Potential contribution of vaccination uptake to occupational differences in risk of SARS-CoV-2: analysis of the ONS COVID-19 Infection Survey.

OBJECTIVES: To assess variation in vaccination uptake across occupational groups as a potential explanation for variation in risk of SARS-CoV-2 infection. DESIGN: We analysed data from the UK Office of National Statistics COVID-19 Infection Survey linked to vaccination data from the National Immunisation Management System in England from 1 December 2020 to 11 May 2022. We analysed vaccination uptake and SARS-CoV-2 infection risk by occupational group and assessed whether adjustment for vaccination reduced the variation in risk between occupational groups. RESULTS: Estimated rates of triple vaccination were high across all occupational groups (80% or above), but were lowest for food processing (80%), personal care (82%), hospitality (83%), manual occupations (84%) and retail (85%). High rates were observed for individuals working in health (95% for office based, 92% for those in patient-facing roles) and education (91%) and office-based workers not included in other categories (90%). The impact of adjusting for vaccination when estimating relative risks of infection was generally modest (ratio of hazard ratios across all occupational groups reduced from 1.37 to 1.32), but was consistent with the hypothesis that low vaccination rates contribute to elevated risk in some groups. CONCLUSIONS: Variation in vaccination coverage might account for a modest proportion of occupational differences in infection risk. Vaccination rates were uniformly very high in this cohort, which may suggest that the participants are not representative of the general population. Accordingly, these results should be considered tentative pending the accumulation of additional evidence.

Understanding inequalities in access to adult mental health services in the UK: a systematic mapping review.

BACKGROUND: Population groups experience differential access to timely and high-quality mental healthcare. Despite efforts of recent UK policies to improve the accessibility of mental health services, there remains a lack of comprehensive understanding of inequalities in access to services needed to do this. This systematic mapping review aimed to address this gap by identifying which population groups continue to be poorly served by access to adult mental health services in the UK, how access has been measured, and what research methods have been applied. METHODS: Seven electronic databases were searched from January 2014 up to May 2022. Primary research studies of any design were included if they examined access to adult NHS mental health services in the UK by population groups at risk of experiencing inequalities. Study characteristics, measures of access, inequalities studied, and key findings were extracted. A best-fit framework approach was used, applying Levesque's Conceptual Framework for Healthcare Access to synthesise measures of access, and applying a template derived from Cochrane Progress-Plus and NHS Long Term Plan equality characteristics to synthesise key findings associated with inequalities. RESULTS: Of 1,929 publications retrieved, 152 studies of various types were included. The most frequently considered dimensions of inequality were gender, age, and ethnicity, whilst social capital, religion, and sexual orientation were least frequently considered. Most studies researched access by measuring "healthcare utilisation", followed by studies that measured "healthcare seeking". Key barriers to access were associated with individuals' "ability to seek" (e.g. stigma and discrimination) and "ability to reach" (e.g. availability of services). Almost half of the studies used routinely collected patient data, and only 16% of studies reported patient and public involvement. CONCLUSIONS: Little appears to have changed in the nature and extent of inequalities, suggesting that mental health services have not become more accessible. Actions to reduce inequalities should address barriers to population groups' abilities to seek and reach services such as stigma-reducing interventions, and re-designing services and pathways. Significant benefits exist in using routinely collected patient data, but its limitations should not be ignored. More theoretically informed research, using a holistic measurement of access, is needed in this area. REVIEW REGISTRATION: https://doi.org/10.17605/OSF.IO/RQ5U7 .

Occupational differences in the prevalence and severity of long-COVID: analysis of the Coronavirus (COVID-19) Infection Survey.

OBJECTIVES: To establish whether prevalence and severity of long-COVID symptoms vary by industry and occupation. METHODS: We used Office for National Statistics COVID-19 Infection Survey (CIS) data (February 2021-April 2022) of working-age participants (16-65 years). Exposures were industry, occupation and major Standard Occupational Classification (SOC) group. Outcomes were self-reported: (1) long-COVID symptoms and (2) reduced function due to long-COVID. Binary (outcome 1) and ordered (outcome 2) logistic regression were used to estimate odds ratios (OR)and prevalence (marginal means). RESULTS: Public facing industries, including teaching and education, social care, healthcare, civil service, retail and transport industries and occupations, had the highest likelihood of long-COVID. By major SOC group, those in caring, leisure and other services (OR 1.44, 95% CIs 1.38 to 1.52) had substantially elevated odds than average. For almost all exposures, the pattern of ORs for long-COVID symptoms followed SARS-CoV-2 infections, except for professional occupations (eg, some healthcare, education, scientific occupations) (infection: OR<1 ; long-COVID: OR>1). The probability of reporting long-COVID for industry ranged from 7.7% (financial services) to 11.6% (teaching and education); whereas the prevalence of reduced function by 'a lot' ranged from 17.1% (arts, entertainment and recreation) to 22%-23% (teaching and education and armed forces) and to 27% (not working). CONCLUSIONS: The risk and prevalence of long-COVID differs across industries and occupations. Generally, it appears that likelihood of developing long-COVID symptoms follows likelihood of SARS-CoV-2 infection, except for professional occupations. These findings highlight sectors and occupations where further research is needed to understand the occupational factors resulting in long-COVID.

The Clinical Trials Assistance Pilot: reducing the financial burden of cancer clinical trials for patients in regional New South Wales.

Objective This study investigated whether the provision of financial assistance to patients living in regional New South Wales influenced patients' decisions to participate in a cancer clinical trial (cancer treatment or supportive care) and resulted in improved psychosocial outcomes. Methods Administrative data were collected from participants, including demographics, travel distances and the value of financial support provided. Qualitative interviews were then conducted with a subset of consenting patients who received financial assistance for a clinical trial. Results Sixty-four patients with cancer received financial support for a clinical trial, 27 (42%) of whom were interviewed. Participants whose distance to a trial site was over 400 km received almost three times as much financial support (M = A$3194.20, s.d. = A$1597.60) as participants whose distance to a trial site was between 50 and 100 km (M = A$1116.29, s.d. = $A1311.23). Half of participants indicated that receiving financial assistance influenced their decision to participate in a clinical trial, and most indicated the support alleviated the financial burden of clinical trial participation. Conclusions The provision of financial assistance to patients living in regional areas may reduce inequities in cancer clinical trial participation and improve psychosocial outcomes.

Unmet vaccination need among children under the age of five attending the paediatric emergency department: a cross-sectional study in a large UK district general hospital.

OBJECTIVE: To estimate vaccination coverage among children under the age of five attending the paediatric emergency department (PED) using tetanus and MMR vaccination as a proxy. DESIGN: A cross-sectional observational study with a single data collection point for each participant. SETTING: A single large PED in Greater Manchester, England. PARTICIPANTS: Children (under 5 years old) attending the PED during October 2021. Participation was 'opt-out' and parents/carers were given until the end of the following month to request that their child's data be excluded. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome of interest was the percentage of children who were up-to-date with their routine childhood vaccinations at their time of attendance to the PED. Secondary outcome measures were the percentage of children who had received age-appropriate tetanus and MMR vaccination, and how these compared with local population data at the ages of 1, 2 and 5 years of age. RESULTS: One-third of under-5s in this study had unmet vaccination need and were missing at least one dose of either MMR or tetanus-containing vaccine. In older age groups, many were missing their tetanus boosters and only 1 in 5 of those eligible had received two doses of MMR. Those in younger age groups had vaccination coverage levels comparable to the local data, but still below the target of 95%. CONCLUSIONS: Those children eligible for preschool boosters (tetanus and MMR2) appear to have considerable unmet vaccination need. While the pandemic has had an impact, the observation that MMR2 uptake is considerably lower than tetanus booster (when they are scheduled together) warrants further investigation. Catch-up campaigns for MMR2 should focus on this cohort of children and the PED may offer an opportunity for an intervention. TRIAL REGISTRATION NUMBER: NCT04485624.

Perceptions of adequacy of fruit and vegetable intake as a barrier to increasing consumption.

AIM: To investigate New South Wales adults' perceived adequacy of their fruit and vegetable consumption and to identify the barriers to consumption. METHOD: An online cross-sectional survey of a sample of adults in New South Wales (n = 1603) in February 2019 measured self-reported fruit and vegetable intakes, perception of consumption adequacy and barriers to consumption. Proportions of participants whose reported consumption met the daily recommended serves of fruit and vegetables per day were calculated. Chi-square and Fisher's exact tests were used to explore differences between demographic characteristics and meeting fruit and vegetable recommendations. For those not meeting recommendations, Chi-square and Fisher's exact tests were used to explore perceived adequacy of intake as a potential barrier to consumption. RESULTS: The sample included 52.7% women, 40.0% aged under 40 years and 28.6% over 59 years, 68.2% lived in a major city, and 32.6% were university educated. Overall, 64.8% of participants reported consuming adequate fruit and 12.4% reported consuming adequate vegetables. Of those consuming less than the guidelines, 21.3% perceived that they were eating enough fruit and 53.7% perceived they were eating enough vegetables. The most common barriers to eating more fruit were preference for other foods (29.6%), fruit spoiling too quickly (28.3%), and habit (27.0%). The most common barriers to eating more vegetables were the perception that they eat enough (26.8%), preference for other foods (21.9%), and habit (19.7%). CONCLUSIONS: Greater efforts are needed to support the public to eat adequate fruit and vegetables, consistent with dietary guidelines. Public education campaigns specifically targeting increasing vegetable consumption are required to address knowledge gaps, given a large proportion of our study population consumed inadequate levels of vegetables yet perceived their intake to be adequate.

Interventions delivered in secondary or tertiary medical care settings to improve routine vaccination uptake in children and young people: a scoping review.

OBJECTIVE: To identify and analyse the interventions delivered opportunistically in secondary or tertiary medical settings, focused on improving routine vaccination uptake in children and young people. DESIGN: Scoping review. SEARCH STRATEGY: We searched CINAHL, Web of Science, Medline, Embase and Cochrane Database of Systematic Reviews for studies in English published between 1989 and 2021 detailing interventions delivered in secondary or tertiary care that aimed to improve childhood vaccination coverage. Title, abstract and full-text screening were performed by two independent reviewers. RESULTS: After deduplication, the search returned 3456 titles. Following screening and discussion between reviewers, 53 studies were included in the review. Most papers were single-centre studies from high-income countries and varied considerably in terms of their study design, population, target vaccination, clinical setting and intervention delivered. To present and analyse the study findings, and to depict the complexity of vaccination interventions in hospital settings, findings were presented and described as a sequential pathway to opportunistic vaccination in secondary and tertiary care comprising the following stages: (1) identify patients eligible for vaccination; (2) take consent and offer immunisations; (3) order/prescribe vaccine; (4) dispense vaccine; (5) administer vaccine; (6) communicate with primary care; and (7) ongoing benefits of vaccination. CONCLUSIONS: Most published studies report improved vaccination coverage associated with opportunistic vaccination interventions in secondary and tertiary care. Children attending hospital appear to have lower baseline vaccination coverage and are likely to benefit from vaccination interventions in these settings. Checking immunisation status is challenging, however, and electronic immunisation registers are required to enable this to be done quickly and accurately in hospital settings. Further research is required in this area, particularly multicentre studies and cost-effectiveness analysis of interventions.

Risks of COVID-19 by occupation in NHS workers in England.

OBJECTIVE: To quantify occupational risks of COVID-19 among healthcare staff during the first wave (9 March 2020-31 July 2020) of the pandemic in England. METHODS: We used pseudonymised data on 902 813 individuals employed by 191 National Health Service trusts to explore demographic and occupational risk factors for sickness absence ascribed to COVID-19 (n=92 880). We estimated ORs by multivariable logistic regression. RESULTS: With adjustment for employing trust, demographic characteristics and previous frequency of sickness absence, risk relative to administrative/clerical occupations was highest in 'additional clinical services' (care assistants and other occupations directly supporting those in clinical roles) (OR 2.31 (2.25 to 2.37)), registered nursing and midwifery professionals (OR 2.28 (2.23 to 2.34)) and allied health professionals (OR 1.94 (1.88 to 2.01)) and intermediate in doctors and dentists (OR 1.55 (1.50 to 1.61)). Differences in risk were higher after the employing trust had started to care for documented patients with COVID-19, and were reduced, but not eliminated, following additional adjustment for exposure to infected patients or materials, assessed by a job-exposure matrix. For prolonged COVID-19 sickness absence (episodes lasting >14 days), the variation in risk by staff group was somewhat greater. CONCLUSIONS: After allowance for possible bias and confounding by non-occupational exposures, we estimated that relative risks for COVID-19 among most patient-facing occupations were between 1.5 and 2.5. The highest risks were in those working in additional clinical services, nursing and midwifery and in allied health professions. Better protective measures for these staff groups should be a priority. COVID-19 may meet criteria for compensation as an occupational disease in some healthcare occupations. TRIAL REGISTRATION NUMBER: ISRCTN36352994.

Ethnic differences in risk of severe Covid-19: To what extent are they driven by exposure?

BACKGROUND: This study quantifies the risk of Covid-19 among ethnic groups of healthcare staff during the first pandemic wave in England. METHODS: We analysed data on 959 356 employees employed by 191 National Health Service trusts during 1 January 2019 to 31 July 2020, comparing rates of Covid-19 sickness absence in different ethnic groups. RESULTS: In comparison with White ethnic groups, the risk of short-duration Covid-19 sickness absence was modestly elevated in South Asian but not Black groups. However, all Black and ethnic minority groups were at higher risk of prolonged Covid-19 sickness absence. Odds ratios (ORs) relative to White ethnicity were more than doubled in South Asian groups (Indian OR 2.49, 95% confidence interval (CI) 2.36-2.63; Pakistani OR 2.38, 2.15-2.64; Bangladeshi OR 2.38, 1.98-2.86), while that for Black African ethnicity was 1.82 (1.71-1.93). In nursing/midwifery staff, the association of ethnicity with prolonged Covid-19 sickness absence was strong; the odds of South Asian nurses/midwives having a prolonged episode of Covid-19 sickness absence were increased 3-fold (OR 3.05, 2.82-3.30). CONCLUSIONS: Residual differences in risk of short term Covid-19 sickness absences among ethnic groups may reflect differences in non-occupational exposure to SARS-CoV-2. Our results indicate ethnic differences in vulnerability to Covid-19, which may be only partly explained by medical comorbidities.

Changing patterns of sickness absence among healthcare workers in England during the COVID-19 pandemic.

BACKGROUND: Patterns of sickness absence shed useful light on disease occurrence and illness-related behaviours in working populations. METHODS: We analysed prospectively collected, pseudonymized data on 959 356 employees who were continuously employed by National Health Service trusts in England from 1 January 2019 to 31 July 2020, comparing the frequency of new sickness absence in 2020 with that at corresponding times in 2019. RESULTS: After exclusion of episodes directly related to COVID-19, the overall incidence of sickness absence during the initial 10 weeks of the pandemic (March-May 2020) was more than 20% lower than in corresponding weeks of 2019. Trends for specific categories of illness varied substantially, with a fall by 24% for cancer, but an increase for mental illness. A doubling of new absences for pregnancy-related disorders during May-July of 2020 was limited to women with earlier COVID-19 sickness absence. CONCLUSIONS: Various factors will have contributed to the large and divergent changes that were observed. The findings reinforce concerns regarding delays in diagnosis and treatment of cancers and support a need to plan for a large backlog of treatment for many other diseases. Further research should explore the rise in absence for pregnancy-related disorders among women with earlier COVID-19 sickness absence.

Delivery of a multi-focus public health intervention in the paediatric emergency department: a feasibility and acceptability pilot study.

OBJECTIVE: The objective was to see if it was feasible and acceptable to deliver a brief public health intervention as part of an attendance at the paediatric emergency department (PED). DESIGN: A feasibility and acceptability pilot design was used as there is no previous work done in this clinical area, population or using this approach in children and young people (CYP). Quantitative and qualitative data were collected. Follow-up was at 1 week and 1, 3 and 6 months. SETTING: This pilot took place in a single PED in Greater Manchester, England. PARTICIPANTS: Participants were CYP (under 16 years old) and their parents/carers, attending the PED during a 2-week recruitment period in September 2019. INTERVENTIONS: The intervention was a brief conversation with a Consultant in Paediatric Public Health Medicine, using Screening, Brief Intervention and Referral to Treatment. The intervention focused on vaccination, dental health, household smoking and frequent attendance. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was information to support the effective development of a larger-scale study. Secondary outcomes were measures of health, again intended to provide additional information prior to a larger study. RESULTS: Thirty CYP were recruited from 29 households. Sixty per cent of CYP triggered at least one screening question, most commonly household smoking and dental health. It was not possible to accurately assess frequent attendance and 97% of parents/carers stated that they thought their child or young person was fully vaccinated for their age, which is likely to be an over-estimate. CONCLUSIONS: It is feasible to deliver a brief public health intervention in the PED and such an approach is acceptable to a variety of stakeholders including CYP, parents/carers and nursing staff. The pilot revealed issues around data quality and access. Future work will focus on vaccination and dental health.

Impact of COVID-19 pandemic on sickness absence for mental ill health in National Health Service staff.

OBJECTIVE: To explore the patterns of sickness absence in National Health Service (NHS) staff attributable to mental ill health during the first wave of the COVID-19 epidemic in March-July 2020. DESIGN: Case-referent analysis of a secondary dataset. SETTING: NHS Trusts in England. PARTICIPANTS: Pseudonymised data on 959 356 employees who were continuously employed by NHS trusts during 1 January 2019 to 31 July 2020. MAIN OUTCOME MEASURES: Trends in the burden of sickness absence due to mental ill health from 2019 to 2020 according to demographic, regional and occupational characteristics. RESULTS: Over the study period, 164 202 new sickness absence episodes for mental ill health were recorded in 12.5% (119 525) of the study sample. There was a spike of sickness absence for mental ill health in March-April 2020 (899 730 days lost) compared with 519 807 days in March-April 2019; the surge was driven by an increase in new episodes of long-term absence and had diminished by May/June 2020. The increase was greatest in those aged >60 years (227%) and among employees of Asian and Black ethnic origin (109%-136%). Among doctors and dentists, the number of days absent declined by 12.7%. The biggest increase was in London (122%) and the smallest in the East Midlands (43.7%); the variation between regions reflected the rates of COVID-19 sickness absence during the same period. CONCLUSION: Although the COVID-19 epidemic led to an increase in sickness absence attributed to mental ill health in NHS staff, this had substantially declined by May/June 2020, corresponding with the decrease in pressures at work as the first wave of the epidemic subsided.

Cancer care disruption and reorganisation during the COVID-19 pandemic in Australia: A patient, carer and healthcare worker perspective.

The COVID-19 pandemic has dramatically impacted cancer care worldwide. Disruptions have been seen across all facets of care. While the long-term impact of COVID-19 remains unclear, the immediate impacts on patients, their carers and the healthcare workforce are increasingly evident. This study describes disruptions and reorganisation of cancer services in Australia since the onset of COVID-19, from the perspectives of people affected by cancer and healthcare workers. Two separate online cross-sectional surveys were completed by: a) cancer patients, survivors, carers, family members or friends (n = 852) and b) healthcare workers (n = 150). Descriptive analyses of quantitative survey data were conducted, followed by inductive thematic content analyses of qualitative survey responses relating to cancer care disruption and perceptions of telehealth. Overall, 42% of cancer patients and survivors reported experiencing some level of care disruption. A further 43% of healthcare workers reported atypical delays in delivering cancer care, and 50% agreed that patient access to research and clinical trials had been reduced. Almost three quarters (73%) of patients and carers reported using telehealth following the onset of COVID-19, with high overall satisfaction. However, gaps were identified in provision of psychological support and 20% of participants reported that they were unlikely to use telehealth again. The reorganisation of cancer care increased the psychological and practical burden on carers, with hospital visitation restrictions and appointment changes reducing their ability to provide essential support. COVID-19 has exacerbated a stressful and uncertain time for people affected by cancer and healthcare workers. Service reconfiguration and the adoption of telehealth have been essential adaptations for the pandemic response, offering long-term value. However, our findings highlight the need to better integrate psychosocial support and the important role of carers into evolving pandemic response measures. Learnings from this study could inform service improvements that would benefit patients and carers longer-term.

Psychosocial impact of COVID-19 on cancer patients, survivors, and carers in Australia: a real-time assessment of cancer support services.

PURPOSE: This study aimed to explore the psychosocial impacts of the coronavirus disease (COVID-19) pandemic on cancer patients, survivors, and carers in Australia. METHODS: Using real-time insights from two Cancer Council NSW services-131120 Information and Support Line and Online Community (CCOC) forums-we assessed service demand trends, distress levels (using the distress thermometer), and content from 131120 calls and online posts between 01 December 2019 and 31 May 2020. Emergent themes were identified through an inductive conventional content analysis with 131120 call notes, followed by a deductive directed content analysis on CCOC posts. RESULTS: In total, 688 COVID-19-related 131120 calls (n = 496) and online posts (n = 192) were analysed. Service demand peaked in March 2020 and self-reported distress peaked in May 2020 at an average of 8/10 [Mean = 7.5; SD = 0.9]. Five themes emerged from the qualitative analysis: psychological distress and fear of virus susceptibility, practical issues, cancer service disruptions, information needs, and carer Issues. CONCLUSIONS: The psychosocial impacts of COVID-19 on people affected by cancer are multifaceted and likely to have long-lasting consequences. Our findings drove the development of six recommendations across three domains of support, information, and access. Cancer patients, survivors, and carers already face stressful challenges dealing with a cancer diagnosis or survivorship. The added complexity of restrictions and uncertainty associated with the pandemic may compound this. It is important that healthcare providers are equipped to provide patient-centred care during and after this crisis. Our recommendations provide points of consideration to ensure care is tailored and patient oriented.

COVID-19: Transatlantic Declines in Pediatric Emergency Admissions.

INTRODUCTION: This cross-sectional study looked at the impact of the SARS-CoV-2/COVID-19 pandemic on pediatric emergency department (PED) attendances and admissions (as a proxy for severity of illness) in the United States and United Kingdom. METHODS: Data were extracted for children and adolescents, younger than 16 years, attending Royal Manchester Children's Hospital (RMCH, United Kingdom), and Yale New Haven Children's Hospital (YNHCH, United States). Attendances for weeks 1 to 20 of 2020 and 2019 were compared, and likelihood of admission was assessed via calculation of odds ratios, using week 13 (lockdown) as a cutoff. RESULTS: Attendance numbers for each PED decreased in 2020 compared with 2019 (RMCH, 29.2%; YNHCH, 24.8%). Odds of admission were significantly higher after lockdown than in 2019-RMCH (odds ratio, 1.26; 95% confidence interval, 1.08-1.46) and YNHCH (odds ratio, 1.60; 95% confidence interval, 1.31-1.98). CONCLUSIONS: Although the absolute numbers of children and adolescents attending the PED and being admitted decreased after lockdown, the acuity of illness of those attending appears to be higher.

Interventions delivered in secondary or tertiary medical care settings to improve routine vaccination uptake in children and young people: a scoping review protocol.

OBJECTIVE: The objective of this review is to identify and collate the available evidence, and to produce an overview of interventions delivered in secondary and tertiary healthcare settings with the aim of improving vaccination uptake in children and young people. INTRODUCTION: Vaccine hesitancy appears in the World Health Organization's Ten Threats to Global Health in 2019. Time spent in secondary or tertiary healthcare settings with a child or young person may present an opportunity to deliver vaccination-focused interventions. National Institute for Health and Care Excellence guidance highlights a gap in the evidence of the effectiveness of different interventions aimed at increasing immunization uptake among children and young people. INCLUSION CRITERIA: Quantitative studies that describe interventions delivered in secondary and tertiary care settings will be included. Participants will include children and young people aged less than 16 years and/or their parents/carers (potentially interventions could be delivered to the child-parent/carer dyad) present in a secondary or tertiary care setting as either a patient or relative. METHODS: This scoping review will be conducted using MEDLINE, CINAHL, Cochrane Library, Embase, Web of Science, as well as gray literature. The scoping review will exclude publications not available in English and any publication older than 30 years. Two reviewers will independently select articles using the inclusion criteria, based on their title and abstract. Data will be extracted from selected full text articles using a data extraction tool based on JBI recommendations. Study findings will be presented in tabular form detailing the interventions identified in the literature.

Correction to: Do pain, anxiety and depression influence quality of life for people with amyotrophic lateral sclerosis/motor neuron disease? A national study reconciling previous conflicting literature.

The original version of this article unfortunately contained a mistake. Oliver Hanemann name was incorrect in the in the acknowledgements section of this paper.

Do pain, anxiety and depression influence quality of life for people with amyotrophic lateral sclerosis/motor neuron disease? A national study reconciling previous conflicting literature.

INTRODUCTION: The importance of elucidating the relationships between pain, mood and quality of life (QoL) amongst people with amyotrophic lateral sclerosis/motor neuron disease is evident to clinicians, yet the literature is limited and inconsistent. We explored the relationships between pain, depression, anxiety and QoL to reconcile the previous contrasting findings and inform future research and clinical practice. METHODS: Patient-reported outcomes were obtained as part of the Trajectories of Outcomes in Neurological Conditions study. Mood and QoL scales underwent Rasch analysis. Correlation coefficients examined the strength of association between variables of interest. A bivariate regression model was developed to examine the effects of pain, depression and anxiety on joint psychological and physical QoL domains. RESULTS: Of 636 people with ALS, 69% reported pain, of these most had mild pain. Seven percent (7%) of participants exceeded published cutoffs for probable depression and 14% had probable anxiety. Pain, depression and anxiety all influence quality of life; depression has a significant effect on both physical and psychological domains of QoL, whereas pain affects physical QoL and anxiety psychological QoL. CONCLUSIONS: These results show the importance of expressing quality of life in a conceptually appropriate way, as failing to take account of the multidimensional nature of QoL can result in important nuances being overlooked. Clinicians must be aware that pain, depression and anxiety all worsen QoL across their ranges, and not just when pain is severe or when anxiety or depression reach case level.

Observational study to assess the effects of social networks on the seasonal influenza vaccine uptake by early career doctors.

OBJECTIVES: To evaluate the effect of social network influences on seasonal influenza vaccination uptake by healthcare workers. DESIGN: Cross-sectional, observational study. SETTING: A large secondary care NHS Trust which includes four hospital sites in Greater Manchester. PARTICIPANTS: Foundation doctors (FDs) working at the Pennine Acute Hospitals NHS Trust during the study period. Data collection took place during compulsory weekly teaching sessions, and there were no exclusions. Of the 200 eligible FDs, 138 (70%) provided complete data. PRIMARY OUTCOME MEASURES: Self-reported seasonal influenza vaccination status. RESULTS: Among participants, 100 (72%) reported that they had received a seasonal influenza vaccination. Statistical modelling demonstrated that having a higher proportion of vaccinated neighbours increased an individual's likelihood of being vaccinated. The coefficient for γ, the social network parameter, was 0.965 (95% CI: 0.248 to 1.682; odds: 2.625 (95% CI: 1.281 to 5.376)), that is, a diffusion effect. Adjusting for year group, geographical area and sex did not account for this effect. CONCLUSIONS: This population exhibited higher than expected vaccination coverage levels-providing protection both in the workplace and for vulnerable patients. The modelling approach allowed covariate effects to be incorporated into social network analysis which gave us a better understanding of the network structure. These techniques have a range of applications in understanding the role of social networks on health behaviours.