No abstract

Adenocarcinoma of the oesophagus has been increasing in incidence in most developed countries in the last two decades (Powell and McConkey, 1990;Blot et al, 1991). The incidence of this condition in British women is among the highest in the world, with half of all cases in Europe occurring in the UK (Black et al, 1997). Previous studies, which had predominantly included men, had identified obesity, diet low in fruit and vegetables, and smoking as the main risk factors (Brown et al, 1995;Vaughan et al, 1995;Gammon et al, 1997;Chow et al, 1998;Lagergren et al, 1999). Little is known about the causes of this cancer in women. Here we report a multi-centre, population-based case-control study among British women together with an estimate of the overall population attributable risk of important risk factors in a multivariate fashion. This population-based case-control study was conducted in the former Regional Health Authorities (RHA) of East Anglia and Oxford, part of Trent RHA and Eastern Scotland covering the Health Boards of Highland, Grampian, Tayside, Fife, Lothian and Forth Valley. Ethical approval was given by all the local research ethics committees.Cases comprised all women aged under 75 years of age (80 years in Trent) resident in the study areas at the time of their diagnosis with oesophageal cancer. Results on adenocarcinoma only are reported here. Cases were identified through pathology departments, treating clinicians and cancer registries and all tumours were histologically confirmed. Care was taken to exclude tumours established as arising in the cardia of the stomach but a small number of cases of those arising at the gastro-oesophageal junction may be included.Cases were accrued over a 2-year period in each study region between 1993 and 1996. A single female control was matched to each case by age (within 5 years) and general practice. Potential controls were randomly selected using the Family Health Service Authority (FHSA) or Health Board primary care registers. Eligible controls who declined to take part were replaced.Women were approached with consultant or General Practitioner (GP) permission and asked for a personal interview. Trained interviewers used a standard form to conduct interviews either in hospital or at home. Information was collected on sociodemographic characteristics, smoking, alcohol, tea and coffee consumption, diet, previous medical and obstetric histories, and a number of other factors, including weight, height and use of vitamin supplements. Smoking was measured in pack years and total years of smoking whilst units of alcohol were categorized by average weekly and total lifetime consumption. A dietary questionnaire was used to obtain information for recent diet (3 years prior to interview) and at age 30 years. Consumption of fresh fruit, salad and vegetables was assessed by questions on food frequency. Categories for analysis were based on quartiles of the frequency of consumption per week among all controls (including those for cases of other histological diagnoses)...

These data challenge several assumptions about the most appropriate treatment for depression in a primary care setting.

(1985), using data derived from a study of 225 men with testicular cancer, calculated that having a first degree relative with testicular cancer was associated with a 6-fold elevated risk in comparison with the general population. There has been relatively little research into whether the excess in familial cases occurs as a result of a genetic predisposition, common environment or both (Gedde-Dahl et al., 1985;Dieckmann et al., 1987;Forman, 1989;Oliver, 1990).We have established a UK-based register for familial testicular cancer to provide a means for the systematic documentation of new cases, including histological verification, and for obtaining standardised lymphocyte-DNA samples from affected and unaffected family members for subsequent genetic linkage analysis. In this paper we describe data on the first 42 families reported to the register for which confirmation of the diagnosis has been obtained.A sub-set of these families were identified from interviews about family history with men diagnosed as having testicular cancer for whom an age-matched control was also interviewed. Using these families, it was possible to estimate the

Objective To provide a new outcome measure for pregnancy specifically related to the individual. Design Computer analysis of physiological factors affecting birthweight. Setting Two provincial teaching hospitals (University and City Hospitals, Nottingham) and an associated district general hospital (Derby City Hospital) serving a defined catchment area in the East Midlands. Subjects All women delivering in the above hospitals since the start of computerised obstetric records: 31 561 women with gestational age verified by early pregnancy ultrasound scan data. Main Outcome Measures Calculation of the predicted birthweight taking into account maternal and fetal physiological factors. Derivation of the individualised birthweight ratio (actual birthweight divided by predicted birthweight expressed as a percentage) for each individual baby. Results The individualised birthweight ratio redefines as normally grown 41% of babies below the 10th centile of crude birthweight for gestation. Other babies previously regarded as normal are redefined as growth retarded. At the upper end of the distribution 46% of those above the 90th centile of birthweight for gestation are redefined as normally grown. Conclusions The predicted birthweight can be calculated for an individual pregnancy at a given gestation. The standardised comparison between this predicted birthweight and the actual birthweight is a more logical reflection of the normality of intrauterine growth and therefore more logical as an outcome measure for pregnancy than crude birthweight for gestation.