Lecture 18

Question 1

What is the complex story about biking helmet laws? What improves safety?

Answer 1

Making helmets mandatory does not improve safety but it does reduce the number of people biking
(e.g., through bike rental programs)

the complex stories look at why do cars hit bikers and how do we prevent that. What really improves safety for bikers is building biking infrastructure and encouraging more people to bike.

What does improve safety is
* separated bike lanes
* greater number of people biking (“safety in numbers”)

Question 2

What did UBC professor Kay Tesche say about bike helmet laws?

Answer 2

It’s a mistake to consider helmets a “preventive measure.” They are an “injury-mitigation measure” after the fact, and do nothing in the way of prevention.

Question 3

Is the bike helmet law a prevention measure or a mitigation measure.

Answer 3

prevention and mitigation. This comment from an academic was really shocking to people but in a health care context it is not prevention measure because it doesn’t reduce injuries. AKA it is mitigation because you are using a helmet to do something abotu the problem that has happened to make it less damaging.

Question 4

What model is one level of causality

Answer 4

model 1

Question 5

What model is two levels of causality

Answer 5

Model 2

Question 6

What is the simple model of biking. Is this mitigation or prevention?

Answer 6

Road accidents involving biking
- cars hitting bikes on the road

causes injury to bike riders

solution: make helmets mandatory.

this is mitigsation

Question 7

What is the complex model of biking. Is this mitigation or prevention?

Answer 7

Cause 1:
- Lack of bike lanes
- biking conditions

Cause 2: Road accidents involving biking
- cars hitting bikes on the road

outcome: injuries among bike riders

solution: improve cause 1

This is prevention

Question 8

What is the smoking comparison the prof made about the bike helmet law?

Answer 8

“It’s a complete abrogation of responsibility for preventing the injury from happening in the first place. That’s what we need to be doing, and it infuriates me that we’ve been focusing on something that in most public health professions we wouldn’t be doing. You know, we advocate smoking cessation: we don’t advocate treatment of lung cancer once you’ve got it. It’s just ridiculous.”

Question 9

What are issues addressed mainly by prevention measures?

Answer 9

e.g., deaths from lung cancer in developed countries

Question 10

What are issues addressed mainly by mitigation measures?

Answer 10

e.g., neonatal mortality in low-income countries
e.g., biking injuries in Vancouver

Question 11

What are some reasons we may engage in mitigation?

Answer 11

lots of prevention involves societal measures so its really hard to change.

mitigation is percieved ease of change and prevention is the actual ease of change.

Question 12

What is the example of the father with the daughter who overdosed and how mitigation measures can be very difficult?

Answer 12

a father tried to do something to help other kids after his 14 year old daughter died of an overdose. This is much harder to analyze. Parents can talk to their children and try to explain the reality of overdose after their child is already addicted so they are having to engage in mitigation. BUT, we need to shift to prevention AKA figuring out how to prevent people to become addicted. Sextortion was another example of something like this.

Question 13

Does associative memory help or hinder our thinking?

Answer 13

it can do either

Question 14

What is one of the reasons that we engage in and get stuck in mitigation measures?

Answer 14

one of the reasons we engage/are stuck in mitigation measures is because of associative memory. We have beliefs about what we can and can’t change. Rememeber how last time we talked about relational integration being the maximum capacity for the human mind which is why we don’t engage in it a lot.

Question 15

What is chunking (grouping)?

Answer 15

Chunking (grouping)
How associative memory can help working memory

• Grouping of items (or elements) based on meaning or previous established associations

All domains: language, perception, motor skills, memory, thinking

Conceptual chunks that are already present in our associative (long-term) memory are determined by what we are exposed to

Question 16

What are we doing when we’re chunking?

Answer 16

you offload some of the working memory processes to associative memory.

Question 16

Whats an example of chunking with numbers?

Answer 16

I give you:

1 9 8 7

You remember it as :
1987

Question 16

what is an example of chunking with letters? Why do we do this?

Answer 16

I give you:
J FKFB INAT OUP SNA SAFI FAEU

You remember it as:
JFK FBI NATO UPS NASA FIFA EU

it becomes easier to remember letter when you don’t have to remember them as individual letters.

Question 17

What is a chunk?

Answer 17

a group of elements that have strong associations with one another

Question 18

How are concepts a form of chunking?

Answer 18

concepts are a form of chunking. You bring things together, you put a lable on them and you make them a group.

Question 19

how do stories relate to chunking? How can we determine the causal complexity of stories?

Answer 19

• Temporal sequences of causally interconnected events, such as desires, difficulties, actions, outcomes — experienced by an agent (who has mental states)
• Serve as conceptual chunks that help us remember (a story is a chunk of events, causes and how mental states and how they are causally connected.)
• Can help us understand complex multi-level causality, but can also obscure the complexity and hinder understanding
• Look to see what solutions are implied by the story and how many levels of causality they take into account (e.g., a villain called Mr. Carbon)

Question 19

Even when we view stories to not think, are we still learning a model of causal complexity?

Answer 19

we see stories to not think but we are still learning and we are learning whatever model is presented in the story relating to the levels of causality.

Question 20

How can stories seek to dumb down causal complexity?

Answer 20

the story can also chose to dumb down the causal complexity by attributing a single causal explanation to the events.

Question 21

Explain how stories can hinder the complexity of our thinking.

Answer 21

the other way we chunk things in our minds is through stories. stories are another form of associative memory that helps us deal with things but can also hinder the complexity of our thinking. If you analyse what stories are, they’re about causality. They are a way to teach you about causality in a predigested way.

Question 22

What causal story is this person doing?

Answer 22

what this person is doing is questioning the distinction between mitigation and prevention. And he is telling a story. The story is about his daughter and its harder to process and he can’t buy the arguments against helmets. What that leads then to is a very automatic counterfactual. The counterfactual drawn is if she hadn’t been wearing that helmet she would have died.

Question 23

What is an example of a counterfactual that is constructed automatically in response to negative outcomes?

Answer 23

a story of a boy who died after his family was trying to cross from syria to turkey. The little boy’s dead body was caputred being carried by a rescue worker. One of the tragic things was that his aunt (on the left) had sent money to her brother to get smuggled across the adriatic sea and in the process, they drowned. The big thing she was quoted about was her regrets and she kept saying she never should have snet the money because if she hadn’t sent his money she would die.

Question 24

What are some counterfactuals we tend to construct automatically? Some counterfactuals we don’t tend to construct automatically? Why?

Answer 24

we do construct: “If my daughter hadn’t been wearing a helmet when she got hit by a car, she would have died.” Don't tend to construct: “If Vancouver had more separated bike lanes, my daughter might not have been hit in the first place.” “If Vancouver didn’t have a mandatory helmet law, this person might not have gotten injured in the first place.” Why: the appeal of the story is more concrete when its about a person.

Question 25

Do negative or positive outcomes lead to the most counterfacutals?

Answer 25

negative outcomes are usually not expected. Unexpected negative outcomes lead to the most coutnerfactuals. In unexpected positive situations, people engage less in counterfactual reasoning but more in other types of causal explanations.

Question 26

Why are we more likely to come up with some counterfactuals and not others?

Answer 26

* level of causality (prevention vs. mitigation) -examples that are not constructed automatically tend to have 2 levels of reasoning. * perceived ease of mutability * changing one action (or one individual) is relatively easy to imagine - easier to get someone to put a helmet on than building bike lanes. * changing our society or environment (roads, laws, women’s status) is relatively difficult to imagine * fluency heuristic + attribute substitution the ease with which we can imagine something changing -> the most effective thing that can be done * the model (of causality) the majority of stories promote (the ‘meta-narrative’ or the ‘grand narrative’ in some area, e.g., childbirth) (tends to be fairly simple)

Question 27

What levels of reasoning do examples that aren't contructed automatically have?

Answer 27

examples that are not constructed automatically tend to have 2 levels of reasoning.

Question 28

What is happening in this situation? “My partner is a registered nurse and we seriously contemplated a homebirth but for various reasons (partly expense) we didn't. Long story short, she had a massive postpartum haemorrhage... Within 1 minute, there were another 2 midwives in attendance and an O&G Registrar whilst our midwife was performing a bimanual compression. In less than 3 minutes, she had 2 wide bore cannulas inserted, stat crystalloid running, blood cross matched and was wheeled into theatre to definitively control the bleeding. Are you seriously going to respond that you could have deftly handled this situation off site when 3 midwives and a doctor struggled - in a major hospital? What if the baby needed attention concurrently? For certain obstetric emergencies (thankfully few), you are more likely to survive in a hospital . You can kid yourself of otherwise - but do not mislead others.”

Answer 28

whats happening in this situation is he has a personal expeirence, he is concluding something really compelling and this leads him to make conclusions about safety. thsi argument is based on counterfactuals which feels more compelling through the fluency heurstic but it is limited in causal explanation.

Question 29

Understand this: Maybe make a better slide “This is what the high quality, Canadian research by Janssen et al. published in the Canadian Medical Association Journal in 2009 says: women are significantly more likely to hemorrhage in the hospital than at home (6.7% at hospital with a doctor, 3.8% at home with midwife). “Two high quality Canadian studies in 2009 (Janssen and Hutton et. al. in Birth) showed no maternal deaths in either hospital or home, but increased adverse outcomes for women in the hospital. What this means is that those women who hemorrhaged at home survived the same as the women who hemorrhaged at the hospital--but if you planned a hospital birth, you were more likely to hemorrhage.

Question 30

Does the birth setting have any association with increased risk for either parent or baby?

Answer 30

“The birth setting had no association with increased risk foreither parent or baby.” Elizabeth Nethery, PhD candidate at UBC’s School of Population and Public Health

Question 31

Look at info on slide 21

Question 32

Are there big differences in the percentage of home births in developed countries?

Answer 32

yes.

Question 33

What is the spectrum of childbirth experiences?

Answer 33

* Scheduled C-section in a hospital - relies on a hospital, gets rid of unpredictability * Hospital birth with an obstetrician - can perform any necessary interventions * Hospital birth with a family doctor - this is not an option anymore because of insurance * Birth center birth with a certified midwife * Home birth with certified midwife * Home birth with traditional birth attendant (traditional midwife) * Freebirth or unassisted/unattended childbirth

Question 34

What is the difference between certified midwifes and traditional birth attendants?

Answer 34

certified midwives are part of the college that regulates midwives. Traditional birth attendants are people who are known to be attending births.

Question 35

What are doulas for?

Answer 35

doulas are there for emotional support whereas the midwives perform physical things that are supposed to be part of the birth process.