Background: A large body of research has been conducted on the "weekend effect," which is the reportedly increased risk of adverse outcomes for patients admitted to the hospital on weekends versus those admitted on weekdays. This effect has been researched in numerous patient populations, including sub-populations of end-stage renal disease (ESRD) patients, with varying conclusions.Objectives: To assess whether differences in in-hospital mortality, access to renal replacement therapy (RRT), time to RRT, and other important outcomes exist in patients with ESRD or patients on RRT admitted on the weekend versus weekdays.Design and setting: A retrospective cohort study was conducted using the 2018 Nationwide Inpatient Sample. Patients were included if they were adults with a principal or secondary diagnosis of ESRD or if they were admitted with a diagnosis related to initiation, maintenance, or complications of RRT. Patients admitted between midnight Friday and midnight Sunday were classified as weekend admissions. Primary outcome measurements included in-hospital mortality, in-hospital dialysis (peritoneal dialysis, hemodialysis, and continuous RRT), and renal transplantation (TP). Secondary outcomes included length of hospital stay (LOS) and total hospitalization charges.Results: The study included 1,144,385 patients who satisfied the inclusion criteria. Compared with patients admitted on weekdays, patients with ESRD admitted on weekends had 8% higher adjusted odds of inhospital mortality (OR: 1.08; 95% CI: 1.03-1.13; p = 0.002), 9% lower adjusted OR of any RRT over the weekend than on weekdays (OR: 0.91; 95% CI: 0.89-0.93; p = 0.000), lower RRT rates (within 24 hours)

The first known reference to Postpartum Depression (PPD), was Hippocrates’ 4th century hypothesis that drainage of lochia, if suppressed, could flow to the brain resulting in agitation, delirium, and episodes of mania. This hypothesis became dogma and lasted over a millennium. Over the years, knowledge of PPD has evolved but researchers still struggle to establish it as a distinct disease entity. It was initially recognized as Major Depressive Disorder (MDD) with postpartum onset in the 1994 revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), the “bible” of diagnostic criteria for mental health professionals and researchers. It is currently recognized as MDD with peripartum onset (DSM-V) and researchers have admitted that persuasive evidence to indicate that postpartum depression is distinct from other existing depressive disorders, has not been found. Several diagnostic tools such as the Edinburg Postpartum Depression Scale (EDPS), the Beck Depression Inventory (BDI-II), Patient Health Questionnaire (PHQ-9), and the Postpartum Depression Screening Scale (PDSS) are available for use but none of these is universally accepted. With much of the published literature plagued with bias and structural inconsistencies, the credibility of the evidence has been greatly diminished. The difficulty with disease designation, the absence of a universally accepted tool for diagnosis and the scarcity of generalizable evidence on the subject has impaired the early recognition and effective management of PPD. It is therefore expedient, to critically appraise some of the available literature and proffer solutions to navigating this conundrum.

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