A hot topic for health: Results of the Global Sauna Survey

ObjectiveSauna-bathing is an ancient tradition that is gaining popularity across the world as a wellness tool. There is a growing body of medical evidence supporting the role of saunas, or whole-body thermotherapy, as a form of treatment for a range of health issues. However, the demographics, motivations and experiences of current sauna bathers have not yet been explored on a global scale. This study is designed to explore these themes.DesignAn online 71-item questionnaire compiling information on the individual characteristics, sauna-related habits and perceived health and wellness experiences of regular sauna bathers was conducted from October 2016 to October 2017. The validated ‘SF-12’ quality of life scoring tool was incorporated into the questionnaire to measure physical and mental indicators of well-being.ResultsOf 572 logins recorded, 482 valid responses were generated. Both men (51.3%) and women (48.7%) were represented, and respondents were predominantly well-educated (81.8%), non-smoking (90.6%), regularly-exercising (78.8%) individuals of normal-to-overweight status (87.1%) who sauna-bathed approximately 1–2 times per week. The key reasons indicated by respondents for sauna-bathing included relaxation/stress reduction, pain relief and socializing. Nearly a third of respondents reported medical conditions and of this subset, those with back/musculoskeletal pain and mental issues cited the greatest improvements in their conditions with sauna-bathing. Of all respondents, 83.5% reported sleep benefits after sauna use. Analysis of well-being scores after stratifying respondents into three groups by sauna-bathing frequency (group I: <5 times per month; group II: 5–15 times per month; group III: >15 times per month) revealed group II respondents had slightly higher mental well-being scores (Kruskal–Wallis testing: H = 6.603 > ꭔ2 of 5.991, p = 0.0368, df = 2 with post hoc analysis using Mann–Whitney U test: p = 0.016) as compared to respondents who were sauna-bathing less frequently (group I). No respective differences were detected between the physical well-being scores of any of the three groups. Adverse reactions to sauna-bathing were recorded as mostly minor (93.1%), including primarily symptoms of dizziness, dehydration and headache. However, there were two reports (0.3%) of chest pain and eye irritation requiring hospitalization.ConclusionsThis cross-sectional study documents that sauna-bathing participants, particularly those from Finland, Australia and the United States, are motivated to use saunas predominantly for relaxation, reporting health benefits especially around mental well-being and sleep, with relatively few adverse effects. While these results reinforce some of the known health benefits of sauna bathing, they indicate that further research and better dissemination of existing evidence is needed to fully develop the sauna's potential as a therapeutic intervention.     

Longitudinal associations of sauna bathing with inflammation and oxidative stress: the KIHD prospective cohort study

Purpose: We sought to determine cross-sectional and longitudinal associations of frequency of sauna bathing with high sensitivity C-reactive protein (hsCRP), fibrinogen, leucocyte count and gamma-glutamyltransferase (GGT).

Design: Baseline sauna bathing habits were assessed in 2269 men aged 42–61 years. Concentrations of hsCRP, fibrinogen, leucocyte count, and GGT were determined at baseline and 11 years later. The associations of sauna bathing frequency with baseline and 11-year hsCRP, fibrinogen, leucocyte count, and GGT levels were examined using robust multivariate regression analyses.

Results: In baseline analysis, 4–7 sauna sessions/week (compared with 1 sauna session/week) was associated with ?0.84?mg/l (95% CI, ?1.55, ?0.14; p?=?.019) lower hsCRP; ?0.07?g/l (95% CI, ?0.15, 0.02; p?=?.112) lower fibrinogen; and ?0.28?×?10⁹/l (95% CI, ?0.51, ?0.06; p?=?.015) lower leucocyte count, after multivariable adjustment. In longitudinal analysis, the corresponding estimates were ?1.66?mg/l (95% CI, ?3.13, ?0.19; p?=?.027); ?0.16?g/l (95% CI, ?0.31, ?0.02; p?=?.031); and ?0.49?×?10⁹/l (95% CI, ?0.85, ?0.14; p?=?.007) respectively. Sauna bathing frequency was not associated with GGT at baseline and 11 years.

Conclusion: Observational evidence supports the hypothesis that reduction in inflammation may be one of the pathways linking frequent sauna bathing with decreased risk of acute and chronic disease conditions.

• KEY MESSAGES

• Cross-sectional evidence or short-term studies suggest Finnish sauna bathing may exert its beneficial health effects via reduction in inflammation and oxidative stress; however, the long-term effects of sauna bathing on these outcomes are uncertain.

• In this population-based prospective cohort study, frequent sauna sessions significantly decreased levels of inflammatory markers at baseline and 11-year follow-up; but had no effect on oxidative stress.

• The health benefits of sauna bathing may in part be mediated via reduced systemic inflammation.

     

Breastfeeding in the context of the COVID-19 pandemic: A discussion paper

Breastfeeding offers one of the most fundamental global health benefits for babies. Breastmilk is lifesaving, providing not only nutrition but immunologic benefits and as such is strongly supported by the World Health Organization and leading healthcare associations worldwide. When the COVID-19 pandemic started in 2020, the impact of the restrictions to prevent the spread of the disease created challenges and questions about provision of safe, quality care, including breastfeeding practices, in a new ‘normal’ environment. Mothers were temporarily separated from their babies where infection was present or suspected, parents were prevented from being present on neonatal units and vital breastfeeding support was prevented. This discussion paper provides an overview of essential areas of knowledge related to practice for neonatal nurses and midwives who care for breastfeeding mothers and babies, in the context of the COVID-19 pandemic and the latest global guidance. Three areas will be discussed; the protective benefits of breastfeeding, keeping breastfeeding mothers and babies together and supporting mothers to breastfeed their babies. Finally, care recommendations are presented to serve as a summary of key points for application to practice for neonatal nurses and midwives.     

COVID-19 impact on the liver

The coronavirus disease 2019 (COVID-19) pandemic imposed arestructuring of global health systems by rethinking spaces used for the care of these patients and the additions of intensive care, infectious diseases and pneumology departments. This paper provides evidence on the presence of severe acute respiratory syndrome coronavirus 2 in hepatocytes and its direct cytopathic activity, as well as the degree of liver damage due to drug toxicity, inflammation and hypoxia in COVID-19. A review of clinical trials has quantified liver damage through both pathology and biochemistry studies. Additionally, we briefly present the results of a study conducted in our clinic on 849 patients admitted for COVID-19 treatment, of which 31 patients had pre-existing chronic liver disease and 388 patients had values above the normal limit for alanine aminotransferase, aspartate aminotransferase, and total bilirubin. It was observed that patients with abnormal liver tests were significantly statistically older, had more comorbidities and had a higher percentage of unfavourable evolution (death or transfer to intensive care). The conclusion of this paper is that the main causes of liver damage are direct viral aggression, coagulation dysfunction and endothelial damage, and patients with impaired liver function develop more severe forms of COVID-19 which requires special care by a multidisciplinary team that includes a hepatologist.     

Age-dependent impact of the major common genetic risk factor for COVID-19 on severity and mortality

BackgroundThere is considerable variability in COVID-19 outcomes among younger adults, and some of this variation may be due to genetic predisposition.MethodsWe combined individual level data from 13,888 COVID-19 patients (n = 7185 hospitalized) from 17 cohorts in 9 countries to assess the association of the major common COVID-19 genetic risk factor (chromosome 3 locus tagged by rs10490770) with mortality, COVID-19-related complications, and laboratory values. We next performed metaanalyses using FinnGen and the Columbia University COVID-19 Biobank.ResultsWe found that rs10490770 risk allele carriers experienced an increased risk of all-cause mortality (HR, 1.4; 95% CI, 1.2–1.7). Risk allele carriers had increased odds of several COVID-19 complications: severe respiratory failure (OR, 2.1; 95% CI, 1.6–2.6), venous thromboembolism (OR, 1.7; 95% CI, 1.2–2.4), and hepatic injury (OR, 1.5; 95% CI, 1.2–2.0). Risk allele carriers age 60 years and younger had higher odds of death or severe respiratory failure (OR, 2.7; 95% CI, 1.8–3.9) compared with those of more than 60 years (OR, 1.5; 95% CI, 1.2–1.8; interaction, P = 0.038). Among individuals 60 years and younger who died or experienced severe respiratory failure, 32.3% were risk-variant carriers compared with 13.9% of those not experiencing these outcomes. This risk variant improved the prediction of death or severe respiratory failure similarly to, or better than, most established clinical risk factors.ConclusionsThe major common COVID-19 genetic risk factor is associated with increased risks of morbidity and mortality, which are more pronounced among individuals 60 years or younger. The effect was similar in magnitude and more common than most established clinical risk factors, suggesting potential implications for future clinical risk management.     

COVID-19: Highlighting Health Disparities in the Los Angeles Latinx Community

Objective: Characterization of COVID-19 in the Latinx community is necessary for guiding public health initiatives, health system policy, clinical management practices, and improving outcomes. Our aim was to describe the socioeconomic background and clinical profile of patients with COVID-19 at a large public hospital in Los Angeles to improve health disparities leading to poor outcomes during the pandemic.Design, Setting and Participants: A single center retrospective cross-sectional study of all patients with a positive polymerase chain reaction (PCR) test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who presented to Los Angeles County (LAC)+University of Southern California (USC) Medical Center between March 15, 2020 and April 30, 2020.Methods: We describe patient characteristics, socioeconomic factors, laboratory findings, and outcomes of the first 278 patients to present to LAC+USC Medical Center with COVID-19.Results: Patients self-identified as Hispanic (82.4%) or non-Hispanic (17.6%). Hispanic patients presented later from symptom onset (6 days vs 3 days, P = 0.027) and had higher post-intubation mortality (40.9% vs. 33.3%, P = 1), intensive care unit (ICU) mortality (31.1% vs. 22.2%, P = 0.87), and overall mortality (11.1% vs 10.2%, P = 1). However, the difference in admission rates, mechanical ventilation rates, and overall mortality rates were not statistically significant. A majority of patients, 275/278 (98.9%), reported residency ZIP codes in areas of higher population density, higher percentage of Latinx, born outside the United States, lower median income, and lower high school graduation rate when compared to the rest of Los Angeles County. Regression analysis within the Hispanic cohort found that age, history of hypertension, history of diabetes, lactate dehydrogenase (LDH), and C-reactive protein (CRP) were predictors of mechanical ventilation and mortality.Conclusion: We show the Latinx community has been disproportionally affected by the pandemic in Los Angeles and we identified multiple socioeconomic and clinical characteristics that predispose this population to COVID-19 infection. This study highlights the need for change in local and national strategies to protect vulnerable communities during public health outbreaks.     

Recognizing the Clinical Sequelae of COVID-19 in Adults: COVID-19 Long-Haulers

As the numbers of acute severe acute respiratory syndrome coronavirus 2 infections continue to rise, we are learning that symptoms do not resolve quickly in all patients. Although why some patients experience persistent symptoms is not clear, these individuals suffer. Long-hauler is the term that is associated with these persistent symptoms, and this review of the literature provides information to nurse practitioners working in primary care about symptoms, risk factors, and resources for disease management.     

COVID-19 pandemic and exacerbation of ulcerative colitis

BACKGROUNDIn 2020, the world faced the unprecedented crisis of coronavirus disease 2019 (COVID-19). Besides the infection and its consequences, COVID-19 also resulted in anxiety and stress resulting from severe restrictions on economic and social activities, including for patients with ulcerative colitis (UC). Fresh acute stress exerts stronger influences than continuous stress on UC patients. We therefore hypothesized that the first wave of the COVID-19 pandemic would have serious effects on UC patients and performed this retrospective control study.AIMTo determine whether the first wave of the COVID-19 pandemic would have serious effects on UC patients included in a retrospective controlled study.METHODSA total of 289 consecutive UC outpatients seen in March and April 2020 were included in this study. Modified UC disease activity index (UC-DAI) scores on the day of entry and at the previous visit were compared. An increase of ≥ 2 was considered to indicate exacerbation. The exacerbation rate was also compared with that in 256 consecutive control patients independently included in the study from the same period of the previous year in the same manner.RESULTSNo significant differences in patient characteristics or pharmacotherapies before entry were seen between the groups. Mean UC-DAI score was significantly higher in subjects during the first wave of COVID-19 (0.67 + 0.07) compared to the previous visit (0.26 + 0.04; P = 0.0000). The exacerbation rate was significantly increased during the first wave of COVID-19, as compared with the previous year (15.9% [46/289] vs 8.9% [23/256]; P = 0.0151).CONCLUSIONThis study demonstrated that the COVID-19 pandemic caused exacerbations in UC patients, probably through psychological and physical stress.     

不忘“三心”,铸就防御防护城

防控新型冠状病毒肺炎疫情已进入关键阶段,随着死亡病例的增加,人们对疫情恐慌的同时,让心搏骤停这一关键词再次进入大众的视野,包括新型冠状病毒肺炎在内导致的死亡,其前都会出现心跳呼吸停止,因此,如何认识心搏骤停产生的原因,采取因人而异的心肺复苏方法,管好原发病毒害心、继发病症攻心、并发病魔伤心这"三心",是提高新型冠状病毒肺炎心搏骤停患者救治成功率的重要环节。     

新型冠状肺炎疫情对一线医务人员心理状态影响

目的：探究新冠疫情对驰援武汉一线的医务人员心理状态影响,探究各个心理状态间是否存在联系。 方法：受访者为复旦大学附属中山医院援助武汉医务人员,采用一般情况调查表、匹兹堡睡眠质量指数、广泛焦虑量表、病人健康问卷-9、创伤应激后障碍量表进行评估。数据分析采用Mann-Whitney U检验、Kruskal-Wallis H检验以及多重线性回归。结果采取双侧检验,p＜0.05认为具有统计学上显著差异。 结果：采用Mann-Whitney U检验,发现在睡眠质量上,性别间差异具有统计学意义（p＜0.05,U=1500）。采用Kruskal-Wallis H检验,发现不同教育程度对PCL-5得分存在影响（H=7.901,p=0.048）;对不同教育程度组采用Mann-Whitney U检验进行两两比较,创伤应激后障碍量表得分在专科组与学士组中存在差异。多重线性回归分析显示,睡眠质量、焦虑对抑郁存在影响,匹兹堡睡眠质量指数斜率为0.072,广泛焦虑量表斜率为0.778,截距为-0.016。回归模型具有统计学意义,F=65.467, p=0.000, 调整R2=0.481。 结论：本研究显示医务工作者心理状态总体处于良好水平,受疫情影响并不显著。可能与他们并未受到疫情爆发时的直接冲击,有较长准备时间;医务人员受到社 会各界广泛支持;临床工作繁重,医务人员无暇顾及心理状态以及党员在其中起到带头作用有关。     

Transition beyond the acute phase of the COVID-19 pandemic: Need to address the long-term health impacts of COVID-19

Despite gaps in knowledge, long-term sequelae of coronavirus disease 2019 (COVID-19) infections are globally acknowledged and thus require special attention by public health organizations and services. Therefore, it is necessary to support and promote public health initiatives that address long-term disability due to COVID-19.     

COVID-19 and Depression

The COVID-19 pandemic embodies overwhelming stresses—unemployment, death, and isolation, among others. When called upon, clinicians must try to sort out demoralization from depression. This commentary discerns the characteristics of demoralization versus depression, and suggests solutions for both, together with a cautionary word on the use chloroquine and hydroxychloroquine in patients with COVID-19.     

检验医学在抗击新型冠状病毒肺炎中发展

检验医学在抗击COVID-19中得到了很大发展和提高。总结经验,发现不足,将有助于我们今后更好地向前发展。     

Diabetes or endocrinopathy admitted in the COVID-19 ward

The Covid-19 pandemic confronted us with unknown clinical pictures, also in diabetology and endocrinology. Sharing clinical experiences is therefore of enormous importance. Actually, information about the care given in the Covid-19 ward (in contrast to that provided in the Emergency Room/ICU) is still sparse. The last weeks we built experience and gathered knowledge while giving hospital care to patients who had a pre-existent endocrine disease (and diabetes; most patients suffered from a type two diabetes). In our contribution we presented our insights obtained from this intensive period obtained in the Covid-19 ward.     

新型冠状病毒肺炎定点医院建设经验

吉林市中心医院在疫情初期迅速果断地申请成为吉林市新型冠状病毒肺炎（简称新冠肺炎）救治的定点医院。根据定点医院评估标准迅速有效地完成改造，第一时间接收新冠肺炎患者，践行了“生命至上、人民至上”的总方针，以集中救治为核心，实现了“应收尽收”“应治尽治”。多团队、多学科协同配合，集中力量救治吉林市急危重症新冠肺炎患者。医疗工作有序开展，防控工作科学规范。我院共组织协调了省内外医疗队9支，收治患者4670例，救治成功率为99.96%，为吉林市“清零”奠定了坚实的基础。本文对该院新冠肺炎救治工作的运行管理经验总结如下，以资参考借鉴。