An economic evaluation attached to a single-centre,parallel group,unmasked, randomized controlled trial of a 3-day intensive social cognitive treatment (can do treatment) in patients with relapsing remitting multiple sclerosis and low disability

Abstract

Aims: This trial-based economic evaluation (EE) assesses from a societal perspective the cost-effectiveness of an intensive 3-day cognitive theory-based intervention (CDT), compared to care-as-usual, in patients with relapsing remitting multiple sclerosis (RRMS) and low disability (Expanded Disability Status Scale [EDDS] score < 4.0).

Materials and methods: The trial of the EE was registered in the Dutch Trial Register: Trial NL5158 (NTR5298). The incremental cost-effectiveness ratio (ICER) was expressed in cost on the Control sub-scale of the Multiple Sclerosis Self-Efficacy Scale (MSSES) and the incremental cost-utility ratio (ICUR) in the cost per Quality Adjusted Life Years (QALY) using the EQ-5D-5L. Bootstrap, sensitivity, and sub-group analyses were performed to determine the robustness of the findings.

Results: The two groups of 79 patients were similar in baseline characteristics. The base case ICER is situated in the northeast quadrant (€72 (40.74/€2,948)) due to a higher MSSES Control score and higher societal costs in the CDT group. The ICUR is situated in the northwest (inferior) quadrant due to losses in QALY and higher societal costs for the CDT group (?0.02/€2,948). Overall, bootstrap, sensitivity, and sub-group analyses confirm the base case findings. However, when the SF-6D is used as a study outcome, there is a high probability that the ICUR is situated in the northeast quadrant.

Limitations: The relative short follow-up time (6?months) and the unexpected increase in MSSES Control in the control group.

Conclusions: When using the EQ-5D-5L to calculate a QALY, CDT is not a cost-effective alternative in comparison to care as usual. However, when using self-efficacy or SF-6D as outcomes, there is a probability that CDT is cost-effective. Based on the current results, CDT for patients with RRMS clearly show its potential. However, an extended follow-up for the economic evaluation is warranted before a final decision on implementation can be made.     

Nature-based recreation associated with connectedness to nature and leisure satisfaction among students in Brazil

ABSTRACT

There is growing evidence that nature-based recreation (NBR) during childhood promotes connectedness to nature, which in turn fuels NBR during adulthood. In addition to providing a number of health benefits, NBR participation may enhance leisure satisfaction, an important predictor of happiness and life satisfaction. In this exploratory study, we tested these hypothesised links using a path model with a cross-sectional sample of 224 Brazilian college students, where NBR participation during childhood increases connectedness to nature and NBR participation during adulthood, which in turn promotes leisure satisfaction. The model fit the data well χ² (2) = 1.924, χ²/df = 0.962 (N = 220, p = .38), CFI = 1.00, AGFI = .978, GFI = .996, and RMSEA = .00, with results showing an indirect positive link between NBR during childhood and leisure satisfaction, and a direct link between NBR during adulthood and leisure satisfaction. The indirect effect of connectedness to nature on leisure satisfaction was also significant: NBR during childhood fostered connectedness to nature, which motivated NBR during adulthood and higher levels of leisure satisfaction. Leisure practitioners can improve people’s leisure satisfaction by promoting engagement in NBR activities across life stages and emphasising connection to nature.     

Asymmetries and interdependencies in time use between Italian parents

In recent decades, changes in parents’ attitudes towards the importance of spending time with children to optimize their future behaviour and cognitive development have greatly affected patterns of time allocation among both working and nonworking parents in all developed countries. We compare the two waves of the Italian Time Use dataset (1988 and 2002) to analyse how family time allocation changed over time in a country that was undergoing a marked increase in female employment rate and a continuous decline in total fertility rate. We focus especially on how parents’ time with their children depends on their employment status and household characteristics. Using a simultaneous sequential approach, we consider links among the different time uses of individuals and correlations with spouses’ decisions. We find that wives’ time at work time strongly influences the time spent by both spouses with their children in 2002, but not in 1988. Fathers were much more involved in childcare and rearing in 2002 than in 1988. In general, as women's work time increased, substitutes for their childcare time were found within the household (fathers or other co-resident adults).     

Nonlinearities in economic growth and club convergence

This paper deals with heterogeneity and nonlinearities in the growth process by developing a two-stage strategy to identify and estimate a club convergence model with threshold externalities. Because of identification and collinearity problems, we develop an entropy-based estimation procedure which simultaneously takes account of ill-posed and ill-conditioned inference problems. First, clubs are identified by introducing a mapping structure in a conditional convergence model. Finally, we estimate a multiple club convergence model, where clubs correspond to subsets of total observations. Our procedure is applied to assess the existence of club convergence for a large sample of countries (1965–2008).     

How does the entrepreneurial orientation of scientists affect their scientific performance? Evidence from the quadrant model

In order to identify the effect of academic entrepreneurship on science, this work compares the publication performance of entrepreneurial scientists with that of conventional scientists. Using Stokes's ‘quadrant model’, this paper examines how the entrepreneurial orientation affects scientific performance. The results on advanced materials research in Japan found that (i) entrepreneurial scientists publish more papers than conventional scientists do; (ii) the papers of conventional scientists demonstrate better citation performance than those of entrepreneurial scientists do, on average; (iii) coming to the top-cited papers, entrepreneurial scientists show higher propensity for publishing high-impact papers than conventional scientists do; and (iv) the portfolio interdisciplinarity of papers authored by entrepreneurial scientists is higher than that of conventional scientists. Although the influence of academic entrepreneurship on scientific performance is still unclear, our findings suggest that entrepreneurial scientists could make a relatively large contribution to furthering the scientific frontier by relying on innovation rather than convention.     

Multi-tiered private labels portfolio strategies: Effects on consumer behavior

Abstract

Retailers wish to expand their standard private label (PL) adopting a multi-tiered portfolio. We study the effects produced by the introduction of two new PLs quality-tiers (economy and premium) on the market share of various national brands (NB; premium-quality and second-tier) and the standard PL. This study proposes a model that accommodates three effects (similarity, attraction, and compromise) for understanding how the introduction of economy and premium PL may affect market incumbents. This study also analyzes the effects of introducing new PL quality-tiers for customer segments. Our results indicate that when economy and premium PL are introduced in the market, the choice probability of standard PL decreases, especially for high purchase quantity customers and PL loyal customers. In addition, introduction of a premium PL decreases the choice probability of second-tier NB and premium-quality NB, especially for PL loyal customers and high purchase quantity customers.     

Finding delay-resistant line concepts using a game-theoretic approach

We present a game-theoretic model for the line planning problem in public transportation, in which each line acts as player. Each player aims to minimize its own delay, which is dependent on the traffic load along its edges. We show that there exists a line plan at equilibrium, which minimizes the probability of delays of the transportation system. This result is achieved by showing that a potential function exists. Numerical results using close-to-real world data in the LinTim framework clearly show that our method indeed produces delay-resistant line concepts.     

Performance measurement and management in Portuguese law enforcement

Performance measurement of police services is complicated by ambiguous and complex goaland objectives-setting, and by the difficulties of measuring outputs. This article looks at the organizational and management changes being made in Portuguese police forces. The authors fill a gap in the literature on performance measurement in Portugal by taking a national approach to the study of how law enforcement agencies are introducing new management accounting changes. The article therefore widens the debate on performance measurement and performance improvements in law enforcement.     

Metropolregionen: Impulsgeber für Strukturwandel und wirtschaftliche Entwicklung

Urban centres and their surroundings often act as highly dynamic economic areas. Due to continuing urban migration, population growth as well as their heightened potential for employment, they have significant impact on Germany’s overall economic performance. Cities benefit from their neighbouring regions via a division of labour based on functional and spatial comparative advantages. Jobs in the service sector are concentrated in the city, while surrounding regions show a relatively high specialisation in the industrial sector. The economic development of metropolitan regions can be fostered particularly by improving supra-regional metropolitan functions related to education and to research and development. Moreover, the improvement of the intra-regional infrastructure also contributes to the economic strength of the whole metropolitan area.     

Physicians' appraisal of mobile health monitoring

This study addresses what factors influence and moderate Japanese physicians' mobile health monitoring (MHM) adoption for diabetic patients. In light of the multilevel sequential check theory, the study tests whether novelty seeking, self-efficacy, and compatibility moderate the effects of overall quality, net benefits, and perceived value of MHM on physicians' usage intention. Self-efficacy serves as an evaluation of resources for coping with an event, while compatibility involves the judgment of an event's congruence with a motive or goal. The study results support four out of nine moderation hypotheses. Our findings clearly indicate that the impact of overall quality and net benefits on physicians' intention to use MHM would be significantly strengthened by self-efficacy and compatibility, but not by novelty seeking.