Acquired hemophilia A is a severe bleeding disorder caused by an autoantibody to factor VIII. Previous reports have focused on referral center patients and it is unclear whether these findings are generally applicable. To improve understanding of the disease, a 2-year observational study was established to identify and characterize the presenting features and outcome of all patients with acquired hemophilia A in the United Kingdom. This allowed a consecutive cohort of patients, unbiased by referral or reporting practice, to be studied. A total of 172 patients with a median age of 78 years were identified, an incidence of 1.48/million/y. The cohort was significantly older than previously reported series, but bleeding manifestations and underlying diseases were similar. Bleeding was the cause of death in 9% of the cohort and remained a risk until the inhibitor had been eradicated. There was no difference in inhibitor eradication or mortality between patients treated with steroids alone and a combination of steroids and cytotoxic agents. Relapse of the inhibitor was observed in 20% of the patients who had attained first complete remission. The data provide the most complete description of acquired hemophilia A available and are applicable to patients presenting to all

Objective-To determine whether the rate of cardiovascular disease is different among parous women with a general practitioner reported history of toxaemia of pregnancy than among those not reported to have experienced toxaemia, or among nuliparous women.

The aim of the present study was to validate a simple scoring system using a parent-completed screening questionnaire to identify children aged 5±15 yrs who may have asthma.A stratified random sample of 157 children of 1,808 whose parents had answered a postal respiratory questionnaire underwent detailed clinical evaluation. The results were reviewed by three independent paediatricians whose opinions were combined to reach, for each child, decisions regarding three standards: 1) "possible asthma" defined as >50% likelihood of having asthma; 2) "possible asthma" defined as meriting a clinical trial of asthma medication; and 3) "probable asthma" defined as >90% likelihood of having asthma. The combined decisions were compared to three sets of questionnaire scores, in order to determine the positive predictive value, sensitivity and specificity of each set in identifying children with probable/possible asthma.The three sets of chosen questionnaire scores all had positive predictive values of 79±96% for predicting possible asthma, using either the combined expert opinion ">50% likelihood of asthma" or that of "warrants a trial of treatment" as the definition. This suggests that a low proportion of false positives would be obtained were this scoring system to be used for a screening programme. The combined decision >90% chance of asthma could be used as a means of estimating prevalence of asthma in the survey. When used for this, the prevalence of asthma in the surveyed population was 18.8% (95% confidence interval 13.1±26.3).In conclusion, the present scoring system, based on a simple respiratory questionnaire, provides a valid method of identifying children likely to have asthma, and who, if unknown to the medical services, would benefit from clinical review.

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Background: Identification and treatment of unrecognised asthmatics in the community is important for improving the health of the individual and minimising cost and quality of life burden. It is not practical to offer clinical diagnostic assessment to whole communities, and a simple tool such as a questionnaire is required to identify a smaller target group. Conventional questionnaire screening methods which separate individuals into positive and negative categories have resulted in large numbers of individuals requiring clinical assessment. This study has therefore developed and tested a weighted scoring system that prioritises those most urgently in need, based on their questionnaire responses.

From data available at April 1987 it was found that the standardised risk ratio for rheumatoid arthritis between current users of oral contraceptives and never users was 0-82 (95% confidence interval 0.59 to 115); the ratio between former users and never users was 0-94 (95% confidence interval 0-72 to 1-22). Important secular trends have occurred within our study population. The incidence of rheumatoid arthritis among former and never users has declined over the past two decades. Current users have not experienced this temporal trend, and the ratio between current and never users has, therefore, approached unity. These secular changes may explain why some studies have found that oral contraceptives have a protective effect, while others have been unable to show such an effect.

Objective-To investigate the effect of induced abortion on the outcome of the next pregnancy. Design-Long-term prospective controlled cohort study. Setting-Joint Royal College of General Practitioners/Royal College of Obstetricians and Gynaecologists study based in gencral practice in England, Scotland and Walcs. Subjects-1311 women whose recruitment pregnancy had ended in induced abortion (the abortion group) and 2131 women whose recruitment pregnancy had a natural conclusion (the non-abortion group). Muitz outcome measures-Non-viablc outcome (spontaneous or missed miscarriage, ectopic pregnancy or stillbirth), birthweight, length of gestation.Results-Induced abortion was not materially associated with any of the three measures of adverse outcome. Compared with the non-abortion group the relative risk of a non-viable outcome in the abortion group was 1.01 (95' 26 CI 0.81 to 1.27). In the abortion group birthweight was an average 23 g lighter (95% CI -76 g to + 30 g) and length of gestation an average 0.9 days shorter (95% CI -2-2 days to + 0.4 days) than in the non-abortion group. Womcn who had their abortions in NHS premises had an increased risk of a non-viable outcome ( R R 2.55, 95% C1 1-31 to 4.94) and had babies with significantly lower mean birthweight (-119 g, 95% CI -233 g to +5 g) comparcd with those who obtained tlicir operations in the private sector. Women whose abortion had been carried out by a consultant had the lowest risk of non-viable outcornc. Although these differences remained after adjustmcnt for a number of important variables, it is possible that factors not measurcd in the present study, such as economic status and occupation, playcd a contributory role. Conclusion-Overall, induccd abortion was not associated with any important effect on the three measures of adverse outcome in the subsequent pregnancy. Despite the greater efficiency and availability ofRoyal College of General Practitioners, Manchester Research Unit, 8 Barlow Moor Road, ManChester M20 OTR P. I . FRANK

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