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Background: We have previously analysed outcomes for all community treatment orders commenced during a 10-year period in New Zealand. Given Te Tiriti O Waitangi obligations to scrutinise health and consider equity for Māori, we completed this analysis to consider community treatment-order outcomes according to ethnicity. Methods: Ministry of Health databases provided demographic, service use and medication dispensing data for community treatment-order recipients between 2009 and 2018. As non-Māori on community treatment orders are older, less deprived and less likely to be diagnosed with a Psychotic Disorder, data were categorised according to age (<35/⩾35 years), level of deprivation (New Zealand Dep levels ⩽3, 4–6 and ⩾7) and diagnosis (Psychotic Disorder/non-Psychotic Disorder). The incidences of key outcome measures (admissions, community care, medication dispensing) were calculated for periods on/off community treatment orders for Māori and non-Māori to consider the differential impact of community treatment orders according to ethnicity. Results: Māori have high rates of community treatment order utilisation and are younger, more likely to be diagnosed with a Psychotic Disorder and spend longer receiving compulsory treatment than non-Māori. Non-Māori are more likely to receive more additional depot antipsychotic medication on–community treatment orders compared with periods off-community treatment order than Māori but other clear patterns of response distinguishing between Māori and non-Māori were not present. Conclusion: The differences between Māori and non-Māori for community treatment-order utilisation suggest the presence of structural inequity in underlying mental illness distribution and treatment provision. Māori cultural expertise at all levels of healthcare including healthcare planning and delivery is required to make advances and reduce disparity. [ABSTRACT FROM AUTHOR]

Introduction The disease severity index [DSI] encapsulates the inflammatory bowel disease [IBD] burden but requires endoscopic investigations. This study developed a non-invasive DSI using faecal calprotectin [DSI-fCal] and faecal myeloperoxidase [DSI-fMPO] instead of colonoscopy. Methods Adults with IBD were recruited prospectively. Baseline biomarker concentrations were used to develop DSI-fCal and DSI-fMPO, and these were correlated with the original DSI, IBD symptoms, endoscopic activity, and quality of life [QoL]. Areas under the receiver operating characteristic curves [AUROC] assessed DSI-fCal and DSI-fMPO as predictors of clinical and biochemical remission at 6 months [symptom remission and fCal < 150 μg/g, respectively], and a complicated IBD-course at 24 months [disease relapse needing escalation of biologics or immunomodulators, recurrent corticosteroids, IBD hospitalisations, and/or surgeries]. Multivariable logistic regression assessed the utility of DSI-fCal and DSI-fMPO in predicting a complicated IBD course at 24 months. Results In total, 171 patients were included (Crohn's disease = 99, female = 90, median age = 46 years, interquartile range [IQR] 36–59]). DSI-fCal and DSI-fMPO correlated with the original DSI [r > 0.9, p  < 0.001], endoscopic indices [r = 0.45–0.49, p  < 0.001], IBD symptoms [r = 0.53–0.58, p  < 0.001] and QoL [r = -0.57–0.58, p  < 0.001]. Baseline DSI-fCal [AUROC = 0.79, 95% CI 0.65–0.92] and DSI-fMPO [AUROC = 0.80, 95% CI 0.67–0.93] were associated with 6-month clinical and biochemical remission. DSI-fCal [AUROC = 0.83, 95% CI 0.77–0.89] and DSI-fMPO [AUROC = 0.80, 95% CI 0.73–0.87] performed similarly in predicting a complicated IBD course to the original DSI [ p difference > 0.05]. The non-invasive DSI was independently associated with a complicated IBD course on multivariable analyses [DSI-fCal28, aOR = 6.04, 95% CI 2.42–15.08; DSI-fMPO25, aOR = 7.84, 95% CI 2.96–20.73]. Conclusions The DSI-fCal and DSI-fMPO perform similarly in prognosticating the longitudinal disease course as the original DSI, whilst avoiding a need for an endoscopic assessment. [ABSTRACT FROM AUTHOR]

Background: Age-related changes can lead to dietary insufficiency in older adults. The inclusion of high-quality, nutrient-dense foods such as ruminant milks can significantly improve health outcomes. However, many older adults worldwide do not meet daily milk intake recommendations because of digestive discomfort and health concerns. Ovine and caprine milks are increasingly popular for their perceived digestive and nutritional benefits. While preclinical studies suggest differences in milk digestion, human studies investigating acute postprandial responses remain inconclusive, and the impacts of sustained milk consumption remain uncertain. Objectives: Hence, we present a randomized controlled trial investigating how the sustained consumption of bovine, caprine, or ovine milk influences digestion, nutrition, and metabolism in older women. Methods: A total of 165 healthy older women were randomized to receive bovine, caprine, or ovine milk, or no milk, twice daily for 12 weeks. The primary outcome is the impact of milk consumption on digestive comfort assessed via the Gastrointestinal Syndrome Rating Scale (GSRS). Secondary outcomes include changes in nutrient intake, plasma amino acid and lipid appearance, bowel habits, the gut microbiota, cardiometabolic health, physical function, physical activity, sleep, mood, sensory perception, and emotional response. Conclusions: The findings could inform dietary recommendations for older women and facilitate the development of targeted functional food products. [ABSTRACT FROM AUTHOR]

Background: Unsupervised machine learning describes a collection of powerful techniques that seek to identify hidden patterns in unlabeled data. These techniques can be broadly categorized into dimension reduction, which transforms and combines the original set of measurements to simplify data, and cluster analysis, which seeks to group subjects based on some measure of similarity. Unsupervised machine learning can be used to explore alternative subtyping of disorders of gut‐brain interaction (DGBI) compared to the existing gastrointestinal symptom‐based definitions of Rome IV. Purpose: This present review aims to familiarize the reader with fundamental concepts of unsupervised machine learning using accessible definitions and provide a critical summary of their application to the evaluation of DGBI subtyping. By considering the overlap between Rome IV clinical definitions and identified clusters, along with clinical and physiological insights, this paper speculates on the possible implications for DGBI. Also considered are algorithmic developments in the unsupervised machine learning community that may help leverage increasingly available omics data to explore biologically informed definitions. Unsupervised machine learning challenges the modern subtyping of DGBI and, with the necessary clinical validation, has the potential to enhance future iterations of the Rome criteria to identify more homogeneous, diagnosable, and treatable patient populations. [ABSTRACT FROM AUTHOR]

Background: There has been increasing interest in examining the potential moderating effects that cognitive functioning has on treatment outcome in bipolar disorder (BD) and major depressive disorder (MDD). Therefore, the aim of this exploratory study was to examine the relationship between baseline cognitive function and treatment outcome in individuals with mood disorders who completed 12 months of interpersonal and social rhythm therapy (IPSRT), and were randomised to receive adjunctive cognitive remediation (CR) or no additional intervention. Methods: Fifty‐eight patients with mood disorders (BD, n = 36, MDD, n = 22), who were randomised to IPSRT‐CR or IPSRT, underwent cognitive testing at baseline and completed follow‐up mood measures after 12 months. General linear modelling was used to examine the relationship between baseline cognitive function (both objective and subjective) and change in mood symptom burden, and functioning, from baseline to treatment‐end. Results: Poorer baseline attention/executive function was associated with less change in mood symptom burden, particularly depressive symptoms, at treatment‐end. Additionally, slower psychomotor speed at baseline was associated with less improvement in mania symptom burden. Subjective cognitive function at baseline was not related to change in mood symptom burden at treatment‐end, and neither objective nor subjective cognitive function was associated with functional outcome. Limitations: Due to the exploratory nature of the study, there was no correction for multiple comparisons. Conclusion: Aspects of objective cognitive function were associated with treatment outcomes following psychotherapy. Further large‐scale research is required to examine the role that cognitive function may have in determining various aspects of mood disorder recovery. [ABSTRACT FROM AUTHOR]

Objectives The minor allele of the common rs2231142 ABCG2 variant predicts inadequate response to allopurinol urate lowering therapy. We hypothesize that additional variants in genes encoding urate transporters and allopurinol-to-oxypurinol metabolic enzymes also predict allopurinol response. Methods This study included a subset of participants with gout from the Long-term Allopurinol Safety Study Evaluating Outcomes in Gout Patients (LASSO), whose whole genome was sequenced (n  = 563). Good responders had a 4:1 or 5:1 ratio of good [serum urate (SU) <0.36 mmol/l on allopurinol ≤300 mg/day] to poor (SU ≥0.36 mmol/l despite allopurinol >300 mg/day) responses over five to six time points, while inadequate responders had a 1:4 or 1:5 ratio of good to poor responses. Adherence to allopurinol was determined by pill counts, and for a subgroup (n  = 303), by plasma oxypurinol >20μmol/l. Using the sequence kernel association test (SKAT), we estimated the combined effect of rare and common variants in urate secretory (ABCC4 , ABCC5 , ABCG2 , SLC17A1 , SLC17A3 , SLC22A6 , SLC22A8) and reuptake genes (SLC2A9 , SLC22A11) and in allopurinol-to-oxypurinol metabolic genes (AOX1 , MOCOS , XDH) on allopurinol response. Results There was an association of rare and common variants in the allopurinol-to-oxypurinol gene group (P SKAT-C = 0.019), and in MOCOS , encoding molybdenum cofactor sulfurase, with allopurinol response (P SKAT-C = 0.011). Evidence for genetic association with allopurinol response in the allopurinol-to-oxypurinol gene group (P SKAT-C = 0.002) and MOCOS (P SKAT-C < 0.001) was stronger when adherence to allopurinol therapy was confirmed by plasma oxypurinol. Conclusion We provide evidence for common and rare genetic variation in MOCOS associating with allopurinol response. [ABSTRACT FROM AUTHOR]

Background and Aim: Inflammatory bowel disease (IBD) is a progressive condition where ongoing inflammation in the gastrointestinal tract can lead to complications such as strictures, and fistulae. The long‐term outcomes of newly diagnosed patients under current medical therapy can be used to plan health service provision and guide patients. Methods: Prospective population‐based data on all incident patients diagnosed with IBD in Canterbury was gathered in 2014 (n = 205). The medical records of these patients were followed for medication use, disease progression, hospitalization, surgery and mortality, in the 10 years since their diagnosis. Survival analysis and cox regression determined characteristics associated with earlier time to these outcomes. Results: Medical records of 184 IBD patients were able to be retrieved. Immunomodulators were used by 62% and biologics by 35%; hospitalization occurred for 42% and surgery for 15%. Montreal phenotype progression occurred for 21 and 7% of the cohort died. Younger age at diagnosis hazard ratio (HR) 2.1 (95% confidence interval [CI] 1.1–4.0) and Crohn's disease HR 1.7 (95% CI 1.1–2.6) was associated with immunomodulator use. Younger age was also associated with biologic use HR 2.9 (95% CI 1.2–6.9). Male gender was associated with surgery HR 2.8 (95% CI 1.2–6.4). Perianal disease at diagnosis (14.7%) was associated with immunomodulator use HR 2.58 (95% CI 1.44–4.59) and Montreal phenotype progression HR 2.93 (95% CI 1.10–7.77). Conclusion: In the 10 years since diagnosis disease progression and treatment escalation occurred for most of this population‐based cohort. Earlier intervention for patients with higher‐risk characteristics may improve long‐term outcomes reducing the burden on health systems. [ABSTRACT FROM AUTHOR]

Background and Aims Modifiable risk factors in inflammatory bowel disease [IBD], such as physical activity, may be used as prevention strategies. However, the findings of previous studies on the association between physical activity and IBD risk have been inconsistent. We aimed to perform a systematic review and meta-analysis to estimate the effect of physical activity on IBD risk. Methods A search was conducted for relevant studies published before April 2023 that assessed the effect of pre-IBD diagnosis levels of physical activity on IBD incidence. Individual summary statistics [relative risks; RR], and confidence intervals [CI] were extracted with forest plots generated. We used the Grading of Recommendations Assessment, Development and Evaluation [GRADE] approach to assess the quality of evidence. Results Ten observational studies were included. For cohort studies, there were 1182 Crohn's disease [CD] and 2361 ulcerative colitis [UC] patients, with 860 992 participants without IBD. For case-control studies, there were 781 CD to 2636 controls, and 1127 UC to 3752 controls. Compared with individuals with low physical activity levels, the RRs of CD in individuals with high physical activity levels for cohort and case-control studies were 0.78 [95% CI 0.68-0.88, p  = 0.0001] and 0.87 [95% CI 0.79-0.95, p  = 0.003], respectively. For UC, the RRs were 0.62 [95% CI 0.43-0.88, p  = 0.008] and 0.74 [95% CI 0.51-1.07, p  = 0.11]. Conclusion This meta-analysis suggests that physical activity is inversely associated with the risk of developing IBD, more so in CD than in UC. [ABSTRACT FROM AUTHOR]