Zusammenfassungen

Ohne Zusammenfassung German translations by Monika Lütke-Daldrup.     

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.     

State of the unions: Assessment by elite American labor leaders

One hundred and sixty-four elite union leaders in the United States completed a survey to assess the condition of the American labor movement and the factors affecting it. The respondents included high-level international union and state federation officers, central labor presidents, and 58 shop stewards. This study compares the responses of these labor officials and finds that they have similar, negative assessments of the condition of the American labor movement. The study also finds that these leaders agree that the most important factors affecting the labor movement are collective bargaining rights, union leadership, union member solidarity, and the NLRB.     

Sexual identity in the ghetto

The more things change, the worse they get.Presented April 18, 1991, Duke University, at the Department of Psychiatry's Grand Rounds, this paper condenses, integrates and updates the author's earlier publication. Acknowledgement and thanks for funding and professional sponsorship of the four research studies this paper draws from are selectively due to the Eugene and Agnes E. Meyer Foundation, the Edgar Stern Family Fund, The National Institute for Mental Health, the Baltimore-Washington Institute for Psychoanalysis and the Department of Psychiatry, Children's Hospital National Medical Center.     

Assessment of influence in non-linear measurement error models

We consider the assessment of outliers and influential observation in non-linear measurement error models. Residuals, leverage measures and case-deletiondiagonostics are examined. The method of local influence is also applied to the models. In particular, the perturbation of measurement error variances has been found useful in assessing the adequancy of the model assumptions. A numerical example is given to illustrate the application of the diagonostics.     

Differences in preferred level of arousal in two sub-groups of problem gamblers: A preliminary report

Twelve problem poker machine players and thirteen horse race gamblers (20 males and 5 females; age range 28–69) completed a series of questionnaires which assessed levels of anxiety, their preferred state of arousal and their motivations to gamble. As predicted, problem poker machine gamblers were found to be more anxious and reported avoiding arousal more frequently than the horse race gamblers. Alternately, problem horse race gamblers were found to prefer heightened levels of arousal and appeared to gamble to achieve these optimal levels of arousal. However, there was no difference between the groups on proneness to boredom. The present results provide evidence which is consistent with the Reversal theory and its application to the field of problem gambling.     

A puzzlement: health-related organisations in the Nonprofit Almanac

Conclusion Data systems created with one purpose inevitably have shortcomings when used for other purposes, so it is not surprising that a database compiled from informational tax returns has serious flaws when used to compile a statistical picture of the non-profit sector. The two-digit NTEE level of aggregation that is published in theAlmanac conceals many problems that appear when the IRS-based data are broken down to the three-digit level.Identification of the problems in the NTEE and in the use of the IRS data is a necessary step toward their correction. At this point, it is clear that the IRS-based numbers in theAlmanac should be regarded, at best, as rough approximations and as a starting point for additional work. My assessment of theAlmanac suggests that, at least as far as health care is concerned, the NTEE needs revision. Correcting the problems with the IRS data will be much, much more difficult.I am grateful for assistance from Steve Noga, Chris Toppe and Virginia Hodgkinson at Independent Sector.     

Screening for patients with alcohol problems: severity of patients identified by the CAGE.

Primary care physicians are well situated to identify patients with substance abuse problems and motivate them to seek appropriate assistance, but active programs are the exception. A study in a community setting was undertaken to assess the CAGE (the first letters of key words in a series of four questions about drinking: cut down; annoyed; guilty; and eye-opener), instrument in the routine screening for alcohol problems in both new and established patients. The screening process identified subjects for a pilot evaluation of a motivational interview designed to encourage problem-solving behavior. This article focuses on the screening results and the use of the CAGE instrument. During June and July of 1990, 687 patients of two primary care physicians belonging to a large group practice were asked to complete a health questionnaire that included the CAGE. Those who responded affirmatively to at least two of the four CAGE questions were requested to participate in follow-up assessment of problems associated with alcohol and health. The type and severity of alcohol problems experienced by patients who scored positive on the CAGE are described. Prevalence of a positive score on the CAGE was 8.6 percent with males, smokers, and blue collar and unemployed persons being more likely to score positive. The positive predictive value was .68. Primarily, persons with moderate alcohol problems were identified. Results show that the CAGE instrument is a useful screening device for identifying those with mild to moderate substance abuse problems, increasing the opportunity for intervention prior to serious medical complications. The instrument is easily administered, and has demonstrated relatively high levels of sensitivity and specificity. When combined with assessment and motivational interviews, the CAGE shows promise in the secondary prevention of substance abuse and related health problems.