In a survey-based study, UK dietitians exhibited significant weight stigma, both towards themselves and towards others.
The study in the Journal of Human Nutrition and Dietetics involved an online survey completed in 2022 by 402 registered dietitians aged 20–70 years old. Most respondents reported personally experiencing weight stigma prior to (51%) and after becoming (59.7%) registered dieticians, and nearly a quarter (21.1%) felt that their weight influenced their own ability to perform as a dietitian.
Weight stigma was experienced across the weight spectrum. Participants reported explicit (or conscious) weight bias attitudes, moderate beliefs that obesity is controllable, and implicit (or unconscious) anti-fat bias.
“The study highlights the need to address weight stigma and its implications within the dietetic profession,” the authors wrote.
Image Credit: Institute of Transformative Bio-Molecules (ITbM), Nagoya University
Researchers at Nagoya University in Japan have developed a new compound, ZTA-261, that binds to thyroid hormone receptor beta (THRβ). THRβ plays an important role in the regulation of lipid metabolism, which affects lipid levels in the blood. Mice administered the drug showed decreased lipid levels in the liver and blood, with fewer side effects in the liver, heart, and bones compared to existing compounds. These findings, published in Communications Medicine, suggest that ZTA-261 is an effective treatment for lipid disorders such as dyslipidaemia.
Approximately one in ten people is classified as obese or overweight, often due to abnormalities in lipid metabolism. Abnormal levels of lipids in the blood, known as dyslipidaemia, lead to an increased risk of chest pain, heart attack, and stroke.
There is growing interest in developing treatments for dyslipidaemia that leverage the properties of thyroid hormones. Thyroid hormones increase overall metabolism through binding to two types of receptors: alpha (THRα) and beta (THRβ). The brain, heart, and muscle contain the α-subtype, whereas the liver and pituitary gland primarily express the β-subtype.
Treatments that rely on THR activation face challenges due to the side effects of thyroid hormones. Although THRα regulates cardiovascular functions, excess levels of thyroid hormone lead to adverse effects in nearby organs such as heart enlargement and muscle and bone wasting. On the other hand, activation of THRβ influences lipid metabolism without these severe side effects.
As a result, THRβ has become a desirable target for treating metabolic disorders such as dyslipidaemia. However, common treatments, such as the natural thyroid hormone T3, show almost no selectivity between the α and β receptors, making it difficult to avoid the severe side effects caused by binding to THRα.
To address this problem, a research team, including Masakazu Nambo, Taeko Ohkawa, Ayato Sato, Cathleen Crudden, and Takashi Yoshimura from Nagoya University’s WPI-ITbM, developed ZTA-261, a thyroid hormone derivative drug with a similar structure. To test its efficacy, they compared it with GC-1, another thyroid hormone derivative, and the natural thyroid hormone T3 in a mouse model.
They found that ZTA-261 had almost 100 times higher selectivity for THRβ than THRα. In comparison, GC-1 showed only a 20-fold difference in affinity, showing ZTA-261’s superior selectivity. This was confirmed by the significant increase in heart weight and bone damage indicators in T3-treated mice but not in those treated with ZTA-261.
“Our findings suggest that ZTA-261 is much less toxic than T3 and even less toxic than GC-1, which is known as a THRβ-selective compound,” Ohkawa said. “I find it amazing that the difference in THR beta-selectivity between ZTA-261 and GC-1 – 100 times selectivity versus 20 times selectivity – truly has this big an impact on heart and bone toxicity.”
As many drugs have been discontinued in preclinical trials because of their toxicity in the liver, the researchers checked for potential liver toxicity by measuring alanine aminotransferase (ALT) levels in the blood. Their findings confirmed the safety of the drug, finding no significant differences in ALT levels between mice treated with ZTA-261 and those treated with saline. Although these results are promising, more studies, including human trials, will be necessary before considering ZTA-261 for clinical use. However, this breakthrough represents a significant step forward in the development of safer treatments for lipid disorders.
“ZTA-261 has extremely high affinity and selectivity for THRβ among the thyroid hormone derivatives developed to date,” Nambo explained. “In the process of synthesising a variety of derivatives, we have found that precise molecular design is crucial for both selectivity and affinity. We believe that this study will provide new and important insights into drug discovery.”
By Margot Brews, Head Health Risk Management Strategy at Momentum Health Solutions
The healthcare sector has been on the cusp of substantial reform for quite some time. However, the introduction and application of artificial intelligence (AI) across various healthcare disciplines will surely stand out as one of the most revolutionary eras in the industry.
This rapidly evolving field has been lauded as the key to unlocking greater quality in healthcare services, introducing more efficient protocols and treatment pathways, as well as considerably increasing access to healthcare across all demographics.
When we place this in a local context, taking into consideration that steps to implement the NHI are already in motion, AI will be critical in helping implement specific elements, such as public health interventions. If we are to refer to the Covid-19 pandemic and its immense scale, AI was leveraged across various countries around the globe to predict the spread of the virus. In doing so, this allowed governments to implement protocols to curb its spread, as well as provide citizens with critical information in an effort to decrease its proliferation.
Looking at the medical schemes sector in South Africa, the industry aims to ultimately improve health outcomes for members and in doing so, encourage and maintain a better quality of life. AI has assisted Momentum Health Solutions in evaluating the delivery of healthcare in the future with clear goals that include increasing access to quality healthcare, and utilising the unmatched innovation that AI offers in assessing member profiles more comprehensively. This is to ensure that we are not only providing a service, but actually understanding in the broadest terms possible what type of care a member requires and partnering with them on that journey.
An example of this is closely analysing commonalities within a member’s treatment pathway. When we review clinical data such as doctors’ consultations, the discipline of the doctor and their particular field of expertise, along with the medication prescribed, we can more timeously start to see patterns developing. This indicates and therefore informs us that the member may have a more serious illness or chronic disease that requires clinical support on a more extensive scale, which we can then discuss with the member and facilitate.
To ensure we are providing tailored healthcare solutions that steer away from offering members generic benefits, we have partnered with Amazon Web Services (AWS), which provides the most comprehensive services, tools, and resources in artificial intelligence today. Through this partnership we have been able to provide members with unique services and individualised care that ultimately ensures their healthcare is a priority.
While AI is indeed key to creating a more efficient healthcare system, ethical considerations remain a concern for many when evaluating factors such as the protection and privacy of data and its ownership, as well as the accuracy of its outputs and conclusions. Having said this, risk mitigation protocols have been implemented to ensure that personal data is protected, and ethical standards are maintained at the highest level.
AI is certainly the most effective solution in the 21st century when investigating ways to solve the ongoing healthcare crisis, particularly in South Africa, where immense disparity exists between the public and private sectors. Leveraging AI, both from a medical scheme provider perspective and more broadly, will not only empower current and future workforces within the sector, but will also create greater opportunity for improved healthcare services that can be sustained. When implemented and utilised for the benefit of all, AI has the potential to be South Africa’s healthcare redeemer.
Dr Winter performing a CT-guided interventional procedure. Photo: Supploed
Radiology encompasses more than just imaging. It is a medical field that uses various imaging techniques to diagnose conditions, guide minimally invasive procedures and, much to the relief of agonised patients, treat chronic pain.
‘Traditionally, radiology is known as a modality where causes of pain are only diagnosed’, says Dr Arthur Winter, a radiologist at SCP Radiology. ‘Interventional radiology has changed this. It is a rapidly developing branch of radiology involving minimally invasive procedures. Pain management procedures are becoming a daily part of busy radiology departments.’
Simply put, interventional radiologists can use precisely targeted injections to intervene in the body’s perception of pain.
Understanding pain
Pain is a signal from the nervous system to let you know that something is wrong in your body. It is transmitted in a complex interaction between specialised nerves, the spinal cord and the brain. It can take many forms, be localised to one part of the body or appear to come from all over.
Pain can be acute or chronic
Harvard Medical School gives an overview of the difference between the two. ‘Most acute pain comes from damage to body tissues. It results from physical trauma such as a sports or exercise injury, a broken bone, a medical procedure or an accident like stubbing your toe, cutting a finger or bumping into something. The pain can feel sharp, aching or throbbing and often heals within a few days to a few weeks.’
In comparison, chronic pain lasts at least two to three months, often long after you have recovered from the injury or illness and may even become permanent. It could also be a result of lifestyle diseases. Symptoms and severity vary and may include a dull ache, shooting, burning, stabbing or electric shock-like pain and sensations like tingling and numbness. Chronic pain can be debilitating and affect your ability to perform activities of daily living.
Interventional pain management
Although some acute pain can be managed with interventions, it is patients with chronic pain that truly benefit. ‘These patients often use high doses of opioid painkillers that may cause nausea, constipation, anorexia and addiction. Other painkillers may also irritate the stomach lining and cause kidney problems,’ says Dr Winter.
An alternative that interventional pain management offers, involves injections called nerve blocks that target very specific nerves.
‘Most of these interventions prevent nerve impulses or pain signals from being transmitted, using long-acting local anaesthetics. The effect is usually temporary but the addition of cortisone – or steroids – often brings longer-lasting relief. In some cases, it could be appropriate to follow the temporary block with neurolysis, which is a permanent disruption or destruction of the target nerves.’
Although nerve blocks and other long-acting pain injections have been done for years, the scope of procedures is evolving fast. The involvement of radiologists has also grown.
Dr Winter explains. ‘Pain management has traditionally been the responsibility of clinicians and anaesthetists. During nerve block procedures, they were typically guided by their knowledge of anatomy or a continuous X-ray technique called fluoroscopy. As ultrasound became more widely available, many anaesthetists learned to do these procedures under ultrasound guidance.
‘These specialists still provide these treatments but, thanks to the availability of specialised imaging equipment, radiologists now have the tools and skill to do procedures under sophisticated image guidance. With CT guidance, some procedures can be performed with great accuracy while avoiding blood vessels and non-target organs,’ says Dr Winter.
‘A lower dose of medication is also needed if the needle is placed accurately next to the target nerves. It is therefore not surprising that this is increasingly becoming a responsibility of interventional radiologists.’
Other procedures where radiologists are involved include targeted Botox injections to treat the symptoms of Piriformis syndrome, epidural cortisone injections for inflammation in the spine and a procedure called epidural blood patch. This is to seal spinal fluid leaks that cause low-pressure headaches.
In conclusion, Dr Winter says chronic pain may cause poor quality of life and depression, often seen in patients with underlying cancer. ‘It is especially these patients who should be considered for interventions. There are, for example, very effective procedures to manage pain caused by pancreatic and pelvic cancers.
‘Specialists like oncologists and neurologists recognise the value of interventional radiology in pain management and work closely with us to support their patients. It is a growing branch of radiology that offers a minimally invasive solution and it’s quite rewarding to see patients regain some quality of life.’
A new large study led by researchers at the American Cancer Society (ACS) suggests incidence rates continued to rise in successively younger generations in 17 of the 34 cancer types, including breast, pancreatic, and gastric cancers. Mortality trends also increased in conjunction with the incidence of liver (in females only), uterine corpus, gallbladder, testicular, and colorectal cancers. The report appears in the journal The Lancet Public Health.
“These findings add to growing evidence of increased cancer risk in post-Baby Boomer generations, expanding on previous findings of early-onset colorectal cancer and a few obesity-associated cancers to encompass a broader range of cancer types,” said Dr Hyuna Sung, lead author of the study and a senior principal scientist of surveillance and health equity science at the American Cancer Society. “Birth cohorts, groups of people classified by their birth year, share unique social, economic, political, and climate environments, which affect their exposure to cancer risk factors during their crucial developmental years. Although we have identified cancer trends associated with birth years, we don’t yet have a clear explanation for why these rates are rising.”
In this analysis, researchers obtained incidence data from 23 654 000 patients diagnosed with 34 types of cancer and mortality data from 7 348 137 deaths for 25 types of cancer for individuals aged 25–84 years for the period Jan 1, 2000, to Dec 31, 2019, from the North American Association of Central Cancer Registries and the U.S. National Center for Health Statistics, respectively. To compare cancer rates across generations, they calculated birth cohort-specific incidence rate ratios and mortality rate ratios, adjusted for age effect and period effect, by birth years, separated by five-year intervals, from 1920 to 1990.
Researchers found that incidence rates increased with each successive birth cohort born since approximately 1920 for eight of 34 cancers. In particular, the incidence rate was approximately two-to-three times higher in the 1990 birth cohort than in the 1955 birth cohort for pancreatic, Kidney, and small intestinal cancers in both male and female individuals; and for liver cancer in female individuals. Additionally, incidence rates increased in younger cohorts, after a decline in older birth cohorts, for nine of the remaining cancers including breast cancer (oestrogen-receptor positive only), uterine corpus cancer, colorectal cancer, non-cardia gastric cancer, gallbladder cancer, ovarian cancer, testicular cancer, anal cancer in male individuals, and Kaposi sarcoma in male individuals. Across cancer types, the incidence rate in the 1990 birth cohort ranged from 12% for ovarian cancer to 169% for uterine corpus cancer higher than the rate in the birth cohort with the lowest incidence rate. Notably, mortality rates increased in successively younger birth cohorts alongside incidence rates for liver cancer (female only), uterine corpus, gallbladder, testicular, and colorectal cancers.
“The increase in cancer rates among this younger group of people indicate generational shifts in cancer risk and often serve as an early indicator of future cancer burden in the country. Without effective population-level interventions, and as the elevated risk in younger generations is carried over as individuals age, an overall increase in cancer burden could occur in the future, halting or reversing decades of progress against the disease,” added Dr Ahmedin Jemal, senior vice president, surveillance and health equity science at the American Cancer Society and senior author of the study. “The data highlights the critical need to identify and address underlying risk factors in Gen X and Millennial populations to inform prevention strategies.”
“The increasing cancer burden among younger generations underscores the importance of ensuring people of all ages have access to affordable, comprehensive health insurance, a key factor in cancer outcomes,” said Lisa Lacasse, president of the American Cancer Society Cancer Action Network (ACS CAN). “To that end, ACS CAN will continue our longstanding work to urge lawmakers to expand Medicaid in states that have yet to do so as well as continue to advocate for making permanent the enhanced Affordable Care Act tax subsidies that have opened the door to access to care for millions.”
