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Objective: To investigate if the core population hypothesis is applicable to patients with genital chlamydia infections. Design: Retrospective cross sectional study. Setting: Two genitourinary medicine (GUM) clinics in the city of Birmingham and eight adjacent clinics. Subjects: All patients with chlamydia (n = 665) or gonorrhoea (n = 584) attending between 1 October 1995 and 30 September 1996 with a postcode within the Birmingham health district. Controls were 727 patients seen in the same period with no infection. Methods: Postcodes were used to calculate population prevalence rates per 100 000 aged 15-65 in the 39 wards of the city and to estimate the socioeconomic status using the Super Profile (SP). Ethnic specific rates were also calculated. Data were obtained on gonorrhoea and chlamydia isolation from all the major laboratories of the city over the same time period. Results: GUM clinic attenders accounted for 67.6% and 82.5% of all chlamydia and gonorrhoea isolates reported by the laboratories and that were available for our epidemiological analysis. Both infections were more common in men and in black ethnic groups. However, patients with gonorrhoea only infection were more likely to be of black ethnicity than those with chlamydia only infection (p = 0.0001) and to have diVerent SP distribution (p = 0.0001). On logistic regression age <20 years, male sex, black ethnicity, and living in neighbourhoods with SP J ("have nots") were predictive of both infections compared with controls. Overall chlamydia and gonorrhoea prevalence rates were 129 and 98.4 per 10 5 respectively. Corresponding rates for whites was 64.7 and 37.2 and for black ethnic groups 1105 and 1183 per 10 5 of each ethnic group. Eight adjacent wards accounted for 41% of the chlamydia and 66.5% of the gonorrhoea. Conclusion: In a large urban setting patients attending GUM clinics with chlamydia belong to core population groups with similar, but not identical, sociodemographic characteristics to patients with gonorrhoea infection. (Sex Transm Inf 2000;76:268-272)

With the growing popularity of water-based sports, cases of swimming-induced pulmonary edema (SIPE) are becoming increasingly recognized. SIPE, a potentially life-threatening condition, is an acute cause of breathlessness in athletes. It has been described frequently in scuba divers, swimmers, and triathletes and is characterized by symptoms and signs of pulmonary edema following water immersion. It is important to recognize that athletes’ symptoms can present with a spectrum of severity from mild breathlessness to severe dyspnea, hemoptysis, and hypoxia. In most cases, there is rapid resolution of symptoms within 48 hours of exiting the water. Recent advances in the understanding of the pathophysiology of SIPE, particularly regarding exaggerated pulmonary vascular pressures, have begun to explain this elusive condition more clearly and to distinguish its predisposing factors. It is essential that event organizers and athletes are aware of SIPE. Prompt recognition is required not only to prevent drowning, but also to implement appropriate medical management and subsequent advice regarding return to swimming and the risk of recurrence. This manuscript provides a current perspective on SIPE regarding the incidence rate, the current understanding of the pathophysiology, clinical presentation, medical management, recurrence rates, and advice on return to sport.

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This report discusses a rare case of a 55-year-old female triathlete who developed recurrent episodes of swimming-induced pulmonary edema (SIPE). She had two hospital admissions with pulmonary edema after developing breathlessness while swimming, including a near-drowning experience in an open water swim. With increasing popularity of triathlon and open water sports, this case highlights the importance of a greater awareness of SIPE among health professionals, event organizers, and athletes. This report explores the previous reported cases in triathletes and those who have suffered recurrent episodes. It is paramount that an accurate diagnosis is made as these individuals may be at an increased risk of future life-threatening episodes.

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Regular physical activity improves glycaemic control in pregnant women with gestational diabetes. Motivational interviewing is an effective technique for increasing activity levels. This report evaluates a clinical pathway developed to integrate physical activity motivational interviewing into routine gestational diabetes care. Women attending a single-centre NHS clinic were invited to engage in a physical activity-focused motivational interview. The aerobic physical activity levels of 62 women were evaluated at baseline and at a 2-week telephone follow up, coded into three categories by minutes of moderate intensity physical activity per week: red (<30 minutes), amber (30–149 minutes) and green (≥150 minutes). At baseline, 30.6% of participants were coded red, 41.9% amber and 27.4% green. At follow up, 4.8% women coded red, 38.7% amber and 56.5% green, demonstrating a significant association for increased activity levels after motivational interviewing (P<0.001). This clinical pathway provides encouraging results that physical activity increased significantly in the short term.

BackgroundSwimming Induced Pulmonary Edema (SIPE) is life-threatening condition that can affect healthy triathletes. There have been several reported cases amongst triathletes, however the current estimation of incidence is derived from a survey of triathletes with self-reported symptoms suggestive of SIPE.ObjectiveTo investigate the incidence of SIPE and associated risk factors in mass participation Triathlon Competitions (TC).DesignA retrospective analysis of Competitors' Medical Records (CMR).Setting11 consecutive UK-based TCs between 2011 and 2016. The competitions involved elite and non-elite competitors who raced Super Sprint, Sprint, Olympic and Olympic Plus distances.ParticipantsCMR of patients presenting to Triathlon Medical Team (TMT) with medical complaints/injuries were analysed. Those diagnosed with SIPE were included. Diagnostic criteria included absence of water aspiration, acute onset of dyspnoea, cough and/or expectoration of frothy sputum, with evidence of pulmonary oedema on physical examination.Assessment of Risk FactorsPatients' Age, gender, race distance, co-morbidities and medical management were recorded.Main Outcome MeasurementsThe incidence of SIPE in TCs.Results68557 competitors started the TCs and 429 competitors presented to the TMT. Five case of SIPE were recorded, giving rise to an incidence of 0.73/10,000 competitors and 1.2% of all presentations to the TMT. Mean age was 42 (21–58) and a third were female. All were non-elite athletes competing in a variety of race distances; one patient had pre-existing cardiac comorbidities; and in 3 cases participants were competing in their first triathlon. All required supplementary oxygen and transfer to hospital for definitive management.ConclusionThis report is the first to describe the incidence of SIPE in mass participation triathlon competitions. Event organisers and TMTs should be prepared for competitors developing SIPE which appears not to be bound by age, gender, race distance or co-morbidities. Further research is required to identity those who are at risk of SIPE.