Colostomy may offer hope in improving quality of life
Spinal cord injury (SCI) causes functional, psychological, and socioeconomic losses, with long-term secondary complications such as bowel management playing an important role in the maintenance of care for SCI patients. For example, after sustaining SCI, changes in bowel movement, together with impaired sphincter control and loss of mobility, make bowel management a significant cause of morbidity.
These facts are cited by Çelik andTaylan (2023), who undertook a qualitative study to both determine the perceptions of nine wheelchair-dependent individuals in relation to bowel movement difficulties and investigate the effect of colostomy surgery on their experiences of bowel movements.
The participants – six female, three male – were aged between 32 and 52 years and were all married. The researchers found that three main themes emerged in relation to bowel movement management: (a) difficult experiences, like ‘I delay going to the toilet and end up with constipation’; (b) coping with difficulties, like ‘I try to go the toilet at the same hour every day to avoid constipation’; and (c) colostomy awareness experience, such as ‘people like me can understand me’.
The authors conclude that bowel functions should be a topic of discussion and evaluation with patients, ‘and individual bowel management schemes should be established during regular follow-ups, which are a part of lifelong care after SCI.’
Youth onset type 2 diabetes: burden of complications and socioeconomic cost
Although type 2 diabetes (T2D) is not only seen in adults, but adolescents too, and can present barriers to care, like non-adherence to medications, making treatment challenging. In this paper, Rodriguez and O'Sullivan (2023) review recent data on youth-onset T2D, including its pathophysiology, complications, and treatment, plus consider the socioeconomic burden of youth-onset T2D.
Youth-onset T2D has more rapid disease progression compared to adult-onset T2D, resulting in earlier and more severe microvascular and macrovascular complications compared to both adult-onset T2D and youth-onset type 1 diabetes. Further, maternal gestational diabetes and maternal obesity are strongly associated with a greater risk of offspring developing T2D, with the authors citing one study which showed that children of mothers with diabetes were diagnosed with diabetes at younger ages and had worse beta cell function.
One approach to treatment is that adolescents with T2D should be part of a lifestyle program that is developmentally and culturally appropriate, aiming to achieve 7–10% decrease in weight through healthy eating changes and involvement in vigorous physical activity 30–60 min a day at least five days a week.
Youth-onset T2D presents a significant clinical and socioeconomic burden because of its ‘aggressive presentation and earlier appearance of complications. Additional research is needed regarding the cost of illness in this population.’
Association between arthritis and fitness
Rheumatoid arthritis (RA) patients with low cardiorespiratory fitness (CRF) have more cardiovascular disease risk factors and higher mortality rates than patients who are more physically active. RA patients have lower CRF compared to the general population, and in this Norwegian questionnaire and modelling-based study Houge et al (2023) investigated the association between RA status and reduced CRF.
There were 227 RA patients (aged 21 to 83 years) and 300 controls (aged 19 to 75 years). The main finding was that both physical symptoms and negative emotions mediated the association between RA status and estimated CRF (eCRF). Physical symptoms like morning stiffness, joint pain, and neck, back or hip pain, explained 37% of the association between RA status and eCRF. The authors speculate that pain mainly affects exercise intensity, as their RA patients reported lower physical activity (PA) intensity than controls, as low-intensity PA would lead to lower CRF compared to PA at higher intensity. But ‘[r]egardless, exercise may lead to some reduction in pain among persons with RA.’
As for negative emotions – which were associated with lower eCRF – the authors suggest that improvements in mental health, ‘particularly if the individual has high levels of depressive symptoms and perceived stress, could lead to increased PA engagement, which again may increase CRF levels.’
The effectiveness of yoga as a form of exercise for rheumatic diseases
There is some evidence that yoga may exert a beneficial effect by lowering inflammatory markers, and it is known that rheumatic diseases often present with joint stiffness, degeneration, wear in cartilage, connective tissue, and bones, together with pain and inflammation.
In this review Kocyigit et al (2023) consider the effectiveness of yoga practices on various rheumatic diseases. In osteoarthritis (OA), for example, they cite a meta-analysis which indicated that yoga may have favourable impacts on pain level, functionality, and stiffness. The authors suggest that given the beneficial effects conferred by yoga on OA, ‘its relatively low risk, and its rising popularity, it can be recommended to patients who prefer yoga-based exercise practices or do not wish to adhere to conventional exercise regimens.’
In rheumatoid arthritis (RA) it appears from one study that while yoga significantly improved the disease activity score in 28 joints according to a health assessment questionnaire in RA patients, ‘no effect on the quality of life was detected.’ As for ankylosing spondylitis (AS) a randomized controlled trial that investigated the effectiveness of tele-yoga on AS patients during COVID pandemic conditions found that the tele-yoga group showed ‘significant improvements in the Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Functional Index, quality of life, and anxiety.’
However, the authors highlight a general lack of articles with high methodological quality and large samples.