Author: Azeem Majeed

I am Professor of Primary Care and Public Health, and Head of the Department of Primary Care & Public Health at Imperial College London. I am also involved in postgraduate education and training in both general practice and public health, and I am the Course Director of the Imperial College Master of Public Health (MPH) programme.

Protecting Against the “Quad-demic”: Influenza, Covid-19, Norovirus, and RSV

As the NHS braces for a challenging winter season, it is grappling with a “quad-demic” of health emergencies caused by influenza, Covid-19, norovirus, and respiratory syncytial virus (RSV). This confluence of viral threats poses a significant risk to public health in the UK as well as putting strain on healthcare resources, emphasising the importance of preventive measures to safeguard public health. Public health measures such a vaccination and good personal hygiene are pivotal in reducing the impact of these illnesses, particularly for vulnerable groups.

The Four Viruses: What Are They?

  • Influenza: A highly contagious respiratory infection that causes significant illness each winter. It can lead to severe complications, particularly in the elderly, young children, pregnant women, and those with chronic health conditions.
  • Covid-19: Though its most acute phase has passed, Covid-19 remains a concern, especially as new variants of SARS-CoV-2emerge. Severe illness continues to disproportionately affect older adults, those with underlying health conditions and people who are immunocompromised.
  • Norovirus: Known as the “winter vomiting bug,” norovirus is a leading cause of gastroenteritis. It can spread rapidly in closed environments like hospitals and care homes, causing outbreaks that pose a risk to health and which can disrupt health and care services.
  • Respiratory Syncytial Virus (RSV): A common virus that primarily affects young children and older adults. It can lead to bronchiolitis and pneumonia in severe cases, particularly among infants and the elderly.

The Role of Vaccination

Vaccination remains a cornerstone of prevention for influenza, Covid-19, and RSV. For those eligible, timely vaccination can significantly reduce the risk of severe illness, hospitalisation, and complications.

  • Who is eligible for vaccines?
    • Influenza Vaccine: Recommended annually for individuals over 65, pregnant women, children aged 2–10, frontline healthcare workers, and those with specific medical conditions.
    • Covid-19 Vaccine: Offered as part of booster campaigns, particularly for high-risk groups such as the elderly, those with weakened immune systems, and frontline healthcare workers.
    • RSV Vaccine: A relatively recent addition, now available for certain at-risk populations, including older adults and during pregnancy.

Vaccination campaigns are a critical public health tool, reducing the overall spread of these viruses and protecting vulnerable populations.

The Importance of Hygiene in Preventing Norovirus and Beyond

While vaccines are effective for influenza, Covid-19, and RSV, combating norovirus relies primarily on hygiene measures. Norovirus spreads easily through contaminated food, surfaces, and person-to-person contact. The following practices are crucial:

  1. Regular Handwashing: Wash hands thoroughly with soap and water, especially after using the toilet and before eating.
  2. Cleaning and Disinfection: Clean surfaces and commonly touched items with a bleach-based disinfectant to kill the virus.
  3. Proper Food Handling and Storage: Avoid preparing food for others if experiencing symptoms of gastroenteritis, such as vomiting or diarrhoea. Ensure food is stored correctly.
  4. Respiratory Hygiene: Although norovirus is not a respiratory virus, maintaining good respiratory etiquette, such as covering coughs and sneezes and disposing of tissues promptly, helps prevent other infections.

Why Prevention Matters

The intersection of these four viruses can lead to increased pressure on the NHS, with simultaneous outbreaks stretching resources and sometimes overwhelming healthcare services. By preventing illness, individuals not only protect their health but also contribute to easing the burden on the NHS.

Vaccination campaigns and hygiene education are crucial public health strategies. For eligible groups, staying up-to-date with vaccinations is essential, while everyone can benefit from reinforcing good hygiene practices. Together, these measures can help mitigate the impact of the “quad-demic” and support the resilience of our healthcare system during this challenging season.

Taking Action: A Collective Effort

In the face of this “quad-demic,” a proactive approach is essential. Whether through getting vaccinated, promoting hygiene, or supporting public health initiatives, we all have a role to play. By taking these steps, we can protect ourselves, our loved ones, and our communities while reducing the strain on healthcare resources.

This winter, prevention is the best medicine. Let’s work together to stay healthy and keep our NHS strong.

Why Vaccination During Pregnancy Matters

Pregnancy is a time filled with excitement, anticipation, and often, a touch of anxiety. Among the many decisions expectant parents make, one of the most crucial involves protecting the health of both the mother and the baby. Vaccination during pregnancy plays a vital role in this, yet uptake remains worryingly low in many regions.

The Importance of Vaccination During Pregnancy

Vaccines offered during pregnancy, such as those against influenza, pertussis (whooping cough), COVID-19, and the newly added respiratory syncytial virus (RSV) vaccine in the UK, are designed to safeguard the health of mothers and their babies. For example:

  • Influenza vaccine: Protects against severe complications from flu, which can be more serious during pregnancy.
  • Pertussis vaccine: Provides critical early protection for babies against whooping cough until they are old enough to be vaccinated themselves.
  • COVID-19 vaccine: Reduces the risk of severe disease and complications from COVID-19 during pregnancy.

Despite the proven benefits, many pregnant women remain unvaccinated, leaving them and their babies vulnerable to preventable diseases.

Barriers to Uptake

Several factors contribute to low vaccination rates during pregnancy:

  1. Concerns About Safety: A common barrier is worry about the vaccine’s safety for the baby. While extensive research confirms the safety and effectiveness of these vaccines, misinformation – often spread online or through social networks – fuels hesitancy.
  2. Access Challenges: Some pregnant women face logistical hurdles, such as needing separate appointments for vaccination instead of being offered vaccines during routine antenatal visits.
  3. Socioeconomic and Demographic Disparities: Vaccination rates are often lower among women from ethnic minority backgrounds and those living in deprived areas. For instance, a study in London showed significantly lower COVID-19 vaccination rates among Black women and those in economically disadvantaged areas.

Overcoming the Barriers

Improving vaccine uptake requires a multi-pronged approach involving healthcare providers, public health campaigns, and structural changes. Here’s how:

  1. Empower Through Education: Healthcare professionals, including midwives, general practitioners, obstetricians and pharmacists, play a critical role in addressing concerns, countering misinformation, and sharing the benefits of vaccination. These conversations should focus on the risks of not vaccinating and provide clear, evidence-based information about vaccine safety.
  2. Enhance Accessibility: Offering vaccinations during routine antenatal visits and using reminder systems (text messages, emails, etc.) can make it easier for pregnant women to get vaccinated.
  3. Tailored Interventions: Targeted campaigns in communities with low vaccination rates can address specific barriers and build trust. Community leaders and trusted figures can help spread positive messages about vaccination.
  4. Efficient Record-Keeping: Ensuring up-to-date vaccination records prevents unnecessary reminders and allows healthcare providers to focus their efforts on those who are unvaccinated.
  5. Supportive Healthcare Settings: Designating a staff member in clinics or practices to lead vaccination efforts ensures a coordinated approach and provides a point of contact for women with questions.

A Shared Responsibility

Vaccination during pregnancy not only protects mothers but also provides early immunity for their babies, saving lives and preventing illness. Addressing vaccine hesitancy and improving access to vaccines requires a collective effort from healthcare providers, public health bodies, and the community.

As an expectant parent, you have the power to make informed decisions that protect your health and that of your baby. If you have questions or concerns about vaccines, talk to your healthcare provider. Together, we can create a safer, healthier future for you and your child.

For more information, visit the NHS vaccinations in pregnancy page.

Read also my recent article in the British Medical Journal.

Why I Support the Fortification of Flour with Folic Acid

From the end of 2026, the UK government will require the addition of folic acid to non-wholemeal flour. This is an important step forward in public health; an intervention that could prevent up to 200 cases of neural tube defects annually as well as improving the health of pregnant women and their babies.

Why Folic Acid Matters

Folic acid is essential for healthy cell growth and development. For pregnant women, folic acid plays a critical role in the early stages of foetal development, particularly in forming the neural tube, which develops into the brain and spinal cord. An insufficient folic acid intake during pregnancy can lead to neural tube defects such as spina bifida and anencephaly—serious conditions that can result in lifelong disability for the child or even loss of life.

While women planning to become pregnant are encouraged to take folic acid supplements, about half of pregnancies in the UK are unplanned. This means that many women may not be taking supplements at the crucial time when the neural tube is developing, often before they even know they are pregnant. Fortifying a staple food such as non-wholemeal flour ensures that more women—and the population in general—have a better intake of folic acid, thereby reducing the risk of neural tube defects.

A Proven Public Health Measure

Folic acid fortification is not a new concept. Countries such as the USA, Canada, Australia and New Zealand have implemented similar policies with with positive public health outcomes. In the USA, for instance, neural tube defect rates dropped after folic acid was added to flour in 1998. This policy has been hailed as one of the most effective public health interventions in recent decades.

By adopting a similar strategy, the UK stands to achieve comparable benefits. The planned fortification could prevent up to 200 neural tube defect cases annually. Beyond these direct health benefits, the policy will also reduce the emotional and financial burden on families and the healthcare system.

Reaching Vulnerable Groups

One of the most main advantages of folic acid fortification is its ability to reach vulnerable populations. People from poorer backgrounds are less likely to take dietary supplements and may have diets that are lower in naturally occurring folate. Fortification ensures that everyone has access to an additional source of this vital nutrient, which can hep in reducing health inequalities.

Safety and Wholemeal Flour Exemption

Some people have expressed concerns about potential risks of folic acid fortification, such as masking vitamin B12 deficiency in older adults. However, evidence from countries with fortification policies shows that these risks are very low and far outweighed by the benefits.

Moreover, wholemeal flour will not be fortified under the new policy, as wholemeal flour is less commonly consumed and many people who choose it also prioritise less processed foods. However, those who consume wholemeal flour should be mindful of their folic acid intake and ensure this is adequate through other sources, including supplements or other products fortified with folic acid.

Looking Ahead

The move to fortify non-wholemeal flour with folic acid is a proactive approach to improving public health. By addressing one cause of neural tube defects, this policy will have a lasting positive impact on many families across the UK. It is a reminder of the power of preventive measures in public health when even a small change can make a large difference at a population level.

As we move toward the implementation of this policy, it is crucial to continue raising awareness about the importance of folic acid, particularly among women of childbearing age. Together, we can support a healthier future for mothers, babies, and society as a whole by supporting positive public health interventions such s folic acid fortification.

Bridging the Digital Divide in Healthcare: Understanding the Use of the NHS App

The NHS App, launched in 2019, was designed to revolutionise how patients engage with their healthcare, offering features such as booking appointments, viewing medical records, and ordering prescriptions. While the app has seen substantial uptake—with millions registering and engaging—it appears that the benefits of this digital innovation are not evenly distributed across the population as we report in our article in the Journal of Medical Internet Research.

The Promise of the NHS App

Digital health tools like the NHS App hold the potential to empower patients, improve self-management of health, and increase access to care. From March 2020 to June 2022, millions of users logged into the app, ordered prescriptions, and accessed medical records. However, a closer look at the data reveals disparities in who is using these features.

The Digital Divide in Action

Our recent study highlights how sociodemographic factors influence app engagement. Key findings include:

  • Socioeconomic Disparities: People in more deprived areas are significantly less likely to use the app. For instance, the rate of app registrations was 34% lower in the most deprived practices compared to the least deprived.
  • Ethnic Differences: Practices serving populations with higher proportions of White patients showed far greater engagement. Prescription ordering rates in these areas were over double those in more ethnically diverse regions.
  • Age and Health Needs: Younger patients were more likely to use appointment booking features, while those with long-term conditions engaged more with medical record views and prescription services.
  • Gender Gaps: Practices with higher proportions of male patients reported lower app engagement overall.

Why Does This Matter?

The NHS App aims to make healthcare more accessible for all, but these disparities suggest that its benefits may not be reaching those who need them most. This mirrors the “digital inverse care law,” where digital solutions are disproportionately used by those with better access and resources, potentially exacerbating health inequalities.

How Can We Close the Gap?

To ensure the NHS App works for everyone, targeted efforts are needed:

  1. Digital Literacy Programmes: Equip underserved communities with the skills needed to navigate digital tools.
  2. Tailored Outreach: Highlight the App’s benefits to specific groups, such as ethnic minorities and those in deprived areas.
  3. Enhanced Support Services: Offer helplines or in-person assistance for individuals less familiar with digital health platforms.
  4. Collaborations with Community Groups: Partner with local organizations to raise awareness and build trust in digital healthcare solutions.

A Call for Inclusive Digital Health

The findings of our study underscore the importance of continuously monitoring and adapting digital health strategies to meet the needs of diverse populations. The NHS App is a powerful tool with the potential to enhance healthcare accessibility, but its success depends on equitable adoption and use.

Let’s work towards a future where digital health bridges gaps rather than widens them, ensuring better health outcomes for everyone, regardless of their background.

Improving Migrant Healthcare: An Evaluation of of Health Catch-UP!

In today’s interconnected world, migration is a key feature of modern societies. The UK has become home to a significant number of migrants seeking new opportunities or fleeing difficult circumstances. Yet, this group often faces unique healthcare challenges, including the risk of undiagnosed infectious and non-communicable diseases and incomplete vaccination records. Addressing these issues is crucial not only for individual well-being but also for broader public health. In a recent article published in the journal BMC Medicine, we evaluated Health Catch-UP!, a digital tool designed to bridge these healthcare gaps.

Understanding the Need

Migrants when compared to local populations are more vulnerable to certain health conditions that are common in their countries of origin. These range from infectious diseases like hepatitis and latent tuberculosis (TB) to non-communicable conditions like diabetes and high cholesterol. Unfortunately, current healthcare services in the UK often overlook these needs, leading to underdiagnosed health issues and missed opportunities for early treatment and prevention.

What is Health Catch-UP!?

Developed as a Clinical Decision Support System (CDSS), Health Catch-UP! is integrated into primary care practices to prompt healthcare providers to offer tailored screening and catch-up vaccinations for at-risk migrant patients. The tool works by collecting key demographic information (such as age, sex, and country of origin) and using this data to recommend relevant health checks and vaccinations according to current UK guidelines.

Key Findings from the Study

Our recent evaluation of Health Catch-UP! in two London-based primary care practices revealed several important insights:

Successful Data Collection: The tool enabled almost complete coding of essential patient demographics, which are often missing from standard records.

High Screening Uptake: Over 60% of the participating migrant patients were eligible for screening, with an impressive 87% choosing to undergo the tests.

New Diagnoses: Through the screening, 12 new health conditions were identified, showcasing the tool’s potential to detect previously unrecognized health issues.

Challenges with Vaccinations: Despite identifying gaps in vaccination coverage, the actual uptake of vaccines was low. This highlights the need for more patient engagement and support in this area.

Patient and Healthcare Staff Perspectives

The feedback from both patients and healthcare professionals was largely positive. Patients appreciated being offered comprehensive health checks, especially when these were explained clearly by their providers. Clinicians found the tool to be user-friendly and felt it integrated well with existing practices. However, they noted that certain questions, such as asking about the date of arrival in the UK, could make some patients uncomfortable. Clear communication was key to overcoming this challenge.

The Road Ahead

While Health Catch-UP! has shown promise in improving healthcare access and outcomes for migrants, there are hurdles to overcome. Low vaccination uptake suggests that more robust patient education and logistical support are needed. Additionally, financial and staffing resources will be critical for widespread implementation, particularly in high-migrant areas.

Conclusion

Health Catch-UP! is a step forward toward more inclusive and effective healthcare for migrants in the UK. By tailoring healthcare to the needs of this diverse group, we can ensure better health outcomes and a stronger, more equitable healthcare system for all.

Cardiovascular risks in people with long-term conditions

People with many long-term conditions are at increased risk of cardiovascular disease. If you or someone you care about is living with a long-term condition, here are some practical steps people can take to reduce their risk:

1. Attend for Scheduled Check-Ups: Make sure you attend for any scheduled check-ups. For example, to check your blood pressure, weight, blood sugar levels and cholesterol; or to review your medication.

2. Healthy Lifestyle Choices: Focus on a healthy diet, regular physical activity and avoiding smoking; all of which can reduce the risk of cardiovascular disease. For exercise, you should aim for at least 150 minutes of moderate intensity activity a week or 75 minutes of vigorous intensity activity a week. But even small changes – such as a modest increase in the amount of exercise you take each day – can have positive benefits. A diet rich in fruits, vegetables and whole grains and with less intake of processed foods and sugary drinks is also helpful for your health.

3. Medication Management: If you are prescribed drugs for conditions such as hypertension (high blood pressure) or diabetes, make sure to follow the treatment plan closely. Discuss any side effects or concerns with your doctor or another health professional.

4. Stay Informed: Understanding how your own health condition interacts with other diseases helps you stay informed about your health and reduce your risk of cardiovascular disease. This is an example of what health professionals call “health literacy”; which is increasingly important because of the greater focus in health systems on areas such as prevention and self-care.

5. Connect with Others: Joining a support group for people with your condition can provide valuable emotional support and practical advice from people who understand your challenges. These groups can be in-person or online.

Finally, remember that this list is not comprehensive. Every individual has their own health needs and personal circumstances that will affect their health.

Understanding Vascular Risks in People with Multiple Sclerosis (MS)

Multiple sclerosis (MS) is a complex neurological condition that affects the central nervous system. While much of the focus on MS is often on the symptoms related to the nervous system, recent research has shed light on another important aspect: the increased risk of vascular diseases, such as diabetes and hypertension, in people living with MS (PwMS). Let’s take a closer look at what this means and how it impacts overall health based on the findings of a recent paper from my team published in the Multiple Sclerosis Journal.

What the Research Shows

A large study conducted between 1987 and 2018 looked at the health records of over 12,000 people with MS and compared them with over 70,000 individuals without MS. The findings were significant:

  • Increased Risk of Diabetes: People living with MS have a higher risk of developing type 2 diabetes after being diagnosed with MS. Over 10 years, the incidence rate of diabetes was notably higher in people with MS compared to those without. Women with MS, in particular, showed an 18% higher rate of developing diabetes than the general population.
  • Hypertension Management: People living with MS were more likely to start treatments for hypertension (high blood pressure) compared to individuals without MS. Encouragingly, those with MS who started treatment for hypertension were also more likely to meet blood pressure management targets, as set by the National Institute for Health and Care Excellence (NICE).

However, despite better management, the overall burden of vascular diseases in people living with MS  remains higher than in the general population.

Why Is This Important?

People living with MS are already dealing with a condition that affects mobility, cognitive function, and quality of life. Adding the risk of cardiovascular diseases like diabetes and hypertension can worsen these issues, as vascular health plays a key role in overall well-being. Managing vascular risk factors is essential because conditions like high blood pressure or diabetes can lead to more frequent MS relapses, quicker disability progression, and lower quality of life.

Addressing the Risks

The good news from the study is that people living with MS are more likely to receive treatment for vascular conditions post-diagnosis. This reflects a positive shift in the healthcare approach to managing these risks. But there is still much work to be done. Vascular disease management in people with MS needs to be tailored to their specific needs, potentially requiring more stringent treatment targets to prevent further health complications.

What You Can Do

If you or someone you care about is living with MS, it’s essential to keep an eye on vascular health. Here are some practical steps:

  1. Regular Check-Ups: Make sure to have regular check-ups with your healthcare provider to monitor blood pressure, blood sugar levels, and cholesterol.
  2. Healthy Lifestyle Choices: Focus on a healthy diet, regular physical activity, and avoiding smoking, all of which can reduce the risk of vascular diseases.
  3. Medication Management: If you’re prescribed medications for conditions like hypertension or diabetes, make sure to follow the treatment plan closely and keep an open line of communication with your doctor about any side effects or concerns.
  4. Stay Informed: Understanding how MS interacts with other health conditions helps you stay ahead. Don’t hesitate to ask your healthcare provider about any concerns related to cardiovascular health.

Final Thoughts

The relationship between MS and vascular diseases is complex, but this research highlights the importance of proactive care. By focusing on managing vascular risk factors, people living with MS  can work toward reducing the additional health burdens that come with the disease, improving their long-term health and quality of life.

This study reminds us that while MS presents many challenges, there are steps we can take to mitigate its impacts, especially when it comes to vascular health. Stay engaged with your healthcare team and prioritise comprehensive care to address both neurological and cardiovascular health.

Preparing for Future Health Shocks: Lessons from the COVID-19 Pandemic

The COVID-19 pandemic was a profound global health crisis that exposed vulnerabilities in our public health systems and forced rapid adaptations worldwide. In the absence of effective pharmaceutical solutions at the pandemic’s onset, non-pharmaceutical interventions (NPIs) such as physical distancing, mask-wearing, and lockdowns became essential tools to mitigate the spread of SARS-CoV-2. While NPIs were crucial in reducing transmission and preventing healthcare system overload, their implementation came with significant social, economic, and psychological costs. Reflecting on these measures – as we do in our recent article in the British Medical Journal – offers valuable insights into preparing for future health shocks.

Evaluating the Effectiveness of Non-Pharmaceutical Interventions

NPIs aim to limit person-to-person contact and control the spread of infectious diseases, but they are not without challenges. The simultaneous application of multiple interventions during the pandemic made it difficult to assess their individual effectiveness. Additionally, variations in implementation, cultural differences, and public trust in government policies affected adherence and outcomes. The urgency to act quickly often outpaced the ability to generate robust evidence, highlighting a tension between evidence-based policy and the need for immediate action.

Moving forward, a more flexible research infrastructure is necessary to enable rapid evaluations of NPIs during health crises. Observational studies, although valuable, come with limitations like biases and confounding factors. Enhancing real-time data collection and creating robust systems for sharing this data is essential to guide policymakers effectively during a health emergency.

The Socioeconomic and Psychological Impact of NPIs

The consequences of NPIs extended far beyond controlling infection rates. School closures disrupted children’s education, exacerbating inequalities, especially for those without access to digital resources. Economic hardships disproportionately affected low-income workers who could not work remotely, while those in high-paying positions often retained job security.

Mental health impacts were also significant. Isolation, financial stress, and health concerns led to increased rates of anxiety, depression, and domestic violence. These effects underline the importance of integrating mental health support and economic relief measures into pandemic preparedness plans. Future strategies should prioritize data on socioeconomic factors and mental health needs to ensure a holistic response to health shocks.

The Role of Healthcare Data in Pandemic Preparedness

Healthcare data, particularly electronic health records, proved invaluable during the COVID-19 pandemic. In the UK, these records facilitated rapid data analysis, aiding in decision-making and public health communication. However, the reliance on existing data infrastructure highlighted gaps in data linkage, particularly regarding social care data. Addressing these gaps can improve responses to future health crises by allowing policymakers to identify and support vulnerable populations more effectively.

Establishing a national pandemic preparedness body could further enhance data-sharing and rapid response capabilities. Such an entity could map potential health threats, design secure data-sharing environments, and streamline ethical approval processes, ensuring that essential data is available and ready for immediate use.

Cost-Effectiveness and International Collaboration

Although NPIs can be effective, they come with substantial economic costs. Early evaluations of the cost-effectiveness of these kind of interventions could help policymakers implement the most impactful measures while minimizing negative outcomes. Moreover, the interconnected nature of modern health challenges emphasizes the need for international collaboration. The COVID-19 pandemic highlighted the benefits of global data sharing and coordination through organizations like the World Health Organization. Countries should continue to strengthen global health agreements and partnerships, as sharing knowledge and resources can optimize response efforts and minimize the impact of future pandemics.

Building Public Trust and Involving Stakeholders

Public trust is critical for the success of NPIs. During the COVID-19 pandemic, transparent communication and engagement with the public helped improve adherence to public health measures. For future health shocks, involving stakeholders, especially those from vulnerable communities, in decision-making processes will be essential. Public engagement can foster a sense of collective responsibility and resilience, which are vital for overcoming health crises.

Conclusion

As we prepare for future health shocks, the lessons from the COVID-19 pandemic are clear. Investing in data infrastructure, ensuring rapid evaluation capabilities, and prioritizing the mental health and socioeconomic well-being of affected populations can build a more resilient society. By fostering international collaboration and public trust, we can strengthen our ability to respond to whatever health challenges lie ahead. The next pandemic may not be preventable, but by learning from the past, we can be better equipped to mitigate its impact on global health.

What are the benefits of a high-fibre diet?

A high-fibre diet is crucial for maintaining overall health and well-being. Fibre, a type of carbohydrate that the body cannot digest, plays a key role in various bodily functions. Here are some of the primary benefits of incorporating more fibre into your diet:

1. Improved Digestive Health: Fibre is essential for maintaining a healthy digestive system. It adds bulk to the stool, which helps prevent constipation and promotes regular bowel movements. Insoluble fibre, found in foods like whole grains and vegetables, passes through the digestive tract relatively intact and speeds up the passage of bowel contents.

2. Helps with Weight Management: High-fibre foods can be more filling than low-fibre foods which help controls appetite and reduce overall calorie intake. By slowing the digestion process fibre can make you feel fuller for longer thus aiding in weight management and reducing the likelihood of overeating.

3. Lower Cholesterol Levels: Soluble fibre, found in foods like oats, beans, and flaxseeds, can help lower blood cholesterol levels. It binds with cholesterol particles in the digestive system and removes them from the body before they are absorbed into the bloodstream.

4. Regulation of Blood Sugar Levels: For people with diabetes or those at risk, a high-fibre diet can help regulate blood sugar levels. Soluble fibre slows the absorption of sugar, which can help improve blood sugar levels and reduce the risk of developing type 2 diabetes.

5. Reduced Risk of Heart Disease: A high-fibre diet has been linked to a lower risk of heart disease. Fibre helps reduce cholesterol levels and improve blood pressure, both of which are risk factors for heart disease. Additionally, fibre’s role in weight management can further contribute to improved cardiovascular health.

6. Healthy Gut Bacteria: Fibre acts as a prebiotic, providing nourishment for beneficial gut bacteria. A healthy gut microbiome is essential for overall health, affecting everything from digestion and immune function to mental health.

7. Reduced Risk of Certain Cancers: Some studies suggest that a high-fibre diet may help reduce the risk of colorectal cancer. Fibre helps speed up the elimination of waste through the colon, reducing the time that harmful substances spend in contact with the intestinal lining.

8. Enhanced Immune Function: A healthy gut, supported by a high-fibre diet, is a key component of a robust immune system. The gut houses a significant portion of the body’s immune cells, and a diverse and balanced gut microbiome can enhance immune responses and reduce inflammation.

Here are some tips for increasing fibre intake

  • Choose Whole Grains: Opt for whole-grain bread, pasta, and cereals instead of refined grains.
  • Eat More Fruits and Vegetables: Aim for at least five servings of fruits and vegetables per day. Leave the skins on when possible to maximize fibre intake.
  • Include Legumes in Your Diet: Beans, lentils, and chickpeas are excellent sources of fibre.
  • Snack on Nuts and Seeds: Almonds and seeds are high in fibre.

Conclusion: Incorporating more fibre into your diet offers numerous health benefits, from improved digestive health and weight management to reduced risks of heart disease and certain cancers. By making simple dietary changes and choosing high-fibre foods, you can significantly enhance your overall health and well-being.

Understanding the Impact of Inhaled Corticosteroids on Adverse Events in People with Asthma

Asthma is a chronic condition that affects many millions of people worldwide, making it difficult for them to breathe due to inflamed airways. Inhaled corticosteroids (ICS) are a cornerstone of asthma treatment, significantly improving patients’ quality of life by reducing symptoms, preventing asthma attacks, and improving lung function. However, while the benefits of ICS are well-established, there are concerns about potential adverse effects, particularly at higher doses.

The Role of Inhaled Corticosteroids

Inhaled corticosteroids are anti-inflammatory medications that are commonly prescribed to manage asthma. They work by reducing inflammation in the airways, making it easier to breathe and reducing the frequency of asthma exacerbations. According to current guidelines, patients should use the lowest effective dose of ICS to manage their asthma effectively.

Key Findings from Our Recent Research Study

Our recent study in the American Journal of Respiratory and Critical Care Medicine has shed light on the association between the dose of ICS and the frequency of adverse events. The study, which analysed data from two large UK nationwide databases, aimed to determine the risk of adverse effects from short-term ICS use in people with asthma. We found that:

Low-Dose ICS: Short-term use of low-dose ICS (≤200mcg per day) was not associated with significant adverse effects.

Medium-High Dose ICS: Use of medium (201-599mcg per day) and high doses (≥600mcg per day) of ICS was associated with an increased risk of several adverse outcomes, including major adverse cardiac events (MACE), arrhythmia, pulmonary embolism (PE), and pneumonia. The risk increased with higher doses.

Major Adverse Cardiac Events (MACE): We found that medium and high doses of ICS were associated with a significantly increased risk of MACE. For medium doses, the hazard ratio (HR) was 2.63, and for high doses, it was 4.63.

Arrhythmia: Similarly, the risk of arrhythmia was higher with medium doses (HR 2.21) and even more so with high doses (HR 2.91).

Pulmonary Embolism (PE): The risk of PE was also elevated, with hazard ratios of 2.10 for medium doses and 3.32 for high doses.

Pneumonia: We study found an increased risk of pneumonia at both medium (HR 2.25) and high doses (HR 4.09).

These findings highlight the importance of adhering to guideline recommendations to use the lowest effective ICS dose to manage asthma, thereby minimizing the risk of adverse events.

Implications for Asthma Management

Our study emphasises the need for clinicians to balance the benefits of ICS in controlling asthma with the potential risks associated with higher doses. Here are some key takeaways for both healthcare providers and patients:

Personalized Treatment Plans: Healthcare providers should tailor asthma treatment plans to each patient, ensuring that the ICS dose is sufficient to control symptoms while minimizing potential risks.

Regular Reviews: Regular asthma reviews and medication assessments should be conducted to ensure that patients are on the lowest effective dose of ICS. This includes considering step-down approaches when asthma is well-controlled.

Patient Education: Patients should be educated about the importance of adhering to their prescribed treatment and the potential risks of using higher doses of ICS without medical guidance.

Conclusion

Inhaled corticosteroids remain a vital component of asthma management, offering significant benefits in reducing symptoms and preventing exacerbations. However, this recent research underscores the importance of using the lowest effective dose to mitigate the risk of adverse events. By working closely with healthcare providers, patients can ensure that their asthma is managed effectively and safely. Finally, as we continue to learn more about the long-term effects of asthma medications, ongoing research and vigilance are crucial in optimizing treatment strategies for better health outcomes.