Additional Days Research Articles

Fungal infection-related conditions and outcomes in severe COVID-19: a nationwide case-control study

BackgroundFungal infections are significant complications of severe coronavirus disease 2019 (COVID-19). Although various risk factors for poor outcomes in patients with COVID-19 have been identified, clinical and treatment factors associated with fungal infections in patients with severe COVID-19 remain unclear. This study aimed to elucidate clinical factors associated with fungal infections during severe COVID-19 treatment.MethodsThis was a post hoc analysis of the J-RECOVER study, a multicenter retrospective observational study involving patients with COVID-19 who required admission at 66 hospitals between January and September 2020. Inclusion criteria were ages ≥ 18 years, COVID-19 diagnosis with reverse-transcription polymerase chain reaction, and treatment with mechanical ventilation (MV). Patients who received antifungal drugs before MV were excluded. Potential predictors were identified through univariate analysis of patient and treatment characteristics between patients with- and those without fungal infection, which was defined as antifungal agent use for ≥ 5 days. To account for facility-specific data clustering, generalized estimating equations (GEE) were employed as adjusted analyses to calculate the relative risks of potentially associated factors. Two sensitivity analyses were performed with modified definitions for the two groups: patients who received antifungal drugs for ≤ 4 days were excluded, and fungal infection was re-defined as antifungal drug use for ≥ 14 days.ResultsAmong 4,915 patients in the J-RECOVER study, 559 adults with COVID-19 who required MV were included. Fungal infections occurred in 57 (10.2%) patients. Univariate analyses identified age, age ≥ 65 years, D-dimer level, remdesivir use, steroid use, and duration of steroid therapy as potential predictors of fungal infections. Multivariate analysis using GEE on these six factors revealed that only the duration of steroid use was significantly associated with an increased risk of fungal infection (odds ratio [OR] for a day increase: 1.01; 95% confidence interval [CI]: 1.00–1.01; p < 0.001). The two sensitivity analyses similarly showed that the duration of steroid use was associated with fungal infection (odds ratio for a day increase: 1.01; 95% CI: 1.00–1.01; p < 0.001 for both).ConclusionsIn patients with severe COVID-19 requiring MV, each additional day of steroid use was associated with prolonged use of antifungal medications for ≥ 5 days.

Factors affecting survival of foals with pneumonia in a referral hospital

BackgroundPneumonia is a common condition in ailing neonatal foals, and it remains an important cause of morbidity and mortality in this veterinary patient group. Factors affecting the survival of young foals with pneumonia have not been thoroughly investigated. The aim of this study was to explore the potential prognostic factors associated with survival of these foals. Fifty foals under one month of age with pneumonia were included in this retrospective clinical study. The foals were divided into groups based on survival (survived to discharge or died/euthanised during hospitalisation). Multiple clinical and laboratory variables were investigated as risk factors with univariate logistic regression analyses and subsequently with multivariate analyses. If a variable showed prediction potential in regression analysis, a receiver operating characteristic (ROC) analysis was conducted.ResultsIn univariate analysis, odds (OR, 95% CI) of non-survival were associated with higher respiratory rate (RR) on the first day after admission to hospital (D1) (1.32, 1.07–1.62, P = 0.009, for each 5-unit increase) and positive bacterial blood culture (12.08, 1.88–77.67, P = 0.009). Odds of non-survival were decreased for Standardbred breed (0.11, 0.01–0.96, P = 0.046) and for foals with longer hospitalisation, with each additional day in hospital further reducing the odds (0.59, 0.40–0.86, P = 0.006). In multivariate analysis, odds of non-survival were associated only with higher RR on D1 (1.36, 1.07–1.71, P = 0.011, for each 5-unit increase). In ROC analysis, optimal cut-off value for RR was ≥ 55/min with sensitivity 75.0% and specificity 76.3%. Based on predictive values, RR < 55/min on D1 favoured survival.ConclusionsHigher RR on D1 is a predictor of non-survival in foals with pneumonia in this study, increasing the odds of death by 36% for each 5-unit increase in RR. Respiratory rate below 55/min on D1 favours survival. These findings could assist in early identification of foals that are at increased risk of mortality, thereby aiding in treatment decisions.

Unplanned Readmission Rate Before Interval Appendectomy After Nonoperative Management of Complicated Appendicitis.

There remains clinical equipoise regarding the preference for upfront appendectomy or nonoperative management for patients with complicated appendicitis. However, the natural history of the appendix following nonoperative management and pending interval appendectomy in children is not well characterized, and the risk of recurrent appendicitis as a function of time from index admission not known. The Pediatric Health Information System (PHIS) was queried for all patients younger than 18 with an ICD-10 diagnosis code for complicated appendicitis admitted between 2018-2021. Patients were included for analysis if they received antibiotics on three or more consecutive days and did not undergo appendectomy during index admission. Kaplan-Meier analysis was performed to determine rates of unplanned readmission, defined as patients readmitted for appendicitis and receiving antibiotics on three or more consecutive days following index admission. 2,826 patients were included in the study for complicated appendicitis. 2,016 (71.4%) patients underwent appendectomy, while the remaining 810 did not undergo appendectomy. Kaplan-Meier survival analysis demonstrated a 7% decrease unplanned readmission rates for each additional day patients were removed from index admission (HR 0.93, 95% CI 0.89-0.96). Additionally, unplanned readmission rates in the first 50 days following index admission were twice as high as days 50-100 (HR 2.31, 95% CI 1.76-3.05). The highest likelihood of recurrent appendicitis or complications following nonoperative management of complicated appendicitis occurs in the first 50 days following index admission. This information will help surgeons during shared decision-making conversations regarding timing of interval appendectomy.

Prolonged Venous Transit on Perfusion Imaging is Associated with Longer Lengths of Stay in Acute Large Vessel Occlusions.

Prolonged venous transit (PVT+) is a marker of venous outflow; it is defined as the presence or absence of time-to-maximum ≥10 seconds timing in either the superior sagittal sinus or torcula. This novel perfusion imaging-based metric has been associated with higher odds of mortality and lower odds of functional recovery. This study aims to assess the relationship between PVT on admission perfusion imaging and length of hospital stay in large vessel occlusion strokes successfully reperfused with mechanical thrombectomy. Acute ischemic stroke patients with large vessel occlusions in the anterior circulation successfully treated with thrombectomy between 01/2017 and 09/2022 were retrospectively reviewed. The primary outcome was length of stay in the hospital due to the acute stroke event. Univariable and forward stepwise multivariable linear regressions were performed for the primary outcome. Of 109 patients meeting inclusion, median age was 71 (interquartile range [IQR] 62-80) years. Median hospital length of stay was significantly greater in PVT+ patients (9 [IQR 6-18] days) compared to PVT-patients (6 [IQR 4-12] days, p=0.03). In multivariable regression, PVT+ was significantly associated with length of stay, and PVT+ was associated with approximately two additional days of hospital stay compared to PVT-(p=0.03). In successfully reperfused large vessel occlusion strokes, PVT+ was associated with an additional two days of hospital stay on average compared to PVT-patients, when adjusting for other clinical covariables. This simple, novel imaging metric is robust in correlating with a range of short and long term clinical outcomes. VO = venous outflow; Tmax = time-to-maximum; PVT = prolonged venous transit; AIS-LVO = large vessel occlusion ischemic stroke; SSS = superior sagittal sinus; rCBF = relative cerebral blood flow; IQR = interquartile range; VIF = variance inflation factor.

Assessing the accuracy gap in early postoperative complication surveillance: ICD-10 codes versus manual curation-clinical and economic implications.

Assessing surgical outcomes, notably postoperative complications (PCs), is crucial for healthcare systems. However, reliance on International Classification of Diseases, 10th revision (ICD-10) codes, may be suboptimal. This study aims to compare the accuracy of ICD-10 codes against manual curation of electronic healthcare records (EHRs) for identifying 13 individual PCs and evaluate associated resource utilization. EHR data from 11,827 surgical cases across 18 Danish hospitals in November 2021 were analyzed. PCs were identified and extracted through both manual curation and ICD-10 codes. Outcomes such as readmission, admission days, intensive care unit (ICU) stays, reoperations, and radiology procedures were assessed as proxies for resource consumption. Statistical and economic analyses quantified resource utilization and associated costs. In total, 1047 PCs were found through manual curation and 439 PCs were found through ICD-10 codings. Only 218 of the PCs found through ICD-10 codes were retrieved during manual curation-corresponding to a correct ICD-10 coding of 20.8% of PCs. Patients with PCs experienced significantly higher resource utilization, including a 6.6 times higher readmission rate, 6 additional admission days, 2 extra ICU days, 7.7 times more reoperations. PCs incurred substantial economic costs, with additional admission days alone accounting for €25.5 million annually, over four times higher than estimates from ICD-10 codes. ICD-10 codes inadequately capture early PCs highlighting the need for improved detection strategies. The actual costs associated with PCs far exceed current estimates, emphasizing the necessity for enhanced monitoring for informed decision-making. In the Danish healthcare system, ICD-10 codes only capture approximately 21% of PCs, making it inadequate for surgical quality monitoring. The actual costs related to PCs, based on study assumptions, are more than four times higher than estimated from current standard. This calls for novel strategies for PC detection to improve healthcare as well as political and financial decision-making.

Oral foci of infection and their relationship with hospital stay after haematopoietic cell transplantation

PurposeOral focus screening is recommended before HCT (haematopoietic cell transplantation). Acute foci are generally treated pre-HCT. However, it is unclear whether chronic foci should be treated pre-HCT. This study aimed to evaluate the association between number of foci and early post-HCT morbidity and mortality.MethodsPatients who received an oral screening pre-HCT at Radboudumc between 2013 and 2023, with a recent panoramic radiograph, were included. Foci were defined as teeth or implants with deep pockets, furcation radiolucencies, periapical radiolucencies, deep caries, partial eruption or retained roots. Dental interventions were provided pre-HCT if deemed necessary and possible. Hospital length of stay (LOS), mortality and oral exacerbations were assessed in the first hundred days post-HCT. Hospital LOS was log-transformed to normalize its skewed distribution. Multivariate regression analyses were performed.ResultsFive hundred patients were included (median age 58 years, 37% female, 56% allogeneic). Four acute foci in two patients remained untreated pre-HCT. Forty-eight percent had at least one untreated chronic focus pre-HCT (mostly furcation radiolucencies and post-endodontic periapical lesions). Mean LOS was 22 days; 20 patients died, and four patients had an oral exacerbation before HCT day + 100. After adjustment for conditioning intensity, age, socioeconomic status and number of teeth, HCT recipients with ≥ 3 foci had five additional days in the hospital compared to those without foci (ratio of means 1.21; 95% CI 1.00 – 1.46). The number of foci was not associated with early post-HCT mortality.ConclusionThe presence of ≥ 3 oral foci is associated with extended hospital LOS in the first hundred days post-HCT.

Central Anticholinergic Syndrome Induced by Atropine Eye Drops: A Case Report

Purpose: We present a case of central anticholinergic syndrome following the administration of atropine eye drops.Case summary: A 60-year-old male presented with decreased visual acuity in his left eye and was diagnosed with intraocular lens dislocation. Preoperatively, Isopto atropine&lt;sup&gt;®&lt;/sup&gt; eye drops (1 drop at 15-minutes intervals) were used for pupil dilation. Within an hour of the first instillation, the patient exhibited drowsiness, disorientation, agitation, and urinary retention. Laboratory tests and computed tomography of the brain were unremarkable. Considering the recent administration of atropine eye drops, a diagnosis of central anticholinergic syndrome was made. The surgery was postponed and the patient recovered fully after 3 hours of observation. He remained asymptomatic during an additional day of hospitalization.Conclusions: A small dose of atropine eye drops even at a therapeutic dose can induce central anticholinergic syndrome. Therefore, ophthalmologists should be aware of this rare and severe complication.

Climate data integration into wheat performance evaluation reveals large inter-varietal responses

Abstract There is an urgent need to adapt crop breeding strategies to boost resilience in the face of a growing food demand and a changing climate. Achieving this requires an understanding of how weather and climate variability impacts crop growth and development. Using the United Kingdom (UK) as an example, we evaluate changes in the UK agroclimate and analyse how these have influenced domestic wheat production. Here we quantify spatial and temporal variability and changes in weather and climate across growing seasons over the last four decades (1981-2020). Drawing on variety trial data, we then use statistical modelling to explore the interaction between genotype and agroclimate variation. &amp;#xD;We show that changes in the UK agroclimate present both risks, and opportunities for wheat growers, depending on location. From 1981-2020, in Wales, the West Midlands, large parts of the North West, and Northern Ireland, there was an overall increase in frost risk in early spring of 0.15 additional frost days per year, whilst in the East early frost risk decreased by up to 0.29 days per year. Meanwhile, over the period 1987-2020, surface incoming shortwave radiation during grainfill increased in the East by up to 13% but decreased in Western areas by up to 15%. We show significant inter-varietal differences in yield responses to growing degree days, heavy rainfall and the occurrence of late frost. This highlights the importance of evaluating variety-climate interactions in variety trial analyses, and in climate-optimised selection of crops and varieties by growers. This work provides guidance for future research on how climate change is affecting the UK agroclimate and resulting impacts on winter cereal production.

Air Pollution and the Labor Market: Evidence from Wildfire Smoke

Abstract We study how air pollution impacts the U.S. labor market by analyzing the effects of drifting wildfire smoke. We link satellite-based smoke plume data with labor market outcomes to estimate that an additional day of smoke exposure reduces quarterly earnings by about 0.1%. Extensive margin responses, including employment reductions and labor force exits, explain 13% of the overall earnings losses. The implied welfare costs from lost earnings due to air pollution exposure is on par with standard valuations of the mortality burden. The findings highlight the importance of labor market channels in air pollution policy responses.

Influences on improved confidence among allied health students in working with Australian Indigenous people during a rural placement: a pre-post survey study

BackgroundTogether with addressing social determinants of health, culturally safe healthcare provision is essential for closing the health outcomes gap experienced by Aboriginal and Torres Strait Islander (Indigenous) Australians. Rural placements potentially provide students of the health professions with opportunities to enhance their knowledge and skills regarding cultural safety. We used rural placements data systematically collected from allied health students, including commencement- and end-of-placement questionnaire responses, to investigate the determinants of confidence in working with Indigenous people.MethodsThe study comprised data from all students who provided survey data at both commencement and end of their first placement directly supervised by the administering University Department of Rural Health during the period 2019–2022. Five-point ordered responses to the question ‘How confident do you feel about working with Aboriginal people?’ were used to assess student and placement-related determinants of confidence (Confident/Very confident versus other) at baseline and increased confidence (≥ 1 point) during the placement using crude and adjusted multivariable robust Poisson regression.ResultsParticipating students (N = 489) were from diverse allied health disciplines (including pharmacy n = 94, 19.2%; chiropractic n= 66, 13.5%; physiotherapy n= 65, 13.3%; social work n = 59, 12.1%; and occupational therapy 58, 11.9%). Confidence in dealing with Aboriginal people was lower at commencement among females compared with males (adjusted relative risk [aRR] 0.65; 95% confidence interval [CI] 0.53–0.80), and higher among students of Australian rural origin compared with others (aRR 1.49; CI 1.22–1.83) and those who reported previous experience working with Indigenous people compared with those reporting none (aRR 1.40; CI 1.14–1.72). Placement attributes associated with increased confidence working with Indigenous people between placement commencement and end were interaction with Indigenous people within the placement (aRR 2.32; CI 1.24–4.34), placement model reflecting more structured academic supervision (aRR 1.18; CI 1.02–1.37), and placement length (aRR per additional day 1.002; CI 1.001–1.004). These associations were robust to modelling that accounted for a ceiling effect on increased confidence.ConclusionsWhile influenced by students’ demographic attributes and prior experiences, confidence of allied health students in working with Indigenous people is enhanced during rural placements, particularly through direct contact with Indigenous people.

Heat and humidity on early-life outcomes: Evidence from Mexico

I provide evidence on the detrimental effect of in utero exposure to heat and humidity on children’s health at birth in a middle-income country, Mexico. Humidity affects the body’s ability to regulate heat via perspiration and may thus exacerbate the adverse effects of high temperatures. I link temperature and humidity exposure during pregnancy to individual outcomes regarding 25 million births and stillbirths from 2008 through 2021 using Mexican administrative records. The results show that high wet-bulb temperatures adversely affect birth outcomes. Specifically, each additional day per month with a wet-bulb temperature above 24 °C (equivalent to about 40 °C at 25% humidity) reduces birth weight by 1.21% and increases the likelihood of preterm birth by 2%. I find that the combined effects of humidity and high temperature on birth outcomes are greater than that of high temperature alone, suggesting that the damaging effects of high temperature can be underestimated when humidity is not accounted for. I also present evidence that the adverse effects of heat on health at birth can be mitigated by adopting air conditioning.

Cost and cost-effectiveness of abstinence-contingent wage supplements for adults experiencing homelessness and alcohol use disorder

BackgroundAlcohol use disorder, unemployment, and risk of homelessness are linked and often co-occurring, but most interventions do not address both alcohol use disorder and unemployment. The Abstinence-Contingent Wage Supplement (ACWS) model of the Therapeutic Workplace offers participants stipends or wage supplements contingent on both their abstaining from alcohol and engaging with an employment specialist or working in a community job. Wearable biosensors continuously tracked alcohol use. Methods and dataThe study randomized participants to Usual Care (UC) (n = 57) and ACWS (n = 62). We used micro-costing methods to identify the resources and costs of the 6-month ACWS intervention. The study team tracked the cost of incentives for wearing biosensors, stipends, and wage supplements. We used 6-month cost and effectiveness data to calculate incremental cost-effectiveness ratios and cost-effectiveness acceptability curves. ResultsOver the 6-month study period, average intervention costs per participant were $7282, with contingent stipends and wage supplements accounting for 50 % of intervention costs. We also reported average per participant costs for healthcare (UC: $17,785; ACWS: $26,734), justice system (UC: $131; ACWS: $153), and public welfare (UC: $1107; ACWS: $1275). The incremental cost-effectiveness ratios (ICERs) at 6 months were $80,911 for an additional participant abstinent, $3894 for an additional drinking free day, $22,756 for an additional participant employed, and $1514 for an additional day worked. ConclusionsThe ACWS intervention for adults with an alcohol use disorder and experiencing homelessness increased costs and improved alcohol use and employment outcomes compared with Usual Care. For policymakers seeking a solution to alcohol use and unemployment with populations experiencing homelessness, ACWS may be a cost-effective solution.

Epistaxis in COVID positive ICU patients, implications, and future interventions

PurposeEpistaxis in critically ill patients may prevent the use of non-invasive ventilation and impair nasal oxygen delivery. Since the onset of COVID-19, high-flow nasal oxygen has dramatically increased. There is a paucity of literature on characteristics of epistaxis in critically ill, COVID-19 positive patients. We aimed to establish the incidence of epistaxis and identify risk factors. Materials and methodsThis was a retrospective observational study conducted at a large academic medical center. Chart review was performed on patients with an intensive care admission and COVID-19 diagnosis between January 2020 and May 2022. Data included epistaxis events, supplemental oxygen delivery and duration, anticoagulation, and antiplatelet therapies. Results932 patients met study criteria. Epistaxis incidence was 7.4 %. Of those with epistaxis, 78 % were administered supplemental oxygen. For each additional day on nasal oxygen, patients were at a 7.1 % higher risk for epistaxis (p < .001). Most antiplatelet agents and therapeutic anticoagulation were not found to increase risk. ConclusionsNasal oxygen was a major risk factor for epistaxis in this population. Nasal hygiene is a standard regimen recommended by otolaryngologists for epistaxis. Protocolizing the inclusion of nasal hygiene measures may be an easy, inexpensive way to prevent epistaxis in this already unstable patient population.

Extreme temperature events, “Life’s Essential 8”, and prevalence of chronic kidney disease: A nationally representative surveillance in China

The population disease burden caused by extreme temperature events has been increasing. However, research on the long-term effects of extreme temperature events on chronic kidney disease (CKD), as well as the combined effects with individual behaviors and metabolic factors is still lacking. Based on 176,874 participants from the most recent nationally representative surveillance on CKD and validated high spatial resolution (0.1°) remote-sensing products, this study investigated the associations between extreme temperature events in the preceding five years before investigation and CKD (defined by reduced renal function or albuminuria) prevalence. We also investigated the associations between “Life’s Essential 8”, a recognized scale to evaluate overall cardiovascular health (CVH) based on individual behaviors and metabolic indicators and CKD prevalence, as well as its combined effects with extreme temperature events. One additional day of heat waves and cold spells per year was associated with increased ORs of CKD [1.10 (95 % CI: 1.08, 1.11) and 1.07 (95 % CI: 1.05, 1.09), respectively]. Meanwhile, per standard deviation (SD) increment in health behavior score (SD = 16.1), health factor score (SD = 18.4), and overall CVH score (SD = 12.4) were associated with decreased ORs of CKD [0.92 (95 % CI: 0.90, 0.93), 0.60 (95 % CI: 0.59, 0.61), and 0.64 (95 % CI: 0.63, 0.65, respectively]. Relative to higher heat wave & lower CVH score group, the ORs of CKD were 0.87 (95 % CI: 0.84, 0.90), 0.51 (95 % CI: 0.48, 0.53), and 0.42 (95 % CI: 0.40, 0.44) in lower & lower, higher & higher, and lower & higher group, respectively. Our findings underscore the importance of considering the synergistic effects of individual behavioral and metabolic factors for strategies to mitigate the impacts of climate change on CKD.

Height status matters for risk of mortality in critically ill children

BackgroundAnthropometric measurements are crucial in pediatric critical care, but the impact of height on ICU outcomes is underexplored despite a substantial number of short-for-age children in ICUs. Previous studies suggest that short stature increases the risk of poor clinical outcomes. This study examines the relationship between short stature and ICU outcomes.MethodsWe conducted a retrospective cohort study using a Japanese nationwide database (the Japanese Intensive Care Patient Database; JIPAD), which included pediatric patients under 16 years admitted to ICUs from April 2015 to March 2020. Height standard deviation scores (SD scores) were calculated based on age and sex. Short-stature patients were defined as height SD score < − 2. The primary outcome was all-cause ICU mortality, and the secondary outcome was the length of stay in ICU.ResultsOut of 6,377 pediatric patients, 27.2% were classified as having short stature. The ICU mortality rate was significantly higher in the short-stature group compared to the normal-height group (3.6% vs. 1.4%, p < 0.01). Multivariable logistic regression showed that short stature was independently associated with increased ICU mortality (OR = 2.73, 95% CI 1.81–4.11). Additionally, the Fine–Gray subdistribution hazards model indicated that short stature was associated with a lower chance of ICU discharge for each additional day (HR 0.85, 95% CI 0.81–0.90, p < 0.01).ConclusionsShort stature is a significant risk factor for increased ICU mortality and prolonged ICU stay in critically ill children. Height should be considered in risk assessments and management strategies in pediatric intensive care to improve outcomes.

How does temperature affect rural income: Channels and implication of adaptation

AbstractThis paper examines the impact of daily temperature variations on rural income per capita and evaluates the effectiveness of adaptation based on China's county‐level socioeconomic statistics and household survey data. We find that high temperatures have significant negative effects on rural income per capita. Relative to the physically comfortable reference temperature between 10 and 15°C, an additional day with a daily average temperature above 30°C reduces the rural income per capita by 0.12% in the year. Evidence from micro‐data indicates that agricultural income of rural households is sensitive to high temperatures relative to other components of household income, such as wage income and transfer income, which leads to a reallocation of rural laborers across sectors. In addition, we indeed find some evidence of adaptation, but we conclude that the current adaptation pattern of rural households probably magnifies the threat of future climate change to China's agricultural sector.

Muscle-strengthening activity is associated with total alcohol consumption and binge drinking among U.S. college students

Objective: To examine the association of muscle-strengthening activity with total alcohol consumption (AC) and binge drinking (BD). Participants: College students (n = 1623) from a large United States university. Methods: Students self-reported their physical activity (PA), AC, and socio-demographic characteristics via an online survey. Hierarchical regression models were computed to examine the association of aerobic PA, and muscle-strengthening activity with total AC and BD. Results: After adjusting for socio-demographic characteristics and aerobic PA, muscle-strengthening activity and achieving muscle strengthening activity recommendations explained a significant proportion of unique variance in total AC (β = .16, p < .001 and β = .16, p < .001, respectively). Similarly, with each additional day of muscle-strengthening activity the odds of reporting BD were 20.9% higher, and individuals who met muscle-strengthening activity recommendations had 93.2% higher odds of reporting BD. Conclusions: Muscle-strengthening activity should be accounted for when examining the relationship between PA and AC.

Nightshift Rotation Schedule and Fatigue in U.K. and Italian Nurses.

Whether hours on shift might impact adaptation to night shift work is still controversial. We conducted a pooled analysis of two studies, including 170 hospital nurses working night shifts, 116 from a United Kingdom study working 12-hour rotating shifts, and 54 from Italy working 8-hour shifts. Both studies used the Epworth Sleepiness Scale (ESS) to detect sleepiness during routine daytime activities as an indicator of fatigue. We compared the prevalence of daytime sleepiness, as indicated by an ESS score≥11, resulting from either shift work schedule. We used logistic regression to calculate the risk of daytime sleepiness associated with 12-hour vs. 8-hour nightshifts, adjusting by age, sex, and parenting children aged≤4. When comparing similar work circumstances, nightshifts prolonged to 12 hours did not increase the risk of daytime sleepiness compared to 8 hours (OR=0.9, 95% CI 0.32, 2.59). Our results suggest that 12-hour rotating nightshifts with additional rest days and 8-hour rotating shift schedules do not differ in their impact on daytime sleepiness. Further research is warranted on what strategies might effectively contrast fatigue, circadian misalignment, and the related metabolic changes leading to adverse health outcomes, including cancer.

80 Yearly change in child zBMI and the COVID-19 pandemic in Canada: A cohort study

Abstract Background Emerging literature suggests accelerated weight gain in children during the pandemic; however, data from Canadian children are limited and individual factors underlying this trend remain unclear. Objectives To determine whether the COVID-19 pandemic was associated with increased yearly change in age- and sex-standardized body mass index (zBMI) in Canadian children and whether staying at home during the pandemic was associated with increased change in zBMI per year. Design/Methods A repeated-measures longitudinal study was conducted with children from an existing practice-based research network in Canada age 1-18y with at least one zBMI measurement pre- and post-onset of the pandemic. Height and weight were measured through primary care office visits and supplemented with at-home parent measurements post-pandemic. Weekly questionnaires were used to measure days stayed at home per week. Piecewise linear mixed effects models accounting for repeated measures through random effects were used to assess yearly change in zBMI. A knot location was placed at the start of the pandemic (March 14, 2020) to compare slopes pre- and post-pandemic onset. Similar mixed effects models were used to explore the association between days at home per week and change in zBMI post-pandemic onset. Stratification by sex and a sensitivity analysis in children with clinic-measured anthropometrics were explored. All models were adjusted for covariates identified a priori. Results In the overall population (n=849 children, 5070 observations), there was no significant difference in slope for yearly change in zBMI post-pandemic (Mar 2020-Sept 2022) compared to prior (Oct 2004-Mar 2020) in fully adjusted models accounting for child age, sex, maternal ethnicity, maternal BMI, family income, birthweight, breastfeeding duration, anthropometrics measurement method (clinic vs parent) and pre-COVID zBMI (post-COVID β=0.03; 95%CI -0.02,0.08; pre-COVID β=0.009; 95%CI-0.009,0.027; p-interaction=0.46). In children with clinic-measured anthropometrics (n=849, 4318 observations), there was a significant increase in yearly change in zBMI after the onset of the pandemic in the fully adjusted model (β=0.07; 95%CI 0.02,0.12) compared to prior (β=0.004; 95%CI -0.01,0.02; p-interaction=0.01). This was driven by changes in boys (post-COVID β=0.08; 95%CI 0.007,0.15; pre-COVID β=-0.003; 95%CI-0.03,0.02; p-interaction 0.04). In boys with clinic-measured anthropometrics post-pandemic onset (n=77 children, 85 observations), there was marginal evidence for increase in yearly zBMI change for every additional day at home per week in the fully adjusted model (β=0.16; 95%CI -0.006,0.32; p=0.06). Conclusion The COVID-19 pandemic was associated with accelerated increase in zBMI per year in Canadian children with clinic-measured height and weight, particularly among boys. Potential competing interests Funding was obtained by J.J. Joseph Jamnik for consultant work for Nutrigenomix Inc, a University of Toronto start-up which offers evidence-based genetic testing for personalized nutrition. Consulting work terminated July 1, 2023. This relationship is unrelated to the work submitted. Research funding: Understanding and mitigating the impacts of the COVID-19 pandemic on children, youth and families in Canada - Operating Grant. CIHR grant 468613. 2021-2024.

Estimating the impact on patient safety of enabling the digital transfer of patients’ prescription information in the English NHS

ObjectivesTo estimate the number and burden of medication errors associated with prescription information transfer within the National Health Service (NHS) in England and the impact of implementing an interoperable prescription...