Mapping the EQ-5D index from the cystic fibrosis questionnaire-revised using multiple modelling approaches.

BACKGROUND: This study was designed to develop a mapping algorithm to estimate EQ-5D utility values from Cystic Fibrosis Questionnaire-Revised (CFQ-R) data. METHODS: A cross-sectional survey of adults with cystic fibrosis (CF) was conducted in the UK. The survey consisted of the CFQ-R, the EQ-5D and a background questionnaire. Eight regression models, exploring item and domain level predictors, were evaluated using three different modelling approaches: ordinary least squares (OLS), Tobit, and a two-part model (TPM). Predictive performance in each model was assessed by intraclass correlations, information criteria (Bayesian information criteria and Alkaike information criteria), and root mean square error (RMSE). RESULTS: The survey was completed by 401 participants. For all modelling approaches the best performing item level model included all items, and the best performing domain level model included the CFQ-R Physical-, Role- and Emotional-functioning, Vitality, Eating Disturbances, Weight, and Digestive Symptoms domains and a selection of squared terms. Overall, the item level TPM, including age and gender covariates performed best within sample validation, but OLS and TPM domain models with squared terms performed best out-of-sample and are recommended for mapping purposes. CONCLUSIONS: Domain and item level models using all three modelling approaches reached an acceptable degree of predictive performance with domain models performing well in out-of-sample validation. These mapping functions can be applied to CFQ-R datasets to estimate EQ-5D utility values for economic evaluations of interventions for patients with cystic fibrosis. Further research evaluating model performance in an independent sample is encouraged

Equity and health policy in Africa: Using concept mapping in Moore (Burkina Faso)

<p>Abstract</p> <p>Background</p> <p>This methodological article is based on a health policy research project conducted in Burkina Faso (West Africa). Concept mapping (CM) was used as a research method to understand the local views of equity among stakeholders, who were concerned by the health policy under consideration. While this technique has been used in North America and elsewhere, to our knowledge it has not yet been applied in Africa in any vernacular language. Its application raises many issues and certain methodological limitations. Our objective in this article is to present its use in this particular context, and to share a number of methodological observations on the subject.</p> <p>Methods</p> <p>Two CMs were done among two different groups of local stakeholders following four steps: generating ideas, structuring the ideas, computing maps using multidimensional scaling and cluster analysis methods, and interpreting maps. Fifteen nurses were invited to take part in the study, all of whom had undergone training on health policies. Of these, nine nurses (60%) ultimately attended the two-day meeting, conducted in French. Of 45 members of village health committees who attended training on health policies, only eight were literate in the local language (Moore). Seven of these (88%) came to the meeting.</p> <p>Results</p> <p>The local perception of equity seems close to the egalitarian model. The actors are not ready to compromise social stability and peace for the benefit of the worst-off. The discussion on the methodological limitations of CM raises the limitations of asking a single question in Moore and the challenge of translating a concept as complex as equity. While the translation of equity into Moore undoubtedly oriented the discussions toward social relations, we believe that, in the context of this study, the open-ended question concerning social justice has a threefold relevance. At the same time, those limitations were transformed into strengths. We understand that it was essential to resort to the focus group approach to explore deeply a complex subject such as equity, which became, after the two CMs, one of the important topics of the research.</p> <p>Conclusion</p> <p>Using this technique in a new context was not the easiest thing to do. Nevertheless, contrary to what local organizers thought when we explained to them this "crazy" idea of applying the technique in Moore with peasants, we believe we have shown that it was feasible, even with persons not literate in French.</p

Desertification and global change

Arid and semiarid regions cover one third of the continental areas on Earth. These regions are very sensitive to a variety of physical, chemical and biological degradation processes collectively called desertification. Although interest in desertification has varied widely in time, there is a renewed concern about the evolution of dryland ecosystems because (1) a significant fraction of existing drylands already suffers from miscellaneous degradation processes, (2) increasing populations will inevitably result in further over-utilization of the remaining productive areas, (3) climatic changes expected from the greenhouse warming might result in drier continental interiors, and (4) some of the desertification processes themselves may amplify local or regional climatic changes. This paper reviews some of the many aspects of this issue in the context of the Global Change research program.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/43891/1/11258_2004_Article_BF00036043.pd

Ledipasvir/Sofosbuvir plus Ribavirin (LDV/SOF+RBV) for 12 Weeks in Decompensated HCV Genotype 1 Patients: SOLAR-1 and-2 Studies Compared to a Real-World Dataset

Meeting AbstractAmer Assoc Study Liver Di