Made available in DSpace on 2015-04-11T13:57:56Z (GMT). No. of bitstreams: 1 Dissertacao Final Valdomiro.pdf: 502458 bytes, checksum: b7b6f643f2da2c5f281cb321434ed212 (MD5) Previous issue date: 2009-03-10 / Fundação de Amparo à Pesquisa do Estado do Amazonas / Brazil has one of the largest tax burdens in the world, accounting for about 37% of GDP, and a very complex tax system, with 80 taxes, 17 thousand tax rules in force and a large number of ancillary obligations. Tax system generates a high cost to taxpayers, which goes well beyond the taxes, it covers the compliance cost, generated by ancillary obligations. However, the accounting currently practiced in Brazil doesn`t measure accurately the burden of the system for organizations. Consequently, this cost is not adequately disclosed in financial statements. This research aims to measure the total costs generated by the brazilian tax system and its impact on the economic result of a complex civil construction in the city of Manaus. Thus, the study determines the value of taxes and compliance cost borne by the organization, determining the relationship of these values with the components of the result of the company. The result is shown in a table to disseminate such information. The work is classified, as to procedures, a case study, with quantitative approach, and about the objectives, it is a descriptive study. The results show that the taxation of all three government spheres represent about 24% of the gross revenue earned by the organization. Regarding the outcome of the organization, the tax impact at 148%. The compliance costs of taxation represent 6.86% of the result. In conclusion, the provisional tax trends for the sector and there is the relevance of the values found for the cost of compliance, alerting it to the waste of resources caused by the Brazilian tax system. Observe that the cost generated by ancillary obligations has a significant impact to the result of the organization, recommending an urgent simplify the tax system, since its complexity causes excessive waste of resources, both as taxpayers of the public. / O Brasil possui uma das maiores cargas tributárias do mundo, correspondendo a cerca de 37% do Produto Interno Bruto, e um sistema tributário bastante complexo, com mais de 80 tributos, 17 mil normas tributárias em vigor e um grande número de obrigações acessórias. Verifica-se que o sistema tributário gera um elevado custo para os contribuintes, que vai além do valor dos tributos, pois abrange ainda os custos de conformidade à tributação, gerado pelas obrigações acessórias. Contudo, a Contabilidade praticada atualmente no país não mensura com precisão o ônus desse sistema para as organizações. Conseqüentemente, esse custo também não é divulgado satisfatoriamente nos demonstrativos contábeis. A presente pesquisa objetiva mensurar o total dos custos gerados pelo sistema tributário brasileiro e o seu impacto no resultado econômico de um empreendimento de construção civil na cidade de Manaus. Para tanto, o estudo apura o valor dos tributos e dos custos de conformidade suportados pela organização, determinando a relação desses valores com os componentes do resultado da empresa. O resultado é demonstrado numa tabela para divulgação dessas informações. O trabalho classifica-se, quanto aos procedimentos, num estudo de caso, com abordagem quantitativa e, quanto aos objetivos, trata-se de uma pesquisa descritiva. Os resultados demonstram que a tributação total das três esferas governamentais representam cerca de 24% da receita bruta auferida pela organização. Em relação ao resultado da organização, os tributos impactam em 148%. Já os custos de conformidade representam 7,26% do resultado. Na conclusão, confirmam-se as tendências para a carga fiscal do setor e observa-se a relevância dos valores encontrados a título de custos de conformidade, alertando-se para o desperdício de recursos ocasionado pelo sistema tributário brasileiro. Observa-se que o custo gerado pelas obrigações acessórias produz um impacto significativo no resultado da organização, recomendando-se uma urgente simplificação do sistema tributário, uma vez que sua excessiva complexidade provoca desperdícios de recursos, tanto dos contribuintes quanto do poder público.

Ser cuidador informal de pacientes com doenças crônicas pode implicar em sobrecarga e sofrimento psicológico significativo, potencialmente prejudiciais para a própria saúde física e mental e para a recuperação do paciente. Pouco se sabe sobre as experiências e características psicossociais dos cuidadores de pacientes portadores de Cardioversor Desfibrilador Implantável (CDI), principalmente na população brasileira, de forma que o presente estudo (quantitativo descritivo transversal) teve por objetivos caracterizar demográfica e psicossocialmente uma amostra não probabilística de cuidadores informais de pacientes portadores de CDI que se encontravam em tratamento médico em um hospital-escola do interior do Estado de São Paulo. As variáveis estudadas incluíram: características sóciodemográficas, qualidade de vida, ansiedade, depressão e percepção de sobrecarga. Participaram da pesquisa 60 cuidadores, entrevistados entre setembro de 2010 a maio de 2011. Para a coleta dos dados foram usados: Roteiro de Entrevista Semiestruturada, elaborado para esta pesquisa, Questionário de Avaliação de Saúde SF-36, Escala Hospitalar de Ansiedade e Depressão e a Zarit Burden Interview. Os dados foram analisados quantitativamente de forma descritiva. Posteriormente verificou-se associação estatisticamente significativa (p<=0,05) entre algumas variáveis de interesse, por meio do Teste Exato de Fisher. Os resultados mostraram que a média de idade dos cuidadores foi de 52,5 anos (DP=14,76), eram em sua maior parte do sexo feminino (n=45, 75%), o cônjuge do(a) paciente (n=39, 65%), com escolaridade predominante de até quatro anos (n=28, 46,67%), sendo a maioria (45, 75%) portadora de problemas de saúde. Vinte e cinco cuidadores (41,67%) apresentaram sintomas indicativos de ansiedade e 13 (21,67%) de depressão. Na avaliação da qualidade de vida, a média de escore mais elevado foi no domínio Aspectos Sociais (Média=78,12, DP=27,48) e o mais baixo em Vitalidade (Média=60,25, DP=26,03). O escore médio relacionado à percepção de sobrecarga foi de 19,93 (DP=12,51, Mediana= 18,5). Os participantes relataram alterações significativas em suas vidas após o implante do CDI, preocupações com a saúde do paciente e funcionamento do dispositivo, dificuldades relacionadas ao papel de cuidador, além de dúvidas sobre o desfibrilador implantável. Os resultados confirmaram que o implante do CDI no paciente impactou significativamente na vida de seus cuidadores informais, sendo necessário o oferecimento de apoio emocional e orientações específicas por parte dos profissionais da saúde para auxiliá-los na adaptação e enfrentamento adequado dessas situações. Dada a escassez de estudos brasileiros nesta população e alguns fatores metodológicos limitantes, é necessário que mais investigações sejam realizadas para comparar estes resultados. / Being an informal caregiver of patients with chronic diseases may imply significant psychological burden and suffering, potentially harmful to caregiver\'s own physical and mental health and patient\'s recovery. Little is known about the psychosocial experiences and characteristics of caregivers of patients with Implantable Cardioverter Defibrillator (ICD), mainly in the Brazilian population, so that the purpose of the present study (transversal descriptive quantitative) was to characterize, both demographically and psychosocially, a nonprobabilistic sample of informal caregivers of patients with ICD undergoing treatment in a university hospital in the interior of the State of São Paulo. The studied variables comprised: sociodemographic characteristics, life quality, anxiety, depression and perception of burden. Sixty caregivers took part in the survey, and they were interviewed between September, 2010 and May, 2011. Data collection used the following instruments: Semi-structured Interview Script prepared for this survey, SF-36 Health Evaluation Questionnaire, Hospital Anxiety and Depression Scale and the Zarit Burden Interview. Data was analyzed quantitatively in a descriptive way. Subsequently, statistically significant association (p<=0,05) was verified between some variables of interest through Fisher\'s Exact Test. Results describe that the average age of caregivers was 52.5 years (DP=14.76), they were mostly female (n=45, 75%), and patient\'s spouses (n=39, 65%), predominantly with up to four years of education (n=28, 46.67%), and most (45, 75%) with health problems. Twenty-five caregivers (41.67%) presented symptoms related to anxiety and 13 (21.67%) to depression. In life quality evaluation, the highest average score was in the Social Aspects dominion (Average=78.12, DP=27.48) and the lowest in Vitality (Average=60.25, DP=26.03). The average score regarding burden perception was of 19.93 (DP=12.51, Median= 18.5). Participants reported significant changes in their lives after ICD implant, concerns about patient\'s health and device operation, difficulties concerning their role as caregivers, in addition to doubts about the implantable defibrillator. Results confirm that the ICD implant had a significant impact in the life of their informal caregivers, requiring provision of emotional support by healthcare professionals in order to help them adapt and properly cope with these situations. Due to the scarcity of Brazilian studies in this population and some limiting methodological factors, further investigation is required to compare these results.

La dengue est une préoccupation mondiale majeure en santé publique, touchant principalement les jeunes enfants en Asie du sud est. Les vaccins contre la dengue sont actuellement en développement. Des études coût-efficacité seront nécessaires en cas d'introduction d'un nouveau vaccin. Pour cela, il est indispensable d’obtenir des informations sur le coût économique lié à la dengue (qui sont relativement rares) et des données précises sur l'incidence de la maladie, ceci afin de fournir des estimations solides quant à l'importance de la dengue dans les régions endémiques.Ce travail de thèse propose une approche méthodologique par laquelle le Ministère de la Santé devrait envisager lors de l'évaluation de la pertinence et de la faisabilité de l'adoption d’un vaccin contre la dengue par les programmes de nationaux de vaccination, particulièrement dans les pays en voie de développement ; le Cambodge par exemple. Nous avons mis en place des études prospectives d'incidence de la dengue sur plusieurs années, réalisées dans la population générale, incluant un large éventail de groupes d'âge. Les résultats de ces études ont été comparés avec les données de surveillance nationale réunis dans la même région en calculant des facteurs de multiplication afin d’estimer la sous-déclaration. D'autres études de coûts de la maladie ont été menées pour estimer le poids financier la dengue sur plusieurs années et d'identifier les groupes vulnérables. Cette approche a également permis de mieux comprendre l'épidémiologie de la dengue dans le pays, dont certaines caractéristiques sont nécessaires pour évaluer la faisabilité de l'introduction d’un nouveau vaccin contre la dengue. Les résultats rapportés dans cette thèse vont permettre (1) d’initier à partir des données cambodgiennes des simulations de coût-efficacité à partir des caractéristiques attendues du vaccin et (2) de développer un modèle dynamique afin de permettre aux autorités nationales d'analyser les études de coût-efficacité en tenant compte des spécificités immunologiques et épidémiologiques des pays concernés. Si un vaccin efficace et fiable est disponible à un prix abordable, son adoption par le programme national de vaccination serait probablement rentable pour le Cambodge mais répondrait surtout à un problème d'inéquité sociale. / Dengue is a major public health concern worldwide, particularly in young children in Southeast Asia. Dengue vaccines are currently in development and policymakers need appropriate economic studies to determine their potential financial and public health impact. Alongside economic assessment, accurate disease incidence data are required to provide robust estimates of disease burden across the regions where dengue is endemic. This thesis proposes a methodological approach by which the Ministry of Health should consider when assessing feasibility of adoption dengue vaccines, with specific reference to developing country settings, e.g. Cambodia. We implemented prospective dengue incidence studies over several years, performed in a general population and include a wide range of ages. The results of these studies were compared with national surveillance data gathered in the same region by calculating multiplication factors to estimate underreporting on several years. Additional prospective cost of illness study was conducted to generate accurate economic burden of disease estimates over several years and identify vulnerable groups. This strategy also allowed better understanding of the epidemiology of dengue in Cambodia, of which some characteristics are needed to evaluate the feasibility of introducing dengue vaccine. Designing cost-effectiveness studies before a vaccine has been fully evaluated requires assumptions about variables such as efficacy and effectiveness, dosage and costs. Our next step will be to determine the threshold price – sensitivity analyses - for a vaccine to be cost-effective rather than assigning a specific cost, because it is difficult to predict cost for a vaccine that has not been marketed. Should this vaccine be safe and affordable enough, the adoption of the new vaccine into a National Immunization Programme would probably be cost-effective but, above all, a matter of social equity.

Magister Curationis - MCur / The purpose of the study will be to explore the discharge referral pathway for patients that have been discharged from hospital to home in the Western Cape Province. A mix of quantitative and qualitative research, using a descriptive design will be undertaken. Quantitatively, following the patient paper trail from Tertiary Hospital to grassroots level. Qualitatively, to identify whether the referral pathway was user friendly. Records of discharged patients from the Tertiary Hospital will be used as the study population. Patient information will be accessed from patient files at the hospital. Interviews will be conducted with the relevant discharge liaison officers at the Tertiary Hospital, and Primary Health Care level. Relevant staff members within the non–governmental –organisations (NGOs), will also be interviewed in order to determine their perception of the discharge referral pathway. The findings of the study will be used to inform policy guidelines. Challenges encountered by staff members in referring patients for continuum of care, and the perception of consumers will also be described and documented.

Currently, there are approximately 1.1 million caregivers who are caring for veterans who have served in the military following September 11 (9/11), 2001 (Ramchand et al., 2014). In this study, a mixed methods analysis of post 9/11 caregivers enrolled in the North Florida South Georgia Caregiver Support Program was completed with a convenience sample of 172 participants for quantitative analysis which included 16 participants for the phenomenological query. Correlations, t-tests, and ANOVAs were used to determine the associations among race, gender, age, caregiver type, diagnosis, tier level, and the presence of children in the home with caregiver burden as measured by the Zarit caregiver burden inventory (ZBI). T-tests resulted in a significantly higher ZBI with caregivers who had children in the home (M = 6.84; SD = 3.21) versus those who did not (M = 5.57; SD = 2.75), t (160) = -2.36, p=.02. An ANOVA was conducted across caregiver role (parent, spouse, significant other and other) and the ZBI and a significant difference was found (F [3, 159] = 1.59, p < .01, with spousal caregivers having a significantly higher ZBI score (M=6.83; SD=3.10) than parental caregivers (M = 4.46; SD=2.70). The phenomenological research focused on shared lived experiences of post 9/11 caregivers of seriously injured veterans, including their experiences with the Caregiver Support Program, the impact of having children in the home, and the utilization of technology and online support with caregiving. Differences between spousal and parental caregivers were also explored. The caregivers’ shared experiences resulted in 22 major themes which included family adjustment, subjective demands, coping techniques, social support, Veterans Affairs (VA) and Department of Defense (DOD) services, self-care, intimacy, role strain, financial resources, and life course changes as the most prevalent. Caregivers and their families had a difficult time adjusting post injury, particularly with subjective demands. Caregivers relied mainly on their own coping mechanisms to adapt to their new role and did not find social support to be helpful with caregiving. Spousal caregivers tended to have more difficulty adjusting than did parental caregivers, which was also found in the quantitative study. While the Caregiver Support Program provided many services that were helpful to the caregivers, including a financial stipend, they wanted additional services which included additional financial support and services while citing issues with program implementation and staffing as major barriers. Children added complexity to the caregiving relationship and increased burden. Children displayed behavioral changes, mostly negative, but some positive such as giving both the caregiver and the veteran a sense of purpose. Lastly, technology and online support with caregiving was used more often than not with mixed feelings about the technology and its trustworthiness; with parents not utilizing these resources as much as spousal caregivers. The study concludes with implications for current and future social work practice and research, as well as the study’s strengths and limitations.

This diploma thesis deals with the tax system of Malaysia in the political-economic context. It outlines the basic tax conditions on the territory of the Federation of Malaysia in the context of tax systems in the region. In order to give a plastic picture of the issue, the current tax conditions and ascertained data are compared, by means of charts and tables, with the countries neighboring Malaysia -- Singapore, Indonesia and Vietnam. In connection with the political-economic development also the Asian financial crisis is emphasized, which caused a drop in economic growth and a change in the existing fiscal policy. A substantial part of the thesis is devoted to the analysis of the tax burden and of the tax system structure. In the conclusion, the thesis compares and evaluates the tax systems of the neighboring countries.

The graduation theses is focused on problems of reduction of emissions of carbon dioxide and other greenhouse gases, which are contributing to acceleration of climate change. From 2005 the EU ETS cames into force, but many economics subjects, which yield to this system of regulation, have to pay environmental taxes as well, because individual member states have adopted own approaches to the problem of abatement emission. Economic subject then face to double burden and that is why they complains. Double steering and double burden should be avoided by reducing and removing the existing CO2 taxation schemes, because it brings inefficiency - like very high cots of abatement emission.

The main object of the study is not only to show and analyse calculation as the main running costs tools of company, but also show them as part of complex system. Calculation is a relatively independent subsystem of economic informations which relates closely to accounting and budgeting. The study deals with costing and exploitation analysis in the running of the company Vltavotýnský nábytek, s.r.o. It is divided into two parts. The first part is theoretical - it contain basic costing notions, components of costing system and types of costs. The following part is practical. This part describe the company (provding some basic informations), and calculating procedure on selected product. The final part includes costing system suggestion and next recommendations for the company management.

This work deals with tax wedges (effective tax rates) for businesses in the Czech Republic. The goal is to use a methodology for measuring the tax wedges for analysis of tax burden on particular business in period 2004 to 2008. Effective tax rate particular firm is compared with the effective tax rates of enterprises in the Czech Republic and the European Union. To achieve that goal literature review, analysis and comparison method are used. The results of the analysis showed that the particular firm had at the beginning of the period a very high tax burden compared to the statutory tax rate. During the period, however, the effective tax rate of the company significantly reduced and thereby was closer to statutory tax rate. The company had a lot of nondeductible expenses which most significantly contributed to the high tax burden. Tax on corporate income for companies is included in the costs, so the company should try to minimize this expense and thereby reduce the effective tax rate.

The goal of this thesis is to analyse the influence of income taxeson the inequality rate in the Czech Republic. The incometaxes in this paper include the person income tax, the health insuranceand the social security insurance. In the relevant period a significant change in the system of income tax was implemented. While the year 2007 was the last year when tax brackets, i.e. the concept of the progressive tax system, were used, since 2008 we encounter the so-called flat tax where the rate is set at 15%, i.e. the linear tax system. The first chapter of this paper looks into the possibilities of analysing the tax progressiveness in general. The presentation of the methods proceeds from the simplest to the more complicated ones. The second part sums up the results of several foregoing researches in this field. The third chapter deals with an analysis of gross monetary income of households and their tax burden. This analysis and the one carried out in the fourth chapter are based on data provided by the Czech Statistical Office. The fourth chapter of this thesis studies the development of tax progressivity in the relevant period. For this analysis four methods were chosen: the Lorenz 5 curve and the Gini coefficient,the Musgrave-Thin index, the Kakwani index and the Robin Hood index. From the results reached by these indexes can be concluded that the level of income tax progressivity in the Czech Republic is low.