Day: March 24, 2025

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Beyond the Smile: South Africa Must Prioritise Oral Health as a Public Health Imperative

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Photo by Hush Naidoo Jade Photography on Unsplash

South Africa’s burden of oral diseases is not only inextricably linked to non-communicable diseases but also presents an urgent public health challenge, with rising concern over its impact on mental health.

Oral diseases are a major health concern for many countries and negatively impacts people throughout their lives. Oral diseases lead to pain and discomfort, social isolation and loss of self-confidence, and they are often linked to other serious health issues. And yet, there is no reason to suffer: most oral health conditions are preventable and can be treated in their early stages.

Globally, every year on March 20, World Oral Health Day is commemorated with the aim to empower people with the knowledge, tools, and confidence to secure good oral health.

This year, the Day’s focus shifts to the mind-mouth connection, with the tagline from the FDI World Dental Federation: “A Happy Mouth Is… A Happy Mind”. This campaign aims to raise awareness of how poor oral health can negatively impact quality of life, highlighting the importance of a healthy mouth for mental well-being.

Macelle Erasmus, Head of Expert at Haleon South Africa – a leader in consumer health and self-care, says, “Oral health is not just about bright smiles and good-looking teeth – it is a critical component of overall well-being. In South Africa, the high prevalence of oral diseases, particularly among children and vulnerable communities, reinforces the urgent need for improved oral health education and preventive care.”

Haleon’s leading oral health brands Aquafresh and Sensodyne, are committed to improving oral health education and access across the country.

Over the course of just three months, we have conducted more than 39,000 gum health screenings across 16 clinics. In 2025, our expansion aims to reach 100,000 underserved communities as part of Haleon’s oral health care outreach programs.

According to the South African Dental Association (SADA), 41% of children aged 1-9 years and close to 28% of people aged 5 years and over experienced untreated tooth decay in milk and permanent teeth respectively, while nearly 25% of people aged 15 years and over experienced severe periodontal disease in 2019. The country also saw 1,933 new cases of lip and oral cavity cancer in 2020.

The World Health Organisation’s Global Strategy and Action Plan on Oral Health 2023–2030, explains that oral health encompasses a range of diseases and conditions. The most prevalent public health issues include dental caries, severe periodontal (gum) disease, complete tooth loss (edentulism), oral cancer, oro-dental trauma, noma and congenital malformations such as cleft lip and palate, most of which are preventable.

The main oral diseases and conditions are estimated to affect close to 3.5 billion people worldwide. These conditions combined have an estimated global prevalence of 45%, which is higher than the prevalence of any other NCD.

However, oral diseases and conditions share risk factors common to the leading NCDs, including all forms of tobacco use, harmful alcohol use, high intake of free sugars and lack of exclusive breastfeeding.

The Department of Health’s National Oral Health Policy and Strategy 2024-2034 acknowledges that oral health is poorly integrated in other health programmes, “though it is an integral part of general health.” It further recognises that: “Its role in management and care of communicable diseases, genetic disorders, trauma, injury, and violence is often overlooked.”

This integration is particularly important as more than three million patients are treated in the country’s public primary healthcare facilities annually, at a cost of R650 million. Addressing oral health holistically – within the broader healthcare system – can significantly reduce this burden.

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Can Exercise Help Reduce Survival Disparities in Colon Cancer Survivors?

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Study indicates that higher levels of physical activity may lessen and even eliminate survival disparities.

Photo by Barbara Olsen on Pexels

Physical activity may help colon cancer survivors achieve long-term survival rates similar to those of people in the general population, according to a recent study published by Wiley online in CANCER, a peer-reviewed journal of the American Cancer Society.

Individuals with colon cancer face higher rates of premature mortality than people in the general population with matched characteristics such as age and sex. To assess whether exercise might reduce this disparity, investigators analysed data from two posttreatment trials in patients with stage 3 colon cancer, with a total of 2875 patients who self-reported physical activity after cancer surgery and chemotherapy. The researchers also examined data on a matched general population from the National Center for Health Statistics. For all participants, physical activity was based on metabolic equivalent (MET) hours per week. (Health guidelines recommend 150 minutes of moderate-intensity exercise per week, translating to approximately 8 MET-hours/week.)

In the analysis of data from the first trial (called CALGB 89803), for patients who were alive at three years after cancer treatment, those with <3.0 MET-hours/week had subsequent 3-year overall survival rates that were 17.1% lower than the matched general population, but those with ≥18.0 MET-hours/week had only 3.5% lower subsequent 3-year overall survival rates than the matched general population. In the second trial (CALGB 80702), among patients who were alive at three years, those with <3.0 and ≥18.0 MET-hours/week had subsequent 3-year overall survival rates that were 10.8% and 4.4% lower than the matched general population, respectively.

In pooled analyses of the two trials, among the 1908 patients who were alive and did not have cancer recurrence by year three, those with <3.0 and ≥18.0 MET-hours/week had subsequent 3-year overall survival rates that were 3.1% lower and 2.9% higher than the matched general population, respectively. Therefore, cancer survivors who were tumour-free by year three and regularly exercised achieved even better subsequent survival rates than those seen in the matched general population.

“This new information can help patients with colon cancer understand how factors that they can control—their physical activity levels—can have a meaningful impact on their long-term prognosis,” said lead author Justin C. Brown, PhD, of the Pennington Biomedical Research Center and the Louisiana State University Health Sciences Center. “Also, medical and public health personnel and policymakers are always seeking new ways to communicate the benefits of a healthy lifestyle. Quantifying how physical activity may enable a patient with colon cancer to have a survival experience that approximates their friends and family without cancer could be a simple but powerful piece of information that can be leveraged to help everyone understand the health benefits of physical activity.”

Source: Wiley

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Nearly Half of Depression Diagnoses Could be Considered Treatment-resistant

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Almost half of patients diagnosed with depression classify as being ‘treatment-resistant’ as new research suggests that many don’t respond to multiple antidepressant options.

The new study, published in the British Journal of Psychiatry was led by academics from the University of Birmingham and Birmingham and Solihull Mental Health NHS Foundation Trust. The study found that 48% of patients whose electronic healthcare records reported a diagnosis of depression had tried at least two antidepressants, and 37% had tried four or more different options.

Treatment-resistant depression (TRD) is typically defined as a form of depression that isn’t effectively managed after a patient tries two different antidepressants. There are currently few guidelines for treating TRD.

Patients who experience TRD were also invited to take part in interviews to share their experiences. Patients talked about a “sense of hopelessness” after trying multiple treatment options for the condition, and many shared their frustrations with a “one size fits all” approach to what works with treatment.

PhD researcher Kiranpreet Gill from the School of Psychology at the University of Birmingham and corresponding author of the study said:

“This paper highlights how widespread treatment-resistant depression is among those who are diagnosed with depression. With nearly half of all patients not responding to multiple drug options, we need better treatment options to be able to support patients for whom first line antidepressant medications don’t make a difference.

“Furthermore, the experiences of patients who took part in this study shows that more awareness and options for treating depression when first line antidepressant medications don’t work well is urgently needed.

“There is an irony that the experience of struggling to treat depression is in itself a risk factor for a worsening sense of ‘hopelessness’ as one patient described it. This should be a clarion call to recognise that treatment-resistant depression needs to be factored into clinical decision making and the ongoing support that patients are offered.”

There are increased risks of other psychiatric disorders among those with TRD such as anxiety, self-harm, and personality disorders, and physical health issues such as heart disease. Data analysis suggests that patients with TRD have 35% higher odds of having a personality disorder and 46% higher odds of cardiovascular disease and the combination with qualitative data suggests that patients have multiple and considerable barriers to achieving good health.

Professor Steven Marwaha, Clinical Professorial Fellow at the Institute for Mental Health at the University of Birmingham, a Consultant Psychiatrist at Birmingham and Solihull Mental Health NHS Foundation Trust, and co-author of the study said:

“This study is important as the data demonstrates people with TRD are at a higher risk of a range of poorer outcomes, and that we need better defined care pathways for helping this population, and are in urgent need of developing and testing new treatments for this group.”

Source: University of Birmingham

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Tests on Animals Demonstrate that New Eye Drops can Slow Vision Loss

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Model of PEDF protein alongside the 17-mer and H105A peptides. Amino acid 105, which is changed from histidine in PEDF and the 17-mer peptide to alanine in the H105A peptide, is shown in green.

Researchers at the National Institutes of Health (NIH) have developed eye drops that extend vision in animal models of a group of inherited diseases that lead to progressive vision loss in humans, known as retinitis pigmentosa. The eye drops contain a small fragment derived from a protein made by the body and found in the eye, known as pigment epithelium-derived factor (PEDF). PEDF helps preserve cells in the eye’s retina. A report on the study is published in Communications Medicine.

“While not a cure, this study shows that PEDF-based eye drops can slow progression of a variety of degenerative retinal diseases in animals, including various types of retinitis pigmentosa and dry age-related macular degeneration (AMD),” said Patricia Becerra, PhD, chief of NIH’s Section on Protein Structure and Function at the National Eye Institute and senior author of the study. “Given these results, we’re excited to begin trials of these eye drops in people.”

All degenerative retinal diseases have cellular stress in common. While the source of the stress may vary—dozens of mutations and gene variants have been linked to retinitis pigmentosa, AMD, and other disorders—high levels of cellular stress cause retinal cells to gradually lose function and die. Progressive loss of photoreceptor cells leads to vision loss and eventually blindness.

Previous research from Becerra’s lab revealed that, in a mouse model, the natural protein PEDF can help retinal cells stave off the effects of cellular stress. However, the full PEDF protein is too large to pass through the outer eye tissues to reach the retina, and the complete protein has multiple functions in retinal tissue, making it impractical as a treatment. To optimize the molecule’s ability to preserve retinal cells and to help the molecule reach the back of the eye, Becerra developed a series of short peptides derived from a region of PEDF that supports cell viability. These small peptides can move through eye tissues to bind with PEDF receptor proteins on the surface of the retina.

Model of PEDF protein alongside the 17-mer and H105A peptides. Amino acid 105, which is changed from histidine in PEDF and the 17-mer peptide to alanine in the H105A peptide, is shown in green.

In this new study, led by first author Alexandra Bernardo-Colón, Becerra’s team created two eye drop formulations, each containing a short peptide. The first peptide candidate, called “17-mer,” contains 17 amino acids found in the active region of PEDF. A second peptide, H105A, is similar but binds more strongly to the PEDF receptor. Peptides applied to mice as drops on the eye’s surface were found in high concentration in the retina within 60 minutes, slowly decreasing over the next 24 to 48 hours. Neither peptide caused toxicity or other side effects.

When administered once daily to young mice with retinitis pigmentosa-like disease, H105A slowed photoreceptor degeneration and vision loss. To test the drops, the investigators used specially bred mice that lose their photoreceptors shortly after birth. Once cell loss begins, the majority of photoreceptors die in a week. When given peptide eye drops through that one-week period, mice retained up to 75% of photoreceptors and continued to have strong retinal responses to light, while those given a placebo had few remaining photoreceptors and little functional vision at the end of the week.

“For the first time, we show that eye drops containing these short peptides can pass into the eye and have a therapeutic effect on the retina,” said Bernardo-Colón. “Animals given the H105A peptide have dramatically healthier-looking retinas, with no negative side effects.”

A variety of gene-specific therapies are under development for many types of retinitis pigmentosa, which generally start in childhood and progress over many years. These PEDF-derived peptide eye drops could play a crucial role in preserving cells while waiting for these gene therapies to become clinically available.

To test whether photoreceptors preserved through the eye drop treatment are healthy enough for gene therapy to work, collaborators Valeria Marigo, PhD and Andrea Bighinati, PhD, University of Modena, Italy, treated mice with gene therapy at the end of the week-long eye drop regimen. The gene therapy successfully preserved vision for at least an additional six months.  

To see whether the eye drops could work in humans – without actually testing in humans directly – the researchers worked with Natalia Vergara, PhD, University of Colorado Anschutz, Aurora, to test the peptides in a human retinal tissue model of retinal degeneration. Grown in a dish from human cells, the retina-like tissues were exposed to chemicals that induced high levels of cellular stress. Without the peptides, the cells of the tissue model died quickly, but with the peptides, the retinal tissues remained viable. These human tissue data provide a key first step supporting human trials of the eye drops.

Source: NIH/National Eye Institute

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South Africa’s Palliative Care Standards Earn Global Recognition

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The 5th edition of the Standards for Palliative Healthcare Services has achieved a major milestone: it has secured accreditation from the International Society for Quality in Health Care’s External Evaluation Association (IEEA).

This international endorsement reaffirms the commitment of the Association of Palliative Care Centres (APCC) to deliver world-class palliative care.

As the only internationally accredited framework guiding palliative care institutions in South Africa, these Standards play a crucial role in ensuring quality, safety, and compassionate service delivery. Developed through a long-standing partnership between the Association of Palliative Care Centres (APCC) and COHSASA, the Standards have been shaping palliative care excellence since 2005.

The 5th edition—available for free at APCC’s website—features:

 ✔A refined presentation structure for easier navigation

 ✔Removal of outdated or duplicated criteria to streamline compliance

✔Changes in terms of new legislation, particularly as it relates to the POPI act

✔ New essential elements to enhance care quality

Why accreditation matters

According to Warren Oxford-Huggett, National Accreditation Manager for the APCC, earning accreditation requires time, energy and commitment, but the rewards are far-reaching.

He highlights three key benefits:

·       Optimal Community Engagement – Accredited palliative service providers gain increased community trust and support, strengthening relationships between institutions, families, and caregivers. “From a patient perspective, knowing that the organisation that is providing care is accredited puts your mind at ease.” 

·       Better Organisational Performance – Self assessments and internal peer reviews drive higher efficiency, sustainability, credibility and overall service quality. It revolves around the framework that COHSASA sets up.

·       A Culture of Excellence – Accreditation fosters a mindset of continuous improvement, embedding best practices within healthcare teams.

Oxford-Huggett also has a role to encourage more palliative care organisations to join APCC’s current 68-member network, particularly as demand grows for structured palliative care in elderly care facilities. Of the five latest institutions that are currently in the process of joining the APCC, four of them are facilities for the aged.

“The market for new APCC members is increasingly swinging to more aged care facilities. What that will mean in terms of cost of care remains to be seen”, says Oxford-Huggett. “Many elderly care institutions advertise or market palliative care, but seldom is anyone adequately trained. It’s early days but we are looking at developing a collaborative model to help these frail care facilities implement structured, high-quality care at an affordable cost. With rising living expenses and an aging population, we must ensure end-of-life care remains accessible without imposing financial strain.”

Mentorship for success

To assist APCC members in meeting these high standards, APCC offers a structured mentorship programme, led by Oxford-Huggett. This initiative guides members through the compliance process, preparing them for COHSASA’s external review and international accreditation.

APCC member, Helderberg Hospice, based in Somerset West, has just achieved their 6th accreditation, with their first accreditation achieved in May 2006.  Robert de Wet, the CEO of Helderberg Hospice comments: “In addition to focusing on clinical compliance, the accreditation process assesses criteria across the entire organisation, including areas relating to governance, fundraising, administration, and human resources. Subjecting your organisation to an intensive external accreditation process is important as it serves to both affirm the positive aspects of the work we do and simultaneously makes us aware of areas in which we require more focus.” They achieved a 97% score.

Setting the Standard for Palliative Care

Since 2005, 95 APCC members have undergone COHSASA accreditation, with 117 accreditation decisions issued—ranging from full accreditation to graded recognition.

Palliative care focuses on improving quality of life for patients with serious illnesses such as cancer, HIV/AIDS and TB as well as conditions such as COPD, heart and organ failure.  The APCC philosophy of palliative care is the activeholistic care of patients who have received a life-threatening diagnosis. The control of pain, of other symptoms and support for psychosocial and spiritual needs is paramount.

APCC members report that around 90% of palliative care efforts take place in patients’ homes, extending support to loved ones, from diagnosis to after bereavement.

Jacqui Stewart, CEO of COHSASA, affirms:“The international accreditation of this 5th edition confirms that the APCC standards align with global best practices. For over 20 years, the APCC and COHSASA have collaborated to ensure that South Africa’s palliative care remains internationally recognised. COHSASA is committed to driving ongoing improvements in palliative care services.”

The 5th Edition of the Standards for Palliative Healthcare Services is available free of charge from the APCC website: https://apcc.org.za/standards-for-palliative-healthcare-services/

For mentorship details, contact warren@apcc.org.za.

For membership details, visit: Become a Member.