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Even in herds with a high number of visitors (mainly AI technicians) in areas with a high prevalence, a protective effect of biosecurity measures has been noted [ 6], demonstrating that a high risk estimate is not absolute.
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Most probably, such procedure reduced technical variability, and this is the most likely explanation for the very high risk estimates in Pisa, previously reported only by another case control study from Taiwan (Liou et al. 1999).
This study revealed high risk estimates for alcohol and multi-drug use when comparing drivers admitted to the emergency department for injuries in car accidents with drivers in normal traffic from the hospital catchment area.
While this seems appropriate given that the score is based on odds ratios, which are multiplicative in nature, we don't know if this is the case for all factors considered here and it is possible that correlations between risk factors not adjusted for in the analyses found in the literature may lead to very high risk estimates for some families.
The highest risk estimate was seen in obese participants with insulin resistance.
Further, the authors reported higher risk estimate for unopposed oestrogen use than oestrogen plus progestin use (Pearce et al, 2009).
These risk estimates indicate that adjustment for confounders and intermediates could also result in a higher risk estimate in the matched analysis than in the unmatched analysis.
In our study all combinations in the younger men were accompanied by a considerably higher risk estimate for MI (PROCAM) compared to men without MetS.
Reflux symptoms showed a slightly higher risk estimate in women (OR 4.6, 95% CI 2.0 10.5) than in men (OR 3.4, 95% CI 2.5 4.6) at least weekly.
For example, if the true lag were 18 hours (ie, 0.75 day), the highest risk estimate would be observed for PM2.5 with 1 day lag.
The exact method produced a slightly higher risk estimate, but not with any clinical significance given that there had been no events.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com