Notes on the overlap measure as an alternative to the Youden index: How are they related?

The receiver operating characteristic (ROC) curve is frequently used to evaluate and compare diagnostic tests. As one of the ROC summary indices, the Youden index measures the effectiveness of a diagnostic marker and enables the selection of an optimal threshold value (cut‐off point) for the marker. Recently, the overlap coefficient, which captures the similarity between 2 distributions directly, has been considered as an alternative index for determining the diagnostic performance of markers. In this case, a larger overlap indicates worse diagnostic accuracy, and vice versa. This paper provides a graphical demonstration and mathematical derivation of the relationship between the Youden index and the overlap coefficient and states their advantages over the most popular diagnostic measure, the area under the ROC curve. Furthermore, we outline the differences between the Youden index and overlap coefficient and identify situations in which the overlap coefficient outperforms the Youden index. Numerical examples and real data analysis are provided.     

Introduction to the Special Issue on “Promoting a Culture of Prevention: an International Perspective”

Prevention Science - The primary goal of this special issue is to showcase novel, theory-driven, creative, and rigorous contributions to our understanding of the existence and development of a...     

The “no problems”-problem: an empirical analysis of ceiling effects on the EQ-5D 5L

Aim

To analyze the association between ceiling effects on the EQ-5D 5L and morbidity in a general population sample.

Methods

We used a cross-sectional sample of the German general population (n?=?5007) to describe the frequency of health state “11111” and “no problems”-answers on the five single dimensions stratified by the number of diseases for which participants utilized health care during the last 6 months. For the five single dimensions we also used specific criteria to analyze their discriminative ability. A logit-model was applied for a multivariate analysis of ceiling effects.

Results

31% of participants reported the health state “11111.” This percentage strongly decreased with increasing morbidity, down to 4.9% if four or more diseases were present. The dimensions “mobility,” “usual activities,” and “pain/discomfort” showed good discriminative abilities. The dimensions “anxiety/depression” and “self -care” were able to discriminate between different levels of morbidity, but nevertheless showed strong ceiling effects, in particular “self-care.”

Conclusion

When analyzing ceiling effects of the EQ-5D 5L, one has to draw attention to morbidity since high proportions of participants indicating the best health state might result from being healthy regarding the dimensions assessed by the EQ-5D, in particular in general population datasets.

     

Using Zoning as a Public Health Tool to Reduce Oversaturation of Alcohol Outlets: an Examination of the Effects of the New “300 Foot Rule” on Packaged Goods Stores in a Mid-Atlantic City

Prevention Science - The oversaturation of alcohol outlets can have disastrous public health consequences. The goal of this study was to evaluate the potential impact of new zoning legislation,...     

Paying for Cures: Perspectives on Solutions to the “Affordability Issue”

Curative therapies and other medicines considered “game-changing” in terms of health gain can be accompanied by high demand and high list prices that pose budget challenges to public and private payers and health systems—the so-called affordability issue. These challenges are exacerbated when longer term effectiveness, and thus value for money, is uncertain, but they can arise even when treatments are proven to be highly cost-effective at the time of launch. This commentary reviews innovative payment solutions proposed in the literature to address the affordability issue, including the use of credit markets and of staged payments linked to patient outcomes, and draws on discussions with payers in the United States and Europe on the feasibility or desirability of operationalizing any of the alternative financing and payment strategies that appear in the literature. This included a small number of semistructured interviews. We conclude that there is a mismatch between the enthusiasm in the academic literature for developing new approaches and the scepticism of payers that they can work or are necessary. For the foreseeable future, affordability pressures will continue to be handled by aggressive price bargaining, high co-pays (in systems in which this is possible), and restricting access to subgroups of patients. Of the mechanisms we explored, outcomes-based payments were of most interest to payers, but the costs associated with operating such schemes, together with implementation challenges, did not make them an attractive option for managing affordability.     

“We know the streets:” race,place, and the politics of harm reduction

This paper explores how a peer-and street-based naloxone distribution program (Bmore POWER) reshapes narratives and practices around drug use and harm reduction in an urban context with an enduring opioid epidemic. Data collection included observations of Bmore POWER outreach events and interviews with peers. Bmore POWER members create a sense of community responsibility around overdose prevention and reconfigure overdose hotspots from places of ambivalence to places of grassroots action. It expands a harm reduction approach to Black communities that have not traditionally embraced it and that have been underserved by drug treatment programs. Policy makers should consider ways to use peers grounded in specific communities to expand other aspects of harm reduction, such as syringe and support services.     

“Putting Meat on the Bones”: Understanding the Implementation of a Community-Based Early Intervention and Prevention Programme—Contextual,Person, and Programme Influences

Prevention Science - The adoption and effective delivery of evidence-based interventions within “real-world” community-based, primary health care service settings are of crucial...     

“Yes they have the right to know,but…”: Young Adult Women Managing Private Health Information as Dependents

This study explored how young adult women manage privacy regarding their health information as dependents on a parent’s insurance policy. Under current and proposed health care reform in the United States, young adults between the ages of 18 and 26 years can remain on a parent’s policy as a dependent, which can improve young adult’s access to health care services. Although dependent expansion provisions can improve coverage for young adults, it may also threaten their privacy by giving a parent access to adult-child’s private health information. Using Communication Privacy Management, this study investigated how dependent young adult women conceptualize and negotiate information ownership with parents in a forced disclosure situation. Results revealed young adult women either felt they alone should own and control their health information or believed a parent as the policy hold should have access to the information. However, all preferred to be in control of the disclosure and used core and catalyst criteria to manage the privacy dilemma current health care policy creates. Specifically, the threat of a parent seeing an adult-child used a stigmatized health service motivated young adult women to engage in deception, pay out of pocket for services covered by insurance, and put off or avoid health care. Results of this study complicate assumptions about privacy management and demonstrate how health care policy affects family communication.     

Birth weight,infant growth,and adolescent blood pressure using twin status as an instrumental variable in a Chinese birth cohort: “Children of 1997”

PurposeTo evaluate the credibility of twin status as an instrumental variable for birth weight and infant growth and to obtain less-confounded estimates of the associations of birth weight or infant growth with adolescent blood pressure (BP).MethodsProspective population-based “Children of 1997” birth cohort of all surviving infants born in Hong Kong, China, from April to May 1997 with sex-, age-, and height-specific BP z-score at approximately 11 years (n = 6276) and approximately 13 years (n = 5305).ResultsIn instrumental variable analyses, birth weight-for-gestational age z-score was not associated with z-score for systolic BP (0.01; 95% confidence interval [CI], −0.22 to 0.25) or diastolic BP (0.04; 95% CI, −0.09 to 0.18) at approximately 11 years adjusted for maternal age and migrant status (F = 38.6). Change in weight z-score at 0 to 12 months was not associated with z-score for systolic BP (−0.003; 95% CI, −0.15 to 0.15) or diastolic BP (−0.02; 95% CI, −0.10 to 0.07) at approximately 11 years (F = 54.4). Estimates were similar for BP at approximately 13 years, although the F-statistic was lower.ConclusionsBirth weight and infant growth may make little contribution to adolescent BP. Extending consideration of the effects of early life to other growth periods, such as puberty, on BP might yield public health benefits.     

From empathic mind to moral behaviour: the “who”, “why” and “how”

In this paper, I start by suggesting a new definition of empathy. I go on by answering the question of “Who feels empathy?”. I list some examples of people, illustrating how the level of feeling empathy differs from one category of people to another. It’s actually almost everybody who feels empathy: the baby, the good Samaritan and the other two priests, the tax evader, the psychopath, the judges, juries, lawyers, the politician, the bully adolescent, the therapist, etc.… Then I explain, “Why empathy is experienced/felt differently?”, by drawing on some neuroscience data, and some literature in psychology or philosophy along with some personal suggestions or assumptions. Just to mention one plausible data: we know that the human brain is half developed at birth. It takes twelve to fourteen years for the brain to fully develop. And the frontal lobe continues to develop until the third decade of life! I suggest we must attend to these phases of brain development to learn empathy since that is when the plasticity of the brain and the learning kick-in. Hence, the third section of the paper demonstrates “How can we develop an empathic mind/behaviour given the nature of our empathic brain?”: with some supportive research and studies, I justify the statement that “ideally from early age, and all the way up to adulthood, empathy can be learned through nurturing, education, imitation…, through alternative realities such as mindfulness and awareness, and through therapy, memory improvement, training programs, etc.…” In the conclusion, I assert, using some philosophical thoughts and analogies, that a fully developed empathic behaviour, that embraces all three aspects cognitive, affective and compassionate empathy, being the opposite of indifference, is the vehicle to a peaceful, harmonious and just society.     

“You get that craving and you go for a half-hour run”: Exploring the acceptability of exercise as an adjunct treatment for substance use disorder

IntroductionThere is a need for effective, inexpensive and scalable interventions in the treatment of substance use disorder (SUD). An adjunct intervention that warrants exploration is exercise.ObjectiveTo examine the acceptability of exercise as an adjunct treatment for individuals in residential treatment for SUD. The secondary objective is to guide exercise intervention development for this population.MethodsAfter an acclimatization period where the first author spent four weeks volunteering at the treatment facility, semi-structured interviews were conducted with adult individuals (mean = 38.93, range 23–58) with SUD in residential treatment (n = 15) to assess the acceptability of exercise as an adjunct treatment. A thematic analysis was conducted using deductive and inductive methods. The interview guide and analysis were informed by the Capability, Opportunity, Motivation- Behaviour (COM-B) model and the Theoretical Domains Framework (TDF).ResultsExercise was considered an acceptable adjunct treatment for SUD. Three themes were identified as prudent for informing intervention development. Participants were 1) receptive to exercise but some lacked the knowledge and skills to participate; 2) aware of opportunities to exercise but these are often underutilized, and 3) looking ahead to life after treatment.ConclusionsThis study provides insight into the acceptability and receptiveness of residential SUD treatment to exercise programming. Our results provide direction for developing an exercise counselling intervention embedded within the residential treatment context.