Voice loss is a very general term including a wide range of impairments. There is detailed guidance on the prevention of voice loss but this is based on expert opinion and is untested in field research. IIAC concluded that diagnosis, causation and impairment were all too uncertain to warrant inclusion as a prescribed disease. Evidence from: Industrial Injuries Advisory Council (IIAC). Position Paper 16. March 2006. “Occupational Voice Loss” Further detail: 6#3-4 37

The report confirms a causal link between exposure to contaminated metalworking fluids and extrinsic allergic alveolitis. Evidence from: DWP IIAC Cm6867 “Extrinsic Allergic Alveolitis” EAA is a very rare disease and can almost always be traced to an occupational exposure. When a disease could arise from several possible causes IIAC look for evidence of a doubling of risk associated with an occupational cause. No such statistical evidence was available for EAA in respect of metalworking fluids; IIAC relied upon the rarity of the disease to conclude that it was too much of a coincidence that one workplace would have more than one case. Further detail: 6#3-4 35

Further evidence that cortisol levels are an unreliable witness for stress, undermining earlier confidence in their role in disease causation, related to stress. Evidence from: PMC Mommersteeg et al. Psychoneuroendocrinology (2006) Vol.31 p 216 – 225 “Clinical burnout is not reflected in the cortisol awakening response, the day-curve or the response to a low-dose dexamethasone suppression test” Seventy five burnout cases were compared with thirty five controls. The cortisol response upon wakening was identical in both groups as was the response to dexamethasone (the test here is of the responsiveness of the endocrine system). Further detail: 6#3-4 33

There were no significant prospective links between stress and objective evidence of heart disease, and, weak prospective links between stress and subjective heart disease. In theory, both the objective and subjective heart diseases observed in this study are caused by the same disease mechanisms. Either they are in fact caused by different mechanisms or, there is no causal relationship between stress and the disease mechanism. Evidence from: NR Nielsen et al. Epidemiology (2006) Vol. 17 p 391 – 397 ‘Perceived Stress and Risk of Ischemic Heart Disease Causation or Bias?’ Objective measures of heart disease show no relationship with stress. Subjective hert disease was weakly related to stress. Further detail: 6#3-4 31

The research provides some evidence that non-specific arm pain is a different phenomenon to specific upper limb disorders. The evidence come from studies of risk factors. Evidence from: K Walker-Bone et al. Occupational Medicine (2006) Vol. 56 p 243 – 250 “Risk factors for specific upper limb disorders as compared with non-specific upper limb pain: assessing the utility of a structured examination schedule” The main risk factors for diagnosable disorders were age,sex and general health. Some effect of work could be detected. For RSI there was no detectable effect of work. This casts doubt on any efforts to prevent RSI. Further detail: 6#3-4 30

The Industrial Injuries Advisory Council has given detailed consideration of the prescription of work related upper limb disorders (PDA 4 to PDA12). Minor modifications are suggested. Other diagnoses were considered e.g. fibromyalgia but there was insufficient evidence on which to base new proposals. Non-specific arm pain does not meet the requirement that there be a positive diagnosis, as opposed to a diagnosis by exclusion. Views on several disorders could be informative for the determination of liability issues. Evidence from: DWP IIAC Cm6868 July 2006. “Work-related upper limb disorders” Extensive detail: 6#3-4 29

The study provides support for the use of cognitive behavioural therapy (CBT) in enabling people to cope with back pain. The beneficial effect seems to last at least 5 years. Evidence from: SJ Linton et al. Spine (2006) Vol.31(8) p 853 – 858 “A 5-Year Follow-Up Evaluation of the Health and Economic Consequences of an Early Cognitive Behavioral Intervention for Back Pain: A Randomized, Controlled Trial” The findings cast some doubt on occupational causation and injury status. Further detail: 6#3-4 28

Evidence from: The Industrial Injuries Advisory Council (IIAC) IIAC Annual Report 2005/6 The annual report confirms the intention to publish a literature review and opinion on the prescription of occupational back pain and cervical spondylosis. Comment In response to a call for comments, the UK’s leading back pain charity, BackCare, indicated that prescription might reinforce unhelpful beliefs about non-specific back pain and the role of work. The best advice for those with non-specific back pain is to remain active and this includes going to work. Expert reviews [e.g. in the development of the Faculty of Occupational Medicine (FOM) guidelines] have consistently concluded that non-specific back pain is not caused by work and neither is it prevented by following standard ergonomic recommendations. Prescription would be possible if IIAC considered that work more than doubled the risk of back pain. More than 20% of the workforce has problems with back pain every year. The numbers involved

Those who were employed to work night shifts had a lower chance of developing Parkinson’s disease. Risk decreased with increasing years of night shift work. Parkinson’s disease and night shift work both affect large numbers of people in the UK; the research provides some reassurance that a causal link between them will not be established. Evidence from: H Chen et al. Am J Epidemiol (2006) Vol.163(8) p 726 – 730 “A Prospective Study of Night Shift Work, Sleep Duration, and Risk of Parkinson’s Disease” Further detail: 6#3-4 25

For information: There are several potential uses for nanotechnology in the food industry. Current regulation could be effective in controlling intentional usage. Evidence from: Advisory Committee for Novel Foods and Processes ACNFP/76/3 Discussion Paper. March 2006. “Nanotechnology and Food” The only example of control of food additives relates to the specification for microcrystalline cellulose, where the presence of small particles (<5 microns) is limited because of uncertainties over their safety. New additives would be assessed by the European Food Standards Agency (EFSA). Further detail: 6#3-4 18

The report finds evidence that contamination of food with BSE agent could, in the 1980s and early 1990’s, occur through standard butchery practices. Tighter regulation and inspection should now prevent this. In any case the frequency of infectivity in cattle is now relatively low. Evidence from: Food Standards Agency Project ZM 0306 “Butchery Practices in the UK” A cluster of vCJD cases emerged at Queeniborough in Leicestershire. Further detail: 6#3-4 13

In our view computing and sensing devices will soon be small and cheap enough to make their integration into the environment commonplace. Connectivity will probably be based on radio waves (WiFi) using internet service protocols. Reliability issues could give rise to liabilities, on the other hand, better control of the environment and operating systems could reduce liabilities. Evidence from: HSE Horizon Scanning Initiative. July 2006. “Pervasive Computing” In our view computing and sensing devices will soon be small and cheap enough to make their integration into the environment commonplace. Connectivity will probably be based on radio waves (WiFi) using internet service protocols. Reliability issues could give rise to liabilities, on the other hand, better control of the environment and operating systems could reduce liabilities. HSE use the term to describe the embedding or integrating of computers into the environment so as to increase access to computing power and to

The report provides a review of the known health effects of exposure to low levels of ozone. People with asthma are vulnerable to increases in symptoms. People with other respiratory disease are less affected. Ozone also does damage to property. Evidence from: US Environment Protection Agency Feb 2006. “Air Quality Criteria for Ozone and Related Photochemical Oxidants” Further detail: 6#3-4 7

The study found no elevation of risk of non-ideal pregnancy outcome in women who were occupationally exposed to pesticides and whose pregnancies exceeded 4 months. Evidence from: JL Zhu et al. J Occ Env Med (2006) Vol. 48 p 347 – 352 “Occupational Exposure to Pesticides and Pregnancy Outcomes in Gardeners and Farmers: A Study Within the Danish National Birth Cohort” There was a higher rate of very preterm births in gardeners. Prematurity was caused by rupture of membranes (possibly linked to pregnancy diabetes), preeclampsia and malformation of the uterus. Exposure to pesticides was not associated with any adverse outcome. Further detail: 6#3-4 5

This study finds evidence that exposure to PCBs is associated with increased risk of adult onset diabetes 25 years after exposure (PCB concentrations greater than 5 ppb in blood samples) was confirmed. The association only applied to women. There was no link with PBBs. PCBs are still found in food, decades after strict controls were introduced. Evidence from: O Vasiliu et al. Epidemiology (2006) Vol.17 p 352 – 359 “Polybrominated Biphenyls (PBB), Polychlorinated Biphenyls (PCB), Body Weight, and Incidence of Adult-Onset Diabetes Mellitus” Further detail: 6#3-4 4

Several autoimmune diseases, with the notable exception of rheumatoid arthritis, were found to be predictive of a diagnosis of schizophrenia. Autoimmune diseases have been repeatedly linked with silica exposure. However, an acquired autoimmune disease may not be equivalent to one primarily linked to genetic factors. Evidence from: WW Eaton et al. Am J Psychiatry (2006) Vol. 163 p 521 – 528 “Association of Schizophrenia and Autoimmune Diseases: Linkage of Danish National Registers” This could be problematic if a potent cause of autoimmune disease was detected. Silica exposure is associated with autoimmune disease. Further detail: 6#3-4 2

Evidence from: R Kanwal et al. JOEM (2006) Vol.48#2 p 149 – 157 “Evaluation of Flavorings-Related Lung Disease Risk at Six Microwave Popcorn Plants” O A Taiwo et al. JOEM (2006) Vol.48#3 p 275 – 282 “Incidence of Asthma Among Aluminum Workers” WHO Fact Sheet No 299 March (2006) “Electromagnetic Fields and Public Health: Static electric and magnetic fields” HSL/2006/19 “Summary Report on Additional Work Carried Out on the Monitoring of Chrysotile Containing Textured Decorative Coatings” Health Protection Agency RCE-2 “Dose Criteria for the Designation of Radioactively Contaminated Land” Health Protection Agency “Tuberculosis Update” Further detail: 6#1 48BB

Evidence from: EW Skorpinski et al. J Allergy and Clin Immunol. (2006) February p 463 – 464 “Two cases of accidental epinephrine injection into a finger” H Aksoy et al. Journal of Applied Tox. (2006) Vol. 26 p 10 – 15 “Genotoxicity study in lymphocytes of offset printing workers” T Murayama et al. Am J Ind Med (2006) Vol.49 p 1 – 7 “Estimation of Future Mortality From Pleural Malignant Mesothelioma in Japan Based on an Age-Cohort Model” TP Brown et al. Env Health Persp (2006) Vol.114#2 p 156 – 164 “Pesticides and Parkinson’s Disease—Is There a Link?” SK Obendorf et al. Arch. Environ. Contam. Toxicol. (2006) Vol.50 p 31 – 44 “Distribution of Pesticide Residues Within Homes in Central New York State” L Hou et al. Epidemiology. (2006) Vol.17 p 302 – 307 “Pendimethalin Exposure and Cancer Incidence Among Pesticide Applicators” HSE RR408 “Genetic variation in susceptibility to chronic effects of organophosph

Evidence from: RD Irwin. J. Appl. Toxicol. (2006) Vol. 26 p 72–80 “A review of evidence leading to the prediction that 1,4-butanediol is not a carcinogen.” L A Mucci et al. Int J Cancer (2006) Vol. 118 p 169 to 173 “Prospective study of dietary acrylamide and risk of colorectal cancer among women” C Pelucchi et al. Int. J. Cancer (2006) Vol. 118 p 467 – 471 “Dietary acrylamide and human cancer” RD Goodwin et al. Psychosomatic Medicine (2006) Vol.68 p 94–98 “Major Depression and Allergy: Does Neuroticism Explain the Relationship?” D Brodie. Industrial Law Journal. (2006) Vol.35 p 87 – 92 “The Enterprise and the Borrowed Worker” Viasystems (Tyneside) Ltd v Thermal Transfer (Northern) Ltd [2005] IRLR 983 (CA) AM Ruder et al. Environ Health Perspect. (2006) Vol.114 p 18–23. “Mortality among Workers Exposed to Polychlorinated Biphenyls (PCBs) in an Electrical Capacitor Manufacturing Plant in Indiana: An Update” AL Oakla

The Government’s chief scientific advisor has requested that restrictions on the use of drug based cognitive performance enhancement be reviewed. The drugs in question were first developed for their disease treatment properties but are now found to enhance cognitive performance in the healthy. Evidence from: Sunday Times 4th June (2006) “No 10 scientist urges brain pills for all” The emergence of performance enhancement raises issues of equality/discrimination and if facilitated, encouraged or knowingly permitted by an employer (for the purpose of gain?) liability for adverse effects could be transmitted to the employer. Adverse effects could include: fatigue, dependency, emotional variability, personality changes… Further detail: 6#1 44

A new measure of mental vulnerability has been tested for its ability to predict objective heart disease. It was a significant moderate predictor. Mental vulnerability would probably increase the rate of reports of distress at work, leading to an association between stress and heart disease. Evidence from: LF Eplov et al. J Psychsom Res (2006) Vol.60 p 169 – 176 “Mental vulnerability—a risk factor for ischemic heart disease” Claims defence would be greatly enhanced by there being any history related to mental vulnerability, provided the employer knew and acted accordingly. Most of the indicators of vulnerability are out with any influence the employer can reasonably exert without an explicit request from the employee. Further detail: 6#1 36

Bullying has many parallels with chronic stress; its victims report higher levels of depression, anxiety and health complaints and it is, on the whole, subjective. Causal direction is unknown; providing opportunities for legal defence. Social forces within a given workplace can act to decide that a given duty holder is a bully and that certain persons are bullied. Claims can be thus contagious. Evidence from: AM Hansen et al. Journal of Psychosomatic Research (2006) Vol. 60 p 63 -72 “Bullying at work, health outcomes, and physiological stress response” In this study of 437 employees 5% reported having been bullied during the past 6 months. Among these, there were statistically significant higher scores on measures of somatisation (perception of symptoms with no organic cause), depression, anxiety and mental ill health. Further detail: 6#1 34

The research could form the justification for specific guidance on cleaning work and musculoskeletal discomfort. Introduction of such guidance would probably stimulate claims making. Cleaners are often supplied by agencies. Evidence from: V. Woods et al. International Journal of Industrial Ergonomics (2006) Vol.36 p 61 – 72 “Musculoskeletal ill health amongst cleaners and recommendations for work organisational change” Further detail: 6#1 32

Ergonomic factors were found to be predictive of back pain, as was fear of pain. The results for pain of a type that could be related to injury were not presented. There were some doubts about the exposure variables, which were measured by self report. Evidence from: A Van Nieuwenhuyse et al. OEM (2006) Vol.63 p 45 – 52 “The role of physical workload and pain related fear in the development of low back pain in young workers: evidence from the BelCoBack Study; results after one year of follow up” Large changes in liability exposure are unlikely unless fear of injury is made more likely. Further detail: 6#1 31