Pharmaceutical competition within molecule markets post-patent expiry: Evidence from the USA, the UK, Germany and France 2000-2005.

In the interest of understanding the nature and degree of competition within off-patent molecule markets and improving purchasing efficiency, this thesis uses IMS Health data to analyse dimensions of competition within the off-patent omeprazole and paroxetine molecule markets in the USA, UK, France and Germany during the 2000q-2005ql period. The main theoretical findings include: Regulation in homogeneous markets may inhibit generic price competition. Generic manufacturers may also product differentiate, resulting in a Bertrand-like model of "softened" price competition. Other forms of product differentiation in off-patent molecule markets may include strength segments and the OTC market. The main empirical findings include: Generic price competition appears stronger in the USA and the UK than in Germany and France, although it is imperfect in all four countries. The USA and the UK achieve some of the lowest generic prices, while the UK is the most effective at actually purchasing its lowest prices. Generic penetration appears weak in less common strength segments, allowing original brand manufacturers' the opportunity to retain relatively large market shares. This results in higher purchased prices and, hence, significant purchasing inefficiencies. There appears to be competition between over-the-counter and prescription omeprazole in the USA, but not in the UK. OTC prices are relatively low in the US, offering the opportunity for cost savings. In the UK, patients may face a financial disincentive to purchase OTC omeprazole, possibly masking the opportunity for improved self-care. Certain countries may want to re-evaluate their generic reimbursement schemes in the interest of more price competitive markets and increased purchasing efficiency. Countries could also benefit from encouraging generic entry in less common strength markets. Finally, in approving an OTC switch, regulators should ensure that demand-side financial incentives are consistent with the goals of achieving cost containment and/or facilitating increased patient self-care

How Follow-Up Counselling Increases Linkage to Care Among HIV-Positive Persons Identified Through Home-Based HIV Counselling and Testing: A Qualitative Study in Uganda

We investigated how follow-up counselling had increased linkage to HIV care in a trial of referral to care and follow-up counseling, compared to referral to care only, for participants diagnosed as HIV-positive through home-based HIV counseling and testing. We carried out a cross-sectional qualitative study. Using random stratified sampling, we selected 43 trial participants (26 [60%] in the intervention arm). Sample stratification was by sex, distance to an ART facility, linkage, and nonlinkage to HIV care. Twenty-six in-depth interviews were conducted with participants in the intervention arm: 17 people who had linked to HIV care and 9 who had not linked after 6 months of follow-up. Home-based follow-up counseling helped to overcome worries resulting from an HIV-positive test result. In addition, the counseling offered an opportunity to address questions on HIV treatment side effects, share experiences of intimate partner violence or threats, and general problems linking to care. The counselling encouraged early linkage to HIV care and use of biomedical medicines, discouraging alternative medicine usage. Home-based follow-up counseling also helped to promote HIV sero-status disclosure, facilitating linkage to, retention in and adherence to HIV care and treatment. This study successfully demonstrated that home-based follow-up counselling increased linkage to care through encouragement to seek care, provision of accurate information about HIV care services and supporting the person living with HIV to disclose and manage stigma. </jats:p

The nation’s health care bill

During the past 50 years, spending on health care services—by households, private businesses, and state and federal governments—increased dramatically and now approaches one out of every five dollars spent in the United States. The benefits of health care spending have not been distributed equally across the population, with less going to a growing number of uninsured people. Moreover, the United States does not realize proportional value for its spending on health care. It spends more per capita than any of six other industrialized countries but ranks below them on measures of health care quality, efficiency, and equity. Unable to sustain rising contributions to health insurance, employers are shifting more of the cost to workers, thereby increasing the number who cannot afford coverage. Federal, state, and local governments have taken on some of these costs by subsidizing the health services of elderly, disabled, and poor people. Health spending, once a small fraction of the federal budget, now exceeds spending on defense or Social Security. State and local governments now devote more of their own taxes to health care than to elementary and secondary education, despite the federal government’s paying for the majority of Medicaid spending. The data in this chartbook indicate that the financial burden of health care spending presents a disproportionate burden on uninsured and sick people, small businesses, and low-wage workers. In addition to the magnitude and maldistribution of health spending, society’s “opportunity costs” are high: Private businesses, households, and state and federal governments could have made other highly productive purchases had health spending not exceeded economy-wide growth. For the government, health care spending decreases the money available for other investments, such as education, infrastructure, and debt reduction. As health costs increase and the population ages, the historical reallocation of US productive capacity to health care is unsustainable. With pressing needs elsewhere, the country must make the health system more efficient, equitable, and affordable. Passage of the Patient Protection and Affordable Care Act (ACA) by Congress in 2010 was a comprehensive step to contain health care costs, particularly for families, while extending health care coverage to millions of uninsured people. The potential benefits of the ACA include better access to health professionals and prescription drugs, decreased medical debt and fewer subsequent bankruptcy filings, and lower labor costs for small businesses. Constrained health care spending will allow businesses and government to make more cost-effective investments elsewhere without raising prices or burdening taxpayers. With this chartbook as a baseline, users can monitor changes that result from the ACA and take future steps to enhance the cost-effectiveness of the US health care system.Publishe

The general population cohort in rural south-western Uganda: a platform for communicable and non-communicable disease studies.

The General Population Cohort (GPC) was set up in 1989 to examine trends in HIV prevalence and incidence, and their determinants in rural south-western Uganda. Recently, the research questions have included the epidemiology and genetics of communicable and non-communicable diseases (NCDs) to address the limited data on the burden and risk factors for NCDs in sub-Saharan Africa. The cohort comprises all residents (52% aged ≥13years, men and women in equal proportions) within one-half of a rural sub-county, residing in scattered houses, and largely farmers of three major ethnic groups. Data collected through annual surveys include; mapping for spatial analysis and participant location; census for individual socio-demographic and household socioeconomic status assessment; and a medical survey for health, lifestyle and biophysical and blood measurements to ascertain disease outcomes and risk factors for selected participants. This cohort offers a rich platform to investigate the interplay between communicable diseases and NCDs. There is robust infrastructure for data management, sample processing and storage, and diverse expertise in epidemiology, social and basic sciences. For any data access enquiries you may contact the director, MRC/UVRI, Uganda Research Unit on AIDS by email to [email protected] or the corresponding author

Author&apos;s personal copy Possible temperature limits to range expansion of non-native Asian shore crabs in Maine

a b s t r a c t a r t i c l e i n f o The intertidal Asian shore crab, Hemigrapsus sanguineus (De Haan, 1835), recently (2001) appeared in very low densities along the southern Maine (USA) coast. Indigenous to Russia and Japan, this species arrived in New Jersey around 1988 and rapidly expanded south to the Carolinas and north to southern New England (CT, RI, MA) by the early 1990s. We examined the characteristics of a non-native species invasion by surveying over 30 intertidal sites in Maine from 2002 to 2005. We found relatively low population densities, slow rates of geographic expansion and virtually no colonization northeast of Penobscot Bay on the central coast of Maine. We hypothesized that further geographic expansion of sustaining populations of H. sanguineus in Maine may be limited by coastal temperatures colder than in its native range. To examine this, we deployed recording thermistors at 11 strategic sites and integrated those data with three oceanographic observation buoys and with satellite thermal images of the coastal zone for the period between 2003 and 2005. We found that Maine&apos;s H. sanguineus population densities in the intertidal peaked during the warmest months (July-September) and were lowest during the coldest months (January-March) when the crabs retreated to the subtidal zone. Densities were also greater in warmer localities (southern Maine) than in cooler localities (central and eastern Maine). In fact, populations were absent from areas with mean summer temperatures cooler than 13°C. In southern Maine, seasonal population densities and reproductive periodicity corresponded to periods with mean temperatures warmer than 15°and 12°C, respectively. There are many physical and biological factors that could limit this invasion. However, our temperature and demographic data are consistent with the thesis that the H. sanguineus invasion has stalled at the terminus of the Gulf of Maine&apos;s cold, Eastern Maine Coastal Current. We compared published mean summer and winter SST data for coastal waters in the western North Atlantic and in the native Asian range of H. sanguineus, and we quantified and compared H. sanguineus abundance in Maine with thermal microenvironments at these sites. From this, we speculate that future distribution of this crab may be limited to the warmer areas of the Maine coast (south and west of Penobscot Bay) and up estuaries that warm every summer. Thus, it may be possible for managers to gauge future risks of marine species invasion from vectors such as ships based on the thermal biogeographic match or mismatch between their ports of origin and their destinations. Such information could be useful for focused monitoring and enforcement of existing laws designed to prevent future introductions of non-native marine species. As coastal waters warm, invasion opportunities could increase from cold-limited species

Adaptation and validation of the child and family follow-up survey (CFFS) tool to measure participation of children with disabilities in Uganda

Definitions and frameworks from high-income countries dominate tools used to measure impairment level, barriers and enablers to participation of children with disabilities in low-income countries. Disability scholars have argued that multiple perspectives and a different discourse are needed to study disability, participation, and inclusion in low-income countries. We examined the use, reliability, and cultural acceptability of the Child and Family Follow-up Survey’s (CFFS) Child and Adolescent Scale of Participation CASP, Child and Adolescent Factors Inventory (CAFI), and the Child and Adolescent Scale of Environment (CASE) scales to measure participation of Ugandan children with disabilities and their peers. The tool testing and adaptation was conducted as part of a pilot and feasibility study of the ‘Obuntu bulamu’ intervention in five private and five public primary schools. Based on disability type, gender, age, and social class, 32 8-14-year-old children with disabilities were enrolled. The translated Luganda CFFS showed excellent internal consistency with CASE, CASP, and CAFI subscales showing good test re-test reliability. Our consistency and reliability results show the three tools are valid and effective to measure environmental issues, childhood social participation, impairment children with disabilities type and severity from a parental perspective in the Ugandan setting. To ensure more in-depth understanding of child participation in the cultural context, we suggest the CFFS scales are used in combination with qualitative child-inclusive methods such as drawings, participatory workshops, and Photo Voice. The study contributes to the existing literature that there need for more Afrocentric interventions and adaptions and development of culturally relevant measurement tools, which build on African cultural values and practices

Faithfulness without sexual exclusivity: gendered interpretations of faithfulness in rural south-western Uganda, and implications for HIV prevention programmes

This article explores gendered meanings of both faithfulness and sexual exclusivity within intimate long-term relationships, and the implications for HIV prevention messaging. In 2011–12, in-depth interviews were conducted with a random sample of 50 men and women (52 per cent women) in long-term relationships in rural Uganda. Confirming prior research, we found that a double standard exists for sexual exclusivity, where men define faithfulness to mean strict sexual exclusivity by their wife, but women defined it as being for both partners. However, both men and women defined fidelity to imply continued support. Fidelity was perceived to be intact if a man continued to provide material support, despite not being sexually exclusive. These findings highlight the limitations of HIV prevention strategies that emphasise faithfulness, where faithfulness is not synonymous with sexual exclusivity.</jats:p

The nation’s health care bill: Who bears the burden? A chartbook

During the past 50 years, spending on health care services—by households, private businesses, and state and federal governments—increased dramatically and now approaches one out of every five dollars spent in the United States. The benefits of health care spending have not been distributed equally across the population, with less going to a growing number of uninsured people. Moreover, the United States does not realize proportional value for its spending on health care. It spends more per capita than any of six other industrialized countries but ranks below them on measures of health care quality, efficiency, and equity. Unable to sustain rising contributions to health insurance, employers are shifting more of the cost to workers, thereby increasing the number who cannot afford coverage. Federal, state, and local governments have taken on some of these costs by subsidizing the health services of elderly, disabled, and poor people. Health spending, once a small fraction of the federal budget, now exceeds spending on defense or Social Security. State and local governments now devote more of their own taxes to health care than to elementary and secondary education, despite the federal government’s paying for the majority of Medicaid spending. The data in this chartbook indicate that the financial burden of health care spending presents a disproportionate burden on uninsured and sick people, small businesses, and low-wage workers. In addition to the magnitude and maldistribution of health spending, society’s “opportunity costs” are high: Private businesses, households, and state and federal governments could have made other highly productive purchases had health spending not exceeded economy-wide growth. For the government, health care spending decreases the money available for other investments, such as education, infrastructure, and debt reduction. As health costs increase and the population ages, the historical reallocation of US productive capacity to health care is unsustainable. With pressing needs elsewhere, the country must make the health system more efficient, equitable, and affordable. Passage of the Patient Protection and Affordable Care Act (ACA) by Congress in 2010 was a comprehensive step to contain health care costs, particularly for families, while extending health care coverage to millions of uninsured people. The potential benefits of the ACA include better access to health professionals and prescription drugs, decreased medical debt and fewer subsequent bankruptcy filings, and lower labor costs for small businesses. Constrained health care spending will allow businesses and government to make more cost-effective investments elsewhere without raising prices or burdening taxpayers. With this chartbook as a baseline, users can monitor changes that result from the ACA and take future steps to enhance the cost-effectiveness of the US health care system