Health care-associated and hospital-acquired infections are two entities associated with increased morbidity and mortality. They are highly costly and constitute a great burden to the health care system. Vitamin D deficiency (< 20 ng/ml) is prevalent and may be a key contributor to both acute and chronic ill health. Vitamin D deficiency is associated with decreased innate immunity and increased risk for infections. Vitamin D can positively influence a wide variety of microbial infections. Herein we discuss hospital-acquired infections, such as pneumonia, bacteremias, urinary tract and surgical site infections, and the potential role vitamin D may play in ameliorating them. We also discuss how vitamin D might positively influence these infections and help contain health care costs. Pending further studies, we think it is prudent to check vitamin D status at hospital admission and to take immediate steps to address existing insufficient 25-hydroxyvitamin D levels.

Dialysis patients are often denied hospice benefits unless they forego dialysis treatments. However, many of those patients might benefit from as-needed dialysis treatments to palliate symptoms of uremia, fluid overload, etc. The current Medicare payment system precludes this "palliative dialysis" except in those few cases where the terminal diagnosis is unrelated to renal failure. As approximately three quarters of all US patients on dialysis have Medicare as their primary insurance, a of review of Medicare policy is suggested, with a goal of creating a new "palliative dialysis" category that would allow patients to receive treatments on a less regular schedule without affecting the quality statistics of the dialysis center.

Objective This study explores how caregiver relationship quality with family, patient, and patient's health care provider (HCP) is associated with subjective caregiver burden during the early treatment phase for late-stage cancer. Method Burden and relationship quality were assessed in telephone interviews with family caregivers (FCGs) of advanced cancer patients. The five subscales of the Caregiver Reaction Assessment measured burden, while relationships were measured with the Family Relationship Index, the Family Inventory of Needs subscale of met needs, and a scale assessing family discord in cancer communication. Results Multiple linear regression analyses in SPSS (v16) of 420 FCGs showed that higher quality relationship with family was associated with lower burden in FCG abandonment, health, scheduling (p<0.001) and finances (p<0.01). Higher quality relationship with patients' HCPs was associated with lower burden in FCG abandonment (p< 0.05), health, and finances (p<0.001). More discordant communication in patient relationship was associated with lower financial burden (p<0.05). Relationship quality was not associated with caregiver self-esteem. Conclusions Findings demonstrate that caregiver relationship quality with family and with HCP are important factors in understanding caregiver burden during the early treatment phase of late-stage cancer care.

Caregivers of children with autism spectrum disorder (ASD) experience unique challenges while fulfilling their long-term responsibilities and often experience and report higher levels of stress and a decrement in well-being compared to other caregivers. By using four databases (EBSCO, ProQuest, Scopus, and Web of Science), a systematic literature review was conducted on interven- tions to improve these aspects among caregivers. The selection process was limited to articles writ- ten in either English or Spanish, peer-reviewed studies, published between 2011 and 2022, and em- pirical data studies. Seven articles that conducted different interventions met the inclusion criteria and were used to analyze the conducted interventions, together with the reported outcomes. Results show a variety of interventions, differences in length, and used approaches. Regarding the outcomes, support programs were found to be effective when reducing stress and improving the well-being of the studied population; however, there is not enough evidence to conclude their long-lasting effects. Future suggestions include studying larger and more representative samples assessing the interven- tion ́s long-term effects.

Thesis (DPhil (Environmental Health))--Cape Peninsula University of Technology, 2016. / Informal caregivers play an important role in the well-being of dependent members in a household. The burdens of these caregivers are multiple and pervasive and may contribute to mental health epidemiology as a result of worry, grief, anxiety and stress. The literature review revealed that studies in caregiving and its various facets began from a pragmatically applied interest rather than from theoretical and intellectual curiosity. The majority of the research on caregiver burden involves meta-analysis of qualitative studies with little quantitative research. Also, many of these studies are concentrated on caregivers of chronically ill patients, such as those suffering from dementia, Alzheimer’s disease, and heart disease, without much attention to care burden resulting from caring for those who are not necessarily ill. Similar studies by other researchers did not consider the impact of the physical health of the care recipients or the environmental factors that are critical in the study of female caregiver burden in low-income settings. In addition, existing studies did not adequately evaluate the many potential factors that may vary and influence the lives of the caregivers, especially in a single, comprehensive model. This study attempted to provide a more complete picture of these relationships in low-income and culturally diverse settings. The study population consisted of black/African and coloured populations living in subsidised or low-cost housing settlements. In each of the two different cultural communities, 100 black/African and 100 coloured female caregivers were selected through a systematic random sampling procedure. In addition, data were also collected from caregivers in Tamale, Ghana to assess differences between the socio-demographic profiles of the caregivers in Cape Town, South Africa and Tamale, Ghana. The theoretical paradigm used in this study is the Stress Process Model by Pearlin et al., (1990). The study instrument assessed caregiver burden with both objective and subjective measures through the use of a fully structured questionnaire. The information that was collected according to the constructs of the Stress Process Model included personal and role strains and incorporated the physical health of the care recipients and environmental factors such as kitchen and toilet hygiene. Inclusion criteria for the respondents in both Cape Town and Tamale were the principal female caregivers who were present, willing, and able to give informed consent. The Statistical Package for Social Sciences (SPSS Version 22) was used for the analyses. The Chi-square test was used to assess the relationships between environmental health, the socio-demographics of the female caregivers and the health status of the care recipients. The hierarchical regression analysis in the form of a General Linear Model was used to model caregiving burden. iv The results showed that the majority of the female caregivers were in the age group 40 – 49 years and in both Cape Town and Tamale, a large proportion was in the low-income group. Also, the majority of the informal caregivers in the two samples were in care tasks as a full-time job, providing more than 40 hours of care per week. Regarding the length of time in caregiving, a large proportion of the caregivers in both Cape Town and Tamale had been in the care role for more than three years preceding the survey, and almost all the caregivers in the Cape Town sample (98.4%) did not use any form of caregiving programme to ameliorate the negative effects of caregiving. Further, the results showed statistically significant relationships between the socio-demographic characteristics of female caregivers (age, education, population group and income status) and the diarrhoea status of the care recipients. Also, a significant relationship was shown between environmental health variables of the home (kitchen hygiene and toilet hygiene) and the physical health of the care recipients. The major predictors of female caregiver burden in the samples were the physical health of the care recipients and access to social grants. On the basis of the analyses, it was recommended that the government should recognise the importance of the physical health of the care recipients and increase the amounts of social grants to the caregivers since this could improve the circumstances of both the caregivers and the care recipients. In addition, this could aid in improving the standard of living of caregivers in these households. Future research in similar settings should disaggregate the data to compare the burden of caring for caregivers of physically strong care recipients with physically ill care recipients.

La thèse de doctorat porte sur l’analyse de l’inflation de la charge normative du patrimoine culturel, reposant dans le droit actuel essentiellement sur les épaules du propriétaire, public ou privé, tout en proposant, dans un volet normatif, un modèle de répartition de la charge plus équilibrée selon les droits et les intérêts des différents acteurs du patrimoine (propriétaire, autorité publique, mais aussi l’acteur collectif).À partir d’une analyse historique du droit du patrimoine culturel belge, la thèse s’attelle à démontrer l’intervention accrue de l’autorité publique dans le droit de propriété, à évaluer celle-ci et, enfin, à proposer des réflexions prospectives quant à la répartition de la charge normative de la protection du patrimoine culturel. Le champ d’analyse se limite au droit belge du patrimoine architectural (les monuments et les sites), ainsi qu’au droit belge des biens culturels mobiliers, ces deux domaines mettant particulièrement en relief les points de tension entre les intérêts individuels et les intérêts collectifs. Le premier volet de la thèse repose sur une description minutieuse des législations et des pratiques patrimoniales de 1835 à nos jours, élaborée à l’aide d’une grille de lecture analytique, afin de démontrer une ingérence renforcée dans le droit de propriété par l’autorité publique compétente. Le deuxième volet évalue cette analyse descriptive, en la relativisant par d’autres éléments, notamment par la charge incombant également à l’autorité publique gardienne du patrimoine. Dans l’exercice d’évaluation, est en outre réalisé un examen exhaustif des évolutions jurisprudentielles du contentieux de l’indemnité en cas de charge disproportionnée imposée au propriétaire, indiquant également un souci d’équilibre lors de l’intervention étatique. Enfin, le troisième volet, qui constitue le cœur de la thèse, s’inscrit dans une dynamique prospective, visant à interroger de manière radicale le droit de propriété, afin de le replacer dans son contexte et de le revisiter à la faveur du patrimoine culturel. À l’aide de la théorie du droit, et notamment de la théorie des biens communs, est ainsi développé le modèle de la propriété culturelle d’intérêt partagé, qui tiendrait mieux compte des intérêts et des droits de chacun des acteurs. Ce modèle accueillerait par ailleurs l’acteur collectif, sous toutes ses multiples composantes, qui s’inscrit entre le propriétaire et l’autorité publique, prenant tant du côté du droit sur la chose (accès, usage et jouissance collective) que de l’intérêt à la chose (intérêt culturel de conservation et de transmission). L’autre versant du modèle est celui de la responsabilité partagée du patrimoine culturel, permettant de mieux répartir la charge entre le propriétaire, l’autorité publique et la collectivité. Ce modèle bicéphale est opérationnalisé en revisitant la propriété tout en étudiant la responsabilité de manière complémentaire. Sont ainsi explorés certains outils de droit privé (contrat, fondation, trust), ainsi que certaines modalités de financement alternatif (mécénat et crowdfunding). / The research analyses the legal burden of cultural heritage, mostly resting on the shoulders of the public or private owner, according to actual legislation. At the same time, the research develops a normative model for a more balanced distribution of the burden, taking various interests and rights of the different actors (owner, public authority but also the collective actor) into consideration. From a historical analysis of Belgian cultural heritage law, the research demonstrates an increased intervention of the public authority in property right. It also measures this intervention and proposes forward-looking ways to rebalance the legal burden for the protection of cultural heritage. The research field is limited to Belgian law on architectural heritage (monuments and sites) and on movable cultural goods, as these both areas particularly highlight the tension between individual and collective interests.The first part of the research meticulously describes the heritage practice and legislations from 1835 onwards, through an analytical reading grid, in order to show an increased interference in ownership rights by the competent public authority. The second part assesses this descriptive analysis by relativizing it with other elements, such as the burden also resting on the public authority as steward. Moreover, in the evaluation exercise, this research exhaustively examines case law changes regarding the excessive burden imposed on the owner in compensation claims, indicating a concern for a balanced State intervention. Finally, the third part, which lies at the heart of the research, is more forward-looking, critically and radically putting into question property right, in order to contextualise it and to revisit in favour of cultural heritage.Relying on legal theory, and in particular on the theory of the commons, this research develops the model of a cultural property of shared interest, which would better take into consideration the interests and rights of each actor. This model would welcome the collective actor, in all its multiple forms, and who would take place between the owner and the public authority, taking both on the side of the right on the object (collective access, use and enjoyment) as on the side of the interest to the object (cultural interest to conservation and transmission). The other side of the model is the shared responsibility towards cultural heritage, allowing for a better distribution of the burden between the owner, the public authority and the collective actor. The research operationalizes this two-headed model by revisiting property and, complementarily, by studying responsibility. It explores certain legal tools in private law (contract, foundation, trust), and certain alternative financial modes (sponsoring and patronage, crowdfunding).

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A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Master of Science in Physiotherapy Johannesburg, 2012 / Introduction: Stroke continues to be a major public health problem for both the developed and developing world despite the various advances in health care. The economic burden of stroke is ever increasing and in light of this, return to work post-stroke is becoming an important area of research for therapists. Thus the main aims of the study were to establish the rate of return to work of patients following stroke and to establish the patients’ perceived factors which influence their return to work after stroke. Method This was a quantitative cross sectional study. A sample of convenience of ninety seven participants were selected from a list of patients obtained from various rehabilitation units and government clinics within the Gauteng province. A self-designed questionnaire was used. A pilot study was conducted to determine the questionnaire’s reliability and validity, and the validity, inter-rater and intra-rater reliability were all found to be satisfactory. The participants were contacted and interviewed at their homes or a location suitable for them using a self-designed questionnaire. The percentage of patients that returned to work was determined and reasons for returning or not returning to work were summarised using frequencies and percentages. A univariate and then multivariate analysis was performed to establish perceived factors which had an influence on return to work Results The study sample had more males than females with an overall mean age of 51years. They were mostly black and between 18 months and 24 months post-stroke. The most common co-morbidities were fatigue and hypertension. There was a 34% return to work rate, with 3% stopping work after a period of time, leaving 31% of the sample working at the time of interview. The most common reasons for returning to work were financial (77%), enjoyment of work (77%) and personal development (73%). For those who did not return to v work the two most common reasons were upper limb dysfunction (61%) and walking difficulties (53%). The main factors that decreased likelihood of return to work included depression and not paying life insurance or monthly car repayments. Conclusion The return to work rate following stroke in this study group is in line with other countries around the world, although it is still relatively low with less than a third of patients with stroke returning to work. Enjoyment of work was shown to be as important a motivating factor for return to work as finances, and physical fallout was the most demotivating factor. Depression was the most likely factor to decrease return to work.