The impact of the Mediterranean diet on immune function in older adults.

Diet is one of the lifestyle factors that is most amenable to intervention, and has a substantial effect on the potential for successful aging and mitigation of the risk of disease. Good nutrition is a pillar of healthy aging, and a large body of evidence attests to the benefits of the Mediterranean diet on the quality of the aging process. The Mediterranean diet comprises a wide range of nutrients which, both individually and collectively, exert positive effects on immunity, in large part mediated by the gut microbiota. In this article, we review the effect of the Mediterranean diet on immunity, and how its beneficial effects are mediated by the gut microbiota. We review the effects of certain key components of the Mediterranean dietary pattern, including vitamins, zinc, selenium, and polyphenols. Overall, the existing body of evidence convincingly demonstrates that the Mediterreanean diet affects immune health by maintaining a healthy body weight and reducing the risk of metabolic and cardiovascular diseases; by reducing inflammation and by promoting a healthy gut microbiota profile.

Nonstructural barriers to adult vaccination.

Adult vaccination coverage remains low, despite vaccine recommendations, improved access, and reimbursement. Low vaccination coverage and an aging population at higher risk from vaccine-preventable diseases lead to preventable disability and deaths, straining healthcare systems. An Advisory Board meeting was, therefore, held to identify non-structural barriers to adult vaccination and discuss potential solutions to increase uptake. Many non-structural factors can influence vaccine uptake, such as heterogeneity in the population, (fear of) vaccine shortages, incentives, or mandates for vaccination, understanding of disease burden and personal risks, time and opportunity for healthcare providers (HCPs) to discuss and deliver vaccines during general practice or hospital visits, trust in the health system, and education. To address these barriers, push-pull mechanisms are required: to pull patients in for vaccination and to push HCP performance on vaccination delivery. For patients, the focus should be on lifelong prevention and quality of life benefits: personal conversations are needed to increase confidence and knowledge about vaccination, and credible communication is required to build trust in health services and normalize vaccination. For providers, quality measurements are required to prioritize vaccination and ensure opportunities to check vaccination status, discuss and deliver vaccines are not missed. Financial and quality-based incentives may help increase uptake.

What is the context?● As populations age, healthcare systems are increasingly struggling with the burden of adult disease. Multiple vaccines are already recommended for adults throughout their lifetime, and more are coming soon, however, even in countries with subsidized programs, few adults are fully vaccinated, leading to frequent cases of illness, disability, hospitalization, or death, which could have been prevented.What is new?● Experts from Europe and the US joined an Advisory Board meeting to find out what is stopping people from getting vaccinated, particularly when vaccines are free, and how this can be helped in future.● The decision to get vaccinated can vary for different subgroups of the population, and can be influenced by vaccine shortages, rules about vaccination, and understanding the disease severity and need for vaccination. In addition, doctors may not have enough time and opportunity to discuss and provide vaccines during visits or may not feel comfortable raising the issue of vaccination with their patients.● To overcome these issues, both patients and doctors must change. Patients need: greater awareness of how illness impacts overall health and quality of life; better conversations with their doctors to address vaccination concerns; and trustworthy information from health services. For providers, vaccination prioritization should be linked to quality measurements, with collaboration from trusted community members to reinforce the importance of prevention, thus ensuring opportunities are not missed to discuss prevention and vaccinate. Normalizing adult vaccination is important for this.What is the impact?● Taking a patient centered prevention approach will help protect adults and ease the burden of vaccine-preventable disease.

Ventilatory Management of Patients with Acute Respiratory Distress Syndrome Due to SARS-CoV-2.

The emergence of the new SARS-CoV-2 in December 2019 caused a worldwide pandemic of the resultant disease, COVID-19. There was a massive surge in admissions to intensive care units (ICU), notably of patients with hypoxaemic acute respiratory failure. In these patients, optimal oxygen therapy was crucial. In this article, we discuss tracheal intubation to provide mechanical ventilation in patients with hypoxaemic acute respiratory failure due to SARS-CoV-2. We first describe the pathophysiology of respiratory anomalies leading to acute respiratory distress syndrome (ARDS) due to infection with SARS-CoV-2, and then briefly review management, focusing particularly on the ventilation strategy. Overall, the ventilatory management of ARDS due to SARS-CoV-2 infection is largely the same as that applied in ARDS from other causes, and lung-protective ventilation is recommended. The difference lies in the initial clinical presentation, with profound hypoxaemia often observed concomitantly with near-normal pulmonary compliance.