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Past projects

Introduction

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
  • analysis
  • presentation of results
  • dissemination of findings

We also have a well-established, highly thought-of teaching programme.

 

THE CAUSES OF OCCUPATIONAL CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) IN THE UK [closed in November 2020] 

  • 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:

  1. Identification of occupations associated with COPD risk using a cross-sectional analysis (see this paper)
  2. Development of a new efficient web-based tool (OSCAR - Occupational Self-Coding Automatic Recording) to collect and code lifetime job-histories (see this paper)
  3. Development of a new job-exposure-matrix (ACE-JEM) to estimate the exposure to specific agents associated with increased COPD risk (see this paper)
  4. Estimation of the work-related COPD burden in the UK general population (publications pending)
  5. 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).

Future steps:

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).

  • Please see details regarding OSCAR, our online tool to collect and code life-time job histories, here

LUNGS AT WORK IN KENT

A study, funded by the Colt Foundation, is examining the impact of respiratory symptoms, COPD and airflow obstruction (FEV1) on present and future employment in 51-60 year olds in Kent. 

Phase 1: initial postal cross-sectional survey of over 20,000 people completed in 2007, demonstrating the significant impact of breathlessness on work performance in this age group. 

Phase 2: Just under 2000 volunteers in full time work completed a detailed clinical assessment, involving spirometry, exercise and muscle strength testing and measurement of fat free mass as well as blood sampling. 

Spirometry results demonstrated that airflow obstruction was significantly associated with impairment in work performance in this general population, particularly in individuals reporting breathlessness.

Phase 3: follow up postal questionnaire survey focusing on job changes in the intervening 18 months, repeat clinical assessment to compare participants experiencing job loss or change in circumstances with individuals from the same population who reported no difference in their employment situation.


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.  This is now published; see this page


THE CYSTIC FIBROSIS EPIDEMIOLOGICAL NETWORK (CF-EpiNet)

  • Danielle Edwards, Olga Archangelidi (both formerly National Heart and Lung Institute, Imperial College), 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:

  1. To develop appropriate methods to link, securely store and analyse information held within the UK CF Registry with other UK data administrative sources.
  2. To apply advanced statistical techniques appropriate for analysis of longitudinal outcome data in CF to assess causal pathways and therapeutic impacts.
  3. 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.
  4. 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.


OCCUPATIONAL LUNG AND HEART DISEASE IN WELDERS

The research comprises:

  • A cross-sectional and panel study looking at the effects of welding fume exposure on welders’ lungs and heart who are working in a repair shipyard in the Middle East; specifically looking at lung disease and arterial stiffness.
  • Analysis of historical longitudinal data of welders from the same shipyard.

Systematic review and meta-analysis of cross-sectional studies on arc welding fume effects and obstructive lung disease.


THE EFFECTS OF REAL-WORLD EXPOSURES TO DIESEL TRAFFIC EMISSIONS ON CARDIO-RESPIRATORY OUTCOMES IN PATIENTS WITH COPD AND IHD: ‘OXFORD STREET 2’ - A BHF-FUNDED STUDY

  • Paul Cullinan, Fan Chung, Rudy Sinharay; Ben Barratt and Frank Kelly (Environmental Research Group, KCL); Jim Zhang (Dukes University USA)

The objectives of this study are to compare the clinical, physiological and inflammatory responses in patients with COPD and IHD after exposure to ambient levels of diesel emission particles in Oxford Street (high levels) and in Hyde Park (low levels).

Physiological outcomes measured included lung function, impulse oscillometry and arterial stiffness.

We would like determine the mechanistic explanations for any physiological findings. In particular we have taken serum samples to look at:

  • Markers that relate to endothelial dysfunction including P-selectin (sCD62P) & sCD40L
  • Markers of oxidative stress including 8-isoprostane and malondialdehyde (oxidative stress

FIRE SERVICE AUDIT

Jo Feary (previously together with Bernadette Fitzgerald) undertook 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 determined the outcome of their application, current asthma control and treatment.


TRAFFIC AIR POLLUTION AND TRANSPLANT FAILURE

A fairly small study in Belgium suggests that about 30% of mortality following lung transplantation can be attributed to traffic-related air pollution.  We will test this through another, much larger study which will include patients who have undergone other solid organ transplants.  If our findings confirm those from Belgium, this research could lead to important advances in the understanding of transplant survival, and in the monitoring and treatment of patients. 


DEVELOPING LABORATORY METHODS TO IDENTIFY AIRBORNE ALLERGENS PRESENT IN AMBIENT AIR POLLUTION

This project is focused on attempting to identify unknown allergens present in air pollution, which may contribute to life-threatening asthma exacerbations. Using recent advances in biomedical laboratory science, allergens are detected by immunological techniques, and protein sequences identified with mass spectrometry at King’s College London. This project forms the basis of a PhD in public health research but also contributes towards increasing our understanding of allergens in occupational and environmental allergic disease mechanisms.


HABITUAL GAIT SPEED: A NOVEL PROGNOSTIC MARKER IN COPD?

This MRC-funded research study aims to assess whether usual walking speed is a useful marker of disease severity and whether it has prognostic value in COPD.

The reliability of the gait speed and the association between gait speed and existing measures of exercise capacity will be assessed in stable COPD patients. The ability of gait speed to predict early hospital readmission in hospitalized patients at discharge following acute exacerbation of COPD will be prospectively evaluated. Furthermore, the ability of gait speed to predict mortality will be prospectively assessed in a cohort of stable COPD patients followed up for a minimum of two years.


QUALITY IMPROVEMENT IN CYSTIC FIBROSIS (CF): WHAT CAN WE LEARN FROM EACH OTHER?

  • Stephanie MacNeill, Janet Allen (CF Trust), Diana Bilton (Royal Brompton and Harefield NHS Trust), Jonathan Boote (University of Sheffield), Siobhan Carr (Royal Brompton and Harefield NHS Trust), Paul Cullinan, Caroline Elston (King’s College Hospital NHS Trust), Steve Harrison (Sheffield Teaching Hospitals NHS Trust), Mohammed Mohammed (University of Bradford), Livia Pierotti and Martin Wildman (Sheffield Teaching Hospitals NHS Trust)

Patients with CF are treated at specialist centres offering dedicated paediatric or adult care. The CF Trust – the national UK charity for CF - maintains a national registry database of detailed clinical and demographic information on all patients attending these specialist centres. Patients are invited to attend annual reviews and based on these data the Trust produces annual reports describing the health of patients. The reports are available on the CF Trust website to be accessed by patients and clinicians alike.  Since 2008 these reports have included comparisons between centres in terms of key clinical outcomes using simple rankings. While these comparisons give a sense of the distribution of outcomes between centres, they encourage the reader to assume that centres with the highest lung function measures are “better” than those with lower values. This is misleading on two grounds:

1)  The rankings make no allowances for the differences in the intake of patients.

2)  The rankings include no formal tests comparing centres. Without formal comparisons we cannot say that there is evidence that outcomes are better at one centre than another let alone conclude that any observed differences are related to the process of care.

Our aim in this study is to avoid the inappropriate interpretation of league tables and to adopt a more systematic and scientific method based on "statistical process control" (SPC) to identify exceptional CF care services in the UK in terms of clinically meaningful outcomes.

Study funded by the NIHR HSDR programme.