Categories : Healthcare Politics and RegulationsTags : Leave a comment

Can SA’s New Director-General for Health Turn Around a Struggling Department?

On By ModernMedia
Dr Thembisile Xulu is the newly-appointed Director General of the National Department of Health. (Photo: Denvor de Wee/Spotlight)

By Marcus Low

Dr Thembisile Xulu is South Africa’s sixth permanent Director-General of health since the dawn of democracy. How will she measure up against her predecessors?

In recent months, we’ve been keeping an especially close eye on the media statements following the twice-monthly meetings of South Africa’s cabinet. Then last week, we finally spotted the line we had been waiting for – the announcement of South Africa’s new Director-General (DG) for Health. 

The name of the country’s sixth permanent DG since 1994 was a familiar one. Back in 2020, Spotlight interviewed Dr Thembisile Xulu when she was appointed CEO of the South African National AIDS Council (SANAC) – the national body established by Cabinet to coordinate South Africa’s response to HIV, Tuberculosis, and Sexually Transmitted Infections. 

In moving from the job of SANAC CEO to health DG, Xulu follows in the footsteps of Dr Sandile Buthelezi, who was CEO of SANAC from 2017 to 2020 and DG for Health from 2020 to early 2026, when he was suspended along with two other senior officials in the department. 

Prior to her time at SANAC, Xulu worked at the non-profit Right to Care for around a decade and a half. She is a medical doctor and has a master’s degree in public health. As far as we can tell, she is well liked in healthcare circles.

A huge task

The job facing Xulu is a daunting one. 

First, she will have to sort out problems within the department itself. As we pointed out in an editorial published in April, the department hasn’t gotten a clean audit in any of the last five years. The Digital Vibes scandal and the suspension of several senior officials earlier this year relating to another matter paints a bleak picture. While we know there are several committed and capable people working in the department, organisationally it seems to be exhibiting all the classic signs of chronic dysfunction and a lack of effective leadership. 

Maybe the most urgent task facing Xulu then is simply to turn the health department into a more professional organisation. This will require strong leadership and management skills, but it will also require her to more effectively protect the department from whatever the political whims of the day may be. Ultimately, a DG that always says, “yes Minister”, isn’t actually doing the Minister, or the public, any favours. 

But it won’t be easy. When the DG job was advertised back in March, the advert did not open by referencing the Constitution or the National Health Act, as one might expect, but by stating that the DG will be responsible for implementing the Presidential Social Compact for transformation of the health sector. The last health compact, signed in 2024, was a controversial document that did not get buy-in from several key business and healthcare worker organisations. That the job advert starts by referencing the compact rather than the relevant laws, seems an ominous sign for the DG’s chances of building a more capable, less politicised, department. 

Second, getting the department’s house in better order will help with what is of course Xulu’s main job – helping to address the country’s many health challenges. Top of the list is the chronic shortages of healthcare workers in the public sector. We have seen an important policy document and some extra funds for healthcare workers, but the incisive leadership and sustained commitment and planning needed to really get on top of the problem has been absent. 

There is a worrying pattern whereby government looks into a problem, maybe a committee of some sort is set up, the intentions are all good, but then everything stalls once some implementation challenge or political complication arises. We need a DG who does not allow important health issues to drift in this way, but who has the focus and determination to find workable solutions and to see them through. 

And then there is NHI

The NHI Act might currently be tangled up in a thicket of litigation, but whatever happens in the courts, NHI will be a big part of the DG’s work in the coming years (DGs are appointed for five years at a time). This may take the form of implementing some elements of the current NHI Act, or working with a revised Act, we just don’t know at this stage. 

But there will be many other bread and butter issues besides NHI demanding Xulu’s attention. In our analysis, the department has badly dropped the ball on urgent issues such as healthcare worker shortages, the regulation of private healthcare, and improving the quality of public healthcare services in areas such as mental health, diabetes, and hypertension. Hopefully under the new DG, the department will find ways of better addressing these issues in parallel with its work on NHI. 

A chance at renewal

There is some reason for optimism. With the appointment of Xulu as DG, and that of Dr Nonhlanhla Ndlovu before that as the department’s HIV czar, new people are now in two of the most important positions in the department. Such leadership changes offer a unique opportunity for organisational renewal. 

Spotlight has requested an interview with Xulu and we hope to get some time with her once she’s been in the job for a few weeks. We will ask her the tough questions, but we will also be fair and give her time. After all, we all want to see a health department and a health system that works. 

– Low is editor of Spotlight

This article was first published by Spotlight – health journalism in the public interest. Sign up to the Spotlight newsletter.

Categories : AgeingTags : Leave a comment

Study Identifies Potentially Harmful Drug Combinations Prescribed to Older Adults

On By ModernMedia
Photo by Kampus Production

A new Ontario-wide study reveals that common medications, from statins to iron supplements, are quietly setting off prescribing cascades that leave older adults unknowingly taking drugs to treat side effects of other drugs.

The research, published in BMJ and led by Paula Rochon, a clinician scientist at Sinai Health and professor of medicine at the University of Toronto’s Temerty Faculty of Medicine, has revealed that certain drug combinations are a common but unrecognised contributor to drug related harm at the population level and add unnecessary costs to the healthcare system. 

A potentially inappropriate prescribing cascade (PIPC) happens when a medication’s side effect gets mistaken for a new health problem, leading to another prescription that may not have been needed in the first place. One common example flagged in the study involves non-steroidal anti-inflammatory drugs (NSAIDs). Commonly prescribed for pain, these drugs are associated with a rise in blood pressure, which can lead to a new prescription for high blood pressure, rather than a second look at the original pain medication. Older adults are especially vulnerable to this pattern because they’re more likely to be on multiple medications at once, due to having multiple conditions, making it harder for both patients and clinicians to trace a new symptom back to an existing drug.

“These sequences of events are common but often missed in clinical practice,” says Rochon, who serves as the director of research at the Weston and O’Born Centre for Mature Women’s Health at Sinai Health. “Knowing what medications you are taking, when they were started and for what indication is important in order to identify possible prescribing cascades that may be problematic.”

The study brought together an interdisciplinary, international team of collaborators and leaders in drug prescribing and geriatric medicine research from the United States, Belgium, Italy, Israel and Ireland, along with Sinai Health researchers and U of T professors Vasily Giannakeas and Nathan Stall, geriatrician Christina Reppas-Rindlisbacher and research staff Wei Wu and Joyce Li.

With the expertise of 12 international panellists specialising in internal medicine, geriatric medicine and clinical pharmacology, the research team previously created a list of 65 PIPCs. Using this list and population-level prescription data from ICES, Ontario’s health data institute, the researchers examined each PIPC against three factors: how common the initial drug was in the population, how often it was followed by the second drug, and how strong the link was between the two. That analysis allowed them to pinpoint the 24 potentially inappropriate prescribing cascades most commonly seen in the population and with a potential to cause harm.

Seeing the pattern behind every prescription 

For Rochon, the findings highlight a gap that opens quietly, one prescription at a time. “Our concern is that so often these conversations between the health care prescriber and the patient are being missed, so people don’t recognise the sequences of events and that they are connected to one another,” she said.

Closing that gap means physicians need to think about medication history at every visit, not just what a patient is currently taking, but why each drug was started in the first place, and whether the next one was really needed.

The work also carries a particular weight for mature women, as they tend to live with more chronic conditions than men over their lifetime. Mature women are prescribed more drug therapies, and experience more adverse drug events. By being on multiple medications at once, they are more exposed to the risk that a drug’s side effect gets mistaken for a new diagnosis rather than traced back to its source.

The team’s findings point to promising next steps.

The first involves technology. Automated clinical decision support tools could flag a prescribing cascade in real time and prompt a second look before a new prescription is added. This information could be leveraged in one of several automated ways to help clinicians be aware of these potentially inappropriate prescribing cascades at the point of care. 

Next is optimising the role of pharmacists as part of the care team and more directly integrating them into the prescribing process alongside physicians. Their expertise can help identify these potentially inappropriate prescribing cascades for further evaluation.

Original written by Jayda Ayriss

Source: University of Ontario

Categories : CancerTags : Leave a comment

Novel Immunotherapy Leads to Complete Regression of Liver Cancer in a Child

On By ModernMedia
Photo by CDC on Unsplash

A new report in the New England Journal of Medicine by researchers at Baylor College of Medicine, Texas Children’s Hospital and Seattle Children’s describes a complete regression of hepatoblastoma, the most common paediatric liver cancer, in a 3-year-old treated with a novel immunotherapy. The patient is enrolled in the CARE study (NCT04715191), a first-in-human, Phase 1 trial evaluating glypican-3-specific chimeric antigen receptor (GPC3-CAR) T cells armed with interleukin-15 and -21 (IL15 and IL21).

The child initially presented with a large primary liver tumour and metastases in the lungs. Prior to enrolment in the CARE study, the patient was treated with three lines of chemotherapy and underwent complete resection of the primary liver tumour and two lung metastases. His cancer was no longer responsive to chemotherapy, and a new lung metastasis recurred after surgery when he was enrolled on the CARE study.

The immunotherapy was engineered from the patient’s own cells at the Good Manufacturing Practices laboratories at the Center for Cell and Gene Therapy using two vectors: one encoding the second-generation GPC3-CAR and the second encoding IL15, IL21 and the inducible caspase 9 safety switch, which Center for Cell and Gene Therapy investigators previously showed controlled CAR T expansion.

Two infusions were administered eight weeks apart in the outpatient setting. A partial response was observed after the first infusion, and imaging showed complete resolution of the metastatic disease after the second infusion. No dose-limiting toxicities or cytokine release syndrome occurred. Complete regression continues one year after treatment.

“This case demonstrates that a durable complete response in a chemotherapy-resistant solid tumour can be achieved entirely in the outpatient setting without systemic toxicity,” said first author Dr David Steffin, associate chief of cellular therapy and bone marrow transplant at Texas Children’s and associate professor of paediatrics – haematology and oncology in the Center for Cell and Gene Therapy at Baylor.

“This study provides evidence that these novel CAR T cells may be a safe and effective modality for hepatoblastoma and highlights the need for further assessment in patients with GPC3+ solid tumors,” said corresponding author Dr Andras Heczey, principal investigator at Seattle Children’s and professor of pediatrics in hematology-oncology at the University of Washington School of Medicine. Heczey was at Baylor and Texas Children’s at the time of research.

Source: Baylor College of Medicine

Categories : NeurologyTags : Leave a comment

Trial Testing Out-of-Body Experiences Produces Unexpected Twist

On By ModernMedia
Photo by Bruce Christianson on Unsplash

A test to determine if people who report out-of-body experiences could identify objects in another room produced results no better than chance, but afterward something strange happened: Two participants described, unprompted, researchers’ locations and activities behind closed doors.

The participants’ unexpected observations were not part of the trial’s predefined outcome measures and therefore can’t be considered evidence for out-of-body experiences, or OBEs, UVA Health investigators say. But the unexplained results may help researchers design better, more effective ways to evaluate the potential validity of a phenomenon that has been reported for decades.

“I hope this study encourages researchers to think creatively about how we test these experiences. The unexpected findings give us a potentially useful new direction, but they also need to be tested prospectively and under rigorous conditions before we can know what they mean,” said researcher Marina Weiler, PhD, of the University of Virginia School of Medicine’s Division of Perceptual Studies. “For me, the most important takeaway is that unexpected findings can sometimes help us ask better questions. We now have a specific idea that can be tested in future experiments, and that is exactly what science should do.”

Understanding Out-of-Body Experiences

In the recent trial, conducted in Brazil, 21 participants attempted to identify a random object on a laptop screen in another room. Of the 21, 10 reported having an out-of-body experience, and 13 provided target descriptions. (The 13 included participants who had not reported leaving their bodies but said they could see images on an internal “mental screen” or the like.)

The descriptions the participants gave of the objects on the laptop screen did not prove statistically more accurate than what could be expected from guessing. But during interviews afterward, one participant described how a researcher in another room, behind closed doors, had been seated on the left looking at a laptop screen while another researcher was farther back reading a book. Another participant described how a researcher had been seated on the right, taking notes, while a second was sitting on the left at the computer.

Trial records confirmed both descriptions were correct at the time of the participants’ sessions. Further, there was no way the participants could have seen the researchers, according to the trial organizers.

That has prompted Weiler and her collaborators to propose that the targets provided during OBE trials may play important roles in determining outcomes. It’s possible, they suggest, that memorable, distinctive or emotionally engaging targets may be easier for participants to visualise. Researchers conducting future trials may want to supplement the traditional targets with other unseen details that participants might notice, such as having a researcher wear a distinctive or colorful item of clothing while behind closed doors. 

If participants could recall such items without seeing or being told about them, that might bolster the case for out-of-body remote viewing.

“I hope these findings encourage us to think more deeply about what they might mean for our understanding of consciousness and, ultimately, the nature of reality. If studies demonstrate that people can obtain accurate information that they could not have accessed through their ordinary senses, we would have to reconsider some of our assumptions about the relationship between consciousness, perception and the physical world,” Weiler said. “At its deepest level, this research is not only asking whether out-of-body experiences are real. It is asking what we mean by ‘real’ in the first place, and whether our current understanding of reality is broad enough to account for everything human consciousness can experience.”

Findings Published

The researchers have published their findings in the peer-reviewed journal Explore. The research team consisted of Weiler, Damon Abraham, David J.P. Acunzo and Niffe Hermansson. The researchers have no financial interest in the work.

Source: University of Virginia Health

Categories : COVIDTags : Leave a comment

Should Adults with Autoimmune Rheumatic Conditions Receive Updated COVID Vaccines?

On By ModernMedia
Photo by SHVETS production

In an Arthritis & Rheumatology analysis of data on 60 980 US adults with autoimmune rheumatic conditions who developed COVID between December 2020 and August 2024, those who received booster or updated (2023-2024) COVID vaccines were less likely to be hospitalised for COVID compared to those who received only the initial series vaccines or who were unvaccinated.

Compared with no vaccination, completion of the initial series, booster vaccination, and updated vaccination were associated with 41%, 71%, and 69% lower adjusted odds of COVID-related hospitalisation, respectively. Among patients who had received only the initial vaccine series versus booster/updated vaccine, the absolute risk reduction was 5.6%.

“Our findings provide important real-world evidence that updated vaccines continue to offer substantial protection in this medically vulnerable population,” said corresponding author Maria I. Danila, MD, MSc, MSPH, of the University of Alabama at Birmingham. “These results underscore the need for continued efforts by clinicians, policymakers, and patient advocacy groups to help ensure that these patients remain current with updated COVID vaccines,” added first author Lesley E. Jackson, MD, MSPH, also of the University of Alabama at Birmingham.

Source: Wiley

Categories : Cardiovascular DiseaseTags : Leave a comment

Too Much Nighttime Light Alters Cardiac Structure and Function

On By ModernMedia
Photo by Cottonbro on Pexels

Exposure to light during the nighttime is linked to important and potentially harmful changes to the structure and function of the heart, according to a study of more than 11 000 people published in the European Heart Journal today (Thursday).

The research was led by Professor Lu Qi from Tulane University, New Orleans, USA. He said: “Previous observational studies have linked nighttime light exposure with a higher risk of cardiovascular disease, but little is known about the related cardiac structure and functional changes. We carried out this research to find out what happens to the heart over time when people are exposed to too much light at nighttime.”

The research included 11 071 people who are part of the UK Biobank study. All participants wore a light sensor on their wrists for seven days to measure light levels over night. Three years later, participants were given a cardiac MRI scan to carefully examine the structures and functions of the heart.

Researchers compared people who were exposed to light levels of more than three lux with people exposed to almost no light at night.

This showed that people with high exposure to nighttime light had thickening of the wall of the left ventricle (one of the chambers of the heart), reducing the space inside of the chamber. There were signs that the heart muscle’s ability to flex during a heartbeat was reduced. This is an early indicator of heart dysfunction. Researchers also found changes in the right ventricles and left atria (two other chambers of the heart).

Professor Qi said: “This is the first study of its kind, and it shows that exposure to higher levels of light at nighttime is linked to cardiac remodelling. This is where the structure and function of the heart changes and we typically see it in response to chronic stress or injury to the heart. It’s our body’s way of adapting to that stress, but ultimately it weakens the heart and can lead to heart failure.

“Light pollution has emerged as a new risk factor for cardiovascular disease. Our findings, together with evidence from other studies, suggest that reduction of nighttime light exposure should be considered as one of the potential strategies for preventing heart disease by clinicians and policy makers.”

In an accompanying editorial Professor Thomas Münzel from University Medical Center Mainz, Germany and colleagues said: “It is time for clinicians, particularly those managing patients with heart failure or atrial fibrillation, to start asking about the sleep environment: how dark the bedroom is, whether the patient works night shifts, and how much screen use occurs after sunset. The advice is simple and inexpensive: blackout curtains, warm-coloured bedside lighting, and covering the small standby LEDs on household electronics. From a public health perspective, the implications are larger still. Light pollution is one of the few environmental hazards that cities can control directly and affordably. Shielded fixtures, warm-spectrum bulbs, and dimming or motion-activated streetlights are already available, energy-efficient, and climate-friendly.

“Ultimately, this study is more than an interesting observation. It provides a crucial link between what satellites already show us, i.e. a planet glowing ever brighter at night, and the clinical reality unfolding inside our chests: hearts that are becoming stiffer, weaker, and less efficient. The relationship is biologically coherent, the effect sizes are clinically meaningful, and the dose–response is unambiguous: more light, worse outcomes. The takeaway is clear, darkness deserves recognition as a vital sign, as essential to cardiovascular health as blood pressure control and clean air.”

Source: European Society of Cardiology

Categories : Mental HealthTags : Leave a comment

Psychiatrists Agree on a Diagnosis in Only 55% of Cases, New Study Finds

On By ModernMedia
Photo by Vitaly Gariev on Unsplash

When psychiatrists assess the same patient, they agree on the diagnosis in only about half of cases, according to a new study from the University of Copenhagen. The findings raise concerns about potential misdiagnosis, inappropriate treatment, and errors in psychiatric research.

In the 1970s, psychiatric diagnoses were marked by considerable uncertainty and disagreement. Since then, organisations such as the American Psychiatric Association and the World Health Organization (WHO) have worked to develop standardised diagnostic criteria that psychiatrists around the world can use.

These efforts have shaped modern psychiatry by establishing common, criteria-based systems for diagnosing mental disorders across institutions and national borders.

However, a new study, led by researchers at the University of Copenhagen, suggests that major challenges remain. In the study, 1038 psychiatrists and physicians working in psychiatry from 19 countries were presented with nine written patient case descriptions. Each participant was assigned two cases and asked to determine the most appropriate diagnosis.

The results surprised the researchers.

“Our study shows that when two psychiatrists diagnose the same patient, they will agree only 55% of the time. We consider that worryingly low. In fact, it is similar to the levels reported in some of the studies conducted in the 1970s, which prompted the development of standardised diagnostic criteria in the first place,” says Professor and Consultant Psychiatrist Julie Nordgaard.

“This is not about psychiatrists doing a poor job. Rather, it reflects the fact that, despite the existence of diagnostic systems, clinicians continue to differ in how they interpret symptoms and which features they consider most important. We need a greater degree of consensus, otherwise patients risk receiving changing diagnoses and treatments,” she adds.

Same symptoms, different diagnoses

The study found substantial variation in diagnostic agreement across different mental disorders. Diagnoses within the schizophrenia spectrum proved particularly challenging.

“Cases that could be diagnosed either as schizophrenia or schizotypal disorder generated especially high levels of disagreement. In many of these cases, agreement among participants was well below 50%,” says PhD candidate Mateo Boberg, the study’s first author.

According to Boberg, one reason is that symptoms frequently overlap across psychiatric disorders. For example, obsessive thoughts may occur in both obsessive-compulsive disorder (OCD) and schizophrenia.

“These are not random errors. There is a clear pattern to the disagreements. This likely reflects the fact that diagnostic categories are not as clearly defined as we have assumed, when experienced psychiatrists can interpret the same symptom presentations so differently.”

Diagnostic uncertainty undermines research

Disagreement about diagnoses is an obvious concern for patients. But the researchers argue that diagnostic uncertainty also threatens the reliability of some kinds of psychiatric research¸ explains Professor Mads Gram Henriksen:

“In research, it is essential that we know exactly what we are studying. If a considerable part of participants enrolled in a study on treatment of personality disorders actually suffer from schizophrenia, the study’s results become difficult to interpret. Which condition is the treatment having – or not having – an effect on? Personality disorders or schizophrenia?”

The researchers argue that progress in psychiatric research risks remaining limited until there is a clearer and more widely shared understanding of what mental disorders are and how they can be distinguished from one another. Greater diagnostic agreement, they say, is a prerequisite for the breakthroughs needed to improve patient care.

“WHO’s ICD-10 diagnostic system, which participants in the study used to assess the cases, contains more than 200 diagnoses, a complexity that may contribute to uncertainty. At the same time, many psychiatric conditions are inherently multifaceted,” says Julie Nordgaard and concludes:

“In our view, it is necessary to take a step back and develop more precise descriptions of psychiatric disorders so that clinicians can distinguish them more clearly. It may also be necessary to reduce the number of diagnostic categories.”

The study, Reliability of Psychiatric Diagnoses in the 21st Century, has been published in Frontiers in Psychiatry.

Source: University of Copenhagen

Categories : Medical Research & TechnologyTags : Leave a comment

The Bias in Medical Research: Africa Carries a Huge Disease Burden but Is Missing from Clinical Trials

On By ModernMedia

Bamba Gaye, MD, MPH, MSc, PhD, Emory University

Modern medicine prides itself on being a universal science, built on evidence from clinical trials.

But there’s a bias in medical research. While Africa accounts for roughly 25% of the global disease burden and 19% of the global population, the continent’s people are largely invisible in some clinical trials.

The scale of the erasure is revealed in a landmark study of 2,472 randomised controlled trials globally published between 2019 and 2024.

I led this team of researchers, who scrutinised the world’s most influential medical publications to quantify African representation. They included the New England Journal of Medicine, The Lancet, the Journal of the American Medical Association, Nature Medicine, and the British Medical Journal. There were also three leading cardiovascular journals in the study: Circulation, the European Heart Journal and the Journal of the American College of Cardiology.

I am a physician-scientist working at the intersection of cardiometabolic epidemiology and biomedical data science. I also focus on large-scale population studies in Africa and data-driven cardiovascular prevention.

Randomised controlled trials are a cornerstone of evidence-based medicine. Introduced in the mid-20th century, they rigorously evaluate the safety and effectiveness of treatments by randomly assigning participants to different groups. This is done to minimise bias. Trials like these have been central to major medical breakthroughs, from cardiovascular therapies to vaccines. They continue to guide clinical decisions and the development of new treatments worldwide.

What we discovered

Our findings show a profound imbalance in the global clinical research landscape. Across the five most prestigious general medical journals, only 3.9% of trials were conducted exclusively in Africa. In cardiovascular health, the numbers drop to a statistical whisper. Of the major trials published in leading cardiology journals, just two studies (0.6%) were conducted solely on African soil.

This is a crisis of scientific accuracy. When clinical trials exclude African populations, they produce evidence that lacks “external validity”. This refers to how well the results of a study can be generalised beyond the participants. It asks whether findings from a clinical trial will still hold true when applied to different populations, settings, or real-world conditions.

Without that validity, doctors are essentially conducting unmonitored experiments on millions of patients every day.

Modern medicine cannot claim to be universal if entire populations remain invisible in the evidence base. Biology, health systems and disease patterns are not identical across the world.

The gap and why it matters

Many treatments used across the continent are based on evidence generated in non-African populations, raising concerns about their applicability.

Moreover, most Africa-based trials still focus on infectious diseases, despite the rising burden of non-communicable diseases such as cardiovascular disease.

Emerging evidence shows that genetics, environment and diet can radically alter how a body responds to a drug. It therefore makes no medical sense that an entire continent is left out of the trial net.

There’s also evidence showing that certain treatments have different safety profiles in Black patients. Diabetes and gout are just two examples. So are certain common blood pressure medications, such as angiotensin-converting enzyme (ACE) inhibitors. Research shows that they carry a three- to four-fold higher risk of severe, life-threatening side effects in people of African descent compared to other populations.

When clinical trials exclude populations, doctors are forced to extrapolate findings from one population and apply them to another.

The study also highlights a dangerous lag between global research funding and the evolving reality of African health. The new data show that nearly 76% of trials conducted exclusively in Africa focused on infectious diseases. But the continent is undergoing a massive epidemiological shift. Non-communicable diseases – heart disease, stroke, and diabetes – now account for about 38% of all deaths in many African nations.

The middle class in Africa has tripled to 300 million people from roughly 100 million people in the early 2000s. More people are now living long enough with lifestyles that increase the risk of chronic conditions such as heart disease, diabetes, and hypertension. Consequently, there is a growing need and market for long-term treatments that manage these diseases, rather than short-term therapies for infections. Yet cardiovascular trials continue to be discouraged.

Even within the continent, the data show deep “black holes” of information. South Africa accounted for over 62% of all trials conducted on the continent. Central Africa, a region that’s home to more than 180 million people, was virtually non-existent in the global research record. It contributed less than 3% of the continent’s limited trial output. Possible reasons include South Africa’s decades of cumulative investment, seen in stronger academic hubs, research governance, experienced trial units, and more established sponsor relationships. Other regions face barriers like fewer resourced research institutions, less access to trial platforms, and sometimes language and publication issues that can reduce visibility in top-tier journals.

The inequity extends into the hierarchy of science itself. Even when African sites are included in large, multicontinental trials, they are often relegated to the role of “recruitment hubs” rather than scientific partners. Our study found that African scientists led only 3.6% of multicontinental trials that included an African site.

Towards a new era of African science

Africa should not simply be a location where studies are conducted.

It must be a place where research is conceived, led and interpreted. The current model creates a cycle of external dependence where international institutions manage the funding and the data. This leaves local research systems fragile and unable to translate evidence into national policy.

There is need for “ring-fenced” funding for African-led research, the development of regional trial networks, and a mandate for medical journals to report on the diversity of trial populations.

There are signs of a rising momentum. Organisations like Alliance for Medical Research in Africa are working to equip a new generation of African investigators. Africa must create a research ecosystem that is too important for the global community to ignore.

Bamba Gaye, MD, MPH, MSc, PhD, Adjunct professor, Emory University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Categories : Mental HealthTags : Leave a comment

“People Are Crying Out for Help,” Says SADAG, with 460 Suicide Attempts a Day in SA

On By ModernMedia
Photo by Alex Green on Pexels

Every day in South Africa, an estimated 23 people die by suicide, while another 460 attempt suicide.

The impact is particularly concerning among younger people. Globally, suicide is the third-leading cause of death among people aged 15 to 29, according to the World Health Organization’s (WHO) latest estimates.[1] The South African Depression and Anxiety Group (SADAG) is also seeing the extent of the need first-hand as its helplines currently receive between 2 500 and 3 000 calls a day, with around one in four serious suicide-related calls.[2]

“People are crying out for help, and the calls we receive every day show us just how many people are struggling,” says SADAG’s Operations Director Cassey Chambers. “For us to make a meaningful difference and prevent suicides, we can’t just intervene at the point of crisis. People need help recognising the warning signs to make it easier to talk openly about suicide and know where they can turn for help. We need families, friends, schools, workplaces and communities to understand that talking about suicide is crucial and that asking someone directly if they are struggling can open the door to getting them the support they need.”

Every conversation counts

This World Suicide Prevention Day (10 September), Cipla is partnering with SADAG to encourage more of these conversations before someone reaches crisis point. The initiative supports SADAG’s 2026 World Suicide Prevention Day campaign, Every Conversation Counts, which provides South Africans with practical resources to help them understand what to say, how to respond and where to find support.[3]

As part of the campaign, Cipla is introducing the Postcard Wall of Hope, an interactive activation where members of the public can write and share messages of encouragement and support for people they may never meet.

“Sometimes, a few words can mean more than we realise. The Postcard Wall* of Hope is about sharing those words while they can still reach someone, reminding them that their life matters and that it is okay to speak about how they are feeling,” says Paul Miller, CEO of Cipla Africa.

Members of the public can read a postcard, take one that speaks to them or write a message for somebody else to find.

“You don’t have to know who will eventually read your postcard or what they may be going through,” says Miller. “It could simply remind someone that they matter or encourage them to keep going and reach out. The Wall is a way of showing that our words don’t only have to come when it is too late. We can use them now to start conversations and remind people that support is available.”

When to start the conversation

SADAG advises people to take changes in a loved one’s behaviour seriously. Warning signs can include talking about death or suicide, withdrawing from loved ones, risky or self-harming behaviour, giving away personal belongings or a sudden change in mood after a period of depression.[4]

“Importantly, asking somebody directly about suicide does not increase their likelihood of attempting it. SADAG encourages people to ask directly if they are thinking about suicide, listen without judgement and encourage them to seek professional help,” adds Cassey Chambers.

Starting a conversation doesn’t mean you need to know exactly what to say or have all the answers. It can begin with noticing that somebody isn’t themselves and asking how they are really doing. “What matters is that we don’t allow our fear of saying the wrong thing to stop us from saying anything at all,” concludes Miller.

Help is available

Anyone experiencing emotional distress, or concerned about someone they know, can contact SADAG for free telephonic counselling and support:

  • Cipla Mental Health Helpline: 0800 456 789 – free, 24-hour counselling
  • Cipla Mental Health WhatsApp: 076 882 2775 – daily, 08:00–17:00
  • For more mental health and suicide-prevention resources, visit the SADAG website: https://www.sadag.org

*The Postcard wall will be launched during Mental Health month in October as malls in Cape Town, Johannesburg and Durban.

References

[1] World Health Organization (2025), *Suicide worldwide in 2021: Global health estimates*. WHO reports suicide as the third-leading cause of death globally among people aged 15–29.

[2]South African Depression and Anxiety Group (SADAG), World Suicide Prevention Day 2026 media information.

[3] South African Depression and Anxiety Group (SADAG), *Every Conversation Counts: World Suicide Prevention Day 2026*.

[4] South African Depression and Anxiety Group (SADAG), *Understanding Suicide*, suicide warning signs and guidance on supporting somebody who may be suicidal.

Categories : NeurologyTags : Leave a comment

Why Some Stroke Patients Fare Better than Others

On By ModernMedia
Ischaemic and haemorrhagic stroke. Credit: Scientific Animations CC4.0

A clot forms. Blood flow to the brain is blocked. Starved of oxygen, neurons begin to die.

This scenario, known as an ischaemic stroke, plays out in roughly 21 000 people worldwide each day, threatening long-term disability or even death. In recent years, clot-busting drugs and mechanical tools for removing them have revolutionised care.

Yet, even with the clot gone and the vessel clear, up to 50% of patients never recover neurologically. New research from CU Boulder and the University of Antwerp helps explain why.

The study, published in the journal PNAS, reveals in unprecedented detail how the brain’s own defence mechanisms against stroke can backfire, triggering additional micro-clots in minor vessels which can damage tissue long after the primary culprit is gone. 

“We now have a way to explain why so many of these patients are not seeing neurological improvements,” said co-author Debanjan Mukherjee, an assistant professor of mechanical engineering at CU Boulder. “Our findings also point to a new potential target for therapeutics that could be extremely impactful for stroke patients.”

The mystery behind ‘no reflow’

Doctors have long known that removing a stroke-causing clot cannot always restore full blood flow to the brain. But why this phenomenon, known as “no reflow,” occurs has remained a mystery.

To unravel it, Mukherjee, who studies the physics of blood flow, teamed up with senior author Frederik Denorme, an assistant professor of biology at the University of Antwerp who studies, as he puts it, “life after the clot.”

“The dogma used to be that you just need to get rid of that blood clot and then all problems should be solved,” said Denorme. “We now know that is not the case.”

In fact, only about 1 in 10 surviving stroke patients recover completely after a stroke; 25% have minor impairments; and half have moderate to severe impairments.

To examine what, precisely, goes on in the brain after a clot is removed, the research team first turned to mice. 

Using a technique called intravital microscopy, they observed in real time how blood flowed in the brain, and cells behaved, in the hour after mice suffering from stroke underwent endovascular thrombectomy. The procedure involves threading a tool through a blood vessel to pluck out an obstructive clot.

While blood quickly started flowing again post-procedure, the researchers were stunned to see that in many mice, it flowed haphazardly, in fits and starts, even reversing course at certain points.

“We saw it with our own eyes. Blood that was flowing left all of a sudden flowed right and vice versa,” said Denorme. “It was remarkable.”

A Jekyll and Hyde protein

An even closer look revealed that, as the brain tried to divert blood around the original obstruction, tiny clots formed where the haphazard channels converged.

To drill down on why those clots formed, Mukherjee’s FLOWLab recreated this scenario using computer simulations. In other research, his lab has recreated similar scenarios using a 3D artificial brain filled with fake blood. 

These experiments implicated von Willebrand factor—a protein best known for stopping bleeding when we get a cut.

In its resting state, Mukherjee explained, von Willebrand factor is coiled up like a ball of string inside blood vessels, waiting for distress signals from the body that make it stretch out and start forming clots to stop bleeding.

In a brain experiencing a stroke, something else unfolds the ball.

“If there is some kind of fluid motion induced after the clot is removed, it can stretch out that ball into an extended thread that attracts platelets, forms new clots and blocks flow even after the original culprit clot is gone,” Mukherjee said.

Meanwhile, the study showed, the brain’s inflammatory response to stress interferes with safeguards that normally keep the protein’s clotting efforts in check, creating what the authors call “a perfect storm” of collateral damage.

Other experiments, looking at blood from stroke patients at the University of Washington in St. Louis, suggest a similar phenomenon happens in humans too.

“We are the first to really show in this hyperacute phase of stroke what is happening with these cells inside blood vessels,” said Denorme. 

More research is necessary to determine why no reflow happens in some stroke patients but not others. But the study did find that stroke patients with higher blood levels of a pro-inflammatory compound called Interleukin 6 had more overactive von Willebrand factor and fared worse long-term.

The researchers envision a day when therapeutics targeting von Willebrand factor, or the inflammatory compounds that exacerbate its clotting capabilities, could be given to stroke patients alongside clot-busting drugs and surgery.

Notably, several such drugs already exist and are approved for use for other disorders.

“It’s early days. But now that we have a lead on what drives these micro-clots, we have a promising new avenue to explore for improving recovery,” said Denorme.

Original written by Lisa Marshall

Source: University of Colorado Boulder