In this issue of Occupational Medicine
Assistant Editor
In the words of Martin H. Fischer, the 19th century American scientist, ‘Diagnosis is not the end, but the beginning of practice’. Having diagnosed a disease in an individual, one of the things that occupational physicians need to do is to determine if the diagnosis is linked to the individual's occupation. Linking disease causation to occupation is a difficult area. However, it is one that will affect every physician at some time or other. These judgements are often difficult and robust evidence is useful to justify any opinion offered. Various attempts have been made in the past to devise concepts and models to attribute diseases to occupations such as the Bradford Hill criteria [1], Mathias criteria for occupational dermatitis [2] and the work done on prescribed diseases by the Industrial Injuries Advisory Council. In this issue, the difficulties in determining occupational causation of diseases are discussed in the excellent editorial by Wakeford and McElvenney [3] and in the paper by Guidotti [4], which looks at the issue of occupational causation of cancer using the example of firefighters. Occupational causation of cancer is further explored in this issue in the paper by Karipidis et al. [5] which is a large case–control study looking at the relationship between radiation exposure and development of glioma. The authors found no relationship between gliomas and exposure to radiation with the exception of UV radiation, where exposure showed an increased glioma risk in men.
Sickness absence management and violence towards National Health Service (NHS) employees are topical areas and are featured in this issue. Determinants of sickness absence, especially modifiable ones are important for occupational physicians to understand and be aware of. With regards to prognosis, it is often said that patients predominantly retain the advice given by the first doctor they see and this may have important ramifications for return to work advice. In the two papers by Clayton et al. [6,7], a major determinant of sickness absence following surgery was the advice given by health care professionals. It is therefore disappointing that knowledge of Department of Work and Pensions guidelines was poor amongst non-occupational physicians, as patients are much more likely to see a non-occupational physician before an occupational physician. The authors ask for national guidelines on post-operative return to work. However, not only are national guidelines needed but also a way of communicating these guidelines to health care professionals outside the occupational health setting is needed. Violence towards health care workers is a topical issue with an estimated 75 000 NHS staff attacked last year. The study by Bayman et al. [8] examines feelings of safety among GP receptionists who work at the front line and are often the recipients of aggressive or violent incidents. Not surprisingly, those receptionists who had previously been threatened or attacked were more worried about their safety in the future, and those who received training about violence and aggression felt safer at work.
This varied and diverse issue of our journal also covers a number of other important occupational health areas including hand–arm vibration syndrome, acute chemical toxicity, occupational allergy assessment and occupational health service provision. Returning to the issue of occupational causation, it is perhaps pertinent to say that although occupation may be the cause of some disease, work and employment have a large part to play in maintaining good health, perhaps best summarized by the words of the 17th century Welsh poet George Herbert ‘A little labour, much health’!
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 Top References |
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- Hill AB. The environment and disease: association or causation? Proc R Soc Med. (1965) 58:295–300.[Web of Science][Medline]
- Mathias CG. Contact dermatitis and workers' compensation: criteria for establishing occupational causation and aggravation. J Am Acad Dermatol (1989) 20(5 Pt 1):842–848.[Web of Science][Medline]
- Wakeford R, McElvenny D. From epidemiological association to causation. Occup Med (Lond) (2007) 57:464–465.
- Guidotti TL. Evaluating causality for occupational cancers: the example of firefighters. Occup Med (Lond) (2007) 57:466–471.
- Karipidis KK, Benke G, Sim MR, Kauppinen T, Giles G. Occupational exposure to ionizing and non-ionizing radiation and risk of glioma. Occup Med (Lond) (2007) 57:518–524.
- Clayton M, Verow P. Advice given to patients about return to work and driving following surgery. Occup Med (Lond) (2007) 57:488–491.
- Clayton M, Verow P. A retrospective study of return to work following surgery. Occup Med (Lond) (2007) 57:525–531.
- Bayman PA, Hussain T. Receptionists' perceptions of violence in general practice. Occup Med (Lond) (2007) 57:492–498.
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