Figure 1. The epidemiological curve of measles outbreak cases, Greater Sekhukhune and Mopani Districts, Limpopo province, September to November 2022 (*Two sporadic cases in Vhembe District are not included). Source: NICD
As of 10 November, the National Institute of Communicable Diseases reported 35 laboratory-confirmed measles cases in Limpopo, with 14 new cases on 8 and 9 November, all in Mopani district. Thus far, most of the laboratory-confirmed cases (25 of 35) fall within the 13 month to 9 year age range.
With these new cases, the Mopani district with 19 cases has overtaken the Greater Sekhukhune district which remains at 16 (see Figure 1). Only seven cases are known to be vaccinated; eight are either unvaccinated or partially vaccinated; vaccination status of the remaining 20 is unknown.
According to a recent study published in BMC Public Health, measles has been experiencing a resurgence in South Africa. Over 2015–16, measles had remained largely under the elimination target of under one case per million in South Africa, but rose above this threshold from 2017–2019. Cases fell below the threshold in 2020 with the onset of COVID, but the pandemic also saw normal vaccination efforts slipping. The article authors also noted a measles vaccine effectiveness of only 80% among 1–4 year olds, compared to the 95% rate found in large datasets.
Those cases reported in the Mopani district were in the Greater Giyani, Ba-Phalaborwa, and Ga-Kgapane sub-districts. Epidemiological investigations showed that in the Mopani district, two siblings with measles infection had contact with cases in the Greater Sekhukhune district when they travelled there for a family funeral.
While two cases were reported in Vhembe District, they were considered sporadic as they had not links to the other cases and are not included in the outbreak tally.
The laboratory-confirmed measles infections have been identified in 19 males and 16 females ranging in age from 6 months and 24 years in the Greater Sekhukhune district, while cases range from 2 to 42 years in the Mopani district (Table 1), with increasing cases in the 5–9 year age range. Two children were hospitalised but no deaths or other complications from measles have been reported.
According to the NICD, the affected districts are continuing with the public health response activities and tracing and vaccinating contacts. Measles catch-up doses are also being given to children who have missed vaccinations.
Unsafe sex, interpersonal violence, high body mass index (BMI), high systolic blood pressure, and alcohol consumption are the top risk factors for disease and death in South Africa, according to the Second Comparative Risk Assessment (SACRA2) study conducted by the South African Medical Research Council’s Burden of Disease (BOD) Research Unit in collaboration with a long list of researchers. The study was recently published in a series of 15 related articles in the South African Medical Journal.
The study differs from other assessments of what people in South Africa die of in that it focusses on risk factors rather than on the eventual cause of death. This is, for example, why the study considers factors like unsafe sex or high body mass index rather than HIV or diabetes.
According to a related policy brief, the aim of the study was “to quantify the contribution of 18 selected risk factors to identify areas of public health priority”. The idea is that policymakers can use these findings to address the underlying causes of death and disease in South Africa since the identified risk factors are considered to be modifiable.
“We have to reduce the underlying drivers of disease and death if we are to improve the health of South Africans,” said CEO and President of the SAMRC Professor Glenda Gray in a statement. “Knowing that this is possible, should strengthen our resolve to ensure that this is accomplished.”
Causes of lost DALYs
Rather than only looking at what people died of, the researchers estimated the lost disability-adjusted life years (DALYs) associated with various risk factors. The World Health Organization describes DALYs as “a time-based measure that combines years of life lost due to premature mortality (YLLs) and years of life lost due to time lived in states of less than full health, or years of healthy life lost due to disability (YLDs). One DALY represents the loss of the equivalent of one year of full health.”
The researchers calculated the proportion of the total burden of disease (measured as DALYs) that can be attributed to each of the 18 risk factors in South Africa in 2012. Unsafe sex was top of the list at 26.6%, followed by interpersonal violence at 8.5%, high body mass index at 6.9%, high systolic blood pressure at 5.8%, and alcohol consumption at 5.6%. There were some differences by sex, with alcohol consumption, for example, ranking third in males, while it ranked fifth overall.
“Improvements have been observed, in particular, the reductions in the burden attributable to household air pollution and water and sanitation,” read the policy brief. “On the other hand, shifts in cardiometabolic risk factors, particularly the rapid emergence of high fasting plasma glucose accompanied by increases in high systolic blood pressure and high BMI, can be seen as well as the increased impact of ambient air pollution.”
According to project lead and BOD Unit Director Professor Debbie Bradshaw, while unsafe sex and interpersonal violence remained high on South Africa’s risk profile for the study period, non-communicable diseases combined are at an all-time high and are highly likely to overtake unsafe sex and interpersonal violence as causes of death and disease in South Africa.
Findings only up to 2012
The SACRA2 findings cover the period from 2000 to 2012. One reason for it only being published now is that the study required access to a wide variety of data sources. “Each data set had to be evaluated to identify any weaknesses or possible bias so that we can develop a robust understanding [of] the trends in the risk factors. This is a painstaking task, involving a large number of scientists, and means that we have only been able to describe the trends for the period 2000 – 2012,” says Bradshaw.
While robust and more up-to-date estimates would likely only come from the next SACRA study, it seems likely that some of the trends identified in SACRA2 would have continued in the years since 2012. For example, findings from SACRA2 suggest that the burden attributable to unsafe sex peaked in 2006 and has been declining ever since, largely due to the provision of antiretroviral treatment. Evidence from other sources, such as Thembisa, the leading mathematical model of HIV in South Africa, suggests that the decline in HIV-related deaths and the increase in treatment coverage have continued in the years since 2012.
Bradshaw describes unsafe sex as a lack of condom use which leads to sexually transmitted infections (STIs) and the possible transmission of HIV.
“Condom use is very important. If we get rid of unsafe sex, we will see the number of people being infected with HIV and STIs being reduced,” she said. “It is important that these epidemic drivers are not neglected in the push towards meeting the 90-90-90 management targets for 2022 and the 95-95-95 targets by 2030. HIV communication programmes should continue to promote male circumcision and risk awareness in the context of non-marital relationships to prevent HIV transmission.” (The first 90/95 refers to the percentage of people living with HIV who are diagnosed, the second to the percentage of those diagnosed on treatment, and the third to the percentage of those on treatment who are virally suppressed.)
Interpersonal violence declining
As with unsafe sex, the trend with interpersonal violence in South Africa also appears to be downward, although, as Megan Prinsloo, a researcher at the SAMRC, and colleagues highlight in one of the 15 papers, it continues to be a leading public health problem for the country.
The researchers found that between 2000 and 2012, there was a decrease in the death rate associated with interpersonal violence from 100 per 100 000 to 71 per 100 000. There was also a decrease in lost DALYs attributable to interpersonal violence from an estimated 2 million in 2000 to 1.75 million in 2012.
“Further strengthening of existing laws pertaining to interpersonal violence, and other prevention measures are needed to intensify the prevention of violence, particularly gender-based violence,” the researchers wrote.
High BMI and high blood pressure
Image by Marcelo Leal on Unsplash
A high BMI is associated with several cardiovascular diseases, diabetes, and chronic kidney disease, among others. According to one of the SACRA2 papers, high BMI caused around 59 000 deaths in 2012. Over the study period, the burden was higher in males than in females. Type 2 diabetes was the leading cause of death attributable to high BMI in 2012, followed by hypertensive heart disease, haemorrhagic stroke, ischaemic heart disease, and ischaemic stroke.
The researchers found that the average BMI increased between 2000 and 2012 and accounted for a growing proportion of both total deaths and DALYs.
High systolic blood pressure is similarly linked to an increased risk of several conditions, including stroke and heart disease. According toa paper by Beatrice Nojilana, a senior research scientist at the SAMRC, and colleagues, the prevalence of hypertension in people aged 25 and older increased from 2000 to 2012 – 31% to 39% in men and 34% to 40% in women.
But there is some interesting nuance. In both men and women, age-standardised rates for deaths and DALYs associated with raised systolic blood pressure increased between 2000 and 2006 but decreased from 2006 to 2012.
High systolic blood pressure is estimated to have caused around 62 000 deaths in South Africa in 2012. Stroke (haemorrhagic and ischaemic), hypertensive heart disease, and ischaemic heart disease accounted for over 80% of the disease burden attributable to raised systolic blood pressure over the period.
Alcohol abuse
Source: Pixabay CC0
In another SACRA2 paper, Dr Richard Matzopoulos, chief specialist scientist at the SAMRC, and colleagues, point out that alcohol abuse has widespread effects on health and contributes to over 200 health conditions. They write that, although the pattern of heavy episodic drinking independently increases the risk for injuries and transmission of some infectious diseases, long-term average consumption is the fundamental predictor of risk for most conditions.
The researchers used data from 17 population surveys to estimate age- and sex-specific trends in alcohol consumption in the adult population of South Africa between 1998 and 2016. For each survey, they calculated sex- and age-specific estimates of the prevalence of drinkers and the distribution of individuals across consumption categories.
Among males, the prevalence of drinkers was found to have decreased between 1998 and 2009, from 56.2% to 50.6%, but had increased again by 2016. Among females, the prevalence of current drinkers rose slightly from 19% in 1998 to 20% in 2016.
Speaking to Spotlight, Matzopoulos stresses that alcohol abuse puts a heavy burden on the already strained health system. “When you enter the trauma unit at hospitals on weekends, all you can smell is alcohol,” he said.
He says in some of his research he has noted a shift where young females are engaging in heavy drinking and young males are engaging in binge drinking over weekends. “These patterns are alarming because alcohol abuse can lead to unsafe sex, which may lead to the transmission of HIV and STIs. Excessive alcohol use also has an impact on some NCDs and can compromise the immune system of a person who is on ARV treatment,” he said.
Matzopoulos said government can put in place policies such as the restriction of alcohol sales, banning alcohol advertising, and increasing the price of alcohol.
A reluctance to make eye contact is a hallmark of autism spectrum disorder (ASD). By simultaneously imaging the brains of people making eye contact, Yale University researchers found that eye contact between two individuals was associated with a specific area associated with social interaction, which synchronises when two people with normal neural development gaze at each other. The results, published in the journal PLOS ONE, showed that in people with ASD, there was less activity in this region when they attempted eye contact.
People with ASD have been showed to have reduced or altered neurological arousal from looking at images of faces or even robots. Although eye contact is a critically important part of social interactions, scientists have been limited in studying the neurological basis of live social interaction with eye-contact in ASD because of the inability to image the brains of two people simultaneously.
Now, using an innovative technology that enables imaging of two individuals during live and natural conditions, Yale researchers have identified specific brain areas in the dorsal parietal region of the brain associated with the social symptomatology of autism. The study finds that these neural responses to live face and eye-contact may provide a biomarker for the diagnosis of ASD as well as provide a test of the efficacy of treatments for autism.
“Our brains are hungry for information about other people, and we need to understand how these social mechanisms operate in the context of a real and interactive world in both typically developed individuals as well as individuals with ASD,” said co-corresponding author Joy Hirsch, Elizabeth Mears and House Jameson Professor of Psychiatry, Comparative Medicine, and of Neuroscience at Yale.
The Yale team, led by Hirsch and James McPartland, Harris Professor at the Yale Child Study Center, analysed brain activity during brief social interactions between pairs of adults – each including a typical participant and one with ASD – using functional near-infrared spectroscopy, a non-invasive optical neuroimaging method. Both participants were fitted with neuroimaging caps which measured brain activity during face gaze and eye-to-eye contact.
The investigators found that during eye contact, participants with ASD had significantly reduced activity in a brain region called the dorsal parietal cortex compared to those without ASD. Further, the more severe the overall social symptoms of ASD as measured by ADOS (Autism Diagnostic Observation Schedule, 2nd Edition) scores, the less activity was observed in this brain region. Neural activity in these regions was synchronous between typical participants during real eye-to-eye contact but not during gaze at a video face. This typical increase in neural coupling was not observed in ASD, and is consistent with the difficulties in social interactions.
“We now not only have a better understanding of the neurobiology of autism and social differences, but also of the underlying neural mechanisms that drive typical social connections,” Hirsch said.
According to a study published in JAMA Pediatrics, cases of young people seeking care for eating disorders greatly increased in the months of the pandemic.
Eating disorders (EDs), such as anorexia nervosa and bulimia nervosa, impact a wide range of individuals. In the developmental stages of adolescent and young adulthood, EDs – especially restrictive ones – can have particularly negative impacts. Furthermore, EDs commonly co-occur with other mental health conditions which can influence the trajectory of illness. Individuals with EDs have greater mortality rates, partly due to increased suicidality.
EDs requires intensive specialist care, which is not often available in many settings. A rise in rates of anxiety and depression have been attributed to the COVID pandemic, as well as a worsening of ED. Possible reasons for this include uncertainty about the future, disruptions in daily routines, inconsistent access to food, more time spent in triggering environments, influence from the media, and changes in access to treatment.
Reports from hospitals indicated increasing numbers of diagnoses and hospital admissions for ED, but there was little geographically widespread data.
Therefore, the researchers set out to investigate trends in patient volume for inpatient medical hospitalisation as well as volume of patients seeking outpatient subspecialty care, both before and after the pandemic.
The researchers used an an observational case series design to compare changes in volume in inpatient and outpatient ED-related care at 15 sites between January 2018 and December 2021.
Before the COVID pandemic, the relative number of pooled inpatient ED admissions were increasing over time by 0.7% per month. After onset of the pandemic, there was a significant increase in admissions over time of 7.2% per month through April 2021, then a decrease of 3.6% per month through December 2021. Before the pandemic, relative outpatient ED assessment volume was stable over time, with an immediate 39.7% decline in April 2020. Thereafter, new assessments increased by 8.1% per month through April 2021, then decreased by 1.5% per month through December 2021. The nonhospital-based ED program did not demonstrate a significant increase in the absolute number of admissions after onset of the pandemic but did see a significant increase of 8.2 additional inquiries for care per month in the first year after onset of the pandemic.
“Given inadequate ED care availability prior to the pandemic, the increased postpandemic demand will likely outstrip available resources. Results highlight the need to address ED workforce and program capacity issues as well as improve ED prevention strategies.”
As climate change continues to increase the severity, frequency and duration of heat wave, prisoners and prison workers are at greater mortality risk if their environment is not air conditioned, according to a new study on Texas prisons published in JAMA Network Open.
The study examined the relationship between heat exposure and mortality risks in Texas prisons, focusing on how these risks vary between prisons with air conditioning and those without it.
The researchers analysed data gathered between 2001 and 2019 showing that 271 people died due to extreme heat exposure during that timeframe.
Even a 1° Fahrenheit (0.56°C) increase above 85°F (29.4°C) can increase the daily mortality risk by 0.7%, the researchers found.
The research team combined data from the US Bureau of Justice Statistics on mortality in Texas prisons with temperature data from NASA and used a novel epidemiologic analysis to arrive at its findings. About 13% of mortality during warm months may be attributable to extreme heat in Texas prison facilities without air conditioning.
It is important to note that while an average of 14 people died each year from heat-related causes in Texas prisons without air conditioning, not a single heat-related death occurred in climate-controlled prisons, said lead study author Julie Skarha, recent PhD graduate.
“The majority of Texas prisons do not have universal air conditioning,” Skarha said. “And in these settings, we found a 30-fold increase in heat-related mortality when compared to estimates of heat-related mortality in the general US population.”
Study co-author Dr David Dosa, an associate professor of medicine at Brown, pointed out that heat is often a silent killer.
“We have seen similar situations in nursing homes, where heat isn’t reported on the death certificate,” said Dosa. “It’s only after we run these analyses that we can determine how much of a role heat played in someone’s death.”
The findings, the researchers said, suggest that an air conditioning policy for Texas prisons may be an important part of protecting the health of people living and working in these facilities.
In a new study published in Molecular Biology of the Cell, a team of Rensselaer Polytechnic Institute researchers identified a previously unknown propofol anaesthetic mechanism, which, despite its frequent clinical application, is poorly understood.The study found that propofol exposure impacted the transportation of proteins to the surface of neurons, interrupting their function.
Almost all animal cells, including human cells, are highly compartmentalised and rely on efficient movement of protein material between compartments in vesicles. This transport must be efficient and highly specific to maintain cellular organisation and function.
The research team was led by Dr Marvin Bentley, associate professor at Rensselaer Polytechnic Institute, whose laboratory studies vesicle transport in neurons. Neurons are particularly reliant on vesicle transport because axons, often organised in nerve bundles. can span distances of up to 100cm in humans. Errors in vesicle transport have been linked to neurodevelopmental and neurodegenerative diseases such as Alzheimer’s and Parkinson’s.
This new study found that propofol affects a family of proteins called kinesins – small ‘motor proteins’ that move vesicles on tiny filaments called microtubules.
Dr Bentley’s team observed that vesicle movement of two prominent kinesins, Kinesin-1 and Kinesin-3, was substantially reduced in cells exposed to propofol. The team then showed that propofol-induced transport delays led to a significant drop in protein delivery to axons.
“The mechanism by which propofol works is not fully understood,” Bentley said. “What we discovered was unexpected: propofol altered the trafficking of vesicles in live neurons.”
Overall, the research contributes significantly to our understanding of how propofol works. Most studies on propofol’s anaesthetic mechanism have instead focused on its interaction with an ion channel called the GABAA receptor, which inhibits neurotransmission when activated.
This new study demonstrates that vesicle transport is an additional mechanism that may be important for propofol’s anaesthetic effect. Discovery of this new propofol effect has important applications for human health and may lead to the development of better anaesthetic drugs.
A recent study comparing atrial fibrillation (AF) treatments, published in The New England Journal of Medicine, shows that early intervention with cryoballoon catheter ablation (cryoablation) is more effective at reducing the risk of serious long-term health impacts, when compared to the current first step in treatment, antiarrhythmic drugs.
“By treating patients with cryoablation right from the start, we see fewer people advancing to persistent, more life-threatening forms of atrial fibrillation,” says Dr Jason Andrade, an associate professor of medicine at University of British Columbia. “In the short term, this can mean less recurrences of arrhythmia, improved quality of life and fewer visits to the hospital. In the long run, this can translate into a reduced risk of stroke and other serious heart problems.”
When used for AF, cryoablation is a minimally invasive procedure that involves guiding a small tube into the heart to kill problematic tissue by freezing. Historically, the procedure has been reserved as a secondary treatment when patients don’t respond to antiarrhythmic drugs.
“This study adds to the growing body of evidence that early intervention with cryoablation may be a more effective initial therapy in the appropriate patients,” says Dr Andrade.
Early intervention halts disease progression
AF affects approximately 3% of the population, and while the condition starts as an isolated electrical disorder, each recurring incident can cause electrical and structural changes in the heart that can lead to persistent AF, where episodes last more than seven days.
“Atrial fibrillation is like a snowball rolling down a hill. With each atrial fibrillation episode there are progressive changes in the heart, and the heart rhythm problem gets worse,” explains Dr Andrade.
The new findings, stemming from a multi-site clinical trial, show that cryoablation can stop this snowball effect.
Researchers enrolled 303 patients with AF in Canada. Half of the patients were randomised to receive antiarrhythmic drugs, while the other half were treated with cryoablation. All patients received an implantable monitoring device that recorded their cardiac activity throughout the study period.
At three years follow-up, patients in the cryoablation group were less likely to progress to persistent AF compared to patients treated with antiarrhythmic drugs. Over the follow-up period, the cryoablation patients also had lower hospitalisation rates and experienced fewer serious adverse health events that resulted in death, functional disability or prolonged hospitalisation.
Addressing the root cause
Because cryoablation targets and destroys the cells that initiate and perpetuate AF, the researchers say it can lead to longer-lasting benefits.
“With cryoablation, we’re treating the cause of the condition, instead of using medications to cover-up the symptoms,” says Dr Andrade. “If we start with cryoablation, we may be able to fix atrial fibrillation early in its course.”
The new study builds on previous work by Dr Andrade and colleagues demonstrating that cryoablation was more effective than antiarrhythmic drugs at reducing the short-term recurrence of atrial fibrillation.
Patients with nasopharyngeal cancer are often treated with immunotherapy. It was previously feared that, due to its immune response stimulation, COVID vaccination could reduce the success of cancer treatment or cause severe side effects. A recent study published as a “Letter to the editor” in the journal Annals of Oncology now gives the all-clear on this matter. What’s more, the study showed that cancer drugs actually worked better after vaccination with the Chinese vaccine SinoVac than in unvaccinated patients.
Many cancer cells are capable of subverting the body’s immune response. They do this by acting on the PD-1 receptor, they effectively shut down these endogenous defence forces. Drugs can be used to block PD-1 receptors. This enables the immune system to fight the tumour more effectively.
Vaccination against COVID also stimulates the immune response, involving the PD-1 receptor. “It was feared that the vaccine would not be compatible with anti-PD-1 therapy,” explains Dr Jian Li of the Institute of Molecular Medicine and Experimental Immunology (IMMEI) at the University Hospital Bonn. “This risk is especially true for nasopharyngeal cancer, which, like the SARS Cov-2 virus, affects the upper respiratory tract.”
Researchers from the Universities of Bonn and Shanxi in the People’s Republic of China investigated whether this concern is justified. More than 1500 patients treated in 23 hospitals from all over China participated in the analysis. Such multi-centre studies are considered to be particularly informative because the participants are very diverse and, moreover, the results are not distorted by regional characteristics.
Better response to cancer therapy
A subset of 373 affected individuals had been vaccinated with the Chinese COVID vaccine SinoVac. “Surprisingly, they responded significantly better to anti-PD-1 therapy than the unvaccinated patients,” explains Prof. Dr. Christian Kurts, Director of IMMEI. “Furthermore, they did not experience severe side effects more often.” The researchers cannot say why the treatment was more successful after vaccination. “We assume that vaccination activates certain immune cells, which then attack the tumor,” says Prof. Dr. Qi Mei of Shanxi University Hospital. “We will now investigate this hypothesis further.”
Nasopharyngeal cancer is quite rare in this country. In southern China and other countries in Southeast Asia, however, the disease is widespread. One of the suspected reasons for this is the frequent use of air conditioning in the hot and humid regions. Nutritional factors also appear to play an important role. In Taiwan, nasopharyngeal cancer is now considered one of the leading causes of death among young men.
Watching violent TV during the preschool years can lead to later risks of psychological and academic impairment by the end of primary school according to a new study published in the Journal of Developmental and Behavioral Pediatrics.
According to study leader Professor Linda Pagani, a professor at Université de Montréal’s School of Psycho-Education, it was previously “unclear to what extent exposure to typical violent screen content in early childhood – a particularly critical time in brain development – can predict later psychological distress and academic risks,” said Pagani.
“The detection of early modifiable factors that influence a child’s later well-being is an important target for individual and community health initiatives, and psychological adjustment and academic motivation are essential elements in the successful transition to adolescence,” she added.
“So, we wanted to see the long-term effect of typical violent screen exposure in preschoolers on normal development, based on several key indicators of youth adjustment at age 12.”
To do this, Pagani and her team examined the violent screen content that parents reported their children viewing between ages three-and-a-half and four-and-a-half, and then conducted a follow-up when the children reached 12.
Follow-up at age 12
At the follow-up, two reports were taken: first, of what teachers said they observed, and second, of what the children themselves, now at the end of Grade 6, described as their psychological and academic progress.
“Compared to their same-sex peers who were not exposed to violent screen content, boys and girls who were exposed to typical violent content on television were more likely to experience subsequent increases in emotional distress,” said Pagani.
“They also experienced decreases in classroom engagement, academic achievement and academic motivation by the end of the sixth grade,” she added.
“For youth, transition to middle school already represents a crucial stage in their development as adolescents. Feeling sadness and anxiety and being at risk academically tends to complicate their situation.”
Pagani and co-authors Jessica Bernard and Caroline Fitzpatrick came to their conclusions after examining data from a cohort of children born in 1997 or 1998 who are part of the Quebec Longitudinal Study of Child Development, coordinated by the Institut de la statistique du Québec.
Close to 2000 children studied
In all, the parents of 978 girls and 998 boys participated in the study of violent TV viewing at the preschool age. At age 12 years, the children and their teachers rated the children’s psychosocial and academic achievement, motivation and participation in classroom activities.
Pagani’s team then analysed the data to identify any significant link between problems with those aspects and violent content they were exposed to at preschool, while trying to account for as many possible biases and confounding influences as possible.
“Our goal was to eliminate any pre-existing conditions of the children or families that could have provided an alternative explanation or throw a different light on our results,” Pagani said.
Watching TV is a common early childhood pastime, and some of the children in the study were exposed to violence and some were not.
Psychological and academic impairment in children is of increasing concern for education and public-health sector workers. According to Pagani, problems starting middle school (ages 13 to 15) are rooted in early childhood.
Identifying with fictional characters
“Preschool children tend to identify with characters on TV and treat everything they see as real,” she said. “They are especially vulnerable to humorous depictions of glorified heroes and villains who use violence as a justified means to solve problems.
“Repeated exposure,” she added, “to rapidly paced, adrenaline-inducing action sequences and captivating special effects could reinforce beliefs, attitudes and impressions that habitual violence in social interactions is ‘ normal’. Mislearning essential social skills can make it difficult to fit in at school.”
Added Bernard: “Just like witnessing violence in real life, being repeatedly exposed to a hostile and violent world populated by sometimes grotesque-looking creatures could trigger fear and stress and lead these children to perceive society as dangerous and frightening.
“And this can lead to habitually overreacting in ambiguous social situations.”
She continued: “In the preschool years, the number of hours in a day is limited, and the more children get exposed to aggressive interactions (on screens) the more they might think it normal to behave that way.”
Pagani added: “Being exposed to more appropriate social situations, however, can help them develop essential social skills that will later be useful and ultimately play a key role in their personal and economic success.”
Women have a better ability to recover from kidney injury than men, but the reasons are not well understood. A study in Cell Reports may provide answers, as researchers found that females have an advantage at the molecular level that protects them from a newly discovered form of cell death that occurs in injured kidneys. This protection could be exploited as a potential therapeutic.
“Kidney disease afflicts more than 850 million people worldwide every year, so it’s important to understand why female kidneys are more protected from these acute and chronic injuries,” said Tomokazu Souma, MD, PhD, assistant professor at Duke University School of Medicine. “Our study is a step toward identifying the causes and suggests that this female resilience could be therapeutically harnessed to improve kidney repair in both sexes.”
Souma and colleagues conducted studies in mice focusing on a form of cell death called ferroptosis, which was only recently discovered. This form of cell death is dependent on iron and oxidative stress. It has been identified as a key player in kidney diseases.
Using genetic and single-cell RNA transcriptomic analysis in mice, the researchers found that being female confers striking protection against ferroptosis through a particular pathway called nuclear factor erythroid 2-related factor 2, or NRF2.
In females, NRF2 is highly active, keeping cell death in check. In males, however, the sex hormone testosterone reduces the activity of NRF2, thus promoting ferroptosis and undermining cell resiliency in kidney injury.
Further experiments showed that chemically activating NRF2 protected male kidney cells from ferroptosis, demonstrating that NRF2 could be a potential therapeutic target to prevent failed renal repair after acute kidney injury.
“By identifying the mechanism in which the female hormonal environment protects and the male hormonal environment aggravates acute and chronic kidney injuries, we believe there is strong potential to boost the resilience of kidneys,” Souma said.
