From Garlic to Acupuncture: Cultural Models of COVID-19 in Traditional Chinese Medicine

Ever since I studied Traditional Chinese Medicine (TCM) in Yunnan, China, I have been curious about it. The cultural and historical aspect of TCM combined with the medical perspective provides a unique concept that is vastly different from Western Medicine (WM). TCM has been practiced for thousands of years in China and surrounding areas. It has seen the rise and fall of kingdoms. It has fought against all types of injuries and illnesses. With the curiosity of TCM combined with the daunting COVID-19, I opted to research how people 3 practice TCM during COVID-19. This research project seeks to understand the cultural and medical aspects that people use against COVID-19

Change in Physical Activity and Sitting Time After Myocardial Infarction and Mortality Among Postmenopausal Women in the Women\u27s Health Initiative-Observational Study

BACKGROUND: How physical activity (PA) and sitting time may change after first myocardial infarction (MI) and the association with mortality in postmenopausal women is unknown. METHODS AND RESULTS: Participants included postmenopausal women in the Women\u27s Health Initiative-Observational Study, aged 50 to 79 years who experienced a clinical MI during the study. This analysis included 856 women who had adequate data on PA exposure and 533 women for sitting time exposures. Sitting time was self-reported at baseline, year 3, and year 6. Self-reported PA was reported at baseline through year 8. Change in PA and sitting time were calculated as the difference between the cumulative average immediately following MI and the cumulative average immediately preceding MI. The 4 categories of change were: maintained low, decreased, increased, and maintained high. The cut points were \u3e /=7.5 metabolic equivalent of task hours/week versus /=8 h/day versus /day for sitting time. Cox proportional hazard models estimated hazard ratios and 95% CIs for all-cause, coronary heart disease, and cardiovascular disease mortality. Compared with women who maintained low PA (referent), the risk of all-cause mortality was: 0.54 (0.34-0.86) for increased PA and 0.52 (0.36-0.73) for maintained high PA. Women who had pre-MI levels of sitting time /day, every 1 h/day increase in sitting time was associated with a 9% increased risk (hazard ratio=1.09, 95% CI: 1.01, 1.19) of all-cause mortality. CONCLUSIONS: Meeting the recommended PA guidelines pre- and post-MI may have a protective role against mortality in postmenopausal women

Global, regional, and national sex-specific burden and control of the HIV epidemic, 1990-2019, for 204 countries and territories: the Global Burden of Diseases Study 2019

Background: The sustainable development goals (SDGs) aim to end HIV/AIDS as a public health threat by 2030. Understanding the current state of the HIV epidemic and its change over time is essential to this effort. This study assesses the current sex-specific HIV burden in 204 countries and territories and measures progress in the control of the epidemic. Methods: To estimate age-specific and sex-specific trends in 48 of 204 countries, we extended the Estimation and Projection Package Age-Sex Model to also implement the spectrum paediatric model. We used this model in cases where age and sex specific HIV-seroprevalence surveys and antenatal care-clinic sentinel surveillance data were available. For the remaining 156 of 204 locations, we developed a cohort-incidence bias adjustment to derive incidence as a function of cause-of-death data from vital registration systems. The incidence was input to a custom Spectrum model. To assess progress, we measured the percentage change in incident cases and deaths between 2010 and 2019 (threshold >75% decline), the ratio of incident cases to number of people living with HIV (incidence-to-prevalence ratio threshold <0·03), and the ratio of incident cases to deaths (incidence-to-mortality ratio threshold <1·0). Findings: In 2019, there were 36·8 million (95% uncertainty interval [UI] 35·1–38·9) people living with HIV worldwide. There were 0·84 males (95% UI 0·78–0·91) per female living with HIV in 2019, 0·99 male infections (0·91–1·10) for every female infection, and 1·02 male deaths (0·95–1·10) per female death. Global progress in incident cases and deaths between 2010 and 2019 was driven by sub-Saharan Africa (with a 28·52% decrease in incident cases, 95% UI 19·58–35·43, and a 39·66% decrease in deaths, 36·49–42·36). Elsewhere, the incidence remained stable or increased, whereas deaths generally decreased. In 2019, the global incidence-to-prevalence ratio was 0·05 (95% UI 0·05–0·06) and the global incidence-to-mortality ratio was 1·94 (1·76–2·12). No regions met suggested thresholds for progress. Interpretation: Sub-Saharan Africa had both the highest HIV burden and the greatest progress between 1990 and 2019. The number of incident cases and deaths in males and females approached parity in 2019, although there remained more females with HIV than males with HIV. Globally, the HIV epidemic is far from the UNAIDS benchmarks on progress metrics. Funding: The Bill & Melinda Gates Foundation, the National Institute of Mental Health of the US National Institutes of Health (NIH), and the National Institute on Aging of the NIH

Effect of remote ischaemic conditioning on clinical outcomes in patients with acute myocardial infarction (CONDI-2/ERIC-PPCI): a single-blind randomised controlled trial.

BACKGROUND: Remote ischaemic conditioning with transient ischaemia and reperfusion applied to the arm has been shown to reduce myocardial infarct size in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). We investigated whether remote ischaemic conditioning could reduce the incidence of cardiac death and hospitalisation for heart failure at 12 months. METHODS: We did an international investigator-initiated, prospective, single-blind, randomised controlled trial (CONDI-2/ERIC-PPCI) at 33 centres across the UK, Denmark, Spain, and Serbia. Patients (age >18 years) with suspected STEMI and who were eligible for PPCI were randomly allocated (1:1, stratified by centre with a permuted block method) to receive standard treatment (including a sham simulated remote ischaemic conditioning intervention at UK sites only) or remote ischaemic conditioning treatment (intermittent ischaemia and reperfusion applied to the arm through four cycles of 5-min inflation and 5-min deflation of an automated cuff device) before PPCI. Investigators responsible for data collection and outcome assessment were masked to treatment allocation. The primary combined endpoint was cardiac death or hospitalisation for heart failure at 12 months in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT02342522) and is completed. FINDINGS: Between Nov 6, 2013, and March 31, 2018, 5401 patients were randomly allocated to either the control group (n=2701) or the remote ischaemic conditioning group (n=2700). After exclusion of patients upon hospital arrival or loss to follow-up, 2569 patients in the control group and 2546 in the intervention group were included in the intention-to-treat analysis. At 12 months post-PPCI, the Kaplan-Meier-estimated frequencies of cardiac death or hospitalisation for heart failure (the primary endpoint) were 220 (8·6%) patients in the control group and 239 (9·4%) in the remote ischaemic conditioning group (hazard ratio 1·10 [95% CI 0·91-1·32], p=0·32 for intervention versus control). No important unexpected adverse events or side effects of remote ischaemic conditioning were observed. INTERPRETATION: Remote ischaemic conditioning does not improve clinical outcomes (cardiac death or hospitalisation for heart failure) at 12 months in patients with STEMI undergoing PPCI. FUNDING: British Heart Foundation, University College London Hospitals/University College London Biomedical Research Centre, Danish Innovation Foundation, Novo Nordisk Foundation, TrygFonden

Correlates of weight patterns during middle age characterized by functional principal components analysis

PURPOSE: Describing weight trajectories using functional methods may further our understanding of how weight impacts health. We characterize weight patterns and describe correlates of these patterns. METHODS: Using a subset of the Framingham Heart Study original cohort limited-access data set (n=1,429), we conducted a functional principal components analysis (PCA) of body mass index from 40 to 55 years of age. Scores from the principal component functions defined weight patterns. Gender-specific logistic regression models provided estimates of association with sociodemographic and lifestyle factors. RESULTS: Overall weight status, weight changes, and cycling emerged as weight patterns during middle age. Overweight/obesity at 25 years was the most consistent correlate of weight patterns (adjusted odds ratios [AORs] for men and women were 14.2 and 3.7 for overall overweight, 99.5 and 28.3 for overall obese, and 1.4 and 3.9 for cycling). Weight status at 25 years was not associated with weight gain in either gender or weight loss in men; for women the AOR was 2.7 for weight loss. CONCLUSIONS: Functional PCA described weight patterns during middle age. The strong associations between weight status at 25 years and overall weight status and cycling during middle age underscore the importance of addressing weight earlier in life

Documentation and management of overweight and obesity in primary care

PURPOSE: We examined overweight/obesity management in primary care in relation to body mass index (BMI), documentation of weight status, and comorbidities. METHODS: This analysis of baseline data from the Cholesterol Education and Research Trial included 2330 overweight and obese adult primary care patients from southeastern New England. Data were obtained via a telephone interview and abstraction of patients\u27 medical records. BMI (kg/m(2)) was calculated from measured height and weight. Management of overweight/obesity included advice to lose weight, physical activity recommendations, dietary recommendations, and referral for nutrition counseling. RESULTS: Documentation of weight status was more common with increasing BMI (13% of overweight patients, 39% of mildly obese patients, and 77% of moderately/severely obese patients). Documentation of overweight/obesity was associated with increased behavioral treatment; the biggest increase was seen for advice to lose weight (odds ratios were 7.2 for overweight patients, 3.3 for patients with mild obesity, and 4.0 for patients with moderate/severe obesity). Although weight-related comorbidities were associated with increased overweight/obesity management at all BMIs, the biggest increase in odds was for patients with moderate/severe obesity. CONCLUSIONS: Documentation of weight management was more common among patients with documented overweight/obesity and with weight-related comorbidities. These insights may help in designing new interventions in primary care settings for overweight and obese patients

Association of objectively measured physical activity and metabolic syndrome among U.S. adults with osteoarthritis

OBJECTIVE: To investigate the association between objectively-measured physical activity and metabolic syndrome among adults with osteoarthritis (OA). METHODS: Using cross-sectional data from 2003-2006 NHANES, we identified 566 adults with OA with available accelerometer data assessed using Actigraph AM-7164 and measurements necessary to determine metabolic syndrome by Adult Treatment Panel III. Analysis of variance was conducted to examine the association between continuous variables in each activity level and metabolic syndrome components. Logistic models estimated the relationship of quartile of daily minutes of different physical activity levels to odds of metabolic syndrome adjusted for socioeconomic and health factors. RESULTS: Among persons with OA, most were female with average age 62.1 years and average duration of disease of 12.9 years. Half of adults with OA had metabolic syndrome (51.0%; 95% Confidence Interval (CI): 44.2% to 57.8%), and only 9.6% engaged in the recommended 150 minutes per week of moderate/vigorous physical activity. Total sedentary time was associated with higher rates of metabolic syndrome and its components while light and moderate/vigorous objectively-measured physical activity were inversely associated with metabolic syndrome and its components. Higher levels of light activity was associated with lower prevalence of metabolic syndrome (quartile 4 versus quartile 1: adjusted odds ratio: 0.45; 95% CI: 0.24 to 0.84; p-value for linear trend \u3c 0.005). CONCLUSION: Most U.S. adults with OA are sedentary. Increased daily minutes in physical activity, especially in light intensity, is more likely to be associated with decreasing prevalence of metabolic syndrome among persons with OA. This article is protected by copyright. All rights reserved

Abdominal obesity and peripheral vascular disease in men and women: a comparison of waist-to-thigh ratio and waist circumference as measures of abdominal obesity

OBJECTIVE: Abdominal obesity is associated with coronary heart disease (CHD) but its relationship to peripheral vascular disease (PVD) is under-researched. This study is to evaluate the association of PVD with two measures of abdominal obesity, waist-to-thigh ratio (WTR) and waist circumference (WC). METHODS AND RESULTS: The study population consisted of 5057 adults aged 40 years or older who participated in NHANES 1999-2002. PVD was defined as an ankle-brachial index (ABI) \u3c0.9. WTR and WC were divided into gender-specific quartiles. Of the 5057 participants, 367 (7.3%) were identified as having PVD. The cross-sectional associations were evaluated using multiple logistic regressions separately by gender. After adjusting for demographic variables and traditional risk factors of PVD, WTR was strongly associated with PVD in men. The odds ratios (95% CI) across the WTR quartiles were 4.21 (1.86,9.51), 4.44 (2.17,9.09) and 4.68 (2.13,10.32) compared to the 1st quartile (P for trend=0.018). Among women, strong linear trend was found indicating significant association between WTR and PVD (P for trend=0.007). While WC was not associated with PVD among men, among women, those in the 4th quartile of WC had an increased odds of PVD compared to the 1st quartile (odds ratio: 2.94, 95% CI: 1.01-8.88). CONCLUSIONS: WTR is associated with PVD in men and women. In contrast, WC is associated with PVD in women, but not in men. Well-controlled prospective studies are needed to assess these two measures of body fat distribution and its association with the development of PVD in men and women

Social isolation, C-reactive protein, and coronary heart disease mortality among community-dwelling adults

Social isolation confers increased risk for coronary heart disease (CHD) events and mortality. In two recent studies, low levels of social integration among older adults were related to higher levels of C-reactive protein (CRP), a marker of inflammation, suggesting a possible biological link between social isolation and CHD. The current study examined relationships among social isolation, CRP, and 15-year CHD death in a community sample of US adults aged 40 years and older without a prior history of myocardial infarction. A nested case-cohort study was conducted from a parent cohort of community-dwelling adults from the southeastern New England region of the United States (N = 2321) who were interviewed in 1989 and 1990. CRP levels were measured from stored sera provided by the nested case-cohort (n = 370), which included all cases of CHD death observed through 2005 (n = 48), and a random sample of non-cases. We found that the most socially isolated individuals had two-and-a-half times the odds of elevated CRP levels compared to the most socially integrated. In separate logistic regression models, both social isolation and CRP predicted later CHD death. The most socially isolated continued to have more than twice the odds of CHD death compared to the most socially integrated in a model adjusting for CRP and more traditional CHD risk factors. The current findings support social isolation as an independent risk factor of both high levels of CRP and CHD death in middle-aged adults without a prior history of myocardial infarction. Prospective study of inflammatory pathways related to social isolation and mortality are needed to fully delineate whether and how CRP or other inflammatory markers contribute to mechanisms linking social isolation to CVD health