Child health is an important public health issue in China and the Chinese government always attached great importance to child health care. With the implementation of a series of medical and health reforms in China in recent decades, the status of child health improved year by year. Objectives This study aims to comprehensively evaluate if the measures implemented in the medical and health reforms effectively promoted the development of Chinese child health care in recent years and provide theoretical support for future decision-making on the policies of child health care in China. Methods A total of six indicators were selected from the China Health Statistics Yearbook. Based on the multi-criteria decision analysis (MCDA) algorithm, three different evaluation methods were applied in the study, which are the weighted technique for order preference by similarity to an ideal solution (TOPSIS) method, the weighted rank-sum ratio (RSR) method, and the fuzzy comprehensive evaluation (FCE). Each indicator\'s weight was calculated by the entropy weight methods objectively. The sensitivity analysis was conducted to validate the stability and accuracy of the rank results. Results The results indicated that the rank values of each year\'s child health care calculated by the different evaluation methods were not exactly the same, but the overall trend is consistent which is that child health care in China improved year by year from 2000 to 2020. The top 5 were ranked from 2016-2020 and the bottom 5 were ranked from 2000-2004. Conclusions The results indicated that the policies and measures implemented in the medical and health reforms, as well as improved sanitation conditions, availability of healthy food and water, etc., have jointly promoted the development of child health care in China in the past 20 years, providing a scientific theoretical basis for future policy-making to promote child health care.

The topic of regional economic resilience has been the subject of intense debate in the academic and political fields over the past decade and gained a new sense of urgency because of the pandemic caused by the SARS-CoV-2 virus as territories faced relevant impacts on their economies and social structures. The economic downturn, the increase in unemployment, and the deterioration of social conditions lead policy makers to search for solutions to make their territories more resilient to this type of event. The current article discusses how multicriteria decision analysis (MCDA) was used to help a Portuguese Intermunicipal Community, formed by 16 councils, develop a strategy to make its territory more cohesive, competitive, sustainable, and resilient. In addition to discussing an innovative application of a MCDA technique, this article illustrates how, through a MCDA approach, it was possible to reach a consensus among several policymakers, despite each of them having their own political agendas.

Vaccines were crucial in controlling the Covid-19 pandemic. As more vaccines receive regulatory approval, stakeholders will be faced with several options and must make an appropriate choice for themselves. We proposed a multi-criteria decision analysis (MCDA) framework to guide decision-makers in comparing vaccines for the Indian context.
We adhered to the ISPOR guidance for the MCDA process. Seven vaccine options were compared under ten criteria. Through three virtual workshops, we obtained opinions and weights from citizens, private-sector hospitals, and public health organisations. Available evidence was rescaled and incorporated into the performance matrix. The final score for each vaccine was calculated for the different groups. We performed different sensitivity analyses to assess the consistency of the rank list.
The cost, efficacy and operational score of the vaccines had the highest weights among the stakeholders. From the six scenario groups, Janssen had the highest score in four. This was driven by the advantage of having a single dose of vaccination. In the probabilistic sensitivity analysis for the overall group, Covaxin, Janssen, and Sputnik were the first three options. The participants expressed that availability, WHO approvals and safety, among others, would be crucial when considering vaccines.
The MCDA process has not been capitalised on in healthcare decision-making in India and LMICs. Considering the available data and stakeholder preference at the time of the study, Covaxin, Janssen, and Sputnik were preferred options. The choice framework with the dynamic performance matrix is a valuable tool that could be adapted to different population groups and extended based on increasing vaccine options and emerging evidence. *ISPOR - The Professional Society for Health Economics and Outcomes Research.

COVID-19 caused the largest pandemic of the twenty-first century forcing the adoption of containment policies all over the world. Many studies on COVID-19 health determinants have been conducted, mainly using multivariate methods and geographic information systems (GIS), but few attempted to demonstrate how knowing social, economic, mobility, behavioural, and other spatial determinants and their effects can help to contain the disease. For example, in mainland Portugal, non-pharmacological interventions (NPI) were primarily dependent on epidemiological indicators and ignored the spatial variation of susceptibility to infection.
We present a data-driven GIS-multicriteria analysis to derive a spatial-based susceptibility index to COVID-19 infection in Portugal. The cumulative incidence over 14 days was used in a stepwise multiple linear regression as the target variable along potential determinants at the municipal scale. To infer the existence of thresholds in the relationships between determinants and incidence the most relevant factors were examined using a bivariate Bayesian change point analysis. The susceptibility index was mapped based on these thresholds using a weighted linear combination.
Regression results support that COVID-19 spread in mainland Portugal had strong associations with factors related to socio-territorial specificities, namely sociodemographic, economic and mobility. Change point analysis revealed evidence of nonlinearity, and the susceptibility classes reflect spatial dependency. The spatial index of susceptibility to infection explains with accuracy previous and posterior infections. Assessing the NPI levels in relation to the susceptibility map points towards a disagreement between the severity of restrictions and the actual propensity for transmission, highlighting the need for more tailored interventions.
This article argues that NPI to contain COVID-19 spread should consider the spatial variation of the susceptibility to infection. The findings highlight the importance of customising interventions to specific geographical contexts due to the uneven distribution of COVID-19 infection determinants. The methodology has the potential for replication at other geographical scales and regions to better understand the role of health determinants in explaining spatiotemporal patterns of diseases and promoting evidence-based public health policies.

UNASSIGNED: Determining cardiovascular disease (CVD) research priorities is essential given the high burden of these diseases, limited financial resources, and competing priorities. This study aimed to determine the research priorities in CVD field in Iran using standard indigenous methods.
UNASSIGNED: An extensive search was done in relevant international and national studies. Then, an indigenous standard multistage approach based on multicriteria decision analysis steps was adapted to local situation and implemented. This process included forming a working group of experts in priority setting methodology, identifying the context and prioritization framework, discussing the methodology with the National Network of CVD Research (NCVDR) members who ultimately determined the priority research topics, weighted topics criteria, ranked topics, and reviewed all determined research priorities for final report.
UNASSIGNED: Thirteen cardiovascular research priorities were determined by the NCVDR members. The first five priorities based on their scores include studies in hypertension, prevention and control of ischemic heart disease (IHD) and its risk factors, burden of IHD, Registration of CVDs, and COVID-19 and CVDs.
UNASSIGNED: Cardiovascular research priorities were determined using a standard indigenous approach by national experts who are the NCVDR members. These priorities can be used by researchers and health decision makers.

BACKGROUND: Alzheimer\'s disease (AD) is a chronic neurodegenerative disorder associated with a high burden of illness. New therapies under development include agents that target amyloid-beta (Aβ), a key component in AD pathogenesis. Understanding the decision-making process for new AD drugs would help determine if such therapies should be adopted by society. Multicriteria decision analysis (MCDA) was applied to three key stakeholder groups to assess treatment alternatives for AD based on a multitude of decision trade-offs covering main components of care.
METHODS: AD caregivers (n = 117), neurologists (n = 90), and payors (n = 90) from the USA received an online survey. The decision problem was broken down into four decision criterion and 12 subcriteria for two treatment scenarios: an Aβ-targeted therapy vs. the standard of care (SOC). Respondents were asked to indicate how much they preferred one option over another on a scale from 1 (equal preference) to 9 (high preference) based on each criterion and subcriterion. The decision criteria and subcriteria were weighted and presented as partial utility scores (pUS), with higher scores suggesting an increased preference for that decision-making component.
RESULTS: Caregivers and payors applied the highest value to need for intervention (mean pUS = 0.303 and 0.259) and clinical outcomes (mean pUS = 0.286 and 0.377). In contrast, neurologists placed the highest value on clinical outcomes and types of benefits (mean pUS = 0.436 and 0.248). When decision subcriteria were examined, efficacy (mean pUS = 0.115, 0.219, and 0.166) and the type of patient benefits (mean pUS = 0.135, 0.178, and 0.126) were among the most valued by caregivers, neurologists, and payors.
CONCLUSIONS: All groups placed the highest value on drug efficacy and types of benefit derived by patients. In contrast, cost implications were among the least important aspects in their decision-making.

In many households, preparation of food in normal times proves to be problematic, particularly when parents endeavour to keep their children on a balanced diet. The COVID-19 pandemic has further exacerbated this problem imposing the requirement of social distancing, which led to disruptions in the food supply chain and multiplication of responsibilities faced by families with children. The present study revisits the standard \"Diet Problem\" to address these challenges and to develop a participatory approach to provide a diversified weekly meal plan that is easy and fun but simultaneously complies with the unique requirements of each participant. This is done by providing a novel framework, which combines linear optimisation with the Parsimonious Analytic Hierarchy Process, a method for individual choices. This novel approach to participatory modelling is tested within two young family settings in Brazil. The model produced through this contemporary framework provides a weekly menu that best meets expectations of the members of a young family in the context of the COVID-19 pandemic.

This paper uses Value-Based Data Envelopment Analysis (VBDEA), to assess the impact of the COVID-19 pandemic on the efficiency of 37 state-owned enterprises (SOE) hospitals by employing data publicly available from the Portuguese Health Service database between January and November 2019 and 2020, respectively. Furthermore, a productivity index (specifically adjusted to the VBDEA approach) is also used that allows identifying which factors are behind the relative efficiency changes of these hospitals. The factors considered to perform the efficiency assessment of the Portuguese SOE hospitals include labour, capacity, and activity-related indicators. Out of the 37 SOE hospitals, 21 and 17 were efficient in 2019 and 2020, respectively. Irrespective of the value functions considered, the hospitals more often viewed as a reference for best practices were Santa Maria Maior, Tâmega e Sousa and Entre Douro e Vouga. Santa Maria Maior and Algarve were the only hospitals found to be robustly efficient for both years. Overall, the majority of SOE hospitals showed negative productivity (except for Évora and Santa Maria Maior) and all of them presented negative technological change, thus highlighting the massive impact that the COVID-19 outbreak has had on the performance of these hospitals. An additional conclusion is that inefficient hospitals substantially increased all their resources in 2020 as compared to inefficient hospitals in 2019, suggesting that the inefficiency of these hospitals was not due to the lack of resources. Finally, irrespective of the model employed, the hospitals located in the Portuguese northern region were more resilient to the COVID-19 crisis. All in all, to become more resilient (even for future COVID-19 outbreaks), hospitals should undertake changes that are advantageous irrespective of the obstacles they face and that are even beneficial during normal times. A culture of cooperation within and across hospitals should also be cultivated, which allows exchanging resources where they can be used more efficiently.

Multicriteria decision analysis (MCDA) is a useful tool in complex decision-making situations, and has been used in medical fields to evaluate treatment options and drug selection. This study aims to provide valuable insights into MCDA in healthcare through examining the research focus of existing studies, major fields, major applications, most productive authors and countries, and most common journals in the domain.
A bibliometric analysis was conducted on the publication related to MCDA in healthcare from the Web of Science Core Collection (WoSCC) database on 14 July 2021. Three bibliometric software (VOSviewer, R-bibliometrix, and CiteSpace) were used to conduct the analysis including years, countries, institutes, authors, journals, co-citation references, and keywords.
A total of 410 publications were identified with an average yearly growth rate of 32% (1999-2021), from 196 academic journals with 23,637 co-citation references by 871 institutions from 70 countries/regions. The United States was the most productive country (n = 80). Universiti Pendidikan Sultan Idris (n = 16), Université de Montréal (n = 13), and Syreon Research Institute (n = 12) were the top productive institutions. A A Zaidan, Mireille Goetghebeur and Zoltan Kalo were the biggest nodes in every cluster of authors\' networks. The top journals in terms of the number of articles (n = 17) and citations (n = 1,673) were Value in Health and Journal of Medical Systems, respectively. The extant literature has focused on four aspects, including the analytic hierarchy process (AHP), decision-making, health technology assessment, and healthcare waste management. COVID-19 and fuzzy TOPSIS received careful attention from MCDA applications recently. MCDA in big data, telemedicine, TOPSIS, and fuzzy AHP is well-developed and an important theme, which may be the trend in future research.
This study uncovers a holistic picture of the performance of MCDA-related literature published in healthcare. MCDA has a broad application on different topics and would be helpful for practitioners, researchers, and decision-makers working in healthcare to advance the wheel of medical complex decision-making. It can be argued that the door is still open for improving the role of MCDA in healthcare, whether in its methodology (e.g., fuzzy TOPSIS) or application (e.g., telemedicine).

OBJECTIVE: Management of inflammatory bowel disease [IBD] is complex and IBD Comprehensive Care Units [ICCUs] facilitate the delivery of quality care to IBD patients. The objective of this study was to update the existing set of quality indicators [QIs] for ICCUs, based on a nationwide quality certification programme carried out in Spain, from a multi-stakeholder perspective and using multicriteria decision analysis [MCDA] methodology.
METHODS: An MCDA comprising three different phases was conducted. In phase 1, a systematic literature review was performed, and after validation by a scientific committee comprising 11 experts, a preliminary set of QIs was developed. In phase 2, a larger group of 49 experts determined the relevance and relative importance of each QI by prioritising and weighing the preliminary set. Finally in phase 3, the scientific committee reviewed the results and made a final selection via a deliberative process.
RESULTS: The final set comprised 67 QIs, classified as Structure [23 QIs], Process [35 QIs] and Outcome [9 QIs], which were ranked according to their relative importance. Multidisciplinary management was the most important requirement in ICCUs, followed by continuity of care, standardisation of clinical care and, especially, the incorporation of patients\' reported outcomes.
CONCLUSIONS: This updated set of QIs comprises a weighted and prioritised set of items that represent the essential minimum of criteria for ensuring appropriate quality of care in the management of IBD patients.