Asthma diagnosis rates in children increased very significantly in the past 20 years. The search for environmental cause has been intense. But how big could the environmental proportion of new cases be? Evidence from: G Koeppen-Schomerus et al. Archives of Diseases in Childhood. November (2001), Vol. 85 #5 p 398. In 1999 Genetics accounted for 70% of asthma diagnoses. It would be interesting and useful to know if the same proportion was still found now. If an environmental cause of asthma diagnosis inflation is found then the maximum proportion would be 30% of cases. The Radar report is available to subscribers: 1#10 13

There was no association between lung asbestos burdens and survival times. Survival time did vary by cancer cell type. If known, cell type could assist with initial reserving. Evidence from: Neumann V, et al. Int Arch Occup Environ Health. (2001) Aug;74(6) p 383-95. Time between first known occupational exposure and diagnosis was 38 year on average. The Radar report is available to subscribers: 1#10 9

Preliminary work on distinguishing long from short prognosis following diagnosis with mesothelioma. Evidence from: Bongiovanni M, et al. Cancer. 2001 Sep 1;92(5) p 1245-50. A test which could distinguish cases into brackets such as up to 12 months and more than 24 months survical would assist with reserving. The Radar report is available to subscribers: 1#10 8

Pain in the neck or upper limbs and sensory symptoms were common in the non-manual workers overall (with 1 week period prevalences of 30% and 15%, respectively), and were associated with older age, smoking, headaches and tiredness or stress. Evidence from: KT Palmer et al. Occup. Med. Sep (2001) Vol.51(6) p 392. The report records that disabling symptoms were much less frequent, that keyboard work had no influence on neck or elbow pain, and moderate influence on shoulder and arm pain. Pain is not the same as injury. The Radar report is available to subscribers: 1#10 6

Neck pain is commonplace and usually trivial. This paper reports the most common risk factors in people who are asked to think about neck pain. Being involved in a car accident often leads to people being asked to think about neck pain. Evidence from: PR Croft et al. Pain. September (2001) Vol.93 #3 p 317. The data provides a baseline against which the rate of whiplash claims can be estimated, assuming that causation is not needed before a claim is made but that there is some disability. This should be an extreme upper limit. For example, if there were 1 million RTAs per year the maximum number of non-cause claims would be 100,000. The Radar report is available to subscribers: 1#10 4

This study provides results which are directly useful in liability exposure estimates. Evidence from: Keith T Palmer et al. Occupational exposure to noise and hearing difficulties in Great Britain. Contract Research Report 361/2001 HSE The Radar report is available to subscribers: 1#10 2

This was an 8 year longitudinal study of those in pain. Pain is commonplace and usually meaningless but what if it was indicative of risk of cancer? Evidence from: GJ Macfarlane et al. BMJ. (2001) #7314 p 662. The report includes estimates of the prevalence of pain and the statistical association between pain and cancer outcomes. It would appear that the pain being described by people before they died had no direct link with the cancer that killed them. The Radar report is available to subscribers: 1#9 12

At the end of the study, High extraversion (women only) was predictive of new cases OR = 1.86 (95% CI = 1.16 to 2.96). Life woes and stress were not predictive. Evidence from: E Huovinen et al. Allergy. October (2001) Vol. 56 # 10 p 971. The potential to link occupational stress to incident allergy seems to be reduced by this finding. The Radar report is available to subscribers: 1#9 10

Outcome of interest = brain cancer. No increased risk was found for either lifetime exposure or the most recent 5 years of exposure. No Dose Response effect was found. Evidence from: T Sorahan et al. Occupational and Environmental Medicine. October (2001) Vol.58 # 10 p 626. The report includes data on the emfs exposure profile and electricity generation workers. The Radar report is available to subscribers: 1#9 8 Evidence from: DA Savitz. Occupational and Environmental Medicine. October (2001) Vol.58 # 10 p 617. The commentator seriously doubts the need for any more expenditure and effort on epidemiology in this area until some new biologically credible mechanism has been proposed. Even then, the new studies would need to quantitatively account for why previous studies had not established a significant risk. 1#9 9

Evidence from: MB Glenn et al. Brain Injury. Sept (2001) Vol. 15 #9 P 811. A study of out patients with traumatic brain injury. At issue is the prevalence of depression. 41 outpatients were tested using the Beck Depression Inventory (BDI) at one year since the injury event. The BDI register someone as mildly depressed if they have a score of 13 or over. Moderate or severe depression corresponds to a score of 19 or more. 59% were >13 = depressed 34% were >19 = moderate or severe depression. Depression is a function of age, female gender, a negative view of the injury event, mild TBI and use of antidepressants. Comment At first this appears to indicate a high prevalence of clinical depression in TBI cases. However, his is an unusual group, most mild TBI cases don’t keep coming for outpatient work at one year, yet many of the cases here were mild TBI. The BDI measures severity and is not usually used for diagnosis. Alternate methods should have been applied to the diagnosis, before

Disabling shoulder pain was related to two ergonomic factors and two psychosocial factors. It was not clear whether the disability was signalled by the inability to perform those two specific ergonomic actions or by some other disability. If the former then the result may be significant but could be little more than a self-fulfilling prophesy. Evidence from: GJ Macfarlane et al. Annals of Rheumatic Diseases. September (2001) Vol. 60 #9 p 852. Incidence of bilateral and unilateral shoulder pain was reported. The Radar report is available to subscribers: 1#8 2

A detailed review of expert opinion was converted into a numerical format. Not surprisingly, the issues which safety practitioners regard as important were highlighted. More usefully, the financial context of a construction project gave rise to potentially useful risk rating ideas. Evidence from: A Research Report by the BOMEL Consortium, The Radar report is available to subscribers: 1#8 1

Further evidence that non-severe head injury can lead to significant effects on daily life. Interventions are possible if detected early. Evidence from: CM Stonnington. Brain Injury. July (2001) Vol. 15 #7 p 561. The Radar report is available to subscribers: 1#7 10

The research found symptoms of HAVS in workers who had not previously reported any. Effects of exposure to hand arm vibration were evident in those with and without any symptoms of HAVS. the findings are consistent with a gradually developing disease. Early identification of trend would be possible, but the false positive rate would be high. Evidence from: R Cederlund et al. Disability and Rehabilitation. September (2001) Vol.23 #13 p 570. The Radar report is available to subscribers: 1#7 9

Claims that shoulder pain is a sign of injury are plausible if there has been an impact event or similar. Gradually emerging pain however can have many potential causes, some of which are addressed by ergonomics standards. But is breach material? This would depend on context and degree of breach. Evidence from: H Miranda et al. Occupational and Environmental Medicine. Aug (2001) Vol.58 #8 p 528. It is tempting to assume that breach of duty must imply a material contribution. However, standards developed for regulation may not meet the standards required by the common law. The Radar report is available to subscribers: 1#7 8

There are many risk factors for asthma. Identifying the significance of a guilty exposure must be set in the context of competing risk factors. Causation research should be corrected for known risk factors. Childhood asthma increases the risk of adult asthma. Evidence from: MM Haby et al. Thorax. August (2001) Vol.56 #8 p 589. Risk factors and their statistical strengths were reported in this paper. The Radar report is available to subscribers: 1#7 6

Silica exposure is well known for its effect on lung fibrosis. An unexpected link to autoimmune disease could be a result of fibrosis or of silica exposure. Either way, the impact on liability exposure would be significant. In this research there is good evidence for an association between silica exposure and renal disease and rheumatoid arthritis. It would be worth keeping a close eye on the effects of other fibrosis conditions. Evidence from: K Steenland et al. Epidemiology. July (2001) Vol. 12 #4 p 405. The Radar report is available to subscribers: 1#7 5

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

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

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

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