Development of the modified Highly Processed Food Withdrawal Scale (mProWS).

The Highly Processed Food Withdrawal Scale (ProWS) is a 29-item measure that operationalizes physical and psychological indicators of withdrawal symptoms associated with cutting down on the consumption of ultra-processed foods. The current study developed a briefer 7-item version of the ProWS (modified ProWS; mProWS) using the participant sample from the ProWS validation paper (n = 231). Then, in an independent sample recruited from Amazon Mechanical Turk, 244 participants (55.3% females) completed the mProWS, the ProWS, and measures of eating-related constructs in order to evaluate the psychometric properties of the mProWS, relative to the ProWS. The mProWS and the ProWS performed similarly on indexes of reliability, convergent validity with addictive-like eating behavior (e.g., Yale Food Addiction Scale 2.0 symptom count), discriminant validity with distinct measures (e.g., cognitive desire to restrict food consumption), and incremental validity evidenced by associations with weight cycling above and beyond body mass index (BMI) and YFAS 2.0 symptoms. The mProWS may be an appropriate choice for studies with higher participant burden (e.g., ecological momentary assessment) to assess withdrawal symptoms in real-time when they occur in response to cutting down on ultra-processed foods.

Time trends and regional variation in utilization of antidiabetic medicines in China, 2015-2022.

AIM: To assess the use of non-insulin antidiabetic medicines in China. MATERIALS AND METHODS: We analysed the national procurement data for 29 non-insulin antidiabetic medicines from nine subgroups in China from 2015 to 2022. We estimated the number of defined daily doses (DDDs) procured per year in seven regions of China for nine subgroups and adjusted the data by the number of patients with diabetes. For each subgroup, the regional ratio was calculated by comparing the procurement per patient in each region with the procurement nationwide. The regional disparity was the difference between the highest and lowest regional ratios. We compared the medication patterns across regions. RESULTS: Nationally, between 2015 and 2022, the number of DDDs per patient increased from 14.45 to 47.37. The two most commonly used categories were sulphonylurea and biguanides, which increased from 7.04 to 15.39 (119%) and 3.28 to 11.11 (239%) DDDs per patient, respectively. The procurement of new drugs (dipeptidyl peptidase-4 inhibitors, sodium-glucose cotransporter type 2 inhibitors and glucagon-like peptide-1 receptor agonists) increased quickly and had >5000% relative changes. Particularly for sodium-glucose cotransporter type 2 inhibitors, it increased from 0.08 to 5.03 DDDs (6662%). The southwest region had the highest relative change (319%), while the southern region had the lowest (118%). Biguanide and thiazolidinediones had the lowest (1.19) and highest level (2.21) of regional disparity in 2022, respectively. CONCLUSION: The procurement of non-insulin antidiabetic medicines in China has increased a lot from 2015 to 2022. In terms of DDDs per patient, sulphonylurea ranked first, followed by metformin. The procurement of new drugs increased greatly. A large regional disparity existed in medicine usage and patterns.

The impact of drug shortages on drug prices: evidence from China.

Introduction: Drug shortages pose a serious global public health challenge, affecting China and other countries. Evidence from USA shows that short-supplied drugs demonstrated a very high price growth during and after a shortage. However, the effect of shortages on drug prices in China remains unknown. This paper aims to understand the impact of drug shortages on prices and explore implications for shortage prevention policy. Methods: We collected the purchase prices and delivery rates of 120 drugs from April 2019 to December 2021 across whole China. We examined price progression of affected drugs using linear mixed-effects models and performed subgroup analyses based on the number of manufacturers and the severity of shortage. Results: Non-shortage cohort had an annual price growth of 11.62% (95% confidence interval [CI] 8.34 to 14.98). Shortage cohort demonstrated an annual price growth of 8.08% (95%CI 0.12 to 16.77) in the period preceding a shortage, 27.57% (95%CI 6.17 to 52.87) during a shortage, and 9.38% (95%CI -12.64 to 36.39) in the post-shortage period. Drug shortages' impact on prices varied across subgroups. Compared with that of drug markets supplied by a single manufacturer, the price growth rate of markets supplied by more than one manufacture declined more after the shortage resolution. Conclusion: Shortages resulted in significant price increases of study markets, especially the low-priced markets, while the shortage resolution slowed the growth. The primary shortage driver has shifted from the low price to others drivers, such as unavailability of active pharmaceutical ingredients. For currently sole-supplied drugs, the expedited review of applications from other manufacturers should be considered.

Chinese TikTok (Douyin) challenges and body image concerns: a pilot study.

BACKGROUND: Social media content on Western platforms promoting thinness, or thinspiration, has been found to negatively affect body image perception of users. Less is known about non-Western social media use and its effects on body image concerns. Chinese TikTok, known as Douyin, is a popular short video platform with 600 million daily active users. Recent trends on Douyin encourage users to demonstrate thinness through participation in 'body challenges'. This paper argues that such content is comparable to thinspiration, however, to date hardly any research has been undertaken on these challenges. Thus, this pilot study aimed to analyse the content of three viral challenges and investigate their impact on Douyin users. METHODS: Thirty most viewed videos were collected for three challenges (N = 90): the Coin challenge, the A4 Waist challenge, and the Spider leg challenge. Videos were coded for variables relating to thin idealisation, including thin praise, sexualisation and objectification, and analysed through content analytic methods. Video comments (N ≈ 5500) were analysed through thematic analysis, and main themes were identified. RESULTS: Preliminary findings showed that participants who objectified their bodies to a greater extent expressed more negative body image concerns. In addition, comments on the videos had themes of thin praise, self-comparison, and promotion of dieting behaviours. In particular, videos of the A4 Waist challenge were found to incite more negative self-comparison in viewers. CONCLUSION: Preliminary findings suggest all three challenges promote the thin ideal and encourage body image concerns. Further research about the broader impact of body challenges is needed.

Evaluation of the effect of managing oxycodone/acetaminophen as a psychotropic medicine: An interrupted time-series study.

Background: Oxycodone/acetaminophen has been reported for misuse for many times in China. To cope with that, Chinese national authorities jointly issued a policy, requiring that oxycodone/acetaminophen should be managed as a psychotropic medicine starting 1 September 2019. This paper aimed to evaluate the effect of this policy in medical institutions. Methods: We used interrupted time-series analysis to examine the immediate level and slope changes in the mean number of tablets prescribed, proportion of oxycodone/acetaminophen prescription exceeding 30 pills, days supplied per prescription and the proportion of days supplied exceeding 10 days with prescription data from 5 tertiary hospitals in Xi'an city between 1 January 2018 and 30 June 2021 (42 months). We divided the prescriptions into two groups, one for long-term drug users, and the other for short-term drug users. Results: In total, 12,491 prescriptions were included in the final study, with 8,941 and 3,550 prescriptions for the short-term and long-term drug users, respectively. Significant differences in the proportion of prescriptions issued by various departments, were observed between pre- and post-implementation of the policy for both short-term and long-term drug users (p < 0.001). For short-term drug users, the policy implementation was only associated with an immediate level decrease in proportion of prescriptions exceeding 30 tablets (-4.09%, p < 0.001). For long-term drug users, after the policy, the mean number of tablets prescribed and the mean proportion of prescriptions exceeding 30 tablets experienced a level decrease of 22.96 tablets (p < 0.001) and a level decrease of 41.13% (p < 0.001), respectively; the mean number of days supplied showed a significant level decrease (6.88 days per prescription) and slope increase (0.19 days per month), and the mean proportion of days supplied exceeding 10 days showed a significant level decrease (-10.51% per prescription) and a slope increase (0.27% per month). Conclusion: Implementation of stricter management for oxycodone/acetaminophen achieved its goal of reducing the risk of misuse in short-term drug users. For those long-term drug users, policy needed to be strengthened as the prescription exceeding 10 days was still at a high level after the intervention. Policies targeting patients with different drug demands are needed. Many other strategies can be implemented, including establishing specific guidelines/principles and conducting training programs.

Procurement of medicines to treat cancer, 2015-2020, China.

Objective: To assess the procurement of medicines to treat cancer in China. Methods: We conducted a descriptive analysis of the national procurement data for 20 anti-cancer medicines in China from 2015 to 2020. We estimated the number of defined daily doses procured per year in three areas of China for essential medicines and medicines for targeted therapies. We adjusted the data by the number of cancer patients in each region for each year. Findings: Between 2015 and 2020, the number of defined daily doses per patient decreased from 40.87 to 35.86 (-12.27%) for essential medicines, while the number increased from 0.85 to 12.52 (1381.15%) for target medicines. The procurement of three out of 10 essential medicines decreased, whereas procurement of all 10 targeted medicines increased. In 2020, the eastern area procured the most essential medicines (44.98 doses per patient) and targeted medicines (16.55 doses per patient), but had the smallest relative change in procurement of both essential medicines (-22.76%) and targeted medicines (978.16%). The central area had the largest increase in procurement of both essential medicines (9.64%; from 25.25 to 27.68 doses per patient) and targeted medicines (4587.81%; from 0.23 to 10.64 doses per patient). Conclusion: Procurement of anti-cancer medicines varied across regions. Specific policies are needed at the national level to eliminate inequalities in access to these medicines. Two issues that need attention are the lower access to many essential anti-cancer medicines in some provinces and the increase in use of targeted medicines.

Drug Shortage: Causes, Impact, and Mitigation Strategies.

Drug shortage is a global issue affecting low, middle, and high-income countries. Many countries have developed various strategies to overcome the problem, while the problem is accelerating, affecting the whole world. All types of drugs, such as essential life-saving drugs, oncology medicines, antimicrobial drugs, analgesics, opioids, cardiovascular drugs, radiopharmaceutical, and parenteral products, are liable to the shortage. Among all pharmaceutical dosage forms, sterile injectable products have a higher risk of shortage than other forms. The causes of shortage are multifactorial, including supply issues, demand issues, and regulatory issues. Supply issues consist of manufacturing problems, unavailability of raw materials, logistic problems, and business problems. In contrast, demand issues include just-in-time inventory, higher demand for a product, seasonal demand, and unpredictable demand. For regulatory issues, one important factor is the lack of a unified definition of drug shortage. Drug shortage affects all stakeholders from economic, clinical, and humanistic aspects. WHO established global mitigation strategies from four levels to overcome drug shortages globally. It includes a workaround to tackle the current shortage, operational improvements to reduce the shortage risk and achieve early warning, changes in governmental policies, and education and training of all health professionals about managing shortages.

Clinical Consumption of Compound Opioid Analgesics in China: A Retrospective Analysis of National Data 2015-2018.

Compound opioid analgesics (COA) are widely used for cancer pain relief, but few studies investigated the use of that. We aimed to report the characteristics and trend of COA consumption in different regions and health facilities in China. The procurement data of two types of COA, compound codeine phosphate (CCP) and oxycodone and acetaminophen (OAA), in all medical institutions of 20 provinces from 2015 to 2018 were used. Data were presented as defined daily dose for statistical purpose (SDDD) and expenditures per million inhabitants per day. The annual consumption of COA and ratio of two combinations were compared among regions and institutions. We found, during 2015-2018, COA consumption increased at an average rate of 7.32% in SDDD and 19.19% in expenditures, while OAA accounted for most of the consumption. Highest COA consumption appeared in Northern China, with 121.72 SDDD and 1689.87 RMB (2015), whereas the lowest COA consumption was only 11.28 SDDD appearing in Southern China. The ratio of OAA and CCP (in SDDD) was highest in Southern China (53.14 in 2018), whereas lowest in West North (0.37 in 2018). In terms of institutions, tertiary had the highest COA consumption, with 16.74 SDDD and 292.73 RMB (2018). The SDDD of OAA was 27.44 times of that of CCP in tertiary, while it was only 0.11 in primary. Overall, COA consumption is on an upward trend and different among regions and health institutions in either amount or types of COA. These findings call for establishment of COA management regulations.

Patients' perception of the outpatient pharmaceutical service quality in hospital pharmacies with auditable pharmaceutical transactions and services in Ethiopia: a cross-sectional study.

OBJECTIVE: To ensure the availability of quality pharmaceutical products and effective pharmaceutical services, a package of interventions named auditable pharmaceutical transactions and services (APTS), was implemented in the tertiary and secondary hospitals across Ethiopia since 2014. This study aimed to evaluate outpatients' perception of pharmaceutical service quality in hospitals with APTS in Ethiopia. DESIGN: Cross-sectional study. SETTING: Seven hospitals of Tigray, Ethiopia. PARTICIPANTS: 794 patients coming for pharmaceutical services. MAIN OUTCOME MEASURES: SERVQUAL instrument was employed to collect the patient's perception of pharmaceutical services. The mean perception score of pharmaceutical service quality was the main outcome measurement. RESULTS: Out of 810 patients approached, 794 participated in the study (response rate of 98.02%). Overall, the mean perception score of the service quality was 3.1 of 5. Among the five dimensions of SERVQUAL, dimension of empathy achieved the highest result with a mean score of 3.71, and tangibility was the second (3.19), followed by responsiveness (3.08), assurance (2.87) and reliability (2.81). The perception of patients in tertiary hospitals of service quality was more positive compared with patients in secondary hospitals (3.265>3.011, p=0.04). However, the difference was only significant in the dimension of assurance when considering the five dimensions separately. Respondents who were older, widowed, illiterate, farmer, retired or Orthodox were found to have better quality service experience compared with others (p=0.001). CONCLUSION: Generally, outpatients' perception of pharmaceutical service quality was positive. However, two dimensions of the service quality (assurance and reliability) were negatively perceived. To improve the service quality, we recommended the following: (1) managers should provide more training for pharmacists to strengthen their professional knowledge and encourage them to cooperate with other professionals; (2) the government needs to develop guidelines on information provided to patients and train the pharmacists to follow them; (3) hospitals can apply various procurement methods and efficient inventory management methods.

Evaluating Price and Availability of Essential Medicines in China: A Mixed Cross-Sectional and Longitudinal Study.

Objectives: To evaluate the price and availability of medicines in China. Methods: A standard methodology developed by WHO and Health Action International was used to collect medicine price and availability data. We obtained cross-sectional data for 48 medicines from 519 facilities (280 public hospitals and 239 private retail pharmacies) in five provinces in China in 2018. We also collected longitudinal data for 31 medicines in Shaanxi Province in 2010, 2012, 2014, and 2018. Medicine price was compared with the international reference price to obtain a median price ratio (MPR). The availability and price in five provinces were compared in matched sets. We used general estimating equations to calculate differences in availability and median prices from 2010 to 2018. Findings: Mean availability of surveyed medicines in five provinces was low in both public (4.29-32.87%) and private sectors (13.50-43.75%). The MPR for lowest priced generics (LPGs) was acceptable (1.80-3.02) and for originator brands (OBs) was much higher (9.14-12.65). The variation was significant for both availability and price of medicines across provinces. In Shaanxi Province, the availability of medicines decreased between 2010 and 2018, but this was not significant in the public or private sector. Compared with 2010, the median adjusted patient price was significantly lower in 2018 for nine OBs (difference -22.4%; p = 0.005) and 20 LPGs (-20.5%; p = 0.046) in the public sector and 10 OBs (-10.2%; p = 0.047) in the private sector. Conclusion: Access to medicines was found to be poor and unequal across China in 2018. Future interventions are needed, and possible strategies include effective and efficient procurement, promoting the development of retail pharmacies and increasing medicine price transparency.

Dispensing Antibiotics without a Prescription for Acute Cough Associated with Common Cold at Community Pharmacies in Shenyang, Northeastern China: A Cross-Sectional Study.

: The inappropriate use of antibiotics is a major health issue in China. We aimed to assess nonprescription antibiotic dispensing and assess pharmacy service practice at community pharmacies in Shenyang, northeastern China, and to compare these practices between pediatric and adult cases. A cross-sectional study was performed from March to May 2018 using the standardized client method. Two different simulated scenarios were presented at pharmacies, namely, pediatric and adult acute cough associated with a common cold. Of 150 pharmacy visits, 147 visits were completed (pediatric case: 73, adult case: 74). A total of 130 (88.4%) community pharmacies dispensed antibiotics without a prescription, with a significant difference between pediatric and adult cases (pediatric case, 79.5% versus adult case, 97.3%, p = 0.005). Symptoms were asked in most visits (pediatric case: 82.2%, adult case 82.4%). Patients' previous treatment and history of allergies were both inquired more frequently in the pediatric cases than in the adult cases. Medication advice was provided more often in the adult cases than in pediatric cases. Antibiotics were easily obtained without a prescription in Shenyang, especially for adult patients. Adequate inquiries and counseling had not occurred in most pharmacies.

Evaluating access to oral anti-diabetic medicines: A cross-sectional survey of prices, availability and affordability in Shaanxi Province, Western China.

OBJECTIVES: To assess the availability and affordability of oral anti-diabetic medicines in Shaanxi Province, Western China. METHODS: In 2015, the prices and availability of 8 anti-diabetic medicines covering 31 different dosage forms and strengths were collected in six cities of Shaanxi Province. A total of 72 public hospitals and 72 private pharmacies were sampled, using a modified methodology developed by the World Health Organization (WHO) and Health Action International (HAI). Medicine prices were compared with international reference prices to obtain a median price ratio. For urban residents, affordability was assessed as the lowest-paid unskilled government workers to purchase cost of standard treatment in days' wages; for rural residents, days' net income was used. RESULTS: The mean availabilities of originator brands (OBs) and generics were 34.3% and 28.7% in public hospitals, and 44.1% and 64.4% in the private pharmacies. OBs and the lowest priced generics (LPGs) were procured at 12.38 and 4.52 times the international reference price in public hospitals, and 10.26 and 2.81 times the international reference prices in private pharmacies. Treatments with OBs were unaffordable even for urban residents. The affordability of the LPGs was good, except for acarbose, repaglinide and pioglitazone. CONCLUSIONS: Most anti-diabetic medicines cannot met the WHO's availability target (80% availability) in Shaanxi Province. The high prices of OBs had severely influenced the affordability of medicines, especially for the rural residents. Effective policies should be initiated to ensure the Chinese people a better access to more affordable anti-diabetic medicines.

The Effects of a New Public Medicine Procurement Policy on Medicine Price in Shaanxi Province, Western China: An Interrupted Time Series Analysis.

Objectives: To assess the effects on medicine price, a new public medicine procurement policy (NPMPP) undertaken in western China in 2015. Methods: An interrupted time series analysis was used to evaluate the impact of NPMPP on the prices of emergency medicines, gynaecological medicines, and paediatric medicines in Shaanxi Province, western China. Based on the procurement records in all the public health institutions in Shaanxi Province, we built three regression models. The monthly average price growth rate of the three categories of medicines was analysed covering the period 2015 to 2017. Findings: Before the intervention, there was an increasing trend in the monthly average growth rate of the three categories of medicines, but significant only in emergency medicines and paediatric medicines. After the introduction of NPMPP, the increasing trend was accelerated for both the emergency medicines (coefficient = 0.114, P < 0.001) and gynaecological medicines (coefficient = 0.078, P < 0.05), whereas the increasing trend for paediatric medicines was slowed down after the intervention (coefficient = -0.024, P < 0.05). Conclusion: Using interrupted time series analysis, we identified a statistically significant increase in the price growth rate of emergency medicines and gynaecological medicines, but a statistically significant decrease in the price growth rate of paediatrics, following the introduction of NPMPP. The impact of NPMPP on emergency medicines was greater than that on gynaecological medicines. To inhibit the growth trend of drug price, effective policies need to be introduced.