No abstract

Priority setting of health interventions is generally considered as a valuable approach to support low- and middle-income countries (LMICs) in their strive for universal health coverage (UHC). However, present initiatives on priority setting are mainly geared towards the development of more cost-effectiveness information, and this evidence does not sufficiently support countries to make optimal choices. The reason is that priority setting is in reality a value-laden political process in which multiple criteria beyond cost-effectiveness are important, and stakeholders often justifiably disagree about the relative importance of these criteria. Here, we propose the use of ‘evidence-informed deliberative processes’ as an approach that does explicitly recognise priority setting as a political process and an intrinsically complex task. In these processes, deliberation between stakeholders is crucial to identify, reflect and learn about the meaning and importance of values, informed by evidence on these values. Such processes then result in the use of a broader range of explicit criteria that can be seen as the product of both international learning (‘core’ criteria, which include eg, cost-effectiveness, priority to the worse off, and financial protection) and learning among local stakeholders (‘contextual’ criteria). We believe that, with these evidence-informed deliberative processes in place, priority setting can provide a more meaningful contribution to achieving UHC.

BackgroundIn rationing decisions in health, many criteria like costs, effectiveness, equity and feasibility concerns play a role. These criteria stem from different disciplines that all aim to inform health care rationing decisions, but a single underlying concept that incorporates all criteria does not yet exist. Therefore, we aim to develop a conceptual mapping of criteria, based on the World Health Organization’s Health Systems Performance and Health Systems Building Blocks frameworks. This map can be an aid to decision makers to identify the relevant criteria for priority setting in their specific context.MethodsWe made an inventory of all possible criteria for priority setting on the basis of literature review. We categorized the criteria according to both health system frameworks that spell out a country’s health system goals and input. We reason that the criteria that decision makers use in priority setting exercises are a direct manifestation of this.ResultsOur map includes thirty-one criteria that are distributed among five categories that reflect the goals of a health system (i.e. to improve level of health, fair distribution of health, responsiveness, social & financial risk protection and efficiency) and leadership/governance one category that reflects feasibiliy based on the health system building blocks (i.e. service delivery, health care workforce , information, medical products, vaccines & technologies, financing and).ConclusionsThis conceptual mapping of criteria, based on well-established health system frameworks, will further develop the field of priority setting by assisting decision makers in the identification of multiple criteria for selection of health interventions.

This study aimed to contribute to the dimensional approach to personality pathology by addressing the applicability of a personality pathology questionnaire, originally developed for adults, in adolescent samples. The psychometric properties of the Dimensional Assessment of Personality Pathology-Basic Questionnaire for Adolescents (DAPP-BQ-A) were studied in two samples including 170 adolescents referred for mental health services and 1,628 nonreferred adolescents, respectively. Factor analysis resulted in a strong replication of the original structure, retaining four factors (Emotional Dysregulation, Dissocial Behavior, Inhibitedness, and Compulsivity), which could be further organized into a two-dimensional structure with factors identifiable as Internalizing and Externalizing, suggesting a possible link between personality and psychopathology. Internal consistency and test-retest reliability proved to be satisfactory for all lower-order dimensions, with the exception of Intimacy Problems. Several of these dimensions showed considerable promise in differentiating nonreferred adolescents, referred adolescents without and referred adolescents with a personality disorder. The present findings underscore the need for a developmental perspective on personality pathology. Promising aspects of the dimensional approach to personality pathology in adolescence are discussed.A growing body of research recognizes the occurrence of personality pathology in adolescence, supporting its validity as a construct, and high prevalence in both clinical and nonclinical populations (for a review, see Johnson, Bromley, Bornstein, & Sneed, 2006). Moreover, longitudinal studies have provided evidence for a wide range of childhood and adolescent developmental antecedents of adult personality pathology (e.g., Johnson, Cohen, Brown, Smailes, & Bernstein, 1999;Kasen et al., 2001). Relatively little attention has been given to adolescent personality pathology as antecedent even though, according to some, childhood and adolescent temperament and personality are among the best candidates as general