Catastrophic health care expenditures in Portugal between 2000-2010: Assessing impoverishment, determinants and policy implications

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Economics from the NOVA – School of Business and EconomicsObjectives: This work assesses the extent and evolution of catastrophic health care expenditures (CHE) in Portugal in the years of 2000, 2005 and 2010, to reveal household factors predicting this outcome, and simulates changes in 2010 CHE levels’ following recent reforms in user charges and prices of pharmaceutical products. Methods: The main contribution of this paper is the calculus and analysis of statistical measures to capture CHE incidence, intensity, income distribution and impoverishment effects on households using INE Household Budget Surveys. A logistic model to determine statistical significance and economic effects of 38 variables on the incidence of CHE is also estimated. Finally, a scenario analysis is presented to analyse reforms concerning user charges and prices of pharmaceuticals. Results: Incidence and intensity of CHE decreased between 2000 and 2010, from 5,005% to 2,439% and 4,693% to 0,334%, respectively. During the period, CHE were concentrated amongst the poorer income quintiles. Statistical significance in CHE prediction for all analysed years was observed for households’ income, smoking and drinking habits, area of the house and secondary education of the household head. Scenario analysis shows that the new levels of user charges in 2012, even if mitigated by the new and enlarged economic exemptions, would increase CHE incidence of 2010 to 3,529%. On the other hand, the reduction in the price of ambulatory pharmaceuticals in 2011 and 2012 is effective in reducing CHE incidence, for price demand elasticities equal or smaller (in absolute value) than 0,4. When the two effects are combined, CHE incidence increases, meaning that reductions in the price of pharmaceuticals are not sufficient to countervail the changes in user charges, even with enlarged economic exemptions

Ferramentas digitais colaborativas e inclusão de alunos com necessidades específicas num Centro Escolar do Agrupamento Gil Paes

O presente estudo teve como objetivo principal perceber em que medida a utilização de Recursos Educativos Digitais (RED) em contexto de sala de aula, são um fator de maior participação, motivação, inclusão bem como de desenvolvimento pessoal e autonomia para alunos com necessidades específicas (NE) no 1º Ciclo. O estudo utilizou a Investigação-Ação e teve dois objetivos: o de perceber se os alunos com NE se sentiam motivados, integrados e aceites pelos seus pares; o de desenvolver um conjunto de boas práticas para potenciar a inclusão dos alunos com NE em sala de aula. Como principais contributos destacam-se: a proposta de boas práticas, que representa um referencial para orientação ao professor, na construção de aprendizagens inclusivas a partir de RED; e a identificação de um conjunto de orientações para a inclusão destes alunos que permitam, ao mesmo tempo, a sua aceitação pelos seus pares.The main objective of this study was to understand to what extent the use of Digital Educational Resources (DER) in the classroom context is a factor of greater participation, motivation, inclusion as well as personal and autonomous development for students with Specific Needs (SN) in the 1st Cycle. The study used Action Research and had two objectives: to understand whether students with SN felt motivated, integrated and accepted by their peers; that of developing a set of good practices to enhance the inclusion of students with SN in the classroom. As main contributions, the following stand out: the proposal of good practices, which represents a reference for teacher guidance, in the construction of inclusive learning from DER; and the identification of a set of guidelines for the inclusion of these students that allow, at the same time, their acceptance by their peers.N/

As tecnologias da informação e da comunicação como facilitadoras da aprendizagem no 1º CEB : estudo de caso utilizando a plataforma Moodle na aprendizagem da matemática

Relatório de estágio apresentado à Escola Superior de Educação do Instituto Politécnico de Santarém para obtenção do grau de mestre em Educação e Comunicação MultimédiaEste relatório apresenta o estudo realizado no âmbito do Mestrado em Educação e Comunicação Multimédia. Teve como objectivo verificar e perceber de que forma a plataforma Moodle pode ser um meio para a aprendizagem colaborativa e ao mesmo tempo um complemento aos modelos de aprendizagem da Matemática no 1º CEB, em particular na Escola EB1 de Asseiceira do Agrupamento de Marinhas do Sal. A execução do estudo foi validada após apresentação da planificação das actividades a serem desenvolvidas e que foi cumprida ao longo do ano lectivo (anexo 3). Assim propusemo-nos avaliar a usabilidade e entender as potencialidades educativas da plataforma Moodle, tentar compreender a motivação dos alunos para um modelo de aprendizagem colaborativa a partir desta plataforma e, ainda, efectuar uma análise comparativa entre o trabalho das aulas tradicionais e as aulas recorrendo à plataforma Moodle procurando enquadrar os resultados num modelo de tratamento estatístico que nos ajude a extrair resultados que permitam interpretações ao estudo efectuado no âmbito da Investigação-Acção (action research) realizada. Antes de entrar no primeiro capítulo iremos apresentar a justificação do estudo de forma a melhor compreendermos as actuais tendências e potencialidades de exploração das plataformas de e-Learning em modelos de ensino-aprendizagem colaborativa. A partir deste enquadramento abordaremos os objectivos a que nos propomos e a forma como este relatório é apresentado

Impact of repaired aortic coarctation in left ventricular myocardial work

personAims: Myocardial strain analysis enables more precise assessment of cardiac performance but is relatively load dependent. New tools have been developed with afterload adjustment. Our objective was to assess myocardial work (MW) in patients with repaired aortic coarctation (rACo). Methods: Prospective study of consecutive patients with rACo who underwent a routine transthoracic echocardiogram in 2018 and 2019 at our center. Patients with significant aortic valve disease, pacemaker, or other congenital heart diseases (except for mild bicuspid aortic valve disease) were excluded. Global longitudinal strain with two dimensional speckle tracking analysis and MW were obtained (GWI:Global Work Index; GCW: Global Constructive Work; GWW: Global Wasted Work; GWE: Global Work Efficiency). Blood pressure was measured in the patient's right arm. Results: We included 42 patients in the analysis, mean age of 37±10 years, 38% males. In this group, 52% had hypertension and 64% had a concomitant bicuspid aortic valve. In comparison to previously published reference values, patients with rACo had significantly lower GWI (1807 vs. 1896 mmHg%) and GCW (2173 vs. 2232 mmHg%) (p0.594). Neither age nor gender were independent predictors. Conclusions: In patients with rACo, there are some signs of left ventricular dysfunction with a reduction in GCW and GWI and with preserved GWE, despite normal ejection fraction and strain.proofepub_ahead_of_prin

Unexpected triggers for pheochromocytoma-induced recurrent heart failure

Pheochromocytoma crisis typically presents as paroxysmal episodes of headache, tachycardia, diaphoresis or hypertension. We describe an uncommon case of recurrent non-hypertensive heart failure with systolic dysfunction in a young female due to pheochromocytoma compression. It presented as acute pulmonary oedema while straining during pregnancy and later on as cardiogenic shock after a recreational body massage. Such crisis occurring during pregnancy is rare. Moreover, of the few reported cases of pheochromocytoma-induced cardiogenic shock, recreational body massage has not yet been reported as a trigger for this condition

Sacubitril/Valsartan Improves Left Atrial and Ventricular Strain and Strain Rate in Patients with Heart Failure with Reduced Ejection Fraction

Background: Data on the impact of sacubitril/valsartan (SV) therapy on phasic left atrial (LA) and left ventricular (LV) strain in heart failure with reduced ejection fraction (HFrEF) are limited. The aim of this study was to evaluate changes in two-dimensional speckle tracking (2D-STE) parameters with SV therapy in HFrEF patients. Methods: Prospective evaluation of HFrEF patients receiving optimized medical therapy. Two-dimensional speckle tracking (2D-STE) parameters were assessed at baseline and after 6 months of SV therapy. LA strain and strain rate (SR) in reservoir, conduit, and contraction phases were compared with LV longitudinal, radial, and circumferential strain and SR and stratified according to heart rhythm and HFrEF etiology. Results: A total of 35 patients completed the 6-month follow-up, with a mean age of 59 ± 11 years, 40% in atrial fibrillation, 43% with ischemic etiology, and LVEF of 29 ± 6%. There were significant improvements in LA reservoir, conduit, and contractile strain and SR following SV therapy, particularly among patients in sinus rhythm. There were significant improvements in longitudinal, radial, and circumferential LV function indices. Conclusion: SV therapy in HFrEF was associated with improved longitudinal, radial, and circumferential function, particularly among patients in sinus rhythm. These findings can provide insights into the mechanisms underlying the improvement of cardiac function and help assess subclinical responses to the treatment