Association between Certificate-of-Need Laws and the Health Outcomes of Home Health Patients

The Certificate of Need (CON) law on home health limits start-ups and expansions by providers. Seventeen states and the District of Columbia maintained CON restrictions in 2015. The regulation was intended to control health care cost and expenditure, and to promote quality public health outcomes, as postulated in the public interest theory. The purpose of the study was to assess the association between the CON laws by the states and the health outcomes of the Medicare patients that used home health services in 2015. The provider ratings data from Home Health Compare were analyzed using multiple linear regression models and t-tests. Findings indicated that the CON significantly contributed to the health outcomes of the patients who used home health services. It was found that the hospitalization rates and the proportion of the patients who used the emergency rooms services were significantly higher in CON states than in the non-CON states. Also, the providers in the CON states had higher improvements on walking, wound healing, breathing, bathing, taking oral medication, pain, and getting in and out of bed. The study adds to the information available to the stakeholders on how the CON affects public health outcomes in the home health sector

Post-marketing assessment of content and efficacy of preservatives in artemisinin-derived antimalarial dry suspensions for paediatric use

BACKGROUND: Artemisinin-derivative formulations are now widely used to treat falciparum malaria. However, the dry powder suspensions developed for children are few and/or are of poor quality. In addition to the active compound, the presence of a suitable preservative in these medicines is essential. In this study, an evaluation of the preservative content and efficacy in some dry suspensions available on the Kenyan market was performed. METHOD: UV spectrophotometry was used to identify the preservatives in each sample while HPLC-UV was used for quantification. After reconstitution of the powders in water, the dissolution of the preservatives was followed for 7 days. Antimicrobial efficacy of the preservatives was assessed by conducting a preservative efficacy test (PET) following the European pharmacopoeia standards. RESULTS: Four different preservatives were identified namely methylparahydroxybenzoate (MP), propylparahydroxybenzoate (PP), benzoic acid and sorbic acid. MP and PP were identified in Artesiane(® )(artemether 300 mg/100 ml), Alaxin(® )(dihydroartemisinin 160 mg/80 ml) andGvither (® )(artemether 300 mg/100 ml) respectively. Sorbic acid was presentin Artenam(® )(artemether 180 mg/60 ml) while benzoic acid was identified in Santecxin(® )(dihydroartemisinin 160 mg/80 ml) andArtexin(® )(dihydroartemisinin 160 mg/80 ml) respectively. Cotecxin(® )(dihydroartemisinin 160 mg/80 ml) did not contain any of the above preservatives. After reconstitution in water, preservativesin 50%(3/6) of the products did not completely dissolve and the PET results revealed that only Artenam(® )and Gvither(® )met the requirements for antimicrobial efficacy. The other products did not conform. CONCLUSION: These results show that paediatric antimalarial dry powder formulations on the market may contain ineffective or incorrect amounts of preservatives. This is a potential risk to the patient. Studies conducted on the dry powder suspensions should include the analysis of both the active ingredient and the preservative, including the efficacy of the latter

Antibody responses to the full-length VAR2CSA and its DBL domains in Cameroonian children and teenagers

Additional file 2. IgG levels to VAR2CSA domains in 10–15 year old Cameroonian girls living in Ngali II and Ntouessong villages. IgG levels to VAR2CSA DBL domains and full-length protein (FV2) were measured in 11–15 year old girls residing in Ngali II and Ntouessong villages. DBL1 domain was from 3D7 strain and all the other proteins from FCR3 parasite strain. Median MFI and Inter-Quartile Range (IQR) are plotted

Guidelines for Field Surveys of the Quality of Medicines: A Proposal

Paul Newton and colleagues propose guidelines for conducting and reporting field surveys of the quality of medicines

The epidemiology of postpartum malaria: a systematic review

Pregnant women are more susceptible to malaria than their non-pregnant counterparts. Less is known about the risk of malaria in the postpartum period. The epidemiology of postpartum malaria was systematically reviewed. Eleven articles fitted the inclusion criteria. Of the 10 studies that compared malaria data from the postpartum period with pregnancy data, nine studies suggested that the risk for malaria infection decreased after delivery. All three studies that compared postpartum data with non-pregnant non-postpartum women concluded that the risk did not return to pre-pregnancy levels immediately after delivery. The results of this review have to be carefully interpreted, as the majority of studies were not designed to study postpartum malaria, and there was large variability in study designs and reported outcomes. Current evidence suggests an effort should be made to detect and radically cure malaria during pregnancy so that women do not enter the postpartum period with residual parasites

Preliminary study of the utilisation of coconut in yoghurt production

The possibility of using the coconut in yoghurt production was evaluated. Four types of yoghurt were made from the mixture of cow milk and coconut milk using the different percentage. The preliminary results show that the final product is delicious, has pleasant coconut flavour. The titratable acidity of yoghurt ranged from 75° T (type D) to 95° T (Type A). The consistency/viscosity of the product has gone up with increase of the percentage of coconut in the mixture. The coagulation time of yoghurt is about 5 hours. After the organoleptic appreciation, the preference was given to different types of yoghurt. The Journal of Food Technology in Africa Volume 6 Number 1 (January-March 2001), pp. 11-1

Preliminary study of the utilisation of coconut in yoghurt production

The possibility of using the coconut in yoghurt production was evaluated. Four types of yoghurt were made from the mixture of cow milk and coconut milk using the different percentage. The preliminary results show that the final product is delicious, has pleasant coconut flavour. The titratable acidity of yoghurt ranged from 75° T (type D) to 95° T (Type A). The consistency/viscosity of the product has gone up with increase of the percentage of coconut in the mixture. The coagulation time of yoghurt is about 5 hours. After the organoleptic appreciation, the preference was given to different types of yoghurt

Safety and efficacy of anakinra as first-line or second-line therapy for systemic onset juvenile idiopathic arthritis-data from the German BIKER registry

Background: The IL-1 receptor-antagonist anakinra is recommended for the treatment of systemic juvenile idiopathic arthritis (sJIA) and was recently approved for first-line treatment. Long-term data from clinical practise are scarce. Methods: SJIA patients from the German biologics in pediatric rheumatology (BIKER) registry starting anakinra were grouped into two cohorts: Patients in the first-line cohort received no prior sJIA treatment except NSAID and a maximum of 3 days of steroids. Second-line cohort patients were pre-treated with steroids; DMARDs or biologics. Patient characteristics, disease-activity parameters, efficacy, and safety-parameters were compared. Results: Until December 2018, 51 anakinra patients were documented, representing 117.96 patient-years. Mean disease duration was 3.5 (+/- 3.8) years. At baseline, all anakinra first-line users had active systemic disease compared to 82% in the second-line users. Significant JADAS-10 improvement at last follow-up was observed in both cohorts (p = 0.02, p = 0.0014). Substantial numbers of patients in both groups reached JADAS-MDA/JADAS-remission/inactive disease (66.7%50%50% in first-liners and 60%45%70% in second-liners). Rates of serious adverse events were comparable and consistent with the overall AE profile of anakinra in patients. Conclusion: This analysis adds to the established safety profile of anakinra and demonstrates that anakinra is effective as first-line or second-line treatment