Reports of low quality pharmaceuticals have been on the rise in the last decade with the greatest prevalence of substandard medicines in developing countries, where lapses in manufacturing quality control or breaches in the supply chain allow substandard medicines to reach the marketplace. Here, we describe inexpensive test cards for fast field screening of pharmaceutical dosage forms containing beta lactam antibiotics or combinations of the four first-line antituberculosis (TB) drugs. The devices detect the active pharmaceutical ingredients (APIs) ampicillin, amoxicillin, rifampicin, isoniazid, ethambutol, and pyrazinamide, and also screen for substitute pharmaceuticals such as acetaminophen and chloroquine that may be found in counterfeit pharmaceuticals. The tests can detect binders and fillers like chalk, talc, and starch not revealed by traditional chromatographic methods. These paper devices contain twelve lanes, separated by hydrophobic barriers, with different reagents deposited in the lanes. The user rubs some of the solid pharmaceutical across the lanes and dips the edge of the paper into water. As water climbs up the lanes by capillary action, it triggers a library of different chemical tests and a timer to indicate when the tests are completed. The reactions in each lane generate colors to form a “color bar code” which can be analyzed visually by comparison to standard outcomes. While quantification of the APIs is poor compared to conventional analytical methods, the sensitivity and selectivity for the analytes is high enough to pick out suspicious formulations containing no API or a substitute API, as well as formulations containing APIs that have been “cut” with inactive ingredients.

This cohort study examines the safety and efficacy of fully remote, asynchronous medication abortion care during the COVID-19 pandemic.

This cohort study evaluates the outcomes and safety of a history-based screening, no-test approach to medication abortion care.

BackgroundThis study was conducted to assess the efficacy and acceptability of using a multi-level pregnancy test (MLPT) combined with telephone follow-up for medical abortion in Tunisia, where the majority of providers are midwives.MethodsFour hundred and four women with gestational age ≤ 70 days’ LMP seeking medical abortion at six study sites were enrolled in this open-label trial. Participants administered a baseline MLPT at the clinic prior to mifepristone administration and were asked to take a second MLPT at home and to call in its results before returning the day of their scheduled follow-up visit 10-14 days later.ResultsAlmost all women with follow-up (97.1 %, n = 332/342) had successful abortions without the need for surgical intervention. The MLPT worked extremely well among women ≤63 days’ LMP in ruling out ongoing pregnancy (negative predictive value (NPV) =100 % (n = 298/298)) and also detecting women with ongoing pregnancies (sensitivity = 100 %; 2/2) as needing follow-up due to non-declining hCG. Among women 64-70 days’ LMP, the test also worked well in ruling out ongoing pregnancy (NPV = 96.9 % (n = 31/32) but not as well in terms of sensitivity (50 %), with only one of two ongoing pregnancies detected by MLPT as needing follow-up. Most women (95.1 %) found the MLPT to be very easy or easy to use and would consider using the MLPT again (97.4 %) if needed.ConclusionsSelf-administered pre and post MLPT are very easy for women to use and accurate in assessing medical abortion success up to 63 days’ LMP. MLPT use for medical abortion follow-up has the potential to facilitate task sharing services and eliminate the burden of routine in-person follow-up visits for the large majority of women. Additional research is warranted to explore the accuracy of the MLPT in identifying ongoing pregnancy among women with gestational ages > 63 days.Trial registrationThis study was registered on May 13, 2010, on clinicaltrials.gov as NCT01150279.

This paper used data from the Global Early Adolescent Study (GEAS) to provide a descriptive analysis of how early adolescents' social environments vary by sex across diverse cultural settings. Methods: The analyses were based on baseline data among 10e14-year old adolescents living in disadvantaged urban areas in seven sites: Kinshasa (DRC), Shanghai (China), Cuenca (Ecuador), Lampung, Semarang and Denpasar (Indonesia), and Flanders (Belgium). Except in Kinshasa where face-to face interviews were used, data were collected using self-administered surveys on mobile tablets. Social environments were measured by examining factors within five main domains, including the household and family, school, peers, neighborhoods, and the media. Site-specific descriptive analyses were performed, using Chi square tests and Student T-tests to identify sexdifferences in each site. Results: The majority of early adolescents lived in two-parent households, perceived their parents/ guardians cared and monitored them, had at least one friend, reported high educational aspirations, and perceived their neighborhoods as safe, socially cohesive, with a high level of social control. Yet, large gender and site differences were also observed. More girls reported same-sex friends and high levels of parental monitoring, while boys were more likely to have mixed-sex friends and spend greater amounts of time with friends. Adolescents in Kinshasa and Semarang watched the most TV per day, while higher proportions of adolescents in Flanders used social media on a daily basis. Significant gender differences in media use were also observed but varied according to site. Conclusions: Understanding how social contexts differ between boys and girls across sites has relevance for how we might examine gender attitude formations and subsequent health behaviors.