The research investigates whether or not physical trauma can aggravate or accelerate rheumatoid arthritis. Evidence from: AWAl-Allaf et al. Rheumatology. March (2001) Vol.40 #3 p 262. A high proportion of people with newly diagnosed RA could recall significant physical trauma in the 6 months preceding diagnosis. Rates of severe trauma are known. If a causal link is found, the number of RA cases could be estimated. The Radar report is available to subscribers: 1#5 4
Evidence from: TRDJ Radstake et al. Journal of Rheumatology. May (2001) Vol. 28 #5 p 962. A study of genetic anticipation among families with Rheumatoid Arthritis (RA) in Europe. Genetic anticipation describes a phenomenon where the age of onset of a genetically determined illness decreases with successive generations. The effect is that diseases that are normally associated with old age can manifest surprisingly early. The result of this may be that the illness is misdiagnosed or the symptoms are attributed to a cause, which is in fact innocent. The paper demonstrated that a small proportion (4%) of cases of RA had a parent with the same condition (28/683) and were diagnosed in advance of the age of diagnosis of the parent. Typically the anticipation was of the order of 16 years. Comment Although the proportion of cases with apparent genetic anticipation is small (4%) it may be worth keeping this possibility in mind when assessing cases of upper limb disorder.
Genetic differences must be accounted for in studies of smoking risk of renal cell cancer. Innate risk of cancer varies with the ability to metabolise environmental toxins, some of which may be carcinogenic. Evidence from: JC Semenza et al. American Journal of Epidemiology. May (2001) Vol. 153 #9. p 851. In this study there were clear differences of rsik between those with a high capacity to acetylate toxins and those with an impaired capacity, regardless of smoking history. Innate vulnerability is not a defence but may be used to discover and bolster causation arguments. The Radar report is available to subscribers: 1#5 1
The study compared lung cancer risk in an occupational cohort with the relevant normal population in the USA. Workers were exposed to silica in sand dust. The potential effects of radon exposure were reduced to a minimum. Evidence from: K.Steenland et al. American Journal of Epidemiology. April (2001). Vol. 153 #7 p 695. The report provides exposure estimates and the strength of association between exposure and lung cancer. Dose response trends were looked for. Given the number of people exposed to silica dust at higher than the recommended level it would be possible to estimate the attributable case load. The Radar report is available to subscribers: 1#4 11
This was a study of multiple chemical sensitivity (MCS) and chronic fatigue syndrome (CFS) in war veterans (Gulf1, Bosnia). Evidence from: S.Reid et al. (Simon Wessely) American Journal of Epidemiology. March (2001) Vol. 153 #6 p604. The Radar report is available to subscribers: 1#4 10
The study focussed on a specific identifiable source of emf exposure at 16.7 Hz: electrified railways. Evidence from: JSchuz et al. British Journal of Cancer. Mar (2001) Vol.84 #5 p 697. 16.7 Hz is one third of mains frequency in the UK. Contributing exposures at this frequency are likely to be very small. The Radar report is available to subscribers: 1#4 6
This research explored the association between occupational exposure to emfs and health outcomes as measured by cause of death. Employees worked for a power generation company. Evidence from: JMHarrington et al. Occupational and Environmental Medicine. May (2001) Vol.58 #5 p 307. Some exposures were well above those typically seen in the domestic setting. Overall, those who worked at this company had a reduced mortality rate compared with the equivalent average population. The Radar report is available to subscribers: 1#4 5
The research suggests that people with RA are much more vulnerable to hip fracture and would benefit from a higher standard of the duty of care. Evidence from: TM Huusko et al. Annals of Rheumatic Diseases May (2001) Vol. 60 #5 It is possible that the cause is related to greater use of steroids. This could then be relevant for asthmatics. The Radar report is available to subscribers: 1#4 4
This editorial suggests a strong case for a specific identifiable cause of vCJD in Queeniborough. Evidence from: H Ashraf. Lancet March (2001) Vol. 357 #9620 p. 937. Five cases of confirmed new-variant CJD have occurred in a geographically small area in Leicestershire. The cases were included in a case control study which established a relative risk of 15 if you purchased and consumed beef from at least one of two butchers who, as standard practice, removed cow brains. Statistical significance was not recorded. Comment Clustering of cases will occur by chance, but the existence of a plausible link between cases reduces the credibility of this alternative explanation. The plausible link is founded on the memory of food purchasing and consumption habits over 20-year period. Victims and controls in the study were not equivalent. 9% of butchers (UK) practiced brain removal during the 80’s (no information available for the early nineties when exposure probably peaked). Slaughtering practice
Evidence from: DJ Hendrick. Clinical and Experimental Allergy Vol. 31 Jan (2001) p.1. An editorial on occupational asthma. The author notes that 11% of incident cases of occupational asthma are in fact reactive airways dysfunction syndrome I.e. no allergen involved. Triggered by irritants and viruses. Comment An important distinction, and one which is increasingly suspected for childhood asthma.
This academic paper seeks evidence for an occupational cause of Cryptogenic Fibrosing Alveolitis (a disease which is similar in some respects to asbestosis). Evidence from: JC McDonald et al. Chest Feb (2001) Vol. 119 #2 p. 428. Significant risks were found in coal miners an electrical/electronics workers. The Radar report is available to subscribers: 1#3 5
The research should provide the means to estimate the attributable case load for leukaemia, rectum cancer, lung cancer and “all” cancer. Work cohorts in this study were dental, medical, industrial and nuclear. Evidence from: WN Sont et al. American Journal of Epidemiology Feb (2001) Vol. 153 #4 p. 309 In practice the results were of doubtful statistical significance. The approach to risk adopted in radiation regulation and medicine seems far removed from an approach based on the balance of probabilities. The Radar report is available to subscribers: 1#3 4
The academic research reports on the prevalence of neck pain among British adults. Associations with ergonomics, sex, smoking, generalised pain and stress were explored. Evidence from: KTPalmer et al. Scandinavian Journal of Work, Environment and Health. Feb (2001) Vol.27 #1 p.49. Neck pain is very common and interferes with normal activity. Inaccurate causal attributions are likely to be made at a high rate. This report shows which factors are associated and which are not. It also provides data which can be used in liability exposure estimates. The Radar report is available to subscribers: 1#3 3
The review carries some weight with policy makers, it focusses on mains frequency fields. The risk in the UK would seem to be small; even when using medical statistics. Evidence from: NRPB Volume 12 #1 (2001). ISSN 0958 5648. price £30.00 ‘ELF Electromagnetic Fields and the Risk of Cancer?’ If eventually there is some causal link uncovered, the data in this report provide a basis from which to estimate the liability exposure. The Radar report is available to subscribers: 1#3 1
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.
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.
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 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
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