Introduction and objectives Case-control studies investigating occupational exposures in idiopath... more Introduction and objectives Case-control studies investigating occupational exposures in idiopathic pulmonary fibrosis (IPF) have found associations with wood, metal, and stone dust. A recent meta-analysis of these studies found pooled odds ratios of 1.7 (1.3–2.2), 2.0 (1.3–3.0), and 1.7 (1.2–2.4) respectively. The majority of studies relied on self-reported exposure histories and used community controls; approaches vulnerable to bias. Our aim was to investigate wood, metal, and stone dust associations by means of a lifetime occupational history, which included details of job tasks, in a hospital based case-control study. Methods Participants (488 cases, 368 controls; all men) from a UK based multicentre hospital-based case-control study, the idiopathic pulmonary fibrosis job exposures study (IPFJES), were asked to recall details of their occupational history including describing job tasks within each job. They were not asked directly about specific exposures. Participants who described working with wood, metal or stone (or silica) were labelled as exposed and (unadjusted) odds ratios for associations between exposure and IPF were calculated. Results 45 cases (9%) and 28 controls (8%) were exposed to wood (OR 0.81 p=0.5), 86 cases (18%) and 48 controls (13%) were exposed to metal (OR 1.43 p=0.07), and 23 cases (5%) and 8 controls (2%) were exposed to stone (OR 2.23 p=0.06). Conclusions: Unprompted reports of wood, metal, and stone dust exposure from job task descriptions are not significantly statistically associated with IPF risk in IPFJES. Our exposure measures may lack sensitivity or estimates of association in previous studies may be an artefact of study-design.
Introduction and objectives Idiopathic pulmonary fibrosis (IPF) should not be diagnosed in the pr... more Introduction and objectives Idiopathic pulmonary fibrosis (IPF) should not be diagnosed in the presence of an identifiable cause. Asbestos is fibrogenic and can cause usual interstitial pneumonia. Occupational asbestos exposure is common in the UK in the population at risk of developing IPF (mostly men in their 70s who have worked in manual occupations). Establishing occupational asbestos exposure in a particular individual, and determining whether or not to attribute causation, is difficult. Our aim was to characterize asbestos exposure in IPF with a view to informing diagnosis. Methods Asbestos exposure was assessed using a job exposure matrix (JEM) based on occupational proportional mortality data for pleural mesothelioma and by means of a validated asbestos exposure reconstruction method for 856 participants (488 cases, 368 controls) from a UK based multicentre hospital-based case-control study, the idiopathic pulmonary fibrosis job exposures study (IPFJES). Results 65% of cases and 63% of controls ever had a high or medium risk (for asbestos exposure) job. Cases spent an average of 24 years (std 17.6, median 21 years) in a high or medium risk job (std 17.1, median 27 years) and controls spent an average of 26 years (std 17.1, median 27 years). 25% of cases and 26% of controls recalled occupational asbestos exposure in sufficient detail to allow exposure reconstruction; mean estimated asbestos exposure was 1129 fibre ml years for cases (std 5663, median 7 fibre ml years) and 586 fibre ml years (std 3194, median 4 fibre ml years) for controls. Conclusions Occupational asbestos exposure is common in patients with IPF and asbestosis is under-diagnosed. Overall, occupational asbestos exposure is not markedly different between patients with IPF and hospital controls; there does not appear to be a clear dose-response relationship or threshold effect.
BackgroundAsbestos has been hypothesised as the cause of the recent global increase in the incide... more BackgroundAsbestos has been hypothesised as the cause of the recent global increase in the incidence of ‘idiopathic’ pulmonary fibrosis (IPF). Establishing this has important diagnostic and therapeutic implications. The association between occupational asbestos exposure and IPF, and interaction with a common (minor allele frequency of 9% in European populations) genetic variant associated with IPF,MUC5Brs35705950, is unknown.MethodsMulticentre, incident case–control study. Cases (n=494) were men diagnosed with IPF at 21 UK hospitals. Controls (n=466) were age-matched men who attended a hospital clinic in the same period. Asbestos exposure was assessed at interview using a validated job exposure matrix and a source-receptor model. The primary outcome was the association between asbestos exposure and IPF, estimated using logistic regression adjusted for age, smoking and centre. Interaction withMUC5Brs35705950 was investigated using a genetic dominant model.Results327 (66%) cases and 2...
ABSTRACTObjectivesThe objective of this study was to measure the impact of the Covid-19 pandemic ... more ABSTRACTObjectivesThe objective of this study was to measure the impact of the Covid-19 pandemic on acceptance of flu vaccination in the 2020-21 season, including for those newly eligible for the UK National Health Service (NHS) free vaccination programme, extended this year to include an estimated 32.4 million (48.8%) of the UK population. Knowing intended uptake is essential to inform supply and steer public health messaging to maximise vaccination given the combined threats of both flu and Covid-19 — the unknown impact of which on both attitudes and the need for mass uptake yet again create the threat of ill-informed planning resulting in failure to meet necessary public health demand.MethodsAn online questionnaire posing question items on influenza vaccination was administered to registrants of the Care Information Exchange (CIE), the NHS’s largest patient electronic personal health record. This was part of a longitudinal study initiated during the Covid-19 pandemic lockdown. Th...
Background In the face of the COVID-19 pandemic, the UK National Health Service (NHS) extended el... more Background In the face of the COVID-19 pandemic, the UK National Health Service (NHS) extended eligibility for influenza vaccination this season to approximately 32.4 million people (48.8% of the population). Knowing the intended uptake of the vaccine will inform supply and public health messaging to maximize vaccination. Objective The objective of this study was to measure the impact of the COVID-19 pandemic on the acceptance of influenza vaccination in the 2020-2021 season, specifically focusing on people who were previously eligible but routinely declined vaccination and newly eligible people. Methods Intention to receive the influenza vaccine in 2020-2021 was asked of all registrants of the largest electronic personal health record in the NHS by a web-based questionnaire on July 31, 2020. Of those who were either newly or previously eligible but had not previously received an influenza vaccination, multivariable logistic regression and network diagrams were used to examine their...
Rationale: Asbestos is posited to cause otherwise 'idiopathic' pulmonary fibrosis (IPF); ... more Rationale: Asbestos is posited to cause otherwise 'idiopathic' pulmonary fibrosis (IPF); establishing this has important diagnostic and therapeutic implications. Objectives: To determine the association between occupational asbestos exposure and IPF; to investigate interaction with MUC5B rs35705950 genotype. Methods: Multi-centre, incident case-control study. Cases (n=494) were men diagnosed with IPF at 21 United Kingdom hospitals. Controls (n=466) were age-matched men who attended a hospital clinic in the same period. Asbestos exposure was measured using a validated job exposure matrix and a source-receptor model. The primary outcome was the association between asbestos exposure and IPF, estimated using logistic regression adjusted for age, smoking and centre. Interaction with MUC5B rs3570950 was investigated using a genetic dominant model. Measurements and Main Results: 327 (66%) cases and 293 (63%) controls ever had a high or medium asbestos exposure risk job; 8% of both ...
Introduction and objectives Case-control studies investigating occupational exposures in idiopath... more Introduction and objectives Case-control studies investigating occupational exposures in idiopathic pulmonary fibrosis (IPF) have found associations with wood, metal, and stone dust. A recent meta-analysis of these studies found pooled odds ratios of 1.7 (1.3–2.2), 2.0 (1.3–3.0), and 1.7 (1.2–2.4) respectively. The majority of studies relied on self-reported exposure histories and used community controls; approaches vulnerable to bias. Our aim was to investigate wood, metal, and stone dust associations by means of a lifetime occupational history, which included details of job tasks, in a hospital based case-control study. Methods Participants (488 cases, 368 controls; all men) from a UK based multicentre hospital-based case-control study, the idiopathic pulmonary fibrosis job exposures study (IPFJES), were asked to recall details of their occupational history including describing job tasks within each job. They were not asked directly about specific exposures. Participants who described working with wood, metal or stone (or silica) were labelled as exposed and (unadjusted) odds ratios for associations between exposure and IPF were calculated. Results 45 cases (9%) and 28 controls (8%) were exposed to wood (OR 0.81 p=0.5), 86 cases (18%) and 48 controls (13%) were exposed to metal (OR 1.43 p=0.07), and 23 cases (5%) and 8 controls (2%) were exposed to stone (OR 2.23 p=0.06). Conclusions: Unprompted reports of wood, metal, and stone dust exposure from job task descriptions are not significantly statistically associated with IPF risk in IPFJES. Our exposure measures may lack sensitivity or estimates of association in previous studies may be an artefact of study-design.
Introduction and objectives Idiopathic pulmonary fibrosis (IPF) should not be diagnosed in the pr... more Introduction and objectives Idiopathic pulmonary fibrosis (IPF) should not be diagnosed in the presence of an identifiable cause. Asbestos is fibrogenic and can cause usual interstitial pneumonia. Occupational asbestos exposure is common in the UK in the population at risk of developing IPF (mostly men in their 70s who have worked in manual occupations). Establishing occupational asbestos exposure in a particular individual, and determining whether or not to attribute causation, is difficult. Our aim was to characterize asbestos exposure in IPF with a view to informing diagnosis. Methods Asbestos exposure was assessed using a job exposure matrix (JEM) based on occupational proportional mortality data for pleural mesothelioma and by means of a validated asbestos exposure reconstruction method for 856 participants (488 cases, 368 controls) from a UK based multicentre hospital-based case-control study, the idiopathic pulmonary fibrosis job exposures study (IPFJES). Results 65% of cases and 63% of controls ever had a high or medium risk (for asbestos exposure) job. Cases spent an average of 24 years (std 17.6, median 21 years) in a high or medium risk job (std 17.1, median 27 years) and controls spent an average of 26 years (std 17.1, median 27 years). 25% of cases and 26% of controls recalled occupational asbestos exposure in sufficient detail to allow exposure reconstruction; mean estimated asbestos exposure was 1129 fibre ml years for cases (std 5663, median 7 fibre ml years) and 586 fibre ml years (std 3194, median 4 fibre ml years) for controls. Conclusions Occupational asbestos exposure is common in patients with IPF and asbestosis is under-diagnosed. Overall, occupational asbestos exposure is not markedly different between patients with IPF and hospital controls; there does not appear to be a clear dose-response relationship or threshold effect.
BackgroundAsbestos has been hypothesised as the cause of the recent global increase in the incide... more BackgroundAsbestos has been hypothesised as the cause of the recent global increase in the incidence of ‘idiopathic’ pulmonary fibrosis (IPF). Establishing this has important diagnostic and therapeutic implications. The association between occupational asbestos exposure and IPF, and interaction with a common (minor allele frequency of 9% in European populations) genetic variant associated with IPF,MUC5Brs35705950, is unknown.MethodsMulticentre, incident case–control study. Cases (n=494) were men diagnosed with IPF at 21 UK hospitals. Controls (n=466) were age-matched men who attended a hospital clinic in the same period. Asbestos exposure was assessed at interview using a validated job exposure matrix and a source-receptor model. The primary outcome was the association between asbestos exposure and IPF, estimated using logistic regression adjusted for age, smoking and centre. Interaction withMUC5Brs35705950 was investigated using a genetic dominant model.Results327 (66%) cases and 2...
ABSTRACTObjectivesThe objective of this study was to measure the impact of the Covid-19 pandemic ... more ABSTRACTObjectivesThe objective of this study was to measure the impact of the Covid-19 pandemic on acceptance of flu vaccination in the 2020-21 season, including for those newly eligible for the UK National Health Service (NHS) free vaccination programme, extended this year to include an estimated 32.4 million (48.8%) of the UK population. Knowing intended uptake is essential to inform supply and steer public health messaging to maximise vaccination given the combined threats of both flu and Covid-19 — the unknown impact of which on both attitudes and the need for mass uptake yet again create the threat of ill-informed planning resulting in failure to meet necessary public health demand.MethodsAn online questionnaire posing question items on influenza vaccination was administered to registrants of the Care Information Exchange (CIE), the NHS’s largest patient electronic personal health record. This was part of a longitudinal study initiated during the Covid-19 pandemic lockdown. Th...
Background In the face of the COVID-19 pandemic, the UK National Health Service (NHS) extended el... more Background In the face of the COVID-19 pandemic, the UK National Health Service (NHS) extended eligibility for influenza vaccination this season to approximately 32.4 million people (48.8% of the population). Knowing the intended uptake of the vaccine will inform supply and public health messaging to maximize vaccination. Objective The objective of this study was to measure the impact of the COVID-19 pandemic on the acceptance of influenza vaccination in the 2020-2021 season, specifically focusing on people who were previously eligible but routinely declined vaccination and newly eligible people. Methods Intention to receive the influenza vaccine in 2020-2021 was asked of all registrants of the largest electronic personal health record in the NHS by a web-based questionnaire on July 31, 2020. Of those who were either newly or previously eligible but had not previously received an influenza vaccination, multivariable logistic regression and network diagrams were used to examine their...
Rationale: Asbestos is posited to cause otherwise 'idiopathic' pulmonary fibrosis (IPF); ... more Rationale: Asbestos is posited to cause otherwise 'idiopathic' pulmonary fibrosis (IPF); establishing this has important diagnostic and therapeutic implications. Objectives: To determine the association between occupational asbestos exposure and IPF; to investigate interaction with MUC5B rs35705950 genotype. Methods: Multi-centre, incident case-control study. Cases (n=494) were men diagnosed with IPF at 21 United Kingdom hospitals. Controls (n=466) were age-matched men who attended a hospital clinic in the same period. Asbestos exposure was measured using a validated job exposure matrix and a source-receptor model. The primary outcome was the association between asbestos exposure and IPF, estimated using logistic regression adjusted for age, smoking and centre. Interaction with MUC5B rs3570950 was investigated using a genetic dominant model. Measurements and Main Results: 327 (66%) cases and 293 (63%) controls ever had a high or medium asbestos exposure risk job; 8% of both ...
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