The Hospital Association of South Africa (HASA) remains unequivocally committed to working with all stakeholders to build a healthcare system that sustainably benefits all citizens of South Africa and urges all involved parties to engage in a solution-oriented approach.
HASA believes the National Health Insurance is neither sustainable nor affordable and that dialogue and collaboration between all stakeholders is critical to finding and developing solutions to achieve universal health coverage.
HASA has thus far deferred filing a legal challenge to the NHI Act as it firmly believes that sustainable and affordable solutions, to achieve universal health coverage for all South Africans, are within reach. However, the government’s lack of response to several constructive and practical proposals, including those of Business Unity South Africa (BUSA), and the Minister of Health’s recent public statements concerning the NHI, including regarding the imminent publication of NHI regulations, have necessitated that HASA move forward with its legal challenge to the NHI legislation.
Even though HASA has decided to proceed with legal action, it remains hopeful that the Presidency will respond positively to the constructive proposals that have been made.
HASA remains open to engaging with the Government on the way forward in parallel to the legal process. Reiterating the time-critical nature of the matter, Melanie Da Costa, Chairperson of HASA, today said, “We remain firmly committed to participating constructively while the legal process unfolds. As an organisation, we have always preferred to resolve matters through dialogue, and we believe that effective healthcare solutions are urgently needed and achievable through a reasonable and collaborative approach.”
Ischaemic and haemorrhagic stroke. Credit: Scientific Animations CC4.0
A new study by researchers at the Department of Molecular Medicine at SDU sheds light on one of the most severe consequences of stroke: damage to nerve fibres – the brain’s “cables” – which leads to permanent impairments. The study, which is published in the Journal of Pathology, used unique tissue samples from Denmark’s Brain Bank located at SDU, may pave the way for new treatments that help the brain repair itself.
The brain tries to repair damage
Following an injury, the brain tries to repair the damaged nerve fibres by re-establishing their insulating myelin sheaths. Unfortunately, the repair process often succeeds only partially, meaning many patients experience lasting damage to their physical and mental functions. According to Professor Kate Lykke Lambertsen, one of the study’s lead authors, the brain has the resources to repair itself. “We need to find ways to help the cells complete their work, even under difficult conditions,” Prof Lykke said.
The researchers have thus focused on how inflammatory conditions hinder the rebuilding. The study has identified a particular type of cell in the brain that plays a key role in this process. These cells work to rebuild myelin, but inflammatory conditions often block their efforts.
How researchers used the brain collection
-Using the brain collection, we can precisely map which areas of the brain are most active in the repair process, explains Professor Kate Lykke Lambertsen.
This mapping has enabled researchers to analyse tissue samples from Denmark’s Brain Bank and gain a deeper understanding of the mechanisms that control the brain’s ability to heal itself.
Through advanced staining techniques, known as immunohistochemistry, the researchers have been able to detect specific cells that play a central role in the reconstruction of myelin in the damaged areas of the brain.
The samples were analysed to distinguish between different areas of the brain, including the infarct core (the most damaged area), the peri-infarct area (surrounding tissue where rebuilding is active), and tissue that appears unaffected.
The analysis provided insight into where repair cells accumulate and how their activity varies depending on gender and time since the stroke.
Women and men react differently
An interesting discovery in the study is that women’s and men’s brains react differently to injuries.
-The differences underscore the importance of future treatments being more targeted and taking into account the patient’s gender and individual needs, says Kate Lykke Lambertsen.
In women, it seems that inflammatory conditions can prevent cells from repairing damage, while men have a slightly better ability to initiate the repair process. This difference may explain why women often experience greater difficulties after a stroke.
The brain collection at SDU is key to progress
The researchers behind the study emphasise that the discoveries could not have been made without the Danish Brain Bank at SDU. The collection consists of tissue samples from humans, used to understand brain diseases at a detailed level.
With access to this resource, researchers can investigate the mechanisms behind diseases like stroke and develop new treatment strategies.
Researchers have found that a newly developed diet inspired by the eating habits of non-industrialised societies can significantly reduce the risk of a number of chronic diseases typical of processed, low-fibre industrialised diets – and are to share recipes with the public.
Their paper, published in Cell, shows that a newly developed diet that mimics eating habits in non-industrialised communities led to significant metabolic and immunological improvements in a human intervention study. In just three weeks the diet:
Promoted weight loss
Decreased bad cholesterol by 17%
Reduced blood sugar by 6%
Reduced C-reactive Protein (a marker of inflammation and heart disease) by 14%
These improvements were linked to beneficial changes in the participants’ gut microbiome, the home to trillions of bacteria that play a vital role in our health, influencing digestion, immunity, and metabolism. The research was conducted by an international teams of scientists led by Professor Jens Walter, a leading scientist at University College Cork. The human trial was performed at the University of Alberta in Canada, Prof Walter’s previous institution.
“Industrialisation has drastically impacted our gut microbiome, likely increasing the risk of chronic diseases.” explained Prof Walter, who is also a Principal Investigator at APC Microbiome Ireland, a world-renowned Research Ireland centre
“To counter this, we developed a diet that mimics traditional, non-industrialised dietary habits and is compatible with our understanding on diet-microbiome interactions. In a strictly controlled human trial, participants followed this diet and consumed L. reuteri, a beneficial bacterium prevalent in the gut of Papua New Guineans but rarely found in the industrialised microbiomes.”
The study demonstrated that the new diet entitled NiMeTM (Non-industrialised Microbiome Restore) diet enhanced short-term persistence of L. reuteri in the gut.
However it also improved microbiome features damaged by industrialisation, such as reducing pro-inflammatory bacteria and bacterial genes that degrade the mucus layer in the gut. These changes were linked to improvements in cardiometabolic markers of chronic disease risk.
Although participants did not consume fewer calories on the NiMe diet, they lost weight, and the diet alone led to considerable cardiometabolic benefits.
In previous research, Prof Walter’s team, studying the gut microbiome in rural Papua New Guinea, found that individuals there have a much more diverse microbiome, enriched in bacteria that thrive from dietary fibre, and with lower levels of pro-inflammatory bacteria linked to western diet. This information was used to design the NiMeTM diet.
The NiMeTM diet shares key characteristics of non-industrialised diets:
Plant-based focus, but not vegetarian: Primarily made up of vegetables, legumes, and other whole-plant foods. One small serving of animal protein per day (salmon, chicken, or pork).
No dairy, beef, or wheat: Excluded simply because they are not part of the traditional foods consumed by rural Papua New Guineans.
Very low in processed foods that are high in sugar and saturated fat.
Fibre-rich: Fibre content was 22 grams per 1000 calories – exceeding current dietary recommendations.
“Everybody knows that diet influences health, but many underestimate the magnitude”, said Prof. Walter.
Commenting on this study, Prof. Paul Ross, Director of APC Microbiome Ireland, said: “This study shows that we can target the gut microbiome through specific diets to improve health and reduce disease risk. These findings could shape future dietary guidelines and inspire the development of new food products and ingredients, as well as therapeutics, which target the microbiome”.
“The recipes from the NiMe Diet will be posted to our Instagram ( @nimediet ) and Facebook pages, and they will also be included in an online cookbook soon. It is important to us to make these recipes freely available so that everyone can enjoy them and improve their health by feeding their gut microbiome,” said Dr Anissa Armet from the University of Alberta, a registered dietitian that designed the NiMe diet and one of the lead authors of the publication.
Antibiotics, antivirals, vaccinations and anti-inflammatory medication are associated with reduced risk of dementia, according to new research that looked at health data from over 130 million individuals.
The study, led by researchers from the universities of Cambridge and Exeter, identified several drugs already licensed and in use that have the potential to be repurposed to treat dementia.
Dementia is a leading cause of death in the UK and can lead to profound distress in the individual and among those caring for them. It has been estimated to have a worldwide economic cost in excess of US$1 trillion dollars.
Despite intensive efforts, progress in identifying drugs that can slow or even prevent dementia has been disappointing. Until recently, dementia drugs were effective only for symptoms and have a modest effect. Recently, lecanemab and donanemab have been shown to reduce the build-up in the brain of amyloid plaques – a key characteristic of Alzheimer’s disease – and to slow down progression of the disease, but the National Institute for Health and Care Excellence (NICE) concluded that the benefits were insufficient to justify approval for use within the NHS.
Scientists are increasingly turning to existing drugs to see if they may be repurposed to treat dementia. As the safety profile of these drugs is already known, the move to clinical trials can be accelerated significantly.
Dr Ben Underwood, from the Department of Psychiatry at the University of Cambridge and Cambridgeshire and Peterborough NHS Foundation Trust, said: “We urgently need new treatments to slow the progress of dementia, if not to prevent it. If we can find drugs that are already licensed for other conditions, then we can get them into trials and – crucially – may be able to make them available to patients much, much faster than we could do for an entirely new drug. The fact they are already available is likely to reduce cost and therefore make them more likely to be approved for use in the NHS.”
In a study published today in Alzheimer’s and Dementia: Translational Research & Clinical Interventions, Dr Underwood, together with Dr Ilianna Lourida from the University of Exeter, led a systematic review of existing scientific literature to look for evidence of prescription drugs that altered the risk of dementia. Systematic reviews allow researchers to pool several studies where evidence may be weak, or even contradictory, to arrive at more robust conclusions.
In total, the team examined 14 studies that used large clinical datasets and medical records, capturing data from more than 130 million individuals and 1 million dementia cases. Although they found a lack of consistency between studies in identifying individual drugs that affect the risk of dementia, they identified several drug classes associated with altered risk.
One unexpected finding was an association between antibiotics, antivirals and vaccines, and a reduced risk of dementia. This finding supports the hypothesis that common dementias may be triggered by viral or bacterial infections, and supports recent interest in vaccines, such as the BCG vaccine for tuberculosis, and decreased risk of dementia.
Anti-inflammatory drugs such as ibuprofen were also found to be associated with reduced risk. Inflammation is increasingly being seen to be a significant contributor to a wide range of diseases, and its role in dementia is supported by the fact that some genes that increase the risk of dementia are part of inflammatory pathways.
The team found conflicting evidence for several classes of drugs, with some blood pressure medications and anti-depressants and, to a lesser extent, diabetes medication associated with a decreased risk of dementia and others associated with increased risk.
Dr Ilianna Lourida from the National Institute for Health and Care Research Applied Research Collaboration South West Peninsula (PenARC), University of Exeter, said: “Because a particular drug is associated with an altered risk of dementia, it doesn’t necessarily mean that it causes or indeed helps in dementia. We know that diabetes increases your risk of dementia, for example, so anyone on medication to manage their glucose levels would naturally also be at a higher risk of dementia – but that doesn’t mean the drug increases your risk.
“It’s important to remember that all drugs have benefits and risks. You should never change your medicine without discussing this first with your doctor, and you should speak to them if you have any concerns.”
The conflicting evidence may also reflect differences in how particular studies were conducted and how data was collected, as well as the fact that different medications even within the same class often target different biological mechanisms.
The UK government is supporting the development of an Alzheimer’s trial platform to evaluate drugs rapidly and efficiently, including repurposed drugs currently used for other conditions.
“Pooling these massive health data sets provides one source of evidence which we can use to help us focus on which drugs we should try first,” said Dr Underwood. “We’re hopeful this will mean we can find some much-needed new treatments for dementia and speed up the process of getting them to patients.”
Whether or not the ANC and DA can find common ground on the future of medical schemes is set to be a major test of South Africa’s Government of National Unity. Ahead of a Cabinet lekgotla where the issue is expected to be on the agenda, momentum has been gathering behind a compromise option.
Little more than a month after President Cyril Ramaphosa signed the National Health Insurance (NHI) Act into law in May last year, the ANC entered into a government of national unity (GNU) following a large drop in their share of the vote in South Africa’s 2024 elections. This raised questions over the future of NHI, given that the second largest party in the GNU, the DA, is vehemently opposed to NHI.
The NHI Act has not yet been promulgated and could be amended if the ANC and DA agree to do so. But whether the parties can agree to a compromise remains unclear, especially since there appears to be a hardline faction in the ANC that is committed to NHI as currently encapsulated in the NHI Act. As it stands, the Act foresees a dramatically reduced role for medical schemes whereby they will not be allowed to cover services that are already covered by the NHI fund.
Also in play are at least four High Court challenges to NHI legislation – by the Board of Healthcare Funders (BHF) challenging Ramaphosa’s assent to the NHI Bill just before the elections last year, Solidarity, and the SA Private Practitioners Forum, both claiming government overreach which impacts on people’s right to choose their own health cover and run their own businesses. The South African Medical Association (SAMA) is also preparing a legal challenge.
Two proposals
Meanwhile, momentum has been growing with two compromise proposals: one from Business Unity South Africa (BUSA), the country’s apex business organisation broadly representing the banking, mining and retail sectors, but more pertinently here, the Health Funders Association, the Hospital Association of South Africa, and the Innovative Pharmaceuticals Association of SA. The other is from the United Healthcare Access Coalition (UHAC), a large coalition of healthcare worker groups including, among others, SAMA, the South African Private Practitioners Forum, and the Progressive Healthcare Forum.
BUSA last year met with Ramaphosa and, on his request, provided a detailed yet currently “confidential” proposal, wanting key sections of the NHI Act amended and/or thrown out to enable medical schemes to remain in play by punting mandatory health insurance.
“The BUSA proposal is being processed by the Department of Health and National Treasury. Once processed, a response to BUSA will be formulated accordingly,” presidential spokesperson Vincent Magwenya told Spotlight this week.
The fundamental difference between the two objecting groups is that the UHAC thinks the NHI Act should be thrown out completely and replaced with their detailed blueprint, while BUSA wants the existing Act amended to accommodate private funders. In its proposal, the UHAC urges implementation of long delayed fundamental systemic reform in both healthcare sectors to enable what they say would be efficient, pragmatic and more politically neutral, consultation-driven universal healthcare measures.
We understand that in a meeting between the two groups, shortly before BUSA lodged its proposal with the Presidency, not enough common ground could be found to join forces.
But there are significant overlaps in their proposals. Both groupings embrace mandatory health insurance and dismiss a single central fund as envisaged under NHI as dangerous and financially unfeasible.
DA spokesperson for health, Michelle Clarke, said her party backs mandatory insurance. She also said the party agrees with the UHAC proposals – and would not hesitate to mount a legal challenge should the NHI go ahead without substantial amendments.
Mandatory health insurance was part of government’s longer term health reform plans until the pendulum swung in favour of NHI at the ANC’s national conference in Polokwane in 2007 when Jacob Zuma became president of the party. The idea was placed back in the spotlight last September when Dr Richard Friedland, immediate past CEO of the Netcare Hospital Group and a key member of BUSA’s health delegation, made the case for it at the HASA conference.
Under mandatory health insurance, everyone who is in formal employment, or who earns above a certain threshold, would be forced by law to be a member of a medical scheme. This, it is argued, would result in medical scheme membership swelling substantially and pressure being taken off the public healthcare system. It is also expected to result in medical scheme premiums being reduced because more healthy, younger people will join the schemes. People who are unemployed or who cannot afford health insurance will still be taken care of by the public healthcare system, which would also take paying medical aid members.
Friedland said at the time that mandatory healthcare insurance would triple the medical scheme market from 9.2 million to potentially 27.5 million beneficiaries over time and reduce those dependent on the state from 53.8 million to 35.5 million.
This week Friedland declined to reveal the contents of the BUSA proposal, saying it was with Ramaphosa and thus confidential.
Meanwhile, Health Minister Dr Aaron Motsoaledi last week rubbished media reports that the cabinet lekgotla scheduled for month end would be taking on board the BUSA proposal. He did however confirm that he will shortly announce which of the far-ranging and long-outstanding recommendations of the Competition Commission’s Health Market Inquiry (HMI) into the private healthcare sector will be implemented, something many have been calling for in recent years.
Far-reaching reforms
Adjunct Professor Alex van den Heever, Chair of Social Security Systems Administration and Management Studies at the University of the Witwatersrand, who with Dr Aslam Dasoo, founder and chair of the Progressive Health Forum, forms part of the UHAC, said their fundamental point of departure is that the status quo is unacceptable.
According to the UHAC report, irregular provincial health expenditure levels provide a proxy indicator for corruption. The combined irregular expenditure for eight of the nine provinces from 2017/18 to 2022/23 consistently averages around 12.3% (around R9 billion per annum) of non-personnel expenditure compared to 0.1% for the DA-run Western Cape.
“The difference in performance between the Western Cape and the other eight provinces is reasonably attributable to governance differences,” the report reads.
Observes Van den Heever: “We’re losing an enormous amount of performance in the public sector because of political appointments into the system. It compromises leadership and results in a massive waste of resources. The Western Cape shows you the difference governance can make.”
He said that in the “dismally” regulated private sector, funding the pooling system was identified as a problem even before 1994, “but you don’t now disrupt the system to amalgamate into a monopoly fund to solve this (i.e. NHI). Risk equalisation would force medical schemes to compete on the value of what they cover, and nobody would be discriminated against in accessing healthcare.”
Van den Heever says the NHI intention to increase taxes and move funding money from the private to the public sector is “unworkable”.
He added: “The way to address pooling problems is to separate pooling from purchasing. The NHI process has pooling and purchasing in the same organisation, centralising everything – which is highly inefficient, unworkable and with negative consequences all the way through.
“The UHAC proposal separates them out with the provinces and medical schemes remaining as purchasers while strategic pooling or resource allocation is a national function. So, risk equalisation and taxation form part of strategic national pooling functions, while the purchasing and provision of health services are protected from political appointments – including national ministers and provincial MECs.”
Dasoo, who is also a founder member of trade union NEHAWU, said the UHAC collaborative proposal draws on all the research developed over several decades including the Taylor Commission, which made recommendations on an effective social security system for South Africa, the HMI, and numerous other official inquiries.
Dasoo described the UHAC report as “everything that the NHI is not. This health pathway requires easy legislative changes and is within current fiscal constraints. We can start the process immediately. It requires a change in governance structure of the provincial health systems where politicians relinquish all direct authority they have over health care institutions and instead focus on strategic policy.”
BHF hearing in March
A spokesperson for the BHF, Zola Mtshiya, confirmed their NHI legal challenge, set for hearing in March, but said the BHF was only invited to sign up to the UHAC proposal after it was made public. The BHF represents most medical aid schemes – except for the largest, Discovery Health.
BHF Managing Director, Dr Katlego Mothudi, said his organisation is “engaging the association [UHAC] on the document”. he added: “We welcome the willingness to collaborate as an industry as strengthening health systems is everybody’s business.”
Cabinet lekgotla next week
Despite all these developments, whether the ANC is open to a potential compromise on NHI remains unclear. On the one hand, the presidency says they have asked Treasury and the Department of Health to consider the BUSA proposal, on the other, Motsoaledi has rubbished suggestions that the ANC’s position on NHI has shifted and appears committed to an NHI system that dramatically limits the role of medical schemes. His position is thus incompatible with that of the DA.
According to media reports, things got very heated between Motsoaledi and DA ministers when NHI and the future role of medical schemes were discussed at a Cabinet meeting last October.
The matter is likely to again be on the agenda at the Cabinet lekgotla set to take place next week.
Asked about how the GNU might eventually influence universal healthcare, Clarke said: “ANC arrogancy has tapered down a lot compared to what I’m used to. There’s a lot more transparency – but we cannot allow for a very badly written law with huge implications for people’s lives and the economy to go ahead.”
Foster Mohale, spokesperson for the national health department, declined to provide comment for this article, referring Spotlight to the Presidency and Motsoaledi. “What I can say is we’re still working on the Health Market Inquiry recommendations and will let you know when there’s an announcement,” he said.
Magwenya did not provide responses to most of Spotlight’s questions, other than saying that both Treasury and the health department are considering the BUSA proposal and confirming that the President had met with BUSA.
A brain-computer interface, surgically placed in a research participant with tetraplegia, paralysis in all four limbs, provided an unprecedented level of control over a virtual quadcopter – just by thinking about moving his unresponsive fingers.
The technology divides the hand into three parts: the thumb and two pairs of fingers (index and middle, ring and small). Each part can move both vertically and horizontally. As the participant thinks about moving the three groups, at times simultaneously, the virtual quadcopter responds, manoeuvring through a virtual obstacle course.
It’s an exciting next step in providing those with paralysis the chance to enjoy games with friends while also demonstrating the potential for performing remote work.
“This is a greater degree of functionality than anything previously based on finger movements,” said Matthew Willsey, U-M assistant professor of neurosurgery and biomedical engineering, and first author of a new research paper in Nature Medicine. The testing that produced the paper was conducted while Willsey was a researcher at Stanford University, where most of his collaborators are located.
While there are noninvasive approaches to allow enhanced video gaming such as using electroencephalography to take signals from the surface of the user’s head, EEG signals combine contributions from large regions of the brain. The authors believe that to restore highly functional fine motor control, electrodes need to be placed closer to the neurons. The study notes a sixfold improvement in the user’s quadcopter flight performance by reading signals directly from motor neurons vs. EEG.
To prepare the interface, patients undergo a surgical procedure in which electrodes are placed in the brain’s motor cortex. The electrodes are wired to a pedestal that is anchored to the skull and exits the skin, which allows a connection to a computer.
“It takes the signals created in the motor cortex that occur simply when the participant tries to move their fingers and uses an artificial neural network to interpret what the intentions are to control virtual fingers in the simulation,” Willsey said. “Then we send a signal to control a virtual quadcopter.”
A screenshot of the game display shows the quadcopter following a green path around the rings. The inset shows a hand avatar. The neural implant records from nearby neurons and algorithms determine the intended movements for the hand avatar. The finger positions are then used to control the virtual quadcopter. Image credit: Nature Medicine
The research, conducted as part of the BrainGate2 clinical trials, focused on how these neural signals could be coupled with machine learning to provide new options for external device control for people with neurological injuries or disease. The participant first began working with the research team at Stanford in 2016, several years after a spinal cord injury left him unable to use his arms or legs. He was interested in contributing to the work and had a particular interest in flying.
“The quadcopter simulation was not an arbitrary choice, the research participant had a passion for flying,” said Donald Avansino, co-author and computer scientist at Stanford University. “While also fulfilling the participant’s desire for flight, the platform also showcased the control of multiple fingers.”
Co-author Nishal Shah, incoming professor of electrical and computer engineering at Rice University, explained, “controlling fingers is a stepping stone; the ultimate goal is whole body movement restoration.”
Jaimie Henderson, a Stanford professor of neurosurgery and co-author of the study, said the work’s importance goes beyond games. It allows for human connection.
“People tend to focus on restoration of the sorts of functions that are basic necessities – eating, dressing, mobility – and those are all important,” he said. “But oftentimes, other equally important aspects of life get short shrift, like recreation or connection with peers. People want to play games and interact with their friends.”
A person who can connect with a computer and manipulate a virtual vehicle simply by thinking, he says, could eventually be capable of much more.
“Being able to move multiple virtual fingers with brain control, you can have multifactor control schemes for all kinds of things,” Henderson said. “That could mean anything, from operating CAD software to composing music.”
Antibiotic overuse is a key driver in the rise of antimicrobial resistance (AMR), a major global health crisis. Researchers from the Yong Loo Lin School of Medicine, National University of Singapore (NUS Medicine) and Duke-NUS Medical School have provided compelling evidence that short-course antibiotic treatments can be a game-changer in tackling ventilator-associated pneumonia (VAP), a serious infection common in critically ill patients.
The findings from the landmark REGARD-VAP trial, published in Lancet Respiratory Medicine, and the accompanying economic analyses published in Lancet Global Health, highlight how prudent antibiotic use can curb resistance, effectively safeguarding patients as well as combatting the global threat of antimicrobial resistance while reducing healthcare costs.
Led by the NUS Medicine research team, the clinical trial examined over 450 patients across intensive care units (ICUs) in Singapore, Thailand, and Nepal. Results revealed that short-course antibiotics. carefully tailored to individual patients’ recovery, are just as effective as traditional longer treatments in preventing death and recurrence of pneumonia. “By shortening the duration of antibiotics, we can reduce the risks of side effects and resistance without compromising patient outcomes,” added Dr Mo Yin, Junior Academic Fellow at the Department of Medicine, NUS Medicine, and principal investigator of the clinical trial, and co-author of the economic analysis.
The economic analyses accompanying the trial were just published in the prestigious journal Lancet Global Health. They demonstrated that adopting short-course antibiotics offers significant value for healthcare systems. In Singapore, the strategy is cost-saving, reducing hospital expenditure while maintaining excellent outcomes for patients. In Thailand and Nepal, short-course antibiotics were highly cost-effective, with health gains outweighing the modest additional costs incurred. “Short-course antibiotics are a pragmatic solution that benefits patients and healthcare systems alike, particularly in resource-limited settings,” said Assistant Professor Yiying Cai, lead researcher from the Health Services and Systems Research Programme at Duke-NUS.
The REGARD-VAP study’s findings have practical implications for hospitals worldwide. Short-course antibiotics can streamline treatment in ICUs, where managing infections efficiently is vital. The approach is effective across high-income (Singapore), middle-income (Thailand), and low-income (Nepal) settings, making it a scalable solution for diverse healthcare systems. These results provide robust evidence including cost-effectiveness data for policymakers to adopt short-course antibiotics into national and institutional guidelines.
The team hopes to disseminate their findings globally to encourage the adoption of short-course antibiotics, particularly in regions with limited resources. They also advocate for integrating cost-effectiveness studies into future clinical trials to strengthen both clinical and economic decision-making processes. By reducing unnecessary antibiotic exposure, short-course treatments help preserve the effectiveness of existing drugs for future generations. Every additional day of antibiotic use increases the risk of drug resistance by 7%. Reducing treatment duration is a critical step in combating this silent epidemic. “Prudent antibiotic use is essential to combat antimicrobial resistance and optimise healthcare outcomes. Our findings make a strong case for adopting short-course antibiotics as the new standard of care,” concluded Dr Mo Yin.
A new study led by University of Arizona researchers in collaboration with fire service partners and other researchers around the country through the Fire Fighter Cancer Cohort Study showed that post-traumatic stress disorder and anxiety are associated with lower levels of anti-Müllerian hormone, a marker of ovarian reserve, among women firefighters.
The ovarian reserve, a measure of fertility, is the number of healthy eggs in a woman’s ovaries that could potentially be fertilised.
“These findings highlight the negative effect that mental health conditions can have on health – specifically, reproductive health,” said first author Michelle Valenti, MPH, a doctoral student in epidemiology at the Zuckerman College of Public Health and program coordinator of the Fire Fighter Cancer Cohort Study’s Women Firefighter Studies.
Firefighters are exposed to high stress and traumatic situations in addition to chemical exposures and have a higher prevalence of PTSD compared with the general population. Previous research showed that women firefighters have lower levels of anti-Müllerian hormone compared with women who are not firefighters; however, the reason why was unknown.
The research team, which included personnel at the Zuckerman College of Public Health’s Center for Firefighter Health Collaborative Research, led this analysis to determine whether anxiety, depression or PTSD were associated with anti-Müllerian hormone levels. They found that clinical diagnoses of PTSD and anxiety among women firefighters were associated with reductions in anti-Müllerian hormone levels of 66% and 33%, respectively.
These findings highlight a potential mechanism through which adverse mental health conditions could lead to adverse reproductive outcomes. Further research is needed to identify potential areas for intervention.
“The work of this AMH study within the broader context of the FFCCS is imperative to taking care of all of our firefighters,” said Captain Caitlin St. Clair of the Puget Sound Regional Fire Authority. “These findings provide scientific leverage to fire departments to implement programs to reduce stress and improve the lives of our firefighter women.”
The Women Firefighter Study, a subgroup of the Fire Fighter Cancer Cohort Study, aims to identify causes of stress, cancer and adverse reproductive health effects in women firefighters that would inform effective interventions to mitigate these conditions.
“This study demonstrates the power of the Fire Fighter Cancer Cohort Study’s Women Firefighter Study to evaluate exposures that lead to adverse gynaecologic conditions,” Valenti said. “The Women Firefighter Study would not be possible without our amazing fire service partners who have championed women firefighter research.”
Improved understanding of why some infections persist could improve treatment, screening, and vaccination strategies for HPV infection
Non-persistent human papillomavirus (HPV) infections are characterized by a sharp increase in viral load followed by a long plateau, according to a study published January 21st in the open-access journal PLOS Biologyby Samuel Alizon of the National Centre for Scientific Research (CNRS), France, and colleagues.
Chronic HPV infection is responsible for more than 600 000 new cancers each year, including nearly all cervical cancers. Infection among young women is common, impacting nearly 20% of women 25 years of age. Fortunately, the vast majority of these infections clear within two years without symptoms. Still, a better understanding of why some infections clear while others persist could improve treatment, screening, and vaccination strategies for HPV-associated diseases.
To monitor the dynamics of HPV infection, the PAPCLEAR cohort study in France followed 189 women aged 18 to 25 years for up to 24 months. Researchers followed participants every two months, collecting information on viral kinetics and immune markers.
By frequently monitoring participants, the researchers achieved unprecedented temporal resolution on viral and immune kinetics. They found that non-persistent infections are characterised by a plateau in HPV viral load that starts around 2 months after infection and lasts for 13 to 20 months before rapidly declining. Additionally, they found a strong correlation between a population of immune cells in between innate and adaptive immunity, namely TCRγδ cells, and the total amount of viruses produced.
The study is limited by the fact that many of the infection follow-ups were truncated, meaning that the participants were already infected when enrolled or were lost to follow-up before infection clearance. Furthermore, only 4 out of 76 infected participants were followed for 18 months or more. Therefore, differences between chronic and acute infections will have to wait for longer studies.
The authors add, “Asymptomatic genital infections by human papillomaviruses (HPVs) display striking dynamics at the frontier between acute and chronic infections. HPV infections appear to be associated with specific patterns of the innate and adaptative local immune response.”
Source: Paul, et al. 2024, Psychiatric Research and Clinical Practice
New research has identified differing trends in attention-deficit/hyperactivity disorder (ADHD) diagnoses among adolescents and adults, including an increase among adults from 2020 to 2023. The study, published in the American Psychiatric Association Journal Psychiatric Research and Clinical Practice, found a significant downward trends in ADHD incidence among adults from 2016 to 2020 and adolescents from 2016 to 2018. The ADHD incidence rate remained stable for adolescents in subsequent years.
ADHD is a neurodevelopmental disorder involving inattention and/or hyperactivity and impulsivity that interferes with a person’s functioning and ability to perform daily activities, including at school or work. ADHD is often viewed as a condition primarily impacting childhood and adolescence; however, it can also affect adults. Research on the prevalence of ADHD in adults remains limited, with findings varying considerably.
The large retrospective cohort study, conducted by researchers at Saint Louis University and SSM Health, involved more than 140 000 adolescents and adult patients who used services with a large healthcare system located in four states. New ADHD diagnoses were identified using patient charts. Regression analysis was used to determine incidence rates and trends in ADHD diagnoses by age group.
They found a significant downward trend in ADHD incidence among adults from 2016 to 2020 and an upward trend from 2020 to 2023. Among adolescents, a significant downward trend was observed between 2016 and 2018, and the incidence rate remained stable between 2018 and 2023.
“Fluctuations in incidence rates are likely due to a complex interplay of various factors,” the authors write. For example, increased awareness and destigmatisation of ADHD can lead to more diagnoses. Changes in diagnostic criteria, such as the expansion of ADHD criteria in the DSM-5 compared to previous editions, may have contributed to an increase in diagnoses. Variations in diagnostic practices and assessment methods can contribute to differences in incidence rates. In addition, there are some indications, the authors note, that the COVID-19 pandemic may have contributed to new ADHD diagnoses and worsening symptoms.
The authors suggest that this research can support future efforts to identify modifiable risk factors, ensure sufficient treatment resources, develop targeted interventions, and address diagnostic disparities.
