A uniform Time Trade Off method for states better and worse than dead: feasibility study of the ‘lead time’ approach

The way Time Trade Off (TTO) values are elicited for states of health considered ‘worse than being dead’ has important implications for the mean values used in economic evaluation. Conventional approaches to TTO, as used in the UK’s ‘MVH’ value set, are problematic because they require fundamentally different tradeoffs tasks for the valuation of states better and worse than dead. This study aims to refine and test the feasibility of a new approach described by Robinson and Spencer (2006), and to explore the characteristics of the valuation data it generates. The approach introduces a ‘lead time’ into the TTO, producing a uniform procedure for generating values either >0 or <0. We used this lead time TTO to value 10 moderate to severe EQ-5D states using a sample of the general public (n=109). We conclude that the approach is feasible for use in valuation studies, and appears to overcome the discontinuity in values around 0 evident in conventional methods. However, further research is required to resolve the issue of how to handle participants who ‘use up’ all lead time; to develop ways of controlling for individual time preferences; and to better understand the implications for valuations of states better than dead

Does the value of quality of life depend on duration?

The aims of this study are to investigate the feasibility of eliciting Time Trade Off (TTO) valuations using short durations; to determine the effect of contrasting durations on individuals’ responses to the TTO; to examine variations within and between respondents’ values with respect to duration; and to consider the insights provided by participants’ comments and explanations regarding their reaction to duration in the valuation task. 27 participants provided TTO values using short and long durations for three EQ-5D states. Feedback was sought using a series of open ended questions. Of the 81 opportunities to observe it, strict constant proportionality was satisfied twice. 11 participants had no systematic relationship between duration and value; 11 provided consistently lower valuations in long durations, while 5 had higher valuations in long durations. Comments provided by participants were consistent with the values they provided. Mean TTO values did not differ markedly between alternative durations. We conclude that it is feasible to elicit TTO values for short durations. There is considerable heterogeneity in individuals’ responses to the time frames used to elicit values. Further research is required to ensure that the values used in cost effectiveness analysis adequately represent preferences about quality and length of life

Area deprivation across the life course and physical capability in mid-life: findings from the 1946 British Birth Cohort

Physical capability in later life is influenced by factors occurring across the life course, yet exposures to area conditions have only been examined cross-sectionally. Data from the National Survey of Health and Development, a longitudinal study of a 1946 British birth cohort, were used to estimate associations of area deprivation (defined as percentage of employed people working in partly skilled or unskilled occupations) at ages 4, 26, and 53 years (residential addresses linked to census data in 1950, 1972, and 1999) with 3 measures of physical capability at age 53 years: grip strength, standing balance, and chair-rise time. Cross-classified multilevel models with individuals nested within areas at the 3 ages showed that models assessing a single time point underestimate total area contributions to physical capability. For balance and chair-rise performance, associations with area deprivation in midlife were robust to adjustment for individual socioeconomic position and prior area deprivation (mean change for a 1-standard-deviation increase: balance, −7.4% (95% confidence interval (CI): −12.8, −2.8); chair rise, 2.1% (95% CI: −0.1, 4.3)). In addition, area deprivation in childhood was related to balance after adjustment for childhood socioeconomic position (−5.1%, 95% CI: −8.7, −1.6). Interventions aimed at reducing midlife disparities in physical capability should target the socioeconomic environment of individuals—for standing balance, as early as childhood

Multiple imputation using linked proxy outcome data resulted in important bias reduction and efficiency gains: a simulation study.

BACKGROUND: When an outcome variable is missing not at random (MNAR: probability of missingness depends on outcome values), estimates of the effect of an exposure on this outcome are often biased. We investigated the extent of this bias and examined whether the bias can be reduced through incorporating proxy outcomes obtained through linkage to administrative data as auxiliary variables in multiple imputation (MI). METHODS: Using data from the Avon Longitudinal Study of Parents and Children (ALSPAC) we estimated the association between breastfeeding and IQ (continuous outcome), incorporating linked attainment data (proxies for IQ) as auxiliary variables in MI models. Simulation studies explored the impact of varying the proportion of missing data (from 20 to 80%), the correlation between the outcome and its proxy (0.1-0.9), the strength of the missing data mechanism, and having a proxy variable that was incomplete. RESULTS: Incorporating a linked proxy for the missing outcome as an auxiliary variable reduced bias and increased efficiency in all scenarios, even when 80% of the outcome was missing. Using an incomplete proxy was similarly beneficial. High correlations (> 0.5) between the outcome and its proxy substantially reduced the missing information. Consistent with this, ALSPAC analysis showed inclusion of a proxy reduced bias and improved efficiency. Gains with additional proxies were modest. CONCLUSIONS: In longitudinal studies with loss to follow-up, incorporating proxies for this study outcome obtained via linkage to external sources of data as auxiliary variables in MI models can give practically important bias reduction and efficiency gains when the study outcome is MNAR

Prikaz knjige: Zorislav Kaleb - Djelovanje kaznene presude na parnični postupak /Vizura, Zagreb, 2008./

Nedavno je u izdanju nakladničke kuće Vizura objavljena knjiga mr. sc. Zorislava Kaleba, suca Kaznenog odjela Općinskog suda u Zagrebu, Djelovanje kaznene presude na parnični postupak s podnaslovom Vezanost parničnog suda za pravomoćnu presudu kaznenog suda. Knjiga Djelovanje kaznene presude na parnični postupak predstavlja autorov izra¬đeni i obranjeni magistarski rad na poslijediplomskom znanstvenom studiju iz trgovačkog prava i prava društava na Pravnom fakultetu Sveučilišta u Zagrebu dana 4. travnja 2006. godine na temu Vezanost parničnog suda za pravomoćnu presudu kaznenog suda pred Povjerenstvom koje su činili akademik Jakša Barbić, predsjednik Povjerenstva, prof. dr. se. Mihajlo Dika kao mentor, te prof. dr. se. Davor Krapac i dr. se. Branko Vukmir kao članovi Povjerenstva. Isti rad je autor u međuvremenu dijelom prilagodio radi objave kao monografije, a također je unio i izmjene koje su se u međuvremenu dogodile našem pozitivnom zakonodavstvu. U knjizi se obrađuje odnos između parničnog i kaznenog postupka, vezanost par¬ničnog suda za pravomoćnu osuđujuću presudu kaznenog suda po tužbi iz istog događaja, prejudicijelno djelovanje presude kaznenog suda na parnični postupak, djelovanje kaznene presude kao pravno relevantne činjenice u parničnom postupku, prekid postupka po od¬luci suda u parničnom postupku, donošenje pravomoćne kaznene presude kao razlog za ponavljanje parničnog postupka, te neki zaključni prijedlozi de legeferenda. Rad dijelom komparativno obrađuje istu materiju i u nekim drugim zakonodavstvima u opsegu koliko je to zanimljivo za našeg praktičara. Knjiga je rezultat dvogodišnjeg istraživanja autora prvenstveno odluka Županijskog suda u Zagrebu i Vrhovnog suda Republike Hrvatske, te potom i dostupnih odluka drugih domaćih i stranih sudova

A Brief Review on Diagnosis of Foot-and-Mouth Disease of Livestock: Conventional to Molecular Tools

Foot-and-mouth disease (FMD) is one of the highly contagious diseases of domestic animals. Effective control of this disease needs sensitive, specific, and quick diagnostic tools at each tier of control strategy. In this paper we have outlined various diagnostic approaches from old to new generation in a nutshell. Presently FMD diagnosis is being carried out using techniques such as Virus Isolation (VI), Sandwich-ELISA (S-ELISA), Liquid-Phase Blocking ELISA (LPBE), Multiplex-PCR (m-PCR), and indirect ELISA (DIVA), and real time-PCR can be used for detection of antibody against nonstructural proteins. Nucleotide sequencing for serotyping, microarray as well as recombinant antigen-based detection, biosensor, phage display, and nucleic-acid-based diagnostic are on the way for rapid and specific detection of FMDV. Various pen side tests, namely, lateral flow, RT-LAMP, Immunostrip tests, and so forth. are also developed for detection of the virus in field condition

Using Data Linkage to Investigate Inconsistent Reporting of Self-Harm and Questionnaire Non-Response

The objective of this study was to examine agreement between self-reported and medically recorded self-harm, and investigate whether the prevalence of self-harm differs in questionnaire responders vs. non-responders. A total of 4,810 participants from the Avon Longitudinal Study of Parents and Children (ALSPAC) completed a self-harm questionnaire at age 16 years. Data from consenting participants were linked to medical records (number available for analyses ranges from 205-3,027). The prevalence of self-harm leading to hospital admission was somewhat higher in questionnaire non-responders than responders (2.0 vs. 1.2%). Hospital attendance with self-harm was under-reported on the questionnaire. One third reported self-harm inconsistently over time; inconsistent reporters were less likely to have depression and fewer had self-harmed with suicidal intent. Self-harm prevalence estimates derived from self-report may be underestimated; more accurate figures may come from combining data from multiple sources