Magister Artium (Social Work) - MA(SW) / Mental illness has been identified as one of the major contributors to the global burden of disease in the world. The four leading causes of mental health disorders are depression, alcohol abuse, schizophrenia, and bipolar disorder. Recent studies indicate that schizophrenia is among the major mental disorders affecting more than 21 to 29 million people in the world. Family members living and caring for a relative diagnosed with schizophrenia may experience burdensome challenges in such a way that can easily generate secondary stress in various life domains such as work and family relationships, loss of quality of life as well as high social and economic costs.

Background: Rectal cancer 5-year survival has increased from 58% of those diagnosed in 1987-1989 to 68% of those diagnosed in 2003-2009. Rectal cancer patients commonly receive one of two surgical treatments: permanent ostomy (a resection of tumor following by a stoma) or anastomosis (a resection followed by a reconnection with or without a prior temporary ostomy). The multifaceted consequences of both types of surgery potentially can affect both long-term psychological well-being and financial concerns of patients and their families. The overall goal of this dissertation is to increase the understanding of the impact of depression on the quality of life of rectal cancer survivors. Methods: The research data were based on a quality of life survey conducted in 2010-2011 among long-term survivors (≥ 5 years post-diagnosis) of rectal cancer. Participants were identified through the Kaiser Permanente (KP) health systems in Northern California and Southwest Washington/Oregon. Data included both the 2010/2011 survey data and KP electronic medical records (EMRs). Results: 1) The 24.7% prevalence of self-reported current depression among long-term rectal survivors was observed with a higher prevalence of 31% among those with permanent ostomies. Although average perceived financial burden level was low in this population of insured cancer survivors, 20% still reported moderate-to-high burden. Perceived financial burden was especially high among those who recalled having depression immediately after surgery and reported depression at the time of survey.2) All self-reported measures showed low sensitivity varying from 26% to 56% and high specificity from 77% to 82.7% against either diagnostic scheme from EMRs. Using either diagnostic scheme, the MCS-12 measure, a Mental Composite Summary (MCS) score from the 12-item Short-Form Health Survey with a cut-off point of≤45.6 for a self-reported depression, performed better as compared to the other two self-reported measures. 3) Approximately one in six rectal cancer survivors experienced depression after their surgery of sufficient severity to result in a depression diagnosis. Among survivors with recurrent depression diagnoses, those with a permanent ostomy reported significantly lower psychological well-being than those with an anastomosis. Conclusions: Depression burden is elevated after receiving surgery and remains a problem long after cancer diagnosis and treatment. Types of rectal cancer surgery received and gender of survivors may complicate the extent of depression burden. Among long-term rectal cancer survivors, having depression is associated with higher perceived financial burden. Chronic or recurrent course of depression may exist in this group of rectal cancer survivors and has significant impact on long-term psychological well-being. Self-reported measures for depression, such as MCS-12 measure with a cutoff point≤45.6, have the potential to be utilized for epidemiological studies when common screening instruments, electronic medical records, or administrative databases are not available. Implications: These findings underline the significance of depression assessments after surgery for this population of rectal cancer survivors and the importance of symptoms monitoring throughout the cancer survivorship continuum. Depressive symptoms should be monitored and managed as early as after cancer diagnosis and surgery to optimize survivors' long-term emotional well-being. In addition, depression screening and treatment as well as discussion of financial issues may have important roles in long-term survivorship care planning, particularly for those with permanent ostomies.

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Background: Every year in the United States approximately half a million youth with special health care needs (SHCN) turn 18. Little is known about how this population fares during the transition to adulthood. Purpose: To examine transitions to adulthood for young adults with SHCN. Methods: Using data from two national longitudinal surveys: the Panel Study of Income Dynamics and the Survey of Adult Transitions and Health, I built linear and logistic regression models to evaluate the relationship between having a history of SHCN during childhood and key transitional outcomes during young adulthood (e.g., mental health status, educational attainment, employment, financial independence and subjective indicators of adulthood). A second set of logistic models examined associations between hypothesized risk and protective factors during childhood (e.g. family financial burden, care in a medical home and access to adequate insurance) and physical health outcomes during young adulthood for youth with SHCN. Multivariate models were adjusted for key confounders. Results: The majority of youth with a history of SHCN were doing well during the transition to adulthood. That said, compared to young adults without a history of SHCN, young adults with a history of SHCN were in significantly worse mental health (adjusted OR of experiencing a non-specific psychological disorder 3.90, 95% CI 1.78-8.53) and had significantly lower odds of graduating from high school (adjusted OR 0.55, 95% CI 0.32-0.96), attending college (adjusted OR 0.61, 95% CI 0.38-0.96), and receiving financial assistance from their families (adjusted OR 0.56, 95% CI 0.38-0.83). Amongst young adults with a history of SHCN, family financial burden during childhood significantly decreased the odds of being in good physical health during the transition to adulthood. There was limited evidence that receipt of care in a medical home or access to adequate insurance during childhood increased the odds of being in good physical health for young adults with a history of SHCN. Conclusions: These findings have important policy implications for programs serving youth with SHCN. Specifically, mental health and educational services may need to be expanded and more emphasis placed on addressing the non-medical determinants of health, like family financial burden.

Submitted by Paulo Emílio Derenusson (paulo.derenusson2013@gvmail.br) on 2015-09-17T19:44:39Z No. of bitstreams: 1 Quem paga o tributo.Repercussão econômica e restituição do indébito tributário.Uma conexão possível.Paulo Emílio Derenusson.pdf: 720055 bytes, checksum: 2f621d771c8c3434a02208301bb49933 (MD5) / Rejected by Renata de Souza Nascimento (renata.souza@fgv.br), reason: Prezado Paulo, boa tarde Conforme normas da ABNT para que possamos aceitar seu trabalho junto à biblioteca, é necessário retirar a acentuação do nome GETULIO (na CAPA). Após alterações realize uma nova submissão. Att on 2015-09-17T21:19:53Z (GMT) / Submitted by Paulo Emílio Derenusson (paulo.derenusson2013@gvmail.br) on 2015-09-22T08:47:07Z No. of bitstreams: 1 Quem paga o tributo.Repercussão econômica e restituição do indébito tributário.Uma conexão possível.Paulo Emílio Derenusson.pdf: 720329 bytes, checksum: 769ee673ae05ae5e197fcf156e1a82ec (MD5) / Approved for entry into archive by Renata de Souza Nascimento (renata.souza@fgv.br) on 2015-09-22T10:37:45Z (GMT) No. of bitstreams: 1 Quem paga o tributo.Repercussão econômica e restituição do indébito tributário.Uma conexão possível.Paulo Emílio Derenusson.pdf: 720329 bytes, checksum: 769ee673ae05ae5e197fcf156e1a82ec (MD5) / Made available in DSpace on 2015-09-22T13:45:43Z (GMT). No. of bitstreams: 1 Quem paga o tributo.Repercussão econômica e restituição do indébito tributário.Uma conexão possível.Paulo Emílio Derenusson.pdf: 720329 bytes, checksum: 769ee673ae05ae5e197fcf156e1a82ec (MD5) Previous issue date: 2015-08-18 / A repetição do indébito visa a restituir ao estado anterior aquele que sofreu redução patrimonial de forma indevida, representando uma norma de equidade. Os pedidos de restituição de tributos indevidamente pagos foram objeto de tratamento desigual pela jurisprudência, que influenciou a edição do Código Tributário Nacional ao eleger regramento próprio para os tributos indevidamente pagos, condicionando a legitimidade do contribuinte à prova de que não transferiu o respectivo ônus financeiro ou está autorizado por aquele que recebeu a translação do tributo a pleitear a restituição. A adoção desse racional econômico é motivo de grande controvérsia tanto na doutrina quanto na jurisprudência, em que se pergunta se, ao conectar a legitimidade para pleitear a restituição ao racional econômico da não transferência, a medida de igualdade sofreu uma sensível redução. Com vistas a confirmar essa hipótese, o presente trabalho busca identificar nas raízes históricas da edição do Código Tributário Nacional e na jurisprudência administrativa e judicial da época uma fonte de influência a esse desenho normativo. Passo seguinte, em um diálogo entre o Direito e a Economia, vamos demonstrar como o tributo repercute economicamente, buscando investigar como o contribuinte pode transferir seu encargo a terceiros, quem são estes, sob quais condições isso pode ocorrer e, se pela natureza dos tributos, cabe ou não a translação. Superada essa etapa, com apoio na jurisprudência dos Tribunais Superiores, identificaremos os principais avanços e desafios da jurisprudência sobre a repercussão econômica do tributo e os pedidos de restituição. Após essa investigação, busca-se concluir se a conexão entre a repercussão econômica e a repetição do indébito tributário foi um vetor de equidade ou se esse ponto de intersecção merece ser abolido. / The repetition of overpayment aims to restore the previous state that suffered asset reduction improperly, representing a rule of equity. Applications for refund of unduly paid taxes were subject to unequal treatment in the case law, which influenced the edition of the National Tax Code to elect rule own to unduly paid taxes, affecting the legitimacy of the contributors to the evidence that did not transfer their financial burden or is authorized by the one who received the translation of the tribute to claim the refund. The adoption of this rational economic motive is highly controversial both in doctrine and case law, where it is asked that by linking the legitimacy to claim the refund to the economic rationale of not transfer, the measure of equality suffered a significant reduction. In order to confirm this hypothesis, this study seeks to identify the historical roots of the issue of the tax code and the administrative and judicial jurisprudence of time a source of influence to this normative design. Next step we will demonstrate how the tax affects economically, in a dialogue between law and economics in order to investigate how the taxpayer can transfer their charge to third parties, who are these, what conditions this can occur and, by the nature of taxes, it the translation or not. Overcome this stage, with support in the case law of the Superior Courts will identify the main advances and challenges of case law on the economic impact of the tax and the refund applications. After this research, we seek to complete the connection between the economic impact and the repetition of the tax overpayment was a vector of equity or if the intersection point deserves to be abolished.