Esta tese aborda a distribuição do ônus da prova no processo trabalhista pretendendo a aplicação da teoria da distribuição dinâmica do onus probandi neste ramo processual especial. Na primeira parte do trabalho são examinadas questões relativas aos direitos fundamentais, bem assim aos princípios constitucionais processuais, com relevo especial ao direito constitucional à prova. Na sequência serão estudadas as matérias relativas ao ônus da prova na teoria geral do processo, suas dimensões, os poderes instrutórios do juiz, a teoria clássica da distribuição do ônus da prova, bem assim as especificidades da inversão da prova no processo do trabalho. Segue-se a abordagem com a apresentação de teoria dinâmica do ônus da prova e sua recepção pelo direito brasileiro, apontando ainda alguns projetos legislativos que já positivam sua adoção no Brasil. Por fim, e considerando a necessidade de superação das regras estáticas do ônus da prova no direito processual do trabalho propõe-se a adoção das regras dinâmicas, partindo da necessidade de efetividade da tutela jurisdicional e concretização dos princípios da igualdade substancial, tudo em observância ao direito fundamental a um processo do trabalho justo e igualitário. Serão, ainda, abordadas algumas decisões jurisprudenciais da Justiça do Trabalho que aplicam o ônus dinâmico da prova. / The present thesis addresses the distribution of the burden of proof in labor procedural law aiming to apply the theory of dynamic distribution of the onus probandi in this branch of special procedural law. In the first part of this paper, issues related to the fundamental rights, as well as procedural constitutional principles, will be assessed, with special emphasis to the constitutional right to poof. Subsequently, matters related to the burden of proof in general procedural theory, its dimensions, the instruction powers of the judge, the classic theory of distribution of the burden of proof, as well as the specificities of the inversion of the proof burden in labor procedural law will be analyzed. Then, an approach to the dynamic theory of the burden of proof and its reception in Brazilian law is presented, highlighting some legislative projects that already indicate the positive adoption in Brazil. Finally, and considering the urge to overcome the static rules of the proof burden in labor procedural law, we propose the adoption of the dynamic rules, from the standpoint of the need for effectiveness in jurisdictional custody and materialization of the principles of substantial equality, in observance of the fundamental right to a fair and equalitarian labor proceeding. And yet, some case law rulings of the Labor Justice applying the principle of dynamic burden of proof will be addressed.

Published Article / A study was conducted to determine the differences between four breeds in respect of coat score, hide-thickness, tick burden and body condition score. The study was comprised of 40 heifers - 10 of each breed, namely Afrikaner, Braford, Charolais and Drakensberger. A subjective system of coat scoring, ranging from extremely short to very woolly, was used. Body condition score was measured subjectively, with 1 being emaciated and 9 being obese. Hide-thickness (in mm) and tick count were also determined. Between August 2007 and early March 2008, measurements were carried out on the same 10 animals of each breed, with highly significant differences in body condition score, hide-thickness and tick count being observed between the breeds in all instances. Coat scores differed significantly between breeds in the earlier and latter stages of the study becoming less significant midway through. A significant difference in body condition score within breeds was also found, while hide-thickness did not differ significantly within breeds.

BACKGROUND:Neurogenic detrusor overactivity (NDO) leads to impaired health-related quality of life (HRQoL), productivity, and greater healthcare resource burden. The humanistic and economic burden may be more apparent in NDO patients with urinary incontinence (UI). The objective of this study was to compare the HRQoL, productivity, and health resource use (HRU) between continent and incontinent NDO patients.METHODS:A retrospective database analysis was conducted using the Adelphi Overactive Bladder (OAB)/UI Disease Specific Programme, a multi-national, cross-sectional survey reported from both patients' and physicians' perspectives. The population for this analysis included NDO patients with or without UI. General and disease-specific HRQoL were assessed using the EuroQoL-5D (EQ-5D), Incontinence Quality of Life questionnaire (I-QOL), and the Overactive Bladder Questionnaire (OAB-q). Productivity and daily activity impairment were measured using the Work Productivity and Activity Impairment (WPAI) questionnaire. HRU indicators included OAB-related surgery, OAB-related hospitalizations, incontinence pad usage, switching anticholinergics used for OAB due to inadequate response or adverse effects, and OAB-related physician visits. Bivariate analyses, multivariate ordinary least squares (OLS) regression analyses and published minimal clinically important differences (MCID) were used to assess relationships between incontinent status and the aforementioned outcome measures.RESULTS:A total of 324 NDO patients with or without urinary incontinence were included, averaging 54years of age (SD 16), of whom 43.8 percent were male. Bivariate analyses detected no significant relationship between incontinent status and HRU variables. Regression analyses revealed that incontinent patients had clinically and statistically lower disease-specific HRQoL and greater impairment in daily activities as compared to continent patients. On average, incontinent patients scored 10 points lower on the I-QOL total score, 9 points lower on the OAB-q HRQoL score, 15 points higher on OAB-q symptom severity, and experienced 8.2 percent higher activity impairment due to their bladder condition (all p <0.001).CONCLUSIONS:Incontinent NDO patients experience significantly lower HRQoL and activity impairment as compared to continent NDO patients.

Background. The Maya are one of the largest Mesoamerican groups. The decline of the classic Maya society, the subsequent Colonial domination and the current national economic policies has had a severe biological and social impact on the Maya across several generations. Accumulated evidence suggests that conditions and environments experienced by one generation can affect the health, growth and development of the next generation (Emanuel, 1986). Historical evidence of political, educational and socioeconomic deprivation suffered by the Maya from Yucatan, Mexico, provides us with the opportunity to test the intergenerational influence hypothesis and ascertain the impact of the biosocial background of urban Maya grandmothers (first generation) and mothers (second generation) on the growth and nutritional status of their children (third generation). Aims. The main objective is to assess the impact of socioeconomic and intergenerational factors on the growth of Maya children, in a sample of children, their mothers and maternal grandmothers. The specific objectives are: 1) to assess the nutritional status and nutritional dual burden prevalence in participants, 2) to identify the pre and postnatal biosocial and economic factors that relate to the nutritional status of the children, and 3) to assess the intergenerational influences on the growth of participants: from grandmothers to mothers and from grandmothers and mothers to children. Methods. The sample is composed of 109 triads of Maya children (6-8 years old), their mothers and their maternal grandmothers from the city of Merida, Yucatan, Mexico. From September 2011 to June 2012 we collected anthropometric, body composition and socioeconomic data on the three generations. We also assessed parameters about living conditions of maternal and grand-maternal childhood. Nutritional status was assessed by comparing the participants against the Comprehensive Growth References published by Frisancho (2008) and based on the NHANES III. Pre and postnatal biosocial and economic factors were analysed through multiple regression models. Intergenerational influences were assessed through: 1) bivariate and partial correlations in anthropometric and derived variables between participants, 2) path analysis to identify the direction and magnitude of direct and indirect causal effects between the three generations, and 3) multiple regression models to identify the effect of anthropometric and socioeconomic intergenerational factors on the growth of mothers and children. Results. Eleven percent of the children were categorized as stunted and 36% met the criteria of risk for abdominal obesity. Only 1% of children exhibited the combination of stunting and abdominal obesity. Mothers and grandmothers showed very low average heights and high levels of abdominal obesity. The combination of maternal abdominal obesity and child stunting was present in the 6% of mother-child dyads. It was found that preeclampsia and cigarette smoke exposure during pregnancy and household overcrowding impacted negatively the linear growth of the children. Maternal education and the presence of grandmothers at home predicted healthier values of BMI, waist circumference, body fat and body lean mass percentages on children. Maternal height and leg length (LL = height sitting height) were positively associated with the linear growth of children. These associations were not modified by the grand-maternal size, in terms of very short stature. In contrast, associations in weight, body mass index, sum of skinfolds and fat mass were stronger in grandmother-child pairs than in mother-child pairs. The birth weight of the children was positively associated with maternal head circumference and negatively associated with the absence of a toilet at home during maternal childhood (i.e. when the mother was growing up). Grand-maternal intergenerational predictors of children s height, leg length, body mass index, waist circumference and skinfolds were: index of household characteristics, family size and school attendance during childhood. Family size and paternal job loss during maternal childhood were the maternal intergenerational factors that influenced significantly the body mass index, waist circumference and skinfolds of children. Conclusions. Growth and nutritional status of the children, mothers and grandmothers reflect the effects of chronic deprivation and poverty that are a constant among the Maya in the Yucatan. Under and-overnutrition coexisted in this sample of three generations. Pre-and-postnatal biosocial and economic factors impacted the growth and nutritional status of children. Harsh living conditions experienced by mothers and grandmothers during their childhood influenced the prenatal and postnatal growth of children. We suggest that disadvantaged conditions experienced by mothers and grandmothers during their first years of life impacted their own growth and this in turn is influencing the growth of children of the third generation. Substantial reductions in poverty levels and increase educational levels of the mothers are required to overcome the intergenerational traces on the future generations.

Tyrimo objektas – verslo įmonės mokesčių našta. Tyrimo tikslas – sukurti mokesčių naštos minimizavimo metodiką ir pateikti pasiūlymus mokesčių naštai mažinti. Tyrimo uždaviniai: 1. Atlikti N įmonės mokestinę analizę ir nustatyti mokesčių naštos lygį įmonėje. 2. Nustatyti verslo įmonės mokesčius ir mokesčių naštą įtakojančius veiksnius bei tarp jų esančio ryšio stiprumą. 3. Sukurti verslo įmonės mokesčių naštos minimizavimo metodiką. 4. Pagal sudarytus scenarijus ir analizuotus minimizavimo variantus įvertinti N įmonės mokesčių naštos kitimą taikant mokesčių naštos minimizavimo metodiką. Tyrimo metodai. Atliekant mokesčių naštos minimizavimo tyrimą buvo naudojami literatūros bendrieji moksliniai tyrimo metodai – literatūros analizė ir sintezė, loginė analizė ir sintezė, loginio modeliavimo metodai. Informacijai apdoroti ir sisteminti panaudoti grupavimo, palyginimo ir grafinio vaizdavimo būdai. Tyrimo rezultatai: • Pirmoje darbo dalyje išnagrinėta mokesčių našta tenkanti verslo subjektui ir nustatyti veiksniai įtakojantys įmonės mokesčių naštą. Nustatyta, kad darbo santykių bei pelno mokestinės naštos yra reikšmingiausios įmonei. • Antroje darbo dalyje sudaryta verslo įmonės mokesčių naštos minimizavimo metodika, išskiriant nuoseklią atliekamų veiksmų seką ir jiem taikomus metodus. • Trečioje darbo dalyje atliktas verslo įmonės mokesčių naštos minimizavimo tyrimas. Pateikti verslo įmonės mokesčių naštos minimizavimo scenarijai ir nustatytas optimaliausias iš jų. Teorinė ir... [toliau žr. visą tekstą] / Object of the research – tax burden in the business enterprise. Aim of the research – to create the method of tax burden minimization and present the suggestions for minimizing the tax burden. Objectives of the research: 1. To perform the tax analysis of enterprise N and to identify the level of the tax burden in the company. 2. To determine the elements that affect taxes of the enterprise and tax burden as well as the intensity of relation between them. 3. To create the method of tax burden minimization in business company. 4. To evaluate the change of company’s N tax burden applying the method of tax burden minimization, in accordance to the concluded scripts and analyzed minimization options. Methods of the research. While carrying out the examination of tax burden the general methods of scientific literature investigation are applied: analysis and synthesis, logical analysis and synthesis, logical modeling techniques. In order to process and systemize the information the methods of classification, comparison and graphic depiction are applied. Results of the research: • In the first part of thesis the tax burden that satisfies the business subject is analyzed and the factors that affect company’s tax burden are determined. It is ascertained, that tax burden of labor relations and profit are the most significant to the enterprise. • In the second part of thesis, by distinguishing the consistent sequence of performed operations and its techniques, the method of tax burden... [to full text]

This thesis seeks to identify, explain, and differentiate the problems of existential doubt and the burden of choice in today’s world versus the previous epochs of human existence. It will attempt to discern the relevant differences in the types of existential doubt, illustrate how these differences came about, and analyze the strength of a potential solution to these problems. My aim is to critique Dreyfus and Kelly’s portrayal and solution to these problems in a way that can further promulgate discussion on an increasingly relevant topic in philosophy, mental health, and science. The conclusion will provide a novel understanding of contemporary nihilism that might be of use in combating this epidemic.

Introduction The main objectives of this study were: 1) to examine the prevalence and characteristics of opioid exposures, 2) to estimate the economic costs associated with opioid poisonings, and 3) to examine the characteristics associated with opioid poisoning-related health care resource use (HCRU) and costs in children. Methods Data from the National Poison Data System from January 1, 2010 to December 31, 2014 were utilized to examine the prevalence and characteristics of opioid exposures and poisonings in children <18 years. Economic costs were estimated using the 2012 Nationwide Emergency Department Sample, Kids’ Inpatient Database, Multiple Cause-of-Death file and other published sources, applying a societal perspective. Direct costs included costs associated with ED visits, hospitalizations and ambulance transports. Indirect cost included productivity costs due to caregivers’ absenteeism and premature mortality among children. Results There were a total of 83,418 pediatric opioid exposures and nearly half of them resulted in poisoning. The epidemiology of opioid exposures differed considerably by age. Opioid exposures were more prevalent and mainly accidental in young children. Exposures in adolescents were more likely to be intentional and severe. The total economic costs of pediatric opioid poisonings in the United States were calculated at $230.8 million in 2012. Total direct costs were estimated to be over $21.1 million. Total productivity costs were calculated at $209.7 million, and 98.6% of these costs were attributed to opioid poisoning-related mortality. Conclusions Opioid exposures and poisonings in children continue to occur and impose an economic burden on the society.

Thesis title: Burden of proving in disputes regarding damages The issue of providing evidence in disputes regarding damages is a theme involving many questions, whose legislation seems to be questionable in some cases. This aspect is compensated for and supplemented by application practise, which makes the theme continuously relevant. The aim of my diploma thesis is to provide a general, descriptive, and comprehensive interpretation of the specifics of providing evidence in disputes regarding damages. Another objective of this diploma thesis is to demonstrate that it is difficult to gain insight both in theoretical and in practical issues of the burden of proof because the opinions of courts and some of the authors specializing in this issue are different in some cases. The first part deals with the general notion of evidence in the civil procedure. I mention the concept and the subject of evidence and its importance in the civil procedure. I also mention selected legal principles connected with providing evidence. A further focus of this part is on procedural obligations of the parties, especially on the obligation of claims and of the burden of proof. It is based on theoretical concepts by significant authors (especially J. Macur). The burden of proof and the related institutes of providing...

PhD (Physiotherapy), Faculty of Health Sciences, University of the Witwatersrand / Despite the improvements that have been made in health care over the years, stroke remains a serious public health problem in low, middle and high-income countries. Post-stroke, there are many consequences that manifest and these include mortality, morbidity and socioeconomic, affecting not only the stroke survivor but also the caregiver. These consequences are felt hardest in low and middleincome countries because they are the least able to deal with health related setbacks to development. Pressure for beds and the need to reduce hospitalisation related costs have resulted in early discharge home of patients culminating in caregivers playing a more significant role post-stroke. The role played by caregivers has of late received much attention and is well documented in highincome regions. Informal caregivers are particularly important in low resourced settings. Caregivers play an important role in the rehabilitation process of the stroke survivor. The discharge home of patients with stroke to unprepared caregivers is associated with burden or strain, which negatively affects the quality of life of not only the caregiver but the stroke survivor as well. The effect of a structured, individualised caregiver training programme on patients with stroke and their carers has not been established in sub-Saharan Africa in general and South Africa in particular. With this in mind, the aim of the study was to establish the impact of caregiver education on the morbidity of the stroke survivors and on the quality of life of the stroke survivors and their carers. The specific objectives of the study were to establish the: physiotherapy caregiver education programmes and associated content in use for managing patients with stroke at Chris Hani Baragwanath hospital, effect of caregiver education on the mobility of the stroke survivors, effect of caregiver education on the health related quality of life of the stroke survivor and the caregivers, effect of caregiver education on the ability of the stroke survivor to socialise and participate in community issues and also the patient and caregiver characteristics associated with caregiver strain post-stroke. To achieve the first objective, a self designed questionnaire was used to establish the physiotherapy caregiver education programmes and associated content in use for managing patients with stroke at Chris Hani Baragwanath hospital from the physiotherapists at the hospital. For the rest of the objectives, a stratified randomised controlled trial using concealed allocation with a broad entry and blinded outcome assessment at baseline, three, six and 12 months was used for data collection. The participants for the study were first time ischaemic patients with stroke admitted to Chris Hani Baragwanath hospital, Soweto, Johannesburg, South Africa. A total of 200 patients and their caregivers participated in the study. These were randomly assigned to either the control group or the experimental group. The caregivers in the experimental group were subjected to an individualised training programme just prior to discharge of the patient with stroke and at the three month follow up. The assessor was blinded to the group allocation of the patients and caregivers until after completion of the study. From the study, the one-year case fatality was 38%. The mean hospital length of stay for patients with stroke was six days and the average number of physiotherapy contacts for the stroke survivors was one. The content of the rehabilitation programme of patients post-stroke was well structured and appropriate at Chris Hani Baragwanath. However, there was no caregiver involvement or training during in-patient rehabilitation. The barriers to caregiver involvement included perceived high workload by therapists, short hospital length of stay, poor referral systems between clinicians and therapists of patients post-stroke and caregivers being unavailable during working hours for training purposes. Using the Barthel Index (BI) scores, 78% of the patients were functionally dependent at 12 months post discharge. None of the patients were fully independent in mobility and stair climbing. The experimental group had better mean BI scores at the three and 12 month follow up periods (p = 0.01 and p = 0.05 respectively) when compared to the control group. Caregiver education had the effect of improving the BI scores by one and 0.7 at the three and 12 months follow ups respectively. However, the functional abilities of the patients from both groups were still low at 12 months with averages of 13.3 and 12.6 for the experimental and control groups respectively (out of a possible 20). The overall patient mobility scores as measured on the Rivermead Mobility Index were low over the study period with averages of 9.1 and 8.5 for the experimental and control group respectively (out of a possible 15). However, the experimental group had slightly better Rivermead Mobility Index (RMI) scores, which were not statistically significant. Caregiver education had the effect of reducing the risk of death by 27% relative to that occurring among the control group patients. The health related quality of life of the stroke survivors was generally poor over the study period. The baseline means from their EQ-5D scores (for health related quality of life) were 42.4 and 43.7 for the control and experimental groups respectively, which rose to 67 and 68.8 at 12 months respectively post discharge. Caregiver education had the effect of improving patients’ EQ-5D scores by a factor of three and this was only at 12 months. The caregivers’ quality of life generally declined over the 12 months of the study period (more in the control group than the experimental group) from averages of 92 and 93 at three months (for the control and experimental groups respectively) to 83 and 86 (respectively) at 12 months. However, the experimental group had better mean EQ-5D scores (health related quality of life) than the control group (p = 0.001). Caregiver education had the effect of improving EQ-5D scores by factors of 3.4 and 3.6 at the six and twelve month follow up period. The ability to socialise and participate in community issues was poor. None of the participants could carry out single and multiple tasks without assistance at 12 months post discharge. More than 87% of the patients had mild to moderate difficulty with walking at 12 months post discharge and they were all unable to lift and carry objects, have fine hand use and move around with equipment without assistance. None of the patients was able to carry out domestic activities without any difficulty and consequently they could not prepare meals and do housework without assistance from helpers. All of the participants had mild to moderate and severe to complete difficulty in basic interpersonal interactions, complex interpersonal interactions and formal relationships. They all had mild to moderate difficulty engaging in recreation and leisure activities while 27% of the control group and 25% of the experimental group had severe to complete difficulty with community life at 12 months post discharge. The design, construction and building products and technology for both public and private use were cited as barriers to community participation. More than 50% of the patients also cited friends as being barriers to community participation but acquaintances, colleagues, neighbours and community members were cited as being facilitators together with personal care providers (caregivers). Transport services, systems and policies were also cited as barriers by more than 80% of the participants. Caregiver education did not seem to influence patients’ ability to participate in community issues given the similarities in percentages between the control and experimental groups. At three months post discharge, 89% of the caregivers in the control group and 92% of those in the experimental group were strained from caregiving duties. However, these percentages declined to 78% and 43% respectively at 12 months, showing the effectiveness of caregiver education. Caregiver education had the effect of reducing strain by a factor of 2.6 at 12 months. The patient characteristics that were associated with caregiver strain were the dependency levels in transfers, mobility, dressing, bathing, poor activities of daily living scores, patient anxiety/depression, pain and poor perceived health state. The only caregiver characteristic that influenced caregiver strain was the level of education. The reduced hospital length of stay, pressure for beds and possibly inadequate rehabilitation personnel levels means that its possible that some caregivers are not adequately trained to meet patient needs, although this needs to be confirmed with further controlled research. The current pressure on in-patient services at Chris Hani Baragwanath hospital is resulting in suboptimal exposure to rehabilitation of patients post-stroke. There is insufficient organised caregiver education at present. Structured individualised caregiver training has the effect of positively influencing the health related quality of life of the patients especially at six and 12 months post discharge. Caregivers for patients with stroke suffer from physical, financial and psychological problems, which negatively affect their health related quality of life. Currently, high levels of caregiver strain persist poststroke. Caregiver education however has the effect of reducing the decline in caregiver health related quality of life over time. Caregiver training did not positively influence patient mobility and this is most probably because the patients had very low or poor functional ability levels at discharge from hospital. However, structured and individualised caregiver training has the effect of improving patients’ quality of life and can help reduce deaths among stroke survivors. The patient ability to socialise and participate in community issues post-stroke is currently poor. This mainly stems from the poor functional ability levels, which necessitate dependency on caregivers. Compounding the low functional ability levels are the transport systems, services and policies, attitudes of friends and the design, construction and building products and technology for both public and private use, which are barriers to community participation. The high patient dependency levels result in caregivers being highly strained. The patient characteristics that influence caregiver strain are dependence in transfers, grooming, mobility, dressing, poor activities of daily living, patient anxiety/depression, pain and poor perceived health state (health related quality of life). The only caregiver characteristic that was associated with caregiver strain is the level of education. The early discharge home with little caregiver training calls for provision of community rehabilitation services preferably through domiciliary visits. Caregivers of patients with stroke should be assessed and treated for depression given its high prevalence among this cohort. The referral system between the local community health centres and the discharging hospital need to be strengthened to ensure access to rehabilitation by all patients post discharge from hospital. The referral to social workers during in-patient and out-patient rehabilitation also need to be strengthened to ensure processing of social grants to alleviate financial strain as is appropriate. Caregiver strain is a complex and multifaceted problem with no single causation or solution. As a result, further research is needed to establish the reasons for poor rehabilitation service provision post-stroke for patients and caregivers and find solutions to these. It is important to explore different methods of caregiver education programmes so that the method that yields the best results for both patients and caregivers can be established in our setting and internationally.

A research report submitted to The Faculty of Health Sciences, University of Witwatersrand, in fulfillment of the requirements for the degree Of Masters in Public Health Johannesburg 2005 / ABSTRACT Swaziland is currently faced with a deepening HIV/AIDS epidemic. A systemic review of available information concerning the economic impact of HIV/AIDS on Swaziland was undertaken to collate data and document this impact in order to inform decision makers and planners. The methodology for the systematic review was based on the guidelines described in the Cochrane Reviewers’ handbook. HIV/AIDS has significantly increased the vulnerability of affected Swaziland rural households to environmental shocks. There is an increased burden of orphans due to HIV/AIDS, reduced household labour and income as adults die of AIDS. HIV/AIDS has reduced farm productivity leading to worsening of food insecurity and poverty in affected households. Due to HIV/AIDS, absenteeism in Swaziland organizations has increased by 20- fold. HIV/AIDS is currently the leading cause of death accounting for over 60 percent of all employee deaths. Organisations that have implemented HIV/AIDS workplace responses have been less affected. The micro-sector is the worst affected and it is recommended that policy makers ensure that this sector is protected from the negative impact of HIV/AIDS. The epidemic of negative impacts of HIV/AIDS in Swaziland has not yet reached the peak.