Cross-sectional Postal Questionnaire Survey Research Articles

The prevalence of undiagnosed postoperative lower limb lymphedema among gynecological oncology patients

ObjectiveLower limb lymphedema (LLL) is a common postoperative complication among gynecological oncology patients following lymph node resection. In the absence of a screening strategy, LLL is frequently diagnosed only through patient's self-reported symptoms. This study investigated the prevalence of undiagnosed postoperative LLL among gynecological oncology patients and identified the associated risk factors. Materials and methodsThis was a cross-sectional postal questionnaire survey at a tertiary gynecological oncology center. Women with gynecological malignancies who underwent lymph node (inguinal/pelvic/para-aortic) resection between 2010 and 2017 were eligible. The Gynecological Cancer Lymphedema Questionnaire (GCLQ) was used and those with a score of ≥4 were referred to a lymphedema specialist for clinical confirmation. ResultsAmong 376 eligible women, postoperative LLL was already diagnosed in 45/376 (12%) women. In the remaining women, 117/331 (35.3%) completed the GCLQ, of which 67/117 (57.3%) scored ≥4. Fifty-five women (55/67, 82.1%) were assessed by a lymphedema specialist and eight cases of postoperative LLL were confirmed. In the 12/67 who declined a clinical assessment, they reported no evidence of LLL. The prevalence of undiagnosed postoperative LLL in our study was 8/117 (6.8%, 95% C.I. 2.3–11.4). On univariate analysis, older women were more likely to have undiagnosed postoperative LLL. ConclusionsUndiagnosed postoperative LLL is not uncommon among gynecological oncology patients, especially in older patients. No vulvar cancer patient had undiagnosed LLL. Increased awareness and improved strategies for lymphedema screening are required after lymph node surgery in gynecological oncology.

The distress and benefit to bereaved family members of participating in a post-bereavement survey.

Few studies have simultaneously collected quantitative data regarding the positive and negative effects of participating in post-bereavement surveys. We conducted a cross-sectional postal questionnaire survey in October 2013. Potential participants were caregivers for family members who had died in four inpatient palliative care units, two home hospices, and a general hospital. We collected opinions regarding the distress and benefit of completing a post-bereavement survey. After collecting data, we provided feedback to participating institutions in the form of study results and de-identified open-ended comments. Of 692 potential participants, 596 were sent questionnaires; 393 returned questionnaires were valid and analyzed. Of the respondents, 62% reported being distressed by completing the questionnaire. Female participants and those who were mentally ill during the caregiving period reported more distress. However, 86% of respondents reported they found the questionnaire beneficial. Better quality of end-of-life care and respondent depression were associated with more benefit. Major benefits were: contributing to the development of end-of-life care as a family (63%); expressing gratitude to the hospital and medical staff (60%); and looking back and reflecting on the end-of-life period (40%). Feeling benefit was not correlated with feeling distressed (P = -0.02). In this large-scale study on the effects of post-bereavement surveys in Japan, many bereaved family members reported that completing the survey was beneficial. In addition to possibly having feelings of distress, post-bereavement surveys might also be beneficial to end-of-life care facilities.

What influences general practitioners' use of exercise for patients with chronic knee pain? Results from a national survey.

BackgroundExercise is a recommended ‘core’ treatment for chronic knee pain (CKP), however it appears to be underused by general practitioners (GPs). While behavioural theories suggest that attitudes and beliefs influence behaviours, no single theory reliably predicts GPs’ behaviours. A theoretical analysis framework, developed from sociocognitive theories, was used to underpin investigation of the key influences associated with GPs’ use of exercise for patients with CKP, to inform future interventions to optimise GPs’ use of exercise.MethodsA cross-sectional postal questionnaire survey investigated UK GPs’ reported use of exercise based on a patient case vignette. Factors influencing GPs’ exercise use (behaviour) were examined using attitude statements, free-text questions and multiple response option questions related to factors within the analysis framework. Unadjusted logistic regression analyses explored the associations between GPs’ attitudes/beliefs and behaviour.ResultsFrom a total sample of 5000 GPs, 835 (17%) returned a questionnaire. Most respondents (n = 729, 87%) reported that they would use exercise. Factors significantly associated with exercise use (OR (95% CI)) included GPs’ beliefs about their role (belief that GPs should give information on type, duration and frequency of exercise (30.71 (5.02,188.01)), beliefs about consequences (agreement that knee problems are improved by local (3.23 (1.94,5.39)) and general exercise (2.63 (1.38,5.02))), moral norm (agreement that GPs should prescribe all patients local (3.08 (1.96,4.83)) and general exercise (2.63 (1.45,4.76))), and GP-related beliefs about capabilities (prior experience of insufficient expertise to give detailed exercise information (0.50 (0.33,0.76)). Whilst perceived time limitations were not associated with exercise use (1.00 (0.33,3.01)), GPs who disagreed that they experienced time limitations were more likely to suggest general (2.17 (1.04,4.55)), or demonstrate local (2.16 (1.06,4.42)), exercises.ConclusionGPs’ attitudes and beliefs are associated with their use of exercise for patients with CKP, particularly beliefs about role, responsibilities and skills in initiating exercise, and about the efficacy of exercise. Although the low response risks response bias, these results can inform future interventions to optimise GPs’ behaviour. The role of GP uncertainty and influences on clinical decision-making need further exploration, thus an amended analysis framework is suggested, which should be tested in future research.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-016-0570-4) contains supplementary material, which is available to authorized users.

Investigating Respondents and Nonrespondents of a Postal Breast Cancer Questionnaire Survey Regarding Differences in Age, Medical Conditions, and Therapy

Background: Collecting patient-reported data via postal questionnaires is a common and frequently used technique. Selection bias may occur through lost data from nonrespondents. This study investigated differences in characteristics between respondents and nonrespondents of a postal breast cancer survey. Patients and Methods: The investigation was based on a cross-sectional postal questionnaire survey for the mandatory annual routine (re-)certification of accredited breast centers in North Rhine-Westphalia in 2010. Out of 4,444 patients meeting the inclusion criteria who gave their consent to participate, 3,856 respondents sent back a questionnaire and 588 nonrespondents did not. Using logistic regression, differences between respondents and nonrespondents regarding information gathered through hospital staff concerning age, affected breast, UICC (Union for International Cancer Control) staging and grading, ASA (American Society of Anesthesiologists) classification, neoadjuvant chemotherapy, and type of surgery were assessed. Results: Very young and very old patients sent back their questionnaire significantly less frequently, as did patients who showed a later cancer stage and poorer general health and those who underwent mastectomy. Conclusion: Differences exist between respondents and nonrespondents with regard to age, disease, and therapy characteristics that need to be considered for the interpretation and generalizability of survey results due to selection bias.

Characteristics of service users and provider organisations associated with experience of out of hours general practitioner care in England: population based cross sectional postal questionnaire survey

Objective To investigate the experience of users of out of hours general practitioner services in England, UK.Design Population based cross sectional postal questionnaire survey.Setting General Practice Patient Survey 2012-13.Main outcome...

Hearing-aid use and its determinants in the UK National Health Service: A cross-sectional study at the Royal Surrey County Hospital

Objectives: The aim of this study was to investigate the rate of and factors contributing to non-adherence to hearing-aid use in the UK National Health Service. Design: A cross-sectional postal questionnaire survey. Study sample: A questionnaire, including the International Outcome Inventory for Hearing Aids, was sent to all patients fitted with hearing aids at the Royal Surrey County Hospital between 2011 and 2012 (N = 1874). A total of 1023 questionnaires were completed and returned (response rate of 55%). Results: A total of 29% of responders did not use their hearing aids on a regular basis (i.e. used them less than four hours per day). Non-regular use was more prevalent in new (40%) than in existing patients (11%). Factors that reduced the risk of non-regular use included bilateral versus unilateral amplification, and moderate or severe hearing loss in the better ear. 16% of responders fitted with bilateral amplification used only one of their hearing aids. Conclusions: The level of non-regular use of hearing aids in NHS found in this study was comparable to those for other countries. Additional support might be needed for patients at a higher risk of non-regular use.

Public opinion of drug treatment policy: Exploring the public's attitudes, knowledge, experience and willingness to pay for drug treatment strategies

BackgroundResearch evidence is strong for opiate replacement treatment (ORT). However, public opinion (attitudes) can be at odds with evidence. This study explored the relationships between, attitudes, knowledge of drugs and a range of socio-demographic variables that potentially influence attitude. This is relevant in the current policy arena in which a major shift from harm reduction to, rehabilitation is underway. MethodsA cross sectional postal questionnaire survey in Scotland was conducted where the drug, treatment strategy has changed from harm-reduction to recovery-based. A random sample (N=3000), of the general public, >18 years, and on the electoral register was used. The questionnaire was largely structured with tick box format but included two open questions for qualitative responses. Valuation was measured using the economic willingness-to-pay (WTP) method. ResultsThe response rate was 38.1% (1067/2803). Less than 10% had personal experience of drug, misuse but 16.7% had experience of drug misuse via a friend/acquaintance. Regression modelling revealed more positive attitudes towards drug users in those with personal experience of drug misuse, (p<0.001), better knowledge of drugs (p=0.001) and higher income (those earning >£50,000 per, annum compared to <£15K; p=0.01). Over half of respondents were not willing to pay anything for drug treatment indicating they did not value these treatments at all. Respondents were willing-to-pay most for community rehabilitation and least for methadone maintenance treatment. Qualitative analysis of open responses indicated many strong negative attitudes, doubts over the efficacy of methadone and consideration of addiction as self-inflicted. There was ambivalence with respondents weighing up negative feelings towards treatment against societal benefit. ConclusionsThere is a gap between public attitudes and evidence regarding drug treatment. Findings suggest a way forward might be to develop and evaluate treatment that integrates ORT with a community rehabilitative approach. Evaluation of public engagement/education to improve knowledge of drug treatment effectiveness is recommended.

Social Capital and Self-rated Health Amongst Older People in Western Finland and Northern Sweden: A Multi-level Analysis

Social capital can be conceptualised as an individual resource residing in relationships between individuals or as a collective resource produced through interactions in neighbourhoods, communities or societies. Previous studies suggest that social capital is, in general, good for health. However, there is a shortage of studies analysing the association between individual and collective social capital in relation to health amongst older people. The purpose of this study was to assess the relationship between municipal- and individual-level social capital and self-rated health amongst older people in Western Finland and Northern Sweden. Data were retrieved from a cross-sectional postal questionnaire survey conducted in 2010. The study included, in total, 6,838 people aged 65, 70, 75 and 80 years living in the two Bothnia regions, Västerbotten, Sweden and Pohjanmaa, Finland. The association between social capital and self-rated health was tested through multi-level logistic regression analyses with ecometric tests. Social capital was measured by two survey items: interpersonal trust and social participation. Individual-level social capital including social participation and trust was significantly associated with self-rated health. A negative association was found between municipal-level trust and health. However, almost all variation in self-rated health resided on the individual level. We conclude that contextual-level social capital on a municipal level is less important for understanding the influence of social capital on health in the Bothnia region of Finland and Sweden. On the other hand, our study shows that individual-level social participation and trust have a positive and significant association with self-rated health. We suggest that other ways of defining social capital at the collective level, such as the inclusion of neighbourhood social capital, could be one direction for future research.

Pitted keratolysis; physicians’ treatment and their perceptions in Dutch army personnel

Pitted keratolysis (PK) is a common plantar skin manifestation in army personnel, farmers and athletes. Due to pain while walking and marching, the condition can cause reduced operational deployability (in case of army personnel). We used a questionnaire to investigate currently used treatment options of PK and perceptions on perceived efficacy of these treatments among Royal Netherlands Armed Forces primary health care physicians. A cross-sectional anonymous postal questionnaire survey was conducted among all Royal Netherlands Armed Forces primary health care physicians. In addition to question about prescription behaviour on the treatment of PK by topical and oral therapies and given non-pharmacological treatment, several questions assessed perceived efficacy of these therapies. Of the 164 eligible primary health care physicians, 51 (31.1%) completed the questionnaire. Half of physicians had seen less than five patients with PK in the preceding year. Two-thirds of physicians reported problems with operational deployability in less than 10% of army personnel with PK. PK was treated mostly with topical and non-pharmacological treatments. Oral therapy was seldom prescribed. For hyperhidrosis, aluminium chloride hexahydrate was used in most cases. PK and related reduced operational deployability were less often reported than expected in this study. Dutch physicians prefer combined topical antibiotic therapy with non-pharmacological treatments and perceive the efficacy of topical antibiotic therapy superior to non-pharmacological treatments. Preventive measures, topical antibiotic therapy and adequate treatment of hyperhidrosis are the mainstay methods in the management of patients with PK.

Social participation, interpersonal trust, and health: A study of 65- and 75-year-olds in western Finland

To study the association between social participation, interpersonal trust, and self-rated health among 65- and 75-year-olds. The data originates from a cross-sectional postal questionnaire survey conducted among 1577 persons aged 65 and 75 years in western Finland (response rate 67%). Logistic regression analyses were performed in order to investigate the association between social capital--in terms social participation and interpersonal trust--and health while controlling for sociodemographic variables. The results showed that the social participation indicator ("active membership in organisations") was positively associated with health among 75-year-olds, but not among 65-year-olds. By contrast, interpersonal trust was positively associated with health in both age groups. The results imply that social participation and its association with health is moderated by age, whereas interpersonal trust is not.

Zu welchen Themen wünschen Patientinnen und Patienten mit Morbus Crohn oder Colitis ulcerosa mehr Informationen und welche eigene Rolle bevorzugen sie bei medizinischen Behandlungsentscheidungen? Ergebnisse einer Betroffenenbefragung in Deutschland

Evidence-based and consented pathways for patients with inflammatory bowel diseases (IBD, Crohn's disease, ulcerative colitis) call for tailored education programmes to foster shared decision-making and patient self-management. Their preferences should be taken into account. In 2005 a cross-sectional postal questionnaire survey was conducted in different regions of Germany. Adult patients with ulcerative colitis (UC) or Crohn's disease (CD) were recruited from specialised gastroenterological practices, university outpatient clinics and the member registry of the relevant patient organisation DCCV. They returned a questionnaire including (inter)nationally established scales (e. g., HADS) as well as questions on their information needs, preferred information sources and their role in decision-making. Data of 1056 responders could be analysed (65 % female; CD: 58 %; DCCV member: 71 %). The mean age of the patients was 42 (SD 12,8) years. Almost all patients wanted more information on "treatment alternatives" (83 %), "causes of disease" (80 %) and "what can I (still) do by myself" (79 %). 27 % of the patients asked for more information on 15 or more of overall 19 topics. The high information need was significantly associated with HADS potential depressive disorder (score > 8) and HADS probable anxiety disorder (score > 10). Most IBD patients (70 %) obviously regard their physicians as the most desirable source of information, 67 % prefer an active involvement in clinical decision-making. The data demonstrate high information needs of IBD patients and may serve in the planning of future educational programmes.

Views of the Scottish general public on community pharmacy weight management services: international implications

Obesity has reached pandemic levels, with more than 1.5 billion adults being affected worldwide. In Scotland two-thirds of men and more than half of women are either overweight or obese, placing Scotland overall third behind the United States of America and Mexico. All community pharmacies in Scotland are contracted to provide public health services such as smoking cessation and there is increasing interest in their contribution to weight management. Researching this area in Scotland may provide valuable information to facilitate the development of community pharmacy services in other parts of the UK and internationally. To describe the views of the Scottish general public on the provision of weight management services via community pharmacies. General public in Scotland. A cross-sectional postal questionnaire survey of 6,000 randomly selected members of the Scottish general public aged 18 years and over. Views on community pharmacy led weight management services. Questionnaires were returned by 20.6% (n = 1,236). Over half 60.1% (n = 751) agreed or strongly agreed that they had easy access to pharmacy services in general and around one-third agreed (35%; n = 438) that it was more convenient to obtain weight management advice from a pharmacist than it is to make an appointment with a GP. Most respondents however lacked awareness of the types of health services available through community pharmacy (13.2%; n = 162) and would not feel comfortable speaking to a pharmacist or medicines counter assistant about weight related issues (25%; n = 320). Concerns over privacy (47.3%; n = 592) and perceived lack of pharmacists' specialist knowledge (open comments) were identified as potential barriers to service uptake by the general public. Overall, respondents appear to be receptive to the idea of accessing weight management services through community pharmacy but a perceived lack of privacy, poor knowledge of pharmacists' skill level and of public health services available to them may explain the reluctance in the uptake of such services to date. The general public's views expressed in this study may help to shape future community pharmacy led weight management service provision.

Why UK-trained doctors leave the UK: cross-sectional survey of doctors in New Zealand

To investigate factors which influenced UK-trained doctors to emigrate to New Zealand and factors which might encourage them to return. Cross-sectional postal and Internet questionnaire survey. Participants in New Zealand; investigators in UK. Participants UK-trained doctors from 10 graduation-year cohorts who were registered with the New Zealand Medical Council in 2009. Reasons for emigration; job satisfaction; satisfaction with leisure time; intentions to stay in New Zealand; changes to the UK NHS which might increase the likelihood of return. Of 38,821 UK-trained doctors in the cohorts, 535 (1.4%) were registered to practise in New Zealand. We traced 419, of whom 282 (67%) replied to our questionnaire. Only 30% had originally intended to emigrate permanently, but 89% now intended to stay. Sixty-nine percent had moved to take up a medical job. Seventy percent gave additional reasons for relocating to New Zealand including better lifestyle, to be with family, travel/working holiday, or disillusionment with the NHS. Respondents' mean job satisfaction score was 8.1 (95% CI 7.9-8.2) on a scale from 1 (lowest satisfaction) to 10 (highest), compared with 7.1 (7.1-7.2) for contemporaries in the UK NHS. Scored similarly, mean satisfaction with the time available for leisure was 7.8 (7.6-8.0) for the doctors in New Zealand, compared with 5.7 (5.6-5.7) for the NHS doctors. Although few respondents wanted to return to the UK, some stated that the likelihood of doctors' returning would be increased by changes to NHS working conditions and by administrative changes to ease the process. Emigrant doctors in New Zealand had higher job satisfaction than their UK-based contemporaries, and few wanted to return. The predominant reason for staying in New Zealand was a preference for the lifestyle there.

Breathlessness and lung function in older working adults is associated with significant work disability

ObjectivesBreathlessness and airflow limitation increase with age and are likely to result in work disability.MethodsA general population survey of adults in their sixth decade was carried out to examine the...

Comparison of owner‐reported health problems with veterinary assessment of geriatric horses in the United Kingdom

Previous studies suggest that owners underestimate or incorrectly recognise or report health problems in geriatric horses. However, few studies have directly compared owner-reported and veterinary assessed disease. To compare the findings of veterinary clinical examination of geriatric horses with owner-reported clinical signs and disease. A total of 200 horses aged ≥ 15 years were randomly selected to receive a veterinary examination, from responses to a cross-sectional postal questionnaire survey. Veterinary examinations were performed within 2 months of questionnaire return, and agreement between owner-reported data and veterinary clinical findings was assessed. Owners under-reported many clinical signs and disease conditions detected on veterinary clinical examination. For example, dental abnormalities (detected in 95.4% of horses, reported by 24.5% of owners); cardiac murmurs (detected in 20% of horses, reported by 0.5% of owners); lameness (present in 50% of horses, reported by 23% of owners) and hoof abnormalities (detected in 80% of horses, reported by 27% of owners). Agreement between owner-reported and veterinary assessed respiratory disease (Kappa 0.02-0.2), body condition score (Kappa 0.24) and coat abnormalities (Kappa 0.42) was poor, fair and moderate, respectively. Range of motion (ROM) of the tarsal and metacarpophalangeal joints was lower in horses with owner-reported osteoarthritis (P = 0.005 and <0.001, respectively). The low prevalence and relatively poor agreement of owner-reported disease compared to that detected on veterinary examination suggests inaccurate or under-recognition, or inaccurate reporting of health problems by owners of geriatric horses, which could lead to a delay in presentation for veterinary treatment. Increased veterinary involvement and improved owner education in the care of geriatric horses should facilitate earlier identification of disease, particularly that which is not readily detectable by owners, and aid management of health and welfare problems.

Prescribing Contraception to Women with Intellectual Disabilities: General Practitioners’ Attitudes and Practices

The challenges of providing appropriate reproductive healthcare to women with intellectual disabilities are set within the context of a primary health care system. The rationale for this study was to explore the prescribing practices and attitudes of General Practitioner’s (GP) when women with intellectual disabilities come to them for contraception. The data reported in this paper come from a cross-sectional postal questionnaire survey conducted with 162 GPs across two counties in England. The majority of respondents had 10 or fewer women with intellectual disabilities of child bearing age on their caseloads. The most commonly prescribed methods of contraception were the Pill (39.7%) and depot medroxyprogesterone acetate (DMPA), (34.2%). The difficulties faced by GPs in determining ‘best interests’ are explored, as are the issues related to the women’s capacity to consent to sex.

Over-the-counter orlistat: early experiences, views and attitudes of community pharmacists in Great Britain

To describe community pharmacists' early experiences, views and attitudes with over-the-counter orlistat, 9 months post legal re-classification from November 2009 to January 2010. 13,200 (81%) randomly selected registered community pharmacies across Great Britain out of a potential 16,200. A cross-sectional postal questionnaire survey of the main pharmacist with greatest responsibility for over-the-counter (OTC) supply. Pharmacists' early experiences, views and attitudes of orlistat supply, demographic data of respondents and personal opinions with the supply of orlistat. Questionnaires were returned by 32.4% (n = 4,026) of pharmacists surveyed. Just over half (51.9%, n = 2,091) reported no sales of orlistat in the previous 4 weeks with only 5.1% (n = 203) reporting frequent (5.1%) or very frequent supply in the same time frame. Two thirds (66.5%, n = 2,676) agreed or strongly agreed that the sale of orlistat was a good opportunity to extend their role as a healthcare professional and 92% (n = 3,712) felt confident in their ability to supply this product. Over half (57.9%, n = 2,334) admitted that customers frequently complained about the cost of the product and 47.8% (n = 1,926) agreed that customers could misuse the product. Despite community pharmacists welcoming orlistat re-classification to increase medicines availability as an opportunity to extend their healthcare professional role there were concerns about poor public uptake, high cost and the potential for misuse. Exploratory studies collecting the views and experiences of the general public about the access and provision of weight management services through community pharmacies are warranted.

General practitioners' views and experiences of over‐the‐counter simvastatin in Scotland

Statins are widely used for the primary and secondary prevention of coronary events in high risk populations. In 2004 simvastatin was reclassified in the UK from prescription only to being available over-the-counter (OTC). The majority of GPs do not support the supply of OTC simvastatin by the community pharmacist. GPs were particularly concerned by the lack of cholesterol and blood pressure data in the CHD risk assessment prior to sale. The aims of this study were to determine the views and experiences of Scottish GPs towards CVD risk assessment by community pharmacists and the supply and sale of simvastatin. A cross sectional postal questionnaire survey of all primary care general practices in Scotland was carried out. The main outcome measure was GPs' awareness of and opinions regarding OTC simvastatin use, experience of OTC simvastatin and opinions regarding community pharmacist involvement in CHD risk assessment. A response rate of 45.7% was obtained. The majority (92.6%, 428) were aware that community pharmacists could sell simvastatin to reduce the risk of a first coronary event in individuals at moderate risk of CHD. However, over half (55.6%, 257) believed that the OTC sale of simvastatin was inappropriate. Just over half were unaware that the pharmacist's CHD risk assessment for the sale of simvastatin did not include lipid (54.8%, n=253) or blood pressure measurement (53.7%, n=248) and 56.7% (262) and 57.8% (267) of respondents, respectively, thought these omissions inappropriate. Almost half of the respondents (48.1%, 222) supported community pharmacists supplying simvastatin as supplementary prescribers while fewer (26.6%, 132) were in favour of supply via an independent prescribing arrangement. This study confirms that the majority of GPs do not support the supply of OTC simvastatin by the community pharmacist, being particularly concerned by the lack of cholesterol and blood pressure data in the CHD risk assessment prior to sale. Other methods of pharmacy based simvastatin supply including supplementary prescribing merit further evaluation.

A survey of pharmacy assistants in Grampian on prevention of HIV and hepatitis B and C

Abstract Objective Prevention of infection with blood-borne pathogens (BBPs) HIV and hepatitis B and C, remains a major public health challenge. The aim of this study was to assess the activity, knowledge and attitudes of community pharmacy assistants in Grampian in prevention of HIV and hepatitis B and C. Method A cross-sectional postal questionnaire survey of community pharmacy assistants. Outcome measures were practice, knowledge and barriers to practice. Setting Grampian, a mixed urban-rural health board area in North-East Scotland with a population of 532 432. Key findings Forty out of 78 (51%) assistants responded. Many were based in pharmacies that provided services for drug misusers, and/or stocked condoms. Twenty-four assistants stated that the pharmacies stocked extra-strong condoms but none was aware of dental dams being stocked. Two-thirds had leaflets relating to safer sex, HIV or hepatitis. Twenty assistants were confident that they could give advice on safer sex. Knowledge of BBPs and the infectivity of hepatitis B was relatively low. Few assistants were aware of recommendations for hepatitis B vaccination. The majority felt that in the future pharmacy assistants could have a greater role in the prevention of these infections. Principal barriers to preventive activity were described as lack of a private area, lack of training and time pressure. Conclusions Pharmacy assistants have the potential to be a focus for advice and simple information relating to prevention of HIV and hepatitis B and C. Resources are needed to address the current barriers identified.

General practitioners’ experiences with provision of healthcare to patients with self-reported multiple chemical sensitivity

Objective. To describe general practitioners’ (GPs’) evaluation of and management strategies in relation to patients who seek medical advice because of multiple chemical sensitivity (MCS). Design. A nationwide cross-sectional postal questionnaire survey. The survey included a sample of 1000 Danish GPs randomly drawn from the membership list of GPs in the Danish Medical Association. Setting. Denmark. Results. Completed questionnaires were obtained from 691 GPs (69%). Within the last 12 months 62.4% (n = 431) of the GPs had been consulted by at least one patient with MCS. Of these, 55.2% of the GPs evaluated the patients’ complaints as chronic and 46.2% stated that they were rarely able to meet the patients’ expectations for healthcare. The majority, 73.5%, had referred patients to other medical specialties. The cause of MCS was perceived as multi-factorial by 64.3% of the GPs, as somatic/biologic by 27.6%, and as psychological by 7.2%. Partial or complete avoidance of chemical exposures was recommended by 86.3%. Clinical guidelines, diagnostic tools, or more insight in the pathophysiology were requested by 84.5% of the GPs. Conclusion. Despite the lack of formal diagnostic labelling the patient with MCS is well known by GPs. The majority of the GPs believed that MCS primarily has a multi-factorial explanation. However, perceptions of the course of the condition and management strategies differed, and many GPs found it difficult to meet the patients’ expectations for healthcare. The majority of the GPs requested more knowledge and clinical guidelines for the management of this group of patients.