Patients who have been treated for heart failure and experience an improvement of their pump function, are still at higher risk of heart-related death or hospitalisation if they stop taking heart failure medications. This is according to a new study from Karolinska Institutet published in Circulation.
“Our finding raises awareness about the importance of implementing and not withdrawing medical treatments in daily clinical practice even if patients with heart failure experience an improvement in symptoms and pump function,” says the study’s last author Gianluigi Savarese, docent and senior lecturer at the Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, and senior cardiologist at Södersjukhuset.
Using data from the Swedish Heart Failure Registry, RiksSvikt, the researchers have analysed more than 8700 patients with heart failure whose heart pump function, the ejection fraction, was initially impaired (below 40%) but later improved to 40% or more.
By linking RiksSvikt with other national registers, the researchers from Karolinska Institutet and Linköping University, Sweden, and the University of Naples, Italy, among others, were able to track hospitalisations and deaths in patients who stopped or continued various heart failure treatments.
Increased morbidity and mortality
The observational study shows that patients who stopped taking medication of the type RASi (renin-angiotensin system inhibitors), ARNi (angiotensin receptor-neprilysin inhibitors) or MRA (mineralocorticoid receptor antagonists) had between 36 and 38% higher risk of heart-related death or hospitalisation within one year of medication discontinuation.
However, stopping beta-blocker medication was only associated with a higher risk in patients whose heart function had only moderately improved.
“Our results show that heart failure medications continue to provide important benefits even when heart function has improved,” says Gianluigi Savarese. “This supports the current recommendation to continue with RASi/ARNi and MRA treatment, but also opens up the possibility of reconsidering whether beta-blockers can be discontinued in certain patients whose heart function has recovered well.”
More tailored treatment strategies
Since it was an observational study, no firm conclusions can be drawn about causality. It cannot be ruled out that the results were influenced by residual confounding. The researchers are now planning further studies to confirm the results.
“Our goal is to understand how heart failure medications affect patients with improved heart function and to develop guidelines for when/if it is safe to discontinue certain treatments. This can lead to more tailored and effective treatment strategies for heart failure patients,” says Christian Basile, the study’s first author and PhD student in Gianluigi Savarese’s research group.
Brain implants hold immense promise for restoring function in patients with paralysis, epilepsy and other neurological disorders. But a team of researchers at Case Western Reserve University has discovered that bacteria can invade the brain after a medical device is implanted, contributing to inflammation and reducing the device’s long-term effectiveness.
The groundbreaking research, recently published in Nature Communications, could improve the long-term success of brain implants now that a target has been identified to address.
“Understanding the role of bacteria in implant performance and brain health could revolutionize how these devices are designed and maintained,” said Jeff Capadona, Case Western Reserve’s vice provost for innovation, the Donnell Institute Professor of Biomedical Engineering and senior research career scientist at the Louis Stokes Cleveland VA Medical Center.
Capadona’s lab led the study, which examined the presence of bacterial DNA in the brains of mouse models implanted with microelectrodes.
To their surprise, researchers found bacteria linked to the gut inside the brain. The discovery suggests that a breach in what is known as “the blood-brain barrier,” caused by implanting the device, could allow microbes to enter.
“This is a paradigm-shifting finding,” said George Hoeferlin, the study’s lead author, who was a biomedical engineering graduate student at Case Western Reserve in Capadona’s lab. “For decades, the field has focused on the body’s immune response to these implants, but our research now shows that bacteria—some originating from the gut—are also playing a role in the inflammation surrounding these devices.”
In the study, mouse models treated with antibiotics had reduced bacterial contamination and the performance of the implanted devices improved—although prolonged antibiotic use proved detrimental.
The discovery’s implications go beyond device failure. Some of the bacteria found in the brain have been linked to neurological diseases, including Alzheimer’s, Parkinson’s and stroke.
“If we’re not identifying or addressing this consequence of implantation, we could be causing more harm than we’re fixing,” Capadona said. “This finding highlights the urgent need to develop a permanent strategy for preventing bacterial invasion from implanted devices, rather than just managing inflammation after the fact. The more we understand about this process, the better we can design implants that work safely and effectively.”
Capadona said his lab is now expanding the research to examine bacteria in other types of brain implants, such as ventricular shunts used to treat hydrocephalus, an abnormal buildup of fluid in the brain.
The team also examined the faecal matter of a human subject implanted with a brain device and found similar results.
“This finding stresses the importance of understanding how bacterial invasion may not just be a laboratory phenomenon, but a clinically relevant issue,” said Bolu Ajiboye, professor in biomedical engineering at the Case School of Engineering and School of Medicine and scientist at the Cleveland VA Medical Center. “Through our strong translational pipeline between CWRU and the VA, we are now investigating how this discovery can directly contribute to safer, more effective neural implant strategies for patients.”
Finance Minister Enoch Godongwana holding a copy of the 2025 Budget Speech. (Photo: Parliament of RSA via X)
By Charles Parry, Funeka Bango, Tamara Kredo, Wanga Zembe, Michelle Galloway, Renee Street and Caradee Wright
While the 2025 national budget boosts health spending, researchers from the South African Medical Research Council stress the need for strong accountability measures. They also raise concerns about rising VAT and omissions related to US funding cuts and climate change.
The 2025 budget speech by Finance Minister Enoch Godongwana saw a welcome boost to the health budget with an increased allocation from R277 billion in 2024/2025 to R329 billion in 2027/2028. This signals a government that is responding to the dire health needs of the public sector, that serves more than 80% of the South African population.
As researchers at the South African Medical Research Council (SAMRC), we listened with interest and share our reflections on some of the critical areas of spend relevant for health and wellbeing.
We note the increase in investment in human resources for health and allocations for early childhood development and social grants. At the same time, we also raise concern about increasing VAT, with knock-on effects for the most vulnerable in our country. There were also worrying omissions in the speech, such as addressing the impact of the United States federal-funding freeze on healthcare services nationally, and a noticeable absence of comment on government’s climate-change plans.
Health and the link with social development: Recognising the importance of early childhood development
Education and specifically early childhood development (ECD) is known to have critical impacts on children’s health and wellbeing, with longstanding effects into youth and adulthood. In South Africa, eight million children go hungry every day, and more than a third of children are reported to live in households below the food poverty line, that is below the income level to meet basic food requirements, not even covering other basic essentials such as clothes.
While the increase in the number of registered ECDs is laudable, many more ECD centres in low-income areas remain unregistered, which means they do not get support from the government in terms of subsidies and oversight.
Social grants
The increase in social grants is welcomed. However, the marginal increase of the Child Support Grant (CSG) by only R30, from R530 to R560, is too little to impact on the high levels of child hunger and malnutrition. The release of the Child Poverty Review in 2023, which highlighted the eight million children going hungry every day, including CSG recipients, proposed the immediate increase of the CSG to at least the Food Poverty Line (R796 in 2024).
Social relief of distress still too small
The Social Relief of Distress (SRD) Grant is an important source of income for low-income, working-age, unemployed adults. Its continuance in 2025 is welcomed. However, it remains too small at R370 per person per month, and the stringent means-test criteria which disrupt continuous receipt from month-to-month, makes it an unreliable, unpredictable source of income for low-income individuals.
Strengthening the healthcare workforce
The Minister stated that “R28.9 billion is added to the health budget, mainly to keep about 9 300 healthcare workers in our hospitals and clinics”. It will also be used to employ 800 post-community service doctors, and to ensure that our pharmacies do not run out of medicines. The speech highlighted the necessary commitment to strengthening the healthcare system, specifically human resources for health.
Considering the pressures on resources, primarily due to the escalating disease burden and challenges within the health workforce, the proposed budget increase from R179 billion to R194 billion – an increase of 8.2% – to maintain the current workforce and employ additional healthcare workers signifies a positive step forward that will aid in addressing staff shortages.
Despite the gains in health spending, the proposed increase in VAT raises substantial concerns to partially negate the potential benefits to the health sector. As the World Bank reports that approximately 60% of people living in South Africa live below the poverty line, increases to VAT will likely drive poverty levels higher.
A focus on other forms of taxation may be better, more evidence-based, and less likely to disproportionately affect those at the highest levels of poverty.
On the issue of alcohol taxes, often mischaracterised as “sin taxes” rather than “health taxes”, the Minister has proposed excise duties of 6.75% on most products for 2025/26. This is 2% above consumer inflation, which stands at 4.75%.
Raising alcohol prices through higher excise taxes is globally recognised as an effective way to address alcohol-related harms. National Treasury is to be commended for adjusting alcohol excise tax rates above CPI in the 2025/26 Budget. This is a move in the right direction, but it does not address the current anomalies in tax rates across different products. This failure to address shortcomings in the excise tax regime is expected, given the release of a discussion document on alcohol excise taxes in December 2024 with a February 2025 response date. The earliest we can expect substantial changes in excise tax rates is in February 2026.
From a public-health perspective, it makes sense to link alcohol excise taxes to the absolute alcohol content of the product to standardise across products. Ethanol is ethanol. The current differential in excise tax rates on different alcohol products is indefensible. Specifically, it makes no sense to tax wine and beer so much less than spirits in terms of absolute alcohol content. Wine, especially bag-in-box wine, is the cheapest product on the market in South Africa, and its affordability increases consumption, leading to more societal harm.
Beer is the most consumed product in the country and is increasingly sold in larger, non-resealable containers. A 2015 SAMRC study in Gauteng found the highest level of heavy episodic drinking with beer products, largely due to their affordability, especially in larger, non-resealable containers. Heavy episodic drinking is a major public-health concern in South Africa, with 43.0% of current drinkers engaging in heavy episodic drinking at least monthly, 50.9% of male and 30.3% of female drinkers. Increasing the excise tax on beer is a powerful tool that the state can use to reduce the level of such behaviour.
Additionally, it makes sense to have lower taxes on alcohol products with lower alcohol content, as this could shift consumption to less harmful products. The current excise tax regimen does not account for this within a single product type like beer or wine, as all products are taxed at the same rate regardless of their alcohol content.
During the COVID-19 pandemic, we saw the benefits of decreased access to alcohol: fewer injuries, fewer unnatural deaths, and communities less disrupted by patrons visiting liquor outlets. While no one advocates for total liquor sales bans, increasing excise taxes on wine and beer would decrease alcohol consumption and reduce harms on drinkers, on others around them, and on society more broadly.
Acute risk to lives with knock on effects due to US federal funding cuts
We believe the South African government has a responsibility to step into the gap left by the sudden US federal funding freeze on HIV and TB services. The US President’s Emergency Plan for AIDS Relief (PEPFAR) funds 17% of HIV and TB services in South Africa and covers salaries for thousands of health workers, including the vital services of community health workers.
The implications for people living with HIV and TB and affected by the externally funded services will be devastating. It will also have ripple effects on the health system as we see inevitable increases in demand for health services to address advancing illness, effects on families caring for ill relatives or losing income.
This area needs to be addressed and clear communication from the National Department of Health is urgently awaited. The US funding cuts clearly impact on essential research funding available to institutions like the SAMRC and no indication has been given in the budget of any plans to augment or replace such funding.
National Health Insurance for South Africa’s public sector
The Minister addressed budget allocations for NHI implementation, specifically, the mid-term indirect and direct conditional grants for NHI were R8.5 billion and R1.4 billion respectively. Although these amounts in themselves are minor compared to other health-budget allocations, allocations for infrastructure (R37.4 billion over the mid-term economic framework period) and additionally allocations for digital patient health information systems, chronic medicine dispensing and distribution systems, and medicine stock surveillance systems are vital for healthcare efficiency and improved outcomes.
Least said not soonest mended: climate change – ‘no comment’?
From a climate-crisis perspective, although the budget speech did not explicitly mention climate change or its related health challenges, there seems to be positive steps being taken to address these issues. Initiatives such as clean energy projects and efforts to improve water management have the potential to benefit all sectors of society, while helping to mitigate the health risks associated with climate change.
Promising spend on health, but who will measure the impact?
Ultimately, increasing health spend is a promising step to increase access to quality health services for South Africa’s population. However, this is not enough, government must seize the opportunity to translate the budget increase into improved health outcomes. The effectiveness of the additional funds must be maximised through efficiency, transparency, and sound governance. The government can reinforce the integrity of public-health services by aligning these increases with robust accountability measures.
Government-academic partnerships represent an opportunity to share knowledge, technical skills and resources to support evidence-informed decision-making for national health decision-making and strengthen monitoring and evaluation mechanisms. There are many examples of this working well, and we trust that the SAMRC, along with the network of higher education institutions are well placed to provide the necessary support.
*Parry, Bango, Kredo, Zembe, Galloway, Street and Wright are researchers with the SAMRC.
Note: Spotlight aims to deepen public understanding of important health issues by publishing a variety of views on its opinion pages. The views expressed in this article are not necessarily shared by the Spotlight editors.
A multicentre study led from Finland has shown that lymph node transfer is a viable treatment for the swelling in the affected limb, a condition known as lymphoedema, after breast cancer surgery. Unfortunately, a drug to improve the outcomes of the transfer treatment was not shown to be effective.
“I am becoming increasingly convinced that lymphoedema is not just a lymphatic problem, but is connected to an immunological factor,” says Plastic Surgeon and InFLAMES Flagship Researcher Pauliina Hartiala from the University of Turku in Finland.
Around one in four women with breast cancer undergo an axillary lymph node removal surgery. The surgery is performed if tests show that the cancer has spread from the breast tissue to the lymph nodes and is often followed by radiotherapy.
After the treatment, around 20–40% of women develop lymphoedema, a lymphatic drainage disorder in the affected arm. In 2022, about 2.3 million women were diagnosed with breast cancer worldwide. In men, the disease is rare.
Swelling can start years after treatment
“Lymphedema usually starts about six months after cancer surgery, but can also occur with a delay of several years after the cancer has been treated,” says Pauliina Hartiala.
In lymphedema, fluid accumulates in the tissue at first, but over time fat and firm connective tissue also begin to accumulate in the arm. Eventually, the upper limb becomes thick and clumsy. An elastic compression sleeve is used to try to control the problem by applying pressure to prevent the limb from swelling. However, the swelling can become so severe that the arm clearly interferes with everyday life, both at work and at leisure.
Lymphedema can be treated with surgical options including liposuction, lymphatic bypass procedure, or lymph node transfer. In the transfer surgery, the patient’s lymph nodes are transferred from the groin area to the armpit, or axilla, to replace the removed lymph nodes. The procedure involves extensive scar removal from the armpit.
Lymph node transfer is often performed at the same time as the breast operated on for cancer is reconstructed with a tissue flap taken from the patient’s abdomen.
A lymph node transfer involves removing lymph nodes from the groin area and transferring them into the armpit. Image: Pauliina Hartiala
Additional benefits were expected from a growth factor
Pauliina Hartiala was one of the leaders of a multicentre study in Turku, Finland, focused on investigating whether the outcome of lymph node transfer could be improved by a growth factor, a drug called Lymfactin, that promotes growth and repair of lymphatic vessels. The study was carried out in five research centres in Finland and Sweden and builds on extensive basic research led by Finnish Professors Kari Alitalo, Seppo Ylä-Herttuala and Anne Saarikko. Lymfactin is a research product from the Finnish pharmaceutical company Herantis Pharma.
The study tested whether the growth factor could improve lymph node flap function compared to a lymph node transfer conducted without the drug. The study involved 39 women. Of these, 20 underwent a transfer procedure where the tissue flap was injected with the lymphatic growth factor before it was transferred. For the second group, the transfer was carried out by adding only saline (placebo) to the tissue flap.
“Even though the drug therapy had worked well in combination with lymph node transfer in the animal model, it did not provide sufficient additional benefit to surgery in humans,” says Pauliina Hartiala.
Although Lymfactin did not work as expected in humans, Pauliina Hartiala is pleased with the other results of the study. In both study groups, the excess arm volume reduced during follow-up. In addition, the patients treated with Lymfactin had a significantly greater reduction in skin interstitial fluid than the placebo group.
“We are the first to show, with a double-blind study, that lymph node transfer is a viable treatment for some patients with lymphoedema after breast cancer surgery. One of the results of our study was the fact that the operation significantly improved women’s quality of life, which is an important finding.”
Pauliina Hartiala works as a Plastic Surgeon at Turku University Hospital, alongside her research work. She now believes that besides a lymphatic problem, lymphedema is linked to an immunological factor. It may be one or more of the immune cells that are involved in the accumulation of connective tissue and fat in the lymphoedema.
“If this is the case, further research will allow us to investigate whether regulating the functions of this cell population could reduce fat accumulation in the limb,” concludes Hartiala.
Marijuana is now legal in many places, but is it safe? Two new studies add to mounting evidence that people who use cannabis are more likely to suffer a heart attack than people who do not use the drug, even among younger and otherwise healthy adults. The findings are from a retrospective study of over 4.6 million people published in JACC Advances and a meta-analysis of 12 previously published studies being presented at the American College of Cardiology’s Annual Scientific Session.
Marijuana use has risen in the United States, especially in states where it is legal to buy, sell and use the drug recreationally. In the retrospective study, researchers found that cannabis users younger than age 50 were over six times as likely to suffer a heart attack compared to non-users. The meta-analysis, which is the largest pooled study to date examining heart attacks and cannabis use, showed a 50% increased risk among those who used the drug.
“Asking about cannabis use should be part of clinicians’ workup to understand patients’ overall cardiovascular risk, similar to asking about smoking cigarettes,” said Ibrahim Kamel, MD, clinical instructor at the Boston University Chobanian & Avedisian School of Medicine and internal medicine resident at St. Elizabeth Medical Center in Boston and the study’s lead author. “At a policy level, a fair warning should be made so that the people who are consuming cannabis know that there are risks.”
Kamel and his team conducted the retrospective study using data from TriNetX, a global health research network that provides access to electronic medical records. Their findings indicate that over an average follow-up of over three years, cannabis users had more than a sixfold increased risk of heart attack, fourfold increased risk of ischaemic stroke, twofold increased risk of heart failure and threefold increased risk of cardiovascular death, heart attack or stroke. All study participants were younger than age 50 and free of significant cardiovascular comorbidities at baseline, with blood pressure and low-density lipoprotein (LDL) cholesterol levels within a healthy range and no diabetes, tobacco use or prior coronary artery disease.
For the meta-analysis, the researchers pooled data from 12 previously published research studies that collectively included over 75 million people. The studies were rated as being of moderate to good quality in terms of methodology. Of the 12 studies, 10 were conducted in the United States, one in Canada and one in India. Some of the studies did not include information about participants’ ages, but the average age was 41 years among those that did, suggesting that the pooled sample reflected a relatively young population.
Taken individually, seven of the studies found a significant positive association between cannabis use and heart attack incidence, while four showed no significant difference and one showed a slightly negative association. When the researchers pooled the data from all studies and analysed it together, they found a significant positive association, with active cannabis users being 1.5 times as likely to suffer a heart attack compared with those who aren’t current users.
Cannabis use and heart attack incidence was assessed in a similar manner across the different studies. However, due to inconsistencies in the data available from each study, researchers were unable to account for several potential confounding factors including the duration and amount of cannabis use or the use of tobacco or other drugs.
“We should have some caution in interpreting the findings in that cannabis consumption is usually associated with other substances such as cocaine or other illicit drugs that are not accounted for,” Kamel said. “Patients should be forthcoming with their doctors and remember that we are their number one advocate and having the full story matters.”
While the mechanisms through which marijuana or its components may impact the cardiovascular system are not fully understood, the researchers hypothesize that it can affect heart rhythm regulation, heighten oxygen demand in the heart muscle and contribute to endothelial dysfunction, which makes it harder for the blood vessels to relax and expand, and can interrupt blood flow. One of the studies included in the meta-analysis found that the risk of heart attack peaked about one hour after marijuana consumption.
Since both studies were limited by their retrospective nature and the meta-analysis was limited by the challenges inherent in pooling data from multiple studies, researchers said that additional prospective studies would help to confirm the findings and determine which groups may face the highest risk.
A previous study presented at the American College of Cardiology’s Annual Scientific Session in 2023 found that daily marijuana use was associated with an increased risk of developing coronary artery disease.
The retrospective analysis will simultaneously publish in JACC Advances.
By Kelly Widdop, Consumer Health Cluster Division Head for Bayer Sub-Saharan Africa
Healthcare innovation in Sub-Saharan Africa is rapidly evolving, driven by the need to address critical healthcare challenges such as limited access to healthcare services, high rates of infectious diseases, and growing non-communicable diseases (NCDs). With a population of over 1.1 billion people, many of whom live in rural and underserved areas, innovations are crucial to improving healthcare delivery, accessibility, and affordability.
What innovation in healthcare looks like
Healthcare innovation means more than introducing new medicines or medical devices; it involves creating integrated solutions that address both immediate health needs and systemic barriers to care. Globally, healthcare innovation is being driven by advances in digital technologies, personalised medicine, and artificial intelligence (AI) diagnostic tools. In developed regions, this includes the development of digital health, which provides remote consultation, diagnostic services, and treatment monitoring, helping to overcome geographical barriers for patients in underserved areas. In Saharan Africa, healthcare innovation is focused on overcoming infrastructure challenges and expanding access to self-care and wellness education. Both globally and locally, and in Sub-Saharan Africa, innovation is reshaping healthcare systems, making them more resilient, accessible, and responsive to the evolving needs of populations.
A decade of transformation – where we are as Sub-Saharan Africa
Sub-Saharan Africa presents a unique set of healthcare challenges, including limited infrastructure, a shortage of resources, and barriers related to affordability and access. Although not showing all at once, many changes are being achieved within the healthcare sector.
Kelly Widdop, Consumer Health Cluster Division Head for Bayer Sub-Saharan Africa
Over the past decade, the consumer health sector has undergone transformative growth, driven by a shift towards personalised wellness and a global demand for accessible and preventative care. Innovations in digital tools such as telemedicine and health-tracking apps, have empowered individuals to take charge of their health in real time, fostering a proactive approach to wellness. Alongside this, there has been a surge in personalised health products from targeted vitamins and mineral supplements, dry-to-sensitive skincare solutions, eco-friendly packaging and natural-based ingredients, which is gaining importance as consumers increasingly seek brands that align with their values. These changes have reshaped consumer health, making it more responsive, inclusive and environmentally conscious.
In the realm of nutritional vitamins and minerals, due to the rise in health awareness and lifestyle health management, many consumer health companies have tailored supplements to address common nutrient deficiencies such as bleeding gums, fatigue, joint pain, and delayed wound healing which are usually linked to, for example, a lack of calcium, vitamin b, vitamin c, vitamin d, and zinc. Consumer healthcare products, particularly vitamins and supplements, have empowered individuals to manage everyday health needs independently. With the availability of essential nutrients that support immunity, energy, mental clarity, and general well-being, consumers can now address minor ailments and manage everyday minor issues without needing to visit a doctor all the time, which can get expensive, especially for the low-income consumer. Instead of relying on medical help from a doctor for minor problems, consumers can now find over-the-counter solutions, saving both time and money.
The past decade has brought many changes in the dermatology space within the Sub-Saharan African market. With a focus on unique skin issues in the region, like sun damage and risks from unregulated skin-lightening products, there have been several public campaigns promoting safer skincare. Plus, with the expansion of telemedicine and digital health platforms, more and more people have access to dermatological consultations than ever before, without worrying about distance. The growing popularity of the use of natural ingredients has become super popular as consumers prefer these safer skincare options. In addition to the easily accessible dermatological products, there has been a significant increase in dermatological education and training across the region to build dermatological expertise in the region. Overall, these investments in both new product innovation and community engagement continuously empower consumers to manage their skin health.
In Sub-Saharan Africa, there have been some great advancements in allergy care, making it easier for people to find over-the-counter solutions for their allergy issues. With more people living in cities and changes in lifestyle and the environment, allergies like rhinitis, food allergies, and seasonal allergies are on the rise. To help with this, healthcare providers and companies have made antihistamines more accessible, allowing people to manage their symptoms without always needing to see a specialist. Plus, there is now a lot of useful information available on how to recognize, prevent, and treat allergic reactions, which helps consumers handle their allergies more effectively without frequent medical visits.
Capacitybuilding – a crucial aspect of the transformation
Capacity building has been a crucial aspect of this transformation. Investments in healthcare infrastructure, training programs, and community health initiatives have strengthened the overall healthcare system. For instance, healthcare providers have been trained to use digital health tools effectively, ensuring that they can offer remote consultations and monitor patients’ health from a distance. Community health workers have been equipped with the knowledge and resources to educate people about self-care practices, preventive measures, and the importance of regular health check-ups. These efforts have not only improved healthcare delivery but also empowered individuals to take control of their health.
Access to self-care has also expanded significantly. With the availability of over-the-counter products, individuals can now manage minor health issues on their own and educational campaigns have raised awareness about the importance of self-care, encouraging people to adopt healthier lifestyles and seek medical advice when necessary. This shift towards self-care has reduced the burden on healthcare facilities and allowed individuals to take a more active role in managing their health, and these changes have reshaped consumer health in Sub-Saharan Africa, making it more responsive, inclusive, and environmentally conscious.
What Sub-Saharan Africa can continuously adopt to succeed
Global relations and intercontinental trade have uniquely provided Sub-Saharan Africa an advantage in bringing successful healthcare innovations to the region.
The adoption of digital health platforms has the potential to change healthcare delivery in rural and underserved areas. Remote monitoring systems can help close the gap in access to health services, making it easier and more convenient for people to get care—just like what has been done successfully in places such as India and Latin America. Personalised health solutions, such as vitamin supplements and skincare products, can cater to local needs and encourage people to take charge of their health and health education initiatives delivered through social media and schools can empower individuals with health literacy, creating a culture of preventive self-care and informed consumer choices.
Additionally, telemedicine and remote care technologies can also be expanded across Africa to keep track of consumers’ health, ensuring they get continuous care even when healthcare facilities are hard to reach. Healthcare in Sub-Saharan Africa should go beyond just offering new products; it should be about creating lasting solutions that truly empower people, patients, and communities. Innovations that fit local needs can make a real difference and improve lives across the continent.
The eye of the sleeping subject was kept open with a special fixation device to record the pupil movements for several hours. (Image: Neural Control of Movement Lab / ETH Zurich)
For the first time, researchers have been able to observe how the pupils react during sleep over a period of several hours. A look under the eyelids showed them that more happens in the brain during sleep than was previously assumed.
While eyes are typically closed in sleep, there is a flurry of activity taking place beneath the eyelids: a team of researchers, led by principal investigators Caroline Lustenberger, Sarah Meissner and Nicole Wenderoth from the Neural Control of Movement Lab at ETH Zurich, have observed that the size of the pupil fluctuates constantly during sleep. As they report in Nature Communications, sometimes it increases in size, sometimes it decreases; sometimes these changes occur within seconds, other times over the course of several minutes.
“These dynamics reflect the state of arousal, or the level of brain activation in regions that are responsible for sleep-wake regulation,” says Lustenberger. “These observations contradict the previous assumption that, essentially, the level of arousal during sleep is low.”
Instead, these fluctuations in pupil size show that even during sleep, the brain is constantly switching between a higher and lower level of activation. These new findings also confirm for humans what other research groups have recently discovered in studies on rodents, who also exhibit slow fluctuations in the activation level (known in the field as arousal).
New method for an old mystery
The regions of the brain which control the activation level are situated deep within the brainstem, making it previously difficult to directly measure these processes in humans during sleep. Existing methods are technically demanding and have not yet been established in this context. The ETH researchers’ study therefore relies on pupil measurements. Pupils are known to indicate the activation level when a person is awake. They can therefore be used as markers for the activity in regions situated deeper within the brain.
The ETH researchers developed a new method for examining the changes in people’s pupils while asleep: using a special adhesive technique and a transparent plaster, they were able to keep the eyes of the test subjects open for several hours.
“Our main concern was that the test subjects would be unable to sleep with their eyes open. But in a dark room, most people forget that their eyes are still open and they are able to sleep,” explains the study’s lead author, Manuel Carro Domínguez, who developed the technique.
Analysis of the data showed that pupil dynamics is related not just to the different stages of sleep, but also to specific patterns of brain activity, such as sleep spindles and pronounced deep sleep waves – brain waves that are important for memory consolidation and sleep stability. The researchers also discovered that the brain reacts to sounds with varying degrees of intensity, depending on the level of activation, which is reflected in the size of the pupil.
A central regulator of the activation level is a small region in the brainstem, known as the locus coeruleus. In animals, scientists have been able to show that this is important for the regulation of sleep stages and waking. The ETH researchers were unable to prove in this study whether the locus coeruleus is indeed directly responsible for pupil changes. “We are simply observing pupil changes that are related to the level of brain activation and heart activity,” Lustenberger explains.
In a follow-up study, the researchers will attempt to influence the activity of the locus coeruleus using medication, so that they can investigate how this affects pupil dynamics. They hope to discover whether this region of the brain is in fact responsible for controlling the pupils during sleep, and how changes in the level of activation affect sleep and its functions.
Using pupillary dynamics to diagnose illnesses
Understanding pupil dynamics during sleep could also provide important insights for the diagnosis and treatment of sleep disorders and other illnesses. The researchers therefore want to investigate whether pupil changes during sleep can provide indications of dysfunctions of the arousal system. These include disorders such as insomnia, post-traumatic stress disorder and possibly Alzheimer’s. “These are just hypotheses that we want to investigate in the future,” says Lustenberger.
Another goal is to make the technology usable outside of sleep laboratories, such as in hospitals where it could help to monitor waking in coma patients or to diagnose sleep disorders more accurately. The pupil as a window onto the brain could thus pave the way for new opportunities in sleep medicine and neuroscience.
In one of the first studies of its kind, a team of researchers from Keck School of Medicine of USC has found that proteins and pathways involved in inflammation are associated with changes in bone mineral density (BMD) over time. Findings from the study were published in the Journal of Bone and Mineral Research.
The research, which was supported by the National Institutes of Health, could potentially lead to the identification of biomarkers that would serve as early indicators of a person’s risk for bone health issues later in life.
Bone mineral density is a measure of bone strength quantified by the amount of minerals in bone tissue. It peaks during young adulthood and slowly declines over the rest of the life cycle. BMD serves as an important marker for bone health and is commonly used to predict the risk of osteoporosis and other bone health conditions.
“Proteins are also substantial in the formation and maintenance of bone, and recently more studies have been trying to identify individual proteins associated with bone health,” says Emily Beglarian, the lead author and an epidemiology doctoral candidate in the Department of Population and Public Health Sciences at the Keck School of Medicine.
The study followed 304 obese/overweight Latino adolescents between the ages of 8 to 13 at baseline from the Study of Latino Adolescents at Risk for Type 2 Diabetes over an average period of three years. The researchers examined associations between over 650 proteins and annual measures of BMD, making this one of the first studies to evaluate these associations over years of follow-up. The proteins found to be associated with BMD were then inputted into a protein pathway database.
“The software determined what pathways the proteins were involved in within the human body. Our primary findings were that many of the proteins associated with BMD were involved in inflammatory and immune pathways in adolescent populations. There are other studies that found some of these same pathways were associated in older adult populations,” says Beglarian.
Existing studies suggest chronic inflammation can disrupt normal bone metabolism leading to lower BMD.
Importance of inclusive research
Childhood is a critical period for the development of BMD and this period can predict lifelong bone health.
“Until now, existing studies have centred on very specific populations. Most of them have small sample sizes, include either Chinese or non-Hispanic white populations, and focus on older adults – primarily on women because osteoporosis is four times more common in women than men,” says Beglarian.
“This is one of the first studies to investigate associations between proteins and BMD in younger populations. Investigating bone mineral density in early stages of life is important to determine how to address factors that may prevent people from reaching their potential peak bone density,” says Beglarian.
Advancing the understanding of bone health biomarkers
Additionally, Beglarian examined associations between BMD and a subset of protein markers from the initial proteins, in a separate cohort of young adults. Here she found that several proteins had similar associations with lower BMD. Low BMD is a risk factor for development of adulthood osteopenia and osteoporosis.
The study’s findings could potentially inform the development of biomarkers of bone health to identify people at risk that might benefit from intervention.
“It was interesting to see the way in which our study overlapped and differed with existing studies. Previous research was investigating BMD at the end of life when levels are already much lower,” she says. “Through my research I hope to address factors that decrease BMD earlier in life to help people get to their highest potential peak density, so they are set up over the rest of their lifetime to have a higher BMD.”
Streptococcus Pyrogenese bound To human neutrophil. Credit: NIH
A new study published in Nature Communications reveals a novel approach to mitigating tissue damage caused by Streptococcus pyogenes, the flesh-eating bacterium responsible for severe infections such as necrotising fasciitis. The research highlights how disrupting bacterial metabolism can help the body better tolerate infection and heal more effectively.
The study was led by Wei Xu, PhD, an assistant professor of biomedical sciences at the Marshall University Joan C. Edwards School of Medicine, and colleagues at Washington University School of Medicine and Central China Normal University. The team discovered that S. pyogenes manipulates the body’s immune response through its aerobic mixed-acid fermentation process, which produces metabolic byproducts, such as acetate and formate, that impair immune cell function, delay bacterial clearance and slow wound healing.
By inhibiting this bacterial metabolic pathway with a pyruvate dehydrogenase inhibitor, the team successfully reduced tissue damage in a mouse model of necrotising skin infection. These findings suggest that reprogramming bacterial metabolism could serve as a novel therapeutic approach, not only to improve host tolerance but also as a potential adjuvant therapy alongside antibiotics. This strategy could enhance the effectiveness of existing treatments, particularly in severe infections where antibiotic resistance or excessive inflammation worsens patient outcomes.
“This study sheds light on how bacterial metabolism influences the immune system,” Xu said. “By understanding these interactions, we can develop new treatment strategies that protect tissues, enhance antibiotic efficacy and improve patient outcomes.”
This effect even occurs with virtual nature – such as nature videos
Photo by Sebastian Unrau on Unsplash
In a new study, an international team of neuroscientists led by the University of Vienna has shown that experiencing nature can alleviate acute physical pain. Surprisingly, simply watching nature videos was enough to relieve pain. Using functional magnetic resonance imaging, the researchers found that acute pain was rated as less intense and unpleasant when watching nature videos – along with a reduction in brain activity associated with pain. The results, published in Nature Communications, suggest that nature-based therapies can be used as promising complementary approaches to pain management.
“Pain processing is a complex phenomenon” explains study lead and doctoral student Max Steininger from the University of Vienna. In order to better understand it and identify treatment options, Steininger and his colleagues investigated how nature exposure influences pain: participants suffering from pain were shown three types of videos: a nature scene, an indoor scene, and an urban scene. The participants rated the pain while their brain activity was measured using functional magnetic resonance imaging. The results were clear: when viewing the nature scene, the participants not only reported less pain but also showed reduced activity in brain regions associated with pain processing.
By analyzing the brain data, the researchers showed that viewing nature reduced the raw sensory signal the brain receives when in pain. “Pain is like a puzzle, made up of different pieces that are processed differently in the brain. Some pieces of the puzzle relate to our emotional response to pain, such as how unpleasant we find it. Other pieces correspond to the physical signals underlying the painful experience, such as its location in the body and its intensity. Unlike placebos, which usually change our emotional response to pain, viewing nature changed how the brain processed early, raw sensory signals of pain. Thus, the effect appears to be less influenced by participants’ expectations, and more by changes in the underlying pain signals,” explains Steininger.
Claus Lamm, head of research in the group, adds: “From another ongoing study, we know that people consistently report feeling less pain when exposed to natural environments. However, the underlying reason for this has remained unclear – until now. Our study suggests that the brain reacts less to both the physical source and the intensity of the pain.”
The current study provides important information on how nature can help alleviate pain and highlights that nature-based therapeutic approaches can be a useful addition to pain treatment. The fact, that this effect was observed by simply watching nature videos suggests that taking a walk outdoors may not be necessary. Virtual nature – such as videos or virtual reality – appears to be effective as well. This opens up a wide range of possible applications in both the private and medical sectors, providing people with a simple and accessible way to relieve their pain.
The study was conducted at the University of Vienna in collaboration with researchers from the Universities of Exeter and Birmingham (UK) and the Max Planck Institute for Human Development.
