Voluntary Contributions to Informal Activities Producing Public Goods: Can these be Induced by Government and other Formal Sector Agents? Some Evidence from Indonesian Posyandus

voluntarism, Indonesia, health service provision, government intervention

Maternal prenatal substance use and behavior problems among children in the U.S.

Prenatal exposure to smoking and alcohol-use is found to be correlated with various adverse consequences for children, including behavior problems. However, it is not clear whether this relationship is an artifact of underlying confounding factors that impact both the mother’s decision to smoke/drink during pregnancy and subsequent child behavior. We investigate the relationship between prenatal substance use and children’s behavior problems using data from the Children of the National Longitudinal Survey (CNLSY). Specifically, we investigate whether prenatal cigarette use and alcohol-use affect children’s behavior problems when they are 4-6 years old, and when they are 8-10 years old. Fixed-effects regression and propensity score methods are used to minimize bias from confounding factors. Our results suggest that the relationship between prenatal smoking and behavior problems are driven by underlying confounding factors, but prenatal alcohol-use may indeed cause behavior problems in children, though there may still be some bias in the results.Prenatal behaviors; substance use; alcohol; smoking; children; development; behavior problems;

Voluntary contributions to informal activities producing public goods: can these be induced by government and other formal sector agents? Some evidence from Indonesian posyandus

This study attempts to determine the extent to which human potential may be unlocked by government or other formal sector actions that induce voluntary contributions by individuals to the activities of Indonesia’s posyandus or village health posts. Posyandus have been an important feature of Indonesia’s public health system and have contributed substantially to the country’s success in lowering infant and child mortality rates at low cost. Our analysis of links between formal activity and voluntary contributions to posyandus is conducted at two levels: individuals and posyandus, and with two different indicators at each level. Our empirical results take advantage of data from all three waves of the Indonesian Family Life Survey (IFLS), i.e., IFLS1, IFLS2 and IFLS3. At each level of analysis there is evidence that voluntary contributions and effective service provision can be positively affected by formal sector intervention. Both community level characteristics, such as income per capita, income inequality, ethnic and religious diversity, and household and individual characteristics have different effects on the different outcome variables at both levels of analysis. The results demonstrate that appropriately designed formal sector interventions can induce voluntary inputs and, through the public goods produced, they can unlock the human potential. – voluntarism ; Indonesia ; health service provision ; government interventio

Roof above the head : A qualitative assessment of rural housing in India

The development of rural housing in a manner that results in adequate, quality shelter for inhabitants of Mahatma Gandhi’s “real India” is a challenge before the nation. What are the issues confronting rural housing development in India? The litany of its woes is endless. At first impression, rural housing is vulnerable to weaknesses in the delivery system for housing materials and services. Gradually, it dawns on the observer that the sector is deeply affected by the infrastructure deficit – roads, electricity supply, drinking water and sanitation. It has been bypassed by the numerous economic revolutions that have made India a vibrant economic superpower. For instance housing finance, which played a key role in the urban housing explosion, is conspicuous by its absence in the rural setting. Additionally, the limited mobility of rural households, the lack of vibrancy in the market for village properties and the marked volatility in agricultural incomes combine to dampen the prospects of this nebulous sector.Housing

Pharmacokinetics and pharmacodynamics of famotidine and ranitidine in critically ill children

To characterize and compare acid suppression (pharmacodynamics) and pharmacokinetics of IV famotidine and ranitidine in critically ill children at risk for stress gastritis. Single‐blind, randomized study in PICU patients 6 months to 18 years requiring mechanical ventilation with continuous gastric pH monitoring, randomized to IV famotidine 12 mg/m 2 or ranitidine 60 mg/m 2 when gastric pH 1 hour with serial blood sampling following first dose. Twenty‐four children randomized to either famotidine (n = 12) or ranitidine (n = 12). Sixteen out of twenty‐four completed both PK and PD study arms (7/12 famotidine; 4.7 ± 3.4 years; 9/12 ranitidine; 6.6 ± 4.7 years; p  = 0.38). Time to gastric pH 4.0 and total time pH above 4.0 similar with no difference in pH at 6 and 12 hours ( p  > 0.2). No difference between drugs in clearance, volume of distribution and half‐life ( p  > 0.05). Ratio of AUC pH to AUC drug concentration 0–12 hours after first dose was significantly greater for famotidine (0.06849 ± 0.01460 SD) than ranitidine (0.02453 ± 0.01448; p  < 0.001) demonstrating greater potency of famotidine. pH lowering efficacy of both drugs is similar. Greater potency of famotidine may offer clinical advantage due to lower drug exposure and less frequent dosing to achieve same pH lowering effect.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/102678/1/jcph219.pd

Risk of Post-ERCP Pancreatitis in Liver Transplant Patients: Single Center Experience

Introduction: Acute pancreatitis remains the most common severe complication of endoscopic retrograde cholangiopancreatography (ERCP). The exact cause of post-ERCP pancreatitis (PEP) is unclear. Regardless of the mechanism that initiates PEP, the pathways of inflammation are similar to other forms of acute pancreatitis and include the activation of various inflammatory cytokines, released from the acinar cells and subsequently from helper T lymphocytes and macrophages. Liver transplants (LTx) patients on immunosuppressive medications have impaired T-cell response and hence decreased ability to generate these cytokines. The aim of this study was to review incidence rates and risk factors of PEP in this LTx subset of patient population compared to non transplant (non-LTx) patients. Methods: Retrospective review of liver transplant database from January 2005 to September 2015 was performed. Liver transplant patients who underwent ERCP in the post-transplant period as part of their usual management were included in the study and compared with non-LTX patients who underwent ERCP. The study was approved by IRB. Electronic medical records were reviewed for any mention of pancreatic-type pain and pancreatic enzyme testing, if any after the ERCP. Diagnosis of Post-ERCP pancreatitis was made on the basis of both clinical and laboratory results as per standard definitions of PEP. Results: During this period, 109 LTx patients underwent 235 ERCP procedures. The data was compared with 348 non-transplant patients (not on any immunosuppression) who underwent total of 536 ERCP procedures. PEP developed in 24 (4.47%) cases in the non-LTx group as compared to 4 (1.7%) cases in the LTx group (p = 0.061, OR 2.70). History of LTx showed trend towards decrease in risk of PEP on univariate analysis (OR 0.36, p = 0.068, 95% CI = 0.12 - 1.07). However, on multivariate analysis only female gender (OR 2.35, P \u3c 0.038, CI 1.04 - 5.28), history of PEP (OR 5.77, P \u3c 0.001, CI 2.01 - 16.55) and pancreatic duct contrast injection (OR 6.20, P \u3c 0.001 CI 2.75 - 13.97) were significantly associated with risk of PEP. Also the severity of pancreatitis was mild in all 4 LTx patients as compared to 21 out of 24 patients (87%) with mild PEP in the non-LTx group (pConclusion:The risk of PEP in liver transplant patients on immunosuppression appears lower than the historical risk. Inhibition of the inflammatory transcriptional factors such as NF-kB and NFAT by the calcineurin inhibitors may be a potential explanation. Further studies are needed targeting calcineurin activation as a therapeutic approach in prevention of PEP

Recombinant interleukin-21 plus sorafenib for metastatic renal cell carcinoma: a phase 1/2 study

Abstract Background Despite the positive impact of targeted therapies on metastatic renal cell carcinoma (mRCC), durable responses are infrequent and an unmet need exists for novel therapies with distinct mechanisms of action. We investigated the combination of recombinant Interleukin 21 (IL-21), a cytokine with unique immunostimulatory properties, plus sorafenib, a VEGFR tyrosine kinase inhibitor. Methods In this phase 1/2 study, 52 mRCC patients received outpatient treatment with oral sorafenib 400 mg twice daily plus intravenous IL-21 (10–50 mcg/kg) on days 1–5 and 15–19 of each 7-week treatment course. The safety, antitumor activity, pharmacokinetic and pharmacodynamic effects of the combination were evaluated. Results In phase 1 (n = 19), the maximum tolerated dose for IL-21 with the standard dose of sorafenib was determined to be 30 mcg/kg/day; grade 3 skin rash was the only dose-limiting toxicity. In phase 2, 33 previously-treated patients tolerated the combination therapy well with appropriate dose reductions; toxicities were mostly grade 1 or 2. The objective response rate was 21% and disease control rate was 82%. Two patients have durable responses that are ongoing, despite cessation of both IL-21 and sorafenib, at 41+ and 30+ months, respectively. The median progression-free survival in phase 2 was 5.6 months. The pharmacokinetic and pharmacodynamic properties of IL-21 appeared to be preserved in the presence of sorafenib. Conclusion IL-21 plus sorafenib has antitumor activity and acceptable safety in previously treated mRCC patients. IL-21 may represent a suitable immunotherapy in further exploration of combination strategies in mRCC. Trial registration ClinicalTrials.gov Identifier: NCT0038928