MP120111AH2_029-1I am Tom Cox: I am an organizational psychologist of some experience broadly specialising in occupational health issues relating to work, health and the sustainability of working life. One of my particular concerns is cancer survivorship and working life.

I hold Chairs at three universities. My primary affiliation is with Birkbeck University of London where I hold the Chair of Occupational Health Psychology & Management and am Director of he Centre for Sustainable Working Life (CSWL) in the School of Business, Economics & Informatics. I am also heavily involved in the METIS Collaboration as its Co Director. METIS is hosted at the University of Aberdeen by the Academic Urology Unit in the School of Medicine & Dentistry. I hold an Honorary Chair in Psychosocial Oncology at that University. Last but not least, I have an Emeritus Chair in Organizational Psychology at the University of Nottingham in the Department of Psychiatry & Applied Psychology.

This is my personal and work blog. The Blog shares news of my current research, my professional activities and opinions, my other interests and my travels. It also copies in my Twitter accounts which are focused on Economic & Political News and Occupational & Public Health News and RSS feeds in my areas of interest. The Blog incorporates some material from The OHP Review which I originally published as an online guide to Occupational Health Psychology.

images-1The blog has achieved over 13,600 hits. Recently, the main ones have been the UK and Australia, then the USA, Taiwan, Canada, Malaysia, Germany, Brazil, the Netherlands and Sweden. However, the blog also seems to have some appeal in countries such as Barbados, Cote d’Ivoire, Kazakhstan, Syria, Burkino Faso, Guyana, Sao Tome and Nepal!


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imagesThe United Kingdom (UK)  is made up of four nations: England, Northern Ireland, Scotland and Wales and is a member of the European Union. Its Parliament, one of the oldest democratic institutions in the world, sits in Westminster, London, and is elected by the peoples of all four constituent nations. It has a Queen, Elizabeth II, who resides in Buckingham Palace, London, but with much used properties in both Scotland and the English regions. She is popular across all four constituent nations.

The UK is emerging from a major financial crisis and a recession and its recovery is one of the strongest in the West and certainly in Europe. This recovery has been hard won and is involving a rethinking of the relationship between the Individual and the State. Furthermore, it faces a serious threat at home from Islamic terrorism, is involved in fighting the Islamic State in Iraq and Syria, and is concerned about the civil war in the Ukraine (Europe) and a returning threat from Russia.

This is clearly a time for unity, good sense and resolve.

UnknownWith the advance of the Scottish National Party (SNP) and UKIP, the current political situation threatens both the integrity of the UK and its membership and role in Europe . The SNP’s relative success in the Scottish Referendum and UKIP’s successes in recent by-elections bear witness to their recent progress. There is no suggestion here that these two parties are, in any way, working together. They are diametrically opposed on a number of key issues. It is their different influences and their aims that, put side by side, pose the threat within the current political situation.

The SNP was founded in 1934 from the merger of the National Party of Scotland and the Scottish Party. As of early 2014, it is now the largest political party in Scotland and among the largest parties in the UK with about 100,000 members.

UnknownUKIP was founded in 1993 by members of the Anti-Federalist League. It is now arguably the fourth largest party in England & Wales with a membership of over 40,000. I am sure that these figures can be contested and are in need of updating. I am simply using them to make the point that both the SNP and UKIP are substantive players in the UK political game and cannot be dismissed.

The recent and marked rise of UKIP has been explained in terms of peoples’ growing dissatisfaction both with the main political parties (as was), Conservative, Labour and the Liberal Democrat, and with the European Union (EU). It also marks the rise in the electoral power of the ‘Ordinary Folk on the High Street‘ who are shedding previous political allegiances. UKIP accuses the main parties (as was) of living in the ‘Westminster Bubble’ and not understanding or particularly caring about the situation and concerns of Ordinary Folk. Interestingly, the SNP also accuses the main political parties (as was) of living in the Westminster Bubble and not understanding or particularly caring about the people of Scotland. These accusations represent a major issue and challenge to the main parties (as was) and one that they are failing to address effectively.

The notion of Ordinary Folk (as above) should not be confused with that of The Man on the Clapham Omnibus which, in English law, is that of a reasonably educated and intelligent but nondescript person against whom one’s behaviour can be judged. The phrase was first put to legal use in a reported judgment by Sir Richard Henn Collins in the 1903 English Court of Appeal libel case, McQuire v Western Morning News. 

images-1The 2015 General Election is the Cross Roads. One extreme outcome could well be the exit from the EU of the UK followed by a SNP Scottish Government unilaterally declaring independence to remain in the EU and doing so with the European Commission’s support. How then would Northern Ireland and Wales stand? Less dramatic outcomes are, arguably, more possible but it is clear that the political situation will be more fraught than ever with issues such as immigration, Europe and Scottish independence capturing centre stage at a possible cost to the economic challenges that we will still face and those of our collective security. Whichever way one looks at it, the decision fast becomes Little England vs The United Kingdom.

The notion of  ‘Little England‘ (and of a ‘Little Englander’) derives from the late 1900s when it indicated, among other things, opposition to the Second Boer War (1899-1902) and to Free Trade and internationalism. The term later came to mark out those who were against the British Empire and for  an ‘England’ extending no further than the borders of the UK.

Unknown-2The three main political parties (as was) need to urgently address the question of Little England vs The United Kingdom but I am concerned that they do not really understand the challenge that faces them before the 2015 General Election. However, to my mind there are three ways forward that might help in the medium term. This is my Agenda. There is a role here for the European Commission. None of the ways forward briefly described here will be easy.


Unknown-1First, and with some urgency, the current Government, with the support of the Labour Opposition, should move to create a federal UK with greater devolution of powers to the constituent nations, England included, and with more local powers given to the English regions. The Westminster Parliament should remain as the Federal Government. This move should politically empower people in all parts of the UK and help them feel greater ownership over events that concern them locally through greater control over those events. It is based on the German federal system.

People should directly elect their own governments (England, Northern Ireland, Scotland and Wales) and their own English regional assemblies (possibly the North West, the North East, the Midlands, the South, the South West, the East and London) and also elect a reduced number of MPs to Westminster. Those governments and assemblies would determine the Upper House ~ the House of Lords being modernised. This model is based on the US Senate and House of Representatives.

Unknown-1Second, the European Commission should work actively to reform the EU and with greater recognition and understanding of the UK’s concerns many of which are shared by people elsewhere in the EU. There should be three guiding principles: work together to save the EU and UK membership, recognise that there can be no  beliefs or regulations that cannot be changed in this situation, and negotiate on the basis of respect, trust and a generous give-and-take. It should be possible to resolve many of the issues which concern Ordinary Folk in the UK.

Red-Tape-BritainThird, the three main political parties (as was) should come out of their Westminster Bubble and work together to explore consensus and shared beliefs and stand together on key issues. They should stop fighting their respective corners for sectarian advantage. The silent majority ~ for numerically in the UK that is what those parties represent ~ should vote together on shared beliefs and issues. If this sounds like a National Coalition for UK Survival perhaps it is.

All-in-all, it will not be easy and will take BIG IDEAS, TOGETHERNESS & RESOLVE to meet the serious challenges that face us at these Cross Roads.

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60b7d52d99a4fee073_l_7eebdMary Stergiou-Kita, Department of Occupational Science and Occupational Therapy, University of Toronto, and her colleagues have published an interesting review of qualitative studies of cancer survivors’ experiences and the development of strategies to facilitate return to work in the Journal of Cancer Survivorship. The journal has a 2013 impact factor of 3.2927.

The authors conducted a systematic search of five databases to identify relevant qualitative studies published between January 2000 and July 2013. In total, 39 studies met their inclusion and quality criteria.

11764The synthesis of these studies is reported to have demonstrated that cancer diagnosis and treatment represent a major change in individuals’ lives and often result in them having to leave full-time work while undergoing treatment or participating in rehabilitation. Many survivors wanted to return to some form of gainful or paid employment. However, there was also evidence that the meaning of paid employment could change following cancer.

Return to work was found to be a continuous process that involved planning and decision-making with respect to work readiness and symptom management throughout the process. Nine key factors were identified as relevant to work success. These include four related to the person (i.e., symptoms, work abilities, coping, motivation), three related to environmental supports (i.e., family, workplace, professionals), and two related to the occupation (i.e., type of work/demands, job flexibility). Finally, issues related to disclosure of one’s cancer status and cancer-related impairments were also found to be relevant to survivors’ return to work experiences.

The authors concluded that cancer survivors need integrated support from health and vocational professionals (e.g., assistance with defining work goals, determining work readiness, determining how symptoms may impact work performance, suggesting workplace supports, and accommodations) to maintain and return to work after cancer diagnosis and treatment. These supports need to be provided throughout the recovery and rehabilitation process.

These findings reported in this review paper are important and resonate with those emerging from the (empirical)  SCOT-PAIS project being conducted through The METIS Collaboration by Sara MacLennan, Sarah Murdoch and Tom Cox funded by Macmillan Cancer Support in Scotland.


Stergiou-Kita, M., Grigorovich, A., Tseung, V., Milosevic, E., Hebert, D., Phan, S., and Jones, J. (2014) Qualitative meta-synthesis of survivors’ work experiences and the development of strategies to facilitate return to work. Journal of Cancer Survivorship, 8, 657-670.

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A Fellowship of the College is one of the oldest and highest honours that Birkbeck University of London can bestow on one of its members. It has awarded such a Fellowship to our friend and esteemed colleague  Professor Philip Dewe. Philip also holds a Fellowship of the European Academy of Occupational Health Psychology awarded last year.

imageThe College has written “Philip Dewe is Professor of Organisational Behaviour in the Department of Organizational Psychology and Deputy Director of the new Centre for Sustainable Working Life. Having joined the College from Massey University in his native New Zealand in 2000, for 11 years Professor Dewe also gave outstanding service to Birkbeck as Vice-Master, stepping down from the role in summer 2014. While this now allows him more time for his research interests, which include work stress and coping, emotions and human resource accounting, he continues to contribute to the College as Pro-Vice-Master for Special Projects. Among his many achievements as Vice-Master has been Professor Dewe’s work in Stratford, east London, which culminated in the opening of the University Square Stratford campus in November 2013.”

His recent publications include two very worthwhile books in occupational health psychology:

Dewe, P., O’Driscoll, M., & Cooper, C. (2010). Coping with work stress: A review and critique. Oxford: Wiley-Blackwell.

Dewe, P., & Cooper C. (2012). Well-being and work: Towards a balanced agenda. Basingstoke: Palgrave-Macmillan.   Our congratulations to Philip.

Read more at: ________________________________________________________

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coverOur empirical paper describing a qualitative study of recently qualified doctors and their apparent lack of interest in geriatric medicine is being published in Medical Teacher. The journal has a 2013 impact factor of 2.045 and a 5-Year impact factor of 2.170.

The paper can be cited as: Samra, R., Griffiths, A., and Cox, T. (In Press) Exploring the lack of interest in geriatric medicine. Medical Teacher. doi: 10.3109/0142159X.2014.970995.

The pre publication version is available online at:

Our thank to Raj Samra for persevering with this paper and seeing it through to publication.


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As an aside from research and professional matters, last Saturday evening (8th November) we went to Kings College School Wimbledon for its annual firework display. The fireworks were provided by Toby Alloway, an old boy of the school, through Titanium Fireworks. Titanium provided the display for the Opening of the Commonwealth Games in Glasgow earlier in the year.

IMG_1605The weather was atrocious and the torrential rain, the mud of the playing fields, the smoke, the flashes and the noise would have been an appropriate nudge in the direction of the appalling conditions of the Flanders battlefields of World War I. Despite this, the Kings College School display was stunning and even more so as it was for a school, albeit a rather good one, rather than a major national or international event. It was a very good evening and a very enjoyable one: to be recommended.

Titanium Fireworks are at:

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The Stoics spoke of Metis as the embodiment of  “prudence”, “wisdom” or “wise counsel”.

UnknownMembers of The METIS Collaboration met in Edinburgh on 6th November at the group’s first Away Day. The meeting was supported by Macmillan Cancer Support in Scotland which provided the venue at its Edinburgh Offices in Rose Street. 9 of our colleagues from four UK universities and from Macmillan attended. The universities were University of Aberdeen, Birkbeck University of London, University of Lancaster with The Work Foundation and University of Newcastle. Sadly 5 members of the Collaboration had to present their apologies due to previous commitments or for family-related reasons.

imagesThe morning session focused on introductions and a discussion of shared research interests which were followed by a presentation on The METIS Collaboration. The presentation covered the principles underpinning the work of the Collaboration, its history and current research projects. The afternoon session, after a buffet lunch, a sandpit was held to elicit and flesh out ideas on research topics that might be pursued by the Collaboration. This led to a discussion of funding strategies. A list of potential projects was agreed with members volunteering to take them forward to the next meeting. The sandpit was followed by a discussion of the ESRC Seminar Series award made to the Centre for Sustainable Working Life, Birkbeck University of London, which was proposed by the then existing members of the Collaboration. It was made clear that the seminar series will involve all members of the Collaboration as appropriate.

It was agreed that the next meeting of the Collaboration would be held in mid to late February 2015 and Macmillan Cancer Support in Scotland again offered the use of its Office in Edinburgh. Agenda Notes were circulated after the meeting.

Thanks to all those who were able to attend and special thanks to Macmillan Cancer Support in Scotland for its continuing support of The METIS Collaboration.

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The Correspondent:


Nicholas Grey has sustained a keen interest in occupational health and safety throughout his working life. In his retirement, he has written a book of tribute to Bernadino Ramazzini. The book is entitled Letters from Ramazzini and will be launched on the 300th Anniversary of his death: 5th November 2014. (see re-blogged article below).

UnknownBernardino Ramazzini was born in Capri on 3rd November 1633. He studied medicine at the University of Padua where his interest in worked-related diseases started to develop. In his late 40s, he was appointed to the Chair of Theory of Medicine at the University of Modena (1682) and later served as Professor of Medicine at the University of Padua from 1700 until his death on the 5th November 1714 in Padua.

On his appointment to the University of Modena, Ramazzini began his seminal study of workers’ health problems in a systematic and scholarly way (Gochfeld, 2005). He visited workplaces, observed workers’ activities and discussed their illnesses with them. The medicine courses that he taught reflected this interest and were dedicated to the diseases of workers (Franco and Franco, 2001).

Ramazzini systematized the existing knowledge on work-related diseases and made a large personal contribution to the field by publishing his own observations in De Morbis Artificum Diatriba ~ Diseases of Workers. The first edition was published in 1700 in Modena and the second in 1713 in Padua. Both editions were written in Latin.

imagesEach chapter of the De Morbis Artificum Diatriba contained a description of the disease associated with a particular work activity (or occupation) followed by analysis of the existing writings, a description of the place of work, questions to be put to the workers, descriptions of the disease, suggested remedies and advice. He covered 52 occupations. Significantly, Ramazzini realised that not all workers’ diseases were attributable to the physico-chemical work environment observing that a number of the common diseases suffered by workers appeared to be caused by prolonged, violent, and irregular motions and prolonged postures.

Ramazzini proposed that his fellow physicians should extend the list of questions that Hippocrates recommended they ask their patients by adding “What is your occupation?” (Gochfeld, 2005; Rom, 1983).

 Largely on the basis of this work, Ramazzini is now often called “the father of occupational medicine” (Gochfeld, 2005; Franco and Franco, 2001; Rosen, 1993). Felton (1997) has argued that although Ramazzini’s the seminal work first appeared in 1700, it was through the English translation by Wilmer Cave Wright in 1940 and the subsequent scholarship of Pericle Di Pietro of Modena that it became widely known in the Western medical community.

Interestingly, in 1713, Ramazzini suggested that nuns developed breast cancer at a higher rate than married women because they did not engage in sexual intercourse and the “unnatural” lack of sexual activity caused instability of the breast tissues that sometimes developed into breast cancer (Olson, 2002).


Gochfeld, M. (2005) Chronologic history of occupational medicine. Journal of Occupational and Environmental Medicine, 47, 96–114.
Felton, J.S. (1997) The heritage of Bernardino Ramazzini. Occupational Medicine, 47, 167-179.
Franco, G. and Franco, F. (2001) Bernardino Ramazzini: The Father of Occupational Medicine American Journal of Public Health, 91, 1382.
Rom W.N. (1983) The discipline of environmental and occupational medicine. In: Rom WN (ed) Environmental and Occupational Medicine. Boston: Little Brown & Co.
Rosen G. (1993) A History of Public Health. Baltimore: The Johns Hopkins University Press.
Olson, J.S. (2002) Bathsheba’s Breast: Women, Cancer & History. Baltimore: The Johns Hopkins University Press.


Originally posted on ramazzini01:

Nicholas Grey has sustained a vital interest in Occupational Health and Safety throughout his working life. So it is not surprising that in retirement he chose to write a book of tribute to Bernadino Ramazzini, the pioneering Italian physician who defined the field of Occupational Medicine.

The original text, in Latin, The Diseases of Working People was a groundbreaking text, addressed to physicians and asking them to consider the working life of their patients in making diagnoses and offering cures, remedies and means to ameliorate further harm caused in the workplace.

Nicholas Grey has now re-written this work in English iambic pentameter verse. It addresses workers as well as physicians. The collection concerns over fifty traditional fields of work characteristic of life in the 18thCentury. He is hoping this easily readable book will give more people access to this still valuable insight into the history of Occupational Health and Safety…

View original 69 more words

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imagesJanice Pascal and her colleagues, at La Trobe Rural Health School, Victoria, have just published an interesting paper in the European Journal of Cancer Care on  the psychosocial care offered to those diagnosed and treated with cancer in rural Victoria (Australia).  The European Journal of Cancer Care has an impact factor of 1.762 and is ranked 40th of 85 journals in Health Care Sciences & Services and 150th of 202 Oncology journals.

The purpose of this research was to highlight gaps in formal psychosocial care for cancer survivors in rural communities. Psychosocial was defined as the “psychological, behavioural and social aspects of illness and its consequences”. Janice Pascal and her colleagues found that psychosocial care was provided informally within the period after cancer diagnosis and treatment when people re-enter their community. Current Australian clinical guidelines on psychosocial care for people with cancer indicate the need for the provision of formal psychosocial care (National Breast Cancer Centre and National Cancer Control Initiative, 2003). Despite this, participants in their study largely cared for themselves, or received informal support from family, friends and community members. Many psychosocial care needs remained unmet and professional support appeared lacking.

jwpascalJanice Pascal and her colleagues argue that their findings have implications for the development of new protocols for treatment and discharge planning, which have a greater emphasis on the health professional–patient–family relationships, and the long-term well-being of cancer survivors living in rural communities. A model for understanding the experience of formal supportive care during the re-entry phase of survivorship is provided in the paper.

The paper’s reference is: Pascal J., Johnson N., Dickson-Swift V. and Kenny A. (2014) Returning home: psychosocial care during the re-entry phase of cancer survivorship in rural Australia. European Journal of Cancer Care. (early view) Doi: 10.1111/ecc.12232

The paper can be accessed at:

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0512-for-webEARTHQUAKEmapOur empirical paper describing a pilot trial of our narrative expressive therapy intervention, working with Sichuan earthquake survivors, has now been published in BMC Psychiatry (see earlier post).  The author version of the paper can be accessed at:

It can be cited as: Zang, Y., Hunt, N., and Cox, T. (In press) Adapting Narrative Exposure Therapy for Chinese earthquake survivors: A pilot randomised controlled feasibility study. BMC Psychiatry, 14:262.

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logo-1Occupational Health [at Work] is a unique on-line publication designed to bring together all the occupational health disciplines by offering a dependable single source of expertly written legal, practical and management occupational health information. It is published six times a yearly by The @Work Partnership which is an independent publisher specialising in occupational health and disability at work issues.

The October / November 2014 (volume 11/3) is now available. and its contents page can be a viewed at:

This journal is to be recommended to all those actively involved in occupational health in the UK but is also of interest to occupational health practitioners and researchers further afield.


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