Primary Care Antibiotic Prescribing and Infection-Related Hospitalisation

Inappropriate prescribing of antibiotics has been widely recognised as a leading cause of antimicrobial resistance, which in turn has become one of the most significant threats to global health. Given that most antibiotic prescriptions are issued in primary care settings, investigating the associations between primary care prescribing of antibiotics and subsequent infection-related hospitalisations affords a valuable opportunity to understand the long-term health implications of primary care antibiotic intervention. A narrative review of the scientific literature studying associations between primary care antibiotic prescribing and subsequent infection-related hospitalisation was conducted. The Web of Science database was used to retrieve 252 potentially relevant studies, with 23 of these studies included in this review (stratified by patient age and infection type). The majority of studies (n = 18) were published in the United Kingdom, while the remainder were conducted in Germany, Spain, Denmark, New Zealand, and the United States. While some of the reviewed studies demonstrated that appropriate and timely antibiotic prescribing in primary care could help reduce the need for hospitalisation, excessive antibiotic prescribing can lead to antimicrobial resistance, subsequently increasing the risk of infection-related hospitalisation. Few studies reported no association between primary care antibiotic prescriptions and subsequent infection-related hospitalisation. Overall, the disparate results in the extant literature attest to the conflicting factors influencing the decision-making regarding antibiotic prescribing and highlight the necessity of adopting a more patient-focussed perspective in stewardship programmes and the need for increased use of rapid diagnostic testing in primary care

Influence of intellectual disability on exercise regulation: exploring verbal, auditory and visual guidance to contribute to promote inclusive exercise environments.

Objective: The role of intellectual disability (ID) in exercise regulation has remained largely unexplored, yet recent studies have indicated cognitive-related impaired pacing skills in people with ID. In a well-controlled laboratory environment, this study aims to (1) establish the role of ID in pacing and explore the ability of people with and without ID to maintain a steady pace; (2) to investigate if verbal feedback and/or (3) the presence of a pacer can improve the ability of people with ID to maintain a preplanned submaximal velocity. Methods: Participants with (n=10) and without ID (n=10) were recruited and performed 7 min submaximal trials on a cycle ergometer (Velotron). Participants with ID also performed a cycling trial with a pacer (virtual avatar). Results: The non-parametric tests for repeated measures data (p≤0.05) showed that (1) people with ID deviated more from the targeted pace compared with people without ID, (2) the verbal feedback did not influence their ability to keep a steady pace and (3) they deviated less from the targeted pace when a visual pacer was introduced. Conclusion: The results revealed the difficulties of people with ID in planning and monitoring their exercise and the difficulties in appropriately responding to auditory and verbal feedback. Coaches and stakeholders who want to offer inclusive exercise pathways should consider that people with ID perform and pace themselves better when supported by intuitive, visual and personally meaningful stimuli such as other cyclists (avatars)

Pacing behaviour development and acquisition: A systematic review

The goal-directed decision-making process of effort distribution (i.e. pacing) allows individuals to efficiently use energy resources as well as to manage the impact of fatigue on performance during exercise. Given the shared characteristics between pacing behaviour and other skilled behaviour, it was hypothesized that pacing behaviour would adhere to the same processes associated with skill acquisition and development. PubMed, Web of Science and PsycINFO databases between January 1995 and January 2022 were searched for articles relating to the pacing behaviour of individuals (1) younger than 18 years of age, or (2) repeatedly performing the same exercise task, or (3) with different levels of experience. The search resulted in 64 articles reporting on the effect of age (n = 33), repeated task exposure (n = 29) or differing levels of experience (n = 13) on pacing behaviour. Empirical evidence identifies the development of pacing behaviour starts during childhood (~ 10 years old) and continues throughout adolescence. This development is characterized by an increasingly better fit to the task demands, encompassing the task characteristics (e.g. duration) and environment factors (e.g. opponents). Gaining task experience leads to an increased capability to attain a predetermined pace and results in pacing behaviour that better fits task demands. Similar to skilled behaviour, physical maturation and cognitive development likely drive the development of pacing behaviour. Pacing behaviour follows established processes of skill acquisition, as repeated task execution improves the match between stimuli (e.g. task demands and afferent signals) and actions (i.e. continuing, increasing or decreasing the exerted effort) with the resulting exercise task performance. Furthermore, with increased task experience attentional capacity is freed for secondary tasks (e.g. incorporating opponents) and the goal selection is changed from achieving task completion to optimizing task performance. As the development and acquisition of pacing resemble that of other skills, established concepts in the literature (e.g. intervention-induced variability and augmented feedback) could enrich pacing research and be the basis for practical applications in physical education, healthcare, and sports. [Abstract copyright: © 2022. The Author(s).

The perception of time is slowed in response to exercise, an effect not further compounded by competitors: behavioral implications for exercise and health.

The theory of relativity postulates that time is relative to context and exercise seems such a situation. The purpose of this study was to examine whether situational factors such as perceived exertion and the introduction of an opponent influence competitors' perception of time. Thirty-three recreationally active adults (F = 16; M = 17) performed three standardized 4-km cycling trials in a randomized order. Velotron 3D software was used to create a visual, virtual environment representing (1) a solo time trial (FAM and SO), (2) a time trial with a passive opponent avatar (PO), and (3) a time trial with an opponent avatar and participant instruction to actively finish the trial before the opponent (AO). Participants were asked to estimate a 30-s time period using a standardized protocol for reproducibility before exercise at 500 m, 1500 m, 2500 m, and post exercise. Rate of perceived exertion (RPE) was measured throughout the trials. Exercise trials revealed that time was perceived to run "slow" compared to chronological time during exercise compared to resting and post-exercise measurements (p < 0.001). There was no difference between exercise conditions (SO, PO, and AO) or time points (500 m, 1500 m, and 2500 m). RPE increased throughout the trials. The results of this study demonstrate for the first time that exercise both with and without the influence of opponents influences time perception. This finding has important implications for healthy exercise choices and also for optimal performance. Independent of RPE, time was perceived to move slower during exercise, underpinning inaccurate pacing and decision-making across physical activities. [Abstract copyright: © 2024 The Authors. Brain and Behavior published by Wiley Periodicals LLC.

The Role of Cognition and Social Factors in Competition: How Do People with Intellectual Disabilities Respond to Opponents?

Exploring pacing behaviour in people with intellectual disabilities (ID) in competition will help to better understand the impact of cognition and social environment in sports, providing support for the shaping of proper inclusive sports environments. The present experimental study aimed to (1) compare the pacing behaviour and performance between people with and without ID who are inexperienced in cycling and (2) investigate how these are influenced by an opponent. Participants with (n = 8) and without ID (n = 10) performed two randomised 4-km maximal cycling trials, alone and against an opponent. Non-parametric tests for repeated measures data (p ≤ 0.05) revealed that people with ID cycled slower, but with higher inter-individual variation (both conditions) and paced themselves differently compared to people without ID when competing against an opponent. In contrast to the previous literature in athletes without ID, the presence of a faster opponent resulted in a decrease in the performance in the participants with ID. The negative influence of the opponent highlights the potential difficulties people with ID experience to adequately use their opponents to enhance their self-regulatory processes and optimize their pacing and performance in maximal exercise trials. Coaches who want to offer inclusive sports environments for people with ID could take these findings into consideration

Unraveling the Role of (Meta-) Cognitive Functions in Pacing Behavior Development during Adolescence:Planning, Monitoring, and Adaptation

Purpose This study aimed to investigate whether (meta-) cognitive functions underpin the development of the self-regulated distribution of effort during exercise (i.e., pacing) throughout adolescence.Methods: Participants included 18 adolescents (9 girls, 15.6 ± 2.5 yr old) and 26 adults (13 women, 26.8 ± 3.1 yr old), all recreationally active but unfamiliar with time trial cycling. The (meta-) cognitive functions involved in preexercise planning were quantified by calculating the difference between estimated and actual finish time during a 4-km cycling time trial. The capability to monitor and adapt one's effort distribution during exercise was measured during a 7-min submaximal trial, in which the participants were tasked with adhering to a set submaximal goal velocity either with (0-5 min) or without (5-7 min) additional feedback provided by the researcher. Analyses included between-group comparisons (ANOVA) and within-group comparisons (correlation) (P &lt; 0.05).Results: Adolescents were less accurate in their estimation of the task duration. The adolescents' overestimation of task duration of the 4-km time trial was accompanied by pacing behavior characteristics resembling a longer trial (i.e., more even power output distribution, lower RPE, more pronounced end-spurt). Contrary to the adults, the adolescents deviated relatively more from the goal velocity during the 7-min submaximal trial, when no additional feedback was provided by the researcher. Within the adolescent group, estimation of task duration accuracy (r = 0.48) and adherence to goal velocity (r = 0.59) correlated with age.Conclusions: The (meta-) cognitive functions involved in the preexercise planning and the monitoring and adaptation of the distribution of effort during exercise underpin the development of pacing behavior during adolescence. Feedback from the (social) environment can be used to aid the monitoring and adaptation of effort expenditure in adolescents.</p

Effects of Experience and Opponents on Pacing Behavior and 2-km Cycling Performance of Novice Youths

Purpose: To study the pacing behavior and performance of novice youth exercisers in a controlled laboratory setting. Method: Ten healthy participants (seven male, three female, 15.8 ± 1.0 years) completed four, 2-km trials on a Velotron cycling ergometer. Visit 1 was a familiarization trial. Visits 2 to 4 involved the following conditions, in randomized order: no opponent (NO), a virtual opponent (starting slow and finishing fast) (OP-SLOWFAST), and a virtual opponent (starting fast and finishing slow) (OP-FASTSLOW). Repeated measurement ANOVAs (p .05). Conclusion: Performance was improved by an increase in experience after one visit, parallel with the ability to anticipate future workload

Pacing in lane-based head-to-head competitions:A systematic review on swimming

Athletes' energy distribution over a race (e.g. pacing behaviour) varies across different sports. Swimming is a head-to-head sport with unique characteristics, such as propulsion through water, a multitude of swimming stroke types and lane-based racing. The aim of this paper was to review the existing literature on pacing behaviour in swimming. According to PRISMA guidelines, 279 articles were extracted using the PubMed and Web of Science databases. After the exclusion process was conducted, 16 studies remained. The findings of these studies indicate that pacing behaviour is influenced by the race distance and stroke type. Pacing behaviours in swimming and time-trial sports share numerous common characteristics. This commonality can most likely be attributed to the lane-based racing set-up. The low efficiency of swimming resulting from propulsion through the water induces a rapid accumulation of blood lactate, prompting a change in swimmers' biomechanical characteristics, with the goal of minimising changes in velocity throughout the race. Although the literature on youth swimmers is scarce, youth swimmers demonstrate more variable pacing profiles and have more difficulty in selecting the most beneficial energy distribution.</p

The Role of the Social Environment in Pacing and Sports Performance: A Narrative Review from a Self-Regulatory Perspective

As proposed by Triplett in 1898 and evidenced by a recent series of lab and field studies, racing against other competitors consistently results in increased performance compared to when racing alone. To explain this phenomenon, we will explore the process of self-regulation, a process relevant to pacing, which is linked to athletes’ emotions and facilitates their sports performance optimization. We will apply the cyclical model of Self-regulation of Learning to pacing and sports performance settings and explore the role of the social environment (in particular, opponents but also coaches) in each phase of the self-regulatory model. It seems that the social environment could be considered as a significant self-regulatory and sports performance facilitator. More specifically, athletes can focus on their social environment (opponents) when they have to set goals and select appropriate strategies to achieve them (forethought phase), monitor and manage their actions and their emotions (performance phase), and make self-judgements and choose self-reactions (self-reflection). Moreover, the social environment (coaches) can observe, step in, and facilitate these intricate processes. These findings could guide athletes and their coaches towards more effective pacing acquisition and development, and better sports performance, which could be of particular relevance for youth athletes or athletes with disabilities impacting on their self-regulatory skills