A recent population-based study indicates that among children with cancer, those with obesity at the time of diagnosis may face an elevated risk of dying. The findings are published by Wiley online in CANCER, a peer-reviewed journal of the American Cancer Society.
The retrospective study was based on information from the Cancer in Young People in Canada (CYP-C) database, including all children with newly diagnosed cancer aged 2 to 18 years across Canada from 2001 to 2020. Obesity was defined as age and sex-adjusted body mass index at or above the 95th percentile.
Among 11 291 children with cancer, 10.5% were obese at the time of diagnosis. Investigators assessed 5-year event-free survival (survival free of cancer relapse), as well as overall survival.
Compared with patients without obesity at the time of initial cancer diagnosis, those with obesity had lower rates of 5-year event-free survival (77.5% versus 79.6%) and overall survival (83.0% versus 85.9%).
After adjusting for factors including age, sex, ethnicity, neighbourhood income quintile, treatment era, and cancer categories, obesity at diagnosis was linked with a 16% increase in the risk of relapse and a 29% increase in the risk of death. The negative impact of obesity on prognosis was especially pronounced in patients with acute lymphoblastic leukaemia and brain tumours.
“Our study highlights the negative impact of obesity among all types of childhood cancers. It provides the rationale to evaluate different strategies to mitigate the adverse risk of obesity on cancer outcomes in future trials,” said co–senior author Thai Hoa Tran, MD, of the Centre Hospitalier Universitaire Sainte-Justine, in Montreal. “It also reinforces the urgent need to reduce the epidemic of childhood obesity as it can result in significant health consequences.”
Pancreatic cancer. Credit: Scientific Animations CC BY-SA 4.0
A recent double-blinded, peer-reviewed analysis published in Cancer Letters revealed that an experimental test for pancreatic cancer correctly identified 71% of lab samples compared to only 44% correctly identified by the current gold-standard test.
An experimental blood test for pancreatic cancer that was developed by teams led by VAI Professor Brian Haab, PhD, and Randall E. Brand, MD, a physician-scientist and professor of medicine at the University of Pittsburgh, created the test. This evaluation by a commercial laboratory is an important milestone toward making the test available for patients.
Before the new test can be used by doctors to diagnose cancer, it must undergo clinical validation. During this process, a CLIA-accredited diagnostics laboratory adapts the experimental test into a version that reliably works under the strict conditions in a clinical lab. CLIA is a rigorous federal standard that ensures lab quality.
“Validation studies are essential for transforming a test developed in an academic lab into one that is used to diagnose real people,” Haab said. “For a person being evaluated for pancreatic cancer, the stakes are high. Validation studies ensure that new tests work as intended.”
The new test works by detecting two sugars — CA199.STRA and CA19-9 — that are produced by pancreatic cancer cells and escape into the bloodstream. CA19-9 is the current gold-standard biomarker for pancreatic cancer. Haab’s lab identified CA199.STRA as a cancer biomarker and developed the technology to detect it.
The new test also greatly reduced the number of false negatives while maintaining a low false positive rate, according to the recent analysis. Low rates of false positives and false negatives are important because they reflect the test’s ability to correctly identify the presence or absence of cancer.
Clinical validation of the test will be conducted by ReligenDx, a CLIA-accredited diagnostics lab based in Pennsylvania. The process is expected to take two years.
If successful in clinical validation, Haab envisions the test being used in two main ways: 1. Catching pancreatic cancer more quickly in people at high risk of the disease, which would enable earlier treatment and 2. Monitoring progression and treatment response in people diagnosed with pancreatic cancer.
Researchers have uncovered how specialised cells surrounding small blood vessels, known as perivascular cells, contribute to blood vessel dysfunction in chronic diseases such as cancer, diabetes and fibrosis. The findings, published today in Science Advances, could change how these diseases are treated.
This new study from Oregon Health & Science University shows that perivascular cells sense changes in nearby tissues and send signals that disrupt blood vessel function, worsening disease progression. It was led by he study, led by OHSU’s Luiz Bertassoni, DDS, PhD.
Nearly a decade ago, Bertassoni and his team developed a method to 3D print blood vessels in the lab, a major breakthrough. Since then, they’ve focused on engineering blood vessels that better mimic those in the human body to study more complex diseases.
“Historically, endothelial cells lining blood vessels have been considered the main contributors of vascular disease,” Bertassoni said. “Our findings represent a paradigm shift, showing how perivascular cells, instead, act as important sentinels. They detect changes in tissues and coordinating vascular responses. This opens the door to entirely new treatment strategies.”
Cristiane Miranda Franca, DDS, PhD, the study’s lead author, said: “The applications of this research are wide. We’ve shown for the first time how perivascular cells trigger inflammation and signal blood vessel changes when surrounding tissues are altered.”
The study used an innovative “blood vessel on-a-chip” model developed by Christopher Chen, MD, PhD, and his team from Boston University and the Wyss Institute at Harvard, who are collaborators on this project. By replicating conditions like tissue stiffening and scarring – common in aging, chronic diseases and cancer – the researchers discovered that perivascular cells drive blood vessel leakage and distortion, worsening inflammation and disease.
“When we removed perivascular cells, blood vessels essentially failed to respond to tissue changes,” Franca said.
The findings shed light on the relationship between the extracellular matrix, blood vessel function and disease progression. Perivascular cells could become targets for therapies aimed at restoring normal vascular function and reducing the progression of various diseases such as fibrosis, diabetes and cancer.
Importantly, the research also holds promise for cancer prevention and early intervention. Early detection and treatment of changes in these cells could help stop tumours before they grow.
“If we intervene early, we might prevent precancerous lesions from advancing to full-blown cancer,” Bertassoni said. “This could revolutionise how we approach cancer prevention and treatment.”
By Dr Yaseen Khan, co-founder and CEO of digital healthcare platform EMGuidance
As South Africa grapples with healthcare costs that consistently outpace inflation, medical aids recently announcing price increases of 10% or more this year, and the proposed National Health Insurance (NHI) estimated to cost as much as R1.3 trillion, the need for innovative solutions has become increasingly urgent.
While much attention in health innovation has focused on specialised solutions and hospital services, evidence points to an underutilised solution: robust primary healthcare (PHC) enhanced by digital innovation. This approach could meaningfully impact the chronic disease prevalence in our country through adequate early diagnosis and preventative treatment using tech and other digital tools. Also, it’s important to bear in mind that managing chronic conditions accounts for the majority of healthcare costs, especially for non-communicable diseases.
The current reactive approach to healthcare is proving unsustainable. Recent data from the Council for Medical Schemes shows that South African medical schemes spend nearly 40% of their resources on hospital-based care, approximately 30% on specialists and downstream care, while less than 10% goes to preventive and primary care services.
In addition, given increasing medical aid costs, more people are opting for low-cost health insurance products that serve primary needs without (or with limited) hospital cover. Recent estimates show that there are now about 1.5 million policyholders using low-cost insurance offerings.
The World Health Organization (WHO) estimates that scaling up primary healthcare interventions across low and middle-income countries could save 60 million lives and increase average life expectancy by 3.7 years by 2030, calling it “the most inclusive, equitable, cost-effective and efficient approach to enhance people’s physical and mental health”.
In addition, it has urged governments and health authorities to refocus and re-strategise on what PHC should be, while innovating to “harness current and future technological advances; and, ultimately, return to and strengthen the human connection between health providers and those they serve”.
GPs are also struggling under large patient loads, as well as trying to juggle the varying requirements of medical aids, multiple digital platforms and networks, and trying to do the best for their patients, optimising for both their health and their pockets, while also keeping track of local public health matters such as vaccine drives and infection screening programmes. This leaves very little time for basic cardiovascular or cancer screening in patients who are high-risk, for instance.
All of this is a starting point for a coordinated and guided digital platform where doctors can get the best out of the system for each patient – choosing the right medicine for them and selecting what the scheme will cover, referring them to the right network hospital, selecting the right network specialist, and really maximising primary healthcare by supporting clinical behaviour tuned to identifying chronic disease and ensuring that high-risk patients are managed aggressively. It’s what “prevention is better than cure” looks like, and will save costs for patients, medical schemes and even the government over the long term.
Both private healthcare providers and medical schemes stand to gain significantly from lower hospital admission rates, a reduction in specialist visits, and better chronic disease management. Proven digital health solutions could also be scaled nationally to assist the NHI with optimised resource allocation, and the implementation of successful preventive care models.
To maximise benefits, several key elements will have to be prioritised in terms of infrastructure development: we need secure digital platforms that integrate existing healthcare systems and portals, and the development of user-friendly interfaces. The goal is to deliver a platform that will make life easier for busy GPs, ease the friction for patients, healthcare practitioners (HCPs) and schemes alike when it comes to managing benefits, and produce better health outcomes at a lower cost.
For South Africa’s healthcare sector, the combination of strengthened primary care and digital innovation presents a compelling opportunity to contain costs while improving care quality. With non-communicable diseases accounting for 55.7% of all deaths in South Africa, and diabetes alone costing the country R2.7 billion annually, the economic case for prevention and early intervention is clear.
Solving for digital adoption among local healthcare providers is fundamental. Providers are overrun with multiple different systems and portals, so simplification of practice systems through integration, enhancing user-friendliness, leveraging systems that are already used, and mobile capabilities is key. A single platform that facilitates co-ordination and collaboration among the various stakeholders in the health sector holds enormous benefits for providers, schemes and patients alike.
The private sector’s experience with digital health solutions and preventive care could also provide valuable insights for both the public and private healthcare sectors, helping to shape a more efficient and sustainable healthcare system for all South Africans. The challenge now lies in accelerating this digital transformation, while ensuring that the human element of healthcare remains central to service delivery.
The soft, gentle murmurs of a baby’s first expressions, like little whispers of joy and wonder to doting parents, are actually signs that the baby’s heart is working rhythmically in concert with developing speech.
Jeremy I. Borjon, University of Houston assistant professor of psychology, reports in Proceedings of the National Academy of Sciences that a baby’s first sweet sounds and early attempts at forming words are directly linked to the baby’s heart rate. The findings have implications for understanding language development and potential early indicators of speech and communication disorders.
For infants, producing recognisable speech is more than a cognitive process. It is a motor skill that requires them to learn to coordinate multiple muscles of varying function across their body. This coordination is directly linked to ongoing fluctuations in heart rate.
Borjon investigated whether these fluctuations in heart rate coincide with vocal production and word production in 24-month-old babies. He found that heart rate fluctuations align with the timing of vocalizations and are associated with their duration and the likelihood of producing recognisable speech.
“Heart rate naturally fluctuates in all mammals, steadily increasing then decreasing in a rhythmic pattern. It turns out infants were most likely to make a vocalisation when their heart rate fluctuation had reached a local peak (maximum) or local trough (minimum),” reports Borjon.
“Vocalisations produced at the peak were longer than expected by chance. Vocalisations produced just before the trough, while heart rate is decelerating, were more likely to be recognised as a word by naïve listener,” he said.
Borjon and team measured a total of 2708 vocalisations emitted by 34 infants between 18 and 27 months of age while the babies played with a caregiver. Infants in this age group typically don’t speak whole words yet, and only a small subset of the vocalisations could be reliably identified as words by naïve listeners (10.3%). For the study, the team considered the heart rate dynamics of all sounds made by the baby’s mouth, be it a laugh, a babble or a coo.
“Every sound an infant makes helps their brain and body learn how to coordinate with each other, eventually leading to speech,” Borjon said.
As infants grow, their autonomic nervous system grows and develops. The first few years of life are marked by significant changes in how the heart and lungs function, and these changes continue throughout a person’s life.
The relationship between recognisable vocalisations and decelerating heart rate may imply that the successful development of speech partially depends on infants experiencing predictable ranges of autonomic activity through development.
“Understanding how the autonomic nervous system relates to infant vocalisations over development is a critical avenue of future research for understanding how language emerges, as well as risk factors for atypical language development,” said Borjon
