Pharmacoepidemiological analyses are needed as a background for evaluation of drug use and for making cost-effective priorities. Drug sales and prescription databases provide useful tools for analysis of drug consumption and expenditures. In this essay, an analysis of the sales and prescribing of proton pump inhibitors (PPIs), drugs used for acid related gastric disorders, are presented. Since 1996, the consumption of PPIs in Norway has increased by approximately 10 % per year, with esomeprazole as the most commonly used drug. An increasing number of individuals are using these drugs with considerable costs for the reimbursement schemes, e.g., in 2006 more than 450 million NOK. Verified reflux oesophagitis is the predominant indication for reimbursement prescribing. There are, however, indications of an overprescribing of PPIs. The prescribing in Norway is different from Denmark and Sweden, both regarding choice of drug and level of consumption. The prevalence of PPI use increased with age, reaching a maximum of nearly 12 % in the age groups 70-79 and 80-89 years of age. A considerable proportion is long-term users (&gt; 2 years). These groups have a high risk of polypharmacy treatment. Even though the PPIs have been on the market for many years, negative effects associated with long term use are being discussed and need to be further explored. Attention should be focused on the rational use of PPIs and not only on the reduction of costs for PPI therapy. / Farmakoepidemiologiske analyser er nødvendige som bakgrunn for å evaluere legemiddelbruk og gjøre kostnads-effektivitets prioriteringer. Databaser med informasjon om salg og forskrivning av legemidler er nyttige redskaper for slike analyser. I denne oppgaven presenteres en analyse av salgs- og forskrivningsdata for protonpumpehemmere, en legemiddelgruppe som brukes ved syrerelaterte gasterointestinale sykdommer. Forbruket av protonpumpehemmere i Norge har siden 1996 økt med 10 % per år, med esomeprazol som vanligste legemiddel. Et økende antall personer bruker disse legemidlene. Utgiftene for det offentlige trygdesystemet er omfattende, mer enn 450 millioner NOK i 2006. Verifisert spiserørbetennelse er den dominerende årsak til forskrivning angitt på reseptene. Det er indikasjoner på en for høy forskrivning av protonpumpehemmere. Forskrivningen i Norge er forskjellig fra Danmark og Sverige, både med hensyn på valg av legemiddel og forbruksnivå. Prevalens for bruk av protonpumpehemmere øker med alder og når et maksimum på nær 12 % av befolkningen i aldersgruppene 70-79 og 80-89 år. En betydelig andel bruker legemidlene over lengre tid (&gt; 2 år). Dette er grupper som bruker mange legemidler samtidig (polyfarmasi). Selv om protonpumpehemmerne har vært på markedet i mange år, diskuteres fortsatt negative følger av langtidsbruk og det er behov for å studere bruken nærmere. Oppmerksomheten bør rettes mot rasjonell bruk av disse legemidlene, ikke bare hvordan utgiftene til dem skal kunne reduseres. / <p>ISBN 978-91-85721-14-6</p>

This study describes the diachronic development of modality in South African English (henceforth SAfE) from the early 19th century up to its contemporary state (1820s to 1990s) in the registers of letters, news, fiction/narrative and non-fiction, on the basis of the theoretical framework of socio historical linguistics and the empirical approach of corpus linguistics. Both quantitative and qualitative analyses are conducted for modal and quasi-modal verbs, by means of the newly compiled historical corpus of SAfE and ICE-SA (with the addition of Afrikaans corpora for comparison). The study explores general frequency changes, register-internal changes and macro- and micro semantic changes, with the focus of the main semantic analysis more strongly on the obligation and necessity cluster1. A set of parameters is compiled for analysing the strength of obligation in the modals must and should, and the quasi-modal HAVE to, and is applied in the micro semantic analyses. The findings are compared with the trends for modality in other native English’s, such as American, British and Australian English (cf. e.g. Mair & Leech, 2006; Collins, 2009a; Leech, 2011), in an attempt to present a complete and comprehensive description of SAfE modality, as opposed to the traditional approach of focusing on peculiar features. It is reported that the trends of modality in SAfE correspond to those of other native varieties in some cases, but do not correspond in others. The modals of SAfE for example have declined more and the quasi-modals have increased less over the 20th century than in other native varieties of English. One particular case, in which SAfE is reported to be unique among other varieties, is the quantitative and qualitative trends for must, which has some implications for the manifestation of the democratisation process. Must in SAfE has not declined significantly over the 20th century (as it has in other native varieties) and has become less face threatening, since uses with a median (weaker) degree of force are just as frequent as those with a higher degree of force by the 1990s (unlike in other native varieties, where must has become restricted to high-degree obligative contexts). Based on socio historical, as well as linguistic evidence (on both quantitative and qualitative levels), language contact with Afrikaans is posited as the main influence for the increased use of must in contexts that are not face threatening. Extrapolating from the semantic findings, some new insights are offered regarding the phase in which SAfE finds itself within Schneider’s (2003) model of the evolution of New English’s, and some support is offered for Bekker’s (2012:143) argument that “SAfE is ...the youngest of the colonial varieties of English”, especially in the Southern Hemisphere. Ultimately, this thesis offers a piece in the larger puzzle that is SAfE, both in terms of linguistic (textual) and socio historical (contextual) aspects. / PhD (English), North-West University, Vaal Triangle Campus, 2014

This study describes the diachronic development of modality in South African English (henceforth SAfE) from the early 19th century up to its contemporary state (1820s to 1990s) in the registers of letters, news, fiction/narrative and non-fiction, on the basis of the theoretical framework of socio historical linguistics and the empirical approach of corpus linguistics. Both quantitative and qualitative analyses are conducted for modal and quasi-modal verbs, by means of the newly compiled historical corpus of SAfE and ICE-SA (with the addition of Afrikaans corpora for comparison). The study explores general frequency changes, register-internal changes and macro- and micro semantic changes, with the focus of the main semantic analysis more strongly on the obligation and necessity cluster1. A set of parameters is compiled for analysing the strength of obligation in the modals must and should, and the quasi-modal HAVE to, and is applied in the micro semantic analyses. The findings are compared with the trends for modality in other native English’s, such as American, British and Australian English (cf. e.g. Mair & Leech, 2006; Collins, 2009a; Leech, 2011), in an attempt to present a complete and comprehensive description of SAfE modality, as opposed to the traditional approach of focusing on peculiar features. It is reported that the trends of modality in SAfE correspond to those of other native varieties in some cases, but do not correspond in others. The modals of SAfE for example have declined more and the quasi-modals have increased less over the 20th century than in other native varieties of English. One particular case, in which SAfE is reported to be unique among other varieties, is the quantitative and qualitative trends for must, which has some implications for the manifestation of the democratisation process. Must in SAfE has not declined significantly over the 20th century (as it has in other native varieties) and has become less face threatening, since uses with a median (weaker) degree of force are just as frequent as those with a higher degree of force by the 1990s (unlike in other native varieties, where must has become restricted to high-degree obligative contexts). Based on socio historical, as well as linguistic evidence (on both quantitative and qualitative levels), language contact with Afrikaans is posited as the main influence for the increased use of must in contexts that are not face threatening. Extrapolating from the semantic findings, some new insights are offered regarding the phase in which SAfE finds itself within Schneider’s (2003) model of the evolution of New English’s, and some support is offered for Bekker’s (2012:143) argument that “SAfE is ...the youngest of the colonial varieties of English”, especially in the Southern Hemisphere. Ultimately, this thesis offers a piece in the larger puzzle that is SAfE, both in terms of linguistic (textual) and socio historical (contextual) aspects. / PhD (English), North-West University, Vaal Triangle Campus, 2014