The aim of the present study was to validate a simple scoring system using a parent-completed screening questionnaire to identify children aged 5±15 yrs who may have asthma.A stratified random sample of 157 children of 1,808 whose parents had answered a postal respiratory questionnaire underwent detailed clinical evaluation. The results were reviewed by three independent paediatricians whose opinions were combined to reach, for each child, decisions regarding three standards: 1) "possible asthma" defined as >50% likelihood of having asthma; 2) "possible asthma" defined as meriting a clinical trial of asthma medication; and 3) "probable asthma" defined as >90% likelihood of having asthma. The combined decisions were compared to three sets of questionnaire scores, in order to determine the positive predictive value, sensitivity and specificity of each set in identifying children with probable/possible asthma.The three sets of chosen questionnaire scores all had positive predictive values of 79±96% for predicting possible asthma, using either the combined expert opinion ">50% likelihood of asthma" or that of "warrants a trial of treatment" as the definition. This suggests that a low proportion of false positives would be obtained were this scoring system to be used for a screening programme. The combined decision >90% chance of asthma could be used as a means of estimating prevalence of asthma in the survey. When used for this, the prevalence of asthma in the surveyed population was 18.8% (95% confidence interval 13.1±26.3).In conclusion, the present scoring system, based on a simple respiratory questionnaire, provides a valid method of identifying children likely to have asthma, and who, if unknown to the medical services, would benefit from clinical review.

We have provided a significant improvement in the surveillance-based methodology used to estimate the number of cases of WRIH captured by THOR and hence enabled more accurate estimations of GB incidence rates for clinical specialist-reported WRIH.

The main result shows that the sensitivity and specificity of the first stage test set an absolute limit on the efficiency of two-phase designs; in particular, two-phase sampling can never be justified on efficiency grounds alone if the test is not accurate enough.

Objective To compare health outcomes during 14-year observational follow-up in women initially randomised to unopposed estrogen or placebo.Design At recruitment to the Estrogen for the Prevention of Re-Infarction Trial (ESPRIT) women were assigned to estradiol valerate: 2 mg or placebo treatment for 2 years.Setting Women were recruited from 35 hospitals in the northwest of England and Wales in July 1996-February 2000.Sample Women aged 50-69 surviving their first myocardial infarction.Methods All women were followed by data linkage to UK mortality and cancer records; mean follow-up 14.1 and 12.6 years, respectively. In an intention-to-treat analysis, hazard ratios (HRs) were computed, overall and stratified by age at recruitment.Outcome measures Death (all-cause, cardiac disease, stroke or cancer) and cancer incidence (any, breast or endometrium).Results There were 418 deaths in 1017 women randomised. The all-cause mortality HR of 1.07 (95% CI 0.88-1.29) indicated no significant difference between treatment groups. Women aged 50-59 years at recruitment had lower HRs than women aged 60-69 years for all outcomes except ischaemic heart disease. Among 149 incident cancers there were seven cases of breast cancer in the intervention arm and 15 in the placebo; HR 0.47 (95% CI 0.19-1.15). There were no deaths from endometrial cancer but three incident cases, one in the active arm and two in placebo.Conclusions These results suggest that unopposed estrogen may be used safely by women with an intact uterus surviving a first myocardial infarction.

Objective-To investigate the effect of induced abortion on the outcome of the next pregnancy. Design-Long-term prospective controlled cohort study. Setting-Joint Royal College of General Practitioners/Royal College of Obstetricians and Gynaecologists study based in gencral practice in England, Scotland and Walcs. Subjects-1311 women whose recruitment pregnancy had ended in induced abortion (the abortion group) and 2131 women whose recruitment pregnancy had a natural conclusion (the non-abortion group). Muitz outcome measures-Non-viablc outcome (spontaneous or missed miscarriage, ectopic pregnancy or stillbirth), birthweight, length of gestation.Results-Induced abortion was not materially associated with any of the three measures of adverse outcome. Compared with the non-abortion group the relative risk of a non-viable outcome in the abortion group was 1.01 (95' 26 CI 0.81 to 1.27). In the abortion group birthweight was an average 23 g lighter (95% CI -76 g to + 30 g) and length of gestation an average 0.9 days shorter (95% CI -2-2 days to + 0.4 days) than in the non-abortion group. Womcn who had their abortions in NHS premises had an increased risk of a non-viable outcome ( R R 2.55, 95% C1 1-31 to 4.94) and had babies with significantly lower mean birthweight (-119 g, 95% CI -233 g to +5 g) comparcd with those who obtained tlicir operations in the private sector. Women whose abortion had been carried out by a consultant had the lowest risk of non-viable outcornc. Although these differences remained after adjustmcnt for a number of important variables, it is possible that factors not measurcd in the present study, such as economic status and occupation, playcd a contributory role. Conclusion-Overall, induccd abortion was not associated with any important effect on the three measures of adverse outcome in the subsequent pregnancy. Despite the greater efficiency and availability ofRoyal College of General Practitioners, Manchester Research Unit, 8 Barlow Moor Road, ManChester M20 OTR P. I . FRANK