Data from hundreds of thousands of U.S. adults suggests that each zip code increase of 10 µm/m3 in PM2.5 levels is associated with a doubling in eczema rates among residents
Photo by Kouji Tsuru on Pexels
People living in areas with higher levels of air pollution are more likely to have eczema, according to a new study published November 13, 2024 in the open-access journal PLOS ONEby Dr Jeffrey Cohen of Yale School of Medicine, USA.
The prevalence of eczema has increased globally with industrialisation, suggesting a possible contribution from environmental factors. In the new study, researchers used data from the U.S. National Institutes of Health All of Us Research Program, covering hundreds of thousands of U.S. adults. The current study included 286 862 people for whom there was available demographic, zip code and electronic health record data.
Overall, 12 695 participants (4.4%) were diagnosed with eczema. After controlling for demographics and smoking status, people with eczema were more likely to live in zip codes with high levels of fine particulate matter, or PM2.5, in the air. For every increase of 10 µm/m3 in average PM2.5 air pollution in their zip code, people were more than twice as likely to have eczema.
The authors conclude that increased air pollution, as measured by PM2.5, may influence the risk of developing eczema, likely through its effects on the immune system.
The authors add: “Showing that individuals in the United States who are exposed to particulate matter are more likely to have eczema deepens our understanding of the important health implications of ambient air pollution.”
With hospitals already deploying artificial intelligence (AI) to improve patient care, a new study has found that using Chat GPT Plus does not significantly improve the accuracy of doctors’ diagnoses when compared with the use of usual resources.
That said, Chat GPT alone outperformed both groups, suggesting that it still holds promise for improving patient care. Physicians, however, will need more training and experience with the emerging technology to capitalise on its potential, the researchers conclude.
For now, Chat GPT remains best used to augment, rather than replace, human physicians, the researchers say.
“Our study shows that AI alone can be an effective and powerful tool for diagnosis,” said Parsons, who oversees the teaching of clinical skills to medical students at the University of Virginia School of Medicine and co-leads the Clinical Reasoning Research Collaborative. “We were surprised to find that adding a human physician to the mix actually reduced diagnostic accuracy though improved efficiency. These results likely mean that we need formal training in how best to use AI.”
Chat GPT for Disease Diagnosis
Chatbots called “large language models” that produce human-like responses are growing in popularity, and they have shown impressive ability to take patient histories, communicate empathetically and even solve complex medical cases. But, for now, they still require the involvement of a human doctor.
Parsons and his colleagues were eager to determine how the high-tech tool can be used most effectively, so they launched a randomized, controlled trial at three leading-edge hospitals – UVA Health, Stanford and Harvard’s Beth Israel Deaconess Medical Center.
The participating docs made diagnoses for “clinical vignettes” based on real-life patient-care cases. These case studies included details about patients’ histories, physical exams and lab test results. The researchers then scored the results and examined how quickly the two groups made their diagnoses.
The median diagnostic accuracy for the docs using Chat GPT Plus was 76.3%, while the results for the physicians using conventional approaches was 73.7%. The Chat GPT group members reached their diagnoses slightly more quickly overall – 519 seconds compared with 565 seconds.
The researchers were surprised at how well Chat GPT Plus alone performed, with a median diagnostic accuracy of more than 92%. They say this may reflect the prompts used in the study, suggesting that physicians likely will benefit from training on how to use prompts effectively. Alternately, they say, healthcare organisations could purchase predefined prompts to implement in clinical workflow and documentation.
The researchers also caution that Chat GPT Plus likely would fare less well in real life, where many other aspects of clinical reasoning come into play – especially in determining downstream effects of diagnoses and treatment decisions. They’re urging additional studies to assess large language models’ abilities in those areas and are conducting a similar study on management decision-making.
“As AI becomes more embedded in healthcare, it’s essential to understand how we can leverage these tools to improve patient care and the physician experience,” Parsons said. “This study suggests there is much work to be done in terms of optimising our partnership with AI in the clinical environment.”
Following up on this groundbreaking work, the four study sites have also launched a bicoastal AI evaluation network called ARiSE (AI Research and Science Evaluation) to further evaluate GenAI outputs in healthcare. Find out more information at the ARiSE website.
By Prelisha Singh, Partner, Martin Versfeld, Partner and Alexandra Rees, Senior Associate, Webber Wentzel
Robust contestation on how to best fulfil the fundamental rights of South Africans complements and strengthens our constitutional democracy. Recent debate has centred on the effective realisation of the right to access healthcare, which the state is required progressively to realise for all South Africans, irrespective of their background and income.
The right to access healthcare came into sharp focus on 15 May 2024, when President Cyril Ramaphosa signed the National Health Insurance (NHI) Act into law, prompting the initiation of constitutional challenges by concerned stakeholders. The most recent of these was filed on 1 October 2024 in the North Gauteng High Court, Pretoria by the South African Private Practitioners Forum (SAPPF), represented by Webber Wentzel.
According to the government, the NHI Act is intended to generate efficiency, affordability and quality for the benefit of South Africa’s healthcare sector.
An assessment of South Africa’s current healthcare landscape shows a stark difference between private and public healthcare. The country has a high quality, effective private healthcare offering. However, it is currently inaccessible to the many South Africans who cannot afford private care or medical aid payments. Public healthcare, on the other hand, is understaffed, poorly managed and plagued by maladministration and limited facilities.
The NHI Act has been positioned as the vehicle to address this disparity and a desire to take steps towards achieving universal healthcare in South Africa. But a closer reading of the Act highlights numerous problems with its content and implementation design. The absence of clarity, detail or guidance contained in the Act makes it impossible to assess how the Act will actually be implemented (or, by extension, what the effects of this implementation will be).
This is particularly concerning given that years have passed since the economic assessments, on which the Act was based, were undertaken. Also problematic is the apparent lack of consideration given by the government to submissions made by affected stakeholders during multiple rounds of constitutionally required public participation.
SAPPF underscores these deficits in seeking both to have the President’s decision to assent to the Act reviewed and set aside, and the Act itself declared unconstitutional.
President Ramaphosa was obliged, in terms of sections 79 and 84(2)(a) to (c) of the Constitution, not to assent to the Act in its current form. Section 79 requires the President to refer back to Parliament any bill that he or she believes may lack constitutionality. In this case, it is difficult to conceive how the President, or any reasonable person in the President’s position could not have had doubts regarding the constitutionality of the NHI Bill. The decision by the President to sign unconstitutional legislation into law, instead of referring it back to Parliament for correction, is also irrational.
The President’s duty properly to have referred the NHI Bill back to Parliament is affirmed by the fact that the President is enjoined, by section 7(2) of the Constitution, to respect, protect, promote and fulfil the rights contained in the Bill of Rights.
SAPPF’s application demonstrates that the NHI Act, in its current form, infringes upon the rights to access healthcare services, to practice a trade, and to own property. Patients, including those using private healthcare, will be forced to use a public healthcare system that currently fails to meet its key constituents’ needs. Practitioners’ rights to freedom of trade and profession will be infringed upon, and the property rights of medical schemes, practitioners, and financial providers will be unjustifiably limited.
On its current text, the Act could make South Africa the only open and democratic jurisdiction worldwide to impose a national health system that excludes by legislation private healthcare cover for those services offered by the state – notwithstanding the level or quality of case.
Concerns regarding the rights infringements in the NHI Act are exacerbated by its lack of clarity and the fact that crucial aspects of its implementation are relegated to regulations, with no clear guidance provided in the Act itself.
For example, section 49 provides that the NHI will be funded by money appropriated by Parliament, from the general tax revenue, payroll tax, and surcharge to personal tax. However, this stance does not reconcile with section 2, which provides that the NHI will be funded through ‘mandatory prepayment’, a compulsory payment for health services in accordance with income level. Crucially, the extent of the benefits covered by the NHI’s funding mechanism and its rate of reimbursement, which impact affordability and the provision of quality healthcare, remain unknown.
The Act is, at best, a skeleton framework, seemingly assented to in haste. It is conceptually vague to the extent that the rights it seeks to promote will, in fact, be infringed if implemented. This renders the Act irrational, in addition to its other constitutional defects.
The NHI Act represents a radical shift of unprecedented magnitude in the South African health care landscape. This should be – and is required to be – underpinned by meaningful public participation, up-to-date socio-economic impact assessments and affordability analyses and final provisions that provide a clear and workable framework for implementation.
It is not sufficient for these vital issues to be addressed after the fact. Further engagements with stakeholders and the solicitation of proposals by the government cannot be used to splint broken laws. Collaborative engagement, including the solicitation of inputs for meaningful consideration, should take place during the law-making process, not after its conclusion.
A shift of the magnitude proposed by the Act, absent compliance with the structures of the law-making process and adherence by the state to constitutional standards, including rights protections, would be detrimental to the entire healthcare sector – public and private – and not in the best interests of patients and practitioners.
Notwithstanding the legal contestation surrounding the Act, it and the laudable goals underlying it can also be a watershed. The achievement of universal health coverage is an opportunity for the different stakeholders in South Africa’s healthcare system to meaningfully collaborate and inform well-supported, factually informed, rational and genuinely progressive legislative steps by the state.
Given the questions surrounding the Act and the evident need it seeks to address, the space exists for healthcare stakeholders to align around shared goals and values. They can leverage their available resources to design a healthcare system that serves all of South Africa’s people fairly and equitably, using the significant existing resources invested in the country’s healthcare sector.
Adolescents who meet the recommended guidelines of nine to 11 hours of sleep per day were shown to have a significantly lower risk of hypertension, according to a new study from UTHealth Houston.
Recently published in the Journal of the American Heart Association, the research revealed that adolescents had a 37% lower risk of developing incidents of high blood pressure by meeting healthy sleep patterns, and underscoring the importance of adequate sleep behaviour. The research further explored the impact of environmental factors potentially impacting sleep.
“Disrupted sleep can lead to changes in the body’s stress response, including elevated levels of stress hormones like cortisol, which in turn can increase blood pressure,” said first author Augusto César Ferreira De Moraes, PhD, assistant professor in the Department of Epidemiology at UTHealth Houston School of Public Health.
De Moraes and his team analysed data from 3320 adolescents across the US to investigate incidents of high blood pressure during nighttime sleep cycles. Scientists identified a rise in hypertension incidents over two data periods, 2018-2020 and 2020-2022, showing an increase from 1.7% to 2.9%. The data included blood pressure readings and Fitbit assessments, which measured total sleep time and REM sleep duration at night. The study’s design analysed covariates such as Fitbit-tracked sleep, blood pressure, and neighbourhood noise by residential geocodes, allowing for a thorough examination of environmental noise exposure for each participant.
Neighbourhood/community noise was not significantly associated with the incidence of hypertension. Environmental factors, such as neighbourhood noise, point to the need for longer-term studies to investigate the relationship between sleep health and hypertension, particularly in relation to socioeconomic status, stress levels, and genetic predispositions.
The study emphasises the importance of improved sleep behaviours and meeting recommendations. “Consistent sleep schedules, minimising screen time before bed, and creating a calm, quiet sleep environment can all contribute to better sleep quality,” advises Martin Ma, MPH, second author of the study and recent graduate of the school. “Although environmental noise didn’t directly affect hypertension in this study, maintaining a quiet and restful sleep environment is still important for overall well-being.”
Patients with a small cranial nerve tumour that can cause hearing loss, vertigo, imbalance and ringing in the ears have typically been watched rather than proactively treated, as the risks of early intervention were thought to outweigh the benefits. Now a study shows that even those patients benefit significantly from non-invasive stereotactic radiosurgery, led by UVA Health physicians has found. The findings were reported in Neurosurgery.
Doctors typically treat larger forms of the tumours, called vestibular schwannomas, while taking a “watch and wait” approach to smaller tumours that aren’t causing appreciable problems. But the new research, from UVA Health neurosurgeon Jason Sheehan, MD, PhD, and collaborators, could change how asymptomatic schwannomas are managed. Their findings demonstrated that stereotactic radiosurgery – a highly targeted form of radiation therapy – can prevent small tumours from growing over time while at the same time sparing patients from potentially irreversible problems in the future.
“This study and our recent Vestibular Schwannoma International Study of Active Surveillance versus Stereotactic Radiosurgery [VISAS] trial demonstrate that radiosurgery affords effective and durable tumour control while more often avoiding the neurological complications that come from watching a vestibular schwannoma,” Sheehan said. “Over time, Gamma Knife radiosurgery bends the curve of growth and problems that commonly arise from watching even the smallest of vestibular schwannomas.”
About vestibular schwannomas
Vestibular schwannomas are growths on a cranial nerve that connects the brain and inner ear. This nerve transmits information about head movements, helps us control our balance and allows us to hear. The growths, however, can disrupt the nerve’s important functions, causing hearing loss, unsteadiness, headaches, tinnitus (ringing in the ear), facial numbness/paralysis and other problems.
Seeking to improve care for patients with these tumours, Sheehan and his team performed a trial through the International Radiosurgery Research Foundation looking at 261 adults with the smallest category of vestibular schwannomas. These were usually picked up early, and the patients often were high functioning and had the most to lose from tumour growth over time. Of the study participants, 182 received stereotactic radiosurgery, while 79 did not.
The patients who underwent radiosurgery using the Gamma Knife system showed consistently better tumour control over time. In this group, 99% of the patients’ tumours either stayed the same size, grew very little (less than 25%) or shrank. This was true at 3 years, 5 years, and 8 years. Only one patient’s tumour significantly increased in size.
Tumour control was much worse among those who didn’t receive radiosurgery: 37% saw their tumours grow significantly at 3 years, 50% at five years, and 67% at eight years.
That difference was seen plainly in the symptoms the patients experienced. Radiosurgery was associated with a 54% lower rate of tinnitus, a 51% lower rate of cranial nerve deterioration and an 83% lower rate of vestibular dysfunction that causes dizziness and loss of balance.
Even with Gamma Knife radiosurgery to treat the tumour arising from this very delicate neural structure, hearing was preserved similarly in both groups.
Sheehan, an expert in stereotactic radiosurgery and brain tumours, urges physicians to take note of the findings because tumour symptoms are often irreversible as the tumour grows. Acting early, before symptoms develop, could greatly improve patients’ long-term quality of life, he says.
“In brain surgery, particularly involving the hearing and balance nerve, our approach must be exceedingly refined,” he said. “This study shows that Gamma Knife radiosurgery substantially improves the future trajectory of vestibular schwannoma patients.”
Updated guidance reaffirms the recommendation for cardiopulmonary resuscitation (CPR) and highlights the importance of compressions with rescue breaths as a first step in responding to cardiac arrest following drowning, according to a new, focused update to Special Circumstances Guidelines from the American Heart Association and the American Academy of Pediatrics. The recommendations were published simultaneously in Circulation (focusing on adults) and Pediatrics (focusing on children).
Drowning is the third-leading cause of death from unintentional injury worldwide. The World Health Organization estimates there are about 236 000 deaths due to drowning each year globally. According to the CDC, it’s the number one cause of death for children ages 1-4 years old in the US.
“The focused update on drowning contains the most up-to-date, evidence-based recommendations on how to resuscitate someone who has drowned, offering practical guidance for health care professionals, trained rescuers, caregivers and families,” said writing group Co-Chair Tracy E. McCallin, M.D., FAAP, associate professor of paediatrics in the division of paediatric emergency medicine at Rainbow Babies and Children’s Hospital in Cleveland. “While we work on a daily basis to lower risks of drowning through education and community outreach on drowning prevention, we still need emergency preparedness training that can be used in tragic circumstances if a drowning occurs.”
Detailed in the new guideline update:
Anyone removed from the water without showing signs of normal breathing or consciousness should be presumed to be in cardiac arrest.
Rescuers should immediately initiate CPR that includes rescue breathing in addition to chest compressions. Multiple large studies over time show more people with cardiac arrest from non-cardiac causes such as drowning survive when CPR includes rescue breaths compared to Hands-Only CPR (calling 911 [10111 in South Africa] and pushing hard and fast in the centre of the chest).
Drowning generally progresses quickly from initial respiratory arrest (when a person is unable to breathe) to cardiac arrest, meaning that the heart stops beating. As a result, blood cannot circulate properly throughout the body, and it is starved of oxygen.
“CPR for cardiac arrest due to drowning must focus on restoring breathing as well as restoring blood circulation,” said writing group Co-Chair Cameron Dezfulian, MD, FAHA, FAAP, senior faculty in paediatrics and critical care at Baylor College of Medicine in Houston.
“Cardiac arrest following drowning is most often due to severe hypoxia, or low blood oxygen levels,“ Dezfulian said. ”This differs from sudden cardiac arrest from a cardiac cause where the individual generally collapses with fully oxygenated blood.”
The updated guidance advises untrained rescuers and the public to:
Provide CPR with breaths and compressions to all people who have a cardiac arrest after drowning. If a person is untrained, unwilling, or unable to give breaths, they can provide chest compressions only until help arrives.
In-water rescue breathing should be given only by rescuers trained in this special skill if it doesn’t compromise their own safety. Trained rescuers should also provide supplemental oxygen if available.
The initiation of CPR should always be prioritised and begin as soon as possible as early lay responder CPR has been shown to improve outcomes from drowning.
The writing group recommends an automated external defibrillator (AED) should be placed in public facilities where aquatic activities are present such as swimming pools or beaches. They can be used once the person is removed from the water, if available, yet should not delay initiation of CPR. If available, the AED should be connected to the patient to assess for shockable rhythms once CPR is ongoing. Although most cases of cardiac arrest following drowning do not have shockable rhythms, if a primary cardiac event such as a heart attack occurs while in the water, the best outcomes are when defibrillation is done quickly. AED use is safe and feasible in aquatic environments.
All individuals requiring any level of resuscitation following drowning, including those who only need rescue breaths, should be transported to a hospital for evaluation, monitoring and treatment.
In addition to the recommendations on drowning resuscitation, the guideline update also highlights the Drowning Chain of Survival, which includes the steps needed to improve chances of survival: prevention, recognition and safe rescue.
Prevention
It has been estimated that more than 90% of all drownings are preventable. Research has found most infants drown in bathtubs, and the majority of preschool-aged children drown in swimming pools. The American Heart Association and the American Academy of Pediatrics recommend being water aware and practicing water safety. See: Prevention of Drowning and other guidelines.
Recognition
Recognition of drowning may be challenging because someone who is drowning may not be able to verbalise distress or signal for help. Drowning happens quickly. People in distress will rapidly submerge, lose consciousness and may be hidden from anyone not actively seeking them.
Safe Rescue and Removal
The guideline update recommends that appropriately trained rescuers, such as lifeguards, swim instructors or first responders, should provide in-water rescue breathing to an unresponsive person who has drowned if it does not compromise their own safety. Previous studies have proven this leads to more favourable survival outcomes. A drowning person who is unconscious and likely in cardiac arrest should be removed from the water in a near-horizontal position, with the head maintained above body level and airway open. If the drowning individual is conscious, a more vertical position may be preferable to reduce the risk of vomiting.
In summary, “These updated guidelines are based on the latest available evidence and are designed to inform trained rescuers and the public how to proceed in resuscitating people who have drowned. Drowning can be fatal. Our recommendations maximise balancing the need for rapid rescue and resuscitation, while prioritising rescuer safety,” Dezfulian said.
More than a quarter of new mothers have fallen asleep recently while feeding their babies, putting the infants at increased risk of sudden infant death syndrome (SIDS), research published in Pediatrics reveals.
More than 80% had not intended to fall asleep, and many had chosen to feed in chairs or on sofas rather than in a bed. Unfortunately, the cushions and confines of those locations can be very unsafe for babies, raising the risk of death by 49 to 67 times.
The researchers, with UVA Health and UVA Health Children’s, are urging care providers to provide additional guidance for new parents on safe feeding practices, such as informing new moms that a hormone naturally released during breastfeeding will make them feel sleepy.
“While falling asleep while feeding young infants is not in itself too surprising, what is very alarming is that the majority of mothers did not plan to fall asleep, so the sleep space was potentially unsafe for the baby while both slept,” said researcher Fern Hauck, MD, MS, a safe-sleep expert at UVA Health and the UVA School of Medicine. “This highlights the need for parents to be educated about the potential risk of falling asleep while feeding and to plan for that possibility by making the space around the baby as safe as possible. That would include removing pillows and blankets to ensure an open airway for the baby.”
Safe infant feeding
Hauck and her collaborators, including UVA’s Ann Kellams, MD, and Rachel Moon, MD, analysed survey results collected from more than 1250 new mothers as part of the Social Media and Risk-reduction Training (SMART) study conducted at 16 US hospitals in 2015 and 2016. Most respondents completed the survey when their infant was between 2 and 3 months of age.
Among the respondents, more than 28% said they had “usually” or “sometimes” fallen asleep during feeding in the prior two weeks. Of those, a whopping 83.4% said falling asleep was unplanned.
Women who fed in bed were more likely to fall asleep (33.6%) than those who fed on a chair or couch (16.8%). The American Academy of Pediatrics (AAP) recommends mothers at risk of falling asleep while breastfeeding should do so in an adult bed rather than a chair or couch.
Many of the women who fell asleep on chairs or sofas said they chose those locations specifically to avoid falling asleep, to avoid locations (such as a bed) they had been told were unsafe or to avoid disturbing someone else. (The AAP warns moms against sharing a bed or other sleep space with an infant because of the risk the parent might accidentally roll over and smother the child, or that the child could become tangled in bedding. But the group also says that beds are safer than chairs and sofas if falling asleep while feeding is a possibility.)
“We need to meet families where they are and come up with a nighttime plan for sleeping and feeding their baby that works for them and is as safe as possible,” said Kellams, a paediatrician and breastfeeding and lactation medicine specialist at UVA Health Children’s. “Our data suggest that too many of these falling asleep incidents are not planned, so discussions about how to plan for feeding your baby when you are very tired are important.”
The researchers note that providing parents with information about safe sleep and feeding has been shown to reduce risk of unexpected death significantly. But this educational outreach needs to be expanded, they say. Care providers should acknowledge that moms face a very real risk of falling asleep while feeding, even if they are trying not to, and provide practical advice on how to reduce that risk. Further, the researchers are urging additional studies to find ways to assist parents in both safe-sleep practices and breastfeeding.
“We hope that parents of young infants will think proactively about what might happen in the middle of the night,” said Moon, a paediatrician and safe-sleep expert at UVA Health Children’s. “Feeding your baby in your bed is safer than feeding on a couch or armchair if you might fall asleep.”
Research by scientists at the University of Sydney has identified cannabinol (CBN), a constituent in the cannabis plant that improves sleep. Their report is the first to use objective measures to show that (CBN), while not intoxicating, does increase sleep in rats. The study, which has been published in the leading journal Neuropsychopharmacology, found that CBN was comparable in efficacy to zolpidem.
“Our study provides the first objective evidence that CBN increases sleep, at least in rats, by modifying the architecture of sleep in a beneficial way.”
CBN is an end-product of the main intoxicating constituent of cannabis, delta9-tetrahydrocannabinol (THC). THC in cannabis is slowly converted to CBN over time, which means older cannabis contains higher levels of this compound. It has been suggested that the consumption of older cannabis is associated with a sleepier cannabis “high”.
In the United States, highly purified CBN products are being sold as sleep aids, but there has been little high-quality scientific evidence to support this application.
The research team at the Lambert Initiative for Cannabinoid Therapeutics tested the effects of purified CBN on sleep in rats. Using high-tech monitoring, the experiments provided insights into the rats’ sleep patterns including the amount of non-rapid eye movement (NREM) and rapid eye movement (REM) sleep.
NREM is deep sleep that promotes physical recovery and strengthens memories, while REM sleep is associated with dreaming and processing of emotions.
Professor Arnold said: “CBN was found to increase both NREM and REM sleep, leading to increased total sleep time, with a comparable effect to the known sleep drug zolpidem.”
Non-intoxicating
Unlike its parent molecule THC, CBN did not appear to intoxicate rats. THC intoxicates by activating CB1 cannabinoid receptors, which are present in the brain. The study showed that unlike THC, CBN only weakly activates these receptors. To their surprise, the researchers found that a metabolite of CBN had significant effects on cannabinoid CB1 receptors.
A metabolite is a chemical produced via the metabolism of a larger molecule in the body.
They also found that the 11-OH CBN metabolite had some impact on sleep architecture, which might contribute to the overall effects of CBN on sleep.
“This provides the first evidence that CBN indeed increases sleep using objective sleep measures. It was a surprise that CBN metabolism in the body can yield a much greater effect on cannabinoid CB1 receptors than the parent molecule CBN, which has much more limited activity,” Professor Arnold said.
“At this stage our results are confined to testing in rats. Further research is needed to see if this translates to humans.”
Further study
In a parallel study, yet to be published, Professor Iain McGregor, Director of Clinical Research at the Lambert Initiative, initiated a placebo-controlled randomised human clinical trial in insomnia patients. This was led by PhD student Isobel Lavender with leading sleep researcher Dr Camilla Hoyos from the Woolcock Institute of Medical Research. The trial has now been completed with very promising results that were recently announced at the International Cannabinoid Research Society and Sleep DownUnder scientific conferences.
“Our research encourages further basic and clinical research on CBN as a new treatment strategy for sleep disorders, including insomnia. Our clinical study only administered CBN on a single occasion. A trial on a larger scale, that includes repeated dosing, is the logical next step,” Professor McGregor said.
Professor Arnold said: “The team has now commenced a preclinical drug discovery program around CBN, as well as observing whether the pro-sleep effects of CBN can be further amplified by other molecules found in cannabis, or by conventional sleep aids, such as melatonin.”
Patients with glioblastoma typically survive less than two years after diagnosis, even with cutting-edge therapies. The latest immunotherapies have been unsuccessful, likely because glioblastoma cells have few, if any, natural targets for the immune system to attack.
In a cell-based study, scientists at Washington University School of Medicine have forced glioblastoma cells to display immune system targets, potentially making them visible to immune cells and newly vulnerable to immunotherapies. The strategy involves a combination of two drugs, each already FDA-approved to treat different cancers.
“For patients whose tumours do not naturally produce targets for immunotherapy, we showed there is a way to induce their generation,” said co-senior author Ting Wang, PhD, professor of medicine and Department of Genetics head at WashU Medicine. “In other words, when there is no target, we can create one. This is a very new way of designing targeted and precision therapies for cancer. We are hopeful that in the near future we will be able to move into clinical trials, where immunotherapy can be combined with this strategy to provide new therapeutic approaches for patients with very hard-to-treat cancers.”
To create immune targets on cancer cells, Wang has focused on stretches of DNA in the genome known as transposable elements. In recent years, transposable elements have emerged as a double-edged sword in cancer, according to Wang. His work has shown that transposable elements play a role in causing tumours to develop even as they present vulnerabilities that could be exploited to create new cancer treatment strategies.
For this study, Wang’s team took advantage of the fact that transposable elements naturally can cause a tumour to churn out random proteins that are unique to the tumour and not present in normal cells. Called tumour antigens or neoantigens, these unusual proteins could be the targets for immunotherapies, such as checkpoint inhibitors, antibodies, vaccines and genetically engineered T cell therapies.
Even so, some tumours, including glioblastoma, have few immune targets produced naturally by transposable elements. To address this, Wang and his colleagues, including co-senior author Albert H. Kim, MD, PhD, neurosurgery professor, have demonstrated how to purposely force transposable elements to produce immune system targets on glioblastoma cells that normally lack them.
The researchers used a combination of two drugs that influence the epigenome, which controls gene activation. When treated with the two epigenetic therapy drugs, the tightly packed DNA molecules of the glioblastoma cells unfurled, triggering transposable elements to begin making the unusual proteins that could be used to target the cancer cells. The two drugs were decitabine, which is approved to treat myelodysplastic syndromes, a group of blood cancers; and panobinostat, which is approved for multiple myeloma, a cancer of white blood cells.
Before investigating this strategy in people, the researchers are seeking ways to target the epigenetic therapy so that only the tumour cells are induced to make neoantigens. In the new study, the researchers cautioned that normal cells also produced targets when exposed to the two drugs. Even though normal cells didn’t produce as many neoantigens as the glioblastoma cells did, Wang and Kim said there is a risk of unwanted side effects if normal cells create these targets as well.
In ongoing work, Wang and Kim are investigating how to use CRISPR molecular editing technology to induce specific parts of the genome in cancer cells to produce the same neoantigens from transposable elements that are common across the human population. Such a strategy could give many patients’ tumours – even different cancer types – the same targets that could respond to the same immunotherapy, while sparing healthy cells. There are then multiple possible ways to go after such a shared target, including checkpoint inhibitors, vaccines, engineered antibodies and engineered T cells.
As global mobility surges, managing chronic conditions like diabetes during travel has become a significant concern. Diabetes remains one of the fastest-growing global public health issues1,affecting approximately 422 million people worldwide and causing 1.5 million deaths annually.2International SOS, the world’s leading health and security services company, has reported a significant year-on-year increase in diabetes-related assistance cases over the past three years, with a 28% increase in 2022 and a 32% increase in 2023.
Meanwhile, year-to-date 2024 data indicates a further uptick.3 With World Diabetes Day approaching on 14 November, organisations are urged to support diabetes prevention and management strategies. This year’s theme, ‘Breaking Barriers, Bridging Gaps’4 highlights the need for equitable, comprehensive and affordable diabetes care.
Dr Katherine O’Reilly, Regional Medical Director at International SOS, emphasises the importance of comprehensive health strategies: “It is important for organisations to understand the unique challenges that employees with diabetes face, particularly when travelling. By recognising these specific needs, companies can provide the necessary support and resources to help their employees manage their condition effectively. This ensures that employees can maintain their health and productivity, even when they are on the go. With thoughtful planning and the right resources, organisations can help their employees navigate the complexities of diabetes, fostering a supportive and inclusive work environment.”
People with diabetes face a double burden: a higher risk of life-threatening conditions like heart attack, stroke, and kidney failure, compounded by the psychological toll of diabetes distress. Individuals with diabetes are two to three times more likely to experience depression compared to those without the condition.5 These challenges can significantly impact employee wellbeing, leading to increased absenteeism, reduced productivity, and higher healthcare costs for employers.
According to The International Diabetes Federation (IDF), the global healthcare costs for individuals living with diabetes are expected to exceed $1054 billion by 2045.6 Furthermore, the prevalence of diabetes is projected to rise, with 643 million people affected by 2030, and 783 million by 2045.7 With this rising prevalence, it is crucial for organisations to implement strategies that help their workforce manage and prevent this chronic condition. Minor adjustments can reduce absenteeism, increase productivity, concentration and energy levels, and reduce the chance of on-the-job injury.
Dr Katherine O’Reilly continues, “Early diagnosis is crucial. Raising awareness about diabetes symptoms can prompt people to get screened, enabling early detection and intervention to prevent or delay its onset. This proactive approach can prevent undiagnosed diabetes from causing severe health complications, affecting various organ systems, including eye damage, heart and kidney disease, nerve damage and poor wound healing. By prioritising employee health, organisations can enhance productivity and foster a more engaged and resilient workforce. This approach also promotes a positive work environment and supports overall employee wellbeing.”
International SOS offers five tips for organisations to support employees in managing and preventing diabetes:
Education and awareness: Increase awareness about diabetes symptoms to encourage early diagnosis and effective management, thereby preventing severe health complications.
Provide comprehensive health solutions: Offer resources such as dietary guidelines, exercise programmes and regular health screenings to help employees manage their diabetes.
Supportive culture and policies: Develop and implement policies allowing for flexible work schedules and access to medical care while travelling. Foster a culture that prioritises health and wellbeing by accommodating regular meals and exercise, and ensuring employees have time to rest and recover from travel.
Promote a healthy lifestyle: Offer guidance on maintaining a healthy diet and regular exercise. Provide resources such as a list of healthy meal options and tips for finding nutritious food in different locations.
Facilitate health monitoring and provide adjustments: Ensure employees have scheduled breaks to take medication, check blood sugar levels and eat regular meals. Provide a private space for insulin administration and other medical needs.
