Access to aff ordable medicines after health reform: evidence from two cross-sectional surveys in Shaanxi Province,western China

Background Limited access to essential medicines is a global problem. Improving availability and aff ordability of essential medicines is a key objective of the National Essential Medicine Policy (NEMP) in China. In its initial implementation in 2009, the NEMP targeted primary hospitals with policies designed to increase availability of essential medicines and reduce patients’ economic burden from purchasing medicines. We assessed medicine availability and price during the early years of the health reform in Shaanxi Province in underdeveloped western China. Methods We undertook two public (hospitals) and private (pharmacy) sector surveys of prices and availability of medicines, in September, 2010 and April, 2012, by a standard methodology developed by WHO and Health Action International. We measured medicine availability in outlets at the time of the surveys and infl ation-adjusted median unit prices (MUPs), taking 2010 as the base year. We used general estimating equations to calculate the signifi cance of diff erences in availability from 2010 to 2012 and the Wilcoxon signed rank test to calculate the signifi cance of diff erences in adjusted median prices. Findings We collected data from 50 public sector hospitals and 36 private sector retail pharmacies in 2010 and 72 public hospitals and 72 retail pharmacies in 2012. Mean availability of surveyed medicines was low in both the public and private sectors; availability of many essential medicines decreased from 2010 to 2012, particularly in primary hospitals (from 27·4% to 22·3% for lowest priced generics; p<0·0001). The MUPs of originator brands and their generic equivalents decreased signifi cantly from 2010 to 2012 in primary hospitals in comparison with secondary and tertiary hospitals. In the public sector, the median adjusted patient price was signifi cantly lower in 2012 than in 2010 for 16 originator brands (diff erence –11·7%; p=0·0019) and 29 lowest-priced generics (–5·2%; p=0·0015); the median government procurement price for originator brands also decreased signifi cantly (–10·9%; p=0·0004), whereas the decrease in median procurement price for lowest-priced generics was not signifi cant (–4·9%; p=0·17). In the private sector, the median percentage decrease in price between 2010 and 2012 for 38 lowest-priced generics was 4·7% (IQR 6·3–13·2), compared with 7·9% (4·9–13·9) for 16 originator brands. Interpretation Although infl ation-adjusted medicine prices were numerically lower, there were concerning decreases in availability of lowest-priced generic medicines in both the public and private sectors in 2012 from already low availability in 2010. A long-term, stable, and consistent information system is needed to monitor eff ects of further implementation of the Chinese Essential Medicine Policy

Single superparticle production via γγ\gamma\gamma collision with explicit R-parity violation

We study the single production of scalar neutrinos or charginos via $\gamma\gamma$ collision in an R-parity ($R_{p}$) violating supersymmetric model. It may be possible to detect a sneutrino or a chargino at a Linear Collider (LC) in $\gamma \gamma$ operation mode, as a test of supersymmetry and $R_p$-violation. Because of the clean background in LC, stringent constraints on $R_p$ violating parameters can be obtained even if the process cannot be observed at the future Linear Collider.Comment: 13 pages, 15 figure

Non-steroidal anti-inflammatory drugs and bladder cancer prevention

Inclusion of phenacetin among ‘proven’ human carcinogens by the IARC in 1987, raised concerns about the carcinogenic potential of acetaminophen, its major metabolite. Acetaminophen has been implicated as a possible causal agent in the development of cancer of the renal pelvis. The bladder and renal pelvis, which derive from the same embryological structure, share the same transitional type of epithelium. Past studies have been inconclusive on the possible relationship among these analgesics and bladder cancer but no large, highly detailed study of this association has been conducted. A population-based case–control study conducted in Los Angeles, California, involved 1514 incident bladder cancer cases and an equal number of controls who were matched to the index cases by sex, date of birth (within 5 years) and race. Detailed information on medication use and prior medical conditions was collected through in-person interviews. Regular use of analgesics was not associated with an increased risk of bladder cancer in either men or women. In fact, compared with non- or irregular users, regular analgesic users were at a decreased risk of bladder cancer overall (odds ratio (OR) = 0.81, 95% confidence interval (CI) = 0.68–0.96). However, there were clear differences in both the direction and strength of the associations between the different formulation classes of analgesics and bladder cancer risk. Intake of phenacetin was positively related to bladder cancer risk in a dose-dependent manner while intake of its major metabolite in humans, acetaminophen, was unrelated to risk. Intake of all classes of NSAIDs, except pyrazolon derivatives, were negatively associated with bladder cancer risk, with suggestive evidence that the protective effect varies in strength by subcategories of formulation. Acetic acids seemed to exhibit the strongest protective effect, whereas aspirin/other salicylic acids and oxicam showed the weakest protection. © 2000 Cancer Research Campaig

Lowering solar mixing angle in inverted hierarchy without charged lepton corrections

In the present work, the inverted hierarchical neutrino mass model which is characterised by opposite CP parity in the first two mass eigenvalues $(m_1,-m_2,m_3)$, is studied in order to lower the predicted value of solar mixing angle $\tan^2\theta_{12}$, from the tri-bimaximal mixing (TBM), without sacrificing the conditions of maximal atmospheric mixing angle and zero reactor angle. The present attempt is different from the earlier approach where the correction from the charged lepton mass matrix is included in the leptonic mixing matrix to lower the prediction on solar mixing angle. The lowering of the solar mixing angle without charged lepton correction, can be obtained through the variation of the input value of a flavour twister term present in the texture of neutrino mass matrix having a 2-3 symmetry. The present analysis agrees with the latest experimental bounds on neutrino mass parameters and also represents an important result on the survival of the inverted hierarchical neutrino mass models having opposite CP parity in the first two eigenvalues.Comment: 10 pages, two figures. Accepted for publication in Journal of Physics G:Nuclear and Particle Physic

Some Implications of a Supersymmetric Model with R-Parity Breaking Bilinear Interactions

We investigate a supersymmetric scenario where R-parity is explicitly broken through a term bilinear in the lepton and Higgs superfields in the superpotential. We show that keeping such a term alone can lead to trilinear interactions, similar to those that are parametrized by $\lambda$-and ${\lambda}'$ in the literature, involving the physical fields. The upper limits of such interactions are predictable from the constraints on the parameter space imposed by the lepton masses and the neutrino mass limits. It is observed that thus the resulting trilinear interactions are restricted to values that are smaller than the existing bounds on most of the $\lambda$-and ${\lambda}'$-parameters. Some phenomenological consequences of such a scenario are discussed.Comment: 26 Pages, 6 Postscript figures, Latex. An additional set of references has been included. Typographic corrections have been made. Figures remain all unchanged. An additional typographic correction has been mad