Aims Firstly, to bring readers up to date with the current organization and delivery of OH to uniformed personnel in the Armed Forces. Secondly, to review the research that has led to an improvement in OH services and the ways in which the Armed Forces are responding to the various challenges.

Methods A description of the type and delivery of OH to the Armed Forces is followed by a review of the relevant contemporaneous literature from both open publications and research dissertations.

Results Although there are some similarities with civilian OH, the principal requirement to prepare and sustain service personnel for operations on land, sea and air adds considerable complexity to the task. Research undertaken by Armed Forces OH professionals has added to the evidence base and enabled attrition in all aspects of the Armed Forces to be reduced.

Conclusions To meet the challenges of the 21st century, Armed Forces OH practitioners must continue to provide the best evidence-based advice to enhance force preparation and sustainment. All consultations in the Armed Forces involve an OH consideration from the simplest consultations through to the input from specialist OH practitioners. While the assessment of fitness to work in home bases and on deployed operations remains the primary output of OH, the provision of support to command policy, procurement and research are also key to the ability to operate worldwide.

Aims To provide a measure of the incidence of work-related mental ill-health reported by specialist psychiatrists and occupational physicians to UK voluntary reporting schemes during the period 2002–05. Additionally, an investigation of determinants, notably factors identified by reporters as precipitants in cases of work-related mental ill-health was undertaken.

Methods The study used data collected by The Health and Occupation Reporting Network (THOR) from 2002 to 2005. Cases were analysed by age, gender, industry and precipitating event.

Results Estimated annual average incidence rates and 95% confidence intervals of work-related mental ill-health diagnoses reported to THOR between 2002 and 2005 by psychiatrists were 89 (78, 101) per million and by occupational physicians were 1589 (1443, 1735) per million. For both groups of reporters, anxiety and depression continued to make up the largest proportion of diagnoses. The majority of cases were attributed to factors such as workload and difficulties with other workers. There was some suggestion that the type of factors associated with the mental ill-health case reports varied between industrial sectors.

Conclusions Work-related anxiety and depression and stress continue to constitute a significant proportion of all work-related mental ill-health diagnoses in the UK, with workload and interpersonal relationships reported as significant risk factors. Further investigations may determine whether guidance for employers and employees on work-related mental ill-health would benefit from being more industry specific.

Aims To explore the association of mental health with occupational stress, coping styles and their interaction among Chinese offshore oil platform workers.

Methods A cross-sectional survey was conducted among 561 Chinese offshore oil platform workers. They were sent a self-administered questionnaire exploring their socio-demographic characteristics, occupational stress, coping styles and mental health. Hierarchical multiple regression was used to assess the main and interactive effects of occupational stress and coping styles on mental health.

Results After controlling for age, educational level, marital status and years of offshore working, poor mental health was significantly positively associated with occupational stress, ‘internal behaviour’ coping methods and the interaction between occupational stress and internal behaviour coping.

Conclusions The results of this study suggest that the mental health of Chinese offshore oil platform workers is associated with occupational stress, some coping styles and interactions of occupational stress and some coping styles.

Aims To compare perceptions of illness, fitness to return to work and time to return to work among employees with those of their occupational physicians (OPs).

Methods A cross-sectional study of employees off sick for >2 weeks, with the return to work date ascertained at 3 months. Employees and their OPs completed similar questionnaires that included the Brief Illness Perception Questionnaire.

Results Of total, 84 employees (76% response rate) and nine OPs participated. Employees reported a greater impact on their life (P < 0.01), a longer duration of illness (P < 0.01), more symptoms (P < 0.01), more concern about their illness (P < 0.01), more emotional impact of their illness (P < 0.01) and that their illness was more serious (P < 0.01) than did the OPs. They attributed their illness to work more often than their OPs (P < 0.05) and predicted more accurately when they would be fit to return to work (P < 0.01). Employees who returned to work believed that their illness was shorter lasting (P < 0.01), more treatable (P < 0.01), more controllable (P < 0.05), less serious (P < 0.01), had less emotional impact (P < 0.01), perceived fewer symptoms (P < 0.05) and had less concern (P < 0.05) than those who failed to return to work.

Conclusions Employees had more negative perceptions about their illness than OPs. Positive perceptions were associated with an earlier return to work. Unhelpful negative beliefs about illness need to be addressed by OPs.

Aims To assess the relative impact of health, work characteristics and perceptions of work on absence and performance.

Methods Cross-sectional survey of two public sector organizations (n = 505). Data were analysed using multivariate linear regression to assess the individual and combined influence of each class of independent variables on the following: days sickness absence, spells of sickness absence, VAS performance and presenteeism.

Results Characteristics of work were weakly associated with days absence and performance. Perceptions of work were more strongly associated with performance than absence. Measures of mental health, rather than physical health, had the greatest influence on ability to work. Poor health had a greater impact on work performance than work absence. When considered together, health variables accounted for the largest proportion of explained variance in both absence and performance when compared with characteristics of work and work perceptions.

Conclusions Using absence as a marker of health-associated compromise at work may lead to an underestimation of the impact of health on work. This study demonstrates the need to manage the impact of health problems on the workforce not only from a bio-medical perspective but also in terms of the psychological pressures and the social context in which employees work.

Aims To ascertain if a multidimensional prevention programme combining physical training, patient transfer technique and stress management prevents sickness absence and LBP in NA students.

Methods The study was a 14-month cluster randomized controlled study. The participants were NA students from 37 randomly selected classes located at two schools of health and social care in Copenhagen, Denmark. The participants completed a comprehensive questionnaire regarding sickness absence, LBP and psychosocial factors on commencement and after completion of the study.

Results Of 766 female NA students, 668 (87%) completed the baseline questionnaire. Sickness absence during the study period increased in both groups but the increase was significantly lower in the intervention group than the control group, mean (standard deviation) number of days 12 (20) versus 18 (34), P < 0.05. The intervention group reported no change in the mean level of general health perception, energy/fatigue or psychological well-being at follow-up, while the control group reported a decline on those scales. There were no significant differences in the prevalence of LBP at follow-up between the intervention and control group.

Conclusions Compared to the control group, the intervention group had significantly less sickness absence. The intervention had no preventive effect on LBP prevalence.

Aims To study the effects of work demands and job control on the autonomic nervous system recovery among the media personnel.

Methods From the cross-sectional postal survey of the employees in Finnish Broadcasting Company (n = 874), three age cohorts (n = 132) were randomly selected for an analysis of HRV in 24 h electrocardiography recordings.

Results In the middle-aged group, those who experienced high job control had significantly better vagal recovery than those with low or moderate control (P < 0.01). Among young and ageing employees, job control did not associate with autonomic recovery.

Conclusions High job control over work rather than low demands seemed to enhance autonomic recovery in middle-aged media workers. This was independent of poor health habits such as smoking, physical inactivity or alcohol consumption.

Aims To investigate the relationship between the HSE MS and the following stress-related work outcomes: ‘job satisfaction’, job-related anxiety and depression and errors/near misses.

Methods An anonymous cross-sectional questionnaire was distributed by either e-mail or post to all employees within a community-based Health and Social Services Trust. Respondents completed the HSE Indicator Tool, a job-related anxiety and depression scale, a job satisfaction scale and an aggregated measure of the number of errors/near misses witnessed. Associations between the HSE Indicator Tool responses and stress-related work outcomes were analysed with regression statistics.

Results A total of 707 employees completed the questionnaire, representing a low response rate of 29%. Controlling for age, gender and contract type, the HSE MS (as measured by the HSE Indicator Tool) were positively associated with job satisfaction and negatively associated with ‘job-related anxiety’, ‘job-related depression’ and ‘witnessed errors/near misses’.

Conclusions This study provides empirical evidence to support the use of the MS approach in tackling workplace stress.

Aims To assess GPs’ training, knowledge and application of the DWP's sickness certification guidelines.

Methods A structured questionnaire was sent to GPs within a (former) primary care trust (PCT). It probed demographics, training and knowledge of sickness certification guidelines. Case histories and structured questions were used to assess current practice.

Results In this group of 113 GPs, there was a low awareness and use of the DWP's guidelines and Website relating to sickness certification. The majority of the GPs (63%) had received no training in sickness certification, and the mean length of time for those who had received training was 4.1 h. Most GPs also felt that patients and GPs have equal influence on the duration of sickness certification.

Conclusions This evidence of variable practice indicates that GPs should have more guidance and education in sickness certification. Closer sickness certification monitoring through existing GP computer systems may facilitate an improvement in practice that benefits patients and employers. The DWP, medical educators and PCTs may all have an additional role in further improving sickness certification practice.

Aims To determine the attitudes of occupational physicians in the UK towards EBG, what prevents them from practising EBM and their workplace Internet access.

Methods Self-administered questionnaires were posted to 357 physicians chosen randomly from the Society of Occupational Medicine membership list. Responders were stratified according to occupational medicine professional grade. The data were analysed using Cronbach's alpha, analysis of variance, chi-square and Kruskal–Wallis test.

Results A total of 259 occupational physicians responded giving a response rate of 73%. The attitude questionnaire showed good reliability. Occupational medicine specialists were more positive towards EBG than general practitioners. Overall, the respondents were more positive towards EBG than physicians in previous studies. The most common barriers to practising EBM were lack of time and limited availability of guidelines. The majority of respondents had workplace Internet access.

Conclusions UK occupational physicians have a positive attitude towards EBG. However, this study has identified a need to make EBG more readily accessible to them. In addition, occupational physicians require adequate time to practise EBM in their daily work. Educational workshops should be developed to enhance their literature search techniques, critical appraisal skills and application of EBM in clinical practice. Online training programmes should be considered to take advantage of their Internet access.

Aims To compare the reported incidence of work-related (WR) MSDs by specialist OPs and specialist rheumatologists and to relate it to self-reported and general practitioners-reported WR MSDs.

Methods Analysis of data reported to surveillance schemes within The Health and Occupation Reporting network and comparison to denominator data derived from the Labour Force Survey and occupational/work activity classifications.

Results There are significant differences between the patterns of WR MSDs seen by the different specialist groups. Thus OPs report three times as many back and lower limb conditions. However, both specialist groups report similar numbers of cases of hand–arm vibration syndrome (12/9%) and ‘vague and ill-defined’ upper limb conditions (16/14%). The absolute risk of physician reported that WR MSDs increases 5-fold between ages 15–24 and 45–64.

Conclusions The specialist reporting schemes give an indication of current practice and are useful both to update and to strategically inform planning. The data are amenable, with appropriate statistical analysis, for comparison with self-reporting and to the characterization of risk in broad categories of occupation and work activity.

Aims To determine the prevalence of acute strain and of repeated episodes of strain over 6- and 12-month periods.

Methods Six and twelve months after completing a Phase I Work and Well-Being questionnaire, 2596 personnel were reassessed using a follow-up General Health Questionnaire-12.

Results The response rates at 6 and 12 months ranged from 51 to 60%. There was no evidence of response bias at follow-up. The prevalence of acute strain was 31% at Phase I. After 6 months, approximately half of strain cases had recovered. Only 10% had strain over the entire period. Change in strain was linked to change in work role.

Conclusions Accumulation of strain and recovery occur within 6 months depending on change in work role. Management of strain might best be achieved by management of work demands and deployment length. Further studies will investigate the rate of accumulation of strain over the course of demanding deployments. Exposure to psychosocial stressors such as effort reward imbalance accounted for much of the difference between chronic strain sufferers and those with no strain.

Aims To examine the documented occupational outcomes following hospital-based treatment for mental health problems within the British Army.

Methods Hospital admission records were linked to occupational outcome data from a database used for personnel administration.

Results A total of 384 records were identified that were then linked to occupational outcome after an episode of hospitalization. Seventy-four per cent of those admitted to hospital with mental health problems were discharged from the Army prematurely, and 73% of the discharges occurred in the first year following hospitalization. Discharge from the Army was associated with holding a junior rank, completing <5 years military service, having a combat role, being male and receiving community mental health team treatment prior to admission.

Conclusions Hospitalization for a mental health problem in a military context is associated with a low rate of retention in service. Outcome was not influenced greatly by duration of hospital stay; however, those who reported receiving individual rather than group-based therapy while in hospital appeared to do better.

Aims To determine the prevalence and risk factors for contact dermatitis and burns among restaurant, catering and fast-food outlet (FFO) staff.

Methods Workers were interviewed and then clinical examination and patch and/or prick tests were conducted in selected individuals.

Results In total, 335 of 457 workers (73% response) were interviewed and 65 (19%) had occupational dermatitis or burns and were examined. Of these, contact dermatitis was the commonest diagnosis, with a 12-month period prevalence of 10% (35 workers) and 3-month period prevalence of 8% (26 workers). All 35 workers had irritant contact dermatitis (ICD) and there were no cases of allergic contact dermatitis. The adjusted prevalence rate ratios of risk factors for ICD were 2.78 (95% CI 1.36–5.72) for frequent hand washing >20 times per day, 3.87 (95% CI 1.89–7.93) for atopy and 2.57 (95% CI 1.21–5.47) for contact with squid. The 3-month period prevalence for burns was 6% (20 workers). Ten workers had other occupational dermatoses such as work-related calluses, paronychia, heat rash and allergic contact urticaria to prawn and lobster.

Conclusions ICD and burns are common occupational skin disorders among restaurant, catering and FFO workers.

Aims To determine the prevalence of workplace violence in paediatric residency training programmes.

Methods In 2007, a 25-item web-based questionnaire about experiences of verbal and/or physical abuse while on duty was distributed to 1211 paediatric residents at all training levels from 25 paediatric programmes.

Results A total of 541 questionnaires were returned giving a 45% response rate. In total, 33% of the respondents had been verbally abused or physically assaulted by patients and/or patients’ families during their residency programme, although verbal abuse was much more common than physical assaults. In total, 71% of respondents reported having no teaching about workplace violence during their residency training. The majority (74%) indicated that they would like to receive more training in managing angry patients and families.

Conclusions Paediatric residents are often exposed to verbal threats during the course of their work. They are also at risk of physical assaults by angry patients and/or families. Paediatric residents require more training on how to prevent and respond to workplace violence, and this important topic should be incorporated into the paediatric residency curriculum.

Aims To examine the association between the hand–arm vibration syndrome (HAVS) Stockholm sensorineural scale stages and tests of peripheral neurological function including measurement of current perception threshold (CPT) and nerve conduction.

Methods All the subjects were men who were assessed for HAVS with a medical and occupational history and physical examination to determine the Stockholm stage, CPT testing at frequencies of 5, 250 and 2000 Hz for the median and ulnar nerves and measurement of nerve conduction carried out in a blinded fashion.

Results A total of 155 of the 157 recruited subjects agreed to take part in the study, a 99% participation rate. CPT was statistically significantly increased (P < 0.001) in both Stockholm sensorineural Stages 1 and ≥2 in comparison to Stage 0 for every frequency and nerve combination. However, CPT could not discriminate well between Stages 1 and ≥2. There was no association between median or ulnar neuropathy measured by nerve conduction and the Stockholm stages. Polychotomous multinomial logistic regression indicated that the CPT measurements at 2000 Hz, corresponding to damage to large myelinated nerve fibres, were most predictive of both Stockholm Stages 1 and ≥2 in comparison to Stage 0.

Conclusions Neuropathy measured by nerve conduction was unrelated to the Stockholm scale stages. CPT was increased above Stage 0 but did not distinguish well between the higher stages of the Stockholm scale.

Aims To evaluate the association between police employment and NIHL.

Methods We undertook a cross-sectional study using review of medical records. Audiometric and otological data and information on potential confounders were extracted from medical records. Global hearing loss and selective 4000 Hz hearing loss were analysed.

Results Of total, 1692 subjects (887 policemen and 805 civil servants) participated in the study. After adjusting for potential cofounders, police officers were 1.4 times more likely to have a selective 4000 Hz hearing loss than civil servants (95% CI 1.1–1.9). This difference was greater between motorcycle police officers and civil servants (OR = 3; 95% CI 1.4–6.3).

Conclusions These data suggest that occupational noise exposure in police work, particularly in motorcycle police officers, may induce hearing loss. Noise sources need to be more accurately defined to confirm high-level noise exposures, to better define significant sources of noise and to identify effective solutions.

Aims To document the levels of cardiorespiratory fitness and the metabolic syndrome, as well as to determine if there is a relationship between these variables, in firefighters.

Methods Maximal cardiorespiratory fitness was assessed using the Bruce treadmill protocol in 214 male firefighters from Colorado. As part of a comprehensive cardiovascular disease risk evaluation, each firefighter was also screened for the metabolic syndrome using the National Cholesterol Education Program/Adult Treatment Panel III (NCEP/ATP III) guidelines.

Results At the time of their evaluation, 32 firefighters (15%) met the NCEP/ATP III diagnostic criteria for the metabolic syndrome, and 54 firefighters (25%) failed to achieve a generally accepted minimum cardiorespiratory fitness level of 42.0 ml/kg/min. A significant inverse trend of increasing cardiorespiratory fitness with decreasing metabolic abnormalities was found (P < 0.001).

Conclusions Increased levels of cardiorespiratory fitness are associated with an improved metabolic profile in male firefighters. Comprehensive cardiovascular disease risk factor management and cardiorespiratory fitness improvement are essential for firefighter health and safety.

Aims To assess the epidemiology of occupational injury hospitalizations using a trauma registry.

Methods Surgical admissions from March 2003 to April 2005 were recorded in the registry at the main trauma hospital in Al Ain city (population 348 000). Prevention-related variables were analysed using SPSS and severity was quantified by injury severity scores (ISS).

Results There were 614 occupational injury hospitalizations, an incidence of ~136/100 000 workers/year. Males accounted for 98% of injuries, the 25–44 age group for 69% and non-nationals for 96%. External causes included falls 51%, falling objects 15%, powered machines 11%, animal-related 7% and burns 6%. Median ISS was 4 for all six main external causes. Extremities were most frequently injured, followed by chest, head and neck, abdomen and face. Mean hospitalization duration was 9.4 days, with 36% hospitalized for >1 week.

Conclusions The main external causes were proportionately much more frequent than in industrialized countries. Effective countermeasures are needed to reduce the incidence and severity of occupational injury among vulnerable migrant workers in the UAE.

Aims To estimate the 12-month prevalence of self-reported musculoskeletal symptoms in the head/neck, shoulders, elbows, wrists/hands, upper back, low back, hips, knees and ankles/feet in salespersons.

Methods A cross-sectional survey using a descriptive questionnaire was used to evaluate musculoskeletal symptoms in 1310 female salespersons in 18 department stores.

Results Of the 1200 subjects (92%) who completed the questionnaire, 1189 were eligible for inclusion in the study. The 1-year prevalence of self-reported musculoskeletal symptoms was 77%. The ankle/foot (35%) was the most frequently affected body region followed by low back (34%), knees (33%), hips (28%), shoulders (28%), head/neck (26%), upper back (21%), wrists/hands (14%) and elbows (3%). The older the salespersons were, the more likely they were to report knee symptoms (P < 0.05). Salespersons with a body mass index (BMI) >23 kg/m² were more likely to report knee symptoms than those with a BMI <18.5 kg/m² (P < 0.05).

Conclusions Musculoskeletal symptoms are common among salespersons with a high proportion experiencing symptoms in the low back, knees and ankles/feet. The prevalence of musculoskeletal symptoms in the knees is associated with age and BMI. Attention should be given to developing specific measures to reduce or prevent musculoskeletal symptoms in salespersons.

Aims To investigate associations between the frequency of previous sickness absence and self-reported perceptions of health and work.

Methods Cross-sectional study of female hospital care workers in which health, work characteristics and coping styles were assessed by questionnaire and linked to the number of sickness absence episodes recorded in the preceding 5 years using negative binomial regression analysis for counts distinguishing between short (1–7 days) and long (>7 days) episodes of absence after adjusting for age and duration of employment in December 2007 and hours worked between 2003 and 2007.

Results Of 350 women employed for at least 5 years, 237 (68%) answered the questionnaire. The hours worked over the 5 year period [rate ratio (RR) = 1.2] and problem solving coping style score (RR = 1.1) were positively associated with the number of short sickness absence episodes. Age (RR = 0.8) and good general health (RR = 0.7) were inversely related to the number of both short and long episodes. Self-reported mental health and work characteristics were not shown to be related to the frequency of sickness absence.

Conclusions Hours worked, problem-solving coping style, age and general health showed associations with the frequency of previous sickness absence among women who had worked at least 5 years in health care. Future prospective studies on the frequency of sickness absence should consider the impact of these factors further.

Aims To evaluate the hypothesis of increased risk of HAV infection in WWs.

Methods The prevalence of antibodies to HAV in 869 WWs was compared to 311 other subjects and analysed to detect the main potentially confounding variables.

Results Univariate analysis demonstrated that occupational exposure to sewage was not significantly associated with the prevalence of anti-HAV(+). The anti-HAV(+) prevalence was strongly associated with age and shellfish consumption (P < 0.05) when the subcategories of workers were examined separately (WWs and control group) and jointly. In the logistic regression model, a significant association between anti-HAV(+) prevalence and duration of employment (P < 0.05) was found. The interaction term (age x duration of employment) was significant (P < 0.001) when included in the logistic model.

Conclusions This study shows that working in a wastewater treatment plant does not seem to be related to a greater prevalence of antibodies to hepatitis A. Moreover, the relative risk of HAV infection among WWs seems to be correlated with low anti-HAV(+) prevalence in the general population.

Aims To evaluate medical students’ knowledge regarding the prevention and management of sharps injuries and their experience of such exposures in the calendar year 2007.

Methods A cross-sectional, web-based, survey of fourth and fifth year medical students enrolled at the University of Aberdeen in Scotland. All students were at the mid-point of their year of study. An invitation e-mail and two electronic reminders were sent, on specified days, to the study population. These contained a summary of the study and the link to the anonymous questionnaire.

Results Of the 395 medical students e-mailed, 238 (60%) responded. When compared with fourth year medical students, final year students had higher mean knowledge scores for sharps injury management (P < 0.01). Of total, 18% reported resheathing used needles and 31% reported disposing of sharps for others, indicating poor compliance with standard precautions. In the event of an injury, 29% stated that they would scrub the wound. Only 44% were familiar with policies for reporting exposures. In all, 11% of students had experienced at least one contaminated sharps injury in 2007 and, of those, 40% had reported the most recent incident.

Conclusions Medical students are at risk of sharps injuries and their knowledge regarding the prevention and management of these exposures is limited: training on these issues should be increased.

Aims To analyse the influence of training programmes on sharps injuries in health care workers (HCW).

Methods The study was carried out in a 350-bed university hospital in north-eastern Italy with 700 HCW. Training courses on biological risk for physicians, nurses, ancillary operators and laboratory technicians have been in place since 1998. Data on all sharps injuries reported by HCW between 1998 and 2006 were analysed together with information on HCW who attended the training courses.

Results Between 1998 and 2006, there was a reduction in the incidence of sharps injuries from 11 to 4% (P < 0.01). During the same period, the number of trained HCW increased from 26 to 69% (P < 0.01). Trained personnel had a statistically significant lower relative risk (RR) for injury with RR = 0.06 (95% CI 0.02–0.18).

Conclusions A continuous educational effort for HCW leads to a reduction of sharps injuries.

Aims To analyse the results of OD Medical Committees of IKA on the claims for OD Disablement Benefit (ODDB) during a 5 year period.

Methods Two hundred and ninety-nine claims for ODDB were submitted to IKA from 2003 to 2007. These claims were examined on a monthly basis.

Results One hundred and seventy-one cases of ODs (153 men and 18 women, mean age = 57 ± 8 years) were recorded (recognition rate = 61%); 125 of these qualified for ODDB (pension rate = 42%). The main diagnosis was allergic contact dermatitis (40% of total cases of ODs), followed by lead toxicity (12%) and asthma (11%). Of the six main diagnoses, the most serious was lead toxicity (mean disability percentage = 59 ± 19%, n = 21).

Conclusions This study reveals flaws in the existing system of recognition of ODs in Greece, illustrated mainly by the small number of claims for ODDB. Possible explanations are delays in establishing a new widened list of ODs, lack of a unified recording and notification system, lack of motivation on behalf of the patients and the small number of occupational physicians.

Aims To provide an overview of the outcomes of recent European research in this field and discusses future research directions to explore and improve the return-to-work experience of cancer survivors.

Methods European research, principally from English and Dutch language journals, on the subject of return to work was reviewed.

Results Few European interventions have been developed and evaluated which enhance returning to work in cancer patients. They include a nurse-based intervention in the UK, a group rehabilitation programme in Sweden, rehabilitation programmes in Germany and a specialist–occupational physician intervention in Holland. Also described are current evaluation and research into models of occupational health support that seek to improve the experience of cancer survivors in their interaction with work. The development of evidence-based guidelines by the Dutch Society of Occupational Medicine is described.

Conclusions Research within the European international scientific literature has begun to identify priorities for the successful rehabilitation of employees back to the workplace after cancer diagnosis.

Methods Of total, 19 papers published between 1999 and 2008 on cancer and work ability were reviewed.

Results Studies have shown that most types of cancers result in decreased work ability compared to healthy controls or those with other chronic conditions. Some cancer types have more decreased work ability than other types. Decreased work ability is associated with type of treatment (chemotherapy), treatment-related side-effects (e.g. fatigue) and co-morbidity with other health conditions. For most cancers, work ability improves over time irrespective of age.

Conclusions More longitudinal research is required to fully determine the impact of cancer and its treatment on work ability, occupational health services can help such employees make a full recovery and maintain employment by regularly assessing work ability and working hours so that work adjustment and support can be appropriately tailored.

Aims To survey UK occupational health physicians (OHPs) regarding their role in rehabilitation of employed survivors of cancer.

Methods Following a pilot study, a questionnaire exploring opinions of OHPs regarding supporting cancer survivors' return to work was posted to all members of the UK Society of Occupational Medicine, with a repeat posting 2 months later. Responses were analyzed for significant correlations with OHP age, sex, qualification level, size of businesses advised and years of experience.

Results There were 797 respondents (response rate 51%). Responses suggested opportunities for developing the knowledge base in relation to prognosis and functional outcomes in patients with a cancer diagnosis; instituting information resources on cancer and work for OHPs and developing communications skills training. Most respondents felt managers treated referral to occupational health (OH) differently for employees with cancer compared with management referral for employees with other diagnoses, with 45% of respondents indicating referral may take place too late to be effective in securing a return to work. A significant lack of understanding of the information requirements of employers and the role of OH by treating doctors was identified.

Conclusions This survey raises several possible significant barriers to return to work by cancer survivors. Recommendations to ameliorate these are made.

Aims To investigate the influence of green tea and coffee ingestion on urinary HA concentrations.

Methods Time-weighted average exposures to toluene were monitored by measuring urinary HA in 245 car painters in 2005 and again in 2006. Samples of both urine and blood were collected during work hours. All the participants were also asked about their alcohol intake, smoking and dietary and beverage habits, especially green tea and coffee. To clarify the relationship between green tea and coffee ingestion, workers were prohibited from consuming green tea and coffee for 1 day before the health check-up in 2006.

Results The frequency of positive urinary HA concentrations (>1.0 g/l) in heavy consumers of green tea and/or coffee was significantly higher than that of the non-consumer or light consumers (OR 2.34, 95% CI 1.15–4.74). Prohibiting green tea and coffee ingestion was effective in decreasing the frequency of falsely elevated urinary HA concentrations (P < 0.01).

Conclusions The consumption of green tea and/or coffee can result in an overestimation of urinary HA concentrations and cause false-positive results during the biological monitoring of workers exposed to low doses of toluene.

Methods A cohort of 308 male production workers from seven factories have been enumerated. All employees had a minimum of 12 months employment and were first employed at one of the participating factories in the period 1973–2000. Mortality and cancer incidence data for the period 1979–2007 were compared with expected values based on national rates.

Results Mortality from all cancers combined was below the expected value [observed (Obs) 5, standardized mortality ratio (SMR) 68]. There was a single death from bladder cancer (SMR 560). The incidence of all cancers combined was also below expectation [Obs 9, standardized registration ratio (SRR) 77]. Site-specific incidence was unexceptional except there was a non-significant excess of bladder cancer based on two cases (SRR 328).

Conclusions The findings for bladder cancer should be treated with caution as they relate to a relatively early period of follow-up and are based on very small numbers.

Aims To obtain a better understanding of factors that are associated with cognitive limitations in employed MBTS.

Methods The study was performed by means of a web-based survey. Occupationally active MBTS (n = 113) and a non-cancer comparison group (n = 123) were recruited. While accounting for demographics, medical factors, health behaviours and problem-solving orientation, the relationship among measures of symptom burden (fatigue, depression and anxiety) and cognitive limitations were investigated.

Results MBTS (average 4 years post-diagnosis) reported higher levels of physical fatigue (P < 0.001), depression (P < 0.001) and anxiety (P < 0.01). MBTS reported more overall cognitive limitations (P < 0.001), memory (P < 0.001), executive function (P < 0.001) and attention (P < 0.001) deficits. Education (B = –3.4, 95% CI = –6.7 to 0.1), ethnicity (B = 5.2, 95% CI = 0.6–9.8), job stress (B = 3.9, 95% CI = 1.5–6.4), depressive symptoms (B = 0.7, 95% CI = 0.1–1.3) and negative problem solving (B = 4.2, 95% CI = 1.5–7.0) were also associated with higher levels of cognitive limitations in both groups.

Conclusions Occupationally active MBTS report higher levels of cognitive limitations. However, modifiable factors were related to cognitive limitations in both groups and should be considered when developing approaches to improve cognitive limitations in the workplace.

Aims To investigate the minimum data requirements to maintain the sensitivity and specificity of the ABC score.

Methods A total of 196 sets of measurements from workers with occupational asthma confirmed by methods other than serial PEFs and 206 records from occupational and non-occupational asthmatics who were not at work at the time of PEF monitoring were analysed according to their mean number of readings per day. Measurements from work and rest days were sequentially removed separately and the ABC score calculated at each reduction. The sensitivity and specificity of the ABC score (using a cut-off of 15 l/min/h) was calculated for each duration.

Results Two-hourly measurements (~8 readings per day) with eight workdays and three rest days had 68% sensitivity and 91% specificity for occupational asthma diagnosis. As readings decreased to ≤4 readings per day, ≥15 workdays were required to provide a specificity above 90%.

Conclusions To be sensitive and specific in the diagnosis of occupational asthma, the ABC score requires 2-hourly PEF measurements on eight workdays and three rest days. This is a short assessment period that should improve patient compliance.

Methods Workers were recruited from a biological detergent formulating and packaging company. Those with occupational asthma symptoms and/or specific IgE to a detergent enzyme were asked to complete 2 hourly PEF measurements for 4 weeks. Outputs from the Oasys program (Oasys score, rest–work score and rest–work difference in diurnal variation) assessed PEF response. These were then related to the levels of sensitization and current occupational exposure to detergent enzymes.

Results In all, 67/72 workers returned PEF records; 97% were able to return a record with at least four readings per day and 87% at least 3 weeks in length. Of total, 79% (n = 27) of those with a final diagnosis of occupational asthma had peak flow records confirming the disease using Oasys. PEF response was similar in those with high, medium and low levels of exposures and those with negative, low–moderate and high specific IgE levels.

Conclusions The Oasys program is a sensitive tool for the diagnosis of detergent enzyme occupational asthma, but the levels of exposure and specific IgE sensitization to enzymes do not affect the magnitude of PEF response in symptomatic workers.

Aims To describe occupational asthma with latency in workers exposed to diesel exhaust in bus garages.

Methods The Shield database of occupational asthma notifications in the West Midlands, UK, was searched between 1990 and 2006 for workers where diesel exhaust exposure was thought to be the cause of the occupational asthma. Those without other confounding exposures whose occupational asthma was validated by serial peak expiratory flow (PEF) analysis using Oasys software were included.

Results Fifteen workers were identified with occupational asthma attributed to diesel exhaust. Three had validated new-onset asthma with latency. All worked in bus garages where diesel exhaust exposure was the only likely cause of their occupational asthma. Occupational asthma was confirmed by measures of non-specific reactivity and serial measurements of PEF with Oasys scores of 2.9, 3.73 and 4 (positive score > 2.5).

Conclusions The known non-specific irritant effects of diesel exhaust suggest that this is an example of low-dose irritant-induced asthma and that exposures to diesel exhaust in at least some bus garages are at a sufficient level to cause this.

Aims To assess the psychological impact of the 2005 London bombings on London Ambulance Service (LAS) personnel, risk factors for the development of psychological ill-health and employee awareness of post incident support.

Methods A total of 525 LAS personnel involved in the bombings, and a control group of uninvolved staff, were sent a questionnaire 2 months after the bombings. Main outcome measures were the presence of probable post-traumatic stress disorder (PTSD) measured using the Trauma Screening Questionnaire and substantial psychological distress using a tool identical to that used to assess the impact of these bombings on the population of London.

Results Fifty-six per cent of those who responded were involved in the bombings. Overall, including controls, the response rate was 32% (341). Four per cent of respondents reported probable PTSD and 13% reported substantial distress. Probable PTSD was more common in those involved in the bombings (6% overall), those working at the disaster scene and, in particular, at one of the incident locations (where 50% of all probable PTSD cases worked). The majority of staff were aware of the post incident support available and how to access this, particularly if personnel were involved in the bombings.

Conclusions The LAS did not report higher levels of probable PTSD and psychological distress than the rest of the London population; however, those more proximal to the incident were more likely to have been affected in spite of being aware of various staff support measures put in place.

Aims To investigate the potential association of these occupational and lifestyle factors, as well as medical history and skin type, with non-melanoma skin cancer in pilots.

Methods Data were collected using a confidential Internet survey administered in collaboration with the Air Line Pilots Association International to all active pilots in four US commercial airlines. Pilots with non-melanoma skin cancer were compared to those without using multivariable analysis.

Results The response rate was 19%. Among pilots flying <20 years prior to diagnosis, factors associated with increased odds of non-melanoma skin cancer were at-risk skin type, childhood sunburns and family history of non-melanoma skin cancer. Off-duty sunscreen use and family history of melanoma were protective. Among pilots with ≥20 years flight time prior to diagnosis, childhood sunburns and family history of non-melanoma skin cancer persisted as risk factors, with the addition of flight time at high latitude.

Conclusions Further investigation regarding the potential health impact of long-term flying at high latitudes is recommended. Additionally, occupational health programmes for pilots should stress awareness of and protection against established risk factors for non-melanoma skin cancer.

Aims To determine whether occupational exposure to ionizing radiation assessed using an Australian JEM is associated with NHL.

Methods We analysed 694 NHL cases, first diagnosed between 1 January 2000 and 31 August 2001 and 694 controls from south-eastern Australia, matched by age, sex and region of residence. A detailed occupational history was obtained using a lifetime calendar and a telephone interview. Exposure to radiation was assessed using the ionizing radiation component of an Australian JEM. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated from logistic regression models that included the matching variables as covariates.

Results The OR for workers ever exposed to ionizing radiation was 0.86 (95% CI = 0.52–1.40). Dividing the subjects into tertiles of exposure also found ORs that were close to or below the null for each exposure group.

Conclusions The application of an Australian JEM did not provide evidence for an association between NHL and occupational exposure to ionizing radiation and is consistent with previous analyses.