Exposure measurement errors, risk estimate and statistical power in case-control studies using dichotomous analysis of a continuous exposure variable.

BACKGROUND: Non-differential errors in exposure measurements have been shown to lead to differential misclassification of exposure. As a consequence, the common tenet that, in absence of bias, imprecise exposure assessment can only bias the risk estimates conservatively does not necessarily hold. We investigate the effects of exposure measurement errors on the risk estimate and on statistical power. METHODS: We used a computer model that simulates a case-control study. We used both hypothetical data and data modelled on empirical measurements of environmental magnetic fields exposure. RESULTS: Measurement errors are found to have a lesser impact on risk estimates and statistical power than would have been the case had misclassification been truly non-differential. However, for a given cutpoint, a bias away from the null cannot be excluded. The predominant direction of the errors is found to have important consequences on both the study power and the risk estimates. CONCLUSION: When sufficient empirical data are available, computer modelling may give a more accurate estimate of the effects of measurement errors than algebraic corrections.

Development and evaluation of a location-specific wire code.

The development of a wire code protocol based on a study of electrical installations in Melbourne, Australia, is described. Because of very significant differences between the Melbourne power distribution system and that used in Denver, Colorado, an approach different from that used by Wertheimer and Leeper was required. A combined practical and theoretical approach was used to determine a continuous exposure index, defined as a measure of the potential for exposure due to external electrical installations. The protocol was tested on a convenient sample of 41 homes in which the field was monitored over a 12 hour overnight period. A correlation of 0.85 (95% CI 0.74-0.92, P < .0001) was obtained between the measured time-weighted average and the wire coding exposure index. To assess the efficacy of the wiring configuration index, a computer simulation of a case-control study was then performed. It was concluded that, using the same basic reasoning of the Wertheimer and Leeper code, it is possible to develop a location-specific code that provides a good correlation with the residential time-weighted average and an acceptable degree of exposure misclassification.

Interictal indices of temporal seizure origin.

Two studies assessed the value of temporal lobe interictal electroencephalographic (EEG) spikes and delta in indicating side of temporal epileptogenesis. The first study determined laterality of spikes/delta in awake recordings of 56 patients whose seizures all began unilaterally as proven by (1) EEG-recorded seizures and (2) > 90% improvement after lobectomy. Spikes of 52 (93%) and delta of 46 (82%) patients predominated or appeared exclusively ipsilateral to seizure origin. Neither predominated contralaterally in any patient. The second study investigated laterality of temporal seizures in a separate group of 156 patients with various side vs side spike or delta ratios on 1 to > or = 4 awake recordings. Ninety-nine of 104 patients (95%) with temporal spikes on four or more awake recordings had most or all seizures ipsilateral to most spikes, including 79 of 80 (99%) of those with > or = 3 side vs side spike ratios. Among the 120 patients with high (> or = 3) side vs side spike ratios, most or all seizures of 118 (98%) originated ipsilateral to most spikes. Predominant seizure origin also correlated with lateralized arrhythmic delta--from 90% ipsilateral seizures of those with one EEG with delta to 100% with > or = 4 such EEGs. Data from these two studies using opposite directions of analysis (seizures-->spikes/delta and spikes/delta-->seizures) demonstrate high correlations between laterality of interictal and ictal entities, particularly if temporal spikes clearly predominate on one side and if unilateral temporal delta activity persists over several recordings. Such correlations suggest that the awake interictal scalp EEG cannot be ignored when assessing laterality of temporal epileptogenesis.