Place, cause and expectedness of death and relationship to the deceased are associated with poorer experiences of end-of-life care and challenges in early bereavement: Risk factors from an online survey of people bereaved during the COVID-19 pandemic

ObjectivesTo identify clinical and demographic risk factors for sub-optimal end-of-life care and pandemic-related challenges prior to death and in early bereavement.DesignOnline open national survey of adults bereaved in the UK from 16 March 2020-5 January 2021, recruited via media, social media, national associations and organisations.SettingGeneral population, UK.Participants711 participants, mean age 49.5 (SD 12.9, range 18-90). 395 (55.6%) had experienced the death of a parent, 152 (21.4%) a partner. 628 (88.6%) were female and 33 (4.7%) from a minority ethnic background. The mean age of the person who died was 72.2 (SD 16.1, range miscarriage to 102 years). 311 (43.8%) deaths were from confirmed/suspected COVID-19, and 410 (57.8%) deaths occurred in hospital.Main outcome measuresEnd-of-life care experiences (six items, e.g. involvement in care decisions) and pandemic-related challenges before and after death (six items, e.g. unable to visit prior to death).ResultsDeaths in hospital/care home increased the likelihood of: unable to visit prior to death, unable to say goodbye as wanted, limited contact in last days of life (all P<0.001). Deaths in hospice/at home increased the likelihood of: involved in care decisions (P<0.001), well supported by healthcare professionals (HCPs) after the death (P=0.003). Hospice deaths increased the likelihood of being given bereavement support information, which was least likely for care home deaths (P<0.001). Hospital deaths decreased the likelihood of knowing the contact details for the responsible care professional (P=0.001). Bereavement due to COVID-19 decreased the likelihood of: involvement in care decisions (P<0.001), feeling well supported by HCPs after the death (P<0.001), and increased the likelihood of: being unable to say goodbye (OR=0.348; 95% CI: 0.2 to 0.605), social isolation and loneliness (OR=0.439; 95% CI: 0.261 to 0.739), limited contact with relatives/friends (OR=0.465; 95% CI: 0.254 to 0.852). Expected deaths were associated with higher likelihood of feeling involved, informed, and well supported by HCPs (all P<0.001). The deceased being a partner or child increased the likelihood of knowing the contact details for the responsible care professional (P=0.001), being able to visit (P<0.001) and given bereavement support information (P<0.001). Being a bereaved partner strongly increased odds of social isolation and loneliness, e.g. OR = 0.092 (95% CI: 0.028 to 0.297) partner versus distant family member.ConclusionsFour clear risk factors were found for poorer end-of-life care and pandemic-related challenges in bereavement: place, cause and expectedness of death, and relationship to the deceased.What is already known on this topic?Since the start of the pandemic, over 20 million family members and friends have been bereaved due to COVID-19, with millions more bereaved due to other causes.Bereavement of any cause during the COVID-19 pandemic is associated with specific challenges, including limited access to people before their death, pressure on health and social care providers, quarantining due to infection or exposure, lockdowns and social distancing.There remains little evidence to inform optimal clinical practice, bereavement support and the policy response to COVID-19 as a mass bereavement event.What this study addsOur study highlights four risk factors for poorer end-of-life care and increased risk of pandemic-related challenges in early bereavement: place, cause and expectedness of death and relationship to the deceased.COVID-19 deaths, hospital and care home deaths and unexpected deaths were generally associated with poorer outcomes, while being a partner of the person who died (regardless of cause) and bereavement due to COVID-19 increased the odds of experiencing social isolation and loneliness in bereavement.These factors should be taken into account in clinical practice, policy and bereavement support.

Assessing Responsible Care implementation for sustainability in Malaysian chemical industries

PurposeThe Responsible Care programme was first introduced in Canada in 1985 and now is implemented worldwide as one of the chemical industries' commitments to improve the industries' public image as well as their performance in health, safety and environmental aspects. In Malaysia, the Responsible Care programme has been implemented since 1994 with a current total of 148 companies pledged to implement it in their company; however, the effectiveness of the programme remains unknown. Hence, this paper aims to assess the effectiveness of the Responsible Care programme in improving performance in the environment, health and safety in terms of documentation, training, selection processes and stakeholders' engagement for the sustainability of chemical industries.Design/methodology/approachA survey was administered to the Responsible Care signatory companies in Malaysia. Of these, a total of 132 member companies either produced or provided services related to chemical products.FindingsThe majority of signatory companies agreed that the Responsible Care programme did improve their performance in the environment, health and safety. Besides that, the signatory companies were also keeping up their commitment to ensuring documentation, training, selection process and stakeholders' engagement run smoothly in line with Responsible Care's mission.Originality/valueAfter more than two decades of implementation in Malaysia, it is important to assess the Responsible Care programme's effectiveness. As an increasing number of chemical firms, without good management, it will possibly pose a danger to the environment and human health and safety. Through assessment, advances in Responsible Care management practices will considerably increase programme effectiveness in terms of environmental health and safety.

Women Healing the Globe, Preserving the Tibetan Plateau

The Tibetan Plateau’s Permafrost is melting at an alarming rate. Six of the world’s major rivers are sourced in the Tibetan Himalayas that are warming at a faster rate than the rest of the earth. If the temperature of the region continues to increase, the rivers will dry up and the earth will warm at an even faster rate. Buddha Yeshe Tsogyal (ye shes mTsho rgyal) (757–817 CE), long considered the Mother of Tibetan Tantric Buddhism, was the consort of Padmasambhava. She reached “complete liberation” or Nirvana in a single lifetime. Her stories are preserved in rman thar. Her life was an exemplary practice of compassion, responsible care, and non-violence toward all sentient beings and the world. Can we follow her proto-eco-feminist example? Can we build responsible care for our planet and humanity across disciplines and faith traditions? What does compassionate, non-violent Buddhist thought and Roman Catholic pastoral care bring to eco-feminism? Can an eco-feminist epistemology informed by Buddhist EcoDharma construct programs of sustainability into humanity’s excessive habits integrating science’s ability to quantify, with Buddha nature? Can Catholicism’s pastoral ability to show dependence on God, the peaceful, compassionate Creator of all allow us to see our dependence on God and our earth? Many women have already begun this work around the globe. In 2002, Rosemary Radford Ruether brought 16 women together from around the globe in Women Healing Earth: Third World Women on Ecology, Feminism, and Religion to tell us how they are doing it and succeeding. Each is highlighted here for their visions on how to heal the planet at the grassroots level. From their insights, this article explores their contributions as being still relevant today and adding new concerns about the dangers arising on the Tibetan Plateau. The article emphasizes their ideas, provides a warning and other ideas that collective activation might inspire to address climate change.

Awards for the Chemical Industries in Italy, from the Responsible Care Program, Examples of Sustainable Development

In this note are reported the awards of the Responsible Care program of Federchimica the Italian Association of Chemical Industries attributed to industries that operate in the following strategies of Sustainable Development: the modification of the processes in order to decrease the consume of energy and water and to decrease the amount of produced wastes the transformation of the wastes of the industrial plants and of the products on the market in useful products or new raw materials; the use of biomass as raw material; the teaching of Sustainable Development to students and to employees in order to increase safety in the work. The awards have been attributed to projects from 2017 to 2020 realized in industrial plants in Italy or in the towns where the industries have the plants.

The Command to Rule over the Creation (Gen 1:26–28) in the Ecological Hermeneutics of the Bible

In the discussions on the possible religious background of the current ecological crisis, the biblical text of Genesis 1:26–28 is the passage most often quoted by all sides of the debate. While for some it is an incentive to unlimited exploitation, and the resultant degradation of the natural environment, for others it carries a positive ecological message and a call for responsible care of the created world. Due to this ambiguity in interpretations, this article attempts to resolve whether the biblical text itself is problematic, and requires correction, or whether it is ecologically adequate, and it is the interpretations that have been thus far insufficient. Each of the three main currents of the ecological hermeneutics of the Bible (apologetic, radical, and neo-orthodox) offers its own specific answer to this question.

Simplified and Integrated Management System for Responsible Care (SIMS-RC) in chemical industries

Purpose The purpose of this paper is to explore the barriers and challenges faced by chemical industries in Malaysia causing to the low participation in Responsible Care program. Also, this paper aims to propose a solution to address the issues in implementing Responsible Care by introducing a Simplified and Integrated Management System for Responsible Care. Design/methodology/approach A questionnaire was distributed to 132 Responsible Care signatory companies in Malaysia, and they were given a week to return it via e-mail. Combining the inputs from the survey and document analysis, a Simplified and Integrated Management System for Responsible Care (SIMS-RC) was proposed. Findings Responsible Care signatory companies faced barriers in implementing product stewardship code and they also faced challenges in getting employees’ commitment from all levels. Taking the inputs received from Responsible Care signatory companies and document analysis, an SIMS-RC was proposed as a closed-loop process which consists of quality, environmental, health and safety management system. Research limitations/implications Some of the chemical companies were unable to share their thoughts in the survey due to the companies’ confidential reason. Originality/value Abundant literature has discussed about the limitation of Responsible Care that needs to be improved. Therefore, several elements and procedures of the program need to be revised and innovated to help the signatory companies to continuously improve their performances and encourage more participation in Responsible Care program. The findings will add value to the current body of knowledge and Responsible Care signatory companies which seek to improve Responsible Care implementation through an integrated management system approach. The proposed SIMS-RC is a simple, integrated, holistic and process-oriented management system in which it blends Responsible Care into quality, environmental, health and safety management system.