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By Dr. Sushama R. Chaphalkar, PhD. Jan 26 2024 Reviewed by Lily Ramsey, LLM

In a recent longitudinal study published in Scientific Reports, researchers from Brazil investigated the potential association between dynapenia (loss of muscle strength and power) with functional outcomes in patients with long coronavirus disease 2019 (COVID-19).

They found that in patients with long COVID, low handgrip strength (HGS) is associated with worse functional outcomes. They further suggested the potential use of low HGS to indicate functional impairment in long COVID patients.

Study:  Low handgrip strength is associated with worse functional outcomes in long COVID . Image Credit: Ralf Liebhold/Shutterstock.com Background

Long COVID, characterized by persistent symptoms after infection with severe acute respiratory syndrome coronavirus 2 (SARS-VoV-2), poses a significant public health challenge. Symptoms include post-exertional malaise, fatigue, and neurocognitive and gastrointestinal issues.

The estimated global prevalence of the condition is 43%, with an even higher prevalence in hospitalized individuals. Vulnerable populations, including middle-aged, female, Hispanic/Latino, and economically constrained groups, are at a higher risk of developing the disease.

Despite its impact, long COVID lacks a consensus definition and a standard biomarker or diagnostic tool. This often leads to potential underdiagnosis, particularly in low-and-middle-income countries (LMICs).

HGS is an indicator of dynapenia and is shown to be associated with various health outcomes, including cognitive disabilities, bone mineral density, depression, functional health, and mortality. In acute COVID-19, decreased HGS is an independent risk factor.

Using HGS as a simple, low-cost indicator could aid in identifying functional impairment, especially in LMICs lacking complex assessment tools.

Researchers in the present study aimed to investigate if individuals with a persistently low HGS after hospital discharge (following severe COVID-19 in early 2020) showed greater respiratory and functional impairments at 120 days. About the studyTop of Form

The present longitudinal study was conducted at a hospital in Brazil from April to October 2020. It followed unvaccinated, adult COVID-19 patients of both sexes who tested positive for SARS-CoV-2 by reverse transcription-quantitative polymerase chain reaction (RT-qPCR) during hospitalization. A total of 113 patients with a mean age of 48 years were included in the study, 54% of whom were female. Related StoriesLong COVID's impact on cardiovascular health: what we do and do not knowEffects of varying COVID-19 vaccination rates on population-level health outcomes across variant waves in the U.S.mRNA COVID-19 vaccines highly effective in preventing hospitalizations among adolescents in Nordic study

At the 120-day (D120) follow-up post-hospitalization, participants underwent assessments including functional capacity test, body composition, HGS, pulmonary function test, and respiratory muscle strength (RMS).

HGS and dynapenia (defined as HGS < 30 Kgf for males and < 20 Kgf for females) were measured using a hand-held digital dynamometer. Spirometry assessed pulmonary function, and RMS was evaluated with a digital manometer.

Outcomes were measured in terms of forced vital capacity (FEV), forced expiratory capacity at the first second of exhalation (FEV1), maximum inspiratory pressure (MIP), and maximum expiratory pressure (MEP).

Functional capacity was assessed using the 6-minute walk test (6MWT), and body composition was determined through bioimpedance analysis.

Data were recorded electronically and analyzed for associations between HGS, respiratory function, and functional capacity. Statistical analysis included the Shapiro–Wilk test, Mann–Whitney test, Chi-square test, Spearman's test, and a regression model. Results and discussion

Out of the 113 long COVID patients, 22% exhibited dynapenia at D120 post-acute severe disease. Dynapenic individuals had lower muscle mass, reduced HGS, higher rates of intensive care unit admission and invasive ventilation during hospitalization, and higher BMI.

A greater proportion of dynapenic individuals showed a history of smoking and diabetes. Additionally, muscle mass between day one and D120 of dynapenic individuals was found to be reduced significantly (30.7 kg to 19.9 kg, p<0.001).

Dynapenia was also associated with worse respiratory function (FEV1, FVC, MIP, MEP), significantly diminished walking distance and a lower percentage of predicted walking distance on the 6MWT. Correlation and regression analyses confirmed the association between HGS and functional outcomes, independent of age.

The study's limitations include a relatively small sample size and a short-term follow-up, preventing comprehensive longitudinal comparisons of HGS and other functional outcomes.

Additionally, the single-center design and the specific timeframe of individuals infected with SARS-CoV-2 in the early 2020s may limit the direct applicability of the results to individuals infected with more recent virus variants and with long-term health outcomes. Conclusion

In conclusion, low HGS in long COVID patients, indicative of dynapenia, is linked to adverse health outcomes such as changes in pulmonary function, respiratory muscle strength, and exercise capacity.

A simple, cost-effective HGS measurement can be a practical biomarker for functional impairment in outpatient and primary care settings.

Recognizing dynapenia's association with in-hospital outcomes months later enables timely patient stratification and risk prevention, potentially reducing comorbidities, delaying functional decline, improving prognosis, and expediting the return to daily activities.

This approach is particularly relevant for LMICs, enhancing healthcare accessibility, facilitating early screening, and managing long-term COVID patients. Journal reference: Amaral, C.M.S.S.B. et al. (2024) Low handgrip strength is associated with worse functional outcomes in long COVID, Scientific Reports, 14, 2049.  doi: https://doi.org/10.1038/s41598-024-52401-z. https://www.nature.com/articles/s41598-024-52401-z 

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Business

Jobless rate hits four-year high- but makes interest rate cut more likely

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Jobless rate hits four-year high- but makes interest rate cut more likely

The UK’s unemployment rate has risen to a four-year high, in a surprise deterioration that boosts the case for a Bank of England interest rate cut.

The Office for National Statistics (ONS) reported a rise in the jobless rate from 4.6% to 4.7% in the three months to May.

No change had been expected after the 0.1 percentage point rise seen just last month.

The ONS data, which still comes with a health warning due to poor participation rates, also showed a reduction in the pace of wage rises, with average weekly earnings rising by 5%. That was down from the 5.2% level reported a month ago.

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ONS director of economic statistics, Liz McKeown, said of its findings: “The labour market continues to weaken, with the number of employees on payroll falling again, though revised tax data shows the decline in recent months is less pronounced than previously estimated.

“Pay growth fell again in both cash and real terms, but both measures remain relatively strong by historic standards.

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“The number of job vacancies is still falling and has now been dropping continuously for three years.”

The data was released 24 hours after a surprise rise in the rate of inflation, to 3.6%, was revealed by the ONS.

It was seen as muddying the waters as the Bank considers the timing of its next interest rate cut.

But a quarter point reduction, to 4%, is widely expected at the next meeting of the rate-setting committee in early August,

The Bank, experts say, will be looking past the headline inflation numbers and see scope to introduce the third cut of the year due to the softening labour market seen in 2025 – a factor the Bank’s governor Andrew Bailey had suggested would come more into focus in a recent interview with The Times.

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What does ‘inflation is rising’ mean?

Weaker pay awards remain a compulsory element to bringing down borrowing costs as there are fears the UK’s difficulties in bringing down inflation are partly linked to wage growth outpacing price hikes since August 2023.

Add to that the slowdown in economic growth and you have a Bank seemingly grappling the effects of so-called stagflation – as scenario of weak growth with inflation persistently well above the Bank’s 2% target.

While there are conflicting forces at play for the Bank’s interest rate deliberations, rising inflation, coupled with weakening growth and jobs data, are all unwelcome for a chancellor under growing pressure.

Rachel Reeves was accused on Wednesday of contributing to inflation through taxes on employment deployed from April – with industry bodies in the grocery sector claiming an element of rising food price growth was down to businesses passing on those extra costs, alongside hikes to minimum pay requirements.

At the same time, those budget measures have clearly held back hiring since the spring.

One crumb of comfort for her is that the prospect of a rate cut next month remains on – with any reduction helping bring down the cost of servicing government debt as the headroom she has within the public finances remains under severe pressure.

Government U-turns on winter fuel payment curbs and welfare reforms have squeezed her fiscal rules, leaving her to cover likely at the autumn budget to cover shortfalls either through further tax hikes or spending cuts.

Yael Selfin, chief economist at KPMG UK, said of the rate cut prospects: “Slowing activity in the labour market, coupled with pay pressures easing, will likely prompt the Bank of England to lower interest rates next month.

“The impact of April’s tax and administrative changes has led to a marked slowdown in hiring activity among firms. With domestic activity remaining sluggish, the MPC will likely want to provide support via looser policy to prevent a more significant deterioration in the labour market.”

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Politics

‘We’re a team’: Jess Phillips defends PM’s decision to suspend Labour rebels

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Starmer suspends four Labour MPs for breaches of party discipline

A minister has defended Sir Keir Starmer’s decision to discipline rebellious MPs, saying they would have used “stronger” language against those who are “continually causing trouble”.

Home Office minister Jess Phillips told Sky News’ Matt Barbet that Labour MPs were elected “as a team under a banner and under a manifesto” and could “expect” to face disciplinary action if they did not vote with the government.

It comes after the prime minister drew criticism for suspending four Labour MPs who voted against the government on its flagship welfare bill earlier this month, while stripping a further three of their roles as trade envoys.

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Brian Leishman, Chris Hinchliff, Neil Duncan-Jordan and Rachael Maskell.
Pic: Uk Parliament
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Brian Leishman, Chris Hinchliff, Neil Duncan-Jordan and Rachael Maskell.
Pic: Uk Parliament

Brian Leishman, Chris Hinchliff, Neil Duncan-Jordan and Rachael Maskell all lost the whip, meaning they are no longer part of Labour’s parliamentary party and will sit as independent MPs.

Labour backbenchers lined up to criticise the move last night, arguing it was a “terrible look” that made “a Reform government much more likely”.

But speaking to Sky News, Ms Phillips said: “We were elected as a team under a banner and under a manifesto, and we have to seek to work together, and if you are acting in a manner that is to undermine the ability of the government to deliver those things, I don’t know what you expect.

“Now I speak out against things I do not like, both internally and sometimes externally, all the time.

“There is a manner of doing that, that is the right way to go about it. And sometimes you feel forced to rebel and vote against.”

Referring to a description of the rebels by an unnamed source in The Times, she said: “I didn’t call it persistent knob-headery, but that’s the way that it’s been termed by some.”

She said she would have described it as “something much more sweary” because “we are a team, and we have to act as a team in order to achieve something”.

More than 100 MPs had initially rebelled against the plan to cut personal independent payments (PIP). Ultimately, 47 voted against the bill’s third reading, after it was watered down significantly in the face of defeat.

Three other MPs – who also voted against the government – have had their trade envoy roles removed. They are Rosena Allin Khan, Bell Ribeiro-Addy and Mohammed Yasin.

However, it is understood this was not the only reason behind the decision to reprimand all seven MPs, with sources citing “repeated breaches of party discipline”.

Ms Maskell was one of the lead rebels in the welfare revolt, and has more recently called for a wealth tax to fund the U-turn.

Mr Hinchliff, the MP for North East Hertfordshire, proposed a series of amendments to the flagship planning and infrastructure bill criticising the government’s approach.

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Mr Duncan-Jordan, the MP for Poole, led a rebellion against the cut to the winter fuel payments while Alloa and Grangemouth MP Mr Leishman has been critical of the government’s position on Gaza as well as the closing of an oil refinery in his constituency.

Ian Byrne, the Labour MP for Liverpool West Derby, wrote on X on Wednesday that the prime minister’s actions “don’t show strength” and were “damaging Labour’s support and risk rolling out the red carpet for Reform”.

Leeds East MP Richard Burgon added that “challenging policies that harm our communities” would “make a Reform government much more likely”.

Ian Lavery, Labour MP for Blyth and Ashington, warned the suspensions were “a terrible look”.

“Dissatisfaction with the direction the leadership is taking us isn’t confined to the fringes,” he wrote.

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Business

Jaguar Land Rover to cut hundreds of UK jobs

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Jaguar Land Rover to cut hundreds of UK jobs

Jaguar Land Rover (JLR) has revealed plans to cut 500 jobs as it moves to save costs while battling a sharp decline in sales.

The UK-based firm said the reduction in management roles, which amounted to 1.5% of its workforce, would be completed through a voluntary redundancy programme.

JLR has been struggling recently on the back of the US trade war.

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It temporarily paused exports to the US, its biggest single foreign market, in April after Donald Trump’s hike to duties covering cars to 25%.

It was later trimmed to 10% under the US-UK trade truce agreement, but that rate only covers the cars it makes in the UK.

The terms of the deal also cap total annual car exports to the US at 100,000 models, so the higher rate will apply to those vehicles exceeding the threshold.

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Sir Keir Starmer told JLR workers in April that he would protect their jobs

The tariff uncertainty, coupled with a planned wind-down of older Jaguar models, meant sales were 15% down over the three months to June to just over 94,000.

JLR confirmed its job cut plans on the day the UK’s jobless rate hit a four-year high.

It also follows on the back of a Kier Starmer speech to staff, promising to protect their jobs, back in April.

The company had said, after the US-UK truce in May, that the deal would do just that.

A spokesperson said: “As part of normal business practice, we regularly offer eligible employees the opportunity to leave JLR through limited voluntary redundancy programmes.”

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