Página 1 dos resultados de 155 itens digitais encontrados em 0.029 segundos

Essays on governance and failure of co-operative banks: the portuguese agricultural credit co-operatives

Paula, Cabo
Tipo: Tese de Doutorado
Português
Relevância na Pesquisa
35.99%
The 2008 global crisis, and the European sovereign debt crisis that follow it, originated, among other consequences, a general mistrust in financial institutions. This situation encourages the debate on the role of co-operative banks within a fairer society and their social responsibility as a key in the economic recovery, namely in the south European countries. The co-operative banking sector remains poorly understood and its specific governance challenges remain largely unexplored. The research included in this thesis aims to improve knowledge of the conduct and performance of the co-operative banks, and its findings should support the decision making process by members and management, mainly in terms of governance model. Thus, the main objective of this research is to analyse, both theoretically and empirically, the governance and financial robustness of co-operative banks, taking as a reference the Portuguese agricultural credit co-operatives (CCAM) and their integrated system (SICAM). Specifically, the thesis is structured in order to answer the following questions: (1) What are the economic bases of co-operative banks?; (2) How does a particular regulatory framework affect co-operative banking activity?; (3) What is the impact of the different governance mechanisms of co-operative banks on control management?; and (4) What are the explanatory factors of Portuguese co-operative bank failures? Besides the Introduction (Chapter 1) and the Conclusions (Chapter 6)...

Ilusão, resignação e resistência: marcas da inclusão marginal de estudantes das classes subalternas na rede de ensino superior privada; Illusion, resignation, and resistance: features of the minimal inclusion of lower-class students in private institutions of higher education

Kalmus, Jaqueline
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Tese de Doutorado Formato: application/pdf
Publicado em 31/05/2010 Português
Relevância na Pesquisa
25.99%
A presente pesquisa parte da constatação de que a atual política educacional, em consonância com interesses advindos do modelo político e econômico vigente no país, promove, cada vez mais, a passagem dos alunos pelos sucessivos graus escolares sem garantir uma formação sólida. Isso resulta em uma nova forma de fracasso escolar, um fracasso relativo, mais sutil, em que uma parcela dos estudantes oriundos de categorias sociais até então prematuramente excluídas da educação formal atinge graus mais elevados de escolarização. Com a participação do Estado e a partir de um discurso que recomenda a qualificação para o mercado de trabalho, também no ensino superior há um grande incentivo para a absorção de um maior contingente de estudantes pobres, que passam a frequentar, sobretudo, instituições de ensino da rede superior privada, muitas imbuídas de uma concepção mercantil de educação. A pesquisa procurou investigar, a partir da narrativa de três estudantes das classes subalternas de uma instituição de ensino superior privada da região metropolitana de São Paulo, os sentidos que eles atribuem à sua experiência nessa modalidade de ensino, os sonhos que são construídos ou impedidos, as formas de consciência...

Autocuidado em insuficiência cardíaca: estudo comparativo entre pacientes de clínica especializada e pronto-socorro; Self-care in heart failure: A comparative study between patients of speciality clinics and emergency rooms

Nascimento, Heloisa Ribeiro do
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: dissertação de mestrado Formato: application/pdf
Publicado em 27/06/2012 Português
Relevância na Pesquisa
35.99%
Trata-se de um estudo descritivo correlacional com abordagem quantitativa, que teve como objetivos: caracterizar pacientes com Insuficiência Cardíaca (IC) atendidos em clínica especializada (grupo A) e em pronto-socorro (grupo B), conforme perfil sócio-demográfico, perfil clínico, tempo de conhecimento da doença e internações no último ano; Identificar ações de autocuidado específicas nos grupos A e B; Verificar a diferença entre o autocuidado dos grupos A e B e Identificar os possíveis fatores precipitantes de descompensação no grupo B. A amostra foi constituída por 120 pacientes de um hospital especializado em cardiologia, localizado no município de São Paulo, sendo 60 em cada grupo. A coleta de dados foi realizada de julho a novembro de 2011, por meio da aplicação de instrumento elaborado para o estudo (1) e instrumento de adesão validado em estudo prévio (2). A análise estatística foi descritiva e inferencial, sendo utilizado o Alpha de Cronbach para avaliar a consistência interna do instrumento 2, Teste Exato de Fisher para variáveis categóricas, Teste t-student para comparação entre as médias das variáveis contínuas, teste não paramétrico de Mann-Whitney quando se rejeitou a hipótese de normalidade da variável. Predominou o sexo masculino 78(65%). Não houve diferença no tempo de conhecimento da doença entre os grupos. Observou-se que o grupo B teve mais internações no último ano. Não houve diferença estatisticamente significativa no escore de adesão do Instrumento 2...

Análise da correlação existente entre Senso de Coerência e adesão ao tratamento em pacientes com diagnóstico de insuficiência cardíaca crônica; Correlation Analysis between Sense of Coherence and Treatment Compliance of patients with a diagnosis of Heart Failure

Moretto, Simone Alvarez
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: dissertação de mestrado Formato: application/pdf
Publicado em 14/06/2013 Português
Relevância na Pesquisa
36.11%
Introdução: a insuficiência cardíaca (IC) caracteriza-se por uma síndrome complexa, que apresenta, como principais sintomas, falta de ar, fadiga e função cardíaca anormal, o que exige, dos pacientes, mudanças no estilo de vida. Observa-se que as orientações de cuidado, muitas vezes, não são incorporados pelo portador de IC, sendo este um importante aspecto para a piora clínica deste paciente. Na perspectiva do enfrentamento, o Senso de Coerência proposto por Aaron Antonovsky, referencial adotado nesta pesquisa, é um construto que, se bem aplicado aos portadores de IC, pode revelar aos profissionais de saúde a percepção que os pacientes apresentam acerca de sua condição de doença. Objetivo: analisar a existência de correlação entre a adesão ao tratamento e o senso de coerência em pacientes ambulatoriais com diagnóstico de IC. Material e Método: estudo exploratório, descritivo, prospectivo e de abordagem quantitativa, realizado no ambulatório especializado em Insuficiência Cardíaca e Transplante do Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, com amostra de 100 pacientes. Os instrumentos utilizados na análise foram o Questionário de Senso de Coerência e o Questionário de Adesão em Pacientes com Insuficiência Cardíaca...

Identificação de melhorias no processo de controle da qualidade em empreendimentos habitacionais de baixa renda; Identification of improve in Quality Control Process of low-income housing projects

Bartz, Cíntia Fassbender
Tipo: dissertação Formato: application/pdf
Português
Relevância na Pesquisa
36.35%
As empresas construtoras de empreendimentos habitacionais de baixa renda no Brasil têm sido impulsionadas a implementar Sistemas de Gestão da Qualidade (SGQ) em função de exigências de certificação por parte de órgãos financiadores deste segmento de mercado, envolvidas no Programa Brasileiro de Qualidade e Produtividade no Habitat (PBQP-H). No entanto, observa-se, ainda, a presença de muitas falhas de qualidade nos empreendimentos de baixa renda, apesar da certificação obtida pelas construtoras. Por outro lado, tendo implementado um SGQ, muitas empresas possuem dados sobre as falhas incidentes em seus produtos, através de registros obtidos por exigências dos próprios requisitos normativos. O objetivo deste trabalho consiste em propor melhorias no processo de controle da qualidade de empreendimentos habitacionais de baixa renda, utilizando para tanto registros de falhas nos produtos. Neste sentido, foram analisados empreendimentos que pertencem aos dois programas de provisão habitacional, o Programa de Arrendamento Residencial (PAR) e o Imóvel na Planta, ambos gerenciados pela Caixa Econômica Federal. A pesquisa foi dividida nas seguintes etapas: (a) revisão bibliográfica; (b) estudo exploratório para identificação da estrutura e funcionamento do sistema de gestão da qualidade de uma empresa construtora; (c) realização de estudos de caso em duas empresas construtoras de empreendimentos habitacionais de baixa renda...

Alguns factores e condicionantes do sucesso escolar académico: a aplicação de modelos de regressão

Afonso, Carlos Miguel
Tipo: info:eu-repo/semantics/masterthesis
Publicado em //2010 Português
Relevância na Pesquisa
26.08%
Dissertação de mestrado em Prospecção e Análise de Dados; O insucesso escolar tem vindo a motivar o estudo em vários domínios das ciências sociais, através não só da reflexão sobre o fenómeno e politicas educativas, bem como através da construção de modelos conceptuais e explicativos do insucesso escolar. O insucesso escolar em ambiente académico pode assumir outros contornos de complexidade que são merecedores de estudo, o que evidencia a necessidade de vislumbrar quais os seus principais factores. O estudo, no qual esta tese se baseia, teve como objectivo a construção de um modelo sócio-psicológico explicativo do sucesso escolar, bem como descortinar os principais factores sociológicos e psicológicos do insucesso académico numa instituição de ensino superior – o Instituto Politécnico de Bragança (IPB). Para isso procedeu-se à construção de um questionário para aplicar a uma amostra de 200 alunos de dois estabelecimentos do ensino (ESSA - Escola Superior de Saúde; ESTIG – Escola Superior de Tecnologia e Gestão) do IPB. Após a recolha da amostra aplicaram-se os Modelos de Regressão Linear Múltipla e de Regressão Logística, por forma a obter os modelo sociológico...

Prediction factors for failure to seek treatment following traumatic dental injuries to primary teeth

Firmino,Ramon Targino; Siqueira,Maria Betânia Lins Dantas; Vieira-Andrade,Raquel Gonçalves; Gomes,Genara Brum; Martins,Carolina Castro; Paiva,Saul Martins; Granville-Garcia,Ana Flávia
Fonte: Sociedade Brasileira de Pesquisa Odontológica - SBPqO Publicador: Sociedade Brasileira de Pesquisa Odontológica - SBPqO
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2014 Português
Relevância na Pesquisa
26.16%
The objective of this study was to evaluate prediction factors for failure to seek treatment following a traumatic dental injury (TDI) to primary teeth among preschool children in the city of Campina Grande, Brazil. A cross-sectional study was carried out involving 277 children 3 to 5 years of age, with TDI, enrolled in public and private preschools. Parents filled out a form addressing demographic data and whether or not they had sought treatment. Clinical examinations were performed by three dentists who had undergone a calibration exercise (Kappa: 0.85 to 0.90) for the evaluation of TDI. Bivariate and multivariate Poisson regression models were constructed (? = 5%). Enamel fracture was the most prevalent type of TDI (48.7%) and the upper central incisors were the most affected teeth (88.4%). The frequency of seeking dental treatment was low (9.7%). The following variables were associated with failure to seek treatment following TDI: a household income greater than one minimum wage (PR = 1.170; 95%CI 1.018-1.341), parents/caregivers’ perception of a child’s oral health as poor (PR = 1.100; 95%CI 1.026-1.176), and the non-perception of TDI by parents/caregivers (PR = 1.250; 95%CI 1.142-1.360). In the present study, the frequency of seeking treatment following TDI was low...

Promoting safe motherhood through the private sector in low- and middle-income countries.

Brugha, Ruair; Pritze-Aliassime, Susanne
Fonte: World Health Organization Publicador: World Health Organization
Tipo: text
Português
Relevância na Pesquisa
26.06%
The formal private sector could play a significant role in determining whether success or failure is achieved in working towards goals for safe motherhood in many low- and middle-income settings. Established private providers, especially nurses/midwives, have the potential to contribute to safe motherhood practices if they are involved in the care continuum. However, they have largely been overlooked by policy-makers in low-income settings. The private sector (mainly doctors) contributes to overprovision and high Caesarean section rates in settings where it provides care to wealthier segments of the population; such care is often funded through third-party payment schemes. In poorer settings, especially rural areas, private nurses/midwives and the women who choose to use them are likely to experience similar constraints to those encountered in the public sector - for example, poor or unaffordable access to higher level facilities for the management of obstetrical emergencies. Policy-makers at the country-level need to map the health system and understand the nature and distribution of the private sector, and what influences it. This potential resource could then be mobilized to work towards the achievement of safe motherhood goals.

Weight Gain in the First Two Years of Life Is an Important Predictor of Schooling Outcomes in Pooled Analyses from Five Birth Cohorts from Low- and Middle-Income Countries12

Martorell, Reynaldo; Horta, Bernardo L.; Adair, Linda S.; Stein, Aryeh D.; Richter, Linda; Fall, Caroline H. D.; Bhargava, Santosh K.; Biswas, S. K. Dey; Perez, Lorna; Barros, Fernando C.; Victora, Cesar G.;
Fonte: American Society for Nutrition Publicador: American Society for Nutrition
Tipo: text
Publicado em /02/2010 Português
Relevância na Pesquisa
25.99%
Schooling predicts better reproductive outcomes, better long-term health, and increased lifetime earnings. We used data from 5 cohorts (Brazil, Guatemala, India, the Philippines, and South Africa) to explore the relative importance of birthweight and postnatal weight gain for schooling in pooled analyses (n = 7945) that used appropriate statistical methods [conditional weight (CW) gain measures that are uncorrelated with prior weights] and controlled for confounding. One SD increase in birthweight, ?0.5 kg, was associated with 0.21 y more schooling and 8% decreased risk of grade failure. One SD increase in CW gain between 0 and 2 y, ?0.7 kg, was associated with higher estimates, 0.43 y more schooling, and 12% decreased risk of failure. One SD increase of CW gain between 2 and 4 y, ?0.9 kg, was associated with only 0.07 y more schooling but not with failure. Also, in children born in the lowest tertile of birthweight, 1 SD increase of CW between 0 and 2 y was associated with 0.52 y more schooling compared with 0.30 y in those in the upper tertile. Relationships with age at school entry were inconsistent. In conclusion, weight gain during the first 2 y of life had the strongest associations with schooling followed by birthweight; weight gain between 2 and 4 y had little relationship to schooling. Catch-up growth in smaller babies benefited schooling. Nutrition interventions aimed at women and children under 2 y are among the key strategies for achieving the millennium development goal of universal primary education by 2015.

Subjective Social Status and Maternal Health in a Low Income Urban Population

Dennis, Erika Fitzpatrick; Webb, David A.; Lorch, Scott A.; Mathew, Leny; Bloch, Joan R.; Culhane, Jennifer F.
Tipo: text
Publicado em /05/2012 Português
Relevância na Pesquisa
26.18%
Appropriate measurement of socioeconomic status (SES) in health research can be problematic. Conventional SES measures based on ‘objective’ indicators such as income, education, or occupation may have questionable validity in certain populations. The objective of this investigation was to determine if a relatively new measurement of SES, subjective social status (SSS), was more consistently and strongly associated with multiple health outcomes for low income mothers. Data available from a large scale community-based study examining maternal and infant health for a low income urban population were used to examine relationships between SSS and a wide range of postpartum physical and emotional health outcomes. Crosstabulations and multivariate analyses focused on the breadth and depth of these relationships; in addition, the relative strength of the relationships between SSS and the health outcomes was compared to that of conventional measures of SES, including both income and education. SSS was significantly related to all physical and emotional health outcomes examined. The overall pattern of findings indicated that these relationships were independent of, as well as more consistent and stronger than, those between conventional measures of SES and postpartum health outcomes. SSS represents an important dimension of the relationship between SES and postpartum physical and emotional health. In low income populations the failure to account for this dimension likely underestimates the influence of SES on postpartum health. This has important implications for the interpretation of findings in empirical studies which seek to control for the effects of SES on maternal health outcomes.

Growth Patterns in Early Childhood and Final Attained Stature: Data from Five Birth Cohorts from Low- and Middle-Income Countries

Stein, Aryeh D; Wang, Meng; Martorell, Reynaldo; Norris, Shane A; Adair, Linda S; Bas, Isabelita; Sachdev, Harshpal Singh; Bhargava, Santosh K; Fall, Caroline HD; Gigante, Denise P; Victora, Cesar G;
Fonte: Wiley Subscription Services, Inc., A Wiley Company Publicador: Wiley Subscription Services, Inc., A Wiley Company
Tipo: text
Português
Relevância na Pesquisa
26.1%
Growth failure is cumulative, and short stature is associated with multiple indices of reduced human capital. Few studies have been able to address in a single analysis both consideration of the timing of growth failure and comparison across populations. We analyzed data from birth cohorts in Brazil, Guatemala, India, the Philippines, and South Africa (n = 4,659). We used data on length at birth (available for three of the five cohorts), 12 mo, 24 mo, and mid-childhood to construct cohort- and sex- specific conditional length measures. We modeled adult height as a function of conditional length in childhood. The five cohorts experienced varying degrees of growth failure. As adults, the Brazil sample was 0.35 ± 0.89 standard deviations (SD) below the World Health Organization reference, while adult Guatemalans were 1.91 ± 0.87 SD below the reference. All five cohorts experienced a nadir in height for age Z-score at 24 mo. Birth length (in the three cohorts with this variable), and conditional length at 12 mo (in all five cohorts) were the most strongly associated with adult height. Growth in the periods 12–24 mo and 24 mo to mid-childhood showed inconsistent patterns across tertiles of adult height. Despite variation in the magnitude of cumulative growth failure across cohorts...

A Number Sense Intervention for Low-Income Kindergartners at Risk for Mathematics Difficulties

Dyson, Nancy I.; Jordan, Nancy C.; Glutting, Joseph
Tipo: text
Português
Relevância na Pesquisa
26.06%
Early number sense is a strong predictor of later success in school mathematics. A disproportionate number of children from low-income families come to first grade with weak number competencies, leaving them at-risk for a cycle of failure. The present study examined the effects of an 8-week number sense intervention to develop number competencies of low-income kindergartners (n = 121). The intervention purposefully targeted whole number concepts related to counting, comparing, and manipulating sets. Children were randomly assigned either to a number sense intervention or a business as usual contrast group. The intervention was carried out in small group, 30-minute sessions, 3 days per week for a total of 24 sessions. Controlling for number sense at pretest, the intervention group made meaningful gains relative to the control group at immediate as well delayed posttest on a measure of early numeracy. Intervention children also performed better than controls on a standardized test of mathematics calculation at immediate posttest.

Income inequality and 30 day outcomes after acute myocardial infarction, heart failure, and pneumonia: retrospective cohort study

Lindenauer, Peter K; Lagu, Tara; Rothberg, Michael B; Avrunin, Jill; Pekow, Penelope S; Wang, Yongfei; Krumholz, Harlan M
Fonte: BMJ Publishing Group Ltd. Publicador: BMJ Publishing Group Ltd.
Tipo: text
Português
Relevância na Pesquisa
25.97%
Objectives To examine the association between income inequality and the risk of mortality and readmission within 30 days of hospitalization.

Waiting to inhale: An exploratory review of conditions that may predispose to pulmonary hypertension and right heart failure in persons exposed to household air pollution in low- and middle-income countries

Bloomfield, Gerald S.; Lagat, David K.; Akwanalo, O. Constantine; Carter, E. Jane; Lugogo, Njira; Vedanthan, Rajesh; Velazquez, Eric J.; Kimaiyo, Sylvester; Sherman, Charles B.
Tipo: text
Português
Relevância na Pesquisa
26.34%
The health effects of exposure to household air pollution are gaining international attention. While the bulk of the known mortality estimates due to these exposures are derived from respiratory conditions, there is growing evidence of adverse cardiovascular health effects. Pulmonary hypertension and right heart failure are common conditions in low- and middle-income countries whose etiology may be related to common exposures in these regions such as schistosomiasis, human immunodeficiency virus, tuberculosis infections and other causes. While little is known of the interplay between exposure to household air pollution, right heart function and such conditions, the large burden of pulmonary hypertension and right heart failure in regions where there is significant exposure to household air pollution raises the possibility of a linkage. This review is presented in three parts. First, we explore what is known about pulmonary hypertension and right heart failure in low- and middle-income countries by focusing on eight common causes thereof. We then review what is known of the impact of household air pollution on pulmonary hypertension and posit that when individuals with one of these eight common comorbidities are exposed to household air pollution they may be predisposed to develop pulmonary hypertension or right heart failure. Lastly...

"Heart Failure: Meeting the Challenges of Surveillance and Knowledge Translation in Resource-poor Settings"

Safraj, Shahulhameed; Ajay, Vamadevan S; Prabhakaran, Dorairaj
Fonte: Bentham Science Publishers Publicador: Bentham Science Publishers
Tipo: text
Português
Relevância na Pesquisa
26.1%
Heart failure (HF) is a major cause of morbidity and mortality in high income countries. Shortage of population based HF studies from Low and Middle Income countries (LMIC) make global prevalence estimates difficult. In this editorial we discuss the possibility of generating HF data in LMICs by initiating HF surveillance systems integrated into the existing health surveillance system..

Predictors of Better Self-Care in Patients with Heart Failure after Six Months of Follow-Up Home Visits

Trojahn, Melina Maria; Ruschel, Karen Brasil; Nogueira de Souza, Emiliane; Mussi, Cláudia Motta; Naomi Hirakata, Vânia; Nogueira Mello Lopes, Alexandra; Rabelo-Silva, Eneida Rejane
Fonte: Hindawi Publishing Corporation Publicador: Hindawi Publishing Corporation
Tipo: text
Português
Relevância na Pesquisa
25.99%
This study aimed to examine the predictors of better self-care behavior in patients with heart failure (HF) in a home visiting program. This is a longitudinal study nested in a randomized controlled trial (ISRCTN01213862) in which the home-based educational intervention consisted of a six-month followup that included four home visits by a nurse, interspersed with four telephone calls. The self-care score was measured at baseline and at six months using the Brazilian version of the European Heart Failure Self-Care Behaviour Scale. The associations included eight variables: age, sex, schooling, having received the intervention, social support, income, comorbidities, and symptom severity. A simple linear regression model was developed using significant variables (P ? 0.20), followed by a multivariate model to determine the predictors of better self-care. One hundred eighty-eight patients completed the study. A better self-care behavior was associated with patients who received intervention (P < 0.001), had more years of schooling (P = 0.016), and had more comorbidities (P = 0.008). Having received the intervention (P < 0.001) and having a greater number of comorbidities (P = 0.038) were predictors of better self-care. In the multivariate regression model...

Risk of childhood undernutrition related to small-for-gestational age and preterm birth in low- and middle-income countries

Christian, Parul; Lee, Sun Eun; Donahue Angel, Moira; Adair, Linda S; Arifeen, Shams E; Ashorn, Per; Barros, Fernando C; Fall, Caroline HD; Fawzi, Wafaie W; Hao, Wei; Hu, Gang; Humphrey, Jean H; Huybregts, Lieven; Joglekar, Charu V; Kariuki, Simon K; Kols
Fonte: Oxford University Press Publicador: Oxford University Press
Tipo: text
Português
Relevância na Pesquisa
25.97%
Background Low- and middle-income countries continue to experience a large burden of stunting; 148 million children were estimated to be stunted, around 30–40% of all children in 2011. In many of these countries, foetal growth restriction (FGR) is common, as is subsequent growth faltering in the first 2 years. Although there is agreement that stunting involves both prenatal and postnatal growth failure, the extent to which FGR contributes to stunting and other indicators of nutritional status is uncertain.

Hepatitis E and Acute-on-Chronic Liver Failure

Kumar, Ashish; Saraswat, Vivek A.
Fonte: Elsevier Publicador: Elsevier
Tipo: text
Português
Relevância na Pesquisa
26.03%
Hepatitis E virus (HEV) is the most common cause of acute viral hepatitis (AVH) globally. It causes large scale epidemics of AVH across the low- and middle income countries in Asia and Africa, and also causes sporadic cases of AVH in the same geographical region. AVH due to HEV is usually an acute, self-limiting illness, similar in clinical presentation to AVH caused by hepatitis A virus (HAV). When HEV causes AVH in patients of chronic liver disease it may worsen rapidly to a syndrome called acute-on-chronic liver failure (ACLF) leading to very high mortality. Acute deterioration of liver function in a patient with compensated chronic liver disease is the characteristic feature of ACLF. The typical disease course of patients with ACLF is the appearance of organ failure, which progresses to multi-organ failure and death. Many publications have reported HEV as one of the leading causes for ACLF from Asia and Africa, where HEV is endemic. The mortality rate of HEV-related ACLF (HEV-ACLF) ranges from 0% to 67% with a median being 34%. These patients require admission in the intensive care unit and they benefit from a team approach of clinicians with expertise in both hepatology and critical care. The goals of treatment are to prevent further deterioration in liver function...

Event Rates, Hospital Utilization, and Costs Associated with Major Complications of Diabetes: A Multicountry Comparative Analysis

Clarke, Philip M.; Glasziou, Paul; Patel, Anushka; Chalmers, John; Harrap, Stephen B.; Woodward, Mark Phillip; Salomon, Joshua A.
Fonte: Public Library of Science Publicador: Public Library of Science
Tipo: Artigo de Revista Científica
Português
Relevância na Pesquisa
26.06%
Philip Clarke and colleagues examined patient-level data for over 11,000 participants with type 2 diabetes from 20 countries and find that major complications of diabetes significantly increased hospital use and costs across settings. Background: Diabetes imposes a substantial burden globally in terms of premature mortality, morbidity, and health care costs. Estimates of economic outcomes associated with diabetes are essential inputs to policy analyses aimed at prevention and treatment of diabetes. Our objective was to estimate and compare event rates, hospital utilization, and costs associated with major diabetes-related complications in high-, middle-, and low-income countries. Methods and Findings: Incidence and history of diabetes-related complications, hospital admissions, and length of stay were recorded in 11,140 patients with type 2 diabetes participating in the Action in Diabetes and Vascular Disease (ADVANCE) study (mean age at entry 66 y). The probability of hospital utilization and number of days in hospital for major events associated with coronary disease, cerebrovascular disease, congestive heart failure, peripheral vascular disease, and nephropathy were estimated for three regions (Asia, Eastern Europe, and Established Market Economies) using multiple regression analysis. The resulting estimates of days spent in hospital were multiplied by regional estimates of the costs per hospital bed-day from the World Health Organization to compute annual acute and long-term costs associated with the different types of complications. To assist...

Residential Exposure to Traffic-Related Air Pollution and Survival after Heart Failure

Medina-Ramón, Mercedes; Goldberg, Robert; Melly, Steven John; Mittleman, Murray A.; Schwartz, Joel David
Fonte: National Institute of Environmental Health Sciences Publicador: National Institute of Environmental Health Sciences
Tipo: Artigo de Revista Científica
Português
Relevância na Pesquisa
35.99%
Background: Although patients with heart failure (HF) have been identified as particularly susceptible to the acute effects of air pollution, the effects of long-term exposure to air pollution on patients with this increasingly prevalent disease are largely unknown. Objective: This study was designed to examine the mortality risk associated with residential exposure to traffic-related air pollution among HF patients. Methods: A total of 1,389 patients hospitalized with acute HF in greater Worcester, Massachusetts, during 2000 were followed for survival through December 2005. We used daily traffic within 100 and 300 m of residence as well as the distance from residence to major roadways and to bus routes as proxies for residential exposure to traffic-related air pollution. We assessed mortality risks for each exposure variable using Cox proportional hazards models adjusted for prognostic factors. Results: After the 5-year follow-up, only 334 (24%) subjects were still alive. An interquartile range increase in daily traffic within 100 m of home was associated with a mortality hazard ratio (HR) of 1.15 [95% confidence interval (CI), 1.05–1.25], whereas for traffic within 300 m this association was 1.09 (95% CI, 1.01–1.19). The mortality risk decreased with increasing distance to bus routes (HR = 0.88; 95% CI...