The guidance identifies lifestyle choices, discrimination and bullying as significant causes of mental ill health in the working population. Methods for tackling these issues are described. The evidence base is probably a synthesis of individual study findings and expert opinion. The emphasis on these cited causes is quite different from the approach adopted in the Stress Management Standards. Evidence from: Department of Health. October 2006. “Action on Stigma: Promoting Mental Health, ending discrimination at work” The six principle of good management described in the Stress Management Standards [SMS] are not highlighted here [demands, control, role, relationships, support and change]. Instead, the new guidance focuses on a description of health promotion, anti discrimination, mutual respect and informed empathy but does not suggest objective or semi objective methods for demonstrating good practice. There is some overlap in that specific aspects of demands, relationships

The study shows that the concepts of burnout and depression are strongly correlated. This was the first attempt to measure this in a large cohort. The study lends weight to the idea that burnout precedes depression. If so, prevention of burnout would help prevent occupational depression. Job strain seems to be a strong predictor of burnout and of depressive symptoms but not of depressive disorder. The apparent contradiction could just be a measure of the low conversion rate from burnout to depression or, that job strain is not a predictor of depression. Previous history of mental disorder is a very strong predictor of burnout, depressive symptoms and current depression. Evidence from: K Ahola et al. JOEM (2006) Vol.48#10 p 1023 – 1030. “Contribution of Burnout to the Association between Job Strain and Depression: the Health 2000 Study” High job strain was predictive of burnout OR = 7.4 (95% CI = 5.6 to 9.6). High job strain was also predictive of depressive symptoms (OR of

Evidence from: HSE Research Report RR503. 2006 “An inventory of fibres to classify their potential hazard and risk” Details of factors which should affect potency. Further detail: 6#7-8 17

Evidence from: M Kabuto et al. Int J cancer. (2006) Vol.119 p 643 – 650 “Childhood leukemia and magnetic fields in Japan: A case-control study of childhood leukemia and residential power-frequency magnetic fields in Japan” The study reinforces the observation of a statistical association between domestic emf exposure and incidence of one kind of childhood leukaemia. G Berg et al. Am. J. Epidemiol. (2006) Vol.164#6 p 538 – 548 “Occupational Exposure to Radio Frequency/Microwave Radiation and the Risk of Brain Tumors: Interphone Study Group, Germany” No statistically significant association between occupational exposure and risk of diagnosed outcome was observed. S Lonn et al. Am. J. Epidemiol. (2006) Vol.164#7 p 637 – 643 “Mobile Phone Use and Risk of Parotid Gland Tumor” There was no statistically significant association between phone use (intensity, cumulative use or duration) and diagnosed outcome. Further detail: 6#7-8 16

Evidence in support of a causal association between night shift work and stomach ulcers. In this study the association with night shift work was moderate to strong but there was no attempt to identify which aspect of night shift work, or associated lifestyle choices, could provide a mechanism. Night shift work is of increasing prevalence, H Pylori infection is very common. Evidence from: A Pietroisti et al. Occ Env Med (2006) Vol.63 p 773-775 “Shift work increases the frequency of duodenal ulcer in H pylori infected workers” The prevalence of duodenal ulcer was higher in night shift workers than in day time workers; 29% vs. 9%. Odds ratio = 3.9 (95% CI = 2.1 to 7.5). Further detail: 6#7-8 15

The government initiatives on nanotechnology have identified several difficulties with risk assessment and regulation of risk. Work is progressing towards developing a language and methodology for risk assessment, focussing mainly on potential human health effects. In our view, current regulations are not well adapted to the proactive risk assessment of these engineered nanoparticles and the prediction of liability risk exposure remains highly uncertain. Most of the relevant regulations have the capacity to support retrospective interventions e.g. restrictions on supply after a harmful event has occurred. Evidence from: Department of Trade and Industry. October 2006. URN 06/1992 ‘Nanoscience and Nanotechnologies: Opportunities and Uncertainties’. Two-Year Review of Progress on Government Actions” Financial quantification of risk, the cost of control or mitigation, compensation and manifestation time-scales are not being tackled in a systematic way. Interest in economic and social

Evidence from: NJ Savill et al. Nature (2006) Vol.442 p 757 “Silent spread of H5N1 in vaccinated poultry” The first reports of the effectiveness of poultry vaccine indicated high levels of protection from disease and high levels of disease containment. Doubts remained about the widespread use of vaccination: o It would not be possible to distinguish vaccinated from diseased birds by blood test. o A diseased bird would present a risk of infection to others. o A vaccinated bird may still be vulnerable to disease. o Low levels of disease would be harder to detect. The present theoretical (computer modelling) research was designed to test whether vaccinated flocks could spread H5N1 disease. Findings: 90% of a flock would need to be vaccinated before the risk of disease propagation was reduced to 50%. Highly vaccinated flocks had a small probability (less than 10% chance) of transmitting disease to healthy but unvaccinated flock, the reason being that diseased birds in the vacci

The Department of Health is proposing to increase the organisation and professionalism of medical expert witnesses in family law cases. Expert work in child protection cases is considered part of the remit of the NHS [to protect children] and could be paid for as a public service. The model has many features which could be applied to other expert witness work and would lead to greater accountability. Evidence from: Department of Health Consultation. October 2006. 277342 “Bearing Good Witness: Proposals for reforming the delivery of medical expert evidence in family law cases – Consultation” Quality assurance, peer review, mentoring and a knowledge service are all potentially transferable to other areas of medical expert witness work. Audit of opinion vs. objective outcomes could also be useful in increasing the accuracy of advice and this would be facilitated by the existence of a more organised body of expert witnesses. Further detail: 6#7-8 12

The detection rate for mesothelioma was assessed by comparing death certificate information with a register of mesothelioma patients. 75% of known cases were detected in routine practice. Evidence from: DR Camidge et al. British Journal of Cancer. (2006) Vol.95 p 649 – 652. “Factors affecting the mesothelioma detection rate within national and international epidemiological studies: insights from Scottish linked cancer registry-mortality data” Where mesothelioma was not the primary cause of death there is a good chance that the person concerned, and their relatives, would not know they had the disease. Further detail: 6#7-8 11

The study finds weak evidence of an increased risk of rheumatoid arthritis in those with exposure to asbestos dust. Evidence from: CW Noonan et al. Environ Health Persp. (2006) Vol. 114 p 1243 – 1247. “Nested Case–Control Study of Autoimmune Disease in an Asbestos-Exposed Population” This was very much a preliminary study but raises the possibility of compensation claims for asbestos related lung disease to include some element of compensation for arthritis. It seems very unlikely that any claim would be for arthritis alone. Further detail: 6#7-8 10

This court decision provides a specific interpretation of environmental protection legislation in South Africa. It is unlikely to set a wider precedent but will be of interest to those with South African exposures. It finds that there is no liability to clean up contamination which was caused before the environmental protection legislation came into effect in 1999. Evidence from: T Field. Journal of Environmental Law. (2006) Vol.18#3 p 479 – 494 “Liability to Remedy Asbestos Pollution.” Only those who cause contamination after the date of effect of the National Environmental Management Act 107 (1998) would be expected to pay the costs of remediation. Further detail: 6#7-8 9

The great majority of human tuberculosis infection cases are contracted as a result close proximity to an infected person with overt illness. 10% of infected people will become ill with the disease, in most circumstances, carriers who are well will not act as a source of infection. In the UK most new cases are among those who contracted the disease while resident abroad. Evidence from: HPA Press Release 2nd November 2006 “Cases of Tuberculosis rise steeply during 2005” The cost of treating a drug-sensitive case of tuberculosis has been estimated to be £6,040, rising to £60,000 if the organism is multi-drug resistant. In 2004 7% of cases died, mostly among those aged over 65. In 2005 8.7% of TB cases were resistant to at least one first line drug. Drug resistance was highest in London and lowest in Northern Ireland but did not vary with country of origin. Further detail: 6#7-8 8

A very large number of traceable zoonotic events occur each year in the EU. Most result in mild illness but some are very serious/fatal. Tracing policy varies from one state to another but most events are caused by contaminated food or drink. People can carry disease while suffering no ill-effects and pass the disease on to others through food handling. Evidence from: The EFSA Journal (2006) 403, 1-62 “Zoonoses, Zoonotic Agents and Antimicrobial Resistance in the European Union in 2004” Bacteria were the cause of the majority of confirmed zoonotic infections in humans in the EU in 2004: Salmanellosis 192,703 cases (42 per 100,000)(principally from raw hen egg, [broiler] flesh and egg products, probably transmitted in animal feeds, between 2% and 18% of fresh poultry meat samples test positive, below 10% in pig meat, outbreaks have also been traced to foods washed with contaminated water, disease in humans is usually reversible, but was reported to have led to 12 deaths) Fur

Rates of TB infection in cattle are increasing rapidly. Tracing the origin of infections is becoming more facile. Risks to Professional Indemnity and product liability exposures should increase. Evidence from: PDO Davies. Journal of the Royal Society of Medicine. (2006) Vol.99 p 539 -540 “Tuberculosis in humans and animals: are we a threat to each other?” In the past 20 years the number of infected herds has increased from 88 to 5,539 per year. The main reason is probably increased rates of cattle to cattle transmission as animals are increasingly moved from farm to farm. There is a highly effective test of disease status; it should be possible to isolate infected cattle. Cause of loss could be traced to a duty-holder. Further detail: 6#7-8 6

This study of just one kind of medicine, used in a wide variety of settings, highlights the potential for accidental exposure to non-nursing staff, especially those with a low awareness of the potential for contamination of patient skin, clothing and bedding. Evidence from: T Meijster et al. Ann. Occ. Hyg. (2006) Vol.50 p 657 – 664 “Exposure to Antineoplastic Drugs outside the Hospital Environment” The degree of risk to home care and nursing home staff cannot be assessed from this study. However, it is clear that protocols are not providing as much protection as would be expected in a hospital setting. It should be expected that employees will come into contact with drugs which are not fully metabolised and metabolic by products, especially where these are present on the skin of the patient. Further detail: 6#7-8 5

This research confirmed in that use of wastes for the purposes of soil improvement provides a mechanism for contamination of food with live microbiological pathogens. Guidance on the management of wastes for application to farm land is expected soon. Evidence from: FSA News October 2006 “Transmission of Pathogens from Farm and Abattoir Waste to the Food Supply Chain and its Impact on the Microbiological Safety of Food” Recycling of animal wastes is becoming more sophisticated but as yet there is no definitive guidance of risk management. Some viruses are very much more persistent in wastes than are E coli. E coli is the usual reference species for risk assessment. Further detail: 6#7-8 4

The study confirms that there is no risk-free exposure to Radon. It also finds no interaction between radon and smoking; the risks are simply additive. In our view, this means that compensation issues should remain separate; material contribution should not be an issue. Evidence from: S Darby et al. Scand J Work Env Health (2006) Vol.32 supp1 p 1-16. “Residential Radon and lung cancer – detailed results of a collaborative analysis of individual data on 7148 persons with lung cancer and 14,208 persons without lung cancer from 13 epidemiological studies in Europe.” For lifelong non-smokers, the risks of lung cancer at 100 Bq/m³ and 400 Bq/m³ were estimated to be 1.2 and 1.6 respectively, relative to no radon exposure. For those smoking 15 – 20 cigarettes per day the relative risk of lung cancer would be 25.8 at 0 radon exposure, 29.9 at 100 Bq/m³ and 42.3 at 400 Bq/m³. Further detail: 6#7-8 3

Following the introduction of the workplace exposure limits (WEL) scheme and corresponding reliance on good practice, HSE have produced this extensive, detailed guidance on hazard control and health surveillance measures for work with respirable crystalline silica. Although very detailed, there remains uncertainty over the value of compliance when defending a civil or H&S enforcement action. Good practice, as defined in this guidance, includes compliance with permitted exposure levels; suggesting that exposure levels are the ultimate test of compliance, a situation which HSE have been trying to steer away from. Evidence from: HSE Series of publications on Silica The guidance covers: Brick and tile making, construction, ceramics, foundry work, silica manufacture, quarry work and slate work. The detail provides evidence of first hand insight into good practice. Further detail: 6#7-8 2

The established associations between silicosis and TB and with pneumoconiosis were confirmed. Support for an association with liver cancer in men is demonstrated. There was very weak, support for links with kidney disease and, lung cancer. Evidence from: A Marinaccio et al. Occ Env Med (2006) Vol. 63 p 762-765 “Retrospective mortality cohort study of Italian workers compensated for silicosis” There was no association with cardiovascular disease. Further detail: 6#7-8 1

Evidence from: SC Larsson et al. Int. J. Cancer (2006) Vol.119 p 2186 – 2189 “Coffee consumption and stomach cancer risk in a cohort of Swedish women” S Coon et al. Env Health Persp (2006) Vol.114 p 1872 – 1876 “Whole-Body Lifetime Occupational Lead Exposure and Risk of Parkinson’s Disease” E Carragee et al. Spine (2006) Vol.31#25 p 2942 – 2949 “Does Minor Trauma Cause Serious Low Back Illness?” Evidence for compensation-related deterioration. MA Nunno et al. Child Abuse & Neglect (2006) Vol. 30 p 1333–1342 “Learning from tragedy: A survey of child and adolescent restraint fatalities” Further detail: 6#9-10 30 BB

Evidence from: S Rohrmann et al. Am J Epidemiol. (2006) Vol.164 p 1103–1114 “Ethanol Intake and Risk of Lung Cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC)” A Smith et al. International Journal of Epidemiology (2006) Vol.35 p 1504–1513 “Childhood leukaemia and socioeconomic status: fact or artefact? A report from the United Kingdom childhood cancer study (UKCCS)” W Anees et al. Thorax (2006) Vol.61 p 751 – 755 “FEV1 decline in occupational asthma” CM Villaneuva et al. Am J Epidemiol (2007) Vol.165 p148–156 “Bladder Cancer and Exposure to Water Disinfection By-Products through Ingestion, Bathing, Showering, and Swimming in Pools” PR Salameh et al. European Journal of Epidemiology (2006) Vol.21 p 681–688 “Chronic bronchitis and pesticide exposure: a case–control study in Lebanon” Further detail: 6#9-10 29 BB

Evidence from: EC C(2006) 6839 “FP7 theme 4 Nanosciences, Nanotechnologies, Materials and New Production Technologies -Nmp” 14th November 2006 DEFRA news release “Atypical scrapie found in sheep flock considered to be TSE-free” DoH news release 15th Jan 2007. “Advice to pregnant women during lambing season” JS Felton et al. Carcinogenesis (2006) vol.27#12 p.2367–2370 “REVIEW: A meat and potato war: implications for cancer etiology” M Fischer et al. Accident Analysis and Prevention (2007) Vol.39 p94–105 “Hyperactive children as young adults: Driving abilities, safe driving behavior, and adverse driving outcomes” Further detail: 6#9-10 28 BB

Evidence from: MMWR Weekly (2006) Vol.55(48) p 1293 – 1296 “Alcohol and Other Drug Use among Victims of Motor-Vehicle Crashes — West Virginia, 2004—2005” DWP Com 7003 “Completion of the review of the scheduled list of prescribed diseases” Further detail: 6#9-10 27 BB

Evidence from: Norton v Corus UK Ltd [2006] EWCA Civ 1630 NHS Gateway number 7645 “Injury Costs Recovery Scheme” CDC Advance Data Number 381 Dec (2006) “The State of Childhood Asthma, United States, 1980–2005” Further detail: 6#9-10 26 BB