The report emphasises the vulnerability of those who live in care homes. It also points out that animal vaccines may become ineffective if not updated (approximately) annually. Evidence from: I Stephenson et al. British Med Bull. (2006) Vol.75+76 p 63 – 80 “Influenza: current threat from avian influenza” The report details the state of knowledge at that time. Vaccination of farm animals could reduce the risk to humans. But it could also go wrong if not done properly. Further details: 6#1 12

Fluoride is added to drinking water to prevent dental caries. In practice fluoride concentrations exceed recommended levels and may cause harm to teeth and bones. Evidence from: Committee on Fluoride in Drinking Water, National Research Council ISBN: 0-309-10128-X, “Fluoride in Drinking Water: A Scientific Review of EPA’s Standards” Safe and harmful levels are detailed in the report. An effect on children is described. Further detail: 6#1 7

The House of Lords is being asked to consider a claim for compensation arising from charitable work undertaken in Bangladesh. There is some dispute as to the remit of that work and the standard to which it was performed. Evidence from: D Pepper. The Lancet (2006) Vol.367 p 199 – 200 “Bangladeshis poisoned by arsenic sue British organisation” Early assessments of liability came to the view that BGS was not proximal to the decision to drink the water. further detail: 6#1 3

“The health, safety and environmental risks associated with hydraulic fracturing (often termed ‘fracking’) as a means to extract shale gas can be managed effectively in the UK as long as operational best practices are implemented and enforced through regulation. “ Evidence from: http://royalsociety.org/uploadedFiles/Royal_Society_Content/policy/projects/shale-gas/2012-06-28-Shale-gas.pdf The report emphasises the need to study baseline conditions before fracking work begins. That way, changes in dissolved methane and other contaminants in ground water, aquifers and streams can be discovered with greater confidence. Induced seismic activity should be continuously monitored and used to slow down or relocate underground injection. Waste water handling is a key issue – regulators must be satisfied that the proposed controls will cope. Long term liabilities are possible: disused wells could provide a conduit for contamination. The conclusions are generic, but were develope

It would seem from this research that 12-hour shifts are no more hazardous than 8-hour shifts. For the workers studied here it would seem that the 12-hour shift was preferred. Evidence from: MD Johnson et al. International Journal of Industrial Ergonomics (2001) Vol.27 p.303. Many industries and services have begun to introduce rotating 12-h schedules. There have been concerns that such schedules may influence the rate of occupational injuries, workers health, and factors that may contribute to stress. Established 8-hour shift patterns are already known to produce sleep disturbance. 412 employees were selected for the study, which was controlled and selected on the basis of accurate representation of work types and employment contracts. Response rates were over 80%. Results from before and after the change in shift pattern were compared. With respect to amount of sleep, the responses were significantly in favour of the 12-h schedule over the 8-h schedule. The study also indicated that

Tackling work-related stress: a managers’ guide to improving and maintaining employee health and well-being. The new guide provides seven broad categories of management that could influence a person’s sense of well being. These are: • culture, • demands, • control, • interpersonal relationships, • change, • role clarity, and • individual factors such as training/skills/previous episodes. Evidence from: HSG 218. Comments While it may be that stress itself is the adverse outcome HSE seeks to address, stress is not in fact an injury. In short, standards for prevention of stress may have only a tenuous link with prevention of injury and as such would arguably be of little relevance to liability assessment. The experience of stress cannot be objectively measured, nor can it be precisely related to injury outcomes. The Radar report identifies several opportunities for defence should these guidance notes be used in evidence in claims. The Radar report is available to subscribers: SK 1#6 6 HSE

Causation of mental breakdown has been accepted in some circumstances. Researchers usually study lower degrees of distress, and assume that causation would translate to the more serious outcomes. Causal direction and correction for personality traits is usually unclear. Even so, this is the research used by policy makers to define duty of care standards and  performance targets. Evidence from: J deJonge et al. Journal of Occupational and Organisational Psychology. Mar (2001) Vol.74 #1 p.29. The most interesting result is that emotional exhaustion predicted high, perceived job-demand and not the reverse. Emotional exhaustion could be anticipated to play a role in the development of psychological ill health. But this study seems to show that perceived job demands were not causal. The Radar report is available to subscribers: SK 1#3 6 Evidence from: A Tsutsumi et al. Scandinavian Journal of Work, Environment and Health. Apr (2001) Vol.27 #2 p 146. The authors conclude that job strain and

Regulation inevitably affects liability exposure, not least because it should lead to reduced risks but also because the required standard is made more explicit and breach of duty easier to define. Evidence from: Proposed revisions to EU Directive 90/220 on deliberate releases of GMOs into the environment. Points of contention: the lack of provision for environmental liability, export from the EU to non-EU countries is less strict than import, the continued use of antibiotic resistance marker genes. The Radar report is available to subscribers: SK 1#2 10   Evidence from: Speech by David Byrne, European Commissioner for Health and Consumer Protection, 10 February 2001 Mr. Byrne discussed the EU approach to engendering public acceptance of GM technology. Proceeding on the assumption that “trust can only come through transparency”, the EU approach would be to introduce “strong” regulation aimed at “giving consumers confidence” and to “promote

Identification of risk factors is a sensible precursor to designing interventions and seeing if they work as expected. It would seem obvious then that if a supposed risk factor turns out not to be valid then it should not feature in intervention studies or duty of care standards. Evidence from:  M.Hakkanen et al. Occupational and Environmental Medicine (2001) Vol.58 #2 p.129. Results show that the most significant risk factor for absence with diagnosable arm, neck and shoulder disorders is age: Age 30-40 Risk Ratio = 2.9 (95% confidence interval 1.2 to 7.1). High physical load was protective. The Radar report is available to subscribers: SK 1#2 5 Evidence from: G.A.M.Ariens et al. Occupational and Environmental Medicine (2001) Vol.58 #3 p.200. Among those sitting, neck pain (but not a diagnosis) was more likely if the neck was flexed by 20 degrees for more than 70% of the time. The Radar report is available to subscribers: SK 1#2 6 Evidence from: RSI conference 2nd March 2001. RSI was

OSHA (USA) have published a framework and supporting tools for the prevention and management of work-related musculoskeletal disorders. The approach is essentially one of responding to significant symptoms by first deciding if they are significant and then, caused by work. the latter includes cases where the initial injury was not at work but where work could slow recovery or aggravate the injury. By responding to symptoms, the standard selects the most vulnerable rather than the average worker. Evidence from: OSHA Ergonomics Standard and supporting evidence review. SK 1#2 1 Evidence from: Occupational Health Review May/June 2001 p 3 Confirmation that the “Ergonomics Standard” which was accepted in the last few days of the Clinton administration, has now been revoked. The standard has been discussed in detail in a previous issue of The State of Knowledge journal Vol. 1#2. The argument against the standard seems to have revolved around the economic burden on business. It is not clear th

This review was created at the outset of the Radar project. The summary here covers diagnosis, causation, foreseeability, duty of care, prognosis, rehabilitation, mitigation, exposure variation. Evidence from: Andrew@reliabilityoxford.co.uk Early attempts to audit stress risk were conceptually flawed. The Radar report is available to subscribers: SK 1#1 3

This review was created at the outset of the Radar project. The summary here covers hazards, measurement of harm, foreseeability, legal regimes, remediation. Evidence from: Andrew@reliabilityoxford.co.uk The Radar report is available to subscribers: SK 1#1 2

This review was created at the outset of the Radar project. A summary of the findings for diagnosis, causation, foreseeability, duty of care, prognosis, rehabilitation. Evidence from: andrew@reliabilityoxford.co.uk The Radar report is available to subscribers: SK 1#1 1

Carbon monoxide is poisonous, but poisoning is preventable. Uncertainty still exists on the effects of low level chronic exposure. Once exposure ceases, the gas is quickly removed from the body through the lungs. Evidence from: HSE CRR01 386 Landlords gas appliance fitters and employers should have insurance for this rare form of poisoning. The Radar report is available to subscribers: 1#12 10

IARC have decided not to recommend the use of sun screens as part of fulfilling a duty to protect against skin cancer. Physical and organisational barriers to exposure are recommended instead. Outdoor work and schools were explicitly considered. The Radar report is available to subscribers: 1#12 9

The Scientific Steering Committee (SSC) advising the EC has recently published opinion on the origin and transmission routes for BSE. They confirm the standing scientific consensus hypotheses that a prion of unknown origin is the agent for transmitting the disease; mainly via feed and cross-contamination of feed, and to a lesser extent via maternal transmission. There is a government funded vCJD compensation scheme. If cases become attributable to eating meat from animals after 2000, there may be pressure for the liability of food producers to be reviewed, opening the possibility of commercial insurance involvement. The spread of BSE to sheep (if possible), should be monitored. The Radar report is available to subscribers: 1#12 8

Given the lack of measurable dose response effect, the authors propose that early signs of injury be used as the trigger for review of systems of work. Qualitative aspects such as awkward postures, high hand forces, highly repetitive motions, repeated impact, heavy lifting frequent lifting awkward lifting, high exposure to vibration, are easy to describe but only at the local level can their actual significance be assessed. Both aspects of this recommendation fall well short of the EC preference for ‘yes or no’ compliance standards. Much would be left to local judges of risk. Evidence from: N Fallentin et al. Scandinavian Journal of Work, Environment and Health. Supplement 2 (2001) Vol.27. A standard based on bio-feedback would be more accurate, and accurate more often than a standard based on arbitrary thresholds, provided the judge of risk was suitably trained. It is not clear whether insurers would pursue a robust defence of such judgement based standards in order to det

These draft guidelines cut through the unfounded professional attitudes to back pain including: bogus diagnoses, illegitimate statements about causation, alarmist prognoses, prognoses based on bio mechanical models and so on. Application of the guidelines should see greater accuracy of medical care and reductions in liability exposure, but only if they are used. Evidence from: N Bogduk. Draft- Evidence-Based Clinical Guidelines For The Management Of Acute Low Back Pain Table 6.1  of the draft guidelines is reproduced in the Radar report. It details which factors really do influence prognosis. The Radar report is available to subscribers: 1#12 1

In principle, the NHS+ service will broaden reasonably practicable access to health screening, pre placement medicals , rehabilitative expertise and guidance on prevention. There will be less acceptance of SME’s not doing the right thing. A small change in liability insurance exposure is foreseeable. NHS+ Launch 19th November 2001 NHS+ is an Occupational Health service now being offered by NHS Trusts to their local communities in exchange for money. Any profits should be reinvested in the local service, there is no central organisation taking money out of the local schemes. When the NHS was established, occupational health services were not included in the core requirements, even though the health/work link was a strong feature of the debate at the time. For many years, NHS staff had limited occupational health support for their own needs, but staff shortages, under performance, sickness absence and ill health retirement costs have led to the creation of comprehensive services wh

The HSE consultation document CD 173 outlines how the Chemical Agents Directive (98/24/EC) modifies the duties under COSHH and the Control of Lead at Work Regulations. HSC propose to retain the UK conditional “So far as is reasonably practicable”  despite objections from the EC and there are potential confusions concerning material contribution and addition to risk. The Radar report is available to subscribers: 1#11 15

The new duties extend the explicit  responsibility of property owners and occupiers. There are also changes to health surveillance regimes. Surveillance could result in insurers being put on notice of the risk of serious disease in 20 to 40 years time. This would create a data management problem. Evidence from: HSE Con Doc CD 176. The Radar report is available to subscribers: 1#11 13 Evidence from: Managing asbestos in premises. rev. ed., HSE, 2001. (INDG223 (rev2)) ISBN 07176209214 Aimed at people who own, occupy, manage or have responsibilities for premises which may contain asbestos and explains a new duty to manage these premises under the revised Control of Asbestos at Work Regulations (due to come into force in 2002). It advises how to identify, assess and manage any asbestos-containing materials in premises to protect the health of workers or others who may use the premises. A checklist is included. Comment Health surveillance organised in this way should be effective in setting

Specialists often assume that osteoarthritis is caused by heavy labouring work. But is it? If it is then defences should be explored as should potential case load. Evidence from: A Lievense et al. Journal of Rheumatology. November (2001) Vol. 28 #11 p 2520. Systematic review of research findings linking work with osteo arthritis of the Hip. 16 articles were selected in out of 2,921 on the grounds of study quality. All retained studies found hip OA associated with heavy vs. light workload. 12 of these were statistically significant but none were high quality cohort studies. That is they were snaphots. So the authors suspect recall bias as a possible explanation for the association. 10 of the 16 studies showed a dose response relationship. Comment This review is of an acceptable quality. The association and dose-response relationships could both be explained by the availability and seeking of medical assistance: Hip OA cases are more likely to seek treatment because pain hinders work hen

This Radar report collates a number of relevant findings in response to the Stewart report. Topics addressed include: Planning-related liability. Causation. Exposure control guidelines – duty of care. Childhood leukaemia – incidence. Risks to fire fighters. The Radar report is available to subscribers: 1#11 2  

Evidence from: A Conference held on the 29th November 2001 Notes on a presentation by: Julie McLean Speech and Language therapist Voice Care Network UK Voice and speech are controlled by a complex arrangement of muscles. These muscles are subject to the same aches and pains that can affect any other muscle. Habitual tension in the voice muscles can be the result of body posture, head posture and facial tension. Tension may have its origins in lack of general well being, poor seating and poor equipment arrangement. As a result, some people develop a syndrome called dysphonia (voice loss) which has features in common with diffuse RSI. In her opinion, emotions, ergonomics and habits conspire to produce a chronic pain/tension syndrome which results in voice loss. Good practice