L’objet de cette thèse est de réaliser une analyse économique du champ de l’aide informelle des personnes adultes jeunes vivant à domicile et atteintes de maladie neurologique grave. La question de recherche posée concerne l’articulation entre l’organisation de l’aide informelle et la cinétique de la pathologie neurologique. La méthodologie repose sur la construction de quatre modèles neuro-pathologiques et économiques d’une part, et sur la constitution de quatre cohortes représentatives, comportant chacune une centaine de binômes « aidant-aidés » d’autre part. Ainsi, les modèles de la pathologie brutale avec handicap résiduel stabilisé, de la pathologie progressive avec handicap croissant, de la pathologie à cinétique déficitaire rapide, de la pathologie dégénérative héréditaire sont-ils respectivement illustrés par le traumatisme crânien, la sclérose en plaques, la tumeur cérébrale et la maladie de Huntington. Nos travaux (1) mettent en évidence les caractéristiques sur le plan économique des aidants informels (conjoints jeunes) qui sont fortement impliqués dans la production du soin, experts d’un accompagnement complexe et déstabilisés dans leur trajectoire professionnelle (2) font la démonstration de la prédétermination forte de la cinétique de la pathologie neurologique sur les comportements d’aide informelle à travers différents indicateurs temporels dont la prise en compte s’avère incontournable pour l’analyse économique (3) montrent la nécessité d’avoir recours à une mesure bidimensionnelle (subjective et objective) dans l’analyse du fardeau des aidants informels. Une telle mesure souligne d’une part l’insuffisance du recours à l’aide professionnelle publique et d’autre part l’impact sur les aidants des troubles cognitivo-comportementaux (handicap invisible) et de la phase neuro-palliative à domicile d’une pathologie neurologique grave. Ces résultats ouvrent des perspectives pour la mise en place de mesures d’action publiques en France dans le champ complexe du handicap neurologique. / The purpose of this thesis is to achieve an economic analysis of informal caregiving of young adults living at home and suffering from a severe neurological disease. The research questions the relationship between the organization of informal care and kinetics of neurological pathology. The methodology is based on the construction of four neuro-pathological and economic models on the one hand, and on the constitution of four representative cohorts, each with a hundred pairs of "patients-caregivers" on the other. Thus, models of brutal disease stabilized with residual disability, progressive disease with increasing disability, fast kinetics disease and neuro-degenerative hereditary disease are respectively illustrated by traumatic brain injury, multiple sclerosis, malignant brain tumor and Huntington's Disease. Our work (1) highlights the economic characteristics of informal caregivers (young spouses) who are highly involved in the production of care, expert of complex care and therapeutic pathways and destabilized in their professional careers (2) demonstrates that the kinetics of neurological disease predicts the economic behavior of informal caregivers : taking account of different time indicators is crucial for economic analysis in neurodisability (3) shows that a two-dimensional subjective and objective outcome measure is necessary in the analysis of the burden of informal caregivers. Such a double indicator first stresses the inadequate use of publicly funded professional care ; it also points out the impact of cognitive-behavioral disorders (so-called “invisible disability”) and of the home neuro-palliative phase on caregivers in case of a severe neurological disease. These results open perspectives for the development of public action measures in France in the complex field of neurological disability.

A presente dissertação volta-se à análise da alteração superveniente das circunstâncias fáticas, especificamente, em contratos interempresariais. Tais contratos, compreendidos como aqueles em que, ao menos, uma das partes é ente empresarial e ambos os contratantes visam auferir lucro, têm características distintas de outros contratos de natureza civil (contratos existenciais), mormente no que se refere à assunção de riscos pelas partes envolvidas. Dado o caráter arriscado da atividade empresarial, a intervenção exógena nos contratos interempresariais visando à tutela dos contratantes deve ser reduzida, de forma a se privilegiar tanto quanto possível a força obrigatória dos contratos (pacta sunt servanda). Nessa medida, as nuances dos contratos interempresariais, em conjunto com a imprescindível atividade estatal de regulação do mercado (fenômeno poliédrico), demandam uma aplicação diferenciada do modelo da onerosidade excessiva previsto nos artigos 478 a 480 do Código Civil, sob pena de desvirtuamento da lógica empresarial e desestímulo ao tráfico mercantil. O primeiro capítulo deste trabalho é destinado à individualização dos principais vetores da atividade empresarial e os respectivos reflexos daqueles na formação dos contratos empresariais. Em seguida, no segundo capítulo da empreitada, são analisadas as teorias revisionistas de maior influência na construção do modelo de onerosidade excessiva brasileiro, bem como as especificidades do próprio modelo em si. Por fim, o terceiro e conclusivo capítulo visa à identificação do suporte fático da onerosidade excessiva em contratos empresariais, bem como à análise dos efeitos decorrentes da aplicação do modelo a referidas formas de contratação. / This dissertation is focused on the analysis of the change of circumstances, regarding specifically entrepreneurial contracts. These contracts, understood as those in which at least one of the parties involved is an entrepreneurial entity and both of the parties seek to obtain profits with the deal, can be defined by distinguished characteristics when compared to civil contracts in general (contratos existenciais), mainly when it comes to the risk assumption by the parties in the contract. Given the risk inherent to business activities, the exogenous intervention in entrepreneurial contracts aiming the protection of one of the parties should be reduced as much as possible, in such a way to respect the binding force of the contracts (pacta sunt servanda). Accordingly, the specificities of the entrepreneurial contracts, together with the indispensable public regulation of the market (polyhedral phenomenon), require a distinguished applicability of the rules provided by the Brazilian Civil Code under the articles 478 to 480, otherwise entrepreneurial rationality of commercial contracts may be ruined and, as a result, the commercial traffic discouraged. The first chapter of this study is dedicated to finding the main features of the business activity and their implications to the formation of entrepreneurial contracts. Subsequently, in the second chapter of the essay, the theories related to change of circumstances that most influenced the construction of a Brazilian theory are analyzed, as well as the peculiarities of the Brazilian theory itself. Finally, the third and concluding chapter seeks to identify the hypothesis provided by articles 478 to 480 for entrepreneurial contracts, as well to analyze the effects arising from the application of this set of rules to referred contracts.

Made available in DSpace on 2016-06-02T19:45:57Z (GMT). No. of bitstreams: 1 DissLZMA.pdf: 788184 bytes, checksum: 487fa9a5ccb31dc3ce033b97c8610d15 (MD5) Previous issue date: 2007-06-15 / Universidade Federal de Sao Carlos / Considering the highest increasing of the elderly population in our country and simultaneously the increasing of morbidity rate of chronic-degenerative disease, in general, there are people seeking to be in attendance, at day centre or hospital; these people are dependents on and when come back home, need familial caregivers. The caregivers are the fundamental importance to keep the patient in his community, to prevent and treat the problems caused by the stress factors among them must contribute to reduce or to postpone the hospitalization of caregivers. Besides, the improvement on quality of life could give the caregivers do better help to patients by influencing positively on the chronic disease course. So, this research try to undestand the reality of the caregivers lifes who s relatives are chronic illnesses pacientes. With this knowlege, implement and evaluate the effectiveness of an intervention proposal with caregivers. The objective of this intervention is to attenuate the happened stress conditions of the care activities. The research will use interview with caregivers at USE, at Federal University at S.Carlos; this interview will be taped and latter, a transcription to analyze the content of answers and to elaborate the intervention plan, in that case, a course. The course will consist of informative aspect about disease and daily life activities, as well as, formative aspect about self knowledge. A quality of life instrument named Caregiver Burden Scale will be given to caregivers. After the intervention (course) the Scale will be give once more to verify the date and to check the efficacy of intervention. / Intervenção: suporte para cuidadores de doentes crônicos através do ensino. Considerando-se o acelerado aumento da população idosa em nosso país e simultaneamente o aumento do índice de morbidade de doenças crônico-degenerativas em geral, temos observado cada vez mais o aumento do número de pessoas buscando atendimento, tanto em nível ambulatorial quanto hospitalar, estas pessoas são muitas vezes dependentes e quando retornam para suas casas precisam receber cuidados de algum membro da família, o cuidador. Sendo os cuidadores de fundamental importância para manter o paciente na comunidade, a prevenção e o tratamento dos problemas (produzidos pelo impacto de fatores estressantes) entre os cuidadores podem contribuir para se reduzir ou protelar a institucionalização. Além do mais, a melhora na qualidade de vida dos cuidadores possibilita-lhes prestar melhor assistência aos pacientes, influenciando positivamente o curso da doença crônica. Assim, esta pesquisa tem como objetivo identificar a realidade de cuidadores de pacientes portadores de doenças crônicas e, a partir deste reconhecimento, implementar e avaliar a eficácia de uma proposta de intervenção junto a cuidadores que objetiva atenuar as condições estressantes advindas das práticas de cuidado. Utilizará para tanto, entrevistas com cuidadores familiares, abordados em uma Unidade Saúde Escola (USE), estas entrevistas serão gravadas e posteriormente transcritas para análise do conteúdo e elaboração da intervenção, no caso um curso, onde serão abordados aspectos informativos sobre a patologia e as atividades desempenhadas no cotidiano, assim como, aspectos formativos como o autoconhecimento; também nesta primeira fase será aplicado um instrumento de qualidade de vida denominado Caregiver Burden Scale. Após a intervenção o instrumento será aplicado novamente para ser possível um confronto de dados e verificar a eficiência da intervenção.

This thesis focuses on mapping out work burden of formal caregivers in social services, above all on cathegories influencing a level of the burden. Its aim is to describe cathegories/areas of work burden of caregivers in retirement homes at standard wards and at wards with a special measures regime, where they take care of clients suffering from dementia. A sub-aim is to find out whether there are differences in perception of the work burden at the two types of wards and differences between work burden at these wards. Based on the conclusion of this thesis, recommendations for the management of retirement homes will be formulated. The research will be conducted in a retirement home which has both types of wards - the standard one and the one with speacial measures regime. Its respondents will be the formal caregivers of these wards. Key words Formal caregiver, paid caregiver, burden, measurement of caregiver burden, workload of formal caregiver, home for the elderly, retirement home, nursing home

Caring for a family member who is ill can be a draining experience (Cooper et al., 2006; Daire, 2002; Zarit et al, 1980). Providing care for a family member that is living with HIV/AIDS is potentially even more stressful because of social meanings associated with HIV/AIDS infection (Stajduhar, 1998) and the contagious nature of the HIV virus (Powell-Cope & Brown, 1992). Research indicates that most caregivers are female (Bunting, 2001; Songwathana, 2000). In Africa women bear the brunt of the burden of providing care for family members who are living with HIV/AIDS (Mushonga, 2001; Olenja, 1999). This study examined coping factors and caregiver burden among female caregivers (N=116) of a family member living with HIV/AIDS in Kenya. Coping factors were derived from a principal components factor analysis of the fourteen scales on the Brief Cope (Carver, 1997). Caregiver burden was measured using the Zarit Caregiver Burden Inventory. Multiple regression analysis was used to investigate the relationships between caregiver burden and coping factors. Post–hoc multiple regression analyses further investigated the relationship between caregiver burden and caregiver demographic characteristics. The relationship between caregiver burden and care recipient characteristics was also investigated. The principle components factor analysis of the Brief Cope yielded five coping factors that were labeled: Social support, Hope, Acceptance, Planning, and Disposition. The regression analysis that was conducted to investigate the relationships between these five coping factors and caregiver burden indicated a significant inverse relationship between Hope and caregiver burden. The post-hoc analyses investigating the relationship between various caregiver and care recipient characteristics indicated a significant relationship between the caregiver's age and caregiver burden, and education level and caregiver burden. An increase in age correlated with a decrease in caregiver burden. An increase in education level correlated with reduced caregiver burden. Implications of the findings for research and practice are discussed.

The aim of this study was to explore spouses' roles in a relationship with a partner with dementia and to understand spouses' situations at home. The study was focusing on gender roles and authority in relationships between the spousal caregivers and their partners with dementia. The method used for this study was qualitative content analysis and the data was collected from seven interviews with spousal caregivers about their roles as partners of people with dementia. By critically examining Twiggs three models, carers as resources, caregivers as co-workers and carers as co-clients, we have been able to visualize how spouses can look upon their role to their partners with dementia. A fourth model has been added to a modification of Twiggs models, because spouse's roles didn't fit into any of Twiggs already existing models. There is not a big gender difference about spousal care for a partner, and the caregivers are in a highly extent affected of the situation with a partner with dementia. Spouses role can fit in with partners as carers, which is a fourth model added to Twiggs original three models.

稅務案件涉及稅捐核課之行政程序和爭端解決之訴訟程序，兩者皆採職權調查主義，當事人對於待證事實之主張及證據聲請不拘束行政機關與法院，其得依其職權就必要且可能之證據為調查。而因稅務案件量大且相關證據皆處於納稅義務人之管領範圍下，致職權調查待證事實困難，故有當事人協力義務之規範，兩者相互影響。若當事人不盡其協力義務將可能使證明度降低，並於審判最終待證事實仍真偽不明時，以客觀舉證責任為判決分配。本文分析現行法規範下行政與訴訟程序中有權機關職權調查、當事人協力義務、證明度調整與舉證責任之分配，並以營利事業所得稅常見之爭議為例，探討現行實務作法是否與理論一致，並於文末提出相關現行作法之修改或法規範之建議，以供參酌。 / Tax administrative lawsuits involve administrative procedures and administrative litigation. Both administrative procedures and administrative litigation follow the inquisitorial investigation. Tax authorities and courts can investigate the facts and circumstance according to their authority and are not restricted by the declaration of the parties. However, due to the fact of a large number of tax administrative lawsuits and tax information often accessible only to taxpayers, tax authorities and courts may encounter great difficulties in the inquisitorial investigation. Therefore, taxpayers are obligated to assist tax authorities to investigate the relevant facts and circumstance. Taxpayers’ obligation to assist tax authorties may have a counter-effect on tax authorities’ obligation to follow the inquisitorial investigation. When the cooperative obligation falls on the party, it may cause essening of the standard of proof. If there still not knows the truth at the end of final judgment, using objective burden of proof to allocate the judgment. This thesis study the relationship between the inquisitorial investigation of the authority, cooperative obligation of the taxpayer, standard of proof adjustments, and the current burden of proof of legal norms. By examining the tax administrative litigation cases concerning the Profit-Seeking Enterprise Income Tax, this thesis analyzes the discrepancy in the practice and the theory, and concludes with relevant suggestions to improve current practice and legal norms.

Background Middle-income countries are currently undergoing nutrition transition more rapidly than did high income countries. These populations are therefore at high risk of over-nutrition (obesity) and nutrition-related, non-communicable diseases before the elimination of under-nutrition and infectious diseases. Such nutritional double burden is most common in low SES groups of middle-income countries, such as the Maya of Mexico. Long-term poor environmental conditions during early life results in a population with high levels of chronic under-nutrition (stunting), and a consequent predisposition toward overweight/ obesity, and associated health risks later in life. It is important to be able to identify individuals at an increased risk of diseases related to double burden and to determine whether stunting impacts the ability to identify at risk individuals. Aims The overall purpose of this doctoral research was to examine double burden in the urban Maya, a low SES section of the Mexican population which is a current example of a population undergoing significant transition. The specific aims of this thesis were fourfold: 1) To describe the living conditions and population characteristics of the urban Maya of southern Merida in the spring and summer of 2010; 2) to determine whether body mass index (BMI) predicts adiposity indicators in a sample of women and children with a high prevalence of stunting, 3) to determine whether measures of linear growth in women can be predicted by their recalled childhood environment and 4) To determine whether the relationship between objectively estimated free-living energy expenditure and body composition is altered by stunting. Methods Data from interviews, anthropometric measurements and bioelectrical impedance analysis were collected on 58 Maya schoolchildren aged 7-9 years-old and their mothers living in the south of Merida, Mexico. Objective, free-living physical activity monitoring using combined accelerometry and heart rate monitoring of the children was also performed for one week. The interview data was used to describe the living conditions of the south of Merida. Whether stunting status or body proportions influenced the power of BMI to predict adiposity indicators was assessed for the mothers and the children. The mothers recalled early life SES was compared to their current measures of linear growth. The children s objectively estimated energy expenditure was compared to their body composition and measurements of body size. Results The Maya of southern Merida overall had access to clean drinking water and basic health care and have apparently eliminated acute under-nutrition. Yet they remained double burdened with simultaneous stunting and overweight/ obesity. Individual double burden levels were high, with 70% of the mothers were simultaneously stunted and overweight. Family level double burden was also high, with 28% of the families having an overweight mother and a stunted child. The rates of childhood malnutrition varied widely when using different cut-offs. Child stunting rates were between 15.5% and 37.9% when using -2 z-scores of Frisancho s Comprehensive (created using NHANES data) reference versus the 5th percentile of the WHO reference, respectively. Child overweight/ obesity rates were less than 10% when using weight-for-age on both the Comprehensive and WHO reference charts. Child overweight/ obesity as classified using BMI z-scores was between 27.5 to 34.5% using the Comprehensive and WHO reference, respectively, while child overfat was over 80% when using body fat percentage for age reference curves. BMI predicted adiposity indicators in these Maya children, explaining between 33 and 84% of the variance in arm fat index and waist circumference z-score, respectively. BMI was less strongly related to the mothers adiposity indicators, explaining between 19 and 70% of the variance in arm fat area and waist circumference. The relationship between BMI and adiposity indicators was unchanged by stunting or body proportions in either mothers or children. Mothers recalled early life SES was significantly related to but explained little of the variance in her measures of linear growth. Birth decade explained 5% of the variance in stature and the Modernisation index (urban/ rural birth, sugar sweetened beverage consumption, packaged food consumption) explained 5% of the variance in mothers leg length. Birth order, sibling number and consumer durable ownership were also significantly related to linear growth of the mothers. These Maya children had high levels of physical activity, as all exceeded the recommended 60 minutes of moderate-to-vigorous physical activity per day. After controlling for fat free mass, short stature did not predict lower resting energy expenditures in the children. However shorter stature did predict lower levels of activity energy expenditure, particularly in girls. Stunted girls had the lowest activity energy expenditures. Conclusions These urban Maya tend to have access to basic sanitation and services and are at a very high risk for NR-NCDs with the co-existence of chronic under-nutrition (stunting) and overweight/ obesity. The high rates of stunting do not impact the usefulness of BMI to estimate adiposity nor does stunting appear to impact children s energy expenditure. While BMI is useful to predict adiposity in these urban Maya children, it is not recommended for use in the mothers. Interventions to reduce childhood adiposity need to begin very early in life to most effectively reduce adiposity. Research into the low SES groups of middle-income countries, offers insight to what may occur in low-income countries as they advance in the nutrition transition.

Aims: To investigate the natural history of CHC, estimate the disease burden of CHC, and assess the cost-effectiveness of screening for CHC among immigrants living in Canada. Methods: A retrospective cohort study compared the prognosis of CHC between immigrant patients and native-born patients who had advanced fibrosis. A cross-sectional study assessed the association between obesity and hepatitis C viremia. The disease burden of CHC among immigrants was estimated through Markov cohort model. The cost-effectiveness of screening for CHC was assessed among immigrants. Results: The retrospective cohort study including 318 patients demonstrated that immigrant patients had significantly higher risk of hepatocellular carcinoma than Canadian-born patients (p=0.005). The hazard ratio associated with ‘immigrant’ for hepatocellular carcinoma in multivariate Cox proportional-hazards analyses reduced to the least and non-significant (p=0.318) after adjusting age and type 2 diabetes. The prevalence of obesity in 1118 individuals tested positive for hepatitis C antibody was 28.8%. Multiple regression analyses and propensity score methods suggested a significant association between obesity and hepatitis C viremia. The disease burden study estimated that immigrants with CHC had much shorter average life years (26.9 years vs. 39.1 years) and quality adjusted life years (20.6 years vs. 32.4 years) than the age matched immigrants without CHC. The cost-effectiveness study indicated that screening for CHC among immigrants from 183 countries (72.1% of immigrant population in Canada) had an incremental cost-effectiveness ratio less than $50,000 per quality adjusted life year gained. Conclusion: Immigrant patients with CHC could have a higher risk of HCC than native-born patients. The significant association between obesity and hepatitis C viremia could explain the observed high prevalence of type 2 diabetes in patients with CHC. CHC reduces the average life expectancy of immigrants with CHC more than 10 years. Screening for CHC is cost-effective among over 70% of immigrants living in Canada.

Tyrimo objektas – valstybės skola. Tyrimo tikslas – įvertinus Lietuvos valstybės skolą, ištirti jos poveikį socialinėms išlaidoms. Uždaviniai: 1. Pateikti valstybės skolos sampratą bei valstybės skolinimosi poreikį sąlygojančius veiksnius. 2. Apibrėžti valstybės skolos naštą ir skolinimosi reikšmę ekonomikai. 3. Pateikti valstybės skolos vertinimo kriterijus. 4. Įvertinti Lietuvos valstybės skolą tarp ES valstybių pagal išskirtus vertinimo kriterijus. 5. Nustatyti Lietuvos valstybės skolos poveikį socialinėms išlaidoms bei palyginti jį su kitomis ES šalimis. Tyrimo metodika. Valstybės skolos sampratai bei valstybės skolinimosi poreikio nustatymui naudoti bendramoksliniai tyrimo metodai – mokslinės literatūros bei teisinių dokumentų analizė ir sintezė. Atliekant Lietuvos valstybės skolos analizę – statistinių duomenų rinkimo bei analizės metodai, palyginimo, grafinio vaizdavimo būdai, loginė analizė ir sintezė. Pritaikius regresinę analizę nustatytas Lietuvos valstybės skolos poveikis socialinėms išlaidoms. Lyginamosios analizės dėka šis poveikis įvertintas Europos Sąjungos šalių kontekste. Tyrimo rezultatai. Pirmojoje darbo dalyje pateikta valstybės skolos samprata, valstybės skolinimosi poreikį sąlygojantys veiksniai, skolinimosi reikšmė ekonomikai, išanalizuoti ir susisteminti skolos naštos modeliai. Antrojoje darbo dalyje, išanalizavus įvairių mokslininkų darbus, pateikti valstybės skolos vertinimo kriterijai, nustatyta valstybės skolos sudėties svarba, pateiktas... [toliau žr. visą tekstą] / Object of the research – public debt. Aim of the research – to evaluate the Lithuanian public debt, to assess its influence on social expenditure. Objectives of the research: 1. to present the concept of public debt and to discuss the factors, which influence government borrowing needs; 2. to define the debt burden and to determine the effect of public debt on economy; 3. to provide the public debt evaluation criteria; 4. to evaluate the Lithuanian public debt in respect to the situation in the EU countries according to the identified criteria; 5. to determine the impact of the Lithuanian public debt on social expenditure and to compare it with that in other EU countries. Research methods. Analysis and synthesis of scientific literature and legal documents, statistical data collection and analysis methods, comparative analysis, graphical representation techniques, logical analysis, regression analysis. Research results. Part One introduces the concept of public debt, analyzes the factors influencing government borrowing needs, importance of borrowing to economy and structured models of debt burden. Part Two, having analyzed various scientific articles, provides criteria of the public debt evaluation, reasons importance of the public debt composition and presents the assessment model of the impact of public debt on social expenditure. Part Three gives structural and dynamic analysis of the Lithuanian public debt, evaluates the amount of public debt, according to the... [to full text]