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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]

Background and Aims: Oxidative stress is an essential factor in the pathogenesis of inflammatory bowel disease (IBD). A previous study found protective potential of some antioxidative nutrients against IBD. However, the association between total antioxidant capacity (TAC) of the diet and incident IBD is unclear., Methods: We conducted a prospective cohort study including 186,195 IBD-free participants at baseline from the UK Biobank. We calculated dietary TAC using the oxygen radical absorbance capacity method based on repeated online 24-hour dietary recalls. Crohn's disease (CD) and ulcerative colitis (UC) were identified via inpatient register and primary care data. Genetic susceptibility for IBD was assessed by a polygenic risk score. Cox proportional hazard models were applied to estimate multivariable-adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs)., Results: During a median follow-up of 11.4 years, we identified 396 CD and 809 UC incident cases. Individuals with the highest quintile of dietary TAC had a lower risk of CD (27.0 vs 17.0 cases/100,000 person-years; aHR 0.66, 95% CI 0.49-0.90) but not UC (46.7 vs 35.5 cases/100,000 person-years; aHR 0.85, 95% CI 0.69-1.06) compared with the lowest group. We observed interactions between TAC and genetic susceptibility at both multiplicative (P-interaction=0.008/0.063 for CD/UC) and additive (both P values>1) scales. Additionally, a polymorphism of the endogenous antioxidant enzyme gene SOD2 (rs4880) modified the dietary TAC-UC association (P-interaction=0.039)., Conclusion: This study suggests that a diet with high TAC may help prevent the development of IBD, particularly in individuals at high genetic risk of IBD and in mutation carriers of rs4880 in SOD2., (Copyright © 2024. Published by Elsevier Inc.)

evidence from animal experiments indicates that anthocyanin supplements can contribute to intestinal health. Nevertheless, no evidence has linked dietary anthocyanins to the prevention potential against inflammatory bowel disease (IBD) in humans. We leveraged data from 188,044 IBD-free individuals (mean age 59 years; 55.2% females) from the prospective cohort UK Biobank. The anthocyanin intake was estimated using dietary information from validated 24 h dietary recalls. Incident IBD was ascertained via national health-related records. Genetic susceptibility to Crohn's disease (CD) and ulcerative colitis (UC) was estimated by polygenic risk scores and further categorized into low- and high-risk groups by median value. The Cox proportional regression model was applied to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs). During the mean follow-up of 9.7 years, we documented 255 CD and 606 UC. We found that compared with participants with the lowest quartiles of anthocyanin intake, those in the highest quartiles were associated with 24% (95% CI 6%-38%, p = 0.012; p-trend = 0.003) and 35% (95% CI 16%-49%, p = 0.001; p-trend < 0.001) reduced risk of IBD and UC, respectively. The inverse associations were stronger (p-interaction = 0.022) among individuals with a high genetic risk of UC. We did not observe a significant association between anthocyanin intake and CD (p-trend = 0.536). Higher dietary anthocyanin intake was associated with reduced risk of IBD and UC, but not CD. Genetic factors may modify the influence of dietary anthocyanin on UC susceptibility, and possible mechanisms need to be further elucidated in the future., (© 2024 The Author(s). Phytotherapy Research published by John Wiley & Sons Ltd.)

Background: Although the beneficial properties of vitamin D in anti-inflammation and immunity-modulation are promising in the management of inflammatory bowel disease (IBD), data were limited for the critical IBD prognosis. The association between serum vitamin D levels and the risk of bowel resection in individuals with IBD remains largely unknown., Materials and Methods: The authors performed a longitudinal cohort study among 5474 individuals with IBD in the UK Biobank. Serum 25-hydroxyvitamin D [25(OH)D] was measured using direct competitive chemiluminescent immunoassay. Bowel resection events were ascertained via national inpatient data. Multivariable-adjusted Cox proportional hazard regression was used to examine the association between serum 25(OH)D and bowel resection risk, presented with hazard ratios (HRs) and 95% CIs. Restricted cubic spline (RCS) was used to evaluate dose-response associations., Results: During a mean follow-up of 13.1 years, the authors documented 513 incident bowel resection cases. Compared to participants with vitamin D deficiency, nondeficient participants showed a significantly reduced bowel resection risk in IBD (HR 0.72, 95% CI: 0.59-0.87, P =0.001), Crohn's disease (CD, HR 0.74, 95% CI: 0.56-0.98, P =0.038), and ulcerative colitis (UC, HR 0.73, 95% CI: 0.57-0.95, P =0.020). When comparing extreme quintiles of 25(OH)D level, participants with IBD showed a 34% reduced risk of bowel resection (95% CI: 11-51%, P =0.007) and participants with UC showed a 46% reduced risk (95% CI: 19-64%, P =0.003), while this association was not significant in CD (HR 0.93, 95% CI: 0.59-1.45, P =0.740). Linear dose-response associations were observed using the RCS curve (all P -nonlinearity>0.05)., Conclusion: Increased serum level of 25(OH)D is independently associated with reduced bowel resection risk in IBD. This association was significant in UC but may not be stable in CD. Vitamin D deficiency is a risk factor for bowel resection in individuals with IBD, and may be an effective metric in predicting and risk-screening surgical events., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)