Older adults (≥65) often receive antibiotics in emergency departments (ED), where guideline concordance is low with both overuse and underuse; whether community disadvantage drives these patterns is unknown.

We analyzed electronic health records from 1,318,281 ED encounters among 790,562 adults ≥65 (2015–2024). Outcomes were guideline concordance and components (overuse, underuse). To address omitted variables and reverse causality, we used two-stage instrumental-variable models with Social Vulnerability Index (SVI) and Social Deprivation Index (SDI) as exposures, instrumented by maximum state Earned Income Tax Credit, adjusting for patient, facility, state, and time covariates.

16.8% of encounters were non-concordant (overuse 9.5%; underuse 7.2%). Concordance improved to 83.8% in 2024. In IV models, each 10-point increase in SVI reduced concordance by 6.37 percentage points (pp) (SE 0.69) and each 10-point increase in SDI by 1.84 pp (SE .20; P < .0005). Declines reflected higher underuse (+0.43 pp per 10-point SVI; +0.12 pp per 10-point SDI) with less overuse (−0.10 and −0.30 pp). Concordance was higher for Black (+12.90 pp vs White) and Medicaid-insured patients (+5.40 pp vs commercial). Overuse was higher in rural (+7.90 pp vs metropolitan) and academic EDs (+5.00 pp vs non-academic), whereas underuse was more common in metropolitan (+42.50 pp) and non-academic EDs (+32.70 pp). Spatial analyses found high deprivation/low concordance in the South and low deprivation/high concordance in the Midwest.

Community disadvantage may causally predict lower guideline-concordant antibiotic prescribing for older adults, primarily via underuse. Stewardship should address underuse and overuse and prioritize disadvantaged regions where gaps are greatest.

The Rey–Osterrieth complex figure (ROCF) test is widely used to assess constructional praxis. Qualitative scoring methods, such as the Boston Qualitative Scoring System (BQSS), enable the detection of alterations in spatial organization, planning, and executive control during copying performance. While alterations in constructional abilities have been previously reported in Parkinson’s disease (PD), the possible presence of subtle qualitative modifications in PD patients without cognitive impairment (PD-CU) and their relationship with the cognitive functioning is still to be elucidated. This study evaluates differences in copying strategies and error patterns in PD patients with (PD-MCI) or without (PD-CU) mild cognitive impairment, assessing the link with the cognitive profile.

Seventy PD patients and 56 healthy controls (HC) were recruited. All participants underwent a neuropsychological assessment, including the ROCF. Their performance was assessed by standard quantitative scoring and qualitative rating scales (BQSS). Statistical analyses compared BQSS performance between groups and examined associations between qualitative visuo-constructional features and other cognitive domains.

Both PD-MCI and PD-CU groups showed qualitative alterations compared to HC, associated with executive dysfunctions. Qualitatively, PD-CU patients showed lower scores in neatness and planning measures compared to HC, the latter particularly associated with executive alterations. Notably, patients reporting a left or right asymmetric copy were characterized by different cognitive profiles.

The here-presented results support the importance of qualitative assessment in identifying early cognitive impairments in PD patients and suggest that BQSS parameters (i.e., planning) may offer complementary insights to standard quantitative assessments in detecting subthreshold executive impairments not yet captured by conventional tests.

To assess changes in (1) sodium content of processed foods in the Canadian food supply and (2) the proportion of products meeting Health Canada’s voluntary sodium reduction targets (SRTs) between 2010 and 2020.

This repeated, cross-sectional study used foods from the 2010 (n=6,929), 2013 (n=9,366), 2017 (n=10,324), and 2020 (n=15,797) collections of the University of Toronto’s Food Label Information and Price database, categorized into Health Canada’s sodium categories. Quantile regression was used to assess changes in sodium content. Firth’s bias-reduced logistic regression was used to evaluate changes in the proportion of foods meeting the SRTs and trends were assessed with Cochran-Armitage tests.

Canada.

Processed foods.

Between 2010-2020, 54% (7/13) of major categories had a left shift (reduction) in their sodium distribution, 15% (2/13) had a right shift (increase), 15% (2/13) had both a left and right shift, and 15% (2/13) did not change. The proportion of products meeting the average targets and maximum levels increased 6% and 4% from 2010-2013 and 4% and 3% from 2013-2017, then decreased 3% and 1% between 2017-2020, with trends for improvement over time (p-trend<0.001).

Although many categories decreased in sodium, some did not change or increased in sodium and improvements in the proportion of products meeting the SRTs were modest and occurred early on. Further actions, such as implementing accountability initiatives that promote industry adherence to voluntary SRTs or introducing mandatory measures, alongside frequent and transparent monitoring are needed to reduce sodium in processed foods in Canada.

Secondary intracranial infections are common and severe complications in patients with viral encephalitis, contributing to higher mortality, prolonged hospitalization and increased healthcare burden. Evidence on risk factors, pathogen spectrum and resistance patterns remains limited, and predictive models tailored to this population are lacking.

We conducted a single-center retrospective cohort study, including 160 consecutive patients diagnosed with viral encephalitis. Clinical, therapeutic, laboratory and microbiological data were extracted from hospital records. Independent risk factors were identified using multivariate logistic and Cox regression. Predictive performance was assessed by receiver operating characteristic analysis. Pathogen distribution and antimicrobial resistance profiles were analyzed descriptively.

During a median follow-up of 16 days, 50 patients (31.3%) developed secondary intracranial infections, corresponding to an incidence of 2.9 events per 1000 patient-days. Independent predictors included older age (adjusted OR 1.39 per 10 years, P = 0.021), comorbidities (OR 2.18, P = 0.048), corticosteroid use ≥7 days (OR 2.45, P = 0.025), ≥2 invasive procedures (OR 2.92, P = 0.007) and elevated CSF protein (OR 2.36, P = 0.037). The multivariable risk score achieved an area under the curve of 0.86 (95% CI 0.80–0.92). Pathogen analysis revealed methicillin-resistant Staphylococcus aureus (MRSA) (24.0%) and Acinetobacter baumannii (20.0%) as predominant isolates, both showing high multidrug resistance, including carbapenem resistance rates of 70% in A. baumannii.

Secondary intracranial infections occur frequently in viral encephalitis and are strongly associated with host vulnerability. The predominance of MRSA and carbapenem-resistant A. baumannii underscores the urgent need for tailored infection control and antimicrobial strategies in neurocritical care.