Methods The mortality (1955–2005) and cancer morbidity experience (1971–2005) of a cohort of 2160 male production workers from a chemical factory in north Wales were investigated. Exposure estimates (or surrogates) were developed for four chemicals: 2-mercaptobenzothiazole (MBT), aniline, phenyl-β-naphthylamine (PBN) and ortho-toluidine. Two analytical approaches were used, indirect standardization and Poisson regression.

Results Based on mortality rates for the general population, there was a statistically significant (P < 0.01) excess mortality from bladder cancer in the 611 study subjects potentially exposed to one or more of the four chemicals being investigated (observed 11, standardized mortality ratio 278, 95% confidence interval 139–497). There was no excess bladder cancer mortality in the remaining 1555 workers. A similar contrast was also shown for bladder cancer incidence. There were 56 study subjects who had suffered from bladder cancer (malignant or benign). In simultaneous analyses of the four exposure history variables, Poisson regression showed a significant positive trend for bladder cancer risk in relation to cumulative duration of employment in the ortho-toluidine department (P < 0.05) and non-significant positive trends in relation to cumulative duration of employment in the PBN department and to cumulative exposure to MBT.

Conclusions Some members of this cohort have suffered from occupational bladder cancer. Exposure to ortho-toluidine appears to be responsible for part of this excess and the manufacture of PBN and exposure to MBT may also have been involved.

Aim To determine whether combat unit (CU) soldiers are more susceptible to exercise-induced asthma (EIA) than other military units.

Methods A follow-up study of recruits with normal clinical and pulmonary function tests over a period of 30 months after having been assigned to CU, maintenance units (MU) or clerical tasks (CT). The participants chosen had already been subjected to additional tests 6 weeks after induction to eliminate any cases of active asthma.

Results Out of 799 subjects, 125 developed asthma during the follow-up. Twenty-one per cent of those in the CU developed asthma against 15% in the MU and 5% in the CT. The relative risks for newly diagnosed asthma were 3.7 for CU/CT (P < 0.001), 2.7 for MU/CT (P < 0.001) and 1.4 for CU/MU (P < 0.05). EIA was observed as the only manifestation of asthma in 32% of the soldiers posted in CU compared to 13 and 11% in MU and CT, respectively.

Conclusion The increased risk of EIA in CU compared to MU and CT may indicate that any one or all the factors associated with CU service conditions could contribute to this increased risk of uncovering the mild cases of asthma, especially EIA, that had been overlooked up to the time of induction into the army.

Methods An audit of the outcome of NHS pre-placement assessments at an NHS Trust between 1 April 2005 and 31 March 2006 was undertaken using an electronic database. The cost of undertaking the assessments was also calculated based on manpower hours spent per year.

Results A total of 2973 pre-placement assessments were undertaken during the 12-month period. Of the employees, 98.5% were passed fit without comment, 1.5% were passed ‘fit with comments’ on the fit slip and no potential employee was found unfit for NHS work. Ten diagnostic categories contributed to a fit with comments result. The manpower cost to this trust per year to process the 2973 NHS assessments was estimated to be approximately £13 502.

Conclusion Given the annual financial costs incurred and the high percentage of employees passed fit for work, alternative pre-placement health assessment methods could be considered. The method should ensure, however, that the ability to detect a wide range of medical conditions at the pre-placement stage still exists.

Aim To determine whether documented National Health Service occupational health assessment of low back pain in the North West region of England conforms to the published guidelines.

Methods A retrospective audit of case notes was conducted. Six performance indicators were derived from the Occupational Health Guidelines for the Management of Low Back Pain at Work in order to evaluate the performance by occupational physicians. Two hundred and seventy-seven case notes were identified from eight different occupational health departments.

Results Low rates of compliance with national standards were observed for recording of some performance indicators, notably for the assessment and documentation of ‘red’ and ‘yellow flags’. Our findings suggest that the quality of documentation of key information in the notes leaves significant room for improvement.

Conclusions For future audits, we recommend having two external auditors and seek to demonstrate a high degree of agreement between observers by conducting a reproducibility exercise. Future Faculty guidelines should emphasize documentation of the assessment and perhaps consider assessment tools to improve documentation.

Aim To examine whether workers' compensation status is an important determinant of outcome of CTS.

Methods Cases, with a Workers' Compensation Board (WCB) claim, and referents, in work but without a WCB claim, were identified from the practice of a single specialist physician. Data on history prior to and at the time of diagnosis, and events since diagnosis, were collected from clinical records and by a telephone-administered questionnaire. Prior events, severity, treatment and outcome associated with a WCB claim were assessed by logistic regression.

Results Interviews were successfully completed for 46 cases and 50 referents. In the model adjusted only for age and gender, claimants had a worse outcome in terms of changing job or stopping work with time loss from work due to CTS [odds ratio (OR) 5.1, 95% confidence interval (CI) 1.9–13.3]. The OR was much influenced by the inclusion of treatment in the model (OR = 9.6, 95% CI 1.6–58.6) with WCB cases more likely to have surgical and physiotherapy treatments. Cases with a WCB claim cost more to treat and reported greater loss in income than those not seeking compensation.

Conclusions Although these data are limited, the results are suggestive of poorer outcome among WCB claimants despite greater use of treatment and comparable severity of disease.

Aims To investigate employment- and work-related disability in a cohort of breast cancer patients to identify possible discrimination and other obstacles to remaining in work.

Methods Questionnaire study of breast cancer patients employed at diagnosis and where diagnosis had been confirmed at least 6 months before the interview. Participants completed a questionnaire concerning cancer-related symptoms and work-related factors and clinical details were obtained from their medical records.

Results The study included 96 consecutive patients with breast cancer aged between 18 and 65 years. In total, 80% of patients were unable to work after diagnosis, but 56% returned to work at the end of treatment. The sequelae of the disease or its treatment and the stage of disease were independently associated with the ability to work after the end of treatment. Only one patient did not tell his/her employers and coworkers about his/her disease. In total, 29% noticed changes in their relation with co-workers and managers, usually in the sense that they tried to be helpful. None reported job discrimination.

Conclusion Breast cancer survivors in this study encountered some problems in returning to work, mainly linked to the sequelae of their disease and its treatment rather than to discrimination by employers or colleagues.

Aim To identify the most important disease-specific aspects of work ability for sick-listed employees with MDD.

Methods An expert brainstorming session identified the specific abilities that were thought to be associated with work ability in sick-listed employees with MDD and that could also be associated with the items of the Hamilton Rating scale for Depression. Sixty-four insurance physicians (IPs) were then selected to participate in a two-round Delphi study. The aim of the first Delphi round was to identify the abilities that were thought to be important by at least 80% of the IPs. In the second Delphi round, the abilities ranked in the top 10 by at least 55% of the IPs were identified as being the most important items.

Results Sixty-one IPs participated in the two Delphi rounds. The most important abilities to be evaluated in work ability evaluation for sick-listed employees with MDD were to take notice, to sustain attention, to focus attention, to complete operations, to think in a goal-directed manner, to remember, to perform routine operations, to undertake structured work activities, to recall and to perform autonomously.

Conclusion According to 55% of the IPs, there were 10 important aspects of work ability that have to be considered in a work ability evaluation of sick-listed employees with MDD.

Aim To examine if flexible work arrangements were associated with work–family conflict among women, 1 year after childbirth.

Methods Employed women, aged ≥18, were recruited while hospitalized for childbirth. Flexible work arrangements were measured at 6 months and work–family conflict was measured at 12 months. General linear models estimated the association between flexible work arrangements and work–family conflict.

Results Of 1157 eligible participants, 522 were included in this analysis giving a 45% response rate. Compared to women who reported that taking time off was very hard, those who reported it was not too hard (β = –0.80, SE = 0.36, P < 0.05) and not at all hard (β = –1.08, SE = 0.35, P < 0.01) had lower average job spillover scores. There was no association between taking time off and home spillover. The ability to change hours was associated with greater home spillover (β = 0.46, SE = 0.18, P < 0.05) but not with job spillover. The ability to take work home was associated with increased home spillover (β = 0.35, SE = 0.14, P < 0.05) but not with job spillover.

Conclusions The ability to change work hours and the ability to take work home were associated with increased home spillover to work. The ability to take time off was associated with decreased job spillover to home. Additional research is needed to examine the intentional and unintentional consequences of flexible work arrangements.

Aims (i) To determine the proportion of sick-listed workers with self-reported work-related health problems not under mandatory occupational health surveillance. (ii) To determine whether self-reported work-related sickness absences occur more frequently among workers under mandatory occupational health surveillance or among workers not under mandatory surveillance.

Methods Questionnaire-based descriptive study. The setting was the work inability assessment consultation of social insurance physicians in Belgium. Patients’ inclusion criteria were employee, age 18–50 and 1–12 months of sickness absence. Workers with pregnancy-related sicknesses were excluded. We cross-tabulated the questionnaire results, noting (i) the workers’ perception of the work relatedness of their sickness absence and (ii) workers’ knowledge of the occupational physician, which was assumed to reflect workers who had undergone mandatory occupational health surveillance.

Results There were 1564 participants. Thirty-seven per cent of workers with self-reported work-related sickness absences were not under mandatory occupational health surveillance. Work-related sickness absences occurred as frequently among workers under mandatory occupational surveillance as among those not under mandatory occupational health surveillance (34 and 35%, respectively; P = 0.80).

Conclusion To prevent work-related illnesses and sickness absences, a revision of the mandatory occupational health surveillance system is indicated.

Aim To describe the sickness absence taken for MSDs of the upper limb (ULD) in a French company and to study their association with demographic and socioeconomic factors.

Methods Sickness absence from 2000 to 2004 (5543 episodes) was studied using data from the company's epidemiology registry and a questionnaire for each episode was completed by physicians. Incidence rates were calculated according to the gender, socioeconomic status and age.

Results The incidence rate of absence for ULD was six episodes per 1000 person-years. Rotator cuff syndrome and carpal tunnel syndrome were the most frequent diagnoses. Less frequent diagnoses, such as Guyon's canal syndrome, had longer sickness absence (55.3 days). Incidence was higher for women and blue-collar workers. Incidence also increased with age.

Conclusions These results are consistent with other studies. Although absenteeism cannot be a surrogate for disease burden or incidence, it may be useful in the prevention of ULD, as it identifies the most disabling diagnoses and the working groups most at risk.

Aims To estimate the incidence rate (IR) of emergency department (ED) visits for blood or body fluid exposures sustained by police and corrections officers in an entire state and to quantify the utilization of HIV post-exposure prophylaxis (PEP) in response to these exposures.

Methods A retrospective study of police and corrections officers presenting to EDs in Rhode Island between 1995 and 2001. The investigators estimated IRs of ED visits for these exposures with 95% confidence intervals and determined factors associated with HIV PEP using bivariate Pearson's ² analyses.

Results The average annual incidence of ED visits for blood or body fluid exposures over the study period was IR 4.41 (2.31–6.51) exposures per 1000 police and corrections personnel. Only 15% of officers sustained percutaneous injuries or blood-to-mucous membrane exposures. Sixteen officers were offered HIV PEP and 10 accepted it. Offering of HIV PEP was 3.3-fold greater for officers sustaining percutaneous and blood-to-mucous membrane exposures instead of other body fluid exposures.

Conclusion The incidence of ED visits for blood or body fluid exposures by police and corrections officers was low and most exposures did not have the potential for HIV transmission. HIV PEP was infrequently used for these exposures.

Aims The aims of this focus group study were to identify and characterize occupational exposures, symptoms and job tasks among domestic and industrial professional cleaners.

Methods Twelve focus group sessions were conducted in Lubbock, TX, and Houston, TX. Participants were asked about their job tasks, type of products they use to clean, bodily symptoms, job training and work environment.

Results Out of 99 attendees, 79 domestic and industrial cleaners participated actively in the focus group sessions. Three general themes emerged regarding cleaning professionals' work experiences: (i) job training, (ii) chemical exposure and use and (iii) competence. Domestic cleaners demonstrated significant skills deficit across each of these three themes as compared to industrial cleaners. Domestic cleaners reported more frequent exposure to respiratory irritants and sensitizers and also reported adverse respiratory symptoms as compared to industrial cleaners.

Conclusions The results from this qualitative study are consistent with earlier findings from quantitative studies placing domestic cleaners at risk of exposure to chemicals that are respiratory irritants and/or sensitizers.