Interest in the presence of environmental contaminants in the Canadian arctic and sub-arctic arises in part over concerns that Aboriginal people residing in these regions continue to rely on subsistence harvesting. Organochlorines (OCs) are a type of persistent organic pollutant (POP) that have a unique chlorine-carbon bond; this bond facilitates their unprecedented environmental longevity, lipophilicity and hydrophobic nature. OCs have been found in both the biotic and non-biotic compartments of northern ecosystems. This study examined patterns of differences with respect to body burden of organochlorines (lipid-adjusted) between the residents of the Ontario First Nations of Fort Albany (the site of MCRL Site 050), Kashechewan (no radar site), and Peawanuck (the site of MCRL 500) to assess whether geo-proximity to abandoned radar sites influenced organochlorine body burden with respect to the people of Fort Albany and Peawanuck. Correspondence analysis (CA-1) revealed people from Fort Albany had relatively higher pesticide concentrations (β-HCH and DDT, but not Mirex) and relatively lower CB (156 and 170) body burdens when compared to participants from Kashechewan and Peawanuck. CA- 2 revealed Peawanuck residents had relatively higher concentrations of CB180, DDE and hexachlorobenzene and relatively lower levels of DDT and mirex compared to participants from Kashechewan and Fort Albany. Results are suggestive but not conclusive that MCRL Site 500 may have influenced body burdens of Peawanuck residents.

BACKGROUND: Literature suggests that many palliative home care patients wish to die at home. This study investigated determinants of caregiver burden among palliative home care patients, with particular interest in its relationship with place-of-death. Previous research has examined how patient care, health conditions, and characteristics of informal support relate to caregiver burden or place of death in palliative home care. However, none of the existing literature has focused on the role of caregiver burden on place of death or congruency between the patients’ preferred vs. actual place of death. It seems likely that, in light of the high dependence on informal care during the last days of life, that caregiver burden plays a significant role in place of death. A number of factors may contribute to the incongruence between preferred versus actual place of death. For example, informal caregivers may lack the necessary skills and/or knowledge to provide adequate care to terminally ill loved ones. They may also be unable to cope with the type of care required by his or her loved one. Longitudinal studies indicating increasing home death rates among palliative home care patients. Research attributed the increased rate of home death to expanding home care programs rather than improving home care services. The goal of this study was to provide home care agencies the means to increase rates of home death among home care patients who wish to die at home by better directing existing types of services to lessen caregiver burden and improving congruency between preferred versus actual place-of-death. OBJECTIVES: The aim of the research was four fold. First, it validated the caregiver burden items in the interRAI Palliative Care (interRAI PC) with self-report caregiver scales. The second section examined the determinants of caregiver burden. The third section examined the determinants of place of death and congruency between preferred vs. actual place-of-death. The final section examined the role of caregiver burden and place-of-death. METHODS: This was a prospective cross-sectional study that employed the Caregiver Burden Scale, the Burden Inventory, and the interRAI PC tool. The sample included all palliative home care patients and their caregivers who received formal care from one Ontario community care access centre. Health information was collected by case managers during regular assessment intervals. RESULTS: The three interRAI PC items measuring caregiver burden are an adequate measure of subjective stress burden. The sum of these items can be used to construct a caregiver burden scale. Determinants of caregiver burden were limited to unstable health and higher levels of self-reported depression, anxiety, and anhedonia. Patients who preferred to die at home were more likely to suffer IADL impairment, but not ADL impairment, and they were more likely to have completed a do-not-hospitalize order or do-not-resuscitate order. Patients whose caregiver was not a spouse or child relative were less likely to prefer home death. Further analyses showed a high level of agreement between preferred versus actual place of death. Overall, 57% of patients died at home, 68% of those patients who wished to die at home had managed to do so. Determinants that increased the likelihood of home death included completion of a do-not-hospitalize order, preference to die at home, and excessive sleep. However, the presence of a caregiver who was unable to continue providing care decreased the likelihood of home death. CONCLUSION: The purpose of this study was to examine the role of caregiver burden in place of death among recipients of palliative home care. Studies such as this are important to the patients, caregivers, and the agencies that provide home care. Results of this study confirm many of the determinants of home death reported by earlier research. It is unique in that it identifies the caregiver’s ability to continue providing care as an important determinant of home death. These results support that notion that the needs of the caregiver should also be examined when determining the needs of the patient and that the patient and caregiver should be considered a unit of care. It also illustrates the important role of advanced directives, more specifically do-not-hospitalize orders, among patients receiving palliative home care.

Abstract Introduction: Vietnam has one of the fastest growing HIV- epidemics in the world. In Vietnam the primary caregivers are the family. Aim:  The aim was to examine caregiver burden and need of support among family members of persons living with HIV [PLHIV] in Ho Chi Minh City, and also to investigate the differences in these matters between genders. Method:  A descriptive cross-sectional study with quantitative method was used. The study was carried out at the Hospital of Tropical Diseases, Ho Chi Minh City, Vietnam where people living with HIV are treated. A convenience sample was used. Seventy one of 87 questionnaires were completed. Result: The largest groups reported “mild to moderate” (35%) and moderate to severe” (42%) caregiver burden. The caregivers felt that they should do more for their relative and a better job in caring for them. They also expressed that the financial situation added to the burden. The needs of support most requested were economic support, knowledge about caring, and mental support to cope. Concerning caregiver burden scale only one significant difference was found, male participants found it more embarrassing to have friends over than female participants. High caregiver burden was strongly associated with depression (p=0.00). Conclusion: High caregiver burden and feeling of depression was strongly associated. The caregivers of PLHIV are in need of different kinds of support to cope with their situation. Intervention including care plan should be given to caregivers to minimize risk of burden and depression and increase their quality of life. / Sammanfattning Introduktion: Vietnam har en av de snabbaste växande HIV-epidemierna i världen. De primära vårdgivarna vid sjukdom är familjemedlemmar. Syfte: Syftet med studien var att undersöka känslan av vårdgivarbelastning hos familjemedlemmar till personer som lever med HIV när de vårdar sin anhörig och vilka stödinsatser de behöver. Vidare var syftet att se om några skillnader mellan män och kvinnor föreligger. Metod: En deskriptiv tvärsnitts studie med en kvantitativ metod användes. Studien genomfördes på Hospital of Tropical Diseases i Ho Chi Minh City, Vietnam. Ett bekvämlighets urval användes. Sjuttioen av 87 enkäter var fullständigt ifyllda och användes för analys. Resultat:Den största delen av deltagarna upplevde ”mild till lindrig” (35%) och ”lindrig till svår” (42%) belastning. Familjevårdgivarna kände att de skulle vilja göra mer för sin anhörig och vårda dem på ett bättre sätt. De uttryckte också att den svåra ekonomiska situationen ökade belastningen. Stödinsatser som efterfrågades mest var ekonomiskt stöd, kunskap om hur man vårdar och mentalt stöd för att klara av situationen som vårdgivare. Gällande vårdgivarbelastning fanns en signifikant skillnad, män var mer generade än kvinnor när de hade besök av vänner. Hög vårdgivarbelastning var starkt associerad med känslan av depression (p=0.000). Slutsats: Hög vårdgivarbelastning och känslan av depression var starkt associerade. Vårdgivarna är i behov av stödinsatser av olika slag för att klara av sin situation. Åtgärder som inkluderar en omvårdnadsplan skulle kunna erbjudas till vårdgivarna för att minimera risken av vårdgivar- belastning, depression och öka deras livskvalité.

Forskning visar att anhörigvårdaren upplever glädje och närhet tillsammans med närstående trots bördor. Syftet med studien var att belysa vad det innebar att må bra och att stärka hälsan som anhörigvårdare. Intervjuer med fem anhörigvårdare genomfördes. Analysen gjordes med kvalitativ innehållsanalys. Huvudtemat beskrevs som en process mot helhet och hälsa. Inre nycklar till stärkt hälsa innebar en ökad kunskap och därmed ökad förståelse för sig själv, närstående och andra. När anhörigvårdarens förståelse växte fram använde hon parallellt avkopplingen, vårdandet av sig själv, naturen samt kreativitet som nycklar. Få känna glädje och göra roliga saker själv och tillsammans med närstående var betydelsefullt. Inre nycklar var också mening och hopp, att få vara självständig samt att hantera vardagen. Yttre nycklar till stärkt hälsa innebar att relationen mellan anhörigvårdare och närstående var betydelsefull. Innebörden i detta var att ha gemensamma minnen samt roligt tillsammans. Ett socialt nätverk med familj, vänner och kommunens service som stöd var centralt. Studien har betydelse för förståelse för anhörigvårdarens hälsa. Slutsatsen blir att trots ett tungt ansvar så uppfattar anhörigvårdaren att hon med inre och yttre stöd har möjlighet att bevara sin hälsa.

Background¡G Ventilator-dependent patients have a great and far-reaching impact on families. Their primary caregivers, who are usually the ventilator-dependent patients¡¦ families, have played important roles during the caring process. Those caregivers are burdened with a lot of responsibility and pressure. It is crucial to find out how to assist the caregivers within selected methods of caring and to provide them with suitable needs in order to reduce their psychological burden. Therefore, the purpose of this study is to explore the related factors and to compare the burden and the needs of the primary caregivers in respiratory care ward and home care on long-term ventilator-dependent patients. Design¡G The survey adopts cross-sectional and purposive sampling by using a structured questionnaire to collect information. Both Burden and Needs Questionnaire¡¦s reliability is respectively 0.923 and 0.943; their KMO is 0.828 and 0.829 ; their Expert Validity (CVI) is 0.88 and 0.91. The questionnaire has reached the ideal value of reliability and validity. The sampling subjects are from respiratory care ward and home care centers in southern Taiwan. Total 260 out of 280 questionnaires are returned (the response rate has reached 92.9%) and there are 241 valid samples. The questionnaires are used for data collection and are divided into four sections; ¡§patient basic information¡¨ , ¡§family basic information¡¨, ¡§caregiver burden scale¡¨, and ¡§caregiver need scale ¡¨. The collected data is analyzed with descriptive statistics-test, one-way ANOVA, Pearson¡¦s correlation and multiple regressions by using SPSS Windows version 12.0. Result¡G (1) Patients from Home-care centre are normally younger in comparison with the patients from respiratory care wards; their average usage of mechanical ventilator is 30.98 month longer; they tend to have more conscious and tracheotomy patients. According to the demography, these two groups of the patients have a significant difference. (2) The average age of primary home care and respiratory care ward caregivers is 50¡ã52; most of them are female; most of the care givers are the patients¡¦ children. (3) "Physiological burdens" and "physiological needs" of home care centers caregivers are greater than the caregivers in respiratory care ward. They have reached a significant difference in statistic. (4) The primary caregivers have a declining health, and their workload and demands are increasing. (5) There is a significant positive correlation between the primary caregivers¡¦ burden and needs. (6) Base on the numbers of admitting to the ICU, the hospital and the current health status of the primary caregivers; the workload is predictable. Conclusion¡G Hopefully the result of this study can provide the Government to formulate a long-term-care insurance. Focus on providing the services to different needs for the caregivers; reduce the caregivers¡¦ burden on caring the mechanical ventilator patients. Also, to provide health care workers and respiratory therapists to implement on transferring patients to respiratory care ward and to offer further health education for the primary caregivers of home care centers.

<p>As the globalization of companies increases day by day, the need for a clear and comprehensible legislation to overcome the problems with transfer pricing transactions increases as well. Incorrect pricing in transfer pricing situations between companies with close economic ties to each other makes countries risk parts of their taxation income.</p><p>Swedish legislation uses the internationally accepted arm’s length principle to regulate the transfer pricing transactions. Through the correction rule, the rule is upheld that the pricing between two companies with close economic ties to each other must apply to the same conditions as it would have been if it was between two companies without close economic ties to each other.</p><p>To ensure that enough material is provided to base the assumption whether or not the correction rule has been followed or not, Swedish legislation provides a number of paragraphs to regulate the matter. The legislation is spread all over and is hard to interpret. The question rises whether this is against the rule of legal certainty or not.</p><p>The taxation authority has provided a proposition on new legislation with tougher documentation requirements where it also wants to give itself part of the power by through directions exactly define what the documentation shall include. Yet again the question is raised whether or not this is against the rule of legal certainty or not.</p> / <p>I takt med att globaliseringen av företag ökar, ökar också behovet av en klar och tydlig lagstiftning för att överkomma problemen med internprissättningstransaktioner. Vid oriktig prissättning vid transaktioner mellan företag i ekonomisk intressegemen-skap riskerar länder att gå miste om delar av sin skattebas.</p><p>Svensk lagstiftning använder sig av den internationellt accepterade armlängdsprincipen för att reglera internprissättningstransaktioner. Genom korrigeringsregeln regleras att prissättningen mellan två företag i ekonomisk intressegemenskap måste ske under samma förutsättningar som skulle ha gällt mellan två företag utan ekonomisk intressegemenskap.</p><p>För att få underlag till huruvida korrigeringsregeln har följts eller inte finns ett antal lagrum i svensk rätt som reglerar dokumentationskrav. Denna lagstiftning är spridd och anses vara svårtolkad. Frågan uppstår om detta strider mot rättsäkerheten.</p><p>Skatteverket har kommit med ett förslag på ny lagstiftning med skärpta dokumentationskrav där man dessutom vill ge sig själv delar av makten att genom föreskrifter exakt bestämma vad dokumentationen skall innehålla. Återigen väcks frågan om det-ta är förenligt med rättssäkerheten.</p>

Family caregivers encounter immense negative consequences including decreased quality of life and increased rates of morbidity and mortality that stem from physical burdens, emotional distress, depression, social isolation, and loss of financial security. Although communication is an important aspect of caregiving, communication tasks are reportedly difficult for end-of-life family caregivers. The goal of this study was to explore the variety of communication stressors experienced by end-of-life family caregivers to gain insight into the communication tasks caregivers perceive as most difficult and the reasons why. Qualitative data was achieved through in-depth, face-to-face interviews with 40 caregivers currently providing care for a family member diagnosed with Alzheimer’s disease and related dementias (n=20; ADRD) and Glioblastoma (n=20; brain tumor [GBM]). A grounded theory approach was employed to gain insight into end-of-life family caregiver communication experiences. The results revealed that communication is perceived as a burden for end-of-life family caregivers. Not only does communication burden exist, end-of-life family caregivers experience immense tension and stress regarding a variety of relational contexts when communicating with the care recipient, others (family, friends), and clinicians. The results further revealed that communication burden stems from the caregiver’s attempt to negotiate between two opposing extremes: a desire to protect the patient and others versus a need to protect oneself. Thus, internal tension occurs when end-of-life family caregivers contemplate whether and how to engage in difficult conversations, and then again when following through. The presence of these contradictory tensions induced the emergence of barriers and therefore communication burden within various aspects of the end-of-life caregiver experience. Added insight into communication burden was achieved through a supplementary scale development study in a sample of ADRD and oncology end-of-life caregivers (N=263), which revealed communication burden as significantly associated with caregiver burden and quality of life. Implications for the advancement of interpersonal and health communication theory as well as practical tailored interventions targeting end-of-life family caregivers are discussed.

Introduction: The purpose of this research was to assess the relationship between the degree of incontinence severity and treatment seeking behavior, healthcare utilization, and work productivity; and to compare overactive bladder (OAB) related disease burden from a global perspective. Methods: A cross-sectional online survey was administered to eligible participants with idiopathic OAB residing in Australia, Canada, France, Germany, Italy, Spain, United Kingdom, and the United States. Participants were categorized into subgroups with dry, mild (1 leak/per day), moderate (2 leaks/day), and severe (3 leaks/day) urinary incontinence (UI) severity groups. Results: A total of 1,334 participants completed the survey. Persons with more severe urinary incontinence symptoms related to OAB consumed more healthcare resources, had a higher occurrence of OAB related clinical consequences, and higher work productivity loss compared to individuals with less severe symptoms. Even though OAB is associated with significant disease burden, many patients do not seek treatment.

Tuberculosis (TB) is an airborne infection. Though effective anti-TB drugs have been available for more than 50 years, over one-third of the world’s population is exposed to TB bacterium; deaths due to TB infection occur at high frequency every day worldwide. Today, drug-resistant TB, TB/HIV co-morbidity and poor health infrastructure are major challenges worldwide, particularly in less developed countries. The primary objective of the study was to assess the progress of TB control programs in twenty-two Eastern Mediterranean Region countries toward Millennium Development Goals (MDGs) including implementation of the Directly Observed Treatment, Short-course (DOTS). Also, the study was designed to explore TB/HIV co-morbidity and to assess some factors potentially associated with TB progress in the region. Secondary data, obtained from the World Health Organization, World Bank, and World Resource Institute on line databases were used. Paired samples t-test and bivariate correlation were conducted. Between 1990 and 2005, TB incidence had decreased 9%, TB prevalence had decreased 37% (statistically significant) and TB mortality had decreased 28%; nevertheless, MDG targets were not met. TB/HIV co-morbidity increased in the region especially in HIV-high burden countries. Though DOTS population coverage was increased to 94% in 2005, DOTS new smear-positive case detection rate was 61% (target 70%) and DOTS treatment success was 80% (target 85%). Thus, the 1991 Stop TB Partnership targets were not met. In spite of the progress of TB control programs in the EMR, MDGs and DOTs targets of 2005 were not obtained. Further efforts such as allocation of more resources, strengthening of TB surveillance systems, extension of drug-resistant TB and TB/HIV collaborative programs, and TB research are required to achieve MDGs by 2015 and to fully implement the new Stop TB Strategy in the region.

Šiame magistro baigiamajame darbe nagrinėjama mokesčių našta Lietuvoje ir ES. Tyrimo tikslas – nustatyti, kokia iš tikrųjų yra mokesčių našta Lietuvoje, lyginant su kitomis ES valstybėmis, ar ji gali būti lygiavertiškai vertinama, kas tai riboja. Darbo pradžioje iškelta hipotezė, kad Lietuvoje mokesčių našta, lyginant su kitomis ES valstybėmis, yra didelė. Pirmoje dalyje bendrai apibūdinome mokesčių naštą, apibrėžėme jos sąvoką, išsiaiškinome mokesčių naštos įvertinimą ir tą įtakojančius veiksnius. Antroje dalyje palyginome Lietuvos ir kitų ES valstybių mokesčių naštą, jos dydį (kitimą), mokesčių naštos apskaičiavimą ribojančias sąlygas. Trečioje dalyje, išskirdami, kokie mokesčiai yra didžiausia mokes��ių našta Lietuvos mokesčių mokėtojams, kurie iš jų moka daugiausiai mokesčių, analizavome mokesčių naštos pasiskirstymą Lietuvoje. Paskutinėje dalyje apibendrinome atliktos anketinės apklausos rezultatus. Darbo pabaigoje pateikėme savo išvadas ir pasiūlymus mokesčių naštos vertinimui, mažinimui Lietuvoje. / The burden of taxation in Lithuania and EU is analyzed in this final post-graduate work. The main purpose of this research – ascertain what is real the burden of taxation in Lithuania, comparing with others EU countries, how it can be estimated, what restricts it. Hypothesis, bought in the beginning of the work, that the burden of taxation in Lithuania, comparing with others EU countries, is big. In the first part of work we described the burden of taxation, defined it‘s concept, found out the burden‘s of taxation valuation, what influences and restricts it. In the second part we compared the burden of taxation in Lithuania with others EU countries, it‘s size (changes), what restricts it‘s calculation. In the third part, separating, what taxes are the biggest burden for tax payers, which of them pay more taxes, we analyzed the burden of taxation distribution in Lithuania. In the last part we generalized results of made questionnaire inquest. In the end of work we presented our conclusions and propositions of the burden of taxation evaluation, it‘s decreasing in Lithuania.