Mathias Barra

Akershus universitetssykehus | Ahus · HØKH - The Health Services Research Unit

Caveat: The first posted pdf of this paper contained extensive misreferencing. Please download this updated version. Priority setting in health care is ubiquitous and health authorities are increasingly recognising the need for priority setting guidelines to ensure efficient, fair, and equitable resource allocation. While cost-effectiveness concer...

Objectives The objective was to quantify temporal trends in stroke mimics (SM) admissions relative to cerebrovascular accidents (CVA), incidence of hospitalized SMs and characterize the SM case-mix at a general hospital's stroke unit (SU). Materials & Methods All SU admissions (n = 11240) of patients aged 15 or older to Haukeland University Hospit...

In recent years, multifetal pregnancy reduction (MFPR) has increasingly been a subject of debate in Norway. The intensity of this debate reached a tentative maximum when the Legislation Department delivered their interpretative statement, Section 2 - Interpretation of the Abortion Act, in 2016 in response to a request from the Ministry of Health (2...

In recent years, it has become commonplace among the Global Burden of Disease (GBD) study authors to regard the disability-adjusted life year (DALY) primarily as a descriptive health metric. During the first phase of the GBD (1990-1996), it was widely acknowledged that the DALY had built-in evaluative assumptions. However, from the publication of t...

Objective: To develop a robust statistical tool for the diagnosis of menstrually related migraine. Background: The International Classification of Headache Disorders (ICHD) has diagnostic criteria for menstrual migraine within the appendix. These include the requirement for menstrual attacks to occur within a 5-day window in at least [Formula: s...

Universal healthcare is constrained by national governments' finite health resources. This gives rise to complex priority-setting dilemmas. In several universal healthcare systems, the notion of severity (Norwegian: 'alvorlighet') is a key consideration in priority setting, such that treatments for 'severe' illness may be prioritised even when evid...

The overarching aim of this article is to scrutinize how severity can work as a qualifier for the moral impetus of malady. While there is agreement that malady is of negative value, there is disagreement about precisely how this is so. Nevertheless, alleviating disease, injury, and associated suffering is almost universally considered good. Further...

Introduction Post-stroke fatigue and increased need for daytime sleep are multidimensional and insufficiently understood sequelae. Our aim was to study the relationships of self-reported cognitive and psychiatric symptoms at 3 months with fatigue and daytime sleep at 12 months post-stroke. Methods Ischemic stroke patients without reported history...

Introduction ‘Severity’ is one of three priority-setting criteria in the Norwegian priority-setting system. How we interpret and apply these criteria have a direct impact on which interventions are available in hospitals–and especially so for high-cost interventions, where the severity of a condition is often the justification for implementing a pa...

Objectives An array of government white papers and scholarly works have raised concerns that a purely utilitarian (QALY-based) approach to health prioritisation is ethically inadequate. To accommodate this, various severity criteria have been suggested and attempted operationalised in e.g. Norway, the Netherlands, Sweden, and recently the UK. Howev...

Introduction Norway has a long tradition of open priority setting in health care services. However, the principles and instruments for priority setting have mainly been used in specialist health care. In 2017, an official committee was commissioned to evaluate if and how to adopt the three Norwegian priority-setting criteria – health benefit, resou...

Background All stroke patients should receive timely admission to a stroke unit (SU). Consequently, most patients with suspected strokes – including stroke mimics (SM) are admitted. The aim of this study was to estimate the current total demand for SU bed capacity today and give estimates for future (2020–2040) demand. Methods Time trend estimates...

In Norway, priority for health interventions is assigned on the basis of three official criteria: health benefit, resources, and severity. Responses to the COVID-19 pandemic have mainly happened through intersectoral public health efforts such as lockdowns, quarantines, information campaigns, social distancing and, more recently, vaccine distributi...

Physical inactivity is the leading cause of non-communicable diseases, and further research on the cost-effectiveness of interventions that target inactivity is warranted. Socioeconomic status is vital in this process. We aim to evaluate the cost-effectiveness of a cycle-network expansion plan in Oslo compared to the status quo by income quintiles....

Introduction: After stroke, emotional symptoms (such as depression or anxiety), cognitive decline and increased daytime sleep are common. However, the relationship between these sequelae remains unclear. We aimed to study if (1) self-reported cognitive decline and emotional symptoms 3 months after hospital discharge predict increased self-reported...

Aim The clinical learning environment and supervisor-student relationship play vital roles in the learning outcomes of nursing students. The aim of this study is to evaluate nursing students’ experiences with the clinical learning environment and supervision in a hospital placement organised with a dual preceptor team – preceptors holding dual posi...

Koronapandemien har synliggjort nødvendigheten av prioriteringer i helsetjenesten vår. Helseprioriteringer i Norge skal gjøres etter de tre kriteriene nytte, ressurs og alvorlighetsgrad. Nytte-og ressurskriteriene utgjør til sammen et kostnadseffektivitetskriterium: Høyere prioritet tilfaller tiltak som skaper mye helse med få ressurser. Alvorlighe...

PurposeTo describe the health-related quality of life (HRQoL) of caregivers and survivors of transient ischaemic attack (TIA) and stroke during one year post discharge in comparison to age- and sex-matched population norms; and to analyse the association of initial stroke severity, measured by a routinely used stroke-specific scale, on subsequent H...

The aim of this article is to examine the arguments for and against the practice of discounting future health benefits. A more general, but related, question is whether we should discount future well-being. We begin with an explanation of what discounting means and how it is used as a method in the evaluation of health interventions. Next, we consi...

Målet med denne artikkelen er å undersøke de viktigste argumentene for og imot diskontering av fremtidige helsegevinster. Et mer generelt spørsmål dreier seg om hvorvidt vi bør diskontere fremtidig velferd (eng. well-being). Vi begynner med en redegjørelse av hva diskontering er, og hvordan diskontering påvirker evaluering av helsetiltak. Deretter...

I en ideell verden ville vi alle fått medisinsk behandling etter behov. Men i virkeligheten danner ressursknapphet selve rammen for vår eksistens: Vi må prioritere, og velge noe foran noe annet.

Background Determinants of length of stay (LOS) on hospital wards is important in many planning, policy, and decision problems. Furthermore, LOS is an important parameter for cost containment, and health managers maintain a strong focus on monitoring and reducing hospital LOS. In addition to being costly, excess LOS also expose the patient to unnec...

To ensure reproducibility in research quantifying episodic migraine attacks, and identifying attack onset, a sound theoretical model of a migraine attack, paired with a uniform standard for counting them, is necessary. Many studies report on migraine frequencies—e.g. the fraction of migraine-days of the observed days—without paying attention to the...

In a recent extended essay, philosopher Daniel Hausman goes a long way towards dismissing severity as a morally relevant attribute in the context of priority setting in healthcare. In this response, we argue that although Hausman certainly points to real problems with how severity is often interpreted and operationalised within the priority setting...

Objectives: The EQ-5D-5L valuation protocol recommends combining time trade-off (TTO) and discrete choice experiments (DCEs). DCEs that include a duration attribute (DCE_TTO) allow modeling on the quality-adjusted life-year scale. Because the choice sequence in a TTO can be construed as a series of DCE_TTO, we used data from a single TTO study to i...

Abstract Background Unequal access to inpatient rehabilitation after stroke has been reported. We sought to identify and compare patient and service factors associated with referral and admission to an inpatient rehabilitation facility (IRF) after acute hospital care for stroke in two countries with publicly-funded healthcare. Methods We compared t...

Background: Stroke incidence rates have fallen in high-income countries over the last several decades, but findings regarding the trend over recent years have been mixed. The aim of the study was to describe and model temporal trends in incidence of stroke by age and sex between 2010 and 2015 in Norway, and to generate incidence projections toward...

An anonymised data set of headache diaries from women attending the City of London Migraine Clinic during the period 1998---1999. Data include 121 women with diaries for at least 3 cycles. For these women the median age was 42.5 years (range 14 to 57 years).The women were not using any hormone treatment, continued their usual migraine treatment and...

Background: To ensure reproducibility in research quantifying episodic migraine attacks, and identifying attack starts, a sound theoretical model of a migraine attack is necessary, paired with a uniform standard for counting attacks. Many studies report on migraine frequencies -e.g. number of migraine-days-without paying attention to the number of...

Aims: Awareness of stroke symptoms and risk factors, and actions taken in order to reduce the risk of new stroke events, should be of great importance among stroke survivors. The aims of this study were to assess changes in stroke-related knowledge and lifestyle behavior among patients experiencing a cerebrovascular event, and to assess the agreeme...

In a recent paper—The disvalue of death in the global burden of disease—we question the commensurability of the two components of the disability-adjusted life year (DALY)—years lived with disability (YLDs) and years of life lost (YLLs)—and offer a tentative solution to this problem. In an exciting and constructive reply—Is consistency overrated?—ph...

Purpose So far there is no Norwegian value algorithm to inform healthcare decision making. The 15D health state values estimated with the original 15D valuation procedure tend to be higher than the values of other generic preference-based health-related quality of life (HRQoL) instruments. The main purpose of this study was to use a new 15D valuati...

An authors' English translation of the article published in the Nordic Journal of Applied Ethics.

(English translation available as supplementary material/linked file) De siste årene har fosterreduksjon i økende grad vært gjenstand for debatt i Norge, og intensiteten nådde et foreløpig maksimum da Lovavdelingen leverte tolknings-uttalelsen § 2 - Tolkning av abortloven i 2016 som svar på at Helse- og omsorgs-departementet (i 2014) ba Lovavdelin...

Supplementary material: Excel implementation of the 15D algorithm based on tariff values estimated in the article. Takes as input 15D health state vector(s) and computes health state utilities. See instructions in Excel-spreadsheet prior to use! In development: R-code and SPSS-code for converting 15D health state vector(s) to heath utlities.

An ethical comparison of multifetal pregnancy reduction and abortion on healthy fetuses, within the context of recent Norwegian public debate (in Norwegian) Accepted for publication in Nordic Journal of Applied Ethics; undergoing proof-editing.

Introduction While there is a general agreement that stroke incidence among the elderly is declining in the developed world, there is a concern that it may be increasing among the young. The present study investigates this issue for the Norwegian population for the years 2010–2015. Cerebrovascular accidents (CVAs) for patients younger than 55 years...

Objectives Treatment on organized stroke units (SUs) improves survival after stroke, and stroke mortality has decreased worldwide in recent decades; however, little is known of survival trends among SU patients specifically. This study investigates changes in survival and characteristics of older stroke patients receiving SU treatment. Materials &...

BACKGROUND: Few studies investigate patient and disease factors related to the decision to refer stroke patients to institution-based rehabilitation by the stroke unit treatment team; most studies relate to discharge to rehabilitation among already referred patients. AIMS: To investigate characteristics of stroke unit patients in relation to refer...

Objectives: Prehospital delay is a challenge for stroke treatment and the delivery of time-critical treatments. Few studies have examined secular trends in prehospital delay, and results vary. This study investigates how prehospital delay among Norwegian stroke patients has changed over the last 2 decades. Methods: We compared time from symptom...

Background and purpose: An increasing proportion of patients presenting with suspected stroke prove to have other conditions, often referred to as stroke mimics. The aim of this study was to present a projection of the number of hospitalized strokes, transient ischemic attacks (TIAs), and stroke mimics in Norway up to the year 2050 based on expect...

Objective: To identify which specifications and approaches to model selection better predict health preferences, the International Academy of Health Preference Research (IAHPR) hosted a predictive modeling competition including 18 teams from around the world. Methods: In April 2016, an exploratory survey was fielded: 4074 US respondents complete...

In the Global Burden of Disease study, disease burden is measured as disability-adjusted life years (DALYs). The paramount assumption of the DALY is that it makes sense to aggregate years lived with disability (YLDs) and years of life lost (YLLs). However, this is not smooth sailing. Whereas morbidity (YLD) is something that happens to an individua...

BACKGROUND & AIMS: Stroke mortality has decreased worldwide over the last four decades. Treatment on organized stroke units has been well-documented in decreasing mortality and improving function after stroke, and access to stroke units has generally improved. Furthermore, population-based studies indicate that the background characteristics of str...

BackgroundA follow-up study on a cohort of stroke patients through a postal survey questionnaire 3 and 12 months after discharge from hospital was performed. The response rate at 3-months follow-up was lower than desired, and pre-contact by phone as a measure for increasing the response rate at 12 months was studied. Methods The study design was a...

Aims and objectives: To investigate to what extent self-reported cues about lack of treatment or concerns about inadequate health care from stroke survivors were associated with symptoms of depression. Background: Stroke survivors are prone to depression, and thus, any easily available cues which may inform healthcare workers about patients' men...

BACKGROUND: Variations in birth frequencies have an impact on activity planning in maternity wards. Previous studies of this phenomenon have commonly included elective births. A Danish study of spontaneous births found that birth frequencies were well modelled by a Poisson process. Somewhat unexpectedly, there were also weekly variations in the fre...

The Norwegian government recently put in place a priority commission tasked with suggesting a set of explicit criteria for priority setting in the health care sector. The commission suggested three criteria, the first two of which equate to cost-effectiveness, where, essentially, the gain is measured in terms of Quality Adjusted Life Years (QALYs)....

Purpose Little is known about estimating utilities for comorbid (or ‘joint’) health states. Several joint health state prediction models have been suggested (for example, additive, multiplicative, best-of-pair, worst-of-pair, etc.), but no general consensus has been reached. The purpose of the study is to explore the relationship between health-rel...

Little is known about estimating utilities for comorbid (or 'joint') health states. Several joint health state prediction models have been suggested (for example, additive, multiplicative, best-of-pair, worst-of-pair, etc.), but no general consensus has been reached. The purpose of the study is to explore the relationship between health-related qua...

Objective To repair and refine a previously proposed method for statistical analysis of association between migraine and menstruation.Background Menstrually related migraine (MRM) affects about 20% of female migraineurs in the general population. The exact pathophysiological link from menstruation to migraine is hypothesized to be through fluctuati...

Multimethodology is the combination of methodologies, often from different paradigms. While methodologies from hard paradigms are rather positivist and treats the organizational world as objective, methodologies from soft paradigms are interpretivist by nature. Some argue that these paradigms are incommensurable and multimethodology is therefore a...

The aim of this paper is to demonstrate empirically the consequences of misinterpreting estimates from subject matter experts (SMEs), and to study the differences between modeling this with triangular and beta distributions. Three estimates which describe the duration of a process; minimum, maximum, and mode, is ideally sufficient as a proxy for th...

Purpose: A recurrent challenge in health-related quality of life (HRQoL) research is how to handle comorbidity, as mean EQ-5D tariff-values (mtv) are usually only known for single health states. Several methods have been proposed to derive joint-state values (jsv) from single-state values (ssv), but comparison of the predicted jsvs with the elicite...

We define and investigate a number of small inductively defined classes (idc's), à la Gregorczyk, that are based on argument-bounded initial functions and the bounded minimalisation and bounded counting schemata. We establish equivalences between these and other classes in the literature, with an emphasis on minimalism. We also obtain characterisat...

In [1], we proved that a certain family of number theoretic functions S * is well-ordered by the majorisation relation ‘≼’. Furthermore, we proved that a lower bound on the ordinal O(S *, ≼ ) of this well-order is the least critical epsilon number τ 0. In this paper we prove that τ 0 is also an upper bound for its ordinal, whence our sought-after r...

The problem of whether a certain set of number-theoretic functions – defined via tetration (i.e. iterated exponentiation) – is well-ordered by the majorisation relation, was posed by Skolem in 1956. We prove here that indeed it is a computable well-order, and give a lower bound τ 0 on its ordinal.

We define a hierarchy of small sub-recursive classes, based on the schema of pure iteration. is compared with a similar hierarchy, based on primitive recursion, for which a collapse is equivalent to a collapse of the small Grzegorczyk-classes. Our hierarchy does collapse, and the induced relational class is shown to have a highly periodic struc...

Four sub-recursive classes of functions, \({\mathcal{B}}\), \({\mathcal{D}}\), \({\mathcal{BD}}\) and \({\mathcal{BDD}}\) are defined, and compared to the classes G 0, G 1 and G 2, originally defined by Grzegorczyk, based on bounded minimalisation, and characterised by Harrow in [5]. \({\mathcal{B}}\) is essentially G 0 with predecessor substituted...

The class D\mathbbN0\Delta^\mathbb{N}_{0} of rudimentary relations and the small relational Grzegorczyk classes e0*, e1*, e2*\varepsilon^{0}_{*}, \varepsilon^{1}_{*}, \varepsilon^{2}_{*} attracted fairly much attention during the latter half of the previous century, e.g. Gandy [6], Paris-Wilkie [20], and numerous others.