Lifelong discrimination linked to high blood pressure in black people

AHA news: lifelong discrimination linked to high blood pressure in black people

Enduring a lifetime of discrimination may increase the risk of high blood pressure in Black people but not in Hispanic, Chinese or white people, a new study suggests.

Previous research has linked lifelong discrimination to the development of high blood pressure, also known as hypertension, in Black people. This new study, however, is among the first to look at multiple types of discrimination in a large multi-ethnic group over a period of time.

The study included 3,297 Black, Hispanic, Chinese and white adults from 45 to 84 years old. They did not have high blood pressure at the start of the study. Participants were asked to report experiences of lifetime and everyday discrimination.

Lifetime discrimination measures included six items, such as being denied a promotion or having life made difficult by neighbors. Everyday discrimination, meanwhile, consisted of nine items, such as being treated with less respect than others or being harassed in day-to-day life.

After nearly two decades, almost half of participants developed high blood pressure. Black participants who reported lifetime discrimination had a 35% increased risk of hypertension, even after accounting for age, income, education, body mass index, physical activity and other factors. Everyday discrimination, however, did not appear to contribute to risk for hypertension.

“Discrimination impacts the health of Black Americans and it should be recognized as a major public health problem,” said Allana T. Forde, lead author of the study published last week in the Journal of the American Heart Association. In November, the American Heart Association issued a “call to action” advisory acknowledging structural racism as “a fundamental cause of poor health and disparities in cardiovascular disease.”

“Health professionals should look beyond traditional risk factors, such as diet and physical activity, and acknowledge discrimination as another risk factor,” said Forde, a researcher at the National Institutes of Health’s National Institute on Minority Health and Health Disparities.

Surprising for researchers, she said, was that lifetime discrimination did not reach the level of statistical significance for contributing to high blood pressure among Chinese and Hispanic participants, even after accounting for being born outside the United States.

Studies in other areas of the U.S. are needed to confirm the findings, researchers said, because the new study was limited to those living in five large cities and one county. In addition, the study only assessed discrimination experiences once at the start of the study, making it unclear what impact changes in discrimination exposure might have had on hypertension development during the follow-up period.

“There is always a concern that not enough subjects were included in the study to show differences in populations or that not all relevant variables were accounted for,” said Dr. Willie Lawrence, chief of cardiology at the Research Medical Center in Kansas City, Missouri. He was not involved in the study.

When measuring decades of discrimination that leads to hypertension, other social determinants of health also must be accounted for. These include health care access, transportation options and a person’s neighborhood.

“Whether communities have sidewalks and green spaces impacts health,” Lawrence said. “If we want to make people healthier, we have to not only eliminate disparities in health care delivery, but we must also seek equity in housing, neighborhoods and education.”

Overall, the study found Black people reported the highest levels of discrimination. About 65% reported lifetime discrimination compared to 42% of Hispanic people, 40% of white people and 23% of Chinese people. Black people most often attributed the unfair treatment to race, whereas white people by far attributed it to non-racial factors such as age, sex or religion. Hispanic and Chinese people were about evenly split between feeling the discrimination was motivated by race versus other factors.

For everyday discrimination, 52% of Black people, 32% of white people, 26% of Hispanic people and 20% of Chinese people reported high levels of exposure.

“Race is complicated in America. It is not genetic,” Lawrence said. “So, I’m not ready to believe that when people of other colors are treated the way Black Americans have been treated for decades that they won’t have higher rates of high blood pressure.”

Even so, he said, “it’s an important study that adds to our belief that social factors impact health.”

Certain, however, is that Black people have higher rates of high blood pressure than other racial and ethnic groups. According to AHA statistics, about 58% of Black adults in the U.S. have the condition, which increases the risk for heart attack and stroke.

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Researchers find delirium in hospitalized patients linked to mortality, disability

Researchers find delirium in hospitalized patients linked to mortality, disability

Delirium, a form of acute brain dysfunction, is widespread in critically ill patients in lower resourced hospitals, and the duration of delirium predicted both mortality and disability at six months after discharge, according to a study published in PLOS ONE.

Working with partners in Zambia, Vanderbilt University Medical Center researchers evaluated 711 hospitalized critically ill patients; delirium occurred in 48.5%. The findings shed light on the impact of delirium on a patient’s recovery—and even whether a patient is likely to live or die.

There have been limited data on the prevalence and outcomes of delirium in low- and middle-income countries, despite there being high numbers of critically ill patients. The mitigation of delirium and post-acute support of patients with delirium is a growing public health concern in the U.S. and Europe as the number of patients in intensive care units surged with the rise of COVID-19 cases.

“There is a driving unmet need to understand what happens with people’s brains in critical illness in low- and middle- income countries as well as with HIV in all settings. The necessity is now urgent because of the COVID-19 pandemic. Delirium has become the epidemic within the pandemic—and it’s the strongest predictor of long-term acquired cognitive impairment after critical illness. These are bread and butter issues people care about: will I live or die and if I live, what will I be like as a person,” said Wesley Ely, MD, MPH, co-director of the Critical Illness, Brain Dysfunction, and Survivorship Center at VUMC and senior author.

Patients with delirium had a higher six-month mortality, 44.6%, than patients without delirium who had a 20.0% six-month mortality. Compared to no delirium, presence of 1, 2 or 3 days of delirium predicted higher odds of six-month mortality of 1.43, 2.20, and 3.92, respectively. A similar relationship was found between duration of delirium and odds of worse six-month disability, assessed using the WHO Disability Assessment Schedule.

The study adjusted for age, sex, education, income, Universal Vital Assessment (UVA) severity of illness score, HIV status, and current antituberculosis treatment in adult patients who spoke English, Nyanja, or Bemba at the University Teaching Hospital, a 1,655-bed national referral hospital in Lusaka with about 17,500 acute admissions annually.

The prevalence of HIV in the study cohort was 45.4% while 27.2% of participants had a history of tuberculosis, suggesting delirium is an important clinical issue impacting the lives of hospitalized patients with HIV and tuberculosis in Sub-Saharan Africa. The high mortality and disability associated with delirium in this medically and socioeconomically vulnerable patient population spotlights an urgent global health issue.

“Acute brain dysfunction can have a variety of drivers, yet we know that delirium can itself lead to poor outcomes. In other parts of the world delirium is recognized as a major public health concern, while in lower resourced communities the magnitude of the problem has been obscured by acutely pressing issues such as HIV, malaria, and tuberculosis. Our research suggests it’s widespread and may present an opportunity to improve the lives of critically ill patients in low- and middle-income countries in the future as well as advocate for global critical care equity during the COVID-19 pandemic,” said Justin Banerdt, MD, MPH, internal medicine resident at Yale School of Medicine, and corresponding author who led the study on the ground in Zambia while a MD/MPH student at Vanderbilt University School of Medicine.

The next step is to see which interventions are effective in resource limited hospitals, said Douglas Heimburger, MD, MS, professor of Medicine and core faculty at the Vanderbilt Institute for Global Health. He leads projects with grant funding from the Fogarty International Center of the National Institutes of Health (NIH).

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Acute itching in eczema patients linked to environmental allergens

Acute itching in eczema patients linked to environmental allergens

In addition to a skin rash, many eczema sufferers also experience chronic itching, but sometimes that itching can become torturous. Worse, antihistamines—the standard treatment for itching and allergy—often don’t help.

New research from Washington University School of Medicine in St. Louis indicates that allergens in the environment often are to blame for episodes of acute itch in eczema patients, and that the itching often doesn’t respond to antihistamines because the itch signals are being carried to the brain along a previously unrecognized pathway that current drugs don’t target.

The new findings, published Jan. 14 in the journal Cell, point to a possible new target and strategy to help eczema patients cope with those episodes of acute, severe itch.

“Years ago, we used to think that itch and pain were carried along the same subway lines in the nerves to the brain, but it turned out they weren’t, and these new findings show there’s another pathway entirely that’s causing these episodes of acute itching in eczema patients,” said principal investigator Brian S. Kim, MD, a dermatologist and an associate professor of medicine. “The itch can be maddening. Patients may rate their chronic itch at around a 5 on a scale of 10, but that goes up to 10 during acute itch flares. Now that we know those acute flares are being transmitted in an entirely different way, we can target that pathway, and maybe we can help those patients.”

The typical pathway for itching in eczema patients involves cells in the skin that are activated and then release histamine, which can be inhibited with antihistamine drugs. But with this acute itching, a different type of cell in the bloodstream transmits itch signals to the nerves. Those cells produce too much of another non-histamine substance that triggers itch; therefore, antihistamines don’t work in response to such signals.

“We’ve connected acute itching in eczema to allergic reactions transmitted by an entirely different population of cells,” said Kim, also the co-director of the Center for the Study of Itch & Sensory Disorders. “In patients who experience episodes of acute itching, their bodies react in the same way as in people with acute allergy. If we can block this pathway with drugs, it might represent a strategy for treating not only itch but other problems, including perhaps hay fever and asthma.”

In recent years, several clinical studies have tested a strategy that involves blocking Immunoglobulin E (IgE), a substance produced by the immune system in response to allergens. Patients with allergies produce IgE, causing allergic reactions, but its role in itch has been unclear.

Reviewing data from clinical studies of drugs aimed at treating chronic itching, Kim found a pattern in which patients reported episodes of acute itching, often after exposure to environmental allergens. He also found that eczema patients who make IgE in response to allergens in the environment were more likely to experience those episodes of severe, acute itch.

“Environmental allergens actually promote this type of itch,” he explained. “Say a patient with eczema goes to Grandma’s house, where there’s a cat, and that person’s itching just goes crazy. It’s likely cat dander is activating IgE, and IgE is activating itch.”

Kim’s team took these observations to the laboratory, where his team made a mouse model of eczema. Studying the animals, they found that when the mice made IgE, they began to itch. But unlike standard itch signals, in which cells in the skin called mast cells release histamine, the IgE in mice with eczema activated a type of white blood cell called a basophil. Those cells then activated an entirely different set of nerve cells than the cells that carry itch signals that respond to antihistamines.

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Preemie-born parents linked to children with autism

premature

In a study of medical registry records of nearly 400,000 parent-child pairs from Denmark, a Yale School of Public Health study found that parents who were themselves born very prematurely were nearly twice as likely to have children with autism spectrum disorder.

The study, recently published in the International Journal of Epidemiology, provides solid evidence that autism spectrum disorder risk factors can span multiple generations—a new hypothesis that previously lacked much empirical evidence in humans. According to senior author Zeyan Liew, assistant professor in the Department of Environmental Health Sciences, these findings can help spark further research into the underlying mechanisms of autism risk transmission in families.

“It’s already well established that preterm birth and low birth weight of the child are risk factors for autism,” he said. “But this is the first study to show that parental preterm birth and low birth weight might carry some risk for their future offspring as well.”

For their research, Liew and his team evaluated data collected from families across Denmark from 1978 to 2017 as part of its central medical records database. Researchers linked birth records of the parents to the medical records in their offspring to investigate whether there is a link between neonatal characteristics of the parents and autism spectrum disorder risk in their children. Their results suggest that women and men who were born at less than 37 weeks or low birth weight were more likely to have children diagnosed with autism spectrum disorder than those without adverse birth characteristics. The study authors reported that some other possible multigenerational risk factors they analyzed, such as grandparents’ education, place of residence, and their age at the time of pregnancy, only contributed minimally to the observed associations.

It remains unclear how exactly autism spectrum disorder risks travel across generations, but Liew said he has some hypotheses. For one, there has been growing evidence showing that changes in gene activity in response to environmental stimuli could be inherited across generations without changing the underlying DNA sequences—a phenomenon known as epigenetic inheritance. “These adverse characteristics at birth may act as a proxy measure of possible heritable epigenetic modifications as a result of harmful prenatal exposures affecting early life growth, which could help explain the multigenerational transmission of disease risk we observed,” Liew said.

Parents who were born with unfavorable characteristics may also be more likely to encounter challenges in the physical, mental, reproductive, or social domains of health in childhood and adulthood. Liew and his group evaluated these factors and found that educational achievement and mental health status of the parents before pregnancy played a small mediating role in the observed associations.

Genetics and other environmental or household factors shared across generations could play a part as well, but the researchers did not have that information for their sample in this study.

Liew and his team plan to do more research in this area to see if the same conclusions hold in other parts of the world and in other populations, with additional considerations of potential methodological challenges of conducting multigenerational studies like this.

“From previous studies, a lot of the findings that we’ve seen in Denmark hold up in other countries as well,” he said. “We think that this is not specific to Denmark, but we need more evidence from other places.”

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Increased exercise in midlife linked with better brain health in later life

exercise older

Scientists in the US have found that the more physical activity people do in midlife the better their brain health in later life. The scientific publication, Neurology, has reported the results today.

The researchers looked at 1,604 volunteers taking part in an existing study, to see if there was a link between activity levels and brain health in later life.

The volunteers reported how much exercise they did at the start of the study and again 25 years later. The research team categorized the amount of exercise the volunteers did at both times points as none, low, middle or high.

The researchers carried out MRI brain scans in volunteers later in life to look for signs of poorer brain health including the presence of a type of brain damage known as cerebrovascular lesions and brain shrinkage.

Scientists linked high levels of mid-life physical activity, over 150 minutes per week with better brain health in later life. This included fewer cerebrovascular lesions in late life.

Dr. Sara Imarisio, head of research at Alzheimer’s Research UK, said, “This research adds to a growing body of evidence suggesting exercise as an important way we can look after our brain health. Although the people in the study self-reported their own level of exercise, which could make it less accurate, high levels of mid-life physical activity were linked with fewer signs of brain damage. The observation that those who exercised more had less damage to the small blood vessels that spread through the brain suggest that physical activity may impact brain health largely through effects on the blood supply.

“As the UK’s leading dementia research charity, Alzheimer’s Research UK is now funding work to see how feasible it is for people in midlife to take up exercise as part of a healthier lifestyle, with a view to larger trials that assess the effect on brain health.

“Just a third of people think it’s possible to reduce their risk of developing dementia, compared to 77% who believe they can reduce their risk of heart disease. While there is no sure-fire risk way to prevent dementia, our brains don’t operate in isolation from the rest of our bodies and a good rule of thumb for everyone is that what is good for your heart is also good for your brain.

“The best current evidence suggests that as well as staying physically and mentally active, eating a healthy balanced diet, not smoking, drinking only within the recommended limits and keeping weight, cholesterol and blood pressure in check are all good ways to support a healthy brain as we age.”

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Hyperglycemia, Hypoglycemia Linked to Poor Outcomes in COVID-19

WEDNESDAY, Dec. 16, 2020 — For patients with COVID-19, hyperglycemia and hypoglycemia are associated with poor outcomes, according to a study published online Dec. 15 in Diabetes Care.

David C. Klonoff, M.D., from the Mills-Peninsula Medical Center in San Mateo, California, and colleagues analyzed pooled data from the Glytec national database for 1,544 patients with COVID-19 from 91 hospitals in 12 states. Patients were stratified according to achieved mean glucose category during days 2 to 3 in non-intensive care unit (ICU) patients or on day 2 in ICU patients. The authors examined the association between glucose category and hospital mortality.

The researchers found that 18.1 percent of patients died in the hospital. Among non-ICU patients, compared with blood glucose <7.77 mmol/L, severe hyperglycemia (>13.88 mmol/L) on days 2 to 3 was independently associated with high mortality (adjusted hazard ratio, 7.17). This association was not significant for admission glucose. In patients admitted directly to the ICU, increased mortality was seen in association with severe hyperglycemia on admission (adjusted hazard ratio, 3.14). This association was not significant on day 2. There was also an association seen for hypoglycemia and increased mortality (odds ratio, 2.2).

“We found that severe hyperglycemia early in the course of hospitalization in patients with COVID-19 admitted to a non-ICU setting was associated with a sevenfold increase in mortality risk,” the authors write. “Our results suggest patients with COVID-19 should promptly receive treatment to improve glycemic control.”

Several authors disclosed financial ties to Glytec.

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Depression Linked to Suicidal Ideation Among Physicians

MONDAY, Dec. 14, 2020 — Depression, but not physician burnout, is associated with suicidal ideation among physicians, while burnout is associated with increased self-reported medical errors, according to a study published online Dec. 9 in JAMA Network Open.

Nikitha K. Menon, from the Stanford University School of Medicine in California, and colleagues examined the correlation between burnout and suicidal ideation after adjustment for depression in a cross-sectional study. Attending and postgraduate trainee physicians were invited to complete an online survey; data were included for 1,354 respondents.

The researchers found that the odds of suicidal ideation were increased significantly with each standard deviation (SD) unit increase in burnout (odds ratio, 1.85; 95 percent confidence interval, 1.47 to 2.31). The correlation did not persist after adjustment for depression (odds ratio, 0.85; 95 percent confidence interval, 0.63 to 1.17). Each SD-unit increase in depression was associated with significantly increased odds of suicidal ideation in the adjusted model (odds ratio, 3.02; 95 percent confidence interval, 2.30 to 3.95). Each SD-unit increase in burnout was associated with an increase in self-reported medical errors in the adjusted model (odds ratio, 1.48; 95 percent confidence interval, 1.28 to 1.71), while there was no correlation seen for depression with self-reported medical errors (odds ratio, 1.01; 95 percent confidence interval, 0.88 to 1.16).

“The findings of this study suggest that burnout without depression does not increase suicide risk and can therefore be safely addressed outside of mental health care,” the authors write.

One author was coinventor of the instruments used in this study, and received a portion of royalties paid for their use.

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Peripheral neuropathy linked to mortality in U.S. population

(HealthDay)—Peripheral neuropathy (PN) is associated with mortality, even among individuals without diabetes, according to a study published online Dec. 8 in the Annals of Internal Medicine.

Caitlin W. Hicks, M.D., from the Johns Hopkins University School of Medicine in Baltimore, and colleagues examined the associations between PN and all-cause and cardiovascular mortality in a prospective cohort study involving 7,116 U.S. adults aged 40 years and older with standardized monofilament testing for PN.

The researchers found that the overall prevalence of PN was 13.5 ± 0.5 percent; prevalence was 27.0 ± 1.4 and 11.6 ± 0.5 percent in adults with and without diabetes, respectively. Overall, 2,128 adults died during a median follow-up of 13 years, including 488 who died of cardiovascular causes. Per 1,000 person-years, the incidence rates of all-cause mortality were 57.6, 34.3, 27.1, and 13.0 in adults with diabetes and PN, adults with PN but no diabetes, adults with diabetes but no PN, and adults with no diabetes and no PN, respectively. In adjusted models, in participants with diabetes, PN was significantly associated with all-cause mortality and cardiovascular mortality (hazard ratios [95 percent confidence intervals], 1.49 [1.15 to 1.94] and 1.66 [1.07 to 2.57], respectively). PN was significantly associated with all-cause mortality in those without diabetes (hazard ratio, 1.31; 95 percent confidence interval, 1.15 to 1.50); after adjustment, the association between PN and cardiovascular mortality was no longer statistically significant (hazard ratio, 1.27; 95 percent confidence interval, 0.98 to 1.66).

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Early birth linked to greater risk of hospital visits during childhood

Being born early (before 37 weeks’ gestation) is associated with a higher risk of hospital admission throughout childhood than being born at full term (40 weeks’ gestation), finds a study published by The BMJ today.

Although the risk declined as the children grew up, particularly after age 2, an excess risk remained up to age 10, even for children born at 38 and 39 weeks’ gestation, representing many potentially vulnerable children, say the researchers.

Preterm birth is a major contributor to childhood ill health. Existing evidence suggests that the risk of illness associated with preterm birth declines as children grow up, but it remains unclear at what age this begins to happen and how these changes vary by week of gestational age at birth.

To explore this further, a team of UK researchers set out to examine the association between gestational age at birth and hospital admissions to age 10 years and how admission rates change throughout childhood.

Their findings are based on data from more than 1 million children born in NHS hospitals in England between 1 January 2005 and 31 December 2006. Children were monitored from birth until 31 March 2015 (an average of 9.2 years per child), during which time the researchers analysed numbers of hospital admissions.

Gestational age at birth was analysed in weeks, from less than 28 up to 42 weeks.

Over 1.3 million hospital admissions occurred during the study period, of which 831,729 (63%) were emergency admissions. Just over half (525,039) of children were admitted to hospital at least once during the study period.

After taking account of other potentially influential risk factors, such as mother’s age, marital status and level of social deprivation, and child’s sex, ethnicity and month of birth, the researchers found that hospital admissions during childhood were strongly associated with gestational age at birth.

The hospital admission rate during infancy in babies born at 40 weeks was 28 per 100 person years—this figure was about six times higher in babies born extremely prematurely (less than 28 weeks). By the time the children were aged 7-10 years, the hospital admission rate in children born at 40 weeks was 7 per 100 person years—this figure was about three times higher in those born at less than 28 weeks.

But even children born a few weeks early had higher admission rates. Being born at 37, 38, and 39 weeks’ gestation was associated with a difference in the rate of admission of 19, 9, and 3 admissions per 100 person years during infancy, respectively, compared with those born at 40 weeks.

The risk of hospital admission associated with gestational age decreased over time, particularly after age 2. However, an excess risk remained up to age 10, even for children born at 38 and 39 weeks’ gestation.

Although this excess risk at 38 and 39 weeks was relatively small, the large number of babies born globally at these gestational ages suggests that they are likely to have a large impact on hospital services, say the researchers.

Infections were the main cause of excess hospital admissions at all ages, but particularly during infancy. Respiratory and gastrointestinal conditions also accounted for a large proportion of admissions during the first two years of life.

This is an observational study, so can’t establish cause, and the researchers point to some limitations, such as being unable to take account of several factors that can impact child health like maternal smoking and breastfeeding.

However, they say this was a large study using routinely collected data over a 10 year period, and the findings remained relatively stable after further analyses, suggesting that the results withstand scrutiny.

As such, the researchers say their findings indicate that gestational age at birth “is a strong predictor of childhood illness, with those born extremely preterm being at the greatest risk of hospital admission throughout childhood.”

And the finding that infections were the main cause of excess hospital admissions at all ages prompt the researchers to call for targeted strategies to help prevent and better manage childhood infections.

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COVID-19 anxiety linked to body image issues

A new study has found that anxiety and stress directly linked to COVID-19 could be causing a number of body image issues amongst women and men.

The research, led by Professor Viren Swami of Anglia Ruskin University (ARU) and published in the journal Personality and Individual Differences, involved 506 UK adults with an average age of 34.

Amongst women, the study found that feelings of anxiety and stress caused by COVID-19 were associated with a greater desire for thinness. It also found that anxiety was significantly associated with body dissatisfaction.

Amongst the male participants, the study found that COVID-19-related anxiety and stress was associated with greater desire for muscularity, with anxiety also associated with body fat dissatisfaction.

Negative body image is one of the main causes of eating disorders, such as anorexia and bulimia, and this new study adds to recent research indicating that fears around COVID-19, and the consequences of the restrictions introduced to help tackle it, could be contributing to a number of serious mental health issues.

Lead author Viren Swami, Professor of Social Psychology at Anglia Ruskin University (ARU), said: “In addition to the impact of the virus itself, our results suggest the pandemic could also be leading to a rise in body image issues. In some cases, these issues can have very serious repercussions, including triggering eating disorders.

“Certainly during the initial spring lockdown period, our screen time increased, meaning that we were more likely to be exposed to thin or athletic ideals through the media, while decreased physical activity may have heightened negative thoughts about weight or shape. At the same time, it is possible that the additional anxiety and stress caused by COVID-19 may have diminished the coping mechanisms we typically use to help manage negative thoughts

“Our study also found that when stressed or anxious, our pre-occupations tend to follow gender-typical lines. During lockdown, women may have felt under greater pressure to conform to traditionally feminine roles and norms, and messaging about self-improvement may have led to women feeling dissatisfied with their bodies and having a greater desire for thinness.

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