Aims: To test the effectiveness of a home based developmental education intervention in improving outcome at 5 years for very preterm infants. Methods: The Avon Premature Infant Project (APIP) is a randomised controlled trial in which the parents of 284 babies born ,33 weeks gestational age received a developmental education programme, a social support intervention, or standard care. A term reference population was also recruited. This study reports outcomes at 5 years (mean age 58 months 15 days) for 187 (66%) of these children without disability. Outcomes were assessed using the British Ability Scales II for cognitive development, the Movement ABC for motor impairment, and the Child Behavior Checklist for behavioural problems. Results: Preterm infants showed poorer cognitive performance than their term peers. Mean (SD) general conceptual ability (GCA) scores were: Portage 99.2 (15.7); parent adviser 100.3 (14.8); preterm control 101.1 (15.0); term reference 107.2 (13.4). There were no significant differences between preterm groups in GCA scores indicating no effect of either intervention. Similarly, there was no significant effect of intervention on behavioural or motor outcomes. Further analyses, in which outcome data were adjusted for social factors, did not reveal any differences between the three preterm groups or by subgroups classified by a range of perinatal variables. Conclusion: The small advantage shown at 2 years of age is no longer detectable at 5 years. These results question the effectiveness of early intervention in enhancing cognitive, behavioural, and motor function at 5 years.

Researchers deal new blow to vaccination" and "London study links children's vaccine to serious disease" proclaimed Britain's newspapers last week. This latest media scare about the measles, mumps, and rubella (MMR) vaccine has left UK doctors fighting a rearguard action to try to minimise damage to vaccine uptake rates, already compromised by previous scares. The research on which the media reports were based linked paramyxovirus infection in childhood with subsequent inflammatory bowel disease (Gastroenterology 1999;116:796-803). Scott Montgomery and colleagues from the Royal Free and University College Medical School in London analysed data from 7019 members of a nationally representative British cohort born in 1970. They identified subjects with inflammatory bowel disease and looked at the pattern of childhood infections recorded before the onset of the condition. They found that measles and mumps infections occurring together in the same year of life were significantly associated with ulcerative colitis and Crohn's disease, with odds ratios of 7.47 (95% confidence interval 2.42 to 23.06) and 4.27 (1.24 to 14.46) respectively, but not with insulin dependent diabetes mellitus, which they studied as a control disease. They concluded that atypical paramyxovirus infections in childhood may be risk factors for later development of inflammatory bowel disease. Some sections of the UK media leapt on the new research with relish, making a link between the effects of the wild viral infections studied and the possible effects of attenuated viruses given in the MMR vaccine. London's Evening Standard, for example, said: "Though the children in the study were naturally exposed to infections before MMR existed, scientists are concerned that today's toddlers could suffer the same fate when they receive modified forms of the viruses through the jab." In the Gastroenterology paper,

esistance to the health reforms of the 1990s has taken many forms, but among general practitioners a recurrent theme has been the threat to personal care and the doctor-patient relationship. Matthews and Bain have set out to show us what it means to be a family doctor in Scotland, in the words of 11 general practitioners practising in a variety of settings. These chatty interview accounts of general practice in deprived inner cities, suburbs, rural villages, and remote Scottish islands and highlands vividly illustrate the meaning of personal care.

The Department of Health has published "league tables" for England allowing health professionals and their patients to scrutinise hospitals' performance for the first time since the NHS was established. Two reports published last week compared the performance of hospitals against a set of six clinical indicators (see below) and how each health authority was performing in areas such as health improvement, and care outcomes (see below). The reports were compiled over two years by using the 11 million patient episode records collected annually in England. The report on clinical indicators showed wide variations in

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