French health insurance for salaried executes algorithms on its databases with a public health purpose. The following published articles aim to target potential deviant behaviours or abuses that put at risk the health of the insured.
Working on databases we should always be aware of the possibility of a re-identification attack on the data we release in our publications. Such possibilities are in fact very rare because we aggregate all our data in the articles we submit to publishers. Nevertheless the odds that our data could be re-identified are to be known. Mathematicians have brilliantly addressed the issue in the article referenced below:
Title: A Game Theoretic Framework for Analyzing Re-Identification Risk
Authors: Zhiyu Wan, Yevgeniy Vorobeychik, Weiyi Xia, Ellen Wright Clayton, Murat Kantarcioglu, Ranjit Ganta, Raymond Heatherly, Bradley A. Malin
Link to the article full text
Clearly the balance has to be found between on one hand the fines paid for the consequences of privacy violation and on the other hand the gain for authors and publishers in terms of respectively grants,notoriety,transparency, and audience for releasing accurate data and practicing data sharing which is what research is heading toward.
Recent researches found that the south north gradient of the occurrence of multiple sclerosis is diminishing in the USA and doesn’t exist anymore in France.
Here are the two articles:
Alvaro Alonso, MD Miguel A. Herna ́n, MD
Temporal trends in the incidence of multiple sclerosis A systematic review
Neurology 71 July 8, 2008
Available in full text here:
Fromont A, Binquet C, Sauleau EA, Fournel I, Bellisario A, Adnet J, et al. Geographic variations of multiple sclerosis in France. Brain 2010;133:1889-99.OpenUrlAbstract/FREE Full Text http://brain.oxfordjournals.org/content/brain/133/7/1889.full.pdf
Thus the epidemiology of multiple sclerosis seems to shift toward a less intense south north gradient but in the same time an aggravation of the sex ratio, aggravating the burden that women bear in this inflammatory disease that affects the central nervous system (i.e. the central unit of our body in terms of information technologies).
This tendency opens new interests for more epidemiological studies in this field. All the more because the observational studies aiming to prove the mixed, genetic and environmental, etiology are entangled with the current migrations of populations, the mobility of young people in view of finding a job and the changes in life habits in the populations of the south such as using more protection against the sun rays.
Professor Confavreux had well depicted the stakes in this editorial:
An unchanging man faced with changing times Christian Confavreux
DOI: http://dx.doi.org/10.1093/brain/aws135 1663-1665 First published online: 24 May 2012
For the present moment multiple sclerosis etiological mechanism is an enigma and risks to remain so if researchers in the domain have no new data to crunch at the populational level.
Joel Kallich of Big Health Data wrote me: Over the last 30 years, the government has been reluctant to release identifiable information, first on an
via The value of identifiable research data.
Life is a permanent flow: one has to let go the past and present in order to authorize freely the next event of one’s life to happen. If not, a damp will interrupt the flow, which is not a good thing from a sound and balanced living perspective.
One has to live a life which is intrinsically ever changing, and thus which is anxiety provoking.
The only thing that is permanent is one’s awareness of being present in the present moment, which by itself is a blessing one should be grateful for .
At that point meditation, wether by focusing on an action like breathing or walking or by observing with detachment the course of our thoughts and feelings created by our mind or by exercising compassion and loving kindness towards other sentient beings can be of some help.
By the way it has been demonstrated by neuro-scientists that meditation modifies the way the brain functions and even the size of some brain regions.
I read an article on this subject in the November 2014 edition of the journal Scientific American entitled Mind of the Meditator, authored by Mathieux Ricard a Buddhist Monk, Antoine Lutz a research scientist at the Frenh National Institute of Health and Medical Research and Richard J Davidson from the University of Wisconsin-Madison.
They conclude that
“even with the requisite cautions, research on meditation provides new insights into methods of mental training that have the potential to enhance human health and well-being”
Here below is a link toward a time series published by the French Agency for pharmaceutical safety (aka ANSM). Although the method is well described and doesn’t raise any concern, nevertheless the interpretation that is done from the results in the discussion is subjected to caution.
My expression of concern is motivated by the fact that the authors of the study link the lowering of the incidence of pulmonary embolism to the lowering of sales of third and fourth generations of contraceptive pills.
Indeed a cofactor can explain the concomitant lowering of both time series:
the large warning campaign in the medias with messages about a) the risks attached to those third and fourth generations of contraceptive pills AND b) the risks of pulmonary embolism (ie blood clots in the lung) every woman faces under contraceptive pills, no matter the generation of the contraceptive pill.
Thus the practitioners could have been more attentive to the risk for all their patients and stopped the contraceptive pill, even for the first and second generation of pill, in case of any doubt (eg a phlebitis of the leg or a tobacco addiction).
One thing is for sure: the results of this study show that the campaign in the media had an impact in term of public health, but no causality can be formally drawn between the lowering of the sales of the third and fourth generations of contraceptive pills and the lowering of pulmonary embolism from the results of this study.
Etude de l’impact de la modification récente des méthodes de contraception sur la survenue d’embolies pulmonaires chez les femmes de 15 à 49 ans (07/11/2014) application/pdf (316 ko)
For persons enduring a severe disability, daily life is a full time job.
Two bloggers share courageously with us their daily struggles to show the amount of supplementary efforts they have to produce just to save an appearance of fluidity (not to say normality).
One blogger compares disability with an iceberg whose greater part is not visible:
An other blogger compares disability with an handful of a limited number of spoons. All seems normal to the surrounding peoples who examine her life as long as she has a sufficient number of spoons left in her hand. But each daily life efforts along the day takes one spoon away from her and when there is only one left in her hand she must stop for the rest of the day and all the activities she has still to do must wait for the next day:
The body of work that economists have done on the field of relationship between happiness and disability shows that not only the disabled persons themselves are less happy but also are their spouses, although this must be tempered by the numerous adaptive strategies that the couple puts in place.
A resume of the scientific literature here:
Journal of Public Economics
June 2008, Vol.92(5):1061–1077, doi:10.1016/j.jpubeco.2008.01.002
Does happiness adapt? A longitudinal study of disability with implications for economists and judges
Andrew J. OswaldNattavudh Powdthavee
Social Science & Medicine
December 2009, Vol.69(12):1834–1844, doi:10.1016/j.socscimed.2009.09.023
Part Special Issue: New approaches to researching patient safety
What happens to people before and after disability? Focusing effects, lead effects, and adaptation in different areas of life
Social Science & Medicine
April 2014, Vol.107:68–77, doi:10.1016/j.socscimed.2014.02.009
Is shared misery double misery?
Merehau Cindy MervinPaul Frijters
We find that the events befalling a partner on average have an effect about 15% as large as the effect of own events.
Quoted from :
Journal of Economic Psychology
August 2009, Vol.30(4):675–689, doi:10.1016/j.joep.2009.06.005
I can’t smile without you: Spousal correlation in life satisfaction
Epidemiology and geography since long ago share common interests.
Epidemiologists have always searched the causes of contagious diseases by locating the very place where the outbreak began. Hence the necessity to develop sophisticated geographical statistical analysis methods in order to localize the point from where the disease originates and then spread across the country. But nowadays those methods are also implemented by searchers to highlight high concentrations of non epidemic, chronic, degenerative diseases in a given country. Here the causal agent is no more a bacteria nor a virus but indeed a spot of concentration of social inequality (or pollution, depending of the research question ). If a geographical concentration exist of lack of knowledge of what a healthy behavior is, or of low incomes restraining access to a healthy life, then the analysis should uncover a higher prevalence of the degenerative disease at less this is the hypothesis. Here below is a link toward a paper very accurate in demonstrating how different geographical statistical analysis methods can lead to a variation in the epidemiological results obtained. This point is crucial to consider because were it Ebola virus or social inequality or educational level context, causes of diseases will always have something to do with geography!
Frontiers in Massive Data Analysis, from the National Research Council, nails some of the challenges of big data. But the challenges for massive data go beyond
via Big data challenges.
Two studies, whose material encompassed the Independent workers health plan data base, analyze the consumption of tranquilizers among various categories of professionals. Lawyers ranked high and pharmacists too.
Lawyers are confronted to conflictual situations by the nature of their work itself and pharmacists are tempted, being surrounded by the product itself; these are the two explanations that I could find for these intriguing results.
Here below are the links to the two studies (I contributed to the second paper).
1-Oxford JournalsMedicine & Health Occupational Medicine Volume 64, Issue 3Pp. 166-171.
Mental health and substance use among self-employed lawyers and pharmacists
S. Leignel1,2,3, J.-P. Schuster1,2,3, N. Hoertel1,2,3, X. Poulain1,2,3 and F. Limosin1,2,3
2-Presse Med. 2011 Apr;40(4 Pt 1):e173-80. doi: 10.1016/j.lpm.2010.10.026. Epub 2011 Jan 11.
[Psychotropic medication use by French active self-employed workers].
[Article in French]
Ha-Vinh P1, Régnard P, Sauze L.