Lisa Bradshaw | Health and Safety Laboratory (original) (raw)

Papers by Lisa Bradshaw

To establish the nature, extent and organization of occupational health service provision for emp... more To establish the nature, extent and organization of occupational health service provision for employees within the National Health Service (NHS) in London and to review the systems for monitoring performance.

317 Vocational driving, diabetes and insulin use Tim Cundy, Paul Drury 318

Occupational and Environmental Medicine, 2009

To assess diagnostic agreement for occupational asthma, and to identify case and rater characteri... more To assess diagnostic agreement for occupational asthma, and to identify case and rater characteristics associated with this diagnosis. Summaries of possible occupational asthma cases were sent to 104 occupational and respiratory physicians. Raters assigned likelihood scores (0-100%) of occupational asthma based on case histories (phase 1), and on histories plus investigative procedures (phase 2). Interclass correlation coefficients were calculated as statistical measures of reliability for occupational asthma scores. Comparisons between mean scores were assessed for statistical significance using tests based on multilevel models. RRs were calculated to summarise effects of raters' demographics, and of supplying investigative procedures information. Occupational asthma scores showed limited agreement within each group of (occupational or respiratory) physicians, but scores were not systematically different. The difference between mean overall scores was 2.1% (52.1% occupational physicians; 50.0% respiratory physicians) in phase 1 (95% CI -2.6 to 6.8, p=0.37). In phase 2, mean overall scores were 46.1% (occupational physicians) and 41.5% (respiratory physicians); the difference in mean overall scores was 4.6% (95% CI -3.5 to 12.5, p=0.27). Raters with General Medical Council registration > or =1986 were more likely to give a positive occupational asthma diagnosis. In phase 2, male raters were more likely to label cases as occupational asthma than female raters (RR 4.5, 95% CI 3.3 to 6.0). The RR of a positive occupational asthma diagnosis was unaffected by clinical specialty. Further work on why physicians consider cases to be occupational asthma will assist better diagnosis and prevention of this disease.

Zeitschrift Für Medienpsychologie

Aims This study investigates whether work-related respiratory symptoms and acute falls in forced ... more Aims This study investigates whether work-related respiratory symptoms and acute falls in forced expiratory volume in 1 second (FEV 1 ), previously observed in current welders, are related to measured workplace exposures to total fume and metals.

Primary Care Respiratory Journal, 2007

Aims: To assess the route to secondary care for patients with possible occupational asthma, and t... more Aims: To assess the route to secondary care for patients with possible occupational asthma, and to document the duration of workrelated symptoms and referral times.

Pulmonary Pharmacology & Therapeutics, 2005

Although many different methods of measuring cough reflex sensitivity have been published, few ar... more Although many different methods of measuring cough reflex sensitivity have been published, few are simple enough to use outside of a hospital or laboratory environment. The aim of this study was to develop a simple, quick, and portable cough challenge, assess its reproducibility, and compare its results with those measured by an existing established hospital protocol.

With the development of different chlorofluorocarbon (CFC)-free metered dose aerosol and dry powd... more With the development of different chlorofluorocarbon (CFC)-free metered dose aerosol and dry powder devices, it is necessary to study and validate the methods used for assessing and comparing their efficacy. This study evaluated the cumulative dose design by determining the bronchodilator response to salbutamol given according to either a high or a low cumulative dose regimen. Adults with asthma (n = 24) were studied in a placebo-controlled, randomized, double-blind, cross-over design. On separate days, cumulative doses of salbutamol (50+50+100+200 or 100+100+ 200+400 or 400+0+0+0 or 0+0+0+0 microg) were given via Turbuhaler with 30 min between doses. The two cumulative dose regimens produced almost identical bronchodilator responses at each time point. The relative dose-potency between the 800- and 400- microg cumulative dose regimens was 0.7 with a 95% confidence interval of 0.5-1.0, excluding the true value of 2. The 400-microg cumulative dose regimen resulted in a higher FEV1 at 115 min than the 400-microg single-dose regimen. There was no difference in the bronchodilator response to the single dose of 50, 100, or 400 microg of salbutamol after either 5 or 25 min. Thus, care should be exercised when using either a cumulative or single-dose design for comparing different beta2-agonists, or different inhalation devices, with respect to their relative dose-potency. In addition, this study provides further evidence that for short-acting beta2-agonists such as salbutamol, lower doses than those normally recommended may be used, and that repeated self-administration of low doses over a period of 60 min may give a better bronchodilator response than a single administration of a high dose.

We read with interest the paper by Smith [1] recently in this journal presenting the results of a... more We read with interest the paper by Smith [1] recently in this journal presenting the results of a respiratory health surveillance programme in bread bakery workers. He describes a mean latency period of 7.3 years for symptomatic sensitization, defined as work-related symptoms and a positive skin prick test to flour or amylase. An apparent difference in latency periods between subjects developing symptoms in the last 10 years and those developing symptoms before 1993 is considered, as well as the potential implications for health surveillance strategies. Although interesting, the data merit further discussion.

Many workers in the study felt let down by the workplace and management and perceived that a lack... more Many workers in the study felt let down by the workplace and management and perceived that a lack of health and safety measures had contributed to the development of their asthma symptoms. Many workers felt that their employers were 'uncaring' and were pursuing or considering medico-legal cases against them.

Journal of Occupational and Environmental Medicine, 2004

Monocyte cell surface CD14 increases following both in vitro challenge with lipopolysaccharide (L... more Monocyte cell surface CD14 increases following both in vitro challenge with lipopolysaccharide (LPS) and exposure to organic dusts. We investigated 9 volunteers, mean age 39 years (range, 29-53 years). Each inhaled increasing concentrations of lipopolysaccharide (0.5 microg, 5.0 microg, and 20 microg). Monocyte cell surface CD14 (expressed as mean linear fluorescence) was measured before and after using flow cytometry. Upregulation of CD14 (up to 6 hours after LPS exposure) did not differ significantly between LPS (mean, 35.8; standard deviation [SD]; 54.3), n = 7 after 20 l g LPS) in comparison to placebo (39.3 [49.0]; n = 7). Maximum mean (SD) percentage CD14 upregulation up to 6 hours after challenge differed, but not significantly between those experiencing a clinically significant event (58.4 [49.2]) in comparison to those who did not (13.8, [43.2]; P = 0.27). Two individuals with a marked clinical response developed marked CD14 upregulation after exposure to LPS.

A random sample of general practitioners (GPs), practice nurses (PNs) and practice managers (PMs)... more A random sample of general practitioners (GPs), practice nurses (PNs) and practice managers (PMs) in Sheffield and Manchester was recruited into a study to evaluate the perceptions of occupational health (OH) in primary care.

Primary Care Respiratory Journal, 2010

Aims: To develop an occupational asthma learning module, which could be used both as an education... more Aims: To develop an occupational asthma learning module, which could be used both as an educational tool and to evaluate awareness and usage of clinical guidelines in primary care.

The objectives of this study were to measure the population prevalence of symptoms of chronic obs... more The objectives of this study were to measure the population prevalence of symptoms of chronic obstructive lung disease and mild airway obstruction and to compare these between occupational groups. There were 1,609 subjects (63.9% response rate) who completed a respiratory questionnaire. Of these, 1,132 (70.4%) underwent pulmonary function testing (FEV1 and FVC). Twenty-one categories of current occupation were used for analysis. Four definitions of chronic obstructive pulmonary disease (COPD) were used: (1) chronic bronchitis, (2) chronic bronchitis with airway obstruction, (3) shortness of breath, and (4) shortness of breath with airway obstruction. For chronic bronchitis, adjusted prevalence odds ratios were significantly elevated for food processors other than bakers (OR = 2.83; 95% CI, 1.27 to 6.29) and chemical processors (OR = 18.84; 3.71 to 95.64). The combination of chronic bronchitis and mild airway obstruction (FEV1/FVC < 0.75) was associated with bakers (OR = 25.5; 3.86 to 168.53) and spray painters (OR = 14.40; 2.85-72.69). Shortness of breath was associated with hairdressers (OR = 2.75; 0.80 to 9.42) and bakers (OR = 6.72; 0.57 to 79.66), and nursing was associated with lower levels of shortness of breath (OR = 0.42; 0.16 to 1.15). Working ever with vapors, gases, dust, or fumes was significantly associated with chronic bronchitis and airway obstruction (OR = 3.13; 1.07 to 9.12). This population-based study has identified certain occupations with increased prevalence of chronic bronchitis and COPD.

To establish the nature, extent and organization of occupational health service provision for emp... more To establish the nature, extent and organization of occupational health service provision for employees within the National Health Service (NHS) in London and to review the systems for monitoring performance.

317 Vocational driving, diabetes and insulin use Tim Cundy, Paul Drury 318

Occupational and Environmental Medicine, 2009

To assess diagnostic agreement for occupational asthma, and to identify case and rater characteri... more To assess diagnostic agreement for occupational asthma, and to identify case and rater characteristics associated with this diagnosis. Summaries of possible occupational asthma cases were sent to 104 occupational and respiratory physicians. Raters assigned likelihood scores (0-100%) of occupational asthma based on case histories (phase 1), and on histories plus investigative procedures (phase 2). Interclass correlation coefficients were calculated as statistical measures of reliability for occupational asthma scores. Comparisons between mean scores were assessed for statistical significance using tests based on multilevel models. RRs were calculated to summarise effects of raters' demographics, and of supplying investigative procedures information. Occupational asthma scores showed limited agreement within each group of (occupational or respiratory) physicians, but scores were not systematically different. The difference between mean overall scores was 2.1% (52.1% occupational physicians; 50.0% respiratory physicians) in phase 1 (95% CI -2.6 to 6.8, p=0.37). In phase 2, mean overall scores were 46.1% (occupational physicians) and 41.5% (respiratory physicians); the difference in mean overall scores was 4.6% (95% CI -3.5 to 12.5, p=0.27). Raters with General Medical Council registration > or =1986 were more likely to give a positive occupational asthma diagnosis. In phase 2, male raters were more likely to label cases as occupational asthma than female raters (RR 4.5, 95% CI 3.3 to 6.0). The RR of a positive occupational asthma diagnosis was unaffected by clinical specialty. Further work on why physicians consider cases to be occupational asthma will assist better diagnosis and prevention of this disease.

Zeitschrift Für Medienpsychologie

Aims This study investigates whether work-related respiratory symptoms and acute falls in forced ... more Aims This study investigates whether work-related respiratory symptoms and acute falls in forced expiratory volume in 1 second (FEV 1 ), previously observed in current welders, are related to measured workplace exposures to total fume and metals.

Primary Care Respiratory Journal, 2007

Aims: To assess the route to secondary care for patients with possible occupational asthma, and t... more Aims: To assess the route to secondary care for patients with possible occupational asthma, and to document the duration of workrelated symptoms and referral times.

Pulmonary Pharmacology & Therapeutics, 2005

Although many different methods of measuring cough reflex sensitivity have been published, few ar... more Although many different methods of measuring cough reflex sensitivity have been published, few are simple enough to use outside of a hospital or laboratory environment. The aim of this study was to develop a simple, quick, and portable cough challenge, assess its reproducibility, and compare its results with those measured by an existing established hospital protocol.

With the development of different chlorofluorocarbon (CFC)-free metered dose aerosol and dry powd... more With the development of different chlorofluorocarbon (CFC)-free metered dose aerosol and dry powder devices, it is necessary to study and validate the methods used for assessing and comparing their efficacy. This study evaluated the cumulative dose design by determining the bronchodilator response to salbutamol given according to either a high or a low cumulative dose regimen. Adults with asthma (n = 24) were studied in a placebo-controlled, randomized, double-blind, cross-over design. On separate days, cumulative doses of salbutamol (50+50+100+200 or 100+100+ 200+400 or 400+0+0+0 or 0+0+0+0 microg) were given via Turbuhaler with 30 min between doses. The two cumulative dose regimens produced almost identical bronchodilator responses at each time point. The relative dose-potency between the 800- and 400- microg cumulative dose regimens was 0.7 with a 95% confidence interval of 0.5-1.0, excluding the true value of 2. The 400-microg cumulative dose regimen resulted in a higher FEV1 at 115 min than the 400-microg single-dose regimen. There was no difference in the bronchodilator response to the single dose of 50, 100, or 400 microg of salbutamol after either 5 or 25 min. Thus, care should be exercised when using either a cumulative or single-dose design for comparing different beta2-agonists, or different inhalation devices, with respect to their relative dose-potency. In addition, this study provides further evidence that for short-acting beta2-agonists such as salbutamol, lower doses than those normally recommended may be used, and that repeated self-administration of low doses over a period of 60 min may give a better bronchodilator response than a single administration of a high dose.

We read with interest the paper by Smith [1] recently in this journal presenting the results of a... more We read with interest the paper by Smith [1] recently in this journal presenting the results of a respiratory health surveillance programme in bread bakery workers. He describes a mean latency period of 7.3 years for symptomatic sensitization, defined as work-related symptoms and a positive skin prick test to flour or amylase. An apparent difference in latency periods between subjects developing symptoms in the last 10 years and those developing symptoms before 1993 is considered, as well as the potential implications for health surveillance strategies. Although interesting, the data merit further discussion.

Many workers in the study felt let down by the workplace and management and perceived that a lack... more Many workers in the study felt let down by the workplace and management and perceived that a lack of health and safety measures had contributed to the development of their asthma symptoms. Many workers felt that their employers were 'uncaring' and were pursuing or considering medico-legal cases against them.

Journal of Occupational and Environmental Medicine, 2004

Monocyte cell surface CD14 increases following both in vitro challenge with lipopolysaccharide (L... more Monocyte cell surface CD14 increases following both in vitro challenge with lipopolysaccharide (LPS) and exposure to organic dusts. We investigated 9 volunteers, mean age 39 years (range, 29-53 years). Each inhaled increasing concentrations of lipopolysaccharide (0.5 microg, 5.0 microg, and 20 microg). Monocyte cell surface CD14 (expressed as mean linear fluorescence) was measured before and after using flow cytometry. Upregulation of CD14 (up to 6 hours after LPS exposure) did not differ significantly between LPS (mean, 35.8; standard deviation [SD]; 54.3), n = 7 after 20 l g LPS) in comparison to placebo (39.3 [49.0]; n = 7). Maximum mean (SD) percentage CD14 upregulation up to 6 hours after challenge differed, but not significantly between those experiencing a clinically significant event (58.4 [49.2]) in comparison to those who did not (13.8, [43.2]; P = 0.27). Two individuals with a marked clinical response developed marked CD14 upregulation after exposure to LPS.

A random sample of general practitioners (GPs), practice nurses (PNs) and practice managers (PMs)... more A random sample of general practitioners (GPs), practice nurses (PNs) and practice managers (PMs) in Sheffield and Manchester was recruited into a study to evaluate the perceptions of occupational health (OH) in primary care.

Primary Care Respiratory Journal, 2010

Aims: To develop an occupational asthma learning module, which could be used both as an education... more Aims: To develop an occupational asthma learning module, which could be used both as an educational tool and to evaluate awareness and usage of clinical guidelines in primary care.

The objectives of this study were to measure the population prevalence of symptoms of chronic obs... more The objectives of this study were to measure the population prevalence of symptoms of chronic obstructive lung disease and mild airway obstruction and to compare these between occupational groups. There were 1,609 subjects (63.9% response rate) who completed a respiratory questionnaire. Of these, 1,132 (70.4%) underwent pulmonary function testing (FEV1 and FVC). Twenty-one categories of current occupation were used for analysis. Four definitions of chronic obstructive pulmonary disease (COPD) were used: (1) chronic bronchitis, (2) chronic bronchitis with airway obstruction, (3) shortness of breath, and (4) shortness of breath with airway obstruction. For chronic bronchitis, adjusted prevalence odds ratios were significantly elevated for food processors other than bakers (OR = 2.83; 95% CI, 1.27 to 6.29) and chemical processors (OR = 18.84; 3.71 to 95.64). The combination of chronic bronchitis and mild airway obstruction (FEV1/FVC < 0.75) was associated with bakers (OR = 25.5; 3.86 to 168.53) and spray painters (OR = 14.40; 2.85-72.69). Shortness of breath was associated with hairdressers (OR = 2.75; 0.80 to 9.42) and bakers (OR = 6.72; 0.57 to 79.66), and nursing was associated with lower levels of shortness of breath (OR = 0.42; 0.16 to 1.15). Working ever with vapors, gases, dust, or fumes was significantly associated with chronic bronchitis and airway obstruction (OR = 3.13; 1.07 to 9.12). This population-based study has identified certain occupations with increased prevalence of chronic bronchitis and COPD.