Antimicrobials in the Hospital are Unevenly Discontinued on Weekdays

Objective Amid the global spread of antimicrobial resistance, antimicrobial stewardship should be further promoted in the clinical setting. Our previous study suggested an intra-week disproportion of discontinuation of broad-spectrum antibiotics. We therefore explored the generalization of this prescription trend by investigating the use of all intravenous antibiotics. Methods A retrospective, observational study. Patients Between January 1, 2018, and December 31, 2020, we collected data on the initiation and discontinuation of intravenous antimicrobials on each day of the week and on days after holidays at Okayama University Hospital, Japan. We compared the monthly antimicrobial prescription initiation and discontinuation using the Kruskal-Wallis test and Mann-Whitney U-test with Bonferroni correction as a post-hoc procedure. Results Data from 15,293 hospitalized cases were analyzed. The initiation of antimicrobials differed slightly among days of the week, although this trend was clinically insignificant. Compared with the initiations, antimicrobial discontinuations were disproportionately biased among the weekdays, tending to occur on Mondays (p <0.001) about twice as often as on other days. Similarly, antimicrobials were unevenly discontinued on the day after holidays compared to other days (p <0.001), with an approximately 2-fold difference. The use of antimicrobials in the hospital was thus unequally terminated on weekdays. Conclusion To further promote antimicrobial stewardship, clinicians should be aware of the influence of behavioral, environmental, and social factors on antimicrobial prescription, which is seemingly beyond medical indications.

Clinical characteristics and outcomes of patients with venous thromboembolism according to diagnosis on weekends versus on weekdays

There are uncertainties on the influence of the days of diagnosis in a week (weekends versus weekdays) on clinical outcomes in patients with acute venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT). The COMMAND VTE registry is a multicenter cohort study enrolling 3027 consecutive patients with acute symptomatic VTE. The current study population consisted of 337 patients diagnosed on weekends and 2690 patients diagnosed on weekdays. We compared the clinical characteristics, management strategies and 30-day outcomes between the 2 groups. The patients diagnosed on weekends more often presented with PE (72% vs. 55%, P < 0.001), and with more severe hemodynamic condition for PE patients. The patients diagnosed on weekends more often received initial parenteral anticoagulation therapy and thrombolysis than those diagnosed on weekdays. The cumulative 30-day incidence of all-cause death was not significantly different between the two groups among PE patients (diagnosis on weekends: 6.2% vs. diagnosis on weekdays: 6.5%, P = 0.87), as well as among DVT patients (0.0% vs. 1.5%, P = 0.24). The most frequent cause of deaths was fatal PE in both groups among PE patients. The risks for recurrent VTE and major bleeding at 30-day were not significantly different between the 2 groups among PE patients, nor among DVT only patients. In conclusion, the VTE patients diagnosed on weekends presented more often with PE, and with more severe condition for PE patients. Nevertheless, the risk for 30-day mortality was not significantly different between patients diagnosed on weekends and on weekdays.

Day-to-day variability of multiple sensor-based physical activity parameters in older persons with dementia

OBJECTIVE

To investigate the day-to-day variability of various sensor-based physical activity (PA) parameters and to analyze effects of weekdays vs. weekend days as well as the influence of concomitant factors (gender, living conditions, cognitive status, physical performance, and level of PA) in multi-morbid, older persons with mild-to-moderate stage dementia.

METHODS

In 53 participants, PA was recorded on three consecutive days. Day-to-day variability was estimated by calculating intraclass correlation coefficients (ICCs) for two consecutive days each (Friday-Saturday, Saturday-Sunday).

RESULTS

Almost all non-walking parameters (lying time, sitting time, standing time, active time, inactive time, and sit-to-stand transitions) showed a consistently low day-to-day variability for Friday-Saturday as well as Saturday-Sunday (ICCs: .60-.96) and hence remained almost unaffected by specific days of the week and concomitant factors. Only the sub-analysis by level of PA revealed slightly deviating results (ICCs: .38-.89). The walking parameters (walking time, walking episodes, and steps) revealed a higher day-to-day variability for Friday-Saturday (ICCs: .01-.40) and a generally lower variability for Saturday-Sunday (ICCs: -.08 - .88), also depending on the respective concomitant factors.

CONCLUSIONS

Two consecutive days are adequate to reliably assess non-walking parameters, whereas walking parameters showed higher day-to-day variability with a relevant influence of type of days and concomitant factors.

Cannabis use motives on weekends versus weekdays: Direct and indirect relations with cannabis use and related problems

College cannabis users report using more cannabis during the weekend than on weekdays, yet little attention has been paid to the role of weekend and weekday-specific motives for use. The present investigation evaluated the impact of weekend and weekday-specific cannabis motives on cannabis use and related problems among current (past-3 month) cannabis using undergraduates (N = 276). Participants reported more cannabis use motives during the weekend than weekday. Enhancement and social motives were greater than coping, conformity, and expansion motives during weekends. Enhancement and conformity motives were indirectly related to problems via cannabis use frequency for both weekdays and weekends. Yet social, coping, and expansion motives were indirectly related to problems via cannabis use frequency for only weekdays. Findings support the differential impact of weekend and weekday-specific motives on cannabis use and related problems.

Curvilinear associations of sleep patterns during weekdays and weekends with glycemic control in type 2 diabetes: the Hong Kong Diabetes Registry

AIMS

We aimed to explore the associations of sleep patterns during weekdays and weekends with glycemic control in patients with type 2 diabetes.

METHODS

We examined the association between indices of glycemic control [glycated hemoglobin (HbA_1c) and fasting plasma glucose (FPG)] and sleep parameters (sleep duration, bedtime, and differences of sleep duration during weekdays and weekends) from adults with type 2 diabetes recruited in a prospective cohort enrolling from hospital medical clinics. Restricted cubic spline regression was used to examine the relationships between the glycemic indices and sleep parameters.

RESULTS

Excluding shift workers, a total of 3508 patients enrolled between July 2010 and July 2014 were included in this analysis. Mean age was 53.9 [standard deviation (SD) 8.7] years, and mean disease duration of diabetes was 8.3 (SD 7.1) years. Fifty-nine percentage were men. Mean sleep duration during weekdays and difference of sleep durations between weekdays and weekends were 7.7 (SD 1.3) hours and 0.6 (SD 1.2) hours, respectively. Mean HbA_1c and FPG were 7.6 (1.5) % and 7.6 (2.5) mmol/L, respectively. Using restricted cubic spline regressions with successive adjustments of potential confounders, sleep duration difference between weekdays and weekends remained significantly associated with both HbA_1c and FPG in a curvilinear manner. Sleep duration of about 1 h more during weekends when compared to weekdays was associated with beneficial effect in HbA_1c (-0.13 %, 95 % confidence interval -0.24 to -0.02).

CONCLUSIONS

In type 2 diabetes, regular sleeping habit with modest sleep compensation during weekends has positive impact on glycemic control.

Weekday-weekend patterns of physical activity and screen time in parents and their pre-schoolers

Background

This study focuses on the comparison of weekday/weekend parent-child behavioural patterns (step count (SC) and screen time (ST)) and answers the question of whether achieving the recommendations for daily SC (10,000) in parents also helps their preschool children achieve the recommended daily SC (11,500).

Methods

The participants (278 parents aged 30–45 and their 194 children aged 4–7) were randomly recruited from 10 Czech public kindergartens. The participants recorded SC (pedometer Yamax Digiwalker SW-200) and ST duration (proxy-report) for seven consecutive days (≥8 h/day) during September–October 2014 and April–May 2015. Differences between weekdays/weekends SC or ST were tested using a paired t-test. The odds of achieving the recommended daily SC for children were estimated using general logistic regression separately for weekdays and weekends.

Results

Only the mothers were found to have a significantly lower SC at weekends than on weekdays. All of the participants showed significantly more ST at weekends than on weekdays (daughters: 78.6 vs. 45.7 min/day, p < 0.001; sons: 78.8 vs. 55.8 min/day; mothers: 93.0 vs. 68.3 min/day; and fathers: 116.6 vs. 87.5 min/day). Daughters and sons were significantly more likely to achieve daily SC recommendation if a) the SC on weekdays during the daily routine in kindergarten exceeded the median of kindergarten SC or b) at weekends if their mother (OR: 9.67, 95 % CI: 3.57–26.23) exceeded 10,000 steps a day.

Conclusions

Especially at weekends, preschoolers have higher odds of meeting the recommended 11,500 steps per day when their mother reaches 10,000 steps per day and this is independent of the amount of parents’ ST. Moreover, physical activity in kindergarten helps preschool children meet the 11,500 recommended steps per day on weekdays. Therefore, interventions to promote physical activity in preschoolers should focus on kindergartens and encourage involvement of their families.

Time trends: a ten-year comparison (2005-2015) of pedometer-determined physical activity and obesity in Czech preschool children

Background

To explore the time trends (2005–2015) of pedometer-determined weekday and weekend physical activity (PA) and obesity prevalence in 4–7-year-old Czech preschool children and changes in proportion of kindergarten vs. leisure-time PA.

Methods

The study compared data of two cross-sectional cohorts of preschool children (2005: 92 boys and 84 girls; 2015: 105 boys and 87 girls) in the Czech Republic, using the same measurements and procedures in both cases. PA was monitored by the Yamax Digiwalker SW-200 pedometer for at least eight continuous hours a day over seven consecutive days. Body weight and height were measured using calibrated Tanita scales and anthropometry. The analysis of variance was conducted to examine the gender and cohort effect on step counts. The t-test was used to examine the difference in step counts in kindergarten (or leisure-time) between non-obese and obese children, and the chi-square test compared the prevalence of obesity between 2005 and 2015.

Results

The steps/day (mean ± standard deviation) of preschoolers was significantly higher (p < 0.05) in 2015 (11,739 ± 4,229 steps/day) than in 2005 (10,922 ± 3,181 steps/day); and (p < 0.001) in boys (11,939 ± 3,855 steps/day) than in girls (10,668 ± 3,587 steps/day). In 2015, girls, but not boys, had a significantly (p < 0.01) greater step count on weekdays than in 2005, but not at weekends. A decline of leisure-time step counts on weekdays between 2005 and 2015 in girls (6,865₂₀₀₅ vs. 6,059₂₀₁₅, p < 0.01) and boys (7,861₂₀₀₅ vs. 6,436₂₀₁₅, p < 0.001) is compensated for by the increase of step counts in kindergarten (girls: 3,058₂₀₀₅ vs. 5,330₂₀₁₅, and boys: 4,003₂₀₀₅ vs. 5,999₂₀₁₅, p < 0.001). The prevalence of obesity was not significantly different either in 2005 or 2015 among preschool girls (7.14 % ₂₀₀₅ vs. 9.20 % ₂₀₁₅) or boys (6.52 % ₂₀₀₅ vs. 9.52 % ₂₀₁₅).

Conclusion

The steps/day of preschoolers was higher in 2015 than in 2005; this higher level of PA was the result of increased PA in kindergartens over the last ten years, particularly among girls. Thus, the current PA program in kindergartens effectively compensates for the decline in PA in leisure-time of weekdays of non-obese and obese preschoolers compared to 2005 and 2015. Prevalence of obesity among Czech preschool children remains relatively stable between 2005 and 2015.