Dying at home: A qualitative study of the perspectives of older South Asians living in East London

South Asians constitute the single largest ethnic minority group in the United Kingdom, yet little is known about their perspectives and experiences on end-of-life care. Aim: To explore beliefs, attitudes and expectations expressed by older South Asians living in East London about dying at home. Methodology and methods: Five focus groups and 29 in-depth semi-structured interviews were conducted with a total of 55 older adults (24 men and 31 women) aged between 52 to 78 years. Participants from six South Asian ethnic groups were recruited via 11 local community organisations. Data were analysed using a constructive grounded theory approach. Findings: Two key themes were identified. The theme of ‘reconsidering the homeland’ draws on the notion of ‘diaspora’ to help understand why for many participants the physical place of death was perceived by many as less important than the opportunity to carry out cultural and religious practices surrounding death. The second theme ‘home as a haven’ describes participants’ accounts of how their home is a place in which it is possible to perform various cultural and religious rituals. Cultural and religious practices were often seen as essential to achieving a peaceful death and honouring religious and filial duties. Conclusion: Older people of South Asian ethnicity living in East London perceive home as more than a physical location for dying relatives. They make efforts to adhere, but also adapt, to important social and cultural values relating to death and dying as part of the wider challenge of living in an emigrant society

Continuity and Change in World Bank Development Discourses and the Rhetoric Role of Accounting

Purpose ? The paper traces how the World Bank has utilised accounting rhetoric/languages in articulating development discourses at different stages of global capitalism through the case study of development projects in Sri Lanka and published development reports. Design/methodology/approach ? Multiple methods are employed including archival research and interviews. In-depth interviews were organised with village level development project participants. Development reports published by the World Bank (1978-2006) are closely examined. Findings ? Development projects in Sri Lanka and development reports show that ideological shifts brought about the changes in accounting rhetoric in development discourses. The paper further shows that the articulations and re-articulations of development discourse have yet to grasp the real complexity of the local problems in those villages in Sri Lanka. The mere focus on management styles (albeit important) driven by the ideology of the aid agencies seems to bring little reward to villagers and, indeed, the policy makers. Research limitations/implications ? This study focuses on the effectiveness of development projects and shows how culture and values in a traditional local setting are in conflict with rational ideas imported from a different setting. This finding has policy implications for the economic development programmes often prescribed by the aid agencies without considering the local context. Originality/value ? The paper adds to the literature on the use of accounting languages in development discourses, especially in the context of Less Developed Countries (LDCs). It will be of great value to researchers and practitioners seeking to gain a better understanding of reforms driven by a particular set of accounting technology in distant places

Probabilistic projections of HIV prevalence using Bayesian melding

The Joint United Nations Programme on HIV/AIDS (UNAIDS) has developed the Estimation and Projection Package (EPP) for making national estimates and short-term projections of HIV prevalence based on observed prevalence trends at antenatal clinics. Assessing the uncertainty about its estimates and projections is important for informed policy decision making, and we propose the use of Bayesian melding for this purpose. Prevalence data and other information about the EPP model's input parameters are used to derive a probabilistic HIV prevalence projection, namely a probability distribution over a set of future prevalence trajectories. We relate antenatal clinic prevalence to population prevalence and account for variability between clinics using a random effects model. Predictive intervals for clinic prevalence are derived for checking the model. We discuss predictions given by the EPP model and the results of the Bayesian melding procedure for Uganda, where prevalence peaked at around 28% in 1990; the 95% prediction interval for 2010 ranges from 2% to 7%.Comment: Published at http://dx.doi.org/10.1214/07-AOAS111 in the Annals of Applied Statistics (http://www.imstat.org/aoas/) by the Institute of Mathematical Statistics (http://www.imstat.org

Probabilistic projections of HIV prevalence using Bayesian melding

The Joint United Nations Programme on HIV/AIDS (UNAIDS) has developed the Estimation and Projection Package (EPP) for making national estimates and short-term projections of HIV prevalence based on observed prevalence trends at antenatal clinics. Assessing the uncertainty about its estimates and projections is important for informed policy decision making, and we propose the use of Bayesian melding for this purpose. Prevalence data and other information about the EPP model's input parameters are used to derive a probabilistic HIV prevalence projection, namely a probability distribution over a set of future prevalence trajectories. We relate antenatal clinic prevalence to population prevalence and account for variability between clinics using a random effects model. Predictive intervals for clinic prevalence are derived for checking the model. We discuss predictions given by the EPP model and the results of the Bayesian melding procedure for Uganda, where prevalence peaked at around 28% in 1990; the 95% prediction interval for 2010 ranges from 2% to 7%.Comment: Published at http://dx.doi.org/10.1214/07-AOAS111 in the Annals of Applied Statistics (http://www.imstat.org/aoas/) by the Institute of Mathematical Statistics (http://www.imstat.org

Financial Anxieties of Large, Medium and Small Enterprises in japan

In our previous article (2005), we investigated financial anxieties over the economy of Japan by treating the conditional variances of TARCH model as the financial anxieties. However we did not distinguish between large enterprises and small enterprises, though we differentiated the financial anxieties between all enterprises and small enterprises. The reason was that we implicitly assumed that the financial anxieties of large firms were smaller than those of small firms in the period of financial distrss, since lerge firms could access the credit markets directly through stock and bond market. Small firms which were more dependent of bank loans were supposed to have much more finanncial anxieties in the finanncial panic than large firms.In this article, we have quantified the financial anxieties for four different catedories of enterprises:large enterprises, medium enterprises, small enterprises and adding altogether (viz., large + medium + small) as all enterprises. Also another new aspest is that we have used EGARCH model instesd of TARCH, because in this model there is no need for non-negative constraints on the parameters and more importantly, it also allows for asymmetries in the variance equation. Then we have compared and explained financial anxieties for all categories through the line of history of the deflationary economy of Japan.Our findings show the opposite results that was expected. That is to say, large firms respond to financial distress more strongly than small firms

Financial Anxieties in Japanese Economy

In this article, financial anxieties over the economy of Japan have been investigated. Some researchers analyzedthis anxiety using the level economic variables in TARCH model without showing time series properties. If the time series involved are nonstationary, naive application of time series analysis may yieldspurious correlation. So, an attempt has been made to recalculate the anxieties in a more optimum way over the period1976-2005. Our results are able to capture the anxieties consistent with the economic point of views. Further discussions are given for the difference of financial anxieties between all enterprises andsmall ones, focusing our attention on the public financial institutions that played the special role for small enterprises

Access to and use of clinical services and disease-modifying therapies by people with progressive multiple sclerosis in the United Kingdom

Background: According to current UK guidelines everyone with progressive MS should have access to an MS Specialist but levels of access and use of clinical services is unknown. Our objective was to investigate access to MS Specialists, use of clinical services and disease-modifying therapies (DMTs) by people with progressive MS in the United Kingdom. Methods: A UK wide, online survey was conducted via the UK MS Register. Inclusion criteria: age over 18 years, primary or secondary progressive MS and a member of the UK MS Register. Participants were asked about access to MS Specialists; recent clinical service use; receipt of regular review and current and previous DMT use. Participant demographics; quality of life and disease impact measures were supplied from the UK MS Register. Results: In total 1298 participants responded: 5% were currently taking DMT; 23% had previously taken DMT; and 95% reported access to an MS Specialist. Most utilised services were: MS Doctor/Nurse (50%), General Practitioner (45%), and Physiotherapist (40%). Seventy-four percent received a regular review although 37% received theirs less than annually. Current DMT use was associated with better quality of life but past DMT use was associated with poorer quality of life and higher impact of disease. Conclusions: Access to, and use of, MS Specialists was high. However a gap in service provision was highlighted in both receiving and frequency of regular reviews

Globalization intentions in tension: The case of Singapore

10.1177/0020872810371202International Social Work535671-68

Ethnic Minorities and their Health Needs: Crisis of Perception and Behaviours

There is considerable evidence to suggest that racial and ethnic disparities exist in the provision of emergency and wider healthcare. The importance of collecting patient ethnic data has received attention in literature across the world and eliminating ethnic and racial health equalities is one of the primary aims of healthcare providers internationally. The poor health status of certain racial and ethnic groups has been well documented. The improvement of racial and ethnic disparities in healthcare is at the forefront of many public health agendas. This article addresses important policy, practice, and cultural issues confronted by the pre-hospital emergency care setup. This aspect of care plays a unique role in the healthcare safety net in providing a service to a very diverse population, including members of ethnic and racial minorities. Competent decision making by the emergency care practitioners requires patient-specific information and the health provider's prior medical knowledge and clinical training. The article reviews the current ethnicity trends in the UK along with international evidence linking ethnicity and health inequalities. The study argues that serious difficulties will arise between the health provider and the patient if they come from different backgrounds and therefore experience difficulties in cross-cultural communication. This adversely impacts on the quality of diagnostic and clinical decision making for minority patients. The article offers few strategies to address health inequalities in emergency care and concludes by arguing that much more needs to be done to ensure that we are hearing the voices of more diverse groups, groups who are often excluded from engagement through barriers such as language or mobility difficulties

Lack of Mutual Respect in Relationship The Endangered Partner

Violence in a relationship and in a family setting has been an issue of concern to various interest groups and professional organizations. Of particular interest in this article is violence against women in a relationship. While there is an abundance of knowledge on violence against women in general, intimate or partner femicide seems to have received less attention. Unfortunately, the incidence of violence against women, and intimate femicide in particular, has been an issue of concern in the African setting. This article examines the trends of intimate femicide in an African setting in general, and in Botswana in particular. The increase in intimate femicide is an issue of concern, which calls for collective effort to address. This article also examines trends offemicide in Botswana, and the antecedents and the precipitating factors. Some studies have implicated societal and cultural dynamics as playing significant roles in intimate femicide in the African setting. It is believed that the patriarchal nature of most African settings and the ideology of male supremacy have relegated women to a subordinate role. Consequently, respect for women in any relationship with men is lopsided in favor of men and has led to abuse of women, including intimate femicide. Other militating factors in intimate femicide ,are examined and the implications for counseling to assist the endangered female partner are discussed