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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.

Objective To describe the prevalence and causes of postnatal maternal morbidity. Design Questionnaire survey of postnatal patients. Further data extracted from SMRl returns, case records and the Aberdeen Maternity and Neonatal Databank. Setting Postnatal care in a teaching maternity hospital, midwife delivery hospital, general practitioner maternity units and in the community. Subjects Twenty percent random sample of deliveries (1249 women) surveyed one week, eight weeks and 12 to 18 months after delivery. Main outcome measures Incidence of self reported maternal morbidity, treatment received, readmission rates and causes for readmission. Results Of mothers in the sample 85% (99% CI 82‐88%) reported at least one health problem in hospital, rising to 87% (84‐90%) of those at home; 76% (71‐81%) reported at least one health problem after eight weeks post‐delivery. Conclusions Maternal morbiditv is extensive and under‐recognised after delivery. Measures to reduce and alleviate it must be sought.

Objective: We compared mindfulness-based cognitive therapy (MBCT) with both cognitive psychological education (CPE) and treatment as usual (TAU) in preventing relapse to major depressive disorder (MDD) in people currently in remission following at least 3 previous episodes. Method: A randomized controlled trial in which 274 participants were allocated in the ratio 2:2:1 to MBCT plus TAU, CPE plus TAU, and TAU alone, and data were analyzed for the 255 (93%; MBCT = 99, CPE = 103, TAU = 53) retained to follow-up. MBCT was delivered in accordance with its published manual, modified to address suicidal cognitions; CPE was modeled on MBCT, but without training in meditation. Both treatments were delivered through 8 weekly classes. Results: Allocated treatment had no significant effect on risk of relapse to MDD over 12 months follow-up, hazard ratio for MBCT vs. CPE = 0.88, 95% CI [0.58, 1.35]; for MBCT vs. TAU = 0.69, 95% CI [0.42, 1.12]. However, severity of childhood trauma affected relapse, hazard ratio for increase of 1 standard deviation = 1.26 (95% CI [1.05, 1.50]), and significantly interacted with allocated treatment. Among participants above median severity, the hazard ratio was 0.61, 95% CI [0.34, 1.09], for MBCT vs. CPE, and 0.43, 95% CI [0.22, 0.87], for MBCT vs. TAU. For those below median severity, there were no such differences between treatment groups. Conclusion: MBCT provided significant protection against relapse for participants with increased vulnerability due to history of childhood trauma, but showed no significant advantage in comparison to an active control treatment and usual care over the whole group of patients with recurrent depression.