El labrador: Año II Número 40 - (27/09/23)

Health promotion interventions can be improved using methods from behavioural economics to identify and target specific decision-making biases at the individual level. In this context, prospect theory provides a suitable framework within which decision-making processes can be operationalised. Focusing on a trade-off between health outcomes and behaviour change incurred by chronic disease management (lifestyle change, or ‘self-management’), we are the first to measure the risk attitudes and quantify the full utility function under prospect theory of a patient population. We conducted a series of hypothetical elicitations over health outcomes associated with different self-management behaviours from a population of individuals with or without ‘manageable’ chronic disease (n = 120). We observed risk aversion in both the gain and the loss domains, as well as significant loss aversion. There seems to be an age effect on risk attitudes in this context, with younger people being on average less risk averse than older people. Our work addresses a need to better understand these decision-making processes, so that behaviour change interventions tailored to specific patient populations can be improved

Can Independently Elicited Adult- and Child-Perspective Health-State Utilities Explain Priority Setting?

Objectives: Time trade-off (TTO) utilities for EQ-5D-Y-3L health states valued by adults taking a child's perspective are generally higher than their valuations of the same state for themselves. Ceteris paribus, the use of these utilities in economic evaluation implies that children gain less from treatments returning them to full health for a specified amount of time than adults. In this study, we explore if this implication affects individuals’ views of priority-setting choices between treatments for adults and children. Methods: We elicited TTO utilities for 4 health states in online interviews, in which respondents valued states for a 10-year-old child and another adult their age. Views on priority setting were studied with person trade-off (PTO) tasks involving the same health states. We tested the ability of the subjects’ TTO utilities to predict these societal choices in PTO. Results: There are no significant differences between adult and child health state valuations in our study, but we do observe a substantial preference for treating children over adults in the PTO task. Conclusions: Our findings suggest that perspective-dependent health-state utilities only explain a small part of views on priority setting between adults and children. External equity weights might be useful to better explain the higher priority given to children.</p

Terra sigillata in southern Latium:The evidence from the Pontine Region Project (1987-2014)

This contribution is the first of a series of publications by the authors to systematically disclose the wealth of material evidence collected during some 30 years of fieldwork in the Pontine region by the Pontine Region Project. This project has, since its inception in the mid-1980s, investigated more than 36 km2 of terrain across all major geomorphological units of the region, largely by means of systematic surface investigations. During these investigations, close to 200 000 artefacts were collected for further study, including c. 1 660 fragments of (Italian) terra sigillata, the emblematic, shiny red fine table ware of the Early Imperial period. In this article, we present a detailed spatial and contextual analysis of the terra sigillata fragments that have been gathered within the Pontine Region Project and discuss the results in light of economic issues (market integration, economic growth). We then supplement this evidence by published evidence of name stamps from surrounding areas to further expose to what extent, and in what ways, the different parts of southern Latium were embedded in the long-distance economic networks of the period

A multidisciplinary study of an exceptional prehistoric waste dump in the mountainous inland of Calabria (Italy) : implications for reconstructions of prehistoric land use and vegetation in Southern Italy

The mountainous inland of northern Calabria (Southern Italy) is known for its sparse prehistoric human occupation. Nevertheless, a thorough multidisciplinary approach of field walking, geophysical survey and invasive research led to the discovery of a major archaeological archive. This archive concerns a rich multi-phased dump, spanning about 3000 years (Late Neolithic to Late Imperial Roman Age) and holding two Somma-Vesuvius tephra. Of these, the younger is a distinct layer of juvenile tephra from the Pompeii eruption, while the older concerns reworked tephra from the Bronze Age AP2 eruption (ca. 1700 cal. yr BP). The large dump contains abundant ceramics, faunal remains and charcoal, and most probably originated through long-continued deposition of waste in a former gully like system of depressions. This resulted in an inversed, mound-like relief, whose anthropogenic origin had not been recognized in earlier research. The tephras were found to be important markers that support the reconstruction of the occupational history of the site. The sequence of occupational phases is very similar to that observed in a recent palaeoecological study from nearby situated former lakes (Lago Forano/Fontana Manca). This suggests that this sequence reflects the more regional occupational history of Calabria, which goes back to ca. 3000 BC. Attention is paid to the potential link between this history and Holocene climatic phases, for which no indication was found. The history deviates strongly from histories deduced from the few, but major palaeorecords elsewhere in the inlands of Southern Italy (Lago Grande di Monticchio and Lago Trifoglietti). We conclude that major regional variation occurred in prehistoric land use and its impacts on the vegetation cover of Southern Italy, and studies of additional palaeoarchives are needed to unravel this complex history. Finally, shortcomings of archaeological predictive models are discussed and the advantages of truly integrated multidisciplinary research

Correction to:Time and lexicographic preferences in the valuation of EQ-5D-Y with time trade-off methodology

The original article that was published contains errors in the abstract and result section head. Please find the corrected text with section heading.</p

The way that you do it? An elaborate test of procedural invariance of TTO, using a choice-based design

The time tradeoff (TTO) method is often used to derive Quality-Adjusted Life Year health state valuations. An important problem with this method is that results have been found to be responsive to the procedure used to elicit preferences. In particular, fixing the duration in the health state to be valued and inferring the duration in full health that renders an individual indifferent, causes valuations to be higher than when the duration in full health is fixed and the duration in the health state to be valued is elicited. This paper presents a new test of procedural invariance for a broad range of time horizons, while using a choice-based design and adjusting for discounting. As one of the known problems with the conventional procedure is the violation of constant proportional tradeoffs (CPTO), we also investigate CPTO for the alternative TTO procedure. Our findings concerning procedural invariance are rather supportive for the TTO procedure. We find no violations of procedural invariance except for the shortest gauge duration. The results for CPTO are more troublesome: TTO scores depend on gauge duration, reinforcing the evidence reported when using the conventional procedure

Eliciting risk preferences that predict risky health behaviour: A comparison of two approaches

Information on attitudes to risk could increase understanding of and explain risky health behaviors. We investigate two approaches to eliciting risk preferences in the health domain, a novel “indirect” lottery elicitation approach with health states as outcomes and a “direct” approach where respondents are asked directly about their willingness to take risks. We compare the ability of the two approaches to predict health-related risky behaviors in a general adult population. We also investigate a potential framing effect in the indirect lottery elicitation approach. We find that risk preferences elicited using the direct approach can better predict health-related risky behavior than those elicited using the indirect approach. Moreover, a seemingly innocuous change to the framing of the lottery question results in significantly different risk preference estimates, and conflicting conclusions about the ability of the indicators to predict risky health behaviors

Protohistoric briquetage at Puntone (Tuscany, Italy):principles and processes of an industry based on the leaching of saline lagoonal sediments

A protohistoric (c.10th-5th c. BC) briquetage site at Puntone (Tuscany, Italy) was studied to unravel the salt production processes and materials involved. Geophysical surveys were used to identify kilns, pits, and dumps. One of these pits and a dump were excavated, followed by detailed chemical and physical analyses of the materials encountered. The pit had been used for holding brine, obtained by leaching of lagoonal sediment over a sieve, that afterwards was discarded to form large dumps. Phases distinguished indicate that the pit filled with fine sediment and was regularly "cleaned." The presence of ferroan-magnesian calcite in the pit fill testifies to the prolonged presence of anoxic brine. The production processes could be reconstructed in detail by confronting the analytical results with known changes in composition of a brine upon evaporation. These pertain in particular to the accumulation of "bitterns" and increased B (boron) concentrations in a residual brine. Both could be traced in the materials studied, and were found to be far more indicative than the ubiquitously studied concentrations of Cl and Na.</p

On the (not so) constant proportional trade-off in TTO

Abstract. Purpose: The linear and power QALY models require that people in Time Trade-off (TTO) exercises sacrifice the same proportion of lifetime to obtain a health improvement, irrespective of the absolute amount. However, evidence on these constant proportional trade-offs (CPTOs) is mixed, indicating that these versions of the QALY model do not represent preferences. Still, it may be the case that a more general version of the QALY model represents preferences. This version has the property that people want to sacrifice the same proportion of utilities of lifetime for a health improvement, irrespective of the amount of this lifetime. Methods: We use a new method to correct TTO scores for utility of life duration and test whether decision makers trade off utility of duration and quality at the same rate irrespective of duration. Results: We find a robust violation of CPTO for both uncorrected and corrected TTO scores. Remarkably, we find higher values for longer durations, contrary to most previous studies. This represents the only study correcting for utility of life duration to find such a violation. Conclusions: It seems that the trade-off of life years is indeed not so constantly proportional and, therefore, that health state valuations depend on durations