Patterns of coronary heart disease mortality over the 20th century in England and Wales : possible plateaus in the rate of decline

Background
Coronary heart disease (CHD) rates in England and Wales between 1950 and 2005 were high and reasonably steady until the mid 1970s, when they began to fall. Recent work suggests that the rate of change in some groups has begun to decrease and may be starting to plateau or even reverse.

Methods
Data for all deaths between 1931 and 2005 in England and Wales were grouped by year, sex, age at death and contemporaneous ICD code for CHD as cause of death. CHD mortality rates by calendar year and birth cohort were produced for both sexes and rates of change were examined.

Results
The pattern of increased burden of CHD mortality within older age groups has only recently emerged in men, whereas it has been established in women for far longer. CHD mortality rates among younger people showed little variation by birth cohort. For younger women (49 and under), the rate of change in CHD mortality has reversed in the last 20 years, indicating a future plateau and possible reversal of previous improvement in CHD mortality rates. Among younger men the rate of change in CHD mortality has been consistent for the past 15 years indicating that rates in this group have continued to fall steadily.

Conclusion
Although CHD mortality rates continue to drop in older age groups the actual burden of coronary heart disease is increasing due to the ageing of the population. The rate of improvement in CHD mortality appears to be beginning to decline and may even be reversing among younger women.

Coronary heart disease trends in England and Wales from 1984 to 2004 : concealed levelling of mortality rates among young adults

Background: Trends in cardiovascular risk factors among UK adults present a complex picture. Ominous increases in obesity and diabetes among young adults raise concerns about subsequent coronary heart disease (CHD) mortality rates in this group.

Objective: To examine recent trends in age-specific mortality rates from CHD, particularly those among younger adults.

Methods and results: Mortality data from 1984 to 2004 were used to calculate age-specific mortality rates for British adults aged 35+ years, and joinpoint regression was used to assess changes in trends. Overall, the age-adjusted mortality rate decreased by 54.7% in men and by 48.3% in women. However, among men aged 35–44 years, CHD mortality rates in 2002 increased for the first time in over two decades. Furthermore, the recent declines in CHD mortality rates seem to be slowing in both men and women aged 45–54. Among older adults, however, mortality rates continued to decrease steadily throughout the period.

Conclusions: The flattening mortality rates for CHD among younger adults may represent a sentinel event. Deteriorations in medical management of CHD appear implausible. Thus, unfavourable trends in risk factors for CHD, specifically obesity and diabetes, provide the most likely explanation for the observed trends.

The naming of child homicide offenders in England and Wales: the need for a change in law and practice

Judicial decisions about whether or not to publicly name child homicide offenders have long ani- mated debate in the United Kingdom and internationally. This article draws on case law and in- depth interviews conducted with members of the English criminal justice system to critically analyse the viability of current domestic legislation in the context of the UK’s international human rights obligations. The article identifies ambiguities surrounding the definition of ‘public interest’ in law; the merits of equating the naming of child offenders with open justice, accountability and transpar- ency; and the increasing sabotage of the principle of rehabilitation. By identifying the complexities of this contentious area of judicial discretion, this article highlights the need for a rights-based approach to decisions about publicly naming children in conflict with the law.

Retrials of persons acquitted of indictable offences in England and Australia: exceptions to the rule against double jeopardy

Jury directions in relation to the issue of consent in trials of sexual offence cases are mandated in two jurisdictions in Australia (Victoria and the Northern Territory). The Australian Law Reform Commission, in conjunction with the New South Wales Law Reform Commission, has recommended that provisions similar to those in Victoria should be contained in relevant legislation in all States and Territories. However, a recent series of cases in Victoria has revealed significant problems in relation to the mandatory jury directions. These difficulties have generated increasingly elaborate and complex directions. The complexity of these directions not only presents considerable challenges for judges but also may overwhelm, rather than assist, members of the jury. The Court of Appeal of Victoria has called for "urgent and wholesale reform". In the light of these concerns, it is suggested that the Victorian mandatory directions do not provide a model for other jurisdictions. Rather, the Victorian experience can be seen as a cautionary tale of the problems and pitfalls of such directions. Recently, the Victorian government has passed the Jury Directions Act 2013. This Act sets out "guiding principles" that should determine the content, and use, of jury directions. These guiding principles should form the basis for any jury directions with respect to sexual offences.

The breast cancer related burden of morbidity and mortality in six European coutries

Background: The burden of breast cancer expressed in Disability Adjusted Life Years (DALYs) was compared for six European countries and its sensitivity to different sources of variation examined. Methods: DALYs were calculated using country-specific epidemiological data and European Disability Weights. Epidemiological data for 1996 were obtained for Denmark, England and Wales, France, the Netherlands, Spain and Sweden. Disability weights were empirically derived. Results:  Denmark and the Netherlands lost the largest number of DALYs (approximately 1100 DALYs per 100,000 women). They were followed by England (87% of the Danish burden), France (72%), Sweden (68%) and Spain (67%). 70 to 80% of the burden was caused by mortality. Cross-national variation in disease epidemiology was the largest source of variation in the burden of breast cancer. Variation in disability weights and uncertainty in epidemiological data had smaller effects. Conclusion: To compare the burden of breast cancer and most other types of cancer mortality rates provide sufficient information.

Animals in international development, poverty reduction and sustainable livelihoods

This paper explores the role and percept¡ons of an¡mals in internat¡onal development efforts and the possible contradictions between differing priorities of agencies involved in internat¡onal charitable efforts. The description ofthe differing descriptions of purposes in the (England and Wales) Charities Act of 2006 prov¡des a good starting point. There are many available purposes for charities, and although having one purpose does not preclude a second, organizations concerned with animal welfare appear to be quite d¡stinct from those work¡ng for poverty alleviation in the developing world. A fun and novel gift of a donkey may equally be perceived as a cruel, environmentally unsustainable and misguided development effort, a valuable asset for a household, or a burden to a household struggling to feed existing mouths..... This paper questions the underlying tensions between human development, animal welfare, and poverty alleviation exploring cultural tensions, philosophical tens¡ons and where areas of common ground may be found.

Media pressures and corporate disclosure of social responsibility performance information : a study of two global clothing and sports retail companies

This paper investigates the social and environmental disclosure practices of two large multinational companies, specifically Nike and Hennés & Mauritz. Utilising a joint consideration of legitimacy theory and media agenda setting theory, we investigate the linkage between negative media attention, and positive corporate social and environmental disclosures. Our results generally support a view that for those industry-related social and environmental issues attracting the greatest amount of negative media attention, these corporations react by providing positive social and environmental disclosures. The results were particularly significant in relation to labour practices in developing countries - the issue attracting the greatest amount of negative media attention for the companies in question.

MAAGs: the next generation. A study of the development of medical audit advisory groups and the arrangements for supporting clinical audit in primary care

Background: MAAGs have, historically, been disparate organisations with a lack of central direction, albeit with the same goal: to develop and support the performance of audit in primary care. This goal has been (and is being) achieved in a number of ways all over the country. In the last two years, MAAGs have witnessed many changes in primary care and are adapting themselves to suit these new arrangements at a local level.

Aim: To formalise our knowledge of where MAAGs are going, how they are getting there and the support they are receiving.

Method: A postal questionnaire to the 104 MAAGs in England and Wales, addressing 6 main issues of relevance to the development of MAAGs and the support they are receiving.

Results: At least two MAAGs have dissolved, leaving a possible total of 102 still in existence. Of these, 76 (74.5%) responded to the survey. The composition of the MAAG committee has changed dramatically since the inception of MAAGs in 1990, and staffing levels appear to have risen substantially. MAAGs appear to be more adequately funded by their health authorities than has previously been reported and many are actively seeking additional sources of funding. There is still large variation in levels of MAAG funding. Furthermore, funding is unrelated to the number of GPs or practices served. Security for MAAG staff appears to have been addressed in many areas, with 84% of MAAGs having at least one member of staff on a permanent employment contract. Many MAAGs are developing rolling programmes in an attempt to eliminate the short-sighted approach to the development of clinical audit that has existed since MAAGs were first set up.

Conclusion: Many MAAGs (with the obvious exception of those that have been dissolved) appear to be thriving without central direction or initiative. It is now evident that we were a little hasty in our concerns for the future of MAAGs beyond April 1996. It would seem that many organisations have taken the situation which arose two years ago as an opportunity to grow and develop in ways that may not have been possible within the confines of the Health Circular.

Real estate employability : differing perceptions of graduates from undergraduate and postgraduate courses

Purpose – Employability is likely to be at the forefront of any degree applicant's mind in England and Wales due to an impending large increase in the cost of tuition. The purpose of this paper is to report the findings of a Centre for Education in the Built Environment-funded project which has investigated real estate graduate competencies and employability. The paper concentrates on significant differences in emphasis by graduates from undergraduate (UG) and postgraduate (PG) courses.

Design/methodology/approach – Following an extensive literature review, 72 competencies have been identified and the Confederation of British Industry classification of knowledge, skills and attributes has been adopted. An online survey of 639 graduates (half UG and half PG) asked respondents to complete five-point Likert attitude scales to rate how their course enabled development of the 72 competencies. Themes developed from the results of the questionnaire study have been explored in greater detail with five real estate education providers and the human resource managers of four large London employers.

Findings – Rather surprisingly, UGs rated their gaining of the vast majority of the competencies more highly than PGs. This finding seems to be at odds with the impression given by the educators and employers, both of whom perceive a preference for the greater maturity and commercial awareness of graduates from PG courses.

Originality/value – Real estate course providers can use the results of this study to ensure that their programmes of study adequately address what is likely to become the crucial factor in the choice of any future programme of study – employability.

The mandatory life sentence for murder : an argument for judicial discretion in England

In 1965, alongside the abolition of capital punishment, a mandatory life sentence for murder was implemented in England and Wales. The mandatory life sentence served as a signal to the public that the criminal justice system would still implement the most severe sanction of life imprisonment in cases of murder. Nearly 50 years later, this article examines whether the imposition of a mandatory life sentence for murder is still in the best interests of justice or whether English homicide law would be better served by a discretionary sentencing system. In doing so, the article considers debates surrounding the political and public need for a mandatory life sentence for murder by drawing upon interviews conducted with 29 members of the English criminal justice system. This research concludes that a discretionary sentencing framework is required to adequately respond to the many contexts within which the crime of murder is committed.

A comparison study of children's independent mobility in England and Australia

We compared independent mobility (freedom to move around the neighbourhood – or similar – without adult accompaniment) among English and Australian schoolchildren. Parents reported mobility licences granted to their children (e.g. allowing them to cross main roads alone) and accompaniment on local trips. Children reported travel mode to school. We examined associations between mobility licences and independent school journeys, and accompaniment on local trips. Among 10–12-year-olds, English children had more licences than Australian children. Mobility licences were directly associated with independent school journeys among primary but not among secondary schoolchildren who travelled further; and inversely associated with parental accompaniment to other destinations. Influences on parental restrictions should be examined to promote children's independent mobility.