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.

Estudoda sismicidade na região de Sobral - CE em 2008

The town of Sobral is located at the northwest part of the Ceará State, 250 km away from its capital, Fortaleza. In January 2008, an intense seismic activity began near Sobral with one event with magnitude 4,2mb on May 21. Since the start of its seismic activity, all events were recorded by the SBBR station (located on EMBRAPA Caprinos Farm), which operates in the region since August 2007. After this event, monitoring the seismic activity was carried out with the deployment of a local three component digital seismographic network, from June 5, 2008 until September 24. Initially, this network was composed of six seismographic stations. Later additional five stations were deployed until August 26 2008. This local network detected approximately 2,800 earthquakes. In this study we analyzed 581 earthquakes recorded by at least three stations for hypocentral and focal mechanism determination, and to contribute to a better explanation of the seismicity which in this region. To determine the hypocenters, we used a half-space model, with vP = 6,00 km/s and vP/vS = 1,71. From the hypocentral determination, it was revealed an active seismic zone with depth ranging between 1 and 8 km, 6 km long in E - W direction. The determination of fault planes and focal mechanism was obtained using the programs FPFIT and PLAN, which allowed comparison between their respective results in order to obtain more accurate results. A set of 24 earthquakes were selected to determine fault using PLAN planes and focal mechanisms using FPFIT. With the aid of detailed map of hypocenters this set, it was possible to identify three structures. Therefore, the set of 24 earthquakes were divided into three subsets. The type of mechanism was predominantly strike-slip with a dextral direction. Although the region has two tectonic structures near the site of the study area: the Café- Ipueiras Fault (normal fault) and the Sobral-Pedro II Lineament (dextral strike-slip fault) it was not possible to correlate the seismicity founded with those structures

Search for scalar leptoquarks and T-odd quarks in the acoplanar jet topology using 2.5 fb(-1) of p(p)over-bar collision data at root s=1.96 TeV

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Adaptabilidade diferencial das variantes moleculares slow e fast da esterase-5 de Drosophila mulleri

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Lezione 10 gennaio 2008

Il file contiene il materiale proiettato e discusso a lezione. Va inteso semplicemente come complemento degli appunti presi in quella sede.

Lezione 11 gennaio 2008

Il file contiene il materiale proiettato e discusso a lezione. Va inteso semplicemente come complemento degli appunti presi in quella sede.

Correcting mortality for loss to follow-up: a nomogram applied to antiretroviral treatment programmes in sub-Saharan Africa

Background The World Health Organization estimates that in sub-Saharan Africa about 4 million HIV-infected patients had started antiretroviral therapy (ART) by the end of 2008. Loss of patients to follow-up and care is an important problem for treatment programmes in this region. As mortality is high in these patients compared to patients remaining in care, ART programmes with high rates of loss to follow-up may substantially underestimate mortality of all patients starting ART. Methods and Findings We developed a nomogram to correct mortality estimates for loss to follow-up, based on the fact that mortality of all patients starting ART in a treatment programme is a weighted average of mortality among patients lost to follow-up and patients remaining in care. The nomogram gives a correction factor based on the percentage of patients lost to follow-up at a given point in time, and the estimated ratio of mortality between patients lost and not lost to follow-up. The mortality observed among patients retained in care is then multiplied by the correction factor to obtain an estimate of programme-level mortality that takes all deaths into account. A web calculator directly calculates the corrected, programme-level mortality with 95% confidence intervals (CIs). We applied the method to 11 ART programmes in sub-Saharan Africa. Patients retained in care had a mortality at 1 year of 1.4% to 12.0%; loss to follow-up ranged from 2.8% to 28.7%; and the correction factor from 1.2 to 8.0. The absolute difference between uncorrected and corrected mortality at 1 year ranged from 1.6% to 9.8%, and was above 5% in four programmes. The largest difference in mortality was in a programme with 28.7% of patients lost to follow-up at 1 year. Conclusions The amount of bias in mortality estimates can be large in ART programmes with substantial loss to follow-up. Programmes should routinely report mortality among patients retained in care and the proportion of patients lost. A simple nomogram can then be used to estimate mortality among all patients who started ART, for a range of plausible mortality rates among patients lost to follow-up.

The EU’s Trouble with Mashups: From Disabling to Enabling a Digital Art Form

New tools for editing of digital images, music and films have opened up new possibilities to enable wider circles of society to engage in ’artistic’ activities of different qualities. User-generated content has produced a plethora of new forms of artistic expression. One type of user-generated content is the mashup. Mashups are compositions that combine existing works (often) protected by copyright and transform them into new original creations. The European legislative framework has not yet reacted to the copyright problems provoked by mashups. Neither under the US fair use doctrine, nor under the strict corset of limitations and exceptions in Art 5 (2)-(3) of the Copyright Directive (2001/29/EC) have mashups found room to develop in a safe legal environment. The contribution analyzes the current European legal framework and identifies its insufficiencies with regard to enabling a legal mashup culture. By comparison with the US fair use approach, in particular the parody defense, a recent CJEU judgment serves as a comparative example. Finally, an attempt is made to suggest solutions for the European legislator, based on the policy proposals of the EU Commission’s “Digital Agenda” and more recent policy documents (e.g. “On Content in the Digital Market”, “Licenses for Europe”). In this context, a distinction is made between non-commercial mashup artists and the emerging commercial mashup scene.

Avances metodológicos del proceso de adopción de los Planes de Ordenamiento de segunda generación frente a los vacios jurídicos de la Legislación Colombiana en materia de Ordenamiento Territorial a la luz del P.O.T. Armenia 2007/2019 “Una Ciudad para la Vida"

Las nuevas realidades territoriales, bajo el innovador panorama constitucional colombiano, requieren de procesos de planificación coherentes, ajustados a las necesidades reales de desarrollo de nuestras sociedades en constante crecimiento. Se requieren acciones inmediatas y contundentes de fortalecimiento, asistencia técnica, desarrollo institucional e implementación de instrumentos de Gestión y financiación del suelo, para responder a la insuficiente capacidad de los entes territoriales para asumir con responsabilidad la formulación e implementación de los instrumentos de planificación y ordenamiento territorial planteados por la ley y la normatividad urbanística vigente. Dicha normatividad, dada su falta de reglamentación y regulación, hace compleja su aplicación en pequeñas y medianas ciudades, debido a la deficiente capacidad operativa y ejecutoria que tienen sus administraciones. El 24 de enero de 1999 el Concejo Municipal de Armenia aprobaba el primer plan de ordenamiento territorial para un municipio Colombiano bajo el marco de la Ley de Desarrollo Territorial 388 de 1997. Veinticuatro horas después se produce un sismo de 6.4 grados (Richter) con epicentro a 24 kilómetros de distancia, generando devastadoras consecuencias en toda la región del eje cafetero, tanto en lo físico como en lo social: “Cuando teníamos las respuestas… cambiaron las preguntas". Las nuevas determinantes territoriales generadas como efecto de la tragedia pondrían el proceso de implementación del plan en un escenario complejo y contradictorio. A pesar de que el concepto de gestión del riesgo había sido abordado por el P.O.T., las realidades del desastre superaban la expectativa planificadora, desbordando cualquier escala de ejecutabilidad de la norma recientemente aprobada. El equipo de formulación del nuevo plan, bajo la coordinación del D.A.P.M. y con apoyo de la academia identificó de manera inmediata la complejidad del proceso. Además, realizó aportes que permitieran a los demás municipios Colombianos evitar cometer los mismos errores, superar los obstáculos, agilizar procesos particulares de planificación territorial y dotar así a sus municipios de unos Planes de Ordenamiento mas aterrizados, realizables y sobretodo mas consecuentes con las necesidades particulares de sus municipios.

The Renaissance in Italian art.

1. The awakening of life.--2. The republic of Siena.--3. The Medici at Florence.--4. Humanism and art.--5. Correggio at Parma.--6. The city triumphant.--7. Leonardo at Milan.--8. The master of Perugia.--9. Rome of the renaissance.

O2 v Hutchison 3G comparative advertising:European trade mark law beyond compare?

Legislation: Directive 89/104 on trade marks art.5 Directive 84/450 on misleading advertising Directive 97/55 amending Directive 84/450 concerning misleading advertising so as to include comparative advertising Case: O2 Holdings Ltd v Hutchison 3G UK Ltd (C-533/06) [2008] E.C.R. I-4231 (ECJ (1st Chamber)) *Comms. L. 155 Long, long ago a trade mark allowed a craftsman to be identified and held accountable for shoddy goods. Today in the era of the ‘Lovemark,’1 due to extensive advertising hopes and aspirations a lifestyle can be purchased with a brand. For many products a trademark is no longer merely a badge of origin but has a commercial value of its own. Through advertising an emotional attachment is created in the heart of the consumer for particular brands. Brand owners are determined that the value of this attachment be preserved and protected against any encroachment into the aura that has been painstakingly created. Comparative advertising, the allusive use of a mark, is seen by the owners of such emotive brands as likely to jeopardise the character of the brand that they have so carefully nurtured. As they have invested so heavily in creating their concept these owners want to control its use by others. There is an issue however as to how far this control ought to extend when the image is used in the marketing of a rival's goods or services.