The major increase in the prevalence of diabetes mellitus (DM) has led to the study of social inequalities in health-care. The aim of this study is to establish the possible existence of social inequalities in the prevention, diagnosis, treatment, control and monitoring of diabetes in Organisation for Economic Co-operation and Development (OECD) countries which have universal healthcare systems. We searched MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews for all relevant articles published up to 15 December 2007. We included observational studies carried out in OECD countries with universal healthcare systems in place that investigate social inequalities in the provision of health-care to diabetes patients. Two independent reviewers carried out the critical assessment using the STROBE tool items considered most adequate for the evaluation of the methodological quality. We selected 41 articles from which we critically assessed 25 (18 cross-sectional, 6 cohorts, 1 case-control). Consistency among the article results was found regarding the existence of ethnic inequalities in treatment, metabolic control and use of healthcare services. Socioeconomic inequalities were also found in the diagnosis and control of the disease, but no evidence of any gender inequalities was found. In general, the methodological quality of the articles was moderate with insufficient information in the majority of cases to rule out bias. This review shows that even in countries with a significant level of economic development and which have universal healthcare systems in place which endeavour to provide medical care to the entire population, socioeconomic and ethnic inequalities can be identified in the provision of health-care to DM sufferers. However, higher quality and follow-up articles are needed to confirm these results.

A systematic review of the literature was conducted to assess the outcomes of preventive interventions (prophylactic surgery, intensive cancer screening, and chemoprevention) in women who carry mutations in BRCA1/2 genes, in terms of reducing breast and gynaecological cancer incidence and/or mortality. A search for relevant articles published between 1996 and 2005 (inclusive) was run on Medline, Embase and other databases. From the 749 journal articles retrieved from this search strategy, 18 studies were eligible for this review (2 systematic reviews, 10 cohort studies and 6 case-control studies). The critical appraisal of the studies was performed by two independent reviewers with a list of ad hoc selected criteria. The synthesis of results was qualitative. Mastectomy and prophylactic gynaecological surgery (oophorectomy or salpingooophorectomy) reduced breast and gynaecological cancer incidence in carriers of BRCA mutations, by comparison to surveillance. However, all the studies presented flaws in internal and external validity, none of these preventive interventions is riskfree, and protection against breast and gynaecological cancer, as well as other cancers linked to BRCA mutations, is incomplete. No studies comparing surveillance programmes of varying intensity were found. Exposure to drugs (tamoxifen, and oral contraceptives) in women carrying BRCA mutations was assessed through a limited number of papers. All of these were case-control studies with prevalent cases and presented major methodological flaws. ' 2007 Wiley-Liss, Inc.Key words: BRCA 1 or BRCA 2; prophylactic mastectomy; prophylactic oophorectomy; chemoprevention; surveillance Breast cancer is the most commonly diagnosed cancer after nonmelanoma skin cancer in women, and it is the second leading cause of cancer-related deaths. Although less common, ovarian cancer is associated with high morbidity and mortality rates and ranks as the fourth cause of all cancer-related deaths among Western women. 1,2 Most breast cancers (70-80%) occur in women with no family history of cancer (sporadic cancers). However, the remaining cases are all linked to a family history of cancer. The aggregation of breast cancer cases in a given family has also been related to an increased risk for ovarian cancer. Although different genes have been linked to hereditary cancer, most familial cases of breast and gynecological cancers (ovarian cancer, Fallopian tube cancer and carcinoma of the peritoneum) are associated with mutations in the BRCA1 and BRCA2 genes.Germ line mutations in BRCA1/2 genes confer a higher risk of breast and ovarian cancer, clearly above the risk for the general population. However, the average magnitude of these risks is uncertain and may depend on context (intensity of family history, ethnic group, environmental factors, etc.). In women carrying BRCA1 mutations, the average cumulative risk of cancer by age 70 years ranged between 51 and 95% for breast cancer and between 22 and 66% for ovarian cancer. In BRCA 2-mutation carriers, the risks ranged be...

There is variability between towns in hospitalisation rates for the most common ACSC; b) the differences in hospitalisation rates for the ACSC studied are linked to organisational features of primary care, the size of the town and the distance from the hospital.

Objective-To estimate the effectiveness ofinfluenza vaccine in preventing hospital admission for pneumonia in noninstitutionalised elderly people. Design-This was a case-control study.

Background: To identify differences among men and women with acute coronary syndrome in terms of in-hospital mortality, and to assess whether these differences are related to the use of percutaneous cardiovascular procedures.