Association between physical activity and depression in adult prescription opioid users: A cross-sectional analysis based on NHANES 2007-2018.

OBJECTIVE: This study was designed to examine the association between physical activity (PA) and depression among adult prescription opioid users. METHOD: Data of adults who recently took prescription opioids were collected from NHANES 2007-2018. Participants were divided into two groups according to whether PA in each domain was ≥600 MET-min/week. According to weekly activity frequency, recreational physical activity (RPA) was divided into inactivity, insufficient activity, weekend warrior (WW), and regular activity. PHQ-9 scores ≥10 were identified as depression. RESULTS: RPA of ≥600 MET-min/week was associated with a 40% (OR: 0.60, 95%CI: 0.38-0.96, P = 0.032) reduction in the risk of depression. Restricted Cubic Spline plots found a nonlinear dose-response relationship between RPA and depression (P = 0.045), and the turning point of depression risk was around 600 MET-min/week. There was no significant difference in the risk of depression between the WW and inactivity groups (OR: 0.65, 95%CI: 0.25-1.72, P = 0.382). The regular activity group had an 45% (OR: 0.55, 95%CI: 0.31-0.99, P = 0.046)lower risk for depression than the inactivity group. CONCLUSION: Only regular RPA is associated with a reduced risk of depression, and RPA showed a nonlinear dose-response relationship. The antidepressant effect of the WW is not significant.

Investigating the weekend effect in decompressive thoracolumbar hemilaminectomy for acute intervertebral disc extrusion: An observational cohort study of 460 cases (2018-2023).

OBJECTIVE: To investigate if weekend surgery is associated with poorer outcomes in dogs with acute thoracolumbar intervertebral disc extrusion (IVDE) undergoing decompressive thoracolumbar hemilaminectomy. STUDY DESIGN: Retrospective observational cohort study. SAMPLE POPULATION: A total of 460 consecutive cases were reviewed, with 401 dogs undergoing weekday surgery (Cohort WD), and 59 dogs undergoing weekend surgery (Cohort WE). METHODS: Medical records of a surgical referral center in the UK were reviewed. Preoperative patient demographic and clinical data, and postoperative outcome data were collected with a minimum 28-day follow-up period. Multivariable logistic regression analysis was used to model the odds of a negative outcome. RESULTS: Cohort WE had a higher preoperative proportion of nonambulatory dogs (p = .0115) but there were no significant differences between the nonambulatory (p = .3762) and deep-pain negative subgroups (p = .6199). Cohort WE had a higher risk of not recovering ambulation compared to Cohort WD [79.2% vs. 91.6% recovery; adjusted OR 3.010 (95% CI: 1.259-7.190); p = .0132] and had a higher risk of postoperative morbidity [32.2% vs. 17.2%; adjusted OR 2.015 (95% CI: 1.089-3.729); p = .0257]. There were no significant differences in other outcome measures between cohorts. CONCLUSION: Weekend surgery in canine decompressive thoracolumbar hemilaminectomy may be associated with poorer patient outcomes, specifically higher postoperative morbidity and a poorer rate of recovery of ambulation. CLINICAL SIGNIFICANCE: This study demonstrates a weekend effect in veterinary surgery, which may be important in surgical decision-making in acute thoracolumbar IVDE. Further scrutiny of the patient's journey through the veterinary healthcare system is warranted.

Bacterial Contamination Control with Sodium Hypochlorite and Jet Lavage Irrigation in a Severe Stage 4 Pelvic Pressure Injury: A Case Report.

ABSTRACT: This case report reviews the effect of combining a 250-cc bottle of standard antimicrobial, buffered sodium hypochlorite with a surgical method, low-pressure jet lavage irrigation in the outpatient setting to control difficult wound contamination. A 73-year-old man had been in treatment for over 8 years, undergoing at least 18 surgical wound debridement procedures for an extensive undermined pelvic pressure injury involving the sacrum, ischium, and greater trochanter. Cultures and polymerase chain reaction diagnostics revealed a multibacterial presence. Autofluorescent imaging (AFI) was used in 21 examinations performed after a 72-hour delay over a long weekend. The AFI contamination exceeded log 4 colony-forming units/g of tissue in all pretreatment examinations and was reduced to less than log 2 colony-forming units in 6 of 21 examinations, with the remaining 15 showing an estimated 80% or higher removal of the bacterial porphyrin "red" appearance. A total of 54 AFI examinations were performed using the combination treatment, and no adverse reactions were encountered. Treatment paradigms can be improved with a multifactorial approach.

Association between weekend catch-up sleep and depression of the United States population from 2017 to 2018: A cross-sectional study.

Insufficient sleep on weekdays has become a societal norm, and studies have shown that sleep deprivation increases the risk of depression. Although individuals often resort to weekend catch-up sleep (CUS) as a compensatory measure, the present evidence supporting its efficacy in mitigating the risk of depression is limited. This article attempts to explore the relationship between CUS and depression. In this study, a total of 5510 participants were included, characterized into two groups: nondepressed (n = 5051) and depressed (n = 459), with data extracted from the National Health and Nutrition Examination Survey (NHANES). Compared with people without CUS, those practicing CUS exhibited a significantly lower risk of depression (OR = 0.81, P = 0.048). In subgroup analysis, this reduction effect was only observed in males (OR = 0.70, 95 % CI 0.05 to 0.99, P = 0.04), middle-aged (>40, ≤60) (OR: 0.57, 95 % CI: 0.40 to 0.81, P = 0.002), married or living with parents (OR: 0.61, 95 % CI: 0.44 to 0.86, P = 0.004), groups with three or more family members (OR: 0.69, 95 % CI: 0.52 to 0.93, P = 0.01), and individuals without alcohol intake (OR: 0.24,95 % CI: 0.09 to 0.67, P = 0.006). Therefore, in the realm of depression treatment, doctors may consider advising patients to get adequate sleep on weekends as part of their overall treatment plan. At the same time, individuals can also choose weekend sleep as a proactive strategy for regulating their psychological status.

Association between holiday and weekend admissions and mortality outcomes among patients with acute myocardial infarction receiving percutaneous coronary intervention in Taiwan.

There is a lack of studies that concurrently differentiate the effect of the holiday season from the weekend effect on mortality risk in patients with acute myocardial infarction (AMI). We evaluated the mortality risk among patients admitted with AMI who underwent percutaneous coronary intervention, using data from the Taiwan National Health Insurance Research Database. Adult AMI patients admitted during January and February between 2013 and 2020 were enrolled and classified into the holiday season (using the Chinese New Year holiday seasons as an indicator) (n = 1729), weekend (n = 4725), and weekday (n = 14,583) groups according to the first day of admission. A multivariable logistic regression model was used to assess the risk. With the weekday group or the weekend group as the reference, the holiday season group did not have increased risks of in-hospital mortality (adjusted odds ratio [aOR] 1.15; 95% confidence intervals [CI] 0.93-1.42 or aOR 1.23; 95% CI 0.96-1.56) and 7-day mortality (aOR 1.20; 95% CI 0.90-1.58 or aOR 1.24; 95% CI 0.90-1.70). Stratified and subgroup analyses showed similar trends. We conclude that holiday season-initiated admissions were not associated with higher mortality risks in AMI admission cases than weekday or weekend admissions.

Analysis of the Weekend Effect on Mortality, Diagnostic Coronary Angiography, and Percutaneous Coronary Intervention in Acute Myocardial Infarction Across Rural US Hospitals.

BACKGROUND: Rural hospitals face several unique challenges in delivering healthcare to an underserved population. Achieving time-sensitive goals in a resource-scarce facility is often a difficult task without the right team at hand. Resources are further depleted on the weekends, exposing understaffed hospitals to poorer outcomes. Acute myocardial infarction (AMI) mortality depends on timely diagnosis and intervention. It is unknown to what extent resource shortages impact rural hospitals during weekends and how they affect AMI mortality. METHODS: This cross-sectional study was performed on patients admitted on weekends with AMI using the National Inpatient Sample (NIS) 2019. Patients with type II non-ST-elevation myocardial infarction (NSTEMI) and missing information were excluded. The rates and timing of in-hospital diagnostic coronary angiograms, PCIs (percutaneous coronary interventions), and in-hospital mortality were studied. Regression models were used for data analyses. RESULTS: A total of 161,625 patients met the inclusion criteria (58,690 females (36%), 114,830 Caucasians (71%), 17,910 African American (11%), 13,920 Hispanic (8.6%); mean (SD) age, 66.5 (0.5) years), including 47,665 (29.5%) ST-elevation myocardial infarction (STEMI) and 113,960 (70.5%) NSTEMI. Patients admitted to rural hospitals were less likely to undergo diagnostic coronary angiogram (adjusted odds ratio (aOR), 0.69; CI, 0.57-0.83; p<0.001) and PCI (aOR, 0.83; CI, 0.72-0.96; p 0.012). Rural hospitals had lesser odds of early diagnostic angiograms (aOR, 0.79; CI, 0.67-0.95; p<0.05) and PCI (aOR, 0.78; CI, 0.66-0.92; p<0.05) within 24 hours. The mortality difference between rural and urban hospitals was not significant (aOR, 1.08; CI, 0.85-1.4; p 0.52). CONCLUSIONS: Diagnostic coronary angiograms and PCI are performed at a lesser rate in rural hospitals during weekends. This trend did not affect rural AMI mortality.

Reading room assistants to reduce workload and interruptions of radiology residents during on-call hours: Initial evaluation.

PURPOSE: To determine how much timesaving and reduction of interruptions reading room assistants can provide by taking over non-image interpretation tasks (NITs) from radiology residents during on-call hours. METHODS: Reading room assistants are medical students who were trained to take over NITs from radiology residents (e.g. answering telephone calls, administrative tasks and logistics) to reduce residents' workload during on-call hours. Reading room assistants' and residents' activities were tracked during 6 weekend dayshifts in a tertiary care academic center (with more than 2.5 million inhabitants in its catchment area) between 10 a.m. and 5p.m. (7-hour shift, 420 min), and time spent on each activity was recorded. RESULTS: Reading room assistants spent the most time on the following timesaving activities for residents: answering incoming (41 min, 19%) and outgoing telephone calls (35 min, 16%), ultrasound machine related activities (19 min, 9%) and paramedical assistance such as supporting residents during ultrasound guided procedures and with patients (17 min, 8%). Reading room assistants saved 132 min of residents' time by taking over NITs while also spending circa 31 min consulting the resident, resulting in a net timesaving of 101 min (24%) during a 7-hour shift. The reading room assistants also prevented residents from being interrupted, at a mean of 18 times during the 7-hour shift. CONCLUSION: This study shows that the implementation of reading room assistants to radiology on-call hours could provide a timesaving for residents and also reduce the number of times residents are being interrupted during their work.

Determinants of Change in Physical Activity in Children During the Transition from Elementary to High School.

INTRODUCTION: Effective public health interventions targeting factors that influence physical activity are urgently needed to reduce the age-related decline in physical activity in youth. The purpose of this study was to identify associations between physical activity and a set of potential influences on physical activity in children as they transition from elementary to high school. METHODS: Participants were 951 children from South Carolina school districts who completed outcome and independent variable measures on at least two time points from the 5th through 11th grades in 2010 - 2017. The primary outcome variable was physical activity, measured by accelerometry. Independent variables included a comprehensive set of variables in the child, parent/home, school, and community domains. Children, parents and school administrators, and staff completed questionnaires to assess psychosocial and home, school, and neighborhood environmental influences. Growth curve analyses identified independent variables associated with physical activity over time, either as a main effect or as an interaction with age. RESULTS: As main effects, self-efficacy, self-schema, sport participation, weekday outdoor hours, importance of child participating in sports and physical activity, safe to play outside, and Physical Activity Resource Assessment weighted score were positively associated with physical activity. The associations between physical activity and enjoyment motivation, appearance motivation, weekend outdoor time, and home equipment exhibited significant interactions with age. Enjoyment motivation influenced physical activity during the earlier years, whereas the remaining three variables influenced physical activity in the later years. CONCLUSIONS: Interventions should target multiple domains of influences that may vary by age.

Impact of Weekday on Short-term Surgical Outcomes After Lumbar Fusion Surgery.

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: The purpose of this study is to investigate whether weekday lumbar spine fusion surgery has an impact on surgical and inpatient physical therapy (PT) outcomes. SUMMARY OF BACKGROUND DATA: Timing of surgery has been implicated as a factor that may impact outcomes after spine surgery. Previous literature suggests that there may be an adverse effect to having surgery on the weekend. METHODS: All patients ≥18 years who underwent primary lumbar spinal fusion from 2014 to 2020 were retrospectively identified. Patients were subdivided into an early subgroup (surgery between Monday and Wednesday) and a late subgroup (surgery between Thursday and Friday). Surgical outcome variables included inpatient complications, 90-day readmissions, and 1-year revisions. PT data from the first inpatient PT session included hours to PT session, AM-PAC Daily Activity or Basic Mobility scores, and total gait trial distance achieved. RESULTS: Of the 1239 patients identified, 839 had surgery between Monday and Wednesday and 400 had surgery between Thursday and Friday. Patients in the later surgery subgroup were more likely to experience a nonsurgical neurologic complication (3.08% vs. 0.86%, P=0.008); however, there was no difference in total complications. Patients in the early surgery subgroup had their first inpatient PT session earlier than patients in the late subgroup (15.7 vs. 18.9 h, P<0.001). However, patients in the late subgroup achieved a farther total gait distance (98.2 vs. 75.4, P=0.011). Late surgery was a significant predictor of more hours of PT (est.=0.256, P=0.016) and longer length of stay (est.=2.277, P=0.001). There were no significant differences in readmission and revision rates. CONCLUSIONS: Patients who undergo surgery later in the week may experience more nonsurgical neurologic complications, longer wait times for inpatient PT appointments, and longer lengths of stay. This analysis showed no adverse effect of later weekday surgery as it relates to total complications, readmissions, and reoperations. LEVEL OF EVIDENCE: Level III.

Impact of Off-Hour Admission on In-Hospital Outcomes for Patients With Stroke Receiving Reperfusion Therapy in China.

BACKGROUND: The structure and staffing of hospitals greatly impact patient outcomes, with frequent changes occurring during nights and weekends. This retrospective cohort study assessed the impact of admission timing on in-hospital management and outcomes for patients with stroke receiving reperfusion therapy in China using data from a nationwide registry. METHODS: Data from patients receiving reperfusion therapy were extracted from the Chinese Stroke Center Alliance. Hospital admission time was categorized according to day/evening versus night and weekday versus weekend. Primary outcomes were in-hospital death or discharge against medical advice, hemorrhage transformation, early neurological deterioration, and major adverse cardiovascular events. Logistic regression was performed to compare in-hospital management performance and outcomes based on admission time categories. RESULTS: Overall, 42 381 patients received recombinant tissue-type plasminogen activator (r-tPA) therapy, and 5224 underwent endovascular treatment (EVT). Patients admitted during nighttime had a higher probability of receiving r-tPA therapy within 4.5 hours from onset or undergoing EVT within 6 hours from onset compared with those admitted during day/evening hours (adjusted odds ratio, 1.04 [95% CI, 1.01-1.08]; P=0.021; adjusted odds ratio, 1.72 [95% CI, 1.59-1.86]; P<0.001, respectively). However, no significant difference was observed between weekend and weekday admissions for either treatment. No notable differences were noted between weekends and weekdays or nighttime and daytime periods in door-to-needle time for r-tPA or door-to-puncture time for EVT initiation. Furthermore, weekend or nighttime admission did not have a significant effect on the primary outcomes of r-tPA therapy or EVT. Nevertheless, in patients undergoing EVT, a higher incidence of pneumonia was observed among those admitted at night compared with those admitted during day/evening hours (adjusted odds ratio, 1.22 [95% CI, 1.05-1.42]; P=0.011). CONCLUSIONS: Patients admitted at nighttime were more likely to receive r-tPA therapy or EVT within the time window recommended in the guidelines. However, patients receiving EVT admitted at night had an increased risk of pneumonia.

Association between weekend catch-up sleep and depressive symptoms in American adults: Finding from NHANES 2017-2020.

BACKGROUND: The effect of weekend catch-up sleep (WCS) on depressive symptoms is inconsistent among different populations, with limited evidence in Americans. Therefore, we aimed to investigate the association between WCS and depressive symptoms in American adults. METHODS: We recruited 7719 participants from the National Health and Nutrition Examination Survey (NHANES) 2017-2020. Information on sleep duration and depressive symptoms were assessed by several self-reported questions and Patient Health Questionnaire-9 (PHQ-9), respectively. Then, WCS duration was calculated as weekend sleep duration minus weekday sleep duration, and WCS was further defined as WCS duration >0 h. Survey designed regression analyses were used to assess the association of WCS and depressive symptoms. RESULTS: In fully adjusted multivariate logistic regression models, the odds ratio (95 % confidence interval) for depressive symptoms and the ß (95 % confidence interval) for PHQ-9 score in response to WCS were 0.746 (0.462, 1.204; P = 0.218) and -0.429 (-0.900, 0.042; P = 0.073), respectively. Besides, the smooth relationship presented L-shaped, and only WCS duration of 0-2 h was statistically significantly associated with depressive symptoms or PHQ-9 score. Subgroup analyses showed that the negative associations were stronger among men, adults younger than 65 years, and those with short weekday sleep duration (P for interaction <0.05). LIMITATIONS: The cross-sectional design limits the capability for causal relationship between WCS and depressive symptoms. CONCLUSIONS: This study suggests that moderate WCS is associated with reduced odds of depressive symptoms, which provides additional epidemiological evidence for the effects of sleep on depressive symptoms.

Towards 24/7 MRI: the effect of routine weekend inpatient MRI scanning on patient waiting times.

BACKGROUND: Demand for inpatient MRI outstrips capacity which results in long waiting lists. The hospital commenced a routine weekend MRI service in January 2023. AIM: The aim of this study was to investigate the effect of a limited routine weekend MRI service on MRI turnaround times. METHODS: Waiting times for inpatient MRI scans performed before and after the introduction of weekend MRI from January 1 to August 31, 2022, and January 1 to August 31, 2023, were obtained. The turnaround time (TAT) and request category for each study were calculated. Category 1 requests were required immediately, category 2 requests were urgent and category 3 requests were routine. RESULTS: There was a 6% (n = 128) increase in MRI inpatient scanning activity in 2023 (n = 2449) compared to 2022 (n = 2322). There was a significant improvement in overall mean TAT for inpatient MRIs (p < .001) in 2023 (mean 65.2 h, range 0-555 h) compared to 2022 (mean 98.3 h, range 0-816 h). There was no significant difference in the mean waiting time for category 1 MRIs between 2022 and 2023. There was a significant improvement (p < .001) in mean waiting time in 2023 (mean 37.2 h, range 0-555) compared to 2022 (mean 55.4 h, range 0-816) for category 2 MRI. The mean waiting time for category 3 studies also significantly improved (p < .001) in 2023 (mean 93.4 h, range 1-2663) when compared to 2022 (mean 154.8, range 1-1706). CONCLUSION: Routine weekend inpatient MRI significantly shortens inpatient waiting times.

Investigating pedestrian-vehicle crashes on interstate highways: Applying random parameter binary logit model with heterogeneity in means.

In the U.S., the interstate highway system is categorized as a controlled-access or limited-access route, and it is unlawful for pedestrians to enter or cross this type of highway. However, pedestrian-vehicle crashes on the interstate highway system pose a distinctive safety concern. Most of these crashes involve 'unintended pedestrians', drivers who come out of their disabled vehicles, or due to the involvement in previous crashes on the interstate. Because these are not 'typical pedestrians', a separate investigation is required to better understand the pedestrian crash problem on interstate highways and identify the high-risk scenarios. This study explored 531 KABC (K = Fatal, A = Severe, B = Moderate, C = Complaint) pedestrian injury crashes on Louisiana interstate highways during the 2014-2018 period. Pedestrian injury severity was categorized into two levels: FS (fatal/severe) and IN (moderate/complaint). The random parameter binary logit with heterogeneity in means (RPBL-HM) model was utilized to address the unobserved heterogeneity (i.e., variations in the effect of crash contributing factors across the sample population) in the crash data. Some of the factors were found to increase the likelihood of pedestrian's FS injury in crashes on interstate highways, including pedestrian impairment, pedestrian action, weekend, driver aged 35-44 years, and spring season. The interaction of 'pedestrian impairment' and 'weekend' was found significant, suggesting that alcohol-involved pedestrians were more likely to be involved in FS crashes during weekends on the interstate. The obtained results can help the 'unintended pedestrians' about the crash scenarios on the interstate and reduce these unexpected incidents.

The "Weekend Effect" in Extracorporeal Cardiopulmonary Resuscitation.

Background: The phenomenon known as the "weekend effect" impacts various medical disciplines. We compared outcomes between regular hours and off hours to investigate the presence of the weekend effect in extracorporeal cardiopulmonary resuscitation (ECPR). Methods: Between January 2018 and December 2020, 159 patients at our center were treated with veno-arterial extracorporeal membrane oxygenation (ECMO) for cardiac arrest. We assessed the time required for ECMO preparation, the rate of successful weaning, and the rate of in-hospital mortality. These factors were compared among regular hours ("daytime": weekdays from 7:00 AM-7:00 PM), off hours on weekdays ("nighttime": weekdays from 7:00 PM-7:00 AM), and off hours on weekends and holidays ("weekend": Fridays at 7:00 PM to Mondays at 7:00 AM). Results: The time from the recognition of cardiac arrest to the arrival of the ECMO team was shortest for the daytime group and longest for those treated over the weekend (daytime, 10.0 minutes; nighttime, 12.5 minutes; weekend, 15.0 minutes; p=0.064). The time from the ECMO team's arrival to ECMO initiation was shortest for the daytime and longest for the nighttime group (daytime, 13.0 minutes; nighttime, 18.5 minutes; weekend, 14.0 minutes; p=0.028). No significant difference was observed in the rate of successful ECMO weaning (daytime, 48.3%; nighttime, 39.5%; weekend, 36.1%; p=0.375). Conclusion: In situations involving CPR, the time to arrival of the ECMO team was longer during off hours. Furthermore, ECMO insertion required more time at night than during the other periods. These findings warrant specific training in decision-making and emergent ECMO insertion.

Is the association between social jetlag and BMI mediated by lifestyle? A cross-sectional survey study in the Dutch general population.

OBJECTIVE: Social jetlag is a discordance between the social and biological rhythm and is associated with higher HbA1c, higher BMI, and higher odds of obesity. The pathways that could explain these associations are still debated. This study aims to assess the mediating role of several lifestyle factors in the cross-sectional association between social jetlag and BMI. METHODS: We used cross-sectional data from 1784 adults from urban areas in the Netherlands, collected in 2019. Social jetlag (difference in midpoint of sleep between week and weekend nights) was categorized as low(<1 h), moderate(1-2h), and high(>2 h). BMI(kg/m2) was calculated from self-reported height and weight. The association between social jetlag and BMI was assessed using linear regression, adjusted for sex, age, education, and sleep duration and stratified for the effect modifier stress (high vs. low). Mediation analysis was performed for self-reported smoking, physical activity, alcohol consumption, and adherence to a healthy diet. RESULTS: High social jetlag was associated with higher BMI (0.69 kg/m2,95%CI 0.05;1.33). This association was stronger in people with high stress (0.93 kg/m2,95%CI 0.09;1.76). Social jetlag was also associated with higher odds of smoking, lower physical activity, higher alcohol consumption, and lower healthy diet adherence. In people with high stress, these factors mediated 10-15% of the association between social jetlag and BMI. CONCLUSIONS: Social jetlag is associated with higher BMI and this association is stronger in people with high stress. In people with high stress, healthy diet adherence mediated 12% of this association. Other pathways involved in this association should be further investigated.

Associations of lifestyle with burnout risk and recovery need in Flemish secondary schoolteachers: a cross-sectional study.

Teacher burnout and high recovery need are a topic of concern for educational institutions. This cross-sectional study assesses the association between lifestyle (including physical activity (PA), sedentary behavior (SB), dietary behavior and sleep), burnout risk and recovery need in 1878 secondary schoolteachers in Flanders. In September-October 2019, an online-questionnaire assessing burnout (i.e., emotional exhaustion, depersonalization, personal accomplishment), recovery need, PA-domains, SB-domains, dietary behavior (including fruit and vegetable intake and diet quality) and sleep during the week and the weekend was completed. Multiple linear regression models were applied. More emotional exhaustion was associated with more domestic and garden PA, work-related SB and sleep during the weekend, whereas higher scores of emotional exhaustion were associated with lower fruit intake, diet quality and less sleep during the week. More depersonalization was associated with more leisure-time PA and work-related SB and with lower fruit intake. Teachers showing more recovery need, showed more domestic and garden PA and work-related SB, but less leisure-time PA and sleep during the week. Future research should use longitudinal or experimental designs to get more insight into causality. Despite the low effect sizes, education networks and schools might benefit from promoting and facilitating a healthy lifestyle in secondary schoolteachers.

Antibiotic Prescribing in Dental Medicine-Best Practices for Successful Implementation.

With rising rates of antimicrobial resistance throughout the world, it is time to revisit antibiotic prescribing policies and practices, and dentistry is an important area for focused intervention, as it accounts for up to 15% of all antimicrobial prescriptions. In this narrative review, we have analyzed the current state of the knowledge, attitudes, and practice regarding antimicrobial use among dental professionals, and we have identified a set of seven recurring themes that drive inappropriate antibiotic prescribing in dental medicine. These include: 1. Prescribing antibiotics to delay or avoid dental treatment. 2. Overlooking the 5Ds-dental treatment (source control), dental condition (indication), drug (antibiotic choice), dose, and duration. 3. Relying on education from the distant past and on previous experience. 4. The heterogeneity of (too many) guideline recommendations leads to confusion and over-prescribing. 5. Decreased access to guideline information in private practice. 6. Psychological factors such as pressure to prescribe, comfort prescribing and the weekend effect, and 7. Feeling removed from antimicrobial resistance and externalizing responsibility. Based on the existing knowledge, we propose a framework based on four key pillars for focused intervention: 1. Education. 2. Internalizing responsibility. 3. Recognizing recurring counter-productive practices, and 4. Addressing recurring counter-productive practices. This framework can be applied in different dental settings to ensure best practices for the successful implementation of rational antimicrobial prescribing.

Late delivery of antibiotics: a new proxy for antimicrobial stewardship?

OBJECTIVES: To analyse the time elapsed between the prescription of antibiotics and their pick-up at the pharmacy and identify their determinants. METHODS: We used the National Health Insurance reimbursement databases on antibiotics delivery in 2021 in La Manche, Western France. Delayed delivery was defined as the time between prescription and antibiotic pick-up of >24 hours. RESULTS: We enrolled 207 250 prescriptions, of whom 18 728 (9.0%) collected their antibiotics at the community pharmacy >24 hours after prescription. Independent factors associated with delayed delivery were age >15 years (15-64 years: OR, 2.08 [1.98-2.19]; p < 0.001 and >65 years OR, 3.27 [3.09-3.46]; p < 0.001), male sex (OR, 00.77 [0.75-0.80]; p < 0.001), low income (OR, 1.08 [1.02-1.15]; p = 0.013), chronic diseases (OR, 1.29 [1.25-1.34]; p < 0.001), prescription during the weekend (OR, 1.49 [1.43-1.56]; p < 0.001), summer season (OR, 1.11 [1.07-1.16]; p < 0.001), lock-down period (OR, 4.15 [3.80-4.53]; p < 0.001), and distance from the patient home to his general practitioner office and the pharmacy >10 km (OR, 1.17 [1.13-1.21]; p < 0.001). DISCUSSION: The delayed delivery of antibiotics after prescription is not uncommon, especially in elderly patients, those with low income or chronic diseases, in case of weekend prescriptions, summer season and when the pharmacy is > 10 km away from the patient's home and his general practitioner office. If confirmed, this potential indicator of unnecessary prescriptions, readily available in some databases, may be used to target antimicrobial stewardship programmes and monitor the effect of interventions.

Transient anticonvulsant effects of time-restricted feeding in the 6-Hz mouse model.

INTRODUCTION: Intermittent fasting enhances neural bioenergetics, is neuroprotective, and elicits antioxidant effects in various animal models. There are conflicting findings on seizure protection, where intermittent fasting regimens often cause severe weight loss resembling starvation which is unsustainable long-term. Therefore, we tested whether a less intensive intermittent fasting regimen such as time-restricted feeding (TRF) may confer seizure protection. METHODS: Male CD1 mice were assigned to either ad libitum-fed control, continuous 8 h TRF, or 8 h TRF with weekend ad libitum food access (2:5 TRF) for one month. Body weight, food intake, and blood glucose levels were measured. Seizure thresholds were determined at various time points using 6-Hz and maximal electroshock seizure threshold (MEST) tests. Protein levels and mRNA expression of genes, enzyme activity related to glucose metabolism, as well as mitochondrial dynamics were assessed in the cortex and hippocampus. Markers of antioxidant defence were evaluated in the plasma, cortex, and liver. RESULTS: Body weight gain was similar in the ad libitum-fed and TRF mouse groups. In both TRF regimens, blood glucose levels did not change between the fed and fasted state and were higher during fasting than in the ad libitum-fed groups. Mice in the TRF group had increased seizure thresholds in the 6-Hz test on day 15 and on day 19 in a second cohort of 2:5 TRF mice, but similar seizure thresholds at other time points compared to ad libitum-fed mice. Continuous TRF did not alter MEST seizure thresholds on day 28. Mice in the TRF group showed increased maximal activity of pyruvate dehydrogenase in the cortex, which was accompanied by increased protein levels of mitochondrial pyruvate carrier 1 in the cortex and hippocampus. There were no other major changes in protein or mRNA levels associated with energy metabolism and mitochondrial dynamics in the brain, nor markers of antioxidant defence in the brain, liver, or plasma. CONCLUSIONS: Both continuous and 2:5 TRF regimens transiently increased seizure thresholds in the 6-Hz model at around 2 weeks, which coincided with stability of blood glucose levels during the fed and fasted periods. Our findings suggest that the lack of prolonged anticonvulsant effects in the acute electrical seizure models employed may be attributed to only modest metabolic and antioxidant adaptations found in the brain and liver. Our findings underscore the potential therapeutic value of TRF in managing seizure-related conditions.

Neurobehavioral functions during recurrent periods of sleep restriction: effects of intra-individual variability in sleep duration.

STUDY OBJECTIVES: To investigate whether neurobehavioral impairments are exacerbated during successive cycles of sleep restriction and recovery in young adults, and whether a variable short sleep schedule can mitigate these impairments relative to a stable one. METHODS: Fifty-two healthy young adults (25 males, aged: 21-28) were randomly assigned to the stable short sleep group, the variable short sleep group, or the control group in this laboratory-based study. They underwent two baseline nights of 8-hour time-in-bed (TIB), followed by two cycles of "weekday" sleep opportunity manipulation and "weekend" recovery (8-hour TIB). During each manipulation period, the stable short sleep and the control groups received 6- and 8-hour TIBs each night respectively, while the variable short sleep group received 8-hour, 4-hour, 8-hour, 4-hour, and 6-hour TIBs from the first to the fifth night. Neurobehavioral functions were assessed five times each day. RESULTS: The stable short sleep group showed faster vigilance deterioration in the second week of sleep restriction as compared to the first. This effect was not observed in the variable short sleep group. Subjective alertness and practice-based improvement in processing speed were attenuated in both short sleep groups. CONCLUSIONS: In young adults, more variable short sleep schedules incorporating days of prophylactic or recovery sleep might mitigate compounding vigilance deficits resulting from recurrent cycles of sleep restriction. However, processing speed and subjective sleepiness were still impaired in both short sleep schedules. Getting sufficient sleep consistently is the only way to ensure optimal neurobehavioral functioning. CLINICAL TRIAL: Performance, Mood, and Brain and Metabolic Functions During Different Sleep Schedules (STAVAR), https://www.clinicaltrials.gov/study/NCT04731662, NCT04731662.