More than half of drinkers aged 59 and over have been heavy drinkers and this is linked to a significantly larger waistline and increased stroke risk, according to a new UCL study.

The study, published in the journal Addiction, examined the association between heavy drinking over a lifetime and a range of health indicators including cardiovascular disease.

The researchers used data from the Whitehall II cohort, which collected information from UK civil servants, aged 34-56 years at study outset, since 1985-88. The final sample for this study was made up of 4,820 older adults, aged between 59 and 83 years. The mean (average) age was 69, and 75% were male.

It found that heavy alcohol consumption over a lifetime is associated with higher blood pressure, poorer liver function, increased stroke risk, larger waist circumferences and body mass index (BMI) in later life, even if you stop drinking heavily before age 50. However, stopping heavy drinking at any point in life is likely to be beneficial for overall health.

Dr Linda Ng Fat (UCL Institute of Epidemiology & Health Care), first author on the study, said: “Alcohol misuse, despite the common perception of young people binge drinking, is common among older adults, with alcohol related hospital admissions in England being the highest among adults aged over 50.

“Previous studies have focused on single snapshots of consumption, which has the potential to mask the cumulative effects of drinking. This study raises awareness of the effect of alcohol consumption over the life-course.”

A heavy drinker was identified using the Alcohol Use Disorders Identification Test for Consumption (AUDIT-C), a standard screening tool for GPs. The screening tool consists of just three questions, and assesses how often you drink, how much you drink, and how often you binge (have six or more drinks). To provide an example a person who has three or four drinks, four or more times a week, would score positive as a hazardous drinker on the AUDIT-C.

Participants were asked on a single occasion to complete the AUDIT-C retrospectively for each decade of their life, from 16-19 to 80 and over. This information was used to categorise their life-time drinking pattern: never hazardous drinker, former early hazardous drinker (stopped before age 50), former later hazardous drinker (stopped at age 50 or after), current hazardous drinker, and consistent hazardous drinker (during every decade of their life).

More than half of drinkers (56%) had been hazardous drinkers at some point in their life, with 21% being current hazardous drinkers and 5% being consistent hazardous drinkers.

Current and consistent heavy drinkers were mainly male (80% and 82%, respectively), predominately white, and likely to be in senior level jobs (61% compared with 52% in the total sample).

Former later, current and consistent hazardous drinkers had significantly higher systolic blood pressure and poorer liver function, than never hazardous drinkers, after adjusting for lifestyle factors. Among current hazardous drinkers, systolic blood pressure was 2.44 mmHG higher and gamma-glutamyl transferase (GGT), a marker of liver disease, was elevated by 22.64 IU/l, compared with never hazardous drinkers.

Current hazardous drinkers had three times greater risk of stroke and former later hazardous drinkers had approximately two times higher risk of non-cardiovascular disease mortality compared with never hazardous drinkers.

Lifetime hazardous drinkers had significantly larger waist circumferences and BMI than never hazardous drinkers, with the magnitude increasing with more current and consistent hazardous drinking.

Former early hazardous drinkers on average had a 1.17 cm larger waist than never hazardous drinkers, whereas former later hazardous drinkers, current hazardous drinkers and consistent hazardous drinkers had a waist circumference that was 1.88 cm, 2.44 cm and 3.85cm larger respectively.

Dr Ng Fat added: “This suggests that the longer adults engage in heavy drinking the larger their waistline in older age. That is why it is beneficial, along with other health benefits, that adults reduce heavy drinking earlier rather than later.”

Professor Annie Britton (UCL Institute of Epidemiology & Health Care), senior author on the study, said: “Despite high prevalence of stroke and liver disease steadily increasing… heavy drinking remains common among older adults.” And so “early intervention and screening for alcohol consumption, as part of regular check-ups, could help reduce hazardous drinking among this demographic.”

The research was carried out with University of Cambridge. It was funded by the UK Medical Research Council/Alcohol Research UK and European Research Council.

It is worth noting that alcoholism is an issue for many members of the LGBTQIA community. In 2017, for instance, a study found that bisexual people have higher odds of engaging in alcohol use behaviors when compared with people from the sexual majority. This is according to a study that – also worth highlighting – similarly found that bullying mediated sexual minority status and alcohol use more particularly among bisexual females.

A multistate study of Medicaid enrollees led by researchers at The Ohio State University Wexner Medical Center found that suicide risk was highest among youth with epilepsy, depression, schizophrenia, substance use and bipolar disorder. In addition, the odds of suicide decreased among those who had more mental health visits within the 30 days before the date of suicide.

Researchers compared the clinical profiles and mental health service patterns of children and adolescents who had died by suicide to see how they differed from the general population. The findings published today in JAMA Pediatrics.

“To the best of our knowledge, no studies have examined the clinical profiles and health and mental health service utilization patterns prior to suicide for children and adolescents within the Medicaid population,” said lead researcher Cynthia Fontanella, an associate professor in the department of psychiatry and behavioral health at Ohio State Wexner Medical Center. “Understanding how health care utilization patterns of suicidal decedents differ from the general population is critical to target suicide prevention efforts.”

This population-based case-control study merged mortality data with US Medicaid data from 16 states spanning all regions of the country and accounting for 65% of the total child Medicaid population.

The study looked at 910 youth aged 10-18 years who died by suicide between January 1, 2009 and December 31, 2013 compared to a control group of 6,346 youth that was matched based on gender, race, ethnicity, Medicaid eligibility category, state and age.

For both groups, researchers examined health and behavioral health visits in the six-month period prior to date of suicide. Associations between visits, clinical characteristics and suicide were examined.

Clinical characteristics included psychiatric diagnoses (attention deficit hyperactivity disorder, conduct disorders, depression, bipolar disorder and other mood disorders, anxiety disorders, schizophrenia/psychosis, substance use and other mental health disorders) and chronic medical conditions (diabetes, seizure disorders, cerebral palsy, asthma or cancer.)

“Our study found that 41% of youth who died by suicide had at least one mental health diagnosis in the six months prior to death, a finding similar to those of previous studies on adults,” Fontanella said. “Our findings suggest that youths with psychiatric disorders, particularly mood disorders, schizophrenia, and substance use should be routinely assessed for suicide risk and receive high-intensity, evidence-based treatments for suicidality, such as cognitive behavioral therapy.”

In the US, the suicide rate among people aged 10-24 years has increased by 50% since 1999. Suicide is currently the second leading cause of death in this age group, accounting for nearly 6,800 deaths in 2017.

“Suicide among young people is a major public health problem. Based on our findings, we believe that implementing suicide screening protocols for youth enrolled in Medicaid – targeted on the basis of frequency of visits and psychiatric diagnoses – has the potential to decrease suicide rates,” Fontanella said.

Members of the LGBTQIA community encounter more issues related to mental health.

In November 2019, for instance, a study noted that sexual minorities were around five times more likely to experience high depressive symptoms (54% vs 15%) and self-harm (54% vs 14%). They also had lower life satisfaction (34% vs 10%), lower self-esteem and were more likely to experience all forms of bullying (i.e. peer bullying 27% vs 10%) and victimization (i.e. sexual assault/harassment 11% vs 3%) .

In September 2017, another study suggested that experiencing anti-bisexual prejudice, internalized heterosexism, and identity concealment appears to be related to feelings of loneliness and ultimately psychological distress and suicidality among bi individuals.

COVID-19 can have fatal consequences for people with underlying cardiovascular disease and cause cardiac injury even in patients without underlying heart conditions, according to a review published today in JAMA Cardiology by experts at The University of Texas Health Science Center at Houston (UTHealth).

Experts have known that viral illnesses such as COVID-19 can cause respiratory infections that may lead to lung damage and even death in severe cases. Less is known about the effects on the cardiovascular system.

“It is likely that even in the absence of previous heart disease, the heart muscle can be affected by coronavirus disease,” said Mohammad Madjid, MD, MS, the study’s lead author and an assistant professor of cardiology at McGovern Medical School at UTHealth. “Overall, injury to heart muscle can happen in any patient with or without heart disease, but the risk is higher in those who already have heart disease.”

The study authors explained that research from previous coronavirus and influenza epidemics suggest that viral infections can cause acute coronary syndromes, arrhythmias, and the development of, or exacerbation of, heart failure.

In a clinical bulletin issued by the American College of Cardiology, it was revealed that the case fatality rate of COVID-19 for patients with cardiovascular disease was 10.5%. Data also points to a greater likelihood that individuals over the age of 65 with coronary heart disease or hypertension can contract the illness, as well experience more severe symptoms that will require critical care.

According to the study authors, critical cases are those that reported respiratory failure, septic shock, and/or multiple organ dysfunction or failure that resulted in death. “It is reasonable to expect that significant cardiovascular complications linked to COVID-19 will occur in severe symptomatic patients because of the high inflammatory response associated with this illness,” said Madjid, who also sees patients at the UT Physicians Multispecialty – Bayshore clinic.

The novel virus that causes COVID-19 was first identified in January 2020. This novel virus originated in Wuhan, China, and by March 11, 2020, the World Health Organization had declared it a global pandemic. The three most common symptoms of COVID-19 include fever, cough, and shortness of breath. Other less common symptoms are muscle pain, sore throat, nasal congestion, and headache. Symptoms can appear as soon as two days after exposure to the virus to up to14 days after. There is a high viral load in both symptomatic and asymptomatic patients, meaning asymptomatic spread between person to person is likely.

Previously identified coronaviruses known to cause severe illness in humans include Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) and Middle East Respiratory Syndrome (MERS-CoV). SARS-CoV was first identified in southern China in 2002, and by 2003 it had killed over 8,000 individuals in 29 countries. Data suggests that SARS-CoV may have resulted in cardiovascular complications, such as acute coronary syndrome and myocardial infarction. MERS-CoV was first discovered in 2012 in Saudi Arabia. As of 2019, 2,494 cases have been confirmed along with 858 deaths in 26 countries.

Current COVID-19 treatment options are being researched, and there is a large effort to develop vaccines for prevention and to test antivirals for the treatment of the disease. In the meantime, the study authors encourage all individuals to consult with their health care providers about being vaccinated against influenza and that at-risk patients seek advice on receiving a pneumonia vaccine from their primary care physician. While these vaccines will not provide specific protection against COVID-19, they can help prevent superimposed infections alongside COVID-19.

Study co-authors include Payam Safavi-Naeini, MD, of the Texas Heart Institute; Scott Solomon, MD, of Harvard Medical School; and Orly Vardeny, PharmD, of the University of Minnesota.

It is worth noting that cardiovascular issues greatly affect members of the LGBTQIA community.

A 2018 study in the US, for instance, noted that lesbian, gay and bisexual adults have a “disproportionately high risk” of heart disease and other cardiac problems when compared to heterosexuals.

Another 2018 study noted that trauma, including abuse and neglect, is associated with higher cardiovascular disease risk for lesbian and bi women.

A recent study from North Carolina State University finds that people who manage to balance living in the moment with planning for the future are best able to weather daily stress without succumbing to negative moods.

“It’s well established that daily stressors can make us more likely to have negative affect, or bad moods,” says Shevaun Neupert, a professor of psychology at NC State and corresponding author of a paper on the recent work. “Our work here sheds additional light on which variables influence how we respond to daily stress.”

Specifically, the researchers looked at two factors that are thought to influence how we handle stress: mindfulness and proactive coping.

Mindfulness is when people are centered and living in the moment, rather than dwelling in the past or worrying about the future. Proactive coping is when people engage in planning to reduce the likelihood of future stress.

To see how these factors influence responses to stress, the researchers looked at data from 223 study participants. The study included 116 people between the ages of 60 and 90, and 107 people between the ages of 18 and 36. All of the study participants were in the United States.

All of the study participants were asked to complete an initial survey in order to establish their tendency to engage in proactive coping. Participants were then asked to complete questionnaires for eight consecutive days that explored fluctuations in mindfulness. On those eight days, participants were also asked to report daily stressors and the extent to which they experienced negative mood.

The researchers found that engaging in proactive coping was beneficial at limiting the effect of daily stressors, but that this advantage essentially disappeared on days when a participant reported low mindfulness.

“Our results show that a combination of proactive coping and high mindfulness result in study participants of all ages being more resilient against daily stressors,” Neupert says. “Basically, we found that proactive planning and mindfulness account for about a quarter of the variance in how stressors influenced negative affect.

“Interventions targeting daily fluctuations in mindfulness may be especially helpful for those who are high in proactive coping and may be more inclined to think ahead to the future at the expense of remaining in the present.”

The paper, “Thinking Ahead and Staying in the Present: Implications for Reactivity to Daily Stressors,” is published in the journal Personality and Individual Differences. First author of the paper is Melody Polk, an undergraduate at NC State. The paper was co-authored by Emily Smith and Ling-Rui Zhang, graduate students at NC State. The work was done with support from NC State’s College of Humanities and Social Sciences.

Department of Health (DOH) Secretary Francisco Duque III advised people who have symptoms of COVID-19 to manage their condition as if they really have the disease caused by the new coronavirus instead of waiting to get tested.

As quoted by Inquirer.net from a television interview, Duque said that “if you already know the symptoms, manage it as if it’s COVID-19. If all indications suggest that it’s probably COVID-19, why wait for a test? Manage it as COVID-19 right away. You assume. That’s the way to do it.”

Among the symptoms of COVID-19 are fever, dry cough, cold, shortness of breath, and diarrhea.

Duque, however, did NOT provide the “how to” on managing COVID-19, particularly for those who are not going to get tested, or access medical facilities.

But on February 17, DOH issued Memorandum No. 2020-0090, which contained the interim guidelines on the management of persons under monitoring (PUMs) suspected with COVID-19 for home quarantine.

The guidelines enumerate people who should be home quarantined:

1. Any person who does not exhibit any sign/symptom, has history of travel to other areas of China and/or history of exposure to a confirmed case of COVID-19 within the past 14 days.
2. Any person who exhibits fever or any symptom of lower respiratory illness, and has a history of travel to other countries with a confirmed case of COVID-19 but without any history of exposure.
3. Those undergoing home quarantine shall be prohibited to leave their rooms/hotels where they are quarantined until they have been certified by the local health official to have finished the 14-day requirement for quarantine procedures.

Now how to implement home quarantine?

PUMs should be isolated.

1. Place the PUM alone in a well-ventilated room, preferably with toilet and bathroom. If this is not possible, maintain a distance of at least one meter from the PUM (for example, sleep in a separate bed).
2. Assign one person who is of good health as caretaker of the PUM.
3. Do not allow visitors, family members and even caregivers in the room of the PUM.
4. Limit the activities of the PUM in his/her room only. If this is not possible, ensure that shared spaces are well-ventilated.

PUM should use surgical mask.

1. The PUM should wear a surgical mask fitted tightly to the nose, mouth and chin when in the same room with another household member or when talking to others.
2. If alone, the PUM is not required to wear mask.
3. Do not touch mask during use. If the mask gets wet or dirty with secretions (e.g. saliva), change immediately and dispose properly.
4. After eight hours, throw used mask. Do not reuse or wash masks.
5. After removal of mask, wash hands with water and soap, or rub hands with 70% alcohol.

Hand hygiene practice for all.

1. Everyone should perform hand hygiene following contact with PUM, or if in contact with immediate environment.
2. Perform hand hygiene by washing hands with water and soap. If hands are not visibly dirty, use 70% alcohol.
3. When using soap and water, dry hands using disposable paper towels. If not available, use dedicated cloth towels and replace when wet.
4. Hand hygiene should be performed before and after preparing food, before eating, after using toilet, and when hand is dirty.

Respiratory hygiene and precaution for all.

1. Cover mouth and nose when coughing or sneezing by using surgical mask, tissues, flexed elbows, sleeves of clothes or inside the neckline of shirts. Follow this up with hand hygiene.
2. Avoid direct contact with body fluids, particularly oral and respiratory secretions, and feces.
3. Avoid sharing toothbrushes, cigarettes, towels, bed linen, etc.

Food handling for PUM under home quarantine.

1. The assigned caretaker should serve the plates/tray only up to the room door (where the PUM is staying).
2. After eating, pick plates/tray using gloves. Perform hand hygiene afterwards.
3. Utensils should be cleaned thoroughly with water and soap. Reused as needed.
4. Do not share utensils with PUMs.

Disposal of used gloves, tissue papers and masks.

1. Immediately throw materials used to cover mouth or nose.
2. If reusable items are used (e.g. handkerchief), immediately wash after use with water and detergent soap.
3. Gloves, tissues and masks used by PUM should be placed in separate container before disposing with other household waste.

Cleaning and disinfection of quarantine venues.

1. Frequently clean/disinfect frequently touched surfaces (e.g. bedside tables, door knobs, bed frames, etc). Use household disinfectant; or diluted bleach solution (i.e. 1 part bleach and 99 parts water).
2. Clean/disinfect bathroom/toilet at least once a day.
3. Regularly clean clothes, bed linens, towels, etc. of PUMs.

Now, this is important.

PUMs who develop symptoms should be immediately transported to the nearest health facility. In the same way, all household members of PUMs should seek immediate medical care when signs/symptoms develop.

Because the DOH is not at all considering mass testing (yet) in the Philippines, these tips may offer temporary comfort as the country continues to come to grips with COVID-19 with the country’s health department’s weaknesses in offering quality healthcare for all now highlighted.

As WHO and health authorities all over the world act to contain the Covid-19 outbreak, advice on safeguarding mental health was developed by the UN health agency’s Department of Mental Health and Substance Use.

WHO’s guidance targets the general population; healthcare workers; health facility managers; childcare providers; older adults, care providers and people with underlying health conditions; and those who are living in isolation to try and contain the spread of the pandemic.

To start, the UN body stated that people should “be empathetic to all those who are affected, in and from any country” as it warned “against stigmatizing anyone who has or had the virus.” 

It also recommended that people seek information updates only from trusted sources. “The sudden and near-constant stream of news reports about an outbreak can cause anyone to feel worried”, said WHO. “Get the facts; not the rumors and misinformation”. 

The UN health agency also pointed out the benefits of helping others, including phoning neighbors or community members who may need some extra assistance. This is because “working together as one community can help to create solidarity in addressing COVID-19”.

Others tips were segregated to target specific populations.

Those who help others

1. People should honor caretakers and healthcare workers… for the role they play to save lives and keep loved ones safe, WHO stated.
2. The feeling of being “under pressure” by healthworkers is normal while emphasizing that stress is “by no means a reflection that you cannot do your job or that you are weak”. 
3. Healthworkers should rest sufficiently, eat healthy foods, get physical activity and stay in contact with family and friends.

“This is a unique and unprecedented scenario for many workers, particularly if they have not been involved in similar responses,” said WHO, with the reminder that “this is not a sprint, it’s a marathon”. 

Those in charge

1. Protect staff from chronic stress and poor mental health to provide them with the capacities they need to perform their duties. 
2. Focus on the longer term rather than short-term crisis responses.
3. Team leaders or health facility managers are encouraged to deliver quality communication and accurate information updates to all staff. 
4. Consider the benefits of rotating workers from higher- to lower-stress functions, and in partnering inexperienced workers with those who are more experienced, to provide reassurance.
5. Maintain the buddy system to “provide support, monitor stress and reinforce safety procedures,” WHO stated, advocating for outreach personnel to work in pairs and to “initiate, encourage and monitor work breaks”.

Those with children

1. Help children find positive ways to express feelings, such as fear and sadness. “Children feel relieved if they can express and communicate their feelings in a safe and supportive environment,” the UN health agency maintained, encouraging that if safe, they be kept close to their parents and family. 
2. Regular contact with parents should be maintained, such as twice-daily scheduled phone or video calls.

Caring for the vulnerable

1. Relay clear instructions in a concise, respectful and patient way (pictures may be utilized) when dealing with older adults and people with underlying health conditions who are vulnerable, as they may become more anxious, agitated and withdrawn during the outbreak.
2. Engage their family and other support networks to provide information and help them practice prevention measures, including handwashing.
3. When in isolation, stay connected and maintain daily routines, as much as possible. 
4. Keep things in perspective starting with avoid listening to or following rumors.

Pregnant, breastfeeding women 

1. Additionally, the UN Population Fund (UNFPA) recommended that breastfeeding women who become ill should not be separated from their newborns.
2. While there is no evidence that the illness can be transmitted through breastmilk, UNFPA urged mothers who are infected to wear a mask when near their baby, wash their hands before and after feeding, and disinfect contaminated surfaces.
3. If a mother is too ill to breastfeed, she should be encouraged to express milk for the baby, while taking all necessary precautions.

In the end, “mental health and psychosocial support should be made available to affected individuals and their families”.