Some aspects of inflation and published accounts

Company accounts are at present drafted in an uneasy compromise between different objectives. It is not yet generally appreciated that no single figure or set of figures can sum up the whole financial state of an enterprise. The basic tools of financial management are short and long-run cash projections and the reports of actual flows which monitor these. The problem in drafting annual accounts so that they will help shareholders and others to make decisions is that financial reality requires a look into the future and this in turn calls for subjective judgement. But the more realistic are the accounts in this sense, the less susceptible are they to objective audit. Inflation adds a further level of distortion, but the effects of this can be brought out in a relatively simple way by making corrections based on movements in a general index of prices. Although there are considerable practical difficulties it seems likely that a more fundamental improvement would be the introduction of a ‘current value’ or modified ‘replacement cost’ approach to ordinary accounting in addition to (but not in place of) the general index inflation correction.     

Trends in life expectancy in wellbeing

Objectives: This paper describes anddiscusses trends in life expectancy inwellbeing between 1989 and 1998.Methods: Data on wellbeing by theBradburn Affect Balance Scale is obtained fromthe Netherlands Continuous Health InterviewSurveys for the calendar years from 1989 to1998. Using Sullivan's method, life expectancyin wellbeing is calculated.Results: For males at the age of 16, lifeexpectancy in wellbeing increases significantlyfrom 52.7 years in 1989 (90.1% of the totallife expectancy) to 54.4 years in 1998(90.8%). This increase is almost completelycaused by the increase in total lifeexpectancy. For females at the age of 16, lifeexpectancy in wellbeing raises significant from54.4 years in 1989 (84.1%) to 56.2 years in1998 (86.3%). This increase is almostcompletely caused by a decrease in the numberof years in a state of distress.For both males and females at the age of 65,the significant increase of life expectancy inwellbeing exceeds the increase in total lifeexpectancy and is mainly caused by the decreasein number of years in distress.Conclusion: Contrary to life expectancyin good perceived health and to disability freelife expectancy – which show a decreasing trend– the overall wellbeing of the population isincreasing. It seems that aspects in human lifethat contribute to wellbeing or quality of lifeother than physical health are gaining inimportance. This makes life expectancy inwellbeing a less appropriate instrument tomonitor changes in population health, but auseful instrument to measure population qualityof life.     

The DYNAMO-HIA Model: An Efficient Implementation of a Risk Factor/Chronic Disease Markov Model for Use in Health Impact Assessment (HIA)

In Health Impact Assessment (HIA), or priority-setting for health policy, effects of risk factors (exposures) on health need to be modeled, such as with a Markov model, in which exposure influences mortality and disease incidence rates. Because many risk factors are related to a variety of chronic diseases, these Markov models potentially contain a large number of states (risk factor and disease combinations), providing a challenge both technically (keeping down execution time and memory use) and practically (estimating the model parameters and retaining transparency). To meet this challenge, we propose an approach that combines micro-simulation of the exposure information with macro-simulation of the diseases and survival. This approach allows users to simulate exposure in detail while avoiding the need for large simulated populations because of the relative rareness of chronic disease events. Further efficiency is gained by splitting the disease state space into smaller spaces, each of which contains a cluster of diseases that is independent of the other clusters. The challenge of feasible input data requirements is met by including parameter calculation routines, which use marginal population data to estimate the transitions between states. As an illustration, we present the recently developed model DYNAMO-HIA (DYNAMIC MODEL for Health Impact Assessment) that implements this approach.     

Some properties of pareto-optimal choices in decision problems

Estimates are derived for the expected number of Pareto-optimal choices when n candidates are compared with respect to q qualities. The number of comparisons needed to find the Pareto-optimal choices, and the possible advantages of suboptimization procedures, are briefly discussed.     

The effects of physical therapists' guidance on improvement in a strength-training program for the frail elderly

Elderly participants experiencing difficulty in chair rising and with a maximum knee-extensor torque below 87.5 N . m were randomized to different versions of a strength-training program for the knee-extensors: to a high-guidance group (HG; two group sessions supervised by a physical therapist and one unsupervised home session per week, n = 17), a medium-guidance group (MG; one supervised group session and two unsupervised home sessions per week, n = 16), or a control group (C; no exercise, n = 16). Maximal isometric knee strength increased more in HG than in C (p = .03) and with increasing guidance (p = .03). The effect was mainly the result of participants with low initial strength. Walking speed increased more for HG than for C (p = .02) and than for MG (p = .06). No statistically significant improvements were seen on other functional tests. In summary, the study shows a trend toward better results with more supervision, but more and larger studies are needed to confirm this.