Droughts occur as a natural feature of many climates. Several southern areas of the UK experienced water stress during 2004-2006 because of low water availability and high water demand. Climate change scenarios suggest that drought frequency could increase here in the future. This will increase the competition for water across all sectors. Understanding people's perceptions of drought and climate change is likely to be an important factor for sustainable water management by pointing to barriers to behavioural change. A mixed methodology study using questionnaires and focus groups was conducted in the Anglian and southern regions of the UK to explore public perceptions of drought and climate change. Respondents attributed the 2004-2006 regional drought to lower than average rainfall. Water-intensive lifestyles, a growth in population, increasing housing developments, leaking pipes and the privatization of water companies were also implicated. The majority of respondents claimed to change their behaviour to conserve water during 2006. Regarding the future, and under a number of different scenarios, people were more inclined to accept restrictions than agree to pay more to ensure the supply of water. They were concerned about climate change and recognized that more frequent water shortages may be one of the impacts, but this concern did not necessarily translate into action. Barriers to engagement with climate change and water-efficient behaviour included a lack of accessible information, a lack of knowledge regarding the integration of environmental spheres, a lack of resources, and a perceived lack of institutional engagement. The barriers identified appear to pose a major challenge to successful adaptation to climate change.

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Vasculitides and their therapies affect all areas of the reproductive life cycle. The ACR, EULAR and the Drugs and Lactation database offer guidance on the management of the reproductive health of patients with rheumatic diseases; however, these guidelines do not address patients with vasculitis specifically. This Review discusses the guidance from multiple expert panels and how these recommendations might apply to men and women with vasculitis, including the safety of contraception, use of assisted reproductive technology, preservation of fertility during cyclophosphamide therapy, disease management in pregnancy and the use of medications compatible with pregnancy and lactation. These discussions are augmented by the existing literature on vasculitis in pregnancy to enable physicians to provide comprehensive, precise and high quality care to patients with vasculitis. The contents of this Review, in conjunction with educational tools, serve to empower patients and physicians to participate in shared decision-making regarding pregnancy prevention, planning and management.

A 26-year-old man with dermatomyositis (DM) presented to the emergency department of an academic medical center with acute abdominal pain. He described diffuse abdominal pain since his initial diagnosis of DM a year prior.