Essays on Family Economics and the Macroeconomy

Doctorado en EconomíaPresidente: Timothy J. Kehoe.- Secretaria: Virginia Sánchez Marcos.- Vocal: Hamish Lo

Improving health-promoting self-care in family carers of people with dementia: a review of interventions

Background: Providing care for a family member with dementia can leave little time for carers to look after their own health needs, which makes them more susceptible to mental and physical health problems. This scoping review aimed to explore potential health benefits of interventions aimed at improving health-promoting self-care in family carers of people with dementia.Methods: A scoping review was carried out using Arksey and O’Malley’s methodological framework. EMBASE, MEDLINE, PsycINFO, Google Scholar databases. Original and peer-reviewed research published in English up to April 2017 were included. Publications were selected by two reviewers independently. Eight experts from several countries provided extra relevant information, which was triangulated with the review results. A narrative approach was used to describe and discuss the review findings.Results: Seven interventions were identified. These were highly heterogeneous in content, method of delivery and outcome measures. None was specifically focused on improving and evaluating health-promoting self-care, instead they often focused on health promotion and healthy lifestyle (e.g. physical activity). Some of the multi-component interventions included ‘self-care’ as a domain, but as none used a specific measure of health-promoting self-care, so we are unable to affirm that the improvements found in the interventions were due to an improvement in this area. Interventions helped reduce carer depression and burden and increased quality of life, positive affect and physical activity. The expert panel recommended to consider carers’ preparedness and capacity to adhere to self-care practices, as well as carers’ age and culture. Future interventions should be context specific, flexible and person-centered.Conclusions: Psychosocial interventions may improve health-promoting self-care behavior, but more research is needed to establish efficacy. Interventions should be flexible, use a person-centered approach, be implemented with fidelity and use the right dosage

Dyadic construction of dementia: meta-ethnography and behaviour-process synthesis

Objectives: Positive identity in people with dementia is maintained when there is good interaction with family caregivers. However, research on the experiences of dyadic interaction in dementia care is still limited. For this reason, we aimed to systematically review the dyadic experience of dementia caring. Method: Studies were identified through searching five databases: MedLine, EMBASE, PsycInfo, ASSIA, and CINAHL. Eligible studies employed qualitative or mixed method design, reported the experience of dyads of dementia with no comorbid organic or psychiatric disorders. No restrictions were made on language or year of publication, nor on sex or age of participants. The quality appraisal of studies was conducted by two researchers independently. We used meta-ethnography to synthesise data and developed a behavioural model to explain dyadic interaction. Results: A total of 17 studies were included in the review. The meta-ethnography generated two third-order constructs: Personal orientation and noises. When both people with dementia and their carers opt for dyadic oriented goals, their behavioural responses are likely to promote positive interaction. When only one partner opts for dyadic goals, the stress posed by the context may affect the interaction because of no perceived shared understanding of the situation. Conclusion: Our findings suggest that unequal power distribution within dementia dyads, can cause significant stress especially when coping strategies are impaired. Implications are found for family carers, people with dementia, and health professionals as the model we derived enhances the understanding of dyadic dynamics to care

Geochemical, textural and micromorphological properties of Angolan agroecosystem soils in relation to region, landscape position and land management

Angola is a country rich in natural resources, containing enormous water resources and a vast area of land yet to be developed. It has a mostly young population, where subsistence family farming supports 90% of the rural population. The country was once an agricultural power in the colonial era, but today its production levels are low, and while soils are potentially suitable for agriculture the status of nutrient elements and related management practices are poorly understood. The concepts of soil improvement are related to the sustainability approaches needed for new agricultural developments in Angola. This project studies Angolan soils with the aim of contributing to a better understanding of the status of nutrient elements and the factors that determine their levels. The objectives of the thesis are to: a) Determine nutrient element status in the agricultural regions of Luanda and Huambo in Angola, the areas of greatest agricultural expansion in the country. Soil sampling for this purpose was based on catena-based soil transects and field profile horizon characteristics of the region’s Ferralsols soils. Soils from two provinces were subject to chemical, physical and micromorphological analysis with the aim of understanding aspects related to characteristics mentioned above and their genesis. Analyses was based on Coulter Counter (textural), ICP-MS (Inductively Coupled Plasma Mass Spectrometry), thin section micromorphology and associated SEM-EDX (Scanning Electron Microscopy-Energy dispersive X-ray spectroscopy) analyses. Levels and locations of nitrogen (N), phosphorus (P), potassium (K) and pH values. b) explain the nutrient element levels in terms of the relative contributions of micromorphological properties, soil texture and cultural amendment of soils. Weathering assessments were undertaken through thin section micromorphology, highlighting both physical and chemical weathering fronts on mineral grains; texture was assessed by using particle size analysis in combination with analysis related pedogenic- features in thin section; and the nature of soil amendments undertaken by subsistence farmers has been assessed through a series of farmer interviews. The findings of this study show that the contents of the macronutrients are higher than the micronutrients. This study shows that the soils have a silty clay loam and silt loam textural classes, with exception of the Ramiro region which, presented a sand texture. Moreover, the textural classes were observed to be related to nitrogen (N) status in relation to profile and depth. The micromorphological and microchemical analysis showed the high degree of weathering of these soils and kaolinite and quartz as the main mineral present, while the highest level of K and P were observed in the fine material. Integration of soil nutrient element status and the explanatory factors has a fundamental significance for Angola and the Southern Africa region with the Southern African Development Community (SADC) now expressing an interest in applying the findings into developing new policies to support subsistence farmers

Direito à saúde e Unidades de Tratamento Intensivo Neonatal (UTINs): uma breve reflexão sobre a eficácia das decisões judiciais no Estado do Maranhão

Resumo: A judicialização das políticas públicas de saúde é um fenômeno crescente em todo o País, tendo diversos âmbitos do Poder Judiciário recebido demandas relacionadas à saúde, no entanto, percebe-se que essa discussão tem reflexos nos três Poderes. O presente artigo teve por escopo compreender o sistema normativo que regulamenta o acesso a leitos de Unidades de Tratamento Intensivo Neonatal (UTINs), bem como analisar a eficácia das decisões judiciais no Maranhão, com foco nas decisões de magistrados da 1ª Vara da Infância e Juventude da comarca de São Luís, MA. Realizou-se um estudo descritivo e exploratório, com levantamento bibliográfico e documental, notadamente, em documentos disponibilizados nos sites do Poder Judiciário maranhense, do Ministério da Saúde, Secretaria de Saúde do Estado do Maranhão e do Município de São Luís. Ao fim, foram feitas algumas considerações sobre a problemática da judicialização da saúde como fenômeno que expõe as fragilidades e as descontinuidades das ações desenvolvidas pelas casas legislativas, pela gestão pública e pelo próprio sistema de justiça. Palavras-chave: Direito à saúde. Unidade de tratamento intensivo. Poder Judiciário.   Abstract: The legalization of public health policies is a growing phenomenon throughout the country, having many areas of the Judiciary received demands related to health, however, it is clear that this discussion is reflected in the three Branches. This article had the scope to understand the legal system that regulates access to the Neonatal Intensive Care Unit beds (NICUs) and to analyze the effectiveness of judgments in Maranhão, focusing on judges decisions of the 1st Court of Childhood and Youth of the district of São Luís, MA. We conducted a descriptive study, with bibliographic and documental survey, notably in documents available on the websites of the judiciary of Maranhão, the Ministry of Health, Health Secretariat of the State of Maranhão, and the City of São Luís. In the end, some considerations were made about the problem of the judicialisation of health as a phenomenon that exposes the weakness and discontinuity of the actions developed by legislative bodies, public management and own justice system. Keywords: Right to health. Neonatal Intensive Care Unit. Judicial Branch

Ontological analysis of means-end links

The i* community has raised several main dialects and dozens of variations in the definition of the i* language. Differences may be found related not just to the representation of new concepts but to the very core of the i* language. In previous work we have tackled this issue mainly from a syntactic point of view, using metamodels and syntactic-based model interoperability frameworks. In this paper, we go one step beyond and consider the use of foundational ontologies in general, and UFO in particular, as a way to clarify the meaning of core i* constructs and as the basis to propose a normative definition. We focus here on one of the most characteristics i* constructs, namely means-end links.Postprint (published version

Role of comprehensive geriatric assessment in healthcare of older people in UK care homes: realist review.

OBJECTIVES:Comprehensive geriatric assessment (CGA) may be a way to deliver optimal care for care home residents. We used realist review to develop a theory-driven account of how CGA works in care homes. DESIGN:Realist review. SETTING:Care homes. METHODS:The review had three stages: first, interviews with expert stakeholders and scoping of the literature to develop programme theories for CGA; second, iterative searches with structured retrieval and extraction of the literature; third, synthesis to refine the programme theory of how CGA works in care homes.We used the following databases: Medline, CINAHL, Scopus, PsychInfo, PubMed, Google Scholar, Greylit, Cochrane Library and Joanna Briggs Institute. RESULTS:130 articles informed a programme theory which suggested CGA had three main components: structured comprehensive assessment, developing a care plan and working towards patient-centred goals. Each of these required engagement of a multidisciplinary team (MDT). Most evidence was available around assessment, with tension between structured assessment led by a single professional and less structured assessment involving multiple members of an MDT. Care planning needed to accommodate visiting clinicians and there was evidence that a core MDT often used care planning as a mechanism to seek external specialist support. Goal-setting processes were not always sufficiently patient-centred and did not always accommodate the views of care home staff. Studies reported improved outcomes from CGA affecting resident satisfaction, prescribing, healthcare resource use and objective measures of quality of care. CONCLUSION:The programme theory described here provides a framework for understanding how CGA could be effective in care homes. It will be of use to teams developing, implementing or auditing CGA in care homes. All three components are required to make CGA work-this may explain why attempts to implement CGA by interventions focused solely on assessment or care planning have failed in some long-term care settings. TRIAL REGISTRATION NUMBER:CRD42017062601

Congenital hyperinsulinism in two siblings with ABCC8 mutation: same genotype, different phenotypes

Congenital hyperinsulinism (CHI) is a heterogenous disease caused by insulin secretion regulatory defects, being ABCC8/KCNJ11 the most commonly affected genes. Therapeutic options include diazoxide, somatostatin analogues and surgery, which is curative in focal CHI. We report the case of two siblings (born two years apart) that presented themselves with hypoketotic hyperinsulinemic persistent hypoglycemias during neonatal period. The diagnosis of diffuse CHI due to an ABCC8 compound mutation (c.3576delG and c.742C>T) was concluded. They did not benefit from diazoxide therapy (or pancreatectomy performed in patient number 1) yet responded to somatostatin analogues. Patient number 1 developed various neurological deficits (including epilepsy), however patient number 2 experienced an entirely normal neurodevelopment. We believe this case shows how previous knowledge of the firstborn sibling's disease contributed to a better and timelier medical care in patient number 2, which could potentially explain her better neurological outcome despite their same genotype.S

LEVANTAMENTO QUALI-QUANTITATIVO DA ARBORIZAÇÃO URBANA NO MUNICÍPIO DE BURITICUPU, MA

A arborização urbana oferece vários benefícios para a população, como melhoria microclimática, melhoria na qualidade de vida dos habitantes, permite ainda interação ecológica e conservação das características florística local. O município de Buriticupu – MA localizado na região da Amazônia Legal vem sofrendo ao longo dos últimos anos perda da sua diversidade vegetal urbana. Assim, conhecer a real situação da arborização urbana é de fundamental importância, pois apresenta subsídio para o planejamento e gerenciamento das áreas urbanas. Neste sentido, foi realizado um inventário quali-quantitativo usando o método de censo da arborização de vias públicas de Buriticupu-MA. Os dados foram obtidos considerando aspectos taxonômicos, ecológicos e fitossanidade. Foram catalogados 544 indivíduos distribuídos em 23 famílias e 33 espécies. As famílias mais frequentes foram a Fabaceae e Arecaceae. Das espécies registradas, 51,51% são nativas do Brasil e 48,49% exóticas. As espécies Licania tomentosa L. e Ficus benjamina L. apresentaram maior frequência. Espera-se que os resultados auxiliem no planejamento e manejo da arborização de Buriticupu-MA