The grouping of chemicals with effects on reproduction and development for the purpose of cumulative risk assessment in Europe.

The European Food Safety Authority (EFSA) is developing approaches for cumulative risk assessment by assigning chemicals (pesticides) to cumulative assessment groups (CAGs) based on common toxic effects on the target system. This document a reviews and refines the approach for reproduction and developmental toxicity published in 2016, to identify relevant substances for grouping with guidance for discriminating between direct effects on the reproductive system or on development of the offspring and those effects which are secondary to other toxicities. The refined approach is then considered in relation to the Classification, Labelling & Packaging (CLP) criteria based on which pesticides are classified for adverse effects on sexual function and fertility, for adverse effects on development of the offspring or for adverse effects on or via lactation. The proposed grouping of effects and accompanying guidance are intended to facilitate knowledge-based interpretation of data from test guideline reproduction and developmental toxicity studies for the purpose of cumulative risk assessment.

Urinary incontinence in Muslim women.

This article describes the results of a qualitative study that explores how religion and culture influence Muslim women's decisions to seek healthcare for urinary incontinence.

The future of medium secure forensic psychiatry in Britain: a survey.

The number of National Health Service (NHS) secure psychiatric beds is increasing. This survey asked forensic services about their plans for expansion. The survey indicated a large increase in medium secure provision over the next five years. The increase in the number of patients being detained in secure settings raises questions about whether there is in Britain an on-going process of 'reinstitutionalisation' of the mentally ill.

Stress incontinence injection therapy: what is best for our patients?

OBJECTIVE: Urethral injection (periurethral/intraurethral bulking) is an established, minimally invasive therapy for stress urinary incontinence (SUI). This review aims to determine which women should potentially benefit from, and be considered as candidates for, injection therapy and to elucidate what we are trying to achieve. METHODS: Based on MEDLINE database searches, all aspects of urethral injection were examined, including patient selection, safety, injection technique, efficacy, quality of life, goals and cost. RESULTS: Such therapy has a low complication rate, improves or cures about 3 out of 4 women, as shown in mainly short-term studies, and improves patients' quality of life. It can be used in the majority of patients with uncomplicated SUI. Therefore, injection therapy may be considered as a first-line treatment option for patients who have failed conservative therapy such as pelvic floor exercises and who decline or have a contraindication for pharmacological treatment. However, the decision of whether to use this type of treatment must be based on an informed discussion between the physician and patient--this dialogue should incorporate questions about patients' own treatment goals. Injection therapy appears to have the profile required to meet patients' goals, based on the findings that a procedure with an improvement in incontinence, minimal short-term risk, no long-term risk, and performed in a clinic, would be acceptable. CONCLUSION: Investigating and trying to achieve patients' own treatment goals will ultimately enable us to do what is best for our patients, but current evidence suggests that injection therapy is a valid option worth discussing with many patients.