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The purpose of this article is to critically analyze the concept of self-perceived burden. The Rodgers Evolutionary Model is augmented with concept critique, a dialogic process grounded in critical hermeneutics. Self-perceived burden is a relatively mature concept with psychological, relational, and dimensional attributes that are shaped by culture and sociopolitical structures. The antecedents are demographics, circumstances, diagnoses, symptoms, prognosis, comorbidities, and knowledge and beliefs. The consequences are psychological, decisional, relational, and existential. Sociocultural factors such as universal health coverage, Confucian ethics, Buddhist/Taoist ethics, karma, and individualist- versus communitarian-based relationships are brought to light. Psychological and relational antecedents and consequences of self-perceived burden were found to be salient.

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Control of antibiotic resistance in bacteria is based on the concept that resistance incurs a fitness cost in non-selective conditions. Fitness costs were assessed for low- and high-level mupirocin resistance in locally-derived Staphylococcus aureus and S. epidermidis. Costs of resistance were assessed in pure cultures by comparing growth curve characteristics and in mixed culture as the proportion of resistant cells surviving. Costs were not present in comparisons of growth rates among groups of naturally-occurring isolates from the different resistance categories. However, in S. aureus, growth rates within resistance categories differed by approximately 30 – 90%. Among near-isogenic pairs of strains, fitness costs ≥10% were present in three of eleven pairs under pure culture and in six of eleven pairs under competition in mixed culture. Differences in intrinsic growth rates could easily mask fitness costs of the magnitudes observed. Thus, clinical outcomes also depend on whether there is a mixed infection and if so, on the growth rates of strains present.

The purpose of this article is to critically analyze the concept of self-perceived burden. The Rodgers Evolutionary Model is augmented with concept critique, a dialogic process grounded in critical hermeneutics. Self-perceived burden is a relatively mature concept with psychological, relational, and dimensional attributes that are shaped by culture and sociopolitical structures. The antecedents are demographics, circumstances, diagnoses, symptoms, prognosis, comorbidities, and knowledge and beliefs. The consequences are psychological, decisional, relational, and existential. Sociocultural factors such as universal health coverage, Confucian ethics, Buddhist/Taoist ethics, karma, and individualist- versus communitarian-based relationships are brought to light. Psychological and relational antecedents and consequences of self-perceived burden were found to be salient.

The Book of Mormon makes it clear that Isaiah's message is of great importance to the modern reader. In order to facilitate modern and personal spiritual application of Isaiah's writings, spiritual "formulas" or principles may be discovered or formulated. These formulas are statements of truth based on the prophet's writings that may be applied in multiple situations and time periods. Such formulas of truth offer valuable insighst across time. These formulas may be understood by analyzing the historical setting of the chapter(s) under review, and through critical examination of the text itself. These formulas provide a solid foundation upon which can be built the framework of personal application. The burden chapters of Isaiah (chapters 13-23) each offer an important formula that can have powerful spiritual application. This work explores each burden prophecy, using historical research and critical analysis of the text to postulate a formula. Each burden chapter has its own message that can lead to spiritual insight.

Objective: To examine whether caregiver burden, parenting style, and sibling relationships in families raising a child with a disability (CWD) predict cooperative and externalizing behaviors in typically-developing sibling (TDS). Methods: This correlational study included 189 families raising both a CWD and a TDS. Mothers and fathers completed self-report questionnaires on caregiver burden, sibling relationships, parenting style, and TDS cooperative and externalizing behaviors. Results: Authoritative parenting was positively associated with cooperative behaviors, whereas authoritarian parenting was positively associated with externalizing behaviors. Hierarchical regression revealed caregiver burden was a significant predictor of cooperative and externalizing behaviors; however, when parenting style was added as a predictor, it was also significant. However, when sibling relationships were added as a predictor, they were the only consistently significant predictor for both cooperative and externalizing TDS behaviors; caregiver burden was no longer significant and parenting style was only significant in predicting externalizing behaviors. Conclusion: Positive sibling relationships may help negate the effects of caregiver burden and poor parenting practices on sibling outcomes. Therefore, interventions improving parenting and sibling relationships are critical in families raising a CWD.

Stroke is the leading cause of long-term disability in the United States and often leaves individuals with physical and cognitive deficits. Stroke survivors are discharging to the home environment in increasing numbers rather than entering a long-term care facility. Family caregivers are needed to provide assistance for engagement in ADL, IADL, communication, and mobility tasks due to the residual deficits resulting from the stroke. Research indicates that caregivers are not adequately prepared in the inpatient setting to assume their new role and are therefore at risk for negative health outcomes and caregiver burnout. This doctoral project intends to address the need in the inpatient setting for proper and adequate caregiver education and training prior to a patient’s discharge home. The Post-Stroke Discharge Planning Toolkit and the caregiver perceived readiness questionnaire will address this need. Specifically, the toolkit will target education on stroke risk factors and complications; eating including swallowing, nutrition, hydration, PEG tube education; bowel and bladder care; positioning; caregiver self-care; supportive problem solving; facilitating of functional transfers, mobility, handling, and lifting; facilitating activities of daily living; communication; psychological aspects of caregiving; and referral services. The questionnaire will help identify gaps in knowledge faced by caregivers and serve as a planning tool and outcomes tool for intervention and evaluation. Ideally, through the use of the Post-Stroke Discharge Planning Toolkit, difficulty with discharge planning and negative health outcome risks associated with assuming the caregiver role can be mitigated or stopped prior to onset. The Post Stroke Discharge Planning Toolkit will be available in print and online.

Despite a growing body of studies on the relationship between housing and health, it is unclear whether and how (a) the housing cost burden deteriorates health and whose health it deteriorates, (b) housing assets interact with income in influencing one’s health, and (c) protective policy measures alleviate mortality risks predicted by housing cost burden. This thesis aims to reduce these knowledge gaps. First, in Chapter two, I synthesize prior literature that focused on the association between housing cost burden and health and discussed methodological issues. Also, the chapter proposes future research directions. Chapter three, co-authored with Dr. Michel Grignon, Dr. Marisa Young, and Dr. James R. Dunn, assesses the potential moderating effect of housing asset level on the link between income and mortality. Although housing assets and income are independently related to mortality risks, the value of housing assets did not significantly moderate the link between income and mortality. Income-related inequalities in mortality are observed among each group of housing asset level. Our findings offer insight into the importance of redistribution of resources that can reduce risks of premature mortality and achieve healthy aging. Chapter four documents that housing cost burden was significantly associated with preventable mortality, treatable mortality, and suicide during post-Global Financial crisis (2009-2017). Also, in countries with an increased level of social spending, higher levels of social housing stock, and rent control, the observed association was substantially attenuated. Taken together, the findings of the three chapters contribute to understandings about the link between housing and health by (a) synthesizing the prior literature and mechanisms, (b) estimating housing inequalities in health, and (c) highlighting the protective roles of social and housing policies that reduce health inequalities. / Thesis / Doctor of Philosophy (PhD) / This thesis aims to investigate housing inequalities in health and the roles of protective social and housing policies in reducing health inequalities. The second chapter, as a scoping review, synthesizes prior literature that estimates the association between housing cost burden and health, and explores potential mechanisms linking housing cost burden to health. Chapter three relies on one of the nationally representative linkage datasets in Canada in order to estimate the association between housing asset, income, and mortality in Canadian older adults. It reveals that the value of housing assets and income predicts mortality risks, but housing assets do not significantly change the link between income and mortality. The fourth chapter examines whether and how housing cost burden is associated with avoidable mortality in OECD countries. Also, the roles of preventive measures including social spending and housing policies are revisited. The thesis strengthens the rationale for identifying housing as one of the important social determinants of health.

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