Carrying out elective surgery on the mainland offers the potential to reduce waiting lists for island residents. The majority of respondents would be willing to travel to the mainland. However, one-fifth of respondents were not willing to travel to the mainland for elective surgery. The preferences of this group are important in policy decisions. More generally, the paper demonstrates the potential application of DCCA to public health issues.

The results confirm the effectiveness of screening but suggest that a five year screening interval may be too long, at least during the early rounds of screening.

A proportionately high registration of nursing home residents is the most likely explanation for the excessive mortality rates of these five GPs. This investigation was time-consuming and costly, and highlights the potential ramifications for primary-care organizations of introducing a national system for monitoring death rates in primary care.

whole screened population the number of babies with Down's syndrome was 25. With Wald and colleagues' screening test, the number of Down's syndrome babies detected was 12. With screening by maternal age > 37 years alone, the number detected could have been 7 out of 25. These proportions are not significantly different (Fisher's exact test p=0-24; odds ratio 2-37; 95% confidence interval 0 73 to 7 68). Even with the different uptake of amniocentesis in the two groups-that is, 75% for all ages and 63% for those ¢ 37 yearsthere was still no significant difference in the result (p=0-2; odds ratio 2-95 (0 77 to 11-3)). Only 4 9% of women were aged ¢ 37 years; the confidential enquiries into maternal deaths in the United Kingdom 1985-7 reported that 8% of pregnant women were over 352 and in our hospital in 1991 the proportion ¢ 37 years was 9-2%. This proportion is likely to rise as women delay their families for personal and financial reasons, and as this proportion rises the detection rates from the triple test and from maternal age alone will become even more similar. In any particular district the cost of introducing this programme will depend on the proportion of women ¢ 37 years; in addition, many authorities (including our own) have now abandoned co fetoprotein testing, relying for neural tube defect screening on ultrasonography alone, and the cost of reintroducing this test would need to be accounted for in the calculations.

No abstract