The aim of the study was to evaluate type 2 diabetes mellitus (DM) medicine management in Government Clinics in Maseru, Lesotho. A two-dimensional research method was employed, consisting of a literature review and an empirical investigation. The objective of the literature review was to provide information on the pathophysiology, signs and symptoms, diagnosis, treatment and clinical management of DM. The empirical investigation consisted of a descriptive pharmacoepidemiological study, in which data for analysis was collected retrospectively from patients‘ medical records (―bukanas‖) at dispensing points, a using data collection tool. The selected study sites were Domiciliary Health Center, Mabote, Likotsi, and Qoaling filter clinics in Maseru district of Lesotho. Data on costs of antidiabetic agents was collected from purchase invoices provided by the pharmacy department of Domiciliary Health Center. Results showed that the overall ratio of males to females was 1.3. There were no statistical difference in DM prevalence between males and females in the different clinics (p = 0.48). The mean age of males and females was 57.5 ± 14.2 years and 58.6 ± 11.3 years, respectively (Cohen‘s d = 0.07). DM was more prevalent in patients 59 to 69 years for both males and females, with the exception of Mabote and Qoaling filter clinics, where DM was more prevalent in patients 49 to 59 years. These differences in prevalence were not statically significant. Overall, 20% (n = 69) of the study sample had DM alone, while 80.0% of patients had DM concurrently with hypertension. The odds ratio implicated that women were 1.7 times more likely to have hypertension concurrently with Type 2 Diabetes Mellitus. The mean blood glucose level at 95% confidence interval for females and males were 10.1 ± 5.9 mmol/L (95% CI: 10.1–11.7) and 10.9 ± 6.2 mmol/L (95% CI: 11.0–14.0) respectively. The difference in the mean blood glucose levels of males vs. females was not statistically significant (p = 0.07). In both males and females there were outliers as high as 33.3 mmol/L. Metformin 850 mg given three times, metformin 500 mg three times a day, glibenclamide 10 mg daily and glibenclamide 5 mg twice daily are oral hypoglycaemic agents that were first, second, third and fourth choice treatment of DM at all four study sites at a frequency of 54.2% (n = 160), 27.7% (n = 82), 4% (n = 12) and 2.7% (n = 27), respectively. Actraphane® 20 units in the morning and 10 units in the evening was prescribed at a frequency of 11.6% (n = 432) in comparison to other Actraphane®-containing regimens. The frequencies of prescribing metformin and Actraphane® as combination therapies represented 10.6% (n = 40), 7.1% (n = 27), and 6.6% (n = 25), respectively, for Actraphane® 20 units in the morning and 10 units in the evening, plus metformin 500 mg three times per day; Actraphane® 20 units in the morning and 10 units in the evening plus metformin 850 mg three times per day; and Actraphane® 30 units in the morning and 15 units in the evening plus metformin 850 mg three times per day. The combination therapy of metformin and glibenclamide were prescribed at frequencies of 24.6% (n = 172), 22.9% (n = 160), and 13.4% (n = 94) respectively for glibenclamide 10 mg daily plus metformin 850 mg three times per day, glibenclamide 5 mg daily plus metformin 850 mg three times per day, and glibenclamide 5 mg once a day plus metformin 500 mg three times per day as first, second and third choice treatments at all study sites. The total cost incurred for all the oral drugs prescribed alone within different regimens was M75.6 with the weighted average cost per patient of M0.81 ± 2.06 per day compared to the cost of Actraphane® which was M40 660.52 per month at a weighted average daily cost of M21.43 ± 6.23 per patient. The overall cost of Actraphane® and metformin combination therapy amounted to M50 676.50, at an average cost per patient of M21.77 ± 6.80 per day. The cost of combination therapy consisting of metformin and glibenclamide amounted to M377.10, at a weighted average cost amounting to M0.49 ± 0.16 per patient, per day. Based on the results of this study some conclusions were reached on the prevalence of DM, prescribing patterns and the cost of antidiabetic agents. Recommendations pertaining to the clinics and further research were made. / MPham (Pharmacy Practice), North-West University, Potchefstroom Campus, 2014

HIV/AIDS is already the leading cause of death worldwide (Unicef et al., 2004:10) with more than 5 million people out of a total of 46 million South Africans that were HIV positive in 2004, giving a total population prevalence rate of 11 per cent (Dorrington et al., 2004:1). Many people infected do not have access to even the basic drugs needed to treat HIV-related infections and other conditions (Wikipedia, 2004:3). The relative high price of many of the antiretroviral (ARV) drugs and diagnostics on the other hand are one of the main barriers to their availability in developing countries (Unicef et al., 2004:77). ARV drugs registered in South Africa include the Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs), Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs) and Protease Inhibitors (PIs) (MCC, 2004:1). The objective of this study was to review, analyse and interpret the prescribing patterns of antiviral drugs, with special reference to antiretroviral drugs, in the private health care sector in South Africa by using a medicine claims database. A quantitative, retrospective drug utilisation review was performed. The data ranging from 1 January 2001 to 31 December 2001, 1 January 2002 to 31 December 2002, and 1 January 2004 to 31 December 2004 were used, dividing each year into three four-month periods, namely January to April, May to August, and September to December. It was found that 0.38 per cent (n=1 475 380) for 2001, 0.72 per cent (n=2 076 236) for 2002, and 1.68 per cent (n=2 595 254) for 2004 of all studied prescriptions for the research periods 2001, 2002, and 2004 respectively, contained ARV drugs. ARV drugs constituted 0.33 per cent (n=2 951 326) for 2001, 0.87 per cent (n=4 042 145) for 2002, and 1.92 per cent (n=5 305 882) for 2004 of the total number of medicine items prescribed for the study years 2001, 2002 and 2004 respectively. The total cost of ARV drugs amounted to R4 990 784.29, thus constituting 1.31 per cent of the total cost (R379 708 489) of all medicine items on the database for 2001, increased to R18 235 075.75, thus constituting 3.03 per cent of the total cost (R601 350 325) of all medicine items on the database for 2002, and increased to R34 714 483.64, thus constituting 5.25 per cent of the total cost (R661 223 146) of all medicine items on the database for 2004. It was found that 35.31 per cent (n=5 599) for 2001, 52.68 per cent (n=15 004) for 2002, and 74.27 per cent (n=43 482) for 2004 of all studied antiviral prescriptions for the research periods 2001, 2002, and 2004 respectively, contained ARV drugs. ARV drugs constituted 46.25 per cent (n=21 183) for 2001, 70.20 per cent (n=50 246) for 2002, and 85.87 per cent (n=118 718) for 2004 of the total number of antiviral medicine items prescribed for the study years 2001, 2002 and 2004 respectively. The total cost of ARV medicine items, represented 67.33 per cent (n=R4 990 784.29) during 2001, 84.72 per cent (n=R18 235 075.75) during 2002, and 91.20 per cent (n=R34 714 483.64) during 2004 of the total cost of all antiviral medicine items claimed through the database (n=R7412577.73 for 2001, n=R21523365.56 for 2002, and n=R38 064 347.38 for 2004). The average cost per ARV medicine items for 2004 increased from R317.93i190.80 for the period January to April to R369.2W219.50 for the period May to August, and decreased to R324.79±212.48 for the period September to December and resulted in a cost saving of R41 044.35 for the period May to August versus September to December for the ARV medicine items. The implementation of the pricing regulations could thus be a possible reason for this cost saving, due to fact that the single exit price only came into effect from May 2004. The weighted average number of ARV medicine items per prescription was 1.75*0.31 for 2001, increased to 2.35±0.03 to 2002 and remained stable on 2.35±0.02 for 2004. It was found that majority of prescriptions contained more combination ARV medicine items than single ARV medicine items, ranging from 6 834 (69.76 per cent; n=9 796) prescriptions containing combination ARV medicine items in 2001 and 32 941 (93.39 per cent; n=35 271) prescriptions containing combination ARV medicine items in 2002 to 98 805 (96.93 per cent; n=101 938) prescriptions containing combination ARV medicine items in 2004. Lastly, it was perceived that didanosine was the active ingredient with the largest prevalence for all three four-month periods of 2001 and also for the periods January to April and May to August of 2002, whilst efavirenz represented the active ingredient with the largest prevalence for the period September to December of 2002, and also for all three four-month periods of 2004. Didanosine represented the active ingredient with the highest total cost for the period January to April of 2001, whilst the combination of lamivudine/zidovudine represented the active ingredient with the highest total cost for the periods May to August and September to December of 2001, and also for all three-four month periods of 2002 and 2004. Nelfinavir has the highest average cost for period January to April of 2001, ritonavir for period May to August of 2001, and saquinavir mesylate for period September to December of 2001. Nelfinavir has the highest average cost for all three-four month periods of 2002, while didanosine has the highest average cost for all three four-month periods of 2004. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2006

Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2006.

The global anti-dyslipidemic market grew by 19% from 2000 to 2001, achieving sales of over $21 billion (Smith, 2004: 2). This market is currently well sewed by a number of effective and well-tolerated treatments. Lipid-lowering drugs are considered as the first choice drugs in control of dyslipidemias and they are well tolerated by most patients. As with many drug therapies, there should be a balance between the benefits of cholesterol lowering agents, increased medication cost and the overall risk of adverse drug reactions. According to Ballesteros (2001: 514), hypolipidemic drugs are consumed on a large scale and most consumers are elderly. This warrants a study of expenditure incurred because of inadequate prescribing of these agents. The general objective of this study was to determine the utilisation and cost of hypolipidemic drugs in the private health care environment in South Africa. A quantitative retrospective drug utilisation review was performed using a medicine claims database. Data for twenty-four consecutive months (May 1, 2001 to April 30, 2003) were used to determine and compare the utilisation patterns and cost of drugs associated with the management of dyslipidemia a year before (1st May 2001 to 30 April 2002) and a year after (1st May 2002 to 30 April 2003) the implementation of a medicine reference price system (MPL). Data analysis was done by calculating the average value, the standard deviation, effect size, and cost-prevalence indices. The results of this study revealed that hypolipidemic drugs constituted 2.70% (n = 21820911) and 2.78% (n =27277825) of the total number of all medicine items for the first and the second study years respectively. On the other hand, the total cost of all hypolipidemic drugs accounted for 6.33% (n= R3 097 604 602) and 6.23 % (n= R 4 053 280 295) of the total cost of all medicine items claimed during the first and the second study years respectively. The prevalence of generic hypolipidemic drugs accounted for 0.89% (n=589036) and 4.88% (n=759675) of the total number of hypolipidemic drugs claimed during the first and second study year respectively. Innovator drugs, on the other hand, constituted 99.1 1% (n=589036) and 95.11% (n=759675) of the total number of hypolipidemic drugs claimed during the first and second study years respectively. It was found that R23 694.5 and R603 277.36 could have been saved for generic bezafibrate and generic simvastatin respectively if they had been sold at ME'L prices. The total cost of generic hypolipidemic drugs accounted for 0.60% and 2.94%. The total cost of innovator hypolipidemic drugs accounted for 99.40% and 97.06% of the total cost of hypolipidemic drugs claimed during the first (n=R 196 076 050) and second (n=R 252 919 285) study year respectively. With respect to the prescribed daily dose, it was found that most prescriptions for individual hypolipidemic drugs did not conform to the defined daily dose. It was, however, found that most prescriptions whose prescribed daily dose was for one tablet once daily and whose strength was similar to the defined daily dose conformed to the defined daily dose. The conclusion is that there was an insignificant difference in both the prevalence and cost of hypolipidemic drugs a year before and after the implementation of MPL. It was further concluded that increased utilisation of generic hypolipidemic medicine items a year after the implementation of the MPL, could have been brought about by the introduction of generic simvastatin into the market as opposed to the implementation of the MPL. Recommendations for further studies will be formulated. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2005.

The global anti-dyslipidemic market grew by 19% from 2000 to 2001, achieving sales of over $21 billion (Smith, 2004: 2). This market is currently well sewed by a number of effective and well-tolerated treatments. Lipid-lowering drugs are considered as the first choice drugs in control of dyslipidemias and they are well tolerated by most patients. As with many drug therapies, there should be a balance between the benefits of cholesterol lowering agents, increased medication cost and the overall risk of adverse drug reactions. According to Ballesteros (2001: 514), hypolipidemic drugs are consumed on a large scale and most consumers are elderly. This warrants a study of expenditure incurred because of inadequate prescribing of these agents. The general objective of this study was to determine the utilisation and cost of hypolipidemic drugs in the private health care environment in South Africa. A quantitative retrospective drug utilisation review was performed using a medicine claims database. Data for twenty-four consecutive months (May 1, 2001 to April 30, 2003) were used to determine and compare the utilisation patterns and cost of drugs associated with the management of dyslipidemia a year before (1st May 2001 to 30 April 2002) and a year after (1st May 2002 to 30 April 2003) the implementation of a medicine reference price system (MPL). Data analysis was done by calculating the average value, the standard deviation, effect size, and cost-prevalence indices. The results of this study revealed that hypolipidemic drugs constituted 2.70% (n = 21820911) and 2.78% (n =27277825) of the total number of all medicine items for the first and the second study years respectively. On the other hand, the total cost of all hypolipidemic drugs accounted for 6.33% (n= R3 097 604 602) and 6.23 % (n= R 4 053 280 295) of the total cost of all medicine items claimed during the first and the second study years respectively. The prevalence of generic hypolipidemic drugs accounted for 0.89% (n=589036) and 4.88% (n=759675) of the total number of hypolipidemic drugs claimed during the first and second study year respectively. Innovator drugs, on the other hand, constituted 99.1 1% (n=589036) and 95.11% (n=759675) of the total number of hypolipidemic drugs claimed during the first and second study years respectively. It was found that R23 694.5 and R603 277.36 could have been saved for generic bezafibrate and generic simvastatin respectively if they had been sold at ME'L prices. The total cost of generic hypolipidemic drugs accounted for 0.60% and 2.94%. The total cost of innovator hypolipidemic drugs accounted for 99.40% and 97.06% of the total cost of hypolipidemic drugs claimed during the first (n=R 196 076 050) and second (n=R 252 919 285) study year respectively. With respect to the prescribed daily dose, it was found that most prescriptions for individual hypolipidemic drugs did not conform to the defined daily dose. It was, however, found that most prescriptions whose prescribed daily dose was for one tablet once daily and whose strength was similar to the defined daily dose conformed to the defined daily dose. The conclusion is that there was an insignificant difference in both the prevalence and cost of hypolipidemic drugs a year before and after the implementation of MPL. It was further concluded that increased utilisation of generic hypolipidemic medicine items a year after the implementation of the MPL, could have been brought about by the introduction of generic simvastatin into the market as opposed to the implementation of the MPL. Recommendations for further studies will be formulated. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2005.

HIV/AIDS is already the leading cause of death worldwide (Unicef et al., 2004:10) with more than 5 million people out of a total of 46 million South Africans that were HIV positive in 2004, giving a total population prevalence rate of 11 per cent (Dorrington et al., 2004:1). Many people infected do not have access to even the basic drugs needed to treat HIV-related infections and other conditions (Wikipedia, 2004:3). The relative high price of many of the antiretroviral (ARV) drugs and diagnostics on the other hand are one of the main barriers to their availability in developing countries (Unicef et al., 2004:77). ARV drugs registered in South Africa include the Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs), Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs) and Protease Inhibitors (PIs) (MCC, 2004:1). The objective of this study was to review, analyse and interpret the prescribing patterns of antiviral drugs, with special reference to antiretroviral drugs, in the private health care sector in South Africa by using a medicine claims database. A quantitative, retrospective drug utilisation review was performed. The data ranging from 1 January 2001 to 31 December 2001, 1 January 2002 to 31 December 2002, and 1 January 2004 to 31 December 2004 were used, dividing each year into three four-month periods, namely January to April, May to August, and September to December. It was found that 0.38 per cent (n=1 475 380) for 2001, 0.72 per cent (n=2 076 236) for 2002, and 1.68 per cent (n=2 595 254) for 2004 of all studied prescriptions for the research periods 2001, 2002, and 2004 respectively, contained ARV drugs. ARV drugs constituted 0.33 per cent (n=2 951 326) for 2001, 0.87 per cent (n=4 042 145) for 2002, and 1.92 per cent (n=5 305 882) for 2004 of the total number of medicine items prescribed for the study years 2001, 2002 and 2004 respectively. The total cost of ARV drugs amounted to R4 990 784.29, thus constituting 1.31 per cent of the total cost (R379 708 489) of all medicine items on the database for 2001, increased to R18 235 075.75, thus constituting 3.03 per cent of the total cost (R601 350 325) of all medicine items on the database for 2002, and increased to R34 714 483.64, thus constituting 5.25 per cent of the total cost (R661 223 146) of all medicine items on the database for 2004. It was found that 35.31 per cent (n=5 599) for 2001, 52.68 per cent (n=15 004) for 2002, and 74.27 per cent (n=43 482) for 2004 of all studied antiviral prescriptions for the research periods 2001, 2002, and 2004 respectively, contained ARV drugs. ARV drugs constituted 46.25 per cent (n=21 183) for 2001, 70.20 per cent (n=50 246) for 2002, and 85.87 per cent (n=118 718) for 2004 of the total number of antiviral medicine items prescribed for the study years 2001, 2002 and 2004 respectively. The total cost of ARV medicine items, represented 67.33 per cent (n=R4 990 784.29) during 2001, 84.72 per cent (n=R18 235 075.75) during 2002, and 91.20 per cent (n=R34 714 483.64) during 2004 of the total cost of all antiviral medicine items claimed through the database (n=R7412577.73 for 2001, n=R21523365.56 for 2002, and n=R38 064 347.38 for 2004). The average cost per ARV medicine items for 2004 increased from R317.93i190.80 for the period January to April to R369.2W219.50 for the period May to August, and decreased to R324.79±212.48 for the period September to December and resulted in a cost saving of R41 044.35 for the period May to August versus September to December for the ARV medicine items. The implementation of the pricing regulations could thus be a possible reason for this cost saving, due to fact that the single exit price only came into effect from May 2004. The weighted average number of ARV medicine items per prescription was 1.75*0.31 for 2001, increased to 2.35±0.03 to 2002 and remained stable on 2.35±0.02 for 2004. It was found that majority of prescriptions contained more combination ARV medicine items than single ARV medicine items, ranging from 6 834 (69.76 per cent; n=9 796) prescriptions containing combination ARV medicine items in 2001 and 32 941 (93.39 per cent; n=35 271) prescriptions containing combination ARV medicine items in 2002 to 98 805 (96.93 per cent; n=101 938) prescriptions containing combination ARV medicine items in 2004. Lastly, it was perceived that didanosine was the active ingredient with the largest prevalence for all three four-month periods of 2001 and also for the periods January to April and May to August of 2002, whilst efavirenz represented the active ingredient with the largest prevalence for the period September to December of 2002, and also for all three four-month periods of 2004. Didanosine represented the active ingredient with the highest total cost for the period January to April of 2001, whilst the combination of lamivudine/zidovudine represented the active ingredient with the highest total cost for the periods May to August and September to December of 2001, and also for all three-four month periods of 2002 and 2004. Nelfinavir has the highest average cost for period January to April of 2001, ritonavir for period May to August of 2001, and saquinavir mesylate for period September to December of 2001. Nelfinavir has the highest average cost for all three-four month periods of 2002, while didanosine has the highest average cost for all three four-month periods of 2004. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2006

A sociedade necessita de indicadores capazes de medir a susceptibilidade ao risco de degradação de um manancial de abastecimento público. O percentual de cobertura florestal de uma bacia hidrográfica pode ser utilizado como um dos indicativos na avaliação da qualidade de um manancial de abastecimento público. O custo do tratamento de águas provenientes de bacias hidrográficas com diferentes percentuais de cobertura florestal é um componente que pode subsidiar discussões sobre a importância da cobertura florestal em mananciais de abastecimento público, como recurso ambiental a ser priorizado pelo poder público e exigido pela sociedade, tendo em vista os benefícios econômicos e de minimização de riscos à saúde humana. O trabalho determinou os custos do tratamento da água proveniente de bacias hidrográficas com diversos percentuais de cobertura florestal através da análise das características operacionais de diversas Estações de Tratamento de Água (ETAs) e suas respectivas captações. Para seis dos sete sistemas e ETAs estudadas, o custo específico com produtos químicos na ETA eleva- se com a redução do percentual de cobertura florestal da bacia de abastecimento. Não se pretendeu situar e associar a localização das áreas de cobertura florestal a outros fatores como, por exemplo, a susceptibilidade do solo à erosão ou ao percentual de área florestada situada em APP’s. Considerando-se o enfoque do trabalho sobre a qualidade de mananciais de abastecimento público e a relevância do episódio de rejeição do rio Piracicaba no ano 2000 como principal manancial de abastecimento público do município de mesmo nome, em decorrência da perda de qualidade de suas águas, dos altos custos do tratamento e da impossibilidade de garantir água de consumo humano de qualidade , o trabalho teve por objetivo também analisar as perspectivas para a qualidade das águas do rio Corumbataí, novo manancial eleito para Piracicaba. Utilizou-se como recurso a análise de dados de caracterização física das bacias e sócio-econômica dos municípios das bacias dos rios Piracicaba e Corumbataí, e da qualidade das águas dos rios Piracicaba e Corumbataí. O estudo faz uma reflexão sobre o atual arranjo de instituições públicas, suas atribuições legais e ferramentas para a aplicação de leis e implementação de ações de planejamento regional nas bacias dos rios Corumbataí e Piracicaba. / The Society needs to be able to check when a water source for public supply is about to reach a degradation level. The percentage off forest covered in the watershed can be used as one of the indicators to measure the quality of a public water source. The cost of water treatment from different water supply areas containing different percentage of soil forest cover, is a component that can be brought into discussions about the importance of the forest cover in drinking water public supply areas, as an environmental natural resource, to be prioritized by the Authorities, and mandatory by the Society, heading to both economical benefits and the human health risks minimization. This work has determined the costs of water treatment from water supply areas with different percentages of natural forest cover, analysis of all operating data of all Treatment Water Stations (ETAs), as well as their water sources. For six out of seven studied systems and ETAs, the specific cost with chemical products in one ETA increases with the reduction of the known portion of rain forest for the watershed. Certainly this study was not intended to try to associate the forest location areas to other factors, as for example, the erosion soil characteristic or to the portion of forest cover, located in riparian areas. Considering the focus of this work about the public supply of drinking water and the recent episode of the Piracicaba river rejection as the main water supply for the Region in year 2000, because of the low level quality of its water, the high treatment costs, and the impossibility to make feasible to count on it to distribute good quality water, this work had also the purpose of analyzing the perspectives for the Corumbataí river, to be elected as the main source of water supply for Piracicaba. Socio-economic of all cities along the river basins of Piracicaba and Corumbataí has been studied. Besides the organization of all administrative offices in charge with the problem, their legal functions and possible available tools to plan and to work properly, has also been analyzed.

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A sociedade necessita de indicadores capazes de medir a susceptibilidade ao risco de degradação de um manancial de abastecimento público. O percentual de cobertura florestal de uma bacia hidrográfica pode ser utilizado como um dos indicativos na avaliação da qualidade de um manancial de abastecimento público. O custo do tratamento de águas provenientes de bacias hidrográficas com diferentes percentuais de cobertura florestal é um componente que pode subsidiar discussões sobre a importância da cobertura florestal em mananciais de abastecimento público, como recurso ambiental a ser priorizado pelo poder público e exigido pela sociedade, tendo em vista os benefícios econômicos e de minimização de riscos à saúde humana. O trabalho determinou os custos do tratamento da água proveniente de bacias hidrográficas com diversos percentuais de cobertura florestal através da análise das características operacionais de diversas Estações de Tratamento de Água (ETAs) e suas respectivas captações. Para seis dos sete sistemas e ETAs estudadas, o custo específico com produtos químicos na ETA eleva- se com a redução do percentual de cobertura florestal da bacia de abastecimento. Não se pretendeu situar e associar a localização das áreas de cobertura florestal a outros fatores como, por exemplo, a susceptibilidade do solo à erosão ou ao percentual de área florestada situada em APP’s. Considerando-se o enfoque do trabalho sobre a qualidade de mananciais de abastecimento público e a relevância do episódio de rejeição do rio Piracicaba no ano 2000 como principal manancial de abastecimento público do município de mesmo nome, em decorrência da perda de qualidade de suas águas, dos altos custos do tratamento e da impossibilidade de garantir água de consumo humano de qualidade , o trabalho teve por objetivo também analisar as perspectivas para a qualidade das águas do rio Corumbataí, novo manancial eleito para Piracicaba. Utilizou-se como recurso a análise de dados de caracterização física das bacias e sócio-econômica dos municípios das bacias dos rios Piracicaba e Corumbataí, e da qualidade das águas dos rios Piracicaba e Corumbataí. O estudo faz uma reflexão sobre o atual arranjo de instituições públicas, suas atribuições legais e ferramentas para a aplicação de leis e implementação de ações de planejamento regional nas bacias dos rios Corumbataí e Piracicaba. / The Society needs to be able to check when a water source for public supply is about to reach a degradation level. The percentage off forest covered in the watershed can be used as one of the indicators to measure the quality of a public water source. The cost of water treatment from different water supply areas containing different percentage of soil forest cover, is a component that can be brought into discussions about the importance of the forest cover in drinking water public supply areas, as an environmental natural resource, to be prioritized by the Authorities, and mandatory by the Society, heading to both economical benefits and the human health risks minimization. This work has determined the costs of water treatment from water supply areas with different percentages of natural forest cover, analysis of all operating data of all Treatment Water Stations (ETAs), as well as their water sources. For six out of seven studied systems and ETAs, the specific cost with chemical products in one ETA increases with the reduction of the known portion of rain forest for the watershed. Certainly this study was not intended to try to associate the forest location areas to other factors, as for example, the erosion soil characteristic or to the portion of forest cover, located in riparian areas. Considering the focus of this work about the public supply of drinking water and the recent episode of the Piracicaba river rejection as the main water supply for the Region in year 2000, because of the low level quality of its water, the high treatment costs, and the impossibility to make feasible to count on it to distribute good quality water, this work had also the purpose of analyzing the perspectives for the Corumbataí river, to be elected as the main source of water supply for Piracicaba. Socio-economic of all cities along the river basins of Piracicaba and Corumbataí has been studied. Besides the organization of all administrative offices in charge with the problem, their legal functions and possible available tools to plan and to work properly, has also been analyzed.

The most frequent intervention performed by physicians is the writing of a prescription. Modern medicine has been remarkably effective in managing diseases. Medicines play a fundamental role in the effectiveness, efficiency and responsiveness of health care systems. However, health care expenditure is a great cause for concern and many nations around the world struggle to contain rising health care costs. Pharmaceutical benefit management programmes such as pharmacoeconomics, drug utilisation review (DUR) and disease management have emerged as control tools to ensure cost effective selection and use of medicine. These managed care instruments are often used to determine whether new strategies or interventions, such as the implementation of a managed medicine reference price list, are appropriate and have "value". The general objective of this study was to investigate the influences of the implementation of a managed medicine reference price list on the usage and cost of antibiotic medicine in the private health care sector of South Africa. The research design used in this study was retrospective, non-experimental and quantitative. The data used for the analysis were obtained over a two-year study period (1 May 2001 to 31 April 2003) from the central medicine claims database of Medschem&. Data was analysed according to prevalence, cost and original (innovator) or generic medicine items. For the purpose of this study antibiotics referred to beta-lactams (penicillins, cephalosporins and "others"), erythromycin and other macrolides, tetracyclines, sulphonamides and combinations, quinolones, chloramphenicol and aminoglycosides. The results of the empirical investigation showed the total number of medicine items claimed during the study period amounted to 49098736 medicine items having a total expenditure of R7150344897.00. There was a decrease in the prevalence of original (innovator) products during the two-year period. The prevalence of generic products increased from 25.87% to 32.47%. A total of 4092495 antibiotic medicine items were claimed with a total cost of R526309279.43 representing 7.36% (n = R7150344897.00) of all pharmaceutical products purchased during the two-year period. Original antibiotics had a prevalence of 42.32%, while generic antibiotics constituted 57.68% of all antibiotic products claimed (n = 4092495). However, original (innovator) products contributed 62.32% and generic products 37.68% to the total cost of all antibiotics claimed. It was concluded that the beta-lactam antibiotics represented 56.99% of all antibiotics claimed (n = 4092495) and contributed 52.51% to the total antibiotic expenditure (n = R526309279.43) for the two-year period. The average cost of beta-lactam items ranged between R112.88 * 69.95 and R122.18 + 81.42. The Medschema Price List (MPL) was implemented in May 2001. The aim of this reference pricing system was to allocate a ceiling price to a group of drugs, which are similar in terms of composition, clinical efficacy, safety and quality, with the ultimate goal to reduce medicine expenditure. During the year of implementation of the MPL 62.24% of beta-lactam antibiotics claimed (n = 1303464) were MPL listed. These products contributed 43.25% to the total cost of all beta-lactam antibiotics (n = R157142778.38). Medical aid companies reimbursed R61649211.86 for penicillins claimed and MPL listed. If all penicillin products were claimed at the ceiling price set by the MPL, a cost saving of 2.79% could have been achieved. Cost analysis indicated that it is possible to reduce health care costs by implementing strategies with the aim to reduce medicine cost. Further research, however, is necessary and in this regard recommendations for further research were formulated. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2005.