Search

Objectives: to evaluate the trends in cesarean sections from 2014 to 2020 across both public and private sectors, utilizing the Robson Classification., Methods: this time series study analyzed the proportion of women who underwent cesarean sections between 2014 and 2020, considering both the Robson classification and the type of healthcare service. Trend analysis was conducted using the Prais-Winsten regression., Results: higher proportions of cesarean sections were observed in all Robson groups within the private sector compared to the public sector. This was despite a decreasing trend in the private sector and an increasing trend in the public sector. Notably, elevated proportions of cesarean sections were recorded in groups that are typically favorable to normal childbirth (Robson 1, 4, and 5)., Conclusions: although there was a decreasing trend in cesarean sections within the private sector, an increasing trend was observed in the public sector. Additionally, there was a high proportion of cesarean sections among women with conditions favorable to normal childbirth. It is crucial to continuously monitor these indicators to evaluate and implement interventions aimed at reducing unnecessary cesarean sections.

Since ride-hailing has become an important travel alternative in many cities worldwide, a fervent debate is underway on whether it competes with or complements public transport services. We use Uber trip data in six cities in the United States and Europe to identify the most attractive public transport alternative for each ride. We then address the following questions: (i) How does ride-hailing travel time and cost compare to the fastest public transport alternative? (ii) What proportion of ride-hailing trips do not have a viable public transport alternative? (iii) How does ride-hailing change overall service accessibility? (iv) What is the relation between demand share and relative competition between the two alternatives? Our findings suggest that the dichotomy-competing with or complementing-is false. Though the vast majority of ride-hailing trips have a viable public transport alternative, between 20% and 40% of them have no viable public transport alternative. The increased service accessibility attributed to the inclusion of ride-hailing is greater in our US cities than in their European counterparts. Demand split is directly related to the relative competitiveness of travel times i.e. when public transport travel times are competitive ride-hailing demand share is low and vice-versa., Competing Interests: SRD is employed by Uber. This does not alter our adherence to PLOS ONE policies on sharing data and materials. This research has not been commissioned by Uber to OC, RK and MY.

Real-time ride-sharing has become popular in recent years. However, the underlying optimization problem for this service is highly complex. One of the most critical challenges when solving the problem is solution quality and computation time, especially in large-scale problems where the number of received requests is huge. In this paper, we rely on an exact solving method to ensure the quality of the solution, while using AI-based techniques to limit the number of requests that we feed to the solver. More precisely, we propose a clustering method based on a new shareability function to put the most shareable trips inside separate clusters. Previous studies only consider Spatio-temporal dependencies to do clustering on the mobility service requests, which is not efficient in finding the shareable trips. Here, we define the shareability function to consider all the different sharing states for each pair of trips. Each cluster is then managed with a proposed heuristic framework in order to solve the matching problem inside each cluster. As the method favors sharing, we present the number of sharing constraints to allow the service to choose the number of shared trips. To validate our proposal, we employ the proposed method on the network of Lyon city in France, with half-million requests in the morning peak from 6 to 10 AM. The results demonstrate that the algorithm can provide high-quality solutions in a short time for large-scale problems. The proposed clustering method can also be used for different mobility service problems such as car-sharing, bike-sharing, etc., Competing Interests: The authors have declared that no competing interests exist.

Private equity has evolved into a major force in health care, with deal values and volumes rising year-over-year as these firms purchase hospital systems and physician groups. Historically, these investors have played an outsized role in highly reimbursed specialties such as dermatology and anesthesia. Private equity is relatively new to women's health; when it has invested in this sector, it has typically done so in fertility services. In recent years, however, private equity firms have ventured into general obstetrics and gynecology, drawn by its promise of steady returns, its fragmented landscape, and the potential to integrate related laboratory, ultrasound, and fertility services into obstetric care. Obstetrics and gynecology practices may soon face the prospect of acquisition by private equity firms offering professional management, centralized back-office functions, streamlined customer service, and the capital needed to reach a broader patient base. However, physicians may have concerns about the tradeoffs that accompany private equity acquisitions. Private equity-owned practices have been known to increase the use of lucrative services, deploy advanced practice professionals in place of physicians, and circumvent conflict-of-interest laws, potentially distorting clinical care and driving up costs for consumers. Furthermore, firms generally aim to exit their investment within a 3- to 7-year timeframe, and short-term growth plans may leave physician-owners with uncertain long-term management. As private equity makes headway into women's health, physicians and policymakers must pay closer attention to how this activity can change practice patterns and transform local health care markets while also demanding transparency in the process.

Background: Different forms of public/private mix have become a central mode of the privatization of healthcare, in both financing and provision. The present article compares the processes of these public/private amalgams in healthcare in Spain and Israel in order to better understand current developments in the privatization of healthcare., Main Text: While in both Spain and Israel combinations between the public and the private sectors have become the main forms of privatization, the concrete institutional forms differ. In Spain, these institutional forms maintain relatively clear boundaries between the private and the public sectors. In Israel, the main forms of public/private mix have blurred such boundaries: nonprofit health funds sell private insurance; public nonprofit health funds own private for-profit hospitals; and public hospitals sell private services., Conclusions: Comparison of the processes of privatization of healthcare in Spain and Israel shows their variegated characters. It reveals the active role played by national and regional state apparatuses as initiators and supporters of healthcare reforms that have adopted different forms of public/private mix. While in Israel, until recently, these processes have been perceived as mainly technical, in Spain they have created deep political rifts within both the medical community and the public. The present article contains lessons each country can learn from the other, to be adapted in each one's local context: The failure of the Alzira model in Spain warns us of the problems of for-profit HMOs and the Israeli private private/public mix shows the risk of eroding trust in the public system, thus reinforcing market failures and inefficient medical systems.

Introduction: The health care consumption for the population insured by the Basic Health Insurance in Morocco are paid directly to the care providers for the health care or health products from the health insurance funds. The level of expenditure recorded is changing at an accelerated rate than the financial resources. The objective of this study is to evaluate the health care consumption care by the insured population under the Basic Health Insurance., Methods: This is a cross-sectional study analysis of the economic data collected by the National Moroccan Health Insurance Agency Related to the expenditures from the health insurance fund for both public and private sectors to identify the behavior of the consumption of health care by the insured population under the Basic Health Insurance., Results: The medical expenditure of the covered population by the basic Health Insurance in Morocco has almost doubled from 354800 to 652500 US Dollars between 2009 and 2014 with significant increase in the public sector than the private sector. The share of expenditures in the public ambulatory care sector under Basic Health Insurance is higher relative to the hospital care. Although in the private sector the share of expenditures for both types of care varies. In 2014, the drug item expenditure accounted for 33% of Health Insurance expenses for both sectors. The level of health care consumption among the population in Long-Term Illness (LTI) represents 49,29% of the total expenditure by the Health Insurance whereas its insured covered population does not exceed 2,78%., Conclusion: Controlling the medical expenditure of the health insurance requires strengthening and the development of regulatory measures that contribute to the health reforms. For chronic diseases, it is necessary to put in place prevention actions., Competing Interests: The authors declare no competing of interest., (© Amal Yassine et al.)

Objectives: to analyze lawsuits brought by beneficiaries of health insurance operators., Methods: this was a cross-sectional descriptive study carried out in a large-capacity private health insurance operator using data collected by the company from 2012 to 2015., Results: ninety-six lawsuits were brought by 86 beneficiaries regarding medical procedures (38.5%), treatments (26.1%), examinations (14.6%), medications (9.4%), home care (6.2%), and other types of hospitalization (5.2%). The procedures with the highest number of lawsuits were percutaneous rhizotomy; chemotherapy; treatment-related positron-emission tomography scans; and for medications relative to antineoplastic and Hepatitis C treatment., Conclusions: the lawsuits were filed because of the operators' refusal to comply with items not established in contracts or not regulated and authorized by the Brazilian National Regulatory Agency for Private Health Insurance and Plans, refusals considered unfounded.

Purpose: To identify temporal and geographic trends in private equity (PE)-backed acquisitions of ophthalmology and optometry practices in the United States., Design: A cross-sectional study using private equity acquisition and investment data from January 1, 2012, through October 20, 2019., Participants: A total of 228 PE acquisitions of ophthalmology and optometry practices in the United States between 2012 and 2019., Methods: Acquisition and financial investment data were compiled from 6 financial databases, 4 industry news outlets, and publicly available press releases from PE firms or platform companies., Main Outcome Measures: Yearly trends in ophthalmology and optometry acquisitions, including number of total acquisitions, clinical locations, and providers of acquired practices as well as subsequent sales, median holding period, geographic footprint, and financing status of each platform company., Results: A total of 228 practices associated with 1466 clinical locations and 2146 ophthalmologists or optometrists were acquired by 29 PE-backed platform companies. Of these acquisitions, 127, 9, and 92 were comprehensive or multispecialty, retina, and optometry practices, respectively. Acquisitions increased rapidly between 2012 and 2019: 42 practices were acquired between 2012 and 2016 compared to 186 from 2017 through 2019. Financing rounds of platform companies paralleled temporal acquisition trends. Three platform companies, comprising 60% of platforms formed before 2016, were subsequently sold or recapitalized to new PE investors by the end of this study period with a median holding period of 3.5 years. In terms of geographic distribution, acquisitions occurred in 40 states with most PE firms developing multistate platform companies. New York and California were the 2 states with the greatest number of PE acquisitions with 22 and 19, respectively., Conclusions: Private equity-backed acquisitions of ophthalmology and optometry practices have increased rapidly since 2012, with some platform companies having already been sold or recapitalized to new investors. Additionally, private equity-backed platform companies have developed both regionally focused and multistate models of add-on acquisitions. Future research should assess the impact of PE investment on patient, provider, and practice metrics, including health outcomes, expenditures, procedural volume, and staff employment., (Copyright © 2020 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Background: Egypt has achieved important reductions in maternal and neonatal mortality and experienced increases in the proportion of births attended by skilled professionals. However, substandard care has been highlighted as one of the avoidable causes behind persisting maternal deaths. This paper describes changes over time in the use of childbirth care in Egypt, focusing on location and sector of provision (public versus private) and the content of immediate postpartum care., Methods: We used five Demographic and Health Surveys conducted in Egypt between 1995 and 2014 to explore national and regional trends in childbirth care. To assess content of care in 2014, we calculated the caesarean section rate and the percentage of women delivering in a facility who reported receiving four components of immediate postpartum care for themselves and their newborn., Results: Between 1995 and 2014, the percentage of women delivering in health facilities increased from 35 to 87% and women delivering with a skilled birth attendant from 49 to 92%. The percentage of women delivering in a private facility nearly quadrupled from 16 to 63%. In 2010-2014, fewer than 2% of women delivering in public or private facilities received all four immediate postpartum care components measured., Conclusions: Egypt achieved large increases in the percentage of women delivering in facilities and with skilled birth attendants. However, most women and newborns did not receive essential elements of high quality immediate postpartum care. The large shift to private facilities may highlight failures of public providers to meet women's expectations. Additionally, the content (quality) of childbirth care needs to improve in both sectors. Immediate action is required to understand and address the drivers of poor quality, including insufficient resources, perverse incentives, poor compliance and enforcement of existing standards, and providers' behaviours moving between private and public sectors. Otherwise, Egypt risks undermining the benefits of high coverage because of substandard quality childbirth care.

Objective: To characterize the available support for infertility treatment and populations served by private foundations across the United States., Design: Web-based cross-sectional survey., Setting: Not applicable., Patient(s): Not applicable., Intervention(s): None., Main Outcome Measure(s): Geographies and populations served, dollar-amount and scope of financial assistance provided by private foundations for individuals seeking financial assistance for infertility treatment., Result(s): Thirty-seven private foundations were identified, 25 responded (68% response rate). More than one-half of the foundations had awarded grants to lesbian, gay, and transgender individuals, as well as single men and women. Forty percent of the foundations serve only a single state or geographic region. Foundations have provided 9,996 grants for infertility treatment, 1,740 in 2016 alone, with an average value of $8,191 per grant. The Livestrong foundation has provide more than 90% of these grants, and only to patients with a history of cancer. Twelve percent of foundations provide assistance for fertility preservation in patients with cancer, and 20% provide assistance for elective oocyte cryopreservation., Conclusion(s): Private foundations significantly increase access to infertility care for individuals and couples affected by cancer who could otherwise not afford treatment. Significant heterogeneity exists regarding the populations served and the services available for grant support by these foundations, and the landscape of options for patients unaffected by cancer is severely limited., (Copyright © 2019 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

We examined the growth in health spending on people with employer-sponsored private insurance in the period 2007-14. Our analysis relied on information from the Health Care Cost Institute data set, which includes insurance claims from Aetna, Humana, and UnitedHealthcare. In the study period private health spending per enrollee grew 16.9 percent, while growth in Medicare spending per fee-for-service beneficiary decreased 1.2 percent. There was substantial variation in private spending growth rates across hospital referral regions (HRRs): Spending in HRRs in the tenth percentile of private spending growth grew at 0.22 percent per year, while HRRs in the ninetieth percentile experienced 3.45 percent growth per year. The correlation between the growth in HRR-level private health spending and growth in fee-for-service Medicare spending in the study period was only 0.211. The low correlation across HRRs suggests that different factors may be driving the growth in spending on the two populations.

Objective: This study describes patterns of medication prescriptions for sarcoidosis patients in a large commercially insured U.S. population, with specific focus on prescribing practices across medical specialties and their associated hospitalization risk., Methods: Using the Marketscan Database we selected adult patients with a diagnosis of sarcoidosis by ICD-9 code during the 2012 calendar year. Differences in prescribing practices were evaluated between provider types. A multivariate model controlling for age, sex, and region assessed hospitalization risk associated with provider type, prednisone dose, and use of non-steroid sarcoidosis medications., Results: Using the described criteria, 11,042 total patients were identified. A majority were female, mean age 49.3 years. Of these, 1,792 (16.2%) had one or more hospital admissions (mean 1.6, SD 1.3) with a mean length of stay of 8.1 days (SD 14.5). 25.5% of patients were prescribed prednisone with a 1 year mean cumulative dose of 250mg. Pulmonary/Rheumatology providers prescribed the highest cumulative prednisone dose (961 mg) and were more likely to prescribe methotrexate and monoclonal antibody medications. Sarcoidosis patients receiving a cumulative prednisone dose >500 mg had an increased risk for hospitalization (OR 2.512, 2.210-2.855), while those prescribed methotrexate and azathioprine had decreased risk (OR 0.633, 0.481-0.833 and 0.460, 0.315-0.671). Monoclonal antibody use was associated with increased OR for hospitalization at 1.359., Conclusion: Sarcoidosis patients treated by subspecialists were more likely to receive higher doses of prednisone and non-steroid sarcoidosis medications. Higher doses of prednisone and monoclonal antibody use were associated with higher hospitalization risk while methotrexate and azathioprine were associated with lower hospitalization risk., (Copyright: © 2019.)

Background: Medicaid expansion among previously uninsured individuals has led to improved healthcare access. However, considerably lower reimbursement rates of Medicaid have raised concerns on the unintended consequence of lower utilization of life-saving therapies and inferior outcomes compared with private insurance. We examined the rates of revascularization and in-hospital mortality among Medicaid beneficiaries versus privately insured individuals hospitalized with ST-segment-elevation myocardial infarction (STEMI)., Methods and Results: We queried the National Inpatient Sample from 2012 to 2015 for STEMI hospitalizations with Medicaid or private insurance as primary payer. Hospitalizations with the following criteria were excluded: (1) age <18 or ≥65 years, (2) transfer to another acute care facility, and (3) left against medical advice. Outcomes were compared in propensity score-matched cohort based on demographics, socioeconomic status (income based), clinical comorbidities, including drug and alcohol use, STEMI acuity (cardiac arrest and cardiogenic shock), and hospital characteristics. A total of 42 645 and 171 545 STEMI hospitalizations were identified as having Medicaid and private insurance, respectively. In unadjusted analyses, Medicaid beneficiaries with STEMI had lower rates of coronary revascularization (88.9% versus 92.3%; odds ratio, 0.67; 95% CI, 0.65-0.70) and higher rates of in-hospital mortality (4.9% versus 2.8%; odds ratio, 1.81; 95% CI, 1.72-1.91) compared with privately insured individuals ( P<0.001 for both). In propensity-matched cohort of 40 870 hospitalizations per group, similar results for lower rates of revascularization (89.1% versus 91.1%; odds ratio, 0.80; 95% CI, 0.76-0.84) and higher in-hospital mortality (4.9% versus 3.7%; odds ratio, 1.35; 95% CI, 1.26-1.45) were observed in Medicaid compared with private insurance, despite extensive matching ( P<0.001 for both)., Conclusions: Medicaid beneficiaries with STEMI had lower rates of revascularization, although small absolute difference, and higher in-hospital mortality compared with privately insured individuals. Further studies are needed to identify and understand the variation in STEMI outcomes by insurance status.

Alarming data on the part of health care providers on the increase of the claim rate and its potential risk has emerged. It is a descriptive study, with the objective of understanding the changes in the healthcare provider sector in recent years, using the temporal analysis of historical series related to the sector. The variables selected for this study were the claim rate, the coverage rate, and the number of private healthcare providers in activity, observed from 2003 to 2014. The method used for evaluation of the temporal trend was Linear Regression. The claim rate and the coverage rate show an upward trend in the period, while the number of operators in Brazil showed a decreasing trend during the same period. These results show that even with the increase in demand, there was a decrease in the number of operators active in the country. The claim rate is one of the possible causes observed this inverse relationship because the increased offers risks of survival and the opening of new operators. Moreover, the decrease in the number of providers, is leading the country to an oligopolistic industry with an increasing demand in the number of beneficiaries. This decrease is also associated with regulatory processes, which regulates the sector's relationship with the beneficiary.

Aim: Angina pectoris continues to affect multitudes of people around the world. In this study the management of stable angina pectoris in private healthcare settings in South Africa (SA) was investigated. In particular, we reviewed the frequency of medical versus surgical interventions when used as first-line therapy., Methods: This was a retrospective inferential study carried out using records of patients in private healthcare settings. All cases that were authorised for reimbursement by medical aid schemes for revascularisation between 2009 and 2014 were retrieved and a database was created. Data were analysed using Microsoft ® Excel and GraphPad Prism ® version 5. The differences (where applicable) were considered statistically significant if the p -value was ≤ 0.05., Results: Nine hundred and twenty-two patients, consisting of 585 males (average age 64.7 years; SD 12.9) and 337 females (average age 65.5 years; SD 14.3), met the inclusion criteria. One hundred and seventy-eighty or 54%, 156 (43%) and 86 (63%) patients with hypertension, hyperlipidaemia and diabetes, respectively, were treated with surgery only. For these patients, percutaneous coronary interventions (PCIs) were significantly ( p < 0.0001) preferred first-line interventions over optimal medical therapy (OMT). Four hundred and thirty-six or 47% of all patients studied were managed with surgery only, while only 25% (227) were managed with OMT. It took 60 months (five years) for patients who were treated with OMT before their first surgical intervention(s) to require the second revascularisation. About 71% of patients who received medical therapy were placed on only one drug, the so called sub-optimal medical therapy (SOMT)., Conclusions: The management of stable angina pectoris in private healthcare settings in SA is skewed towards surgical interventions as opposed to OMT. This is contrary to what consistent scientific evidence and international treatment guidelines suggest.

Purpose of Review: The purpose of this study was to review public and private sector obesity policies in Canada and to make recommendations for future evidence-based obesity prevention and management strategies., Recent Findings: Synthesis of obesity prevention and management policies and research studies are presented in three primary themes: (1) Increased awareness about the impact of weight bias and obesity stigma in Canada; (2) Inadequate government obesity prevention and management policies and strategies; and (3) Lack of comprehensive private sector obesity prevention and management policies. Findings suggest that in Canada, obesity continues to be treated as a self-inflicted risk factor, which affects the type of interventions and approaches that are implemented by governments or covered by private health plans. The lack of recognition of obesity as a chronic disease by Canadian public and private payers, health systems, employers, and the public, has a trickle-down effect on access to evidence-based prevention and treatment. Although there is increasing recognition and awareness about the impact of weight bias and obesity stigma on the health and social well-being of Canadians, interventions are urgently needed in education, healthcare, and public policy sectors. We conclude by making recommendations for the advancement of evidence-based obesity prevention and management policies that can improve the lives of Canadians affected by obesity.

Significant changes have been witnessed in the Brazilian health system over the last 30 years. This article outlines trends in outpatient and hospital care, staffing, and health service use during this period. There was a significant expansion of the public health network, particularly of primary care services, leading to improved access to consultations and a reduction in hospital admissions. However, there is a persistent shortage of health professionals in Brazil's public health system, particularly dentists. Despite improvements in coverage, the public system continues to face serious challenges, particularly with respect to funding, service provision, and its relationship with the private sector.

Background: Health insurance coverage changes for many patients after liver transplantation, but the implications of this change on long-term outcomes are unclear., Aims: To assess post-transplant patient and graft survival according to change in insurance coverage within 1 year of transplantation., Methods: We queried the United Network for Organ Sharing for patients between ages 18-64 years undergoing liver transplantation in 2002-2016. Patients surviving > 1 year were categorized by insurance coverage at transplantation and the 1-year transplant anniversary. Multivariable Cox regression characterized the association between coverage pattern and long-term patient or graft survival., Results: Among 34,487 patients in the analysis, insurance coverage patterns included continuous private coverage (58%), continuous public coverage (29%), private to public transition (8%) and public to private transition (4%). In multivariable analysis of patient survival, continuous public insurance (HR 1.29, CI 1.22, 1.37, p < 0.001), private to public transition (HR 1.17, CI 1.07, 1.28, p < 0.001), and public to private transition (HR 1.14, CI 1.00, 1.29, p = 0.044), were associated with greater mortality hazard, compared to continuous private coverage. After disaggregating public coverage by source, mortality hazard was highest for patients transitioning from private insurance to Medicaid (HR vs. continuous private coverage = 1.32; 95% CI 1.14, 1.52; p < 0.001). Similar differences by insurance category were found for death-censored graft failure., Conclusion: Post-transplant transition to public insurance coverage is associated with higher risk of adverse outcomes when compared to retaining private coverage.

The paper specifically looks at the rural-urban interaction and contribution of various entities or agents to the total employment in China, rural China, and urban China. The study concentrated on the total employment after 1978 reforms. The paper looked at the 1978-2004 reform and after 2004 reform. It was revealed that 1978-2004 reform hindered the flow of labor from rural to urban but after 2004 reform promoted the flow of labor force from rural to urban China the development, which resulted in a drastic reduction in the rural labor force. Before the reforms, state- and collective-owned units were the only entities that were employing people in China. Even though private enterprises were allowed after the reforms, the leading role of the state- and collective-owned units persist. State-owned units contribute immensely to the total employment in China and urban employment, but its contribution to employment in rural China is negative. Collective-owned and cooperative units show a positive contribution to employment in rural areas but its contribution to the total employment in China is negative. Units with funds from Hong Kong, Macao, and Taiwan and rural private enterprises also contribute positively to total employment in China. Cooperative units, joint holding corporations Ltd., foreign-funded units, and rural self-employed individuals contribute negatively to the total employment in China. Collective-owned and cooperative units contribute negatively to employment in the urban areas. Urban and rural private enterprises and rural self-employed individuals contribute positively to urban employment.

Background: The continued rise in caesarean section (c-section) deliveries raises a major public health concern worldwide. This study assessed the trend of c-section deliveries and examined factors associated with a rise in c-section deliveries among the Egyptian mothers, from 2005 to 2014, by place of delivery., Methods: This study utilized the 2005, 2008, and 2014 Egypt Demographic and Health Surveys (EDHS). The EDHS reported on the mode of delivery for the last birth occurred within five years preceding each survey including place of delivery and sociodemographic information for a total sample of over 29,000 mothers in the three surveys. To document trend of c-section, the EDHS-2005 was set as a reference in two binary logistic regression models; among all mothers together and for mothers stratified by place of delivery (public or private). P-value for the trend was assessed by entering the year of the survey as a continuous variable. The study followed STROBE statement in reporting observational studies., Results: Institutional-based c-sections increased by 40.7 points from EDHS-2005 to EDHS-2014 (aOR, 3.46, 95%CI: 3.15-3.80, P trend  < 0.001). Compared to mothers with low socioeconomic status (SES), mothers with high SES had higher odds (aOR, 1.78, 95%CI: 1.25-2.54, P = 0.001) for c-section, but only in EDHS-2005. The adjusted trend of c-sections was found to be 4.19-time (95%CI: 3.73-4.70, P < 0.001) higher in private sector while that in public sector it was 2.67-time (95%CI: 2.27-3.13, P = 0.001) higher, in EDHS-2014 relative to EDHS-2005. This increase in the private sector is explained by significant increases among mothers who are potentially at low risk for c-sections; mothers aged 19-24 years vs. ≥35 years (aOR: 0.31, 95%CI: 0.21-0.45, in EDHS-2005 vs. 0.43, 95%CI: 0.33-0.56, in EDHS-2014, P < 0.001); primigravida mothers vs. mothers with ≥4 children (aOR: 1.62, 95%CI: 1.12-2.34, in EDHS-2005 vs. 3.76, 95%CI: 2.94-4.80 in EDHS-2014); and among normal compared to high risk birth weight babies (aOR: 0.79, 95%CI: 0.62-0.99 in EDHS-2005 P < 0.05 vs. 0.83, 95%CI: 0.65-1.04 in EDHS-2014, P > 0.05)., Conclusions: Results showed a steady rise in c-sections in Egypt that has reached an alarming level in recent years. This increase appears to be associated with a shift towards delivery in private health care facilities. More vigilance of c-section deliveries, particularly in the private sector, is warranted.

Objective: To describe the increasing number of pharmacy schools in Jordan., Method: A review for numbers of schools and their curricula was conducted., Key Findings: To date, there are 18 pharmacy schools in Jordan. PharmD program is offered by two public schools. PhD program is offered by one school; while MSc program is offered by seven schools. Public pharmacy schools have two similar programs in terms of curricula, 'regular' and 'parallel'. The ratio of pharmacists to 1000 population was 2.1 in 2012. Substantial increase in pharmacists' integration is needed in public and private primary care settings., Conclusions: Number of pharmacy schools and pharmacy graduates in Jordan seems to be 'high'. If the schools are to remain on a track of growth, let the emphasis shift to PharmD expansion., (© 2017 Royal Pharmaceutical Society.)

Objective: To investigate intergenerational equity in consumption using the Australian National Transfer Accounts (NTA)., Methods: Australian NTA estimates of consumption were used to investigate disparities in consumption between people of different ages and generations in Australia between 1981-1982 and 2009-2010., Results: There is a clear patterning of consumption by age, with the distribution by age of consumption funded by the private sector being very different to that of consumption funded by the public sector. Australians have achieved notable equality in total consumption among people between the ages of 20 and 75 years. Substantial disparities exist, however, between different generations, with earlier generations experiencing lower levels of total consumption in real terms at particular ages than later generations., Conclusion: An accurate picture of intergenerational equity in consumption requires consideration of both cohorts and cross sections, as well as consumption funded by both the public and the private sectors., (© 2017 AJA Inc.)

Objective: To illustrate the use of National Transfer Accounts (NTA) for understanding ageing and the economic life cycle in Australia., Methods: The NTA methodology is applied utilising a range of unit record, demographic and administrative data sets from 1981 to 2010., Results: During early and later life, total consumption (public and private) is greater than labour income. On a time series and cohort basis, we show that each successive generation has improved their level of well-being (as measured by consumption) relative to the previous years or previous cohorts from 1981 to 1982 onwards. We also show a substantial increase in labour income earned by mature age workers over this period. International comparisons show Australia to have consumption and labour income age profiles very similar to those of Canada but dissimilar to many other countries, driven by differences in demographic and policy settings., Conclusion: The NTA approach provides a powerful framework to track differences in the economic life cycle across age groups, across time, across cohorts and across countries., (© 2017 AJA Inc.)

Background: Low-density lipoprotein cholesterol (LDL-C) control is higher among insured than uninsured adults, but data on time trends and contributing factors are incomplete and important for improving health equity., Methods and Results: Awareness, treatment, and control of elevated LDL-C were compared among insured versus uninsured and publicly versus privately insured adults, aged 21 to 64 years, in National Health and Nutrition Examination Surveys from 2001 to 2004, 2005 to 2008, and 2009 to 2012 using Adult Treatment Panel-3 criteria. Compared with insured adults, uninsured adults were younger; were more often minority; reported lower incomes, less education, and fewer healthcare encounters; and had lower awareness and treatment of elevated LDL-C ( P <0.0001). LDL-C control was higher among insured than uninsured adults in 2001 to 2004 (mean±SEM, 21.4±1.6% versus 10.5±2.6%; P <0.01), and the gap widened by 2009 to 2012 (35.1±1.9% versus 11.3±2.2%; P <0.0001). Despite more minorities ( P <0.01), greater poverty, and less education ( P <0.001), publicly insured adults had more healthcare visits/year than privately insured adults ( P <0.001) and similar awareness, treatment, and control of LDL-C from 2001 to 2012. In multivariable logistic regression, significant positive predictors of cholesterol awareness, treatment, and control included more frequent health care (strongest), increasing age, private healthcare insurance versus uninsured, and hypertension. Public insurance (versus uninsured) was a significant positive predictor of LDL-C control, whereas income <200% versus ≥200% of federal poverty was a significant negative predictor., Conclusions: LDL-C control improved similarly over time in publicly and privately insured adults but was stagnant among the uninsured. Healthcare insurance largely addresses socioeconomic barriers to effective LDL-C management, yet poverty retains an independent adverse effect., (© 2017 The Authors and Clinical Directors Network, Inc. Published on behalf of the American Heart Association, Inc., by Wiley.)

Changes in demographic and sociocultural environment, improved health awareness, and information technology have considerably changed the outlook of healthcare sector in India. While both the public and the private healthcare sectors have priority of increasing access while minimizing costs, they try hard to achieve goals without letting the quality suffer. Customers with rising disposable income no longer have faith in the public healthcare system and are willing to migrate to the private healthcare sector, which is more professional, technology savvy, and trustworthy. However, there are enough loopholes in the private healthcare sector that are yet to be plugged. The purpose of this research study was to identify and assess the relative importance of the diverse service quality dimensions and prioritize them to draw meaningful conclusions. Survey responses from 370 customers were analyzed using factor analysis to find underlying relationships between the survey items. This allowed the individual items to be placed into related groups. Independently, a ridit analysis was conducted to determine the relative importance of each item to the survey respondents. Based on the ridit analysis a priority ranking was assigned to each item. An analysis was then undertaken of the degree to which the items grouped into each particular factor tended to have high or low priority rankings. The results of the study may be helpful to the managers of the private healthcare sector to focus their strategies and plan their efforts in line with the findings to gain superior customer satisfaction and retention.

Background: The South African Renal Registry (SARR) was re-established in 2010. The first report was produced in 2014. It revealed that only 3182 patients out of 43.6 million people who were dependent on the state for medical care, received renal replacement therapy (RRT) in 2012 (73 per million population)., Aim: To describe the state of RRT for children in South Africa in 2012., Methods: From the SARR report and 2012 dataset, a cross-sectional study was performed of children under 14 years of age who received chronic dialysis, and incident renal transplants in 2012. Patient demographics, treatment modalities and outcome were recorded and RRT rates computed., Results: Fifty-nine children received dialysis in South Africa in 2012, a rate of 3.8 per million age-related population (pmarp). The mean age was 9 years 11 months. The most common cause of end stage renal failure (ESRF) was acquired glomerular disorders (83%). Ninety percent of the children received treatment in two of the nine provinces. Six children (10%) were treated in the only private dialysis unit. Eleven patients received kidney transplants (19%): six private and five public sector patients. Sixteen patients (27.1%) died: seven due to cardiovascular and three due to cerebrovascular events., Conclusion: There was a low RRT rate of 3.8 pmarp for children in South Africa in 2012. Private sector patients were likely to receive more optimal treatment. The poor performance of the state health sector can largely be ascribed to a deficiency of funding for RRT facilities and trained personnel., (© 2016 Asian Pacific Society of Nephrology.)

Advances in genetic testing and the aggressive marketing of genetic tests by commercial diagnostic laboratories have driven both consumer demand and the need for unbiased information about how tests should guide healthcare delivery. This paper uses the countervailing powers framework to explore the role of state public health agencies as arbiters of quality and safety, specifically through their efforts to encourage physicians to follow evidence-based recommendations for screening for hereditary cancers. Social scientists have often viewed actions by the state to regulate cost, quality, or safety as a threat to physician autonomy. This paper draws on case studies from two US states-Michigan and Connecticut-to better understand the specific role of state public health agencies, and especially whether their activities to encourage adherence to evidence-based recommendations bolster or subvert the interests of other parties in the healthcare arena. We find that lacking authority to compel provider to follow evidence-based recommendations, they improvised ways to foster compliance voluntarily, for example, by emphasizing the role of the physician as gatekeeper, thus affirming the importance of physician autonomy and clinical judgment. Both states also used public health surveillance data to make rare diseases visible and illustrate gaps between recommendations and practice. Finally, they both showed that following evidence-based recommendations could align the professional and market interests of healthcare stakeholders. Both states employed similar strategies with similar effects, despite substantial differences in the regulatory climate and organizational capacity. Taken as a whole, their activities orchestrated a countervailing response that checked the profit-seeking motives of commercial laboratories. Our findings demonstrate that rather than eroding physician autonomy, state action to monitor healthcare quality and encourage adherence to evidence-based recommendations can actually reinforce physician authority., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background: The World Health Organization guidelines have recommended that all cases of suspected malaria should receive a confirmatory test with microscopy or a malaria rapid diagnostic test (RDT), however evidence from sub-Saharan Africa (SSA) illustrates that only one-third of children under five with a recent fever received a test. The aim of this study was to evaluate availability, price and market share of microscopy and RDT from 2009/11 to 2014/15 in 8 SSA countries, to better understand barriers to improving access to malaria confirmatory testing in the public and private health sectors., Results: Repeated national cross-sectional quantitative surveys were conducted among a sample of outlets stocking anti-malarial medicines and/or diagnostics. In total, 169,655 outlets were screened. Availability of malaria blood testing among all screened public health facilities increased significantly between the first survey wave in 2009/11 and the most recent in 2014/15 in Benin (36.2, 85.4%, p < 0.001), Kenya (53.8, 93.0%, p < 0.001), mainland Tanzania (46.9, 89.9%, p < 0.001), Nigeria (28.5, 86.2%, p < 0.001), Katanga, the Democratic Republic of the Congo (DRC) (76.0, 88.2%, p < 0.05), and Uganda (38.9, 95.6%, p < 0.001). These findings were attributed to an increase in availability of RDTs. Diagnostic availability remained high in Kinshasa (the DRC) (87.6, 97.6%) and Zambia (87.9, 91.6%). Testing availability in public health facilities significantly decreased in Madagascar (88.1, 73.1%, p < 0.01). In the most recent survey round, the majority of malaria testing was performed in the public sector in Zambia (90.9%), Benin (90.3%), Madagascar (84.5%), Katanga (74.3%), mainland Tanzania (73.5%), Uganda (71.8%), Nigeria (68.4%), Kenya (53.2%) and Kinshasa (51.9%). In the anti-malarial stocking private sector, significant increases in availability of diagnostic tests among private for-profit facilities were observed between the first and final survey rounds in Kinshasa (82.1, 94.0%, p < 0.05), Nigeria (37.0, 66.0%, p < 0.05), Kenya (52.8, 74.3%, p < 0.001), mainland Tanzania (66.8, 93.5%, p < 0.01), Uganda (47.1, 70.1%, p < 0.001), and Madagascar (14.5, 45.0%, p < 0.01). Blood testing availability remained low over time among anti-malarial stocking private health facilities in Benin (33.1, 20.7%), and high over time in Zambia (94.4, 87.5%), with evidence of falls in availability in Katanga (72.7, 55.6%, p < 0.05). Availability among anti-malarial stocking pharmacies and drug stores-which are the most common source of anti-malarial medicines-was rare in all settings, and highest in Uganda in 2015 (21.5%). Median private sector price of RDT for a child was equal to the price of pre-packaged quality-assured artemisinin-based combination therapy (QAACT) treatment for a two-year old child in some countries, and 1.5-2.5 times higher in others. Median private sector QAACT price for an adult varied from having parity with an RDT for an adult to being up to 2 times more expensive. The exception was in both Kinshasa and Katanga, where the median price of QAACT was less expensive than RDTs., Conclusions: Significant strides have been made in the availability of testing, mainly through the widespread distribution of RDT, and especially in public health facilities. Significant barriers to universal coverage of diagnostic testing can be attributed to very low availability in the private sector, particularly among pharmacies and drug stores, which are responsible for most anti-malarial distribution. Where tests are available, price may serve as a barrier to uptake, particularly for young children. Several initiatives that have introduced RDT into the private sector can be modified and expanded as a means to close this gap in malaria testing availability and promote universal diagnosis.

Background: Pakistan, being a developing country, presents the dismal picture of maternal and neonatal mortality and morbidity. The majority of maternal and neonatal deaths could be avoided if Continuum of Care (CoC) is provided in a structured pathway from pregnancy to birth and to the first week of life of the newborn child. This study aimed to analyse the trends of CoC at all three levels (antenatal care, skilled delivery and postpartum care) and to identify various factors affecting the continuation in receiving CoC in Pakistan during 2006 to 2012., Methods: Secondary data analysis was performed on nationally representative data from the last two iterations of Pakistan Demographic and Health Survey (PDHS), conducted during 2006/07 to 2012/13. The analysis is limited to women of the reproductive age group (15-49 years) who gave birth during the last five years preceding both surveys. This leads to a sample size of 5,724 and 7,461 respondents from PDHS 2006/07 and 2012/13 respectively. The association between CoC and several factors, including individual attributes (reproductive status), family influences, community context, as well as cultural and social values was assessed in bivariate analyses in a first step. Furthermore, odds ratios and adjusted odds ratios with 95% confidence intervals using a binary and multivariable logistic regression were calculated., Results: Our research presents the trends of a composite measure of CoC including antenatal care, delivery assistance and postpartum care. The largest gap in CoC was observed at antenatal care followed by delivery and postnatal care within 48 h after delivery. Results show that CoC completion rate has increased from 15% to 27% amongst women in Pakistan over time from 2006 to 2012. Women with high age at first birth, having less number of children, with higher education, belonging to richest quintile, living in Sindh province and urban areas, having high autonomy and exposure to mass media were most likely to avail complete CoC., Conclusions: The findings show that women in Pakistan still lack the CoC. This calls for attention to develop and implement tailored interventions, focusing on the needs of women in Pakistan to provide CoC in an integrated manner, involving both public and private sectors by appropriately addressing the factors hindering CoC completion rates.

Purpose: To characterize the first 10 years of intravitreal anti-vascular endothelial growth factor (VEGF) medication use for ophthalmic disease, including bevacizumab, ranibizumab, and aflibercept., Design: A retrospective cohort study using administrative claims data from January 1, 2006 to December 31, 2015., Subjects: Total of 124 835 patients 18 years of age or over in the United States., Methods: OptumLabs Data Warehouse, which includes administrative claims data for over 100 million commercially insured and Medicare Advantage individuals, was used to identify patients receiving intravitreal anti-VEGF injections based on Current Procedural Terminology codes., Main Outcome Measures: Total and annual numbers of intravitreal anti-VEGF injections, as well as injections per 1000 enrolled patients per general category of ophthalmic disease, overall and for each available medication., Results: There were 959 945 anti-VEGF injections among 124 835 patients from 2006 to 2015. Among all injections, 64.6% were of bevacizumab, 22.0% ranibizumab, and 13.4% aflibercept; 62.7% were performed to treat age-related macular degeneration (AMD), 16.1% to treat diabetic retinal diseases (including 0.9% of all injections that were for proliferative diabetic retinopathy), 8.3% to treat retinal vein occlusions, and 12.9% for all other uses. Use of bevacizumab and ranibizumab for AMD plateaued as of 2011/2012 and decreased thereafter (in 2006, 58.8 and 35.3 injections/1000 AMD patients, respectively; in 2015, 294.4 and 100.7 injections/1000), whereas use of aflibercept increased (1.1 injections/1000 AMD patients in 2011 to 183.0 injections/1000 in 2015). Bevacizumab use increased each year for diabetic retinal disease (2.4 injections/1000 patients with diabetic retinal disease in 2009 to 13.6 per 1000 in 2015) while that of ranibizumab initially increased significantly and then declined after 2014 (0.1 in 2009 to 4.0 in 2015). Aflibercept use increased each year in patients with diabetic retinal diseases and retinal vein occlusions (both <0.1 per 1000 retinal vein occlusion patients in 2011, 5.6 and 140.2 in 2015)., Conclusions: Intravitreal injections of anti-VEGF medications increased annually from 2006 to 2015. Bevacizumab was the most common medication used, despite its lacking U.S. Food and Drug Administration approval to treat ophthalmic disease, and AMD was the most common condition treated. Ranibizumab use declined after 2014 while both the absolute and relative use of bevacizumab and aflibercept increased., (Copyright © 2016 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

In a context of economic difficulties, the Tunisian government is required to find solutions to meet the expectations of the population. Health sector is one of the critical areas requiring radical reform. The objective of this paper is to find the place of public private partnership project in the harmonious development of both public and private sectors in Tunisia. Indeed, the Tunisian health system consists of two main sectors: the public sector, and the private sector, booming since the 90s. Tunisian infrastructure and staff resources distribution is characterised by a very significant regional disparity, to the detriment of the interior regions, which is more pronounced in the private sector. This area, considered innovative and responsive, captures the local wealthy clientele, and the foreign highly specialized care seekers. It wins over the best healthcare providers, inspite of some reported claims against pricing abuses leading to user's lack of confidence. As for the public sector under funded, handicapped by red tape and some forms of lack of transparency and lobbying, it can not cope with the influx of customers of poor and middle classes. The relationship between the two sectors misses often. The current challenge in the Tunisian health sector is how can public and private sectors combine and harmonize their efforts to achieve common interest objectives. The public-private partnership, is a process helping the state to involve private investors in the realization of public interest projects and develop long term contracts. So, the two sectors will share resources and technical expertise and will access to further advantages. However, it is essential to establish clear and effective legal and institutional frameworks governing private participation in the public sector.

Background: Medical donation programs for drugs, other medical products, training and other supportive services can improve access to essential medicines in low- and middle-income countries (LMICs) and provide emergency and disaster relief. The scope and extent to which medical donation programs evaluate their impact on recipients and health systems is not well documented., Methods: We conducted a survey of the member organizations of the Partnership for Quality Medical Donations (PQMD), a global alliance of non-profit and corporate organizations, to identify evaluations conducted in conjunction with donation programs., Results: Twenty-five out of the 36 PQMD organizations that were members at the time of the survey participated in the study, for a response rate of 69 %. PQMD members provided information on 34 of their major medical donation programs. Half of the donation programs reported conducting trainings as a part of their donation program. Twenty-six (76 %) programs reported that they conduct routine monitoring of their donation programs. Less than 30 % of donation programs were evaluated for their impact on health. Lack of technical staff and lack of funding were reported as key barriers to conducting impact evaluations., Conclusions: Member organizations of PQMD provide a broad range of medical donations, targeting a wide range of public health issues and events. While some level of monitoring and evaluation was conducted in nearly 80 % of the donation programs, a program's impact was infrequently evaluated. Opportunities exist to develop consistent metrics for medical donation programs, develop a common framework for impact evaluations, and advocate for data collection and analysis plans that collect meaningful metrics.

Background: Public-private mix (PPM) for tuberculosis (TB) care implies working with all relevant public and private health care providers to ensure that high-quality TB care is offered to all who need it. Despite significant global progress in PPM expansion and in TB control in general, a large proportion of care providers in high-incidence countries remain unengaged, and one third of the estimated TB cases go unnotified or undetected., Objective: To present a global perspective on the progress and prospects of expanding PPM for TB care and prevention., Discussion: People with TB in high-incidence countries approach diverse care providers. Productive working collaborations between national TB programmes and other care providers have been scaled up in many countries. However, a large proportion of private providers still do not participate in collaboration or follow recommended TB management practices. Persisting challenges include weak commitment and capacity to work together within both public and private sectors, poor enforcement of essential regulations and inadequate investments., Conclusion: Scaling up PPM programmes is critical to ending the TB epidemic. Investing in implementing bold policies that harness public and private sector capacity, combine collaborative and regulatory approaches and promote modern digital tools to simplify care delivery is the logical way forward.

The private sector provides the majority of health care in Africa and Asia. A number of interventions have, for many years, applied different models of subsidy, support and engagement to address social and efficiency failures in private health care markets. We have conducted a review of these models, and the evidence in support of them, to better understand what interventions are currently common, and to what extent practice is based on evidence. Using established typologies, we examined five models of intervention with private markets for care: commodity social marketing, social franchising, contracting, accreditation and vouchers. We conducted a systematic review of both published and grey literature, identifying programmes large enough to be cited in publications, and studies of the listed intervention types. 343 studies were included in the review, including both published and grey literature. Three hundred and eighty programmes were identified, the earliest having begun operation in 1955. Commodity social marketing programmes were the most common intervention type, with 110 documented programmes operating for condoms alone at the highest period. Existing evidence shows that these models can improve access and utilization, and possibly quality, but for all programme types, the overall evidence base remains weak, with practice in private sector engagement consistently moving in advance of evidence. Future research should address key questions concerning the impact of interventions on the market as a whole, the distribution of benefits by socio-economic status, the potential for scale up and sustainability, cost-effectiveness compared to relevant alternatives and the risk of unintended consequences. Alongside better data, a stronger conceptual basis linking programme design and outcomes to context is also required., (© The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: To assess whether private general practitioners (GPs) belonging to a diabetes-care network adhered more closely to clinical practice guidelines for diabetes care than GPs not in such a network, for all their patients with type 2 diabetes treated with medication (patients with diabetes), regardless of whether they received care through a network (that is, whether a halo effect occurred)., Research Design and Measures: The study, based on health insurance reimbursement databases in southeastern France, included 468 GPs in two networks and 468 non-network GPs in the same geographical area, matched one-to-one by propensity scores. We followed up their patients with diabetes (n=22,808) from 2008 through 2011, conducting multivariate time-to-event analyses (Cox models) that took the matching design into account to evaluate time from inclusion until performance of the given number of each of six recommended examinations/tests., Results: GPs belonging to a diabetes-care network adhered more closely to clinical practice guidelines but our result were slightly pronounced. Hazard ratios (HR) were significantly higher for patients of network GPs for the implementation of 3 HbA1C assays (HRa=1.13; [95%CI=1.10-1.16]), or 1 microalbuminuria assay (1.4 [1.35-1.45]); they were lower for LDL-cholesterol assays (1.04 [1.01-1.07]) and ophthalmological checkups (1.07 [1.04-1.10]), and not significant for creatinemia or cardiac monitoring., Conclusions: Network GPs had better diabetes monitoring practices for all their patients with diabetes than the other GPs, especially for the most diabetes-specific tests. Further research is needed in other settings to confirm the existence of this halo effect., (Copyright © 2016 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.)

Background: Health insurance status at heart transplantation influences recipient survival, but implications of change in insurance for long-term outcomes are unclear., Methods and Results: Adults aged 18 to 64 receiving first-time orthotopic heart transplants between July 2006 and December 2013 were identified in the United Network for Organ Sharing registry. Patients surviving >1 year were categorized according to trajectory of insurance status (private compared with public) at wait listing, transplantation, and 1-year follow-up. The most common insurance trajectories were continuous private coverage (44%), continuous public coverage (27%), and transition from private to public coverage (11%). Among patients who survived to 1 year (n=9088), continuous public insurance (hazard ratio =1.36; 95% confidence interval 1.19, 1.56; P<0.001) and transition from private to public insurance (hazard ratio =1.25; 95% confidence interval 1.04, 1.50; P=0.017) were associated with increased mortality hazard relative to continuous private insurance. Supplementary analyses of 11 247 patients included all durations of post-transplant survival and examined post-transplant private-to-public and public-to-private transitions as time-varying covariates. In these analyses, transition from private to public insurance was associated with increased mortality hazard (hazard ratio =1.25; 95% confidence interval 1.07, 1.47; P=0.005), whereas transition from public to private insurance was associated with lower mortality hazard (hazard ratio =0.78; 95% confidence interval 0.62, 0.97; P=0.024)., Conclusions: Transition from private to public insurance after heart transplantation is associated with worse long-term outcomes, compounding disparities in post-transplant survival attributed to insurance status at transplantation. By contrast, post-transplant gain of private insurance among patients receiving publicly funded heart transplants was associated with improved outcomes., (© 2016 American Heart Association, Inc.)

Background Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most commonly used pharmaceutical agents worldwide. NSAIDs are considered nephrotoxic and should therefore be used with caution or be avoided completely in high risk patients, such as chronic kidney disease (CKD) patients. Objective This study aimed to investigate the prescribing of NSAIDs in CKD patients in order to generate awareness and improve the outcome of these patients. Setting The study was conducted using medicine claims data in the private health sector of South Africa. Method A descriptive, quantitative study was performed, using retrospective data obtained from a Pharmaceutical Benefit Management company. Data from 1 January 2009 to 31 December 2013 were analysed. The study population consisted of all patients with an ICD-10 code for a CKD (N18), in association with a paid claim for an NSAID. Main outcome measure The stratification of NSAID prescribing volume among the CKD population in terms of gender, age, NSAID type, dosage and prescriber type. Results The prescribing of NSAIDs in CKD patients varied between 26 and 40 % over the 5 year study period. No association between gender and CKD patients who received NSAIDs versus those who did not was found, with p > 0.05 and Cramer's V < 0.1 for each year of the study. The association between age groups and CKD patients who received NSAIDs versus those who did not was statistically significant, but practically weak (p < 0.05; Cramer's V ≥ 0.1). Most NSAID prescriptions (52-63 %) were for patients aged 35-64 years. Diclofenac (34.25 %) was the single most frequently prescribed NSAID, but the COX-2-inhibitors (celecoxib, meloxicam and etoricoxib) were the preferred NSAID class to be prescribed. The majority (61.6 %) of the NSAIDs were prescribed by general medical practitioners in dosages meeting and even exceeding the recommended daily dosage of patients with normal kidney function. Conclusions Even though NSAIDs are regarded as nephrotoxic drugs, they are still being prescribed to at-risk CKD patients, in particular, the elderly.

e- and m-Health communication technologies are now common approaches to improving population health. The efficacy of behavioral nutrition interventions using e-health technologies to decrease fat intake and increase fruit and vegetable intake was demonstrated in studies conducted from 2005 to 2009, with approximately 75% of trials showing positive effects. By 2010, an increasing number of behavioral nutrition interventions were focusing on body weight. The early emphasis on interventions that were highly computer tailored shifted to personalized electronic interventions that included weight and behavioral self-monitoring as key features. More diverse target audiences began to participate, and mobile components were added to interventions. Little progress has been made on using objective measures rather than self-reported measures of dietary behavior. A challenge for nutritionists is to link with the private sector in the design, use, and evaluation of the many electronic devices that are now available in the marketplace for nutrition monitoring and behavioral change.