Statin Adherence, Utilisation, and Prescribing Patterns. Improving effectiveness of treatment

Statins are one of the most widely studied and evidence-based medications. Randomised controlled trials have provided convincing evidence on the benefits of statin therapy in preventing cardiovascular events. Despite proven benefits, low costs, and few adverse effects, everyday effectiveness of statins is limited, since adherence to statin therapy is poor. This thesis was conducted as four pharmacoepidemiological studies using register data on statin users in real clinical care. The main purpose of the study was to evaluate prescribing patterns and to discover the lifestyle factors predicting statin nonadherence and discontinuation. This knowledge is essential in order to help physicians to motivate the adherence of their patients to treatment. In Finland, from 1998 to 2004, the number of statin initiators nearly doubled. The discovered channelling of atorvastatin and simvastatin may have affected the treatment outcomes at the public health level. It is possible that money spent on statins in Finland in 1998‒2004 could have been used in a more cost-effective way. In 2015, the percentage of patients receiving reimbursement for statins was 12% of the total population. Thus, it is a major public health and economic challenge to improve statin effectiveness and allocate therapy correctly. Among the participants with cardiovascular comorbidities, risky alcohol use or clustering of lifestyle risks were predictors of nonadherence. In addition, the prevalence of nonadherence to statins increased after retirement among both men and women. This increase in post-retirement nonadherence was highest among those receiving statins for secondary prevention. Discontinuation of statin therapy was predicted by high patient co-payment, and in women, by risky alcohol use. Recognising the predictors of nonadherence to statins is important because nonadherence is associated with an increased risk of adverse cardiovascular outcomes and higher healthcare costs. In conclusion, optimal outcomes in medical therapy require both efficacious medications and adherence to those treatments. When prescribing statins to eligible patients, the physician’s clinical expertise in recognising patients at risk of statin discontinuation and nonadherence, as well as their ability to increase adherence, may have a great effect on public health.

Fixation du prix de vente des exploitations agricoles québécoises: comparaison entre fermes laitières et autres types de production

L’écart croissant entre les valeurs marchande et économique des exploitations agricoles québécoises complexifie le processus de transfert des fermes à la prochaine génération. La capacité de payer limitée des repreneurs et les besoins de retraite des cédants restreignent la marge de manoeuvre nécessaire afin de déterminer un prix de vente de l’entreprise adéquat. La présente étude vise à analyser les déterminants du prix de vente des fermes et montre que dans notre échantillon, le prix est significativement corrélé avec les besoins de retraite nets des cédants et de façon moins significative, avec la valeur économique des fonds propres de l’entreprise. Les considérations financières semblent éclipser les aspects humains et d’importants compromis sont réalisés des deux côtés de la transaction en vue d’assurer la continuité de l’entreprise. L’influence d’intervenants externes à l’entreprise entre également en ligne de compte dans la fixation du prix, ce qui implique que la décision ne découle pas uniquement d’une négociation entre cédants et repreneurs. De façon générale, les fermes laitières semblent confrontées aux mêmes défis que les autres types de production quant à la fixation de leur prix de vente, ce qui suggère que la problématique soit davantage une question de gestion plutôt qu’une question spécifique au secteur. À moins d’un rétrécissement de l’écart entre la valeur marchande des actifs et leurs capacités à générer des revenus, la fixation du prix de vente de plusieurs fermes du Québec risque d’être encore plus contraignante à l’avenir.

An Analysis of Principal Attrition in a Large Urban School District

Principal attrition is a national problem particularly in large urban school districts. Research confirms that schools that serve high proportions of children living in poverty have the most difficulty attracting and retaining competent school leaders. Principals who are at the helm of high poverty schools have a higher turnover rate than the national average of three to four years and higher rates of teacher attrition. This leadership turnover has a fiscal impact on districts and negatively affects student achievement. Research identifies a myriad of reasons why administrators leave the role of principal: some leave the position for retirement; some exit based on difficulty of the role and lack of support; and some simply leave for other opportunities within and outside of the profession altogether. As expectations for both teacher and learner performance drive the national education agenda, understanding how to keep effective principals in their jobs is critical. This study examined the factors that principals in a large urban district identified as potentially affecting their decisions to stay in the position. The study utilized a multi-dimensional, web-based questionnaire to examine principals’ perceptions regarding contributing factors that impact tenure. Results indicated that: • having a quality teaching staff and establishing a positive work-life balance were important stay factors for principals; • having an effective supervisor and collegial support from other principals, were helpful supports; and • having adequate resources, time for long-term planning, and teacher support and resources were critical working conditions. Taken together, these indicators were the most frequently cited factors that would keep principals in their positions. The results were used to create a framework that may serve as a potential guide for addressing principal retention.

Poetyckie dialogi Czesława Miłosza i Tadeusza Różewicza

Wydział Filologii Polskiej i Klasycznej

Essays on the Effects of Social Insurance for Disability

This dissertation examines how social insurance, family support and work capacity enhance individuals' economic well-being following significant health and income shocks. I first examine the extent to which the liquidity-enhancing effects of Worker's Compensation (WC) benefits outweigh the moral hazard costs. Analyzing administrative data from Oregon, I estimate a hazard model exploiting variation in the timing and size of a retroactive lump-sum WC payment to decompose the elasticity of claim duration with respect to benefits into the elasticity with respect to an increase in cash on hand, and a decrease in the opportunity cost of missing work. I find that the liquidity effect accounts for 60 to 65 percent of the increase in claim duration among lower-wage workers, but less than half of the increase for higher earners. Using the framework from Chetty (2008), I conclude that the insurance value of WC exceeds the distortionary cost, and increasing the benefit level could increase social welfare. Next, I investigate how government-provided disability insurance (DI) interacts with private transfers to disabled individuals from their grown children. Using the Health and Retirement Study, I estimate a fixed effects, difference in differences regression to compare transfers between DI recipients and two control groups: rejected applicants and a reweighted sample of disabled non-applicants. I find that DI reduces the probability of receiving a transfer by no more than 3 percentage points, or 10 percent. Additional analysis reveals that DI could increase the probability of receiving a transfer in cases where children had limited prior information about the disability, suggesting that DI could send a welfare-improving information signal. Finally, Zachary Morris and I examine how a functional assessment could complement medical evaluations in determining eligibility for disability benefits and in targeting return to work interventions. We analyze claimants' self-reported functional capacity in a survey of current DI beneficiaries to estimate the share of disability claimants able to do work-related activity. We estimate that 13 percent of current DI beneficiaries are capable of work-related activity. Furthermore, other characteristics of these higher-functioning beneficiaries are positively correlated with employment, making them an appropriate target for return to work interventions.

Transcript of proceedings : collective bargaining /

At head of cover title: This is a rough draft.

[Annual accountability report]

Each year the South Carolina Retirement Systems of the South Carolina Budget and Control Board produces an annual accountability report for the South Carolina General Assembly. Included is a mission statement, program description, program goals and performance measures.

[Annual accountability report]

Each year the South Carolina Retirement Systems of the South Carolina Budget and Control Board produces an annual accountability report for the South Carolina General Assembly. Included is a mission statement, program description, program goals and performance measures.

Accountability report FY 2004

Each year the South Carolina Retirement Systems of the South Carolina Budget and Control Board produces an annual accountability report for the South Carolina General Assembly. Included is a mission statement, program description, program goals and performance measures.

Accountability Report, FY 2005

Each year the South Carolina Retirement Systems of the South Carolina Budget and Control Board produces an annual accountability report for the South Carolina General Assembly. Included is a mission statement, program description, program goals and performance measures.

Accountability Report, FY 2006

Each year the South Carolina Retirement Systems of the South Carolina Budget and Control Board produces an annual accountability report for the South Carolina General Assembly. Included is a mission statement, program description, program goals and performance measures.

Accountability Report, FY 2007

Each year the South Carolina Retirement Systems of the South Carolina Budget and Control Board produces an annual accountability report for the South Carolina General Assembly. Included is a mission statement, program description, program goals and performance measures.

Autoeficácia, características sociodemográficas e capacitação profissional: um estudo com servidores de uma Universidade Federal

Self-efficacy, the construct developed by Albert Bandura in 1977 and widely studied around the world, means the individual's belief in his own capacity to successfully perform a certain activity. This study aims to determine the degree of association between sociodemographic characteristics and professional training to the levels of Self-Efficacy at Work (SEW) of the Administrative Assistants in a federal university. This is a descriptive research submitted to and approved by the Ethics Committee of UFRN. The method of data analysis, in quantitative nature, was accomplished with the aid of the statistical programs R and Minitab. The instrument used in research was a sociodemographic data questionnaire, variables of professional training and the General Perception of Self-efficacy Scale (GPSES), applied to the sample by 289 Assistants in Administration. Statistical techniques for data analysis were descriptive statistics, cluster analysis, reliability test (Cronbach's alpha), and test of significance (Pearson). Results show a sociodemographic profile of Assistants in Administration of UFRN with well-distributed characteristics, with 48.4% men and 51.6% female; 59.9% of them were aged over 40 years, married (49.3%), color or race white (58%) and Catholics (67.8%); families are composed of up to four people (75.8%) with children (59.4%) of all age groups; the occupation of the mothers of these professionals is mostly housewives (51.6%) with high school education up to parents (72%) and mothers (75.8%). Assistants in Administration have high levels of professional training, most of them composed two groups of servers: the former, recently hired public servants (30.7%) and another with long service (59%), the majority enter young in career and it stays until retirement, 72.4% of these professionals have training above the minimum requirement for the job. The analysis of SEW levels shows medium to high levels for 72% of assistants in administration; low SEWclassified people have shown a high average of 2.7, considered close to the overall mean presented in other studies, which is 2.9. The cluster analysis has allowed us to say that the characteristics of the three groups (Low, Medium and High SEW) are similar and can be found in the three levels of SEW representatives with all the characteristics investigated. The results indicate no association between the sociodemographic variables and professional training to the levels of self-efficacy at work of Assistants in Administration of UFRN, except for the variable color or race. However, due to the small number of people who declared themselves in color or black race (4% of the sample), this result can be interpreted as mere coincidence or the black people addressed in this study have provided a sense of efficacy higher than white and brown ones. The study has corroborated other studies and highlighted the subjectivity of the self-efficacy construct. They are needed more researches, especially with public servants for the continuity and expansion of studies on the subject, making it possible to compare and confirm the results

O desenvolvimento e as transições da carreira atlética dos jogadores de futebol de elite : estudo de caso num contexto de Seleção Nacional

A compreensão do desenvolvimento da carreira atlética e, em particular, das estratégias de ajustamento dos desportistas aos momentos de mudança no seu percurso de envolvimento no desporto, é fundamental para desenhar as facetas dos contextos promotores do talento, às quais a investigação tem vindo a destacar uma atenção especial nas últimas décadas. Nesse sentido, este estudo teve como objetivo descrever o processo de desenvolvimento e transições da carreira de futebolista de elite, esclarecendo as principais características e vivências ao longo do seu percurso desportivo. Para o efeito, foram realizados três estudos onde se incluem uma revisão sistemática de literatura e dois estudos de caso, com recurso a entrevistas semiestruturadas a 11 atletas de elite retirados que exercem funções nas seleções nacionais de futebol. Os resultados esclarecem o papel da prática precoce e diversificada, do suporte parental e da relação com o treinador como determinantes da carreira atlética. A participação em atividades desportivas informais e diversificadas é percecionada como promotora do desenvolvimento de competências técnicas e de relacionamento com pares, enquanto a especialização é observada como potenciadora, sobretudo, das competências de nível motor. Ao contrário de outros estudos realizados, as transições de júnior para sénior e do término da carreira foram identificadas como processos que não constituíram uma ameaça para os futebolistas. Finalmente, conclui-se que os atletas de elite vivenciam grandes dificuldades em conciliar as atividades académicas com a prática do futebol e o risco de abandono dos estudos surge regularmente associado à aproximação da subida ao escalão sénior pelo aumento da exigência e do investimento numa carreira profissional.

Household portfolio allocation, risk attitudes and credit constraints : evidence from the eurozone

Mestrado em Economia Monetária e Financeira