Informal care for stroke survivors. Results from the North East Melbourne stroke incidence study (NEMESIS)

Background and Purpose-: Informal caregivers play an important role in the lives of stroke patients, but the cost of providing this care has not been estimated. The purpose of this study was to determine the nature and amount of informal care provided to stroke patients and to estimate the economic cost of that care.

Methods-: The primary caregivers of stroke patients registered in the North East Melbourne Stroke Incidence Study (NEMESIS) were interviewed at 3, 6, and 12 months after stroke, and the nature and amount of informal care provided were documented. The opportunity and replacement costs of informal care for all first-ever-in-a-lifetime strokes (excluding subarachnoid hemorrhages) that occurred in 1997 in Australia were estimated.

Results-: Among 3-month stroke survivors, 74% required assistance with activities of daily living and received informal care from family or friends. Two thirds of primary caregivers were women, and most primary caregivers (>90%) provided care during family or leisure time. Total first-year caregiver time costs for all first-ever-in-a-lifetime strokes were estimated to be A$21.7 million (opportunity cost approach) or A$42.5 million (replacement cost approach), and the present values of lifetime caregiver time costs were estimated to be A$171.4 million (opportunity cost approach) or A$331.8 million (replacement cost approach).

Conclusions-: Informal care for stroke survivors represents a significant hidden cost to Australian society. Because our community is rapidly aging, this informal care burden may increase significantly in the future.

Out of pocket costs to stroke patients during the first year after stroke - results from the North East Melbourne stroke incidence study

Non-reimbursed ‘out of pocket’ costs to stroke patients have not been included in existing cost of illness studies. We aimed to determine the nature and magnitude of ‘out of pocket’ costs to stroke patients during the first year after stroke. ‘Out of pocket’ costs during the first year after stroke were documented for 165 persons registered in a community-based stroke incidence study during 1996/1997. Virtually all cases reported some ‘out of pocket’ costs. The average cost over 12 months was A$1110. The highest cost items were home modifications, aids and equipment. The most commonly incurred expense was for prescription medications. Total ‘out of pocket’ costs incurred by first-ever stroke patients in Australia in 1997 were estimated to be A$29 million or 5% of the total cost of stroke. The majority of ‘out of pocket’ costs relate to post-acute care aimed at minimising disability and handicap rather than to ‘acute’ healthcare.

Evaluation of the childhood obesity prevention program kids - go for your life

Background
Kids - 'Go for your life' (K-GFYL) is an award-based health promotion program being implemented across Victoria, Australia. The program aims to reduce the risk of childhood obesity by improving the socio-cultural, policy and physical environments in children's care and educational settings. Membership of the K-GFYL program is open to all primary and pre-schools and early childhood services across the State. Once in the program, member schools and services are centrally supported to undertake the health promotion (intervention) activities. Once the K-GFYL program 'criteria' are reached the school/service is assessed and 'awarded'. This paper describes the design of the evaluation of the statewide K-GFYL intervention program.

Methods/Design
The evaluation is mixed method and cross sectional and aims to:
1) Determine if K-GFYL award status is associated with more health promoting environments in schools/services compared to those who are members only;
2) Determine if children attending K-GFYL award schools/services have higher levels of healthy eating and physical activity-related behaviors compared to those who are members only;
3) Examine the barriers to implementing and achieving the K-GFYL award; and
4) Determine the economic cost of implementing K-GFYL in primary schools
Parent surveys will capture information about the home environment and child dietary and physical activity-related behaviors. Environmental questionnaires in early childhood settings and schools will capture information on the physical activity and nutrition environment and current health promotion activities. Lunchbox surveys and a set of open-ended questions for kindergarten parents will provide additional data. Resource use associated with the intervention activities will be collected from primary schools for cost analysis.

Discussion
The K-GFYL award program is a community-wide intervention that requires a comprehensive, multi-level evaluation. The evaluation design is constrained by the lack of a non-K-GFYL control group, short time frames and delayed funding of this large scale evaluation across all intervention settings. However, despite this, the evaluation will generate valuable evidence about the utility of a community-wide environmental approach to preventing childhood obesity which will inform future public health policies and health promotion programs internationally.

Trial Registration
ACTRN12609001075279

Quantifying the profile and progression of impairments, activity, participation, and quality of life in people with Parkinson disease : protocol for a prospective cohort study

Background Despite the finding that Parkinson disease (PD) occurs in more than one in every 1000 people older than 60 years, there have been few attempts to quantify how deficits in impairments, activity, participation, and quality of life progress in this debilitating condition. It is unclear which tools are most appropriate for measuring change over time in PD.
Methods and design This protocol describes a prospective analysis of changes in impairments, activity, participation, and quality of life over a 12 month period together with an economic analysis of costs associated with PD. One-hundred participants will be included, provided they have idiopathic PD rated I-IV on the modified Hoehn & Yahr (1967) scale and fulfil the inclusion criteria. The study aims to determine which clinical and economic measures best quantify the natural history and progression of PD in a sample of people receiving services from the Victorian Comprehensive Parkinson's Program, Australia. When the data become available, the results will be expressed as baseline scores and changes over 3 months and 12 months for impairment, activity, participation, and quality of life together with a cost analysis.
Discussion This study has the potential to identify baseline characteristics of PD for different Hoehn & Yahr stages, to determine the influence of disease duration on performance, and to calculate the costs associated with idiopathic PD. Valid clinical and economic measures for quantifying the natural history and progression of PD will also be identified.

Submission to the New Zealand Parliamentary Inquiry : New Zealand Convention Centre Bill 2013

The Bill outlines the overarching purpose of the NZICC Agreement ‘to provide economic benefits to New Zealanders’. It is really a form of PPP (Public Private Partnership) where the beneficiaries are said to be the Crown and SkyCity but the real payment comes from the losses of the (mainly) community members who will gamble on the expanded facilities outlined in the Agreement. The Howeth International Convention and Exhibition Centre study (2009) established a clear business case for an international convention centre; with an optimistic benefit-cost ratio of 1.433 (which translates into a benefit to the economy of $1.433
for ever $1 spent). Aside from the short-term stimulus to jobs of the construction phase, a convention centre with capacity for 1000 delegates would create about 800 new jobs and attract up to 35 additional conferences of between 150 and 2500 delegates per year (an additional 22,000 additional international visitors and more than 200,000 extra visitor days, worth approximately $85.4 million in tourism-related expenditure per year15. It is therefore questionable as to why this venture needs to be captured by gambling interests, which will also dictate the location. This points to the efficacy of a non-casino provider being able to tender for establishment of an International Convention Centre that could be run profitably without being part of the for-profit model based on expanded gambling machines/revenue.

Costs of bronchoalveolar lavage-directed therapy in the first 5 years of life for children with cystic fibrosis.

To determine whether bronchoalveolar lavage (BAL)-directed therapy for infants and young children with cystic fibrosis (CF), rather than standard therapy, was justified on the grounds of a decrease in average costs and whether the use of BAL reduced treatment costs associated with hospital admissions.

Economic evaluation of a group-based exercise program for falls prevention among the older community-dwelling population

BACKGROUND: Falls among older people are of growing concern globally. Implementing cost-effective strategies for their prevention is of utmost importance given the ageing population and associated potential for increased costs of fall-related injury over the next decades. The purpose of this study was to undertake a cost-utility analysis and secondary cost-effectiveness analysis from a healthcare system perspective, of a group-based exercise program compared to routine care for falls prevention in an older community-dwelling population.

METHODS: A decision analysis using a decision tree model was based on the results of a previously published randomised controlled trial with a community-dwelling population aged over 70. Measures of falls, fall-related injuries and resource use were directly obtained from trial data and supplemented by literature-based utility measures. A sub-group analysis was performed of women only. Cost estimates are reported in 2010 British Pound Sterling (GBP).

RESULTS: The ICER of GBP£51,483 per QALY for the base case analysis was well above the accepted cost-effectiveness threshold of GBP£20,000 to £30,000 per QALY, but in a sensitivity analysis with minimised program implementation the incremental cost reached GBP£25,678 per QALY. The ICER value at 95% confidence in the base case analysis was GBP£99,664 per QALY and GBP£50,549 per QALY in the lower cost analysis. Males had a 44% lower injury rate if they fell, compared to females resulting in a more favourable ICER for the women only analysis. For women only the ICER was GBP£22,986 per QALY in the base case and was below the cost-effectiveness threshold for all other variations of program implementation. The ICER value at 95% confidence was GBP£48,212 in the women only base case analysis and GBP£23,645 in the lower cost analysis. The base case incremental cost per fall averted was GBP£652 (GBP£616 for women only). A threshold analysis indicates that this exercise program cannot realistically break even.

CONCLUSIONS: The results suggest that this exercise program is cost-effective for women only. There is no evidence to support its cost-effectiveness in a group of mixed gender unless the costs of program implementation are minimal. Conservative assumptions may have underestimated the true cost-effectiveness of the program.

Remoção de óleos emulsificados por flotação por ar dissolvido

Neste trabalho estuda-se o processo de flotação por ar dissolvido (FAD) como método de remoção de óleos emulsificados. Realizou-se uma revisão bibliográfica tanto do processo de flotação como dos fundamentos físico-químicos envolvidos na estabilidade e flotação de emulsões. Foram realizados testes de estabilidade de emulsões, de FAD descontínuos e contínuos, utilizando-se emulsões de 1000 mg/l de Óleo diesel e heptano. Verificou-se a eficiência do sulfato de alumínio e de compostos poliméricos como agentes desestabilizantes. Estudou-se a influência do tipo e concentração dos agentes desestabilizantes, pH da emulsão, do tipo de água e agitação nos testes de estabilidade como também na flotação por ar dissolvido. Os resultados obtidos indicaram a viabilidade técnica da aplicação do processo para a clarificação de efluentes oleosos atingindo valores de turbidez residual satisfatórios (menores que 5 UNT). O sulfato de alumínio mostrou-se mais eficiente como agente desestabilizante de ambas emulsões nos estudos de estabilidade e testes de PAD descontínuos, mas o polímero catiônico C-505 apresentou melhores resultados nos testes de flotação contínuos. O presente trabalho ainda apresenta um estudo de dimensionamento e do custo da unidade de FAD para remoção de óleos emulsificados que leva em consideração os custos de investimentos e de operação da unidade. Verifica-se que o custo total da unidade depende da vazão de alimentação, taxa de recirculação, taxa ar/sólido em massa e concentração inicial de óleos. Conclui-se que para as taxas de ar/sólido usados na indústria (geralmente menores que 0,1) o custo operacional do reagente é o parâmetro determinante do custo total atualizado da unidade. Isto faz com que o custo total atualizado seja essencialmente independente da relação taxa de aplicação - taxa ar/sólido.

Estilo e agrupamento de fundos : um estudo aplicado aos fundos multimercados brasileiros

Uma classificação adequada de fundos é importante para que o investidor possa organizar a informação disponível de tal modo que possa tomar decisões de aplicação de seus recursos de forma eficiente. No Brasil, existem dois sistemas de classificação amplamente utilizados, o CVM e o ANBIMA, porem ambos possuem categorias com fronteiras subjetivas, isto é, possuem um elevado grau de arbitrariedade na definição de suas categorias, este fato prejudica uma alocação eficiente por parte do investidor. Fundos multimercado são fundos que possuem política de investimento que envolvem vários fatores de risco sem concentração em nenhum fator especial, diferentemente das outras classes de fundos do mercado brasileiro. Sob este aspecto, uma categorização adequada dos fundos multimercados traria inúmeros benefícios tais como a redução do custo de análise, a maior facilidade no processo de tomada de decisão de investimento, uma diversificação mais eficiente, clareza na comparação de desempenho e o melhor entendimento dos riscos incorridos dentre outros benefícios. O presente trabalho tem como objetivo, utilizando-se da já consagrada técnica de análise de estilo de Sharpe (1992), decompor a exposição de cada fundo em seus principais fatores de risco, após isto, utilizar-se da análise de cluster para agrupar os fundos de forma coerente a suas exposições, tentando assim fazer um classificação mais eficiente; isto seria um contraponto a classificação mais utilizada pelo mercado brasileiro, a classificação Anbima, que se baseia no regulamento do fundo, isto é, no que o fundo “pode” investir, e não no que o fundo efetivamente investe.

Satisfação da equipe de enfermagem do serviço de atendimento móvel às urgências (SAMU) no ambiente de trabalho

Descriptive exploratory study, prospective with quantitative approach, performed on the Medical Regulation Central of SAMU/Natal, aiming to identify the level of professional satisfaction of the members of the nursing team working at SAMU/Natal; and verify the degree of importance attributed by the professionals to each of the components Professional Satisfaction: autonomy, interaction, professional status , work requirements, organizational rules and remuneration. The population was of 60 professionals, with data collected from january to february 2005. We used an instrument translated and validated by Lino (1999) to the portuguese language, the Professional Satisfaction Rate (PSR). The results demonstrate that there was a slight predominance of the female gender (54,9%); aged between 36 and 45 years old (60,8%); married (58,8%), 82,4% with children, 30,8% aged between 05 and 09. Regarding formation, we observed that 78,4% were nursing technicians and 21,6% nurses, formed for 11 to 15 years (17,5%). From the 11 nurses, 09 (81,8%) informed they have specialization, 29,4% of the team has been working for 11 to 15 years on the urgency area, 58.8% works for more than 02 years on SAMU, 72,6% of the team members have fixed work schedules. There was homogeneity on the work shifts: 41,2% on the day shift and 53% on the night shift. Regarding the reason to be working on SAMU, 64% chose to work in the service, and among these 76,3% predominantly perform direct care to the patients, 96,1% like and are satisfied to work in the service. Regarding the remuneration, 90,9% informed they receive 05 to 10 minimum wages; 70% of the technicians informed they receive -2 to 05 minumum wages, 50,1% informed they receive no additional benefit. The analysis of PSR through Cronbach s Alpha Coeficient resulted on the value of 0,94 and through Kendall s Tau Coeficient on 0,87, demonstrating to be a trustworthy instrument to measure the level of professional satisfaction of the SAMU nursing team, in our environment. As for the level of importance attributed to the components of professional satisfaction, we indentified that the nursing team considered the Autonomy component as the most important, followed by the component Remuneration, Interaction, Work Requirements, Work Requirements, Organizational Rules and Professional Status . Regarding the current level of professional satisfaction, we identified they were most satisfied with the Professional Status , Autonomy, Interaction, Remuneration, Work Requirements and Organizational Rules. The real professional satisfaction level, calculated through statistics, however, tells these professionals are more satisfied with Autonomy, Remuneration, Interaction, Work Requirements, professional Status and Organizational Rules. The PSR in our work was of 8,6, indicating the SAMU Natal nursing team has little satisfaction on their work environment

Controlador adaptativo por posicionamento de pólos e estrutura variável aplicado ao controle de geradores eólicos baseados em máquina de indução duplamente alimentada

In the last decade, the renewable energy sources have present a major propulsion in the world due to several factors: political, environmental, financial and others. Within this context, we have in particular the energy obtained through wind, wind energy - that has highlighted with rapid growth in recent years, including in Brazil, mostly in the Northeast, due to it s benefit-cost between the clean energies. In this context, we propose to compare the variable structure adaptive pole placement control (VS-APPC) with a traditional control technique proportional integral controller (PI), applied to set the control of machine side in a conversion system using a wind generator based on Double-Fed Induction Generator (DFIG). Robustness and performance tests were carried out to the uncertainties of the internal parameters of the machine and variations of speed reference.

Avaliação econômica de sistemas agroflorestais implantados para recuperação de reserva legal no Pontal do Paranapanema, São Paulo

O Pontal do Paranapanema, extremo oeste do Estado de São Paulo, é conhecido em todo o Brasil devido aos conflitos pela posse da terra, protagonizados pelo Movimento dos Trabalhadores Rurais Sem Terra (MST), que transformou significativamente a paisagem da região, onde atualmente se observam pequenas ilhas de assentamentos rurais imersos numa matriz de grandes pastagens. O Código Florestal prevê que esses assentamentos, assim como qualquer propriedade rural, deve manter 20% de sua área com cobertura vegetal arbórea. Essa área, conhecida como Reserva Florestal Legal, deve ser restaurada, caso não exista. Assim, esta pesquisa se desenvolveu no assentamento Santa Zélia, Município de Teodoro Sampaio, São Paulo, numa área de 15 ha de Reserva Legal. Seis famílias desse assentamento foram responsáveis pela restauração da área, através de módulos agroflorestais (Taungya) temporários. Dois indicadores foram utilizados para avaliação econômica da produção agrícola na área: Valor Presente Líquido (VLP) e Relação Benefício-Custo (RB/C). Os resultados indicaram valores positivos em todas as famílias analisadas, levando à conclusão de que sistemas agroflorestais podem ser adotados na recuperação de áreas de reserva legal em propriedades rurais. Sua maior ou menor viabilidade econômica irá depender de um manejo mais intenso na área para produção agrícola e de preços satisfatórios para venda no mercado.

Transverse cylindrical grinding of a eutectic alloy

We report herein on a comparison of the performance of two different grinding wheels (conventional and CBN) in the transverse cylindrical grinding of a eutectic alloy. Three cutting conditions were tested: rough, semi-finishing and finishing. The parameters of evaluation were the cutting force, roughness and wheel wear. The optimal cutting force and roughness values were obtained when grinding with the conventional wheel, due to the superior dressing operation performed under every cutting condition tested. Although the CBN wheel presented the best G ratio values, they were lower than expected owing to the inappropriate dressing operation applied. Excessive wheel corner wear was detected in both wheels, caused by the grinding kinematics (transverse grinding) employed. In terms of cutting force and roughness, the conventional wheel proved to be the better choice under the conditions tested. However, in terms of the G ratio, a cost analysis is crucial to determine whether the differences between the wheels justify the use of the CBN wheel, in which case the dressing operation requires improvement.