Objectives To compare the efficacy of antidepressant drugs and generic counselling for treating mild to moderate depression in general practice. To determine whether the outcomes were similar for patients with randomly allocated treatment and those expressing a treatment preference. Design Randomised controlled trial, with patient preference arms. Follow up at 8 weeks and 12 months and abstraction of GP case notes. Setting 31 general practices in Trent region. Participants Patients aged 18-70 who met research diagnostic criteria for major depression; 103 patients were randomised and 220 patients were recruited to the preference arms.

We report results on risk factors for invasive squamous cell and adenocarcinomas of the cervix in women aged 20 -44 years from the UK National Case -Control Study of Cervical Cancer, including 180 women with adenocarcinoma, 391 women with squamous cell carcinoma and 923 population controls. The risk of both squamous cell and adenocarcinoma was strongly related to the lifetime number of sexual partners, and, independently, to age at first intercourse. The risk of both types of cervical cancer increased with increasing duration of use of oral contraceptives, and this effect was most marked in current and recent users of oral contraceptives. The risk of squamous cell carcinoma was associated with high parity and the risk of both squamous cell and adenocarcinoma increased with early age at first birth. Long duration smoking (20 or more years) was associated with a two-fold increase in the risk of squamous cell carcinoma, but smoking was not associated with the risk of adenocarcinoma. Further studies are needed to confirm the suggestion from this and other studies of differences in risk related to smoking between squamous cell and adenocarcinomas of the cervix. Among cancers of the uterine cervix, adenocarcinomas are much less common than squamous cell carcinomas. As for squamous cell carcinoma, human papillomavirus (HPV) infection appears to be a major risk factor for adenocarcinoma of the cervix (Kjaer and Brinton, 1993;Walboomers et al, 1999;Santos et al, 2001;Altekruse et al, 2003), but evidence on other factors that may affect the risk of adenocarcinoma is limited and not entirely consistent (Parazzini and La Vecchia, 1990;Kjaer and Brinton, 1993;Ursin et al, 1994Ursin et al, , 1996Lacey et al, 1999Lacey et al, , 2000Lacey et al, , 2001Madeleine et al, 2001;Altekruse et al, 2003). The question of whether there are substantial differences in the risk factors for adenocarcinomas and squamous cell carcinomas remains unresolved. Few epidemiological studies have been designed specifically to provide a direct comparison between adenocarcinoma and squamous cell carcinoma of the cervix, and most studies of cervical carcinoma have had too few cases of adenocarcinoma to allow full evaluation of the possible risk factors. We present here results from the UK National Case -Control Study of Cervical Cancer, a case -control study of risk factors for invasive cervical cancer in women under 45 years old at diagnosis, with 180 cases of adenocarcinoma (including adenosquamous carcinoma), 391 cases of squamous cell carcinoma and 923 population controls. Information was available for all study subjects on sexual and reproductive factors, cervical screening, body weight, smoking and the use of barrier and hormonal contraceptives. Additional information was collected on HPV serology for a subgroup of subjects, and for this subgroup results have previously been published on the relationship between HPV positivity and risk of cervical cancer (Jha et al, 1993), and on oral contraceptive use as a risk factor for cervical cancer in relati...

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Objective To estimate the cost effectiveness of alternative methods of managing low grade cervical cytological abnormalities detected at routine screening. Design Cost analysis within multicentre individually randomised controlled trial. Setting Grampian, Tayside, and Nottingham. Participants 4201 women with low grade abnormalities. Interventions Cytological surveillance or referral to colposcopy for biopsy and recall if necessary or referral to colposcopy with immediate treatment based on colposcopic appearance. Main outcome measures Data on resource use collected from participants throughout the duration of the trial (36 months), enabling the estimation of both the direct (health care) and indirect (time and travel) costs of management. Quality of life assessed at recruitment and at 12, 18, 24, and 30 months, using the EQ-5D instrument. Economic outcomes expressed as costs per case of cervical intraepithelial neoplasia (grade II or worse) detected, by trial arm, as confirmed at exit, and cost utility ratios (cost per quality adjusted life year (QALY) gained) for the three pairwise comparisons of trial arms. Results The mean three year discounted costs of surveillance, immediate treatment, and biopsy and recall were £150.20 (€177, $249), £240.30 (€283, $415), and £241.10 (€284, $4000), respectively, viewed from the health service perspective. From the social perspective, mean discounted costs were £204.40 (€241, $339), £339.90 (€440, $563), and £327.50 (€386, $543), respectively. Estimated at the means, the incremental cost effectiveness ratios indicated that immediate treatment was dominated by the other two management methods, although it did offer the lowest cost per case of cervical intraepithelial neoplasia detected and treated. The pronounced skews in the distributions indicated that probabilistic uncertainty analysis would offer more meaningful estimates of cost effectiveness. The observed differences in the cost effectiveness ratios between trial arms were not significant. Conclusion Judged within the time frame of the TOMBOLA evaluation, there is no compelling economic reason to favour any one follow-up method over either of the others. Trial Registration ISRCTN 34841617.

A case-control study was undertaken of 471 children on the Nottingham Special Needs Register (SNR) who were born in one of the two maternity units in the city between 1987 and 1993 (inclusive). Controls were selected as the next infant born at the same hospital following each index case. The aim of the study was to identify risk factors on the Nottingham Obstetric Database for a baby subsequently appearing on the SNR. Disability was analysed by both ICD-9 coding and functional assessment. Factors which independently and significantly predicted a child's likelihood of being on the SNR were breech presentation (adjusted odds ratio (OR) = 4.0), congenital abnormality (OR=4.9), intrapartum fetal distress (OR=1.7), fetal growth restriction (OR=2.0), socioeconomic deprivation (OR=1.8), prematurity (OR=2.2), reduced fetal movements (OR=2.5) and medication in pregnancy (OR=10.4). To our knowledge the last two factors have not previously been reported as risk predictors for neurodevelopmental disability.