Decision-making Process Research Articles

Burden of inflammatory bowel disease in Belgium, 2020

Abstract Inflammatory bowel disease (IBD) comprises digestive disorders resulting from non-infectious inflammation of the colon and gastrointestinal tract. With its global prevalence on the rise, IBD poses significant challenges to healthcare systems. There is a need for more accurate disease burden estimates to guide decision-making processes within the health sector. As a part of the Belgian national burden of disease study (BeBOD), this study aims to estimate the burden of IBD in Belgium based on locally available data. We estimated the Belgian IBD burden in 2020 in terms of mortality, prevalence, years of life lost (YLLs) due to premature death, years lived with disability (YLDs), and disability-adjusted life years (DALYs). As there is no single comprehensive data source on prevalence of IBD in Belgium, a critical appraisal of existing local and national data sources was conducted. Prevalence data were combined with disability weights to yield YLDs. YLLs were calculated using the most recent Global Burden of Disease (GBD) 2019 reference life table and the number of deaths caused by non-infective IBD (ICD-10 K50-52). Cause of death data were extracted from Statbel, the Belgian statistical office. The best available data source to estimate the IBD prevalence in Belgium was a widespread network of general practitioners. The prevalence of IBD was 1.5% in 2020. The prevalence-based YLD for IBD was 220 YLDs per 100 000, while the YLL rate was 11.5 per 100 000. We estimated 26 276 DALYs caused by IBD in 2020. Of the total DALYs caused by IBD, 5% were due to YLLs and 95% were due to YLDs. Our burden estimates for IBD in Belgium were however higher than those of the GBD study. IBD imposes a low fatal burden, whereas the burden of morbidity is more prominent. Our findings could be useful for policy makers to justify and prioritize resource allocation. Integrating the current research in BeBOD will allow monitoring the burden of IBD over time. Key messages • Inflammatory bowel disease is characterized by a substantial non-fatal burden due to chronic relapsing and persistent symptoms. • National inflammatory bowel disease burden estimates are useful to guide decision-making within the health sector.

A year of rapid reviews: evidence-based decision support for Austrian social insurances & hospitals

Abstract Background The Austrian Institute for Health Technology Assessment (AIHTA) has supported the decisions of Austrian social insurance funds and hospital providers with rapid reviews since 2023. This summary of rapid reviews aims to provide insights on findings, as well as experiences and challenges of conducting the rapid reviews after one year. Methods We included all rapid reviews that were requested to the AIHTA team in 2023. For research questions that were withdrawn, the reasoning was documented. The completed rapid reviews were grouped into medical specialties, depending on the intervention analysed. The conclusions of the rapid reviews were presented in tabular form, with the strength of the available evidence classified as high, moderate, low or insufficient. Results The rapid reviews on interventions (n = 9) cover a variety of medical specialties (orthopaedics, gynaecology, neurology, physical medicine, ophthalmology, vascular surgery and dermatology). In three rapid reviews, the analysed evidence on the intervention was insufficient for benefit (compared to standard of care). In four rapid reviews, the evidence indicated a potential benefit with some limitations (e.g. indication-specific results, or minimal clinically important difference not clearly achieved). In two rapid reviews, the evidence indicated a potential benefit. For three topics, no rapid review was conducted (topic scope too broad for rapid review, change in prioritisation). Challenges include time constraints, as well as narrowing the research questions to be suitable for rapid reviews. Conclusions The overview of rapid reviews highlights evidence-based findings on medical interventions. Further steps include collecting feedback from inquirers, on the extent to which the evidence from rapid reviews was used to support the decision-making. Rapid reviews are a feasible tool but require continuous evaluation and further adaptation of methods. Key messages • The rapid reviews to inform decision-making processes for Austrian social insurance funds and hospitals spanned multiple specialties and revealed varying levels of evidence. • To improve the implementation of rapid reviews, and to overcome challenges of time constraints and narrowing down research questions, feedback from stakeholders should be collected.

Prolonged dual antiplatelet therapy in an extended Phase 3 Cardiac Rehabilitation Program following myocardial infarction

Abstract Background Prolonged dual antiplatelet therapy (P-DAPT) is recommended in selected patients beyond 12 months after myocardial infarction (MI). Several risk scores have been developed to estimate the ischemic and bleeding risk and individualize the decision-making process. Purpose We aim to analyse the factors, including ischemic and bleeding scores, associated with P-DAPT prescription in MI patients submitted to a Cardiac Rehabilitation Program (CRP). Methods Patients with ST-segment elevation MI (STEMI) or occlusion MI (OMI) who were submitted to our CRP underwent Phase 2 CRP and were prospectively included. Patients were followed in an extended Phase 3 CRP, and a follow-up visit was scheduled 12 months after hospital discharge. Baseline and follow-up clinical characteristics and treatment after the 12-months visit were registered, specifically P-DAPT. Ischemic (DAPT score) and bleeding (PRECISE-DAPT and CRUSADE scores) risk scores were retrospectively computed. Predictors of P-DAPT were studied by univariate analysis and multivariable binary logistic regression. The model was tested by area under the curve (AUC) analysis in receiver operating characteristic curves. A p<0.05 was considered statistically significant. Results The cohort comprised 78 patients (mean age 61±11 years, 84.6% male). Anterior and inferior STEMI were the most common presentations (43.6% and 47.4%, respectively). The most prevalent cardiovascular risks factors were hypercholesterolemia (85.9%), hypertension (53.8%), smoking habit (46.2%) and diabetes mellitus (23.1%). P-DAPT was prescribed in 39 (50%) patients beyond 12 months after MI, primarily combining aspirin 100mg o.d. and ticagrelor 60mg b.i.d. (n=33, 84.6%). On multivariate analysis, variables associated with P-DAPT prescription were hypertension (HR 4.92 [1.37-17.68], p=0.02), diabetes mellitus (HR 5.13 [1.09-24.09], p=0.04), multivessel disease (HR 5.54 [1.55-19.79], p=0.008), and stent diameter <3mm (HR 5.46 [1.25-23.78], p=0.02). The predictive power of the model was excellent (AUC 0.88 [0.8-0.96], p<0.001). Ischemic (DAPT score) and bleeding (PRECISE-DAPT and CRUSADE) risk scores were not associated with P-DAPT neither in continuous form nor by using their standard cutoffs (≥2, <25 and >40 points, respectively). Conclusions In a real-life cohort of MI patients undergoing extended Phase 3 Cardiac Rehabilitation, P-DAPT was prescribed in half of the population. Clinical (hypertension and diabetes mellitus) and angiographic (multivessel disease and stent diameter <3mm) variables straightforwardly predict the likelihood of receiving P-DAPT, unlike ischemic and bleeding risk scores. The clinical consequences of this management should be further explored.Prolonged DAPT in Cardiac Rehabilitation

Effects of metaphorical communication on vaccine confidence in the adolescent population

Abstract Vaccine hesitancy, defined as delay or refusal of vaccination despite the availability of vaccination services, has been included by WHO among the top 10 global health threats. Individual decision-making process can be strongly affected by communication. The use of metaphors is common in public health communication and increased during the COVID19 pandemic. Although some evidence has supported the persuasive potential of metaphorical language over scientific language, further research is needed. Our study aimed at comparing the effects of neutral scientific talk with war and protective metaphors on health communication. An online survey was conducted on a convenience sample of Italian teenagers randomly allocated to three study arms. Each participant was invited to watch a specific version of an informative video on infections and vaccines (group 1: neutral-scientific approach, group 2: metaphorical-war, and group 3: metaphorical-protective approach). After watching the video, each participant responded to an ad-hoc questionnaire. A total of 2681 subjects were randomly allocated to the three groups. No significant differences regarding age, sex and geographical area were detected between groups. Median age of the sample was 17 years (mean 16,8) and 56.8% were girls. The general attitude towards vaccination in group 2 and 3 was largely positive, with the majority agreeing (strongly or tend to agree) on the fact that vaccination is important (group 2: 89%; group 3: 92%), safe (group 2: 91%; group 3: 92,5%), effective (group 2: 85%; group 3: 88%), and does not generate anxiety (group 2: 80%; group 3: 83%). Higher level of distrust against vaccines was found in group 1, where 32% of participating adolescents are strongly or tend to be anxious about getting vaccinated. The results of our survey suggest that emotional involvement evoked through the use of metaphorical language may have, at least in the short run, some positive effect on vaccine confidence. Key messages • Use of metaphors can be successfully used in public health communication. • Messages evoking either war or protecting concepts are more efficacious than plain scientific language.

The empowering role of health literacy in combatting fake news, misinformation and infodemics

Abstract Background In times of the rapid digital transformation, people need to acquire specific knowledge, skills and attitudes to deal with data, digital information and technology. Such skills are particularly important in times of crisis, as the COVID-19 pandemic has shown. Alongside the pandemic, a so called “infodemic” has emerged, i.e., an overabundance of information, accompanied by misinformation, which impedes sound decision-making processes, affects health literacy (HL) and impacts public health. However, while misinformation poses a well-known threat to our health and well-being, we still lack viable concepts and approaches to satisfactorily solving this issue. Thus, we aimed at reviewing the concept of HL in view of the infodemic and health-related challenges. Methods In a 12-month participatory process in Switzerland in 2023, we investigated the empowering role of HL in light of the polycrisis. On behalf of the Swiss Federal Office of Public Health, we conducted a literature review on existing HL definitions. Then, we conducted 6 expert interviews and 2 focus group interviews with other 10 experts in HL and associated domains, which guided and informed the review process. Results As a result, HL can be understood as a bundle of competencies to proactively deal with health-related information, services, and challenges and thereby empowers people to manage their and other’s health and well-being. Thus, HL empowers people to better manage digital information and services and promotes critical thinking. This in turn is necessary to assess information quality, uncover misinformation and to adequately manage health data and information. Conclusions HL represents a crucial prerequisite for individuals, professionals, and decision-makers to find trustworthy health information, to reflect upon the quality and credibility of sources and content, and to understand the complex interrelations of the determinants of health and is therefore crucial for public health. Key messages • Health literacy empowers people to adequately deal with fake news, misinformation and infodemics. • Strengthening health literacy offers great potential for public health to promote critical thinking and to rebuild trust.

Mixed-method study of women’s experiences of Respectful-Disrespectful Maternity Care in Cyprus

Abstract Background Since the WHO reports on Disrespect and Abuse (D&A) in childbirth, there was an increase in studies across Europe exploring women’s experiences. Even though contentious, a 2024 EU Committee report adopts the term obstetric violence. With the highest caesarean section (C/S) in the EU, the birth environment in Cyprus raises questions about informed choices. Methods The RESPECT mixed-method study gained insights into the experiences of women in Cyprus with focus groups (N = 6, 28 women) and survey (online and in-person) tapping on Rights for Respectful Maternity Care (RMC), as measured by Person-Centred Maternity Care scale (PCMC), autonomy in decision making (MADM), dignity and respect (MoRi) and mistreatment (MIST). Results Among 516 responses (61% first childbirth, 38.5% vaginal, 15% public sector, consistent with official statistics), the 35-item PCMC (range 0-100%) represents a continuum of quality standards deviations (Med=81, IQR=61-92). Lowest scores were recorded for “Communication & Autonomy”, with 28.5% reporting ‘feeling pushed into a decision’, with associations observed with younger age, first-time birth, mode and place of birth, highlighting social inequity. Based on MADM, 23.8%, 14.1% and 14.7% women were classified as having moderate, low or very low autonomy. For mistreatment, 32.0% reported at least one of 11 indicators, most commonly privacy violations and no freedom of movement. Formula feeding against wishes (13.6%), vaginal examinations (11.6%) and episiotomy (7.8%) where most common among 33.7% reporting procedures without consent. Deductive content analysis of narratives according to RMC triangulate findings of weak shared decision-making processes. Conclusions Given that C/S reduction was identified as a national priority in Cyprus, the RESPECT findings can widen the conversation about quality improvement and form the basis to engage with local stakeholders in an open-dialogue about RMC, guided by participatory action research principles. Key messages • In the medicalized birth environment of Cyprus, women report a range of sub-optimal practices, with ethical implications, primarily affecting the right to autonomy. • Adopting the Respectful Maternity Care framework, the findings can stimulate and shape quality improvement efforts in a participatory and inclusive process with local stakeholders.

The burden of psoriasis in Belgium, 2021

Abstract Psoriasis is a common, chronic, inflammatory skin disease with a great impact on healthcare systems. Given the limitations of the currently available burden estimates, estimates of the Belgian national burden of disease study are necessary in order to guide decision-making processes within the health sector. According to the Global Psoriasis Atlas, the prevalence of psoriasis is rising globally. The current study aims to estimate the burden of psoriasis in Belgium using national data. As there is no single comprehensive data source on prevalence of psoriasis in Belgium, a critical appraisal of existing local and national data sources was conducted. We estimated the non-fatal psoriasis burden in terms of years lived with disability (YLD). Estimated prevalence data were combined with disability weights to yield YLDs imposed by psoriasis. Mortality attributable to psoriasis was assumed to be zero, in line with the Global Burden of Disease study (GBD) 2019. We assessed three data sources containing information on existing cases with psoriasis in Belgium. Based on qualitative and quantitative appraisal, a widespread network of general practitioners was identified as the best available national data source. In 2021, the prevalence of psoriasis in Belgium was 2.1%, leading to 13084 DALYs (113 DALYs per 100 000). The burden of psoriasis was in line with national disease burden estimates for bipolar disorder, multiple myeloma, and hearing loss. Our prevalence, YLD, and DALY estimates for psoriasis in Belgium were however lower than those of the GBD study. Psoriasis imposes a non-negligible burden on population health in Belgium, despite it not being a cause of death. Along progression in psoriasis management, objective evaluation of psoriasis burden is critical to track the trends at the population level. Key messages • Psoriasis is a common skin disease with a relatively high morbidity burden. • Information on psoriasis prevalence and burden are crucial for disease management and appropriate health-care planning.

Breast implant illness in women with implant-based reconstruction after breast cancer

Abstract Background This study investigated the association between silicone breast implants and health symptoms (Breast Implant Illness (BII)) in women with implant-based breast reconstruction after breast cancer. While there is increasing evidence of an association with BII in cosmetic breast augmentation cases, for women with implant-based breast reconstruction this is unknown. Methods Retrospective cohort study of 254 women who underwent implant-based reconstruction after breast cancer and a control group of 487 women who underwent breast-conserving therapy or simple mastectomy. We linked Dutch Breast Implant Registry data (2015-2019) and general practice electronic health records data (2014-2022) to study the occurrence of thirteen BII-related health symptoms in general practice and the number of consultations for these symptoms one year before to three years after breast surgery. Results Over the three years following implantation, no significant differences in symptom occurrence were observed compared to both the year before implantation and the control group. Women with breast implants did not have more consultations compared to the control group during follow-up. However, there was an increased likelihood of multiple consultations in the first and second years post-implantation compared to before implantation (≥3 consultations first year OR = 2.10, p = 0.005; second year OR = 1.70, p = 0.048; ≥5 consultations first year OR = 2.57, p = 0.02). Conclusions This study found no evidence for BII in women with implant-based reconstruction after breast cancer. Despite certain limitations in examining BII in this specific patient group, these findings add valuable information to the decision-making process of breast cancer patients considering reconstructive options. Key messages • This is the first study on BII that focused solely on women with breast implants for reconstruction after breast cancer. • No evidence of BII was found in this patient group.

Effective decision-making in public health organizations: reference to the COVID-19 pandemic.

The role of public health organizations during the COVID-19 pandemic was crucial. These groups acted to slow the spread of infection through the implementation of initiatives, policies, research and more. However, the rapidly changing and uncertain climate of the pandemic resulted in suboptimal processes and decision-making within these organizations. These already complex organizations and networks of people became even more nuanced. Thus, organizational decision-making processes must be improved upon based on previous experiences and lessons learnt. With minimal peer-reviewed literature available, resources for effective organizational decision-making in these organizations are scarce. This served as the impetus for this review. To conduct this literature review, both peer-reviewed and grey literature were incorporated to better understand effective organizational decision-making practices for public health organizations. Recommendations found in the literature review were identified, coded and themed to provide a novel decision-making framework to be used by public health executives. Nine key themes of effective organizational decision-making were identified, including utilize decision-making tools, define the problem and acknowledge an imminent decision, establish decision rights, outline a clear escalation path, create a supportive organizational culture, set decision objectives and goals, and evaluate decision alternatives. These findings in conjunction with existing decision-making models were used to create a seven-step effective decision-making framework for public health organizations. The review and analysis of effective organizational decision-making practices is instructive. Public health executives and decision-makers should incorporate the themes identified and employ the proposed decision-making framework to encourage improved decision-making practices.

Epiretinal membrane: an overview and update.

Epiretinal membrane (ERM) is a frequently diagnosed macular disease associated with aging, characterized by a fibrous membrane forming on the internal limiting membrane (ILM) and leading to visual dysfunctions such as metamorphopsia. Various hypotheses regarding the pathology of metamorphopsia have been proposed; however, the complete pathophysiologic mechanism underlying ERM remains unclear. Optical coherence tomography (OCT) provides detailed images enabling precise diagnosis and characterization of ERM, with several recent studies using the latest OCT imaging techniques. Surgical removal of ERM is the only treatment option; however, criteria for surgical intervention are not established, complicating the decision-making processes. Furthermore, the debate on whether simultaneous peeling of the ILM during ERM surgery enhances outcomes or poses unnecessary risks is ongoing, with no definite conclusion having yet been reached. This review also focuses on epiretinal proliferation, which is different from ERM and is characteristic of lamellar macular hole (LMH). Recently, diagnostic criteria for LMH and related diseases were proposed. Reports on effective surgical procedures for LMH exist, although more research is needed to confirm the long-term outcomes. Thus, this review article aims to provide an overview and updated knowledge of ERM, LMH, and related diseases.

Integrating Machine Learning for Enhanced Agricultural Productivity: A Focus on Bananas and Arecanut in the Context of India’s Economic Growth

AbstractAgriculture is one of the sectors that has an important impact, taking into account the problem of sufficient food supply on a global level. The process of predicting the yield of crops is among the most challenging undertakings in the agricultural industry. Agriculture is the main source of income for most developing nations. The purpose of the study is to investigate the significant role that agriculture plays in boosting India's economic growth. Additionally, the research considers the challenges posed by a growing population and a changing environment in terms of agricultural production and food security. The research focuses on analysing the complex characteristics of the agricultural industry, with a particular emphasis on the nutritional importance of tropical fruits, notably bananas and arecanut. These fruits are well-known for their vital nutrients and their role in ensuring world food security. This study acknowledges the importance of sustainable agriculture practices and incorporates sophisticated machine learning algorithms as dynamic tools to forecast crop yields and enhance decision-making processes throughout the crop development cycle. The main aim of this study is to create strong machine learning models and statistical techniques that can accurately predict crop yield by combining a variety of environmental parameters, then assess which models outperform each other. Assist yield projections may provide governments and policymakers with valuable information to make well-informed choices about food security, import–export policies, and resource allocation. It facilitates national- and regional-level food supply planning. The validation method utilises important metrics like R square (R2), Mean Absolute Error (MAE), and Root Mean Squared Error (RMSE). This present research adds to the continuing discussion on using creative methods to promote sustainable agricultural growth and ensure food security.

Working on new applications: Use of economic evaluation in burden of disease estimates

Abstract Burden of disease (BoD) analyses provide policy-makers with useful evidence to prioritise policy responses to major public health threats. Increasingly, however, epidemiological data alone is not considered as sufficient to inform decisions, particularly when funding is allocated within a single government approach and different sectors compete for a larger share of the overall budget. Similarly, other funders, such as charities and foundations, may want to prioritise budget allocation between health and non-health objectives. In all these cases, traditional BoD analyses need to be complemented by economic evaluations. In its simplest form, the economic component may mean adding an assessment of the healthcare costs caused by the diseases in the study. A more comprehensive, though still with limitations, approach is to use monetary values to measure the extent to which individuals are willing to exchange their income - which can be spent on other things - for the health outcomes they experience. Finally, in its most advanced and comprehensive form, analyses can include assessments of a number of relevant dimensions, such as those in the OECD’s Better Life Index. The latter approach is also consistent with, and its results support the implementation of, a health in all policies approach. This presentation will look at traditional and innovative approaches that can be used to add an economic dimension to BoD analyses. After introducing the rationale and key methodological issues of each approach, the presentation will discuss the advantages and disadvantages of each methodology and will identify areas where their use can be beneficial in guiding the decision-making process. Examples of the use of these methodologies in real-world analyses will also be presented to support the theoretical part of the discussion.

Vaccination in the post pandemic era - a qualitative study of the experiences of Somali immigrants

Abstract Background The Somali population is the largest non-European immigrant group in Norway and past studies have indicated lower coverage for both childhood vaccines and COVID-19. However, little is known about views and experiences of vaccination among this group and how their experiences might impact their vaccination decision-making process. This study explored views and experiences with vaccination among Somali immigrants in Norway. Methods We conducted semi-structured interviews with 15 participants in the fall of 2022. To better understand the participants’ perceptions of vaccine information, the data was inductively analyzed using a reflexive thematic analysis. Results Based on the thematic analysis, we focused on four sub themes: 1) the impact of COVID-19 on views of vaccines; 2) new versus old vaccines; 3) childhood vaccination; 4) trust in vaccines. The study found that the participants’ experiences during the pandemic have impacted their views on vaccination in general. Many of the participants expressed positive views and high levels of trust in the Norwegian health authorities and their vaccination recommendations. It was found that having sufficient information and trust in vaccination recommendations contributed to higher vaccine readiness. Viewing vaccines as new and insufficiently tested or researched, as well as lacking information about potential side-effects, increased participants’ hesitancy when faced with vaccination decisions. Among the parents in this study, postponing the measles-mumps-rubella-vaccine due to fear of autism was a common occurrence. Conclusions The current study fills an important gap in knowledge about views, experiences, and vaccination decisions among the Somali population in Norway. Knowledge from this study can help adapt better vaccine information and further improve the prevention of infectious diseases in Norway in general and for under-vaccinated groups in particular. Key messages • Having sufficient information and trust in vaccination recommendations contributed to higher vaccine readiness. • Viewing vaccines as new and insufficiently tested/researched, as well as lacking information about potential side-effects, increased participants’ vaccine hesitancy.

The knowledge layer: the role of key messages for translating data into meaning

Abstract The large volume of data generated by health information systems often remains siloed within the institutions that produce it, posing significant challenges to its reuse and interpretation. This fragmentation can result in conflicting information on critical health topics, complicating the decision-making process for policymakers. To address this issue, Belgium has initiated the ‘Health Status Report’ website, hosted at healthybelgium.be. This website aims to synthesize and present health data in a manner that supports evidence-based policy formulation. The website adopts a structured approach to data integration and interpretation: initially, we identify and prioritize key health topics based on their relevance and the quality of available data. Subsequently, we merge and analyze data from diverse sources to discern patterns and trends that are crucial for public health monitoring. The insights gained are then presented through both narrative texts and interactive visualizations, facilitating access and understanding for a broad audience. Crucial to this process is ongoing communication with experts and stakeholders, ensuring that the data is not only accurately interpreted but also aligns with the needs and expectations of its users. We also aim to translate the raw data into meaningful key messages by consulting with internal and external experts. This interactive platform thus serves as a critical tool for translating complex health data into actionable knowledge, enabling informed public health strategies and interventions.

Leveraging Behavioural Insights to Create Healthier Online Environment for Children

Abstract Issue/Problem The proliferation of digital marketing poses a significant threat to children’s health and well-being, necessitating innovative solutions grounded in cross-disciplinary systems approach. Description of the problem Children’s exposure to harmful digital marketing is pervasive, influencing their preferences, behaviours, and health outcomes. Traditional regulatory approaches often fall short in addressing the dynamic nature of online advertising, exacerbating the challenge. Without effective interventions, children remain vulnerable to the detrimental effects of marketing for unhealthy products and services, undermining public health efforts. Results Integrating behavioural sciences with public health suggests promising avenues for addressing the complexities of harmful digital marketing to children. The WHO KidAd app is a ground-breaking tool designed for objective monitoring of digital marketing. Coupled with evidence-based behavioural strategies such as nudges, choice architecture, and social norms, policymakers can influence decision-making in favour of healthier choices, thereby reducing the impact of harmful marketing. By understanding the decision-making processes and behavioural patterns involved, policymakers can design targeted interventions to mitigate exposure and protect children. Lessons Learned The application of behavioural sciences in public health policy-making yields valuable lessons. Firstly, personalized and contextually relevant interventions resonate more effectively with target audiences, enhancing their efficacy. Secondly, leveraging behavioural insights allows for the design of interventions that complement existing regulatory frameworks, filling gaps in enforcement and compliance. Thirdly, interdisciplinary collaboration between public health experts, policymakers, and behavioural scientists is essential for developing evidence-based strategies tailored to the digital landscape’s evolving challenges. [Grant: APVV-22-0587] Speakers/Panelists Amandine Garde Law & Non-Communicable Diseases Unit, Liverpool, UK

6.P. Scientific session: Economic evaluation of health impacts for better decision choices

Abstract The strategy of Health in All Policies (HiAP) pursues to analyse the wider determinants of health affected by the decision-making process of traditionally non-health sectors, seeking to enhance population health benefits while avoiding health inequalities. This usually involves the use of health impact assessment (HIA) or health lens analysis to any policy, program, plan or project (PPPP), preferably prior to its implementation. On the other hand, decision-makers from a wide range of public and private sectors also demand a better insight of the meaning of the health impacts quantified under HIA. Assuming the (ubiquitous) situation of limited resources and budgets, decisions need to be based on cost effectiveness criteria and, whenever possible, direct and indirect health costs should be part of the impact assessment. Economic appraisal attempts to define whether a proposal makes a net contribution to social welfare, quantifying and valuing changes to individuals’ utility from the societal perspective, taking into account the impact of health on the individual, their family, employers, healthcare providers and the state. This approach can incorporate different components of the welfare costs of illness, including direct medical and paid care expenses, indirect lost opportunity costs such as productivity and the value of informal care time, as well as a value that monetises the disutility or pain and suffering associated with disease. The range of methods and estimated benefits can make it challenging to identify a best practice approach. The present session aims to address certain methodological aspects related to the economic evaluation of health impacts, which still generate some controversy and debate, with particular emphasis on the following topics: • Approaches for synthesizing evidence on health impact pathways and economic evaluation of health impacts for a better decision choice; • Health metrics: influence on the conclusions of economic analysis within HIA; • Sources of metrics used for economic analysis; • Uncertainties inherent to economic valuation of health outcomes: how to deal with it. Key messages • The economic analysis of health impacts can help prioritizing aspects with the greatest impact on population health, facilitating a more effective use of human and economic resources. • The economic analysis within HIA can improve decision-making but requires careful consideration of health metrics, sourcing of data, and management of uncertainties.

Bribery Transfer Among Foreign‐Invested Firms in Vietnam

ABSTRACTBribery in international business is an important field of study, but lack of research examines which types of firms are more likely to pursue bribery transfer, or subcontracting bribery‐related transactions to the third party or intermediaries, instead of handling themselves. We conduct an empirical investigation into this issue using rich data from the PCI survey, which has been conducted annually in Vietnam during the period 2017–2020. The empirical results show that, in dealing with risks associated with bribery engagement, foreign‐invested firms in Vietnam pursue two different types of risk self‐controlling and risk transferring. Investors from OECD countries, subsidiaries of multi‐national corporations, and firms with larger bribery amount are more likely to pursue risk transferring strategy by subcontracting bribery‐related transactions to intermediaries, compared to the other firms' cohorts. Firms operating a longer time in Vietnam and bigger sized ones are more likely to follow risk self‐controlling strategy by handling bribery‐related transactions themselves. These results are robust while controlling for firms' legal status, year‐fixed effects, and, especially, nonresponse and selection biases, which are inherent in the bribery decision process. This study thus contributes greatly to international business in emerging economies where foreign‐invested firms exhibit heterogenous motives in dealing with risks associated with bribery‐related transactions.

User-Perceived Capacity: Theory, Computation, and Achievable Policies

User-perceived throughput is a novel performance metric attracting a considerable amount of recent attention because it characterizes the quality of the experience in mobile multimedia services. For instance, it gives a data rate of video streaming with which a user will not experience any lag or outage in watching video clips. However, its performance limit remains open. In this paper, we are interested in the achievable upper bound of user-perceived throughput, also referred to as the user-perceived capacity, and how to achieve it in typical wireless channels. We find that the user-perceived capacity is quite limited or even zero with channel state information at the receiver (CSIR) only. When both CSIR and channel state information at the transmitter (CSIT) are available, the user-perceived throughput can be substantially improved by power or even rate adaptation. A constrained Markov decision process (CMDP)-based approach is conceived to compute the user-perceived capacity with joint power–rate adaptation. It is rigorously shown that the optimal policy obeys a threshold-based rule with time, backlog, and channel gain thresholds. With power adaptation only, the user-perceived capacity is equal to the hard-delay-constrained capacity in our previous work and achieved by joint diversity and channel inversion.

Determinant of Family Takaful Adoption Among Puncak Alam Residents

This study investigates the key determinants influencing the adoption of family takaful among residents of Puncak Alam, Selangor. Despite the strategic design of family takaful to provide financial protection, particularly for low-income earners in the event of financial loss, its market penetration in Malaysia remains low. This raises important questions about the barriers to its widespread adoption, despite extensive promotional efforts by the takaful industry. The research aims to address these challenges by identifying and analyzing the factors that hinder the broader uptake of family takaful. A quantitative and descriptive research approach was adopted to gain a deeper understanding of the issue. Data collection was conducted using random sampling techniques, and the responses were analyzed using descriptive statistics with the help of the Statistical Package for Social Sciences (SPSS) software. The study involved a structured survey of 100 respondents from Puncak Alam, which examined the impact of three key variables - price, knowledge, and satisfaction - on the adoption of family takaful. The findings of this study underscore the significance of these three factors in shaping consumers' decision-making processes regarding family takaful. Price, as an indicator of affordability, knowledge about family takaful products, and the level of satisfaction with existing services, were all found to significantly influence adoption rates. By highlighting these critical determinants, the research provides valuable insights for policymakers, takaful operators, and financial service providers to refine their strategies and promote wider adoption of family takaful, ultimately enhancing financial security for the Malaysian population.

The Dominance of TikTok in Shaping Online Purchasing Intention

In recent years, TikTok has emerged as a dominant force in the realm of social media, captivating millions worldwide with its short-form video content. This paper explores the significant influence of TikTok on consumers' online purchase intentions. Through an examination of relevant literature and empirical studies, the paper elucidates the mechanisms through which TikTok impacts consumer behavior and decision-making processes. It delves into the role of user-generated content, influencer marketing, and algorithmic recommendations in shaping consumer preferences and driving purchase intentions on the platform. Additionally, the paper discusses the unique features of TikTok, such as its immersive and engaging format, personalized content delivery, and seamless integration of e-commerce functionalities, which contribute to its efficacy as a persuasive tool for brands and marketers. Furthermore, the paper highlights the implications of TikTok's dominance for businesses seeking to leverage the platform for marketing purposes and outlines strategies for effectively harnessing its potential to enhance online sales and brand engagement. Overall, this paper sheds light on the transformative influence of TikTok in the digital landscape and underscores its pivotal role in shaping contemporary consumer behavior and purchase intentions.