The Use of Health State Utility Values In Decision Models

Methodological issues of how to use health state utility values (HSUVs) in decision models arise frequently, including the most appropriate evidence to use as the baseline (e.g. the baseline HSUVs associated with avoiding a particular health condition or event), how to capture changes due to adverse events and how to appropriately capture uncertainty in progressive conditions where the expected change in quality of life is likely to be monotonically decreasing over time. As preference-based measures provide different values when collected from the same patient, it is important to ensure that all HSUVs used within a single model are obtained from the same instrument where ever possible. When people enter the model without the condition of interest (e.g. primary prevention of cardiovascular disease, screening or vaccination programmes), appropriate age- and gender-adjusted HSUVs from people without the particular condition should be used as the baseline. General population norms may be used as a proxy if the exact condition-specific evidence is not available. Individual discrete health states should be used for serious adverse reactions to treatment and the corresponding HSUVs sourced as normal. Care should be taken to avoid double counting when capturing the effects for both less severe adverse reactions (e.g. itchy skin rash or dry cough) and more severe adverse events (e.g. fatigue in oncology). Transparency in reporting standards for both the justification of the evidence used and any ‘adjustments’ is important to increase readers’ confidence that the evidence used is the most appropriate available

Prevenció de la infecció respiratòria

Infecció respiratòria; Prevenció; Atenció sanitàriaInfección respiratória; Prevención; Atención sanitáriaRespiratory infection; Prevention; Health careMonografia sobre temes concrets relacionats amb la prevenció de la infecció respiratòria relacionada amb l‟atenció sanitària. Ha estat elaborada per un comitè d‟experts amb una àmplia trajectòria en el camp de l'atenció a pacients amb problemes respiratoris. El document comença fent una posada al dia de l‟epidemiologia i l‟etiopatogènia de les infeccions respiratòries nosocomials i, sense voler repetir capítols de la monografia d'aïllaments, continua fent una pinzellada de les mesures que cal dur a terme per evitar la transmissió de les infeccions respiratòries dins dels centres sanitaris. Tot seguit, s‟aborden de manera pràctica situacions quotidianes, com el maneig de la via aèria, i es fan algunes recomanacions sobre com dur-les a terme. Una part important i poc coneguda per molts professionals és la prevenció de la infecció respiratòria de causa instrumental, motiu pel qual en el darrer capítol es fa una revisió minuciosa de com procedir per reutilitzar aquests aparells.Monografía sobre temas concretos relacionados con la prevención de la infección respiratoria con la atención sanitaria. Ha sido elaborada por un comité de expertos con una amplia trayectoria en el campo de la atención a pacientes con problemas respiratorios. El documento empieza haciendo una puesta al día de la epidemiologia y la etiopatogenia de las infecciones respiratorias nosocomiales y, sin querer repetir capítulos de la monografía de aislamientos, continua haciendo una pincelada de las medidas que son necesarias para evitar la transmisión de las infecciones respiratorias dentro de los centros sanitarios. Seguidamente se tratan de manera práctica situaciones cotidianas, como el manejo de la vía aérea y se hacen algunas recomendaciones sobre como llevarlas a cabo. Una parte importante y poco conocida para muchos profesionales es la prevención de la infección respiratoria de causa instrumental, motivo por el cual en el último capítulo se hace una revisión minuciosa de como proceder para reutilizar estos aparatos

Standard comparison of local mental health care systems in eight European countries

Aims. There is a need of more quantitative standardised data to compare local Mental Health Systems (MHSs) across international jurisdictions. Problems related to terminological variability and commensurability in the evaluation of services hamper like-with-like comparisons and hinder the development of work in this area. This study was aimed to provide standard assessment and comparison of MHS in selected local areas in Europe, contributing to a better understanding of MHS and related allocation of resources at local level and to lessen the scarcity in standard service comparison in Europe. This study is part of the Seventh Framework programme REFINEMENT (Research on Financing Systems' Effect on the Quality of Mental Health Care in Europe) project. Methods. A total of eight study areas from European countries with different systems of care (Austria, England, Finland, France, Italy, Norway, Romania, Spain) were analysed using a standard open-access classification system (Description and Evaluation of Services for Long Term Care in Europe, DESDE-LTC). All publicly funded services universally accessible to adults (>= 18 years) with a psychiatric disorder were coded. Care availability, diversity and capacity were compared across these eight local MHS. Results. The comparison of MHS revealed more community-oriented delivery systems in the areas of England (Hampshire) and Southern European countries (Verona - Italy and Girona - Spain). Community-oriented systems with a higher proportion of hospital care were identified in Austria (Industrieviertel) and Scandinavian countries (Sor-Trondelag in Norway and Helsinki-Uusimaa in Finland), while Loiret (France) was considered as a predominantly hospital-based system. The MHS in Suceava (Romania) was still in transition to community care. Conclusions. There is a significant variation in care availability and capacity across MHS of local areas in Europe. This information is relevant for understanding the process of implementation of community-oriented mental health care in local areas. Standard comparison of care provision in local areas is important for context analysis and policy planning.Peer reviewe

What drives local government spending in Spain? A dynamic spatial panel approach

What drives local government spending in Spain? A dynamic spatial panel approach. Spatial Economic Analysis. This paper extends traditional spatial spillover models of government spending by including dynamic effects and exogenous interaction effects. Using annual data for a sample of 3032 Spanish municipalities during 2000-12, we estimate a dynamic spatial Durbin panel data model to quantify the relevance of spatial spillovers and diffusion effects over time as well as the impact of a variety of spending determinants. We find that government spending at the local level is mainly explained by economic factors, while demographic factors and political factors appear to be less relevant

Prevenció de la infecció respiratòria

Infecció respiratòria; Prevenció; Atenció sanitàriaInfección respiratória; Prevención; Atención sanitáriaRespiratory infection; Prevention; Health careMonografia sobre temes concrets relacionats amb la prevenció de la infecció respiratòria relacionada amb l‟atenció sanitària. Ha estat elaborada per un comitè d‟experts amb una àmplia trajectòria en el camp de l'atenció a pacients amb problemes respiratoris. El document comença fent una posada al dia de l‟epidemiologia i l‟etiopatogènia de les infeccions respiratòries nosocomials i, sense voler repetir capítols de la monografia d'aïllaments, continua fent una pinzellada de les mesures que cal dur a terme per evitar la transmissió de les infeccions respiratòries dins dels centres sanitaris. Tot seguit, s‟aborden de manera pràctica situacions quotidianes, com el maneig de la via aèria, i es fan algunes recomanacions sobre com dur-les a terme. Una part important i poc coneguda per molts professionals és la prevenció de la infecció respiratòria de causa instrumental, motiu pel qual en el darrer capítol es fa una revisió minuciosa de com procedir per reutilitzar aquests aparells.Monografía sobre temas concretos relacionados con la prevención de la infección respiratoria con la atención sanitaria. Ha sido elaborada por un comité de expertos con una amplia trayectoria en el campo de la atención a pacientes con problemas respiratorios. El documento empieza haciendo una puesta al día de la epidemiologia y la etiopatogenia de las infecciones respiratorias nosocomiales y, sin querer repetir capítulos de la monografía de aislamientos, continua haciendo una pincelada de las medidas que son necesarias para evitar la transmisión de las infecciones respiratorias dentro de los centros sanitarios. Seguidamente se tratan de manera práctica situaciones cotidianas, como el manejo de la vía aérea y se hacen algunas recomendaciones sobre como llevarlas a cabo. Una parte importante y poco conocida para muchos profesionales es la prevención de la infección respiratoria de causa instrumental, motivo por el cual en el último capítulo se hace una revisión minuciosa de como proceder para reutilizar estos aparatos

Population norms for the EQ-5D-3L: a cross-country analysis of population surveys for 20 countries

This study provides EQ-5D population norms for 20 countries (N = 163,838), which can be used to compare profiles for patients with specific conditions with data for the average person in the general population in a similar age and/or gender group. Descriptive EQ-5D data are provided for the total population, by gender and by seven age groups. Provided index values are based on European VAS for all countries, based on TTO for 11 countries and based on VAS for 10 countries. Important differences exist in EQ-5D reported health status across countries after standardizing for population structure. Self-reported health according to all five dimensions and EQ VAS generally decreased with increasing age and was lower for females. Mean self-rated EQ VAS scores varied from 70.4 to 83.3 in the total population by country. The prior living standards (GDP per capita) in the countries studied are correlated most with the EQ VAS scores (0.58), while unemployment appeared to be significantly correlated in people over the age of 45 only. A country's expenditure on health care correlated moderately with higher ratings on the EQ VAS (0.55). EQ-5D norms can be used as reference data to assess the burden of disease of patients with specific conditions. Such information, in turn, can inform policy-making and assist in setting priorities in health care