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Think of the Children: A Discussion of the Rationale for and Implications of the Perspective Used for EQ-5D-Y Health State Valuation
Full text link_Objectives:_ The recently published EQ-5D-Y valuation protocol prescribes the general public values EQ-5D-Y health states for a
10-year-old child. This child perspective differs from the individual perspective applied for valuation of adult EQ-5D
instruments. This article discusses the rationale for and implications of applying a child perspective for EQ-5D-Y health
state valuation.
_Methods:_ This article was informed by an exploration of the normative and empirical literature on health state valuation. We
identified and summarized key discussion points in a narrative review.
_Results:_ Although valuing EQ-5D-Y health states from an individual perspective is feasible, it may be problematic for several
reasons. The use of a child perspective implies that—rather than valuing one’s own health—someone else’s health is valued.
This may require the projection of one’s own beliefs, expectations, and preferences on others, which could change the
decision processes underlying the elicited preferences. Furthermore, because preferences are obtained for a 10-year-old
child, it is unclear if this given age as well as other (missing) information on the described child beneficiary (should)
affect valuation of EQ-5D-Y health states.
_Conclusions:_ The change from an individual to a child perspective in the valuation of EQ-5D-Y will likely lead to differences in
utilities. This has implications for the estimation of incremental health-related quality-of-life gains in economic evaluations of
health technologies for children and adolescents and therefore might affect reimbursement decisions. Further research is
necessary for gaining insight into the extent to which this impact is normatively and empirically justified
T2mapping of healthy knee cartilage: Multicenter multivendor reproducibility
Full text linkBackground: T2 mapping is increasingly used to quantify cartilage degeneration in knee osteoarthritis (OA), yet reproducibility studies in a multicenter setting are limited. The purpose of this study was to determine the longitudinal reproducibility and multicenter variation of cartilage T2 mapping, using various MRI equipment and acquisition protocols. Methods: In this prospective multicenter study, four traveling, healthy human subjects underwent T2 mapping twice at five different centers with a 6-month-interval. Centers had various MRI scanners, field strengths, and T2 mapping acquisition protocols. Mean T2 values were calculated in six cartilage regions of interest (ROIs) as well as an average value per patient. A phantom was scanned once at each center. To evaluate longitudinal reproducibility, intraclass correlation coefficients (ICC), root-mean-square coefficient of variation (RMS-CV), and a Bland-Altman plot were used. To assess the variation of in vivo and phantom T2 values across centers, ANOVA was performed. Results: ICCs of the T2 mapping measurements per ROI and the ROI's combined ranged from 0.73 to 0.91, indicating good to excellent longitudinal reproducibility. RMS-CVs ranged from 1.1% to 1.5% (per ROI) and 0.6% to 1.6% (ROIs combined) across the centers. A Bland-Altman plot did not reveal a systematic error. Evident, but consistent, discrepancies in T2values were observed across centers, both in vivo and in the phantom. Conclusions: The results of this study suggest that T2mapping can be used to longitudinal assess cartilage degeneration in multicenter studies. Given the differences in absolute cartilage T2values across centers, absolute T2values derived from various centers in multicenter multivendor trials should not be pooled
Vascular complications with a plug-based vascular closure device after transcatheter aortic valve replacement: Predictors and bail-outs
Full text linkBackground: The MANTA vascular closure device (VCD) is dedicated to large bore access closure and associated with favorable results in selected study populations. Anatomical predictors for access site complications are lacking. Aim: To evaluate MANTA in a real-world population and identify predictors for vascular complications. Methods: All patients undergoing transfemoral transcatheter aortic valve replacement (TAVR) between January 2016 and May 2020 with MANTA closure were included. Baseline characteristics were collected, pre-procedural computed tomography and post-deployment femoral angiograms were analyzed for anatomical differences. The primary endpoint was a composite of access site related major and minor vascular complications at 30 days follow-up according to the VARC-2 definitions. Secondary endpoints included bleeding, time to hemostasis, procedural length and incomplete arteriotomy closure or arterial occlusion by angiography. A Cox proportional hazards model was used to compare all-cause mortality for patients with and without an access site complication. Results: The 512 patients underwent TAVR with MANTA access closure. Median age was 80 (IQR 75–85), 53% was male, median BMI was 26.4 kg/m2 (IQR 23.4–29.7). Access site related major- or minor vascular complication occurred in 20 (4%) and 23 (4%) of patients respectively. Median time to hemostasis was 42 s (IQR 28–98). Post deployment angiogram showed an occlusion in 24 patients (5%), incomplete closure in 60 patients (12%) or both in three patients (1%). Of these 87 patients, 36 (41%) had a vascular complication. Femoral artery diameter (OR 0.70 [0.53–0.93]), low- (OR 3.47 [1.21–10.00]) and high (OR 2.43 [1.16–5.10]) arteriotomies were independent predictors for vascular complications. Conclusion: In this contemporary TAVR population, access-site related complications occurred in 8% of patients and were mainly due to percutaneous closure device failure. Small artery diameter and off-target punctures were independent predictors
The new divided city: Class transformation, civic participation and neighbourhood context
Full text linkThe dissertation investigates contemporary transformations in the class structure of Rotterdam. In addition, it is studied to what extent changing societal conditions affect levels of civic participation
Willingness to Pay for Health-Related Quality of Life Gains in Relation to Disease Severity and the Age of Patients
Full text link_Objectives:_ Decision-making frameworks that draw on economic evaluations increasingly use equity weights to facilitate a
more equitable and fair allocation of healthcare resources. These weights can be attached to health gains or reflected in the
monetary threshold against which the incremental cost-effectiveness ratios of (new) health technologies are evaluated.
Currently applied weights are based on different definitions of disease severity and do not account for age-related
preferences in society. However, age has been shown to be an important equity-relevant characteristic. This study
examines the willingness to pay (WTP) for health-related quality of life (QOL) gains in relation to the disease severity and
age of patients, and the outcome of the disease.
_Methods:_ We obtained WTP estimates by applying contingent-valuation tasks in a representative sample of the public in The
Netherlands (n = 2023). We applied random-effects generalized least squares regression models to estimate the effect of
patients’ disease severity and age, size of QOL gains, disease outcome (full recovery/death 1 year after falling ill), and
respondent characteristics on the WTP.
_Results:_ Respondents’WTP was higher for more severely ill and younger patients and for larger-sized QOL gains, but lower for
patients who died. However, the relations were nonlinear and context dependent. Respondents with a lower age, who were
male, had a higher household income, and a higher QOL stated a higher WTP for QOL gains.
_Conclusions:_ Our results suggest that—if the aim is to align resource-allocation decisions in healthcare with societal
preferences—currently applied equity weights do not suffice
Douanewaarde in een globaliserende wereld
Full text linkThe customs value is the taxable amount to determine the customs debt. The internationally accepted system for determining customs values reflects the economic reality of the 1970s. Economic globalization caused worldwide increases in trade flows, more intensively (inter-firm) transactions, and value of goods is increasingly being determined by intangible rights. As a result the use of the transaction value is under pressure. From a EU law perspective, this PhD research examines to what extent the transaction value of imported goods can still be determined under this system, with a focus on the use for determining customs values in successive sales, inter-firm transactions, and when the value of imported goods is accounted for, at least partially, by intangibles
Pathology and pathogenesis of eurasian blackbirds (Turdus merula) naturally infected with usutu virus
No full textThe Usutu virus (USUV) is a mosquito-borne zoonotic flavivirus. Despite its continuous circulation in Europe, knowledge on the pathology, cellular and tissue tropism and pathogenetic potential of different circulating viral lineages is still fragmentary. Here, macroscopic and micro-scopic evaluations are performed in association with the study of cell and tissue tropism and com-parison of lesion severity of two circulating virus lineages (Europe 3; Africa 3) in 160 Eurasian blackbirds (Turdus merula) in the Netherlands. Results confirm hepatosplenomegaly, coagulative necro-sis and lymphoplasmacytic inflammation as major patterns of lesions and, for the first time, vascu-litis as a novel virus-associated lesion. A USUV and Plasmodium spp. co-infection was commonly identified. The virus was associated with lesions by immunohistochemistry and was reported most commonly in endothelial cells and blood circulating and tissue mononucleated cells, suggesting them as a major route of entry and spread. A tropism for mononuclear phagocytes cells was further supported by viral labeling in multinucleated giant cells. The involvement of ganglionic neurons and epithelial cells of the gastrointestinal tract suggests a possible role of oral transmission, while the involvement of feather follicle shafts and bulbs suggests their use as a diagnostic sample for live bird testing. Finally, results suggest similar pathogenicity for the two circulating lineages.</p
The Framing of "alzheimer's Disease"
No full textBackground and Objectives: The meaning of Alzheimer's disease (AD) is changing in research. It now refers to a pathophysiological process, regardless of whether clinical symptoms are present. In the lay literature, on the other hand, AD is understood as a form of dementia. This raises the question of whether researchers and the lay audience are still talking about the same thing. If not, how will these different understandings of AD shape perspectives on (societal) needs for people with AD? Research Design and Methods: We use framing analysis to retrieve the understandings of the term AD that are upheld in the research literature and in national Dutch newspaper articles. We make explicit how the framings of AD steer our normative attitudes toward the disease. Results: In the analyzed research articles, AD is framed as a pathological cascade, reflected by biomarkers, starting in cognitively healthy people and ending, inevitably, in dementia. In the lay literature, AD is used as a synonym for dementia, and an AD diagnosis is understood as an incentive to enjoy "the time that is left."Discussion and Implications: The two different uses of the term AD in research and in the lay literature may result in misunderstandings, especially those research framings that falsely imply that people with AD biomarkers will inevitably develop dementia. Adoption of the research understanding of AD in clinical practice will have normative implications for our view on priority setting in health care. For example, it legitimizes biomarker testing in people without dementia as improving "diagnostic"certainty. </p
CSF sTREM2 is elevated in a subset in GRN-related frontotemporal dementia
No full textExcessive microglial activation might be a central pathological process in GRN-related frontotemporal dementia (FTD-GRN). We measured soluble triggering receptor expressed on myeloid cells 2 (sTREM2), which is shed from disease-associated microglia following cleavage of TREM2, in cerebrospinal fluid of 34 presymptomatic and 35 symptomatic GRN mutation carriers, 6 presymptomatic and 32 symptomatic C9orf72 mutation carriers and 67 healthy noncarriers by ELISA. Although no group differences in sTREM2 levels were observed (GRN: symptomatic (median 5.2 ng/mL, interquartile range [3.9–9.2]) vs. presymptomatic (4.3 ng/mL [2.6–6.1]) vs. noncarriers (4.2 ng/mL [2.6–5.5]): p = 0.059; C9orf72: symptomatic (4.3 [2.9–7.0]) vs. presymptomatic (3.2 [2.2–4.2]) vs. noncarriers: p = 0.294), high levels were seen in a subset of GRN, but not C9orf72, mutation carriers, which might reflect differential TREM2-related microglial activation. Interestingly, 2 presymptomatic carriers with low sTREM2 levels developed symptoms after 1 year, whereas 2 with high levels became symptomatic after >5 years. While sTREM2 is not a promising diagnostic biomarker for FTD-GRN or FTD-C9orf72, further research might elucidate its potential to monitor microglial activity and predict disease progression.</p
Higher 1-year mortality in women admitted to intensive care units after cardiac arrest
No full textPurpose: We study sex differences in 1-year mortality of out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA) patients admitted to the intensive care unit (ICU). Data: A retrospective cohort analysis of OHCA and IHCA patients registered in the NICE registry in the Netherlands. The primary and secondary outcomes were 1-year and hospital mortality, respectively. Results: We included 19,440 OHCA patients (5977 women, 30.7%) and 13,461 IHCA patients (4889 women, 36.3%). For OHCA, 1-year mortality was 63.9% in women and 52.6% in men (Hazard Ratio [HR] 1.28, 95% Confidence Interval [95% CI] 1.23–1.34). For IHCA, 1-year mortality was 60.0% in women and 57.0% in men (HR 1.09, 95% CI 1.04–1.14). In OHCA, hospital mortality was 57.4% in women and 46.5% in men (Odds Ratio [OR] 1.42, 95% CI 1.33–1.52). In IHCA, hospital mortality was 52.0% in women and 48.2% in men (OR 1.11, 95% CI 1.03–1.20). Conclusion: Women admitted to the ICU after cardiac arrest have a higher mortality rate than men. After left-truncation, we found that this sex difference persisted for OHCA. For IHCA we found that the effect of sex was mainly present in the initial phase after the cardiac arrest.</p