from InterStudy (now called the Health Outcomes Institute) in America, on which the anglicised versions used in the Sheffield study and the Oxford healthy life study were based, and two more recent versions Objective-To assess the validity, reliability, and acceptability of the short form 36 (SF36) health survey questionnaire (a shortened version of a battery of 149 health status questions) as a measure of patient outcome in a broad sample of patients suffering from four common clinical conditions. Design-Postal questionnaire, foliowed up by two reminders at two week intervals.Setting-Clinics and four training practices in north east Scotland.Subjects-Over 1700 patients aged 16-86 with one of four conditions-low back pain, menorrhagia, suspected peptic ulcer, or varicose veins-and a comparison sample of 900 members of the general population.Main outcome measures-The eight scales within the SF 36 health profile.Results-The response rate exceeded 75% in the patient population (1310 respondents). The SF36 satisfied rigorous psychometric criteria for validity and internal consistency. Clinical validity was shown by the distinctive profiles generated for each condition, each ofwhich differed from that in the general population in a predictable manner. Furthermore, SF 36 scores were lower in referred patients than in patients not referred and were closely related to general practitioners' perceptions ofseverity.Conclusions-These results provide support for the SF 36 as a potential measure of patient outcome within the NHS. The SF 36 seems acceptable to patients, internally consistent, and a valid measure of the health status of a wide range of patients. Before it can be used in the new health service, however, its sensitivity to changes in health status over time must also be tested.

The EuroQol (EQ-5D) generic health index comprises a five-part questionnaire and a visual analogue self-rating scale. The questionnaire may be used as a health index to calculate a 'utility' value or as a health profile. The validity, reliability and responsiveness of EQ-5D were tested in 233 patients with rheumatoid arthritis stratified by functional class. EQ-5D demonstrated moderate to high correlations with measures of impairment and high correlations with disability measures. Stepwise regression models showed that EQ-5D utility values and visual analogue scores were explained best as a function of pain, disability, disease activity and mood (R2 approximately 70%), although other variables (side-effects, years of education) were required to explain the visual analogue scores. The EQ-5D health index and visual analogue scale are more responsive than any of the other measures, except pain and doctor-assessed disease activity. The reliability of the EQ-5D index and EQ-5D visual analogue scale is as good or better than that of all other instruments except the Health Assessment Questionnaire. Some patients with severe long-standing disease had health states which attracted utility values below zero, i.e. from a societal perspective they were regarded as being in states 'worse than death'. The practical and ethical implications of these utility valuations are discussed, and at present the utility values should be used and interpreted with caution. With this caveat, EQ-5D is simple to use, valid, responsive to change and sufficiently reliable for group comparisons. It is of potential use as an outcome measure in clinical trials, audit and health economic studies, but further work is required on its performance in other clinical contexts and on the interpretation of the utility values.

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The study confirms the relationship between deprivation and the prevalence of Type 2 diabetes. There are more obese, diabetic patients in deprived areas. They require more targeted resources and more primary prevention.