Sunday, January 26, 2020

Ibandronate vs. Alendronate for Osteoporosis

Ibandronate vs. Alendronate for Osteoporosis Cost-Effectiveness of Ibandronate vs. Alendronate used in treatment of osteoporosis, in a specialized clinic in Tirana. Dr. Mirela Miraà §i1; Msc.Arlinda Demeti2; Prof.as Zamira Ylli3; Prof.Mira Zià §ishti3; Prof.As Suela Kellià §i1 Faculty of Pharmacy, University of Medicine, Tirana. Bioparafarmacia Franceze Neostyle Clinic Abstract: Osteoporosis is â€Å"a systemic skeletal disease with a high prevalence. Biphosphonates are medicaments which are chosen for their efficacy in reducing fracture incidence, increasing bone density and improving bone microarchitecture. The aim of the study is to evaluate the effectiveness of the drugs (ibandronate and alendronate) used in osteoporosis treatment, in post-menopausal women over the age of 50 years at a specialized clinic in Tirana; to calculate the annual cost of treatment of osteoporosis and to perform a cost effectiveness analyze. Methods: Retrospective. The patients were all female, in menopause or post menopause, with T-score -1 to -6, treated with alendronate or ibandronate. The effectiveness is calculated as the average percentage of change in bone mineral density (av. % of change in BMD) of year 2011 vs. 2010 baseline. The annual cost of the treatment of osteoporosis according to the protocols and the cost of the examination with DXA scan (dual x-ray absorptiometry) were calculated. Finally a comparison of the cost-effectiveness was performed. Conclusion:  Patients with osteoporosis treated with Ibandronate, at our clinic in Tirana, have an average change from baseline higher compared with patients treated with Alendronate, with statistically significant difference between them (Man Whitney U = 66.0, p The annual cost of the disease when treated with ibandronate is 1.3 times higher than the annual cost of treatment with alendronate. Ibandronate is more cost effective than all other alendronate . Introduction: Osteoporosis is â€Å"a systemic skeletal disease characterized by low bone mass and micro architectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fractures† (1) The World Health Organization defines osteoporosis as â€Å"bone density 2.5 standard deviations (SDs) below the mean for young white adult women at lumbar spine, femoral neck or forearm†. (2) Osteoporosis leads to nearly 9million fractures each year worldwide and over 300,000patients with fragility fractures are registered in UK hospitals each year (British Orthopaedic Association, 2007).(3) Osteoporoza, à «shtà « njà « sà «mundje me njà « prevalencà « tà « lartà « edhe nà « Shqipà «ri (7.28% e popullatà «s dhe 9.6% tek femrat)4, e njà «jtà « me atà « tà « hasur pà «r astmà «n apo sà «mundjet e zemrà «s; †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. Direct medical costs due to fragility fractures in UK healthcare economy were estimated at  £1.8billion in 2000, with the potential to increase to  £2.2billion by 2025 and the major part of these costs were related to hip fracture care. (5) The annual cost of osteoporosis and fractures in the US elderly was estimated at $16 billion(6) Osteoporosis is diagnosed by a T-score, which is the number of standard deviation (SD) that patient’s bone mineral density (BMD), measured using dualX-ray absorptiometry, differs from the mean BMD of 30-years old premenopausal women. Patients with T-score of between -1 and -2.5 SD are said to have osteoporosis.7,8 Biphosphonates are medicaments which are chosen for their efficacy in reducing fracture incidence, increasing bone density and improving bone microarchitecture.9-15 Top of Form Methods: Retrospective. The patients were all female, in menopause or post menopause, 50 years old or elder, with T-score -1 to -6, diagnosed for the 1rst time in 2010 (the 1rst BMD measurement), who have received treatment (alendronate or ibandronate) for 12 months and in 2011 have performed a 2nd BMD measurement. The effectiveness is calculated as the average percentage of change in bone mineral density (av.% of change in BMD) of year 2011 vs. 2010 baseline. It was calculated the annual cost of the treatment of osteoporosis according to the protocols: with once monthly 150 mg oral ibandronate plus supplements (calcium, vitamine D) and once weekly 70 mg alendronate (4 times per month) plus supplements (calcium, vitamine D). There are also included other direct costs such as the examination with DXA scan (dual x-ray absorptiometry) to determine the diagnosis and the medical visits. Finally a comparison of the cost-effectiveness will be performed. Statistical Analysis Data were analyzed with SPSS 20 statistical package. It is used the non-parametric Man Whitney U test to compare the continuous variables, Fisher Exact test was used to compare proportions between variables and the the Odds Ratio OR for assessing the association between variables. Point estimations are accompanied with interval estimation by 95 % CI. For continuous variables is presented the average, the standard deviation and the minimum and maximum values. The level of statistical significance is defined at ÃŽ ± ≠¤ 005. Statistical tests are two-sided.duhet te shihet gjuha e perdorur, a qendron ne anglisht? Results of the study In our study were included 70 patients who fulfill the inclusion criteria. 24 patients were treated with once monthly 150 mg oral ibandronate and 46 patients with once weekly 70 mg alendronate.There were not case of fracture among our patients. Table 1 compares the frequency of pathologies (osteopenia and osteoporosis) in two groups of patients treated with alendronat or ibandronat. Osteoporosis Osteopenia Ibandronate 14 10 Alendronate 18 28 OR= 1.3 95%CI 0.5 4.2 p=0.4 Your contribution will be used to improve translation quality and may be shown to users anonymously Contribute Close Thank you for your submission. Number of patients treated with alendronate is 1.3 times higher than the number of patients treated with ibandronate in the case of osteoporosis. (OR = 1.3, 95% CI 0.5-4.2, p = 0.4). Chart 1 Calculation of efficiency We have to calculate the average percentage of change of BMD (2011) to baseline (2010): Table2. In the group of Alandronate (N=46) we have found this data: Osteoporosis n=18 Osteopeni n= 28 M (SD) min max M (SD) min max Mann-Whitney U p T Score 2010 -3.2 (0.7) -4.6 -2.5 -1.9 (0.4) -2.4 -1.1 507.0 T Score 2011 -3.1 (0.8) -4.7 -2.2 -1.8 (0.6) -2.4 -1.1 515.5 Age, yrs 61.2 (8.0) 51.0 – 79.0 59.1 (7.8) 51.0 – 81.0 223.5 0.3 Height, m 1.5 (0.05) 1.4 – 1.6 1.5 (0.07) 1.4 – 1.7 304.5 0.3 Weight, kg 58.8 (8.3) 46.0 – 73.0 68.6 (11.1) 51.0 – 95.0 376.5 0.01 *Age-Group, yrs n (%) n (%) OR (95% CI) 50 -59 yrs 8 (17) 19 (41) 60 -69 yrs 7 (15.2) 6 (13.0) 1.6 0.4 – 6.7 0.4 >70 yrs 3 (7) 3 (7) 2.8 0.4 – 25.2 0.3 *Fisher exact test p=0.3 There are 46 patients treated with alendronate. 18 ( 39.1 %) (95% ; CI 29.7 52.1) of them suffer from osteoporosis and 28 ( 60.9 % ) (95 % CI 47.8 74.2) from osteopenia, with no statistically significant difference between them, p = 0.9 Grupmosha 60 – 69 vjeà § ka 1.6 herà « mà « tepà «r gjasa qà « tà « vuajnà « nga Osteoporoza sesa grupmosha 50-59 vjeà §, por pa ndryshim sinjifikant ndà «rmjet tyre (OR=1.6; 95%CI 0.4–6.7; p=0.4) Grupmosha >70 vjeà § ka 2.8 herà « mà « tepà «r gjasa qà « tà « vuajnà « nga osteoporoza sesa grupmosha 50-59 vjeà §, por pa ndryshim sinjifikant ndà «rmjet tyre (OR=2.8; 95%CI 0.4–25.2; p=0.3) Pacientet me Osteopeni kanà « peshà « mesatare mà « tà « lartà « krahasuar me pacientà «t me Osteoporozà «, me ndryshim statistikisht tà « rà «ndà «sishà «m ndà «rmjet tyre (Man Whitney U=376.5, p=0.01) Pacientà «t me Osteoporozà « kanà « tà « njà «jtà «n gjatà «si mesatare me pacientà «t me Osteopeni, pa ndryshim statistikisht tà « rà «ndesishà «m ndà «rmjet tyre (Man Whitney U=304.5, p=0.3). The change from baseline for Alendronate group The change from baseline is calculated: Table 3 Osteoporosis n=18 Osteopenia n= 28 M (SD) min max M (SD) min max Mann-Whitney U p The change from baseline 2.1 (4.5) -7.6 – 13.9 1.7 (6.2) -23 – 11.1 316.0 0.2 Patients with osteopenia have an average change from baseline higher compared with patients with osteoporosis, no statistically significant difference between them (Man Whitney U = 316.0, p = 0.2). Table 4. In the group of Ibandronate (N = 24) we have find this data: Osteoporosis n=14 Osteopeni n= 10 M (SD) min max M (SD) min max Mann-Whitney U p T Score 2010 -3.7 (0.7) -5.0 -2.7 -1.8 (0.3) -2.2 -1.4 140.0 T Score 2011 -3.2 (0.8) -4.4 -1.7 -1.5 (0.4) -2.1 -1.0 134.5 Age yrs 64.3 (7.3) 53.0 77.0 59.1 (5.0) 53.0 – 68.0 39.5 0.07 Height (m) 1.5 (0.05) 1.4 – 1.6 1.5 (0.06) 1.4 – 1.6 71.0 0.9 Weight 66.2 (10.9) 47.0 – 84.0 70.7 (7.1) 65.0 – 82.0 90.5 0.2 *Age-group, yrs n (%) n (%) OR (95% CI) 50 -59 yrs 3 (12.5) 6 (25.0) 60 -69 yrs 8 (33.3) 4 (16.7) 3.7 0.6 – 27.8 0.2 >70 yrs 3 (12.5) 0 13 0.5 – 33.0 0.03 *Fisher exact test p There are 24 patients treated with Ibandronate. 14 (58.3%), (95% CI 33.2-76.5) of them suffer from osteoporosis and 10 (43.7%), (95% CI 23.4-61.7) of osteopenia, no statistically significant difference between them, p = 0.9. Pacientà «t me Osteoporozà « kanà « njà « moshà « mesatare mà « tà « lartà « krahasuar me pacientà «t me Osteopeni, por pa ndryshim statistikisht tà « rà «ndà «sishà «m ndà «rmjet tyre (Man Whitney U=39.5, p=0.07). Pacientà «t me Osteoporozà « kanà « tà « njejtà «n gjatà «si mesatare me pacientet me Osteopeni, pa ndryshim statistikisht tà « rà «ndà «sishà «m ndermjet tyre (Man Whitney U=71.0, p=0.9) Grupmosha 60 – 69 vjeà § ka 3.7 herà « mà « tepà «r gjasa qà « tà « vuajà « nga Osteoporoza sesa grupmosha 50-59 vjeà §, por pa ndryshim sinjifikant ndà «rmjet tyre (OR=3.7; 95%CI 0.6–27.8; p=0.2). Grupmosha >70 vjeà § ka 13 herà « mà « tepà «r gjasa qà « tà « vuajà « nga osteoporoza sesa grupmosha 50-59 vjeà § me ndryshim sinjifikant ndà «rmjet tyre (OR=13; 95%CI 0.5–33.0; p=0.03). Pacientà «t me Osteopeni kanà « peshà « mesatare mà « tà « lartà « krahasuar me pacientà «t me Osteoporozà «, por pa ndryshim statistikisht tà « rà «ndà «sishà «m ndà «rmjet tyre (Man Whitney U=90.5, p=0.2) The change from baseline for Ibandronate group (N=24) The change from baseline is calculated: Table5 Osteoporosis n=14 Osteopenia n= 10 M (SD) min max M (SD) min max Mann-Whitney U p The change from baseline 7.3 (6.1) -0.5 – 17.3 3.3 (2.2) -1.3 – 6.3 43.0 0.1 Patients with osteoporosis have an average change from baseline higher compared with patients with osteopenia, no statistically significant difference between them (Man Whitney U = 43.0, p = 0.1) Comparison of change from baseline for patients with osteoporosis referring the two drugs. Table 6. Alendronate n=18 Ibandronate n= 14 M (SD) min max M (SD) min max Mann-Whitney U p The change from baseline 2.1 (4.5) -7.6 – 13.9 7.3 (6.1) -0.5 – 17.3 66.0 Chart 2. The change from baseline for patients with osteoporosis Pacientà «t me Osteoporozà « tà « mjekuar me medikamentin Ibandronat kanà « njà « ndryshim mesatar nga baseline mà « tà « lartà « krahasuar me pacientet e mjekuar me Alendronat, me ndryshim statistikisht tà « rà «ndesishà «m ndà «rmjet tyre (Man Whitney U=66.0, p Table 7. Percentages of the average change of BMD from baseline Total Osteoporosis Ostopenia Alendronate 1.83564848 2.081694 1.677476 Ibandronate 5.635355 7.27025 3.346503 Chart 3. Nga figura rezulton se efikasiteti i medikamentit ibandronat (5.6) à «shtà « dukshà «m mà « i lartà « se efikasiteti i medikamentit alendronat (1.8). Efikasiteti i medikamentit ibandronat tek pacientà «t me osteoporozà « (7.3) à «shtà « dukshà «m mà « i lartà « se efikasiteti i medikamentit alendronat (2.1). Efikasiteti i medikamentit ibandronat tek pacientà «t me osteoponi (3.3) à «shtà « mà « i lartà « se efikasiteti i medikamentit alendronat (1.7). Cost analysis We consider only direct costs such as: DXA scanner examinations, medical visits and medications costs (drugs and the supplements), according to a well-defined treatment protocol. In Albania, there is only one kind of ibandronate (only one brand) 150 mg / once a month, while there are lots of alendronate (different brands) 70 mg / 4 times per month, which we have called A1,A2,A3, A4,A5. We have calculated the costs of the only ibandronate and the costs of five types of alendronate, including the alendronate produced by a pharmaceuticals firm in the country, which has the lowest price in the market. In both cases the basic treatment is associated with calcium and vitamin D. Table 8 Annual Cost of treatment and cost of examination Nr Currency Quantity Cost Month Annual Costs 1 Diagnostics skaner DXA Lek1 1 4,000 4,000 Medical examination 1 1,000 1,000 2 Type of Alendronat 70mg A1 lek 4 3,410 12 40,920 A2 lek 4 2,093 12 25,116 A3 lek 4 3,301 12 39,612 A4 lek 4 4,102 12 49,224 A.5 (Albanian Product) lek 4 1,200 12 14,400 3 Ibandronat 150 mg lek 1 4,873 12 58,476 4 Calcium Carbonat 1000 mg + Colecalciferol 880 UI lek 30 1,019 12 12,228 Table 9 Cost of illness according the type of medications Type of Alendronat 1+2+4 Annual costs A1 lek 58,148 A2 lek 42,344 A3 lek 56,840 A4 lek 66,452 A5 lek 31,628 Type of Ibandronat 1+3+4 Annual costs I1 lek 75,704 The annual cost of the disease when treated with ibandronate is 2.4 times higher than the annual cost of treatment with alendronate the alendronate produced by a pharmaceuticals firm in the country, which has the lowest price in the market, respectivly 537[1] euro versus 226 euro per patient in alendronate group. Having all the annual costs and the efficiency for each drug, we can compare: Table 10 Name (Changes by baseline in %) Efficiency of alendronate 1.83565 Efficiency of ibandronate 5.63536 Table11 Type of treatment C/E Alendronate A1 31,677 A2 23,068 A3 30,965 A4 36,201 A5 17,230 Ibandronate 13,434 The analyse of cost per efficiency unit (Table 10) shows that in the case of ibandronate the value obtained is 13.434 units and in alendronate A1 case is 31.677 units. Discussion of results Patients with osteoporosis treated with Ibandronate, at our clinic in Tirana, have an average change from baseline higher compared with patients treated with Alendronate, with statistically significant difference between them (Man Whitney U = 66.0, p 16 The annual cost of the disease when treated with ibandronate is 1.3 times higher than the annual cost of treatment with alendronate A1 and 2.4 times higher than the annual cost of treatment with the alendronate produced by a pharmaceuticals firm in the country, which has the lowest price in the market. So as claimed, the cost for effectiveness unit is lower (about 2.3 times) in the case of ibandronate compared to alendronate A1. Well ibandronate results the most cost- effective. Ibandronate turns more cost effective than all other alendronate including the alendronate produced by a pharmaceuticals firm in the country, which has the lowest price in the market Literature Christiansen, C. (1993). Consensus development conference: diagnosis, prophylaxis,and treatment of osteoporosis. Am J Med 94:646–50. Kanis, J.A. (1994). Assessment of Fracture Risk and its Application to Screening forPostmenopausal Osteoporosis. Report of a WHO Study Group. Geneva: World HealthOrganization. Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporosis International 17: 1726–33. Dorina Ruco,(Dhjetor 2011): Osteoporoza nà « qytetin e Tiranà «s British Orthopaedic Association (2007).The care of patients with fragility fracture. Burge RT, Worley D, Johansen A, et al. The cost of osteoporotic fractures in the UK: projections for 2000–2020. Journal of Medical Economics 4: 51–52. Blume SW,Curtis JR Osteoporos Int.2011 Jun;22(6):1835-44. doi: 10.1007/s00198-010-1419-7. Epub 2010 Dec 17. Medical costs of osteoporosis in the elderly Medicare population. BMJ Group. Annual zoledronic acid for osteoporosis. Drug Ther Bull. 2008 Dec;46(12):93-6. Cummings SR, Melton LJ. Epidemiology and outcomes of osteoporotic fractures. Lancet 2002;359:1761e7. Delmas PD. Treatment of postmenopausal osteoporosis. Lancet 2002;359:2018e26. Hochberg MC, Ross PD, Black D, et al. Larger increases in bone mineral density during alendronate therapy are associated with a lower risk of new vertebral fractures in women with postmenopausal osteoporosis.Fracture Intervention Trial Research Group. Arthritis Rheum 1999;42:1246e54. Hochberg MC, Greenspan S, Wasnich RD, et al. Changes in bone density and turnover explain the reductions in incidence of nonvertebral fractures that occur during treatment with antiresorptive agents. J Clin Endocrinol Metab 2002;87:1586e92. Epstein S. The roles of bone mineral density, bone turnover, and other properties in reducing fracture risk during antiresorptive therapy. Mayo Clin Proc 2005;80:379e88. McClung MR, Wasnich RD, Recker R, et al. Oral daily ibandronateprevents bone loss in early postmenopausal women with osteoporosis.J Bone Miner Res 2004;19:11e8. Rosen CJ. Postmenopausal osteoporosis. N Engl J Med 2005;353: Miller PD,Epstein S,Sedarati F,Reginster JY Once-monthly oral ibandronate compared with weekly oral alendronate in postmenopausal osteoporosis: results from the head-to-head MOTION study. http://www.ncbi.nlm.nih.gov/pubmed/18042311

Saturday, January 18, 2020

Persuasive Study: Why We Vote Essay

America has been the land of the free and the home of the brave since 1776. America has been free from the monarchy of Great Britain. Over 200 years later, American citizens still fight for freedom and to uphold a strong democracy. Voting is important in America because the opinions and the results of voters reflect America’s morals and ethic, and the right to vote is a privilege. Also, every vote counts. Because America has the opportunity to vote, the overall view of America is not formed of what she truly is, but what the citizens are. What a person’s character is consists of what their values and beliefs are. When voting is accessible, those who do vote, vote for what represents them most accurately. If the voters don’t vote, the only representation of this country is of those who did vote. America is one of the only countries that have the freedom to vote with a democracy government in the world. Many countries do not have an option of whether or not they wish to vote. Monarchies or dictatorships, for example, have one ruler that enforces and makes all the laws and rules of that specific country; the citizens do not have a say about what they think is wrong or right. Because America has the opportunity to vote, the privilege should be expressed as much as possible. With the dilemma of not all citizens voting, the democracy can be far from a success. Those citizens that do vote present strong patriotism. Although patriotism is a praised emotion, not all patriotic people have the same ideas for this country. For example, a recent controversy is the problems with abortion. If majority of citizens that vote are not against abortion but a few others are against voting, they will lose all possibilities of opposing abortion simply because they gave up. Ever since 1776, America has been a democracy and a free country. Having a government that is a democracy, the right to vote accompanies it. Voting is crucial to the system of democracy for various reasons: the laws and representatives exemplify not only the government but the whole country, voting can be taken for granted and should be appreciated more, and if a citizen does not vote, they have no say in what happens in this country.

Friday, January 10, 2020

Nestle Group

Management On Nestle International Ltd MGT: 141 Principal of management Prepared For: Afrins farid Assistant Professor Faculty, Business Administration Prepaid By: Km Iftakharul huq| 12310527| Nusrat jahan| 12310305| Estiaq hasan| 12310312| Israt sharmin| 12310217| Farzana sultana| 12310219| Rakib hasan| 12310532| University of Information Technology & Science (UITS) Contents December, 12, 2012 To, Afrins farid Assistant Professor Faculty, Business Administration University Of Information Technology & ScienceSubject: Submission of a report. Dear Madam, With due regards and respect we state that we are very thankful to you as you assigned us this report on ‘’Management in Nestle International Ltd’’. it is a great opportunity for us to acquire the theoretical & practical knowledge about five functions of management in Nestle International Ltd which is a reputed multinational organization . we have tried our best to gather what we believe to be The most comple te information available. Sincerely THE MANAGER 2. HistoryNestle – the world's largest food group, not only in terms of its sales but also in terms of its product range and its geographical presence: Nestle covers nearly every field of nutrition: infant formula, milk products, chocolate and confectionery, instant coffee, ice-cream, culinary products, frozen ready-made meals, mineral water etc. We are also a major producer of pet food. In most of these product groups and in most markets, Nestle is the leader or at least a strong number two. We are a very focused Company, with more than 94 percent of the sales coming from the food and beverage sector.Nestle is present around the globe, on all continents, with around 230,000 people working in more in an 84 countries with 466 factories and with sales representatives in at least another 70 countries. Many of our brand names are familiar to you: Nescafe, Nido, Maggi, Polo, Smartest, Milo, Perrier, Friskies, KitKat, Crunch†¦. S ome of our products have broken records: 3,000 cups of Nescafe are consumed every second. and KitKat merited an entry in the Guinness Book of World Records as the world's best-selling chocolate bar with 418 KitKat fingers eaten every second around the world!Nestle management provided their employees functionally with good environment, they also influences their employees various facilities like Healthy Salaries, increments. We are acquired more experience to research and analysis this report, that help us future job performance. We create this by Microsoft office 2007. Finally, we thanked those people who are help through valuable information of as. Also thanks our honorable Teacher Afrins farid for her guideline 2. 1Background of the Report: Management is a phenomenon.It is a very popular and widely used term. All organization are involved in management because it helps and directs the various efforts towards a definite purpose. We are student of BBA program, our principal of manag ement Afrins Farid Assigned as to prepare a report on ’Management in Nestle International Ltd’’. We have made a survey for required information in Nestle official site in net. We have selected our topics as ’Management in Nestle International Ltd’’. We have prepared our report on December 07, 2012 which will be submitted by December 12, 2012. . 1. 2Objective: The report aims to provide information on suggest more valuable information a report on ‘Management on Nestle International Ltd’. The objective of Nestle is to gain more market share and become the global market leader in the Food and Nutrition industry. The company has to experience a hardship in order to sustain that position especially to stay ahead of Cadbury. It is because that Cadbury is being acquired by Kraft food which is the world leader in the chocolate business.Nestle's business objective, and that of management and employees at all levels, is to manufacture and market the Company’s products in such a way as to create value that can be sustained over the long term for shareholders, employees, consumers, business partners and the large number of national economies in which Nestle operates; 1. 2 Management. Objectives: The report aims to provide 3Primary employee motivated effected by the Nestle International Ltd though information on suggest more valuable information to how the 1. 2. 1Scope of the study:There is a certain boundary to cover this report. Our particular report only covers on how the ‘Management on Nestle International Ltd’. we mainly focus five function of business ; managerial skills. 1. 2. 2. Limitation of the study: We are lucky enough to get change to prepare a report on ‘Management on Nestle International Ltd’. We tried heart ; soul to purpose a well-informed a report. But unfortunates we faced some difficulties’ when preparing this report. We tried to overcome the difficulties. In spite of trying our level best some difficulties that hamper our schedule report work.The employee of regional office of Bangladesh was too busy of their work. For this, they did not sufficient time to fulfill our queries and some of them neglected us to support. 1. 2. 3. Difficulty in collecting data: Many employers of the organization were not well known about all information that we asked them. Many of them also hesitated to answer the questions. These things humped the information collection. 1. INTRODUCTION Nestle with headquarters in Vevey, Switzerland was founded in 1866 by Henri Nestle and is today the world's leading nutrition, health and wellness  Company.Sales for 2007 were CHF 107. 6 ban, with a net profit of CHF  10. 6 bn. We employ around 276  050 people and have factories or operations in almost every country in the world. The Company's strategy is guided by several fundamental principles. Nestle's existing products grow through innovation and renovation while m aintaining a balance in geographic activities and product lines. Long-term potential is never sacrificed for short-term performance. The Company's priority is to bring the best and most relevant products to people, wherever they are, whatever their needs, throughout their lives.The Nestle Addresses navigation at the top of this page will give you access to Nestle offices and websites around the world. We demonstrate through our way of doing business in all the countries where we are present a deep understanding of the local nature of nutrition, health and wellness; we know that there is no one single product for everyone – our products are tailored to suit tastes and habits wherever you are. 1. 1Nestle at a glance: Nestle S. A. Industry Food processing Founded Anglo-Swiss Condensed Milk Company (1866) Ferine Lactee Henri Nestle (1867)Nestle and Anglo-Swiss Condensed Milk Company (1905) Founder(s) Henri Nestle, Charles Page, George Page * Henri Nestle endowed his company with the symbol derived from his name. His family coat of arms, the nest with a mother bird * protecting her young, became the Company's logo and a symbol of the Company's care * and attitude to life-long nutrition. The Nestle nest represents the nourishment, security and sense of family that are so essential to life. * Headquarters Vevey, Switzerland * Area served Worldwide * Key people Peter Brabeck-Letmathe (Chairman)Paul Bulcke (CEO) * Products Baby food, coffee, dairy products, breakfast cereals, confectionery, bottled water, ice cream, pet foods) * Revenue CHF 83. 64  billion (2011) * Operating income CHF 12. 53  billion (2011) * Profit CHF 9. 487  billion (2011) * Total assets CHF 114. 09  billion (2011) * Total equity CHF 58. 27  billion (2011) * Employees 328,000 (2012) * Website www. nestle. com 1. 1. 2 KEY DATES 1866|   | Foundation of Anglo-Swiss Condensed Milk Co. | 1867|   | Henry Nestle's Infant cereal developed| 1905|   | Nestle and Anglo Swiss Condensed M ilk Co. new name after merger)| 1929|   | Merger with Peter, Cailler, Kohler Chocolats Suisses S. A. | 1934|   | Launch of Milo| 1938|   | Launch of Nescafe| 1947|   | Nestle Alimentana S. A. (New name after merger with Maggi)| 1948|   | Launch of Nestea and Nesquik| 1969|   | Vittel (initially equity interest only)| 1971|   | Merger with Ursina-Franck| 1973|   | Stouffer (with Lean Cuisine)| 1974|   | L'Oreal (associate)| 1977|   | Nestle S. A. (new company name)| |   | Alcon (2002: partial IPO)| | | | 1981|   | Galderma (joint venture with L’Oreal)| 1985|   | Carnation (with Coffee Mate and Friskies)| 986|   | Creation of Nestle Nespresso S. A. | 1988|   | Buitoni-Perugina, Rowntree (with Kit Kat)| 1990|   | Cereal Partners Worldwide (joint venture with General Mills)| 1991|   | Beverage Partners Worldwide (joint venture with Coca-Cola)| 1992|   | Perrier (with Poland Spring)| 1993|   | Creation of Nestle Sources Internationals (2002: N estle Waters)| 1997|   | Creation of Nutrition Strategic Business Division (2006: Nestle Nutrition)| 1998|   | San Pellegrino and Spillers Pet foods| |   | Launch of Nestle Pure Life | 2000|   | Power Bar| 2001|   | Ralston Purina| 2002|   | Scholler and Chef America|   | Dairy Partners Americas (joint venture with Fonterra)|   |   | Laboratories inneov (joint venture with L’Oreal)| 2003|   | Move pick and Dreyer's| 2005|   | Wagner, Proteika and Musashi| 2006|   | Acquisition of Uncle Toby’s and Jenny Craig. Creation of Foodservices Strategic Business Division|   |   | Lactalis Nestle Produits Frais (associate)| |   | Jenny Craig, Uncle Toby’s and Delta Ice Cream| 2007|   | Acquisition of Novartis Medical Nutrition, Gerber and Henniez. |   |   | Re-launch of Foodservices as Nestle Professional. |   |   | Partnership with luxury chocolate maker Pierre Marcolini. 1. 1. 3 Vision Beyond sound nutrition, the future of foods wi ll increasingly be driven by science. Nestle scientists are looking ahead to the foods of the future. Nestle  R&D  is translating nutrition and food science in two ways: * From consumer needs into research priorities * From emerging science into consumer benefits, and services. The vision of Nestle  R&D  is long term. 1. 1. 4 Mission At Nestle, we believe that research can help us to make better food, so that people live better life. Good food is the primary source of good health, so we are trying to make good food.To provide fresh and pure products to the customers, we introduced (SHE) Safety, Health and environment policy to protect health of our employs and keep clean our surrounding environment. 3. Senior Management: The executive board, a distinct entity from the board of directors, includes: * Peter Brabeck-Letmathe, Chairman of the Board of Directors, Nestle S. A. * Paul Buckle, Chief Executive Officer, Nestle S. A. * Werner Bauer, Executive Vice President, Nestle S. A. , Chief Technology Officer, Head of Innovation, Technology, Research & Development * Friz van Dijk, Executive Vice President, Nestle S.A. Asia, Oceania, Africa, Middle East * Chris Johnson, Executive Vice President, Nestle S. A. United States of America, Canada, Latin America, Caribbean * Jose Lopez, Executive Vice President, Nestle S. A. Operations, GLOBE * John J. Harris, Executive Vice President, Nestle S. A. Chairman & CEO of Nestle Waters * Nandu Nandkishore, Executive Vice President, Nestle S. A. CEO of Nestle Nutrition * James Singh, Executive Vice President, Nestle S. A. Finance and Control, Legal, IP, Tax, Global Nestle Business Services * Laurent Freixe, Executive Vice President, Nestle S. A. Europe * PetraeaHeynike, Executive Vice President, Nestle S. A. Strategic Business Units, Marketing, Sales and Nespresso * Marc Caira, Deputy Executive Vice President, Nestle S. A. Head of Nestle Professional Strategic Business Division * Jean-Marc Duvoisin, Deputy Executive Vice P resident Nestle S. A. Head of Human Resources and Centre Administration * David P. Frick, Senior Vice President and ex officio Member of the Executive Board Brazil headquarters in Brooklin Novo, Sao Paulo According to a 2006 global survey of online consumers by the Reputation Institute, Nestle has a reputation score of 70. 4 on a scale of 1–100. . 1. Management of Nestle Management of Nestle believes in an open door policy and highly discourages bureaucracy in the operational process. The Organization offers an international and multicultural working climate which is conducive to creativity, innovation and the development of personality, and which gives new employees responsibility at an early stage of their career, and opportunities of fast development of high performers. Nestle is a human company where people are the most important asset and where they can develop their personality and skills to their own and their families' satisfaction.Nestle offers a competitive compensa tion package and social benefits in line with Nestle's commitment to high standards. In addition, the organization offers progressive development through on-going training throughout your career. Training possibilities are available to all staff. Nestle recently introduced e-learning in Bangladesh, a web-based programmed for self development. When joining Nestle, your training is not over – it is only just the beginning Management is defined as the process of setting and achieving goals through the execution of 5 basic management functions that utilize human, financial and material resources. Efficiently means using resources optimally / best possible use * Effectively means getting the things done/making right decision and implementation 4. PLANNING Planning of Nestle: Planning: Deciding what needs to happen in the future (today, next week, next month, next year, over the next five years, etc. ) and generating plans for action. * Decision Making and the Planning Process Stra tegic goals Strategic plans Tactical goals Operational goals Operational plans The organization’s mission The Environmental Context †¢ Purpose †¢ Premises †¢ Values †¢ Directions Tactical plansKinds of organization plan * Strategic Plans * A general plan outlining resource allocation, priorities, and action steps to achieve strategic goals. The plans are set by and for top management. * Tactical Plans * A plan aimed at achieving the tactical goals set by and for middle management. * Operational Plans * Plans that have a short-term focus. These plans are set by and for lower-level managers. 4. 1. 1 Time frame for planning * The Time Dimension of Planning * Is based on the principle of commitment. Planning must provide sufficient time to fulfill the managerial commitments involved. Long-range Plans * Cover present and future strategic issues; normally extend beyond five years in the future. * Intermediate Plans * Usually cover from 1 to 5 years and parallel tactical plans. * Are the principal focuses of organizational planning efforts. * Short-range Plans * Have a time frame of one year or less. * include action plans and reaction (contingency) plan 4. 1. 2Planning Staff * Planning staff personnel gather information, coordinate planning activities, and take a broader view than individual managers. * Planning Task Force * Created when the organization wants special circumstance addressed. * Board of Directors * Establishes corporate mission and strategy. May engage in strategic planning * Chief Executive Officer * Usually serves as president or chair of the board of directors. Has a major role in the planning process and implements the strategy 4. 1. 3. B arrier to goal setting and planning: 4. 1. 4Policies and strategies in the planning process * They give mid and lower-level managers a good idea of the future plans for each department in an organization. * A framework is created whereby plans and decisions are made. Mid and lower-leve l management may add their own plans to the business's strategies.. Organizing: (Implementation)pattern of relationships among workers, making optimum use of the resources required to enable the successful carrying out of plans. Nestle has a Board of Directors, led by our Chairman Peter Brabeck-Letmathe, who was the former Nestle CEO. There are 14 members of the Board of Directors. Full details of each member and the committees that they operate within can be found in our Board of Directors section. The day to day management of the Nestle business is taken care of by our Executive Board members.The 13 designated Board Members manage diverse parts of the global business and a full curriculum vital of each member can be found in the Executive Board section. In addition to how our managers carry out their work as leaders, Nestle pragmatically implements The following organizational principles: †¢ Being as decentralized as possible to optimally respond to the needs of consumers, wi thin the framework defined by our fundamental policies, strategic directions and operational efficiencies †¢ Ensuring collaboration of all Nestle businesses and compliance with Nestle principles, policies And standards (Nestle in the Market approach) Building and maintaining a structure which assures operational speed, with a strong focus on results and removing unnecessary obstacles. †¢ Establishing flat and flexible organizations with minimal levels of management and broad spans of control, which also enable people development. †¢ Setting a shared vision and common goals to leverage the strength of people and organizational alignment. †¢ Defining clear levels of responsibility. Teamwork does not affect the manager’s duty towards his/her people and business results . A team must always have a leader who assumes full responsibility 4. 2. 1.A Mutual commitment: Living up to the Nestle Management and Leadership Principles is a commitment and a responsibility for everyone in our Company. To be effective, engaging and inspiring, all Nestle people must â€Å"walk the talk† and lead by example in their daily work; in this context, actions speak louder than words. Therefore, at Nestle, in addition to professional skills – and regardless of origin, nationality, religion, race, gender, sexual orientation and age – the capacity and willingness to live up to these principles are the key criteria’s for progressing within the organization 5. Staffing:Job analysis, recruitment and hiring for appropriate jobs. Staffing involves: -Manpower planning -Recruitment selection ; placement -training ; development 5. 1. Training: Process of altering employee behavior ; attitudes in a way that increases the probability of goal attainment * The most common topics covered in cultural training include: Social| history | Politics| Business| customs| Economics| | | | | Training and development is the field which is concerned with organ izational activity aimed at bettering the performance of individuals and groups in organizational  settings.It has been known by several names, including  employee development,  human resource development, and  learning and development. Major types of cross-cultural training programs Environmental Briefings Cultural Orientation Language Training Cultural Assimilators Sensitivity Training Field Experience Orientation ; Training Programs at Nestle Formal Orientation Local Training International Training Literacy Training Nestle Apprenticeship ProgramInternational Training Nestle’s success in growing local companies in each country has been highly influenced by the functioning of its international Training Centre, Switzerland. International Training: Classes are carefully composed to include people with a range of geographic and functional backgrounds. Typically a class contains 15–20 nationalities. The Centre delivers some 70 courses. Attended by about 1700 manag ers each year from over 80 countries. Only 25% of the teaching is done by outside professionals, as the primary faculty is the Nestle senior management.Its providing services for over 30 years. Managers from around the world to learn from senior Nestle managers and from each other. Country managers decide who attends which course. The programs can be broadly divided into two groups: 1. Management courses 2. Executive courses Training and trainer around the world: Local 1. DMBP: Distribution Management Best Practice. Trainer: Anirban Basu, Nestle India. 2. FMBP: Field Management Best Practice. Trainer: Ziaul Hafiz, Nestle Bangladesh. 3. DMBP plus: Distribution Management Best Practice.Trainer: Anirban Basu, Nestle India. Managing Partner: Good to Better. Trainer: Anirban Basu, Nestle India. International 1. SDS: SAR (South Asian Region) Distributor Solution (Distribution Management System), Chennai, India, 2009. 5. 2Findings ; Recommendation Nestle said that from the factory floor to the top management, training at Nestle is continuous. And because it is mainly given by Nestle people, it is always relevant to your professional life. Approach is unique in many ways: * It reflects the company's decentralized nature.Whichever country you are working in, you will be given the knowledge and tools you need to respond to local needs * It encourages you to broaden your horizons, by working with people from many different countries and cultures in the course of your career For international assignment Preliminary Visits Preliminary trip of host country Accept or reject the assignment based on experience Language Training Host country language skills and adjustment: improves expatriate’s effectiveness and negotiating ability, info of host country, social support * Role of English language Knowledge of corporate language: a common company language –English Practical Assistance Adaptation to new environment, assist in relocation 6. Leading/directing: Determin ing what needs to be done in a situation and getting people to do it. Nestle managers at all levels are more with leading and inspiring people to add value to the Company and society rather than with exercising formal authority. This calls for a high personal commitment of each employee and a common mindset geared towards results. In an increasingly dynamic world, leaders face Significant challenges and opportunities.These stem from shifts to new social patterns and unprecedented worldwide competition. Achieving ongoing success requires that each Nestle leader understands the context and capitalizes on it, as described in the following principles: Lead to win †¢ Has built credibility as a result of coherent action, leadership and achievement. †¢ Is able to think from different perspectives and to create a climate of innovation. This implies openness to risk and the possibility of making mistakes, but also the willingness to correct and learn from them. †¢ Believes in the importance of alignment and management of expectations. Has broad interests, a good general Education, responsible behavior as well as a balanced lifestyle. Manage for results †¢ Embraces personal commitment and courage in execution. This includes the capacity and the willingness to take initiatives and risks while maintaining composure under pressure. †¢ Values proactive cooperation in order to create synergies at local, regional and global levels. †¢ Embraces change and is able to implement it and manage its consequences. †¢ Believes in achieving business objectives rooted in compliance and sustainable practices. Grow talent and teams Has a passion for building and sustaining an environment where people have a sense of personal commitment to their work and give their best to promote our Company’s success. †¢ Cares for and develops the leaders of tomorrow through addressing all areas that Allow them to progress in their work and to expand their c apabilities. †¢ Understands the importance of continuous learning and improvement, as well as sharing knowledge and ideas freely with others. †¢ Is committed to giving and receiving honest, accurate and timely feedback, including performance evaluation, in a climate of mutual respect . Believes in the importance of building diverse teams, and promotes the advantages of gender balance. Compete and connect externally †¢ Constantly looks for ways to satisfy our consumers and customers while attracting new ones in unique and compelling ways. †¢ Displays curiosity and open-mindedness as well as a high level of interest in other cultures and lifestyles. †¢ Believes in openness and dialogue with outside stakeholders about future trends in society, technology, consumer habits, and business opportunities. Understands the external impact of our operations and, as a result, proactively seeks to engage and partner with the community, authorities, shareholders and other stakeholders. Strategic leadership To force the businesses to become more efficent To crete a regional manufacturing network To integrate the company ‘s business on a global scale 7. Controlling/monitoring: * Types of Controls 1. Areas of Control 1. Physical resources—inventory management, quality control, and equipment control. 2. Human resources—selection and placement, training and development, performance appraisal, and compensation. . Information resources—sales and marketing forecasts, environmental analysis, public relations, production scheduling, and economic forecasting. 4. Financial resources—managing capital funds and cash flow, collection and payment of debts. Strategic control Structural control Operations control Financial control * The Purpose of Control 2. Control is one of the four basic management functions. The control function, in turn, has four basic purposes. Adapt to environmental change Limit the accumulation of error Contro l helps the organization Cope with organizational complexity Minimize costsSteps of controlling process: Establish standards Measure performance Compare performance against standards Maintain the status quo Correct the deviation Change standards Determine need for corrective action 2 1 4 3 Checking progress against plans. 1. The regulation of organizational activities so that some targeted element of performance remains within acceptable limits. 2. Provides organizations with indications of how well they are performing in relation to their goals. 3. Control provides a mechanism for adjusting performance to keep organizations moving in the right direction. Basic rolesCategory Role Example Interpersonal Figure head Leader Liaison Representing the org. Motivating employees Coordinating activities Informational Monitor Disseminator Spokesperson Scanning industry reports Sending memos Making speech Decisional Entrepreneur Disturbance handler Resource allocator Negotiator Developing new i deas Resolving conflict Examining budgets Pursuing agreements * Interpersonal: roles that involve coordination and interaction with employees. * Informational: roles that involve handling, sharing, and analyzing information. * Decisional: roles that require decision-making. 8.Management skills: * Political: used to build a power base and establish connections. * Conceptual: used to analyze complex situations. A conceptual skill is the ability to imagine the integration and coordination of the parts of an organization – all its processes and systems. A manager needs conceptual skills to see how factors are interrelated, to understand the impact of any action on the other aspects of the organization and to plan long range. * Interpersonal: used to communicate, motivate, mentor and delegate. * Diagnostic: ability to visualize most appropriate response to a situation. Technical: Expertise in one's particular functional area. Technical skills are the knowledge of and ability to us e the processes, practices, techniques or tools of a specialty responsibility area. E. g. accountants, engineers, salespersons, etc. Implementation of policies and strategies * All policies and strategies must be discussed with all managerial personnel and staff. * Managers must understand where and how they can implement their policies and strategies. * A plan of action must be devised for each department. * Policies and strategies must be reviewed regularly. Contingency plans must be devised in case the environment changes. * Assessments of progress ought to be carried out regularly by top-level managers. * A good environment and team spirit is required within the business. * The missions, objectives, strengths and weaknesses of each department must be analyzed to determine their roles in achieving the business's mission. * The forecasting method develops a reliable picture of the business's future environment. * A planning unit must be created to ensure that all plans are consist ent and that policies and strategies are aimed at achieving the same mission and objectives. . Levels of management Most organizations have three management levels: first-level, middle-level, and top-level managers. [These managers are classified in a hierarchy of authority, and perform different tasks. In many organizations, the number of managers in every level resembles a pyramid. Each level is explained below in specifications of their different responsibilities and likely job titles. 9. 1. Top-level managers Consists of board of directors, president, vice-president, CEOs, etc. They are responsible for controlling and overseeing the entire organization.They develop goals, strategic plans, company policies, and make decisions on the direction of the business. In addition, top-level managers play a significant role in the mobilization of outside resources and are accountable to the shareholders and general public. According to Lawrence S. Kleiman, the following skills are needed a t the top managerial level * Broadened understanding of how: competition, world economies, politics, and social trends effect organizational effectiveness. The role of the top management can be summarized as follows – * Top management lays down the objectives and broad policies of the enterprise. It issues necessary instructions for preparation of department budgets, procedures, schedules etc. * It prepares strategic plans ; policies for the enterprise. * It appoints the executive for middle level i. e. departmental managers. * It controls ; coordinates the activities of all the departments. * It is also responsible for maintaining a contact with the outside world. * It provides guidance and direction. * The top management is also responsible towards the shareholders for the performance of the enterprise. 9. 1. 1Middle-level managers Consist of general managers, branch managers and department managers.They are accountable to the top management for their department's function. They devote more time to organizational and directional functions. Their roles can be emphasized as executing organizational plans in conformance with the company's policies and the objectives of the top management, they define and discuss information and policies from top management to lower management, and most importantly they inspire and provide guidance to lower level managers towards better performance. Some of their functions are as follows: * Designing and implementing effective group and intergroup work and information systems. Defining and monitoring group-level performance indicators. * Diagnosing and resolving problems within and among work groups. * Designing and implementing reward systems supporting cooperative behavior. 9. 1. 2. First-level managers Consist of supervisors, section leads, foremen, etc. They focus on controlling and directing. They usually have the responsibility of assigning employees tasks, guiding and supervising employees on day-to-day activities, ensuring quality and quantity production, making recommendations, suggestions, and up channeling employee problems, etc.First-level managers are role models for employees that provide: * Basic supervision. * Motivation. * Career planning. * Performance feedback. Factors that influence a manager to fit in one of the style: * The task that is being undertaken * The traditions of the organization * The type of Labor Force * The size of the group * The personality of the Leader * Personalities * Time 10. The Nestle factories are operating in the region of: 1. Africa 2. America 3. Asia 4. Europe 5. Oceania Being a company dedicated to food from the beginning, Nestle remains ensitive to culinary and eating habits, and responds to specific nutritional problems, whilst also setting and matching new trends such as growing out-of-home consumption and caring about the wellbeing of its consumers. * Zone Asia, Oceania and Africa ; 6. 6% organic growth, strong performance in most emerging market s ; Japan continued to suffer deflation but achieved positive RIG, With good performances in Soluble coffee and Chocolate ; China slow due to product exchange in Dairy, but on improving trend ; South Asia, Africa and Middle East amongst the highlights 0. 1Nestle Focus in Bangladesh Nestle is the world's leading Nutrition, Health and Wellness Company. In Bangladesh we have Maggi noodles and soups, breakfast cereal, Nescafe, coffee mate, baby food, milk and a seasoning. However, worldwide we have more than 10000 products in different variants. As of today, we employ over 276,000 people across more than 500 state-of-the-art facilities around the world. But it was never our ambition to be the biggest at what we do – it was our ambition to be the best. That sums up what we mean by Nestle Focus.It means we also appreciate that size and success are nothing without the finer details – such as genuine care for our consumers, a commitment to our people and a wider sense of respo nsibility towards our customers, suppliers and our communities. When you work for us, you'll see the difference that makes at every stage. It will mean becoming part of an organization which can offer you subsidiary of Nestle S. A. whatever you want from your career. Nestle Bangladesh Limited started its first commercial production in Bangladesh in 1994. In 1998. Nestle S. A. ook over the remaining 40% share from our local partner when Nestle Bangladesh became a fully owned Nestle Bangladesh's vision is to be recognized as the most successful food and drink Company in Bangladesh, generating sustainable, profitable growth and continuously improving results to the benefit of shareholders and employees. Our factory is situated at Sripur, 55 km north of Dhaka, the factory produces instant noodles, cereals and repacks milks, soups, beverages and infant nutrition products. Today Nestle Bangladesh Ltd. is a strongly positioned organization.The Company will continue to grow through our poli cy of constant innovation and renovation, concentrating on our core competencies and our commitment to high quality, with the aim of providing the best quality food to the people of Bangladesh. In Bangladesh, Nestle started its operation in 1994 and its factory is situated in Sreepur, Gazipur. Nestle Bangladesh directly employs more than 650 people and more than 1000 people are employed by suppliers and distributors in connection to Nestle. Our products in Bangladesh are Nido, Nescafe, Maggi noodles and soup, breakfast Cereals, Coffee-Mate, Nestea, Nesfruta ,Nesfrappe and many more.Nestle is present around the globe, on all continents, with around 230,000 people working in more in an 84 countries with 466 factories and with sales representatives in at least another 70 countries. Nestle is the world's largest food group, not only in terms of its sales but also in terms of its product range and its geographical presence. Nestle covers nearly every field of nutrition: infant formula, m ilk products, chocolate and confectionery, instant coffee, ice-cream, culinary products, frozen ready-made meals, mineral water etc. Nestle is a focused company, with more than 94 percent of the sales coming from the food and beverage sector.Did you know 3,000 cups of Nescafe are consumed every second? KitKat merited an entry in the Guinness Book of World Records as the world's best-selling chocolate bar with 418 KitKat fingers eaten every second around the world! 10. 2 Selected awards, certifications and rankings * In May 2006, Nestle’s executive board decided to adapt the existing Nestle management systems to full conformity with the international standards ISO 14001 (Environmental Management Systems) and OHSAS 18001 (Occupational Health and Safety Management Systems), and to certify all Nestle factories against these standards by 2010.In the meanwhile a lot of the Nestle factories have obtained these certifications. For instance, Nestle’s three factories in Japan (H imeji factory: Hyogo Prefecture, Shimada factory: Shizuoka Prefecture and Kasumigaura factory: Ibaraki Prefecture) have each obtained ISO standard certifications: ISO14001, ISO 22000 (Food Safety Management Systems) and OHSAS 18001 as of the end of December, 2008. * In 2009, Nestle Waters earned a sixth LEED certification. The certification was given by the U. S. Green Building Council's Leadership in Energy and Environmental Design which the company become its first recipient.It highlights the environmentally conscious elements of the facility which enables them to receive the certification. * Nestle Purina received in 2010 the Malcolm Balding National Quality Award for their excellence in the areas of leadership, customer and market focus, strategic planning, process management, measurement, analysis and knowledge management, workforce focus and results * In September 2011, Nestle occupied 19th position in the Universal’s global ranking of Best Employers Worldwide. Accordin g to a survey by Universal Communications Nestle was in 2011 the best employer to work for in Switzerland. Based on independent research by the Corporate Research Foundation Institute, Nestle (South Africa) has been certified in 2011 as a Best Employer in South Africa. * Nestle USA has been recognized by Business Week magazine as one of the â€Å"Best Places to Launch a Career. † Business Week ranked Nestle USA #25 on their annual list of the best companies for new college graduates to launch their careers. * For the twelfth consecutive year, Fortune Magazine included in 2011 Nestle in their list of The 10 Most Admired Companies in the World. Nestle won in 2011 the Stockholm Industry Water Award for its leadership and performance to improve water management in its internal operations and throughout its supply chain. * The International Union of Food Science and Technology (IUFoST) honored Nestle in 2010 with the Global Food Industry Award. * In May 2011, Nestle won the 27th W orld Environment Center (WEC) Gold Medal award for its commitment to environmental sustainability. * In 2011, Nestle Malaysia won an award of the Association of Chartered Certified Accountants for their Sustainability Reporting. On 19 April 2012, The Great Place to Work ® Institute Canada mentioned Nestle Canada Inc. as one of the '50 Best Large and Multinational Workplaces' in Canada (with more than 1,000 employees working in Canada and/or worldwide). * In April 2012, Nestle obtained an A+ rating from the Global Reporting Initiative (GRI) for their global annual report on Creating Shared Value. To reach A+ the company provided new data in their annual report on a number of criteria such as human rights, diversity and gender, climate change, biodiversity and corruption.Nestle was the first food and Beverage Company to achieve an A+ rating from the GRI for a global sustainability report. * On 21 May 2012, Gartner published their annual Supply Chain Top 25, a list with global supply chain leaders. Nestle ranks 18th in the list. Address: Nestle Bangladesh Ltd. Address: Gulshan Tower, Plot # 31, Road # 53, Gulshan North C/A City:Dhaka Location:Gulshan Phone:+880-2-9882759 Ext-255 Category: Milk Products Produce: For tetra Ltd 9, Prince Street P. O. Box-92032 Oakland, Newlands Nestle consumer service Post box no-11037, Uttra,Dhaka Care line number: 01730637853 0800217777 e-mail:concumer. [email  protected] nestle. com

Thursday, January 2, 2020

Health Care Disparities, the Uninsured, and the Role of...

Health Care Disparities, the Uninsured, and the Role of Cardiologists in the National Debate Presidential Address to the Opening Plenary: American College of Cardiology Scientific Sessions Steven E. Nissen MD MACC We live in the wealthiest nation in the history of the world and practice our profession in an era of unprecedented technological capability. In cardiovascular medicine, we can diagnose and treat heart disease with innovative approaches unimaginable to the previous generation of physicians. However, as a wealthy nation with a technologically advanced health care system, history will judge us not by our scientific progress, but by how we treat the weakest and most vulnerable amongst us. By this critical measure of†¦show more content†¦In 2005, the federal government considered the poverty level as an annual income of approximately $20,000 for a family of four. If we consider families with incomes between 100% and 200% of the poverty level (between $20,000 and $40,000 annually), the rate of uninsured families is a staggering 33%. For families with incomes between 40,000 and 60,000 dollars annually, the uninsured rate is still about 16%. How do these figures translate int o access to healthcare? In 2005, a survey by the Kaiser Family Foundation found that 31% of the uninsured had no regular source of health care, 35% postponed needed care due to lack of money and insurance, and 36% spent less on basic needs to pay for health care. Parents with children comprise about a quarter of the total uninsured population. Women are disproportionately represented – 20% of women ages 18 to 64 have no health insurance. That figure rises to 38% for Hispanic women. With such statistics, is it any wonder that we rank 46th in life expectancy and have high rates of infant mortality? For our own specialty, the disparities in cardiovascular outcomes for the financially disadvantaged are profound. In a manuscript published just two weeks ago in JAMA, prominent College member Harlan Krumholtz reported that, after a myocardial infarction, patients with financial barriers to healthcare were much more likely to require re-hospitalization, suffer from angina, and have a lower quality ofShow MoreRelatedEssay on Community Health and Population Focused Nursing7251 Words   |  30 Pages069- Retail trade-18, 906 Professional, scientific and technical services-18,412 Education-16,427 Arts, entertainment and recreation-12,012 Construction accounts for 9,660. Top three employers: AMR Corp. (American Airlines and Envoy Air) Texas Health Resources  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Lockheed Martin Financial Annual Unemployment Rate in 2014- 5%. Total county income - $52,247,302,144 Per capita income - $28,265 Political Tarrant County has consistently supported Republican Party presidentialRead More_x000C_Introduction to Statistics and Data Analysis355457 Words   |  1422 Pagesan elected member of the International Statistics Institute. Roxy has recently completed ï ¬ ve years as the Chief Reader for the Advanced Placement Statistics Exam and currently chairs the American Statistical Association’s Joint Committee with the National Council of Teachers of Mathematics on Curriculum in Statistics and Probability for Grades K–12. In addition to her texts in introductory statistics, Roxy is also co-editor of Statistical Case Studies: A Collaboration Between Academe and Industry