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Background Different definitions of constipation have been used to estimate its prevalence in the community but this creates difficulties when comparing results from various studies. This study explores the impact of different definitions on prevalence estimates in the same population and compares the performance of simple definitions with the Rome III criteria. Methods The prevalence of constipation in a large nationally representative sample of community-dwelling adults was estimated using five simple definitions of constipation and compared with definitions based on the Rome III criteria. The sensitivity, specificity, and positive and negative predictive values, were calculated for each definition using the Rome III criteria as the gold standards for chronic and sub-chronic constipation. Results Prevalence estimates for the five simple definitions ranged from 9.4 to 58.9%, while the prevalence estimates using the Rome III criteria were 24.0% (95%CI: 22.1, 25.9) for chronic constipation and 39.6% (95%CI: 37.5, 41.7) for sub-chronic constipation. None of the simple definitions were adequate compared to the Rome III criteria. Self-reported constipation over the past 12 months had the highest sensitivity (91.1%, 95%CI: 88.8, 93.4) and negative predictive value (94.5%, 95%CI: 93.1, 96.1) compared to the Rome III criteria for chronic constipation but an unacceptably low specificity (51.3%, 95%CI: 48.8, 53.8) and positive predictive value (37.1%, 95%CI: 34.4, 39.9). Conclusions The definition used to identify constipation within a population has a considerable impact on the prevalence estimate obtained. Simple definitions, commonly used in research, performed poorly compared with the Rome III criteria. Studies estimating population prevalence of constipation should use definitions based on the Rome criteria where possible.

ObjectiveTo evaluate if a pharmacist-led medication review is effective at reducing the anticholinergic/sedative load, as measured by the Drug Burden Index (DBI).DesignRandomised controlled single blind trial.Setting15 community pharmacies in the Northern Netherlands.Participants157 community-dwelling patients aged ≥65 years who used ≥5 medicines for ≥3 months, including at least one psycholeptic/psychoanaleptic medication and who had a DBI≥1.InterventionA medication review by the community pharmacist in collaboration with the patient’s general practitioner and patient.Primary and secondary outcomes measuresThe primary outcome was the proportion of patients whose DBI decreased by at least 0.5. Secondary outcomes were the presence of anticholinergic/sedative side effects, falls, cognitive function, activities of daily living, quality of life, hospital admission and mortality. Data were collected at baseline and 3 months follow-up.ResultsMean participant age was 75.7 (SD, 6.9) years in the intervention arm and 76.6 (SD, 6.7) years in the control arm, the majority were female (respectively 69.3% and 72.0%). Logistic regression analysis showed no difference in the proportion of patients with a≥0.5 decrease in DBI between intervention arm (17.3%) and control arm (15.9%), (OR 1.04, CI 0.47 to 2.64, p=0.927). Intervention patients scored higher on the Digit Symbol Substitution Test, measure of cognitive function (OR 2.02, CI 1.11 to 3.67, p=0.021) and reported fewer sedative side effects (OR 0.61, CI 0.40 to 0.94, p=0.024) at follow-up. No significant difference was found for other secondary outcomes.ConclusionsPharmacist-led medication review as currently performed in the Netherlands was not effective in reducing the anticholinergic/sedative load, measured with the DBI, within the time frame of 3 months. Preventive strategies, signalling a rising load and taking action before chronic use of anticholinergic/sedative medication is established may be more successful.Trial registration number NCT02317666.

While progress has been made in oncology treatments, including the introduction of combination therapies, barriers affect patient access. There are approaches that could improve access including combination-specific pricing that allow the price to reflect whether a product is used in monotherapy or in combination. The feasibility of this solution requires data on the utilization of combination therapies. To investigate the ability of data systems across Belgium, England, France, Italy, Spain, Sweden, Switzerland and Australia to track drug utilization of combination therapies, particularly in oncology. A targeted literature review was conducted to investigate the attributes of the key data systems. One-on-one semi-structured interviews were subsequently conducted with country experts to validate the research, who were screened based on their expertise and knowledge of the respective data and reimbursement systems in their countries, followed by an advisory board to align on policy recommendations. Country-specific and cross-border insights were gathered from nine experts across these countries. There are data systems that routinely collect medicine utilization data across seven European countries and Australia. These datasets can potentially be leveraged to track the utilization of combination therapies. Where available, administrative data systems, such as reimbursement claims data, can be leveraged, though other types of systems, such as product registries, may be more suitable in some countries, emphasizing the need to consider country-specific nuances. Using existing data systems is likely to be less resource-intensive than setting up a novel system for this application. While viable sources of data exist in most countries, many need improving to fully harness their tracking potential. There are several common areas where improvement is needed to track combination therapies effectively. These include data quality, access for different stakeholders, minimizing the burden of data entry and management, and increasing support from national authorities to foster multi-stakeholder engagement. While most countries possess data systems that could serve as a foundation for tracking combination oncology therapies, these systems require optimization and proper implementation. Our core recommendation is for policymakers to explore the expansion and enhancement of data infrastructures.

[This corrects the article DOI: 10.3389/fphar.2025.1532022.].

New IRAM KID array 2 (NIKA2) is a camera dedicated to millimeter-wave astronomy based upon kilopixel arrays of kinetic inductance detectors [ 1 ] (KID). The pathfinder instrument, NIKA [ 2 ], has already shown state-of-the-art detector performance. NIKA2 builds upon this experience but goes one step further, increasing the total pixel count by a factor ∼ 10 while maintaining the same per pixel performance. For the next decade, this camera will be the resident photometric instrument of the Institut de Radio Astronomie Millimetrique (IRAM) 30 m telescopes in Sierra Nevada (Spain). In this paper, we give an overview of the main components of NIKA2 and describe the achieved detector performance. The camera has been permanently installed at the IRAM 30 m telescope in October 2015. It will be made accessible to the scientific community at the end of 2016, after a 1-year commissioning period. When this happens, NIKA2 will become a fundamental tool for astronomers worldwide.

At the end of life goals of care change from disease prevention to symptomatic control, however, little is known about the patterns of medication prescribing at this stage. To explore changes in prescribing of symptomatic and preventive medication in the last year of life in older nursing home residents. A retrospective cohort study was conducted using pharmacy medication supply data of 553 residents from 16 nursing home facilities around Sydney, Australia. Residents received 24-h nursing care, were aged ≥ 65 years, died between June 2008 and June 2010 and were using at least one medication 1 year before death. Medications were classified as symptomatic, preventive, or other. A linear mixed model was used to compare changes in prescribing in the last year of life. 68.1% of residents were female, mean age was 88.0 ( : 7.5) years and residents used a mean of 9.1 ( : 4.1) medications 1 year before death. The mean number of symptomatic medications per resident increased from 4.6 medications 1 year before death to 5.1 medications at death [95% CI 4.4-4.7 to 5.9-5.2, = 0.000], while preventive medication decreased from 2.0 to 1.4 medications [95% CI 1.9-2.1 to 1.3-1.5, = 0.000]. Symptomatic medications were used longer in the last year of life, compared to preventive medications (336.3 days [95% CI 331.8-340.8] versus 310.9 days [95% CI 305.2-316.7], = 0.000). Use of medications for symptom relief increased throughout the last year of life, while medications for prevention of long-term complications decreased. But changes were slight and clinical relevance can be questioned.

Airway inflammation is the most common hallmark of allergic asthma. Chemokine receptors involved in leukocyte recruitment are closely related to the pathology in asthma. CCR9 has been described as a homeostatic and inflammatory chemokine receptor, but its role and that of its ligand CCL25 during lung inflammation remain unknown. To investigate the role of CCR9 as a modulator of airway inflammation, we established an OVA-induced allergic inflammation model in CCR9-deficient mice. Here, we report the expression of CCR9 and CCL25 as early as 6 hours post-OVA challenge in eosinophils and T-lymphocytes. Moreover, in challenged CCR9-deficient mice, cell recruitment was impaired at peribronchial and perivenular levels. OVA-administration in CCR9-deficient mice leads to a less inflammatory cell recruitment, which modifies the expression of IL-10, CCL11, and CCL25 at 24 hours after OVA challenge. In contrast, the secretion of IL-4 and IL-5 was not affected in CCR9-deficient mice compared to WT mice. These results demonstrate for the first time that CCR9 and CCL25 expressions are induced in the early stages of airway inflammation and they have an important role modulating eosinophils and lymphocytes recruitment at the first stages of inflammatory process, suggesting that they might be a potential target to regulate inflammation in asthma.

Background: Antimicrobial resistance (AMR) is a global health challenge with significant global variation. Little is known about the prevalence on a smaller geographical scale. Objectives: This study aimed to explore the geo-temporal variation in antibiotic resistance in Escherichia coli (E. coli) urinary isolates in the Illawarra Shoalhaven region, a region south of Sydney. Methods: Data from urine E. coli isolates from people living in the community were geospatially analysed from 2008 to 2018. The proportion of resistant isolates was mapped by antibiotic type (amoxicillin with clavulanic acid, cefalexin, norfloxacin, and trimethoprim), postcode, and year. Results: Resistance varied by antibiotic, postcode, and over time, with some postcodes showing increased resistance one year and a decrease the following year. Areas with consistently higher resistance included metropolitan, port, and lake regions. We found low resistance in E. coli to amoxicillin with clavulanate, cefalexin, and norfloxacin (<5% to 10–19%) and the highest resistance for trimethoprim (10–19% to 30–39%). Overall, from 2008 to 2018, E. coli resistance to all four antibiotics increased in this region. Conclusions: This study shows temporal and geospatial changes in E. coli AMR over small geospatial areas, indicating the opportunity for geospatial analysis to assist in area-specific empirical treatment guidance.

The aim of this study was to use routinely collected electronic medicines administration (eMAR) data in residential aged care (RAC) to investigate the quality use of medicines. A cross-sectional analysis of eMAR data. 71 RAC facilities in New South Wales and the Australian Capital Territory, Australia. Permanent residents living in a participating facility on 1 October 2015. None. Variation in polypharmacy (≥5 medications), hyper-polypharmacy (≥10 medications) and antipsychotic use across facilities was examined using funnel plot analysis. The study dataset included 4775 long-term residents. The mean resident age was 85.3 years and 70.6% of residents were female. The median facility size was 60 residents and 74.3% were in metropolitan locations. 84.3% of residents had polypharmacy, 41.2% hyper-polypharmacy and 21.0% were using an antipsychotic. The extent of polypharmacy (69.75-100% of residents), hyper-polypharmacy (38.81-76.19%) and use of antipsychotic medicines (0-75.6%) varied considerably across the 71 facilities. Using eMAR data we found substantial variation in polypharmacy, hyper-polypharmacy and antipsychotic medicine use across 71 RAC facilities. Further investigation into the policies and practices of facilities performing above or below expected levels is warranted to understand variation and drive quality improvement.

In this study, we use real-world data to explore trends in antibiotic use in a dynamic cohort of long-term care (LTC) residents. A cross-sectional retrospective analysis of pharmacy medication supply records of 3459 LTC residents was conducted from 31 May 2016 to 31 May 2019. The primary outcome was the monthly prevalence of residents with an antibiotic episode. Secondary outcomes were the type of antibiotic used and duration of use. Over the three-year study period, residents were supplied 10460 antibiotics. On average, 18.9% of residents received an antibiotic monthly. Antibiotic use decreased slightly over time with a mean of 168/1000 (95% CI 146–177) residents using at least one antibiotic per month in June 2016 to 148/1000 (95% CI 127–156) in May 2019. The total number of antibiotic days per 100 resident days remained relatively constant over the study period: 8.8 days in 2016–2017, 8.4 in 2017–2018 and 6.4 in 2018–2019. Prolonged durations exceeding 100 days were seen for a small percentage of residents. We found extensive antibiotic use, which is a recognized contributor to antimicrobial resistance development, underscoring the necessity for quality treatment guidelines in this vulnerable population.