Influence of body mass index on prescribing costs and potential cost savings of a weight management programme in primary care

Objectives Prescribed medications represent a high and increasing proportion of UK health care funds. Our aim was to quantify the influence of body mass index (BMI) on prescribing costs, and then the potential savings attached to implementing a weight management intervention.

Methods Paper and computer-based medical records were reviewed for all drug prescriptions over an 18-month period for 3400 randomly selected adult patients (18–75 years) stratified by BMI, from 23 primary care practices in seven UK regions. Drug costs from the British National Formulary at the time of the review were used. Multivariate regression analysis was applied to estimate the cost for all drugs and the ‘top ten’ drugs at each BMI point. This allowed the total and attributable prescribing costs to be estimated at any BMI. Weight loss outcomes achieved in a weight management programme (Counterweight) were used to model potential effects of weight change on drug costs. Anticipated savings were then compared with the cost programme delivery. Analysis was carried out on patients with follow-up data at 12 and 24 months as well as on an intention-to-treat basis. Outcomes from Counterweight were based on the observed lost to follow-up rate of 50%, and the assumption that those patients would continue a generally observed weight gain of 1 kg per year from baseline.

Results The minimum annual cost of all drug prescriptions at BMI 20 kg/m2 was £50.71 for men and £62.59 for women. Costs were greater by £5.27 (men) and £4.20 (women) for each unit increase in BMI, to a BMI of 25 (men £77.04, women £78.91), then by £7.78 and £5.53, respectively, to BMI 30 (men £115.93 women £111.23), then by £8.27 and £4.95 to BMI 40 (men £198.66, women £160.73). The relationship between increasing BMI and costs for the top ten drugs was more pronounced. Minimum costs were at a BMI of 20 (men £8.45, women £7.80), substantially greater at BMI 30 (men £23.98, women £16.72) and highest at BMI 40 (men £63.59, women £27.16). Attributable cost of overweight and obesity accounted for 23% of spending on all drugs with 16% attributable to obesity. The cost of the programme was estimated to be approximately £60 per patient entered. Modelling weight reductions achieved by the Counterweight weight management programme would potentially reduce prescribing costs by £6.35 (men) and £3.75 (women) or around 8% of programme costs at one year, and by £12.58 and £8.70, respectively, or 18% of programme costs after two years of intervention. Potential savings would be increased to around 22% of the cost of the programme at year one with full patient retention and follow-up.

Conclusion Drug prescriptions rise from a minimum at BMI of 20 kg/m2 and steeply above BMI 30 kg/m2. An effective weight management programme in primary care could potentially reduce prescription costs and lead to substantial cost avoidance, such that at least 8% of the programme delivery cost would be recouped from prescribing savings alone in the first year.

A interação das áreas de produção e de marketing e o impacto estratégico

Recentes avanços nas tecnologias e métodos de produção e seu impacto sobre a competitividade das empresas têm atraído a atenção daqueles ligados às atividades empresarial e acadêmica. Aumentam as alternativas e as implicações quando tomam-se decisões que influenciam a maneira com que empresas competem no mercado. É necessário coerência entre as atividades das diversas áreas funcionais de forma a propiciar ações coordenadas e alinhadas aos objetivos das organizações. Este estudo aborda, a partir da perspectiva de produção, a relação entre produção e marketing. Analisa-se informações coletadas em duas empresas confrontado-as com uma revisão bibliográfica realizada sobre o assunto. Diferentes realidades foram encontradas nas empresas estudadas. Em uma delas tem-se a integração entre as áreas, enquanto na outra ocorrem conflitos com impactos negativos sobre seu desempenho. Através do entendimento das áreas de produção e marketing, evidencia-se a importância de seu bom relacionamento. Verificam-se pontos de conflito e suas causas, mecanismos que proporcionam integração e as implicações para as empresas. Finalmente, conclui-se que, apesar da grande importância da relação entre produção e marketing, o assunto não é dominado. Faltam conceitos, raciocínio e linguagem desenvolvidos. Além disto, em ambos os casos, a área de produção tende a se concentrar em aspectos operacionais.

A atuação de consórcio de exportação do segmento de moda praia e moda intima no Brasil: uma análise na perspectiva do marketing

This dissertation tried to study qualitatively the performance of the exportation¿s consortiums in the segment of beach fashion in Brazil in the perspective of the marketing. Making use of the method of Grounded Theory, this study aimed to identify the categories that compose and make influence on the exporting performance of four consortiums in Brazil , based on the segment of beach fashion. This study becomes relevant because it classifies the categories found on the field research and exposes their relations. These categories have been characterized as big categories, intermediate categories and initial categories, having it¿s aim respectively: (a) to identify the characteristics found only on the studied consortiums; to identify (b) the promotional composition based on the (c) characteristics found in the segment of beach fashion. The study presents theoretical and managemental implications when shows two important categories that are relevant on the actuation of the exportation¿s consortiums on the external market, which are: knowledge of marketing in the external market and characteristics of the consortiums.

Como o marketing verde interfere na imagem da marca da indústria de celulose: o estudo de caso da aracruz celulose

The purpose of this work, is to analyze the principles underlying the pulp and paper industry, here portrayed by Aracruz Celulose S A, in the marketing standpoint, as far as it concerns being in harmony with nature and adapting its relations with the stakeholders, notably regarding the community of the State of Espírito Santo. As they form, indeed, part of the same discussion, the goal is to proceed with a detailed examination of the major aspects and conditions involved, based in its corporate communications, leading to the construction of a positive corporate brand. The results found throughout this study show that despite Aracruz and the communities¿ different goals, they converge regarding their interests towards the best practices in social and environmental practices, and a more objective communication. Industry and community can work together for a same benefit: the best relations of man towards Nature, and of man towards man. The examples here stated will endorse our perception as well as serve to evaluate the results of the measures adopted in this relationship. It could be verified how internal and external aspects of the organization influence the company¿s reputation, leading to important changes in attitude and in the production process. Pressures from stakeholders have contributed largely in helping Aracruz become more conscious of the important role it plays in the social-environmental universe of the State of Espírito Santo. The assessment of leading the process of communications within in-depth transparency have signaled that, despite a closer approach with its stakeholders, Aracruz still needs to fulfill an existing gap: an excellent rapport between the company and the communities where it influences still needs to be pursued, especially regarding communicating its activities.

"Marketing glocal": marketing global com estratégias locais como vantagem competitiva de mercado

The objective of this dissertation is to explore and deeply study the concepts about Glocal Marketing, explaining this recent phenomenon, highlighting the importance and the influence of local culture on the marketing mix of global organizations, in order to have successful commercialization of their products and services in different markets. Searching for a better understanding of Glocal Marketing became extremely important in the XXI Century, since there is an increase in the number of global companies which want to explore new markets in order to survive and remain in the highly competitive market. Concepts of Globalization, Marketing, Glocal Marketing, Culture are defined and explored. Also, the influence of culture on consumer behavior and on the marketing mix of global organizations is analyzed. The Hofstede¿s cultural typology is explained and it is used to give the reader an overview and a better understanding about the cultural influence in the acceptance of new products in new markets. The relationship between culture and marketing mix is discussed, as well as the importance of standardization versus customization of the marketing mix among countries with high cultural differences. The methodology is composed by descriptive research and a case study about a global organization, the Coca-Cola Company. Therefore, this dissertation aims to show and exemplify how the Coca-Cola Company applies glocal strategies on its marketing mix as a way to establish a competitive advantage in the market.

The influence of materialism on consumption indebtedness in the context of low income consumers from the city of São Paulo

This research is in the domains of materialism, consumer vulnerability and consumption indebtedness, concepts frequently approached in the literature on consumer behavior, macro-marketing and economic psychology. The influence of materialism on consumer indebtedness is investigated within a context that is characterized by poverty and by factors that cause vulnerability, such as high interest rates, limited access to credit and to quality affordable goods. The objectives of this research are: to produce a materialism scale that is well adapted to its environment, characterizing materialism adequately for the population studied; to compare results obtained with results of other studies; and to measure the relationship between materialism, socio-demographic variables, attitude to debt and consumption indebtedness. The primary data used in the analyses were collected from field research carried out in August, 2005 that relied on a probabilistic household sample of 450 low income individuals who live in poor regions of the city of Sao Paulo. The materialism scale, adapted and translated into Portuguese from Richins (2004), proved to be very successful and encourages new work in the area. It was noted that younger adults tend to be more materialistic than older ones; that illiterate adults tend to be less materialistic than those who did literacy courses when they were already adults; and that gender, income and race are not associated with the materialism construct. Among the other results, a logistic regression model was developed in order to distinguish those individuals who have an installment plan payment booklet from those who do not, based on materialism, socio-demographic variables and purchasing and consumer habits. The proposed model confirms materialism as a behavioral variable useful for forecasting the probability of an individual getting into debt in order to consume, in some cases almost doubling the chance of occurrence of this event. Findings confirm the thesis that it is not only adverse economic factors that lead people to get into debt; and that the study of demand for credit for consumption purposes must, of necessity, include variables of a psychological nature. It is suggested that the low income materialistic consumer experiences feelings of powerlessness and exclusion because of the gap that exists between their possessions and their desires. Lines of conduct to combat this marginalization from the consumer society are drawn targeting marketing professionals, public policy makers and vulnerability researchers. Finally, the possibility of new studies involving the materialism construct, which is central to literature on consumer behavior, albeit little used in empirical studies in Brazil, are discussed.

O setor de seguros e o marketing de relacionamento

o grande crescimento do mercado segurador no Brasil trouxe, ao longo dos últimos, dificuldades para as empresas se relacionarem adequadamente com seus clientes (corretores e segurados), obrigando-as a repensarem seus negócios. Nesse contexto, o comportamento do consumidor do mercado securitário de automóvel assume conotação especial e passa a ser questão obrigatória na busca da vantagem competitiva. Assim, o objetivo geral do presente estudo é estabelecer procedimentos entre o corretor, o segurado e a seguradora, com um plano de ação de fidelização para maximizar resultados para as empresas, a partir de estratégias de marketing de relacionamento, baseadas na tríade cliente, corretor e seguradora. Para tanto, utiliza-se de um levantamento teórico e empírico da realidade do setor de seguros de automóvel, apurada no estágio atual, e apresenta conceitos e ferramentas de marketing de relacionamento que, adaptadas, poderiam levar ao aumento dos valores alTecadados pelas seguradoras, com conquista de novos clientes e retenção dos atuais. Os resultados indicam que há inúmeras felTamentas de marketing de relacionamento passíveis de aplicabilidade no segmento de seguros de automóvel, como sugere o estudo de caso da filial Niterói da organização pesquisada, capazes de fazer com que as empresas do setor incrementem seu potencial de receita e maximizem seu relacionamento com os COlTetores e com os consumidores finais.

The influence of emotional contagion on products evaluation

Emotional Contagion is the mechanism that includes mimicking and the automatic synchronization of facial expressions, vocalizations, postures, and movements with another person and, consequently, convergence of emotions between the sender and receiver. Researches of this mechanism conducted usually in the fields of Psychology and Marketing tends to investigate face-to-face interactions. However, the question remains to what extent, if any, emotional contagion may occur with facial expressions in photos, since many purchase situations are brought on by catalogues or websites. This thesis has the goal to verify this gap and, in addition, verify whether emotional contagion is more common in females than in males as stated in previous studies. Emotions have been studied because it is intuitively apparent that emotions affect the dynamics of the interaction between a salesperson and customers (Verbeke, 1997); in other words, emotions may significantly affect consumer behavior. Therefore, this thesis also verified whether the facial expressions that transmit emotions could be associated to product evaluations. To investigate these questions, an experiment was done with 171 participants, which were exposed to either smiling (positive emotion) or neutral advertising. The differences between the individual advertisements were limited to the facial expressions of figures in the advertisements (either smiling or neutral/without smiling). One specialist and two students analyzed videotaped records of the participants’ responses, and found that participants who saw the positive stimulus mimicked the picture (smiling back) confirming the Emotional Contagion in Photos (the first hypothesis). The second hypothesis was to analyze if there is difference based in gender. The results demonstrated that there is not a significant difference between genders; female and male equally suffer Emotional Contagion. The third hypothesis was related to whether the positive emotions vs. neutral emotions acquired from the positive facial expression in the photo are associated to a positive evaluation of the product also displayed in the photo. Evidences show that the ad with a positive expression could change more positively the attitude, the sympathy, the reliability, and the intention of purpose of the participant compared to those who were exposed to the neutral condition. Therefore, the analysis concludes that the facial expressions displayed in photos produce emotional contagion and may interfere on the evaluation product. A discussion of the theoretical and practical implications and limitations for these findings are presented.

The influence of the supply chain agents on the new product development's performance: an analysis based on the multi-group moderation

Este estudo buscou verificar a influencia dos agentes da cadeia de suprimentos no desempenho do desenvolvimento de novos produtos quando os agentes são analisados em conjunto. A motivação desta pesquisa veio de estudos que alertaram para a consideração da integração da cadeia de suprimentos como um constructo multidimensional, englobando o envolvimento da manufatura, fornecedores e clientes no desenvolvimento de novos produtos; e devido à falta de informação sobre as influencias individuais destes agentes no desenvolvimento de novos produtos. Sob essas considerações, buscou-se construir um modelo analítico baseado na Teoria do Capital Social e Capacidade Absortiva, construir hipóteses a partir da revisão da literatura e conectar constructos como cooperação, envolvimento do fornecedor no desenvolvimento de novos produtos (DNP), envolvimento do cliente no DNP, envolvimento da manufatura no DNP, antecipação de novas tecnologias, melhoria contínua, desempenho operacional do DNP, desempenho de mercado do NPD e desempenho de negócio do DNP. Para testar as hipóteses foram consideradas três variáveis moderadoras, tais como turbulência ambiental (baixa, média e alta), indústria (eletrônicos, maquinários e equipamentos de transporte) e localização (América, Europa e Ásia). Para testar o modelo foram usados dados do projeto High Performance Manufacturing que contém 339 empresas das indústrias de eletrônicos, maquinários e equipamentos de transporte, localizadas em onze países. As hipóteses foram testadas por meio da Análise Fatorial Confirmatória (AFC) incluindo a moderação muti-grupo para as três variáveis moderadoras mencionadas anteriormente. Os principais resultados apontaram que as hipóteses relacionadas com cooperação foram confirmadas em ambientes de média turbulência, enquanto as hipóteses relacionadas ao desempenho no DNP foram confirmadas em ambientes de baixa turbulência ambiental e em países asiáticos. Adicionalmente, sob as mesmas condições, fornecedores, clientes e manufatura influenciam diferentemente no desempenho de novos produtos. Assim, o envolvimento de fornecedores influencia diretamente no desempenho operacional e indiretamente no desempenho de mercado e de negócio em baixos níveis de turbulência ambiental, na indústria de equipamentos de transporte em países da Americanos e Europeus. De igual forma, o envolvimento do cliente influenciou diretamente no desempenho operacional e indiretamente no desempenho de mercado e do negócio em médio nível de turbulência ambiental, na indústria de maquinários e em países Asiáticos. Fornecedores e clientes não influenciam diretamente no desempenho de mercado e do negócio e não influenciam indiretamente no desempenho operacional. O envolvimento da manufatura não influenciou nenhum tipo de desempenho do desenvolvimento de novos produtos em todos os cenários testados.

Influence of laparoscopy and laparotomy on gasometry, leukocytes and cytokines in a rat abdominal sepsis model

Laparoscopic surgery is associated with reduced surgical trauma, and less acute phase response, as compared with open surgery. Cytokines are important regulators of the biological response to surgical and anesthetic stress. The aim of this study was to determine if CO2 pneumoperitoneum would change cytokine expression, gas parameters and leukocyte count in septic rats. Methods: Wistar rats were randomly assigned to five groups: control (anesthesia only), laparotomy, CO2 pneumoperitoneum, cecum ligation and puncture by laparotomy, and laparoscopic cecum ligation and puncture. After 30 min of the procedures, arterial blood samples were obtained to determine leukocytes subpopulations by hemocytometer. TNFα, IL-1β, IL-6 were determined in intraperitoneal fluid (by ELISA). Gas parameters were measured on arterial blood, intraperitoneal and subperitoneal exsudates. Results: Peritoneal TNFα, IL-1β and IL-6 concentrations were lower in pneumoperitoneum rats than in all other groups (p<0.05). TNFα, IL-1β and IL-6 expression was lower in the laparoscopic than in laparotomic sepsis (p<0.05). Rats from laparoscopic cecum ligation and puncture group developed significant hypercarbic acidosis in blood and subperitoneal fluid when compared to open procedure group. Total white blood cells and lymphocytes were significantly lower in laparoscopic cecum ligation and puncture rats than in the laparotomic (p<0.01). Nevertheless, the laparotomic cecum ligation rats had a significant increase in blood neutrophils and eosinophils when compared with controls (p<0.05). Conclusions: This study demonstrates that the CO2 pneumoperitoneum reduced the inflammatory response in an animal model of peritonitis with respect to intraperitoneal cytokines, white blood cell count and clinical correlates of sepsis. The pneumoperitoneum produced hypercarbic acidosis in septic animals

Influence of Splenectomy on the Biodistribution of Technetium-99m Dimercaptosuccinic Acid (99mTc-DMSA) in Rats

This study aimed to evaluate if the splenectomy alters the biodistribution of 99mTc-DMSA and renal function in Wistar rats. The animals were separated in the groups: splenectomy (n = 6) and control (n = 6). After splenectomy (15 days), the administration of 0.1ml of 99mTc-DMSA IV (0.48 MBq) was carried out. Thirty minutes later, kidney, heart, lung, thyroid, stomach, bladder and femur and samples of blood were isolated. The organs were weighed, counted and the percentage of radioactivity -g (%ATI-g) determined. Serum urea and creatinine, hematocrit, leukocytes and platelets were measured. Statistics by t test (p<0.05) was done. There was a significant reduction in %ATI-g in kidney and blood (p<0.05) of splenectomized animals, a significant increase (p<0.05) of urea (88.8 ± 18.6 mg-dL) and creatinine (0.56 ± 0.08 mg-dL), compared to the controls (51.5±1.6, 0.37±0.02mg-dL, respectively), as well as increase in platelets and leucocytes, and hematocrit reduction. The analysis of the results indicates that in rats, splenectomy seems to alter the renal function and the uptake of 99mTc-DMSA

Thermal Decomposition Kinetics of Humic Substances Extracted from Mid-Rio Negro (Amazon Basin) Soil Samples

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

A propaganda de medicamentos voltados à clínica obstétrica e/ou ginecológica e sua influência sobre a prescrição

INTRODUCTION: Drug advertisement stimulates self-medication and irrational use of medicines, especially when it starts to interfere in the prescription. Monitoring advertisements, as well as the observation of its influence on health professionals, prescriptions become necessary because of this public health problem. OBJECTIVE: The aim of this work was to analyze drug advertisements directed to gynecologists and/or obstetricians doctors relating them to the current legislation as well as its influence on prescription. METHODOLOGY: The sample was composed of drug advertisements divulged to the gynecologists and / or obstetricians doctors and was analyzed according to RDC96/2008. To evaluate the influence of advertisement on prescription, a questionnaire was administered to gynecologists / obstetricians doctors and prescriptions of a public maternity were also evaluated. RESULTS AND CONCLUSION: Concerning the advertisements analyzed, 48% complied fully with current legislation and 52% of the advertisements analyzed were in accordance to the RDC No. 96/2008 in most of the items evaluated. The doctors interviewed are used to receive the visits of propagandists, even in the public service, receiving gifts offered by the industry and believe that medicine advertisement tries to influence prescribing. Many of them use the material provided by the propagandist as a source for their prescription, although they present a critical view about them information. The use of trade name / mark on the prescription is a common practice among the doctors interviewed, even in the public service, suggesting there is an influence of medicine advertisement on the prescription

Influence of the season of year, stage of lactation and milking time on the chloride content in bovine milk

From January to October 1995, chloride content determinations were accomplished in 2,218 samples of milk collected from 67 quarters of 17 lactating cows, in initial, middle and final stages of lactation, in the morning and afternoon milking. The highest means of chloride contents were observed among the milk samples collected in the final stage of lactation (0,203 gC1/100ml), in the summer (0,212 gC1/100ml) and in the morning milking (0,189 g C1/100ml). The differences observed between the chloride contents in the samples obtained in the different stages of lactation and the seasons of the year were statistically significant (P<0.0001). The gratest occornce of chloride at rates superior to 0.22 gC1100ml was observed in the final stge of lactation (31.4%), summer (44.2%) and after the morning milking (27.8%). These results evidentiate the influence of physiological and external factors (stage of lactation and season of the year) on the concentration of chloride of milk.

Organic matter fractions and soil fertility under the influence of liming, vermicompost and cattle manure

Os efeitos do vermicomposto de esterco de curral associado à calagem em atributos da fertilidade do solo foram avaliados através de experimento em vasos empregando um Latossolo Vermelho, distrófico, textura média. Cinco doses do vermicomposto (equivalentes a 0; 28; 42; 56 e 70 t ha-1, peso seco) e cinco doses de calcário (visando elevar a saturação por bases a: 20; 30; 40; 50 e 60%) foram combinadas em esquema fatorial, sendo as amostras de solo incubadas por 180 dias. Para comparação entre o vermicomposto e o esterco de curral, amostras do mesmo solo receberam o equivalente a 70 t ha-1 do esterco de curral que originou o vermicomposto e as cinco doses de calcário listadas anteriormente. Através do cálculo do Índice de Eficiência Agronômica, foi verificado que o potencial de fornecimento de K e de Mg pelo esterco é maior do que o do vermicomposto, e que o de P, é semelhante. O vermicomposto aumentou os teores de Ca2+ e de matéria orgânica (MO), os valores de pH em CaCl2 e a CTC a pH 7. Com o aumento das doses de vermicomposto houve diminuição do C-ácidos húmicos e aumento do C-humina e com a calagem o C-total não aumentou mas houve diminuição do C-ácidos húmicos.