Epidemiological study of oesophageal and gastric cancer in south-east England

Background: This epidemiological study was carried out to establish the magnitude of the changing incidence of gastric and oesophageal cancer. Methods: Time-trend analyses of subsite-specific cancers of the oesophagus and stomach were performed using data from the Thames Cancer Registry database (1960-1996) for the South Thames Region. The changes in sex ratio and peak age of incidence are reported. Results: In the upper two-thirds of the oesophagus there was no significant change in the incidence rate, but the lower third of the oesophagus showed a marked rise for both sexes (average annual change + 0.05 for men, + 0.009 for women). For the gastric cardia, the incidence in males increased (average annual change + 0.025), while in females it remained unchanged. Cancers of the oesophagogastric junction showed a clear increase for both sexes (average annual change + 0.07 for men, + 0.009 for women). There were changes in the sex ratio and peak age of incidence for all subsite cancers for both sexes. Conclusion: Over a 37-year period the incidence of cancer of the oesophagogastric junction increased threefold, while the incidence of cancers of the other subsites of the stomach decreased. Further studies are needed to investigate the aetiology of these changes.

South East London Palliative and End of Life Care Education and Training Strategy: Meeting the Education and Training Needs of the Health & Social Care Workforce Involved in the Care of Patients and Carers at the End of Life.

EXECUTIVE SUMMARY Aims 1. The aims of this strategy are • to ensure that a full range of education and training related to the adult end of life care pathway is available across South East London to meet the needs of our health and social care workforce • to enable those responsible for end of life care education and training commissioning to procure comprehensively from a full range of education providers in a systematic and strategic manner. Background 2. The work that underpins this strategy was begun by the South East London Cancer Network via its Palliative and End of Life Care Coordinating Group and then developed by way of the Marie Curie Delivering Choice Programme’s Education and Training work stream.

Sustainability and local tourism branding in England's South Downs

This paper reports on a stakeholder consultation exercise that examined the tourism industry's perception of developing a local tourism branding scheme within the South Downs' protected areas in south-east England. The research shows that such schemes could offer potential benefits that are recognisable by the tourism industry, while helping to meet the statutory aims of the protected area. The paper records the perceptions of small tourism businesses, their fears, awareness of tourism impacts, perceptions of sustainable tourism and of local branding, and key criteria connected to the future organisation of a local tourism branding scheme. The conclusion lists the recommendations for the implementation of a local branding scheme, including grassroots stakeholder consultation that encourages ownership and participation, institutional frameworks that support capacity-building and the importance of developing core values within a local brand.

Culture-bound technological solutions: An artificial theoretic insight

Sometimes, technological solutions to practical problems are devised that conspicuously take into account the constraints to which a given culture is subjecting the particular task or the manner in which it is carried out. The culture may be a professional culture (e.g., the practice of law), or an ethnic-cum-professional culture (e.g., dance in given ethnic cultures from South-East Asia), or, again, a denominational culture prescribing an orthopraxy impinging on everyday life through, for example, prescribed abstinence from given categories of workday activities, or dietary laws. Massimo Negrotti's Theory of the artificial is a convenient framework for discussing some of these techniques. We discuss a few examples, but focus on the contrast of two that are taken from the same cultural background, namely, technological applications in compliance with Jewish Law orthopraxy. •Soya-, mycoprotein- or otherwise derived meat surrogates are an example ofnaturoid; they emulate the flavours and olfactory properties, as well as the texture and the outer and inner appearance, of the meat product (its kind, cut, form) they set out to emulate (including amenability to cooking in the usual manner for the model), while satisfying cultural dietary prohibitions. •In contrast, the Sabbath Notebook, a writing surrogate we describe in this paper, is atechnoid: it emulates a technique (writing to store alphanumeric information), while satisfying the prohibition of writing at particular times of the liturgical calendar (the Sabbath and the major holidays).

Exploring strategies for promoting the use of research findings in practice

Following the integration of nurse and midwifery education into institutions of higher education in the United Kingdom, a number of studies have shown that a defined clinical framework for nursing and midwifery lecturers in practice areas is lacking. The aim of this study was to explore strategies that nurse and midwifery lecturers from one higher education institution in south east England can use to work collaboratively with nurses and midwives to promote the utilization of research findings in practice. A cross-sectional survey using a structured questionnaire was sent to a sample of 60 nurse and midwifery lecturers and 90 clinical managers. Response rates of 67% (40) and 69% (62) respectively were obtained. The main strategies suggested were to make clinical staff more aware of what research exist in their specialties; to help them to access research information from research databases; and to critically appraise this information. Other strategies were for teachers to run research workshops on site; to undertake joint research projects with clinical staff; to set up journal clubs or research interest groups; and to help formulate clinical guidelines and protocols which are explicitly research-based.

A price worth paying?: Women and work – choice, constraint or satisficing

Purpose – Are women held back or holding back? Do women choose their jobs/careers or are they structurally or normatively constrained? The purpose of this paper is to shed fresh light on these questions and contribute to an on-going debate that has essentially focused on the extent to which part-time work is women’s choice, the role of structural and organisational constraints and the role of men in excluding women. Design/methodology/approach – The paper uses data from interviews with 80 working women – both full-time and part-time – performing diverse work roles in a range of organisations in the south east of England. Findings – It was found that many women do not make strategic job choices, rather they often ‘‘fall into’’ jobs that happen to be available to them. Some would not have aspired to their present jobs without male encouragement; many report incidents of male exclusion; and virtually all either know or suspect that they are paid less than comparable men. Those working reduced hours enjoy that facility, yet they are aware that reduced hours and senior roles are seen as incompatible. In short, they recognise both the positive and negative aspects of their jobs, whether they work full or part-time, whether they work in male-dominated or female-dominated occupations, and whatever their position in the organisational hierarchy. Accordingly, the paper argues that the concept of ‘‘satisficing’’, i.e. a decision which is good enough but not optimal, is a more appropriate way to view women’s working lives than are either choice or constraint theories. Originality/value – There is an ongoing, and often polarised, debate between those who maintain that women choose whether to give preference to work or home/family and others who maintain that women, far from being self-determining actors, are constrained structurally and normatively. Rather than supporting these choice or constraint theories, this paper argues that ‘‘satisficing’’ is a more appropriate and nuanced concept to explain women’s working lives.

We could make a meal out of nothing: contested explanations of inequalities in health

This paper reports on the qualitative findings from a comparative study of public health and lifestyles in South East England and Northern France, regions with similar geographic and economic characteristics. Data from health surveys showed that both countries had an increasing BMI with age, particularly in Northern France. This was despite the finding that the percentage eating fresh fruit and vegetable at least five days a week in Northern France increased with age (from well over 50% to over 90%) compared to around 50% to around 75% in South East England. Qualitative data on health inequalities and how they could be addressed were gathered by focus groups sampling from five tiers using the Townsend Index for comparability (14 in England with 106 participants overall; 13 in France with 143 participants). Both had about two thirds women participants, with a preponderance of middle aged and older people. There was a striking difference in the salience of diet between the two countries; in the French data it was raised only 14 times, whereas in England there were 165 occurrences, and these were often distinguished by their use of narrative. Older respondents contrasted the pressures on families today and the expense of fresh fruit and vegetables with their own childhood or childrearing, when cheap meals could be created using skills which have now been lost. These data therefore provide further evidence that providing food is a moral activity.

Exploring strategies for promoting the use of research findings in practice

Following the integration of nurse and midwifery education into institutions of higher education in the United Kingdom, a number of studies have shown that a defined clinical framework for nursing and midwifery lecturers in practice areas is lacking. The aim of this study was to explore strategies that nurse and midwifery lecturers from one higher education institution in south east England can use to work collaboratively with nurses and midwives to promote the utilization of research findings in practice. A cross-sectional survey using a structured questionnaire was sent to a sample of 60 nurse and midwifery lecturers and 90 clinical managers. Response rates of 67% (40) and 69% (62) respectively were obtained. The main strategies suggested were to make clinical staff more aware of what research exist in their specialties; to help them to access research information from research databases; and to critically appraise this information. Other strategies were for teachers to run research workshops on site; to undertake joint research projects with clinical staff; to set up journal clubs or research interest groups; and to help formulate clinical guidelines and protocols which are explicitly research-based.

The exposure to verbal abuse of student nurses gaining placement experience

Clinical placement experience has a key role to play in the socialisation and preparation of future members of the nursing profession. Aggression experienced by healthcare workers is currently receiving considerable attention and student nurses have been identified as a group vulnerable to experiencing workplace abuse (Little 1999). The primary aim of the study is to gain a greater understanding of the nature, severity, frequency and sources of verbal abuse experienced by student nurses in health care settings in the south east of England, using as a definition, “the use of inappropriate words… causing distress” (Department of Health 2003). A convenience sample of 156 third year student nurses of all four branches of one preregistration nursing programme in the south east of England was studied with questionnaires distributed retrospectively; 11 4 student nurses returned the questionnaires equating to a response rate of 73%. Results 46% of respondents reported experiencing verbal abuse, 39% had witnessed other students experiencing verbal abuse and 61% reported that they were aware of other students experiencing verbal abuse. Students reported experiencing threats to kill, racial abuse, sexually orientated verbal abuse and bullying while gaining placement experience. Student nurses are a high risk group for experiencing verbal abuse whilst gaining placement experience.In the literature, mental health and learningdisability settings are viewed as high risk areasfor experiencing aggression (Beech and Leather 2003); this study suggests that student nurses experience verbal abuse in a variety of settings and verbal abuse may be more prevalent on general medical and surgical wards than previously expected.