Effects of an air pollution personal alert system on health service usage in a high-risk general population: a quasi-experimental study using linked data.

BACKGROUND: There is no evidence to date on whether an intervention alerting people to high levels of pollution is effective in reducing health service utilisation. We evaluated alert accuracy and the effect of a targeted personal air pollution alert system, airAware, on emergency hospital admissions, emergency department attendances, general practitioner contacts and prescribed medications. METHODS: Quasi-experimental study describing accuracy of alerts compared with pollution triggers; and comparing relative changes in healthcare utilisation in the intervention group to those who did not sign-up. Participants were people diagnosed with asthma, chronic obstructive pulmonary disease (COPD) or coronary heart disease, resident in an industrial area of south Wales and registered patients at 1 of 4 general practices. Longitudinal anonymised record linked data were modelled for participants and non-participants, adjusting for differences between groups. RESULTS: During the 2-year intervention period alerts were correctly issued on 208 of 248 occasions; sensitivity was 83.9% (95% CI 78.8% to 87.9%) and specificity 99.5% (95% CI 99.3% to 99.6%). The intervention was associated with a 4-fold increase in admissions for respiratory conditions (incidence rate ratio (IRR) 3.97; 95% CI 1.59 to 9.93) and a near doubling of emergency department attendance (IRR=1.89; 95% CI 1.34 to 2.68). CONCLUSIONS: The intervention was associated with increased emergency admissions for respiratory conditions. While findings may be context specific, evidence from this evaluation questions the benefits of implementing near real-time personal pollution alert systems for high-risk individuals.

Retropubic urethropexy (Burch colposuspension).

Many varied procedures have been described for the surgical treatment of female stress incontinence. Over the years these have had enthusiastic proponents, but not until the recent publication of two systematic literature reviews did their relative efficacies become apparent. At present it would appear that open suprapubic urethropexy is the current 'gold standard' procedure. Many new minimal-access techniques aimed at reducing the morbidity of a Burch colposuspension have been proposed. However, careful analysis of the medium- to long-term success of these procedures and their associated complications is needed before they are adopted universally.

A comparison of the objective and subjective outcomes of colposuspension for stress incontinence in women.

OBJECTIVES: To investigate the impact of colposuspension for stress incontinence on the symptoms and quality of life of women undergoing both primary and repeat surgery for genuine stress incontinence and in addition to assess the use of a condition specific quality of life questionnaire as an outcome measure following surgery. DESIGN: Prospective case series: videocystourethrography performed before and between six and twelve months after surgery. Validated condition specific quality of life (QoL) questionnaires completed by women before and six to twelve months after surgery. SETTING: A tertiary referral Urogynaecology Unit in a teaching hospital. PARTICIPANTS: A consecutive series of 83 women undergoing colposuspension between March 1995 and December 1997. Pre-operative assessment and surgery was performed by, or was under the direct supervision of, the unit director. INTERVENTION: Modified Burch colposuspension. MAIN OUTCOME MEASURES: Objective results of surgery assessed with videocystourethrography. Subjective results evaluated using a condition specific QoL tool, the Kings Health Questionnaire (KHQ). Symptom severity was evaluated as a component of the condition specific QoL questionnaire. RESULTS: Objective cure was demonstrated in 92% of women undergoing primary surgery with an 8% incidence of de-novo detrusor instability and a 10% incidence of voiding difficulties. In the group of women having repeat surgery the objective cure rate was 81% with no de-novo detrusor instability and a 6% incidence of post-operative voiding difficulties. QoL scores improved in 95% of women. Improvements of over 25% were seen in 70% of women and of over 50% in 28%. However, 2.4% of women recorded a deterioration in QoL scores. CONCLUSIONS: Colposuspension performed in this setting, assessed using both objective and standardised subjective measures, completed by women themselves, appears to produce good objective and subjective results and leads to enhanced quality of life in the great majority of women.

The impact of the menstrual cycle on urinary symptoms and the results of urodynamic investigation.

Four hundred and eighty-three consecutive women referred for videocystourethrography completed a structured questionnaire about their menstrual status and urinary symptoms. Women were included in the study if they were premenopausal, had a regular menstrual cycle and were not taking hormonal therapy. One hundred and thirty-three women satisfied the inclusion criteria of whom 55 (41%) complained that their urinary symptoms were cyclical. The times at which symptoms were said to be at their worst were reported by the women as follows: during a period (n = 20; 36%); just after a period (n = 4; 7%); middle of the month (n = 8; 15%); just before a period (n = 23; 42%). The prevalence of abnormal detrusor activity on videocystourethrography increased significantly with time from the last menstrual period (chi2 for trend = 6.56, P = 0.01) and might reflect increases in the circulating level of progesterone following ovulation. This study provides further indirect evidence that progesterone could have an adverse effect on female lower urinary tract function. In addition, it might be necessary to consider the stage within the menstrual cycle when interpreting the results of urodynamic investigation.

A new intravaginal device for stress incontinence in women.

OBJECTIVE: To compare two versions of the same type of disposable intravaginal device (the Conveen Continence Guard, CCG, and the Contrelle Continence Tampon, CCT, Coloplast a/s, Humlebaek, Denmark) for treating stress incontinence in women. PATIENTS AND METHODS: Women with the predominant symptom of stress incontinence were recruited from four centres in Denmark, Australia and the UK. The women were assessed using a 24-h pad-test, uroflowmetry, postvoid residual urine volume and a voiding diary before treatment, and after 5 weeks using each of the two devices. Vaginal swabs and specimens of urine were sent for culture, and a questionnaire about the subjective effect and adverse events completed at each visit. In all, 94 women were recruited, of whom 62 (66%) completed the study. RESULTS: Both devices reduced the amount of leakage significantly, but the CCT reduced urine loss significantly more than the CCG. Uroflowmetry values and residual urine volume were unchanged when using the two devices. Vaginal culture showed no abnormality during the study period, and only one woman was treated for a urinary tract infection. Side-effects were few and not serious. The women found both devices easy to prepare, insert and use; two-thirds preferred the CCT to the CCG. CONCLUSION: The new intravaginal device (CCT) is more effective for treating stress incontinence than the currently available version (CCG), and patient acceptability of the new device seems to be superior.

Genuine stress incontinence: colpocystourethropexy versus sling procedures.

Both colpocystourethropexy (colposuspension) and sling operations have been shown to be effective in treating female stress incontinence. The present review discusses the literature available and compares the results and complications of both procedures. Colposuspension can give excellent results as both primary and secondary surgery. Slings also give excellent results, but are prone to complications relating to the sling material and postoperative voiding difficulties. Slings are arguably best reserved for women in whom vaginal scarring makes colposuspension impossible. Colposuspension remains the gold standard operation against which new techniques should be compared.

Current trends in management of ectopic pregnancy in the United Kingdom.

The potential advantages of laparoscopic management of ectopic pregnancy include lower morbidity, faster return to work, and less impact on reproductive health. This study aimed to investigate the current management of ectopic pregnancy in the United Kingdom. Thirty-five per cent of ectopic pregnancies are currently managed laparoscopically. Units that tended to operate laparoscopically were more likely to attempt to preserve the fallopian tube at surgery. Ninety per cent of units in the UK feel that they potentially could manage ectopic pregnancies laparoscopically but in practice only 60% managed any of the last three ectopic pregnancies by this technique.