Using the E-Value to Assess the Potential Effect of Unmeasured Confounding in Observational Studies. Association of Optimism with Cardiovascular Events and All-Cause Mortality: A Systematic Review and Meta-analysis. Rozanski A, Bavishi C, Kubzansky LD, Cohen R. It would be a valuable service to the scientific community if, as with p-values and confidence intervals, observational studies would routinely report E-values.ġ. In summary, E-value analyses suggest moderate unmeasured confounding would refute causal associations between optimism and cardiovascular events or all-cause mortality. In subgroup analyses, no 95% CI E-values exceeded 2.5, suggesting that unmeasured confounders such as diet, comorbidity, or cultural norms could negate causal associations between optimism and cardiovascular events or all-cause mortality. Corresponding 95% CI E-values for relative risks were 1.9 for cardiovascular events and 1.4 for all-cause mortality. We calculated E-values for the relative risks in Table 2 in Rozanski et al. which are all known to impact the risk of CV events and mortality, as well as affect mood and optimism.Īn approach for conducting sensitivity analysis for unmeasured confounding is an E-value analysis, addressing how strong would any unmeasured confounding have to be to negate the observed results. results, including diet, exercise, wealth, comorbidities, cultural norms, social support networks, stress, sleep, etc. Unobservable confounders are more likely to explain the Rozanski et al. conclude that “…optimism is associated with a lower risk of cardiovascular events and all-cause mortality.” However, interventions promoting optimism and reducing pessimism may not actually reduce these risks. However, the study has not thoroughly investigated the potential effects of unmeasured confounders on the findings. concluded that “…optimism is associated with a lower risk of cardiovascular events and all-cause mortality”, finding a relative risk of 0.65 (95% CI: 0.51-0.78) and 0.86 (95% CI: 0.80-0.92) for the association with cardiovascular events and all-cause mortality, respectively.
Hay, MA, MPhil, PhDĭetermining causality with real world evidence is fraught with complexity as seen in recent JAMA Network Open papers. It is thus plausible that a more balanced interplay between “happiness hormones” brings about optimism, and is itself a basic promoter of good health and body function.Ĭo-authors: Sang Kyu Cho, PharmD, MPH, MS, Roy Zawadzki, Jeffrey Tran, MD, Luanda Grazette, MD, MPH, Nadine K. Similarly, panic disorder and social phobia are associated with a RH hyperactivity. There is evidence that post-traumatic stress disorder (PTSD) - where the original mental trauma is re-experienced through flashbacks and nightmares that re-activate the fear and stress responses - is coupled with an increase in RH activation. Higher levels of cortisol induced by stress and anxiety correlated with a greater RH activation. The RH greater involvement in mediating fearful experiences is reflected also in its significant role in regulating the stress hormone cortisol. These studies demonstrate how a high self-esteem and good appreciation of oneself are associated with the LH, while a low self-esteem and a negative attitude are linked with the RH. Likewise, neurological reports suggest that LH stroke patients, whose emotional and psychological profile presumably reflect the intact RH, have a relatively lower self-esteem, and their caregivers suffer from greater stress, as compared to RH stroke patients. In contrast, greater physiological activity in the frontal parts of the RH is associated with an increased risk of feeling hopeless about negative events in one's life, and a higher likelihood of falling into depression. “EEG studies revealed that a greater physiological activity in the frontal parts of the LH, relative to the RH, is associated with a higher self-esteem, a general sense of happiness and well-being, as well as a better resilience and recovery from an abusive childhood. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.
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