Clearing the cloudy crystal balls: Hybrid modelling for energy and climate change mitigation scenarios – A case study for Portugal

Dissertação para obtenção do Grau de Doutor em Ambiente

Burden experienced by families of patients with schizophrenia and its related factors

RESUMO: Objetivo: Este estudo teve como objetivo avaliar a carga dos cuidadores de doentes com Esquizofrenia e avaliar a correlação com determinadas características demográficas dos doentes e dos cuidadores, assim como com o nível de emoção expressa na família. Métodos: Este estudo descritivo-analítico foi realizado em 172 doentes com Esquizofrenia e seus cuidadores primários, que foram selecionados em ambulatório, a partir da consulta externa do Hospital Psiquiátrico em Teerão, no Irão, mediante uma amostra de conveniência. Os cuidadores foram entrevistados utilizando as escalas Zarit Burden Interview e Family Questionnaire, de forma a avaliar a sobrecarga sentida pelos cuidadores e o nível de emoção expressa na família, respectivamente. Os dados foram analisados por meio de testes de Mann-Whitney, Kruskal-Wallis, e Spearman. Resultados: O nível de sobrecarga vivenciada pela maioria dos cuidadores primários foi moderada a grave. A pontuação obtida nas sub-escalas de comentários emocionais, envolvimento excessivo e comentários críticos foram maiores do que o ponto de corte em 51,7% e 64,5% dos cuidadores, respectivamente. Os resultados mostraram que as pontuações obtidas nas duas subescalas do questionário família tinham uma correlação significativa e direta com a carga experimentada pelos cuidadores. O nível de carga experimentada pelos cuidadores foi significativamente diferente entre os grupos de idade e estado civil dos cuidadores, e género, status ocupacional e estado civil dos doentes. O número de membros da família, as condições 5 de alojamento, o tempo gasto pelo cuidador com o paciente diariamente, o nível de renda familiar e a duração da doença afetaram significativamente o nível de carga experimentada pelo cuidador. Conclusão: Com base nos resultados, alguns fatores demográficos dos cuidadores, pacientes e seus familiares afetam significativamente a carga experimentada pelos cuidadores primários. A maioria das famílias dos pacientes têm alto nível de emoção expressa e existe uma significativa associação direta entre as emoções expressas e a carga experimentada.------------ABSTRACT: Aim: This study aimed to assess the burden experienced by the caregiver of patients with Schizophrenia, and evaluate its correlation with some demographic characteristics of patients, their caregivers, and the level of expressed emotion in the family. Methods: This descriptive-analytic study was conducted on 172 schizophrenic patients and their primary caregivers selected from the outpatient clinic of a mental hospital in Tehran, Iran using convenience sampling. Caregivers were evaluated with Zarit Burden Interview and Family Questionnaire to assess the burden experienced by the caregivers and the level of expressed emotion in the family, respectively. Data were analyzed using Mann-Whitney, Kruskal-Wallis, and Spearman’s tests. Results: The level of burden experienced by the majority of primary caregivers was moderate to severe. The scores obtained in the subscales of emotional over-involvement and critical comments were higher than the cutoff point in 51.7% and 64.5% of caregivers respectively. The results showed that the scores obtained in the two subscales of family questionnaire had a significant, direct correlation with the burden experienced by the caregivers. The level of burden experienced by the caregivers was significantly different between the subgroups of age and marital status of the caregivers, and gender, occupational status and marital status of the patients. Number of family members, home ownership status, time spent by the caregiver with the patient daily, level of family income and duration of disorder significantly affected the level of burden experienced by the caregiver. Conclusion: Based on the results, some demographic factors of the primary caregivers, patients and their family significantly affect the burden experienced by the primary caregivers. Most of the families of patients have high expressed emotions and a significant, direct association exists between the expressed emotions and the burden experienced.

Clinical and laboratory findings in patients with dengue associated with hepatopathy

INTRODUCTION: Hepatic disorders caused by dengue infection may progress to severe manifestations, including mortality and morbidity. Cytokines are involved in it, such as the migration inhibitory factor of macrophages (MIF), tumor necrosis factor (TNF), natural killer cells (NK), B lymphocytes, and macrophages. METHODS: This study was carried out from January to April 2007 at a public hospital from the Federal University of Mato Grosso do Sul, Campo Grande, Brazil. Sixty-eight patients were studied concerning hepatic alterations, with 56 reported having classic dengue, 6 with hemorrhagic dengue grade I, and 6 with hemorrhagic dengue grade II. RESULTS: Among the 56 with classic dengue, 83.3% had aspartate aminotransferase (AST) alterations, and 69.6% had altered alanine aminotransferase (ALT). For those with hemorrhagic dengue grade I, 100% had AST alterations, and 83.3% had altered ALT. All the patients with hemorrhagic dengue grade II had AST and ALT alterations. AST variations reached 22.0 and 907.0, with an average value of 164.6. For ALT, we found variations between 25.0 and 867.0, with an average value of 166.07. There had been statistical significance between dengue clinical shapes and hepatic function markers. CONCLUSIONS: We conclude that the infection was predominant in adults, females, and in those with low income and education. The liver enzymes were of larger amount in hemorrhagic dengue, but there was weak statistical evidence of the clinical manifestations and transaminases. Major signs and clinical symptoms were fever, headache, myalgia, arthralgia, weakness, severe pain behind the eyes, and rashes.

Spatio-temporal patterns of tuberculosis incidence in Ribeirão Preto, State of São Paulo, southeast Brazil, and their relationship with social vulnerability: a Bayesian analysis

INTRODUCTION: The purpose of this ecological study was to evaluate the urban spatial and temporal distribution of tuberculosis (TB) in Ribeirão Preto, State of São Paulo, southeast Brazil, between 2006 and 2009 and to evaluate its relationship with factors of social vulnerability such as income and education level. METHODS: We evaluated data from TBWeb, an electronic notification system for TB cases. Measures of social vulnerability were obtained from the SEADE Foundation, and information about the number of inhabitants, education and income of the households were obtained from Brazilian Institute of Geography and Statistics. Statistical analyses were conducted by a Bayesian regression model assuming a Poisson distribution for the observed new cases of TB in each area. A conditional autoregressive structure was used for the spatial covariance structure. RESULTS: The Bayesian model confirmed the spatial heterogeneity of TB distribution in Ribeirão Preto, identifying areas with elevated risk and the effects of social vulnerability on the disease. We demonstrated that the rate of TB was correlated with the measures of income, education and social vulnerability. However, we observed areas with low vulnerability and high education and income, but with high estimated TB rates. CONCLUSIONS: The study identified areas with different risks for TB, given that the public health system deals with the characteristics of each region individually and prioritizes those that present a higher propensity to risk of TB. Complex relationships may exist between TB incidence and a wide range of environmental and intrinsic factors, which need to be studied in future research.

Fiscal adjustments and sovereign default in different government systems

This paper extends the model of Spolaore (2004) about adjustments in di erent government systems for the context of scal adjustments and sovereign default. We introduce asymmetry between groups in income and preferences towards scal reforms. Default a ects di erently each group and becomes a possibility if reforms are not enacted after public nance solvency shocks, in uencing the political game according to its likelihood. With the extensions, new situations which were not possible with the previous framework arise. After the exposition of the model, the Argentine default in 2001 provides an example of the political con icts addressed by the model.

Decentralization and privatization in Portuguese health reforms

ABSTRACT - The Portuguese National Health Service (SNS), a universal, centralized and public owned health care system, exhibits an extraordinary record of equalization in the access to health care and health gains in the late thirty years. However, the most recent history of the Portuguese health reform is pervaded by the influence of decentralization and privatization. Decentralization has been present in the system design since the 1976 Constitution, at least in theory. Private ownership of health care suppliers and out-ofpocket expenditures, on the financing side, both have a long tradition of relevance in the NHS mix of services. The initial aim of this study was to demonstrate expected parallelism between health reforms and public administration reforms, where a common pattern of joint decentralization and privatization was observed in many countries. Observers would be tempted to consider these two movements as common signs of new public management (NPM) developments. They have common objectives, are established around the core concepts of gains in effectiveness, efficiency, equity and quality of public services, through improved accountability. However, in practice, in Portugal, each movement was developed in a totally separated way. Besides those rooted in the NPM theory, there are few visible signs of association between decentralization and privatization. Decentralization, in the Portuguese SNS, was never intended to be followed by a privatization movement; it was seen merely as a public administration tool. Private management of health services, as stated in the most recent SNS legislation, was never intended to have decentralization as a condition or as a consequence. Paradoxically, in the Portuguese context, it has led invariably to centralized control. While presented as separate instruments for a common purpose, the association between decentralization and privatization still lacks a convincing demonstration. Many common health care management stereotypes remain to be checked out if we want to look for eventual associations between these two organizational tools.

Analysis of factors and drivers in graduates success among Portugal, India and Italy- extracurricular activities before university

Field lab: Business project

Psychiatric morbidity and quality of life of primary care attenders in two cities in Brazil

Objective: To identify the associations among quality of life (QoL), social determinants and psychological distress in primary care in two cities in Brazil. Methods: A cross-sectional study with 1,466 patients from 2009 to 2010. The statistical analysis used the t-test to compare the variables of interest to the study. Results: The prevalence of Common Mental Disorders (CMD3), severe forms of Common Mental Disorders (CMD5), anxiety and depression were 20.5%, 32%, 37% and 25.1% respectively. Thes presence of psychological distress is associated with worse QoL among the patients studied, especially those older than 40 years of age. In cases of CMD3, those with higher income and educational levels presented higher QoL in the psychical and psychological domains. For the cases of probable anxiety, those with higher educational levels presented lower scores on the physical and social relationship scores. Conclusion: Psychological distress can be associated with a worse QoL among those studied and can be influenced by socioeconomic conditions. Therefore, it is important to structure patient-centered help, which should also include patients’ social contexts.

Glazing daylighting performance and Trombe wall thermal performance of a modular façade system in four different Portuguese cities

This paper reports on a new façade system that uses passive solutions in the search for energy efficiency. The differentials are the versatility and flexibility of the modules, which are important advantages of the system. The thermal performance of Trombe walls and glazings and the daylighting performance of glazing were the key aspects analyzed in the results. Computational simulations were accomplished for the thermal performance of different arrangements of the modules with DesignBuilder software. The glazing daylighting performance was studied by means of Ecotect and Desktop Radiance programs and compared with the transmittance curves of glazings. Occupancy profile and internal gains were fixed according to the Portuguese reality for both studies. The main characteristics considered in this research were the use of two double glazings, four different climates in Portugal and one and two Trombe walls in the façade. The results show an important reduction in the energy consumption with the use of Trombe walls and double self-cleaning glazing in the façade, which also presented better daylighting performance.

Current Account imbalances, thriftiness and the real exchange rate in a growing economy

This paper analyses the theoretical relevance of the dynamical aspects of growth on the discussion about the observed positive correlation between per capita real income and real exchange rates. With this purpose, we develop a simple exogenous growth model where the internal, external and intertemporal equilibrium conditions of a typical macroeconomic model are imposed; this last one through the inclusion of a balanced growth path for the foreign assets accumulation. The main result under this consideration is that the relationship defended by the Balassa-Samuelson hypothesis is no more so straightforward. In our particular approach, the mentioned bilateral relationship depends on a parameter measuring thriftiness in the economy. Therefore, the probability of ending up with a positive relationship between growth and real exchange rates -as the classical economic theory predicts- will be higher when the economy is able to maintain a minimum saving ratio. Moreover, given that our model considers a simple Keynesian consumption function, some explosive paths can also be possible.

Interactions between product and labour market reforms

Labour market reforms face very often opposition from the employed workers, because it normally reduces their wages. Also product market regulations are regularly biased towards too much benefitting the firms. As a result there remain many frictions in both the labour and product markets that hinder an optimal functioning of the economy. These issues have recently received a lot of attention in the economics literature and scholars have been looking for politically viable reforms in both markets. However, despite its potential importance, there has been done virtually no research on the interaction between reforms in product and labour markets. We find that when combining reforms, the opposition for reforms decreases considerably. This is because there exist complementarities and the gains in total welfare can be more evenly distributed over the interest groups. Moreover, the interaction of reforms offers a way out for the so-called 'sclerosis' effect.

Recent trends in Spanish income distribution: a robust picture of falling income inequality

Income distribution in Spain has experienced a substantial improvement towards equalisation during the second half of the seventies and the eighties; a period during which most OECD countries experienced the opposite trend. In spite of the many recent papers on the Spanish income distribution, the period covered by those stops in 1990. The aim of this paper is to extent the analysis to 1996 employing the same methodology and the same data set (ECPF). Our results not only corroborate the (decreasing inequality) trend found by others during the second half of the eighties, but also suggest that this trend extends over the first half of the nineties. We also show that our main conclusions are robust to changes in the equivalence scale, to changes in the definition of income and to potential data contamination. Finally, we analyse some of the causes which may be driving the overall picture of income inequality using two decomposition techniques. From this analyses three variables emerge as the major responsible factors for the observed improvement in the income distribution: education, household composition and socioeconomic situation of the household head.

Petrol consumption and redistributive effects of its taxation in Spain

The objective of this paper is to estimate a petrol consumption function for Spain and to evaluate the redistributive effects of petrol taxation. We use micro data from the Spanish Household Budget Survey of 1990/91 and model petrol consumption taking into account the effect that income changes may have on car ownership levels, as well as the differences that exist between expenditure and consumption. Our results show the importance that household structure, place of residence and income have on petrol consumption. We are able to compute income elasticities of petrol expenditure, both conditional and unconditional on the level of car ownership. Non-conditional elasticities, while always very close to unit values, are lower for higher income households and for those living in rural areas or small cities. When car ownership levels are taken into account, conditional elasticities are obtained that are around one half the value of the non- conditional ones, being fairly stable across income categories and city sizes. As regards the redistributive effects of petrol taxation, we observe that for the lowest income deciles the share of petrol expenditure increases with income, and thus the tax can be regarded as progressive. However, after a certain income level the tax proves to be regressive.

A Computable general equilibrium approach to hypothetical extractions and missing links

Identifying key sectors or key locations in an interconnected economy is of paramount importance for improving policy planning and directing economic strategy. Hence the relevance of categorizing them and hence the corresponding need of evaluating their potential synergies in terms of their global economic thrust. We explain in this paper that standard measures based on gross outputs do not and cannot capture the relevant impact due to self- imposed modeling limitations. In fact, common gross output measures will be systematically downward biased. We argue that an economy wide Computable General Equilibrium (CGE) approach provides a modeling platform that overcomes these limitations since it provides (i) a more comprehensive measure of linkages and (ii) an alternate way of accounting for links' relevance that is in consonance with standard macromagnitudes in the National Income and Product Accounts.

Ten Propositions on Rural Poverty and Agrarian Transition in Central Eurasia

The relation between agricultural development and rural poverty reduction in six Central Eurasian countries, namely Azerbaijan (South Caucasus) and Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan (Central Asia), is discussed by presenting and analyzing ten propositions. These propositions cover a broad range of issues that relate to rural poverty in this region, such as: the state of income and non-income poverty; the diverse processes of land reform and farm restructuring, and agricultural policy reform; and finally, the institutional and market framework that is needed for dynamic agricultural and rural development. The paper contends that rural poverty is not responding as robustly to rapid economic growth in these countries, and that agricultural growth, in particular in the newly emerging peasant farm sector, is necessary to promote rural poverty reduction.