Self-administered Postal Questionnaire Research Articles

A case-case study of mobile phone use and acoustic neuroma risk in Japan

Results of case-control studies of mobile phone use and acoustic neuroma have been inconsistent. We conducted a case-case study of mobile phone use and acoustic neuroma using a self-administered postal questionnaire. A total of 1589 cases identified in 22 hospitals throughout Japan were invited to participate, and 787 cases (51%) actually participated. Associations between laterality of mobile phone use prior to the reference dates (1 and 5 years before diagnosis) and tumor location were analyzed. The overall risk ratio was 1.08 (95% confidence interval (CI), 0.93-1.28) for regular mobile phone use until 1 year before diagnosis and 1.14 (95% CI, 0.96-1.40) for regular mobile phone use until 5 years before diagnosis. A significantly increased risk was identified for mobile phone use for >20 min/day on average, with risk ratios of 2.74 at 1 year before diagnosis, and 3.08 at 5 years before diagnosis. Cases with ipsilateral combination of tumor location and more frequently used ear were found to have tumors with smaller diameters, suggesting an effect of detection bias. Furthermore, analysis of the distribution of left and right tumors suggested an effect of tumor-side-related recall bias for recall of mobile phone use at 5 years before diagnosis. The increased risk identified for mobile phone users with average call duration >20 min/day should be interpreted with caution, taking into account the possibilities of detection and recall biases. However, we could not conclude that the increased risk was entirely explicable by these biases, leaving open the possibility that mobile phone use increased the risk of acoustic neuroma.

Predictive factors of chronic post-traumatic stress disorder 6 months after a road traffic accident

Background This study sets out to identify risk factors for post-traumatic stress disorder (PTSD) after a road traffic accident with a view to improving prevention. Methods The study used a prospective cohort of road traffic accident casualties. All subjects over 15 years of age were recruited in the course of an interview conducted while they were receiving care in a hospital of the Rhône area administrative département. Six months after their accident, they answered a self-administered postal questionnaire that included the Post-traumatic Check-List Scale (PCLS) in order to evaluate PTSD. Multivariate logistic regression analysis was conducted to compare those subjects with a PCLS score of 44 or over with those with a lower score, in order to identify factors that might be associated with PTSD. Results 592 subjects (out of 1168) returned the 6-month questionnaire and 541 completed the PCLS test. One hundred subjects had a PCLS score ≥44, suggesting PTSD, and 441 subjects did not. The factors associated with PTSD were initial injury severity, post-traumatic amnesia, the feeling of not being responsible for their accident and persistent pain 6 months after it. A lower odds-ratio was associated with users of two-wheel than four-wheel motor vehicles (OR = 0.4; 0.2–0.9). Conclusion Besides predictive factors for PTSD (injury severity, post-traumatic amnesia and the feeling of not being responsible for their accident), our study suggested a reduced risk of PTSD among two-wheel motor vehicle users.

A case-control study: occupational cooking and the risk of uveal melanoma

BackgroundA European-wide population based case-control study (European rare cancer study) undertaken in nine European countries examined risk factors for uveal melanoma. They found a positive association between cooks and the risk of uveal melanoma. In our study we examine whether cooks or people who worked in cook related jobs have an increased uveal melanoma risk.MethodsWe conducted a case-control study during 2002 and 2005. Overall, 1653 eligible subjects (age range: 20-74 years, living in Germany) participated. Interviews were conducted with 459 incident uveal melanoma cases, 827 population controls, 180 ophthalmologist controls and 187 sibling controls. Data on occupational exposure were obtained from a self-administered postal questionnaire and a computer-assisted telephone interview. We used conditional logistic regression to estimate odds ratios adjusting for the matching factors.ResultsOverall, we did not observe an increased risk of uveal melanoma among people who worked as cooks or who worked in cook related jobs. When we restricted the source population of our study to the population of the Federal State of Northrhine-Westphalia, we observed an increased risk among subjects who were categorized as cooks in the cases-control analysis.ConclusionOur results are in conflict with former results of the European rare cancer study. Considering the rarity of the disease laboratory in vitro studies of human uveal melanoma cell lines should be done to analyze potential exposure risk factors like radiation from microwaves, strong light from incandescent ovens, or infrared radiation.

General practitioners' knowledge on and risk percetion of electromagnetic fields – a cross-sectional study in Germany

General practitioners (GPs) play an important role in the communication about the risks of electromagnetic fields (EMF). The aim of this analysis was to assess whether knowledge about EMF or trust in organizations predict risk perception of GPs. A 7% random sample was drawn from online lists of all GPs working in Germany. 1,867 doctors received a long version of a self-administered postal questionnaire about knowledge on EMF and health (response rate 23.3%), 928 doctors received a short version (response rate 49.1%). To determine the association between knowledge, trust and risk perception of EMF, a multiple logistic regression analysis was carried out with the data obtained from the long questionnaire. Risk perception explained by GPs as being concerned about health risk derived from EMF was the dependent variable. Independent variables were different kinds of knowledge and trust in information given by the WHO, the model was adjusted for potential confounders. 37.3% of responders to the short and 57.5% of responders to the long questionnaire were concerned about EMF. The knowledge of GPs about EMF measured with seven questions was rather poor. In the logistic regression analysis, two variables turned out to be associated statistical significantly with the perception of EMF risks: trust in information given by WHO was associated with lower risk perception, wrong knowledge of GPs was associated with higher risk perception. However, correct knowledge of GPs was not associated with their perception of EMF risks. About a third of German GPs associates EMF with health complaints, and thus deviates considerably from current scientific knowledge. There is no association between knowledge and their own risk perception or their own attitude to the potential hazard. Only the incorrect knowledge which might be interpreted as misconception and trust in information given by international organisations were found to predict risk perception.

A cross‐sectional study of geriatric horses in the United Kingdom. Part 1: Demographics and management practices

With growing numbers of aged horses, geriatric medicine is becoming increasingly important in equine veterinary practice; however, there is a paucity of information on the UK equine geriatric population. To describe the demographic characteristics of the equine geriatric population and to assess management practices undertaken by owners of geriatric horses (aged≥15 years). A cross-sectional study was conducted, surveying a randomly selected sample of veterinary registered owners with horses aged≥15 years, using a self-administered postal questionnaire. Horses aged≥15 years represented 29% of the equine population in the study area. The response rate to the questionnaire survey was 80.2%. Management practices were similar to those previously described for the general equine population. However, the level of exercise and feeding practices changed significantly with increasing age. A summary of the demographic characteristics, feeding and management of horses in a sample of the geriatric equine population is presented. The management of geriatric horses has a direct effect on their health and welfare and this study has provided valuable information on the demographics and management of geriatric horses and ponies in the UK. The information can be used to form targeted owner education programmes for geriatric health and should aid in the investigation and prevention of disease.

A cross‐sectional study of geriatric horses in the United Kingdom. Part 2: Health care and disease

Geriatric horses (aged≥15 years) represent a substantial proportion of the equine population, yet very few studies have investigated the prevalence of diseases within the UK equine geriatric population. To describe the provision of routine preventive health care measures, prevalence of clinical signs of disease and the prevalence of owner reported diseases. Additionally, the effect of increasing age on the provision of preventive health care and the presence or absence of clinical signs and disease was assessed. A cross-sectional study was conducted, surveying a randomly selected sample of veterinary registered owners with horses aged≥15 years, using a self-administered postal questionnaire. As geriatric horses increased in age, there was a reduction in the provision of preventive health care measures, such as vaccination, farrier care and routine veterinary checks. Only 68.7% of horses had received a routine veterinary visit within the previous 12 months. Owners frequently observed clinical signs in their animals, with 77% reporting at least one clinical sign of disease. Increasing age was associated with increased reporting of many clinical signs of disease. Over half (58%) of horses had at least one episode of disease within the previous 12 months, yet only 31% of owners reported that their animal currently suffered from a known disease or disorder. Although owners frequently observed clinical signs in their aged horse, there may be incorrect or under recognition of many diseases and health problems. Reduced frequency of routine preventive health care measures, along with suboptimal owner recognition of health and welfare problems may lead to compromised welfare in the geriatric population.

Effectiveness of a Home-Based Postal and Telephone Physical Activity and Nutrition Pilot Program for Seniors

Objective. To evaluate the effectiveness of a 12-week home-based postal and telephone physical activity and nutrition pilot program for seniors. Methods. The program was delivered by mailed material and telephone calls. The main intervention consisted of a booklet tailored for seniors containing information on dietary guidelines, recommended physical activity levels, and goal setting. Dietary and walking activity outcomes were collected via a self-administered postal questionnaire pre- and postintervention and analysed using linear mixed regressions. Of the 270 seniors recruited, half were randomly selected for the program while others served as the control group. Results. The program elicited favourable responses. Postintervention walking for exercise/recreation showed an average gain of 27 minutes per week for the participants in contrast to an average drop of 5 minutes for the controls (P < .01). Little change was evident in errand walking for both groups. The intervention group (n = 114) demonstrated a significant increase in fibre intake (P < .01) but no reduction in fat intake (P > .05) compared to controls (n = 134). Conclusions. The participants became more aware of their health and wellbeing after the pilot program, which was successful in increasing time spent walking for recreation and improving fibre intake.

General practitioners' preferences for managing insomnia and opportunities for reducing hypnotic prescribing

Insomnia and sleep problems are common with many sufferers seeking medical help from general practitioners (GPs) whose clinical response is limited, often involving prescription of hypnotic drugs. The case for improving the quality of care for patients with insomnia is compelling but there is little evidence about how better care could be achieved in a primary care setting. The aim of this study was to investigate GPs' management preferences for sleep problems and their awareness and perception of opportunities for improving care as well as reducing the use of benzodiazepines and Z drugs. Cross-sectional survey of GPs using a self-administered postal questionnaire in 2005 to all GPs in West Lincolnshire Primary Care Trust Lincolnshire, UK. A total of 84 of 107 (78.5%) questionnaires sent to GP principals were returned after one reminder. Respondents favoured Z drugs over benzodiazepines for the majority of indications. Respondent attitudes to benzodiazepines and Z drugs were generally negative whereas they were positive towards initiatives to reduce hypnotic prescribing through personal guidance, awareness-raising strategies and organizational interventions. GPs were negative in attitude towards hypnotics and positive towards reducing prescribing for sleep problems. They need to develop resources and better strategies for assessment and non-pharmacological management of patients presenting with insomnia for the first time as well as those on long-term hypnotics. The feasibility and effectiveness of psychosocial interventions tailored to patient and service needs in primary care setting should be evaluated systematically seeking to understand potential clinical benefits as well as potential undesirable effects of service changes.

Influence of ownership type on role orientation, role affinity, and role conflict among community pharmacy managers and owners in Canada

Background Ownership of community pharmacies is increasingly being controlled by a relatively small number of corporate entities. The influence of this ownership type should not be ignored, because ownership has the ability to impact pharmacy practice. Objectives To examine the relationship between ownership type and community pharmacy managers with regard to role orientation, role affinity, and role conflict. Methods This study consisted of a cross-sectional survey of community pharmacy managers in Canada by means of a self-administered postal questionnaire sent to a stratified sample of community pharmacies. Statistical analysis consisted of exploratory factor analysis with reliability testing on identified constructs. Frequencies, 1-way analyses of variance, and Scheffe post hoc tests were used to determine significant differences among groups, including ownership structure, on each of the constructs. Results A total of 646 completed questionnaires were received (32.9% response rate). Most of the respondents were males (60.8%), with slightly less than half of the respondents identifying their practice type as an independent pharmacy (44.6%). There were 5 multi-item scale constructs (professional orientation, business orientation, professional affinity, business affinity, and role conflict) arising from the data, which were analyzed against the pharmacy ownership structure (independent, franchise, corporate) independent variable. Analysis revealed significant differences for 3 of the 5 constructs; however, no differences were seen regarding the 2 professionally focused constructs. Conclusions Community pharmacy managers/owners are generally oriented to their professional role; however, those working in a corporate pharmacy environment are less oriented to their business role when compared with those working in an independent or franchise pharmacy environment. Further research is needed to identify different practice cultures that may exist in various practice settings and the extent to which these cultures attract or define the managers working in them.

Investigation of relative risk estimates from studies of the same population with contrasting response rates and designs

BackgroundThere is little empirical evidence regarding the generalisability of relative risk estimates from studies which have relatively low response rates or are of limited representativeness. The aim of this study was to investigate variation in exposure-outcome relationships in studies of the same population with different response rates and designs by comparing estimates from the 45 and Up Study, a population-based cohort study (self-administered postal questionnaire, response rate 18%), and the New South Wales Population Health Survey (PHS) (computer-assisted telephone interview, response rate ~60%).MethodsLogistic regression analysis of questionnaire data from 45 and Up Study participants (n = 101,812) and 2006/2007 PHS participants (n = 14,796) was used to calculate prevalence estimates and odds ratios (ORs) for comparable variables, adjusting for age, sex and remoteness. ORs were compared using Wald tests modelling each study separately, with and without sampling weights.ResultsPrevalence of some outcomes (smoking, private health insurance, diabetes, hypertension, asthma) varied between the two studies. For highly comparable questionnaire items, exposure-outcome relationship patterns were almost identical between the studies and ORs for eight of the ten relationships examined did not differ significantly. For questionnaire items that were only moderately comparable, the nature of the observed relationships did not differ materially between the two studies, although many ORs differed significantly.ConclusionsThese findings show that for a broad range of risk factors, two studies of the same population with varying response rate, sampling frame and mode of questionnaire administration yielded consistent estimates of exposure-outcome relationships. However, ORs varied between the studies where they did not use identical questionnaire items.

Effects of Family Socialization in the Organizational Commitment of the Family Firms from the Moral Economy Perspective

This study examines the effects of socializing activity of the owned family in family firms in order to find out if the special characteristics of the socializing processes in this type of firm can contribute to defining a climate that favors employees’ commitment to the organization. For this purpose, this study uses the main arguments of the sociological approach known as moral economy. The data required for this analysis was collected using a self-administered postal questionnaire and the results show that the special type of socialization that takes place in the family firm, and particularly the emotional mediation that this type of socialization tends to entail, favors the appearance of noneconomic links between employers and employees. Thus, in family firms the climate favors the management of the affective, normative, and symbolic aspects. The authors consider that this provides an explanation for the higher levels of identification, involvement, and loyalty – and consequently organizational commitment – that they find empirically among the employees of such firms.

German wide cross sectional survey on health impacts of electromagnetic fields in the view of general practitioners

The proportion of general practitioners (GPs) in Germany who assume health impacts of electromagnetic fields (EMF) is assessed. Moreover, factors associated with this risk perception are examined. A 7% random sample was drawn from online lists of all the GPs working in Germany. 1,867 doctors received a long version of a self-administered postal questionnaire about EMF and health (response rate 23.3%), 928 doctors received a short version (response rate 49.1%). 37.3% of responders to the short and 57.5% of responders to the long questionnaire agreed "that there are persons whose health complaints are caused by EMF when legal limit values are met". A late responder analysis for the survey with the short questionnaire led to a still lower estimate of 29% for GPs believing in health-relevant effects of EMF. About a third of German GPs associate EMF with health complaints and thus deviate considerably from current scientific knowledge. To avoid a strong selection bias in the surveys of the perception of EMF risks, use of short questionnaires and late responder analysis are recommended.

Pratiques vaccinales déclarées suite à la levée de l’obligation de vaccination généralisée par le BCG. Enquête auprès des médecins généralistes et des pédiatres

Tuberculosis prevention has been based on generalized BCG vaccination in France since 1949. The aim of this cross-sectional survey was to assess the impact of the change in BCG administration (in January 2006) and the end of compulsory vaccination (in July 2007).A self-administered postal questionnaire was sent to a random sample of 2248 physicians practicing in 6 departments in the Rhône-Alpes region in 2008.Overall, 923 questionnaires were analyzed. The median age of the respondents was 52 years, 67 % were male, 93 % were general practitioners, and 91 % practiced in private practice offices. The median number of BCG vaccines administered on a quarterly basis was 5 (interquartile range [IQR], 3-10) before January 2006, one (IQR, 0-3) between January 2006 and July 2007, and zero (IQR, 0-1) after July 2007 (P<0.001). The rate of BCG vaccination was significantly lower for male physicians, physicians older than 50 years, general practitioners, practitioners working in private offices, and for some departments. Thirty-nine percent of the physicians were informed of the national program against tuberculosis 2007-2009, and 41 % wished to be trained in the practice of intradermal vaccination.This survey suggests that the withdrawal of Monovax and the lifting of generalized vaccination requirements were followed by a substantial decrease in the number of BCG vaccinations. The intradermal route constitutes an obstacle for BCG vaccination that might be overcome by specific training.

A survey of general practitioners' assessment and management of shoulder pain: training and practice

Abstract Introduction: Weaknesses in training of general practitioners (GPs) in musculoskeletal care have been identified. Little is known about methods of training GPs in shoulder pain management or the assessments they use in clinical practice. The aim of this study was to assess the effect of training methods in shoulder pain management on GPs' clinical practice. Methods: A validated, self-administered postal questionnaire on dealing with shoulder pain was sent to 1081 GPs. Results: Response rate was 48% (n = 520). The majority (82%) identified training at postgraduate meetings, 17% had attended clinics and 11% attended musculoskeletal courses. Practitioners who had been trained at clinics (odds ratio [OR] 17.5) and musculoskeletal courses (OR 8.2) were likely to perform injections. Similarly, GPs' confidence in shoulder examination was related to their attendance at clinics (P = 0.019) and musculoskeletal courses (P < 0.001) but not postgraduate meetings. In their clinical examination, GPs found that ...

Lower urinary tract symptoms: lack of change in prevalence and help‐seeking behaviour in two population‐based surveys of women in 1991 and 2007

To test the hypothesis that the overt prevalence and help-seeking pattern for lower urinary tract symptoms (LUTS) might have changed over time, by comparing the prevalence of urinary incontinence (UI), overactive bladder (OAB) and other LUTS (principally storage symptoms) and help-seeking pattern in two equivalent groups of women 16 years apart. We compared two cross-sectional studies; population-based random samples of women aged ≥20 years in the central district of Gothenburg in 1991 (2911) and 2007 (3158) were asked to complete similar self-administered postal questionnaires regarding UI and other LUTS. The mean (sd, range) age of the two groups was 48.1 (20.4, 20-98) years in 1991 and 46.2 (20.0, 20-101) years in 2007, respectively. When comparing the two study populations there were no significant differences in the reported prevalence of UI, OAB or nocturia (defined as two or more voids per night) over time. Nocturia according to the International Continence Society definition was significantly more prevalent in 2007 than 1991, as was daytime voiding frequency of eight or more times a day. OAB dry (i.e. with no incontinence) was more common in 1991, while OAB wet (i.e. with incontinence) was more prevalent in 2007. Of the women in 1991 and 2007, 6% and 7%, respectively, had sought help from the healthcare system due to UI. Significantly more women in 2007 than in 1991 stated that the presence of UI limited their social life (29% vs 13%, P < 0.001). LUTS are common in women and the prevalence rates of UI and OAB have not changed during the last 16 years. Many women still do not seek help from the healthcare system, and the help-seeking pattern has remained unchanged, despite effective treatment currently being offered.

Summary of: Paediatric conscious sedation: views and experience of specialists in paediatric dentistry

Objectives The objectives were three-fold: to investigate the level of conscious sedation training received prior to and during specialist training in paediatric dentistry; to establish the use of conscious sedation during and following specialisation; and to determine the attitudes of specialists in paediatric dentistry to conscious sedation. Subjects and methods A self-administered postal questionnaire was sent to all specialists in paediatric dentistry registered with the General Dental Council in January 2008. Non-responders were contacted again after a four-week period. Results A response rate of 60% was achieved. Of the 122 respondents, 67 (55%) had received sedation training as an undergraduate; 89 (75%) had been trained during specialisation. All respondents performed dental treatment under sedation as a trainee and the majority used nitrous oxide inhalation sedation (NOIS). Over 90% of respondents felt that NOIS should be available to all children, both in appropriate primary care settings and in hospitals. One hundred and twenty-one (99%) respondents thought that all trainees in paediatric dentistry should have sedation training. Conclusions The most popular form of sedation amongst specialists in paediatric dentistry was NOIS. However, some of the respondents felt that children should have access to other forms of sedation in both the primary care and hospital settings. Additional research on other forms of sedation is required to evaluate their effectiveness and safety.

Past, present, future major sport event management practice: The practitioner perspective

The last decade has seen unprecedented demand to host major sport events, since they can potentially fulfil multi-levelled economic, social, and political agendas. However, despite their universal appeal and long history of implementation, the emergent industry is too often associated with examples of mismanagement. In the light of these continuing major sport event management incidents, the purpose of this study is to provide a review of current management practice and to place this in some sense of temporal context by reflecting on the historical as well future development of the evolving industry. Adopting a practitioner focus at the local organising committee level, a self-administered postal questionnaire was sent to 178 major sport event organisers from 11 countries. Based upon a stratified sample of the 20 priority sports of England, the most senior manager of these sport governing bodies and local authority hosts was invited to participate in the study. Providing a questionnaire response rate of 26% a second phase of data collection was undertaken. This entailed 10 in-depth face-to-face semi-structured interviews selected on the basis of a geographical convenience sample (50 mile radius of author) of returned questionnaire respondents. The findings reveal that current success is based upon effective and efficient management of the tripartite relationship of sport, media, and the event funders, as well as limiting chance occurrences. Reflecting on the historical and future drivers of the event industry, it was further concluded that a better understanding of economics, technology and culture are fundamental to ensuing a safer and new era of global professionalism.

Paediatric conscious sedation: views and experience of specialists in paediatric dentistry

The objectives were three-fold: to investigate the level of conscious sedation training received prior to and during specialist training in paediatric dentistry; to establish the use of conscious sedation during and following specialisation; and to determine the attitudes of specialists in paediatric dentistry to conscious sedation. A self-administered postal questionnaire was sent to all specialists in paediatric dentistry registered with the General Dental Council in January 2008. Non-responders were contacted again after a four-week period. A response rate of 60% was achieved. Of the 122 respondents, 67 (55%) had received sedation training as an undergraduate; 89 (75%) had been trained during specialisation. All respondents performed dental treatment under sedation as a trainee and the majority used nitrous oxide inhalation sedation (NOIS). Over 90% of respondents felt that NOIS should be available to all children, both in appropriate primary care settings and in hospitals. One hundred and twenty-one (99%) respondents thought that all trainees in paediatric dentistry should have sedation training. The most popular form of sedation amongst specialists in paediatric dentistry was NOIS. However, some of the respondents felt that children should have access to other forms of sedation in both the primary care and hospital settings. Additional research on other forms of sedation is required to evaluate their effectiveness and safety.

A Longitudinal Population-based Survey of Urinary Incontinence, Overactive Bladder, and Other Lower Urinary Tract Symptoms in Women

BackgroundFemale urinary incontinence (UI), overactive bladder (OAB), and other lower urinary tract symptoms (LUTS) are highly prevalent conditions with a profound influence on well-being and quality of life. There are a few studies describing progression as well as remission, in the short term, of UI in the general population as well as in selected groups; at present, there are very few population-based studies describing the natural course of other LUTS in the same women, and there are no long-term longitudinal studies. ObjectiveTo describe the prevalence of UI, OAB, and other LUTS in the same women studied prospectively over time and, thus, to assess possible progression or regression. Design, setting, and participantsA longitudinal population-based study was performed in one primary health care district in the city of Gothenburg, Sweden. The participants were a sample of women aged ≥20 yr who were randomly selected from the Swedish National Population Register, assessed in 1991 (n=2911), and available for reassessment in 2007 (n=1408). MethodsA self-administered postal questionnaire regarding UI, OAB, and other LUTS was returned by 77% of the contacted women in 1991. The same women who responded in 1991 and who were still alive and available in the Swedish National Population Register 16 yr later were reassessed using a similar self-administered postal questionnaire. Results and limitationsIn 2007, 1081 of the available 1408 women responded to the questionnaire (77%). The overall prevalence of UI, OAB, nocturia, and daytime micturition frequency of eight or more times per day increased by 13%, 9%, 20% (p<0.001), and 3% (p<0.05), respectively, from 1991 to 2007. The incidence of UI and OAB were 21% and 20%, respectively, and the corresponding remission rates were 34% and 43%, respectively. Women with OAB symptoms were classified as OAB dry or OAB wet, depending on the presence or absence of concomitant UI. The prevalence of OAB dry did not differ between the two assessment occasions (11% and 10%, respectively), but the prevalence of OAB wet increased from 6% to 16% (p<0.001). ConclusionsUI and other LUTS constitute dynamic conditions. In this study, there was a marked overall increase in the prevalence of UI, OAB, and nocturia in the same women from 1991 to 2007. Both incidence and remission of most symptoms were considerable.

Positive Interaction Between Light Iris Color and Ultraviolet Radiation in Relation to the Risk of Uveal Melanoma: A Case-Control Study

To examine the association among phenotypic characteristics, chronic and intermittent ultraviolet (UV) radiation, and the risk of uveal melanoma. Case-control study. Overall, between September of 2002 and March of 2005, 1677 eligible subjects (age range: 20-74 years, living in Germany) participated. Interviews were conducted with 459 incident uveal melanoma cases (response proportion 94%), 827 population controls (55%), 180 ophthalmologist controls (52%), and 187 sibling controls (57%). Data on phenotypic characteristics and chronic and intermittent UV radiation exposure were obtained from a self-administered postal questionnaire and computer-assisted telephone interview. We used conditional logistic regression to estimate odds ratios adjusting for the matching factors. Furthermore, we studied the presence of synergy (super additive of risk or relative excess risk due to interaction) between light iris color and several UV radiation exposures. Hair color at age 20 years, eye color, untanned skin color, ability to tan, propensity to burn on exposure, freckling, occupational sun exposure, artificial UV radiation, burns to the eyes. In all 3 control groups, fair skin color, freckling as a child, nevi on the upper arms, burns to the eyes, use of sunlamps, and ever worked outside for 4 or more hours per day were positively associated with uveal melanoma. The association with eye color was apparent only in population controls (odds ratio = 1.9; 95% confidence interval [CI], 1.4-5.2), resulting in a relative excess risk due to interaction of 0.9 (95% CI, -0.6-2.3) for light iris color and more than 5 eye burns (UV-related keratitis) and 0.6 (95% CI, -0.3 to 1.5) for light iris color and eye protection. Our interaction analyses suggest that there is an etiologic synergism between light iris color and the exposure of UV radiation. People with light iris color may have an especially increased risk for uveal melanoma if they are exposed to UV radiation. The author(s) have no proprietary or commercial interest in any materials discussed in this article.