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Rachmi, Cut Novianti. "The double burden of malnutrition in Indonesia." Thesis, The University of Sydney, 2018. http://hdl.handle.net/2123/18254.
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Introduction The double burden of malnutrition (DBM) is characterised by overlapping conditions of under- and over-nutrition within one population, household, or even individual. Indonesia faces this situation. The overall aim of this thesis was to provide a better understanding of DBM in Indonesian children. Methods This thesis used a mixed methods approach, combining a secondary data analysis from the Indonesian Family Life Survey (IFLS) and a qualitative study. Prevalence data for DBM, from Indonesian children aged 2.0-4.9 years at four different time points -1993, 1997, 2000, and 2007 - were calculated. In addition I undertook a longitudinal analysis of children aged 2.0 to 4.9 years at baseline (1993 and 2000) and their weight and blood pressure status 7 (2000 and 2007) and 14 years (2007) later. In the qualitative study I explored the perceptions of Indonesian mothers and grandmothers of under-five and elementary school-aged children towards child obesity and food choices. I conducted twelve focus group discussions in West Java with 94 carers from three different socioeconomic status groups. Results DBM occurs in Indonesian children, with decreasing secular trends in stunting and underweight; and increasing trends in overweight/obesity. I found an inconsistent trend in the prevalence of concurrent stunting and overweight across 1993 to 2007. Although the cross sectional data showed that stunted children are more likely to be overweight/ obese, my longitudinal evidence showed the opposite. I found no association between stunting in early childhood and thinness, overweight/ obesity, or high blood pressure in the later years. In the qualitative study, primary carers still define overweight subjectively. The “chubbier is healthier” concept may be a contributing factor, and even though some mothers realize that their children are overweight/ obese, denial of the effect of overweight/ obesity on their children’s physical ability is still apparent. There are complex reasons behind primary carers’ decision-making processes around their children’s food choices that may additionally contribute to the increased prevalence of overweight/ obesity. Conclusion These results provide a better understanding of DBM in Indonesia. Such information is likely to reveal potential strategies to tackle this issue both in Indonesia, and potentially in other low- and middle-income countries.
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Park, Min Hae. "The impact of childhood obesity on long-term health burden in the UK." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2013. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.590559.
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Gomes, André Ferraz de Campos Amaral. "Obesity and diabetes in Mozambique: the double burden of disease in a resource poor country." Master's thesis, Faculdade de Medicina da Universidade do Porto, 2009. http://hdl.handle.net/10216/55404.
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Gomes, André Ferraz de Campos Amaral. "Obesity and diabetes in Mozambique: the double burden of disease in a resource poor country." Dissertação, Faculdade de Medicina da Universidade do Porto, 2009. http://hdl.handle.net/10216/55404.
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Mahmudiono, Trias. "Child stunting in households with double burden of malnutrition: applications of behavioral epidemiology." Diss., Kansas State University, 2016. http://hdl.handle.net/2097/32540.
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Doctor of Philosophy<br>Human Nutrition<br>Richard R. Rosenkranz<br>Child stunting refers to a condition where the child is relatively shorter in height, in comparison to their age group. Child stunting is a public health nutrition problem that hinders the development of future generations, not only physiologically but also potentially deprives their cognitive function and productivity. The demographic transition, conjoined with the epidemiological and nutrition transitions, has resulted in the coexistence of an over- and under-nutrition problem known as double burden of malnutrition, and child stunting has been a persistent part of the problem. In 2014, the World Health Organization (WHO) reported that one-fourth of the children in the developing countries have been suffering from child stunting.
The objective of this research was to apply the behavioral epidemiology approach to tackle child stunting in households with double burden of malnutrition. It was hypothesized that unlike any other households with problem of child stunting, households with double burden of malnutrition possess some degree of capacity that, with proper support and direction, might enable them to help themselves reduce or prevent this nutrition-related debacle.
Results from a secondary data analysis revealed that child stunting was associated with lower dietary diversity as an indication of poor food choice in the household, related to children’s nutrient requirements. Another cross-sectional study in this dissertation was conducted in an urban setting in Indonesia, and found that households with child stunting alone was associated with extreme food insecurity, while households with double burden of malnutrition ─ in the form of stunted child and overweight/obese mother (SCOWT) ─ was associated with even a mild degree of food insecurity. These results support our hypothesis that households with double burden of malnutrition lack the capacity to direct their resources properly to prevent child stunting. Most notably, we expected that the role of the mothers to manage healthy food choices through indirect measure of dietary diversity, availability and distribution within the household was lacking. In order to equip mothers with necessary components to be able to overcome these problems, we conducted a behaviorally based intervention that targeted mothers in the households experiencing the problem of double burden of malnutrition. The intervention provided the potential to achieve participant self-administered goal setting to improve diet, as well as child feeding behavior, by means of improved self-efficacy, nutrition literacy and dietary diversity. Maternal self-efficacy may be potentially enhanced by vicarious experience and active mastery experience gained during 6 sessions of behavioral intervention and verbal motivation by community health workers during 6 additional home visits.
These studies, collectively comprising the present dissertation, present a message for policy makers in developing countries: nutrition literacy and behaviors for choosing healthy foods are lacking in mothers that affect both maternal and child food intake, but efforts such as improving vicarious and mastery experience on child feeding practices and healthy food choices can boost mother’s self-efficacy to engage in appropriate behaviors and improve their child’s nutrition.
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Vaezghasemi, Masoud. "Nutrition transition and the double burden of malnutrition in Indonesia : a mixed method approach exploring social and contextual determinants of malnutrition." Doctoral thesis, Umeå universitet, Epidemiologi och global hälsa, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-130552.
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Introduction Nutrition transition concerns the broad changes in the human diet that have occurred over time and space. In low- to middle-income countries such as Indonesia, nutrient transition describes shifts from traditional diets high in cereal and fibre towards Western pattern diets high in sugars, fat, and animal-source foods. This causes a swift increase in the prevalence of overweight and obesity while undernutrition remains a great public health concern. Thus a double burden of malnutrition occurs in the population. The main aim of this investigation was to explore social and contextual determinants of malnutrition in Indonesia. The specific objectives were: (i) to examine body mass index (BMI) changes at the population level, and between and within socioeconomic groups; (ii) to estimate which context (i.e., household or district) has a greater effect on the variation of BMI; (iii) to assess the prevalence of double burden households (defined as the coexistence of underweight and overweight individuals residing in the same household) and its variation among communities as well as its determining factors; and (iv) to explore and understand what contributes to a double burden of malnutrition within a household by focusing on gender relations. Methods A mixed method approach was adopted in this study. For the quantitative analyses, nationally representative repeated cross-sectional survey data from four Indonesian Family Life Surveys (IFLS; 1993, 1997, 2000, 2007) were used. The IFLS contains information about individual-level, household-level and area-level characteristics. The analyses covered single and multilevel regressions. Data for the qualitative component were collected from sixteen focus group discussions conducted in Central Java and in the capital city Jakarta among 123 rural and urban men and women. Connell’s relational theory of gender and Charmaz’s constructive grounded theory were used to analyse the qualitative data. Results Greater increases in BMI were observed at higher percentiles compared to the segment of the population at lower percentiles. While inequalities in mean BMI decreased between socioeconomic groups, within group dispersion increased over time. Households were identified as an important social context in which the variation of BMI increased over time. Ignoring the household level did not change the relative variance contribution of districts on BMI in the contextual analysis. Approximately one-fifth of all households exhibited a double burden of malnutrition. Living in households with a higher socioeconomic status resulted in higher odds of double burden of malnutrition with the exception of women-headed households and communities with high social capital. The qualitative analysis resulted in the construction of three categories: capturing the significance of gendered power relations, the emerging obesogenic environment, and generational relations for child malnutrition. Conclusion At the population level, greater increases in within-group inequalities imply that growing inequalities in BMI were not merely driven by socioeconomic factors. This suggests that other under-recognised social and contextual factors may have a greater effect on the variation in BMI. At the contextual level, recognition of increased variation among households is important for creating strategies that respond to the differential needs of individuals within the same household. At the household level, women’s empowerment and community social capital should be promoted to reduce inequalities in the double burden of malnutrition across different socioeconomic groups. Ultimately community health and nutrition programmes will need to address gender empowerment and engage men in the fight against the emerging obesogenic environment and increased malnutrition that is evident within households, especially overweight and obesity among children.
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Kukka, Antti Juhani. "Prevalence of Double Burden of Malnutrition among Indian Pre-School Children : an Analysis of Cross-Sectional DLHS-4 Data from 23 States." Thesis, Uppsala universitet, Internationell mödra- och barnhälsovård (IMCH), 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-352007.
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Background: Double burden of malnutrition means co-existence of under- and overnutrition in a community, household or an individual. It is observed in countries undergoing nutrition transition. Research on double burden among Indian children aged under five has been scarce. I therefore aim to studythe prevalence of double burden of malnutrition in this age group. Methods: Cross-sectional population-based data from District Level Household and Facility Survey 4 conducted in 2012-2013 in 23 Indian States and Union Territories were used for the analysis. Prevalence of overweight, stunting and anaemia were examined as main outcomes at the community level. Simultaneous overweight and stunting or anaemia in same child were the main outcomes for individuallevel prevalence. Households with stunted child and overweight adult were also examined. Results: In this sample, 40.1 % of children were stunted, 74.2 % anaemic and 8.2 % overweight. Simultaneous overweight and stunting as well as overweight and anaemia both affected about 5.5 % of children. Stunted children had a higher prevalence of overweight than non-stunted children. No such association was seen for anaemia. At household level, 26.5 % of households had an overweight adult and a stunted child. Discussion: Double burden of malnutrition is emerging among Indian children aged under five and should be included in national nutrition policy. Undernutrition is still bigger concern than overnutrition, but overweight is spreading also to lower wealth quintiles. Further studies should be done to examine this phenomenon at the national level.
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Mytton, Oliver. "A population perspective on physical activity and health." Thesis, University of Cambridge, 2017. https://www.repository.cam.ac.uk/handle/1810/264414.
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Regular physical activity reduces the risk of many chronic diseases. Consequently, the promotion of it and particular types (e.g. walking and cycling for travel), have become a priority for governments seeking to improve health and constrain rising demand on health services. Despite this many uncertainties persist. The aim of this thesis is to address two particular areas of uncertainty: a) the association of walking and cycling for travel with indices of health and well-being; b) and the extent to which increases in physical activity will reduce need for health and social care. The first part of my thesis consists of three studies that describe the health benefits associated with walking and cycling to work among working age adults. The first is a longitudinal study of the associations between maintenance of active commuting with sickness absence and well-being using the Commuting and Health in Cambridge dataset. The second, using the same dataset, describes the longitudinal associations between maintenance of active commuting and self-reported body mass index. Building on this, the third study using a large cohort study (the Fenland Study) with detailed characterisation of diet and physical activity (including objective measurement) describes the baseline associations between active commuting and objective measures of adiposity. The second part of my thesis describes the development of a combined microsimulation multi-state life table model that is used to characterise the effects of a population ‘shift’ in physical activity on the burden of six major diseases at the population-level. Specifically, it seeks to better describe the effect of increases in physical activity on healthcare need considering not just the effect of physical activity on disease incidence but also the effect on healthcare need arising from consequent survival to an older age (at which disease incidence is higher), and contrasts this with a method that does not make allowance for increased survival. The findings of this thesis provide evidence of the importance of walking or cycling to work in maintaining or improving the health and well-being of working age adults. It suggests that increases in physical activity, even after allowance for increased survival, are likely to reduce need for healthcare, although the reductions in need are less than might be assumed when allowance is not made for increased survival. Taken together this work provides a stronger empirical basis to inform public health practice. A stronger ‘health case’ for active travel can be made. The benefits of which should be communicated to individuals choosing how to travel as well as policy makers and others who can influence the determinants of active travel. It also provides a more realistic and nuanced understanding of how increases in physical activity may affect future healthcare need.
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Figura, Andrea. "Psychological and psychosomatic aspects of bariatric surgery for the treatment of obesity in adults." Doctoral thesis, Humboldt-Universität zu Berlin, 2018. http://dx.doi.org/10.18452/19115.
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Das Krankheitsbild der Adipositas hat sich weltweit zu einem relevanten Gesundheitsproblem entwickelt. Die bariatrische Chirurgie wird zunehmend als wirkungsvolle Behandlung bei schwer ausgeprägter Adipositas eingesetzt. Jedoch ist über die Rolle psychologischer Variablen im bariatrischen Behandlungsverlauf noch wenig bekannt. Die vorliegende Dissertation untersucht Einfluss und Veränderung patientenberichteter Gesundheitsmerkmale in der chirurgischen Adipositastherapie. Dazu werden in einer naturalistischen Beobachtungsstudie Patienten mit schwerer Adipositas vor und im Durchschnitt zwei Jahre nach einer bariatrischen Operation (OP) befragt. Ziele der Arbeit sind 1) die Charakterisierung adipöser Patienten vor OP hinsichtlich bio-psycho-sozialer Variablen; 2) die Identifikation möglicher Einflussvariablen auf den gewichtsbezogenen Behandlungserfolg nach OP; 3) die Untersuchung von Auswirkungen der OP auf das Essverhalten; und 4) die Analyse von Veränderungen in der essstörungsbezogenen Psychopathologie und in der gesundheitsbezogenen Lebensqualität nach OP. Die Ergebnisse der bariatrischen Patienten werden im Vergleich zu denen konservativ behandelter Patienten betrachtet. Die Ergebnisse zeigen, dass Patienten mit bariatrischem Behandlungswunsch eine somatisch und psychisch belastete Patientengruppe darstellen. Die bariatrische OP führt im zweiten postoperativen Jahr zu einer nachhaltigen und klinisch bedeutsamen Gewichtsreduktion. Der präoperative Body-Maß-Index, das Bildungsniveau und aktives Problembewältigungsverhalten sind mit dem Gewichtsverlust nach OP assoziiert. Im Vergleich zur konservativen Behandlung berichten die Patienten, die sich der OP unterziehen, über stärker ausgeprägte Verbesserungen in ihrem Essverhalten und eine Steigerung ihrer Lebensqualität. Auf Basis der Befunde wird ein routinemäßiges Monitoring der somatischen und psychischen Situation der Patienten nach bariatrischer OP empfohlen, um die gezeigten Behandlungserfolge optimal zu sichern.<br>Obesity has become a relevant global health problem. Bariatric surgery is an effective treatment for severe obesity. However, while the number of operations performed continues to increase, the role of psychological variables throughout the bariatric surgery pathway remains uncertain. The present dissertation investigates the patient-reported health status as it impacts and results from bariatric surgery. In a naturalistic observational study, patients with severe obesity are assessed before and, on average, two years after the surgical treatment. Main aims are 1) to characterize obese patients prior to bariatric surgery in terms of biological, psychological and socio-demographic variables; 2) to identify possible predictors for the postoperative weight-related treatment success after bariatric surgery; 3) to examine changes in eating behaviors; and 4) to analyze changes in eating-related psychopathology and in health-related quality of life (HRQoL). The outcomes of surgical patients are compared with those of conservatively treated patients for the same follow-up period. The findings show that bariatric surgery candidates represent a vulnerable patient group with high physical and psychological burden. In the second postoperative year after bariatric surgery, a sustainable and clinically meaningful weight reduction is achieved. The preoperative body mass index, education level and active coping behavior are associated with weight loss after surgery. Compared with conservative treatment, patients who undergo bariatric surgery report not only greater improvements in their eating behavior and eating-related psychopathology but also an increase in their HRQoL. Based on the results, the provision of a routine monitoring of the somatic and psychological situation of patients following bariatric surgery is recommended to secure longer-term treatment success.
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Depoix, D. J. "Purity : blessing or burden?" Thesis, Stellenbosch : Stellenbosch University, 2002. http://hdl.handle.net/10019.1/53024.
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Thesis (MPhil)--Stellenbosch University, 2002<br>ENGLISH ABSTRACT: During the history of Israel the concept of "purity"
had developed as a way in which God's people could honour
his holiness and draw nearer to him, as a sanctified
nation. By the time of Jesus, in Second Temple Judaism,
the purity system had become restrictive. This had been
influenced by political and social developments, including
an increased desire to withdraw from Hellenistic and other
factors which were seen as contaminating the integrity of
Judaism.
There were diverse perceptions regarding the
achievement of the purity of Israel, including
militaristic confrontation and expulsion of alien
occupation forces, stricter adherence to the Law and, in
some cases, total withdrawal from general society (such as
at Qumran). It was, however, particularly the Pharisaic
imposition of the supplementary oral tradition, supposed
to clarify the written Law, which imposed hardship on
those who, through illiteracy or inferior social status,
were unable to meet all the minute provisions which would
ensure ritual purity. The expansion of the Law of Moses
by the commentary of the rabbis, which over time became
the entrenched oral "tradition of the fathers", was
originally intended to promote access to God by clarifying
obscure points of the Law, in the pursuit of purity.
However, this oral tradition had, in fact, become an
instrument of alienation and separation of the ordinary people not only from the Pharisees, who considered
themselves as the religious elite, but also from God.
The common people, that is, a large section of the
population, felt rejected and on the outside of both
religious and social acceptance. On the material level
they also suffered under a heavy tax burden, from both
Temple and State, which aggravated their poverty.
It was this situation which Jesus confronted in his
mission to change the ideological climate and to reveal
the Kingdom of God as being accessible to all who accepted
the true Fatherhood of God, in penitence and humility.
He denounced the hypocrisy which professed piety but which
ignored the plight of those who were suffering.
Hark 7 : 1-23 symbolizes the difference between the
teaching and practice of Jesus and that of the Pharisees,
and provides metaphorically a pattern of Christian
engagement which is relevant in the South African
situation today.
The Christian challenge is to remove those barriers,
both ideological and economic, which impede spiritual and
material well-being within society. By active engagement,
rather than by retreating to the purely ritualistic and
individualistic practice of religion, the realization of
the Kingdom of Heaven, as inaugurated by Jesus, will be
advanced.<br>AFRIKAANSE OPSOMMING: Gedurende die geskiedenis van Israel het die konsep van reinheid ontwikkel as 'n
wyse waarin die die volk van God Sy heiligheid kan eer en tot Hom kan nader, as 'n
geheiligde volk. Teen die tyd van Jesus, tydens Tweede Tempel Judaïsme, het die
reinheid sisteem beperkend geword. Dit is beïnvloed deur politieke en sosiale
ontwikkelinge, insluitende 'n toenemende drang om te onttrek van Hellenistiese en
ander faktore, wat beskou is as 'n besoedeling van die integriteit van Judaïsme.
Daar was diverse persepsies aangaande die uitvoering van die reinheid van Israel,
insluitende militaristiese konfrontasie en die uitwerping van vreemde
besettingsmagte, strenger onderhouding van die Wet en in sekere gevalle, totale
onttreking van die algemene samelewing (soos by Qumran). Tog was dit in besonder
die Fariseërs se oplegging van bykomende mondelinge tradisie, veronderstelom die
geskrewe Wet te verhelder, wat ontbering veroorsaak het vir die wat as gevolg van
ongeletterdheid of minderwaardige sosiale status nie in staat was om aan elke haarfyn
bepaling, wat rituele reinheid sou verseker, te voldoen nie. Die uitbreiding van die wet
van Moses deur die kommentaar van die rabbies, wat met verloop van tyd die
ingegrawe mondelinge "tradisie van die vaders" geword het, was oorsproklik bedoel
om toegang tot God te verseker, deur die verheldering van onduidelike aspekte van
die wet, in die nastreef van reinheid.
Hierdie mondelinge tradisie het egter 'n instrument van vervreemding geword en
skeiding gebring tussen gewone mense en die Fariseers, sowel as die wat hulleself
beskou het as die religieuse elite. Dit het egter ook skeiding gebring tussen mense en
God.
Die gewone mense, dit is die meerderheid van die bevolking, het verwerp gevoel en
aan die buitekring van beide religieuse en sosiale aanvaarding. Op materiële vlak het
hulle ook gelyonder die juk van swaar belasting, van beide die Tempel en die Staat,
wat hulle toestand van armoede vererger het.
Dit was hierdie situasie wat Jesus gekonfronteer het in sy strewe om die ideologiese
klimaat te verander en om die Koninkryk van God te openbaar as toeganklik vir almal wat die ware Vaderskap van God aanvaar, in berou en in nederigheid. Hy het die
skynheiligheid verwerp wat aanspraak maak op vroomheid, maar die toestand van die
lydendes ignoreer.
Markus 7:1-23 simboliseer die verskil tussen die onderrig en die praktyk van Jesus en
dié van die Fariseërs en voorsien metafories 'n patroon van Christelike verbintenis,
wat relevant is binne die eietydse Suid-Afrikaanse konteks.
Die uitdaging aan die Christendom is om die skeidslyne te verwyder, beide ideologies
en ekonomies, wat geestelike en materieële welsyn binne die gemeenskap belemmer.
Deur aktiewe betrokkenheid, eerder as om bloot te onttrek tot die suiwer ritualistiese
en individualistiese beoefening van religie, sal die realisering van die Koninkryk van
die Hemel soos ingehuldig deur Jesus, bevorder word.
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Petropoulos, Nikolaos. "Burden Dynamics and Fragmentation." Licentiate thesis, Luleå tekniska universitet, Geoteknologi, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:ltu:diva-18162.
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Drill and blast is a dominant technique in several surface and underground mines in the world. The purpose of this technique is to break rock mass into fragments, which can be handled by mining equipment. The identified major influencing factors in rock blasting are stress waves and gas pressurization. In underground mines, especially in sublevel caving mines, the blast is performed under confined conditions. Hence, one more category of mechanisms has to be taken into consideration which describes the behavior of granular materials. Several small-scale tests have been conducted in order to define parameters which affect fragmentation by blasting as well as to measure the burden behavior during blasting. The purpose of these tests was to investigate how firing pattern, confinement and inter-hole delay time influence the fragmentation. Additionally, an incremental relative distance sensor was developed to measure the burden movement during blasting. The results showed that the burden moved with a velocity of approximately 29 m/s. The V-shaped firing pattern gave coarser fragmentation compared with sequential firing pattern for both the blasted material and confining material.After the small-scale tests, a zero pillar test was conducted under confined conditions to evaluate and validate a newly developed measuring system. The purpose of this system was to measure the burden dynamics. The system was calibrated in laboratory conditions under dynamic loading. This system was based on a piston-like structure and it was equipped with accelerometers and a potentiometric distance sensor. In addition to the measuring system, several installation and initiation procedures have been developed. The results of the measuring system showed that the burden moved 0.98 m at a velocity of 17-18 m/s. All the procedures performed as well as expected and designed.In addition to the study of blasting related mechanisms, the results of a blast also have to be measured. Sieving is usually not an option for large scale operations due to high costs. The alternative way is to implement digital image analysis. This procedure does not interfere with the production of a mine. Several trials have been conducted at the Aitik open pit mine to investigate the influence of short inter-hole delay time (1 ms, 3 ms and 6 ms or 0.14 ms/m burden, 0.43 ms/m burden and 0.86 ms/m burden) on fragmentation. The examined mechanism was the interaction of stress waves between neighboring blastholes. The fragmentation results showed that the trial with 3 ms inter-hole delay time gave a finer fragmentation by 10 % compared with reference blasts and other trials. However, there was an indication that the large specific charge at the mine overshadows the stress wave interaction mechanisms.An additional set of trials was conducted at the Kiruna mine to investigate the gravity flow of broken material. The fragmentation measurements were done with SplitDesktop®. This is a digital image analysis software which calculates fragmentation based on a delineation process of the particles in an image. The aim of in these trials was to develop a procedure to minimize the image editing time. The application of ‘Unsharp Mask’ filter improved the image quality and enhanced the contrast between the particles combined with a quick rating system (developed by LKAB) so that the image processing time was significantly reduced from 2 hours to 10-15 minutes.<br>Godkänd; 2015; 20150831 (nikpet); Nedanstående person kommer att hålla licentiatseminarium för avläggande av teknologie licentiatexamen. Namn: Nikolaos Petropoulos Ämne: Gruv- och berganläggningsteknik/Mining and Rock Engineering Uppsats: Burden Dynamics and Fragmentation Examinator: Professor Erling Nordlund, Institutionen för samhällsbyggnad och naturresurser, Avd Geoteknologi, Luleå tekniska universitet Diskutant: Associate Professor Zongxian Zhang, The University Centre in Svalbard (UNIS), Longyearbyen, Norge Tid: Fredag 2 oktober 2015 kl 10.00 Plats: F1031, Luleå tekniska universitet
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Zhang, Yuqi. "The burden of diabetes-related foot disease: Estimating the existing burden and the impact of implementing guideline-based care on the future burden." Thesis, Queensland University of Technology, 2022. https://eprints.qut.edu.au/232310/1/Yuqi_Zhang_Thesis.pdf.
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This doctoral program of research systematically estimated the global disease burden of diabetes-related foot disease (DFD), investigated factors contributing to the burden, and explored cost-effective ways to reduce the burden. Through four studies, this thesis identified DFD as a comparatively large and growing cause of global and national disease burden, identified several modifiable factors that reduce ulcer healing time in a real-world cohort, and provided novel economic evidence on the cost-effectiveness of implementing guideline-based care in clinical practice to potentially reduce future burdens globally. This research provides important new evidence, and a solid foundation for future research to reduce the burden.
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O'Donovan, Simon Terence. "Dementia caregiving : burden and breakdown." Thesis, University of South Wales, 2004. https://pure.southwales.ac.uk/en/studentthesis/dementia-caregiving(34088905-f406-4d82-bc09-aeed052f5e3c).html.
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This study was an investigation of the phenomenon of dementia caregiving burden and breakdown in community caregiving situations. 109 carer subjects participated in the study, with 91 current carers - 17 via face-to-face interview and 74 via the internet, and 18 past carers - two via face-to-face interview and 16 via the internet, contributing their experiences of dementia caregiving. Two new carers' assessment tools were devised to meet more fully the requirements of the 'Carers (Recognition and Services) Act 1995' (DoH, 1995), namely the 'Dementia Caregiving Problems Questionnaire (DCPQ)' and 'Dementia Caregiving Burden Questionnaire (DCBQ)'. These new assessments were tested and demonstrated to be reliable, with Cronbach Alpha scores of 0.7029 and 0.8430 respectively, and are recommended for implementation in clinical practice. The key predictive risk factors for high caregiving burden in this study were perceived stress; omission of caregiving satisfactions; carer depression; perceived impact on quality of life; perceived helpfulness of community care services; behaviour problems - especially shouting, swearing and screaming, irritability and night disturbance; poor quality carer/dependant relationship; mood problems; perceived helpfulness of informal support; perceived impact of caregiving on dependant emotional well-being and, to a lesser extent, hours spent in caregiving. The key predictive risk factors for expected relinquishment of home caregiving were DCBQ score; perceived impact on quality of life; perceived stress; carer depression and, to a lesser extent, geographical distance in caregiving; perceived helpfulness of community care services and omission of positive feelings in the carer. Based on the above risk factors, a new 'Dementia Caregiving Breakdown Risk Assessment Tool (DCBRAT)' is proposed for use by community care managers to identify 'at risk' caregiving situations so that service interventions can be targetted more towards carers who are highly burdened in their role, who are at risk of developing psychological health problems or who may be nearing breakdown in their caregiving situation. Thus the effectiveness of service interventions may be maximised and optimal health gain for carers achieved, resulting in improved outcomes for people with dementia. The DCBRAT and the similarly proposed 'Conceptual Model of Dementia Caregiving, Burden and Breakdown' will need to be further tested in post-doctoral research.
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Kolomiiec, U. V. "The excess burden of taxation." Thesis, Видавництво СумДУ, 2012. http://essuir.sumdu.edu.ua/handle/123456789/26075.
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Sloan, Tyler E. "The Abortion Burden: Examining Abortion Access, Undue Burden and Supreme Court Rulings in the United States." Oberlin College Honors Theses / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=oberlin1494418153379172.
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Pennock, Jennifer M. "The economic burden of bottle-feeding." Thesis, University of Ottawa (Canada), 2002. http://hdl.handle.net/10393/6254.
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Bottle-feeding has been associated with excess childhood disease. The costs of managing this burden have not yet been quantified in Canada. This thesis estimated the direct costs of three childhood diseases (diarrhea, otitis media and lower respiratory infection) attributable to bottle-feeding among Ontario infants under the age of one year in 1994. A systematic review identified relative risks among bottle-fed children. The prevalence of bottle-feeding was determined from the National Longitudinal Survey of Children and Youth, 1994/1995. Impact fractions were calculated for each of the three diseases and applied to the costs of physician visits and hospitalizations which were provided by the Institute for Clinical Evaluative Sciences. The net direct costs of bottle-feeding were estimated as the sum of attributable costs minus cost savings. The cost of health care attributable to bottle-feeding was estimated to be $2.2 million. A sensitivity analysis revealed that bottle-feeding could have yielded cost savings of $88,900 or cost just under $4.0 million. This estimate was conservative as the costs of drugs were not included.
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Wong, Yuen-ting, and 黃婉婷. "Burden and severity of influenza viruses." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2014. http://hdl.handle.net/10722/207194.
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Background: The seriousness of human influenza virus infection, in combination with the transmissibility of the virus, determines the impact that the virus will have in a population. However, the uncertainty surrounding the seriousness and changes in seriousness hindered the calibration of the early public health response.
Methods: I applied statistical models to population-based mortality data and hospitalizations among patients with laboratory-confirmed H1N1pdm09. I estimated the disease burden, retrospectively and prospectively determined seriousness of influenza virus infections including the risk of death on a per-infection basis (IFR) and on a per-hospitalization (HFR) of H1N1pdm09, and investigated changes in seriousness. I used serologic surveillance data to estimate the cumulative incidence of infection in a population, and used it as the denominator of the IFR. I also conducted systematic reviews and meta-analysis to summarize published estimates of the risk of death among cases (CFR) and HFR of the pandemic influenza H1N1pdm09 virus.
Results: I estimated that the first wave of H1N1pdm09 was associated with approximately 232 (95% confidence interval: 136, 328) excess deaths in all ages in Hong Kong, which was around 4 times the observed number of laboratory-confirmed deaths of H1N1pdm09. The point estimates for the IFR and HFR increased substantially with age. I included 77 estimates for the CFR from 50 published studies; whereas I included 187 estimates for the HFR from 184 published studies. The CFR was widely used to assess seriousness but the variation of a ‘case’ varied considerably in the literature. Variability in published estimates of the HFR was much less than variability in the CFR.
Conclusions: Early in the next pandemic, estimation of the HFR, IFR or symptomatic CFR may provide a timely picture of the seriousness of infection, particularly if presented in comparison between two influenza virus infections in the same setting. Ongoing monitoring of mortality and influenza activity could permit identification of changes in seriousness of influenza virus infections.<br>published_or_final_version<br>Public Health<br>Doctoral<br>Doctor of Philosophy
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Kennedy, Owen. "Valuing caregiver burden in palliative care." Thesis, City University London, 2014. https://kclpure.kcl.ac.uk/portal/en/theses/valuing-caregiver-burden-in-palliative-care(582190ea-6bbd-4ebf-8e0a-98eee7832753).html.
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There is a clear need to account for caregiver burden in economic evaluations of healthcare interventions, since omitting it has the potential to produce skewed cost-effectiveness estimates. This is particularly important in palliative care, as interventions in this field are often explicitly intended to help patients’ families and informal caregivers as well as the patients themselves. However, caregiver burden is a complex concept with a number of different dimensions, so valuation can be a challenging task. This paper describes the different dimensions of caregiver burden and provides suggestions as to how those dimensions might be valued for inclusion in economic evaluations. Outcomes are found to be far more complex to value than costs, with considerable controversy over the appropriateness of quality adjusted life years (QALYs) as a unit of outcome both for palliative care and for informal care more generally. The results of a cost-effectiveness analysis of a palliative care intervention are also presented. This analysis was conducted both to demonstrate how to apply the valuation techniques discussed in the first section in practice, and to illustrate how accounting for caregiver burden can significantly affect the estimated cost-effectiveness of palliative care interventions. A simple two-state Markov model was used, with results reported both with and without caregiver burden taken into account. The intervention in question was a multidisciplinary service in southeast London for patients prone to breathlessness. Including both caregiver costs and outcomes in cost-effectiveness calculations was found to reduce the estimated incremental cost-effectiveness ratio (ICER) for the intervention from £103,744 to £26,194 per QALY. Sensitivity analyses revealed substantial uncertainty around these results due to the small sample size in the primary dataset. It is concluded that while accounting for caregiver burden when assessing the cost-effectiveness of palliative care interventions is vital and has the potential to significantly alter ICER estimates, further research on how best to value caregiver outcomes is required, since consensus in this area is necessary to ensure the consistency and comparability of cost-effectiveness estimates.
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Top, Justin Brent. "Isaiah's Burden Prophecies As Spirtual Formulas." Diss., CLICK HERE for online access, 2007. http://contentdm.lib.byu.edu/ETD/image/etd2208.pdf.
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Webb, Don. "Adjunct faculty a boon or burden? /." Diss., Mississippi State : Mississippi State University, 2007. http://library.msstate.edu/etd/show.asp?etd=etd-06262007-164338.
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Battle, Katherine Elizabeth. "The burden of Plasmodium vivax malaria." Thesis, University of Oxford, 2015. https://ora.ox.ac.uk/objects/uuid:ae06b0cb-14bc-44f7-acbe-e98e6c42867e.
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Plasmodium vivax is the most geographically widespread of the human malarias and is capable of causing severe debilitating disease. The parasiteâs unique biology poses challenges to control of the disease and the understanding of its epidemiology. It is less researched and well understood than the more deadly P. falciparum. In this thesis, spatial relapse patterns and models of endemicity and clinical disease were applied to generate robust estimates of the P. vivax burden to address a key knowledge gap in malaria epidemiology. First, a review of the distribution of the parasite, its vectors and populations at risk found nearly one third of the global population living at risk, and more potential vectors than P. falciparum. In spite of low observed endemicity, the public health impact of P. vivax is likely to have been seriously underestimated in the past. To accurately define the burden of P. vivax it was necessary to improve understanding of one of the parasiteâs most unique and challenging aspects, its ability to relapse. A meta-analysis of individual records of relapse showed that relapse periodicity varied systematically by geographic region and could be categorized by nine global regions. The nine regions were applied to a model to quantify the relationship between prevalence of infection and incidence of clinical disease. As relapse would have an influence on both measures, separate relationships were drawn for each relapse zone. The prevalence-incidence model was used to translate maps of predicted endemicity into measures of clinical burden. The evidence-base of P. vivax prevalence was poor in some regions and therefore a burden estimate based on surveillance reports was also derived. Reported cases must be adjusted for parameters such as under-reporting and treatment-seeking behaviours. A model used to fill gaps in treatment-seeking data available from national household surveys was developed to allow burden to be estimated using both cartographic modelling and surveillance reporting methods. To improve fidelity, the results of the two approaches were combined to enumerate P. vivax burden globally. The results and conclusions of these studies are discussed with recommendations for how these findings influence our understanding of P. vivax epidemiology and implications for future control and elimination efforts.
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Arellanes-Amador, Yvonne. "Caregiver burden in the Latino family." CSUSB ScholarWorks, 2006. https://scholarworks.lib.csusb.edu/etd-project/3094.
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The study focused on the attitudes and beliefs regarding perceived and actual burden experienced by Latino caregivers and their use of formal support services. It also looked at the needs of Latino caregivers and explored their beliefs about why they had taken on the caregiver role, the responsibilities the role entailed, and coping skills used by these caregivers. Participants were obtained from two Alzheimer's caregiver support groups in the East Los Angeles area, and an adult day health care center in the high desert area of San Bernardino county. The author used both qualitative interviews and quantitative questionnaires. The findings suggest that high beliefs about responsibility to the family and low levels of service use may contribute to the stress and strain that these caregivers feel. Latino caregivers have been providing a significant amount of care without the help of sufficient formal services. Recommendations for social work practice, policy and further research are provided. Statistics for the study were generated by using SPSS Graduate Pack 13 for Windows.
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Lanefelt, Lily Stroubouli. "Multiculturalism, Liberalism and the Burden of Assimilation." Doctoral thesis, Stockholms universitet, Statsvetenskapliga institutionen, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-81978.
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Should a liberal state meet claims for accommodation of cultural difference with a liberal multicultural approach that grants cultural rights to minorities? The present thesis tries to answer this question by investigating if a liberal state may adopt a multicultural approach and still remain liberal. The purpose of the thesis, more specifically, is to study whether the accommodation of multiculturalism through cultural rights can be based on liberal values or not. The inquiry focuses on three influential liberal multicultural approaches which claim that cultural rights are congruent with equality, toleration and autonomy respectively. The coherence of these models is, however, questioned in the thesis. These models may neither be claimed to promote liberal values in a coherent and unambiguous way, nor be described as the adequate response to the type of burden of assimilation that members of minority cultures experience in liberal states. The main conclusion of the study is that liberal multiculturalism does not follow consistently from liberal premises and that the possibility of a normative conjunction between multiculturalism and liberalism therefore should be characterized as an open question in political theory. From liberal premises, a liberal neutralist model of integration based on anti-discrimination and equality of opportunity, in fact, still seems to be the most promising basis for a multicultural policy. It is argued in the thesis that this model can be developed if combined with a liberal scheme for deliberation on multicultural issues based on the principle of equality of opportunity.
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Morrison, Laura C. D. "Understanding subjective family burden in elder care." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2001. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp05/MQ62803.pdf.
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Wittchen, Hans-Ulrich, Stephan Mühlig, and Lukas Pezawas. "Natural course and burden of bipolar disorders." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2013. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-117282.
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Despite an abundance of older and more recent retrospective and considerably fewer prospective-longitudinal studies in bipolar disorders I and II, there are still remarkable deficits with regard to our knowledge about the natural course and burden. The considerable general and diagnosis-specific challenges posed by the nature of bipolar disorders are specified, highlighting in particular problems in diagnostic and symptom assessment, shifts in diagnostic conventions and the broadening of the diagnostic concept by including bipolar spectrum disorders. As a consequence it still remains difficult to agree on several core features of bipolar disorders, such as when they begin, how many remit spontaneously and how many take a chronic course. On the basis of clinical and epidemiological findings this paper summarizes (i) a significant need to extend the study of the natural course of bipolar disorder in clinical samples beyond the snapshot of acute episodes to the study of the mid-term and long-term symptom course, associated comorbidities and the associated burden of the disease. (ii) In terms of epidemiological studies, that are also of key importance for resolving the critical issues of threshold definitions in the context of the bipolar spectrum concept, there is a clear need for identifying the most relevant risk factors for the first onset and those for the further illness progression in early stages. Since there are some indications that these critical processes might start as early as adolescence, such studies might concentrate on young cohorts and clearly before these prospective patients come to clinical attention. (iii) The value of both types of studies might be enhanced, if beyond the use of standardized diagnostic interview, special attempts are made to use prospective life- and episode-charting methods for bipolar illnesses.
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Parham, Rhian. "Caregiver burden in paediatric chronic kidney disease." Thesis, Canterbury Christ Church University, 2011. http://create.canterbury.ac.uk/10347/.
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Section A provides an overview of the role of family caregivers of individuals with chronic illness, and describes key conceptualisations and theories posited in the caregiver literature. This is followed by an overview of research conducted with caregivers of children with chronic kidney disease (CKD), a summary of the limitations of this research, and suggestions for future research. Section B Despite a recognised need to monitor caregiver burden in caregivers of children with CKD, there is no measurement tool currently available to meet this aim. The present research documents the development of a measure of caregiver burden specific to family caregivers of children with CKD. Methods: Interviews were conducted with 16 caregivers of children with CKD and 10 healthcare professionals in order to generate measure items. A provisional version of the measure was developed and piloted with 18 caregivers of children with CKD and five healthcare professionals. Results: An initial pool of 97 items was generated from the content of interviews, which was reduced to 60 items following review for item redundancy. A piloting exercise provided preliminary evidence for the usability, readability, and relevance of measure items; adaptations further to piloting resulted in the 51-item ‘Paediatric Renal Caregiver Burden Scale’ (PR-CBS). Conclusions: It is hoped that the PR-CBS will serve to identify areas of need amongst caregivers of children with CKD, and in turn improve outcomes for this caregiver population and children with CKD. Section C is a critical appraisal of the conducted research study, and includes an overview of research abilities acquired during its completion, reflections on how the research may have been conducted differently, implications for future clinical practice, and ideas for future research.
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Atkinson, Thomas A. "Marine Corps expeditionary rifle platoon energy burden." Thesis, Monterey, California: Naval Postgraduate School, 2014. http://hdl.handle.net/10945/44514.
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Approved for public release; distribution is unlimited<br>In 2009, the Commandant of the Marine Corps declared energy a top priority and created the U.S. Marine Corps (USMC) Expeditionary Energy Office to develop an energy strategy to reduce and optimize energy usage throughout the Marine Corps. This thesis examines the operational tasks and capabilities that drive the current USMC rifle platoon’s energy burdens using an Expeditionary Warrior 2012 war-game scenario. The primary conclusion of the research is that increasing the platoon’s ability to carry supplies and developing standardized, rechargeable batteries offers the USMC opportunities to reduce energy at the platoon level. This thesis recommends that the USMC should investigate the use of robotic transport systems and use of unmanned aerial vehicles to reduce the number of sustainment flights required of large aircraft. It also recommends further research should be conducted to calculate the energy usage at the company level, analyzing robotic solutions and standardized batteries to reduce energy at the platoon level and conducting analysis for water reduction.
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Eckerblad, Jeanette. "Symptom burden among people with chronic disease." Doctoral thesis, Linköpings universitet, Hälsa, Aktivitet, Vård (HAV), 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-122742.
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Introduction: Chronic diseases tend to increase with old age. Older people with chronic disease are commonly suffering from conditions which produce a multiplicity of symptoms and a decreased health-related quality of life. Nurses have a responsibility to prevent, ease or delay a negative outcome through symptom management, or assist in achieving an acceptable level of symptom relief. Aim: The overall aim of the thesis was to describe different aspects of symptom burden from the perspective of community-dwelling people with chronic disease. Methods: This thesis is based upon four papers that used both quantitative and qualitative data to describe different aspects of symptom burden, experienced by people with chronic diseases. Paper (I) is a cross-sectional study with 91 participants diagnosed with chronic obstructive pulmonary disease. Papers (II and IV) are based upon secondary outcome data from a randomized controlled trial with 382 community-dwelling older people with multimorbidity. Paper (II) is a cross-sectional study and Paper (IV) has a descriptive and an explorative design reporting on the trajectory of symptom prevalence and symptom burden. Paper (III) is a qualitative study with participants from the AGe-FIT. Results: Among people diagnosed with COPD the most prevalent symptoms with the highest symptom burden scores were shortness of breath, dry mouth, cough, sleep problems, and lack of energy, with just a few differences between participants with moderate and severe airflow limitation (I). For older people with multimorbidity, pain was the symptom with the highest prevalence and burden. Other highly prevalent symptoms were lack of energy and a dry mouth. Poor vision, likelihood of depression, and diagnoses of the digestive system were independently related to the total symptom burden score (II). The symptoms experienced by the older people were persistent and the symptom burden remained high over time (IV). The experience of living with a high symptom burden was described as an endless struggle. The analysis revealed an overall theme, “To adjust and endure” and three sub-themes, “to feel inadequate and limited”, “to feel dependent”, and “to feel dejected” (III). Conclusions: The results of this thesis indicate the importance of early symptom identification. People with chronic diseases have an unmet need for optimized treatment that focuses on the total symptom burden, and not only disease specific symptoms. A large proportion of older people with multimorbidity suffer a high and persistent symptom burden, and the prevalence and trajectory of pain are high. Older people sometimes think their high age is the reason they experience a diversity of symptoms, and they do not always communicate these to their health-care provider.
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Semple, Leanne. "Living with dementia : the burden of guilt." Thesis, University of Warwick, 2015. http://wrap.warwick.ac.uk/76014/.
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Previous research has identified guilt as a significant emotion for both people with dementia and their caregivers. As guilt has been associated with psychopathology and depression, it is important to explore the nature, prevalence and clinical implications of this self-conscious emotion within the context of the dementia caregiving dyad. Chapter 1 presents a critical review of the quantitative and qualitative literature exploring feelings of guilt and caregiver burden in informal caregivers of people with dementia. The paper particularly focuses on evidence regarding the relationship of guilt to the construct of caregiver burden, the conceptualisation and measurement of guilt and burden in dementia caregivers and the factors associated with caregiver guilt and burden. Methodological limitations are discussed in relation to the clarity of the results. Clinical implications and future research suggestions are identified. Chapter 2 presents a mixed methods research paper on the development and validation of a measure of guilt for people with dementia. The results reveal strong item-total correlation in the new scale. Good reliability and convergent validity of the measure are also demonstrated. Study limitations, clinical implications and future directions are discussed. Chapter 3 offers a reflective account of my experience of the research process as well as my reflective learning, personal and professional development during this process and clinical training.
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Cox, Anna Clare. "eHealth and the burden of cancer survivorship." Thesis, University of Surrey, 2016. http://epubs.surrey.ac.uk/812706/.
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Cancer survivorship is increasing year on year due to an aging population and improvements in cancer screening and treatments. The experience of survivorship can be challenging; individuals living with and beyond cancer can face a burden of survivorship. Cancer survivors not only experience symptom burden (the severity and impact of biopsychosocial consequences of disease and its treatment), there is also evidence that individuals living with chronic conditions experience treatment burden (the ‘work’ required of them in managing their condition and its symptoms). Traditional clinic-based approaches to relieving the burden of cancer survivors may not be sustainable or the most beneficial. eHealth interventions are developing exponentially and there is an expectation that they can improve the experience of cancer survivorship. This thesis considers the impact of eHealth supportive care interventions on the burden of those living with and beyond cancer, reporting the experience of adult cancer survivors and the perceptions of health care professionals (HCPs). Five publications form the body of this thesis. The first publication indicates that while most cancer survivors want to be fully informed many do not receive sufficient information in all areas (e.g. psychosocial issues), thus supporting the consideration of alternative approaches to providing cancer survivors with supportive care. Two publications report positive impact of a telephone follow-up intervention on the burden of survivorship. Two publications consider HCP perceptions of remote symptom monitoring and internet care plans. These papers report that HCPs perceive eHealth interventions to increase burden for specific groups of cancer survivors depending on individual patient factors, the context of their care, and the content of the intervention. This body of work supports the potential of eHealth to alleviate the burden of cancer survivors but acknowledges that the complexity of for whom and how these benefits occur warrants exploration through further research. Involving cancer survivors and HCPs in the development of eHealth supportive care interventions is key to creating and implementing sustainable effective solutions to relieving the burden of future cancer survivors.
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Wittchen, Hans-Ulrich, Stephan Mühlig, and Lukas Pezawas. "Natural course and burden of bipolar disorders." Technische Universität Dresden, 2003. https://tud.qucosa.de/id/qucosa%3A27010.
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Despite an abundance of older and more recent retrospective and considerably fewer prospective-longitudinal studies in bipolar disorders I and II, there are still remarkable deficits with regard to our knowledge about the natural course and burden. The considerable general and diagnosis-specific challenges posed by the nature of bipolar disorders are specified, highlighting in particular problems in diagnostic and symptom assessment, shifts in diagnostic conventions and the broadening of the diagnostic concept by including bipolar spectrum disorders. As a consequence it still remains difficult to agree on several core features of bipolar disorders, such as when they begin, how many remit spontaneously and how many take a chronic course. On the basis of clinical and epidemiological findings this paper summarizes (i) a significant need to extend the study of the natural course of bipolar disorder in clinical samples beyond the snapshot of acute episodes to the study of the mid-term and long-term symptom course, associated comorbidities and the associated burden of the disease. (ii) In terms of epidemiological studies, that are also of key importance for resolving the critical issues of threshold definitions in the context of the bipolar spectrum concept, there is a clear need for identifying the most relevant risk factors for the first onset and those for the further illness progression in early stages. Since there are some indications that these critical processes might start as early as adolescence, such studies might concentrate on young cohorts and clearly before these prospective patients come to clinical attention. (iii) The value of both types of studies might be enhanced, if beyond the use of standardized diagnostic interview, special attempts are made to use prospective life- and episode-charting methods for bipolar illnesses.
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Dodd, Julia. "The Medical and Psychological Burden of Infertility." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/etsu-works/7331.
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Ryberg, Erik. "Lgr 11's Postcolonial Burden of History." Thesis, Malmö högskola, Fakulteten för kultur och samhälle (KS), 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-22702.
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AbstractIn 2011, the Swedish government created a new curriculum for the compulsory school. This curriculum included stricter guidelines about what was to be taught in a variety of subjects taught in public and many private schools. This policy, entitled Lgr 11, has potential to influence a generation or more of Swedes regarding their understanding of the postcolonial world and future dealings with that part of the world and its peoples. In this paper, elements of postmodern and postcolonial historiography is employed when analyzing Lgr 11’s history syllabus. How the postcolonial world and its histories are represented in Lgr 11‘s narrative(s) is investigated. The importance of this document to Swedes is that, with a significant proportion of the Swedish population recent immigrants from the postcolonial world, the perspectives of that region are important in the development of identity for recent immigrants, Swedes themselves and in understandings of a large portion of the world for less recent immigrant Swedes. Swedish identity now includes postcolonial histories.
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Zhao, Rui. "Integrated Analysis of Longitudinal Tumor Burden Data." Thesis, Harvard University, 2014. http://nrs.harvard.edu/urn-3:HUL.InstRepos:14226076.
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The first part of this thesis introduces a new statistical method to estimate parameter values in a mixed population consisting of both single- and bi- phasic longitudinal trajectories. This pro- posed model is capable of categorizing patients according to their longitudinal relationships and estimating the associated parameters of interest, while accounting for between-patient variability. We applied this method to a large phase III randomized trial and found significant differences in patients between different treatment cohorts and within the same treatment cohort, in terms of their longitudinal relationships, with the majority of patients displaying complex bi-phasic trends. In the second part of this thesis, we designed a dynamical system model to explain the observed bi-phasic longitudinal trends and their implications for the underlying cancer biology. We found that a hybrid model encompassing both hierarchical cellular model and clonal expansion model is needed to explain the observed bi-phasic patterns. The third part of this thesis explores the effects of proliferative patterns in colon crypt on crypt stability and rates of somatic evolution.
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Gupta, Sameer. "Gender Disparity and Mutation Burden in Melanoma." Thesis, Harvard University, 2016. http://nrs.harvard.edu/urn-3:HUL.InstRepos:27007743.
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A female advantage in melanoma incidence and outcome has been consistently observed but remains unexplained. We hypothesized that tumors are genetically distinct between men and women and analyzed the mutation spectra in 266 metastatic melanomas (102 women and 164 men) from The Cancer Genome Atlas (TCGA). We found a statistically significantly greater burden of missense mutations among men (male median 298 vs female median = 211.5; male-to-female ratio [M:F] = 1.85, 95% confidence interval [CI] = 1.44 to 2.39). We validated these initial findings using available data from a separate melanoma exome cohort (n = 95) and found a similar increase in missense mutations among men (male median 393 vs female median 259; M:F = 1.59, 95% CI = 1.12 to 2.27). In addition, survival improves with increasing log-transformed missense mutation count (univariate hazard ratio = 0.82, 95% CI = 0.69 to 0.98) for TCGA samples. Our analyses are the first to demonstrate a gender difference in mutation burden in cutaneous melanoma.
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Rydvall, Helena, and Hanna Sinner. "Psychological Features and Symptom Burden of Endometriosis." Thesis, Örebro universitet, Institutionen för juridik, psykologi och socialt arbete, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-75844.
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Williams, Kelly Ann. "Alternative minimum tax: A middle class burden." CSUSB ScholarWorks, 2006. https://scholarworks.lib.csusb.edu/etd-project/2960.
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Since its inception in 1969, the Alternative Minimum Tax (AMT) has been utilized to keep taxpayers with higher income from taking advantage of loopholes and paying little or no income tax. This project presents an outline of what the AMT is, how it is calculated, and its history; and also illustrates why the AMT is no longer viable today.
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Bawaked, Rowaedh Ahmed 1985. "Childhood obesity : interrelation amoong diet quality, lifestyle factors, and obesity." Doctoral thesis, Universitat Pompeu Fabra, 2018. http://hdl.handle.net/10803/665009.
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La obesidad infantil sigue siendo una importante carga para la salud pública. Comprender e identificar la compleja relación entre la calidad de la dieta y los factores del estilo de vida es importante para el control de peso en los niños y las estrategias de prevención de la obesidad infantil. Esta tesis se basa en datos de tres estudios: i) Enkid, un estudio nacional representativo de la población española de 2 a 24 años, n = 3534; ii) POIBC, un programa de obesidad infantil basado en la comunidad, que incluye niños de 8 a 10 años, n = 2250. El estudio se llevó a cabo durante dos años escolares, desde 2012 a 2014, con un seguimiento promedio de 15 meses; iii) INMA, cohorte de nacimiento de base poblacional con niños de 4 años i un seguimiento promedio de 3 años, n = 1.480. Encontramos que la ingesta total de flavonoides, la frecuencia de las comidas y la actividad física se asociaron positivamente con la adherencia a la dieta mediterránea, mientras que el tiempo de pantalla y la alimentación externa se asociaron con una mala adherencia. Un alto nivel de educación materna fue asociado a una más alta adherencia a la dieta mediterránea en los niños. Usamos el índice inflamatorio de la dieta para explorar la asociación entre el potencial inflamatorio de la dieta y su calidad. Concluimos que una dieta saludable, caracterizada por una alta adherencia a la dieta mediterránea, una alta capacidad antioxidante, o una baja densidad energética, estaba relacionada con un mayor potencial antiinflamatorio de la dieta. Finalmente, en dos estudios, evaluamos el impacto de los comportamientos obesogénicos en el estilo de vida sobre la obesidad infantil y la obesidad abdominal. En el primer estudio (artículo IV), definimos cuatro comportamientos obesogénicos como: <1 hora de actividad física/día; ≥2 horas/día de tiempo de pantalla; saltarse el desayuno; y tener menos de 3 comidas/día. Encontramos que la concurrencia de conductas obesogénicas (tiempo de pantalla alto, saltarse el desayuno, o baja actividad física y frecuencia de comidas) aumentaba el riesgo de tener un z-score de IMC más alto, un mayor relación cintura-altura y mayores probabilidades de sobrepeso y obesidad abdominal. Además, un alto nivel de educación materna y parental se asoció con la disminución de la presencia de comportamientos obesogénicos. En el segundo estudio (artículo V), construimos un score de estilo de vida saludable infantil (CHLS, por sus siglas en inglés) que comprendía cinco comportamientos de estilo de vida de interés que eran favorables (actividad física extracurricular, tiempo de sueño, consumo de alimentos basados en plantas) o desfavorables (tiempo de televisión y consumo de alimentos ultraprocesados). Encontramos que el CHLS a los 4 años de edad se asoció negativamente con el IMC, z-score de cintura, y mayores probabilidades de sobrepeso y obesidad a los 7 años. In Conclusión, Esta investigación de doctorado demuestra un aumento en el IMC entre los niños españoles con baja actividad física, frecuencia de comidas y tiempo de sueño, y un alto tiempo de TV y consumo de alimentos ultraprocesados. Los hallazgos también resaltan una relación inversa entre la circunferencia de la cintura y la actividad física i el tiempo de sueño. En contraste con esto, observamos lo opuesto a saltarse el desayuno y el tiempo de televisión. El nivel educativo materno está asociado con la calidad de la dieta de los niños y la presencia de factores
de estilo de vida obesos. Nuestros resultados destaca varios comportamientos modificables clave que pueden ser objeto de políticas e intervenciones para mejorar la calidad de la dieta, con el objetivo de abordar el problema de la obesidad infantil en España.<br>Childhood obesity remains a major public health burden. Understanding and identifying the complex relationship between diet quality and lifestyle factors is important for pediatric weight control and obesity prevention strategies. The main scope of the present thesis was to determine the complex correlation between obesogenic behaviors, diet quality and overweight and obesity in Spanish youth. This thesis is based on data from three studies: i) Enkid, a representative national study of the Spanish population aged 2 to 24 years, n=3534; ii) POIBC, a community based childhood obesity program, including children aged 8 to 10 years, n = 2250. The study was carried out during two school years, 2012 to 2014, with an average follow-up of 15 months; iii) INMA, population-based birth cohort, including children aged 4 years with an average follow-up of 3 years, n= 1480. We found that total flavonoids intake (paper I), meal frequency and physical activity were positively associated with adherence to the Mediterranean diet (paper III), while screen time and external eating were associated with poor adherence (paper III). A high maternal level of education increased the odds of a child adhering to the Mediterranean diet (paper III).We used the diet inflammatory index to explore the association between the inflammatory potential of diet and diet quality (paper II). We concluded that a healthy diet, characterized by high adherence to the Mediterranean diet, high total dietary antioxidant capacity, or low energy density, was linked to greater anti-inflammatory potential of the diet. Finally, in two studies we evaluated the impact of lifestyle obesogenic behaviors on childhood obesity and abdominal obesity. In the first study (paper IV), we defined four obesogenic behaviors as: <1 hour physical activity/day; ≥2 hour/day of screen time; skipping breakfast; and having fewer than 3 meals/day. We found that the concurrence of obesogenic behaviors (high screen time, skipping breakfast, and low physical activity and meal frequency) increased risk of higher Body mass index (BMI) z-scores, higher waist-to-height ratio (WHtR) and higher odds of overweight and abdominal obesity. In addition, high maternal and parental education was associated with decreasing presence of obesogenic behaviors. In the second study (paper V), we constructed a child healthy lifestyle score (CHLS) comprising five target lifestyle behaviors that were either favorable (extracurricular physical activity, sleep time, plantbased food consumption) or unfavorable (television time and consumption of ultra-processed foods).We found that CHLS at age 4 years was negatively associated with BMI, waist circumference (WC) z-scores and higher odds of overweight and obesity at age 7 years. This PhD research shows an increase in BMI among Spanish children with low physical activity, meal frequency, and sleep time, and high TV time and ultra-processed food intake. The findings also highlight an inverse relationship between waist circumference and physical activity, sleep time, whereas skipping breakfast, and TV time were positively associated with WC z-score and increased the odds of abdominal obesity. Maternal educational level determines children’s diet quality, and the presence of obesity lifestyle factors. Our finding highlights several key modifiable behaviors that can be targeted by policies and interventions to improve diet quality and to tackle the childhood obesity problem in Spain.
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Tucakovic, Lada. "Role of anthocyanins in attenuating obesity and obesity-induced inflammation." Thesis, Griffith University, 2018. http://hdl.handle.net/10072/381005.
Full textAbstract:
The incidence of obesity and its related metabolic diseases, such as diabetes,
cardiovascular disease and hypertension, has escalated dramatically over the past decades
worldwide, so much so that it has reached epidemic proportions. It has become a
significant public health issue and a massive burden to the health-care system in
developed and developing countries. Obesity is the fifth leading risk for human mortality
around the globe, resulting in 2.8 million adult deaths each year. Another alarming fact is
that childhood obesity has increased dramatically since 1990. Childhood obesity is one
of the serious public health challenges of the 21st century, with there expected to be about
60 million obese children by 2020 globally.
Obesity is connected with chronic low-grade inflammation manifested by increased
circulatory levels of several cytokines and acute phase proteins associated with
inflammation. While many are secreted by adipocytes, it is believed that increased
adipose tissue mass is either directly or indirectly associated with the increased
production of inflammation-related factors.
Several therapeutic options have been used for short-term treatment of obesity, however
many of these cause unpleasant side-effects, including dizziness, headache, anxiety,
elevated heart rate and gastro-intestinal issues. There is strong evidence supporting the
therapeutic use of polyphenols such as stilbenes, flavonoids and curcuminoids, given that
they show potential in the prevention and/or treatment of obesity and its metabolic
complications. They are widely accepted in health promotion due to their antioxidant,
anti-inflammatory, anti-carcinogenic, anti-obesity, anti-diabetic, and anti-ageing
properties. The actions of their effect are thought to be through the suppression of
adipocyte differentiation and proliferation, inhibition of fat absorption from the gut, inhibition of lipogenesis, stimulation of β-oxidation, inhibition of production of proinflammatory
adipokines, and the stimulation of adiponectin secretion.
Polyphenols, specifically anthocyanins, present in a novel plum variety, Queen-Garnet
plums (QGP), have been studied in the first clinical trial. It was hypothesised that
anthocyanin-rich QGP juice could be effective in reducing body weight and production
of adipose tissue hormones (Chapter 4). It was observed that QGPJ significantly reduced
body weight in humans after 4 weeks of supplementation. Furthermore, anthocyanins had
significant effects on secretion of adiponectin as well as effects on the production of
leptin.
Anti-inflammatory actions of anthocyanins extracted from bilberries (Vaccinium
myrtillus) and blackcurrant (Ribes nigrum) and their effect on pro-inflammatory markers
were studied in the second clinical trial. It was hypothesised that high-dose anthocynin
supplementation, in the form of MEDOX® capsules, would downregulate inflammatory
adipocytokines in overweight and obese individuals (Chapter 5). Results illustrated the
significant effect of anthocynins on secretion of MCP1/CCL2 and IL-6 in overweight and
obese populations, as well as an effect on TNF-α production in obese individuals.
The anti-obesity effect of anthocynin supplementation on body weight and production of
adipose tissue hormones was also evaluated in the second clinical trial. It was
hypothesised that high-dose anthocyanins would regulate the secretion of hormones as
well as decrease the body weight in overweight and obese populations after 4 weeks of
supplementation (Chapter 6). It was demonstrated that supplementation with
anthocyanins resulted in significant increases in adiponectin secretion as well as
significant decreases in leptin production in overweight and obese individuals.
Due to the showed beneficial effects of polyphenols on anti and pro inflammatory
adipocytokine secretion, the influence of anthocyanins present in QGPJ and MEDOX® supplements on the gene expression of these markers was investigated (Chapters 4, 5 and
6). Interestingly, it was observed that polyphenols did not have a significant effect on the
modulation of anti and pro-inflammatory markers’ gene expression.
From the observed effects of polyphenols, specifically anthocyanins, on secretion and
production of anti and pro-inflammatory markers as well as hormones, further studies
with a larger number of volunteers and for a longer time are needed. Investigation of other
anti and pro-inflammatory markers, as well as comparison of anthocyanins supplements
to current anti-inflammatory and anti-obesity therapies and treatments, could also be
beneficial.<br>Thesis (PhD Doctorate)<br>Doctor of Philosophy (PhD)<br>School of Medical Science<br>Griffith Health<br>Full Text
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Thomson, Christopher Martin. "On the burden of proof in ordinary argumentation." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2001. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp04/NQ59049.pdf.
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Fehm, Lydia, Antoine Pelissolo, Thomas Furmark, and Hans-Ulrich Wittchen. "Size and burden of social phobia in Europe." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2013. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-108615.
Full textAbstract:
This paper provides a critical review of the prevalence of social phobia in European countries, a description of associated disability and burden and of clinical correlates and risk factors associated with social phobia. On the basis of a comprehensive literature search we identified 21 community studies and two primary care studies. The median lifetime and 12-month prevalence rates of social phobia in community samples referring to DSM-III-R and DSM-IV criteria were 6.65% and 2.0%, respectively. Younger individuals showed the highest rates, and women were more frequently affected than men. Social phobia was shown to be a persistent condition with a remarkably high degree of comorbid conditions, associated impairment and disability. Research deficits lie in a lack of data for most EU countries and in a lack of studies in children and the elderly. No data are available addressing met and unmet needs for intervention and costs, and data for vulnerability and risk factors of malignant course are scarce.
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Cesur, Resul. "Essays on the Aggregate Burden of Alcohol Abuse." Digital Archive @ GSU, 2009. http://digitalarchive.gsu.edu/econ_diss/4.
Full textAbstract:
This dissertation attempts to uncover the causal relationship between alcohol abuse and both income growth and crime. These two research questions are investigated in three essays: Essay I investigates the relationship between alcohol abuse and income growth in the United States; Essay II examines the impact of alcohol abuse on income growth at the international level; Essay III investigates the effect of alcohol abuse on crime in the united states. Essay I of this dissertation uses state level data from the United States for the period 1970-1998 to estimate the impact of alcohol abuse on income growth by utilizing per capita beer consumption as the measure of alcohol abuse. Results suggest that, even though generally small, there is a negative relationship between alcohol abuse and income growth once the endogeneity between income growth and per capita beer consumption is addressed by utilizing levels of excise alcohol taxes and the Minimum Drinking Age Law of 21 as instruments. These results indirectly favor the previous research on two dimensions: First, alcohol abuse generates a significant burden on the economy; Second, increases in excise alcohol taxes would be efficient in terms of income growth. Essay II of this dissertation uses data from 72 countries for the period 1960-1995 to estimate the impact of alcohol abuse on income growth by utilizing per capita beer, wine, liquor, and total ethanol consumption as the measures of alcohol abuse. Results suggest that, even though generally small, there is a negative significant relationship between per capita beer consumption and income growth once the endogeneity between income growth and per capita beer consumption is addressed with system GMM dynamic panel estimators. These results show that per capita beer consumption is the medium of alcohol abuse not only in the United States, but also around the world. Moreover, these results favor the previous research on the fact that alcohol abuse generates a significant burden on economies. Essay III of this dissertation uses state level data from the United States for the period 1982-2000 to investigate the relationship between crime and alcohol abuse by utilizing per capita beer consumption as the measure of alcohol abuse. Potential endogeneity between per capita beer consumption and crime is addressed by using excise beer taxes and alcohol control measures as instruments. Results show that alcohol abuse seems to have a positive impact overall on the crime rate. Nevertheless, the effect is not uniform among different crime types. In the case of property crime types, results suggest that alcohol abuse plays a more important role in crime types that require a lesser degree of organization and more spontaneity (i.e., larceny theft versus burglary and motor vehicle theft). In the case of violent crime types, results suggest that the impact of alcohol abuse is more pressing in non-murder crime types versus murder. These results have policy implications: excise alcohol taxes and alcohol control policies may play a role in reducing certain crime types, which are larceny theft, rape, robbery, and aggravated assault, but not the other crime types, which are burglary, motor vehicle theft, and murder.
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Rutherford, Mark John. "Predicting the future burden of cancer on society." Thesis, University of Leicester, 2012. http://hdl.handle.net/2381/10201.
Full textAbstract:
Evaluating the burden of cancer on society is of great interest to health officials and planning authorities. It is of particular importance to be able to correctly estimate the burden of cancer in the coming years in order that appropriate provisions can be put in place. The vast majority of developed, and also developing, countries have a cancer registry set-up and have at least 20 years of complete data. In the leading developed countries, the cancer registry data is complete and reliable for the past 50 years. Using this data it is possible to estimate key quantities that can be used to assess the burden of cancer. Prevalence gives a good proxy for the burden of cancer on society; it gives an estimate of the number of people who are alive having had a previous cancer diagnosis. Prevalence can be estimated by combining models for incidence and patient survival. To accurately model the prevalence, it is important to develop the best methods for modelling the incidence and patient survival from population-based cancer registries. Therefore, as part of this thesis, novel methods have been developed for projecting cancer incidence into the future using an approach that treats the data continuously. Also, methods for projecting cancer patient survival have been assessed and improved as part of the work by effectively estimating the quantities in continuous time. These projected estimates have been combined to give future estimates of cancer prevalence. Making predictions is obviously fraught with danger and, therefore, it should be made clear that these projections are liable to be uncertain and based on strong assumptions. However, if the assumptions of these models are fully understood, they may well provide a useful tool for health and financial planning in terms of assessing the disease burden due to the differing forms of cancer.
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Hargell, Joanna. "Supervised Learning for Prediction of Tumour Mutational Burden." Thesis, KTH, Matematisk statistik, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-291801.
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Tumour Mutational Burden is a promising biomarker to predict response to immunotherapy. In this thesis, statistical methods of supervised learning were used to predict TMB: GLM, Decision Trees and SVM. Predictions were based on data from targeted DNA sequencing, using variants found in the exonic, intronic, UTR and intergenic regions of the human DNA. This project was of an exploratory nature, performed in a pan-cancer setting. Both regression and classification were considered. The purpose was to investigate whether variants found in these regions of the DNA sequence are useful when predicting TMB. Poisson regression and Negative binomial regression were used within the framework of GLM. The results indicated deficiencies in the model assumptions and that the use of GLM for the application is questionable. The single regression tree did not yield satisfactory prediction accuracy. However, performance was improved by using variance reducing methods such as bagging and random forests. The use of boosted regression trees did not yield any significant improvement in prediction accuracy. In the classification setting, binary as well as multiple classes were considered. The distinction between classes was based on commonly used thresholds in clinical care to achieve immunotherapy. SVM and classification trees yielded high prediction accuracy for the binary case: a misclassification rate of 0.0242 and 0 respectively for the independent test set. In the multiple classification setting, bagging and random forests were implemented, yet, did not improve performance over the single classification tree. SVM produced a misclassification rate of 0.103, and the corresponding number for the single classification tree was 0.109. It was concluded that SVM and Decision trees are suitable methods for predicting TMB based on targeted gene panels. However, to obtain reliable predictions, there is a need to move from a pan-cancer setting to a diagnosis-based setting. Furthermore, parameters affecting TMB, like pre-analytical factors need to be included in the statistical analysis.<br>Denna uppsats undersöker tre metoder inom statistisk inlärning: GLM, Decision Trees och SVM, med avsikt att förutsäga mutationsbörda, TMB, för cancerpatienter. Metoderna har applicerats både inom regression och klassificering. Förutsägelser gjordes baserat på data från panel-baserad DNA-sekvensering som innehåller varianter från kodande, introniska UTR och intergeniska regioner av mänskligt DNA. Projektet ämnar att undersöka om varianter från dessa regioner av DNA-sekvensen kan vara användbara för att förutsäga mutationsbördan för en patient. Poisson-regression och Negativ Binomial-regression undersöktes inom GLM. Resultaten indikerade på brister i modellerna och att GLM inte är lämplig för denna tillämpning. Regressionsträden gav inte tillräckligt noggranna förutsägelser, men implementering av bagging och random forests förbättrade modellernas prestanda. Boosting förbättrade inte resultaten. Inom klassificering användes både binära klasser och multipla klasser. Avgränsningen mellan klasser baserades på kända gränser för TMB inom vården för att få immunoterapi. SVM och decision trees gav god prestanda för binär klassificering, med ett klassificeringsfel på 0.024 för SVM och 0 för decision trees. Bagging och random forests implementerades för det multipla fallet inom decision trees, men förbättrade inte prestandan. För multipla klasser gav SVM ett klassificeringnsfel på 0.103 och decision trees 0.109. Både SVM och decision trees visade sig vara lämpliga metoder för för att förutse värdet på TMB. Däremot, för att förutsägelserna ska vara tillförlitliga finns det ett behov av att göra denna typ av analys för varje enskild cancerdiagnos. Dessutom finns det ett behov av att inkludera parametrar från den bioinformatiska processen i den statistiska analysen.
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Fehm, Lydia, Antoine Pelissolo, Thomas Furmark, and Hans-Ulrich Wittchen. "Size and burden of social phobia in Europe." Technische Universität Dresden, 2005. https://tud.qucosa.de/id/qucosa%3A26762.
Full textAbstract:
This paper provides a critical review of the prevalence of social phobia in European countries, a description of associated disability and burden and of clinical correlates and risk factors associated with social phobia. On the basis of a comprehensive literature search we identified 21 community studies and two primary care studies. The median lifetime and 12-month prevalence rates of social phobia in community samples referring to DSM-III-R and DSM-IV criteria were 6.65% and 2.0%, respectively. Younger individuals showed the highest rates, and women were more frequently affected than men. Social phobia was shown to be a persistent condition with a remarkably high degree of comorbid conditions, associated impairment and disability. Research deficits lie in a lack of data for most EU countries and in a lack of studies in children and the elderly. No data are available addressing met and unmet needs for intervention and costs, and data for vulnerability and risk factors of malignant course are scarce.
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Weigel, Kayla Marie. "Decreasing Dementia Caregiver Burden: A Quality Improvement Intervention." Diss., North Dakota State University, 2018. https://hdl.handle.net/10365/27857.
Full textAbstract:
A caregiver is defined as someone who offers care to another individual who is not capable of carrying out activities essential for daily living. The role of caregivers is often overlooked, but their contributions are foundational to the nation?s long-term healthcare organizations. Numerous reasons exist for the projected increase in caregiver burden, including: the nation?s aging population, increased dementia prevalence, increased caregiver demand, and increased long-term care turnover rates. A current and projected shortage of caregivers will profoundly impact the long-term care workforce. Job turnover and burden rates are often reported highest among dementia caregivers related to increased physical, mental, and emotional demands. Research emphasizes the importance of enhancing dementia caregiver education levels to decrease turnover, reduce burden, and enhance outcomes. Based on practicality, scope of practice, a detailed literature review, and a community needs assessment, a dementia caregiver training program was chosen as a priority dementia caregiver need. The practice improvement project design focused on increasing dementia caregiver knowledge and decreasing levels of burden through implementation of a dementia caregiver training program at a local long-term care agency. Twenty-six agency dementia caregivers attended a training session followed by pre-post and two-month post-education questionnaires and scales. During the training program, education was provided to caregivers through an interactive PowerPoint presentation. The training session included an introduction followed by participant completion of a pre-education knowledge questionnaire and a pre-education burden scale. Training content included burden, self-care tips, communication, and managing dementia associated behaviors. Evaluation included group discussion and completion of the post-education knowledge questionnaire and the post-education burden scale. Two-months following program completion, a two-month post-education knowledge questionnaire and a two-month post-education burden scale were completed by participants. Data analysis indicated implementation of the dementia caregiver training program resulted in increased knowledge, increased comfort, and decreased caregiver burden.
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Hillison, Joel R. "New Members, New Burdens: Burden-Sharing Within NATO." Diss., Temple University Libraries, 2009. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/34174.
Full textAbstract:
Political Science<br>Ph.D.<br>The purpose of this dissertation is to examine the burden-sharing behavior of new NATO members and the impact of enlargement on NATO burden-sharing. Qualitative and quantitative methods are used to test several hypotheses. The findings suggest that large NATO members are burden-sharing at a greater rate than smaller NATO members when looking at military expenditures and air contributions to NATO missions, in accordance with the logic of collective action. Contribution of troops to NATO missions depends on the mix of private and public benefits received, in accordance to the joint product model. The findings support the hypothesis that new NATO members are burden-sharing at a greater rate than older NATO members. An analysis of the burden-sharing behavior of NATO's new members reveals that new NATO members have demonstrated the willingness to contribute to NATO missions, but are often constrained by their limited capabilities. However, new member contributions to NATO have improved and, in comparison to older NATO members, the new members are doing quite well. Finally, NATO expansion did not lead to greater free-riding behavior in NATO.<br>Temple University--Theses
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Given, BarbaraA, CharlesW Given, Alla Sikorskii, Eric Vachon, and Asish Banik. "Medication burden of treatment using oral cancer medications." MEDKNOW PUBLICATIONS & MEDIA PVT LTD, 2017. http://hdl.handle.net/10150/625510.
Full textAbstract:
Objective: With the changes in healthcare, patients with cancer now have to assume greater responsibility for their own care. Oral cancer medications with complex regimens are now a part of cancer treatment. Patients have to manage these along with the management of medications for their other chronic illnesses. This results in medication burden as patients assume the self-management. Methods: This paper describes the treatment burdens that patients endured in a randomized, clinical trial examining adherence for patients on oral cancer medications. There were four categories of oral agents reported. Most of the diagnoses of the patients were solid tumors with breast, colorectal, renal, and gastrointestinal. Results: Patients had 1u4 pills/day for oral cancer medications as well as a number for comorbidity conditions (3), for which they also took medications (10u11). In addition, patients had 3.7u5.9 symptoms and side effects. Patients on all categories except those on sex hormones had 49%u57% drug interruptions necessitating further medication burden. Conclusions: This study points out that patients taking oral agents have multiple medications for cancer and other comorbid conditions. The number of pills, times per day, and interruptions adds to the medication burden that patients' experience. Further study is needed to determine strategies to assist the patients on oral cancer medications to reduce their medication burden.
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Ndimubanzi, Patrick Cyaga. "The global burden of neurocysticerosis a systematic review /." Oklahoma City : [s.n.], 2009.
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Rickard, Gary K. "The burden of proof between theism and atheism." Online full text .pdf document, available to Fuller patrons only, 1999. http://www.tren.com.
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