Daily Archives: 23 August 2024

Recent Research Emphasises Worldwide Inequalities in Mobility Restrictions and Utilisation of Assistive Technologies

A recent investigation involving over 175,000 individuals across 25 nations has revealed that people in low—and middle-income countries encounter more significant challenges in their daily activities and are less inclined to use assistive devices than their counterparts in high-income countries. This revelation underscores concerns about the disproportionate global burden of disability, particularly prevalent in poorer regions.

Although global statistics show a decline in mortality and cardiovascular diseases, along with an extension in life expectancy, the health outcomes in less affluent nations remain substantially inferior to those in wealthier countries. The disparity in the prevalence of disabilities across various regions remains less explored. This pioneering prospective study surveyed participants on mobility, vision, and hearing limitations, discovering that such impairments are widespread, with mobility, bending, and visual challenges being the most common. Notably, one-third of the respondents reported experiencing at least one form of limitation, with older adults and women being the most affected groups.

The study revealed that limitations in daily activities are notably more prevalent in lower-income settings. Instances of walking and visual impairments are two and five times higher, respectively than in more affluent nations.

Raed Joundi, the study’s lead author and a researcher at the Population Health Research Institute (PHRI) of McMaster University and Hamilton Health Sciences, emphasised the scarcity of comprehensive data on activity limitations and their impact globally. The study aimed to bridge this gap by examining the frequency of fundamental activity limitations, the adoption of assistive technologies, and the resultant health outcomes across 25 countries.

As part of the extensive Prospective Urban Rural Epidemiological (PURE) study led by PHRI and Salim Yusuf, the senior scientist, the research was published in The Lancet on July 25, 2024. It gathered data from individuals aged between 35 and 70 using standardised questionnaires and monitored them over an average of 11 years, extending up to 20 years in some cases.

The findings also highlighted that simple yet essential assistive devices such as canes or glasses could significantly alleviate the daily challenges faced by individuals with disabilities. However, in poorer nations, the use of such basic aids was less than half that observed in wealthier countries.

Yusuf stressed the critical importance of access to assistive devices in enhancing the quality of life and enabling individuals to reach their potential despite disabilities. He pointed out the significant gap in access as a pivotal area for health policy and intervention in low—and middle-income countries.

Moreover, the research linked mobility restrictions with severe health issues, including elevated risks of mortality, cardiovascular diseases, pneumonia, and falls, underlining the profound impact of activity limitations on health.

Joundi called for developing policies and programmes to ensure disabled individuals in less affluent countries access essential assistive devices and other resources necessary for maintaining health. He also advocated for a deeper understanding of the factors leading to these limitations and the formulation of public health strategies to prevent them, aiming for a future where individuals can enjoy longer, healthier, and more fulfilling lives.

More information: Raed A Joundi et al, Activity limitations, use of assistive devices, and mortality and clinical events in 25 high-income, middle-income, and low-income countries: an analysis of the PURE study, The Lancet. DOI: 10.1016/S0140-6736(24)01050-X

Journal information: The Lancet Provided by McMaster University

Research Reveals Adolescent Sports Boost Bone Health in Older Adults

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Loss of bone mineral density (BMD) as individuals age significantly contributes to osteoporosis—a degradation of bone tissue. In Japan, this deterioration is a primary cause of falls among older adults, leading to fractures and extended nursing care. Addressing osteoporosis in the ageing population can reduce disease prevalence and healthcare expenditures.

Lifestyle choices made early in life, particularly during adolescence, can profoundly impact health outcomes in later years. Engaging in physical activity during these formative years contributes to the accumulation of bone mass, which peaks in the 20s and then diminishes as one age. Research indicates that increasing peak bone mass by 10% during adolescence could postpone the onset of osteoporosis by as many as 13 years. Nevertheless, the specific types of sports activities during adolescence that benefit BMD and overall bone health in later life remain unclear.

Aiming to fill this knowledge gap, a team of researchers from Juntendo University in Japan has explored how different sports played during adolescence affect bone density in later years. Their findings were published in the 14th volume of ‘Frontiers in Physiology’ on 12 October 2023. The research team included Professor Yoshifumi Tamura of the Faculty of International Liberal Arts, alongside colleagues from the Sportology Center and the Department of Metabolism & Endocrinology at the Graduate School of Medicine.

Professor Tamura elaborated on their discoveries, noting the challenges in boosting BMD once it has declined and highlighted the crucial role of maximising bone mass during youth to sustain bone health into old age. Their research provides pivotal insights into how exercise in youth can prevent osteoporosis and supports the creation of early intervention strategies.

The study surveyed 1,596 elderly individuals aged 65 to 84 from the Bunkyo Health Study in Tokyo. Assessments included physical fitness tests, vitamin D levels, and BMD measurements of the femoral neck and lumbar spine using dual-energy X-ray absorptiometry. Participants were also interviewed about their involvement in sports during adolescence, and additional data on their health and lifestyle were collected.

Findings showed that while BMD levels in the femoral neck and lumbar spine were generally normal among men, women exhibited lower values, with a significant number on osteoporosis medication. The study also highlighted disparities in conditions like diabetes and lifestyle factors such as smoking and alcohol consumption between genders. Popular sports during the participants’ youth included baseball, basketball, judo, table tennis, tennis, volleyball, and swimming.

Basketball, in particular, was associated with higher femoral BMD in older adults and women, with body weight and vitamin D levels also influencing BMD. Women who had engaged in volleyball and swimming showed higher lumbar spine BMD, though no sports were linked to lumbar spine BMD in men. Factors such as body weight, vitamin D levels, and diabetes presence were also important.

The results suggest that engaging in high-impact sports during adolescence leads to better bone density and health in later life, with benefits extending beyond athletes to the general population who participated in sports during their school years.

This underscores the significance of encouraging impactful sports activities in schools, as early sporting engagement can lay the groundwork for robust bone health throughout life. “Engaging in physical exercise during adolescence has long-term benefits on BMD, extending over fifty years into older age,” concluded Professor Tamura, emphasising the long-lasting impact of adolescent sports on health in later years.

More information: Hikaru Otsuka et al, Playing basketball and volleyball during adolescence is associated with higher bone mineral density in old age: the Bunkyo Health Study, Frontiers in Physiology. DOI: 10.3389/fphys.2023.1227639

Journal information: Frontiers in Physiology Provided by Juntendo University Research Promotion Center

Chances of Anxiety and Suicide Attempts Could Increase Substantially Following Hospitalization for Heart Issues

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In an enlightening study published in the Journal of the American Heart Association, it was discovered that individuals hospitalized for heart disease, stroke, or other cardiovascular conditions are significantly more likely to be diagnosed with mental health issues such as anxiety, depression, and suicidal behaviours within the first year post-discharge, compared to those without cardiovascular disease. The research, led by Huan Song, M.D., PhD, a professor of epidemiology at the West China Biomedical Big Data Center at West China Hospital, Sichuan University in Chengdu, China, highlights the essential link between physical and mental health following such diagnoses. Unlike previous studies, this analysis incorporated environmental and lifestyle factors. It examined the effects of genetic predispositions on the relationship between cardiovascular and psychiatric conditions, using data from the UK Biobank—a large-scale biomedical database with health information from about 500,000 adults.

Cardiovascular conditions defined in the study included ischemic heart disease and cerebrovascular diseases such as stroke, blood clots, heart failure, and irregular heart rhythms. The analysis focused on the prevalence of psychiatric disorders diagnosed after hospitalization for these conditions, contrasting it with a control group matched for age, gender, and health status but free from prior cardiovascular or psychiatric conditions. The findings revealed an 83% increased likelihood of a psychiatric disorder diagnosis within a year of a cardiovascular-related hospital admission, with a sustained 24% increased risk extending nearly eight years after the event. Exceptionally high risks were noted for anxiety, depression, and suicidal behaviours, with those experiencing stroke or other cerebrovascular events facing more than three times the risk of psychiatric disorders within the first year and a 49% increased risk after that.

Mariell Jessup, M.D., FAHA, chief science and medical officer of the American Heart Association, emphasized the importance of integrating mental health care into cardiovascular patients’ treatment and recovery process. The findings affirm that after a cardiovascular diagnosis and hospitalization, patients face a higher risk for mental health issues, thus necessitating mental health screening and early intervention as critical components of patient care. Routine screenings and referrals for mental health services are recommended, aligning with the association’s guidelines for comprehensive care encompassing psychological and physical health.

Dr. Song also highlighted the necessity for individuals experiencing mental health difficulties post-cardiovascular events to seek immediate support. Healthcare professionals can provide valuable support and direct patients to mental health specialists or support networks essential for managing these challenges. It’s crucial for patients, families, and caregivers to be proactive in recognizing signs of mental distress and to communicate any changes to the healthcare team promptly.

However, the study acknowledges its limitations, such as the potential underrepresentation of less severe cardiovascular cases that did not require hospitalization and reliance on hospital admission data for cardiovascular diagnosis. Additionally, since the data primarily represents white British adults, the findings may not fully apply to other racial, ethnic, or geographic groups.

This comprehensive analysis underscores the intricate interplay between cardiovascular health and mental well-being, advocating for an integrated approach to patient care that addresses both dimensions to enhance overall patient outcomes. This approach not only aids in recovery but also supports long-term health management, highlighting the necessity for vigilant monitoring and intervention in the mental health of cardiovascular patients.

More information: Jie Yang et al, Cardiovascular Disease, Genetic Susceptibility, and Risk of Psychiatric Disorders and Suicide Attempt: A Community‐Based Matched Cohort Study Based on the UK Biobank, Journal of the American Heart Association. DOI: 10.1161/JAHA.123.031280

Journal information: Journal of the American Heart Association Provided by American Heart Association

Is the ‘Treat-All’ Approach for Chronic Hepatitis B Virus Infection in China Fully Implemented?

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Chronic hepatitis B (CHB) remains a significant public health issue, particularly in China, where the disease is prevalent. In response, the 2022 Chinese guidelines for the prevention and treatment of CHB have adopted a more aggressive stance, broadening treatment criteria and simplifying management protocols to improve overall disease control. This essay elaborates on Mengyang Zhang et al.’s study, published in the Journal of Clinical and Translational Hepatology, which assesses these new guidelines and evaluates the impact of a “Treat-all” strategy in managing CHB. The review begins by emphasising the substantial health burden of untreated CHB, which can progress to severe liver diseases like cirrhosis and hepatocellular carcinoma (HCC), particularly underlining the situation in China, where HBV is a major cause of liver-related death.

The “Treat-all” strategy outlined in the guidelines advocates for initiating treatment in all individuals with detectable HBV DNA or positive HBsAg, aiming to reduce the disease burden by preventing the progression to more severe liver conditions. The rationale is that early treatment can enhance quality of life, minimise infectivity, and manage comorbidities such as fatty liver disease and HBV reactivation in the context of immunosuppressive therapies. This approach supports evidence that early antiviral treatment can prevent the progression of liver disease and reduce the incidence of HCC, suggesting a significant shift towards proactive disease management.

The expanded criteria in the 2022 guidelines now recommend treatment for nearly all patients with detectable HBV DNA, mainly targeting those at higher risk of disease progression. This includes adults over 30, due to the increased risk of disease progression and HCC, and children aged 1-7, who have a higher chance of achieving a functional cure and present significant liver damage. Furthermore, treatment is advised for at-risk adults exhibiting symptoms like elevated ALT, cirrhosis, considerable fibrosis, extrahepatic manifestations, or a family history of HCC.

A central discussion point in the review is the treatment of patients with HBeAg-positive chronic HBV infection, which traditionally was not immediately treated due to perceived minimal liver damage. Recent studies challenge this view, showing significant histological damage even in this phase and suggesting that early antiviral treatment can prevent disease progression and reduce HCC risk. The article also stresses the cost-effectiveness of early treatment initiation, utilising decision-tree Markov models to demonstrate that expanding antiviral treatment to all HBsAg-positive patients could drastically reduce liver-related events and overall healthcare costs, aligning with WHO’s goals to decrease HBV-related mortality by 65%.

Despite the promising prospects of the “Treat-all” strategy, it also presents challenges such as the potential for overtreatment, the necessity for sustained adherence to antiviral therapy, and managing the risks associated with treatment withdrawal, like viral relapse and liver failure. The review calls for continued research and adaptation of treatment strategies to address these challenges and improve patient outcomes effectively.

The 2022 Chinese guidelines for CHB mark a significant advancement in the proactive management of chronic hepatitis B. By advocating a “Treat-all” approach, despite its associated challenges, there is a substantial potential to reduce the burden of HBV-related liver diseases and contribute to the elimination of hepatitis B as a public health threat by 2030. The insights provided by Mengyang Zhang et al. are crucial. They emphasise the importance of early treatment and explore both the benefits and challenges of a more inclusive antiviral treatment approach in the context of global health strategies.

More information: Mengyang Zhang et al, “Treat-all” Strategy for Patients with Chronic Hepatitis B Virus Infection in China: Are We There Yet? Journal of Clinical and Translational Hepatology. DOI: 10.14218/JCTH.2024.00091

Journal information: Journal of Clinical and Translational Hepatology Provided by Xia & He Publishing Inc.