Being obese significantly increases the chances of also developing mental disorders. This applies to all age groups, with women at higher risk than men for most diseases, as a recent study of the Complexity Science Hub and the Medical University of Vienna shows. The results were published in the specialist journal Translational Psychiatry.
“We analysed a population-wide national registry of inpatient hospitalisations in Austria from 1997 to 2014 in order to determine the relative risks of comorbidities in obesity and identify statistically significant sex differences,” explains Elma Dervic of the Complexity Science Hub. Consequently, it became evident that an obesity diagnosis significantly enhances the likelihood of a wide range of mental disorders across all age groups – including depression, nicotine addiction, psychosis, anxiety, eating and personality disorders. “From a clinical point of view, these results emphasise the need to raise awareness of psychiatric diagnoses in obese patients and, if necessary, to consult specialists at an early stage of diagnosis,” says Michael Leutner of the Medical University of Vienna.
First diagnosis: obesity
“In order to find out which illness typically appeared prior and subsequently to the obesity diagnosis, we had to develop a new method,” explains Dervic. This allowed the researchers to determine if there were trends and typical patterns in disease occurrence.
In case of all co-diagnoses, with the exception of the psychosis spectrum, obesity was in all likelihood the first diagnosis made prior to the manifestation of a psychiatric diagnosis. “Until now, physicians often considered psychopharmacological medications to cause the association between mental disorders and obesity as well as diabetes. This may be true for schizophrenia, where we see the opposite time order, but our data does not support this for depression or other psychiatric diagnoses,” explains Alexander Kautzky from Department of Psychiatry and Psychotherapy of the Medical University Vienna. However, whether obesity directly affects mental health or whether early stages of psychiatric disorders are inadequately recognised is not yet known.
Women more impacted
Surprisingly, the researchers found significant gender differences for most disorders — with women showing an increased risk for all disorders except schizophrenia and nicotine addiction.
While 16.66% of obese men also suffer from nicotine abuse disorder, this is only the case in up to 8.58% of obese women. The opposite is true for depression. The rate of diagnosed depressive episodes was almost three times higher in obese women (13.3% obese; 4.8% non-obese). Obese men were twice as likely to be affected (6.61% obese; 3.21% non-obese).
Early intervention is key
Since this study now also shows that obesity often precedes severe mental disorders, the findings reinforce its importance as a pleiotropic risk factor for health problems of all kinds. This is especially true for young age groups, where the risk is most pronounced, and for whom the researchers strongly recommend obesity screening.
Engineers have developed a simple, low-cost clip that uses a smartphone’s camera and flash to monitor blood pressure at the user’s fingertip. The clip works with a custom smartphone app and currently costs about $0.80 to make. The researchers estimate that the cost could be as low as $0.10 apiece when manufactured at scale. The technology was described in the journal Scientific Reports.
Researchers say it could help make regular blood pressure monitoring easy, affordable and accessible to people in resource-poor communities. It could benefit older adults and pregnant women, for example, in managing conditions such as hypertension.
“We’ve created an inexpensive solution to lower the barrier to blood pressure monitoring,” said study first author Yinan (Tom) Xuan, an electrical and computer engineering PhD student at University of California San Diego.
“Because of their low cost, these clips could be handed out to anyone who needs them but cannot go to a clinic regularly,” said study senior author Edward Wang, a professor of electrical and computer engineering at UC San Diego and director of the Digital Health Lab. “A blood pressure monitoring clip could be given to you at your checkup, much like how you get a pack of floss and toothbrush at your dental visit.”
Another key advantage of the clip is that it does not need to be calibrated to a cuff.
“This is what distinguishes our device from other blood pressure monitors,” said Wang. Other cuffless systems being developed for smartwatches and smartphones, he explained, require obtaining a separate set of measurements with a cuff so that their models can be tuned to fit these measurements.
“Our is a calibration-free system, meaning you can just use our device without touching another blood pressure monitor to get a trustworthy blood pressure reading.”
To measure blood pressure, the user simply presses on the clip with a fingertip. A custom smartphone app guides the user on how hard and long to press during the measurement.
The clip is a 3D-printed plastic attachment that fits over a smartphone’s camera and flash. It features an optical design similar to that of a pinhole camera. When the user presses on the clip, the smartphone’s flash lights up the fingertip. That light is then projected through a pinhole-sized channel to the camera as an image of a red circle. A spring inside the clip allows the user to press with different levels of force. The harder the user presses, the bigger the red circle appears on the camera.
The smartphone app extracts two main pieces of information from the red circle. By looking at the size of the circle, the app can measure the amount of pressure that the user’s fingertip applies. And by looking at the brightness of the circle, the app can measure the volume of blood going in and out of the fingertip. An algorithm converts this information into systolic and diastolic blood pressure readings.
The researchers tested the clip on 24 volunteers from the UC San Diego Medical Center. Results were comparable to those taken by a blood pressure cuff.
“Using a standard blood pressure cuff can be awkward to put on correctly, and this solution has the potential to make it easier for older adults to self-monitor blood pressure,” said study co-author and medical collaborator Alison Moore, chief of the Division of Geriatrics in the Department of Medicine at UC San Diego School of Medicine.
While the team has only proven the solution on a single smartphone model, the clip’s current design theoretically should work on other phone models, said Xuan.
Next steps include making the technology more user friendly, especially for older adults; testing its accuracy across different skin tones; and creating a more universal design.
Heparin, commonly prescribed to pregnant women with an inheritable blood clotting condition and a history of recurrent miscarriage does not help to reduce their miscarriage risk, new research has found. The UK-led international study was published in The Lancet.
Researchers are now advising doctors to stop offering the anticoagulant heparin to women and birthing people with inherited thrombophilia, an inherited condition which increase clotting risk.
Despite the lack of evidence and guidance, doctors often prescribe heparin to women with recurrent miscarriage and inherited thrombophilia. It’s costly for health services, and inconvenient for women who must inject the drug daily and are more likely to experience bruising as a result.
The results show that a daily injection of heparin does not improve the chance of a live birth for women who have previously had two or more miscarriages and confirmed inherited thrombophilia, when compared to standard care.
Led by Professor Siobhan Quenby at the University of Warwick, the ALIFE2 trial recruited women from 40 hospitals in Europe and the US.
326 women with inherited thrombophilia and recurrent miscarriage were split into 2 groups; 164 received heparin across the course of their pregnancy, starting from as soon as possible after a positive pregnancy test and ending at the start of labour. 162 were not offered the medication.
All women received standard obstetrician-led care and all women were encouraged to take folic acid.
The rate of live births for each group was roughly the same: 116 women (71.6%) treated with heparin had a baby born alive after 24 weeks’ pregnancy. 112 women (70.9%) in the standard care group had a baby born alive after 24 weeks’ pregnancy.
The risk of other pregnancy complications, including miscarriage, babies with low birth weight, placental abruption, premature birth or pre-eclampsia, was about the same for both groups.
As expected, bruising easily was reported by 73 (45%) of women in the group taking heparin (mostly around injection-sites) and only 16 (10%) in the standard care group.
Professor Siobhan Quenby says, “Based on these findings, we don’t recommend the use of Low Molecular Weight Heparin for women with recurrent pregnancy loss and confirmed inherited thrombophilia.”
“We also suggest that screening for inherited thrombophilia in women with recurrent pregnancy loss is not needed. Patients and doctors will always value knowing about any factor which could be associated with recurrent miscarriage, but the association between inherited thrombophilia and recurrent miscarriage isn’t proven: a recent review of research showed that thrombophilia is as common in the general population as it is in women with recurrent miscarriage.”
“Many women with recurrent miscarriage around the world are tested for inherited thrombophilia and are treated with heparin daily. Research now shows that this screening is not needed, the treatment isn’t effective, and it is giving false hope to many by continuing to offer it as a potential preventive treatment.”
Twenty-eight percent of women who participated in the trial lost their badly wanted pregnancies, and these unexplained losses will be the focus of further study, as our researchers continue to search for answers and treatment to prevent early pregnancy loss.
Research published in Nature has identified a new compound that can stimulate nerve regeneration after injury, as well as protect cardiac tissue from the sort of damage seen in heart attack. The UCL-led study identified a chemical compound, named ‘1938’, that activates the PI3K signalling pathway, and is involved in cell growth.
Results from this early research, which was done in partnership with the MRC Laboratory of Molecular Biology (MRC LMB) and AstraZeneca, showed the compound increased neuron growth in nerve cells, and in animal models, it reduced heart tissue damage after major trauma and regenerated lost motor function in a model of nerve injury.
Though further research is needed to translate these findings into the clinic, 1938 is one of just a few compounds in development that can promote nerve regeneration, for which there are currently no approved medicines.
Phosphoinositide 3-kinase (PI3K) is a type of enzyme that helps to control cell growth. It is active in various situations, such as initiating wound healing, but its functions can also be hijacked by cancer cells to allow them to proliferate. As a result, cancer drugs have been developed that inhibit PI3K to restrict tumour growth. But the clinical potential of activating the PI3K pathway remains underexplored.
Dr Roger Williams, a senior author of the study from the MRC Laboratory of Molecular Biology, said: “Kinases are ‘molecular machines’ that are key to controlling the activities of our cells, and they are targets for a wide range of drugs. Our aim was to find activators of one of these molecular machines, with the goal of making the machine work better. We found that we can directly activate a kinase with a small molecule to achieve therapeutic benefits in protecting hearts from injury and stimulating neural regeneration in animal studies.”
In this study, researchers from UCL and MRC LMB worked with researchers from AstraZeneca to screen thousands of molecules from its chemical compound library to create one that could activate the PI3K signalling pathway. They found that the compound named 1938 was able to activate PI3K reliably and its biological effect were assessed through experiments on cardiac tissue and nerve cells.
Researchers at UCL’s Hatter Cardiovascular Institute found that administering 1938 during the first 15 minutes of blood flow restoration following a heart attack provided substantial tissue protection in a preclinical model. Ordinarily, areas of dead tissue form when blood flow is restored that can lead to heart problems later in life.
When 1938 was added to lab-grown nerve cells, neuron growth was significantly increased. A rat model with a sciatic nerve injury was also tested, with delivery of 1938 to the injured nerve resulting in increased recovery in the hind leg muscle, indicative of nerve regeneration.
Senior author Professor James Phillips said: “There are currently no approved medicines to regenerate nerves, which can be damaged as a result of injury or disease, so there’s a huge unmet need. Our results show that there’s potential for drugs that activate PI3K to accelerate nerve regeneration and, crucially, localised delivery methods could avoid issues with off-target effects that have seen other compounds fail.”
Given the positive findings, the group is now working to develop new therapies for peripheral nerve damage, such as those sustained in serious hand and arm injuries. They are also exploring whether PI3K activators could be used to help treat damage in the central nervous system, for example due to spinal cord injury, stroke or neurodegenerative disease.
Much of South Africa’s public health sector is plagued by long waiting times for surgery, a situation that was made much worse by the COVID-19 pandemic. Now, an inspiring project at Groote Schuur Hospital in Cape Town has reached the target of slashing its backlog by 1 500 elective surgeries – two months ahead of target.
At the end of March, a small team of healthcare workers completed the project called ‘Surgical Recovery’. The project ran from May 2022 and was originally planned to conclude 12 months later.
While this hasn’t cleared the entire backlog of people waiting for surgery at Groote Schuur, it has helped the hospital return to about the same waiting list level as it had before the COVID-19 pandemic, according to Professor Lydia Cairncross, the head of general surgery at Groote Schuur. (Spotlight previously reported on the human cost of surgical waiting lists and on what could be done about it.)
The surgeries took place mainly in the E4 Surgical Day Ward at Groote Schuur. Cairncross explains that ward E4 was built as a Day Ward – meaning it handles surgeries where patients don’t require an overnight stay pre- or post-surgery – with the aim of increasing daycare surgery capacity for the hospital. And for the last 12 months, it has been the host of the Surgical Recovery Project.
E4 has 16 patient beds, four recovery beds, and two theatres, which were completed just as the COVID-19 pandemic hit the country. During the third wave of the pandemic, it was used as a COVID High Care Unit.
According to Dr Shrikant Peters, a public health specialist and the medical manager of theatre and ICU services at Groote Schuur, the hospital’s CEO Dr Bhavna Patel “had the foresight to request provincial use of COVID funding to develop the space as COVID High Care, and eventually to be used long-term as an Operating Suite and High Care Ward in line with prior hospital plans”.
The Surgical Recovery Project
By the end of the third wave of the COVID-19 pandemic, according to Cairncross, there were discussions about how to catch up on the surgeries that had to be postponed because of COVID-19.
“The backlog in surgery comes on top of a pre-existing backlog. So, it’s not that the backlog was created by COVID, but it made it much, much, much worse,” she says, “In November 2021, we did an audit of how many patients were just physically waiting for surgery at the hospital. It was around 6 000 plus. We don’t actually have a baseline for pre-COVID, but we knew that we lost about 50% of our operating capacity,” Cairncross says.
“So, the idea was really to find a way to utilise this theatre space so that we could catch up with some of that backlog.”
From here, the Surgical Recovery Project for Groote Schuur was born with the ambitious target of performing 1 500 surgeries in 12 months.
Funds from the project came from three sources. Kristy Evans, head of the Groote Schuur Hospital Trust, tells Spotlight that fundraising for the project was kick-started by a R5 million donation from Gift of the Givers. The recently established Groote Schuur Hospital Trust focused on Surgical Recovery as their first project to fundraise for. An additional R1 million was raised by the Trust from over 500 corporate and private donors.
“People are always willing… [they] give what they can. We had donations from people who would transfer R10 into the account, sometimes people transfer R180 000,” Evans says.
She adds that the Project will continue into its second year, but the details regarding targets had not yet been finalised by the time of publication.
The Western Cape Provincial Department of Health also donated around R6.5 million to the project from their budget for surgical recovery post-COVID-19. According to Mark van der Heever, the provincial health spokesperson, this money was part of the R20 million that the department allocated to various surgical backlog recovery initiatives.
“[The] COVID-19 pandemic meant that elective surgical services had to be significantly de-escalated, as staff were deployed to COVID services, and this resulted in an increase in the backlog of operations. Hence, a specific practi[cal] plan to address this backlog in the short and long term has been developed,” says van der Heever. “Similar projects and initiatives across hospitals have already taken shape and also yielded success, such as at Karl Bremer Hospital, which also received a portion of the R20 million from the department. The hospital was able to perform an extra 328 procedures since August last year.”
Working around difficulties
At Groote Schuur, the project had to find a way to work around the difficulties of surgical catch-up. According to Cairncross, with any surgical catch-up, the challenges don’t just come from needing a physical space to operate in but also from having the appropriately trained staff. Not having enough trained staff in the public health sector, like theatre and surgery nurses, makes it hard to implement a surgical catch-up programme, even if there is money to do so.
To work around these difficulties, they came up with a centralised model for surgical recovery, where one theatre team of nurses could be employed on a contract rate for the 12 months. This team, led by Sister Melinda Davids, the nursing operations manager for the E4 theatre, would work Monday to Thursday in one of the E4 theatres and occasionally other theatres in the hospital for each of the 1 500 surgeries.
According to Cairncross, many surgeons, herself included, would come and operate on patients in addition to their normal surgeries and other duties. The funds, a total of about R 12.5 million, were used to pay the staff involved in the surgeries. The day-to-day operations were run by Davids and Peters.
According to Peters, the 1 500 operations occurred across all surgical specialities, ranging from cataract to cardiothoracic.
Success factors
Cairncross attributes the success of the project to the existing systems at Groote Schuur, supportive management, and the dedication of the surgical team and surgeons that gave their time to the project.
She says that because the hospital has a relatively functional system to start off with and a supportive management team, it allowed for “enough of a regulatory environment to keep things safe and above board but not to the extent where you can’t move”.
It was also about having the right person in charge of the team, she adds, gesturing to Davids.
Davids, who started her nursing career in 1989 and qualified as a theatre nurse in 2009, started working at Groote Schuur six years ago. She explains that the surgical team at E4 consisted of about 18 people. This includes herself, five scrub nurses, three anaesthetic nurses, three floor nurses, a registered nurse who assists in recovery, and a clerk. Peters adds that there are also two surgical medical officers and two anaesthetic registrars.
According to Davids, when the project started, several of the nurses had not worked in a theatre before so had to be trained and upskilled by her and some of the specialist nurses who make up the scrub nurse team. She also had to get creative about having the right equipment for each surgery, which sometimes meant she had to borrow equipment from other theatres.
“It’s been a challenge, but it’s a good challenge that’s kept me going,” she says. “We’re a good team.”
“Trust [in staff] has been fundamental to this,” says Peters, “I mean, the ability to trust junior staff to upskill themselves to become scrub nurses, to hand surgeons the right instrument when they asked for it. That’s been really heart-warming.”
‘Behind every number on the list is a patient’
When asked why it was so important to do this kind of catch-up, Cairncross says the surgeries that were postponed during the COVID-19 pandemic were ones that weren’t urgent or emergent, but those patients who were bumped still struggled physically because of the delays.
“Behind every number on the list is a patient with a story of either progressive blindness, invasive skull tumours, or tumours around the auditory canal that result in hearing loss, chronic pain from joint problems and urinary retention with recurrent infections and admissions or having a stoma bag [a colostomy bag] with them for months longer than needed,” Cairncross says. “Heart-breaking stories and often these were the patients who kept getting cancelled [on]. They would come in and if something urgent would come up, they would be cancelled or the COVID wave would come.”
She adds that at the time when the idea for Surgical Recovery came about, the morale amongst the surgical teams was at a real low. Patients would be coming to the outpatient clinics and asking, for the umpteenth time, “when am I going to have my operation?” to which the healthcare workers had to keep responding that they don’t know.
“It’s just a terrible thing and so people [staff] started to feel disempowered and disillusioned and I really think that the project helped them to at least see some progress. That there were some changes or some shift in what they were dealing with,” Cairncross says. “It hasn’t cleared our entire backlog, and a once-off project will not do that, but it has reset us pretty close to where we were pre-COVID-19.”
Peters adds that while the backlogs haven’t been fully cleared, “for every case that we’ve done in the project, it’s someone off of a waiting list”.
Health system at a ‘precipice’
While the COVID-19 pandemic caused many surgeries to be postponed and added tremendously to surgical waiting lists, it isn’t the only factor contributing to backlogs. According to Peters, the issue of a shrinking health budget for tertiary services is and will continue to add to the existing backlogs across the country.
“There’s this building backlog coming up against the shrinking budget. And that’s going to be with us for multiple years going into the future and if the clinicians aren’t protecting the budget for these patients that get missed, we’re going to focus on as we have been the emergency patients that come through the door,” he says. “But it’s always difficult for tertiary academic services because to keep up the skills of surgeons to maintain the quality of care, they do need to be managing waiting lists of booked patients. And so, I think across the country we’re going to be struggling with that across all tertiary services.”
Cairncross tells Spotlight that the project is just a temporary measure. In the long term, healthcare systems need to be fixed in order to address issues like surgical backlogs.
“The lesson, I suppose, is that these are temporising measures. We can do them, but fundamentally we need to fix the health system at a core, structural level. And we can’t work in isolation from the rest of the country because we are one health system and tertiary hospitals are only a part of that ecosystem,” she says. “The services at Groote Schuur Hospital, for example, cannot be sustained if the health systems from primary care to district health facilities, in urban and rural facilities, and across provinces are not supported and strengthened.”
The health system is at a precipice, according to Cairncross, and big academic hospitals need to be anchoring elective surgical services together with emergency services, as the problem with emergency services will only get bigger down the line if electives aren’t dealt with now.
“We know that postponed elective surgery just becomes emergency surgery over time, making cancelling elective surgery a false economy. We need to plan robust systems that ensure all types of surgical services are maintained,” she says.
“The strongest voice [in defence of the health system] is a conscious and motivated health workforce. So, where the nurses and doctors and managers are standing and defending patient services, they are supporting the health system,” she says. “I think this is an example of health workers standing up and saying, we can’t allow this deterioration in services. We’ve got to do more. We really want to tell the story, so that people can see it can be done.”
