Month: September 2023

Categories : Cardiovascular Disease Obstetrics & GynaecologyTags :

Study Links Hot Flashes to Cardiovascular Risk Factors

On By ModernMedia
Photo by CDC on Unsplash

It has long been known that hot flashes are linked to a number of adverse health effects. Emerging data suggests an association between them and cardiovascular disease. A new study is the first to link physiologically assessed hot flashes with heightened systemic inflammation – a risk factor for cardiac disease. Study results will be presented during the 2023 Annual Meeting of The Menopause Society in Philadelphia September 27-30.

Vasomotor symptoms, more often referred to as hot flashes, are one of the most common symptoms identified during the menopause transition, with roughly 70% of midlife women reporting them. Not only do they interfere with a woman’s quality of life, but they have also been related to physical health risks, such as cardiovascular disease.

Previous research linking hot flashes with heightened systemic inflammation has relied on self-reporting to document the frequency and severity of the hot flashes. These self-reports of hot flashes are limited as they ask women to recall hot flashes over weeks or longer and may be subject to memory or reporting biases. A new study that included 276 participants from the MsHeart study, however, utilised sternal skin conductance to physiologically assess hot flashes and tested whether more frequent physiologically assessed hot flashes are associated with heightened system inflammation.

While large increases in inflammatory markers indicate acute infection or clinical disease, small and sustained increases of markers of inflammation that are in the physiologically normal range are predictive of later disease risk. For example, small and/or sustained increases in inflammatory biomarkers (conceptualised as heightened levels of systemic inflammation) have been related to plaque development and atherosclerotic cardiovascular disease.

Based on the results, the researchers concluded that physiologically assessed hot flashes during wake were associated with higher levels of a high-sensitivity C-reactive protein, even after adjusting for potential explanatory factors such as age, education, race/ethnicity, body mass index, and oestradiol.

The results will be presented during the Annual Meeting of The Menopause Society as part of the presentation entitled “Physiologically measured vasomotor symptoms and systemic inflammation among midlife women.”

“This is the first study to examine physiologically measured hot flashes in relation to inflammation and adds evidence to a growing body of literature suggesting that hot flashes may signify underlying vascular risk and indicate women who warrant focused cardiovascular disease prevention efforts,” says Mary Carson, MS, lead author from the Department of Psychology at the University of Pittsburgh.

“Since heart disease is the leading cause of death for women in the US, studies like these are especially valuable,” adds Dr Stephanie Faubion, medical director of The Menopause Society. “Healthcare professionals need to ask their patients about their hot flash experiences as they not only interfere with their quality of life but may also indicate other risk factors.”

Source: EurekAlert!

Categories : Medical Research & TechnologyTags :

The Vagus Nerve also Plays a ‘Fight or Flight’ Role for the Heart

On By ModernMedia
Photo by Stephen Andrews

Researchers have reported in Circulation that the vagus nerve, known for its parasympathetic role in ‘resting and digesting’, also has an important role in exercise, helping the heart pump blood.

Exercise science currently holds that the ‘fight or flight’ (sympathetic) nervous system is active during exercise, helping the heart beat harder, and the ‘rest and digest’ (parasympathetic) nervous system is lowered or inactive. However, University of Auckland physiology Associate Professor Rohit Ramchandra says that this current understanding is based on indirect estimates and a number of assumptions which this new study has proven to be wrong.

“Our study finds the activity in these ‘rest and digest’ vagal nerves actually increases during exercise,” Dr Ramchandra says. “Our group has used ‘tour de force’ electrical recording techniques to directly monitor vagal nerve activity in exercising sheep and has found the activity in these vagal nerves going to the heart increases during exercise.

”For the heart to sustain a high level of pumping, it needs a greater blood flow during exercise to fuel the increased work it is doing: our data indicate that the increase in vagal activity does just this.”

During exercise, there is a four to five-fold increase in the amount of blood pumped out by the heart per minute, requiring increased cardiac output. This is modulated by autonomic nerves that travel from the brain, including the sympathetic and parasympathetic vagal nerves.

The vagal nerve connects the brain to the heart, and other internal organs including the gut, regulating the ‘rest and digest’ parasympathetic nervous system responses. The new research finds the parasympathetic and sympathetic nervous systems work together in exercise to help increase cardiac output. The researchers also investigated the role of mediators released by the cardiac vagal nerve.

“The cardiac vagus nerve releases multiple mediators, and previous research has focused on a neurotransmitter, acetylcholine, which has no impact on our ability to exercise,” says Dr Ramchandra. “Our study focused on a different mediator, vasoactive intestinal peptide (VIP) and it shows that the vagus nerve releases this peptide during exercise, which helps the coronary vessels dilate allowing more blood to pump through the heart.”

The first and co-corresponding author Dr Julia Shanks says, “Vasoactive intestinal peptide was first found in the gut and it does help in digestion, but what we now know is that it is also important in exercise.”

The trial was conducted in sheep, because of their similarity to humans in many important respects including cardiac anatomy and physiology. They are also well-established as an animal model to assist with finding ways to combat heart disease that translate to humans.

These fundamental findings could have applications in diseases, including heart failure, where people cannot tolerate exercise.

“This inability to carry out simple tasks involving exertion means that quality of life is severely compromised in these patients,” Dr Ramchandra says. “One potential reason why exercise tolerance is reduced is that the diseased heart simply does not receive enough blood. Our follow-up study will try to see whether we can use this important role of cardiac vagal nerves to improve exercise tolerance in heart failure.”

There is a lot of interest in trying to ‘hack’ or improve vagal tone as a means to reduce anxiety. Investigating this was outside the scope of the current study.

Dr Ramchandra says we do know that the vagus mediates the slowing down of heart rate and if we have high vagal activity, then our hearts should beat slower.

“Whether this is the same as relaxation, I am not sure, but we can say that regular exercise can improve vagal activity and has beneficial effects.”

Source: University of Auckland

Categories : HIVTags :

An Injectable Hydrogel could Deliver Long-term ART for HIV Patients

On By ModernMedia
Photo by Raghavendra V Konkathi on Unsplash

A new injectable solution that self-assembles into a gel under the right conditions could help manage HIV unlike any currently available methods, researchers report in the Journal of the American Chemical Society. Developed by John Hopkins University researchers, the new gel releases a steady dose of the antiretroviral lamivudine over six weeks, suggesting people living with HIV could have an alternative to the daily pill regimen.

“The primary challenge in HIV treatment is the need for lifelong management of the virus, and one way to address this is to reduce dosing frequencies to help patients stick to medical regimens,” said lead researcher Honggang Cui, a chemical and biomolecular engineer. “This new molecular design shows us a future in which drug hydrogelation can do that to improve HIV treatment.”

In plasma-like conditions, Cui’s team showed the gel quickly separates into molecules of lamivudine. By injecting the gel in the backs of mice, the researchers found one injection was sufficient to maintain effective and lasting drug concentrations for 42 days with nearly no side effects.

“Our goal is to help improve people’s quality of life,” Cui said. “The antiviral substance can be injected under the skin and remain in place over an extended period, releasing the therapeutic compound slowly and consistently – a critical need for individuals with HIV.”

For people living with HIV, the key is maintaining bloodstream drug levels at concentrations that suppress virus load in the body. But that can be difficult with traditional approaches because the body naturally rids itself of these chemicals, Cui said, which is why different treatments require different dosages and dosing frequencies to work.

Most antiretroviral therapies use a combination of drugs, so the researchers plan to include other drugs in tests. Because lamivudine is an FDA-approved drug to treat HIV and hepatitis B, the researchers said the hydrogel could also help manage hepatitis B.

“This is a novel way to deliver anti-HIV meds, and this platform has the advantage that a single polymer can be programmed to deliver several different drugs simultaneously,” said co-author Charles W. Flexner, a professor of medicine, pharmacology, and molecular sciences in the Johns Hopkins School of Medicine. “One of the drawbacks of the approved injectable HIV treatments is that none have activity against hepatitis B virus, which is a common co-infection with HIV, especially in Asia and Africa. This formulation delivers lamivudine, a drug active against both HIV and HBV, but can also be modified to deliver tenofovir, which is the current standard of care for HBV treatment.”

The team envisions their hydrogel working as a preventive measure, similar to how some people take anti-HIV drugs to avoid infection.

“Keeping the high drug levels in plasma for 42 days is very impressive,” Cui said. “But in the future, we hope it will be even longer.”

Hydrogels have unique water-absorbing properties that give them a jellylike consistency resembling biological tissue. The new gel undergoes self-formulation, stays close to the site of injection, and separates into molecules that can fend off the virus without the need for additional carriers or delivery materials.

“The most exciting aspect of these gel filaments is that they consist entirely of the therapeutic agent itself,” Cui said. “Everything originates from the same compound after injection, and this simplest drug formulation could streamline the regulatory approval process once clinical efficacy is demonstrated.”

The team tweaked the molecular properties of lamivudine to act as the building blocks of a supramolecular polymer, a large chain of repeating molecules that can either stick together tightly or come apart, depending on temperature, pH, and other external conditions.

Source: Johns Hopkins University

Categories : Metabolic DisordersTags :

Researchers Find a Mechanistic Link between Zinc Levels and Risk of Diabetes

On By ModernMedia

Researchers have identified a mechanistic link between zinc levels in humans and the risk of type 2 diabetes and non-alcoholic fatty liver disease (NAFLD). The research, published today as a Reviewed Preprint in eLife, is described by editors as a fundamental study that substantially advances our understanding of the role of zinc in metabolism. The evidence comes from genetic analysis of a large population of human participants and comprehensive lab studies of a potential therapeutic target for NAFLD and type 2 diabetes.

Converging lines of evidence have shown that zinc plays a crucial role in insulin production and glucose metabolism. “We know that increasing zinc intake improves blood glucose control in people with prediabetes or type 2 diabetes, and people with a mutation in a key zinc transporter protein have reduced risk of diabetes.” says first author Shek Man Chim, Principal Scientist at Regeneron Pharmaceuticals, Inc, New York, US. “However, the mechanism for how zinc influences systemic blood glucose levels and diabetes risk remains unclear.”

To explore the diabetes-protective role of zinc, Chim and colleagues tested loss-of-function mutations from genetic sequence data collected from a large population of participants of European ancestry who took part in the Regeneron Genetics Center-Geisinger Health System DiscovEHR study. This identified a rare mutation that causes loss of function in a zinc transporter protein called SLC39A5, associated with increased circulating zinc levels.

To confirm this, they looked at how loss-of-function mutations in SLC39A5 were associated with type 2 diabetes in a meta-analysis of four multi-ethnic European and US studies totalling >62 000 cases of diabetes and > 518 000 healthy controls. This confirmed that circulating zinc levels in carriers of the SLC39A5 loss-of-function mutation were elevated and associated with a reduced risk of diabetes.

Having identified SLC39A5 as an important clinical link between zinc and diabetes, the team explored its function by genetically deleting the zinc transporter protein in mice. As anticipated, these mice had elevated blood and tissue levels of zinc. When the team fed mice a high-fat, high-fructose diet to induce obesity, there was a significant reduction in fasting glucose compared to the control mice fed the same diet. Similar results were observed in a congenital (leptin receptor-deficiency) model of obesity. Loss of SLC39A5 also resulted in reduced insulin resistance.

As diabetes often coincides with NAFLD, the team explored whether loss of SLC39A5 protects the liver, too. As hoped, mice lacking SLC39A5 had less build-up of fat in the liver and in blood markers of liver damage. Moreover, mice lacking SLC39A5 but fed a high-fat, high-fructose diet also had less fat accumulation in the liver and improved insulin sensitivity compared to control mice.

The improvements seen in the livers of mice lacking SLC39A5 prompted the researchers to see whether loss of SLC39A5 protects against progression of non-alcoholic fatty liver disease to non-alcoholic steatohepatitis (NASH), a more severe liver inflammation that leads to fibrosis. They used a high-fat, high-cholesterol diet to induce NASH in mice and found increased markers of liver damage, body weight, fasting blood glucose and liver fibrosis. By contrast, the mice lacking SLC39A5 had reduced liver damage markers, fasting blood glucose and improvements in liver inflammation and fibrosis.

One concern highlighted by public reviewers was that observed differences in the metabolic consequences of SLC39A5 inactivation between male and female mice remained unclear. Further work will need to explore this further, as well as characterise the role of SLC39A5 in pancreatic cell function and glucose tolerance more fully.

“Our study provides for the first-time genetic evidence demonstrating the protective role of zinc against high blood sugar and unravels the mechanistic basis underlying this effect,” concludes senior author Harikiran Nistala, currently Head of functional Genomics at Alkermes Inc, Waltham, US. “Our observations suggest that blocking SLC39A5 could be a potential therapeutic avenue for type 2 diabetes and other indications where zinc supplementation alone is inadequate.”

Source: eLife

Categories : Emergency Medicine Healthcare Politics and RegulationsTags :

Alarm Raised over Amendments to Road Accident Fund Act

On By ModernMedia
Photo by Pixabay

By Tania Broughton for GroundUp

The Law Society of South Africa (LSSA) has urged members of the public and civic associations to formally object to proposed amendments to the Road Accident Fund Act which, if approved, will have “dire consequences” for all South African road users.

The draft amendment bill was gazetted earlier this month by the transport minister. It proposes major changes to how the fund operates and how it will pay claims.

According to the LSSA, it proposes significant changes to the existing law, including removing the rights of drivers, passengers and pedestrians to claim compensation for injuries they have suffered. Instead, it proposes that the fund will only provide significantly reduced “social benefits”.

And, says the LSSA, an innocent injured party would still be denied the common law claim against the guilty party for the balance of his or her loss.

Yet all road users contribute directly or indirectly to the fund through the fuel levy, estimated to be about R45-billion a year.

“The poor and disempowered, who make up the vast majority of claimants and who are compelled to use public transport, will bear the brunt of the consequences of these amendments. They will be forced into the public health system, as the prescribed tariffs will not cover the actual costs incurred at a private hospital. Under the present system, many receive treatment at dedicated private healthcare facilities,” the LSSA says in its statement.

Claimants will also not receive any lump sum payments and, if they are not able to produce a payslip, it was unlikely that they would receive compensation for loss of earnings.

The LSSA said those who can afford it will be compelled to take out private accident cover for medical and other expenses as well as accident benefits.

“This is likely to be very costly, as there will be no reimbursement of expenses covered from the fund. Medical aids will more than likely exclude cover or the cost thereof will have to materially increase to preserve the funds in the pool for all members.”

The LSSA said road accident victims will be uniquely discriminated against by the proposed legislation.

“Their rights to be compensated for harm suffered by the fault of another will be taken away. Persons who suffer harm from medical negligence or are injured in train or plane or boat accidents or in shopping centres, hotels, construction sites, holiday resorts, private homes or by electrocution or pollution and by a host of other causes, have unfettered rights to seek compensation from the person or entity who caused them harm.

“Innocent motor vehicle accident victims, alone, do not have this right, despite the fact that they pay premiums to the fund.”

At present, injuries sustained in a motor car accident anywhere in South Africa by any person are covered by the Fund.

The Bill now excludes injuries suffered in motor vehicle accidents in parking areas, sports fields, farm roads, driveways, private estates, game reserves or any other private road.

People who are not citizens or permanent residents are also not covered.

Persons crossing a highway are not covered. Persons injured in a hit and run are not covered. Pedestrians, drivers and cyclist who may test over the legal limit for alcohol and their dependents are not covered.

The Bill also proposes doing away with payments for pain and suffering, loss of amenities of life, disability, disfigurement or shock.

It also does away with lump sum payments for loss of earnings or support, replacing them with monthly payments, and giving the fund the right to continually reassess its liability to continue to pay.

While at present all medical and other expenses reasonably incurred that arise directly from the accident are covered, these will now be subject to a prescribed tariff. Any future medical expenses have to be pre-authorised.

The LSSA said the Bill also largely ousts the role of the courts in determining contested claims, establishing instead alternative dispute resolution procedures followed by referral to be a yet-to-be established Road Accident Fund Adjudicator.

Co-chair of the KZN Personal Injury Lawyers Association Anthony De Sousa said the biggest issues around the Bill was what was not known, such as what “social benefits” were and what the treatment tariffs would be.

“We don’t know what we are signing up for”.

“What also worries me is the people it excludes, such as pedestrians crossing highways. They don’t do that for fun. They do it because they have no choice and are trying to get to work or home.

“They are poor people and if they are knocked down, they really need help. To exclude them is just weird.”

He said while there may be a case not to cover motorists who don’t have licences, or who are over the legal alcohol limit, the Bill also proposed that their dependents are not covered, such as a child who is injured.

“The kids are not at fault, but suddenly they have no claim.”

He said the approach seemed to be: “Let’s try and save some money”.

“We pay a lot of money to the fund in terms of the levy. If you were to take that money and take up an insurance policy, you would probably get better cover and better value for money.

“I don’t think, no matter how they change it, it won’t work until they sort out the dysfunctionality, the administrative inefficiencies in the fund. You can change it to whatever system. They cannot properly administer it and run it.

“If they did their jobs properly, the fund would be saving itself a bucket load of money.”

De Sousa said the association was presently putting together its formal response to the proposals.

Collen Msibi, spokesperson for the Department of Transport said, “The bill is out for comments. The department will welcome all views and suggestions for its consideration.”

Comments and objections can be sent to Lindiwe Twala at twala@dot.gov.za or Trevor Mphahlele at mphahlelet@dot.gov.za

The deadline for comments is 8 October.

Republished from GroundUp under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Source: GroundUp

Categories : Hospitals Medical IndustryTags :

Hospice Palliative Care Association Rebrands as the Association of Palliative Care Centres

On By ModernMedia

As of the 1st of September 2023, the Hospice Palliative Care Association (HPCA) is known as the Association of Palliative Care Centres (APCC).

“This rebranding is not just a visual change,” says Ewa Skowronska, CEO of the APCC. “It is an important message to all medical professionals and the public that our members (many of whom still refer to themselves as hospices) offer quality, specialised and expert palliative care services. Too many people equate hospice with end-of-life only and many medical professionals refer very late. This leads to thousands of patients, and their loved ones, missing out on the holistic support that palliative care provides – support that, ideally, should be from diagnosis of a life-threatening illness and not solely in the last few days of life.”

The rebrand includes a new logo element that reflects that palliative care can be provided alongside curative treatments and into end-of-life care, including bereavement support (if needed). 

“Our members adhere to the Standards for Palliative Healthcare Services, 4th edition, 2020 approved by the Council for Health Service Accreditation of South Africa (COHSASA) and the International Society for Quality in Health Care (ISQua),” says Leigh Meinert, Advocacy and Operations Manager of APCC. “This is important as sometimes there is a perception that our members are only servicing patients who do not have private healthcare support and might not be at the same level as private organisations. In reality, they have decades of palliative care experience, and compliance with these Standards ensures an ongoing level of excellence.”

As much as 90% of APCC member’s services are provided to the patient in the comfort of their own home. The patient’s loved ones are also supported by way of an interdisciplinary team. Such a team typically consists of a medical doctor, nurse, social worker, and home-based carers who can work alongside the patient’s healthcare professional and support quality of life.

Palliative care covers conditions such as HIV/AIDS, drug-resistant TB, chronic respiratory diseases, cardiovascular and neuromuscular diseases, MND and more. “Both adults and children are catered for,” says Meinert. “While patients can move in and out of a palliative care service, they may remain beneficiaries of the services for as long as they (or their loved ones) need or wish to.  Patients may be discharged from the service if they are doing well and able to function independently.  This is always negotiated between the patient, family, and members of the care team. We encourage patients to engage with an APCC member from the point of diagnosis as this helps to dispel fears and provides insight into the holistic services that can be offered. We believe that all patients have benefitted from an improved quality of life through the supportive care received from APCC members.”

“APCC has a cloud-based patient care monitoring, evaluation and reporting system able to report in detail on interventions given to any patient,” says Skowronska. “Our members are comfortable working alongside the primary clinician or specialist.  They can provide a supportive extension of care to the patient and their loved ones and, in most cases, the APCC members inter-disciplinary teams collaborate and work alongside the referring doctors who are treating the patient. They also provide supportive care to the patient’s loved ones. This may include advanced healthcare planning, as well as psychosocial and spiritual support.” 

“Our palliative care definition says it all,” concludes Meinert. “Palliative care is the physical, psychological, social and spiritual care provided by an interdisciplinary team of experts to anyone with a life-threatening illness and their loved ones. Care is offered from the point of diagnosis and extends to bereavement support if needed. Over 90% of the care that APCC members provide is home-based with a focus on promoting quality of life.

We sincerely hope that this rebranding results in more people receiving the support that they so desperately need during some of the most difficult times in a person’s life.”

For more info, visit www.apcc.org.za

Categories : Healthcare Politics and Regulations HospitalsTags :

Concerns Raised at Public Health Conference over Freezing of Healthcare Worker Posts

On By ModernMedia

By Luvuyo Mehlwana for Spotlight

Photo by Hush Naidoo Jade Photography on Unsplash

The National Treasury’s Cost Containment Letter sent to government departments instructing, among others, the freezing of posts was one of the big themes underlying talks about building South Africa’s healthcare worker capacity during the Public Health Association of South Africa’s (PHASA) conference held recently in Gqeberha.

With Finance Minister Enoch Godongwana expected to deliver the medium-term budget policy statement on 1 November, the freezing of posts will further hamstrung already strained health services, some presenters at the conference warned.

An oversight visit to TB hospitals by members of the provincial legislature (MPLs) in the Eastern Cape in the first week of September (5 to 8 September) showed just how bad the staff shortages are. The only remaining hospital in Nelson Mandela Bay dedicated to TB services, Jose Pearson Hospital in Bethelsdorp, has had staff vacancies hovering around 20% since 2019. The hospital provides dedicated TB services to the western part of the province. MPLs heard that in some other hospitals, vacancy rates are even higher, and non-filling of critical posts in some cases results in further medico-legal claims against the department, as the current staff buckles under massive patient loads.

Last year, in response to a parliamentary question, figures the health department released showed that there were 3 892 vacant healthcare worker posts in the province. In the nursing categories, there was a vacancy rate of 15.3%. For paramedics (EMS) the vacancy rate was 10.7%, medical practitioners 8.4%, and pharmacists 13.7%. By June this year, in another response relating to specialist nurses, the vacancy rate in the province had dropped to 13%.

Dr Prudence Ditlopo Senior Researcher at the University of the Witwatersrand, was presenting her research on the impact of nurse workloads and professional support on healthcare outcomes at the PHASA conference. Ditlopo said nurses already have a huge workload and issues around budget cuts impact morale. “I am sure they are asking themselves what will happen to [them] when we [they’re] already understaffed.

“This is not the first time that this monotonous cycle has been happening. Yes, we understand the economic side of it, but at the very same time, what does it say about the well-being of the nurse practice environment, the patients, and the quality of patient care? If nurses see that they are overwhelmed by the workload, they will make sure to find ways that will enable them to cope.

“Enable them to cope” means nurses will find a way that works for them. If what works for them is only seeing ten patients per day, they will do that and they will be gatekeepers for other patients who are coming to the facility. That alone will influence the quality and standard of care in primary care in South Africa,” said Ditlopo.

‘Will create more problems’

Dr Busisiwe Matiwane of the University of The Witwatersrand’s School of Public Health also weighed in on the implications of the Treasury letter.

“In the current system, health professionals have to work for the government to fulfil their community service obligations. However, it can be challenging for them to be assigned to specific hospitals when it is time for their community service. Additionally, with the government announcing a freeze on posts, many individuals who are not government-funded may be compelled to seek employment outside of the government after completing their community service,” Matiwane told delegates.

“If these posts are indeed frozen, does that mean that the government will also halt the placement of individuals who are required to complete community service? The current structure dictates that if you fail to fulfil your community service, you will not be recognised by the statutory bodies as an independent practitioner.

“The implication of this proposal by the government will create more problems, as we already face the challenge of health professionals’ placement or their community services,” she said. “The main concern is whether the posts will be frozen and what will be done. I think this concern has raised questions for many people, who wonder what it means if they are unable to complete their community service or the internship. Does it mean they cannot work?” she asked.

‘protect what is already there’

Speaking on the sidelines of the three-day conference, director of the Rural Health Advocacy Project, Russell Rensburg, said the wage agreement on a 4.5% increase for the public sector had Treasury’s back against the wall since that was not budgeted for in their February budget.

“Treasury is playing hardball and the provinces must decide what they need. The national government must also decide what they need. If they follow through on this, they won’t be able to sustain the public health system. There is concern that doctors will leave as part of cost containment measures, and you can’t run a healthcare system without healthcare workers. But we will only know the true position of the Treasury when they publish the medium-term budget policy statement,” said Rensburg.

“I believe at the moment they are just testing the market. They are saying we must have one thing, but we can’t have both, so that is the game they are playing. Our position is clear on this issue. Before any salary cuts or job freezes, we need to protect what is already there. We need to retain this year’s cohort of community service doctors, pharmacists, and nurses because these people helped us during COVID-19. Some were interns during COVID-19 and they are the core that can build the health service in the post-COVID-19 era. So, the immediate priority is to retain those posts because we don’t know if there will still be community service going forward,” said Rensburg.

‘working with what we have’

Several speakers and presenters at the PHASA conference raised concerns about the existing scarcity of healthcare workers and urged the Department of Health to take action. The experts, academics, researchers, students, non-governmental organisations, and civil society members all agree that healthcare is a fundamental human right, but that right won’t be fulfilled without healthcare workers, as there cannot be health services without workers. The government’s key policy document on human resources for health warned as far back as 2020 that the country is facing a critical shortage of healthcare workers.

Dr Krish Vallabhjee, former Chief Director of Strategy and Health Support in the Western Cape Health Department, believes that management must use whatever resources are available to achieve good results.

Vallabhjee said, “Budget cuts are a reality, so whatever we talk about here and in many of these conference sessions, we can’t be talking about wanting more and more. We need to work with what we have. How can we repurpose the people we have? Can’t we use them more effectively to achieve the same effect?” he asked.

“Managers need to work with their staff instead of just sitting in some corner and making budget cut decisions. Managers need to engage with staff to address the problem of not having enough budget. How do we work together? What are our priorities? As managers, we must listen to what people are saying on the ground. What are the doctors, nurses, and local managers saying? We must be united. [It should not be a thing that one hospital, clinic, and the district [are] fighting for their own piece. We are one department and we have this problem of a budget. How do we unite and do the best we can?”

Government will clarify

In a cabinet statement issued on 14 September, Minister in the Presidency, Khumbudzo Ntshavheni said that Finance Minister Enoch Godongwana would clarify the cost-containment letter issued on August 31.

“Cabinet appreciates the current fiscal constraints which are not unique to South Africa but have resulted in budget shortfall. Cabinet has iterated that measures to address the budget shortfall must not impact negatively on service delivery. The Minister of Finance will shortly issue guidelines clarifying the unintended misunderstanding arising from the Cost Containment Letter issued on 31 August 2023. In addition, as part of the in-year performance review of progress in implementation priorities agreed to with Ministers, the President, and Deputy President will meet with individual Ministers to ensure that fiscal management does not derail the agreed to priorities.”

Source: Spotlight

Categories : PaediatricsTags :

Listening Carefully to Parents of a Child with Gastroenteritis could Prevent After-hours Visits

On By ModernMedia
Photo by cottonbro on Pexels

Acute gastroenteritis is a common infectious disease in children aged under 6 years. Although it often resolves on its own, it has a high consultation rate in primary care, especially during out-of-office hours. In a study published in The Annals of Family Medicine, Dutch researchers interviewed parents who contacted GPs outside of normal hours, and found that who felt misunderstood or ignored were more likely to request a visit.

The researchers conducted 14 semi-structured interviews with parents who contacted primary care physicians outside of normal operating hours seeking medical attention for their children. They sought to explore parental motivations, expectations, and experiences of off-hours primary care contacts for children with acute gastroenteritis. Parents were more likely to contact their primary care physician after hours when their child exhibited unusual behaviour, to prevent symptom deterioration, and to gain medical reassurances.

The researchers reported that parents expected their doctors to perform a thorough physical examination, provide information, and make follow-up care agreements. Parents reported dissatisfaction if they felt their doctors didn’t listen to them, misunderstood them, or didn’t take them seriously. This increased their likelihood of seeking another consultation. Researchers concluded that there is often a mismatch between parental expectations and GPs’ actions. Greater awareness and understanding on the part of GPs about the feelings and expectations of parents could guide them in interacting with parents, which may improve satisfaction with primary health care and reduce after-hours care requests.

The researchers found that among parents who requested out-of-office consultations for their children who were experiencing gastroenteritis, those that felt misunderstood or not listened to by their doctors were more likely to request such a visit. Taking greater account and understanding about parents’ feelings and expectations about care for their child may improve satisfaction with primary health care, specifically with requests that come in after normal clinic hours.

Source: EurekAlert!

Categories : Neurology Regenerative MedicineTags :

Neuroscientists Regenerate Neurons in Mice with Spinal Cord Injury

On By ModernMedia
Source: CC0

In a new study using mice, neuroscientists have uncovered a crucial component for restoring functional activity after spinal cord injury. In the study, published in Science, the researchers showed that re-growing specific neurons back to their natural target regions led to recovery, while random regrowth was not effective.

In a 2018 study in Nature, the team identified a treatment approach that triggers axons to regrow after spinal cord injury in rodents. But even as that approach successfully led to the regeneration of axons across severe spinal cord lesions, achieving functional recovery remained a significant challenge.

For the new study, the team of researchers from UCLA, the Swiss Federal Institute of Technology, and Harvard University aimed to determine whether directing the regeneration of axons from specific neuronal subpopulations to their natural target regions could lead to meaningful functional restoration after spinal cord injury in mice. They first used advanced genetic analysis to identify nerve cell groups that enable walking improvement after a partial spinal cord injury.

The researchers then found that merely regenerating axons from these nerve cells across the spinal cord lesion without specific guidance had no impact on functional recovery. However, when the strategy was refined to include using chemical signals to attract and guide the regeneration of these axons to their natural target region in the lumbar spinal cord, significant improvements in walking ability were observed in a mouse model of complete spinal cord injury.

“Our study provides crucial insights into the intricacies of axon regeneration and requirements for functional recovery after spinal cord injuries,” said Michael Sofroniew, MD, PhD, professor of neurobiology at the David Geffen School of Medicine at UCLA and a senior author of the new study. “It highlights the necessity of not only regenerating axons across lesions but also of actively guiding them to reach their natural target regions to achieve meaningful neurological restoration.”

The authors say understanding that re-establishing the projections of specific neuronal subpopulations to their natural target regions holds significant promise for the development of therapies aimed at restoring neurological functions in larger animals and humans. However, the researchers also acknowledge the complexity of promoting regeneration over longer distances in non-rodents, necessitating strategies with intricate spatial and temporal features. Still, they conclude that applying the principles laid out in their work “will unlock the framework to achieve meaningful repair of the injured spinal cord and may expedite repair after other forms of central nervous system injury and disease.”

Source: University of California – Los Angeles Health Sciences

Categories : COVID Medical Research & TechnologyTags :

‘Long COVID’ Risks are Inflated by Flawed Research, Reviewers Find

On By ModernMedia
Photo by Usman Yousaf on Unsplash

‘Long COVID’ is a mysterious constellation of symptoms associated with having recovered from COVID infection – but how many cases represent a true condition, and how many fall under a poorly-defined umbrella of currently known ones? Overly broad definitions, a lack of appropriate, or any, comparison groups, among other things, in studies looking at the epidemiology of the condition have distorted the risks, say the authors of a review published in BMJ Evidence-based Medicine.

This is further compounded by inclusion of poorly conducted studies into systematic reviews and pooled data analyses that end up overstating the risk yet again, they add. 

Likely consequences include increased public anxiety and healthcare spend; misdiagnoses; and diversion of funds from those who really do have other long term conditions secondary to COVID infection, suggest the researchers.

Many after-effects of COVID infection include post-ICU syndrome, which is a constellation of health issues that are present when the patient is in intensive care and which persist after discharge home, and shortness of breath following pneumonia. The trouble is that these are common to many upper respiratory viruses, the researchers point out.

None of the working definitions of ‘long COVID’ used by influential health bodies, such as the US Centers for Disease Control and Prevention, the World Health Organization, the UK National Institute for Health and Care Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN), and the Royal College of General Practitioners requires a causal link between SARS-CoV2 and a range of symptoms. 

Not only should comparator (control) groups be included in ‘long COVID’ studies, when they often aren’t, but they should also be properly matched to cases, ideally by age, sex, geography, socioeconomic status and, if possible, underlying health and health behaviours, which they rarely are, say the researchers.

During the early stages of the pandemic, when SARS-CoV-2 testing wasn’t widely available, studies were more likely to include a non-representative sample of SARS-CoV-2-positive patients by including fewer patients with mild or no symptoms.

This is known as sampling bias, which occurs when certain members of a population have a higher probability of being included in a study sample than others, potentially limiting the generalisability of a study’s findings, explain the researchers.

“Our analysis indicates that, in addition to including appropriately matched controls, there is a need for better case definitions and more stringent [‘long COVID’] criteria, which should include continuous symptoms after confirmed SARS-CoV-2 infection and take into consideration baseline characteristics, including physical and mental health, which may contribute to an individual’s post COVID experience, “ they write, adding that the umbrella term ‘long COVID’ should be jettisoned in favour of different terms for specific after effects.

While the results of high quality population studies on ‘long COVID’ in adults and children have been reassuring, they point out,  the body of research “is replete with studies with critical biases” they add, setting out common pitfalls.

“Ultimately, biomedicine must seek to aid all people who are suffering. In order to do so, the best scientific methods and analysis must be applied. Inappropriate definitions and flawed methods do not serve those whom medicine seeks to help,” they insist.

“Improving standards of evidence generation is the ideal method to take long COVID seriously, improve outcomes, and avoid the risks of misdiagnosis and inappropriate treatment,” they include.

Source: EurekAlert!