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Health care decision making does not usually involve the use of incremental cost-effectiveness ratios to determine that a program efficiently uses scarce resources. In the health care field, analysts do not engage in projects that are completely divisible or exhibit constant returns to scale which lead to constant marginal opportunity costs. The evaluation of health care programs should be seen as a method that allocates a given budget to various programs in an effort to maximize the health of the community.

A study was conducted to refute the claim that the healthy-years-equivalents (HYE) is equivalent to the quality-adjusted life-years (QALY) as an aid in choosing health care interventions. The claim of equivalence is based on the failure to distinguish between choice under certainty and choice under uncertainty. It also confuses the measurement technique with the utility theory from which it arises. It was argued that HYE is superior to QALY in economic evaluations of health care interventions.

Cost effectiveness and cost-utility analyses have often been used to evaluate the economic feasibility of health care programs. However, not enough attention has been given to the theoretical aspects of the two techniques. Although cost effectiveness and cost-utility analyses allow analysts to formulate objective assessments of managerial plans, they are often inconsistent with welfare economic objectives.

Sham acupuncture has been used as a control in acupuncture efficacy trials. However, questions have been raised about whether it is a physiologically inert placebo. We aimed to understand global research trends and provide guidance for future research by conducting a bibliometric analysis of sham acupuncture studies. Journal articles published to date related to sham acupuncture were retrieved from Web of Science on May 29, 2023. The publication year, country, keyword, author, and organization of the studies were analyzed using the available bibliometric information. Using VOSviewer software, the co-occurrence of keywords in sham acupuncture studies was visualized as a network map by cluster analysis and overlay analysis according to the publication year. A total of 3428 studies were included in the analysis. Studies on sham acupuncture have been steadily increasing since 1991, with most of the studies conducted in China (1514 studies, 44.17 %), followed by the United States (789 studies, 23.02 %) and South Korea (277 studies, 8.08 %). The keywords of sham acupuncture research were classified into four clusters: evidence synthesis, pain clinical research, mechanism research, and acupressure research. Keyword analysis according to the publication year showed that evidence synthesis on sham acupuncture was recently focused on psychiatric conditions including depression and insomnia through systematic reviews, and clinical and mechanism studies on sham acupuncture were mostly conducted relatively in the past. This bibliometric analysis provides a comprehensive overview of the development and global trends of sham acupuncture research to date, suggesting directions for future research. • This is the first bibliometric analysis of sham acupuncture studies. • Keywords were classified into evidence synthesis, pain clinical research, mechanism research, and acupressure research. • The article thoroughly discusses the hotspots and trends in sham acupuncture research. [ABSTRACT FROM AUTHOR]

In the face of rapidly ageing populations and increasing costs of health care provision, questions continue to be raised about the long-term sustainability of publicly funded health care programmes around the world. But despite increasing evidence of dynamic changes in epidemiology, most official health service planning models continue to rely on the implicit assumption that age-specific requirements for services (and by implication age-specific needs for care) will remain constant across future years ('constant-use models'). In this paper, we discuss the advantage of dynamic 'changing needs' planning models, compared to 'constant-use' planning models, and consider a framework that integrates population needs directly into health service planning. Using Australian survey data, we empirically illustrate the difference between static health service planning approaches to dynamic needs-driven planning models. We use data from the Household, Income and Labour Dynamics Survey in Australia (HILDA) to explore trends in health needs from 2001 to 2020. We subsequently simulate a 'changing-needs' planning model where changes in health needs by birth-cohorts are incorporated into official government estimates from the Australian Intergenerational Reports (IGR) to understand the potential impact on future health care requirements. Our results show that healthy ageing trends are being observed for successive birth-cohorts with these trends greatest in older age groups, the age groups for which health care expenditures are largest. Adjusting for these changes in needs using Australian data leads to reductions in the expenditures required for future years ranging from 1.5 (2.50%) to 3 billion (5.25%) 2019 AUD. We conclude that 'constant-use' planning models based on the expected future numbers of people in different age groups applied to current levels of service use by age groups without any consideration given to changing age-specific needs for health care lead to inefficient resource planning. • We discuss the advantages of dynamic needs-driven health service planning models. • We use 19 waves of longitudinal data from Australia. • We study changes in health status among birth cohorts by age group. • We find healthy ageing trends among people aged 65 and over. • Accounting for changing needs leads to reductions in future spending estimates. [ABSTRACT FROM AUTHOR]

Introduction Pattern identification (PI) is a unique concept in traditional East Asian medicine that refers to diagnostic process. This study aims to summarize and critically evaluate the reliability and validity of all Korean designed PI instruments. Methods A systematic literature search was conducted in MEDLINE, EMBASE, and eight Korean medical databases from the study’s inception to August 2017 to identify all studies that described Korean PI instruments. We included PI instruments without restriction on the types of diseases or, conditions of participants. General characteristics of the included instruments, reliability verification, internal consistency, and the types of validity, including construct validity, content validity, and criterion validity, were reviewed. Results Thirty-six PI instruments were identified and analyzed. Ten of them were PI diagnostic tools for specific diseases. Fifteen were related diagnoses of PI for non-specific diseases. Four instruments involved the diagnosis of PI for specific decoction treatment and seven were related to the diagnosis of constitution, including Sasang constitution. The most commonly used statistical test was Cronbach’s alpha, an estimator of internal consistency. A total of ten studies conducted test-retest reliability with varying time intervals, and the test-retest coefficient was moderate to good. Conclusions This article examined the reliability and validity of the PI instruments used in Korea and the need to improve the standardisation of PI diagnosis. Almost studies reported the value of internal consistency only. Clinical studies on the application of future questionnaires will be needed in the future. [ABSTRACT FROM AUTHOR]

Clinical practice guidelines (CPGs) are an important tool for clinicians and health authorities to help select appropriate therapies for different patients and problems. While systematic reviews and meta-analyses look at best-available trial evidence, CPGs are less limited since they compare that best evidence to the same evidence for other therapies for the same condition, while at the same time including comparison of safety and cost-effectiveness of those therapies. Thus CPGs inform more about the clinical utility of a therapy within a broader health care context, still CPGs can be subject to bias in their inclusion and evidence-selection process. CPGs are influenced by many factors, including local political and socio-economic, in order to try to improve relevance for their target audience. Acupuncture, a traditional medical intervention that lies outside mainstream medicine, has been extensively investigated with emerging evidence for its effectiveness in many areas. The extent to which acupuncture is included in CPG development processes and recommended by CPGs is subject to many factors and is not well known within the acupuncture community. Many more recommendations for the use of acupuncture exist than previously thought, making it critical for the acupuncture community to become more informed about these recommendations and to try to improve implementation of the CPG recommendations in mainstream health care. [ABSTRACT FROM AUTHOR]

In a previous study, evidence was found of the variability of signs/symptoms (s/s) of blood stasis syndrome among texts of Chinese and Asian origin and English language texts including evidence of the differences between non-Asian and Asian patients. In the current study the diagnostic patterns of qi deficiency (QD) and qi stagnation (QS) were examined to see if similar results could be found. The study consisted of two phases – a search of libraries and a search of electronic databases, and searching for texts describing QD and QS s/s ensuring inclusion of Asian origin texts (principally Chinese) and Western origin texts. More commonly mentioned s/s were compared for each type of source and across all sources. Study one: From the 21 included QD texts, six s/s were generally agreed upon with three more commonly mentioned in Western origin texts, three more commonly mentioned in Chinese origin texts. From the 17 included QS texts, three s/s were more generally agreed upon with three more commonly mentioned in Western origin texts. Study two: Comparing s/s in 13 QD studies, five were mentioned by more than half the studies. Comparing six QS studies, six s/s were more generally agreed upon. In a comparison of s/s for QD mentioned by Western and Chinese origin texts and the Asian studies, three were mentioned by >50% sources, one more often by Chinese texts, three more often by Western texts and one more often by Asian studies. In a comparison of s/s for QS mentioned by Western and Chinese origin texts and the Asian studies, two were mentioned by >75%, two more often by Western texts and two more often by Asian studies. English language texts and studies describing QD and QS s/s were examined. Evidence of agreement on a few s/s were identified. English origin texts showed differences in texts originating from Asia, which may support the hypothesis that QD and QS may manifest differently among Western and Asian patients. [ABSTRACT FROM AUTHOR]

Background: Acupuncture may be useful to treat the various clusters of symptoms occurring after a stroke. The use of evidence to underpin clinical practice and treatment guidelines (CPGs and TGs respectively) varies from country to country and may affect what recommendations are made by guideline developers.Purpose: To examine the extent to which international clinical and treatment guidelines on post-stroke treatment mention the role of acupuncture and to identify what symptoms they recommend for its use.Method: Scoping of national and international websites of CPGs and TGs r on the after care and rehabilitation of stroke patients provided by professional and government organisations was conducted. The presence/absence of recommendations and the underpinning evidence was appraised for the use of acupuncture for symptoms following stroke.Results: Of 84 CPGs and TGs on post stroke after-care identified from 27 countries between 2001 and 2021, 49 made statements about acupuncture. Positive recommendations on the use of acupuncture were identified for 15 symptom areas from 11 countries for: stroke rehabilitation, dysphagia, shoulder pain, motor recovery, walking, balance, spasticity, upper limb extremity impairment, post-stroke pain, central post stroke pain, cognitive disorder, depression, and sleep problems. Thirty-five CPGs (2001-2018) from 18 countries published over the same period were identified that made no mention of acupuncture and therefore no recommendations were made on its use.Conclusions: Currently, evidence used by international guideline developers varies and this influences whether a positive or negative recommendation is made. Recommendations to use acupuncture should be based on the best available evidence which has been quality appraised. [ABSTRACT FROM AUTHOR]

Objectives: The primary aim of the survey was to explore the information needs and information seeking behavior amongst the ETCMA members concerning professional literature (scientific as well as practical background knowledge).Methods: A web-based survey comprising of 18 questions with a total of 25 items was carried out in 15 affiliated associations in 14 countries in June 2012. The survey consisted out of 4 parts: (1) Demographics, (2) Level of interest in and availability of professional literature, (3) Insight, needs and opinions on EBM (Evidence Based Medicine), and (4) Awareness of the science workshop at the TCM Rothenburg Congress.Results: 2590 (25%) from 10,428 members completed the questionnaire, of which 58.8% was female. More than 50% of the respondents from eleven out of fourteen countries indicate an interest in more education on reading scientific literature. Case studies (range 3.19/4-3.86/4) are preferred compared to scientific (range 2.78/4-3.59/4) or philosophical knowledge (range 3.0/4-3.56/4). Exchange with colleagues (range 2.95/4-3.64/4) is preferred compared to deepening knowledge (range 2.57/4-3.05/4) in the theoretical spectrum. 61% has no knowledge of the EBM model and base clinical decisions on personal experience (range 3.47-3.82) and practical skills (range 3.47-3.74) compared to clinical practice guidelines (range 2.6-3.27).Conclusions: Due to heterogeneity in structure and size of the affiliated associations no strict conclusions can be made. We can conclude though that TCM practitioners rely mostly on practical knowledge and have less tendency toward more scientifically oriented models like the EBM model. We find this reflected in information needs as well as information seeking behavior patterns. [ABSTRACT FROM AUTHOR]

Objectives: To review the literature of economic evaluations regarding diagnostic methods used in dentistry. Data sources: Four databases (MEDLINE, Web of Science, The Cochrane library, the NHS Economic Evaluation Database) were searched for studies, complemented by hand search, until February 2013. Study selection: Two authors independently screened all titles or abstracts and then applied inclusion and exclusion criteria to select full-text publications published in English, which reported an economic evaluation comparing at least two alternative methods. Studies of diagnostic methods were assessed by four reviewers using a protocol based on the QUADAS tool regarding diagnostic methods and a check-list for economic evaluations. The results of the data extraction were summarized in a structured table and as a narrative description. Results: From 476 identified full-text publications, 160 were considered to be economic evaluations. Only 12 studies (7%) were on diagnostic methods, whilst 78 studies (49%) were on prevention and 70 (40%) on treatment. Among studies on diagnostic methods, there was between-study heterogeneity methodologically, regarding the diagnostic method analysed and type of economic evaluation addressed. Generally, the choice of economic evaluation method was not justified and the perspective of the study not stated. Costing of diagnostic methods varied. Conclusions: A small body of literature addresses economic evaluation of diagnostic methods in dentistry. Thus, there is a need for studies from various perspectives with welldefined research questions and measures of the cost and effectiveness. Clinical significance: Economic resources in healthcare are finite. For diagnostic methods, an understanding of efficacy provides only part of the information needed for evidence-based practice. This study highlighted a paucity of economic evaluations of diagnostic methods used in dentistry, indicating that much of what we practise lacks sufficient evidence. [ABSTRACT FROM AUTHOR]

Abstract: Changes were made to the management and delivery of primary dental care in the NHS in England in 2006 aimed at improving access to NHS dental services among populations with low use. These included: (i) commissioning of NHS dental services by primary care trusts (ii) replacing item of service patient charges by Course of Treatment cost bands and (iii) changing the remuneration of dentists providing NHS dental care. Using longitudinal data from the 1991-2008 waves of the British Household Panel Survey, we estimate the effects of these changes on the levels and distribution of dental care in the population and on the public–private mix of primary dental care services in England using dynamic probit models. We find evidence of a decrease in NHS use, driven by reductions in use among populations with previously good access to care and a positive effect of the reforms on consumer transitions from NHS to private practice. Our results highlight the potential (unintended) consequences of reforming public health care systems. It appears that contrary to expanding NHS access, the dental reforms contracted NHS use amongst those with previously good access. This contraction relied upon the ability of the private sector to absorb this group. [Copyright &y& Elsevier]

Abstract: Despite the central role of the threshold incremental cost-effectiveness ratio (ICER), or lambda (λ), in the methods and application of cost-effective analysis (CEA), little attention has been given to the determining the value of λ. In this paper we consider ‘what explains the silence of the λ’? The concept of the threshold ICER is critically appraised. We show that there is ‘silence of the λ’ with respect to justification of the value of ICER thresholds, their use in decision-making and their relationship to the opportunity cost of marginal resources. Moreover, the ‘sound of silence’ extends to both ‘automatic cut-off’ and more sophisticated approaches to the use of λ in determining recommendations about health care programs. We argue that the threshold value provides no useful information for determining the efficiency of using available resources to support new health care programs. On the contrary, the threshold approach has lead to decisions that resulted in increased expenditures on health care programs and concerns about the sustainability of public funding for health care programs without any evidence of increases in total health gains. To improve efficiency in resource allocation, decision-makers need information about the opportunity costs of programs. [Copyright &y& Elsevier]

The application of Sen''s notion of capabilities to problems of the allocation of resources to health in the form of an extra-welfarist framework underlies the justification of quality adjusted life years (QALYs) as the method for valuing the benefits of health care. In this paper we critically appraise this application from both conceptual and empirical perspectives. We show that the alleged limitations of the welfarist approach are essentially limitations in its application, not in the capacity of the approach to accommodate the concerns of extra-welfarists. Moreover, the arguments used to justify the application of the extra-welfarist framework are essentially welfarist. We demonstrate that the methods used to measure QALYs share their basic theoretical roots with welfarist valuation methods, such as willingness to pay (WTP). Although QALYs and WTP share many challenges, we argue that WTP provides a method which performs better with respect to those challenges. In the context of evaluating alternative allocations of health care resources we are left asking what is ‘extra’ in extra-welfarism? [Copyright &y& Elsevier]

While there is a large and growing literature investigating the relationship between an individual''s employment status and health, considerably less is known about the effect on this relationship of the context in which unemployment occurs. The aim of this paper is test for the presence and nature of contextual effects in the ways unemployment and health are related, based on a simple underlying model of stress, social support and health using a large population health survey. An individual''s health can be influenced directly by own exposure to unemployment and by exposure to unemployment in the individual''s context, and indirectly by the effects these exposures have on the relationship between other health determinants and health. Based on this conceptualization an empirical model, using multi-level analysis, is formulated that identifies a five-stage process for exploring these complex pathways through which unemployment affects health. Results showed that the association of individual unemployment with perceived health is statistically significant. Nevertheless, this study did not provide evidence to support the hypothesis that the association of unemployment with health status depends upon whether the experience of unemployment is shared with people living in the same environment. Above all, this study demonstrates both the subtlety and complexity of individual- and contextual-level influences on the health of individuals. Our results caution against simplistic interpretations of the unemployment–health relationship and reinforce the importance of using multi-level statistical methods for investigation of it. [Copyright &y& Elsevier]

Focuses on the relationship between smoking behavior and health status in a population. Framework for the determinants of health model; Odds ratio for poor health among smokers as compared to non-smokers in the high income group.

Signs/symptoms of blood stasis syndrome (BSS) in standard instruments from China, Korea and Japan show variability but there are reasons to suspect that there may be differences between non-Asian and Asian patients. A literature review was conducted to investigate these issues. Two searches were conducted: Searching for texts describing BSS signs/symptoms ensuring inclusion of Asian origin texts (principally Chinese) and Western origin texts (Study one). Electronic databases were searched to identify BSS scientific studies describing BSS signs/symptoms (Study two). More commonly mentioned signs/ were compared. Study one: From the 21 included texts, six signs/symptoms were generally agreed upon, two more commonly mentioned in Western origin texts, three more commonly mentioned in Chinese origin texts. Study two: Comparing signs/symptoms only three were mentioned by more than half of the 13 studies. In a comparison of signs/symptoms most commonly mentioned across the Western and Chinese origin texts and the Asian instruments/studies, only dark tongue was generally agreed upon, with five others more weakly agreed upon. Three were commonly agreed upon by two of the three source types with one more commonly mentioned in texts of Chinese and one by Western origin and five by Asian instruments/studies. English language texts and studies describing BSS signs/symptoms were examined. Evidence of agreement on a few signs/symptoms were identified. English origin texts showed differences to texts originating from Asia, which may support the hypothesis that BSS may manifest differently among Western and Asian patients. [ABSTRACT FROM AUTHOR]

The article reports that much attention has been given to the critical appraisal of the healthy years equivalent (HYE) concept as an alternative and superior approach to the measurement of preferences over probabilistic health states compared to quality-adjusted life year (QALY). The debate about relative merits of the HYE and the QALY has clarified some things but left many questions unanswered. Measuring HYE is likely to involve greater respondent burden mainly in terms of the number of questions being asked. In terms of the conceptual limitations of the HYE, it is noted that HYE definition imposes same restrictions as the QALY in terms of underlying assumptions of utility independence between health and other commodities in an individual's utility function. The HYE-QALY debate has demonstrated the need to understand clearly the nature of the problem and the objective being pursued in attempting to solve the problem of measurement of preference.

Chronic pain was reclassified by the World Health Organisation in 2019 into primary and secondary chronic pain. Clinical guidelines on chronic primary pain recently issued in the UK for consultation by the National Institute of Health and Care Excellence (NICE) have included acupuncture as a primary treatment. The aim of this article was to explore the evidence in support of this recommendation and gauge whether NICE is in line with international guidelines. UK clinical guideline recommendations on the use of acupuncture for chronic pain were compared with selected key national and international guidelines to identify whether acupuncture was included and whether it was recommended. By recommending acupuncture as a potential treatment for chronic primary pain, NICE is now in line with clinical guideline recommendations from within the UK nations (Scotland, Wales) and other countries such as the USA, Australia, Canada, New Zealand, Germany, Austria as well as organizations such as the British Pain Society and the European Pain Federation The problems of drug dependency especially overuse of opioids and their associated unwanted side effects suggest that non-pharmacological methods that can deal with chronic pain are imperative. Acupuncture provides a bone fide choice particularly as its evidence of effectiveness continues to grow. [ABSTRACT FROM AUTHOR]

Health workforce planning is traditionally based on demographically-driven 'silo-based' models in which future requirements for particular health professions are determined by applying estimates of the future population to the existing population-based level of workforce supply. Estimates of future workforce requirements are focused on, and constrained by population size and requirements increase monotonically. Key failures of existing models include (1) lack of integration between planning the health care workforce, health care services and health care funding and (2) lack of integration between planning different health care inputs and the potential for substitution between inputs. Hence planning models fail to incorporate emerging developments in healthcare delivery and workforce change. We present an integrated needs-based framework for health workforce planning and apply the framework using data from nine European countries to explore the workforce and financial implications of re-configuring the delivery of care through changes in the allocation of treatment tasks between health care professions (skill mix). We show that cost consequences depend not only on pay differences. Instead, workforce planning in rapidly changing workforce environments must consider and incorporate between-provider group differences in productivity (the number of patients that are served per fixed period of time) and practice style (the number and mix of tasks used in providing care to the same type of patient). • We derive health workforce plans from care needs and services required to meet needs. • Plans require integration across different provider types and groups. • Skill mix affects cost through differences in pay, production and practice style. [ABSTRACT FROM AUTHOR]

In traditional East Asian Medicine (TEAM), various systems of practice exist that have used different theories to guide their practice. Although data gathering has been limited to what can be observed by the four examinations - si zhen , the different systems of practice have focused on different observational data to make diagnostic decisions and choose corresponding treatments. The organization of the data into patterns has led to what is called Pattern Identification based systems of practice (PIs). The range of systems, theories, treatments and PIs were explored in order to highlight important issues for researchers to consider in performing PI based research Expert opinions, scholarly and clinical literature on the key issues which compose 'pattern identification' (PI) were identified with respect to the history, development, nature and the different strategies used by different PIs for diagnosing and treating patients. It is important for researchers to understand these issues so as not to weaken their results and findings, whether conducting survey-based research, clinical trial research, laboratory studies or seeking to influence teaching and practice. This is the first in a series of papers by the international Pattern Identification Network Group (iPING) helping to clarify the area of research on PIs and which seek to expand lines of research on PIs so that teaching, practice, clinical and laboratory research can be more consequential. [ABSTRACT FROM AUTHOR]

Training and practice of Traditional East Asian Medicine (TEAM) varies globally although similar diagnostic methods are used based on patients presenting signs and symptoms. These methods assist in determining disease patterns and treatment principles. The use of diagnostic principles and pattern identification (PI) was explored in this survey of TEAM practice across different countries. A web-based survey was disseminated to acupuncture professional membership organisations in UK, Australia, Italy, Korea and China using a Survey Monkey link between December 2015 and September 2017. The 618 fully completed responses were available for comparison (UK 66, Australia 106, China 87, Italy 226, Korea 133). Demographic characteristics varied; UK practitioners were more likely to be female (71%) compared to the other countries (51-59%), Koreans tended to be under 40yrs (80%), compared to elsewhere (14-27%). Korean, UK and Australian respondents had fewer practitioners with biomedical training, 95% of the Italians had a biomedical qualification. TEAM diagnostic methods were more likely practised in the UK and Australian samples (> 90%) but were lowest for the Italian sample (78%). TCM differential diagnosis was the predominant type of PI. PI was rated essential by 85% of Chinese practitioners, versus 32% Koreans, 45% Italians, 67% UK and 68% Australian respondents. This first international survey about acupuncturists use of PI demonstrated wide variation. The sample was limited to certain countries and relied on dissemination by specific professional bodies and participants completing an electronic questionnaire which may have affected responses but provides a platform for future studies. [ABSTRACT FROM AUTHOR]

Pattern differentiation is a critical component for traditional Chinese medicine (TCM) diagnosis and treatment. However, the issue of whether pattern differentiation is appropriately applied in TCM interventional trials, including Chinese herbal medicine (CHM) interventions and non-herbal TCM interventions, is unclear. The aim of this study was to i) systematically review the current status of pattern differentiation used in WHO-registered clinical trials for different types of TCM interventions; and ii) provide suggestions for improving the use of pattern differentiation in future clinical trial design. The World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) database was searched for all TCM interventional trials registered up to 31 December 2017. In this systematic review trials with a TCM pattern differentiation in their design were included. Descriptive statistics were collated to demonstrate the characteristics of pattern differentiation applied for different TCM interventional trials. Among 2955 TCM interventional trials registered during 1999–2017, 376 (12.7%) trials included pattern differentiation. Of 376 trials, the use of pattern differentiation was identified in; –the title (30.6%), objective (50.5%), participants inclusion (100%), outcomes (43.6%) and study background (12.5%). Further, 85.4% reported the specific name of the TCM intervention, 10.6% provided the intervention's targeted pattern, 83.8% reported the specific name of the TCM pattern, 7.2% presented diagnostic criteria for the pattern studied, and 19.1% adopted a pattern-related outcome as primary outcome for evaluation. The reporting and application of pattern differentiation in TCM trials were inadequate and confusing, which was mainly due to lack of clarity regarding study design, objectives, diagnostic criteria and outcomes. [ABSTRACT FROM AUTHOR]

Editorial. Provides information on how editors select health economics papers for possible publication in the periodical `Social Science & Medicine.' Attributes of acceptable research projects; Theoretical basis of research submitted; Relevance of the research to the periodical's readership.

Health care decision makers are required to make planning decisions over a medium to long term planning horizon. Whilst population ageing is an important consideration for planners, age-stratified demographic models may produce misleading estimates of future resource requirements if the actual relationship between age and health is not fixed. We present a methodology which tests whether the assumption of a fixed age–health relationship is valid and estimate the magnitude of planning errors using a long time-series of measures of chronic health and service utilisation (N = 2419) taken from the Great British General Household Survey (1980–2008). We find that age-only models contain significant omitted variable bias, and that the relationship between age and health varies significantly across birth cohorts. Chronic sickness has fallen across birth cohorts born between 1890 and 2008, particularly before birth year 1930. Generational health improvements have mitigated the effects of population ageing, meaning that the population rate of sickness fell between 1980 and 2008. Planning based only on age leads to overestimation of the population level of health care need if successive cohorts are becoming healthier. Many alternative approaches exist which allow planners to relax the assumption of a fixed relationship between age and health. [ABSTRACT FROM AUTHOR]

Compared with other health areas, the mental health impacts of climate change have received less research attention. The literature on climate change and mental health is growing rapidly but is characterised by several limitations and research gaps. In a field where the need for designing evidence-based adaptation strategies is urgent, and research gaps are vast, implementing a broad, all-encompassing research agenda will require some strategic focus. We followed a structured approach to prioritise future climate change and mental health research. We consulted with experts working across mental health and climate change, both within and outside of research and working in high, middle, and low-income countries, to garner consensus about the future research priorities for mental health and climate change. Experts were identified based on whether they had published work on climate change and mental health, worked in governmental and non-governmental organisations on climate change and mental health, and from the professional networks of the authors who have been active in the mental health and climate change space. Twenty-two experts participated from across low- and middle-income countries (n = 4) and high-income countries (n = 18). Our process identified ten key priorities for progressing research on mental health and climate change. While climate change is considered the biggest threat to global mental health in the coming century, tackling this threat could be the most significant opportunity to shape our mental health for centuries to come because of health co-benefits of transitioning to more sustainable ways of living. Research on the impacts of climate change on mental health and mental health-related systems will assist decision-makers to develop robust evidence-based mitigation and adaptation policies and plans with the potential for broad benefits to society and the environment. [ABSTRACT FROM AUTHOR]

This article examines the degree to which relationships between social capital and health are embedded in local geographical contexts and influenced by demographic factors, socio-economic status, health behaviours and coping skills. Using data from a telephone survey of a random sample of adults (N = 1504 respondents, response rate = 60%), the article determines if relationships between involvement in voluntary associations and various measures of individual health are associated with neighbourhood of residence in the mid-sized city of Hamilton, Canada. Associational involvement and overweight status (assessed by body-mass score) were weakly but significantly related after controlling for the other variables; involvement had relationships with self-rated health and emotional distress before but not after controlling for socio-economic status, health behaviours and coping skills. Relationships between neighbourhood of residence and two health outcomes, self-rated health and overweight status, were statistically significant before and after controlling for the other characteristics of respondents; neighbourhood of residence was not a significant predictor of number of chronic conditions and emotional distress in multivariate models. The neighbourhood and associational involvement relationships with health were not dependent upon one another, suggesting that neighbourhood of residence did not help to explain the positive health effects of this particular measure of social capital. [ABSTRACT FROM AUTHOR]

Much research has been devoted to handling uncertainty in cost-effectiveness analysis. The current literature suggests summarizing uncertainty in cost-effectiveness analysis using acceptability curves or net health benefits. These approaches, however, focus only on uncertainty associated with costs and effects of the programs under consideration. In the real world, most decision-makers have to fund a portfolio of health care programs. Therefore, a more comprehensive approach would include in the analysis the uncertainty of costs and effects of all programs supported by the fixed budget. This paper extends the decision rule described by Birch and Gafni (J. Health Econ. 11(3) (1992) 279) within the context of a portfolio of programs when costs and effects are uncertain and resources constrained. [Copyright &y& Elsevier]

Bridges and Terris (Soc. Sci. Med. (2004)) critique our paper on the alternative decision rule of economic evaluation in the presence of uncertainty and constrained resources within the context of a portfolio of health care programs (Sendi et al. Soc. Sci. Med. 57 (2003) 2207). They argue that by not adopting a formal portfolio theory approach we overlook the optimal solution. We show that these arguments stem from a fundamental misunderstanding of the alternative decision rule of economic evaluation. In particular, the portfolio theory approach advocated by Bridges and Terris is based on the same theoretical assumptions that the alternative decision rule set out to relax. Moreover, Bridges and Terris acknowledge that the proposed portfolio theory approach may not identify the optimal solution to resource allocation problems. Hence, it provides neither theoretical nor practical improvements to the proposed alternative decision rule. [Copyright &y& Elsevier]