| 6. |
- Aabrekk, S., et al.
(author)
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Deliverable 2.2 Possible market strategies for one stop shops of renovation of single family house. : Report prepared for Nordic Innovation Centre
- 2012
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Reports (other academic/artistic)abstract
- The document describes examples of missions, visions and strategies based on the potentialpiloting models defined in report 3.2. It is based on status of interest amongst thestakeholders, and the information, figures and challenges which were discussed in the reportD 2.1 Stakeholder interests. The different service models will request different missionsdepending on the stakeholder in charge of the model. Also visions and strategies could bedifferent depending on the composition of services (core business) offered within each pilot aswell as the additional services offered by sub suppliers and the network connected to the pilot.In the report D2.1 Stakeholders interests, the following 5 different piloting models aresuggested:Type 1 Joint venture of industry, retailers and contractorsType 2 Joint venture of construction/renovation, industry and architect/engineering companiesType 3 Complementary businesses expand their business into renovationType 4 Joint venture of type house producer, bank and home owner associationType 5 Energy/building consultant, real estate agent and financing institutions, e.g. bankIn this report we have described mission, vision and market strategies for 4 existing orproposed models; The Project Manager by Bolig Enøk, from Norway (type 1), ENRA concept(type 2) and K-Rauta & Rautia (type 3) from Finland, and ProjectLavenergi (type 2) fromDenmark. Cleantech by Dong Energy (type 3) from Denmark is also addressed, but notdescribed in detail. As there is no concrete examples representing two of the models fromD2.1 (types 4 and 5), we have made a theoretical exercise in developing mission, vision andmarket strategies for type 5 model, while type 4 is not handled.It may be concluded that there are commercial actors in different parts of the value chainwhich see an opportunity in developing different approaches of “one stop shops” for energyefficient holistic renovations. The concepts are still in a development phase and differ inrespect to how they are organised (as supply side). We may say that the pilots in the differentcountries also find inspiration from each other through this research project. Due to thecomplexity of a holistic renovation project, it is a prerequisite with good partnerships even inthe development phase. In all identified models there is however one main actor taking thelead and ownership to the business model.Independent of the business model the responsible company needs to make some strategicchoices. The starting point is the SWOT analysis which sums up all major challenges for therespective business model. How the strategies should be developed is described in this report.Although the main target group for this report is companies seeing an interest in developingbusiness models for renovation, we found some important issues identified in the SWOTanalysis which the authorities may influence including lack of interest in the market (need ofmore public attention through holistic campaigns), fragmented solutions (stop subsidisingsingle measures without a holistic plan), serious vs unserious companies (need of certificationsystems to build credibility), cost focus leads to limited renovation (need of subventionschemes for holistic retrofitting including tax deduction measures) and finally lack incompetence within companies (need of support to training and collaboration acrosscompanies).
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| 9. |
- Abbasi, Seyed
(author)
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Determinants of social inequalities in cardiovascular disease among Iranian patients
- 2018
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Doctoral thesis (other academic/artistic)abstract
- Background and objectives: Cardiovascular disease (CVD) is the single largest cause of mortality in the world. Similar to other health issues, CVD is generally affected either by individual risk factors, which may influence the risk for developing an illness or its complications, or by social indicators (social determinants of health). There is evidence from developed countries which shows that the so-called "upstream factors"—including social determinants such as political, social, spiritual, cultural, and economic factors—may affect the prevalence and incidence of CVD. Scarce evidence from studies in low- and middle-income countries also suggests that social factors may affect the distribution of CVD across population groups. However, there is a dearth of such data in Iran, where only a few small-sizedstudies have focused on the social determinants of health. Therefore, the present thesis sought to fill this gap by assessing the effects of socioeconomic status (SES) on the distribution of CVD and the relevant inequalities within the Iranian context.Methods: This thesis is based on four studies, which used data from the Tehran Heart Center’s Databases. In Study I, a total of 44,820 patients who underwent coronary angiography at Tehran Heart Center between 2005 and 2010 were recruited. Then, their pre- and post-procedural data—including demographics, CVD risk factors, symptoms, and laboratory tests—were compared between men and women. In Study II, 6,246 patients with acutecoronary syndrome who were hospitalized between March 2004 and August 2011 were included and, based on their education and their employment status, were divided into high- and low-SES groups. Thereafter, the effect of SES on the in-hospital death of the patients was evaluated. In Study III, 20,165 patients with documented coronary artery disease who underwent coronary angiography at Tehran Heart Center were enrolled and CVD risk factors and severity (measured by the Gensini score) were assessed among the six major Iranian ethnic groups. In Study IV, 9,088 patients with acute coronary syndrome who were hospitalized at Tehran Heart Center between May 2007and June 2014 were recruited and the association between in-hospital death due to acute coronary syndrome and place of residence (rural/urban) was assessed using logistic regression adjusted for potential confounders.Results: In this thesis, the data analyses were based on the hypothesis that there is a potential association between the different socioeconomic indicators and the selected cardiovascular outcomes. In Study I, among the recruited participant, 25,363 men and 11,995 women had coronary artery disease and the women not only were significantly older, less educated, and more overweight but also had higher blood levels of triglyceride, cholesterol, low-density lipoprotein, high-density lipoprotein, and fasting blood sugar than the men. Moreover, hypertension and diabetes mellitus showed the strongest association in the women with coronary artery disease (OR=3.45, 95% CI: 3.28to 3.61 and OR=2.37, 95% CI: 2.26 to 2.48, respectively). In addition, the frequency of post-procedural recommendations for non-invasive procedures was higher in the women than in the men (20.1% vs 18.6%; P<0.001). In StudyII, of the 6,246 recruited patients with acute coronary syndrome, 3,290individuals were considered low-SES and 2,956 high-SES individuals. In-hospital death occurred in 79 (1.26%) patients: 1.9% in the low-SES and 0.6% in the high-SES groups. After adjustment for the possible cofounders, our multivariate analysis demonstrated a significant effect of the patients’ SES on their in-hospital death and a lower in-hospital mortality rate was shown in the high-SES patients (OR=0.30, 95% CI: 0.09 to 0.98; P=0.046). In Study III, the Fars (8.7%) and Gilak (8.6%) ethnic groups had the highest frequency of having at least four simultaneous risk factors. Additionally, the mean Gensini score was lowest in the Lurs (67.5±52.8) and highest among the Gilaks (77.1±55.9). The multivariable regression analysis indicated that the Gilaks showed the worst CVD severity (β: 0.056, 95% CI: 0.009 to 0.102; P=0.018), followed by the Turks (β: 0.032, 95% CI: 0.005 to 0.059; P=0.020), and the lowest CVD severity, was detected in the Lurs (β: -0.087, 95% CI: -0.146 to -0.027;P=0.004). Study IV showed that while smoking (P=0.002), positive family history of coronary artery disease (P=0.003), higher body mass index (P=0.013),and hyperlipidemia (P=0.026) were more prevalent in the urban patients, the rural patients showed lower educational levels (P<0.001) and higher frequency of unemployment (P=0.009). Meanwhile, in-hospital death occurred in 135 (1.5%) patients: 125 (1.5%) urban and 10 (1.2%) rural. To adjust the effects of the possible confounders, we utilized the Firth regression model, which showed no significant difference regarding in-hospital death betweenthe rural and urban patients (OR=1.57, 95% CI: 0.376 to 7.450; P=0.585).Conclusions: The aim of this thesis was to investigate the effects of social determinants (particularly SES) on CVD and its modifiable risk factors among Iranian patients. Results showed that medical treatment for CVD was more recommended (by treating physicians) to the women than the men, and the low-SES patients with acute coronary syndrome were more likely to die in the hospital than their high-SES counterparts. In addition, the thesis found heterogeneity in the distribution of the traditional risk factors for CVD as well as CVD severity in the major Iranian ethnic groups. Further, there were no differences concerning the in-hospital death rates due to acute coronary syndrome between the urban and rural patients after adjustment for the potential confounders.
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