Thesis (Ph.D.)--Virginia Commonwealth University, 2010. / Prepared for: Dept. of Health Administration. Title from title-page of electronic thesis. Bibliography: leaves 133-143.

This thesis deals with the basic moments in the U.S. health care reform. The theoretical part is based on the concept of health as human capital, as a factor of labor productivity. The rate of depreciation of health capital is closely associated with age and grows throughout the life cycle. In the U.S. is currently more than 46 million people uninsured and their access to health care is very limited. U.S. health care system is a highly cost, total expenditure exceeded 16 percent of GDP. Based on various calculations, the thesis describes assumed purposes of reform in terms of health coverage of population, share of private and public spending, additional insurance, etc. The thesis also deals with a reduction in price elasticity of demand for health care in context of increasing the number of insured persons. Theoretically justifies a possibility of moral hazard at participating elementary subjects.

<p>Hronična opstruktivna bolest pluća (HOBP) je rastući zdravstveni problem radno sposobne populacije. Akutne egzacerbacije hronične opstruktivne bolesti pluća (AEHOBP) značajno doprinose pogor&scaron;anju bolesti i sa aspekta kvaliteta života bolesnika i sa aspekta tro&scaron;kova. Cilj istraživanja je bila identifikacija faktora visokih tro&scaron;kova lečenja AEHOBP koja može pomoći u definisanju strategija smanjenja HOBP egzacerbacija ove bolesti i analiza podataka o prehospitalnom lečenju obolelih od HOBP. Materijal i metode: Istraživanjem je obuhvaćeno 130 pacijenata koji su ispunjavali uključujuće kriterijume studije. Rezultati: Ukupni godi&scaron;nji direktni tro&scaron;kovi hospitalizacija usled AEHOBP čine17,3% od tro&scaron;kova svih hospitalizovanih pacijenata. Prosečna dužina hospitalizacije je bila duža kod pacijenata sa te&scaron;kom AEHOBP u odnosu na srednje te&scaron;ku, razlika je statistički značajna (p = 0,044). Prema rezultatima istraživanja o potro&scaron;nji lekova godinu dana pre hospitalizacije, adekvatnu terapiju je koristilo 41,7% pacijenata, a neadekvatnu 58,3% pacijenata i postojala je negativna korelacija između adekvatnosti lečenja i stepena težine akutne egzacerbacije. Multivarijantnom logističkom regresijom dobijena je formula za predikciju ukupnih tro&scaron;kova. Zaključak: Nezavisni prediktori direktnih tro&scaron;kova lečenja su: mu&scaron;ki pol, pu&scaron;ačka navika, te&scaron;ka AEHOBP, postojanje acidoze, primena neadekvatne ili adekvatne terapije trajanja kraćeg od devet meseci tokom godine koja je prethodila hospitalnom lečenju egzacerbacije.</p> / <p>Chronic obstructive pulmonary disease (COPD) is a rising health issue of working population. Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are significantly contributing to worsening of the disease prognosis, consequently leading to decline of patient&rsquo;s quality of life and increasing costs of treatment. Objective of the study was identification of factors for high AECOPD treatment costs, which can help in defining strategy for decreasing COPD exacerbations and data analysis of prehospital treatment of COPD patients. Material and Methods: The study included 130 patients who fulfilled including criteria of the study. Results: Total direct costs of AECOPD hospitalizations demonstrated 17.3% of all hospitalized patients costs. Average length of hospitalization was longer in patients with severe AECOPD compared to patients with moderate AEHOBP, there was statistically significant difference (p= 0,044). According to research results of medication usage one year before the hospitalization, adequate treatment used 41.7% of patients, and inadequate 58.3%; there was negative correlation between adequate treatment and level of severance of acute exacerbations. Multivariate logistic regression was used for obtaining total costs predictions formula. Conclusion: Independent predictors of direct treatment costs were: male patients, smokers, prehospital treatment, inadequate or adequate, not longer than nine months per year.</p>

O cuidado paternal exclusivo à prole é a forma mais rara de investimento parental pós-zigótico na natureza, tendo evoluído independentemente em não mais do que 14 linhagens de artrópodes. Embora muitas dessas espécies sejam facilmente observadas e manipuladas, apenas recentemente os pesquisadores começaram a prestar atenção e a testar hipóteses sobre investimento parental e evolução de papéis sexuais nesses interessantes sistemas biológicos. O principal objetivo desta tese foi investigar características individuais e populacionais que poderiam afetar o sucesso reprodutivo de machos de opiliões (Arachnida: Opiliones) com cuidado paternal. No primeiro capítulo, fazemos uma revisão teórica detalhada, desde trabalhos clássicos de papéis sexuais até os mais recentes avanços, abordando também de maneira sistemática o conhecimento atual acerca de custos e benefícios do cuidado paternal em artrópodes, assim como o papel da seleção sexual sobre a evolução do comportamento parental e dos papéis sexuais. Em seguida, nos capítulos 2 e 3, acessamos os custos energéticos e em termos de sobrevivência do cuidado paternal nos opiliões Iporangaia pustulosa e Zygopachylus albomarginis. Comparando essas duas espécies, que apresentam diferentes níveis de investimento paternal, testamos previsões direcionadas de que os machos que investem mais na prole deveriam pagar maiores custos do cuidado. No quarto capítulo, por meio de informações da história natural e parâmetros populacionais estimados para I. pustulosa, fazemos previsões sobre qual dos sexos deveria ser criterioso ao escolher parceiros e as testamos utilizando observações comportamentais de interações entre machos e fêmeas. Por fim, no capítulo 5, avaliamos a importância relativa do sítio de oviposição, assim como do tamanho e do estado parental dos machos sobre a sua atratividade. Ao final, integramos os resultados obtidos em um corpo teórico sobre a inter-relação entre aparentes demandas conflitantes entre esforço parental e esforço reprodutivo, cuidado paternal e papéis sexuais, abrangendo não apenas as espécies estudadas, mas com um escopo bem mais amplo / Exclusive paternal care is the rarest form of post-zygotic parental investment in nature, which has independently evolved in no more than 14 arthropod lineages. Although many of those species are easily observed and manipulated, only recently researchers have started to pay attention and test hypotheses on parental investment and evolution of sex roles in such interesting biological systems. The main goal of this thesis was investigating individual and population characteristics that affect the reproductive success of males of harvestmen (Arachnida: Opilioes) with paternal care. In the first chapter, we revise the theory in details, since seminal works on sex roles until the most recent advances in the area, sistematically approaching the current knowledge abot costs and benefits of paternal care in arthropods, as well as the role of sexual selection on the evolution of parental behavior and sex roles. Then, in chapters 2 and 3, we access energetic and survival costs of paternal care in the harvestmen Iporangaia pustulosa and Zygopachylus albomarginis. Comparing these two species, that show different levels of parental investment, we test directional predictions that males which invest more should also pay more intense costs rekated to care. In the fourth chapter, based on natural history information and population parameters for I. pustulosa, we predict which sex should be choosier when selecting sexual partners, and test such predictions using behavioral data on male-female interactions. Finally, in chapter 5, we evaluate the relative importance of oviposition site, males\' body size and males\' parental state on their attractiveness. At the end, we integrate all the results obtained during the five chapters into a theoretical framework about the inter-dependence among trade-offs between parental and mating efforts, paternal care and sex roles, not only regarding the pair od species studied, but in a broad way.

O cuidado paternal exclusivo à prole é a forma mais rara de investimento parental pós-zigótico na natureza, tendo evoluído independentemente em não mais do que 14 linhagens de artrópodes. Embora muitas dessas espécies sejam facilmente observadas e manipuladas, apenas recentemente os pesquisadores começaram a prestar atenção e a testar hipóteses sobre investimento parental e evolução de papéis sexuais nesses interessantes sistemas biológicos. O principal objetivo desta tese foi investigar características individuais e populacionais que poderiam afetar o sucesso reprodutivo de machos de opiliões (Arachnida: Opiliones) com cuidado paternal. No primeiro capítulo, fazemos uma revisão teórica detalhada, desde trabalhos clássicos de papéis sexuais até os mais recentes avanços, abordando também de maneira sistemática o conhecimento atual acerca de custos e benefícios do cuidado paternal em artrópodes, assim como o papel da seleção sexual sobre a evolução do comportamento parental e dos papéis sexuais. Em seguida, nos capítulos 2 e 3, acessamos os custos energéticos e em termos de sobrevivência do cuidado paternal nos opiliões Iporangaia pustulosa e Zygopachylus albomarginis. Comparando essas duas espécies, que apresentam diferentes níveis de investimento paternal, testamos previsões direcionadas de que os machos que investem mais na prole deveriam pagar maiores custos do cuidado. No quarto capítulo, por meio de informações da história natural e parâmetros populacionais estimados para I. pustulosa, fazemos previsões sobre qual dos sexos deveria ser criterioso ao escolher parceiros e as testamos utilizando observações comportamentais de interações entre machos e fêmeas. Por fim, no capítulo 5, avaliamos a importância relativa do sítio de oviposição, assim como do tamanho e do estado parental dos machos sobre a sua atratividade. Ao final, integramos os resultados obtidos em um corpo teórico sobre a inter-relação entre aparentes demandas conflitantes entre esforço parental e esforço reprodutivo, cuidado paternal e papéis sexuais, abrangendo não apenas as espécies estudadas, mas com um escopo bem mais amplo / Exclusive paternal care is the rarest form of post-zygotic parental investment in nature, which has independently evolved in no more than 14 arthropod lineages. Although many of those species are easily observed and manipulated, only recently researchers have started to pay attention and test hypotheses on parental investment and evolution of sex roles in such interesting biological systems. The main goal of this thesis was investigating individual and population characteristics that affect the reproductive success of males of harvestmen (Arachnida: Opilioes) with paternal care. In the first chapter, we revise the theory in details, since seminal works on sex roles until the most recent advances in the area, sistematically approaching the current knowledge abot costs and benefits of paternal care in arthropods, as well as the role of sexual selection on the evolution of parental behavior and sex roles. Then, in chapters 2 and 3, we access energetic and survival costs of paternal care in the harvestmen Iporangaia pustulosa and Zygopachylus albomarginis. Comparing these two species, that show different levels of parental investment, we test directional predictions that males which invest more should also pay more intense costs rekated to care. In the fourth chapter, based on natural history information and population parameters for I. pustulosa, we predict which sex should be choosier when selecting sexual partners, and test such predictions using behavioral data on male-female interactions. Finally, in chapter 5, we evaluate the relative importance of oviposition site, males\' body size and males\' parental state on their attractiveness. At the end, we integrate all the results obtained during the five chapters into a theoretical framework about the inter-dependence among trade-offs between parental and mating efforts, paternal care and sex roles, not only regarding the pair od species studied, but in a broad way.

The thesis deals with the issue of the formation of the ABC model in healthcare facilities. The aim of this work is the formation of the ABC model on the example of the Infectious Department of the selected teaching hospital. The work is divided into theoretical and practical part. In the framework of the theoretical part are summarised findings from literature review regarding the Activity-Based Costing method and its application in medical organisations. In the practical part are already constructs of the ABC model itself, based on an annual data basis using a procedure adapted to the medical facilities.

Bakgrund: Prevalensen för Diabetes mellitus typ 2 ökar i världen och antalet förväntas stiga till 783 miljoner år 2045. Sjukdomen är kronisk och kräver långtidsvård vilket gör att den globala kostnadsbördan förblir hög. Några anledningar till det är sämre delaktighet från patienter, en lägre läkemedelsföljsamhet och förhöjda risker för komplikationer och sjukvårdsinläggningar. På så vis är relationskontinuitet en strategi som syftar att stärka förhållandet mellan patienter och sjukvårdspersonal och därmed generera i lägre vårdkostnader samt en bättre hälsa på individuell- och befolkningsnivå. Syfte: Syftet med litteraturstudien är att undersöka hälsoekonomiska effekter av relationskontinuitet mellan sjukvårdspersonal och patienter med typ-2 diabetes. Metod: Litteraturstudie med data från 11 vetenskapliga artiklar. Databaserna CINAHL och Web of Science användes för att samla in data och de sökord som applicerades var: Continuity of care for diabetes patients, patient continuity for diabetes, diabetes type 2 mellitus, T2DM, healthcare costs, costs of care, effects och impacts. Materialet analyserades enligt Braun &amp; Clarkes tematiska analysmetod. Resultat: Tre huvudteman och fyra subteman påträffades. Första temat var ökad hälsolitteracitet som en beskrivning av patienters förbättrade förmåga att förstå och applicera hälsoinformation. Informationen främjade självtillit och läkemedelsföljsamhet. Andra temat var kostnadseffektiv vård som på grund av ur relationskontinuiteten genererade en minskad vårdbelastning. Det sista temat var hälsoekonomiska effekter som en beskrivning av de lägre utgifterna inom ett samhälle. Bland huvudfynden påvisas att desto högre nivå av relationskontinuitet mellan sjukvårdspersonal och patienter desto lägre vårdkostnader, färre sjukhusinläggningar och komplikationer. Slutsats: Relationskontinuitet bidrog till positiva effekter vad gäller vårdkostnader för patienter med diabetes mellitus typ 2. Dock föreligger svårigheter med implementeringen av strategin som gör att effektiviseringen av diabetesvård och i sin tur dess kostnader inte når sin fulla potential. / Background: The prevalence of diabetes mellitus type 2 is increasing in the world and the number is expected to rise to 783 million in 2045. The disease is chronic and requires long-term care, which means that the global cost burden remains high. Some of the reasons for this are poorer patient participation, lower medication adherence and increased risks of complications and hospital admissions. Thus, continuity of care is a strategy that aims to strengthen the relationship between patients and healthcare personnel and thereby generate lower healthcare costs and better health at the individual and population level. Aim: The aim of this study was to examine the health economic effects of continuity of care between health care personnel and diabetes type 2 patients. Method: A literature study with data from 11 different scientific articles. The databases CINAHL and Web of Science were used to collect data and the keywords applied were: Continuity of care for diabetes patients, patient continuity for diabetes, diabetes type 2 mellitus, T2DM, healthcare costs, costs of care, effects och impacts. The material was analyzed in accordance with Braun &amp; Clarkes thematic analysis. Results: Three main themes and four subthemes were identified. The first theme was increased health literacy as a description of patients enhanced ability to understand and apply health information. The information resulted in self-efficacy and medical adherence. The other theme was cost-effective care which in turn led to a lessened burden of care. The last theme was health economic effects to describe the recognized decrease in expenditure within societies. Among the main findings, it is demonstrated that the higher the level of relationship continuity between healthcare professionals and patients, the lover the healthcare costs, fewer hostpitalizations and complications. Conclusion: Continuity of care contributed to positive effects in costs of care for patients with diabetes mellitus type 2. However, there are difficulties with the implementation of the strategy which means that the efficiency of diabetes care and in turn, its costs fail to reach their full potential.