Factors of Customer Loyalty in Pharmacy Retail: a Case from Bulgaria

Introduction: Pharmacy retail in Bulgaria has been a growing market in last few years. There are more pharmacies in big cities than in smaller towns and villages. There is a large competition between pharmacies in big cities and they offer many services to retain their customers.Materials and Methods: An empirical sociological research was conducted among 433 adult citizens in Varna, in February 2017, using a structured questionnaire. It was developed by the authors to explore the customers` preferences and attitudes when choosing a pharmacy.Results: The respondents were predominantly women (65%). They were divided into several age groups. According to the social status, working individuals prevailed (44%), followed by students (32%), entrepreneurs (10%) and retired people (10%). These demographic characteristics have key role in the determination of the factors of customer loyalty.Conclusion: According to this survey, customer loyalty to a particular pharmacy depends on the range of products it offers, low prices and competent and friendly personnel. The leading factors for customer loyalty are various and pharmacies must meet their expectations and challenges in this competitive market

Cost-effectiveness of specialist eating disorders services for children and adolescents with anorexia nervosa: a national surveillance study.

BACKGROUND: Evidence suggests specialist eating disorders services for children and adolescents with anorexia nervosa have the potential to improve outcomes and reduce costs through reduced hospital admissions. This study aimed to evaluate the cost-effectiveness of assessment and diagnosis in community-based specialist child and adolescent mental health services (CAMHS) compared to generic CAMHS for children and adolescents with anorexia nervosa. METHOD: Observational, surveillance study of children and adolescents aged 8 to 17, in contact with community-based CAMHS in the UK or Republic of Ireland for a first episode of anorexia nervosa. Data were reported by clinicians at baseline, 6 and 12-months follow-up. Outcomes included the Children's Global Assessment Scale (CGAS) and percentage of median expected body mass for age and sex (%mBMI). Service use data included paediatric and psychiatric inpatient admissions, outpatient and day-patient attendances. A joint distribution of incremental mean costs and effects for each group was generated using bootstrapping to explore the probability that each service is the optimal choice, subject to a range of values a decision-maker might be willing to pay for outcome improvements. Uncertainty was explored using cost-effectiveness acceptability curves. RESULTS: Two hundred ninety-eight children and adolescents met inclusion criteria. At 12-month follow-up, there were no significant differences in total costs or outcomes between specialist eating disorders services and generic CAMHS. However, adjustment for pre-specified baseline covariates resulted in observed differences favouring specialist services, due to significantly poorer clinical status of the specialist group at baseline. Cost-effectiveness analysis using CGAS suggests that the probability of assessment in a specialist service being cost-effective compared to generic CAMHS ranges from 90 to 50%, dependent on willingness to pay for improvements in outcome. CONCLUSIONS: Assessment in a specialist eating disorders service for children and adolescents with anorexia nervosa may have a higher probability of being cost-effective than assessment in generic CAMHS. TRIAL REGISTRATION: ISRCTN12676087 . Date of registration 07/01/2014

How gene tests travel: Bi-national comparison of the institutional pathways taken by diagnostic genetic testing for Maturity Onset Diabetes of the Young (MODY) through the British and the German health care system

Scientific developments in genetics receive great public and political attention. However, genetic tests as medical innovations need to travel from the laboratory to the individual patient in order to fulfil the goal that makes the science so attractive. A medical innovation has to pass through the institutions of diverse health care systems. This thesis compares how the structures of two very different health care systems in Europe (Germany and the UK) foster or hinder the diffusion of genetic technologies. It presents a detailed analysis of the institutional pathways involved in order to discuss whether and in which way the kind of medical innovation that genetic testing represents is accommodated. The case study used for analysing the passage of a genetic test in both countries is diagnostic testing for Maturity Onset Diabetes of the Young (MODY). This example has the idiosyncratic dimension that it had strong support by scientists and government when the UK Government prioritized genetics in health policy. However, MODY testing was chosen for this study because MODY is a ‘simple’ monogenetic test, and it is one of the few at present that are both reliable and lead to altered treatment with a better quality of life for the patient. MODY represents, according to the current state of genomic knowledge, a prime example of what genetics is likely to deliver at best over the coming decades. In brief, the comparison of the pathways MODY travelled and the degree to which it reached patients successfully shows that both systems are not optimally set up to exploit what MODY genetic testing has to offer, but that the vertical structure and centralization in the UK system fit the needs of genetic medical innovations better than the horizontal, diversified and market oriented structures dominating the German health care system.HuSS (University of Exeter), EGENIS (ESRC Centre), Foundation Brocher (Hermance, Geneva, Switzerland

How gene tests travel : bi-national comparison of the institutional pathways taken by diagnostic genetic testing for Maturity Onset Diabetes of the Young (MODY) through the British and the German health care system

Scientific developments in genetics receive great public and political attention. However, genetic tests as medical innovations need to travel from the laboratory to the individual patient in order to fulfil the goal that makes the science so attractive. A medical innovation has to pass through the institutions of diverse health care systems. This thesis compares how the structures of two very different health care systems in Europe (Germany and the UK) foster or hinder the diffusion of genetic technologies. It presents a detailed analysis of the institutional pathways involved in order to discuss whether and in which way the kind of medical innovation that genetic testing represents is accommodated. The case study used for analysing the passage of a genetic test in both countries is diagnostic testing for Maturity Onset Diabetes of the Young (MODY). This example has the idiosyncratic dimension that it had strong support by scientists and government when the UK Government prioritized genetics in health policy. However, MODY testing was chosen for this study because MODY is a ‘simple’ monogenetic test, and it is one of the few at present that are both reliable and lead to altered treatment with a better quality of life for the patient. MODY represents, according to the current state of genomic knowledge, a prime example of what genetics is likely to deliver at best over the coming decades. In brief, the comparison of the pathways MODY travelled and the degree to which it reached patients successfully shows that both systems are not optimally set up to exploit what MODY genetic testing has to offer, but that the vertical structure and centralization in the UK system fit the needs of genetic medical innovations better than the horizontal, diversified and market oriented structures dominating the German health care system.EThOS - Electronic Theses Online ServiceHuSS (University of Exeter) : EGENIS (ESRC Centre) : Foundation Brocher (Hermance, Geneva, Switzerland)GBUnited Kingdo

Analysis of the national ecosystem database of Bulgaria: (Mis)matches with the MAES framework

The mapping of ecosystems is a significant element in the European Biodiversity Strategy and the results of its implementation should support the maintenance and restoration of ecosystems and their services. The quality of the spatial data is of crucial importance for the achievement of these goals. A methodological framework for Bulgaria in the form of nine separate methodologies has been developed in recent years. In this paper, we analyze the ecosystem typology for Bulgaria and the GIS database to assess the possibilities to develop a common database for the needs of integrated water management. The data analyses were carried out in two dimensions: 1) the typology and attributive data were analyzed by cross-tabular approach; and 2) the spatial data were analyzed by topology rules.  The results of the study reveal three main problems of the typology: 1) for some types it is developed to the fourth level while for others it is to the third level; 2) in some of the ecosystem types, especially in the freshwater ecosystems, different categories are mixed within a single hierarchical level; 3: there are duplicated numerical designations between grassland and forest ecosystems. This necessitates a revision of the typology and the development of a correct uniform classification to be used for the needs of integrated assessment. The topology analyses of the merged data from the eight ecosystem GIS layers show extremely large numbers of gaps and overlaps. The main reason is the use of different sources for the mapping of different ecosystem types. The main conclusion is that it is practically impossible to generate topologically correct integrated GIS layers from the eight ecosystem type layers. Therefore, it is necessary to develop a new approach for mapping all ecosystem types into a uniform database

Palliative Care for Older People: Better Practices

Populations around the world are ageing, and more people are living with the effects of serious chronic illness towards the end of life. Meeting their needs presents a public health challenge. This publication aims to provide examples of better palliative care practices for older people to help those involved in planning and supporting care-oriented services most appropriately and effectively. Examples have been identi?ed from literature searches and from an international call for examples through various organizations, including the European Association of Palliative Care and the European Union Geriatric Medicine Society. Some examples consider how to improve aspects within the whole health system; speci?c smaller examples consider how to improve palliative care education, support in the community, in hospitals or for speci?c groups of people, such as people in nursing homes and people with dementia and their families. Some examples await rigorous evaluation of effectiveness, and more research is needed in this ? eld, especially the cost -- effectiveness and generalizability of these initiatives. This publication takes both an individual person and a health systems approach, focusing on examples from or relevant to the WHO European Region. The publication is intended for policy makers, decision-makers, planners and multidisciplinary professionals concerned with the care and quality of life of older people

Monitoring of water cycle in karst geosystems and its integration into ecosystem assessment framework

Karst is a widely spread natural phenomenon which provides essential benefits to human society, such as drinking water. The water cycle in the karst geosystems is the main factor for their formation and at the same time one of the main drivers for ecosystem services (ES) provision. The monitoring of the water cycle can provide valuable information regarding its functioning and ensure data for ES assessment. This paper aims to present an overview of the monitoring of the water cycle in the karst geosystems and the opportunities to integrate the monitoring data into the water regulation ES assessment. The monitoring of the water cycle is based on the methodological framework ProKARSTerra. It is applied in model karst geosystems, which are representative of the main karst types in Bulgaria. One of them is the Brestnitsa karst geosystem, which is the case study of this work. The monitoring ensures data for analyses of the water cycle which can be used in the assessment of water-related ecosystem services. The results from the analyses of the data requirements and availability show that some services such as water flow regulation and regulation of chemical condition of freshwaters can be easily provided through data for quantification, while for others further studies are needed. The results of the long-term integrated monitoring in Brestnitsa karst geosystem provide the foundation for important conclusions and models for the karst genesis and function under global changes and active anthropogenic pressure. Their integration into the assessment framework and mapping of ecosystem services is an essential step towards the development of models for sustainable use of natural resources in the karst areas

Lung Transplantation of a Patient with Pulmonary Hypertension

Introduction: Pulmonary hypertension is a condition that is characterised by increase in the blood pressure in the pulmonary artery above 25 mmHg at rest and above 30 mmHg during exercise. The disease has a poor prognosis and is fatal despite contemporary treatment.Materials and Methods: We present a case of a 36-year-old man, complaining of progressive dyspnea and dry irritating cough. At the age of 3, he had a surgical intervention for persistent ductus arteriosus. In 2011, he was diagnosed with paralysis of the left vocal fold and high-degree pulmonary arterial hypertension. A number of noninvasive and invasive tests, among which electrocardiography, echocardiography and chest CT scan with contrast, were performed.Results: The results from these tests revealed high pressure in the right ventricle and in the right atrium, severe tricuspid regurgitation, blood pressure of 80 mmHg in the pulmonary artery (above normal), 6 MWDT 316m and dyspnea that required breaks during the test. The final diagnosis was pulmonary arterial hypertension - group I, and targeted treatment with Tracleer and Revatio was started in addition to diuretic therapy. Anticoagulants were not included, because of recurrent episodes of hemoptoe. Despite the treatment, progression of the disease required further actions to be taken. Thus, in 2016 the patient was assessed as a suitable candidate for lung transplantation and the procedure was performed in Vienna. After the surgery, the quality of life and physical state of the patient improved.Conclusion: Early diagnosis and adequate treatment greatly improve the prognosis and the quality of life of patients with pulmonary arterial hypertension