Tag: health.harvard.edu

Before flu season is underway and COVID cases rise, boost your immunity.

 

Autumn’s arrival heralds cool temperatures, warm sweaters, and anticipation of the upcoming holiday season. But it’s also when infectious respiratory viruses start to spread more readily. That’s why October is the ideal time to shore up your immunity against two common, potentially life-threatening viruses: influenza (flu) and SARS CoV2, the virus that causes COVID-19.

Winter warning: A bad flu season ahead?

With all the attention on COVID over the past two years, the focus on flu has waned somewhat. Last year’s flu season was very mild — in fact, the peak number of positive cases was the lowest in at least the 25 years prior to the COVID-19 pandemic. But don’t count on a repeat this winter.

“The general consensus is that this year’s flu season could be worse than average, for a couple of reasons,” says infectious disease specialist Dr. John J. Ross, assistant professor of medicine at Harvard Medical School.

First, Australia had a particularly severe flu season this year, with three times the normal amount of cases. Australia is in the southern hemisphere and their winter flu season peaks in August, often predicting what happens in the United States and elsewhere in the northern hemisphere, he notes. Second, the masking and social distancing that many people followed to prevent COVID also prevented the flu. “But the era of widespread masking has ended, so we’re expecting more viral transmission this season,” says Dr. Ross.

Continued complications from COVID-19

COVID cases and hospitalizations have dropped dramatically since earlier this year. On average, about 340 people died each day from the virus in August and September, compared to about 3,400 per day in early February 2022. “We expect that COVID rates will rise again over the winter, although not at the same magnitude as last winter,” Dr. Ross says. There’s clear evidence that Omicron — currently the most widely circulating COVID variant — spreads more easily than earlier strains, but it’s less likely to kill you, he adds.

Flu vaccine advice for adults

All adults should get an annual flu vaccine, with the rare exception of people who’ve had a life-threatening reaction to the shot in the past. The vaccine is especially important for those with a higher risk for serious complications from the flu. This includes

• people over age 65
• residents of nursing homes and other long-term care facilities
• people who have heart failure and other cardiac conditions, or who suffer from asthma, COPD, or other lung diseases
• people who have Parkinson’s disease, multiple sclerosis, strokes, or other neurological problems
• people who have diabetes, weak immune systems, and chronic liver or kidney disease
• pregnant women and new mothers.

If you’re over 65, the CDC recommends getting one of the vaccines that produces higher levels of antibodies that help protect you against the flu: the Fluzone High-Dose Quadrivalent, Flublock Quadrivalent recombinant, or the Fluad Quadrivalent adjuvanted vaccines. The first two contain higher amounts of antigens, the proteins that trigger the body’s antibody response. The third contains an adjuvant, which is an additive that enhances immune response. People who fall into the other high-risk categories mentioned above might also want to seek out one of these vaccines, says Dr. Ross. But get the standard flu vaccine if none of the other options are readily available.

COVID vaccine advice for adults

The CDC is urging all adults to also stay up to date with COVID vaccines, including the new bivalent mRNA booster. The bivalent shots target both the original COVID strain and the two most recent Omicron subvariants (BA.4 and BA.5), which are more contagious than earlier strains. You should wait at least two months after your previous booster or primary vaccine series to get the new booster. Booster recommendations may differ for people who have a weakened immune system. See the CDC website for more detail on COVID vaccines and boosters.

“The real-world effectiveness of these boosters is a big question mark, but I certainly recommend one to anyone who’s due for a booster, especially if you’re older,” says Dr. Ross. Certain data from the earlier rounds of boosters suggests that anything you can do to expand your immune system’s repertoire of response to Omicron will likely protect you against severe disease and hospitalization from COVID, he adds. For example, a recent study among nursing home residents shows 26% fewer COVID infections, a 60% reduction in hospitalizations, and a 90% reduction in deaths for those who had received two booster shots at appropriate intervals compared with only one booster shot.

There’s no downside to getting the booster at the same time you get your annual flu shot, although those who experienced unpleasant side effects from a COVID vaccine in the past might want to get their flu shot on a different day. But for many people, getting both shots over and done with is a smart strategy.

What else can I do to avoid viral infections?

Simple measures such as washing your hands often, using hand sanitizer when you can’t wash your hands, and avoiding touching your eyes, nose, and mouth can help you stay healthy. Also, be sure to eat well, stay active, and get a good night’s sleep.

The CDC has additional advice for protecting yourself against COVID-19, such as moving indoor activities outdoors, improving ventilation of indoor air, and taking precautions like wearing masks and distancing when in crowded places, or when COVID cases are high in your community.

Multiple supportive connections in community settings can help people lose weight.

Attaining and maintaining a healthy weight is a major health issue, not only in the United States but in many countries throughout the world. Governments are looking to identify the most effective services to support people to lose weight and improve overall health. A recent systematic review and meta-analysis (a larger study of studies) examined the effectiveness of weight management interventions delivered in primary care settings, and included data from the United States, the United Kingdom, and Spain.

Looking at weight loss support in primary care

Researchers evaluated 34 studies with adults who had a body mass index greater than 25 (overweight). They looked at people who received weight loss interventions within primary care settings. The interventions included instruction on weight management behaviors such as low-calorie diets, increased exercise, use of food diaries, and/or behavioral self-management approaches with support by clinic staff to set weight-related goals, solve problems, and increase self-efficacy.

Weight loss interventions were conducted by telephone, the internet, email, or face-to-face, and included group-based and/or individual connections. The research compared these types of interventions to no weight loss treatment, minimal intervention (use of printed or electronic education about weight loss), or instruction in attention control to resist urges or behaviors, but not focusing specifically on weight loss behavior.

Programs delivered in primary care did produce meaningful weight loss

The interventions were delivered by a variety of medical professionals (nurses, dietitians, and general practitioners) and nonmedical practitioners such as health coaches. The interventions lasted between one session (with patients following the program unassisted for three months) and several sessions over three years, with a median of 12 months.

Results showed that the mean difference between the intervention and comparison (no specific weight loss intervention) groups at one year was a weight loss of 5.1 pounds, and at two years it was 4 pounds for those that received weight loss interventions in primary care. There was also a mean difference in waist circumference of -2.5 cm, in favor of the intervention at one year.

Importantly, since this was a systematic review of 34 trials with a wide range of interventions, the authors were not able to specifically identify which interventions produced the result.

Even small weight loss impacts health

The authors noted that although a 5-pound greater weight loss in the intervention group may seem small, research has shown that a 2% to 5% weight loss is associated with health benefits, including lower systolic blood pressure along with reduced triglyceride and glucose levels, which may impact cardiac health.

Do personal check-ins and support impact weight loss?

The study recognized that the comparison groups had fewer person-to-person contacts than the intervention groups, and this may have played a critical role in the findings. A greater number of contacts between patients and providers led to more weight loss. The research suggests that programs should be developed to include at least 12 contacts (face-to-face, telephone, or a combination).

Although the study did not determine the costs of the programs, it is likely that interventions delivered by nonmedical personnel, with supervision and support from primary care health professionals, would be less expensive. It may be that a combination of practitioners would be most effective, since physicians and general practitioners most likely will not have the time for 12 consultations to support a weight management program.

Prior research supports community-based behavioral interventions for weight loss

A study prepared for the US Preventive Services Task Force and published in 2018 found similar results. This review reported a reduction of 5.3 pounds in participants who received weight management interventions in a variety of settings, including universities, primary care, and the community. Compared with controls, participants in behavior-based interventions had greater mean weight loss at 12 to 18 months and less weight regain.

In the two largest trials (of the 124 identified), there was a decreased probability of developing type 2 diabetes compared with those who did not receive the weight management interventions. There was an absolute risk reduction of approximately 14.5% in both trials over three to nine years, meaning those who received weight loss management intervention had a 14.5% reduced chance of developing diabetes compared to a control group.

What’s the takeaway?

Weight management interventions delivered in primary care settings are an effective way to deliver services. Primary care practices offer good reach into the community, and oftentimes are the first point of contact for people to the healthcare system. With our growing obesity epidemic, every effort should be considered to connect with patients struggling with their weight and offer viable, effective interventions.

What can you do?

• Ask your PCP if their practice or clinic offers programs to support weight management.
• Contact your health insurance and inquire about programs they have in their system to help reduce risk factors and manage weight. Ask if they are free or discounted as part of your plan.
• Check in your area if there are any community-based programs such as the YMCA, a school-based program, or a senior center focused on wellness and weight management.

If you’re in your 80s or 70s and you’ve noticed that you’re having some memory loss, it might be reasonable to be concerned that you could be developing Alzheimer’s disease or another form of dementia. But what if you’re in your 60s, 50s, or 40s… surely those ages would be too young for Alzheimer’s disease or dementia, right?

About 10% of Alzheimer’s disease is young onset, starting before age 65

Not necessarily. Of the more that 55 million people living with dementia worldwide, approximately 60% to 70% of them have Alzheimer’s disease. And of those 33 to 38.5 million people with Alzheimer’s disease, memory loss or other symptoms began before age 65 in 10% of them. Alzheimer’s is, in fact, the most common cause of young onset dementia. A recent study from the Netherlands found that of those with a known classification of their young onset dementia, 55% had Alzheimer’s disease, 11% vascular dementia, 3% frontotemporal dementia, 3% Parkinson’s disease dementia, 2% dementia with Lewy bodies, and 2% primary progressive aphasia.

Young onset dementia is uncommon

To be clear, young onset dementia (by definition starting prior to age 65, and sometimes called early onset dementia) is uncommon. One study in Norway found that young onset dementia occurred in 163 out of every 100,000 individuals; that’s in less than 0.5% of the population. So, if you’re younger than 65 and you’ve noticed some trouble with your memory, you have a 99.5% chance of there being a cause other than dementia. (Whew!)

There are a few exceptions to this statement. Because they have an extra copy of the chromosome that carries the gene for the amyloid found in Alzheimer’s plaques, more than half of people with Down syndrome develop Alzheimer’s disease, typically in their 40s and 50s. Other genetic abnormalities that run in families can also cause Alzheimer’s disease to start in people’s 50s, 40s, or even 30s — but you would know if you are at risk because one of your parents would have had young onset Alzheimer’s disease.

How does young onset Alzheimer’s disease differ from late onset disease?

The first thing that should be clearly stated is that, just as no two people are the same, no two individuals with Alzheimer’s disease show the same symptoms, even if the disease started at the same age. Nevertheless, there are some differences between young onset and late onset Alzheimer’s disease.

People with typical, late onset Alzheimer’s disease starting at age 65 or older show the combination of changes in thinking and memory due to Alzheimer’s disease plus those changes that are part of normal aging. The parts of the brain that change the most in normal aging are the frontal lobes. The frontal lobes are responsible for many different cognitive functions, including working memory — the ability to keep information in one’s head and manipulate it — and insight into the problems that one is having.

This means that, in relation to cognitive function, people with young onset Alzheimer’s disease may show relatively isolated problems with their episodic memory — the ability to form new memories to remember the recent episodes of their lives. People with late onset Alzheimer’s disease show problems with episodic memory, working memory, and insight. So, you would imagine that life is tougher for those with late onset Alzheimer’s disease, right?

Depression and anxiety are more common in young onset Alzheimer’s disease

People with late onset Alzheimer’s disease do show more impairment, on average, in their cognition and daily function than those with young onset Alzheimer’s disease, at least when the disease starts. However, because their insight is also impaired, those with late onset disease don’t notice these difficulties that much. Most of my patients with late onset Alzheimer’s disease will tell me either that their memory problems are quite mild, or that they don’t have any memory problems at all!

By contrast, because they have more insight, patients with young onset Alzheimer’s disease are often depressed about their situation and anxious about the future, a finding that was recently confirmed by a group of researchers in Canada. And as if having Alzheimer’s disease at a young age wasn’t enough to cause depression and anxiety, recent evidence suggests that in those with young onset Alzheimer’s disease, the pathology progresses more quickly.

Another tragic aspect of young onset Alzheimer’s disease is that, by affecting individuals in the prime of life, it tends to disrupt families more than late onset disease. Teenage and young adult children are no longer able to look to their parent for guidance. Individuals who may be caring for children in the home now need to care for their spouse as well — perhaps in addition to caring for an aging parent and working a full-time job.

What should you do if you’re younger than 65 and having memory problems?

As I’ve discussed, if you’re younger than 65 and you’re having memory problems, it’s very unlikely to be Alzheimer’s disease. But if it is, there are resources available from the National Institute on Aging that can help.

What else could be causing memory problems at a young age? The most common cause of memory problems below age 65 is poor sleep. Other causes of young onset memory problems include perimenopause, medication side effects, depression, anxiety, illegal drugs, alcohol, cannabis, head injuries, vitamin deficiencies, thyroid disorders, chemotherapy, strokes, and other neurological disorders.

Here are some things that everyone at any age can do to improve their memory and reduce their risk of dementia: