Cultural and psychosocial influences on illness and disability attributed to occupational hazards

Lead Research Organisation: Medical Research Council
Department Name: Medical Research Council

Abstract

The topics that we propose to research are of immediate concern to the general public. A high proportion of people have at some time suffered disability from disorders of the back or upper limb, and there is intense media interest in the health risks from technologies such as pesticides. The hypothesis that we will investigate will be unpopular with some people, who will interpret it as implying that their symptoms, which may be severely disabling, are all in their mind . In communicating our work, it will therefore be important to adopt a sensitive approach, explaining clearly what it does and does not mean. We hope that it will provide opportunities to educate journalists further in the principles of risk management, and through them, the public at large.

Technical Summary

Evidence is accumulating that the standard approach to risk management for occupational hazards may not be appropriate for many of the risks that today are of most concern. We hypothesise that a substantial proportion of the illness and disability that currently is attributed to injurious exposures in the workplace does not arise from organic pathology, but is psychologically mediated. If correct, this theory has important implications for the management of work-related hazards such as low back pain and upper limb disorders, and the risks associated with new technologies such as pesticides and mobile phones. To test the hypothesis and its implications, we propose a programme of linked studies that evolve from, and capitalise on, the research that we have carried out over the past five years. These studies will focus on disorders of the back and upper limb, and on acute illness associated with exposure to pesticides. The research will require a multi-disciplinary approach and to ensure appropriate expert input, we have established collaborations with colleagues from a range of other scientific disciplines. The programme will be associated with the new MRC Epidemiology Resource Centre, and will thereby benefit from the efficiencies of shared infrastructure and the opportunity to work alongside other epidemiologists and statisticians in a stimulating intellectual environment.

Publications


10 25 50
 
Description Academic Dean & Dep President, RCP FOM (2007-13) Member, RCP FOM Exec Comm (2007-13) Chair, RCP FOM Academic Comm (2007-13) Member, RCP FOM Assessment Comm (2007-13) Member, RCP FOM Specialist Training Comm (2007-13), Examiner RCP FOM (1994-2007)KP
Geographic Reach National 
Policy Influence Type Membership of a guidance committee
Impact KP had national responsibility for specialist training; postgrad education; professional competencies; standards of specialist occupational physicians; & a lead role in preparations for revalidation of doctors practising occupational medicine in the UK
 
Description Faculty of Occupational Medicine of the Royal College of Physicians various positions, dates and details below
Geographic Reach National 
Policy Influence Type Membership of a guidance committee
 
Description Health surveillance for HAVS, developing policy on occupational causes of cancer (2007) KP
Geographic Reach National 
Policy Influence Type Participation in advisory committee
 
Description Health, work and wellbeing: Development of an introductory training package for primary care. KP
Geographic Reach National 
Policy Influence Type Influenced training of practitioners or researchers
Impact This is an e learning package for GPs developed through the Royal College of General Practitioners and the Faculty of Occupational Medicine, with KTP as the lead author and project coordinator.
 
Description Member / Advisor to various international committees and working groups, dates and details below. DC
Geographic Reach Multiple continents/international 
Policy Influence Type Participation in advisory committee
 
Description Member of AcMed Roy Coll Specialist Training Comm (2007-09); World Ass of Medical Editors (WAME) (2003-09); Comm on Publication Ethics (COPE) (2003-09); European Ass of Science Editors (EASE) (2003-09); Faculty of Occup Med Academic Forum (2006-now) KP
Geographic Reach National 
Policy Influence Type Influenced training of practitioners or researchers
Impact Contributed to the arrangements for higher specialist training nationally and to international editorship.
 
Description Member, Scientific Committee on Epidemiology in Occupational Health, ICOH (2003-present) - Member, Scientific Committee of PREMUS (ICOH subcommittee for the prevention of work-related musculoskeletal disorders) (2004-present) KP
Geographic Reach Multiple continents/international 
Policy Influence Type Participation in advisory committee
 
Description VIBRISKS (2002 - 2009) - Appeals Panel, Postgraduate Medical Education Training Board (2005 - present) - RCP Occupational Clinical Effectiveness Unit Guideline Development Group on Management of Upper Limb Disorders (2007 - 2009) KP
Geographic Reach National 
Policy Influence Type Participation in advisory committee
 
Title VIBRISKS 
Description The principal objective of VIBRISKS was to improve understanding of the risks of injury from exposures to hand-transmitted vibration and whole-body vibration at work by means of multi-national epidemiological studies, supported by fundamental laboratory research and biodynamic modelling. Secondary objectives were: To contribute to a scientific basis for political decisions on the adequacy of current preventive measures and expenditure on prevention. To provide guidance on health surveillance that can be applied by occupational health workers across Europe for the minimisation of risk (primary prevention), the screening of exposed workers, and the management of individuals who have symptoms of hand-transmitted vibration injuries (secondary prevention). To help industry by reducing the social and economic costs associated with disorders 
Type Of Material Biological samples 
Year Produced 2006 
Provided To Others? Yes  
Impact VIBRISKS has contributed to the prevention and control of vibration-induced disorders by disseminating new methods, new findings, and experience from the project to occupational health professionals, standards committees (national, European, and International), and to employers and their workers. The VIBRISKS Final Report and all 21 Annexes are publicly available to assist others undertaking relevant research. The VIBRISKS protocols for diagnosing vibration-induced injuries, and the VIBRISKS guidelines for the health surveillance of persons exposed to hand-transmitted vibration or whole-body vibration, are available for application by occupational health workers across Europe and worldwide. Two international conferences and workshops were organised by the VIBRISKS project team to disseminate information from the project: (i) the 3rd International Conference on Whole-body Vibration Injuries in Nancy, France (7-9 June 2005) and (ii) the 2nd International Workshop on HTV Injuries in Gothenburg, Sweden (6-7 September 2006). The results are also presented in many papers already published or awaiting publication in scientific journals. 
 
Title VIBRISKS 
Description The principal objective of VIBRISKS was to improve understanding of the risks of injury from exposures to hand-transmitted vibration and whole-body vibration at work by means of multi-national epidemiological studies, supported by fundamental laboratory research and biodynamic modelling. Secondary objectives were: To contribute to a scientific basis for political decisions on the adequacy of current preventive measures and expenditure on prevention. To provide guidance on health surveillance that can be applied by occupational health workers across Europe for the minimisation of risk (primary prevention), the screening of exposed workers, and the management of individuals who have symptoms of hand-transmitted vibration injuries (secondary prevention). To help industry by reducing the social and economic costs associated with disorders 
Type Of Material Biological samples 
Year Produced 2006 
Provided To Others? Yes  
Impact VIBRISKS has contributed to the prevention and control of vibration-induced disorders by disseminating new methods, new findings, and experience from the project to occupational health professionals, standards committees (national, European, and International), and to employers and their workers. The VIBRISKS Final Report and all 21 Annexes are publicly available to assist others undertaking relevant research. The VIBRISKS protocols for diagnosing vibration-induced injuries, and the VIBRISKS guidelines for the health surveillance of persons exposed to hand-transmitted vibration or whole-body vibration, are available for application by occupational health workers across Europe and worldwide. Two international conferences and workshops were organised by the VIBRISKS project team to disseminate information from the project: (i) the 3rd International Conference on Whole-body Vibration Injuries in Nancy, France (7-9 June 2005) and (ii) the 2nd International Workshop on HTV Injuries in Gothenburg, Sweden (6-7 September 2006). The results are also presented in many papers already published or awaiting publication in scientific journals. 
 
Description CUPID - Iran DC 2013 
Organisation Shahroud University of Medical Sciences
Country Iran, Islamic Republic of 
Sector Academic/University 
PI Contribution Experrtise and publication of papers
Collaborator Contribution Data collection and expertise
Impact PLoS One. 2013 http://dx.plos.org/10.1371/journal.pone.0057544. PMID: 23469019 Pain. 2013;154:856-63. PMID: 23688828 PMCID: PMC3675684 Pain 2013;154:1769-77. PMID: 23727463 PMCID: PMC3747979 WORK 2015;51:239-44 PMID: 247633443
Start Year 2006
 
Description CUPID - Spain DC 2013 
Organisation Biomedical Research Centre Network for Epidemiology and Public Health (CIBERESP)
Country Spain, Kingdom of 
Sector Public 
PI Contribution Expertise and publication of papers
Collaborator Contribution Data collection and publication of papers
Impact Scand J Work Environ Health 2010;36:54-61. PMID:20011982 PMCID:PMC3324043 PLoS One. 2012;7:e39820. PMID: 22792189 PMCID: PMC3391206 Occup Environ Med. 2013;70:57-62. PMID: 22864247 PMCID: PMC3526654 Pain. 2013;154:856-63. PMID: 23688828 PMCID: PMC3675684 Occup and Environ Med. 2013;70:575-84. PMID: 23695413 PMCID: PMC3710073 Scand J Work Environ Health 2013;39:589098 PMID: 23955508 PMCID: 3819230 WORK 2014 In press (Are determinants for new and persistent upper limb pain different? An analysis based on anatomical sites. Pain 2013;154:1769-77. PMID: 23727463 PMCID: PMC3747979 Scand J Work Environ Health. 2013 Nov;39(6):589-98. doi: 10.5271/sjweh.3377. Epub 2013 Aug 16. PMID: 23955508 PMCID: PMC3819230 PLoS One. 2016 Apr 29;11(4):e0153748. doi: 10.1371/journal.pone.0153748. PMID: 27128094
Start Year 2006
 
Description CUPID - Spain DC 2013 
Organisation Government of Catalonia
Department Center for Research in Environmental Epidemiology (CREAL)
Country Spain, Kingdom of 
Sector Academic/University 
PI Contribution Expertise and publication of papers
Collaborator Contribution Data collection and publication of papers
Impact Scand J Work Environ Health 2010;36:54-61. PMID:20011982 PMCID:PMC3324043 PLoS One. 2012;7:e39820. PMID: 22792189 PMCID: PMC3391206 Occup Environ Med. 2013;70:57-62. PMID: 22864247 PMCID: PMC3526654 Pain. 2013;154:856-63. PMID: 23688828 PMCID: PMC3675684 Occup and Environ Med. 2013;70:575-84. PMID: 23695413 PMCID: PMC3710073 Scand J Work Environ Health 2013;39:589098 PMID: 23955508 PMCID: 3819230 WORK 2014 In press (Are determinants for new and persistent upper limb pain different? An analysis based on anatomical sites. Pain 2013;154:1769-77. PMID: 23727463 PMCID: PMC3747979 Scand J Work Environ Health. 2013 Nov;39(6):589-98. doi: 10.5271/sjweh.3377. Epub 2013 Aug 16. PMID: 23955508 PMCID: PMC3819230 PLoS One. 2016 Apr 29;11(4):e0153748. doi: 10.1371/journal.pone.0153748. PMID: 27128094
Start Year 2006
 
Description CUPID - Spain DC 2013 
Organisation Mar Institute of Medical Research Foundation (Institut Hospital del Mar d'Investigacions Mèdiques IMIM)
Country Spain, Kingdom of 
Sector Public 
PI Contribution Expertise and publication of papers
Collaborator Contribution Data collection and publication of papers
Impact Scand J Work Environ Health 2010;36:54-61. PMID:20011982 PMCID:PMC3324043 PLoS One. 2012;7:e39820. PMID: 22792189 PMCID: PMC3391206 Occup Environ Med. 2013;70:57-62. PMID: 22864247 PMCID: PMC3526654 Pain. 2013;154:856-63. PMID: 23688828 PMCID: PMC3675684 Occup and Environ Med. 2013;70:575-84. PMID: 23695413 PMCID: PMC3710073 Scand J Work Environ Health 2013;39:589098 PMID: 23955508 PMCID: 3819230 WORK 2014 In press (Are determinants for new and persistent upper limb pain different? An analysis based on anatomical sites. Pain 2013;154:1769-77. PMID: 23727463 PMCID: PMC3747979 Scand J Work Environ Health. 2013 Nov;39(6):589-98. doi: 10.5271/sjweh.3377. Epub 2013 Aug 16. PMID: 23955508 PMCID: PMC3819230 PLoS One. 2016 Apr 29;11(4):e0153748. doi: 10.1371/journal.pone.0153748. PMID: 27128094
Start Year 2006
 
Description CUPID - Spain DC 2013 
Organisation Occupational Health Service
Country Spain, Kingdom of 
Sector Public 
PI Contribution Expertise and publication of papers
Collaborator Contribution Data collection and publication of papers
Impact Scand J Work Environ Health 2010;36:54-61. PMID:20011982 PMCID:PMC3324043 PLoS One. 2012;7:e39820. PMID: 22792189 PMCID: PMC3391206 Occup Environ Med. 2013;70:57-62. PMID: 22864247 PMCID: PMC3526654 Pain. 2013;154:856-63. PMID: 23688828 PMCID: PMC3675684 Occup and Environ Med. 2013;70:575-84. PMID: 23695413 PMCID: PMC3710073 Scand J Work Environ Health 2013;39:589098 PMID: 23955508 PMCID: 3819230 WORK 2014 In press (Are determinants for new and persistent upper limb pain different? An analysis based on anatomical sites. Pain 2013;154:1769-77. PMID: 23727463 PMCID: PMC3747979 Scand J Work Environ Health. 2013 Nov;39(6):589-98. doi: 10.5271/sjweh.3377. Epub 2013 Aug 16. PMID: 23955508 PMCID: PMC3819230 PLoS One. 2016 Apr 29;11(4):e0153748. doi: 10.1371/journal.pone.0153748. PMID: 27128094
Start Year 2006
 
Description CUPID - Spain DC 2013 
Organisation Pompeu Fabra University
Department Centre for Research in Occupatrional Health (CISAL)
Country Spain, Kingdom of 
Sector Academic/University 
PI Contribution Expertise and publication of papers
Collaborator Contribution Data collection and publication of papers
Impact Scand J Work Environ Health 2010;36:54-61. PMID:20011982 PMCID:PMC3324043 PLoS One. 2012;7:e39820. PMID: 22792189 PMCID: PMC3391206 Occup Environ Med. 2013;70:57-62. PMID: 22864247 PMCID: PMC3526654 Pain. 2013;154:856-63. PMID: 23688828 PMCID: PMC3675684 Occup and Environ Med. 2013;70:575-84. PMID: 23695413 PMCID: PMC3710073 Scand J Work Environ Health 2013;39:589098 PMID: 23955508 PMCID: 3819230 WORK 2014 In press (Are determinants for new and persistent upper limb pain different? An analysis based on anatomical sites. Pain 2013;154:1769-77. PMID: 23727463 PMCID: PMC3747979 Scand J Work Environ Health. 2013 Nov;39(6):589-98. doi: 10.5271/sjweh.3377. Epub 2013 Aug 16. PMID: 23955508 PMCID: PMC3819230 PLoS One. 2016 Apr 29;11(4):e0153748. doi: 10.1371/journal.pone.0153748. PMID: 27128094
Start Year 2006
 
Description CUPID - USA - DC 2013 
Organisation University of Texas
Country United States of America 
Sector Academic/University 
PI Contribution Expertise
Collaborator Contribution Expertise, data collection and contribution towards publication of papers
Impact Occup Med. 2012;62:269-72. PMID: 22661663 PMCID: PMC3428920 PLoS One. 2012;7:e39820. PMID: 22792189 PMCID: PMC3391206 Pain. 2013;154:856-63. PMID: 23688828 PMCID: PMC3675684 Pain 2013;154:1769-77. PMID: 23727463 PMCID: PMC3747979 Campos-Fumero A, et al Occup Environ Med 2016;0:1-7. doi:10.1136/oemed-2015-103327 Campos-Fumero A et al. Inj Prev. 2016 Sep 1. pii: injuryprev-2016-042091. doi: 10.1136/injuryprev-2016-042091. [Epub ahead of print] PMID: 27585564
 
Title Validation of urinary biomarkers for DU 
Description A study to validate methods for assessing past exposure to depleted uranium underpinned the retrospective exposure testing programme for Gulf War veterans provided by the Depleted Uranium Oversight Board, and biomonitoring of military personnel who have served more recently in Iraq. 
Type Diagnostic Tool - Non-Imaging
Current Stage Of Development Wide-scale adoption
Year Development Stage Completed 2007
Development Status Closed
Impact These biomonitoring programmes have now been successfully completed. The results were covered by the media. The monitoring programmes using the test method developed helped to rule out DU as an important cause of ill health in military personnel. 
 
Description Accidental Pesticide Poisoning - DC 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/parliamentarians
Results and Impact Our findings from a study on accidential pesticide poisoning nationally fed into regulatory policy on pesticides in the UK.

This led to increased efforts to promote safe storage of pesticide products and also helped to inform policy on bystander exposure to pesticides
Year(s) Of Engagement Activity 2008
 
Description Briefing journalists and interviews on radio and television - DC 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact Briefing of journalists, interviews on radio and television

Newspapers and broadcast programmes
Year(s) Of Engagement Activity 2006,2007,2008,2009,2010
 
Description Briefing to policy makers - DC 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? Yes
Geographic Reach National
Primary Audience Policymakers/parliamentarians
Results and Impact Presentations to Ministers, FSA Board, Parliamentary Science Committee

Changed FSA policy on caffeine in pregnancy. Changed DH policy on peanut consumption during pregnancy and infancy
Year(s) Of Engagement Activity 2006,2007,2008,2009
 
Description EPICOH Barcelona Sept 2016 - Presentation by Georgia Ntani - KWB 2017 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Georgia gave a talk on Ntani G, Walker-Bone K, Palmer K, Coggon D and the CUPID Collaboration. General propensity to pain is a major risk factor for disabling wrist/hand pain. Association between disabling low back pain and general propensity to musculoskeletal pain. EPICOH Conference, Barcelona.
Year(s) Of Engagement Activity 2016
URL http://www.epicoh.org/conference.html
 
Description EPICOH Conference, Barcelona Sept 2016 Presentation by David Coggon - KWB 2017 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact David presented a talk from Coggon D, Ntani G, Walker-Bone K, Palmer KT, Linaker CH, Harris EC, on behalf of the CUPID Consortium. Epidemiological differences between localised and non-localised low back pain: Findings from the CUPID study. EPICOH Conference, Barcelona.
Year(s) Of Engagement Activity 2016
URL http://www.epicoh.org/conference.html
 
Description Formaldehyde and cancer - DC 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? Yes
Geographic Reach International
Primary Audience Policymakers/parliamentarians
Results and Impact Our research on formaldehyde and cancer contributed importantly to the last IARC evaluation of this chemical, and thereby to regulatory policy inthe UK and other countries
Year(s) Of Engagement Activity 2006
 
Description Illness following exposure to pesticides 2007 - DC 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/parliamentarians
Results and Impact Findings from our research on acute symptoms and long term neurological symptoms following work with pesticides fed into ACP deliberations on human health effects on pesticides.

The findings indicated that excess symptoms associated with exposure to pesticides may occur through non-toxic mechanisms, and this was taken into account when considering the need for tighter regulatory control.
Year(s) Of Engagement Activity 2007
 
Description Knee osteoarthritis and occupational activity 2009 - DC & KP 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? Yes
Geographic Reach International
Primary Audience Policymakers/parliamentarians
Results and Impact Findings from our research on knee osteoarthirtis and occupational activity have fed into policy making on social security compensation for occupational disease both in the UK and in Germany

The Industrial Injuries Advisory Council has recommended that knee osteoarthritis should be classed an an occupational disease in coal miners
Year(s) Of Engagement Activity 2009
 
Description Multiple media contacts - DC 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? Yes
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact Briefing of journalists, interviews on radio and television

Newspapers and broadcast programmes
Year(s) Of Engagement Activity 2006,2007,2008,2009
 
Description PREMUS Conference, Toronto, Canada Invited lectures: 'Epidemiological differences between localised and non-localised low back pain: Findings from the CUPID study' June 2016 - KWB 2017 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Karen attended the PREMUS Conference, Toronto, Canada and gave a lecture entitled: 'Epidemiological differences between localised and non-localised low back pain: Findings from the CUPID study'
Year(s) Of Engagement Activity 2016
URL https://premus2016.iwh.on.ca/
 
Description Systematic Reviews of Upper Limb Disorders and Occupation - DC 2007 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/parliamentarians
Results and Impact Two reviews, one of carpal tunnel syndrome, and one of tenosynovitis and epicondylitis, fed into decision making by the Industrial Injuries Advisory Council on whether prescription of these disorders as occupational diseases for Social Security compensation should be extended.

A report was published by the Industrial Injuries Advisory Council
Year(s) Of Engagement Activity 2007
 
Description Systematic review of work relatedness of chronic neck pain - KP 2007 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? Yes
Geographic Reach International
Primary Audience Policymakers/parliamentarians
Results and Impact This review fed into decision making by the Danish National Board of Industrial Injuries on the appropriateness of the prescription of this disorder as an occupational disease.

The review was published by the Scandinavian Journal of Work Environment and Health.
Year(s) Of Engagement Activity 2007
 
Description Validation of urinary biomarkers for DU 2006 - DC 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/parliamentarians
Results and Impact A study to validate methods for assesssing past exposure to depleted uranium underpinned the retrospecive exposure testing programme for Gulf War veterans provided by the Depleted Uranium Oversight Board, and biomonitoring of military personnel who have served more recently in Iraq.

These biomonitoring programmes have now been sucessfully completed. The results were covered by the media.
Year(s) Of Engagement Activity 2006