Cost-effectiveness and budget impact of saxagliptine as additional therapy to metformin for the treatment of diabetes mellitus type 2 in the Brazilian private health system

Cost-effectiveness and budget impact of saxagliptine as additional therapy to metformin for the treatment of diabetes mellitus type 2 in the Brazilian private health system Objectives: To compare costs and clinical benefits of three additional therapies to metformin (MF) for patients with diabetes mellitus type 2 (DM2). Methods: A discrete event simulation model seas built to estimate the cost-utility ratio (cost per quality-adjusted life years [QALY)) of saxagliptine as an additional therapy to MF when compared to rosiglitazone or pioglitazone. A budget impact model (BIM) was built to simulate the economic impact of saxagliptine use in the context of the Brazilian private health system. Results: The acquiring medication costs for the hypothetical patient group analyzed in a time frame of three years, were R$ 10,850,185, R$ 14,836,265 and R$ 14,679,099 for saxagliptine, pioglitazone and rosiglitazone, respectively. Saxagliptine showed lower costs and greater effectiveness in both comparisons, with projected savings for the first three years of R$ 3,874 and R$ 3,996, respectively. The BIM estimated cumulative savings of R$ 417,958 with the repayment of saxagliptine in three years from the perspective of a health plan with 1,000,000 covered individuals. Conclusion: From the perspective of private paying source, the projection is that adding saxagliptine with MF save costs when compared with the addition of rosiglitazone or pioglitazone in patients with DM2 that have not reached the HbA1c goal with metformin monotherapy. The BIM of including saxagliptine in the reimbursement lists of health plans indicated significant savings on the three-year horizon.

Harassment at work? Empowerment and autonomy as coping strategies of young workers

There is a considerable number of researches about workplace violence, but few relate young workers and work harassment. This study aimed to investigate the reported perceptions of young apprentices and trainees about moral harassment at work and related coping strategies. Forty adolescent workers (22 men and 18 women) between 15 and 20 years old who received training by a non-governmental organization in Sao Paulo, Brazil, participated in the study. Data collection included individual and collective interviews. It was used an in-depth semi structured interview protocol. The discourses were analyzed using the hermeneutic-dialectic frame. Results showed that young workers reported little or no knowledge of strategies to cope with moral harassment at work, showing vulnerability to the effects of aggression. Effective coping strategies at work should embrace two important concepts of health promotion: empowerment and autonomy.

Hands-on experiments in the Practicum: repositioning student teachers' autonomy.

Following a worldwide trend, the Initial Teacher Education (ITE) Programmes in Brazil are recently searching for ways of integrating practice into curriculum. It raises question about what practice must be integrated and how. Notably, university-based courses are disconnected from school and have low commitment with school issues (Zeichner, 2009).The student teacher induction into school daily life is not an easy task, mainly when the practitioners are transforming physics classroom practice toward an active learning. Drawing on cultural-historical framework (Wolff-Michael Roth & Lee, 2007; Vygotsky, 1978) this study addresses the articulation between Practicum in Physics Classes and the Hands-on Experiments (HoE) used throughout the Practicum. Although in a different level, both Practicum and HoE are linked with an idea of practice. Particularly, this study focuses on how HoE might foster student teachers' autonomy and agency in the Practicum. Data was gathered in the course Practice of Physics Teaching at University of São Paulo/Brazil in 2010; in a cohort of 60 student teachers doing a year-long Practicum in urban school in São Paulo city. Data was analysed using qualitative research methods (Roth, 2005), based on 14 interviews and video records of the student teacher preparing the HoE for Practicum we will present in general lines the role of HoE for student teacher autonomy.

Democracy Reconsidered : Britain, France, Sweden, and the EU

The purpose of this thesis is to investigate whether some positions in democratic theory should be adjusted or abandoned in view of internationalisation; and if adjusted, how. More specifically it pursues three different aims: to evaluate various attempts to explain levels of democracy as consequences of internationalisation; to investigate whether the taking into account of internationalisation reveals any reason to reconsider what democracy is or means; and to suggest normative interpretations that cohere with the adjustments of conceptual and explanatory democratic theory made in the course of meeting the other two aims. When empirical methods are used, the scope of the study is restricted to West European parliamentary democracies and their international affairs. More particularly, the focus is on the making of budget policy in Britain, France, and Sweden after the Second World War, and recent budget policy in the European Union. The aspects of democracy empirically analysed are political autonomy, participation, and deliberation. The material considered includes parliamentary debates, official statistics, economic forecasts, elections manifestos, shadow budgets, general election turnouts, regulations of budget decision-making, and staff numbers in government and parliament budgetary divisions. The study reaches the following conclusions among others. (i) The fact that internationalisation increases the divergence between those who make and those who are affected by decisions is not by itself a democratic problem that calls for political reform. (ii) That international organisations may have authorities delegated to them from democratic states is not sufficient to justify them democratically. Democratisation still needs to be undertaken. (iii) The fear that internationalisation dissolves a social trust necessary for political deliberation within nations seems to be unwarranted. If anything, views argued by others in domestic budgetary debate are taken increasingly serious during internationalisation. (iv) The major difficulty with deliberation seems to be its inability to transcend national boundaries. International deliberation at state level has not evolved in response to internationalisation and it is undeveloped in international institutions. (v) Democratic political autonomy diminishes during internationalisation with regard to income redistribution and policy areas taken over by international organisations, but it seems to increase in public spending. (vi) In the area of budget policy-making there are no signs that governments gain power at the expense of parliaments during internationalisation. (vii) To identify crucial democratic issues in a time of internationalisation and to make room for theoretical virtues like general applicability and normative fruitfulness, democracy may be defined as a kind of politics where as many as possible decide as much as possible.

Sedimentary budget on Las Canteras Beach, Gran Canaria (Canary Islands, Spain)

[EN]This paper deals with sedimentary balances and how the sediments move in function of the waves in a beach with special boundary conditions. For this purpose, the topography of the beach was done with a total station and two prism. Topography data were analyzed with SIG software. Wave data were taken from deepwater buoys. Two parameters were calculated, the Dean’s parameter and Larson’s (1988) parameter, to know the type of the beach. Balances show an accretion of sand on the beach even though in some periods there were big losses of sand on the beach. The parameters calculated are not good to estimate the type of the beach due to the boundary conditions of this particular beach

The EU and Dispute Settlement within the WTO: a strategy for the protection of the Union’s autonomy in the domestic regulation of goods?

Oggetto della ricerca è l’accertamento dell’esistenza, nonché la definizione, della strategia dall’UE in materia di controversie commerciali aventi ad oggetto l’interpretazione e l’applicazione di norme facenti capo agli Accordi OMC in materia di misure sanitarie e di barriere tecniche al commercio. Nella prima parte della tesi, si ricostruiscono gli obbiettivi perseguiti dall’UE in materia di controversie SPS e TBT. In questo contesto, un’importanza di primo piano è attribuita alla difesa dell’autonomia regolamentare dell’Unione. Ad essa si riconduce la prassi UE finalizzata a prevenire il sorgere di controversie sul piano bilaterale attraverso la conclusione di accordi di mutuo riconoscimento, la cui portata ella sottolinea essere tuttavia limitata. L’analisi di cinque controversie sorte in ambito OMC di cui l’Unione è o è stata parte convenuta e che si fondano su presunte o accertate violazioni delle norme facenti capo ai due accordi menzionati consente di classificare gli argomenti giuridici avanzati dall’Unione nel contesto di tali controversie. Nella seconda parte della ricerca, la candidata identifica i mezzi a servizio della strategia UE, in primo luogo, attraverso l’analisi del quadro giuridico relativo alla partecipazione dell’Unione e degli Stati Membri al sistema OMC di risoluzione delle controversie; in secondo luogo, attraverso lo studio, da un lato, dello status delle norme OMC nell’ordinamento UE e, dall’altro, degli effetti delle pronunce dell’Organo di Risoluzione delle Controversie e della questione della responsabilità dell’Unione per violazione del diritto OMC. Sulla base del lavoro di ricerca svolto, si conclude che una strategia dell’UE esiste nella misura in cui l’Unione persegue l’obbiettivo di preservare la propria autonomia regolamentare attraverso, anche se non esclusivamente, gli strumenti afferenti all’ordine giuridico interno analizzati nella seconda parte. La candidata conclude altresì che la riforma del diritto delle relazioni esterne operata dal Trattato di Lisbona può indurre un cambiamento di tale strategia.

Autonomia finanziaria degli enti territoriali al tempo della crisi, tra unione europea e garanzia dei diritti

La tesi si propone di ricostruire la struttura attuale dell'autonomia finanziaria degli enti locali italiani, e in particolare le regioni italiane, alla luce delle riforme legislative e costituzionali approvate dal Parlamento italiano negli ultimi anni (come ad esempio il bilancio riforma costituzionale equilibrata del 2012). Lo studio si concentra sulla situazione italiana alla luce dei vincoli europei introdotti nel corso degli anni, da quelli contenuti nel Trattato di Maastricht a quelli derivati dalla crisi economica e finanziaria. L'obiettivo è quello di verificare se le scelte del legislatore italiano possano dirsi coerenti con il processo di unione politica europea e quali conseguenze abbiano avuto sulla garanzia dei diritti. In particolare, lo studio si concentra sulla garanzia dei diritti sociali nel contesto politico ed economico attuale, a livello europeo e nazionale, con particolare attenzione al diritto alla salute.