Towards an overall model April, 2013. Modeling Decisions Outcome (What are we explaining?) General...
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Transcript of Towards an overall model April, 2013. Modeling Decisions Outcome (What are we explaining?) General...
Towards an overall model
April, 2013
Modeling Decisions
Outcome (What are we explaining?)• General (e.g., longevity) vs. specific (e.g., MI)?• Incidence vs. progression or survival?
(i.e., absolute or relative?) • Outcomes or distribution of outcomes? (Individual vs. societal?)
Population (Whom are we considering?)• Overall average tendencies, or particular sub-groups?• Local or universal? Current patterns or historical trends?
Perspective (Why?)• All factors or a simplified model? How distilled?• Prediction vs. explanation?
Form (How?)• Mathematical or compositional?• Organic or structural? Next
Diseasemanagementbehaviors
Seema Nagpal, PhD thesis, 2011
Social Support Back
Family
Neighborhood
National
Global Factors
Determinants at higher level
influence health at lower level
∑
Explanations:Reasons lookoutwards (the
“Why?” questions)
Analysis:Mechanisms look
inwards (the “How?” questions)
∑∑
∑ Health statusand risk factors at lower levels
aggregate to higher levels
Physical Emotio
nal
SocialSpiritu
al
The Person
Back
PopulationIncidence
Individual risk categoriesLow High
High
D
RF
Causes of cases vs. Population Rates
Back
Elements of a ‘model’
• Elements & links; is this sufficient?
• Magnitude & pattern of influence
• Layering of influences
• Historical: time dimension & external influences
• Model vs. Framework
Lalonde
Selye
IOTF
Minard
Next
Frank-Etches
Health
Health CareOrganization
HumanBiology
Environment
Lifestyle
Lalonde’s Health Field Concept Back
Theory of Planned Behaviour
AttitudesAttitudes
Subjective Subjective NormsNorms
Perceived Perceived BehaviouraBehavioura
l Controll Control
BehaviouraBehavioural Intentionl Intention BehaviourBehaviour
Ajzen & Madden, (1986), Journal of Experimental Social Psychology, 22, 453
Back
Alarm Resistance Exhaustion
Selye’s conception of generalized reaction:initial fall in performance during alarm phasefollowed by heightened vigilance during resistance phase, leading to precipitous fallas body becomes exhausted.
Selye’s notion of optimal levelof stress: too little impairs performance(‘rust out’); we operate at peak under optimal stress, but canwear out with prolonged stress.Note similar findings for anxiety.
Back
Charles Joseph Minard’s 1869 diagram of Napoleon’s Russian campaign of 1812-13
Back
John Frank
Vera Etches
Back
Globalinfluences
Societal processes
Individualactions
Biologicalprocesses
Healthoutcomes,
e,g.:
Structural Starting-Point for our Overall Model
Overallmortality
CVD,cancer
Mental health
Obesity
QoL