Day: February 19, 2024

Categories : Healthcare Politics and RegulationsTags :

Worst of Hiring Freeze Over, Western Cape Health Department Assures Health Workers

On By ModernMedia

By Daniel Steyn for GroundUp

Dr Keith Cloete, head of the Western Cape Department of Health and Wellness, has told health workers in the province that the “severe and drastic measures” taken to “constrain the filling of posts” in the past three months has brought the department back within budget.

Cloete was speaking in a video update circulated to the department’s employees on Thursday. Health workers in the province have raised concerns over a “near-complete” freezing of vacant posts to curb budget cuts imposed by National Treasury.

Initial cuts to provincial budgets and conditional grants that fund hospitals were made at the start of 2023/24 and were further exacerbated by in-year cuts.

Provincial governments also had to absorb within their existing budgets a mandatory public sector wage increase. National Treasury recommended in November that provincial departments freeze hiring.

Since November, posts in the Western Cape could only be filled on approval by head office, but Cloete said in his video that those decisions will now be “decentralised” again.

Line managers may again fill vacant posts on condition that they “apply their minds” and work within “a tight framework”, said Cloete. He added that he was mindful of the impact the hiring constraints have had on services.

In January, GroundUp reported on significant staff shortages at Groote Schuur Hospital and Red Cross War Memorial Hospital. Senior hospital managers in the province complained that there had been a lack of communication from the department’s management on how long budget cuts would last and what would be done to mitigate their impact.

On 4 February, more than 1200 doctors wrote an open letter to Western Cape Premier Alan Winde, Western Cape Finance Minister Mireille Wenger and national Finance Minister Enoch Godongwana, calling for an end to “catastrophic budget cuts”.

The health workers warned that the cuts will cause surgical operations to be cancelled or postponed; patients in need of specialist medical care to wait longer; cancer treatment to be delayed and cancers diagnosed at later stages with less chance of successful treatment; and gains in neonatal, infant and paediatric care would be “reversed”, among many other issues.

In Thursday’s video update, Cloete said that the budget for the 2024/25 financial year has not yet been finalised. The final budget allocation will be tabled in the provincial legislature in early March.

Budget cuts are expected to continue into the foreseeable future. Over the next three years, the Western Cape government faces cuts amounting to R6.7-billion. According to premier Alan Winde, 37% of the province’s budget goes to healthcare.

Cloete announced that a meeting will be held with managers, clinicians and support staff “to have a discussion of how do we redesign our healthcare services across the entire system in the Western Cape” on 21 February.

“I understand anxieties that everyone will experience in this specific area. I call on everyone to please attempt to get a slightly bigger view …. And for us to do this together. Together, we can actually navigate this successfully.”

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

Source: GroundUp

Categories : CancerTags :

Extract of Sandalwood Oil Prevents Prostate Cancer Progression

On By ModernMedia
Ccancer-associated fibroplasts surrounding a prostate tumour. Credit: Moscat and Diaz Meco lab.

Extracted from the core of sandalwood trees (santalum album tree), sandalwood oil has been used for many centuries by several cultures throughout the world for perfume, soaps, incense and candles. With its earthy sweet scent, this essential oil also is used in the food industry and topically in various cosmetic preparations.

Importantly, this natural oil is known for its health benefits and medicinal applications from antibacterial to anticancer because of its phytochemical constituents. In addition to containing esters, free acids, aldehydes, ketones and santenone, sandalwood oil primarily (> 90%) constitutes santalol, equal amounts of two compounds, alpha and beta-santalol.

Now, researchers from Florida Atlantic University’s Schmidt College of Medicine and collaborators are the first to demonstrate in vivo the chemo-preventive properties of alpha-santalol against prostate cancer development using a transgenic mouse model.

Results of the study, published in the journal Phytomedicine Plus, showed that administration of alpha-santalol decreased the incidence of prostate tumours by decreasing cell proliferation and inducing apoptosis, without causing weight loss or any noticeable side effects.

Apoptosis (programmed cell death) is a method the body uses to get rid of unneeded or abnormal cells such as cancer cells. Findings revealed that the area occupied by normal tissue in alpha-santalol-treated mice was 53% compared to 12% in control mice.

This suggests that administering alpha-santalol protected the normal tissue and delayed progression from prostatic intraepithelial neoplasia, a precancerous condition, to poorly differentiated carcinoma, a high-grade form of cancer where cancer cells and tissue look very abnormal.

These results are significant because mortality in prostate cancer patients is mainly attributable to advanced stages of the disease.

In prior studies, the researchers demonstrated the efficacy of alpha-santalol in suppressing growth and inducing apoptotic cell death in cultured human prostate cancer cells.

Based on these observations, they selected a genetically engineered mouse model that resembles many features similar to human prostate cancer, eliciting different lesion grades and cancer progression.

“Although our cellular studies provided important mechanistic insights, relevant in vivo models are vital for developing novel chemo-preventive agents for clinical use and to determine if alpha-santalol offers protection against prostate cancer development,” said senior author Ajay Bommareddy, PhD, associate professor of pharmacology in the Department of Biomedical Science, FAU Schmidt College of Medicine.

“Prior to this new study, alpha-santalol’s in vivo efficacy against prostate cancer development had not yet been established.”

Additional findings of the current study showed alpha-santalol reduced the incidence of visible prostate tumors compared to control-treated mice.

Only 11% in the treated group developed prostate tumours whereas more than half in the control group developed the tumours.

The differences in urogenital and prostate weights were statistically significantly different in alpha-santalol-treated mice compared with controls.

The average wet weight of urogenital tract in alpha-santalol treated mice was about 74.28% lower compared with control mice.

Similarly, the average wet weight of the prostate gland was lower by 52.9% compared with control mice.

Current treatment methods for prostate cancer include androgen ablation, chemotherapy, radiotherapy and radical prostatectomy, but are ineffective against advanced prostate cancers.

Early detection and local therapy have resulted in improved outcomes but has been challenging with the management of advanced stages.

“Identifying agents that have the ability to selectively target cancerous cells and delay onset and progression of prostate cancer is greatly needed,” said Bommareddy.

“Additional studies are essential to systemically explore the feasibility of alpha-santalol as a promising chemo-preventive and anti-tumour agent against human prostate cancer development and to elucidate the mechanisms surrounding the role of pro-apoptotic and antiapoptotic proteins.”

Source: Florida Atlantic University

Categories : HIVTags :

New Trial Highlights Incremental Progress Towards a Cure for HIV-1

On By ModernMedia
Colourised transmission electron micrograph of an HIV-1 virus particle (yellow/gold) budding from the plasma membrane of an infected H9 T cell (purple/green).

Antiretroviral therapies (ART) stop HIV replication in its tracks, allowing people with HIV to live relatively normal lives. However, despite these treatments, some HIV still lingers inside cells in a dormant state known as “latency.” If ART is discontinued, HIV will awaken from its dormant state, begin to replicate, and cause acquired immunodeficiency syndrome (AIDS). To create a cure, researchers have been attempting to drive HIV out of latency and target it for destruction.

A new clinical trial led by Cynthia Gay, MD, MPH, associate professor of infectious diseases, David Margolis, MD, the Sarah Kenan Distinguished Professor of Medicine, Microbiology & Immunology, and Epidemiology, and other clinicians and researchers at the UNC School of Medicine suggests that a combination of the drug vorinostat and immunotherapy can coax HIV-infected cells out of latency and attack them.

The immunotherapy was provided by a team led by Catherine Bollard, MD, at the George Washington University, who took white blood cells from the study participants and expanded them in the laboratory, augmenting the cells’ ability to attack HIV-infected cells, before re-infusion at UNC.

Their results, published in the Journal of Infectious Diseases, showed a small dent on the latent reservoir, demonstrating that there is more work to be done in the field.

“We did show that this approach can reduce the reservoir, but the reductions were not nearly large enough, and statistically speaking were what we call a “trend” but not highly statistically significant,” said David Margolis, MD, director of the HIV Cure Center and senior author on the paper. “We need to create better approaches to flush out the virus and attack it when it comes out. We need to keep chipping away at the reservoir until there’s nothing there.”

DNA inside cell nuclei is kept in a tightly packed space by chromosomes, which act as highly organised storage facilities. When you unfurl a chromosome, you’ll find loop-de-loop-like fibres called chromatin. If you keep unfurling, you’ll see long strands of DNA wrapped around scaffold proteins known as histones, like beads on a string. Finally, when the unfurling is complete, you will see the iconic DNA double helix.

Vorinostat works by inhibiting a lock-like enzyme called histone deacetylase. By stopping this mechanism, tiny doors within the chromatin fibres unlock and open up, effectively “waking up” latent HIV from its slumber and making it vulnerable to an immune system attack. As a result, a tiny blip of HIV expression shows up on very sensitive molecular assays.

But the effects of vorinostat are short lived, only lasting a day per dose. For this reason, Margolis and other researchers are trying to find safe and effective ways to administer the drug and keep the chromatin channels open for longer periods of time.

For the study, six participants were given multiple doses of vorinostat. Researchers then extracted immune cells from the participants and expanded the cells that knew how to attack HIV-infected cells.

This immunotherapy method, which has been successful against other viruses such as Epstein-Barr virus and cytomegalovirus, involves giving participants back their expanded immune cells in the hopes that these cells will further multiply in number and launch an all-out attack on the newly exposed HIV-infected cells.

However, in the first part of this study, only one of the six participants saw a drop in their HIV reservoir levels. To test whether the result was simply random or something more, researchers gave three participants their usual dose of vorinostat, but introduced five times the amount of engineered immune cells. All three of the participants had a slight decline in their reservoirs.

But, statistically speaking, the results were not large enough to be definitive.

“This is not the result we wanted, but it is research that needed to be done,” said Margolis. “We are working on improving both latency reversal and clearance of infected cells, and we hope to do more studies as soon as we can, using newer and better approaches.”

Many of the participants in the study have been working with Margolis’s research team for years, sacrificing their own time and blood for research efforts. Their long-term partnership and commitment have been essential for data collection. The data, which follows the size of the viral reservoir in these people over years prior to this study, makes the small changes found more compelling.

“People living with HIV come in a couple of times a year, and we measure residual traces of virus in their blood cells, which doesn’t have any immediate benefit to them,” said Margolis. “It’s a very altruistic action and we couldn’t make any progress without their help.”

Source: University of North Carolina Health Care

Categories : Cardiovascular Disease Obstetrics & GynaecologyTags :

New Findings on Cardiovascular Risk, Menopause and Migraines Ease Concerns

On By ModernMedia
Photo by Karolina Grabowska on Pexels

Research suggesting a link between migraines and menopause symptoms and cardiovascular disease has gotten a lot of attention. But a pair of new studies in the journal Menopause suggest that most women experiencing these symptoms can rest easier, especially if they don’t have both migraines and long-term hot flashes and night sweats.

Instead, they should focus on tackling the other factors that can raise their cardiovascular risk by getting more sleep, exercise and healthy foods, quitting tobacco, and minding their blood pressure, blood sugar, cholesterol and weight.

For women who have experienced both migraines and hot flashes or night sweats over many years, one of the new studies does suggest an extra level of cardiovascular risk.

That makes heart disease and stroke prevention even more important in this group, says study leader Catherine Kim, MD, MPH, of the University of Michigan.

And for women currently in their 20s and 30s who experience migraines, the new research suggests that they might be heading for a higher risk of long-term menopause-related symptoms when they get older.

Long-term study yields important insights

Kim and her colleagues at Michigan Medicine, U-M’s academic medical centre, published the new pair of studies based on an in-depth analysis of data from a long-term study of more than 1900 women who volunteered to have regular physical exams and blood tests, and to take yearly health surveys, when they were in their late teens to early 30s.

Those women, now in their 50s and 60s, have provided researchers with a priceless view of what factors shape health in the years leading up to menopause and beyond, through their continued participation in the CARDIA study.

“The anxiety and dread that women with migraines and menopausal symptoms feel about cardiovascular risk is real – but these findings suggest that focusing on prevention, and correcting unhealthy habits and risk factors, could help most women,” said Kim, who is an associate professor of internal medicine at U-M and a primary care physician.

“For the subgroup with both migraines and early persistent hot flashes and night sweats, and for those currently experiencing migraines in their early adulthood, these findings point to an added need to control risks, and address symptoms early,” she adds.

Just over 30% of the middle-aged women in the study reported they had persistent hot flashes and night sweats, which together are called vasomotor symptoms or VMS because they relate to changes in the diameter of blood vessels.

Of them, 23% had reported also having migraines. This was the only group for whom Kim and her colleagues found extra risk of stroke, heart attack or other cardiovascular events that couldn’t be explained by other risk factors that have long been known to be linked to cardiovascular problems.

In addition to those with persistent vasomotor symptoms starting in their 40s or before, 43% of the women in the study had minimal levels of such symptoms in their 50s, and 27% experienced an increase in VMS over time into their 50s and early 60s.

The latter two groups had no excess cardiovascular risk once their other risk factors were taken into account, whether or not they had migraines.

Use of hormone-based birth control and estrogen to address medical issues did not affect this risk.

Controlling destiny

In the study of data from the same women in their earlier stages of life, the researchers found that the biggest factors in predicting which ones would go on to have persistent hot flashes and night sweats were having migraines, having depression, and smoking cigarettes, as well as being Black or having less than a high school education.

“These two studies, taken together, underscore that not all women have the same experiences as they grow older, and that many can control the risk factors that might raise their chances of heart disease and stroke later in life,” said Kim.

“In other words, women can do a lot to control their destiny when it comes to both menopause symptoms and cardiovascular diseases.”

She notes that the American Heart Association calls these risk factors the “Essential 8” and offers guides for what women, men and even children and teens can do to address them.

Evolving knowledge and treatment

The long-term study that the two new findings come from was specifically designed to look at cardiovascular risks when it launched in the mid-1980s. CARDIA stands for Coronary Artery Risk Development in Young Adults.

Back in the 80s, knowledge about the biology of blood vessels, down to the cellular and molecular level, was nowhere near where it is today. Both vasomotor symptoms in menopause and migraines have to do with blood vessel contraction and dilation.

But decades of research has shown the microscopic impacts on blood vessels of years of smoking, poor sleep, poor eating habits and lack of activity, as well as a person’s genetic inheritance, life experiences and hormonal history.

Newer injectable migraine medications called calcitonin gene-related peptide (CGRP) antagonists have reached the market in recent years. Using monoclonal antibodies, they target a key receptor on the surface of blood vessel cells to prevent migraines and cluster headaches. But they are expensive and not covered by insurance for all people with migraines.

While the new study is based on data from years before these medications became available, Kim said she recommends them to her patients with persistent migraines, as well as working with them to understand what triggers their migraines and how to use other medications including pain relievers and antiseizure medications to prevent them.

She also notes that the paper on future risk of persistent hot flashes and night sweats echoes the recent trend of using antidepressant medications to try to ease these menopause effects.

Kim also says that evidence has grown about the importance of healthy sleep habits for reducing hot flashes, as well the short-term use of oestradiol-based hormone therapy patches, which have not been shown to have a link to cardiovascular risk. And, she notes that research has not shown any over-the-counter supplement or herbal remedy to be effective, and that these are far less regulated than medications.

Source: Michigan Medicine – University of Michigan

Categories : Ethics and LawTags :

Global Health Photographers Navigate Murky Ethical Waters for Clients

On By ModernMedia

Photographers report moderation, enhancement, and staging of global health images to meet the marketing goals of clients – while photographers react to these practices with resistance and routinely push back, the problem persists as the demand for global heath visuals continues

Photo by William Bayreuther on Unsplash

Global health photography is often caught between photojournalistic intentions of accurately reflect local communities, and marketing directives to create attention-grabbing imagery, according to a study published February 14, 2024 in the open-access journal PLOS Global Public Health by Arsenii Alenichev from Oxford Population Health, the University of Oxford, United Kingdom, and colleagues. Standing at such representational crossroads, photographers are forced to engage with numerous – and often unresolvable – ethical and practical dilemmas.

Photographers are often commissioned by non-governmental organisations and agencies to document the pain and empowerment of others, with a goal to yield donations and attract attention to issues in communities. While photojournalism is often framed as objective, simply by being present, photographers interfere with local communities and can face challenging ethical dilemmas. To better understand how global health photographers operate and ethically obtain consent from subjects, the authors interviewed 29 photographers reflecting the demographic realities of the field about the moral and practical challenges they face on the job. The authors identified common themes across the anonymized interview transcripts to highlight major issues faced by global health photographers.

The authors found that in the current global health landscape, organisations often direct photographers to quickly create attention-grabbing marketing images to compete with mainstream ads. Photographers typically have to work with client-created ‘briefs’ detailing what images they need to take, and with limited time and resources. In practice, it pushes photographers to increasingly sanitise, sensationalise, or stage scenes to produce the desired image – misrepresenting the realities of local communities, especially in the Global South, to which photographers react with resistance. Acquiring ethical consent from subjects is also complicated by power imbalances, language barriers and illiteracy, and misplaced fear and trust in both the photographer and the legal documents they are asked to sign. Given these emergent themes, the authors argue that organizations should push for a more photojournalistic approach to the creation of global health images, weighing ethical clarity over potential economic sacrifice. While their sample of respondents may have been biased towards critical perspectives, the authors believe that this broad overview of tensions will equip other researchers to conduct future studies of more localised, nuanced experiences.

The authors add: “Decolonisation of global health and its visual culture will prove impossible without taking the ethical experiences of photographers seriously, especially the local ones. Global  health images should  not be understood as neutral depictions of interventions – they are in fact political agents participating in the formulation of stereotypes about people and entire communities.”