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Jan 13, 2017

Weekender

The story

If you had free weekends, you might use them to work out. But before you shed a tear for your old Saturday soccer league, take a minute to catch up on the latest in exercise patterns research.

The basics

We told you this summer about the costs and mortality risks of a sedentary lifestyle, but when and how to exercise remains unclear. The World Health Organization recommends 150 minutes per week of moderate-intensity exercise, spread evenly between days if possible. Since people are on the whole pretty busy – an estimated 24% of Americans do not engage in leisure time physical activity – many wonder about the health effects of infrequent exercise.

The headline

Weekend warriors got most of the mortality benefits of regular exercise in one or two sessions a week, says a British health survey of over 60,000 participants. By cross-referencing mortality records, the authors found that the self-reported weekend warriors had a reduction in all-cause mortality risk of 30% compared to inactive peers, only slightly less than those who exercised greater than 3 days a week. 
JAMA Int Med

The nuts and bolts

A look under the hood leaves us less sure that the study outcomes reflect the weekend warrior lifestyle. Survey participants were lumped into four notable groups: active ( > 150 minutes of exercise a week) persons who exercised 1 - 2 times per week, which the study authors dubbed weekend warriors; active persons who exercised 3 or more times a week; persons who exercised for < 150 minutes a week; and sedentary persons. The three exercise groups saw similar mortality benefits relative to sedentary individuals.

The takeaway

This study got a lot of attention by putting the words ‘weekend warrior' in the title, when what the authors really compared was sedentary vs. active lifestyles. We’re hopeful the interest it’s generated can lead to better data on healthy activity patterns.

Say it on rounds

When that butter-smooth bedside manner has your patients coming back

Ease up, Princess Charming. Since the passage of the Affordable Care Act's Readmissions Reduction Program in 2012, hospitals have incurred financial penalties for readmits within 30 days for acute MI, CHF exacerbations, and pneumonia. A pre-post analysis of 2,800 hospitals estimated that the new financial penalties reduced readmissions by 67 - 95 readmissions per 10,000 discharges. The largest improvements were seen in hospitals that had the highest readmission rates prior to passage of the bill.
Annals

When you worry your med school education is already out of date

Breast cancer screening keeps getting trickier. A Danish study of over 200,000 women found that introducing biennial screening with mammography for women aged 50 - 69 led to an increase in the incidence of localized disease, but was not associated with a decreased incidence of advanced cancer. Because screening in Denmark was implemented at different times, researchers were able to directly compare women who were and were not screened. The study adds to a growing debate about which lesions represent dangerous breast cancer and the magnitude of harm from overdiagnosis.
Annals

When you leave fresh breath out of your pre-rounds routine

There are many reasons to add mouthwash to hospital supply rooms. A study of 200 men who have sex with men with pharyngeal gonorrhea found that rinsing with Cool Mint Listerine reduced bacterial colonies compared to saline rinse and gargle. Clinical impact and effect on disease spread remains unclear.
Sex Transm Infect

Brush up

Bacterial meningitis

Vaccines have vastly decreased bacterial meningitis in kids, but adults still face mortality rates of up to 30% despite prompt administration of antibiotics. Look for fever, headache, neck stiffness, or altered consciousness. Lumbar puncture is essential for diagnosis, and early antibiotic treatment targeting Streptococcus pneumoniae and Neisseria meningitidis, the two most common pathogens, reduces mortality. Add vancomycin, used to target resistant bacteria, to a beta-lactam to form first-line empiric therapy, and make sure you cover Listeria in ages 55 and up.

What's the evidence

For steroids in meningitis?  A 2002 Dutch trial of 300 patients found that adjunctive dexamethasone reduced the risk of death by 52% and unfavorable outcomes on a disability scale by 41% compared to placebo. Subsequent RCTs performed in developing countries did not show a benefit for steroids, which many suspect is due to different bacteria populations. 

Scholar-in-chief

NEJM first author Barry O thinks that repealing the Affordable Care Act without a replacement is dangerous and irresponsible. His remarks, tailored for the medical community, are published here.

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