Tag: 12/6/23

Categories : Surgeries & ProceduresTags : Leave a comment

The Three Global Challenges Surgeons Need to Tackle

On By ModernMedia
Photo by Jafar Ahmed on Unsplash

Despite significant advances over the last 30 years, surgical research is still limited to comparing the benefit of one technique over another. It can be founded on assumptions that a new device or approach is always better – leading to poorly evaluated devices and procedures having negative effects on patients.

Writing in The Lancet, experts from the NIHR Global Health Research Unit for Global Surgery GlobalSurg Collaborative – a programme backed by funding from the NIHR (National Institute for Health and Care Research) – propose three priority areas for surgery:

Access, equity, and public health must be recognised as crucial issues for surgery.

In 2015, five billion people did not have access to safe and affordable surgical care. Of those who did, 33 million individuals faced catastrophic health expenditure in payment for surgery and anaesthesia. During the COVID-19 pandemic, over 28 million cases of elective surgery are likely to have been cancelled. Surgery has a key role in addressing the most important and growing global health challenges, such as trauma, congenital anomalies, safe childbirth, and non-communicable diseases.

Inclusion and diversity must improve in both surgical research and the profession.

Women, minoritised groups, and patients from low-income and middle-income countries remain under-represented in clinical practice and major research work. Advancing inclusion and diversity will ensure a research agenda that delivers pragmatic, simple, and context-specific research that reflects the needs of all patients.

Climate change is the greatest global health threat facing the world.

Surgical theatres are some of the most energy and resource intense areas of a hospital. Surgical practice relies on many single-use, non-biodegradable products as well as anaesthetic gases that have a large environmental footprint. Moving towards net-zero operating practices could reduce health-sector carbon emissions and allow surgeons and policy makers to reassess how surgery fits into a wider health system.

Comment co-author Dmitri Nepogodiev, from the University of Birmingham, said: “Richard Horton, Editor-in-Chief of The Lancet, once described surgical research as ‘a comic opera performance’. That was in 1996 and things have changed significantly since then.

“However, truly improving lives requires surgical researchers to use the next quarter of a century to tackle the most pressing questions on equity and access, the role of surgery in public health, and sustainability.

“Despite the problems of large waiting lists and an economic squeeze on health systems, surgeons must focus on these priority areas — placing surgery as a leader in medical specialties and demonstrating its value as a fundamental element of universal health care.”

The experts note that large, randomised controlled trials with well-defined endpoints are now more usual in surgical research, whilst exploration into the placebo effect, has led to a fundamental re-examination of the benefits of some surgical procedures and whether they benefit patients at all.

Surgeons and anaesthetists have developed successful international collaborative research efforts that have enabled rapid recruitment of participants and globally relevant studies and trials, while following internationally set standards of clinical trial practice. Surgeons can now provide reliable answers to crucial questions in operative surgery, and their research has improved patient care and resource use in health systems.

Categories : Mental HealthTags : Leave a comment

Cannabis is Being Prescribed for Mental Health Disorders Without Evidence

On By ModernMedia
Photo by Kindel Media on Unsplash

New research shows Australian healthcare practitioners are often prescribing medicinal cannabis for psychiatric conditions where the evidence for effectiveness is unclear. But researchers who looked into the prescribing data believe that perhaps something has been overlooked, possibly leading to new avenues for treatment. The findings come University of Sydney researchers and are published in Frontiers in Pharmacology.

“These data confirm many Australians have unmet needs around their mental health and that medicinal cannabis is now frequently being trialled as an alternative to conventional therapies,” said study leader Dr Elizabeth Cairns.

“Medicinal cannabis is not typically prescribed as a first-line therapy, so those using it for conditions such as anxiety and depression likely have not had success with other treatments.

“This provides us with new leads for our clinical trials that will hopefully produce high-quality evidence to support or discourage current patterns of use.”

Dr Cairns and colleagues analysed the complete record of medicinal cannabis prescribed through Special Access Scheme B (SAS-B), using data supplied by the Australian Therapeutic Goods Administration (TGA) going back to the drug’s legalisation there in 2016, which allowed a diverse range of CBD and THC products to be legally available for medical use.

Prescriptions through this scheme have been increasing annually since the drug made its way into Australia’s pharmaceutical market in late 2016. From February 2021 the number of prescriptions started to boom, leaping from 100 000 to 300 000 by September the following year.

After treatment for chronic pain, analysis by the Lambert researchers shows anxiety is the second most common condition being treated with prescribed medicinal cannabis in Australia. However, evidence for the effectiveness of medicinal cannabis products in treating anxiety is surprisingly poor.

There is also increasing prescribing for conditions such as depression, ADHD and autism where an “evidence gap” exists around effectiveness.

Psychiatric prescriptions, used to treat mental, emotional, developmental and behavioural disorders, make up 33.8% of total approvals.

“Despite prescribing for a variety of different psychiatric indications, there is limited published high-quality evidence of efficacy to support this prescribing,” Dr Cairns said.

“The key here is not that the evidence shows cannabis products don’t work, more that high-quality studies supporting current prescribing just haven’t been done.”

Medicinal cannabis has been approved for anxiety disorders far more than any other psychiatric condition, making up 22.6% of all SAS-B prescriptions, and the type of medications used to treat anxiety caught the interest of scientists at Lambert.

“The anxiety data are really interesting because more than three quarters of the products prescribed contain THC (tetrahydrocannabinol), but THC is often thought of as anxiety-inducing, with cannabis use sometimes associated with paranoia and social anxiety,” Dr Cairns said.

“It makes you think, is there something about THC that we’ve missed historically?”

Dr Cairns suggested more priority research funding is needed to examine the effectiveness of medicinal cannabis products at improving mental health and quality of life.

The researchers said healthcare professionals often struggle to find reliable information about prescribing the hundreds of medicinal cannabis products available, and whether THC or CBD products are best used for different psychiatric conditions. 

Source: University of Sydney

Categories : Diet and Nutrition Mental HealthTags : Leave a comment

How Chronic Stress Drives Cravings for ‘Comfort Foods’

On By ModernMedia
Photo by Patrick Fore on Unsplash

Reaching for a high-calorie snack is a common reaction when stressed – but this could be driving a vicious circle. Australian scientists report that stress combined with calorie-dense ‘comfort’ food creates brain changes that drive more eating, boost cravings for sweet, highly palatable food and lead to excess weight gain.

A team from the Garvan Institute of Medical Research reported in the journal Neuron that stress overrode the brain’s natural response to satiety, leading to non-stop reward signals that promote eating more highly palatable food. This occurred in a part of the brain called the lateral habenula, which when activated usually dampens these reward signals.

“Our findings reveal stress can override a natural brain response that diminishes the pleasure gained from eating — meaning the brain is continuously rewarded to eat,” says Professor Herzog, senior author of the study and Visiting Scientist at the Garvan Institute of Medical Research.

“We showed that chronic stress, combined with a high-calorie diet, can drive more and more food intake as well as a preference for sweet, highly palatable food, thereby promoting weight gain and obesity. This research highlights how crucial a healthy diet is during times of stress.”

From stressed brain to weight gain

Most people will eat more than usual during times of stress and choose calorie-rich options high in sugar and fat. To understand what drives these eating habits, the team investigated in mouse models how different areas in the brain responded to chronic stress under various diets.

“We discovered that an area known as the lateral habenula, which is normally involved in switching off the brain’s reward response, was active in mice on a short-term, high-fat diet to protect the animal from overeating. However, when mice were chronically stressed, this part of the brain remained silent – allowing the reward signals to stay active and encourage feeding for pleasure, no longer responding to satiety regulatory signals,” explains first author Dr Kenny Chi Kin Ip.

“We found that stressed mice on a high-fat diet gained twice as much weight as mice on the same diet that were not stressed.”

The researchers discovered that at the centre of the weight gain was the molecule NPY, which the brain produces naturally in response to stress. When the researchers blocked NPY from activating brain cells in the lateral habenula in stressed mice on a high-fat diet, the mice consumed less comfort food, resulting in less weight gain.

Driving comfort eating

The researchers next performed a ‘sucralose preference test’ – allowing mice to choose to drink either water or water that had been artificially sweetened.

“Stressed mice on a high-fat diet consumed three times more sucralose than mice that were on a high-fat diet alone, suggesting that stress not only activates more reward when eating but specifically drives a craving for sweet, palatable food,” says Professor Herzog.

“Crucially, we did not see this preference for sweetened water in stressed mice that were on a regular diet.”

Stress overrides healthy energy balance

“In stressful situations it’s easy to use a lot of energy and the feeling of reward can calm you down — this is when a boost of energy through food is useful. But when experienced over long periods of time, stress appears to change the equation, driving eating that is bad for the body long term,” says Professor Herzog.

The researchers say their findings identify stress as a critical regulator of eating habits that can override the brain’s natural ability to balance energy needs.

“This research emphasises just how much stress can compromise a healthy energy metabolism,” says Professor Herzog. “It’s a reminder to avoid a stressful lifestyle, and crucially – if you are dealing with long-term stress – try to eat a healthy diet and lock away the junk food.”

Source: Garvan Institute of Medical Research

Categories : Ethics and Law Healthcare Politics and RegulationsTags : Leave a comment

124 Fake Doctors Arrested, Minister of Health Says

On By ModernMedia
Photo by Tingey Injury Law Firm on Unsplash

Minister of Health Dr Joe Phaahla has confirmed the arrest of 124 fake doctors as a result of a crackdown by the Health Professions Council of South Africa (HPCSA), reports IOL. He revealed the information in a response to a parliamentary question.

He said that the doctors were able to avoid the system by taking cash payments, or working in the practices of registered doctors. Dr Phaahla noted that it was a criminal offence to practice medicine without being registered.

The arrests came as a result of the HPCSA establishing an Inspectorate to crack down on illegal practising medical workers. The Inspectorate currently has offices in all of South Africa’s provinces save Northwest and Northern Cape.

The relevant section of the Act reads [PDF]:

  1. (I) No person shall be entitled to practise within the Republic–
    (a) the profession of a medical practitioner, dentist, psychologist or as an intern; or
    (b) except in so far as it is authorized by the provisions of the Nursing Act, 1957 (Act No. 69 of 1957), the Chiropractors Act, 1971 (Act No. 76 of 1971), the Pharmacy Act, 1974, and sections 32, 33, 34 and 39 of this Act, for gain any other profession the practice of which mainly consists of-
    (i) the physical or mental examination of persons;
    (ii) the diagnosis, treatment or prevention of physical or mental defects, illnesses or deficiencies in man;
    (iii) the giving of advice in regard to such defects, illnesses or deficiencies; or
    (iv) the prescribing or providing of medicine in connection with such defects, illnesses or deficiencies,
    unless he is registered in terms of this Act.

Source: IOL

Categories : Diet and Nutrition Healthcare Politics and RegulationsTags : Leave a comment

New Billboard Campaign Challenges Politicians and Businesses to Close the Food Gap

On By ModernMedia
Photo by Gemma on Unsplash

Child hunger and resulting malnutrition is a national emergency so consequential that it should be the number one issue for politicians and businesses ahead of next year’s general elections. Already, one in five South African households don’t have enough food on the table, and times are getting tougher as food prices soar.

This is why public innovator, the DG Murray Trust (DGMT) and Grow Great, a national zero-stunting organisation, have launched a national advocacy campaign, involving over 300 billboards, to demand urgent action to make basic nutritious food more affordable.

The first set of billboards is a picture of a child making his mark at a voting booth with the words ‘I vote for food’. It’s a challenge to every political party to respond to the growing food crisis by ensuring that household food security is a central objective of every election manifesto.

“Our campaign features a series of incisive messages that present child nutrition as a national priority for public health, education and economic growth,” says David Harrison, DGMT’s Chief Executive Officer.

“South Africa has the worst record of household food insecurity compared to middle-income countries of similar per capita GDP. The last national survey, done in 2016, found that 27% of children under the age of five had stunted growth – a proxy for impaired brain development,” Harrison explains.

The relationship between malnutrition and low education outcomes is highlighted in the second set of billboards of a uniformed schoolboy conveying a lesson to a group of adults with the words ‘if I grow well, I learn well’ written on a chalkboard. This message makes the point that without good nutrition our children’s bodies and brains are deprived of the fuel they need to grow and develop.

Stunted children are more likely to drop out of school, struggle to find employment and live in poverty as adults. The consequence is successive generations of children unable to reach their full potential.

The third set of billboards show a girl confidently seated on an office desk overlooking a cityscape with the message ‘good nutrition today is good for business tomorrow’.“

According to the World Bank, high stunting rates are one of the main reasons for South Africa’s dismal economic growth because our country doesn’t have a sufficient human capital pipeline to drive productivity. But if we ensured that all children had enough food, our long-term economic prospects would be radically different,” says Harrison.

These billboards also aim to build public support for a bold new proposal championed by DGMT and Grow Great earlier this year – a proposal that requires food producers, retailers and the government to work together to reduce the cost of 10 nutritious foods by at least 30%.

These items are eggs, dried beans and lentils, tinned fish, fortified maize meal, peanut butter, rice, amasi, soya mince, 4-in-1 soup mix, and powdered full cream milk – many are already staple pantry items in South African households.

What’s in the proposal?

The proposal involves food manufacturers and retailers agreeing to waive the mark-ups of at least one product label of each of the ‘10 best buys’. Government would then show its support by agreeing to provide a rebate to retailers and manufacturers.

A fourth set of billboards acknowledges that times are tough and invites parents and caregivers to contact Grow Great to learn more about the 10 best buys.

“Civil society organisations can do their part by raising awareness about the 10 best buys and sharing the resources and information we’ve made available on our platforms, like our WhatsApp number 060 073 3333,” says Dr Edzani Mphaphuli, Grow Great executive director.

Good nutrition cannot only be the responsibility of the Department of Health, Mphaphuli adds. “Given what we know about the consequence of child malnutrition on households and the economy, we need the whole of society to mobilise to turn things around.”

“We call on the government, food producers, wholesalers and retailers to stand in solidarity with South African families to close the food gap,” she concludes.