Annoyance from transportation noise: relationships with exposure metrics DNL and DENL and their confidence intervals.

We present a model of the distribution of noise annoyance with the mean varying as a function of the noise exposure. Day-night level (DNL) and day-evening-night level (DENL) were used as noise descriptors. Because the entire annoyance distribution has been modeled, any annoyance measure that summarizes this distribution can be calculated from the model. We fitted the model to data from noise annoyance studies for aircraft, road traffic, and railways separately. Polynomial approximations of relationships implied by the model for the combinations of the following exposure and annoyance measures are presented: DNL or DENL, and percentage "highly annoyed" (cutoff at 72 on a scale of 0-100), percentage "annoyed" (cutoff at 50 on a scale of 0-100), or percentage (at least) "a little annoyed" (cutoff at 28 on a scale of 0-100). These approximations are very good, and they are easier to use for practical calculations than the model itself, because the model involves a normal distribution. Our results are based on the same data set that was used earlier to establish relationships between DNL and percentage highly annoyed. In this paper we provide better estimates of the confidence intervals due to the improved model of the relationship between annoyance and noise exposure. Moreover, relationships using descriptors other than DNL and percentage highly annoyed, which are presented here, have not been established earlier on the basis of a large dataset

Telecare and self-management: a guideline for anticipating future care in scenario-based design

An important aim of telecare technologies for chronic patients is supporting self-management. Although patient involvement is crucial for successful implementation, any adaptation of telecare systems to needs of users requires explicit reflection regarding which form of self-management it should support. Scenario-based methods (SBDs) are proposed to involve users in the earlier phases of development. This paper aims to extend SBDs by incorporating explicit exploration of self-management forms. We first analyzed what self-management forms were inscribed in the design of a telecare system for COPD patients. These were mainly based on compliance to medical treatment. However, our study shows that many patients thrive better on self-management based on cooperation and concordance with healthcare professionals. To overcome this discrepancy between design and use practices we developed a guideline enabling designers to anticipate and reflect on which form of self-management is desirable to incorporate in the design of telecare technologies for chronic patients

Influence of Multiple Traumatic Event Types on Mental Health Outcomes: Does Count Matter?

The experience of potentially traumatizing events (PTEs) may be associated with conflicting outcomes: individuals may experience greater psychological distress (dose-response theory), or individuals may become more resilient against repeated PTEs (stress-inoculation theory). With limited empirical data comparing these theories, we examined the relationships between the count of lifetime PTE types and psychological outcomes [posttraumatic stress disorder (PTSD), depression, impaired distress tolerance] using linear and quadratic regressions. A linear relationship would support the dose-response theory, and a quadratic relationship would support the stress-inoculation theory. We also explored whether there was a threshold number of PTE types fostering resiliency before an increase of distressing outcomes. The sample included 123 (68.30% female) treatment-seeking patients at a community mental health center participating in a larger study (Contractor et al. in Psychiatry Research, 252, 252215–252222, 2017). Linear regression results indicated number of PTE types significantly predicted increasing PTSD and depression severity and distress tolerance difficulties. Quadratic regression model results were not significant. ROC analyses indicated exposure to at least 3.5 PTE types predicted PTSD with moderate accuracy. In conclusion, the dose-response theory was supported, with results indicating there may be a threshold count of lifetime PTE types (\u3e 3) influencing traumatic stress outcomes

eHealth in support for daily functioning of people with intellectual disability:Views of service users, relatives, and professionals on both its advantages and disadvantages and its facilitating and impeding factors

Background: The use of eHealth in support for daily functioning of service users with intellectual disability (ID) is a rather unexplored domain. Therefore, the current study identified the a) level of familiarity, b) advantages/disadvantages, and c) facilitating/impeding factors for the use of eHealth in support for daily functioning of people with ID according to service users, relatives, and professionals. Method: Four focus groups and one semi-structured qualitative interview were conducted. Results: Participants were familiar with numerous eHealth applications. Benefits were related to service users (e.g., increased independency) and relatives/professionals (e.g., providing more efficient support). Adequate informing and involving all stakeholders and centrally positioning the needs and possibilities of service users were reported as important facilitators. Contrary, impeding factors were malfunctioning Internet, expenses of eHealth, and lack of proper IT-support. Conclusions: The results provide imperative information for future eHealth implementations and to direct its use more specifically to people with ID

MO4 - Using AHP weights to fill missing gaps in Markov decision models

OBJECTIVES:\ud We propose to combine the versatility of the analytic hierarchy process (AHP) with the decision-analytic sophistication of health-economic modeling in a new methodology for early technology assessment. As an illustration, we apply this methodology to a new technology to diagnose breast cancer.\ud \ud METHODS:\ud The AHP is a technique for multicriteria analysis, relatively new in the fi eld of technology assessment. It can integrate both quantitative and qualitative criteria in the assessment of alternative technologies. We applied the AHP to prioritize a more versatile set of outcome measures than most Markov models do. These outcome measures include clinical effectiveness and costs, but also weighted estimates of patient comfort and safety. Furthermore, as no clinical data are available for this technology yet, the AHP is applied to predict the performance of the new technology with regard to all these outcome measures. Results of the AHP are subsequently integrated in a Markov model to make an early assessment of the expected incremental cost-effectiveness of alternative technologies.\ud \ud RESULTS:\ud We systematically estimated priors on the clinical effectiveness and wider impacts of the new technology using AHP. In our illustration, AHP estimates for sensitivity and specifi city of the new diagnostic technology were used as probability parameters in the Markov model. Moreover, the prioritized outcome measures including clinical effectiveness (weight = 0.61), patient comfort (weight = 0.09), and safety (weight = 0.30) were integrated into one outcome measure in the Markov model.\ud \ud CONCLUSIONS:\ud Combining AHP and Markov modelling is particularly valuable in early technology assessment when evidence about the effectiveness of health care technology is still limited or missing. Moreover, combining these methods is valuable when decision makers are interested in other patient relevant outcomes measures besides the technology’s clinical effectiveness, and that may not (adequately or explicitly) be captured in mainstream utility measures

Empirical comparison of discrete choice experiment and best-worst scaling to estimate stakeholders' risk tolerance for hip replacement surgery

Objectives Empirical comparison of two preference elicitation methods, discrete choice experiment (DCE) and profile case best-worst scaling (BWS), regarding the estimation of the risk tolerance for hip replacement surgery (total hip arthroplasty and total hip resurfacing arthroplasty). Methods An online survey was constructed, following international guidelines, and consisted of socio-demographic questions and two randomised sections with 12 DCE and 8 BWS questions. The survey was sent to a general population who can be faced with choosing between THA and TRA (males between 45-65 years old) in the US. After an intensive literature search, the following attributes were selected: probability of a first and a second revision in seven years, pain relief, ability to perform moderate daily activities, and hospital stay. In addition, survey respondents rated the difficulty of each method and the time to complete each section was monitored. BWS and DCE data was analysed using conditional logit analysis. The maximum acceptable risk (MAR) for a revision was estimated for four different hypothetical hip replacement scenarios. Results The final data set consisted of 429 respondents. The MARs estimated for four hypothetical hip replacement scenarios differed between both methods, ranging from 0% to 19% difference for a first revision. BWS questions took significantly more time (401 s.) than DCE (228 s.) questions. And respondents found BWS more difficult to complete. Conclusions Both methods to elicit stakeholder preferences produce different results. Yet, both seem to be consistent in predicting risk tolerance if the benefits are changed. However, DCE seems to be more sensitive for a change in benefits and risks while the MAR estimates obtained through BWS have considerably lower uncertainty than DC