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CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / O presente trabalho objetivou descrever o consumo de psicofÃrmacos entre os usuÃrios assistidos na AtenÃÃo PrimÃria de SaÃde (APS) e encaminhados ao Centro de Apoio Psicossocial (CAPS) no municÃpio de MaracanaÃ; avaliar a prÃtica de prescriÃÃo, aquisiÃÃo e uso prolongado dos psicofÃrmacos; conhecer o que representa o uso desses medicamentos no dia-a-dia e avaliar os fatores determinantes ao consumo de psicofÃrmacos, entre as variÃveis sociais, econÃmicas, demogrÃficas e biolÃgicas. Trata-se de um estudo epidemiolÃgico, quantitativo, observacional e transversal realizado no perÃodo de setembro de 2006 a fevereiro de 2008, cujo objeto de avaliaÃÃo foram os indivÃduos provenientes da APS e encaminhados ao CAPS. As informaÃÃes foram obtidas atravÃs de um roteiro de entrevista, contendo 57 perguntas. A amostra foi calculada em funÃÃo do nÃmero de pessoas cadastradas e acompanhadas pelo CAPS. No total, foram entrevistadas 200 pessoas, em que 121 (60,5%) afirmaram ter consumido psicofÃrmacos nos Ãltimos 15 dias; destas, a maioria era do sexo feminino, com renda individual mensal atà 2 salÃrios mÃnimos (85,4%), baixa escolaridade (68,8% eram analfabetos) e com algum tipo de doenÃa secundÃria (54,5%). Alguns (20,0%) informaram ser usuÃrios de bebidas alcoÃlicas, 54,0% fumavam e 72,0% nÃo praticavam atividade fÃsica. Quanto à representaÃÃo desses medicamentos no dia-a-dia, a maioria (47,9%) referiu âalÃvioâ. A mÃdia do consumo de psicofÃrmacos foi de 1,5 medicamento por pessoa. A maioria das pessoas (78,3%) os utilizava de forma contÃnua e 73,3% afirmaram nÃo ter recebido orientaÃÃo quanto aos riscos de utilizÃ-los por tempo prolongado. Os mÃdicos foram responsÃveis por 93,9% das indicaÃÃes. Os usuÃrios referiram jà ter tentado parar de tomar esses medicamentos (57,8%), sendo que 78,3% conseguiram isto de forma brusca e outros (75,6%), que estavam fazendo uso hà mais de 12 meses, relataram nÃo ter conseguido parar de tomÃ-los de forma alguma. Os grupos de medicamentos mais consumidos foram: ansiolÃticos (36,5%), antidepressivos (31,5%), antipsicÃticos (17,7%) e antiepilÃpticos (11,0%). Entre os ansiolÃticos o mais consumido foi o diazepam (27,0%). Os principais motivos para o consumo de psicofÃrmacos foram: ânervosismoâ (20,4%), âinsÃniaâ (17,8 %) e âdepressÃoâ (11,6%). Quanto à aquisiÃÃo dos psicofÃrmacos, 41,6% foram adquiridos na farmÃcia do CAPS, mas 24,3% compraram tais medicamentos. Algumas pessoas (18,3%) adquiriam esses produtos sem receita mÃdica e 83,5% utilizavam tambÃm outros medicamentos, destacando-se, segundo a classificaÃÃo ATC, os do Sistema Cardiovascular (39,5%) e do Trato Alimentar e Metabolismo (17,9%). O captopril, hidroclorotiazida, ranitidina, omeprazol, propranolol, prometazina e o paracetamol foram responsÃveis por 38,5% do consumo geral de medicamentos. O estudo possibilitou o aporte de informaÃÃes relevantes acerca do uso de psicofÃrmacos em Maracanaà e sobre seus usuÃrios. / The objectives of the present work is to describe the consumption of psychoactives amongst users who attended in the Primary Care of Health (PCS) and were directed to the Centre of Psychologic and Social Support (CPSS) in the city of MaracanaÃ; to evaluate the practice of prescribing, the acquisition and chronic use of psychoactives; to find out what represents the use of these medicines on a day-by-day basis and to evaluate factors that determine consumption of psychoactives, such as social, economic, demographic and biological variables. This was an epidemiologic, quantitative, observational, and cross sectional study carried out from September of 2006 to February of 2008 which evaluated individuals proceeding from the PCS and directed to the CPSS. The information was obtained through an interview comprising 57 questions. The sample was calculated as a function of the number of people registered and followed up by CPSS. In the total 200 people were interviewed, where 121 (60.5%) had affirmed to have consumed psychoactives in last the 15 days; of these, the majority were female, with an individual monthly income greater than two minimum salaries, low schooling (68.8% were illiterate) and with some type of secondary disease (54.5%). Some of them reported consumption of alcoholic beverages (20.0%), 54.0% were smokers and 72.0% did not take any physical activity. Concerning the questions about what the medicines represent to them, the majority (47.9%) said they felt something like âreliefâ. The average of the consumption of psychoactives was of 1,5 medicines per person. The majority of the people (78.3%) used them continuously and 73.3% had reported that they did not received any information about the risks of long-term use. Doctors were responsible for 93,9% of the indications. Of the users who reported that they had attempted to stop taking these medicines (57.8%), 78.3% did this suddenly. The groups of the most consumed medicines were: Anxyolitics (36.5%), Antidepressants (31.5%), Antipsychotics (17.7%) and Antiepileptics (11.0%). Of the anxyolitic drugs, the most consumed was diazepam it (27.0%). The main reasons for the consumption of psychoactives were: ânervousnessâ (20.4%), âsleeplessnessâ (17.8%) and âdepressionâ (11.6%). Concerning the acquisition of psychoactives, 41.6% were obtained from the pharmacy of the CPSS, but 24.3% of these medicines were bought by patients. Some people (18.3%) got these drugs without medical prescription and 83.5% also used other medicines. These were, according to ATC classification, medicines of the Cardiovascular System (39.5%) and of the Gastric Tract (17.9%). Captopril, hidroclorotiazide, ranitidine, omeprazole, propranolol, prometazine and paracetamol were responsible for 38,5% of general medicines consumed. Our study provided relevant information about the use of psychoactive drugs in Maracanaà and on its users.

L’efficacité d’une thérapeutique repose, en grande partie, sur la bonne observance de la prescription. Une mauvaise observance est susceptible de provoquer un échec thérapeutique et une escalade dans les traitements. Elle est également génératrice de surcoûts pour le système de protection sociale. La base de données Erasme, base de remboursement du régime général de l’assurance maladie (Cnam-TS), constitue une source d’information importante pour la mesure de l’utilisation des médicaments et donc, possiblement, de l’observance. Hors, depuis de nombreuses années, il a été proposé des descripteurs de l’observance calculable à partir des remboursements de différents systèmes d’assurance maladie dans le monde. Le but de ce travail était de : - recenser ces indicateurs et les appliquer à la base Erasme ; - proposer de nouveaux indicateurs ; - catégoriser ces indicateurs. Dans une première partie nous faisons l’état des lieux de la notion et du concept d’observance médicamenteuse et de sa mesure à partir des bases de données de remboursement. Dans une deuxième partie, nous présentons la base Erasme et proposons des nouveaux indicateurs. Afin d’illustrer nos propos, nous présentons les études que nous avons réalisé à partir de l’étude de médicaments ayant des profils de consommation différents : traitement au long cours d’une affection symptomatique (asthme), traitement au long cours d’une affection asymptomatique (hypercholestérolémie), traitement au long cours d’une affection grave (diabète), traitement « minute » (infection urinaire) et un traitement de durée moyenne (contraception orale). / The efficacy of a therapeutic response depends largely on good adherence to the prescription. Poor adherence may lead to therapeutic failure and an escalation of treatment. Furthermore, this generates excess cost for the health insurance system. The Erasme reimbursement database of the largest health insurance system in France (régime général de l'assurance maladie, Cnam-TS), represents an important source of information on the use of medicines, and, therefore, possibly adherence. This is particularly the case as several indicators have been proposed to describe adherence from reimbursements in the different health insurance systems around the world. The objective of the current work was to: - identify the indicators and to apply these to the Erasme database; - propose new indicators; - categorise these indicators. The first part introduces the notion and concept of medication adherence and its measurement from reimbursement databases. The second part describes the Erasme database and the propositions for new indicators. This will then be illustrated by the studies that we have performed on medicines that have different profiles of use: long-term treatment of symptomatic disease (asthma), long-term treatment of asymptomatic disease (hypercholesterolaemia), long-term treatment of serious disease (diabetes), short-term treatment (urinary infection), and medium-term treatment (oral contraceptives).

Masters of Science / Background: In Africa, traditional medicine (TM) practice has been in existence since time immemorial as the major source of pharmacotherapy. However, unlike orthodox medicines TM policies and regulations are not formalised let alone standardised. African nations have different approaches and regulatory requirements whereas in some states policies are even non-existent. Aim: The aim of the mini thesis was to assess the current policies and guidelines for regulation of TM in five selected sub-Saharan African countries relative to the WHO recommendations on traditional medicine policy. Method: The mini thesis was a desk review of current policy frameworks and guidelines for regulation of traditional medicines relative to WHO recommendations on TM policy in sub- Saharan Africa using five selected countries. Result: The results from the five selected countries showed significant difference in the current policies and guidelines on the regulation of TM, but no significant difference in the actual WHO TM policy indicators that the countries implemented. Discussion: Regularisation of TM practice by integrating it into main health systems could make it more acceptable. The complexity of TM/herbal products needs a different yet integrated approach. Harmonisation of regulatory requirements eliminates the need for redundant testing, ensures consistency across regions and improves implementation of WHO TM policy indicators.

Masters of Public Health - see Magister Public Health / Overreliance on donor supported health programs has crippled many African countries and there is inadequate long-term planning on the future sustainability of health systems. In the age of uncertainty in global politics and global economy, the future of these donor funded programs is also uncertain. It is imperative for African nations to begin to take responsibility for their health programs. In as much as the name “donation” suggests that something is given free of charge, in actual sense this may not be the case due to hidden costs attached. In medicine access, the hidden costs are the supply chain costs including cost for clearance, storage and distribution of such medicines which are charged as a percentage of claimed commodity costs on donors’ or suppliers’ invoices. Since the medicines donated are in originators’ brands, the invoiced prices are high thus supply chain costs are high as well. In some cases, it is thought that the hidden costs are higher than the cost of medicines had they been sourced locally as generics. The aim of this research was to assess and determine the hidden supply chain costs associated with the four medicine donation programs supporting the Tanzania Neglected Tropical Diseases Program and inform policy decision on optimal financing options for the program Methodology The cost analysis of the two options was undertaken from a payers’ perspective which in this case is the Government of Tanzania (Ministry of Health). Data was collected on both product and supply chain cost drivers incurred in the medicine donation programs from July 2014 to June 2017. Costs of the current mechanism were obtained from the program’s quantification reports and transaction data for the study period. Transactional data was obtained from shipment documents including sales invoices, parking list, proof of delivery and goods receiving notes were evaluated for actual quantities shipped, commodity prices and other supply chain cost. To verify the actual supply chain cost charged by the program, both the official bills from Medical Stores Department (MSD) to the program and the electronic bills available at MSD electronic database covering the study period were studied.

Η Υγεία αποτελεί θεμελιώδες αγαθό για κάθε άνθρωπο, εντούτοις έντονος προβληματισμός παρατηρείται τα τελευταία χρόνια στη χώρα μας από την αύξηση των δαπανών της γενικότερα αλλά και των φαρμακευτικών δαπανών ειδικότερα. Η φαρμακευτική περίθαλψη αποτελεί γενικότερα ένα χρονίζον Ελληνικό πρόβλημα, οι λύσεις του οποίου μέχρι σήμερα τουλάχιστον ήταν πρόχειρες και εφήμερου χαρακτήρα. Επιπροσθέτως το πρόβλημα του φαρμάκου συνδέεται άμεσα με το ακανθώδες ασφαλιστικό σύστημα της χώρας, κύριο χαρακτηριστικό του οποίου ήταν η ύπαρξη μεγάλου αριθμού ταμείων και μεγάλου εύρους ασφαλιστικών σχημάτων, καθένα από τα οποία υπέκειτο σε διαφορετική νομοθεσία και σχεδόν σε όλες τις περιπτώσεις υπήρχαν έντονες διαφοροποιήσεις με αποτέλεσμα να προκύπτουν ανισοτιμίες στην πρόσβαση και τη χρηματοδότηση των υπηρεσιών, με τη δαπάνη του φαρμάκου να καλύπτεται σχεδόν εξολοκλήρου από αυτά τα ασφαλιστικά ταμεία. Η υπερσυνταγογράφηση, ο σχεδόν ανύπαρκτος σχετικός έλεγχος και η ανυπαρξία σχεδιασμού ως προς τη διάθεση και γενικά κατανάλωση φαρμάκου, έχει συντελέσει σε τεράστιες ετήσιες εκροές στον τομέα αυτό. Συνήθως εστιάζοντας τις λύσεις σε εσφαλμένες παραμέτρους του προβλήματος, το πρόβλημα όχι απλά δεν επιλύθηκε, παρά τα τελευταία χρόνια, η φαρμακευτική δαπάνη σημείωσε υπέρογκες αυξήσεις. Η τελευταία προσπάθεια με την ιδέα της ενοποίησης των ταμείων και την ίδρυση του ΕΟΠΥΥ σε ένα και μοναδικό φορέα παροχής υπηρεσιών υγείας, φαίνεται ως ιδέα να έχει θεωρητικό υπόβαθρο. Η συγκρότηση του ΕΟΠΥΥ πάντως συνιστά μια απόπειρα μεταρρύθμισης της κοινωνικής ασφάλισης υγείας και της υγειονομικής περίθαλψης γενικότερα, κρίσιμης σημασίας για την παρούσα συγκυρία . Δυστυχώς όμως ο ατελής σχεδιασμός του νέου αυτού Οργανισμού σε συνδυασμό με την άμεση μετάθεση σε αυτόν των πολλαπλών προβλημάτων του παρελθόντος, κυρίως οικονομικού και διαρθρωτικού χαρακτήρα, και με δεδομένη την αδυναμία σοβαρής κρατικής επιχορήγησης, έφεραν τον ΕΟΠΥΥ σε χρηματοδοτικό έμφραγμα. Η χρηματοδοτική αυτή εμπλοκή του ΕΟΠΥΥ, σε συνάρτηση με τις ακολουθούμενες πολιτικές έχουν δημιουργήσει μείζονα κρίση εμπιστοσύνης και αξιοπιστίας μεταξύ του οργανισμού και των επαγγελματιών υγείας (γιατρών, φαρμακοποιών και άλλων), των εξωτερικών προμηθευτών (ιδιωτικές κλινικές, διαγνωστικά εργαστήρια) αλλά και των πολιτών, φαινόμενο το οποίο ωθεί σε διαδικασία απονομιμοποίησης. Με την εφαρμογή πάντως κανόνων ελέγχου όπως η ηλεκτρονική συνταγογράφηση να έχουν δείξει άμεσα αποτελέσματα, φαίνεται η προφανής ορθή πορεία που θα πρέπει να ακολουθηθεί πλέον, μέσω άρτιου σχεδιασμού και ορθών εκτιμήσεων. / The Health constitutes fundamental good for each person, nevertheless intense reflection is observed in the past few year in our country by the increase of expenses more generally but also pharmaceutical expenses more specifically. The pharmaceutical care constitutes more generally a dragging on Greek problem, the solutions of which up to today at least were off-hand and ephemeral character. Besides the problem of medicine is connected immediately with the thorny actuarial system of country, main characteristic opoioyitan the existence of big number of funds and big breadth of actuarial forms, each one from which ypekeito in different legislation and almost in the all cases existed intense differentiations so that they result anisotimies in the access and the financing of services, with the expense of medicine it is covered almost exolokliroy by these actuarial funds. The ypersyntagografisi, the almost non-existent relative control and the non-existence of planning as for the disposal and in general consumption of medicine, have contributed in enormous annual flows in this sector. Usually focusing the solutions in been mistaken parameters of problem, the problem was no simply not solved, despite in the past few year, the pharmaceutical expense showed huge increases. The last effort with the idea of unification of funds and the foundation of EOPYY in one and unique institution of benefit of services of health, appears as idea to have theoretical ypobathro.I constitution of EOPYY in any case is founded a attempt of reform of social insurance of health and sanitary care more generally, critical importance for the present economic situation. Unfortunately however the incomplete planning of this new Organism in combination with the direct change in that of multiple problems the past, mainly economic and structural character, and with given the weakness of serious government owned subsidy, they brought EOPYYse financing infarction. The chrimatodotikiayti entanglement of EOPYY, in connection with the followed policies they have created more major crisis of confidence and reliability between the organism and the professionals of health of (doctors, pharmacists and other), the exterior suppliers (private clinics, diagnostic laboratories) but also the citizens, phenomenon which prompts in process aponomimopoiisis. With the application of in any case rules of control as the electronic syntagografisi they have shown direct results, appears the obvious equitable course that will be supposed it is followed henceforth, via even planning and equitable estimates.

The first workers to use the isolated perfused rat liver for the study of gluconeogenesis were Corey and Britton (1941). Subsequently, other investigators found the modified method of Miller et al (1951) to be more suitable. This technique, with modifications introduced by Mortimore (1961) and Hems et al (1966) was used in the present study. The isolated liver is perfused through the portal vein with saline, supplemented by bovine serum albumin and washed human erythrocytes, under a pressure of about 20cm of water, maintained by a reservoir of adjustable height. The perfusate which passes through the liver enters the inferior vena cava and passes, via a cannula, to a collecting vessel from which it is pumped to the top of a multiple bulb oxygenator and then returned to the liver for re-perfusion. This technique has proved to be a satisfactory means of assessing changes in the metabolic status of hepatic cells in response to starvation and exposure to halothane. The study described here was performed to determine whether the isolated liver perfusion technique can be used to measure the effects on liver perfusion of therapeutic and supratherapeutic doses of various drugs, some of which have been reported to affect liver metabolism adversely in the intact animal. Liver function was assessed by studying gluconeogenesis and bromosulphthalein clearance. Alcohol and hexane were administered in toxic doses, rifampicin and isoniazid in high doses and paracetamol in therapeutic doses. Inbred male Wistar rats were used for these studies. Hexane was injected subcutaneously, while the other drugs were given per os on 7 consecutive days each week for a period of 90 days; with the exception of the control group in the hexane study, all the control groups were untreated. Pyruvate, a precursor for gluconeogenesis (synthesis of glucose from non-carbohydrate sources) is an excellent substrate for the formation of oxaloacetate, which is probably an obligatory intermediate in the pathway to glucose synthesis. It has been used over a number of years by different investigators who have .studied gluconeogenesis using the isolated liver perfusion technique. It was used for the same purpose in the present study. Methylene blue, a redox dye, capable of oxidising NADH to NAD+, was used to determine whether an altered NADH : NAD+ ratio would have any effect on the output of glucose in the ethanol, paracetamol and hexane studies. Fructose, a non-NAD+ dependent precursor of glucose. was also used for this purpose in the ethanol study. All the drugs studied were found to inhibit gluconeogenesis. This was shown by a decrease in glucose levels and an increase in lactate : pyruvate ratios in the perfusion medium of experimental livers. The decreased glucose production by the experimental livers, which occurred pari passu with an increased pyruvate utilization, indicates that in these animals pyruvate was used for the production of other compounds such as lactate. In contrast. glucose production and pyruvate utilization were increased in the control group indicating that pyruvate was used mainly for the production of glucose. In the ethanol group, impaired gluconeogenesis was probably due to a change in the NADH : NAD+ ratio; when methylene blue was introduced into the perfusion medium of this group the output of glucose was high. Impaired gluconeogenesis in the paracetamol and hexane-treated groups was probably related to the non-availability of oxaloacetate or impairment of the activity of key enzymes involved in gluconeogenesis; when methylene blue was added to the perfusion medium of these animals the glucose output remained low. Except for the rifampicin study. bromosulphthalein clearance was impaired in all the experimental groups. Histological examination of liver tissue obtained from the hexane-treated animals demonstrated severe fatty change. In conclusion, these studies have demonstrated that the isolated liver perfusion technique is a suitable method of evaluating the effect of therapeutic and supra-therapeutic doses of some drugs which affect hepatic function. Ethanol, isoniazid, rifampicin, paracetamol (in therapeutic doses) and hexane were found to alter liver function as evidenced by impaired gluconeogenesis and bromosulphthalein clearance. In addition, histological evidence of liver damage was noted in rats treated with hexane. / Thesis (M.Med.Sc.)-University of Natal, Durban, 1988.

<p>The underlying rational behind the protection of intellectual property rights is to strike a balance between the interests of intellectual property rights holders on the one hand and users of protected knowledge on the other hand. This thesis sought to achieve the following objectives: to create a good understanding of the historical development of the primary and secondary legal instruments related to the intellectual property rights/public health debate / to determine to what extent a balance is struck by the Agreement on Trade Related Aspects of Intellectual Property Rights with reference to the flexibilities provided for in the Treaty, read together with the subsequent World Trade Organization Ministerial Declarations and TRIPS Council Decisions / to evaluate the extent to which selected developing and least developed country members of the World Trade Organization have taken measures to implement the said flexibilities, taking cognizance of their relevant strengths and weaknesses / to suggest ways in which select countries in the developing world specifically India and Zambia can take greater advantage of the flexibilities to promote better access to medicines which taking into consideration various opportunities and threats that are foreseeable / to identify public health aspects of TRIPS that the developing country and least developed countries World Trade Organization members would do well to address in further negotiations.</p>

Mental health disorders such as depression and insomnia are prevalent in the community; the use of antidepressants and benzodiazepines is therefore common. However if these medications are not prescribed and used appropriately issues relating to safety and/or efficacy can occur. There is also some concern about the misuse of benzodiazepines by the injecting drug user (IDU) community. The overall aim of this PhD was to perform international utilization comparison studies and analyze national prescribing data to understand and describe factors influencing the use of prescription medicines, in particular antidepressants and benzodiazepines, and to develop some ideas and initiatives to improve future use. Comparisons in the prescribing of benzodiazepines and antidepressants between Nova Scotia, Canada and Australia were undertaken. Dispensing data for all publicly subsidized benzodiazepines and related compounds and antidepressant classes of medications and utilization was compared from 2000-2003, using the World Health Organisation ATC/ DDD system. Australian dispensing data were also used to examine changes in the utilization of antidepressants and benzodiazepines between different age groups within Australia from 2003-2006. Dispensing data and numerical data derived from reports from Australia’s Illicit Drug Reporting System (IDRS) were used to estimate benzodiazepine use by those who inject heroin, in areas with high proportion of persons who inject heroin in Sydney, Melbourne and Brisbane. To determine a strategy aimed at improving the use of benzodiazepines, the literature was searched and the latest interventions, solely focusing on increasing appropriate prescribing and reducing long term use of benzodiazepines worldwide were retrieved and analyzed. The comparison studies showed the use of benzodiazepines increased at a steady but comparable rate in both Australia and Nova Scotia, although overall use was much higher in Nova Scotia than Australia (123 and 48 DDD/1000 beneficiaries/day, respectively). However, the use of antidepressants in Nova Scotia increased at a higher rate than Australia. The variations between the two jurisdictions may be due to the more limited range of benzodiazepines available in Australia, or perhaps different initiatives to control. The differences may also be due to increased exposure to marketing, promotion, education or different prescribing practices in Nova Scotia compared to Australia. From 2003 to 2006, the use of antidepressants increased with age, with those over 65 years having the greatest use (86.9 and 97.7DDD/1000 population/day, respectively). Differences were also seen in the antidepressant most utilized, with the elderly using more tricyclic antidepressants than those who were younger. The utilization of benzodiazepines decreased from 2003-2006 in the same population (66.6 and 61 DDD/1000 concession beneficiaries/day, respectively). However, those over 85 had the highest use of benzodiazepines and used more long acting benzodiazepines than those aged 35-44. This demonstrates that the elderly still account for most use per capita of benzodiazepines. Some of this use may be inappropriate (e.g. use of long-acting benzodiazepines) and hence may provide a useful target for future educational intervention. The elderly also account for the largest per capita use of antidepressants. In areas with a high proportion of heroin IDU, the utilization of benzodiazepines by the estimated IDU population decreased (4064048DDDs in 2000 to 2613100 DDDs in 2006) however the overall use of benzodiazepines in Australia continued to increase from 2000-2006. This demonstrates that the increase in benzodiazepine utilization during this period was not primarily driven by use among IDU. The review identified three main target audiences at which interventions for improving the use of benzodiazepines were aimed at. These were consumers, General Practitioners or long term care facilities. Education, audit and feedback and alerts were the 3 major intervention approaches taken in the studies. The review concluded that studies which used a multi-factorial approach had the largest and most sustained reductions in benzodiazepines use. It appears that support groups for patients, non-voluntary recruitment of GPs, and oral delivery of alerts or feedback may all improve the outcomes of interventions. Using the review findings, an intervention targeting consumers and health professionals was conducted in a rural and urban area of Australia, using informative emails, bookmarks and website over a 6 month period. The intervention showed a significant decrease in the long term use of benzodiazepines within nursing homes located in the intervention geographical areas compared to the control areas. In conclusion the utilization studies revealed the current trends in utilization of antidepressants and benzodiazepines for Australia and led to the development of an intervention, based on factors that were found to influence prescribing of benzodiazepines. The intervention aimed at various target audiences did produce a small improvement in the prescribing of benzodiazepines.

Magister Scientiae - MSc (Pharmacy Administration and Policy Regulation) / Due to inadequacy of data on the effectiveness of medicines regulatory systems in Zambia, this study was framed. The aim was to evaluate legislative provisions for medicines regulation under three legalregulatory- frameworks in place over the period from 1995 to 2015. The study was structured in two distinct phases: the first involved document review of available legislation and secondary data relevant to the subject matter, covering the study period; the second involved a questionnaire survey for health practitioners to gather opinions on the effectiveness of the medicines regulatory systems in Zambia. Assessment of secondary data reported by Ministry of Health, and World Health Organisation on treatment outcomes and medicines regulation was conducted. Reviewed data showed relative reduction in incidence of some selected diseases of national importance. It was also evident that the regulatory systems had improved considerably over the study period. Responses from Health Practitioners and other players in the health and pharmaceutical sectors indicated that they were aware of medicines regulatory requirements, supported the need for medicines regulation, and indicated the need for regional collaboration and increased public awareness raising as means for improving current medicines regulatory systems. It was recommended that more comprehensive studies be undertaken to establish causal relationships between medicines regulatory systems, and disease outcomes. A further recommendation was made to implement more integrated information management systems in the Ministry of Health, and the Zambia Medicines Regulatory Authority.