Submitted by Salome Lema (salome.lema@hec.edu) on 2016-11-24T07:36:33Z No. of bitstreams: 1 20161102_Salome_Lema_Thesis - vf.pdf: 1739716 bytes, checksum: 9e2585c7ecc0b8105afd91779c254775 (MD5) / Approved for entry into archive by Josineide da Silva Santos Locatelli (josineide.locatelli@fgv.br) on 2016-11-24T10:16:30Z (GMT) No. of bitstreams: 1 20161102_Salome_Lema_Thesis - vf.pdf: 1739716 bytes, checksum: 9e2585c7ecc0b8105afd91779c254775 (MD5) / Made available in DSpace on 2016-11-24T11:16:37Z (GMT). No. of bitstreams: 1 20161102_Salome_Lema_Thesis - vf.pdf: 1739716 bytes, checksum: 9e2585c7ecc0b8105afd91779c254775 (MD5) Previous issue date: 2016-11-24 / In August 2011, the Brazilian government taxed short positions in the foreign exchange (FX) derivative market in order to weaken the surge of post-crisis capital inflow, discourage carry trade strategies on the Real and avoid further local currency appreciation. Nevertheless, nonfinancial firms are also end-users of derivatives and might have suffered in case financial institutions transfer the regulatory cost to their clients in the real economy. To the extent that this tax increases the cost of hedging, firms may decide to hedge less, causing an increase in their exposure to currency risk. This paper aims at analysing if this regulatory change had an impact on Brazilian non-financial firms FX exposure, measured by the sensitivity of stock prices to currency fluctuation (FX-Beta). Therefore, it seeks to compare the FX beta of Brazilian non-financial listed firms before and after the implementation of the measure, to assess their degree of exposure to currency risk. In accordance with an increasing cost of hedging for those companies, results show that the beta difference also reached a riskier level. / Em agosto de 2011, o governo brasileiro passou a tributar posições vendidas no mercado de derivativos cambiais para diminuir o influxo de capital estrangeiro no pós-crise, desencorajar operações de carry trade e evitar que o real continuasse a se valorizar frente ao dólar. No entanto, empresas não financeiras também são usuárias de derivativos, e podem ter tido seus custos de proteção cambial aumentados, caso as instituições financeiras tenham transferido esse custo adicional para seus clientes na economia real. Na medida em que o tributo aumenta o custo de fazer proteção cambial com derivativos, as empresas podem ter decidido proteger uma parcela menor de sua exposição, causando um aumento em sua exposição cambial. Essa dissertação analisa se essa mudança regulatória teve um impacto na exposição cambial das empresas não financeiras, medida pela sensibilidade do preço das ações às variações cambiais (FX-Beta). Assim, o estudo compara os FX-Betas das empresas brasileiras antes e depois da implementação do tributo, para medir o grau de mudança em suas exposições cambiais. Em linha com o aumento no custo do hedge para essas empresas, os resultados mostram alguma evidência de que algumas empresas se tornaram mais expostas ao câmbio.

Introduction Older adults are regular consumers of over-the-counter (OTC) medications. OTC medications are generally considered safe, and convenient to use without requiring a prescription. However, the safety of an OTC medication and the final health outcome depends in part upon consumers’ perceptions, beliefs, and their decision-making about OTC medication use. The main objectives of this study were: 1) to examine the prevalence and characteristics of OTC medication use among community-dwelling US older adults (65 years and older), 2) to explore older adults’ knowledge, attitudes, beliefs and experiences about OTC medications, and 3) to elicit the OTC medication decision-making process in this population. Methods Data from the National Social Life, Health, and Aging Project (NSHAP) wave 2 was utilized to examine the prevalence and characteristics of OTC medication use in a nationally representative sample (N=2,637) of community-dwelling US older adults (65 years and older). OTC medication use was characterized based on sociodemographic, intrapersonal, interpersonal, organizational, and community-level factors. Further, a mixed-methods study was conducted in two senior-living communities in Richmond, VA. The qualitative phase of this mixed-methods study used focus group methodology to explore the knowledge, attitude, beliefs, and experiences about OTC medications, and the OTC medication decision-making process in a sample (N=80) of older adults using the criterion sampling strategy of purposeful sampling. Results from the qualitative phase informed the development of a semi-structured questionnaire, which was used to collect data in the quantitative phase of the mixed-methods study. The quantitative phase used in-person interviews to quantify attitudes, beliefs, preferences, and practices associated with the OTC medication use and decision-making process in a different convenient sample (N=88) of older adults within the same settings. Results NSHAP Study: The majority of participants were women (54%), whites (82%), and with an education greater than high school (57%). Study findings indicate a high weighted prevalence (76%) of OTC medication use in a nationally representative sample of older adults. Among older adult men, education (p value=0.0038), race (p value=0.0003) and comorbidity (p value =<0.0001) significantly and independently predicted the OTC medication use. Older adult men who were whites had greater odds of using OTC medication than other races. Older adult men with higher than high school education were 1.54 times more likely (95% CI: 1.15-2.06) to use OTC medications than their counterparts. It was observed that with every unit increase in the number of co-morbid conditions, OTC medication use decreases by 26% (OR: 0.74, 95% CI: 0.65-0.84) among older adult men. Among older adult women, education (p value=0.0244), race (p value=0.0048), smoking (p value=0.0494), and social participation (p value=0.0341) showed a significant and independent association with OTC medication use. Older adult women who were whites and non-smokers had greater odds of using OTC medication than their counterparts. Older adult women with higher than high school education were 1.36 times more likely (95% CI: 1.04-1.79) to use OTC medications than their counterparts. It was observed that with every unit increase in the social participation, OTC medication use increases by 15% (OR: 1.15, 95% CI: 1.01-1.31) among older adult women. Qualitative Study: The majority of the sample were women (63%), whites (54%), and with an education greater than high school (60%). The study indicated that the OTC medications are generally considered very safe and effective for treating minor/routine symptoms by older adults. Brand version OTC medications were generally favored over generics by this sample of US older adults. There were found two types of decision-making scenarios following after the older adults make sense of their symptoms: 1) treatment decision-making and 2) purchase decision-making. The treatment decision-making comes with two approaches: 1) a decision to treat their symptoms by themselves (self-recommended) or 2) a decision to ask and/or follow physician’s recommendation (physician-recommended). Each of these treatment approaches may lead to the other depending on the person’s financial and healthcare resources, severity of the symptoms, experiences with the medication (past or current), and relationship with the physician. While purchasing OTC medication from the store, the majority of consumers first explore information on the drug-label, ask a pharmacist, compare various options (generic or brand), compare prices/deals, and make a final purchase decision favoring the maximum and fast relief, followed by the lower cost, and easy to swallow dosage forms. Quantitative study: The majority of the sample was women (55%), blacks (61%), and with an education less than or equal to high school (55%). Analgesics were the most (76%) prevalent OTC therapeutic category, and aspirin was the most (65%) prevalent OTC medication. A greater (82%) proportion of the participants reported self-recommended OTC medication use (self-medication with OTC medications) rather than physician-recommended use. A high (41%) prevalence of inappropriate use of OTC medications was observed in this sample of older adults. Most participants considered OTC medications very safe or safe (80%) and very effective or effective (80%) to use. The majority (79%) of participants felt very satisfied, and 16% felt satisfied with their OTC medication use. Brand name OTC medications were considered more safe and effective compared to generic versions. The pharmacy was the most (93%) commonly reported purchase location to buy an OTC medication. Physicians were the most (90%) commonly reported information source about OTC medications. Conclusions Older adults feel positive and satisfied with their OTC medication use, in general. Considering the self-reported high use, inappropriate use, and experiences of facing side effects, education focused toward older adults should be encouraged to aid in safe and responsible OTC decision-making.

Evaluation of marketing communication selected from the group of pharmaceutical products, OTC drugs intended for treatment of flu and colds by a questionnaire survey focused on specific factors influencing consumer behavior of the target group of customers

In this thesis, the pricing of counterparty credit risk on an OTC plain vanilla interest rate swap is investigated. Counterparty credit risk can be defined as the risk that a counterparty in a financial contract might not be able or willing to fulfil their obligations. This risk has to be taken into account in the valuation of an OTC derivative. The market price of the counterparty credit risk is known as the Credit Value Adjustment (CVA). In a bilateral contract, such as a swap, the party’s own creditworthiness also has to be taken into account, leading to another adjustment known as the Debit Value Adjustment (DVA). Since 2013, the international accounting standards (IFRS) states that these adjustments have to be done in order to reflect the fair value of an OTC derivative. A short background and the derivation of CVA and DVA is presented, including related topics like various risk mitigation techniques, hedging of CVA, regulations etc.. Four different pricing frameworks are compared, two more sophisticated frameworks and two approximative approaches. The most complex framework includes an interest rate model in form of the LIBOR Market Model and a credit model in form of the Cox-Ingersoll- Ross model. In this framework, the impact of dependencies between credit and market risk factors (leading to wrong-way/right-way risk) and the dependence between the default time of different parties are investigated. / I den här uppsatsen har prissättning av motpartsrisk för en OTC ränteswap undersökts. Motpartsrisk kan definieras som risken att en motpart i ett finansiellt kontrakt inte har möjlighet eller viljan att fullfölja sin del av kontraktet. Motpartsrisken måste tas med I värderingen av ett OTC-derivat. Marknadspriset på motpartrisken är känt som Credit Value Adjustment (CVA). I ett bilateralt kontrakt, t.ex. som en swap, måste även den egna kreditvärdighet tas med i värderingen, vilket leder till en justering som är känd som Debit Value Adjustment (DVA). Sedan 2013 skall, enligt den internationella redovisningsstandarden (IFRS), dessa prisjusteringar göras vid redovisningen av värdet för ett OTC derivat. En kort bakgrund samt härledningen av CVA och DVA ar presenterade tillsammans med relaterade ämnen. Fyra olika metoder för att beräkna CVA har jämförts, två mer sofistikerade metoder och två approximativa metoder. I den mest avancerade metoden används en räntemodell i form av LIBOR Market Model samt en kreditmodell i form av en Cox-Ingersoll-Ross modell. I den här metoden undersöks även påverkan av CVA då det existerar beroenden mellan marknads

<p>  </p> <p>Polypharmacy in older adults presents several challenges, such as suboptimal therapeutic outcomes and increased adverse effects. Deprescribing, a clinically supervised process of decreasing dosage or stopping the medication when risks outweigh benefits, has emerged as one possible solution to these problems. However, the literature describing deprescribing intervention frameworks is heterogenous regarding targeted medications to deprescribe, population characteristics, clinical settings, and measured outcomes. This dissertation utilizes Linsky et al.'s deprescribing conceptual model, which details factors influencing decisions regarding initiating deprescribing interventions and their direct impact on the process. </p> <p>This dissertation utilizes a multimethod approach to investigate factors that facilitate and improve the deprescribing of anticholinergic medications for older adults, addressing gaps in this population's anticholinergic medication use. The three studies included in this dissertation provide a comprehensive understanding of deprescribing anticholinergic medications for this population, each contributing unique insights and results. </p> <p>The first study explores the feasibility of in-person and remote Home Medication Inventory Method (HMIM) approaches to evaluate over-the-counter (OTC) and prescription medication possession and use, including anticholinergics. Results demonstrate that both methods can accurately assess anticholinergic medication usage patterns, providing healthcare providers with reproducible methods and detailed medication profiles to make informed deprescribing decisions based on complete medication lists.</p> <p>The second study examined the intertwined roles of social determinants of health and health beliefs in predicting older adults' self-reported deprescribing behaviors, proposing the Deprescribing Health Belief Model (DeRx-HBM) framework that can be utilized for these efforts. These results emphasize the importance of considering these elements when creating a patient-centric and culturally sensitive intervention since they significantly shape deprescribing behaviors.</p> <p>In the third study, we explored the use of a symptom-specific scale for measuring the symptom burden in older adults during the deprescribing of anticholinergic medications prescribed for urinary incontinence, depression, and pain management. This research introduces a validated scale for assessing anticholinergic symptom burden prior to, throughout, and following the deprescribing attempt. The implementation of this scale has the potential to enhance the reproducibility and standardization of deprescribing decisions. Furthermore, it can improve communication between healthcare professionals and patients, as well as monitor the effectiveness of interventions during and after the deprescribing process.</p> <p>Collectively, these studies provide invaluable insights into factors influencing deprescribing decisions, obstacles to implementing deprescribing practices, and potential strategies to optimize medication management in older adults. The major takeaway from these studies is that addressing these factors leads to more informed decisions among healthcare professionals and patients - potentially leading to improved patient outcomes, ensure the ongoing effectiveness of deprescribing initiatives among older adults, and the promotion of health equity throughout the deprescribing process.</p>

Inom den offentliga sektorn spelar hälso- och sjukvårdsorganisationer en central roll för styrning kring organiseringen av metaboliska sjukdomar (OTC-brist, Ornitin- transkarbamylasbrist), vilka utgör en allt större börda för samhället och kräver en samordnad insats över olika sektorer för att förebygga och behandla effektivt. Genom studier vid Södra Älvsborgs sjukhus i Borås och Sahlgrenska Universitetssjukhuset i Göteborg utfördes en kvalitativ studie för att undersöka hur befintliga styrformer inom hälso-och sjukvårdsorganisationer påverkar samverkan. Studien syftade till att analysera och förstå dynamiken i samverkan mellan olika aktörer, med målet att identifiera framgångsfaktorer och utmaningar för att förbättra samarbetet inom hälso- och sjukvårdssektorn. Sex intervjuer genomfördes med representanter från olika yrkesroller inom hälso-och sjukvårdsorganisationer för att få bättre förståelse för samverkansprocesserna genom respondenternas upplevelser och deltagande. Det empiriska materialet analyserades utifrån teoretiska ramverk och fyra teman: Den dagliga arbetsgången, arbetsuppgifter &amp; sjukdom, organisationens olika domäner och beslutsfattande organ.  Resultaten visade på en rad utmaningar och möjligheter för samverkan. Tidsbegränsningar, hög arbetsbelastning och bristande kommunikation identifierades som hinder, medan tydlig kommunikation, samarbete mellan olika yrkesgrupper och integrerade samverkansstrukturer framhölls som främjande faktorer. Genom att koppla resultaten till teoretiska ramverk inom samverkan, organisations- och ledningsteorier, betonades vikten av att främja en samarbetskultur och organisatoriska förutsättningar. En holistisk metod och engagemang från relevanta intressenter och beslutsfattande organ i samverkan ansågs vara avgörande för att främja effektivt samarbete. Slutligen betonar uppsatsen behovet av fortsatt forskning och utveckling för att adressera de identifierade utmaningarna och främja en effektiv samverkan mellan primärvård och sjukvård vid hanteringen av metaboliska sjukdomar. Detta är avgörande för att förbättra vården och uppnå bättre resultat för alla inblandade. / Within the public sector, healthcare organizations play a central role in public administration concerning the management of metabolic diseases (OTCD, Ornithine transcarbamylase deficiency), which pose an increasingly significant burden on society and require coordinated efforts across various sectors for effective prevention and treatment. A qualitative study was conducted through research at Södra Älvsborg Hospital in Borås and Sahlgrenska University Hospital in Gothenburg to examine how existing public administration structures within healthcare organizations impact collaboration. The study aimed to analyze and understand the dynamics of collaboration among different actors, with the goal of identifying success factors and challenges to improve cooperation within the healthcare sector. Six interviews were conducted with representatives from various professional roles within healthcare organizations to gain a better understanding of the collaboration processes through the experiences and participation of the respondents. The empirical material was analyzed based on theoretical frameworks and four themes: Daily workflow, tasks &amp; diseases, the organization's different domains, and decision-making bodies.   The results revealed a range of challenges and opportunities for collaboration. Time constraints, high workloads, and inadequate communication were identified as barriers, while clear communication, collaboration among different professional groups, and integrated collaboration structures were highlighted as facilitating factors. By linking the results to theoretical frameworks within collaboration, organizational, and public administrations  theories, the importance of promoting a culture of collaboration and organizational conditions was emphasized. A holistic approach and engagement from relevant stakeholders and decisionmaking bodies in collaboration were considered crucial to promote effective cooperation. Finally, the paper emphasizes the need for further research and development to address the identified challenges and promote effective collaboration between primary care and healthcare in managing metabolic diseases. This is crucial for improving healthcare and achieving better outcomes for all involved.

Inherited metabolic disorders (IMD) form a diverse group of several hundred different diseases with a relatively high cumulative incidence (stated up to 1:600). They are associated with accumulation of the substrates and lack of the products in specific metabolic pathways, which is caused by deficiency of the enzyme or its activator, or dysfunction of the transport protein. However, the underlying cause is at the DNA level. The grounds for different phenotype manifestation in patients with the same genotype are often not known. During my work at the Institute of Inherited Metabolic Disorders, I designed several new methods for the research of IMD and applied them in the patients and their families. I created procedures for the isolation of lysosomal membranes that are used for the research of lysosomal storage disorders and general properties of lysosomes. Next, I introduced several novel assays for determination of the X-inactivation ratio, which led to a significant increase of informative women. Nowadays, we use these methods in heterozygous women with X-linked diseases in order to study the influence of X-inactivation on the manifestation of the diseases. The cases of a girl with mucopolysaccharidosis type II, a girl with OTC deficiency and a family with the mutation in HPRT1 gene are described...

Inherited metabolic disorders (IMD) form a diverse group of several hundred different diseases with a relatively high cumulative incidence (stated up to 1:600). They are associated with accumulation of the substrates and lack of the products in specific metabolic pathways, which is caused by deficiency of the enzyme or its activator, or dysfunction of the transport protein. However, the underlying cause is at the DNA level. The grounds for different phenotype manifestation in patients with the same genotype are often not known. During my work at the Institute of Inherited Metabolic Disorders, I designed several new methods for the research of IMD and applied them in the patients and their families. I created procedures for the isolation of lysosomal membranes that are used for the research of lysosomal storage disorders and general properties of lysosomes. Next, I introduced several novel assays for determination of the X-inactivation ratio, which led to a significant increase of informative women. Nowadays, we use these methods in heterozygous women with X-linked diseases in order to study the influence of X-inactivation on the manifestation of the diseases. The cases of a girl with mucopolysaccharidosis type II, a girl with OTC deficiency and a family with the mutation in HPRT1 gene are described...

In this paper, Monte Carlo simulation for CCR (Counterparty Credit Risk) modeling is investigated. A jump-diffusion model, Bates' model, is used to describe the price process of an asset, and the counterparty default probability is described by a stochastic intensity model with constant intensity. In combination with Monte Carlo simulation, the variance reduction technique importance sampling is used in an attempt to make the simulations more efficient. Importance sampling is used for simulation of both the asset price and, for CVA (Credit Valuation Adjustment) estimation, the default time. CVA is simulated for both European and Bermudan options. It is shown that a significant variance reduction can be achieved by utilizing importance sampling for asset price simulations. It is also shown that a significant variance reduction for CVA simulation can be achieved for counterparties with small default probabilities by employing importance sampling for the default times. This holds for both European and Bermudan options. Furthermore, the regression based method least squares Monte Carlo is used to estimate the price of a Bermudan option, resulting in CVA estimates that lie within an interval of feasible values. Finally, some topics of further research are suggested. / I denna rapport undersöks Monte Carlo-simuleringar för motpartskreditrisk. En jump-diffusion-modell, Bates modell, används för att beskriva prisprocessen hos en tillgång, och sannolikheten att motparten drabbas av insolvens beskrivs av en stokastisk intensitetsmodell med konstant intensitet. Tillsammans med Monte Carlo-simuleringar används variansreduktionstekinken importance sampling i ett försök att effektivisera simuleringarna. Importance sampling används för simulering av både tillgångens pris och, för estimering av CVA (Credit Valuation Adjustment), tidpunkten för insolvens. CVA simuleras för både europeiska optioner och Bermuda-optioner. Det visas att en signifikant variansreduktion kan uppnås genom att använda importance sampling för simuleringen av tillgångens pris. Det visas även att en signifikant variansreduktion för CVA-simulering kan uppnås för motparter med små sannolikheter att drabbas av insolvens genom att använda importance sampling för simulering av tidpunkter för insolvens. Detta gäller både europeiska optioner och Bermuda-optioner. Vidare, används regressionsmetoden least squares Monte Carlo för att estimera priset av en Bermuda-option, vilket resulterar i CVA-estimat som ligger inom ett intervall av rimliga värden. Slutligen föreslås några ämnen för ytterligare forskning.

The purpose of this study was to determine the profile of parents with children in Early Childhood Development (ECD) centres using Over the Counter (OTC) homeopathic remedies, specific to the Pretoria East region. Secondary objectives included determining the extent of use of OTC homeopathic remedies, the perceptions of parents regarding homeopathy and natural remedies as well as the positioning of homeopathy. The research was designed around descriptive and exploratory methods using quantitative research techniques. Aspects such as demographic information and the general health of families, attitudes, perceptions and opinions specific to homeopathy, natural remedies and conventional medicine, as well as details on remedy usage and brands, were addressed. From the findings of the study a clear profile could be identified. Further to the profile, the perceptions of respondents regarding OTC homeopathic remedies as well as reasons for using these remedies are discussed. The positioning of OTC homeopathic remedies was done based on spider graphs, exploratory factor analysis, cluster analysis and multidimensional scaling. Several recommendations were made to the homeopathic industry, the Ministry of Health, medical professionals, Medical Aid Schemes, pharmacists and the pharmaceutical industry, as well as the Department of Social Development. The study concludes with details specific to the limitations of the study and further research suggestions. / Economics / M.A. Commerce (Business Management)