48 resultados para Terminal Care


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RESUMO - Asumo Insuficiência Renal Crónica Terminal é um problema de Saúde Pública, com elevada incidência e prevalência a nível mundial. Contudo, persistem variações geográficas destes indicadores que não são explicados pelos fatores clínicos ou fisiológicos. O objetivo do estudo é identificar os determinantes socioculturais e políticas de saúde que poderão influenciar a variação geográfica da incidência da insuficiência renal crónica sob terapêutica de substituição da função renal. Realizou-se uma revisão sistemática da literatura segundo a metodologia Prisma Statement nas bases de dados PubMed, Web of Science, Reportório Científico de Acesso Aberto de Portugal, Biblioteca Online e Google Académico, no período de 2010 a 2015, em inglês e português. De acordo com a metodologia eleita, foram definidos critérios de elegibilidade e, após a aplicação dos mesmos e avaliação da qualidade dos estudos (através do sistema de GRADE), foram identificados 5 artigos. Tendo por base os resultados obtidos, não foi possível identificar fatores socioculturais com influência na variação da incidência da insuficiência renal crónica sob terapêutica de substituição da função renal nos diferentes países. Por outro lado, constatou-se que as políticas de saúde, questões de acessibilidade e investimento na prevenção e diagnóstico precoce da patologia são fatores que exercem forte influência na incidência das terapêuticas de substituição da função renal. A identificação destes fatores é de extrema importância para intervir na promoção da saúde e diminuição das co-morbilidades relacionadas com a insuficiência renal crónica.

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A synthetic essay about portuguese Late Cretaceous (Upper Campanian-Maastrichtian) and Paleogene is presented. This does include most of the so far known data, a critical approach to the problems of such formations, and to previous works on them. Our viewpoints (party original) are exposed in a shorter text in French where most of the discussion was suppressed (see reference in Resumo).

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The synthetic study of the uppermost Cretaceous of the Beira Litoral (fauna, flora) confirms its upper Campanian-Maastrichtian age. It shows the presence of a tropical to subtropical climate in an area constituted by a low coastal plain only occasionally linked to the sea, saturated with fresh water and possessing accordingly, a predominantely freshwater fauna (Viso, Aveiro); this plain changed towards the interior into a drier more forested zone with a more abundant terrestrial fauna which includes mammals (Taveiro). A thorough study of the chelonian Rosasia, abundant on the coastal plain, was made possible thanks to the discovery of a skull: it demonstrates that the genus belongs to the family Bothremydidae, revalided here. The composition of this family is presented, its phylogenetic and paleobiogeographic relation with the other pleurodires are analyzed, and its diagnosis established. The family is constituted of three groups; Rosasia belongs to one of these, the Bothremys group.

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The reef levels of the gulf of Skoura belong to the reef formation of the Upper Miocene of the South-Rifan straits. A detailed analysis of the vertical distribution of various forms of colonies has led to the establishment of precise coral morphologies zonation. This palaeoecological approach leads us to distinguish between two environments in the Skoura gulf, probably corresponding to two reef episodes. The palaeogeographical implications (relationships between the Atlantic ocean and the Mediterranean sea) will be pointed out.

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In this paper, the determinants of growth of aggregate health expenditures are investigated. The study departs from previous literature in that it looks at differences across countries in growth (and not levels) of health care expenditures. Estimation is made for 24 OECD countries. Health system characteristics usually believed to influence health expenditures growth, like population ageing, the type of health system (public reimbursement, public contract or integrate) and existence of gatekeepers, are found to be non-significant. Nevertheless, there is evidence that health expenditures experienced a clear slower growth in the last decade. The explanation for this slowdown could not be found in the proposed model and should stimulate further research.

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Our main objective is to estimate the additional health care costs to the Portuguese National Health Service (NHS) due to domestic violence against women. We collected information through a survey addressed to health care centres’ female users. Both victims and non-victims of violence were inquired. We estimate costs according to five different groups – consultation costs, health care treatment and therapeutic costs, costs of complementary and diagnostic exams, drugs costs and transport costs. The estimations have been split into two perspectives – the NHS perspective (public perspective) and private perspective of inquired women (out of pocket payments). The timeframe of our calculations is one year, referring to all costs generated by domestic violence situations in the last twelve months. Essentially costs were estimated through the product of total number of episodes by the average estimated price per episode. Additionally, for the private costs, we also considered the costs originated by income losses, the opportunity cost of time spent on health care treatments and the work inability caused by sickness. The results suggest that the victims of domestic violence’s additional demand for health care is valued €140 per annum, that is about 22% higher than health care costs of non-victims. These results match those of similar studies for the United States, taking account of per capita differences in health care spending. A large proportion (90%) of the additional costs associated with domestic violence is supported by the NHS, where consultations and drugs are the most important contributors of such costs. Health consequences of domestic violence result from losses in quality of life and worst health status of victims and correspond to additional permanent economic costs of domestic violence episodes.

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Dissertação apresentada na Faculdade de Ciências e Tecnologia da Universidade Nova de Lisboa para a obtenção do grau de Mestre em Engenharia do Ambiente, perfil Gestão e Sistemas Ambientais

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The participation of the Fraunhofer Institute for Manufacturing Engineering and Automation IPA (Stuttgart, Germany) and the companies User Interface Design GmbH (Ludwigsburg, Germany) plus MLR System GmbH (Ludwigsburg, Germany) enabled the research and findings presented in this paper; we would like to namely mention Birgit Graf and Theo Jacobs (Fraunhofer IPA) furthermore Peter Klein and Christiane Hartmann (User Interface Design GmbH).

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The synthetic study of the uppermost Cretaceous of the Beira Litoral (fauna, floral confirms its upper Campanian-Maastrichtian age. It shows the presence of a tropical to subtropical climate in an area constituted by a low coastal plain only occasionally linked to the sea, saturared with fresh water and possessing accordingly, a predominantely freshwater fauna (Viso, Aveiro); this plain changed towards the interior into a drier more forested zone with a more abundant terrestrial fauna which includes mammals (Taveiro). A thorough study of the chelonian Rosasia, abundant on the coastal plain, was made possible thanks to the discovery of a skull: it demonstrates that the genus belongs to the family Bothremydidae, revalided here. The composition of this family is presented, its phylogenetic and paleobiogeographic relation with the other pleurodires are analyzed, and its diagnosis established. The family is constituted of three groups; Rosasia belongs to one of rhese, the Bothremys group.

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The reef levels of the gulf of skoura belong to the reef formation of the Upper Miocene of the South-Rifan straits. A detailed analysis of the vertical distribution of various forms of colonies has led to the establishment of precise coral morphologies zonation. This palaeoecological approach leads us to distinguish between two environments in the Skoura gulf, probably corresponding to two reef episodes. The palaeogeographical implications (relationships between the Atlantic ocean and the Mediterranean sea) will be pointed out.

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A rich uppermost Miocene selachian fauna from the Alvalade Basin (represented by more than 10.000 teeth) is accounted for. It is the most modern miocene fauna of neritic habit under warm-temperate to subtropical conditions, known in the european Miocene.

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An Upper Miocene important sedimentary break can be accurately recognised in the Portuguese basins and is reflected by a drastic palaeogeographic change in relation to a large-scale tectonic event of probable uppermost Vallesian-Turolian (9,5 Ma; middle Tortonian) age. The characterisation of the sedimentary record of this tectonic event, as well as its relations with interpreted active faults is made for different situations: Douro (NW border), Mondego, Lower-Tagus and Sado Tertiary basins. The sedimentary record, considered upper Tortonian-Messinian ? (uppermost Vallesian-Turolian ?) is interpreted mainly as endorheic alluvial fans (internal drainage), developed along active NNE-SSW indent-linked strike-slip faults and NE-SW reverse faults. At NE Portugal, proximal fluvial systems of an endorheic hydrographic network drained eastwards to the Spanish Duero interior Basin. The main evidences of the betic compression clímax in Portugal mainland are presented; the interpreted active tectonic structures are in accordance with an intense NNW-SSE crustal shortening, but some regional differences are also documented.

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Dissertação de Mestrado em Engenharia Informática

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An individual experiences double coverage when he bene ts from more than one health insurance plan at the same time. This paper examines the impact of such supplementary insurance on the demand for health care services. Its novelty is that within the context of count data modelling and without imposing restrictive parametric assumptions, the analysis is carried out for di¤erent points of the conditional distribution, not only for its mean location. Results indicate that moral hazard is present across the whole outcome distribution for both public and private second layers of health insurance coverage but with greater magnitude in the latter group. By looking at di¤erent points we unveil that stronger double coverage e¤ects are smaller for high levels of usage. We use data for Portugal, taking advantage of particular features of the public and private protection schemes on top of the statutory National Health Service. By exploring the last Portuguese Health Survey, we were able to evaluate their impacts on the consumption of doctor visi

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Dissertation presented to obtain the Ph.D degree in Developmental Biology