AHA News: Cluster of Risky Conditions That Can Lead To Heart Disease Is Rising in Hispanic Adults

TUESDAY, Sept. 22, 2020 (American Heart Association News) — A cluster of conditions called metabolic syndrome that could lead to heart disease and stroke is becoming more common among Hispanic adults, and experts say there needs to be more research and more work in prevention.

Overall, metabolic syndrome affects about 1 in 3 adults in the United States and puts them at higher risk of heart disease, diabetes and stroke, according to statistics from the American Heart Association. For some groups in particular, it is becoming more common.

A recent JAMA study that analyzed surveys of 17,000 U.S. adults from 2011-2016 showed the syndrome’s prevalence increased by 5.2% among adults 20 to 39, and 4.9% among women of any age. But the biggest boost in cases was among participants of Hispanic descent, which rose by nearly 8% – from 32.9% to 40.5%.

Although metabolic syndrome isn’t a diagnosable clinical disease, researchers use the term when a person has any combination of at least three of these risk factors: obesity or a waistline greater than 40 inches in men or 35 inches in women; elevated triglycerides at or above 150 mg/dL; low “good” HDL cholesterol; high blood pressure; or elevated blood sugar.

Experts say the rise of cases in the Hispanic community is especially worrisome because the pandemic already has revealed crushing health disparities for certain racial, ethnic and socioeconomic groups who are disproportionally hit with obesity and hypertension. Those conditions have been associated with more severe COVID-19 symptoms.

“Metabolic syndrome is not going down, and it’s probably worsening in some of these subgroups,” said Dr. Anne Thorndike, an associate professor of medicine at Harvard Medical School and director of the Metabolic Syndrome Clinic at Massachusetts General Hospital in Boston.

“This condition, which is very highly correlated with obesity, is continuing to get worse,” she said. “We’re all trying to work towards reversing the trend in obesity going up.”

According to new data from the Centers for Disease Control and Prevention, 33.8% of Hispanic adults in the United States are obese compared with 29.9% of non-Hispanic white adults.

While the data points negatively toward the overall Hispanic population, Dr. Sadiya Sana Khan, a cardiologist and assistant professor of medicine at Northwestern University Feinberg School of Medicine in Chicago, cautions that future research also needs to take into account subgroups within that population.

The Hispanic community is “very diverse, so it’s tough to make a broad statement without disaggregating different groups, and I think speaks to the importance of future research looking at individual groups,” Khan said.

For example, she said, obesity is an important contributor to the increased risk for cardiovascular disease at a younger age in the Hispanic community. “This is especially important right now as we are seeing more and more young people developing heart disease.”

Thorndike said making lifestyle changes, such as eating a healthy diet, exercising and losing weight, is the key to managing or preventing metabolic syndrome. Also limit processed sugar, she said, and “minimize your blood pressure by making sure you’re not consuming too much sodium.”

American Heart Association News covers heart and brain health. Not all views expressed in this story reflect the official position of the American Heart Association. Copyright is owned or held by the American Heart Association, Inc., and all rights are reserved. If you have questions or comments about this story, please email [email protected]

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When is HIIT the best exercise fit?

Determining whether high-intensity interval training (HIIT) is an appropriate form of exercise for the average person has been hotly debated for years. But for one UBC Okanagan researcher, there’s not much to debate—interval exercise, when used appropriately, can fit into people’s menu of flexible exercise options.

“The physiological benefits of HIIT or SIT [sprint interval training] are well established,” says Matthew Stork, a postdoctoral fellow in the School of Health and Exercise Sciences and study lead author. “What has been difficult to nail down is if interval-based exercise should be promoted in public health strategies. If so, how can we help people, especially those who are less physically active, get that kind of exercise on a regular basis and over the long term?”

Stork describes interval exercise as repeated short, high-intensity efforts that are separated by periods of low-intensity rest or recovery and that typically last around 20-25 minutes or less. HIIT usually consists of bouts performed around 80-90 percent of a person’s maximum heart rate. SIT involves shorter bouts of activity, but at an even higher, “all-out” intensity.

“While SIT can be attractive for those who feel particularly short on time, it can be pretty off-putting for those that aren’t used to exercising at all-out intensities,” he explains.

And that, says Stork, is why there’s debate among exercise scientists.

While all styles of exercising have similar health benefits, critics of interval exercise argue that it’s not a sustainable public health strategy—it’s high-intensities may deter people from sticking with it in the long-term.

“Unsurprisingly, different people tolerate different exercise programs in different ways,” says Stork. “That makes it difficult to establish the ‘best’ exercise program for the ‘average’ person. There’s little research to unpack the experiences and perceptions of HIIT and SIT compared to traditional continuous exercise in the way we have in this study.”

Stork and his co-authors, including UBC Professor Kathleen Martin Ginis, interviewed 30 inactive adults—18 men and 12 women—before and after they participated in different types of continuous and interval exercise in a controlled lab setting and on their own free time.

Participants discussed the trade-offs of interval versus traditional exercise, the appeal of HIIT or SIT as an idea compared with actually doing it, and creative ways interval exercise can be adapted when working out on their own.

Stork says the factors that influence adherence to traditional or interval training are far more complex than what has been captured in research to date, but there’s certainly room for HIIT and SIT in exercise plans for the general public.

“I think many people assume that they need to go all-in on one form of exercise—if they’re a ‘HIIT person,’ they must have to do HIIT all the time,” he says. “But what I’m seeing is that different forms of exercise can be used interchangeably and that people should approach their exercise with a flexible ‘menu’ of options.”

Stork points to the parent of a toddler as an example.

“Maybe one day you only have 20 minutes to squeeze in a HIIT session while your child naps, but the next day you prefer an hour-long hike up the mountain to destress from work. As long as you’re getting a bit of exercise, you should feel empowered to choose a protocol that fits your needs in that particular time and situation.”

He says the next stage of this research is to determine what tools and resources can be used to help people engage in HIIT or SIT on their own while unsupervised.

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Study shows that rheumatoid arthritis is associated with a 23% increased risk of developing diabetes

A new study presented at this year’s annual meeting of the European Association for the Study of Diabetes (EASD), held online this year, shows that rheumatoid arthritis (RA) is associated with a 23% increased risk of type 2 diabetes (T2D), and may indicate that both diseases are linked to the body’s inflammatory response. The research was conducted by Zixing Tian and Dr. Adrian Heald, University of Manchester, UK, and colleagues.

Inflammation has emerged as a key factor in the onset and progression of T2D, and RA is an autoimmune and inflammatory disease. The team suggest that the systemic inflammation associated with RA might therefore contribute to the risk of an individual developing diabetes in the future.

The team conducted a comprehensive search of a range of medical and scientific databases up to 10 March 2020, for cohort studies comparing the incidence of T2D among people with RA to the diabetes risk within the general population. Statistical analyses were performed to calculate the relative risks, as well as to test for possible publication bias (in which the outcome of research influences the decision whether to publish it or not). The eligible studies identified comprised a total of 1,629,854 participants. Most of the studies were population-based and one was hospital-based, while no evidence was found for publication bias in any of them.

The authors found that having RA was associated with a 23% higher chance of developing T2D, compared to the diabetes risk within the general population. They conclude that: “This finding supports the notion that inflammatory pathways are involved in the pathogenesis of diabetes.”

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This Is How Long Coronavirus Actually Lasts If You Get Sick

As the coronavirus epidemic continues in the US, you might be wondering just how long you'll be sick if you do contract COVID-19. Every case is different, but after months of scientific study and data collection, experts have a fairly good idea. Here are the symptoms you'll be dealing with, when they'll likely strike, and how long it will take until you're fully recovered and can safely emerge from self-isolation. 

When do the first COVID-19 symptoms appear? 

Not everyone who gets COVID-19 has symptoms—in fact, the World Health Organization (WHO) says 80% of infections are mild or asymptomatic. Yet those who do may develop fever and chills, a cough, muscle or body aches, fatigue, shortness of breath or difficulty breathing, or a loss of taste or smell. Other people with COVID-19 have reported headache, sore throat, congestion or runny nose, nausea or vomiting, and diarrhea. 

The Centers for Disease Control and Prevention (CDC) says symptoms may appear 2-14 days after exposure to the virus. Yes, that’s a pretty large window. But a recent study by US immunologists, published in the Annals of Internal Medicine, narrowed it down. They analyzed more than 180 COVID-19 cases and found that, on average, it takes just over five days for COVID-19 symptoms to hit. 

The research team also found that 97% of people who get the virus will develop symptoms within 11 days from the time they are first infected. Any of these symptoms can strike at any time during the course of the illness, from day one to the last days.

How long does it take to recover? 

The COVID-19 recovery period depends on the severity of the illness. If you have a mild case, you can expect to recover within about two weeks. But for more severe cases, it could take six weeks or more to feel better, and hospitalization might be required.  

According to the CDC, older adults and people who have severe underlying medical conditions, like heart or lung disease or diabetes, may be at risk for developing more serious complications from COVID-19.

What is ‘viral persistence,’ and how does that affect the course of the disease?

Sometimes the coronavirus sticks around longer than expected—and scientists are still trying to figure out why that happens in some patients, how it varies by individual, and exactly how long the virus stays alive inside the body. This is known as viral persistence, and it affects how long someone is contagious and therefore how long they should stay in isolation. 

“Viral clearance is the disappearance of an infecting virus, either in response to a therapeutic agent or as a result of the body’s immune response,” Dr. Bailey explains. “This implies recovery from infection and lack of ongoing contagiousness. On the other hand, viral persistence is the continued presence of a virus, usually within specific types of cells, after resolution of symptoms of the acute viral infection.”

Viral persistence is seen in HIV, chronic hepatitis, chickenpox/shingles and herpes simplex, and Epstein-Barr. While it’s not typically a characteristic of acute respiratory infections such as COVID-19, research suggests that some people do have persistent COVID-19 infections. One study from China published in Quantitative Imaging in Medicine and Surgery demonstrates this: In the study, a woman had mild COVID-19 symptoms, which disappeared after 2–3 weeks. However, she retained a positive diagnosis status for over two months. 

When can you safely go out in public?  

The biggest risk of going out in public after having COVID-19 is transmitting the virus to others. If you follow the guidelines, however you can minimize the dangers.  

“In most instances, contagiousness is negligible after 10 days, but this period may be more prolonged, e.g. two weeks or more, in those with an impaired immune system,” Charles Bailey, MD, medical director of infection prevention at St. Joseph Hospital and Mission Hospital in Orange County, California, tells Health. “If feasible, prolonging isolation for such people should be considered, perhaps to two or even three weeks, and they should be encouraged to wear a mask when they do venture out in public.” (As should everyone who goes outside and isn't able to socially distance.)

If you do come down with COVID-19, the best way to determine whether you’re still contagious is to get tested, but that’s not an option for everyone. “Currently, there is limited repeat testing ability due to supply shortages, so we rely on symptom-based resolution,” Jorge Vournas, MD, medical director of the Emergency Department at Providence Little Company of Mary Medical Center in Torrance, California, tells Health. 

Your doctor will be able to advise you based on your overall health and the severity of your illness, but the CDC recommendation is to wait at least 10 days from the onset of symptoms and three days free without fever, provided your symptoms are improving. 

And venturing out into the world again doesn’t mean throwing caution to the wind—far from it. Dr. Vournas advises being “extra cautious for several weeks.”  

“Practice physical distancing, wear a mask, and wash hands regularly—these are the best practices at the moment,” he says. “There is no good reason to not be too careful. In addition to the common recommendations, be careful with who you interact with, especially high-risk elderly and those with comorbid conditions,” aka, health complications or impaired immunity.  

The information in this story is accurate as of press time. However, as the situation surrounding COVID-19 continues to evolve, it's possible that some data have changed since publication. While Health is trying to keep our stories as up-to-date as possible, we also encourage readers to stay informed on news and recommendations for their own communities by using the CDC, WHO, and their local public health department as resources.

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Biomarker reveals how aggressive biliary tract cancer is in patients

The cancer called biliary tract cancer (BTC) is not the most widespread form of cancer. In western countries, about 1.6 in 100.000 gets the diagnose every year. It is, however, a very aggressive form of cancer.

The majority of patients with BTC are diagnosed with advanced disease and has an average survival of only 1 year from initiation of chemotherapy. With such narrow survival windows, it is crucial to improve our understanding of the disease.

Now, researchers from Biotech Research & Innovation Centre at the University of Copenhagen and Herlev and Gentofte Hospital along with collaborators from Rigshospitalet and Sygehus Lillebaelt have identified a biomarker that can tell doctors how aggressive a patient’s disease may be.

“We have found a biomarker that reliably predicts how aggressive a patients disease will evolve, which in the future could help doctors in the hospitals make the right decisions about chemotherapy for the benefit of each BTC patient,” says Jesper Andersen, Associate Professor at BRIC.

Biomarkers can used for more than the diagnosis

The researchers measured the levels of two inflammatory proteins and a biomarker commonly used in pancreatic cancer before and during chemotherapy in patients with advanced BTC and found that patients with higher levels of these markers before chemotherapy had a lower survival rate. Especially one protein called IL6 (interleukin-6) proved to be superior to the other markers in predicting those patients at greatest risk of death.

“A common misperception may be that biomarkers are mainly needed to diagnose a specific cancer type, but diverse biomarkers are also needed to guide clinical decision-making throughout each patients’ individual journey. These types of prognostic and predictive biomarkers deserve increased attention, in particular as they are playing important roles in the increasingly individualized management of more common cancer types”, says Jesper Andersen.

There are several markers to predict patients at greatest risk of death, however it was confirmed that the prognostic information provided by measuring IL-6 is not captured by other inflammatory markers already in routine clinical use. For instance, about 10 percent of the population does not express the marker that is normally measured (CA19-9) to predict the patient clinical outcome. Therefore, the course of disease cannot be predicted for these patients using CA19-9, for which IL-6 may be used instead.

Inhibiting IL-6 may improve response to chemotherapy

By inhibiting signaling of the protein IL-6 in a mouse model of human BTC, researchers discovered that the response of mouse tumors to chemotherapy significantly increased.

“Our data suggests that inhibiting IL-6 signaling may extend therapeutic benefit compared to chemotherapy alone. However, this will require careful evaluation in randomized clinical trial settings. Such a trial is currently ongoing at Herlev and Gentofte Hospital and results from this and potential future trials will contribute to our knowledge in regards to the potential of targeting the IL-6 pathway in patients with BTC”, says Jesper Andersen

Large sample size made possible through collaboration

Researchers studying BTC face a data-challenge since only 1.6 per 100,000 of Western populations are diagnosed with BTC annually. This makes it difficult to collect comprehensive amounts of patient data. Therefore, one of the key strengths of this study lies in the patient numbers attained and analyzed in this rare cancer demographic, amounting to 1590 serum samples from 452 patients with advanced BTC.

Furthermore, the study explores advanced BTC patients who represent the majority of patients at diagnosis, while the majority of previous BTC studies published to date have focused on early stage disease.

“It is imperative to increase representation of these patients with the worst prognosis in subsequent studies. These studies should also include longitudinal sampling throughout the patient’s clinical history, as we have done here”, says Jesper Andersen, group leader at BRIC.

The sample size achieved in this study was only made possible through the comprehensive collaboration between Herlev and Gentofte Hospital, Rigshospitalet and Sygehus Lillebaelt in Denmark.

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If sitting at a desk all day is bad during coronavirus, could I lie down to work instead?

Most of us have heard that too much sitting is bad for you. Studies show sitting increases the risk for cardiovascular disease and mortality, Type 2 diabetes and cancer.

With Americans more sedentary than ever, that’s particularly alarming. Even before COVID-19, many of us had managed to engineer physical activity out of our lives. But now, the pandemic has made things worse. Going outside less, missing the gym, working from home and countless hours on Zoom has meant, for most of us, even more sitting.

One question that occasionally comes up about this, perhaps from couch potatoes looking for a loophole, or maybe just those who prefer a more precise definition: Is reclining better? Instead of sitting upright (or slumped over) at a desk all day, is it somehow healthier to lie on the sofa, or relax in a hammock, or lean back in the easy chair? After all, your body is positioned differently. Does that distinction matter?

As an exercise physiologist, I can give you a short answer to that: No. (Sorry.) And instead of “sitting,” maybe we should use the term “sedentary behavior,” which is any waking behavior (note the word “waking”) that’s associated with low levels of energy expenditure. That includes sitting, reclining or lying down, according to the 2018 Physical Activity guidelines.

Move, move, move

Does physical activity help reduce, even eliminate, the negative impact of sedentary behavior? A 2016 study reviewed data from more than 1 million men and women. Those who sat a lot, and had little moderate or vigorous physical activity, had the highest risk of mortality from all causes. Those who sat only a little, and had high levels of moderate or vigorous physical activity, had the lowest risk.

What about someone in between? Someone who sits a lot but also engages in plenty of physical activity? The findings show mortality risk decreases as long as physical activity increases, regardless of sitting time. But the best way to go: high levels of activity, low levels of sedentary behavior.

How much activity do you need? The current estimate is 60 to 75 minutes a day of moderate activity, or 30 to 40 minutes of vigorous activity; do at least one of the two.

Physical activity: Good for everyone

Now let’s define physical activity: body movements that require energy expenditure, according to the World Health Organization. That covers plenty of ground: Any movement while working or playing counts, whether chores around the house or walks around the neighborhood. Your benefits from this activity begin immediately, and any amount helps. It doesn’t matter if you’re very young, very old or if you have chronic disabilities.

Notice I haven’t yet used the word “exercise”—until now. Exercise, obviously, is a type of physical activity, structured to improve flexibility, balance and speed, along with cardio and muscular fitness. It’s one of the best things you can do to improve your health and quality of life.

Benefits include a lower risk of mortality from all causes: heart disease, stroke, Type 2 diabetes, cancer, obesity, hypertension and osteoporosis. Your brain health will be better, perhaps enough to help ward off depression, anxiety, dementia and Alzheimer’s. And your sleep will improve.

Sleep on it

About sleep: The sedentary behavior referenced earlier does not include sleep. For optimal health, sleep is an absolute must.

Everyone is compromised by sleep deficiency, sometimes known as short sleep, or fewer than six hours per day. Difficulties with behavior, emotional control, decision-making and problem-solving are just some of the effects in people of all ages.

Poor sleep can also affect the immune system in people of all ages, leading to vulnerability to infections. It can be a factor in suicide, depression and high-risk behavior. And poor sleep also promotes obesity; essentially, a deficiency increases your “hunger hormone” (ghrelin) and decreases the “satiety hormone” (leptin). This makes you more likely to overeat.

In adults, sleep deficiency is associated with an increased risk of heart disease, high blood pressure, stroke and kidney disease. Adults need seven to eight hours per day.

Kids also suffer when they do not get enough sleep. Lack of sleep slows the release of growth hormone. Teens need 8-10 hours of sleep, and children age 6-12 need 9-12 hours.

Physical activity and good sleep go hand in hand. Moderate to vigorous activity lets you fall asleep faster and get more deep sleep; it reduces daytime sleepiness and use of sleep medications.

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90 Day Fiance's Paul Claims Estranged Wife Karine Is Pregnant With 2nd Son

A bittersweet announcement. Paul Staehle claims his estranged wife, Karine Martins is pregnant with another baby boy, but he may “never” see the little one.

90 Day Fiance’s Paul and Karine’s Ups and Downs Through the Years

“For everyone thinking I am chasing Karine in Brazil, Karine is in Indiana USA,” the 90 Day Fiancé alum, 37, wrote on his Monday, August 31, Instagram Story after sharing footage from Brazil. “Karine is not in Brazil. I knew that when I traveled here.”

The Kentucky native explained, “I came here alone to clean and organize our Brazil home. It needs to be sanitary and baby safe. I have been keeping busy since she left. I finished cleaning and organizing [our] USA house, so now I am doing the same thing in Brazil. All my work is on the Internet, so as long as I have Internet I can be anywhere. Even court is on the Internet these days.”

Adorable! ’90 Day Fiance’ Babies: Pics

Staehle was hit with a restraining order last month after an altercation at the couple’s home that saw Martins flee with their 17-month-old child, Pierre. “I have not seen my son since July. Next court date is now in December,” Staehle wrote.

The TLC personality then revealed the sex of their baby-to-be, writing, “I will not see my sons for a very long time. I have to cope the fact I probably will never see my wife and son again. Or see the birth or ever see my unborn child. … I have lost my sons. That being said, I think I am mentally doing what is best staying constructive and busy.”

He and Martins tied the knot in November 2017 and welcomed Pierre two years later. In July, Staehle alleged via Instagram that the pregnant star was missing with their son after filing “a full restraining order” against him.

Martins subsequently released a statement saying she wasn’t missing and wrote, “Relationships are hard and sometimes it just can’t be fixed anymore. I need this time to organize my thoughts, work on myself and care for my son after everything we have been through in the last year and a half.”

Laguna Beach’s Talan Torriero, More Celeb Parents’ Cutest Gender Reveals

In August, a judge ordered Martins to not communicate or come within 500 feet of Staehle after he claimed that she “assaulted” him and endangered their toddler.

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Why is wildfire smoke so bad for your lungs?

If I dare to give the coronavirus credit for anything, I would say it has made people more conscious of the air they breathe.

A friend texted me this week after going for a jog in the foothills near Boise, Idaho, writing: “My lungs are burning … explain what’s happening!!!”

A wildfire was burning to the east of town — one of dozens of fires that were sending smoke and ash through communities in hot, dry western states. As an environmental toxicologist, I research how air pollution, particularly wood smoke, impacts human health and disease.

I gave my friend the short answer: The state had issued a yellow, or moderate, air quality index warning due in part to wildfires. The high temperature for the day was expected to reach 100 degrees Fahrenheit, and it was already approaching 90. That combination of high temperatures and elevated levels of particles from a fire can affect even healthy lungs. For someone with lung damage or respiratory illness, moderate levels of smoke particulate can exacerbate respiratory problems.

That’s only the start of the story of how wildfire smoke affects humans who breathe it. The rest, and how to stay healthy, is important to understand as the western wildfire season picks up.

What’s in wildfire smoke?

What exactly is in a wildfire’s smoke depends on a few key things: what’s burning — grass, brush or trees; the temperature — is it flaming or just smoldering; and the distance between the person breathing the smoke and the fire producing it.

The distance affects the ability of smoke to “age,” meaning to be acted upon by the sun and other chemicals in the air as it travels. Aging can make it more toxic. Importantly, large particles like what most people think of as ash do not typically travel that far from the fire, but small particles, or aerosols, can travel across continents.

Smoke from wildfires contains thousands of individual compounds, including carbon monoxide, volatile organic compounds (VOCs), carbon dioxide, hydrocarbons and nitrogen oxides. The most prevalent pollutant by mass is particulate matter less than 2.5 micrometers in diameter, roughly 50 times smaller than a grain of sand. Its prevalence is one reason health authorities issue air quality warnings using PM2.5 as the metric.

What does that smoke do to human bodies?

There is another reason PM2.5 is used to make health recommendations: It defines the cutoff for particles that can travel deep into the lungs and cause the most damage.

The human body is equipped with natural defense mechanisms against particles bigger than PM2.5. As I tell my students, if you have ever coughed up phlegm or blown your nose after being around a campfire and discovered black or brown mucus in the tissue, you have witnessed these mechanisms firsthand.

The really small particles bypass these defenses and disturb the air sacks where oxygen crosses over into the blood. Fortunately, we have specialized immune cells present in the air sacks called macrophages. It’s their job to seek out foreign material and remove or destroy it. However, studies have shown that repeated exposure to elevated levels of wood smoke can suppress macrophages, leading to increases in lung inflammation.

What does that mean for COVID-19 symptoms?

Dose, frequency and duration are important when it comes to smoke exposure. Short-term exposure can irritate the eyes and throat. Long-term exposure to wildfire smoke over days or weeks, or breathing in heavy smoke, can raise the risk of lung damage and may also contribute to cardiovascular problems. Considering that it is the macrophage’s job to remove foreign material — including smoke particles and pathogens — it is reasonable to make a connection between smoke exposure and risk of viral infection.

Recent evidence suggests that long-term exposure to PM2.5 may make the coronavirus more deadly. A nationwide study found that even a small increase in PM2.5 from one U.S. county to the next was associated with a large increase in the death rate from COVID-19.

What can you do to stay healthy?

The advice I gave my friend who had been running while smoke was in the air applies to just about anyone downwind from a wildfire.

Stay informed about air quality by identifying local resources for air quality alerts, information about active fires, and recommendations for better health practices.

If possible, avoid being outside or doing strenuous activity, like running or cycling, when there is an air quality warning for your area.

Be aware that not all face masks protect against smoke particles. In the context of COVID-19, the best data currently suggests that a cloth mask benefits public health, especially for those around the mask wearer, but also to some extent for the person wearing the mask. However, most cloth masks will not capture small wood smoke particles. That requires an N95 mask in conjunction with fit testing for the mask and training in how to wear it. Without a proper fit, N95s do not work as well.

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Establish a clean space. Some communities in western states have offered “clean spaces” programs that help people take refuge in buildings with clean air and air conditioning. However, during the pandemic, being in an enclosed space with others can create other health risks. At home, a person can create clean and cool spaces using a window air conditioner and a portable air purifier.

The EPA also advises people to avoid anything that contributes to indoor air pollutants. That includes vacuuming that can stir up pollutants, as well as burning candles, firing up gas stoves and smoking.

This article was originally published at The Conversation. The publication contributed the article to Live Science’s Expert Voices: Op-Ed & Insights.

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Study shows liver injury is common and prognostic in COVID-19 patients

Researchers from the Faculty of Medicine at The Chinese University of Hong Kong (CU Medicine) have recently conducted a study to investigate the impact of liver injury on clinical outcomes in COVID-19 patients. Data from over 1,000 COVID-19 patients in Hong Kong was analysed and liver injury was found in around 20% of the patients. The estimated risk of COVID-19 patients with liver injury experiencing adverse clinical outcomes such as intensive care unit (ICU) admission, use of invasive mechanical ventilation or death was almost eight times of other patients. It is suggested that liver function monitoring is important regarding its association with adverse clinical outcomes in COVID-19 patients. These findings have been published recently in the world-renowned medical journal Gut. In view of the high prevalence of various chronic liver diseases in the Asia-Pacific region, CU Medicine’s researchers led a group of experts from Mainland China, Japan, Singapore and Australia to issue a position statement on the management of COVID-19 patients with liver derangement. The statement has been published recently in another international medical journal The Lancet Gastroenterology & Hepatology.

About 20% of COVID-19 patients in Hong Kong were found to have liver injury

Liver injury, in the form of hepatitis, cholestasis or both, can be observed in patients infected by different coronaviruses. For the territory-wide study in Gut, researchers from CU Medicine analysed the data from 1,040 COVID-19 patients in Hong Kong. It was found that the level of liver enzyme alanine aminotransferase (ALT) or aspartate aminotransferase (AST) was elevated in 23% of the COVID-19 patients, which indicated liver damage.

An association between liver injury and the chance of adverse clinical outcomes was also identified. Overall, 53 (5.1%) were admitted to ICU, 22 (2.1%) received invasive mechanical ventilation, and 4 (0.4%) died. Among them, 71% had liver injury. The analysis indicated that the estimated risk of patients with liver injury having adverse clinical outcomes is eight times of others.

First author of the study, Dr. Terry Cheuk Fung YIP, post-doctoral fellow of the Department of Medicine and Therapeutics at CU Medicine, explained, “Our study shows that liver injury was common in COVID-19 patients. Although the exact impact of the novel virus on the liver has not been well elucidated so far, our findings proved that the chance of patients with liver injury having adverse clinical outcomes is obviously higher than that of others. This shows that liver injury is prognostically significant in COVID-19 patients.”

Professor Grace Lai Hung WONG, Professor, Division of Gastroenterology and Hepatology, Department of Medicine and Therapeutics at CU Medicine, added, “Liver injury is possibly caused by systemic inflammation and adverse drug reactions in severe COVID-19 patients who have been receiving different medical treatments. As the degree of liver injury could be impacted by coexisting chronic hepatitis in patients, a thorough review of medical history and detailed investigation for concomitant liver diseases are crucial to improve patient outcomes.”

Furthermore, cautious use of appropriate medications with least hepatotoxicity as well as vigilant monitoring of liver biochemistries are recommended in order to minimise liver injury in COVID-19 patients.

As the pandemic continues and CU Medicine’s study has proved that the risk of adverse clinical outcomes in COVID-19 patients is closely related to liver health, it would be clinically helpful to provide practice recommendations for various common clinical scenarios of liver derangement, especially in the Asia-Pacific region where the prevalence of liver diseases is the highest worldwide. According to the World Health Organization, liver diseases caused 4.6% of deaths in the Asia-Pacific region in 2015, compared with 2.7% in the U.S. and 2.1% in Europe.

In response to this utmost need, the Asia-Pacific Working Group for Liver Derangement, led by the hepatologists from CU Medicine, published an Asia-Pacific position statement in June this year on the management of COVID-19 patients who have been or are at risk of developing liver derangement. Clinical scenarios covered in the statement included the precautions for the use of pharmacological treatment for COVID-19 in patients with liver derangement, for example liver test should be conducted twice weekly in patients on potentially hepatotoxic medication, those with pre-existent liver disease, and more frequently in any patients with abnormal liver function.

The statement also proposed the assessment and management of patients with hepatitis B or hepatitis, non-alcoholic fatty liver disease, liver cirrhosis, and liver transplantation during the pandemic.

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How beneficial is a family meal?

The family meal has long been associated with numerous health and wellbeing benefits for both adults and children, but researchers from Flinders University’s Caring Futures Institute are questioning where the hard evidence is to support this emotive belief.

With changing pressures influencing a modern family’s time commitments, lead researcher Georgia Middleton is examining whether the longstanding ideal of the family meal is still a viable option for many time-poor families, and whether trying to pursue the traditional model of the family meal ideal is introducing unnecessary increased pressures to families.

She found a lack of conclusive evidence about the benefits family meals have on health, through examining existing family meal research, but has identified a need to shape a clearer model of ideal family eating habits through further research.

The resulting study—”What can families gain from the family meal? A mixed-papers systematic review”, by Georgia Middleton, Rebecca Golley, Karen Patterson, Fairley Le Moa and John Coveney—has been published by Appetite.

“Our aim is to find what is the most beneficial meal model, in ways that maximise nutrition and health, enjoyment and engagement, adaptability and efficiency,” says Ms Middleton, a Ph.D. candidate at Flinders University’s College of Nursing and Health Sciences. “At the moment, there are many people trying to chase the ideal of the family meal model that might be introducing yet more pressures to family life.”

As a consequence of identifying gaps in assessment of family meal benefits, Ms Middleton is now calling for participants in new research that will provide detailed snapshots of how families eat in diverse Adelaide suburbs—initially targeting the areas surrounding Ferryden Park in the west, and Burnside in the east.

Participants in the new study will be reimbursed for their time with an $80 gift voucher and the chance to win one of six Sprout Cooking School ‘Quick. Easy. Healthy’ cookbooks. Details can be found on the study website: https://www.facebook.com/thefamilymealstudy

“We are currently looking for families, with at least one child aged 12 years or under living at home, to participate in a virtual interview to discuss their current experiences with the family meal, and the work involved in bringing the family together for the family meal today,” explains Ms Middleton.

While their systematic review found a lack of causational evidence that family meals are beneficial to health, this does not mean family meals are not beneficial for health, or that families should stop engaging in them.

“More work is needed in this area to better understand the relationship between family members and meals, especially if we are to continue promoting the family meal as a health and wellbeing strategy for families,” she says.

Looking at research conducted in the past 10 years, Ms Middleton found that existing studies into family meals do not clearly determine whether changes in health outcomes are due to changes in the family meal, or changes to other behaviours.

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