The problem of this study was to better understand spouse caregivers' leisure involvement, experience, and barriers and their relationships with perceived burden. Thirty-six wife and 19 husband caregivers of persons with Alzheimer's disease and related disorders volunteered to participate in this study, either by mailed questionnaire or interview. Respondents were primarily female, white, with an average age of 72 years. The conclusions of the study were: (a) caregivers significantly reduce both their leisure involvement; (b) self-reported health, perceived social supports, income level, use of paid help, and leisure activity patterns are major factors associated with caregivers' leisure; and (c) leisure barriers are a significant contributor to caregivers' perceived burden. Recommendations were presented for caregivers, practitioners, and future study.

Made available in DSpace on 2015-03-05T19:13:45Z (GMT). No. of bitstreams: 0 Previous issue date: 30 / Nenhuma / Analisa-se neste trabalho o disclosure da carga tributária nas Demonstrações Contábeis publicadas em 31/12/2006, por uma amostra de companhias do setor de energia elétrica, listadas nas Maiores e Melhores da revista exame, edição de 2007. Os dados foram coletados no balanço patrimonial, demonstração de resultado do exercício, notas explicativas, demonstração do valor adicionado, demonstração dos fluxos de caixa, demonstração das mutações do patrimônio líquido, demonstração das origens e aplicações de recursos, demonstração do resultado por atividade, demonstrações estas divulgadas na página web da Comissão de Valores Mobiliários (CVM). A metodologia da pesquisa utilizada consistiu em um procedimento de pesquisa documental, com abordagem qualitativa-quantitativa. Apurou-se que no cenário do setor de energia elétrica no Brasil, as informações tributárias são pouco evidenciadas não sendo divulgados, de forma separada ou aberta, os dados relativos aos tributos e encargos do setor. Ao todo foram analisadas as dem / This research aims to analyze the disclosure of the tax burden in the Financial Statements published in Dec 31st 2006 by a sample of companies in the sector of electric energy, listed in the Maiores e Melhores of Exame magazine, 2007 edition. Data were collected in the balance sheet, in the income statement for the year, notes, demonstration of the value added, statement of the cash flows and of changes in equity, demonstration of the origins and application of resources demonstration of the result by activity, which were disclosed on the webpage of the Comissão de Valores Mobiliários (CVM). The research methodology consisted of a procedure of documentary research, with qualitative and quantitative approach. It was found that in the scenario of the sector of electric energy in Brazil the tributary information are little evidenced, being not disclosed, in isolation or open, data concerning the taxes and charges of the sector. Overall the statements of 17 companies in the sector of electric energy in Brazil wer

Introdução/Objetivos: O impacto da artrite psoriásica (APso) percebido pelo paciente que vive fora do continente europeu ainda é pouco conhecido, uma vez que quase todos os estudos qualitativos sobre o tema recrutaram populações europeias. O presente trabalho tem como objetivo avaliar o impacto físico, emocional, profissional e social da APso em pacientes brasileiros. Também se compara o impacto da APso percebido por pacientes franceses e brasileiros. Métodos: Um estudo qualitativo foi realizado em dois hospitais universitários no Brasil e na França; pacientes ambulatoriais que preenchiam critérios de classificação para APso participaram de entrevistas individuais na linguagem local. O tamanho da amostra foi definido através do princípio de saturação; as entrevistas foram gravadas, os dados foram transcritos e uma análise de conteúdo foi realizada. Resultados: Quinze pacientes foram entrevistados no Brasil e 13 na França. A média de duração da doença foi de 16,.5 ± 12,5 anos (variando de 8 meses até 47 anos) e 14,4 ± 8,4 anos (variando de 12 meses a 29 anos), para brasileiros e franceses, respectivamente. Medicamentos biológicos foram prescritos para 33% dos brasileiros (N=5) e 23% dos participantes franceses (N=3). Um amplo impacto foi reportado: 67 categorias emergiram durante as entrevistas e foram agrupadas em 24 domínios de saúde. O impacto da doença percebido pelos brasileiros e franceses foi globalmente similar: 67% dos domínios foram comuns a ambas as nacionalidades. Apesar do impacto percebido pelas duas amostras ser semelhante, alguns domínios importantes para os brasileiros e ainda pouco estudados nesta população como desordens do sono, disfunção sexual e fadiga foram identificados. Este trabalho também expõe o impacto emocional, social e profissional do preconceito causado pela psoríase em pacientes brasileiros. Conclusão: Brasileiros e franceses com APso percebem um amplo e similar impacto da doença, que transcende os aspectos físicos. Domínios importantes para pacientes que vivem fora da Europa e que permanecem pouco estudados podem ser reconhecidos através da metodologia qualitativa. / Background: The patient-perceived impact of Psoriatic Arthritis (PsA) outside the European background is still few studied since almost all qualitative studies on the subject have been performed in European populations. This work aimed to evaluate the physical, emotional, professional and social impact of PsA in Brazilian patients. It also compares patient-perceived impact of PsA between Brazilian and French subjects. Methods: A qualitative study was conducted in two university hospitals in Brazil and France; outpatients fulfilling classification criteria for PsA participated in individual interviews in the local language. The sample size was defined by saturation; interviews were recorded, data were transcribed and content analysis was performed. Results: Fifteen patients were interviewed in Brazil and 13 in France. Mean disease duration was 16.5 ± 12.5 years (range: 8 months to 47 years) and 14.4 ± 8.4 years (range 12 months to 29 years), for Brazilian and French subjects, respectively. Biologic drugs were prescribed to 33% of Brazilians (N=5) and 23% of French participants (N=3). A broad impact was perceived: 67 categories of impact emerged from the interviews and were grouped in 24 health domains. The impact of disease perceived by Brazilian and French participants was globally similar: 67% of domains were common to both nationalities. Despite the similar impact among the samples, some domains important for Brazilian patients and still few studied in this population as sleep disorders, sexual dysfunction and fatigue were identified. This work also exposed the emotional, social and professional impact of prejudice due to psoriasis in Brazilian patients. Conclusions: Brazilian and French subjects living with PsA perceive a broad and similar impact of disease which goes far beyond physical aspects. Domains important to patients living outside Europe and which remain few studied can be recognized through qualitative methodology.

Stroke är den tredje vanligaste dödsorsaken i Sverige och risken för att insjukna ökar med stigande ålder. Vid stroke har personen drabbats antingen av en infarkt eller av en blödning i hjärnan. Restsymtomen efter en stroke kan uttrycka sig på olika vis. Vanligaste symtomen är domningar eller förlamningar i ansikte, armar och ben. Rehabilitering efter en stroke kan ta lång tid och efter sjukhusvistelsen är det ofta närstående som tar det största ansvaret för omvårdnaden av personen som drabbats av stroke. Syfte med studien var att undersöka närståendes upplevelser och erfarenheter av att vårda en person som drabbats av stroke. Litteraturöversikten genomfördes genom kritisk granskning och analys av kvalitativa och kvantitativa vårdvetenskapliga artiklar, enligt analysmodellen av Friberg (2006). Litteratursökningen gjordes i databaserna Cinahl och Pubmed. I resultatet framträdde två huvudteman : Förändrad livsvärld och Upplevelser och erfarenhet med hälso- och sjukvårdspersonal. Resultatet visade att närstående upplevde en stor livsförändring där rutiner och livsmönster ändrades och anpassades efter personen som drabbats av stroke. Det gjorde att närstående upplevde att det inte fanns tid för egna intressen. Närstående upplevde både psykisk- och fysisk ohälsa som stress, depression, ångest, högt blodtryck, magsmärtor och sömnsvårigheter. Många närstående upplevde att informationen från hälso- och sjukvårdspersonalen var otillräcklig. Det medförde att närstående kände sig osäkra på att vårda den som drabbats av stroke. Sjuksköterskor har möjlighet att påverka närståendes upplevelser genom att bemöta dem på ett respektfullt och lyhört sätt. Det handlar också om att de kan identifiera informationsbehovet för att ge adekvat information som kan stilla närståendes oro. / Program: Sjuksköterskeutbildning

Submitted by Ana Lúcia Torres (bfmhuap@gmail.com) on 2017-09-19T15:51:38Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertação de Mestrado Jaqueline Abel - versão final (1).pdf: 1209039 bytes, checksum: eed9b8980c55578d399792746ea7274d (MD5) / Approved for entry into archive by Ana Lúcia Torres (bfmhuap@gmail.com) on 2017-09-19T15:52:52Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertação de Mestrado Jaqueline Abel - versão final (1).pdf: 1209039 bytes, checksum: eed9b8980c55578d399792746ea7274d (MD5) / Made available in DSpace on 2017-09-19T15:52:52Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertação de Mestrado Jaqueline Abel - versão final (1).pdf: 1209039 bytes, checksum: eed9b8980c55578d399792746ea7274d (MD5) Previous issue date: 2016 / Universidade Federal Fluminense. Hospital Universitário Antonio Pedro / As infecções primárias de corrente sanguínea (IPCS) estão entre as infecções relacionadas à assistência à saúde (IRAS) mais frequentemente adquiridas no ambiente hospitalar. Essas infecções aumentam o tempo de internação, o custo e a mortalidade intra-hospitalar. No entanto, o impacto deste agravo em perda de saúde permanece desconhecido. Método: foi conduzida uma coorte de IPCS com comprovação microbiológica (IPCS-CM) com objetivo de estimar a carga de doença das IPCS-CM detectadas no Hospital Universitário Antônio Pedro (HUAP), de dezembro de 2013 a dezembro de 2014. Os anos de vida perdidos por morte prematura e os vividos sem condições plenas de saúde foram calculados conforme metodologia do Global Burden of Disease de 2010. O DALY (Disabilty-ajusted Life Year) foi calculado através de planilha da Organização Mundial de Saúde (OMS). Resultados: o DALY das IPCS-CM foi 20,44/1000 pacientes internados. Os anos de perdidos por morte prematura (YLL) contribuíram com a maior fração do DALY (YLL = 20,42/1000), comparado com os anos vividos sem condições ideais de saúde (YLD = 0,02/1000). Quando comparadas as infecções por microrganismos multirresistentes com aquelas por germes multissensíveis, as infecções por multirresistentes contribuíram mais para o DALY (multirresistentes: 13,42 DALYs/1000; multissensíveis: 7,18 DALYs/1000; DALY GAP: 6,24/1000). Conclusão: esses resultados demonstram através da elevada carga de doença o impacto em perda de saúde das IPCS-CM, principalmente naquelas infecções causadas por microrganismos multirresistentes. / Central line-associated bloodstream infections (CLABSI) are among the most often health care associated infections (HAIs) acquired in the hospital. CLABSI increase the length of stay, cost and hospital mortality. However, its impact on health loss remains unknown. This study was a cohort of CLABSI episodes in order to estimate the burden of CLABSI detected in a Brazilian public university-affiliated hospital from December 2013 to December 2014. The Disability-adjusted Life Year (DALY) was calculated based on the Global Burden of Disease methodology of 2010, through Excel spreadsheet of the World Health Organization (WHO). The DALY of CLABSI in HUAP was 20.44 / 1,000 inpatients. The Years of Life Lost due to premature death (YLL) contributed with the largest DALYs fraction (YLL=20.42/1,000), when compared with the Years Lost due to Disability (YLD) (YLD=0.02/1,000). Multiresistant infections contribute more to the DALY than those caused by non-multiresistant agents (multiresistant: 13.42 DALYs/1,000; non-multiresistant: 7.18 DALYs/1,000; DALY GAP: 6.24/1,000). These results demonstrate the great impact on loss of health due to CLABSI caused by multiresistant microorganisms.

Made available in DSpace on 2016-03-15T19:34:03Z (GMT). No. of bitstreams: 1 Alexandre Luna da Cunha.pdf: 789188 bytes, checksum: 33512918478e91ea743041393abed46b (MD5) Previous issue date: 2007-04-12 / The Brazilian Consumer Protection and Defense Code rules the principles for shift of evidence burden. This paper broaches the relation between citizenship, legal process and consumer rights besides bringing to a focus the shift of evidence burden. It goals to develop the idea that the application of shift of evidence burden must consider the principles of easing access to the justice for the consumer, and putting into effect his rights. It also explores the functioning of shift of evidence burden in consumer area. / O Código de Defesa do Consumidor estipula os princípios para a aplicação da inversão do ônus da prova. A presente dissertação trata da relação entre cidadania, processo e direitos do consumidor, em especial a inversão do ônus da prova. Desenvolve a noção de que a aplicação da inversão do ônus da prova deve levar em conta os princípios da facilitação do acesso à justiça e da efetivação dos direitos do consumidor. Explora os mecanismos da inversão do ônus da prova na seara consumerista.

A demanda extra de cuidados é definida como sobrecarga e pode impactar a vida da família, considerando que a natureza crônica da doença mental submete o familiar ao efeito prolongado de eventos estressores envolvidos na experiência cotidiana de cuidar, o que pode afetar a sua própria saúde mental. Este estudo teve por objetivo avaliar a ocorrência de sobrecarga entre cuidadores de pessoas com transtorno mental em início de internação psiquiátrica e sua relação com a ocorrência de estresse e de sofrimento mental. Foi realizado um estudo epidemiológico, transversal, com duração de dois anos. Participaram do estudo 112 cuidadores, de ambos os sexos, maiores de 18 anos. Para coleta de dados foram utilizados: um questionário para coleta de dados sociodemográficos, de condições ocupacionais, de saúde e de conhecimento pelo cuidador a respeito da doença do paciente com transtorno mental; a Escala de Sobrecarga Zarit Burden Interview (ZBI); o Inventário de Sintomas de Stress para Adultos da LIPP (ISSL); e o Self-Reporting Questionnaire (SRQ 20). Utilizou-se estatísticas descritiva e analítica, com medidas de tendência central, testes Qui- Quadrado de Pearson, o Exato de Fisher e teste de Concordância Kappa, com coeficiente de correlação de Pearson e regressão logística. Foi considerado nível de significância de 0,05. Todos os aspectos éticos foram respeitados. Entre os cuidadores, houve predomínio do sexo feminino (82%), a maioria era casada ou possuía companheiro fixo (59%), e idade média de 49 anos. Os escores de sobrecarga entre os cuidadores variaram de 13 a 81 pontos, com média de 50,2. Evidenciou-se que apenas 3,6% destes cuidadores não apresentaram sobrecarga e que a maioria apresentava sobrecarga de moderada a severa; 79,5% apresentaram sintomas de estresse, sendo que a maioria estava na fase de estresse chamada de Resistência (52,7%) e com predomínio de sintomas psicológicos de estresse (66,1%); 67,9% dos cuidadores estavam em sofrimento mental. Houve associação com elevada significância estatística entre a sobrecarga destes cuidadores e a ocorrência de estresse e de sofrimento mental. Os sintomas psicológicos do estresse, como: preocupação, ansiedade e irritabilidade, foram fatores de risco para sobrecarga severa. Assim, os resultados deste estudo deflagram a alarmante situação dos cuidadores de pessoas com transtornos mentais em início de internação psiquiátrica, evidenciando sua situação de sobrecarga e vulnerabilidade ao adoecimento e ao sofrimento mental. Portanto, é evidente a necessidade de intervenções e estudos que visem ampliar e qualificar o cuidado a saúde destes familiares cuidadores / The extra demand for care is defined as burden and it can affect family life whereas mental illness chronic nature shall expose the family to the prolonged effect of stressful events involved in everyday experience of care, which can affect their own mental health. This study aimed to evaluate the burden occurrence among caregivers of patients in early psychiatric hospitalization and the relation with their stress and mental suffering. An epidemiological, cross-sectional study was conducted, lasting two years. A number of 112 family carers, older than 18 years old, participated in the study. For data collection, it was used: a questionnaire to collect sociodemographic data, occupational condition, health and knowledge by the caregiver about the mental disorder patient illness; Zarit Burden Interview (ZBI); Inventory of Stress Symptoms for Adults of Lipp (ISSL); and the Self-Reporting Questionnaire (SRQ 20). It was used descriptive and analytical statistics, performing chi-square tests of Pearson, Fisher\'s exact test and Kappa Agreement with Pearson\'s correlation coefficient and logistic regression, considering ,0.05 significance level. All ethical aspects were respected. There was a female predominance (82%), most of them were married (59%) and had an average age of 49 years old. The burden scores among carers ranged from 13 to 81 points, averaging 50.2. Only 3.6% of these caregivers did not show burden, and most of them had moderate to severe burden; 79.5% showed stress symptoms and most of them was in the phase of stress called resistance (52.7%), with a predominance of psychological symptoms of stress (66.1%); 67.9% of caregivers were in mental suffering. There was an association with high statistical significance between the burden of these caregivers and the occurrence of stress and mental suffering. Psychological symptoms of stress, such as worry, anxiety and irritability, were risk factors for severe burden. Thus, the results of this study trigger the alarming condition of the carers of people with mental disorders in early psychiatric hospitalization, indicating their vulnerability to illness and mental suffering. Therefore, it is clear the need for interventions and studies that aim to widen and improve the health care of these family caregivers

In this study, we discussed the impacts of human water consumption to the nutrient burden in a river estuary, and used Huanghe River as a case study. The agricultural water consumption from the Huanghe River has significantly decreased the natural water flows, and the amount of water consumption could be almost twice as high as the water entering into the estuary. According to our calculation, agricultural water usage decreased TN outflows by 6.5 x 104 Mg/year and TP outflows by 2.0 x 103 Mg/year. These account for 74% and 77% of the total output loads. It has been widely reported that the majority of the rivers in northern China were severely polluted by nutrients. Its implication on the budget of nutrient in the estuary ecosystem is not well characterized. Our study showed that the discharge of nutrients in the coast waters from polluted rivers was over concerned. Nutrients in the polluted rivers were transported back to the terrestrial systems when water was drawn for human water consumption. The magnitudes of changes in riverine nutrient discharges even exceed the water-sediment regulation trails in the Huanghe River. It has non-negligible impact on estimating the nutrient burden in costal water ecosystem.

Black carbon (BC) is a significant component of fine particulate matter (PM2.5) air pollution, which has been linked to a series of adverse health effects, in particular premature mortality. Recent scientific research indicates that BC also plays an important role in climate change. Therefore, controlling black carbon emissions provides an opportunity for a double dividend. This study quantifies the national burden of mortality and morbidity attributable to exposure to ambient BC in the United States (US). We use GEOS–Chem, a global 3-D model of atmospheric composition to estimate the 2010 annual average BC levels at 0.5 x 0.667° resolution, and then re-grid to 12-km grid resolution across the continental US. Using PM2.5 mortality risk coefficient drawn from the American Cancer Society cohort study, the numbers of deaths due to BC exposure were estimated for each 12-km grid, and then aggregated to the county, state and national level. Given evidence that BC particles may pose a greater risk on human health than other components of PM2.5, we also conducted sensitivity analysis using BC-specific risk coefficients drawn from recent literature. We estimated approximately 14,000 deaths to result from the 2010 BC levels, and hundreds of thousands of illness cases, ranging from hospitalizations and emergency department visits to minor respiratory symptoms. Sensitivity analysis indicates that the total BC-related mortality could be even significantly larger than the above mortality estimate. Our findings indicate that controlling BC emissions would have substantial benefits for public health in the US.

Psychosocial support from family is important in outpatient treatment programs for individuals with depressive disorder. The purpose of this phenomenological study was to explore the lived experiences and perceptions of parents of patients with depressive disorder regarding intensive outpatient treatment. The research question was what are the experiences and perceptions of parents of patients with depression regarding their role as caretakers in intensive outpatient treatment? The conceptual framework was a biopsychosocial framework and family systems theory. Content analysis was used to analyze data provided from interviews with parent participants (n = 8). Many participants reported high levels of involvement with various forms of support. They maintained positive relations with professionals, were involved in patient socialization, and facilitated adherence to patients' treatment plans. The results of this study indicated that family caregivers experienced ambivalent emotions toward their roles and patients. Findings also indicated experiences of exhaustion, strong emotions about the burden of having to support the patient, and concern for their own and the rest of the family's well-being. Future researchers should study these aspects further. Researchers, clinical practitioners, and policy makers must increase efforts to support those who help family members suffering from depression to intensify the search for effective ways to reduce the toll on those caregivers. Because of these findings, researchers could expand literature to illuminate the decisions and practices of psychotherapists, leading to improvements in intensive treatment programs for both patients and their caretakers. This study impacts social change by providing insights to aid policy makers in ensuring that outpatients receive the best treatment program available and that their primary caretakers are psychologically prepared and healthy.