Yoga Position May Prevent Vasovagal Syncope

 Regular practice of a specific yoga maneuver appears to reduce susceptibility to reflex vasovagal syncope, a new study suggests.

The tadasana exercise — a movement-based contemplative practice that gradually corrects orthostatic imbalance by strengthening protective neuromuscular reflexes — practiced for just 15 minutes twice a day, was associated with the complete elimination of episodes of vasovagal syncope for many patients.

Dr Hygriv Rao

"These exercises are very easy to perform, inexpensive, and very effective. This is a very easy fix for a scary and potentially dangerous condition," lead author Hygriv Rao, MD, told theheart.org | Medscape Cardiology. "We are excited about these results. We thought it would work, but we did not expect it to be so effective. It seems to work for almost all patients.

"We found that with the tadasana maneuver, episodes of full syncope, where the patient actually loses consciousness, ceased completely, and episodes of near-syncope, where the patient feels faint but does not completely pass out, were greatly reduced," Rao added. "The actual loss of consciousness, which is the most dangerous part, is practically gone. This gives a lot of confidence to patients and their families."

The researchers report their initial results from a pilot study of the technique in a letter to JACC: Clinical Electrophysiology that was published online January 26.

Rao, a cardiologist at the KIMS Hospitals, Hyderabad, India, explained that vasovagal syncope is a brief loss of consciousness due to a neurologically induced drop in blood pressure caused by faulty neuromuscular reflexes.

It is typically triggered by emotional stress, prolonged standing, or getting up from a sitting position too quickly.

Very few treatments have been shown effective, with current management approaches involving avoiding triggers, increasing fluids, and if the individual feels an episode coming on, they can take steps to stop it by lying down, raising their legs, or lowering their head to increase blood flow to the brain.

"Recently, there has been a lot of interest in yoga as a preventative therapy for vasovagal syncope," Rao noted. "We considered various yoga positions and we chose the tadasana maneuver to study in this context as it resembles exercises sometimes given to patients with vasovagal syncope but with some differences including the addition of synchronized breathing, which may help stabilize autonomic tone."

For the tadasana maneuver, the individual stands straight with their feet together, arms by their side (against a wall if they need support), and alternatively lift the front and back part of their feet.

They first lift their toes with their weight resting on the ball of their feet, then after a few seconds they raise their heels with their weight on the front of the foot. Then after a few more seconds they lift their arms over their shoulders, stretching upward while standing on their toes.

These movements are synchronized with breathing exercises, with the individual taking a deep breath in as they lift their arms and breathing out again on lowering the arms.

"Each movement takes a few seconds, and each cycle of movements takes about 2 minutes. If this is performed 8 times, then this would take about 15 minutes. We recommend this 15-minute routine twice a day," Rao said.

For the current study, 113 patients diagnosed with recurrent vasovagal disorder were counseled to practice standard physical maneuvers and maintain adequate hydration. Medications were prescribed at the discretion of the treating physician.

Of these, 61 patients were additionally trained to practice the tadasana maneuver and asked to practice the movement for 15 minutes twice a day. The mean durations of symptoms and follow-up in the two groups were similar. The average follow-up was about 20 months.

Results showed that episodes of both near-syncope and syncope decreased in both groups but there was a much larger reduction in the patients practicing the tadasana maneuver.

Before treatment, the 52 patients in the conventional group experienced 163 syncope or near-syncope events. At follow-up, 22 symptom recurrences occurred in 12 patients (23%). Total mean events per patient declined from 3 to 0.4.

Full syncope events in this group declined from 65 in 32 patients to 2 in 2 patients (mean per patient, 1.3 to 1), and near-syncope events fell from 98 in 34 patients to 20 in 10 patients (mean per patient, 2.0 to 0.4).

In the tadasana group, 61 patients had 378 syncope/near-syncope events before treatment; at follow-up, only 6 events occurred in 5 patients (8%). Per patient, total events declined from a mean of 6 to 0.1.

Full syncope events fell from 108 in 48 patients to 0 (mean per patient, 1.8 to 0), and near-syncope events declined from 269 in 33 patients to 6 in 5 patients (mean per patient, 4.4 to 0.1).

"This combination of exercise and breathing influences the neuromuscular reflex malfunction that occurs in vasovagal syncope," Rao noted. "The movements focus on strengthening neuromuscular reflexes in the quadriceps and the calf muscles, which can increase the blood circulation and venous return, thus preventing blood pooling in the lower body," he explained.

The researchers say this pilot study offers three main findings. First, both conventional therapy and conventional plus tadasana therapy appeared to benefit patients compared with their respective baseline symptom burden. Second, application of tadasana as an adjunctive treatment was associated with fewer total event recurrences (ie, syncope and near-syncope combined), and third, tadasana was well tolerated, with no adverse events reported.

"The reduction in total events (ie, syncope and near-syncope events) compared with pre-treatment numbers was substantial and most tadasana patients were managed without any pharmacotherapy," the authors report.

Rao noted that at baseline almost all patients in both groups were taking medications for the condition, but during the study these medications were reduced as fewer episodes occurred. At the end of the follow up, 80% of the conventional group were still taking medication compared with just 14% of those in the tadasana group.

Patients had an initial training session in person with a yoga instructor and then received follow on training by video online. Rao said there was a very high rate of compliance, "almost 100%."

He reports that a total of 200 patients have now been treated with this approach at his hospital with very similar results to those seen in the initial study.

This work was supported in part by a grant from the Dr Earl E. Bakken Family in support of heart-brain research. Rao has disclosed no relevant financial relationships.

J Am Coll Cardiol EP. Published online January 26, 2022. Letter

https://www.medscape.com/viewarticle/967513

Uncontrolled Blood Pressure Is Sending More People to the Hospital

 The number of people hospitalized for a hypertensive crisis—when blood pressure increases so much it can cause a heart attack, stroke or other sudden cardiovascular event—more than doubled from 2002 to 2014, according to Cedars-Sinai investigators.

The increase occurred during a period when some studies reported overall progress in blood pressure control and a decline in related cardiovascular events in the U.S. The findings are published in the Journal of the American Heart Association.

“Although more people have been able to manage their blood pressure over the last few years, we’re not

Joseph E. Ebinger, MD

 seeing this improvement translate into fewer hospitalizations for hypertensive crisis,” said Joseph E. Ebinger, MD, a clinical cardiologist and director of clinical analytics at the Smidt Heart Institute and first author of the study.

Ebinger said there could be various explanations for why a growing number of people are being hospitalized for dangerously high blood pressure. It could be that an increasing number may be unable to afford medications to control hypertension or are seeing their blood pressure rise after taking inadequate doses of these drugs. Socioeconomic factors may also make it difficult for people to avoid a high-salt diet, inactivity, smoking or other unhealthy behaviors that can contribute to hypertension. These factors may include limited access to health care, financial insecurity, or work and family demands.

“We need more research to understand why this is happening and how clinicians can help patients stay out of the hospital,” Ebinger said.

To conduct their study, the investigators analyzed data from the National Inpatient Sample, a publicly available database. The data include a subset of all hospitalizations across the U.S., providing a picture of nationwide trends. They found that annual hospitalizations for hypertensive crises more than doubled over a 13-year period. Hospitalizations related to hypertensive crises represented 0.17% of all admissions for men in 2002 but 0.39% in 2014. Hospitalizations related to hypertensive crisis represented 0.16% of all admissions for women in 2002 but 0.34% in 2014.

The investigators estimated that from 2002 to 2014, there were 918,392 hospitalizations and 4,377 in-hospital deaths related to hypertensive crisis across the U.S.

The risk of dying from a hypertensive crisis, however, did decrease slightly overall during the studied time period. Women died at the same rate as men, even though they had fewer health issues than men who also were hospitalized for a hypertensive crisis.

“These findings raise the question: Are there sex-specific biologic mechanisms that place women at greater risk for dying during a hypertensive crisis?” said Susan Cheng, MD, MPH, director of the Institute for Research on Healthy Aging in the Department of Cardiology at the Smidt Heart Institute and senior author of the study. “By understanding these processes, we could prevent more deaths among women,” added Dr. Cheng, who is also the Erika J. Glazer Chair in Women's Cardiovascular Health and Population Science and professor of cardiology.

Other Cedars-Sinai researchers who worked on this study are Yunxian Liu, PhD, MS; Matthew Driver, MPH; C. Noel Bairey Merz, MD; Florian Rader, MD, MSc; and Christine M. Albert, MD, MPH.

Funding: The research reported in this study was funded in part by National Institutes of Health under award numbers R01-HL134168, R01-HL131532, R01-HL143227, R01-HL142983, R01-HL146158, K23-HL153888, and U54-AG065141; the National Center for Advancing Translational Sciences under award number UL1TR000124; the Edythe L. Broad and the Constance Austin Women’s Heart Research Fellowships; the Barbra Streisand Women’s Cardiovascular Research and Education Program; the Linda Joy Pollin Women’s Heart Health Program; the Erika Glazer Women’s Heart Health Project; and the Adelson Family Foundation; and Cedars Sinai Medical Center.

https://www.cedars-sinai.org/newsroom/uncontrolled-blood-pressure-is-sending-more-people-to-the-hospital/

Curtailed sleep may alter how intense exercise stresses the heart

 In a new study, participants underwent an intense bout of exercise after both normal sleep and after three nights of curtailed sleep. When they exercised after curtailed sleep, the levels of the heart injury biomarker troponin increased slightly more, compared with when the participants performed exercise in their well-rested condition. The study is a smaller pilot study and it is not yet possible to determine if the findings may be of relevance for cardiovascular health. The study is published in the journal Molecular Metabolism.

Previous epidemiological studies have demonstrated that, at the population level, chronically disrupted and shortened sleep increases the risk of several cardiovascular diseases, such as high blood pressure and myocardial infarction. In contrast, physical exercise can reduce the risk of cardiovascular disease. However, it has been unknown whether controlled sleep restriction can modulate cardiac stress during strenuous exercise.

"Exercise is great for the heart, while lack of sleep can adversely impact the cardiovascular system. But it has been unknown whether shortened sleep can modulate the physiologic stress that intense exercise seems to have on the cells of the heart," says Jonathan Cedernaes, physician and associate professor of medical cell biology at Uppsala University, who led the study.

A specific type of the protein troponin is found in the heart's muscle cells. Low amounts of troponin can be released after high-intensity training. Levels of troponin are routinely determined in the clinic, as significantly higher levels are seen in the setting of acute cardiovascular events.

"Higher blood levels of troponin after exercise have been linked to a relative increased prospective risk of cardiovascular diseases. It is not really known what the mechanism is, but at the same time, we know that one's cardiovascular health is modulated through an interplay of lifestyle factors. We therefore thought it would be important to investigate whether the release of troponin during exercise can be affected by sleep restriction. One reason is the fact that many occupations entail work that disrupts sleep, such as for healthcare workers," says Cedernaes.

Previous studies have found that exercise can counteract certain adverse effects of curtailed sleep on metabolism. Furthermore, data at the population level indicate that exercise can counteract the negative effects of chronic sleep loss on the cardiovascular system.

"Those who report exercising on a regular basis, but get less sleep than the ideal amount, still reduce their risk of dying from cardiovascular disease. At the same time, we know that chronic or recurrent sleep disruption is bad for cardiovascular health. It is therefore possible that a more pronounced lack of sleep in the long run can increase the relative risk that the heart is injured in some way by more intense exercise. But many individuals experience a temporary lack of sleep, and the need for sleep is also very individual," Cedernaes points out. "The epidemiological evidence related to disturbed sleep per se, applies primarily to chronic lack of sleep and long-term shift work, and are seen when averaging at the population level."

16 young men, healthy and normal-weight, underwent the study. All were extensively screened for previous cardiovascular disease, as well as for heredity for such conditions. In addition, all participants had normal sleeping habits within the recommended range -- that is, they reported getting 7-9 hours of sleep on a regular basis.

The participants were monitored in a sleep laboratory, where their meal and activity schedules were standardized. In one of the two sessions, participants got a normal amount of sleep, three nights in a row. During their other session, the participants were kept awake for half the nights, three nights in a row. On each occasion, blood samples were taken in the evening and in the morning. After both sleep interventions, blood samples were also taken on the last day, both before and after a 30-min-long intense stationary cycling session.

The researchers measured two biomarkers in the blood samples. NT-proBNP reflects the load on the heart. The second protein, troponin, is commonly used as a marker of cardiac injury. The results showed that the levels of NT-proBNP increased in response to exercise, but this increase did not differ depending on the amount of sleep. Blood levels of troponin also increased after the workout. However, for troponin, the increase after exercise was almost 40% higher after three nights of partial sleep restriction, compared with after three nights of normal sleep.

"An important observation was that the levels of troponin and NT-proBNP were not elevated in response to sleep restriction at any time prior to the workout. It is possible that lack of sleep may instead lower the threshold at which an increased exercise load results in measurable stress in heart muscle cells, as may occur in response to strenuous exercise," says Cedernaes. "However, we noted that the increase in circulating troponin levels following exercise was variable across individuals. Previous research under resting conditions has also hinted at such variability, and it would be interesting to uncover the mechanisms."

Cedernaes continues:

"Today there is no evidence to suggest that it would be harmful to the heart if you exercise regularly when you have slept too little. One can instead turn the argument around: by ensuring that one gets enough sleep, one may further increase the positive impact of physical exercise. While we know that high-intensity training generally has benefits in the long run, our results may be worth considering and exploring in specific groups of individuals. Examples include athletes and the military. These groups may be required to perform at extreme physical levels even under conditions of curtailed sleep. It may be good to further consider the importance of sleep in these contexts, especially as we also know that improving sleep can also improve one's performance, both cognitively and physically."

One limitation of the current study was that only 16 individuals were included. The study should be considered as a pilot study that requires further validation and follow up. Such studies are also needed to examine if these changes also apply to other age groups or women.

---

Story Source:

Materials provided by Uppsala University. Note: Content may be edited for style and length.

---

Journal Reference:

1. Teemu Martikainen, Fjola Sigurdardottir, Christian Benedict, Torbjørn Omland, Jonathan Cedernaes. Effects of curtailed sleep on cardiac stress biomarkers following high-intensity exercise. Molecular Metabolism, 2022; 101445 DOI: 10.1016/j.molmet.2022.101445

https://www.sciencedaily.com/releases/2022/01/220127114315.htm

How Regular Exercise Restructures The Brain

 

 by Ross Pomeroy via RealClear Science (emphasis ours),

Physical activity can do wonders for the body. Exercise can trim weight, chisel muscles, and strengthen the lower back, among many other benefits. Less overt, but no less consequential, physical activity can also buff up your brain. Science is increasingly revealing that the brains of those who regularly work out can look very different compared to the brains of people who don't.

Changes can start to occur in adolescence. Reviewing the scientific literature in 2018, researchers from the University of Southern California found that for teens aged 15-18, regular exercisers tended to have larger hippocampal volumes as well as larger rostral middle frontal volumes compared to healthy matched control teenagers. The hippocampus is most commonly associated with memory and spatial navigation, while the rostral middle frontal gyrus has been linked to emotion regulation and working memory. Studies suggest that these structural changes translate to improved cognitive performance and better academic outcomes.

Exercise's brain augmenting qualities extend into adulthood, even though the brain tends to be less 'plastic' (easily changed) as we get older. Rutgers University scientists beautifully demonstrated this in a study published early last year:

The researchers recruited older African Americans, all previously sedentary, to complete twenty weeks of twice-weekly cardio-dance exercise classes held at local churches and senior centers. As compared to the control group comprised of community members of similar age and background who did not exercise, those in the program showed significant improvements in dynamic brain connectivity (or “neural flexibility”) in their hippocampus and surrounding medial temporal lobe, as measured using resting-state functional MRI.

In another study, published in August 2019, scientists looked at 45 sets of adult identical twins, who, within their pair, all differed greatly in physical activity levels. "More active co-twins showed larger gray matter volumes in striatal, prefrontal, and hippocampal regions, and smaller gray matter volumes in the anterior cingulate area than less active co-twins," the researchers found.

The scientists also probed the twins' cognitive abilities.

"More physical activity may expedite preconscious processing of visual stimuli and, in somatosensory domain, improve selective attentional processing by dampening the strength of unattended deviant somatosensory signals," they added.

The brain alterations do appear beneficial, but current twin studies are too small, and the participants too young, to find whether exercise-induced changes can actually reduce the risk of cognitive disorders or improve outcomes such as education or income.

Researchers have also tried exercise interventions on much older adults, even those with Alzheimer's disease, to see if physical activity could repair their stricken brains. In 2016, a team of scientists recruited 68 older individuals with probable Alzheimer's disease to determine whether moving more could help with their symptoms. Some subjects aerobically exercised for 150 minutes per week while others underwent a less rigorous control regimen of stretching and toning for 26 weeks. Compared to the control group, the aerobic exercise group improved more on the Disability Assessment for Dementia at the study's conclusion. Boosts to cardiorespiratory fitness were also linked to improvements in memory and reduced atrophy of the hippocampus.

Working out also augments the brains of otherwise healthy older adults. Getting thirty minutes of physical activity each day does seem to preserve brain volumes in adults over age 70 compared to sedentary individuals, according to a study published in August of last year. Moreover, higher cardiorespiratory fitness was linked to lower levels of brain atrophy in the research.

One way exercise can induce changes in the brain is by increasing levels of the protein brain-derived neurotrophic factor (BDNF) in the blood, which is linked to neurogenesis. More BDNF may mean more new neurons in the brain. Regular exercise also increases the growth of additional blood vessels in the brain and helps maintain current ones, leading to boosted blood flow for the oxygen-hungry organ. Lastly, physical activity seems to keep microglia in good working order. Microglia "constantly check the brain for potential threats from microbes or dying or damaged cells and clear any damage they find," Áine Kelly, a Professor in Physiology at Trinity College Dublin wrote for The Conversation.

Regularly moving one's body may be the closest thing there is to a health panacea, for both outside the skull and inside.

https://www.zerohedge.com/medical/how-regular-exercise-restructures-brain

Which companies are in the running to take over Boots?

 Since Boots owner Walgreens Boots Alliance (WBA) put the health and beauty chain up for sale last month, many have had their interests piqued.

The health and beauty conglomerate is understood to have placed a £7 billion price tag for the chain, which includes its operations in the UK, Ireland and Thailand, as well as the No7 beauty brand.

Retail Gazette takes a look at the companies in the running to take over Boots.

Asda

Asda owners, the Issa brothers, are considering a multi-billion pound takeover of Boots to add to its growing retail portfolio.

---

The Issas, self-made billionaires who made their money by growing a petrol forecourt retail empire.

After buying Asda in 2020 for £6.8bn, the Issas have made plays for other businesses including Caffè Nero.

The brothers are in early discussions to add Boots to their portfolio. Boots would be complementary to Asda and could enable the grocer to add pharmacies and beauty concessions into its vast supermarket and hypermarket network.

Bain Capital and CVC

Private equity firms Bain Capital and CVC Capital Partners have placed a joint bid on Boots in their effort to snap up the retailer.

Bain and CVC are being advised by bankers at Lazard on their interest in Boots.

CVC managing partner Dominic Murphy is playing a pivotal role in the bid. Murphy has an extensive knowledge of the Boots business. He is currently a director of Boots owner Walgreens Boots Alliance (WBA) and a was an architect of the £11 billion takeover of Alliance Boots by private equity firm KKR in 2007.

Tesco 

Tesco could also be a potential buyer for Boots.

The UK’s biggest grocer has got its own business firing on all cylinders and boss Ken Murphy, an ex-Boots man, is eyeing further growth opportunities.

He flagged to the City back in October that Tesco would consider “inorganic growth opportunities that may arise”.

Few know Boots, and the opportunities to grow the business, better than Murphy. The Irishman worked with Alliance owner Stefano Pessina to integrate the business with Boots following its merger in 2006. He later became chief operating officer for Boots in the UK and then executive vice president, chief commercial officer and president of global brands at Walgreens Boots Alliance.

Boots and Tesco share many similarities, including a similar customer base and a big focus on data and loyalty with Boots’ Advantage cared and Tesco Clubcard the two most successful schemes in UK retail.

There is an opportunity to add beauty and pharmacies to larger Tesco stores which could help it boost its basket size.

Sainsbury’s

Sainsbury’s is also tipped to be interested in Boots.

Like Tesco, Sainsbury’s is led by an ex-Boots director, Simon Roberts, who held the role of joint chief operating officer from 2011, along with Ken Murphy.

---

Roberts became managing director of Boots in 2013, with Murphy becoming managing director of Boots International.

Since joining Sainsbury’s in 2016, Roberts has made a big push into beauty and has launched beauty concessions in its supermarket stores. This illustrates what a big opportunity Roberts believes beauty is for grocery retailers.

Sainsbury’s is no stranger to big transformative deals having snapped up Argos in 2016. That acquisition has run smoothly and help transform the business into a multichannel, general merchandise business.

Adding Boots to its portfolio could expand Sainsbury’s empire further and turn it in to a retail conglomerate.

---

Fortress Investment Group

Private equity firm Fortress is also thought to be in the running to buy Boots.

The US firm already has an interest in UK retail having snapped up Majestic Wine in 2019 for £95m.

Fortress bought Majestic Wine in 2019

Fortress clearly sees great opportunity in the sector as it narrowly missed out on buying Morrisons last year.

Fortress partner Joshua Pack said in October: ‘The UK remains a very attractive investment environment from many perspectives and we will continue to explore opportunities to help strong management teams grow their businesses and create long-term value.’

---

Apollo Global Management

Fellow private equity firm Apollo is also lining up to buy Boots.

Apollo was in the running to buy Morrisons

The New York firm has its sights firmly set on UK retail and was in the running to buy both Morrisons and Asda over the past 18 months.

It is also understood to be considering bids for both M&S and Sainsbury’s. It makes sense that Boots, a venerable name on the UK high street, would be a target.

https://www.retailgazette.co.uk/blog/2022/01/which-companies-are-looking-to-take-over-boots

BU study: infant deaths from RSV are much higher than previously known

 RSV is a common virus that produces cold-like symptoms and is merely a nuisance for the vast majority of people who contract it. But for babies—especially infants in low- and middle-income countries who lack adequate access to medical care—the virus can be fatal.

Prior research has estimated that about 120,000 infants die from RSV each year, but this figure is based on modeling conducted in hospital-based settings and does not account for RSV deaths that occur in the community, which are not captured in hospital-based surveillance.  

Now, a new study led by Boston University School of Public Health (BUSPH) researchers has found that the true burden of RSV infant mortality is substantially higher than what was previously believed.

Published in the journal The Lancet Global Health, the study used systematic surveillance to measure the presence of RSV among infants who died in medical facilities or in the community and found that the virus was present in 7 to 9 percent of infants under 6 months old and was primarily concentrated in infants under 3 months old.

Notably, two-thirds of these deaths occurred in the community—i.e., among infants who never received medical care in a hospital and were overlooked in previous facility-based surveillance.

“The concentration of deaths in young infants less than 3 months old(<3m) is important for two main reasons,” says study principal investigator Dr. Christopher Gill, associate professor of global health at BUSPH.  “First, it is a reminder that these very young infants with very small airways are at particular risk of RSV infections anatomically. Second, both of the proposed new tools to prevent RSV infections—maternal vaccinations and infant monoclonal antibodies—will be most effective immediately after birth and could wane after.”

The findings are part of, conclude the three-year Zambia Pertussis RSV Infant Mortality Estimation (ZPRIME) study, which was conducted among infants at one of the busiest morgues in Lusaka, Zambia. The study is the largest post-mortem RSV surveillance study of its kind and the first to directly measure RSV infant deaths in the community, rather than rely on modeling estimates.  

For the project, Gill and colleagues partnered with local mortuary staff to obtain consent for a nasal swab and PCR test of infants from families who lost a child between the ages of four days and six months. The researchers enrolled 2,286 deceased infants, representing almost 80 percent of infant deaths in Lusaka from August 2017 to August 2020, with the exception of a brief suspension of enrollment during the first wave of the COVID-19 pandemic in 2020.

RSV was detected in at least 7 percent of deceased infants, and closer to 9 percent of deceased infants during the time periods with uninterrupted data. The virus was found in 9 percent of deaths that occurred in the community, compared to 4 percent of deaths that occurred within 48 hours at a medical facility, and 5 percent of deaths that occurred after 48 hours in a medical setting. About 72 percent of the deaths occurred in infants under 3 months old.

The study showed that RSV directly caused at least 2.8 percent of all infant deaths, and 4.7 percent of all infant deaths outside of hospitals. The majority of these deaths were seasonal, occurring in the first half of the year, and were concentrated in the most impoverished areas of Lusaka.

“Our prior work has shown that delays to seeking and accessing appropriate care is the rule rather than the exception in many impoverished countries,” says study co-author Rachel Pieciak, a research fellow in the Department of Global Health at BUSPH.  “Managing RSV infections tends to rely heavily on supportive care such as supplemental oxygen and suction, but we suspect that the majority of the young infants in our study are dying before accessing even basic care. While no small feat, public health interventions aimed at addressing common barriers to care could have the potential to prevent these infant deaths.”

Preventative measures such as RSV vaccination of mothers who could pass on antibodies to her baby would also effectively be the most effective strategy to reduce infant mortality from the virus, the researchers say. There is currently no approved vaccine for RSV, but trials are underway.

“Our findings build upon our previous work in the Pneumonia Etiology Research for Child Health Study, which showed that RSV was the most frequent and most lethal respiratory infection in children under 5, and especially in infants, in the eight low- and middle-income countries that we studied,” says study team member Dr. Donald Thea, professor of global health at BUSPH. “Many of the young infants who develop RSV require very specialized facilities-based care, which is in short supply in these low and middle-income countries. By far the best approach to dealing with this problem is to effectively vaccinate mothers late in pregnancy so that her ample antibodies cross the placenta and ‘fill the infant’s tank’ to provide good protection during the critical first 6 months of life.”

**

About Boston University School of Public Health

Founded in 1976, Boston University School of Public Health is one of the top five ranked private schools of public health in the world. It offers master's- and doctoral-level education in public health. The faculty in six departments conduct policy-changing public health research around the world, with the mission of improving the health of populations—especially the disadvantaged, underserved, and vulnerable—locally and globally.

 

 

---

JOURNAL

The Lancet Global Health

METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Infant deaths from respiratory syncytial virus in Lusaka, Zambia from the ZPRIME study: a 3-year, systematic, post-mortem surveillance project

ARTICLE PUBLICATION DATE

18-Jan-2022

https://www.eurekalert.org/news-releases/941604

Long-term pain after knee surgery reduced with new treatment

 With one in five people experiencing ongoing pain long after knee replacement surgery, new research, led by the University of Bristol and North Bristol NHS Trust (NBT) and published in The Lancet Rheumatology today [27 January], has shown a way to help reduce people’s continuing pain that could also save the NHS time and money too. 

One hundred thousand knee replacement surgeries are carried out in the UK every year.  Most of these operations take place to treat pain related to osteoarthritis. Unfortunately, each year, around 20,000 people who have knee replacement surgery to relieve their pain find that they have moderate to severe pain three months or longer after their operation, which impacts on their everyday lives. 

The study found the STAR care pathway (Support and Treatment After joint Replacement) reduces pain severity, the amount pain interferes with people’s lives and is cost-effective.  The new treatment could potentially save the NHS up to £14 million per year through reduced inpatient admissions.

The study found patients who received the STAR care pathway had:

• Less pain severity and impact on daily life at both six and 12 months after treatment (nine and 15 months after surgery)
• Half the number of hospital re-admissions
• Reduced length of hospital stay for any inpatient admissions three months after surgery
• Less unpaid time off work

The aim of the five-year STAR programme was to find ways to improve the care and support that people with ongoing pain receive. The programme, funded by the National Institute for Health Research (NIHR), designed and tested a new treatment in a randomised controlled trial in eight UK hospitals.

The programme looked at how likely patients are to get ongoing knee pain after their operation and discovered why patients don’t seek help. The research team developed a new treatment – a care pathway -- for patients and compared how patients did on the STAR care pathway when compared with a control group who had the usual care.

STAR care pathway:

• Three months after surgery patients attended an hour-long clinic, ran by specially trained health care professionals
• Detailed pain questionnaires were filled out and X-rays were taken as well as a blood test for infection. If needed patients were referred for further ongoing treatment
• Patients received up to six ‘phone calls over the next 12 months, making sure they had their referral, and to check how they were doing

Rachael Gooberman-Hill, lead researcher for the STAR programme, Professor of Health and Anthropology and Director of Bristol's Elizabeth Blackwell Institute, said: “People have a knee replacement to relieve their pain and it’s immensely disappointing if they find that they have long-term pain afterwards. Unfortunately, one in five people who have knee replacement have long-term pain afterwards - that is around 20,000 people each year in the UK alone.

“As a research team we wanted to do something that would help. We found that our new STAR care pathway had a positive impact on people’s pain. People who had long-term pain after their knee replacement and who were given STAR had less pain and the pain interfered less with their lives one year later. People told us that STAR helped them to feel supported, to find out more about their pain and STAR meant that they were able to get further treatment that was tailored to their pain. We are enormously pleased with our research findings because it should make a real difference to people who find that they have pain after their knee replacement.”

Brenig, a participant on the STAR trial, explained: “As part of the STAR trial, you have tailored physiotherapy appointments.  At my three-month review with a STAR physiotherapist, I was having a problem not being able to straighten my leg out.  She gave me some simple exercises, which worked and straightened the leg out.  Occasionally I have problems at the back of the knee, then I do the exercises and it goes back to normal. So that was a very positive side of what we actually did.  

“I felt that being part of the STAR trial gave me access to a specialist physiotherapist. Her knowledge was far, far superior and specific to my issue.  Some mornings I get up and feel on top of the world and then the following day I have leg pain.  Eventually you get to accept it, but doing the exercises helps.”

The study has benefited greatly from Bristol’s Musculoskeletal Research Unit’s patient involvement group, PEP-R  (Patient Experience Partnership in Research) who worked closely with the STAR research team to develop the design of the programme.

Dr Vikki Wylde, Associate Professor in Musculoskeletal Health at Bristol Medical School (THS), and co-author, added: “The new STAR care pathway provides benefit to people with pain at three months after knee replacement, but we still need more research to understand how we could prevent people from developing this pain.  High-quality research to pre-operatively identify patients at high risk of developing pain after their operation is needed. These patients could be offered treatments to increase their chance of a good outcome after knee replacement.”

Nick Howells, Consultant Orthopaedic Knee Surgeon at NBT and Honorary Senior Lecturer at Bristol Medical School: THS, continued: “Knee replacement surgery is a great  operation that changes the lives of many people suffering with knee osteoarthritis, improving pain, function and quality of life, however, a proportion of people are left with ongoing pain. To have developed an intervention which has been shown to make a difference for some of these people is really satisfying for our team and a great step forward in treatment.

“We have now successfully introduced the STAR care pathway into our NHS clinical care pathway at North Bristol and hope it will be adopted in other centres across the NHS in the future.”

Paper

‘The STAR care pathway for patients with pain at three months after total knee replacement: a multicentre, pragmatic randomised controlled trial’ by Vikki Wylde, Rachael Gooberman-Hill et al in The Lancet Rheumatology

---

JOURNAL

The Lancet Rheumatology

DOI

10.1016/S2665-9913(21)00371-4 

METHOD OF RESEARCH

Randomized controlled/clinical trial

SUBJECT OF RESEARCH

People

ARTICLE TITLE

The STAR care pathway for patients with pain at three months after total knee replacement: a multicentre, pragmatic randomised controlled trial

ARTICLE PUBLICATION DATE

27-Jan-2022

https://www.eurekalert.org/news-releases/941385