Causal pathway

Wilkinson indicates that he considers social cohesiveness to be an epiphe-nomenon. The evidence shows that where income differences are greater, violence tends to be more common, people are less likely to trust each other, and social relations are less cohesive. However, the impression that social cohesion is beneficial to health may be less a result of its direct effects, and more of a marker for the underlying psychological pain of low social status . He believes that the biological causal pathways are Likely to center on the influence that the quality of social relations has on neuroendocrine pathways (Wilkinson, 1999, p. 48). 

Thus, a deterministic answer assumes that the laws of physics and chemistry have causally and sequentially determined the obligatory series of events leading from inanimate matter to life - that each step is causally linked to the previous one and to the next one by the laws of nature. In principle, in a strictly deterministic situation, the state of a system at any point in time determines the future behavior of the system - with no random influences. In contrast, in a non-deterministic or stochastic system it is not generally possible to predict the future behavior exactly and instead of a linear causal pathway the sequence of steps may be determined by the set of parameters operating at each step. 

The question of causality can only be fully resolved with controlled studies that randomly control sleep duration. For short sleep, controlled trials of longterm prescription of hypnotics or long-term use of sleep hygiene, etc., may help us understand the causal role of sleep. Similarly, for those with long sleep, controlled restriction of sleep or time-in-bed may help clarify the causal pathways. 

Biological plausibility A detailed knowledge of the pathophysiology of the disease or condition of interest is helpful, as is demonstration that the surrogate endpoint of interest in the clinical trial is on the causal pathway to the clinical endpoint of primary interest. 

The focus of this chapter is occupational asthma mediated by immunological hypersensitivity, termed occupational asthma with a latency period by Bernstein et al. (1993). This may involve formation of IgE antibody, but not necessarily. Rhinitis, conjunctivitis and urticaria are included because they co-exist commonly with asthma and share common mechanisms. Occupational asthma caused by an irritant exposure sufficient to damage airway mucosa is excluded. There may be immunological epiphenomena, such as formation of specific antibody, in irritant-induced asthma but, when present, these do not imply an immunological causal pathway. 

Frank IE, Kowalski BR, A multivariate method for relating groups of measurements connected by a causal pathway, Analytica Chimica Acta, 1985, 167,51-63. 

Own health is linked with the consequence Eat healthily, which is strongly connected with Naturally produced, and also with Tastes good. In particular, there seems to be a specific motivational pathway relating to the health value of the higher vitamin content of wholemeal cereals. Enjoyment is the second most important value (17) and is linked with Food as enjoyment as an instrumental value. At cut-off 4, a causal pathway was observed from Eat healthily to Family health showing again that health concerns are not only self-oriented. The environment was shown to be as important to the purchase of cereals as it was to the purchase of dairy products the concrete attribute, Less pesticides connected to Protect the environment and Respect for nature (6), interview transcripts... 

While the research only reported correlations between the variables, and a degree of caution is required in translating correlations into a causal pattern, it does seem logical to interpret the relationship in the way shown in Fig. 6.1. It would also appear that the assumed causal pathway is not unique to a particular sample, as one... 

Note though that it is nearly always possible through inference to derive scenarios where failures of these systems could eventually compromise patient care. For example, errors in staff rostering could contribute to a service being understaffed which could then lead to an adverse outcome. Generally the harm causality pathway in these cases is tenuous or convoluted. There is sufficient human intellect embedded within the business processes to catch potential problans long before they realistically affect care. In other words any hazards are simply not credible in the real world or would fall into a category where risk reduction would not be justified by the effort required. 

Likelihood of occurrence of a particular event or outcome Consequences of the particular event or ontcome occnrring Exposure or Causal pathway leading to the event... 

The mode of action (MoA) approach seeks to gain an understanding of the key events along a causal pathway that lead to a toxicological endpoint. Extensive reviews of MoA examples exist in the literature [18,19,20]. Additionally, The International Programme on Chemical Safety (IPCS) has published Human Relevance Frameworks [21, 22], a process that incorporates a weight of evidence approach relying heavily on robust mechanistic and experimental data. The evaluation sequence is listed below as a series of questions. 

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