Mental Health Startup Uses Voice ‘Biomarkers’ To Detect Signs Of Depression And Anxiety

Young female character having a panic attack, an imaginary monster shadow silhouette, mental health issues, psychology

The quick brown fox jumps over the lazy dog,” Rima Seiilova-Olson says slowly and emphatically over Zoom.

The simple sentence holds enormous value for mental health care, she explains, smiling as if to acknowledge that it might be less than obvious how a silly phrase could be so meaningful to a computer programmer and leader of an artificial intelligence startup.

The short saying contains every letter of the alphabet and phoneme in the English language, says Seiilova-Olson, an immigrant from Kazakhstan who is cofounder and chief scientist of Kintsugi Mindful Wellness. Kintsugi believes these sounds offer invaluable insight that can help mental health providers better support people with depression and anxiety.

The Bay Area-based company is building AI software that analyzes short clips of speech to detect depression and anxiety. This so-called voice biomarker software is being integrated into clinical call centers, telehealth services and remote monitoring apps to screen and triage patients reaching out for support, helping providers more quickly and easily assess their needs and respond.

“There’s just not a lot of visibility as to who is severely depressed or anxious.”

Kintsugi CEO and co-founder Grace Chang

Seiilova-Olson, 36, first met co-founder and CEO Grace Chang, 40, a Taiwanese immigrant now based in Berkeley, in 2019 at an open AI hackathon in San Francisco. Surprised to cross paths at a male-dominated event, the women began comparing notes about their respective personal challenges trying to access mental health care:

Seiilova-Olson had struggled to secure a therapist during postpartum depression with her first child, and when Chang had needed her own support, she said it had taken months for anyone from Kaiser to call her back.

“Living in the Bay Area, you can push a button and a car can come to you or food can come to you,” Chang says. “But this was really a challenge.” As engineers, they viewed the dilemma differently than clinicians might.

“We saw this as an infrastructure problem, where you have so many people trying to jam through that front door,” Chang explains. “But there’s just not a lot of visibility as to who is severely depressed or anxious, who is low-to-moderate. And if we could provide this information to those frontline practitioners, then we’d maybe have an opportunity to greatly alleviate that bottleneck.”

Kintsugi was born out of that idea in 2019. It sits in a competitive space of health tech startups like Ellipsis Health and Winter Light Labs that are using voice biomarkers to detect mental health or cognitive issues, built on research showing that certain linguistic patterns and characteristics of a person’s voice can be correlated with psychiatric or neurological conditions.

Kintsugi last year raised $8 million in seed funding led by Acrew Capital, and in February, announced it had closed a $20 million Series A round led by Insight Partners, which valued the company at nearly $85 million, according to PitchBook.

In-person mental health facilities typically use questionnaires to gauge the severity of patients’ anxiety or depression, measures known as PHQ-9 and GAD-7 scores. But during telehealth visits or phone consults — where face-to-face interaction is lost, making it harder to pick up on symptoms — Kintsugi’s technology helps to fill that gap.

Nicha Cumberbatch, assistant director of public health at Spora Health, a provider focused on health equity and people of color, uses Kintsugi’s software to assess women in its all-virtual, doula-led maternal health program, Spora Mommas.

The voice analysis tool, which Spora began using for patient consultations a few weeks ago, has helped Cumberbatch identify women who are, or may be at risk of, experiencing anxiety and depression before, during or after their pregnancies. When a patient starts speaking to a Spora clinician or doula on Zoom, Kintsugi’s AI begins listening to and analyzing her voice.

After processing 20 seconds of speech, the AI will then spit out the patient’s PHQ-9 and GAD-7. The employee can then use that mental health score to decide what additional testing may be needed and how best to advise or direct the patient to resources — like a psychiatrist, cognitive behavioral therapist or obstetrician.

Cumberbatch says Kintsugi’s technology is allowing her to “​​keep a more watchful eye” on her patients “and then move forward with proactive recommendations around mitigating their symptoms.” And while it’s not meant to replace clinicians or formal medical evaluations, she adds, it can be used as a screening tool to “allow us to have a more well-rounded, 360-view of the patient when we don’t have them in front of our face.”

“That technology… [allows] us to have a more well-rounded, 360-view of the patient when we don’t have them in front of our face.”

Nicha Cumberbatch, assistant director of public health at Spora Health

Dr. ​​Jaskanwal Deep Singh Sara, a Mayo Clinic cardiologist who has collaborated with Ellipsis and led research on potential uses of voice biomarkers for cardiology, cautions that while the technology is promising for health care, the field has a long way to go to ensure that it’s accurate, safe and beneficial for patients and clinicians alike.

“It’s not ready for primetime by any stretch of the imagination yet,” Dr. Sara says. Studies in psychiatry, neurology, cardiology and other areas have shown an association between voice biomarkers and various conditions or diseases, but they haven’t shown how this relationship can be used to improve clinical outcomes, he says.

Such research is “not the same as saying, ‘How can we instrumentalize it in clinical practice, and how feasible is it? How effective is it in gauging an individual’s medical trajectory?’” he explains. “If it doesn’t provide any benefits in terms of how we manage them, then the question is: why would you do it?”

He says addressing those questions is “one of many next steps that we have to undertake on this” and that larger clinical trials are needed to answer them. “If it makes health care delivery cheaper or more efficient, or if it improves outcomes for patients, then that’s great,” he adds. “But I think we need to demonstrate that first with clinical trials, and that hasn’t been done.”

To address these issues and validate its software, Kintsugi is conducting clinical studies, including with the University of Arkansas for Medical Sciences, and the National Science Foundation has awarded Kintsugi multiple grants to ramp up its research. The company is also pursuing FDA “de novo” clearance and continuing to build its own dataset to improve its machine learning models.

(Data and insights from Kintsugi’s voice journaling app, as well as conversations with call centers or telehealth providers and clinical collaborations with various hospitals, all become part of an enormous dataset that feeds Kintsugi’s AI.) Seiilova-Olson says this self-generated, unfettered proprietary dataset is what sets Kintsugi apart in the AI health care space — where many technologies are reliant on outside data from electronic health records.

That collection of troves of data on individuals’ speech can be concerning — particularly in the mental health and wellness space, which is widely considered a regulatory Wild West. (These products and services are often not subject to the same laws and stringent standards that govern how licensed clinicians provide formal medical care to patients.)

But Kintsugi’s founders say that patient privacy is protected because what matters for its technology is not what people are saying, but how they are saying it. Patients are also asked for their consent to be recorded and care is not affected by their decision to opt in or opt out, according to the founders.

Kintsugi says it has served an estimated 34,000 patients. The company is currently working with a large health system with 90 hospitals and clinics across 22 states, and they are active in a care management call center that services roughly 20 million calls per year. It is also partnering with Pegasystems, which offers customer service tools for health care and other industries, to help payers and providers handle inbound calls.

Chang says other customers include Fortune 10 enterprise payers, pharmaceutical organizations and digital health applications focused on remote patient monitoring, but that she could not yet share their names. Kintsugi’s clinical partners include Children’s Hospital Colorado, Joe DiMaggio Children’s Hospital in Florida, Chelsea and Westminster Hospital in London and SJD Barcelona Children’s Hospital in Spain, Chang said.

Prentice Tom, Kintsugi’s chief medical officer, adds that it’s working with the University of Arkansas to explore how the tool can be used to possibly identify patients with suicidal ideation, or increased or severe suicide risk, as well as with Loma Linda University, to look at how the technology can be used to spot burnout amongst clinicians.

The team is also looking for ways to expand availability and uses for younger and elderly patients, as well as for maternal and postpartum populations. And beyond patients themselves, it’s perhaps nurses who are benefiting most from Kintsugi’s work, according to the founding team: having a triage tool that helps reduce administrative work or the time spent asking generic questions enables nurses to more seamlessly move patients in their journey.

But Tom, a Harvard-trained emergency medicine physician and former faculty member at Stanford University’s Department of Emergency Medicine, says Kintsugi is now doing far more than addressing infrastructure issues alone. It’s democratizing access to mental health care, Tom said, moving away from a physician-centric paradigm that caters more to people with significant enough depression that they require medical evaluation.

“This tool actually creates a view of mental health in terms of mental wellness,” Tom said, “where everyone has the opportunity to understand where they sit on the spectrum and that actually stratifies treatment options well beyond the current infrastructure.”

I’m a Senior Writer at Forbes covering the intersection of technology and society. Before joining Forbes, I spent three years as a tech reporter at Politico, where I covered

Source: Mental Health Startup Uses Voice ‘Biomarkers’ To Detect Signs Of Depression And Anxiety

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Planning For Surgery? You Might Not Need All Those Tests Beforehand

Let’s say you’re scheduled for a common and relatively low-risk operation, like a cataract removal, hernia repair or a hip or knee replacement. It’s normal to feel anxious about any upcoming surgery.

But what if one of the presurgical tests your doctor orders — for example, a chest X-ray or cardiac stress test — turns up something unexpected, like a suspicious nodule or a mild heart abnormality? Now you have even more reason to worry, and your surgery will likely be delayed until further tests assure the doctor it would be safe to operate.

Experts say that presurgical testing is often unjustified for many common operations. Many of these tests are a waste of time and money, a growing body of research shows, and the tests themselves can sometimes result in complications.

For more than two decades, experts in various medical specialties, including cardiology, ophthalmology and anesthesiology, have issued guidelines directed at reducing preoperative tests that rarely provide findings relevant to a patient’s surgical risk. Yet practicing doctors often do not follow this advice.

Guidelines published in 2002, for example, from the American College of Cardiology, the American Heart Association and the American Society of Anesthesiologists resulted in almost no change in doctors’ presurgical orders nearly a decade later, according to a report in JAMA Internal Medicine. The only exception was a decline in the use of electrocardiograms, or EKGs, a noninvasive test that checks heart function at rest.

Sometimes a preoperative test of questionable value results in unanticipated complications, as happened to a man in his 50s scheduled for repair of a very painful hernia. Two Colorado doctors reported in 2014 that the man’s lab tests and physical exam were normal. But a chest X-ray, ordered because he had a history of mild asthma, suggested he had a nodule on a lung.

Doctors delayed the surgery until he got a CT scan, which did not confirm a lung nodule but did find one on an adrenal gland. Again, doctors postponed surgery to allow for further work-up of the adrenal nodule, which was ultimately found to be benign. The man finally had his hernia repaired after six additional months of debilitating pain and repeated anxiety over incidental test findings suggesting he could have cancer.

However, doctors are making some headway. In 2019 in JAMA Internal Medicine, Dr. John N. Mafi, an internist at the David Geffen School of Medicine at the University of California, Los Angeles, and his colleagues described an effort to reduce “low-value preoperative care” for patients about to have cataract surgery. New guidelines were issued, and a specially trained quality improvement nurse advised the surgeons about the new recommended protocol.

The result, as assessed in a controlled clinical trial of 1,054 patients, was a dramatic decline in preoperative testing, a significant projected cost saving after the first year and “no measurable adverse effects” on the patients’ surgery, he said.

Perhaps most problematic among common preoperative procedures is a cardiac stress test, which assesses blood flow to the heart while patients exercise. Dr. Alana E. Sigmund, an internal medicine physician at the Hospital for Special Surgery in New York who has studied physicians’ responses to preoperative guidelines, said in an interview, “Cardiac stress testing is over-ordered. If there’s no indication of a heart problem, like shortness of breath, there’s no reason to do this test prior to surgery.”

The latest guidelines, which the American College of Cardiology and American Heart Association issued in 2014, advise that a cardiac stress test before surgery is generally not recommended for patients lacking symptoms suggestive of heart disease. The guidelines leave the decision to test up to the doctor, and you might think it’s better to rule out a possible heart problem before surgery.

But existing evidence shows no health or lifesaving benefit from a preoperative stress test when the patient lacks cardiac symptoms or has fewer than two major risk factors for having a heart attack, like high blood pressure and smoking, especially when the prospective surgery itself is low-risk.

Yet despite these guidelines and a national campaign called Choosing Wisely, aimed at curbing unnecessary tests and procedures, a recent study by Dr. Daniel S. Rubin and his colleagues at the University of Chicago found that many doctors persist in ordering preoperative stress tests among patients at very low risk for cardiac complications. The study, published in JAMA Cardiology in January, looked at more than 800,000 patients having a hip or knee replaced, which is usually considered a low-risk surgery.

It found that nearly half the patients who were given a preoperative stress test had no cardiac risk factors that might justify its use. Furthermore, the stress test did not lessen the risk of suffering a heart attack or cardiac arrest during or immediately after surgery, even among patients with one or more cardiac risk factors.

In fact, the stress test might have been counterproductive. For reasons Dr. Rubin could not explain, patients without risk factors who were given a cardiac stress test had double the surgical complication rate experienced by comparable patients who did not have one.

Whatever the explanation for that finding, testing itself is not free of risk, as noted by Dr. Ravi Chopra, a resident in neurology at Washington University School of Medicine. In JAMA Internal Medicine in October, Dr. Chopra and his colleagues described a 72-year-old patient with no known cardiovascular disease or cardiac symptoms who was given a stress test before a hip replacement. The test showed a mild heart abnormality, prompting a catheterization that resulted in damage to two blood vessels that then had to be surgically repaired.

“Testing can cause harm,” Dr. Chopra said. “We need to think hard about whom we’re testing. There should be a really good reason.”

Experts suggest you’d be wise to ask whether the prescribed tests would reveal anything relevant to your surgical risk that the doctor could not determine by asking you a few questions during a routine physical. For example, answering a simple question like, “Do you get out of breath climbing a flight of stairs or walking four city blocks?” might provide a quick assessment of whether you might be having heart symptoms.

Dr. Mafi added that “it’s hard to change physician behavior with guidelines,” especially when doctors fear being sued if something goes wrong that might have been prevented by a presurgical test. He suggested that patients can help by questioning what a particular test might show and whether it’s really needed. Also helpful, he said, is to choose a doctor “who’s thoughtful, takes time to listen and is judicious about testing. You don’t have to order 100 tests if just one test will do.”

Portrait of Jane E. Brody

 

Jane E. Brody is the Personal Health columnist for The New York Times, a position she has held since 1976. Ms. Brody’s widely read and quoted column, which appears in The Times’s Science Times section and in scores of other newspapers around the country, earned her the title of “High Priestess of Health” from Time magazine.

Source: Planning for Surgery? You Might Not Need All Those Tests Beforehand. – The New York Times

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A Little RedBull May Give You Wings, But It Probably Will Not Affect Your Tpe

“Energy drinks” (EDs) often contain high levels of caffeine and sugar, with variable levels of taurine, guarana, other “supplements,” and on occasion, vitamins. Frequently chosen by teens and young adults, the sale of EDs has enjoyed tremendous market growth. Over 4.6 billion cans of the most successful of these beverages, Red Bull, were sold in 2011. This prosperity resulted from the strong, recent worldwide annual growth, such as 11% in the United States, 35% in France, and 86% in Turkey.

Whether consumed alone or with alcohol or other drugs, EDs may have significant physical and behavioral effects (). Marketing materials for EDs often imply that these products will improve energy level, attention span, and physical and/or mental performance . Red Bull has been shown to increase heart rate and blood pressure and can reduce cerebral blood flow; these effects can be potentiated under conditions of stress . EDs were responsible for over 20,000 emergency department visits in the United States in 2011, including a doubling in the incidence between 2007 and 2011.

In this issue of the Anatolian Journal of Cardiology, Elitok et al. reported on the electrocardiographic effects of Red Bull. They had particular interest in Red Bull’s effects on ventricular repolarization. The dispersion of ventricular repolarization (DVR), as indicated by a longer interval between the T wave’s peak and end (Tpe or Tpe/QT), correlates with arrhythmic risk in multiple populations .

The healthy volunteer medical students in this investigation consumed a single can of Red Bull under controlled conditions, and the effects on heart rate, blood pressure, and electrocardiographic measurements were observed. As expected, both blood pressure and heart rate increased following Red Bull consumption. However, no change in electrocardiographic DVR was found.

Should young club-going people take this news as vindication of their next order for a “vodka and Red Bull?” Can we write off Red Bull’s cardiovascular effects as benign? Not so fast. The absence of an acute effect of a small dose of ED on one arrhythmia risk factor measured only in ECG lead V5 among a relatively small number of healthy young adults at rest does not equate to definite harmlessness. Our understanding of Red Bull’s effects remains incomplete, especially in cases wherein larger doses are consumed, especially by sicker people and under more strenuous conditions.

Would the consumption of five cans of Red Bull affect healthy subjects’ ECGs? Might only one serving of Red Bull affect ECG of a cardiomyopathy patient or ECG of a patient taking other cardiovascular active medications? Does chronic Red Bull consumption have the same or different effects as a Red Bull binge?

Elitok et al. should be congratulated for their interest in exposing potentially dangerous effects of popular EDs. More studies are required for us to declare Red Bull consumption to be harmless. For now, we can take heart in the absence of one signal of potential danger. At least this little bull is not in the proverbial china shop.

Energy drinks have the effects caffeine and sugar provide, but there is little or no evidence that the wide variety of other ingredients have any effect. Most of the effects of energy drinks on cognitive performance, such as increased attention and reaction speed, are primarily due to the presence of caffeine. Advertising for energy drinks usually features increased muscle strength and endurance, but there is little evidence to support this in the scientific literature.

A caffeine intake of 400 mg per day (for an adult) is considered as safe from the European Food Safety Authority (EFSA). Adverse effects associated with caffeine consumption in amounts greater than 400 mg include nervousness, irritability, sleeplessness, increased urination, abnormal heart rhythms (arrhythmia), and dyspepsia. Consumption also has been known to cause pupil dilation. Caffeine dosage is not required to be on the product label for food in the United States, unlike drugs, but most (although not all) place the caffeine content of their drinks on the label anyway, and some advocates are urging the FDA to change this practice.

Excessive consumption of energy drinks can have serious health effects resulting from high caffeine and sugar intakes, particularly in children, teens, and young adults. Excessive energy drink consumption may disrupt teens’ sleep patterns and may be associated with increased risk-taking behavior. Excessive or repeated consumption of energy drinks can lead to cardiac problems, such as arrhythmias and heart attacks, and psychiatric conditions such as anxiety and phobias.

In Europe, energy drinks containing sugar and caffeine have been associated with the deaths of athletes. Reviews have noted that caffeine content was not the only factor, and that the cocktail of other ingredients in energy drinks made them more dangerous than drinks whose only stimulant was caffeine; the studies noted that more research and government regulation were needed

By: Todd M. Rosenthal and Daniel P. Morin

Source: A little Red Bull may give you wings, but it probably will not affect your Tpe

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The Great Millennial Blood Pressure Problem

You know the guy. You work with him, or you’re friends with him, or maybe you even are him. He’s youngish. Fit-ish. Flirting with fasting and CBD. Always tracking his steps, his sleep, his heart rate, his meditation streaks. But these trackers overlook one metric: blood pressure. Those two numbers measure how well your blood vessels handle the 2,000 gallons of blood your heart pumps around your body in a day. And young guys’ vessels aren’t doing the job so well.

In 2019, Blue Cross Blue Shield released data from the claims of 55 million people in its Health of Millennials report. One of the most shocking stats: From 2014 to 2017, the prevalence of high blood pressure in people ages 21 to 36 jumped 16 percent, and compared with Gen Xers when they were the same age, high blood pressure among millennials was 10 percent more prevalent.

So what exactly do we mean by “high”? We mean blood pressure that measures above 130 systolic (the pressure in your arteries when your heart contracts) or 80 diastolic (the pressure between beats). And when that happens, explains preventive cardiologist Michael Miedema, M.D., M.P.H., of the Minneapolis Heart Institute Foundation, your blood vessels stiffen up, forcing blood pressure even higher. That can create stress on vessel walls, leading to an ugly chain of inflammation, plaque buildup, and higher risk for heart attack and stroke.

For the longest time, most young people didn’t have to worry about this. “Youth has always been a relative Teflon coating,” says Eric Topol, M.D., founder and director of the Scripps Research Translational Institute in La Jolla, California. Blood-pressure issues were strictly for older people, and the idea that this protection might be eroding is forcing doctors to examine what’s really going on. Here’s what they’re finding.

All That #Wellness Isn’t Making you Healthy

You’d think customized vitamins, kombucha, and cryotherapy would get you to #peakwellness, but when it comes to blood pressure, they’re not doing much. “With millennials, you hear a lot about wellness and not as much about health—and they’re different,” says Christopher Kelly, M.D., a cardiologist at North Carolina Heart and Vascular Hospital, and a millennial himself.

“Wellness trends promise great results with little effort, but few have any proven long-term benefits,” he says. “You won’t see ads on Instagram for the few things that we know promote health, including regular exercise, not smoking, being at a healthy weight, and screening for blood-pressure and cholesterol issues.”

Being Broke Can Break You

Millennials carry more than $1 trillion in debt. A large chunk of that is due to student loans—millennials owe more than four times what Gen Xers do. Add this weight to other pressures and it makes sense that millennials reported the highest average stress level of any generation, at 5.7 out of 10, in the American Psychological Association’s Stress in America survey. (Gen Xers came in at 5.1, Gen Zers at 5.3, and boomers at a relatively zen 4.1.)

“Most of us overlook that the medical word we use for high blood pressure, hypertension, is really hyper and tension,” says cardiologist Andrew M. Freeman, M.D., of National Jewish Health in Denver. Not only does chronic stress play a role in high blood pressure, but the responses we often have to what’s stressing us out—like binge eating and cutting sleep short—jack it up, too.

Blame Seamless and Postmates

The Johns Hopkins Bloomberg School of Public Health found that people who ate home-cooked meals almost every day consumed nearly 1,000 fewer calories a week than those who went with home-cooked once a week or less. And that’s bad news for millennials: The average millennial eats out or buys takeout food five times per week, according to a Bankrate survey, which means they’re devouring all the pressure-boosting sodium and calories that come with it.

(Sodium is particularly sneaky: In one study, 90 percent of people thought their restaurant meal had about 1,000 milligrams—around half a day’s worth—less than it did.) And sodium ends up in your diet via some surprising foods, like bread (see the top sources here).

Then there’s the weight factor. Millennials are on track to be the heaviest generation in history, and extra weight on a young adult can ratchet up blood pressure and thicken the heart muscle early, inviting heart disease later on.

It’s Easy to Avoid Moving

“The heart requires the challenge of moving blood through the body to keep things supple and functioning normally,” says Aaron Baggish, M.D., of Massachusetts General Hospital. And between more screen time, longer commutes, and more labor-saving devices, Dr. Baggish explains, “many millennials are just not doing enough activity.” See the best exercises to get started with.But There’s Good News About Young Guys’ Blood Pressure

You can head off this whole saga with some pretty simple lifestyle changes. Start with the six basic steps at right, and keep on top of your blood-pressure rates with the three gizmos below. Even minor adjustments can bring down your BP, especially the ones below.

6 Small Changes That Take Blood Pressure Down

1.) Lose two pounds. For every two pounds or so you shed, you could see a one-point drop in systolic blood pressure (the top number).

2.) Get up every 45 minutes and walk around. This simple move was enough to significantly lower diastolic blood pressure in one study.

3.) Eat for your heart. “Following a heart-healthy diet can drop systolic blood pressure as much as a pill can,” says cardiologist Michael Miedema, M.D., M.P.H. That’s about three to five points.

4.) Fill up on potassium. This mineral can counteract the effects of sodium in your diet. Help it out and counter sodium yourself by nixing key sources like bread, cold cuts, and pizza.

5.) Say yes to pickup basketball. The adrenaline and cortisol that swirl around when you’re stressed can hike up blood pressure. In fact, one recent study found that male med students were 13 times as likely to have elevated numbers as their female counterparts. Friends help buffer stress. Bonus if you combine hanging out with a workout.

6.) Monitor pressure at home. Everyone should check their BP once a month at home, even if they’re healthy, says John Elefteriades, M.D., director of the Aortic Institute at Yale-New Haven Hospital. It can help you ID triggers so you can keep them from messing with your numbers and your life.

By: Cassie Shortsleeve

Cassie Shortsleeve is a skilled freelance writer and editor with almost a decade of experience reporting on all things health, fitness, and travel. A former Shape and Men’s Health editor, her work has also been published in Women’s Health, SELF, Runner’s World, Men’s Journal, CNTraveler.com, and other national print and digital publications. When she’s not writing, you’ll find her drinking coffee or running around her hometown of Boston.

Source: The Great Millennial Blood Pressure Problem

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Association Between Visit-to-Visit Blood Pressure Variability in Early Adulthood and Myocardial Structure and Function in Later Life

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Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19·1 million participants

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