Long-term Conditions Research Articles

Health-related conditions among long-term cancer survivors diagnosed in adolescence and young adulthood (AYA): results of the SURVAYA study.

With 5-year survival rates > 85%, gaining insight into the long-term and late health-related conditions of cancer survivors diagnosed in adolescence and young adulthood is of utmost importance to improve their quantity and quality of survival. This study examined the prevalence of and factors associated with, patient-reported health-related conditions and their latency times among long-term adolescent and young adult (AYA) cancer survivors. AYA cancer survivors (5-20years after diagnosis) were identified by the population-based Netherlands Cancer Registry (NCR), and invited to participate in the SURVAYA questionnaire study. Participants reported the prevalence and date of diagnosis of health-related conditions. Clinical data were retrieved from the NCR. Three thousand seven hundred seventy-six AYA cancer survivors (response rate 33.4%) were included for analyses. More than half of the AYAs (58.5%) experienced health-related conditions after their cancer diagnosis, of whom 51.4% were diagnosed with two or more conditions. Participants reported conditions related to vision (15.0%), digestive system (15.0%), endocrine system (14.1%), cardiovascular system (11.7%), respiratory system (11.3%), urinary tract system (10.9%), depression (8.6%), hearing (7.4%), arthrosis (6.9%), secondary malignancy (6.4%), speech-, taste and smell (4.5%), and rheumatoid arthritis (2.1%). Time since diagnosis, tumor type, age at diagnosis, and educational level were most frequently associated with a health-related condition. A significant proportion of long-term AYA cancer survivors report having one or more health-related conditions. Future research should focus on better understanding the underlying mechanisms of, and risk factors for, these health-related conditions to support the development and implementation of risk-stratified survivorship care for AYA cancer survivors to further improve their outcomes. NCT05379387.

A Numerical Study on the Influence of Bolt Corrosion on the Long-Term Behavior of Steel–Concrete Composite Beams

This study establishes a numerical model for beam-type steel–concrete composite specimens considering the corrosion of anchor bolts, with which studies the long-term deformation performance of the components under sustained load. The experimental results were compared with the calculated values obtained by combining the effective modulus method according to the CEB-FIP 1990 code and the ACI 209R code. Then a comparison with the calculation method of shrinkage and creep in standards (Standard Creep Method (SCM)) is made, and it shows that by supplementing the degradation of interface stiffness due to corrosion (using the defined modulus method (DMM)), the simulation results match better with the experimental results, confirming that this approach is suitable for analyzing the long-term load conditions of anchor bolt corrosion. Furthermore, based on the defined modulus method, the long-term behavior of composite beams under different loads and varying corrosion rates is studied.

Long-term health conditions and UK labour market outcomes during the COVID-19 pandemic.

Long-term health conditions can affect labour market outcomes. COVID-19 may have increased labour market inequalities, e.g. due to restricted opportunities for clinically vulnerable people. Evaluating COVID-19's impact could help target support. To quantify the effect of several long-term conditions on UK labour market outcomes during the COVID-19 pandemic and compare them to pre-pandemic outcomes. The Understanding Society COVID-19 survey collected responses from around 20,000 UK residents in nine waves from April 2020-September 2021. Participants employed in January/February 2020 with a variety of long-term conditions were matched with people without the condition but with similar baseline characteristics. Models estimated probability of employment, hours worked and earnings. We compared these results with results from a two-year pre-pandemic period. We also modelled probability of furlough and home-working frequency during COVID-19. Most conditions (asthma, arthritis, emotional/nervous/psychiatric problems, vascular/pulmonary/liver conditions, epilepsy) were associated with reduced employment probability and/or hours worked during COVID-19, but not pre-pandemic. Furlough was more likely for people with pulmonary conditions. People with arthritis and cancer were slower to return to in-person working. Few effects were seen for earnings. COVID-19 had a disproportionate impact on people with long-term conditions' labour market outcomes.

Evaluating video and hybrid group consultations in general practice: mixed-methods, participatory study protocol (TOGETHER 2)

Background General practice is facing an unprecedented challenge in managing the consequences of the pandemic. In the midst of a policy drive to balance remote and in-person service provision, substantial workload pressures remain, together with increasing prevalence of long-term conditions, and declining staff numbers and morale. To address these challenges, some practices in the UK have been delivering video and hybrid group consultations (VHGCs). Despite positive initial findings and enthusiasm, there are still gaps in our understanding of the influence VHGCs have on patient experience, healthcare utilisation, quality, safety, equity and affordability. Objectives To generate an in-depth understanding of VHGCs for chronic conditions in general practice, surface assumptions and sociotechnical dynamics, inform practice and extend theorisation. Methods Mixed-methods, multi-site research study using co-design and participatory methods, from qualitative, quantitative and cost-related perspectives. WP1 includes a national, cross-sectional survey on VHGC provision across the UK. In WP2 we will engage patients and general practice staff in co-design workshops to develop VHGC models with emphasis on digital inclusion and equity. In WP3 we will carry out a mixed-methods process evaluation in up to 10 GP practices across England (5 sites already running VHGCs and 5 comparison sites). Qualitative methods will include interviews, focus groups and ethnographic observation to examine the experiences of patients, carers, clinical and non-clinical NHS staff, commissioners and policy-makers. Quantitative methods will examine the impact of VHGCs on healthcare utilisation in primary and secondary care, patient satisfaction, engagement and activation. We will also assess value for money of group and individual care models from a health economics perspective. Conclusions We aim to develop transferable learning on sociotechnical change in healthcare delivery, using VHGCs as an exemplar of technology-supported innovation. Findings will also inform the design of a future study.

Clinical effectiveness of drop-in mental health services at paediatric hospitals: A non-randomised multi-site study for children and young people and their families - study protocol.

Despite the high prevalence of mental health difficulties in children and young people with long-term health conditions (LTCs), these difficulties and experiences are often overlooked and untreated. Previous research demonstrated the effectiveness of psychological support provided via a drop-in mental health centre located in a paediatric hospital. The aim of this prospective non-randomised single-arm multi-centre interventional study is to determine the clinical effectiveness of drop-in mental health services when implemented at paediatric hospitals in England. It is hypothesised that families who receive psychological interventions through the drop-in services will show improved emotional and behavioural symptoms. Outcomes will be measured at baseline and at 6-month follow-up. The primary outcome is the difference in the total difficulties score on the Strengths and Difficulties Questionnaire (SDQ) reported by parent or child at 6 months. Secondary outcomes include self and parent reported Paediatric Quality of Life Inventory (PedsQL), self-reported depression (PHQ-9) and anxiety measures (GAD-7) and family satisfaction (CSQ-8). This trial aims to determine the clinical effectiveness of providing psychological support in the context of LTCs through drop-in mental health services at paediatric hospitals in England. These findings will contribute to policies and practice addressing mental health needs in children and young people with other long-term health conditions. ISRCTN15063954, Registered on 9 December 2022.

The welfare of ill and injured feedlot cattle: a review of the literature and implications for managing feedlot hospital and chronic pens

By definition, ill and injured animals are on the negative valence of animal welfare. For beef cattle kept in feedlot settings, advances in cattle health management have resulted in a greater understanding and prevention of illness and injury. However, the management of cattle once they become ill and injured is an understudied area, and there are gaps in knowledge that could inform evidence-based decision-making and strengthen welfare for this population. The aim of this review is to provide a comprehensive overview of the acquired knowledge regarding ill and injured feedlot cattle welfare, focusing on existing knowledge gaps and implications for hospital and chronic pen management and welfare assurance. Ill and injured feedlot cattle consist of acutely impaired animals with short-term health conditions that resolve with treatment and chronically impaired animals with long-term health conditions that may be difficult to treat. A literature search identified 110 articles that mentioned welfare and ill and injured feedlot cattle, but the population of interest in most of these articles was healthy cattle, not ill and injured cattle. Articles about managing ill and injured cattle in specialized hospital (n = 12) or chronic (n = 2) pens were even more sparse. Results from this literature search will be used to outline the understanding of acutely and chronically ill and injured feedlot cattle, including common dispositions and welfare considerations, behavior during convalescence, and strategies for identifying and managing ill and injured cattle. Finally, by working through specific ailments common in commercial feedlot environments, we illustrate how the Five Domains Model can be used to explore feelings and experiences and subsequent welfare state of individual ill or injured feedlot cattle. Using this approach and our knowledge of current industry practices, we identify relevant animal-based outcomes and critical research questions to strengthen knowledge in this area. A better understanding of this overlooked topic will inform future research and the development of evidence-based guidelines to help producers care for this vulnerable population.

Addressing challenges in the management of long-term conditions in prisons

Addressing challenges in the management of long-term conditions in prisons

Shining a Light on How Soil Organic Carbon Behaves at Fine Scales under Long-Term Elevated CO2: An 8 Year Free-Air Carbon Dioxide Enrichment Study.

Building and protecting soil organic carbon (SOC) are critical to agricultural productivity, soil health, and climate change mitigation. We aim to understand how mechanisms at the organo-mineral interfaces influence SOC persistence in three contrasting soils (Luvisol, Vertisol, and Calcisol) under long-term free air CO2 enrichment conditions. A continuous wheat-field pea-canola rotation was maintained. For the first time, we provided evidence to a novel notion that persistent SOC is molecularly simple even under elevated CO2 conditions. We found that the elevated CO2 condition did not change the total SOC content or C forms compared with the soils under ambient CO2 as identified by synchrotron-based soft X-ray analyses. Furthermore, synchrotron-based infrared microspectroscopy confirmed a two-dimensional microscale distribution of similar and less diverse C forms in intact microaggregates under long-term elevated CO2 conditions. Strong correlations between the distribution of C forms and O-H groups of clays can explain the steady state of the total SOC content. However, the correlations between C forms and clay minerals were weakened in the coarse-textured Calcisol under long-term elevated CO2. Our findings suggested that we should emphasize identifying management practices that increase the physical protection of SOC instead of increasing complexity of C. Such information is valuable in developing more accurate C prediction models under elevated CO2 conditions and shift our thinking in developing management practices for maintaining and building SOC for better soil fertility and future environmental sustainability.

The association of protein-bound methionine sulfoxide with proteomic basis for aging in beech seeds

BackgroundEuropean beech (Fagus sylvatica L.) trees produce seeds irregularly; therefore, it is necessary to store beech seeds for forestation. Despite the acquisition of desiccation tolerance during development, beech seeds are classified as intermediate because they lose viability during long-term storage faster than typical orthodox seeds. In this study, beech seeds stored for short (3 years) or long (20 years) periods under optimal conditions and displaying 92 and 30% germination capacity, respectively, were compared.ResultsAged seeds displayed increased membrane damage, manifested as electrolyte leakage and lipid peroxidation levels. Analyses have been based on embryonic axes, which contained higher levels of reactive oxygen species (ROS) and higher levels of protein-bound methionine sulfoxide (MetO) in aged seeds. Using label-free quantitative proteomics, 3,949 proteins were identified, of which 2,442 were reliably quantified pointing to 24 more abundant proteins and 35 less abundant proteins in beech seeds under long-term storage conditions. Functional analyses based on gene ontology annotations revealed that nucleic acid binding activity (molecular function), ribosome organization or biogenesis and transmembrane transport (cellular processes), translational proteins (protein class) and membranous anatomical entities (cellular compartment) were affected in aged seeds. To verify whether MetO, the oxidative posttranslational modification of proteins that can be reversed via the action of methionine sulfoxide reductase (Msr) enzymes, is involved in the aging of beech seeds, we identified and quantified 226 MetO-containing proteins, among which 9 and 19 exhibited significantly up- and downregulated MetO levels, respectively, in beech seeds under long-term storage conditions. Several Msr isoforms were identified and recognized as MsrA1-like, MsrA4, MsrB5 and MsrB5-like in beech seeds. Only MsrA1-like displayed decreased abundance in aged seeds.ConclusionsWe demonstrated that the loss of membrane integrity reflected in the elevated abundance of membrane proteins had a higher impact on seed aging progress than the MetO/Msr system. Proteome analyses enabled us to propose protein Sec61 and glyceraldehyde-3-phosphate dehydrogenase as potential longevity modulators in beech seeds.

Association between emergency department attendances, sociodemographic factors and long-term health conditions in the population of Norfolk and Waveney, England: Cross sectional study.

Demand for urgent and emergency health care in England has grown over the last decade, for reasons that are not clear. Changes in population demographics may be a cause. This study investigated associations between individuals' characteristics (including socioeconomic deprivation and long term health conditions (LTC)) and the frequency of emergency department (ED) attendances, in the Norfolk and Waveney subregion of the East of England. The study population was people who were registered with 91 of 106 Norfolk and Waveney general practices during one year from 1 April 2022 to 31 March 2023. Linked primary and secondary care and geographical data included each individual's sociodemographic characteristics, and number of ED attendances during the same year and, for some individuals, LTCs and number of general practice (GP) appointments. Associations between these factors and ED attendances were estimated using Poisson regression models. 1,027,422 individuals were included of whom 57.4% had GP data on the presence or absence of LTC, and 43.1% had both LTC and general practitioner appointment data. In the total population ED attendances were more frequent in individuals aged under five years, (adjusted Incidence Rate Ratio (IRR) 1.25, 95% confidence interval 1.23 to 1.28) compared to 15-35 years); living in more socioeconomically deprived areas (IRR 0.61 (0.60 to 0.63)) for least deprived compared to most deprived,and living closer to the nearest ED. Among individuals with LTC data, each additional LTC was also associated with increased ED attendances (IRR 1.16 (1.15 to 1.16)). Among individuals with LTC and GP appointment data, each additional GP appointment was also associated with increased ED attendances (IRR 1.03 (1.026 to 1.027)). In the Norfolk and Waveney population, ED attendance rates were higher for young children and individuals living in more deprived areas and closer to EDs. In individuals with LTC and GP appointment data, both factors were also associated with higher ED attendance.

Comparing natural language processing representations of coded disease sequences for prediction in electronic health records.

Natural language processing (NLP) algorithms are increasingly being applied to obtain unsupervised representations of electronic health record (EHR) data, but their comparative performance at predicting clinical endpoints remains unclear. Our objective was to compare the performance of unsupervised representations of sequences of disease codes generated by bag-of-words versus sequence-based NLP algorithms at predicting clinically relevant outcomes. This cohort study used primary care EHRs from 6286233 people with Multiple Long-Term Conditions in England. For each patient, an unsupervised vector representation of their time-ordered sequences of diseases was generated using 2 input strategies (212 disease categories versus 9462 diagnostic codes) and different NLP algorithms (Latent Dirichlet Allocation, doc2vec, and 2 transformer models designed for EHRs). We also developed a transformer architecture, named EHR-BERT, incorporating sociodemographic information. We compared the performance of each of these representations (without fine-tuning) as inputs into a logistic classifier to predict 1-year mortality, healthcare use, and new disease diagnosis. Patient representations generated by sequence-based algorithms performed consistently better than bag-of-words methods in predicting clinical endpoints, with the highest performance for EHR-BERT across all tasks, although the absolute improvement was small. Representations generated using disease categories perform similarly to those using diagnostic codes as inputs, suggesting models can equally manage smaller or larger vocabularies for prediction of these outcomes. Patient representations produced by sequence-based NLP algorithms from sequences of disease codes demonstrate improved predictive content for patient outcomes compared with representations generated by co-occurrence-based algorithms. This suggests transformer models may be useful for generating multi-purpose representations, even without fine-tuning.

An ecosystem of accepting life with chronic pain: A meta-ethnography

Background Chronic pain is a highly prevalent long-term condition, experienced unequally, impacting both the individual living with pain, and wider society. ‘Acceptance’ of chronic pain is relevant to improved consultations in pain care, and navigating an approach towards evidence-based, long-term management and associated improvements in health. However, the concept proves difficult to measure, and primary qualitative studies of lived experiences show complexity related to our socio-cultural-political worlds, healthcare experiences, and difficulties with language and meaning. We framed acceptance of chronic pain as socially constructed and aimed to conceptualise the lived experiences of acceptance of chronic pain in adults. Methods We conducted a systematic search and screening process, followed by qualitative, interpretive, literature synthesis using Meta-ethnography. We included qualitative studies using chronic pain as the primary condition, where the study included an aim to research the acceptance concept. We conducted each stage of the synthesis with co-researchers of differing disciplinary backgrounds, and with lived experiences of chronic pain. Findings We included 10 qualitative studies from Canada, Sweden, The Netherlands, Ireland, UK, Australia and New Zealand. Our ‘lines of argument’ include a fluid and continuous journey with fluctuating states of acceptance; language and meaning of acceptance and chronic pain, a challenge to identity in a capitalist, ableist society and the limits to individualism; a caring, supportive and coherent system. The conceptual framework of the meta-ethnography is represented by a rosebush with interconnected branches, holding both roses and thorns, such is the nature of accepting life with chronic pain. Conclusion Our findings broaden conceptualisation of ‘acceptance of chronic pain’ beyond an individual factor, to a fluid and continuous journey, interconnected with our socio-cultural-political worlds; an ecosystem.

Dynamic identification of coupler force of heavy haul locomotive: An effective and long-term intelligent measurement method

Longitudinal impulse, as a common dynamic problem of heavy haul trains, could induce the lateral instability of the coupler and the separation of the locomotive and wagon connection and thus seriously hinder the train running safety. The coupler force undergoes complex changes during longitudinal impulse transmission and exhibits strong nonlinear characteristics, which poses significant challenges to the identification of the coupler force. To address these issues, this paper reports a novel quantitative method for the coupler force identification of heavy haul locomotives. Firstly, the moving average filtering method is used to preprocess the signal of longitudinal relative displacement between the coupler and carbody (LRDCC), and the approximate relative velocity (ARV) feature is also extracted from the preprocessed signal. Then, a Convolutional Neural Network (CNN) model is constructed to extract high-level features from LRDCC and ARV. The model with randomly initialized weight parameters does not require additional training and thus reduces the computational cost. Finally, an Extreme Learning Machine (ELM) is used as the regression layer to process the extracted high-level features and further improve the identification performance. Additionally, the dung beetle algorithm is used to obtain the optimal model parameters to improve the coupler force identification performance. Not only a dynamics simulation but a field test is carried out to show that the proposed method could accurately detect the coupler force of heavy haul locomotives. Furthermore, the proposed method shows promising prospects in replacing the traditional monitoring method under the actual long-term working conditions of trains.

Early-life exposures and long-term health: adverse gestational environments and the programming of offspring renal and vascular disease.

According to the Developmental Origins of Health and Disease (DOHaD) hypothesis, exposure to certain environmental influences during early life may be a key determinant of fetal development and short- and long-term offspring health. Indeed, adverse conditions encountered during the fetal, perinatal, and early childhood stages can alter normal development and growth, as well as put the offspring at elevated risk of developing long-term health conditions in adulthood, including chronic kidney disease (CKD) and cardiovascular diseases. Of relevance in understanding the mechanistic basis of these long-term health conditions, are previous findings showing low glomerular number in human intrauterine growth restriction and low birth weight - indicators of a sub-optimal intrauterine environment. In different animal models, the main sub-optimal intrauterine conditions studied relate to maternal dietary manipulations, poor micronutrient intake, prenatal ethanol exposure, maternal diabetes, glucocorticoid and chemical exposure, hypoxia, and placental insufficiency. These studies have demonstrated changes in kidney structure, glomerular endowment, and expression of key genes and signalling pathways controlling endocrine, excretion and filtration function of the offspring. This review aims to summarize those studies to uncover the effects and mechanisms by which adverse gestational environments impact offspring renal and vascular health in adulthood. This is important for identifying agents and interventions that can prevent and mitigate the long-term consequences of an adverse intrauterine environment on the subsequent generation.

Remission Rate of Pemphigus Vulgaris and Pemphigus Foliaceus in the Institute of Dermatology: A 7 Years Retrospective Study

Pemphigus, an autoimmune blistering disease caused by autoantibodies targeting desmoglein 1, desmoglein 3, and desmosomal cadherins, is characterized by blister formation and can be a long-term condition with the possibility of relapse. This study aimed to evaluate the remission rates and compare them between pemphigus vulgaris (PV) and pemphigus foliaceus (PF) at the Institute of Dermatology. A retrospective analysis was conducted on 426 patients diagnosed and treated at the Institute of Dermatology in Bangkok, Thailand, between January 1, 2016, and December 31, 2022, for PV and PF. Patients were followed up for 1, 2, and 5 years to assess complete remission using Consensus statement criteria. The remission rates for PV and PF were 3.3%, 17.5%, and 48.4% at 1, 2, and 5 years, and 7.9%, 33.1%, and 61.6% at the same intervals, respectively. PF demonstrated significantly higher remission rates compared to PV at all time points (p< .001). The average time to remission was 60 months for PV and 36 months for PF. Prognostic factors associated with complete remission included age, age at onset, control of underlying disease, disease severity, primary site of involvement, and initial mucosal involvement. In conclusion, the remission rates for PV and PF at five years were 48.4% and 61.6%, respectively. PF achieved complete remission more frequently than PV. Good control of underlying disease, absence of initial mucosal involvement, and mild disease severity were associated with better prognosis for both PV and PF.

The economic burden of multimorbidity: Protocol for a systematic review.

Multimorbidity, also known as multiple long-term conditions, leads to higher healthcare utilisation, including hospitalisation, readmission, and polypharmacy, as well as a financial burden to families, society, and nations. Despite some progress, the economic burden of multimorbidity remains poorly understood. This paper outlines a protocol for a systematic review that aims to identify and synthesise comprehensive evidence on the economic burden of multimorbidity, considering various definitions and measurements of multimorbidity, including their implications for future cost-of-illness analyses. The review will include studies involving people of all ages with multimorbidity without any restriction on location and setting. Cost-of-illness studies or studies that examined economic burden including model-based studies will be included, and economic evaluation studies will be excluded. Databases including Scopus (that includes PubMed/MEDLINE), Web of Science, CINAHL Plus, PsycINFO, NHS EED (including the HTA database), and the Cost-Effectiveness Analysis Registry, will be searched until March 2024. The risk of bias within included studies will be independently assessed by two authors using appropriate checklists. A narrative synthesis of the main characteristics and results, by definitions and measurements of multimorbidity, will be conducted. The total economic burden of multimorbidity will be reported as mean annual costs per patient and disaggregated based on counts of diseases, disease clusters, and weighted indices. The results of this review will provide valuable insights for researchers into the key cost components and areas that require further investigation in order to improve the rigour of future studies on the economic burden of multimorbidity. Additionally, these findings will broaden our understanding of the economic impact of multimorbidity, inform us about the costs of inaction, and guide decision-making regarding resource allocation and cost-effective interventions. The systematic review's results will be submitted to a peer-reviewed journal, presented at conferences, and shared via an online webinar for discussion.

The prevalence and pattern of comorbid long-term conditions with low back pain and osteoarthritis in low- and middle-income countries: a systematic review and meta-analysis

ABSTRACT Chronic musculoskeletal (MSK) pain, specifically low back pain (LBP) and osteoarthritis (OA), are a major cause of global disability, reduced quality of life and high socioeconomic burden. Research in high income countries suggests MSK pain is often comorbid with other long-term conditions / non-communicable diseases (NCDs) including diabetes, hypertension, and cardiovascular disease. However, the epidemiology of comorbid NCDs and MSK pain in low- and middle-income countries (LMICs) is unclear. This systematic review aims to describe the prevalence and pattern of comorbid NCDs in adults with MSK pain in LMICs. Nine databases were searched for epidemiological studies in LMICs (World Bank categories). Paired researchers independently identified studies, extracted data, and completed critical appraisal using Hoy risk of bias tool. Random-effect meta-analysis was used to estimate prevalence of NCDs comorbid with MSK pain. From 2112 citations; 14 studies (n=6093 adults with MSK pain, mean age=46.9years) were included. Overall prevalence of MSK pain with comorbid NCDs was 46.1% (95%CI 32.3 - 59.9). Systemic hypertension had the highest comorbid prevalence with MSK pain (42.6%, 95%CI 25.6-59.6), followed by diabetes (26.7%, 95%CI 16.1-37.3) and mental health conditions (anxiety/depression; 24.9% 95%CI 11.5-38.4). A high proportion of patients with MSK pain in LMICs experience comorbid NCDs. Variable data/population samples, and under-reporting limit accurate capture of prevalence estimates. Understanding the true burden of MSK pain (specifically lower back pain and hip/knee osteoarthritis) and comorbid NCDs is critical to informing effective treatment strategies. The health systems implications of these findings are imperative towards person-centred care, organisation of care and efficient resource utilisation in LMICs.

Novel Approaches to Control Diabetes.

Diabetes is a chronic, long-term, incurable, but controllable condition. Diabetes mellitus (DM) is a group of metabolic disorders characterized by hyperglycemia that results from defects in insulin secretion, insulin action, or both. People who have diabetes often experience a variety of symptoms, including blurry vision, excessive thirst, fatigue, frequent urination, hunger, and weight loss. This review article includes a discussion on diabetes types, symptoms, diagnostic tests, and various therapies for treating, controlling, and managing blood glucose levels, with a focus on its most recent innovation of therapies and medications. Diabetes management will also be reviewed, along with clinical pharmacodynamics, bioavailability, advantages, and complications of combined drugs/medications.

Singing for lung health in COPD: a multicentre randomised controlled trial of online delivery

BackgroundSinging for lung health (SLH) is an arts-based breathing control and movement intervention for people with long-term respiratory conditions, intended to improve symptoms and quality of life. Online, remotely delivered...

Supported self-management in long-term conditions in an African context.

There is a need to develop locally derived African solutions. Self-management strategies for long-term health conditions should be developed, considering traditional holistic African health systems.