Irrational use of medicines is widespread in the South-East Asia Region (SEAR), where policy implementation to encourage quality use of medicines (QUM) is often low. The aim was to determine whether ...public-sector QUM is better in SEAR countries implementing essential medicines (EM) policies than in those not implementing them.
Data on six QUM indicators and 25 EM policies were extracted from situational analysis reports of 20 country (2-week) visits made during 2010-2015. The average difference (as percent) for the QUM indicators between countries implementing versus not implementing specific policies was calculated. Policies associated with better (> 1%) QUM were included in regression of a composite QUM score versus total number of policies implemented.
Twenty-two policies were associated with better (> 1%) QUM. Twelve policies were associated with 3.6-9.5% significantly better use (p < 0.05), namely: standard treatment guidelines; formulary; a government unit to promote QUM; continuing health worker education on prescribing by government; limiting over-the-counter (OTC) availability of systemic antibiotics; disallowing public-sector prescriber revenue from medicines sales; not charging fees at the point of care; monitoring advertisements of OTC medicines; public education on QUM; and a good drug supply system. There was significant correlation between the number of policies implemented out of 22 and the composite QUM score (r = 0.71, r
= 0.50, p < 0.05).
Country situational analyses allowed rapid data collection that showed EM policies are associated with better QUM. SEAR countries should implement all such policies.
Since 1998 the serious public health problem in South East Asia of counterfeit artesunate, containing no or subtherapeutic amounts of the active antimalarial ingredient, has led to deaths from ...untreated malaria, reduced confidence in this vital drug, large economic losses for the legitimate manufacturers, and concerns that artemisinin resistance might be engendered.
With evidence of a deteriorating situation, a group of police, criminal analysts, chemists, palynologists, and health workers collaborated to determine the source of these counterfeits under the auspices of the International Criminal Police Organization (INTERPOL) and the Western Pacific World Health Organization Regional Office. A total of 391 samples of genuine and counterfeit artesunate collected in Vietnam (75), Cambodia (48), Lao PDR (115), Myanmar (Burma) (137) and the Thai/Myanmar border (16), were available for analysis. Sixteen different fake hologram types were identified. High-performance liquid chromatography and/or mass spectrometry confirmed that all specimens thought to be counterfeit (195/391, 49.9%) on the basis of packaging contained no or small quantities of artesunate (up to 12 mg per tablet as opposed to approximately 50 mg per genuine tablet). Chemical analysis demonstrated a wide diversity of wrong active ingredients, including banned pharmaceuticals, such as metamizole, and safrole, a carcinogen, and raw material for manufacture of methylenedioxymethamphetamine ('ecstasy'). Evidence from chemical, mineralogical, biological, and packaging analysis suggested that at least some of the counterfeits were manufactured in southeast People's Republic of China. This evidence prompted the Chinese Government to act quickly against the criminal traders with arrests and seizures.
An international multi-disciplinary group obtained evidence that some of the counterfeit artesunate was manufactured in China, and this prompted a criminal investigation. International cross-disciplinary collaborations may be appropriate in the investigation of other serious counterfeit medicine public health problems elsewhere, but strengthening of international collaborations and forensic and drug regulatory authority capacity will be required.
Friction brake material is important component in the braking system of the vehicles. These materials are usually made of asbestos and non-asbestos materials. Some non-asbestos materials use natural ...fibers as reinforcement and phenolic resin as a binder. The post-curing process is carried out by heating a material with specific temperature and time. During post curing, ammonia gas as the reaction of the phenolic resin and HMTA diffuses out from the friction brake material. The heating rate in post curing was supposed affecting process of removal ammonia gas from composite and it will affect mechanical properties of the composite. Therefore, this paper is concerned with effect of post curing method on the composite flexural strength. Composite specimen were manufactured by mixing the ingredients, preforming, hot molding and followed by post curing. Bending tests performed to determine the effect of post curing the flexural strength. The results showed that heating rate in post curing affected flexural strength of composite. Flexural strength of composite decreased with increasing heating rate. Internal defect that were formed during post curing decreased composite flexural strength.
Explores the scientific basis and practice of drug therapy. This book examines the practice of clinical pharmacology and pharmacotherapy in the developing as well as the developed world. It covers ...general clinical pharmacology, pharmacology of various drug groups and the treatments specific to various diseases.
Purpose
Community-based HIV testing and counselling (HTC) has been recommended for improving access to prevention, care, and treatment services in at-risk populations. Earlier systematic reviews and ...meta-analyses have been undertaken, but due to some methodological limitations, their findings do not yet provide a practical significance. The purpose of this paper is to re-examine the recent evidence of the efficacy of community-based HTC approaches on the uptake of HTC in at-risk populations.
Design/methodology/approach
The database of PubMed online, Science Direct, the Lancet Global Health, the Cochrane Central Register of Controlled Trials, and Google Scholar were systematically searched using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to obtain empirical papers published between March 2013 and December 2015.
Findings
Of 600 collected papers, there were 6 cluster randomized trials papers which met the inclusion criteria. Compared to the health facilities-based HTC, community-based HTC approaches have been shown to improve the uptake of HIV testing from 5.8 to 37 per cent, and improve HIV testing in men and their partners together from 6.8 to 34 per cent. The community approaches also detected lower HIV-positive cases (0.29 per cent as compared to 4 per cent), improved access to treatment services from 0.3 to 25 per cent, demonstrated higher cluster differentiation 4 count in newly diagnosed patients (median of 400-438 cells/µl), and increased the rate of first-time HIV testing from 9 to 11.8 per cent. With respect to social and behavioural outcomes, community-based HTC increased social norms for HIV testing by 6 per cent (95 per cent CI 3-9), decreased multiple sex partners by 55 per cent (95 per cent CI 42-73), lowered casual sex by 45 per cent (95 per cent CI 33-62), increased knowledge about HIV (83.2 vs 28.9 per cent), improved positive attitudes towards HIV patients (73.0 vs 34.3 per cent), and increased the use of condoms (28.0 vs 12.3 per cent).
Originality/value
Community-based HTC combined with behavioural interventions have been found to be more effective in increasing the uptake of HIV testing as well as other outcomes as compared to the conventional health facilities-based testing and counselling approaches.
To achieve universal health care coverage, the Government of China invested in large–scale health care reform. One of the major reform components focuses on improving access to essential medicines to ...reduce high out–of–pocket medicines spending. The reform policies were comprehensive, and included systematic selection of essential medicines to improve availability, centralized procurement and tendering at provincial levels, pricing policies, provision of essential medicines at cost in primary level facilities, and stronger quality and safety standards. While challenges remain, China's system sets an example of a comprehensive approach that other countries could emulate in reforming their health care systems and achieving universal coverage.
Street children's level of knowledge, attitudes, and practice (KAP) regarding sexually transmitted infections (STIs) and HIV-related diseases remains a challenge since it is difficult to reach all ...key populations. This study aims to provide an overview of the findings of STI cases and their association with the KAP of street children in Jakarta and Banten.
We conducted a cross-sectional study on 259 male street children (aged 10 -21 years old). We collected the data through questionnaire interviews, history taking, physical examination, and specimen collection for STI and HIV testing.
5.8% (
= 15) STI cases were discovered, consisting of Hepatitis B (
= 6), Hepatitis C (
= 1), HIV (
= 2), Chlamydia (
= 3), Syphilis (
= 1), and Gonorrhea (
= 1). Buskers (44.4%) and other occupations like helping parents sell their wares, parking lot attendants, shoe shiners, or gathering (44.8%) dominated the sociodemographic characteristics. Condomless sex predominated risky sexual behavior, despite some subjects already having good knowledge.
Sociodemographic characteristics and the KAP of street children in Indonesia are varied. The association between the KAP level and STI cases in street children is challenging to describe. Further studies covering more areas in Indonesia are required.
Purpose
The health belief model (HBM) is the behavioral change theory most widely used in health behavior studies. Several studies have identified the limitations of this model, one of which concerns ...the validity in predicting behavioral changes. The purpose of this paper, scoping review, is to map the validity of HBM variables in predicting behavioral changes based on available synthesized evidences.
Design/methodology/approach
A scoping review was conducted using the Arksey and O’Malley’s framework. PubMed, Health Evidence, Cochrane Database of Systematic Reviews, ScienceDirect and Google Scholar were searched using a combination of keywords: health belief model, review, systematic review and meta-analysis between February 15 and March 18, 2016.
Findings
Of the 1,457 articles, 4 met the inclusion criteria. All results showed that HBM variables were consistently related to behaviors and the strength of the correlation were varied. Perceived barriers and perceived benefits were the strongest predictor, while perceived severity was the weakest. The association between HBM variables and behaviors was moderated by some aspects of behavioral outcomes, the study design and the time interval between measurement of the HBM variables and behavior.
Originality/value
Although the four main variables of HBM have been shown to be related to behavior, the overall outcomes are varied and have not demonstrated conclusive evidence during the last ten years. The results of this scoping review imply the need for a systematic review and meta-analysis of the results of recent studies. In addition, more longitudinal studies are needed to ensure the validity of HBM variables by considering any possible moderators.
The brake block is an important component that serves to slow down and stop the train. The safety of this transportation is very dependent on the reliability of this component. One of the important ...features of the brake block material is the coefficient of friction. The coefficient of friction of the brake block material must meet and match the requirements. The coefficient of friction of a material is measured using a friction test. Previous studies have shown that the friction coefficient of a material is influenced by braking conditions, namely contact pressure and friction speed. Many friction testing methods have been developed to study the characteristics of friction materials. In contrast to previous studies, in this study, the frictional characteristics of gray cast iron brake blocks were evaluated using a reduced scale dynamometer. The friction test is carried out by pressing the brake block specimen to the surface of the rotating wheel. The specimen size of the brake block and carriage wheels is reduced to 1/4 of the original size. The friction test is carried out at a contact pressure of 0.15, 0.20, 0.25, and 0.30 (MPa) and the friction speeds of 3, 6, 9, and 12 (m/s). The results of this study indicate that the coefficient of friction of the gray cast iron brake block decreases with increasing friction speed and contact pressure.
Purpose
Community-based HIV testing and counselling (HTC) has been recommended for improving access to prevention, care, and treatment services in at-risk populations. Earlier systematic reviews and ...meta-analyses have been undertaken, but due to some methodological limitations, their findings do not yet provide a practical significance. The purpose of this paper is to re-examine the recent evidence of the efficacy of community-based HTC approaches on the uptake of HTC in at-risk populations.
Design/methodology/approach
The database of PubMed online, Science Direct, the Lancet Global Health, the Cochrane Central Register of Controlled Trials, and Google Scholar were systematically searched using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to obtain empirical papers published between March 2013 and December 2015.
Findings
Of 600 collected papers, there were 6 cluster randomized trials papers which met the inclusion criteria. Compared to the health facilities-based HTC, community-based HTC approaches have been shown to improve the uptake of HIV testing from 5.8 to 37 per cent, and improve HIV testing in men and their partners together from 6.8 to 34 per cent. The community approaches also detected lower HIV-positive cases (0.29 per cent as compared to 4 per cent), improved access to treatment services from 0.3 to 25 per cent, demonstrated higher cluster differentiation 4 count in newly diagnosed patients (median of 400-438 cells/µl), and increased the rate of first-time HIV testing from 9 to 11.8 per cent. With respect to social and behavioural outcomes, community-based HTC increased social norms for HIV testing by 6 per cent (95 per cent CI 3-9), decreased multiple sex partners by 55 per cent (95 per cent CI 42-73), lowered casual sex by 45 per cent (95 per cent CI 33-62), increased knowledge about HIV (83.2 vs 28.9 per cent), improved positive attitudes towards HIV patients (73.0 vs 34.3 per cent), and increased the use of condoms (28.0 vs 12.3 per cent).
Originality/value
Community-based HTC combined with behavioural interventions have been found to be more effective in increasing the uptake of HIV testing as well as other outcomes as compared to the conventional health facilities-based testing and counselling approaches.
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