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The possibility of improving the effectiveness of antenatal screening for Down's syndrome by measuring human chorionic gonadotrophin concen- IntroductionDown's syndrome is the most common congenital cause of severe mental retardation, with an incidence at birth of about 1-3 per 1000. The current method of antenatal screening is to select women for a diagnostic amniocentesis on the basis of advanced age. Age is, however, a poor basis for screening and has had little impact on the incidence at birth. With age as a basis for screening only about 30% of all Down's syndrome pregnancies can be detected by carrying out amniocentesis on the 5% of women most at risk-that is, those aged 36 years or greater-though in practice fewer than 15% of affected pregnancies are detected because fewer than half of these older women actually have amniocentesis.' Additional antenatal screening tests such as maternal serum measurements of c fetoprotein and unconjugated oestriol can increase the rate of detection to about 45% if the 5% of pregnant

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Few studies have examined associations between childhood overweight and adult disease. We examined the relation between BMI measured in childhood and adult all-cause and cardiovascular mortality in a 57-y follow-up of a cohort study based on the Carnegie (Boyd Orr) Survey of Family Diet and Health in prewar Britain (1937-1939). Complete baseline and follow-up data were available for 1165 males and 1234 females who were aged between 2 y and 14 y 9 mo when they were examined. All-cause and cardiovascular mortality were associated with higher childhood BMIs. Compared with those with BMIs between the 25th and 49th centiles, the hazard ratio (95% CI) for all-cause mortality in those above the 75th BMI centile for their age and sex was 1.5 (1.1, 2.2) and for ischemic heart disease it was 2.0 (1.0, 3.9). There was also a suggestion of a nonlinear association with overall mortality; those in the 25-49th centile of the BMI distribution had the lowest mortality rates. The linear associations may be due in part to the tracking of BMI between childhood and adulthood. High BMI in adults is known to be associated with raised blood pressure and abnormal lipid profiles. The relative contributions of adult and childhood overweight to the observed mortality patterns are uncertain. From the public health perspective, strategies aimed at reducing weight in childhood are important but may only affect adult health if such weight reduction persists into adulthood.

SummaryThis report describes the social distribution of central obesity and the metabolic syndrome at the Whitehall II study phase 3 examination, and assesses the contribution of health related behaviours to their distribution. Cross-sectional analyses were conducted utilising data collected in 1991-1993 from 4978 men and 2035 women aged 39-63 years who completed an oral glucose tolerance test. There was an inverse social gradient in prevalence of the metabolic syndrome. The odds ratio (95 % confidence interval) for having the metabolic syndrome comparing lowest with highest employment grade was: men 2.2 (1.6-2.9), women 2.8 (1.6-4.8). Odds ratios for occupying the top quintile of the following variables, comparing lowest with highest grade, were, for waist-hip ratio: men 2.2 (1.8-2.8), women 1.6 (1.1-2.4); postload glucose: men 1.4 (1.1-1.8), women 1.8 (1.2-2.6); triglycerides: men 1.6 (1.2-2.0), women 2.2 (1.5-3.3); fibrinogen: men 1.7 (1.4-2.3), women 1.9 (1.2-2.8). Current smoking status, alcohol consumption and exercise level made a small contribution (men 11%, women 9 %) to the inverse association between socioeconomic status and metabolic syndrome prevalence. In conclusion, central obesity, components of the metabolic syndrome and plasma fibrinogen are strongly and inversely associated with socioeconomic status. Our findings suggest the metabolic syndrome may contribute to the biological explanation of social inequalities in coronary risk. Health related behaviours appear to account for little of the social patterning of metabolic syndrome prevalence. [Diabetologia (1997[Diabetologia ( ) 40: 1341[Diabetologia ( -1349

Although similar findings have been reported in men who report same sex behaviour, 21 to our knowledge no other population study has focused specifically on sexual problems in bisexual as distinct from homosexual men.We thank Josephine Woolf for her collaboration in obtaining funding; Alice Gladwin, Monique Cloherty, and Üta Drescher for their assistance in collecting the data; and Bob Blizard for his statistical advice on the project. Contributors: See bmj.com Funding: health service research project grant provided by the Wellcome Trust (reference 991026); the North and Central Thames Research Network (NoCTeN) provided service support costs involved with the recruitment at the general practices. Competing interests: None declared. Ethical approval: Two London local research ethical committees approved the study. The need for estimates of the extent of sexual function problems in the general population has become more urgent given recent debates surrounding the identification and definition of "sexual dysfunction," the increased availability of pharmacological interventions, and possible changes in our expectations of what constitutes sexual function and fulfilment. 1 We report results from the national survey of sexual attitudes and lifestyles (Natsal 2000). Participants, methods, and resultsNatsal 2000 was a stratified probability sample survey done between May 1999 and February 2001 of 11 161 men and women aged 16-44 years resident in Britain.2 3 The response rate was 65.4%. A computer assisted self interview asked participants about their sexual lifestyles and attitudes. We asked questions about their experience of sexual problems based on those used in the US national health and social life survey, 4 which measured the main dimensions of sexual dysfunction, as defined in ICD-10 (international classification of diseases, 10th revision). We analysed data in STATA accounting for the sample's stratification, clustering, and weighting. A total of 34.8% of men and 53.8% of women who had at least one heterosexual partner in the previous year reported at least one sexual problem lasting at least one month during this period ( in sex, premature orgasm, and anxiety about performance; and among women, inability to experience orgasm and painful intercourse.Persistent sexual problems-lasting at least six months in the previous year-were less prevalent among men (6.2%) than among women (15.6%). The most common persistent problem among men was premature orgasm and among women, lack of interest in sex.Among people who had sexual problems, 32.5% (95% confidence interval 29.7% to 35.3%) of men and 62.4% (60.4% to 64.3%) of women avoided sex because of their problems. Only 10.5% (8.8% to 12.4%) of men and 21.0% of women (19.3% to 22.7%) with problems in the previous year sought help. People with persistent problems were more likely to have sought help (20.5% (15.8% to 26.3%) of men and 31.9% (28.4% to 35.5%) of women). Among people seeking help, 63.8% (54.6% to 72.1%) of men and 74.3% (70.1% to 78.1%) of women consulted the...

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