The commonest prescribed group of drugs is antimicrobials. Various studies have shown that they are overused globally. Since Primary health care represents the first tier of the health care system, evaluation of antimicrobial use in primary health w e settings is a necessity to ensure rational and cost-effective use of these agents in the treatment of infectious diseases. It has been reported by Hooton and Levy (2001 : 1088) that 20% to 50% of antimicrobials are inappropriately used in developing countries. According to Rebana et al. (1998: 175) the increasing overuse of antimicrobials has resulted in an enormous escalation in the total costs of drugs contributing to 15% to 30 % of the total health budget. Hooton and Levy (2001: 1087) reported in a study that inappropriate use and overuse of antimicrobials are risk factors for the emergence of antibiotic resistant bacteria. There is a high incidence of infectious diseases in developing countries that are due to the rapid spread of resistant strains through over-crowding, poor sanitation and unsafe sexual practices (Liu et al., 1999: 540). The general objective of the study was the analysis and interpretation of the usage and related costs of antimicrobial prescriptions in a private primary health w e setting in South Africa. The study is a non-experimental, quantitative, retrospective drug utilisation review of antimicrobial usage in a private primary health care setting. Data were obtained from the central database of a private primary health care service provider. Data of nine randomly selected clinics, situated in different geographical areas of South Africa, were extracted for the period 1st January to 31st December 2001. The study population was made of the total patient population of patients using antimicrobials during this one year period. Antimicrobial usage was analysed according to: number of patients, age and gender distribution, diagnosis, pharmacological groups. The total number of patients who visited the nine clinics during the year was 83 655 of which 59.50% were females and 40.22% males. In 0.28% of the cases gender was not indicated. Patients in age groups 6 (20-40 years) and 7 (40-60 years) accounted for the highest number of patients (66.31%, n = 54 964). A total of 515 976 medicine items costing R1 716 318.90 were prescribed, of these, 18.69%, (N=96 423) were antimicrobials costing 60.89%, (R1 045 108.00). Of the total number of patients that visited the nine clinics, 65.34% (N=54 663) were prescribed antimicrobials. The total number of diagnoses (140 723) where antimicrobials were prescribed accounted for 68.52% (N46 42 1). The highest number of antimicrobial prescriptions according to pharmacological and age groups were: penicillins followed by sulphonamides and tetracyclines. The diagnoses with the highest number of antimicrobial prescriptions were the respiratory tract infections (viral influenza, acute bronchitis and upper respiratory tract infection) and pelvic inflammatory disease The prescribing of antimicrobials in respiratory tract infections could indicate overuse and inappropriate use of these drugs. Because most of these infections are caused by viruses or other non-bacterial agents, are self limiting. Therefore, the use of antibiotics courses is neither necessary nor appropriate in these conditions. The overuse and inappropriate use of such drugs have an effect on the health of the patients needing cure, and the general budget on health care service. It is recommended that further studies are conducted on antimicrobial prescribing and use. / Thesis (M. Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2005.

Social perspectives on natural resources management have become an increasingly valuable part of natural resources management decision making, especially at the policy or governance level. However, due to the range of social contexts that can exist around management questions, not every technique for incorporating stakeholders into management is suited for every management problem. My research examines the social landscape around chronic wasting disease (CWD) management on the Canadian prairies in order to identify a way forward for stakeholder involvement in CWD management. CWD is a prion disease that results in neurodegeneration and death in cervids. CWD has the potential for broad social impact because it infects elk and deer, species which are both hunted and ranched. Furthermore, management and monitoring efforts in free-ranging cervids frequently incorporate hunting activity. Q methodology was used to survey stakeholders in Saskatchewan and Manitoba and synthesize perspectives about stakeholder understanding of CWD as a problem and preferences for potential solutions. The perspectives that emerged emphasized the importance of increasing knowledge about CWD and a generalized trust in government management, coupled with a desire for stakeholder consultation under the auspices of government leadership. I found that CWD management may not be ready for stakeholder spearheaded management activity due to ambivalence and uncertainty among stakeholders, but stakeholder involvement in CWD management can still offer valuable insight for managers. This is especially notable in light of the recent loss of Saskatchewan’s CWD monitoring program.

DM is a serious and complex public health problem in the U.S. The CDC (2013) estimated that 25.8 million people, or 8.3% of the U.S. population, were suffering from DM in 2011. DM can significantly affect patient’s quality of life. Additionally, DM places a significant economic burden on the U.S. healthcare system. Over the past two decades, DMPs have emerged as a promising intervention to improve health outcomes for patients suffering from chronic conditions, such as DM, and to bend the cost curve. DMP’s aim is to improve communication and follow-up so that patients can better manage their chronic condition(s) to avoid costly hospital stays and emergency room visits (Fireman, Bartlett, & Selby, 2004). The Georgia region of Kaiser Permanente (KPGA) is a fully integrated health system that serves 260,000 members at 28 medical offices along with two specialty offices in the metropolitan Atlanta area. The Center for Care Partnership, the population care division of KPGA, administers a chronic disease management program (DMP), Healthy Solutions (HS). HS exists to improve and maintain the health of chronically ill KPGA members, including patients diagnosed with diabetes mellitus (DM), by providing health coaches via telephone who counsel members on their specific chronic disease and aid members in starting or maintaining a physician approved self-care management plan. In order to determine the impact HS has on KPGA members with DM, an evaluation plan was created to evaluate the impact HS has on members’ glycated hemoglobin (A1C), blood pressure, and emergency department (ED) utilization. This capstone thoroughly details the proposed evaluation plan created for HS by using Robert Milstein and Scott Wetterhall’s six-step framework for program evaluation. Additionally, further evaluation questions are suggested and discussed in order to provide a more complete picture of program performance to stakeholders.

In South Africa, significant changes in health care have taken place since the first democratic elections in 1994. The change had lead to a position of integrated service delivery with specific reference to primary health care. Increasingly in developing countries, the private sector impacts significantly on the rights to education and the highest attainable standard of health. Inappropriate prescribing e.g. prescribing a drug without an acceptable indication, specifying an incorrect dosage, schedule or duration of treatment, duplicating therapeutic agents and prescribing drugs without adequate regard to potential interactions, can cause adverse outcomes, deplete health care resources, compromise the quality of care and possible increase in health costs. One approach monitoring prescribing practices is drug utilisation review. The general objective of this study was to review and interpret aspects of drug usage patterns in a private primary health care setting, with special reference to the top ten diagnoses made and the top twenty medicine items prescribed as well as the associated costs. A quantitative, retrospective drug utilisation review as well as certain aspects of managed and primary health care, pharmacoeconomics, pharmacoepidemiology, medicine formularies and standard treatment guidelines were reviewed in the literature as a base for the study. The results of the empirical study showed that 83648 patients consulted at the nine medicentres during the study period (1 January to 31 December 2001). A total number of 132591 patient visits (consultations) were made, 140723 medical conditions (diagnoses) performed and 516177 medicine items prescribed during the study period. Analysis of medicine usage patterns and associated costs of the top ten diagnoses made and top twenty medicine items prescribed in the study population, revealed the following: The top ten diagnoses determined accounted for 29.07% of the total number of diagnoses made, . a total medicine treatment cost accounting for 32.11% in the study population, . the top twenty medicine items determined accounted for 56.23% of the total medicine items prescribed and . a total medicine treatment cost accounting for 28.63% in the study population. The highest prevalence of diagnoses made and medicine items prescribed was found in age groups 4 and 5 (Le. patients between the ages of 19 to 40 years) and was also found to be more prevalent in the female than in the male population. In completion of the research, recommendations to review the medicentres medicine treatment protocols and on provision of primary health care education were made. Reference to the investigation of environmental factors is also made. / Thesis (M.Pharm.)--North-West University, Potchefstroom Campus, 2004.

Health is a fundamental human right. Access to health care, which includes providing a population with safe, effective, good quality drugs at the least possible cost, is a prerequisite to realising that right. Drugs or medicines play a fundamental role in the effectiveness, efficiency and responsiveness of health care systems. Drugs also constitute a major recurrent expense in both state-run and private sector health care. To ensure that health care workers prescribe the most cost-effective drugs through the essential drugs list, training, as well as evaluation and monitoring systems must be regarded as important elements of containing costs. Pharmaceutical benefit management programmes such as pharmacoeconomics, drug utilisation review (DUR), evidence-based medicine and disease management have emerged as tools to ensure cost-effective selection and use of drugs, particularly for chronic diseases. These managed care tools are often investigated to determine whether new technologies or interventions are appropriate and have "value". Affordable prices of medicines, on their own, however, do not ensure access to medicines. Also important are reliable procurement, distribution and storage systems, and appropriately trained personnel to manage these components of drug management. Poorly regulated drug supply systems can have serious consequences such as antibiotic resistance, problems with safety or quality and most importantly wastage, as it is believed that a significant proportion of drugs purchased by the state in South Africa find their way into the private sector market through a "grey market". The general objective of this study was to review and analyse the cost and medicine usage of the "top twenty" pharmaceutical products according to the monthly pharmaceutical purchasing reports of the Department of Health in the North West Province. The research can be classified as retrospective and quantitative. The data used for the analysis were obtained over a two-year study period (1 Apr 2000 - 28 Feb 2002) from the private provider operating the medical stores in the North West Province. The results of the empirical investigation, showed the total number of "top twenty" products appearing during the study period amounted to 460 different products having a total purchasing cost of R 66,263,674.51 representing 37.2% (n = R 178,163,061.50) of all pharmaceutical products purchased during the two-year period. Through analysis it was found, when classified according the Anatomical Therapeutic Chemical (ATC) therapeutic main group, antihypertensives had the highest quantity purchased for year one (20.69%; n = 134,515,640) with cough and cold preparations revealing the highest purchasing quantity for year two (40.55%; n = 103,567,031) of all "top twenty" pharmaceuticals during the study period. Antibacterials for systemic use presented with the highest cost percentages for both years, representing 20.68% (n = R35, 568,221.31) and 16.72% (n = R 31,370,435.51) respectively. Hydrochlorothiazide presented with the highest purchasing quantity for both years when classified according to chemical substance with, Methyldopa having the highest purchasing cost for year one followed by vaccine Hib-DTP 10 dose vial (Haemophilus influenzae type B vaccine-diphtheria, pertusis and tetanus vaccine) for year two. Furthermore it was also found that the majority of the "top twenty" products were in the oral dosage form. Finally it was concluded that drugs used in the treatment of hypertension and cardiac failure were the most utilised in comparison to other "top twenty" products during the study period. Possible misappropriation based on the defined daily dose of the "top twenty" products might have occurred. In completion of this study, recommendations for future research were made. / Thesis (M.Pharm.)--North-West University, Potchefstroom Campus, 2004.

The commonest prescribed group of drugs is antimicrobials. Various studies have shown that they are overused globally. Since Primary health care represents the first tier of the health care system, evaluation of antimicrobial use in primary health w e settings is a necessity to ensure rational and cost-effective use of these agents in the treatment of infectious diseases. It has been reported by Hooton and Levy (2001 : 1088) that 20% to 50% of antimicrobials are inappropriately used in developing countries. According to Rebana et al. (1998: 175) the increasing overuse of antimicrobials has resulted in an enormous escalation in the total costs of drugs contributing to 15% to 30 % of the total health budget. Hooton and Levy (2001: 1087) reported in a study that inappropriate use and overuse of antimicrobials are risk factors for the emergence of antibiotic resistant bacteria. There is a high incidence of infectious diseases in developing countries that are due to the rapid spread of resistant strains through over-crowding, poor sanitation and unsafe sexual practices (Liu et al., 1999: 540). The general objective of the study was the analysis and interpretation of the usage and related costs of antimicrobial prescriptions in a private primary health w e setting in South Africa. The study is a non-experimental, quantitative, retrospective drug utilisation review of antimicrobial usage in a private primary health care setting. Data were obtained from the central database of a private primary health care service provider. Data of nine randomly selected clinics, situated in different geographical areas of South Africa, were extracted for the period 1st January to 31st December 2001. The study population was made of the total patient population of patients using antimicrobials during this one year period. Antimicrobial usage was analysed according to: number of patients, age and gender distribution, diagnosis, pharmacological groups. The total number of patients who visited the nine clinics during the year was 83 655 of which 59.50% were females and 40.22% males. In 0.28% of the cases gender was not indicated. Patients in age groups 6 (20-40 years) and 7 (40-60 years) accounted for the highest number of patients (66.31%, n = 54 964). A total of 515 976 medicine items costing R1 716 318.90 were prescribed, of these, 18.69%, (N=96 423) were antimicrobials costing 60.89%, (R1 045 108.00). Of the total number of patients that visited the nine clinics, 65.34% (N=54 663) were prescribed antimicrobials. The total number of diagnoses (140 723) where antimicrobials were prescribed accounted for 68.52% (N46 42 1). The highest number of antimicrobial prescriptions according to pharmacological and age groups were: penicillins followed by sulphonamides and tetracyclines. The diagnoses with the highest number of antimicrobial prescriptions were the respiratory tract infections (viral influenza, acute bronchitis and upper respiratory tract infection) and pelvic inflammatory disease The prescribing of antimicrobials in respiratory tract infections could indicate overuse and inappropriate use of these drugs. Because most of these infections are caused by viruses or other non-bacterial agents, are self limiting. Therefore, the use of antibiotics courses is neither necessary nor appropriate in these conditions. The overuse and inappropriate use of such drugs have an effect on the health of the patients needing cure, and the general budget on health care service. It is recommended that further studies are conducted on antimicrobial prescribing and use. / Thesis (M. Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2005.

This dissertation proposes principles for the design of ubiquitous health monitoring applications that support reflection and learning in context of diabetes management. Due to the high individual differences between diabetes cases, each affected individual must find the optimal combination of lifestyle alterations and medication through reflective analysis of personal diseases history. This dissertation advocates using technology to enable individuals' proactive engagement in monitoring of their health. In particular, it proposes promoting individuals' engagement in reflection by exploiting breakdowns in individuals' routines or understanding; supporting continuity in thinking that leads to a systematic refinement of ideas; and supporting articulation of thoughts and understanding that helps to transform insights into knowledge. The empirical evidence for these principles was gathered thought the deployment studies of three ubiquitous computing applications that help individuals with diabetes in management of their diseases. These deployment studies demonstrated that technology for reflection helps individuals achieve their personal disease management goals, such as diet goals. In addition, they showed that using technology helps individuals embrace a proactive attitude towards their health indicated by their adoption of the internal locus of control.

Thesis (Ph. D.)--University of Alabama at Birmingham, 2008. / Title from first page of PDF file (viewed Feb 11, 2009). Includes bibliographical references (p. 73-94).

Risk factors for psychological insult following deployment to Operation Enduring Freedom or Operation Iraqi Freedom among veterans: A systematic review: The systematic review aimed to establish more clearly the risk factors for mental health problems in the veteran population. Five databases were searched. Included studies (n = 10) required that veterans served in Operation Enduring Freedom (OEF) and/or Operation Iraqi Freedom (OIF) and included risk factors of mental health problems among the veteran population. Data from included studies were extracted and critically appraised based on critical appraisal tools following a narrative approach to synthesise data. All of the studies reviewed identified risk factors, although due to their heterogeneous nature key findings varied considerably. However, it was consistently reported that combat exposure and deployment experiences were associated with emergence of post operational mental health problems. The current review provides preliminary evidence that there are a number of specific risk factors that may increase susceptibility to mental health problems subsequent to military deployment. It is suggested that interventions are needed in order to mitigate risk factors and bolster protective factors. A cross-sectional study investigating the impact of disease activity and disease related cognitions on adjustment in Inflammatory Bowel Disease: The research journal aimed to investigate the degree to which psychological illness related cognitions will mediate the effect of disease activity on Quality of Life (QoL). In addition, to assess the impact of disease activity, and several psychological factors, in several adjustments outcomes in IBD to see whether the adjustment variables are significant predictors of multiple outcomes. Mediation was used followed by an exploratory cross-sectional correlational design. Three hundred and thirty eight participants were recruited through an IBD charity and invited to respond to a self-report questionnaire online. Measures targeted different aspects of the IBD profile to give an indication of adjustment associated with IBD diagnosis, psychological factors and Quality of Life (QoL). Mediation analysis found support for significant indirect effects on the relationship between disease activity and QoL through Gastrointestinal (GI) anxiety, perceived disability and illness representations. The subsidiary analysis indicated that pain catastrophising, disease activity, stigma, illness representations and GI anxiety were found to be significant predictors of adjustment in IBD. The results indicate that there is an important relationship with the adjustment factors, QoL, and psychological functioning. In addition, stress, depression, anxiety and QoL were found to be predicted by the adjustment factors. The current study has provided insight into psychological factors and adjustment indicators from a multi-faceted perspective, which will facilitate advancement of managing IBD from a biopsychosocial framework with a view to enable more effective disease management.

Target spot is a foliar disease of soybean that can produce yield losses. The disease has recently become a concern due to increasing intensity of its epidemics in the main soybean growing countries (USA, Brazil and Argentina). The goals of this study were to i) estimate the target spot control efficiency and yield response of labeled fungicides for the main soybean growing region of Brazil and identify factors affecting their performance; ii) characterize the relationship between target spot severity and soybean yield using meta-analytic techniques, and to identify patterns which allow understanding the heterogeneity in the relationship; iii) to explore the variability of genetic resistance of cultivars and verify the less time-consuming methodology for doing it; iv) explore the pathogen-host interaction effects on the epidemic development; v) compare the sensitiveness of the canopy strata position injured by C. cassiicola to reduce grain yield. Fungicides containing fluxapyroxad + pyraclostrobin were the most efficient ones to control target spot, with control levels of 75% and their yield response depended on the disease pressure (DP, DPLow < 35% target spot severity at untreated checks <= DPHigh). At DPLow was unprofitable the use of fungicides and at DPHigh the latter fungicides had the best performances increasing yield relative to the untreated check in > 469 kg ha-1 (+19.1%). Potential yield of soybean in absence of target spot was estimated in 3507 kg ha-1 for 41 trials in Brazil and the percentual reduction for each target spot severity point was calculated in 0.48%, what would represent a reduction of 24% in a hypothetical target spot severity of 50% (ranging from 8% to 42%). The soybean cultivar had a significant effect to explain this wide range of responses: potential losses of 11%, 18.5% and 42% was calculated for cultivar BMX Potência RR, TMG803 and M9144RR respectively at target spot severity = 50%. We observed high variability on the genetic resistance in the tested germplasm: cultivars with very low target spot intensity (BRS360) to highly susceptible cultivars. A single-point disease severity assessment was not as reliably as an integrative three-point assessment, which had no difference with a less time-consuming two-point disease assessment. In trials where 3 C.cassicola isolates from different regions of Brazil were inoculated individually on 3 soybean cultivars contrasting in their resistance level we observed that the incubation period, disease severity, lesion density and lesion size at 14 days after inoculation, were influenced by the cultivar and not by isolate geographical origin. Using disease severity coupled with defoliation assessments throughout the reproductive growth stages, we performed correlations between grain yield and the leaf area injury at different plant positions - growth stages. The best correlation was observed with the assessments at R5.5 for injuries at middle canopy section. / A mancha alvo é uma doença foliar que pode ocasionar perdas de rendimento na cultura da soja. A doença tornou-se recentemente uma preocupação nos principais países produtores de soja (EUA, Brasil e Argentina), devido à crescente intensidade de suas epidemias. Os objetivos deste estudo foram: i) estimar a eficiência de controle da mancha alvo por fungicidas comerciais registrados no Brasil e a resposta em rendimento da soja, identificando fatores que afetam o desempenho dos fungicidas; ii) caracterizar a relação entre a severidade da mancha alvo e o rendimento da soja, utilizando técnicas meta-analíticas e identificar padrões que permitam compreender a heterogeneidade existente nessa relação; iii) explorar a variabilidade da resistência genética de cultivares de soja e verificar a metodologia mais eficiente para discriminar cultivares suscetíveis de resistentes; iv) explorar os efeitos da interação entre a origem do isolado de C. cassiicola e a cultivar de soja no desenvolvimento da epidemia; v) comparar a sensibilidade da posição do estrato do dossel afetado por C. cassiicola na redução do rendimento de grãos. Fungicidas compostos pelos ingredientes ativos fluxapyroxad + piraclostrobina foram os mais eficientes para controlar a mancha alvo, com níveis de controle de até 75%, e sua resposta ao rendimento dependeu da pressão da doença (PD, PDbaixa < 35% de severidade da mancha alvo na testemunha não tratada <= PDalta). Na PDbaixa, a aplicação de fungicidas não foi lucrativa, e em PDalta os fungicidas compostos por fluxapyroxad + piraclostrobina apresentaram os melhores desempenhos, superando o rendimento em relação à testemunha em 469 kg ha-1 (+ 19,1%). O rendimento potencial geral da soja, na ausência da mancha alvo, foi estimado em 3507 kg ha-1 para 41 ensaios distribuídos no Brasil. A redução no rendimento para cada ponto percentual de incremento na severidade da mancha alvo foi calculada em 0,48%. Com isso, níveis (hipotéticos) de severidade de mancha alvo de 50% ocasionariam uma redução de rendimento de 24% (variando entre 8% a 42%). A cultivar de soja teve um efeito significativo para explicar esta grande amplitude de respostas: reduções potenciais (com 50% de severidade) de 11%, 18,5% e 42% foram calculadas, respectivamente, para as cultivares BMX Potência RR, TMG803 e M9144RR. Foi constatada alta variabilidade na resistência genética no germoplasma testado, desde cultivares com intensidade de mancha alvo muito baixa (BRS360) até cultivares altamente suscetíveis. Avaliações da severidade da doença em uma única data não foi tão confiável quanto a avaliação integrada de duas ou três datas. Em experimentos onde 3 isolados de diferentes regiões do Brasil foram inoculados isoladamente em 3 cultivares contrastantes nos níveis de resistência, observou-se que o período de incubação, a severidade da doença, a densidade de lesões e o tamanho das lesões aos 14 dias após a inoculação foram influenciados pela cultivar. Porém, não foi observado efeito da origem geográfica do isolado de C. cassiicola nos componentes monocíclicos avaliados. A severidade da doença em diferentes posições da planta, juntamente com as avaliações de desfolha ao longo dos estádios de crescimento reprodutivo da soja, foi correlacionada ao rendimento de grãos. A melhor correlação entre o rendimento de grãos e a intensidade da doença (severidade + desfolha) foi observada nas avaliações em R5.5 na seção média do dossel.