Pédiatrie [Current progress in pediatrics: obesity and diagnosis approach to the febrile child]

The literature shows that obesity is a public health problem concerning especially the general paediatrician. While prevention has probably more chances of success than treatment, drugs or, in case of failure, the surgical approach are reserved for extreme cases. In the domain of infectiology the different laboratory tests allow only partially to diagnose severe infections. But in the context of a potential influenza pandemic rapid virologic tests become more and more important. They allow a more precise diagnosis and a reduction of hospitalisations and of antibiotic prescriptions. A review of the north American experience with the pneumococal vaccine shows that the heptavalent vaccine will change our approach in infants with fever in whom we suspect a severe infection.

Symbolic meaning of local identity – A case study on Barcelona place brand representation

The core objective of this research process was to design an operational tool for place brand analysis. By modelling the emotional significance and the deeper-lying symbols associated to a specific place identity I expected to create a semiotic tool that could be applied, mutatis mutandis, on other similar place brands. As a field case study to develop the instrument, my choice of the research arena was Barcelona city, the capital of Catalonia Autonomous Community, Spain. Barcelona brand identity was approached in the line of the Chicago Urban Anthropology School. The research methods were designed according to the prescriptions of the urban anthropology, namely qualitative methods: in-depth interviews and discourse analysis. The final research outcome was a model summarizing a range of specific emotional values that support a place brand to position in the collective mindset and to assume a positively valued status and identity in the world order.

The impotence of price controls: failed attempts to constrain pharmaceutical expenditures in Greece.

BACKGROUND: While the prices of pharmaceuticals are relatively low in Greece, expenditure on them is growing more rapidly than almost anywhere else in the European Union. OBJECTIVE: To describe and explain the rise in drug expenditures through decomposition of the increase into the contribution of changes in prices, in volumes and a product-mix effect. METHODS: The decomposition of the growth in pharmaceutical expenditures in Greece over the period 1991-2006 was conducted using data from the largest social insurance fund (IKA) that covers more than 50% of the population. RESULTS: Real drug spending increased by 285%, despite a 58% decrease in the relative price of pharmaceuticals. The increase in expenditure is mainly attributable to a switch to more innovative, but more expensive, pharmaceuticals, indicated by a product-mix residual of 493% in the decomposition. A rising volume of drugs also plays a role, and this is due to an increase in the number of prescriptions issued per doctor visit, rather than an increase in the number of visits or the population size. CONCLUSIONS: Rising pharmaceutical expenditures are strongly determined by physicians' prescribing behaviour, which is not subject to any monitoring and for which there are no incentives to be cost conscious.

Financial Repression in a Natural Experiment: Loan Allocation and the Change in the Usury Laws in 1714

If financial deepening aids economic growth, then financial repression should be harmful. We use a natural experiment – the change in the English usury laws in 1714 – to analyze the effects of interest rate restrictions. We use a sample of individual loan transactions to demonstrate how the reduction of the legal maximum rate of interest affected the supply and demand for credit. Average loan size and minimum loan size increased strongly, and access to credit worsened for those with little ‘social capital.’ While we have no direct evidence that loans were misallocated, the discontinuity in loan receipts makes this highly likely. We conclude that financial repression can undermine the positive effects of financial deepening.

Drug Utilization Studies and Data Registries in Primary Care.

This article reviews the methodology of the studies on drug utilization with particular emphasis on primary care. Population based studies of drug inappropriateness can be done with microdata from Health Electronic Records and e-prescriptions. Multilevel models estimate the influence of factors affecting the appropriateness of drug prescription at different hierarchical levels: patient, doctor, health care organization and regulatory environment. Work by the GIUMAP suggest that patient characteristics are the most important factor in the appropriateness of prescriptions with significant effects at the general practicioner level.

Ordonnance de sortie d'hôpital: un défi pour la continuité des soins et la collaboration interprofessionnelle [Hospital's discharge prescription: a challenge for continuity of care and the interprofessional collaboration].

The transition between hospital and community is an interface at high risk for medication. "The Association of Family Doctors" committee in the canton of Vaud (MFVaud), together with community pharmacists' and Homecare representatives, have begun to consider the following improvements: fast and co-ordinated care providers' information; arrangements for family doctors appointments as soon as possible; awareness and education for interprofessional collaboration; more secured preparation of pill boxes; development of interprofessional means such as medication use reviews and reconciliations. In the opinion of all the experts, there is an urgent public health need to act in an interprofessional manner, even if the solutions required (especially change in professional culture and technologies) are not immediate.

A Adopção, pela primeira vez – Constrangimentos Encontrados na Adopção n óptica Financeira

Os efeitos da globalização da economia, a graduação de Cabo Verde à categoria de país de desenvolvimento médio, a entrada para a OMC, a parceria especial com a União Europeia, são acontecimentos verificados num passado próximo que vieram trazer novas exigências ao país em diversos domínios. A preparação das contas e o relato da informação pode ser considerada uma delas. De facto, o normativo contabilístico existente até então, assente num Plano Oficial de Contabilidade (PNC) aprovado por diploma legislativo datada de 1984 já não respondia a todas as necessidades de informação nos domínios da contabilidade, fiscalidade e financeira. O trabalho assenta sobretudo na adopção do SNCRF – Sistema de Normalização Contabilística e de Relato Financeiro. O objectivo é analisar o processo de adopção pela primeira vez deste sistema e os impactos que esta adopção teve na posição financeira nas empresas. Foi feito um estudo de caso para ilustrar este processo. Descrevemos como foi adoptado o SNCRF, fizemos uma apreciação a essa adopção e sugerimos melhoria que deveria ser introduzidas para que os resultados do processo incorporassem a quase totalidade dos procedimentos instituídos nos diversos documentos normativos e legais. Ao trabalho foi dado uma dimensão prática consubstanciada num estudo de caso que serviu para ilustrar o processo de transição. O estudo foi abordado numa perspectiva apreciativa tendo sido inventariadas as situações que deveriam ser salvaguardas (de acordo com o novo normativo e imperativos legais) no processo de transição / conversão e que não foram feitas. Demonstrou-se ainda (através da análise da posição financeira da entidade), que o processo de adopção implicou algumas alterações na estrutura financeira e no valor do capital próprio. A conclusão que se chegou indica que o processo não terá sido tão linear como se desejaria apesar de em, substancia, os principais requisitos terem sido cumpridos. The effects of globalization of its economy, the upgrading of Cape Verde to the category of medium development country, the entry to WTO, the special partnership with European Union, are recent events that brought new demands to the country in several areas. . Preparation of the accounts and information report are included in these new requirements. In fact, the accounting standards till then in force, based on an Official Chart of Accounts (PNC) in force after a law of 1984, didn’t meet the requirements on accounting, fiscal and financial information. This work is basically on the adoption of the new SNCRF – System of Accounting Standardization and Financial Reporting. Our aim is to review the initial adoption process of such system and the impacts this adoption has caused to the financial position of enterprises. A case study is included to illustrate this process. We describe how the SNCRF was adopted; we made an analysis of this adoption and suggested improvements to be introduced in such way that the results of the process include most of the procedures established by law. A practical dimension was attached to this work, through a case study illustrating the transition process. The study adopted an analytical approach, listing the situations that should have been (according to the new standards and legal prescriptions) but were not prevented during the transition / conversion process. The study shows (by the analysis of the financial statements of the studied entity) that the adoption process implied some changes to the financial structure and to the owners’ equity value). One arrives to the conclusion that the process was not as linear as one would expect, although essentially the main requirements were accomplished.

The Role of Public Administration: A Global Perspective

From my experience with public administration in my country, Cape Verde, and through readings in the area of development administration, I have found that a distinctive role and specific societal goals are usually ascribed to public administration in developing country. In studying American public administration approaches and operation, I was stuck by the fact that the definition of roles and societal goals for public administration seems not to be a forefront concern in the field. How to do things and achieve efficiency, in a managerial and rational perspective, seemed to draw much more attention than the purpose of doing things. Somehow, the contrast with the concept of development administration seemed too sharp, and I became curious about the reasons for such disparate approaches. Historical, cultural, and environmental differences would probably not be the only explanation for that since the concept of development administration was shaped, in the late 50’s and 60’s, by American authors and institutional aid agencies, and then “offered” to developing countries. At the same time, looking to poor results of the successive prescriptions of the development administration movement, I was no sure that such a concept and the framework it establishes was worthwhile. What practical answers and arrangement did they bring to the needs and challenges of public administrations in developing countries? …

Computerized advice on drug dosage to improve prescribing practice.

BACKGROUND: Maintaining therapeutic concentrations of drugs with a narrow therapeutic window is a complex task. Several computer systems have been designed to help doctors determine optimum drug dosage. Significant improvements in health care could be achieved if computer advice improved health outcomes and could be implemented in routine practice in a cost effective fashion. This is an updated version of an earlier Cochrane systematic review, by Walton et al, published in 2001. OBJECTIVES: To assess whether computerised advice on drug dosage has beneficial effects on the process or outcome of health care. SEARCH STRATEGY: We searched the Cochrane Effective Practice and Organisation of Care Group specialized register (June 1996 to December 2006), MEDLINE (1966 to December 2006), EMBASE (1980 to December 2006), hand searched the journal Therapeutic Drug Monitoring (1979 to March 2007) and the Journal of the American Medical Informatics Association (1996 to March 2007) as well as reference lists from primary articles. SELECTION CRITERIA: Randomized controlled trials, controlled trials, controlled before and after studies and interrupted time series analyses of computerized advice on drug dosage were included. The participants were health professionals responsible for patient care. The outcomes were: any objectively measured change in the behaviour of the health care provider (such as changes in the dose of drug used); any change in the health of patients resulting from computerized advice (such as adverse reactions to drugs). DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data and assessed study quality. MAIN RESULTS: Twenty-six comparisons (23 articles) were included (as compared to fifteen comparisons in the original review) including a wide range of drugs in inpatient and outpatient settings. Interventions usually targeted doctors although some studies attempted to influence prescriptions by pharmacists and nurses. Although all studies used reliable outcome measures, their quality was generally low. Computerized advice for drug dosage gave significant benefits by:1.increasing the initial dose (standardised mean difference 1.12, 95% CI 0.33 to 1.92)2.increasing serum concentrations (standradised mean difference 1.12, 95% CI 0.43 to 1.82)3.reducing the time to therapeutic stabilisation (standardised mean difference -0.55, 95%CI -1.03 to -0.08)4.reducing the risk of toxic drug level (rate ratio 0.45, 95% CI 0.30 to 0.70)5.reducing the length of hospital stay (standardised mean difference -0.35, 95% CI -0.52 to -0.17). AUTHORS' CONCLUSIONS: This review suggests that computerized advice for drug dosage has some benefits: it increased the initial dose of drug, increased serum drug concentrations and led to a more rapid therapeutic control. It also reduced the risk of toxic drug levels and the length of time spent in the hospital. However, it had no effect on adverse reactions. In addition, there was no evidence to suggest that some decision support technical features (such as its integration into a computer physician order entry system) or aspects of organization of care (such as the setting) could optimise the effect of computerised advice.

What other sciences look like

In order to have references for discussing mathematical menus in political science, Ireview the most common types of mathematical formulae used in physics andchemistry, as well as some mathematical advances in economics. Several issues appearrelevant: variables should be well defined and measurable; the relationships betweenvariables may be non-linear; the direction of causality should be clearly identified andnot assumed on a priori grounds. On these bases, theoretically-driven equations onpolitical matters can be validated by empirical tests and can predict observablephenomena.

The renal hemodynamic effects of ibuprofen in the newborn rabbit.

In early childhood, nonsteroidal anti-inflammatory drugs are mainly used to either prevent or treat premature labor of the mother and patent ductus arteriosus of the newborn infant. The most frequently used prostaglandin-synthesis inhibitor is indomethacin. Fetuses exposed to indomethacin in utero have been born with renal developmental defects, and in both the unborn child and the term and premature newborn this drug may compromise renal glomerular function. The latter has in the past also been observed when i.v. indomethacin or i.v. acetylsalicylic acid (aspirin) were administered to newborn rabbits. The present experiments were designed to evaluate whether ibuprofen has less renal side effects than indomethacin, as claimed. Three groups of anesthetized, ventilated, normoxemic neonatal rabbits were infused with increasing doses of ibuprofen (0.02, 0.2, 2.0 mg/kg body weight) and the following renal parameters were measured: urine volume, urinary sodium excretion, GFR, and renal plasma flow. Renal blood flow, filtration fraction, and the renal vascular resistance were calculated according to standard formulae. Intravenous ibuprofen caused a dose-dependent, significant reduction in urine volume, GFR, and renal blood flow with a fall in filtration fraction in the animals receiving the highest dose of ibuprofen (2 mg/kg body weight). There was a very steep rise in renal vascular resistance. Urinary sodium excretion decreased. These experiments in neonatal rabbits clearly show that acute i.v. doses of ibuprofen also have significant renal hemodynamic and functional side effects, not less than seen previously with indomethacin.

Haggadah de Pâque (hébreu) (judéo-italien). Padoue

Haggadah de pâque, texte avec version italienne et commentaire abrégé de l'explication d'Isaac Abravanel. Une préface à ce même commentaire, par Juda Arié de Modène, se trouve tête de volume, accompagnant les prescriptions rituelles de la fête de pâque. Ecrit par Elie ben Ascher Malakhi Cohen en l'an 5544 de la Création, à Padoue. Titre rouge et noir entouré d'un triple cadre, les deux lignes externes en lignes ornées, et le cadre médiant constitué de verset de l'Exode (II, 17-19). Dessins à la plume sur chaque page, et initiales enluminées. Grande ériture arrée vocalisée pour le texte, rubrique des vignettes en petit module. Commentaire en écriture rabbinique italienne. A la fin du manuscrit la version allemande du poème un cabri.

Quality safeguards and regulation of online pharmacies

Using econometric evidence, this article confirms that distribution ofmedicines online is split into two market segments of very diversequality, and identifies the factors that drive quality and qualityassurance in this activity. Unlike fraudulent, rogue, websites, whichoffer scant guarantees and usually sell just a few medicines withoutprescription, online pharmacies offering insurance coverage and linkedto conventional pharmacies typically sell a wholerange of drugs, require third-party medical prescriptions and provideabundant information to patients. It is shown that, where onlinepharmacies are allowed to act legally, market forces enhance quality,as private insurers require professional standards, and specialized thirdparties make a business of certifying them. Furthermore, older onlinepharmacies and those running conventional operations offer higherquality, probably because of reputational investments. Overall, this evidence supports licensing online pharmacies, especiallyconsidering that prohibiting them is ineffective against fraudulent sites.

Desenvolvimentos estimados de custo amortizado e imparidade, segundo SNCRF - caso prático

O tema do Trabalho de Fim de Curso - “Desenvolvimentos Estimados de Custo Amortizado e Imparidade segundo SNCRF”, insere-se no âmbito da conclusão da Licenciatura em Contabilidade e Administração – Ramo Administração e Controlo Financeiro ministrada pelo ISCEE – Instituto Superior de Ciências Económicas e Empresariais. O trabalho ora apresentado, espelha uma análise sumária das normas internacionais e do novo normativo nacional no que diz respeito aos instrumentos financeiros com foco em tratamento contabilístico dado pelo método de custo amortizado e reconhecimento de perda por imparidade. Foi preparado com base em consulta de bibliografia especializada e normativos estabelecidos no país, pois permitirá ter acesso tanto a conteúdos teóricos como práticos o que implica um estudo mais abrangente de todos os recursos disponíveis. O desenvolvimento da temática foi orientado numa primeira etapa através de pesquisa necessária a construção do referencial teórico centrado por um lado na evolução teórica das normas internacionais sobre os instrumentos financeiros e consequentemente o tratamento dado pela nossa norma. Na segunda etapa, os casos práticos apresentam os principais casos de contabilização dos instrumentos financeiros utilizando o método de custo amortizado, e reconhecimento de imparidade de acordo com o SNCRF, e a conclusão que se chegou é que o custo amortizado implica a utilização do método de taxa de juro efectiva menos qualquer perda por imparidade, sendo que o método de taxa de juro efectiva distribui os pagamentos e recebimentos dos juros ao longo do período do instrumento financeiro aplicando a taxa de juro efectiva ao valor a transportar do activo ou de passivo de cada período, e uma entidade que usa o método de custo amortizado reconhece os activos financeiros e passivos financeiros pelo seu valor líquido no balanço, e à data de cada relato financeiro deve avaliar a imparidade de todos os activos financeiros e reconhecer perdas por imparidade, visto que, a imparidade representa uma redução no valor de um activo financeiro ou seja reflecte a depreciação (perda permanente) do valor de um activo financeiro e verifica quando a quantia recuperável for superior ao seu valor contabilístico.