查看更多>>摘要：Cover Legend A collection of images taken from articles in this special issue “Occupational lung health” and stock images. Artwork by Delia Sala, Wiley. Illustrations credit: Lung diagram: Luckystep/Shutterstock.com; Background image: msvr/Pexels.com; Images clockwise from top right: Apte et al, p.437; Arjun MJ/Unsplash.com; Cedric Fauntleroy/Pexels.com; Nishant Aneja/Pexels.com; Daniel Mensah Boafo/Unsplash.com; alireza naseri/Unsplash.com; Abubakar Balogun/Unsplash.com; Aloe et al, p.427; KATERYNA KON/SCIENCE PHOTO LIBRARY‐GettyImages.com.au; M Mahbub A Alahi/Pexels.com; Georg Arthur Pflueger/Unsplash.com; guruXOX/Shutterstock.com; Rodolfo Quirós/Pexels.com; Cleyder Duque/Pexels.com; Hoy et al, p. 387.
Ryan F. HoyMohamed F. JeebhayCatherine CavalinWeihong Chen...
12页
查看更多>>摘要：Abstract Silicosis not a disease of the past. It is an irreversible, fibrotic lung disease specifically caused by exposure to respirable crystalline silica (RCS) dust. Over 20,000 incident cases of silicosis were identified in 2017 and millions of workers continue to be exposed to RCS. Identified case numbers are however a substantial underestimation due to deficiencies in reporting systems and occupational respiratory health surveillance programmes in many countries. Insecure workers, immigrants and workers in small businesses are at particular risk of more intense RCS exposure. Much of the focus of research and prevention activities has been on the mining sector. Hazardous RCS exposure however occurs in a wide range of occupational setting which receive less attention, in particular the construction industry. Recent outbreaks of silicosis associated with the fabrication of domestic kitchen benchtops from high‐silica content artificial stone have been particularly notable because of the young age of affected workers, short duration of RCS exposure and often rapid disease progression. Developments in nanotechnology and hydraulic fracking provide further examples of how rapid changes in technology and industrial processes require governments to maintain constant vigilance to identify and control potential sources of RCS exposure. Despite countries around the world dealing with similar issues related to RCS exposure, there is an absence of sustained global public health response including lack of consensus of an occupational exposure limit that would provide protection to workers. Although there are complex challenges, global elimination of silicosis must remain the goal.
查看更多>>摘要：Abstract Chronic obstructive pulmonary disease (COPD) is caused by exposure to noxious particles and gases. Smoking is the main risk factor, but other factors are also associated with COPD. Occupational exposure to vapours, gases, dusts and fumes contributes to the development and progression of COPD, accounting for a population attributable fraction of 14%. Workplace pollutants, in particular inorganic dust, can initiate airway damage and inflammation, which are the hallmarks of COPD pathogenesis. Occupational COPD is still underdiagnosed, mainly due to the challenges of assessing the occupational component of the disease in clinical settings, especially if other risk factors are present. There is a need for specific education and training for clinicians, and research with a focus on evaluating the role of occupational exposure in causing COPD. Early diagnosis and identification of occupational causes is very important to prevent further decline in lung function and to reduce the health and socio‐economic burden of COPD. Establishing details of the occupational history by general practitioners or respiratory physicians could help to define the occupational burden of COPD for individual patients, providing the first useful interventions (smoking cessation, best therapeutic management, etc.). Once patients are diagnosed with occupational COPD, there is a wide international variation in access to specialist occupational medicine and public health services, along with limitations in workplace and income support. Therefore, a strong collaboration between primary care physicians, respiratory physicians and occupational medicine specialists is desirable to help manage COPD patients' health and social issues.
Catherine M. BennettNatasha SmallwoodWarren HarrexMegan Rees...
16页
查看更多>>摘要：Abstract The severe acute respiratory syndrome coronavirus (SARS‐CoV‐2) disease or COVID‐19 pandemic is associated with more than 230 million cases and has challenged healthcare systems globally. Many healthcare workers (HCWs) have acquired the infection, often through their workplace, with a significant number dying. The epidemiology of COVID‐19 infection in HCWs continues to be explored, with manifold exposure risks identified, leading to COVID‐19 being recognised as an occupational disease for HCWs. The physical illness due to COVID‐19 in HCWs is similar to the general population, with some HCWs experiencing a long‐term illness, which may impact their ability to return to work. HCWs have also been affected by the immense workplace and psychosocial disruption caused by the pandemic. The impacts on the psychological well‐being of HCWs globally have been profound, with high prevalence estimates for mental health symptoms, including emotional exhaustion. Globally, governments, healthcare organisations and employers have key responsibilities, including: to be better prepared for crises with comprehensive disaster response management plans, and to protect and preserve the health workforce from the physical and psychological impacts of the pandemic. While prioritising HCWs in vaccine rollouts globally has been critical, managing exposures and outbreaks occurring in healthcare settings remains challenging and continues to lead to substantial disruption to the health workforce. Safeguarding healthcare workforces during crises is critical as we move forward on the new path of ‘COVID normal’.
Christian Anthony AloeTracy Li‐Tsein LeongHari WimaleswaranYet Hong Khor...
10页
查看更多>>摘要：Abstract Background and objective Inhalation of high concentrations of respirable crystalline silica (RCS) can lead to silicosis. RCS contains varying levels of iron, which can cause oxidative stress and stimulate ferritin production. This study evaluated iron‐related and inflammatory markers in control and silicosis patients. Methods A cohort of stone benchtop industry workers (n?=?18) were radiologically classified by disease severity into simple or complicated silicosis. Peripheral blood and bronchoalveolar lavage (BAL) were collected to measure iron, ferritin, C‐reactive protein, serum amyloid A and serum silicon levels. Ferritin subunit expression in BAL and transbronchial biopsies was analysed by reverse transcription quantitative PCR. Lipid accumulation in BAL macrophages was assessed by Oil Red O staining. Results Serum iron levels were significantly elevated in patients with silicosis, with a strong positive association with serum ferritin levels. In contrast, markers of systemic inflammation were not increased in silicosis patients. Serum silicon levels were significantly elevated in complicated disease. BAL macrophages from silicosis patients were morphologically consistent with lipid‐laden foamy macrophages. Ferritin light chain (FTL) mRNA expression in BAL macrophages was also significantly elevated in simple silicosis patients and correlated with systemic ferritin. Conclusion Our findings suggest that elevated iron levels during the early phases of silicosis increase FTL expression in BAL macrophages, which drives elevated BAL and serum ferritin levels. Excess iron and ferritin were also associated with the emergence of a foamy BAL macrophage phenotype. Ferritin may represent an early disease marker for silicosis, where increased levels are independent of inflammation and may contribute to fibrotic lung remodelling.
Simon H. ApteMaxine E. TanViviana P. LutzkyTharushi A. De Silva...
10页
查看更多>>摘要：Abstract Background and objective An epidemic of silicosis has emerged due to a failure to control risks associated with exposure to high‐silica content respirable dust generated while working with artificial stone products. Methods for quantification of alveolar crystal burden are needed to advance our understanding of the pathobiology of silica‐related lung injury as well as assisting in the diagnosis, clinical management and prognostication of affected workers. The objective of this study was to develop and validate novel methods to quantify alveolar crystal burden in bronchoalveolar lavage (BAL) fluid from patients with artificial stone silicosis. Methods New methods to quantify and analyse alveolar crystal in BAL from patients with artificial stone silicosis were developed. Crystals were isolated and counted by microscopy and alveolar crystal burden was calculated using a standard curve generated by titration of respirable α‐Quartz. The utility of the assay was then assessed in 23 patients with artificial stone silicosis. Results Alveolar crystal burden was greater in patients with silicosis (0.44 picograms [pg]/cell [0.08–3.49]) compared to patients with other respiratory diagnoses (0.057?pg/cell [0.01–0.34]; p?<?0.001). Alveolar crystal burden was positively correlated with years of silica exposure (ρ?=?0.49, p?=?0.02) and with decline in diffusing capacity of the lungs for carbon monoxide (ρ?=??0.50, p?=?0.02). Conclusion Alveolar crystal burden quantification differentiates patients with silicosis from patients with other respiratory disorders. Furthermore, crystal burden is correlated with the rate of decline in lung function in patients with artificial stone silicosis.
Yong SongKatherine SouthamB. Basil BeamishGraeme R. Zosky...
8页
查看更多>>摘要：Abstract Background and objective Coal mine dust has a complex and heterogeneous chemical composition. It has been suggested that coal particle chemistry plays a critical role in determining the pathogenesis of coal workers' pneumoconiosis (CWP). In this study, we aimed to establish the association between the detrimental cellular response and the chemical composition of coal particles. Methods We sourced 19 real‐world coal samples. Samples were crushed prior to use to minimize the impact of particle size on the response and to ensure the particles were respirable. Key chemical components and inorganic compounds were quantified in the coal samples. The cytotoxic, inflammatory and pro‐fibrotic responses in epithelial cells, macrophages and fibroblasts were assessed following 24?h of exposure to coal particles. Principal component analysis (PCA) and stepwise regression were used to determine which chemical components of the coal particles were associated with the cell response. Results The cytotoxic, inflammatory and pro‐fibrotic response varied considerably between coal samples. There was a high level of collinearity in the cell responses and between the chemical compounds within the coal samples. PCA identified three factors that explained 75% of the variance in the cell response. Stepwise multiple regression analysis identified K2O (p?<0.001) and Fe2O3 (p?=?0.011) as significant predictors of cytotoxicity and cytokine production, respectively. Conclusion Our data clearly demonstrate that the detrimental cellular effects of exposure to coal mine dusts are highly dependent on particle chemistry. This has implications for understanding the pathogenesis of CWP.
查看更多>>摘要：Abstract Background and objective Artificial stone benchtops are a popular kitchen product, but dust from their preparation and installation contains respirable crystalline silica, which causes silicosis. Silicosis is a preventable, permanent lung disease. The aim of this study was to assess mental health in workers from the artificial stone benchtop industry at risk of silicosis. Methods Workers from the artificial stone benchtop industry undergoing assessment for silica‐associated disease were included. Information on demographics; occupational, medical and smoking history; modified Medical Research Council dyspnoea scale; Perceived Stress Scale (PSS‐10) questionnaire; spirometry; and chest x‐ray was collected. Univariate and multivariate regression analyses were conducted. Results Of the 547 participants, the majority were men, aged under 45?years, in the industry for less than 10?years. With each increase of dyspnoea score, PSS‐10 scores increased. Higher PSS‐10 scores were also observed in those no longer in the industry, with a history of anxiety or depression, attending assessment early in the programme and a medium exposure duration. Participants who used an interpreter reported lower stress. No difference was observed across job title, age, sex, smoking, spirometry or chest x‐ray categories after multivariate analysis. Conclusion This study identified workers with dyspnoea as likely to report higher stress. Other factors, such as leaving the industry, early attendance and a history of anxiety or depression, are also helpful in identifying workers at risk of poorer mental health outcomes.
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