Year: 2024

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Syphilis had its Roots in the Americas

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Electron micrograph imagery of Treponema pallidum, the bacteria that cause syphilis, including a foreground close-up of a single particle (right). Spiral-shaped bacteria are colourised in gold. Credit: NIAID

A research team led by members of the Max Planck Institute for Evolutionary Anthropology has taken a crucial step towards resolving a long-standing controversy – was syphilis introduced to Europe from the Americas at the end of the 15th century, or had it been there all along? Ancient pathogen genomes from skeletons that pre-date 1492 confirm its introduction from the Americas, but its world-wide spread remains a grim legacy of the colonial period. 

In spring 1495, the Italian campaign of Charles VIII of France was interrupted by an intense outbreak of an apparently unknown illness – a disease of high mortality that quickly engulfed the whole of Europe and left its survivors with life changing impairments to their bodies and minds. This documented epidemic is now interpreted to be the first historical account of syphilis.

The origin of syphilis is the subject of a decades-long debate. The late 15th century outbreak occurred shortly after the return of Columbus and his crew from their early expeditions to the Americas, which led some to believe that contact with new lands and people may have had something to do with the sudden disease onset. Though many communicable diseases made a westward journey from Europe to the Americas during the early colonial period where they imparted devastating consequences on indigenous groups, syphilis is one of the few that possibly made the reverse journey.

This “Columbian theory” for syphilis has gained popularity over the years, but still has its critics. Its simple narrative starts to unravel when experts turn their attention to lesions seen in bones from Mediaeval Europe. Both long-term sufferers and those born with an infection can develop changes in their bones or teeth, and over the past several decades, a number of such skeletons have been found in Europe that predate 1492. Many now believe the history of syphilis in Europe began long before Columbus, and the late 15th century pandemic happened for reasons independent of new contacts. But neither theory has been confirmed.

Analysing five ancient pathogen genomes

Pathogen DNA retrieved from archaeological bone has the potential to tip the scales in support of one theory over another. It has already told us volumes about the deep history of plague, tuberculosis, leprosy, and smallpox, though unthreading the history of syphilis has proven more challenging. “Several genomes from the syphilis family have been reconstructed from archaeological bone, but these haven’t been able to address core questions related to the pre- or post-Columbian theories surrounding syphilis”, says Kirsten Bos, group leader for molecular paleopathology at the Max Planck Institute for Evolutionary Anthropology.

A new study led by Bos and Johannes Krause, director of the Department of Archaeogenetics at the Max Planck Institute for Evolutionary Anthropology in Leipzig, has taken a critical step toward resolving this debate. Working with scientists and archaeologists from several countries in the Americas, the study focused on archaeological bone from these regions, where infections that left lesion patterns similar to syphilis are apparent from deep time periods. It is published in Nature.

“We’ve known for some time that syphilis-like infections occurred in the Americas for millennia, but from the lesions alone it’s impossible to fully characterise the disease”, comments Casey Kirkpatrick, a postdoctoral researcher and paleopathologist who contributed to the current study. Bone pathology also cannot tell us whether the disease originated in the Americas, or if it came from Asia deep in our past and merely accompanied groups during the early peopling events of the Americas some 15000 years ago. 

Using state of the art techniques, the team was able to recover and analyse five ancient genomes of the syphilis disease family from Mexico, Chile, Peru, and Argentina. Computational microbiologist and postdoctoral researcher Lesley Sitter undertook the task of putting together the ancient molecular puzzles and adds “while preservation posed some analytical challenges, we were able to confidently determine the relationships between these extinct forms and the strains that impact global health today”.

Syphilis family of diseases in the Americas pre-dates “Columbus”

Syphilis is part of a small family of diseases that also includes yaws and bejel, both classified as neglected tropical diseases that are found in equatorial regions across the globe. Postdoctoral researcher Rodrigo Barquera has worked previously with archaeological bone from colonial Mexico, and has confirmed the presence of both syphilis and yaws in Mexico City by the 17th century.

Drawing upon the latest ancient genomic data, it is now clear that the Americas were a hub for ancient diversity within this disease group before the arrival of Columbus. “We see extinct sister lineages for all known forms of this disease family, which means syphilis, yaws, and bejel are the modern legacies of pathogens that once circulated in the Americas”, asserts Barquera.

“The data clearly support a root in the Americas for syphilis and its known relatives, and their introduction to Europe starting in the late 15th century is most consistent with the data”, adds Bos. Subsequent to this, an explosion in cases of syphilis and yaws seems to have occurred around AD 1500. This is likely behind the breadth and intensity of the 16th century outbreak in Europe, whose global spread was facilitated by human trafficking networks and European expansions across the Americas and Africa in the decades and centuries that followed. “While indigenous American groups harboured early forms of these diseases, Europeans were instrumental in spreading them around the world,” she concludes.

With support for an American origin of syphilis, how does the current narrative square up with the evidence of syphilis-like bone lesions that many claim to have identified in pre-1492 Europe?  “The search will continue to define these earlier forms, and ancient DNA will surely be a valuable resource”, comments Krause.  “Who knows what older related diseases made it around the world in humans or other animals before the syphilis family appeared.”

Source: Max Planck Institute for Evolutionary Anthropology

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Study Likely to Change Standard of Care for Deadly Vertebrobasilar Stroke

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Ischaemic and haemorrhagic stroke. Credit: Scientific Animations CC4.0

Endovascular therapy (EVT), a minimally invasive surgery performed inside the blood vessels, is 2 ½ times more likely than standard medical management to achieve a positive outcome after vertebrobasilar stroke that affects the back of the brain, including the brain stem. A meta-analysis of four randomised clinical trials, published in The Lancet, was led by UPMC Stroke Institute director Raul Nogueira, MD.

Investigators from the US, Netherlands and China formed a multi-centre collaboration of all four randomised trials of EVT in vertebrobasilar occlusion with data that provides the strongest evidence to date of the benefits of EVT over alternative approaches for complicated vessel obstructions in life-sustaining areas of the brain.

Although vertebrobasilar artery occlusions interrupting blood flow in the back of the brain account for only a small fraction of all ischaemic strokes, they are especially deadly. Without an appropriate intervention, vertebrobasilar strokes lead to high rates of severe disability and mortality that may exceed 70%.

“While the overwhelming benefit of EVT for acute ischaemic strokes due to occlusions of large vessels that supply the anterior brain has been well established, the benefit of this therapy for vertebrobasilar artery occlusion, one of the most devastating forms of stroke, has been more controversial,” said Nogueira, endowed professor of neurology and neurosurgery at the University of Pittsburgh.

To address this uncertainty, the consortium of investigators, called VERITAS, focused on providing more precise, comprehensive and statistically powered estimates of the benefits of EVT with a particular focus on specific patient subgroups of clinical interest.

As the primary coordinating centre for the study, the Pitt team established common variables, definitions and trial specifications that laid the groundwork for a core pooled dataset from the four randomised controlled clinical trials ATTENTION, BAOCHE, BASICS and BEST of EVT for stroke due to vertebrobasilar artery occlusion.

Meta-analysis showed that at three months after the surgery, despite higher rates of brain bleeds with the procedure, EVT significantly reduced patient mortality and overall post-stroke disability, increasing patients’ functional independence. Notably, patients who underwent EVT were nearly 2 ½ times more likely to regain their ability to walk independently compared to patients who received the current medical standard of care, including intravenous thrombolytics.

“The results of the VERITAS collaboration are expected to influence treatment guidelines and impact stroke care globally,” Nogueira said. “We hope that this analysis sets the foundation for improved recovery after vertebrobasilar strokes and helps more people regain their independence after this catastrophic medical event.”

Source: University of Pittsburgh

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How Processing Depletes the Nutrients in Milk Substitutes

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Photo by Pixabay on Pexels

A University of Copenhagen study of plant-based drinks reveals a common issue: they are lacking in proteins and essential amino acids compared to cow’s milk. The explanation lies in their extensive processing, causing chemical reactions that degrade protein quality in the product and, in some cases, produce new substances of concern.

Over the last decade, the global market for plant-based beverages has seen remarkable growth, with oat, almond, soy and rice drinks emerging as popular alternatives to cow’s milk in coffee and oatmeal during this time.

One of the likely reasons for millions of litres of plant-based drinks ending up in the shopping baskets of consumers is that their climate footprint is often lower than that of cow’s milk. But consumers would be mistaken if they considered plant-based beverages healthier than cow’s milk. This is highlighted in a new study conducted by the University of Copenhagen in collaboration with the University of Brescia, Italy.

In the study, published in Food Research International, researchers examined how chemical reactions during processing affect the nutritional quality of ten different plant-based drinks, comparing them with cow’s milk. The overall picture is clear:

“We definitely need to consume more plant-based foods. But if you’re looking for proper nutrition and believe that plant-based drinks can replace cow’s milk, you’d be mistaken,” says Department of Food Science professor Marianne Nissen Lund, the study’s lead author.

Long shelf life at the expense of nutrition

While milk is essentially a finished product when it comes out of a cow, oats, rice, and almonds require extensive processing during their conversion to a drinkable beverage. Moreover, each of the plant-based drinks tested underwent Ultra High Temperature (UHT) treatment, a process that is widely used for long-life milks around the world. In Denmark, milk is typically found only in the refrigerated sections of supermarkets and is low-pasteurized, meaning that it receives a much gentler heat treatment. 

“Despite increased plant-based drink sales, cow milk sales remain higher. Consequently, plant-based drinks undergo more intense heat treatments than the milk typically sold in Denmark, in order to extend their shelf life. But such treatment comes at a cost,” says Marianne Nissen Lund.

UHT treatment triggers a so-called “Maillard reaction”, a chemical reaction between protein and sugar that occurs when food is fried or roasted at high temperatures. Among other things, this reaction impacts the nutritional quality of the proteins in a given product.

“Most plant-based drinks already have significantly less protein than cow’s milk. And the protein, which is present in low content, is then additionally modified when heat treated. This leads to the loss of some essential amino acids, which are incredibly important for us. While the nutritional contents of plant-based drinks vary greatly, most of them have relatively low nutritional quality,” explains the professor.

For comparison, the UHT-treated cow’s milk used in the study contains 3.4 grams of protein per liter, whereas 8 of the 10 plant-based drinks analyzed contained between 0.4 and 1.1 grams of protein. The levels of essential amino acids were lower in all plant-based drinks. Furthermore, 7 out of 10 plant-based drinks contained more sugar than cow’s milk.

Heat treatment may produce carcinogens

Besides reducing nutritional value, heat treatment also generates new compounds in plant-based drinks. One such compound measured by the researchers in four of the plant-based drinks made from almonds and oats is acrylamide, a carcinogen that is also found in bread, cookies, coffee beans and fried potatoes, including French fries.

“We were surprised to find acrylamide because it isn’t typically found in liquid food. One likely source is the roasted almonds used in one of the products. The compound was measured at levels so low that it poses no danger. But, if you consume small amounts of this substance from various sources, it could add up to a level that does pose a health risk,” says Marianne Nissen Lund.

Additionally, the researchers detected α-dicarbonyl compounds and hydroxymethylfurfural (HMF) in several of the plant-based drinks. Both are reactive substances that could potentially be harmful to human health when present in high concentrations, although this is not the case here.

While professor of nutrition Lars Ove Dragsted is not particularly concerned about the findings either, he believes that the study highlights how little we know about the compounds formed during food processing:

“The chemical compounds that result from Maillard reactions are generally undesirable because they can increase inflammation in the body. Some of these compounds are also linked to a higher risk of diabetes and cardiovascular diseases. Although our gut bacteria break down some of them, there are many that we either do not know of or have yet to study,” says Lars Ove Dragsted of the Department of Nutrition, Execercise and Sports.

Professor Dragsted adds: “This study emphasizes why more attention should be paid to the consequences of Maillard reactions when developing plant-based foods and processed foods in general. The compounds identified in this study represent only a small fraction of those we know can arise from Maillard reactions.”

Make Your Own Food

According to Professor Marianne Nissen Lund, the study highlights broader issues with ultra-processed foods: 

“Ideally, a green transition in the food sector shouldn’t be characterized by taking plant ingredients, ultra-process them, and then assuming a healthy outcome. Even though these products are neither dangerous nor explicitly unhealthy, they are often not particularly nutritious for us either.”

Her advice to consumers is to: “generally opt for the least processed foods and beverages, and to try to prepare as much of your own food as possible. If you eat healthy to begin with, you can definitely include plant-based drinks in your diet – just make sure that you’re getting your nutrients from other foods.”

At the same time, Professor Lund hopes that the industry will do more to address these issues:
“This is a call to manufacturers to further develop their products and reconsider the extent of processing. Perhaps they could rethink whether UHT treatment is necessary or whether shorter shelf lives for their products would be acceptable.”

Source: University of Copenhagen

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Researchers Develop New Test for Early Osteoarthritis Diagnosis

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Photo by Mehmet Turgut Kirkgoz on Unsplash

Diagnosing osteoarthritis often occurs in the late stages when cartilage degradation is severe, making it difficult to distinguish it from other types of arthritis and to determine the best treatment plan. In work published in the Journal of Orthopaedic Research, investigators have developed and tested a new diagnostic test that uses two markers found in the synovial fluid of patients’ joints.

After assessing levels of cartilage oligomeric matrix protein and interleukin‐8, the team came up with an algorithm based on the ratio of these two markers and validated its efficacy in differentiating osteoarthritis from inflammatory arthritis in 171 human knee synovial fluid specimens.

“This study addresses an unmet need for objective diagnosis of osteoarthritis to improve clinical decision-making and patient outcomes,” said corresponding author Daniel Keter, BA, of CD Diagnostics, A Division of Zimmer Biomet.

Source: Wiley

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AI Developed “Beer Goggles” Looking at Knee X-rays

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Photo by Pavel Danilyuk on Pexels

Medicine, like most fields, is transforming as the capabilities of artificial intelligence expand at lightning speed. AI integration can be a useful tool to healthcare professionals and researchers, including in interpretation of diagnostic imaging. Where a radiologist can identify fractures and other abnormalities from an X-ray, AI models can see patterns humans cannot, offering the opportunity to expand the effectiveness of medical imaging.

A study led by Dartmouth Health researchers, in collaboration with the Veterans Affairs Medical Center in White River Junction, VT, and published in Nature’s Scientific Reports, highlights the hidden challenges of using AI in medical imaging research. The study examined highly accurate yet potentially misleading results – a phenomenon known as “shortcut learning.”

Using knee X-rays from the Osteoarthritis Initiative, researchers demonstrated that AI models could “predict” unrelated and implausible traits, such as whether patients abstained from eating refried beans or drinking beer. While these predictions have no medical basis, the models achieved surprising levels of accuracy, revealing their ability to exploit subtle and unintended patterns in the data.

“While AI has the potential to transform medical imaging, we must be cautious,” said Peter L. Schilling, MD, MS, an orthopaedic surgeon at Dartmouth Health’s Dartmouth Hitchcock Medical Center (DHMC) and an assistant professor of orthopaedics in Dartmouth’s Geisel School of Medicine, who served as senior author on the study. “These models can see patterns humans cannot, but not all patterns they identify are meaningful or reliable. It’s crucial to recognize these risks to prevent misleading conclusions and ensure scientific integrity.”

Schilling and his colleagues examined how AI algorithms often rely on confounding variables – such as differences in X-ray equipment or clinical site markers to make predictions – rather than medically meaningful features. Attempts to eliminate these biases were only marginally successful: the AI models would just “learn” other hidden data patterns.

The research team’s findings underscore the need for rigorous evaluation standards in AI-based medical research. Over-reliance on standard algorithms without deeper scrutiny could lead to erroneous clinical insights and treatment pathways.

“This goes beyond bias from clues of race or gender,” said Brandon G. Hill, a machine learning scientist at DHMC and one of Schilling’s co-authors. “We found the algorithm could even learn to predict the year an X-ray was taken. It’s pernicious; when you prevent it from learning one of these elements, it will instead learn another it previously ignored. This danger can lead to some really dodgy claims, and researchers need to be aware of how readily this happens when using this technique.”

“The burden of proof just goes way up when it comes to using models for the discovery of new patterns in medicine,” Hill continued. “Part of the problem is our own bias. It is incredibly easy to fall into the trap of presuming that the model ‘sees’ the same way we do. In the end, it doesn’t. It is almost like dealing with an alien intelligence. You want to say the model is ‘cheating,’ but that anthropomorphizes the technology. It learned a way to solve the task given to it, but not necessarily how a person would. It doesn’t have logic or reasoning as we typically understand it.”

To read Schilling and Hill’s study – which was also authored by Frances L. Koback, a third-year student at the Geisel School of Medicine at Dartmouth – visit bit.ly/4gox9jq.

Source: Dartmouth College

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Books Beat TV When it Comes to Brain Health

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…but is that any surprise?

Photo by Nong on Unsplash

It’s that time of the year when most of us get the chance to sit back and enjoy some well-deserved down time. But whether you reach for the TV controller, or a favourite book, your choice could have implications for your long-term brain health, say researchers at the University of South Australia who published their research in the Journals of Gerontology.

Assessing the 24-hour activity patterns of 397 older adults (aged 60+), researchers found that the context or type of activity that you engage in, matters when it comes to brain health. And specifically, that some sedentary (or sitting) behaviours are better for cognitive function than others.

When looking at different sedentary behaviours, they found that social or mentally stimulating activities such as reading, listening to music, praying, crafting, playing a musical instrument, or chatting with others are beneficial for memory and thinking abilities. Yet watching TV or playing video games are detrimental.

Researchers believe that there is likely a hierarchy of how sedentary behaviours relate to cognitive function, in that some have positive effects while others have negative effects.

It’s a valuable insight that could help reduce risks of cognitive impairment, particularly when at least 45% of dementia cases could be prevented through modifiable lifestyle factors.

In Australia, about 411,100 people (or one in every 1000 people) are living with dementia. Nearly two-thirds are women. Globally, the World Health Organization estimates that more than 55 million people have dementia with nearly 10 million new cases each year.

UniSA researcher Dr Maddison Mellow says that not all sedentary behaviours are equal when it comes to memory and thinking ability.

“In this research, we found that the context of an activity alters how it relates to cognitive function, with different activities providing varying levels of cognitive stimulation and social engagement,” Dr Mellow says.

“We already know that physical activity is a strong protector against dementia risk, and this should certainly be prioritised if you are trying to improve your brain health. But until now, we hadn’t directly explored whether we can benefit our brain health by swapping one sedentary behaviour for another.

“We found that sedentary behaviours which promote mental stimulation or social engagement — such as reading or talking with friends — are beneficial for cognitive function, whereas others like watching TV or gaming have a negative effect. So, the type of activity is important.

“And, while the ‘move more, sit less’ message certainly holds true for cardiometabolic and brain health, our research shows that a more nuanced approach is needed when it comes to thinking about the link between sedentary behaviours and cognitive function.”

Now, as the Christmas holidays roll around, what advice do researchers have for those who really want to indulge in a myriad of Christmas movies or a marathon of Modern Family?

“To achieve the best brain health and physical health benefits, you should prioritise movement that’s enjoyable and gets the heart rate up, as this has benefits for all aspects of health,” Dr Mellow says.

“But even small five-minute time swaps can have benefits. So, if you’re dead set on having a Christmas movie marathon, try to break up that time with some physical activity or a more cognitively engaged seated activity, like reading, at some point. That way you can slowly build up healthier habits.”

Source: University of South Australia

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What is the Drug Captagon and How is it Linked to Syria’s Fallen Assad Regime?

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Nicole Lee, Curtin University

After the fall of the al-Assad regime in Syria, large stockpiles of the illicit drug captagon have reportedly been uncovered.

The stockpiles, found by Syrian rebels, are believed to be linked to al-Assad military headquarters, implicating the fallen regime in the drug’s manufacture and distribution.

But as we’ll see, captagon was once a pharmaceutical drug, similar to some of the legally available stimulants we still use today for conditions including attention-deficit hyperactivity disorder (ADHD).

Captagon was once a pharmaceutical

Captagon is the original brand name of an old synthetic pharmaceutical stimulant originally made in Germany in the 1960s. It was an alternative to amphetamine and methamphetamine, which were both used as medicines at the time.

The drug has the active ingredient fenethylline and was initially marketed for conditions including ADHD and the sleeping disorder narcolepsy. It had a similar use to some of the legally available stimulants we still use today, such as dexamphetamine.

Captagon has similar effects to amphetamines. It increases dopamine in the brain, leading to feelings of wellbeing, pleasure and euphoria. It also improves focus, concentration and stamina. But it has a lot of unwanted side effects, such as low-level psychosis.

The drug was originally sold mostly in the Middle East and parts of Europe. It was available over the counter (without a prescription) in Europe for a short time before it became prescription-only.

It was approved only briefly in the United States before becoming a controlled substance in the 1980s, but was still legal for the treatment of narcolepsy in many European countries until relatively recently.

According to the International Narcotics Control Board pharmaceutical manufacture of Captagon had stopped by 2009.

The illicit trade took over

The illegally manufactured version is usually referred to as captagon (with a small c). It is sometimes called “chemical courage” because it is thought to be used by soldiers in war-torn areas of the Middle East to help give them focus and energy.

For instance, it’s been reportedly found on the bodies of Hamas soldiers during the conflict with Israel.

Its manufacture is relatively straightforward and inexpensive, making it an obvious target for the black-market drug trade.

Black-market captagon is now nearly exclusively manufactured in Syria and surrounding countries such as Lebanon. It’s mostly used in the Middle East, including recreationally in some Gulf states.

It is one of the most commonly used illicit drugs in Syria.

A recent report suggests captagon generated more than US$7.3 billion in Syria and Lebanon between 2020 and 2022 (about $2.4 billion a year).

What we know about illicit drugs generally is that any seizures or crackdowns on manufacturing or sale have a very limited impact on the drug market because another manufacturer or distributor pops up to meet demand.

So in all likelihood, given the size of the captagon market in the Middle East, these latest drug discoveries and seizures are likely to reduce manufacture only for a short time.

Nicole Lee, Adjunct Professor at the National Drug Research Institute (Melbourne based), Curtin University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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Momentum Health: Pioneering Public-Private Partnerships for Universal Health Coverage

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Dr Ali Hamdulay, Chief Executive Officer (CEO) of Metropolitan Health, a subsidiary of Momentum Health

As we commemorate Universal Health Coverage (UHC) Day on Thursday, 12 December 2024, it is essential to reflect on the progress made in advancing healthcare access and quality in South Africa. Universal health coverage means ensuring that all individuals and communities receive the health services they need without facing economic barriers. In the South African context, this involves addressing the disparities in our healthcare sectors and ensuring that every citizen, regardless of their financial or social status, has equitable access to quality care.

In South Africa, a large portion of the population lacks medical protection cover, underscoring the urgent need for affordable healthcare solutions. Employed and insured individuals seek comprehensive yet affordable healthcare, while the employed but uninsured (6 to 8 million) face financial strain accessing quality care. Workers in the informal sector and SMEs often lack medical cover too, exposing them to significant out-of-pocket expenses. Those unable to afford any medical funding rely heavily on overburdened public healthcare facilities, highlighting the necessity for accessible and inclusive universal healthcare across all economic groups.

For over 60 years, South Africa’s healthcare sector has been characterised by a dual system of providers. Government has invested heavily in healthcare infrastructure and services and has made notable strides in improving access to quality healthcare. However, there is a significant opportunity for greater collaboration and meaningful partnerships within South Africa’s healthcare sector, focused on developing solutions that cater to the diverse needs of the population.

The healthcare ecosystem relies on the interdependence of various role players, including healthcare professionals, facilities, funders, administrators and government entities. Each of these contributors play a crucial role in ensuring the health and wellbeing of every citizen.

For the system to be sustainable, we must understand, recognise and cater to the unique contributions and requirements of each role player. This approach is vital for maintaining service continuity, quality, and access to necessary healthcare services through collaboration. Effective partnerships across these functions are critical to the success of the healthcare ecosystem.

To address the needs of low-income earners who are privately employed but uninsured, Momentum Health launched Health4Me, a healthcare insurance product that enables employer groups to provide affordable healthcare cover to those who might not otherwise be able to afford it. Our approach goes beyond merely paying claims; we focus on promoting health, wellbeing, and productivity, ultimately enhancing quality of life. This is achieved through primary healthcare facilities, technology, and incentivising wellbeing. The rapid growth of this healthcare insurance solution speaks to its success and its impact on offering more healthcare for more South Africans, for less. By expanding access to universal healthcare through primary healthcare, technological capabilities, and healthcare-strengthening initiatives, there are opportunities to collaborate and address the needs of additional population cohorts.

Through our vast experience in the design and management of healthcare solutions, we have learned valuable lessons that enable us to effectively collaborate across sectors. One of the critical lessons is the importance of clear communication and defined roles for all stakeholders involved in working towards establishing universal healthcare access. Successful partnerships have demonstrated that when goals are aligned across sectors to achieve a common objective, such as improving patient outcomes, success is possible.

As such, the success of creating a healthcare sector that ensures access for all hinges on flexibility and adaptability. The healthcare landscape is constantly evolving, and partnerships must be adaptable to address new challenges and opportunities. This includes being open to innovative solutions and technologies that can enhance service delivery and patient care.

Healthcare is essential not only for individuals and households, but also as a cornerstone of the economy. Without a healthy workforce, productivity declines, leading to far-reaching ripple effects on business sustainability. In this evolving landscape, preventative measures, therefore, become increasingly important. Providing wellness programmes that support both the mental and physical wellbeing of employees is crucial. Equally important is equipping healthcare consumers with the tools and knowledge to understand and improve their health status.

By investing in community health programmes and early interventions, we can address health issues before they escalate, easing the burden on healthcare systems. Collaboration across sectors can significantly increase access to preventative care by leveraging the resources and expertise of both sectors. Integrating preventative care into primary healthcare shifts the focus from reactive to proactive care.

It is advantageous to focus on co-creating platforms and mutually solving for the needs of our population through collaboration. This approach fosters consistency in service delivery and builds trust between entities. Metropolitan Health, a subsidiary of Momentum Health, has demonstrated its commitment to health strengthening by supporting leadership and professional development through its partnership with the National School of Government. By sharing and imparting knowledge, we are supporting the education and empowerment of future healthcare leaders through regular joint training and capacity-building programmes. This further improves collaboration by fostering a culture of continuous learning and development.

Building on these collaborative efforts, innovative models such as health hubs can further enhance healthcare delivery. These hubs combine offerings from both sectors, providing a range of services from primary care to specialised treatments under one roof. Telehealth is another innovative approach that has shown great promise. By utilising digital platforms, we can extend healthcare services to remote and underserved areas, ensuring that more people have access to quality care.

While effective collaboration is key to providing access to quality healthcare for more people, success cannot be achieved without fostering an environment that encourages innovation and supports conducive partnership development. By creating a more enabling environment, we can facilitate smoother collaboration and attract more private sector investment in healthcare.

Looking towards 2025, the vision for healthcare in South Africa is one of greater access, integration, and collaboration. By working together, we can create a more resilient and responsive healthcare system that meets the needs of all citizens. I envision the future of healthcare delivery as one that drives innovation and improves access to care. By leveraging partnerships and co-creation, I believe we can make significant strides towards achieving universal health coverage and ensure that no one is left behind.

Categories : Ageing CancerTags :

Cancer Risk Declines in Old Age – New Research Helps Explain Why

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When it comes to cancer, aging is a double-edged sword, researchers are increasingly learning. Age is considered the most important risk factor for cancer, due to the buildup of genetic mutations over time.

Now a study from researchers at Memorial Sloan Kettering Cancer Center (MSK) and their collaborators provides new evidence about how advanced age can also be protective against cancer. The study, conducted in a mouse model of lung cancer, was published in Nature.

“We know that as people get older, they’re more likely to get cancer,” says study first author Xueqian Zhuang, PhD, postdoc in the lab of senior study author Tuomas Tammela, PhD. “But there’s still a lot that’s unknown about how aging actually changes the biology of cancer.”

As with many types of cancer, lung cancer is diagnosed in most people around age 70, Dr Zhuang says. But once you get to 80 or 85, the incidence rate starts to come down again.

“Our research helps show why,” she adds. “Aging cells lose their capacity for renewal and therefore for the runaway growth that happens in cancer.”

Overall, the findings have two key implications, the researchers say:

  • First, they point to the underappreciated role that iron plays in aging cells’ ability to regenerate — suggesting that therapies that target iron metabolism may work better in younger people than older ones.
  • Second, they underline the potential value of early intervention and prevention efforts, targeting the window when most cancers initiate.

Cells’ regeneration ability linked to iron metabolism

To investigate why cancer incidence peaks in the early senior years and then starts to decline again, the MSK research team studied a genetically modified mouse model of lung adenocarcinoma, a common type of lung cancer that accounts for about 7% of all cancer deaths worldwide.

One of the things that makes it challenging to study aging in laboratory models is that mice take two years to develop to an age that’s equivalent to 65–70 years in people. The scientists found that as the mice get older, they make more of a protein called NUPR1. More NUPR1 makes the cells in the lungs function as if they are iron deficient.

“The aging cells actually have more iron, but for reasons we don’t yet fully understand, they function like they don’t have enough,” Dr Zhuang says.

Since the cells in the older mice functioned as though they didn’t have enough iron, they lost some of their ability to regenerate. And because that regenerative capacity is directly linked to the rise of cancer, the older mice developed far fewer tumours than their younger counterparts.

Intriguingly, this effect could be reversed by giving the older mice additional iron or by reducing the amount of NUPR1 in their cells.

“We think this discovery may have some immediate potential to help people,” Dr. Tammela says. “Right now, millions of people, especially following the COVID-19 pandemic, live with insufficient lung function because their lungs didn’t fully heal from an infection, or for some other reason. Our experiments in mice showed that giving iron can help the lungs regenerate, and we have really good ways of delivering drugs directly to the lungs – like asthma inhalers.”

But this is also where the double-edged nature of the discovery comes into play. By restoring the ability of the cells in the lungs to regenerate, one is also increasing the tissue’s ability to develop cancer, the study showed.

“So this type of approach might not be appropriate for people who are at a high risk of developing cancer,” he adds.

Older and younger patients may respond differently to iron-metabolism targeting treatments

The team’s findings also have important implications for therapies based on a type of cell death called ferroptosis, which is triggered by iron. Ferroptosis was discovered in 2012, and there are a number of ferroptosis-inducing small molecule compounds, as well as drugs previously approved by the FDA, that are being investigated for their potential to kill cancer cells.

Older cells are far more resistant to ferroptosis than younger cells because they function as if they don’t have enough iron, the researchers found. This means treatments that target ferroptosis may not be as effective in older patients as they are in younger ones.

“One of the things that we showed exploring all of this iron biology is that ferroptosis is tumour suppressive, as everybody suspected – but much more profoundly in younger animals,” Dr Tammela says.

Dr Zhuang adds: “To us, this says that because the biology of cells changes with aging, the sensitivity to drugs also changes. So doctors might need to really be careful in clinical trials, for example, to look at the effects in both older and younger patients.”

And for Dr Tammela, the research ultimately has an even bigger takeaway.

“What our data suggests in terms of cancer prevention is that the events that occur when we’re young are probably much more dangerous than the events that occur later,” he says. “So, preventing young people from smoking, or from tanning, or from other obvious carcinogenic exposures are probably even more important than we thought.”

Source: Memorial Sloan Kettering Cancer Center

Categories : Cardiovascular Disease ExerciseTags :

Bursts of Activity could Cut Heart Risk in Women

On By ModernMedia
Photo by Teona Swift on Unsplash

An average of four minutes of incidental vigorous physical activity a day could almost halve the risk of major cardiovascular events, such as heart attacks, for middle-aged women who do not engage in structured exercise, according to new research from the University of Sydney, published in the British Journal of Sports Medicine.

“We found that a minimum of 1.5 minutes to an average of 4 minutes of daily vigorous physical activity, completed in short bursts lasting up to 1 minute, were associated with improved cardiovascular health outcomes in middle-aged women who do no structured exercise,” said lead author Professor Emmanuel Stamatakis, Director of the Mackenzie Wearable Hub at the Charles Perkins Centre and the Faculty of Medicine and Health.

High-intensity physical activity that forms part of a daily routine is known as “vigorous intermittent lifestyle physical activity” (VILPA). Physical activity is incidental such as walking to the shops, vs exercise, which is structured, eg going to the gym. Longer sessions of VILPA are linked to significantly lower cardiovascular disease risk.

The researchers say that, given fewer than 20% of middle-aged or older adults engage in regular structured exercise, engaging in VILPA could be a good alternative.

“Making short bursts of vigorous physical activity a lifestyle habit could be a promising option for women who are not keen on structured exercise or are unable to do it for any reason. As a starting point, it could be as simple as incorporating throughout the day a few minutes of activities like stair climbing, carrying shopping, uphill walking, playing tag with a child or pet, or either uphill or power walking,” said Professor Stamatakis.

The study drew on UK Biobank data from 22 368 participants (13 018 women) aged 40–79 who reported they did not engage in regular structured exercise and who wore physical activity trackers for almost 24 hours a day for 7 days.

Cardiovascular health was monitored through hospital and mortality records, tracking major adverse cardiovascular events (MACE), such as heart attack, stroke, and heart failure, until November 2022.

After adjusting for factors such as lifestyle, socioeconomic position, cardiovascular health, co-existing conditions, and ethnicity, the researchers found that the more VILPA women did, the lower their risk of a major cardiovascular event.

Women who averaged 3.4 minutes of VILPA daily were 45 percent less likely to experience a major cardiovascular event. They were also 51% less likely to have a heart attack and 67 percent less likely to develop heart failure than women who did no VILPA.

Even when amounts of daily VILPA were lower than 3.4 minutes they were still linked to lower cardiovascular event risk. A minimum of 1.2 to 1.6 minutes of VILPA per day was associated with a 30 percent lower risk of total major cardiovascular events, a 33 percent lower risk of heart attack, and a 40 percent lower risk of heart failure.

However, men reaped fewer benefits from tiny bursts of VILPA. Those who averaged 5.6 minutes daily were only 16% less likely to experience a major cardiovascular event compared with men who did none. A minimum of 2.3 minutes per day was associated with only an 11% risk reduction.

Professor Stamatakis said more testing was needed to understand how VILPA may improve cardiovascular health.

“To date, it hasn’t been clear whether short bursts of VILPA lower the risk of specific types of cardiovascular events, like heart attack or stroke. We aimed to identify minimum daily thresholds and feasible amounts for testing in community programs and future trials,” he said.

“Importantly, the beneficial associations we observed were in women who committed to short bursts of VILPA almost daily. This highlights the importance of habit formation, which is not always easy. VILPA should not be seen as a quick fix – there are no magic bullets for health. But our results show that even a little bit higher intensity activity can help and might be just the thing to help people develop a regular physical activity – or even exercise – habit,” he said.

For the purposes of this story, physical activity is incidental, eg carrying shopping or briefly power walking, and exercise is structured, eg going to the gym or playing sport.

Source: University of Sydney