Economic evaluations in medical technological innovations a mapping review of methodologies.

RATIONALE: Economic evaluations play an important role in the development and implementation of healthcare innovations. For pharmaceutical products, the methodologies used are laid down in guidelines, whereas for medical technologies the guidelines are not as strenuous. The aim of this review was therefore to analyze what types of methodologies are used in economic evaluations of medical technologies. METHODS: We performed a mapping review to identify economic evaluations for medical technologies. We decided to limit our search to one year (2022) and included cost utility and cost effectiveness analyses in which health technologies were evaluated. For each included study we identified the main methodological characteristics. RESULTS: A total of 364 papers were included in the analysis, 268 (74%) contained cost-utility analyses and 91 (25%) cost-effectiveness analyses. A model was used in 236 (64%) analyses, 117 analyses were trial based evaluations. Probabilistic sensitivity analyses and/or bootstrapping was performed in 266 (73%) analyses. Deterministic sensitivity analyses were used in 306 (84%). Time horizon and perspective were underreported in 15-25% of the included studies. CONCLUSIONS: This review shows the wide range of methodologies used in economic evaluations as well as the extent and rigor in which these methodologies are used. Many of the included papers did no use or did not sufficiently report the use of appropriate standard methods. This may lead to research waste, a delay in successful implementation of valuable innovations and in the end may delay improvement patient outcomes.

Parenting, family contexts, and personality characteristics in youngsters with VCFS.

Parenting, family contexts, and personality characteristics in youngsters with VCFS: The personality profiles for 48 youths with Velo-Cardio-Facial syndrome (VCFS) were described using the California Child Q-Set (CCQ). Associations between personality characteristics and parenting (i.e., Control and Warmth vs. Anger) and family contexts (i.e., Experienced Family Stress, Marital Conflict and Parental Consistency) were investigated. Personality characteristics were found to be related to parenting (in particular, Parental Warmth vs. Anger) but not to family contexts. Parents who reported more Parental Warmth (and less Anger) in interactions had children with higher Agreeableness, Conscientiousness and Emotional Stability and with lower Irritability and Dependency. Parental Control was positively related to children's Dependency and negatively to children's Conscientiousness. Compared to fathers, mothers exerted more Control. Differences in parenting and family contexts were related to the mode of inheritance but not to IQ, age, gender, and cardiac defects. Families in which a familial deletion occurred reported higher levels of Marital Conflict and lower Warmth in the parent-child interactions.

Personality profiles of children and adolescents with neurofibromatosis type 1.

The personality profile of 44 youngsters (24 males, 20 females; mean age 11 years, 3 months) with neurofibromatosis type 1 (NF1) was compared with a group of 220 non-NF1 control youngsters (matched on age and gender). Personality characteristics of each youngster were rated by both parents, using the California Child Q-set (CCQ); [Block and Block, 1980]. The scores on eight personality dimensions were compared, i.e., Extraversion, Agreeableness, Conscientiousness, Emotional Stability, Openness, Motor Activity, Irritability, and Dependency. Moreover, personality of NF1 youngsters was related to IQ level, severity of medical problems, the presence or absence of visible cosmetic disfiguring, and de novo versus familial origin of NF1. The personality profile of NF1 youngsters was markedly different from the non-NF1 youngsters. Compared to the 220 control children, they were equally agreeable, but less conscientious, less emotionally stable, less open for new experience, with less motor activity, and more extravert, more dependent, and more irritable. Personality characteristics were similar for children with maternally or paternally inherited NF1, or for children with a new mutation. There was no association with gender, the severity of medical and cosmetic problems, and IQ.

Personality profiles of youngsters with velo-cardio-facial syndrome.

The personality profile of 48 youngsters (24 males and 24 females, mean age 8 years, 5 months) with Velo-Cardio-Facial Syndrome (VCFS) was compared with a group of 240 non VCFS control youngsters (matched on age and gender), and, in addition, with groups of youngsters with Prader-Willi (PWS), Fragile X (FXS), and Williams Syndromes (WS). Personality characteristics of each youngster were rated by both parents, using the California Child Q-set (CCQ). The scores on eight personality dimensions were compared, i.e., Extraversion, Agreeableness, Conscientiousness, Emotional Stability, Openness, Motor Activity, Irritability, and Dependency. Moreover, Individual differences in personality of VCFS youngsters were related to IQ level, presence or absence of cardiac defects, and de novo versus familial origin of VCFS. The personality profile of VCFS youngsters was markedly different from all non-VCFS groups. Compared to the 240 control children, they were equally extravert and agreeable, less conscientious and emotional stable and more Irritable and dependent. Some personality characteristics in youngsters with VCFS were related to IQ and Age, but not to cardiac defects or de novo versus familial genetic origin of the 22q11 deletion.

Relational support and person characteristics in adolescence.

In this paper, an heuristic model of the personality characteristics of adolescents and the supportive dimensions of interactions, relationships and groups is presented. The model takes the concept of developmental tasks as its starting point and it is assumed that developmental tasks can be characterized in terms of four modalities: intentions, behaviour, cognitions and affect. The same four modalities can also be used to characterize dimensions of personality and aspects of interactional and relational support. The results of several empirical studies are presented to illustrate the model. Together, these studies present a transactional picture of the personality of adolescents and their relationships in which personality and relationships influence each other and jointly determine psychosocial functioning.

Family contexts, parental behaviour, and personality profiles of children and adolescents with Prader-Willi, fragile-X, or Williams syndrome.

The personality profiles for youths with Prader-Willi, fragile-X, or Williams syndrome were compared to three matched groups attending regular schools. Using the California Child Q-Set (CCQ), both of the parents of the 39 children with Prader-Willi syndrome, 32 boys with fragile-X syndrome, 28 children with Williams syndrome, and children in the comparison groups provided independent personality descriptions in terms of the Big Five personality factors of Extraversion, Agreeableness, Conscientiousness, Emotional Stability, and Openness, along with Motor Activity and Irritability. Specific personality phenotypes for each of the three syndrome groups were found to be differentially related to parental behaviours (i.e. control and anger) and family contexts (i.e. experienced family stress, marital conflict, and parental consistency).

Problem behaviors and personality of children and adolescents with Prader-Willi syndrome.

OBJECTIVE: Compare behavioral and emotional problems of children and adolescents with Prader-Willi Syndrome (PWS) and clients consulting mental health centers (MHC) and related behavioral and emotional problems to the children's personality in the PWS group. METHODS: Participants were 39 children with PWS and 585 matched MHC clients. Child Behavior Checklist (CBCL) syndromes were related to the Big-Five personality factors measured with the California Child Q-sort (CCQ). RESULTS: Mean CBCL Total Problems scores were not different for the PWS and MHC groups, but differences were found for several of the CBCL subscales. Patterns of correlations among CBCL scales were similar in both groups, although coefficients were generally higher in the PWS group, indicating higher comorbidity or co-absence of CBCL syndromes in children and adolescents with PWS. Personality profiles were specific for internalizing and Externalizing problems of children and adolescents with PWS.

Adolescent personality factors in self-ratings and peer nominations and their prediction of peer acceptance and peer rejection.

In this study, the robustness of the Big Five personality factors in adolescents' self-ratings and peer nominations was investigated. Data were obtained on 2,001 adolescents attending secondary school (885 girls; 1,116 boys; M age = 14.5 years). Exploratory and confirmatory factor analyses on the self-ratings confirmed the Big Five personality factors. In contrast, exploratory analysis on the peer nominations revealed five different factors: Aggression-Inattentiveness, Achievement-Withdrawal, Self-Confidence, Sociability, and Emotionality-Nervousness. It is suggested that peers evaluate group members not in terms of their personality but in terms of their group reputation. Peer evaluations contributed substantially to the prediction of peer acceptance and rejection; the Big Five personality factors based on self-ratings did not.

Personality profiles of youngsters with Prader-Willi syndrome and youngsters attending regular schools.

For the study of the personality profile of youngsters with Prader-Willi syndrome (PWS), a PWS group was compared with a matched group of youngsters attending regular school. The PWS group consisted of 28 youngsters (12 males and 16 females; mean age 11 years, 11 months). These youngsters were matched on gender and age level with 28 youngsters out of a group of 333 youngsters in regular school. Behaviour and personality characteristics of each youngster in both groups were described by both parents, using a Dutch version of the California Child Q-set (CCQ; Block & Block 1980). The present authors compared the scores of both groups on eight personality dimensions, derived from the aggregated CCQ-descriptions for fathers and mothers. The personality dimensions were Extraversion, Agreeableness, Conscientiousness, Emotional Stability, Openness, Motor Activity, Irritability and Dependency. The authors investigated further individual differences of PWS youngsters on the same eight CCQ personality dimensions, considering gender and age level as well as IQ level and the presence or absence of a 15q11-q13 deletion. The personality profile of PWS youngsters was markedly different from youngsters in regular school. Some personality characteristics were related to gender and IQ. The lower level of physical activity in PWS girls without 15q11-q13 deletion needs further study.

Development of behavioral distress in reaction to acute pain in two cultures.

Studied developmental and gender differences in distress behavior during separate phases of a medical treatment in 2 cultures. Distress reactions of 175 children with cancer (age 8 months-18 years 7 months) were observed during bone marrow aspirations (BMA) in 2 different treatment centers (one in the United States, one in The Netherlands) using a behavioral checklist (Procedure Behavioral Rating Scale). The BMAs contained a preparatory phase, the actual needle introduction, and a recovery period. In both cultures almost all separate distress behaviors occurred less in older children, except for increasing muscle tension during the actual puncture. Distress was highest during the needle introduction and significantly lower during the preparatory and recovery phases; in addition, somewhat different patterns of distress behavior were found in separate phases. Culture and sex differences were found. The latter were less robust than developmental and phase differences.

[Nursing home problems in a large city. A report from practice]. / De verpleeghuisproblemen in een grote stad. Een bericht uit de praktijk.

At the moment The Hague has the oldest population of all Dutch cities. In the years to come this will continue to be so. Even though the permitted permillage for nursing home beds for the three major cities in Holland is already higher than for other cities, the permitted permillage for the number of beds in The Hague is even higher. Nevertheless, at this moment The Hague is facing a huge problem in placing patients with irreversible demential disorders.

[Bone marrow biopsy in children with leukemia. Determination and reduction of pain and fear reactions]. / Beenmergpuncties bij kinderen met leukemie. Vaststelling en verlaging van pijn- en angstreacties.

The development and reduction of distress in children with leukemia was studied during a frequently recurring medical procedure, i.e., a bone marrow aspiration (BMA). The role of a number of factors in the development of distress display in children during this procedure was studied. The intensity of distress display was assessed with a behavioral rating scale. The intensity of distress display was found to be independent of the physician who performed the punction, the part of the body to which the punction was administered, the number of previously administered BMA'S, whether the child had to undergo a lumbar puncture after the BMA, and whether the child was sedated. The intensity of distress display varied with age and sex of the child. The intensity of distress display was weaker in older children, but this age effect was stronger for boys than for girls. An experimental program was developed and administered in order to reduce distress display during medical treatment. This program consisted of three parts (relaxation, imagination of a pleasant situation and arousal of the concomitant feelings, as well as watching a model). The experimental program was found to be effective in reducing distress display in children. The amount of reduction was dependent of the number of prior BMA'S (the fewer the prior BMA'S, the greater the decrease) and of the level of pretreatment display of distress (the higher the level, the smaller the decrease.

[A mouth full of poison (author's transl)]. / Een mond vol gif.

Veterinary environmental toxicology is concerned with environmental pollution and its possible ill-effects on animals. The Department of Analytical Chemistry and Toxicology of the Central Veterinary Institute has become increasingly involved in industrial and environmental toxicological problems affecting domestic as well as free-living wild animals during the last five years. Its main duties lie not only in the field of diagnostic procedures but it also deals with other factors such as inquiries into the facts of poisoning, tracing poisons to their sources, modes of dissemination and contamination of the environment and food of animals with toxic substances. Some typical features and characteristics of research projects of the department, which are closely connected with these duties, are described. The results of investigations of special cases in the field and the experience thus gained clearly show the close relationship between veterinary and environmental toxicology.

[Arsenic poisoning through the roof. A case of arsenic poisoning in cattle]. / 'Met arsenicum onder dak'. Een geval van arsenicumintoxicatie bij runderen.

A case of arsenic poisoning in cattle is reported, in which six out of fifteen animals died. The source of poisoning was traced to a substance in the loft of the hay-barn, which probably consisted of the remains of a pesticide which had been there for several years. This had become liquefied as the result of a leak in the roof and had found its way into the hay. The arsenic content of the substance ranged from 17 to 37 per cent, that of the hay being up to 0.3 per cent. The concentration of arsenic in the organs, blood, faeces and urine of the animals were indicative of poisoning. The main clinical findings consisted in profuse diarrhoea, loss of appetite, muscular weakness and an ataxic gait. Dehydration set in later and the animals became deeply soporous. Symptomatic treatment was mainly directed against dehydration, hypoglycaemia and hypocalcaemia. The greater part of the animals gradually recovered. Marked hyperaemia of the abomasal mucosa and, to a less extent, hyperaemia of the small and large intestines was observed on post-mortem examination.

Phenylmercuric acetate intoxication in mink.

Mink died following an incidental phenylmercuric acetate (PMA) intoxication. Mortality was restricted to the older animals (31% in the females and 40% in the males). Of all organs the kidneys were most seriously damaged (tubulonephrosis) and contained the highest residual levels of mercury. No lesions were observed in the central nervous system. Twenty-one weeks after exposure mercury residues had declined to normal levels. The half-time of disappearance of mercury was 10 days in skeletal muscle, 22 days in kidneys, 27 days in brain and 36 days in liver. The reproductivity of the surviving mink was not affected by the PMA-intoxication.