Tag: health

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Swimming Pool

Summer time is the time to enjoy outdoors. Hiking, biking, climbing as well as swimming are high on the agenda. With the Olympic games 2024 around the corner we rise to the challenge and get started again with more sports activities. Swimming has many health advantages. Most people think of cardiovascular training and relieve of back pain. Exercise without carrying your body weight is great for your joints and ligaments. The benefits for psychological wellbeing have long been underestimated. Diving into silence under water even if it is only for some seconds or a minute calms your spirit. The water pressure holds you tight without restricting your movements. Breath control is an almost meditative experience. Everyone can do it, again and again. Childhood memories, good and bad, are associated with swimming. Choose your style, costume and pool. The summer break is an ideal occasion to test the marvelous experience again of cold or warm water. The cold water bucket challenge of everyday life takes a break. Time to find your pool again. (Image extract from Susanne Hay, Swimming Pool II, 1996 in private collection, exhibition in Yerres, summer 2023)

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Live longer

It is an old dream of mankind to live longer and longer. The Covid-19 pandemic has taught us many lessons that there are powerfully viruses and their continued mutations which threaten this. Life expectancy declined slightly during the pandemic and we learned that long Covid is yet another threat to our life expectancy. Scientists have found other sources that are crucial for survival. Like sepsis, it is the constant inflammation processes in our bodies. Long working times, stressful commute to work and interrupted or shortened vacations all contribute to keep inflammation at higher levels than is healthy from a longevity perspective. The research note published in Nature on the inflammation enhancing protein IL-11 highlights the chain reaction process of inflammation causing cancer and autoimmune disorders and diseases. Hence, it is essential to watch the biomarkers of inflammation and probably adjust our lifestyles accordingly. The sources of inflammation are manifold, but the potential rewards to address the issue are huge as well. Among the easy to address sources is nutrition, exercise and working life. Changing just a little bit here and there can make already a change. Monitoring how you feel about such changes puts you on a learning curve for your own inflammation levels. Vacation times are also perfect for adaptive behavioral changes. We just need to keep trying.

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Greening Brussels

We tend to believe that inner cities have lost the fight against traffic jams and climate change. However, the number of projects that stem the tide is growing and some have gained visibility beyond their immediate neighborhood. This is the case of an urban planning project in Brussels that has taken back space from urban traffic to the citizens living there. Planting new trees and a gardening space reserved for flowers changed the street into a pleasant environment where people meet and greet again rather than hold their breath and disappear as quickly as possible. Parking of cars has been reduced on the street and instead bicycle parking has become a hint towards more sustainable mobility in inner cities. Walking the city, staying and shopping nearby will allow behavioral change for healthier lifestyles. It needs a lot of persuasion to accomplish this impact and years of reaching majorities for such projects and the ability to raise sufficient resources to implement them. The additional challenge is the need to take care of the green spaces that only works with the support of neighborhoods assisting in the care and protection of the urban lungs. As the awareness to act against inner city heat and pollution increases the number of persons willing to act and devote resources as well as time for such projects increases as well. It is a long way to improve inner city health again, but these signs of exemplary projects will convince many other people that urban renewal can work to the benefit of people.

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Back pain

Most people know some form of back pain. This is understandable as an ever increasing share of people work in seated positions and spend additional leisure time in a similar position (gaming). Recurrent back pain is a frequent diagnosis. An Australien study has found a rather simple remedy for the widespread pain. The WalkBack experiment succeeded to significantly reduce recurrent lower back pain in study participants. Individualized and progressive walking accompanied by an education program did the trick. Keep on walking and try to extend the range of the exercise. It’s amazing to witness how the human body adapts to being challenged. Learning about the mechanics at work like the release of own personal “pain killers” hormones helps to trust in your body’s positive response to each dose of the challenge to pain. Do not walk too quickly too far. Stretching is a must and not an option. Go for it. Modern technology (in any smartphone) supports your efforts with counting your steps and measuring distances. Keeping track of a “pain diary” might give you guidance not to overdo the exercise and pause activities. Join a group of friends or people who are like-minded and get adequate shoes and clothes to feel comfortable while walking and afterwards as well.

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Smoke Gamble

Smoking is like a gamble. Your input is your health and money. This is not including those who might rely on you or family relationships that might suffer one way or another. The other link has gambling at its source and smoking goes along with the continuous risk taking or the belief to be able to master the risks involved with both forms of potential addictions. Research has accumulated evidence that in fact both smoking and gambling occur frequently in combination with each other. Taking risks against the odds of suffering losses, maybe only in the medium or longer run perspectives like for health seems acceptable for those people. Society has put rather high taxes on both activities to discourage people and invests in prevention of addictions. However, it does not have substantial effects on people as smoking remains around the same level and gambling (poker online) or betting on sports (Euro 2024) are rising rapidly. Vaping and internet gaming have broadened the spectrum of addictive behaviors mostly for younger persons and young adults. The risks are manifold and increasing in their addictive potential since the smartphone is always in some pocket just like the smoking device. The behavioral turn in the social sciences has been well understood by the industries as well. The stakes for human development are high in this endeavor to offer young people equal opportunities at entry into adulthood.

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Cannabis Alcohol

The use of cannabis and/or alcohol is yet another question where we are used to ask questions in the form of: either the or the other? Over generations we have gotten used to no longer ask for each do you or don’t you. With the controlled liberalization or legalization of cannabis in some Western European states the framing of the question is more like you do the one or the other, particularly for many younger persons.
Decriminalization of both drugs in small quantities is apparently reducing crimes link to drug use and drug dealing. On the other hand, the thresholds for doing drugs are lower than they used to be. In inner cities it is therefore no longer a surprise to find both kinds of drugs with addictive potential next to each other (see image below). We know that it is a slippery road from regular drug use to uncontrolled dependency and personal disaster. For cannabis a study published in the Lancet (Petrilli et al. 2022) added the importance of the potency of tetrahydrocannabinol to the estimate of risks. This is similar to the studies that differentiate the level of alcohol in drinks consumed. The higher the concentration, the higher the risks. A simple proportional relationship prevails in both drugs. The cumulative effects of consuming both together might have quite surprising non-linear effects.
The big issue is the risks of mental health related to these drugs. However, the causal direction is not easy to detect. Drugs induce mental health problems, but also mental health issues lead to drug abuse. This remains quite a puzzle for scientists to disentangle.
Additionally, the link to smoking and addiction to nicotine is a frequently observed corollary. Studying just one single source of health problems and addiction might be too restrictive to learn about the whole set of causal effects and casualties. For the time being we seem to jump from one field of attention to the next one ignoring the multiple interrelated factors at hand.

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Smoking Vaping

Both smoking and vaping are big business. Nicotine is well known for its addictive capacity. Once started, it is very hard to give it up again. For many decades we devote considerable efforts and costs to encourage people to give up on smoking or, better, not to start smoking in the first place. The young are particularly vulnerable as damages persist for a longer time. Progress has been made to reduce passive smoking of children and people in restaurants, at work and public spaces. The relatively recent trend of vaping instead of smoking is considered less harmful, but scientific long-term evaluations, whether these effects are lasting for several years, are still missing.
A repeated cross-section study in England (Tattan-Birch et al. 2024) has revealed that the declining trend of nicotine use has already been reversed among youth due to the rise in vaping. Vaping seems to move from the fashionable niche product to the popular mainstream among youth. The addicts are only cost-sensitive on the margin. The relative prices of smoking and vaping might play a role to put people on different health trajectories. The question is not between either smoking or vaping, but for some it is both, although it should be none of both. The question of smoking yes/no is likely to be framed as either vaping/or smoking.  The re-framing of the question shows the harmful potential in the longer run. We shall have a hard time to convince people and particularly youth not to be tempted by either/or but to focus on their long-term health trajectory and potential. (Image: Extrait from Arnold Böcklin, Self-portrait with death playing the violine 1872, Alte Nationalgalerie Berlin)

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Marketing bicycles

The marketing of bicycles has changed considerably over the course of history. Today’s narrative is more about the eco friendly impact of it. Historically the freedom aspect of free movement and emancipation of women was at the forefront. The collection of images in poster formats presented at the DTM in Berlin is impressive. The focus on women on bicycles is quite surprising for this early time around 1900. Few of the companies from the early days have survived until today. Bicycles are still fascinating children and adults today. The experience of a fragile equilibrium, your own strength and weakness in muscle power, cardiac or pulmonary strength is always challenging. It is you who is in control of speed and direction. This should be easy to sell to the masses, and it was and still is. “Bikenomics” is here to stay. Artists had the same impression and created a whole universe of promises for riders of bicycles. The long run health benefits were not even known at the time, but it was unthinkable that humans would spend most hours sitting in offices, cars and on their couches. The biking story needs to be retold to encourage people to take up the emancipating storyline again. Get on your bike again!

DTM Berlin 2024-6
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Patient Empowerment

The empowerment of patients is a well-established practice in the treatment of diabetes. Measuring your own blood sugar and adjusting your medication to the self-monitored data is common practice. For patients with high blood pressure this patient empowerment is less prevalent. A medical study carried out in Valencia (Spain) by Martínez-Ibáñez et al. (2024) has tested the effects of such a self-monitoring and self-medication experiment.
The results publishes in (JAMA) gave rise to considerable attention in the profession as the empowerment of patients is one way out of the likely increasing shortage of medical professionals in aging societies. Whereas other studies found that total costs to the medical system might increase, the study in Spain provides evidence of the cost-reduction effect of such an empowerment. 24 months after the beginning of the trial. After the establishment of a “medication based on an individualized prearranged plan used in primary care” the self-administering participants achieved a significant decrease in their blood pressure that lasted until the end of the study after 2 years. The drop-outs of the study seem to follow a random pattern.
The conclusion gives support to the potential of patient empowerment in the widespread treatment of higher blood pressure beyond the regular visits of medical doctors. The monitoring of changes in lifestyle add to this to keep the costs of health care under control in aging societies.

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Camparing Covid-19

In the middle of May 2024 we tend to believe the Covid-19 pandemic is over. However, towards the beginning of the year 2024 in the U.S. we observed at the peak about 2500 deaths per week. In Germany deaths/week amounted to 250. Compared to the overall population size killing is more pervasive in the U.S. than in Germany. The map of the specialized agency “Centers for Disease Control and Prevention” (CDC) in the U.S. shows the coastal regions to be more affected than the center. Population density seems to be still a driver of the spread of infections, illness and deaths. The timeline of deaths due to Covid-19 infections for Germany follows a broadly similar pattern, albeit on a lower level even if roughly accounting for population size (RKI-data). As we tend to forget what the pandemic caused as social and economic disaster in societies, we have to stay alert as the major prevention of Covid-19. Learn to live with the virus around us. This means to keep up our preventive levels of hygiene as well as monitoring of trends.
Many thanks to all those who do the sometimes boring number crunching for us. This includes the medical doctors who bother to do the timely reporting of new infectious diseases on a regular basis.

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Killing me softly

The problem with pollution is, it is killing you softly from inside. It is almost impossible to escape air pollution as it is pervasive in cities, but also in the countryside where you do not expect it that much. This is the result of the study by Kuzma et al. (2024) published in “The Lancet Regional Health Europe”. Based on a data set of 8 million persons from Eastern Poland the effects of air pollution on myocardial infarction incidence was analysed. The use of the “European Union’s Earth Observation Programme” contributed data on air pollutants like PMs, BaP (benzo(a)pyrene), SO2 and NO2 concentrations. The multi-level data of 5 voivodeships, 101 counties, and 709 communities in Poland allows to differentiate the effects of damage to the heart tissue on cardiovascular disease. The other well-known factors are arterial hypertension, diabetes, obesity, chronic kidney disease, hyperlipidaemia, and smoking as most of us know already. The effects of  BaP (benzo(a)pyrene) is shown for rural areas despite the lower observed traffic density in these areas. The killing occurs softly from within our bodies by just breathing in and out, and in and out continuously. The disease burden in these regions is observed with “recorded 63,154 hospitalizations and 5921 in-hospital deaths (9.4%) due to STEMI; and 76,543 hospitalizations and 4079 (5%) in-hospital deaths due to NSTEMI”. In short, the need to reduce air pollution further is an urgent demand that saves lives eventually.
(Image from public domain wikipedia or “do-it-yourself” here).

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Silent Pandemic

There is a pandemic that is silently spreading across countries and continents. It only indirectly related to the Covid-19 pandemic. The medical journal “The Lancet Respiratory Health” (2024) has an editorial about the inequities of asthma as they develop over the life course. The development of asthma has pre-natal, genetic, environmental, life-style and socio-economic co-determinants. The study of respiratory disease, therefore, is a multi-factorial issue, which needs to disentangle the specific influences. Smoking as well as obesity have an impact on asthma, instantaneously or with delayed time effects of sometimes many years. Hence, it is important to take the whole life course into account, if we want to address the rising disease burden of asthma. Air pollution and heating-up of the planet are important drivers of the silent asthma pandemic across the globe. The social distribution of people working in “asthma- prone” work environments and/or living in highly polluted urban, suburban or rural areas near high frequency traffic is another latent factor causing huge costs to persons and society as a whole. Health inequity is growing over the life course. This is not easy to tackle as policy target as the onset of the disease has no single trigger, but rather a combination of influences that contribute in varying amounts to the evolution of respiratory diseases. (Image air pollution https://aqicn.org/map/germany/de/)

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Weight Stigma

The fashion industry has for a long time produced images of mostly women and men that did not correspond to the normal weight distribution of people. Skinny models were present across all media. The so-called social media of today amplify this trend further. The “Barbie hype” has reinforced the idea of low weight as a socially desirable norm. In scientific research the term coined for this phenomenon is “internalized weight stigma” (IWS). A study shows (Highes et al. 2024) it affects more women than men and more people who are described as socioeconomically disadvantaged adults. Pressure to lose weight originates from multiple sources and social media platforms have given rise to bullying. A major outcome of IWS is eating disorders as eating is often wrongly associated to be the only cause of higher weight. It is not. Many other factors contribute to the actual weight of a person. Even the overuse of the body mass index (BMI) as short hand version to define overweight or obesity is misleading for persons with strong muscles. Just fixing on one parameter of body shape or weight tends to reinforce weight stigma. “Keep walking” and a regular healthy diet, this avoids to internalize a weight stigma. Exercise is fun, the more you do it in a group, the easier it is to get going regularly. We ought to keep trying and eventually it will become a routine.

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Screening Paradoxon

In the field of public health the screening paradoxon is a well-known feature of large scale programs to check for and contain the large increases in cancer among populations. A recent medical study underscores the necessity to curtail the screening paradox in Europe. The screening paradoxon is defined as “the underuse of screening by those with unhealthy lifestyles and high risks”. The opposite cases, “the overuse of screening by those with healthy lifestyles and low risks” only cause a problem for the costs of the health system as those unlikely of attaining a form of cancer make extensive use of screening. In terms of social inequality we have to be concerned about both ends of these distributions. The publicly available screening programs are skewed towards the higher educated with risk awareness as well as healthy life styles. More of them participate in screening. The other distribution of actual risks and detection of cancer is skewed towards the other end of the risk distribution. The 2 probability distributions overlap to an extent that is most likely co-determined by cultural factors like general attitudes towards prevention.
With the increase in cancer rates generally and due to demographic aging of societies, we shall need to target our resources devoted to health more precisely rather than spending too much on screening of people with very low risks. Increasing the duration between screenings might not impede detection rates of those with healthy lifestyles, but could allow to devote more resources to those people who are hard to reach by screening programs so far. Evaluations of such programs are necessary to judge the need for more targeted programs.(Image own representation inspired by Ola et al. 2024)

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Hospital Bias

Asking people about differences between private and public hospitals, you are most likely getting answers that the private hospitals deliver superior patient outcomes. Whereas private hospitals seem to have a positive stigma attached to them, public hospitals commonly have a negative stigma. Scientific evaluations are helpful to set the record straight again. The study published in “The Lancet Regional Health” in 2024 shows that in the simple descriptive statistics on several patient outcome indicators, this is what the data showed between 2026 and 2019. However, a more precise statistical analysis reveals that there is also a selective admission to the private and public hospitals in England. Using so-called instrumental variables approaches that account for the selection process between admission to the 2 types of hospitals (private versus public) most of the differences between the hospital types disappear. The underlying mechanism is a sorting of different patients into the private or public hospitals. Put in easy words, for a routine intervention people tend to chose the private hospital, but the more rare and difficult operations were more likely admitted to public hospitals. The number of co-morbidities (heart disease) is also of importance as they might negatively affect patient outcomes. Jumping to conclusions and reinforcing stigma about public or private provision of services hinders progress and an equitable provision of services.
The analysis of a potential selection bias can reveal the “creaming” effect of private provision of (health) services. Just caring for the “easy” or routine cases and avoiding the more difficult and costly cases has economic advantages, but for society as a whole the costs overall remain the same. A good public service in health is a definite asset.

(Image: Exposition Isa Genzken 2023 in Neue Nationalgalerie Berlin)

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Causal Benefit Model

In the field of medicine we move more and more towards precision medicine. Previously, the term of personalized medicine was used which suggested to a certain degree that a personalization might be feasible. The budget constraints have forced us to change the term to avoid unrealistic, untenable promises. In the field of cardiology scientific advances advocate to shift from a risk-based model of treatment to a causal benefit model. (Kohli-Lynch et al. 2024 Link). Long-term benefits of a treatment are more promising, if the treatment addresses the causal mechanisms at work. It is wide spread practice to deal with general risk profiles as guidelines as the precision medicine based on a causal benefit model is far more laborious since to search the causal mechanism at work requires additional testing of hypotheses. This becomes immediately clear if genetic causes enter into consideration. Nevertheless, medical research advances more and more in this direction. Genetic testing has been shown to be useful in analyzing and treating issues like sudden cardiac arrest (in survivors). We are somehow aware that genetics may play a role here, but we shall need a lot of additional studies to make the causal benefit model a feasible option for widespread applications. Targeting research in this field will offer new avenues for precision medicine in the 2020s.

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Sleeping BPS-SPB

Sleeping is a good example of the co-determination of the biological, psychological and societal spheres of life. The environment with the daily cycles of light and dark as well as the social norms of work and rest determine the circadian cycles of hormones. Shift work or otherwise disrupted sleep patterns depend on social norms like regulation of noise or light in cities. Healthy sleep patterns, therefore, depend to a large amount on regulation and implementation of those social norms. Birthday parties are tolerated, but much less the irregular partying in shared housing with lots of neighbours. Reducing social contacts during Covid-19 led to the changes in sleep patterns as well.
The psychological determinants of sleep go well beyond the world of dreams as theorized by Freud. Nowadays, we investigate all sorts of behavioural patterns that have an impact on sleeping like “bedtime technology use” of smartphones or the ability to switch off thinking of problems. Sleeping is a particular functional state of our mind. A lot of sorting of daily impressions into memory occurs during the different phases while sleeping. Persistent disrupted or impeded sleep is recognized as torture in severe cases. Stress at work or working overtime is also a major cause of sleep disorders.
The biological indicators used to investigate sleep have revealed a lot of links of sleep and the hormones of melatonin as well as cortisol. Testing has become more accessible and provides good indicators of how the biological clocks tick within our bodies.
However, we are only at the beginning of the analysis of more complex interactions of the multiple forms of interaction of the bio->psycho->social (BPS) as well as the social->psycho->bio (SPB) co-determination of sleeping. Scientific research is faced with a steep challenge as the direction of causality is not uniform except in very controlled experimental settings. Maybe the arts have coined and popularized a useful term in this respect. “I am in a New York state of mind”.
(Image: extrait of Magritte. La clairvoyance, 1936 and The cultural context of aging, Jay Sokolovsky)

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Sleep biology

Biological processes work hard during our sleep. Our immune system in particular benefits a great deal from undisturbed sleep. This is the simplest summary of the study by Kabrita et al. (2024).
We can study the temporal expression pattern of major histocompatibility complex MHC class I for example in mice. 2 groups of sleep-restricted versus normal mice reveal the biological impact of sleep restriction. In comparison to the control group sleep restriction in mice produced a bimodal pattern of Splenocytes with higher protein levels during the resting period. Such an increased protein expression during resting periods indicates a “preparedness for a potential infection”. Sleep recovery, even if short compared to the longer sleep restriction, allows to return to the baseline of protein levels. The good message is that at least mice seem to recover rather quickly from sleep deprivation with their immune response system.
The biology of repeated phases of longer sleep deprivation could inform us on the implications of sleep deprivation on aging processes. The biological responses in single event sleep deprivation seem to show a fast recovery pattern. Probably it is worth studying the same recovery process of groups of young versus aged mice.
Anecdotal evidence from myself indicates that recovery after sleep deprivation in older humans is no longer as fast as at younger ages. Behavioural responses might be less sleep deprivation (less fun) or longer recovery periods (stay in bed longer). The behavioural response of humans appears to be an obvious one. Instead of either or, we tend to go for both at the same time.
(AI Image: BING +Dall-E. one group of mice is partying in a club at night. Another group of mice is sleeping tight in another room. Cartoon-like images. 2024-3-18)

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Personal Health

Most people would agree, health is a personal issue. From the onset of life, we have package of genes that predetermine a number of factors of our personal health. Epigenetics has taught us there are many factors to take into account additionally. Environmental factors have huge impacts as well. Improvements in the availability of medical devices in the hands of individuals as well as AI systems on portable devices like smartphones facilitate the monitoring of personal health. Several indicators of early-onset of illness can be retrieved from such devices. Dunn et al. (2024) show that prior to the onset of symptoms of Covid-19 or influenza portable devices can indicate the presence of infections through indicators of resting body temperature, heart rate/min, heart rate variability/millisecond or respiratory rate/min. Combined with the indicators of air quality, indoors as well as outdoors, the presence of allergens a much more personalized data set emerges which can easily be part of an AI-assisted diagnosis. More abundant personal health data and analytical power allows remote and digital health applications to inform patients, medical doctors and the public at large. Digital health technologies are only at the beginning to unfold their potential. Prevention becomes more feasible using such devices, medical professionals should be allowed to focus on interpretation of data and treatment rather than simple data gathering. Thinking about digital health technologies points in the direction of dealing with climate and environmental hazards as sickening causes more forcefully. Personal medicine and personal health are, after all, still heavily dependent on health and safety at work, commuting practices and all sorts of pollution. Personal health, however, is a good starting point to raise awareness of the potentials of digital health technologies to better our lives.
(Image: AI MS-Copilot: 2 robots run in a city. They sweat. The air is full of smog. 2 other robots rest near pool. All look at their wrist watch showing heart beats)