Month: July 2024

Categories : Neurodegenerative Diseases NeurologyTags :

Positive Life Experiences Boost Brain Mitochondria

On By ModernMedia
Photo by Matteo Vistocco on Unsplash

Having more positive experiences in life is associated with lower odds of developing brain disorders like Alzheimer’s disease, slower cognitive decline with age, and even a longer life. But how feelings and experiences are translated into physical changes that protect or harm the brain is still unclear. 

Now, a study from Columbia researchers suggests that the brain’s mitochondria may play a fundamental part. The new study shows that the molecular machinery used by mitochondria to transform energy is boosted in older adults who experienced less psychological stress during their lives compared with individuals who had more negative experiences. 

“We’re showing that older individuals’ state of mind is linked to the biology of their brain mitochondria, which is the first time that subjective psychosocial experiences have been related to brain biology,” says Caroline Trumpff, assistant professor of medical psychology, who led the research with Martin Picard, associate professor of behavioural medicine at Columbia University Vagelos College of Physicians and Surgeons and in the Robert N. Butler Columbia Aging Center. 

“We think that the mitochondria in the brain are like antennae, picking up molecular and hormonal signals and transmitting information to the cell nucleus, changing the life course of each cell,” says Picard. “And if mitochondria can change cell behaviour, they can change the biology of the brain, the mind, and the whole person.” 

Study details 

The new research used data collected by two extensive studies of nearly 450 older adults in the United States. Each study collected detailed psychosocial information from the participants for two decades during their lives. Study participants donated their brains after death for further analysis, which provided data on the state of the participants’ brain cells. 

Trumpff created indices that converted patients’ reports of positive and negative psychosocial factors into a single score of overall psychosocial experience. She also scored each participant on seven domains that represent distinct genetic networks active in mitochondria. 

“The use of multivariate mitotype indices is an important innovation because we could more easily interpret the biological state of the mitochondria with networks of related genes than an analysis of thousands of individual genes,” Picard says. 

Study results 

The results showed that one mitochondrial domain – which assessed the organelle’s energy transformation machinery – was associated with psychosocial scores. 

“Greater well-being was linked to greater abundance of proteins in mitochondria needed to transform energy, whereas negative mood was linked to lower protein content,” Trumpff says. “This may be why chronic psychological stress and negative experiences are bad for the brain, because they damage or impair mitochondrial energy transformation in the dorsolateral prefrontal cortex, the part of the brain responsible for high-level cognitive tasks.” 

The researchers also analysed mitochondria in specific cell types in the brain and found that the associations between mitochondria and psychosocial factors were driven not by the brain’s neurons, but its glia cells, which may be playing more than their traditionally assumed “supportive” roles. 

“This piece of the study, made possible by our collaboration with the Columbia Center for Translational and Computational Neuroimmunology, is what I think makes it particularly significant,” Picard says. “To ask questions at this level of cellular resolution in the brain is unprecedented in the mitochondrial field.

“Neurons have been the focus of neuroscience, but we’re waking up to the fact that other cells in the brain may be driving disease.” 

Do mitochondria change mood, or does mood change mitochondria? 

Though the current study cannot determine if the participant’s psychosocial experiences altered their brain mitochondria or if innate or acquired mitochondrial states contributed to those experiences, other studies suggest that the relationship between mitochondria and mood works both ways. 

In animal studies, the evidence is very strong, Picard says, that chronic stress affects mitochondrial energy transformation. And in people, a recent study conducted by Picard and collaborator Elissa Epel at UCSF found the first evidence that mood may affect mitochondria in humans: In that study, positive mood predicted greater mitochondrial energy production in the participants’ blood cells on subsequent days, but mitochondrial activity did not predict mood on subsequent days. 

A growing body of work in animals and humans also indicates that mitochondria themselves can alter behaviour. 

“It’s possible that these mechanisms reinforce one another,” Trumpff says. “Chronic stress could alter an individual’s mitochondrial biology in ways that subsequently affects their perception of social events, creating more stress. The emerging picture in the literature is that all these pathways are interactive.” 

Next steps 

Though the brain’s energy transformation machinery was greater in participants with higher psychosocial scores, the researchers do not yet know if that leads to greater energy transformation. Trumpff and Picard are currently doing those studies with hundreds of brains from the same cohorts of participants. 

The team is also exploring a way to measure the brain’s mitochondrial health, which could be used in doctors’ offices in the future. 

“Mitochondria are the source of health and life, but we don’t have ways to quantify health, only disease,” Picard says. “We need a science of health. We need tests that show how healthy and resilient someone is.

“This would be valuable clinically to monitor changes in health before the appearance of disease, and it could transform medical research by giving scientists something to target other than decades of accumulated protein deposits or other forms of long-term damage.”

Source: Columbia University Irving Medical Center

Categories : Diseases, Syndromes and ConditionsTags :

Debunking Myths About Mpox

On By ModernMedia
Mpox (monkeypox) virus. Source: NIH

Myths are widely held beliefs about various issues, including illness and disease. They come about through frequent storytelling and retelling. Dr Themba Hadebe, Clinical Executive at Bonitas Medical Fund, helps debunks myths about monkeypox (mpox).

Myth 1: Mpox (formerly monkeypox) is a new disease created in a lab

Fact: The mpox virus was discovered in Denmark (1958) in a colony of monkeys at a laboratory kept for research.  The first reported human case was in 1970 in the DRC. Mpox is a zoonotic disease, meaning it can be spread between animals and people. It is found regularly in parts of Central and West Africa and can spread from person to person or occasionally from animals to people.  

Myth 2: Mpox comes from monkeys

Fact: Despite its name, monkeypox does not come from monkeys. The disease earned the name when the ‘pox like’ outbreaks happened in the research monkeys. While monkeys can get mpox, they are not the reservoir (where a disease typically grows and multiplies). The reservoir appears to be rodents.

Myth 3:  Only a handful of people have contracted mpox

Fact: Globally, more than 97 000 cases and 186 deaths were reported across 117 countries in the first four months of 2024. South Africa is among the countries currently experiencing an outbreak.  On the 5 July, it was reported that the number of mpox cases in the country has risen to 20. This after four more cases have been confirmed in Gauteng and KwaZulu-Natal in the last few days.

15 patients have, however been given a clean bill of health.

Myth 4:  It is easy to diagnose mpox

Fact: It is easy to mistake mpox for something else. While the rash can be mistaken for chickenpox, shingles or herpes, there are differences between these rashes. Symptoms of mpox include fever, sore throat, headache, muscle aches, back pain, low energy and swollen lymph nodes. Fever, muscle aches and a sore throat appear first. The rash begins on the face and spreads over the body, extending to the palms of the hands and soles of the feet and develops over 2-4 weeks in stages. The ‘pox’ dip in the centre before crusting over.

Laboratory confirmation is required. A sample of one of the sores is diagnosed by a PCR test for the virus (MPXV).

Myth 5: Mpox is easily treated

Fact: ‘Currently,’ says the National Institute for Communicable Diseases (NICD), ‘there is no registered treatment for mpox in South Africa. However, the World Health Organization (WHO) recommends the use of TPOXX for treatment of severe cases, in immunocompromised people’. However, the Department of Health (DoH) has only obtained this treatment, with approval on a compassionate use basis, for the five known patients with severe disease.

There is no mpox vaccine currently available in South Africa.

Myth 6: You can get mpox from being in a crowd or from a public toilet seat

Fact: Mpox is not like Covid-19 which is highly contagious. It spreads through direct contact via blood, bodily fluid, skin or mucous lesions or respiratory droplets.

It can also spread though bites and scratches. Studies have shown that the virus can stay on surfaces but it is not spreading in that way or in a public setting. The risk of airborne transmission appears low.

Myth 7: Mpox is deadly

Fact: While mpox lesions can look similar to smallpox lesions, mpox infections are much milder and are rarely fatal. That said, symptoms can be severe in some patients, needing hospitalisation and, in rare cases, result in death. It is, however, painful and very unpleasant. So, it is important to avoid infection.

Myth 8: Mpox is sexually transmitted

Fact: You can become infected though close, direct contact with the lesions, rash, scabs or certain bodily fluids of someone who has mpox. Even though this could imply transmission though sexual activity, it is not limited to that.  You can also be exposed if you are in close physical proximity to infected people, such as spouses or young children who sleep in the same bed.

Myth 9: I can’t protect myself from getting Mpox

Fact:  You can take precautions: Avoid handling clothes, sheets, blankets or other materials that have been in contact with an infected animal or person. Wash your hands well with soap and water after any contact with an infected person or animal and clean and disinfect surfaces. Practice safe sex and use personal protective equipment (PPE) when caring for someone infected with the virus.

Myth 10:  You can’t stop other people being infected by you

Fact: You may not protect them by 100% but you can isolate. Also, alert people who have had recent contact with you.  Wash your hands regularly with soap and water or use hand sanitiser, especially before or after touching sore and disinfected shared spaces.  Cover lesions when around other people, keep skin dry and uncovered (unless in a room with someone else).

Mpox is a notifiable medical condition but is treatable, if you are concerned, call the DoH toll free number of 0800 029 999 but remember, your GP is your first port of call for all your healthcare needs.

Categories : Gastrointestinal GenderTags :

Higher Rates of Cirrhosis in Transgender Individuals

On By ModernMedia
Source: CC0

Cirrhosis is chronic, progressive end-stage liver disease that occurs when scar tissue prevents the liver from functioning normally. Studies have shown that two of the leading causes of cirrhosis – alcohol use disorder and viral hepatitis – occur more frequently in transgender individuals, but there has been little research examining if these risk factors translate into greater incidences of cirrhosis among transgender patients.  

A new study from Keck Medicine of USC published in The American Journal of Gastroenterology finds that transgender adults have double the prevalence of cirrhosis compared to cisgender adults (people whose gender identity matches the sex they were assigned at birth), suggesting a need for more supportive, preventive care. 

“Our study reveals that cirrhosis disproportionately affects transgender individuals and highlights a pressing health issue that needs addressing,” said Brian P. Lee, MD, MAS, a hepatologist and liver transplant specialist with Keck Medicine and principal investigator of the study. 

Lee and his colleagues launched the study to provide scientifically backed liver health guidance for physicians so they could offer transgender patients a higher level of care. 

Besides discovering that transgender cirrhosis rates are double that of the cisgender population, the study authors also learned that the majority of transgender adults with cirrhosis (60%) have a diagnosis of anxiety and/or depression, compared to 40% of the cisgender patients with cirrhosis.  

They also found that alcohol was the leading cause of cirrhosis in the transgender group, accounting for some 60% of cases while the percentage of cisgender adults with alcohol-associated cirrhosis was approximately 50%. 

In other findings, transgender patients with cirrhosis also tended to be younger (a larger portion were 44 or younger), had higher rates of viral hepatitis and were five times more likely to have HIV/AIDS than their cisgender counterparts.  

Possible reasons behind the disparity  

Lee hypothesises that the increased rates of depression and anxiety may be driving higher rates of alcohol use among transgender patients, which in turn, may result in greater cases of cirrhosis.  

The increased rate of HIV/AIDS among transgender patients may also be a factor in that both conditions are known to be associated with liver disease progression, according to Lee.  

Lack of access to quality health care could also play a role, hypothesises Jeffrey Kahn, MD, a hepatologist and liver transplant physician with Keck Medicine and co-author of the study.  

Similar outcomes

Researchers also studied the five-year outcomes among all transgender and cisgender patients with cirrhosis. Interestingly, despite the differences in the two groups, the number of possible negative outcomes of cirrhosis – liver failure, liver transplant and liver cancer, as well as death, by any cause – was the same.  

“This finding suggests that the transgender community is underserved in the initial stages of liver disease, but individuals are able to secure the care they need once cirrhosis is diagnosed,” said Kahn. “Early prevention is key because if liver disease is caught in time, there is less of a chance it will progress to cirrhosis.”  

To reach their conclusions, study authors culled data from a large national database, Optum, that contained medical claims for more than 60 million patients between 2007–2022. They first identified all transgender and cisgender adults (transgender patients accounted for 0.07%), and then compared the incidences of cirrhosis among each group as well as causes of the disease. Additionally, researchers tracked depression and anxiety in patients. 

Lee and Kahn hope the study will spur more research and motivate health care practitioners to provide transgender patients with extra support, including liver screenings and access to mental health resources. “This population requires specific attention from clinicians and researchers alike,” said Lee. 

Source: University of Southern California – Health Sciences

Categories : General InterestTags :

Holiday Season Already? Anticipation Might Make Time Seem to Fly

On By ModernMedia

Those excited for Christmas or Ramadan are more likely to feel they come quicker, study shows

Photo by Malvestida on Unsplash

Christmas or Ramadan might seem to come around more quickly each year, for people who pay more attention to time, are more forgetful of plans, and love a good holiday. A research team led by Ruth Ogden of Liverpool John Moores University, UK, and Saad Sabet Alatrany of Imam Ja’afar Al-Sadiq University, Iraq, published these findings in the open-access journal PLOS ONE on July 10, 2024. They suggest this could mean that someone’s experience of time is shaped not only by what they’ve done, but what is left to do.

“Christmas seems to come quicker each year,” is a staple of small talk. But the feeling that a holiday comes around faster could also mean that someone’s sense of time is slightly distorted. To find out how often people sense this phenomenon, and what shapes their perception of time, Ogden and colleagues conducted a survey of more than 1000 people in the United Kingdom and more than 600 people in Iraq. They asked them if they believed Christmas or Ramadan came more quickly each year, and measured their memory function and attention to time as well as asking about age, gender, and social life.

The authors found 76 percent of people in the United Kingdom felt Christmas came quicker every year, and 70 percent of people in Iraq felt the same about Ramadan. For both cases, people were more likely to report this perceived acceleration if they enjoyed the holiday, and also for UK participants, if they reported better social lives. In both Iraq and the UK, people were more likely to feel holidays came earlier if they thought about the passage of time more often, and if they were prone to prospective memory errors – such as forgetting to do a planned task. Perhaps surprisingly, age did not play a role in the perception.

While Ramadan and Christmas are very different holidays, and perceptions of time could certainly be influenced by marketing and other factors, the scientists suggest that our experience of time might be shaped both by our attention to its passage and by our plans for the future.

Provided by PLOS

Categories : Obstetrics & Gynaecology Substance UseTags :

Adolescent Behaviour Problems and In Utero Cannabis Exposure: A Biological Link

On By ModernMedia

More evidence shows potential connection between cannabis exposure in womb and adolescent behavioural problems

Photo by Thought Catalog on Unsplash

Scientists are trying to understand how cannabis may affect long-term neurodevelopment from in utero exposure. Previous work by Washington University in St. Louis researchers Sarah Paul and David Baranger in the Behavioral Research and Imaging Neurogenetics (BRAIN) lab led by Ryan Bogdan found associations between prenatal cannabis exposure and potential mental health conditions in childhood and adolescence, but potential biological mechanisms that could possibly explain this association were unclear.

In research published in Nature Mental Health this month, Bogdan, professor of psychological and brain sciences, and senior scientist Baranger outline some of those potential mechanisms, the intermediate biological steps that could play into how prenatal cannabis exposure leads to behavioural issues down the line.

“We see evidence that cannabis exposure may influence the developing brain, consistent with associations with mental health,” Baranger said.

Trying to draw out the long-term impacts of cannabis exposure during pregnancy is not a simple knot to untangle. There are many confounding factors that affect mental health and behavior.

For example, say someone was exposed in utero to cannabis and later develops attention deficit disorder as a teen – how do you differentiate that as an inherited trait or a trait influenced by environmental factors, versus a trait that cannabis exposure somehow contributed to early on in development? It is also possible that all three potentially could contribute to eventual psychopathology.

Another complication is the increasing prevalence of the drug, including among the pregnant population, where cannabis use has increased from 3% to 7% from 2002 to 2017.

Researchers have statistical methods to filter out some of those confounding factors that they used in the previous study, but now they can point to specific biological measurements that further signal a connection to cannabis exposure and adolescent behavioral problems.

Bogdan said that nothing can establish causation with certainty, “but we can look at the plausibility of causation and identifying biological correlates that are associated with exposure and these mental health outcomes suggests it’s plausible.”

Researchers have been using data on the children and their mothers from the Adolescent Brain and Cognitive Development (ABCD) Study, an ongoing research project that includes nearly 12 000 children across the country. As part of that study, they collected data about each mother’s substance use prior to the birth as well as the neuroimaging data of their offspring when they were between 9 and 10 and 11 and 12 years old. Some 370 children were exposed to cannabis prior to the mother’s knowledge of pregnancy, and 195 were exposed before and after learning of pregnancy.

The researchers looked at a variety of neuroimaging measurements that factor into brain development, including measures of brain thickness and surface area, as well as measures reflecting water diffusion in and outside of cells. The patterns found in the group exposed to cannabis are consistent with potential reductions in neuroinflammation.

“It’s possible what we’re seeing is an anti-inflammatory effect of cannabis, which is leading to differences in how the brain is being pruned during neurodevelopment,” Bogdan said.

Much has been touted about the anti-inflammatory effects of cannabis, but it’s not always good to reduce inflammation. It’s all about the timing: too much of a reduction of inflammation at the wrong time could affect how the brain is pruned and primed.

Another theory is that cannabis exposure leads to accelerated aging. But don’t expect to find the smoking gun of biological clues pinning mental health problems to early cannabis exposure.

It might not even be about cannabis effects on pruning but the post-combustion products from smoking cannabis that set off accelerated aging and the downstream cognitive effects, Bogdan said.

Or, it could all come down to sociological factors, he added.

Trying to find the one-to-one connection that proves that prenatal cannabis exposure has negative effects during the teenage years is a challenge and may not be possible with retrospective studies. Baranger notes that the major limitation of this data set is that it was retrospective; mothers reported what their cannabis use was 10 years ago, so he’s looking forward to new data from prospective, longitudinal studies that will offer more recent, accurate and detailed information about cannabis use in pregnancy.

“That will potentially give us more answers to these questions in the future,” Baranger said.

Baranger said these results reaffirm that if someone is thinking about using cannabis while pregnant, they should “talk to their doctor about their choices and what other options there might be.”

Source: Washington University in St. Louis

Categories : General Interest Medical IndustryTags :

Social Media’s Double-edged Sword: Boosting Connections or Risking Careers?

On By ModernMedia
Photo by Pexels on Pixabay

Social media has become an integral part of our daily lives, revolutionising how we communicate, connect and share information. So much so that insights suggest that over 5 billion people worldwide use social media, with 259 million users coming online within the last year. Closer to home, of the 45 million internet users in South Africa, 26 million use social media. 

Platforms such as Facebook, Instagram, LinkedIn and X (formerly Twitter), have bridged gaps, brought distant loved ones closer, and created communities around shared interests and passions. While these platforms have enriched our personal lives in countless ways, they are also a mixed blessing, impacting the professional lives of some individuals in unprecedented ways.

According to Jennifer Barkhuizen, Head of Marketing at MIE, companies are increasingly relying on screening the social media platforms of potential and current employees to gain a window into a candidate’s true self, and provide insights into their hobbies, interests and overall personality. 

“For companies, social media has become an invaluable tool to find the perfect cultural fit for their organisations. However, this practice also uncovers another side of the coin, exposing any unprofessional or inappropriate behaviour that companies may not want to be associated with,” she says.

A significant 70% of recruiters, both across the human resources industry and those within companies, now use social media to screen potential candidates, a trend that continues to grow rapidly. As the digital footprint of individuals becomes more prominent, the trend of social media screening is expected to continue its upward trajectory, reshaping the recruitment landscape.

While the increasing reliance on social media screening by recruiters is bolstering the recruitment process, it is also having a profound psychosocial impact on employees. 

“Knowing that their online activities are being screened can lead to anxiety and a sense of privacy being invaded,” adds Barkhuizen. “Employees may feel pressured to meticulously curate their online presence and the content that they post, which can be mentally exhausting and foster a sense of inauthenticity. The fear of being judged for past posts or casual comments can undermine personal freedom and contribute to a perpetual state of vigilance.” 

Although social media screening helps companies make more informed hiring decisions, it is crucial to acknowledge and address the psychological burden it places on individuals navigating the increasingly blurred lines between their personal and professional lives.

For individuals, balancing positive and negative content on social media is crucial, particularly in the context of social recruiting. Here, studies indicate that positive content, such as showcasing achievements, sharing inspirational messages, and participating in professional discussions, can significantly enhance a candidate’s appeal. Furthermore, positive interactions on social media can create a favourable impression, portraying candidates as engaged, motivated and a cultural fit for the organisation.

“Conversely, negative content, including illicit activity, unprofessional behaviour and controversial opinions, can be detrimental and raise red flags about a candidate’s suitability for a professional environment,” explains Barkhuizen. “So much so that a survey conducted by CareerBuilder found that of the 70% of employers who screen candidates on social media, 54% have decided not to hire a candidate based on their online presence.”

Barkhuizen adds that while people seek to be publicly visible online as they look to share their own ‘personal brand’, thoughts and opinions with the world, it is only when an individual crosses into engaging in undesirable or illicit content that they risk their own reputation and that of their employer.

Despite social media screening potentially leading to anxiety for individuals, it’s a crucial step for businesses to ensure they hire the right candidates. This practice helps protect the company’s reputation by identifying online behaviour that could negatively impact the organisation. It also helps ensure a good cultural fit by revealing candidates’ values and interests, aligning them with the company’s ethos. 

To mitigate the risks associated with using social media during the screening process, Barkhuizen points to five key best practices that HR professionals should abide by. These include:

  1. Develop a social media screening policy: Document a policy outlining the purpose, scope and procedure for social media screening to minimise bias or discrimination. Separate decision-makers from those conducting checks to ensure a fair and compliant hiring process.
  2. Educate staff: Train staff on the legal and ethical aspects of social media screening, ensuring they apply the process consistently to all candidates in the same job category,
  3. Be transparent: Inform candidates about the screening process and obtain their written consent if a social media check is conducted. 
  4. Be respectful: Respect candidates’ privacy settings and only view publicly available information. Avoid “friending” or “following” candidates during the hiring process.
  5. Be impartial and job-specific: Focus on professional information relevant to the job, such as skills and accomplishments. Document information consistently and avoid using protected characteristics like race, religion or gender. To this end, it is advisable to use a third party supplier to avoid bias. 

In today’s digital landscape, where social media is a powerful yet double-edged sword, leveraging the expertise of industry leaders such as MIE can make a significant difference. 

With trusted and innovative smart vetting solutions, MIE’s extensive industry knowledge ensures thorough and reliable background checks, helping businesses navigate the complexities of social media screening to make informed, strategic hiring decisions while safeguarding their reputation and maintaining a positive workplace culture.

Categories : Healthcare Politics and RegulationsTags :

A Holistic Approach will Build a Stronger Rural Healthcare System

On By ModernMedia
Photo by Hush Naidoo on Unsplash

As part of a series of podcasts titled “Advancing Healthcare” that examine the critical issues that must be addressed to achieve universal healthcare, Russell Rensburg of the Rural Health Advocacy Project calls for a focus and prioritisation of rural health. 

Across rural South Africa, the health profile of South Africans is changing. Thanks to the rollout of antiretroviral drugs, South Africa’s life expectancy has increased, and with that, the population is getting older. While this is good news, an ageing population does bring new challenges to the healthcare system.

Rensburg noted that as part of the success of the HIV response in the last 10 years, there has been an increase in life expectancy. But the challenge is that as disease profiles change, health care needs change too. “We need to respond to the differing health needs of young people and older populations,” he adds.

According to Rensburg, available data shows we must start taking differentiated approaches to delivering healthcare for different population segments. However, more data is required because no one knows the prevalence of certain diseases, like cancer. Also, lacking management data means little information on how facilities are run. Without the right data, he says, “We haven’t figured out a way of doing health promotion and health literacy.” 

The Rural Health Advocacy Project is a division of Wits University’s health consortium, and it aims to promote better health care for rural communities. However, providing meaningful rural health care requires understanding that each province within South Africa has its own challenges.

In Kwazulu-Natal, for instance, a recent study involving basic screening found high levels of diseases like diabetes and tuberculosis in people who had never accessed the healthcare system.

The Eastern Cape, says Rensburg, has too many hospitals that are expensive to run. “Some of those hospitals they don’t need,” he said. “There are, like, 91 district hospitals in the Eastern Cape; many of them are like old mission hospitals that, in my view, are sometimes too expensive to run.”

Limpopo, says Rensburg, has a malnutrition problem. “They have severe acute malnutrition rates that are quite high, which is ironic because it’s kind of a breadbasket province,” he said.

Another overreaching problem that healthcare professionals have to deal with in the rural districts of South Africa is that patients often bypass the community clinics and go to the hospitals when they need medical attention.

These clinics are bypassed because of negative experiences where patients endure day-long queues and medicines that aren’t in stock. “They go to the hospital, which costs probably five or six times more for the state to deliver that care,” explained Rensburg.

Rensburg believes more community health workers should be hired, and their training should be standardised to improve rural health care. “We need to professionalise them because it’s an opportunity to create employment in parts of the country with low economic activity,” he said.

According to Rensburg, other interventions that could improve rural health care could include cutting queuing times, improving antenatal care, and making maternity care easier to access. Pregnant mothers can wait up to 14 hours to access a bed.

Access to better management data would help in the better running of facilities. “I think the first baseline into improving healthcare is getting more people to understand their health status. And I think how we do that is being much more focused on gathering information. And then using that information for decision-making,” Rensburg said.

However, improving the well-being of South Africans living in the rural parts of the country goes beyond what the health sector can offer. “So maybe something like a Basic Income Grant could have a massive impact on people’s health, particularly in the rural areas where unemployment is 90%.” The basic income grant could help reduce malnutrition, Rensburg adds.

What could influence rural health soon is NHI. “I think the NHI is an opportunity to change how we deliver healthcare,” said Rensburg. “But when you look at the NHI proposals, it was about restructuring public-funded health care services. The whole thing talks about how we better manage hospitals by giving them their budgets.” Rensburg adds that restructuring publicly funded services, prioritising district health services, and improving the efficiency and efficacy of central, tertiary and regional hospitals by giving them greater autonomy should also be considered key to improving rural health.

This podcast, which is part of a series that aims at creating critical discussion around achieving universal health care, can be accessed at https://hasa.co.za/hasa-podcasts/ 

Categories : Metabolic Disorders OphthalmologyTags :

Study Reveals Association Between Semaglutide Use and Optic Neuropathy

On By ModernMedia
Photoreceptor cells in the retina. Credit: Scientific Animations

Researchers from Mass Eye and Ear have discovered an association between semaglutide use and an increased risk of nonarteritic anterior ischaemic optic neuropathy (NAION) in patients with type 2 diabetes, overweight or obesity. The findings, which appear in JAMA Ophthalmology, only show an association and cannot establish causation.

Though NAION is relatively rare, occurring in in about 10 in 100 000, it is the second most common cause of optic nerve blindness, behind glaucoma, and it is the most common cause of sudden optic nerve blindness. Caused by decreased blood flow to the optic disc, it usually affects only one eye but in 15% of cases both eyes are involved. There are no treatments for this disease and little prospect for improvement, although it is painless.

The study was led by Joseph Rizzo, MD, director of the Neuro-Ophthalmology Service at Mass Eye and Ear and the Simmons Lessell Professor of Ophthalmology at Harvard Medical School.

In mid-2023 Rizzo, a resident (study co-author Seyedeh Maryam Zekavat, MD, PhD) and other Mass Eye and Ear neuro-ophthalmologists noticed a disturbing trend – three patients in their practice had been diagnosed with vision loss from this relatively uncommon optic nerve disease in just one week. They did notice however that all three were taking semaglutide.

“The use of these drugs has exploded throughout industrialised countries and they have provided very significant benefits in many ways, but future discussions between a patient and their physician should include NAION as a potential risk,” said Rizzo, corresponding author of the study. “It is important to appreciate, however, that the increased risk relates to a disorder that is relatively uncommon.” 

This prompted the Mass Eye and Ear research team to run a retrospective analysis of their patient population to see if they could identify a link between this disease and these drugs.

They performed matched cohort study of 16 827 patients revealed higher risk of NAION in patients prescribed semaglutide compared with patients prescribed non–GLP-1 receptor agonist medications for diabetes or obesity.

The researchers found that patients with diabetes who were prescribed and took semaglutide were four times (hazard ratio [HR], 4.28) more likely to be receive a NAION diagnosis. The odds increased to more than seven times (HR, 7.64) when the prescription was for weight control in obesity.

The researchers analysed the records of more than 17 000 Mass Eye and Ear patients treated over the six years since Ozempic was released and divided the patients in those who were diagnosed with either diabetes or overweight/ obesity. The researchers compared patients who had received prescriptions for semaglutide compared to those taking other diabetes or weight loss drugs. Then, they analysed the rate of NAION diagnoses in the groups, which revealed the significant risk increases.

Study limitations include the fact that Mass Eye and Ear sees an unusually high number of people with rare eye diseases, and the number of NAION cases seen over the six-year study period is relatively small. With small case numbers, statistics can change quickly, Rizzo noted. Medication adherence could also not be assessed.

Only correlation can be shown by the study, not causality. How or why this association exists remains unknown. Likewise, the reason for the reported difference between diabetic and overweight groups – but this does not appear to result from a difference in baseline characteristics. The optic nerve is known to host GLP-1 receptors, but the study did not adequately address all the confounding factors. They also caution against generalising the results (from a majority white population) since Black individuals have a lower risk of NAION.

“Our findings should be viewed as being significant but tentative, as future studies are needed to examine these questions in a much larger and more diverse population,” Rizzo said. “This is information we did not have before and it should be included in discussions between patients and their doctors, especially if patients have other known optic nerve problems like glaucoma or if there is pre-existing significant visual loss from other causes.”

Categories : Neurodegenerative DiseasesTags :

How Astrocytes Know to Give the Brain an Energy Boost

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Image of an astrocyte, a subtype of glial cells. Glial cells are the most common cell in the brain. Credit: Pasca Lab, Stanford University

A key mechanism by which astrocytes detect when an energy boost is needed for the brain has been elucidated by University College of London researchers using mouse-based and in vitro studies.

The findings, published in Nature, could inform new therapies to maintain brain health and longevity, the researchers say, since other studies have found that brain energy metabolism can become impaired late in life and contribute to cognitive decline and the development of neurodegenerative disease.

Lead author Professor Alexander Gourine (UCL Neuroscience, Physiology & Pharmacology) said: “When our brain is more active, such as when we’re performing a mentally taxing task, our brain needs an immediate boost of energy, but the exact mechanisms that ensure on-demand local supply of metabolic energy to active brain regions are not fully understood.”

First and co-corresponding author Dr Shefeeq Theparambil, who began the study at UCL before moving to Lancaster University, said: “The normal activities of the brain require enormous amounts of energy, comparable to that of a human leg muscle running a marathon. This energy is primarily derived from blood glucose. Neurons in the brain consume more than 75% of this energy.”

Prior research has shown that numerous brain cells called astrocytes appear to play a role in providing the brain neurons with energy they need. Astrocytes, shaped like stars, are a type of glial cell, which are non-neuronal cells found in the central nervous system. When neighbouring neurons need an increase in energy supply, astrocytes jump into action by rapidly activating their own glucose stores and metabolism, leading to the increased production and release of lactate. Lactate supplements the pool of energy that is readily available for use by neurons in the brain.

Professor Gourine explained: “In our study, we have figured out how exactly astrocytes are able to monitor the energy use by their neighbouring nerve cells, and kick-start this process that delivers additional chemical energy to busy brain regions.”

In a series of experiments using mouse models and cell samples, the researchers identified a set of specific receptors in astrocytes that can detect and monitor neuronal activity, and trigger a signalling pathway involving an essential molecule called adenosine. The researchers found that the metabolic signalling pathway activated by adenosine in astrocytes is exactly the same as the pathway that recruits energy stores in the muscle and the liver, for example when we exercise.

Adenosine activates astrocyte glucose metabolism and supply of energy to neurons to ensure that synaptic function (neurotransmitters passing communication signals between cells) continues apace under conditions of high energy demand or reduced energy supply.

The researchers found that when they deactivated the key astrocyte receptors in mice, the animal’s brain activity was less effective, including significant impairments in global brain metabolism, memory and disruption of sleep, thus demonstrating that the signalling pathway they identified is vital for processes such as learning, memory and sleep.

Dr Theparambil said: “Identification of this mechanism may have broader implications as it could be a way of treating brain diseases where brain energetics are downregulated, such as neurodegeneration and dementia.”

Professor Gourine added: “We know that brain energy homeostasis is progressively impaired in ageing and this process is accelerated during the development of neurodegenerative diseases such as Alzheimer’s disease. Our study identifies an attractive readily druggable target and therapeutic opportunity for brain energy rescue for the purpose of protecting brain function, maintaining cognitive health, and promoting brain longevity.”

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1 in 7 Patients Experience Symptoms After Discontinuing Antidepressants

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Approximately one in seven patients who discontinued their use of antidepressants experienced discontinuation symptoms, according to a wide-ranging analysis published in The Lancet Psychiatry. In arriving at this figure, the researchers accounted for a high frequency of anticipated discontinuation symptoms.

The emergence of adverse symptoms after antidepressant cessation has been described as far back as 1959, but was mostly neglected until the late 1990s. Today, the existence of antidepressant discontinuation symptoms is widely accepted, with transnational guidelines suggesting safe tapering. They can be highly variable and non-specific, with the most frequently reported symptoms being dizziness, headache, nausea, insomnia, and irritability. It has been reported that symptoms typically occur within a few days and are usually transient, but can last up to several weeks or months.

The incidence and severity of symptoms remained controversial however, with estimates ranging up to a majority (56%) of patients experiencing them, half of them severe. Previous reviews have been criticised for bias, and medical opinions are polarised on the subject.

The researchers reviewed 79 studies involving more than 21 000 participants, and found that about one-third of patients experienced symptoms such as headaches, nausea, insomnia, and irritability after accounting for patient expectations. Even in patients taking placebo, 17% experienced symptoms – suggesting that this is attributable to patient expectations about the adverse effects of stopping the drug.

After taking this into account, roughly one in seven individuals had antidepressant discontinuation symptoms. Neither tapering nor abrupt cessation of the drugs made no difference in the proportion of people who experienced discontinuation symptoms.

In addition, about 1 in 35 people experienced severe discontinuation symptoms. Desvenlafaxine, venlafaxine, imipramine, and escitalopram were associated with higher frequencies of discontinuation symptoms, and imipramine, paroxetine, and either desvenlafaxine or venlafaxine were associated with higher symptom severity. The authors cautioned that there was substantial heterogeneity of results.