Case-control Study Of Childhood Leukemia Research Articles

Sociodemographic and Lifestyle Characteristics Associated with Maternal Dietary Patterns in Mexico.

There is scarce evidence on sociodemographic and lifestyle characteristics that may explain adherence to different dietary patterns (DPs) during pregnancy. Our aims were to identify dietary patterns in a sample of pregnant Mexican women and to describe their association with selected sociodemographic and lifestyle characteristics. This is a secondary cross-sectional analysis of 252 mothers of children that participated as controls in a hospital-based case-control study of childhood leukemia. We obtained parents' information about selected sociodemographic characteristics, as well as alcohol and tobacco consumption. We also obtained dietary information during pregnancy. We identified DPs using cluster and factor analyses and we estimated their association with characteristics of interest. We identified two DPs using cluster analysis, which we called "Prudent" and "Non healthy", as well as three DPs through factor analysis, namely "Prudent", "Processed foods and fish", and "Chicken and vegetables". Characteristics associated with greater adherence to "Prudent" patterns were maternal education, older paternal age, not smoking, and being a government employee and/or uncovered population. Likewise, the "Processed foods and fish" pattern was associated with greater maternal and paternal education, as well as those with less household overcrowding. We did not identify sociodemographic variables related to the "Chicken and Vegetables" pattern. Our results may be useful to identify target populations that may benefit from interventions aimed to improve individual dietary decisions during pregnancy.

Glyphosate in house dust and risk of childhood acute lymphoblastic leukemia in California

BackgroundResidential use of pesticides has been associated with increased risk of childhood acute lymphoblastic leukemia (ALL). We evaluated determinants of glyphosate concentrations in house dust and estimated ALL risk in the California Childhood Leukemia Study (CCLS). MethodsThe CCLS is a population-based case-control study of childhood leukemia in California. Among those < 8-years (no move since diagnosis/reference date), we collected dust (2001–2007) from the room where the child spent the most time while awake and measured > 40 pesticides. Three-to-eight years later, we collected a second sample from non-movers. We used Ultra-Performance Liquid Chromatography Tandem Mass Spectrometry to measure glyphosate (µg/g dust) for 181 ALL cases and 225 controls and for 45 households with a second dust sample. We used multivariable Tobit regression to evaluate determinants of glyphosate concentrations. Odds ratios (ORs) and 95 % confidence intervals (CI) were calculated for ALL and quartiles of the concentration (first samples) using unconditional logistic regression. We computed the within- and between-home variance and intraclass correlation coefficient (ICC). ResultsGlyphosate was frequently detected (cases: 98 %; controls: 99 %). Higher concentrations were associated with occupational pesticide exposure, nearby agricultural use, treatment for lawn weeds and bees/wasps, and sampling season. Increasing concentrations were not associated with ALL risk (adjusted ORQ4vsQ1 = 0.8, CI: 0.4–1.4). We observed similar null associations for boys and girls, Hispanics and non-Hispanic whites, and among those who resided in their home since birth (76 cases/117 controls) or age two (130 cases/176 controls). The ICC was 0.32 indicating high within-home temporal variability during the years of our study. ConclusionsWe observed higher concentrations in homes associated with expected predictors of exposure but no association with childhood ALL risk. Due to continuing use, potential exposure to young children is high. It will be important to evaluate risk in future studies with multiple dust measurements or biomarkers of exposure.

Cadmium (Cd) and Lead (Pb) topsoil levels and incidence of childhood leukemias

There are few well-established risk factors for childhood leukemias. While the frequency of childhood leukemias might be partially attributable to some diseases (accounting for a small fraction of cases) or ionizing radiation, the role of heavy metals has not been assessed. The objective of our study was to assess the potential association between levels of cadmium (Cd) and lead (PB) in soil and childhood leukemias incidence. We conducted a population-based case-control study of childhood leukaemia in Spain, covering 2897 incident cases gathered from the Spanish Registry of Childhood Tumours and including 14 Spanish Regions with a total population of 5,307,433 children (period 1996-2015). Cd and Pb bioavailable levels at every children's home address were estimated using data from the Geochemical Atlas of Spain. We used logistic regression to estimate odds ratios (ORs) and their 95% confidence intervals (95%CIs); we included as covariates: sex, rurality, employment rate and socioeconomic status. Metal levels were analysed according to two definitions: as continuous variable assuming linearity and as categorical variables to explore a potentially nonlinear association (quantiles). Increases in both Cd and Pb topsoil levels were associated with increased probability of childhood leukemias incidence. The results for the models with the continuous variables showed that a unit increase on the topsoil level was associated with an OR of 1.11 for Cd (95%CI 1.00-1.24) and an OR of 1.10 for Pb (95%CI 0.99-1.21). Our study may point towards a possible link between residential Cd and Pb topsoil levels and the probability of childhood leukemias incidence. Residing in a location with the highest concentrations of these heavy metals compared to those locations with the lowest could increase the risk around a 20%, for both Cd and Pb.

Residential proximity to plant nurseries and risk of childhood leukemia

BackgroundPesticides are a potential risk factor for childhood leukemia. Studies evaluating the role of prenatal and/or early life exposure to pesticides in the development of childhood leukemia have produced a range of results. In addition to indoor use of pesticides, higher risks have been reported for children born near agricultural crops. No studies have looked at pesticide exposure based on proximity of birth residence to commercial plant nurseries, even though nurseries are located much closer to residences than agricultural crops and can potentially result in chronic year-round pesticide exposure. ObjectivesTo evaluate whether risk of childhood leukemia is associated with pesticide use as determined by distance of residence at birth to commercial, outdoor plant nurseries. MethodsWe conducted a large statewide, record-based case-control study of childhood leukemia in California, which included 5788 childhood leukemia cases and an equal number of controls. Pesticide exposure was based on a spatial proximity model, which combined geographic information system data with aerial satellite imagery. ResultsOverall, the results supported an increased childhood leukemia risk only for birth residences very close to nurseries. For birth residences less than 75 m from plant nurseries, we found an increased risk of childhood leukemia (odds ratio (OR) 2.40, 95% confidence interval (CI) 0.99-5.82) that was stronger for acute lymphocytic leukemia (OR 3.09, 95% CI 1.14-8.34). DiscussionThe association was robust to choices of reference group, cut points and data quality. Our findings suggest that close proximity to plant nurseries may be a risk factor for childhood leukemia and that this relationship should be further evaluated.

Assessment of Grouped Weighted Quantile Sum Regression for Modeling Chemical Mixtures and Cancer Risk.

Individuals are exposed to a large number of diverse environmental chemicals simultaneously and the evaluation of multiple chemical exposures is important for identifying cancer risk factors. The measurement of a large number of chemicals (the exposome) in epidemiologic studies is allowing for a more comprehensive assessment of cancer risk factors than was done in earlier studies that focused on only a few chemicals. Empirical evidence from epidemiologic studies shows that chemicals from different chemical classes have different magnitudes and directions of association with cancers. Given increasing data availability, there is a need for the development and assessment of statistical methods to model environmental cancer risk that considers a large number of diverse chemicals with different effects for different chemical classes. The method of grouped weighted quantile sum (GWQS) regression allows for multiple groups of chemicals to be considered in the model such that different magnitudes and directions of associations are possible for each group of chemicals. In this paper, we assessed the ability of GWQS regression to estimate exposure effects for multiple chemical groups and correctly identify important chemicals in each group using a simulation study. We compared the performance of GWQS regression with WQS regression, the least absolute shrinkage and selection operator (lasso), and the group lasso in estimating exposure effects and identifying important chemicals. The simulation study results demonstrate that GWQS is an effective method for modeling exposure to multiple groups of chemicals and compares favorably with other methods used in mixture analysis. As an application, we used GWQS regression in the California Childhood Leukemia Study (CCLS), a population-based case-control study of childhood leukemia in California to estimate exposure effects for many chemical classes while also adjusting for demographic factors. The CCLS analysis found evidence of a positive association between exposure to the herbicide dacthal and an increased risk of childhood leukemia.

Radiation exposure from computerized tomography and risk of childhood leukemia: Finnish register-based case-control study of childhood leukemia (FRECCLE).

The only well-established risk factors for childhood leukemia are high-dose ionizing radiation and Down syndrome. Computerized tomography is a common source of low-dose radiation. In this study, we examined the magnitude of the risk of childhood leukemia after pediatric computed tomography examinations. We evaluated the association of computed tomography scans with risk of childhood leukemia in a nationwide register-based case-control study. Cases (n=1,093) were identified from the population-based Finnish Cancer Registry and three controls, matched by gender and age, were randomly selected for each case from the Population Registry. Information was also obtained on birth weight, maternal smoking, parental socioeconomic status and background gamma radiation. Data on computed tomography scans were collected from the ten largest hospitals in Finland, covering approximately 87% of all pediatric computed tomography scans. Red bone marrow doses were estimated with NCICT dose calculation software. The data were analyzed using exact conditional logistic regression analysis. A total of 15 cases (1.4%) and ten controls (0.3%) had undergone one or more computed tomography scans, excluding a 2-year latency period. For one or more computed tomography scans, we observed an odds ratio of 2.82 (95% confidence interval: 1.05 – 7.56). Cumulative red bone marrow dose from computed tomography scans showed an excess odds ratio of 0.13 (95% confidence interval: 0.02 – 0.26) per mGy. Our results are consistent with the notion that even low doses of ionizing radiation observably increase the risk of childhood leukemia. However, the observed risk estimates are somewhat higher than those in earlier studies, probably due to random error, although unknown predisposing factors cannot be ruled out.

Childhood leukaemia risk and residential proximity to busy roads

BackgroundCurrent evidence suggests that childhood leukaemia can be associated with residential traffic exposure; nevertheless, more results are needed to support this conclusion. ObjectivesTo ascertain the possible effects of residential proximity to road traffic on childhood leukaemia, taking into account traffic density, road proximity and the type of leukaemia (acute lymphoid leukaemia or acute myeloid leukaemia). MethodsWe conducted a population-based case-control study of childhood leukaemia in Spain, covering the period 1990–2011. It included 1061 incidence cases gathered from the Spanish National Childhood Cancer Registry and those Autonomous Regions with 100% coverage, and 6447 controls, individually matched by year of birth, sex and autonomous region of residence. Distances were computed from the respective participant's residential locations to the different types of roads and four different buffers. Using logistic regression, odds ratios (ORs) and 95% confidence intervals (95%CIs), were calculated for four different categories of distance to roads. ResultsCases of childhood leukaemia had more than three-fold increased odds of living at <50 m of the busiest motorways compared to controls (OR = 2.90; 95%CI = 1.30–6.49). The estimates for acute lymphoid leukaemia (ALL) were slightly higher (OR = 2.95; 95%CI = 1.22–7.14), while estimates for cases with the same address at birth and at diagnosis were lower (OR = 2.40; 95%CI = 0.70–8.30). ConclusionsOur study agrees with the literature and furnishes some evidence that living near a busy motorway could be a risk factor for childhood leukaemia.

Radiation exposure from computerized tomography and risk of childhood leukemia: Finnish register-based case-control study of childhood leukemia (FRECCLE).

The only well-established risk factors for childhood leukemia are high-dose ionizing radiation and Down syndrome. Computerized tomography is a common source of low-dose radiation. In this study, we examined the magnitude of the risk of childhood leukemia after pediatric computed tomography examinations. We evaluated the association of computed tomography scans with risk of childhood leukemia in a nationwide register-based case-control study. Cases (n=1,093) were identified from the population-based Finnish Cancer Registry and three controls, matched by gender and age, were randomly selected for each case from the Population Registry. Information was also obtained on birth weight, maternal smoking, parental socioeconomic status and background gamma radiation. Data on computed tomography scans were collected from the ten largest hospitals in Finland, covering approximately 87% of all pediatric computed tomography scans. Red bone marrow doses were estimated with NCICT dose calculation software. The data were analyzed using exact conditional logistic regression analysis. A total of 15 cases (1.4%) and ten controls (0.3%) had undergone one or more computed tomography scans, excluding a 2-year latency period. For one or more computed tomography scans, we observed an odds ratio of 2.82 (95% confidence interval: 1.05 – 7.56). Cumulative red bone marrow dose from computed tomography scans showed an excess odds ratio of 0.13 (95% confidence interval: 0.02 – 0.26) per mGy. Our results are consistent with the notion that even low doses of ionizing radiation observably increase the risk of childhood leukemia. However, the observed risk estimates are somewhat higher than those in earlier studies, probably due to random error, although unknown predisposing factors cannot be ruled out.

Effects of incomplete residential histories on studies of environmental exposure with application to childhood leukaemia and background radiation

When evaluating environmental exposures, residential exposures are often most relevant. In most countries, it is impossible to establish full residential histories. In recent publications, childhood leukaemia and background radiation have been studied with and without full residential histories. This paper investigates the consequences of lacking such full data.Data from a nationwide Finnish Case-Control study of Childhood Leukaemia and gamma rays were analysed. This included 1093 children diagnosed with leukaemia in Finland in 1990–2011. Each case was matched by gender and year of birth to three controls. Full residential histories were available. The dose estimates were based on outdoor background radiation measurements. The indoor dose rates were obtained with a dwelling type specific conversion coefficient and the individual time-weighted mean red bone marrow dose rates were calculated using age-specific indoor occupancy and the age and gender of the child. Radiation from Chernobyl fallout was included and a 2-year latency period assumed.The median separation between successive dwellings was 3.4 km and median difference in red bone marrow dose 2.9 nSv/h. The Pearson correlation between the indoor red bone marrow dose rates of successive dwellings was 0.62 (95% CI 0.60, 0.64). The odds ratio for a 10 nSv/h increase in dose rate with full residential histories was 1.01 (95% CI 0.97, 1.05). Similar odds ratios were calculated with dose rates based on only the first dwelling (1.02, 95% CI 0.99, 1.05) and only the last dwelling (1.00, 95% CI 0.98, 1.03) and for subjects who had lived only in a single dwelling (1.05, 95% CI 0.98, 1.10).Knowledge of full residential histories would always be the option of choice. However, due to the strong correlation between exposure estimates in successive dwellings and the uncertainty about the most relevant exposure period, estimation of overall exposure level from a single address is also informative. Error in dose estimation is likely to cause some degree of classical measurement error resulting in bias towards the null.

Residential mobility and childhood leukemia

AimsStudies of environmental exposures and childhood leukemia studies do not usually account for residential mobility. Yet, in addition to being a potential risk factor, mobility can induce selection bias, confounding, or measurement error in such studies. Using data collected for California Powerline Study (CAPS), we attempt to disentangle the effect of mobility. MethodsWe analyzed data from a population-based case-control study of childhood leukemia using cases who were born in California and diagnosed between 1988 and 2008 and birth certificate controls. We used stratified logistic regression, case-only analysis, and propensity-score adjustments to assess predictors of residential mobility between birth and diagnosis, and account for potential confounding due to residential mobility. ResultsChildren who moved tended to be older, lived in housing other than single-family homes, had younger mothers and fewer siblings, and were of lower socioeconomic status. Odds ratios for leukemia among non-movers living <50 meters (m) from a 200+ kilovolt line (OR: 1.62; 95% CI: 0.72–3.65) and for calculated fields ≥ 0.4 microTesla (OR: 1.71; 95% CI: 0.65–4.52) were slightly higher than previously reported overall results. Adjustments for propensity scores based on all variables predictive of mobility, including dwelling type, increased odds ratios for leukemia to 2.61 (95% CI: 1.76–3.86) for living < 50 m from a 200 + kilovolt line and to 1.98 (1.11–3.52) for calculated fields. Individual or propensity-score adjustments for all variables, except dwelling type, did not materially change the estimates of power line exposures on childhood leukemia. ConclusionThe residential mobility of childhood leukemia cases varied by several sociodemographic characteristics, but not by the distance to the nearest power line or calculated magnetic fields. Mobility appears to be an unlikely explanation for the associations observed between power lines exposure and childhood leukemia.

Residential magnetic fields exposure and childhood leukemia: a population-based case-control study in California.

Studies have reported an increased risk of childhood leukemia associated with exposure to magnetic fields. We conducted a large records-based case-control study of childhood leukemia risk and exposure to magnetic fields from power lines in California. The study included 5,788 childhood leukemia cases (born in and diagnosed in California 1986-2008) matched to population-based controls on age and sex. We calculated magnetic fields at birth addresses using geographic information systems, aerial imagery, historical information on load and phasing, and site visits. Based on unconditional logistic regression controlling for age, sex, race/ethnicity, and socioeconomic status using subjects geocoded to a basic standard of accuracy, we report a slight risk deficit in two intermediate exposure groups and a small excess risk in the highest exposure group (odds ratio of 1.50 (95% confidence interval [0.70, 3.23])). Subgroup and sensitivity analyses as well as matched analyses gave similar results. All estimates had wide confidence intervals. Our large, statewide, record-based case-control study of childhood leukemia in California does not in itself provide clear evidence of risk associated with greater exposure to magnetic fields from power lines, but could be viewed as consistent with previous findings of increased risk.

The risk of childhood leukaemia following exposure to ionising radiation—a review

Since the early years of follow-up of the Japanese atomic-bomb survivors, it has been apparent that childhood leukaemia has a particular sensitivity to induction by ionising radiation, the excess relative risk (ERR) being expressed as a temporal wave with time since exposure. This pattern has been generally confirmed by studies of children treated with radiotherapy. Case-control studies of childhood leukaemia and antenatal exposure to diagnostic x-rays, a recent large cohort study of leukaemia following CT examinations of young people, and a recent large case-control study of natural background γ-radiation and childhood leukaemia have found evidence of raised risks following low-level exposure. These findings indicate that an ERR/Sv for childhood leukaemia of ∼50, which may be derived from risk models based upon the Japanese atomic-bomb survivors, is broadly applicable to low dose or low dose-rate exposure circumstances.

Statistical adjustment of genotyping error in a case–control study of childhood leukaemia

BackgroundGenotyping has become more cost-effective and less invasive with the use of buccal cell sampling. However, low or fragmented DNA yields from buccal cells collected using FTA cards often requires additional whole genome amplification to produce sufficient DNA for genotyping. In our case–control study of childhood leukaemia, discordance was found between genotypes derived from blood and whole genome amplified FTA buccal DNA samples. We aimed to develop a user-friendly method to correct for this genotype misclassification, as existing methods were not suitable for use in our study.MethodsDiscordance between the results of blood and buccal-derived DNA was assessed in childhood leukaemia cases who had both blood and FTA buccal samples. A method based on applying misclassification probabilities to measured data and combining results using multiple imputations, was devised to correct for error in the genotypes of control subjects, for whom only buccal samples were available, to minimize bias in the odds ratios in the case–control analysis.ResultsApplication of the correction method to synthetic datasets showed it was effective in producing correct odds ratios from data with known misclassification. Moreover, when applied to each of six bi-allelic loci, correction altered the odds ratios in the logically anticipated manner given the degree and direction of the misclassification revealed by the investigations in cases. The precision of the effect estimates decreased with decreasing size of the misclassification data set.ConclusionsBias arising from differential genotype misclassification can be reduced by correcting results using this method whenever data on concordance of genotyping results with those from a different and probably better DNA source are available.

EMFs and Childhood Leukemia

In their otherwise informative and concise review of the current state of evidence concerning risk factors for acute childhood leukemia, Belson et al. (2007) did not correctly address nonionizing radiation and, in particular, power frequency magnetic fields as a possible risk factor for childhood leukemia. This failure may be due to a widespread misconception about the evidence concerning nonionizing electromagnetic fields (EMFs) as a health hazard. It is also apparent in the Churchill County leukemia cluster study published in the same issue, in which Rubin et al. (2007) investigated a multitude of factors, many with sparse or ambiguous previous evidence of an association with childhood leukemia. Although power frequency magnetic fields have been classified as a possible human carcinogen (group 2B) by the International Agency for Research on Cancer (IARC 2002) and by a National Institute of Environmental Health Sciences (NIEHS) working group (NIEHS 1998), based on the evidence of an association with childhood leukemia, these were apparently not considered by Rubin et al. (2007). In their review of nonionizing radiation, Belson et al. (2007) inappropriately mixed original research and pooled analyses, further contributing to the prevailing confusion. Both Ahlbom et al. (2000) and Greenland et al. (2000) presented pooled analyses that included the important study of Linet et al. (1997). Hence, it is inappropriate to present results of the latter as an independent source. Almost all epidemiologic studies of residential exposure to power frequency magnetic fields published before 1999 are included in either the pooled analyses of Ahlbom et al. (2000) or Greenland et al. (2000). Only the study of Myers et al. (1990) was not included because authors refused to provide requested data. Although the study of Linet et al. (1997) is often cited as failing to support the hypothesis of an association between residential exposure to magnetic fields and childhood leukemia [it was also cited by Belson et al. (2007)], it actually was one of the most important supporters of an association in the pooled analyses and contributed the greatest number of highly exposed children. Two large and well-conducted studies published after the pooled analyses (Kabuto et al. 2006; Schuz et al. 2001) lend further support to the results of the pooled analyses of an increased risk from high average levels of magnetic field exposure. It is also incorrect to characterize the evidence as “some have found a small association … while others have not ….” First of all, the association is not small, but is comparable or larger than that for all other factors considered by Belson et al. (2007). Second, the evidence is consistent across different continents, study types, measurement methods, and other factors. Of course, there are potential sources of bias, in particular selection bias. However, thorough investigations of these potential biases have rendered it unlikely that they can completely explain the association. Up to now, there is no other risk factor of childhood leukemia that has been as comprehensively studied concerning possible biases and confounding factors. It is high time that exposure to power frequency EMFs is recognized as a potential risk factor for childhood leukemia and is properly included in the protocols of cluster studies and in epidemiologic studies of other risk factors as a potential confounder.

Assessment of Pesticide Exposure in the Agricultural Population of Costa Rica

We describe a model for the retrospective assessment of parental exposure to 26 pesticides, selected by toxicity-based prioritization, in a population-based case-control study of childhood leukaemia in Costa Rica (301 cases, 582 controls). The model was applied to a subset of 227 parents who had been employed or self-employed in agriculture or livestock breeding. It combines external data on pesticide use for 14 crops, 21 calendar years and 14 regions, and individual interview data on determinants (task and technology, personal protective equipment, field reentry, storing of pesticides, personal hygiene) of exposure. Recall was enhanced by use of checklists of pesticides in the interview. An external database provided information on the application rate (proxy for intensity of potential exposure) for each pesticide. The calendar time was individually converted to five time windows (year before conception, first, second and third trimester, and first year of the child). Time-windowed individual data on determinants of exposure and their expert-based general weights and their category-specific hazard values jointly provided an individual determinant score. This score was multiplied by the application rate to obtain an individual index of exposure intensity during application. Finally, average exposure intensity during entire time windows was estimated by incorporating in the model the individual time fraction of exposure during application. Estimates of exposure intensities were proxies assumed to be proportional to dermal exposure intensity, which represents the major pathway of occupational exposure to pesticides. A simulated sensitivity analysis resulted in a correlation coefficient of 0.91 between two sets of 10 000 values of individual exposure indices, based on two different but realistic sets expert-assigned weights. Lack of measurement data on concurrent exposures in comparable circumstances precluded direct validation of the model.

PREDICTORS OF LONG-TERM PSYCHOLOGICAL HEALTH AMONG INDIVIDUALS AFFECTED BY THE CHERNOBYL ACCIDENT

ISEE-289 Abstract: While there is no strong evidence that the Chernobyl nuclear accident in 1986 has led to serious physical health effects other than childhood thyroid cancer, there is considerable concern about psychological health problems associated with this event. We conducted a comprehensive psychological health assessment among individuals who have previously participated in a case-control study of childhood leukemia in the Gomel and Mogilev regions of Belarus. The Gomel region was by far the most contaminated area in the former Soviet Union, but parts of the Mogilev region were also affected by high radionuclide contamination. Participants include 416 individuals from these regions who, in addition to contamination status of their residence, also differed with respect to having a family member with childhood leukemia. All participants completed an interviewer-administered questionnaire, which included information on demographics, life stressors, life style factors and economics. General and psychological functioning was assessed using the Russian language version of the SF-36 Health Survey and the 53-item Brief Symptom Inventory (BSI). We observed striking differences in general and psychological health between participants from the Gomel and Mogilev regions. Compared to Mogilev residents, participants from the Gomel region had significantly (p > .05) lower scores (i.e., poorer functioning) on all but one (bodily pain) subscales of the SF-36. We also observed significantly (p > .05) greater reported symptoms among Gomel residents on all subscales of the BSI, as well as the global BSI score (p > .001). These differences between regions were still apparent when females and males were examined separately. Contrary to expectations, SF-36 and BSI scores were similar for participants with and without a family member with childhood leukemia. Results from linear regression analyses indicated that, while factors such as residence (R2=0.02) and concern about adverse Chernobyl-related health effects in children (R2=0.02) were significantly predictive of psychological health (measured as the global BSI score), number of reported daily hassles was by far the strongest predictor of psychological health in this populstion (R2=0.22). Our results indicate that, while there are substantial differences in psychological functioning between residents of the Gomel and Mogilev regions in Belarus, ′current life-stressors are much more predictive of psychological health than measures related to the Chernobyl accident.

An icon-based interview for the assessment of occupational pesticide exposure in a case-control study of childhood leukemia.

An icon-calendar interview form (ICF) for a case-control study of childhood leukemias and parental exposures to pesticides is described. It includes calendar sheets, icons for life events, crops, jobs, regions, non-agricultural jobs, application techniques and personal protection, markers for durations of exposure patterns, and checklists of pesticides. The ICF collects monthly data from two years before birth until diagnosis of cancer (index children) or until either the interview date or age 15 (controls). Data ascertainment was easy in 62% of interviews, moderately easy in 32%, and difficult in 6%. Seventy-eight subjects delivered data on specific pesticides with pesticide checklists, which improved identification of pesticides. ICF performs satisfactorily for crops, tasks, and other determinants of exposure. Data on pesticides will be further improved by introducing external data use on different crops, time periods, and regions, and by exposure modeling for 27 pesticides.

Is the timing of exposure to infection a major determinant of acute lymphoblastic leukaemia in Hong Kong?

The hypothesis that protection of infants from exposure to infectious agents with delayed first exposure to one or more specific agents together contribute to the aetiology of childhood leukaemia, especially common acute lymphoblastic leukaemia (cALL), has substantial indirect support from descriptive epidemiology and case-control studies in developed Western countries. A case-control study of childhood leukaemia diagnosed at ages 2-14 years has now been conducted in Hong Kong. Cases (n=98) formed a consecutive series of Chinese children diagnosed with acute leukaemia; controls (n=228) were identified following a survey using random digit dialling and required to attend for medical examination by a paediatrician. Interviews with mothers were conducted in hospital by one trained interviewer using a structured questionnaire. Odds ratios (OR) and 95% confidence intervals (CI) are reported for exposure variables capable of serving as proxies for exposure to infection in two critical time periods: first year of life, year before reference date (diagnosis for cases, corresponding date for controls). Analyses used logistic regression with adjustment for appropriate confounders. Change of area of residence reduced risk if during the first time period (OR = 0.47 [95% CI 0.23, 0.98]) and increased risk if during the second (OR=3.92, [95% CI 1.47, 10.46]). Reported roseola and/or fever and rash in the first year of life reduced risk (OR=0.33 [95% CI 0.16, 0.68]) whereas tonsillitis in the period 3-12 months before reference date increased risk (OR=2.56 [95% CI 1.22, 5.38]). Some other proxies for exposure to infection at the critical times were associated with predicted patterns of risk but day-care attendance failed to show predicted associations. These results provide support for the delayed exposure hypothesis in an affluent geographical setting in which population exposure to infectious agents is quite distinct from the settings of previous case-control studies.

Electromagnetic field exposures and childhood leukaemia in New Zealand

A nationwide case-control study of childhood leukaemia in New Zealand included measurements of electric and magnetic fields in children's homes. There was no significant association between leukaemia and the time-weighted average of the 50 Hz magnetic or electric fields in the bedroom and living (or daytime) room combined.

A case-control study of childhood leukemia in southern Ontario, Canada, and exposure to magnetic fields in residences.

A population-based case-control study was conducted in Ontario, Canada, to assess the relation between the risk of childhood leukemia and residential exposure to magnetic fields. Participating subjects consisted of 201 cases, diagnosed at 0 to 14 years of age during 1985-1993, ascertained from the records at the Hospital for Sick Children (Toronto), and 406 individually matched controls. Where possible, point-in-time measurements of magnetic fields were made in all residences occupied by subjects during the period of inquiry in the defined catchment area. Three different classification schemes of wire code were assigned to each residence. Detailed information was collected by interviewer-administered questionnaires, which enabled risk estimates to be adjusted for socio-economic characteristics, medical history of parent(s) and child and environmental exposures. Inconsistent elevations in risk were associated with time-weighted averages of magnetic fields both inside and outside the home for subjects having residential point-in-time measurements that represented at least 70% of their etiological period. These risks increased in magnitude when analysis was restricted to children under 6 years of age at diagnosis or to those with acute lymphoblastic leukemia. For children younger than 6 years at diagnosis, outside perimeter measurements of the residence, > or = 0.15 microT, were associated with increased leukemia risk (OR = 3.45, 95% CI = 1.14-10.45). Evaluation of different exposure times for point-in-time magnetic field measurements and wire configuration suggested that exposures earliest in the etiological period were associated with greater risks for children diagnosed at a younger age (OR = 2.50, 95% CI = 1.14-5.49). Our findings did not support an association between leukemia and proximity to power lines with high current configuration.