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author:("jawbone, R")
1.  Clinical investigation of an outbreak of alveolitis and asthma in a car engine manufacturing plant 
Thorax  2007;62(11):981-990.
Exposure to metal working fluid (MWF) has been associated with outbreaks of extrinsic allergic alveolitis (EAA) in the USA, with bacterial contamination of MWF being a possible cause, but is uncommon in the UK. Twelve workers developed EAA in a car engine manufacturing plant in the UK, presenting clinically between December 2003 and May 2004. This paper reports the subsequent epidemiological investigation of the whole workforce. The study had three aims: (1) to measure the extent of the outbreak by identifying other workers who may have developed EAA or other work‐related respiratory diseases; (2) to provide case detection so that those affected could be treated; and (3) to provide epidemiological data to identify the cause of the outbreak.
The outbreak was investigated in a three‐phase cross‐sectional survey of the workforce. In phase I a respiratory screening questionnaire was completed by 808/836 workers (96.7%) in May 2004. In phase II 481 employees with at least one respiratory symptom on screening and 50 asymptomatic controls were invited for investigation at the factory in June 2004. This included a questionnaire, spirometry and clinical opinion. 454/481 (94.4%) responded and 48/50 (96%) controls. Workers were identified who needed further investigation and serial measurements of peak expiratory flow (PEF). In phase III 162 employees were seen at the Birmingham Occupational Lung Disease clinic. 198 employees returned PEF records, including 141 of the 162 who attended for clinical investigation. Case definitions for diagnoses were agreed.
87 workers (10.4% of the workforce) met case definitions for occupational lung disease, comprising EAA (n = 19), occupational asthma (n = 74) and humidifier fever (n = 7). 12 workers had more than one diagnosis. The peak onset of work‐related breathlessness was Spring 2003. The proportion of workers affected was higher for those using MWF from a large sump (27.3%) than for those working all over the manufacturing area (7.9%) (OR = 4.39, p<0.001). Two workers had positive specific provocation tests to the used but not the unused MWF solution.
Extensive investigation of the outbreak of EAA detected a large number of affected workers, not only with EAA but also occupational asthma. This is the largest reported outbreak in Europe. Mist from used MWF is the likely cause. In workplaces using MWF there is a need to carry out risk assessments, to monitor and maintain fluid quality, to control mist and to carry out respiratory health surveillance.
PMCID: PMC2117138  PMID: 17504818
2.  Dust related risks of clinically relevant lung functional deficits 
To quantify the risks of clinically important deficits of FEV1 in coal miners in relation to cumulative and average concentrations of respirable dust.
Data were studied from over 7000 men who had been surveyed in the late 1970s. Linear regression equations for the association between FEV1 and self‐reported breathlessness on mild exertion were used to define clinically important levels of FEV1 deficit, and the probabilities that individuals with different dust exposures would experience these deficits were calculated.
Levels of FEV1 were lower among breathless men than among others, with a large overlap of the distributions. The relations between standardised FEV1 and breathlessness were constant over all age and smoking groups. A decrease of 100 ml in FEV1 was associated with an increase of 1.12 in the odds of reporting breathlessness. FEV1 deficits of −0.367, −0.627, and −0.993 l (designated as “small”, “medium”, and “large” deficits) were, on average, associated with proportional increases of risks of breathlessness by factors of 1.5, 2.0, and 3.0 respectively. Cumulative respirable dust exposure ranged up to 726 gh/m3, mean 136 gh/m3 (British Medical Research Council measurement convention). An increase of 50 gh/m3 was associated with an increase of about 2% in the proportion of men with small deficits in FEV1. For medium deficits the increases ranged from 1.5% to 2%, depending on age. A similar pattern was seen for large deficits, but with smaller increases.
In the unlikely event of continuous exposure at the proposed new maximum respirable dust limit for British mines of 3 mg/m3 (ISO‐CEN measurement convention) for a working lifetime, the risk of a medium deficit of FEV1 for a non‐smoker at age 60 would be estimated to be 34%, compared with 25% for zero dust exposure; for smokers, about 54% compared with 44%.
PMCID: PMC2092488  PMID: 16621852
lung function; breathlessness; coalmine dust; exposure‐response
4.  Quantifying the advantages and disadvantages of pre-placement genetic screening 
Background: Tests of genotype may enable workers at unusual risk of future ill-health to be identified. Using them to select for employment, however, entails gains and losses to employers and employees. Ensuring a fair balance between the rights and obligations of each group requires a value judgement, but the advantages and disadvantages to interested parties must first be quantified in a meaningful way.
Method and Results: The purposes of pre-employment screening are reviewed, and several simple measures relevant to the separate interests of employers and job applicants proposed—number screened to prevent a single adverse outcome; number excluded to prevent a case; expected incidence of the adverse outcome in those excluded; and preventable fraction. The derivation of these measures is illustrated, and the factors that influence them (the prevalence of the prognostic trait, the relative risk that it carries for an adverse outcome, and the overall incidence of disease) are related algebraically and graphically, to aid judgement on the utility of screening under different circumstances.
Conclusions: In sensitive areas such as genetic testing the onus should be on the employer to justify plans for pre-placement screening. Several quantitative measures can be used to inform the ethical and economic debate about screening and to evaluate alternative strategies for prevention.
PMCID: PMC1740790  PMID: 15090667
5.  Prevalence of sensitisation to cellulase and xylanase in bakery workers 
Methods: Serum samples (n = 135) from a previous cross sectional study investigating the prevalence of respiratory symptoms and sensitisation to dust components, were reanalysed for specific IgE to the mixed enzymes cellulase, hemicellulase, and xylanase.
Results: Eight (6%) of sera tested had detectable specific IgE to mixed enzymes (excluding fungal α-amylase) and 16 (12%) to fungal α-amylase. A significant increase (p = 0.03) in nasal symptoms was found in those workers sensitised to enzymes (including α-amylase and the mixed enzymes, but with or without sensitisation to wheat flour) when compared to those sensitised to wheat flour alone. Both groups had significantly greater levels of nasal symptoms in comparison to those with no evidence of sensitisation.
Conclusions: The association between specific IgE to mixed enzymes, and an increased prevalence of nasal symptoms in individuals sensitised to enzymes, highlights the importance of measuring sensitisation to the full range of exogenous enzymes used in the baking industry, as well as to wheat flour.
PMCID: PMC1740398  PMID: 14504373
6.  Future impact of genetic screening in occupational and environmental medicine 
New genetic technologies open up the possibility of predictive screening, both for individual genetic risk factors for susceptibility to workplace hazards and for late onset (both single gene and multifactorial) hereditary disease. Although the initiative for testing may lie with employers and employees there are many potential stakeholders--from family members and workplace colleagues to insurers and society in general. The role of the occupational health professional will not only involve the contextual interpretation of genetic test results but also the myriad of associated ethical and moral questions. This paper considers a range of ethical issues with which the occupational health professional may be confronted as genetic technology advances.
PMCID: PMC1757681  PMID: 10658555
8.  Switching to low tar cigarettes: are the tar league tables relevant? 
Thorax  1984;39(9):657-662.
Representative samples of smokers of regular middle tar and regular low tar cigarettes responded to a questionnaire concerning their smoking habits and participated in a blind product test, returning 24 hour butt collections from the smoking of both middle tar and low tar cigarettes. An estimate of the mouth intake of tar derived from a measurement of filter nicotine confirmed partial compensation by the low tar smokers relative to the middle tar smokers, resulting in 32% lower tar delivery rather than the 46% expected from the standard machine values. Most middle tar smokers (98%) achieved an estimated tar delivery within or below that of the league table middle tar band when smoking middle tar cigarettes, while 70% of low tar smokers had a mouth intake of 10 X 49 mg or below within the low tar band when smoking low tar cigarettes. These results support the current tar league tables as a guide to the smoker in selecting a lower delivery cigarette.
PMCID: PMC459894  PMID: 6474400
9.  Low tar means less tar. 
PMCID: PMC1052541  PMID: 3772289
10.  Respiratory impairment induced by smoking in children in secondary schools. 
A longitudinal study was carried out from 1975 to 1979 in a cohort of 405 secondary school children. At yearly intervals they underwent a series of tests of pulmonary function designed to monitor lung development; some of these tests are relatively sensitive indicators of early abnormalities. A self administered questionnaire provided details of smoking habits and respiratory symptoms. The prevalence of smoking increased with age; most of those smoking at 16 had already been smoking, at least experimentally, at 13. Taking up smoking was clearly associated with the early onset of cough, production of phlegm, and shortness of breath on exertion. After two years of smoking more than a few cigarettes a day the children who smoked appeared considerably less healthy than their non-smoking peers and showed some evidence of early obstruction of the airways.
PMCID: PMC1441672  PMID: 6423130
11.  Cigarette smoking among secondary schoolchildren 1975-79. 
Archives of Disease in Childhood  1982;57(5):352-358.
A questionnaire relating to smoking habits, respiratory symptoms, and health attitude was administered to schoolchildren aged between 11 and 17 throughout a defined geographical area in both 1975 and 1979, with a valid response from 10498 and 12002 young people respectively. Each cohort was almost entirely different. The results suggest that although the prevalence of regular smoking has decreased in boys from 16 to 13% it has increased in girls from 13 to 14% and that at all ages more girls smoke more than boys. However despite the fall in the prevalence of regular smoking in boys there has been an overall increase in cigarette consumption. Young people who are regular smokers predominantly smoke middle tar cigarettes while among experimental smokers there is a high incidence of low tar smoking, which might suggest that such cigarettes facilitate the taking up of the habit in children. The previously described relationships between smoking and respiratory symptoms was confirmed. During the 4-year study period young people's knowledge of the associated links between smoking and heart disease and stroke has increased appreciably. It is suggested that specific health education during the years 1975-79 has not been successful, and there is the need for research.
PMCID: PMC1627565  PMID: 7092290
13.  Low-tar smoking versus middle-tar smoking. 
British Medical Journal  1980;281(6235):309.
PMCID: PMC1713803  PMID: 7427258
14.  Self-titration by cigarette smokers. 
British Medical Journal  1979;2(6192):731-732.
PMCID: PMC1596253  PMID: 509080
15.  Cigarette smoking among secondary schoolchildren in 1975. Prevalence of respiratory symptoms, knowledge of health hazards, and attitudes to smoking and health. 
A questionnaire relating to smoking habits, respirator symptoms, and health attitudes was administered to 10 498 secondary schoolchildren in 1975. The results reported in this paper indicate that children who smoke regularly have a higher prevalence of upper respiratory tract infections and a higher incidence of the respiratory symptoms, cough, phlegm production with a cold, and shortness of breath, compared with non-smokers. Children are aware of the risks of lung cancer when smoking, but less aware of the other more immediate health risks, and this is particularly so in the younger age groups. It is suggested that health education should be directed towards younger children and that more use should be made of the fact that smoking clearly makes them less healthy.
PMCID: PMC1087311  PMID: 262590
17.  Letter: Drug-induced platelet antibodies. 
British Medical Journal  1973;4(5890):490-491.
PMCID: PMC1587533  PMID: 4758472
18.  Anabolic Steroids and Bone Marrow Toxicity During Therapy with Methotrexate 
British Journal of Cancer  1972;26(5):395-401.
The effect of the anabolic steroids nandrolone decanoate and oxymetholone on the peripheral blood haemoglobin, total leucocyte and platelet counts was studied in a controlled trial in which patients received standardized chemotherapy for one form of malignant disease. The results indicate that these agents have no protective effect on bone marrow suppression during cytotoxic chemotherapy. It was observed that the time interval between the initial nadir total leucocyte count and the return to pre-treatment values in those patients receiving the anabolic steroids was significantly shorter than in the control group.
PMCID: PMC2008626  PMID: 4343678

Results 1-20 (20)