Objective-To compare the relative risks of serious gastrointestinal complications reported with individual non-steroidal anti-inflammatory drugs.Design-Systematic review of controlled epidemiological studies that found a relation between use of the drugs and admission to hospital for haemorrhage or perforation.Setting-Hospital and community based casecontrol and cohort studies.Main outcome measures-(a) Estimated relative risks of gastrointestinal complications with use of individual drugs, exposure to ibuprofen being used as reference; (b) a ranking that best summarised the sequence of relative risks observed in the studies.

This paper reports our experience with the use of an improved self-administered questionnaire for assessing quality of life (QOL) after acute myocardial infarction. The modified questionnaire significantly increased the proportion of patients able to answer all questions from 84%-92%. The additional questions in the improved questionnaire increased the total variance explained by the Emotional, Physical and Social QOL factors from 65.8%-66.5%. Internal consistency and construct validity were assessed and found to be high. Overall, we have found that this improved questionnaire is easy to administer and that it possesses desirable properties of validity and reliability.

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SUMMARYMany extensions of survival models based on the Cox proportional hazards approach have been proposed to handle clustered or multiple event data. Of particular note are "ve Cox-based models for recurrent event data: Andersen and Gill (AG); Wei, Lin and Weissfeld (WLW); Prentice, Williams and Peterson, total time (PWP-CP) and gap time (PWP-GT); and Lee, Wei and Amato (LWA). Some authors have compared these models by observing di!erences that arise from "tting the models to real and simulated data. However, no attempt has been made to systematically identify the components of the models that are appropriate for recurrent event data. We propose a systematic way of characterizing such Cox-based models using four key components: risk intervals; baseline hazard; risk set, and correlation adjustment. From the de"nitions of risk interval and risk set there are conceptually seven such Cox-based models that are permissible, "ve of which are those previously identi"ed. The two new variant models are termed the &total time } restricted' (TT-R) and &gap time } unrestricted' (GT-UR) models. The aim of the paper is to determine which models are appropriate for recurrent event data using the key components. The models are "tted to simulated data sets and to a data set of childhood recurrent infectious diseases. The LWA model is not appropriate for recurrent event data because it allows a subject to be at risk several times for the same event. The WLW model overestimates treatment e!ect and is not recommended. We conclude that PWP-GT and TT-R are useful models for analysing recurrent event data, providing answers to slightly di!erent research questions. Further, applying a robust variance to any of these models does not adequately account for within-subject correlation.

H. pylori infection is associated with a 2-fold increased risk of developing gastric adenocarcinoma.

No abstract

The objective of this study was to validate the SF-12 Health Survey in heart and stroke patients using a community-based study. Between November 1995 and August 1996, 3,362 patients were invited to join the Hunter Heart and Stroke Register in New South Wales, Australia and to complete the SF-12 Health Survey. Of the 3,362 patients, 2,341 (70%) returned the SF-12. Of those 2,341 patients, 78% completed all 12 items. Those who did not complete the questionnaire were significantly more likely to be females, older, less educated, have stayed longer in hospital and been admitted on emergency. The SF-12 demonstrated construct validity in an analysis restricted to the 1,831 patients who completed the questionnaire: scores measuring physical and mental health status were statistically significantly higher in men than women, in younger than older, in those who had shorter than longer lengths of stay in hospital, in patients whose hospital admissions were planned than emergencies and in heart than stroke patients. Construct validity of the SF-12 among patients able to complete the SF-12 suggests considerable potential for its use in assessing health status in large-scale surveys. However, caution should be taken with the heart and stroke population because of a relatively high in completion rate.

Background and Purpose-The influence of body temperature on stroke outcome remains uncertain. The aim of this study was to investigate the prognostic role of admission body temperature on short-term and long-term mortality in a retrospective cohort study of patients with acute stroke. Methods-A retrospective cohort of 509 patients with acute stroke, admitted to a tertiary hospital between July 1, 1995, and June 30, 1997, was studied. The relationship between admission body temperature and mortality both in-hospital and at 1-year mortality was evaluated. Body temperature on admission was classified as hypothermia (Յ36.5°C), normothermia (Ͼ36.5°C and Յ37.5°C), and hyperthermia (Ͼ37.5°C). Logistic regression and proportional hazards function analysis were performed after adjustment for clinical predictors of stroke outcome. Results-In ischemic stoke, mortality was lower among patients with hypothermia and higher among patients with hyperthermia. The odds ratio for in-hospital mortality in hypothermic versus normothermic patients was 0.1 (95% CI, 0.02 to 0.5). The relative risk for 1-year mortality of hyperthermic versus normothermic patients was 3.4 (95% CI, 1.6 to 7.3). A similar but nonsignificant trend for in-hospital mortality was seen among patients with hemorrhagic stroke. Conclusions-An association between admission body temperature and stroke mortality was noted independent of clinical variables of stroke severity. Hyperthermia was associated with an increase in 1-year mortality. Hypothermia was associated with a reduction in in-hospital mortality. (Stroke. 2000;31:404-409.)