suspicious for metastatic disease, however, would have resulted in an unacceptably low sensitivity of 20%. Considering the high incidence of bone metastases at initial diagnosis, this might lead to a dramatic increase in the number of patients undergoing futile surgery or neoadjuvant chemotherapy.Contributors: MH had the original idea, designed the study, selected the patients, managed the study, interpreted the results, wrote the first draft of the paper, and edited the paper. JH gathered, interviewed, and examined the patients. CA interpreted the bone scans; gathered, interviewed, and physically examined the patients; interpreted the results, and prepared the manuscript. KN interpreted the magnetic resonance images. HS had the original idea, interpreted the bone scans, and prepared the manuscripts. MH and HS are guarantors.Funding: None. The prevalence of symptoms of asthma, allergic rhinitis, and atopic eczema in children in the United Kingdom ranks among the highest in the world.

The International Study of Asthma and Allergies in Childhood (ISAAC) Phase One showed large worldwide variations in the prevalence of symptoms of asthma, rhinoconjunctivitis and eczema, up to 10 to 20 fold between countries. Ecological analyses were undertaken with ISAAC Phase One data to explore factors that may have contributed to these variations, and are summarised and reviewed here.In ISAAC Phase One the prevalence of symptoms in the past 12 months of asthma, rhinoconjunctivitis and eczema were estimated from studies in 463,801 children aged 13 - 14 years in 155 centres in 56 countries, and in 257,800 children aged 6-7 years in 91 centres in 38 countries. Ecological analyses were undertaken between symptom prevalence and the following: Gross National Product per capita (GNP), food intake, immunisation rates, tuberculosis notifications, climatic factors, tobacco consumption, pollen, antibiotic sales, paracetamol sales, and outdoor air pollution.Symptom prevalence of all three conditions was positively associated with GNP, trans fatty acids, paracetamol, and women smoking, and inversely associated with food of plant origin, pollen, immunisations, tuberculosis notifications, air pollution, and men smoking. The magnitude of these associations was small, but consistent in direction between conditions. There were mixed associations of climate and antibiotic sales with symptom prevalence.The potential causality of these associations warrant further investigation. Factors which prevent the development of these conditions, or where there is an absence of a positive correlation at a population level may be as important from the policy viewpoint as a focus on the positive risk factors. Interventions based on small associations may have the potential for a large public health benefit.

A parent-held record has been issued to all children born in New South Wales (NSW), Australia since 1988. Five years after its introduction, an evaluation was undertaken to determine its retention rate over time, rate of documentation of immunization status and other important child health information, and its perceived usefulness to parents. The cross-sectional study comprised an interviewer administered questionnaire to 622 households derived from a stratified random sample of 25 local government areas, representative of 73% of all households containing children under 5 years of age in NSW. A concurrent postal survey assessed the attitudes and use of the Personal Health Record (PHR) among a stratified random sample of 911 health care providers. Results showed that the PHR was well retained, with 89% claimed retention at 4 years, and over 78% of parents able to produce the record for inspection at interview. Of the records examined, 91% had at least one immunization recorded while 68% had a complete regimen documented by age 4 years. Overall, 93% of parents expressed satisfaction with the PHR, while 64% of all health care providers also felt that the PHR was 'beneficial to the health care children received', although only 53% of these used it regularly to record their findings. It is concluded that the PHR currently issued in NSW is well retained and valued by parents, and used by and useful to a range of health professionals.

The measurement of quality in any clinical discipline depends, in part, on a comparison with an accepted standard. Currently, such standards do not exist for the management of many common clinical situations in Australian general practice. As part of the General Practice Evaluation Programme, a group of Illawarra general practitioners (GPs) selected 'GP management of the menopause and asthma' for in-depth study, and were able to arrive at a consensus on 'principles of practice' and 'minimal acceptable care' for these conditions through a series of focus (research) group meetings. However, the process by which these standards were derived was felt, of itself, to be a valuable means of: (i) reducing professional isolation; (ii) promoting quality assurance; (iii) introducing peer review; (iv) introducing clinical audit; and (v) providing meaningful and targeted continuing medical education appropriate to Australian general practice. This paper describes the focus group methodology used in this process.