Pressure or stress, in most humans, contributes to higher blood pressure. Sources for pressure are manifold and that is the basic problem. As it is hard to identify the major sources of high blood pressure, we often use a summary term “life style” in order to avoid shaming particular substances, (tabaco, red meat, alcohol to name just a few). Among life style elements is the daily rush to work and back home or bringing children to school and home again. Work itself is a major contributor as well. Leisure activities are not free of pressure in order to perform at a person’s best. As in many health topics, the balance does the trick. This is common knowledge beyond the Asian world as in their health philosophy of Yin and Yang. The Western world is proud to have the best and highest availability of medical treatment and hospitals for their populations, accepting some inequality in access nevertheless. For countries with less means for curative practices they have no choice and have to focus on preventive strategies (Lancet Study Link). Rural China, therefore, is a good case to study access and willingness to apply western medical type treatment of high blood pressure is too expensive and just not available in sufficient numbers. The good news is, with a preventive programme based on nurses rather than medical doctors the prevention of high blood pressure works reasonably well. Community health workers are therefore a cost-effective alternative in reducing blood pressure. Sitting is the new smoking, and driving around in a car rather than walking or cycling are health risks, even if the car or the chair is a very nice one.
The pandorra’s box is wide open. With ChatGPT applications the discussion has started to use it for more medical applications. As for much research having assistants to support you in routine tasks in your research is a standard procedure. Now the medical profession is also discussing the use of ChatGPT for the boring and time-consuming task to draft reports. The first study, published in the Lancet Digital Health, evaluates in a preliminary form the patient-sensitive form of communication between clinics and patients. Beyond chatbots, which organise information from calling persons, the obvious application is the use of ChatGPT to draft patient clinic letters. The example in the study is the skin cancer reporting. Lengthy reporting back to patients of lots of “hot and cold spots” might be done by AI with sufficient reliability. All depends on the correctness of the data base, the screening and samples taken. The communication between clinic and patient can then focus on other issues. ChatGPT just like neuroflash has its strength in being able to control for the “level” of the language. In addition to the choice of the output language it is possible to use, as it is required in the U.S., an average understanding level of patients. In other words, easy language rather than medical expert language is an option or even a requirement. Anecdotal evidence and the PISA for adults studies show how difficult it can be to talk the same language even if you talk the same language. There is ample scope for improvement and ChatGPT or neuroflash for German applications of AI are prime candidates to fill this gap in clinic patient communication. Considering that our mobile phones (can) do already most of the scanning of skin cancer dots and AI is used in pre-scanning the images and recommends to consult medical expertise, the next step to improve health delivery seems feasible. Whereas the statistical analysis explains 62% of “median humanness”, the score of 37% of explained variance of median correctness is a surprise as the basis of the model to explain deviation from correctness should be as low as possible. Medical data, like many other data, is not simply binary. The way forward is most likely relying on a “human-in-the-loop” approach for some time. A limited human input might reassure many patients as well.
Source: Stephen R Ali, Thomas D Dobbs, Hayley A Hutchings, Iain S Whitaker (2003). Using ChatGPT to write patient clinic letters. Lancet Digit Health 2023 https://doi.org/10.1016/S2589-7500(23)00048-1
V for Value
Value in its singular form refers for most people to the value of things. Since Karl Marx we have been fighting about the surplus value of a worker’s work. Nowadays, we have to deal with speculation bubbles on the value of property or even basic elements of nutrition (Water, wheat, energy). Max Weber introduced us to the rigorous analysis of value judgements. In political science the plural “values” refers to basic human rights as fundamental values of humanity. Many other associations with the letter V pop up and arouse emotions: victory, video, view(s), vision, visit, voice, vote, vulnerability.
Creating lasting value seems to transform itself into part of our system of values later on. The longitudinal dimension of value is often neglected, particularly in the short-term focus of much of economic reasoning. Value over time, in addition to the distribution question, or as part of distribution over time, excites researchers of inequality and policy design for generations. Approaching the end of the alphabet increases the stakes of the “endgame”, it seems. Value for me, might not be of value for others. I hope you have found a person that values much of the same as you do yourself.
Interpersonal value, value exchange and intertemporal value are own fields of research. Since the Scottish enlightenment and Adam Smith’s work on “The theory of moral sentiments (TMS)”, reciprocity in value exchange has been an issue, well before the utilitarian turn in his own writings on “The wealth of nations”. Even Adam Smith refers to happiness and interest as a kind of value and “very laudable principles of actions” (part VII.ii.3.15 in TMS).
Children learn and experience value as natural part of growing up. Material things which you valued highly as toddler, you are ready to trash or exchange a couple of years later at much lower prices. Above which monetary value are you ready to trade in your humanitarian values? Never? History and bargaining theory is full of experiments and experiences that teach us otherwise. Corruption is the prominent example of exchanging or trading material value against immaterial values. Reading Kwame Anthony Appiah on “Experiments in ethics” is highly instructive. This bring me back to the economist joke I used to tell in lectures: You know that you’re an economist, if you ask your child, whether s/he prefers 20 Euros in cash, a trip to an adventure park later, a basket ball set or a pizza party for the next birthday. Economists do all this to find out about the value of each item, the preferences, the time frame of delayed reward or discounting of value also called the net-present value. Reading up to here is equal to the value of, maybe, an online bachelor in economics or social science. In your very own life review of learnings you then can estimate the value of your readings to you, your community or humanity. Alternatively, enjoy the joy of just living in peace with optimism.
Chopin + Sand
Frédéric Chopin und George Sand erschufen ein Lehrstück zum besseren Verständnis des Mäzenatentums. Die Autorin und Zeitungsverlegerin George Sand hat es Chopin ermöglicht, sich auf den Landsitz im Sommer zurückzuziehen und sich fern der Hektik von Paris auf das Komponieren zu konzentrieren. Chopin‘s Frustration über die 1837 aufgelöste Verlobung, die der Vater der Geliebten initiiert hat, hat sicherlich der Gesundheit und psychischen Verfassung des Komponisten einen weiteren Schlag versetzt (Ganche & Saint-Saens, 1913). George Sand kannte Chopin seit dem Abend, an dem sie Chopin in einem Pariser Salon Franz Liszt vorgestellt hatte. Hinzu kam die Ermöglichung in der Nachbarschaft einer Wohnung am Place Pigalle (Montmartre, Paris) eine preiswerte Untermiete bei derselben Gönnerin zu beziehen. Die in Polen lebenden Geschwister und Verwandten von Chopin haben sich persönlich bei George Sand bedankt und die Notwendigkeit erwähnt den mit Tuberkulose ringenden Musiker, der zusätzlich eine Tendenz hatte in Traumwelten abzudriften, mit Entscheidungshilfen beizustehen (Ganche, É. & Mercure de France, 1935). Diesem nahezu elterlichem Ansinnen auf nicht nur finanzielle Unterstützung, sondern auch psychologischer Begleitung wird die Schriftstellerin gut 7 Jahre lang gerecht. Die Aufenthalte auf dem Landsitz Nohant (région Indre ) werden für beide zu einer fantastischen Inspiration. Continue reading “Chopin + Sand”
Es ist schon mehr als 1 Jahr her. Die Einzelfallprüfung zur asymptomatischen Infektion war uns bekannt. Alle Alarmglocken hätten klingeln müssen. Aber weit über München scheint die anschließende Veröffentlichung im New England Journal of Medicine nicht ernsthaft gewürdigt worden zu sein. Mit #Covid-19 Infizierte Personen sind ansteckend bevor sie selbst Symptome zeigen. Heute freundlich begrüßt, infiziert und einige Tage später selbst erst die typischen Symptome. Das SARS-CoV-2-Virus hat die kommunikativ weit überlegene Species Homo sapiens einfach ausgetrickstSARS-CoV-2-Virus hat die kommunikativ weit überlegene Species Homo sapiens einfach ausgetrickst, indem es kommunikatives Handeln (Bisous,Bisous, talk, talk) als Schwäche ausnutzt für eine rapide Übertragung. Wir müssen nicht gleich ins Schweigekloster umziehen, aber unsere Kommunikation auf digitale Medien temporär umleiten. Das sollte uns doch nicht schwer fallen, wir haben damit die Technik das Virus zu übertrumpfen. Nur wollen müssen wir es. Das Leid der 52.000 CoronaToten und deren Angehörigen wird es nicht mehr lindern können, aber weiteres Leiden und die Arroganz der Überlebenden bleibt uns hoffentlich erspart. Daher heißt es jetzt: Klaus ist allein zuhaus.
With almost 6 months into COVID-19 in the USA since the first official case, the public health situation is still scary. Data and figures from the official U.S. Department of Health & Human Services, particularly the recent data release from the Centers for Disease Control and Prevention show around 50.000 new cases of Covid-19 every day again (see figure).
By using the data and calculating a simple linear trend shows the following evolution in case no policy change occurs.
Using a seasonality in the calculation of about 3 weeks (=20days) the evolution looks much different with huge margins of error.
Hence, all is possible by chart analysis or the language of investors. Public health analysts would rather look at the disaggregated state by state or even county be county detailed analysis. A seasonality of 3 weeks could make sense. With a high level Covid-19 cases in one state people move (also with Covid-19) to other states for one week exporting the virus. After 2 more weeks incubation, case numbers rise in this receiving area, which will make visitors (and the virus) move back again. A oscilating pattern of the spread of the virus will result, making a nationwide lockdown much more likely. In natural sciences (Video-Link)we call this coupled oscillation, here of Covid-19 between several US-states. (take Florida and New York for example).
Now, let us apply the same simple statistical modelling to the international level. As we enjoy Summer in Europe , in the southern hemisphere of the world Winter, Covid-19 and the flu are spreading there now. When we shall move from Autumn to Winter, we might receive another wave of cases from the other part of the world.
Conclusion: Get prepared for another wave as of now. Helping the global South now, saves lives in Autumn and Winter also in Europe. Simple isn’t it. Let’s just act accordingly (the not so simple part). Train health care professionals (95.000 of them got infected in the US and 500 !!! died).
On Mortality in EU
It is normal business for demographers to deal with mortality and the statistics of mortality. The latest data I found from official European statistics from Eurostat refer back to 2015. They mention 571.000 potentially avoidable deaths in the Europen Union of the 1.7 Million deaths among the population younger than 75 years of age, the lower bound of average life expectancy. A look at the leading causes of preventable death shows that prevention of deaths due to alcohol, smoking and environmental causes beyond suicide could safe more than 200.000 lifes per year! Please pause a while in front of these figures.
In Germany we deplore more than 900.000 deaths each year and according to the statistical office on an average day during the year we have 2100 persons leaving us. In a severe case of influenza these death rates jumped for example in February 2018 to more than 3.100 persons in one day. Hence, keep calm and carry on with taking Covid-19 seriously, but no reason to panic.
Taking a look at our Belgian neighbors, the public health statistics on Belgian Mortality show a cycllical pattern of mortality with peaks in January for the influenza period and sometimes on hot summer days.
Additionally, there are several severe environmental health hazards which we have gotten used to. Not much fuzz in public about these increased death rates any more. They include many preventable deaths as well. The deadly cocktail of fine particle dust in high traffic countries combined with peaks in temperature and ozone levels yield preventable peaks in death tolls across Europe not just in Belgian, different from region to region and city to city or suburbs or proximity to risky areas. No prove available yet, just coincidence data that need close monitoring. Please follow up on the web page of Epistat and the B-momo project.The EuroMoMo-project and data can be followed on the new webpage, commented by tagesschau.de on the 23.4.2020. Late data reporting as accused for UK by the Financial times needs to be followed closely for all countries.
Students should build their statistical methods skill and get ready to use the statistical software R for further analyses useful to produce nice figures and even better advanced analyses.
Health and Care
Some surveys in the social sciences remain a reference due to their interesting scope of questions included. The Canadian National Survey of the Work and Health of Nurses is such a survey since they “dared” to ask a representative sample of 18.000 nurses, health care workers and care assistants questions including medication errors, fall injuries, and complaints of older adults in Canada. The study by Zafar Mehdi, Ramzi Nasser, Hildegard Theobald and myself reveals the importance of further training and sufficient staffing to prevent medication errors, fall injuries and other complaints of patients. DOI: 10.5539/gjhs.v11n3p111
Besides the interesting results of this study based on a little used data set, the study should encourage and reward transparency of medical practices and analyses (relevant in #Covid-19). Hopefully many other studies, ideally with longitudinal designs, will build on this interesting kind of data collection. Evidence-based human resource policies should not stop in front of hospitals and care institutions. Unfortunately, such sensitive data are still rarely collected, although conclusions are helpful for nurses, patients and society as a whole.
The Link to the paper in the Global Journal of Health Sciences and the download is free of charge here. For science policy it is interesting to notice that the paper was part of a self-financed Ph.D. of Zafar Mehdi, accepted at the University of Vechta recently.