Factors associated with poor self-reported health within the UK military and comparisons with the general population: a cohort study

Objective: To investigate the self-rated health of the UK military and explore factors associated with poor self-rated health. Compare self-rated health of the military to the general population. / Design: A cohort study. / Participants: A total of 7626 serving and ex-serving UK military personnel, aged between 25 and 49; 19,452,300 civilians from England and Wales. / Setting: United Kingdom (military), England and Wales (civilians). / Main outcome measures: Self rated health for both populations. Additional data for the military sample included measures of symptoms of common mental disorder (General Health Questionnaire-12), probable post-traumatic stress disorder (post-traumatic stress disorder checklist Civilian Version), alcohol use (Alcohol Use Disorders Identification Test), smoking behaviour, history of self-harm and body mass index. / Results: In the military sample, poor self-rated health was significantly associated with: common mental disorders and post-traumatic stress disorder symptomology, a history of self-harm, being obese, older age (ages 35–49) and current smoking status. However, the majority of military personnel report good health, with levels of poor self-rated health (13%) not significantly different to those reported by the general population (12.1%). / Conclusions: Self-rated health appears to relate to aspects of both physical and psychological health. The link between poor self-rated health and psychological ill-health emphasises the need for military support services to continue addressing mental health problems

A systematic review of the psychological correlates of adjustment outcomes in adults with inflammatory bowel disease

Inflammatory bowel disease (IBD) is a chronic long term condition which poses significant psychosocial adjustment challenges. The purpose of this review was to systematically identify psychological factors related to adjustment in adults with IBD with the aim of suggesting evidence based targets that may be modifiable though psychological intervention. Twenty five studies met inclusion criteria and were included in the systematic review and a narrative synthesis was conducted. A wide range of psychological variables were addressed covering six broad categories; personality traits, interpersonal traits, stress and coping, emotions and emotional control, IBD related cognitions and non IBD related cognitions. The most consistent relationship was found between certain emotion focused coping strategies and worse adjustment outcomes in IBD. Some evidence also hi-lighted a relationship between personality traits (such as neuroticism,) perceived stress, emotions and emotional control (such as alexithymia) and IBD related cognitions (such as illness perceptions) and negative adjustment outcomes. The results of this review suggest that interventions to improve adjustment in IBD may benefit from a focus on coping strategies, perceived stress and IBD related cognitions

Adherence to the test, trace, and isolate system in the UK: results from 37 nationally representative surveys

Objective: To investigate rates of adherence to the UK’s test, trace, and isolate system over the initial 11 months of the covid-19 pandemic. Design: Series of cross sectional online surveys. Setting: 37 nationally representative surveys in the UK, 2 March 2020 to 27 January 2021. Participants: 74 697 responses from 53 880 people living in the UK, aged 16 years or older (37 survey waves, about 2000 participants in each wave). Main outcome measures: Identification of the main symptoms of covid-19 (cough, high temperature or fever, and loss of sense of smell or taste), self-reported adherence to self-isolation if symptoms were present and intention to self-isolate if symptoms were to develop, requesting a test for covid-19 if symptoms were present and intention to request a test if symptoms were to develop, and intention to share details of close contacts. Results: Only 51.5% of participants (95% confidence interval 51.0% to 51.9%, n=26 030/50  570) identified the main symptoms of covid-19; the corresponding values in the most recent wave of data collection (25-27 January 2021) were 50.8% (48.6% to 53.0%, n=1019/2007). Across all waves, duration adjusted adherence to full self-isolation was 42.5% (95% confidence interval 39.7% to 45.2%, n=515/1213); in the most recent wave of data collection (25-27 January 2021), it was 51.8% (40.8% to 62.8%, n=43/83). Across all waves, requesting a test for covid-19 was 18.0% (95% confidence interval 16.6% to 19.3%, n=552/3068), increasing to 22.2% (14.6% to 29.9%, n=26/117) from 25 to 27 January. Across all waves, intention to share details of close contacts was 79.1% (95% confidence interval 78.8% to 79.5%, n=36 145/45 680), increasing to 81.9% (80.1% to 83.6%, n=1547/1890) from 25 to 27 January. Non-adherence was associated with being male, younger age, having a dependent child in the household, lower socioeconomic grade, greater financial hardship during the pandemic, and working in a key sector. Conclusions: Levels of adherence to test, trace, and isolate are low, although some improvement has occurred over time. Practical support and financial reimbursement are likely to improve adherence. Targeting messaging and policies to men, younger age groups, and key workers might also be necessary

COVID-19 and Ventilation in the Home; Investigating Peoples’ Perceptions and Self-Reported Behaviour (the COVID-19 Rapid Survey of Adherence to Interventions and Responses [CORSAIR] Study)

Ventilating indoor spaces helps prevent COVID-19 transmission. We investigated self-reported rates of opening windows to improve ventilation in the home, perceived effectiveness of opening windows, and confidence that if you wanted to, you could open windows. One in 6 people reported rarely, if ever, opening windows in their home in the last week. Three in 4 people knew that opening windows to improve ventilation was an effective way to prevent the spread of COVID-19 and 5 in 6 were confident that they could open windows in their home. Official messaging should continue to seek to improve knowledge about the effectiveness of ventilation for reducing COVID-19 transmission, and increase the frequency of window opening

Do members of the public think they should use lateral flow tests or PCR tests when they have COVID-19-like symptoms? The COVID-19 Rapid Survey of Adherence to Interventions and Responses [CORSAIR] study

OBJECTIVES: To investigate public use of lateral flow test [LFT] or polymerase chain reaction [PCR] test when experiencing key COVID-19 symptoms. STUDY DESIGN: Two waves of a cross-sectional nationally representative online survey (data collected 1-2 June and 14-15 June 2021; n=3665 adults aged 18 years or over living in England or Scotland). METHODS: We report data investigating which type of test, if any, the public think Government guidance asks people to use if they have COVID-19 symptoms. In people with key COVID-19 symptoms (high temperature, cough, loss of sense of taste or smell), we also describe uptake of testing, if any. RESULTS: 10% of respondents thought Government guidance stated that they should take an LFT if symptomatic, while 18% of people thought that should take a PCR test; 60% thought they should take both types of test (12% did not select either option). In people who were symptomatic, 32% reported taking a test to confirm whether they had COVID-19. Of these, 53% reported taking a PCR test and 44% reported taking an LFT. CONCLUSIONS: Despite Government guidance stating that anyone with key COVID-19 symptoms should complete a PCR test, a significant percentage of the population use LFT tests when symptomatic. Communications should emphasise the superiority of, and need for, PCR tests in people with symptoms

Holding a stigmatizing attitude at the start of the COVID-19 outbreak: A cross-sectional survey

OBJECTIVES: To identify the prevalence of a stigmatizing attitude towards people of Chinese origin at the start of the COVID-19 outbreak in the UK population and investigate factors associated with holding the stigmatizing attitude. DESIGN: Online cross-sectional survey conducted 10-13 February 2020 (n = 2006, people aged 16 years or over and living in the UK). METHODS: We asked participants to what extent they agreed it was best to avoid areas heavily populated by Chinese people because of the COVID-19 outbreak. Survey materials also asked about: worry, perceived risk, knowledge, information receipt, perception of government response to COVID-19, and personal characteristics. We ran binary logistic regressions to investigate associations between holding a stigmatizing attitude, personal characteristics, and psychological and contextual factors. RESULTS: 26.1% people (95% CI 24.2-28.0%, n = 524/2006) agreed it was best to avoid areas heavily populated by Chinese people. Holding a stigmatizing attitude was associated with greater worry about COVID-19, greater perceived risk of COVID-19, and poorer knowledge about COVID-19. CONCLUSIONS: At the start of the COVID-19 pandemic, a large percentage of the UK public endorsed avoiding areas in the UK heavily populated by people of Chinese origin. This attitude was associated with greater worry about, and perceived risk of, the COVID-19 outbreak as well as poorer knowledge about COVID-19. At the start of future novel infectious disease outbreaks, proactive communications from official sources should provide context and facts to reduce uncertainty and challenge stigmatizing attitudes, to minimize harms to affected communities

Worry and behaviour at the start of the COVID-19 outbreak: results from three UK surveys (the COVID-19 Rapid Survey of Adherence to Interventions and Responses [CORSAIR] study)

We aimed to describe worry and uptake of behaviours that prevent the spread of infection (respiratory and hand hygiene, distancing) in the UK at the start of the COVID-19 outbreak (January and February 2020) and to investigate factors associated with worry and adopting protective behaviours. Three cross-sectional online surveys of UK adults (28 to 30 January, n=2016; 3 to 6 February, n=2002; 10 to 13 February 2020, n=2006) were conducted. We used logistic regressions to investigate associations between outcome measures (worry, respiratory and hand hygiene behaviour, distancing behaviour) and explanatory variables. 19.8% of participants (95% CI 18.8% to 20.8%) were very or extremely worried about COVID-19. People from minoritized ethnic groups were particularly likely to feel worried. 39.9% of participants (95% CI 37.7% to 42.0%) had completed one or more hand or respiratory hygiene behaviours more than usual in the last seven days. Uptake was associated with greater worry, perceived effectiveness of individual behaviours, self-efficacy for engaging in them, and having received more information. 13.7% (95% CI 12.2% to 15.2%) had reduced the number of people they had met. This was associated with greater worry, perceived effectiveness, and self-efficacy. At the start of novel infectious disease outbreaks, communications should emphasise perceived effectiveness of behaviours and ease with which they can be carried out

Factors associated with nonessential workplace attendance during the Covid-19 pandemic in the UK in early 2021: evidence from cross-sectional surveys

Objectives: Working from home where possible is important in reducing spread of Covid-19. In early 2021, a quarter of people in England who believed they could work entirely from home reported attending their workplace. To inform interventions to reduce this, this study examined associated factors. Study design: Data from the ongoing CORSAIR survey series of nationally representative samples of people in the UK aged 16+ years in January-February 2021 were used. Methods The study sample was 1422 respondents who reported that they could work completely from home. The outcome measure was self-reported workplace attendance at least once during the preceding week. Factors of interest were analysed in three blocks: 1) sociodemographic variables, 2) variables relating to respondents’ circumstances, and 3) psychological variables. Results 26.8% (95%CI=24.5%-29.1%) of respondents reported having attended their workplace at least once in the preceding week. Sociodemographic variables and living circumstances significantly independently predicted non-essential workplace attendance: male gender (OR=1.85,95%CI=1.33-2.58), dependent children in the household (OR=1.65,95%CI=1.17-2.32), financial hardship (OR=1.14,95%CI=1.08-1.21), socio-economic grade C2DE (OR=1.74, 95%CI=1.19-2.53), working in sectors such as health or social care (OR=4.18, 95%CI=2.56-6.81), education and childcare (OR=2.45, 95%CI=1.45-4.14) and key public service (OR=3.78, 95%CI=1.83-7.81), and having been vaccinated (OR=2.08,95%CI=1.33-3.24). Conclusions Non-essential workplace attendance in the UK in early 2021 during the Covid-19 pandemic was significantly independently associated with a range of sociodemographic variables and personal circumstances. Having been vaccinated, financial hardship, socio-economic grade C2DE, having a dependent child at home, working in certain key sectors were associated with higher likelihood of workplace attendance

Study protocol for a prospective, longitudinal cohort study investigating the medical and psychosocial outcomes of UK combat casualties from the Afghanistan war: the ADVANCE Study.

INTRODUCTION: The Afghanistan war (2003-2014) was a unique period in military medicine. Many service personnel survived injuries of a severity that would have been fatal at any other time in history; the long-term health outcomes of such injuries are unknown. The ArmeD SerVices TrAuma and RehabilitatioN OutComE (ADVANCE) study aims to determine the long-term effects on both medical and psychosocial health of servicemen surviving this severe combat related trauma. METHODS AND ANALYSIS: ADVANCE is a prospective cohort study. 1200 Afghanistan-deployed male UK military personnel and veterans will be recruited and will be studied at 0, 3, 6, 10, 15 and 20 years. Half are personnel who sustained combat trauma; a comparison group of the same size has been frequency matched based on deployment to Afghanistan, age, sex, service, rank and role. Participants undergo a series of physical health tests and questionnaires through which information is collected on cardiovascular disease (CVD), CVD risk factors, musculoskeletal disease, mental health, functional and social outcomes, quality of life, employment and mortality. ETHICS AND DISSEMINATION: The ADVANCE Study has approval from the Ministry of Defence Research Ethics Committee (protocol no:357/PPE/12) agreed 15 January 2013. Its results will be disseminated through manuscripts in clinical/academic journals and presentations at professional conferences, and through participant and stakeholder communications. TRIAL REGISTRATION NUMBER: The ADVANCE Study is registered at ISRCTN ID: ISRCTN57285353