Background and study aims Pan-enteric capsule endoscopy (CE) provides a comprehensive mucosal assessment of both the small bowel and colon in Crohn's disease (CD). However, its incremental impact on structured clinical decision-making and inter-observer agreement remains insufficiently defined. We aimed to evaluate whether the availability of CE findings influences therapeutic decisions, risk stratification and monitoring strategies in patients with CD. Patients and methods We performed a multicentre, retrospective, paired case-based study including 50 real-world CD cases (35 adults, 15 paediatric). For each case, two anonymised vignettes were generated: one incorporating clinical, biochemical and cross-sectional imaging data without CE, and one additionally including CE findings. Ten experienced inflammatory bowel disease (IBD) gastroenterologists (six adult, four paediatric) independently reviewed all vignettes in randomised order using a structured questionnaire. The primary outcome was change in therapeutic decision-making after disclosure of CE findings. Secondary outcomes included changes in risk stratification, assessment of treatment efficacy, timing of follow-up, confidence in decision-making and inter-observer agreement. Results Access to CE findings significantly modified risk assessment and treatment selection. Overall, 53.3% of risk-stratification responses and 56.7% of treatment decisions changed, with a consistent shift towards higher perceived risk and treatment escalation (p < 0.0001 for both). CE also altered monitoring strategies, increasing reliance on endoscopic/CE-based assessment (change rate 36.7%; p < 0.0001), and modestly shortened planned follow-up intervals (change rate 18.5%; p = 0.0366). Confidence scores showed no significant overall shift (p = 0.2700), despite 41.6% of individual ratings changing. Inter-observer agreement improved from fair to moderate across several domains when CE results were available. No cases with isolated colonic CD were included in the final case set, and no capsule retention occurred in the included cohort. Conclusions In this multicentre paired case-based study, pan-enteric CE substantially influenced risk stratification, treatment selection and monitoring plans in CD, while improving inter-observer agreement across several decision domains. These findings indicate that CE meaningfully affects structured clinical decision-making in selected patients, particularly when small-bowel involvement is suspected or when conventional investigations are discordant. Prospective longitudinal studies are needed to determine whether CE-guided decisions translate into improved clinical outcomes.
To conduct an epidemiological study based on notifications of births with congenital anomalies recorded in the Brazilian Live Birth Information System (SINASC). We performed an observational study using SINASC data from 2010 to 2023. Annual birth rates, means, and time trends were analyzed. Congenital anomalies were classified according to the ICD-10 and a national priority list. Fisher’s Exact Test, with Bonferroni correction, was used to evaluate statistical associations between maternal-fetal characteristics and the presence of anomalies. A significant geographic disparity was observed, with São Paulo showing the highest mean annual incidence (1604.75 ± 241.63) and Maranhão the lowest (560.23 ± 163.19). Among priority anomalies, limb defects were the most frequent (60.41 ± 5.97 per 100,000 live births). Inferential analysis confirmed strong and consistent associations between congenital anomalies and key markers of neonatal compromise (5-minute Apgar score < 7, low birth weight and preterm birth), as well as advanced maternal age. Higher odds of registered anomalies in the Southeast region likely reflect differences in surveillance quality rather than true prevalence. The findings indicate an increasing trend and a geographic heterogeneity in the incidence of congenital anomalies in Brazil. This finding reinforces the need to strengthen surveillance and prevention strategies, with a focus on the high-risk places identified in this study.
Abstract The first year of life is considered a sensitive period for the acquisition of phonetic categories, a hallmark of successful native language specialization. The extent to which this process depends on early auditory experience and intrinsic biological constraints remains unresolved. We measured neural encoding of continuous natural speech in hearing children (HC) and cochlear implant (CI) users with congenital or acquired deafness, contrasting children with and without access to auditory input in the first year of life. Speech encoding was present across all groups, but its specificity depended on early input: auditory phonetic features were encoded only in children exposed to speech within the first year, whereas visually discriminable phonetic features were encoded regardless of auditory deprivation. These findings show that early sensory input gates phonetic attunement; this constraint is not limited to or grounded in audition but instead reveals a sensitive period that is modality-flexible in mechanism and experience-dependent in expression.
Therapeutic adherence to subcutaneous(SC)biologic agents in inflammatory bowel disease(IBD)patients is a key determinant of clinical remission, reduced hospitalization, and improved quality of life.Real-world Italian data on adherence patterns remain limited, especially regarding recently introduced SC formulations This retrospective observational study included adult patients diagnosed with Crohn’s disease or ulcerative colitis who initiated SC biologics (adalimumab, infliximab, ustekinumab, golimumab, vedolizumab SC) between January 2019 and December 2024 at the ASUFC (Udine, Italy).Data were obtained from electronic health records and pharmacy dispensing archives. Adherence was assessed using Medication Possession Ratio (MPR ≥80% considered adherent).Secondary outcomes included persistence, switching, and predictors of non-adherence evaluated through multivariate regression. A total of 132 patients were included (mean age 42 ( ± 16) years; 58% male; 68% Crohn’s disease).Median follow-up was 18.6 months, while median (95% CI) treatment persistence was 34 [9, 58] months. Overall adherence rate was 92% (MPR ≥80%). Ustekinumab showed the highest adherence (mean MPR 97% ( ± 12)), followed by Adalimumab (mean MPR 95% ( ± 12)).During the observation period, 16 patients (12%) switched to a second subcutaneous biologic, while 48 individuals (36%) discontinued therapy.Patients treated with an anti-TNF-alpha agent had a higher probability of switching (17%) compared with those treated with Ustekinumab or Vedolizumab (4%; p = 0.037).Adherence was lower among individuals who discontinued treatment (mean MPR 92% (+-16)) compared with those who did not experience treatment failure (mean MPR 98% (+-6);p = 0.01).Moreover, therapy failure was associated with sex, 47% of females discontinuing treatment versus 28% of males (p = 0.02).Younger age, sex and diagnosis where not associated with adherence, suggesting that these factors do not significantly influence treatment adherence in this cohort. Adherence to SC biologics in this real-world Italian IBD cohort was generally high,with variability across agents.Early identification higher risk patients of non-adherence could improve therapeutic outcomes.Targeted nursing interventions including structured education programs, periodic adherence monitoring, nurse-led outpatient clinics, and facilitation of self-injection skills represent actionable strategies to support sustained treatment engagement. Strengthening the role of IBD nurses within multidisciplinary teams may enhance adherence, reduce avoidable discontinuations, and ultimately improve long-term disease control.Future prospective studies should evaluate the effectiveness of standardized nursing-led adherence support models. References: 1. Van der Have, M. et al. Inflammatory Bowel Diseases. 2015;21(5):1107–1113. 2. Kane, S. et al. Alimentary Pharmacology & Therapeutics. 2003;18(2):165–172. 3. Gingold-Belfer, R. et al. Patient Preference and Adherence. 2021;15:1113–1120. 4. Zingone, F. et al. Digestive and Liver Disease. 2022;54(6):773–780. 5. Kawalec, P. et al. Journal of Crohn’s and Colitis. 2017;11(2):161–171. 6. Schultheiss, J. et al. Therap Adv Gastroenterol. 2022;15:1–12. 7. Fiorino, G. et al. Expert Opinion on Biological Therapy. 2021;21(9):1181–1190. Conflict of interest: Marino, Marco: No conflict of interest Magni, Elena: No conflict of interest Simonetta, Grubissa: No conflict of interest Farina, Giuliana: No conflict of interest Martinis, Arianna: No conflict of interest D’Agaro, Paola: No conflict of interest Marangone, Sandra: No conflict of interest Zenarola, Michela: No conflict of interest Rosolen, Valentina: No conflict of interest Morsanutto, Andrea: No conflict of interest Berretti, Debora: No conflict of interest Povoli, Arianna: Takeda, Janssen, Pfizer, Sofar
