Database

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.