Detailed examination of research findings showed that WBV can (at very high levels) aggravate organic conditions but its action as an initiator of injury remained uncertain.The clearest finding was that high levels of exposure to WBV made work uncomfortable / too difficult for a significant proportion of people who have back pain. They then report back pain as the reason for work absence. The Radar report is available to subscribers: 1#10 22

The research report referenced here examines the feasibility of providing written instruction informing about signs and personalised care for each child with a known predisposition. It finds that such personalised programmes can be obtained and managed successfully. Evidence from: DA Moneret-Vautrin et al. Allergy. November (2001) Vol. 56 # 11 p 1071 Allergy prevention and response would seem to be reasonably practicable in schools. The Radar report is available to subscribers: 1#10 14

Pain in the neck or upper limbs and sensory symptoms were common in the non-manual workers overall (with 1 week period prevalences of 30% and 15%, respectively), and were associated with older age, smoking, headaches and tiredness or stress. Evidence from: KT Palmer et al. Occup. Med. Sep (2001) Vol.51(6) p 392. The report records that disabling symptoms were much less frequent, that keyboard work had no influence on neck or elbow pain, and moderate influence on shoulder and arm pain. Pain is not the same as injury. The Radar report is available to subscribers: 1#10 6

Nerve function is affected by carpal tunnel syndrome (CTS). This paper suggests that testing nerve function before CTS is diagnosable will identify some of those who are on the path to injury. This would allow intervention if the cause was subject to a duty of care. The test will not be added to surveillance requirements until it is fully characterised. Evidence from: RA Werner et al. Muscle and Nerve. September (2001) Vol.24 #11 p 1462. The Radar report is available to subscribers: 1#10 5

Noise induced hearing loss is still an issue. This reform of duty of care standards will bring more people within the claimant population. Poor understanding in the courts risks providing compensation for trivial harm. Given that exposure measurement is also subject to considerable uncertainty, a Duty to ensure exposure (with hearing protection) is less than 85 dB(A) would seem to be in accord with the requirements of civil liability (for the 50 year old male manual worker). That is, exposure below this value would not be shown to have on the balance of probabilities, contributed to measured HTLs. Evidence from: andrew@reliabilityoxford.co.uk A full description of the noise Directive its strengths and weaknesses. The Radar report is available to subscribers: 1#10 1

BS8800 Occupational Health and Safety Management Standard This British Standard was first approved and published in 1996 and has since been converted into a commercial certification scheme, referred to as OHSAS 18001. On several occasions since 1996, there have been attempts to convert BS8800 into an international (ISO) standard for the purposes of certification (akin to ISO 9000 etc.). Support has come from several countries but the issue is confused by rival bids from ILO and other national standards organisations. It may be that imported certification schemes would be recognised as valid in the UK, thereby taking advantage of the UK’s inability to come up with its own scheme. Opposition to a certifiable standard has been fierce and mainly from industry. All British Standards have to be reviewed. The review period for BS8800 was 5 years. BRE and ABI were original participants in the creation of BS8800 and were therefore invited to attend a review meeting in September 2001. Participan

General fitness was not protective against non-recreational causes of musculoskeletal disorders. Evidence from: CA Macera et al. American Journal of Epidemiology. July (2001) Vol. 154#3 p 251. The Radar report is available to subscribers: 1#9 2

Intervention before sickness absence would be the prerogative of the employer, it would be difficult to involve liability insurance until actual harm had been done. Evidence from: I Vaananen-Tomppo et al. International Journal of Rehabilitation Research. September (2001) Vol.24 #3. p 171. State employees in Finland have access to rehabilitation services at their usual place of work. The gatekeeper is a fully qualified occupational physician or psychologist, as appropriate. The trigger is any report of a threat to the ability to perform normal duties. Very often the service is triggered before deterioration to the extent that the employees requires time off work. Interventions and return to work programmes take place at the usual place of work. This study was designed to assess the cost benefit ratio of this system. The reference population consisted of those who did not ask for help, but went off sick. The analysis presented here is hard to understand, but suggests a cost benefit ratio

MF Jeebhay et al. Occupational and Environmental Medicine. Sept (2001) Vol.58 #9 p 553. A selective review of occupational seafood allergy. In general seafood processing seems highly energetic and manually involved. This creates the potential for extensive skin contact with fish proteins and the production of respirable protein aerosols. The author finds that most types of seafood have been found to cause occupational allergy:

Acrylamide exposure is common in construction projects. In this project, blood levels were measured and found to be slowly decreasing with a half life of 40 to 80 days. At the same time, symptoms of numbness and tingling gradually declined. Evidence from: L Hagmar et al. Scandinavian Journal of Work, Environment and Health. August (2001) Vol.27 #4 p 219. A NOAEL was identified. The Radar report is available to subscribers: 1#8 7 Evidence from: F Granath et al. Occupational and Environmental Medicine. Sept (2001) Vol.58 #9 p 608. A comment on an earlier study of a proposed association between occupational exposure to acrylamide and, cancer. A 10-year follow-up study was reported in 1999 Occupational and Environmental Medicine Vol.56, p 181 to 190. The main conclusion of the original report was that there was no significant long-term cancer risk. The letter (here) suggests the original study was severely flawed. Comment Our reading of the criticism of the original work leads us to believ

This was a powerful study of physical and psychosocial risk factors for regular back pain. Neither physical nor psychosocial factors were predictive of new cases of back pain. Emotional exhaustion was predictive.  Evidence from: WE Hoogendoorn et al. Scandinavian Journal of Work, Environment and Health. August (2001) Vol.27 #4 p 258. The Radar report is available to subscribers: 1#8 6

A study of physical and psychosocial risk factors for back pain and chronic back pain.. Evidence from: LAM Elders et al. Occupational and Environmental Medicine. Sept (2001) Vol.58 #9 p 597. The only results, which showed statistical significance, were; associations between general ill health and LPB and, general ill health and LBP-related disability. Strenuous arm position was associated with LBP related disability. The Radar report is available to subscribers: 1#8 5

The study sought an association between exposure to environmental tobacco smoke at work and two measures of lung function (FEV1 and FVC). Actual lung function was compared with expected. Exposure was measured by cotinine levels and by questionnaire. Evidence from: R Chen et al. Occupational and Environmental Medicine. Sept (2001) Vol.58 #9 p 563. The observed effects were small and may have been reversible. The Radar report is available to subscribers: 1#8 4

This powerful prospective study demonstrated some strong associations between work tasks and symptoms. If symptoms are a clear indicator of subsequent injury risk then they could be used as prompts for change to the system of work.  Evidence from: A Leclerc et al. Scandinavian Journal of Work, Environment and Health. August (2001) Vol.27 #4 p 268. Risk factors and their precision estimates were reported along with 3-year incidence. The Radar report is available to subscribers: 1#8 3

Disabling shoulder pain was related to two ergonomic factors and two psychosocial factors. It was not clear whether the disability was signalled by the inability to perform those two specific ergonomic actions or by some other disability. If the former then the result may be significant but could be little more than a self-fulfilling prophesy. Evidence from: GJ Macfarlane et al. Annals of Rheumatic Diseases. September (2001) Vol. 60 #9 p 852. Incidence of bilateral and unilateral shoulder pain was reported. The Radar report is available to subscribers: 1#8 2

Claims that shoulder pain is a sign of injury are plausible if there has been an impact event or similar. Gradually emerging pain however can have many potential causes, some of which are addressed by ergonomics standards. But is breach material? This would depend on context and degree of breach. Evidence from: H Miranda et al. Occupational and Environmental Medicine. Aug (2001) Vol.58 #8 p 528. It is tempting to assume that breach of duty must imply a material contribution. However, standards developed for regulation may not meet the standards required by the common law. The Radar report is available to subscribers: 1#7 8

Responses to injury should include steps aimed at preventing recurrence. If the cause was at work, then this serves as a prompt for the employer to adapt or modify the system of work. It would also act as a prompt for a compensation claim. The authors have developed a set of tools for deciding whether or not an injury is work-related. Evidence from: Peter Buckle, A Kilbom, A Grieco, Keith Palmer, Cyrus Cooper, Malcolm Harrington et al. Scandinavian Journal of Work, Environment and Health Supplement. June (2001) Vol.27 suppl 1. Although very simple in summary: Step 1 “Did the symptoms begin, recur or worsen after the current job (task) was started”. Step 2 “Are there exposures factors known (believed by the authors) to be (significant) risk factors for that part of the body?” Step 3 “Ask whether or not there are non occupational origins for the symptoms” Step 4 “Make a decision about the level of work relatedness” in practice each of these must be set in the correct context for regulato

Under the Employers’ Liability (Compulsory Insurance) Regulations 1998, it is a legal requirement for Employers, as of 1st January 1999, to retain their Employers’ Liability Insurance Certificates or copies for 40 years. The Certificate of Employers’ Liability Insurance Register (www.celir.com 01234 352999) proposes to provide an archiving service to client companies for each annual certificate for the required forty years. They also propose to provide a research facility for potential claimants needing to trace insurance providers. However, this facility is limited to the database of certificates lodged with CELIR by client companies. Potential claimants wishing to trace insurance providers outside the CELIR scheme are being advised to contact ABI for assistance. The CELIR scheme currently appears of little use to potential claimants for EL claims. If the venture is successful then it’s utility may well increase.

Tobacco smoke is an irritant which excavation asthma in asthmatics. But does it also cause or aggravate asthma? Literature review. Evidence from: J Bousquet and AM Vignola. Allergy. June (2001) Vol. 56 # 6 p 466. None of the reports can demonstrate with any certainty that new cases of asthma were not simply cases that no-one had noticed before. The Radar report is available to subscribers: 1#6 10

A study of a proposed association between exposure to trihalomethanes in water and birth defects. Chemicals are added during drinking-water treatment. Evidence from: LDodds and WDKing. Occupational and Environmental Medicine. July (2001) Vol.58 #7 p 443. Chemicals of interest were: Chloroform (CLF), bromodichloromethane (BDCM), bromoform and chlorodibromomethane. The Radar report is available to subscribers: 1#6 9

Popular culture has it that back pain is a result of injury. Disability is a result of pain and injury. Objective records of actual activity during a normal day were compared with questionnaires designed to measure disability and pain. Evidence from: JA Verbunt et al. Archives of Physical Medicine and Rehabilitation. June (2000) Vol. 82 #6 p 726. There was no significant correlation between any of the three questionnaire scores and objective activity measures. There was no significant difference in objectively measured activity between cases and controls. The Radar report is available to subscribers: 1#6 4 Evidence from: T Jacob et al. Archives of Physical Medicine and Rehabilitation. June (2000) Vol. 82 #6 p 735. There was no correlation between high disability scores and low activity scores. The Radar report is available to subscribers: 1#6 5 Evidence from: JM Stevenson et al. Spine. June (2001) Vol. 26 #12 p 1370. Physical activity is protective against back pain. The Radar report i

This was a prospective study of new recruits with no previous pain in the preceding month. Ergonomic factors were independently observed as well as reported by questionnaire. Risk factors for new reports of pain lasting more than a day were identified. Evidence from: CM Pritchard (GJMacfarlane) Occupational and Environmental Medicine. June (2001) Vol.58 #6 p 374. Psychosocial factors were not predictive. The work reported here suggests that eliminating unbalanced and heavy lifting at work would improve, self-reported, employee comfort. A sense of what is meant by “heavy” can be gleaned from the detailed results. None of those reporting new pain had taken any time off work because of it. The Radar report is available to subscribers: 1#5 2

Two studies of atopy (the innate risk of developing an allergy) and the effect of exposure to allergens. Given that people with a history of allergies are more likely to develop occupational allergy perhaps this should be used as a pre-placement screening enquiry?  Evidence from: BM Sympson et al. Clinical and Experimental Allergy. March (2001) Vol. 31 # 3 p 391. DH Garabrant et al. American Journal of Epidemiology. March (2001) Vol. 153 #6 p 515.   The Radar report is available to subscribers: 1#4 12

The research suggests that people with RA are much more vulnerable to hip fracture and would benefit from a higher standard of the duty of care. Evidence from: TM Huusko et al. Annals of Rheumatic Diseases May (2001) Vol. 60 #5 It is possible that the cause is related to greater use of steroids. This could then be relevant for asthmatics. The Radar report is available to subscribers: 1#4 4