Survival from cancer among children and young adults has improved, but a need remains to care for the one in four who cannot yet be cured. [1][2][3] One component of quality care is to provide it in the place of choice, 3 usually home; we analysed factors affecting place of death. Participants, methods, and resultsWe derived data from death registrations for all cancer deaths (international classification of diseases, 9th revision, codes 140-239) in England and Wales, for 1995-9, for ages 0-24. Age, sex, social class, country of place of birth, geographical location, underlying cause of death, and place of death were available directly. Further potential explanatory variables were a classification of local authority type (rural, urban, inner London, etc) from the Office for National Statistics and deprivation indices for 2000, from the Department of Environment, Transport, and the Regions, at parliamentary ward level (treated as continuous variables, higher scores indicated greater deprivation). We defined two further variables: diagnosis (main primary tumour) and whether or not the cancer was a solid tumour.Response variables indicated whether death took place at home or in hospital, or in a hospice or palliative care unit. We analysed age groups 0-15 (children and adolescents) and 16-24 (young adults) separately. Social class, recategorised on a scale (I-VI, table) and treated as a continuous variable, was based on parents for age range 0-15 years. We used binary logistic regression models in our exploratory analysis to examine associations between place of death and potential explanatory variables. We used multiple logistic regression models to determine the joint effect of variables identified as significant or borderline (P = 0.05-0.1) during exploratory analysis. Odds ratios with 95% confidence intervals are presented.During 1995-9 a total of 3197 deaths from cancer in young people aged 0-24 were registered in England. Of the small number of deaths in hospices, 23 (42.6%) among children and adolescents and 34 (24%) among young adults were from brain cancer (table).Descriptive statistics for cancer deaths registered in England and Wales in 1995-9, for children and adolescents (age range 0-15) and young adults (age range 16-24). Values are numbers (percentages) unless otherwise indicated Age rangeChildren and adolescents (n=1725) Young adults

The objective of this study was to evaluate the impact of the Macmillan GP Facilitator Programme in Palliative Care on the knowledge, attitudes and confidence in symptom control of general practitioners (GPs), communication with patients and out-of-hours practice. GP Facilitators work on average for two sessions a week with practices in their locality. The design included a before and after study, with geographical controls matched on type of area (inner city, urban and rural) and broadly on Jarman scores using postal questionnaires sent to GPs. Scores measured change in GP awareness, attitudes and practice over two years of the intervention, derived from Likert scale responses to the postal questionnaires. Although overall few significant results were found, we did identify an increase in the use of palliative care guidelines in Facilitator districts, together with an increase in awareness of day care. The programme was associated with increased positive attitudes towards specialist palliative care services and results suggested increased satisfaction with out-of-hours services for patients. No change was found for confidence in symptom control and communication over diagnosis with cancer patients was less than in control districts. The design also incorporated a qualitative component, and from this we found the Facilitator programme to be popular with local GPs who valued the support of a colleague who knew the demands and constraints of general practice. In conclusion, we have demonstrated an impact of the GP Facilitator programme on GP awareness of, use and increased positive attitudes towards specialist palliative care services. By improving communication between primary and specialist palliative care, the programme should contribute substantially to improved care of the dying at home.

The U.S. Department of Health and Human Services obtains information about U.S. registered nurses through the periodic National Sample Survey of Registered Nurses (NSSRN). Occupational health nurses comprise less than 1% of the U.S. nursing population and published NSSRN reports usually include only estimates of the total occupational health nurse population and minimal information about occupational health nurses' characteristics. The objectives of this study were to develop a knowledge base of occupational health nurses' characteristics; examine characteristics that may influence entry and retention in occupational health nursing practice; and explore indications of demand for occupational health nurses. Descriptive and inferential statistics were used in a secondary analysis of data from recent (1992 to 2004) NSSRN. The findings are reported in two parts. This article, Part I, provides descriptive data about occupational health nurses based on responses to the 1992 through 2004 NSSRN questionnaires. Part II will provide findings from analysis of 2004 responses indicative of occupational health nurses' entry, retention, and demand characteristics.

This article is a summary of information about occupational health nurses and occupational health nursing in the United States. The article provides demographic, education, credentialing, role, and other data based on secondary analysis of occupational health nurses' responses to the 2008 National Sample Survey of Registered Nurses. Current issues affecting the U.S. work force and businesses are addressed and high-risk business and industrial sectors are noted. Occupational health nurse practice opportunities are highlighted and practice areas where occupational health nursing research is currently focused are discussed. The article also examines the challenges facing the next generation of occupational health nurses.

This article is a summary of information about occupational health nurses and occupational health nursing in the United States. The article provides demographic, education, credentialing, role, and other data based on secondary analysis of occupational health nurses' responses to the 2008 National Sample Survey of Registered Nurses. Current issues affecting the U.S. work force and businesses are addressed and high-risk business and industrial sectors are noted. Occupational health nurse practice opportunities are highlighted and practice areas where occupational health nursing research is currently focused are discussed. The article also examines the challenges facing the next generation of occupational health nurses.

Autonomy, the freedom to practice independently and to exercise professional judgment in practice activities, is a central element for professional practice. Numerous articles and studies have reported on professional autonomy in general nursing practice; however, professional autonomy for occupational health nurses has not been explored in depth. This article advances the development of a body of knowledge relative to professional autonomy in the practice of occupational health nursing. This article also provides an overview of professional autonomy in nursing practice; discusses the nature and importance of professional autonomy in the occupational health practice setting; reports findings from a seminal study of occupational health nurse autonomy; and addresses professional autonomy in the context of collaborative practice.

Autonomy, the freedom to practice independently and to exercise professional judgment in practice activities, is a central element for professional practice. Numerous articles and studies have reported on professional autonomy in general nursing practice; however, professional autonomy for occupational health nurses has not been explored in depth. This article advances the development of a body of knowledge relative to professional autonomy in the practice of occupational health nursing. This article also provides an overview of professional autonomy in nursing practice; discusses the nature and importance of professional autonomy in the occupational health practice setting; reports findings from a seminal study of occupational health nurse autonomy; and addresses professional autonomy in the context of collaborative practice.

The U.S. Department of Health and Human Services obtains information about U.S. registered nurses through the periodic National Sample Survey of Registered Nurses (NSSRN). Occupational health nurses comprise less than 1% of the U.S. nursing population and published NSSRN reports usually include only estimates of the total occupational health nurse population and minimal information about occupational health nurses' characteristics. The objectives of this study were to develop a knowledge base of occupational health nurses' characteristics; examine characteristics that may influence entry and retention in occupational health nursing practice; and explore indications of demand for occupational health nurses. Descriptive and inferential statistics were used in a secondary analysis of data from recent (1992 to 2004) NSSRN. The findings are reported in two parts. This article, Part I, provides descriptive data about occupational health nurses based on responses to the 1992 through 2004 NSSRN questionnaires. Part II will provide findings from analysis of 2004 responses indicative of occupational health nurses' entry, retention, and demand characteristics.