Because of the coronavirus epidemic, stroke survivors may not be receiving rehabilitation in time
Rehabilitation should be started within three months of a stroke
The pandemic has prompted professionals to deliver rehabilitation services in creative ways
Timely rehabilitation is crucial for stroke survivors, but some may not be receiving it due to the coronavirus pandemic, experts say.
Rehabilitation can help the 795 000 stroke survivors in the United States achieve the best possible recovery, according to the American Stroke Association (ASA).
That’s why it’s critical to begin rehabilitation within three months of a stroke, when the brain most quickly adapts to stroke damage and survivors are best able to learn new ways to do things.
“After a stroke, a person may need therapy to learn to walk or talk again, relearn skills needed to be independent, recover communications and cognition skills, and address other consequences of stroke,” said Dr Joel Stein, vice-chair of the ASA’s Guidelines for Adult Stroke Rehabilitation and Recovery.
Rehabilitation an important step
“Unfortunately, during the Covid-19 pandemic, some recent stroke patients may be going without rehab during this important ‘golden’ time and other survivors may also be forgoing helpful therapy,” he said in an association news release.
The pandemic has forced rehabilitation professionals to get creative to deliver services. Steps include video calls, teaming up with organisations providing in-home support, and the use of personal protective equipment for staff and patients at in-person visits.
“Rehabilitation is an important step in a stroke survivor’s recovery,” Stein said. “Knowing how important it is and how to best support someone who has recently had a stroke during the pandemic may be one of the most impactful things you can do as a caregiver.”
The association recommends that stroke survivors ask their doctor for an assessment of the physical and mental challenges they face and a plan to address each one. Patients should then work with their doctor on steps to manage risk factors to prevent another stroke. Those steps could include more physical activity, not smoking and managing blood pressure.
Stroke survivors should start rehabilitation as soon as they get the go-ahead from their medical team, the ASA said.
Damage to the lungs can lead to a puncture, causing lung collapse which is called a pneumothorax
This is happening in about 1% of hospitalised Covid-19 patients
Most younger patients with punctured lungs survive, but older patients are at greater risk
Punctured lungs occur in as many as one in 100 hospitalised Covid-19 patients, a new study finds.
Before the pandemic, this problem was typically seen in very tall young men or older patients with severe lung disease. But some British researchers noticed that several patients with Covid-19 developed the condition and decided to investigate.
“We started to see patients affected by a punctured lung, even among those who were not put on a ventilator,” said Stefan Marciniak, a professor at the University of Cambridge Institute of Medical Research.
“To see if this was a real association, I put a call out to respiratory colleagues across the UK via Twitter,” Marciniak said in a university news release. “The response was dramatic – this was clearly something that others in the field were seeing.”
Increased risk of death
The researchers noted that damage to the lungs can lead to a puncture. As air leaks out, it builds up in the space between the lung and chest, causing lung collapse. This is also called a pneumothorax.
For the study, Marciniak analysed data from 16 hospitals in Britain. He found that 0.91% of their Covid-19 patients had developed a punctured lung.
Of those patients with a punctured lung, 63% survived, but older patients had an increased risk of death. The survival rate among those younger than 70 was 71%, compared with 42% among those who were older, according to the study. The results are in the 9 September European Respiratory Journal.
Patients with abnormally acidic blood, called acidosis, also had poorer outcomes. Acidosis can result from poor lung function.
Diagnosis by chance
“Doctors need to be alert to the possibility of a punctured lung in patients with Covid-19, even in people who would not be thought to be typical at-risk patients,” Marciniak said.
“Many of the cases we reported were found incidentally – that is, their doctor had not suspected a punctured lung and the diagnosis was made by chance,” he noted.
The researchers said there are a number of ways that Covid-19 could lead to a punctured lung, including the formation of cysts in the lungs.
Plaque in the arteries of people with psoriasis increases the risk of coronary artery disease
Treatment with biologic therapy reduced coronary plaque by 6% to 8% after one year
This is as effective as statin therapy on heart arteries
Biologic therapy for the skin condition psoriasis may reduce patients’ risk of heart disease, new research suggests.
Chronic inflammation in people with psoriasis is associated with the development of plaque in heart arteries, which increases the risk of coronary artery disease. In biologic therapy, patients receive protein-based infusions to reduce inflammation.
“This is the first time an imaging study in humans has shown what one year of ongoing, untreated inflammation can do to arteries of the heart, and that we can reverse this damage,” said study senior author Dr Nehal Mehta. He’s chief of the inflammation and cardiometabolic diseases lab at the US National Heart, Lung, and Blood Institute.
Prone to rupture
“Untreated inflammation is dangerous. You are just waiting for a heart attack or stroke to happen,” Mehta added.
This study focused on a dangerous type of coronary plaque called lipid-rich necrotic core. It’s composed of dead cells and cell debris, and is prone to rupture. Ruptured plaque can lead to a heart attack or stroke.
The study included 209 patients, aged 37 to 62, with psoriasis. They were selected to receive biologic therapy (124 patients) or assigned to the control group and received topical creams and light therapy (85 patients).
After one year of treatment, CT scans showed that patients who received biologic therapy had an 8% decrease in coronary plaque, while those in the control group had a slight increase.
The findings held even after the researchers adjusted for cardiovascular risk factors and psoriasis severity. The study was published on 15 September in the journal Circulation: Cardiovascular Imaging.
Just as beneficial as statin therapy
“Having inflamed plaque that is prone to rupture increases the risk of heart attack fivefold within 10 years,” Mehta said in a journal news release.
Treatment with cholesterol-lowering statins reduces coronary plaque approximately 6% to 8%, Mehta noted. “Similarly, our treatment with biologic therapy reduced coronary plaque by the same amount after one year. These findings suggest that biologic therapy to treat psoriasis may be just as beneficial as statin therapy on heart arteries,” he added.
Along with psoriasis patients, the study findings could have implications for people with other chronic inflammatory conditions such as HIV, lupus and rheumatoid arthritis, who also have an increased risk of heart disease, according to the researchers.
“We have never before been able to show healing of an inflamed plaque like this in humans. Biologic therapy reduces systemic inflammation and immune activation, and it has a favourable impact on improving overall vascular health,” Mehta said.
The authors said a larger study is needed to confirm the results.
Whether we are male or female affects our physiology in profound ways
Disease biology may, therefore, remain obscured when males and females are considered as a single group
Differentiating between the sexes can thus lead to an improved, more personal medicinal approach
Researchers say your biological sex affects gene expression in nearly every type of tissue – influencing body fat, cancer and birth weight.
Gene expression is the amount of product created by a gene for cell function, the international team of researchers explained.
They said their findings could prove important for personalised medicine, creating new drugs and predicting patient outcomes.
“These discoveries suggest the importance of considering sex as a biological variable in human genetics and genomics studies,” said project leader Barbara Stranger, an associate professor of pharmacology at Northwestern University Feinberg School of Medicine in Chicago.
Unreported links
The researchers analysed 44 types of healthy human tissue from 838 people to find out if there were differences between women and men in the average amount of gene expression.
They discovered that 37% of all human genes were expressed at different levels in women and men in at least one type of tissue.
They also identified 369 instances where a genetic variant present in males and females affected gene expression to a different degree in each sex. This led to the discovery of 58 previously unreported links between genes and blood pressure, cholesterol levels, breast cancer and body fat percentage.
Gender differences in gene expression were also found for genes involved in how the body responds to medications, how women control blood sugar levels in pregnancy, how the immune system functions and how cancer develops.
Critical component of personalised medicine
“If specific genes or genetic variants contribute differentially to a given trait in males and females, it could suggest sex-specific biomarkers, therapeutics and drug dosing,” Stranger said in a Northwestern news release.
“In the future, such knowledge may form a critical component of personalised medicine or may reveal disease biology that remains obscured when considering males and females as a single group,” she said.
Signs of stress, depression or anxiety beyond the normal teenage angst may predict future heart problems in men
In a study, lower physical fitness was associated with poorer mental health
Fitness in youth, which is sustained into middle age is, therefore, likely to protect against heart disease
Middle-aged men who were anxious or depressed teens are at increased risk for heart attack, according to a large, long-term study.
It included more than 238 000 men born between 1952 and 1956 who underwent extensive exams when they were 18 or 19 years old and were followed to age 58.
Men diagnosed with anxiety or depression in their late teens had a 20% higher risk of heart attack than those who didn’t, the study showed.
‘Be vigilant’
The findings only reflect an association. The link was partly, but not fully, explained by poorer ability to cope with everyday stress and lower physical fitness in teens with the mental health conditions, according to findings presented at a virtual meeting of the European Society of Cardiology.
The takeaway: “Be vigilant and look for signs of stress, depression or anxiety that is beyond the normal teenage angst: Seek help if there seems to be a persistent problem,” suggested study author Cecilia Bergh, a senior lecturer in health sciences at Orebro University in Sweden.
“If a healthy lifestyle is encouraged as early as possible in childhood and adolescence it is more likely to persist into adulthood and improve long-term health,” she said in a meeting news release.
Bergh said researchers already knew that men who were physically fit but stressed as teens seemed less likely to maintain fitness.
Strategies to deal with stress
“Our previous research has also shown that low stress resilience is also coupled with a greater tendency towards addictive behaviour, signalled by higher risks of smoking, alcohol consumption and other drug use,” she noted.
Better fitness in youth is likely to protect against heart disease, particularly if people stay fit as they age, Bergh said, adding that exercise may also alleviate negative consequences of stress.
“This is relevant to all adolescents, but those with poorer well-being could benefit from additional support to encourage exercise and to develop strategies to deal with stress,” she said.
Research presented at meetings is typically considered preliminary until published in a peer-reviewed journal.
During the school year, schools provide learners with regular exercise
Currently, while at home, kids don’t get enough exercise, which can lead to overweight
Parents are advised to schedule physical activities for their children and provide them with a healthy diet
A lot of kids have been pushing up the scale numbers while home during the pandemic – and parents need to take steps to prevent the dreaded “quarantine 15”, an expert says.
“During the school year, most parents rely on schools to provide their child with regular exercise,” said Dr Joyce Samuel, an associate professor of paediatrics at McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth).
Get outside every day
“Because of the ongoing situation surrounding Covid-19, it is important for parents to focus on their child’s health and ensure they are getting the proper exercise and nutrition to avoid child obesity,” Samuel said in a centre news release.
If your children are learning remotely, she noted there are plenty of apps with videos for short, home-based workouts that usually require little or no equipment. Another option is to get outside for a daily 30-minute walk or jog.
“As long as you are maintaining physical distancing and staying with members of your household, this is a safe way to get some fresh air and regular exercise,” Samuel said.
Other exercise suggestions for children include: jumping rope or running to help strengthen bones; playing games like tug-of-war to strengthen muscles; aerobic activities like bike riding or walking to benefit the heart; outdoor sports; scooter riding; tag, and neighbourhood scavenger hunts.
Schedule activities for children several times a week, Samuel said.
Many kids are stressed
In terms of diet, provide children with meals that have both protein and produce. Frozen fruits and vegetables are a good, cheaper alternative to fresh produce, as long as there’s no added sugar, syrup or salt.
Limit unhealthy drinks and snacks like chips, cookies, candy and gummies. Encourage children to drink water instead of soda, juices or sports drinks.
“As parents, we need to understand that a healthy diet and exercise provide great benefits to our children’s minds and bodies,” Samuel said. “Many kids are stressed right now due to all of the uncertainty surrounding Covid-19, and doing regular exercise is a great way to relieve stress and develop healthy habits at a young age.”
Adequate sleep is also crucial in preventing obesity: eight to 10 hours a night for teens and nine to 12 hours a night for children ages six to 12. Reducing screen time can also help lower the risk of becoming overweight.
“Later bedtimes have been shown to be associated with obesity, so putting the devices away at a reasonable bedtime and getting back to a more typical sleep schedule is another way to combat obesity,” Samuel said.
Participants in a study clenched a pen between their teeth to replicate a smile
It was found that this ‘fake smile’ caused participants to view things in a more positive light
This has great implications for those suffering from mental health issues like anxiety and depression
Smiling can trick your mind into being more positive, according to a new study.
Researchers at the University of South Australia found that the simple act of moving your facial muscles into a smile can make you view the world more positively.
“When your muscles say you’re happy, you’re more likely to see the world around you in a positive way,” said lead researcher Fernando Marmolejo-Ramos, a human and artificial cognition expert at the university.
The motions of a smile
He and his colleagues studied how people interpret various images of facial and bodily expressions that range from happy to sad, based on whether or not they were smiling themselves.
The study involved 256 volunteers from Japan, Poland, Spain and Sweden. Participants were asked to hold a pen between their teeth, an act that forces facial muscles to replicate the motions of a smile.
They were then shown images of facial expressions that ranged from frowning to smiling, and videos of a person walking in different positions, ranging from “sad walking” to “happy walking”.
The participants viewed each image or video with and without a pen in their teeth, and then evaluated if the evoked emotion was “happy” or “sad”.
The researchers observed that the participants were more likely to view a broader range of the images and videos as “happy” when smiling themselves.
Interesting implications
“In our research, we found that when you forcefully practice smiling, it stimulates the amygdala – the emotional centre of the brain – which releases neurotransmitters to encourage an emotionally positive state,” Marmolejo-Ramos said in a university news release.
The results suggest that everyone, and particularly those suffering from mental health issues like anxiety and depression, may benefit from the simple act of smiling.
“For mental health, this has interesting implications. If we can trick the brain into perceiving stimuli as ‘happy,’ then we can potentially use this mechanism to help boost mental health,” Marmolejo-Ramos said. “A ‘fake it till you make it’ approach could have more credit than we expect.”
The study was published recently in the journal Experimental Psychology.
In their last hours, many people become unresponsive
However, EEG data indicated that their awareness of sounds was similar to healthy people
This suggests that they may still be aware of the presence of their loved ones, even though they seem unconscious
Even if they appear unresponsive, dying people may still be able to hear.
That’s the takeaway from a Canadian analysis of hospice patients in Vancouver.
Researchers compared electroencephalography (EEG) data – a measure of electrical activity in the brain – collected when patients were conscious and when they became unresponsive at the end of life. Those patients were compared to a healthy control group.
The study looked at brain response to various patterns of common and rare sounds that changed frequency, and found that responses of some of the dying patients were similar to those of healthy people – even hours before death.
Dying brain can respond to sound
“In the last hours before an expected natural death, many people enter a period of unresponsiveness,” said lead author Elizabeth Blundon, a doctoral student in psychology at the University of British Columbia at the time of the study.
“Our data shows that a dying brain can respond to sound, even in an unconscious state, up to the last hours of life,” she said in a university news release.
Co-author Lawrence Ward, a professor of psychology, said researchers were able to identify specific mental processes in both groups of participants.
“We had to look very carefully at the individual control participants’ data, to see if each one of them showed a particular type of brain response before we felt confident that the unresponsive patient’s brain reacted similarly,” he said in the release.
The findings were recently published in the journal Scientific Reports.
Being present is meaningful
“This research gives credence to the fact that hospice nurses and physicians noticed that the sounds of loved ones helped comfort people when they were dying,” said study co-author Dr Romayne Gallagher, a now-retired palliative care physician at St. John Hospice in Vancouver.
“And to me, it adds significant meaning to the last days and hours of life and shows that being present, in person or by phone, is meaningful,” she said. “It is a comfort to be able to say goodbye and express love.”
While the evidence of brain activity supports the idea that dying people might hear, it’s not known if they’re aware of what they’re hearing, Blundon noted.
“Their brains responded to the auditory stimuli, but we can’t possibly know if they’re remembering, identifying voices, or understanding language,” she said. “There are all these other questions that have yet to be answered. This first glimpse supports the idea that we have to keep talking to people when they are dying because something is happening in their brain.”
Increased cellphone and social media use are causing teens to face more cyberbullying
With unemployment and more parents at home, family dynamics have also changed
Adolescents with loving parents are, however, less likely to engage in cyberbullying, researchers found
Cyberbullying is less common among teens who feel loved and supported by their parents, new research shows.
The findings could be especially relevant during the coronavirus pandemic, say a team from New York University.
“With remote learning replacing classroom instruction for many young people, and cellphones and social media standing in for face-to-face interaction with friends, there are more opportunities for cyberbullying to occur,” noted study author Laura Grunin. She’s a doctoral student at NYU’s Rory Meyers College of Nursing, in New York City.
“New family dynamics and home stressors are also at play, thanks to higher unemployment rates and more parents working from home,” she added in a university news release.
Emotional support
For the study, which was based on surveys from 2009 and 2010, Grunin and her team analysed responses from more than 12 600 US youth aged 11 to 15 years. The kids were asked about their bullying behaviours and their relationship with their parents.
The more adolescents considered their parents as loving, the less likely they were to cyberbully, the survey findings showed.
Those who said their parents were “almost never” loving were at least six times more likely to engage in high levels of cyberbullying than those who said their parents were “almost always” loving.
Other types of emotional support, including how much adolescents felt their parents help and understand them, also influenced cyberbullying behaviour, the researchers noted.
The study was published in the International Journal of Bullying Prevention.
Teen’s perception of emotional support
More than half of US teens say they’ve experienced online harassment, insults, threats or spreading rumours.
According to study co-author Sally Cohen, a clinical professor at NYU Meyers, “Understanding what factors are related to a young person’s cyberbullying of peers is important for developing ways that families, schools and communities can prevent bullying or intervene when it occurs.”
Grunin said the findings point to the importance of emotional support from parents.
“I would stress to parents it is not necessarily if they think they are being supportive, but what their adolescent thinks,” Grunin explained. “Parents should strive to discern their teen’s perception of parental emotional support as it might be associated with youth cyberbullying behaviour.”
Many kids who are not physically going to school are losing out on exercise
As it is, about 60% of US kids have an insufficient level of cardiorespiratory fitness
With a bit of imagination, teachers and parents can adapt lessons to include physical activity
When schools close to protect families from the coronavirus, the main worry for many parents might be the lost learning. But for students who end up staying indoors and staring at phones and monitors most of the day, there could be health costs, too.
“You have to give the parents some grace and say we’re all sort of in survival mode right now,” said Hildi Nicksic, a clinical assistant professor in the department of health and kinesiology at Texas A&M University in College Station. Still, the increase in screen time and inactivity makes for “a really scary reality”.
If you’re a kid who has lost access to school, you’ve also lost recess and all the other opportunities for moving around during a school day. You’ve lost physical education classes and sports teams. “And really, you might not even be going outside because maybe you live in an area where your parent doesn’t feel comfortable with you exiting the house,” Nicksic said.
Families can find ways to cope, said Dr Geetha Raghuveer, a paediatric cardiologist at Children’s Mercy in Kansas City, Missouri. But it starts with knowing how vital it is for a child to stay physically active.
Benefits beyond basic health
According to a 2020 report in Circulation written by an American Heart Association panel Raghuveer led, about 60% of US youth have a less-than-healthy level of cardiorespiratory fitness.
The effects of low fitness are multifaceted, she said. “It’s physical, it’s cardiac, it’s mental, it’s academic, it’s long term, it’s short term.”
Federal guidelines recommend children and teens ages six to 17 get at least an hour of moderate to vigorous activity a day, including more intense activities at least three times a week.
Nicksic, who spent more than 10 years as a teacher in public schools before earning her doctorate, said the benefits of activity go beyond basic health.
Regular physical activity has been shown to boost academic results. “A lot of the improvement is seen specifically in math, but there is a general understanding that that benefit will happen across subjects,” she said.
And it might make things easier on teachers and parents by helping kids focus, studies have shown.
Adapt lessons to include action
“If you take a 60-minute lesson, and you pare that down to 55 minutes and have five minutes of physical activity, the remaining 55 minutes is likely going to be a more productive learning time,” Nicksic said.
Breaks aren’t the only way to get kids to move. Teachers – or parents – can adapt lessons to include action. Younger students learning to use a ruler can actively measure things around the room instead of sitting in front of a piece of paper. A teacher working with students over video could ask them to fetch a topic-relevant item from somewhere in their home. “That gets the student away from just looking at the screen, even if it’s just to stand up, move around and come back and sit down.”
The Wide Open School project offers additional ideas, in English and Spanish, at wideopenschool.org. Nicksic compiled her own list at classroomsinmotion.com. The American Heart Association has suggestions through efforts such as Kick Cabin Fever to the Curb and the NFL Play 60 Challenge.
Ultimately, Nicksic and Raghuveer said, fitness works best as a family activity.
“It helps a lot if the family can engage in physical fitness activities as a family as opposed to just telling the kid to go out and do something,” Raghuveer said.
Some families are privileged
That approach has worked for Jenny Groshong, a fourth-grade teacher in Eugene, Oregon.
Her daughters – Libby, 13, and Peyton, 12 – have had plenty of screen time this year, she said. But when it got to be too much, she didn’t always just tell them to put the screen down.
“I’m a runner, so I would make one of them come with me. Some days, the other one would just jump up and say, ‘I’m coming too,’ and they ride their bikes while I go run.”
Their family also hikes. An old tandem bike even gets hauled out sometimes. “Every once in a while, they’ll get on that, which is hysterical,” she said, laughing. “You want to teach your kids how to get along? Put them on a tandem.”
She’s aware that her family is privileged to get to do all they do. “When families are in crisis, or they’re struggling financially, or they’re having a hard time getting food on the table, they don’t have the luxury of hopping in their Suburban and driving an hour to go on a hike,” she said.
Okay to start small
Groshong, who teaches at a school with many students from low-income families, found small ways to work movement into her curriculum. This spring, as the region’s abundant plant life was in full bloom, she sent students (who had school-issued equipment) to capture images of flowers in “all the colours of the rainbow” and arrange them in a colour-wheel collage. Not every kid had to walk very far, she said. “But at least they got outside.”
Raghuveer and Nicksic would approve. Both emphasized it’s OK to start small.
“Baby steps are fine,” Nicksic said. “You don’t need to go from no physical activity to making sure your kid goes for an hour-long walk or something. Anything helps.”
