Use of the Short Form-36 to detect the influence of upper gastrointestinal disease on self-reported health status.

Patient-centred outcome measures such as the Short Form-36 (SF-36) have been developed to assess the impact of ill health and medical interventions on self-reported health status. The objective of the study was to assess the impact of gastrointestinal disease upon health status as measured by the SF-36 physical and mental health component scores (PCS and MCS) and to assess whether these component scores might be an appropriate outcome measure for use in clinical research in gastroenterology. The subjects were 364 patients aged between 18 and 64 years who had been prescribed proton pump inhibitors (PPIs) by general practitioners in Oxfordshire. The general practices participating identified patients who had been prescribed PPIs. The data were abstracted from the general practice medical records of these patients concerning gastrointestinal diagnoses and other prescribed medications. The patients were sent the SF-36 questionnaire by post and the PCS and MCS scores were derived, which were adjusted for age and sex and compared with the scores of the general population of the Oxford region. Co-morbidity was assessed by the extent to which non-gastric medications were also used. The commonest diagnoses were oesophagitis/gastro-oesophageal reflux and indigestion. People with these diagnoses had significantly lower health status than the general population. Differences persisted when the results were controlled for the possible effects of co-morbidity. It was concluded that the SF-36 is sensitive to the impact of gastrointestinal disease on health status.

Trends in mortality from primary liver cancer in England and Wales 1975-92: influence of oral contraceptives.

Numerous case-control studies have suggested a link between the oral contraceptive pill and liver cancer. The secular trends in liver cancer mortality rates for England and Wales from 1975 to 1992 were examined to determine whether an effect of the pill was apparent. Liver cancer mortality has remained constant in women in the age groups that have had major exposure to the pill.

Ovarian and endometrial cancers.

Trends in the incidence and mortality of endometrial and ovarian cancer are described for England and Wales from 1950 to 1991 and for other selected countries from 1955 to 1985. The mortality from endometrial cancer has been falling in England and Wales since 1950 in all age groups. This has not been reflected by a decline in incidence. Most of the other countries show a similar decline in mortality in all ages but stable incidence rates. Mortality from ovarian cancer has been declining in women aged under 55 in England and Wales since the early 1970s but has been rising in women over 55. The international pattern is varied, but several countries show a decline in mortality in younger women that began in the early 1970s. The incidence in younger women has not fallen to the same degree. It is difficult to explain the trends in endometrial cancer mortality in terms of the known risk factors for the disease. The trends in ovarian cancer mortality are consistent with an effect of the combined oral contraceptive pill.

PIP: There is noteworthy global conformity in downward trends in endometrial cancer-related mortality while incidence rates are stable, indicating a ubiquitous environmental factor accounting for this trend. In England and Wales between 1950 and 1991, endometrial cancer-related deaths fell 67% for 35-54 year olds, 44.7% for 55-64 year olds, 33.6% for 65-74 year olds, and 13.1% for 75-84 year olds. Research suggests that the combined oral contraceptive (COC) may protect against endometrial cancer, so it may be contributing to this downward trend. A review of the literature of other possible risk factors shows that hormone replacement therapy and obesity and diet do not likely contribute to the downward trend. Examination of national vital statistics, which indicate a downward trend in endometrial cancer-related deaths, did not exclude women who have had a hysterectomy. An increasing hysterectomy rate would exaggerate any decrease in the endometrial cancer rate and vice versa. A possible treatment effect may explain the divergence of trends in incidence and mortality. No single clear trend in ovarian cancer-related mortality emerged from an analysis of different countries. This may be a factor of the heterogeneity of ovarian tumors. National vital statistics do not list ovarian cancer-related deaths by the different histological types of tumors. The proportions of the different types may vary from country to country. Further, each type has different trends in incidence and mortality. In Australia, Canada, Denmark, England, Israel, and Wales, there has been a reduction in ovarian cancer-related mortality in women less than 55 years old since the early 1970s. The COC may explain this downward trend, since it appears to have a protective effect against ovarian cancer. Other known risk factors (e.g., parity) do not explain the trends of ovarian cancer-related mortality, however.