Causation is highly informed by previous history. Back pain is episodic. Back pain in adolescence is very common. Evidence from: DE Feldman et al. American Journal of Epidemiology. July (2001) Vol. 154 #1 p 30. A study of proposed risk factors for the development of LBP in adolescence. It is well established that previous episodes of LBP are prognostic of further problems. LBP in childhood increases the probability of LBP in subsequent years. Identification of risk factors for childhood LBP may lead to more effective prevention measures. 502 adolescents from Montreal were studied between 1995 and 1996 and followed up a year later. LBP was defined as substantial , at least once a week within the past 6 months. Assessment was made at 0, 6 months and 1 year. At time zero 377 out of 502 had no LBP within the past 6 months but 65 of these developed LBP during the year. Growth spurt (>5 cm a year) was a risk factor as was smoking and poor mental health. Activity was not a risk factor. Mus

The policy relationship between genetics and liability continues to be that you must take the person as you find them. Vulnerability is only an issue if you as the duty holder should have known and acted upon it. Probabilistic liability exposure however is affected by genetics. Risk rating would be justified even if duty holders are ethically bound to be gene blind. Evidence from: SE Humphries et al. The Lancet. July (2001) Vol. 357 #9276 p 115. The effect of genetics on disease risk is illustrated by this article on apolipoprotein genotype in smokers. The Radar report is available to subscribers: 1#7 2

Responses to injury should include steps aimed at preventing recurrence. If the cause was at work, then this serves as a prompt for the employer to adapt or modify the system of work. It would also act as a prompt for a compensation claim. The authors have developed a set of tools for deciding whether or not an injury is work-related. Evidence from: Peter Buckle, A Kilbom, A Grieco, Keith Palmer, Cyrus Cooper, Malcolm Harrington et al. Scandinavian Journal of Work, Environment and Health Supplement. June (2001) Vol.27 suppl 1. Although very simple in summary: Step 1 “Did the symptoms begin, recur or worsen after the current job (task) was started”. Step 2 “Are there exposures factors known (believed by the authors) to be (significant) risk factors for that part of the body?” Step 3 “Ask whether or not there are non occupational origins for the symptoms” Step 4 “Make a decision about the level of work relatedness” in practice each of these must be set in the correct context for regulato

Confidence in epidemiological findings is often expressed by a statistical measure. In 2001 the following view was expressed. We have since updated the criterion based on confidence limits. The difference between the upper and lower 95% confidence limits should be smaller than 3 times the (relative risk, minus 1).  (upper – lower) < 3× (RR-1) Understanding the confidence in epidemiology results is essential if the uncertainty in liability exposure estimates is to be usefully expressed. Uncertainty is often greater than the central exposure estimate. Evidence from: andrew@reliabilityoxford.co.uk Epidemiological results are often supported by reference to P values. It has become commonplace to refer with great confidence to results with P values less than 0.05. Such confidence may be misplaced. For example, a P value of 0.04 tells us that if the null hypothesis were true, an association as strong as the one we observe in that particular experiment would occur with a probability

Under the Employers’ Liability (Compulsory Insurance) Regulations 1998, it is a legal requirement for Employers, as of 1st January 1999, to retain their Employers’ Liability Insurance Certificates or copies for 40 years. The Certificate of Employers’ Liability Insurance Register (www.celir.com 01234 352999) proposes to provide an archiving service to client companies for each annual certificate for the required forty years. They also propose to provide a research facility for potential claimants needing to trace insurance providers. However, this facility is limited to the database of certificates lodged with CELIR by client companies. Potential claimants wishing to trace insurance providers outside the CELIR scheme are being advised to contact ABI for assistance. The CELIR scheme currently appears of little use to potential claimants for EL claims. If the venture is successful then it’s utility may well increase.

Chronic pain is naturally self resolving in the great majority of cases where tissue damage is repaired. But it persists and is disabling to a significant proportion. This study examines the role of anxiety. Interventions for anxiety are possible. Evidence from: MJ Zvolensky et al. Behavioural Research and Therapy. June (2001) Vol. 39 #6 p 683. The Radar report is available to subscribers: 1#6 15

Views about head injury are evolving. Greater attention is now being paid to relatively minor symptoms which have powerful effects on quality of life and damages. Evidence from: B Gurr et al. Brain Injury. May (2001) Vol. 15 #5 p 387. A report of the effect of concussion caused by an injury event and the effectiveness of graduated exposure, in a safe environment, on rehabilitation. The report states that between 51% and 86% of minor head injuries are accompanied by post concussion syndrome (PCS): • dizziness 25-30%, • visual problems 19%, • depression >35%, • anxiety >45% Duration is often >3 months (but without stating how often and in what circumstances). The report into rehabilitation of such cases was not particularly noteworthy. Comment Treatment and the organisation of post injury services should make allowances for PCS. Therapy to prevent unnecessary chronicity and severity of the above complications may prove valuable in preventing unnecessary morbidity and disability.

The purpose of intervention in back pain can vary from one stakeholder to another. A medic might aim for pain reduction, a physio might aim for range of movement, an employer might aim for return to work. All three are inter-related and contribute to damages awards. But it isn’t as simple as that. What does the injured person aim for? Evidence from: J Guzman et al (C Bombardier). BMJ. June (2001) #7301 p 1511. A review of intervention studies and what works. The Radar report is available to subscribers: 1#6 13

Genetic contributions to risk can be estimated. One problem for claims is that a certain proportion of people will get cancer regardless of exposure to hazard. Those that by chance also have a history of negligent exposure, may win a claim. Evidence from: MFG Murphy et al. British Journal of Cancer. June (2001) Vol.84 #11 p 146. A study of childhood cancer rates amongst twins, compared with national data, in England. 13,009 twins born between 1963-89 were eligible for the study. Their histories were checked on what is believed to be a very comprehensive cancer registry. Registry entries up to 31 Dec 1995 were included. Roughly 20% fewer cancers were found among twins than were expected. A statistically significant result. Comment This finding is not unique, it confirms for example a 10% reduction in cancer rates among twins seen in a study from Norway. Epidemiology of childhood cancers should attempt to account for this effect in their

A disease which continues to worsen after exposure has ceased might be regarded as indivisible; making it difficult to share liability on a time on risk basis. This study examined silicosis cases over a period of 17 years after exposure ended. Some progression was observed. Damages awards should take this into account if they are to fully indemnify. Evidence from: HS Lee et al. Occupational and Environmental Medicine. July (2001) Vol.58 #7 p467. Prediction of progression in individual cases may not be possible, but the probability can be estimated from this research. The Radar report is available to subscribers: 1#6 11

Tobacco smoke is an irritant which excavation asthma in asthmatics. But does it also cause or aggravate asthma? Literature review. Evidence from: J Bousquet and AM Vignola. Allergy. June (2001) Vol. 56 # 6 p 466. None of the reports can demonstrate with any certainty that new cases of asthma were not simply cases that no-one had noticed before. The Radar report is available to subscribers: 1#6 10

A study of a proposed association between exposure to trihalomethanes in water and birth defects. Chemicals are added during drinking-water treatment. Evidence from: LDodds and WDKing. Occupational and Environmental Medicine. July (2001) Vol.58 #7 p 443. Chemicals of interest were: Chloroform (CLF), bromodichloromethane (BDCM), bromoform and chlorodibromomethane. The Radar report is available to subscribers: 1#6 9

Reliable, sensitive and specific skin prick tests are on the way. However, some allergens are present in the environment as well as in the suspected sensitiser. Sensitisation can occur innocently. Evidence from: PS Grendelmeier et al. International archives of Allergy and Immunology. June (2001) Vol.125 #2 p 96. Tests for allergic sensitisation often rely on skin prick tests using preparations of suspect allergens. Standardisation of such preparations is difficult. This article reviews the success, so far, of producing recombinant allergens using the example of latex allergy. Latex (produced from Heveae Brasiliensis (Hev b)) contains more than 10 known allergens, some of which are identical to ones found in some fruits and moulds. Isolated artificial proteins – Hev b 5,6 and 7 when combined into a test preparation have been used to diagnose latex allergy with 93% sensitivity and 100% specificity. Such mixtures can be accurately and reliably reproduced. Comment Reliable, sensitive

Popular culture has it that back pain is a result of injury. Disability is a result of pain and injury. Objective records of actual activity during a normal day were compared with questionnaires designed to measure disability and pain. Evidence from: JA Verbunt et al. Archives of Physical Medicine and Rehabilitation. June (2000) Vol. 82 #6 p 726. There was no significant correlation between any of the three questionnaire scores and objective activity measures. There was no significant difference in objectively measured activity between cases and controls. The Radar report is available to subscribers: 1#6 4 Evidence from: T Jacob et al. Archives of Physical Medicine and Rehabilitation. June (2000) Vol. 82 #6 p 735. There was no correlation between high disability scores and low activity scores. The Radar report is available to subscribers: 1#6 5 Evidence from: JM Stevenson et al. Spine. June (2001) Vol. 26 #12 p 1370. Physical activity is protective against back pain. The Radar report i

The researchers measured the effect of a public information campaign. The aim was to change the popular beliefs about back pain and disability from one of passive to active coping. Setting = Victoria Australia. Compensation claims for back pain fell 15%. Evidence from: R Buchbinder et al. BMJ June (2001) #7301 p 1517. The Radar report is available to subscribers: 1#6 3

The relationship between interrupted sleep and risk of accidents is explored in this study of sleep apnoea. Evidence from: LJ Findley et al. Thorax. July (2001) Vol.56 #7 p 505. There is data that could be used to estimate the annual motor insurance risk. The Radar report is available to subscribers: 1#6 2

The researchers find some support for a bio mechanical view of whiplash neck injury but a range of inconsistencies in the view make it unreliable. Evidence from: Eck et al. American Journal of Medicine. June (2001) Vol. 110 # 8 p 651. H Kasch et al. Spine. June (2001) Vol. 26 #11 p 1246. topics addressed include MRI, NIC, ROM, collision speed. Age and BMI were fair predictors of ROM. The Radar report is available to subscribers: 1#6 1

The study found evidence of a statistical association between exposure to 16.6 Hz emfs and leukaemia and brain cancer. Evidence from: CE Minder et al. American Journal of Epidemiology. May (2001) Vol. 153 #9 p 825. This was a well designed study. Clearer evidence of a dose-response relationship would have strengthened the case that there is a genuine association. Other factors were not fully accounted for. The Radar report is available to subscribers: 1#5 11

The study suggests a moderate association between work in the SiC industry and three forms of cancer. Evidence from: P Romundstad et al. American Journal of Epidemiology. May (2001) Vol. 153 #10 p 978. If there had been no other exposure to carcinogens this research would be a strong indicator of causation but with several details to be worked out. The Radar report is available to subscribers: 1#5 10

The diagnostic test for asbestosis had been developed by ILO in 1980. It was proposed that HRCT would be more sensitive than the ILO scheme. Evidence from: O Huuskonen et al. Scandinavian Journal of Work, Environment and Health. Apr (2001) Vol.27 #2 p 106. Greater sensitivity would lead to more claims but these would be lower value claims. The Radar report is available to subscribers: 1#5 9

The origin of pleural plaques can be quite varied. Association with heart disease would provide a potential link between asbestos exposure and heart disease. Evidence from: O Korhola et al. Scandinavian Journal of Work, Environment and Health Apr (2001) Vol.27 #2 p 154. The Radar report is available to subscribers: 1#5 8

Pain, Psychological distress, fear-avoidance beliefs, efficacy in coping were moderately good predictors of disability prior to therapy. Improvements in strength and endurance were made in all three treatments, but these were unrelated to improvements in ability or reductions in pain. Evidence from: AFMannion et al. Spine. April (2001) Vol. 26 #8 p 897 The Radar report is available to subscribers: 1#5 7

The prospective study measured cholesterol levels before and after changes to shift work patterns were agreed by consensus. Some reductions in risk level were observed. the effect of these reductions could not be projected into reductions of actual disease but lend support to the idea that shift work changes risk. Evidence from: H Boggild et al. Scandinavian Journal of Work, Environment and Health. Apr (2001) Vol.27 #2 p 87. The Radar report is available to subscribers: 1#5 6

The study provides evidence that early signs of thrombosis can be prevented in healthy people. there is implied support for the use of surgical stockings in high risk travellers. Exactly what it is about long distance flights that leads to early signs of thrombosis in the calf is not known but there is speculation that prolonged sitting at a desk could have the same effect. Evidence from: JHScurr et al Lancet. May (2001) Vol. 357 #9267 p 1485. A study of the development of deep vein thrombosis during long distance flights (>8hours). 89 males and 142 females aged over 50 with no recorded history of thromboembolism volunteered in response to an advert. All were scheduled to undertake a journey involving continuous flight for more than 8 hours. 30 of them were used as controls by making measurements 2 weeks and then 2 days before travel. In this way the potential for development of signs of DVT in absence of air travel could be tentatively assessed. Those volunteers that were retained