Several studies have examined the cardiovascular effects of atmospheric parameters as separate factors; however, few have investigated atmospheric parameters’ joint effects. We aim to explore the joint effects of atmospheric parameters on acute cardiovascular diseases (ACVDs) and on major cardiovascular risk factors (CRFs). We correlated all ACVD admissions with major CRFs and local atmospheric conditions during a 5-year study period. A seasonal variation was detected in a higher incidence rate during cold atmospheric conditions. There were significant incidence relative ratios, including: 1.140 (95% CI [1.020, 1.283]) for daily temperature change (≥5 °C); 0.991 (95% CI [0.988, 0.994]) for average daily temperature; and 1.290 (95% CI [1.090, 1.599]) for the interaction of daily temperature change (≥5 °C) with humidity change (≥40%). We observed a significant association between the atmospheric parameters’ joint effects and hyperlipidaemia, diabetes, and previous ACVDs. Patients with diabetes had the highest significant incidence relative ratio at 2.429 (95% CI [1.088, 5.424]) for humidity-temperature interactions. Thus, the atmospheric parameters’ joint effects play an important role as minor CRFs. These unfavourable atmospheric situations are predicted to increase the number of ACVDs mainly. Our study may help to organize prevention strategies more effectively and to reduce cardiovascular risks.

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From the economic perspective introduction of the 3-yearly screening programme is justifiable and it provides a good value for money. Copyright © 2016 John Wiley & Sons, Ltd.

External price referencing (EPR) is applied more and more frequently worldwide by payers to control pharmaceutical prices. Together with the parallel trade of pharmaceuticals, EPR may result in lower pharmaceutical prices in higher-income countries and higher prices in lower-income countries, which implies that pharmaceutical expenditure grows more rapidly in the latter than in the former group. Our objective was to assess this hypothesis. We used hierarchical linear models on country-level panel data to show that-after controlling for compounding factors such as GDP, the proportion of the old-age population or life expectancy-the annual growth rate of pharmaceutical expenditure was 2.1% points larger in the lower- than in the higher-income members of the European Union between 2000 and 2008. This difference in trends became non-significant (0.6% points) after the onset of the global economic crisis. There was no significant difference between lower- and higher-income countries in the growth rate of non-pharmaceutical health expenditure in either period. Our results indirectly support the presence of price convergence of pharmaceuticals among European countries, and EPR and parallel trade may provide a reasonable explanation to the observed trend difference of pharmaceutical expenditure in the two groups of countries between 2000 and 2008. This higher growth rate of pharmaceutical expenditure put extra burden on public health care budgets in lower-income countries and resulted in disproportionately more cost-containment measures compared to higher-income countries after 2008. It remains to be seen whether the disappearance of the difference in trend growth rates due to special health policy interventions in countries with economic difficulties is temporary or permanent.

Objectives: Expert elicitation has been proposed as a method for quantifying uncertainty in decision models when evidence from studies is unavailable. Elicitation refers to a formal, structured process of extracting experts' beliefs in probabilistic form. Elicited distributions can vary depending on who we ask and how we ask them. Credibility of elicited distributions relies on strict processes and transparency, yet guidelines on how to select appropriate experts are vague. This paper explores how perception of uncertainty varies between experts and how the choice of expert can affect estimates of uncertainty. MethOds: A literature review was conducted to identify measurable indicators of expertise. Beliefs about a number of parameters were then elicited from a heterogeneous sample of experts to explore how the identified indicators of expertise affect experts' beliefs. Two aspects of their distributions were compared: confidence and the consistency of elicited distributions with those observed in a clinical trial, unknown to experts. Results: Years of experience, numeracy, adaptive thinking scores, research experience and time spent with relevant patients were identified as potential indicators of expertise. Results of the elicitation exercise suggested that experts with limited quantitative skills were more likely to provide implausible distributions (e.g. mode outside the stated range). Experts with no research experience were more prone to overconfidence than experts with research experience. Determinants of consistency with trial results were different when eliciting parameters that have been observed by experts, compared to those that require predicting unknown quantities. cOnclusiOns: Variation in elicited distributions could potentially be explained by expert heterogeneity. The effect of heterogeneity depends on the type of parameter. The optimal method of eliciting quantities should complement the experts involved. Teaching skills required to accurately express opinion in probabilistic form may not always be feasible; when this is the case experts with existing quantitative skills may be preferred.