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Objective To measure sales of antibiotics without a prescription in pharmacies in China in 2017 and 2021, before and during the coronavirus disease 2019 (COVID-19) pandemic, and determine the factors associated with such sales. Methods We conducted cross-sectional surveys using the simulated patient method in retail pharmacies in 13 provinces in eastern, central and western China in 2017 and 2021. At the pharmacies, the simulated patients (trained medical students) reported that they had mild respiratory tract symptoms and asked for treatment, using a three-stage process: (i) request some treatment; (ii) request antibiotics; (iii) request specific antibiotics. We used multivariable logistic regression analysis to determine factors associated with sale of antibiotics without a prescription. Findings Of the pharmacies visited in 2017, 83.6% (925/1106) sold antibiotics without a prescription; this figure was 78.3% (853/1090) in 2021 (P-value: 0.002). After excluding pharmacies prohibited from selling antibiotics because of COVID-19, this difference was not significant (83.6% versus 80.9%; 853/1054; P-value: 0.11). Factors significantly associated with selling antibiotics without a prescription in both 2017 and 2019 were: location in central and western China compared with eastern China; being in a township or village compared with in a city; and presence of a counter where antibiotics were dispensed. Conclusion Although laws became stricter between 2017 and 2021, antibiotic sales without a prescription were still common in pharmacies across China. Existing regulations need to be more strictly enforced, and pharmacy staff and the public should be made more aware of the risks of antibiotic misuse and dangers of antimicrobial resistance. Objectif Mesurer les ventes d'antibiotiques sans ordonnance dans les pharmacies de Chine en 2017 et 2021, avant et pendant la pandemie de maladie a coronavirus 2019 (COVID-19), et determiner les facteurs associes a ces ventes. Methodes Nous avons mene des enquetes transversales a l'aide de la technique des patients simules dans des pharmacies de detail situees dans 13 provinces de Chine orientale, centrale et occidentale en 2017 et 2021. Dans ces pharmacies, les patients simules (des etudiants en medecine formes a cet effet) ont evoque des symptomes legers au niveau des voies respiratoires et sollicite un traitement selon un processus en trois etapes: (i) demande de traitement; (ii) demande d'antibiotiques; (ii) demande d'antibiotiques specifiques. Nous avons ensuite utilise une analyse multivariee de regression logistique afin d'identifier les facteurs lies a la vente d'antibiotiques sans ordonnance. Resultats Sur l'ensemble des pharmacies examinees en 2017, 83,6% (925/1106) ont vendu des antibiotiques sans ordonnance, contre 78,3% (853/1090) en 2021 (valeur-p: 0,002). Apres avoir exclu les pharmacies n'ayant pas le droit d'en vendre a cause de la COVID-19, cette difference s'est revelee negligeable (83,6% contre 80,9%; 853/1054; valeur-p: 0,11). Les principaux facteurs associes a la vente d'antibiotiques sans ordonnance, tant en 2017 qu'en 2019, etaient: le fait d'etre en Chine centrale et occidentale plutot qu'en Chine orientale; le fait d'etre une commune ou un village plutot qu'une ville; et enfin, le fait qu'il y ait ou non un comptoir oU se procurer des antibiotiques. Conclusion Bien que les lois soient devenues plus strictes entre 2017 et 2021, la vente d'antibiotiques sans ordonnance est restee monnaie courante partout en Chine. La reglementation en vigueur doit etre appliquee plus severement; en outre, le personnel des pharmacies et le grand public doivent etre mieux sensibilises aux risques lies a un usage inapproprie des antibiotiques et aux dangers que represente la resistance aux antimicrobiens. Objetivo Medir las ventas de antibioticos sin receta en farmacias de China en 2017 y 2021, antes y durante la pandemia de la enfermedad por coronavirus de 2019 (COVID-19), y determinar los factores asociados a estas ventas. Metodos Se realizaron encuestas transversales utilizando el metodo del paciente simulado en farmacias minoristas de 13 provincias de China oriental, central y occidental en 2017 y 2021. En las farmacias, los pacientes simulados (estudiantes de medicina entrenados) informaron que tenian sintomas leves del tracto respiratorio y solicitaron tratamiento, mediante un proceso de tres etapas: (i) solicitar algun tratamiento; (ii) solicitar antibioticos; (ii) solicitar antibioticos especificos. Se utilizo un analisis de regresion logistica multivariable para determinar los factores asociados a la venta de antibioticos sin receta. Resultados De las farmacias visitadas en 2017, el 83,6% (925/1106) vendian antibioticos sin receta; esta cifra fue del 78,3% (853/1090) en 2021 (valor de p: 0,002). Una vez excluidas las farmacias que tenian prohibida la venta de antibioticos debido a la COVID-19, esta diferencia no fue significativa (83,6% frente a 80,9%; 853/1054; valor de p: 0,11). Los factores que se asociaron significativamente con la venta de antibioticos sin receta tanto en 2017 como en 2019 fueron: la ubicacion en el centro y occidente de China en comparacion con el oriente del pais; estar en un municipio o pueblo en comparacion con estar en una ciudad; y la presencia de un mostrador donde se dispensaban antibioticos. Conclusion Aunque las leyes se hicieron mas estrictas entre 2017 y 2021, la venta de antibioticos sin receta seguia siendo habitual en las farmacias de toda China. Es necesario aplicar mas estrictamente la normativa vigente, y concienciar al personal de las farmacias y al publico en general sobre los riesgos del uso indebido de antibioticos y los peligros de la resistencia a los antimicrobianos., Introduction Antimicrobial resistance is one of the most serious threats to the health of the world's population. [1,2] In 2019, antimicrobial resistance was associated with 4.95 million deaths globally. [3] [...]

Background: Previous studies indicated that air pollution plausibly increases the risk of adverse outcomes in inflammatory bowel disease (IBD) via proinflammatory mechanisms. However, there is scant epidemiological data and insufficient prospective evidence assessing associations between ambient air pollution and clinical outcomes of IBD. Objectives: We aimed to investigate the associations between ambient air pollution and clinical outcomes among individuals with IBD. Methods: Leveraging data from the UK Biobank, we included 4,708 individuals with IBD recruited in the period 2006- 2010 in this study. A land use regression model was used to assess annual mean concentrations of ambient air pollutants nitrogen including oxides (N[O.sub.x]), nitrogen dioxide (N[O.sub.2]), and particulate matter (PM) with aerodynamic diameter [less than or equal to]10 [micro]m (P[M.sub.10]) and PM with aerodynamic diameter Results: During a mean follow-up of 12.0 y, 265 enterotomy events, 124 incident gastrointestinal cancer, and 420 death events were documented among individuals with IBD. We found that each interquartile range (IQR) increase in exposure to P[M.sub.2.5] was associated with increased risk of enterotomy (HR= 1.16; 95% CI: 1.00, 1.34, p = 0.043), whereas an IQR increase in exposure to N[O.sub.x] (HR=1.10; 95% CI: 1.01, 1.20, p = 0.016), N[O.sub.2] (HR = 1.16; 95% CI: 1.03, 1.29, p = 0.010), P[M.sub.10] (HR = 1.15; 95% CI: 1.03, 1.30, p = 0.015), and P[M.sub.2.5] (HR=1.14; 95% CI: 1.02, 1.28, p = 0.019) was associated with increased risk of all-cause mortality among individuals with IBD. We did not observe any significant associations between air pollutants and gastrointestinal cancer in the primary analyses. Consistent results were observed in subgroup and sensitivity analyses. Conclusions: Ambient pollution exposure was associated with an increased risk of enterotomy and all-cause mortality among individuals with IBD, highlighting the important role of environmental health in improving the prognosis of IBD. https://doi.org/ 10.1289/EHP12215, Introduction Inflammatory bowel disease (IBD), comprising Crohn's disease (CD) and ulcerative colitis (UC), is a chronic immune-mediated digestive disease that poses a substantial burden worldwide. (1) As an important environmental [...]

OBJECTIVE: We aimed to evaluate whether individuals with type 2 diabetes (T2D) were at higher risk of developing a wide range of gastrointestinal diseases based on a population-based cohort study. RESEARCH DESIGN AND METHODS: This study included 374,125 participants free of gastrointestinal disorders at baseline; of them, 19,719 (5.27%) with T2D were followed-up by linking to multiple medical records to record gastrointestinal disease diagnoses. Multivariable Cox models were used to estimate the hazard ratios (HRs) and CIs. Logistic models were used to examine the associations between polygenic risk scores (PRS) and clinical gastrointestinal phenotypes. RESULTS: During a median follow-up of 12.0 years, we observed the new onset of 15 gastrointestinal diseases. Compared with nondiabetes, participants with T2D had an increased risk of gastritis and duodenitis (HR 1.58, 95% CI 1.51–1.65), peptic ulcer (HR 1.56, 95% CI 1.43–1.71), diverticular disease (HR 1.19, 95% CI 1.14–1.24), pancreatitis (HR 1.45, 95% CI 1.24–1.71), nonalcoholic fatty liver disease (HR 2.46, 95% CI 2.25–2.69), liver cirrhosis (HR 2.92, 95% CI 2.58–3.30), biliary disease (HR 1.18, 95% CI 1.10–1.26), gastrointestinal tract cancers (HR 1.28, 95% CI 1.17–1.40), and hepatobiliary and pancreatic cancer (HR 2.32, 95% CI 2.01–2.67). Positive associations of PRS of T2D with gastritis, duodenitis, and nonalcoholic fatty liver disease were also observed. CONCLUSIONS: In this large cohort study, we found that T2D was associated with increased risks of a wide range of gastrointestinal outcomes. We suggest the importance of early detection and prevention of gastrointestinal disorders among patients with T2D. [ABSTRACT FROM AUTHOR]

Background: Beverage consumption was found to be associated with cardiovascular disease and mortality in the general population. However, it is unclear whether this association still exists in individuals with inflammatory bowel disease (IBD). Objectives: To investigate the associations of sugar-sweetened beverages, artificially sweetened beverages, and natural juices with cardiovascular disease and all-cause mortality among individuals with IBD. Design: Prospective cohort study. Methods: We included 1981 participants with IBD in the UK Biobank. Consumption of beverages was measured using a validated 24-h diet recall. Outcomes of interest were overall cardiovascular disease and all-cause mortality. Cox proportional hazard models were used to estimate the hazard ratios and 95% confidence intervals (CIs). Results: During a mean (SD) follow-up of 10.1 (1.7) years, we documented 205 cardiovascular events and 133 deaths. Compared to non-consumers, those consuming sugar-sweetened beverages more than 1 unit/day (reported in glasses/cans/250 ml/cartons) were associated with 64% (95% CI: 5–155, p = 0.030) and 97% (95% CI: 16–233, p = 0.012) increased risk of cardiovascular disease and all-cause mortality, respectively. We also observed a 78% (95% CI: 3–205, p = 0.038) increased risk of cardiovascular disease in participants who consumed artificially sweetened beverages more than 1 unit/day when compared with non-consumers. We did not observe significant associations between natural juice consumption and the two outcomes in IBD. Conclusion: Higher sugar- and artificially sweetened beverage consumption were associated with adverse cardiovascular and mortality outcomes in IBD. These exploratory results were consistent with the evidence in the general population and highlighted the importance of diet management in individuals with IBD. [ABSTRACT FROM AUTHOR]

Summary: Background: Limited prospective studies that have examined the association of dietary fibre with IBD have provided inconsistent evidence. Aim: To examine any associations between dietary fibre intake and subsequent incidence of IBD, Crohn's disease (CD) and ulcerative colitis (UC) Methods: We conducted a prospective cohort study of 470,669 participants from the UK Biobank and estimated dietary fibre intake from a valid food frequency questionnaire at baseline. Incident IBD was ascertained from primary care data and inpatient data. Cox proportional hazard models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between dietary fibre intake and the risk of IBD, CD and UC. Results: During an average follow‐up of 12.1 years, we ascertained 1473 incident IBD cases, including 543 cases of CD and 939 cases of UC. Comparing the lowest quintiles, an inverse association was observed between dietary fibre intake and risk of IBD (HR 0.74, 95% CI 0.58–0.93, p = 0.011) and CD (HR 0.48, 95% CI 0.32–0.72, p < 0.001), but not UC (HR 0.92, 95% CI 0.69–1.24, p = 0.595). For specified sources, dietary fibre intake from fruit and bread decreased the risk of CD, while dietary fibre intake from cereal decreased the risk of UC. Conclusions: Higher consumption of dietary fibre was associated with a lower risk of IBD and CD, but not UC. Our findings support current recommendations to increase the intake of dietary fibre. [ABSTRACT FROM AUTHOR]

Background: The cardioprotective diet was reported to be associated with several chronic cardiometabolic diseases through an anti-inflammation effect. However, the association between the cardioprotective diet and the risk of inflammatory bowel disease (IBD) was unclear and deserved to be further explored. Methods: We calculated the cardioprotective diet score based on the consumptions of seven common food groups using the validated food frequency questionnaire data in the UK Biobank. Incident IBD was ascertained from primary care data, inpatient data, and the death registry. Cox proportional hazard models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between the cardioprotective diet score and the risk of IBD. Results: During a mean follow-up of 12.1 years, we documented 2717 incident IBD cases, including 851 cases of Crohn's disease and 1866 cases of ulcerative colitis. Compared to participants with a cardioprotective diet score of 0–1, we observed a decreased risk of IBD among participants with cardioprotective diet scores of 3 (HR 0.85, 95% CI 0.73–0.99), 4 (HR 0.84, 95% CI 0.72–0.98), and 5–7 (HR 0.77, 95% CI 0.66–0.89) (p-trend < 0.001). Conclusions: A greater adherence to the cardioprotective diet was associated with a lower risk of IBD. Our finding highlighted the importance of focusing on the cardioprotective diet to prevent IBD. [ABSTRACT FROM AUTHOR]

Background: Nonlinear association between serum 25-hydroxyvitamin D [25(OH)D] concentration and all-cause mortality has been widely reported for the general population, but this association has not been quantified for individuals with inflammatory bowel disease (IBD).Objectives: The aim was to explore the association between serum 25(OH)D and all-cause mortality in individuals with IBD.Methods: We identified 2690 females and 2532 males aged 40-69 y with diagnosed IBD at baseline in the UK Biobank. Serum 25(OH)D concentration was measured by direct competitive chemiluminescent immunoassay. The outcome was all-cause mortality, ascertained via the death registry. Cox proportional hazard regression was used to evaluate associations between serum 25(OH)D in quintiles and all-cause mortality among individuals with IBD [Crohn disease (CD; n = 1760) and ulcerative colitis (UC; n = 3462)]. Restricted cubic splines were used to investigate potential nonlinearity.Results: During the mean follow-up period of 11.9 y, 529 deaths (198 in CD and 331 in UC) were documented among 5222 individuals with IBD. Compared with the lowest quintile of serum 25(OH)D, HRs for the second to the highest quintiles were 0.82 (95% CI: 0.63, 1.06), 0.63 (95% CI: 0.47, 0.83), 0.64 (95% CI: 0.48, 0.85), and 0.74 (95% CI: 0.55, 0.99), respectively. Nonlinearity was detected in the dose-response association between serum 25(OH)D concentration and all-cause mortality (P-nonlinearity < 0.001), and 25(OH)D concentrations of 44-78 nmol/L were associated with a 50% lower risk of all-cause mortality (than 10 nmol/L). Subgroup analyses showed that the nonlinear association mostly applied to females (P-nonlinearity < 0.001 compared with 0.080 in males).Conclusions: We observed a nonlinear association, mostly applicable to females, between serum 25(OH)D concentrations and all-cause mortality among individuals with IBD. A 25(OH)D concentration range of 44-78 nmol/L can serve as a starting point for future research to confirm recommended 25(OH)D concentrations for individuals with IBD. [ABSTRACT FROM AUTHOR]

Educational interventions are considered an important component of antibiotic stewardship, but their effect has not been systematically evaluated in outpatient settings in China. This research aims to evaluate the effectiveness of educational interventions for health workers on antibiotic prescribing rates in Chinese outpatient settings. Eight databases were searched for relevant randomized clinical trials, non-randomized trials, controlled before–after studies and interrupted time-series studies from January 2001 to July 2021. A total of 16 studies were included in the systematic review and 12 in the meta-analysis. The results showed that educational interventions overall reduced the antibiotic prescription rate significantly (relative risk, RR 0.72, 95% confidence interval, CI 0.61 to 0.84). Subgroup analysis demonstrated that certain features of education interventions had a significant effect on antibiotic prescription rate reduction: (1) combined with compulsory administrative regulations (RR With: 0.65 vs. Without: 0.78); (2) combined with financial incentives (RR With: 0.51 vs. Without: 0.77). Educational interventions can also significantly reduce antibiotic injection rates (RR 0.83, 95% CI 0.74 to 0.94) and the inappropriate use of antibiotics (RR 0.61, 95% CI 0.51 to 0.73). The limited number of high-quality studies limits the validity and reliability of the results. More high-quality educational interventions targeting the reduction of antibiotic prescribing rates are needed. [ABSTRACT FROM AUTHOR]