Year: 2023

Categories : Expert Opinion Medical IndustryTags :

Opinion Piece: The Rise of Affordable Medical Insurance

On By ModernMedia

Reaching the masses with quality healthcare services

Photo by Hush Naidoo Jade Photography on Unsplash

By Sandra Sampson, Director at Allmed Healthcare Professionals

With its two-tiered, highly unequal healthcare system, only 14.86% of South Africa’s population can currently afford private healthcare, and rising costs are making it difficult for many to keep paying their monthly medical aid premiums. There are plans to implement National Health Insurance (NHI) to fund healthcare in the public and private sectors, although this process which began in August 2011 has been slow, and the NHI Bill is still under consideration in the National Assembly.

Despite concerns about the state’s ability to implement the NHI effectively and competently, delivering quality medical care to the population must continue to be a priority for every healthcare provider. This is where a specialist Temporary Employment Services (TES) provider can assist – delivering a flexible, competent, quality workforce on demand for institutions in both the public and private sectors.

Increasing access to quality healthcare

The public healthcare sector is primarily intended to serve those who are unable to access private medical aid and is currently accessible to all, regardless of immigration status or nationality. Significant funding is a massive drawcard for specialists in the private sector, which has resulted in a widening gap between public and private healthcare facilities in much of the country. The impending NHI is intended to address this gap and enable greater access to specialist care and more free services for all, while improving the quality of public healthcare by establishing a national fund that will allow for the purchasing of healthcare services on behalf of users. Estimates for funding this national health initiative range from R165bn to R450bn, and the government has been given the go-ahead by the Gauteng High Court to continue its recruitment drive before the bill has even passed.

Access starts with affordability

In line with this move, affordable healthcare insurance is on the rise. This trend starts with partnerships between healthcare and financial services providers, and has already been seen in the likes of Dischem, Clicks and Tyme Bank’s TymeHealth, all offering medical insurance, enabling access to high-quality healthcare specialists to a market that was previously woefully under-serviced. As the demand for quality healthcare increases, there will be a proportionate increase in the need for healthcare professionals.

Practical resourcing alternatives

It is not economically or practically feasible for healthcare institutions (whether in the private or public sector) to hire more medical professionals permanently, which means they will have to explore other resourcing options. This is becoming increasingly difficult in South Africa, as many skilled medical staff are seeking work elsewhere as a result of poor working conditions created by loadshedding, corruption, and incompetent administration. Although the Department of Home Affairs has added new skills to our country’s critical skills list (many of which include medical practitioners and individual specialisations) the healthcare industry is still severely understaffed. Hospital groups are only growing more frustrated with the government’s inability to address the decreasing number of medical practitioners, particularly nurses. The Hospital Association of South Africa (HASA) has reported that nurses in the country are reaching retirement age without the necessary inflow of younger employees. In 2020, there were more than 21,000 nurses in training, but South Africa still needs as many as 26,000 additional nurses to meet the growing demand.

Meeting the demand flexibly

TES providers in the healthcare sector have the potential to meet the demand of healthcare institutions for nurses and specialists, without these institutions having to commit to the responsibilities and costs associated with full-time employment. TES providers are on hand to supply the vetted and highly-skilled workers so desperately needed. Every healthcare institution can be supplied with the resources necessary on a shift-by-shift basis. So, if, for example, there is a deficit of five ICU nurses at a certain hospital, a TES provider can meet this with very short notice. If, on the other hand, patients are discharged or rerouted, these additional nurses can be cancelled at short notice, and the TES provider picks up the hospital’s slack and answers it with flexible resources on demand. Additionally, when it comes to meeting the fluctuating demand for speciality staff, a TES partner will become indispensable.

Equitability and affordability depend on agility

Ultimately, regardless of when the NHI comes to fruition, healthcare institutions should begin partnering with a TES provider if they haven’t already. Along with providing medical professionals on demand, this comes with cost-saving benefits for the hospital or clinic. Not having to employ full-time staff to meet fluctuating needs is a cost-saving exercise. Not only from a wage standpoint but also from an HR perspective in terms of payroll, industrial relations and skills development. The TES partner is responsible for all aspects of the employment relationship, while the healthcare institution gains access to qualified healthcare professionals as needed, at a fixed rate on flexible terms. This means that as soon as hospitals decide to invest in making their wards and spaces bigger and more efficient, they will have access to the medical resources necessary to staff them in a manner that enables equitable access to quality healthcare.

Categories : Diet and Nutrition ExerciseTags :

Strength Training may Reduce Health Risks of a High-protein Diet

On By ModernMedia
Photo by Jonathan Borba on Unsplash

Progressive strength training using resistance can protect against the detrimental effects of a high-protein diet, according to new research in mice.

The study, published today as a Reviewed Preprint in eLife, presents what the editors describe as a valuable finding on the relationship between a high-protein diet and resistance exercise on fat accumulation and glucose homeostasis, supported by solid evidence. They say the findings will be relevant to dietitians and others trying to understand links between dietary protein, diabetes and exercise.

Dietary protein provides essential nutrients that control a wide variety of processes in the body and can influence health and lifespan. Protein consumption is generally thought of as good, promoting muscle growth and strength, especially when combined with exercise. Yet in people with a sedentary lifestyle, too much protein can increase the risk of heart disease, diabetes and death.

“We know that low-protein diets and diets with reduced levels of specific amino acids promote healthspan and lifespan in animals, and that the short-term restriction of protein improves the health of metabolically unhealthy, adult humans,” explains lead author Michaela Trautman, Research Assistant at the Department of Medicine, School of Medicine and Public Health, University of Wisconsin, US. “But this presents a paradox — if high dietary protein is so harmful, many people with high-protein diets or protein supplements would be overweight and at an increased risk of diabetes, whereas athletes with high-protein diets are among the most metabolically healthy.”

To examine the possibility that exercise can protect against the detrimental effects of a high-protein diet, the researchers used a progressive resistance-based strength training program in mice. The animals pulled a cart carrying an increasing load of weight down a track three times per week for a three-month period, or pulled an identical cart without any load for the same time period. One group of mice were fed a low-protein diet (7% of calories from protein) and a second group were fed a high-protein diet (36% of calories from protein). The team then compared the body composition, weight and metabolic measurements, such as blood glucose, of the different groups.

The results were as the team expected: the high-protein diet impaired metabolic health in sedentary mice pulling no weight; these mice gained excess fat mass compared to the low-protein diet mice. But in the mice pulling the increasing weight, a high-protein diet led to muscle growth especially in the forearm, and protected the animals from gaining fat. However, the exercise did not protect the mice from the effects of high protein on blood sugar control.

Additionally, although the high-protein-fed mice gained strength more quickly than the low-protein-fed mice, there was no difference in the maximum weight each set of mice could pull by the end of the study period, even though the mice fed high-protein diets were bigger and had larger muscles.

Although the evidence supporting the claims of the study was considered to be solid, the editors highlight a couple of limitations. For instance, the use of mice might limit the generalisability of the findings to humans, due to inherent physiological differences. The editors note that the findings would also be strengthened further by the inclusion of a direct investigation into the underlying molecular mechanisms responsible for the observed results.

“We know that many people deliberately consuming high-protein diets or consuming protein supplements to support their exercise regimen are not metabolically unhealthy, despite the body of evidence showing that high-protein levels can have detrimental metabolic effects,” says senior author Dudley Lamming, Associate Professor of Medicine (Endocrinology) at the Department of Medicine, School of Medicine and Public Health, University of Wisconsin. “Our research may explain this conundrum, by showing that resistance exercise protects from high-protein-induced fat gain in mice. This suggests that metabolically unhealthy, sedentary individuals with a high-protein diet or protein supplements might benefit from either reducing their protein intake or more resistance exercise.”

Source: eLife

Categories : Lab Tests and ImagingTags :

Eyes may be the Window to the Soul, but the Tongue Mirrors Health

On By ModernMedia
Photo by Andrea Piacquadio

A 2000-year-old practice by Chinese herbalists – examining the human tongue for signs of disease – is now being embraced by computer scientists using machine learning and artificial intelligence.

Tongue diagnostic systems are fast gaining traction due to an increase in remote health monitoring worldwide, and a new paper in AIP Conference Proceedings provides more evidence of the increasing accuracy of this technology to detect disease.

Engineers from Middle Technical University (MTU) in Baghdad and the University of South Australia (UniSA) used a USB web camera and computer to capture tongue images from 50 patients with diabetes, renal failure and anaemia, comparing colours with a data base of 9000 tongue images.

Using image processing techniques, they correctly diagnosed the diseases in 94 per cent of cases, compared to laboratory results. A voicemail specifying the tongue colour and disease was also sent via a text message to the patient or nominated health provider.

MTU and UniSA Adjunct Associate Professor Ali Al-Naji and his colleagues have reviewed the worldwide advances in computer-aided disease diagnosis, based on tongue colour.

“Thousands of years ago, Chinese medicine pioneered the practice of examining the tongue to detect illness,” Assoc Prof Al-Naji says.

“Conventional medicine has long endorsed this method, demonstrating that the colour, shape, and thickness of the tongue can reveal signs of diabetes, liver issues, circulatory and digestive problems, as well as blood and heart diseases.

“Taking this a step further, new methods for diagnosing disease from the tongue’s appearance are now being done remotely using artificial intelligence and a camera – even a smartphone.

“Computerised tongue analysis is highly accurate and could help diagnose diseases remotely in a safe, effective, easy, painless, and cost-effective way. This is especially relevant in the wake of a global pandemic like COVID, where access to health centres can be compromised.”

Diabetes patients typically have a yellow tongue, cancer patients a purple tongue with a thick greasy coating, and acute stroke patients present with a red tongue that is often crooked.

A 2022 study in Ukraine analysing tongue images of 135 COVID patients via a smartphone showed that 64% of patients with a mild infection had a pale pink tongue, 62% of patients with a moderate infection had a red tongue, and 99% of patients with a severe COVID infection had a dark red tongue.

Previous studies using tongue diagnostic systems have accurately diagnosed appendicitis, diabetes, and thyroid disease.

“It is possible to diagnose with 80% accuracy more than 10 diseases that cause a visible change in tongue colour. In our study we achieved a 94% accuracy with three diseases, so the potential is there to fine tune this research even further,” Assoc Prof Al-Naji says.

Source: University of South Australia

Categories : Dermatology Immune SystemTags :

When This Itch Cytokine ‘Talks’, Neurons Respond

On By ModernMedia
Photo by FOX

Scratching an itch can be a relief, but for many patients it can get out of control, becoming a serious health problem. So what normally stops this progression?

A paper published in Science Immunology reports a breakthrough that could transform how doctors treat conditions from atopic dermatitis to allergies, they have discovered a feedback loop centred on a single immune protein called IL-31 that both causes the urge to itch and dials back nearby inflammation.

The findings, by Scientists at UC San Francisco, lay the groundwork for a new generation of drugs that interact more intelligently with the body’s innate ability to self-regulate.

Previous approaches suggested that IL-31 signals itch and promotes skin inflammation. But the UCSF team discovered that nerve cells, or neurons, that respond to IL-31, triggering a scratch, also prevent immune cells from overreacting and causing more widespread irritation.

“We tend to think that immune proteins like IL-31 help immune cells talk to one another, but here, when IL-31 talks to neurons, the neurons talk right back,” said Marlys Fassett, MD, PhD, UCSF professor of dermatology and lead author of the study. “It’s the first time we’ve seen the nervous system directly tamp down an allergic response.”

The discovery could eventually change how asthma, Crohn’s and other inflammatory diseases are treated, due to IL-31’s presence throughout the body.

“IL-31 causes itch in the skin, but it’s also in the lung and in the gut,” said Mark Ansel, Ph.D., UCSF professor of immunology and senior author of the study. “We now have a new lead for fighting the many diseases involving both the immune and nervous systems.”

More than an itch

IL-31 is one of several “itch cytokines” because of its ability to instigate itch in animals and people. Fassett, a dermatologist and a researcher, has wanted to know why since she arrived at UCSF in 2012, a few years after its discovery. She reached out to Ansel, a former colleague and asthma expert who welcomed her into his lab.

First, Fassett removed the IL-31 gene from mice and exposed them to the house dust mite, a common, itchy allergen.

“We wanted to mimic what was actually happening in people who are chronically exposed to environmental allergens,” Fassett said. “As we expected, the dust mite didn’t cause itching in the absence of IL-31, but we were surprised to see that inflammation went up.”

Why was there inflammation but no itching? Fassett and Ansel found that a cadre of immune cells had been called into action in the absence of the itch cytokine. Without IL-31, the body was blindly waging an immunological war.

IL-31 brings balance to the forces

Ansel and Fassett then homed in on the nerve cells in the skin that received the IL-31 signal. They saw that the same nerve cells that spurred a scratch also dampened any subsequent immune response. These nerve cells were integral to keeping inflammation in check, but without IL-31, they let the immune system run wild.

The findings squared well with what dermatologists were increasingly seeing with a new drug, nemolizumab, which blocked IL-31 and was developed to treat eczema. While clinical trial patients found that the dry, patchy skin of their eczema receded on the drug, other skin irritation, and even inflammation in the lungs, would sometimes flare up.

“When you give a drug that blocks the IL-31 receptor throughout the whole body, now you’re changing that feedback system, releasing the brakes on allergic reactions everywhere,” Ansel said.

Fassett and Ansel also found that these neurons released their own signal, called CGRP, in response to the itch signal, which could be responsible for dampening the immune response.

“The idea that our nerves contribute to allergy in different tissues is game changing,” Fassett said. “If we can develop drugs that work around these systems, we can really help those patients that get worse flares after treatment for itch.”

Fassett recently founded her own lab at UCSF to tease apart these paradoxes in biology that complicate good outcomes in the clinic. And Ansel is now interested in what this itch cytokine is doing beyond the skin.

“You don’t itch in your lungs, so the question is, what is IL-31 doing there, or in the gut?” Ansel asked. “But it does seem to have an effect on allergic inflammation in the lung. There’s a lot of science ahead for us, with immense potential to improve therapies.”

Source:

Categories : Medical IndustryTags :

Sharing Health Data Saves Lives: Showcasing the CareConnect Health Information Exchange in Action in SA

On By ModernMedia

In a nation where healthcare has been marred by disjointed systems and fragmented care, South Africa’s healthcare organisations are making strides to change this narrative.

South Africa’s health journey has faced challenges with siloed information, often paper-based systems, and a lack of information flow between health professionals, funders and health facilities. These barriers have significantly impacted the cost, quality, and access to healthcare for patients. In response, the Competition Commission’s Health Market Inquiry (HMI) panel spotlighted the urgent need for solutions that bolster transparency, coordination, and innovation.

South Africa’s first industry-wide health information exchange, CareConnect HIE, is a game-changing initiative and the brainchild of major hospital groups, including Life Healthcare, Mediclinic, and Netcare, coupled with leading medical scheme administrators like Discovery Health, Medscheme, and Momentum Health. Their shared vision? An interoperable health system that breaks historic barriers, promoting enhanced patient care, quality, and efficiency. This transformative approach to healthcare was showcased in action at an event in Sandton today, providing attendees a firsthand look at the potential of HIE in South Africa.

Since its launch in August 2022, CareConnect HIE has rapidly advanced, with over 5.2 million consented lives now integrated into the system. However, the true value – from population health benefits to progressive funding and health delivery models – exponentially increases as the amount of data on the exchange grows.  Therefore, the aim of the HIE is to be the hub of exchange and the single integration point for ALL health data – from both the public sector and the private sector. Bearing testament to this, representatives from the South African Private Practitioners Forum,  the Radiological Society of SA, Mediclinic, Discovery Health, Altron and Momentum Health will share their insights on how HIE will be used in their organisations. In addition, representatives from the Western Cape Department of Health will talk to the public-private collaboration with CareConnect.  

CareConnect has adopted a set of international standards (FHIR and HL7) to transfer and share data between various healthcare systems regardless of how it is stored in those systems.  These standards underpin interoperability because all participants are ‘speaking the same language’.  An interoperable health system will be critical in achieving Universal Health Coverage (UHC) which will require the ability for patients to move seamlessly between the public and private health sectors, facilities, clinicians or other service providers, depending on the expertise and care they require. To this end, there is engagement with the National Department of Health, who were represented at the event.

Dr Rolan Christian, CEO of CareConnect HIE

Central to the CareConnect HIE is a Unified Care Record (UCR), an electronic medical record that holds a patient’s entire medical journey. This constantly updated and ever-evolving record gives clinicians on-demand access to consolidated patient data, promoting swift, well-informed treatment decisions when and where they are needed.

Privacy and security of data is critical to the success of HIE. The CareConnect HIE conforms to both local and international data privacy regulations to ensure that sensitive health information remains protected at all times and will only be accessible to healthcare providers when medically necessary and only with the patient’s consent. User-based access permissions are automatically regulated by the HIE, further safeguard­ing sensitive patient information.

Sharing health data saves lives. The more data the industry shares, the more value and benefit to the patient that will be extracted from the HIE.

Dr Rolan Christian, CEO of CareConnect HIE

CareConnect’s innovative new use cases, ranging from tracking acute and chronic patient conditions, listing allergies and adverse reactions, to standardising doctor clinical (discharge) summaries, were demonstrated at the event. These features will enable better coordination of care, minimise medical errors and pave the way to a more cohesive health system. 

HIE in various forms has become common across many health systems in the world and has become a priority on many a government health policy agenda as a solution to achieving greater cohesion within health systems  and as a mechanism to address cost and quality issues in health. Reflecting global best practices, the CareConnect HIE aligns with the world’s most mature HIEs and breathes life into the National Department of Health’s National Health Digital Strategy for South Africa.  This important document outlines the country’s goals towards the development of electronic health records and building interoperability and linkages between existing patient-based information systems.

A strict code of ethics relating the use of information is governed by an internationally recognised and best practice multi-party trust agreement, called DURSA. The DURSA provides a framework that deals with sharing of data among HIE participants and defines the permitted purpose for which the data can only be used.

Dr Rolan Christian, CEO of CareConnect HIE shared: “Sharing health data saves lives. The more data the industry shares, the more value and benefit to the patient that will be extracted from the HIE. We envision that CareConnect HIE will become a ‘utility’ for the entire health sector – to enable improved quality of care, better health outcomes and a more responsive health system.”

The event today boasted a stellar lineup of speakers. Notably, Dr Stavros Nicolaou from B4SA and Aspen Pharmacare and Dominick Bizzarro, offering international perspectives from MVP Health Care, joined other industry luminaries. Their combined insights painted a promising future for healthcare – one that’s harmonised, transparent, and unequivocally cantered on the patient.

Categories : Healthcare Politics and RegulationsTags :

With Funding and Partnerships, Africa’s Healthcare Sector can Become More Capable

On By ModernMedia
Photo by Sora Shimazaki

By Robert Appelbaum & Prelisha Singh, Partners at Webber Wentzel

In Africa, dysfunctional governments are often unable to allocate sufficient funds for essential aspects of healthcare. This results in a shortage of new primary and specialised hospitals, little local pharmaceutical and medical device manufacture and the inability to train doctors beyond undergraduate level, creating a shortage of medical specialists.

In a recent seminar hosted by Invest Africa and moderated by Webber Wentzel, panelists Silven Chikengezha, Liza Eustace, Jen Pedersen, Jasen Smallbone and Dr Sue Tager, shared their insights on how to tackle the problems of financing healthcare in Africa, and building a pipeline of medical professionals who remain in Africa.

Funding

From the perspective of the IFC, the obvious need for greenfield hospitals in Africa is not sufficient to attract funding. To be attractive, projects need to meet certain criteria.

The first is that it must have a sponsor with experience in construction and operations. The second is that it has to have the potential to grow. It takes at least three years for a hospital to start making returns. Primary care is an identified area of potential growth on the continent, but it offers low margins so it needs to build up volumes. If the hospital is a primary healthcare facility that addresses an identified need in the local community, it is more likely to attract reliable footfall. But there is very little revenue in basic services like treating TB, AIDS and giving vaccination, so the facility should offer a range of affordable treatments.

The third criterion for any hospital project seeking funding is that it should have, or will be able to attract suitably qualified staff. Doctors like to work in complementary practice groups, so the hospital should be able to offer an attractive environment for medical professionals.

The next important issue is the certainty of cash flow. Although government-sourced revenue for the hospital can provide a steady income stream, governments can be slow payers. It is important to look at each government’s history of making timely payments. Commercial banks will also consider the affordability of the hospital’s services, given that a very small proportion of Africa’s population has medical insurance. In some countries, governments require employers to pay their employees’ medical bills, which provides a level of comfort to the banks. Technology can help to improve affordability, for example, innovations such as monitors that track the temperature of heat-sensitive medicines in transit, which reduces wastage.

A fifth critical issue for funders is the way the funding is structured. If a large hospital project is structured with 60-70% debt from its initial stages, it is likely to struggle to meet interest payments. It is better to start with a smaller facility that is scaleable, and structure the funding so that there is more equity than debt in the early years.

ABSA noted that they would seek strong equity holders before considering debt, and they will look carefully at who the main equity funders are. This is an area where the IFC and other Development Finance Institutions (DFIs) can play a role because they are usually willing to take the “first loss” risk, which encourages commercial banks to extend debt. Commercial banks take comfort from developers with strong balance sheets.

An emerging source of funding for healthcare projects in Africa (as well as other projects, such as in energy, water and education) are social impact bonds, in which an institutional funder will lend money to an implementer that can correctly manage a project that meets a need – often a need identified by the government. Corporates should be pooling their available funds to create scaleable projects that will make an impact.

If healthcare financing is intended to support existing service providers in Africa, it has to adapt to the capacity of what are often very small- to medium-sized businesses. These businesses, which may be anything from manufacturers of medical devices to providers of digi-health services, need far less than USD 20 million, so they tend to be ignored. But funding is essential to help established businesses build scale. This is another area where DFIs and commercial banks working together can help, as the DFI can provide the first loss facility which allows commercial banks to take risk on smaller clients.

Public-private partnerships

The pandemic made it clear that perceived obstacles between public and private entities in providing healthcare together could be overcome if there was the right will and people in the room.

Speakers discussed the Wits Donald Gordon Medical Centre as an example of a successful PPP, which could be replicated elsewhere. The Donald Gordon offers treatment to the private sector, and the derived profits are used to train medical students from Wits University, which is the public partner. The centre also performs liver transplants for all patients, both public and private. Mediclinic has a share in Donald Gordon but does not receive dividends. All profits are recycled back into the hospital.

A PPP model for the provision of healthcare needs partners who have similar levels of sophistication and can work together. Governments have to appreciate that the role of the private sector is not merely to bring money so that the government can continue running things the way they have always done. Private sector partners should be allowed to introduce the levels of efficiency in delivery that are typically found in the private sector.

Categories : Environmental EffectsTags :

Microplastics are a Danger to our Health. Here’s How to Reduce Our Exposure to Them

On By ModernMedia
Photo by FLY:D on Unsplash

By Neil Thomas Stacey for GroundUp

About ten billion tonnes of plastic have been produced to date, of which around six billion tonnes have been discarded as waste. This is a severe threat to the environment, particularly oceans and lakes.

When plastics break down into particles smaller than five millimetres we call them microplastics. They are especially worrying.

Microplastics are an emerging threat to human health. They have been detected in organs in the human body and circulating in our bloodstreams. Studies have shown microplastics may deform red blood cells, inhibiting their ability to transport and transfer oxygen.

A study on mice exposed to microplastics found them in every tissue examined, and showed behavioural changes and heightened inflammation. While the exact effects on human health are not yet known, the risk is high enough that we should be very cautious about allowing them to pervade our atmosphere and food supply.

Microplastics have even been detected in high amounts in clouds, where they may affect rainfall patterns. They can also enter our food supply through rainfall.

A recent study of sediments in the Vaal river found an alarmingly high abundance of microplastics, which may enter the local food supply through crop irrigation. The sampling in this study was done in the region of the Vaal River Barrage, which is downstream of the Vaal Dam and fed by rivers that pass through heavily populated areas including Johannesburg.

Sampling at the Barrage gives direct insight into the rates at which we are producing microplastics in major population centres. And sampling at the Vaal Dam, which is the major drinking water supply for Gauteng, provides insight into the extent to which our drinking water is affected. Both these sampling points are needed as we track the levels of microplastics. Those levels are likely to rise dramatically; the microplastics we are seeing currently are only the tip of the iceberg, as there is a lag between the production of plastic, and it breaking down into microplastics.

Microplastic proliferation is not tied directly to accumulation of waste plastic. Examination of microplastics to ascertain their source is not an exact science, but it is reported that the main sources of microplastic pollution, at least for now, are car tyres and textiles and the pollution arises, not at the end-of-life when these are discarded as waste, but during their day-to-day use.

In other words, even if we solve the problem of waste plastic, we would still face the problem of microplastics that are emitted during the normal lifespan of products made of plastic.

There are, fortunately, some concrete steps that people can take to reduce personal exposure to microplastics. While microplastics are clearly able to travel throughout the atmosphere, their levels are concentrated around the sources releasing them. Microplastic concentrations are higher in indoor than outdoor air; old-fashioned fresh air and good ventilation are beneficial. So too is regularly wiping down surfaces, as they accumulate microplastic dust. Household air filters may also reduce microplastic concentrations.

Perhaps the most useful thing we as individuals can do is to have a different relationship with clothing. Synthetic fabrics are a prolific source of microplastics. These are released in our immediate surroundings, making our exposure to them disproportionately high.

Most microplastic release from textiles occurs within the first few washes after purchase, so purchasing long-lasting clothing rather than frequently replacing items of clothing can reduce your exposure, as can choosing natural fabrics such as cotton, where possible.

The other major source of microplastics is car tyres, which shed microplastics constantly as they wear down.

There are also activities which may seem environmentally-friendly but probably exacerbate microplastics pollution.

It is increasingly common to convert waste plastic into useable products from shoes and clothing to integration of waste plastic into road surfaces.

At first glance, this appears to be an environmental win-win. But recycled products tend to be more susceptible to the abrasion that causes microplastic release. Moreover, waste and recycled plastics tend to wear out more quickly and require replacement more frequently.

This is perhaps most harmful in the case of clothing made of waste or recycled plastic; the release of microplastics in early washes will be more severe because of the weaker polymer. This is particularly worth highlighting because recent research has shown that tumble-drying of synthetic textiles results in prolific microplastic release, much of which may be discharged into the indoor environment and breathed in or otherwise consumed.

Currently we have no practical way to remove microplastics from the environment; the particles are simply too small and widely dispersed. This means that we must exercise extreme caution to minimise emissions and our personal exposure to them.

Republished from GroundUp under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Source: GroundUp

Categories : Gastrointestinal Surgeries & ProceduresTags :

Hold the GLP-1 Agonists Before Surgery, New Advice Says

On By ModernMedia
Photo by Natanael Melchor on Unsplash

Patients taking Glucagon-like peptide-1 (GLP-1) receptor agonists should stop taking them before they have surgery, due to the risk of aspirating while under general anaesthesia. This is the latest advice from the American Society of Anesthesiologists (ASA).

Initially approved by the Food and Drug Administration (FDA) for type 2 diabetes mellitus and cardiovascular risk reduction, GLP-1 agonists have shot up in popularity due to their effectiveness in weight loss. Despite having recent FDA approval, they have been used off-label for this purpose for quite some time.

When it comes to surgery, a number of organisations have recommended to hold these drugs either the day before or day of the procedure. For patients on weekly dosing, it is recommended to hold the dose for a week, the ASA notes.

GLP-1 agonists are associated with adverse gastrointestinal effects such as nausea, vomiting and delayed gastric emptying. The effects on gastric emptying are reported to be reduced with long-term use, most likely through rapid tachyphylaxis at the level of vagal nerve activation. Based on recent anecdotal reports, there are concerns that delayed gastric emptying from GLP-1 agonists can increase the risk of regurgitation and pulmonary aspiration of gastric contents during general anaesthesia and deep sedation. Patient taking GLP-1 agonists are more likely to have increased residual gastric contents as predicted by adverse gastrointestinal symptoms (nausea, vomiting, dyspepsia, abdominal distension).

The use of GLP-1 agonists in paediatrics has primarily been reported for the management of type 2 diabetes mellitus and obesity. The published literature on GLP-1 agonists in paediatrics is predominantly from paediatric patients 10 to 18 years old and concerns are similar to those reported in adults. During the conduct of general anaesthesia/deep sedation, children on GLP-1 agonists have similar gastrointestinal adverse events at a rate similar to adults.

In a review of the literature, the ASA Task Force on Preoperative Fasting found that, beyond a few case reports, there was little evidence for guidance on preoperative management of GLP-1 agonists. Nevertheless, they made recommendations for elective procedures. In the case of urgent or emergent procedures, they suggested treating the patient as ‘full stomach’.

If the patient’s GLP-1 agonists prescribed for diabetes management are held for longer than the dosing schedule, the guidelines urge surgeons to consider consulting an endocrinologist for bridging the antidiabetic therapy in order to avoid hyperglycaemia.

They further recommend that if gastrointestinal symptoms, such as severe nausea/vomiting/retching, abdominal bloating, or abdominal pain, are present, surgeons should consider delaying elective procedures. If the patient has no gastrointestinal symptoms and the GLP-1 agonists have been held as advised, the surgical team can carry on as normal.

Source: American Society of Anesthesiologists

Categories : Diet and Nutrition PaediatricsTags :

Study Classifies Four Eating Eating Behaviours of Children

On By ModernMedia
Photo by cottonbro studio

Children fall broadly into four eating categories, according to new research at Aston University, and parents feed their children differently depending on those categories.

The four categories identified by Dr Abigail Pickard and the team in the School of Psychology are ‘avid’, ‘happy’, ‘typical’, and ‘fussy’. The results, which showed specific temperaments and carer feeding patterns associated with overeating, are published in the journal Appetite.

In the UK, around a fifth of children are overweight or obese when they begin school, rising to around a third by the time they leave primary school at age 11. The team sought to identify eating behaviour patterns and how these are associated with temperament, feeding practices and food insecurity, as a way to predict which children are more at risk of becoming overweight.

Typical eaters made up 44% of the children in the study, while fussy eaters accounted for 16%. But of greatest interest to the team was that around one in five young children in the study were found to show “avid eating,” including greater enjoyment of food, faster eating speed, and weaker sensitivity to internal cues of ‘fullness’. The behaviours that distinguish children with avid eating from those who show ‘happy’ eating (17.7% of children in the study), who have similarly positive responses to food, are wanting to eat (or eating more) in response to the sight, smell or taste of palatable food, and a higher level of emotional overeating. In combination, these eating behaviours can lead to overeating and subsequent weight gain.

Dr Pickard and the team have also shown that there are significant differences in children’s temperament and caregivers’ feeding practices between each of the four eating behaviour patterns. Children with avid eating are more likely to be active and impulsive, and their caregivers are more likely to give them food to regulate their emotions or to restrict food for health reasons. Children with avid eating were also less food secure than children who showed happy or typical eating behaviours.

Principal investigator of the project, Professor Jackie Blissett, said: “Whilst feeding practices are key intervention targets to change children’s eating behaviour and child weight outcomes, there has been little evaluation of how feeding practices interact with children’s food approach behaviours to predict eating behaviour.”

She explained that despite the knowledge of the influence of feeding practices on children’s weight, current public health advice is generic and does not reflect variability in children’s appetites. Parents and caregivers can be left feeling frustrated when trying to manage their child’s food intake. By defining the four eating behaviour profiles, this research project, which is funded by the Economic and Social Research Council and co-developed by Professor Claire Farrow, Dr Clare Llewellyn, Dr Moritz Herle, Professor Emma Haycraft and Dr Helen Croker will make it easier to identify the best feeding practices for each eating pattern and provide tailored, effective advice for parents.

Dr Pickard said: “Parents can use this research to help them understand what type of eating pattern their child presents. Then based on the child’s eating profile the parent can adapt their feeding strategies to the child. For example, children in the avid eating profile may benefit more from covert restriction of food, i.e., not bringing snacks into the home or not having foods on display, to reduce the temptation to eat foods in the absence of hunger. Whereas, if a child shows fussy eating behaviour it would be more beneficial for the child to have a balanced and varied selection of foods on show to promote trying foods without pressure to eat.”

The team has planned further research investigating avid eating behaviour and will invite the caregivers and their children into the specialist eating behaviour lab at Aston University to get a better picture of what avid and typical eating behaviours look like in a real-life setting. All the findings will be integrated and the researchers will work with parents to develop feasible and helpful feeding guidelines to reduce children’s intake of palatable snack foods.

Source: Aston University

Categories : Neurodegenerative DiseasesTags :

Surgery-free Deep Brain Stimulation Could be New Treatment for Dementia

On By ModernMedia

A new form of deep brain stimulation offers hope for an alternative treatment option for dementia, without the need for surgery.

Researchers at Imperial College London are leading the development of the technique, known as temporal interference (TI). This non-invasive method works by delivering electrical fields to the brain through electrodes placed on the patient’s scalp and head. Their initial findings, which are published in the journal Nature Neuroscience, could lead to an alternative treatment for brain diseases such as Alzheimer’s, and its associated memory loss.

Temporal interference

By targeting the overlapping electrical fields researchers were able to stimulate an area deep in the brain called the hippocampus, without affecting the surrounding areas – a procedure that until now required surgery to implant electrodes into the brain.

The approach has been successfully trialled with 20 healthy volunteers for the first time by a team at the UK Dementia Research Institute (UK DRI) at Imperial and the University of Surrey.

Their initial results show that when healthy adults perform a memory task whilst receiving TI stimulation it helped to improve memory function.

The team is now conducting a clinical trial in people with early-stage Alzheimer’s disease, where they hope TI could be used to improve symptoms of memory loss.

Dr Nir Grossman, from the Department of Brain Sciences at Imperial College London, who led the work said: “Until now, if we wanted to electrically stimulate structures deep inside the brain, we needed to surgically implant electrodes which of course carries risk for the patient, and can lead to complications.

“With our new technique we have shown for the first time, that it is possible to remotely stimulate specific regions deep within the human brain without the need for surgery. This opens up an entirely new avenue of treatment for brain diseases like Alzheimer’s which affect deep brain structures.”

Reaching deep brain regions

TI was first described by the team at Imperial College London in 2017 and shown to work in principle in mice.

This latest work, funded and carried out through the UK Dementia Research Institute, shows for the first time that TI is effective at stimulating regions deep within the human brain.

According to the researchers, this could have broad applications and will enable scientists to stimulate different deep brain regions to discover more about their functional roles, accelerating the discovery of new therapeutic targets.

Source: Imperial College London