A Cohort Study of Public Health Insurance Coverage Loss among Oregon Adolescents

ABSTRACT Introduction: Churning on and off and/or experiencing coverage gaps is common among public health insurance recipients. Although the Affordable Care Act (ACA) provisions to extend parental coverage for adolescents transitioning to young adulthood on private insurance plans were implemented in 2010, no such protection was mandated for adolescents with public health insurance. Methods: Oregon public health insurance enrollment and electronic health record data from community health centers were used to conduct a retrospective, observational cohort study of Oregon adolescents (17-19 years of age) with public coverage [January 1, 2011-December 31, 2013 (n=51,988)] to assess loss. Time-to-event methods determined the association of coverage loss with sociodemographic characteristics. Results: Although adolescents are vulnerable to coverage loss as they age out of child public health insurance coverage, \u3e35% of 19 year olds in this study kept their coverage for up to one year after their 19th birthday. Conclusions: Our findings suggest that the support many community health centers offer to help their patients maintain insurance coverage may be having an impact, especially during this important transition period. Additional research to understand how these 19 year olds were able to keep coverage will provide recommendations for future adolescents as they transition to young adulthood

DEHBA (di-2-ethylhexylbutyramide) gamma radiolysis under spent nuclear fuel solvent extraction process conditions

International audienc

Efficacy and safety of ridinilazole compared with vancomycin for the treatment of Clostridium difficile infection: a phase 2, randomised, double-blind, active-controlled, non-inferiority study

Background: Clostridium difficile infection is the most common health-care-associated infection in the USA. We assessed the safety and efficacy of ridinilazole versus vancomycin for treatment of C difficile infection. Methods: We did a phase 2, randomised, double-blind, active-controlled, non-inferiority study. Participants with signs and symptoms of C difficile infection and a positive diagnostic test result were recruited from 33 centres in the USA and Canada and randomly assigned (1:1) to receive oral ridinilazole (200 mg every 12 h) or oral vancomycin (125 mg every 6 h) for 10 days. The primary endpoint was achievement of a sustained clinical response, defined as clinical cure at the end of treatment and no recurrence within 30 days, which was used to establish non-inferiority (15% margin) of ridinilazole versus vancomycin. The primary efficacy analysis was done on a modified intention-to-treat population comprising all individuals with C difficile infection confirmed by the presence of free toxin in stool who were randomly assigned to receive one or more doses of the study drug. The study is registered with ClinicalTrials.gov, number NCT02092935. Findings: Between June 26, 2014, and August 31, 2015, 100 patients were recruited; 50 were randomly assigned to receive ridinilazole and 50 to vancomycin. 16 patients did not complete the study, and 11 discontinued treatment early. The primary efficacy analysis included 69 patients (n=36 in the ridinilazole group; n=33 in the vancomycin group). 24 of 36 (66·7%) patients in the ridinilazole group versus 14 of 33 (42·4%) of those in the vancomycin group had a sustained clinical response (treatment difference 21·1%, 90% CI 3·1–39·1, p=0·0004), establishing the non-inferiority of ridinilazole and also showing statistical superiority at the 10% level. Ridinilazole was well tolerated, with an adverse event profile similar to that of vancomycin: 82% (41 of 50) of participants reported adverse events in the ridinilazole group and 80% (40 of 50) in the vancomycin group. There were no adverse events related to ridinilazole that led to discontinuation. Interpretation: Ridinilazole is a targeted-spectrum antimicrobial that shows potential in treatment of initial C difficile infection and in providing sustained benefit through reduction in disease recurrence. Further clinical development is warranted. Funding: Wellcome Trust and Summit Therapeutics