Database

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

It could be argued that physiotherapy could play a role in recovery if it helps overcome obstacles (such as temporary pain relief) to return to normal activity. While there was no evidence in the review to support this, it would be presumed by most practitioners. Anecdotal support for this presumption is persistent and strong. Evidence from: RD Herbert et al. BMJ. October (2001) #7316 p 788. Recommendations for prevention and treatment of chronic MSK pain are: don’t get chronic get active; return to normal activity. Massage and manual therapy and other physical modalities are not proven or are variable. The Radar report is available to subscribers: 1#9 13

This was an 8 year longitudinal study of those in pain. Pain is commonplace and usually meaningless but what if it was indicative of risk of cancer? Evidence from: GJ Macfarlane et al. BMJ. (2001) #7314 p 662. The report includes estimates of the prevalence of pain and the statistical association between pain and cancer outcomes. It would appear that the pain being described by people before they died had no direct link with the cancer that killed them. The Radar report is available to subscribers: 1#9 12

The concern is that if inflammation is a potent cause of lung cancer then any negligent cause of inflammation could be cited as a potential contributor to outcome. This research studied the effect on lung cancer risk of chronic inflammation arising from infection with a bacterium that causes mild pneumonia. Evidence from: H Koyi et al. APMIS. September (2001) Vol. 109, #9 p 572. Inflammation is such a common response to environmental exposures that the need for specific carcinogens to cause cancer would be greatly reduced. The Radar report is available to subscribers: 1#9 11

At the end of the study, High extraversion (women only) was predictive of new cases OR = 1.86 (95% CI = 1.16 to 2.96). Life woes and stress were not predictive. Evidence from: E Huovinen et al. Allergy. October (2001) Vol. 56 # 10 p 971. The potential to link occupational stress to incident allergy seems to be reduced by this finding. The Radar report is available to subscribers: 1#9 10