Information bias and lifetime mortality risks of radiation-induced cancer

Additive and multiplicative models of relative risk were used to measure the effect of cancer misclassification and DS86 random errors on lifetime risk projections in the Life Span Study (LSS) of Hiroshima and Nagasaki atomic bomb survivors. The true number of cancer deaths in each stratum of the cancer mortality cross-classification was estimated using sufficient statistics from the EM algorithm. Average survivor doses in the strata were corrected for DS86 random error ($\sigma$ = 0.45) by use of reduction factors. Poisson regression was used to model the corrected and uncorrected mortality rates with covariates for age at-time-of-bombing, age at-time-of-death and gender. Excess risks were in good agreement with risks in RERF Report 11 (Part 2) and the BEIR-V report. Bias due to DS86 random error typically ranged from $-$15% to $-$30% for both sexes, and all sites and models. The total bias, including diagnostic misclassification, of excess risk of nonleukemia for exposure to 1 Sv from age 18 to 65 under the non-constant relative projection model was $-$37.1% for males and $-$23.3% for females. Total excess risks of leukemia under the relative projection model were biased $-$27.1% for males and $-$43.4% for females. Thus, nonleukemia risks for 1 Sv from ages 18 to 85 (DRREF = 2) increased from 1.91%/Sv to 2.68%/Sv among males and from 3.23%/Sv to 4.02%/Sv among females. Leukemia excess risks increased from 0.87%/Sv to 1.10%/Sv among males and from 0.73%/Sv to 1.04%/Sv among females. Bias was dependent on the gender, site, correction method, exposure profile and projection model considered. Future studies that use LSS data for U.S. nuclear workers may be downwardly biased if lifetime risk projections are not adjusted for random and systematic errors. (Supported by U.S. NRC Grant NRC-04-091-02.) ^

Bias na Representação de Assunto: Uma Discussão de Oposições Binárias nos Functional Requirements for Subject Authority Data (FRSAD)

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Perceções sociais dos portugueses face aos riscos associados às alterações climáticas

O aquecimento do sistema climático é inequívoco e a influência humana é clara. A continuação da emissão de gases com efeito de estufa irá potenciar os impactes das alterações climáticas, representando um compromisso futuro que se perpetuará por vários séculos. As alterações climáticas não proporcionam uma experiência sensorial direta, embora as variações de temperatura e de precipitação e os extremos climáticos de vários tipos poderem ser experienciados. O cidadão comum não se apercebe do que está a acontecer, a menos que ocorram mudanças significativas, no estado normal do tempo para uma determinada época, na região do mundo onde ele vive. Mesmo para os especialistas, o problema só é cognoscível através de uma vasta rede científica, técnica e institucional. O conhecimento, é portanto, transmitido ao público em geral maioritariamente através de representações dos media sobre o discurso produzido pela comunidade científica. O principal objetivo deste trabalho é averiguar a interligação entre o discurso científico, o discurso mediático e as perceções da população portuguesa na temática das alterações climáticas. A metodologia utilizada, para a prossecução do objetivo, num trabalho que cruza o domínio científico da engenharia do ambiente com o das ciências sociais, encontra-se dividida em 3 fases principais: (1) Uma primeira fase onde se realiza uma análise ao discurso científico de produção nacional, com uma análise de conteúdo aos resumos dos artigos científicos, utilizando 884 resumos da base de dados Scopus de 1975 a 2013 com a palavra-chave ‘Climate Change’; (2) Uma segunda fase onde se analisa o conteúdo de notícias de meios de comunicação social portugueses, aplicando uma análise de conteúdo a 4340 notícias veiculadas por 4 órgãos de comunicação social (Correio da Manhã, Público, RTP e TSF) entre 2004 e 2013, utilizando os respetivos motores de busca online com a palavra-chave ‘Alterações Climáticas’; e, (3) uma terceira fase onde se compila a informação dos estudos existentes sobre a população portuguesa, utilizando os dados dos Eurobarómetros que incluem o tema das alterações climáticas de 1982 a 2014. Seguindo uma linha condutora que inclui o discurso científico, o discurso mediático e as perceções sociais, almejou-se uma abrangência do tema das alterações climáticas, investigando a existência do fenómeno e as respetivas causas, as consequências com a análise dos impactes e dos riscos associados a esses impactes e as soluções através de medidas de mitigação e de adaptação. Nos principais resultados emerge a evidência de que a intensidade de crescimento da produção científica nacional não se traduz num crescimento consistente dos índices de noticiabilidade dos órgãos de comunicação social e desde 2010 que o número de dias por ano, sem notícias sobre alterações climáticas, ultrapassa dos 50%. Em consequência, os níveis de informação da população portuguesa sobre as alterações climáticas são sistematicamente inferiores à média europeia. Em Portugal as taxas de pouco ou nulo conhecimento rondam os dois terços de inquiridos. Não obstante o seu caráter contínuo, para que as alterações climáticas se tornem alvo de interesse dos media é necessário que ocorram reuniões políticas, encontros científicos ou outros acontecimentos. A visibilidade alcançada pelos acontecimentos nacionais é muito fraca e os acontecimentos meteorológicos extremos, não são frequentemente relacionados com o fenómeno das alterações climáticas. No seio da comunidade científica portuguesa existe um claro consenso sobre a existência das alterações climáticas e das suas causas antropogénicas. No discurso mediático português não se verifica enviesamento da informação não sendo surpreendente os baixos níveis de ceticismo dos portugueses. A abordagem aos impactes das alterações climáticas, tanto no discurso científico como no discurso mediático, é robusta e em 2014, cerca de sete em dez portugueses afirma que as alterações climáticas são um problema muito sério. Contudo, Portugal apresenta a proporção mais baixa da Europa de respondentes que percepcionam as alterações climáticas como o problema mais grave que o mundo enfrenta. Para estes resultados poderá contribuir a baixa inclusão de termos relacionados com o risco, tanto no discurso científico como no mediático, não ultrapassando os 20%. Tanto o discurso científico como o discurso mediático não estão direcionados para as soluções (mencionando especificamente medidas de mitigação ou medidas de adaptação). A menção às medidas de mitigação e às medidas de adaptação não ultrapassam os 16% no discurso científico e apresentam valores ainda mais baixos no discurso mediático (13%). Em ambos os discursos existe uma clara preferência pela menção às medidas de adaptação em detrimento das medidas de mitigação. Com valores tão baixos na abordagem às soluções das alterações climáticas não surpreendem os também diminutos níveis de responsabilidade que a população portuguesa atribui a si própria no combate às alterações climáticas.

Mesures subjectives et épidémiologie : problèmes méthodologiques liés à l'utilisation des techniques psychométriques

L’utilisation des mesures subjectives en épidémiologie s’est intensifiée récemment, notamment avec la volonté de plus en plus affirmée d’intégrer la perception qu’ont les sujets de leur santé dans l’étude des maladies et l’évaluation des interventions. La psychométrie regroupe les méthodes statistiques utilisées pour la construction des questionnaires et l’analyse des données qui en sont issues. Ce travail de thèse avait pour but d’explorer différents problèmes méthodologiques soulevés par l’utilisation des techniques psychométriques en épidémiologie. Trois études empiriques sont présentées et concernent 1/ la phase de validation de l’instrument : l’objectif était de développer, à l’aide de données simulées, un outil de calcul de la taille d’échantillon pour la validation d’échelle en psychiatrie ; 2/ les propriétés mathématiques de la mesure obtenue : l’objectif était de comparer les performances de la différence minimale cliniquement pertinente d’un questionnaire calculée sur des données de cohorte, soit dans le cadre de la théorie classique des tests (CTT), soit dans celui de la théorie de réponse à l’item (IRT) ; 3/ son utilisation dans un schéma longitudinal : l’objectif était de comparer, à l’aide de données simulées, les performances d’une méthode statistique d’analyse de l’évolution longitudinale d’un phénomène subjectif mesuré à l’aide de la CTT ou de l’IRT, en particulier lorsque certains items disponibles pour la mesure différaient à chaque temps. Enfin, l’utilisation de graphes orientés acycliques a permis de discuter, à l’aide des résultats de ces trois études, la notion de biais d’information lors de l’utilisation des mesures subjectives en épidémiologie.

Development of the Andalusian Registry of Patients Receiving Community Case Management, for the follow-up of people with complex chronic diseases.

Background: Complex chronic diseases are a challenge for the current configuration of Health services. Case management is a service frequently provided for people with chronic conditions and despite its effectiveness in many outcomes, such as mortality or readmissions, uncertainty remains about the most effective form of team organization, structures, and the nature of the interventions. Many processes and outcomes of case management for people with complex chronic conditions cannot be addressed with the information provided by electronic clinical records. Registries are frequently used to deal with this weakness. The aim of this study was to generate a registry-based information system of patients receiving case management to identify their clinical characteristics, their context of care, events identified during their follow-up, interventions developed by case managers, and services used. Methods and design: The study was divided into three phases, covering the detection of information needs, the design and its implementation in the healthcare system, using literature review and expert consensus methods to select variables that would be included in the registry. Objective: To describe the essential characteristics of the provision of ca re lo people who receive case management (structure, process and outcomes), with special emphasis on those with complex chronic diseases. Study population: Patients from any District of Primary Care, who initiate the utilization of case management services, to avoid information bias that may occur when including subjects who have already been received the service, and whose outcomes and characteristics could not be properly collected. Results: A total of 102 variables representing structure, processes and outcomes of case management were selected for their inclusion in the registry after the consensus phase. Total sample was composed of 427 patients, of which 211 (49.4%) were women and 216 (50.6%) were men. The average functional level (Barthel lndex) was 36.18 (SD 29.02), cognitive function (Pfeiffer) showed an average of 4.37 {SD 6.57), Chat1son Comorbidity lndex, obtained a mean of 3.03 (SD 2.7) and Social Support (Duke lndex) was 34.2 % (SD 17.57). More than half of patients include in the Registry, correspond lo immobilized or transitional care for patients discharged from hospital (66.5 %). The patient's educational level was low or very low (50.4%). Caregivers overstrain (Caregiver stress index), obtained an average value of 6.09% (SD 3.53). Only 1.2 % of patients had declared their advanced directives, 58.6 had not defined the tutelage and the vast majority lived at home 98.8 %. Regarding the major events recorded at RANGE Registry, 25.8 % of the selected patients died in the first three months, 8.2 % suffered a hospital admission at least once time, 2.3%, two times, and 1.2% three times, 7.5% suffered a fall, 8.7% had pressure ulcer, 4.7% had problems with medication, and 3.3 % were institutionalized. Stroke is the more prevalent health problem recorded (25.1%), followed by hypertension (11.1%) and COPD (11.1%). Patients registered by NCMs had as main processes diabetes (16.8%) and dementia (11.3 %). The most frequent nursing diagnoses referred to the self-care deficit in various activities of daily living. Regarding to nursing interventions, described by the Nursing Intervention Classification (NIC), dementia management is the most used intervention, followed by mutual goal setting, caregiver and emotional support. Conclusions: The patient profile who receive case management services is a chronic complex patient with severe dependence, cognitive impairment, normal social support, low educational level, health problems such as stroke, hypertension or COPD, diabetes or dementia, and has an informal caregiver. At the first follow up, mortality was 19.2%, and a discrete rate of readmissions and falls.

Attention and memory bias for body image and health related information using an Emotional Stroop task in a non-clinical sample

It has been proposed that body image disturbance is a form of cognitive bias wherein schemas for self-relevant information guide the selective processing of appearancerelated information in the environment. This threatening information receives disproportionately more attention and memory, as measured by an Emotional Stroop and incidental recall task. The aim of this thesis was to expand the literature on cognitive processing biases in non-clinical males and females by incorporating a number of significant methodological refinements. To achieve this aim, three phases of research were conducted. The initial two phases of research provided preliminary data to inform the development of the main study. Phase One was a qualitative exploration of body image concerns amongst males and females recruited through the general community and from a university. Seventeen participants (eight male; nine female) provided information on their body image and what factors they saw as positively and negatively impacting on their self evaluations. The importance of self esteem, mood, health and fitness, and recognition of the social ideal were identified as key themes. These themes were incorporated as psycho-social measures and Stroop word stimuli in subsequent phases of the research. Phase Two involved the selection and testing of stimuli to be used in the Emotional Stroop task. Six experimental categories of words were developed that reflected a broad range of health and body image concerns for males and females. These categories were high and low calorie food words, positive and negative appearance words, negative emotion words, and physical activity words. Phase Three addressed the central aim of the project by examining cognitive biases for body image information in empirically defined sub-groups. A National sample of males (N = 55) and females (N = 144), recruited from the general community and universities, completed an Emotional Stroop task, incidental memory test, and a collection of psycho-social questionnaires. Sub-groups of body image disturbance were sought using a cluster analysis, which identified three sub-groups in males (Normal, Dissatisfied, and Athletic) and four sub-groups in females (Normal, Health Conscious, Dissatisfied, and Symptomatic). No differences were noted between the groups in selective attention, although time taken to colour name the words was associated with some of the psycho-social variables. Memory biases found across the whole sample for negative emotion, low calorie food, and negative appearance words were interpreted as reflecting the current focus on health and stigma against being unattractive. Collectively these results have expanded our understanding of processing biases in the general community by demonstrating that the processing biases are found within non-clinical samples and that not all processing biases are associated with negative functionality

Task relevance of emotional information affects anxiety-linked attention bias in visual search

Task relevance affects emotional attention in healthy individuals. Here, we investigate whether the association between anxiety and attention bias is affected by the task relevance of emotion during an attention task. Participants completed two visual search tasks. In the emotion-irrelevant task, participants were asked to indicate whether a discrepant face in a crowd of neutral, middle-aged faces was old or young. Irrelevant to the task, target faces displayed angry, happy, or neutral expressions. In the emotion-relevant task, participants were asked to indicate whether a discrepant face in a crowd of middle-aged neutral faces was happy or angry (target faces also varied in age). Trait anxiety was not associated with attention in the emotion-relevant task. However, in the emotion-irrelevant task, trait anxiety was associated with a bias for angry over happy faces. These findings demonstrate that the task relevance of emotional information affects conclusions about the presence of an anxiety-linked attention bias.

Denying the foreseeability of an event as a means of self-protection. The Impact of Self-Threatening Outcome Information on the Strength of the Hindsight Bias

The hindsight bias represents the tendency of people to falsely believe that they would have predicted the outcome of an event, once the outcome is known. Two experiments will be presented that show a reduction or even reversal of the hindsight bias when the outcome information is self-threatening for the participants. Participants read a report of an interaction between a man and a woman that ended with different outcomes: The woman was raped vs. the woman was not raped vs. no outcome information was given. Results of the first experiment indicated that especially female participants, who did not accept rape myths, showed a reversed hindsight bias, when they received the rape outcome information. The more threatening the rape outcome had been, the lower was their estimated likelihood of rape. Results of the second experiment confirmed those of the first. Female participants, who did not accept rape myths and perceived themselves highly similar to the victim, showed a strong reversed hindsight bias, when threatened by the rape outcome, whereas female participants, who did believe in rape myth and were not similar to the victim, showed a classical hindsight bias. These effects were interpreted in terms of self-serving or in-group serving functions of the hindsight bias: Participants deny the foreseeability of a self-threatening outcome as a means of self-protection even if they are not personally affected by the negative information, but a member of their group.

Information and the evolution of codon bias

The informational properties of biological systems are the subject of much debate and research. I present a general argument in favor of the existence and central importance of information in organisms, followed by a case study of the genetic code (specifically, codon bias) and the translation system from the perspective of information. The codon biases of 831 Bacteria and Archeae are analyzed and modeled as points in a 64-dimensional statistical space. The major results are that (1) codon bias evolution does not follow canonical patterns, and (2) the use of coding space in organsims is a subset of the total possible coding space. These findings imply that codon bias is a unique adaptive mechanism that owes its existence to organisms' use of information in representing genes, and that there is a particularly biological character to the resulting biased coding and information use.

Addressing issues in sparseness, ecological bias and formulation of the adjacency matrix in Bayesian spatio-temporal analysis of disease counts

The main objective of this PhD was to further develop Bayesian spatio-temporal models (specifically the Conditional Autoregressive (CAR) class of models), for the analysis of sparse disease outcomes such as birth defects. The motivation for the thesis arose from problems encountered when analyzing a large birth defect registry in New South Wales. The specific components and related research objectives of the thesis were developed from gaps in the literature on current formulations of the CAR model, and health service planning requirements. Data from a large probabilistically-linked database from 1990 to 2004, consisting of fields from two separate registries: the Birth Defect Registry (BDR) and Midwives Data Collection (MDC) were used in the analyses in this thesis. The main objective was split into smaller goals. The first goal was to determine how the specification of the neighbourhood weight matrix will affect the smoothing properties of the CAR model, and this is the focus of chapter 6. Secondly, I hoped to evaluate the usefulness of incorporating a zero-inflated Poisson (ZIP) component as well as a shared-component model in terms of modeling a sparse outcome, and this is carried out in chapter 7. The third goal was to identify optimal sampling and sample size schemes designed to select individual level data for a hybrid ecological spatial model, and this is done in chapter 8. Finally, I wanted to put together the earlier improvements to the CAR model, and along with demographic projections, provide forecasts for birth defects at the SLA level. Chapter 9 describes how this is done. For the first objective, I examined a series of neighbourhood weight matrices, and showed how smoothing the relative risk estimates according to similarity by an important covariate (i.e. maternal age) helped improve the model’s ability to recover the underlying risk, as compared to the traditional adjacency (specifically the Queen) method of applying weights. Next, to address the sparseness and excess zeros commonly encountered in the analysis of rare outcomes such as birth defects, I compared a few models, including an extension of the usual Poisson model to encompass excess zeros in the data. This was achieved via a mixture model, which also encompassed the shared component model to improve on the estimation of sparse counts through borrowing strength across a shared component (e.g. latent risk factor/s) with the referent outcome (caesarean section was used in this example). Using the Deviance Information Criteria (DIC), I showed how the proposed model performed better than the usual models, but only when both outcomes shared a strong spatial correlation. The next objective involved identifying the optimal sampling and sample size strategy for incorporating individual-level data with areal covariates in a hybrid study design. I performed extensive simulation studies, evaluating thirteen different sampling schemes along with variations in sample size. This was done in the context of an ecological regression model that incorporated spatial correlation in the outcomes, as well as accommodating both individual and areal measures of covariates. Using the Average Mean Squared Error (AMSE), I showed how a simple random sample of 20% of the SLAs, followed by selecting all cases in the SLAs chosen, along with an equal number of controls, provided the lowest AMSE. The final objective involved combining the improved spatio-temporal CAR model with population (i.e. women) forecasts, to provide 30-year annual estimates of birth defects at the Statistical Local Area (SLA) level in New South Wales, Australia. The projections were illustrated using sixteen different SLAs, representing the various areal measures of socio-economic status and remoteness. A sensitivity analysis of the assumptions used in the projection was also undertaken. By the end of the thesis, I will show how challenges in the spatial analysis of rare diseases such as birth defects can be addressed, by specifically formulating the neighbourhood weight matrix to smooth according to a key covariate (i.e. maternal age), incorporating a ZIP component to model excess zeros in outcomes and borrowing strength from a referent outcome (i.e. caesarean counts). An efficient strategy to sample individual-level data and sample size considerations for rare disease will also be presented. Finally, projections in birth defect categories at the SLA level will be made.