It’s possible that I shall make an ass of myself. But in that case one can always get out of it with a little dialectic. I have, of course, so worded my proposition as to be right either way (K.Marx, Letter to F.Engels on the Indian Mutiny)
Sunday, December 11, 2022
Incoherent use of ethnoracial categories in biomedical literature on COVID-19
The authors studied articles on COVID-19 to understand how the terms “race”, “racial” or “ethnicity” co-exist in the biomedical literature about COVID-19 that used terms “gene”, “genetic”, and “genomic”
INTERDISCIPLINARY CENTRE FOR ETHICS, JAGIELLONIAN UNIVERSITY IN KRAKÓW
Researchers from Adam Mickiewicz University in Poznań (Poland) and the Interdisciplinary Centre for Ethics of Jagiellonian University in Kraków (Poland) have analyzed the full texts of 119 articles from the Lit Covid database published in 2020 and 2021 to reconstruct the theoretical background assumptions about ethnoracial categories that researchers implicitly assume in their studies. Their results were recently published in Medicine, Health Care and Philosophy.
Soon after the outbreak of the pandemic, scientists started to study and report so-called racial differences in the incidence and mortality of COVID-19. Most scholars emphasized that it is racism, not races themselves, that generate disparities in health. But there were also opposing voices that assumed that racial groups are distinct biological populations and that some differences may be caused by biological factors.
Previous studies demonstrated that researchers using racial categories in biomedical studies are often unsure of their references. There are also reports on enormous differences in the way in which racial categories are reported, both between countries and institutions, as well as between individual scientists. In addition, some studies noticed the spillover of US regulatory standards regarding race/ethnicity into the European Union.
Researchers from Poland proposed five interpretations of ethnoracial terms that appeared in the examined papers and labeled them as (a) folk, (b) demogeographic, (c) socio-cultural, (d) multileveled, and (e) institutional. Most of the analyzed articles did not present any definitions of the racial/ethnic terms and their uses differed significantly, making it difficult to compare and interpret research using ethnoracial categories in genetic contexts, as well as to draw practical conclusions from them. Moreover, in about 60% of the analyzed articles, the category of race referred (either implicitly or explicitly) to some genetic differences between representatives of different populations distinguished according to folk racial classifications or geographical origin.
The authors of the article conclude that what is termed “race” or “ethnicity” in one article may mean something else in another. They also argue that the tendency to biologize ethnoracial categories in genetics and genomics may be explained to some extent by the biases of reductionism, which is largely inscribed in the methodology of genetic research. In this understanding, many health disparities are interpreted as the result of genetic differences, although it would be more appropriate to treat them as the effects of societal racism.
“The most basic “feature” of reductionism that fosters the biologization of social categories is that reductionist methods and explanations usually concentrate on internal factors (most often decomposed and cited in isolation) while ignoring or simplifying the environment of the system in the study,” says Dr. Joanna Karolina Malinowska from Adam Mickiewicz University.
Another result of the research is the observation that replacing the word “race” with “ethnicity” (a growing trend in biomedical sciences) may be problematic. Malinowska and Żuradzki point out that since the term “ethnicity” usually refers to cultural phenomena, using it in reference to ancestry can lead to the mistaken impression that the cultural sphere is reducible to biological factors.
“We believe that the current institutional framework in the US (in contrast to the majority of EU countries) that requires the use of ethnoracial categories to collect and report data in submissions for clinical trials may reinforce the assumption that ethnoracial categories are biologically relevant – says Prof. Tomasz Żuradzki, head of the Interdisciplinary Centre for Ethics at Jagiellonian University. Instead, we propose a reversed regulatory framework in which researchers should justify why they want to use ethnoracial categories as variables and proxies in their research.”
This research received funding from National Science Centre (NCN) in Poland (no. UMO-2020/39/D/HS1/00636), and from the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation program (grant agreement 805498).
UNIVERSITY OF CALIFORNIA - LOS ANGELES HEALTH SCIENCES
UCLA Research Brief
FINDINGS
While use of insulin pumps to manage type 1 diabetes has grown over 20 years, there has been no improvement in racial, ethnic, and socioeconomic disparities in their use. By the end of the period studied, insulin pump use was 67% among non-Hispanic whites, 41% among Hispanics, 29% among Blacks, and 46% among other racial and ethnic groups. In addition, 70% of people with bachelor’s degrees or higher used the pumps, compared with 56% among those with some college, 40% among holders of high school degrees, and 18% among those with no high school education. By income level, 74% of those with household incomes of $75,000 or more, 66% with $50,000 to 74,999, 51% with $25,000 to $49,999, and 41% with less than $25,000, used the pumps.
BACKGROUND
Insulin pump use has been shown to lead to improvements in glycemic control, quality of life, satisfaction with treatment, and lower diabetes distress. Overall use has grown over two decades from about 32% to 59% among people with type 1 diabetes.
METHOD
The researchers examined data from the SEARCH for Diabetes Youth Study, a multicenter, observational, and population-based study of youth under 20 years of age. They broke up the analysis across four time periods between 2001 and 2019: 690 youth and young adults with type 1 diabetes in 2001-2005, 1,706 in 2006-2010, 2,385 in 2011-2015, and 2,257 in 2016-2019.
IMPACT
Research is needed on ways to improve access to insulin pumps and address persistent inequities in use of the devices, which are known to improve health and quality of life for people with type 1 diabetes.
COMMENT
“Diabetes technology has numerous benefits for patients with type 1 diabetes, but the problem is that there is a huge divide in who actually has access to these technologies,” said study lead Dr. Estelle Everett, assistant professor of medicine in the division of endocrinology, diabetes & metabolism at the David Geffen School of Medicine at UCLA. “Our study found that over the past 20 years, despite the overall increase in the use of insulin pumps, racial-ethnic minority groups and those of lower socioeconomic status still have unequal access to this very beneficial management tool. This is very concerning because these groups have more challenges managing their diabetes and have higher risk of complications with diabetes, so they may actually gain the most benefit from diabetes technology use. Changes in the approach to diabetes care and health policies are needed to ensure equal access to this life changing diabetes device because everyone deserves an equal opportunity to improve their diabetes health.”
AUTHORS
Additional co-authors are Lauren Wisk of UCLA; Davene Wright of Harvard University; Adrienne Williams of DNA Solutions LLC; Jasmin Divers of New York University; Dr. Catherine Pihoker and Dr. Jason Mendoza of University of Washington; Angela Liese of University of South Carolina; Anna Bellatorre of University of Colorado; Dr. Anna Kahkoska and Elizabeth Mayer-Davis of University of North Carolina at Chapel Hill; and Ronny Bell of Wake Forest University.
FUNDING
The SEARCH for Diabetes in Youth Cohort Study (1R01DK127208-01 and 1UC4DK108173) is funded by the National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases and supported by the Centers for Disease Control and Prevention. The Population Based Registry of Diabetes in Youth Study (1U18DP006131, U18DP006133, U18DP006134, U18DP006136, U18DP006138, and U18DP006139) is funded by the Centers for Disease Control and Prevention (DP-15-002) and supported by the National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases.
IMAGE: BAOTS IN THE MEKONG RIVER DELTA (PHOTO: TSUYOSHI WATANABE).view more
CREDIT: TSUYOSHI WATANABE
The Mekong River Delta is the agricultural heartland of Vietnam; it is affected by droughts and flooding, which have become more severe in recent years. If severe weather events can be more accurately predicted, risk assessments in the regions can be improved. This, in turn, will reduce the negative effects of floods and droughts in the region.
A team led by Tsuyoshi Watanabe at Hokkaido University has revealed the clearest picture yet of how the El Niño Southern Oscillation (ENSO) affected rainfall in the Mekong Delta over the last hundred years. Their findings were published in the journal Scientific Reports. They correlated water salinity data from reef coral samples with historical weather records and uncovered that the ENSO has caused seasons of heavy and light rainfall, resulting in patterns of both flooding and droughts, respectively.
The ENSO occurs in the central and Eastern tropical Pacific ocean, in irregular cycles of two to seven years. It consists of the El Niño (warming of the ocean surface), La Niña (cooling of the ocean surface) and neutral (neither warming, nor cooling).
“We found that heavy rains and flooding have become more severe in recent years, driven by changes in the ENSO due to global warming,” said Watanabe, corresponding author of the study. “The Mekong River Delta will continue to be faced with a higher risk of severe flooding.”
El Niño and La Niña have significant effects on weather patterns and extreme weather events in these regions. Understanding the weather patterns caused by ENSO in the Mekong River Delta (MRD) is critical to ensuring a stable food supply.
The team headed by Watanabe discovered a reef coral on Con Dao Island, 90 km south of the MRD. From a core sample of this coral, they were able to determine monthly fluctuations in the salinity of the surrounding water. “Reef corals have growth rings, similar to trees,” says Watanabe. “These rings preserve a record of the salinity of the surrounding water in each year. The reef coral we sampled was on Con Dao Island, close to the MRD; as a result, the salinity records can be associated with increased or decreased rainfall in the MRD—and hence with flooding or droughts.”
Combining the salinity data with historical annual rainfall maximums allowed the team to extend rainfall data back to 1924.
Analysis of this rainfall data showed that the hydrological changes in the MRD are affected by El Niño and La Niña in the Central Pacific Ocean — associated with light rain and heavy rain in the MRD respectively. In particular, heavy rain in the MRD is strongly associated with La Niña in the recent past, while the association between light rain and El Niño have been consistent during the last century.
This improved understanding of the effects of the ENSO in the Mekong River Delta will allow for more accurate weather predictions in the future. This should also enable better preparation for extreme weather events, increasing both safety of the population and food security.
This press release is dedicated to the memory of Dr. Tung Thanh Phan, co-first author, who unexpectedly passed away on October 28, 2022. This study is partially based on the results of his doctoral research.
(Left) A map showing the amount of rainfall across South East Asia in October from 1980 to 2005 (Takaaki K. Watanabe, Tung Thanh Phan, et al. Scientific Reports. December 7, 2022). (right) A satellite photo of the Mekong River Delta (Google Earth).
CREDIT
Takaaki K. Watanabe, Tung Thanh Phan, et al. Scientific Reports. December 7, 2022; Google Earth
Members of the Coral Reef Environmental Earth Sciences Laboratory including key members of the research team. From the left, Atsuko Yamazaki (co-author), Kevin Garas, Kaeru Takeuchi, Tung Thanh Phan (co-first author), Tsuyoshi Watanabe (corresponding author), Takaaki K. Watanabe (co-first author) and Motoya Odajima (Photo: Tsuyoshi Watanabe).
IMAGE: WHERE DID AMERICANS MOVE OVER THE LAST DECADE? RESEARCH SHOWS THAT THE TOP MIGRATION DESTINATIONS (SHOWN IN RED) ALL FACE SIGNIFICANT CLIMATE RISKS, INCLUDING CITIES AND SUBURBS IN THE PACIFIC NORTHWEST, PARTS OF THE SOUTHWEST (IN ARIZONA, COLORADO, NEVADA, UTAH), TEXAS, FLORIDA, AND A LARGE SWATH OF THE SOUTHEAST (FROM NASHVILLE TO ATLANTA TO WASHINGTON, D.C.). IN CONTRAST, PEOPLE TENDED TO MOVE AWAY FROM PLACES (SHOWN IN BLUE) IN THE MIDWEST, THE GREAT PLAINS, AND ALONG THE MISSISSIPPI RIVER, INCLUDING MANY COUNTIES HIT HARDEST BY HURRICANES OR FREQUENT HEATWAVES, THE STUDY SHOWS.view more
CREDIT: M. CLARK, G. GALFORD, E. NKONA
Americans are leaving many of the U.S. counties hit hardest by hurricanes and heatwaves—and moving towards dangerous wildfires and warmer temperatures, finds one of the largest studies of U.S. migration and natural disasters.
The ten-year national study reveals troubling public health patterns, with Americans flocking to regions with the greatest risk of wildfires and significant summer heat. These environmental hazards are already causing significant damage to people and property each year—and projected to worsen with climate change.
“These findings are concerning, because people are moving into harm’s way—into regions with wildfires and rising temperatures, which are expected to become more extreme due to climate change,” said the University of Vermont (UVM) study lead author Mahalia Clark, noting that the study was inspired by the increasing number of headlines of record-breaking natural disasters.
Published by the journal Frontiers in Human Dynamics on December 8, the study—titled “Flocking to Fire”—is the largest investigation yet of how natural disasters, climate change and other factors impacted U.S. migration over the last decade (2010-2020). “Our goal was to understand how extreme weather is influencing migration as it becomes more severe with climate change,” Clark said.
The top U.S. migration destinations over the last decade were cities and suburbs in the Pacific Northwest, parts of the Southwest (in Arizona, Colorado, Nevada, Utah), Texas, Florida, and a large swath of the Southeast (from Nashville to Atlanta to Washington, D.C.)—locations that already face significant wildfire risks and relatively warm annual temperatures, the study shows. In contrast, people tended to move away from places in the Midwest, the Great Plains, and along the Mississippi River, including many counties hit hardest by hurricanes or frequent heatwaves, the researchers say. (See maps for migration hotspots.)
“These findings suggest that, for many Americans, the risks and dangers of living in hurricane zones may be starting to outweigh the benefits of life in those areas,” said UVM co-author Gillian Galford. “That same type of tipping point has yet to happen for wildfires and rising summer heat, our results suggest, probably because they’ve only become problems at the national level more recently.”
One implication of the study—given how development can exacerbate risks in fire-prone areas—is that city planners may need to consider discouraging new development where fires are most likely or difficult to fight, researchers say. At a minimum, policymakers must consider fire prevention in areas of high risk with large growth in human populations, and work to increase public awareness and preparedness.
“We hope this study will increase people’s awareness of wildfire risk,” said Clark, noting the study includes several maps highlighting the severity of national hazards across the country. “When you’re looking for a place to live on Zillow or through real-estate agents, most don’t highlight that you’re looking at a fire-prone region, or a place where summer heat is expected to become extreme. You have to do your research,” said Clark, noting the website Redfin recently added risk scores to listings.
Despite climate change’s underlying role in extreme weather events, the team was surprised by how little the obvious climate impacts of wildfire and heat seemed to impact migration. “If you look where people are going, these are some of the country’s warmest places—which are only expected to get hotter.”
“Most people still think of wildfires as just a problem in the West, but wildfire now impacts large swaths of the country—the Northwest down to the Southwest, but also parts of the Midwest and the Southeast like Appalachia and Florida,” said Clark, a researcher at UVM’s Gund Institute for Environment and Rubenstein School of Environment and Natural Resources.
Beyond the aversion to hurricanes and heatwaves, the study identified several other clear preferences—a mix of environmental, social, and economic factors—that also contributed to U.S. migration decisions over the last decade.
The team’s analysis revealed a set of common qualities shared among the top migration destinations: warmer winters, proximity to water, moderate tree cover, moderate population density, better human development index (HDI) scores—plus wildfire risks. In contrast, for the counties people left, common traits included low employment, higher income inequality, and more summer humidity, heatwaves, and hurricanes.
Researchers note that Florida remained a top migration destination, despite a history of hurricanes—and increasing wildfire. While nationally, people were less attracted to counties hit by hurricanes, many people—particularly retirees—still moved to Florida, attracted by the warm climate, beaches, and other qualities shared by top migration destinations. Although hurricanes likely factor into people’s choices, the study suggests that, overall, the benefits of Florida’s desirable amenities still outweigh the perceived risks of life there, researchers say.
“The decision to move is a complicated and personal decision that involves weighing dozens of factors,” said Clark. “Weighing all these factors, we see a general aversion to hurricane risk, but ultimately—as we see in Florida—it’s one factor in a person’s list of pros and cons, which can be outweighed by other preferences.”
For the study, researchers combined census data with data on natural disasters, weather, temperature, land cover, and demographic and socioeconomic factors. While the study includes data from the first year of the COVID pandemic, the researchers plan to delve deeper into the impacts of remote work, house prices, and the cost of living.
The study, “Flocking to Fire: How Climate and Natural Hazards Shape Human Migration Across the United States” is the largest investigation yet of how natural disasters and climate change impacted U.S. migration over the last decade.
As global climate change progresses, the U.S. is expected to experience warmer temperatures, as well as more frequent and severe extreme weather events, including heat waves, hurricanes, wildfires and floods. Each year, these events cost dozens of lives and do billions of dollars worth of damage.
Americans are leaving many of the U.S. counties hit hardest by hurricanes and heatwaves—and moving towards dangerous wildfires and warmer temperatures, finds one of the largest studies of U.S. migration and natural disasters. The ten-year national study reveals troubling public health patterns, with Americans flocking to regions with the greatest risk of wildfires and significant summer heat. These environmental hazards are already causing significant damage to people and property each year—and projected to worsen with climate change.
The climate crisis has caused humans to move both within their countries of origin and across borders. Although climate migration is often treated as a phenomenon of the ‘global south’, a team of scientists led by Mahalia Clark at the University of Vermont (UVM) turned the spotlight on the US. The US has experienced numerous destructive weather events recently, which have killed and injured many people and done billions of dollars of damage. But the team found that despite the death toll, more people are moving to areas in the United States that are at serious risk of wildfires.
“Our original motivation was the increasing number of headlines each year about record breaking heat waves, hurricanes, and wildfires,” said Clark, a researcher at UVM’s Gund Institute for Environment. “I had been studying natural amenities — features of the climate and environment that are attractive to movers — but I began to wonder if the threat of these hazards might have a deterring effect on migration.”
Homes in danger
Clark and her team created a dataset that combined census data from 2010-2020 with data on temperature, weather, landscape, demographic variables, and socioeconomic factors. They focused particularly on the availability of natural amenities, although they suspected that in metropolitan areas, these would be less influential. The data agreed: economic factors played a larger role in migration decisions around built-up areas than natural amenities.
Natural hazards affect different regions differently. This is particularly true for heatwaves, because dangerous temperatures depend on how acclimatized the population is and the availability of mitigations like air conditioning. However, the effects of natural hazards can be underestimated outside key areas. The authors found that people in the US moved away from areas with frequent hurricanes but towards areas with higher year-round temperatures and a higher wildfire risk.
“This suggests that people may be drawn to the very landscapes that are most prone to wildfires, which is concerning given that wildfires are expected to increase in frequency and intensity with climate change,” said Clark. “We also found increased migration into metropolitan areas with relatively hot summers, where heat will grow deadlier with climate change.”
Fireproofing for the future
Some risk is dependent on preparation and planning. Long-term residents may have acclimatized to local hazards, while newcomers may not be aware of or may have discounted the dangers. They may also have decided that the risk of wildfire is worth it to live somewhere desirable – or they may not be able to leave.
Clark and her team point out that their analysis is necessarily incomplete. The team could not include data on family ties, professional networks, housing values and the cost of living, which also play a part in migration. There is also no data yet on how the rise of remote work will affect people’s choices about where they live.
“I hope our work will increase people’s awareness of their exposure to wildfires,” said Clark. “Americans tend to think of wildfires as something affecting the west, but they are also a threat across large swaths of the south and even midwest. Our findings highlight the need for policymakers in affected areas to prioritize sufficient firefighting and fire prevention resources for a growing population, to increase public awareness and preparedness, and perhaps even to discourage new development in areas where fires are most likely or most difficult to fight.”
Flocking to Fire: How Climate and Natural Hazards Shape Human Migration Across the United States
ARTICLE PUBLICATION DATE
8-Dec-2022
COI STATEMENT
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest
People with disabilities who mis-use opioid drugs 73% more likely to attempt suicide, national US study finds
People who take medical opioid drugs without a doctor’s prescription are 37% more likely than non-users to plan suicide – and the risk is even greater for those with disabilities, who have 73% higher odds of attempting to take their own life.
The findings are from a study of over 38,000 adults who took part in the US National Survey on Drug Use and Health in 2019, published in the peer-reviewed journal Substance Use and Misuse.
“Suicide can be understood as a severe expression of psychological distress, and people with disabilities are likely under-identified and under-treated for mental health issues which may result in increased risks for suicidality, especially in the context of the opioid epidemic,” says lead author Keith Chan an Assistant Professor, from Hunter College, New York.
Since the 1990s, the US has been in the grip of an opioid crisis; widespread over-use and mis-use of medical opioid drugs which are intended to be prescribed as painkillers.
According to the US Department of Health and Human Services, in 2019 alone 10.1 million people misused opioid drugs and there were 48,000 deaths from overdosing on medical opioids (for example Methadone, OxyContin and Vicodin).
The research, co-authored by Dr. Christina Marsack-Topolewski from Eastern Michigan University, looked at the link between non-medical prescription opioid use and suicide among people with and without disabilities.
While this study is not the first to look at how opioid misuse affects suicide risk, few have looked at the problem in people with disabilities.
Of the 38,000 people who responded to the national survey, 1,621 (3.6%) reported that they had mis-used medical prescription opioids over the past year, defined as any use of prescription opioid pain relievers which was not directed by a doctor. Twice as many people with disabilities taking part in the study (nearly 6%) reported that they mis-used opioids, compared to 3.0% of people without disabilities.
Consistent with past research, those mis-using drugs were more likely to have serious thoughts of suicide, a plan for suicide and to have made an attempt on their own life over the past year. They were also more likely to be young, male, unmarried and living on a low income, and less likely to be a college graduate, the research showed.
What is more, those with a disability were around three times more likely than non-disabled drug mis-users to report suicidal thoughts (12.6% compared to 4.2%), to have made a suicide plan (5.5% compared to 1.3%) or to have made a suicide attempt (3.9% compared to 0.8%) over the past year. That remained true even when other factors such as using other substances, self-rated health, mental health and health access were taken into account.
Previous research has shown that people with disabilities are both prescribed more opiates and are more likely to mis-use them. Medicare beneficiaries with a disability are one of the fastest growing groups of people to be hospitalized for opioid or heroin poisoning, and 23% are chronic users of the drugs. Mis-using opioids to help deal with difficult feelings or emotions is also more common among those with disabilities.
“Many people with disabilities have real and ongoing needs to manage pain, and more research is needed to identify alternatives that can be effective while addressing mental health for this population,” adds Chan, from the Silberman School of Social Work at Hunter.
“We recommend that healthcare professionals who work with people with disabilities take into account the risks of suicide for those with a history of prescription opioid misuse. There is a need for effective mental health services tailored for people with disabilities to address the impact of the opioid epidemic.“
The findings highlight that critical investments in mental health infrastructure may be what is necessary to address the impact of the opioid epidemic for vulnerable populations such as people with disabilities.
“Health workers can serve as a nexus point in effectively engaging at-risk people with disabilities in substance use and mental health prevention and recovery services,” says Marsack-Topolewski from the School of Social Work at East Michigan.
Future research could expand on this analysis by examining trends across years and across a range of ages and disability types and looking at how these groups get access to treatment, add the authors.
The Association of Opioid Misuse and Suicidality among People with Disabilities
ARTICLE PUBLICATION DATE
8-Dec-2022
Adding yoga to regular exercise improves cardiovascular health and wellbeing
A pilot study in patients with hypertension concludes that adding yoga to regular exercise is better than stretch exercises alone, report investigators in the Canadian Journal of Cardiology
Philadelphia, December 8, 2022 – A three-month pilot study of patients with hypertension appearing in the Canadian Journal of Cardiology, published by Elsevier, demonstrates that adding yoga to a regular exercise training regimen supports cardiovascular health and wellbeing and is more effective than stretching exercises. Incorporation of yoga reduced systolic blood pressure and resting heart rate and improved 10-year cardiovascular risk.
Yoga is part of spiritual and exercise practices for millions of people worldwide. With yoga practice becoming a widely accepted form of exercise, the body of yoga research is growing. It is a multifaceted lifestyle activity that can positively enhance cardiovascular health and wellbeing. Physical exercises such as stretching exercises and the physical components of yoga practices have several similarities, but also important differences.
“The aim of this pilot study was to determine whether the addition of yoga to a regular exercise training regimen reduces cardiovascular risk,” explained lead investigator Paul Poirier, MD, PhD, Quebec Heart and Lung Institute – Laval University, and Faculty of Pharmacy, Laval University, Quebec, Canada. “While there is some evidence that yoga interventions and exercise have equal and/or superior cardiovascular outcomes, there is considerable variability in yoga types, components, frequency, session length, duration, and intensity. We sought to apply a rigorous scientific approach to identify cardiovascular risk factors for which yoga is beneficial for at-risk patients and ways it could be applied in a healthcare setting such as a primary prevention program.”
Investigators recruited 60 individuals with previously diagnosed high blood pressure and metabolic syndrome for an exercise training program. Over the 3-month intervention regimen, participants were divided into 2 groups, which performed 15 minutes of either structured yoga or stretching in addition to 30 minutes of aerobic exercise training 5 times weekly. Blood pressure, anthropometry, high-sensitivity C-reactive protein (hs-CRP), glucose and lipids levels as well as the Framingham and Reynolds Risk Scores were measured. At baseline, there was no difference between groups in age, sex, smoking rates, body mass index (BMI), resting systolic and diastolic blood pressure, resting heart rate and pulse pressure.
After 3 months, there was a decrease in resting systolic and diastolic blood pressure, mean arterial blood pressure and heart rate in both groups. However, systolic blood pressure was reduced by 10 mmHg with yoga vs 4 mmHg with stretching. The yoga approach also reduced resting heart rate and 10-year cardiovascular risk assessed using Reynold's Risk score.
While yoga has been shown to benefit hypertensive patients, the exact mechanism underlying this positive effect is not fully understood. This pilot randomized study shows that its benefits cannot be simply attributed to stretching alone.
“This study provides evidence for an additional non-pharmacologic therapy option for cardiovascular risk reduction and blood pressure control in patients with high blood pressure, in the setting of a primary prevention exercise program,” noted Dr. Poirier. “As observed in several studies, we recommend that patients try to find exercise and stress relief for the management of hypertension and cardiovascular disease in whatever form they find most appealing. Our study shows that structured yoga practices can be a healthier addition to aerobic exercise than simply muscle stretching.”
IMAGE: THE BEST AND POOREST QUALITY HOSPITALS AND CLINICS IN HO CHI MINH CITY. THE BEST HOSPITALS AND CLINICS ARE MARKED RED AND THE POOREST ARE MARKED BLUE. (HEALTHCARE QUALITY SCORE).view more
CREDIT: THE AUTHORS.
The quality and accessibility of healthcare plays a crucial role in preventing and mitigating health problems. A study conducted in Ho Chi Minh City, Vietnam’s largest city of 9 million residents, showed that people living in the city’s established and new urban areas have access to better-quality and better-accessible healthcare than people living in the suburban areas. According to the researchers, digital healthcare, road improvements and better urban planning could be used to promote more equal healthcare in a cost-effective manner.
Conducted by the University of Eastern Finland, the University of Social Sciences and Humanities – Vietnam National University Ho Chi Minh City, and the Ho Chi Minh City Institute for Development Studies, the study showed that nearly 1.2 million people in Ho Chi Minh City live in deficiently served areas in terms of healthcare. Their travel time to the nearest hospital is more than 30 minutes, and more than 15 minutes to the nearest clinic.
Published in BMC Health Services Research, the study utilised data from public registers on hospitals, health clinics, streets, roads, population, and healthcare quality. The researchers analysed the quality and accessibility of healthcare and, relying on international studies, they also examined the opportunities of digital healthcare to improve the provision of services.
In Ho Chi Minh City, healthcare services are provided by public and private hospitals and clinics. Some hospitals are focused on specialised medical care, while clinics typically provide primary and emergency care. In the city’s new developing urban areas, healthcare facilities have been built in cooperation with private sector developers, thus aiming to improve their accessibility. In suburban areas in the outskirts of the city, however, sporadic demand and small market for healthcare have led to its poor quality and poor accessibility.
“This is a shortcoming that requires action and new solutions. Our study links digital healthcare solutions to the planning of healthcare and urban development, while also providing an example and tools for planning a more equal system of digital and physical healthcare also elsewhere,” says Researcher Khanh Hung Le of Vietnam National University Ho Chi Minh City.
The researchers recommended prompt adoption and development of digital healthcare services by hospitals and clinics capable of doing so, while also setting an example for others.
“Ho Chi Minh City has set the digitalisation of healthcare as a goal in its digital transformation programme for 2030,” Researcher Thi Xuan Phuong La of HCMC Institute for Development Studies notes.
“Remote clinics, self-monitoring, remote monitoring and healthcare applications should be developed in order to improve the quality and cost-effectiveness of healthcare services, for example in situations where the demand for healthcare services is sporadic and the supply does not adequately meet the demand. The development of remote healthcare services would also reduce the need for travel,” says Professor Markku Tykkyläinen of the University of Eastern Finland.
The map shows how patients in the urban areas of the city are most likely to receive the best-quality healthcare, and where the best-quality healthcare facilities are concentrated.
Hospital Service Areas. Maximum patient travel time 10, 20 and 30 minutes and respective distances along the street and road network to the nearest hospital at the average speed of 20 km/h. (Service Area).
Clinic service areas. Maximum patient travel time 5, 10 and 15 minutes and respective distances along the street and road network to the nearest clinic at the average speed of 20 km/h. (Service Area).
