Mean Number Of Hours Research Articles

Modern CRRT systems are associated with lower risk of hypothermia.

One risk of continuous renal replacement therapy (CRRT) is inadvertent hypothermia (IH), which is defined as a non-therapeutic core temperature decrease below normal. In continuous renal replacement therapy, heat loss will always occur from blood pumped through the dialysis circuit to cooler environment, predisposing for hypothermia. Blood flow and effluent flows are the most important parameters causing heat loss. We investigated and compared the novel TherMax warmer to previous generation technologies during CRRT in a multicenter setting. This was a prospective observational multicenter study with historic single-center controls. The study group consisted of 100 patients in eight Swedish ICUs with clinical indication for CRRT, using the PrisMax platform and TherMax warmer. Both patient and set warmer temperatures were recorded hourly for the first 24h. The presence of treatment hours in hypothermia (< 36.0 Celsius) and the difference between set warmer temperature and measured patient temperature in the multi-center study cohort were compared to a matched single-center historic control cohort treated with the old Prismaflex platform and adjacent Barkey warmer. In the TherMax group 77/100 (77.0%) of patients, and for controls 26/86 (30.2%) of patients were free of hypothermia (Chi square, p < 0.001). The mean number of hours spent in hypothermia was (mean ± SD) 0.66 ± 1.60 and 6.92 ± 7.79h in the TherMax and control groups, respectively (Chi square p < 0.001).In the study group the patient temperature was higher than the set temperature on the warmer with a difference of Δ0.47 ± 0.80°C (minor difference), whereas in the control group the set temperature on the warmer was higher than the patient temperature with a difference of Δ4.55 ± 1.00°C (over-correction).The novel TherMax warmer technology protected against hypothermia and was significantly more accurate than the Barkey warmer.

"Ardor and diligence": Quantifying the faculty effort needed in emergency medicine graduate medical education.

Regulatory requirements around protected faculty effort to support graduate medical education (GME) programs have changed. The amount of labor required to run a GME program is unknown. We sought to describe the work performed by program leadership and core faculty in emergency medicine (EM). We performed a prospective survey study of core faculty in EM. Participants completed a demographic questionnaire followed by quarterly time surveys, covering activities in eight domains: evaluation, teaching and education, scholarly activity, service, interview/recruitment, clinical supervision, student responsibilities, and wellness and administration. We collected data from April 2022 to March 2023. We calculated descriptive statistics and used analyses of variance (ANOVA) to assess differences by faculty role and quarter. A total of 596 physicians completed the demographic questionnaire and 347 (58.2%) completed at least one quarterly time survey including 142 (41%) females, 48 (14%) program directors (PDs), 84 (24%) assistant/associate program directors (APDs), and 215 (62%) general core faculty (GCF). The mean number of hours per week spent on nonclinical education work was 60 h for PDs, 47 h for APDs, and 44 h for GCF. ANOVA found significant differences in mean hours per week and faculty role in domains of evaluation (p < 0.001), service (p = 0.007), and interview/recruitment (p < 0.001). We detected differences in mean hours per week and quarter in domains of evaluation (p < 0.001), teaching and education (p < 0.001), interview and recruitment (p < 0.001), and clinical supervision (p < 0.001). Running a residency program requires many hours of faculty work, which can vary based on faculty role and time of year. These results can inform decisions regarding faculty support.

Prevalence and factors associated with second hand smoke exposure among a sample of pregnant women in Cairo, Egypt

PurposeThis study estimated the prevalence of and factors associated with secondhand smoke (SHS) exposure, and assessed attitudes and knowledge about SHS among pregnant women in Cairo, Egypt.MethodsPregnant women in the third trimester were recruited to participate in a survey assessing tobacco smoking and SHS exposure during their current pregnancy. Participants were recruited from three antenatal clinics in Cairo, Egypt, from June 2015 to May 2016. We examined differences in sociodemographic characteristics and SHS exposure, attitudes, and knowledge by smoking/SHS status. We used multivariable ordinary least squares regression to examine the association between husbands’ smoking and pregnant women’s mean daily hours of SHS exposure, adjusting for women’s smoking status, age group, education, and urban (vs. suburban/rural) residence.ResultsOf two hundred pregnant women aged 16–37 years, about two-thirds (69%) had a husband who smoked tobacco. During their current pregnancy, most women reported being non-smokers (71%), and 38% of non-smokers reported being SHS-exposed. Non-smokers exposed to SHS tended to live in more rural areas and have husbands who smoked in the home. In adjusted analyses, having a husband who smoked was significantly associated with a greater mean number of hours of SHS exposure per day exposed, and this difference was driven by husbands who smoked in the home (p < 0.001). Women in the SHS-exposed group were less likely than other groups to agree that SHS exposure was harmful to their own or their future child’s health; however, all groups agreed that SHS was harmful to newborn health.ConclusionAmong our sample of pregnant women in Cairo, Egypt, there was a high rate of SHS exposure as well as misconceptions about the safety of SHS exposure to a developing fetus. Our findings suggest a need for targeted education and gender-sensitive messaging about SHS exposure, along with improved enforcement of existing tobacco control policies.

Effects of COVID-19 lockdown on children´s sleep quality, physical activity, screen time, and diet.

Background: this study aimed to assess how the COVID-19 lockdown (March to June 2020) affected children's sleep quality, physical activity, screen time, and nutrition. Material and methods: the survey consisted of 479 children from the SENDO project, a pediatric cohort in Spain, aged 4-5 years. The BEAR questionnaire was used to evaluate sleep quality. Hierarchical models with two-level clustering were used to account for intra-cluster correlation between siblings, and the difference regression method was used to study the association between changes in screen consumption and physical activity and changes in sleep quality. Results: the results showed an increase in the consumption of homemade pastries and snacks. Sleep quality worsened significantly during confinement, with a mean score on the BEAR scale of 0.52 before, 1.43 during, and 1.07 after confinement. Although sleep quality improved significantly after the end of confinement, it remained worse than before. The average daily screen time increased from 1.13 hours before confinement to 2.65 hours during confinement. Physical activity decreased during confinement, with the mean number of hours per day decreasing from 1.27 to 0.79. Children who spent more time on screens during confinement had worse sleep quality, as indicated by their higher scores on the BEAR scale. We used the difference regression method to identify a statistically significant association between the increased screen time for leisure hours and the worsening of children's sleep quality during confinement. Conclusion: we observed a significant relationship between confinement and reduced sleep quality. Although the end of the lockdown led to a slight improvement, the average BEAR scale score remained higher post-confinement, suggesting that the consequences of the lockdown may persist over time.

Towards Zero Phrenic Nerve Injury in Reoperative Pediatric Cardiac Surgery: The Value of Intraoperative Phrenic Nerve Stimulation.

Phrenic nerve injury is a devastating complication that results in significant morbidity and mortality. We developed a novel technique to localize the phrenic nerve and evaluate its success. Two groups of children underwent repeat sternotomy for a variety of indications. Group I (69 patients, nerve stimulator) and Group II (78 patients, no nerve stimulator). There was no significant difference in the mean age and weight between the two groups: (6.4 ± 6.5 years vs. 5.6 ± 6.4 years; p = 0.65) and (25.2 ± 24.1 vs. 22.6 ± 22.1; p = 0.69), respectively. The two groups were comparable in the following procedures: pulmonary conduit replacement, bidirectional cavopulmonary anastomosis, aortic arch repair, and Fontan, while Group I had more pulmonary arterial branch reconstruction (p = 0.009) and Group II had more heart transplant patients (p = 0.001). There was no phrenic nerve injury in Group I, while there were 13 patients who suffered phrenic nerve injury in Group II (p < 0.001). No early mortality in Group I, while five patients died prior to discharge in Group II. Eleven patients underwent diaphragm plication in Group II (p = 0.001). The mean number of hours on the ventilator was significantly higher in Group II (137.3 ± 324.9) compared to Group I (17 ± 66.9), p < 0.001. Group II had a significantly longer length of ICU and hospital stays compared to Group I (p = 0.007 and p = 0.006 respectively). Phrenic nerve injury in children continues to be associated with significant morbidities and increased length of stay. The use of intraoperative phrenic nerve stimulator can be an effective way to localize the phrenic nerve and avoid its injury.

Surveillance reports to identify duplicate anticoagulant prescribing

Abstract Introduction A number of patients admitted to hospital on direct oral anticoagulants (DOACs) are often switched to low molecular weight heparin (LMWH) for a limited period of time as part of their clinical management. Electronic prescribing systems (EPMA) allow DOACs to be suspended temporarily and then re-started when clinically indicated. However the system does not generate an alert when DOACs are re-started, leading to unintentional co-prescribing of LMWH which could lead to severe patient harm.1,2 Aim To determine whether anticoagulation surveillance reports reduce the number of inappropriate duplicate anticoagulation prescriptions. Methods A retrospective review of duplicate anticoagulation errors was carried out between September 2017 and March 2022 across the 3 main Royal Cornwall hospital sites. Data on all anticoagulant administrations and the administration time was collected from EPMA via Crystal Reporting pre and post intervention with each period covering 831 days. Data was analysed using Excel. As part of the intervention, surveillance reports were set up in December 2019 to identify patients who were prescribed both LMWHs and DOACs. Reports were generated twice a day, 7 days a week and reviewed for patients who were prescribed both LMWHs and DOACs. The ward pharmacists were then alerted of co-prescribing to complete the necessary interventions. As this project falls under the definition of a service evaluation, according to UK NHS Research Ethics Committees, formal ethical approval was not required. This project was registered on the hospital’s clinical audit database. Results 948,036 doses of LMWH and DOACs were administered (September 2017 to March 2022) with 817 duplicate prescribing identified, a 0.09% error rate. The longest time on duplicate therapy was dramatically reduced pre and post intervention from 322 hrs to 36 hrs with mean number of hours reduced from 14.03 to 8.07. The number of patients receiving more than two doses of co-prescribed LMWH and DOAC before the error was rectified, also reduced from 56 (pre-intervention) to 30 (post-intervention). Likewise, the average duration of more than 2 doses of co-prescription reduced from 48.3 to 18.7 hours before the error was corrected. Discussion/Conclusion Some limitations of the study are that staffing is more limited on weekends which may have prevented pharmacists actioning these alerts over weekends. Data will only include anticoagulants prescribed on EPMA so excludes some infusions such as unfractionated heparin. Timestamps associated with administrations on EPMA are user-entered so may not be exact to the time given. Although EPMA generates an alert when patients on DOACs are prescribed LMWHs, it does not provide a similar alert when suspended DOACs are re-started. EPMA providers are planning to develop alerts to correct this. In the interim we have shown that surveillance reports capture co-prescribing of DOACs and LMWH at an earlier stage preventing potential serious patient harm. It also allows for pharmacists to educate prescribers on risks of anticoagulation co-prescribing. This report is now routine practice, including additional monitoring - patients on warfarin, fondaparinux, LMWH prescribed twice daily and INR levels. We will re-evaluate to include new parameters.

A Prospective Intervention Study With 6 Months Follow-up of the Effect of Reablement in Home Dwelling Elderly: Patient-reported and Observed Outcomes

ObjectivesTo investigate the effect of a reablement intervention (a person-centered, interdisciplinary rehabilitation approach) compared with usual care services in home-dwelling elderly experiencing functional declines in activities of daily living. DesignA non-randomized controlled trial comparing a reablement intervention with usual care; outcomes were measured at baseline, after intervention, and at a 6-month from baseline in both groups. SettingMunicipal public health service. ParticipantsSixty-five home-dwelling elderly with functional decline were assigned by the participants home care service zone to a reablement group (n=35), or a usual care group (n=30). The mean participant age was 80±11 years in the reablement group and 78±12 in the usual care group. InterventionThe reablement group received a person-centered and tailored reablement program provided by an interdisciplinary team, consisting of a physiotherapist, an occupational therapist, and a nurse. The usual care group received standard home care services. Main Outcome MeasuresThe dimension “Your health today” from the European Quality of Life-Visual Analog Scale (HRQOL), the patient-specific functional scale for goals in ADL (PSFS), the short physical performance battery (SPPB), and home care services in hours per week. ResultsThere were significant differences over time in favor of the reablement group with between-group effect sizes of Cohen h2=0.36 (P=.001) for HRQOL, h2=0.60 (P=.001) for PSFS, h2=0.30 (P=.001) for SPPB, and h2=0.10 (P=.013) for hours of home care services per week. The within-group effect size for PSFS was h2=0.15 (P=.010) in favor of the reablement group. The mean number of hours of home care services per week was mean 0.38±1.07 (P=.001) in the reablement group and mean 30.38±64.13 (P=.023) in the usual care group. ConclusionsThe participants in the reablement group achieved and maintained better physical function, a higher HRQOL and needed considerably less home care services than the usual care group participants. Thus, reablement appears to be a more beneficial and sustainable approach than the usual care services for the home-dwelling elderly with functional decline.

P-618 Morning or evening start of exogenous progesterone five days before blastocyst transfer does not have an impact on ongoing pregnancy rates in artificial cycles.

Abstract Study question Does morning or evening start of exogenous progesterone five days before a blastocyst transfer have an impact on pregnancy rates in artificial cycles? Summary answer Ongoing pregnancy rate is comparable when exogenous progesterone is started either in the morning or evening on the first day of progesterone exposure before ET. What is known already Luteal phase support (LPS) with exogenous progesterone (P) is mandatory in artificial cycles due to the absence of corpus luteum. The time of P exposure needed to optimize the outcome remain uncertain. Some endometrial receptivity tests claim for individualization of duration of LPS before ET to optimize the implantation potential of the embryo. As routine practice, 5 days of P exposure are needed for a blastocyst transfer in general population, but it is not clear yet if exogenous P has to be started in the morning or evening of the first day of P administration. Study design, size, duration Single-centre retrospective cohort study of 6493 artificial cycles for blastocyst transfer between December 2018 and July 2022. Endometrial preparation was performed with oestrogens and LPS with micronized vaginal progesterone (400 mg/12h MVP). LPS was given from five days before blastocyst transfer. Ongoing pregnancy rate (&amp;gt;12w) was analysed according to the moment of starting progesterone (morning or evening) and hours of P exposure. Cases in which LPS duration was different to 5 days were not included. Participants/materials, setting, methods Infertile patients undergoing ET in artificial cycles. Until March 2021, exogenous P was started in the evening of day 0 of P exposure (“evening start”); since April 2021, P was started in the morning of day 0 (“morning start”), before blastocyst ET. ET are performed between 12 and 18pm. Serum P was measured at the time of ET (+2h). Routinely, patients with suboptimal P levels were added subcutaneous P (25mg/day) from the day of ET. Main results and the role of chance LPS was started in the evening in 3993 patients and in the morning in 2500 patients, all started five days before ET. Of note, there were no differences in these baseline/cycle characteristics: age, BMI, serum P in the proliferative phase, mid-luteal serum P, oocyte origin, EMT, number of embryos transferred. Patients with morning start had a significantly higher estradiol level (320.4 pg/mL vs 282.2pg/mL, p = 0.001). Mean number of hours of P exposure until ET was 113.8 + 2.1h after evening start of MVP and 125.5 + 2.1h after morning start, p = 0.000. The minimum was 108.2 hours and maximum of 132.9 hours of P exposure. Quartiles of P exposure (hours) before ET were: Q1:113.2h, Q2:115.8h, Q3:124.7h. No differences in OPR were observed according to these quartiles (&amp;lt;Q1:47.4%; Q1-Q3:45.7%; &amp;gt;Q3:47.1%, p = 0.46). Likewise, evening or morning start of LPS did not exert any impact either in OPR (46.2% vs 46.8%, p = 0.65) or clinical miscarriage rate (17.2% vs 18.1%, p = 0.53). Binary logistic regression showed no differences in OPR (aOR (95%CI): 0.96 (0.85-1.09; p = 0.52) after adjusting for potential confounding variables. Suboptimal mid-luteal P levels were observed in 23% (evening) vs 19.4% (morning start) of patients (p = 0.01). Having low P didńt impact on OPR (45.7%vs46.7%, p = 0.55) as rescue treatment was performed. Limitations, reasons for caution The limitation is the retrospective study design, although sample size is large enough to draw conclusions and control for potential confounding factors. Moreover, study period was different in both groups, although protocols and general results were comparable. If these results are similar in other ways of P administration, remains unknown. Wider implications of the findings These findings suggest that a difference of 12 hours in the initiation of exogenous P does not impact on the cycle outcome in artificial cycles as far as it is started 5 days before ET. Thus, LPS can be started either in the morning or evening without hampering the results. Trial registration number not applicable

Very-early detection of atrial fibrillation in patients after ablation evaluated by a home-based wearable ECG-patch

Abstract Funding Acknowledgements Type of funding sources: None. Background Evaluation of atrial fibrillation (AF) recurrence after AF ablation has been validated by routine ECG and ambulatory 24-h Holter monitoring after a 3-month blanking period. However, assessment of heart rhythm after AF ablation, conducted with the use of intermittent or continuous recording systems, has shown that early recurrences are common, often asymptomatic, and may predict late AF recurrences. The E-Patch (Bio Tel Heart) is an innovative thin, single-use adhesive electrode with extended continuous ECG monitoring for up to 120 hours. Aim To describe and characterize predictors of early AF recurrence based on the very- early blanking period after AF ablation. Methods Single-centre, prospective, longitudinal study, including consecutive patients (P), 24 hours after AF ablation, monitored with the E- patch. Baseline characteristics at the time of AF ablation as well as the effectiveness of the device in continuously recording within 5 days after ablation were analyzed. A logistic regression model was used to derive predictors of very-early AF recurrence. Results A total of 40P were included (60% male, 62±9 years). AF ablation was performed with radiofrequency energy in 23P and with cryoballoon in 17P. All P were in sinus rhythm at the beginning of the E- patch recording. The mean number of hours of recording was 113±18. During E-patch recording 11P (27.5%) presented AF (AF burden 27.4% of the recording, IQR 5.5-32.3%) and 7P (18%) had sinus pauses. In a multivariate logistic regression model, a higher CHADS2VAS2C index and a higher average heart were associated with an OR 3.0 (95% CI 1.13-8.1, p = 0.027) and OR 1.23 (95% CI 1.02-1.48, p = 0.025) for AF recurrence, respectively. No significant differences were found between ablation modalities. There were no complaints about discomfort in the use of the device, and there were no artefacts compromising the quality or the interpretation. Conclusions The use of the E-patch recording very-early after AF ablation is effective for AF detection. A higher CHADS2VAS2C index and average heart appear to be significantly predictive of very-early AF recurrence post-ablation.

ECG-patch assessment of atrial fibrillation during the very-early blanking predicts late blanking period recurrence: preliminary data from a prospective registry

Abstract Funding Acknowledgements Type of funding sources: None. Background Ablation of atrial fibrillation (AF) is a procedure that causes significant atrial tissue lesions, with transient, albeit significant tissue oedema and inflammation. These mechanisms may trigger early rhythm abnormalities that do not necessarily correlate with future arrhythmias, and, therefore, evaluation of AF recurrence is currently validated by routine ECG and ambulatory 24h Holter monitoring, only after a 3-month blanking period. However, recent data have shown that AF episodes occurring during the blanking period are common and may predict late AF recurrences. The E-Patch (Bio Tel Heart) is an innovative, thin single-use adhesive electrode with extended continuous ECG monitoring for up to 120h. Aim To assess if continuous extended monitoring in the very-early blanking period can be associated with event recorder data performed in the late blanking period after AF ablation. Methods Single-centre, prospective, longitudinal study, including consecutive patients (P) 24h after AF ablation, monitored with the E-patch. The effectiveness of the device in continuously recording within 5 days after ablation was analyzed, as well as the occurrence of AF episodes during an external 7- day loop-recorder, obtained in the 2nd-month post-ablation. Results A total of 30P were included (57% male, 63±8 years). AF ablation was performed with radiofrequency (RF) energy in 14P and with a balloon of cryoenergy in 16P. All P were in sinus rhythm at the beginning of the recording. The mean number of hours of recording was 113±16, with no discomfort complaints in the use of the device or interpretation artefacts. During the E-patch monitoring, a total of 10P (33%) presented AF (AF burden 6.8% of the recording, IQR 3.0-20%). All 30P underwent an external loop recorder for 7 days 2 months post-ablation, with 40% showing AF periods (&amp;gt; 30 seconds duration). All 10P that had AF detection in the very-early E-patch recording had also recurrence in the 2 nd month of extended 7-day continuous recording. Very- early AF detection had a sensitivity of 83.3% and a specificity of 100% to detect late blanking period AF (ROC 0.916±0.06; 95%CI 080-1.0). Conclusions The use of the E-patch very-early after AF ablation is effective for AF detection and is highly predictive of AF recurrence in the late blanking period. These findings require validation in larger studies to assess the potential of very-early assessment in the determination of a higher risk for AF recurrence.

Functional neurological symptoms are a frequent and relevant comorbidity in patients with multiple sclerosis.

Functional neurological symptoms (FNS) in multiple sclerosis (MS) have shown to be underinvestigated even though neurological diseases such as MS represent a risk factor for developing FNS. Comorbidity of FNS and MS can produce high personal and social costs since FNS patients have high healthcare utilization costs and a quality of life at least as impaired as in patients with disorders with underlying structural pathology. This study aims to assess comorbid FNS in patients with MS (pwMS) and investigate whether FNS in pwMS are associated with poorer health-related quality of life and work ability. Newly admitted patients (234) with MS were studied during their stay at Kliniken Schmieder, a neurological rehabilitation clinic in Konstanz, Germany. The degree to which the overall clinical picture was explained by MS pathology was rated by neurologists and allied health practitioners on a five-point Likert scale. Additionally, neurologists rated each symptom reported by the patients. Health-related quality of life was assessed using a self-report questionnaire and work ability was assessed using the mean number of hours worked per day and information regarding disability pension as reported by patients. In 55.1% of cases, the clinical picture was completely explained by structural pathology due to MS. 17.1% of pwMS presented an overall clinical picture half or less of which could be explained by underlying structural pathology. PwMS with a higher comorbid FNS burden had a lower health-related quality of life and reported fewer working hours per day than pwMS with symptoms explained by structural pathology. Furthermore, pwMS with a full disability pension had a higher comorbid FNS burden than pwMS with no or partial disability pension. These results show that FNS should be addressed diagnostically and therapeutically since such symptoms are an important comorbidity in MS that is related to poorer health-related quality of life and lower work ability.

8 The Effect of Decreased Physical Activity on Physical and Mental Health of School-Aged Children During the COVID-19 Pandemic

Abstract Background School-aged children are recommended to complete at least one hour of moderate to vigorous intensity physical activity per day. North American data has shown that due to COVID-19 restrictions placed on in person schooling and extracurricular activities, children were not meeting recommended levels of physical activity. Additional barriers to activity during the first wave of the COVID-19 pandemic included lack of access to public facilities including community centers, parks, and outdoor recreation. Decreased physical activity in children has been shown to have a negative impact on both physical and mental health, and childhood development. However, there is a paucity of literature on parents’ perceptions of the association between physical activity and physical and mental health. Objectives The objective of this study was to gain a better understanding of the implications of the COVID-19 pandemic on levels of physical activity and parents’ perceptions surrounding physical activity and physical and mental health. Design/Methods An online survey was distributed to parents of school-aged children aged 4-13 in Ontario. The survey included questions regarding demographics, children’s physical activity prior to and during the first wave of the COVID-19 pandemic, and parental perceptions regarding the pandemic’s impact on mental and physical health. This study received ethics approval, was hosted on the REDCapTM platform, and distributed from February-June 2021 through a local school board, the Pediatrics section of the Ontario Medical Association, and through social media. Results Of 361 participants, 90.4% strongly agreed that physical activity was important for mental health, and 92.2% strongly agreed that physical activity was important for physical health. There was a statistically significant decrease in the overall mean number of hours of physical activity per week between pre-COVID and the first wave of COVID (mean difference = 9.34 hours, SD = 10.06, p&amp;lt;0.001). Additionally, parents of children with decreased physical activity reported a statistically significant negative impact on physical and mental health as compared to parents whose children had no change in amount of physical activity. Decreased energy, poor sleep, increased anxiety, mood disturbances, and disruptive behaviour were noted by over 50% of respondents. Conclusion This survey highlights that parents themselves perceived a significant negative impact on children’s mental and physical well-being with decreased physical activity during the COVID-19 pandemic. This emphasizes the importance of retaining access to recreational facilities and extracurricular activities. Future research includes identifying ways to re-engage parents and children with physical activity during times of decreased access.

7 Does Physical Activity Vary By Virtual or In-Person School Models in School-Aged Children?

Abstract Background Current recommendations for school-aged children’s physical activity include at least one hour of moderate to vigorous intensity physical activity per day. Schools play an essential role in providing access to physical activity, through both structured and unstructured activity such as physical education and recess. North American data has shown that due to restrictions placed on in-person schooling, children were not meeting recommended levels of physical activity during the first wave of the COVID-19 pandemic. Objectives The objective of this study was to understand the effect schooling models have on access to physical activity and subsequent reported changes in mental and physical health. Design/Methods An online survey was distributed to parents of school-aged children aged 4-13 in Ontario. The survey included questions regarding demographics, children’s physical activity prior to and during the first wave of the COVID-19 pandemic, and parental perceptions regarding the pandemic’s impact on mental and physical health. This study received ethics approval, was hosted on the REDCapTM platform, and distributed from February-June 2021 through a local school board, the Pediatrics section of the Ontario Medical Association, and through social media. Results A total of 361 survey participants responded. Although there was a statistically significant decrease in the overall mean number of hours of physical activity per week from prior to the COVID-19 pandemic and the first wave of the COVID-19 pandemic (mean difference = 9.34 hours, SD = 10.06, p&amp;lt;0.001), there was no significant difference in hours of physical activity when comparing in-person and virtual school models (p=0.892 pre-COVID-19 pandemic and p=0.146 during the first wave of the COVID-19 pandemic). There was no significant difference in parent-reported impact of either physical (p=0.724) or mental (p=0.822) health between those that were enrolled in virtual or in-person school models, and no significant difference between school model and restarting activities (p=0.078). Conclusion This survey highlights not only that parents identified a significant decrease in children’s physical activity during the pandemic but also that there was no correlation between school model and physical activity. This may be due to several organized physical activities not being re-started despite schools reopening, thus contributing to similar outcomes for children in both school models. Future research may include exploring why virtual and in-person models demonstrated no significant difference in physical activity and to conduct a qualitative analysis on methods used by parents to engage children in activity.

Interest in and exposure to headache disorders among neurology residents in Denmark: A nationwide cross-sectional survey.

Headache disorders constitute a leading cause of disability worldwide, but there is a consistent absence of awareness and educational activities for healthcare providers across regions. Thus, we found it timely to identify potential structural challenges and factors that may affect acquisition of knowledge of headache disorders and their management during their 4-year residency. We conducted a nationwide cross-sectional survey of residents in neurology in Denmark including, but not limited to, questions on interest in neurological subspecialties and disorders, adequacy of training in headache disorders, exposure to headache disorders during training including time spent on headache disorders, exposure to specialist outpatient clinics, whether their hospital have a tertiary headache clinic, training in specific procedures (anesthetic blockade, e.g., greater occipital nerve blockade, and onabotulinumtoxinA for headache), and an estimate of proportion of cases with headache among patients managed in the last week. The survey was distributed to 127 residents in Denmark between March 2022 and April 2022. Of these, 59 (47%) completed all questions of the survey. Headache disorders were the fourth most popular subspecialties among respondents (n=15 [25%]) following movement disorders (n=27 [46%]), vascular neurology (n=26 [44%]), and neuromuscular disorders (n=25 [42%]). The mean number of hours spent in a course or a structured educational activity in headache disorders during residency was 12.1 h. Half of respondents (n=27 [46%]) reported that they perceived their training in headache disorders to be inadequate. Even in Denmark, a country with excellent headache services, half of residents in neurology report an inadequate training despite a higher-than-average number of hours of structured educational activities. These findings should incentivize stakeholders to make structural changes to improve education in headache disorders during the most fundamental years of training.

Effects of digital devices and online learning on computer vision syndrome in students during the COVID-19 era: an online questionnaire study

PurposeComputer vision syndrome (CVS) describes a group of eye and vision-related problems that result from prolonged digital device use. This study aims to assess the prevalence and associated factors of...

The Compulsory Care Act: Early Observations and Expectations of In- or Outpatient Involuntary Treatment.

BackgroundOn January 1, 2020, the Dutch Compulsory Care Act (WvGGZ) replaced the Special Admissions Act (BOPZ). While the old law only allowed compulsory treatment in hospitals, the new law allows it both inside and outside the hospital. Moreover, the new law prioritizes the patient's own opinion on coercive measures. By following patients' own choices, the Compulsory Care Act is hoped to lead to fewer admission days and less inpatient compulsory treatment in involuntarily admitted patients.MethodsWe studied the seclusion and enforced-medication events before and after January 1, 2020, using coercive measures monitoring data in a Mental Health Trust. Trends in hours of seclusion and the number of enforced-medication events per month from 2012 to 2019 were compared with 2020. We used generalized linear models to perform time series analysis. Logistic regression analyses and generalized linear models were performed to investigate whether patient compilation determined some of the observed changes in seclusion use or enforced-medication events.ResultsThe mean number of hours of seclusion between 2012 and 2019 was 27,124 per year, decreasing from 48,542 in 2012 to 21,133 in 2019 to 3,844 h in 2020. The mean incidence of enforced-medication events between 2012 and 2019 was 167, increasing from 90 in 2012 to 361 in 2019 and then fell to 294 in 2020. In 2020, we observed 3,844 h of seclusion and 294 enforced-medication events. Near to no outpatient coercion was reported, even though it was warranted. The time series analysis showed a significant effect of the year 2020 on seclusion hours (β = −1.867; Exp(β) = 0.155, Wald = 27.22, p = 0.001), but not on enforced-medication events [β = 0.48; Exp(β) = 1.616, Wald = 2.33, p = 0.13].DiscussionThere was a reduction in the number of seclusion hours after the introduction of the Compulsory Care Act. The number of enforced-medication events also increased from a very low baseline, but from 2017 onwards. To see whether these findings are consistent over time, they need to be replicated in the near future.ConclusionWe observed a significant increase in enforced-medication use and a decrease in seclusion hours. The year 2020 predicted seclusion hours, but not enforced-medication events.

Early objective adherence to hypoglossal nerve stimulation therapy.

To assess early adherence to therapy with hypoglossal nerve stimulation therapy. This is a prospective study of consecutive patients with moderate to severe obstructive sleep apnea who underwent implantation of hypoglossal nerve stimulation therapy within a single academic practice and attended a follow-up appointment after greater than 30 days of therapy use. Objective adherence data were extracted from an objective monitoring database and compared to patient characteristics. The study population was 79 participants who were 29.1% female with a mean age of 58.7 ± 12.8 years old, body mass index of 28.9 ± 3.4 kg/m2, and baseline apnea-hypopnea index of 33.8 ± 17.6 events/h. In the first 7 days after device activation, average use was 7.8 h/night, with 91.9% of nights with greater than 4 hours of therapy use and an average of 0.2 pauses in therapy per night. These figures remained stable after 30 days of use: 7.7 h/night, 91.0% of nights longer than 4 hours, and 0.3 pauses per night. Objective evidence of difficulty with acclimatization was associated with age less than 60 years (odds ratio 2.8, 95% confidence interval 1.1-7.1, P = .03) and a history of prior upper airway surgery (3.9, 1.2-11.9, P = .015). Insomnia was present in 31 patients and was not associated with objective evidence of difficulty tolerating therapy. Early adherence to hypoglossal nerve stimulation is excellent (92.4% >4 hours on >70% of nights), suggesting that the acclimatization period is straightforward in most. Younger age and a history of prior upper airway surgery appear to be associated with an increased risk of difficulty with acclimatization. Huyett P. Early objective adherence to hypoglossal nerve stimulation therapy. J Clin Sleep Med. 2022;18(2):631-636.

There Are Predictors of Eating Disorders among Internet Use Characteristics—A Cross-Sectional Study on the Relationship between Problematic Internet Use and Eating Disorders

The aims of this cross-sectional study were: (i) to establish the prevalence of problematic Internet use (PIU) and eating disorders (EDs) among Polish students; (ii) to investigate potential correlations between the two phenomena; and (iii) to identify predictors of eating disorders among socio-demographic and Internet use characteristics in this population. To this end, a total of 1008 Polish students aged 18–40, completed the Problematic Internet Use Test (TPIU22), the Eating Attitudes Test (EAT-26) and a self-designed Socio-demographic and Internet Use Survey. Men received more PIU scores (p < 0.001), while women received more EAT-26 scores (p < 0.05) with a significant correlation observed between those variables (rho = 0.212; p < 0.001). The strongest predictors of EDs were as follows: preoccupation with the Internet, neglect of sleep in favor of Internet use, alleviation of negative feelings while online, higher mean number of hours spent online on weekends for academic and work-related purposes, extracurricular activity, lower height and higher BMI. An association has been demonstrated between problematic internet use and eating disorders. Somewhat surprisingly, our results suggest that people at risk of EDs use the Internet primarily to fulfill their routine duties. Nevertheless, further research is needed to establish the causality of EDs and PIU.

Impact of the COVID-19 Pandemic on the Lifestyles and Quality of Life of Women With Fertility Problems: A Cross-Sectional Study.

Background: The COVID-19 pandemic has implied worldwide the imposition of confinement measures and mobility restrictions, to a greater or lesser extent. It has also meant the closure of some public medical services such as reproductive care. This situation may have impacted the health-related behaviour and quality of life of women with fertility problems.Objective: The objective of this study was to analyse the effects of confinement and the suspension of reproductive medical care on the lifestyle (diet, physical exercise, and smoking habits), anxiety and depression, and quality of life of infertile women by comparing their pre- and post-confinement situations.Methods: We carried out a cross-sectional, internet-based study. Information was collected on these women's adherence to the Mediterranean diet (MEDAS questionnaire), physical exercise (IPAQ-SF), anxiety and depression (HADS), and quality of life related to fertility (FertiQol) before, during, and after confinement. The survey was conducted between 1 September and 28 October 2020.Results: A total of 85 women participated. There had been a significant increase in anxiety and depression levels (P < 0.001) and an increase in tobacco consumption among female smokers during confinement vs. pre-confinement (62.5% had increased their consumption). The participants had also increased the mean number of hours they spent sitting (P < 0.001). There had also been an increase in vigorous and moderate exercise levels by 40 and 30%, respectively (P = 0.004). However, no differences were observed in these patients' eating habits as a result of confinement (P = 0.416). When the reproduction service was resumed, the participants showed higher anxiety level scores (P = 0.001) with respect to the pre-confinement situation as well as lower mean FertiQol scale score (P = 0.008).Conclusions: Confinement had increased anxiety and depression levels among these infertile women as well as tobacco use among the participants who were smokers. The prolonged closure of reproductive care units decreased the quality of life of the participants of this study. These results suggest the need to implement online programs to improve healthy habits and quality of life of this population group.

Self-reported Continuous Positive Airway Pressure Device Compliance of Patients with Obstructive Sleep Apnoea Syndrome

Introduction: Patients with obstructive sleep apnoea syndrome (OSAS) are often prescribed the use of continuous positive airway pressure (CPAP) devices to overcome obstruction during sleep. We aimed at assessing the adherence rates to CPAP therapy in two clinical subtypes of OSAS. Patients and Methods: Patients diagnosed with positional or rapid eye movement related OSAS using polysomnography were included. Patients were contacted by telephone calls to collect data. Inclusion criteria were age >18 years, a total apnea-hypopnea index (AHI) >5, and a physician recommendation to initiate therapy with a CPAP device. Patients were excluded if they had known neurological disorders, were unwilling to answer all questions and had no recommendation to use CPAP therapy. Results: A total of 286 patients, 99 females (34.6%) and 187 males (65.4%), with a mean age of 56.5 ± 11.3 years were included. There were 134 (46.9%) CPAP users and 152 (53.1%) CPAP nonusers. Reasons for not using the CPAP device included unwillingness to use the device (n = 73, 48%), reduced patient comfort due to noise, hose, or air pressure (n = 31, 20.3%), reimbursement problems (n = 38, 25%), and reasons such as recovery or operation (n = 10, 6.5%). Age, duration of use/months, number of nights per week during which the device was used and the mean number of hours per night were not significantly different between OSAS types (P > 0.05), while the mean AHI and body mass index were significantly different between OSAS types (P < 0.05). Conclusion: A significant proportion of OSAS patients do not use CPAP devices due to various reasons. Adherence to CPAP therapy was not significantly different between groups.