Feasibility randomised controlled trial of a guided workbook intervention to support work-related goals among cancer survivors in the UK.

OBJECTIVES: Employment following illness is associated with better physical and psychological functioning. This study aimed to assess the feasibility and acceptability of a theoretically led workbook intervention designed to support patients with cancer returning to work. DESIGN: Parallel-group randomised controlled trial with embedded qualitative interviews. SETTING: Oncology clinics within four English National Health Service Trusts. PARTICIPANTS: Patients who had received a diagnosis of breast, gynaecological, prostate or colorectal cancer and who had been receiving treatment for a minimum of two weeks. INTERVENTION: A self-guided WorkPlan workbook designed to support patients with cancer to return to work with fortnightly telephone support calls to discuss progress. The control group received treatment as usual and was offered the workbook at the end of their 12-month follow-up. OUTCOME MEASURES: We assessed aspects of feasibility including eligibility, recruitment, data collection, attrition, feasibility of the methodology, acceptability of the intervention and potential to calculate cost-effectiveness. RESULTS: The recruitment rate of eligible patients was 44%; 68 participants consented and 58 (85%) completed baseline measures. Randomisation procedures were acceptable, data collection methods (including cost-effectiveness data) were feasible and the intervention was acceptable to participants. Retention rates at 6-month and 12-month follow-up were 72% and 69%, respectively. At 6-month follow-up, 30% of the usual care group had returned to full-time or part-time work (including phased return to work) compared with 43% of the intervention group. At 12 months, the percentages were 47% (usual care) and 68% (intervention). CONCLUSIONS: The findings confirm the feasibility of a definitive trial, although further consideration needs to be given to increasing the participation rates among men and black and ethnic minority patients diagnosed with cancer. TRIAL REGISTRATION NUMBER: ISRCTN56342476; Pre-results.

Birmingham COPD Cohort: a cross-sectional analysis of the factors associated with the likelihood of being in paid employment among people with COPD.

BACKGROUND: Employment rates among those with chronic obstructive pulmonary disease (COPD) are lower than those without COPD, but little is known about the factors that affect COPD patients' ability to work. METHODS: Multivariable analysis of the Birmingham COPD Cohort Study baseline data was used to assess the associations between lifestyle, clinical, and occupational characteristics and likelihood of being in paid employment among working-age COPD patients. RESULTS: In total, 608 of 1,889 COPD participants were of working age, of whom 248 (40.8%) were in work. Older age (60-64 years vs 30-49 years: odds ratio [OR] =0.28; 95% confidence interval [CI] =0.12-0.65), lower educational level (no formal qualification vs degree/higher level: OR =0.43; 95% CI =0.19-0.97), poorer prognostic score (highest vs lowest quartile of modified body mass index, airflow obstruction, dyspnea, and exercise (BODE) score: OR =0.10; 95% CI =0.03-0.33), and history of high occupational exposure to vapors, gases, dusts, or fumes (VGDF; high VGDF vs no VGDF exposure: OR =0.32; 95% CI =0.12-0.85) were associated with a lower probability of being employed. Only the degree of breathlessness of BODE was significantly associated with employment. CONCLUSION: This is the first study to comprehensively assess the characteristics associated with employment in a community sample of people with COPD. Future interventions should focus on managing breathlessness and reducing occupational exposures to VGDF to improve the work capability among those with COPD.

Dietary exposure to copper in the European Union and its assessment for EU regulatory risk assessment.

EU legislation requires a multimedia exposure assessment for substances supplied within the EU. Dietary intake is the main source of exposure for the majority of the population hence an essential component of the human risk assessment. This paper describes the available data for dietary copper and its use in estimating daily intake including variability and determinants of exposure. Typical and reasonable worst-case estimates are derived for the general population from the available peer reviewed literature. Intakes from drinking water are found to exhibit more variability than those from food. Therefore, different exposure scenarios are derived to reflect the range of acute and chronic exposures that may occur. Estimates of typical copper intakes for the EU population are in the range 0.8-1.8 mg/day. Typical copper intakes of men are higher than those of women while the intake among the general adult population is higher than that of the elderly. Intakes of both men and women are generally close to the WHO normative requirements but may be somewhat lower in specific locations where background levels of copper are unusually low. Alcoholic beverages represent minor contribution daily copper intakes. Intakes for children are rather variable ranging broadly from 0.7 to 1.5 mg/day and are somewhat age and sex dependent. Greater uncertainty applies to the assessment of local exposure incorporating food produced on land directly impacted by contemporary copper industry emissions. Specifically, the extent to which soil is enriched in copper in these conditions is unclear. However, effective homeostatic control mechanisms in plants limit uptake and transfer to the human food chain. A best estimate of 0.25 mg/day in addition to regional exposure was derived. Drinking water is estimated to contribute only marginally to total copper intake in most cases. Higher intakes may occur in areas of poor water quality and/or corroded distribution systems. Such elevated exposures appear unusual but their frequency is unknown.