Search

The recent advisory issued by the United States Food and Drug Administration, cautioning against the routine administration of probiotics in preterm neonates, has sparked a lively debate within the scientific community. This commentary presents a perspective from members of the Special Interest Group on Gut Microbiota and Modifications within the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and other authors who contributed to the ESPGHAN position paper on probiotics for preterm infants, as well as representatives from the European Foundation for the Care of Newborn Infants. We advocate for a more nuanced and supportive approach to the use of certain probiotics in this vulnerable population, balancing the demonstrated benefits and risks., (© 2024 The Authors. Journal of Pediatric Gastroenterology and Nutrition published by Wiley Periodicals LLC on behalf of European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.)

Stress urinary incontinence (SUI) is defined as a condition characterized by the involuntary leakage of urine during activities that increase intra-abdominal pressure which may decrease quality of life with a significant economic impact on health systems, necessitating the implementation of cost-effective management plans. Urodynamics (UDS) has been considered during the last decades as the gold standard for assessment of lower urinary tract symptoms (LUTS) due to their high reproducibility. At the same time, concerns about the systematic use of UDS before SUI surgery were raised due to a limited evidenced base to recommend their routine use. In uncomplicated female patients with SUI, UDS can offer further insights into LUTS, potentially assisting the physician in determining the appropriate therapeutic approach. However, it has not been shown that preoperative UDS can directly impact the surgical outcome for continence. Indeed, evidence supports the conclusion that pre-operative UDS in women with uncomplicated, clinically demonstrable, SUI does not improve the outcome of surgery for SUI. Nevertheless, asymptomatic detrusor overactivity (DO) identified by urodynamic testing or pre-existing voiding dysfunction are associated with an increased occurrence of postoperative overactive bladder (OAB) and voiding dysfunction, respectively. The EUGA Working Group concluded that the evidence does not support the systematic preoperative use of UDS for uncomplicated cases. However, in cases where mixed symptoms, voiding dysfunction, previous surgery, or concomitant prolapse are present, preoperative UDS are advised as they can be beneficial in anticipating postoperative outcomes. This aids in conducting comprehensive and thorough preoperative counseling. The Group recommend performing preoperative UDS considering the patient's specific clinical situation and the surgeon's judgment, with consideration given to the potential benefits, risks, and impact on treatment decisions and patient outcomes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Introduction: Measurement of breath hydrogen (H 2 ) and methane (CH 4 ) excretion after ingestion of test-carbohydrates is used for different diagnostic purposes. There is a lack of standardization among centers performing these tests and this, together with recent technical developments and evidence from clinical studies, highlight the need for a European guideline., Methods: This consensus-based clinical practice guideline defines the clinical indications, performance, and interpretation of H 2 -CH 4 -breath tests in adult and pediatric patients. A balance between scientific evidence and clinical experience was achieved by a Delphi consensus that involved 44 experts from 18 European countries. Eighty eight statements and recommendations were drafted based on a review of the literature. Consensus (≥80% agreement) was reached for 82. Quality of evidence was evaluated using validated criteria., Results: The guideline incorporates new insights into the role of symptom assessment to diagnose carbohydrate (e.g., lactose) intolerances and recommends that breath tests for carbohydrate malabsorption require additional validated concurrent symptom evaluation to establish carbohydrate intolerance. Regarding the use of breath tests for the evaluation of oro-cecal transit time and suspected small bowel bacterial overgrowth, this guideline highlights confounding factors associated with the interpretation of H 2 -CH 4 -breath tests in these indications and recommends approaches to mitigate these issues., Conclusion: This clinical practice guideline should facilitate pan-European harmonization of diagnostic approaches to symptoms and disorders, which are very common in specialist and primary care gastroenterology practice, both in adult and pediatric patients. In addition, it identifies areas of future research needs to clarify diagnostic and therapeutic approaches., (© 2021 The Authors. United European Gastroenterology Journal published by Wiley Periodicals LLC. on behalf of United European Gastroenterology.)

Introduction: 13 C-breath tests are valuable, noninvasive diagnostic tests that can be widely applied for the assessment of gastroenterological symptoms and diseases. Currently, the potential of these tests is compromised by a lack of standardization regarding performance and interpretation among expert centers., Methods: This consensus-based clinical practice guideline defines the clinical indications, performance, and interpretation of 13 C-breath tests in adult and pediatric patients. A balance between scientific evidence and clinical experience was achieved by a Delphi consensus that involved 43 experts from 18 European countries. Consensus on individual statements and recommendations was established if ≥ 80% of reviewers agreed and <10% disagreed., Results: The guideline gives an overview over general methodology of 13 C-breath testing and provides recommendations for the use of 13 C-breath tests to diagnose Helicobacter pylori infection, measure gastric emptying time, and monitor pancreatic exocrine and liver function in adult and pediatric patients. Other potential applications of 13 C-breath testing are summarized briefly. The recommendations specifically detail when and how individual 13 C-breath tests should be performed including examples for well-established test protocols, patient preparation, and reporting of test results., Conclusion: This clinical practice guideline should improve pan-European harmonization of diagnostic approaches to symptoms and disorders, which are very common in specialist and primary care gastroenterology practice, both in adult and pediatric patients. In addition, this guideline identifies areas of future clinical research involving the use of 13 C-breath tests., (© 2021 The Authors. United European Gastroenterology Journal published by Wiley Periodicals LLC on behalf of United European Gastroenterology.)

Objective: The Cow's Milk-related Symptom Score (CoMiSSTM) was developed as an awareness tool to recognize possible manifestations of cow's milk protein allergy (CMPA). Arbitrarily, a cut-off value of ≥12 was defined as a "positive score." The aim of this study was to determine an age-related CoMiSS in healthy infants to minimize the risk of false reassurance or over-diagnosis of CMPA in case of a negative or positive score, respectively., Methods: General pediatricians determined the CoMiSS in presumed healthy infants aged ≤6 months during a routine visit. Exclusion criteria included any known acute or chronic disease, preterm delivery (< 37 weeks), therapeutic formula, any food supplement (except vitamins) or medication., Results: Data from 891 consecutive infants were collected. Complete information was obtained from only 413 (46.4%) infants: Belgium: 31.2%, Italy 18.2%, Poland 19.1% and Spain 31.5%. Since gender (girls vs boys) (p = 0.579) had no influence on the CoMiSS, the data were re-calculated to include those infants with missing gender. The overall median and mean (SD) CoMiSS scores were, respectively, 3.0 and 3.7 (2.9). The 95th percentile was 9. Median crying (p<0.001), regurgitation (p = 0.009) and eczema (p = 0.039) scores differed significantly across the age categories. The other components of the CoMiSS were not age dependent., Conclusion: In healthy infants ≤ 6 months, the median CoMiSS is 3.0. More prospective studies in different sites and comparing healthy and allergic infants are warranted to obtain further evidence on the utility of the CoMiSS., Competing Interests: Y. Vandenplas has participated as a clinical investigator, and/or advisory board member, and/or consultant, and/or speaker for Abbott Nutrition, Biocodex, Danone, Nestle Health Science, Nestle Nutrition Institute, Nutricia, Mead Johnson, Phacobel, United Pharmaceuticals. S. Salvatore has participated as a consultant and/or speaker for Danone-Nutricia, Deca, IMS-Health, Menarini, Nestle. Carmen Ribes-Koninckx has participated as a consultant and/or speaker for Danone-Nutricia, Mead-Johnson, Nestle Nutrition Institute. Hania Szajewska had academic-associated speaking engagements and/or received research funding from companies manufacturing infant formulae. The other authors have no conflicts of interest to disclose. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Background: Monitoring the scale of pharmaceuticals, illicit and licit drugs consumption is important to assess the needs of law enforcement and public health, and provides more information about the different trends within different countries. Community drug use patterns are usually described by national surveys, sales and seizure data. Wastewater-based epidemiology (WBE) has been shown to be a reliable approach complementing such surveys., Method: This study aims to compare and correlate the consumption estimates of pharmaceuticals, illicit drugs, alcohol, nicotine and caffeine from wastewater analysis and other sources of information. Wastewater samples were collected in 2015 from 8 different European cities over a one week period, representing a population of approximately 5 million people. Published pharmaceutical sale, illicit drug seizure and alcohol, tobacco and caffeine use data were used for the comparison., Results: High agreement was found between wastewater and other data sources for pharmaceuticals and cocaine, whereas amphetamines, alcohol and caffeine showed a moderate correlation. methamphetamine and 3,4-methylenedioxymethamphetamine (MDMA) and nicotine did not correlate with other sources of data. Most of the poor correlations were explained as part of the uncertainties related with the use estimates and were improved with other complementary sources of data., Conclusions: This work confirms the promising future of WBE as a complementary approach to obtain a more accurate picture of substance use situation within different communities. Our findings suggest further improvements to reduce the uncertainties associated with both sources of information in order to make the data more comparable.

Background: Wastewater-based epidemiology (WBE) is a new methodology for estimating the drug load in a population. Simple summary statistics and specification tests have typically been used to analyze WBE data, comparing differences between weekday and weekend loads. Such standard statistical methods may, however, overlook important nuanced information in the data. In this study, we apply functional data analysis (FDA) to WBE data and compare the results to those obtained from more traditional summary measures., Methods: We analysed temporal WBE data from 42 European cities, using sewage samples collected daily for one week in March 2013. For each city, the main temporal features of two selected drugs were extracted using functional principal component (FPC) analysis, along with simpler measures such as the area under the curve (AUC). The individual cities' scores on each of the temporal FPCs were then used as outcome variables in multiple linear regression analysis with various city and country characteristics as predictors. The results were compared to those of functional analysis of variance (FANOVA)., Results: The three first FPCs explained more than 99% of the temporal variation. The first component (FPC1) represented the level of the drug load, while the second and third temporal components represented the level and the timing of a weekend peak. AUC was highly correlated with FPC1, but other temporal characteristic were not captured by the simple summary measures. FANOVA was less flexible than the FPCA-based regression, and even showed concordance results. Geographical location was the main predictor for the general level of the drug load., Conclusion: FDA of WBE data extracts more detailed information about drug load patterns during the week which are not identified by more traditional statistical methods. Results also suggest that regression based on FPC results is a valuable addition to FANOVA for estimating associations between temporal patterns and covariate information.

Background: Inside-out tension-free vaginal transobturator tape (TVT-O) is currently one of the most effective and popular procedures for the surgical treatment of female stress urinary incontinence (SUI), but data reporting long-term outcomes are scarce., Objective: To evaluate the efficacy and safety of TVT-O 5-yr implantation for management of pure SUI in women., Design, Setting, and Participants: A prospective observational study was conducted in four tertiary reference centers. Consecutive women presenting with urodynamically proven, pure SUI treated by TVT-O were included. Patients with mixed incontinence and/or anatomic evidence of pelvic organ prolapse were excluded., Intervention: TVT-O implantation without any associated procedure., Outcome Measurements and Statistical Analysis: Data regarding subjective outcomes (International Consultation on Incontinence-Short Form [ICIQ-SF], Patient Global Impression of Improvement, patient satisfaction scores), objective cure (stress test) rates, and adverse events were collected during follow-up. Multivariable analyses were performed to investigate outcomes., Results and Limitations: Of the 191 women included, 21 (11.0%) had previously undergone a failed anti-incontinence surgical procedure. Six (3.1%) patients were lost to follow-up. The 5-yr subjective and objective cure rates were 90.3% and 90.8%, respectively. De novo overactive bladder (OAB) was reported by 24.3% of patients at 5-yr follow-up. Median ICIQ-SF score significantly improved from 17 (interquartile range [IQR]:16-17) preoperatively to 0 (IQR: 0-2) (p<0.0001). Failure of a previous anti-incontinence procedure was the only independent predictor of subjective recurrence of SUI (hazard ratio [HR]: 4.4; p = 0.009) or objective (HR: 3.7; p = 0.02). No predictive factor of de novo OAB was identified., Conclusions: TVT-O implantation is a highly effective option for the treatment of women with pure SUI, showing a very high cure rate and a low incidence of complications after 5-yr follow-up., (Copyright © 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Aim: The aim of the study was to provide an updated position statement from the ESPGHAN European Pediatric Impedance Working Group on different technical aspects such as indications, methodology, and interpretation of multichannel intraluminal impedance-pH monitoring (MII-pH)., Methods: Evidence was used where available, but the article is based mainly on expert opinion and consensus., Results: MII-pH provides more information than simple pH monitoring because reflux detection is not limited to acid reflux. Different companies provide commercialized MII-pH recording systems, making the method widely available and useable in daily clinical practice; however, the technique still has limitations: high cost, limited additional value regarding therapeutic implications, and lack of evidence-based parameters for the assessment of gastroesophageal reflux and symptom association in children., Conclusions: MII-pH recording is a promising procedure needing further validation and development to increase its additional benefit over conventional investigation techniques. The added value of the technique regards mainly clinical circumstances in which nonacid or weakly acid reflux may be relevant such as persisting symptoms during antireflux treatment with proton pump inhibitors and feeding-related reflux; and assessing specific discontinuous symptoms thought to be associated with gastroesophageal reflux; and research.

Gastro-oesophageal reflux (GOR) and food allergy (FA) are common conditions, especially during the first 12 months of life. When GOR leads to troublesome symptoms, that affect the daily functioning of the infant and family, it is referred to as GOR disease (GORD). The role of food allergens as a cause of GORD remains controversial. This European Academy of Allergy and Clinical Immunology (EAACI) position paper aims to review the evidence for FA-associated GORD in young children and translate this into clinical practice that guides healthcare professionals through the diagnosis of suspected FA-associated GORD and medical and dietary management. The task force (TF) on non-IgE mediated allergy consists of EAACI experts in paediatric gastroenterology, allergy, dietetics and psychology from Europe, United Kingdom, United States, Turkey and Brazil. Six clinical questions were formulated, amended and approved by the TF to guide this publication. A systematic literature search using PubMed, Cochrane and EMBASE databases (until June 2021) using predefined inclusion criteria based on the 6 questions was used. The TF also gained access to the database from the European Society of Paediatric Gastroenterology and Hepatology working group, who published guidelines on GORD and ensured that all publications used within that position paper were included. For each of the 6 questions, practice points were formulated, followed by a modified Delphi method consisting of anonymous web-based voting that was repeated with modified practice points where required, until at least 80% consensus for each practice point was achieved. This TF position paper shares the process, the discussion and consensus on all practice points on FA-associated GORD., (© 2022 European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.)

Acute gastroenteritis is one of the most common diseases in children and an important cause of morbidity and mortality worldwide. No specific treatment is available; therefore, management is exclusively symptomatic. Xyloglucan has been approved in Europe as a class IIa medical device for restoration of the physiological functions of the intestinal wall. Our objective was to assess efficacy and safety of xyloglucan for the treatment of acute gastroenteritis in children. We performed a triple‐blind, randomized placebo‐controlled clinical trial in four primary care centers and one continued care hospital center. The study population comprised children with acute gastroenteritis aged >3 months and <5 years. Our primary endpoint was time (in hours) of resolution of diarrhea, defined as the time to resolution of stool consistency (Bristol Stool Form Scale ≤5 or Amsterdam Stool Form Scale B or C) or time until deposition frequency resumes to normality, whichever occurred first. We also recorded intravenous rehydration, hospitalization, stools per day, Vesikari scale, vomiting, relapse, weight loss, drugs prescribed, and adverse events. Eighty children were included in the intention‐to‐treat population (43 xyloglucan and 37 placebo) and 74 (93%) in the per‐protocol population. Time to resolution of diarrhea was similar in both groups with (median, 95% CI) 24, 17–24 h in the xyloglucan group versus 24, 19–24 h in the placebo group, p =.680. Significant differences were observed for patients with moderate‐to‐severe diarrhea (Vesikari scale ≥9): xyloglucan group (20 [15–24] h) versus placebo group (85 [51–120] h) (p =.04). No other significant differences were found. Xyloglucan can be considered safe and other studies should be performed to confirm the usefulness in patients with moderate‐to‐severe diarrhea. [ABSTRACT FROM AUTHOR]

The 'homo semioticus paradigm' offers new insights on how 'matters of concerns' arise when communicating geosciences [1]. This paradigm has been formulated (within the 'Semiotic Cultural Psychological Theory', SCPT) to describe 'affective sense-making of people'. Functioning at the group level, 'affective sense-making' causes people perceiving evidence, insights or concepts in accordance with (their) 'symbolic universes' (worldviews) [2]. Regarding geosciences, the 'homo semioticus paradigm' offers a new lens to explore how people relate to its concepts. This contribution introduces the homo semioticus paradigm, discusses its applicability given the ecological concept of 'human niche', and applies its analytical key-feature ('symbolic universes') to how people may perceive the normative framework of geoethics [3] to act in their niche.SCPT has successfully revealed structures of the perception of the cultural-political features of European societies by describing people's experiences, their perceptions, predispositions, reactions and acts depending on (their mode of) 'affective sense-making'. People are found to identify with and apply various 'symbolic universes', such as 'ordered universe', 'interpersonal bound', 'caring society', 'niche of belongingness', and 'others' world'. It seems possible, so the hypothesis of this essay, to structure analogously how a 'homo semioticus' perceives its place within the 'human niche'. The metaphorical term 'human niche' or the corresponding technical notion 'anthropogenic biome' labels systems of intersecting natural processes, technological schemes and human practices. An anthropogenic biome consists of networked complex-adaptive societal-ecological systems, which exhibit societal and environmental dynamics that are non-separable. Likewise, human sense-making is an intrinsic part of these systems [4]. Complex-adaptive socio-ecological systems are challenging people's capabilities to gain insights and, subsequently to act responsibly. In such circumstances, people deploy (their) worldviews ('symbolic universes') as a device to aggregate evidence, insights, concepts and norms in a conveniently biased manner. The normative call of geoethics (addressing scientists and citizens), namely to reflect "on the values which underpin appropriate behaviours and practices, wherever human activities interact with the Earth system" will trigger different response, depending on the 'symbolic universe' that shapes the respondent's way of feeling and thinking. Likewise, people will perceive a given feature of the 'human niche' depending on their 'symbolic universes'. Hence, people's individual and collective value-laden decision making (including policy-making) will bias evidence, insights, concepts and norm as perceived through the lens of their 'symbolic universe'. Summarising, this contribution sketches an approach to study, through the 'homo semioticus paradigm', the sense-making feedback-loop in complex-adaptive socio-ecological systems; a loop that the normative call of geoethical thinking aims to addresses.[1] Stewart, I. S., & Lewis, D. (2017). https://doi.org/10.1016/j.earscirev.2017.09.003[2] Salvatore, S., et al. (2018). https://doi.org/10.1177/1354067X18779056[3] Di Capua et al. (2017). https://doi.org/10.4401/ag-7553[4] Bohle, M. (forthcoming). Homo Semioticus Migrating out of Area? In: S. Salvatore et al. (eds.), What future for Europe? Symbolic Universes in the time of (post)crisis, Springer [ABSTRACT FROM AUTHOR]

Prostate cancer is one of the most common neoplasms in elderly males in Europe and is rapidly becoming a major health burden throughout the world. Radical prostatectomy is a first-line treatment in the case of organ-confined prostate cancer and in selected cases of locally advanced disease. Recent studies have suggested that the urinary bladder wall thickness (BWT) is an important predictor of an overactive bladder (OAB). This article focuses on a hypothesis for the mechanism of urine incontinence in patients after radical prostatectomy due to urinary bladder hypertrophy. To verify the possible influence of changes in the urinary bladder structure on urine incontinence development, we designed an experiment in which patients with prostate cancer were qualified for radical prostatectomy. Our hypothesis that urinary bladder hypertrophy influences urine incontinence development in patients after radical prostatectomy may provide an insight toward the prevention and control of urine incontinence after surgery by oral pharmacotherapy or intravesical onabotulinumtoxinA injections in pre-radical prostatectomy mode. [ABSTRACT FROM AUTHOR]

High pressure processing (HPP) is a novel food processing technology that uses minimal heat and preservatives. It can inactivate a variety of pathogenic and spoilage bacteria to ensure safe foods and extend shelf life by maintaining nutritional and sensory attributes. The present investigation studied the effects of HPP (200, 400, 600 MPa; 5, 10 min; room temperature) on the following parameters: contents of carotenoids and vitamin E and antioxidant capacity (AOC) in spinach and rosehip puree; chlorophyll contents in spinach and in vitro bioaccessibility of carotenoids in rosehip puree. Contents of carotenoids, chlorophylls and vitamin E were determined by HPLC. AOC was analysed by several assays (total phenolics, TEAC, ORAC). In spinach, HPP led to a significant increase of the content of carotenoids, chlorophylls and vitamin E, probably due to an increased extractability. Total carotenoid content in rosehip puree was almost unchanged by HPP with single carotenoids behaving differently. The in vitro digestion model showed that 42.2 ± 7.4% of the total carotenoids of the rosehip puree was released and is potentially available for absorption. HPP had no significant effect on the bioaccessibility of total carotenoids. No distinct trend for the effects of HPP on the tocopherol contents in both food samples could be deduced. Mostly, no changes were induced by pressure. In both plant foods, the AOC was retained. The results provide further scientific evidence of the benefits of HPP in retaining micronutrients and phytochemical properties of plant foods. [ABSTRACT FROM AUTHOR]

Background: Wastewater-based epidemiology (WBE) is a novel approach in drug use epidemiology which aims to monitor the extent of use of various drugs in a community. In this study, we investigate functional principal component analysis (FPCA) as a tool for analysing WBE data and compare it to traditional principal component analysis (PCA) and to wavelet principal component analysis (WPCA) which is more flexible temporally.Methods: We analysed temporal wastewater data from 42 European cities collected daily over one week in March 2013. The main temporal features of ecstasy (MDMA) were extracted using FPCA using both Fourier and B-spline basis functions with three different smoothing parameters, along with PCA and WPCA with different mother wavelets and shrinkage rules. The stability of FPCA was explored through bootstrapping and analysis of sensitivity to missing data.Results: The first three principal components (PCs), functional principal components (FPCs) and wavelet principal components (WPCs) explained 87.5-99.6 % of the temporal variation between cities, depending on the choice of basis and smoothing. The extracted temporal features from PCA, FPCA and WPCA were consistent. FPCA using Fourier basis and common-optimal smoothing was the most stable and least sensitive to missing data.Conclusion: FPCA is a flexible and analytically tractable method for analysing temporal changes in wastewater data, and is robust to missing data. WPCA did not reveal any rapid temporal changes in the data not captured by FPCA. Overall the results suggest FPCA with Fourier basis functions and common-optimal smoothing parameter as the most accurate approach when analysing WBE data. [ABSTRACT FROM AUTHOR]

Infant formulas are the only suitable substitute for human milk. The most common infant formulas are standard formulas based on cow's milk. In addition, there are formulas for infants showing signs and symptoms of intolerance and for clinical conditions such as allergy, prematurity, and gastrointestinal diseases. A comprehensive review of the literature was made to review the composition of standard and specialized infant formulas and analyze indications for use, real or presumed nutrition differences and properties, and impact on infant growth. A brief consideration on costs is outlined for each formula. Over the past few years, industrial production and advertising of infant formulas have increased. Human milk still remains the most complete source of nutrition for infants and should be continued according to the current recommendations. Few differences exist between infant formulas, both for the nutrition action and the macronutrient/micronutrient composition. Specialized infant formulas have limited indications for use and high costs. The role of the pediatrician is crucial in the management of infant nutrition, promotion of breastfeeding, and prescribing of specialized formulas only in specific clinical conditions., (© 2019 American Society for Parenteral and Enteral Nutrition.)

Background and Objective: Risk-minimization measures (RMM), including label revisions were implemented in Europe for domperidone because of evidence of increased incidence of cardiac arrhythmia and sudden cardiac death. In accordance with the guideline on good pharmacovigilance practices, the European Medicines Agency Pharmacovigilance Risk Assessment Committee requested to conduct two studies to evaluate the effectiveness of these risk minimization measures., Methods: In Belgium, France, Germany, Spain, and the UK, surveys were conducted to assess physicians' knowledge on the updated domperidone labeling information, and a drug-utilization study (DUS) was conducted using healthcare databases to assess domperidone prescribing patterns before and after the RMM. Four DUS sensitivity analyses (scenarios) evaluated uncertainty regarding domperidone treatment duration and indication., Results: Among 1805 physicians participating in the survey, most were aware of the approved indication (nausea and vomiting, 80%), treatment duration (≤ 7 days, 70%), and maximum adult daily dose (10 mg three times daily, 84%). Only 33% selected the on-label indication from a list of indications for which they would prescribe domperidone. Awareness was low for medications contraindicated for concomitant use (26%) and contraindicated conditions (4%). In the DUS, under the optimistic scenario, a large improvement in labeling compliance from pre- to post-implementation period was observed in France (27% vs. 69%), while Belgium, Germany, Spain, and the UK showed small improvements (< 10%). In the other scenarios, there was little to no improvement in compliance with the revised labeling from the pre- to post-implementation periods in most countries., Conclusions: The survey findings documented that most physicians in all five countries were aware of the main aspects of the revised labeling. Results of the DUS were inconclusive regarding the effect of the RMM and compliance with the revised labeling for all countries except France.

The COVID-19 pandemic and the resulting restrictions led to a reduced number of surgeries. This study examines its impact on the course of treatment and clinical outcome of surgically treated paediatric upper limb fractures during that specific period. This retrospective cohort study evaluated all children aged 0–18 years presenting with an upper limb fracture treated surgically at the level 1 trauma centre of the University Clinic of Orthopaedics and Trauma Surgery of Vienna within lockdown from 16 March to 29 May 2020 (definition applied through corresponding legislation) compared to the same period from 2015 to 2019. A total number of 127 children (m:63; f:44) were included. The lockdown did not lead to a significant increase in complications during and after initial surgery. Time until removal of implant was not significantly prolonged (p = 0.068; p = 0.46). The clinical outcome did not significantly differ compared to previous years. The experience of a level 1 trauma centre showed that despite reduced surgical capacity during the COVID-19 pandemic, no negative differences concerning course of treatment and clinical outcome of surgically treated paediatric upper limb fractures were present. These findings are still of importance since the COVID-19 pandemic continues and several countries in Central Europe are currently under their fourth lockdown. [ABSTRACT FROM AUTHOR]

The main research question concerned the identification of changes in the COVID-19 epidemiological situation using fuzzy clustering methods. This research used cross-sectional time series data obtained from the European Centre for Disease Prevention and Control. The identification of country types in terms of epidemiological risk was carried out using the fuzzy c-means clustering method. We also used the entropy index to measure the degree of fuzziness in the classification and evaluate the uncertainty of epidemiological states. The proposed approach allowed us to identify countries' epidemic states. Moreover, it also made it possible to determine the time of transition from one state to another, as well as to observe fluctuations during changes of state. Three COVID-19 epidemic states were identified in Europe, i.e., stabilisation, destabilisation, and expansion. The methodology is universal and can also be useful for other countries, as well as the research results being important for governments, politicians and other policy-makers working to mitigate the effects of the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Background: We aimed to review the literature regarding the epidemiology of constipation in Europe and Oceania and the associated prevalence/risk factors. Methods: Two reviewers performed PubMed searches and a hand search of references. A study was considered eligible for inclusion if it reported data about the prevalence of constipation in any population, free of other gastrointestinal disorders, in Europe and Oceania. Studies were evaluated for quality. Data regarding the setting, type of study, definition of constipation, study population, prevalence of constipation, factors associated with increased odds for constipation, and the female to male ratio, were collected. Results: The 21 reviewed studies depict prevalence rates in 34 different population groups ranging widely from a low 0.7% to a high 81%. In the general population of Europe the mean value of the reported constipation rates is 17,1 % and the median value 16.6%. Among the studies conducted in Oceania, the mean value of constipation prevalence was 15.3%. Female gender, age and socioeconomic and educational class seem to have major effect on constipation prevalence. A number of various other risk factors are, less clearly, associated with constipation. Conclusion: This systematic review depicts the high prevalence and related risk factors of a disorder that decreases the health-related quality of life and has major economic consequences. [ABSTRACT FROM AUTHOR]

Overactive bladder (OAB) affects an estimated 49 million people in Europe, but only a minority receive appropriate treatment. Others are bothered by unacceptable levels of symptoms that severely impair their quality of life and represent a significant financial burden to themselves and to their healthcare providers. Recently updated guidelines from the International Consultation on Incontinence (ICI) and the European Association of Urology (EAU) take account of important new developments in the management of bladder problems in both primary and secondary care. However, local implementation of previous guidance has been variable, with many patients with OAB and other bladder problems failing to gain full benefit from current clinical and scientific understanding of these conditions. The recent expansion of the range of treatments available for OAB and stress urinary incontinence makes it especially important that physicians become aware of the differential diagnosis of these conditions – the questions they need to ask, and the investigations which will help determine the most appropriate course of action. [ABSTRACT FROM AUTHOR]

This commentary discusses some questions entailed in the Regina Day Langhout's (2005) article. The authors' point of view is an interpretative approach anchored in the European scholastic world, in particular that of Southern Europe with its Latin and Mediterranean culture. In the first part of the article we compare the model of school involved in Langhout's study with the South-West European one. In the second part, we deal with some epistemological and theoretical issues concerning the way cultural processes are investigated: the level/model of explanation of psycho-social context; the problems raised by the notion of intentionality; the limits of the functionalist interpretative schema of analysis. These issues are traced back to a basic topic: the position of the observer in respect of the cultural system analysed. [ABSTRACT FROM AUTHOR]