Musculoskeletal Manifestations of COVID-19: A Systematic Search and Review

Coronavirus disease (COVID-19) started its journey around the world from Wuhan, China and gradually became a pandemic. COVID-19 often affects the respiratory system, but symptoms may include fatigue, myalgia, arthralgia, arthritis, and spine and bone pain as presenting complaints. In the present systematic search and review, we aim to highlight the musculoskeletal manifestations during COVID-19. PubMed Central and Google Scholar search engines were searched for the key words “muscle pain”, “joint pain”, “body ache”, and “fatigue”, in Covid-19 patients. After screening, a total of 76 articles dated between January 1 and July 1, 2020 met the inclusion criteria and were included in the study. All articles were published in English comprising 36,558 COVID-19 cases. In cross-sectional studies, fatigue was found in 55%, myalgia in 26%, and arthralgia in 20% of cases, respectively. In cohort studies, fatigue was found in 35%, myalgia in 15%, and arthralgia in 5%, respectively. Sporadic case reports also mention back pain, bone pain, myositis, and arthritis as presenting symptoms of COVID-19. Fatigue was the most frequent musculoskeletal (MSK) manifestation of COVID-19 followed by myalgia and joint pain. The frequency of the different MSK manifestations in COVID-19 may vary widely among different geographic regions. MSK like fatigue, myalgia and arthralgia are frequent symptoms in COVID-19 patients and may vary in different countries

Young people's exposure to point-of-sale tobacco products and promotions

The study was funded by the UK National Institute for Health Research (NIHR, PHR 10/3000/07).Objectives. Point of sale (POS) displays are one of the most important forms of tobacco marketing still permitted in many countries. Reliable methods for measuring exposure to such displays are needed in order to assess their potential impact, particularly on smoking attitudes and uptake among young people. In this study we use a novel method for evaluating POS exposure based on young people's use of retail outlets and recall of tobacco displays and observational data on the characteristics of displays. Study design. Observational audit of retail outlets (n = 96) and school-based pupil survey (n = 1482) in four Scottish communities reflecting different levels of social deprivation and urbanisation, conducted in 2013 before legislation to remove POS displays was implemented in supermarkets. Methods. Measures were taken of: visibility and placement of tobacco displays; internal and external advertising; display unit size, branding and design; visibility of pack warnings; proximity of tobacco products to products of potential interest to children and young people; pupils' self-reported frequency of visiting retail outlets; and pupils' recall of tobacco displays. Variation in POS exposure across social and demographic groups was assessed. Results. Displays were highly visible within outlets and, in over half the stores, from the public footway outside. Tobacco products were displayed in close proximity to products of interest to children (e.g. confectionery, in 70% of stores). Eighty percent of pupils recalled seeing tobacco displays, with those from deprived areas more likely to recall displays in small shops. When confectioners, tobacconists and newsagents (CTNs) and grocery/convenience stores (two of the outlet types most often visited by young people) were examined separately, average tobacco display unit sizes were significantly larger in those outlets in more deprived areas. Conclusions. POS displays remain a key vector in most countries for advertising tobacco products, and it is important to develop robust measures of exposure. The data reported in this paper provide a baseline measure for evaluating the efficacy of legislation prohibiting such displays.Publisher PDFPeer reviewe

A randomized controlled trial on the effectiveness of strength training on clinical and muscle cellular outcomes in patients with prostate cancer during androgen deprivation therapy: rationale and design

Background Studies indicate that strength training has beneficial effects on clinical health outcomes in prostate cancer patients during androgen deprivation therapy. However, randomized controlled trials are needed to scientifically determine the effectiveness of strength training on the muscle cell level. Furthermore, close examination of the feasibility of a high-load strength training program is warranted. The Physical Exercise and Prostate Cancer (PEPC) trial is designed to determine the effectiveness of strength training on clinical and muscle cellular outcomes in non-metastatic prostate cancer patients after high-dose radiotherapy and during ongoing androgen deprivation therapy. Methods/design Patients receiving androgen deprivation therapy for 9-36 months combined with external high-dose radiotherapy for locally advanced prostate cancer are randomized to an exercise intervention group that receives a 16 week high-load strength training program or a control group that is encouraged to maintain their habitual activity level. In both arms, androgen deprivation therapy is continued until the end of the intervention period. Clinical outcomes are body composition (lean body mass, bone mineral density and fat mass) measured by Dual-energy X-ray Absorptiometry, serological outcomes, physical functioning (muscle strength and cardio-respiratory fitness) assessed with physical tests and psycho-social functioning (mental health, fatigue and health-related quality of life) assessed by questionnaires. Muscle cellular outcomes are a) muscle fiber size b) regulators of muscle fiber size (number of myonuclei per muscle fiber, number of satellite cells per muscle fiber, number of satellite cells and myonuclei positive for androgen receptors and proteins involved in muscle protein degradation and muscle hypertrophy) and c) regulators of muscle fiber function such as proteins involved in cellular stress and mitochondrial function. Muscle cellular outcomes are measured on muscle cross sections and muscle homogenate from muscle biopsies obtained from muscle vastus lateralis. Discussion The findings from the PEPC trial will provide new knowledge on the effects of high-load strength training on clinical and muscle cellular outcomes in prostate cancer patients during androgen deprivation therapy. Trial registration ClinicalTrials.gov: NCT0065822

A randomised controlled trial to evaluate the efficacy of a 6 month dietary and physical activity intervention for prostate cancer patients receiving androgen deprivation therapy

<p>Abstract</p> <p>Background</p> <p>Treatment with Androgen Deprivation Therapy (ADT) for prostate cancer is associated with changes in body composition including increased fat and decreased lean mass; increased fatigue, and a reduction in quality of life. No study to date has evaluated the effect of dietary and physical activity modification on the side-effects related to ADT. The aim of this study is to evaluate the efficacy of a 6-month dietary and physical activity intervention for prostate cancer survivors receiving ADT to minimise the changes in body composition, fatigue and quality of life, typically associated with ADT.</p> <p>Methods</p> <p>Men are recruited to this study if their treatment plan is to receive ADT for at least 6 months. Men who are randomised to the intervention arm receive a home-based tailored intervention to meet the following guidelines a) ≥ 5 servings vegetables and fruits/day; b) 30%-35% of total energy from fat, and < 10% energy from saturated fat/day; c) 10% of energy from polyunsaturated fat/day; d) limited consumption of processed meats; e) 25-35 gm of fibre/day; f) alcoholic drinks ≤ 28 units/week; g) limited intake of foods high in salt and/or sugar. They are also encouraged to include at least 30 minutes of brisk walking, 5 or more days per week. The primary outcomes are change in body composition, fatigue and quality of life scores. Secondary outcomes include dietary intake, physical activity and perceived stress. Baseline information collected includes: socio-economic status, treatment duration, perceived social support and health status, family history of cancer, co-morbidities, medication and supplement use, barriers to change, and readiness to change their health behaviour. Data for the primary and secondary outcomes will be collected at baseline, 3 and 6 months from 47 intervention and 47 control patients.</p> <p>Discussion</p> <p>The results of this study will provide detailed information on diet and physical activity levels in prostate cancer patients treated with ADT and will test the feasibility and efficacy of a diet and physical activity intervention which could provide essential information to develop guidelines for prostate cancer patients to minimise the side effects related to ADT.</p> <p>Trial registration</p> <p>ISRCTN trial number ISCRTN75282423</p

Sources of youth access to JUUL vaping products in the United States.

INTRODUCTION: This study assessed sources of youth access to JUUL vaping products, the highest selling brand of the most commonly used tobacco product among adolescents in the United States. METHODS: A cross-sectional online survey assessed use of JUUL vaping products in a non-probability, nationally representative sample of 9865 adolescents aged 13-17 years in the United States. Past 30-day JUUL users (n = 1537) were asked how they got the JUUL vaping products they had used in the past 30-days. Those who reported having bought JUUL products themselves were asked about the places and people from whom they had bought products. Population-weighted percentages and 95% confidence intervals are reported for each source of access. RESULTS: An estimated 79.6% (95% CI = 77.5-81.6%) of current JUUL users obtained JUUL products from at least one social source (e.g. 'someone bought for me, someone offered to me) in the past 30 days. By comparison, 20.0% [95% CI = 18.0-22.0%) of current users bought JUUL products themselves. Of 1322 youth who reported obtaining JUUL products from at least one source or by buying products themselves in the past 30 days, 77.5% (95% CI = 75.3-79.8%) had obtained JUUL products exclusively from social sources (i.e. they did not buy products directly), 17.2% (95% CI = 15.2-19.3%) obtained JUUL products exclusively by buying the products themselves (i.e. they did not obtain products from any social sources), and 5.2% (95% CI = 4.0-6.4%) had obtained JUUL products both from social sources and from buying the products themselves. Among youth who bought JUUL products themselves, the most common place of purchase was 'a gas station or convenience store' [53.1% (95% CI = 47.5- 58.6%)]. CONCLUSIONS: Youth who are currently using JUUL vaping products obtain these products predominantly through social sources, such as friends and peers. Youth sources of access to JUUL vaping products appear to mirror youth sources of access to other tobacco products. Reducing youth use of JUUL vaping products will require a greater focus on measures that deter or penalize legal-age purchasers who give or sell products to minors

Measurement and meaning: reporting sex in health research

These findings of sex and gender blindness represent the continuation of centuries-old archetypes that see male sex as the norm, resulting in a unidimensional view of humanity. Larivière and colleagues have provided strong empirical evidence that change to two-dimensional vision is possible—and have shown that change happens when the people doing the research also change