A new study from the University of Turku showed that reducing daily sitting prevented back pain from worsening over six months. The results, published in BMJ Open, strengthen the current understanding of the link between activity and back pain as well as the mechanisms related to back pain.
Intuitively, it is easy to think that reducing sitting would help with back pain, but previous research data is surprisingly scarce. The study from the Turku PET Centre and UKK Institute in Finland investigated whether reducing daily sitting could prevent or relieve back pain among overweight or obese adults who spend the majority of their days sitting. The participants were able to reduce their sitting by 40 min/day, on average, during the six-month study.
“Our participants were quite normal middle-aged adults, who sat a great deal, exercised little, and had gained some extra weight. These factors not only increase the risk for cardiovascular disease but also for back pain,” says Doctoral Researcher and Physiotherapist Jooa Norha from the University of Turku in Finland.
Previous results from the same and other research groups have suggested that sitting may be detrimental for back health but the data has been preliminary.
The figure presents the change in back pain intensity on a scale from 0 to 10. The blue bars represent individuals in the intervention group that reduced sitting and the red bars represent the control participants who did not change their sitting habits. Most of the participants in the intervention group decreased their back pain whereas the back pain in the control participants tended to increase.
Robust methods for studying the mechanisms behind back pain
The researchers also examined potential mechanisms behind the prevention of back pain.
”However, we did not observe that the changes in back pain were related to changes in the fattiness or glucose metabolism of the back muscles,” Norha says.
Individuals with back pain have excessive fat deposits within the back muscles, and impaired glucose metabolism, or insulin sensitivity, can predispose to pain. Nevertheless, back pain can be prevented or relieved even if no improvements in the muscle composition or metabolism take place. The researchers used magnetic resonance imaging (MRI) and PET imaging that is based on a radioactive tracer to measure the back muscles.
“If you have a tendency for back pain or excessive sitting and are concerned for your back health, you can try to figure out ways for reducing sitting at work or during leisure time. However, it is important to note that physical activity, such as walking or more brisk exercise, is better than simply standing up,” Norha points out.
The researchers wish to remind that switching between postures is more important than only looking for the perfect posture.
An ultrasound test that detected 96% of ovarian cancers in postmenopausal women should replace current standard of care test in the UK according to a new study.
In a paper published in Lancet Oncology, research led by Professor Sudha Sundar from the University of Birmingham compared all currently available tests to diagnose ovarian cancer in postmenopausal women head-to-head in a high-quality diagnostic test accuracy study.
Of the six diagnostic tests investigated, the IOTA ADNEX model which looks at ultrasound features (how the lump looked like on ultrasound) had the best accuracy of all and could detect up to 96% of women with ovarian cancer.
The ultrasound test outperforms the current standard of care in the UK significantly and so the researchers recommend that the IOTA ultrasound ADNEX model should replace the current standard of care test called risk of malignancy (RMI1) test in the UK which identifies 83% of ovarian cancers.
Sudha Sundar, Professor of Gynaecological Cancer at the University of Birmingham and consultant in gynaecological cancer surgery at Sandwell and West Birmingham NHS Trust said:
“This is the first time that a head-to-head study of all available ovarian cancer tests have been done in the same population. Here we studied their use with symptomatic, postmenopausal women who are most at risk of this cancer. Our trial found that the IOTA ADNEX ultrasound protocol had highest sensitivity for detecting ovarian cancer compared to the standard of care and other test.
“The ultrasound test also performs well when delivered by a trained sonographer who have received specific training and certification and quality assurance, and as the vast majority of ultrasound scans are performed by sonographers it is important that a new standard is able to be delivered by as many clinical professionals as possible.
“We found that the higher sensitivity of the IOTA ADNEX model is likely to lead to some women who don’t have cancer also being flagged up as having a higher risk of cancer. We however did discuss this extensively with patients, cancer charity Target ovarian cancer and NHS experts who all agreed that in postmenopausal women who are at higher risk of ovarian cancer, picking up more women with cancer would benefit women overall.”
The research team note that the IOTA ADNEX model achieved 96% accuracy when delivered by NHS sonographers who were appropriately trained and received quality assurance. As most scans worldwide are carried out by sonographers rather than gynaecologists, introductory free online resources have been created by the researchers for NHS staff to undergo the specialist ultrasound training and get certification and quality assurance.
A UCLA research team has created the Comorbid Operative Risk Evaluation (CORE) score to better account for the role chronic illness plays in patient’s risk of mortality after operation, allowing surgeons to adjust to patients’ pre-existing conditions and more easily determine mortality risk.
For almost 40 years, researchers have used two tools, the Charlson Comorbidity Index (CCI) and Elixhauser Comorbidity Index (ECI), to measure the impact of existing health conditions on patient outcomes. These tools use ICD codes that are input by medical professionals and billers to account for patient illness. These tools, however, were not designed for patients undergoing surgery and often address chronic illnesses that are not relevant to surgical populations. They often capture data from medical billing records and lack nuanced information regarding pre-existing health conditions.
A total of 699 155 patients were used to develop the model, of which 139 831 (20%) comprised the testing cohort. The researchers queried adults undergoing 62 operations across 14 specialties from the 2019 National Inpatient Sample (NIS) using International Classification of Diseases, 10th Revision (ICD-10) codes. They sorted ICD-10 codes for chronic diseases into Clinical Classifications Software Refined (CCSR) groups. They used logistic regression on CCSR with non-zero feature importance across four machine learning algorithms predicting in-hospital mortality, and used the resultant coefficients to calculate the Comorbid Operative Risk Evaluation (CORE) score based on previously validated methodology. The final score ranges from zero, representing lowest risk, to 100, which represents highest risk.
Impact
Health services and outcomes research using retrospective databases continues to represent a growing proportion of surgical research. Researchers highlighting quality issues and disparities are well-intentioned. However, without appropriate tools, it can be unclear if poor outcomes are independent of pre-existing conditions.
“The advent of novel statistical software and methodology have enabled researchers to exploit large databases to answer questions of healthcare quality, disparities, and outcomes,” said Dr Nikhil Chervu, a resident physician in the UCLA Department of Surgery and the study’s lead author. “These databases, however, often capture data from medical billing records and lack nuanced information regarding pre-existing health conditions. Without addressing differences in patients’ chronic illnesses, population comparisons may fall flat. Incorporation of this score in additional research will further validate its use and help improve analysis of surgical outcomes using large databases.”
Mycobacterium tuberculosis drug susceptibility test. Photo by CDC on Unsplash
A compound found in African wormwood – a plant used medicinally for thousands of years to treat many types of illness – could be effective against tuberculosis, according to a new study available online in the Journal of Ethnopharmacology.
The team, co-led by Penn State researchers, found that the chemical compound, an O-methylflavone, can kill Mycobacterium tuberculosis, or Mtb, that causes tuberculosis in both its active state and its slower, hypoxic state, which the mycobacteria enters when it is stressed.
Bacteria in this state are much harder to destroy and make infections more difficult to clear, according to co-corresponding author Joshua Kellogg, assistant professor of veterinary and biomedical sciences in the College of Agricultural Sciences.
While the findings are preliminary, Kellogg said the work is a promising first step in finding new therapies against tuberculosis.
“Now that we’ve isolated this compound, we can move forward with examining and experimenting with its structure to see if we can improve its activity and make it even more effective against tuberculosis,” he said. “We’re also still studying the plant itself to see if we can identify additional molecules that might be able to kill this mycobacterium.”
Tuberculosis is one of the world’s leading killers among infectious diseases, according to the Centers for Disease Control and Prevention. There are about 10 million cases a year globally, with approximately 1.5 million of those being fatal.
While effective therapies exist for TB, the researchers said there are several factors that make the disease difficult to treat. A standard course of antibiotics lasts six months, and if a patient contracts a drug-resistant strain of the bacteria, it stretches to two years, making treatment costly and time consuming.
Additionally, the bacteria can take two forms in the body, including one that is significantly harder to kill.
“There’s a ‘normal’ microbial bacterial form, in which it’s replicating and growing, but when it gets stressed – when drugs or the immune system is attacking it – it goes into a pseudo-hibernation state, where it shuts down a lot of its cellular processes until it perceives that the threat has passed,” Kellogg said. “This makes it really hard to kill those hibernating cells, so we were really keen to look at potential new chemicals or molecules that are capable of attacking this hibernation state.”
Multiple species of the Artemisia plant have been used in traditional medicine for centuries, the researchers said, including African wormwood, which has been used to treat cough and fever. Recent studies in Africa have suggested that the plant also has clinical benefits in treating TB.
“When we look at the raw plant extract that has hundreds of molecules in it, it’s pretty good at killing TB,” Kellogg said. “Our question was: There seems to be something in the plant that’s really effective – what is it?”
For their study, the researchers took raw extract of the African wormwood plant and separated it into “fractions” – versions of the extract that have been separated into simpler chemical profiles. They then tested each of the fractions against Mtb, noting whether they were effective or ineffective against the bacteria. At the same time, they created a chemical profile of all of the tested fractions.
“We also used machine learning to model how the changes in chemistry correlated with the changes in activity that we saw,” Kellogg said. “This allowed us to narrow our focus to two fractions that were really active.”
From these, the researchers identified and tested a compound that effectively killed the bacteria in the pathogen’s active and inactive states, which the researchers said is significant and rare to see in TB treatments. Further testing in a human cell model showed that it had minimal toxicity.
Kellogg said the findings have the potential to open new avenues for developing new, improved therapeutics.
“While the potency of this compound is too low to use directly as an anti-Mtb treatment, it may still be able to serve as the foundation for designing more potent drugs,” he said. “Furthermore, there appear to be other, similar chemicals in African wormwood that may also have the same type of properties.”
The researchers said that in the future, more studies are needed to continue exploring the potential for using African wormwood for treating TB.
As we celebrate Carer’s Week, an annual campaign recognising the invaluable work of caregivers, it’s essential to highlight the critical role they play in supporting the elderly and their families. In South Africa, the growing number of elderly individuals has created a pressing need for qualified caregivers.
Given the deep-rooted relationships between many domestic helpers and their employers, formally training these helpers to become specialised caregivers presents a promising solution. This approach not only ensures consistent care but also respects the deep connection between employer and helper, facilitating a smooth transition into a new phase of support and companionship.
Through specialised training, domestic workers can acquire the necessary qualification to provide professional elderly care within a three-month timeframe, while also enhancing their long-term career prospects.
Setting the stage for specialised care In South Africa, the Older Persons Act is clear that caregivers for the elderly must possess formal qualifications to ensure the provision of quality care. Temporary Employment Services (TES) offer a practical solution to this growing need, providing training and up-skilling of helpers to become qualified caregivers. Through focused instruction and hands-on learning, helpers gain formal proficiency in addressing the unique needs of the elderly, including wound care, palliative care, medication management, and mental health support.
The benefits of training domestic helpers Investing in training toward a formal qualification for domestic helpers has broader implications beyond immediate caregiving. For the helpers, it enhances their job prospects and ensures their continued employment security. Importantly, it equips them with the skills needed to navigate the changing terrain of elder care with assurance and proficiency.
In this way, empowering domestic helpers with specialised skills addresses the growing demand for quality elder care while contributing to the professional development and well-being of a dedicated workforce capable of caring for society’s most vulnerable.
The importance of trust and training The combination of trust and training serves as a cornerstone in elder care. The deep-rooted relationships between domestic helpers and their employers provide a foundation of trust and understanding, facilitating effective communication and collaboration.
When coupled with specialised training, these relationships become even more valuable, ensuring that the elderly receive personalised and compassionate care from individuals who genuinely care about their well-being.
TES providers can play a vital role in facilitating this transition, providing the necessary training and support to equip domestic helpers with the skills and knowledge required to become competent caregivers. Accredited training programs ensure that helpers are equipped to handle the challenges and responsibilities associated with elder care.
Benefits for the elderly and their families Beyond the immediate benefits, investing in training for domestic helpers can also contribute to the overall well-being of the elderly population. When the elderly receive care from trusted individuals who are familiar with meeting their specific needs, they are more likely to experience improved quality of life, reduced stress, and increased feelings of security and belonging. This can have a positive impact on their physical and mental health, leading to better overall outcomes.
As the elderly population grows, demand for quality elder care services will only increase. By empowering domestic helpers to take on caregiver roles, it is possible to meet this demand and reduce the strain on families who may be struggling to balance their own responsibilities with the needs of caring for their elderly loved ones.
Benefits for the caregiver and community In addition to the benefits for the elderly and their families, training domestic helpers for specialised elderly care can also have a positive impact on the broader community. Investing in the professional development of domestic helpers contributes to the growth and development of a skilled workforce. This can have long-term economic benefits for the country, as it can help to create jobs and boost the economy.
Training as a caregiver and receiving a formal qualification offers numerous benefits for domestic workers. This training enhances their job security, increases their earning potential, develops new skills, and helps to provide a sense of personal satisfaction and fulfilment. A caregiver qualification can open doors to a wider range of job opportunities, improve career prospects, and provide extensive opportunities for overseas employment.
A care transition that makes sense for everyone Empowering domestic helpers for specialised elderly care is a win-win situation. It addresses the growing demand for quality elder care, ensures continuity of care for the elderly, and provides opportunities for professional advancement for domestic helpers. As South Africa’s population ages, training domestic helpers to become specialised caregivers is a practical and effective approach to addressing the growing need for quality elder care.
This initiative not only benefits the elderly and their families but also empowers domestic workers and contributes to the development of a skilled and qualified caregiving workforce. By recognising the value of caregivers during Carer’s Week, we can highlight the importance of investing in their training and support.
