A modified random-effect procedure for combining risk difference in sets of 2×2 tables from clinical trials

Summary Meta-analyses of sets of clinical trials often combine risk differences from several 2×2 tables according to a random-effects model. The DerSimonian-Laird random-effects procedure, widely used for estimating the populaton mean risk difference, weights the risk difference from each primary study inversely proportional to an estimate of its variance (the sum of the between-study variance and the conditional within-study variance). Because those weights are not independent of the risk differences, however, the procedure sometimes exhibits bias and unnatural behavior. The present paper proposes a modified weighting scheme that uses the unconditional within-study variance to avoid this source of bias. The modified procedure has variance closer to that available from weighting by ideal weights when such weights are known. We studied the modified procedure in extensive simulation experiments using situations whose parameters resemble those of actual studies in medical research. For comparison we also included two unbiased procedures, the unweighted mean and a sample-size-weighted mean; their relative variability depends on the extent of heterogeneity among the primary studies. An example illustrates the application of the procedures to actual data and the differences among the results. This research was supported by Grant HS 05936 from the Agency for Health Care Policy and Research to Harvard University.     

Improving the contributions of technology assessment to the health care system of the U.S.A.

Summary Based on 14 case studies of highly effective therapies and the reasons they succeeded less frequently than they could, we propose a variety of steps to improve the health care system of the U.S.A. Whatever proposal emerges from current national debates until innovations are shown to be safe and effective, they should not be supported; when slightly better technologies are much more expensive than other good ones we need to consider appropriate choices carefully; simplified billing and bookkeping would reduce our costs; when a technology is rapidly introduced cautionnary measures may be needed; tracking immunization and repairing their omissions requires a new system; educational programs such as seen effective in hypertension should be applied in other areas such as vaccination; in organ transplantation the nation should consider “presumed consent”; our payment system sometimes creates perverse incentives and therefore needs review; and the preferences of the public in allocation of health resources need to be discovered once the public is informed about the issues. Research supported by Andrew W. Mellon Foundation.     

Economic Reform in the Czech Republic: Economic Strain,Depression, Hostility,and the Difference Gender Makes*

The Czech Republic is changing rapidly and its current economic transformation is a strain on Czech families. In this study, the connection between economic strain and individual well-being is investigated via mailed questionnaires from 234 households in the Czech Republic. For Czech women, depression rises more with economic strain than does hostility, while Czech men become more hostile than depressed in the face of economic strain. For women, social support is a buffer between economic strain and hostility, whereas self-esteem is a buffer for depression. For men, both self-esteem and social support exacerbate hostility in the context of economic strain.     

Effects of Category Order on Answers in Mail and Telephone Surveys1

Abstract Past research suggests that mail surveys encourage a primacy effect, which is a tendency to choose the first answers from a list, whereas telephone surveys encourage a recency effect, a tendency to choose the last answers from a list. This paper summarizes results from 82 new experiments conducted in 12 separate surveys in seven states. Only four of 33 mail survey comparisons exhibited significant primacy effects, while five of 26 experiments in telephone surveys exhibited recency effects. In addition, only three of 23 cross-method comparisons produced a significant primacy/recency effect in the expected manner. The conclusion is that the prevalence of primacy and recency effects has been over-estimated by past research and a new theoretical approach that takes into account multiple causation is needed for examining these effects.     

Tearoom trade: A research update

Conclusion Like many studies of covert deviance, this paper is based upon a captive sample of persons who have come to the attention of law enforcement agencies. The existence of Laud Humphreys' research, however, makes possible a comparison of police generated data with data obtained through observations and interviews with unapprehended offenders. Because police observations were so detailed, a rare opportunity to replicate a qualitative study presented itself. This research largely substantiates the picture drawn by Humphreys in his classic study,Tearoom Trade: Impersonal Sex in Public Places. Consistent with his observations, most tearoom participants (a) communicate through non-verbal gestures and seldom speak, (b) do not associate outside the tearoom or attempt to learn one another's identity or exchange biographical information, (c) do not use force or coercion or attempt to involve youths or children, (d) are primarily heterosexual and married, (e) depart separately with the insertor leaving first, (f) commit their sex acts out of sight of the entrance and accidental exposure, (g) do not undress or engage in anal sex, (h) break off sexual contact when someone enters the washroom, (i) rarely approach straight men, (j) read and write sexually explicit homosexual graffiti, and (k) linger inside and outside the washroom for someone to appear. In addition, (1) fellatio is generally not reciprocated and fellators are usually older men; (m) most offenders are neat in appearance; (n) some engage in series and simultaneous encounters; (o) encounters are brief, usually not exceeding twenty minutes; and (p) few have criminal records with the exception of those previously convicted of similar offenses.The behavior of players reveals remarkable consistency over time, from community to community, and across national boundaries. Many men, the majority of them married and primarily heterosexual, continue to visit out-of-the-way public washrooms in search of fast, impersonal, and exciting sex despite the risk to family, friends, job, and reputation. Although shopping malls have usurped public parks as the favorite locale of tearoom participants, the basic rules of the game and profile of the players—as Humphreys contends—remain the same over time and place.     

Loneliness and Adolescents’ Neural Processing of Self,Friends, and Teachers: Consequences for the School Self‐Concept

The present interdisciplinary study explored whether perceived loneliness is associated with ventromedial prefrontal cortex (vMPFC) activation during self‐ and social judgments (friends and teachers) in adolescents. Moreover, we examined how vMPFC activity is related to the academic self‐concept (ASC). Results of manifest path analysis indicated that high perceived loneliness was related to lower neural response to self‐judgments. In turn, high neural response to self‐judgments was positively associated with the ASC, whereas there was a trendwise negative association between high neural response to teacher‐related judgments and ASC. This study reveals associations between perceived loneliness and neural processing of the self, underlining the idea that feeling isolated from others may hinder self‐insight and, by extension, the formation of a stable academic self‐concept.     

Disability at the intersections

Complete and accurate understandings of stratification depend on more regular consideration of disability. To build sociologists' recognition of disability as a socially constructed axis of stratification, we first demonstrate the construction of the disability category through classic legitimating processes: moral attributions, biological attributions, separation, and dichotomization. Expanding understandings of basic processes of stratification, we then document the centrality of disability in the social construction of class, race, gender, sexual orientation, and age. Finally, we show various ways disability functions as an axis of stratification in intersection with other key axes of stratification.     

A reduced form of the Workplace Bullying Scale – the EAPA-T-R: A useful instrument for daily diary and experience sampling studies

The need for more longitudinal studies (i.e. daily diary and experience sampling studies) focused on counterproductive work behaviours such as bullying requires shorter scales that at the same time do not compromise their content validity. Our main objective is to develop and validate a reduced version of the Workplace Bullying Scale (Escala de Abuso Psicológico Aplicado en el Lugar de Trabajo): the EAPA-T-R. Two studies (Study 1: 1506 and Study 2: 932 employees, respectively) were conducted to evaluate its psychometric properties and to ensure the external validity of the EAPA-T-R. Correlation and regression analyses were performed to reduce the current 12-item scale to a more parsimonious 4-item scale. Moreover, the psychometric properties of potential models were compared. Subsequently, the new scale was assessed using confirmatory factor analysis. Likewise, statistically significant relationships were found between the EAPA-T-R and other dimensions evaluated, such as job characteristics, transformational leadership, engagement, job satisfaction, and subjective performance. Moreover, bullying mediated the relationship between transformational leadership and burnout. To sum up, the EAPA-T-R showed good reliability and validity across studies, supporting its use in future research. The benefits of this short scale for daily diary and experience sampling studies and when using large surveys are discussed.     

Improving Weight of Evidence Approaches to Chemical Evaluations

Federal and other regulatory agencies often use or claim to use a weight of evidence (WoE) approach in chemical evaluation. Their approaches to the use of WoE, however, differ significantly, rely heavily on subjective professional judgment, and merit improvement. We review uses of WoE approaches in key articles in the peer‐reviewed scientific literature, and find significant variations. We find that a hypothesis‐based WoE approach, developed by Lorenz Rhomberg et al., can provide a stronger scientific basis for chemical assessment while improving transparency and preserving the appropriate scope of professional judgment. Their approach, while still evolving, relies on the explicit specification of the hypothesized basis for using the information at hand to infer the ability of an agent to cause human health impacts or, more broadly, affect other endpoints of concern. We describe and endorse such a hypothesis‐based WoE approach to chemical evaluation.     

Adolescents’ Socio‐Motivational Relationships With Teachers,Amygdala Response to Teacher's Negative Facial Expressions,and Test Anxiety

The amygdala is essential for processing emotions, including the processing of aversive faces. The aim of this multimethodological study was to relate the amygdala reactivity of students (N = 88) toward teachers’ fearful and angry faces, to students’ relationship with their teachers. Furthermore, students’ neural responses during the perception of teachers’ faces were tested as predictors of test anxiety (controlling for neuroticism as a potential trait anxiety effect). Multiple regression analysis revealed that students reporting high‐quality teacher–student relationships showed stronger amygdala activity toward fearful faces, which was related to worry. Furthermore, students with high levels of neuroticism tended to perceive their teachers as motivators and showed higher amygdala activity toward angry faces, which was related to the measures of emotionality.