As older couples age, often one partner becomes more competent and able to care for the other, in which case they are able to remain in their homes. In one township in the northeastern United States, the caregiving role had a significant effect on the lives of elderly men who care for their wives. The purpose of this quantitative project study was to determine the relationship between perceived stress burden and perceived level of social support services and between perceived stress burden and use of support services by elderly male spousal caregivers residing in active adult communities. Watson's theory of caring provided the theoretical foundation for this study. A correlational design was used and data were collected from 82 elderly male spousal caregivers with (a) the Zarit Burden Interview; (b) the Multidimensional Scale of Perceived Social Support; and (c) a checklist, Support Services in Your Area. Descriptive analysis indicated that participants carry a large stress burden, particularly emotional stress (Zarit Burden score of 36.58/65), enjoy strong social support (Multidimensional Scale score of 45.47/75), and use few community services. Pearson's product-moment correlation revealed no significant relationship between perceived stress burden and perceived social support or between perceived stress burden and use of community services, indicating that men feel emotional stress but the feelings are not related to their use of community services. As community services were not used by elderly male caregiver spouses, a workshop for professionals was developed to help the professionals expand programs and services that may have value for these men in their caregiver role. This study has social significance because satisfaction with the caregiver role has consequences for the health and financial well-being of the elderly and for U.S. society.

Cirka 20-40 procent av Sveriges befolkning drabbas av psykisk ohälsa vilket även påverkar deras närstående. Efter avinstitutionaliseringen har ansvaret för den psykiskt sjuka förflyttats från institution till de närstående. Trots det ökade ansvaret som de närstående fått rapporterar sjuksköterskor svårigheter i att involvera de närstående i vårdandet.   Syftet var att belysa närståendes upplevelse av att vara närstående till en person med psykisk ohälsa. Litteraturöversikt i enlighet med Friberg (2012). Databaser som användes var CINAHL plus with Full Text och PsycINFO. Författarna valde ut sju kvalitativa, en kvantitativ artikel och en som var både kvalitativ- och kvantitativ. Artiklarna skulle besvara frågeställningarna: Hur påverkas de närståendes vardagliga liv när de lever nära en person med psykisk ohälsa? och vilka upplevelser belyses rörande det vardagliga livet och mötet med vården som följer av att vara närstående till en person med psykisk ohälsa? Den teoretiska referensram som valdes var systemteorin enligt Strømsnes Ekern (2003). Resultatet visar att närstående upplever att deras liv påverkas och att de exkluderas när det kommer till vårdandet av patienten. De önskar att deras behov blir tillgodosedda av den psykiatriska vården och att de blir mer delaktiga i vårdandet. Den psykiatriska vården bör se till de närståendes behov och erbjuda stöd då detta kan leda till minskad upplevd börda och ohälsa, vilket även påverkar patienten positivt. Kvinnor deltar i högre grad i valda studier och rapporterar även högre upplevd börda, något som även det bör uppmärksammas av sjukvården. Genom att använda systemteorin kan sjuksköterskan få en insikt av hur patient och dennes närstående påverkar varandra, vilket kan leda till en mer tillfredsställande omvårdnad.

Improving cancer care through clinical research is a major public health issue. However, in Georgia, the exact number of cancer clinical trials is unknown, indicating the need for baseline data regarding cancer clinical trial locations and cancer burden. This study provides the first statewide analysis of cancer clinical trial locations using Geographic Information Systems (GIS). This study examines cancer clinical trial locations by county, according to incidence rates, racial patterns and mortality rates of the four major cancer types: breast, colorectal, lung, and prostate. Findings from this study suggest that metro-Atlanta counties have higher densities of cancer clinical trials. This study also found that there were little or no cancer clinical trials available in counties with the highest rates of overall incidence, African American incidence and overall mortality. This research demonstrates the need to increase availability of cancer clinical trials in counties with the highest cancer burden.

Ekonominio nuosmukio sąlygomis, fiskalinės politikos sprendimai ypač svarbūs, nes vienokie ar kitokie žingsniai gali sutrumpinti arba pailginti ir pagilinti ūkio nuosmukį. Tokiu metu ekonomikos dalyviai labai jautriai reaguoja į fiskalinės politikos klaidas. Taigi svarbu tinkamai įvertinti kiekvieno sprendimo pasekmes. Dabartinės sąlygos neleidžia didinti valstybės išlaidų bei biudžeto deficito ir taip skatinti ekonominį atsigavimą. Tenka mažinti išlaidas ir stengtis didinti pajamas labai tam nepalankiu metu. Siekiant padidinti mokestines pajamas didinant mokestinę naštą, įvertinti tik aritmetinį to rezultatą nepakanka. Teorija ir empiriniai Lietuvos ir kitų šalių biudžeto surinkimo duomenys rodo, kad didesni mokesčiai ne visada lemia didesnes mokestines pajamas dėl dviejų priežasčių: dėl sumažėjusio ekonominio aktyvumo ir dėl šešėlinės ekonomikos dalies didėjimo. Viena iš pagrindinių šešėlinės ekonomikos plėtros priežasčių, kaip parodė daugelis tyrimų visame pasaulyje, yra mokestinė našta ir valstybės reguliavimas. Apibendrinus visas sąlygas Lietuvoje - ekonomikos smukimą, neigiamus ekonomikos dalyvių lūkesčius ir kita - paaiškėja, kad susidaro gana palanki aplinka šešėlinės ekonomikos plėtrai. Atsižvelgiant į biudžeto surinkimo duomenis ir atliktus tyrimus, galima daryti prielaidą, kad šešėlinės ekonomikos plėtra Lietuvoje galėjo lemti didesnį nei prognozuota ekonomikos smukimą. Turint omenyje mažesnį nei planuota biudžeto surinkimą ir padidinus mokesčius, galima... [toliau žr. visą tekstą] / During the economic slowdown, fiscal policy decisions are very important because they can shorten or lengthen and deepen economic downturn. At these times economic actors are very sensitive to fiscal policy mistakes. So it is important to evaluate the consequences of every single decision. Today’s situation does not allow stimulation of economy by increasing government expenditure and budget deficit. One must reduce expenditure and increase revenue in such unfavourable time. While trying to increase tax revenue by increasing tax burden, it is not sufficient to evaluate only arithmetical effect. Theory and empirical Lithuanian and other countries budget collection show that higher taxes do not always bring higher tax revenue because of two reasons: lower economic activity and increase in shadow economy. According to numerous surveys, the main reason of shadow economy is tax burden and state regulation. By summing up all the conditions – economic slowdown, negative expectation of economic actors and other – it is quite clear that the conditions for shadow economy are quite favourable. Considering budget collection and surveys, increase in shadow economy could have encouraged higher than forecasted economic slowdown. Lower than planned budget collection even with higher taxes allow to forecast that further increase in tax burden would only decrease tax revenue. Furthermore, collection of separate taxes shows that the collection of those taxes which were increased, differed from... [to full text]

Sleep disturbance is common in patients with heart failure (HF) and the family caregivers. Sleep disturbance is known as a predictor of poor quality of life (QoL) in individual level. The manner in which patients’ and caregivers’ sleep disturbances influence each other’s QoL has not been determined. The purpose of this dissertation was to investigate the associations of sleep disturbance and outcomes in patients with HF and their primary family caregivers. The specific aims were to: 1) examine whether sleep disturbance of patients and their family caregivers predict their own and their partners’ QoL; 2) examine the mediator effects of depressive symptoms on the association between sleep disturbance and QoL in patients and family caregivers; and 3) provide evidence of the psychometric priorities of the Zarit Burden Interview (ZBI) as a measure of caregiving burden in caregivers of patients with HF. The three specific aims were addressed using secondary analyses of cross-sectional data available from 143 patients with HF and their primary family caregivers. To accomplish Specific Aim One, multilevel dyadic analysis, actor-partner interdependence model was used for 78 patient- caregiver dyads. Individuals’ sleep disturbance predicted their own poor QoL. Caregivers’ sleep disturbance predicted patients’ mental aspect of QoL. For Specific Aim Two, a series of multiple regressions was used to examine the mediation effect in patients and caregivers separately. Depressive symptoms significantly mediated the relationship between sleep disturbance and mental aspect of QoL in patients. The mediation effect was similar in caregivers. For Specific Aim Three, the internal consistency and convergent and construct validity of the ZBI in 124 family caregivers of patients with HF were examined. The results showed that the ZBI is a reliable and valid measure of caregiving burden in this population. This dissertation has fulfilled important gaps in the evidence base for the QoL outcome in patients with HF and caregivers. The findings from this dissertation provided evidence of the importance of monitoring sleep disturbance for better QoL in both patients and caregivers and the importance of assessing caregivers’ sleep disturbance for improving patients’ QoL. It also provided evidence of the importance of managing depressive symptoms when targeting sleep disturbance to improve QoL in both patients and caregivers.

Pastarąjį dešimtmetį kilusios problemos dėl ekonomikos raidos bei mokesčių vaidmens šiuolaikinėje ekonomikoje skatino diskusijas apie fiskalinės politikos poveikį konkurencingumui. Tyrimai stokoja vertinimo argumentacijos, dauguma vertinimų grindžiamos tik BVP kitimo tendencijomis, kurios nerodo socialinių pokyčių. Mokslinė problema: kaip įvertinti mokesčių naštos ir ekonomikos konkurencingumo sąveiką socialinės aplinkos kontekste? Mokesčių naštos poveikio ekonomikos konkurencingumui vertinimas socialinės aplinkos kontekste modelis sudarytas, vadovaujantis teorinėmis, istorinėmis ir praktinėmis mokesčių kitimo ir įtakos ekonomikos, konkurencingumo, socialinio aplinkos lygio raidai bei valstybės dalyvavimo ekonominėje veikloje vertinimui ir yra argumentuotas instrumentas, tinkamas vertinti mokesčių vaidmenį ekonomikos konkurencingumo formavime socialinės aplinkos kontekste. Atlikti mokesčių naštos lygio ekonomikos aplinkos pokyčiams tyrimo rezultatai rodo, kad mokesčiai yra svarbi ekonomikos vystymosi aplinkybė, kuri šiuolaikinėje aplinkoje turi būti vertinama plačiau, ne tik valstybės dalyvavimo ekonomikoje lygio aspektu. Mokestinės naštos poveikį aktualu įvertinti ekonominio potencialo, konkurencingumo, socialinės aplinkos lygio ir viešųjų išlaidų poreikio kontekste. Kompleksinis mokesčių vertinimas leidžia atskleisti mokesčių naštos poveikį ne tik ekonomikos pokyčiams, bet parodo ir mokestinių pajamų perskirstymo vaidmenį ekonomikos konkurencingumo ir socialinės aplinkos... [toliau žr. visą tekstą] / Over the last decade, problems with the economic development and role of taxation in the modern economy, encouraged debate on fiscal policy impact on competitiveness. Studies lack reasoning, most estimates are based only on the GDP change trends, which do not reflect social changes. The scientific problem: how to assess the interaction of tax burden and economic competitiveness in the context of social environment? The model “Assessment of the tax burden impact on competitiveness of economy in context of the social environment” was created in accordance with the theoretical, historical and practical taxation changes and their impact on assessment of economy, competitiveness, social environment development level and state participation in economic activities. The model is reasoned assessment tool, suitable for evaluation of the role of taxation in the formation of economic competitiveness in social environment context. Results of the performed study of tax burden impact on economic environment changes show that taxes are an important factor in economic development, which in today's environment must be regarded as more, than just a level of state involvement in the economy. It is relevant to assess impact of tax burden in the context of economic potential, competitiveness, social environment level and public expenditure need. Complex assessment of taxes allows not only to reveal the impact of tax burden on changes in the economy, but also shows the role of tax revenue... [to full text]

The research presented in this dissertation focuses on the waste management techniques currently used by Chevron-Escravos Nigeria Limited (CENL), as background knowledge of the existing waste disposal system practiced by the company. Investigation has shown that more than four tons (4tons) of organic food waste that CENL generates daily is being disposed of by using incineration and landfilling of the resulting residues. The high recoverability and economic values in form of nutrients and stored energy is not being considered. The main dissertation problem was to develop an alternative means of promoting the economic and environmental recoverability of these huge amounts of organic wastes, by developing a disposal technique other than the current incineration and landfill methods. The mechanism considered to achieve this objective was laid out in the customized organic waste converter or processor that provides one of the baselines for this dissertation. It also presents a procedural description of converting organic food waste to bio-feeds and feedstock of high quality. This alternative processing and utilization of organic food waste was carried out to provide information about tradeoffs to the current practice of incineration and landfill management systems. This was done to guide decision making and to serve as a framework within which the plausibility of the proposed solution could be examined. A comparative analysis of the two scenarios of waste to feed and waste to incineration system, the environmental impact, economic viability, and opportunity cost of recycling organic food waste produce of animal bio-feed was assessed by using: • Life cycle analysis (LCA) • By-products Breakeven Sale Product (BBSP) model. The BBSP model evaluates the opportunity of recycling the organic food waste in production of animal bio-feed to waste incineration. The outcome of the dissertation indicates that incineration is an important contributor to human and environmental toxicity and global warming. The proposed solution (recycling approach) balances the socio-economic, political and environmental safety by producing renewable, clean and eco-friendly feed and by-products. It was also concluded that there are alternative possibilities for the utilization of industrial organic food waste, where both the energy and nutrients are completely utilized, rather than the norms of conversion through chemical, biological, and thermal or other forms of energy fuels), which typically utilizes only one of these (calorific contents) categories at a time. The above mentioned utilization can be achieved by transforming the current waste disposal system. By introducing an alternative model for the recycling of plant and animal nutrients and the utilization of energy, renewable energy can be saved, human health and the environment can be protect and a sustainable economy can be maintained. In summary, it was demonstrated that there is huge capital losses and environmental contamination due to the current waste management practices. Recycling of OF W for feed production would be cost effective method that contributes towards protecting the environment achieving economic sustainability. / Thesis (M.Ing. (Development and Management Engineering))--North-West University, Potchefstroom Campus, 2009.

The research presented in this dissertation focuses on the waste management techniques currently used by Chevron-Escravos Nigeria Limited (CENL), as background knowledge of the existing waste disposal system practiced by the company. Investigation has shown that more than four tons (4tons) of organic food waste that CENL generates daily is being disposed of by using incineration and landfilling of the resulting residues. The high recoverability and economic values in form of nutrients and stored energy is not being considered. The main dissertation problem was to develop an alternative means of promoting the economic and environmental recoverability of these huge amounts of organic wastes, by developing a disposal technique other than the current incineration and landfill methods. The mechanism considered to achieve this objective was laid out in the customized organic waste converter or processor that provides one of the baselines for this dissertation. It also presents a procedural description of converting organic food waste to bio-feeds and feedstock of high quality. This alternative processing and utilization of organic food waste was carried out to provide information about tradeoffs to the current practice of incineration and landfill management systems. This was done to guide decision making and to serve as a framework within which the plausibility of the proposed solution could be examined. A comparative analysis of the two scenarios of waste to feed and waste to incineration system, the environmental impact, economic viability, and opportunity cost of recycling organic food waste produce of animal bio-feed was assessed by using: • Life cycle analysis (LCA) • By-products Breakeven Sale Product (BBSP) model. The BBSP model evaluates the opportunity of recycling the organic food waste in production of animal bio-feed to waste incineration. The outcome of the dissertation indicates that incineration is an important contributor to human and environmental toxicity and global warming. The proposed solution (recycling approach) balances the socio-economic, political and environmental safety by producing renewable, clean and eco-friendly feed and by-products. It was also concluded that there are alternative possibilities for the utilization of industrial organic food waste, where both the energy and nutrients are completely utilized, rather than the norms of conversion through chemical, biological, and thermal or other forms of energy fuels), which typically utilizes only one of these (calorific contents) categories at a time. The above mentioned utilization can be achieved by transforming the current waste disposal system. By introducing an alternative model for the recycling of plant and animal nutrients and the utilization of energy, renewable energy can be saved, human health and the environment can be protect and a sustainable economy can be maintained. In summary, it was demonstrated that there is huge capital losses and environmental contamination due to the current waste management practices. Recycling of OF W for feed production would be cost effective method that contributes towards protecting the environment achieving economic sustainability. / Thesis (M.Ing. (Development and Management Engineering))--North-West University, Potchefstroom Campus, 2009.

The global burden of injury is severely underappreciated and disproportionately affects low-income countries. With timely, appropriate orthopaedic treatment disability and mortality can be prevented, yet appropriate health resources are seldom available. Without orthopaedic medical devices (OMDs), quality of orthopaedic care suffers and the burden of preventable injury is exacerbated. A qualitative case study of 45 key informant interviews was conducted in Uganda to explore accessibility of OMDs, such as plaster, external fixators and implants. Data analysis elicited four major themes as barriers preventing access to OMDs in Uganda: 1) Poor leadership in government and corruption; 2) inadequate human resources; 3) inefficient and insufficient health care infrastructure; and 4) high costs of OMDs and poverty. Potential solutions for improving access to orthopaedic care were categorized as policies prioritizing orthopaedic services, training more orthopaedic specialists and creating incentives for them to work in underserviced areas, and innovative strategies funding for orthopaedic services.

Aims: To investigate the natural history of CHC, estimate the disease burden of CHC, and assess the cost-effectiveness of screening for CHC among immigrants living in Canada. Methods: A retrospective cohort study compared the prognosis of CHC between immigrant patients and native-born patients who had advanced fibrosis. A cross-sectional study assessed the association between obesity and hepatitis C viremia. The disease burden of CHC among immigrants was estimated through Markov cohort model. The cost-effectiveness of screening for CHC was assessed among immigrants. Results: The retrospective cohort study including 318 patients demonstrated that immigrant patients had significantly higher risk of hepatocellular carcinoma than Canadian-born patients (p=0.005). The hazard ratio associated with ‘immigrant’ for hepatocellular carcinoma in multivariate Cox proportional-hazards analyses reduced to the least and non-significant (p=0.318) after adjusting age and type 2 diabetes. The prevalence of obesity in 1118 individuals tested positive for hepatitis C antibody was 28.8%. Multiple regression analyses and propensity score methods suggested a significant association between obesity and hepatitis C viremia. The disease burden study estimated that immigrants with CHC had much shorter average life years (26.9 years vs. 39.1 years) and quality adjusted life years (20.6 years vs. 32.4 years) than the age matched immigrants without CHC. The cost-effectiveness study indicated that screening for CHC among immigrants from 183 countries (72.1% of immigrant population in Canada) had an incremental cost-effectiveness ratio less than $50,000 per quality adjusted life year gained. Conclusion: Immigrant patients with CHC could have a higher risk of HCC than native-born patients. The significant association between obesity and hepatitis C viremia could explain the observed high prevalence of type 2 diabetes in patients with CHC. CHC reduces the average life expectancy of immigrants with CHC more than 10 years. Screening for CHC is cost-effective among over 70% of immigrants living in Canada.