Psychotherapy in diabetes

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An analysis of the impact of generic medicine reference pricing in a sector of the South African private healthcare insurance industry

Includes bibliographical referencesBackground: Pharmaceuticals are responsible for a substantial percentage of the total cost of health care and continue to exceed economic growth and inflation. Generic medicines play an important role in limiting this expenditure, and consequently there is an international drive to implement pro - generic policies particularly in high income countries. One such policy is generic medicine reference pricing (GRP). Generic reference pricing sets a fixed maximum reimbursement amount for clusters of bio - equivalent drugs without placing any restrictions on the manufacturers' price. Numerous studies have been conducted in high income countries to analyse the impact of generic reference pricing; however, the impact of this reference pricing in low - to - middle income countries (LMIC s) is not well established. Objective: This dissertation aims to address this lack of information in LMICs by providing empirical aggregated claims data on the impact of generic reference pricing on price, expenditure, utilisation and out - of - pocket (OOP) p ayments in a sector of South Africa's private health insurance industry. Methods: This time series intervention study of retrospective claim - level secondary data analyses the impact of one of several generic reference pricing models applied by various private medical insurance companies in South Africa. Criteria applied for the selection of referenced categories and sample claims data intend to maximize the data set as well as the analysis period, while minimizing confounders such as medical insurance member variation and specific managed care policies. The impact of the reference price on variables of drug price, drug expenditure, market share and out - of - pock et payment is measured by analysing changes in the originator, 'authorised generic' ('clone') and generic drugs within each cluster. (An 'authorised generic' (AG) is an exact copy of the originator, approved as a brand - name drug under a patent protection but marketed as a generic.) Results: Two referenced priced categories (Desloratadine and Clopidogrel) and a population of approximately 100,000 were identified as being eligible for inclusion. An authorised generic was launched for Clopidogrel but not for Desloratadine. The implementation of generic reference pricing appears to have had no or minimal impact on the price of the originator and authorised generic - at the end of the study period the price of the originator drugs of the two categories was 268% and 86% higher than the reference and the authorised generic of Clopidogrel was 69 % higher than the reference price. Most often the reference price appeared to be based on the price of a generic drug; however once the reference price was set other generics tended to align at or below the reference price. The implementation of generic reference pricing was associated with an overall increase in dispensed volumes and a decrease in expenditure for both categories; both categories' originator market share declined dramatically by volume (to 23% and 4%) and value (to 35% and 9 %). For Clopidogrel the authorised generic took the majority of market share (63% by volume and 68% by value); the generics only gained one third of the market, despite lower product prices and minimal co - payments. Desloratadine generics captured 80% of the market by the end of the study. For both categories there was no notable change in the total drug expenditure paid out - of - pocket across the study period. The percentage of drugs dispensed that had a co - payment decreased dramatically for Desloratadine, but were only seen to decrease marginally for Clopidogrel. Limitations: Due to the small sample and limited reference categories analysed, the findings from this study are not representative of the South African private healthcare sector and cannot be extrapolated to South Africa. In addition, any savings identified should take the expense of non - referenced alternatives into account

An investigation into the use of a nature reserve as a cross-curricular teaching resource

This study documents the development of the Queenstown nature reserve as a cross-curricular tea~hing resource. Participants in the project included the researcher, the municipality nature conservation officer and the senior Geography and Biology teachers from five high schools in the town. A modified action research approach was adopted. Data was collected from workshops and interviews and then analyzed. The conclusion of the research was that the participants perceived that the project had been worthwhile and was to be continued. The nature reserve is now more widely and usefully use

Two neuroanatomical signatures in schizophrenia: Expression strengths over the first 2 years of treatment and their relationships to neurodevelopmental compromise and antipsychotic treatment

BACKGROUND AND HYPOTHESIS: Two machine learning derived neuroanatomical signatures were recently described. Signature 1 is associated with widespread grey matter volume reductions and signature 2 with larger basal ganglia and internal capsule volumes. We hypothesized that they represent the neurodevelopmental and treatment-responsive components of schizophrenia respectively. STUDY DESIGN: We assessed the expression strength trajectories of these signatures and evaluated their relationships with indicators of neurodevelopmental compromise and with antipsychotic treatment effects in 83 previously minimally treated individuals with a first episode of a schizophrenia spectrum disorder who received standardized treatment and underwent comprehensive clinical, cognitive and neuroimaging assessments over 24 months. Ninety-six matched healthy case-controls were included. STUDY RESULTS: Linear mixed effect repeated measures models indicated that the patients had stronger expression of signature 1 than controls that remained stable over time and was not related to treatment. Stronger signature 1 expression showed trend associations with lower educational attainment, poorer sensory integration, and worse cognitive performance for working memory, verbal learning and reasoning and problem solving. The most striking finding was that signature 2 expression was similar for patients and controls at baseline but increased significantly with treatment in the patients. Greater increase in signature 2 expression was associated with larger reductions in PANSS total score and increases in BMI and not associated with neurodevelopmental indices. CONCLUSIONS: These findings provide supporting evidence for two distinct neuroanatomical signatures representing the neurodevelopmental and treatment-responsive components of schizophrenia

Associations of premorbid adjustment with type and timing of childhood trauma in first-episode schizophrenia spectrum disorders

CITATION: Smit, A. M. et al. 2021. Associations of premorbid adjustment with type and timing of childhood trauma in first-episode schizophrenia spectrum disorders. South African Journal of Psychiatry, 27:a1639, doi:10.4102/sajpsychiatry.v27i0.1639.The original publication is available at https://sajp.org.zaBackground: Childhood trauma may contribute to poorer premorbid social and academic adjustment which may be a risk factor for schizophrenia. Aim: We explored the relationship between premorbid adjustment and childhood trauma, timing of childhood trauma’s moderating role as well as the association of clinical and treatment-related confounders with premorbid adjustment. Setting: We conducted a secondary analysis in 111 patients with first-episode schizophrenia (FES) disorders that formed part of two parent studies, EONKCS study (n =73) and the Shared Roots study (n =38). Methods: Type of childhood trauma was assessed with the Childhood Trauma Questionnaire, short-form and premorbid adjustment using the Premorbid Adjustment Scale. Timing of childhood trauma was assessed using the Life Events Checklist and life events timeline. Linear regression analyses were used to assess the moderating effect of timing of childhood trauma. Clinical and treatment-related confounders were entered into sequential hierarchical regression models to identify independent predictors of premorbid adjustment across key life stages. Results: Childhood physical neglect was associated with poorer premorbid academic functioning during childhood and early adolescence, and poorer premorbid social functioning during early and late adolescence. By hierarchical regression modelling (r2 = 0.13), higher physical neglect subscale scores (p = 0.011) independently predicted poorer premorbid social adjustment during early adolescence. Timing of childhood trauma did not moderate the relationship between childhood trauma and premorbid functioning. Conclusion: In patients with FES, childhood physical neglect may contribute to poorer premorbid social functioning during early adolescence. This may provide us with an opportunity to identify and treat at-risk individuals earlier.https://sajp.org.za/index.php/sajp/article/view/1639Publisher's versio

The GPR55 agonist lysophosphatidylinositol acts as an intracellular messenger and bidirectionally modulates Ca2+-activated large-conductance K+ channels in endothelial cells

Lysophospholipids are known to serve as intra- and extracellular messengers affecting many physiological processes. Lysophosphatidylinositol (LPI), which is produced in endothelial cells, acts as an endogenous agonist of the orphan receptor, G protein-coupled receptor 55 (GPR55). Stimulation of GPR55 by LPI evokes an intracellular Ca2+ rise in several cell types including endothelial cells. In this study, we investigated additional direct, receptor-independent effects of LPI on endothelial large-conductance Ca2+ and voltage-gated potassium (BKCa) channels. Electrophysiological experiments in the inside-out configuration revealed that LPI directly affects the BKCa channel gating properties. This effect of LPI strictly depended on the presence of Ca2+ and was concentration-dependent, reversible, and dual in nature. The modulating effects of LPI on endothelial BKCa channels correlated with their initial open probability (Po): stimulation at low Po (<0.3) and inhibition at high Po levels (>0.3). In the whole-cell configuration, LPI in the pipette facilitated membrane hyperpolarization in response to low (0.1–2 μM) histamine concentrations. In contrast, LPI counteracted membrane hyperpolarization in response to supramaximal cell stimulation with histamine. These results highlight a novel receptor-independent and direct bidirectional modulation of BKCa channels by LPI on endothelial cells. We conclude that LPI via this mechanism serves as an important modulator of endothelial electrical responses to cell stimulation

Country-level gender inequality is associated with structural differences in the brains of women and men

男女間の不平等と脳の性差 --男女間の不平等は脳構造の性差と関連する--. 京都大学プレスリリース. 2023-05-10.Gender inequality across the world has been associated with a higher risk to mental health problems and lower academic achievement in women compared to men. We also know that the brain is shaped by nurturing and adverse socio-environmental experiences. Therefore, unequal exposure to harsher conditions for women compared to men in gender-unequal countries might be reflected in differences in their brain structure, and this could be the neural mechanism partly explaining women’s worse outcomes in gender-unequal countries. We examined this through a random-effects meta-analysis on cortical thickness and surface area differences between adult healthy men and women, including a meta-regression in which country-level gender inequality acted as an explanatory variable for the observed differences. A total of 139 samples from 29 different countries, totaling 7, 876 MRI scans, were included. Thickness of the right hemisphere, and particularly the right caudal anterior cingulate, right medial orbitofrontal, and left lateral occipital cortex, presented no differences or even thicker regional cortices in women compared to men in gender-equal countries, reversing to thinner cortices in countries with greater gender inequality. These results point to the potentially hazardous effect of gender inequality on women’s brains and provide initial evidence for neuroscience-informed policies for gender equality

Country-level gender inequality is associated with structural differences in the brains of women and men

Gender inequality across the world has been associated with a higher risk to mental health problems and lower academic achievement in women compared to men. We also know that the brain is shaped by nurturing and adverse socio-environmental experiences. Therefore, unequal exposure to harsher conditions for women compared to men in gender-unequal countries might be reflected in differences in their brain structure, and this could be the neural mechanism partly explaining women's worse outcomes in gender-unequal countries. We examined this through a random-effects meta-analysis on cortical thickness and surface area differences between adult healthy men and women, including a meta-regression in which country-level gender inequality acted as an explanatory variable for the observed differences. A total of 139 samples from 29 different countries, totaling 7,876 MRI scans, were included. Thickness of the right hemisphere, and particularly the right caudal anterior cingulate, right medial orbitofrontal, and left lateral occipital cortex, presented no differences or even thicker regional cortices in women compared to men in gender-equal countries, reversing to thinner cortices in countries with greater gender inequality. These results point to the potentially hazardous effect of gender inequality on women's brains and provide initial evidence for neuroscience-informed policies for gender equality