI 1.0 to 2.4) over the following month for all cause, cardiovascular, respiratory, and "other" cause mortality respectively. The effect of temperature on mortality was not observed to be significantly modified by season. There was little indication that "wind chill" temperature was a better predictor of mortality than "dry bulb" temperature. CONCLUSIONS: Exposure to cold temperature is an important public health problem in Scotland, particularly for those dying from respiratory disease.