Lietuvos Respublikoje įgyvendinant teisinę reformą, vykstant spartiems socialiniams pokyčiams, šeimos teisinių santykių reguliavimas taip pat patiria pokyčius. Įsigaliojus naujajam Civiliniam kodeksui didelės permainos įvykdytos ir šeimos santykių reguliavime. Ieškinio senaties šeimos teisėje reguliavimas taip pat ne išimtis. Šiame magistro baigiamajame darbe nagrinėjama šeimos teisės samprata ir vieta teisės sistemoje, ieškinio senaties samprata ir funkcijos, ieškinio senaties šeimos teisėje reguliavimas galiojant Santuokos ir šeimos kodeksui bei įsigaliojus naujajam Civiliniam kodeksui, apžvelgiama Lietuvos Aukščiausiojo Teismo praktika ieškinio senaties šeimos teisėje taikymo klausimais. Ieškinio senaties institutas žinomas visų pasaulio valstybių todėl šiame darbe trumpai apžvelgiama ieškinio senaties reguliavimas kai kuriose užsienio valstybėse (Rusijos Federacijoje, Prancūzijoje, Anglijoje ir Velse). Minėti klausimai nagrinėjami siekiant nustatyti praktines ieškinio senaties šeimos teisėje taikymo problemas bei pateikti siūlymų dėl ieškinio senaties taikymo šeimos teisėje nuostatų, kurios padėtų siekti visokeriopos šeimos teisini���� santykių dalyvių teisių ir interesų apsaugos. / A lot of relations have been newly regulated by the new Civil Code (2000) which came into force on the 1st of July, 2001. The greatest alternations involve matrimonial and family relations. There is no separate Matrimonial and Family Code left as such. After the 1st of July, 2001 matrimonial and family relations are regulated by the 3rd book of Civil Code (2000) which is intituled Family Law. Great changes were also made in regulation of extinctive prescription in family law. Essentially was innovated the general rule anticipating to apply extinctive prescription for claims arising from matrimonial and family relations. This master’s study analyses the conception of family law, the conception of extinctive prescription, norms regulating application of extinctive prescription for the claims arising from matrimonial and family relations. Also compares the norms regulating extinctive prescription settled in Matrimonial and Family Code (1969) and in new Civil Code (2000), analyses the practise of Highest Court. These questions are analysed in order to realize what changes were made in regulation of extinctive prescription implementing law reform, what problems do arise in application of extinctive prescription in family law and how it is possible to solve them. Extinctive prescription is law institute known in all countries. This master’s study briefly overlooks the regulation of extinctive prescription in some foreign countries (Federation of Russia; France; England and Wales).

Prescription drugs play an increasingly significant role in the Canadian healthcare system. Drug spending accounts for a considerable share of total healthcare expenditure and continues to be one of the fastest growing expenditure components in Canada. But, drug manufacturers’ price setting behaviours are not well understood in the literature. I develop a framework of oligopoly theory with two-dimension product differentiation based on a synthesis of the literature on the institutional history and development of the Canadian pharmaceutical system. I find that: (1) The differentiation in perceived quality between brand-name and generic drugs can explain the generic competition paradox. The degree of the product differentiation can be pivotal in shaping the brand-name drug manufacturers’ price setting behaviours in response to the shift in patients’ preference and changes in government policies. (2) Copay and generic drug price-cap policies are commonly adopted by the Canadian public drug plans to contain drug reimbursement cost. Policy-makers should use caution when applying these policies in combination or separately in order to reach the intended outcomes. (3) The generic drug price-cap can elicit competition among brand-name drug manufacturers, but it may need coordinated regulations on patented drug prices. Without full coordination among major stakeholders and across jurisdictions, the benefits of lowered drug prices for some can become additional costs for others. I innovatively adopt the multilevel model to analyze the pharmaceutical market structure and evaluate the net effect of the generic competition paradox. The empirical research on the drug price dynamics is consistent with the predictions of the previously developed theory. I find that: (1) More generic substitutes in a drug molecule are associated with a net effect of increases in drug prices, after other contextual variables are properly controlled for. (2) More therapeutic substitutes do not have a net effect of lowering drug prices. (3) When a generic substitution policy is in place, the studied brand-name drugs maintain net price premiums over their generic substitutes. But, the net price premiums in the case when there is a generic substitution policy are lower than those where there is no such policy.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

Background. Good health care is becoming increasingly unaffordable. A wider use of generic medicines offers significant cost savings. As the family practitioner is the gatekeeper in prescribing medicines, his attitude towards generic medicines is crucial. The factors that influence family practitioners' prescription of pharmaceuticals require investigation. Objectives. The primary objective of this study is to assess attitudes and perceptions that family practitioners have towards generic medicines and evaluate factors that influence its prescription. The secondary aim is to assess the individual characteristics and personality traits of family practitioners that may impact on generic prescription. Methods. This study is a convenient sample of 198 family practitioners that are surveyed by means of a questionnaire. Responses were based largely on a Likert scale and evaluated by factor analysis. Results. Using factor analysis, five factors identified in the order of importance are as follows: 1) Patient factors: It is primarily the patients' disease profile and their financial capacity that determines the use of generic versus ethical drugs. 2) Clinical autonomy of the family practitioners: Family practitioners resent their clinical decisions being challenged by managed care organisations. 3) Strategies promoting generics: Improved marketing by the generic pharmaceutical industry and the provisions of acceptable financial incentives are likely to promote wider use of generics. 4) Cost of medicines: Most family practitioners are price-sensitive. A further reduction in the price of generic medicines is therefore likely to increase the use. 5) Specialists' opinion: Specialists use fewer generics and their choice of medication is respected by family practitioners. A wider use of generic medicines by specialists will positively impact on generic prescription by family practitioners. Personality traits and individual characteristics of the family practitioners do not affect their prescription of generic medicines. It is noted that most family practitioners have encountered specific instances of reduced efficacy, an increased side-effect profile, substandard packaging, erratic availability and poor patient confidence with the use of generic drugs. Conclusion. In order to bring about a reduction in the healthcare costs by promoting wider use of generics, different stakeholders in the industry need to act synergistically. All stakeholders need to increase the awareness of generic medicines by continuing health education. Specific recommendations for the generic pharmaceutical industry include increased marketing, further reduction in the price of generics and implementation of research and surveillance studies to ensure satisfactory clinical efficacy of their drugs. Medicines Control Council need to closely monitor the number and quality of available generic medicines. Managed care organisations need to respect the clinical autonomy of family practitioners and work closely with them. Finally, acceptable and ethical incentives need to be considered for family practitioners, the gatekeepers, to achieve the objective of wider use of generic medicines. / Thesis (M.B.A.)-University of Natal, 2001.

Prescription opioid pain reliever utilization has been increasing since the 1990s, due in part to changes in recommendations for the treatment of chronic pain, but also to abuse and diversion. One innovative policy solution to the abuse and diversion of prescription opioids is state prescription drug monitoring programs (PDMPs), which provide prescribers and other selected parties with patient controlled substance dispensation history; thereby, correcting an information asymmetry problem between prescribers and patients. The widespread implementation of state PDMPs, which vary in program design and requirements, has resulted in a variety of intended and unintended consequences. Previous PDMP evaluations have suggested such outcomes as the reduction of consumer access to opioids, the influencing of healthcare provider prescribing behaviors for opioids, and the re-shaping of the United States market for prescription opioids. PDMPs may also be associated with unintended outcomes: namely, the restriction of pharmaceutical opioids could be associated with an increase in heroin use, as evidenced by increases in heroin substance abuse treatment facility discharges. The analyses in this project examine the influence of PDMPs on healthcare providers and the market for prescription drugs by comparing trends in opioid utilization in states with varying PDMP features using Medicaid prescription utilization data and commercial insurance claims. The effect of PDMPs on consumers is explored with an analysis comparing substance abuse treatment facility discharge data for heroin abuse with pharmaceutical opioid prescriptions before and after PDMP regulatory change. Finally, the impact of other related opioid policy interventions, opioid overdose medication access laws, are analyzed by comparing opioid overdose mortality across states with differing overdose medication access policies over time. Contributions to the understanding about the impacts of these state-level opioid abuse and diversion policies can be used to improve or amplify intended outcomes and ameliorate unintended consequences.

BACKGROUND: Exercise on Prescription (EoP) means that a doctor writes out a customized form of exercise to the patient instead of medicine, or in combination with medication. The activity becomes a part of the treatment. Since many today do not follow recommendations for physical activity occurs in the long term a number of public health diseases. EoP promotes health and prevents disease. AIM: The aim of this paper is toexamine whether EoP from a patient perspective perceived to be an efficient and effective method of treatment. METHOD: A qualitative approach was used. Semi-structured interviews were conducted by telephone. The target audience was adults over age 18 who received EoP. RESULTS: The findings of the interviews were that the experience of EoP was largely positive and that most understood why it was important to have physical activity. A visit to a health care raised the direct motivation to exercise, but declined unless follow-up occurred. Several had been needed more help and advice from a contact person or coordinator that the patient could turn to. CONCLUSION: By getting more help with motivation probably more of the respondents had received better results from EoP. / BAKGRUND: Fysisk aktivitet på recept (FaR) innebär att en läkare skriver ut en anpassad träningsform till patienten istället för medicin, eller i kombination med medicin. Aktiviteten blir en del i behandlingen. Eftersom många idag inte följer rekommendationerna för fysisk aktivitet uppstår på sikt en rad folkhälsosjukdomar. FaR främjar hälsan och förebygger sjukdom. SYFTE: Syftet med den här uppsatsen är att undersöka huruvida FaR ur ett patientperspektiv upplevs vara en effektiv och fungerande behandlingsmetod. METOD: En kvalitativ ansats har använts. Semistrukturerade intervjuer har genomförts via telefon. Målgruppen var vuxna personer över 18 år som fått FaR. RESULTAT: Det som framkom av intervjuerna var att upplevelsen av FaR i stort sett var positiv och att de flesta förstod varför det var viktigt med fysisk aktivitet. Besöket hos sjukvården höjde direkt motivationen till att träna, men sjönk om inte uppföljning skedde. Trots den positiva upplevelsen så hade det i flera fall behövts mer råd och hjälp. Det saknades i många fall en kontaktperson eller samordnare som patienten kunde vända sig till. SLUTSATS: Genom att få mer hjälp med motivation och stöttning hade troligen flera av respondenterna fått bättre resultat av FaR.

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>

Background: Insufficient physical activity is a public health problem. Nordic healthcare professionals use physical activity on prescription (PaP) to increase physical activity. Purpose: This study aimed to evaluate the effectiveness of PaP that includes organized exercise. Method: Prospective data was obtained from four Swedish counties during fall 2009 and spring 2010. The study population comprised 98 patients whose healthcare professional prescribed PaP to prevent or treat disease. Questionnaires administered at baseline, three and six months after initiating PaP evaluated self-reported physical activity levels, adherence, factors influencing adherence, and experience of PaP. Results: Although the majority of patients receiving PaP including organized exercise are middle-age women, there are a wide distribution regarding e.g., age, socioeconomic status and reason of receiving PaP. Most participants received initial support from healthcare providers and activity organizers, and most were satisfied with the support they got. Approximately 70% participated in several activities at all measuring points. Although PaP including organized exercise increased activity levels only marginally, sedentary behavior decreased significantly. Six months after initiating PaP including organized exercise, 68% adhered to the prescribed physical activity level. Most participants deemed PaP including organized exercise a good method for becoming physically active. However, there is a need for regularly and longer support. Importantly, individualized instruction, adjusted exercise regimens, and support from other participants provide positive reinforcement. On the other hand, PaP with organized exercise imposes additional costs and decreases flexibility including both time commitment and scheduling constraints. Conclusion: Adherence levels to PaP with organized exercise are similar to those achieved by other chronic disease treatments. PaP including organized exercise can decrease sedentary behavior, an important factor in promoting public health in the Nordic countries. / <p>ISBN 978-91-86739-16-4</p>

Darbo tikslas. Įvertinti vaistinės klientų nuomonę apie savigydą. Uždaviniai. 1. Išsiaiškinti vaistinės klientų nuomonę apie savarankišką gydymąsi nereceptiniais vaistiniais preparatais. 2. Nustatyti pagrindinius informacijos šaltinius, kuriais vaistinėje apsilankę gyventojai vadovaujasi, pasirenkant nereceptinius vaistinius preparatus lengvų negalavimų gydymui. 3. Nustatyti amžiaus, lyties, išsimokslinimo bei socialinės padėties ryšį su gyventojų turimomis žiniomis apie nereceptinius vaistinius preparatus ir jų vartojimą. Tyrimo metodika. Tyrimo objektas - Eurovaistinės 210 filialo, esančio prekybos centre „BIG“, Ukmergės g. 369, Vilniuje, klientų nuomonė apie savarankišką gydymąsi. Tyrimo metodai – kiekybinis tyrimas, instrumentas - anoniminė anketinė apklausa. Tyrimas buvo vykdomas 2012 metų vasario 6 – kovo 6 dienomis, gavus leidimą iš UAB „Eurovaistinė“ vadovybės. Mėnesio laikotarpyje buvo išdalinta 300 anketų. Atsakas – 80,3 proc. Tyrimo duomenys apdoroti statistiškai, naudojant „SPSS 19.0 for Windows“ programą. Rezultatai. Tyrimo metu paaiškėjo, kad dažniau vaistinėje lankosi moterys negu vyrai, respondentai pagal lytį pasiskirstė atitinkamai 70,4 proc. ir 29,6 proc. Pusė apklaustųjų – 51,5 proc. vaistinės lankytojų savo sveikatą įvertino kaip gera, beveik trečdalis, 29 proc. – patenkinama. 77,9 proc. apklaustųjų vaistinės klientų lengvi negalavimai vargina. Didžioji dalis respondentų (83,4 proc.) pajutę lengvo negalavimo simptomus, linkę juos malšinti... [toliau žr. visą tekstą] / Work objective. Evaluate drugstore clients opinion on self-treatment. Work tasks. 1. Determine the opinion of drugstore clients about self-medication with non-prescription medication. 2. Determine basic sources of information which are used by drugstore clients while choosing non-prescription medication for ailment treatment. 3. Estimate the relation of clients‘ age, sex and education background also social status with their knowledge about non-prescription medication and their usage. Research method. Research objective – opinion of Eurovaistinė 210-th branch, in shopping centre „BIG“, Ukmergės str. 369, Vilnius clients’ about self-medication. Research methods i.e quantative research, instrument - anonymous questionnaire. The research performed in the period between February 6 and March 6 of 2012, after the management of the drugstore UAB „Eurovaistinė“ gave a permission. 300 hundred questionnaires were completed during the month. The response reached 80,3 percent. The data of the research was processed statistically by using software program „SPSS 19.0 for Windows“. Results of the research. The research revealed that woman attend drugstore more often than men so respondents distributed according the sex respectively 70,4 and 29,6 percent. Half of respondents’ i.e. 51,5 percent of customers of drugstore thought their health to be of good condition, almost one third - 29 percent treated their health satisfactory. 77,9 percent of drugstore clients suffer from ailments... [to full text]

<p>Infusions, decoctions, alcoholic preparations and other dosage forms of Artemisia afra are frequently used in South African traditional medicine. Generally when these preparations are made without applying good manufacturing practices they do not meet microbial quality control standards, safety and toxicity criteria and encourage poor patients compliance. To overcome the aforementioned disadvantages of traditional dosage forms a sold dosage form, i.e. a table might be recommended. The first objective of this study was to formulate and manufacture a rapid release tablet dosage of Artemisia afra that would contain an amount of plant material equivalent to that found in its traditional liquid dosage forms and that would meet conventional pharmaceutical standards. The second objective was to conduct a pilot study to obtain a preliminary profile of the bioavailability of select flavonoids presents in both the tablet and traditional liquid preparation of Artemisia afra in humans.</p>