O caráter normativo dos princípios jurídicos

Inclui notas explicativas, bibliográficas e bibliografia

Custos de procedimentos de saúde e associação com nível de atividade física e estado nutricional de idosos hipertensos e diabéticos: análise do Estudo SABE - Saúde, Bem-estar e Envelhecimento, 2010

Introdução O nível de atividade física (NAF) insuficiente e estado nutricional (EN) inadequado conferem risco de desenvolvimento de hipertensão arterial e diabete, bem como dificultam o controle destas doenças. Assim, infere-se que os custos despendidos pelo SUS com medicamentos, internações e consultas de hipertensos e diabéticos apresentem relação inversa com NAF, incluindo a prática de caminhada e EN. Entretanto, estudos epidemiológicos que descrevam estes custos e analisem essas associações na população idosa são inexistentes no Brasil, o que dificulta a fundamentação para a implementação de políticas publicas para a economia de recursos. Objetivo Descrever os custos com procedimentos de saúde de idosos hipertensos e diabéticos e verificar qual a sua associação com NAF e EN, segundo sexo e grupos etários. Métodos A amostra foi constituída por 806 idosos com autorreferência à hipertensão e/ou diabete ( 60 anos) residentes no município de São PauloSP, participantes das três coortes do Estudo Saúde, Bem-estar e Envelhecimento SABE - em 2010. A variável dependente custo total anual (em Reais), foi estimada com base nos dados autorreferidos sobre uso de medicamentos, uso dos serviços ambulatoriais e internações hospitalares, retroativos a um ano da coleta de dados. A variáveis explanatórias: i) NAF foi estimada a partir de entrevista utilizando o International Physical Activity Questionnaire (IPAQ, versão curta), classificando os idosos segundo duração da realização de atividades físicas moderada, em ativos ( 150 minutos/semana) e insuficientemente ativos (< 150 minutos/semana); ii) Prática de caminhada, categorizada segundo frequência semanal: a) 4 dias/ semana; b) 1 a 3 dias/semana; c) não caminha. iii) EN, identificado pelo índice de massa corporal (IMC), classificando os idosos em dois grupos: a) IMC < 28 kg/ m²; b) IMC 28 kg/ m² (excesso de peso); as variáveis de controle foram o sexo, grupos etários (a. 70 anos; b. 65 a 69 anos; c. 60 a 64 anos); estado civil (a. casado; b. outros) e, escolaridade (a. sem escolaridade; b. 1 ano). A descrição dos custos segundo as NAF e EN foi representada pelos valores de média e IC95 por cento , mediana e P25 P75, valores mínimos e máximos. Modelos de regressão logística múltipla foram empregados para analisar as associações entre variáveis dependentes e explanatórias. O nível de significância foi estabelecido em 5 por cento e todas as análises foram realizadas considerando amostras complexas, por meio do software Stata, 13.0. 9 Resultados: A média de custo total anual por pessoa foi de R$ 732,54 e a soma dos custos relativa a 12 meses para os 806 idosos foi de R$ 609.587,20, sempre superiores para idosos em excesso de peso, com NAF insuficiente e para idosos que não caminham. Idosos em excesso de peso apresentaram chance 50 por cento superior de estarem no grupo de maior custo total anual (OR 1.49, IC95 por cento 1.01 2.18) e mais de 70 por cento superior de maior custo com medicamentos (OR 1.71, IC95 por cento 1.18 2.47). A ausência de caminhada significou a chance superior para maiores custos anuais com medicamentos (OR 1.63, IC95 por cento 1.06 2.51) e custos totais (OR 1.82, IC95 por cento 1.17 2.81). Todas as análises ajustadas por sexo e idade. O NAF não se associou aos custos totais e custo com medicamentos (p>0.05). Conclusão: Os custos para o controle de HAS e DM em idosos são altos e se associam inversamente à prática de caminhada e ao estado nutricional, especialmente em relação ao custo com o uso de medicamentos antihipertensivos e hipoglicemiantes.

Ending uncertainty: recapitalisation under European Central Bank supervision. Bruegel Policy Contribution 2013/18, 17 December 2013

Estimates of the recapitalisation needs of the euro-area banking system vary between €50 and €600 billion. The range shows the considerable uncertainty about the quality of banks’ balance sheets and about the parameters of the forthcoming European Central Bank stress tests, including the treatment of sovereign debt and systemic risk. Uncertainty also prevails about the rules and discretion that will applyto bank recapitalisation, bank restructuring and bank resolution in 2014 and beyond. The ECB should communicate the relevant parameters of its exercise early and in detail to give time to the private sector to find solutions. The ECB should establish itself as a tough supervisor and force non-viable banks into restructuring. This could lead to short-term financial volatility, but it should be weighed against the cost of a durably weak banking system and the credibility risk to the ECB. The ECB may need to provide large amounts of liquidity to the financial system. Governments should support the ECB, accept cross-border bank mergers and substantial creditor involvement under clear bail-in rules and should be prepared to recapitalise banks. Governments should agree on the eventual creation of a single resolution mechanism with efficient and fast decision-making procedures, and which can exercise discretion where necessary. A resolution fund, even when fully built-up, needs to have a common fiscal backstop to be credible.

Pliocene-Pleistocene stack of globally distributed benthic stable oxygen isotope records

We present a 5.3-Myr stack (the ''LR04'' stack) of benthic d18O records from 57 globally distributed sites aligned by an automated graphic correlation algorithm. This is the first benthic delta18O stack composed of more than three records to extend beyond 850 ka, and we use its improved signal quality to identify 24 new marine isotope stages in the early Pliocene. We also present a new LR04 age model for the Pliocene-Pleistocene derived from tuning the delta18O stack to a simple ice model based on 21 June insolation at 65 N. Stacked sedimentation rates provide additional age model constraints to prevent overtuning. Despite a conservative tuning strategy, the LR04 benthic stack exhibits significant coherency with insolation in the obliquity band throughout the entire 5.3 Myr and in the precession band for more than half of the record. The LR04 stack contains significantly more variance in benthic delta18O than previously published stacks of the late Pleistocene as the result of higher resolution records, a better alignment technique, and a greater percentage of records from the Atlantic. Finally, the relative phases of the stack's 41- and 23-kyr components suggest that the precession component of delta18O from 2.7-1.6 Ma is primarily a deep-water temperature signal and that the phase of d18O precession response changed suddenly at 1.6 Ma.

(Table 1) Concentrations of Os, Ir, Pt and 187Os/188Os ratio in ODP Hole 130-806C samples

New osmium (Os) isotope and platinum group element (PGE) concentration data are used in conjunction with published 3He and Th isotope data to determine the relative proportions of lithogenic, extraterrestrial and hydrogenous iridium (Ir) in a Pacific pelagic carbonate sequence from the Ocean Drilling Program (ODP) Site 806 on the Ontong Java Plateau (OJP). These calculations demonstrate that lithogenic and extraterrestrial contributions to sedimentary Ir budget are minor, while hydrogenous Ir accounts for roughly 85% of the total Ir. Application of analogous partitioning calculations to previously reported data from a North Pacific red clay sequence (LL44-GPC3) yields very similar results. Total Ir burial fluxes at Site 806 and LL44-GPC3 are also similar, 45 and 30 pg/cm**2/kyr, respectively. Average Ir/3He and Ir/xs230Th_initial ratios calculated from the entire Site 806 data set are similar to those reported earlier for Pacific sites. In general, down-core profiles of Ir, 3He and xs230Th_initial, are not well correlated with one another. However, all three data sets show similar variance and yield sediment mass accumulation rate estimates that agree within a factor of two. While these results indicate that Ir concentration has potential as a point-paleoflux tracer in pelagic carbonates, Ir-based paleoflux estimates are likely subject to uncertainties that are similar to those associated with Co-based paleoflux estimates. Consequently, local calibration of Ir flux in space and time will be required to fully assess the potential of Ir as a point paleoflux tracer. Measured 187Os/188Os of the OJP sediments are systematically lower than the inferred 187Os/188Os of contemporaneous seawater and a clear glacial-interglacial 187Os/188Os variation is lacking. Mixing calculations suggest Os contributions from lithogenic sources are insufficient to explain the observed 187Os/188Os variations. The difference between the 187Os/188Os of bulk sediment and that of seawater is interpreted in terms of subtle contributions of unradiogenic Os carried by particulate extraterrestrial material. Down-core variations of 187Os/188Os with Pt/Ir and Os/Ir also point to contributions from extraterrestrial particles. Mixing calculations for each set of several triplicate analyses suggest that the unradiogenic Os end member cannot be characterized by primary extraterrestrial particles of chondritic composition. It is noteworthy that in efforts aimed at determining the effect of extraterrestrial contributions, 187Os/188Os of pelagic carbonates has greater potential compared to abundances of PGE. An attempt has been made for the first time to estimate sediment mass accumulation rates based on amount of extraterrestrial Os in the OJP samples and previously reported extraterrestrial Os flux. Throughout most of the OJP record, Os isotope-based paleoflux estimates are within a factor of two of those derived using other constant flux tracers. Meaningful flux estimates cannot be made during glacial maxima because the OJP sediments do not record the low 187Os/188Os reported previously. We speculate that this discrepancy may be related to focusing of extraterrestrial particles at the OJP, as has been suggested to explain down-core 3He variations.