Little is known about the impact of weekend admission on acute variceal hemorrhage (AVH). Thus, we investigated whether day of admission due to AVH influenced in-hospital mortality.
Materials and Methods
We retrospectively reviewed the medical records of 294 patients with cirrhosis admitted between January 2005 and February 2009 for the management of AVH. Clinical characteristics were compared between patients with weekend and weekday admission, and independent risk factors for in-hospital mortality were determined by multivariate binary logistic regression analysis.
No demographic differences were observed between patients according to admission day or in the clinical course during hospitalization. Seventeen (23.0%) of 74 patients with weekend admission and 48 (21.8%) of 220 with weekday admission died during hospitalization (p=0.872). Univariate and subsequent multivariate analysis showed that initial presentation with hematochezia [p=0.042; hazard ratio (HR), 2.605; 95% confidence interval (CI), 1.038-6.541], in-patient status at the time of bleeding (p=0.003; HR, 4.084; 95% CI, 1.598-10.435), Child-Pugh score (p<0.001; HR, 1.877; 95% CI, 1.516-2.324), and number of endoscopy sessions for complete hemostasis (p=0.001; HR, 3.864; 95% CI, 1.802-8.288) were independent predictors for in-hospital mortality.
Weekend admission did not influence in-hospital mortality in patients with cirrhosis who presented AVH.
Cirrhosis; endoscopy; esophageal and gastric varices; hemorrhage; mortality
Background and Purpose
Stroke requires consistent care, but there is concern over the "weekend effect", whereby a weekend admission results in a poor outcome. Our aim was to determine the impact of weekend admission on clinical outcomes in patients with acute ischemic stroke in Korea.
The outcomes of patients admitted on weekdays and weekends were compared by analyzing data from a prospective outcome registry enrolling 1247 consecutive patients with acute ischemic stroke admitted to four neurology training hospitals in South Korea between September 2004 and August 2005. The primary outcome was a poor functional outcome at 3 months, defined as modified Rankin Scale (mRS) of 3-6. Secondary outcomes were 3-month mortality, use of thrombolysis, complication rate, and length of hospitalization. Shift analysis was also performed to compare overall mRS distributions.
On weekends, 334 (26.8%) patients were admitted. Baseline characteristics were comparable between the weekday and weekend groups except for more history of heart disease and shorter admission time in weekend group. Univariate analysis revealed poor functional outcome at 3 months, 3-month mortality, complication rate, and length of hospitalization did not differ between the two groups. In addition, overall mRS distributions were comparable (p=0.865). After adjusting for baseline factors and stroke severity, weekend admission was not associated with poor functional outcome at 3 months (adjusted odds ratio, 1.05; 95% CI, 0.74-1.50). Furthermore, none of secondary endpoints differed between the two groups in multivariate analysis.
Weekend admission was not associated with poor functional outcome than weekday admission in patients with acute ischemic stroke in this study. The putative weekend effect should be explored further by considering a wider range of hospital settings and hemorrhagic stroke.
weekend effect; weekend admission; ischemic stroke
Several studies have demonstrated increased inhospital mortality following weekend admission. We hypothesized that the presence of resident trainees reduces the weekend mortality trends.
We identified all patients with a non-elective hospital admission from 1/1/2003 through 12/31/2008. We abstracted vital status on discharge and calculated the Charlson comorbidity score for all inpatients. We compared odds of inpatient mortality following non-elective admission on a weekend day as compared to a weekday, while considering diagnosis, patient characteristics, comorbidity, hospital factors, and care at hospitals with resident trainees.
Data were available for 48,253,968 patient discharges during the six-year study period. The relative risk of mortality was 15% higher following weekend admission as compared to weekday admission. After adjusting for diagnosis, age, sex, race, income level, payer, comorbidity, and weekend admission the overall odds of mortality was higher for patients in hospitals with fewer nurses and staff physicians. Mortality following a weekend admission for patients admitted to a hospital with resident trainees was significantly higher (17%) than hospitals with no resident trainees (p < 0.001).
Low staffing levels of nurses and physicians significantly impact mortality on weekends following non-elective admission. Conversely, patients admitted to hospitals with more resident trainees had significantly higher mortality following a weekend admission.
Mortality; Weekend; Trainee; Non-elective
Although acute hospitals offer a twenty-four hour seven day a week service levels of staffing are lower over the weekends and some health care processes may be less readily available over the weekend. Whilst it is thought that emergency admission to hospital on the weekend is associated with an increased risk of death, the extent to which this applies to elective admissions is less well known. We investigated the risk of death in elective and elective patients admitted over the weekend versus the weekdays.
Retrospective statistical analysis of routinely collected acute hospital admissions in England, involving all patient discharges from all acute hospitals in England over a year (April 2008-March 2009), using a logistic regression model which adjusted for a range of patient case-mix variables, seasonality and admission over a weekend separately for elective and emergency (but excluding zero day stay emergency admissions discharged alive) admissions.
Of the 1,535,267 elective admissions, 91.7% (1,407,705) were admitted on the weekday and 8.3% (127,562) were admitted on the weekend. The mortality following weekday admission was 0.52% (7,276/1,407,705) compared with 0.77% (986/127,562) following weekend admission. Of the 3,105,249 emergency admissions, 76.3% (2,369,316) were admitted on the weekday and 23.7% (735,933) were admitted on the weekend. The mortality following emergency weekday admission was 6.53% (154,761/2,369,316) compared to 7.06% (51,922/735,933) following weekend admission. After case-mix adjustment, weekend admissions were associated with an increased risk of death, especially in the elective setting (elective Odds Ratio: 1.32, 95% Confidence Interval 1.23 to 1.41); vs emergency Odds Ratio: 1.09, 95% Confidence Interval 1.05 to 1.13).
Weekend admission appears to be an independent risk factor for dying in hospital and this risk is more pronounced in the elective setting. Given the planned nature of elective admissions, as opposed to the unplanned nature of emergency admissions, it would seem less likely that this increased risk in the elective setting is attributable to unobserved patient risk factors. Further work to understand the relationship between weekend processes of care and mortality, especially in the elective setting, is required.
Hospital staffing is often lower on weekends than weekdays, and may contribute to higher mortality in patients admitted on weekends. Because esophageal variceal hemorrhage (EVH) requires complex management and urgent endoscopic intervention, limitations in physician expertise and the availability of endoscopy on weekends may be associated with increased EVH mortality.
To assess the differences in mortality, hospital length of stay (LOS), and costs between patients admitted on weekends versus patients who were admitted on weekdays.
The United States Nationwide Inpatient Sample database was used to identify patients hospitalized for EVH between 1998 and 2005. Differences in mortality, LOS, and costs between patients admitted on weekends and weekdays were evaluated using regression models with adjustment for patient and clinical factors, including the timing of endoscopy.
Between 1998 and 2005, 36,734 EVH admissions to 2207 hospitals met the inclusion criteria. Compared with patients admitted on weekdays, individuals admitted on the weekend were slightly less likely to undergo endoscopy on the day of admission (45% versus 43%, respectively; P=0.01) and by the second day (81% versus 75%; P<0.0001). However, mortality (11.3% versus 10.8%; P=0.20) and the requirement for endoscopic therapy (70% versus 69%; P=0.08) or portosystemic shunt insertion (4.4% versus 4.7%; P=0.32) did not differ between weekend and weekday admissions. After adjusting for confounding factors, including the timing of endoscopy, the risk of mortality was similar between weekend and weekday admissions (OR 1.05; 95% CI 0.97 to 1.14). Although LOS was similar between groups, adjusted hospital charges were 4.0% greater (95% CI 2.3 to 5.8%) for patients hospitalized on the weekend.
In patients with EVH, admission on the weekend is associated with a small delay in receiving endoscopic intervention, but no difference in mortality or the requirement for portosystemic shunt insertion. The weekend effect observed for some medical and surgical conditions does not apply to patients with EVH.
Cirrhosis; Database; Health services research; Hemorrhage; Outcome assessment; Portal hypertension
Background and Purpose
Prior studies found mortality among ischemic stroke patients to be higher on weekends. We sought to evaluate whether weekend admission was associated with worse outcomes in a large comprehensive stroke center (CSC) cohort.
Consecutive ischemic stroke patients presenting within 6 hours of symptom onset were identified using the 8 CSC SPOTRIAS database. Patients who received intra-arterial therapy or were enrolled in a non-observational clinical trial were excluded. All patients meeting inclusion criteria were then divided into two groups: weekday admissions or weekend admissions. Weekend admission was defined as Friday 17:01 to Monday 08:59. The remainder were classified weekday admissions. Multivariate logistic regression was used adjusting for age, stroke severity on admission via NIHSS, and admission glucose to compare outcomes in the weekend vs. weekday groups.
8581 subjects from the combined SPOTRIAS database were screened from 2002-2009. 2090 (24.4%) met inclusion criteria. There was no significant difference in t-PA treatment rates between weekday and weekend groups (58.5% vs. 60.4%, p=.397). Weekend admission was not a significant independent predictor of in-hospital mortality (8.4% vs. 9.9%, p=.056), LOS (4 days vs. 5 days, p=.442), favorable discharge disposition (38.0% vs. 42.2%, p=.122), favorable functional outcome at discharge (41.6% vs. 43.4%, p=.805), favorable 90 day functional outcome (54.2% vs. 46.9%, p=.301), or 90 day mortality (18.2% vs. 19.8%, p=.680) when adjusting for age, NIHSS, and admission glucose.
In this large cohort of ischemic stroke patients treated at CSC’s, we did not observe the “weekend effect.” This may be due to 24/7/365 access to stroke specialists, nurses with stroke experience, and the organized system for delivering care available at CSCs. These results suggest EMS protocol should be reexamined regarding preferential delivery of weekend stroke victims to hospitals that provide all levels of reperfusion therapy. This further highlights the importance of organized stroke care.
Acute Care; Acute Stroke; Emergency Medical Services; Epidemiology; Organized Stroke Care; Outcomes; Stroke Delivery; Thrombolytic RX
To quantify the difference in weekday versus weekend occupancy and the opportunity to smooth inpatient occupancy to reduce crowding at children’s hospitals.
Daily inpatient census data for 39 free-standing, tertiary-care children’s hospitals were used to calculate occupancy and to model the impact of reducing variation in occupancy and the change in the number of patients, patient days, and hospitals exposed to high occupancy pre- and post-smoothing. We also calculated the proportion of weekly admissions that would require different scheduling to achieve within-week smoothing.
Overall, hospitals’ mean occupancy ranged from 70.9%–108.1% on weekdays and 65.7%–94.9% on weekends. Weekday occupancy exceeded weekend occupancy with a median difference of 8.2%-points. The mean post-smoothing reduction in weekly maximum occupancy across all hospitals was 6.6%-points. Through smoothing, 39,607 patients from the 39 hospitals were removed from exposure to occupancy levels >95%. To achieve within-week smoothing, a median 2.6% of admissions would have to be scheduled on a different day of the week; this equates to a median of 7.4 patients per week (range 2.3–14.4).
Hospitals do have substantial unused capacity and smoothing occupancy over the course of a week could be a useful strategy that hospitals can use to reduce crowding and protect patients from crowded conditions.
Bed Occupancy; Hospital Bed Capacity; Length of Stay; Patient Admission; Patient Discharge; Hospitalization; Hospitalized Child; Elective Surgical Procedures; Pediatric Hospital
Weekend admissions have been shown to be associated with an increased risk of mortality compared with weekday admissions for many diagnoses. We analysed emergency department admissions within the Scottish National Health Service to investigate whether mortality is increased in case of weekend emergency department admissions.
A cohort study.
Scotland National Health Service (NHS) emergency departments.
5 271 327 emergency department admissions between 1999 and 2009. We included all patients admitted via emergency departments recorded in the Scottish Morbidity Records (SMR01) in NHS, Scotland for whom complete demographic data were available.
Primary outcome measures
Death as recorded by the General Register Office (GRO).
There was a significantly increased probability of death associated with a weekend emergency admission compared with admission on a weekday (unadjusted OR 1.27, 95% CI 1.26 to 1.28, p<0.0001; adjusted for year of admission, gender, age, deprivation quintile and number of comorbidities OR 1.42, 95% CI 1.40 to 1.43, p<0.0001).
Despite a general reduction in mortality over the last 11 years, there is still a significant excess mortality associated with weekend emergency admissions. Further research should be undertaken to identify the precise mechanisms underlying this effect so that measures can be put in place to reduce patient mortality.
Accident & Emergency Medicine
To explore how weekday and weekend sleep patterns are related to adolescent substance use, depressive symptoms, and school truancy.
Self-report surveys of 242 youth (93.4% white, mean age 16.4 years).
Longer weekday sleep duration was inversely associated with depressive symptoms, past month alcohol use, and drunkenness. Later weekend bedtime and wake-times, compared to those of weekdays, were associated with increased substance use and truancy.
Weekday sleep duration appears to be protective for substance use, depression and school truancy for teenagers. However, inconsistent sleep patterns between weekdays and weekends were associated with a range of markers for adolescent risk.
adolescents; sleep; risk behaviors; depressive symptoms
To examine the impact of birth at night, on the weekend, and during July or August – the first months of the academic year – and the impact of resident duty-hour restrictions on mortality and morbidity of VLBW infants.
Outcomes were analyzed for 11,137 infants with birth weight 501–1250 grams enrolled in the NICHD Neonatal Research Network registry 2001–2005. Approximately half were born before the introduction of resident duty-hour restrictions in 2003. Follow-up assessment at 18–22 months was completed for 4,508 infants. Mortality (7-day and 28-day), short-term morbidities, and neurodevelopmental outcome were examined with respect to the timing of birth: night vs day, weekend vs weekday, and July or August vs other months, and after vs before implementation of resident duty-hour restrictions.
There was no effect of hour, day, or month of birth on mortality and no impact on the risks of short-term morbidities except the risk of ROP requiring operative treatment was lower for infants born during the late night hours than during the day. There was no impact of timing of birth on neurodevelopmental outcome except the risk of hearing impairment or death was slightly lower among infants born in July or August compared with other months. The introduction of resident and fellow duty-hour restrictions had no impact on mortality or neurodevelopmental outcome. The only change in short-term morbidity after duty-hour restrictions were introduced was an increase in the risk of ROP (stage 2 or higher).
In this network of academic centers, the timing of birth and the introduction of duty-hour restrictions had little effect on the risks of mortality and morbidity of VLBW infants, suggesting that staffing patterns were adequate to provide consistent care.
Neonatal; preterm infants; morbidity/mortality; resident education/training; workforce
Objectives To assess the association between mortality and the day of elective surgical procedure.
Design Retrospective analysis of national hospital administrative data.
Setting All acute and specialist English hospitals carrying out elective surgery over three financial years, from 2008-09 to 2010-11.
Participants Patients undergoing elective surgery in English public hospitals.
Main outcome measure Death in or out of hospital within 30 days of the procedure.
Results There were 27 582 deaths within 30 days after 4 133 346 inpatient admissions for elective operating room procedures (overall crude mortality rate 6.7 per 1000). The number of weekday and weekend procedures decreased over the three years (by 4.5% and 26.8%, respectively). The adjusted odds of death were 44% and 82% higher, respectively, if the procedures were carried out on Friday (odds ratio 1.44, 95% confidence interval 1.39 to 1.50) or a weekend (1.82, 1.71 to 1.94) compared with Monday.
Conclusions The study suggests a higher risk of death for patients who have elective surgical procedures carried out later in the working week and at the weekend.
AIM: To evaluate whether weekend or nighttime admission affects prognosis of peptic ulcer bleeding despite early endoscopy.
METHODS: Retrospective data collection from four referral centers, all of which had a formal out-of-hours emergency endoscopy service, even at weekends. A total of 388 patients with bleeding peptic ulcers who were admitted via the emergency room between January 2007 and December 2009 were enrolled. Analyzed parameters included time from patients’ arrival until endoscopy, mortality, rebleeding, need for surgery and length of hospital stay.
RESULTS: The weekday and weekend admission groups comprised 326 and 62 patients, respectively. There were no significant differences in baseline characteristics between the two groups, except for younger age in the weekend group. Most patients (97%) had undergone early endoscopy, which resulted in a low mortality rate regardless of point of presentation (1.8% overall vs 1.6% on the weekend). The only outcome that was worse in the weekend group was a higher rate of rebleeding (12% vs 21%, P = 0.030). However, multivariate analysis revealed nighttime admission and a high Rockall score (≥ 6) as significant independent risk factors for rebleeding, rather than weekend admission.
CONCLUSION: Early endoscopy for peptic ulcer bleeding can prevent the weekend effect, and nighttime admission was identified as a novel risk factor for rebleeding, namely the nighttime effect.
Early endoscopy; Nighttime effect; Peptic ulcer bleeding; Rebleeding; Weekend effect
Optimal management of acute pulmonary embolism (PE) requires medical expertise, diagnostic testing and therapies, which may not be consistently available throughout the entire week. We sought to assess whether there are associations between weekday and weekend admission and mortality and length of hospital stay for patients hospitalized with PE.
Methods and Results
We evaluated patients discharged with a primary diagnosis of PE from 186 acute care hospitals in Pennsylvania (01/2000-11/2002). We used random-effect logistic models to study the association between weekend admission and 30-day mortality and used discrete survival models to study the association weekend admission and time to hospital discharge, adjusting for hospital (region, size, teaching status) and patient factors (race, insurance, severity of illness, use of thrombolytic therapy). Among 15,531 patient discharges with PE, 3286 (21.2%) were admitted on a weekend. Patients admitted on weekends had a higher unadjusted 30-day mortality (11.1% vs 8.8%) compared to patients admitted on weekdays, with no difference in length of stay. Patients admitted on weekends had a significantly greater adjusted odds of dying (odds ratio 1.17, 95% confidence interval: 1.03-1.34) compared to patients admitted on weekdays. The higher mortality among patients hospitalized on weekends was driven by the increased mortality rate among the most severely ill patients.
Patients with PE who are admitted on weekends have a significantly higher short-term mortality than patients admitted on weekdays. Quality improvement efforts should aim to ensure that there is a consistent approach to the management of PE 7 days a week.
lung embolism; prognosis; mortality
Higher risks of stillbirth or early neonatal death, or both, have been reported from several countries for births on weekend days. It is unclear whether such higher risks have persisted in recent years. We investigated weekend-associated risks of stillbirth and early neonatal death in most Canadian provinces.
We studied all 3 239 972 births recorded in Canada, excluding Ontario, between 1985 and 1998. The main outcome measures were the relative risks (RRs) of stillbirth and early neonatal death for infants born on weekends versus weekdays.
The proportion of births on weekend days was 24% lower than the proportion on weekdays. Infants born on weekend days had slightly but significantly elevated risks of stillbirth (RR 1.06, 95% confidence interval [CI] 1.02–1.09) and early neonatal death (RR 1.11, 95% CI 1.07–1.16). However, the higher risks disappeared after adjustment for gestational age.
The crude risks of stillbirth and early neonatal death remained slightly higher for births on weekend days, but the excesses were much smaller than those reported from other countries.
Patients admitted to a 30 bedded acute geriatric medical ward in 1993 were followed up to discharge. The admission rate on weekend days was half that for weekdays. Six percent of ward discharges occurred at weekends, over half being due to death. Respiratory, cardiovascular and central nervous systems disorders were the commonest reasons for admission (56%) and death (73%). Greater emphasis should be placed on discharging patients at weekends.
Previous studies have shown that patients admitted to the intensive care unit (ICU) after “office hours” are more likely to die. However these results have been challenged by numerous other studies. We therefore analysed this possible relationship between ICU admission time and in-hospital mortality in The Netherlands.
This article relates time of ICU admission to hospital mortality for all patients who were included in the Dutch national ICU registry (National Intensive Care Evaluation, NICE) from 2002 to 2008. We defined office hours as 08:00–22:00 hours during weekdays and 09:00–18:00 hours during weekend days. The weekend was defined as from Saturday 00:00 hours until Sunday 24:00 hours. We corrected hospital mortality for illness severity at admission using Acute Physiology and Chronic Health Evaluation II (APACHE II) score, reason for admission, admission type, age and gender.
A total of 149,894 patients were included in this analysis. The relative risk (RR) for mortality outside office hours was 1.059 (1.031–1.088). Mortality varied with time but was consistently higher than expected during “off hours” and lower during office hours. There was no significant difference in mortality between different weekdays of Monday to Thursday, but mortality increased slightly on Friday (RR 1.046; 1.001–1.092). During the weekend the RR was 1.103 (1.071–1.136) in comparison with the rest of the week.
Hospital mortality in The Netherlands appears to be increased outside office hours and during the weekends, even when corrected for illness severity at admission. However, incomplete adjustment for certain confounders might still play an important role. Further research is needed to fully explain this difference.
Electronic supplementary material
The online version of this article (doi:10.1007/s00134-010-1918-1) contains supplementary material, which is available to authorized users.
Hospital mortality; Admission time; ICU; Severity of illness; APACHE II
All medication errors are serious, but those associated with the IV route of administration often result in the most severe outcomes. According to the literature, IV medications are associated with 54% of potential adverse events, and 56% of medication errors.
To determine the type and frequency of errors associated with prescribing, documenting, and administering IV infusions, and to also determine if a correlation exists between the incidence of errors and either the time of day (day versus night) or the day of the week (weekday versus weekend) in an academic medicosurgical intensive care unit without computerized order entry or documentation.
As part of a quality improvement initiative, a prospective, observational audit was conducted for all IV infusions administered to critically ill patients during 40 randomly selected shifts over a 7-month period in 2007. For each IV infusion, data were collected from 3 sources: direct observation of administration of the medication to the patient, the medication administration record, and the patient’s medical chart. The primary outcome was the occurrence of any infusion-related errors, defined as any errors of omission or commission in the context of IV medication therapy that harmed or could have harmed the patient.
It was determined that up to 21 separate errors might occur in association with a single dose of an IV medication. In total, 1882 IV infusions were evaluated, and 5641 errors were identified. Omissions or discrepancies related to documentation accounted for 92.7% of all errors. The most common errors identified via each of the 3 data sources were incomplete labelling of IV tubing (1779 or 31.5% of all errors), omission of infusion diluent from the medication administration record (474 or 8.4% of all errors), and discrepancy between the medication order as recorded in the patient’s chart and the IV medication that was being infused (105 or 1.9% of all errors).
Strict definitions of errors and direct observation methods allowed identification of errors at every step of the medication administration process that was evaluated. Documentation discrepancies were the most prevalent type of errors in this paper-based system.
IV infusion; continuous infusion; errors; intensive care unit; critical care; perfusion i.v.; perfusion continue; erreurs; unité de soins intensifs; soins aux malades en phase critique
Health insurance characteristics shift at age 65 as most people become eligible for Medicare. We measure the impacts of these changes on patients who are admitted to hospitals through emergency departments for conditions with similar admission rates on weekdays and weekends. The age profiles of admissions and comorbidities for these patients are smooth at age 65, suggesting that the severity of illness is similar on either side of the Medicare threshold. In contrast, the number of procedures performed in hospitals and total list charges exhibit small but statistically significant discontinuities, implying that patients over 65 receive more services. We estimate a nearly 1-percentage-point drop in 7-day mortality for patients at age 65, equivalent to a 20% reduction in deaths for this severely ill patient group. The mortality gap persists for at least 9 months after admission.
To determine the relationship between napping and cognitive function in preschool-aged children.
Daytime napping, nighttime sleep and cognitive function were assessed in fifty-nine typically developing children ages 3-5 years, who were enrolled in full-time childcare. Participants wore an actigraphy watch for 7 days to measure sleep and napping patterns, and completed neuropsychological testing emphasizing attention, response control, and vocabulary. Parents of participants completed behavior ratings and sleep logs during the study. Sleep/wake cycles were scored with the Sadeh algorithm.
Children who napped more on weekdays were also more likely to nap during weekends. Weekday napping and nighttime sleep were inversely correlated, such that those who napped more slept less at night, while total weekday sleep remained relatively constant. Weekday napping was significantly (negatively) correlated with vocabulary and auditory attention span, and weekday nighttime sleep was positively correlated with vocabulary. Nighttime sleep was also significantly negatively correlated with performance, such that those who slept less at night made more impulsive errors on a computerized go/no-go test.
Daytime napping is actually negatively correlated with neurocognitive function in preschoolers. Nighttime sleep appears to be more critical for development of cognitive performance. Cessation of napping may serve as a developmental milestone of brain maturation. Children who nap less do not appear to be sleep deprived, especially if they compensate with increased nighttime sleep. An alternative explanation is that children who sleep less at night are sleep deprived and require a nap. A randomized trial of nap restriction would be the next step in understanding the relationship between napping and neurocognitive performance.
childhood; attention; sleep; cognition; actigraphy; preschool
In a study designed to investigate the variations in rates of admission to hospital for appendicitis in Wales Hospital Activity Analysis listings were analysed according to the sex and age of the patients and the month and day of the week of admission. The incidence of hospitalisation was greatest among boys aged 10-14 and girls aged 15-19. The number of admissions was higher on weekdays than at weekends, but there were no seasonal variations. Durations of stay differed between the 17 health districts. We conclude that admission rates vary mainly because of differing hospital admission policies. Admission is not wholly governed by the sudden onset of abdominal pain; other factors include the threshold of consultation of each patient, the referral habits of general practitioners, the availability of hospital beds, and the degree to which doctors and patients expect admission.
Microsporidial gastroenteritis, a serious disease of immunocompromised people, can have a waterborne etiology. During summer months, samples of recreational bathing waters were tested weekly for human-virulent microsporidian spores and water quality parameters in association with high and low bather numbers during weekends and weekdays, respectively. Enterocytozoon bieneusi spores were detected in 59% of weekend (n = 27) and 30% of weekday (n = 33) samples, and Encephalitozoon intestinalis spores were concomitant in a single weekend sample; the overall prevalence was 43%. The numbers of bathers, water turbidity levels, prevalences of spore-positive samples, and concentrations of spores were significantly higher for weekend than for weekday samples; P values were <0.001, <0.04, <0.03, and <0.04, respectively. Water turbidity and the concentration of waterborne spores were significantly correlated with bather density, with P values of <0.001 and <0.01, respectively. As all water samples were collected on days deemed acceptable for bathing by fecal bacterial standards, this study reinforces the scientific doubt about the reliability of bacterial indicators in predicting human waterborne pathogens. The study provides evidence that bathing in public waters can result in exposure to potentially viable microsporidian spores and that body contact recreation in potable water can play a role in the epidemiology of microsporidiosis. The study indicates that resuspension of bottom sediments by bathers resulted in elevated turbidity values and implies that the microbial load from both sediments and bathers can act as nonpoint sources for the contamination of recreational waters with Enterocytozoon bieneusi spores. Both these mechanisms can be considered for implementation in predictive models for contamination with microsporidian spores.
A survey on sleep schedule, sleep health, school performance and school start times was conducted in 1,941 adolescents. A high level of early and circadian-disadvantaged sleep/wake schedules during weekdays was observed. Shorter sleep duration on weekdays was reported, especially in upper classmen. Complaints of inadequate sleep and sleepiness during weekdays, alarm clock use, and napping were prevalent. Night awakening and prolonged sleep onset were common and associated with poor school performance. Students with a sleep length of less than 7 hours on both weekdays and weekends exhibited poorer performance, while those who made up this sleep loss on weekends did not. The total number of poor sleep factors in an individual also correlated with poor school performance. Earlier school start times were associated with a perception of poor sleep quality, shorter sleep duration and more sleep health problems. We conclude that sleep inadequacies and sleep health problems were prevalent in this population, especially in those who started school earlier in the morning, and that these poor sleep factors were associated with school performance.
sleep deprivation; sleep health problem; adolescents; performance; school start time
Few studies have differentiated between weekday and weekend day sleep duration in their association with indicators of weight status in children. Therefore, we examined the association of week and weekend day sleep duration with indicators of body composition in 10–12 year old European school children.
Methods and Findings
Multi-level linear regression analysis was performed to examine the association between parent-reported week and weekend day sleep duration and objectively assessed child BMI and WC, adjusting for socio-demographic variables and energy balanced related behaviours EBRBs (i.e. dietary, physical and sedentary behaviour). Compared to sleeping 10 hrs/night or more, sleeping on average less than 10 hrs/night during weekdays was associated with higher BMI (for example, B = 0.86 and CI = [0.27;1.45] when sleeping ≤7 hrs) and WC (for example, B = 1.99 and CI = [0.32;3.65] when sleeping ≤7 hrs). Sleeping 9 hrs/night during weekend days, but not ≤8 hrs, was associated with higher WC (B = 0.66; CI = [0.04;1.28]) compared to sleeping more than 10 hrs/night. Average (week and weekend) sleep duration less than 10 hrs/night was associated with higher values for BMI (B = 0.98; CI = [0.24;1.73] and WC (B = 2.35; CI = [0.08;4.31]).
Weekday sleep duration seems more strongly associated with body composition in European school children than weekend day sleep duration. Promoting adequate sleep duration may contribute to healthy weight in children.
Recent recommendations for physicians in the UK outline key aspects of care that should improve patient outcomes and experience in acute hospital care. Included in these recommendations are Consultant patterns of work to improve timeliness of clinical review and improve continuity of care. This study used a contemporaneous validated survey compared with clinical outcomes derived from Hospital Episode Statistics, between April 2009 and March 2010 from 91 acute hospital sites in England to evaluate systems of consultant cover for acute medical admissions. Clinical outcomes studied included adjusted case fatality rates (aCFR), including the ratio of weekend to weekday mortality, length of stay and readmission rates. Hospitals that had an admitting Consultant presence within the Acute Medicine Unit (AMU, or equivalent) for a minimum of 4 hours per day (65% of study group) had a lower aCFR compared with hospitals that had Consultant presence for less than 4 hours per day (p<0.01) and also had a lower 28 day re-admission rate (p<0.01). An ‘all inclusive’ pattern of Consultant working, incorporating all the guideline recommendations and which included the minimum Consultant presence of 4 hours per day (29%) was associated with reduced excess weekend mortality (p<0.05). Hospitals with >40 acute medical admissions per day had a lower aCFR compared to hospitals with fewer than 40 admissions per day (p<0.03) and had a lower 7 day re-admission rate (p<0.02). This study is the first large study to explore the potential relationships between systems of providing acute medical care and clinical outcomes. The results show an association between well-designed systems of Consultant working practices, which promote increased patient contact, and improved patient outcomes in the acute hospital setting.
Adolescent girls are one of the most sedentary demographic groups. A better understanding of their accumulation of sedentary time is needed to inform future interventions. The purpose of this study was to examine the longitudinal levels and bouts of objectively measured sedentary time accumulated during different days of the week and periods of the weekday among a large sample of adolescent girls.
The results are based on 655 adolescent girls from the Girls in Sport Intervention and Research Project. Levels and bouts of sedentary time were derived from accelerometer data collected at baseline and 18-month follow-up. Total, weekday, weekend, school (i.e., morning bell to afternoon bell), after school (i.e., afternoon bell to 19:00), and evening (i.e. 19:01 to 23:59) sedentary time levels and bouts were calculated. Repeated-measures ANCOVAs were conducted to examine differences in sedentary time levels and bouts between days and time periods after adjusting for wear time, accelerometer model, and intervention group.
Cross-sectional analyses revealed that levels and bouts of sedentary time were higher on weekdays compared to weekend days at baseline. Similar trends were observed at follow-up. In addition, percentage of wear time spent sedentary and bouts/hr of sedentary time were highest in the evening compared to the school and after school periods at both baseline and follow-up. Longitudinal analyses revealed that levels and bouts of sedentary time were higher at follow-up compared to baseline across the different days of the week and periods of the weekday examined, with the biggest increase (15%) occurring in the school period.
Future interventions targeting sedentary time among adolescent girls should consider developing strategies to reduce and break up prolonged sedentary time during the school day and in the evening.
Sedentary time; Patterns; Adolescents; Girls