The unending burden of high out-of-pocket expenditure on institutional deliveries in India.

OBJECTIVE: This study aims to address the question that whether out-of-pocket expenditure (OOPE) on institutional deliveries remained high or reduced over time in India, in particular after the introduction of conditional cash transfer (CCT) incentive programmes such as Janani Suraksha Yojana (JSY) in 2005. STUDY DESIGN: The study presents the trends in average OOPE on institutional deliveries in India, in an effort to evaluate the impact of the JSY programme on it. METHODS: For the purpose, the study used recently released 75th round of National Sample Survey data, 2017/18 about household social consumption (Health) and two of its previous rounds in 2004 and 2014. RESULTS: The results suggest that, except at rural public facilities, the average OOPE for institutional delivery has increased significantly in both rural and urban areas from 2004 to 2017/18, even after adjusting to inflation in the prices. In addition, the results have shown that overall 14 of 33 states for rural public facilities, 20 of 25 states in rural private facilities, 21 of 32 states in urban public facilities and 29 of 32 states in urban private facilities have experienced more than 50% raise in OOPE on institutional delivery during 2004-2017/18, despite JSY incentives. CONCLUSION: The findings suggest that the current level of JSY incentives will not be sufficient to avoid catastrophic spending on institutional deliveries for the households as the incentives in several states are much less than the state average OOPE per delivery. Thus, there is a need to consider a raise in the state or central contribution for CCT under the JSY programme to reduce the burden of OOPE on institutional deliveries through recently launched Pradhan Mantri Matru Vandana Yojana.

Planning of births and maternal, child health, and nutritional outcomes: recent evidence from India.

OBJECTIVES: In an effort to provide recommendation for maximizing synergy between maternal, infant, and young children's nutrition and family planning in India, this study makes a comprehensive assessment of the effects of the planning of births in terms of timing, spacing and limiting childbearing on maternal and child health outcomes. STUDY DESIGN: This study used the latest National Family Health Survey data of India that is globally known as the Demographic and Health Survey. A robust two-stage systematic random sampling was used for selecting representative samples for measuring demographic and health indicators. METHODS: Maternal and child health outcomes are measured by body mass index (grouped as normal, underweight, and overweight) and anemia for mothers, and stunting, underweight, anemia, and under-five mortality for the children. Logistic regression and Cox proportional hazard models were applied. RESULTS: Women with a higher number of births and among those with first-order births with fewer than 2 years between marriage and first birth, the risk of being underweight and having anemia was significantly higher compared with their counterparts. In addition, the probability of being underweight and risk of stunting, anemia, and mortality was higher among the children from women with a higher number of births and with fewer than 3 years of spacing between births than that of their counterparts. CONCLUSIONS: The findings from this study support the importance of birth planning in improving maternal, child health, and nutritional outcomes. The proper planning of births could help to achieve the Sustainable Development Goal-3 of good health and well-being for all by 2030 in India, where a significant proportion of women still participate in early marriages, early childbearing, and a large number of births with close spacing.

An evaluation of the FDA adverse event reporting system and the potential for reporting bias.

BACKGROUND: The FDA maintains the Adverse Event Reporting System (CAERS) database, which contains product complaint reports for foods, dietary supplements, and cosmetics. Product line perception and subsequent adverse event reporting may be impacted by negative media attention. METHODS: The purpose of this analysis was to use the CAERS database to analyze temporal trends in adverse event reporting before and after media coverage of alleged health effects, using WEN by Chaz Dean (WCD) cleansing conditioners as a case study. WCD cleansing conditioner adverse event reports from January 2005 to December 2018 were abstracted from the CAERS database. Zero-inflated negative binomial regression models were used to analyze the rate of adverse events (WCD events/10,000 WCD cleansing conditioner units sold/month), adjusted for temporal trends in CAERS. RESULTS: There was a statistically significant higher rate of adverse event reporting after negative media coverage in December 2015 (IRR 16.71 [95% CI: 7.89-35.39]) when compared to the rate of adverse event reporting before December 2015. CONCLUSIONS: This analysis highlights the importance of assessing potential external factors, such as negative news media coverage, that may alter reporting behaviors due to societal shifts in product-specific risk perception. Consideration of these factors in post-market surveillance programs would result in more comprehensive safety evaluations.

Ventricular rate control during atrial fibrillation by cardiac parasympathetic nerve stimulation: a transvenous approach.

OBJECTIVES: To identify intravascular sites for continuous, stable parasympathetic stimulation (PS) in order to control the ventricular rate during atrial fibrillation (AF). BACKGROUND: Ventricular rate control during AF in patients with congestive heart failure is a significant clinical problem because many drugs that slow the ventricular rate may depress ventricular function and cause hypotension. Parasympathetic stimulation can exert negative dromotropic effects without significantly affecting the ventricles. METHODS: In 22 dogs, PS was performed using rectangular stimuli (0.05 ms duration, 20 Hz) delivered through a catheter with an expandable electrode-basket at its end. The catheter was positioned either in the superior vena cava (SVC, n = 6), coronary sinus (CS, n = 10) or right pulmonary artery (RPA, n = 6). The basket was then expanded to obtain long-term catheter stability. Atrial fibrillation was induced and maintained by rapid atrial pacing. RESULTS: Nonfluoroscopic (SVC) and fluoroscopic (CS/RPA) identification of effective intravascular PS sites was achieved within 3 to 10 min. The ventricular rate slowing effect during AF started and ceased immediately after on-offset of PS, respectively, and could be maintained over 20 h. In the SVC, at least a 50% increase of ventricular rate (R-R) intervals occurred at 22 +/- 11 V (331 +/- 139 ms to 653 +/- 286 ms, p < 0.001), in the CS at 16 +/- 10 V (312 +/- 102 ms vs. 561 +/- 172 ms, p < 0.001) and in the RPA at 18 +/- 7 V (307 +/- 62 ms to 681 +/- 151 ms, p < 0.001). Parasympathetic stimulation did not change ventricular refractory periods. CONCLUSIONS: Intravascular PS results in a significant ventricular rate slowing during AF in dogs. This may be beneficial in patients with AF and rapid ventricular response since many drugs that decrease atrioventricular conduction have negative inotropic effects which could worsen concomitant congestive heart failure.

Endovascular neural stimulation via a novel basket electrode catheter: comparison of electrode configurations.

We previously showed that parasympathetic stimulation by a basket electrode catheter (BEC) positioned in the superior vena cava (SVC) can slow sinus rate (SR) or ventricular response (VR) during atrial fibrillation (AF). In 11 dogs, anesthetized with Na-pentobarbital, standard ECG leads II and aVR, blood pressure and right atrial electrograms were continuously monitored. Two different BEC configurations (B1, B2) were tested in the SVC. B1 consisted of five metal splines, each 3 cm in length. Stimulation was applied between adjacent splines. B2 consisted of 2 electrodes at opposite ends of each of 5 splines and a larger electrode at the middle of each spline. Stimulation was delivered between the two end electrodes and the middle electrode on the same arm. Stimulation consisted of square wave stimuli, each 0.1 msec duration, frequency 20 Hz at voltages from 1-40 V. Six dogs were studied with B1 and five were studied with the B2 configuration. The average voltage required to produce a 50% decrease in heart rate was 22+/- 12 V when stimulating between adjacent splines (B1) compared to 10+/- 5 V when stimulating along a single spline (B2), a 55% decrease (p

Transvenous parasympathetic cardiac nerve stimulation: an approach for stable sinus rate control.

INTRODUCTION: Epicardial electrical stimulation of parasympathetic nerves innervating the sinus node has been shown to decrease sinus rate. We investigated whether intravascular parasympathetic cardiac nerve stimulation (IPS) can be achieved over a relatively long-term period to slow the supraventricular rate. METHODS AND RESULTS: Fifteen dogs were investigated. IPS was performed with rectangular stimuli (0.05-msec duration, 20 Hz) using a catheter with an expandable electrode basket. The catheter was positioned in the superior vena cava (SVC; n = 9) or right pulmonary artery (RPA; n = 6). The basket then was expanded to hold the catheter in place. Nonfluoroscopic identification of effective IPS sites was achieved within 5 minutes in the SVC. Increasing IPS voltage resulted in a graded response of supraventricular rate slowing. A 50% prolongation of the baseline atrial cycle length was achieved with 28 V in the SVC (1,056 +/- 355 msec vs 489 +/- 154 msec; P < 0.001) and 25 V in the RPA (1,181 +/- 306 msec vs 518 +/- 138 msec; P < 0.01). The rate slowing started immediately after IPS onset, terminated abruptly after IPS cessation, and could be maintained over 10 hours. A rate slowing effect also was observed when the sinus rate was increased by isoproterenol (SVC: 304 +/- 8 msec/RPA: 341 +/- 9 msec with isoproterenol vs SVC: 635 +/- 12 msec with isoproterenol + IPS at 39 V/ RPA: 584 +/- 16 msec with isoproterenol + IPS at 38 V; n = 6). CONCLUSION: IPS results in a significant supraventricular rate slowing that is stable over a relatively long period and may be applied to slow undesirable sinus tachycardia in acute ischemic syndromes or to counteract undesirable chronotropic effects of catecholamines during treatment of cardiogenic or septic shock and acute congestive heart failure.