World’s largest study shows the more you walk, the lower your risk of death
>> Friday, August 18, 2023
WELLNEWS
Dr.
Dumaguing
SOPHIA ANTIPOLIS, France -- The number of steps you should walk every day to start seeing benefits to your health is lower than previously thought, according to the largest analysis to investigate this.
The study, published in the European Journal of Preventive Cardiology found that walking at least 3867 steps a day started to reduce the risk of dying from any cause, and 2337 steps a day reduced the risk of dying from diseases of the heart and blood vessels (cardiovascular disease).
However, the new analysis of 226,889 people from 17 different studies around the world has shown that the more you walk, the greater the health benefits. The risk of dying from any cause or from cardiovascular disease decreases significantly with every 500 to 1000 extra steps you walk. An increase of 1000 steps a day was associated with a 15% reduction in the risk of dying from any cause, and an increase of 500 steps a day was associated with a 7% reduction in dying from cardiovascular disease.
The researchers, led by Maciej Banach, Professor of Cardiology at the Medical University of Lodz, Poland, and Adjunct Professor at the Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, found that even if people walked as many as 20,000 steps a day, the health benefits continued to increase.
They have not found an upper limit yet.
“Our study confirms that the more you walk, the better,” says Prof. Banach. “We found that this applied to both men and women, irrespective of age, and irrespective of whether you live in a temperate, sub-tropical or sub-polar region of the world, or a region with a mixture of climates. In addition, our analysis indicates that as little as 4,000 steps a day are needed to significantly reduce deaths from any cause, and even fewer to reduce deaths from cardiovascular disease.”
There is strong evidence that a sedentary lifestyle may contribute to an increase in cardiovascular disease and a shorter life. Studies have shown that insufficient physical activity affects more than a quarter of the world’s population. More women than men (32% versus 23%), and people in higher income countries compared to low-income countries (37% versus 16%) do not undertake a sufficient amount of physical activity. According to World Health Organization data, insufficient physical activity is the fourth most frequent cause of death in the world, with 3.2 million deaths a year related to physical inactivity. The Covid-19 pandemic also resulted in a reduction in physical activity, and activity levels have not recovered two years on from it. Dr. Ibadete Bytyçi from the University Clinical Centre of Kosovo, Pristina, Kosovo, senior author of the paper, says: “Until now, it’s not been clear what is the optimal number of steps, both in terms of the cut-off points over which we can start to see health benefits, and the upper limit, if any, and the role this plays in people’s health. However, I should emphasize that there were limited data available on step counts up to 20,000 a day, and so these results need to be confirmed in larger groups of people.”
This meta-analysis is the first not only to assess the effect of walking up to 20,000 steps a day, but also to look at whether there are any differences depending on age, sex or where in the world people live.
The studies analyzed by the researchers followed up participants for a median (average) of seven years. The mean (average) age was 64, and 49% of participants were female.
In people aged 60 years or older, the size of the reduction in risk of death was smaller than that seen in people aged younger than 60 years. In the older adults, there was a 42% reduction in risk seen in those who walked between 6,000 and 10,000 steps a day, while there was a 49% reduction in risk in younger adults who walked between 7,000 and 13,000 steps a day.
Prof. Banach says: “In a world where we have more and more advanced drugs to target specific conditions such as cardiovascular disease, I believe we should always emphasise that lifestyle changes, including diet and exercise, which was a main hero of our analysis, might be at least as, or even more effective in reducing cardiovascular risk and prolonging lives. We still need good studies to investigate whether these benefits may exist for intensive types of exertion, such as marathon running and iron man challenges, and in different populations of different ages, and with different associated health problems.
However, it seems that, as with pharmacological treatments, we should always think about personalizing lifestyle changes.”
Strengths of the meta-analysis include its size and that it was not restricted to looking at studies limited to a maximum of 16,000 steps a day. Limitations include that it was an observational study and so cannot prove that increased step counts cause the reduction in the risk of death, only that it is associated with it. The impact of step counts was not tested on people with different diseases; all the participants were generally healthy when they entered the studies analyzed. The researchers were not able to account for differences in race and socioeconomic status, and the methods for counting steps were not identical in all the studies included in this meta-analysis.
WELLNEWS
Dr. Dumaguing
Under 40s with mental health problems have elevated risk of heart attack and stroke
SOPHIA ANTIPOLIS, France -- Adults in their 20s and 30s with mental disorders have an up to three-fold elevated likelihood of a heart attack or stroke, according to a study in more than 6.5 million individuals published in the European Journal of Preventive Cardiology, a journal of the European Society of Cardiology (ESC). 1 Lifestyle behaviors did not explain the excess risk.
One in every eight of the 20- to 39-year-old participants had some kind of mental illness including depression, anxiety and insomnia.
“Psychological problems were common in young adults and had strong links with
cardiovascular health,” said study author Professor Eue-Keun Choi of Seoul National University College of Medicine, Republic of Korea. “The findings indicate that these individuals should receive regular health check-ups and medication if appropriate to prevent myocardial infarction and stroke. While lifestyle behaviors did not explain the excess cardiovascular risk, this does not mean that healthier habits would not improve prognosis.
Lifestyle modification should therefore be recommended to young adults with mental disorders to boost heart health.”
This study investigated the association between mental disorders in adults aged 20 to 39 years and the risks of developing myocardial infarction and ischaemic stroke. The study used the Korean National Health Insurance Service (NHIS) database which covers the country’s entire population. A total of 6,557,727 individuals aged 20 to 39 years who underwent health examinations between 2009 and 2012 and had no history of myocardial infarction or stroke were included in the study. The average age was 31 years, and more than half (58%) of participants were 30 years or older.
Some 856,927 (13.1%) participants had at least one mental disorder. Among those with mental disorders, nearly half (47.9%) had anxiety, more than one in five (21.2%) had depression and one in five (20.0%) had insomnia. More than one-quarter (27.9%) of participants with mental health problems had somatoform disorder, while 2.7% had substance use disorder, 1.3% had bipolar disorder, 0.9% had schizophrenia, 0.9% had an eating disorder, 0.7% had personality disorder and 0.4% had post-traumatic stress disorder (PTSD).
Participants were followed until December 2018 for new-onset myocardial infarction and stroke. During a median follow-up of 7.6 years, there were 16,133 myocardial infarctions and 10,509 strokes.
The authors analyzed the association between mental disorders and
cardiovascular outcomes after adjusting for factors that could influence the relationships including age, sex, high blood pressure, diabetes, high cholesterol, metabolic syndrome, chronic kidney disease, smoking, alcohol, physical activity and income.
Participants with any mental disorder had a 58% higher likelihood of myocardial infarction and 42% greater risk of stroke compared to those with no mental disorder. The risk of myocardial infarction was elevated for all mental disorders studied, with the magnitude ranging from 1.49- to 3.13-fold. Looking at each condition separately, compared to participants with no mental disorder, the risk of myocardial infarction was 3.13 times higher in those with PTSD, 2.61 times higher for schizophrenia, 2.47 times higher for substance use disorder, 2.40 times higher for bipolar disorder, 2.29 times higher for personality disorder, 1.97 times higher for eating disorders, 1.73 times higher for insomnia, 1.72 times higher for depression, 1.53 times higher for anxiety and 1.49 times higher for somatoform
disorder.
The risk of stroke was elevated for all mental health issues except PTSD and eating disorders, with hazard ratios ranging from 1.25 to 3.06. The hazard ratios for each condition were 3.06 for personality disorder, 2.95 for schizophrenia, 2.64 for bipolar disorder, 2.44 for substance use disorder, 1.60 for depression, 1.45 for insomnia, 1.38 for anxiety and 1.25 for somatoform disorder.
The authors also analyzed the associations according to age and sex. Depression, anxiety, schizophrenia and personality disorder were associated with higher risks of myocardial infarction for participants in their 20s compared with those in their 30s. In addition, depression and insomnia were linked with greater risks of heart attack and stroke in women than men.
Study author Dr. Chan Soon Park of Seoul National University Hospital, Republic of Korea, said: “Patients with mental health problems are known to have a shorter life expectancy than the general population, with the majority of deaths due to physical illnesses.
Our study shows that substantial numbers of young adults have at least one mental health problem, which may predispose them to heart attack and stroke. Future research should examine the cardiovascular benefits of managing psychological problems and monitoring heart health in this vulnerable group.
One in every eight of the 20- to 39-year-old participants had some kind of mental illness including depression, anxiety and insomnia.
“Psychological problems were common in young adults and had strong links with
cardiovascular health,” said study author Professor Eue-Keun Choi of Seoul National University College of Medicine, Republic of Korea. “The findings indicate that these individuals should receive regular health check-ups and medication if appropriate to prevent myocardial infarction and stroke. While lifestyle behaviors did not explain the excess cardiovascular risk, this does not mean that healthier habits would not improve prognosis.
Lifestyle modification should therefore be recommended to young adults with mental disorders to boost heart health.”
This study investigated the association between mental disorders in adults aged 20 to 39 years and the risks of developing myocardial infarction and ischaemic stroke. The study used the Korean National Health Insurance Service (NHIS) database which covers the country’s entire population. A total of 6,557,727 individuals aged 20 to 39 years who underwent health examinations between 2009 and 2012 and had no history of myocardial infarction or stroke were included in the study. The average age was 31 years, and more than half (58%) of participants were 30 years or older.
Some 856,927 (13.1%) participants had at least one mental disorder. Among those with mental disorders, nearly half (47.9%) had anxiety, more than one in five (21.2%) had depression and one in five (20.0%) had insomnia. More than one-quarter (27.9%) of participants with mental health problems had somatoform disorder, while 2.7% had substance use disorder, 1.3% had bipolar disorder, 0.9% had schizophrenia, 0.9% had an eating disorder, 0.7% had personality disorder and 0.4% had post-traumatic stress disorder (PTSD).
Participants were followed until December 2018 for new-onset myocardial infarction and stroke. During a median follow-up of 7.6 years, there were 16,133 myocardial infarctions and 10,509 strokes.
The authors analyzed the association between mental disorders and
cardiovascular outcomes after adjusting for factors that could influence the relationships including age, sex, high blood pressure, diabetes, high cholesterol, metabolic syndrome, chronic kidney disease, smoking, alcohol, physical activity and income.
Participants with any mental disorder had a 58% higher likelihood of myocardial infarction and 42% greater risk of stroke compared to those with no mental disorder. The risk of myocardial infarction was elevated for all mental disorders studied, with the magnitude ranging from 1.49- to 3.13-fold. Looking at each condition separately, compared to participants with no mental disorder, the risk of myocardial infarction was 3.13 times higher in those with PTSD, 2.61 times higher for schizophrenia, 2.47 times higher for substance use disorder, 2.40 times higher for bipolar disorder, 2.29 times higher for personality disorder, 1.97 times higher for eating disorders, 1.73 times higher for insomnia, 1.72 times higher for depression, 1.53 times higher for anxiety and 1.49 times higher for somatoform
disorder.
The risk of stroke was elevated for all mental health issues except PTSD and eating disorders, with hazard ratios ranging from 1.25 to 3.06. The hazard ratios for each condition were 3.06 for personality disorder, 2.95 for schizophrenia, 2.64 for bipolar disorder, 2.44 for substance use disorder, 1.60 for depression, 1.45 for insomnia, 1.38 for anxiety and 1.25 for somatoform disorder.
The authors also analyzed the associations according to age and sex. Depression, anxiety, schizophrenia and personality disorder were associated with higher risks of myocardial infarction for participants in their 20s compared with those in their 30s. In addition, depression and insomnia were linked with greater risks of heart attack and stroke in women than men.
Study author Dr. Chan Soon Park of Seoul National University Hospital, Republic of Korea, said: “Patients with mental health problems are known to have a shorter life expectancy than the general population, with the majority of deaths due to physical illnesses.
Our study shows that substantial numbers of young adults have at least one mental health problem, which may predispose them to heart attack and stroke. Future research should examine the cardiovascular benefits of managing psychological problems and monitoring heart health in this vulnerable group.
WELLNEWS
Dr.
Dumaguing
How to stop obese children having heart disease in adulthood
SOPHIA, ANTIPOLIS,
France - Childhood is a window of opportunity to tackle obesity before the
damage it causes is irreversible, according to a scientific statement by
experts on heart disease and childhood obesity..1
The document was produced by the Task Force for Childhood Health of the European Association of Preventive Cardiology (EAPC) of the ESC and the European Childhood Obesity Group (ECOG).
Childhood obesity is on the rise. According to the World Health Organization, while less than 1% of children and adolescents aged 5-19 were obese in 1975, more 124 million (6% of girls and 8% of boys) were obese in 2016.2 “The global rise in childhood obesity, to a large extent driven by more physical inactivity, has been linked with an increased prevalence of high blood pressure, blood lipids and blood glucose in childhood,” said first author Professor Henner Hanssen of the University of Basel, Switzerland. “This combination of factors is in turn linked with damage to the arteries and heart, which can be reversed with exercise in children but much less so in adults.”
Childhood obesity and the associated problems of high blood pressure, blood lipids and blood glucose track into adulthood. For example, obese children are five times more likely to become obese adults than their healthy weight peers.
The document emphasizes the need to tackle obesity and the accompanying risk factors together, as having more than one problem compounds the likelihood of cardiovascular disease (CVD) in adulthood.
Compared to children with a low body mass index (BMI), those with a high BMI are 40% more likely to suffer from CVD in midlife. Children with a combination of risk factors including smoking and high BMI, blood pressure and blood lipids have a two- to nine-fold greater risk of heart attack and stroke in midlife.
Habits also track into adulthood, giving further impetus to the argument to intervene now. “Prevention of adult coronary heart disease through interventions in childhood is supported by the fact that dietary habits and food preferences are formed early in life and that family-related lifestyle and eating habits tend to be maintained throughout the life span,” states the paper.
School-age young people should do at least 60 minutes per day of moderate to vigorous aerobic physical activity. In addition, muscle strengthening activities should be done at least three times per week. Sedentary time, particularly screen time, should be limited. Regarding diet, children should eat an adequate breakfast, avoid eating between meals, eat three meals and no more than two snacks per day, limit portion sizes, avoid energy-dense and nutrient-poor foods such as fruit juices or fast food, increase intake of unprocessed fruit, vegetables and fiber-rich cereals, and lower fat and sugar intake.
A range of policies and actions are needed to stop obesity and the associated problems in their tracks. Central to these are physical activity and nutrition. Policymakers should:
Promote physical activity and raise awareness of the need to reduce sedentary time
Encourage healthy eating habits
Provide diet counselling and psychological support for behavior change
Reduce unhealthy food marketing in media and social media
Promote parenting styles that encourage physical activity and healthy eating
Avoid stigmatization
Involve schools, family and friends in education programs
Increase availability and affordability of healthy food
Provide playgrounds and green spaces to be physically active in urban settings.
“Policies to stop CVD later in life need to go beyond just telling young people to exercise and eat a healthy diet,” said Professor Hanssen. “If there are no spaces to enjoy being active and nutritious food is unavailable or unaffordable, it is very difficult to change behavior.
Some children will benefit from psychological support to understand which habits are problematic and how to develop new ones. And instead of criticizing children for being inactive and eating junk food, schools and parents can show that being physically active and preparing healthy food is fun.”
Schools should take the lead with healthy school meals, cooking classes, education about nutrition and activity, and sports clubs. Family and friends should be invited to take part, as both have an influence on a child’s lifestyle and weight. Professor Hanssen said: “Healthy, affordable diets should start at the school canteen and physical activity can be promoted through active breaks at schools. Education about healthy lifestyles won’t have much of an impact if parents are not involved.”
The document points to the influence of the media on children’s diets. It notes: “Most children are exposed to promotion and marketing of products such as fast food and sugar-sweetened beverages up to about 200 times per week on social media.” The authors state that marketing of unhealthy food and drink should be minimized or prohibited, especially in schools, since it influences children’s behavior.
While the equivalent marketing of healthy products appears to have no effect, Professor Hanssen said: “Instead of marketing simply telling people to consume healthy products, promoting a healthy lifestyle as fun and cool may be more effective.”
The document stresses the need to avoid stigmatization of overweight and obese children as this could push them towards eating disorders and inactivity. “How to identify children at risk and offer individual treatment while avoiding stigmatization remains challenging and this needs to be addressed sensitively,” said Professor Hanssen. “At school level, for example, all children and families may benefit from prevention strategies, from the healthy canteen to active breaks.”
He concluded: “Prevention of CVD needs to start early. Rather than wait and see whether or not today’s obese children become tomorrow’s heart attacks and strokes, an action plan is needed now to put a halt to future health problems. We already know that obesity is harming children’s health. What more proof do we need?
The document was produced by the Task Force for Childhood Health of the European Association of Preventive Cardiology (EAPC) of the ESC and the European Childhood Obesity Group (ECOG).
Childhood obesity is on the rise. According to the World Health Organization, while less than 1% of children and adolescents aged 5-19 were obese in 1975, more 124 million (6% of girls and 8% of boys) were obese in 2016.2 “The global rise in childhood obesity, to a large extent driven by more physical inactivity, has been linked with an increased prevalence of high blood pressure, blood lipids and blood glucose in childhood,” said first author Professor Henner Hanssen of the University of Basel, Switzerland. “This combination of factors is in turn linked with damage to the arteries and heart, which can be reversed with exercise in children but much less so in adults.”
Childhood obesity and the associated problems of high blood pressure, blood lipids and blood glucose track into adulthood. For example, obese children are five times more likely to become obese adults than their healthy weight peers.
The document emphasizes the need to tackle obesity and the accompanying risk factors together, as having more than one problem compounds the likelihood of cardiovascular disease (CVD) in adulthood.
Compared to children with a low body mass index (BMI), those with a high BMI are 40% more likely to suffer from CVD in midlife. Children with a combination of risk factors including smoking and high BMI, blood pressure and blood lipids have a two- to nine-fold greater risk of heart attack and stroke in midlife.
Habits also track into adulthood, giving further impetus to the argument to intervene now. “Prevention of adult coronary heart disease through interventions in childhood is supported by the fact that dietary habits and food preferences are formed early in life and that family-related lifestyle and eating habits tend to be maintained throughout the life span,” states the paper.
School-age young people should do at least 60 minutes per day of moderate to vigorous aerobic physical activity. In addition, muscle strengthening activities should be done at least three times per week. Sedentary time, particularly screen time, should be limited. Regarding diet, children should eat an adequate breakfast, avoid eating between meals, eat three meals and no more than two snacks per day, limit portion sizes, avoid energy-dense and nutrient-poor foods such as fruit juices or fast food, increase intake of unprocessed fruit, vegetables and fiber-rich cereals, and lower fat and sugar intake.
A range of policies and actions are needed to stop obesity and the associated problems in their tracks. Central to these are physical activity and nutrition. Policymakers should:
Promote physical activity and raise awareness of the need to reduce sedentary time
Encourage healthy eating habits
Provide diet counselling and psychological support for behavior change
Reduce unhealthy food marketing in media and social media
Promote parenting styles that encourage physical activity and healthy eating
Avoid stigmatization
Involve schools, family and friends in education programs
Increase availability and affordability of healthy food
Provide playgrounds and green spaces to be physically active in urban settings.
“Policies to stop CVD later in life need to go beyond just telling young people to exercise and eat a healthy diet,” said Professor Hanssen. “If there are no spaces to enjoy being active and nutritious food is unavailable or unaffordable, it is very difficult to change behavior.
Some children will benefit from psychological support to understand which habits are problematic and how to develop new ones. And instead of criticizing children for being inactive and eating junk food, schools and parents can show that being physically active and preparing healthy food is fun.”
Schools should take the lead with healthy school meals, cooking classes, education about nutrition and activity, and sports clubs. Family and friends should be invited to take part, as both have an influence on a child’s lifestyle and weight. Professor Hanssen said: “Healthy, affordable diets should start at the school canteen and physical activity can be promoted through active breaks at schools. Education about healthy lifestyles won’t have much of an impact if parents are not involved.”
The document points to the influence of the media on children’s diets. It notes: “Most children are exposed to promotion and marketing of products such as fast food and sugar-sweetened beverages up to about 200 times per week on social media.” The authors state that marketing of unhealthy food and drink should be minimized or prohibited, especially in schools, since it influences children’s behavior.
While the equivalent marketing of healthy products appears to have no effect, Professor Hanssen said: “Instead of marketing simply telling people to consume healthy products, promoting a healthy lifestyle as fun and cool may be more effective.”
The document stresses the need to avoid stigmatization of overweight and obese children as this could push them towards eating disorders and inactivity. “How to identify children at risk and offer individual treatment while avoiding stigmatization remains challenging and this needs to be addressed sensitively,” said Professor Hanssen. “At school level, for example, all children and families may benefit from prevention strategies, from the healthy canteen to active breaks.”
He concluded: “Prevention of CVD needs to start early. Rather than wait and see whether or not today’s obese children become tomorrow’s heart attacks and strokes, an action plan is needed now to put a halt to future health problems. We already know that obesity is harming children’s health. What more proof do we need?
WELLNEWS
Dr. Dumaguing
Excessive daytime napping linked with elevated risk of heart rhythm disorder
MALAGA, Spain – Daytime napping for 30 minutes or longer is associated with an increased likelihood of developing atrial fibrillation, according to research presented at ESC Preventive Cardiology 2023.1
“Our study indicates that snoozes during the day should be limited to less than 30 minutes,” said study author Dr. Jesus Diaz-Gutierrez of Juan Ramon Jimenez University Hospital, Huelva, Spain. “People with disturbed night-time sleep should avoid relying on napping to make up the shortfall.”
Atrial fibrillation is the most common heart rhythm disorder, affecting more than 40 million people worldwide.2 People with this arrhythmia have a five times greater risk of stroke than their peers. Dr. Diaz-Gutierrez said: “Previous studies have suggested that sleep patterns may play a role in the development of atrial fibrillation, but as far as we know this was the first study to analyse the relationship between daytime napping and risk of the arrhythmia.”
The study used data from the University of Navarra Follow-up (SUN) Project, a prospective cohort of Spanish university graduates. A total of 20,348 participants free of atrial fibrillation at baseline completed a questionnaire every two years. Information was obtained on sociodemographics (age, sex, working hours), medical conditions (high cholesterol, high blood pressure, diabetes, sleep apnoea, cardiovascular diseases including atrial fibrillation), lifestyle (napping, smoking, exercise, coffee intake, binge drinking, adherence to a Mediterranean diet, TV watching), height and weight.
Participants were divided into three groups according to their average daily napping duration at baseline: none, less than 30 minutes, and 30 minutes or more. Short daytime nappers were defined as those who snoozed for less than 30 minutes.
New atrial fibrillation diagnoses were initially self-reported and subsequently confirmed by an expert committee of cardiologists, who used a predefined protocol which included reviewing medical records. The risk of atrial fibrillation according to daytime napping duration was analysed after adjusting for the information collected in the questionnaire.
The average age of participants at baseline was 38 years and 61% were women. During a median follow up of 13.8 years, 131 participants developed atrial fibrillation. Compared to short daytime nappers, those who snoozed for 30 minutes or more per day had a nearly doubled risk of developing atrial fibrillation (hazard ratio [HR] 1.90; 95% confidence interval [CI] 1.26–2.86). Meanwhile, compared with short nappers, risk was not elevated in those who avoided napping (HR 1.26; 95% CI 0.82–1.93).
The researchers conducted a second analysis to identify the nap duration associated with the lowest risk of atrial fibrillation. This analysis included those who reported regular napping and excluded participants who did not nap. Participants were divided into three categories according to their average daily napping duration at baseline: less than 15 minutes, 15 to 30 minutes, and more than 30 minutes. Compared with those who napped for more than 30 minutes per day, those who napped for less than 15 minutes had a 42% lower risk of developing atrial fibrillation (HR 0.58; 95% CI 0.35–0.95) while those who napped for 15 to 30 minutes had a 56% reduced risk (HR 0.44; 95% CI 0.27–0.72).
Dr. Diaz-Gutierrez said: “The results suggest that the optimal napping duration is 15 to 30 minutes. Larger studies are needed to determine whether a short nap is preferable to not napping at all. There are numerous potential explanations for the associations between napping and health. For example, long daytime naps may disrupt the body’s internal clock (circadian rhythm), leading to shorter night-time sleep, more nocturnal awakening and reduced physical activity. In contrast, short daytime napping may improve circadian rhythm, lower blood pressure levels and reduce stress.
“Our study indicates that snoozes during the day should be limited to less than 30 minutes,” said study author Dr. Jesus Diaz-Gutierrez of Juan Ramon Jimenez University Hospital, Huelva, Spain. “People with disturbed night-time sleep should avoid relying on napping to make up the shortfall.”
Atrial fibrillation is the most common heart rhythm disorder, affecting more than 40 million people worldwide.2 People with this arrhythmia have a five times greater risk of stroke than their peers. Dr. Diaz-Gutierrez said: “Previous studies have suggested that sleep patterns may play a role in the development of atrial fibrillation, but as far as we know this was the first study to analyse the relationship between daytime napping and risk of the arrhythmia.”
The study used data from the University of Navarra Follow-up (SUN) Project, a prospective cohort of Spanish university graduates. A total of 20,348 participants free of atrial fibrillation at baseline completed a questionnaire every two years. Information was obtained on sociodemographics (age, sex, working hours), medical conditions (high cholesterol, high blood pressure, diabetes, sleep apnoea, cardiovascular diseases including atrial fibrillation), lifestyle (napping, smoking, exercise, coffee intake, binge drinking, adherence to a Mediterranean diet, TV watching), height and weight.
Participants were divided into three groups according to their average daily napping duration at baseline: none, less than 30 minutes, and 30 minutes or more. Short daytime nappers were defined as those who snoozed for less than 30 minutes.
New atrial fibrillation diagnoses were initially self-reported and subsequently confirmed by an expert committee of cardiologists, who used a predefined protocol which included reviewing medical records. The risk of atrial fibrillation according to daytime napping duration was analysed after adjusting for the information collected in the questionnaire.
The average age of participants at baseline was 38 years and 61% were women. During a median follow up of 13.8 years, 131 participants developed atrial fibrillation. Compared to short daytime nappers, those who snoozed for 30 minutes or more per day had a nearly doubled risk of developing atrial fibrillation (hazard ratio [HR] 1.90; 95% confidence interval [CI] 1.26–2.86). Meanwhile, compared with short nappers, risk was not elevated in those who avoided napping (HR 1.26; 95% CI 0.82–1.93).
The researchers conducted a second analysis to identify the nap duration associated with the lowest risk of atrial fibrillation. This analysis included those who reported regular napping and excluded participants who did not nap. Participants were divided into three categories according to their average daily napping duration at baseline: less than 15 minutes, 15 to 30 minutes, and more than 30 minutes. Compared with those who napped for more than 30 minutes per day, those who napped for less than 15 minutes had a 42% lower risk of developing atrial fibrillation (HR 0.58; 95% CI 0.35–0.95) while those who napped for 15 to 30 minutes had a 56% reduced risk (HR 0.44; 95% CI 0.27–0.72).
Dr. Diaz-Gutierrez said: “The results suggest that the optimal napping duration is 15 to 30 minutes. Larger studies are needed to determine whether a short nap is preferable to not napping at all. There are numerous potential explanations for the associations between napping and health. For example, long daytime naps may disrupt the body’s internal clock (circadian rhythm), leading to shorter night-time sleep, more nocturnal awakening and reduced physical activity. In contrast, short daytime napping may improve circadian rhythm, lower blood pressure levels and reduce stress.
WELLNEWS
Dr. Dumaguing
Excessive daytime napping linked with elevated risk of heart rhythm disorder
MALAGA, Spain – Daytime napping for 30 minutes or longer is associated with an increased likelihood of developing atrial fibrillation, according to research presented at ESC Preventive Cardiology 2023.1
“Our study indicates that snoozes during the day should be limited to less than 30 minutes,” said study author Dr. Jesus Diaz-Gutierrez of Juan Ramon Jimenez University Hospital, Huelva, Spain. “People with disturbed night-time sleep should avoid relying on napping to make up the shortfall.”
Atrial fibrillation is the most common heart rhythm disorder, affecting more than 40 million people worldwide.2 People with this arrhythmia have a five times greater risk of stroke than their peers. Dr. Diaz-Gutierrez said: “Previous studies have suggested that sleep patterns may play a role in the development of atrial fibrillation, but as far as we know this was the first study to analyse the relationship between daytime napping and risk of the arrhythmia.”
The study used data from the University of Navarra Follow-up (SUN) Project, a prospective cohort of Spanish university graduates. A total of 20,348 participants free of atrial fibrillation at baseline completed a questionnaire every two years. Information was obtained on sociodemographics (age, sex, working hours), medical conditions (high cholesterol, high blood pressure, diabetes, sleep apnoea, cardiovascular diseases including atrial fibrillation), lifestyle (napping, smoking, exercise, coffee intake, binge drinking, adherence to a Mediterranean diet, TV watching), height and weight.
Participants were divided into three groups according to their average daily napping duration at baseline: none, less than 30 minutes, and 30 minutes or more. Short daytime nappers were defined as those who snoozed for less than 30 minutes.
New atrial fibrillation diagnoses were initially self-reported and subsequently confirmed by an expert committee of cardiologists, who used a predefined protocol which included reviewing medical records. The risk of atrial fibrillation according to daytime napping duration was analysed after adjusting for the information collected in the questionnaire.
The average age of participants at baseline was 38 years and 61% were women. During a median follow up of 13.8 years, 131 participants developed atrial fibrillation. Compared to short daytime nappers, those who snoozed for 30 minutes or more per day had a nearly doubled risk of developing atrial fibrillation (hazard ratio [HR] 1.90; 95% confidence interval [CI] 1.26–2.86). Meanwhile, compared with short nappers, risk was not elevated in those who avoided napping (HR 1.26; 95% CI 0.82–1.93).
The researchers conducted a second analysis to identify the nap duration associated with the lowest risk of atrial fibrillation. This analysis included those who reported regular napping and excluded participants who did not nap. Participants were divided into three categories according to their average daily napping duration at baseline: less than 15 minutes, 15 to 30 minutes, and more than 30 minutes. Compared with those who napped for more than 30 minutes per day, those who napped for less than 15 minutes had a 42% lower risk of developing atrial fibrillation (HR 0.58; 95% CI 0.35–0.95) while those who napped for 15 to 30 minutes had a 56% reduced risk (HR 0.44; 95% CI 0.27–0.72).
Dr. Diaz-Gutierrez said: “The results suggest that the optimal napping duration is 15 to 30 minutes. Larger studies are needed to determine whether a short nap is preferable to not napping at all. There are numerous potential explanations for the associations between napping and health. For example, long daytime naps may disrupt the body’s internal clock (circadian rhythm), leading to shorter night-time sleep, more nocturnal awakening and reduced physical activity. In contrast, short daytime napping may improve circadian rhythm, lower blood pressure levels and reduce stress.
“Our study indicates that snoozes during the day should be limited to less than 30 minutes,” said study author Dr. Jesus Diaz-Gutierrez of Juan Ramon Jimenez University Hospital, Huelva, Spain. “People with disturbed night-time sleep should avoid relying on napping to make up the shortfall.”
Atrial fibrillation is the most common heart rhythm disorder, affecting more than 40 million people worldwide.2 People with this arrhythmia have a five times greater risk of stroke than their peers. Dr. Diaz-Gutierrez said: “Previous studies have suggested that sleep patterns may play a role in the development of atrial fibrillation, but as far as we know this was the first study to analyse the relationship between daytime napping and risk of the arrhythmia.”
The study used data from the University of Navarra Follow-up (SUN) Project, a prospective cohort of Spanish university graduates. A total of 20,348 participants free of atrial fibrillation at baseline completed a questionnaire every two years. Information was obtained on sociodemographics (age, sex, working hours), medical conditions (high cholesterol, high blood pressure, diabetes, sleep apnoea, cardiovascular diseases including atrial fibrillation), lifestyle (napping, smoking, exercise, coffee intake, binge drinking, adherence to a Mediterranean diet, TV watching), height and weight.
Participants were divided into three groups according to their average daily napping duration at baseline: none, less than 30 minutes, and 30 minutes or more. Short daytime nappers were defined as those who snoozed for less than 30 minutes.
New atrial fibrillation diagnoses were initially self-reported and subsequently confirmed by an expert committee of cardiologists, who used a predefined protocol which included reviewing medical records. The risk of atrial fibrillation according to daytime napping duration was analysed after adjusting for the information collected in the questionnaire.
The average age of participants at baseline was 38 years and 61% were women. During a median follow up of 13.8 years, 131 participants developed atrial fibrillation. Compared to short daytime nappers, those who snoozed for 30 minutes or more per day had a nearly doubled risk of developing atrial fibrillation (hazard ratio [HR] 1.90; 95% confidence interval [CI] 1.26–2.86). Meanwhile, compared with short nappers, risk was not elevated in those who avoided napping (HR 1.26; 95% CI 0.82–1.93).
The researchers conducted a second analysis to identify the nap duration associated with the lowest risk of atrial fibrillation. This analysis included those who reported regular napping and excluded participants who did not nap. Participants were divided into three categories according to their average daily napping duration at baseline: less than 15 minutes, 15 to 30 minutes, and more than 30 minutes. Compared with those who napped for more than 30 minutes per day, those who napped for less than 15 minutes had a 42% lower risk of developing atrial fibrillation (HR 0.58; 95% CI 0.35–0.95) while those who napped for 15 to 30 minutes had a 56% reduced risk (HR 0.44; 95% CI 0.27–0.72).
Dr. Diaz-Gutierrez said: “The results suggest that the optimal napping duration is 15 to 30 minutes. Larger studies are needed to determine whether a short nap is preferable to not napping at all. There are numerous potential explanations for the associations between napping and health. For example, long daytime naps may disrupt the body’s internal clock (circadian rhythm), leading to shorter night-time sleep, more nocturnal awakening and reduced physical activity. In contrast, short daytime napping may improve circadian rhythm, lower blood pressure levels and reduce stress.
WELLNEWS
Dr. Dumaguing
Depressed patients less likely to take their heart medications
EDINBURGH, UK -- Patients who feel low when having a cardiac device implanted are more likely to stop taking their heart medications than those without depression, according to research presented at ACNAP 2023, a scientific congress of the European Society of Cardiology (ESC).1
Study author Mr. Ole Skov, a psychologist and PhD student in cardiac psychology at the University of Southern Denmark, Odense, Denmark said: “Medications help to control symptoms and prevent further heart problems so adherence is important. Patients with an implantable cardioverter defibrillator (ICD) who feel depressed or anxious should be encouraged to express their concerns, thoughts, and feelings and contact a health care professional who can screen them for distress to explore the best course of action.
This could be referral to a psychologist or other measures.”
An ICD implantation is recommended for people at high risk of a life-threatening arrhythmia and for those who have had a sudden cardiac arrest. It is estimated that approximately one in every five patients with an ICD is affected by depression or anxiety.
Both mental health issues have been linked with an elevated risk of death in those with an ICD. Most patients with an ICD are prescribed medication to manage their heart disease. Failure to take cardiac medications increases the risk of complications and death, making it crucial to identify patients who are more likely to stop taking their medication so that support measures can be initiated.
This study examined whether anxiety and depression at the time of ICD implantation are associated with medication adherence one year after receiving the device. The study was a secondary analysis of the ACQUIRE-ICD randomized controlled trial of an eHealth intervention, which enrolled patients from all six implantation centres in Denmark.
Of 478 patients in the trial with an ICD or an ICD with cardiac resynchronization therapy (CRT-D), 433 (91%) were taking at least one heart medication when their device was implanted.
These included beta-blockers, ACE inhibitors, statins and diuretics. Of the 433 patients, 322 patients (74%) completed assessments of medication adherence at both baseline (implantation) and 12 months after implantation and were included in the current analyses.
Medication adherence was measured by self-report using the Morisky Medication Adherence Scale (MMAS) with scores ranging from 0 to 8.6 Low, medium and high adherence were defined as scores below 6, 6 to <8, and 8, respectively. Depression and anxiety were assessed at baseline with the Patient Health Questionnaire 9 (PHQ-9; scores 0-27) and the Generalized Anxiety Disorder (GAD-7; scores 0-21) scale, with higher scores indicating more symptoms. Both were used as continuous measures, and patients were not categorized as depressed/not depressed or anxious/not anxious.
The average age of participants was 60 years and 84% were men. Medication adherence was generally medium to high at baseline (6.8% low adherence, 40.1% medium adherence, 53.1% high adherence; average MMAS score 7.31) and at 12 months (8.1% low adherence, 37.3% medium adherence, 54.6% high adherence; average MMAS score 7.33).
The researchers analysed the association between mental health scores and medication adherence after adjusting for baseline MMAS score, sex, trial intervention group, heart failure severity and implantation centre. Depression scores at baseline were negatively associated with medication adherence at 12 months (p=0.02).
The association with anxiety was not statistically significant.
Mr. Skov said: “Patients with higher levels of depressive symptoms at the time of ICD implantation were less likely to be taking their heart medications one year later. The effect of depression was statistically significant but small, which is not surprising given the complexity and multitude of factors involved in medication adherence.”
He concluded: “These results highlight the importance of considering the psychological status of people receiving an ICD. Those with symptoms of depression at the time of implantation could be at risk of discontinuing their heart medications, even if they are taking them initially, and may need extra support.
Study author Mr. Ole Skov, a psychologist and PhD student in cardiac psychology at the University of Southern Denmark, Odense, Denmark said: “Medications help to control symptoms and prevent further heart problems so adherence is important. Patients with an implantable cardioverter defibrillator (ICD) who feel depressed or anxious should be encouraged to express their concerns, thoughts, and feelings and contact a health care professional who can screen them for distress to explore the best course of action.
This could be referral to a psychologist or other measures.”
An ICD implantation is recommended for people at high risk of a life-threatening arrhythmia and for those who have had a sudden cardiac arrest. It is estimated that approximately one in every five patients with an ICD is affected by depression or anxiety.
Both mental health issues have been linked with an elevated risk of death in those with an ICD. Most patients with an ICD are prescribed medication to manage their heart disease. Failure to take cardiac medications increases the risk of complications and death, making it crucial to identify patients who are more likely to stop taking their medication so that support measures can be initiated.
This study examined whether anxiety and depression at the time of ICD implantation are associated with medication adherence one year after receiving the device. The study was a secondary analysis of the ACQUIRE-ICD randomized controlled trial of an eHealth intervention, which enrolled patients from all six implantation centres in Denmark.
Of 478 patients in the trial with an ICD or an ICD with cardiac resynchronization therapy (CRT-D), 433 (91%) were taking at least one heart medication when their device was implanted.
These included beta-blockers, ACE inhibitors, statins and diuretics. Of the 433 patients, 322 patients (74%) completed assessments of medication adherence at both baseline (implantation) and 12 months after implantation and were included in the current analyses.
Medication adherence was measured by self-report using the Morisky Medication Adherence Scale (MMAS) with scores ranging from 0 to 8.6 Low, medium and high adherence were defined as scores below 6, 6 to <8, and 8, respectively. Depression and anxiety were assessed at baseline with the Patient Health Questionnaire 9 (PHQ-9; scores 0-27) and the Generalized Anxiety Disorder (GAD-7; scores 0-21) scale, with higher scores indicating more symptoms. Both were used as continuous measures, and patients were not categorized as depressed/not depressed or anxious/not anxious.
The average age of participants was 60 years and 84% were men. Medication adherence was generally medium to high at baseline (6.8% low adherence, 40.1% medium adherence, 53.1% high adherence; average MMAS score 7.31) and at 12 months (8.1% low adherence, 37.3% medium adherence, 54.6% high adherence; average MMAS score 7.33).
The researchers analysed the association between mental health scores and medication adherence after adjusting for baseline MMAS score, sex, trial intervention group, heart failure severity and implantation centre. Depression scores at baseline were negatively associated with medication adherence at 12 months (p=0.02).
The association with anxiety was not statistically significant.
Mr. Skov said: “Patients with higher levels of depressive symptoms at the time of ICD implantation were less likely to be taking their heart medications one year later. The effect of depression was statistically significant but small, which is not surprising given the complexity and multitude of factors involved in medication adherence.”
He concluded: “These results highlight the importance of considering the psychological status of people receiving an ICD. Those with symptoms of depression at the time of implantation could be at risk of discontinuing their heart medications, even if they are taking them initially, and may need extra support.
WELLNEWS
Dr. Dumaguing
Loneliness linked with elevated risk of cardiovascular disease
in patients with diabetes
SOPHIA ANTIPOLIS, France -- Loneliness is a bigger risk factor for heart disease in patients with diabetes than diet, exercise, smoking and depression, according to research published in European Heart Journal, a journal of the European Society of Cardiology (ESC).1
“The quality of social contact appears to be more important for heart health in people with diabetes than the number of engagements,” said study author Professor Lu Qi of Tulane University School of Public Health and Tropical Medicine, New Orleans, US. “We should not downplay the important of loneliness on physical and emotional health. I would encourage patients with diabetes who feel lonely to join a group or class and try to make friends with people who have shared interests.”
“Loneliness and social isolation are common in today's societies and have become a research focus during the last years, especially driven by the Covid-19 pandemic and the continuous digitalization of society,” state Kahl et al. in an accompanying editorial.
Loneliness refers to the quality of social contacts, while isolation refers to the quantity. They add: “The human species is inherently social by nature.
Humans not only require the presence of others, but rely on meaningful social relationships to develop into healthy adulthood.
As individuals, we strive to belong to a family, a peer group, a community. These social interactions with family, friends, neighbours or colleagues are paramount for our physical and mental well-being.”
Patients with diabetes are at greater risk of cardiovascular disease and are more likely to be lonely than their healthy peers.
Previous studies in the general population have found that loneliness and social isolation are both related to a higher likelihood of cardiovascular disease.
This study in patients with diabetes examined whether patients who were lonely or socially isolated were more likely to develop cardiovascular disease than those who were not.
The study included 18,509 adults aged 37 to 73 years in the UK Biobank with diabetes but no cardiovascular disease at baseline.
Loneliness and isolation were assessed with questionnaires, with high-risk features allocated one point each.
High-risk loneliness featured were feeling lonely and never or almost never being able to confide in someone, for a total score of 0 to 2. High-risk social isolation factors were living alone, having friends and family visit less than once a month, and not participating in social activity at least once per week, for a total score of 0 to 3.
Some 61.1%, 29.6% and 9.3% participants had loneliness scores of 0, 1 or 2, respectively, while 44.9%, 41.9% and 13.2% had isolation scores of 0, 1 or >2, respectively.
The researchers analyzed the association between loneliness, isolation and incident cardiovascular disease after adjusting for factors that could influence the relationships including sex, age, deprivation, body mass index (BMI), medications, physical activity, diet, alcohol, smoking and control of blood sugar, blood pressure and cholesterol.
During an average follow-up of 10.7 years, 3,247 participants developed cardiovascular disease, of which 2,771 was coronary heart disease and 701 was stroke (some patients had both). Compared to participants with the lowest loneliness score, the risk of cardiovascular disease was 11% and 26% higher in those with scores of 1 or 2, respectively.
Similar results were observed for coronary heart disease but the association with stroke was not significant. Social isolation scores were not significantly related to any of the cardiovascular outcomes.
The researchers also assessed the relative importance of loneliness, compared with other risk factors, on the incidence of cardiovascular disease.
Loneliness showed a weaker influence than kidney function, cholesterol and BMI, but a stronger influence than depression, smoking, physical activity and diet.
Professor Qi said: “Loneliness ranked higher as a predisposing factor for cardiovascular disease than several lifestyle habits. We also found that for patients with diabetes, the consequence of physical risk factors (i.e. poorly controlled blood sugar, high blood pressure, high cholesterol, smoking and poor kidney function) was greater in those who were lonely compared to those who were not.”
Take home message, family members, relatives, friends should be aware of the loneliness of a patients with low self-esteem due to their resignation to the chronicity and seemingly hopeless nature of their illness; buoy up their sagging spirits with jokes and humor. Cliché as it may seem, the oft-said adage,” laughter is the best medicine”
WELLNEWS
Dr. Dumaguing
TB is endemic the world over, occurs in all ages frequently early in life up to middle-aged adults. There are two peaks in incidence of TB; with the first occurring within the first three years of life; the second peak in women occurs in third decade while in men, it is on the fifth decade of life.
Tuberculosis is a granulomatous infection, similar to leprosy, syphilis, tularemia, sarcoidoisis, but differs in the creation of a amorphous pink lipid rich debris which is cheese-like giving the disease its characteristic caseation necrosis. Although the microbe is composed of carbohydrates, proteins-which is responsible for its antigenicity- it is the lipid portion that makes it more virulent
TB is an acquired disease; humans are susceptible only to the human strain (90%) with 10% due to bovine strain. The bacilli is resistant to drying and can survive for days in ordinary room temperatures and humidity.
Four possible portals of entry of the microbe are thru respiratory tract- inhalation of minute particles less than 15 microns in diameter- lymphoid tissue of the oropharynx, gut and skin. Natural resistance is varied; with the black race more susceptible than Caucasians. Malnutrition, fatigue, debilitation, intercurrent diseases esp. diabetes mellitus, severity of exposure; they all materially influence susceptibility to the disease. Testing techniques includes intracutaneous inoculation of tuberculoprotein or PPD-purified protein derivative- also called Mantoux test.
Tuberculosis
Tuberculosis is an acute and chronic infection caused by Mycobacterium tuberculosis, an acid-fast microbe which involves primarily the lungs-the largest respiratory organ- but may affect any organ of the body.TB is endemic the world over, occurs in all ages frequently early in life up to middle-aged adults. There are two peaks in incidence of TB; with the first occurring within the first three years of life; the second peak in women occurs in third decade while in men, it is on the fifth decade of life.
Tuberculosis is a granulomatous infection, similar to leprosy, syphilis, tularemia, sarcoidoisis, but differs in the creation of a amorphous pink lipid rich debris which is cheese-like giving the disease its characteristic caseation necrosis. Although the microbe is composed of carbohydrates, proteins-which is responsible for its antigenicity- it is the lipid portion that makes it more virulent
TB is an acquired disease; humans are susceptible only to the human strain (90%) with 10% due to bovine strain. The bacilli is resistant to drying and can survive for days in ordinary room temperatures and humidity.
Four possible portals of entry of the microbe are thru respiratory tract- inhalation of minute particles less than 15 microns in diameter- lymphoid tissue of the oropharynx, gut and skin. Natural resistance is varied; with the black race more susceptible than Caucasians. Malnutrition, fatigue, debilitation, intercurrent diseases esp. diabetes mellitus, severity of exposure; they all materially influence susceptibility to the disease. Testing techniques includes intracutaneous inoculation of tuberculoprotein or PPD-purified protein derivative- also called Mantoux test.
Patch test involves exposure of a measured area of skin to a known dose of TB protein with hyperemia as positive result.
Primary TB follows the first seeding of the tissues of the body by the Tb microbe, usually in infants, young children but may also occur in adults when they have never been exposed to the microbe in early life. The lesion is called GHON focus/lesion, a l to l.5 cm area of gray white consolidation in the hilum-root of the lungs, lower part of upper lobes, upper part of the lower lobes. Ghon complex is formed with the combination of the primary lesion plus the lymphatic nodes involved in the draining of the bacilli. Reinfection TB, also called adult TB or Secondary TB is the phase of infection that follows reactivation of a primary TB or a repeat infection of a previously exposed individuals. It is well known that viable TB microbe may persist in caseous, partially fibrotic and even calcified lesions for many years and even for life.
TB in children is also called primary complex, whose lesions are mostly hilar unlike in adult TB where the lesion is mostly in the apex or copula because the microbe is an obligate aerobe. The first exposure to the microbe in children means no previous sensitization to the TB protein thus there is very little, if at all scarring when the infection is healed. In adults however, there is a florid, excessive reaction of lymphocytes and other macrophages resulting to massive lung tissue destruction which sadly leads to a fibrotic scarring which is present on xray even when the patient is well. TB in children is not communicable while in adults it is more likely especially if the lesion is close or connected to a bronchus, thus expelling the microbe thru coughing, sneezing or even loud talking.
The presence of lymph nodes on the posterior triangle of the neck- movable, non-tended, matted- are highly suggestive of TB in children with associated frequent upper respiratory tract infection.
Cough may be a late symptom in adults, with night sweats even in cold nights, late afternoon fever, and unexplained weight loss are more common presenting signs and symptoms in adults.
Common with Primary complex and adult Tb is the now recommended duration of treatment; a six-month regimen divided into two phases, two-months aggressive and 4-months maintenance treatment. Rifampicin-gold standard in TB therapy- Isoniazid or isonicotinic acid hydrazide, and pyrazinamide are given in first two months in children, the remaining four months without PZA because of its hepatotoxicity. For adults, Rifampicin, INH, PZA and Ethambutol- the last one not given to chidren because of its effect on their retina-comprise the aggressive phase of treatment, with PZA likewise eliminated in the last for months. Traditionally, streptomycin, an aminoglycoside was a routine drug for TB in adults-not in children – quite efficacious and cheap but it is given only parenterally, l gram per day for one or two months, with warnings about its ototoxicity. Pulmonologists and infectious disease experts strongly recommend that the TB drugs are all together taken before breakfast daily for maximum efficacy.
From experience, strict isolation of a TB patient requires only 21 days, by then there would have been sterilization of the bacilli.
Extrapulmonary tuberculosis include military TB in which the whole lung fields are seeded with millet-seed like particles or like the canary bird seeds; with the liver and spleen most commonly affected when the microbe erodes the pulmonary artery. The meninges could also be affected, so are the eyes, kidneys, bones- Potts disease is affectation of the spine esp thoracolumbar part, Scrofula is Tb of the lymph nodes, usually mistaken as Hodgkin’s lymphoma of the neck. In males possible cause of infertility is involvement of the epididymis while in female, their fallopian tubes are common sites of TB.
The Peyer’s patches on the distal part of the ileum could also be sites of GIT TB. Hemoptysis is a serious manifestation of a far-advanced Tb infection and requires immediate hospitalization considering the respiratory difficulty it entails.
Fortunately, in general with the improvement in socioeconomic conditions esp. among developing nations, plus a more active primary health care initiatives of health agencies, less than 10 percent of those affected die of the disease.
The Department of Health has an active program on helping TB patients with its free TB-DOTS- TB-Direct Observed Treatment Short Course, which should be availed of by our citizens.
WELLNEWS
Dr. Dumaguing
Artificial intelligence to personalize treatment of heart failure patients
SOPHIA, Antipolis, France -- The first trustworthy artificial intelligence (AI) model for tailoring management of heart failure patients is being developed by the AI4HF project, launched this month in Utrecht, the Netherlands. The ground-breaking project is being conducted by a consortium of international partners including the European Society of Cardiology (ESC).
“An innovative personalised risk calculator will be created to pinpoint the most beneficial treatments for each heart failure patient,” said AI4HF coordinator Professor Folkert Asselbergs of Amsterdam Heart Centre. “The model will incorporate data on symptoms and lifestyle behaviours, blood tests, electrocardiograms and cardiac imaging, and will be co-created with patients and clinicians.”
Heart failure is the leading cause of hospitalisation in people over the age of 65.1 About half of hospital readmissions are related to co-existing conditions, multiple medications, and disabilities related to heart failure.2 The prognosis of heart failure is worse than many forms of cancer.3 Management is challenging as the condition has many causes and manifestations, from decreased quality of life to regular hospitalisations, heart attack, and premature death.
Professor Asselbergs said: “A personalised medicine approach is needed where we tailor the advice and treatment we give to individual patients including medication, diet, exercise, pacemakers and cardiac resynchronisation therapy based on early prediction of their risk of poor outcomes. Projections indicate that the number of patients living with heart failure will be 46% higher in 2030 due to an ageing population and unhealthy lifestyles, so it’s important that we act now.”4
The largest-ever dataset of heart failure patients will be harnessed to develop the AI model during this pioneering four-year project, which is funded by the European Health and Digital Executive Agency (HaDEA) and involves 16 organisations around the world.5 The inclusion of hundreds of thousands of patients with heart failure in Europe, South America and Africa will result in novel analyses across populations, clinical settings and ethnic groups.
To achieve its ambitious goal, the AI4HF consortium will leverage a unique blend of resources and tools. Real-world health data will be obtained from BigData@Heart (www.bigdata-heart.eu) and integrated using the FAIR4Health platform (www.fair4health.eu) following best practice recommendations for building trustworthy AI tools established by FUTURE-AI (www.future-ai.eu).
Professor Asselbergs said: “AI4HF promises to benefit patients with heart failure by adapting management to individual needs. In addition, a state-of-the-art AI passport will be introduced which uses new methods to continuously update the model following its deployment in real-world practice and will act as a framework for developing trustworthy AI solutions across all areas of health
“An innovative personalised risk calculator will be created to pinpoint the most beneficial treatments for each heart failure patient,” said AI4HF coordinator Professor Folkert Asselbergs of Amsterdam Heart Centre. “The model will incorporate data on symptoms and lifestyle behaviours, blood tests, electrocardiograms and cardiac imaging, and will be co-created with patients and clinicians.”
Heart failure is the leading cause of hospitalisation in people over the age of 65.1 About half of hospital readmissions are related to co-existing conditions, multiple medications, and disabilities related to heart failure.2 The prognosis of heart failure is worse than many forms of cancer.3 Management is challenging as the condition has many causes and manifestations, from decreased quality of life to regular hospitalisations, heart attack, and premature death.
Professor Asselbergs said: “A personalised medicine approach is needed where we tailor the advice and treatment we give to individual patients including medication, diet, exercise, pacemakers and cardiac resynchronisation therapy based on early prediction of their risk of poor outcomes. Projections indicate that the number of patients living with heart failure will be 46% higher in 2030 due to an ageing population and unhealthy lifestyles, so it’s important that we act now.”4
The largest-ever dataset of heart failure patients will be harnessed to develop the AI model during this pioneering four-year project, which is funded by the European Health and Digital Executive Agency (HaDEA) and involves 16 organisations around the world.5 The inclusion of hundreds of thousands of patients with heart failure in Europe, South America and Africa will result in novel analyses across populations, clinical settings and ethnic groups.
To achieve its ambitious goal, the AI4HF consortium will leverage a unique blend of resources and tools. Real-world health data will be obtained from BigData@Heart (www.bigdata-heart.eu) and integrated using the FAIR4Health platform (www.fair4health.eu) following best practice recommendations for building trustworthy AI tools established by FUTURE-AI (www.future-ai.eu).
Professor Asselbergs said: “AI4HF promises to benefit patients with heart failure by adapting management to individual needs. In addition, a state-of-the-art AI passport will be introduced which uses new methods to continuously update the model following its deployment in real-world practice and will act as a framework for developing trustworthy AI solutions across all areas of health
0 comments:
Post a Comment