American journal of epidemiology
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Prior research has demonstrated that shortly after the 1991 Gulf War (Gulf War I), chronic multisymptom illness (CMI) was more common among deployed veterans than among nondeployed veterans. The aims of the current study were to determine the prevalence of CMI among deployed and nondeployed veterans 10 years after Gulf War I, compare the distribution of comorbid conditions, and identify prewar factors associated with CMI. Cross-sectional data collected from 1,061 deployed veterans and 1,128 nondeployed veterans examined between 1999 and 2001 were analyzed. ⋯ Nicotine dependence and veteran-reported physician-diagnosed infectious mononucleosis were associated with CMI among deployed veterans, and migraine headaches and gastritis were associated with CMI among nondeployed veterans. CMI continues to be substantially more prevalent among deployed veterans than among nondeployed veterans 10 years after Gulf War I, but it manifests similarly in both groups. It is likely to be a common, persistent problem among veterans returning from the current Gulf War.
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Community-acquired alveolar pneumonia (CAAP) is typically associated with bacterial infections and is especially prevalent in vulnerable populations worldwide. The authors studied nutritional status and diarrheal history as risk factors for CAAP in Bedouin children <5 years of age living in Israel. In this prospective case-control study (2001-2002), 334 children with radiographically confirmed CAAP were compared with 529 controls without pneumonia with regard to nutritional status and diarrhea history. ⋯ Anemia (adjusted odds ratio (AOR) = 3.32, 95% confidence interval (CI): 2.24, 4.94; p < 0.001), low birth weight (AOR = 2.16, 95% CI: 1.32, 3.54; p = 0.002), stunting (AOR = 2.22, 95% CI: 1.31, 3.78; p = 0.004), serum retinol concentration (AOR = 1.03 per microg/dl, 95% CI: 1.02, 1.05; p < 0.001), and having > or =1 diarrhea episodes within 31 days prior to enrollment (AOR = 2.30, 95% CI: 1.26, 4.19; p = 0.007) were identified as risk factors for CAAP. Results suggest that improving antenatal care and the nutritional status of infants may reduce the risk of CAAP in Bedouin children. Furthermore, they suggest that vaccines developed to prevent diarrhea may also lower the risk of CAAP.
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Observational research on postmenopausal hormone therapy suggests a 40-50% reduction in coronary heart disease incidence among women using these preparations. In contrast, the Women's Health Initiative clinical trial of estrogen plus progestin found an elevated incidence over a 5.6-year intervention period through July 7, 2002. Toward explaining this discrepancy, the authors analyzed data from this trial, which included 16,608 postmenopausal women aged 50-79 years, and corresponding data from 53,054 women in the Women's Health Initiative observational study, 33% of whom were estrogen-plus-progestin users at baseline. ⋯ However, hazard ratios tended to decrease with increasing time from initiation of estrogen-plus-progestin use, and observational study hazard ratio estimates are heavily weighted by longer-term use while clinical trial hazard ratio estimates reflect shorter-term use. Following control for time from estrogen-plus-progestin initiation and confounding, hazard ratio estimates were rather similar for the two cohorts, although there was evidence of some remaining difference for stroke. These analyses have implications for both the design and the analysis of observational studies.
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Comparative Study
Predictors of self-reported confidence ratings for adult recall of early life sun exposure.
Use of self-reported confidence ratings may be an efficient method for assessing recall bias. In this exploratory application of the method, the authors examined the relation between case-control status and self-reported confidence ratings. In 2002 and 2003, melanoma cases (n = 141) and controls (n = 143) aged 20-44 years residing in Ontario, Canada, estimated the amounts of time they had spent outdoors in summer activities when they were 6-18 years of age and indicated their confidence in the accuracy of each estimate. ⋯ Types of activity were associated with more confident reporting for both age strata; as the number of stable outdoor activity periods (total number of similar outdoor periods within each activity) reported by respondents increased, confidence decreased. Cumulative time spent outdoors was also associated with more confidence but reached statistical significance only for the age stratum 12-18 years. There was no statistically significant association between case-control status and self-reported confidence for either age stratum (6-11 years: odds ratio = 0.91; 12-18 years: odds ratio = 1.32), which suggests an absence of recall bias for reported time spent outdoors.
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Several European countries have guidelines suggesting that women should not receive mercury-containing dental amalgam fillings during pregnancy. One concern raised by several studies is that mercury exposure during pregnancy may lead to decreased birth weight. A population-based, case-control study was designed to investigate whether placement of mercury-containing fillings in 1993-2000 during pregnancy increased the low-birth-weight risk. ⋯ The results indicated that 13% of a dentally insured population had one or more restorative procedures during pregnancy that, regardless of chemical composition, did not increase the low-birth-weight risk (odds ratio = 0.96, 95% confidence interval: 0.88, 1.05). The 4.9% of the women (n = 249) who had at least one mercury-containing amalgam filling during pregnancy were not at an increased risk for a low-birth-weight infant (odds ratio = 0.75, 95% confidence interval: 0.45, 1.26) and neither were women who had 4-11 amalgam fillings placed (odds ratio = 1.00, 95% confidence interval: 0.27, 3.68). This study found no evidence that mercury-containing dental fillings placed during pregnancy increased low-birth-weight risk.