Background: This thesis focuses on the economic analyses of type‐2 diabetes complications defined as macro‐vascular (myocardial infarction, stroke, ischemic heart disease, heart failure) and micro‐vascular (amputation and eye‐related complications leading to blindness in one eye). Diabetes‐related complications are a substantial component of the overall economic, physical and psychological burden of the disease. As the efforts in treating diabetes are geared towards reducing the likelihood of complications, understanding the welfare benefits and future savings from reducing diabetes complications is paramount in determining the cost‐effectiveness of competing diabetes therapies. Aims: The thesis is divided into three essays aiming to (1) characterize changes in the health related quality of life of diabetes patients over time and assess the contributions of diabetes complications to these changes; (2) study the drivers of healthcare expenditure for people with diabetes in terms of both inpatient care and non‐inpatient resource utilization, and estimate the impacts of diabetes‐related complications on health care costs; (3) understand the role played by self‐reported quality of life in predicting mortality after controlling for clinical risk factors. Methods: This thesis uses longitudinal data to answer the questions of interest. A unifying theme across the thesis is the challenge of estimating causal parameters in a context in which there may be substantial observed and unobserved patient heterogeneity. Findings: Failing to account for patient heterogeneity, and in particular un‐measurable variation in patients’ outcomes, is likely to bias the impact of complications on quality of life and on non‐inpatient costs, as well as to confound predicted time to death. In the case of QoL, ignoring heterogeneity is likely to overestimate the impact of complications on self reported utility because the patients who will eventually experience diabetes‐related complications are already on a lower utility path compared to those who do not. In the case of both inpatient and non‐inpatient costs, patients who go on to develop complications have higher cost both pre and post complications. In the case of inpatient costs there is no evidence that unobserved patient heterogeneity matters, while in the case of non‐inpatient utilization the hypothesis of a common baseline level of utilization is rejected in the subset of patients that contribute to the FE identification. This subset however is systematically different from the sample as a whole, being predominately more likely to have complications and other causes of hospitalization. Moreover, a trade‐off occurs when we are interested in predictions; models that exploit within‐patient variation have wider confidence intervals and have thus less precision than population average models. The final substantive chapter finds that HRQoL is significantly associated with survival at the population level and that when patient specific unobserved heterogeneity is taken into account, the power of QoL to predict life expectancy increases. Neglected heterogeneity in frailty causes underestimation of both the extent of positive duration dependence and the impacts of time varying covariates.

Thesis (Ph. D.)--University of Washington, 1995. / Vita. Includes bibliographical references (leaves [188]-209).

RESUMO GONÇALVES, A.M. Cuidados diante do abuso e da dependência de drogas: desafio da prática do Programa Saúde da Família. 2002. 209fl. Tese. (Doutora-do em Enfermagem Psiquiátrica) – Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto. Este estudo tem como objeto a prática de cuidados relacionados ao abuso e à dependência de drogas no cotidiano de uma equipe do Programa Saúde da Família (PSF). Reconhecendo a gravidade dos problemas relaciona-dos ao abuso e à dependência de drogas e suas implicações para o indivíduo, a família e a comunidade, que refletem no processo de formação e na prática dos profissionais, tivemos como objetivo desenvolver com os membros de uma equipe do PSF uma ação-reflexão sobre essa prática, visando contribuir para a superação de problemas e contradições enfrentados pela equipe no cotidiano de trabalho. Realizamos uma investigação com abordagem qualitativa, na mo-dalidade de pesquisa-ação, fundamentada pelo materialismo histórico-dialético como parte intrínseca da visão de mundo vinculada à práxis. O cenário da pes-quisa foi a área geopolítica de atuação de uma equipe do Programa no municí-pio de Contagem, Estado de Minas Gerais, Brasil. A pesquisa de campo foi realizada no período de setembro de 2000 a julho de 2001 e teve como sujeitos os integrantes da equipe (um médico, uma enfermeira, uma auxiliar de enfer-magem e quatro agentes comunitários de saúde). Os resultados da pesquisa confirmaram a tese inicial sobre a importância do PSF para a prática de cuida-dos relacionados ao abuso e à dependência de drogas. Os resultados eviden-ciaram fragilidades e potencialidades técnicas (práticas e políticas) do Progra-ma para enfrentar esse desafio, além de apontar possibilidades de superação mediante investimento na capacitação da equipe e na criação de um projeto de ação comunitária. A pesquisa contribuiu com subsídio para formulação de polí-ticas de saúde, voltadas para o desafio de desenvolver cuidados relacionados ao abuso e à dependência de drogas na prática do PSF, bem como de outros serviços de saúde que venham valer-se dessa experiência para aplicá-la em condições semelhantes. / This study has as object the practice of cares related to the abuse and to the dependence of drugs in the daily of a team of the Program Health of the Family (PHF). Recognizing the gravity of the problems related to the abuse and to the dependence of drugs and their implications for the individual, the family and the community, that reflect in the formation process and in practice of the professionals, we had as objective develops with the members of a team of PHF an action-reflection on that practice, seeking to contribute to overcome the problems and contradictions faced by the team in the daily of work. We accom-plished an investigation with qualitative approach, in the research-action modal-ity, based by the materialism historical-dialectic as intrinsic part of the world vi-sion linked to the praxis. The scenery of the research was the area geopolitics of performance of a team of the Program in the municipal district of Contagem, State of Minas Gerais, Brazil. The field research was accomplished in the pe-riod from September of 2000 to July of 2001 and had as subjects the members of the team (a doctor, a nurse, a nursing auxiliary and four community agents of health). The results of the research confirmed the initial theses about the impor-tance of PHF for the practice of cares related to the abuse and to the depend-ence of drugs. The results evidenced fragilities and technical potentialities (practices and politics) of the Program to face that challenge, besides pointing possibilities to overcome that by investment in the training of the team and in the creation of a project of community action. The research contributed with subsidy to articulate politics of health, come back for the challenge from devel-oping cares related to the abuse and to the dependence of drugs in practice of the PHF, as well as of other services of health that come to be worth of that ex-perience to apply it in similar conditions.

RESUMO GONÇALVES, A.M. Cuidados diante do abuso e da dependência de drogas: desafio da prática do Programa Saúde da Família. 2002. 209fl. Tese. (Doutora-do em Enfermagem Psiquiátrica) – Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto. Este estudo tem como objeto a prática de cuidados relacionados ao abuso e à dependência de drogas no cotidiano de uma equipe do Programa Saúde da Família (PSF). Reconhecendo a gravidade dos problemas relaciona-dos ao abuso e à dependência de drogas e suas implicações para o indivíduo, a família e a comunidade, que refletem no processo de formação e na prática dos profissionais, tivemos como objetivo desenvolver com os membros de uma equipe do PSF uma ação-reflexão sobre essa prática, visando contribuir para a superação de problemas e contradições enfrentados pela equipe no cotidiano de trabalho. Realizamos uma investigação com abordagem qualitativa, na mo-dalidade de pesquisa-ação, fundamentada pelo materialismo histórico-dialético como parte intrínseca da visão de mundo vinculada à práxis. O cenário da pes-quisa foi a área geopolítica de atuação de uma equipe do Programa no municí-pio de Contagem, Estado de Minas Gerais, Brasil. A pesquisa de campo foi realizada no período de setembro de 2000 a julho de 2001 e teve como sujeitos os integrantes da equipe (um médico, uma enfermeira, uma auxiliar de enfer-magem e quatro agentes comunitários de saúde). Os resultados da pesquisa confirmaram a tese inicial sobre a importância do PSF para a prática de cuida-dos relacionados ao abuso e à dependência de drogas. Os resultados eviden-ciaram fragilidades e potencialidades técnicas (práticas e políticas) do Progra-ma para enfrentar esse desafio, além de apontar possibilidades de superação mediante investimento na capacitação da equipe e na criação de um projeto de ação comunitária. A pesquisa contribuiu com subsídio para formulação de polí-ticas de saúde, voltadas para o desafio de desenvolver cuidados relacionados ao abuso e à dependência de drogas na prática do PSF, bem como de outros serviços de saúde que venham valer-se dessa experiência para aplicá-la em condições semelhantes. / This study has as object the practice of cares related to the abuse and to the dependence of drugs in the daily of a team of the Program Health of the Family (PHF). Recognizing the gravity of the problems related to the abuse and to the dependence of drugs and their implications for the individual, the family and the community, that reflect in the formation process and in practice of the professionals, we had as objective develops with the members of a team of PHF an action-reflection on that practice, seeking to contribute to overcome the problems and contradictions faced by the team in the daily of work. We accom-plished an investigation with qualitative approach, in the research-action modal-ity, based by the materialism historical-dialectic as intrinsic part of the world vi-sion linked to the praxis. The scenery of the research was the area geopolitics of performance of a team of the Program in the municipal district of Contagem, State of Minas Gerais, Brazil. The field research was accomplished in the pe-riod from September of 2000 to July of 2001 and had as subjects the members of the team (a doctor, a nurse, a nursing auxiliary and four community agents of health). The results of the research confirmed the initial theses about the impor-tance of PHF for the practice of cares related to the abuse and to the depend-ence of drugs. The results evidenced fragilities and technical potentialities (practices and politics) of the Program to face that challenge, besides pointing possibilities to overcome that by investment in the training of the team and in the creation of a project of community action. The research contributed with subsidy to articulate politics of health, come back for the challenge from devel-oping cares related to the abuse and to the dependence of drugs in practice of the PHF, as well as of other services of health that come to be worth of that ex-perience to apply it in similar conditions.

No description available.

Palliativ vård är en rättighet som barn med livsbegränsande och obotliga sjukdomar har tillgång till. Den palliativa vården utförs i stor utsträckning i hemmet där föräldrarna är delaktiga och har ett stort ansvar i den vården barnet får. Som vårdpersonal är det viktigt att ha kunskap angående föräldrarnas erfarenhet för att lättare kunna bemöta och anpassa vården utefter vad familjen behöver. Syftet med denna studie är att belysa föräldrars upplevelser av den palliativa vård som deras barn får i hemmet och metoden som används för att svara på syftet var en integrerande sammanställning av kvalitativ forskning. Resultatet ledde till fyra teman: Frihet och styrka i hemmet under en svår tid, God kommunikation och stöttning, Tryggheten av hemsjukvård, Fridfullheten av att säga hejdå och åtta subteman: Tillgång till hemsjukvård, familjecentrerad vård, vårdandet, bemötande, delaktighet, dygnetruntvård, kompetens, vården efter döden. Resultatet visade att föräldrarna värdesatte hemsjukvården de fick och gav dem möjlighet att uppnå ett normalt familjeliv. Föräldrarna upplevde att vårdpersonalen behöver ha ett respektfullt, ärligt bemötande för att vården ska fungera i hemmet. Kompetens och kontinuitet var viktigt för att skapa en trygg miljö samt att stöd från vårdpersonalen var en avgörande faktor för att föräldrarna skulle klara av situationen de drabbats av. I diskussionen tas det upp att den valda metoden har kunnat svara på studiens syfte genom att de teman och subteman som framkommit, tydligt får fram föräldrarnas upplevelser av fenomenet.

<p>На узорку од 258 испитаника предшколског узраста (5-7 година) спроведено је<br />истраживање са циљем да се испитају ефекти свакодневног физичког васпитања на<br />развој моторичких вештина и физичке форме повезане са здрављем. Истраживање је<br />спроведено у предшколској установи &bdquo;Вера Гуцуња&ldquo; из Сомбора, а узорак је подељен на<br />експерименталну (N=125 - 48.45%) и контролну групу (N=133 - 51.55%). Просечна<br />старост деце на иницијалном мерењу је била 6.07&plusmn;0.42 година, при чему је просечан<br />узраст за експерименталне групе 6.05&plusmn;0.43 година, а за контролне групе 6.10&plusmn;0.40<br />година. Експериментална група је била укључена у иновативан програм физичког<br />васпитања који је трајао шест месеци, док је контролна група реализовала стандардни<br />програм предвиђен годишњим планом установе.<br />Батерије тестова које су примењене за испитивање ефеката експерименталног програма<br />након шест месеци вежбања су: КТК тест за процену опште координације тела, ТГМД-2<br />батерија тестова за процену локомоторних и манипулативних вештина и PREFIT<br />батерија тестова за процену физичке форме повезане са здрављем.<br />Након примене шестомесечног програма дошло се до закључка да је експериментална<br />група знатно побољшала квалитет моторичких вештина, ниво координације и унапредила<br />физичку форму повезану са здрављем, те да постоји већи напредак у односу на<br />контролну групу. На основу резултата истраживања може се закључити да је<br />свакодневно организовано физичко васпитање неопходно за побољшање моторичког<br />развоја и унапређење физичке форме повезане са здрављем предшколске деце као важан<br />фактор превенције и лечења прекомерно ухрањене и гојазне деце, а такође и смањења<br />потенцијалних кардиоваскуларних и метаболичких болести у каснијем животу.</p> / <p>Na uzorku od 258 ispitanika predškolskog uzrasta (5-7 godina) sprovedeno je<br />istraživanje sa ciljem da se ispitaju efekti svakodnevnog fizičkog vaspitanja na<br />razvoj motoričkih veština i fizičke forme povezane sa zdravljem. Istraživanje je<br />sprovedeno u predškolskoj ustanovi &bdquo;Vera Gucunja&ldquo; iz Sombora, a uzorak je podeljen na<br />eksperimentalnu (N=125 - 48.45%) i kontrolnu grupu (N=133 - 51.55%). Prosečna<br />starost dece na inicijalnom merenju je bila 6.07&plusmn;0.42 godina, pri čemu je prosečan<br />uzrast za eksperimentalne grupe 6.05&plusmn;0.43 godina, a za kontrolne grupe 6.10&plusmn;0.40<br />godina. Eksperimentalna grupa je bila uključena u inovativan program fizičkog<br />vaspitanja koji je trajao šest meseci, dok je kontrolna grupa realizovala standardni<br />program predviđen godišnjim planom ustanove.<br />Baterije testova koje su primenjene za ispitivanje efekata eksperimentalnog programa<br />nakon šest meseci vežbanja su: KTK test za procenu opšte koordinacije tela, TGMD-2<br />baterija testova za procenu lokomotornih i manipulativnih veština i PREFIT<br />baterija testova za procenu fizičke forme povezane sa zdravljem.<br />Nakon primene šestomesečnog programa došlo se do zaključka da je eksperimentalna<br />grupa znatno poboljšala kvalitet motoričkih veština, nivo koordinacije i unapredila<br />fizičku formu povezanu sa zdravljem, te da postoji veći napredak u odnosu na<br />kontrolnu grupu. Na osnovu rezultata istraživanja može se zaključiti da je<br />svakodnevno organizovano fizičko vaspitanje neophodno za poboljšanje motoričkog<br />razvoja i unapređenje fizičke forme povezane sa zdravljem predškolske dece kao važan<br />faktor prevencije i lečenja prekomerno uhranjene i gojazne dece, a takođe i smanjenja<br />potencijalnih kardiovaskularnih i metaboličkih bolesti u kasnijem životu.</p> / <p>The current study was conducted to examine the effects of implementation of physical<br />education on daily basis on the development of motor skills and health-related physical fitness<br />of 258 preschool children (5-7 years old). The study was carried out at the &ldquo;Vera Gucunja&rdquo;<br />preschool in Sombor, and the sample was divided into experimental (N = 125 - 48.45%) and<br />control group (N = 133 - 51.55%). The mean age of children at the initial measurement was<br />6.07 &plusmn; 0.42 years, with the mean age of the experimental group being 6.05 &plusmn; 0.43 years and the<br />control group 6.10 &plusmn; 0.40 years. The experimental group was involved in an innovative physical<br />education program, which lasted for six months, while the control group implemented the<br />standardized program provided in the institution&#39;s annual plan.<br />To test the changes that occurred after six months, we used the following test batteries: the<br />KTK Test- K&ouml;rperkoordinations test f&uuml;r Kinder, the TGMD-2- The Test of Gross Motor<br />Development, and the PREFIT battery tests used for estimation of health-related physical form<br />in children.<br />After applying the 6-months program, we came to the conclusion that the experimental group<br />has significantly improved the elements of motor skills, coordination and health-related<br />physical fitness. Based on the results, it can be concluded that this group has achieved greater<br />improvement than the control group. The findings also suggest that daily organized physical<br />education is necessary for improving motor development and physical fitness associated with<br />health of young children. Exercising daily is an important factor in prevention and treatment of<br />overweight and obese children, as well as in reducing potential cardiovascular and metabolic<br />diseases in later life.</p>

<p>This study attests to the fact that disability is an issue in conflict-affected populations, in particular refugees. Refugees with disabilities living in Mayukwayukwa refugee camp also have poor HRQOL similar to other studies. Education was the only variable significantly correlated to the psychological and social domains of the HRQOL. The study highlighted that environmental and personal variables played a role in the determination of health related quality of life among refugees with disabilities.</p>

<p>This study attests to the fact that disability is an issue in conflict-affected populations, in particular refugees. Refugees with disabilities living in Mayukwayukwa refugee camp also have poor HRQOL similar to other studies. Education was the only variable significantly correlated to the psychological and social domains of the HRQOL. The study highlighted that environmental and personal variables played a role in the determination of health related quality of life among refugees with disabilities.</p>