Researchers at Karolinska Institutet have evaluated dispatching drones equipped with automated external defibrillators (AED) to patients with suspected cardiac arrest. In more than half of the cases, the drones were ahead of the ambulance by an average of three minutes. The drone-delivered defibrillator was used in a majority of the cases which proved to be cardiac arrests. The results have been published in The Lancet Digital Health.
“The use of an AED is the single most important factor in saving lives. We have been deploying drones equipped with AED since the summer of 2020 and show in this follow-up study that drones can arrive at the scene before an ambulance by several minutes. This lead time has meant that the AED could be used by people at the scene in several cases,” says Andreas Claesson, Associate Professor at the Center for Cardiac Arrest Research at the Department of Clinical Research and Education, Södersjukhuset, Karolinska Institutet, and principal investigator of the study.
Every year, around 6000 people in Sweden suffer a sudden cardiac arrest, but only a tenth of those affected survive. Although an early shock with a AED can dramatically increase the chance of survival and there are tens of thousands of AED in the community, they are not available in people’s homes where most cardiac arrests occur.
Since 2020, in an effort to cut the time to defibrillation with an AED, Karolinska Institutet, together with Region Västra Götaland, SOS Alarm and the drone operator Everdrone, have tested the possibility of dispatched an AED-carrying drone at the same time as an ambulance is alerted. The project covered an area of approximately 200 000 people in western Sweden. An initial study conducted in the summer of 2020 in Gothenburg and Kungälv showed that the idea was feasible and safe.
“This more comprehensive and follow-up study now shows in a larger material that the methodology works throughout the year, summer and winter, in daylight and darkness. Drones can be alerted, arrive, deliver AED, and people on site have time to use the AED before the ambulance arrives,” says Sofia Schierbeck, PhD student at the same department and first author of the study.
In the study, drones delivered a AED in 55 cases of suspected cardiac arrest. In 37 of these cases, the delivery took place before an ambulance, corresponding to 67%, with a median lead of 3 minutes and 14 seconds. In the 18 cases of actual cardiac arrest, the caller managed to use the AED in six cases, representing 33%. A shock was recommended by the device in two cases and in one case the patient survived.
“Our study now shows once and for all that it is possible to deliver AED with drones and that this can be done several minutes before the arrival of the ambulance in connection with acute cardiac arrest,” says Andreas Claesson. “This time saving meant that the healthcare emergency centre could instruct the person who called the ambulance to retrieve and use the AED in several cases before the ambulance arrived.”
The research was mainly funded by the Swedish Heart-Lung Foundation.
Antibiotic-resistant bacteria are a growing global problem, but of the solution may lie in copying the bacteria’s own weapons. Researchers in the Norwegian city of Tromsø has found a new bacteriocin, in a very common skin bacterium, which they describe in Microbiology Spectrum. Bacteriocin inhibits the growth of antibiotic-resistant bacteria that are often the cause of disease and can be difficult to treat.
One million deaths each year
The fact that we have medicines against bacterial infections is something many people take for granted. But increasing resistance among bacteria means that more and more antibiotics do not work. When the bacteria become resistant to the antibiotics we have available, we are left without a treatment option for very common diseases. Over one million people die each year as a result of antibiotic resistance.
The first step in developing new antibiotics is to look for substances that inhibit bacterial growth.
Sami name for an exciting discovery
The research group for child and youth health at UiT The Arctic University of Norway has studied substances that the bacteria themselves produce to inhibit the growth of competitors. These substances are called bacteriocins. Through the work, they have discovered a new bacteriocin, in a very common skin bacterium. Bacteriocin inhibits the growth of antibiotic-resistant bacteria that can be difficult to treat with common antibiotics.
The researchers have called the new bacteriocin Romsacin, after the Sami name for Tromsø, Romsa. The hope is that Romsacin can be developed into a new medicine for infections for which there is currently no effective treatment.
Long way to go
At the same time, researcher Runa Wolden at the Department of Clinical Medicine at UiT emphasizes that there is a long way to go before it is known whether Romsacin will be developed and taken into use as a new medicine. Because that’s how it is with basic research; you cannot say in advance when someone will make use of the results you produce.
“This discovery is the result of something we have been researching for several years. Developing Romsacin – or other promising substances – into new antibiotics is very expensive and can take 10-20 years,” says Wolden, who is part of the research group for child and youth health.
Effective against bacterial types
Before new antibiotics can be used as medicines, one needs to make sure that they are safe to use. Currently, researchers do not know how the bacteriocin works in humans. A further process will involve comprehensive testing, bureaucracy and marketing.
“This naturally means that there is a long way to go before we can say anything for sure. What we already know, however, is that this is a new bacteriocin, and that it works against some types of bacteria that are resistant to antibiotics. It’s exciting,” says Wolden.
The new bacteriocin is produced by a bacterium called Staphylococcus haemolyticus. The bacteriocin is not produced by all S. haemolyticus, but by one of the 174 isolates that the researchers have available in the freezer.
“We couldn’t know that before we started the project, and that’s one of the things that makes research fun,” says Wolden.
She says that ten years ago the researchers collected bacterial samples from healthy people when they wanted to compare S. haemolyticus in healthy people with those found in patients in hospital.
“Subsequently, we have done many experiments with these bacteria, and this is the result from one of our projects,” says Wolden.
One of the primary chlorine disinfectants currently used for hospital infection control does not kill off spores of the notorious cause of hospital-acquired infection Clostridioides difficile, according to a new study published in the journal Microbiology.
Research by the University of Plymouth has shown that C. Diff spores are completely unaffected despite being treated with high concentrations of bleach used in many hospitals.
In fact, the chlorine chemicals are no more effective at damaging the spores when used as a surface disinfectant – than using water with no additives.
The study’s authors say susceptible people working and being treated in clinical settings might be unknowingly placed at risk of contracting the superbug.
As a result, and with incidence of biocide overuse only serving to fuel rises in antimicrobial resistance (AMR) worldwide, they have called for urgent research to find alternative strategies to disinfect C. diff spores in order to break the chain of transmission in clinical environments.
Dr Tina Joshi, Associate Professor in Molecular Microbiology at the University of Plymouth, carried out the study with Humaira Ahmed, a fourth year Medicine student from the University’s Peninsula Medical School.
Dr Joshi, said: “With incidence of anti-microbial resistance on the rise, the threat posed by superbugs to human health is increasing. But far from demonstrating that our clinical environments are clean and safe for staff and patients, this study highlights the ability of C. diff spores to tolerate disinfection at in-use and recommended active chlorine concentrations. It shows we need disinfectants, and guidelines, that are fit for purpose and work in line with bacterial evolution, and the research should have significant impact on current disinfection protocols in the medical field globally.”
C. diff causes diarrhoea, colitis and other bowel complications, causing around 29 000 deaths per year in the USA, and almost 8500 in Europe, with the most recent data showing that, in the UK, incidence of C. diff infection was increasing prior to the start of the COVID pandemic.
Previously, Dr Joshi and colleagues had demonstrated the ability of C. diff spores to survive exposure to recommended concentrations of sodium dichloroisocyanurate in liquid form and within personal protective fabrics such as surgical gowns.
The new study examined spore response of three different strains of C. diff to three clinical in-use concentrations of sodium hypochlorite. The spores were then spiked onto surgical scrubs and patient gowns, examined using scanning electron microscopes to establish if there were any morphological changes to the outer spore coat.
Dr Joshi, who is on the Microbiology Society Council and Co-Chairs their Impact & Influence Committee, added: “Understanding how these spores and disinfectants interact is integral to practical management of C. diff infection and reducing the burden of infection in healthcare settings. However, there are still unanswered questions regarding the extent of biocide tolerance within C. diff and whether it is affected by antibiotic co-tolerance. With AMR increasing globally, the need to find those answers – both for C. diff and other superbugs – has never been more pressing.”
Red Blood Cell Infected with Malaria Parasites
Colourised scanning electron micrograph of red blood cell infected with malaria parasites (teal). The small bumps on the infected cell show how the parasite remodels its host cell by forming protrusions called ‘knobs’ on the surface, enabling it to avoid destruction and cause inflammation. Uninfected cells (red) have smoother surfaces. Credit: NIAID
New compounds are continuously required due to the risk of malaria parasites becoming resistant to the medicines currently used. A team of researchers at Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) combined the anti-malaria drug artemisinin with coumarin, and developed a compound from both bioactive plant-derived substances. This compound is also autofluorescent, making it particularly useful as it can be used for imaging in live cells.
The working group, led by Prof Dr Svetlana B. Tsogoeva, also discovered that the autofluorescent artemisinin-coumarin hybrids are able to destroy a certain drug-resistant malaria pathogen called Plasmodium palcifarum. They published their findings in the journalChemical Science.
Artemisinin is a highly-effective and common ingredient for the manufacture of malaria medication gained from a plant called sweet wormwood (Artemisia annua L.). Coumarin is a secondary plant compound found in various plants.
In the development of drugs against malaria, active substances such as artemisinin are labelled with fluorescent substances in order to identify how they act against malaria pathogens in precise chronological order using imaging techniques.
Combining substances to achieve autofluorescence
A significant disadvantage of labeling with fluorescent substances is the fact that they alter how the medication works.
For example, this means that in certain circumstances cells infected with malaria absorb a drug like artemisinin differently after fluorescent marking than previously.
The solubility of the drug can also change. This was avoided by the development of autofluorescent hybrids, which are compounds made of two or more basic compounds that are inherently fluorescent and whose mode of action can be precisely observed using imaging techniques.
Active agent with special skills
The team decided to combine artemisinin with bioactive coumarins because coumarin derivatives also possess anti-malaria properties. They can also be easily chemically altered so that they become extremely fluorescent.
The researchers discovered that it was not only possible to observe the mode of action of this first autofluorescent artemisinin-coumarin hybrid in living red blood cells infected with P. falciparum.
In conjunction with Prof. Barbara Kappes (Department of Chemical and Biological Engineering, FAU) and Dr. Diogo R. M. Moreira (Instituto Gonçalo Moniz, Fiocruz Bahia, Brazil), they also discovered that the active agent was highly effective against P. falciparum strains in vitro that are resistant to chloroquin and other malaria drugs.
Above all, however, the new compound also proved highly effective against the malaria pathogens in vivo in mouse models.
With the creation of the first autofluorescent artemisinin-coumarin hybrid, the FAU researchers hope that they have laid the foundation for the development of further autofluorescent agents for treating malaria and have made significant process in overcoming multi-drug resistance in the treatment of malaria.
Ischaemic and haemorrhagic stroke. Credit: Scientific Animations CC4.0
Contrary to the commonly-held view, the brain does not have the ability to rewire itself to compensate for conditions such as stroke, loss of sight or an amputation, say scientists in the journal eLife.
Professors Tamar Makin of Cambridge University and John Krakauer of Johns Hopkins University argue that the notion that the brain, in response to injury or deficit, can reorganise itself and repurpose particular regions for new functions, is fundamentally flawed – despite being commonly cited in scientific textbooks. Instead, they argue that what is occurring is merely the brain being trained to utilise already existing, but latent, abilities.
One of the most common examples given is where a person loses their sight – or is born blind – and the visual cortex, previously specialised in processing vision, is rewired to process sounds, allowing the individual to use a form of ‘echolocation’ to navigate a cluttered room. Another common example is of people who have had a stroke and are initially unable to move their limbs repurposing other areas of the brain to allow them to regain control.
Krakauer, Director of the Center for the Study of Motor Learning and Brain Repair at Johns Hopkins University, said: “The idea that our brain has an amazing ability to rewire and reorganise itself is an appealing one. It gives us hope and fascination, especially when we hear extraordinary stories of blind individuals developing almost superhuman echolocation abilities, for example, or stroke survivors miraculously regaining motor abilities they thought they’d lost.
“This idea goes beyond simple adaptation, or plasticity – it implies a wholesale repurposing of brain regions. But while these stories may well be true, the explanation of what is happening is, in fact, wrong.”
In their article, Makin and Krakauer look at a ten seminal studies that purport to show the brain’s ability to reorganise. They argue, however, that while the studies do indeed show the brain’s ability to adapt to change, it is not creating new functions in previously unrelated areas – instead it’s utilising latent capacities that have been present since birth.
For example, a 1980s study by Professor Michael Merzenich at University of California, San Francisco looked at what happens when a hand loses a finger. The hand has a particular representation in the brain, with each finger appearing to map onto a specific brain region. Remove the forefinger, and the area of the brain previously allocated to this finger is reallocated to processing signals from neighbouring fingers, argued Merzenich – in other words, the brain has rewired itself in response to changes in sensory input.
Not so, says Makin, whose own research provides an alternative explanation.
In a study published in 2022, Makin used a nerve blocker to temporarily mimic the effect of amputation of the forefinger in her subjects. She showed that even before amputation, signals from neighbouring fingers mapped onto the brain region ‘responsible’ for the forefinger — in other words, while this brain region may have been primarily responsible for process signals from the forefinger, it was not exclusively so. All that happens following amputation is that existing signals from the other fingers are ‘dialled up’ in this brain region.
Makin, from the Medical Research Council (MRC) Cognition and Brain Sciences Unit at the University of Cambridge, said: “The brain’s ability to adapt to injury isn’t about commandeering new brain regions for entirely different purposes. These regions don’t start processing entirely new types of information. Information about the other fingers was available in the examined brain area even before the amputation, it’s just that in the original studies, the researchers didn’t pay much notice to it because it was weaker than for the finger about to be amputated.”
Another compelling counterexample to the reorganisation argument is seen in a study of congenitally deaf cats, whose auditory cortex appears to be repurposed to process vision. But when they are fitted with a cochlear implant, this brain region immediately begins processing sound once again, suggesting that the brain had not, in fact, rewired.
Examining other studies, Makin and Krakauer found no compelling evidence that the visual cortex of individuals that were born blind or the uninjured cortex of stroke survivors ever developed a novel functional ability that did not otherwise exist.
Makin and Krakauer do not dismiss stories such as blind people navigating using hearing, or individuals who have experienced a stroke regain their motor functions. They argue instead that rather than completely repurposing regions for new tasks, the brain is enhancing or modifying its pre-existing architecture — and it is doing this through repetition and learning.
Understanding the true nature and limits of brain plasticity is crucial, both for setting realistic expectations for patients and for guiding clinical practitioners in their rehabilitative approaches, they argue.
Makin added: “This learning process is a testament to the brain’s remarkable – but constrained – capacity for plasticity. There are no shortcuts or fast tracks in this journey. The idea of quickly unlocking hidden brain potentials or tapping into vast unused reserves is more wishful thinking than reality. It’s a slow, incremental journey, demanding persistent effort and practice. Recognising this helps us appreciate the hard work behind every story of recovery and adapt our strategies accordingly.
“So many times, the brain’s ability to rewire has been described as ‘miraculous’ – but we’re scientists, we don’t believe in magic. These amazing behaviours that we see are rooted in hard work, repetition and training, not the magical reassignment of the brain’s resources.”
With frequent and long stints at their computers, the average gamer is a sedentary night owl, often compromising on sleep – especially quality sleep – and being exposed to too much blue light. The topic has been explored in University of Cape Town (UCT) PhD candidate Chadley Kemp’s doctoral thesis, a meaty study of over 70 000 words.
Kemp’s research into habitual gaming activities is supervised by Associate Professor Dale Rae, a sleep researcher and senior lecturer at the Health Through Physical Activity, Lifestyle and Sport Research Centre (HPALS) in the Faculty of Health Sciences.
This work is founded on Kemp’s 2018 research underpinning a master’s in medical science at UCT’s former Department of Exercise Science and Sports Medicine in the Sports Science Institute of South Africa. This was upgraded to a PhD in 2020.
His research (he is an esports and video game enthusiast) explores adult esports players’ sleep, health status, light exposure patterns and physical activity.
“We know that sleep affects mental functioning in general, but we weren’t sure about the extent to which this applied to esports players,” said Kemp.
Framework for healthier gameplay
Kemp’s goal is to produce objective data that will guide the development of a framework aimed at promoting healthier gameplay standards and encouraging policy reform within the esports industry.
The tests they used to assess neurocognitive performance were intended to serve as proxies for certain aspects of esports performance because they tested specific mental skills important to gaming, he added.
“We gathered it would be a useful addition to compel gamers to adopt better sleep and lifestyle behaviour changes if it meant … that their health would improve, and they would benefit from better in-game performance – and get an edge over their competitors!”
Kemp’s focus is not on professional gamers, but what he calls “the missing middle” of the esports community: the amateur and semi-competitive gamers.
“This group doesn’t have the same infrastructure and support as their professional counterparts,” he explained. “But what makes them particularly interesting is the fact that they have to balance their gaming commitments with holding down a job, studies, or juggling family or household commitments.”
Global attraction
Esports are burgeoning across the globe – and not only among competitive gamers but audiences too. Writing in the South African Journal of Sports Medicine, Kemp and his co-authors noted that globally competitive gaming attracts 532 million fans alone, according to statistics released in 2022.
However, his study wasn’t motivated by an influx of gamers presenting themselves with sleep difficulties at Associate Professor Rae’s sleep consultancy, Sleep Science. Rather, it stemmed from a broader observation and concern within the local esports community about gamers and poor-quality and short-duration sleep, high levels of sedentarism, and excessive exposure to artificial or electronic night at night.
Based on these conversations and endorsed by anecdotal evidence from within the esports industry, Kemp said he and Rae were able to determine that sleep curtailment had seemingly become a “rite of passage” among gamers. Primarily, most gaming takes place at night because of gamers’ daytime commitments.
As there wasn’t much literature on the topic (much of it is focused on the implications of gaming in children and adolescents) and most studies were survey-based and didn’t target esports players or those regularly engaged with gaming, there was significant knowledge gap that needed filling. As a demographic, Kemp is particularly interested in adult esports players because of the greater health risks posed by age and unhealthy lifestyle factors, such as smoking and alcohol consumption.
Because he needed a tool to measure sleep and physical activity concurrently, he validated the Actiwatch, a special research device, to do this. The device also measures light exposure. For his sample group, Kemp recruited eligible esports players and measured variables of interest. These were clinical measures (anthropometry, blood pressure, blood markers) and self-report data (questionnaires on sleep, chronotype, daytime sleepiness and gaming addiction) and their cognitive performance.
“We also included non-gamers in our study, so we could compare our gamers against people who were not gamers. In total, we had 59 male participants (31 gamers; 28 non-gamers). (The females volunteering to participate did not meet the study’s inclusion criteria.) For a week, these individuals wore the Actiwatch to track their sleep, physical activity, and light exposure.”
Key findings
The key findings of his research make for interesting reading:
esports players have comparable sleep duration to non-gamers (control group) but tend to sleep later than others. They hit the middle of their sleep cycle around 04:08 compared to 03:01 for the control group.
A much larger percentage of esports players (45.2%) showed night-oriented habits (or evening chronotypes), ie they are more active and alert at night. This is in contrast to only 7.1% of the control group showing similar evening tendencies.
They nap more during the day, but their night sleep duration is similar to that of the control groups.
There was no significant difference in risks related to heart diseases or metabolic diseases between the two groups, which Kemp speculates might be related to their young age. But most of the health markers were tentatively raised, which could point to worse cardiometabolic health in future.
Esports players smoke more.
Esports players performed better in brain-based tasks, showing better attention and accuracy, and making fewer mistakes.
Esports players are less active than the control group. They sit more (11.2 vs 9.1 hours a day) and are less physically active, whether it’s moderate- or vigorous-intensity activity.
Esports players have specific active and inactive hours. They are less active in the early morning and certain evening hours but are more active around midnight.
Esports players are exposed to dimmer light for a more significant part of their day, and their exposure to bright light happens later at night.
This work is important for several reasons, said Kemp. A key takeaway from the research revolves around chronotypes.
“Esports players seem to have sleep patterns that align with being night owls and this may be influenced both by their natural tendencies and their gaming habits. It’s also possible that a genetic disposition and exposure to artificial light from screens collectively contributes to these sleep patterns.
“The combined effect is thought to create a cycle where their preference for evening activities leads to more gaming, which in turn reinforces the night owl tendencies. This impacts on their sleep quality and quantity.”
He added: “Perhaps more obviously, gaming is a massively popular phenomenon that transcends age, sex, and geography. It’s a dominant form of entertainment and its competitive arm, esports, is progressing towards acceptance as a genuine form of sporting competition.”
From the neurocognitive side, it’s clear that gaming can sharpen several cognitive abilities, such as attention and problem-solving.
“However, the catch is, if you’re not getting enough sleep, these enhanced skills could take a hit,” said Kemp. “Gamers might see slower reactions, flawed decision-making, and even a drop in their in-game stamina. So, while gaming certainly has its merits and can even boost certain mental skills, it doesn’t come without health considerations. “
Kemp’s research is aimed at ensuring that anyone engaged with gaming or esports does so in a healthy way.
“The purpose is to create a steppingstone towards health regulation in gaming and esports,” he said. “By creating awareness and providing evidence-based recommendations to prevent chronic health problems caused by unhealthy gaming behaviour, it supports individual decision making, governments, and policy makers. It’s valuable to anyone involved in or impacted by gaming.”
Kemp’s guidelines for gamers:
Get between seven and nine hours’ sleep a night and keep a regular sleep schedule (on weekends too).
Set fixed waking and sleep times to establish a more robust sleep–wake cycle.
For better sleep, ensure your bedroom is dark, quiet, and cool (16-18°C is optimal).
Limit the amount of light exposure in the hours before bedtime (including light from phones, laptops, TVs, etc).
Limit caffeine to the morning and afternoon. This means no energy drinks during those night-time gaming sessions).
For some people, drinking red wine even in small amounts causes a headache, which typically occurs within 30 minutes to three hours after drinking as little as a small glass of wine. Researchers have examined why this happens – even to people who don’t get headaches when drinking small amounts of other alcoholic beverages. In their work, published in the journal Scientific Reports, the researchers posit that a flavanol found naturally in red wines can interfere with the proper metabolism of alcohol and can lead to a headache.
The headache culprit: Quercetin, a flavanol
This flavanol is called quercetin and it is naturally present in all kinds of fruits and vegetables, including grapes. It’s considered a healthy antioxidant and is even available in supplement form. But when metabolized with alcohol, it can be problematic.
“When it gets in your bloodstream, your body converts it to a different form called quercetin glucuronide,” said wine chemist and corresponding author Andrew Waterhouse, professor emeritus with the UC Davis Department of Viticulture and Enology. “In that form, it blocks the metabolism of alcohol.”
Acetaldehyde toxin buildup leads to flushing, headache, nausea
As a result, people can end up accumulating the toxin acetaldehyde, explains lead author Apramita Devi, postdoctoral researcher with the UC Davis Department of Viticulture and Enology.
“Acetaldehyde is a well-known toxin, irritant and inflammatory substance,” said Devi. “Researchers know that high levels of acetaldehyde can cause facial flushing, headache and nausea.”
The medication disulfiram prescribed to alcoholics to prevent them from drinking causes these same symptoms. Waterhouse said that’s because the drug also causes the toxin to build up in the body when normally an enzyme in the body would break it down. About 40% of the East Asian population also has an enzyme that doesn’t work very well, allowing acetaldehyde to build up in their system.
“We postulate that when susceptible people consume wine with even modest amounts of quercetin, they develop headaches, particularly if they have a preexisting migraine or another primary headache condition,” said co-author Morris Levin, professor of neurology and director of the Headache Center at the University of California, San Francisco. “We think we are finally on the right track toward explaining this millennia-old mystery. The next step is to test it scientifically on people who develop these headaches, so stay tuned.”
Sunlight increases headache-causing flavanol in grapes
Waterhouse said levels of this flavanol can vary dramatically in red wine.
“Quercetin is produced by the grapes in response to sunlight,” Waterhouse said. “If you grow grapes with the clusters exposed, such as they do in the Napa Valley for their cabernets, you get much higher levels of quercetin. In some cases, it can be four to five times higher.”
Levels of quercetin can also differ depending on how the wine is made, including skin contact during fermentation, fining processes and aging.
Clinical trial on wine headaches
Scientists will next compare red wines that contain a lot of quercetin with those that have very little to test their theory about red wine headaches on people. This small human clinical trial, funded by the Wine Spectator Scholarship Foundation, will be led by UCSF.
Researchers said there are still many unknowns about the causes of red wine headaches. It’s unclear why some people seem more susceptible to them than others. Researchers don’t know if the enzymes of people who suffer from red wine headaches are more easily inhibited by quercetin or if this population is just more easily affected by the buildup of the toxin acetaldehyde.
“If our hypothesis pans out, then we will have the tools to start addressing these important questions,” Waterhouse said.
Photo by Sora Shimazaki: https://www.pexels.com/photo/diverse-anonymous-colleagues-shaking-hands-at-table-with-coffee-and-folders-5673475/
As various players in South Africa’s health arena give input into the National Health Insurance, and the form it should take, they are agreed on one thing: its goal to achieve quality universal healthcare for all South Africans.
The recent COVID-19 vaccine rollout is a good foretaste of what is possible for South Africa’s healthcare system through the power of cross-sectoral collaboration – and a great case study for health systems strengthening in other countries too.
The rollout saw the public and private sectors, trade unions and community organisations pooling their resources and expertise to get the vaccines to South Africans as fast as possible, and the campaign showed that the country has the resources and expertise to provide a better, more equitable healthcare service.
The question is how we take these lessons and embed them in a healthcare system that serves all of a country’s citizens, and does so in a sustainable way, while adhering to best practice standards.
The clear answer is through the power of partnership – which has been demonstrated to work both here and in the rest of the developing world. Promoting public-private partnerships (PPPs), can accelerate access and distribution of innovative medications. By working together, government, originator companies, and funders can ensure that patients benefit from the latest advancements in healthcare.
Rwanda, for instance, has made significant progress in managing non-communicable diseases (NCDs) through community-based health insurance schemes. Brazil has successfully implemented a comprehensive primary healthcare approach. These countries have prioritised prevention, early detection, and treatment of NCDs, which can be adapted to the South African context.
Locally implemented initiatives under the global Making More Health (MMH) programme include training community health workers to provide primary care services, supporting local entrepreneurs in developing innovative healthcare solutions, and partnering with NGOs to improve access to healthcare in rural areas. These initiatives have helped address complex healthcare issues by empowering local communities and leveraging local resources.
MMH is a social initiative from Boehringer Ingelheim in collaboration with Ashoka, which combines business and social values to unleash innovation and achieve economic and social progress in healthcare. The objective of this long-term initiative is to source social innovation around the world, to explore unconventional partnerships and business models, and to encourage Boehringer Ingelheim employees.
We must also turn our attention to NCDs, which are a major health threat. The WHO estimates that globally, they are responsible for 74% of all deaths. Research into South Africa’s NCD states can play a crucial role in health systems strengthening by identifying the most prevalent diseases, understanding their risk factors, and informing evidence-based policies and interventions. This would help target resources more effectively and improve health outcomes.
This requires robust health data, hosted on a digital infrastructure, which would promote data-sharing among healthcare providers, and encourage the use of standardised data collection methods. This would help create a more accurate picture of the population’s health needs and enable better decision-making across the entire health ecosystem.
We also need to make sure we retain our world-class doctors, and address our critical nursing shortage – it’s estimated we need about 26 000 additional nurses to fill the gap. Without sufficient personnel to deliver healthcare, all the best intentions in the world will not deliver universal health coverage.
We must invest in improving the working conditions and incentives for healthcare professionals in the public sector, strengthen primary healthcare services, and promote collaboration between public and private providers. This would help to ensure that the expertise and experience of these professionals is effectively employed to benefit the broader population.
Moreover, increased collaboration with innovator companies in the private sector, many of whom are already involved in initiatives to strengthen the health system, would ensure patients receive the right treatment while expanding reach across the entire population. This would help tackle inefficiencies, streamline processes, and enable better resource allocation.
The fundamentals of health system strengthening in South Africa include adequate financing, a well-trained and motivated healthcare workforce, efficient supply chain management, and strong governance and leadership. Addressing these gaps – through partnership and collaboration – would help build a more resilient and responsive healthcare system and ensure that South African citizens have access to better healthcare.
Dependence on pain medication is on the rise due to lack of vigilance by medical professionals, according to a new study from the University of Surrey. In the paper published in the journal Pain and Therapy, patients dependent on pain medication describe feelings of ‘living in a haze’ and being ignored and misunderstood by the medical profession.
In the first study of its kind in the UK, Louise Norton and Dr Bridget Dibb from the University of Surrey investigated the experiences of patients dependent on medication for chronic pain. Pharmacological treatment for chronic pain usually involves potentially addictive substances such as non-steroidal anti-inflammatory drugs, gabapentinoids, and opioids. Increased prescription levels of such pain relief medications have been associated with heightened levels of overdose and misuse.
Dr Bridget Dibb, Senior Lecturer in Health Psychology at the University of Surrey, said: “An increasing number of people are experiencing chronic pain, which can interfere with their daily life and lead to depression and anxiety. Medication can help alleviate pain and return a sense of normalcy to a person’s life; however, there is a risk of dependence, which can potentially cause damage to vital organs, including the liver and kidneys.
“The first step to tackle this problem is to learn more about a person’s experience, how they perceive their dependence and how they interact with others, including the medical profession.”
To learn more, interviews were carried out with nine participants who had become dependent on pain medication. Participants spoke about how their dependence on pain medication resulted in them feeling not fully present and removed from their lives due to the side effects of the treatment. Many also expressed frustration about the lack of alternative treatment options available on the NHS to manage their pain, with medications being too readily prescribed.
The majority of participants also spoke about their negative interactions with medical professionals, with some attributing the cause of their dependence on them. Many believed a lack of continuity between doctors led to missed opportunities in spotting their dependence, enabling it to continue.
Louise Norton added: “Relationships with medical professionals substantially affect the experiences of those with painkiller dependence. Doctors can often be seen as authority figures due to their expertise and so patients may be apprehensive to question their treatment options. However, through providing patients with thorough information, doctors can enable more shared-decision making in which patients feel better supported and equipped to manage their chronic pain.”
Researchers noted participants felt stigmatised when speaking with others about their dependence due to a lack of understanding about their reliance to prescribed pain medications. Such interactions left participants feeling ashamed and critical of themselves.
Dr Dibb added: “Those with a dependence on prescription painkillers not only have to navigate their reliance on the medication but the shame and guilt associated with such a need. Combining this with feelings of being misunderstood and ignored by medical professionals, they have a lot of emotional needs to be managed alongside their physical pain. To prevent this from happening medical professionals need to be more vigilant when prescribing medication and ensure that their patients are fully aware of the risk of dependence before they begin treatment.”
Women have long been known to outlive men. But new research published in JAMA Internal Medicine shows that, at least in the United States, the gap has been widening for more than a decade. Among the factors driving the trend are the COVID pandemic and the opioid overdose epidemic.
The study, led by UC San Francisco and Harvard T.H. Chan School of Public Health, found the difference between how long American men and women live increased to 5.8 years in 2021, the largest since 1996. This is an increase from 4.8 years in 2010, when the gap was at its smallest in recent history.
The pandemic, which took a disproportionate toll on men, was the biggest contributor to the widening gap from 2019–2021, followed by unintentional injuries and poisonings (mostly drug overdoses), accidents and suicide.
“There’s been a lot of research into the decline in life expectancy in recent years, but no one has systematically analysed why the gap between men and women has been widening since 2010,” said the paper’s first author, Brandon Yan, MD, MPH, a UCSF internal medicine resident physician and research collaborator at Harvard Chan School.
Life expectancy in the US dropped in 2021 to 76.1 years, falling from 78.8 years in 2019 and 77 years in 2020.
The shortening lifespan of Americans has been attributed in part to so-called “deaths of despair.” The term refers to the increase in deaths from such causes as suicide, drug use disorders and alcoholic liver disease, which are often connected with economic hardship, depression and stress.
“While rates of death from drug overdose and homicide have climbed for both men and women, it is clear that men constitute an increasingly disproportionate share of these deaths,” Yan said.
Interventions to reverse a deadly trend
Using data from the National Center for Health Statistics, Yan and fellow researchers from around the country identified the causes of death that were lowering life expectancy the most. Then they estimated the effects on men and women to see how much different causes were contributing to the gap.
Prior to the COVID pandemic, the largest contributors were unintentional injuries, diabetes, suicide, homicide and heart disease.
But during the pandemic, men were more likely to die of the virus. That was likely due to a number of reasons, including differences in health behaviours, as well as social factors, such as the risk of exposure at work, reluctance to seek medical care, incarceration and housing instability. Chronic metabolic disorders, mental illness and gun violence also contributed.
Yan said the results raise questions about whether more specialised care for men, such as in mental health, should be developed to address the growing disparity in life expectancy.
“We have brought insights to a worrisome trend,” Yan said. “Future research ought to help focus public health interventions towards helping reverse this decline in life expectancy.”
Yan and co-authors, including senior author Howard Koh, MD, MPH, professor of the practice of public health leadership at Harvard Chan School, also noted that further analysis is needed to see if these trends change after 2021.
“We need to track these trends closely as the pandemic recedes,” Koh said. “And we must make significant investments in prevention and care to ensure that this widening disparity, among many others, do not become entrenched.”
