Calls for Stricter Legislation and Fear in the European Immigrant Community: Reflections of the Public Charge Debate Ongoing in the United States; Comment on “A Crisis of Humanitarianism: Refugees at the Gates of Europe”

In the editorial, “A Crisis of Humanitarianism: Refugees at the Gates of Europe,” Marianna Fotaki elegantly highlights the changing dynamics of governmental policy toward refugees, forced migrants into Europe and the move away from the principles of humanitarianism.1 The perceived threats to economy, security, and concerns of globalization and multiculturalism often are manifested as a “cry of wolf ” about alleged health risks. This in effect has raised concerns of inadmissibility on health-related grounds and calls for stricter legislation for determining who is eligible for legal permanent residence, precipitated in part by the “public charge” debate occurring in the United States.2 As Marianna notes “anti-migration rhetoric is now a permanent fixture of European politics.

Blocked Randomization with Randomly Selected Block Sizes

When planning a randomized clinical trial, careful consideration must be given to how participants are selected for various arms of a study. Selection and accidental bias may occur when participants are not assigned to study groups with equal probability. A simple random allocation scheme is a process by which each participant has equal likelihood of being assigned to treatment versus referent groups. However, by chance an unequal number of individuals may be assigned to each arm of the study and thus decrease the power to detect statistically significant differences between groups. Block randomization is a commonly used technique in clinical trial design to reduce bias and achieve balance in the allocation of participants to treatment arms, especially when the sample size is small. This method increases the probability that each arm will contain an equal number of individuals by sequencing participant assignments by block. Yet still, the allocation process may be predictable, for example, when the investigator is not blind and the block size is fixed. This paper provides an overview of blocked randomization and illustrates how to avoid selection bias by using random block sizes

Season of Birth and Risk for Adult Onset Glioma

Adult onset glioma is a rare cancer which occurs more frequently in Caucasians than African Americans, and in men than women. The etiology of this disease is largely unknown. Exposure to ionizing radiation is the only well established environmental risk factor, and this factor explains only a small percentage of cases. Several recent studies have reported an association between season of birth and glioma risk. This paper reviews the plausibility of evidence focusing on the seasonal interrelation of farming, allergies, viruses, vitamin D, diet, birth weight, and handedness. To date, a convincing explanation for the occurrence of adult gliomas decades after a seasonal exposure at birth remains elusive

The Association between Trust in Health Care Providers and Medication Adherence among Black Women with Hypertension

Background: Black women have the highest prevalence of hypertension in the world. Reasons for this disparity are poorly understood. The historical legacy of medical maltreatment of Blacks in the U.S. provides some insight into distrust in the medical profession, refusal of treatment, and poor adherence to treatment regimens. Methods: Black women (N = 80) who were prescribed antihypertensive medications were recruited from urban communities in North Carolina. Study participants completed the Trust in Physician and Hill-Bone Compliance to High Blood Pressure Therapy questionnaires. An exact discrete-event model was used to examine the relationship between trust and medication adherence. Results: Mean age of study participants was 48 ± 9.2 years. The majority of participants (67%) were actively employed and 30% had incomes at or below the federal poverty level. Increasing levels of trust in the health care provider was independently associated with greater medication adherence (PTrend = 0.015). Conclusion: Black women with hypertension who trusted their health care providers were more likely to be adherent with their prescribed antihypertensive medications than those who did not trust their health care providers. Findings suggest that trusting relationships between Black women and health care providers are important to decreasing disparate rates of hypertension

A method to compute multiplicity corrected confidence intervals for odds ratios and other relative effect estimates.

Epidemiological studies commonly test multiple null hypotheses. In some situations it may be appropriate to account for multiplicity using statistical methodology rather than simply interpreting results with greater caution as the number of comparisons increases. Given the one-to-one relationship that exists between confidence intervals and hypothesis tests, we derive a method based upon the Hochberg step-up procedure to obtain multiplicity corrected confidence intervals (CI) for odds ratios (OR) and by analogy for other relative effect estimates. In contrast to previously published methods that explicitly assume knowledge of P values, this method only requires that relative effect estimates and corresponding CI be known for each comparison to obtain multiplicity corrected CI

Racial Differences in Survival among Hemodialysis Patients after Coronary Artery Bypass Grafting

The aim of this study was to examine racial differences in long-term survival among hemodialysis patients after coronary artery bypass grafting (CABG). To our knowledge this has not been previously addressed in the literature. Black and white hemodialysis patients undergoing first-time, isolated CABG procedures between 1992 and 2011 were compared. Survival probabilities were computed using the Kaplan-Meier product-limit method and stratified by race. Hazard ratios (HR) and 95% confidence intervals (CI) were computed using a Cox regression model. A total of 207 (2%) patients were on hemodialysis at the time of CABG. White (n = 80) hemodialysis patients had significantly decreased 5-year survival compared with black (n = 127) patients (adjusted HR = 1.9, 95% CI = 1.2–2.8). Our finding provides useful outcome information for surgeons, primary care providers, and their patients