Orientador: Iveraldo dos Santos Dutra / Resumo: O objetivo geral do estudo foi avaliar os riscos sanitários associados ao uso de fontes exógenas de hormônios sexuais nos programas de sincronização e indução de ovulação “Inseminação Artificial em Tempo Fixo (IATF)”, “Transferência de Embriões em Tempo Fixo (TETF)”, "Superestimulação ovariana (SOV)” sobre a saúde coletiva e meio ambiente. Para isto, o trabalho foi dividido em quatro capítulos. O primeiro capítulo apresenta as considerações gerais sobre legislação, período de carência, equipamentos de proteção individual, grupos de risco e resíduos sólidos de saúde. No segundo capítulo o objetivo foi avaliar o conhecimento e a percepção de risco dos criadores de bovinos e médicos veterinários na utilização de hormônios e determinar os possíveis riscos para a saúde coletiva. Neste experimento foram entrevistados 65 criadores e 40 médicos veterinários que utilizavam hormônios nos programas de reprodução assistida em bovinos (IATF, TETF, SOV). A análise de correspondência múltipla foi processada com os fatores socioeconômicos (escolaridade, tempo na atividade) e a percepção de risco no uso de hormônios reprodutivos. A totalidade dos criadores entrevistados afirmaram que “os estabelecimentos que comercializam produtos veterinários não exigiram prescrição veterinária para a venda dos hormônios”. Os “períodos de carências” na carne e no leite eram desconhecidos por 69,2% dos criadores e por 65% dos médicos veterinários. Dos profissionais que afirmaram conhecer a informação, apenas ... (Resumo completo, clicar acesso eletrônico abaixo) / Doutor

INTRODUÇÃO: A síndrome coronariana aguda (SCA) é uma das manifestações clínicas da doença arterial coronariana. A Estratégia de Registro em Insuficiência Coronariana (ERICO) é uma coorte de indivíduos atendidos no Hospital Universitário da Universidade de São Paulo por SCA. O presente trabalho teve por objetivo descrever a frequência de uso o tempo para administração dos medicamentos habitualmente usados no tratamento das SCA nos participantes do estudo ERICO. MÉTODOS: Foram incluídos 746 participantes ERICO, entre fevereiro de 2009 e dezembro de 2012 que procuraram diretamente o hospital (N=656) ou que se dirigiram inicialmente a unidades de atenção primária à saúde (APS; N=90). Avaliamos o tempo do contato médico ao tratamento com aspirina, clopidogrel, heparina e trombolíticos, de acordo com a unidade de primeiro contato, utilizando modelos de regressão logística. Posteriormente, foram revisados os prontuários de 563 (85,8%) participantes que vieram diretamente ao hospital, e descritas as frequências de administração de aspirina, clopidogrel, heparinas, betabloqueadores, inibidores da enzima conversora de angiotensina (IECA) / bloqueadores dos receptores da angiotensina II (BRA), estatinas, nitratos e morfina. Os motivos de não-administração ou suspensão da aspirina, clopidogrel, heparinas, betabloqueadores e IECA/BRA foram obtidos dos registros em prontuário. RESULTADOS: Observamos que 93,6%, 86,1% e 86,5% dos participantes do estudo receberam aspirina, clopidogrel e heparina, respectivamente, durante as primeiras 24 horas de internação. Em modelos ajustados, indivíduos encaminhados de unidades de APS tinham mais chance de receber aspirina nas primeiras 3 horas (Razão de chances [RC]: 3,65; intervalo de confiança de 95% [IC95%]: 2,04-6,52), mas menor chance de receber heparina (RC: 0,32; IC95%: 0,16-0,62) ou clopidogrel (RC: 0,49; IC95%: 0,29-0,83) no mesmo intervalo de tempo. Entretanto, 24,4% dos participantes encaminhados das unidades de APS não receberam aspirina antes da transferência ao hospital. A não administração de aspirina, clopidogrel e heparina ao longo da internação foi um evento raro, e geralmente ligada a um maior risco de sangramento. Os betabloqueadores não foram prescritos para 15,8% dos participantes, e a principal causa encontrada foi a insuficiência cardíaca descompensada. IECA/BRA não foram prescritos para 16,7%, e a principal causa foi choque ou hipotensão. Entretanto, as causas de não-administração (64,0%) e de suspensão (26,4%) frequentemente não estavam descritas. CONCLUSÕES: Em nosso estudo, participantes que primeiramente foram a unidades de atenção primária tiveram uma maior probabilidade de receber tratamento precoce com aspirina, em comparação aos participantes que foram diretamente ao hospital. Entretanto, proporção significativa não recebeu o medicamento antes da transferência, apontando espaço para potenciais melhorias no atendimento. A frequência do uso de medicamentos no estudo ERICO foi, em geral, igual ou superior à maior parte dos estudos encontrados. A falha de registro adequado dos motivos de não-administração e suspensão em prontuário foi um achado frequente, e que também aponta para oportunidade de aperfeiçoamento da assistência / BACKGROUND: Acute coronary syndrome (ACS) is one of the clinical manifestations of coronary artery disease. The Strategy of Registry of Acute Coronary Syndrome (ERICO) is a cohort of individuals treated at the Hospital Universitário da Universidade de São Paulo due to an ACS event. The aim of this study was to describe the frequency of use and time-to-treatment for drugs commonly used in ACS treatment, in the ERICO study. METHODS: We included 746 ERICO participants enrolled from February 2009 to December 2012 who either sought the hospital directly (N = 656) or were initially referred to primary care units (N = 90). We evaluated the time-to-treatment with aspirin, clopidogrel, heparins and thrombolytics, according to the unit of first contact, using logistic regression models. Subsequently, the medical records of 563 (85.8%) participants who came directly to the hospital were reviewed and the frequency of aspirin, clopidogrel, heparins, beta-blockers, angiotensin-converting enzyme inhibitors (ACEI) / angiotensin II receptor blockers (ARB), statins, nitrates and morphine use. The reasons for non-administration and/or withdrawal of aspirin, clopidogrel, heparins, beta-blockers and ACEI / BRA were obtained from medical records. RESULTS: We observed that 93.6%, 86.1% and 86.5% of study participants received aspirin, clopidogrel and heparin, respectively, during the first 24 hours of hospitalization. In adjusted models, individuals referred from primary care units were more likely to receive aspirin within the first 3 hours (odds ratio [OR]: 3.65, 95% confidence interval [95%CI]: 2.04-6.52), But less likely to receive heparin (OR: 0.32; 95%CI: 0.16-0.62) or clopidogrel (OR: 0.49; 95%CI: 0.29-0.83) in the same time interval. However, 24.4% of the participants referred from primary care units did not receive aspirin before transfer to hospital. Non-administration of aspirin, clopidogrel, and heparin during hospitalization was a rare event, and generally linked to an increased risk of bleeding. Beta-blockers were not prescribed for 15.8% of the participants, and the main cause was decompensated heart failure. ACEI / ARB were not prescribed for 16.7%, and the main cause was shock or hypotension. However, the causes of non-administration (64.0%) and withdrawal (26.4%) were often not described. CONCLUSIONS: In our study, participants who first went to primary care units were more likely to receive early treatment with aspirin compared to those who went directly to the hospital. However, a significant proportion did not receive the drug prior to the transfer, indicating room for potential improvements in care. The frequency of medication use in the ERICO study was generally equal to or greater than those described in other studies. Failure to properly register the reasons for drug non-administration and treatment withdrawal was a frequent finding, pointing to an opportunity for improved care

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2016-05-19T14:31:23Z No. of bitstreams: 2 Dissertação Marilia Oliveira Morais - 2013.pdf: 1820357 bytes, checksum: f5d19dc55daf286af2de46f79df8659f (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2016-05-19T14:32:53Z (GMT) No. of bitstreams: 2 Dissertação Marilia Oliveira Morais - 2013.pdf: 1820357 bytes, checksum: f5d19dc55daf286af2de46f79df8659f (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2016-05-19T14:32:53Z (GMT). No. of bitstreams: 2 Dissertação Marilia Oliveira Morais - 2013.pdf: 1820357 bytes, checksum: f5d19dc55daf286af2de46f79df8659f (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2013-08-23 / Fundação de Amparo à Pesquisa do Estado de Goiás - FAPEG / Therapeutic modalities for the treatment of oral cancer result in local adverse effects that can cause interruptions of the radiotherapy and consequently to influence in the patient survival. For the reduction and control of the adverse effects, Dental Care Protocol is applied to patients with oral cancer by dental surgeon team before, during and after radiotherapy and chemotherapy. Objective: The aim of this study was to investigate the adhesion of patients with oral cancer to a Dental Care Protocol and its Impact in the interruption and survival. Patients and methods: In this study 133 cases of oral cancer undergoing radiotherapy were selected. The patients were classified according to the period of dental adhesion: no adhesion (group I), adhesion less than or equal to 6 months (group II) and adhesion higher than 6 months (group III). Clinic and pathological aspects, occurrence of interruption of radiotherapy, disease-free survival and overall survival were investigated. Results: The incidence of radiotherapy interruption due to symptoms was statistically significant in group III compared to group I (p = 0.01). The frequency and duration of interruption due to symptoms were not statistically significant between groups. The conclusion of radiotherapy rate was statistically significant in the group that exceeded 6 months of dental adhesion (p = 0.02). Patient’s survival was higher in group III (p = 0.01) when compared to the other groups. Conclusion: The adhesion to a dental care protocol did not have any impact on the radiotherapy interruption due to the occurrence of symptoms, however, patients who had higher adhesion to the Dental Care Protocol showed a higher rate of disease-free survival and overall survival. / Modalidades de tratamentos para o câncer de cavidade oral resultam em efeitos adversos locais que podem gerar interrupções da radioterapia e consequentemente influenciar na sobrevida do paciente. Para a redução e controle dos efeitos adversos, protocolos de preparo do paciente oncológico são estabelecidos por equipes odontológicas antes, durante e pós-tratamento radioterápico e quimioterápico. Objetivo: Verificar a adesão dos pacientes portadores de câncer de cavidade oral ao protocolo preventivo odontológico e seu impacto na interrupção da radioterapia e sobrevida do paciente. Pacientes e método: Neste estudo foram selecionados 133 casos de câncer de cavidade oral submetidos à radioterapia. Os pacientes foram classificados de acordo com o tempo de adesão odontológica: sem adesão (grupo I), adesão inferior ou igual a 6 meses (grupo II) e adesão superior a 6 meses (grupo III). Foram investigadas as características clínico-patológicas, ocorrência de interrupção da radioterapia, sobrevida livre de doença e sobrevida global. Resultados: A ocorrência de interrupção por sintomas foi estatisticamente significante no grupo III quando comparado ao grupo I (p=0,01). A frequência e a duração de interrupção por sintomas não foram estatisticamente significante entre os grupos. A conclusão da radioterapia foi estatisticamente significante no grupo com adesão superior a 6 meses (p=0,02). A sobrevida dos pacientes foi maior no grupo III (p=0,01) quando comparado aos demais grupos. Conclusão: A adesão ao protocolo não teve impacto sobre interrupção da radioterapia devido ocorrência da interrupção por sintomas, no entanto, pacientes que tiveram adesão ao protocolo preventivo odontológico apresentaram um melhor índice de sobrevida livre de doença e de sobrevida global.

SETTLEMENT SHARE AND DETERMINATION OF ITS AMOUNT ABSTRACT The subject of my thesis is to analyse the legal regulation governing the settlement share and determination of its amount. The aim is to provide comprehensive picture of the issue of the settlement share both in terms of the commercial law, as well as in terms of the tax and accounting law. With regard to the recent and significant changes in private law, and thus in the area of settlement share, there is devoted ample space in the thesis to comparison of the current and former legal framework including application of the available judicature. The change of the particular law brought a lot of new questions and disputed interpretations, which are subsequently identified and analysed. My thesis consists of introduction, seven chapters and conclusion. Chapters one to four represent a general part in relation to the settlement share. The first chapter gives the definition of a settlement share from both the legal and economical perspective. It includes also consideration about possible treatment with the settlement share. The second chapter deals with the termination of the participation of a partner, which leads to the constitution of the settlement share. Chapter three analyses the various options for determining the value of the settlement share...

Purpose. To systematically develop and field test an intervention to engage families and healthcare teams in the decision-making process about life support for critically ill patients in the Intensive Care Unit (ICU). Setting. Adult medical-surgical ICU at a Canadian academic teaching hospital. Methods. The International Patient Decision Aid Standards (IPDAS) criteria and the Interprofessional Shared Decision Making (SDM) model guided the study of families facing decisions about life support for their relative in ICU that involved:1) systematic review; 2) qualitative descriptive study; 3) mixed methods field test of a novel patient decision aid (DA). Systematic review findings. Of 3162 citations, four trials evaluated interventions to improve communication between health professionals and patients/families. One intervention met eight of nine criteria for SDM but did not evaluate its effect on the benefit to communication. Qualitative study findings. Six family members and nine health professionals identified two options (life support or comfort care) and values associated with these options. Values included maintaining quality of life, surviving critical illness, minimizing pain and suffering, not being attached to machines, giving the family enough time to adapt emotionally to the patient’s health situation, and the judicious use of healthcare resources. Families were unlikely to become engaged without healthcare professionals making the decision explicit and minimizing other barriers across the decision-making process. Field test findings. Family members and health professionals for eight patients indicated that the DA was feasible to use, acceptable to users, had the potential to do what was intended, and did not seem to present adverse consequences to users. An enhanced delivery strategy is needed for future evaluation of its effect on facilitating patient/family involvement in decisions. Conclusions. Limited involvement of families in the process of decision-making about life support in the ICU reinforced the need for effective interventions to facilitate SDM. These studies validated the operationalization of the IPDAS criteria, as part of a systematic process for developing and field testing DAs. However, IPDAS criteria stop short of elements necessary to consider when implementing the DA in the processes of care.

Les organismes de placement collectif (OPC) permettent aux investisseurs d'avoir accès à une gestion professionnelle, à la diversification, aux économies d'échelle, à un réinvestissement efficient des revenus et à la liquidité. Les formes juridiques et les systèmes fiscaux des OPC peuvent varier considérablement d'une juridiction à une autre. L'objet de cette thèse est de voir si les investisseurs dans un OPC sont dans la même situation dans laquelle ils se seraient trouvés s'ils avaient investi directement. Contrairement à un contexte national, les investisseurs de portefeuille transfrontaliers ne sont pas placés dans la même situation dans laquelle ils se seraient trouvés si le revenu de placement était réalisé directement. En effet, l'investissement transfrontalier en valeurs mobilières est entravé par des obstacles fiscaux résultant des retenues à la source et des lacunes actuelles de l'allégement conventionnel, en particulier en ce qui concerne les OPC. Afin d'assurer une plus grande sécurité fiscale aux OPC et à leurs investisseurs, diverses solutions possibles à ces difficultés ont alors été abordées. Il a été souligné qu'il faudrait améliorer les conventions de double imposition et les systèmes d'allègement conventionnel en octroyant les avantages soit au niveau de l'OPC soit au niveau de leurs investisseurs. Des perspectives sont également offertes par les règles de non-discrimination en vertu du droit de l'UE à travers notamment les initiatives de la Commission européenne et la jurisprudence de la CJUE. Ces perspectives permettent de suggérer que les États devraient rechercher un accord multilatéral pour abolir les retenues à la source sur les dividendes dans l'État de la source du revenu lorsqu'il est payé à des OPC établis dans d'autres États. Idéalement, tout accord visant à abolir les retenues à la source devrait être combiné à un système d'échange automatique d'informations. Il a été souligné que les inefficacités fiscales favorisent l'innovation financière tels que les produits dérivés et autres instruments financiers qui sont largement utilisés par les gestionnaires d'actifs comme une alternative pour éviter la retenue à la source sur les dividendes. / Collective investment vehicles (CIVs) permit investors to obtain access to professional management, diversification, economies of scale, efficient reinvestment of income and liquidity. The legal forms and tax structures of CIVs may vary considerably from one jurisdiction to another. The purpose of this thesis is to see if CIV investors are in the same position in which they would have been if they had invested directly.Unlike in a domestic context, cross-border portfolio investors are not placed in the same position as if investment income was realised directly. Indeed, cross-border investment in securities is hampered by tax obstacles resulting from withholding taxes and the current deficiencies of treaty relief, especially in relation to collective investment vehicles. In order to provide more certainty to CIVs and underlying investors, various possible remedies to those difficulties have been then addressed. It was highlighted that we should improve double taxation treaties and treaty relief systems by granting benefits either on OPC level either on the level of underlying investors. Perspectives are also offered by non-discrimination rules under EU law, especially through the EU Commission's initiatives and the ECJ cases law. Based on these prospects, it is submitted that the states should seek a multilateral agreement to abolish withholding taxes on dividends in the source state of income, when paid to CIVs established in another states. Optimally, any agreement to abolish withholding taxes should be combined with an automatic exchange of information system. We pointed out that tax inefficiencies promote financial innovation such as derivatives and other financial instruments which are widely used by asset managers as alternatives to avoid dividend withholding tax.

Short term assignments to other countries are increasing and it is important to take note of the associated potential tax compliance requirements. South Africa is part of the Southern African Development Community (SADC) whose main objective is to advance the development and economic growth of the member countries through regional integration. It is difficult for persons with limited or no international tax background to identify potential taxes when going on short term assignments to other SADC countries as very little has been published with regard to the procedure to follow. The procedure to follow and the main tax concepts (corporate tax, personal tax, VAT and withholding tax) have not been published in a user friendly, holistic format to enable such persons to identify potential tax implications. In this research a conceptual tax-compliance framework was created and tested to enable persons to follow the procedure to identify potential taxes that could be triggered when going on short term assignments. It also enables them to have an understanding of the concepts of the main tax principles applicable in SADC countries that have double tax agreements in place with South Africa. / Dissertation (MCom)--University of Pretoria, 2013. / lmchunu2014 / Taxation / unrestricted

This is a thesis about anti-paternalism – the liberal doctrine that we may not interfere with a person’s liberty for her own good. Empirical circumstances and moral values may certainly give us reason to avoid benevolent interference. Anti-paternalism as a normative doctrine should, however, be rejected. Essay I concerns the definitions of paternalism and anti-paternalism. It is argued that only a definition of paternalism in terms of compound reason-actions can accommodate its special moral properties. Definitions in terms of actions, common in the literature, cannot. It is argued, furthermore, that in specifying the reason-actions in further detail, the notion of what is self-regarding, as opposed to other-regarding, is irrelevant, contrary to received opinion. Essay II starts out with the definition of paternalism defended in essay I and claims that however this very general definition is specified, anti-paternalism is unreasonable and should be rejected. Anti-paternalism is the position that certain reasons – referring one way or the other to the good of a person, give no valid normative support to certain actions – some kind of interferences with the same person. Since the reasons in question are normally quite legitimate and important reasons for action, a convincing argument for anti-paternalism must explain why they are invalid in cases of interference. A closer look at the reasons and actions in question provides no basis for such an explanation. Essay III considers a concrete case of benevolent interference – the withholding of information concerning uncertain threats to public health in the public’s best interest. Such a policy has been suggested in relation to the European Commission’s proposed new system for the Registration, Evaluation, and Authorisation of Chemicals (REACH). Information about uncertain threats to health from chemicals would allegedly spread anxiety and depression and thus do more harm than good. The avoidance of negative health effects is accepted as a legitimate and good reason for withholding of information, thus respecting the conclusion of essay II, that anti-paternalism should be rejected. Other reasons, however, tip the balance in favour of making the information available. These reasons include the net effects on knowledge, psychological effects, effects on private decisions and effects on political decisions. / QC 20101115

This study used narrative inquiry to answer the question “What are the stories of older adults who choose not to share information with health care professionals?” The study explored the experiences of older adults who did not share information with health care professionals (HCPs), who they defined as doctors. A thematic analysis of five participants’ stories revealed three themes: Illusions of Care, describing the participants’ experiences with doctors before they chose not to share information; The Last Straw, revealing the final incident that caused participants to choose not to share information; and The Mask of the Non-sharing Older Adult, describing how participants interacted with their doctors after they decided not to share information. Relationship development between older adults and their doctors, sensitive topics, issues and perceptions of ageing, and structure of the health care system contribute to the complex issue of older adults not sharing information. The decision not to share information with health care professionals may adversely affect the health and health care of older adults.

This study used narrative inquiry to answer the question “What are the stories of older adults who choose not to share information with health care professionals?” The study explored the experiences of older adults who did not share information with health care professionals (HCPs), who they defined as doctors. A thematic analysis of five participants’ stories revealed three themes: Illusions of Care, describing the participants’ experiences with doctors before they chose not to share information; The Last Straw, revealing the final incident that caused participants to choose not to share information; and The Mask of the Non-sharing Older Adult, describing how participants interacted with their doctors after they decided not to share information. Relationship development between older adults and their doctors, sensitive topics, issues and perceptions of ageing, and structure of the health care system contribute to the complex issue of older adults not sharing information. The decision not to share information with health care professionals may adversely affect the health and health care of older adults.