Benefits of physical activity
A couple of weeks ago, Minerva complained that, although studies showing physical exercise improved health outcomes were two a penny, most were small and their follow-up periods short. Here’s an exception, in which 400 000 adults who provided data on leisure time physical activity were tracked for around 12 years. Regular leisure time physical activity led to a 24% reduction in mortality in women and a 15% reduction in men. Men reached their maximal survival benefit from 300 minutes a week of moderate-to-vigorous physical activity. Women, on the other hand, needed to exercise for only half as long to achieve the same benefit (J Am Coll Cardiol doi:10.1016/j.jacc.2023.12.019).
Attention deficit/hyperactivity disorder
Methylphenidate, atomoxetine, and lisdexamfetamine are the most commonly prescribed medications for attention deficit/hyperactivity disorder. A large Swedish case-control study finds that they are all associated with an increased likelihood of cardiovascular diseases—particularly hypertension and arterial disease and particularly if treatment is long term. The risk of hypertension is doubled in people exposed to these drugs for longer than five years (JAMA Psychiatry doi:10.1001/jamapsychiatry.2023.4294).
Stopping proton pump inhibitors
Critically ill patients are often given proton pump inhibitors (PPIs) to protect them from stress ulcers. Unfortunately, the treatment is often continued long after the need for it has passed. A retrospective study in intensive care units in Germany reports that around 40% of patients continued with PPI therapy without an indication. What’s worse, continuation of PPIs was associated with an increased risk of pneumonia and cardiovascular events (Crit Care Med doi:10.1097/CCM.0000000000006104).
Communicating prognosis to parents of very preterm infants
When discussing prognosis and risk of complications with parents of very preterm infants, is it better to frame the conversation optimistically in terms of the probability of survival and non-impairment, or to frame it pessimistically by speaking about the risk of death and the likelihood of impaired survival? A trial in which parents of surviving preterm infants were shown scripted video vignettes depicting conversations between neonatologists and parents, all portrayed by professional actors, found that nine out of 10 participants preferred the optimistic framing. Participants were also more likely to recall numerical estimates for survival accurately when the conversation was framed optimistically (JAMA Netw Open doi:10.1001/jamanetworkopen.2024.0105).
Faecal occult blood screening for colorectal cancer
A Swedish study estimated the effect of biennial guaiac based faecal occult blood test screening by comparing mortality from colorectal cancer among people invited for screening in 2008-2012 with those who hadn’t been invited or who had been invited after 2013. After 14 years’ follow-up, colorectal cancer was 14% lower in those who had been invited for screening. Disappointingly, the study failed to consider either the possible harms associated with screening or its cost effectiveness (JAMA Netw Open doi:10.1001/jamanetworkopen.2024.0516).
Evidence or action?
US president Harry Truman famously asked for a one handed economist. UK government ministers may have felt similarly about epidemiologists and public health experts during the covid-19 pandemic. On one hand, some experts advised that decisions should be based on the best available evidence and that, where evidence was lacking, action might well do more harm than good. On the other, some took the view that, at the outset of a pandemic involving a novel pathogen, delay would lead to dire consequences and that intervention, even in the absence of sound evidence, was imperative (https://undark.org/2024/02/21/evidence-based-medicine/).