Jeanette M. Lilley

The 'Impact on Participation and Autonomy': acceptability of the English version in a multiple sclerosis outpatient setting.

To elicit the opinion of multiple sclerosis (MS) patients about the acceptability of a newly designed participation questionnaire - the ‘Impact on Participatio n and A utonomy’ (IPA), 35 MS outpatients who had completed an English version of the IPA questionnaire (IPA-E) were interviewed. Patients were recruited consecutively from outpatients attending the MS clinic. They were invited to answer 15 short questions during a 20-minute interview after signing a consent form and completing the IPA -E questionnaire. C ompletion time of the IPA -E questionnaire was 19.3 ± 4.7 minutes. Most respondents believed that the IPA -E items were easy or very easy to understand (83%), relevant (more than 74%), not embarrassing (more than 97%) and 94% considered that no items should be removed. Three additional topics were suggested: ‘looking after children’, ‘the extent of information on current services’ and information about ‘treatment progress’. A mong the eight domains of the IPA, most respondents considered mobility to be the most important and education the least important. The IPA -E was found to be acceptable and relevant to a sample of MS outpatients, although it could have been enhanced by items on parental or family roles.

Dementia and 'borderline dementia' in Britain: 8-year incidence and post-screening outcomes.

Survivors from a nationally representative sample of elderly people originally screened in 1985 were reassessed in 1989 and again in 1993. On each occasion respondents were rated as cognitively impaired, borderline impaired or unimpaired (using a brief information/orientation scale), with the validity of these ratings assessed in subsequent clinical interviews. Where follow-up screening was not possible, information was derived from death certificates and hospital case-notes. Over 8 years (1985-93) the overall incidence rate per person-year at risk was 1.58%, giving age-specific rates of 0.72, 1.32, 1.63, 3.46, 2.55 and 1.41% for the age groups 65-69, 70-74, 75-79, 80-84, 85-89 and > or = 90 respectively. Of 43 individuals classified at screening as borderline impaired in 1985 and 1989, 19 were diagnosed as demented at clinical interviews conducted within 16 weeks of screening. Four-year follow-ups among the remaining 24 showed that 15 had died, while 6 showed a worsened cognitive status. Controlling for both age and sex, aggregated 4-year mortality was significantly higher among those defined at screening in 1985 and 1989 as either impaired or borderline, when compared with the unimpaired.

A health profile of adults with multiple sclerosis living in the community

Objective To describe the frequency of impairments, disabilities, and related services used in a community sample of adults with multiple sclerosis (MS) to estimate the service needs of this population. Methods A community-based postal survey conducted using a self-completion questionnaire consisting of MSQOL-54 questionnaire, Nottingham Extended Activities of Daily Living (NEADL) and some demographic items as well as items to ask about MS-related symptoms and/or problems and using available services. Adults with a diagnosis of MS confirmed by a neurologist were recruited via primary care services in Southern Derbyshire, UK. Results Questionnaires were sent to 310 adults with MS and 201 completed questionnaires were returned – a response rate of 65%. The most commonly reported symptoms and/or problems were fatigue, sexual problems, urinary problems, and painful muscle spasms. Most respondents reported at least one contact with their general practitioner (GP) during the previous 12 months. However, contacts with other services potentially able to alleviate specific symptoms and/or problems were low. Conclusions The findings suggest under-use of existing health care services by those who experience potentially treatable symptoms and/or problems associated with MS. More needs to be done to raise awareness among people with MS and their carers about the services available to them. Given the very high proportion of people with MS known to make contact with primary care services, GPs have a vital role in providing this information.

Associations of morbidity in the underweight.

Background/Objectives:There is little research on the demographic characteristics and morbidity of people categorized as ‘underweight’ from their body mass index (BMI) although they have often been shown to have greater mortality. This uncertainty makes it difficult to determine whether to include or exclude these individuals when estimating the health and mortality impacts of BMI. This project compares the demographic characteristics and morbidity patterns of the underweight with those of acceptable weight and the overweight.Subjects/Methods:Data on 10 243 community-living residents from the Health Survey for England (2003) were used. Logistic regression models were constructed to compare demographic, biochemical and anthropometric factors in the underweight (BMI<18.5) with those classified as acceptable weight (BMI 18.5–24.9) or overweight (BMI 25.0–29.9).Results:Univariate analyses found, when compared with other BMI categories, underweight individuals were significantly younger, more likely to smoke, alcohol abstainers, inactive, poorer and were less likely to be ethnically white (all P<0.001). U-shaped relationships between BMI and activities of daily living, respiratory disease, physical activity and mental health variables were seen. In multivariate analysis, the fewest number of significant differences in demographic and morbidity factors were between the underweight and those of acceptable weight.Conclusions:We recognize that these are cross-sectional data and exclude individuals in institutional settings, but these findings are important. Overall, we could not conclude that the underweight were less healthy than individuals in the other BMI categories. We cannot therefore recommend that the underweight should be excluded from analyses that examine the effects of obesity on mortality.

Food choice in later life

Elderly people have often been neglected in lifestyle surveys, so little is known about the foods they eat and the attitudes which inform their food choices. Describes a collaborative study currently in progress in the City of Nottingham which investigates food choice among elderly people living at home. Aims to improve our understanding of the decisions and circumstances which influence the quality and quantity of foods consumed by older people by assessing the influence of taste preference factors, micro‐economic factors, personal and health status factors, practical considerations and accessibility of food retail outlets on the selection of foods by older people.

Considerations for the interpretation of epidemiological studies of injuries in team sports: illustrative examples.

Injury surveillance is an important component of the ‘‘sequence of prevention’’ 1 for reducing sports injury incidence, and a number of studies evaluating injury surveillance methodology have aimed to ensure that reliable and comparable data are produced. Arguably, the most important methodological issue surrounding injury surveillance is the definition of injury. This determines the threshold at which an injury is deemed reportable for surveillance purposes and has been addressed by a number of authors. The injury definition debate focuses on whether to use a broad definition or whether to place restrictions on a definition that might limit recognition to, for example, an injury that limits game participation. It has been suggested that 70% to 92% of all injuries are excluded when the injury definition is restricted, but it has been pointed out that no study using a broad definition has demonstrated good reliability and thus a ‘‘match time loss only’’ injury definition should be adopted. There is an emerging body of evidence that highlights issues of a sociocultural and psychological nature that may affect the validity of injury surveillance findings in team sports. These issues may result in both underreporting and overreporting of injuries. In rugby union, for example, it has been suggested that concussions may be underreported to avoid International Rugby Board rules restricting participation after such injuries. These matters, and their impact on injury surveillance, have not been discussed or assessed in detail. We believe that their further discussion is essential for both the development and accurate interpretation of injury surveillance data. Such matters are of particular significance not only for researchers designing and interpreting surveillance studies but also for team sport clinicians who must transfer research findings into evidence-based practice. In addition, they may raise ethical dilemmas more common in a team sports environment.

Coding sports injury surveillance data: has version 10 of the Orchard Sports Injury Classification System improved the classification of sports medicine diagnoses?

Objectives: To compare versions 8 and 10 of the Orchard Sports Injury Classification System (OSICS) to determine whether the revised version of OSICS has improved its use in a sports medicine setting, and to assess the inter-rater reliability of OSICS-10. Methods: Injury surveillance data, gathered over a 2 year period in professional football, cricket and rugby union to produce 335 diagnoses, were coded with both OSICS-8 and OSICS-10. Code–diagnosis agreement was assessed for OSICS-8 in terms of whether a diagnosis was codeable or noncodeable, and for OSICS-10 by evaluating the highest available OSICS-10 tier of coding. Eight clinicians coded a list of 20 diagnoses, comprising a range of pathologies to all gross anatomical regions, which were compared to assess inter-rater reliability. Results: All diagnoses could be assigned an appropriate code with OSICS-10, compared with 87% of diagnoses that could be assigned an OSICS-8 code. Contusions comprised almost half of OSICS-8 noncodeable diagnoses. OSICS-10 tier 2 codes accounted for 20% of diagnoses coded with the updated system. Of these 20%, almost half contained a more detailed diagnosis that did not have an available OSICS-10 tier 3 or 4 code. Inter-rater reliability increased with decreasing diagnostic detail, with an overall level shown to be moderate (k = 0.56). Conclusions: OSICS-10 is a more encompassing system than OSICS-8 to use in classifying sports medicine diagnoses, and has a moderate level of inter-rater reliability. Further minor revision may be required to address lack of detail in some strain, effusion and contusion codes.

Incidence of Dementia: Preliminary Findings from the Nottingham Longitudinal Study of Activity and Ageing

In a 4-year follow-up of 1,042 randomly sampled elderly people (aged 65+), levels of dementia were assessed using a two-phase case finding procedure (screening followed by clinical interview) among survivors. Clinical information on those not re-interviewed was provided by death certificates, hospital case notes or postal questionnaires. The unweighted 4-year cumulative incidence of dementia was 4.3%, with age-specific rates of 0.9, 2.8, 5.2, 9.0 and 8.7% for the age groups 65-69, 70-74, 75-79, 80-84, and 85-89, respectively.

Defining recovery: an overlooked criterion in sports injury surveillance.

An understanding of issues of definition in sports injury surveillance is critical to the accurate interpretation of surveillance data. A number of parameters require strict definition and include injury, severity, and exposure among others. Regrettably, there is disparity in the levels of discussion in the literature regarding these surveillance definitions; recovery, in particular, has received minimal attention. We would assert that an examination of published literature reveals that certain surveillance definitions are interdependent, with both “injury” and “recovery” impacting on other surveillance parameters; furthermore, we would argue that the importance of the definition of recovery has been severely overlooked to date.

Dietary supplement use in later life

Describes self‐reported dietary supplement use among elderly people in the UK and explores the association between supplement use and socioeconomic, physical and dietary factors. A three‐phase survey incorporating face‐to‐face interviews, self‐completed four‐day dietary diaries with a food frequency questionnaire and follow‐up face‐to‐face interviews took place in urban Nottingham and rural Nottinghamshire, Lincolnshire and Leicestershire. A total of 957 elderly people (aged over 65) were randomly selected from general practitioner lists. A total of 36 per cent of the urban respondents and 41 per cent of rural respondents were taking at least one dietary supplement. Respondents who did not smoke were of a higher social class and had more qualifications were the most likely to take supplements. Fish oil was the most commonly taken supplement, followed by multivitamins, garlic tablets and vitamin C. The mean dietary intake of all respondents was above the reference nutrient intakes (RNIs) for nutrients studied. The diets of supplement users, excluding nutrients derived from supplementation, contained more iron, vitamin C, fibre, folate and oily fish than non‐users. Dietary supplement usage is widespread among the UK elderly, although supplement users within this sample do not appear to have diets which warrant supplementation to meet RNIs in the nutrients studied. Many advantages are, however, reported of consuming fish oils, garlic and higher intakes of anti‐oxidants.