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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2005.11.054 Byline: Francine M. Toye (a), Julie Barlow (b), Chris Wright (b), Sarah E. Lamb (c) Keywords: Osteoarthritis; Total knee replacement; Patient experience; UK; Gender Abstract: This study explores patients' personal meanings of knee osteoarthritis (OA) and total knee replacement (TKR). Personal meanings are important because decisions regarding the need for TKR do not seem to be explained by symptoms alone. A total of 18 semi-structured interviews were conducted with a purposive sample of respondents who were listed for TKR at one UK specialist orthopaedic hospital, and who had lower than average disease burden according to standard quantitative criteria. Data were analysed using interpretive phenomenological analysis. Several themes related to need for TKR emerged: adoption of the medical model, a person's social network, pain, functional loss, feelings of vulnerability, dependency, low mood and fatigue, ideas related to disease progression and expectations of TKR. Results suggest that the decision to undergo TKR is not related to symptoms alone, but to personal meanings. Some of these personal meanings may not be useful in accurately assessing the need for TKR, and may result in mis-targeting of treatment. It is important for health professionals to explore and tackle personal meanings when considering treatment. In particular, it may be important to consider gender differences that may influence when men and women are listed for TKR. For example: women may be less likely to discuss treatment options with their doctor; they may be more likely to have heard negative examples of TKR from friends or family; they may be more likely to discuss pain and mobility issues than activities requiring higher function; and they may be more likely to discuss the effect on their mood and the emotional impact of OA. Author Affiliation: (a) Department of Physiotherapy, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK (b) Interdisciplinary Research Centre in Health, Coventry University, UK (c) Warwick Medical School, University of Warwick, UK

The impact on attendance of the distance to general practice surgeries, and the attributes offered by those surgeries, was investigated. One thousand and forty four subjects, selected at random from the metropolitan area of Perth, Western Australia, responded to a household interview survey concerning which attributes of general practice (GP) surgeries they found attractive and the identity of the surgery they preferred to attend. The sample was stratified by different levels of social disadvantage and by good and poor global levels of spatial accessibility of GP surgeries. In separate fieldwork, interviewers collected detailed environmental data from practice staff at 466 GP surgeries available to the community survey respondents within metropolitan Perth. Respondents living in areas of poor global access were more likely to attend their nearest surgery (25% vs. 6%) and to bypass fewer surgeries to attend a preferred surgery (median 2 vs. 20). Those who were most socially disadvantaged were less likely than those who were better off to bypass surgeries where global access was poor, but more likely to bypass nearby surgeries and to seek out a surgery that bulk billed in areas where global access was good. A number of attractiveness factors had an important influence on choice of surgery, including: `easy to make an appointment'; `generally sees patients on time'; `pharmacy nearby'; `bulk bills' and `open at all on Sundays'. Respondents attending their nearest surgery were more likely to have all of their nominated `very important' attributes satisfied at that surgery than non-attenders (40% vs. 16%). A logistic regression model, adjusting for distance effects and size of surgery, showed within each level of global access and social disadvantage a consistent increase in the odds of attending a surgery that satisfied the attributes desired by respondents. Keywords: Spatial access; General practice; Attractiveness; Social disadvantage; Perth; Australia

Forty-five women with stress urinary incontinence (SUI) and their partners have been interviewed three months before and one year after surgical treatment to investigate the social consequences of their impairment. One year after surgery 76% of the women reported that they were cured (group A, n = 34) and 24% that they were improved (group B, n = 11). The cured women were significantly younger than the improved women. The duration of urinary leakage before the operation was significantly shorter in group A than in group B. One year post surgery group A reported a significantly decrease in impediments to exert certain tasks due to urine leakage. As concerns leisure time, group A reported a higher level of overall activities before surgery than group B, whereas postsurgery both groups obtained about the same level of activities. Regarding social support, no differences between the groups occurred as concerns attachment. Furthermore, group A women showed a significantly higher degree of adequacy of social integration compared with group B. The majority of the couples could openly discuss sexual matters with their partners and were satisfied with their sexual life. More than half of the interviewed men reported an increase in sexual desire one year after their partners operation. Whereas about every third woman in both groups reported an increase in sexual desire. However, the frequency of intercourse did not change in any groups. In conclusion, this study underlines the importance of social factors in the assessment of the consequences of stress urinary incontinence and its treatment. Key words - stress urinary incontinence, social adjustment, leisure time, employment, spouse relationship, sexuality, social network