BackgroundThe etiology and progression of neurodegenerative disorders depends on the interactions between a variety of factors including: aging, environmental exposures, and genetic susceptibility factors. Enhancement of proinflammatory events appears to be a common link in different neurological impairments, including Alzheimer's disease, Parkinson's disease, amyotrophic lateral sclerosis, and multiple sclerosis. Studies have shown a link between exposure to particulate matter (PM), present in air pollution, and enhancement of central nervous system proinflammatory markers. In the present study, the association between exposure to air pollution (AP), derived from a specific source (diesel engine), and neuroinflammation was investigated. To elucidate whether specific regions of the brain are more susceptible to exposure to diesel-derived AP, various loci of the brain were separately analyzed. Rats were exposed for 6 hrs a day, 5 days a week, for 4 weeks to diesel engine exhaust (DEE) using a nose-only exposure chamber. The day after the final exposure, the brain was dissected into the following regions: cerebellum, frontal cortex, hippocampus, olfactory bulb and tubercles, and the striatum.ResultsBaseline levels of the pro-inflammatory cytokines tumor necrosis factor alpha (TNF-α) and interleukin-1 alpha (IL-1α) were dependent on the region analyzed and increased in the striatum after exposure to DEE. In addition, baseline level of activation of the transcription factors (NF-κB) and (AP-1) was also region dependent but the levels were not significantly altered after exposure to DEE. A similar, though not significant, trend was seen with the mRNA expression levels of TNF-α and TNF Receptor-subtype I (TNF-RI).ConclusionsOur results indicate that different brain regions may be uniquely responsive to changes induced by exposure to DEE. This study once more underscores the role of neuroinflammation in response to ambient air pollution, however, it is valuable to assess if and to what extent the observed changes may impact the normal function and cellular integrity of unique brain regions.

Objective: To systematically review literature reporting processes, impact and outcomes of medication review and reconciliation in Australian residential aged care facilities (RACFs). Methods: PubMed/MEDLINE, EMBASE, CINAHL, Informit Health and grey literature were searched from 1995 to July 2018. Studies reporting outcomes of a stand-alone medication review or reconciliation interventions in Australian RACFs were included. Results: Thirteen studies investigated medication review, eight of which studied Residential Medication Management Reviews (RMMRs). Five studies reported that medication reviews identified an average of 2.7-3.9 medication-related problems (MRPs) per resident. One study reported medication reviews had no impact on quality of life, hospitalisation or mortality, but was not powered to assess these. Three studies reported general practitioners' acceptance of pharmacists' recommendations to resolve MRPs, ranging between 45 and 84%. Conclusions: Medication review may be a useful strategy to identify and prompt resolution of MRPs. However, the impact on clinical and resident-centred outcomes remains unclear. K E Y W O R D Saged care, geriatric medicine, health services, medication review, medication therapy management, pharmacist interventionThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. Practice ImpactThis review suggests that RMMRs identify 2.7-3.9 medication-related problems (MRPs) per resident and general practitioners (GPs) accept 45-84% of recommendations to resolve these MRPs. This highlights the value of pharmacists and GPs working together to optimise medication management in this setting.

OBJECTIVES To evaluate the efficacy and complications of botulinum A toxin (Dysport, Ipsen Ltd, Slough, UK) 500 U in refractory idiopathic detrusor overactivity (IDO). PATIENTS AND METHODS In a prospective study of 25 patients with refractory IDO, the baseline evaluation included an assessment of symptoms, a 7‐day voiding diary, 24‐h pad test, record of symptoms on a visual analogue scale (VAS) (0–10), the Kings Health Questionnaire (KHQ) and urodynamics. Dysport 500 U was administered at 20 sites in the bladder, sparing the trigone. Patients were followed at 6 weeks and 3, 6 and 9 months; the urodynamic assessment was repeated at 3 months. RESULTS Fifteen (63%) patients reported being continent from 1 week after treatment; at 3 months, six (32%) (P = 0.01) patients were still dry, remaining so at 6 months (P = 0.025). Weekly leakage episodes decreased from 5.5 to 1.8 (P = 0.044) at 6 weeks and this was sustained, at 2.7 episodes (P = 0.012), at 9 months. The mean VAS score (0–10) decreased from 8.3 to 5.0 (P = 0.001) at 1 week, to 5.0 at 6 weeks (P = 0.001) and 3 months (P = 0.03) and to 6.1 (P = 0.013) at 6 months. On the KHQ there was a significant improvement in the severity measures domain (P = 0.021) and incontinence impact domain (P = 0.015) up to 9 months. The volume at first desire to void increased from 177 to 251 mL (P = 0.04) at 3 months. At 6 weeks and 3 months, 35% of patients required catheterization, as did 22% at 6 months, but only one at 9 months. CONCLUSIONS Intradetrusor Dysport 500 U was associated with significant subjective and objective improvements in refractory IDO. The present patients initially had a significant increase in voiding dysfunction that resolved by 9 months.

High-quality evidence suggests influenza vaccination reduces hospitalization. Polypharmacy and PIMs are consistently associated with increased all-cause hospitalization.

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