Desigualdades sociais em saúde nos idosos : um retrato para Portugal

RESUMO - Contexto: As desigualdades sociais em saúde são uma questão central de justiça social. No contexto de forte envelhecimento populacional em Portugal, as desigualdades nos idosos representam um desafio crucial para o futuro, sobre as quais existe pouca evidência. Este estudo pretende investigar a existência de desigualdades socioeconómicas em saúde nos idosos, em Portugal. Metodologia: Foram utilizados os dados para Portugal, da quarta vaga do Survey of Health, Ageing and Retirement in Europe. O estudo engloba 2017 indivíduos com 50 ou mais anos. Foram utilizados quatro indicadores de saúde: problemas de saúde, saúde auto-reportada, doenças de longa duração e atividade limitada. Foi utilizado o nível de educação como indicador socioeconómico. As desigualdades socioeconómicas foram avaliadas através de regressões logísticas multivariadas. Resultados: Existem desigualdades socioeconómicas em saúde nos idosos favoráveis aos mais educados. Os indivíduos com menor educação estão em maior risco de reportar má saúde (OR=5,5); maior risco em ter problemas de saúde, existindo um gradiente social na Hipertensão Arterial (OR=2,4) e na Artrite (OR=7,0); maior risco de doenças de longa duração (OR=1,6) e maior risco de limitação nas atividades diárias (OR=5,1). As desigualdades socioeconómicas diminuem com a idade. Conclusão: De forma a melhorar a saúde e reduzir as desigualdades socioeconómicas em saúde nos idosos, os resultados apontam para a necessidade de implementar medidas no âmbito dos problemas de saúde em que existe um gradiente social, melhorar o nível de educação da população geral e implementar medidas de educação para a saúde, aumentando a literacia em saúde nos idosos mais jovens.

Acute renal failure due to abdominal compartment syndrome: report on four cases and literature review

We report on 4 cases of abdominal compartment syndrome complicated by acute renal failure that were promptly reversed by different abdominal decompression methods. Case 1: A 57-year-old obese woman in the post-operative period after giant incisional hernia correction with an intra-abdominal pressure of 24 mm Hg. She was sedated and curarized, and the intra-abdominal pressure fell to 15 mm Hg. Case 2: A 73-year-old woman with acute inflammatory abdomen was undergoing exploratory laparotomy when a hypertensive pneumoperitoneum was noticed. During the surgery, enhancement of urinary output was observed. Case 3: An 18-year-old man who underwent hepatectomy and developed coagulopathy and hepatic bleeding that required abdominal packing, developed oliguria with a transvesical intra-abdominal pressure of 22 mm Hg. During reoperation, the compresses were removed with a prompt improvement in urinary flow. Case 4: A 46-year-old man with hepatic cirrhosis was admitted after incisional hernia repair with intra-abdominal pressure of 16 mm Hg. After paracentesis, the intra-abdominal pressure fell to 11 mm Hg.

`When I'm sixty-four': old age, family values, and private financial transfers

Private financial transfers are becoming more and more important as ageing levels increase in Europe, with elders acting as both givers and receivers. Our study is divided in two main parts. In the first part we analyse the determinants of private financial transfers, using the Survey of Health, Ageing, and Retirement in Europe (SHARE). In the second part we analyse the importance of family values for these transfers, combining SHARE with European Values Study. We show that family functions as the main agent of private transfers. We conclude that family values drive financial transfers, mainly gifts provided by elderly individuals. We find that receipts by old-aged people are more related with need cases, such as illness and poorness; moreover, for these particular cases, family network plays a very important role, working as a safety net.

Factors that determine the level of care children and adolescents experiencing mental disorders receive

RESUMO: Resumo Uma prestação de serviços de saúde mental para crianças e adolescentes (CAMHS) oportuna, eficaz e baseada na evidência pode evitar incapacidade a longo prazo. No entanto, estes serviços são criticamente sub-financiados em todo o mundo. É um imperativo garantir que este precioso recurso não seja desperdiçado. Os governos e outras partes interessadas relevantes na área da saúde mental precisam de conhecer o estado de saúde mental da população, quais os recursos disponíveis e como melhor utilizar os recursos disponíveis para orientar uma política e decisões efectivas sobre os níveis de serviços. Objetivo: O objetivo deste artigo é explorar o papel da acuidade, gravidade e complexidade na determinação dos cuidados em saúde mental especializados recebidos por crianças e adolescentes que sofrem perturbações mentais. Métodos: Este estudo é exploratório envolvendo uma revisão sistemática da literatura. Foi realizada uma pesquisa com palavras-chave utilizando bases de dados PsychINFO, EMBASE, PubMed e MEDLINE. A literatura cinzenta também foi investigada com um enfoque nas abordagens sistémicas, organizacionais e políticas para a organização e comissionamento de CAMHS. Foram selecionados apenas documentos escritos em Inglês. Três países, Bélgica, Reino Unido e Estados Unidos, todos eles com modelos muito diferentes de organização de CAMHS, foram revistos para investigar de que forma os conceitos de acuidade, gravidade e complexidade foram utilizados na sua concepção de serviços para determinar o nível da assistência prestada. Resultados: Nem a Bélgica, nem o modelo norte-americano de CAMHS organização de serviço parecem estar alinhados com os principais conceitos na determinação do nível de prestação de serviços. O sistema de serviços do Reino Unido de CAMHS está mais estreitamente alinhado com esses conceitos e tem uma alocação de recursos mais equilibrada entre o hospital e a comunidade. O seu ponto fraco está na falta de flexibilidade entre os níveis de serviço e na falta de apoio para com o sector dos cuidados de saúde primários. Conclusões: A variabilidade na alocação de recursos a diferentes níveis especializados de CAMHS (em regime de internamento, ambulatório, e na comunidade) e o modelo diferente de estrutura de serviços entre os países estudados indica uma inconsistência na forma como as crianças e adolescentes que apresentam aos CAMHS são referenciados para os cuidados que recebem. Isto põe em questão se as crianças e adolescentes com perturbações mentais estão a receber o nível e tipo de cuidados concordantes com as suas necessidades. A concepção e o comissionamento de sistemas de CAMHS levam-nos à discussão de uma série de princípios fundamentais que devem ser considerados. O sistema perfeito no entanto, ainda está para ser encontrado. -------------------------------- ABSTRACT: Provision of timely, effective, evidence based mental health services to children and adolescents can prevent long term impairment, but they are critically underfunded across the globe. There is an imperative to ensure this precious resource is not wasted. Governments and other relevant mental health stakeholders need to know the mental health status of the population, what resources are available and how best to use the resources available to guide effective policy and decisions about service levels. Aim: The aim of this paper is to explore the role of acuity, severity and complexity in determining the specialist mental health care that children and adolescents experiencing mental disorders receive. Methods: This study is exploratory involving a systematic scan of the literature. A key word search was conducted using databases PSYCHINFO, EMBASE, PUBMED and MEDLINE. Grey literature was also searched to focus on systemic, organisational and policy approaches to the organisation and commissioning of CAMHS. Only documents written in English were selected. Three countries Belgium, UK and the US all with very different models of service organisation for CAMHS were reviewed to investigate how well the concepts of acuity, severity and complexity were used to determine the level of care delivered in their service design. Findings: Neither the Belgium nor the US model of CAMHS service organisation appear to align with the key concepts driving intensity of level of service provision. The UK CAMHS service system most closely aligns with the concepts. It has a more balanced resource allocation between hospital and community. Its downfall is in its lack of flexibility between service levels and its lack of support for the primary care sector. Conclusions: The variability in resource allocation to different service levels (inpatient, outpatient, community) within specialist CAMHS and the differing model of service structure across countries indicates an inconsistency in how children and adolescents presenting to CAMHS are allocated to the care they receive. This puts into question whether children and adolescent with mental disorders are receiving a level and type of care commensurate with their needs. In commissioning and designing CAMHS systems a number of key principles that should be considered are discussed. The perfect system however, is yet to be found.

Four new species of Wing Rolling Neodawnaria (Homoptera : Derbidae) from the Amazon Basin

Four new species of Neidawnaria are described, and compared with other members of the genus. Keys and geographical distribution are given for all nem species and the wings of two other species are illustrated.

The perfect paint in modern art conservation: a comparative study of 21st century vinyl emulsions

Contemporary painting places, and will continue to place, several questions about its meaning, its chemical nature, its durability and the best way to preserve it. This research aims at putting together comprehensive data on vinyl based paints, including their components, their properties, their aging behavior and their response to selected cleaning products. In this project degradation mechanisms of vinyl binders and formulations used in the 20th and 21st century were studied. Stability over time of selected vinyl polymers was assessed through natural indoor and artificially aging. The objective was to enhance knowledge and understanding of vinyl emulsion formulations and their performance over time. Overall conservation state of pictorial layers namely, adhesion, cohesion and discoloration of selected case studies from the Portuguese artist Julião Sarmento (b.1948) was correlated with the observed molecular level changes studied in laboratory experiments. Sarmento’s paintings were chosen due to conservation concerns (discoloration) on some of his works from the 90’s. Besides, research was carried out to start increasing the knowledge of what can be expected of PVAc based paints in terms of response to conservation treatments namely, surface cleaning. Artificial aging showed that the most recent formulations which are based on a poly(vinyl acetate), poly(vinyl chloride) and polyethylene terpolymer are less stable when compared to some homopolymer formulations. From the four pigments studied, titanium dioxide rutile and a carbon based black proved to be stabilizers for both types of polymer. The mixture lithopone plus calcium carbonate has showed to have a photocatalytic effect on the binders. The studied paintings showed to be in an overall good state of conservation except for the paintings created in the 90’s with white glue and a mixture of white lithoponeand calcium carbonate. Discoloration of this white paint seems to be irreversible and ongoing and is still a major concern. The disapearance of the plasticizer was the only change detected. The current works created by Sarmento are expected to be more stable as they were painted using the rutile titanium dioxide. Immersion/cleaning tests showed that vinyl based paints can be susceptible to water and organic solvents like ethanol as some evidences point to the removal/diffusion of additives from the paint. The observations made point to the need to further proceed in this research field.

Peer interaction and learning opportunities in cohesive and less cohesive L2 classrooms

The present study investigates peer to peer oral interaction in two task based language teaching classrooms, one of which was a self-declared cohesive group, and the other a self- declared less cohesive group, both at B1 level. It studies how learners talk cohesion into being and considers how this talk leads to learning opportunities in these groups. The study was classroom-based and was carried out over the period of an academic year. Research was conducted in the classrooms and the tasks were part of regular class work. The research was framed within a sociocognitive perspective of second language learning and data came from a number of sources, namely questionnaires, interviews and audio recorded talk of dyads, triads and groups of four students completing a total of eight oral tasks. These audio recordings were transcribed and analysed qualitatively for interactions which encouraged a positive social dimension and behaviours which led to learning opportunities, using conversation analysis. In addition, recordings were analysed quantitatively for learning opportunities and quantity and quality of language produced. Results show that learners in both classes exhibited multiple behaviours in interaction which could promote a positive social dimension, although behaviours which could discourage positive affect amongst group members were also found. Analysis of interactions also revealed the many ways in which learners in both the cohesive and less cohesive class created learning opportunities. Further qualitative analysis of these interactions showed that a number of factors including how learners approach a task, the decisions they make at zones of interactional transition and the affective relationship between participants influence the amount of learning opportunities created, as well as the quality and quantity of language produced. The main conclusion of the study is that it is not the cohesive nature of the group as a whole but the nature of the relationship between the individual members of the small group completing the task which influences the effectiveness of oral interaction for learning.This study contributes to our understanding of the way in which learners individualise the learning space and highlights the situated nature of language learning. It shows how individuals interact with each other and the task, and how talk in interaction changes moment-by-moment as learners react to the ‘here and now’ of the classroom environment.

The relationship between the education level of successor's and the firm performance in German publicly listed family firms- an empirical analysis

The purpose of this thesis is to investigate how far the education level of the second or third generation of publicly traded German family firms affects the post-succession firm performance. By conducting a correlational and regression design, the aim is to examine how several variables influence the performance of family firms. Performance measures, for example ROA and Tobin’s q and variables, like Education level and succession periods, examine analytically that a positive succession trend will occur. However, with the used model, only a less rigid model shows empirical evidence.

Return on assets in the Tobacco Industry analysis of the four main Tobacco Manufacturers

This paper studies operating profitability drivers in the Four Main Tobacco Manufacturers for the period 2004-2014. The operating profitability is analyzed as return on assets (ROA) based on the DuPont Extended Model breakdown in degree of operational risk, gross sales margin and assets turnover. The sources of ROA are market share and price strategies appraised through the drivers: firm-size, global value and strategic choices. Using consolidated data, results suggest that firm-size and global value holds a positive relationship with ROA. Also innovation through less harmful tobacco products can lead to better ROA despite no correlation between R&D and ROA.

How small accounting firms can compete in an environment in which the big four are getting bigger

This paper sets out to determine how small accounting firms can compete in the United States in the early 21st century. The first chapter identifies the central goal of the paper: namely, to use existing literature and market data to define a business strategy for Ross & Moncure, Inc., a small accounting firm in the metropolitan Washington area. The second chapter is a literature review, and in it the author finds that large accounting firms are advantaged in terms of reputation, ability to diversify, and ability to retain employees, but are disadvantaged in their ability to form longstanding successful relationships with clients. In the third chapter, the author explores the relationship between the Big Four firms and their employees. The goal of this chapter is to determine how small accounting firms can compete for top talent in the HR market, and the author finds that this can be done by offering faster career progression and more client interaction. The fourth chapter looks at the market for accounting services in the United States, exploring the different options that consumers have to meet their accounting needs. It is found in this chapter that big and small accounting firms tend to compete for clients of different profiles. In the fifth chapter, the author uses proprietary company data to explore the composition, existing strategy and culture of Ross & Moncure. In the sixth chapter, all of the previous chapters come together to formulate a strategy and plan for action for Ross & Moncure: specifically, that the firm should further cultivate networks and relationships, and should create a fulfilling professional environment by increasing client-employee interaction, encouraging external education, and allowing employees to take on many different projects

Contributions towards smart cities : exploring block level census data for the characterization of change in Lisbon

The interest in using information to improve the quality of living in large urban areas and its governance efficiency has been around for decades. Nevertheless, the improvements in Information and Communications Technology has sparked a new dynamic in academic research, usually under the umbrella term of Smart Cities. This concept of Smart City can probably be translated, in a simplified version, into cities that are lived, managed and developed in an information-saturated environment. While it makes perfect sense and we can easily foresee the benefits of such a concept, presently there are still several significant challenges that need to be tackled before we can materialize this vision. In this work we aim at providing a small contribution in this direction, which maximizes the relevancy of the available information resources. One of the most detailed and geographically relevant information resource available, for the study of cities, is the census, more specifically the data available at block level (Subsecção Estatística). In this work, we use Self-Organizing Maps (SOM) and the variant Geo-SOM to explore the block level data from the Portuguese census of Lisbon city, for the years of 2001 and 2011. We focus on gauging change, proposing ways that allow the comparison of the two time periods, which have two different underlying geographical bases. We proceed with the analysis of the data using different SOM variants, aiming at producing a two-fold portrait: one, of the evolution of Lisbon during the first decade of the XXI century, another, of how the census dataset and SOM’s can be used to produce an informational framework for the study of cities.

Implementation of a probabilistic based framework for safety assessment of existing timber elements

The assessment of existing timber structures is often limited to information obtained from non or semi destructive testing, as mechanical testing is in many cases not possible due to its destructive nature. Therefore, the available data provides only an indirect measurement of the reference mechanical properties of timber elements, often obtained through empirical based correlations. Moreover, the data must result from the combination of different tests, as to provide a reliable source of information for a structural analysis. Even if general guidelines are available for each typology of testing, there is still a need for a global methodology allowing to combine information from different sources and infer upon that information in a decision process. In this scope, the present work presents the implementation of a probabilistic based framework for safety assessment of existing timber elements. This methodology combines information gathered in different scales and follows a probabilistic framework allowing for the structural assessment of existing timber elements with possibility of inference and updating of its mechanical properties, through Bayesian methods. The probabilistic based framework is based in four main steps: (i) scale of information; (ii) measurement data; (iii) probability assignment; and (iv) structural analysis. In this work, the proposed methodology is implemented in a case study. Data was obtained through a multi-scale experimental campaign made to old chestnut timber beams accounting correlations of non and semi-destructive tests with mechanical properties. Finally, different inference scenarios are discussed aiming at the characterization of the safety level of the elements.

Avaliação do desempenho de fundos de investimento de obrigações: evidência para o mercado Brasileiro

Dissertação de mestrado em Finanças

Three-phase three-level current-source converter for EVs fast battery charging systems

This paper presents a three-phase three-level fast battery charger for electric vehicles (EVs) based in a current-source converter (CSC). Compared with the traditional voltage-source converters used for fast battery chargers, the CSC can be seen as a natural buck-type converter, i.e., the output voltage can assume a wide range of values, which varies between zero and the maximum instantaneous value of the power grid phase-to-phase voltage. Moreover, using the CSC it is not necessary to use a dc-dc back-end converter in the battery side, and it is also possible to control the grid current in order to obtain a sinusoidal waveform, and in phase with the power grid voltage (unitary power factor). Along the paper is described in detail the proposed CSC for EVs fast battery charging systems: the circuit topology, the power control theory, the current control strategy and the grid synchronization algorithm. Several simulation results of the EV fast battery charger operating with a maximum power of 50 kW are presented.

Comparing standard and low-cost tools for gradient evaluation along potential cycling paths

Promoting the use of non-motorized modes of transport, such as cycling, is an important contribution to the improvement of mobility, accessibility and equity in cities. Cycling offers a fast and cheap transportation option for short distances, helping to lower pollutant emissions and contributing to a healthier way of life. In order to make the cycling mode more competitive in relation to motorized traffic, it is necessary to evaluate the potential of alternatives from the perspective of the physical effort. One way to do so consists of assessing the suitability of locations for implementing cycling infrastructures. In this work, four tools to determine the gradient along potential cycling paths are compared. Furthermore, an evaluation of the reliability of some low-cost tools to measure this parameter was conducted, by comparison with standard measurements using cartographic plans, on a field case study applied to the city of Braga, Portugal. These tools revealed a good level of accuracy for the planning stage, but proved to be less reliable for use in design.