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The policy and health service background to this discussion are the radical changes in cancer services currently underway in the wake of the Calman-Hine Report and the wider changes ushered in by the NHS and Community Care Act 1990 (UK). Using the changing face of hospice care as the focus, the authors explore some of the potential issues and dilemmas involved in providing supportive care for cancer patients and their families. Three 'themes', or areas of concern, are highlighted: links between services, changing organizational factors, and increasing 'medical imperialism'. Potential benefits and drawbacks of the changing ethos and organizational structures are discussed. Interview data are used as 'triggers' for the presentation of the authors' own reflections on developments in the hospice and cancer services' arenas. The paper draws on interview data collected in the pilot phase of a 3-year study on the psycho-social needs of cancer patients and their informal carers in north-west England. Twenty-nine interviews were conducted with a range of professionals involved in the provision of cancer services in Lancaster and Kendal. In the spirit of 'gathering thoughts' and facilitating debate, a commentary on developments in the hospice sector is offered rather than any firm conclusion.

Summary We describe a class of models for the investigation of possible raised risk of disease around putative sources of environmental pollution. An adaptation of the point process method suggested by Diggle and Rowlingson is presented, allowing the use of routinely available aggregated data and incorporating the more general distance–risk model suggested by Elliott and co-workers. An application to data on cancers of the stomach around municipal solid waste incinerators is presented.

This paper outlines a qualitative exploratory study of the individual experiences of older people who practise Tai Chi for health. The study aimed to identify factors that influence the attraction of Tai Chi for older people. Participants were recruited from a selection of Tai Chi clubs in the north of England. Participant and non-participant observation of a selection of Tai Chi practice sessions was undertaken along with interviews with 7 older people. Findings show that individuals who practice Tai Chi report a variety of immediate and lasting physical and mental benefits. Being part of a group that both learns and practises Tai Chi together appears to be important to the experience and awareness of the spiritual nature of Tai Chi was also reported. It is argued that older people who practise Tai Chi may have a particular view on ageing, health and well-being that the activity of Tai Chi allows them to express and future study intends to investigate this in more detail.

In response to a Request for Proposal (RFP) issued by the AIAA Airbreathing Propulsion Technical Committee, a team of undergraduate students at Georgia Institute of Technology proposed CELESTE, a cost-effective, low-noise, efficient, Supersonic Business Jet (SBJ) turbofan engine, which is capable of an entry into service of 2010, as mandated by the RFP. The RFP stipulated that the powerplant must meet several stringent criteria, including maximum noise levels during takeoff, a maximum tip diameter, and an ability to operate on a specified supersonic business jet airframe that meets certain performance requirements. The figures of merit for CELESTE are the thrust specific fuel consumption for the proposed powerplant, the maintenance and acquisition costs, and the weight of the engine and aircraft. In October 2004, the CELESTE design team at Georgia Institute of Technology was officially awarded first place in the AIAA Undergraduate Team Engine Design Competition.

The place of death of cancer patients has become an important theme in UK cancer and palliative care policy. This paper examines the place of death preferences of 41 terminally ill cancer patients and 18 of their informal carers, living in the Morecambe Bay area of north-west England. We interviewed cancer patients referred to the research team by 13 specialist palliative care professionals; patients had an estimated 3 months of life remaining. The study design involved an in-depth qualitative interview with each patient soon after referral to the study, followed by an interview some 4 weeks later and subsequent tracking interviews by telephone at 2–4 week intervals until death occurred. Interviews were also conducted with main coresident carers soon after patient referral to the study and again in the post-bereavement period. Thirteen factors were identified as shaping the place of death preference of patients and carers. These are organised into four thematic domains: the informal care resource, management of the body, experience of services, and existential perspectives. In documenting these factors, this paper adds significantly to current knowledge on the factors that shape place of death preference, a field of enquiry acknowledged to be underdeveloped (J. Palliative Med. 3 (2000) 287). More importantly, it uncovers some of the reasons that underpin these preferences. Our research revealed a much stronger preference for deaths in a hospice than had been anticipated, leading us to take a qualified stance on the current policy drive in favour of home deaths by those charged with delivering UK cancer and palliative care services.

In a study of psychosocial needs amongst cancer patients, the possession of a religious faith has been identified as a significant factor in determining a range of psychosocial needs. Of the 354 respondents to a questionnaire, which included a comprehensive psychosocial needs inventory, 83% said they had a religious faith, and in general these patients were less reliant on health professionals, had less need for information, attached less importance to the maintenance of independence and had less need for help with feelings of guilt, with their sexuality or with some practical matters than those who said they had no religious faith. In addition, they had fewer unmet needs overall (32% compared with 52%). The knowledge of a patient's spirituality should help service providers to predict aspects of psychosocial need and to respond sensitively and appropriately to a patient's experience of cancer.

Cancer and faith. Having faith – does it make a difference among patients and their informal carers? This research considers the impact of having a religious faith on the cancer experience of patients and informal carers, focusing primarily on the association between faith and psychosocial needs. A questionnaire survey of 1000 patients in the north-west of England returned 402 completed questionnaires; around two-thirds of patients indicated they had an informal carer. Using logistic regression analysis, we examine the relationship between the importance of 48 needs and faith for 189 paired patients and carers, while controlling for the effect of eight socio-demographic and clinical variables. Patients with expressed faith identified fewer psychosocial needs than those without faith. In contrast, carers with expressed faith identified more needs than those without faith in relation to support from family and neighbours. Carers also needed more help with finding a sense of purpose and meaning, and help in dealing with unpredictability. Not surprisingly, both patients and carers with faith identified a greater need for opportunities for personal prayer, support from people of their own faith and support from a spiritual adviser. Various explanations of these differences between patients and carers are proposed. The crucial point is that one should not too readily assume that the cancer experience is shared in the same way by patients and carers. In understanding the faith dimension, one needs to consider both the spiritual and secular aspects of having a religious faith.

OBJECTIVES To examine the associations between temperature, housing, deprivation and excess winter mortality using census variables as proxies for housing conditions. DESIGN Small area ecological study at electoral ward level. Setting Great Britain between 1986 and 1996. PARTICIPANTS Men and women aged 65 and over. MAIN OUTCOME MEASURES Deaths from all causes (International Classification of Diseases, Ninth Revision [ICD-9] codes 0-999), coronary heart disease (ICD-9 410-414), stroke (ICD-9 430-438) and respiratory diseases (ICD-9 460-519). Odds of death occurring in winter period of the four months December to March compared to the rest of the year. RESULTS During the study period (excluding the influenza epidemic year of 1989/90), a total of 1,682,687 deaths occurred in winter and 2,825,223 deaths occurred during the rest of the year among people aged > or =65 (around 30,000 excess winter deaths per year). A trend of higher excess winter mortality with age was apparent across all disease categories (P < 0.01). There was a significant association between winter mortality and temperature with a 1.5% higher odds of dying in winter for every 1 degrees C reduction in 24-h mean winter temperature. The amount of rain, wind and hours of sunshine were inversely associated with excess winter mortality. Selected housing variables derived from the English House Condition Survey showed little agreement with census-derived variables at electoral ward level. For all-cause mortality there was little association between deprivation and excess winter mortality, although lack of central heating was associated with a higher risk of dying in winter (odds ratio [OR] = 1.016, 95% CI : 1.009-1.022). CONCLUSIONS Excess winter mortality continues to be an important public health problem in Great Britain. There was a strong inverse association with temperature. Lack of central heating was associated with higher excess winter mortality. Further work is needed to disentangle the complex relationships between different indicators of housing quality and other measures of socioeconomic deprivation and their relationship to the high number of excess winter deaths in Great Britain.

Joint interviewing lies somewhere between individual in-depth interviews and focus groups in the panoply of qualitative methodology, yet it has been little explored or described in health research. This article sets out to reflect on the process of choosing to combine joint and individual interviews in the context of a study on the needs of cancer patients and their carers. Questions of intrusion, inclusion, power, and difference caused the researchers to refine their research methods and become more responsive to the preferences of their participants. The article goes on to describe the kind of data generated by joint interviewing and to consider questions of analysis. The author concludes by suggesting that in appropriate circumstances, joint interviewing offers a valuable method of enquiry.

OBJECTIVE: To investigate the risk of adverse birth outcomes associated with residence near landfill sites in Great Britain. DESIGN: Geographical study of risks of adverse birth outcomes in populations living within 2 km of 9565 landfill sites operational at some time between 1982 and 1997 (from a total of 19 196 sites) compared with those living further away. SETTING: Great Britain. SUBJECTS: Over 8.2 million live births, 43 471 stillbirths, and 124 597 congenital anomalies (including terminations). MAIN OUTCOME MEASURES: All congenital anomalies combined, some specific anomalies, and prevalence of low and very low birth weight (

We describe a matched case-control study investigating the association between respiratory illness and proximity of residence to main roads. The study was carried out in response to previously inconsistent reports on this question1-3; the null hypothesis was of no association of traffic related air pollution to respiratory illness, hospital admissions for asthma and chronic obstructive airways disease. The study focused on Tower Hamlets, East London where hospital admissions for asthma are 80% above national rates.1 2 The cases were extracted from the medical summaries of sequential emergency medical admissions through the casualty departments at The Royal London Hospitals in 1991–1992. Patient records with a diagnosis of asthma or chronic obstructive airways disease, and resident in Tower Hamlets, were identified. Individually matched controls (also obtained from emergency medical admissions through the casualty departments) with a non-chest related illness were selected based on sex, year of admission and consultant team. The selection method of these controls precludes surgical, orthopaedic or trauma cases. Overall, 82% of the pairs were matched to within five years, the remainder to within 10 years. For each case and control, address, ethnic group, whether there had been treatment in intensive therapy, and whether there had been any re-admission during that year, were extracted. Smoking data were too incomplete to be used. Using the Address-point software the addresses of cases and controls were expressed as a grid reference for all but eight participants. This software allows each postal address to be located to the “front …

This conceptual paper examines the stakeholder salience model proposed by Mitchell, Agle, and Wood (1997) and applies it to three explanations of corporate philanthropy: (1) theories of strategic p...