Once endoscopy and culture have been performed, SGT is superior to empirical 7 or 10 day triple therapy for first-line treatment. Further studies are needed to evaluate the effectiveness of SGT in clinical practice, especially when compared with currently recommended first-line quadruple therapies.

BackgroundNon-steroidal anti-inflammatory drugs (NSAIDs) have been shown to be efficacious to prevent pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP). However, the target patients, the type of NSAID, the route of administration and the time of drug delivery remain unclear, as well as the potential efficacy in reducing the severity of pancreatitis, length of hospital stay and mortality. The objective of the study was to evaluate these questions by performing a systematic review and meta-analysis.MethodsMultiple searches were performed in the main databases. Randomized controlled trials (RCTs) comparing NSAIDs vs. placebo in the prevention of post-ERCP pancreatitis were included. Primary endpoint of the study was the efficacy for pancreatitis prevention. Sub-analyses were performed to determine the risk reduction in high and low risk patients, and to define optimal time, route of administration, and type of NSAID. Secondary endpoints were safety, moderate to severe pancreatitis prevention and reduction of hospital stay and mortality.ResultsNine RCTs enrolling 2133 patients were included. The risk of pancreatitis was lower in the NSAID group than in the placebo group (RR 0.51; 95%CI 0.39–0.66). The number needed to treat was 14. The risk of moderate to severe pancreatitis was also lower in the NSAID group. (RR 0.46; 95%CI 0.28–0.76). No adverse events related to NSAID use were reported. NSAIDs were effective in both high-risk and unselected patients (RR 0.53; 95%CI 0.30–0.93 and RR 0.57; 95%CI 0.37–0.88). In the subanalyses, only rectal administration of either indomethacin (RR 0.54; 95%CI 0.38–0.75) or diclofenac (RR 0.42; 95%CI 0.21–0.84) was shown to be effective. There were not enough data to perform a meta-analysis in hospital stay reduction. No deaths occurred.ConclusionA single rectal dose of indomethacin or diclofenac before or immediately after ERCP is safe and prevents procedure-related pancreatitis both in high risk and in unselected patients.

Background: Susceptibility-guided therapies (SGTs) have been proposed as preferable to empirical rescue treatments after two treatment failures. The aim of this study was to perform a systematic review and meta-analysis evaluating the effectiveness and efficacy of SGT as third-line therapy. Methods: A systematic search was performed in multiple databases. Studies reporting cure rates of Helicobacter pylori with SGT in third-line therapy were selected. A qualitative analysis describing the current evidence and a pooled mean analysis summarizing the cure rates of SGT in third-line therapy was performed. Results: No randomized controlled trials or comparative studies were found. Four observational studies reported cure rates with SGT in third-line treatment, and three studies which mixed patients with second-and third-line treatment also reported cure rates with SGT. The majority of the studies included the patients when culture had been already obtained, and so the effectiveness of SGT and empirical therapy has never been compared. A pooled mean analysis including four observational studies (283 patients) showed intention-to-treat and perprotocol eradication rates with SGT of 72% (95% confidence interval 56-87%; I 2 : 92%) and 80% (95% confidence interval 71-90%; I 2 : 80%), respectively. Conclusions: SGT may be an acceptable option as rescue treatment. However, cure rates are, at best, moderate and this approach has never been compared with a well-devised empirical therapy. The evidence in favor of SGT as rescue therapy is currently insufficient to recommend its use.

This paper presents the first results of a case study on the ways in which playgrounds are constructed and experienced in children's daily lives in two medium sized Mediterranean Catalan cities. The research is based on qualitative methodology through participant observation and interviews with institutional actors. Our research suggests that playgrounds are organised around age as the central category; nevertheless, gender is important in the use and activities developed as children get older. Specific aspects from Mediterranean and medium-sized cities are raised such as a positive perception and an intense use of public space by both adults and children. Specific childhood policies in city planning and a stronger gender awareness among institutional actors would improve the social role of playgrounds as participatory, socialising and inclusive spaces.

This paper analyses how rurality is represented in two lifestyle magazines about country living: LevLandlig in Norway and Vivir en el Campo in Spain. Since material, imaginative and practised ruralities are intertwined and research indicates that representations of the rural affect residential preferences and other consumption activities, we argue that it is important to critically investigate potentially influential representations. Given that the majority of works on representations of the rural in mass media originate mainly from the United Kingdom and the United States, we aim to add the perspectives of a Scandinavian and a Mediterranean country. Furthermore, we analyse the gendering of the visions of the rural. We reveal that the ‘rural idyll’ is the main vision ‘sold’ in both magazines, and in both the same four sub-themes — ‘home’, ‘family’, ‘nature’ and ‘how to make a living in a rural area’ — stand central in the idyll. The gendering of the idyll and the meanings attached to the sub-themes vary between the Spanish and the Norwegian magazines, thus illustrating the contextual character of knowledge about rurality.

Background Susceptibility‐guided treatment has been proposed as a way to improve Helicobacter pylori eradication rates. Evidence on its efficacy for rescue therapy is very scarce. The aim of this study was to indirectly assess the applicability and effectiveness of susceptibility‐guided treatment by evaluating (a) the rate of acceptance of endoscopy, (b) its success in detecting resistances, and (c) infection cure rates in patients harboring strains found to be susceptible to the antibiotics administered in clinical trials in which the efficacy of second‐line treatments was reported. Methods A systematic review of studies evaluating second‐line H pylori treatment was carried out in multiple databases. Studies reporting antibiotic susceptibility evaluation and/or cure rates in patients harboring sensitive and resistant strains were selected. Data were extracted in duplicate. Results The systematic review identified 36 eligible studies. Acceptance was evaluated in only one study of 60 patients, of whom only 38 agreed to endoscopy. Among the 2890 patients who received endoscopy and culture, resistances were finally determined in 86.5%. Cure rate was 72.5% in the 113 patients harboring a clarithromycin‐susceptible strain after previous clarithromycin treatment, 93.5% in the 765 patients harboring a metronidazole‐susceptible strain, and 83.8% in the 192 patients harboring a levofloxacin‐susceptible strain. No studies with repeated administration of levofloxacin or metronidazole were found. Conclusion Even if the culture shows a clarithromycin‐sensitive strain, repeating clarithromycin after a first failure should be discouraged. Susceptibility‐guided treatment alone did not achieve adequate cure rates for rescue therapies. Additional measures are needed to design rescue treatments that consistently achieve excellent cure rates.

PAM was less efficacious than clarithromycin-including triple therapies. However, its efficacy was similar to that of PAC when drugs were administered for 14 days, although ITT cure rates did not reach 90%. Use of 14 day, thrice daily and high-metronidazole-dose PAM treatments markedly increased the cure rate.

s-OPAT administered by patients or their caregivers using elastomeric devices was safe and effective in the treatment of infections in older people.