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Towards an overall model

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?)

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Towards an overall model

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  1. Towards an overall model April, 2013

  2. 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

  3. Social Support Diseasemanagementbehaviors Seema Nagpal, PhD thesis, 2011 Back

  4. Explanations:Reasons lookoutwards (the“Why?” questions) Analysis:Mechanisms lookinwards (the “How?” questions) The Person Emotional Physical Spiritual Social Health statusand risk factors at lower levels aggregate to higher levels Family Determinants at higher level influence health at lower level Neighborhood National ∑ ∑ ∑ ∑ Global Factors Back

  5. Causes of cases vs. Population Rates High PopulationIncidence RF D Low High Individual risk categories Back

  6. 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 Frank-Etches Next

  7. Back Lalonde’s Health Field Concept HumanBiology Environment Health Health CareOrganization Lifestyle

  8. Theory of Planned Behaviour Attitudes Subjective Norms Behavioural Intention Behaviour Perceived Behavioural Control Ajzen & Madden, (1986), Journal of Experimental Social Psychology, 22, 453

  9. Back

  10. Back 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. Alarm Resistance Exhaustion 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.

  11. Back Charles Joseph Minard’s 1869 diagram of Napoleon’s Russian campaign of 1812-13

  12. Back Vera Etches John Frank

  13. Structural Starting-Point for our Overall Model Healthoutcomes, e,g.: Globalinfluences Societal processes Individualactions Biologicalprocesses Overallmortality CVD,cancer Mental health Obesity QoL

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