<p>Non-adherence to medication is a major obstacle in the treatment of depression. The objectives of the present study were to explore the effect of two interventions aiming to increase antidepressant treatment adherence, and to examine long-term consequences and costs of depression in adherent and non-adherent primary care patients. </p><p>A randomised controlled design was used to assess the respective effects of a written educational adherence enhancing programme and therapeutic drug monitoring in patients with major depression treated with sertraline for 24 weeks. All patients were prospectively followed during two years. </p><p>Treatment adherence was found in 41% of the 1031 included patients. None of the interventions resulted in a significant increase in adherence rate. However, significantly more patients in the group receiving the written educational material had responded at week 24 as compared to patients in the control group. </p><p>The overall remission rate after two years was 68%. In total, 34% of the responders experienced at least one relapse. Response and remission rates at week 24, year 1 and year 2 were significantly higher in adherent as compared to non-adherent patients. No relationship between adherence and relapse rate was seen. </p><p>The mean total cost per patient during two years was KSEK 363 whereof indirect costs represented 87%. No significant differences in costs between intervention groups or between adherent and non-adherent patients could be demonstrated. However, the mean cost per patient was 39% lower for treatment responders as compared to non-responders. </p><p>Non-adherence was predicted by age below 35 or above 64 years, no concomitant medications, personality disorder, sensation seeking personality traits and substance abuse. </p><p>The results indicate a strong positive relationship between treatment adherence and clinical outcome. In addition, the study shows that depression is a costly disease and that certain patient characteristics predict non-adherence.</p>

Thesis (M. Pharm.)--North-West University, Potchefstroom Campus, 2008.

Non-adherence to medication is a major obstacle in the treatment of depression. The objectives of the present study were to explore the effect of two interventions aiming to increase antidepressant treatment adherence, and to examine long-term consequences and costs of depression in adherent and non-adherent primary care patients. A randomised controlled design was used to assess the respective effects of a written educational adherence enhancing programme and therapeutic drug monitoring in patients with major depression treated with sertraline for 24 weeks. All patients were prospectively followed during two years. Treatment adherence was found in 41% of the 1031 included patients. None of the interventions resulted in a significant increase in adherence rate. However, significantly more patients in the group receiving the written educational material had responded at week 24 as compared to patients in the control group. The overall remission rate after two years was 68%. In total, 34% of the responders experienced at least one relapse. Response and remission rates at week 24, year 1 and year 2 were significantly higher in adherent as compared to non-adherent patients. No relationship between adherence and relapse rate was seen. The mean total cost per patient during two years was KSEK 363 whereof indirect costs represented 87%. No significant differences in costs between intervention groups or between adherent and non-adherent patients could be demonstrated. However, the mean cost per patient was 39% lower for treatment responders as compared to non-responders. Non-adherence was predicted by age below 35 or above 64 years, no concomitant medications, personality disorder, sensation seeking personality traits and substance abuse. The results indicate a strong positive relationship between treatment adherence and clinical outcome. In addition, the study shows that depression is a costly disease and that certain patient characteristics predict non-adherence.

For many products, the adaptation to customer specifications is essential and requires flexible product design and manufacture while maintaining competitive pricing. Engineering design is often concerned with striking a good balance between product properties, e.g. performance, and the resources required to manufacture and assemble the product. When different courses of action are to be evaluated, even seemingly small changes in customer requirements, product design, and manufacturing properties have to be handled with caution. Small changes can entail products with: low level of conformability with the manufacturing system, highly increased cost, and extended manufacturing lead-time. For most companies, the manufacturing system is a valuable asset that is more or less fixed and only minor adaptations are allowed. This implies that the product design has to be adapted to the manufacturing system to a large extent. Design for producibility (DFP) is the process in which a systematic method is used to reach the required functional properties of the product at the same time as good compliance with the manufacturing system is ensured. The DFP process usually needs to involve several persons simultaneously for the purpose of sharing information and knowledge. For many manufacturing companies, the collaboration between engineering design and production engineering is a critical issue and they have to improve their methods and tools for ensuring and enhancing producibility. This can be achieved by introducing computer-supported design for producibility. The present research is intended to contribute to the development and utilisation of different application systems that can be used as such computer support. The aim is to provide companies with support in application system development and to show how different application systems can be used in a systematic way as means to ensure and enhance producibility. The competitive advantages to gain from introducing computer-supported design for producibility are: product designs with high level of conformability with the production system, shortened manufacturing lead-time, and decreased manufacturing cost. This work contributes to the achievement of these advantages by introducing a framework with principles and models supporting application systems development. Three types of application systems are presented and their practical usefulness is examined, showing practitioners how producibility aspects can be assessed systematically. The main scientific and theoretical contribution of the work comprises: the descriptions concerning how to structure and describe the product and product-related information (manufacturing requirements, costs, process plans and production resources), the foundation of different information models, and the clarification of the models’ interrelationships. This is perceived as a contribution to a better understanding of the domains and how they relate to each other.Design for producibility (DFP) is the process in which a systematic method is used to reach the required functional properties of the product at the same time as good compliance with the manufacturing system is ensured. The DFP process usually needs to involve several persons simultaneously for the purpose of sharing information and knowledge. For many manufacturing companies, the collaboration between engineering design and production engineering is a critical issue and they have to improve their methods and tools for ensuring and enhancing producibility. This can be achieved by introducing computer-supported design for producibility. The present research is intended to contribute to the development and utilisation of different application systems that can be used as such computer support. The aim is to provide companies with support in application system development and to show how different application systems can be used in a systematic way as means to ensure and enhance producibility.

Green Cargo är den största aktören för godstransporter på järnväg i Sverige. Dotterbolaget Road&amp;Logistics erbjuder kombinerade transporter bestående av järnväg och lastbil. Järnvägen utnyttjas för de långväga transporterna och lastbilarna för slingtrafiken. Med hjälp av crossdockingterminaler samlastas även gods från olika lastbärare till en enhet. Detta för att optimera kapacitetsutnyttjandet, vilket ger synergieffekter i form av miljövinster och sänkta kostnader. På senare år har olika verktyg utvecklats för att underlätta distributionsplaneringen. Simulering är ett exempel på ett modernt verktyg för att analysera befintliga eller tänkta system. Jag har utvärderat en befintlig simuleringsmodell och tagit reda på om den på kort sikt kunnat analysera behovet av resursanvändningen alternativt den optimala användningen av dessa i ett distributionsnät bestående av konfektion. Studien är geografiskt avgränsad till att enbart omfatta Stockholmsregionen, vilket innebär att lastbil är det enda transportmedlet som behandlas. I arbetet ingår butikskedjorna H&amp;M, KappAhl, Dressmann, Lindex och Fashionet. Fashionet är en portal med alla mindre konfektionsbutiker, som ingår i Green Cargo Road&amp;Logistics kundkrets. Efter genomförda simuleringar är slutsatsen att ett antal tekniska modifikationer måste göras för att modellen ska kunna bli användbar. Modellen är i grunden avsedd för operativ planering, samtidigt som det operativa användandet både är omständigt och tidskrävande. Därför skulle alternativ lösning kunna vara att utveckla olika scenarion som representerar typveckor. Transportplanerarens uppgift blir då att identifiera distributionen för närmaste timmen, dagen eller veckan och sedan jämföra detta med de på förhand skapade scenarion. På så sätt undviks själva simuleringsprocessen, inklusive inmatning av data. Tillämpningen av lämpligt optimeringsverktyg parallellt med simuleringen skulle vara ytterligare ett sätt att effektivisera planeringsarbetet. En oväntad positiv bieffekt var att ett antal svårupptäckta kodfel kunde identifieras och korrigeras, tack vare den noggranna verifikationen. I simuleringsprojektär tidspressen ofta så hög att detaljerade verifieringar inte kan göras.

La présente recherche nous a permis de voir de près les dessous d'un projet d'envergure métropolitaine, en l'occurrence le tronçon de l'Autoroute 25, et ses impacts, en particulier sur l'étalement urbain. L'étalement du territoire urbanisé au détriment du territoire agricole est une caractéristique des villes contemporaines. Il est aidé par l'utilisation de l'automobile comme moyen de transport. Les citadins s'installent en banlieue pour diverses raisons. L'éloignement de la banlieue dépend des moyens de transport, car sa localisation correspond à celle des réseaux routiers. C'est à partir de là que nous avons développé notre hypothèse de recherche qui suppose qu'un tronçon de cette envergure encouragera l'étalement urbain. Comme le tronçon se trouve dans la Communauté métropolitaine de Montréal (CMM), nous avons également analysé l'étalement urbain à l'échelle de la CMM, en observant de près quelques facteurs (indicateurs) qui y participent. Ensuite, nous nous sommes penchés sur le territoire limitrophe au tracé de l'Autoroute 25. Nous avons procédé par une étude comparative de deux périodes distinctes, 1999 et 2008, afin de voir les changements réalisés sur ce site. Le dernier volet de notre mémoire traite des intérêts économiques qui entourent le projet. Nous pensons que seuls de forts intérêts économiques peuvent expliquer l'acharnement de certains partis à le réaliser, malgré une opposition farouche de différents organismes. Nos recherches nous ont menés aux résultats suivants : Dans un premier temps, nos recherches, qui ont visé l'étalement au niveau de la zone limitrophe au tracé de l'Autoroute 25, nous ont aidés à découvrir que l'étalement urbain est déjà visible, puisque 10 % du territoire qui était jadis (1999) agricole est désormais urbanisé (2008). Dans un deuxième temps, nous avons constaté que de grosses sommes d'argent ont été investies dans la réalisation de ce projet. Ces intérêts économiques se présentent sous forme d'intérêts personnels (des particuliers) ou des collectivités locales. ______________________________________________________________________________ MOTS-CLÉS DE L’AUTEUR : Étalement urbain, intérêts économiques, cadre bâti, terres agricoles, terres urbanisées, banlieue, cité-jardin, la couronne sud, la couronne nord, mouvement de la population, centre-ville, expansion urbaine, réseau de transport

<p>Green Cargo är den största aktören för godstransporter på järnväg i Sverige. Dotterbolaget Road&Logistics erbjuder kombinerade transporter bestående av järnväg och lastbil. Järnvägen utnyttjas för de långväga transporterna och lastbilarna för slingtrafiken. Med hjälp av crossdockingterminaler samlastas även gods från olika lastbärare till en enhet. Detta för att optimera kapacitetsutnyttjandet, vilket ger synergieffekter i form av miljövinster och sänkta kostnader. </p><p>På senare år har olika verktyg utvecklats för att underlätta distributionsplaneringen. Simulering är ett exempel på ett modernt verktyg för att analysera befintliga eller tänkta system. </p><p>Jag har utvärderat en befintlig simuleringsmodell och tagit reda på om den på kort sikt kunnat analysera behovet av resursanvändningen alternativt den optimala användningen av dessa i ett distributionsnät bestående av konfektion. Studien är geografiskt avgränsad till att enbart omfatta Stockholmsregionen, vilket innebär att lastbil är det enda transportmedlet som behandlas. I arbetet ingår butikskedjorna H&M, KappAhl, Dressmann, Lindex och Fashionet. Fashionet är en portal med alla mindre konfektionsbutiker, som ingår i Green Cargo Road&Logistics kundkrets. </p><p>Efter genomförda simuleringar är slutsatsen att ett antal tekniska modifikationer måste göras för att modellen ska kunna bli användbar. Modellen är i grunden avsedd för operativ planering, samtidigt som det operativa användandet både är omständigt och tidskrävande. Därför skulle alternativ lösning kunna vara att utveckla olika scenarion som representerar typveckor. Transportplanerarens uppgift blir då att identifiera distributionen för närmaste timmen, dagen eller veckan och sedan jämföra detta med de på förhand skapade scenarion. På så sätt undviks själva simuleringsprocessen, inklusive inmatning av data. Tillämpningen av lämpligt optimeringsverktyg parallellt med simuleringen skulle vara ytterligare ett sätt att effektivisera planeringsarbetet. </p><p>En oväntad positiv bieffekt var att ett antal svårupptäckta kodfel kunde identifieras och korrigeras, tack vare den noggranna verifikationen. I simuleringsprojektär tidspressen ofta så hög att detaljerade verifieringar inte kan göras.</p>

Reproduction de : Thèse de doctorat : Économie appliquée : Lille 1 : 2006. / N° d'ordre (Lille 1) : 3941. Résumé en français et en anglais. Titre provenant de la page de titre du document numérisé. Bibliogr. p. 502-524.

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.