Journals Watch: Incontinence and sinusitis

Not had the time to read all of the journals? Let Dr Gwen Lewis update you on the latest research.

Prevalence of urinary incontinence was considerably lower in women who delivered by caesarean section (Photograph: SPL)
Prevalence of urinary incontinence was considerably lower in women who delivered by caesarean section (Photograph: SPL)

Prevalence of urinary incontinence after labour
BJOG 2012; doi.10.111/j1471-0528.2012.03301.X

Urinary incontinence is a common condition affecting women of all ages.

This study from Sweden-SWEPOP (Swedish pregnancy, obesity and pelvic floor study) was conducted in 2008 and looked at women who gave birth between 1985 and 1988.

A total of 6,148 completed a questionnaire on their height, weight, urinary or faecal incontinence, genital problems and menstrual status.

Overall prevalence of urinary incontinence was considerably higher at 40.3% in those women who delivered vaginally compared with those who were delivered by lower segment caesarean section (LSCS).

Prevalence of incontinence after more than 10 years almost tripled after vaginal delivery at 10.1% compared with 3.1% after LSCS. The increased risk of incontinence more than doubled in obese women compared with women with a normal BMI after vaginal delivery and more than trebled after LSCS.

We should aim to encourage women to lose weight to improve symptoms of urinary incontinence.

Resolution of heavy menstrual bleeding
BJOG 2012; 119: 545-53

Heavy menstrual bleeding is a common presenting symptom. The object of this study was to establish the rate of spontaneous resolution of heavy menstrual bleeding and to explore any association with specific menstrual symptoms.

The study involved seven general practices in the UK. A baseline questionnaire was sent to all women aged 40-54 years and follow-up questionnaires sent at six-, 12-, 18- and 24-month intervals.

A total of 7,121 baseline questionnaires were sent out with an initial response rate of 63%. A total of 2,051 women were recruited for the entire study.

Spontaneous rate of resolution of heavy bleeding at 24 months varied from 8.1% in women aged 45-49 years to 35% in women aged 50-54 years. Rates were lower in those women who reported interference with life from heavy bleeding.

The significant rate of resolution of heavy bleeding means that GPs can reassure patients for whom this is a problem.

HPV quadrivalent vaccine and subsequent disease
BMJ 2012; 344: e1401

Little is known about the effect of HPV vaccine on developing subsequent disease.

This was a retrospective analysis of data from two international, double-blind, placebo-controlled trials of quadrivalent HPV vaccine versus placebo. Three doses were given after one day, two months and six months in primary care centres in 24 countries.

A total of 17,622 women aged 15-26 years underwent randomisation to vaccine or placebo. Of these women, 2,054 received cervical surgery or were diagnosed with genital warts or vulvar or vaginal intraepithelial neoplasia.

Of those undergoing treatment for cervical disease, 587 had received HPV vaccination while 763 received placebo. Incidence of subsequent HPV-related disease was reduced by 46.2% in the vaccinated women. In addition, vaccination caused significant reduction in risk of any subsequent high-grade disease of the cervix by 64.9% and of genital warts by 35.2%.

This study provides good evidence for the positive effects of HPV vaccination.

Cardiac arrest and use of adrenaline
JAMA 2012; 307 (11): 1161-8

This study is topical after the much-publicised cardiac arrest of the footballer Fabrice Muamba. Adrenaline is widely used in cardiac arrest out of hospital, but is it effective?

A total of 417,188 cardiac arrests out of hospital in Japan were studied between 2005 and 2008. Return of circulation before arrival at hospital was observed in 18.5% of those who received adrenaline and only 5.7% in those who did not.

However, survival at one month was decreased in those who received adrenaline, as was good functional outcome in terms of cerebral performance and lack of serious neurological disability.

This study questions the use of adrenaline in cardiac arrest out of hospital.

CRP testing in rhinosinusitis and antibiotic prescribing
Fam Pract 2012 doi: 10.1093/fampra/cms026

Does CRP testing affect prescribing of antibiotics in patients with rhinosinusitis? This was an audit-based Spanish study involving 836 cases of rhinosinusitis.

One group of GPs was given advice on rational antibiotic prescribing guidelines and use of patient information leaflets, and also had access to rapid CRP test, and another group received the same advice but no access to CRP testing.

Antibiotics were prescribed to 56.7% of patients whose GPs had access to CRP testing and to 82.9% of those whose GPs had no access to CRP testing.

There was significant reduction in antibiotic prescribing in rhinosinusitis when CRP testing is available. I have my doubts that in the UK we will have access to rapid CRP testing to aid diagnosis.

Where do students access sexual healthcare?
Sex Transm Infect 2012 doi: 10.1136/sextrans-2011-050452

This study used data from the Prevention of Pelvic Infection cohort. This described where sexually active female students reported accessing healthcare and association between numbers of sexual partners during 12 months of follow-up and healthcare usage.


Vaginal swabs and a sexual health questionnaire were taken at baseline and again at 12 months when healthcare attendances were also ascertained.

A total of 1,865 students were involved in the study and of these 79% made at least one visit to their GP in the follow-up 12 months, whereas only 21% attended a family planning clinic and even fewer visited a GUM clinic (14%).

As the number of sexual partners increased so did the likelihood of attendance at a GUM clinic. It was also found that women with more sexual partners were more likely to smoke, use condoms, be aged less than 16 years at first sexual experience and have an STI at baseline. This shows that many young women consult their GP, so we are in a good position to screen for STIs.

Reflect on this article and add notes to your CPD Organiser on MIMS Learning

  • Dr Lewis is a GP in Windsor, Berkshire, and a member of our team who regularly review the journals

These further action points may allow you to earn more credits by increasing the time spent and the impact achieved.

  • Consider lifestyle advice, such as weight management, that you could give to women with urinary incontinence.
  • Consider organising a journal club to review evidence regarding the HPV vaccine, so you are prepared for any patient questions.
  • Review your antibiotic prescribing for rhinosinusitis. Is there anything you would do differently?

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