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We have particular expertise in design and analysis of occupational and environmental epidemiological surveys
In addition to our specific research projects, we provide assistance with:
- statistical design
- data management
- presentation of results
- dissemination of findings
We also have a well-stablished, highly thought-of teaching programme.
Grenfell Firefighters Study
We are planning a study of firefighters from the London Fire Brigade who attended the fire at Grenfell Tower in 2017. The study is designed to look at the medium and long term risks associated with firefighting, with a particular emphasis on cardiorespiratory health. Recruitment is likely to begin in late 2019.
UNDERSTANDING THE AETIOLOGY OF CHRONIC HYPERSENSITVITY PNEUMONITIS (CHP)
Jo Feary and Paul Cullinan are developing a protocol for a multi-centre, case-control study of the aetiology of CHP; at present 50% or more of cases have no identified cause. The focus will be on mould exposures but other exposures, and genetic determinants, will also be considered.
Jo Feary is currently conducting pilot work which includes ‘fungome’ analyses of bronchoalveolar lavage samples for patients with CHP.
IDIOPATHIC PULMONARY FIBROSIS JOB EXPOSURE STUDY (IPFJES)
- Carl Reynolds, Paul Cullinan, Chris Barber (Northern General Hospital, Sheffield) and Sara De Matteis
IPFJES is a UK based multi-centre case-control study that aims to find out if job exposures are an under-recognized cause of idiopathic pulmonary fibrosis (IPF).
Men with IPF and hospital controls are being interviewed to collect information about previous job exposures; blood is drawn to investigate genetic susceptibility.
INDIVIDUALLY VENTILATED CAGES IN LABORATORY ANIMAL FACILITIES AND THE PREVENTION OF LABORATORY ANIMAL ALLERGY: A PROOF OF CONCEPT STUDY
The SPIRAL (Safe Practice in Reducing Allergy in Laboratories) study is funded by an NIHR post-doctoral fellowship for Dr Johanna Feary. The project is designed to determine if the introduction of individual ventilated cages has resulted in a significant reduction in the risk of laboratory animal allergy. We have recruited some of the largest and most prestigious research institutions in and around London with whom we have a close clinical and /or academic relationship. The study started in 2014 and recruitment (n=750) finished in 2017. Analyses are underway.
THE CAUSES OF OCCUPATIONAL CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) IN THE UK
- Paul Cullinan, Lesley Rushton (School of Public Health, Imperial College), Debbie Jarvis (National Heart and Lung Institute, Imperial College), Sara De Matteis, Jon Ayres (University of Birmingham), David Fishwick (Health and Safety Laboratory, Buxton, Derbyshire/Northern General Hospital, Sheffield), and Steven Sadhra (University of Birmingham).
Occupational hazards are important and preventable causes of COPD worldwide. However the list of occupations and underlying specific exposures responsible for the increased risk is still unknown. The overarching goal of the HSE-COPD study is to identify the occupational causes of COPD and related burden in the UK general population in order to implement focused preventive strategies at workplace.
This work takes place within the UK Biobank study, a UK population-based cohort including half a million subjects.
The specific goals achieved so far are:
- Identification of occupations associated with COPD risk using a cross-sectional analysis (see this paper)
- Development of a new efficient web-based tool (OSCAR - Occupational Self-Coding Automatic Recording) to collect and code lifetime job-histories (see this paper)
- Development of a new job-exposure-matrix (ACE-JEM) to estimate the exposure to specific agents associated with increased COPD risk (see this paper)
- Estimation of the work-related COPD burden in the UK general population (publications pending)
- Analysis of the longitudinal lifetime job-histories collected and coded using OSCAR to identify the occupations at increased COPD risk (see this paper; judged at the ERS Congress in Madrid, September 2019, to be one of the best published in the ERJ this year - see our news item on this).
Application of the new ACE-JEM to both the cross-sectional and longitudinal data in order to identify the specific agents responsible of the increased COPD risk (analyses using the ALOHA + JEM on the longitudinal data have been completed; the related article will be drafted soon).
- OSCAR, our online tool to collect and code life-time job histories, is live - please see details here.
THE INFLUENCE OF AGRICULTURAL EXPOSURES ON RESPIRATORY HEALTH WITH A SPECIFIC FOCUS ON LOW- AND MIDDLE-INCOME COUNTRIES
Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide. While smoking is the main cause of the disease, the first findings of the multinational BOLD study found that low income countries with a low smoking prevalence are prone to higher than expected "COPD" mortality. As farming is a common occupation in developing countries and has been associated with chronic lung disease, farming exposures, particularly to pesticides, could be an important cause of chronic lung disease in these countries.
To test the relationship between chronic lung disease and agricultural exposures with a specific focus on low- and middle-income settings, this PhD project will:
- undertake a systematic review of the association between pesticide exposure and lung function
- develop a new instrument for assessing risks to respiratory health in farming settings
- analyse occupational effects on lung function in the BOLD study
- conduct a cross-sectional survey of farming communities in north Thailand in the remaining 18 to 24 months.
The MultiTex RCT study (Multifaceted intervention package for protection against cotton dust exposure among textile workers – a cluster randomized controlled trial), run by Asaad Nafees, aims to determine the effectiveness of an intervention package for reducing cotton dust levels in textile mills and improving the respiratory health of workers.
Measurements for cotton dust level will be taken, in addition to interviews and spirometry for approximately 1700 workers across 28 textile mills in Karachi, Pakistan. Baseline assessment will be followed by the implementation of the intervention in the intervention arm; comprising occupational health training of workers and managers and strategies for reducing dust exposure, including wet mopping and provision of facemasks. Key outcome measures including dust levels and lung function will be assessed at each follow-up over a period of 2 years.
FIRE SERVICE AUDIT
- Johanna Feary and Bernadette Fitzgerald
Jo Feary (previously together with Bernadette Fitzgerald) is undertaking a pre-employment assessment of fire service applicants with a history of asthma. Such individuals are referred to our specialist clinic for assessment of their asthma status and suitability for work as a firefighter. Follow-up questionnaires determine the outcome of their application, current asthma control and treatment.
FOLLOW–UP STUDY ON PATIENTS DIAGNOSED WITH OCCUPATIONAL ASTHMA OR RHINITIS
All patients diagnosed with occupational asthma or rhinitis in our clinic are contacted 12 months later to find out how their condition has affected their life. Key points of enquiry are symptom improvement, changes to workplace exposures, effect on career, income and quality of life, satisfaction with their care, and how fairly they were treated by their employer. The study is ongoing.
ADVANCE (ArmeD SerVices TrAuma RehabilitatioN OutComE) is a 20-year study investigating the long-term medical and psychosocial outcomes of UK battlefield casualties from Iraq or Afghanistan (2003-2014). The study also supports these injured men during and after their transition into civilian life.
The study is mainly based at the Defence Medical Rehabilitation Centre (DMRC). The DMRC relocated in 2018 to Stanford Hall, Leicestershire from its previous site at Headley Court near Epsom.
ADVANCE receives financial support from Help for Heroes, the MOD and HM Treasury (via the LIBOR Fund).
The principal Investigators are as follows:
- Gp Capt Alex Bennett – MSK disease & rehabilitation: Stanford Hall
- Lt Col (rtd.) Christopher Boos – CVD: Bournemouth University
- Prof Paul Cullinan – respiratory disease & epidemiology: Imperial College London
- Prof Anthony Bull – bioengineering: Imperial College London
- Prof Nicola Fear - mental health & epidemiology: King’s College London
Statistical analyses are undertaken by Susie Schofield.
Further details can be found on the ADVANCE Study website.
- Details of a seminar given by Melanie Chesnokov to our group in December 2017 can be seen here.
ASTHMA IN ASHFORD
Now part of STELAR (Study Team for Early Life Asthma Research)
- Paul Cullinan, Meinir Jones, Susie Schofield, Silvia Colicino, Cosetta Minelli (National Heart and Lung Institute, Imperial College), Angela Simpson (University of Manchester) and Adnan Custovic (University of Manchester)
The Ashford study is a longitudinal study and aims at investigating asthma and other allergic disorders, their development during children’s lives and the effect of risk factors on these conditions. The study recruited pregnant women who gave birth to 642 infants born in Ashford, Kent between 1992 and 1993. Environmental measurements were collected from the babies' homes soon after birth. Additional data were collected at each annual visit along with health information, such as wheezing and other respiratory symptoms, other allergies and family history (including skin prick tests for the parents).
In 2013, the Ashford cohort joined the Study Team for Early Life Asthma Research (STELAR) consortium, a collaborative network of all asthma UK birth cohorts (ALSPAC, MAAS, SEATON and IoW), the North West Institute for Bio-Health Informatics and Microsoft Research Cambridge.
THE CYSTIC FIBROSIS EPIDEMIOLOGICAL NETWORK (CF-EpiNet)
- Danielle Edwards, Olga Archangelidi, Siobhan Carr (Royal Brompton Hospital), Diana Bilton, Debbie Jarvis, David Taylor Robinson (Liverpool University), Jenny Whitty (University of East Anglia), Ruth Keogh (LSHTM), Sanja Stanojevic (University of Toronto) and Paul Cullinan
CF-EpiNet: Harnessing Data to Improve Lives project has four main objectives:
- To develop appropriate methods to link, securely store and analyse information held within the UK CF Registry with other UK data administrative sources.
- To apply advanced statistical techniques appropriate for analysis of longitudinal outcome data in CF to assess causal pathways and therapeutic impacts.
- To identify social and other risk factors at critical time points that are associated with and predict the impact of disease on patients’ lives, disease progression and survival.
- To improve the evidence available to inform economic models and decisions about appropriate CF care.
The project uses data of cystic fibrosis patients that has been collected through: 1) The UK CF Registry that records CF patients’ clinical, demographic and treatment data on the day of their annual reviews at CF clinics in UK, 2) an online survey on Quality of Life of CF patients (Living with Cystic Fibrosis study) that started in November 2016.
- There is also an Imperial webpage with information about the EpiNet project (including a privacy notice for participants): https://www.imperial.ac.uk/nhli/research/centres-and-initiatives/strategic-research-centre-cystic-fibrosis-epinet/