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The Weekend

Physical activity improves health, and current recommendations encourage daily exercise. However, little is known about any health benefits associated with infrequent bouts of exercise (e.g., 1-2 episodes/week) that generate the recommended energy expenditure. The authors conducted a prospective cohort study among 8,421 men (mean age, 66 years) in the Harvard Alumni Health Study, without major chronic diseases, who provided details about physical activity on mailed questionnaires in 1988 and 1993. Men were classified as "sedentary" (expending /=1,000 kcal/week from sports/recreation 1-2 times/week), or "regularly active" (all others expending >/=1,000 kcal/week). Between 1988 and 1997, 1,234 men died. The multivariate relative risks for mortality among the sedentary, insufficiently active, weekend warriors, and regularly active men were 1.00 (referent), 0.75 (95% confidence interval (CI): 0.62, 0.91), 0.85 (95% CI: 0.65, 1.11), and 0.64 (95% CI: 0.55, 0.73), respectively. In stratified analysis, among men without major risk factors, weekend warriors had a lower risk of dying, compared with sedentary men (relative risk = 0.41, 95% CI: 0.21, 0.81). This was not seen among men with at least one major risk factor (corresponding relative risk = 1.02, 95% CI: 0.75, 1.38). These results suggest that regular physical activity generating 1,000 kcal/week or more should be recommended for lowering mortality rates. However, among those with no major risk factors, even 1-2 episodes/week generating 1,000 kcal/week or more can postpone mortality.

The Weekend

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Sicker patients are admitted over the weekend as compared to weekdays and hence patient level factors may explain differences in outcomes (8-13). Interestingly, as demonstrated by Walker et al., commonly measured biochemical and haematological blood test results, as markers for disease severity, can account for about half of the residual excess mortality risk associated with weekend emergency admissions after adjustment for standard patient characteristics (8). Similarly, a study which used arrival by ambulance as a surrogate for illness severity, found that adjustment with this method alone corrected for any increase in mortality associated with out of hours admissions (14). Previous research had adjusted for patient level factors contributing to mortality utilising co-morbidities and demographics rather than using bio-markers (15). Another problem in assessing the weekend effect is that often, a lesser proportion of patients who attended Emergency services on weekends are admitted to hospital, thereby creating a selection bias (16). The reasons driving this change in admission threshold are not apparent, although, hospital bed availability may in part dictate this, and concurrently, patients with milder symptoms are likely to elect to be at home. For instance, a review of heart failure admissions found Mondays had the highest admission rates, and Fridays the highest discharge rates (17). Interestingly, Friday discharge was also associated with the highest rate of re-admission (17). These findings could offer one possible insight into weekend mortality, as patients desire to be at home on weekends, and these preferences, in combination with bed availability pressures, are likely to influence physician decisions regarding admission and discharge.

Weekend effect on mortality is apparent only in a minority of diseases, and not across entire gamut of disease presentations (10,11). Consequently, variations in the case-mix, between weekends and weekdays, could explain the differences in outcomes (13). Malignancies account for 7 of the top 10 diagnostic conditions having the strongest association between out of hours admission and mortality (10). In the case of malignancies, reduced availability of end-of-life care in the community over weekends could possibly be the cause behind the phenomenon where cancer patients with more critical illnesses are admitted over the weekend (11-13,15-18). However, malignancies do not surface in the 10 most prevalent admission diagnoses in the cohort analysed by Walker et al. (8) and hence it is not clear how the case mix contributed to the association with mortality in this study. Conversely, other research has shown that cancer patients have a steady risk pattern with a relatively constant mortality risk across the week after admission (11).

Publication bias may exist especially in studies reporting adjusted odds ratio of the association between weekend effect and mortality (19). Survival analysis models that take only the day of admission into account often fail to account for the effect of confounders including other key milestones in the clinical pathway (14). For example, the timing of surgery (Sunday surgery) and the timing of discharge (Sunday or out of hours discharges) can impact outcomes (14). Hospital workload and staffing patterns do not seem to explain the association between weekend admissions and mortality. In one study, although there was reduced specialist staffing across weekends, this was likely compensated for by the significant increase in time spent evaluating emergency admissions. As a result, there was no statistically significant correlation between weekend staffing pattern of specialists and mortality risk for emergency admissions (20). This finding is echoed in the intensive care unit setting as well (21). Much of these analyses are based on administrative data and optimal adjustment of baseline illness severity is vital. A recent clinical registry based audit showed no difference in 30-day survival between stroke patients admitted over the weekends when compared to those admitted on weekdays (22). Contrastingly, earlier studies based on administrative data showed a 26% increase in in-hospital mortality for patients admitted with stroke on Sundays compared to weekdays (23). Baseline patient characteristics, including severity scores like the National Early Warning Score and routinely available blood test results have been used across various studies to match the baseline risk of patients admitted over the weekend and on weekdays. However, coding may be inaccurate. Acute medical admissions are especially vulnerable to coding inaccuracies and can be subjective, at times (24). Erroneous coding is especially a problem in patients with multiple co-morbidities, where elective admissions for management of co-existing diseases are often miscoded as acute medical admissions. An analysis of systematic biases, inherent in evaluating the effect of weekend admissions on stroke mortality in the UK, revealed that coding inaccuracies abound in administrative data, especially the practise of coding false positive cases as weekday admissions resulting in a low case fatality rate in this group (25). These biases cannot be easily adjusted for, and could possibly explain the discordance in the association between weekend admission and stroke mortality across studies using administrative data and adjudicated clinical data (25). Data-duplication is another possible artefact that is especially a problem with meta-analyses (18).

Even though the weekend effect is restricted to specific disease conditions (26), it has been implied as being ubiquitous across multiple healthcare systems (18). The weekend effect can be expected in the case of uncommon diseases requiring emergent and highly specialized diagnostic and interventional procedures. For instance, in the case of patients presenting with an impending rupture of an aortic aneurysm, issues with the availability of a vascular surgeon or an interventional radiologist may influence outcomes. Not surprisingly, aortic aneurysms have the strongest association between weekend admission and mortality (26-28). On the contrary, while we do not expect a weekend effect in the case of commoner conditions where emergent treatment is the standard of care, it is interesting to note that even in the case of ST-segment elevation myocardial infarction, out-of-hours presentation is associated with increased mortality and worse clinical performance measures (9). Additionally, it is important to consider that although weekend mortality effects have been replicated across various healthcare configurations including the United States (18), geographic variations do exist (9).

Below are some examples showing how native English speakers typically use over the weekend. As you can see, the thing that happens during the weekend can be something quick, like a phone call, or something that lasts most of the weekend, like a trip to Miami.

The meaning of on the weekend is similar to the meaning of over the weekend, although it is not used quite as often. The two expressions are usually interchangeable and choosing one or the other is mostly a matter of personal preference. In all of the examples below with on the weekend, over the weekend would also be correct.

Soak up Mediterranean vibes in Catalina Island. Indulge in traditional Mexican flavors and spices in Ensenada, home of the fish taco. Or jump into the emerald waters of Cabo San Lucas. Adventure is calling. Travel back in time as you roam thousand-year-old Maya temples in Cozumel. There are plenty of weekend cruises sailing from Los Angeles or Florida.

Beyond The Weekend is a five-day-a-week devotional delivered to your inbox Monday through Friday morning. This short email combines Scripture, words of encouragement and simple tasks to draw you back to the weekend message and closer to God and others.

RowingTwo CAA crews are slated to hit the water this weekend to open the spring rowing season. UC San Diego will be on Mission Bay in a dual meet against Loyola Marymount, while Eastern Michigan heads to Tuscaloosa for a dual meet against Alabama on the Black Warrior River.

The best part of the weekend is that you have more free time. So while you might not be able to squeeze in a 30-minute run over lunch during the week, you can use the weekend to go for a longer run at a beautiful park nearby. Or go to the gym to try a new hour-long class. Use the weekend as a time to refresh your workout and get more activity in without feeling rushed. 041b061a72


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