Amino acid formula as a new strategy for diagnosing cow’s milk allergy in infants: is it cost-effective?

Aims: To estimate the cost-effectiveness of a new strategy that uses an amino acid formula in the elimination diet of infants with suspected cow’s milk allergy (CMA).

Materials and methods: This pharmacoeconomic study was developed from the perspective of the Brazilian Public Healthcare System. The new strategy proposes using an amino acid formula in the diagnostic elimination diet of infants (≤24 months) with suspected CMA. The rationale is that infants who do not respond to the amino acid formula do not suffer from CMA. Patients with a positive oral challenge test receive a therapeutic elimination diet based on Brazilian Food Allergy Guidelines. This approach was compared to the current recommendations of the Brazilian Food Allergy Guidelines. A decision model was constructed using TreeAge Pro 2012 software. Model inputs were based on a literature review and the opinions of a panel of experts. A univariate sensitivity analysis of incremental cost-effectiveness ratios was performed.

Results: The mean cost per patient of the new amino acid formula strategy was R$3,341.57, while the cost of the current Brazilian guidelines strategy was R$3,641.08. The mean number of symptom-free days per patient, which was used as an indicator of effectiveness, was 900.6 and 875.7 days, respectively. The new strategy is, therefore, dominant. In the sensitivity analysis, the dominance was maintained with parameter variation.

Limitations: In the absence of information in the literature, some premises were defined by a panel of specialists.

Conclusions: The new strategy, which uses an amino acid formula in the elimination diagnostic diet followed by an oral food challenge, is a dominant pharmacoeconomic approach that has a lower cost and results in an increased number of symptom-free days.     

Employees' overestimation of functional and relational service quality: A gap analysis

This study extends previous research on gap analysis of service quality by including not only functional service quality but also relational benefits. To this end, a field study was carried out in 36 hotels and 35 restaurants. The samples consisted of 213 employees and 657 customers. A questionnaire format was used to measure both functional and relational service quality, as well as customers' loyalty. When comparing employee and customer perceptions, gaps potentially range from ‘overestimation’ (employees' perceptions are greater than customers' perceptions) to ‘underestimation’ (customers' perceptions are greater than employees' perceptions). In general, the results indicated that the employees surveyed overestimated the service quality they offer to customers, although gaps were greater for certain service attributes than for others. In addition, some gaps were more related to customer loyalty than others. The findings also showed that employees' overestimation of relational benefits plays a moderating role, increasing the negative relationship between employees' overestimation of functional service quality and customers' loyalty. The theoretical and managerial implications of the results are discussed further in this paper.     

Current account sustainability in Latin America

This paper examines the sustainability of the current account deficit in eighteen Latin American countries through the analysis of the stationarity properties of the current account balance. First, we apply traditional unit root tests and consider the possibility of structural breaks. Second, since the current account may have a nonlinear behaviour, we test for linearity in the data and analyse current account stationarity by means of a recently developed nonlinear unit root test. Results from linear and nonlinear unit root tests show that current account sustainability is supported for the majority of Latin American countries with the exception of Argentina, Brazil, Chile and Paraguay. For the Dominican Republic, Honduras, Mexico, Panama, Peru, Uruguay and Venezuela the current account dynamics are best described by a stationary linear model, and by a stationary linear model with a mean shift in years 2003, 1982 and 1980 in Bolivia, Costa Rica and Nicaragua, respectively. In the case of Colombia, Ecuador, El Salvador and Guatemala, results show that the current account is best described by a mean-reverting nonlinear process.     

Financing constraints,firm dynamics,export decisions,and aggregate productivity

We present a dynamic model in which firms accumulate wealth to avoid bankruptcy and to overcome financing constraints that affect their fixed operational costs and the costs of becoming an exporter. Financing constraints not only affect firms directly when they are binding, but also indirectly, through precautionary saving and the selection of firms via entry and exit of the domestic and export markets. We calibrate the model and test some of its predictions using a rich dataset of Italian manufacturing firms for the period 1995–2003. Financing constraints reduce the aggregate productivity gains induced by trade liberalization by 25 percent by distorting the incentives of the most productive firms to self-select into exporting.     

Environmental Management Systems and Local Community Perceptions: the Case of Petrochemical Complexes Located in Ports

Most oil refineries and factories producing basic chemical products are located in port areas, with the result that industrial complexes potentially have a strong environmental impact on their area of influence. These externalities result in a loss of welfare for citizens residing in neighbouring areas. In a context of sustainable development, companies must integrate concerns about the natural environment in their business strategy. External stakeholders, as residents, find it difficult to visualize the actions firms take to reduce their environmental impact, and the adoption of voluntary certified environmental management systems (EMSs) acts as a signal indicating the adequate environmental behaviour of these companies. These certifications enable companies to achieve the social legitimacy they need for long‐term survival and competitiveness. In the context of a petrochemical industrial complex located in the port of Castellón (Spain), this paper primarily discusses whether such certifications – which act as signals of firms’ desirable environmental conduct – translate into higher trust in firms and lower risk perception by residents. Contrary to what might be expected, despite the widespread use by companies of voluntary and certified EMSs, the research findings confirm a relatively high citizen perception of risk regarding the industrial complex and a low trust in companies. On the other hand, the findings also show a low trust in the public institutions responsible for authorizing and monitoring firms’ activities and for enforcing possible sanctions in non‐compliance cases. Copyright © 2013 John Wiley & Sons, Ltd and ERP Environment     

Firm size and productivity from occupational choices

Small Business Economics - We model the distributions of firm sizes and of firms’ total factor productivity (TFP) as outcomes of a market equilibrium from the occupational decisions of...     

Loving Outside the Neighborhood: The Conflicting Effects of External Linkages on Incremental Innovation in Clusters

The present study assesses the explanatory capacity of three levels of factors, namely, internal to the company, and internal and external to the cluster, in predicting firms' incremental innovative performance in cluster contexts. The empirical research conducted here focuses on a sample of 92 companies from the Spanish textile industrial cluster in Valencia. Findings reveal that the significant role played by firms' interorganizational ties as a moderating factor between absorptive capacity and their incremental innovative performance. Additionally, results reflect the differentiated roles developed by intra‐ and extra‐cluster linkages in these interaction processes.