Stroke is rare among women of childbearing age. Low-estrogen oral-contraceptive preparations do not appear to increase the risk of stroke.

No abstract

). The composition of the cohort changed markedly from 1974 to 1997, with a much greater proportion of survivors in 1997 being in the least deprived fifth than in the most deprived (27% and 14%, respectively, of men and 23% and 17% of women).These effects of deprivation on premature death may not be obvious in tables or histograms.2 Our cohort survival graphs, which can be constructed without complex links between records, clearly show the relation between deprivation and mortality.We thank the General Register Office for providing the mortality and population data and David Murphy of the Information and Statistics Division for his help in the initial analyses.Contributors: JC had the original idea, which he then developed with SC. JC did the analyses. Both authors drafted and wrote the paper. JC is the guarantor for the paper.Competing interests: None declared. Although people with multiple sclerosis may have impaired mobility, their lifespans are similar to age matched population controls. They therefore need standard preventive services to prevent early mortality. We evaluated the relation between mobility and use of preventive services in women with multiple sclerosis. Participants, methods, and resultsIn 1996, we sent questionnaires to 1164 adults with multiple sclerosis who had received outpatient care in 1993 or 1994 from one of three systems of health care (two forms of managed care and fee for service insurance) in two regions of the United States. 2 The overall response rate was 80% (930/1164). We report here survey analyses from the 713 women respondents.We collected self reported rates of cervical smear testing, mammography, and breast examination (if over age 50), blood pressure checks, cholesterol screening, and physician assessment of health habits. We assessed these rates according to the patient's mobility level (fully ambulatory, ambulatory with help, and not ambulatory) and compared them with Healthy People 2000 recommendations. 3 For each preventive service, we used logistic regression to model the relation between that service, mobility, patient demographics, comorbidity, 2 system of health care, indicators for having a primary care physician and a multiple sclerosis physician, and specialty of these physicians.The mean age of the women was 47 years; 86% were white and 40% had a four year college degree. Overall rates for cervical smear tests, breast examinations, and mammography exceeded Healthy People 2000 recommendations, but rates were highest for the ambulatory group and lowest for the non-ambulatory group (P<0.05, table). Cervical smear testing was below Healthy People 2000 goals for the ambulatory with help and non-ambulatory groups. In contrast, rates for general preventive services did not differ by mobility.In the multivariable models, ambulatory patients had 5.32 times the odds of having a cervical smear test, 3.62 times the odds of having a breast examination, and 3.24 times the odds of having mammography relative to non-ambulatory patients (all P < 0.05). Older age was associa...