Reaching the age of 100 does not necessarily mean a life fraught with illness. A new study from Karolinska Institutet shows that centenarians not only live longer, they also stay healthier than other older people, with fewer diseases that develop more slowly.
The study, published in eClinicalMedicine, compared people who reached the age of 100 with those who died earlier. The results show that centenarians not only suffer from fewer diseases, they also develop them more slowly.
While many older people accumulate several diagnoses quickly during their final years, the disease burden of centenarians seems to level off from around the age of 90. They more often have diseases that are limited to a single organ system and significantly fewer concurrent conditions.
The study also shows that cardiovascular disease is less common and occurs later in life among centenarians. Neuropsychiatric diseases are also less prevalent among those who live the longest.
”Our results challenge the widespread belief that a longer life inevitably means more diseases. We show that centenarians follow a distinct ageing curve, with slower disease progression and greater resistance to common age-related diseases,” says last author Karin Modig, associate professor at the Institute of Environmental Medicine, Karolinska Institutet.
Ages in a different ways
The study covered the entire Swedish birth cohort between 1920 and 1922, totalling over 270,000 individuals. The researchers followed the participants’ health from the age of 70 and up to three decades. The progression of disease in centenarians was compared with those who lived shorter lives using national health registers. The results show that centenarians not only delay disease – they seem to age in a fundamentally different way.
”We show that exceptional longevity is not just about delaying ill health. It reflects a unique pattern of ageing. The results suggest that centenarians have preserved homeostasis and resistance to disease despite ageing and physiological stresses – something that may be due to a favourable combination of genes, lifestyle and environment,” says Karin Modig.
The study was funded by Karolinska Institutet. No conflicts of interest have been reported.
Although metformin is the most widely prescribed diabetes drug in the world, its mechanism of action is still not clear. Kobe University endocrinologist OGAWA Wataru has now made significant progress, finding that it changes blood metal levels in humans. Photo by Towfiqu Barbhuiya on Unsplash
The widely used diabetes drug metformin may achieve its effects by changing blood metal levels in humans. The Kobe University study is an important step in understanding the drug’s many actions and designing better ones in the future.
Metformin is the most widely prescribed diabetes drug in the world. Apart from lowering blood sugar levels, it is also known to have a broad range of beneficial side effects such as against tumours, inflammations and atherosclerosis. However, although it has been used for more than 60 years now, its mechanism of action is still not clear, hampering the development of even better drugs against these conditions.
Kobe University endocrinologist OGAWA Wataru says: “It is known that diabetes patients experience changes in the blood levels of metals such as copper, iron and zinc. In addition, chemical studies found that metformin has the ability to bind certain metals, such as copper, and recent studies showed that it is this binding ability that might be responsible for some of the drug’s beneficial effects. So, we wanted to know whether metformin actually affects blood metal levels in humans, which had not been clarified.” To do so, Ogawa and his team enlisted about 200 diabetes patients at Kobe University Hospital, half of which took metformin and half of which did not, in a study to analyse their blood serum levels for those metals and various metal deficiency indicators.
In the journal BMJ Open Diabetes Research & Care, the Kobe University team now published the first clinical evidence of altered blood metal levels in patients taking metformin. They showed that drug-taking patients have significantly lower copper and iron levels and heightened zinc levels. Ogawa says: “It is significant that we could show this in humans. Furthermore, since decreases in copper and iron concentrations and an increase in zinc concentration are all considered to be associated with improved glucose tolerance and prevention of complications, these changes may indeed be related to metformin’s action.”
Recently, Japan has approved the use of imeglimin, a new diabetes drug that is a derivative of metformin but that should not be able to bind metals the same way as its parent. “Imeglimin is thought to have a different method of action, and we are already conducting studies to compare the effects the two drugs have,” says Ogawa.
It is not just about understanding the current drugs, however. Ogawa explains the bigger picture, saying: “We need both clinical trials and animal experiments to pinpoint the causal relationship between the drug’s action and its effects. If such studies progress further, they may lead to the development of new drugs for diabetes and its complications by properly adjusting the metal concentrations in the body.”
A 3D map of the islet density routes throughout the healthy human pancreas. Source: Wikimedia CC0
Cornell researchers have developed an implant system that can treat Type 1 diabetes by supplying extra oxygen to densely packed insulin-secreting cells, without the need for immunosuppression. The system could also potentially provide long-term treatment for a range of chronic diseases.
The findings appear in Nature Communications. The co-first authors were former postdoctoral researcher Tung Pham and doctoral candidate Lora (Phuong) Tran.
The technology builds off previous implantable encapsulation devices developed in the lab of Minglin Ma, professor of biological and environmental engineering in the College of Agriculture and Life Sciences (CALS) and the paper’s senior author.
Ma has explored a variety of ways to address Type 1 diabetes, which is typically managed through daily insulin injections or insulin pumps, but even with that treatment, patients still suffer the devastating effects of the disease.
Ma’s previous implantable devices have proved effective in controlling blood sugar in diabetic mice, but they can only last so long.
“One of the major challenges is the implant itself often dies due to the lack of oxygen after implantation,” Tran said. “In our lab, they had success in micethat lived over one year, and they controlled the diabetes very effectively with some small capsules without oxygen generation. However, when we scale up, we need more cells, we need more density, especially. We need a higher dose. If we implant without generating oxygen, the cells often die within two weeks.”
Ma’s team developed the new system in collaboration with electrochemical researchers from Giner Inc, including co-author Linda Tempelman, PhD ’93.
The key components of the system are a cylindrical capsule with a ring-shaped cross-section that contains transplanted insulin-secreting cells, and an electrochemical oxygen generator that is roughly the size of a dime and removeable. A nanofibrous membrane outside the capsule protects the cells from the host body’s immune system; a permeable membrane in the core of the capsule allows the central supply of oxygen to reach the ring of cells.
“We have to meet two requirements,” Tran said. “The first is immune protection. And second, you have to maintain mass transfer, like the glucose and other nutrients and molecules that can go in and out.”
Working with Dr James Flanders, associate professor emeritus in the College of Veterinary Medicine, the researchers successfully tested the system in rat models.
“It’s the proof of concept. We really proved that oxygenation is important, and oxygenation will support high cell-density capsules,” Tempelman said. “The capsules are immune protective and last for a long time without having some kind of fouling of the membrane. The body never likes when you put a foreign substance in. So that’s the engineering in the Ma Lab, to look for materials and coatings for the materials that are immune protective, but also don’t invoke excess response from the body because of the material.”
The new system would enable a much greater number of the 2 million people who suffer from Type 1 diabetes in the US to now have an islet transplant or cell therapy without requiring immune suppression, which is considered too dangerous for routine use. Also, the new system can provide much tighter sugar control, effectively curing the disease and enabling the person to eat, drink and exercise like everyone else.
The next step will be to implant the system in a pig model, and also test it with human stem cells. The researchers are interested in eventually trying to use the system for implanting different cell types in humans for long-term treatment of chronic diseases, according to Tempelman, who is CEO of Persista Bio Inc., a new startup she founded with Ma and Flanders that is licensing these technologies.
“We see an age where people will be getting implants with allogeneic cells from other human beings, from stem cell lines, and using it long term to treat things that your body is missing,” Tempelman said. “Here we’re missing insulin. In pain control, maybe you need more endorphins or some other molecule. In enzyme replacement therapy, you need more enzymes. We’re interested in things like other autoimmune diseases where there’s inflammation that’s out of control.
“So maybe you could put a small molecule in that would treat inflammation, and then someone, like a Lupus patient, wouldn’t have to take an oral medication. They could just have a low-level implant that provides a low amount of it.”
The blood thinner heparin is used during and after surgery and is essential to kidney dialysis. Most of today’s heparin comes from pigs, but the Federal Drug Administration is encouraging the use of alternative sources, including cows and synthetic forms of heparin, to diversify the supply chain.
Unfortunately, heparin from animals other than pigs just doesn’t work as well.
The reasons are connected to ongoing questions in modern cell biology. Now, an interdisciplinary Virginia Tech team has uncovered new molecular clues that may explain why some sources of heparin are more effective than others. The findings, published recently in the Proceedings of the National Academy of Sciences, may open doors for designing safer, more reliable heparin therapies.
“The structure of heparin and how that structure impacts function is an ongoing puzzle,” said Brenna Knight, first author of the study and recent graduate student studying in the Department of Chemistry. “Seemingly small differences in the content and arrangement of [chemical entities called] sulfates on the molecule cause substantial differences in the energetics that drive chemical activity.”
From mineralization to medicine
Heparin hails from a family called heparan sulfates, or heparans, present in all living creatures. These chains of sugars are diverse, serve many functions in organisms, and many, including heparin, are incredibly complex.
As a student of Patricia Dove in the Departments of Geosciences and Chemistry, Knight was originally looking at heparans for a completely different reason: to understand how the sulfates could impact biological mineralisation, which is the process by which organisms build crystal-strengthened tissues such as bones, teeth, shells, and corals.
Dove is one of today’s pre-eminent geochemists and was elected to the National Academy of Sciences in 2012. Unravelling the process of biomineralisation has been one of her major passions over the past three decades.
“Animals grow crystals in specific places, usually to make structures that serve to support, defend, or feed themselves.” said Dove. “It’s a coordinated result of many chemical reactions within the organism and a crowning achievement of biology. We’ve been trying to better understand the reactions that produce these working biomaterials for a long time.”
That mineralization process unexpectedly linked back to medicine.
Heparan sulfates are just one of many different agents that interact with calcium to trigger a diverse portfolio of biochemical operations. One of those operations is integral to blood clotting.
Team science
To better understand how heparan sulfates help facilitate biomineralisation, Dove and Knight teamed with Kevin Edgar, professor in the Department of Sustainable Biomaterials, who was interested in heparans from the healthcare angle. To study interactions of calcium with heparin, they worked with Michael Schulz and graduate student Connor Gallagher in the chemistry department.
When they applied their combined expertise to calcium-heparin interactions, they found that slight variations in heparin’s molecular composition changed how effective it was at binding calcium. These differences could affect its ability to form biominerals and blood thinners.
“This paper provides insights for how to bioengineer synthetic pathways to effective heparin products for applications in therapeutics and drug delivery,” Edgar said.
NIH-funded clinical trial shows potential to simplify treatment for early syphilis.
Photo by Raghavendra V Konkathi on Unsplash
Researchers funded by the National Institutes of Health (NIH) have found that a single injection of the antibiotic benzathine penicillin G (BPG) successfully treated early syphilis just as well as the three-injection regimen used by many clinicians in the United States and elsewhere. These findings from a late-stage clinical trial suggest the second and third doses of conventional BPG therapy do not provide a health benefit. The results were published in The New England Journal of Medicine.
“Benzathine penicillin G is highly effective against syphilis, but the three-dose regimen can be burdensome and deter people from attending follow-up visits with their healthcare providers,” said Carolyn Deal, PhD, chief of the enteric and sexually transmitted infections branch of NIH’s National Institute of Allergy and Infectious Diseases (NIAID). “The new findings offer welcome evidence for potentially simplifying treatment with an equally effective one-dose regimen, particularly while syphilis rates remain alarmingly high.”
Syphilis is a common sexually transmitted infection (STI) caused by the bacterium Treponema pallidum. The United States reported 209 253 total syphilis cases and 3882 congenital syphilis cases in 2023, representing 61% and 108% increases over 2019 numbers, respectively. Without treatment, syphilis can result in neurological and organ damage as well as severe pregnancy complications and congenital abnormalities. Syphilis can also increase a person’s likelihood of acquiring or transmitting HIV.
BPG is one of the few antibiotics known to effectively treat syphilis, and stockouts are common worldwide. The antibiotic is currently being imported to the United States to resolve a nationwide shortage.
The study was conducted at ten U.S. sites and enrolled 249 participants with early syphilis, which encompasses the primary, secondary, and early latent stages of disease. Sixty-four percent of participants were living with HIV and 97% were men. The participants were randomly assigned to receive either a single intramuscular (IM) injection of BPG 2.4 million units (MU) or a series of three IM injections of BPG 2.4 MU at weekly intervals. All participants were monitored for safety. Biological markers of successful treatment in the blood – known as the serologic response to therapy – were examined at six months following treatment.
Seventy-six percent of participants in the single-dose group had a serologic response to treatment compared to 70% of participants in the three-dose group. The difference between groups was not statistically significant, even when participants were stratified by HIV status. One participant developed signs of neurosyphilis three days after starting BPG therapy and was excluded from the analysis. Three serious adverse events were reported but were not related to BPG.
“Syphilis has been studied and treated for more than a century, and BPG has been in use for more than 50 years, yet we are still acquiring knowledge to help us optimise treatment,” said Principal Investigator Edward W. Hook III, MD, emeritus professor of medicine and epidemiology at the University of Alabama at Birmingham. “We hope these promising results will be complemented by scientific advances in syphilis prevention and diagnosis.”
According to the study authors, the results from this trial provide substantial evidence that single-dose BPG 2.4 MU is as effective as three doses in treating early syphilis. More research is needed to understand the full potential of this abbreviated treatment strategy and to evaluate therapeutic approaches for all stages of syphilis, including late syphilis, latent syphilis of unknown duration, and clinical neurosyphilis.
The study was conducted through the NIAID-funded Sexually Transmitted Infections Clinical Trials Group.
For more information about this trial, please visit ClinicalTrials.gov using the study identifier NCT03637660.
New study supports anecdotal claims about the risks of using a smartphone during toilet time
Photo by Jan Antonin Kolar on Unsplash
Survey participants who reported using a smartphone while on the toilet had a higher risk of haemorrhoids than non-users. Chethan Ramprasad of Beth Israel Deaconess Medical Center, U.S., and colleagues present these findings in a new study in the open-access journal PLOS One on September 3, 2025.
Every year in the US, haemorrhoids lead to nearly 4 million visits to the doctor or emergency room and more than $800 million in healthcare spending. Haemorrhoids involve swollen veins in the anal or rectal area and can cause pain and bleeding. Anecdotal evidence has linked smartphone use on the toilet with increased risk of haemorrhoids.
However, few studies have explored whether smartphone use on the toilet is actually associated with haemorrhoid risk. To help clarify, Ramprasad and colleagues conducted a study of 125 adults undergoing screening colonoscopy. The participants answered online survey questions about their lifestyle and toilet habits, and endoscopists evaluated them for haemorrhoids.
Among all participants, 66% reported using smartphones on the toilet, and they tended to be younger than non-users. After statistically accounting for other factors thought to possibly be linked with haemorrhoid risk – such as exercise habits, age, and fibre intake – the researchers found that participants who used a smartphone on the toilet had a 46% higher risk of haemorrhoids than non-users.
Time spent on the toilet was significantly higher for smartphone users than non-users; 37% of smartphone users spent more than 5 minutes at a time on the toilet compared to just 7.1% of non-users. Reading news and using social media were the most commonly reported smartphone activities on the toilet. Interestingly, straining while using the toilet was not associated with increased haemorrhoid risk, in contrast to some prior studies.
On the basis of the findings, the researchers suggest that smartphone use may inadvertently prolong toilet time, potentially increasing pressure in anal tissues, which may then lead to haemorrhoids.
This study could help inform clinicians’ recommendations to patients. Future research could also expand on these findings, such as by tracking patients over time and exploring interventions to limit prolonged smartphone use on the toilet.
Trisha Pasricha, senior author of the study, adds: “Using a smartphone while on the toilet was linked to a 46 per cent increased chance of having haemorrhoids. We’re still uncovering the many ways smartphones and our modern way of life impact our health. It’s possible that how and where we use them – such as while in the bathroom –can have unintended consequences.
“This study bolsters advice to people in general to leave the smartphones outside the bathroom and to try to spend no more than a few minutes to have a bowel movement. If it’s taking longer, ask yourself why. Was it because having a bowel movement was really so difficult, or was it because my focus was elsewhere?
“It’s incredibly easy to lose track of time when we’re scrolling on our smartphones – popular apps are designed entirely for that purpose. But it’s possible that constantly sitting longer on the toilet than you intended because you’re distracted by your smartphone could increase your risk of haemorrhoids. We need to study this further, but it’s a safe suggestion to leave the smartphone outside the bathroom when you need to have a bowel movement.”
Researchers from the Broad Institute and Mass General Brigham have shown that a low-oxygen environment – similar to the thin air found at Mount Everest base camp – can protect the brain and restore movement in mice with Parkinson’s-like disease.
The new research, in Nature Neuroscience, suggests that cellular dysfunction in Parkinson’s leads to the accumulation of excess oxygen molecules in the brain, which then fuel neurodegeneration – and that reducing oxygen intake could help prevent or even reverse Parkinson’s symptoms.
“The fact that we actually saw some reversal of neurological damage is really exciting,” said co-senior author Vamsi Mootha, an institute member at the Broad, professor of systems biology and medicine at Harvard Medical School, a Howard Hughes Medical Institute investigator in the Department of Molecular Biology at Massachusetts General Hospital (MGH), a founding member of the Mass General Brigham healthcare system. “It tells us that there is a window during which some neurons are dysfunctional but not yet dead – and that we can restore their function if we intervene early enough.”
“The results raise the possibility of an entirely new paradigm for addressing Parkinson’s disease,” added co-senior author Fumito Ichinose, the William T. G. Morton professor of anesthesia at Harvard Medical School and MGH.
The researchers caution that it’s too soon to translate these results directly to new treatments for patients. They emphasize that unsupervised breathing of low-oxygen air, especially intermittently such as only at night, can be dangerous and may even worsen the disease. But they’re optimistic their findings could help spur the development of new drugs that mimic the effects of low oxygen.
The study builds on a decade of research from Mootha and others into hypoxia – the condition of having lower than normal oxygen levels in the body or tissues – and its unexpected ability to protect against mitochondrial disorders.
“We first saw that low oxygen could alleviate brain-related symptoms in some rare diseases where mitochondria are affected, such as Leigh syndrome and Friedreich’s ataxia,” said Mootha, who leads the Friedreich’s Ataxia Accelerator at Broad. “That raised the question: Could the same be true in more common neurodegenerative diseases like Parkinson’s?”
Eizo Marutani, an instructor of anesthesia at MGH and Harvard Medical School, is the first author of the new paper.
A long-standing link
Parkinson’s disease, which affects more than 10 million people worldwide, causes the progressive loss of neurons in the brain, leading to tremors and slowed movements. Neurons affected by Parkinson’s also gradually accumulate toxic protein clumps called Lewy bodies. Some biochemical evidence has suggested that these clumps interfere with the function of mitochondria, that Mootha knew were altered in other diseases that could be treated with hypoxia.
Moreover, anecdotally, people with Parkinson’s seem to fare better at high altitudes. And long-term smokers – who have elevated levels of carbon monoxide, leading to less oxygen in tissues – also appear to have a lower risk of developing Parkinson’s.
“Based on this evidence, we became very interested in the effect of hypoxia on Parkinson’s disease,” said Ichinose.
Mootha and Ichinose turned to a well-established mouse model of Parkinson’s in which animals are injected with clumps of the α-synuclein proteins that seed the formation of Lewy bodies. The mice were then split into two groups: one breathing normal air (21% oxygen) and the other continuously housed in chambers with 11% oxygen – comparable to living at an altitude of about 4800m.
A new paradigm for Parkinson’s
The results were striking. Three months after receiving α-synuclein protein injections, the mice breathing normal air had high levels of Lewy bodies, dead neurons, and severe movement problems. Mice that had breathed low-oxygen air from the start didn’t lose any neurons and showed no signs of movement problems, despite developing abundant Lewy bodies.
The findings show that hypoxia wasn’t stopping the formation of Lewy bodies but was protecting neurons from the damaging effects of these protein clumps – potentially suggesting a new mode of treating Parkinson’s without targeting α-synuclein or Lewy bodies, Ichinose said.
What’s more, when hypoxia was introduced six weeks after the injection, when symptoms were already appearing, it still worked. The mice’s motor skills rebounded, their anxiety-like behaviors faded, and the loss of neurons in the brain stopped.
To further explore the underlying mechanism, the team analyzed brain cells of the mice and discovered that mice with Parkinson’s symptoms had much higher levels of oxygen in some parts of the brain than control mice and those that had breathed low-oxygen air. This excess oxygen, the researchers said, likely results from mitochondrial dysfunction. Damaged mitochondria can’t use oxygen efficiently, so it builds up to damaging levels.
“Too much oxygen in the brain turns out to be toxic,” said Mootha. “By reducing the overall oxygen supply, we’re cutting off the fuel for that damage.”
Hypoxia in a pill
More work is needed before the findings can be directly used to treat Parkinson’s. In the meantime, Mootha and his team are developing “hypoxia in a pill” drugs that mimic the effects of low oxygen to potentially treat mitochondrial disorders, and they think a similar approach might work for some forms of neurodegeneration.
While not all neurodegenerative models respond to hypoxia, the approach has now shown success in mouse models of Parkinson’s, Leigh syndrome, Friedreich’s ataxia, and accelerated aging.
“It may not be a treatment for all types of neurodegeneration,” said Mootha, “but it’s a powerful concept – one that might shift how we think about treating some of these diseases.”
The popular large language model performs better than expected but still has some knowledge gaps – and hallucinations
When people worry that they’re getting sick, they are increasingly turning to generative artificial intelligence like ChatGPT for a diagnosis. But how accurate are the answers that AI gives out?
Research recently published in the journal iScience puts ChatGPT and its large language models to the test, with a few surprising conclusions.
“People talk to ChatGPT all the time these days, and they say: ‘I have these symptoms. Do I have cancer? Do I have cardiac arrest? Should I be getting treatment?’” Hamed said. “It can be a very dangerous business, so we wanted to see what would happen if we asked these questions, what sort of answers we got and how these answers could be verified from the biomedical literature.”
The researchers tested ChatGPT for disease terms and three types of associations: drug names, genetics and symptoms. The AI showed high accuracy in identifying disease terms (88–97%), drug names (90–91%) and genetic information (88–98%). Hamed admitted he thought it would be “at most 25% accuracy.”
“The exciting result was ChatGPT said cancer is a disease, hypertension is a disease, fever is a symptom, Remdesivir is a drug and BRCA is a gene related to breast cancer,” he said. “Incredible, absolutely incredible!”
Symptom identification, however, scored lower (49–61%), and the reason may be how the large language models are trained. Doctors and researchers use biomedical ontologies to define and organise terms and relationships for consistent data representation and knowledge-sharing, but users enter more informal descriptions.
“ChatGPT uses more of a friendly and social language, because it’s supposed to be communicating with average people. In medical literature, people use proper names,” Hamed said. “The LLM is apparently trying to simplify the definition of these symptoms, because there is a lot of traffic asking such questions, so it started to minimize the formalities of medical language to appeal to those users.”
One puzzling result stood out. The National Institutes of Health maintains a database called GenBank, which gives an accession number to every identified DNA sequence. It’s usually a combination of letters and numbers. For example, the designation for the Breast Cancer 1 gene (BRCA1) is NM_007294.4.
When asked for these numbers as part of the genetic information testing, ChatGPT just made them up – a phenomenon known as “hallucinating.” Hamed sees this as a major failing amid so many other positive results.
“Maybe there is an opportunity here that we can start introducing these biomedical ontologies to the LLMs to provide much higher accuracy, get rid of all the hallucinations and make these tools into something amazing,” he said.
Hamed’s interest in LLMs began in 2023, when he discovered ChatGPT and heard about the issues regarding fact-checking. His goal is to expose the flaws so data scientists can adjust the models as needed and make them better.
“If I am analysing knowledge, I want to make sure that I remove anything that may seem fishy before I build my theories and make something that is not accurate,” he said.
New research from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s College London, in partnership with the University of Bath, has found that the reasons why a person chooses to use cannabis can increase their risk of developing paranoia.
Photo by Thought Catalog on Unsplash
The use and potency of cannabis is increasing worldwide, and dependence and cannabis-induced psychosis are also greatly increasing as a result, especially in North America. Two new research papers, both using data from Cannabis & Me – the largest survey of its kind – have identified key risk factors associated with the more severe forms of paranoia in cannabis users.
The first study, published in BMJ Mental Health, explored the relationship between why people first started using cannabis, and how this affected their subsequent use.
3389 former and current cannabis users aged 18 and over responded to a survey examining their reasons for first and continued use, their weekly consumption of cannabis in THC units, and their mental health.
Researchers established several key findings. Respondents who first started using cannabis to self-medicate an illness, including physical pain, anxiety, depression, or because they were experiencing minor psychotic symptoms, all demonstrated higher paranoia scores.
This was in contrast to those respondents who tried cannabis for fun or curiosity, or with their friends, who reported the lowest average paranoia and anxiety scores.
Dr Edoardo Spinazzola, a Research Assistant at King’s IoPPN and the study’s first author said, “This research suggests that using cannabis as a mean to self-medicate physical or mental discomfort can have a negative impact on the levels of paranoia, anxiety, and depression. Most of these subgroups had average scores of depression and anxiety which were above the threshold for referral to counselling.”
Respondents were also asked to provide data on the frequency and strength of the cannabis they were using so that researchers could track their average weekly consumption of Tetrahydrocannabinol (THC) – the principle psychoactive component of cannabis.
The researchers found that the average respondent consumed 206 units of THC a week. This might equate to roughly 10-17 ‘joints’ per week, if the user was consuming an expected 20% THC content that is standard for the most common types of cannabis available in London.
However, respondents who started using cannabis to help with their anxiety, depression, or in cases where they started due to others in their household who were already using cannabis, reported on average 248, 254.7, and 286.9 average weekly THC units respectively.
Professor Tom Freeman, Director of the Addiction and Mental Health Group at the University of Bath and one of the study’s authors said, “A key finding of our study is that people who first used cannabis to manage anxiety or depression, or because a family member was using it, showed higher levels of cannabis use overall.
“In future, standard THC units could be used in a similar way to alcohol units – for example, to help people to track their cannabis consumption and better manage its effects on their health.”
In a separate study, published in Psychological Medicine, researchers explored the relationship between childhood trauma, paranoia and cannabis use.
Researchers used the same data set from the Cannabis & Me survey, with just over half of respondents (52 per cent) reporting experience of some form of trauma.
Analysis established that respondents who had been exposed to trauma as children reported higher average levels of paranoia compared to those who hadn’t, with physical and emotional abuse emerging as the strongest predictors.
Researchers also explored the relationship between childhood trauma and weekly THC consumption. Respondents who reported experience of sexual abuse had a markedly higher weekly intake of THC, closely followed by those who reported experiencing emotional and physical abuse.
Finally, the researchers confirmed that the strong association between childhood trauma and paranoia is further exacerbated by cannabis use, but is affected by the different types of trauma experienced. Respondents who said they had experienced emotional abuse or household discord were strongly associated with increased THC consumption and paranoia scores. Respondents reporting bullying, physical abuse, sexual abuse, physical neglect and emotional neglect on the other hand did not show the same effects.
Dr Giulia Trotta, a Consultant Psychiatrist and Researcher at King’s IoPPN and the study’s first author said,
“We have not only established a clear association between trauma and future paranoia, but also that cannabis use can further exacerbate the effects of this, depending on what form the trauma takes.
“Our findings will have clear implications for clinical practice as they highlight the importance of early screening for trauma exposure in individuals presenting with paranoia.”
Professor Marta Di Forti, Professor of Drug use, Genetics and Psychosis at King’s IoPPN, Clinical Lead at the South London and Maudsley NHS Foundation Trust’s Cannabis Clinic for Patients with Psychosis, and the senior author on both studies said, “There is extensive national and international debate about the legality and safety of cannabis use.
“My experience in clinic tells me that there are groups of people who start to use cannabis as a means of coping with physical and emotional pain. My research has confirmed that this is not without significant further risk to their health and wellbeing, and policy makers across the world should be mindful of the impact that legalisation , without adequate public education and health support, could have on both the individual, as well as on healthcare systems more broadly.”
Home-based hypertension care led to reductions in systolic blood pressure and improvements in hypertension control in South Africa, according to late-breaking research presented in a Hot Line session at ESC Congress 20251 and simultaneously published in the New England Journal of Medicine.
“Hypertension is the primary risk factor for stroke and heart disease, which are leading causes of death in South Africa. Despite the wide availability of low-cost, effective therapies, hypertension control remains extremely poor in resource-limited settings. Obstacles include a lack of patient confidence to manage their own hypertension care, overcrowded clinics with long wait times and the cost of transport to clinics,” explained the IMPACT-BP trial’s Co-Principal Investigator Doctor Thomas Gaziano from Mass General Brigham (MGB) and Harvard Medical School, Boston, USA. “Our trial aimed to assess the effectiveness and implementation of reliable, home-based, technology-supported interventions to improve blood pressure control in low-resourced rural South Africa.”
IMPACT-BP was an open-label, randomised controlled trial conducted at the Africa Health Research Institute (AHRI) in KwaZulu-Natal, South Africa, in which patients were recruited from two public-sector primary healthcare clinics. The implementation study was designed with Co-Principal Investigator, Doctor Mark Siedner of AHRI and MGH, Professor Nombulelo Magula of the University of KwaZulu-Natal, and the KwaZulu-Natal Provincial Department of Health.
Adult patients were eligible if they had evidence of uncontrolled hypertension as defined by South African Department of Health Guidelines: two measurements of systolic blood pressure (SBP) >140 mmHg and/or diastolic BP (DBP) >90 mmHg, taken a minimum of 6 months apart.
Patients were randomised to one of three strategies: 1) standard-of-care, clinic-based blood pressure (BP) management; 2) home-based BP self-monitoring supported by the provision of BP machines, community health workers (CHWs) who conducted home visits for data collection and medication delivery, and remote nurse-led care assisted by a mobile application with decision support; or 3) an enhanced CHW group in which BP machines included cellular technology to transmit BP readings automatically to the mobile application. The primary outcome was change in SBP from enrolment to 6 months.
In total, 774 patients were randomised. The mean age was 62 years, 76% were women, 14% had diabetes and 47% were living with HIV.
Compared with standard-of-care, mean SBP at 6 months was lower in the CHW group (−7.9mmHg; 95% confidence interval [CI] −10.5 to −5.3; p < 0.001) and the enhanced CHW group (−9.1mmHg; 95% CI −11.7 to −6.4; p < 0.001). In the standard-of-care group, hypertension control at 6 months was 57.6% compared with 76.9% in the CHW group and 82.8% in the enhanced CHW group. Improved BP with home-based care appeared to persist at 12 months.
Severe adverse events (2.7%) and deaths (1.0%) were uncommon overall and similar across groups. Retention in care remained more than 95% in both intervention groups, with patients reported to have enjoyed managing their own hypertension.
Summarising, Doctor Siedner said, “This study is an important example of how making models of chronic disease care more convenient – taking it from the clinic to patients’ homes and letting them play a major role in their own care – can substantially improve hypertension outcomes.”
Of particular value was that the programme was successful in a community that has historically had low access to care. Professor Magula concluded: “Achieving hypertension control in over 80% of people in a predominantly Black African community in rural South Africa is a clear example that equitable health care access can be achieved in disadvantaged communities. Similar models of care that address structural barriers could be considered to improve hypertension control in other remote and resource-limited settings. Expansion of the model to include the care of people with multiple comorbidities may also be valuable.”
