Preferences for place of care and place of death among informal caregivers of the terminally ill

Objectives: (1) To determine informal caregivers perceptions about place of care and place of death; and (2) to identify variables associated with a home death among terminally ill individuals who received in-home support services in a publicly funded home care system. Participants and design: A total of 216 informal caregivers participated in a bereavement interview. Data collection included care recipient and informal caregiver characteristics, the use of and satisfaction with community services, and preferences about place of death. Results: Most caregivers reported that they and the care recipient had a preferred place of death (77 and 68%, respectively) with over 63% reporting home as the preferred place of death. Caregivers had a greater preference for an institutional death (14%) than care recipients (4.7%). While 30% of care recipients did not die in their preferred location, most caregivers (92%) felt, in retrospect, that where the care recipient died was the appropriate place of death. Most caregivers reported being satisfied with the care that was provided. The odds of dying at home were greater when the care recipient stated a preference for place of death (OR: 2.92; 95% CI: 1.25, 6.85), and the family physician made home visits during the care recipients last month of life (Univariate odds ratios (OR): 4.42; 95% CI: 1.46, 13.36). Discussion: The ethic of self-control and choice for the care recipient must be balanced with consideration for the well being of the informal caregiver and responsiveness of the community service system. © 2005 Edward Arnold (Publishers) Ltd.

A shared care model pilot for palliative home care in a rural area:Impact on symptoms, distress, and place of death

Context: Shared care models integrating family physician services with interdisciplinary palliative care specialist teams are critical to improve access to quality palliative home care and address multiple domains of end-of-life issues and needs. Objectives: To examine the impact of a shared care pilot program on the primary outcomes of symptom severity and emotional distress (patient and family separately) over time and, secondarily, the concordance between patient preferences and place of death. Methods: An inception cohort of patients (n = 95) with advanced, progressive disease, expected to die within six months, were recruited from three rural family physician group practices (21 physicians) and followed prospectively until death or pilot end. Serial measurement of symptoms, emotional distress (patient and family), and preferences for place of death was performed, with analysis of changes in distress outcomes assessed using t-tests and general linear models. Results: Symptoms trended toward improvement, with a significant reduction in anxiety from baseline to 14 days noted. Symptom and emotional distress were maintained below high severity (7-10), and a high rate of home death compared with population norms was observed. Conclusion: Future controlled studies are needed to examine outcomes for shared care models with comparison groups. Shared care models build on family physician capacity and as such are promising in the development of palliative home care programs to improve access to quality palliative home care and foster health system integration. © 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

Predictors of place of death for those in receipt of home-based palliative care services in Ontario, Canada

Many cancer patients die in institutional settings despite their preference to die at home. A longitudinal, prospective cohort study was conducted to comprehensively assess the determinants of home death for patients receiving home-based palliative care. Data collected from biweekly telephone interviews with caregivers (n=302) and program databases were entered into a multivariate logistic model. Patients with high nursing costs (odds ratio [OR]: 4.3; confidence interval [CI]: 1.8-10.2) and patients with high personal support worker costs (OR: 2.3; CI: 1.1-4.5) were more likely to die at home than those with low costs. Patients who lived alone were less likely to die at home than those who cohabitated (OR: 0.4; CI: 0.2-0.8), and those with a high propensity for a home-death preference were more likely to die at home than those with a low propensity (OR: 5.8; CI: 1.1-31.3). An understanding of the predictors of place of death may contribute to the development of effective interventions that support home death.

The Effect of Community-Based Specialist Palliative Care Teams on Place of Care

BACKGROUND: Prior research on community-based specialist palliative care teams used outcome measures of place of death and/or dichotomous outcome measures of acute care use in the last two weeks of life. However, existing research seldom measured the diverse places of care used and their timing prior to death.

OBJECTIVE: The study objective was to examine the place of care in the last 30 days of life.

METHODS: In this retrospective cohort study, patients who received care from a specialist palliative care team (exposed) were matched by propensity score to patients who received usual care in the community (unexposed) in Ontario, Canada. Measured was the percentage of patients in each place of care in the last month of life as a proportion of the total cohort.

RESULTS: After matching, 3109 patients were identified in each group, where 79% had cancer and 77% received end-of-life home care. At 30 days compared to 7 days before death, the exposed group's proportions rose from 33% to 41% receiving home care and 14% to 15% in hospital, whereas the unexposed group's proportions rose from 28% to 32% receiving home care and 16% to 22% in hospital. Linear trend analysis (proportion over time) showed that the exposed group used significantly more home care services and fewer hospital days (p < 0.001) than the unexposed group. On the last day of life (place of death), the exposed group had 18% die in an in-patient hospital bed compared to 29% in usual care.

CONCLUSION: Examining place of care in the last month can effectively illustrate the service use trajectory over time.

Main causes of death in Dande, Angola: results from verbal autopsies of deaths occurring during 2009–2012

bACKGROUND - The Dande Health and Demographic Surveillance System (HDSS) located in Bengo province, Angola, covers nearly 65,500 residents living in approximately 19,800 households. This study aims to describe the main causes of deaths (CoD) occurred within the HDSS, from 2009 to 2012, and to explore associations between demographic or socioeconomic factors and broad mortality groups (Group I-Communicable diseases, maternal, perinatal and nutritional conditions; Group II-Non-communicable diseases; Group III-Injuries; IND-Indeterminate). Methods - Verbal Autopsies (VA) were performed after death identification during routine HDSS visits. Associations between broad groups of CoD and sex, age, education, socioeconomic position, place of residence and place of death, were explored using chi-square tests and fitting logistic regression models. Results - From a total of 1488 deaths registered, 1009 verbal autopsies were performed and 798 of these were assigned a CoD based on the 10th revision of the International Classification of Diseases (ICD-10). Mortality was led by CD (61.0%), followed by IND (18.3%), NCD (11.6%) and INJ (9.1%). Intestinal infectious diseases, malnutrition and acute respiratory infections were the main contributors to under-five mortality (44.2%). Malaria was the most common CoD among children under 15 years old (38.6%). Tuberculosis, traffic accidents and malaria led the CoD among adults aged 15–49 (13.5%, 10.5 % and 8.0% respectively). Among adults aged 50 or more, diseases of the circulatory system (23.2%) were the major CoD, followed by tuberculosis (8.2%) and malaria (7.7%). CD were more frequent CoD among less educated people (adjusted odds ratio, 95% confidence interval for none vs. 5 or more years of school: 1.68, 1.04–2.72). Conclusion - Infectious diseases were the leading CoD in this region. Verbal autopsies proved useful to identify the main CoD, being an important tool in settings where vital statistics are scarce and death registration systems have limitations.

Quality of cause-of-death reporting using ICD-10 drowning codes : a descriptive study of 69 countries

Background: The systematic collection of high-quality mortality data is a prerequisite in designing relevant drowning prevention programmes. This descriptive study aimed to assess the quality (i.e., level of specificity) of cause-of-death reporting using ICD-10 drowning codes across 69 countries.---------- Methods: World Health Organization (WHO) mortality data were extracted for analysis. The proportion of unintentional drowning deaths coded as unspecified at the 3-character level (ICD-10 code W74) and for which the place of occurrence was unspecified at the 4th character (.9) were calculated for each country as indicators of the quality of cause-of-death reporting.---------- Results: In 32 of the 69 countries studied, the percentage of cases of unintentional drowning coded as unspecified at the 3-character level exceeded 50%, and in 19 countries, this percentage exceeded 80%; in contrast, the percentage was lower than 10% in only 10 countries. In 21 of the 56 countries that report 4-character codes, the percentage of unintentional drowning deaths for which the place of occurrence was unspecified at the 4th character exceeded 50%, and in 15 countries, exceeded 90%; in only 14 countries was this percentage lower than 10%.---------- Conclusion: Despite the introduction of more specific subcategories for drowning in the ICD-10, many countries were found to be failing to report sufficiently specific codes in drowning mortality data submitted to the WHO.

Learning from sustainable landscapes of death in Bali : landscape planning and Tri Hita Karana

Landscape planning in many countries is predicated upon on fulfilling the functions for human living objectives. Many land use practices have been plotted for living, busines~, trading, industrial, farming as well as providing places for dead people primarily through cemeteries. Research in Palm Beach County, FL, has demonstrated the need to plan for 30 years of demand of land use functions to service death (Coutts, Basmaj ian et al. 20 I I). Coutts et al assert that planners are required and responsible for the planning of funeral necessities. Therefore, the protection of landscapes of death is an important consideration in the planning of landscapes. Bali is popular with its beautiful landscape, hospitality, and traditional architecture as demonstrating the integrity between human, environment and God, as expressed in the Balinese Tri Hita Karana concept. Balinese commemorate life from birth to death through their traditional ceremonies which informs their traditional cultural landscape. One of the most important landscapes, which cannot be separated fi·om Balinese life are graveyards which are used for deceased ceremonies. This landscape is an integral part of traditional village patterns across Bali. Culturally, Balinese people have their own traditional cremation ceremony which is call the Ngaben Ceremony. The Ceremony takes place in graveyards and thereupon ashes are placed in the sea waters surrounding Bali. An interesting point of planning in Bali is how to enable eco-friendly interment extensions to villages. This is occurring because of the increasing number of corpses that require cremation thus necessitating no accretions in land provision of graveyards. This research investigates the landscape of death in Bali expressed in its traditional values in the area of planning which implicate sustainable environments and land conservation topics. Other functions of graveyards, as noted by Strangstad ( 1988), include ceremonial and their role as educational tools for history lessons, art, sociology, geology, English lessons, as well as for scavenger hunts.

Tapes, Transgression and Mundanity: the participatory engenderment of death metal and grindcore

Since its origins in the early 1980s, the popular rise of extreme metal throughout the globe has been phenomenal. The emergence of extreme metal's most sonically transgressive subgenres of death metal and grindcore between the mid 1980s and the early 1990s, however, was not an easy one. Indeed, during this period, the only way for globally dispersed extreme metal fans and unsigned extreme metal bands to stay musically connected was via the underground practice of tape-trading. The aim of this study is to illuminate the impact of tape-trading upon the global spread of extreme metal. The study will situate the historical context of extreme metal tape-trading by exploring how it emerged, and why it was necessary in the first place. Utilising the concept of 'extreme metal scene', the study will focus on the central scenic discourse of transgression and explore how this was negotiated into the mundane scenic practice of tape-trading. In relation to this, and utilising the concept of participatory culture, the study will further explore how the music arose and spread throughout the globe via the socially networked practice of both musician and non-musician tape-traders in relation to the tape cassette technology itself. Ethnographic interviews were undertaken with both types of traders in order to gain a deeper understanding of the phenomenon in question. The research concludes that the tape-traders were able to challenge the status quo of record company gatekeepers, by facilitating the engenderment and global distribution (including the later commercial distribution) of death metal and grindcore. Such powerfully affective music via its continual global spread, offers as it did for the original tape-traders, a pleasurable and empowering communal/personal space for disempowered people throughout the globe. Further research into extreme metal tape-trading would require deeper exploration into other extreme metal subgenres, especially black metal, tape-traders situated outside of North America and Europe, women tape-traders as well as exploration of the phenomenon after the early 1990s.

Tapes, Transgression and Mundanity: the participatory engenderment of death metal and grindcore

Since its origins in the early 1980s, the popular rise of extreme metal throughout the globe has been phenomenal. The emergence of extreme metal's most sonically transgressive subgenres of death metal and grindcore between the mid 1980s and the early 1990s, however, was not an easy one. Indeed, during this period, the only way for globally dispersed extreme metal fans and unsigned extreme metal bands to stay musically connected was via the underground practice of tape-trading. The aim of this study is to illuminate the impact of tape-trading upon the global spread of extreme metal. The study will situate the historical context of extreme metal tape-trading by exploring how it emerged, and why it was necessary in the first place. Utilising the concept of 'extreme metal scene', the study will focus on the central scenic discourse of transgression and explore how this was negotiated into the mundane scenic practice of tape-trading. In relation to this, and utilising the concept of participatory culture, the study will further explore how the music arose and spread throughout the globe via the socially networked practice of both musician and non-musician tape-traders in relation to the tape cassette technology itself. Ethnographic interviews were undertaken with both types of traders in order to gain a deeper understanding of the phenomenon in question. The research concludes that the tape-traders were able to challenge the status quo of record company gatekeepers, by facilitating the engenderment and global distribution (including the later commercial distribution) of death metal and grindcore. Such powerfully affective music via its continual global spread, offers as it did for the original tape-traders, a pleasurable and empowering communal/personal space for disempowered people throughout the globe. Further research into extreme metal tape-trading would require deeper exploration into other extreme metal subgenres, especially black metal, tape-traders situated outside of North America and Europe, women tape-traders as well as exploration of the phenomenon after the early 1990s.

The place of writing in first grade Kuwaiti english education : a sociological case study

A hybridized society, Kuwait meshes Islamic ideologies with western culture. Linguistically, English exists across both foreign language and second language nomenclatures in the country due to globalization and internationalization which has seen increasing use of English in Kuwait. Originally consisting of listening, speaking, reading and writing, the first grade English curriculum in Kuwait was narrowed in 2002 to focus only on the development of oral English skills, and to exclude writing. Since that time, both Kuwaiti teachers and parents have expressed dissatisfaction with this curriculum on the basis that this model disadvantages their children. In first grade however, the teaching of pre-writing has remained as part of the curriculum. This research analyses the parameters of English pre-writing and writing instruction in first grade in Kuwaiti classrooms, investigates first grade English pre-writing and writing teaching, and gathers insights from parents, teachers and students regarding the appropriateness of the current curriculum. Through interviews and classroom observations, and an analysis of curriculum documents, this case study found that the relationship between oral and written language is more complex than suggested by either the Kuwaiti curriculum reform, or international literature concerning the delayed teaching of writing. Intended curriculum integration across Kuwait subjects is also far more complex than first believed, due to a developmental mismatch between English pre-writing skills and Arabic language capabilities. Findings suggest an alternative approach to teaching writing may be more appropriate and more effective for first Grade students in the current Kuwait curriculum context. They contribute also to an emerging interest in the second and foreign language fields in the teaching of writing to young learners.

Social justice and high-quality human services : visioning the place of a contemporary professional association

The current world situation is plagued by “wicked problems” and a widespread sense of “things are going to get worse”. We confront the almost imponderable consequences of global habitat destruction and climate change, as well as the meltdown of the financial markets with their largely yet to be seen damage to the “real economy”. These things will have considerable negative impacts on the social system and people's lives, particularly the disadvantaged and socially excluded, and require innovative policy and program responses delivered by caring, intelligent, and committed practitioners. These gargantuan issues put into perspective the difficulties that confront social, welfare, and community work today. Yet, in times of trouble, social work and human services tend to do well. For example, although Australian Social Workers and Welfare and Community Workers have experienced phenomenal job growth over the past 5 years, they also have good prospects for future growth and above average salaries in the seventh and sixth deciles, respectively (Department of Education, Employment and Workplace Relations, 2008). I aim to examine the host of reasons why the pursuit of social justice and high-quality human services is difficult to attain in today's world and then consider how the broadly defined profession of social welfare practitioners may collectively take action to (a) respond in ways that reassert our role in compassionately assisting the downtrodden and (b) reclaim the capacity to be a significant body of professional expertise driving social policy and programs. For too long social work has responded to the wider factors it confronts through a combination of ignoring them, critiquing from a distance, and concentrating on the job at hand and our day-to-day responsibilities. Unfortunately, “holding the line” has proved futile and, little by little, the broad social mandate and role of social welfare has altered until, currently, most social programs entail significant social surveillance of troublesome or dangerous groups, rather than assistance. At times it almost seems like the word “help” has been lost in the political and managerial lexicon, replaced by “manage” and “control”. Our values, beliefs, and ethics are under real threat as guiding principles for social programs.