Poorly presented risk statistics could misinform health decisions

Poorly presented risk statistics could misinform health decisions

From the March 15 Eureka news alert item

Choosing the appropriate way to present risk statistics is key to helping people make well-informed decisions. A new Cochrane Systematic Review[abstract]*** found that health professionals and consumers may change their perceptions when the same risks and risk reductions are presented using alternative statistical formats.

Risk statistics can be used persuasively to present health interventions in different lights. The different ways of expressing risk can prove confusing and there has been much debate about how to improve the communication of health statistics.

For example, you could read that a drug cuts the risk of hip fracture over a three year period by 50%. At first sight, this would seem like an incredible breakthrough. In fact, what it might equally mean is that without taking the drug 1% of people have fractures, and with the drug only 0.5% do. Now the benefit seems to be much less. Another way of phrasing it would be that 200 people need to take the drug for three years to prevent one incidence of hip fracture. In this case, the drug could start to look a rather expensive option.

Statisticians have terms to describe each type of presentation. The statement of a 50% reduction is typically expressed as a Relative Risk Reduction (RRR). Saying that 0.5% fewer people will have broken hips is an Absolute Risk Reduction (ARR). Saying that 200 people need to be treated to prevent one occurrence is referred to as the Number Needed to Treat (NNT). Furthermore, these effects can be shown as a frequency, where the effect is expressed as 1 out of 200 people avoiding a hip fracture.

In the new study, Cochrane researchers reviewed data from 35 studies assessing understanding of risk statistics by health professionals and consumers. They found that participants in the studies understood frequencies better than probabilities. Relative risk reductions, as in “the drug cuts the risk by 50%”, were less well understood. Participants perceived risk reductions to be inappropriately greater compared to the same benefits presented using absolute risk or NNT.

“People perceive risk reductions to be larger and are more persuaded to adopt a health intervention when its effect is presented in relative terms,” said Elie Akl of the Department of Medicine, University at Buffalo, USA and first author on the review. “What we don’t know yet is whether doctors or policymakers might actually make different decisions based on the way health benefits are presented.”

Although the researchers say further studies are required to explore how different risk formats affect behaviour, they believe there are strong logical arguments for not reporting relative values alone. “Relative risk statistics do not allow a fair comparison of benefits and harms in the same way as absolute values do,” said lead researcher Holger Schünemann of the Department of Clinical Epidemiology and Biostatistics at McMaster University in Ontario, Canada. “If relative risk is to be used, then the absolute change in risk should also be given, as relative risk alone is likely to misinform decisions.”

 

***  For suggestions on how to get this review for free or at low cost click here

Cochrane Reviews are ” systematic reviews of primary research in human health care and health policy. They investigate the effects of interventions (literally meaning to intervene to modify an outcome) for prevention, treatment and rehabilitation. They also assess the accuracy of a diagnostic test for a given condition in a specific patient group and setting.”

Please go here for a previous posting on Cochrane Reviews.

 

Electronic medical records improve quality of care in resource-limited countries, study suggests

Electronic medical records improve quality of care in resource-limited countries, study suggests

From the March 18 2011 Science Daily news item

ScienceDaily (Mar. 18, 2011) — A new study [Abstract***], conducted by researchers from the Regenstrief Institute and the schools of medicine at Indiana University and Moi University, is one of the first to explore and demonstrate the impact of electronic record systems on quality of medical care in a developing country….

…This work is particularly significant because of the many medical errors that occur in settings where too few skilled health-care providers deal with a large patient population with critical illnesses. In developed countries, patients with HIV are often seen by infectious disease specialists for their HIV care. In contrast, a large number of HIV-positive patients in resource-limited countries like Kenya are taken care of by clinical officers whose level of training is similar to that of nurse practitioners. The combination of overworked staff with limited training, increasingly busy clinics, the challenges of providing chronic disease management, and the difficulty of keeping up-to-date often results in suboptimal patient care.

***For suggestions on how to get this article for free or at low cost click here

Related articles

Towards electronic healthcare centred on the patient (Science Daily)

A vast computer based glossary of healthcare terms culled from so-called e-health tools, medical news sites, telemedicine applications, home care-management systems, internet-based public health records, and even health-oriented and medical blogs could help improve the relationship between patients and healthcare workers, according to new research.

Abstract is here

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Masked fears: Are fears that are seemingly overcome only hidden?

Masked fears: Are fears that are seemingly overcome only hidden?

One group of nerve cells in the brain controls the fear behaviour (right). This can be suppressed by a second group of nerve cells (left) — but the fear is only masked, and has not disappeared completely. (Credit: Carlos Toledo/Bernstein Center Freiburg)

From the March 18 2011 Science Daily News Item

ScienceDaily (Mar. 20, 2011) — Fear is a natural part of our emotional life and acts as a necessary protection mechanism. However, fears sometimes grow beyond proportions and become difficult to shed. Scientists from Freiburg, Basel and Bordeaux have used computer simulations to understand the processes within the brain during the formation and extinction of fears.

In the current issue of the scientific journal PLoS Computational Biology [full text of article], Ioannis Vlachos from the Bernstein Center Freiburg and colleagues propose for the first time an explanation for how fears that were seemingly overcome are in reality only hidden

The reason for the persistency of fears is that, literally, their roots run deep: Far below the cerebral cortex lies the “amygdala,” which plays a crucial role in fear processes. Fear is commonly investigated in mice by exposing them simultaneously to a neutral stimulus — a certain sound, for example — and an unpleasant one. This leads to the animals being frightened of the sound as well. Context plays an important role in this case: If the scaring sound is played repeatedly in a new context without anything bad happening, the mice shed their fear again. It returns immediately, however, if the sound is presented in the original, or even a completely novel context. Had the mice not unlearned to be frightened after all?

 

Economics and evolution help scientists identify new strategy to control antibiotic resistance

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Economics and evolution help scientists identify new strategy to control antibiotic resistance

From the March 18 2011 Science Daily news article

ScienceDaily (Mar. 20, 2011) — A team of scientists from the University of Oxford, U.K. have taken lessons from Adam Smith and Charles Darwin to devise a new strategy that could one day slow, possibly even prevent, the spread of drug-resistant bacteria. In a new research report published in the March 2011 issue of Genetics, [Abstract***]the scientists show that bacterial gene mutations that lead to drug resistance come at a biological cost not borne by nonresistant strains. They speculate that by altering the bacterial environment in such a way to make these costs too great to bear, drug-resistant strains would eventually be unable to compete with their nonresistant neighbors and die off.

“Bacteria have evolved resistance to every major class of antibiotics, and new antibiotics are being developed very slowly; prolonging the effectiveness of existing drugs is therefore crucial for our ability to treat infections,” said Alex Hall, Ph.D., a researcher involved in the work from the Department of Zoology at the University of Oxford. “Our study shows that concepts and tools from evolutionary biology and genetics can give us a boost in this area by identifying novel ways to control the spread of resistance.”

The research team measured the growth rates of resistant and susceptible Pseudomonas aeruginosa bacteria in a wide range of laboratory conditions. They found that the cost of antibiotic resistance has a cost to bacteria, and can be eliminated by adding chemical inhibitors of the enzyme responsible for resistance to the drug. Leveling the playing field increased the ability of resistant bacteria to compete effectively against sensitive strains in the absence of antibiotics. Given that the cost of drug resistance plays an important role in preventing the spread of resistant bacteria, manipulating the cost of resistance may make it possible to prevent resistant bacteria from persisting after the conclusion of antibiotic treatment. For instance, new additives or treatments could render antibiotic resistance more costly for bacteria, making it less likely that the resistant strains will persist at the end of treatment.

“If we’ve learned one thing about microscopic organisms over the past century, it’s that they evolve quickly, and that we can’t stop the process,” said Mark Johnston, Editor-in-Chief of the journal GENETICS. “This research turns this fact against the bacteria. This is an entirely new strategy for extending the useful life of antibiotics, and possibly for improving the potency of old ones.”

***For suggestions on how to get this article for free or at low cost click here

Related Articles

• Antibiotic resistance is not just genetic (sciencedaily.com)
• Pollution with antibiotics leads to resistant bacteria (physorg.com)
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Radiation risks to health: A joint statement from leading scientific experts

Radiation risks to health: A joint statement from leading scientific experts

ScienceDaily (Mar. 20, 2011) — The growing concern surrounding the release of radiation from an earthquake and tsunami-stricken nuclear complex in Japan has raised fears of radiation exposure to populations in North America from the potential plume of radioactivity crossing the Pacific Ocean. To help Americans understand their radiation-related health risks, the American Association of Clinical Endocrinologists (AACE), the American Thyroid Association (ATA), The Endocrine Society and the Society of Nuclear Medicine (SNM) issued a joint statement [full text of statement].

The statement suggests that the principal radiation source of concern, in regard to impact on health, is radioactive iodine including iodine-131.This presents a special risk to health because exposure of the thyroid to high levels may lead to development of thyroid nodules and thyroid cancer years later.

Radioactive iodine uptake to the thyroid can be blocked by taking potassium iodide (KI) pills. However the statement cautions KI should not be taken unless there is a clear risk of exposure to high levels of radioactive iodine. While some radiation may be detected in the United States as a result of the nuclear reactor accident in Japan, current estimates indicate radiation levels will not be harmful to the thyroid gland or general health. If radiation levels did warrant the use of KI, the statement recommends it should be taken as directed by physicians or public health authorities until the risk for significant exposure dissipates….

The complete statement is here

Related Items

Harmful Health Effects of Nuclear Radiation Exposure: Resources for Prevention
This Web site contains links to seven reports and books on how to mitigate the harmful health effects of radiation exposure, including the distribution of potassium iodide tablets. They are available to read free on the National Academies Press Web site.
http://notes.nap.edu/2011/03/18/harmful-health-effects-of-nuclear-radiation-exposure-resources-for-prevention/?utm_medium=etmail&utm_source=National%2520Academies%2520Press&utm_campaign=NAP%2520mail%2520eblast%25203.18.11%2520-%2520Radiation&utm_content=Downloader&utm_term=
[From the Resource Guide for Public Health Preparedness]

FDA Works to Ensure Safety of Products Imported from Japan
http://www.fda.gov/NewsEvents/PublicHealthFocus/ucm247403.htm
FDA is closely monitoring the situation in Japan and is working with the Japanese government and other U.S. agencies to continue to ensure that imported food remains safe.

Related Articles

• Radiation risks to health: A joint statement from leading scientific experts (jflahiff.wordpress.com)
• International Group Of Experts Calls For Long-term Support For Research To Fully Evaluate The Health Consequences Of The Chernobyl Accident(MedicalNewsToday)
• What Japan’s nuclear crisis means for public health (Q&A) (news.cnet.com)
• Response: The Chernobyl deniers use far too simple a measure of radiation risk (guardian.co.uk)
• Short-Term and Long-Term Health Risks of Nuclear-Power-Plant Accidents (NEJM, April 20, 2011)
• “Radiation Risks to Health: A Joint Statement from Leading Scientific Experts” and related posts (health.am)

Health information technology ‘control tower’ could improve earthquake response

Health information technology ‘control tower’ could improve earthquake response

From the March 21 2011 Science Daily news article

ScienceDaily (Mar. 21, 2011) — A new study published by researchers at Weill Cornell Medical College and the University of California, Davis, foresees improvements in patient outcomes after a major earthquake through more effective use of information technology. A control tower-style telemedicine hub to manage electronic traffic between first responders and remote medical experts could boost the likelihood that critically injured victims will get timely care and survive, according to the team’s computer simulation model.

The team’s results, published in the Journal of Medical Systems, show that introducing telemedicine linkages between remote specialists and immediate responders in the aftermath of a widespread disaster like an earthquake could decrease both patient waiting times and hospitalization rates at nearby hospitals, while increasing the likelihood that patients with life-threatening injuries receive appropriate care — as compared with standard emergency department-based triage and treatment.

These findings demonstrate the power of interdisciplinary approaches to complex issues at the border between medicine, public health and logistics…

 

 

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• Study Shows Health IT Efforts Worthwhile (techdailydose.nationaljournal.com)
• Health Information Technology Resources (asapnys.wordpress.com)
• Health Information Technology: A Case-Based Reasoning System Proposal (Health Information Technology: Practical Concepts) (thevellum.wordpress.com)

Chicken soup for the soul: Comfort food fights loneliness

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Chicken soup for the soul: Comfort food fights loneliness

From the March 21, 2011 Science Daily news item

ScienceDaily (Mar. 21, 2011) — Mashed potatoes, macaroni and cheese, meatloaf…they may be bad for your arteries, but according to an upcoming study in Psychological Science, a journal of the Association for Psychological Science, they’re good for your heart and emotions. The study focuses on “comfort food” and how it makes people feel.

“For me personally, food has always played a big role in my family,” says Jordan Troisi, a graduate student at the University of Buffalo, and lead author on the study. The study came out of the research program of his co-author Shira Gabriel, which has looked at social surrogates — non-human things that make people feel like they belong. Some people counteract loneliness by bonding with their favorite TV show, building virtual relationships with a celebrity or a movie character, or looking at pictures and mementos of loved ones. Troisi and Gabriel wondered if comfort food could have the same effect by making people think of their nearest and dearest….

 

Related Articles

• The Comfort-Food Diet (everydayhealth.com)

Trauma patients protected from worse outcomes associated with so-called ‘weekend effect’

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Trauma patients protected from worse outcomes associated with so-called ‘weekend effect’

From a March 21 2011 Science Daily news article

ScienceDaily (Mar. 21, 2011) — Patients who’ve been hurt in car or bike crashes, been shot or stabbed, or suffered other injuries are more likely to live if they arrive at the hospital on the weekend than during the week, according to new University of Pennsylvania School of Medicine research published in the March 21 issue of Archives of Surgery. The findings, which also showed that trauma patients who present to the hospital on weeknights are no more likely to die than those who presented during the day, contrast with previous studies showing a so-called “weekend effect” in which patients with emergent illnesses such as heart attacks and strokes fare worse when they’re hospitalized at night or on weekends.

The authors say the trauma system’s unique organization and staffing appears to serve as a built-in protection for these critically injured patients, and may provide a roadmap for ongoing efforts to restructure and better coordinate U.S. emergency care, which needs to provide optimal care day or night.

“Whether patients have an emergent illness or a severe injury, the common denominator is time. Patients must rely on the system to quickly get them to the place that’s best prepared to save their lives,” says lead author Brendan G. Carr, MD, MS, an assistant professor in the departments of Emergency Medicine and Biostatistics and Epidemiology. “Trauma systems have been designed to maximize rapid access to trauma care, and our results show that the system also offers special protection for patients injured during periods that are known to be connected to worse outcomes among patients with time-sensitive illnesses.”…

Related Articles

• Rehabilitation for Brain Trauma Patients (brighthub.com)
• Medical Consequences of Testicular Trauma in Childhood (brighthub.com)
• Vulnerable Patients May Lack Access to Trauma Care (nlm.nih.gov)
• Trauma Patients Fare Poorly After Hospital Discharge (webmd.com)
• Trauma patients have higher rate of death for several years following injury (physorg.com)
• Risk of hospital patient mortality increases with nurse staffing shortfalls, study finds(ScienceDaily)
• Military Funds Brain Injury Study: Immediate Nutrition Is Key (April 2011)

  Excerpt: Due to a high level of brain injury in the field, the United States Military commissioned the Institute of Medicine (IOM) to look into the best way to immediately treat traumatic brain injuries. The institute found that a quick infusion of calories, proteins and vitamins should now be a part of standard care in the military. This research will cross over into the public sector as well…
  

Streptococcus Enzyme Could Compete With Toothbrushes, Dental Floss

Streptococcus Enzyme Could Compete With Toothbrushes, Dental Floss

From a March 21 2011 Science Daily news article

ScienceDaily (Mar. 21, 2011) — Investigators from Japan show in vitro that the bacteriumStreptococcus salivarius, a non-biofilm forming, and otherwise harmless inhabitant of the human mouth, actually inhibits the formation of dental biofilms, otherwise known as plaque. Two enzymes this bacteria produces are responsible for this inhibition.

The research is published in the March 2011 issue of the journalApplied and Environmental Microbiology.

[For suggestions on how to get this article for free or at low cost, click here]

 

Related Articles

• A Guide to Flossing Your Teeth (everydayhealth.com)
• A Guide to Nighttime Oral Care (everydayhealth.com)
• Bad breath could signal other health problems (charlotte.news14.com)