Bangladesh, Developing countries, International Development, Happiness, Quality of Life, Culture, Poverty, Relationships,

1 WeD -Wellbeing in Developing Countries ESRC Research GroupWeD is a multidisciplinary research group funded by the ESRC, dedicated to the study of poverty, inequality and the quality of life in poor countries. The research group is based at the University of Bath and draws on the knowledge and expertise from three different departments (Economics and International Development, Social and Policy Sciences and Psychology) as well as an extensive network of overseas contacts and specific partnerships with institutes in Bangladesh, Ethiopia, Peru and Thailand. The purpose of the research programme is to develop conceptual and methodological tools for investigating and understanding the social and cultural construction of well-being in specific countries. Correspondence SUMMARYThe idea of personal autonomy is central to many accounts of eudaimonic well-being. Yet it is often criticised as a Western concept celebrating individualism and independence over group obligations and interdependence or dependence. This paper rejects this view and argues that coherent accounts of autonomy must always recognize the interdependence of people in groups, and that autonomy can coexist with substantial relationships of dependence. It illustrates this drawing on evidence from Bangladesh, a poor country usually absent from crosscultural studies and one where personal relationships of hierarchy and dependence are endemic. Argument and evidence is presented showing the coexistence of personal autonomy and dependence, and the relationship between collective action and autonomy. We also address some of the specific problems encountered in researching autonomy in a social context where it is mainly expressed in relational forms. We conclude that autonomy can be directed toward both personal and social goals, and can be enacted individually, or by participation in groups. Autonomy is a universal psychological need but its expression is always contextual.

Drawing on research from Bangladesh, this article questions the dominance of a narrow view of sustainability that rests predominantly on financial considerations. The push for financial sustainability has produced ambiguous results and, more important, has also introduced a degree of uncertainty into the relationship nongovernmental organizations maintain with their members. This article will argue that in the context of Bangladesh, an accurate notion of sustainability rests more on social and political considerations than on economic ones. Fundamental tensions exist between social/political and economic considerations, and paradoxically, the relentless pursuit of one may undermine efforts to establish the other. The article therefore seeks to subject the logic and validity of efforts to promote sustainability among nongovernmental organizations in Bangladesh to theoretical and empirical scrutiny.

Background: Renal impairment is a potent risk factor for stroke, which remains a leading cause of death and disability. Thrombolysis for acute ischemic stroke has transformed patient outcomes, although the safety and efficacy of this approach remain poorly characterized in patients with renal dysfunction, who manifest a higher risk of bleeding due to uremia. We therefore examined the impact of renal impairment on clinical outcomes with thrombolysis within the current 4.5-hour therapeutic window. Methods: This retrospective multicenter cohort study (2009–2011) examined 229 stroke patients receiving thrombolysis with alteplase (0.9 mg/kg; mean age 70 ± 13 years; 59% male, 24% diabetic). Sixty-five patients had an estimated glomerular filtration rate (eGFR) <60 ml/min. The primary outcome was the improvement in National Institutes of Health Stroke Scale (NIHSS) score at 24 h. Secondary outcomes included the NIHSS score at 7 days, the incidence of symptomatic and asymptomatic intracranial hemorrhage (ICH), extracranial bleeding and death during the index hospitalization. Univariate and multivariate regression analyses were performed to determine the association between demographic characteristics and comorbid factors of interest and outcomes. eGFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. Results: There was no significant difference in mean time to thrombolysis between the groups (221 ± 66 vs. 220 ± 70 min from symptom onset; p = 0.9). An eGFR <60 ml/min was independently associated with a statistically significant reduction of the therapeutic effect of alteplase at 24 h on multivariate regression [coefficient –2.3, 95% confidence interval (CI) –3.7 to –0.9; p = 0.002], and this persisted at 7 days (coefficient –3.5, 95% CI –5.3 to –1.7; p < 0.001). On modeling eGFR as a continuous variable, every 10 ml/min decline in eGFR was associated with a 0.40 diminution in NIHSS score improvement with alteplase (95% CI 0.07–0.74; p = 0.02). Older age and a higher presenting NIHSS score were associated with a greater therapeutic effect (p = 0.04 and p < 0.001, respectively). In-patient mortality was 5%, with no significant differences between groups. Renal impairment was not associated with a higher rate of ICH (6.2 vs. 6.7%; p = 0.9). Greater NIHSS score at presentation was the only factor associated with a greater risk of death (odds ratio 1.24, 95% CI 1.10–1.40; p < 0.001) and ICH (odds ratio 1.12, 95% CI 1.03–1.23; p = 0.004). Conclusions: Our results suggest that renal impairment is associated with reduced efficacy of thrombolysis in acute ischemic stroke without any excess hemorrhagic complications. This may relate to diminished fibrinolysis in the uremic milieu or differences in infarct anatomy. Longer-term prospective studies are required to characterize and improve functional outcomes following stroke in a manifestly high-risk group.

Since the early 1980s non-governmental organisations have become a major phenomenon in development, and a focus of attention for academics and practitioners alike. The study of NGOs tends to emphasise their role in the delivery of welfare services and pays less attention to their political significance. This despite numerous claims about the contribution of NGOs to civil society and democracy. The article draws on ethnographic research carried out in Bangladesh to explore in more detail the NGO-politics nexus. It demonstrates that there is a strong but complex link between NGOs and politics. On the one hand it confirms the political nature of NGO intervention and activity. On the other hand it highlights how the organisation of politics through NGOs reproduces clientelistic forms of action. This apparent paradox runs counter to most of the assumptions underpinning NGO research. The article closes by exploring this paradox and offering illustrations of how it may actually be an effective form of social action for the poor.