Objective: With the changes in healthcare, patients with cancer now have to assume greater responsibility for their own care. Oral cancer medications with complex regimens are now a part of cancer treatment. Patients have to manage these along with the management of medications for their other chronic illnesses. This results in medication burden as patients assume the self-management. Methods: This paper describes the treatment burdens that patients endured in a randomized, clinical trial examining adherence for patients on oral cancer medications. There were four categories of oral agents reported. Most of the diagnoses of the patients were solid tumors with breast, colorectal, renal, and gastrointestinal. Results: Patients had 1u4 pills/day for oral cancer medications as well as a number for comorbidity conditions (3), for which they also took medications (10u11). In addition, patients had 3.7u5.9 symptoms and side effects. Patients on all categories except those on sex hormones had 49%u57% drug interruptions necessitating further medication burden. Conclusions: This study points out that patients taking oral agents have multiple medications for cancer and other comorbid conditions. The number of pills, times per day, and interruptions adds to the medication burden that patients' experience. Further study is needed to determine strategies to assist the patients on oral cancer medications to reduce their medication burden.

Magister Legum - LLM / This paper attempts a comprehensive analysis of the offence of illicit enrichment in Zambia. It focuses on how the offence fits into the broader legislative framework in Zambia. More importantly, the paper addresses aspects of the offence related to the presumption ofinnocence, the protection against self-incrimination and the presumption of legality in the light of the Zambian Constitution to determine whether the concerns raised are legitimate. Also, considering the potential effectiveness of criminalising illicit enrichment by public officials, this study investigates whether the law in Zambia can be implemented to balance the constitutional rights of the accused and the right of society to recover illicitly obtained wealth. Finally, the research seeks to determine the possible challenges of implementing and prosecuting the offence, and its efficacy in the fight against corruption in Zambia.

Background The trajectory of recovery after sepsis varies. Survivors may have considerable ongoing limitations, requiring a caregiver for a prolonged period. Objectives To learn about experiences, quality of life, coping, resilience, and social support of caregiver caring for survivors of sepsis. Methods We conducted a convergent mixed-methods study, recruiting informal caregivers of patients who had survived sepsis in the past year and were readmitted to the intensive care unit with sepsis. Individual face-to-face, semistructured interviews and validated surveys on quality of life, coping, caregiver burden, resilience, and social support were administered to caregivers. Interview transcripts were analyzed using content analysis. Surveys were scored and summarized using descriptive statistics. Results Caregivers were primarily middle-aged, White, and female. Half were spouses of their care recipient. Caregivers reported some deficits in mobility, pain, and anxiety/depression. Coping styles varied, with engaged coping being more prevalent. Most caregivers reported mild to moderate burden, all reported either normal or high resilience levels, and types of social support were similar. However, interviews and survey findings were not always consistent. Major themes that emerged from the analysis included (1) advocating for and protecting their loved one, (2) coping with caregiving, (3) uncertain future, (4) rewards of caregiving, and (5) need to optimize communication with family. Discussion Caregivers of sepsis survivors are protective of their care recipient and use a variety of strategies to advocate for their loved one and to cope with the uncertainty involved in a new intensive care unit admission. More advocacy and support are needed for this population.

Background: Severe mental illnesses (SMI) cause significant impairment for those living with the illnesses and often rely on caregivers for the ongoing care. Available evidence suggests that individuals responsible for caregiving may get distressed due to the caregiving experience, a phenomenon researchers call caregiver burden. Following the shift to community-centered mental health services, several studies on caregiving burden have been conducted in high income countries (HIC). However, there remains scarcity of data on the subject in SubSaharan Africa including Malawi. Therefore, the present study investigated the prevalence and associated factors of caregiving burden among caregivers of individuals with SMI at St John of God Hospitaller Services (SJOGHS) in Mzuzu-Malawi. Methods: The study adopted a hospital based cross sectional study. Recruitment took place at two outpatient departments of SJOGHS. Informal caregivers who were 18 years and above were asked to participate. The study recruited 139 caregivers and two research assistants approached participants at the waiting area. Caregivers who gave consent were asked questions about their caregiving activities using the Zarit Burden Interview (ZBI) (maximum score, 88). Data analysis was done using frequency distributions and descriptive statistics. The study used non-parametric tests such as a chi-square on all categorical measurements to test associations between variables and parametric tests such as t test on all continuous variables. The unadjusted and adjusted associations between socio-demographic factors and caregiving burden was conducted using logistic regression models. Results: On average, most caregivers experienced mild to moderate caregiving burden on the ZBI score (31.5 ± 16.7). In the adjusted model after controlling for caregivers’ gender, caregivers’ age, level of education, social support, care recipients’ age and care recipients’ gender, only caregivers’ age, social support and care recipients’ age remained significantly associated with caregiving burden. Older caregivers were more likely to experience caregiving burden than younger caregivers (OR=1.03, 95% CI 1.00-1.06), caregivers with social support were 71 % less likely to develop caregiving burden than those without social support (OR=0.29, 95% CI 0.14-0.62) and caregivers of older care recipients were less likely to experience caregiving burden than those of younger care recipients (OR=0.26, 95% CI 0.11-0.64). v Conclusion: Even though the caregiving burden found in this study was low compared to other previous studies in some arguably developed countries such as Iran and Turkey, it remains high in other developing countries such as Ghana and Nigeria. The low burden in this study, could be attributed to several factors and context in which the study was conducted. One such factor is the routine psychoeducation that the hospital often conducts for caregivers during the subsequent monthly reviews of their care recipients. An important follow up would be to investigate caregiving burden among caregivers who are unable to access the services at SJOGHS. The results of this study are important to guide policy in the formation of effective community programs that may assist mitigate the burden of informal caregivers. Finally, to understand the importance and implications of informal caregiving, further studies are needed in Malawi.

INTRODUCTION: Asthma, the leading chronic disease in children, is a major public health issue with 6.2 million children below 18 years currently diagnosed with asthma in the United States. This study sought to examine the national estimates and predictors of the burden of childhood asthma-hospitalizations in children below 18 years. METHODS: Data from the 2012 Kids’ Inpatient Database was used for analysis. Principal asthma diagnoses were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification code 493. xx. The burden was assessed in terms of number of asthma-related hospitalizations, total numbers of days spent in the hospital and total costs. Multivariate regression analysis was conducted to examine the predictors of childhood asthma hospitalizations. RESULTS: There were an estimated 82,634 asthma-related hospitalizations among children below 18 years in the United States in 2012, accounting for about 1 billion US dollars in hospital charges and more than 150,000 hospital days. Government payers (Medicare and Medicaid) were billed for about 60% of asthma-related hospitalizations in children. The rate of asthma hospitalizations was lowest in the Midwest (19.23%) and males accounted for more than half (62.57%) of asthma cases in children in the United States. The mean of hospital charges per discharge was 12,900 US dollars and the mean length of stay was 1.96 days. Older age (ages 12-17), Government insurance status, being female, living in the Western region and longer length of stay predicted higher total charges for childhood asthma-related hospitalizations. Factors associated with longer length of stay included older age (ages 12-17), private insurance status, being female and living in the Southern region of the country. CONCLUSION: The study findings suggest that childhood asthma remains a healthcare burden therefore, there is need for improvements in medications and outpatient treatments of asthma to reduce childhood asthma-hospitalizations in the United States. Keywords: children, asthma, hospitalizations, burden

Cancer is a public health burden which continues to cause many deaths and an economic burden worldwide. New and improved ways of thinking about anti-cancer drug design and development are needed now and in future. Recent reports demonstrate the key role played by the tumour microenvironment (TME) in tumour progression and the development of drug resistance. This study investigated the interactions between cancer cells and the stroma within the TME, specifically fibroblasts, mesenchymal stem cells (MSC), cancer stem cells (CSCs) as well as the extracellular matrix (ECM), with the goal to develop an in vitro model that mimics solid tumours in terms of cellular characteristics and drug response. Mesenchymal stem cells were investigated as potential sources of cancer-associated fibroblasts (CAFs) in solid tumours. The expression of CAFs markers, α-SMA and vimentin, increased significantly in MSCs co-cultured with oesophageal and breast cancer cells indicating conversion of MSCs into cell-like CAFs. WHCO1 (oesophageal) and MDA MB 231 (breast) cancer cells co-cultured with MSCs survived paclitaxel and cisplatin treatments better than cancer cells alone. To assess the prognostic value of CSCs, the expression and malignant behaviour of CSC markers were also examined in clinicopathologically-confirmed oesophageal cancer biopsies and in vitro. Oesophageal cancer biopsies stained strongly for the cancer stem cell markers, CD44 and ALDH1A1, demonstrating the presence of CSCs in these tumours. FACS-isolated side population cells exhibited high levels of cancer stem cell markers, self-renewal markers and drug resistance proteins and were associated with increased drug resistance versus cancer cells. In order to measure how ECM proteins affect oesophageal cancer cell response to chemotherapeutic drugs, 3D cell-derived ECMs was used as a model. The analysis of ECM proteins using qRT-PCR in oesophageal cancer biopsies showed that collagens, fibronectin, and laminins were overexpressed in tumour tissue compared with adjacent normal tissues. The culture of cancer cells on decellularised ECMs reduced the effect of drugs on cancer cells compared to those plated on plastic (control). The reduction of the effects of drugs was associated with significant activation of survival signalling pathways. Knockdown of collagen and fibronectin with siRNA combined with drugs resulted in increased sensitivity of cancer cells to drugs and lower colony formation and cancer cell migration. Lastly, this study utilized multi-cell tumour spheroids (MCTS) from WHCO1 and MDA MB 231 cells co-cultured with WI38 and CT1 fibroblasts to mimic tumour cell-stromal cell interactions as observed within the in vivo tumour microenvironment. The data show that spheroids were more resistant to drugs than monolayer cultures of the same cells. MCTS displayed characteristics similar to in vivo tumours in terms of response to drugs. Associated with these findings were increased levels of CSCs in MCTS compared to monolayer. This study demonstrated that MSCs are a possible source of ‘CAFs' in vivo and can support cancer cell growth. This study also demonstrated the presence of CSCs in tumours and that the targeting of these cells can shrink tumours and prevent potential metastasis and relapse of tumours. This study revealed that ECM proteins play major roles in the response of cancer cells to chemotherapy and suggest that targeting ECM proteins, especially type I collagen and fibronectin, can be an effective therapeutic strategy against chemoresistant tumours. MCTS, as shown in this study, is a valuable tool for the evaluation of the therapeutic effect of drugs. Overall, this study demonstrates the critical role played by the tumour microenvironment in tumour growth and metastasis and provides new insights into cancer treatment.

Individuals who live with depressed partners have increased rates of anxiety, depression, and difficult coping. They experience greater burdens of parenting and financial responsibilities, and often feel isolated and restricted. Much of this is similar to what has been termed caregiver burden in the context of other illnesses. This study used qualitative interviews to explore the day-to-day experience of what it is like to live with a depressed partner, as well as to test the fit of the term `caregiver burden' in the context of depression. Participants were seven individuals who were in long-term relationships with depressed partners. Analysis of the interviews identified four stages of a helping process that individuals go through as they care for their depressed partners and transition from partners to caregivers. These individuals are experts on their partners and have important perspective and essential support to offer when their depressed partners are seeking care. Findings underline the importance of advanced nursing and medical care that recognizes the significant burden that nondepressed partners experience and the important ways that they can help their depressed partners seek and stay with treatment.

No description available.

Yes / and Objectives: There is a growing evidence base that informal caregivers can identify positive aspects of providing care and that this may have a beneficial influence on their well-being. The aim of this systematic review was to explore how positive aspects of caregiving (PAC) affects the well-being of caregivers of people with dementia. Research Design and Methods: We searched electronic databases for quantitative studies exploring the association between PAC and caregiver well-being. Studies were included if they involved informal (unpaid) caregivers of people with dementia, at least 75% of whom had to be residing in the community. A narrative synthesis was used to explore patterns within the data. Results: Fifty-three studies were included in the narrative synthesis. Most studies utilized a cross-sectional design. The majority of samples consisted primarily of spouses and female caregivers. Twenty different PAC measures were employed and studies referred to a variety of constructs, such as satisfactions, gains, meaning, and rewards. PAC was associated with lower depressive symptoms and burden. Conversely, PAC was associated with better mental health, quality of life, satisfaction with life, and competence/self-efficacy. PAC was not associated with self-rated health or personal strain/stress. Discussion and Implications: The findings suggest that identifying PAC is associated with better caregiver well-being, although further longitudinal studies are required to explore how this relationship changes over time. Interventions that enable caregivers to gain a more positive experience of caregiving could be beneficial for their well-being.

1 The burden of proof in the disputes for unjust enrichment Abstract This diploma thesis deals with the institute of the burden of proof. Its aim is to analyse the distribution of the burden of proof in disputes for unjust enrichment. The thesis consists of an introduction, four main chapters, which are further internally divided and the conclusion. The introduction is focused mainly on the reasons of author's choice of the topic. The first chapter contains the general characteristics and interpretation of key concepts as well as related institutes, whose basic knowledge will be a key to other parts of the text. It explains the differences between the concepts of proof, counter-proof and objection. It then analyses the standard of proof needed to prove certain facts. It also describes the state of non liquet and analyses the individual procedural obligations and burdens of the parties. The subject of the second chapter of the thesis is the term of the burden of proof, which can be divided into the objective and subjective burden of proof. The subjective burden of proof can be further subdivided into the abstract and concrete burden of proof. The chapter goes on to analyse selected theories of distribution of the burden of proof, while not neglecting the negative theory of proof. In the partial conclusion,...