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Background The role of antibiotics in malignancies treated with immune checkpoint inhibitors (ICI) remains unclear. Several studies suggested a detrimental impact of antibiotic use on the response to ICI, but were susceptible to confounding by indication. Our objective was therefore to assess whether the relationship between antibiotic use and ICI response is causative or merely associative.Methods A large, single-center observational cohort study was performed with individuals treated for either non-small cell lung carcinoma (NSCLC) or metastatic melanoma. An effect modification approach was used, aiming to estimate the association between antibiotic use and overall survival (OS) and compare these estimates between individuals receiving first-line ICI treatment versus those receiving first-line tyrosine kinase inhibitors (TKIs). Exposure of interest was antibiotic use within 30 days before the start of anticancer treatment. HRs for OS were estimated for antibiotics versus no antibiotics in each cohort using multivariable propensity adjusted analysis. The “true antibiotic effect” within the ICI versus TKI cohort was modeled using an interaction term.Results A total of 4534 patients were included, of which 1908 in the ICI cohort and 817 in the TKI cohort. Approximately 10% of patients in each cohort used antibiotics within 30 days before the start of anticancer treatment. Our results demonstrate a lack of synergistic interaction between current antibiotic use and ICI therapy in relation to OS: although antibiotic use was significantly associated with OS decline in the ICI cohort (HR=1.26 (95% CI 1.04 to 1.51)), a similar magnitude in OS decline was found within the TKI cohort (HR=1.24 (95% CI 0.95 to 1.62)). This was reflected by the synergy index (HR=0.96 (95% CI 0.70 to 1.31)), which implied no synergistic interaction between current antibiotic use and ICI.Conclusion This study strongly suggests that there is no causal detrimental association between antibiotic use and ICI therapy outcome when looking at OS in individuals with malignant melanoma or NSCLC. The frequently observed inverse association between antibiotics and ICI response in previous studies is most likely driven by confounding by indication, which was confirmed by the findings in our reference TKI cohort.

The COVID-19 pandemic lockdowns were accompanied by an abrupt transition from face-to-face education to online education. The aim of this study was to evaluate the impact of the COVID-19 pandemic on academic functioning and mood in Dutch pharmacy students and PhD candidates. A total of n = 341 participants completed an online survey including questions on mood and academic functioning, assessed retrospectively for before and during the COVID-19 pandemic. Overall, during COVID-19 lockdown, significantly more time was spent on academic activities, and study grades/output significantly improved. However, the overall effects were of small magnitude, and there was great variability among students, reporting either improved, unchanged or poorer academic functioning. Compared to before COVID-19, the lockdown periods were associated with significantly increased levels of stress, anxiety, depression, fatigue, and loneliness, and a significant reduction in optimism and happiness. Significant negative correlations were found between ‘performance quality’ and stress, ‘performance quality’ and fatigue, ‘study grades/output’ and stress, and between ‘study grades/output’ and fatigue. Correlations of mood and items related to academic interactions were not statistically significant. Differential effects were seen when the data was analyzed according to sex, living situation, and ethnicity, revealing that women, students living alone, and those with a migration background reported that COVID-19 lockdowns had greater negative mood effects and a more negative impact on academic functioning. Poorer sleep quality and reduced quality of life were significantly associated with reduced mood, as well as reduced academic performance quality and role satisfaction. Regression analysis revealed that being young and not having a non-Western migration background were predictors of improved performance quality. However, only being young was a significant predictor of improved study grades/output during the COVID-19 pandemic. Increased levels of stress and fatigue were significant predictors of both reduced performance quality and poorer study grades/output during the COVID-19 pandemic. In conclusion, for the sample as a whole, the transition to online education during the COVID-19 lockdown was judged as having significant positive effects on academic performance. The lockdown periods were associated with significantly reduced mood and reduced social interactions. It should be taken into account that about one third of students reported academic functioning to be poorer during the COVID-19 pandemic. This represents a substantial group of students who require more attention and guidance to make a successful transition to online education and cope with lockdown-associated stress and fatigue.

Mixed results have been published on the impact of the 2019 coronavirus (COVID-19) pandemic and its associated lockdown periods on academic functioning, mood, and health correlates such as alcohol consumption. Whereas a number of students report an impaired academic performance and increased alcohol intake during lockdown periods, other students report no change or an improvement in academic functioning and a reduced alcohol consumption. This data descriptor article describes the dataset of a study investigating the impact of the COVID-19 pandemic on academic functioning. To investigate this, an online survey was conducted among Dutch pharmacy students, PhD candidates and postdoctoral researchers (postdocs) of Utrecht University, the Netherlands. Compared to before the COVID-19 pandemic, the survey assessed possible changes in self-reported academic functioning, mood and health correlates such as alcohol consumption, perceived immune functioning and sleep quality. Retrospective assessments were made for four periods, including (1) the year 2019 (the period before COVID-19), (2) the first lockdown period (15 March–11 May 2020), (3) summer 2020 (no lockdown) and (4) the second lockdown (November 2020–April 2021). This article describes the content of the survey and corresponding dataset. The survey had a response rate of 24.3% and was completed by 345 participants.

To stimulate learners’ autonomy, autonomy-supportive teaching strategies were included in the design of a multidisciplinary elective course on pain. During this course, students explored pain from different disciplinary angles, i.e., from biomedical, psychological, arts, philosophical, and anthropological perspectives. In the course, autonomy was stimulated by giving students freedom of choice, especially in their final assignments. The aim of this study was to explore students’ freedom of choice and students’ perceptions of the multidisciplinary course on pain, particularly students’ perception of autonomy in the light of self-determination theory (SDT). To address the aim of this study, a mixed methods approach was used. Directed content analysis was conducted on a reflective part of the final individual assignment and was used to find categories fitting within SDT and also outside it. In addition to this, the diversity of topics as well as different disciplines present in the final individual assignments was explored to demonstrate students’ freedom of choice. This study shows that the course setup supported students’ autonomy and relatedness and stimulated students’ interest in and relevance to pain. Moreover, it stimulated students’ freedom of choice and stimulated curiosity towards disciplines such as arts and philosophy. Therefore, it can be concluded that we successfully developed a multidisciplinary course on pain in which students are exposed to different autonomy-supportive teaching strategies based on the SDT framework.