Evidence from: Andrew@reliabilityoxford.co.uk Risk Ratios are usually accompanied by an estimate of precision measured by the 95% confidence interval (CI). What this means is that the true risk ratio (for that particular study) has a 95% probability of falling within the stated range and that its most likely value is the one reported. For example, a RR of 2.1 (95% CI 1.8 to 3.1) means that the ‘true’ risk ratio has a 95% probability of being between 1.8 and 3.1, the most likely value being 2.1. The wider the 95% CI the less probable the stated RR. If the 95% CI includes 1.0 the result is usually considered not to be statistically valid. E.g. RR = 2.1 (95% CI = 0.8 to 5.6) and e.g. RR = 0.75 (95% CI = 0.4 to 1.5). It is debatable whether or not the 95% confidence interval is the appropriate one to consider in the context of the civil law. The usual test of evidence at civil law is that of the balance of probabilities, or >50%. It is technically possible to quote the results of epidem

The research measures and compares the protective effect of air bags, lap/shoulder belts and lap belts. Evidence from: CS Crandall et al. American Journal of Epidemiology Feb (2001) Vol. 153 #3 p.219. The outcome measure was death within 30 days of the accident. Presence or absence of these devices would be of interest to motor insurers, accident and health insurers. The Radar report is available to subscribers: 1#2 12

The research investigated whether there were any obvious pre-placement risk factors that could be used to reduce the risk of back pain. Evidence from: P. Lee et al. The Journal of Rheumatology. Feb (2001) Vol.28 #2 p. 346. A cross-sectional study of 1,562 employees, using a back pain questionnaire and measurements of abdominal muscle strength. Lifetime and point prevalences were 60% and 11% respectively. There was no correlation with body mass index or height. Prevalence was slightly higher among married subjects. Comment It is well established that pre employment screening based on physical characteristics is not effective in preventing reports of low back pain. Prevalences were not linked to occupation. It would appear that primary prevention measures are unlikely to be effective (except for impact injuries), secondary prevention would be a sensible response.

This review focussed on multidisciplinary biopsychosocial interventions for those suffering from sub-acute low back pain.. Biopsychosocial factors have a very strong influence on the course if back pain related disability and work absence. A simplistic view would suggest that tackling any of the most potent factors should improve prognosis, leading to reduced insurance outlay. Evidence from: Karjakainen K, et al (Cochrane Back Review Group), Spine (2001), Vol. 26 #3, p.262-9. Review of research into multidisciplinary biopsychosocial (MBP) rehabilitation for sub-acute low back pain (LBP) in working-age adults. The authors state that there is moderate evidence showing MBP for sub-acute LBP is effective. Comment Such a wide range of inhomogeneous studies examined therefore would be very hard to compare properly. This area is lacking in well designed studies. LBP is a leading cause of morbidity in the working age population and is often linked with negligence. While the validity of this li

This academic research investigated a proposed link between manifest allergy and death from cardiovascular disease. Allergy status was prospectively determined using a battery of skin-prick tests. Evidence from: PJ Gergen et al. Clinical and Experimental Allergy December (2000) Vol. 30 p.1717. If allergy was a risk factor for fatal disease then those which should be controlled e.g. occupational allergens, could give rise to liabilities. Data from research such as this could provide a prospective estimate of the case load. The Radar report is available to subscribers: 1#2 8

Evidence from: Strannegård Ö, Strannegård I-L, Allergy (2001) Vol. 56 #2, p.91-102. Review of research into the causes of the increasing prevalence of allergies. Many reasons investigated, but none proven. Author proposed that a major factor is a lower “microbial load” when young compared to good old days, i.e. today’s (perceived) higher hygiene standards present less chance for the immune system to be stimulated regularly at a young age (less stimulation of T-helper¹ cells). This is suggested to prevent ‘hyperactivity’ later in life. Comment This may be one of many possible factors. However nothing was proven. Innocent causes of allergies should continue to be monitored.

The standard test for BSE agent involves contaminating live mice and waiting several months to examine brain tissue samples. A new test, which could take less than a day, has been developed to proof-of-principle stage. Evidence from: JP Deslys, et al. Nature. (2001) Vol. 409 6819, p 476-7 A cheap accurate test could enable rapid testing of cattle nearing slaughter. More work is needed before this test permits case by case decision-making for individual cattle. The Radar report is available to subscribers: 1#2 6

This academic paper presents a meta analysis of evidence for a multiplicative risk effect of combined asbestos and smoking exposure. Evidence from: PN Lee. Occupational and Environmental Medicine (2001) Vol.58 #3 p.145. Under typical exposure conditions, the relative risk from asbestos dust exposure was around 5 and from smoking, around 10 giving a combined relative risk of 50. The Radar report is available to subscribers: 1#2 5

This academic paper reports a risk function linking death from coronary heart disease to age, diastolic blood pressure, cholesterol and smoking.  Evidence from: JJMcNeil et al. Journal of Cardiovascular Risk. Feb (2001) Vol.8 #1 p.31. When there are multiple possible causes, the contribution made by a negligent exposure may be estimated if the contribution from all other relevant exposures is known. Heart disease is a slowly developing condition leading to sudden deterioration. The Radar report is available to subscribers: 1#2 4

This academic paper reports a strong association between smoking (cumulative exposure) and a diagnosis of rheumatoid arthritis. There was evidence of increasing risk with increasing exposure, but this was not systematic in pattern. Evidence from: D. Hutchinson et al. Annals of Rheumatic Disease. Jan (2001) Vol. 60 #3 Along with estimates of the incidence of rheumatoid arthritis and the prevalence of smoking habit, the annual number of cases attributable to tobacco smoke may be estimated. The Radar report is available to subscribers: 1#2 3

Evidence from: Sandström M, et al, Occupational Medicine,(2001) Vol. 51 #1, p.25-35. Research into mobile phone use and association with subjective symptoms (sensations of warmth, headaches and discomfort). Comparisons of analogue and digital systems were made, with few significant results. Lower risk for sensations of warmth were observed for digital systems. This was linked to differences in phone temperatures between the two systems. Comment No attempt was made to ascribe links to harm. Indeed any subjective symptoms appeared to be automatically linked to mobile phone use rather than any other psychosocial factors.

This report of the proceedings of a meeting held at the Royal Institution of Great Britain, 21st Feb 2001. Mains frequency and radio frequency exposures were reviewed and reported upon; providing a snap shot of the state of knowledge. Evidence from: A meeting at the Royal Institution of Great Britain 21st February 2001. Uncertainty was the main characteristic of each of the topics discussed yet application of the precautionary principle (as it was then understood) gave rise to some recommendations which could be regarded by some as indicating a date of knowledge. Besides the ‘high fear’ diseases such as cancer, there was a reference to microwave sickness (reference provided). The Radar report is available to subscribers: (3 pages) 1#2 1

The speech by Peter Skinner MEP highlights sun light, stress and ergonomics as the key focus of regulatory attention in the coming years. Evidence from: Conference report, Bilbao 27th November 2000. Peter Skinner was particularly encouraged by the emergence of ergonomics standards in the USA. These are reported elsewhere in this database. The Radar report is available to subscribers: 1#1 12

Evidence from: Andrew@Reliabilityoxford.co.uk A brief reminder that the key outcome measures from epidemiology are often expressed as risk or odds ratios. A ratio of 1.0 indicates that the exposure effect relationship being tested shows neither an increased nor a decreased risk. That is, there was no detectable association between hypothetical cause and effect. A ratio of less than 1.0 (but more than 0.0) indicates that the exposure might be protective against the outcome. A ratio of more than 1.0 indicates increased risk. Similarly, a standardised mortality ratio (SMR) of 100 indicates no detected risk. In terms of probabilities, a risk ratio of more than 2.0 (or more than 200 for SMR) indicates that there is a probability of an association between exposure and outcome of more than 50%. This would seem to satisfy the test of the balance of probabilities.

This academic study suggests that physical work demands delay return-to-work following absence with occupational back pain. The greater the demands, the longer the delay. Causation may not be explained by prevailing orthodoxies concerning injury and breach of duty. Evidence from: M.Mahmud et al. Journal of Occupational and Environmental Medicine (2000) Vol. 42 #12. p 1178. At the time of publication it was widely assumed that work was a direct cause of back pain and that pain must be an indication of injury. Neither of these is a fact but Worker’s Compensation administrators have adopted this line of thinking. This research used scans to see if degree of abnormality was predictive of outcome. It wasn’t. Neither was injury severity. In the absence of a violent event, such as being struck or falling from height, back pain may not be an indication of breach of duty or causation. Length of absence is not explained by injury factors. Radar opinion at the time was that psychosoci

Total caffeine intake was assessed before and during pregnancy. A connection between caffeine, feelings of nausea and spontaneous abortion is suggested. Evidence from: W.Wen et al. Epidemiology (Jan 2001) Vol. 12 p 38. Producers and providers of caffeinated products could be exposed to liability issues, but on the basis of this evidence this is  a low probability. The Radar report is available to subscribers: 1#1 9

This academic paper reports a strong and statistically significant association between vinyl chloride and liver cancer in employees. There is a dose-response relationship. Although not directly translatable, the work can be used to estimate liability exposure in other settings. Evidence from: K.Mundt et al. Occupational and Environmental Medicine (2000) Vol. 57 #11 p 774. Risk estimates are not easily translated into other workplace settings but may be indicative by way of a first approximation.  Current case load can be converted into anticipated case load using the data in this paper. The Radar report is available to subscribers: 1#1 8

An epidemiological study of uveal cancer – a form of eye cancer. The reported association with mobile phone use was very strong, but the precision is below the level that would normally pass the standard adopted by this author. Evidence from: A.Stang et al. Epidemiology (2001) Vol 12 p7. The study would have been more meaningful if known risk factors, such as UV exposure, had been corrected for. As it stands, the outcome should be added to the list of emf related emerging risks, but with low probability. Radar report is available to subscribers: 1#1 7

This academic paper finds a power relationship between cumulative smoking and death from lung cancer. This is as expected. The form of relationship permits the calculation of the date when risk was doubled, which may be useful in ‘injury-in-fact’ arguments, and when risk was first detectable which may be useful in ‘de minimis’ arguments. Evidence from: N.Yamaguchi et al. International Journal of Epidemiology (Dec 2000) Vol. 29, p 963. Potential exposure to insurable outcomes can be estimated using functions of this sort. Radar report is available to subscribers: 1#1 6

Two academic papers report preliminary work on apparent changes to brain function when a person is experiencing chronic pain. Diagnoses included Fibromyalgia and low back pain. Evidence from: R.Kwaitek et al. Arthritis and Rheumatism (Dec 2000) Vol. 43 #12. and I.Grachev et al. Pain (2000) Vol. 89 #1 Dec 2000 p 7 – 18. Correction for traits, past history of injury events and reversibility would help establish causal direction. Radar report is available to subscribers: 1#1 5

This academic paper reports the annual frequency of newly diagnosed occupational asthma and provides the leading identified causes. It has become clear that a task focussed approach to prevention may be more successful than an industry focussed approach. Evidence from: JC McDonald et al, Occupational and Environmental Medicine (2000), Vol. 57 #12 p 823. Radar report is available to subscribers: 1#1 4

This academic paper provides tools for assessing the incidence of allergy in populations such as work groups.  It should also help identify people at risk of diagnosable occupational asthma. Evidence from: M.Ng et al. Clinical and Experimental Allergy (Oct 2000) Vol. 30. Radar report is available to subscribers: 1#1 3

This academic paper suggest that exposure to irritant pollutants is not associated with childhood asthma symptoms and diagnosis made by GPs. Evidence from: M.Ramadour et al. Allergy (2000). Vol.55 #12. Childhood asthma continues to increase in prevalence – cause unknown. Radar report is available to subscribers: 1#1 2

The draft ACoP records the state of knowledge in 2001. It lays emphasis on health surveillance where there is any suspicion of risk – in addition to compliance with official exposure controls. Early signs of sensitisation should be managed. The key distinction between ‘caused or made worse‘ and, ‘made more symptomatic‘ is recorded here. Evidence from: HSE CD 164 (2001) ‘An Approved Code of Practice for Occupational Asthma.’ Radar report is available to subscribers: 1#1 1