Entry in the ADHD drugs market: Welfare impact of generics and me-toos

Recent decades have seen a growth in treatments for attention deficit hyperactivity disorder (ADHD) including many branded and generic drugs. In the early 2000's, new drug entry dramatically altered market shares. We estimate a demand system for ADHD drugs and assess the welfare impact of new drugs. We find that entry induced large welfare gains by reducing prices of substitute drugs, and by providing alternative delivery mechanisms for existing molecules. Our results suggest that the success of follow-on patented drugs may come from unanticipated innovations like delivery mechanisms, a factor ignored by proposals to retard new follow-on drug approvals

THE COST STRUCTURE OF MICROFINANCE INSTITUTIONS IN EASTERN EUROPE AND CENTRAL ASIA

Microfinance institutions are important, particularly in developing countries, because they expand the frontier of financial intermediation by providing loans to those traditionally excluded from formal financial markets. This paper presents the first systematic statistical examination of the performance of MFIs operating in Eastern Europe and Central Asia. A cost function is estimated for MFIs in the region from 1999-2004. First, the presence of subsidies is found to be associated with higher MFI costs. When output is measured as the number of loans made, we find that MFIs become more efficient over time and that MFIs involved in the provision of group loans and loans to women have lower costs. However, when output is measured as volume of loans rather than their number, this last finding is reversed. This may be due to the fact that such loans are smaller in size; thus for a given volume more loans must be made.http://deepblue.lib.umich.edu/bitstream/2027.42/40195/3/wp809.pd

Demographics of infertility and management of unexplained infertility

Peer reviewedPostprin

“Early Rupture of Membranes” during Induced Labor as a Risk Factor for Cesarean Delivery in Term Nulliparas

OBJECTIVE: To determine if "early rupture of membranes" (early ROM) during induction of labor is associated with an increased risk of cesarean section in term nulliparas. STUDY DESIGN: The rate of cesarean section and the timing of ROM during the course of labor were examined in term singleton nulliparas whose labor was induced. Cases were divided into 2 groups according the timing of ROM: 1)"early ROM", defined as ROM at a cervical dilatation<4 cm during labor; and 2) "late ROM", ROM at a cervical dilatation≥4 cm during labor. Nonparametric techniques were used for statistical analysis. RESULTS: 1) In a total of 500 cases of study population, "early ROM" occurred in 43% and the overall cesarean section rate was 15.8%; 2) patients with "early ROM" had a higher rate of cesarean section and cesarean section due to failure to progress than did those with "late ROM" (overall cesarean section rate: 24%[51/215] vs. 10%[28/285], p<0.01; cesarean section rate due to failure to progress: 18%[38/215] vs. 8%[22/285], p<0.01 for each) and this difference remained significant after adjusting for confounding variables. CONCLUSION: "Early ROM" during the course of induced labor is a risk factor for cesarean section in term singleton nulliparas

Preconception Care in International Settings

Objectives: This literature review briefly describes international programs, policies, and activities related to preconception care and resulting pregnancy outcomes. Methods: Electronic databases were searched and findings supplemented with secondary references cited in the original articles as well as textbook chapters, declarations, reports, and recommendations. Results: Forty-two articles, book chapters, declarations, and other published materials were reviewed. Policies, programs, and recommendations related to preconceptional health promotion exist worldwide and comprise a readily identifiable component of historic and modern initiatives pertaining to women's health, reproductive freedom, and child survival. Conclusions: The integration of preconception care services within a larger maternal and child health continuum of care is well aligned with a prevention-based approach to enhancing global health

Predictors of PTSD and CPTSD in UK firefighters

Background: Globally, professional firefighters are often exposed to traumatic events and are at high risk of developing posttraumatic stress disorder (PTSD) symptoms. Objective: With the publication of the 11th edition of the International Classification of Diseases (ICD-11) there arose a need for research based on the new diagnostic criteria, and the associated disorder, Complex PTSD (CPTSD). Method: Participants were 1300 former or present firefighters from the UK. Prevalence rates of PTSD and CPTSD were estimated using International Trauma Questionnaire in accordance with ICD-11 criteria, and service related and personal trauma exposure were also assessed using an anonymous online questionnaire. Multinomial logistic regression was performed to assess how service and personal trauma exposure predicted PTSD and CPTSD. Results: CPTSD criteria were met by 18.23% (95% CI 16.13–20.33%) and PTSD criteria were met by 5.62% (95% CI 4.37–6.87%) of the sample. Experiencing higher levels of service-related trauma significantly increased the risk for both PTSD and CPTSD, and nonwork related trauma uniquely predicted CPTSD but not PTSD. Conclusions: This study provided the first examination of the new ICD-11 criteria for PTSD and CPTSD in a large sample of firefighters, and CPTSD was more common than PTSD. Exposure to multiple different types of trauma increased the odds of PTSD and CPTSD

Attributing human influence on July 2017 Chinese heatwave: the influence of sea-surface temperatures

On 21st-25thJuly 2017 a record breaking heatwave occurred in Central Eastern China affecting nearly half of the national population and causing severe impacts on public health, agriculture and infrastructure. Here, we compare attribution results from two UK Met Office Hadley Centre models, HadGEM3-GA6 and weather@home (HadAM3P driving 50km HadRM3P). Within HadGEM3-GA6 July 2017-like heatwaves were unequaled in the ensemble representing the world without human influences. Such heatwaves became approximately a 1 in 50 year event and increased by a factor of 4.8 (5-95% range of 3.1 to 8.0) in weather@home as a result of human activity. Considering the risk ratio (RR) for the full range of return periods shows a discrepancy at all return times between the two model results. Within weather@home a range of different counterfactual Sea Surface Temperature (SST) patterns were used whereas HadGEM3-GA6 used a single estimate. The global mean difference in SST (between factual and counterfactual simulations) is shown to be related to the Generalised Extreme Value (GEV) location parameter and consequently the RR, especially for return periods less than 50 years. It is suggested that a suitable range of SST patterns are used for future attribution studies to ensure that this source of uncertainty is represented within the simulations and subsequent attribution results. It is shown that the risk change between factual and counterfactual simulations is not purely a simple shift in the distribution (i.e. change in GEV location parameter). For return periods greater than 50 years the GEV shape parameter is found to strongly influence the RR determined with the GEV scale parameter affecting only the most severe events

Does Jacobson's relaxation technique reduce consumption of psychotropic and analgesic drugsin cancer patients? A multicenter pre-post intervention study

Background: Cancer patients often suffer from emotional distress as a result of the oncological process. The purpose of our study was to determine whether practice of Jacobson?s relaxation technique reduced consumption of psychotropic and analgesic drugs in a sample of cancer patients. Methods: This was a multicenter pre?post intervention design. Participants were 272 patients aged over 18 years attending 10 Spanish public hospitals with oncological pathologies and anxiety symptoms. The intervention consisted of a protocol of abbreviated progressive muscle relaxation training developed by Bernstein and Borkovec. This was followed up by telephone calls over a 1-month period. The intervention was performed between November 2014 and October 2015. Sociodemographic variables related to the oncological process, mental health variables, and intervention characteristics were measured. Results: A reduction in the consumption of psychotropic and analgesic drugs was observed throughout the follow-up period. Improvement was observed throughout the 4-week follow-up for all the parameters assessed: anxiety, relaxation, concentration, and mastery of the relaxation technique. Conclusions: The practice of abbreviated Jacobson?s relaxation technique can help to decrease the consumption of psychotropic and analgesic drugs. Patients experienced positive changes in all the evaluated parameters, at least during the 1-month follow-up. To confirm these findings, additional long-term studies are needed that include control groups. Trial registration: ISRCTN 81335752, DOI 10.1186/ISRCTN81335752 17. Date of registration: 22/11/2016 (retrospectively registered)

Civic Nationalism and Language-in-Education Policies in the United Arab Emirates

A founding principle of the United Arab Emirates is the belief that tolerance promotes peace, while isolation encourages division and conflict. With more than 200 nationalities residing in the UAE, Emiratis constitute only 10% of the population, making them a minority in their own country. Despite the government promoting diversity and tolerance as the norm, such demographic imbalance come with a cost to the Arabic language, the national identity and culture, and the education system. This chapter addresses those concerns through a series of recent government initiatives. The author classifies neo-nationalist movements into different types, arguing that the one in the UAE largely fits within the civic type with its non-hostile, overall welcoming attitude toward foreigners. At the end of the chapter, she discusses the impact of neo-nationalism on education and calls for clearer policies that take into account language(s) as a right and as a resource

The ending of southern Africa's tripartite dream: the cases of South Africa, Namibia and Mozambique

This article examines the rise and decline of tripartite experiments in southern Africa, focusing on South Africa, Mozambique and Namibia, where tripartism emerged as part of the broader processes of democratisation and embedding democratic institutions. Why did these experiments largely fail to achieve the gains for labour that might have been anticipated? In each case, the lack of success can be ascribed to the ecosystemic dominance of neo-liberalism, returning growth fuelled by higher commodities prices, the changing structure of elites, dominant partyism, and structural weaknesses in both organised business and the labour movement