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The article investigates the impact of six-years of vegetable cropping on the weed seed populations present in the soil subjected to three long experiments in Warwick, England, from 1953 to 1959. Specifically, it examines the impact of cropping, manurial treatment particularly farmyard manure and fallowing on total number of weed seeds. Experiments include the nitrogen experiment, the NPK (nitrogen, phosphate and potash) experiment and the cultivation experiment. Findings show that the total weed seed population declined during several years of cropping, except for Poa annua, Senecio vulgaris and Stellaria media. Analysis also reveals that application of various inorganic fertilizer treatments have little impact on the weed seed population.

The article focuses on the effects of different primary cultivation on several weeds at Wellesbourne in South Warwickshire, England. The aim of the experiment was to determine the effects of different yields of vegetable crops and on soil properties, in which the main comparison in the experiments was based on the three depths of working such as ploughing and rotary cultivation and the treatments with different methods of traction. The result shows that if the production of weed seeds takes place from time to time, and must be regarded as almost inevitable, then the build-up of high particular species is likely to occur rapidly, where rotary cultivation rather than ploughing to the same depth is employed for primary cultivation.

The article presents a study on the effects of manurial and cultural treatments on soil properties and on vegetable crops, including Stellaria media, Poa annua and Chenopodium album. It states that in 1952, the Chemistry section at the National Vegetable Research Station planned three long-term field experiments for the study of the impacts of manurial and cultural treatments on soil properties and vegetable crops. These experiments are conducted in Soakwaters, which is a field of 36 acres in Warwick, England. Results showed that after the first year of vegetable cropping, it was found that the population of vegetable crops had been reduced to 38% of the original level. By the end of the second year of cropping, however, the population had fallen by 19% of that originally present.

Introduction: People with Parkinson’s (PwP) and their caregivers often report poor diagnosis experiences and a lack of information, support and control over Parkinson’s. First Steps is a two-day course delivered by volunteers with Parkinson’s, which aims to help those newly diagnosed and their caregivers face the future positively and take control of Parkinson’s. This study aimed to capture the views and experiences of participants and volunteer hosts of First Steps, and evaluate if it meets those aims. Methods: Using purposive sampling, twelve participants comprising four PwP, five caregivers and three volunteer hosts were recruited. Face-to-face, semi-structured interviews were conducted, audio-recorded, transcribed verbatim and analysed thematically. Results: Course participants found First Steps informative, supportive, and helpful in feeling more positive about Parkinson’s. Participants were reassured by the hosts having Parkinson’s, despite prior concerns regarding seeing people who might have more advanced Parkinson’s. Some found First Steps more relatable than other support services and reported that the course complemented clinician-led courses as the content was aimed at caregivers as well as PwP, with variation in information delivery techniques. Among the PwP and caregivers, two thirds reported a lack of control over Parkinson’s and some felt First Steps had improved their control. Hosts felt they had control over Parkinson’s and perceived their role to be both challenging and rewarding. Conclusions: First Steps was perceived as a helpful course, offering information and support for those newly diagnosed and their caregivers in a positive and non-clinical environment. Volunteer hosts felt more control over Parkinson’s than other participants, but there was evidence that the course helped some experience more control. Suggested course improvements included: additions to the presentation content with more emphasis on taking control, and offering group follow up sessions. This will inform current expansion across the UK. [ABSTRACT FROM AUTHOR]

Introduction: Appetite loss in older people -anorexia of ageing (AA) - is common. Recognised consequences include under nutrition, sarcopenia, frailty, and increased mortality after discharge from hospital. Identification and management of AA may prevent onset of these health burdens. Whilst appetite can be assessed, this is often not routine. Methods: Cross-sectional data from three studies (carried out 2010-2017), with comparable data collection methods and drawn from the same population, were combined. Participants were over 70 years, admitted to acute wards within a large UK hospital. Appetite was assessed using the simple 4 item Simplified Nutritional Appetite Questionnaire (SNAQ); a score of ≤14/20 defines poor appetite. Correlates of SNAQ scores were evaluated. Results: The dataset included 474 participants (64% female) with mean age 84 (6.5), median Barthel 78 (IQR 53-91), mini-mental state exam (MMSE) 27 (IQR 23-29) and comorbidity index 5 (IQR 4-7). The median GDS for the population was 4 (IQR 4-6). The mean SNAQ score was 13.9 (SD 2.6), and 265 (56%) participants scored ≤14 indicating poor appetite. There was no significant difference between mean SNAQ scores of men and women (P=.26), or those living alone and with others (P=.62). Age, MMSE, comorbidity index, and total number of medications were not related to SNAQ score in continuous analyses but geriatric depression score (GDS-15) was (adjusted coefficient -.248; P<.001); such that lower mood was associated with poorer appetite. Conclusions: These findings highlight the importance of assessing appetite in hospitalised older people, as poor appetite is very common. Appetite can be assessed in hospital using the simple 4 item SNAQ tool. Subclinical low mood, measured by GDS-15, had the strongest association with SNAQ score whilst in hospital. Therefore, for those with poor appetite in hospital, clinicians should have a low threshold to evaluate and treat low mood. [ABSTRACT FROM AUTHOR]

Introduction: In the UK, care homes in unsuitable older buildings are closing. Involuntary relocation is associated with increased mortality and negative emotions among residents. Extensive planning canmitigate this. The aim was to understand the experience of a planned relocation between two care homes. Methods: In the UK, care homes in unsuitable older buildings are closing. Involuntary relocation is associated with increased mortality and negative emotions among residents. Extensive planning canmitigate this. The aim was to understand the experience of a planned relocation between two care homes. Results: Seven themes were identified and organised under three stages: pre-move (communication and involvement; preparation for the move; and attitudes towards the move), day-of- the-move (organisation of the move), and post-move (environmental change and impact; staff organisation and management; and settling in). Family and staff members reported that the pre-move information provided was inconsistent and staff did not feel involved in the planning and design process. Pre-move visits and staff and family support were beneficial for residents’ preparation for the move. All participants expressed sadness about the closure, and reported apprehension about moving. The moving day felt disorganised and stressful to staff who had to spread between the two homes. Post-move, the new care home was perceived by many participants as a ‘hotel’ rather than a home. Its larger size and confusing layout impacted negatively on residents and staff. New staff and changes in management structure were perceived by the different stakeholders to cause increased staff workload. Residents adjusted variably to the new home, with family support and staff continuity of care proving to be facilitators. Conclusions: Despite extensive planning, relocation and adjustment was challenging. Recommendations for future relocations include: increasing involvement of staff in the planning and design of the home; ensuring consistent communication and organising staff rotas to maintain continuity of care. [ABSTRACT FROM AUTHOR]

Introduction: Physical activity (PA) is important for older people to maintain functional independence and healthy ageing. PA interventions for community-dwelling older adults are often delivered by healthcare professionals, fitness instructors or trained members of a research team. Innovative approaches are needed to ensure that these interventions are practical and sustainable.This systematic review explores the effectiveness of volunteer-led PA interventions in improving health outcomes for community-dwelling older people. Methods: Following PRISMA recommendations, five databases (MEDLINE, Embase, CINAHL, PEDro, Cochrane library) were systematically searched until May 2019, for studies using trained volunteers to deliver PA interventions for community-dwelling older people aged ≥ 65 years, reporting on participant outcomes. Meta-analysis was not conducted due to included study heterogeneity. Results: Twelve papers (eight studies including three randomised controlled trials (RCTs)) were included in the review; five papers reported different outcomes from the same RCT. Intervention settings included community exercise groups (n=4), home (n=2) and care homes (n=2). All eight studies included strength and balance exercises and frequency of PA ranged from once daily to weekly sessions. The three RCTs showed improvement in grip strength, nutritional and frailty status, and reduction in fear of falling, among 39 older adults (mean age 83 years) who received a physical training and nutritional intervention; improvement in grip strength and activity of daily living scores among 56 nursing home older adults (mean age 78 years) who received resistance exercise training; and a significantly higher proportion of older adults (n = 193, 9% improvement vs 0.5% in the control group) achieved the recommended target of 150 minutes of moderate vigorous PA per week using the Falls Management Exercise intervention. Two studies compared volunteer and health professional-delivered PA interventions and reported that both interventions were equally effective in reducing fear of falls and improving quality of life. Two quasi-experimental studies reported improvement in functional outcomes including functional reach, timed up and go test, and chair stand. A large prospective cohort study (n = 1620) reported a reduction in disability among older adults who received volunteer-led exercise compared to control, with a hazard ratio of 0.73 (95% CI 0.62-0.86) for development of disability. Conclusions: Trained volunteers can lead PA interventions among community-dwelling older adults with some evidence of improved health outcomes including nutritional, functional and frailty status. [ABSTRACT FROM AUTHOR]

Background The All Wales Medical Genomics Service (AWMGS) receives around 90 FFPE solid tumour samples per week for genetic analysis. Streamlining of testing is required in order to ensure the laboratory has the capacity and capability to meet the growing needs of the precision medicine era. With this in mind, AWMGS aimed to validate and incorporate a single NGS panel into service for the detection of, in the first instance, single nucleotide variations in a range of tumour types using a minimum of 10ng FFPE-derived DNA. Methods The validation involved the evaluation of the panel for the detection of single nucleotide variations in FFPE-extracted DNA. The workflow consisted of a SeqCap EZ HyperCap (Roche) protocol, sequencing on the Nextseq 550 (Illumina) and an in-house bioinformatic analysis pipeline. The validation encompassed the determination of assay sensitivity, specificity, accuracy, reproducibility and limit of detection via a series of validation rounds whereby previously tested surplus FFPE-derived DNAs of known genotype along with 2 cell-line reference standards were used as control samples to evaluate the performance of the panel. Results The panel showed a high degree of specificity, sensitivity and reproducibility, and could reliably detect variants in samples with as little as 10ng input DNA. However, despite multiple optimisation attempts, low input samples of < 50ng DNA did not consistently achieve the 250x read depth required to ensure a 5% variant could be excluded with confidence. Conclusions AWMGS successfully validated and optimised a bespoke NGS pan-cancer panel to provide molecular characterisation of FFPE solid tumour samples, with a minimum requirement of 50ng input DNA. This panel was implemented into the laboratory in a phased approach, initially replacing existing technologies for the delivery of existing NHS services. The panel provides an increased level of genomic information compared to previous testing methods and has greater clinical utility. As the panel has been designed to detect copy number and structural variations, once validated within the laboratory, this will have an even greater impact on the streamlining of testing. Legal entity responsible for the study Cardiff and Vale University Health Board. Funding NHS England's Estates and Technology Transformation Fund. Disclosure All authors have declared no conflicts of interest. [ABSTRACT FROM AUTHOR]

Discusses research being done on patient recovery after stroke. Reference to study by J. Kwan et al, presented at the British Geriatrics Society Communications to the Autumn Meeting in Harrogate, England from October 6 to 8, 2004; Accuracy of predicting functional outcome after stroke; Importance of healthcare professionals' prediction of recovery; Methodology and result of the study.

Introduction: Children and young people (CYP) presenting with a mental health (MH) crisis are frequently admitted to general acute paediatric wards as a place of safety. Prior to the pandemic, a survey in England showed that CYP occupied 6% of general paediatric inpatient beds due to an MH crisis, and there have been longstanding concerns about the quality of care to support these patients in this setting. Mental Health Admissions to Paediatric Wards Study aims to generate a theory of change (ToC) model to improve the quality of care for CYP admitted to acute paediatric services after presenting in a MH crisis., Methods and Analysis: We will undertake a national (England), sequential, mixed methods study to inform a ToC framework alongside a stakeholder group consisting of patients, families/carers and healthcare professionals (HCPs). Our study consists of four work packages (WP) undertaken over 30 months. WP1 is limited to using national routine administrative data to identify and characterise trends in MH admissions in acute paediatric wards in England between 2015- 2022., Ethics and Dissemination: WP1 received ethical approval (Ref 23/NW/0192). We will publish the overall synthesis of data and the final ToC to improve care of CYP with MH crisis admitted to general acute paediatric settings. As coproducers of the ToC, we will work with our stakeholder group to ensure wide dissemination of findings. Potential impacts will be on service development, new models of care, training and workforce planning., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Introduction: Children and young people (CYP) presenting with a mental health (MH) crisis are frequently admitted to general acute paediatric wards as a place of safety. Prior to the pandemic, a survey in England showed that CYP occupied 6% of general paediatric inpatient beds due to an MH crisis, and there have been longstanding concerns about the quality of care to support these patients in this setting. MAPS aims to generate a Theory of Change (ToC) model to improve the quality of care for CYP admitted to acute paediatric services after presenting with an MH crisis. Here, we describe work packages (WPs) 2 and 3 of the study, which have been granted ethics approval., Methods and Analysis: We will undertake a national (England), sequential, mixed-methods study to inform a ToC framework alongside a stakeholder group consisting of patients, families/carers and healthcare professionals (HCPs). Our study consists of four WPs undertaken over 30 months. WP2 is limited to working with stakeholders to develop a data collection instrument and then use this in a prospective study of MH admissions over 6 months in 15 purposively recruited acute paediatric wards across England. WP3 consists of gathering the views of CYP, their families/carers and HCPs during admissions using semistructured interviews., Ethics and Dissemination: WP2 and WP3 received ethical approval (ref: 23/LO/0349). We will publish the overall synthesis of data and the final ToC to improve care of CYP with MH crisis admitted to general acute paediatric settings. As co-producers of the ToC, we will work with our stakeholder group to ensure wide dissemination of findings. Potential impacts will be upon service development, new models of care, training and workforce planning., Prospero Registration Number: CRD42022350655., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Background: Treatment burden is the effort required of patients to look after their health and the impact this has on their functioning and wellbeing. It is likely treatment burden changes over time as circumstances change for patients and health services. However, there are a lack of population-level studies of treatment burden change and factors associated with this change over time. Furthermore, there are currently no practical screening tools for treatment burden in time-pressured clinical settings or at population level., Methods and Analysis: This is a three-year follow-up of a cross-sectional survey of 723 people with multimorbidity (defined as three or more long-term conditions; LTCs) registered at GP practices in in Dorset, England. The survey will repeat collection of information on treatment burden (using the 10-item Multimorbidity Treatment Burden Questionnaire (MTBQ) and a novel single-item screening tool), sociodemographics, medications, LTCs, health literacy and financial resource, as at baseline. Descriptive statistics will be used to compare change in treatment burden since the baseline survey in 2019 and associations of treatment burden change will be assessed using regression methods. Diagnostic test accuracy metrics will be used to evaluate the single-item treatment burden screening tool using the MTBQ as the gold-standard. Routine primary care data (including demographics, medications, LTCs, and healthcare usage data) will be extracted from medical records for consenting participants. A forward-stepwise, likelihood-ratio logistic regression model building approach will be employed in order to assess the utility of routine data metrics in quantifying treatment burden in comparison to self-reported treatment burden using the MTBQ., Impact: To the authors' knowledge, this will be the first study investigating longitudinal aspects of treatment burden. Findings will improve understanding of the extent to which treatment burden changes over time for people with multimorbidity and factors contributing to this change, as well as allowing better identification of people at risk of high treatment burden., Competing Interests: The authors have declared that no competing interests exist.

Introduction: Molecular characterisation of tumours is increasing personalisation of cancer therapy, tailored to an individual and their cancer. FOCUS4 is a molecularly stratified clinical trial for patients with advanced colorectal cancer. During an initial 16-week period of standard first-line chemotherapy, tumour tissue will undergo several molecular assays, with the results used for cohort allocation, then randomisation. Laboratories in Leeds and Cardiff will perform the molecular testing. The results of a rigorous pre-trial inter-laboratory analytical validation are presented and discussed., Methods: Wales Cancer Bank supplied FFPE tumour blocks from 97 mCRC patients with consent for use in further research. Both laboratories processed each sample according to an agreed definitive FOCUS4 laboratory protocol, reporting results directly to the MRC Trial Management Group for independent cross-referencing., Results: Pyrosequencing analysis of mutation status at KRAS codons12/13/61/146, NRAS codons12/13/61, BRAF codon600 and PIK3CA codons542/545/546/1047, generated highly concordant results. Two samples gave discrepant results; in one a PIK3CA mutation was detected only in Leeds, and in the other, a PIK3CA mutation was only detected in Cardiff. pTEN and mismatch repair (MMR) protein expression was assessed by immunohistochemistry (IHC) resulting in 6/97 discordant results for pTEN and 5/388 for MMR, resolved upon joint review. Tumour heterogeneity was likely responsible for pyrosequencing discrepancies. The presence of signet-ring cells, necrosis, mucin, edge-effects and over-counterstaining influenced IHC discrepancies., Conclusions: Pre-trial assay analytical validation is essential to ensure appropriate selection of patients for targeted therapies. This is feasible for both mutation testing and immunohistochemical assays and must be built into the workup of such trials., Trial Registration Number: ISRCTN90061564., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Objective: Painful peripheral neuropathy in people with type 2 diabetes is a disabling complication. We explored associations of this condition with socioeconomic deprivation., Research Design and Methods: The Townsend index of socioeconomic deprivation was examined in the pseudonymised GP records of 15388 (44.1% female) individuals with type 2 diabetes in the Cheshire county of England, and related to prevalence of drug treated painful diabetic neuropathy. We also analysed prescription trends with respect to pharmacotherapy for neuropathy pain relief., Results: Treatment for neuropathic pain was initiated in 3 266 (21.2%) of patients. Those on treatment were older [68.2 (95% CI 67.8-68.7) vs. 66.6 (66.4-66.8) years] than those not on treatment. There was no difference in HbA1c (7%, 55 mmol/mol).There were significant differences between the groups for the Townsend deprivation index, with a greater proportion (30.6% vs. 22.8% of patients with treated neuropathic pain) having a score of ≥1 (Χ(2)=83.9, p<0.0001).Multivariate logistic regression analyses indicated that each unit increment in the Townsend index was associated with an 6% increased odds of requiring neuropathic pain treatment [odds ratio (95%CI) 1.06 (1.05-1.08), p<0.0001] independent of 5 year age band, BMI, gender, systolic BP, eGFR, HbA1C and total cholesterol., Conclusions: In this study using pseudonymised clinical records, a higher level of socioeconomic deprivation seemingly may predispose to severe neuropathic pain in diabetes requiring pharmacological intervention. Targeted allocation of healthcare resources to this group may offer clinical benefits., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Childhood obesity is high on the policy agenda of wealthier nations, and many interventions have been developed to address it. This work describes an overview of schemes for obese and overweight children and young people in England, and the 'mapping' approach we used., Methods: Our search strategy, inclusion criteria and coding frame had to be suitable for describing a potentially large number of schemes within a short timeframe. Data were collected from key informants, scheme publicity and reports, and via a web-survey. To be included, schemes had to be based in England, follow a structured programme lasting at least two weeks, promote healthy weight, and be delivered exclusively to overweight and/or obese children and young people (age range 4-18). Data were entered into a coding frame recording similar information for each scheme, including any underpinning research evidence, evaluation or monitoring reports. Priority questions were identified in consultation with colleagues from the Department of Health and the Cross Government Obesity Unit., Results: Fifty-one schemes were identified. Some operated in multiple areas, and by using estimates of the number of schemes provided by multi-site scheme leads, we found that between 314 and 375 local programmes were running at any time. Uncertainty is largely due to the largest scheme provider undergoing rapid expansion at the time of the mapping exercise and therefore able to provide only an estimate of the number of programmes running. Many schemes were similar in their approach, had been recently established and were following NICE guidelines on interventions to promote healthy weight. Rigorous evaluation was rare., Conclusions: Our methods enabled us to produce a rapid overview of service activity across a wide geographic area and a range of organisations and sectors. In order to develop the evidence base for childhood obesity interventions, rigorous evaluation of these schemes is required. This overview can serve as a starting point for evaluations of interventions to address obesity. More generally, a rapid and systematic approach of this type is transferable to other types of service activity in health and social care, and may be a tool to inform public health planning.

Concerns remain that health and social care services often fail people dying of chronic illnesses other than those with cancer. British government policy aims to improve end-of-life care and to enable people to make choices about place of care near the end of life, with the assumption that home is often the preferred option. However, some elderly people may lack suitable social networks, family carers and other resources to remain at home. Community hospitals offer a potentially accessible resource for local provision of end-of-life care. They have the advantage of being located within easy reach for family members, are staffed by local people and in most of them, general practitioners can maintain continuity of care. This paper examines patients' and family carers' experiences of end-of-life care in community hospitals. In-depth organisational case studies were conducted in six community hospitals in the south of England. Interviews were undertaken with elderly patients dying of cancer and other advanced conditions (n = 18) and their family carers (n = 11). Qualitative analysis of transcribed interviews were undertaken, using the principles of grounded theory. Patients and family carers valued the flexibility, local nature (which facilitated visiting) and personal care afforded to them. Most participants regarded community hospitals as preferable to larger district general hospitals. Our research reveals that these participants regarded community hospitals as acceptable places for end-of-life care. Finally, we discuss the implications of our findings for improving end-of-life care.

Objectives: The perceptions of bereaved family members were obtained to evaluate the nature and quality of end-of-life care in community hospitals., Design: During organizational case studies in six community hospitals in the South East and South West of England, bereaved family members were asked to participate in semi-structured interviews., Participants: Fifty-one interviews were conducted with family members of patients who had received end-of-life care in a community hospital within the previous year., Results: Respondents were very positive about the care they and the patient had received. They valued the convenience of access for frequent and long-stay visiting and the familiarity of the local hospital. Comparisons were made with more negative experiences at their nearest District General Hospital. Issues raised included the noise at the community hospitals, and the lack of contact with qualified nurses., Discussion: The results of this study have implications for UK government initiatives, such as the National Framework for Older People, and the Department of Health's 'Keeping the NHS Local'.

Day care can play a prominent part in the overall development of high quality health and social care provision for older people. This paper describes an approach to evaluating day care services which brings together costs and service users' views as a means of establishing the overall 'value'. This strategy, it is argued, underlines the purpose of day care itself as a means of promoting the independence and autonomy of older people.

Objective: To examine the quality of social support among unemployed residents in Trent, England., Design: Secondary analysis of data generated by those of working age drawn from a postal lifestyle survey of the adult population of Trent region., Subjects and Setting: Subjects were 6987 individuals (males 16-64 years and females 16-59 years of age), of whom 9.9% (689/6987) were unemployed., Main Outcome Measures: Responses about the quality of social support obtained from three key questions., Results: Generally, the unemployed reported poorer quality of social support than employed persons (p < 0.0001) on all three key elements examined: 31% v 17% respectively had no practical support; 19% v 10% had no help with solving problems, and 21% v 10% had no emotional support. Only 57% of the unemployed had all three of these elements compared with 75% of the employed. Unemployment and lack of social support had independent and deleterious effects on perceptions of general health and mental health. Relationships remained after allowing for the possible confounding effects of age, gender, and household composition., Conclusions: There is a relationship between unemployment and poorer quality of social support which may help to explain some of the increased morbidity and mortality experienced by this group, especially that related to mental health.

We sought the views of purchasers and provider managers in the South and West Region on the relative priorities of 15 possible performance measures of a geriatric medical service. Using a postal questionnaire, subjects were asked to rank the measures in order of priority. Improving patients' quality of life was judged the most important measure by all groups except for the purchasing chief executives, who placed it second to improving patients' physical function (which was overall the second most important measure). The lowest priority was given to measurement of levels of activity and reducing mortality rates. Priorities were similar to those found with patients and geriatricians in a previous study, and supports the development and use of performance measures of disability and the quality of life of patients.

The objective of this work was to examine the efficiency of a postal survey in generating data relevant to Trent Regional Health Authority's need for baseline measures as indicators for health promotion, as specified in its strategy for health promotion. A representative sample, by District, was identified using Family Health Service Authority registers as the sampling frame, stratified by age (16-70 years) and gender. Data were collected from the resulting sample of 21,603 using a self-completion illustrated questionnaire. Delivery was postal with two reminders. Prepaid envelopes were supplied for returns. Questions about lifestyle, e.g. behaviour, attitudes and beliefs about smoking. The survey took place in each of the 12 Districts of Trent Region, the total population of which is over 4.5 million. The main outcome measures were behaviour, attitudes and beliefs about health by age and gender and by social class. The response was 61% after exclusions. Young males were under-represented in response. Sixty four per cent of respondents were non-smokers, 14% took optimal exercise on a monthly basis and 15% never drank alcohol. In the week prior to the study males were more likely to have drunk more than the recommended units of alcohol (24%) than women (9%). Over two-thirds of respondents (72%) had three key elements of social support. The postal survey generated data directly relevant to indicators embedded within Trent Health's health promotion strategy. Across the Region it was possible to examine patterns of response by age, gender and by social class. Data were adequate as baseline measures and repeat studies will monitor change. However, data are biased with sub-groups under-represented. In addition, non-responders are known to be different from responders. Data are therefore limited, but can be used to describe general patterns amongst responders. Other methods of data collection are required for the collection of more sensitive and/or qualitative data.

Study Objective: The study aimed to consider the impact of two different types of reminder on response rates and costs in a postal survey., Design: The study was a cross sectional survey. A self-completion lifestyle questionnaire was used. Those who did not respond after the initial mailing were randomly allocated to receive either a postcard or questionnaire as a first reminder. All outstanding non-responders received a questionnaire as a second reminder., Subjects: A representative sample of 698 adults aged 16-70 was used, drawn from a family health services authority register., Main Results: Postcard reminders were as effective as questionnaire reminders in increasing response whether one or two reminders are sent. The costs per response were calculated. Two questionnaires as reminders were found to be 1.7 times more expensive than a postcard plus questionnaire. Including the initial mailing, the cost per response using all questionnaires was 1.3 times the cost when a postcard was used for the first reminder., Conclusions: To increase the response to a postal survey effectively and economically, two reminders should be sent--first a postcard and then a questionnaire.

Little is known about the number of people who perceive themselves to be sufferers of hay fever. This study investigated how many people between the ages of 15 and 59 years perceived themselves to be hay fever sufferers and how they treated themselves. The study was carried out in a general practice in Arnold, Nottingham, using a postal questionnaire, to which the response rate was 77% from a sample size of 1062. Of the 813 respondents, 232 (29%) claimed to have had hay fever within the last two years. The prevalence of hay fever decreased significantly with age, and was associated with a history of asthma. One hundred and twenty five sufferers (54%) used over the counter treatments for their hay fever, and one third of these said that they felt drowsy after using them. These findings point to the need for general practitioners to be aware that a number of people, more than has been indicated by previous surveys, perceive themselves to be hay fever sufferers and are prepared to treat themselves using over the counter preparations.