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1.
Rev Saude Publica ; 53: 94, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31644724

RESUMO

OBJECTIVE: To evaluate trends in the use of generic and non-generic medicines to treat hypertension and diabetes under the Farmácia Popular Program (FP) and its impact on generic medicines sales volume and market share in the Brazilian pharmaceutical market. METHODS: This longitudinal, retrospective study used interrupted time series design to analyze changes in monthly sales volume and proportion of medicines sales (market share) for oral antidiabetic and antihypertensive medicines for generic versus non-generic products. Analyses were conducted in a combined dataset that aggregate monthly sales volumes from the Farmácia Popular program and from the QuintilesIMS™ (IQVIA) national market sales data from January 2007 to December 2012. The Farmácia Popular program phases analyzed included: a) 2009 reductions in medicines reference prices (AFP-II) and b) 2011 implementation of free medicines program for hypertension and diabetes, the Saúde não tem preço (SNTP - Health has no price). RESULTS: Patterns of use for FP-covered antidiabetic and antihypertensive medicines were similar to their use in the market in general. After one year of the decreases in government subsidies in April 2010, market share of antidiabetic and antihypertensive medicines experienced relative declines of -54.5% and -59.9%, respectively. However, when FP-covered medicines were made free to patients, overall market volume for antidiabetic and antihypertensive generics increased dramatically, with 242.6% and 277.0% relative increases by February 2012, as well as non-generics with relative increase of 209.7% and 279% for antidiabetic and antihypertensive medicines, respectively. CONCLUSIONS: Ministry of Health policies on the amount of patient cost sharing and on the choice of medicines on coverage lists have substantial impacts on overall generic sales volume in retail pharmacies.


Assuntos
Anti-Hipertensivos/uso terapêutico , Comércio/tendências , Serviços Comunitários de Farmácia/tendências , Medicamentos Genéricos/uso terapêutico , Hipoglicemiantes/uso terapêutico , Programas Nacionais de Saúde/tendências , Brasil , Comércio/estatística & dados numéricos , Serviços Comunitários de Farmácia/estatística & dados numéricos , Diabetes Mellitus/tratamento farmacológico , Política de Saúde , Humanos , Hipertensão/tratamento farmacológico , Análise de Séries Temporais Interrompida , Estudos Longitudinais , Programas Nacionais de Saúde/estatística & dados numéricos , Farmácias/estatística & dados numéricos , Farmácias/tendências , Avaliação de Programas e Projetos de Saúde , Valores de Referência , Estudos Retrospectivos , Fatores de Tempo
3.
Environ Sci Pollut Res Int ; 26(29): 29978-29990, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31414388

RESUMO

The developing world in general is facing so many crucial problems including global warming in recent years. Global warming has multiple consequences on each segment of the society and therefore, its root causes are important to identify. The present study examines the impact of per capita income, trade openness, urbanization, and energy consumption on CO2 emissions. Countries located in South Asian Association for Regional Cooperation (SAARC) are considered in the study. The selection of the SAARC region is motivated by the diverse nature of its members and further lack of available empirical literature on the same relationship. Annual data from 1980 to 2016 are analyzed using appropriate panel data techniques. The results revealed the presence of environmental Kuznets curve (EKC) in the SAARC region. Further, the introduction of cubic function into the model indicated that the shape of the EKC is N shaped. Besides, trade openness has negative while urbanization and energy consumption have impacted CO2 emissions positively. Moreover, the causality exercise explored a bidirectional causality between urbanization, energy consumption, per capita income, and CO2 emissions. Similarly, energy consumption, per capita GDP, and urbanization are also bidirectionally related. Further, a unidirectional causality running from CO2 emissions, urbanization, and energy consumption to trade openness is detected. Lastly, a unidirectional causality is witnessed from per capita income to energy consumption.


Assuntos
Dióxido de Carbono/análise , Comércio/economia , Conservação de Recursos Energéticos/economia , Desenvolvimento Econômico , Renda , Urbanização/tendências , Ásia , Comércio/tendências , Conservação de Recursos Energéticos/tendências , Desenvolvimento Econômico/tendências , Pesquisa Empírica , Humanos , Renda/tendências , Modelos Teóricos
4.
Nutrients ; 11(8)2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31374858

RESUMO

Fish and seafood consumption in Australia has been growing, yet the implications of this trend across the food system, from both a health and sustainability perspective have not been fully explored. This paper aims to map out the fish and seafood food system in Australia, linking production and consumption, to articulate challenges and opportunities for enhancing the sector's contribution to future healthy and sustainable diets. We conducted a secondary analysis of publicly available datasets on fish and seafood production and consumption, triangulated and supplemented with peer-reviewed and grey literature on environmental, economic and social sustainability issues throughout the food system. A key challenge for health is the high proportion of fish and seafood consumed as discretionary food, particularly among children. Key challenges for sustainability include the narrow focus on environmental sustainability (with little consideration of the other domains), and the focus on production with little consideration for sustainability throughout post-harvest handling, processing, retail, distribution and consumption. Key opportunities for health and sustainability include the innovative use of processing and packaging technology to maximise nutritional quality; creation of markets and supply chains for a greater diversity of underutilised fish and seafood species and processing by-products; and reductions in waste and loss throughout the entire supply chain.


Assuntos
Comércio/tendências , Conservação dos Recursos Naturais/tendências , Peixes , Manipulação de Alimentos , Abastecimento de Alimentos , Indústria de Processamento de Alimentos/tendências , Alimentos Marinhos/provisão & distribução , Animais , Austrália , Comportamento do Consumidor , Bases de Dados Factuais , Comportamento Alimentar , Humanos , Valor Nutritivo
7.
Nutrients ; 11(6)2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31200513

RESUMO

BACKGROUND: The role of processed foods in nutrition transition in the Pacific is receiving some attention in the context of a significant obesity and diet-related noncommunicable disease health burden. However, trends, patterns and underlying drivers of processed food markets in the Pacific are not well understood. The aim of this study was to investigate recent trends and patterns of processed food markets in the region and interpret the findings by engaging key literature on relevant food systems drivers. METHODS: We conducted a mixed-methods approach involving two steps; (1) We analysed Euromonitor market sales data for processed food and beverage products sold from 2004-2018 for 16 countries differentiated by income level, and (2) guided by a food systems conceptual framework, we drew upon key literature to understand the likely drivers of our observations. RESULTS: We observed plateaus and declines in processed food sales in some high-income countries but increases in upper-middle and lower-middle income countries, and most rapidly in the latter. Beverage markets appear to be stagnating across all income groups. Carbonated soft drinks, baked goods, vegetable oils, processed meats, noodles and sweet biscuits made up the majority of sales in transitioning countries. These observations are likely a result of income growth, urbanising populations, trade and globalisation, and various policies implemented by Pacific governments. CONCLUSIONS: A processed foods nutrition transition is well underway in the Pacific region and accelerating most prominently in lower-middle income countries.


Assuntos
Bebidas/provisão & distribução , Comércio/tendências , Fast Foods/provisão & distribução , Manipulação de Alimentos , Abastecimento de Alimentos/estatística & dados numéricos , Dieta/efeitos adversos , Dieta/estatística & dados numéricos , Humanos , Obesidade/epidemiologia , Obesidade/etiologia , Ilhas do Pacífico/epidemiologia
8.
Jpn J Infect Dis ; 72(5): 326-329, 2019 Sep 19.
Artigo em Inglês | MEDLINE | ID: mdl-31061356

RESUMO

The National Action Plan on Antimicrobial Resistance in Japan aims to achieve a 50% reduction in the use of broad-spectrum oral antimicrobials (cephalosporins, macrolides, and quinolones) from 2013 to 2020. Based on the national sales data for antimicrobials, we estimated the regional antimicrobial use (AMU) from 2013-2016 and evaluated the differences in the use of broad-spectrum oral antimicrobials among three regions in which differences had been identified previously. The AMU was standardized based on the defined daily dose (DDD) and described as the DDDs/1,000 inhabitants/day (DID). Annual combined total oral and parenteral AMU during 2013-2016 was 14.9, 14.5, 14.7, and 14.6 DID, respectively. The change in mean ± standard deviation in the total AMU at the prefectural level was - 0.2 ± 0.8 DID. Among the 47 prefectures, decreasing trends were observed in 34, while in the remaining 13 prefectures increasing trends were recorded. In 2016, no significant differences in the mean usage of oral cephalosporins among the three regions were observed. The mean usage of oral macrolides in the eastern (4.1 DID) was significantly lower than that in the central region (4.7 DID) (p = 0.009) and the western (4.8 DID) (p = 0.002). The mean usage of oral quinolones in the western (3.2 DID) was significantly higher than that in the eastern (2.3 DID) (p < 0.001) and central (2.7 DID) (p = 0.001) regions. To determine appropriate targets for the implementation of antimicrobial stewardship for reducting the use of broad-spectrum oral antimicrobials, further studies are required to identify the reasons underlying these differences.


Assuntos
Antibacterianos/uso terapêutico , Comércio/estatística & dados numéricos , Uso de Medicamentos/estatística & dados numéricos , Comércio/tendências , Uso de Medicamentos/tendências , Humanos , Japão
9.
PLoS One ; 14(4): e0215032, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30978225

RESUMO

This paper provides a general equilibrium approach to pricing volatility. Existing models (e.g., ARCH/GARCH, stochastic volatility) take a statistical approach to estimating volatility, volatility indices (e.g., CBOE VIX) use a weighted combination of options, and utility based models assume a specific type of preferences. In contrast we treat volatility as an asset and price it using the general equilibrium state pricing framework. Our results show that the general equilibrium volatility method developed in this paper provides superior forecasting ability for realized volatility and serves as an effective fear gauge. We demonstrate the flexibility and generality of our approach by pricing downside risk and upside opportunity. Finally, we show that the superior forecasting ability of our approach generates significant economic value through volatility timing.


Assuntos
Comércio/tendências , Custos e Análise de Custo/economia , Administração Financeira/normas , Investimentos em Saúde/economia , Modelos Econômicos , Tomada de Decisões , Administração Financeira/métodos , Humanos
10.
Artigo em Inglês | MEDLINE | ID: mdl-30823400

RESUMO

BACKGROUND: E-cigarettes are purchased through multiple channels, including general retail, online, and specialty smoke and vape shops. We examine how e-cigarette users' primary purchase place relates to e-cigarette use and smoking cessation behaviors. METHODS: Probability-based samples of the U.S. population who were current e-cigarette users were surveyed in 2014 (N = 879) and 2016 (N = 743), with responses combined for most analyses. E-cigarette use and smoking cessation behaviors were compared across users' primary purchase place. RESULTS: Higher percentages of vape shop (59.1%) and internet (42.9%) customers were current daily users of e-cigarettes compared to retail (19.7%) and smoke shop (23.2%) customers (p-values < 0.001). Higher percentages of vape shop (40.2%) and internet (35.1%) customers were also former smokers, compared to 17.7% of retail and 19.3% of smoke shop customers (p's < 0.001). Among those smoking 12 months prior to survey, smoking cessation rates were higher for vape shop (22.2%) and internet customers (22.5%) than for retail customers (10.7%, p = 0.010 and p = 0.022, respectively), even though retail customers were more likely to use FDA-approved smoking cessation aids. The percentage of customers purchasing from vape shops increased from 20.4% in 2014 to 37.6% in 2016, surpassing general retail (27.7%) as the most likely channel in 2016. CONCLUSIONS: E-cigarette customers differed in significant ways by channels of purchase, most notably in their smoking cessation behaviors. Previous population studies have relied mostly on retail channel data, which accounted for less than 30% of all products sold by 2016. Future studies of e-cigarette use should consider a broader set of channels.


Assuntos
Comércio/estatística & dados numéricos , Fumantes/estatística & dados numéricos , Abandono do Hábito de Fumar/estatística & dados numéricos , Vaping/epidemiologia , Adulto , Comércio/tendências , Feminino , Humanos , Masculino , Fumar/epidemiologia , Abandono do Hábito de Fumar/métodos , Inquéritos e Questionários , Produtos do Tabaco , Fumar Tabaco , Vaping/tendências
11.
PLoS One ; 14(2): e0211199, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30730913

RESUMO

Consumer spending on organic food products has grown rapidly. Some claim that organics have ecological, equity, and health advantages over conventional food and therefore should be subsidized. Here we explore the distributive impacts of an organic fruit subsidy that reduces the retail price of organic fruit in the US by 10 percent. We estimate the impact of the subsidy on organic fruit demand in a representative poor, middle income, and rich US household using three analytical methods; including two econometric and one machine learning. We do not find strong evidence of regressive redistribution due to our simulated organic fruit subsidy; the poor household's relative reaction to the subsidy is not much different than the reaction at the other two households. However, the infra-marginal savings from the subsidy tend to be larger in richer households.


Assuntos
Alimentos Orgânicos/economia , Frutas/economia , Agricultura Orgânica/economia , Comércio/economia , Comércio/estatística & dados numéricos , Comércio/tendências , Simulação por Computador , Comportamento do Consumidor/economia , Comportamento do Consumidor/estatística & dados numéricos , Financiamento Governamental/economia , Financiamento Governamental/estatística & dados numéricos , Alimentos Orgânicos/estatística & dados numéricos , Humanos , Renda/estatística & dados numéricos , Aprendizado de Máquina , Agricultura Orgânica/estatística & dados numéricos , Agricultura Orgânica/tendências , Estados Unidos
12.
Am J Public Health ; 109(4): 637-639, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30789776

RESUMO

OBJECTIVES: To estimate changes in sugar-sweetened beverage (SSB) and water consumption 3 years after an SSB tax in Berkeley, California, relative to unexposed comparison neighborhoods. METHODS: Data came from repeated annual cross-sectional beverage frequency questionnaires from 2014 to 2017 in demographically diverse Berkeley (n = 1513) and comparison (San Francisco and Oakland; n = 3712) neighborhoods. Pretax consumption (2014) was compared with a weighted average of 3 years of posttax consumption. RESULTS: At baseline, SSBs were consumed 1.25 times per day (95% confidence interval [CI] = 1.00, 1.50) in Berkeley and 1.27 times per day (95% CI = 1.13, 1.42) in comparison city neighborhoods. When we adjusted for covariates, consumption in Berkeley declined by 0.55 times per day (95% CI = -0.75, -0.35) for SSBs and increased by 1.02 times per day (95% CI = 0.54, 1.50) for water. Changes in consumption in Berkeley were significantly different from those in the comparison group, which saw no significant changes. CONCLUSIONS: Reductions in SSB consumption were sustained in demographically diverse Berkeley neighborhoods over the first 3 years of an SSB tax, relative to comparison cities. These persistent, longer-term reductions in SSB consumption suggest that SSB taxes are an effective policy option for jurisdictions focused on improving public health.


Assuntos
Bebidas/economia , Bebidas/estatística & dados numéricos , Comércio/economia , Edulcorantes/efeitos adversos , Impostos , California , Comércio/tendências , Estudos Transversais , Água Potável , Feminino , Humanos , Masculino , Inquéritos e Questionários
13.
Int J Public Health ; 64(3): 423-430, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30683951

RESUMO

OBJECTIVES: The use of roll-your-own (RYO) cigarette has substantially increased in most high-income countries recently. This work aims to update Italian trends on loose tobacco sales and to describe the consumer profile of predominant RYO users. METHODS: Data from the Italian Agency of Customs and State Monopolies and from PASSI (Italian behavioral risk factor surveillance system) were used. Information on 16,858 interviews to current smokers aged 18-69 was analyzed. RESULTS: Sales of loose tobacco increased more than sevenfold between 2004 and 2017. In 2015-2016, 11.6% of smokers reported smoking predominantly RYO cigarettes, with higher percentages among the youngest where a significant association between use of RYO and education was observed, unlike what happened in older adults. The association between economic difficulties and use of RYO was observed only in older adults. CONCLUSIONS: A growing trend in RYO cigarette sales was registered between 2004 and 2017. In young smokers, the greater use of RYO was observed among the most educated regardless of financial strain, while in older ones among those with economic difficulties.


Assuntos
Comércio/economia , Comércio/estatística & dados numéricos , Produtos do Tabaco/economia , Produtos do Tabaco/estatística & dados numéricos , Fumar Tabaco/economia , Fumar Tabaco/tendências , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Comércio/tendências , Feminino , Previsões , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Adulto Jovem
14.
Eur J Orthop Surg Traumatol ; 29(4): 759-766, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30627923

RESUMO

Orthopaedic surgeons often require highly specialized medical devices, implants, and equipment, which are usually offered by several vendors/companies. This study assesses long-term market trends for orthopaedic medical device companies and examines various implications for healthcare cost. Using S&P Capital IQ, a Wall Street database, financial data were gathered on orthopaedic device companies, ranked by worldwide sales, from 1999 to 2015. Annual sales were aggregated to calculate market share and compounded annual growth rates (CAGRs). Overall, the global orthopaedic device market grew at 12.0% CAGR from 1999 to 2008, before slowing to 2.8% from 2009 to 2015. Between 1999 and 2015, the top 5 companies increased total market share from 52.8 to 62.2%. The orthopaedic device market is not only consolidating under a few dominant players, but also growing at a decreasing rate, both of which signal a maturing industry. These trends are likely to shape patient care and healthcare costs in orthopaedic surgery in years to come.


Assuntos
Comércio/tendências , Indústrias/tendências , Equipamentos Ortopédicos/tendências , Comércio/economia , Humanos , Indústrias/economia , Ortopedia
15.
Tob Control ; 28(Suppl 1): s20-s30, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-29674513

RESUMO

BACKGROUND: The price of tobacco products in relation to the income of tobacco users-affordability-is recognised as a key determinant of tobacco use behaviour. The effectiveness of a price increase as a deterrent to tobacco use depends on how much price increases in relation to the income of the potential users. The aim of this paper is to examine the distribution of and trends in the affordability of tobacco products in Bangladesh. METHOD: Using four waves of International Tobacco Control Survey data on Bangladesh, this study measures affordability of tobacco products at the individual level as the ratio of self-reported price and self-reported income. The trends in affordability by brand categories of cigarettes and of bidi and smokeless tobacco are estimated using multivariate linear regression analysis. RESULTS: Despite significant increase in price, the affordability of cigarettes increased between 2009 and 2014-2015 due to income growth outpacing price increase. The increase was disproportionately larger for more expensive brands. The affordability of bidis increased over this period as well. The affordability of smokeless tobacco products remained unchanged between 2011-2012 and 2014-2015. CONCLUSION: The tax increases that were implemented during 2009-2015 were not enough to increase tobacco product prices sufficiently to outweigh the effect of income growth, and to reduce tobacco consumption. The findings from this research inform policymakers that in countries experiencing rapid economic growth, significant tax increases are needed to counteract the effect of income growth, in order for the tax increases to be effective in reducing tobacco use.


Assuntos
Comércio/tendências , Custos e Análise de Custo/tendências , Renda/tendências , Produtos do Tabaco/economia , Adolescente , Adulto , Bangladesh , Comércio/estatística & dados numéricos , Custos e Análise de Custo/estatística & dados numéricos , Estudos Transversais , Feminino , Humanos , Renda/estatística & dados numéricos , Masculino , Fatores Socioeconômicos , Adulto Jovem
16.
Tob Control ; 28(2): 146-151, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-29853561

RESUMO

BACKGROUND: While national surveys showed declines in e-cigarette use in the USA between 2015 and 2016, recent reports indicate that JUUL, a sleekly designed e-cigarette that looks like a USB drive, is increasingly being used by youth and young adults. However, the extent of JUUL's growth and its marketing strategy have not been systematically examined. METHODS: A variety of data sources were used to examine JUUL retail sales in the USA and its marketing and promotion. Retail store scanner data were used to capture the retail sales of JUUL and other major e-cigarette brands for the period 2011-2017. A list of JUUL-related keywords was used to identify JUUL-related tweets on Twitter; to identify JUUL-related posts, hashtags and accounts on Instagram and to identify JUUL-related videos on YouTube. RESULTS: In the short 3-year period 2015-2017, JUUL has transformed from a little-known brand with minimum sales into the largest retail e-cigarette brand in the USA, lifting sales of the entire e-cigarette category. Its US$150 million retail sales in the last quarter of 2017 accounted for about 40% of e-cigarette retail market share. While marketing expenditures for JUUL were moderate, the sales growth of JUUL was accompanied by a variety of innovative, engaging and wide-reaching campaigns on Twitter, Instagram and YouTube, conducted by JUUL and its affiliated marketers. CONCLUSIONS: The discrepancies between e-cigarette sales data and the prevalence of e-cigarette use from surveys highlight the challenges in tracking and understanding the use of new and emerging tobacco products. In a rapidly changing media environment, where successful and influential marketing campaigns can be conducted on social media at little cost, marketing expenditures alone may not fully capture the influence, reach and engagement of tobacco marketing.


Assuntos
Comércio/estatística & dados numéricos , Sistemas Eletrônicos de Liberação de Nicotina/economia , Marketing/economia , Marketing/estatística & dados numéricos , Vaping/economia , Comércio/tendências , Humanos , Mídias Sociais/estatística & dados numéricos , Mídias Sociais/tendências , Estados Unidos
17.
Nicotine Tob Res ; 21(4): 475-480, 2019 03 30.
Artigo em Inglês | MEDLINE | ID: mdl-29394419

RESUMO

INTRODUCTION: Tobacco price increases can generate increased public interest in smoking cessation, but it is not clear how long this interest lasts. Our objective was to evaluate the duration of the impact of cigarette price increase in Japan using Google search data. METHODS: Monthly or daily aggregated Google search volume for smoking cessation in Japan from 2004 to 2016 was collected in terms of relative search volume (RSV) ranging from 0 to 100. Using monthly RSV data, we evaluated possible relationships between the RSVs and tobacco control measures in Japan. Time periods within which the impact of search volume significantly increased were identified by cluster detection test, using daily RSV data. A spike in RSV preceding the enforcement of a cigarette price increase revealed an anticipation effect. RESULTS: Between 2004 and 2016, the three highest monthly RSV spikes were observed in July 2006 (RSV = 66), when cigarette prices increased by 11%, and in September (RSV = 90) and October 2010 (RSV = 100), when cigarette prices increased by 37%. Regarding daily RSV, the detected cluster size around the price increase in 2010 (52 days) was longer than that in 2006 (17 days). In 2010, a cluster period of 25 days before the date of the price increase was observed, suggesting an anticipation effect. After the onset of the price increase, a cluster of 27 days was detected. When the cigarette price increased due to consumption tax in April 2014, almost no anticipation effect was observed. CONCLUSIONS: The population impact of tobacco price increases on smoking cessation may be assessed using Google Trends data. The cluster indicates that a higher cigarette price increase had a higher and longer lasting effect on population interest in cessation, but the impact may continue for a relatively short time. IMPLICATIONS: To examine the duration of the impact of cigarette price increases on population interest in smoking cessation in Japan, Google search data for smoking cessation were analyzed. Between 2004 and 2016, the three highest spikes of monthly RSV were observed in October 2010, when cigarette prices increased by 37%. Analyzing daily RSV data, the detected cluster size around the price increase in 2010 was 52 days, and a cluster period of 25 days before the date of the price increase was observed, suggesting an anticipation effect. The cluster indicates that a higher cigarette price increase had a higher and longer lasting effect, but the population impact continues for a relatively short time. Further increases in the price of cigarettes are necessary.


Assuntos
Comércio/economia , Comércio/tendências , Internet/economia , Internet/tendências , Abandono do Hábito de Fumar/economia , Produtos do Tabaco/economia , Adulto , Fumar Cigarros/economia , Fumar Cigarros/psicologia , Fumar Cigarros/tendências , Coleta de Dados/tendências , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Japão/epidemiologia , Masculino , Abandono do Hábito de Fumar/psicologia , Impostos/tendências , Indústria do Tabaco
18.
J Ethnopharmacol ; 229: 205-214, 2019 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-30339980

RESUMO

ETHNOPHARMACOLOGICAL RELEVANCE: Worldwide, one of the drivers of substitution and adulteration is the cost of the natural resources (plants, animals, fungi) that are ingredients of traditional medicines. Relatively few studies have been done that link prices of traditional medicine ingredients to what drives changes in price, yet this is an important topic. Theoretically, prices have been widely considered as an economic indicator of resource scarcity. Rare, slow growing medicinal plants sell for high prices and common, less popular species for low prices. Price levels also influence the viability of farming vs. wild harvest (and incentives to overharvest high value species when tenure is weak). Prices can also influence the harvesting or buying behaviour of harvesters, traders or manufacturers. When prices are high, then there is a greater incentive to use cheaper substitute species or adulterants. As previous studies on herbal medicine ingredients have shown, adulteration applies in a wide variety of cases, including to some Traditional Chinese Medicine (TCM) species. AIM OF THE STUDY: The aim of this study was to gain a better understanding of which factors influenced changes in the market prices of document prices for four popular, but very different traditional Chinese medicine (TCM) species (2002 - 2017). MATERIALS AND METHODS: Fluctuations in market prices were followed over a 15-year period (2002-2017) for four very different TCM ingredients: two plant species (one wild harvested for fruits (Schisandra sphenanthera Rehder & E.H. Wilson) the other in a transition from wild harvest to cultivation (Paris polyphylla Smith), an animal species (the Tokay gecko (Gekko gecko L.)) and the entomophagous "caterpillar fungus" (Ophiocordyceps sinensis (Berk). G.H. Sung, J.M. Sung, Hywel-Jones & Spatafora). RESULTS: High prices of medicinal plants are widely considered to reflect resource scarcity. Real-time market prices for three of the four very different TCM species we studied all showed major price fluctuations. The exception was P. polyphylla, whose wild populations are widely known to be increasingly scarce, where there was a steady increase in price, with few fluctuations in the upward price trend. The three other species showed significant price fluctuations. These were driven by multiple factors. Ecological and biogeographic factors that influence abundance or scarcity of supply certainly played a role. But other factors were also influential. These included both national and global economic factors (the influence of the Global Financial Crisis (GFC)), national policy changes that in turn influenced businessmen giving expensive gifts (that included O. sinensis)), climate change (influencing fruiting success of S. sphenanthera), price speculation by traders and lack of information (e.g: reduction in G. gecko prices due to traders incorrectly believing that domestication would increase supplies). CONCLUSIONS: Price fluctuations in the four TCM species we examined are influenced by many factors and not just resource scarcity. And the situation is more complex than the trajectory based on Homma's (1992) model, where he predicted that higher prices would result in a shift to cultivation, thus replacing wild harvest. In case of both O. sinensis and P. polyphylla, Homma (1992, 1996) was right in terms of scarcity and high prices stimulating a major investment in cultivation (P. polyphylla) and artificial production (O. sinensis). But in both cases, intensive production through cultivation or artificial propagation do not yet occur on a large enough scale to reduce harvest of wild stocks. Substitution and adulteration occur with all four species. Improving information to medicinal plant traders on the supply status of TCM stocks, whether from wild harvest or from cultivation could benefit product quality, cultivation initiatives and conservation efforts.


Assuntos
Comércio/tendências , Medicina Tradicional Chinesa/economia , Recursos Naturais/provisão & distribução , Animais , Plantas Medicinais
19.
Tob Control ; 28(2): 176-180, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-29875154

RESUMO

BACKGROUND: Flavoured tobacco is increasingly popular with youth. The twin cities of Minneapolis and Saint Paul, Minnesota restricted the sale of flavoured tobacco to adult-only tobacco shops in an effort to reduce youth access and exposure to these products. This observational study explores the impact of these policies on the retail environment. METHODS: Between November 2015 and April 2017, observational assessments were conducted at convenience and grocery stores preimplementation and postimplementation of flavoured tobacco restrictions in Minneapolis (n=41), Saint Paul (n=37) and the comparison city of Brooklyn Park, Minnesota (n=14). RESULTS: After policy implementation, significantly fewer of the convenience and grocery stores sold flavoured tobacco in Minneapolis (85.4% vs 39.0%, p<0.001, n=41) and Saint Paul (97.3% vs 8.1%, p<0.001, n=37). The average proportion of tobacco inventory that was unflavoured increased significantly in Minneapolis (42.9%±2.7% vs 56.7%±3.1%, p=0.002) and Saint Paul (40.8%±2.5% vs 70.3%±1.9%, p<0.001). Flavoured tobacco was available at significantly fewer convenience and grocery stores in Minneapolis (39.0%, p<0.001) and Saint Paul (8.1%, p<0.001) than in the comparison city of Brooklyn Park (100%, n=14). Most retailers complied with these policies by removing flavoured tobacco from their shelves. CONCLUSIONS: Policies that restrict the sale of flavoured tobacco to adult-only tobacco shops are associated with decreased availability of flavoured tobacco in convenience and grocery stores and increased proportion of tobacco inventory that is unflavoured.


Assuntos
Comércio/estatística & dados numéricos , Aromatizantes , Políticas , Produtos do Tabaco/economia , Fatores Etários , Cidades/estatística & dados numéricos , Comércio/tendências , Humanos , Minnesota
20.
J Am Acad Dermatol ; 80(5): 1353-1357, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-29544742

RESUMO

BACKGROUND: There is limited data regarding generic medication prices. Recent studies have shown price changes at the retail level, but much is not known about the pharmaceutical supply chain or price changes at the manufacturer level. OBJECTIVE: We sought to examine the extent of price changes for topical generic medications. METHODS: A comprehensive review of average wholesale prices (AWPs) and manufacturers of topical generics and available corresponding branded medications was conducted for 2005 and 2016. RESULTS: A total of 51 topical chemical entities were examined. Between 2005 and 2016, the AWP of topical generic medications increased by 273% and the AWP of topical branded medications increased by 379%. The topical generic with the greatest price change increased by 2529%. Eight of the top 20 topical generic medications with the greatest increases in AWP also had an increase in the number of manufacturers. LIMITATIONS: These findings are not generalizable to medications used in other areas of medicine. CONCLUSION: Topical generic prices are rapidly increasing at the manufacturer level.


Assuntos
Comércio/tendências , Fármacos Dermatológicos/economia , Custos de Medicamentos/tendências , Indústria Farmacêutica/tendências , Medicamentos Genéricos/economia , Administração Tópica , Custos e Análise de Custo , Fármacos Dermatológicos/administração & dosagem
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