Population density and cancer mortality by gender and age in England and Wales and the Western World 1963–93

The aetiology of malignant disease is multi-factorial, including contributory environmental factors. Based upon the premise that increases in the density of population will be coterminous with a worsening of the environment, it is hypothesised that such changes should be reflected in an increase in cancer mortality in general and in elderly populations. By focusing upon changes in the elderly (+75) deaths between two time periods, the study corrects for age factors related to cancer mortality.The study tests this hypothesis via correlations between population density and malignancy death rates in general and elderly age bands over a thirty year period.It was found that there were positive and significant correlations between population density and malignancy mortality rates in the Western World, especially amongst men, but all correlations strengthened in the direction hypothesised. The findings were not an artefact of longevity, further research is required to give a better understanding of these findings.     

Longitudinal perspectives on caregiving, employment history and marital status in midlife in England and Wales

In this paper, we examine associations between employment history and marital status and unpaid care provision among those aged 40-59 in England and Wales. We used data from a large nationally representative longitudinal study, the Office for National Statistics Longitudinal Study. Initially based on a sample drawn from the 1971 Census, in 2001 this study included data on 110,464 people aged 40-59 of whom 5% provided 20 or more hours per week of unpaid care. We analysed associations between caregiving of this intensity and current employment, employment history, employment characteristics, marital status, and employment after childbearing. Among men, caregiving was associated with a history of lower levels of employment. The small group of men with a history of least employment were 70% more likely to provide care than those with a history of most employment. Among women, caregiving was associated with a history of non-employment, but there were no differences between those with fully engaged and partially engaged labour market histories. Analyses of a subset of data on women who had a child between 1981 and 1991 showed that those who had returned to full-time paid work by 1991 were over 50% less likely to later become caregivers. Some associations between employment characteristics and propensity to provide 20 or more hours per week of care were also identified. Those in public sector jobs and those previously in employment with a caregiving dimension were 20-30% more likely than other working women to provide unpaid care. These results suggest a continuing gender dimension in care provision which interacts with marital status and employment in gender-specific ways. It also suggests that implementation of strategies to enable those in midlife to combine caregiving and work responsibilities, should they wish to do so, should be an urgent priority.     

Health needs of prisoners in England and Wales: the implications for prison healthcare of gender, age and ethnicity

This paper aims to provide evidence of the healthcare needs of prisoners in relation to gender, age and ethnicity, drawing from a larger systematic overview of the policy and research literature concerning primary care nursing in prisons in England and Wales. The literature overview shaped the initial stages of a research project funded by the Department of Health to examine the views and perspectives of prisoners and nurses working in prisons, and to identify good primary care nursing in the prison environment. At total of 17 databases were searched using search terms related to primary healthcare in prisons (health, nurs*, primary care, healthcare, family medicine, prison*, offender*, inmate*) with terms truncated where possible in the different databases. Following this, a sifting phase was employed using inclusion/exclusion criteria to narrow and focus the literature perceived as relevant to the research questions. All papers were critically appraised for quality using standardised tools. Findings from the literature overview show that prisoners are more likely to have suffered some form of social exclusion compared to the rest of society, and there are significantly greater degrees of mental health problems, substance abuse and worse physical health in prisoners than in the general population. Women, young offenders, older prisoners and those from minority ethnic groups have distinct health needs compared to the prison population taken as a whole, with implications for the delivery of prison healthcare, and how these needs are met effectively and appropriately.     

The Geography of a rapid rise in elderly mortality in England and Wales, 2014-15

Since at least the early 1900s almost all affluent nations in the world have continually experienced improvements in human longevity. Using ONS mid-year population and deaths estimates for Local Authorities for England and Wales, we show that these improvements have recently reversed. We estimate that in England and Wales there were 39,074 more deaths in the year to July 2015 as compared to the year to July 2014 (32,208 of these were of individuals aged 80+). We demonstrate that these increases occurred almost everywhere geographically; in poor and affluent areas, in rural and urban areas. The implications of our findings are profound given what has come before them, combined with the current political climate of austerity.     

Differences in breast cancer incidence in Australia and England by age,extent of disease and deprivation status: women diagnosed 1980–2002

Objective: To compare breast cancer incidence in England and Australia by age, extent of disease and deprivation. Methods: We analysed data for women aged 15–99 years diagnosed with breast cancer in England or Australia during the period 1990 to 1994, and in West Midlands or New South Wales during the period 1980 to 2002. We calculated three‐year rolling average incidence rates and incidence rate ratios (IRR) between West Midlands and New South Wales by age, extent of disease and category of deprivation. Results: Breast cancer incidence was higher in England than in Australia, and in West Midlands than in New South Wales but became more similar over time. Socio‐economic differences in incidence were greater in New South Wales than in West Midlands. The most deprived women in West Midlands were diagnosed at a later stage of disease than the most deprived women in New South Wales. Incidence among elderly women was higher in West Midlands than in New South Wales. There were also high proportions of tumours with unknown stage among elderly women in West Midlands. Conclusions: Although the overall incidence of breast cancer is similar, differences by age, extent of disease and deprivation exist. Implications: The underlying reasons for these patterns require further examination.     

Policy and action for cancer prevention – highlights from a new report by the World Cancer Research Fund and the American Institute for Cancer Research

In 2007, the World Cancer Research Fund/American Institute for Cancer Research produced food, nutrition and physical activity recommendations for personal and public health goals for reducing cancer risk. A companion publication, Policy and Action for Cancer Prevention , addresses the external influences on people's eating and physical activity habits over a lifetime and evaluates potential actions to change these behaviours. The Policy Report makes recommendations for policies and actions that will help achieve the public health goals for reducing cancer risk. The recommendations are addressed to policy-makers and decision-takers at international, national and local level. These recommendations, if implemented, will help influence and change the lifestyle choices that people make, thereby reducing the risk of cancer and other chronic diseases within the population. The overarching message of the Policy Report is that public health is everyone's business. The protection and improvement of public health does not happen by accident – it requires policies and actions to be implemented by all relevant sectors of society.     

Semi-parametric models of long- and short-term survival: an application to the analysis of breast cancer survival in Utah by age and stage

A flexible class of semi-parametric survival models is proposed that takes account of long- and short-term covariate effects in cancer survival. The diversity of responses described by the models include non-proportional and crossing survival curves as well as a fraction of long-term survivors. Restricted non-parametric maximum likelihood estimation procedures (RNPMLE) are developed to provide point estimates, confidence intervals and tests for the models. Numerical algorithms to fit semi-parametric survival models are emphasized. The methods are applied to analyse post-treatment survival of breast cancer patients diagnosed in Utah by age and stage.     

Enabling ‘citizen voice’ in the English health and social care system: A national survey of the organizational structures,relationships and impacts of local Healthwatch in England

BackgroundLocal Healthwatch have been operating since 2013 as ‘consumer champions’ in health and social care in England. There is little evidence about how they operate and the daily practices through which they seek to represent citizen views and influence others.ObjectiveTo explore (a) the current organizational arrangements, relationships and impact of local Healthwatch in England, and (b) to what extent do these vary across local Healthwatch organizations.DesignAn online survey of all 150 local Healthwatch in England between December 2018 and January 2019. The survey comprised 47 questions and used a combination of closed‐ and open‐response questions.ResultsWe received responses from 96 local Healthwatch (68% response rate). Most local Healthwatch reported that they are ‘independent’ organizations that only do Healthwatch‐related work (58.3%) and are funded through a contract (79.2%). Budget cuts have affected four‐fifths of local Healthwatch (79.3%) since 2013. Three‐quarters (74%) of local Healthwatch currently receive funding external to that provided by their local authority for their Healthwatch functions. Most Healthwatch engage with only one CCG (56.3%), one mental health trust (82.3%) and one community health trust (62.5%), though 59.4% engage with more than one hospital trust. Healthwatch respondents overwhelmingly reported impacts that were local in nature.ConclusionsGeographical and historical factors, the quality and quantity of their relationships with stakeholders, and different funding arrangements all contribute to high variability in the structure and activities of local Healthwatch and to shaping the nature of their work and impact across England.     

DDT and breast cancer in young women: new data on the significance of age at exposure

BACKGROUND: Previous studies of DDT and breast cancer assessed exposure later in life when the breast may not have been vulnerable, after most DDT had been eliminated, and after DDT had been banned. OBJECTIVES: We investigated whether DDT exposure in young women during the period of peak DDT use predicts breast cancer. METHODS: We conducted a prospective, nested case-control study with a median time to diagnosis of 17 years using blood samples obtained from young women during 1959-1967. Subjects were members of the Child Health and Development Studies, Oakland, California, who provided blood samples 1-3 days after giving birth (mean age, 26 years). Cases (n = 129) developed breast cancer before the age of 50 years. Controls (n = 129) were matched to cases on birth year. Serum was assayed for p,p'-DDT, the active ingredient of DDT; o,p'-DDT, a low concentration contaminant; and p,p'-DDE, the most abundant p,p'-DDT metabolite. RESULTS: High levels of serum p,p'-DDT predicted a statistically significant 5-fold increased risk of breast cancer among women who were born after 1931. These women were under 14 years of age in 1945, when DDT came into widespread use, and mostly under 20 years as DDT use peaked. Women who were not exposed to p,p'-DDT before 14 years of age showed no association between p,p'-DDT and breast cancer (p = 0.02 for difference by age). CONCLUSIONS: Exposure to p,p'-DDT early in life may increase breast cancer risk. Many U.S. women heavily exposed to DDT in childhood have not yet reached 50 years of age. The public health significance of DDT exposure in early life may be large.     

A multicentric prospective open trial on the quality of life and oxidative stress in patients affected by advanced head and neck cancer treated with a new benzoquinone-rich product derived from fermented wheat germ (Avemar)

Background and aim  Anorexia/cachexia syndrome is frequently correlated with increased oxidative stress (OS). A fermented wheat-germ extract with a standardized benzoquinone content (brand name Avemar) has been shown to exert an intense antioxidant activity with no side effects. The aim of this study was to investigate the effects of Avemar in patients affected by head and neck cancer, correlating the variations with OS with the quality of life as assessed by the Spitzer’s index Patients and methods  A cohort of 60 patients affected by head and neck tumours (stage IIIa, IIIb, IV) were enrolled in the study following an open-label protocol. The patients were assigned to two subgroups, A or B. Group A was treated with conventional oncological therapy alone, and group B was treated with Avemar in addition to standard therapy. After 2 months only 55 patients survived and could be evaluated (29 in the control group and 26 in the Avemar group). Each patient was checked for circulating concentrations of hydroperoxides using the FRAS III test Results  The levels of OS significantly decreased after 2 months in the group receiving Avemar (group). The value of Spitzer’s index was significantly higher in group B, attesting to an improved quality of life Conclusion  Although the specific active substance in Avemar has not yet been identified, the reduction in free oxygen radicals induced by it is correlated with a clinically significant improvement in the quality of life in patients with advanced cancer