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Objectives: against a backdrop of rising levels of obesity, we describe and estimate associations of body mass index (BMI), age and gender with time to revision for participants undergoing primary total hip (THR) or knee (TKR) replacement in the UK.Design: population-based cohort study.Setting: routinely collected primary care data from a representative sample of general practices, including linked data on all secondary care events.Participants: population-based cohort study of 63?162 patients with THR and 54?276 with TKR in the UK General Practice Research Database between 1988 and 2011.Primary and secondary outcomes: risk of THR and TKR revision associated with BMI, age and gender, after adjusting for the competing risk of death.Results: the 5-year cumulative incidence rate for THR was 2.2% for men and 1.8% for women (TKR 2.3% for men, 1.6% for women). The adjusted overall subhazard ratio (SHR) for patients with THR undergoing subsequent hip revision surgery, with a competing risk of death, were estimated at 1.020 (95% CI 1.009 to 1.032) per additional unit (kg/m2) of BMI, 1.23 (95% CI 1.10 to 1.38) for men compared with women and 0.970 (95% CI 0.967 to 0.973) per additional year of age. For patients with TKR, the equivalent estimates were 1.015 (95% CI 1.002 to 1.028) for BMI; 1.51 (95% CI 1.32 to 1.73) for gender and 0.957 (95% CI 0.951 to 0.962) for age. Morbidly obese patients with THR had a 65.5% increase (95% CI 15.4% to 137.3%, p=0.006) in the subhazard of revision versus the normal BMI group (18.5–25). The effect for TKR was smaller (a 43.9% increase) and weaker (95% CI 2.6% to 103.9%, p=0.040).Conclusions: BMI is estimated to have a small but statistically significant association with the risk of hip and knee revision, but absolute numbers are small. Further studies are needed in order to distinguish between effects for specific revision surgery indications

We have assessed the effect of the first round of the Breast Cancer Screening Programme on the presentation of breast cancer in the Southampton Health District with respect to number of cases and pathological characteristics. A retrospective comparative survey of the presentation of breast cancer in the 3 years prior to breast cancer screening (1985–1988) with the presentation of breast cancer during the prevalent round of breast cancer screening (1988–1991) was performed. During the period of study 1536 cases of breast cancer presented. Six hundred and sixty presented in the years prior to screening and 864 during the first round of screening. All patients lived within the Southampton Health District. The study was designed to assess the changes in breast cancer presentation with regard to age, pathological characteristics, and treatment. Even allowing for the increases in the local population there was a significant increase in the number of cases of breast cancer diagnosed (χ2=23.7, df=1, P< 0.001). The majority of this increase was in the 50–64 age group. There was also a significant shift towards an earlier stage at diagnosis and a significant reduction in tumour size when all cases were included (mean 26 mm versus 34 mm P< 0.001). Screening also created the opportunity for less invasive treatment. Consequently there was a rise in the number of excisions by localization biopsy from 1% to 13% during the screening period. In conclusion, the National Breast Cancer Screening Programme (NBCSP) has had a significant impact on the presentation of breast cancer. This has resulted in a greater awareness of the disease with earlier presentation, smaller tumours, and a higher local excision rate in the study group.

Otitis media is the most common reason for children to receive antibiotics, but there is no evidence about the effect of prescribing on reattendance.To evaluate the changing workload of middle ear disease in general practice, and the impact on surgery reattendance of prescribing antibiotics at first attendance.A case-linked cohort analysis for antibiotic prescribing versus no prescribing at first consultation event.Two hundred and ninety-one practices spread throughout the UK recording for the General Practice Research Database (GPRD) and incorporating individual patient data records for 2,265,574 patients.All middle ear disease coded events that can be classed within acute otitis media (AOM) or glue ear sub-categories (and excluding chronic suppurative otitis media) were selected for analysis when the first event was from 1991-2001. The effect of antibiotic prescription on the risk of reattendance using Cox proportional hazards regression was analysed.Total consultations for AOM have fallen markedly over this decade, and glue ear consultations have risen but by a much smaller extent (26,000 decrease versus 4000 increase in consultations per year), which makes relabelling an unlikely explanation of the fall in AOM consultations. In the 2-10 years age range, consultations for AOM fell from 105.3 to 34.7 per 1000 per year, with glue ear consultations unaltered (15.2 to 16.7 per 1000 per year). Antibiotic prescribing for AOM has stayed remarkably constant (80-84% of consultations), but antibiotic prescribing for glue ear has risen sharply (13 to 62%). Prescribing antibiotics increased the risk of reattendance for AOM (hazard ratio [HR] = 1.09, 95% confidence interval [CI] = 1.07 to 1.10) and has reduced the risk of reattendance for glue ear (HR = 0.92, 95% CI = 0.88 to 0.96).Prescribing antibiotics for AOM probably increased reattendance, but the opposite effect has been noted for glue ear, which suggests a treatment effect of antibiotics in glue ear. Further research is needed to clarify whether this possible benefit is worth the known harms, and if so in which subgroups of children.

To evaluate a pilot service offering therapy specifically to adults with a history of child sexual abuse.Questionnaire survey.Specialised therapy unit, Breakfree, which offers care, therapy, and support.116 clients presenting to the service who were offered therapy.Scores from three psychological questionnaires--the social activities and distress scale, the general health questionnaire, and the delusions, symptoms, and states inventory--and from questionnaires about the clients' abuse, previous use of health services, and opinion of the Breakfree service.Clients had received previous help from health services and other agencies without apparent effect; they were highly distressed according to their psychological scores; and they were very frequent users of the health services. The clients showed significant improvement in their psychological scores (Wilcoxon's matched pairs signed ranks test): social activities and distress scale, z = -3.3, P = 0.001; general health questionnaire, z = -5.8, P0.00001; delusions, symptoms, and states inventory, z = -4.8, P0.00001). This was most pronounced for those who had completed therapy by the end of the study. Whereas 82/88 clients had a score for the general health questionnaire that indicated clinical distress at the start, only 28/58 did so at the end of the study (only 17/35 among those who had finished therapy).This group of adults with a history of child sexual abuse were highly disturbed and previous high users of the health service. The specialist service Breakfree was effective in the short term and, if the benefits are sustained, would yield a net cost saving to the health service.

The influence of breast size on the prognosis of 196 patients with early breast cancer diagnosed in the period 1984-1985 was studied. Breast size was based on the volume from mammography. This method was validated against the volume of the mastectomy specimen determined by water displacement in 18 patients and found to be accurate (r = 0.93, P < 0.01). The median breast volume was 833.5 cm3 (interquartile range 522.8-1153.3 cm3). Breast size was significantly associated independently with age (Spearman's rank r = 0.24. P = 0.001), menstrual status (z = -4.81, P < 0.001), body weight (Spearman's rank r = 0.61, P < 0.001), T stage (z = -1.91, P = 0.05) but not N stage (z = -1.64, P = 0.10) or hormone receptor status (z = -0.80, P = 0.42). In an analysis of breast size and other known prognostic factors, based upon Cox's proportional hazards regression, N stage was the only significant factor for both breast cancer survival and disease-free survival. Even though women with larger tumours at presentation had larger breasts, breast size was not a significant prognostic factor in early breast cancer.