Submitted by Cláudia Bueno (claudiamoura18@gmail.com) on 2015-11-03T16:46:05Z No. of bitstreams: 2 Dissertação - Lilian Ribeiro Batista - 2015.pdf: 1964612 bytes, checksum: b9bd7ed726cf48d3b1c896f2d3efb42a (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2015-11-04T09:38:10Z (GMT) No. of bitstreams: 2 Dissertação - Lilian Ribeiro Batista - 2015.pdf: 1964612 bytes, checksum: b9bd7ed726cf48d3b1c896f2d3efb42a (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2015-11-04T09:38:10Z (GMT). No. of bitstreams: 2 Dissertação - Lilian Ribeiro Batista - 2015.pdf: 1964612 bytes, checksum: b9bd7ed726cf48d3b1c896f2d3efb42a (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2015-03-06 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Despite the efforts of many pharmaceutical companies to replace or reduce the content, many liquid medications still contains ethanol, which needs to have its contents regulated and monitored by quality control. Ethanol analyzes are generally carried out using one-dimensional gas chromatograph, however this technique does not always have adequate separation for the analysis of complex samples. The multidimensional chromatography has emerged as an innovative alternative because it allows the combination of two or more independent separation steps, significantly increasing the power of separation of the corresponding one-dimensional techniques. In this way, towards doing ethanol analysis in syrups for child and adult audience, a method by multidimensional gas chromatography-mass spectrometry was developed and validated for quality control purposes in the pharmaceutical industry. The analytical method developed led to a gain in selectivity by using the headspace extraction phase of ethanol in miniaturized and automated sample preparation. The use of HS-MDGC / GCMS provided a better separation of syrup components allowing to evidence that some commercial syrup have ethanol content above the maximum levels recommended by ANVISA. The method was validated according to standards established by ANVISA. The method was validated according ANVISA standards, presenting LOD 0.03% (v / v) and the LOQ of 0.06% (v / v) ethanol. The recovery values were 96.71% to 101.38%. Commercial samples of syrup in selected pharmacies in Goiânia/GO were analyzed by the proposed method and the content of ethanol in some samples was higher than maximum value allowed for this medicines. / Apesar dos esforços de muitas empresas farmacêuticas em substituir ou reduzir o teor alcoólico, muitos medicamentos líquidos ainda contém etanol, o qual precisa ter seu teor regulado e monitorado por técnicas específicas e precisas de controle da qualidade. Análises de etanol são geralmente realizadas utilizando cromatografia gasosa unidimensional, porém esta técnica nem sempre apresenta adequada separação para a análise de amostras complexas. A cromatografia multidimensional surgiu como uma alternativa inovadora, pois permite a combinação de duas ou mais etapas de separação independentes, aumentando significativamente o poder de separação das técnicas unidimensionais correspondentes. Assim, visando efetuar a análise de etanol em xaropes destinados ao público infantil e adulto, um método via cromatografia gasosa multidimensional acoplada à espectrometria de massas foi desenvolvido e validado para fins de controle de qualidade na indústria farmacêutica. O método analítico desenvolvido proporcionou ganho de seletividade pela utilização do headspace como fase extratora de etanol em sistema miniaturizado e automatizado de preparo de amostra. O uso de HS-MDGC-MS proporcionou a separação mais adequada dos componentes do xarope, permitindo evidenciar que alguns xaropes comerciais apresentam teor de etanol acima dos teores máximos preconizados pela Anvisa. O método foi validado segundo as normas estabelecidas pela Anvisa apresentando LD de 0,03% (v/v) e o LQ de 0,06% (v/v) de etanol. Os valores de recuperação foram de 96,71% a 101,38%. Amostras comerciais de xarope selecionados em farmácias de Goiânia/GO foram analisadas pelo método proposto, sendo que em algumas dessas amostras a concentração de etanol obtida foi superior aos limites máximos permitidos nestes medicamentos.

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2016-10-03T13:23:24Z No. of bitstreams: 2 Dissertação - Sâmia Cristina Rodrigues Borges Aragão - 2015.pdf: 3374814 bytes, checksum: f4bc7c58a16e041e8274c3529234f038 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2016-10-03T13:24:52Z (GMT) No. of bitstreams: 2 Dissertação - Sâmia Cristina Rodrigues Borges Aragão - 2015.pdf: 3374814 bytes, checksum: f4bc7c58a16e041e8274c3529234f038 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2016-10-03T13:24:52Z (GMT). No. of bitstreams: 2 Dissertação - Sâmia Cristina Rodrigues Borges Aragão - 2015.pdf: 3374814 bytes, checksum: f4bc7c58a16e041e8274c3529234f038 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2015-10-21 / Medications readily available for the Brazilian population in the Unified Health System (SUS) is one of the health policies and programmes that meet the constitutional right of every Brazilian citizen. Lots of regulations have been created for medication distribution through Pharmaceutical Assistance (PA), however the user of the medication sometimes is confused and how obtain it. Describe the pathway and regulations for medication distribution through the public health policies in a city. Qualitative research held from December 2014 to January 2015, which focused on normative and explanatory documents for the public health system in Brazil in the city of Goiania in Goias state. An extensive bibliographic research has been carried out on this topic to fundament the analysis of the documents. The medication right is defined in the Brazilian’s constitution, legislation and regulatory acts for the private labour sector and public through co-payment as a means for medication access. In Goiania establishes the Pharmaceutical Assistance (PA) as it is for the Pharmacy and Therapeutics Committee (CFT), SMS Pharmacies, publicizing information related to drugs, health programmes such as “Farmácia Popular“ and the administrative access road through the Division of Assets Evaluation and non-Standardized Services (DABSNP) as a way to meet the demands of those users who have failed treatment through public policies. The medications available through the public policies are organized by REMUNE and the list of medications with high costs of Juarez Barbosa. The public health programmes “Farmácia Popular” and “Saúde Não Tem Preço“ are the ways of co-payment and free of charge. Medications not listed on REMUNE or unavailable to the user are available via administrative process to prevent lawsuit. Conclusion: The medication right is defined in the Brazilian’s constitution, and public policies with little or no influence of local city government. However, how to obtain it, the list of available medication, and the requirements is a local governmental duty. Therefore, the policies defined for such programmes can facilitate the understanding of the network comprising the Pharmaceutical Assistance (PA) in the Brazil’s Unified Health System (SUS). / O acesso a medicamentos no Sistema Único de Saúde (SUS) integra as ações de atenção à saúde como um direito dos brasileiros. As vias institucionalizadas de acesso ao medicamento surgem mediante uma diversidade de regulamentações relacionadas à operacionalização da Assistência Farmacêutica (AF) que muitas vezes incorre em “confusão” junto ao usuário, na busca pela efetivação deste direito. Esta dissertação objetiva descrever as vias institucionalizadas de acesso ao medicamento em uma cidade brasileira. A pesquisa documental constituiu-se de natureza descritiva realizada nos meses de dezembro/2014 a janeiro/ 2015. O objeto de estudo foram documentos de caráter legal, normativo e explicativo capazes de descrever as vias de acesso institucionalizadas pelas políticas públicas de saúde vigentes no Brasil, em nível de assistência ambulatorial, no município de GoiâniaGO. Destaca-se que o direito ao acesso ao medicamento foi positivado no texto constitucional, na legislação infraconstitucional e em atos regulatórios que definem as vias pública, privada e através de co-pagamento como formas de acesso aos medicamentos. Em Goiânia a AF se encontra normatizada a respeito da Comissão de Farmácia e Terapêutica (CFT), funcionamento das farmácias da Secretaria Municipal de Saúde (SMS), publicização de informações relacionadas a medicamentos, implementação da Farmácia Popular (FP) e a via administrativa de acesso através da Divisão de Avaliação de Bens e Serviços Não-Padronizados (DABSNP), como forma de atender a demanda daqueles usuários que não conseguiram tratamento através das políticas públicas. O fluxo de acesso em Goiânia indica que os medicamentos disponíveis no sistema público estão organizados por meio da Relação Municipal de Medicamentos Esssenciais (REMUME) e da Lista de medicamentos de Alto Custo-Juarez Barbosa (Componente Especializado). As vias por co-pagamento e gratuitos são disponibilizadas pelos programas FP e “Saúde Não Tem Preço” (SNTP) e suas respectivas listas. A via administrativa de acesso, para medicamentos não constantes na REMUME ou indisponível para o usuário, cumpre papel de evitar que a demanda gere processo judicial. Conclusão: O direito ao medicamento é basicamente definido pelas políticas nacionais sofrendo pouca influência local. Já o itinerário que cada cidadão terá que percorrer e os medicamentos disponíveis são definidos em nível municipal. Portanto, o fluxo de acesso elaborado pode facilitar a compreensão da intrincada rede que constitui a Assistência Farmacêutica no Brasil.

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2017-04-25T15:43:12Z No. of bitstreams: 2 Dissertação - Larissa Juliana Patrocínio da Silva - 2017.pdf: 1537272 bytes, checksum: c1fc2b7ec4303e9dd7265a84ef53bc5e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2017-04-25T15:43:54Z (GMT) No. of bitstreams: 2 Dissertação - Larissa Juliana Patrocínio da Silva - 2017.pdf: 1537272 bytes, checksum: c1fc2b7ec4303e9dd7265a84ef53bc5e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2017-04-25T15:43:54Z (GMT). No. of bitstreams: 2 Dissertação - Larissa Juliana Patrocínio da Silva - 2017.pdf: 1537272 bytes, checksum: c1fc2b7ec4303e9dd7265a84ef53bc5e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2017-03-08 / To ensure the quality of the medicines that come from the supplier and go to clients, the distributors must check the quality of these at the time of receipt. At the conference during the receipt of medicines by the distributors, it is necessary to verify that the physical products correspond to those of the invoice of purchase and the conditions of transport, to see if there are damaged medicines. Not all medications received from suppliers by the distributor are in compliance. Some have problems, referred to in this study as Technical Deviations, so these medicines can not and should not be passed on to customers and must be identified as soon as possible and returned to the supplier. Technical deviations are conditions presented by the products that during the manufacturing, transportation or storage process deviated from the quality parameters established by ANVISA. But distributors face difficulties in performing reverse logistics, since some suppliers use the power of the brand and create obstacles and bureaucracy for this return, and also sometimes do not want to have extra costs, locking Processes and causing losses to the distributor. The present study aimed to identify, categorize and quantify technical and financial aspects of the deviations that generate returns in a medicine distributor. First, the work brings a theoretical reference and to achieve the objective of the study, a case study and documentary analysis of records was carried out at a medicine distributor. The Distributor provided the records of technical deviations made in the period of 2014 and 2015. Through the documentary analysis, a spreadsheet with the types of technical deviations and product name, quantity, class, lot, laboratory, price and expiration. Through the analysis were identified and characterized all the reasons why deviations were considered and generated devolution. Seven technical deviations were found: defect, lack, surplus, short validity, batch divergence, product exchange and packaging error from which its characteristics were presented. The total amount of loss found for the Distributor surveyed was R$ 914.864,57 in the studied period. A ranking of the suppliers with the highest number of registrations was presented and a Check-list for distributor of medicines identifies possible technical deviations. / Para garantir a qualidade dos medicamentos que vem do fornecedor e vão para clientes, as distribuidoras precisam conferir a qualidade destes no ato do recebimento. Na conferência durante o recebimento de medicamentos pelas distribuidoras é preciso verificar se os produtos físicos correspondem aos da nota fiscal de compra e também as condições de transporte, para ver se há medicamentos danificados. Nem todos medicamentos recebidos dos fornecedores pela distribuidora estão em conformidade. Alguns possuem problemas, denominados neste estudo como desvios técnicos, desse modo, estes medicamentos não podem e não devem ser repassados aos clientes devendo ser identificados o quanto antes e devolvidos ao fornecedor. Desvios técnicos são condições apresentadas pelos produtos que durante o processo de fabricação, transporte ou armazenamento se afastaram dos parâmetros de qualidade estabelecidos pela ANVISA. Mas as distribuidoras enfrentam dificuldades em realizar a logística reversa, pois alguns fornecedores, já que possuem grande volume de vendas e criam empecilhos e burocracia para esta devolução, e também às vezes não querem ter custos a mais, travando processos e trazendo prejuízos para a distribuidora. O presente trabalho teve como objetivo identificar, categorizar e quantificar em relação aos aspectos técnicos e financeiros os desvios que geram devoluções em uma distribuidora de medicamentos. Primeiramente, o trabalho traz um referencial teórico a respeito do tema e para atingir o objetivo do trabalho foi realizado um estudo de caso e análise documental de registros em uma distribuidora de medicamentos. A Distribuidora forneceu os registros de desvios técnicos realizados no período de 2014 e 2015. Através da análise documental foi criada uma planilha com os tipos de desvios técnicos, nome do produto, quantidade, classe, lote, laboratório, preço e validade. Por meio da análise foram identificados e caracterizados todos os motivos pelos quais foram considerados desvios e geraram devolução. Foram encontrados sete desvios técnicos: avaria, falta, excedente, validade curta, divergência de lote, troca de produto e erro de embalagem dos quais foram apresentadas suas características. O valor total encontrado de prejuízo para a Distribuidora pesquisada foi R$914.864,57 no período estudado. Foi apresentado um ranking dos fornecedores com maior número de registros e um Check-list para que a distribuidora de medicamentos possam identificar possíveis Desvios Técnicos.

Há muitas razões que impedem o atendimento pelo Sistema Único de Saúde (SUS) dos desejos e demandas do cidadão-usuário por bens ou por prestações de serviços de saúde. Geralmente, isto desemboca em ações judiciais por medicamentos e insumos, nas quais o deferimento de liminares, em face da Secretaria de Saúde do Estado do Pará, é corriqueiro, geralmente por meio de petições do Ministério Público. Estudos empíricos que avaliam o impacto financeiro e as consequências sanitárias dessas demandas são escassos ou inexistentes no Estado do Pará e seus municípios. Essa escassez de bases referenciais justifica a realização do presente estudo, o qual busca detalhar quantitativa e qualitativamente as demandas judiciais individuais de assistência a saúde contra o Estado do Pará iniciadas entre janeiro de 2011 a dezembro de 2013. Aplica-se, para isso, a metodologia do estudo empírico, transversal, baseado na análise de dados qualitativos e quantitativos extraídos dos autos dos processos judiciais dessas demandas, bem como se utilizam do Manual de Indicadores de Avaliação e Monitoramento das Demandas Judiciais de Medicamentos. Os resultados obtidos servem como parâmetros para a reformulação da política e gestão da assistência farmacêutica, de forma a minimizar seus efeitos e melhorar o acesso do cidadão ao medicamento/insumos para a saúde dentro do Estado / There are many reasons that prevent the attendance by the Unified Health System (SUS) from the desires and demands of the citizen-user for goods or for the provision of health care services. Generally, this leads to lawsuits for medicines and supplies, where the granting of injunctions, facing the Secretary of health of the Para State, is commonplace, usually by petitions of the Prosecutor\'s Office. Empirical studies that evaluate the financial impact and the health consequences of those demands are sparse or non-existent in the Para State and its counties. This lack of referential bases justifies the accomplishing of this study, which seeks quantitative and qualitative detail the individual lawsuits against the health service of the Para State initiated from January 2011 to December 2013. Applies, for that, the methodology of empirical study, transversal, based on the analysis of qualitative and quantitative data extracted from the record of the court proceedings of those demands, as well as use of Evaluation Indicators Manual and Monitoring of the Litigation for Medicines. The results obtained serve as parameters for the reformulation of the policy and management of pharmaceutical assistance, with the purpose to minimize its effects and improve citizen access to the medicine/health inputs in the State

O marketing de relacionamento contribui para a sobrevivência das empresas e para o sucesso dos negócios. Sua meta é desenvolver relacionamentos profundos, duradouros e mutuamente satisfatórios entre fornecedores e clientes. O marketing de relacionamento está associado a uma perspectiva estratégica, de posicionamento da empresa e da necessidade de a empresa se relacionar com outras organizações. Neste estudo são pesquisadas as trocas relacionais que ocorrem entre o distribuidor e o varejista, isto é, entre aquele que oferece vários produtos e serviços e aquele que vende esses produtos e serviços para o consumidor final. O assunto deste estudo trata do relacionamento entre a farmácia e a drogaria, situadas na Grande São Paulo, e o seu distribuidor principal de remédios. Comprometimento e confiança são conceitos importantes neste relacionamento, além de exercerem uma posição mediadora em um conjunto de variáveis existentes no relacionamento. Foi aplicado o modelo da teoria do comprometimento-confiança do marketing de relacionamento (Key mediating variable) de Morgan e Hunt (1994), com a inclusão do constructo poder. Inicialmente, foi realizada uma pesquisa qualitativa, que contribuiu para um maior conhecimento do contexto farmacêutico e uma segunda pesquisa qualitativa para a avaliação dos constructos e seus indicadores. Em seguida foi realizada uma pesquisa quantitativa, que consistiu de entrevistas pessoais com os responsáveis pelas compras de medicamentos das farmácias e drogarias, para a obtenção de dados com o fim de se aplicar o modelo teórico no contexto farmacêutico. A principal técnica estatística utilizada foi a modelagem de equações estruturais com o software SmartPLS. Os resultados indicam que o constructo poder pode fazer parte do modelo, além de confirmarem que confiança e comprometimento são conceitos mediadores do relacionamento. Entre várias descobertas interessantes, foram constatadas: a necessidade de maior comunicação e cooperação entre as partes envolvidas; a relação inversa entre grau de comprometimento e propensão para deixar o relacionamento; a relação direta entre confiança e cooperação e entre confiança e comprometimento entre as partes envolvidas. O modelo utilizado deve ser testado em pesquisas futuras com um maior enriquecimento dos constructos utilizados, tanto no contexto farmacêutico em outras localidades, como em outros setores de atividade em que seja pertinente a análise das ações do marketing de relacionamento. Os profissionais de marketing podem avaliar o relacionamento com seus parceiros de negócios com a aplicação do modelo estudado e identificar orientações estratégicas para o fortalecimento deste relacionamento. / The relationship marketing contributes for the survival of companies and for the business success. Its goal is to develop deep, lasting and mutually satisfactory relationships between suppliers and customers. The relationship marketing is associated with a strategic perspective, with the company positioning and with the necessity of relationship of the company with the others organizations. In this study relational exchanges between the distributor and retailer are investigated, that is, between who offers various products and services and who sells these products and services to the final consumers. The subject of this study deals with the relationship between the pharmacy and drugstore, located in the Great São Paulo, and their main distributor of medicines. Commitment and trust are important concepts in this relationship, and play a mediator position within a set of existing variables in the relationship. The model of the commitment-trust theory of relationship marketing (Key mediating variable) of Morgan and Hunt (1994) was applied, with the inclusion of the construct power. Initially it was carried out a qualitative research, which contributed to a greater knowledge of the pharmaceutical context and a second qualitative research to assess the constructs and their indicators. Next, it was carried out a quantitative research, which consisted of personal interviews with those responsible for purchasing the medicines to the pharmacies and drugstores, to obtain data in order to apply the theoretical model in the pharmaceutical context. The main statistical technique used was structural equation modeling with the software SmartPLS. The results indicate that the construct power can be part of the model, and confirm that trust and commitment are mediators constructs of the relationship. Among several interesting findings were noted: the need for greater communication and cooperation between the parties, the inverse relation between the degree of commitment and the propensity to leave the relationship, the relation between trust and cooperation and between trust and commitment between the involved parties. The model should be tested in future research with a greater enrichment of the constructs used, both in the pharmaceutical context in other localities, as in other sectors of activity that is relevant to the analysis of relationship marketing actions. Marketing professionals can assess the relationship with theirs business partners with the application of the studied model and identify strategic guidelines for the strengthening of this relationship.

Orientador: Susanne Rath / Tese (doutorado) - Universidade Estadual de Campinas, Instituto de Química / Made available in DSpace on 2018-08-21T08:01:07Z (GMT). No. of bitstreams: 1 Doretto_KeityMargareth_D.pdf: 2722057 bytes, checksum: d4c5a2090af2c524cc8d28125e30eaa2 (MD5) Previous issue date: 2012 / Resumo: Antimicrobianos, entre eles as sulfonamidas, têm sido amplamente utilizados em medicina veterinária para fins terapêuticos e profiláticos. Uma vez excretados os fármacos e/ou metabólitos podem levar a contaminação do meio ambiente e estudos sobre o impacto ambiental ainda são escassos. Em adição, no Brasil, ainda não existe uma fiscalização de medicamentos veterinários. A não conformidade dos medicamentos reflete diretamente na saúde animal, como também é um tópico relevante quanto à segurança alimentar. Assim sendo, métodos foram desenvolvidos e validados para a determinação de sulfadiazina (SDZ), sulfadimetoxina (SDM) e sulfaquinoxalina (SQX) em medicamentos de uso veterinário por cromatografia líquida de alta eficiência associada a um detector de arranjo de fotodiodos (HPLC-DAD). Os resultados obtidos indicam a necessidade de controle de qualidade dos fármacos de uso veterinário comercializados no Brasil. Ainda, o trabalho estudou a sorção da SDZ, SDM e SQX em quatro solos característicos do Estado de São Paulo. Os estudos foram conduzidos conforme recomendação do Guia OECD 106. As sulfonamidas foram quantificadas nas soluções de solo por um método HPLC-DAD previamente validado. Os dados de adsorção/dessorção das sulfonamidas nos quatro solos foram ajustados com isotermas de Freundlich na forma linear ou logarítmica. Um fenômeno de histerese de adsorção/dessorção foi evidente em todos os solos. Os baixos valores do coeficiente de Freundlich (KF) obtidos sugerem fraca adsorção das sulfonamidas nos solos avaliados e, portanto, estas tendem a ser lixiviados e, por sua vez apresentam potencial para contaminar águas superficiais e subterrâneas / Abstract: Antimicrobials, including sulfonamides, have been widely used in veterinary medicine for therapeutic and prophylactic purposes. Once excreted, drugs and/or metabolites can contaminate the environment. Environmental impact studies are still scarce. In addition, in Brazil, there is no surveillance of veterinary medicines. The poor quality of drugs may reflect directly on animal health and is also a topic relevant to food safety. Therefore, methods were developed and validated for the determination of sulfadiazine (SDZ), sulfadimethoxine (SDM) and sulfaquinoxaline (SQX) in veterinary drugs, using high performance liquid chromatography coupled to a photodiode array detector (HPLC-DAD). The obtained results indicate the need for a quality control program of veterinary drugs comercialized in Brazil. Moreover, the present work aim studied the sorption of sulfonamides (SDZ, SDM and SQX) in four characteristic soils of the State of São Paulo. The studies were conducted as recommended by the OECD Guidelines 106. The sulfonamides were quantified in the soil solutions by a previously validated HPLC-DAD method. Adsorption/desorption data of sulfonamides in soils were fitted to Freundlich isotherms in the linear or logarithmic forms. A hysteresis of adsorption/desorption was evident in all four soils evaluated. The low values of the Freundlich coefficient (KF) obtained suggest weak adsorption of sulfonamides in soils, and therefore they tend to be leached and present high potential to contaminate surface and groundwater / Doutorado / Quimica Analitica / Doutora em Ciências

info:eu-repo/semantics/nonPublished

Research has shown that people who participate in regular physical activity (PA) can experience improved wellbeing and quality of life, including better physical health, cognitive function, positive affect, and self-esteem (Fox, 1999). Such benefits support the application of PA as a strategy to improve the general population's mental health and those recovering from mental illness. However, the contemporary understanding of PA and the recovery from mental illness is almost exclusively underpinned by the principles of clinical recovery (e.g. symptom remission), which can overlook the patient's values. Conversely, personal recovery may reconnect people with their inner resources, personal strengths, and offer opportunities for people to reconstruct hope, meaning, responsibility and a positive identity as part of recovery (Slade, 2009). These values also mark a shift in the UK Government's (2011a) mental health strategy, toward integrating personal recovery as part of people's mental health care. Yet, few studies have examined the role of PA within the context of personal recovery, including the impact of PA on the wider elements of personal recovery. Accordingly, this thesis sets out to examine the role of PA during the personal recovery from mental illness, as a case study at a voluntary sector mental health organisation. The research methodology was guided by social constructivism, and data was collected between October 2010 and June 2014 using participant-observations, semi-structured interviews, focus groups and photo elicitation methods. Seven members of staff and twenty-two attendee's volunteered to participate in the research study, and their accounts were analysed thematically (Braun & Clarke, 2006) using NVivo to manage and aid the data analysis. Additionally, effort was made to satisfy the authenticity criteria throughout the research to maintain constructivist rigour (Lincoln & Guba, 2013). The research findings identified six high-ordered themes that indicate a process of personal recovery through PA. These were (a) 'Battles against the mind', (b) 'the centre as a place of refuge and support', (c) 'exercise is one part of the whole package', (d) 'the connection between body and mind', (e) 'my gateway onto other things', and (f) 'from small acorns to big oak trees'. These findings were congruent with the existing literature, and added that PA participation can support people's meaningful engagement in their personal medicines and other life events (e.g. employment, being with family, and relationship with pets). The findings are discussed in relation to the delivery of PA in mental health services, the relationship of PA with meaningful activities during recovery, and the impact of PA on elements of hope, meaning, positive identity, and personal responsibility. The thesis concludes with a guiding standpoint on the application of PA for personal recovery as a personal medicine or as an adjunct activity. This standpoint can be used to inform the general population, mental health and exercise professionals, multiagency mental health service staff and attendees, commissioning bodies and policymakers.

[pt] Em organizações hospitalares há uma grande variedade de produtos e existe o compromisso de não se permitir as perdas e o fracasso operacional (Portela, 2001). Uma maneira de se evitar essas perdas é o emprego racional dos medicamentos através de uma padronização (Klugl et al, 1999). Desse modo é possível criar valor ao paciente de modo que a farmácia consegue administrar os produtos de forma adequada oferecendo serviços de qualidade (Barbieri e Machline, 2006). Nesse cenário, a gestão dos custos das organizações de saúde tem papel estratégico. Medicamentos representam parcela significativa destes custos e a sua logística interna, complexa e com muitas particularidades, deve funcionar da melhor maneira possível. Isso porque os processos, nos quais estão envolvidos, são parte fundamental para a assistência de qualidade tanto prezada pelos hospitais. Este trabalho tem como objetivo investigar e analisar a situação atual de dois processos, unitarização e a dispensação que afetam diretamente a farmácia, observando as práticas, adotadas no segmento hospitalar. Para isto, foi feito uma análise das farmácias hospitalares e dos fluxos de ambos os processos com o objetivo de entendê-los melhor. Em seguida, estudou-se em um caso real, diagnosticando os pontos de melhoria da operação. Assim, pôde-se chegar a algumas soluções, que tiveram como objetivo otimizar os processos estudados, para os pontos de melhoria levantados e comprovar a hipótese de que a centralização do estoque pode ser aplicados, com devidas adaptações respeitando as particularidades, às organizações hospitalares. / [en] In hospital organizations there is a wide variety of products and there is a commitment not to allow the losses and the operational failure (Portela, 2001). One way to avoid these losses is the rational use of medicines through standardization (Klügl et al, 1999). Thus you can create value to the patient so that the pharmacy handling the products properly offering quality services (Barbieri and Machline, 2006). In this scenario, the management of the health costs organizations have strategic role. Medicines represent a significant portion of these costs and their internal logistics, complex and with many details, should work in the best possible way. This is because the processes, in which they are involved, are fundamental parts to the quality of care both prized by hospitals. This study aims to investigate and analyze the current situation of two processes, unitarization and the dispensation that directly affect the pharmacy, observing the practices adopted in the hospital segment. For this, he was made an analysis of hospital pharmacies and flows of both processes in order to understand them better. Then studied in a real case, diagnosing the points of improvement of the operation. Thus, we could come up with some solutions that were designed to optimize the processes studied for improvement points raised and prove the hypothesis that the stock of centralization can be applied, with necessary adaptations respecting the individual, to hospitals.

Understanding the philosophy of a different culture and integrating this understanding into the provision of pharmaceutical care is challenging and complex. This thesis argues the importance for community pharmacists to acknowledge that culture, religion, family and community dynamics can impact on patients' health, health seeking behaviour and medicines adherence. The perceptions of members of the South Asian population, general practitioners, and community pharmacists about how these factors are viewed in relation to community pharmacy services were explored in this study. It was conducted in Leicester City, which has a South Asian minority ethnic population of more than 25%. Participants' views of the role of extended community pharmacy services in the wider government agenda were explored. South Asians attitudes to healthcare, self care and the management of minor ailments were discussed. A qualitative methodology approach was adopted, which used constructivist and interpretive principles. Data collection for the study was conducted in two phases. In Phase 1, one to one semi-structured interviews were conducted separately with six local GPs and five community pharmacists from both 'white' (European) and South Asian backgrounds. In Phase 2, six gender specific focus groups were convened comprising of fifty five participants in total from the Sikh, Moslem and Hindu communities. Bi-lingual community workers were used in this study which allowed a more 'sensitive' exploration of the sociological aspects of health seeking behaviour and the impact of 'cultural' influences on medicines adherence. The need for 'cultural competence' of community pharmacists is discussed as one of the major contributions to the evidence base for pharmacy practice. Such initiatives would require pharmacists to acquire more effective consultation skills in the first instance. South Asians expressed views that community pharmacists need to be more knowledgeable, responsive and flexible in their professional practice by assessing their pharmaceutical needs and being aware of particular cultural sensitivities when planning their services in line with the new pharmaceutical contract. More specifically, South Asian participants illustrated the need for community pharmacists and their staff to be more 'culturally knowledgeable' about the communities in which they practice. It is argued that the provision of a more culturally sensitive and pro-active service is needed to develop a better patient-practitioner professional relationship that promotes trust. South Asians illustrated how certain behavioural, religious and cultural beliefs impact on medicines adherence, such as compliance issues whilst on holiday to their homeland, the impact of religious pilgrimage and fasts. Many South Asian participants had limited understanding about 'generic' medicines and considered these to be 'inferior' or 'less effective' than 'branded' medication. Participants' views of 'sharing' of medicines and medicines waste were also illustrated. Factors such as 'stress', 'fate' and 'karma' and their impact on health of the participants were discussed. Many of these factors could not be solely attributable to a South Asian 'culture'. However, the findings illustrate a need for a Medicines Use Review (MUR) service to include more 'targeted' exploration of medicines adherence and medicines optimisation for this population. The findings also highlighted why South Asians rarely consult the community pharmacist about sensitive or stigmatised issues such as depression, and how some conditions and symptoms were perceived to have negative impact on the 'social acceptance' of South Asian individuals within their own communities. South Asians suggested that community pharmacists needed to be more pro-active and 'responsive' to their pharmaceutical needs and respect confidentiality through use of private consultation areas for routine counselling, health promotion and medicines information. All participants endorsed a need for more 'professional' recognition of the pharmacist not only as an autonomous health care professional, but as one integral to providing NHS services relating to medicines and public health. The findings illustrated a lack of professional collaboration between community pharmacists and GPs, confounded by community pharmacists being 'subordinate' to GPs and portraying more of a 'shopkeeper' image. South Asians were well informed about the lack of shared medical records and relied heavily on a doctor's definitive 'diagnosis' for somatic symptoms related common ailments. South Asians pro-actively engaged with 'community action' based approaches in health education and health promotion, and an opportunity for community pharmacists to become more involved with social initiatives was inferred from the findings. Candid and animated discussions explored their understanding of exercise as part of weight management and their interpretation of effects of the use of herbal products, alternative practitioners and the importance of collaboration with religious and community leaders in promoting medicines adherence. Participants desired alternative communication methods other than leaflets (translated or otherwise), including the use of audio-visual means and use of media. Communication difficulties were still prevalent, and trained interpreters were rarely used. By embracing some of these challenges, community pharmacists could enhance the value of their services and provide a more meaningful, 'culturally' competent and responsive services based on the needs of their local populations and nurture a better trusting and professional relationship with their service users and healthcare colleagues.