Day: May 7, 2024

Categories : Ageing Cardiovascular DiseaseTags :

Age-related Brain Changes Affect Stroke Recovery, Study Finds

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Photo by Kampus Production on Pexels

A new study by a global team of researchers has revealed that areas of age-related damage in the brain relate to motor outcomes after a stroke – a potentially under-recognised phenomenon in stroke research. The study was published in Neurology.

A stroke often leads to motor impairment, which is traditionally linked to the extent of damage to the corticospinal tract (CST), a crucial brain pathway for motor control. Signaling along the CST is involved in a variety of movements, including walking, reaching, and fine finger movements like writing and typing. However, stroke recovery outcomes aren’t fully predicted by damage to the CST, suggesting other factors are at play.

The new observational from the Enhancing Neuroimaging Genetics through Meta-Analysis (ENIGMA) Stroke Recovery working group. It examines how one such factor could be white matter hyperintensities (WMHs) – areas of age-related damage in the brain’s white matter, which represent vascular dysfunction and are known to impact cognitive functions. The goal of the ENIGMA Stroke Recovery working group is to understand how changes in the brain after stroke relate to functional outcomes and recovery. ENIGMA Stroke Recovery has data from over 2100 stroke patients collected across 65 research studies and 10 countries, comprising the most extensive multisite retrospective stroke data collaboration to date.

Study leader Sook-Lei Liew, PhD, said: “We are grateful for our many collaborators around the world who lead independent stroke research programs and who are willing to come together and enable large-scale investigations into these critical questions about the role of overall brain health in stroke recovery and rehabilitation.” Dr Liew is an associate professor at the Keck School of Medicine of USC.

The study analysed data from 223 stroke patients across four countries and found that larger WMH volumes were associated with more severe motor impairment after a stroke (e.g., difficulty moving or using their arm for daily tasks), independent of CST damage. WMHs are related to chronic hypertension, diabetes, high cholesterol, and smoking, among other factors and conditions, and have been strongly related to cognitive impairment, but not extensively studied in the context of motor impairment. Interestingly, the relationship between CST damage and motor impairment varied based on WMH severity. Patients with mild WMHs showed a typical relationship between CST damage and motor impairment, while patients with moderate to severe WMHs did not have this relationship. Instead, motor impairment was related to WMH volume, not CST damage.

These findings suggest that WMHs, indicative of cerebrovascular damage from a variety of sources, could provide additional context to understand an individual’s potential for recovery post-stroke. Therefore, assessing WMH volume could improve predictive models for stroke recovery.

“WMHs are related to overall cardiovascular and brain health as we age. By integrating assessments of age-related brain health, we may be better able to predict stroke recovery and tailor rehabilitation to individual needs. This personalised approach could open avenues to improve outcomes after stroke,” says lead author Jennifer K. Ferris, PhD, of Simon Fraser University.

The researchers’ next step is to pursue longitudinal studies to confirm their findings. This insight lays the groundwork for developing more accurate markers for recovery, which could transform post-stroke care and rehabilitation.

Source: Keck School of Medicine of USC

Categories : GenderTags :

Sex Differences Don’t Disappear as a Country’s Equality Develops – Sometimes They Become Stronger

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Master1305/Shutterstock

Agneta Herlitz, Karolinska Institutet

The more gender equal a society is, the more similar men and women will be, adopting more similar interests, personality traits and behavioural patterns. Or so many people seem to believe.

Statements like this might sound like truisms, but science shows reality may be more complicated.

Several studies have found that some psychological sex differences, such as those in personality, are larger in more gender-equal countries. The same goes for countries that are more educated, prosperous and otherwise have better living conditions. This has become known as the gender-equality paradox.

Until recently, it was unclear how widespread this pattern might be. My team, which included research assistant Kare Hedebrant, tried to address that in a recently published study, where we investigated which psychological sex differences are associated with living conditions and, if so, how.

The study covered a range of themes, from personality and cognitive functions to sexting and circadian rhythm. Our study focused on mostly western countries but used some data from other countries such as India and Kenya.

We reviewed 54 articles that analyse the relationship between magnitudes of psychological sex differences and country-level indicators of living conditions. We also used data from 27 meta-analyses (reviews of previous research) of psychological sex differences and conducted new analyses to determine associations between sex differences and national economy, education, health, gender equality and more.

Sex differences

Each study used data from at least five countries, usually spanning several decades.

We grouped the many psychological dimensions covered by these studies into six categories: personal characteristics, cognition, interpersonal relations, emotion, academic preferences (such as a pull towards science, technology, engineering and maths) and morals and values.

Our findings paint a complex picture, showing that variation in psychological sex difference did not follow a uniform pattern. In countries with better living conditions, males and females are more alike in some regards and more different in others.

For example, differences in personality characteristics were frequently found to be larger in countries with better living conditions. This includes traits such as extroversion, agreeableness and altruism, which research seems to show are more strongly associated with women. The same was true for sex differences in some dimensions of emotion, specifically negative emotions in which females tend to score higher, such as shame.

Woman's hands holding a white paper sheet with male and female symbol over a crowded city street background
The gender paradox has confused researchers. StunningArt/Shutterstock

There were also exceptions to the gender-equality paradox. Sex differences in sexual behaviour, like engaging in casual sex, were consistently found to be smaller in countries with better living conditions. This is probably because women in these countries, where there are more permissive norms, have better access to contraceptives.

A complicated phenomenon

For cognitive functions, sex differences were sometimes larger, sometimes smaller in countries with better living conditions. Interestingly, the sex differences were larger in cognitive domains where women have strengths.

For instance, episodic memory (memory for experienced events) and verbal ability, where females typically do better than males, saw larger sex differences as living conditions improved. Females got better at episodic memory when they had better living conditions. By contrast, sex differences in semantic memory (memory for facts) and mathematical ability, where males tend to do better, decreased when living conditions improved.

This suggests that, when it comes to cognitive abilities, females benefit more than males from improvements in living conditions. The performance gap increases in domains where females have an advantage and closes in domains where males are ahead.

Not all psychological sex differences were associated with living conditions in the same way. So, can we say that there is a gender-equality paradox? Yes, to some extent, since more sex differences grew, rather than decreased, in countries with better living conditions.

In most cases, however, psychological sex difference magnitudes were not significantly associated with living conditions. This suggests that, in general, psychological sex differences are not greatly affected by living conditions but seem instead quite stable. For instance, research often finds females get higher grades at school across different subjects. It’s also common for researcher to find males have greater interest in maths. But neither seems to be affected by living conditions.

Even in cases where the magnitude of sex differences did vary in relation to living conditions, the pattern of male and female advantages usually remained the same. So, for example, though the female advantage over males in episodic memory ability is greater in some countries than others, females outperform males in almost all countries.

In summary, we found little support for the idea that psychological sex differences will vanish as societies develop. Policymakers probably cannot rely on that if they hope to achieve equal distributions of men and women in different professions. Instead, it appears that the dominant feature of psychological sex differences is their robustness in the face of social change.

Agneta Herlitz, Professor of Psychology, Karolinska Institutet

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

Categories : Cardiovascular Disease Metabolic DisordersTags :

Top Medical Minds Gather to Address Diabetes Threat

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South Africa has seen the quickest and most alarming rise of diabetes on the continent; from an estimated 1.9 million people living with the condition in 2011 to 4.2 million by 2021 – with 7.5 million predicted to be afflicted by 20451. South Africa also has the fastest rising prevalence on the continent with an estimated 20% of the adult population either diabetic or pre-diabetic1. Globally, diabetes prevalence is predicted to rise by 46% between 2019 and 20452. It currently stands at some 537 million people worldwide1.

This emerged at the recently held annual Sanofi medical meeting, the Cardio-Metabolic Axis Forum from April 19th–21st in Cape Town. This was a meeting of leading endocrinologists, specialist physicians, nephrologists, diabetes-treating doctors, academics and Patient Advocacy Groups (PAGs).

Speaking at the conference, specialist physician and endocrinologist, Dr Landi Lombard – former editor of the South Africa Journal of Diabetes and Vascular Disease – told delegates that the risk of death associated with diabetes in cardiovascular conditions is more than twice that of people with non-diabetes, while in all-cause mortality, it’s just under twice that of a person living without diabetes. Of the estimated 537 million people living with diabetes globally, only about half are diagnosed, of whom 25% receive care, 12.5% achieve treatment targets, and 6% live a life free of diabetes-related complications1.

Dr Lombard said that the pandemic is being driven by poor lifestyle choices and diet, lack of exercise and widespread obesity in the population, so better healthcare worker communication and education of patients is vital to stem the tide of diabetes.

Professor Robert Ritzel of the Department of Endocrinology, Diabetology and Angiology at Schwabing Hospital in Munich, said the Pacific Islands and the Middle East led the world with diabetes prevalence at between 25 % and 40 %. He said what precipitated a surge in diabetes was the speed at which a nation changed from a traditional to a modern lifestyle. When this happened within a few years, diabetes prevalence was likely to range between 20% and 40%. However, when change occurred over many generations, it gave epidemiologists and clinicians time to adapt.

Lombard said one of the biggest challenges was what diabetologists called ‘therapeutic inertia’ which contributes to a patient living with sub-optimal blood sugar control for many years. This term embraced physician, patient and healthcare system factors, patient injection related factors, time and resource constraints among physicians and the lack of a proper healthcare system plan. He said that in people with Type 2 diabetes, the median time it takes for the disease to intensify while taking one or more anti-diabetic drugs is 2.9 years. However, the use of an injectable slowed intensification down to 7.2 years or more.

Reasons for failure to intensify treatment or progress to injectable therapies varied between specialist and primary care physicians but were mainly because of a patient fear of injection, too many injections, perceptions of this being a ‘last resort’ treatment, fear of weight gain, fear of low blood sugar, and poor communication with patients.

Lombard said even 1 year of poor blood sugar control in people with Type 2 diabetes could result in an increase in the cumulative incidence of kidney disease of 18%, neuropathy of 8%, retinopathy of 7% and a significantly increased risk of heart attack (67%), heart failure (64%), stroke (51%) and composite cardiovascular events (62%).

Professor Naomi ‘Dinky’ Levitt, former Head of Endocrinology and Diabetic Medicine at the University of Cape Town and Groote Schuur Hospital and Director of the Chronic Disease Initiative for Africa, highlighted gestational diabetes as one of the greatest challenges.

Described as the “doyenne” of endocrinology in South Africa (SA), Levitt said one third of women who have gestational diabetes go on to develop diabetes within 6 years of giving birth, so post-partum intervention is crucial.

According to Levitt, lifestyle interventions had about a 20% positive effect, mainly because new mothers were pulled in all directions by family, the baby, husband, and domestic and work needs.

She said that with 31.4% of SA women estimated to have developed gestational diabetes, it would be ideal to screen all pregnant women at 24 and 28 weeks. However, this would collapse the healthcare system because of the healthcare staffing demands, so the alternative was to focus on risk factors such as being over 30 years old or being overweight.

She said that focusing on women with gestational diabetes would have the greatest impact on the pandemic, as treatment can help avoid pre-eclampsia and improve foetal development, resulting in fewer admissions to the neonatal ICU.

Speaking on behalf of Sanofi the conference sponsor, Dr Asafika Mbangata said: “Sanofi puts patients first and the aim of the conference was to empower stakeholders with the right information to help make critical care decisions for patients by sharing the latest data on advancements in treatments and technologies, along with insights into global and local policy changes impacting diabetes care.”

“As we chase the miracles of science to improve people’s lives, we know we cannot shape the future of diabetes management without partnerships with healthcare professionals and other stakeholders. Collaboration across all medical disciplines is essential if we are to overcome this pandemic, and we’re hopeful the conference opened the door to future robust collaborative actions that improve patient outcomes,” concluded Dr Mbangata.

References

  1. Adapted from IDF Diabetes Atlas (10th edition). International Diabetes Federation. 2022. http://www.diabetesatlas.org/. Accessed 23 April, 2024.
  2. IDF Facts and Figures. https://idf.org/about-diabetes/diabetes-facts-figures/. Accessed 7 May, 2024.
Categories : Neurodegenerative DiseasesTags :

Study Suggests Leprosy Drug may be Effective in Huntington’s Disease

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Source: CC0

A preclinical study from Karolinska Institutet offers hope for treating severe neurodegenerative diseases with an existing drug: clofazimine, which is used to treat leprosy, may be effective in the treatment of Huntington’s disease.

The research group examined whether existing drugs could reduce the toxicity of so-called polyQ proteins. These proteins are found in patients with certain hereditary neurodegenerative diseases, including Huntington’s disease, for which there is no cure. 

Screening hundreds of drugs, they found that the leprosy drug clofazimine reduces the toxicity of polyQ proteins and restores mitochondrial function in zebrafish and worms. The finding, published in eBioMedicine, supports the previous hypothesis that polyQ diseases are associated with the dysfunction of mitochondria, the organelles in charge of producing energy within cells.

“Our work not only suggests the interest of a specific drug for the treatment of polyQ neurodegenerative diseases, but also helps us to better understand what causes these diseases. It is possible to find new uses for old drugs, which reduces the time needed to find novel therapies”, says last author Oscar Fernandez-Capetillo, Professor and research group leader at the Department of Medical Biochemistry and Biophysics at Karolinska Institutet.

Clofazimine is not very efficient in entering the nervous system, however. The research group are now trying to figure out solutions to this limitation, by testing the efficacy of clofazimine in mammalian models of neurodegenerative disease. 

“We hope that our discovery can be developed into a new medicine, but there are still some hurdles that need to be overcome,” says Oscar Fernandez-Capetillo.

The researchers are also conducting similar drug screens in other age-related pathologies such as cancer and other neurodegenerative disorders.

Source: Karolinska Institutet

Categories : Expert OpinionTags :

Opinion Piece: Addressing Sanitation Challenges – A Call for Prioritising Basic Needs in South Africa’s Upcoming Elections

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By Robert Erasmus, Managing Director at Sanitech

Photo by Hush Naidoo Jade Photography on Unsplash

In South Africa, and across many developing nations, the discourse leading up to elections often centre on fundamental issues that directly impact the daily lives of citizens, such as the cost of living and access to clean water and sanitation. As the world witnesses a significant portion of its population gearing up to vote in 2024, it becomes evident that the voting criteria in developing countries vastly differ from those in developed ones.

While developed nations may debate topics like climate change and immigration, citizens in developing countries like South Africa are primarily concerned with securing basic necessities for survival and dignity. The disparity in voting patterns reflects the stark contrast in the challenges faced by people living in different parts of the world.

Elevating the discussion on South Africa’s paradox

South Africa, despite being regarded relatively highly in terms of election fairness, grapples with persistent challenges in providing access to clean water and adequate sanitation facilities. Our democratic process works, but it needs to be leveraged correctly for the benefit of our people. Many communities across the country continue to suffer due to the absence of proper sanitation infrastructure, perpetuating cycles of poverty and disease. The lack of clean water exacerbates these challenges, posing significant obstacles to health, dignity, and economic progress.

The interconnectedness of health, dignity, and economic progress

It is worth noting that the voting populace in South Africa has shifted its focus from ideological differences to practical concerns about the delivery of basic human rights. This shift underscores the importance of addressing the immediate needs of citizens before delving into broader policy discussions. Without access to clean water and sanitation, individuals and communities struggle to break free from the cycle of poverty and disease, hindering their ability to participate fully in economic and social life.

The impact of inadequate sanitation and clean water access extends beyond health and dignity – it also affects economic progress. Families burdened with preventable illnesses spend precious resources on healthcare instead of investing in education and livelihoods. Children often sacrifice their education to care for sick family members, further perpetuating the cycle of poverty. To address these challenges, practical solutions must be prioritised that ensure equitable access to clean water and sanitation for all citizens to break the cycle of poverty and disease and pave the way for economic growth.

Solving South Africa’s challenges starts with sanitation

These solutions include investing in infrastructure that can provide clean water and adequate sanitation facilities to all communities, especially those in rural and underserved areas, while at the same time investing in the repair and maintenance of existing infrastructure.

Implementing technologies such as water purification systems and innovative sanitation solutions tailored to local needs can help bridge the gap in access. Additionally, community engagement and education programs are essential to promote hygiene practices and ensure the long-term sustainability of water and sanitation initiatives. By prioritising these solutions, South Africa can make significant strides towards ensuring equitable access to clean water and sanitation for all its citizens.

Advocating for real change beyond election promises

Citizens have a central role to play in advocating for real commitment from political candidates. By elevating the discussion around sanitation and clean water access, voters are better informed to hold leaders accountable for delivering on their promises. Political parties must recognise the importance of addressing basic needs and commit to implementing sustainable solutions that uplift communities and promote dignity. For political parties this will be one of the most effective ways to win and retain the vote.

As we get closer to election date, it is essential to correctly prioritise the basic needs of citizens, including access to clean water and sanitation. This is not a critique of the government but a call to action – a recognition of the fundamental rights that must be upheld for all individuals to thrive. By addressing sanitation challenges, South Africa can pave the way for a future where every citizen has the opportunity to live a healthy, dignified life and contribute to the nation’s prosperity.