Database

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

If successful, denervation would tend to support the view that back pain was a result of injury or degeneration. This RCT tested the effect of denervation surgery. Evidence from: R Leclaire et al. Spine. July (2001) Vol. 26 #13 p 1411. The Radar report is available to subscribers: 1#7 4

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