Family intervention in a prison environment : a systematic literature review

Background The prison population in England and Wales is approximately 85,000, and elevated rates of mental health difficulties have been reported among the prisoners. Despite frequent recommendations for family interventions to optimise prisoner outcomes, the evidence for its use and impact in prison remain unclear. Aim The aim of the study is to conduct a systematic review of published literature on family interventions in prisons. Methods Embase, PsychINFO and Medline were searched using terms for family interventions and for prisoners or young offenders. No limit was imposed on study design, but, for inclusion, we required that papers were written in English and published in peer‐reviewed journals. Results Nine hundred eighty‐three titles were retrieved. Twenty‐two met criteria for inclusion. Three were case studies, 12 were descriptive, 6 were quasi‐experimental and one was a randomised controlled trial. Interventions and study methods were too heterogeneous for meta‐analysis. All studies gave positive conclusions about family interventions, but empirical data on effectiveness were slight. Conclusions Consistency in findings across the wide‐ranging studies suggested that family therapies may indeed be helpful for prisoners and their families, so further research is warranted. The fact that a randomised controlled trial proved feasible should encourage researchers to seek more robust data and to determine which form of intervention is effective and in which circumstances. It would also be useful to develop an improved understanding of mechanisms of change

Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial

Background: The EMPA KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. Methods: EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. Findings: Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5–2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62–0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16–1·59), representing a 50% (42–58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). Interpretation: In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. Funding: Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council

Destruktivt entreprenörskap : Fusket/missbruket med assistansersättningen

Purpose: The aim is to investigate the mechanisms behind the destructive entrepreneurship in the assistance industry. Method: To investigate the destructive entrepreneurship in the assistance industry, we conducted a qualitative study in the form of semi-structured questions. In total, we interviewed four authorities and an employer organization. Theory: Theoretical framework: The study is based on Baumol's (1990) theory of productive, unproductive and destructive entrepreneurship and rent-seeking by Murphy et al (1991), but the study's principal theory that we have chosen to apply is the routine activity theory of Cohen & Felson (1979) that describes three elements that must come together in order for a crime to be committed. Conclusions and discussion: Our study shows that it is clear that there is both fraud and abuse within the assistance allowance, which can be done in different ways. Some users simulate their illness that they exaggerate their need for assistance. Some assistance providers have abused the compensation by paying lower wages and empty false wages etc. The study showed that there also exists a type of human trafficking. The fraud/abuse includes millions of kroner and it requires several people to accomplish the embezzlement. The most common form in which cheating occurs is limited but it is suspected that the abuse occurs in all forms of assistance other than the cooperative assistance form. The assistance industry is not in a position of being undermined; however, compensation levels may be slightly compressed.Syfte: Syftet är att utreda mekanismerna bakom det destruktiva entreprenörskapet i assistansbranschen. Metod: För att undersöka det destruktiva entreprenörskapet i assistansbranschen har vi genomfört en kvalitativ undersökning i form av semistrukturerade intervjuer. Totalt intervjuade vi fyra myndigheter och en arbetsgivareorganisation. Teoretisk referensram: Studien utgår ifrån Baumols (1990) teori om produktivt, improduktivt samt destruktivt entreprenörskap och privilegiejaktsteorin av Murphy med flera (1991), men studiens huvudteori som vi har valt att tillämpa är rutinaktivitetsteorin av Cohen & Felson (1979) som beskriver tre förutsättningar som måste sammanstråla för att ett brott ska kunna begås. Slutsats och Diskussion: Vår studie visar att det står klart att det förekommer både fusk och missbruk inom assistansersättningen vilket kan utföras på olika sätt. Från att vissa brukare simulerar sin sjukdom till att de överdriver sina assistansbehov. Vissa assistansanordnare har missbrukat ersättningen genom att betala lägre löner och t.o.m. falska löner mm. Studien visade att det också förekommer en typ av människohandel. Fusket/missbruket handlar om miljonbelopp och det krävs ett nätverk av personer för att åstadkomma förskingringen. Den vanligaste formen där fusket förekommer är aktiebolag men det misstänks att missbruket förekommer i alla assistansformerna utom den kooperativa assistansformen. Assistansbranschen riskerar dock inte att undermineras däremot kan ersättningsnivåerna komma att pressas något

Destruktivt entreprenörskap : Fusket/missbruket med assistansersättningen

Purpose: The aim is to investigate the mechanisms behind the destructive entrepreneurship in the assistance industry. Method: To investigate the destructive entrepreneurship in the assistance industry, we conducted a qualitative study in the form of semi-structured questions. In total, we interviewed four authorities and an employer organization. Theory: Theoretical framework: The study is based on Baumol's (1990) theory of productive, unproductive and destructive entrepreneurship and rent-seeking by Murphy et al (1991), but the study's principal theory that we have chosen to apply is the routine activity theory of Cohen & Felson (1979) that describes three elements that must come together in order for a crime to be committed. Conclusions and discussion: Our study shows that it is clear that there is both fraud and abuse within the assistance allowance, which can be done in different ways. Some users simulate their illness that they exaggerate their need for assistance. Some assistance providers have abused the compensation by paying lower wages and empty false wages etc. The study showed that there also exists a type of human trafficking. The fraud/abuse includes millions of kroner and it requires several people to accomplish the embezzlement. The most common form in which cheating occurs is limited but it is suspected that the abuse occurs in all forms of assistance other than the cooperative assistance form. The assistance industry is not in a position of being undermined; however, compensation levels may be slightly compressed.Syfte: Syftet är att utreda mekanismerna bakom det destruktiva entreprenörskapet i assistansbranschen. Metod: För att undersöka det destruktiva entreprenörskapet i assistansbranschen har vi genomfört en kvalitativ undersökning i form av semistrukturerade intervjuer. Totalt intervjuade vi fyra myndigheter och en arbetsgivareorganisation. Teoretisk referensram: Studien utgår ifrån Baumols (1990) teori om produktivt, improduktivt samt destruktivt entreprenörskap och privilegiejaktsteorin av Murphy med flera (1991), men studiens huvudteori som vi har valt att tillämpa är rutinaktivitetsteorin av Cohen & Felson (1979) som beskriver tre förutsättningar som måste sammanstråla för att ett brott ska kunna begås. Slutsats och Diskussion: Vår studie visar att det står klart att det förekommer både fusk och missbruk inom assistansersättningen vilket kan utföras på olika sätt. Från att vissa brukare simulerar sin sjukdom till att de överdriver sina assistansbehov. Vissa assistansanordnare har missbrukat ersättningen genom att betala lägre löner och t.o.m. falska löner mm. Studien visade att det också förekommer en typ av människohandel. Fusket/missbruket handlar om miljonbelopp och det krävs ett nätverk av personer för att åstadkomma förskingringen. Den vanligaste formen där fusket förekommer är aktiebolag men det misstänks att missbruket förekommer i alla assistansformerna utom den kooperativa assistansformen. Assistansbranschen riskerar dock inte att undermineras däremot kan ersättningsnivåerna komma att pressas något

Exploring the Creation of a Destination Brand Identity for Libya

This thesis aims to explore the concept of developing a brand identity for Libya as a tourism destination. The author adopts a model proposed by Iliachenko (2005) to do this. The model is based upon a destination’s culture, history and nature in creating a destination brand identity. The author recognises that this model was proposed as an exploratory tool so he seeks to further explore its usefulness in the destination brand identity development process. Data collection for this thesis adopted a qualitative approach. This involved conducting semi-structured interviews with internal stakeholders in the Libyan tourism sector (Tourism Authority, tourism companies, academic staff, hotel company, Committee for the Preparation of Tourism Master Plan); this was complemented with document analysis. The results of the empirical study identify that the Iliachenko model was reviewed with great satisfaction by the respondents and they identified how Libya might be defined as a destination brand. They also saw a lot of merit in urgently adopting the model in developing a destination brand identity for Libya. The author, however, in analysing the findings, considers the Iliachenko model to be incomplete as a tool to enable a destination brand identity to be developed. To cover these deficiencies the author argues there is a need to add two new elements to the Iliachenko model to represent Libyan tourist destination brand identity, these are: people; and safety and security. In addition, for the model to be useful it must be applied within a political context, defined by processes of governance, economic structure the process of applying the model. In so doing a new model is thus proposed: The Alghalli destination brand identity pentagon (see figure 9.2). This thesis concludes that a tourist destination brand identity for Libya must include a ‘vision’ that promotes ‘Libya as a tourist destination that is safe, secure and also hospitable’. From this a destination brand identity can emerge that captures the personality elements of the destination of Libya as being ‘beautiful, quiet, safe and honest, welcoming and culturally diverse and of great age’. The contribution of this thesis is both practical and theoretical, and it finishes with the identification of areas of further research while the application of the new model in Libya and in different destination contexts