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COVID-19 ICU patients have higher risk for blood clots, study shows

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Hospitalized COVID-19 patients face an increased risk of developing dangerous blood clots, a new review indicates.

The odds of a clot are highest for the most critically ill patients. Analysis of 66 studies found that 23% of COVID-19 patients in an intensive care unit developed a blood clot in the leg, known as a deep vein thrombosis, or DVT.

Overall prevalence of a DVT was 14% among ICU and non-ICU COVID-19 patients, and 8% among those with mild-to-moderate disease risk who were not admitted to the ICU.

The “numbers are surprisingly high when compared with other hospitalized patients,” said study author Dr. Cihan Ay.

Of great concern are blood clots in the legs that can break away and travel to the lungs. This is a life-threatening condition known as pulmonary embolism, or PE.

Nearly 4% of patients not admitted to the ICU developed a pulmonary embolism. And “we found a very high PE risk of 14% in patients treated at an intensive care unit,” said Ay, an associate professor in hematology and hemostaseology at the Medical University of Vienna in Austria.

According to the American Heart Association, DVT and PE are each a form of venous thromboembolism, or VTE, as both refer to a blood clot that originates in a vein.

VTE is estimated to affect between 300,000 and 600,000 Americans every year, the AHA notes. It is most frequently triggered by surgery, cancer, hospitalization or long-term immobilization.

To examine VTE risk related to COVID-19, Ay and his colleagues analyzed the findings of 66 studies, involving roughly 28,000 COVID-19 patients.

On average, the COVID-19 patients were about 63 years old, and six in 10 were men. About one-fifth had been admitted to an ICU.

None of the studies looked at clotting risk among COVID-19 patients who had not received hospital treatment. So the findings do not speak to DVT or PE risk among such patients, said Ay, although “it seems that the risk of clots is low in patients with a mild clinical course of COVID-19.”

Early in the pandemic, it became clear that blood clot risk seemed elevated in patients with COVID-19 compared to other diseases. To prevent clotting, “physicians worldwide intensified dosing of blood thinners for COVID-19 patients,” Ay said.

This created another potential problem, however, since blood thinners increase the risk of bleeding.

The study authors hope their review will offer clinicians more insight into clotting risk profiles, offering guidance as to which patients truly need preventive clot treatment, Ay said.

As to why COVID-19 might drive up clotting risk in the first place, Ay said experts can only speculate based on available data.

“First, the clinical course in such patients is often severe, which by itself increases the thrombosis [clotting] risk,” he said. “Second, researchers found that COVID-19 interacts with the blood clotting system and the blood vessels, which might explain the increased risk in those patients.”

Dr. Gregg Fonarow is director of the University of California, Los Angeles Cardiomyopathy Center. He offered some additional specifics regarding that interaction.

“The virus … which causes COVID-19 has been shown to directly invade the cells that line blood vessels, endothelial cells,” he noted. “Endothelial injury can lead to venous thrombosis.”

In addition, extended bed rest or the placement of venous catheters during treatment for COVID-19 can also increase the risk for venous thrombosis, Fonarow noted.

The study results were published online recently in Research and Practice in Thrombosis and Haemostasis.

More information

There’s more on blood clots at the American Heart Association.

Copyright 2020 HealthDay. All rights reserved.



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Limiting TV ads for foods high in sugar, salt, fat may reduce child obesity

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Limiting TV ads for sugary, salty and high-fat foods and drinks might help reduce childhood obesity, British researchers suggest.

They looked at advertising of these products between 5:30 a.m. and 9 p.m. If all such ads were withdrawn during those hours, the number of obese kids in Britain between the ages of 5 and 17 would drop by 5% and the number of overweight kids would fall 4%, the study found.

That’s equivalent to 40,000 fewer kids in Britain who would be obese and 120,000 fewer who would be overweight, the researchers said.

The findings were published online this week in the journal PLOS Medicine.

Oliver Mytton, an academic clinical lecturer at the Center for Diet and Activity Research at the University of Cambridge, led the study.

“Measures which have the potential to reduce exposure to less-healthy food advertising on television could make a meaningful contribution to reducing childhood obesity,” the authors said in a journal news release.

But they also pointed out that they could not fully account for all factors that would affect the impact of the policy, if implemented.

They added: “Children now consume media from a range of sources, and increasingly from online and on-demand services, so in order to give all children the opportunity to grow up healthy it is important to ensure that this advertising doesn’t just move to the 9-10 pm slot and to online services.”

More information

For more on childhood obesity, visit the U.S. Centers for Disease Control and Prevention.

Copyright 2020 HealthDay. All rights reserved.



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Blood type may predict risk for severe COVID-19, studies say

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There’s more evidence that blood type may affect a person’s risk for COVID-19 and severe illness from the disease.

The findings are reported in a pair of studies published Oct. 14 in the journal Blood Advances.

In one, researchers compared more than 473,000 people in Denmark with COVID-19 to more than 2.2 million people in the general population.

Among the COVID-19 patients, there was a lower percentage of people with blood type O and higher percentages of those with with types A, B and AB.

The findings suggest that people with A, B or AB blood may be more likely to be infected with COVID-19 than people with type O blood. Infection rates were similar among people with types A, B and AB blood.

The other study included 95 critically ill COVID-19 patients hospitalized in Canada. Patients with type A or AB blood were more likely to require mechanical ventilation, suggesting that they had greater rates of lung injury from COVID-19.

More patients with type A and AB blood required dialysis for kidney failure, the study added.

The results suggest that COVID-19 patients with A and AB blood types may have an increased risk of organ dysfunction or failure than those with type O or B blood, according to the researchers.

They also found that while people with blood types A and AB didn’t have longer overall hospital stays than those with types O or B, on average, they were in intensive care longer, which may indicate more severe COVID-19.

“The unique part of our study is our focus on the severity effect of blood type on COVID-19. We observed this lung and kidney damage, and in future studies, we will want to tease out the effect of blood group and COVID-19 on other vital organs,” said study author Dr. Mypinder Sekhon, a clinical instructor in the Division of Critical Care Medicine at the University of British Columbia in Vancouver, Canada.

“Of particular importance as we continue to traverse the pandemic, we now have a wide range of survivors who are exiting the acute part of COVID-19, but we need to explore mechanisms by which to risk stratify those with longer-term effects,” he added in a news release.

More information

The U.S. Centers for Disease Control and Prevention has more on COVID-19.

Copyright 2020 HealthDay. All rights reserved.



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Personality traits govern success of workplace wellness programs, study finds

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Oct. 14 (UPI) — The personality traits of individual employees play a strong role in determining the success of workplace wellness programs designed to boost physical activity, a study published Wednesday by the journal PLOS ONE found.

Those identified as extroverted and motivated significantly improved their daily step counts by an average of 945 steps after participating in a competitive gamification program — which uses elements of game playing to encourage engagement — but did not sustain these gains over a 12-week period, the data showed.

Conversely, gamification programs generated 1,100- to 1,200-step improvements in introverted and less motivated study participants that they sustained over the 12 weeks they were monitored, the researchers said.

“This suggests that ongoing incentives and reminders may be necessary to sustain motivation for some groups of people,” study co-author Dr. Shirley Chen, an assistant professor of medicine at Mount Sinai Health System, said in a statement.

Workplace wellness programs have become increasingly popular as employers seek to improve staff health and well-being. However, recent studies have suggested that they offer limited benefits.

The study by Chen and her colleagues is a follow-up to the 2019 analysis of the STEP UP program, which aimed to increase the step counts of roughly 600 Deloitte professionals classified as being either obese or overweight over a period of six months.

In the STEP UP program, personalized daily step counts were established for each participant, but they were then randomly funneled into four different groups: one that just gave the participants their goals and a step tracker, and three others that mixed in different forms of nudges that were “gamified” using a point system, the researchers said.

For the new analysis, they divided participants into different classifications of certain psychological and behavioral characteristics that the researchers called “phenotypes.”

Study participants completed surveys to help researchers identify personality types and social support needs, according to Chen.

The phenotypes that emerged were “more extroverted and more motivated,” which made up 54% of study participants and “less active and less social,” which was 20%, the researchers said. The remaining participants — 25% — were classified as “less motivated and at-risk.”

The participants then were assigned to one of three gamification programs — supportive, collaborative or competitive.

In the supportive program, participants were asked to identify a friend or family member who encouraged them and received weekly reports on their progress.

Participants in the collaborative program were placed into teams of three and a designated member was selected each day to represent them in their step activity.

Participants in the competitive program were assigned into teams of three and received a weekly “leader-board” email to foster competition.

Although more extroverted and motivated participants in the competitive program saw an uptick in step counts, these same gains were not seen among those in the collaborative or supportive programs, the researchers said.

In addition, gains were not sustained over 12 weeks of follow-up, they said.

However, participants classified as “less active and less social” saw step count improvements ranging from 1,000 to 1,200 in all three programs — and these increases were maintained over the 12-week follow-up period, according to the researchers.

Conversely, those in the “less motivated and at-risk” group had no improvement during the study, the researchers said.

“A one-size-fits-all approach to nudging new behaviors within wellness programs can have limited success,” study co-author Dr. Mitesh Patel, director of the Penn Medicine Nudge Unit, said in a statement.

“We’ve shown that different forms of nudging can be effective, and in this latest study … we’ve now demonstrated that matching nudges to the right behavior profiles can unlock their full potential,” Patel said.



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