DIGITAL SEARCH ADVERTISING – THE ROLE OF POST-CLICK FACTORS IN GENERATING PURCHASE CONVERSIONS

A lot of research is available on the effectiveness of search as an advertising channel. Most of these studies tend to treat a click on a search ad as a binary event. All of them study the events leading to the click. This paper goes beyond this to study the post click actions taken by a user subsequent to clicking on a search ad, and refers to those actions as depth of interaction, and testing the variables that have an effect on the nal outcome. We use a prescriptive research design employing binary logistic regression analysis. Results indicate that the duration of time spent, device used, and recency of visit have a very high positive effect on the nal outcome.

Analysis of drug use in medical institutions of Guangdong area during 2017-2022 / 中国药房

OBJECTIVE To analyze the situation of drug use in medical institutions of Guangdong area from 2017 to 2022， and to provide reference for the production， sale and procurement of drugs by government departments， medical insurance departments， pharmaceutical enterprises， drug sales enterprises and hospitals. METHODS Using the retrospective analysis method， based on original data from Guangdong hospital information network from 2017 to 2022， statistical analysis was conducted on the drug procurement amount of 118 medical institutions that had been online for the past 6 years， as well as the distribution of 14 major categories of drugs among all purchased drugs by online medical institutions， and sales amount of drug production enterprises. RESULTS The drug procurement amount of 118 medical institutions that had been online in Guangdong area from 2017 to 2022 showed a growth-negative growth-slow growth trend. Among the 14 major categories of drugs， the top 5 drugs in the list of consumption sum were anti-infective drugs， cardiovascular drugs， nervous system drugs， anti-tumor drugs， and digestive system drugs； among the top 200 drugs in terms of procurement amount， three major categories of drugs， namely the anti-infective drugs， anti-tumor drugs and cardiovascular system drugs， occupied the main position. The top 10 drugs in the list of procurement amounts were mainly anti-tumor drugs and cardiovascular system drugs； foreign manufacturers occupied the top 3 places in the list of sales amounts in medical institutions of Guangdong area. CONCLUSIONS In Guangdong area， the growth of drug procurement amount in medical institutions is gradually slowing down， the usage of anti-infective drugs is still abundant， the prevention and treatment of chronic diseases need great attention， and foreign pharmaceutical companies are in a leading position in the sales amount of medical institutions.

Restrição da venda de produtos de tabaco apenas em tabacarias: uma medida necessária para o fortalecimento da Política Nacional de Controle do Tabaco / Restricting the sale of tobacco products only in tobacconists: a necessary measure to strengthen the National Tobacco Control Policy

Resumo Objetivo Investigar e analisar a legislação atual, experiências e cenários existentes sobre a restrição da venda de produtos derivados de tabaco apenas em tabacarias, a fim de elaborar recomendações para o poder público, visando fortalecer a Política Nacional de Controle do Tabaco. Método Revisão de escopo conduzida de acordo com a metodologia Joanna Briggs Institute, com base na estrutura do PRISMA Checklist and Explanation. As bases de dados utilizadas foram Biblioteca Virtual em Saúde (BVS), Epistemonikos, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Medical Literature Analysis and Retrieval Sistem (MEDLINE) via Pubmed, Biblioteca eletrônica SCIELO, SCOPUS, Web of Science, Biblioteca Digital de Teses e Dissertações (BDTD) e Johns Hopkins. Dados coletados em março de 2021, considerando os estudos publicados no período de janeiro de 2005 a dezembro de 2020. Foram incluídos artigos e pesquisas acadêmicas desenvolvidas no cenário brasileiro e publicadas entre janeiro de 1994 e dezembro de 2020. Resultados Os bairros de baixa renda geralmente têm uma densidade maior de pontos de venda de tabaco e apresentam taxas mais altas de uso do tabaco, levando a iniquidades em saúde. Estudos indicam que as crianças têm maior probabilidade de fumar quando vivem ou vão à escola em bairros com alta densidade de varejistas de tabaco. Conclusão Por meio deste estudo, compreende-se que é preciso instituir a venda de produtos derivados de tabaco exclusivamente em tabacarias no Brasil, mas tais estabelecimentos estariam sujeitos a um novo ordenamento jurídico a ser instituído em âmbito nacional.

Abstract Objective To investigate and analyze current legislation, existing experiences and scenarios regarding the restriction of the sale of tobacco products only in tobacconists, in order to prepare recommendations for the public authorities, aiming to strengthen the National Tobacco Control Policy. Method Scope review conducted according to the Joanna Briggs Institute methodology, based on the PRISMA Checklist and Explanation framework. The databases used were the Virtual Health Library (BVS), Epistemonikos, Latin American and Caribbean Health Sciences Literature (LILACS), Medical Literature Analysis and Retrieval System (MEDLINE) via Pubmed, SCIELO electronic library, SCOPUS, Web of Science, Digital Library of Theses and Dissertations (BDTD) and Johns Hopkins. Data collected in March 2021, considering studies published from January 2005 to December 2020. Articles and academic research developed in the Brazilian scenario and published between January 1994 and December 2020 were included. Results Low-income neighborhoods generally have a higher density of tobacco outlets and have higher rates of tobacco use, leading to health inequities. Studies indicate that children are more likely to smoke when they live or go to school in neighborhoods with a high density of tobacco retailers. Conclusion This study shows that it is necessary to set up the sale of tobacco products exclusively in tobacconists in Brazil, but such establishments would be subject to a new legal order to be instituted at the national level.

Dismorfia Muscular Prediz Dependência de Exercício e Ortorexia em Praticantes de Exercício Brasileiros? / Does Muscle Dysmorphy Predict Exercise Dependence and Orthorexia in Brazilian Exercise Practitioners? / ¿La Dismorfia Muscular Predice la Dependencia del Ejercicio y la Ortorexia en los Practicantes de Ejercicio Brasileños?

O estudo analisou o papel preditor dos sintomas de dismorfia muscular na dependência de exercícios e na ortorexia em 158 praticantes de exercício brasileiros (corrida = 38, crossfit = 85, musculação = 35) de ambos os sexos (mulheres = 81, homens = 77), com idade média de 31,59 anos (± 7,99) e experiência de 4,5 anos (± 5,27). Utilizou-se a Escala de Dedicação ao Exercício, o Questionário para o Diagnóstico de Ortorexia e o Questionário Complexo em Adonis. A análise dos dados foi conduzida por meio da correlação de Pearson e de análise de regressão múltipla (p < 0,05). A dismorfia muscular prediz positivamente a dependência de exercícios (ß = ,51, p < ,001) e negativamente a ortorexia (ß = -,19, p < ,01), sendo importante discutir a temática com praticantes de exercícios físicos a fim de minimizar a prevalência e os efeitos deletérios associados a esse distúrbio psicológico

This study aimed to analyze the predictive role of muscle dysmorphia symptoms in exercise addiction and orthorexia in 158 Brazilian exercise practitioners (running = 38, crossfit = 85, bodybuilding = 35) of both sexes (women = 81, men = 77), with a mean age of 31.59 years (± 7.99) and experience of 4.5 years (± 5.27). The Dedication to Exercise Scale, the Questionnaire for the Diagnosis of Orthorexia, and the Complex in Adonis Questionnaire were used. Data analysis was conducted through Pearson's correlation and multiple regression analysis (p < .05). It was found that the muscle dysmorphia symptoms predicted positively exercise addiction (ß = .51, p < .001) and negatively orthorexia (ß = -.19, p < .01), and it is important to discuss the issue with physical exercise practitioners in order to minimize the prevalence and deleterious effects associated with this psychological disorder.

O estudo analisou o papel preditor dos sintomas de dismorfia muscular na dependência de exercícios e na ortorexia em 158 praticantes de exercício brasileiros (corrida = 38, crossfit = 85, musculação = 35) de ambos os sexos (mulheres = 81, homens = 77), com idade média de 31,59 anos (± 7,99) e experiência de 4,5 anos (± 5,27). Utilizou-se a Escala de Dedicação ao Exercício, o Questionário para o Diagnóstico de Ortorexia e o Questionário Complexo em Adonis. A análise dos dados foi conduzida por meio da correlação de Pearson e de análise de regressão múltipla (p < 0,05). A dismorfia muscular prediz positivamente a dependência de exercícios (ß = ,51, p < ,001) e negativamente a ortorexia (ß = -,19, p < ,01), sendo importante discutir a temática com praticantes de exercícios físicos a fim de minimizar a prevalência e os efeitos deletérios associados a esse distúrbio psicológico.

Performance of Holstein-Friesian calves drinking desalinated water in the preweaning period

Background: High salinity of drinking water can adversely affect health and productive performance of calves during artificial rearing. Objective: To evaluate the effect of drinking water total dissolved salts (TDS) content on productive performance of Holstein-Friesian calves during artificial rearing. Methods: Twenty-nine newborn Holstein-Friesian calves weighing 39±0.94 kg at birth were randomly assigned to two treatment groups for 56 d. Treatment 1 (n=14) consisted of drinking water with 1,469±75 mg L-1 TDS, while treatment 2 (n=15) used drinking water from the same source but filtered by reverse osmosis to contain 107±31 mg L-1 TDS. Results: Water intake was numerically affected by TDS concentration, increasing 13% (p>0.08) when drinking low-TDS water (3,554 versus 3,088 ml d-1). Feed intake (dry basis) decreased 26% (500 versus 676 g d-1; p0.05) by TDS content in the drinking water. Conclusion: Desalinated water improves productive performance of Holstein-Friesian calves during artificial rearing.

Antecedentes: Una alta salinidad del agua de bebida puede afectar negativamente la salud y el comportamiento productivo de los terneros durante la crianza. Objetivo: Evaluar el efecto del contenido de sales disueltas totales (SDT) en el agua de bebida sobre el comportamiento productivo de los terneros durante la crianza artificial. Métodos: Veintinueve terneros Holstein- Friesian recién nacidos, con 39±0,94 kg de peso vivo fueron asignados aleatoriamente a dos tratamientos. El tratamiento 1 consistió de 14 terneros que bebieron agua con 1.469±75 mg L-1 de SDT; mientras que al tratamiento 2 se asignaron 15 terneros que recibieron agua de la misma fuente, pero filtrada mediante el procedimiento de ósmosis inversa y conteniendo 107±31 mg L-1 de SDT. Resultados: La concentración de SDT afectó numéricamente el consumo de agua durante los 56 días de lactancia (p>0,08), incrementándose 13% cuando los terneros bebieron agua con bajo contenido de sales (3.554 vs 3.088 ml d-1). El consumo de alimento (base seca) disminuyó 26% (500 vs 676 g d-1; p0,05). Conclusión: El agua de bebida desalinizada mejora el comportamiento productivo de terneros Holstein durante la crianza artificial.

Antecedentes: Alta salinidade da água potável pode afetar adversamente a saúde e o desempenho produtivo de bezerros durante o acasalamento. Objetivo: Avaliar o efeito do total de sais dissolvidos (TSD) na água potável sobre o comportamento dos bezerros durante a lactação. Métodos: Vinte e nove terneiros Holstein-Friesian recém-nascidos, com 39±0,94 kg de peso vivo, foram designados aleatoriamente a dois tratamentos. O tratamento 1 considerou 14 terneiros os quais beberam água com 1.469±75 mg L-1 do total de sais dissolvidos (TSD); enquanto ao tratamento 2 se designaram 15 terneiros bebendo água da mesma fonte filtrada através do procedimento de osmose inversa e contendo 107±31 mg L-1 de TSD. Resultados: O consumo de água de bezerros durante os 56 dias de lactação artificial foi ligeiramente afetado pela concentração de TDS na água potável (p>0,08) e aumentou em 13% quando os bezerros beberam água com baixo teor de sal (3.554 vs 3.088 ml d-1); o consumo de alimento sólido (base seca) diminuiu em 26% (500 vs 676 g d-1; p0,05) pelo conteúdo de TSD na água de beber. Conclusão: A dessalinização da água de beber melhora o comportamento produtivo de terneiros Holstein durante o período de lactação artificial..

Adherencia al consumo de suplementos de hierro y factores asociados en gestantes peruanas / Adherence to iron supplements consumption and associated factors in Peruvian pregnant women

Introducción: La anemia durante el embarazo se considera un problema de salud pública. La estrategia para su reducción incluye la administración de suplementos de hierro. Objetivo: Analizar la adherencia al suplemento de hierro en gestantes atendidas en los establecimientos de salud del Ministerio de Salud del Perú. Métodos: Se realizó un estudio transversal de vigilancia centinela de adherencia a sales de hierro en 1038 gestantes del Perú, atendidas en hospitales, centros de salud y puestos de salud, que recibieron suplementos de hierro. Se aplicó una entrevista estructurada para medir los factores a la adherencia y se determinó adherencia cuando el consumo de suplementos fuera > 75 por ciento. Se aplicó la estadística descriptiva y regresión logística. Resultados: El 42,3 por ciento de las gestantes fueron adherentes al suplemento de hierro. Se asociaron a la adherencia: tener educación universitaria (ORa 3,4; IC 95 por ciento 1,5:7,7), consumir alimentos ricos en hierro (ORa 1,6; IC 95 por ciento 1,1:2,5), no suspender el tratamiento por molestias (ORa: 2,8 IC 95 por ciento 1,7:4,6) y residir en una altitud entre 1001 m s. n. m. a 2000 m s. n. m. (ORa 4,0; IC 95 por ciento 1,6:10,1). Estos factores explican entre el 12 por ciento y el 16 por ciento de la adherencia, y fueron predictivos para identificar adherencia en gestantes con un área bajo la curva del 70,4 por ciento. Conclusiones: El tratamiento con sales de hierro en gestante es insuficiente, por lo que debe incluirse en su dieta, de manera integral y simultánea, el consumo de alimentos ricos en hierro y otros fortificados dirigidos básicamente a las embarazadas. Además, se deben trazar estrategias de salud que permitan identificar determinantes sociales, como el nivel educativo, que inciden en la adherencia al tratamiento, con vista a disminuir su influencia(AU)

Introduction: Anemia during pregnancy is considered a public health problem. The strategy for its reduction includes iron supplementation. Objective: Analyze adherence to iron supplements in pregnant women treated in health facilities of the Peruvian Ministry of Health. Methods: A cross-sectional sentinel surveillance study of adherence to iron salts was conducted in 1038 pregnant women from Peru, who were treated in hospitals, health centers and health posts, and who received iron supplements. A structured interview was applied to measure the factors to adherence, and adherence was determined when supplement consumption was > 75percent. Descriptive statistics and logistic regression were applied. Results: 42.3percent of the pregnant women were adherents to the iron supplement. Adherence was associated with: having a university education (ORa 3.4; CI 95percent 1.5:7.7), consumption of foods rich in iron (ORa 1.6; 95percent CI 1.1:2.5), do not discontinue the treatment due to discomfort (ORa: 2.8 CI 95percent 1.7:4.6) and living at an altitude between 1001 m.a.s.l to 2000 m.a.s.l (ORa 4.0; CI 95percent 1.6:10.1). These factors explain between 12percent and 16percent of the adherence rates, and were predictive to identify adherence in pregnant women with an area under the curve of 70.4percent. Conclusions: Treatment with iron salts in pregnant women is insufficient, so the consumption of foods rich in iron and other fortified foods basically aimed at pregnant women should be included in their diet, in a comprehensive and simultaneous way. In addition, health strategies must be drawn up to identify social determinants, such as educational level, that affect adherence to treatment, with a view to reduce their influence(AU)

Sales of Medication for Obstructive Pulmonary Diseases and Asthma Mortality in Argentina for the Last 40 Years

Abstract Introduction: Global asthma mortality is still an unresolved issue, despite the existence of highly effective treatments. This occurs in Argentina, where there are also some effective treatments, but there is few information about the relationship between asthma mortality and sales of inhaled medication. The purpose of this study was to analyze sales in pharmacies of medication for obstructive respiratory diseases and asthma deaths, before and after the appearance of inhaled corticosteroids (ICSs) and their combinations. Materials and Methods: An official bulletin was the source document for data about asthma mortality in Argentina between 1983 and 2018. All data on pharmacy sales were provided by the same source (IQVIA Solutions Argentina), but there are no sales data from 1990 to 1999. Results: The mean ± standard deviation of the ratio between total sales of short-acting β2-adrenergic agonist bronchodilators (SABAs) over total sales of ICS and their combinations was 13.68 ± 2.85 between 1983-1988 and 1.03 ± 0.12 between 2010-2019 (p < 0.0001). There was a significant correlation between the SABA/ICS ratios and the number of asthma deaths from 1983 to 2018 (Pearson correla tion: r = 0.977, p < 0.0001). During the period from 2010 to 2018 there was a significant decrease in the number of deaths compared to 1980-1989 (145.9 ± 28.58 vs. 43.1 ± 5.2; p <0.0001). Since 2016, SABA sales started to decrease and were overtaken in 2019 by the combinations of ICS/long-acting b2-agonist bronchodilators (LABAs). Conclusions: The significant correlation between the SABA/ICS sales ratio and asthma deaths would make us rethink the long-established treatment stereotype of SABAs for the management of asthma.

Discuss on Supervision Mechanism for Online Drug Sales from the Perspective of Regulatory Science / 中国药房

OBJECTIVE：To provide su ggestions for perfecting drug electronic commerce regulatory policy and online drug sale supervision mechanism in China. METHODS ：The evolution of online drug sale policy in China were sorted out. The related regulations of online drug sale supervision mechanism stated in newly revised Drug Administration Law in 2019 and Measures for Online Drug Sale Supervision （Exposure Draft ）in Nov. 2020（hereinafter referred to as New Exposure Draft ）were analyzed on the basis of regulatory science to put forward the opinion. RESULTS & CONCLUSIONS ：Drug e-commerce in China has experienced 4 stages of development ，and is now in a new stage of encouraging innovation ，inclusiveness and prudence. The newly revised Drug Administration Law and New Exposure Draft catch up with the trend of “Internet plus ”development in the new era ，and conditionally liberate the network prescription drug operation ，and build new advantages and new kinetic energy for the development of pharmaceutical business. The new network drug supervision mechanism is an important embodiment of the regulatory department ’s active adaptation to social development ，a specific practice of the innovation of scientific drug regulatory concept，and also provides legal guarantee and policy space for new business forms of innovation drug circulation. However ，the author thinks that the relationship between prescription drug information and drug advertising ，network prescription transmission and authenticity ，legitimacy audit ，as well as the concept definition of sales behavior and service behavior are still questionable. Relevant concepts and terms should be adjusted and redefined. It is suggested that online drug sellers should be defined as “drug e-commerce operators ”or“online drug operators ”. The third party platform of online drug trading is defined as “drug e-commerce platform operator ”or“online drug trading platform operator ”.

Confiabilidad y vigencia de un instrumento que mide el emprendimiento en comerciantes del centro de México / Reliability and validity of an instrument that measures entrepreneurship of merchants in central mexico

ABSTRACT The objective of this study is to contribute to the validity and reliability of the Garcia Coffee Entrepreneurship Scale (2016). A non-experimental, cross-sectional, and exploratory study was conducted with a non-random selection of 300 coffee merchants. The results confirm the original report, although the incidence of another factor, that the literature identifies as cooperativism, is noted. The extension of the work to other scenarios and samples of micro entrepreneurs is suggested, in order to confirm the dimensions of the undertaking.

RESUMEN El objetivo de este estudio fue contribuir a la validez y confiabilidad de la Escala de Emprendimiento Cafetero de García (2016). Se realizó un estudio no experimental, transversal y exploratorio con una selección no aleatoria de 300 comerciantes de café. Los resultados confirman el informe original, aunque se nota la incidencia de otro factor que la literatura identifica como cooperativismo. Se sugiere la extensión del trabajo a otros escenarios y muestras de microempresarios con el fin de confirmar las dimensiones del emprendimiento.

Trabalho, subjetividade e gestão gerencialista: um estudo com trabalhadores do comércio / Work, subjectivity and management techniques: a study with commerce workers

O presente estudo teve como objetivo caracterizar e problematizar as técnicas de gestão gerencialistas utilizadas no contexto de trabalho do comércio varejista. Essa análise teve como eixos teóricos os estudos de Vincent de Gaulejac a respeito das técnicas de gestão da subjetividade e os estudos da Psicodinâmica do Trabalho. Realizou-se uma pesquisa qualitativa, por meio de entrevistas semiestruturadas com cinco comerciários da cidade de Porto Alegre. As entrevistas foram submetidas à análise de conteúdo, a partir da qual foram identificadas quatro categorias temáticas. Destacou-se primazia da gestão do desempenho e da excelência, pautada por técnicas que visam à homogeneização de comportamentos e à mobilização subjetiva dos trabalhadores. Os resultados dão luz a particularidades e precarizações no setor do comércio, assim como às implicações dessas técnicas de gestão para a subjetividade dos trabalhadores.

This study aims to characterize and discuss management techniques applied in the retail business. The analysis was based on the studies of Vincent de Gaulejac on techniques for managing subjectivity and on Psychodynamic of Work. We conducted five semi-structured interviews with retailers from Porto Alegre, Brazil, which were analyzed using qualitative methods. The results showed four categories. It was highlighted the primacy of performance management and excellence, ruled by techniques that aim to homogenize behavior management. The results also shed light on particularities and precariousness in the commercial sector, as well as the implications of management techniques on the subjectivity of the workers.

Medical and social legal aspects of the use of hydrophyte plants for food

The species diversity of hydrophytes suitable for human consumption and the possibility of their introduction into the practice of organic farming and sustainable polyculture are explored in the article. The economic and environmental potential of shallow freshwater areas and waterlogged areas are discussed from the perspective of sustainable agriculture. The possibility of using some hydrophyte plants for food and drugs is indicated. The necessity of using the practice of traditional nature management by the native population in relation to water and near-water food plants is mentioned. The relevant issues of providing the growing population of the Earth with food and technical plant raw materials from hydrophytes are discussed. It has been established that a necessary condition for the operation of the market for wild-growing medicinal hydrophytes in accordance with the concept of sustainable development is its efficient legal regulation at all levels.

Development and current situation of Japanese Kampo Preparations and its meaning for Chinese materia medicine / 中草药

With the development of the Japanese quality management system (QMS) as the starting point, the development of the Kampo Preparations is described from three aspects of the development, production and sales of the Kampo to provide reference for the research and development of traditional Chinese medicine preparation and the construction of quality standard management system. It is necessary to refer to Japan’s good management philosophy and a complete quality management system. Learning from their successful experience of the development of Japanese Kampo preparations to improve the level of Chinese herbal medicine cultivation, proprietary Chinese medicine production technology and the quality management of the whole process of proprietary Chinese medicine preparation, thus promoting the development of Chinese medicine industry.

Validade do autorrelato de anemia e do uso terapêutico de sais de ferro durante a gestação: coorte de nascimentos de 2015 de Pelotas, Rio Grande do Sul, Brasil / Validity of patient-reported anemia and therapeutic use of iron supplements during pregnancy: 2015 Pelotas (Brazil) birth cohort / Validez del autoinforme de anemia y uso terapéutico de sales de hierro durante la gestación: cohorte de nacimientos de 2015 en Pelotas, Río Grande do Sul, Brasil

O objetivo deste estudo é investigar a validade do autorrelato de anemia e de uso terapêutico de sais de ferro, frente à informação de hemoglobina da carteira da gestante. O estudo utiliza dados da coorte de nascimentos de 2015 de Pelotas, Rio Grande do Sul, Brasil. Para a validação do autorrelato de anemia, foram incluídas todas as mães que tinham registro de hemoglobina na carteira da gestante (N = 3.419), ao passo que, para a validação do autorrelato de uso terapêutico de sais de ferro, foram incluídas as que tinham registro de exames de hemoglobina na carteira da gestante e que relataram haver utilizado algum medicamento com sulfato ferroso em sua composição durante a gestação. Anemia foi definida como, pelo menos, um registro de hemoglobina ≤ 11g/dL na carteira da gestante (padrão-ouro). A prevalência de anemia conforme padrão-ouro foi 35,9% (34,3-37,5), ao passo que a de anemia autorrelatada foi 42,2% (40,8-43,7), e o autorrelato de uso terapêutico de sais de ferro, 43,2% (41,3-45,1). A sensibilidade do autorrelato de anemia foi 75,2% (72,8-77,6) e a especificidade, 75,1% (73,3-76,9). Para o autorrelato de uso terapêutico de sais de ferro, a sensibilidade foi 66,4% (63,5-69,2) e a especificidade, 71,9% (69,7-74,0). A especificidade do autorrelato de anemia e do autorrelato de uso terapêutico de sais de ferro entre mães com ≥ 12 anos de escolaridade foi 78,4% (75,4-81,4) e 79,5% (76,1-82,9). Na população estudada, com alta prevalência de anemia, de cada cinco puérperas que relataram anemia ou uso terapêutico de sais de ferro, três relatavam a verdade. A especificidade de ambos os autorrelatos foi mais elevada entre mães com ≥ 12 anos de escolaridade.

This study aimed to investigate the validity of patient-reported anemia and therapeutic use of iron supplements, compared to hemoglobin values recorded on the patient's prenatal card. The study used data from the 2015 Pelotas (Brazil) birth cohort. For validation of self-reported anemia, we included all mothers with hemoglobin values recorded on their prenatal card (N = 3,419), while validation of self-reported therapeutic use of iron supplements included those who had hemoglobin values recorded on their prenatal care and who reported having used medicines containing ferrous sulfate during pregnancy. Anemia was defined as at least one record of hemoglobin ≤ 11g/dL on the prenatal card (gold standard). Prevalence of anemia according to the gold standard was 35.9% (34.3-37.5), while patient-reported anemia was 42.2% (40.8-43.7), and patient-reported therapeutic use of iron supplements was 43.2% (41.3-45.1). Sensitivity of patient-reported anemia was 75.2% (72.8-77.6) and specificity was 75.1% (73.3-76.9). For patient-reported therapeutic use of iron supplements, sensitivity was 66.4% (63.5-69.2) and specificity was 71.9% (69.7-74.0). Specificity of patient-reported anemia and patient-reported therapeutic use of iron supplements in mothers with ≥ 12 years of schooling was 78.4% (75.4-81.4) and 79.5% (76.1-82.9), respectively. In the study population, for every five postpartum women that reported anemia or therapeutic use of iron supplements, three were telling the truth. The specificity of both self-reports was high in mothers with ≥ 12 years of schooling.

El objetivo de este estudio es investigar la validez del autoinforme de anemia y uso terapéutico de sales de hierro, respecto a la información sobre la hemoglobina, presente la cartilla de la embarazada. El estudio utiliza datos de la cohorte de nacimientos en Pelotas, Rio Grande ddo Sul, Brasil, 2015. Para la validación del autoinforme de anemia, se incluyeron a todas las madres que tenían un registro de hemoglobina en la cartilla de la embarazada (N = 3.419), al mismo tiempo que, para la validación del autoinforme del uso terapéutico de sales de hierro, se incluyeron a quienes tenían registro de exámenes de hemoglobina en la cartilla de la embarazada, y que informaron haber utilizado algún medicamento con sulfato ferroso en su composición durante la gestación. La anemia se definió como, por lo menos, un registro de hemoglobina ≤ 11g/dL en la cartilla de la embarazada (patrón ideal). La prevalencia de anemia, según el patrón ideal, fue de un 35,9% (34,3-37,5), mientras que la de la anemia autoinformada fue de un 42,2% (40,8-43,7), y el autoinforme de uso terapéutico de sales de hierro, 43,2% (41,3-45,1). La sensibilidad del autoinforme de anemia fue de un 75,2% (72,8-77,6) y la especificidad, 75,1% (73,3-76,9). Para el autoinforme de uso terapéutico de sales de hierro, la sensibilidad fue 66,4% (63,5-69,2) y la especificidad, 71,9% (69,7-74,0). La especificidad del autoinforme de anemia y del autoinforme de uso terapéutico de sales de hierro entre madres con ≥ 12 años de escolaridad fue 78,4% (75,4-81,4) y 79,5% (76,1-82,9). En la población estudiada, con una alta prevalencia de anemia, de cada cinco puérperas que informaron anemia o uso terapéutico de sales de hierro, tres relataban la verdad. La especificidad de ambos autoinformes fue más elevada entre madres con ≥ 12 años de escolaridad.

Iron salts and vitamins: use, purchase and sources of obtainment among children in Brazil / Sais de ferro e vitaminas: uso, aquisição e fontes de obtenção para crianças brasileiras / Sales de hierro y vitaminas: uso, adquisición y fuentes de obtención entre niños en Brasil

To verify the prevalence of use, purchase and sources of iron salts and vitamins by children aged from 0 to 12 years in Brazil. Population-based transversal study (Brazilian National Survey on Access, Utilization, and Promotion of Rational Use of Medicines - PNAUM), including 7,528 children up to 12 years of age. Information was obtained through questionnaires answered by the children's tutors, about the use of iron salts and vitamins 15 days before the interview; forms of financing, and sources of obtainment, sociodemographic characteristics, and presence of chronic disease. Descriptive and bivariate analyses were performed and the main variables were expressed by relative frequencies and 95% confidence intervals (95%CI). The prevalence of use of iron salts was 1.6% (95%CI: 1.2-2.1), with higher prevalence among children under 1 year old (8.5%; 95%CI: 6.3-11.5) and residents of the southeastern region (2.3%; 95%CI: 1.5-3.4). Prevalence of use of vitamins was 4.8% (95%CI: 4.2-5.6), with higher prevalence among children under 1 year old (24.3%; 95%CI: 20.3-28.7) and residents of the northern region (8.6%; 95%CI: 6.2-11.7). Purchase occurred by direct reimbursement for 41.6% (95%CI: 27.9-56.7) of the iron salts, and for 82.4% (95%CI: 76.3-87.2) of the vitamins. The iron salts were predominantly obtained from SUS pharmacies (51.5%; 95%CI: 36.4-66.4), and the vitamins from commercial pharmacies (80.6%; 95%CI: 77.4-85.6). The results suggested the use of iron salts in the Brazilian pediatric population was low, with reduction in use as age increased, regional differences and free-of-charge obtainment, predominantly from SUS.

O estudo teve como objetivo verificar a prevalência do uso, aquisição e fontes de saís de ferro e vitaminas para crianças entre 0 e 12 anos de idade no Brasil. Foi realizado um estudo transversal de base populacional (Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - PNAUM), incluindo 7.528 crianças até 12 anos de idade. As informações foram obtidas através de questionários respondidos pelos pais ou responsáveis, sobre o uso de sais de ferro e vitaminas nos 15 dias anteriores à entrevista; formas de financiamento e fontes de aquisição, características sociodemográficas e presença de doenças crônicas. Foram realizadas análises descritivas e bivariadas, e as principais variáveis foram expressas como frequências relativas com intervalos de 95% de confiança (IC95%). A prevalência do uso de sais de ferros foi 1,6% (IC95%: 1,2-2,1), com prevalência maior entre crianças com menos de 1 ano de idade (8,5%; IC95%: 6,3-11,5) e residentes da Região Sudeste (2,3%; IC95%: 1,5-3,4). A prevalência do uso de vitaminas foi 4,8% (IC95%: 4,2-5,6), com prevalência maior entre crianças com menos de 1 ano (24,3%;IC95%: 20,3-28,7) e residentes da Região Norte (8,6%; IC95%: 6,2-11,7). A aquisição ocorreu por reembolso direto em 41,6% (IC95%: 27,9-56,7) dos sais de ferro e em 82,4% (IC95%: 76,3-87,2) das vitaminas. Os sais de ferro foram adquiridos predominantemente através das farmácias do SUS (51,5%; IC95%: 36,4-66,4), e as vitaminas em farmácias comerciais (80,6%; IC95%: 77,4-85,6). Os resultados sugerem que o uso de sais de ferro na população pediátrica brasileira é por baixo, com uma redução no uso conforme aumenta a idade da criança, além de diferenças regionais e aquisição gratuita, predominantemente do SUS.

Este trabajo tiene el fin de verificar la prevalencia de uso, adquisición y fuentes de sales de hierro y vitaminas por parte de niños desde 0 a 12 años de edad en Brasil. Se trata de un estudio transversal, basado en población (Encuesta Nacional sobre el Acceso, Uso y Promoción de Uso Racional de Medicinas - PNAUM por sus siglas en portugués), que incluye a 7.528 niños de hasta 12 años de edad. La información se obtuvo a través de cuestionarios respondidos por los tutores de los niños, sobre el uso de sales de hierro y vitaminas 15 días antes de la entrevista; formas de financiación, y fuentes de adquisición, características sociodemográficas, y presencia de alguna enfermedad crónica. Se realizaron análisis descriptivos y bivariados, además las variables principales se plasmaron mediante frecuencias relativas e intervalos del 95% de confianza (IC95%). La prevalencia del uso de sales de hierro fue de un 1,6% (IC95%: 1,2-2,1), con una prevalencia más alta entre niños por debajo de un 1 año de edad (8,5%; IC95%: 6,3-11,5) y residentes de la Región sudeste (2,3%; IC95%: 1,5-3,4). La prevalencia del uso de vitaminas fue de un 4,8% (IC95%: 4,2-5,6), con una prevalencia más alta con niños menores de 1 año de edad (24,3%; IC95%: 20,3-28,7) y residentes de la Región nordeste (8,6%; IC95%: 6,2-11,7). La adquisición tuvo lugar por reembolso directo en un 41,6% (IC95%: 27,9-56,7) de sales de hierro, y por un 82,4% (IC95%: 76,3-87,2) de las vitaminas. Las sales de hierro se obtuvieron predominantemente en farmacias del SUS (51,5%; IC95%: 36,4-66,4), y las vitaminas en farmacias comerciales (80,6%; IC95%: 77,4-85,6). Los resultados sugirieron el consumo de las sales de hierro en la población pediátrica brasileña fue por bajo, con una reducción en su consumo a medida que la edad aumentaba, además de diferencias regionales, y su obtención gratuita, predominantemente del SUS.

Analysis on regional distribution characteristics and changing trend of Chinese patent medicine industry / 中国中药杂志

Through the collection and collation of the industrial sales output values of Chinese patent medicines in 31 provinces of China from 2005 to 2014,the regional distribution characteristics and changing trend of Chinese patent medicine industry in the past ten years were analyzed by using the descriptive statistical analysis method in statistics.The results showed that the industrial sales output values of Chinese patent medicines in Jilin, Shandong, Jiangxi, Sichuan and Guangdong accounted for the largest proportion of the country, while Ningxia accounted for only 0.04% of the whole country. Anhui Province had the largest fluctuations in data, and its coefficient of variation was as high as 102.03%.The average annual growth rate of the industrial sales output value of Chinese patent medicines was lowest in Ningxia, only －1.09%.Based on the statistical analysis of the industrial sales output value of Chinese patent medicines in four major economic regions, the data concentration trend was as follows： east> west> central> northeast; the data fluctuation trend was northeast> central> west> east, and the average annual growth rate from large to small was northeast> central> west> east.This study was conducive to understand the differencesin the industrial sales output value of Chinese patent medicines among various provinces and economic regions,and to lay the foundation for the correct understanding and in-depth exploration of the factors that may affect the industrial sales output value of Chinese patent medicines.This study has reference value for the management and economic research of traditional Chinese medicine resources.

Application of Antibacterial Drugs for Special Use and Bacterial Resistance in Our Hospital before and af-ter the Implementation of Network Online Approval Process / 中国药师

Objective:To analyze the indicators and resistance rate of antibacterial drugs for special use in our hospital before and after the implementation of network online approval process to provide reference for the management and rational use of antibacterial drugs for special use. Methods:A retrospective analysis was performed, and the consumption amount, sales amount, utilization ratio, AUD, submission rate of microbial specimen and resistance rates for the main pathogenic bacteria of antibacterial drugs and ones for special use were investigated during 2012 and 2015 in our hospital. Results:The approval process of antibacterial drugs for special use developed from handwork to network online. The consumption amount of antibacterial drugs increased slightly year by year from 2012 to 2015 in our hospital, the mean expense of antibacterial drugs for the inpatients increased from 1602. 85 yuan to 1888. 63 yuan,and AUD increased from 54. 50 DDDs/(100 persons × d) to 65. 47 DDDs/(100 persons × d). The sales amount proportion of antibacterial drugs for special use (13. 90%) was the lowest in 2013, and the highest (17. 34%) in 2015, and AUD increased from 4. 85 DDDs/(100 person × d)to 6. 37 DDDs/(100 person × d), and the submission rate of microbial specimen before the treatment increased from 85. 5% to 90. 0%. The main pathogenic bacteria were Staphylococcus aureus, Escherichia coli, Klebsiella pneumonia, Pseudomonas aeruginosa and Acinetobacter baumannii,and their ratio had slight change. Except Staphylococcus aureus, the resistance rate of the other four pathogenic bacteria kept increasing, and the resistance rates of Acinetobacter baumannii to cefepime and carbapenems were over 50%. Conclusion:The approval process management of antibacterial drugs for special use must be strengthened in order to truly a-chieve reasonable use of antibacterial drugs for special use.

The impact of separating drug sales from medical services reform on the operation of tertiary general hospital in Beijing:Case study of R hospital / 中国卫生政策研究

Objective:To empirically evaluate the impact of the reform of separating drug sales from medical services reform on the operation of public hospitals in Beijing. Methods:Taking R hospital as a case study,Twenty-six clinical departments were selected as samples, and the indicators which have significant change after medical reform were analyzed by descriptive statistics,Pairing test,Correlation test and Spearman correlation test. 24 tested indicators included workload,cost and medication behavior. Results:After the Beijing medical reform between May to September 2017,and from May to September 2016, R hospital workload and cost indicators changed in varying degrees. There were differences between the two groups in terms of the internal medicine and surgery,and the medi-cation behavior had no significant change. Conclusion:The effect of Beijing's healthcare reform policy is obvious. R hospital has the trend of decreasing outpatient volume, drug proportion and medical insurance costs. The medical reform policy may have a profound impact on the development of the clinical subject.

Impact of separating drug sales from medical services reform on Beijing Cancer Hospital from the perspective of medical insurance data / 中国卫生政策研究

objective:To analyze the policy impact of separating drug sales from medical services on a certain oncology hospitals in Beijing,and provide the basis for further development and adjustment of the reform. Methods:Using interrupted time series segmented regression model to analyse the instant change and trend change of medical service utilization by outpatient(including tumor-specified outpatient) and overall inpatient services,especially in in-dicators of drug proportion,self-pay ratio,and so on after the reform. Results:Tumor treatment is a relative specific-ity. The proportion of previous inpatients in tumor specialized hospitals ranged between 49.31% and 49.96%, and the actual compensation rates were between 57.05% and 63.57%. In our case analysis, the expenditure of outpa-tients dropped after this reform,with RMB 4.33 monthly decline on average cost and with 2.32 percentage monthly decrease on a self-pay rate. Drug proportion was declined expectedly,and the proportion of outpatient and inpatient drugs immediately decreased by 4.63% and 2.98% respectively after the reform. Therewith consumptive material proportion was raised, and the proportion of outpatient and inpatient materials instantly increased by 0.22% and 1.17% respectively. Conclusion:As per the results of this study,the reform has weakened the economic dependence on drug income in sample hospital and reduced the burden on patients. However,tumor treatment is on rigid demand and brings about a relatively great impact on hospital's finance and medical insurance fund. The rationality regards of cost-shifting should be investigated in the long run.

The impact of separating drug sales from medical services reform on mechanism of controlling outpatient and emergency expenses in Beijing / 中国卫生政策研究

Objective:To evaluate the impact and analyze the mechanism of separating drug sales from medical services reform on the total medical expenditure containment of outpatient services in Beijing. Methods:The monitoring data and historical data from 89 third-level,78 second-level public hospitals,and 206 primary health institutions and community health service agencies,which participated in the reform,were analysed to estimate the impacts on outpa-tient service utilization and service price. The analysis was based on the data of the first and second quarters of 2016 outpatient and emergency department fee changes,and analysis of service utilization and service price factors on the im-pact of changes in outpatient and emergency services mechanism. Results:The total outpatients'expenditure in Beijing in the second quarter of 2017 was 17.38 billion yuan,representing a slight decrease of 1.14% than the expenditure in 2016. The growth rate reduced by 2.46%. Expenditure in third-level and second-level hospitals decreased by 2.82% and 3.02%,respectively,with reductions in growth rates of 4.06% and 3.74% respectively. Expenditure in primary institutions increased by 17.09%. The increase rate in the second quarter of 2017 was 26.28%,representing a remark-able increase compared to the rate in 2016(15.84%). The contribution from the medical institution service prices and service utilization to the change of outpatient and emergency medical expenditure containment was 6.98% and -7. 65%,respectively. For third-level hospitals,the contribution was 10.37% and -12.00%,respectively;second-level hospitals were 0.72% and -3.35%,respectively;and the primary health institutions was 6.08% and 9.57%. Con-clusions:Beijing's comprehensive reform of separating drug sales from medical services reform has effectively controlled the rising medical expenditure of outpatient services,mainly by adjusting outpatients service utilization between differ-ent level healthcare institutions.

Effect evaluation of comprehensive reform of medical price in urban public hospital: A case study of Nanjing city / 中国卫生政策研究

Objectives:This study aims to analyze the change of income and medical service revenue of hospi-tals in Nanjing after the comprehensive reform of the medical prices of public hospitals,evaluate the effect of compen-sation and explore the differentiated compensation plan, and provide the basis for establishing the compensation mechanism of dynamic adjustment. Methods: A total of 10 municipal-affiliated hospitals were selected to collect fi-nancial income and expenditure data for the 48 months before the reform (2011.11—2015.10) and the 12 months after the reform(2015.11—2016.10) in Nanjing,and used interrupted time series model to estimate the growth rate of drug profit and service revenue,and finally made a comparison between the counterfactual and actual figures. Re-sults:It was found that,after the form,the drug profit decreased by 14.98%,and the service revenue increased by 24.79%. The revenue from medicines accounted for 42.7% and 36.9% before and after the reform respectively, and service for 28.9% and 30.3% respectively. The net financial aid accounted for 20.43% of the total drug-sales loss in average,and the net service revenue rate averaged 87.3% meeting the policy target,but within the 10 hospi-tals these rate ranged diversely from -21.9% to 712.5%,and 28.9% to 712.5%. The regression analysis indica-ted that the service compensation rate was significantly positively correlated with the proportion of service revenue in the total medical revenue before the reform. Conclusions:The Nanjing Pricing Reform basically achieved its desired goals of abolishing the drug-sales addition and the hospital compensation effect of 80% service +20% fiscal structure from service revenue and financial aid in average. However, the compensation differences among the hospitals are quite large with service-dependent hospitals compensated by over 400% and drug-dependent hospital less than 30%. However,for general hospitals,the compensation rated directly depended on the revenue structure before the reform and management performance and varied from 50% to 100%. The study at last gave its advices on improvement to further increase the service prices and establish a yearly-adjusted individualized compensation mechanism.