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© 2020 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology. Aims: To understand gender differences in the prognosis of women and men with heart failure, we compared mortality, cause of death and survival trends over time. Methods and results: We analysed UK primary care data for 26 725 women and 29 234 men over age 45 years with a new diagnosis of heart failure between 1 January 2000 and 31 December 2017 using the Clinical Practice Research Datalink, inpatient Hospital Episode Statistics and the Office for National Statistics death registry. Age-specific overall survival and cause-specific mortality rates were calculated by gender and year. During the study period 15 084 women and 15 822 men with heart failure died. Women were on average 5 years older at diagnosis (79.6 vs. 74.8 years). Median survival was lower in women compared to men (3.99 vs. 4.47 years), but women had a 14% age-adjusted lower risk of all-cause mortality [hazard ratio (HR) 0.86, 95% confidence interval (CI) 0.84–0.88]. Heart failure was equally likely to be cause of death in women and men (HR 1.03, 95% CI 0.96–1.12). There were modest improvements in survival for both genders, but these were greater in men. The reduction in mortality risk in women was greatest for those diagnosed in the community (HR 0.83, 95% CI 0.80–0.85). Conclusions: Women are diagnosed with heart failure older than men but have a better age-adjusted prognosis. Survival gains were less in women over the last two decades. Addressing gender differences in heart failure diagnostic and treatment pathways should be a clinical and research priority.

Aim To determine whether the Diabetes Inpatient Care and Education (DICE) programme, a whole-systems approach to managing inpatient diabetes, reduces length of stay, in-hospital mortality and readmissions. Research design and methods Diabetes Inpatient Care and Education initiatives included identification of all diabetes admissions, a novel DICE care-pathway, an online system for prioritizing referrals, use of web-linked glucose meters, an enhanced diabetes team, and novel diabetes training for doctors. Patient administration system data were extracted for people admitted to Ipswich Hospital from January 2008 to June 2016. Logistic regression was used to compare binary outcomes (mortality, 30-day readmissions) 6 months before and after the intervention; generalized estimating equations were used to compare lengths of stay. Interrupted time series analysis was performed over the full 7.5-year period to account for secular trends. Results Before-and-after analysis revealed a significant reduction in lengths of stay for people with and without diabetes: relative ratios 0.89 (95% CI 0.83, 0.97) and 0.93 (95% CI 0.90, 0.96), respectively; however, in interrupted time series analysis the change in long-term trend for length of stay following the intervention was significant only for people with diabetes (P=0.017 vs P=0.48). Odds ratios for mortality were 0.63 (0.48, 0.82) and 0.81 (0.70, 0.93) in people with and without diabetes, respectively; however, the change in trend was not significant in people with diabetes, while there was an apparent increase in those without diabetes. There was no significant change in 30-day readmissions, but interrupted time series analysis showed a rising trend in both groups. Conclusion The DICE programme was associated with a shorter length of stay in inpatients with diabetes beyond that observed in people without diabetes.

Aim The aim of this study was to explore hospital staff perceptions of the perceived challenges and outcomes of implementing a critical care outreach service. Background A nurse-led critical care outreach service was designed and implemented to identify and treat acutely ill patients in a large tertiary care hospital in Iran. Methods A qualitative analysis of data from two focus groups and seven interviews was carried out using conventional content analyses techniques. A total of 24 hospital staff members participated, including critical care outreach team members, physicians, ward head nurses and ward staff. Findings Two main categories described the perceived challenges to the implementation of the critical care outreach service: 1) the hospital context, with four subcategories related to staff shortages, the instability of physician positions, the lack of specialized essential services and the absence of a system to establish do-not-resuscitate orders, and 2) staff resistance to different nursing priorities, routines and extra work. In two additional main categories, participants also described positive and negative perceived outcomes. The positive perceived outcomes included three subcategories of alleviating equipment shortages, improving nursing knowledge and patient care and improving patient and healthcare professional satisfaction. Discussion While critical care outreach has the potential to improve patient perceived outcomes and both patient and provider satisfaction with care, the contextual and clinical realities in hospitals are significant and must be examined during the planning and implementation of future outreach. Conclusion and Implications for nursing and health policy A critical care outreach service in the context of an Iranian hospital has the potential to improve ward nurse familiarity with the care of acutely ill patients and the quality of palliative care. However, attention ought to be paid to the hospital's structural and contextual factors. Alleviating nursing shortages, reducing staff resistance and preparing goals of care guidelines that address restrictions on resuscitation could facilitate implementation of critical care outreach services.

Background and purpose Clinical management after transient ischaemic attack (TIA) is focused on stroke prevention; however, a number of small studies suggest that patients may experience ongoing residual impairments. Methods This was a retrospective matched-cohort study using anonymized electronic primary care records from The Health Improvement Network database, which covers approximately 6% of the UK population. Adults (≥ 18 years old) who experienced a first TIA between 2009 and 2013 were matched in a ratio of 1:5 to controls by age, sex and general practice. The time to first consultation for fatigue, psychological impairment or cognitive impairment was estimated by Kaplan–Meier survivor functions and adjusted hazard ratios. Results A total of 9419 TIA patients and 46 511 controls were included. The Kaplan–Meier curves showed that TIA patients were more likely than controls to consult for all three impairments (P < 0.0001). Within 7.1 months (95% confidence interval (CI), 6.2–8.2), 25% of TIA patients consulted for psychological impairment compared with 23.5 months (95% CI, 22.5–24.6) for controls. Hazard ratios for TIA patients were 1.43 (95% CI, 1.33–1.54) for consulting for fatigue, 1.26 (95% CI, 1.20–1.31) for psychological impairment and 1.45 (95% CI, 1.28–1.65) for cognitive impairment. Conclusions Transient ischaemic attack is associated with significantly increased subsequent consultation for fatigue, psychological impairment and cognitive impairment. These findings suggest that impairments exist after initial symptoms of TIA have resolved, which should be considered by clinicians when treating TIA patients.

Background Approximately 80 000 children and young people in the UK suffer from depression, but many are untreated because of poor identification of early warning signs and risk factors. Aims This study aimed to derive and to investigate discrimination characteristics of a prediction model for a first recorded diagnosis of depression in young people aged 15–24 years. Method This study used a matched case–control method using electronic primary care records. Stepwise conditional logistic regression modelling investigated 42 potential predictors including symptoms, co-morbidities, social factors and drug and alcohol misuse. Results Of the socio-economic and symptomatic predictors identified, the strongest associations were with depression symptoms and other psychological conditions. School problems and social services involvement were prominent predictors in men aged 15–18 years, work stress in women aged 19–24 years. Conclusion Our model is a first step in the development of a predictive model identifying early warning signs of depression in young people in primary care.

Diabet. Med. 29, e445–e448 (2012) Abstract Aim To study the length of stay and inpatient mortality of patients with diabetes who had an episode of hypoglycaemia in a non critical care setting at University Hospital Birmingham, UK. Methods Retrospective analysis of routinely available electronic data of 6374 admissions with a recording of either laboratory or point-of-care blood glucose value. Based on the lowest recorded blood glucose values, patients were categorized into a group without hypoglycaemia (> 3.9 mmol/l), a group with mild to moderate hypoglycaemia (2.3–3.9 mmol/l) and a group with severe hypoglycaemic (≤ 2.2 mmol/l). Length of stay and inpatient mortality were compared between the three groups, adjusting for age, gender, ethnicity, deprivation, admission type, use of insulin and modified Charlson co-morbidity score. Results There were 148 admissions (2.3%) with severe hypoglycaemia (≤ 2.2 mmol/l), 500 admissions (7.8%) with mild to moderate hypoglycaemia (2.2–3.9 mmol/l) and 5726 admissions with no recorded hypoglycaemic episode (> 3.9 mmol/l). After adjustment, length of stay, when compared with those without a recorded hypoglycaemic episode, was 1.51 (95% CI 1.35–1.68) times higher in the group with blood glucose values of 2.3–3.9 mmol/l and 2.33 (95% CI 1.91–2.84) higher in the group with blood glucose values ≤ 2.2 mmol/l. Adjusted odds ratio of inpatient mortality when compared with the group without hypoglycaemia was 1.62 (95% CI 1.16–2.27) in the group with blood glucose values of 2.3–3.9 mmol/l and 2.05 (95% CI 1.24–3.38) in the group with blood glucose values ≤ 2.2 mmol/l. Conclusion Hypoglycaemia is associated with increased length of stay and inpatient mortality. Whilst causative evidence is lacking, our data are consistent with the need to avoid hypoglycaemia in our current and continued approach for optimal glycaemic control in people with diabetes admitted to hospital.

BACKGROUND: Computerized clinical decision support systems have been claimed to reduce prescription errors and improve patient care. They may play an important role in the care of hospitalized patients with diabetes. AIM: To collate evidence for the use of clinical decision support systems in improving the care of hospitalized patients with diabetes in a non-critical care setting and to assess their effectiveness. METHODS: We searched four databases from 1980 to 2010 without language restrictions. All types of studies other than case reports were included. Data extraction and quality assessment were carried out based on the Centre for Review and Dissemination guidance. A narrative synthesis was conducted. RESULTS: Fourteen studies met the inclusion criteria, including two cluster randomized controlled trials, eight before-and-after studies and four other descriptive studies. Generally, the quality of the studies was not very high. Nine out of 10 studies reported reduction in mean blood glucose or similar measures (patient-day-weighted mean blood glucose) during inpatient stay. The reduction using computerized physician order entry system in patient-day-weighted mean blood glucose ranged from 0.6 to 0.8 mmol/l (10.8-15.6 mg/dl). Other beneficial effects during inpatient stay included reduced use of sliding scale insulin and greater use of basal-bolus insulin regimen. Only one study found a significant increase in hypoglycaemic events. CONCLUSIONS: Clinical decision support systems have been used, often as part of a complex programme, to improve the care of hospitalized patients with diabetes. There is some evidence that they may have a beneficial effect, but this needs further confirmation.

Objective: To investigate inequalities in cesarean delivery rates in Brazil according to ethnic group and level of access to hospital delivery. Methods: Cross-sectional analysis of data for primiparous women with singleton deliveries between 2003 and 2004 from the National Information System of Live-Births (6 064 799 live births). Robust Poisson regression modeling was applied to estimate prevalence ratios of cesarean deliveries for ethnic group and level of access to hospital delivery according to residence. Results: There were 2 438 180 primiparous deliveries and the cesarean rate was 45.8%. Ethnic inequalities in cesarean delivery rates showed lower rates for all ethnic groups compared with white women, with the lowest rates recorded for indigenous women. The association between ethnicity and cesarean delivery was higher in states with lower access to hospital (P < 0.001). Multiple regression models showed that this association was, in part, explained by older maternal age and higher levels of education and prenatal care. Conclusions: Overuse of cesarean delivery and strong evidence of ethnic inequalities in cesarean rates exist in Brazil. The inequalities are greater in states with lower access to hospital and were partially explained by socioeconomic factors and prenatal care, suggesting a misuse of medical technology at birth. (C) 2009 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

OBJECTIVES To examine the association between midwife density, other characteristics of midwifery provision and village contextual factors, and the percentage of births attended by a health professional and deliveries via caesarean section in two districts in West Java, Indonesia. METHODS Analysis of: (i) a census of midwives; (ii) a population-based survey of women who had delivered over a 2-year period; (iii) a census of all caesareans in the four hospitals serving the two districts; and (iv) data from National Statistical Office. RESULTS At an average density of 2.2 midwives per 10 000 population, 33% of births are with a health professional, and 1% by caesarean section. Having at least six midwives per 10 000 population was associated with a fourfold increase in caesareans [adjusted risk ratio (RR) 4.3: 95% confidence interval (CI): 3.3-5.5] and a threefold increase in the odds of having a health professional attend the delivery [adjusted odds ratio (OR) 2.88: 95% CI: 0.96-8.70]. The assigned midwife's professional status and the duration of her service in the village were also associated with higher rates of health professionals' attendance of delivery and caesareans. Regardless of the provision of services, women's education and wealth were strong predictors of delivery with a health professional. CONCLUSIONS Promoting a stable workforce of midwives, better financial access for the poor and expanding female education are important for the achievement of the fifth Millennium Development Goal (MDG-5).

Summary Objective The K10 and K6 are short rating scales designed to detect individuals at risk for depressive disorder, with or without anxiety. Despite being widely used, they have not yet been validated for detecting postnatal depression. We describe the validity of these scales for the detection of postnatal depression in Burkina Faso. Method The English language version of the K10 questionnaire was translated into West African French and local languages for use in Burkina Faso. Scores for 61 women were compared with the diagnostic interview made by a local psychiatrist within 3 days of administering the K10. Results Clinical assessment found that 27 (44%) women were probable cases of depression. Internal consistency of K10 and K6 scores, defined by Cronbach’s alpha coefficient, was 0.87 and 0.78, respectively, indicating satisfactory reliability. The performance of the scores was not significantly different, with areas under the curve of 0.77 and 0.75 for the K10 and K6, respectively. To estimate prevalence of depression, we suggest cut-offs of ≥14 for the K10 and between ≥9 and ≥11 for the K6 for identifying women at high risk of depression. At ≥14, the K10 has 59% sensitivity, 91% specificity; at ≥10, the K6 has 59% sensitivity and 85% specificity. Conclusion This study suggests that K10 and K6 are reasonably valid measures of depression among postpartum women in Burkina Faso and can be used as relatively cheap tools for estimating prevalence of postnatal depression in developing countries. Objectif Les K10 et les K6 sont des echelles d’evaluation rapide concues pour detecter les individus a risque de trouble depressif avec ou sans anxiete. Malgre leur emploi etendu, elles n’ont pas ete encore validees pour la detection de la depression postnatale. Nous decrivons ici, la validite de ces echelles pour la detection de la depression postnatale au Burkina-Faso. Methode La version anglaise du questionnaire K10 a ete traduite en langues locales ouest africaines et francaise pour etre utilisee au Burkina-Faso. Les scores pour 61 femmes ont ete compares a l’interview de diagnostique realisee par un psychiatre local dans les trois jours suivant l’application du K10. Resultats L’evaluation clinique a revele que 27 femmes (44%) etaient des cas probables de depression. La consistance interne des scores de K10 et K6 definie par le coefficient alpha de Cronbach’s etait de 0,87 et 0,78 respectivement, indiquant une fiabilite satisfaisante. La performance des scores n’etait pas significativement differente, avec des aires sous la courbe (AUC) de 0,77 et de 0,75 pour le K10 et le K6, respectivement. Pour estimer la prevalence de la depression, nous suggerons des seuils limites ≥14 pour le K10 et comprises entre ≥9 et ≥11 pour le K6 pour identifier les femmes a risque eleve pour la depression. Pour un score ≥14, le K10 a une sensibilite de 59% et une specificite de 91%; a ≥ 10, le K6 a une sensibilite de 59% et une specificite de 85%. Conclusion Cette etude suggere que K10 et K6 sont des mesures raisonnablement valides pour la depression chez les femmes qui ont accouche au Burkina-Faso et peuvent etre utilises comme outils relativement bon marche pour estimer la prevalence de la depression postnatale dans les pays en voie de developpement. Objetivo K10 y K6 son escalas de clasificacion corta disenadas para detectar individuos a riesgo de desordenes depresivos, con o sin ansiedad. A pesar de ser ampliamente utilizadas, no han sido aun validadas para detectar la depresion posparto. Aqui describimos la validez de estas escalas para la deteccion de la depresion posparto en Burkina Faso. Metodo Se tradujo la version inglesa del cuestionario del K10 al frances y a las lenguas locales de Africa Occidental, para su uso en Burkina Faso. Se compararon los puntajes de 61 mujeres con la entrevista de diagnostico realizada por el psiquiatra local dentro de los 3 dias de administracion del K10. Resultados La evaluacion clinica encontro que 27 (44%) mujeres eran casos probables de depresion. La consistencia interna de los puntajes del K10 y el K6, definidos por el coeficiente alfa de Cronbach, era 0.87 y 0.78 respectivamente, indicando una fiabilidad satisfactoria. El desempeno de los puntajes no era significativamente diferente, con areas bajo la curva de 0.77 y 0.75 para el K10 y K6, respectivamente. Para estimar la prevalencia de depresion, hemos sugerido puntos de corte de ≥14 para el K10 y entre ≥9 y ≥ 11 para el K6, con el fin de identificar mujeres con alto riesgo de depresion. A ≥ 14, el K10 tiene un 59% de sensibilidad, 91% de especificidad; a ≥ 10, el K6 tiene un 59% de sensibilidad y un 85% de especificidad. Conclusion Este estudio sugiere que el K10 y el K6 son medidas razonables para la depresion posparto en mujeres de Burkina Faso, y pueden utilizarse como herramientas relativamente baratas para estimar la prevalencia de esta condicion en paises en vias de desarrollo.

AIMS: To examine the effects of the home environment on unintentional domestic injuries and related health care attendance in infants from deprived families. METHODS: Ten mechanisms that caused unintentional domestic injury during the first year were investigated in a population-based study of 1-year-old children in southern Brazil. Odds ratios of injury-related health care attendance were estimated by number of injury mechanisms reported. Variation in number of mechanisms (in the whole sample) and odds ratios of care attendance (in children with reported injuries) were estimated for socioeconomic and psychosocial variables. RESULTS: Among all children (394) 86% had injuries; 10.9% care attendance and 0.5% hospitalisation were reported, and 14.5% presented dental trauma. Injury-related care attendance increased with the number of injury mechanisms (linear trend OR = 1.34, 95% CI = 1.09-1.66). In multivariable linear regression, injury mechanisms increased with the number of home hazards (p = 0.047) and decreased with duration of exclusive breastfeeding (p = 0.039), maternal involvement-responsiveness (p = 0.037) and mother's paid work (p = 0.018). Injury-related health care attendance among children with reported injuries was positively associated with maternal involvement-responsiveness (OR = 2.27, 95% CI = 1.11-4.67) and home organization (OR = 2.25, 95% CI = 1.09-4.65). CONCLUSION: Injury control can benefit from policy and practice that improve housing, reduce home hazards and promote breastfeeding, maternal bonds, safety practices and injury care. Language: en

A method for translating research data from the Denver Test into individual scores of developmental status measured in a continuous scale is presented. It was devised using the Denver Developmental Screening Test (DDST) but can be used for Denver II. The DDST was applied in a community-based survey of 3389 under-5-year-olds in Porto Alegre, Brazil. The items of success were standardised by logistic regression on log chronological age. Each child's ability age was then estimated by maximum likelihood as the age in this reference population corresponding to the child's success and failures in the test. The score of developmental status is the natural logarithm of this ability age divided by chronological age and thus measures the delay or advance in the child's ability age compared with chronological age. This method estimates development status using both difficulty and discriminating power of each item in the reference population, an advantage over scores based on total number of items correctly performed or failed, which depend on difficulty only. The score corresponds with maternal opinion of child developmental status and with the 3-category scale of the DDST. It shows good construct validity, indicated by symmetrical and homogeneous variability from 3 months upwards, and reasonable results in describing gender differences in development by age, the mean score increasing with socio-economic conditions and diminishing among low-birthweight children. If a standardised measure of development status (z-scores) is required, this can be obtained by dividing the score by its standard deviation. Concurrent and discriminant validity of the score must be examined in further studies.

Subclinical mastitis, defined as raised milk sodium/potassium (Na/K) ratio, is associated with poor infant growth and, among HIV-infected women, with increased milk HIV viral load. We conducted a longitudinal cohort study in Lusaka, Zambia, in order to investigate the relative importance of several potential causes of subclinical mastitis: maternal infection, micronutrient deficiencies and poor lactation practice. Women (198 HIV-infected, 189 HIV-uninfected) were recruited at 34 weeks' gestation and followed up to 16 weeks postpartum for collection of information on their health, their infant's health, infant growth and infant feeding practices. Milk samples were collected from each breast at 11 postpartum visits and blood at recruitment and 6 weeks postpartum. The geometric mean milk Na/K ratio and the proportion of women with Na/K ratio > 1.0 in one or both breasts were significantly higher among HIV-infected than among uninfected women. Other factors associated with the higher mean Na/K ratio in univariable analyses were primiparity, high maternal alpha(1)-acid glycoprotein (AGP) at 6 weeks, maternal overall morbidity and specific breast symptoms, preterm delivery, low infant weight or length, infant thrush and non-exclusive breast feeding. In multivariable analyses, primiparity, preterm delivery, breast symptoms, HIV status and raised AGP were associated with the raised Na/K ratio. Thus the main factors associated with subclinical mastitis that are amenable to intervention are poor maternal overall health and breast health. The impact of improved postpartum health care, especially management of maternal infections and especially in primiparous women, on the prevalence of subclinical mastitis and its consequences requires investigation.

Background Physical activity may be associated with reduced risk of colorectal cancer. The main aim of this paper is to review the available evidence for a link between exercise and large bowel cancer. Methods A Cochrane-type methodology was performed. Data extracted included, type of study, type of physical activity measured and the numerical results. The risk ratios (RR) of the studies have been pooled according to the type of study, type of exercise, type of cancer and sex. Pooling was undertaken using fixed effect meta-analysis. A random effect meta-analysis was used where substantial heterogeneity existed. Result Data from 19 cohort studies showed a statistically significant reduction in the risk of colon cancer in physically active males, RR being 0.79 (95% CI 0.72–0.87) and 0.78 (95% CI 0.68–0.91) for occupational and recreational activities, respectively. In women only recreational activities are protective against colon cancer (RR = 0.71, 95%CI 0.57–0.88). Case-control studies showed significantly reduced risks of colon cancer in both sexes irrespective of the type of activity. No protection against rectal cancer is seen in either sex. Conclusion There is considerable evidence that physical activity is associated with reduced risk of colon cancer in both males and females.

We report the findings of an evaluation of a programme in three districts in South Kalimantan, Indonesia, which consisted of the training, deployment and supervision of a large number of professional midwives in villages, an information, education and communication (IEC) strategy to increase use of village midwives for birth, and a district-based maternal and perinatal audit (MPA). Before the programme, the midwives had limited ability to manage obstetric complications, and 90% of births took place at home. Only 37% were attended by a skilled attendant. By 1998-99, 510 midwives were posted in the districts and skilled attendance at delivery had increased to 59%. Through in-service training, continuous supervision and participation in the audit system midwives also gained confidence and skills in the management of obstetric complications. Despite this, the proportion admitted to hospital for a caesarean section declined from 1.7 to 1.4% and the proportion admitted to hospital with a complication requiring a life-saving intervention declined from 1.1% to 0.7%. The strategy of a midwife in every village has dramatically increased skilled birth attendance, but does not yet provide specialized obstetric care for all women needing it. The high cost of emergency obstetric interventions may well be the most important obstacle to the use of hospital care.

We describe a sib pair with craniofacial anomalies, micrognathia, Mobius sequence, generalised myopathy, relative macrocephaly, and developmental delay. They appear to have the Carey-Fineman-Ziter syndrome (MIM 254940), which has been reported in only four children, a sib pair and two sporadic cases. This report on an additional affected brother and sister pair supports autosomal inheritance as the likely cause. These cases also confirm that scoliosis, talipes equinovarus, and a non-specific primary myopathy are important manifestations of Carey-Fineman-Ziter syndrome. Am. J. Med. Genet. 82:110–113, 1999. © 1999 Wiley-Liss, Inc.

In countries where population-based data on health problems are scarce, the extent of reproductive morbidity can be estimated from replies in structured interviews as a complement or as an alternative to reports from physician's examination and laboratory tests. We examined the sensitivity and specificity of detected morbidity based on these replies as compared to medical diagnoses and explored the consistency of replies when the questionnaire was administered twice, by two types of interviewers in different environments. Data were collected in a cross-sectional survey in Istanbul. The presence or absence of five morbidities, reproductive and urinary tract infections (RTI and UTI), menstrual disorders, pelvic relaxation and anaemia was determined by algorithms based on the replies, and by the physician's diagnosis. Except with anaemia, questionnaire replies were more specific than sensitive in detecting morbidity, probably partly due to many morbid conditions being accepted as normal. Sepcificity exceeded 80% for home reports of menstrual disorders (93.0%), pelvic relaxation (95.7%), RTI (abnormal discharge and pain) (81.2%) and UTI (80.7%), with the corresponding figure for anaemia at 41.7%; the best sensitivity results were for anaemia (58.3%), RTI (abnormal discharge only) (49.3%) and menstrual disorders (45.4%) with figures for pelvic relaxation and UTI reaching only 17.3 and 13.0%. Reliability between the interviews (assessed by the K coefficient), was highest at 66.1% for pelvic relaxation and lowest at 39.9% for menstrual disorders. Reliability varied between the two lay interviewers, suggesting the interviewer and the interview conditions are important. Questionnaire-based information on this type of morbidity is most useful for ascertaining perceived ill-health and only of limited use for the corresponding medically defined conditions.

Aims and methods: Concurrent validity of maternal opinion of child development was estimated in a cross-sectional, population-based survey of 6–59-mo children (n=3025), using a standard measure devised from the Denver Developmental Screening Test. Results: Sensitivity, specificity and negative predictive value increased with maternal education and family income. Positive predictive value was higher in low-income families and children with impairments, low birthweight and long hospital stays. Conclusion: Children at social and clinical risk should be assessed more carefully, even if maternal report is normal or advanced.