New Horizons in Health An Integrative Approach (2001) / Chapter Skim
Currently Skimming:
Methodology Priorities
Methodology Priorities
Pages 164-183
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 164... ...
Finally, the objective of unclerstancling complex systems at multiple levels of description poses new statistical challenges, beyond the reach of currently available techniques. These challenges extend to the need to design and evaluate multicomponent .
|
From page 165... ...
information, and multiple neurophysiological assessments (e.g., measures in the current allostatic load inventory, immune system assays of antibody responses to influenza and hepatitis A vaccine, EEG assessments of brain asymmetry, and fMRI assessments; e.g., Singer and Ryff, 1999~. The 1999 round of the National Long Term Care Survey contains an extensive array of biomarkers, including assessment of apolipoprotein E (apoE)
|
From page 166... ...
Gene expression studies on large populations that, until a few years ago would not have been feasible, can also now be considered in future data collection, thanks to microarray chip technology (see Chapter 4~. However, before delineating practical next steps regarding investment in longitudinal studies, it would be useful to consider what an optimal portfolio of such studies might be.
|
From page 167... ...
As indicated in other sections of this report (e.g., Chapters 2, 3, and 7) , there are few extant longitudinal surveys (birth cohorts in particular)
|
From page 168... ...
are central to pathway specifications relating to both negative and positive health outcomes (see Chapter 5~. Recent literature suggests that the emotional aspects of personal ties are salient features linking the psychosocial level of description to biology and downstream health consequences (Ryff and Singer, in press)
|
From page 169... ...
This should include measures of cumulative adversity and responses to short-term challenges that are reflected in shifts in allostatic load over the life course. Assessment of Positive Health and Resilience Pathways of resilience and of persistent flourishing require specification of the principal positive features of lives at the individual and community levels that are most strongly associated with the maintenance of allostasis (see Chapter 3~.
|
From page 170... ...
Linking these collective measures to psychosocial and biological indicators at the individual level is a critical priority for characterizing the full range of pathways discussed in this report. ADVANCING THE UNDERSTANDING OF BIOLOGICAL MECHANISMS Going beyond statistical association to address the mechanisms by which behavioral, psychological, and social factors operate at various levels requires methodological development.
|
From page 171... ...
With this knowledge, it is possible to formulate mechanistic hypotheses about how life events and psychosocial factors, insofar as they influence brain circuitry, can have downstream effects on the periphery and thereby influence health. Most extant research indicates variations in activation of the left prefrontal region with differences in approach-related positive affect (Sutton and Davidson, 1997~.
|
From page 172... ...
has utilized the notion of primary mediators leading to primary effects and then to secondary outcomes, which lead finally to tertiary outcomes that represent actual diseases. Primary mediators are chemical messengers released as part of allostasis.
|
From page 173... ...
could reveal the impact of allostatic load on cellular and humoral immune function and help distinguish between the immuno-enhancing effects of acute stress and the immunosuppressive effects of chronic stress. Tertiary outcomes are the actual diseases or disorders that are the result of the allostatic load predicted from the elevated/extreme values of the secondary outcomes and primary mediators.
|
From page 174... ...
A third aspect of the further operationalization of allostatic load that warrants further investigation is gender differences in resting levels and in transient response to challenges of particular primary mediators and secondary outcomes. For example, a higher proportion of elderly women show elevated levels of cortisol, epinephrine, and norepinephrine and low levels of DHEA-S.
|
From page 175... ...
The primary and secondary mediators linked to secondary and tertiary outcomes represent a system of multiple indicators reaching high risk levels over time and subsequently influencing diverse kinds of outcomes. Organizing these dynamics in a comprehensive statistical framework could involve the use of structural equation modeling, including the incorporation of latent variables to represent unmeasured biological parameters.
|
From page 176... ...
Statistical methodologies for the formation of coherent categories of pathways based on complex life histories are in their infancy. Such strategies are broadly referred to as person-centered methods, and they differ in both detail and objective from the widely available variablecentered techniques (Abbott and Hrycak, 1990; Cairns et al., 1998; Giele and Elder, 1998; Singer et al., 1998~.
|
From page 177... ...
Under the latter the construction of narratives is part of an analytical strategy designed to formulate a coherent picture of a life history as it relates to physiology and health outcomes. Effectively integrating narratives as data, narratives constructed as part of an analytical strategy, and numerical information is a major challenge in pathway specification urgently in need of research support.
|
From page 178... ...
What is needed are defensible strategies for designing and evaluating complex intervention programs where selfselection is a criterion for entry into the program. A quite sophisticated labor economics literature on this topic has developed in the context of evaluating manpower training programs (Heckman and Smith, 1995~.
|
From page 179... ...
They represent the clinical counterpart to the evaluation methodology for multicomponent primary prevention programs described above. Serious attention should be given to this much neglected but ever more important aspect of providing effective curative medicine for the U.S.
|
From page 180... ...
2. development of person-centered statistical methodologies to facilitate characterizations of predisease and positive health pathways that link behavioral, psychosocial, environmental, and biological levels of analysis; 3.
|
From page 181... ...
risk communication can be hard" Journal of the National Cancer Institute Monographs 25:7-13. Fischhoff B
|
From page 182... ...
Vickers MV, Sernmence A 1985 "Fibrinogen: A possible link between social class and coronary heart disease" BritisI7 Medical Journal 291:1312-1314.
|
From page 183... ...
Ryff CD. 1999 "Hierarchies of life histories and associated health risks" Annals of tI7e New York Academy of Sciences 896:96-115.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.