Database

‘Well being’ is not the opposite of ‘ill being’. Causes for one are not necessarily mirror images of causes for the other. Evidence from: CD Ryff et al. Psychother Psychosom (2006) Vol.75 p 85–95 “Psychological Well-Being and Ill-Being: Do They Have Distinct or Mirrored Biological Correlates?” The problem is that duty of care will be established on the basis of linear logic: if x is a cause of stress then stop doing x or provide more of the opposite of x. The logic has been assumed rather than validated. This research shows the assumption is unsound in more ways than it was sound. Further detail: 6#3-4 34

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

The research aimed to develop a commonly agreed framework for the determination of a case of work related stress. The framework would primarily be used for research work but it was hoped that it could also be used in occupational health and compensation. In our view, the framework is generally applicable but actual validity depends on the specification of the tools used and the assumed thresholds. It seems highly unlikely that a single set of tools and thresholds would be of general validity. In our view, expert (not GP) assessment is required for occupational and compensation-related determinations, but these could follow the framework suggested here. Evidence from: T Cox et al. HSE Research Report RR449 (2006) “Defining a case of work-related stress” The framework is logical but more work is needed to determine sensitivity and specificity. Further detail: 6#3-4 32

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