Inequalities in the incidence of cervical cancer in South East England 2001–2005: an investigation of population risk factors

BACKGROUND: The incidence of cervical cancer varies dramatically, both globally and within individual countries. The age-standardised incidence of cervical cancer was compared across primary care trusts (PCTs) in South East England, taking into account the prevalence of known behavioural risk factors, screening coverage and the deprivation of the area. METHODS: Data on 2,231 cases diagnosed between 2001 and 2005 were extracted from the Thames Cancer Registry, and data on risk factors and screening coverage were collated from publicly available sources. Age-standardised incidence rates were calculated for each PCT using cases of squamous cell carcinoma in the screening age group (25-64 years). RESULTS: The age-standardised incidence rate for cervical cancer in South East England was 6.7 per 100,000 population (European standard) but varied 3.1 fold between individual PCTs. Correlations between the age-standardised incidence rate and smoking prevalence, teenage conception rates, and deprivation were highly significant at the PCT level (p < 0.001). However, screening coverage was not associated with the incidence of cervical cancer at the PCT level. Poisson regression indicated that these variables were all highly correlated and could not determine the level of independent contribution at a population level. CONCLUSION: There is excess disease burden within South East England. Significant public health gains can be made by reducing exposure to known risk factors at a population level

Foraging site recursion by forest elephants Elephas maximus borneensis

Recursion by herbivores is the repeated use of the same site or plants. Recursion by wild animals is rarely investigated but may be ubiquitous. Optimal foraging theory predicts site recursion as a function of the quality of the site, extent of its last use, and time since its last use because these influence site resource status and recovery. We used GPS collars, behaviour and site sampling to investigate recursion to foraging sites for two elephant Elephas maximus borneensis herds in the Lower Kinabatangan Wildlife Sanctuary, Borneo, over a 12 month period. Recursion occurred to 48 out of 87 foraging sites and was most common within 48 hours or between 151–250 days, indicating two different types of recursion. Recursion was more likely to occur if the site had previously been occupied for longer. Moreover, the time spent at a site at recursion was the same as the time spent at the site on the first occasion. The number of days that had passed between the first visit and recursion was also positively correlated with how much time was spent at the site at recursion. Habitat type also influenced the intensity of site-use, with more time spent at recursion within riverine/open grass areas along forest margins compared to other habitat types. Recursion is a common behaviour used by the elephants and its pattern suggests it may be a foraging strategy for revisiting areas of greater value. The qualities of recursion sites might usefully be incorporated into landscape management strategies for elephant conservation in the are

The concept of solidarity: emerging from the theoretical shadows?

The concept of solidarity has been relatively neglected by social scientists since Durkheim's pioneering work in the late 19th century. The discipline of politics has been guilty of overlooking this 'subjective' element of community life, but recent works by Stjernø and Brunkhorst reflect a growing awareness of the theoretical significance of the concept. Whereas early liberal attempts to theorise solidarity took the nation state to be the appropriate community for its realisation, the emergence of globalisation raises the possibility of human solidarity developing in the global community. Traditional forms of solidarity have been dissipated by the social changes accompanying globalisation, but they were often locked into the defence of particular interests. New forms may be emerging to rekindle the broader vision of human solidarity. Recent work by writers such as Habermas, Honneth, Rorty and Touraine focuses on widening and deepening democratic participation and/or the articulation of our ethical obligations in various ways. It is argued here that these perspectives need to be supplemented by a radical humanist approach grounded in a normative theory of human self-realisation

Palliative care needs and integration of palliative care support in chronic obstructive pulmonary disease (COPD): a qualitative study

Background The provision of palliative care for severe chronic obstructive pulmonary disease (COPD) remains low resulting in unmet needs in patients and carers. Research Question This study aimed to 1) explore palliative care needs of patients living with severe COPD and their caregivers, 2) understand views of accessing and providing palliative care and factors influencing these experiences, and 3) explore to what extent palliative care and COPD services have been integrated. Study Design and Methods A multicentre qualitative study was undertaken in COPD services and specialist palliative care in the UK, involving patients with severe COPD, their carers and health professionals. Data were collected using semi-structured interviews and analysed using framework analysis. Themes were integrated using the constant comparison process, enabling systematic data synthesis. Results Four themes were generated from interviews with 20 patients, six carers and 25 health professionals: management of exacerbations, palliative care needs, access to palliative care and pathways, and integration of palliative care support. Uncertainty and fear were common in patients and carers, with identified needs for reassurance, rapid medical access, home care and finance advice. Timely palliative care was perceived as important by health professionals. Palliative care was integrated into COPD services although models of working varied across regions. Reliable screening tools and needs assessment, embedded psychological care and enhanced training in palliative care and communication skills were perceived important by health professionals for timely palliative care referrals and optimised management. Interpretation Palliative care is increasingly being implemented for non malignant diseases including COPD throughout the UK although models of working vary. A theoretical model is developed to illustrate the concept and pathway of the integration of palliative care support. A standardised screening and needs assessment tool is required to improve timely palliative care and address the significant needs of this population

A visual summary of the EUROCARE-4 results: a UK perspective.

BACKGROUND: This paper provides a one-page visual summary of the previously published relative survival estimates for 42 types of cancers in 23 countries in Europe. METHODS: The cancer patients in these analyses were 15 years or older at the time of their diagnosis in the period 1995-1999. Follow-up was to the end of 2003 and relative survival estimates were computed by the cohort method. RESULTS: The analysis of 1-year survival had good discriminatory power and visibly separated a group of countries with consistently high survival estimates (Switzerland, France, Sweden, Belgium and Italy) and another group of countries with lower estimates (Poland, Czech Republic, Ireland, Denmark and United Kingdom-Northern Ireland). After the first year, there was less variation between the countries. CONCLUSION: To more fully understand the UK situation, a rational comparison would select countries with data-quality, prosperity and healthcare systems that are similar to the United Kingdom. In otherwise comparable populations, a pronounced difference in 1-year survival is most likely to be due to variation in a strong prognostic factor, which exerts its effect in the short term. A likely explanation for the short-term survival deficit in the United Kingdom compared with the Nordic countries is a less favourable stage distribution in the United Kingdom. However, the present superficial analysis does not exclude possible functions for other factors relating to the organisation and quality of cancer care services

Ethnicity coding in a regional cancer registry and in Hospital Episode Statistics

BACKGROUND: The collection of ethnicity information as part of cancer datasets is important for planning services and ensuring equal access, and for epidemiological studies. However, ethnicity has generally not been well recorded in cancer registries in the UK. The aim of this study was to determine the completeness of ethnicity coding in the Thames Cancer Registry (TCR) database and within the Hospital Episode Statistics (HES) data as held by the London Health Observatory, and to investigate factors associated with ethnicity being recorded. METHODS: Records for 111821 hospital admissions of London residents with a malignant cancer as a primary diagnosis between April 2002 and March 2003 and records for 25581 London residents diagnosed with cancer in 2002 were examined. Data on sex, age, cancer network of residence, deprivation, proportion of non-whites in the local authority population, and site of cancer were available. The proportion of patients in each group with a valid ethnicity code was calculated. In the TCR data proportions were also calculated adjusted for all other variables. RESULTS: Ethnicity was recorded for 90661 (81.1%) of the hospital admissions in the HES data and 5796 (22.7%) patients on the TCR database. Patients resident in areas with a higher proportion of non-white residents and the most deprived populations were more likely to have an ethnic code on the TCR database, though this pattern was not seen in the HES data. Adjustment did not materially affect the association between deprivation and ethnicity being recorded in the TCR data. CONCLUSION: There was a large difference in completeness of ethnicity between the data sources. In order to improve the level of recording in TCR data there needs to be better recording of ethnicity in sources TCR data collection staff have access to, or use of information from other sources e.g. electronic data feeds from hospitals or pathology laboratories, or HES data itself supplied directly to TCR. Efforts to collect ethnicity data should be encouraged in all healthcare settings. Future research should explore where the difficulties collecting ethnicity information lie, whether with patients, healthcare professionals or the recording procedure, and how such problems can be overcome

Standard of civilization, nomadism and territoriality in nineteenth-century international society

In this chapter, the encounter between the Russian Empire and the nomads of the Eurasian steppe in the nineteenth century is analyzed using the theoretical framework of the standard of civilization. The creation of the Westphalian state-model in Europe in the seventeenth century, linked to the later emergence of the notion of the standard of civilization led to the ‘othering’ of the nomads of the Eurasian steppe as barbarians, as a threat to the borders of civilized Europe. The chapter presents also an argument to define ‘territoriality’ as not only an institution of international society of the time but also as a distinctive quality and requirement for being considered ‘civilized’. In this analytical framework, the nomads become the ‘other’, the ‘alien’, the ‘menace’, onto which projections of rationality and modernity were cast in order to prevent threats to Russia’s European and civilized identity. The chapter sheds light on the encounter between ‘fixed’ and ‘mobile’ units in the course of expansion of international society; contextualizes the role played by nomadic tribes in resisting the application of Westphalian spatial categories in the Eurasian space; and scrutinizes what the role of nomads was in constructing a European, civilized identity.PostprintPeer reviewe

The Concept of Transparency in International Relations: towards a critical approach

Transparency is an important concept in International Relations. The possibility of realizing transparency in practice operates as a central analytical axis defining distinct positions on core theoretical problems within the field, from the security dilemma to the function of international institutions and beyond. As a political practice the pursuit of transparent governance is a dominant feature of global politics, promoted by a wide range of actors across a vast range of issue areas, from nuclear proliferation to Internet governance to the politics of foreign aid. Yet, despite its importance, precisely what transparency means or how the concept is understood is frequently ill-defined by academics and policy-makers alike. As a result, the epistemological and ontological underpinnings of approaches to transparency in IR often sit in tension with their wider theoretical commitments. This article will examine the three primary understandings of transparency used in IR in order to unpack these commitments. It finds that while transparency is often explicitly conceptualized as a property of information, particularly within rationalist scholarship, this understanding rests upon an unarticulated set of sociological assumptions. This analysis suggests that conceptualizing ‘transparency-as-information’ without a wider sociology of knowledge production is highly problematic, potentially obscuring our ability to recognize transparent practices in global governance. Understanding transparency as dialogue, as a social practice rooted in shared cognitive capacities and epistemic frameworks, provides a firmer analytical ground from which to examine transparency in International Relations

Losing Sight of Land: Tales of Dyslexia and Dyspraxia in Psychophysical Actor Training

This article reports on the findings of a research project into the impact of psychophysical actor training methods on neurodiverse students. It illustrates how the application of a Social Theory of Learning Difference reveals the mechanisms whereby these training methods dysconsciously discriminate against those students who are dyslexic and/or dyspraxic learners. The research findings recognise the inherent value of psychophysical methods in the training of actors but suggests that there is a need to move away from a singular Psycho-Medical Theory of Learning Difference and to adopt a framework of learning difference based on the Social Model of (dis)ability, which requires institutions to adapt their provision to better meet a diverse range of needs. A revision of psychophysical approaches is proposed, which draws on a neuroscientific theory of experiential practice and a psychological framework of actor engagement. This new approach seeks to enhance the effective communication of embodied knowledge and skills in diverse actor training contexts and to allow students who are dyslexic and/or dyspraxic learners equal access to that learning