New research by the University of Sussex could help to increase life expectancy and improve treatment for glioblastoma. In the study, published in the Journal of Advanced Science, researchers have discovered that an understudied protein, called PANK4, is able to block cancer cells from responding to chemotherapeutic treatment for the highly intrusive brain cancer, glioblastoma.
Scientists at Sussex have demonstrated that if the protein is removed, cancer cells respond better to temozolomide, the main chemotherapy drug for the treatment of glioblastoma.
Prof Georgios Giamas, Professor of Cancer Cell Signalling at the University of Sussex explains: “Glioblastoma is a devastating brain cancer, and researchers are working hard to identify ways to delay progression of the disease, and tackle cell resistance to treatment. As this is the first time that PANK4 has been linked to glioblastoma, the next step is to develop a drug targeting this protein to try to reverse chemo-resistance and restore sensitivity, ensuring that patients receive the best treatment and have better outcomes.”
Glioblastoma is one of the most aggressive forms of brain cancer. Approximately 250 000 – 300 000 globally are diagnosed with it annually, with a best-case survival rate of just one to 18 months after diagnosis.
Following surgery to remove the tumour, glioblastoma patients are typically treated with radiation and the chemotherapeutic drug, temozolomide. Although patients initially respond well to the drug, the cancer cells quickly develop resistance to this treatment.
The University of Sussex scientists led an international research team to understand the possible reasons for this resistance, helping to guide future therapies to improve quality of life and increase life expectancy for those with glioblastoma.
The team identified a protein called PANK4 which, when removed from the cancer cells, can lead to the cell’s death, and saw patients better responding to temozolomide. Linked to this, the researchers found that patients expressing high levels of the PANK4 protein had lower survival rates.
Dr Viviana Vella, research fellow at the University of Sussex explains: “There are a multitude of under-investigated proteins that may hold great potential for therapeutic intervention. Our study sheds light on this understudied protein, PANK4, unveiling a protective role in temozolomide-resistant cancer cells. Ultimately, PANK4 depletion represents a vulnerability that can now be exploited to restore sensitivity to the drug and improve treatment.”
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.”
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.”
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.”
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.
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
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.”
During the 2023 Christmas holidays, a freezer failure occurred at the Karolinska Institutet’s Neo building, where the automatic refilling of cryotanks with liquid nitrogen was interrupted for some reason. As a result, the temperature in 16 of 19 cryogenic tanks rose and large amounts of biological research material have been destroyed, including medical research samples which stretch back for decades.
An investigation with internal and external experts is now underway to find out how this failure could have happened, although there are no signs of sabotage. On the evening of 22 December, the level of liquid nitrogen in the Neo building’s cryo tanks, which contain biomaterial and cell lines from multiple departments, was due to be routinely topped up from an external tank.
The automatic refilling of nitrogen ensures that the correct temperature of -190°C can be maintained in the isothermal (cryo) tanks.
However, for reasons unknown, the flow of nitrogen from the external storage tank malfunctioned that evening, and the temperature in 16 of the tanks rose.
Automatic alarm
The cryotanks are able to maintain a sufficiently low temperature for up to 96 hours without refilling. During the Christmas break, they remained un-refilled for around 120 hours, and their internal temperature increased.
“When the flow of nitrogen ceased on 22 December, an automatic alert was supposed to be sent out, both by email and SMS, to registered owners of material in the freezers. However, a malfunction in the alarm unit meant that the alerts did not work properly. The email reached the recipients, but the texts got stuck in the server and never arrived,” explains Elisabeth Raschperger, researcher and senior lab manager at Neo.
According to Dr Raschperger, there has been a history of false alarms from freezers and cryotanks at Neo, partly caused by overly sensitive settings for when alarms should go off.
The alarm supplier inspected the system in 2023 and gave approval for its continued use in November.
Troubleshooting by the suppliers
Five days after the incident when the Neo service team found out what had happened, they called in the suppliers to make an initial check of the valves, pipes and pressure regulation tanks. The alarm was also tested.
“The companies went through every part of the system and found no faults or indications that any piece of equipment was faulty or broken, with the exception of the SMS alarm,” says Dr Raschperger. “We also looked through the operational logbook for the external nitrogen tank for October, November and December, and the refilling system had been working perfectly.”
The affected departments
From a research perspective, the Department of Medicine, Huddinge (MedH), was most affected, but so too were researchers at the Department of Biosciences and Nutrition (BioNut).
“At MedH, the research areas of haematology, endocrinology and cardiology have been particularly affected by the crash. It involves a very large amount of irreplaceable research material with samples, cell lines and biomaterials collected over decades,” says Professor Petter Höglund, head of MedH. He continues:
“The affected research teams are now working to take stock of the full extent of the losses. The analyses made so far speak for themselves: the malfunction will have far-reaching consequences for the department’s research in the affected areas.”
The staff at Neo, BioNut and MedH receive regular updates on the incident and the steps being taken to investigate the cause. They are also receiving crisis support from HR.
Expert inquiry
An inquiry to ensure that the incident never happens again is now underway. The inquiry will take a technical and procedural – rather than a personal – approach to chart and analyse the incident and look into how KI can build sustainable, robust systems going forward. Pending the inquiry’s report, it is important not to make a bad situation worse.
“Rumours are circulating that the malfunction was an act of sabotage,” says Dr Raschperger. “I would like to emphasise that there are at the present no such indications, and urge everyone to wait for the experts’ conclusions.”
A course of acupuncture may curb the heightened risk of stroke associated with rheumatoid arthritis, finds a comparative study published in the open access journal BMJ Open.
The effects seem to be independent of sex, age, medication use, and co-existing conditions, the findings indicate, prompting the researchers to suggest that the procedure may reduce levels of pro-inflammatory proteins (cytokines) in the body that are linked to cardiovascular disease.
The principal cause of death in people with rheumatoid arthritis is cardiovascular disease. And they are more likely to have a stroke than the general population, note the researchers.
Acupuncture is already used to control pain and dampen down inflammation, and the researchers wanted to find out if it might also lower the risk of ischaemic stroke that is associated with systemic inflammation.
They drew on national medical records from the Registry for Catastrophic Illness Patients Database (RCIPD), for 47 809 adults newly diagnosed with rheumatoid arthritis between 1997 and 2010.
The final analysis included 23 226 patients with complete data, 12 266 of whom were treated with acupuncture following their diagnosis up until the end of December 2010.
Of these, 11 613 were each matched for age, sex, co-existing conditions (diabetes, high blood pressure, high blood fats, congestive heart failure, anxiety/depression, obesity, atrial fibrillation, alcohol dependency, and smoking), medication use (non-steroidal anti-inflammatory drugs, statins, and disease modifying drug) and year of diagnosis with a patient who hadn’t been treated with acupuncture.
Women, those aged 40–59, and participants with high blood pressure predominated in both groups.
Most (87%) of those in the acupuncture group were treated with manual acupuncture (87%); 3% were treated with electroacupuncture, whereby an electrode producing a low pulse of electricity is attached to the needle; and 10% received both types.
On average, 1065 days elapsed between a rheumatoid arthritis diagnosis and receipt of the first acupuncture treatment, with the number of treatments averaging around 10 in total.
During the monitoring period up to the end of 2011, 946 patients had an ischaemic stroke. Unsurprisingly, risk rose in tandem with increasing age, and with the number of co-existing conditions.
Those with high blood pressure, for example, were more than twice as likely to have a stroke as those with normal blood pressure, while those with diabetes were 58% more likely to do so.
But there were significantly fewer cases of ischaemic stroke among the acupuncture group: 341 vs 605, equivalent to a 43% lower risk. And this was independent of age, sex, medication use, and co-existing conditions.
This is an observational study, and as such, no firm conclusions can be drawn about cause and effect, and the researchers also acknowledge that they were only able to estimate disease severity from the drugs the patients took.
Nor did they have information on potentially influential factors, such as height, weight, lab tests or physical activity levels, and not everyone would have had the same pressure points needled, they add.
But they point out: “Inflammation is a consistent and independent predictor of cardiovascular disease in [rheumatoid arthritis],” so acupuncture may lower pro-inflammatory proteins, thereby reducing the risk of cardiovascular disease, including ischaemic stroke, they suggest.
“Unstable blood pressure and lipid profiles are the two risk factors for ischaemic stroke, and acupuncture therapy has the advantage of controlling both hypertension and dyslipidaemia,” they explain, adding: “If acupuncture relieves morning stiffness and joint pain, patients might also benefit from increasing daily activities, which might also reduce the risk of stroke.”
Researchers at the University of Cape Town (UCT) have found that in most cases, the Older Persons Grant is not sufficient to meet the needs of elderly people in South Africa.
Professor Elena Moore and other researchers from Family Caregiving, based in the Department of Sociology at UCT, interviewed 30 families in rural KwaZulu-Natal and 50 families in the Western Cape to find out how families headed by pensioners are making ends meet and whether older persons are able to get the care they need.
About 3.9 million people in South Africa receive the monthly Older Persons Grant, also known as the Old Age Grant, currently at R2080 per person per month.
Family Caregiving analysed data from Wave 5 of UCT’s National Income Dynamics Study (NIDS), which shows that the vast majority of beneficiaries live in households of five people where the average household income is R6850.
Older people have significant and unique care needs, the researchers argue. According to StatsSA data from 2021, the majority of older people need chronic medication and need to access healthcare facilities: 24% of older persons in South Africa have diabetes, 68% live with hypertension, and 14% have arthritis. Older people also often have difficulties with sight, mobility and cognition, meaning they need additional support to go about their day-to-day lives, say the researchers.
In a rural area in KwaZulu-Natal, Family Caregiving found that most households had between eight and nine members and were struggling to cover the cost of food, medical supplies, and transport to clinics.
In this area, accessing healthcare is expensive, the team found. A round trip to town by taxi cost R46 and a trip to the closest clinic and back costs R82. Physically disabled older people often have to hire a car for between R200 and R600 to get to a clinic and back. A pack of adult incontinence products costs R219 and lasts only seven days.
Because of the costs of transport and medical supplies, many of these large households were spending an average of only R1000–R1500 a month on food, according to the report. A lack of access to water and electricity creates an additional burden for older people in rural areas.
In urban areas, such as Cape Town, there is greater access to water and electricity, health facilities are closer, and households are smaller, meaning the Older Persons Grant is not stretched as far. But still, the researchers found, older people are often required to carry households at the expense of their own care.
Low income and low-middle income families in Khayelitsha and Eerste River told the researchers that the only way to make ends meet is to spend less on food. Many families are stuck in debt cycles, borrowing from loan sharks from month-to-month with extremely high interest rates. Unpaid utility bills stack up, and electricity tariff hikes and rising rental prices put further pressure on older persons.
The monthly cost of nutritious food for a family of seven is R5324, according to Pietermaritzburg Economic Justice and Dignity’s household affordability index. Family Caregiving found that low-income households headed by older persons are often spending less than half that amount on food because of other household expenses. This has serious consequences for older people, especially those who need to eat before taking medication.
The report recommends additional investment by the government to care for older people, such as free transport to health facilities and consistent supply of incontinence products.
Researchers from Institut Pasteur have discovered that the immune impacts of smoking can last for many years, leaving smokers with effects on some of their bodies’ defence mechanisms acquired while smoking. These findings, which for the first time reveal a long-term memory of the effects of smoking on immunity, are published in the journal Nature.
Individuals’ immune systems vary significantly in terms of how effectively they respond to microbial attacks. But how can this variability be explained? What factors cause these differences? “To answer this key question, we set up the Milieu Intérieur cohort comprising 1000 healthy individuals aged 20 to 70 in 2011,” explains Darragh Duffy, Head of the Translational Immunology Unit at the Institut Pasteur and last author of the study. While certain factors such as age, sex and genetics are known to have a significant impact on the immune system, the aim of this new study was to identify which other factors had the most influence.”
The scientists exposed blood samples taken from individuals in the Milieu Intérieur cohort to a wide variety of microbes and observed their immune response by measuring levels of secreted cytokines(1). Using the large quantities of data gathered for individuals in the cohort, the team then determined which of the 136 investigated variables (body mass index, smoking, number of hours’ sleep, exercise, childhood illnesses, vaccinations, living environment, etc) had the most influence on the immune responses studied. Three variables stood out: smoking, latent cytomegalovirus infection(2) and body mass index. “The influence of these three factors on certain immune responses could be equal to that of age, sex or genetics,” points out Darragh Duffy.
As regards smoking, an analysis of the data showed that the inflammatory response, which is immediately triggered by infection with a pathogen, was heightened in smokers, and moreover, the activity of certain cells involved in immune memory was impaired. In other words, this study shows that smoking disrupts not only innate immune mechanisms, but also some adaptive immune mechanisms. “A comparison of immune responses in smokers and ex-smokers revealed that the inflammatory response returned to normal levels quickly after smoking cessation, while the impact on adaptive immunity persisted for 10 to 15 years,” observes Darragh Duffy. “This is the first time it has been possible to demonstrate the long-term influence of smoking on immune responses.”
Basically, the immune system appears to have something resembling a long-term memory of the effects of smoking. But how? “When we realised that the profiles of smokers and ex-smokers were similar, we immediately suspected that epigenetic processes were at play(3),” says Violaine Saint-André, a bioinformatician in the Institut Pasteur’s Translational Immunology Unit and first author of the study. “We demonstrated that the long-term effects of smoking on immune responses were linked to differences in DNA methylation(4) – with the potential to modify the expression of genes involved in immune cell metabolism – between smokers, ex-smokers and non-smokers.” It therefore appears that smoking can induce persistent changes to the immune system through epigenetic mechanisms.
“This is a major discovery elucidating the impact of smoking on healthy individuals’ immunity and also, by comparison, on the immunity of individuals suffering from various diseases,” concludes Violaine Saint-André.
Notes:
(1) proteins secreted by a large number of immune cells to communicate among themselves and participate in immune defense.
(2) a virus in the herpes family that is often asymptomatic though dangerous to foetuses.
(3) changes in DNA that affect how genes are expressed, i.e. how they are used by cells.
(4) methylation is a type of chemical modification. Methyl groups position themselves on DNA, changing the way in which the genome is read in the cell.
