Postal Questionnaire Research Articles

The questionnaire survey as more‐than‐human achievement

Geography is fostering a diverse range of methodologies that engage the more‐than‐human dimensions of research. Debates surround the efficacy of both longstanding and emergent methodological approaches in grappling with how to do more‐than‐human geography. Much attention has been given to the methodological implications of theoretical debates that evoke distributed agency and calls to “enliven” research. To date, however, questionnaire surveys have not been considered as part of these deliberations. Survey response rates are normally reported as percentages, with scholarly attention focusing on how question design, financial incentives, and delivery format may influence human engagement with the questionnaire. Little attention has been paid to questionnaire survey methods in or for more‐than‐human research. Inversely, there is also little discussion of the agency of non‐human bodies, processes, and materials, and how they work for or against survey completion. This paper contributes to these deliberations by exploring more‐than‐human agency in the delivery and completion of a postal questionnaire, distributed to rural households that are self‐sufficient for water on the south coast of New South Wales, Australia. By focusing on the elements, infrastructure, and animals that work with and against survey delivery and completion, we show that questionnaire surveys are a more‐than‐human achievement. Consideration of the chewed and weathered survey, and the more‐than‐human processes that influence its delivery and completion, matters in challenging “human‐centred” notions of field research. We argue that what we know about the world through a survey is always a performative process, not only by considering how research design aligns with politics and knowledge practices, but also the more‐than‐human.

Health Utilities and Costs for Motor Neurone Disease

BackgroundMotor neurone disease (MND) places a significant burden on patients, their carers, and healthcare systems. ObjectivesTo estimate health utilities and costs of MND within the UK setting. MethodsPatients with MND, recruited via 22 regional clinics, completed a postal questionnaire of a cost and quality-of-life survey. Health outcome assessment included the EuroQoL (EQ)-5D-5L, EQ-5D-visual analogue scale, Amyotrophic Lateral Sclerosis Utility Index, and the Amyotrophic Lateral Sclerosis Functional Rating Scale–Revised. Clinical staging was based on the Kings and Milano-Torino (MiToS) systems. The questionnaire asked about patients’ use of primary, secondary, and community care services in the previous 3 months. Variability in total costs was examined using regression models. Results595 patients were included in the health utility analysis, of whom 584 patients also completed a resource use questionnaire. Mean health utility decreased and costs increased between consecutive Kings stages, from 0.76 (95% CI 0.71-0.80) and £1096 (£757-£1240) in Kings stage 1, to 0.50 (0.45-0.54) and £3311 (£2666-£4151) in stage 4, respectively. The changes by MiToS stages were from 0.71 (0.69-0.73) and £1115 (£937-£1130) in MiToS stage 0, to 0.25 (0.07-0.42) and £2899 (£2190-£3840) in stage 2. Kings stages 3 and 4 and MiToS stages 1 and 2, respectively, were significant in explaining variability in total costs. ConclusionsThe impact of MND on health utilities and costs differs by disease severity. The data provided here can be used in cost-effectiveness analyses and to inform decision-making regarding healthcare provision for people with MND.

Sleep duration and psychological well-being among New Zealanders

ObjectiveTo identify the prevalence of short and long sleep duration and examine the relationship between sleep duration and psychological well-being among New Zealand adults. DesignMultiple regression using data from the New Zealand Attitudes Values Study postal questionnaire. ParticipantsNew Zealand Attitudes Values Study respondents in 2014, 2015, and/or 2016 (Ns =15,820, 13,942, and 21,937). MeasurementsParticipants were asked, “During the past month, on average, how many hours of actual sleep did you get per night?” They also reported their demographic characteristics, physical and psychological health, and personality traits. ResultsMost New Zealanders reported having optimal sleep duration (7 to <9 hours, 58%), but more than a third reported having short (<7 hours, 37%) and 4.5% reported long sleep duration (≥ 9 hours). Māori and Pacific peoples showed particularly high rates of short sleepers. Compared to optimal sleep, short sleep consistently showed negative relationships with various measures of positive psychological well-being (eg, self-esteem, life satisfaction) independent of a broad range of demographic, health, and personality factors. Long sleep was only associated with an increased likelihood of depression. Personality traits, especially neuroticism, also showed strong associations with psychological well-being. ConclusionsThe high proportion of short sleepers in New Zealand is a major issue of concern because short sleep showed consistent associations with negative psychological well-being.It is vital to implement sleep awareness campaigns and increase research on the reasons for short sleep among different groups. Given the ethnic disparity in sleep duration, target interventions for Māori and Pacific peoples are particularly crucial.

Most associations of early‐life environmental exposures and genetic risk factors poorly differentiate between eczema phenotypes: the Generation R Study

SummaryBackgroundChildhood eczema is variable in onset and persistence.ObjectivesTo identify eczema phenotypes during childhood, and their associations with early‐life environmental and genetic factors.MethodsIn this study of 5297 children from a multiethnic population‐based prospective cohort study, phenotypes based on parent‐reported physician‐diagnosed eczema from age 6 months to 10 years were identified using latent class growth analysis. Information on environmental factors was obtained using postal questionnaires. Four filaggrin mutations were genotyped and a risk score was calculated based on 30 genetic variants. Weighted adjusted multinomial models were used for association analyses.ResultsWe identified the following five eczema phenotypes: never (76%), early transient (8%), mid‐transient (6%) and late transient (8%) and persistent eczema (2%). Early transient and persistent eczema were most common in first‐born children, those with a parental history of eczema, allergy or asthma and those with persistent wheezing [range of odds ratio (OR): 1.37, 95% confidence interval (CI) 1.07–1.74 and OR 3.38, 95%CI 1.95–5.85]. Early transient eczema was most common in male children only (OR 1·49, 95% CI 1·18–1·89). Children with late transient or persistent eczema were more often of Asian ethnicity (OR 2·04, 95% CI 1·14–3·65 and OR 3·08, 95% CI 1·34–7·10, respectively). Children with early, late transient and persistent eczema more often had a filaggrin mutation or additional risk alleles (range OR: 1.07, 95%CI 1.02–1.12 and OR 2.21, 95%CI 1.39–3.50). Eczema phenotypes were not associated with maternal education, breastfeeding, day care attendance and pet exposure.ConclusionsFive eczema phenotypes were identified in a multiethnic paediatric population with limited differences in risk profiles, except for sex and ethnicity. What's already known about this topic? Two previous studies in longitudinal birth cohorts identified four and six different eczema phenotypes, predominantly in children of European ethnicity. What does this study add? Five eczema phenotypes were identified in a multiethnic paediatric population using latent class growth analysis.Children with early transient and persistent eczema were most often first‐born children and had persistent wheezing, filaggrin mutation or additional risk alleles.Previously known eczema risk factors had limited differentiating capabilities for eczema phenotypes, except for the association of early transient eczema with male children, and late transient and persistent eczema with Asian ethnicity.

Anxiety and distress following receipt of results from routine HPV primary testing in cervical screening: The psychological impact of primary screening (PIPS) study.

We used a cross‐sectional survey to examine short‐term anxiety and distress in women receiving different results following routine human papillomavirus (HPV) primary testing at cervical screening. Participants were women aged 24–65 (n = 1,127) who had attended screening at one of five sites piloting HPV primary screening in England, including a control group with normal cytology who were not tested for HPV. Women completed a postal questionnaire ~2 weeks after receiving their screening result. Unadjusted mean anxiety scores ranged from 32.9 (standard deviation [SD] = 12.2) in HPV‐negative women to 42.1 (SD = 14.9) in women who were HPV‐positive with abnormal cytology. In adjusted analyses, anxiety was significantly higher in women testing HPV‐positive with either normal cytology (mean difference [MD] = 3.5, CI: 0.6–6.4) or abnormal cytology (MD = 7.2, CI: 3.7–10.6), than the control group. Distress was slightly higher in women who tested HPV‐positive with abnormal cytology (MD = 0.9, CI: 0.02–1.8), than the control group. We also found increased odds of very high anxiety in women who tested HPV‐positive with normal or abnormal cytology compared to the control group. This pattern of results was only observed among women receiving their first HPV‐positive result, not among women found to have persistent HPV at 12‐month follow‐up. Testing HPV‐positive with normal cytology for the first time, is associated with elevated anxiety despite carrying very low immediate cervical cancer risk. However, receiving the same test result at 12‐month early recall does not appear to be associated with higher anxiety, suggesting anxiety may normalise with repeated exposure and/or over time.

Junior doctors\u2019 early career choices do not predict career destination in neurology: 40\u2009years of surveys of UK medical graduates

BackgroundThe rapidly rising rates of brain diseases due to the growing ageing population and the explosion in treatment options for many neurological conditions increase the demand for neurologists. We report trends in doctors’ career choices for neurology; investigate factors driving their choices; and compare doctors’ original choices with their specialty destinations.MethodsA multi-cohort, multi-purpose nation-wide study using both online and postal questionnaires collected data on career choice, influencing factors, and career destinations. UK-trained doctors completed questionnaires at one, three, five, and ten years after qualification. They were classified into three groups: graduates of 1974–1983, graduates of 1993–2002, and graduates of 2005–2015.ResultsNeurology was more popular among graduates of 2005–2015 than earlier graduates; however, its attraction for graduates of 2005–2015 doctors reduced over time from graduation. A higher percentage of men than women doctors chose neurology as their first career choice. For instance, among graduates of 2005–2015, 2.2% of men and 1.1% of women preferred neurology as first choice in year 1. The most influential factor on career choice was “enthusiasm for and commitment to the specialty” in all cohorts and all years after graduation. Only 39% who chose neurology in year 1 progressed to become neurologists later. Conversely, only 28% of practicing neurologists in our study had decided to become neurologists in their first year after qualification. By year 3 this figure had risen to 65%, and by year 5 to 76%.ConclusionsCareer decision-making among UK medical graduates is complicated. Early choices for neurology were not highly predictive of career destinations. Some influential factors in this process were identified. Improving mentoring programmes to support medical graduates, provide career counselling, develop professionalism, and increase their interest in neurology were suggested.

Experiences of Non-consensual Sex of Older Adult Men and Women in Norway, Denmark, Belgium and Portugal

This study aimed to determine the prevalence of non-consensual sex in older adult men and women across Europe, and to find out what variables predict such experiences in different European countries. Data were collected using probability samples from populations, aged 60–75 years, in Norway (N = 1271), Denmark (N = 1045), Belgium (N = 991), and Portugal (N = 509), using postal questionnaires. Around 5% of men included in the study, in all of the countries, reported non-consensual sexual experiences. Non-consensual sexual experiences were higher in gay/bisexual men when compared against heterosexual men. Partnered men had a lower likelihood of childhood non-consensual sex than those without partners. Compared against men with primary education, those who had undergone tertiary education had a lower likelihood of having experienced adult non-consensual sex. For women, rates of reporting non-consensual sex before and after the age of 18 years were lowest in Portugal (2% and 6%, respectively) and highest in Norway (9% and 11%, respectively). Compared with women with no religious affiliations, protestant women showed a lower likelihood of having experienced childhood non-consensual sex. In comparison to Norwegian women, Belgian and Portuguese women were observed to have had a lower likelihood of having experienced childhood non-consensual sex. Compared to women who were non-partnered, had no religious affiliation, or had primary education, women who were partnered, Roman Catholic, and had higher education showed a lower likelihood of having experienced non-consensual sex in adulthood. Experience of non-consensual sex correlated significantly, albeit weakly, with greater levels of both anxiety and depression, decreased subjective well-being, lower perceived intimacy with one’s partner, and higher feelings of loneliness.

Self-efficacy and self-management strategies in acute intermittent porphyria

BackgroundAcute intermittent porphyria (AIP) is an inherited metabolic disease with low clinical penetrance caused by mutations in the hydroxymethylbilane (HMBS) gene. Although most patients experience little or no symptoms, serious attacks may include excruciating pain, severe electrolyte disturbances, paresis, and respiratory failure. Several drugs and lifestyle factors are potential attack inducers and avoiding known triggers is important to avoid symptomatic disease in both patients and genetically predisposed carriers. Our aim in this study was to describe self-efficacy and self-management strategies in self-reported symptomatic and asymptomatic HMBS mutation carriers, and to elucidate motives for predictive genetic testing.MethodsThis is a cross-sectional retrospective survey with postal questionnaires. We received responses from 140 HMBS carriers for the general self-efficacy scale (GSES), study-specific questions about symptoms, self-management strategies and motives for genetic testing and satisfaction with the genetic counseling scale (SCS).ResultsThe results indicated high levels of self-efficacy in these Norwegian HMBS mutation carriers. Both self-reported symptomatic and asymptomatic cases recorded changes in behavior after diagnosis, such as avoiding possible triggering drugs and aspiring recommended eating habits. They were in general satisfied with the genetic counseling they had received. The possibility to prevent disease and learn about the risk of their children was their most important motives to undergo genetic testing.ConclusionsThis study indicates that continuing to provide information, counseling and education is beneficial in AIP, and that HMBS mutation carriers, both those self-assessed as asymptomatic and as symptomatic, are using their knowledge to avoid triggering factors.

A multi-centre, UK-based, non-inferiority randomised controlled trial of 4 follow-up assessment methods in stroke survivors

BackgroundRecovery following a stroke is a long and ongoing process. Post-stroke follow-up after leaving the hospital is recommended. Methods for follow-up patients include face-to-face, via the telephone, post or online (internet). However, there is a debate which method is preferred by patients. This study aimed to determine whether telephone interview, online questionnaire and postal questionnaire were as acceptable as face-to-face follow-up.MethodsIn a blinded, UK-wide, multi-centre, Zelen’s designed, 4-arm (postal, online, telephone, compared to face-to-face), pragmatic non-inferiority randomised controlled trial of the mode of administration, stroke survivors were randomised to postal, online, telephone and face-to-face assessment, in an equal ratio (1:1:1:1). The primary outcome was the proportion of participants that responded to the three allocation groups, compared to the face-to-face group. Subgroup analyses for age, aphasia and type and severity of stroke were carried out. A non-inferiority margin of 0.025 was used, and Holm-Bonferroni multiplicity adjustment was made.ResultsOf the 2074 eligible patients randomised, 55% were male (1142/2074), with an average age of 73.0 years old (SD = 13.2). Of those randomised, 22% (116/525), 9% (47/515) and 20% (101/513) responded in postal, online and telephone, respectively, compared to 17% (89/521) in the face-to-face group. The reduction in the online response rate compared to face-to-face was found to be both inferior and not non-inferior and estimated as an 8% reduction (95% CI 3.9 to 12.0%; p < 0.001). The association with lower online completion was present regardless of age, stroke type (haemorrhage or infarct) and stroke severity. In haemorrhagic stroke, the reduction in response online, compared to face-to-face, was 21% (95% CI 10 to 32%; p value = 0.002). A secondary analysis found non-aphasic stroke survivors preferred postal completion adjusted odds ratio of 1.43 (95% CI 1.04 to 1.95; p = 0.026).ConclusionsThe study found that fewer stroke survivors completed follow-up assessment using an online method, compared to face-to-face. This finding was present in all age groups. Caution should be employed when considering online follow-up methods in stroke survivors, particularly in those who have experienced a cerebrovascular haemorrhage.Trials registrationClinicalTrials.gov, NCT03177161. Registered on 6 June 2017.

Patient reporting of complications after surgery: what impact does documenting postoperative problems from the perspective of the patient using telephone interview and postal questionnaires have on the identification of complications after surgery?

ObjectivesTo identify the frequency of postoperative complications, including problems identified by patients and complications occurring after discharge from hospital. To identify how these impact on quality of life (QoL) and...

Discussions of lifestyle habits as an integral part of care management: a cross-sectional cohort study in patients with established rheumatoid arthritis in Sweden

ObjectivesThe primary aim was to determine whether patients with RA recalled having discussions concerning lifestyle habits during their health-care visits. The secondary aim was to study the association between patients' reported lifestyle and their wish to discuss it.MethodsA postal questionnaire sent to 1542 eligible patients from the Better Anti-Rheumatic Pharmacotherapy (BARFOT) study included questions on lifestyle habits (physical activity, diet, smoking and alcohol), on whether these were discussed during health-care visits and on whether there was an interest in such discussions.ResultsA total of 1061 patients (68%) responded [mean age 67 (s.d. 13) years, 73% women]. Half of the patients (49%) recalled discussions on physical activity, and 23% recalled discussions about diet. Those who reported health-enhancing levels of physical activity were more likely to discuss physical activity with their health professionals. Likewise, patients who reported having a non-traditional mixed diet were more likely to discuss diet. Smoking was discussed with 25% of the patients, more often with current smokers than with non-smokers (32 vs 17%; P < 0.001). Alcohol was discussed with 17% of the patients. Of those patients who reported having hazardous drinking habits, 77% had not discussed alcohol use with any health professional.ConclusionDiscussions about lifestyle were recalled by half of the patients with established RA. There is a need for improvement, because lifestyle habits may affect the long-term outcome in a chronic disease, such as RA. Patient education concerning lifestyle habits should be an integral part of care management and an interactive process.

An allied health rehabilitation program for patients following surgery for abdomino-pelvic cancer: a feasibility and pilot clinical study

To investigate the feasibility of conducting a rehabilitation program for patients following surgery for abdomino-pelvic cancer. A non-randomised controlled before-and-after study. Patients who had undergone surgery for stage I-III abdomino-pelvic cancer (colorectal, gynaecological or prostate cancer) were recruited. The rehabilitation group (n = 84) received an 8-week, bi-weekly education and exercise program conducted by a physiotherapist, exercise physiologist, health psychologist and dietician, supplemented by exercise diaries and telephone coaching sessions. The comparator group (n = 104) completed postal questionnaires only. Feasibility measures, functional exercise capacity, muscle strength, physical activity levels, pelvic floor symptoms, anxiety and depression, health-related quality of life (HRQoL) and self-efficacy were measured at baseline (time 1), immediately post-intervention (time 2) and at 6months post-baseline (time 3) and compared within- and between-groups. The consent rate to the rehabilitation program was 24%. Eighty-one percent of the rehabilitation group attended 85-100% of 16 scheduled sessions. Overall satisfaction with the program was 96%. Functional exercise capacity, handgrip strength in males, bowel symptoms, physical activity levels, depression and HRQoL were significantly improved in the rehabilitation group (p < 0.05) at time 2. The improvements in all these outcomes were sustained at time 3. The rehabilitation group had significantly improved physical activity levels, depression and HRQoL compared with the comparator group at times 2 and 3 (p < 0.05). Recruitment to this oncology rehabilitation program was more difficult than expected; however, attendance and patient satisfaction were high. This program had positive effects on several important clinical outcomes in patients following abdomino-pelvic cancer treatment. ANZCTR 12614000580673.

Musculoskeletal complaints among professional divers.

Previous publications have indicated a high risk of musculoskeletal complaints among professional divers. This study aims to investigate which factors influence professional divers' risk of musculoskeletal complaints. Based on data gathered from a postal questionnaire sent to Norwegian inshore divers in 2011, the prevalence of musculoskeletal complaints, strain injuries and joint pain among divers with different certification levels, work-related tasks and decompression sickness (DCS) experiences were analysed. The risk of musculoskeletal complaints, strain injuries and joint pain was significantly higher among divers working in the quay/construction industry versus divers not working in this industry, and among divers who had experienced DCS. Likewise, a higher risk was found among divers doing construction, inspection, pipelaying, blasting and welding, other physically demanding work, and working with vibrating and/or rotating tools. Having experienced tingling and/or numbness in fingers after working with vibrating and/or rotating tools or having sick leave due to tendonitis, periosteum inflammation, stretch injuries or sprains caused by diving also increased the risk. Professional divers working in the quay/construction industry, divers doing tasks with heavy physical demands and divers having experienced DCS are at a higher risk of musculoskeletal complaints than other professional divers.

Audit of minimally-invasive surgery for submandibular sialolithiasis

Sialolithiasis is one of most common diseases to affect major salivary glands, with a symptomatic incidence of 27 cases per million per annum. The majority form within the submandibular gland where minimally-invasive treatments have all but eliminated adenectomy. All records of patients presenting with submandibular stones between 1997 and 2015 were reviewed. Stones <5mm were retrieved through endoscopic or radiographic techniques, 5-7mm stones were initially considered for extra-corporeal shock wave lithotripsy, but after poor results were treated through intraoral surgical removal with those >7mm. Follow up was performed at 1 week and 3 months with current status performed with postal and telephone questionnaires. 378 patients had 424 stones removed, successful retrieval in 94% (n=356), with 50 having had previous failures. Median number of stones per patient was 1 (range 1-4), with a mean size of 8.6mm (SD 4.5mm) mainly located at the hilum (50.5%), anterior duct (30%) and Genu (17%). 256 patients (65%) treated through intraoral surgical extraction, 92 (24%) endoscopic alone. Inpatient stay was 1.4 days in first third and 0.5 days in final third. Adenectomy occurred in 14 patients, due to failure to retrieve the sialolith or unresolved symptoms. Complications involved 11 patients with permanent paraesthesia, 7 ranulas and 14 strictures. Patients with preoperative strictures were more likely to develop complications (p=0.002) with paraesthesia being most common. Intraoral minimally-invasive surgery is aesthetic, curative and spares the risk to marginal mandibular nerve and submandibular gland. Length of inpatient stay improved and ranula risk reduced throughout the study.

Achieving Self-Directed Integrated Cancer Aftercare (ASICA) in melanoma: protocol for a randomised patient-focused pilot trial of delivering the ASICA intervention as a means to earlier detection of recurrent and second primary melanoma

BackgroundMelanoma is common; 15,906 people in the UK were diagnosed with melanoma in 2015 and incidence has increased fivefold in 30 years. Melanoma affects old and young people, with poor prognosis once metastatic. UK guidelines recommend people treated for cutaneous melanoma receive extended outpatient, hospital follow up to detect recurrence or new primaries. Such follow up of the growing population of melanoma survivors is burdensome for both individuals and health services. Follow up is important since approximately 20% of patients with early-stage melanoma experience a recurrence and 4–8% develop a new primary; the risk of either is highest in the first 5 years. Achieving Self-directed Integrated Cancer Aftercare (ASICA) is a digital intervention to increase total-skin-self-examination (TSSE) by people treated for melanoma, with usual follow up.MethodsWe aim to recruit 240 adults with a previous first-stage 0-2C primary cutaneous melanoma, from secondary care in North-East Scotland and the East of England. Participants will be randomised to receive the ASICA intervention (a tablet-based digital intervention to prompt and support TSSE) or control group (treatment as usual). Patient-reported and clinical data will be collected at baseline, including the modified Melanoma Worry Scale (MWS), the Hospital Anxiety and Depression Scale (HADs), the EuroQoL 5-dimension 5-level questionnaire (EQ-5D-5 L), and questions about TSSE practice, intentions, self-efficacy and planning. Participants will be followed up by postal questionnaire at 3, 6 and 12 months following randomization, along with a 12-month review of clinical data. The primary timepoint for outcome analyses will be12 months after randomisation.DiscussionIf the ASICA intervention improves the practice of TSSE in those affected by melanoma, this may lead to improved psychological well-being and earlier detection of recurrent and new primary melanoma. This could impact both patients and National Health Service (NHS) resources. This study will determine if a full-scale randomised controlled trial can be undertaken in the UK NHS to provide the high-quality evidence needed to determine the effectiveness of the intervention. ASICA is a pilot study evaluating the effectiveness of the practice of digitally supported TSSE in those affected by melanoma.Trial registrationClinical Trials.gov, NCT03328247. Registered on 1 November 2017.

Cancer-related symptoms, mental well-being, and psychological distress in men diagnosed with prostate cancer treated with androgen deprivation therapy

PurposeThere are known associations between treatment of prostate cancer (PCa) involving Androgen Deprivation Therapy (ADT) and psychological and physical side effects. We investigate the associations between cancer-related symptoms, health-related quality of life (HRQL), and poor psychological outcomes in men whose treatment for PCa involved ADT.MethodsA cross-sectional postal questionnaire was administered to UK men 18–42 months post diagnosis of PCa. Men completed items on functional outcomes using the Expanded Prostate Cancer Index Composite (EPIC-26), EuroQol-5D (EQ-5D), and the European Organisation for Research and Treatment of Cancer (EORTC) Fatigue subscale. Psychological outcomes (mental well-being and psychological distress) were assessed using the Short Warwick–Edinburgh Mental Well-being Scale (SWEMWBS) and the Kessler 6-item scale (K6), respectively. Associations between explanatory variables and psychological outcomes were assessed using stepped logistic regression.Results13,097 men treated with ADT completed a questionnaire. A minority of men reported poor mental well-being (15.5%) or severe psychological distress (6.6%). After controlling for sociodemographic and clinical variables, reporting clinically significant fatigue was strongly associated with severe psychological distress (OR 9.92; 95% CI 7.63 to 12.89) and poor well-being (OR 3.86; 95% CI 3.38 to 4.42). All cancer-related symptoms and HRQL variables were associated with both psychological outcomes.ConclusionsWhile the majority of men treated with ADT did not report poor psychological outcomes, a small proportion reported severe problems. Clinically significant fatigue was demonstrated as a possible indicator of poor outcomes. Healthcare systems need to have clear protocols in place which specifically and routinely target psychological distress and fatigue.

Risk Factors for Knee Osteoarthritis in Retired Professional Footballers: A Cross-Sectional Study.

To determine risk factors for 3 knee osteoarthritis (KOA) outcomes, knee pain (KP), radiographic KOA (RKOA), and total knee replacement (TKR) in professional footballers. This was a cross-sectional study involving a postal questionnaire, followed by radiographic assessment in a subcohort of responders. Four thousand seven hundred seventy-five questionnaires were sent to retired professional footballers, who had played in the English football league, and 1207 responded. Of these, 470 underwent knee radiographs. Potential factors include age, body mass index (BMI), knee alignment, a history of football-related knee injury, and training hours (during career) were collected through the questionnaire. Knee osteoarthritis outcomes were current KP (pain for most days of the previous month), TKR (self-reported), and RKOA (observed through radiographs). Football-related injury was the strongest risk factor for KP [adjusted odds ratio (aOR), 4.22; 95% confidence interval (CI), 3.26-5.48], RKOA [aOR, 2.88; 95% CI, 1.81-4.59], and TKR [aOR, 4.83; 95% CI, 2.87-8.13]. Footballers had a 7% increased risk of RKOA for every 1000 hours trained. Although age and gout were associated with all 3 KOA outcomes, BMI, nodal osteoarthritis (OA), a family history of OA, knee malalignment, and 2D:4D ratio were associated with one or another of these 3 KOA outcomes. This study is the first to examine KOA risk factors in retired professional footballers. The study has identified several risk factors, both specific (eg, knee injury and training dose) and nonspecific (eg, age and gout) to footballers. This may be used to develop prevention strategies to reduce the risk of KOA in professional footballers after retirement.

Lower risk of invasive meningococcal disease during pregnancy: national prospective surveillance in England, 2011-2014.

To describe cases of invasive meningococcal disease (IMD) in women of childbearing age and to estimate the disease incidence and relative risk of IMD in pregnant compared with non-pregnant women. Prospective enhanced national surveillance for IMD. England. Women of reproductive age (15-44years) with laboratory-confirmed IMD. Public Health England conducts enhanced national surveillance for IMD in England. Laboratory-confirmed cases are followed up with postal questionnaires to general practitioners. All cases confirmed in women of reproductive age from 1 January 2011 to 31 December 2014 were included. Annual IMD incidence and relative risk of IMD in pregnant compared with non-pregnant women of reproductive age. During the 4-year surveillance period, there were 1502 cases of IMD in females across England; of these, 310 (20.6%) cases were in women of reproductive age, including four women who were pregnant at the time of IMD confirmation (1.3%). Serogroup distribution of IMD cases in women of childbearing age was similar to the overall distribution. The four cases in otherwise healthy pregnant women were confirmed across all trimesters and all survived; one case in the first trimester had a septic miscarriage. The incidence of IMD was lower in pregnant than in non-pregnant women (0.16 compared with 0.76 per 100000 pregnant and non-pregnant years, respectively), giving a lower risk of IMD in pregnant women (incidence rate ratio, IRR, 0.21; 95% confidence interval, 0.06-0.54). Pregnant women are nearly five times less likely to develop IMD compared with non-pregnant women, but the infection can be severe. The risk of meningococcal disease is lower in pregnant women compared with non-pregnant women; the infection can occur across all trimesters and can be severe.

Changes in functional outcome over five years after stroke.

ObjectivesData on the long‐term time course of poststroke functional outcome is limited. We investigated changes in functional outcome over 5 years after stroke in a hospital based cohort.Materials and MethodsConsecutive patients who were independent in activities of daily living (ADL) and admitted to a Stroke Unit at Skaraborg Hospital, Sweden for a first acute stroke from 2007 to 2009 (n = 1,421) were followed‐up after 3 months and thereafter annually over 5 years using a postal questionnaire. Clinical variables at acute stroke and 3 months post stroke were obtained from the Swedish Stroke Register. ADL dependency was defined as dependence in dressing, toileting or indoor mobility.ResultsThe proportions of survivors who reported ADL dependency remained stable throughout follow‐up (19%–22%). However, among survivors who were ADL independent at 3 months, about 3% deteriorated to dependency each year. Deterioration was predicted by age (HR 1.11; 95% CI 1.08–1.13), diabetes (HR 1.65; 95% CI 1.12–2.44), NIHSS score (HR 1.07; 95% CI 1.04–1.10), and self‐perceived unmet care needs one year post stroke (HR 2.01; 95% CI 1.44–2.81). Transitions from ADL dependency to independence occurred mainly during the first year post stroke. Improvement was negatively predicted by living alone before stroke (HR 0.41 95% CI 0.19–0.91), NIHSS score (HR 0.90; 95% CI 0.86–0.95) and ischemic stroke (vs. hemorrhagic stroke), HR 0.39; 95% CI 0.17–0.89.ConclusionTransitions between ADL independence and dependency occur up to 5 years after stroke. Some of the factors predicting these transitions are potentially modifiable.

Social class and social mobility among ICAEW members from the interwar period to the present day

ABSTRACTIn the recent political and academic debate over social exclusivity and inequality in Britain, accountancy has come in for specific criticism. The Milburn panel on fair access to the professions concluded that accountancy has seen the greatest decline in social mobility. Through the use of a postal questionnaire of members of the Institute of Chartered Accountants in England and Wales (ICAEW), this study challenges this assessment by demonstrating that historically the ICAEW has always had a significant proportion of members from the lower middle and working classes. However, in recent decades there has been an increase in the proportion from the upper middle class and a decline in those from the lower classes. This shift was not due to educational changes such as the decline of grammar schools or the rise of the graduate profession but resulted from the reduced role of medium- and small-sized firms in recruitment and training and the rise in importance of the largest accounting firms which have always tended to take on trainees from higher social backgrounds.